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A friend came to my study, saw *Zhi Bi Bi Bian* (Knowing Medicine Must Be Distinguished), read it through, and found it clear and fluent, beneficial to people. He strongly urged me to add ten or more additional chapters.

I replied: What I have written now is merely intended to instruct future generations, aiming for clarity and plain language so that descendants can understand it at a glance! If I were to have it printed and published, the text would be too vulgar and crude, inviting ridicule from experts. This is the first reason why it cannot be done. The discussions in the book often offend contemporary practices, which are taboo for mediocre practitioners. Suppose those individuals see my arguments and repent; then not only would it benefit society, but it would first benefit medicine. However, nowadays, most people are stubborn and conceited, while few are humble and open-minded; it would only increase resentment and malice! This is the second reason why it cannot be done. Moreover, once printed, it will inevitably spread to other regions. Doctors in other places may not be perfect, and their habits may differ from ours. Those who see my book might find it strange, saying there are no such harmful practices in our area, asking what use this book is? Or they might belittle and polish it, leading to incomprehensible medical principles. As a person of this region, what glory would I gain? This is the third reason why it cannot be done. Furthermore, nowadays, those ignorant of medicine do not discuss medical theory but focus on tricks, calling friends and recruiting followers, praising each other, killing people without remorse. When I was young, the elders I saw did not have such bad habits. This is what Mr. Jiayan (Yu Chang) called the unfortunate fate of the people, causing ghostly tricks to repeatedly emerge in the medical way! After this period, perhaps the bad luck will end, those people will die out, and later generations will truly study the Yellow Emperor and Qibo (Huangdi and Qibo, ancient mythical emperors and physicians regarded as founders of Chinese medicine), avoiding bad habits. In that case, where would my book be needed? This is the fourth reason why it cannot be done. The friend said: Listening to your repeated arguments, all contain profound truths. It is right to decide not to print it, but your fondness for debate is hard to deny. I smiled and replied: Do I enjoy debating? I am compelled to do so!

Preface again in the first month of spring, in the year Jiyu (1849) of the Daoguang era, at Qiushui Xuan in Hanyi Hall, aged seventy-eight.

*Neijing* (The Inner Canon) is a book from the ancient "Sanfen" (Three Ancient Treatises). No book is older than *Neijing*. Some suspect it has been embellished by later generations, which is not without cause. Ancient books not only lacked modern printing blocks but also had no pens or paper; they were merely carved onto bamboo slips bound with leather cords. Thus, compiling them was very difficult, and transmitting them was rare. During the Warring States period, only Yi Xiang, the Left Historian of Chu, could read them. Was he the only one intelligent enough? No, but since the books were hard to obtain, few readers existed. At that time, Qin had many good doctors, such as He and Huan. Could there have been none who read *Lingshu* (Spiritual Pivot) and *Suwen* (Basic Questions)? Qin must have possessed them. When Qin Shi Huang burned books, he did not burn medical texts, so *Neijing* survived. However, due to the passage of time, it must have suffered much damage. Even the Sage broke the binding cords while studying *Yijing* (Book of Changes); how could the bamboo slips of *Neijing* remain intact over centuries? After Qin, during the Chu-Han contention, who repaired *Neijing*? By the reigns of Emperors Wen and Jing of Han, when peace prevailed, great scholars emerged and likely revised *Neijing*. Reading the complete work today, it bears the flavor of Han dynasty literature, certainly not the original words of Huangdi and Qibo. Yet, the Five Movements and Six Qi (Wuyun Liuqi, a theory of cosmic cycles affecting health) described in *Suwen* are profound and mysterious, and the meridians and acupoints detailed in *Lingshu* are meticulously analyzed. These are indeed spiritual texts of secret manuals; only gods could know them. Modern students of medicine need not read the entire book. The dialogues between Huangdi and Qibo can be deleted; one should only memorize the essential sentences. When treating patients, citing classics provides a solid foundation. Therefore, I say: Wu Qian’s *Leizuan* (Classified Compilation) and Li Shicai’s *Zhiyao* (Essentials) are sufficient for practical application.

Master Zhang Zhongjing wrote *Shanghan Lun* (Treatise on Cold Damage) during the Later Han Dynasty. By then, Meng Tian’s pen and Cai Hou’s paper existed, making compilation easier than carving bamboo. However, Cai paper was scarce, and silk was still used. After Zuo Si’s *San Du Fu* became popular, paper in Luoyang became expensive. Even for a governor like Han Yang, producing a book was not easy. Unlike modern printing, where one copy yields thousands, his sixteen-volume work lost six volumes of *Zhubing Lun* by the Jin Dynasty, which remain unseen today. Nevertheless, observing the 113 formulas in the remaining ten volumes, covering attacking, tonifying, cooling, and warming, applications are inexhaustible. Later formula books, numbering in the thousands, cannot exceed its scope. If students carefully explore Zhongjing’s formulas, they will find resources everywhere, rendering other medical books optional. Collecting formulas extensively began with Wang Tao’s *Waitai Miyao* (Secret Essentials of the Outer Court) in the Tang Dynasty. Many formulas therein are outdated; for instance, *Fuling Yin* (Poria Decoction) is rarely applicable across eras. Hence, these books are "readable but not necessarily usable."

Among medical books, the one raising the most doubts is Bian Que’s *Nanjing* (Classic of Difficult Issues). Bian Que, courtesy name Yueren, was from Bohai Commandery, surnamed Qin, residing in Lu, hence called Doctor Lu. *Records of the Grand Historian* states he met Master Changsang, received secret prescriptions, drank water from above the pool, and could see internal organ pathologies, famous especially for pulse diagnosis. He treated Duke Jian of Zhao, the Crown Prince of Guo, and Duke Huan of Qi, diagnosing instantly. In Zhao, he treated gynecological disorders; in Zhou, ear, nose, and throat obstructions in the elderly; in Qin, pediatrics. Biographies are detailed but mention no *Nanjing*. When Zhang Zhongjing wrote *Shanghan Lun*, he relied solely on *Neijing*, never using *Nanjing*. Attributing it to Bian Que is highly suspicious. Moreover, disease mechanisms are myriad, yet *Nanjing* contains only eighty-one difficulties; how can it encompass everything? Chapters 1-21 discuss pulses; 22-29 discuss meridians, extraordinary vessels, and prognosis; 30-43 discuss Ying-Wei, Sanjiao, zang-fu, and bowels; 44-45 discuss the Seven Gates; 46-47 discuss sleep, qi-blood decline, and facial cold resistance; 48-61 discuss pulse signs, cold damage vs. miscellaneous diseases, and four diagnostic methods; 62-81 discuss zang-fu, Ying-Wei, and acupuncture tonification/sedation. Thus, only up to Chapter 61 relates to prescription and pulse. How can this exhaust pathology? Its theories largely derive from *Neijing*; if *Neijing* is detailed, why need *Nanjing*’s brevity? Where they conflict, which should one follow? More suspiciously, Chapter 44 on the Seven Gates lists lips as Flying Gate, teeth as Household Gate, epiglottis as Suction Gate, stomach entrance as Receiving Gate, lower stomach outlet as幽门 (Yumen/Hiding Gate), large/small intestine junction as Lan Gate, and anus as Po Gate. Why add the first two seemingly to fill space? Chapter 35 calls small intestine Red Intestine, large intestine White Intestine, gallbladder Green Intestine, stomach Yellow Intestine, bladder Black Intestine. This seems novel but useless. A divine doctor like Bian Que would not write such filler or useless theories. Before Han, Jin, and Six Dynasties, no one attributed *Nanjing* to Yueren. It first appears in *Sui-Tang Book of Classics and Arts*. Is it truly Bian Que’s or a later forgery? Fortunately, the book is short. Students should prioritize *Neijing* and consult *Nanjing* selectively.

In learning medicine, sacred classics must be read, but later books need not be studied extensively. Xu Sizong of Tang had profound medical knowledge but refused to write, saying "medicine is intention," understood intuitively but not verbally. Those who love writing, even if accurate, merely elaborate on sacred classics; those innovating often have biases. For example, Wang Shuhe’s *Maijing* (Pulse Classic), claiming to be Zhongjing’s disciple, faced much criticism. Today, the Four Great Masters of Jin-Yuan—Liu, Zhang, Zhu, Li—are revered. Liu Wansu’s *Yuanbing Shi* (Original Formulas for Disease Patterns) is insightful and essential, though biased toward cooling herbs. Zhang Congzheng left no works. Zhu Danxi emphasized nourishing yin. Li Dongyuan emphasized warming and tonifying. Li’s *Piwei Lun* (Treatise on Spleen and Stomach) contains profound truth. His *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) reveals an ancient secret with infinite applications. However, he attributed all diseases to spleen-stomach issues, ignoring that organs can suffer independently. If we follow him, Danxi’s yin-nourishing books would be obsolete. Yet, today, 60-70% suffer yin deficiency. Strengthening earth to control water is not always solved by strengthening spleen. Spleen (yin earth) prefers aromatic-dryness; stomach (yang earth) prefers clearing-unblocking. Their natures differ, requiring distinct treatments. Generalizing them lacks clarity. Thus, even the Four Masters’ books are not fully trustworthy, let alone inferior ones. Only Liu Wansu’s lineage is rarely transmitted, likely because excessive cooling fails to produce effects. Liu claimed dreams of immortals giving him wine, enhancing his wisdom. This mimics Bian Que’s story to impress others. Otherwise, Liu himself suffered cold damage for eight days without eating, unable to heal himself, needing Zhang Jiegu’s help. How could immortal transmission save others but not himself? This shows he combined practice with trickery. Zhang Jiegu’s herbal notes were unfinished; his ideas appeared in *Nanjing*, transmitted to Li Dongyuan. Zhu Danxi’s disciple Dai Yuanli inherited his way well; Ming Taizu respected him. His methods were unpretentious and effective, proving proper transmission. Later forgers used his name for *Zhengzhi Yaojue* (Essential Guidelines for Diagnosis and Treatment), which is too simple and shallow. They sought profit, disgracing the master.

Li Dongyuan taught many, notably Wang Haizang and Luo Qianfu. Later, Xue Lizhai followed him exclusively. Xue wrote extensively, including *Xue Shi Yi An* (Case Records of Dr. Xue), focusing on warming-tonifying spleen-stomach. Zhang Jingyue valued Xue greatly, leading to his own bias toward warming-tonification. I read *Xue Shi Yi An*; it is thick, listing countless cases per page for men, women, children. Details are sparse, making memory difficult. Were these real diagnoses or hypothetical scenarios?

Seeing Yu Xichang’s *Yuyi Cao* (Grass of Meaningful Intentions), I sighed: this truly qualifies as a case record. Its discussions are detailed and penetrating, benefiting the mind. Although Wang Kentang’s *Zhengzhi Zhunsheng* (Standard Guidelines for Diagnosis and Treatment) is orthodox and rich in cases, it cannot match Yu. This is why I admire Xichang and ignore other case records. *Feng Shi Jin Nang* (Golden Pouch of the Feng Family) represents extensive experience. Its content is balanced and accessible, covering pediatrics before internal medicine, with sound principles for gynecology, surgery, and smallpox. It is precise, unlike modern pediatricians who blindly use rhubarb and cooling herbs. I saved several smallpox patients using *Jin Nang*. Besides Yu, Feng is excellent; his book is essential.

Li Shicai’s *Yizong Bixdu* (Must-Read Books for Medical Practitioners), though less famous than the Four Masters, is beneficial and worth reading. *Dongui Bogam* (Eastern Medical Treasure Mirror), though foreign, bases internal/external structures on *Neijing*, providing valuable reference. Its categorization is detailed. It includes entries on evil spirits absent in Chinese texts. Though formulas are complex, they allow selection for clinical reference. It is indispensable. Medical books are numerous; no one can read them all. Even in my family, beginners cannot read them all. But if one thoroughly studies the books cited in my discussions, surpassing empty-headed contemporaries, one can practice and help the world.

Some books are famous but useless, such as *Chishui Yuanzhu* (Pearl of Chishui) by Shengshengzi. It claims profundity but is derivative and mediocre. Its thickness equals *Jin Nang*, but studying it is inferior to studying Feng. *Shishi Milu* (Secret Records of the Stone Chamber) falsely attributes itself to Chen Meigong and uses spirit-writing. Huangdi, Qibo, Leigong, Bian Que, Zhongjing, Hua Tuo supposedly visit daily. Absurd! Formulas are copied but dosages increased to pounds, claimed as miraculous or immortal. Unreasonable! Though some treatments are acceptable, the formulas are unusable. Mencius said: "To believe everything in books is better than having no books." This applies here.

Thus, my arguments clarify only a fraction of medical truth. Since predecessors often deceived, and I refuse to be deceived, I must distinguish clearly for future generations. Hence, I titled this section *Zhi Bi Bi Bian* (Knowing Medicine Must Be Distinguished).