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*Zhengmai* (Standard Pulse Diagnosis) is used to widely disseminate its theories. Now, I have selected a few important discussions from it and recorded them at the end of this medical treatise, so that future generations will know of this book and find it convenient to explore, thereby relieving people's suffering and helping everyone reach the realm of benevolence and longevity. This is my aspiration. Recorded by Guozhai (Wang Kentang's pseudonym).

*Zhiyuan Zhixian* (Verified Treatments from Zhiyuan) records: Mr. Meng Shuzheng suffered from hiccups for three days and nights due to anger. He urgently sent a letter summoning me, but I was delayed by other matters and did not arrive until Wei hour (1:00 PM - 3:00 PM). Meng appeared sorrowful, complained bitterly, wept, and sighed in pain. Upon examination, I said, "You came too late, yet the effect was extremely rapid! After taking the medicine, you slept." The next day, he happily saw me and said, "Yesterday, my heart felt as if it were splitting; I was preparing my final affairs. It was only because your humorous words comforted me who knew not why one dose of medicine worked so effectively." I replied, "I treated liver Qi stagnation. Your extreme anger caused Qi to fail to flow freely. The Qi attempted to enter the Stomach but could not, thus causing hiccups. I did not directly treat the hiccups; rather, I used Chai Hu (Bupleuri Radix) and other herbs to unblock Wood stagnation (soothe the Liver). Once the stagnation resolved, the hiccups stopped. Since it was an acute illness and the healthy Qi was not yet damaged, it was easy to cure. With deepening scholarly accumulation, one can see the source of the disease upon observing symptoms. Moreover, since it was an acute illness with undamaged healthy Qi, the effect was sudden and recovery swift."

Commentary: Hiccups arising from anger occur when rushing Qi attempts to enter the Stomach but cannot, thus triggering hiccups. Master Lu cured this by using Chai Hu to unblock Wood stagnation. He did not reveal the full prescription, valuing the Dao and unwilling to lightly disclose treatment methods, which prevented successors from imitating him. However, given the use of Chai Hu to unblock Wood stagnation, one can infer the remaining herbs are likely Bo He (Menthae Haplocalycis Herba), Fu Ling (Poria), Bai Shao (Paeoniae Radix Alba), Dang Gui (Angelicae Sinensis Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma)—essentially the formula Xiao Yao San (Free Wanderer Powder), which resolves Wood stagnation and thereby all stagnations. In my verified treatments, I also followed the intent of Master Gufeng, not adhering rigidly to the original formula. I used He Huan Pi (Albiziae Cortex), Chuan Yu Jin (Curcumae Radix), Pi Pa Ye (Loquat Leaf), Xiang Fu (Cyperi Rhizoma), Ju Luo (Citri Reticulatae Pericarpium Retinervum), Jin Ju Bing (Preserved Kumquat), and Mei Gui Hua (Rosae Rugosae Flos), modifying the formula according to circumstances, often achieving efficacy. The only concern with the original formula is Bai Zhu (Atractylodis Macrocephalae Rhizoma), which may obstruct Qi mechanism and cause turbidity without dispersion; it is advisable to omit it after careful consideration. Herbs such as Su Geng (Perillae Caulis), Fu Xiong (Ligusticum Chuanxiong Rhizoma), Qie Nan (Agarwood), Tan Xiang (Sandalwood), and Xuan Fu Hua (Inulae Flos) can be selected according to symptoms. Thus, famous physicians must modify established formulas based on clinical presentation, surpassing the mediocre.

Another case involved leukorrhea: Mrs. Dai Yangwu, wife of a Secretary, was summoned for diagnosis. The Cun and Guan pulses were not penetrating. She suffered from constant fatigue, dizziness, anorexia, and chest/epigastric stuffiness. I diagnosed this as inability of Liver and Spleen Qi to extend, and prescribed Ba Zhen Tang (Eight Treasure Decoction) plus Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix). She recovered and her constitution strengthened. Whenever she fell ill subsequently, taking this previous formula brought immediate relief. Later, when she went to Rui'an and Yunnan, she relied on this formula for fifteen years. If slightly modified, it would lose efficacy. Mr. Dai, having retired to live in seclusion, always met me when passing the Xiang River and often expressed his wife's firm faith in this formula. His wife had a calm temperament and a robust physique, living comfortably. Consequently, her Qi and Blood were weak and diminished. Therefore, in tonifying Qi, I added lifting agents, adapting to her nature, much like relying on cloth and grain throughout life. The term "firm faith" is truly good medicine. Physicians today who discard the ordinary for the novel, switching from Zhang Zhongjing to Li Shizhen daily, and indiscriminately collecting prescriptions, cause mild cases to become severe and severe cases critical. This stems from ignorance of the dangers of lacking firm faith.

Commissioner Lai Xi'an urgently summoned me to treat his nephew. The nephew was strong and robust. He had suffered from Shang Han (Cold Damage) for twenty-eight days, was unconscious, unable to speak, flailing his limbs, with a drum-like distended abdomen that was hot to the touch, red eyes, coarse breathing, dry teeth, and a black tongue. He had taken Ren Shen (Ginseng Radix), Fu Zi (Aconiti Lateralis Radix Praeparata), Shi Gao (Gypsum Fibrosum), Mang Xiao (Natrii Sulfas), Da Huang (Rhei Radix et Rhizoma), Huang Qin (Scutellariae Radix), and Huang Lian (Coptidis Rhizoma) without success, and many famous physicians had left. Upon diagnosis, I found only a surging pulse. I administered Da Huang (Rhei Radix et Rhizoma) in a dosage of one liang, assisted by blood-invigorating herbs. After one dose, he passed one or two dou of black, foul-smelling blood, and became slightly conscious. After four doses, he cleared completely. Lord Xi'an asked me, "My nephew has been comatose for three days, with only a breath remaining. Why did you use such large and heavy dosages? Fortunately, he survived. May I ask the rationale?" I replied, "Treating disease with medicine is like drinking wine. For someone with the capacity of the vast sea, giving a single drop would dry their throat and lips. With such a large body and deep pathogenic factors, how else could efficacy be achieved without ten times the usual dosage? Furthermore, this condition involves cold pathogen entering the Stomach and blood stasis accumulating in the middle jiao. The coma and flailing represent severe mania akin to madness. Not recognizing the disease and hoping for death is abandoning the patient. Da Huang was not unused; however, if administered at the wrong time or in light dosages, and failing to produce a response, one's mind becomes confused. How then could one dare to use it boldly?"

This is Yangming Blood Accumulation Syndrome. Only a heavy dose of Tao Ren Cheng Qi Tang (Peach Kernel Drains the Lower Jiao Decoction) can overcome the enemy. However, only those with both knowledge and skill can achieve this.

Mr. Shi Dazheng of Hushu vomited loudly enough to be heard a hundred wu away. The Zuo Guan pulse surged against the finger but did not connect to the Cun pulse. Both Chi pulses were slippery and forceful, especially on the left. Water and fluids had not entered his lips for seven days. I therefore prescribed a formula to penetrate Liver stagnation and predicted he would father a son. After taking the medicine, vomiting ceased, and at full term, he indeed delivered a male child. He asked me, "My wife suffered severe alternating chills and fever, vomiting, and anorexia. Others treated her as Shang Han, but you alone identified pregnancy. Although Chai Hu, Bai Shao, Wu Zhu Yu (Evodiae Fructus), and Huang Lian were not specifically used, why did vomiting cease after one dose?" I said, "Physicians claiming expertise in pulse diagnosis must determine the formula based on pulse findings. People merely observe symptoms without tracing the cause, leading to errors. Here, the pulses are present and not deceived by symptoms. Medication is prescribed according to the disease, hence the accuracy."

A slippery pulse at the Chi position certainly indicates pregnancy. The Guan pulse not connecting to the Cun suggests Liver Qi is focused and stagnant, prone to anger but poor at expressing it. Long-standing stagnation eventually erupts, showing signs of violent shaking and breaking. By following its nature to soothe and regulate it, Liver Qi becomes smooth and calm, nausea faces no obstruction, and vomiting ceases naturally.

For morning sickness (E Zu) vomiting, the slippery Chi pulse confirms pregnancy. Treatment focuses on soothing Liver Qi and following its nature, so vomiting subsides.

It is reported that your mother, in the winter of Bingwu year, suddenly felt her Heart Qi scattering and sinking, accompanied by constipation and insomnia for nearly three months. Upon diagnosis, only the Zuo Guan pulse was weak and failed to respond to pressure. I diagnosed Liver deficiency requiring tonification of its mother (Kidney/Water nourishing Liver/Wood). I predicted improvement would begin at Lichun (Start of Spring). I used Shu Di Huang (Rehmanniae Radix Praeparata) as the sovereign herb, assisted by Fu Ling (Poria), Suan Zao Ren (Ziziphi Spinosae Semen), Dang Gui (Angelicae Sinensis Radix), Ren Shen (Ginseng Radix), Fang Feng (Saposhnikoviae Radix), and Yuan Zhi (Polygalae Radix). After twenty doses, she recovered by the predicted time. Her son asked, "Insomnia and scattered Heart Qi belong to the Heart Meridian. Why did Kidney and Liver herbs work? And why did improvement start at Lichun? Please explain." I said, "This conclusion comes from the pulse. The Classics state: 'Liver deficiency leads to fear; fear causes Qi to sink.' Although there was no emotional fear, the physiological manifestation resembled it. Based on the pulse and symptoms, Liver deficiency is undeniable. Due to Liver insufficiency, the disease manifested ahead of its seasonal timing. Tonifying the mother (Kidney) generates Earth (Spleen); waiting for the appropriate time allows Yuan Qi (Original Qi) to recover. One cannot simply attribute this to Heart Qi scattering and constipation belonging to the Heart Meridian. This is not Heart Qi scattering, but the Heart perceiving the image of Qi scattering in the body. Thus, 'scattering' is not the disease itself. If it were a Heart disease, it would manifest differently. Tonifying the mother to benefit the child is a 'treatment across two organs' strategy. Predicting recovery at Lichun means Liver healthy Qi becomes prosperous while pathogens retreat."

Tang Meisheng suffered from abdominal pain, with palpable masses around the umbilicus during attacks, sometimes reaching unbearable levels. Others believed vital Qi was cut off internally, fearing death. My diagnosis revealed a slippery pulse near the Chi position at the Guan level, with distending pain upon palpation. His Qi was depleted and lacked luster. I used Gou Qi Zi (Lycii Fructus) as the sovereign herb, assisted by Bai Shao (Paeoniae Radix Alba), Fu Ling (Poria), Rou Gui (Cinnamomi Cortex), and Wu Zhu Yu (Evodiae Fructus). Pain ceased after six doses. He then took one batch of Si Zhi Gou Qi Wan (Four-Processed Lycium Pill) from *Ruizhutang Fang*, resulting in complete recovery. Li Maoxian asked what disease this was. I said, "Umbilical Hernia (Qi Hernia)." While hernias typically牵引 the genitals, this case lacks that symptom. However, 'hernia' refers to painful masses with fixed locations (characterized by the mountain radical), not necessarily involving the genitals. Hernias fundamentally belong to Jueyin Liver disorders. The severity resembling death is also a Jueyin syndrome. Thus, warming and tonifying Liver herbs restored vital Qi, preventing internal cutoff. This case, attributing success to Heaven, can be viewed as a resurrection example.

Umbilical hernia is a dangerous Jueyin condition; treating with warming and tonification addresses the root.

A patient surnamed Li suffered from mouth and tongue ulcers for nearly three years. The pulse was floating, fine, rapid, and urgent, feeling empty upon pressure, especially at the Chi position. Applying Xue Lizhai's method for Kidney deficiency with Fire not returning to its source, I prescribed modified Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) ingredients. He recovered in two doses. This was my first trial of Master Lizhai's methodology, demonstrating such rapid efficacy. Modern brilliant physicians often seek unique approaches beyond standard rules, disregarding Lizhai. What do they think of him?

He Jiefu, a scholar from Yongjia, had a calm temperament and suffered from Spleen disease for years, eating little and appearing listless. He consulted me in July of Xinyou year. Both Guan pulses were weak and did not reach the Cun position. I prescribed Ren Shen (Ginseng Radix), Fu Ling (Poria), Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Chen Pi (Citri Reticulatae Pericarpium), Fang Feng (Saposhnikoviae Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma) for dozens of doses. By September, he returned home and began enjoying rich foods. His years-long illness vanished. In spring of Renxu year, he visited Qiantang again, bringing generous gifts of Canna and Hibiscus flowers, asking, "Your illness lasted years. Tonifying Spleen and Kidney methods were detailed yet ineffective. How did you achieve results with such simple methods?" I replied, "Your disease lies in the Liver, not the Spleen or Kidney. Diagnosing requires tracing the source, not being misled by symptoms. Reduced appetite relates to the Spleen/Stomach, but what causes the Spleen disease? This must be examined. Your right Guan pulse weakness confirms Spleen deficiency. But what about the left? This indicates Spleen substance is insufficient, and Spleen function fails. What is Spleen function? The Liver. Astrology considers the element that controls me as the functional spirit. Without Liver Wood supporting Spleen Earth, Qi and Blood do not flow smoothly, digestion slows, and the Spleen suffers. During autumn's metal dominance, Liver Qi is further constrained. I supplemented Liver Wood Qi, allowing it to flourish, which relaxed Spleen Earth, causing spirit to emerge naturally. Though I did not treat the Spleen directly, I effectively treated it. Why use extraordinary methods? I fear I cannot be simple enough. Simple words are what I strive for."

Famous physicians seek the source and differentiate pulses, not confused by external symptoms. They tonify deficiency and reduce excess, establishing formulas based on classic principles.

Wu Shuxian developed sores in March of Gengshen year. After eye sores healed, he suffered severe asthma, unable to lie down for ten days. I treated him by first opening the Lungs and venting the sores, then descending Qi and tonifying the Kidneys. I predicted sores would appear in two days, foot swelling in five, fluid discharge in six, and asthma resolution/sleep restoration in ten. Subsequently, toxic sores appeared on his feet, recovering fully in three months. He studied at the Imperial Academy in autumn. In July of the following year, a slight wind-cold fever caused his left three-position pulse to vanish. Large doses of Ren Shen, Dang Gui, Mu Tong (Akebiae Caulis), and Gan Cao raised the pulse in ten doses and normalized it in twenty. In October, another infection made the left pulse even weaker, though he felt fine. In March, lying down caused severe headache. I warned his brother of the danger, predicting coma meant death, but he doubted me. On the ninth day, he became slightly comatose and delirious; on the twelfth, he lost recognition; seven days later, he died. His cousin asked, "Last year he was critical, and your predictions proved accurate, saving him. This winter, minor symptoms matched your prediction of death. Are the cause and syndrome one or two?" I answered, "Shuxian has innate weak bone Qi and incomplete Kidney Essence. His sores originated from the Kidney. Unknowingly using dispersing herbs consumed Yuan Qi, causing toxin to reverse into the Lungs, inducing asthma. I used Si Ni San (Frigid Extremities Powder) to open Taiyin Qi, venting sores outward; Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) helped Shaoyin grasp Qi, regulating respiration, clearing the upper and descending turbidity, causing foot swelling and abscesses, expelling disease outward, thus saving him. This autumn, the left pulse failed to rise, indicating internal depletion of Yuan Qi, unable to circulate. The disease attacking the marrow caused brain pain and coma, an 'Inner Closure' syndrome where Qi cuts off internally, leading to death. Fundamentally, both stem from the Kidney; it is one, not two. It depends not on symptom severity but on the underlying difference." This case demonstrates precise differentiation, achievable only through deep understanding of *Ling Shu* and *Su Wen*.

Shaoyin Kidney deficiency with internal depletion of Yuan Qi is a critical Inner Closure syndrome, representing internal cutoff of vital Qi, an untreatable condition.

Ruan Taihe, a Xiaolian from Fushun, Sichuan, contracted a severe epidemic illness under Mount Wu. Summoned for diagnosis, he sat up reluctantly, speaking strongly, but his spirit was internally depleted. He had alternating fever, thick yellow tongue coating, having caught cold in Wu men and nourished himself with meat broth, leading to a month-long lingering illness. Light dispersing herbs reduced the fever, but overeating caused recurrence and inability to rise. I was in Fuchun and returned after five days. He had been delirious, laughing/crying, and unrecognizing for three days, emaciated, sweating profusely, with intense internal heat, especially in the chest/hypochondrium, hot to the touch, though the pulse retained spirit. I added eight qian of Ren Shen to Si Ni San. Delirium ceased after one dose; heat cleared after three. He claimed his soul wandered heaven and earth, saved by divine talisman. Recovery took ten days before he could eat porridge. He wrote a record of his illness and medications. I believe cold injured Heart Qi, gradually deepening and gathering in the chest. Due to failing the imperial exams and returning south, illness lingered en route, separating him from family and lacking medication. Heart was injured, repeated sweating depleted fluids, internal mastery was lost, and heat entered the chest. The chest is the palace of the Heart Master; spirit scattered, causing wandering soul transformation. Si Ni San expelled heat outward; Ren Shen consolidated spirit inward. Qi recovered, pathogens dispersed, thus survival.

Initially, Qi stagnation injured the Liver; subsequent forced eating injured the Spleen, causing spirit scattering and wandering soul. Si Ni San expelled external heat; Ren Shen tonified Yuan Qi.

Zhou's wife and Ma's daughter, both young women, suffered edema, swollen limbs, abdominal distension, blocked urination, and anorexia. Diagnosed variously as jaundice, drum distension, or Qi disorder. I deemed medicine ineffective and needled the feet, draining stone-measures of water. Distension decreased slightly the next day and significantly by the third day. Feet remained swollen, so I needled again. Prescribed Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) to warm the Kidneys. Within a year, both became pregnant. Zhou cared well, mother and child survived; Ma neglected care, both died. This resulted from insufficient Kidney Yang and excess Yin, causing water accumulation. Diet and medicine failed to guide water, exacerbating the condition. Needling drained water, releasing stagnation. Post-drainage Kidney decline required warming and tonification to prevent turbid Yin reaccumulation and restore Kidney Fire. With systemic Yang rooted, Tian Gui (menstruation/fertility) functions normally, ensuring childbirth. Like refugees needing nurturing, proper care ensures survival; neglect leads to death.

Insufficient Kidney Yang and excess Yin causing water accumulation is the source of this disease, as described in *Nei Jing*: "Accumulated water forms similar categories."

On the night of the 27th of the 12th lunar month in Gengshen year, I suffered abdominal pain, aversion to cold, and diarrhea, which stopped at dawn, returned at dusk, and stopped again the next day. On the fifth day of the new era, mild pain appeared on the left of the anus. Attributing this to sexual excess and Kidney diarrhea, I took a large dose of Si Shen Wan (Four Spirits Pill), stopping diarrhea and pain. Next morning, a small nodule appeared on the left anus, pain moving toward the tailbone, becoming unbearable at night. I applied bear bile dissolved in water, feeling coolness rising to the left Lung, easing pain slightly. Midnight: expectorated phlegm with a few drops of blood. Chen hour: hemorrhoids discharged white pus, allowing sitting. Eleventh day: talked excessively, bleeding occurred while combing hair. Endured it, calming Qi stopped bleeding. Took Liu Wei Wan (Six-Ingredient Pill) ingredients for Kidney deficiency. Evening: woke at midnight with blood gushing like a tide, sawing respiration. Consumed child's urine and Liu Wei decoction; Qi stabilized slightly. Smelling ginger soup triggered fresh bleeding. Dawn: eased. Night: recurrence. Brief sleep caused back heat; waking brought blood to throat, filling a handful. Heart anxious, wanting to talk, sound triggered bleeding. Thirteenth day: discussion, no one dared act. Evening: critical, seemingly hopeless. Used Heart-draining and blood-coagulating purgatives, ineffective. Night: heavy snow, freezing rain. Took Da Huang powder mixed with water. Wanted to remove blankets, drank bitter Huang Qin/Huang Lian tea as if sweet. Fifth watch: forced clear rice drink; drug power shifted. Passed black, foul stool/mucus three times, bleeding slowed. Fifteenth day, Yin hour: transitioned to Lichun (Start of Spring). Jian Ning lotus root decoction tasted good. Foot sweat appeared, then palm sweat, then back steaming. Day peaceful. Evening: talking caused hematemesis. Yi'er cited Zhang Zhongjing, prescribing Chi Xiao Dou (Vigna Angularis Semen) and Lian Qiao (Forsythiae Fructus) combined with Xie Xin Tang (Drain the Epigastrium Decoction). Upper body Qi opened, lower abdomen felt stuffy but immobile. Sweating similar to before. Three days: bleeding decreased. Beyond twentieth day: stool passed like green mud, then iron-ball-like stools, blood finally cleared. Alas! Before passage, near death; after sweating, vitality returned.

Reflecting on the cause: I had recently raged, stomping and shouting, panting briefly. Seventeenth of the twelfth month: sat exposed by the stove half the night, fingernails broke next morning. Ten days later, illness struck. Since October, mental clarity faded, reading depth decreased, spirit grew confused. Ten days later, illness worsened greatly. Twenty years treating hematemesis, I often rescued crises. Facing my own, I lost focus. Believing sexual excess caused night diarrhea, Si Shen Wan seemed curative, confirming Kidney deficiency. Who knew Si Shen and Liu Wei would aggravate it? (Initial cause: rage/Qi stagnation congealed blood vessels; subsequent night exposure to cold plus stove fire intensified cold congealing and blood burning, creating stasis. Must use blood-dispelling to break sharpness and remove root. Disaster stemmed from Si Shen and Liu Wei misuse, proving one cannot treat based on a single meridian theory.) If not for accidentally hitting Zhang Zhongjing's method, death was inevitable. My illness originated from cold injuring Yin division. Cold-water Qi should attack Heart Fire; Yin pathogens should force blood. Using Kidney-tonifying/blood-stopping herbs aided cold, congealing blood further, causing fire to burn violently and blood to stagnate. Lichun Yin-division sweating naturally resolved the pattern. Stasis/purging cleared, blood purified. Initially slight cold led to great disaster. Drug difficulty is common. Mistaking visceral toxin pain or asthma from hematemasis requires recognizing cold origin. When unresolved, even if pointed out, one may not believe it, let alone ignorant physicians. Thus, prescribing must not rigidly follow rules. Today, knowing hematemasis, people use hemostatic, blood-moving, Qi-smoothing, Qi-descending methods. Is this not profound logic? If not hitting the mark precisely, it becomes toxic. Caution! Caution!

Forty days post-recovery, I could walk with a cane, pacing the room. Leaving for Suzhi Zen Room, reflecting quietly, I felt ashamed. I compiled these cases for broad review.

Master An read the cases and questioned: "Hematemasis originating from cold may exist; but claiming blood gushing is not due to fire is hard to deeply accept..."