Library

A common scholar, if harboring a mind to benefit all things, will surely contribute to the welfare of all. Although he may live in poverty and wander about, compared with those who take office when the time is right, they are not comparable; yet his aspiration is worthy of admiration. Mr. Yuan Ti'an, a staff officer, stood alone without companions, residing by the shores of Zhu Lake. He loved reading and understood both prosperity and adversity. His talent was like a five-shi gourd, unsuitable for worldly use, yet his heart to save people and benefit creatures never left him. In his early years, while attending to his parents' illnesses, he extensively studied medical texts and received secret teachings from unusual masters. Thus, he took it as his responsibility to care for the livelihoods of the weary, frail, crippled, and disabled throughout the world. Viewing others' groans and pain was like seeing someone drowning in an abyss; he would cry out for rescue and strive to help them personally. Amidst his duties of strategizing, his writings on medicine filled his chests; "Yi Jin Yi Fa" (A Raft in the Sea of Medicine) is merely one such work. He often lamented that most contemporary medical books were little more than picking up the dregs of predecessors, cutting, pasting, and plagiarizing to gain fame, yielding nothing upon deep inquiry. If one indulges subjective views and acts arbitrarily, it leads only to death or despair for patients. Mr. Yuan's "Zhengzhi Xin Chuan" (Heart Transmission of Diagnosis and Treatment), however, synthesizes various schools, incorporates clinical experience, elucidates profound mysteries where doubts arise, and records them casually for future correction. I appreciate his explication of principles essential through ancient and modern times; this is indeed a book unseen in the world, allowing later learners to extend its knowledge, internalize it in daily life, and apply it at the bedside, benefiting the populace significantly. Amidst military turmoil, I took time to read and verify it, waiting for the flames of war to subside before hastily having it printed to offer to those studying medicine. If they study it and gain insights, they will avoid the evil reputation of killing and practice the benevolent art of saving lives, which is truly admirable.

Recorded in the mid-autumn month of the Guiwei year of the Chongzhen era by Shi Kefa, Envoy of the Ministry of War, from Liyang.

I often sigh that contemporary physicians rarely excel in speed when diagnosing diseases; even those seeking doctors consider speed a virtue. Why is there such a disparity between ancient and modern times? The diagnosis of disease must be based on prudence. Rapid pulse-taking is the perfunctory act of market quacks; great physicians do not act thus. In every case, one must employ observation, auscultation/olfaction, inquiry, and palpation (Wang, Wen, Wen, Qie), discuss meticulously, then differentiate root and branch, exterior and interior, deficiency and excess, considering the seasonal climate changes, and prescribe formulas accordingly. Although this may not fully align with the transmission of ancient sages, it avoids the fault of self-will and private bias.

Moreover, recent medical books often argue primarily for tonifying deficiency. In cases of "true excess presenting as false deficiency" (Da Shi You Lei Zhuang), where turbid pathogens and excess evils stagnate internally, since this cannot be seen directly, and the notion of "suitability for tonification" dominates the mind, one is often confused by false deficiency signs, leading many to view purgative methods as a path of dread. Furthermore, some fail to understand the appropriateness of deficiency and excess, resulting in misuse by practitioners. It is common to see contemporary physicians, wishing to preserve their reputation, unwilling to lightly use purgatives; by the time the illness lingers and righteous qi becomes deficient, they administer mild purgatives, which naturally yield no effect. Conversely, incompetent physicians, eager for quick results, recklessly use purgatives, causing devastation. Seeing that contemporary physicians' purgatives fail and quacks' purgatives cause disaster, people mistakenly treat false deficiency with warming tonics, resulting in many deaths. They fail to recall the teaching in *Neijing*: "Where there is pathology, there is no damage [to the righteous qi]" (You Gu Wu Sun), and Zhang Zhongjing's method of urgent purgation to preserve fluids. For instance, Chengqi Tang and Xianxiong Tang in *Shanghan Lun*, when used appropriately, can immediately turn danger into safety. When pathogens enter the interior, it is like bandits occupying the capital region, not comparable to border raiders; urgent clearance is needed. However, performing such dangerous military-like treatments within the abdominal organs requires absolute certainty of success. Here, I present my verified experiences entirely to save people from crisis and prevent premature death.

Generally, pulse diagnosis alone is unreliable because pulses can have superficial deceptions; observing the tongue coating is the standard because coatings lack disguise and are obvious. Generally, if a thick, greasy, yellow, dry coating is present, one should immediately use purgatives. One dose brings relief; subsequently, adjust dosage up or down until the coating clears, indicating the elimination of pathogens, clear at a glance. Another type of coating, appearing intermittently, yellow or gray, must be examined carefully: if it floats and feels empty but shows turbid characteristics, it is a deficiency coating; do not mistake it for excess and use purgatives, lest you harm the patient. Recently, I have seen doctors who read but lack flexibility, rigidly adhering to *Shanghan Lun*, insisting on "Day 1 Taiyang," holding firmly to "treat exterior first, interior later," and arguing solely based on days of transmission, ignorant of internal stagnation causes and the principles of constancy and change. They often insist that the spleen and stomach prefer aromatic, warm, and dry herbs, strictly avoiding bitter-cold purgatives, failing to grasp the intent of prescription formulation. For example, Li Dongyuan's Buzhong Yiqi Decoction aids the root (righteous qi); Zhang Zhongjing's Chengqi and Xianxiong methods dispel pathogens. While temporary organ changes due to pathogens follow normal logic, extraordinary variations exist. Frail elderly or young children may present with severe excess syndromes requiring strong purgatives over multiple doses to heal. Conversely, robust adults may suddenly suffer from deficiency-cold, or previously weak individuals may suddenly suffer from severe excess. Some argue that diseases arise from Qi transformation; transformations into excess, deficiency, cold, or heat cannot always be predicted by routine logic. Clinical practice must not stick to conventions or fixed views; the key lies in accurate syndrome differentiation and appropriate medication to achieve efficacy.

Once a disease has formed, even skilled physicians cannot guarantee perfection. The highest way is to treat disease before it arises. Diseases, though manifesting suddenly, have brewed over many days. Before onset, signs appear in complexion and form; if a wise practitioner treats them preemptively, disasters can be eliminated before they sprout. When the disease trend subsides, final recuperation requires extra caution: do not leave pathogens to cause lingering issues, nor overdose to damage righteous qi; both are crucial. Pastes and pills are for slow conditioning and aftercare, but one must know urgency and examine details carefully. If righteous qi recovers, stop administration to prevent long-term use from increasing Qi imbalance and causing other ailments; do not assume tonics can be taken indefinitely. In short, healthy people should not use drugs for maintenance; it is not only useless but harmful due to the biased nature of medicinal properties. One must still study classics, grasp the guideline of Yin and Yang, which is the simplest approach. For example, food injury without Yin-Yang imbalance causes only temporary bloating, resolved by fasting for a day; if inhibited by yin-cold, the stagnant food becomes like ice in water; if suppressed by warmth-heat, it becomes like charcoal in a furnace. Formless Qi attaches to material substance, and material substance supports formless Qi, creating disease. Blood stasis has causes of cold coagulation or heat binding; roundworm movement differs by extreme cold or heat.

All diseases, whether caused by climatic influences, emotional injuries, or inherent deficiency, ultimately stem from the two Qi (Yin and Yang). Understanding *Neijing*: "Water and Fire are the manifestations of Yin and Yang; Cold and Heat are the natures of Yin and Yang," allows one to return from complexity to simplicity. To understand the profundity of medical theory, one must study the secrets of *Suwen* and *Lingshu*, and familiarize oneself with Zhang Zhongjing's *Shanghan Lun*, achieving mastery effortlessly, rather than relying merely on Yin-Yang and Five Elements to create methods of nourishing Yin or warming tonification, modifying Bawei Wan and Liuwei Wan, which mislead people significantly. My discussed methods aim to correct the abuses of warming tonification, out of necessity, not to compete for fame with contemporary physicians, nor to criticize authors blindly, but truly to clarify deficiency and excess, distinguish root and branch, serving as a profound lesson for longevity and humanitarian aid.

Note by Lan: When the Master wrote this book, prior to the Jiashen year of Chongzhen, the realm was in chaos. His criticism of the harm of warming tonification implicitly rebuked the errors of Xue Lizhai. At that time, scholars were misled by warming tonification, causing many mistakes. The Master did not state this explicitly, fearing to offend the times and attract blame, avoiding secular taboos. Instead, by emphasizing clarifying deficiency/excess and distinguishing root/branch as techniques for longevity and aid, he cried out loudly; his heart was truly benevolent.