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The key to diagnosis and examination lies in first carefully observing the patient's complexion and physique, then meticulously inquiring about the causes of the disease. Listen to the hoarseness or loudness of their voice, observe the leanness or plumpness of their skin and muscles, inquire about their suffering and desires, palpate the chest and abdomen, inspect the tongue coating, and consult on thirst, drinking habits, and the patency or obstruction of urination and defecation. If one is not afraid of tedious repetition, the essential characteristics of deficiency/excess (Xu/Shi) and cold/heat within the interior can be grasped.

Generally speaking, if there is pathogenic stagnation in the Stomach, there will inevitably be a tongue coating. By examining whether the coating is dry or moist, yellow or white, thick or thin, one can distinguish the depth of the pathogenic stagnation and determine whether to use mild purgation or heavy purgation methods. Regarding thirst: those who can drink belong to excess heat causing thirst; those who cannot drink belong to deficiency heat. Reddish, scanty, and painful urination with dry, hard stools indicate excess heat; clear, profuse, and smooth urination with loose, watery stools indicate deficiency cold. If one deduces with deep concentration, the cold/heat and deficiency/excess nature of the disease will naturally be free from doubt. Then, by referring to the floating/sinking (Fu/Chen) and slow/rapid (Chi/Shuo) qualities of the pulse, the differentiation of root/branch (Biao/Ben) and deficiency/excess becomes even clearer.

In my practice of pulse-taking for syndrome differentiation, I am particularly cautious and prudent, daring not to neglect it lightly. My experience derived from long-term verification leads to the conclusion that the Left hand pulse primarily reflects Yin aspects, while the Right hand pulse primarily reflects Yang aspects. In all warm-heat diseases, where heat pathogens scorch the Yin fluids, the Right pulse is large, and the Left pulse is faint. Only after the heat pathogens are completely expelled via purgation does the Left pulse recover, and the Right pulse become peaceful. In cases of deep-seated cold and chronic cold conditions, the Right pulse is extremely deep and faint, while the Left pulse is tight and vigorous. It is only after multiple applications of warming treatments that the Left pulse becomes peaceful and the Right pulse rises. In cases of partial deficiency of Yin or Yang, this can also be verified through the left and right pulses. If Yin Qi fails first, the Left pulse fails first; if Yang Qi fails first, the Right pulse fails first. Furthermore, the Tight pulse (Jin Mai) resembles the Rapid pulse (Shuo Mai), but they differ fundamentally in indicating Cold versus Heat, so they must be clearly distinguished. Recently, in severe cases of warm epidemics, because the healthy Qi is constrained by the pathogen, the pulse may appear extremely faint as if non-existent. One must examine whether the patient had chronic illnesses in the past, and differentiate based on age and physical strength. For instance, if a person has no prior illnesses and possesses a strong constitution, judging that the pulse changes due to the disease, one must look for signs such as a yellow, turbid, dry, and cracked tongue coating, and tenderness/rejection upon pressure in the chest and abdomen. Once purgation is applied, as the pathogenic evil gradually recedes, the pulse will also gradually rise. If a great deficiency presents with an appearance of excess, or a great excess presents with a emaciated form, or Yang disease mimics Yin, or Yin disease mimics Yang, failing to examine carefully and precisely could easily lead to fatal errors!

Among the four therapeutic methods of Warming (Wen), Clearing (Qing), Attacking/Purgation (Gong), and Tonifying (Bu), mild tonification is the lightest. This is because slight tonification does not aid the disease and can assist the healthy Qi, whereas heavy, cloying tonification carries the risk of obstructing the expulsion of pathogens. Moreover, ancient formulas often incorporate pathogen-expelling herbs within tonifying formulas, and include healthy-Qi-supporting strategies within purgative formulas. For potent formulas involving major attacking, major heating, or major cooling properties, if there is any ambiguity, doses should be increased gradually. Never exceed the appropriate dosage to damage the healthy Qi. If deficiency syndromes are mistakenly treated with purgation, disaster follows immediately, reaching a point of no return. Therefore, caution is paramount! For example, in heat syndromes that are not excess, Baohu Tang (White Tiger Decoction) and Huanglian (Coptis Rhizome) should be used. If Chengqi Tang (Major Order the Qi Decoction) or Didang Tang (Defend Against Blood Stasis Decoction) are mistakenly administered, it will lead to deterioration. Conversely, in cases of Yin deficiency with deficiency heat, where blood-nourishing and Yin-moistening are indicated, mistakenly administering Huanglian or Baohu Tang is equally dangerous. Furthermore, after treating an excess syndrome with purgation, if the disease condition is fully resolved but fever suddenly recurs or chills and fever alternate incessantly, this indicates a sudden depletion of healthy Qi, and immediate major tonification is required to conclude the treatment properly. There are also cases where cold diseases transform into heat, or heat syndromes turn into cold, or deficiency contains excess, or excess includes deficiency. These transformations are manifold. The key lies in precise differentiation and careful observation to avoid the error of "reinforcing excess and depleting deficiency" (making excess more excess and deficiency more deficient), thereby keeping a clear conscience. Otherwise, treating human lives as worthless is heartbreaking to witness. I hope everyone adopts this mindset, embodying Heaven's virtue of cherishing life, so that the tragedy of premature death in the world might be somewhat alleviated.

Lan's Note: Disease manifestations change endlessly, but the crux lies in examining complexion and physique, listening to the voice, asking about the cause, and then taking the pulse. In this way, deficiency and excess can be distinguished immediately, and cold and heat judged instantly, preventing confusion by external appearances. Applying "treat cold with heat, treat heat with cold," profound ailments can be cured instantly, and the reputation of a good physician spread. Reading Mr.'s handwritten notes, every part emphasizes caution and prudence. He elucidates that the Left hand belongs to Yin and the Right hand to Yang; in severe warm-heat diseases, the pulse appears faint and minute as if absent; and he discusses the severe consequences of mistaken purgation and the aggravation of disease by mistaken tonification. These insights were not previously stated by predecessors, demonstrating both benevolence and wisdom. Given the profundity of Mr.'s academic knowledge, his attention to detail is still so meticulous. His intention to benefit and rescue others is commendable. I wish everyone would follow his example to avoid treating lives carelessly, which is the ultimate expression of benevolence and righteousness. For junior practitioners, although they may not possess Mr.'s talent and insight, if they emulate his conscientious attitude and proceed with caution and prudence despite lesser learning, they can sufficiently follow in the footsteps of good physicians.