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I have observed that Shanghan (Cold Damage) belongs to external contraction diseases, while Zabing (Miscellaneous Diseases) belongs to internal injury diseases. Sages of past and present have discussed this in detail. As a person of shallow ability like myself, there is no need for me to add another word. Nevertheless, external contractions arise from the invasion of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) from outside, while internal injuries stem from pathological changes within the Five Zang organs. I believe that when the Six Qi invade, it is invariably because Yuanqi (Original Qi) is deficient first, causing Wei Qi (Defensive Qi) to fail in protecting the exterior, thereby allowing pathogenic factors to invade the Wei level; and Ying Qi (Nutritive Qi) to fail in nourishing the interior, thereby allowing pathogenic factors to attack the interior. Excessive labor and fatigue that cannot be endured lead to deficiency of Lung Yuanqi; excessive thinking that cannot be managed leads to deficiency of Heart Yuanqi; inability of diet to be transported and transformed leads to deficiency of Spleen Yuanqi; inability to make decisive plans leads to deficiency of Liver Yuanqi; and insufficiency of Essence and Blood leads to deficiency of Kidney Yuanqi. These constitute internal injuries of the five zang organs. The entire body, encompassing Yin and Yang, interior and exterior, meridians and collaterals, and zang-fu organs, is connected by a single Qi. Therefore, if Qi is substantial, the five zang organs are also substantial, the skin and hair become firm, and the Six Qi find it difficult to invade. If Qi is deficient, the skin and hair also become weak; even if the Six Qi do not enter, the five zang organs will generate susceptibility internally. The ancients said that when the Liver is deficient, wind arises spontaneously; when the Kidney is deficient, cold arises spontaneously. This illustrates the principle clearly. How can one treat Yin and Yang, interior and exterior, meridians and collaterals, and zang-fu organs as separate entities? Regrettably, medical practitioners fail to investigate this and divide external contractions and internal injuries into two distinct specialties. This is akin to dividing one person into two bodies, implying that Heaven and Earth need not interact, Water and Fire need not balance, and the Qi and Blood of the human body need not support each other. Consequently, those who specialize in Shanghan lack knowledge of Zabing, and those who specialize in Zabing lack knowledge of Shanghan. When encountering Shanghan that resembles Zabing, they use medicines for Zabing; when encountering Zabing that resembles Shanghan, they use medicines for Shanghan. Is this not a ridiculous inversion, capable of killing someone with a mere flip of the hand? This is a common malady throughout history, incurable even by Bian Que. I say: although treatment can be categorized, medical skills must be comprehensively mastered. Those attentive to this path should recognize this and not assume that specialization guarantees proficiency.

In the late spring of Jiashen year, Zeng Yizhao, the second son of Censor Zeng Jingxuan, was forty years old. He had a lifestyle of indulgence and lacked physical exertion, and following the grief and depression of losing his son, he had been ill for two years, with treatment exacerbating his condition. On the seventh day, I was summoned to examine him. His face was dark and lusterless, his head hung low, his speech was faint and he preferred sleep, he had little appetite, sometimes his legs were flaccid and weak, his stool was slippery and incontinent, and his urine was clear and profuse. Externally, his scalp sores had not healed. The pulse was deep, slow, and non-pulsatile in all six positions; the left Guan position was deep and choppy; the left Chi position was deep, slow, and moderate; and the Spleen pulse was wiry. This indicates extreme Yang deficiency. The therapeutic principle should be to benefit the source of Fire to eliminate Yin shadows (warm and tonify Kidney Yang to dispel Yin cold). Reviewing his previous prescriptions, they mostly consisted of Dang Gui (Angelicae Sinensis Radix), Bai Shao (Paeoniae Radix Alba), Suan Zao Ren (Ziziphi Spinosae Semen), Yi Yi Ren (Coicis Semen), Wei Ling Xian (Clematidis Radix), Huang Bo (Phellodendri Cortex), and Zhi Mu (Anemarrhenae Rhizoma). I said: The root of the disease lies in the deficiency of both Liver and Kidney. Even with vigorous tonification, we might fear insufficiency. How could one instead use bitter-cold herbs that damage the Stomach, cause loose stools, and deplete Qi, thereby severely draining True Yang? A dark and lusterless face indicates that Yang Qi cannot warm the upper body and sinks downward. Faint speech and preference for sleep indicate that Yang Qi fails to ascend and emerge. Lack of appetite indicates that the Spleen and Stomach have been damaged by cold herbs, leaving Stomach Qi deficient and cold, unable to digest food well. Flaccid legs indicate laxity of sinews and vessels due to unrestrained Liver Qi. Slippery bowel movements and urination indicate that Mingmen Fire (Gate of Life Fire) is too weak to warm the Earth (Spleen/Stomach), and Kidney Qi is deficient and cold, failing to consolidate fluids. Non-healing sores indicate failure of Spleen Qi. A deep, slow, non-pulsatile pulse signifies decline of Yuanqi. A deep, choppy left Guan pulse suggests being overcome by Metal; a wiry right Guan pulse suggests being overcome by Wood; a deficient and slow left Chi pulse suggests being overcome by Earth. I predicted he would not survive until early summer. I told his brother, Yi Yuan: With three types of pulse overcoming indicated, if urgent treatment is not administered, how can life be restored? I prepared a prescription as a guarantee. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), removing Sheng Ma (Cimicifugae Rhizoma) and Chen Pi (Citri Reticulatae Pericarpium), doubling the dose of Ren Shen (Ginseng Radix et Rhizoma), and adding Rou Gui (Cinnamomi Cortex), Fu Zi (Aconiti Lateralis Radix Praeparata), Pao Jiang (Zingiberis Rhizoma Praeparatum), Gu Zhi (Dictamni Cortex), and Wu Wei Zi (Schisandrae Chinensis Fructus). After four doses, diarrhea decreased gradually, and the pulse became slightly stronger. I continued with Bawei Wan (Eight-Ingredient Pill), removing Ze Xie (Alismatis Rhizoma), and adding Ren Shen, Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle), E Jiao (Asini Corii Colla), and Wu Wei Zi. He had already purchased the medicine but showed my prescription to his previous doctor, who claimed I recklessly used drying/hot herbs and insisted on continuing the previous treatment. He died on June 12th.

In the late summer of Yiyi year, my relative-in-law Chen Taiyu, over sixty years old, suffered from deficiency wheezing and expectoration, spontaneous sweating, fatigue and desire to lie down, anorexia, vomiting after eating, clear and profuse urination, loose stools, cyanotic and dark complexion, and emaciation. The pulse was deficient, floating, and powerless in the left three positions, and wiry and small in the right Guan and Chi positions. I diagnosed this as Mingmen Fire deficiency with Yang Qi escaping and sinking, manifesting as Zang Pulse (True Pulse indicating organ failure), which is ominous when Earth Qi is strong. I reluctantly prescribed Liujunzi Tang (Six-Gentleman Decoction) plus Gan Jiang (Zingiberis Rhizoma) and Rou Gui, along with Bawei Wan. Symptoms improved initially but returned after several doses, leading to cessation of medication. By month-end, the condition worsened. A few more doses of the previous prescription were given. On the fourth day of the next month, upon re-examination, the pulse showed even less Stomach Qi. I prescribed a large dose of Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Rou Gui, and Fu Zi, but to no avail. I predicted death within thirty days and advised his sons to prepare funeral arrangements. Another doctor, believing my use of Gui and Fu was erroneous, diagnosed Phlegm-Fire excess and prescribed Qingqi Huatan Wan (Clear the Qi and Resolve Phlegm Pill), Mai Dong (Ophiopogonis Radix), and Gua Lou (Trichosanthis Fructus). Initially, the patient felt relief in the chest, but after three doses, undigested food was vomited, and confusion increased. He demanded payment and invited Chen Xuetan to prescribe Spleen-tonifying herbs, which might have been closer to the correct approach. However, even knowing to tonify the Mother (Kidney/Spleen relationship contextually implies warming Fire to generate Earth or tonifying Spleen to generate Lung), it was too late. He died on the 28th of that month. Earlier in May, he had visited me seeking consultation, and I advised immediate tonic treatment, but he delayed, worsening his condition. My analysis of these cases is that Mingmen Fire deficiency fails to generate Spleen Earth, which in turn fails to generate Lung Metal. Symptoms like vomiting after eating, emaciation, spontaneous sweating, expectoration, and loose stools indicate failure of Earth and deficiency of Metal, manifesting as Zang Pulses. Even strict adherence to "tonify the mother when deficient" might not suffice. How could one mistakenly diagnose excess and "drain the child," using Lung-clearing methods, thus hastening death? I often see physicians treating phlegm without distinguishing deficiency or excess, stubbornly attributing it to Fire and attacking it, while patients accept this self-mistreatment. Phlegm can be Heat-Phlegm, Cold-Phlegm, Wind-Phlegm, Damp-Phlegm, Wine-Phlegm, Blood-Phlegm, Qi-Phlegm, Shock-Phlegm, Food-Phlegm, Old-Phlegm, or New-Phlegm. It may arise from Kidney fluids overflowing, Spleen fluids surging, or stagnant Fire rising, resembling fluid or saliva. Whether coughed, spat, or vomited, the origins vary and must be distinguished carefully, along with accompanying symptoms. This is crucial. Expectoration is invariably caused by Yuanqi deficiency-cold and Mingming Fire decline. Prescriptions such as Sishen Dan (Four-Spirit Pellet) or Bawei Wan should be used urgently to aid the source of transformation, offering hope. I append several case records of sages below to illustrate general principles for physicians and patients alike. Treatment must address the root, not just current symptoms, avoiding inappropriate prescriptions. This aims to break the rigid views of contemporary doctors.

According to Mr. Xue Lizhai: A scholar, despite midsummer heat, preferred fire and wished to soak his limbs in boiling water, yet had a red face and expectorated phlegm, seemingly Fire-excess. Vomiting was severe, expelling undigested food. Only eating pepper and ginger brought relief. I stated that vomiting after eating indicates Spleen-Stomach deficiency-cold. Using Bawei Wan and Shiquan Dabu Tang (Ten-Agent Great Tonifying Decoction) plus Pao Jiang, he gradually recovered and was healthy within a month. Also, Chen Chanlin of the Ministry of Works had fever and phlegm. After taking Erchen Tang (Two-Aged Decoction), Huang Lian (Coptidis Rhizoma), and Zhi Ke (Aurantii Fructus), his condition worsened. In late winter of Jiachen year, his pulse was micro-fine at the right Chi, floating-large at the right Guan, and weak upon heavy pressure. I diagnosed Mingmen Fire deficiency failing to generate Earth, causing Spleen disease. Tonifying Fire to generate Earth might cure him. He did not heed this, continued previous meds, and his Spleen Earth weakened further. By leap January of Yisi year, his condition deteriorated. The right Cun pulse was flat and detached, indicating Earth failing to generate Metal and vital Qi perishing internally. I declined treatment. The Classic states: "When deficient, tonify the mother; when excess, drain the child." If disease is in the Child, tonify the Mother. How much more so if the Mother is deficient and one drains the Child? Death is inevitable. Also, Kuang Zijing of the Court of Imperial Entertainments had a pale face, mental fatigue, poor appetite, and difficulty digesting. He took Erchen Tang, Pi Pa Ye (Loquat Leaf), Zhi Zi (Gardeniae Fructus), and Zhi Shi (Aurantii Fructus Immaturus). He wasted away. I diagnosed Spleen-Stomach deficiency-cold and advised tonifying the Mother of Earth (Fire/Kidney). He refused, directly tonified Earth, and died. Also, my cousin's wife had cough, fever, vomiting of phlegm/saliva (5-6 bowls/day), continuous wheezing, chest fullness, dry mouth/thirst, anorexia, and uterine bleeding. This was Mingmen Fire deficiency and Spleen Earth deficiency-cold. Treated with Bawei Wan and Fuzi Lizhong Tang (Aconite and Ginger Decoction to Warm the Middle) modified, she recovered. Also, Luo Gongbu had abdominal coldness in midsummer while feeling hot externally, cold abdomen when inhaling through nose, wind aversion, and large-deficient-micro pulse. He needed hot porridge and ginger to prevent abdominal coldness. I said "Heat does not produce heat; there is no Fire." Use Bawei Wan to benefit the source of Fire. He took Siwu Tang (Four-Substance Decoction) and Xuan Shen (Scrophulariae Radix) and died. Also, a fat, drinking scholar had phlegm-wheezing in mid-autumn. Erchen Tang, Huang Qin (Scutellariae Radix), and Huang Lian worsened it. Adding Sang Bai Pi (Mori Cortex) and Xing Ren (Armeniace Semens) caused night sweats and shortness of breath. Adding Bei Mu (Fritillariae Bulbus) and Zhi Ke increased intermittent fever. I diagnosed Spleen-Lung deficiency-cold, used Bawei Wan to tonify the Mother of Earth, and Buzhong Yiqi Tang to support Middle Qi, resulting in recovery. Also, Chancellor Meng Youya had shortness of breath, phlegm-dizziness, and urinary incontinence after taking acrid-aromatic herbs. Pulses at both Chi positions were floating-large but empty upon pressure. I diagnosed Kidney's failure to grasp Qi, exacerbated by aromatic-drying herbs. Three doses of Bawei Wan material cured him. Also, a man fond of rich foods had chest fullness and phlegm. I diagnosed internal accumulated heat due to rich diet, treated with processed Qingqi Huatan Wan, and he recovered. He shared this remedy, harming those with Spleen-Stomach deficiency. Also, my elder brother had abundant phlegm, forceful pulse, intolerance to effort, dizziness upon wind exposure, cracking/redness of mouth/tongue. Mistakenly eating ginger/garlic worsened mouth ulcers. One qian of Bawei Wan plus Buzhong Yiqi Tang with Fu Zi cured him immediately. Symptoms returned after stopping meds for a month. This is Mingmen Deficient Fire failing to return to its origin. These ten cases illustrate Mr. Lizhai's treatment of Mingmen Fire deficiency with phlegm/deficiency. His treatment of Yin-deficiency phlegm was also excellent. Mr. Lizhai is a medical sage. Yet contemporaries like Chen Chanlin, Kuang Zijing, and Luo Gongbu ignored his advice, succumbing to aggressive treatments by contemporary doctors. Since Wang Jiezai's Laotan Wan and Wang Yinjun's Guntan Wan were published, everyone imitated them, damaging Stomach Qi and draining Yang, causing countless deaths. Their methods are only suitable for robust individuals with accumulated heat, for temporary use. Mr. Ye Jingjun of Bian Prefecture wrote in his preface: I met Jingyue in Gui Mao year. I exhausted Spleen and Kidney Qi through study, suffering chronic diarrhea for twenty years. Doctors attributed it to Fire-excess; Jingyue attributed it to Fire-deficiency, prescribing Ren Shen, Bai Zhu, Rou Gui, and Fu Zi to tonify Mingmen Fire. Critics arose, but I trusted him, taking it for five years until cured and Spleen-Kidney restored. My courage lay in boldness; Jingyue's in insight. Neither could exist without the other. Alas! Treating Mingmen without Gui and Fu is incorrect. The critics' barking shows ignorance of Mingmen, wrongly attributing chronic diarrhea to Fire-excess. My use of Mother-tonifying herbs for Zeng Yizhao and Chen Taiyu drew criticism from peers, which is fitting. While Ye's metaphor was harsh, it was appropriate. However, I believe both failing to use Gui/Fu when needed (cowardice/ignorance) and using them when not needed (recklessness/harm) are errors. Both harm patients. Current doctors ignore Yin-Yang, Water-Fire, deficiency-excess, and true/false distinctions, treating only symptoms for fame and profit, quoting classics to impress nobles. I fear they will err constantly and incur blame. Tao Jian'an said: "Killing without a blade"—this applies here. Generally, mild/slow diseases allow gentle remedies. Severe/rapid diseases require swift action; delaying misses the opportunity. Physicians must have courage and insight to fulfill their responsibility.

In early spring of Jiashen year, Zhou Kaifu, a military officer over sixty, contracted sores after getting wet during travel. External surgeons prescribed cooling/cold herbs, damaging the Stomach and causing stool incontinence. Only after realizing this and taking Fire-benefiting herbs did he improve. Later, night patrol exposed him to Wind-Cold, causing phlegm-vomiting and anorexia. Pulse was wiry-solid generally, wiry-thin at right Guan/Chi. I diagnosed this not as phlegm, but Spleen Qi failure with fluid loss upward. Predicted death within three months; he died in mid-spring. Sores and ulcers reflect internal organ damage manifesting externally. Mr. Lizhai stated all thirteen departments follow one principle. External surgeons often stick to fixed formulas, ignoring interior/exterior, deficiency/excess, and meridian/organ patterns, causing errors. I advocate integrating internal and external medicine, treating according to syndrome. Why do people view sores as trivial, ignore deficiency/excess, take cold herbs lightly, and entrust lives to incompetent surgeons? One must beware.

In winter of Renwu year, my nephew Wang Jiu suffered from scabies for years without improvement. A surgeon prescribed Shuihuo Dan (Water-Fire Pill) containing mercury. I warned against it: Mercury is extremely cold/heavy; refined with fire, it becomes a toxic, drying agent that damages soft intestines/stomach. Such reckless harm deserves death. I taught him to take Liuwei Wan (Six-Ingredient Pill), curing him before finishing the dose. This follows Mr. Lizhai's method. Most texts attribute scabies to Damp-Heat in Yangming Meridian. Mr. Lizhai traced it to Deficient-Heat in Foot-Shaoyin (Kidney) Meridian. This insight transcends millennia.

In summer of Guiwei year, a maid of Lian Cantian's mother had a foot ulcer for a year, taking cooling/cold detox herbs and walking on bricks, yet it didn't heal. Her head tilted, face dark. I told Lian: Death is near. Pulse/symptoms showed Stomach failure and stool incontinence. Predicted death in autumn; it happened. Most sores/ulcers result from Blood deficiency in Foot-Taiyin/Yinming/Jueyin. Non-healing sores indicate Spleen Qi failure. Even if initial toxicity is high, if constitution is strong, cooling herbs are only temporary. Once heat subsides, prioritize tonifying Qi, Blood, and strengthening Spleen. Full Spleen Qi generates flesh; robust Yin/Blood resolves stasis. Recovery is certain. Why die?

In spring of Guiwei year, a relative's wife, over forty, had emotional stagnation, phlegm-vomiting, anorexia, chest/abdominal pain/distension, wore wool in summer, had floating-knotted pulses, occasional thirst/insomnia. I diagnosed Mingmen Fire deficiency and Yuanqi deficiency-cold. Prescribed Liujunzi Tang plus Gan Jiang/Rou Gui and Bawei Wan. She followed treatment strictly, ignoring others, and recovered completely in two months.