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How could it be otherwise? (Referring to the dire consequences if not treated promptly.) Thus, large doses of Rhinoceros Horn (Xijiao), Gypsum (Shigao), Lonicerae Flos (Yinhua), Trichosanthis Radix (Huafen), fresh Rehmanniae Radix (Xiashengdi), and Ophiopogonis Radix (Maidong) were used. It was instructed to decoct three large bowls of medicine, place them by the bedside, and administer them frequently. While the medicine was still being decocted, it was ordered that fresh sugarcane juice be squeezed first and drunk freely. The elders looked at the prescription, glancing at each other, daring not to decide. Fortunately, my late mother presided over the matter within the household, and externally, Mr. Jin Lusi strongly opposed the majority opinion. Thus, the medicine was decocted according to the method and administered. It took a week to complete the treatment, after which the illness showed improvement and gradually healed. At that time, I was only twelve years old; I listened to Ye Tianshi's words and committed them to memory. Over two years later, my father passed away, and I traveled far for a livelihood. I heard that Mr. Shanglin was praised by many for his skillful use of cooling medicines, so he turned to the teachings of Zhang Jingyue and became known for warm tonification. Deviating from the right path to cater to others—what a pity!

Pulse diagnosis is listed last among the Four Diagnostic Methods (Wang, Wen, Wen, Qie) because the categories of pulse are limited, whereas the syndromes of disease are infinite. Since syndromes cannot be fully encompassed by pulse alone, one must first examine what is visible and audible, then feel the pulse condition, combine it with the syndrome presentation, and integrate the Four Diagnostic Methods so that the disease cannot hide its true nature. If there is inconsistency, there must be a reason; one may follow or discard the pulse findings, as there are inherent principles. Divine insight and clarity depend on the practitioner.

(Collation Note) The above discusses observation (Wang Zhen).

This is my late grandfather's manuscript, written down as his thoughts arose, without categorization, hence titled "Casual Notes" (Suibi). My late father edited and annotated it but did not finish before suddenly passing away. I have not deeply studied medicine, so I dare not add annotations. I respectfully organized and collated it, copied it into a clean draft, awaiting publication. On the second day after the Dragon Boat Festival in the 21st year of Jiaqing, grandson Shen Sheng carefully collated.

(Publication Note) *Quanxin Xinlun* states: A normal person's single breath consists of one exhalation and one inhalation combined. Because the human body is inherently hot, exhalation expels internal waste gas, while inhalation receives the vital energy of heaven and earth. Therefore, holding one's breath for a moment causes restlessness and oppression, which is relieved only by a long sigh. The hundred vessels of the body move with the blood. Comparing by time units, a healthy adult pulses 70 to 75 times per 18 breaths; infants may pulse 130 times; the elderly may pulse 60 or 50 times; women pulse about 10 times more than men. Considering an individual, standing, sitting, walking, and lying down yield different pulses: standing is 7-8 beats faster than sitting; sitting is 3-4 beats faster than lying down. Other factors include eating being faster than hunger, and daytime being faster than night, though these change with circumstances. After activity, fright, or drunkenness, there is no fixed rate. This applies to the whole body; pulse is not named only at the hands, feet, and neck, but vessels elsewhere are protected by flesh and difficult to palpate, hence pulse is taken only at the hands, feet, and neck. Now, only the wrist pulse is taken because beneath the wrist pulse lies bone support, allowing for heavy and light pressing, facilitating face-to-face observation and inquiry, and offering convenience in extension and retraction. Jiang Bihua said: Pulse diagnosis merely distinguishes floating/sinking to determine exterior/interior, slow/rapid to differentiate cold/heat, and strong/weak to judge deficiency/excess. Other aspects are clear in mind but hard to discern under the fingers; pulses vary in size and depth, making the six positions hard to standardize. Thus, physicians say that determining syndrome solely by pulse is a deceptive claim. My comment: *Neijing* states: If flesh and muscle are wasted away, even if the Nine Positions of pulse are harmonious, death ensues. If pulse is harmonious when flesh is wasted, how much more peaceful was the pulse before wasting occurred? As stated in *Nanjing*: "Qi Kou pulse is flat yet the patient dies," indicating that the vital Qi has been exhausted internally. In such cases where the pulse does not reflect the severity of the disease, one cannot rely solely on pulse to diagnose. (However, cases where pulse indicates disease while the person appears healthy, allowing prediction of death by holding the arm, have been verified by me in the cases of Academician Chen Tieqiao and Sima Wang Shaohai.) Only in the case of Miss Shen Yueting's second daughter, who had no apparent illness but presented with a rapid, storm-like pulse, did I predict death within half a year. More than a year later, her pulse was still very slow (8 beats per cycle), and she has now been buried in the Fan family tomb for half a year. Such is the reliability and unreliability of pulse. Ultimately, it is reliable most of the time, though subtle and unpredictable. My great-grandfather summarized it with: "Divine insight and clarity." Learners should exert themselves fully. I lost my father in childhood and had no formal education. To inherit my ancestor's will, I specialized in the arts of Huangdi and Qibo. Although I read widely, I ultimately reconciled my knowledge here. The reason for delaying publication is not laziness, but a desire to supplement various syndromes and elaborate in detail. However, limited by learning and busy with travel, I have procrastinated until now, unable to continue writing. Yet time flies like a white pony passing a crevice, and I fear loss of transmission. Reading my uncle's preface, I felt ashamed and sweating. I respectfully saved from my food and clothing expenses, occasionally added insights on acupoints, submitted it to the woodblocks, to present to experts for review, hoping to inspire further thought, and do not claim completeness. On New Year's Day of the Renzi year in the Xianfeng era, great-grandson Shen Shixiong carefully published.

In previous years, the daughter of Dongchi, younger brother of Yu Boquan, had regular menstruation but suddenly suffered severe hemorrhage in mid-March. Wang from Zhenhai prescribed several doses of large-dose warm tonifying herbs; bleeding stopped but qi rebellion and fever ensued. Chu switched to nourishing and filling herbs, with no effect. Shen diagnosed it as warm pathogenic invasion and prescribed clearing and resolving herbs continuously, also ineffective. Inviting me to consult, the patient's complexion and form were depleted, with panting, sweating, loose stools, chaotic rapid pulse, excessive phlegm, poor appetite, intermittent fever, and insomnia all night. I said: This is acute consumption (Ji Lao); it cannot wait until summer. The family and other doctors said: She was healthy normally; even if it becomes consumption, surely life can be extended. If incurable, a hundred days should suffice. Why say it cannot wait until summer? I said: *Qianjin Yi Fang* explicitly states under the Licorice Decoction section that critical cases die in eleven days. Upper damage reaching the stomach, lower damage reaching the spleen, damage involving three zang organs, takes at least a hundred days at the fastest. Before symptoms appear, people do not feel internal damage, so sudden onset leads to critical, incurable conditions. However, before onset, pulse signs must exist. This "pulse indicates disease while the person appears healthy" state of the "walking corpse" is precisely the term for unmanifested disease. The family did not believe, invited Wang again. Wang also believed it was post-hemorrhagic pathogenic invasion, gave three doses of medicine, and the patient died. Indeed, on the day before Start of Summer. Last winter, Shen Huanzhang's son fell ill, treated as Winter Warmth by physicians. Days later, form collapsed and spirit scattered. His landlord, Wu Qucheng, pulled me to examine. Pulse and color were depleted, with no exterior signs. I said: Acute consumption; danger period is around eleven days? Later, it proved true. Though this was a lucky hit, acute consumption is recorded often in my cases, yet people doubt *Qianjin Yi Fang*, claiming consumptive diseases do not last only ten-plus days, likely failing to cross-reference the "walking corpse" theory. When disciples asked about this case, coinciding with the nearing completion of this edition, I appended this note. There are also cases relying on a single pulse without examining the syndrome, thereby shortening lives, which are too numerous to list. Alas! Following names without verifying reality misleads all living beings. Medicine is indeed a field worthy of bitter tears. On the Lantern Festival of the Yihai year, Shixiong added notes.