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1. Avoid rice soup. As the saying goes, "He who obtains grain prospers." The life and death of all diseases depend on the existence or extinction of Stomach Qi (Stomach Energy), just as the supply line is the most critical matter for a military campaign. However, this does not apply to epidemic pathogens causing Huoluan (Cholera-like disease) and Shazhang (Sha distension). This is because the pathogenic factors of summer-heat, dampness, filth, and malodor are inhaled through the mouth and nose into the Lung and Stomach, obstructing the free flow of Qi in the air passages. It is a condition of blockage and obstruction. Therefore, turbid Qi cannot descend, leading to abdominal pain and vomiting; clear Qi cannot ascend, leading to diarrhea without sneezing (or indicating lack of Qi dissemination). Or there may be an urge to vomit but inability to do so, an urge to defecate but inability to do so, with the pathogen occupying the central pivot. If immediate measures to resolve transformation and promote circulation are not taken, the pathogen will enter the collaterals from the meridians, and the fu organs from the zang organs, becoming difficult to manage due to its spread. Within the first week of illness, if even a single mouthful of rice soup is swallowed, it leads to unbearable abdominal distension and rebellious Qi. This is precisely because grain Qi entering the Stomach generates Yang heat. Moreover, cooked liquid can further obstruct the channels and collaterals. What is the difference between this and supplying weapons and food to the enemy? Only when vomiting and diarrhea have been excessive, the pathogen has declined, and the healthy Qi has been depleted, resembling a situation where bandits have left and the people are impoverished, should one provide relief. At this stage, clear rice soup can be drunk warm to provide continuity of nourishment. One must not prohibit it too strictly, lest the Stomach Qi become difficult to restore. Understanding the sequence of priorities brings one close to the Dao of medicine.

Among foods, none is more neutral in nature than grains. They are the supreme treasure of human life, yet during the peak of pathogenic heat in Huoluan and Sha distension, they must not be tried. If rice soup is contraindicated, how much more so are tonics? Illness does not necessarily occur simultaneously with seasons, nor does every seasonal illness become Huoluan. Since Huoluan occurs simultaneously and spreads widely, forming epidemics, why do physicians fail to recognize the nature of this disease? Every disease has its specific indications and contraindications. One must discuss the disease before discussing the prescription; if the medication matches the disease, it is good medicine. Therefore, if administered correctly, Nuxiao (Mirabilite) and Huanglian (Coptis Rhizome - *Note: Text says Xiaoshi/Dahuang contextually implies purgatives like Mirabilite and Rhubarb*) act as tonics; if administered incorrectly, Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) act as poisons. Consider alcohol, lust, wealth, and anger: mediocre people use them to kill themselves, while heroes may use them to realize their ambitions. Rituals, music, literature, and essays allow sages to govern the world, but pedantic scholars misuse them to harm the common people. Medicines function similarly in medicine. Correcting deviations and remedying defects requires appropriateness to the time. Disease conditions are not fixed, nor are drug properties fixed. How can one discard the disease condition and judge drugs solely by their purity or impurity?

Some say: "Supporting Yang and suppressing Yin" is the way to govern the world, used by ancient sages to establish teachings, and Zhang Jingyue used it to metaphorize medicine. Now, with the body's imbalance and internal chaos, we reject warming and tonifying methods that support Yang, focusing only on clearing heat and assisting Yin. Is this not overly biased towards cold and cool herbs, inviting criticism from later generations? I reply: Supporting Yang and suppressing Yin in the *I Ching* (Book of Changes) was originally used to metaphorize gentlemen versus petty men. Thus, Zhang Xugu stated: "This can be used to discuss governing the world, but not to discuss treating disease." Unfortunately, Master Zhang did not fully grasp this point. Human Yuan Qi (Primal Qi) is like Yang; external pathogenic Qi is like Yin. To support healthy Qi and suppress pathogenic Qi, must one rely exclusively on hot herbs? For instance, when heat damages Stomach fluids, Zhongjing refers to this as "absence of Yang." However, to support its Yang, one must replenish its fluids. To suppress its Yin, one must eliminate its heat. Although urgent purgation is called "preserving Yin," urgent purgation targets the pathogen. Eliminating the pathogen is suppressing Yin. Preserving Yin is preserving Healthy Qi. Preserving Healthy Qi is supporting Yang. If one understands this principle, then the principles of the *I Ching* and medicine are consistent. If one merely sticks to warming and tonifying herbs as means to support Yang, without understanding that Yin and Yang are metaphors for Pathogen and Healthy Qi, then despite having extensive knowledge, one creates a trap for the people. Treating humans and governing the world follow the same logic.

Another asks: Zhu Danxi said the human body suffers from Yin deficiency; Zhang Jingyue said it suffers from Yang deficiency. Who is correct? I say: The human body is a small universe. Let us analyze it using the theory of heaven and earth. Yin and Yang are inherently balanced, without bias. Cold and summer-heat are opposites; day and night are opposites. Yet, the nourishment of rain and dew, and the descent of frost and snow, all serve to assist the insufficiency of Yin and restrain the excess of Yang. Understanding this clarifies the correctness or incorrectness of Zhu and Zhang. Another asks: You say supporting Healthy Qi is supporting Yang, so tonifying Yin and tonifying Yang are both supporting Yang. Suppressing Yin is suppressing the pathogen, so expelling cold and expelling heat are both suppressing Yin. But if one focuses solely on expelling the pathogen and does not advocate tonifying Healthy Qi, does this not contradict the principle of supporting Yang and suppressing Yin? I respond with my late mother's teaching: Regardless of external contraction, one must not recklessly administer warming and tonifying herbs. Even considering the principle, purely deficient syndromes are rare. Xu Lingtai also said: Generally, people die of old age or disease; those who die of deficiency without illness are less than one in a thousand. Moreover, when the disease leaves, the deficient person recovers; when the disease remains, the excess person dies. Therefore, removing the disease is precisely how one supports Yang. I once said that human Qi forms the body. Following the vigorous movement of Heaven, there is no moment of cessation. Only when the Five Qi invade externally, or Seven Emotions disturb internally, causing Qi mechanisms to deviate, do diseases arise. Thus, even in extremely deficient individuals, once ill, there is excess within deficiency. Whether enduring extreme heat or cold, everyone is exposed, yet some get sick and others do not; this depends not entirely on age or strength, but on whether the Qi within the body is in deviation or not. Deviation allows pathogen retention, attaching to cause disease; non-deviation allows Qi to operate silently, dissolving issues secretly. Regulating deviation to prevent it achieves the treatment of external and internal diseases without omission. What about Huoluan?

(Sharing all knowledge without reservation shows great benevolence towards future learners. If one reads this and still does not understand, do not engage in this profession.)
Suiyuan said: Where human Qi and Blood stagnate, the strong develop abscesses and ulcers, while the weak develop consumption and tuberculosis. I have always admired this as a profound statement. Reading this treatise aligns perfectly with these two sentences. (Yang Zhaoli, courtesy name Sulian, from Dingzhou)

Another asks: The classic states, "Where the pathogen gathers, the Qi must be deficient." Is this not true? I say: Human Qi and Blood naturally vary in strength. The strong are not necessarily long-lived; the weak are not necessarily short-lived. Precisely because even strong Qi, if invaded by pathogens, becomes deviated in flow, appearing deficient. If the pathogen is not removed, the disease becomes more excess and the Healthy Qi more deficient, eventually leading to death, causing premature demise despite initial strength. If Qi and Blood are weak but not invaded by pathogens, their flow is not deviated, and deficiency is not felt. Even if invaded, removing the pathogen ensures the disease does not linger, allowing Healthy Qi to remain at peace, enabling the weak to live out their natural lifespan. Consider brave warriors like Meng Ben and Xia Yu; their bodies do not feel heavy because Healthy Qi moves vigorously without stopping. Suddenly struck by Sha pathogen, they may die with cold limbs and hidden pulse because Qi is closed by the pathogen, causing flesh and blood to perish. Thus, "Where the pathogen gathers, the Qi must be deficient" should be interpreted this way. When treating such cases, should one urgently open the closure to promote circulation, or push the patient down further by administering blocking tonics? This applies not only to Sha syndromes. Whenever tonification is given while the disease remains, the diseased area becomes more excess, and unaffected areas become more deficient, as Qi and Blood from unaffected areas are drawn to the diseased site. Tonics do not create Qi and Blood from nothing; they merely redistribute, taking from the abundant to supplement the scarce. In healthy people, this causes problems; how much worse for patients? Thus, the classic warns against failing to treat deficiency properly... [Text fragment] ...leading to accumulation without expenditure, akin to burying oneself in a pit. A small hoarder impoverishes hundreds; a large hoarder impoverishes thousands. Though the miser believes wealth accumulates permanently, disaster and war can wipe out a century's wealth in a day. Does it truly stay? A ruler who focuses on hoarding wealth leads to universal poverty and the end of heavenly mandate. Just as national resources are like human Qi and Blood, allowing free circulation prevents disease. Hence, I mention this while discussing Huoluan.

(My uncle compiled the book *Yuhou Xuzhi* during the Daoguang era to encourage proper conduct among the lower classes. He included a passage on Wei Zhaobo's views on stinginess, which attracted criticism. Yet, over ten years later, his words proved prophetic, which is lamentable. Regarding the treatment of deficiency, he was uniquely skilled. I recall in the spring of the Dingsi year, at age twenty-seven, I suffered from hematemesis in Shanghai. Physicians used cooling fire and yin-tonifying herbs for a long time without success, and my condition became critical. Returning to Hangzhou for consultation, I was prescribed a large dose of Renshen (Ginseng Root). After several doses, I recovered. I remain healthy today, stronger than before, able to work despite displacement. Reading this treatise, I record this to express my gratitude. (Shao Wu))
(This summer, Mr. came to Shanghai. Mo happened to suffer from fever, diarrhea, and dry mouth. Fortunately, he could eat and continued working. The physician observed a wiry and large pulse, stating: "This is a syndrome of severe worry and fatigue, with major depletion of Yuan Qi." He prescribed a large dose of Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Fuling (Poria), Gancao (Licorice Root), Fangfeng (Saposhnikovia Root), Shaoyao (Peony Root), Juhong (Tangerine Peel), Shihu (Dendrobium Stem), and Mugua (Chaenomeles Fruit). Within ten days, he recovered. He then returned home to visit relatives, arrived in Shanghai after a month, and suffered from chills and fever. The physician diagnosed it as summer-dampness resembling malaria and prescribed clearing and transforming herbs. After four doses, he recovered completely. Feeling fatigued, he was treated with strong tonics including Renshen (Ginseng Root)... Gancao (Licorice Root), and Baiziren (Baiji Seed), and healed. His unique skill in treating deficiency is indeed credible. (Chen Tingmo, courtesy name Banqiao, from Gui'an))

2. Avoid ginger and sugar. Mr. Xu said: If there is summer-heat pathogen, ginger must absolutely not be used. Even if used concurrently with Huangqin (Scutellaria Root) and Lianzi (Lotus Plumule), it is inadvisable. How much more so is ginger soup alone? Only in early stages complicated by cold might a small amount be considered based on the syndrome. Sugar promotes damp-heat and causes greasy stagnation in the middle jiao. Misuse gives rise to filth and turbidity. It not only increases vomiting but also extends to dates, longan, licorice, and all sweet, greasy, and stagnant drugs, which can be inferred similarly.

3. Avoid hot soups, wine, and bathing. These three are methods to dispel cold. When cold injures the form, the guest pathogen is in the exterior. Drinking hot soups and wine, or bathing in a warm room, can allow the cold pathogen to resolve through sweating. Therefore, herbs that release the exterior to dispel cold are often assisted by Gancao (Licorice Root), ginger, and dates. This aids Middle Qi to push the pathogen outward and prevents external pathogens from entering inward. However, summer-heat, dampness, heat, epidemic, filth, and malodor pathogens are all inhaled through the mouth and nose, directly injuring the Qi level and gradually entering the Ying (Nutritive) level. Immediate cooling and draining are required to allow Qi to expand and turbidity to move, enabling the pathogen to exit downward, which provides a chance for survival. Not only must pungent-warm and sweet-greasy herbs be avoided, but hot soups, wine, and bathing must also be strictly prohibited as they fuel the rampant heat.

4. Be cautious with Sha pills. There are many formulas for Sha medicines, addressing different syndromes. Some suit summer-heat diseases, others suit cold-damp diseases. How can one casually experiment? There are also unorthodox formulas gathering fierce and potent ingredients mixed together. They falsely claim to cure all diseases. Benevolent but unlearned people produce and distribute them widely. Occasionally, they are effective, mostly in robust individuals suffering from exposure to wind and dew. General application often results in mild cases becoming severe and severe cases resulting in death. Therefore, taking medicine is difficult, and dispensing medicine is harder. One must select good formulas and fine herbs. Published treatments must distinguish between cold and heat, practiced sincerely and effectively, to achieve merit without弊端. For example, someone collapsing suddenly on the road under scorching sun, though not named Huoluan or Sha distension, suffers a more severe condition. Using generic Sha medicines often fails to save them. Death may result from bleeding from mouth and nose, indicating summer-heat pathogen directly entering the Pericardium Collateral. Only Zixue Powder (Purple Snow Powder)灌 (irrigated/administered) will be effective. However, this medicine is expensive and rare. Those with means who prepare it to help the world will surely receive good karma. Individuals with Yin deficiency and internal heat, or women after childbirth with blood loss, or during sexual activity, or in extreme heat, may suffer this even staying indoors. I have seen this frequently. See detailed accounts in the third chapter *Mengying*.

5. Be cautious in selecting a physician. A physician's use of medicine is like a general's use of troops. Generals paid by the state are rarely excellent. Physicians seeking livelihood are likely to be inferior. Yet, in a town of ten households, there must be someone loyal and trustworthy. The saying goes: "One who is a son must know medicine." Pay attention normally, knowing he has the art of saving lives, and is not a rumor-monger. Then, when ill, you can entrust your life to him. Knowing he has the talent of warfare, and is not a cowardly or money-loving person, you can entrust your land and people to him when attacked. Alas! It is difficult.

6. Be cautious in taking medicine. Selecting a physician is as hard as selecting a general. Once selected, he may have fame but no real learning, or be learned but not versatile, or versatile but lacking insight, or see clearly but... [Text fragment]. So how can one take his medicine? Observe his clinical practice: careful questioning, thorough thinking, precise differentiation, clear prescriptions, frank and reasonable speech, and dignified demeanor. Even if never met before, one can recognize a good physician at first sight. His medicine can be taken.

7. Prefer coolness. Huoluan and Sha distension, spreading as epidemics, are caused by the fermentation of hot and pathological qi. Therefore, rooms should not be crowded, doors and windows should not be closed, allowing air to vent. Bedding should not be thick; the degree is when the patient does not feel cold. Ignorant people force extra clothing and blankets, causing irritability and confusion, which is common. Those living upstairs must move beds to cool places. In severe cases, lie on mats placed on cool, dry mud ground, as heat dissipates into the soil. Seeing someone collapsed on the road, even without medicine, moving them to a shady spot is like giving a dose of Cooling Powder. Vomit and feces should be cleaned up immediately. Do not let odors affect the patient and others, especially when the doctor arrives. Otherwise, the smell is unbearable. How can one calm the mind to differentiate the syndrome?

8. Prefer tranquility. Patients with acute syndromes naturally fear for their lives. If bystanders show panic, the patient anticipates death, turning mild cases severe and killing severe ones with fright. Although people live to a hundred, none do not love life and fear death; this is human nature. Therefore, empathetic physicians, even facing critical conditions, must not speak of doom to hearing patients. Relatives must not whisper to increase fear. Women must not frown or cry, turning false alarms into reality.

9. Prefer universal love. In acute syndromes, life and death depend on breath. Without rapid rescue, the disease deepens. Rescue without detail may lead to relapse. Family members feel each other's pain and need not hesitate. The most bitter are the poor and elderly without support, traveling merchants, or those lodging on boats, with no relatives nearby. They rely on neighbors' kindness and landlords' righteousness to open their purses and exert effort to save this crisis... [Text fragment].

10. Protect pregnancy. If a pregnant woman in summer suddenly suffers abdominal pain, even near term, first hold her hand to check if fingertips are cold, and touch her forehead to check for fever. If not cold and not feverish, it is labor pain. Otherwise, it is Sha pathology. Most Sha medicines hinder pregnancy and should not be tried lightly. I usually treat it with Late Silkworm Sand (Can Sha) and Xue Geng (Snow Soup), achieving immediate effect. If complicated by cold, Zi Su (Perilla Leaf), Sharen (Amomum Fruit), Xiangfu (Cyperus Rhizome), and Juhong (Tangerine Peel) can be used. If suffering severe Huoluan, first apply well-bottom mud to the epigastrium and Dantian. Then, take five qian of dried, unbloomed tender lotus leaves, half that amount of clam powder, grind together, mix with fresh water and honey, take three qian orally, and apply the residue to the abdomen. This is called Zaotai San (Fetal-Covering Powder). If cold Huoluan, use Fulonggan (Dragon's Liver/Calcined House-hold Earth) ground to powder, mixed with water, applied to the navel square inch, reapplying when dry. Medication must be extremely cautious; all items harmful to the fetus are forbidden. Huiyang Gao (Return-Yang Plaster) must not be applied.