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I often heard Mr. Yifangchuan say: "A scholar living in this world, if he cannot establish merit and benefit all things, is but a pest in heaven and earth." Thus I recall Fan Zhongyan saying: "When successful, be a good prime minister; when unsuccessful, be a good physician." Alas! Great men who do not meet their time might only emulate the style of Youxiongshi (Yu Fu, a legendary ancient healer)? Yet they have ambition but fail to achieve it. Not long after, my father suffered from a heat syndrome, with severe illness, seeking doctors everywhere. Some recommended: "So-and-so is a skilled practitioner, so-and-so has virtue, hurry to invite them." Others slandered: "So-and-so is a lowly craftsman, so-and-so lacks integrity," thus discarding them. Whenever proposals for tonification were made, everyone said they were profound, leading to the administration of herbs like Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). Whenever proposals for purgation were made, everyone agreed, leading to the administration of formulas containing Mirabilite (Mangxiao) and Rheum Palmatum Root and Rhizome (Dahuang). Whenever theories advocating hot-natured drugs were praised as novel, formulas containing Aconiti Lateralis Radix Preparata (Fuzi) and Cinnamomi Cortex (Guizhi) were used. Whenever arguments for cold-natured drugs were deemed reasonable, decoctions containing Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian) were advanced. Unable to distinguish fragrant from foul, right from wrong, [my father] ultimately died wrongly due to medication, leaving an eternal regret. This is the disaster of ignorance of medicine. Thus, I resolved to study medicine, reciting *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions), reading *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), exploring the essence of various schools. Investigating the functions of various drugs, thinking how to save those in the world and future generations suffering from physiological disabilities or severe illnesses, preserving their lives, to slightly atone for sins that even a hundred bodies could not redeem. Was it merely to rely on trivial medical skills to gain fame in one's village for a moment? Therefore, I did not fear labor. For thirty years, burning oil day and night, diligent and steadfast, I compiled two volumes, *Yi Jing* (Medical Mirror) and *Yi Yao* (Medical Essentials), hoping to revive the declining medical ethos. Due to poverty, I could not bear the cost of printing, leaving only unfulfilled ambitions. Privately, I reflect that today—

Medical errors prevail, and patients with paralysis or strangury suffer greatly. If no one rises to correct this, when will the error harm the common people cease? Our prefecture is renowned as a source of talent, where many understand classics, recognize current affairs, and stand out. Some remain silent to cultivate themselves; others fear public criticism and stay silent. Alas! Who am I to dare judge the gains and losses of the medical path?

I pondered, and pondered again. If I also clamped my mouth and tied my tongue, it would suit my self-interest, but with a heart to save the people from premature death, I could not do so. I wrote this treatise, eager to clarify the Dao of medicine, out of necessity. In the past, Jia Yi wrote the *Policy on Pacifying the State*, discussing the times, evoking tears and sighs. I believe there are three aspects of current medical弊端 worthy of weeping bitterly, and two worthy of long sighs. Let me explain. For instance, winter cold damage (Shanghan), people revere Zhang Zhongjing, which is correct. But one must know Zhongjing lived in the Han Dynasty, when customs were pure, residing in the north where the land was high and cold. Thus, his exterior-releasing agents were heavy, acrid-hot formulas. In the south, cold is less severe, distance from antiquity increases, and vital qi thins. Exterior-releasing methods should use light, acrid-warm agents. For spring warmth and summer heat exterior release, acrid-cool or acrid-cold substances are appropriate. His principles can be modeled, but his drugs should not be rigidly applied. This does not violate Zhongjing but adapts to time and place. Xu Xueshi said: "I read Zhongjing's books, follow his methods, but never exclusively use his formulas." Zhang Jingyue said: "In treating cold damage, I rarely use standard formulas from the school; I apply them freely and they work. This is truly learning from Zhongjing." Yu Jiayan discussed the acrid-hot formulas in Zhongjing's *Treatise on Cold Damage*, noting they were mostly used reluctantly to restore yang after erroneous sweating, vomiting, or purging. People failed to examine closely, treating them as fixed rules, copying them, even using them recklessly in spring, summer, and autumn for exterior syndromes. Patients often claim wind-cold or cold-dampness. Seeing warm-hot drugs used, they feel satisfied. Even in midsummer, they close windows and curtains, wearing clothes under blankets. This causes patient restlessness, desire for cold water, desire to jump into wells. Instead of recognizing heat, it is called "yin restlessness," prohibiting cold-cool drugs, leading to wrongful death. They remain unrepentant, obstructing other doctors from using cold drugs. How foolish! Oh! Warm-heat and plague diseases are all heat syndromes; there is no cold damage, so where does yin come from? Even transmitted cold damage is a heat disease. Though entering the Three Yin levels, named yin divisions, it belongs to heat pathogens, requiring clearing and resolving as primary. If downward symptoms exist, purge them. This is vastly different from deep winter cold pathogens directly striking the Shaoyin Kidney meridian causing yin syndromes, requiring Dried Ginger (Ganjiang), Prepared Aconite Root (Fuzi), and Cinnamon Bark (Guizhi). Yu Jiayan clearly stated that yang syndromes suddenly turning into yin cold limbs occur once in ten thousand, never in history. Wu Youke mentioned rare yin syndromes in the world. If one mistakenly follows Jie'an's theory that cold extending past elbows and knees with weak pulse indicates yin, and administers Fuzi and Guizhi, death is certain upon swallowing. I often treat exterior syndromes, saving many, even claiming "Bai Hu Tang brings back life," advising earnestly. Yet people do not investigate, instead mocking my skill with cold-cool drugs. Upon seeing cold limbs, hiccups, vomiting roundworms, muscle twitching, they still suspect yin syndromes, administering hot agents. Thousand cures, thousand deaths; ten thousand cures, ten thousand deaths. Occasionally, one or two survive due to thick viscera resisting toxicity, innate yin-cold constitution, or accidental match with cold drugs. These are hailed as miraculous resurrection formulas, divine pills of Fuzi and Guizhi. This is the common malpractice in treating exterior syndromes today, worthy of bitter weeping—the first point.

Regarding miscellaneous diseases, deficiency consumptive diseases (Xu Lao) are all yin deficiency. The main principle is strengthening water and clearing metal, cultivating spleen and strengthening middle, primarily using sweet-cold agents in large doses over long periods for benefit. Previously, formularies mixed qi, blood, yin, and yang in discussion, leading later generations to lack direction. Treating such cases, seeing cold aversion and cold feet, practitioners use Ba Wei Wan (Eight-Ingredient Pill) to guide fire back to its source. This is adding firewood to save a fire, worsening upper jiao heat. For diarrhea, Lizhong Wan (Regulate the Middle Pill)'s drying-hot nature further aids yang and robs yin. Ascending and lifting agents in tonifying the middle cause yin fire to rebel upward. For chills, fever, nasal congestion, head distension and mild pain, acrid-warm ascending-dispersing agents are used to release the exterior. For women with bone-steaming fever, blood dryness, and amenorrhea, acrid-hot blood-moving agents are used to unblock menstruation. All accelerate death. Regarding swelling, modern practitioners do not examine if caused by food stagnation or phlegm, nor what to dissolve; if caused by water or blood stasis, nor what to move; if qi stagnation condenses, nor what to open; if spleen/kidney weak, nor what to tonify. One claims following Xue's method, another Zhao's method. Regardless of cold/heat or deficiency/excess, they indiscriminately administer Shen Qi Wan (Kidney Qi Pill) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Victims are numerous. Regarding Ge Syndrome (diaphragmatic obstruction), excess patterns are treatable; blood deficiency, fluid depletion, and flaming fire are hard to reverse. Yet now, qi-tonifying and spleen-strengthening, aromatic-drying and depression-resolving agents are administered. Seeking to prolong time is impossible. Other examples: Yin deficiency with phlegm-fire using Sheng Jiang (Fresh Ginger), Ban Xia (Pinellia), Tian Nan Xing (Arisaema), Bai Zhu (Atractylodes); Stomach heat vomiting using Sheng Jiang, Ban Xia, Huo Xiang (Pogostemon), Dou Kou (Black Cardamom); Stroke generally treated with Liu Jun Zi Tang (Six-Gentlemen Decoction) or Shen Fu Tang (Ginseng and Aconite Decoction); Dysentery wrongly treated with Ba Wei Wan or Lizhong Wan; Heatstroke with cold sweat and deficient pulse mistakenly treated with warm-hot drugs; Postpartum blood stasis not fully expelled, tonics hastily administered. Commonly, after taking medicine, mild cases worsen, severe cases die. These are the myriad common malpractices in treating miscellaneous diseases today, worthy of bitter weeping—the second point.

For the elderly, heavenly truth gradually ceases, leaving only isolated yang. Like old trees with little nourishing gum, now bodies with dried blood and exhausted essence. Not focusing on tonifying yin, but using purely yang Guizhi and Fuzi, robbing residual yin. This is like adding fierce fire to dead wood. Is it disaster or blessing? There is a reason. Zhao Xianke compared the body to a moving lantern lamp: strong fire moves fast, weak fire moves slow, extinguished fire stops. Jingyue also said true yang is the great treasure of the body. Jiayan in the Cold Strike chapter said: "If healers use precious yin and despise yang as treatment, therapy will deviate." He noted elderly relatives often took Shen Fu Tang successfully, leading nationwide trust in kidney-deficiency fire-tonifying drugs. Did they not consider fire's strength depends on oil quantity? The Classic says: "The five zang organs store essence; do not injure them. Injury leads to loss of control and yin deficiency. Yin deficiency leads to qi deficiency; qi deficiency leads to death. Is this not meaning 'oil exhausted, fire extinguished'?" Did they not examine Jingyue's later words: "Only in middle age did I comprehend tonifying yin, achieving results too numerous to recount"? And "Harmonious yang fire generates life; excessive fierce fire harms life"? Jiayan also said in Cold Strike: "Acrid-hot drugs are used reluctantly initially; once yang is settled, tonify yin. Do not take excessively, lest other disorders arise." And "Adding oil to the lamp makes it brighter." Observing these two masters, their views are clear. Thus, treating the elderly requires adding essence and filling marrow, using sentient substances (blood/meat-based tonics), vigorously tonifying yin. Modern people do not grasp this, and the elderly misuse Guizhi and Fuzi, aiding yang to indulge desires, causing internal blazing fire, scorching fluids, shortening lifespan. This is the common malpractice in treating the elderly today, worthy of bitter weeping—the third point.

In antiquity, Emperor Xuanyuan practiced medicine, Qibo assisted, Zhi Chuan and Dong Bin practiced as immortals, Hong Jing and Si Miao practiced as recluse gentlemen, Zhongjing and Meng Xian practiced as scholars. Ancients said: "One who understands Heaven, Earth, and Man is a Grand Physician; one who reads and exhausts principles is a Confucian Physician." Medicine holds the power of life and death, responsibility is heavy and difficult. Even scholars with clear literary skills lament the boundless depth of *Ling Su* and the obscurity of *Jin Gui*. Now, crude literacy, unclear sentence interpretation, picking up a few formulas, relying on eloquence, claiming divine revelation, pretending secret transmission, yet proudly calling oneself a doctor! Ask their pulse diagnosis: Can they truly distinguish the images of the twenty-eight pulses (floating, sinking, slow, rapid, large, small, slippery, rough) and their indications and combined pulses? Ask their pharmacology: Do they truly understand the ascending/descending, cold/hot/warm/neutral/toxic properties of each herb, their mutual indications, and contraindications? Ask their formula construction: Can they distinguish the Seven Forms (odd, even, large, small, slow, urgent, compound) and Ten Categories (dispersing, penetrating, tonifying, purging, heavy, light, slippery, rough, drying, moistening), and the roles of Sovereign, Minister, Assistant, and Courier? Ask their treatment: Can they differentiate exterior/interior, cold/heat, deficiency/excess, pathogen/righteousness (the Eight Essentials), and suspicious syndromes like extreme deficiency resembling excess, extreme excess resembling deficiency, extreme yin resembling yang, extreme yang resembling yin? Such people, unable to penetrate one principle or investigate one symptom, yet arrogantly call themselves doctors. This is worthy of long sighing—the first malpractice.

In the past, Di Lianggong used medicine to rescue crises before passing exams; Lu Xuangong collected ancient formulas to benefit the world after resigning. Former dynasties' Wang Jiezhai, Wang Yutai, Nie Liuwu, all passed imperial examinations, held high office, yet studied medicine, compiling *Ming Yi Za Zhu*, *Zheng Zhi Zhun Sheng*, writing *Huo Dong Xin Fa*, benefiting contemporaries and posterity. Medicine is indeed the economic talent of a gentleman; its way must be valued, its character established. In social interactions, one finds it hard to treat subordinates and superiors alike. The rich are often willful; the noble often autocratic. Compliance is right, opposition is wrong, natural law. But diseases have deficiency/excess, so formulas establish tonification/purgation. Deficiency must not be forcibly purged; excess must not be forcibly tonified. Follow me, you recover; ignore me, danger ensues. If they persist in their views, ignoring advice, or are arrogant and rude, then silence your skills, hide your intent, and leave calmly. This is the wise scholar. If a wealthy family invites many doctors, holding conflicting views, follow the correct ones, politely refute the incorrect ones. If outsiders cannot influence insiders, few cannot overcome many, and the Dao cannot be practiced, better to be a "good先生" (yes-man) and withdraw quietly, rather than argue and invite accusations of jealousy and narrow-mindedness. If the Dao is not clarified, it is my shame. If the Dao is clarified but not used, it is the doctor's bad character and the patient's misfortune. Where is my shame? Today's doctors are the opposite. Some flatter and please, some beg door-to-door, behaving like market vendors. Not worth discussing. But even well-dressed gentlemen tread this path. Though driven by livelihood needs, what is the meaning of a scholar being content with poverty and devoted to the Dao? How can they endure this! Checking Song Dynasty records, a Daoist priest from Maoshan excelled in medicine but did not sell easily. A scholar dressed as a servant to petition him, willing to serve as a disciple, only then was he invited. Their respect for the Dao and establishment of character reached such heights. Why have medical practitioners not heard of this before? Worse, some engage in bizarre, indescribable acts, bringing shame to scholars and contempt to fools. Medical ethics are swept away. This is worthy of long sighing—the second malpractice.

As for gentry families, they often avoid observation and inquiry, lacking reference from speech and appearance. They dislike detailed questioning, avoiding verbose mediocrity. Not knowing that Observation, Auscultation/Olfaction, Inquiry, and Palpation (Wang, Wen, Wen, Qie) were never neglected by ancient sages, now abandoning three for one. Moreover, failing to understand even one, expecting not to miss the disease condition is impossible. Acute patients with chronic conditions often change doctors and mix medications, seeking speed but hastening harm. Severe patients given light formulas are like a cartload of firewood on a cup of water; indecision brings great disaster. Laughable are those with yin deficiency coughing, told that taking Shu Di Huang (Rehmannia), Mai Dong (Ophiopogon), Bei Mu (Fritillaria), Pi Pa Ye (Loquat Leaf) will cause consumptive disease. Syndromes of extreme excess and heat are told to use Ren Shen (Ginseng), Huang Qi (Astragalus), Dang Gui (Angelica), Bai Zhu (Atractylodes), Fu Zi (Aconite), Gui Zhi (Cinnamon) to prevent collapse. Visiting patients intimately, showing off insight, speaking of deficiency as excess, pointing at heat as cold, confusing hearts, leaving people lost. Divination fails, leading to harm and death. Hearing doctors are not invited, or insults are exchanged. If truly excellent, the person must be upright; they cannot be forced. If mediocre, skills are poor, why force them? Strange also is that patients love to discuss fees and guarantee cures, thinking themselves frugal and winning. Doctors, not foreseeing unpredictable changes, only seek bribes, hoping for success, often costing wealth and life. Greedy doctors face humiliation or regret. Also, destroying signs and insulting doctors often comes from wealthy homes. When wealthy patients are critically ill, medicines become bland, wanting to avoid blame and disaster. Who wants to nurture disease and harm the body? If warming/tonifying is indicated, perhaps death is avoided; if cooling/purging is indicated, survival is unlikely. Such malpractices are countless. Today, I bare my heart, exhaust my wisdom, point out errors, state habits. I hope benevolent medical practitioners and health-preserving gentlemen, not tiring of trivial listening, will review this, forgive my arrogance, appreciate my sincerity, adopt humble advice, advocate together, inherit the true transmission of sage ways, reverse contemporary deviations. Seeing from near to far, from present to future, their virtue and merit will be immeasurable! Will not my wish be satisfied? Yet I have regret. If my late father had spirit, he would surely rise from the nine springs to reproach me: "Why did you not understand the meaning of Qi and Huang, why did you not study the year of my death, letting me die at fifty from庸医 (mediocre doctors') hot drugs?" Alas! Painful! Fearful! Thus I sigh and weep, saying: Any child must know medicine.

Grand Historian Xu Daoji said: "Because my son suffered from flaccidity syndrome, I invited Brother Song to my home, allowing me to see his writings in poetry, prose, and medicine. Truly a triple excellence. Reading this treatise three times, I know his benevolent heart, diligent study, upright character, and filial piety. He is truly a gentleman."

Grand Historian Qiao Xuezhai said: "Brother Song is both friend and relative to me, our bond is deep. Every time passing Wumen, I visit his home. I also deeply love Qi-Huang books, asking profound questions. Brother Song answers precisely, forgetting sleep and food. He likes self-contentment, indifferent to power and profit. After taking leave from the Imperial Hospital, he closed his curtains to read and write abundantly. This treatise openly discusses common treatment malpractices, forcefully reversing customary turbulence. Truly words of medicine saving the world. I admire it greatly. I add: For carbuncles and sores, they result from Ying qi excess and rebellious qi knotting. Treatment should cool blood, invigorate blood, dissipate knots, and resolve toxins, which is the usual method. Now surgeons opening wounds either blame wind-cold or claim yin syndrome, frequently using Guizhi, Ginger, and Fuzi, positioning themselves as grand masters. Many suffer, unaware. Worse, depraved villains intentionally cause major disasters, extorting heavy rewards. When condition becomes critical and incurable, they attribute it to fate, creating sin without repentance. If they reflect due to my words and改正 (correct) past mistakes, they might avoid regret before King Yanluo."

Xiaolian Cao Meiying said: "My nephew Songyuan studied in the academy in childhood, failed multiple exams, bitterly studying for civil service. His body was frail, already aspiring to learn medicine. Soon after, my elder sister's husband suffered a seasonal syndrome. Famous doctors were invited. Five or six proposed warm-tonifying treatments. Mistakenly following them, he was harmed by Renshen and Fuzi, deeply regretting. Thus he vowed to Qi-Huang, meditated for nine years, grasping the essence. Every formula he prescribed worked miraculously. This treatise has no paragraph not thoroughly explained, no sentence not precise, all stemming from long-term learning and deep experience."

Vice Prefect Shu Dianxu said: "My late father, Duke Wenkang, was famous for his statesmanship in the universe, still worshipped today. My nephew Songyuan benefits the people with medical books, also leaving immortal fame. Ancients said: 'If not a good prime minister, be a good physician.' Good prime ministers harmonize yin and yang, pacify the world. Good physicians harmonize yin and yang, restore creation. Viewing this treatise, it not only restores creation but aims to transform customs."