先大父秀山公云。老医断病如老吏断狱。善断病者必善治病。前哲陆九芝云。案者断也
。方者法也。惟能断而有法。乃可称方案。旨哉言乎。夫吾国医学之发明。其源古矣。周秦
时代。医师诊病之法。大率注重于气色脉候。听声写形。详见素灵难经。后汉张仲景崛兴。
于望鼻色目色外。更注意语声呼吸以参合脉候症状。六朝至唐。如褚彦道孙思邈辈。则又重
在明症候。询嗜好。察致疾之由来。辨病脏之虚实。相其老壮。酌其浅深。归本于博涉多诊
。屡用三端。此周秦以迄晋唐。诊断术之大略也。厥后金元四大家。暨明之韩天爵陶节庵等
。名医 起。则又兼审风土时令。以决病之阴阳燥湿。且兼施腹诊之法。佐望闻问切四诊之
不逮。是又视周秦汉晋之时加详矣。清初江右喻嘉言出。乃主张先议病。后议药。取古人诊
病之法而融会贯通之。凡风土时令。体质肥瘦。年龄长幼。病之新久。以及情志苦乐。脉症
现状。莫不辨析毫芒。以审定其阴阳虚实。外感内伤。上下表里。何脏何腑。何因何症。然
后采用古人七方中何方。十剂中何剂。规则谨严。有条不紊。盖至是而吾国医师诊病。乃有
一定之规则。而颟顸卤莽妄投药饵之弊。赖以廓清。诚万世不祧之良法也。今日东西医家。
号称为实质的学派。解剖的智识。而窃观其诊断一方。多凭官能的诊断。及尿之外观沉渣。
与粪便咯痰。舌苔外貌。眼势体温体量。及器械上诊察之所得。其间泰半与吾国古法相通。
然后叹中医诊断术之精妙。殊未逊于西人。虽器械之用未备。而脉诊望诊问诊腹诊之法既
精。则亦足以赅括之矣。况辨虚实。分气血。论攻补。昔贤发明。尤多独到之处，足补西医
之缺。而惜乎解人难索也。袁君桂生。吴中之名医也。邃于医学。立论平允。学术精湛。而
感慨淋漓。保存国粹之盛心。跃然纸上。可谓先得我心者矣。顷邮示其所着丛桂草堂医草。
属为之序。浏览一通。见其辨症剀切。用方工稳。每述一病。原原本本。剖析无遗。洵足开
学人之智能。昔周学海氏有云。宋后医书。惟案最好看。不似注释古书之多穿凿也。每部医
案中。必有一生最得力处。潜心研究。最能吸取众家之所长。余按医案一门。当推喻氏寓意
草一书为冠。盖其案虽仅六十二条。而反复推论。务阐明其审症用药之所以然。较之诸家医
案。但泛言某病用某药而愈者。甚相悬殊。前清四库全书提要赞其极有发明。足资开悟。近
代名医如张石顽叶香严顾松园徐灵胎尤在泾俞东扶吴鞠通王孟英林 琴等。皆折衷其诊
病之法。默收治疗之功。各发表于医案之内。今袁君此书。即仿喻氏体例而先议病。后议药。悉
遵喻氏法程。且其中有学宋人及金元诸家者。有学明人及清之张叶徐魏吴王诸家者。亦有运
用经方及自出新意者。洵能萃众家之长而神明变化者矣。宜乎批却导 。而恢恢乎游刃有余
也。嗟乎。今之医风 然。颓敝极矣。出版之书。除一二译本而外。几如凤毛麟角。而入主
出奴。于今为烈。滔滔天下。伊芳于胡底矣。安得全国医家。皆如君者起而振此坠绪也。序君
之书。盖不禁百感横集已。
\x乙卯六月廿八日越医何肖严廉臣书于绍城卧龙山麓之宣化坊
我的祖父秀山公曾说：老练的医生判断病情，就像老练的官吏审理案件一样。善于诊断疾病的医生，必然也善于治疗疾病。前代哲人陆九芝说：“案”就是断决的意思，“方”就是法则的意思。只有能够做出准确判断并有法度可循，才可以称为“方案”。这话真是意义深远啊。
我国的医学发明，其源头非常古老。在周秦时代，医师诊断疾病的方法，大抵注重于观察气色和脉象候诊，通过听声音、察形态来了解病情，这些内容在《素问》《灵枢》《难经》中有详细记载。到了后汉，张仲景崛起，他在观察鼻色、目色的基础上，更加注意通过语声和呼吸来参合脉象与症状。从六朝到唐代，如褚彦道、孙思邈等人，则又重在明确症候，询问患者的嗜好，考察致病的原因，辨别病变脏腑的虚实，观察患者的年老体壮情况，斟酌病情的深浅，最终归结于广泛涉猎并多次诊治的经验，反复运用“三端”（指望、闻、问、切或类似的综合诊断手段）。这是从周秦直到晋唐时期，诊断术的大致概况。
此后，金元四大家以及明代的韩天爵、陶节庵等名医相继兴起，他们又兼审地理风土和时令气候，以决定疾病的阴阳燥湿属性，并且兼施腹诊的方法，弥补望、闻、问、切四诊的不足。这比起周秦汉晋时期来说，又更加详尽了。
清初，江西人喻嘉言出现，他主张先讨论病情，再讨论用药，融会贯通古人的诊断方法。凡是风土时令、体质肥瘦、年龄长幼、疾病的新久，以及情志的苦乐、脉象与症状的现状，无不辨析得极其细微，从而审定其阴阳虚实、外感内伤、上下表里、何脏何腑、何因何症。然后才采用古人“七方”中的哪一方，“十剂”中的哪一种。规则严谨，有条不紊。大概到了这个时候，我国医师的诊断疾病才有了固定的规则，而以前那种糊涂鲁莽、乱投药饵的弊端，才得以清除。这确实是万世不可废除的好方法。
当今东西方的医家，号称是实质学派，拥有解剖学的知识。但我私下观察他们的诊断方法，大多凭借感官诊断，以及尿液的外观沉渣、粪便、咯痰、舌苔外貌、眼神、体温体量，还有器械检查所得的结果。其中一半以上与我们中国古法相通。由此我感叹中医诊断术的精妙，丝毫不逊色于西方人。虽然器械使用尚不完善，但既然脉诊、望诊、问诊、腹诊的方法已经精妙，就足以概括全面了。况且辨别虚实、区分气血、论述攻补，这些都是先贤发明的，尤其多有独到之处，足以弥补西医的缺失。可惜理解这种深意的人很难找到。
袁桂生君，是吴地（苏州一带）的名医，精通医学，立论平允，学术精湛，且感慨淋漓，保存国粹的热心跃然纸上，可以说是先得我心的人啊。近日他邮寄给我他所著的《丛桂草堂医草》，嘱咐我为之作序。浏览一遍，见其辨证恳切，用方工稳，每叙述一种疾病，原原本本，剖析无遗，确实足以开启学者的智慧。
过去周学海氏曾说：宋代之后的医书，只有医案最好看，不像注释古书那样多有穿凿附会。每一部医案中，必定包含作者一生最得力之处，潜心研究，最能吸取众家之长。我认为医案这一门类，应当推举喻嘉言的《寓意草》为第一。因为他的医案虽然仅有六十二条，但反复推论，务必阐明其审症用药之所以然，与那些诸家医案中只是泛泛而言某病用某药而痊愈的情况，相差甚远。清代《四库全书提要》称赞它极有发明，足以启发悟性。近代名医如张石顽、叶香严、顾松园、徐灵胎、尤在泾、俞东扶、吴鞠通、王孟英、林琴等人，都折衷采纳其诊断方法，默默收效于治疗之功，各自发表在自己的医案之中。
如今袁君的这本书，就是仿照喻氏的体例，先议病，后议药，完全遵循喻氏的法度。而且其中有学习宋人及金元诸家的地方，有学习明人及清代张、叶、徐、魏、吴、王诸家的地方，也有运用经方及自出新意的地方，确实能荟萃众家之长而神明变化。因此处理起来像批开牛骨引导刀刃一样顺利，宽宽绰绰游刃有余。
唉！现在的医风颓废至极。出版的书籍，除了一两个译本之外，几乎像凤毛麟角一样稀少。而且门户之见，党同伐异，现在尤为严重。滔滔天下，究竟在哪里呢？怎能期望全国医家都能像袁君这样的人起来振兴这坠落的传统呢？为袁君的书作序，不禁让我百感交集。
乙卯年六月二十八日，越地医生何肖严廉臣，写于绍兴卧龙山麓宣化坊。
My grandfather, Mr. Xiushan, once said: An experienced physician judging a disease is like an experienced magistrate adjudicating a case. A physician who is good at diagnosing diseases must also be good at treating them. The former philosopher Lu Jiuzhi stated: "An" (Case Record) means judgment; "Fang" (Prescription) means method. Only when one can make judgments and follow methods can it be called a "Case Record." These words are truly profound.
The invention of medicine in our country has ancient origins. During the Zhou and Qin dynasties, the methods used by physicians to diagnose diseases largely focused on observing complexion and pulse conditions, listening to sounds, and examining forms, as detailed in the *Suwen* (Basic Questions), *Lingshu* (Spiritual Pivot), and *Nanjing* (Classic of Difficult Issues). In the Later Han dynasty, Zhang Zhongjing rose to prominence. Beyond observing nasal and ocular colors, he paid more attention to voice and respiration to correlate with pulse conditions and symptoms. From the Six Dynasties to the Tang dynasty, figures such as Chu Yandao and Sun Simiao emphasized clarifying symptoms, inquiring about preferences, investigating the origin of diseases, distinguishing the deficiency or excess of affected organs, assessing age and physical strength, and weighing the depth of the condition, ultimately relying on extensive experience and frequent diagnoses, repeatedly applying diagnostic principles. This was the general overview of diagnostic techniques from the Zhou-Qin period through the Jin-Tang eras.
Subsequently, the Four Great Masters of the Jin-Yuan dynasties and Ming dynasty famous doctors such as Han Tianjue and Tao Jie'an emerged. They additionally considered local climate and seasonal changes to determine the yin-yang and dryness-moisture nature of diseases, and employed abdominal palpation to supplement the limitations of inspection, auscultation/olfaction, inquiry, and palpation (Wang, Wen, Wen, Qie). This was even more detailed than during the Zhou, Qin, Han, and Jin periods.
In the early Qing dynasty, Yu Jiayan from Jiangxi appeared. He advocated discussing the disease first and then the medication, integrating and mastering ancient diagnostic methods. Factors such as local climate, body constitution (fat or thin), age, duration of illness, emotional states (suffering or joy), current pulse and symptom presentations were all analyzed with extreme precision to determine yin-yang deficiency/excess, external contraction/internal injury, upper/lower, exterior/interior, specific organs involved, causes, and manifestations. Only then would he select which formula from the ancient "Seven Forms" (Qi Fang) or which category from the "Ten Categories" (Shi Ji) to use. The rules were rigorous and orderly. It was only then that Chinese physicians had fixed rules for diagnosing diseases, clearing away the弊 (malpractice) of haphazard and reckless prescription. This is indeed an excellent method that should never be abandoned.
Today, Eastern and Western physicians claim to belong to the substantive school, possessing anatomical knowledge. However, upon private observation, their diagnostic methods rely heavily on sensory diagnosis, as well as the appearance and sediment of urine, feces, sputum, tongue coating, eye expression, body temperature, volume, and findings from instrumental examinations. About half of these correspond with our ancient Chinese methods. Thus, I sigh at the sophistication of Traditional Chinese Medicine (TCM) diagnostics, which is by no means inferior to that of the West. Although instrumental usage is not yet complete, the precision of pulse diagnosis, inspection, inquiry, and abdominal palpation is sufficient to encompass the whole. Moreover, the differentiation of deficiency and excess, separation of qi and blood, and discussion of attacking and tonifying methods were pioneered by past sages, offering unique insights that can supplement Western medicine. Unfortunately, those who truly understand this are hard to find.
Mr. Yuan Guisheng is a famous physician in Wu (Suzhou area). He is profound in medical science, holds balanced views, possesses exquisite academic expertise, and expresses deep emotion, with his fervent desire to preserve national essence evident on paper. He can be said to have understood my thoughts beforehand. Recently, he mailed me his work, *Conggui Caotang Yicao* (Medical Cases of Conggui Cottage), and requested a preface. After reading it, I found his syndrome differentiation earnest and precise, and his prescriptions stable and skillful. In every case description, he presents the facts comprehensively and analyzes them thoroughly, truly capable of enlightening scholars.
Zhou Xuehai once said: Among medical books after the Song dynasty, only case records are best to read, unlike commentaries on ancient texts which often involve forced interpretations. Each set of medical cases must contain the author's most effective experiences, studied deeply, absorbing the strengths of various schools. I believe that among the genre of medical cases, Yu Jiayan's *Yuyi Cao* (Drafts of Intended Meaning) ranks first. Although his cases number only sixty-two, he repeatedly deduces and strives to clarify the rationale behind syndrome differentiation and medication, which differs significantly from other authors' cases that merely state vaguely that a certain disease was cured with a certain drug. The *Siku Quanshu Tiyao* (Abstracts of the Complete Library of Four Treasuries) praises it for its great innovations and ability to inspire enlightenment. Modern famous physicians such as Zhang Shiwang, Ye Xianyan, Gu Songyuan, Xu Lingtai, You Zaijing, Yu Dongfu, Wu Jutong, Wang Mengying, and Lin Qin all adopted his diagnostic methods as a compromise, silently benefiting from his therapeutic efficacy, and published their own cases.
This book by Mr. Yuan today imitates Yu's format: discussing the disease first, then the medication, strictly following Yu's standards. It includes learning from Song and Jin-Yuan masters, from Ming and Qing masters (Zhang, Ye, Xu, Wei, Wu, Wang), as well as the application of classical formulas and original ideas. It truly gathers the strengths of various schools and applies them with spiritual flexibility. Hence, handling it is like guiding a blade through joints—effortless and smooth.
Alas! The current medical ethos is decadent. Published books, except for a few translations, are as rare as phoenix feathers and unicorn horns. Sectarianism and mutual hostility are now rampant. Where is the world heading? How can we hope for national physicians to rise like Mr. Yuan to revive this declining tradition? Writing this preface for Mr. Yuan's book, I cannot help but feel a surge of mixed emotions.
On the 28th day of the sixth month of the Yimao year, He Xiaoyan Lianchen, a physician from Yue, wrote at Xuanhua Fang, at the foot of Wolong Mountain in Shaoxing.