汉郭玉曰∶“贵者处尊高以临臣，臣怀怖慑以承之，其为疗也，有四难焉。自用意而不任臣
，一难也；将身不谨，二难也；骨节不疆不能药，三难也；好逸恶劳，四难也。夫玉为一代
良工，而犹若此，矧在中医，使临以威严，必畏栗失措，而延医有误矣。《薛立斋医案》云
∶一稳婆止有一女，分娩时，巡街御史适行牌取视其室，分娩女因惊吓，未产而死。后见御
史以威颜分付，迨视产母，胎虽顺而顾偏在一边，以致难产，因畏其威，不敢施手，由是母
子俱不能救。即此推之，凡求医治病，断不可恃势分之尊也。
凡病不能自治，必求治于医者，而其要则有四焉。一曰择人必严，医者之品学不同，必取心
地诚谨，术业精能者，庶可奏功。一曰说症必详，脉理渊微，知之者鲜，惟问可究病情，乃
医之自以为是者，往往厌人琐语，而病家亦不能详述，此大误也，故凡求医延医，必细述病
源，勿惮其烦。一曰察药必慎，药之伪者不必论，即寻常品味，肆中人粗心，往往以他物搀
溷，必亲自查看，方免舛误，至炮煎诸法，亦宜精审，服之斯可获效。一曰录方必勤心，俗
于医者所定之方，服药既讫，随手弃掷，余谓宜汇录一册，以备检阅，此不过举手之劳耳，
有心人见之，则上工之治验，固可采以示法，中工之方案，亦可因以征学识之浅深，品诣之高下，而定其取舍矣。
《钱塘县志·方技传》∶沈好问精小儿医，尤善治痘，江鲁陶子一岁，痘止三颗，见额上、
耳后、唇傍，好问曰∶儿痘部位心肾脾三经逆传，土克水，水克火，宜攻不宜补，攻则毒散
，补则脏腑相戕。治至十四日，痘明润将成矣，好问曰∶以石膏治之，恐胃土伤肾水。俗医
怜儿小，谬投以参，好问见之，惊曰∶服参耶？不能过二十一日矣。儿卒死。夫治痘已有成
效，竟为庸医所误，由于恒情皆畏攻而喜补也，此亦可为任医不专之戒。
赠医诗鲜有佳者；近阅临川李小湖回卿（联 ）《好云楼初集》中，有赠医士费晋卿明经诗，
语殊警惕。咸丰中，回卿督学江苏，知江苏有二名医，一为阳湖吴仲山《斐融》，居印墅，
一为武进费晋卿伯雄，居孟河城，遂并访之。吴以回卿未有子，投补剂为嗣育计。费谓回卿
肝阳过旺，心肾两亏，投以养心平肝之剂。回卿主费说，因赠以诗云∶儒林与文苑，千秋照
简编，岂无艺术传，别表冠世贤。华佗许颖宗，妇孺惊若仙，本草三千味，《难经》八十篇
。格致即圣学，名与精神传，况用拯危殆，能夺造化权。活人较良相，未知谁后先，莘渭不
巷遇，只手难回天。孟城一匹夫，所值蒙生全，日济什百人，功德几万千。大哉农轩业，托
汉代郭玉说：“地位尊贵的人居高临下对待臣子，臣子怀着恐惧敬畏之心来侍奉他，在治疗时就有四种困难。一是病人自以为是而不信任医生，这是第一难；二是病人自身起居不谨慎，这是第二难；三是病人骨节不强健、不能配合服药，这是第三难；四是病人贪图安逸、厌恶劳动，这是第四难。郭玉是一代名医，尚且如此，何况是中医呢？如果让医生面对威严的权势者，必定会畏惧战栗、手足无措，从而导致就医误事。《薛立斋医案》记载：一位稳婆只有一个女儿，分娩时，巡街御史恰好传牌取视其居室，产妇因此受惊吓，未生产便死亡。后来见到御史以威严的脸色吩咐，等到查看产母时，胎儿虽然位置顺但偏向一边，导致难产，因为畏惧御史的威严，不敢动手施治，结果母子都无法挽救。由此推断，凡是求医治病，绝对不可倚仗身份地位的尊贵。
凡是疾病无法自我治愈，必须向医生求治，其中关键有四点。第一是择人必须严格，医生的品德学问各不相同，必须选取心地诚实谨慎、医术精湛能干的人，才可以奏效。第二是陈述病情必须详细，脉理深奥微妙，了解的人很少，只有问诊才能探究病情，然而那些自以为是的医生，往往厌烦病人的琐碎言语，而病人家属也不能详细叙述，这是很大的错误，所以凡是求医延请医生，必须细致讲述病源，不要怕麻烦。第三是察药必须慎重，药材伪劣的不必说，即使是寻常药材，药店中人粗心大意，往往用其他物品掺杂混淆，必须亲自查看，才能避免差错，至于炮制煎煮的方法，也应当精细审慎，服用后才能获得疗效。第四是记录处方必须用心，世俗之人对医生开出的处方，服药结束后随手丢弃，我认为应该汇编成册，以备查阅，这不过是举手之劳，有心人看到它，那么上工的高明治疗验证，固然可以采纳作为法则，中工的方案，也可以借此考察学识的浅深、品行的优劣，从而决定取舍。
《钱塘县志·方技传》记载：沈好问精通儿科，尤其擅长治疗痘疹。江鲁陶的儿子一岁时，痘疮只出了三颗，出现在额头、耳后、嘴唇旁边。沈好问说：“小儿痘疮部位属于心、肾、脾三经逆传，土克水，水克火，应当攻邪而不宜补益，攻邪则毒气消散，补益则脏腑相互伤害。”治疗到第十四天，痘疮明亮润泽即将成熟时，沈好问说：“如果用石膏治疗，恐怕损伤胃土和肾水。”庸俗的医生怜悯孩子小，错误地投用参类补药。沈好问看见后，惊恐地说：“服用了人参吗？活不过二十一天了。”孩子最终死亡。治疗痘疹已有成效，竟然被庸医误事，这是因为常情都畏惧攻邪而喜欢补益，这也足以作为任用医生不专一的警戒。
赠给医生的诗很少有佳作；最近阅读临川李小湖回卿（联）的《好云楼初集》，其中有赠给医士费晋卿明经的诗，话语特别令人警惕。咸丰年间，回卿担任江苏学政，得知江苏有两位名医，一位是阳湖吴仲山（斐融），居住在印墅；一位是武进费晋卿（伯雄），居住在孟河城，于是同时拜访了他们。吴仲山因为回卿没有儿子，投用补剂为他谋划生育后代。费晋卿认为回卿肝阳过旺，心肾两亏，投用养心平肝的药剂。回卿采纳费晋卿的说法，因此赠诗说：“儒林与文苑，千秋照简编，岂无艺术传，别表冠世贤。华佗许颖宗，妇孺惊若仙，本草三千味，《难经》八十篇。格致即圣学，名与精神传，况用拯危殆，能夺造化权。活人较良相，未知谁后先，莘渭不巷遇，只手难回天。孟城一匹夫，所值蒙生全，日济什百人，功德几万千。大哉农轩业，托”
Guo Yu of the Han Dynasty said: "When a person of high status treats a subject from a position of superiority, and the subject serves with fear and reverence, there are four difficulties in treatment. The first is when the patient is self-willed and does not trust the physician; the second is when the patient's own conduct is not careful; the third is when the patient's joints are not strong and cannot cooperate with medication; the fourth is when the patient loves ease and hates labor. Guo Yu was a renowned craftsman of his generation, yet he faced such difficulties, let alone in traditional Chinese medicine (TCM). If a physician faces someone with authority and majesty, they will surely be terrified and lose their composure, leading to errors in medical practice. The *Medical Cases of Xue Lijia* records: A midwife had only one daughter who died during childbirth without delivering due to fright caused by a patrol censor who happened to order an inspection of her room. Later, upon seeing the censor's stern demeanor, and when examining the mother, although the fetus was in a normal position but tilted to one side causing difficult labor, the physician dared not intervene due to fear of the censor's authority, resulting in the death of both mother and child. From this, it can be inferred that in seeking medical treatment for illness, one must absolutely not rely on the prestige of one's social status.
Whenever a disease cannot heal itself, one must seek treatment from a physician, and the key points are fourfold. First, selection of the physician must be strict; since physicians vary in character and learning, one must choose those who are sincere, cautious, and proficient in their profession to ensure success. Second, the description of symptoms must be detailed; pulse diagnosis is profound and subtle, understood by few, so inquiry is necessary to ascertain the condition. However, physicians who are self-righteous often tire of trivial details, while patients fail to describe thoroughly, which is a major error. Therefore, when seeking a doctor, one must detail the origin of the illness without fearing tediousness. Third, examination of medicines must be cautious; besides fake drugs, even common herbs may be adulterated by careless pharmacists, so one must inspect them personally to avoid mistakes. Methods of processing and decocting should also be precise to ensure efficacy. Fourth, recording prescriptions must be diligent; commonly, prescriptions are discarded after use. I suggest compiling them in a book for reference. This is a minor effort, but for the attentive person, the successful treatments of expert physicians can serve as models, and the cases of average physicians can reveal the depth of their knowledge and the quality of their character, aiding in decision-making.
The *Qiantang County Annals · Biography of Medical Practitioners* states: Shen Haowen specialized in pediatrics, particularly in treating smallpox. Jiang Lutao's son, aged one, had only three smallpox pustules appearing on the forehead, behind the ears, and beside the lips. Shen Haowen said, "The location of the child's smallpox indicates a reverse transmission involving the Heart, Kidney, and Spleen meridians. Earth overcomes Water, and Water overcomes Fire. It is appropriate to attack [the pathogen] rather than tonify. Attacking disperses the toxin, while tonifying harms the internal organs." By the fourteenth day, the pustules were bright and moist, nearing maturity. Shen Haowen said, "Using Shigao (Gypsum Fibrosum) might damage Stomach Earth and Kidney Water." Quack doctors, pitying the child's young age, erroneously administered Ginseng Radix et Rhizoma (Renshen). Upon seeing this, Shen Haowen exclaimed in alarm, "Has Ginseng been taken? The child will not survive past the twenty-first day." The child indeed died. Although the treatment of smallpox had shown effectiveness, it was ultimately ruined by quacks because common sentiment fears attacking pathogens and prefers tonification. This serves as a warning against inconsistent choice of physicians.
Poems dedicated to physicians are rarely good. Recently, I read *Haoyun Lou Chuji* by Li Xiaohu Huiqing (Lian) of Linchuan, which contains a poem dedicated to the physician Fei Jinqing Mingjing, with words that are particularly cautionary. During the Xianfeng era, Huiqing served as the Education Commissioner of Jiangsu, learning of two famous physicians there: Wu Zhongshan (Feirong) of Yanghu, residing at Yinshu, and Fei Jinqing Boxiong of Wujin, residing at Menghe City. He visited both. Wu Zhongshan, knowing Huiqing had no heir, prescribed tonic formulas to plan for offspring. Fei Jinqing diagnosed that Huiqing had excessive Liver Yang and deficiency in both Heart and Kidney, prescribing formulas to nourish the Heart and pacify the Liver. Huiqing adopted Fei's advice and presented a poem: "In the Confucian circles and literary academies,千秋 shines through the bamboo slips. Are there no arts transmitted? To specially honor the sages of the world. Hua Tuo and Xu Yingzong, women and children marvel at them as immortals. Three thousand flavors in the *Bencao*, eighty chapters of the *Nanjing*. Investigating things is the sage's study, fame and spirit are transmitted. Moreover, using [medicine] to save from danger, one can seize the power of creation. Saving lives compared to good ministers, unknown who comes first. Shang and Wang did not meet in the alley, one hand cannot turn back heaven. A commoner of Mengcheng, those who met him received life and preservation. Daily saving dozens or hundreds, merit and virtue nearly ten thousand. Great is the work of Nongxuan, entrusted..."