人生何生乎？莫不生于钱。人生何死乎？莫不死于病。甚矣，生命金钱疾病，三者固互
相维系，而变相为用者也。生命重乎？金钱重乎？疾病重乎？非有生命不能有金钱，非无疾
病不能保生命，则生命重矣。天之于人，既不能各长其生命，悉与以金钱尽免其疾病，则医
又重矣。医所以去病卫生也，无论良否，能舍金钱以生乎，抑或天别与医以金钱乎？奈何世
之人壹是皆以要钱为本，壹是皆以一己要钱为本，壹是皆以不愿他人要钱为本，其至一钱
如命，或竟要钱不要命，或且得命又思财，此世界之普通病，即所以致医之病也。在穷乏无
告者，犹或可说，而不谓富贵利达者，转居多数也。可谓不恕之甚矣。非强恕而行世，安得
有良医哉！庸医杀人，不可胜道，然亦实由重视金钱者之自误，虽即谓之自杀也。可又况有
一知半解者，舍脉论病，舍病论药，从旁助刀耶。
世之人曰∶医者意也。意为之者也。又曰∶医者，易也。至便至易之事也。此不特门外汉
之言，实病医而误尽苍生之言，不知医之为
言，易也，精微广大有如易道，诚合古今中外事业学问，无有难于此者。孔子曰∶人而无恒，
不可以作巫医。恒，常久也。易，卦也。所谓天地之道，恒久而不已也。日月得天而能久
照，四时变化而能久成，圣人于其道而天下化成，观其所恒而天地万物之情可见矣。恒之时
义如此，医之道亦当如此。医既为子之所训，
故疾遂为子之所慎，未达不敢尝之旨，其难其慎为何如乎？自朱子误注，虽小道必有可观，
章谓小道如农圃医卜之属，于是世人更以小道目贱工待之，至重者，不过数金之酬，或只
数十百钱呼之即至，且有并此区区而不畀者，一有不效，诟毁随之，不恕之事莫此为甚。尤
可怪者，平时既以小道贱工视之，而临病时又以神仙望之，岂小道贱工中有神仙游戏耶？自
问当亦哑然自笑（医本于易，章虚谷先生《医门棒喝》论之精详，此段发端与章不同，故持
论各异，非有出入也。）
小道贱工之名，数十百钱之利，其微末亦至极矣。而谓贤者为之乎，乃欲以求良医而保
生命，不唯不恕，亦且自轻良医，如何可得？盖良医虽不好利，未尝不自惜名，在病者之意，
不过谓病有大小轻重浅深之不同，小者、轻者、浅者何必定求良医，不知不遇良医则小
者、轻者、浅者必致于大、致于重、致于深，或更致于危险而不可为，此病之常势也。善卫生
者，必谨小慎微而不忽略于轻浅，以故圣人治未病，不治已病，所谓治制于未乱，保邦于未
危也。奈何世人只以金钱为重，殆至危险而不可为，则虽有善者，亦无如之何矣。况当是时
尚，多不能舍金钱以求保生命于一线，卒之又不能带入冥中，徒令后人笑其拙。呜呼，亦可
怜矣。
此种可怜情形，古今天下当如恒河沙数，《史记》扁鹊传谓扁鹊受桑君之术，饮上池之
水，视见垣一方人，以此视病，洞见五脏 结，尝于赵、于虢多着神效，天下尽以为能生死
人。及于齐，齐桓侯客之，入朝见曰∶君有疾，
在腠理，不治将深。桓候曰∶寡人无疾。扁鹊出，桓候谓左右曰∶医之好利也，欲以不疾者
为功。后五日，扁鹊复见曰∶君有疾，在血脉，不治恐深。桓侯曰∶寡人无疾。扁鹊出，桓侯
不悦，又五日，扁鹊复见曰∶君有疾，在肠胃，不治必深。桓候不应，扁鹊出，桓候不悦。五
日，扁鹊复见，望见桓候而退走，桓候使人问其故，扁鹊曰∶疾之在腠理也，汤熨之所及也；
在血脉，针石之所及也；其在肠胃，酒醪之所及也。今在骨髓，虽司命无奈之何，臣是以无
请也。后五日，桓候体病，使人召扁鹊，扁鹊已逃去，桓候遂死。使圣人预知微，能使良医得
早从事，则疾可已，身可活也。人之所病病疾多，而医之所病病道少。故病有六不治∶骄恣
不论理，一不治也；轻身重财，二不治也；衣食不能适，三不治也；阴阳并，脏气不定，四不治
也；形羸不能服药，五不治也；信巫不信医，六不治也。有此一者则重难治也。夫扁鹊，良医
也，桓候，富有之国君也，即使扁鹊好利，桓候非不能应，况扁鹊并无是心，其所以谆谆于桓
候者，不过欲神其术以为广大，名节则或有之，而不意桓候重财轻身，转以好利疑之，卒
致疾发而不可为，殊可哀也。又仲景见侍中王仲宣时年二十余，谓曰∶君有病，四十当眉落，
眉落半年而死，令服五石汤可免。仲宣嫌其言忤，受汤不服。居三日，见仲宣，谓曰∶服汤否？
仲宣曰∶已服。仲景曰∶色候固非服汤之诊，君何轻命也。仲宣犹不言，后二十年，果眉落，
落后一百八十七日而死。此二事者，所谓圣人治未病也。愚尝于中风、虚劳两证辄先谆谆于
人，如扁鹊之于桓候，仲景之于仲宣，唯人不曰危词耸听，即曰意别有在，卒之皆竟如桓
候、仲宣。噫！今天下如扁鹊、仲景者无几，而如桓候、仲宣者无限，世人其不惜为桓候、仲
宣乎？抑不愿为桓候、仲宣乎？或亦望有扁鹊、仲景者乎？自计不可不早。
如必欲生命金钱并保，唯有人人读书，必兼习医，且必如吾之所谓医而后可，不然则不
得不听命于医。医欲良乎？否乎？此不待问
而知也。谚云∶又要马儿跑得好，又要马儿不食草，世界那得有是事，世人却多有是心，此
神骏龙驹所以不世出也。
吾不敢谓世之人皆重财也，自世道衰而势利甚，捐纳之途，夤缘之风，弊混之事，日
乎天下而不可遏。虽盈千累万之金钱，亦必亟亟焉谋之而乐为用，甚至倾家荡产，以及丧
耻辱身，曾不稍自顾惜。唯一旦对于医者，则必反其所为，纵较向所乐用者，不过千万之一
二，仍如出纳之吝而不肯少宽假，此最不可解者也。岂不曰以利为利，谋生之事大，而卫生
之事小耶。亦何轻重失宜至是耶。
又尝见夫挥金如土，掷金若沙于嫖赌者矣。当其初入迷途，尚未至于倾家荡产，父兄
或预为严责，师友或婉为戒劝，皆不能阻其挥霍浪掷之心。及一旦对于医者，则又大反其所
为，虽区区者亦必靳以与人而卒之家产仍然倾荡于嫖赌中，或且召染恶疾，或且流为盗
匪，并至丧失其身而不悔，此尤不可解者也。然此特无益有损之大者耳，而凡小焉者毋论
矣。世之人盖禁绝无益之用而转为有益之用哉。
圣人之用财也，自奉俭约，待人丰浓，而于理欲之界，尤严防其出入。世人之用财，则
反是矣。于欲路上，虽恣用千万不嫌其多，于理路中，虽偶用一二即谓为过。此圣道所以日
衰，世道医道因此日坏也。然亦间有理欲并用者，则仍是求福免祸之心，非真能绳向理路，
上为作用也。如各省官医局及各赠医院，皆官界社会，所以分济贫乏也，局中院中主持医
者，不知果为良否，然一医日诊数十人者有之，且过百诊者亦有之，此虽圣神不能如是，
是直以为儿戏矣。其中纵或有一得，而究之所失者多，然则官医局与各赠医院之设，非仁者
与非也，所谓好仁不好学也。
医本仁术，赠医局院之发起，亦本仁心，唯不得其道，则转以仁者之心而反为不仁之
事。盖得一良医，可以活千万人，否则，反是何如？得千万之良医而全活天下后世无量数之
人？此其义虽前人亦偶见及，不过责望医者之自为良而不能深切着明，医者之病根，改良医
者之方药，纵使责望再深，学堂开遍，局院设满于天下，无当也。《医医医》一篇正所以济仁
者无穷之心，而不使偶有贻误，稍留缺憾，只须浓筹经费，丰给修火，多聘通医，严订功过，
无论局院，大小病者，多寡限制，各医一日不得过十诊，并须随证详立脉相病情、治否方
法，以及一切禁忌，交给病患，仍一面注册存之局院，按月分年合榜通衢，以待官府考核。
照此章程逐渐扩充，由省会以及各府州县，自城市以至各乡村落，一省如此，直省皆然。除
富浓者足以自行奉请外，其有不能设立局院者，即合一区之众，预为浓集养医之费，或论
年月给奉，或临时分诊给奉，皆可取之公中，总使医者足以赡其身家而有余，并一洗从前
苟且轻贱之习，则天下随处皆良医，天下病者亦皆全活而无患矣。
《医医医》一篇，非特欲世界之人皆无疾病，医尽良医，且更望人人皆为圣贤。人生富
贵不可必，神仙不可求，而疾病则可却，圣贤亦可为也。古今天下之病，推而广之，不知几
千万种，而一证又千头万绪，差之毫厘，谬以千里，诚不易言医治。约而言之，又不过外感、
内伤两病，外感则风、寒、暑、湿、燥、火六淫之气为之，内伤则喜、怒、哀、乐、爱、恶、欲七情
所发，合之所谓十三因也。然人能慎起居而适其寒温，自可以却外感，且外感除伤寒两感、
温疫四感与中风之直中脏者，则俱可以不死，而世之多死于外感者，皆医药误之也。内伤则
无不死者，何也？本非草木无情可治也。间尝窃论神农、黄帝、岐伯、仲景为外感之国手，若
内伤则孔孟为国手，降而宋儒、明儒，旁及老庄、佛氏亦内伤之好手，其书千言万语，莫非
治人性情，洵为内伤良药。惜古今天下人无一善读而觉者，古今天下医更无一梦见而觉者，
故死于内伤者又不知何限。今特为世界医界大放光明，如此于岐景孔孟之书以及各大家
诸大儒之语论一一寻绎，融会深长思之，则外感内伤无不毕治矣。明儒吕新吾先生有曰∶以
淡食为二陈，以寡欲为四物，以清心省事为四君子，无方之药，不名之医，取诸身而已。旨哉
斯言，庶几与吾不谋而合，惟惜阐发未尽耳。吾尝于内伤之证，辄先以言语之药为治，其情
并属病者，以情治情，无如皆以为迂腐，不但不服此方，且非笑之，而唯乞灵于草木，曷可
得耶？世界之人如不愿轻身重财也，则请悉遵吾方以医医，良医自必辈出，以应所欲。如仍
生命财产并重也，则唯人人多读书而兼习医，合医道治过而为一贯，更以自治而渐进于圣
贤之室，循致默化列强竞争之病而合中外为大同之世，勿谓圣贤不可为也。颜渊曰∶舜何
人也？予何人也？有为者亦若是。公明仪曰∶文王，我师也。周公岂欺我哉。曹交曰∶人皆
可以为尧舜。孟子曰∶尧舜与人同耳。又曰∶圣人与我同类也。此皆为圣贤之方药也。疾
病云乎哉，若以为徒为高论，是不为也，非不能也，吾未如之何也已。
人生为何而生存？无不为了金钱。人生为何而死亡？无不因为疾病。生命、金钱和疾病这三者，确实相互关联并互相转化发挥作用。生命重要吗？金钱重要吗？疾病重要吗？没有生命就没有金钱，没有疾病才能保全生命，所以生命是最重要的。上天对于人，既然不能让人人都长寿，也不能给人人足够的金钱以完全免除疾病，那么医生就显得更加重要了。医生的作用在于去除疾病、维护健康。无论医生水平高低，难道能舍弃金钱来换取生命吗？还是上天专门赋予医生金钱呢？无奈世间之人，全都把谋取钱财作为根本，全都以一己之私利为根本，全都以不愿他人谋利为根本，甚至视一钱如命，或者竟然为了钱不要命，或者得到了性命又想着发财，这是世间的普遍弊病，也就是导致医学衰败的原因。对于穷困无助的人，或许还可以劝说，没想到富贵显达的人反而占了多数。这可以说是极其不宽厚了。如果不努力推行推己及人的恕道，怎么能出现良医呢！庸医杀人，数不胜数，但这其实也是那些重视金钱的人自误，即使称之为自杀也不为过。更何况那些只懂一点皮毛的人，抛开脉象谈论病情，抛开病情谈论药物，从旁协助（病人）走向死亡。
世人说：医者，意也。意思是靠心意去领会。又说：医者，易也。是非常方便容易的事情。这不仅是门外汉的话，实在是误导医生而害尽苍生的言论。不知道“医”这个字，通“易”，其精微广大如同《易经》的道理，确实集合了古今中外的事业学问，没有比这更难的了。孔子说：“人而无恒，不可以作巫医。”恒，是长久不变的意思。易，是卦象。所谓天地的道理，是恒久不停止的。日月顺应天道就能长久照耀，四季变化就能长久成就，圣人遵循这个道理就能教化天下，观察其所恒常的东西，就能看清天地万物的情状了。恒道的意义如此之大，医道也应当如此。医生既然是孔子所训诫的职业，所以疾病也是孔子所谨慎对待的，未曾通达不敢轻易尝试的宗旨，其艰难谨慎到了什么程度呢？自从朱熹错误地注解，认为“小道必有可观”，将小道解释为像农圃医卜这类技艺，于是世人更把医生看作小道，用对待低贱工匠的态度对待他们，最重的报酬也不过几两金子，或者只有几十几百文钱，叫一声就到，甚至还有连这点微薄报酬都不给的。一旦疗效不佳，责骂毁谤随之而来，不宽厚的事情没有比这更严重的了。尤其奇怪的是，平时既把医生看作小道和低贱工匠，等到生病时又把医生当作神仙来期望，难道小道和低贱工匠中有神仙游戏人间吗？自己问心无愧时也会哑然失笑。（医学本源于易学，章虚谷先生在《医门棒喝》中论述得非常精详，这段发端与章先生不同，所以持论各异，并非有出入。）
“小道”、“低贱工匠”的名声，几十几百文钱的利益，其卑微渺小已经到了极点。却想让贤德的人去做，想要以此求得良医来保全生命，这不仅是不宽厚，而且是自己轻视良医，怎么可能实现呢？大概良医虽然不喜欢贪利，但从未不珍惜自己的名声。在病人的想法里，不过是认为病情有大小轻重浅深的不同，小的、轻的、浅的病何必一定求良医？却不知道如果不遇到良医，小的、轻的、浅的病一定会变得大、重、深，或者更进一步变得危险而无法救治，这是疾病的常规趋势。善于养生的人，必定谨慎细微而不忽略轻浅的疾病，所以圣人治疗未发生的病，而不是治疗已发生的病，所谓在混乱未发生前就加以控制，在国家未危亡前就加以保卫。无奈世人只看重金钱，直到病情危险无法救治时，即使有善治之人，也无能为力了。况且在这个时候，大多数人还不能舍弃金钱来保全一线生机，最终又不能把金钱带入冥界，徒然让后人嘲笑他们的愚蠢。唉，也可怜啊。
这种可怜的情形，古往今来当如恒河沙数般多。《史记·扁鹊传》记载扁鹊向桑君学习医术，饮用上池之水，能看见墙另一边的人，凭借此法看病，能透彻看到五脏的结聚，曾在赵国、虢国多次取得神奇疗效，天下人都认为他能起死回生。到了齐国，齐桓侯接待了他，入朝拜见时说：“您有病，在皮肤纹理之间，不治将会深入。”桓侯说：“我没有病。”扁鹊出去后，桓侯对左右侍从说：“医生喜欢牟利，想把没病的人说成有病来邀功。”五天后，扁鹊再次拜见说：“您的病在血脉，不治恐怕会加深。”桓侯说：“我没有病。”扁鹊出去，桓侯不高兴。又过了五天，扁鹊再次拜见说：“您的病在肠胃，不治必然加深。”桓侯不应声，扁鹊出去，桓侯不高兴。再过五天，扁鹊再次拜见，远远看见桓侯就转身跑开，桓侯派人询问原因，扁鹊说：“病在皮肤纹理间，是汤药热敷所能达到的范围；在血脉，是针石所能达到的范围；在肠胃，是酒醪（药酒）所能达到的范围。现在病在骨髓，即使是掌管生死的神灵也无可奈何，所以我就不再请求诊治了。”五天后，桓侯身体发病，派人召扁鹊，扁鹊已经逃走了，桓侯于是死了。如果圣人能预见细微之处，能让良医尽早介入治疗，那么疾病可以治愈，身体可以存活。人们所担忧的是疾病繁多，而医生所担忧的是医道稀少。所以有病六种情况难以治疗：骄傲放纵不讲理，是一不治；轻视身体看重钱财，是二不治；衣食不能适应调节，是三不治；阴阳失调，脏气不稳定，是四不治；形体消瘦不能服药，是五不治；相信巫师不相信医生，是六不治。有其中一种情况，就很难治疗了。扁鹊是良医，桓侯是富有的国君，即使扁鹊好利，桓侯也不是不能支付，何况扁鹊并没有这样的心思，他之所以对桓侯谆谆告诫，不过是想神化他的医术以为光大，名节或许有，却没料到桓侯重财轻身，反而怀疑他好利，最终导致疾病发作而无法救治，实在令人悲哀。还有张仲景见到侍中王仲宣时，王仲宣二十多岁，张仲景说：“您有病，四十岁时眉毛会脱落，眉毛脱落后半年就会死，服用五石汤可以避免。”仲宣嫌他的话冒犯，接受汤药却不喝。过了三天，张仲景再见仲宣，问：“喝汤了吗？”仲宣说：“已经喝了。”张仲景说：“面色征象确实不像服过汤的样子，您为什么轻视自己的生命呢？”仲宣还是不说话。二十年后，果然眉毛脱落，脱落一百八十七天后死去。这两件事，就是所谓的圣人治疗未发生的病。我曾经对中风的证候、虚劳的证候总是先对人谆谆告诫，就像扁鹊对齐桓侯、张仲景对王仲宣一样，只是人们不是说危言耸听，就是说别有用心，最终都竟像桓侯、仲宣那样。唉！如今天下像扁鹊、张仲景这样的人很少，而像桓侯、仲宣这样的人无数，世人难道不爱惜自己成为桓侯、仲宣吗？还是不愿意成为桓侯、仲宣呢？或者也希望有扁鹊、张仲景这样的人出现吗？自己盘算起来不可不早做打算。
如果一定要生命和金钱都保全，只有人人读书，必须兼修医学，并且必须像我所说的医学那样才可以，否则就只能听命于医生。医生想好吗？不想好吗？这不用问就知道了。谚语说：“又要马儿跑得好，又要马儿不吃草。”世界上哪有这种事，世人却多有这种心思，这就是神骏龙驹之所以不世出的原因。
我不敢说世上的人都看重钱财，自从世道衰败而势利盛行，捐官纳粟的途径，攀附权贵的风气，弊端混杂的事情，每天都在天下蔓延而不可遏制。即使拥有成千上万金钱，也必定急切地谋求它们并乐于使用，甚至倾家荡产，以至于丧失耻辱自身，都不稍微自我顾惜。一旦面对医生，却完全反其道而行之，纵然比向来乐于使用的金额，不过只有千万分之一二，仍然像出纳财物那样吝啬而不肯稍加宽待，这是最不可理解的。难道不是认为以利为利，谋生的事情大，而养生的事情小吗？这也太轻重失宜到这种地步了。
我又曾见过挥金如土、掷金若沙在嫖赌之中的人了。当他们刚陷入迷途，尚未至于倾家荡产时，父兄或许预先严厉责备，师友或许委婉劝戒，都不能阻止他们挥霍浪掷的心。一旦面对医生，却又完全反其道而行之，虽然是微薄的费用也必定吝惜不给别人，最终家产依然在嫖赌中倾荡，或者甚至染上恶疾，或者流落为盗匪，甚至丧失性命也不后悔，这更是不可理解的。然而这只是无益且有损的大害罢了，至于其他小的就更不用说了。世人大概应该禁止无益的使用而转为有益的使用吧。
圣人使用财物，自己生活俭约，待人丰厚，而在理与欲的界限上，尤其严防其出入。世人使用财物则相反。在欲望的路上，即使恣意花费千万也不嫌多，在理性的路上，即使偶尔使用一二也认为是过错。这就是圣道日益衰败，世道和医道因此日益败坏的原因。但也间或有理欲并用的人，那仍然是追求福报避免灾祸的心，并不是真正能约束自己走向理性之路，起到作用。比如各省的官办医局和各慈善赠医医院，都是官界和社会用来接济贫乏的，局中和院中主持医疗的人，不知道是否真的良医，然而一个医生一天诊断几十人的有，甚至超过百诊的也有，这即使是圣神也不能做到，简直是当作儿戏了。其中纵然偶有一得，但终究失去的多，那么官办医局和慈善赠医医院的设立，不是仁者的行为也不是不对，所谓“好仁不好学”。
医学本是仁术，发起赠医局院，也本是仁心，只是不得其道，反而用仁者的心去做不仁的事。得到一个良医，可以救活千万人，否则，反过来又是如何？得到千万个良医而全活天下后世无量数的人？这个道理前人也曾偶然提及，不过是责备期望医者自我成为良医而不能深切明白，医者的病根，改良医者的方药，即使责备期望再深，学堂开遍，局院设满天下，也没有用处。《医医医》这篇文章正是为了救济仁者无穷的心，而不使偶有失误，稍留缺憾，只需要筹措经费，丰厚供给薪水，多聘请通晓医学的人，严格订立功过考核，无论局院大小，对病患多少限制，每个医生一天不得超过十诊，并且必须随证详细记录脉象病情、治疗方法以及一切禁忌，交给病患，同时一面注册存于局院，按月分年汇总张贴在大街上，等待官府考核。按照这个章程逐渐扩充，由省会一直到各府州县，从城市一直到各个乡村，一省如此，直隶各省都一样。除了富裕的人足以自行聘请外，那些不能设立局院的地区，就集合一区众人的力量，预先集中供养医生的费用，或者按年月供给，或者临时分诊供给，都可以取自公中，总要使医生足以赡养自家而有盈余，并彻底洗刷从前苟且轻贱的习气，那么天下随处都是良医，天下的病患也都能全活而没有忧患了。
《医医医》这篇文章，不仅希望世上的人都没有疾病，医生都是良医，而且更希望人人都能成为圣贤。人生的富贵不一定有，神仙不可求，而疾病可以祛除，圣贤也可以成为。古往今来的病，推广开来，不知有几千万种，而一个证候又有千头万绪，差之毫厘，谬以千里，确实不容易谈论医治。概括来说，不过是外感、内伤两种病，外感则是风、寒、暑、湿、燥、火六淫之气所致，内伤则是喜、怒、哀、乐、爱、恶、欲七情所引发，合起来称为十三因。然而人能谨慎起居并适应寒温，自然可以抵御外感，而且外感除了伤寒两感、温疫四感与中风直中脏腑的情况，都是可以不死，而世上大多死于外感的，都是医药误之。内伤则没有不死的，为什么呢？本来就不是草木无情之物可以治疗的。我曾经私下议论神农、黄帝、岐伯、张仲景是治疗外感的国手，至于内伤，孔孟是国手，降而宋儒、明儒，旁及老庄、佛家也是内伤的好手，他们的书千言万语，无非是治疗人的性情，确实是内伤的良药。可惜古往今来的人没有一个善于阅读而觉悟的，古往今来的医生更没有一个是梦见而觉悟的，所以死于内伤的又不知有多少。现在特意为世界医学界大放光明，如此对岐伯、张仲景、孔孟的书以及各位大家诸大儒的言论一一寻绎，融会贯通深思，那么外感内伤没有不全部治愈的。明儒吕新吾先生说：“以清淡饮食作为二陈汤，以寡欲作为四物汤，以清心省事作为四君子汤，无固定方剂的药，没有名字医生，取之于自身罢了。”这话真好啊，几乎与我意见不谋而合，只是可惜阐发不够详尽。我曾经对内伤的证候，总是先用言语的药来治疗，其情志都属于病者，以情治情，无奈大家都认为迂腐，不但不服这个方子，而且讥笑它，而只乞灵于草木药材，怎么能够得到呢？世上的人如果不愿轻视身体看重钱财，那么就请完全遵照我的方法来医治自己，良医自然会辈出，以满足大家的愿望。如果仍然生命财产并重，那就只有人人多读书并兼修医学，将医道治理好而合为一贯，再通过自治而逐渐进入圣贤的境界，进而潜移默化消除列强竞争带来的弊病，达成中外大同的世界，不要说圣贤不可为。颜渊说：“舜是什么样的人？我是什么样的人？有所作为的人也能像他一样。”公明仪说：“文王是我的老师。周公怎么会欺骗我呢？”曹交说：“人都可以成为尧舜。”孟子说：“尧舜与人相同罢了。”又说：“圣人与我是同类。”这些都是成为圣贤的方药。疾病算什么，如果认为是空谈高论，那就是不去做，不是不能做，我也拿他没办法了。
What is the purpose of human life? It is nothing but for money. Why do people die? It is nothing but due to disease. Indeed, life, money, and disease are inextricably linked and transform into one another in their functions. Which is more important: life or money or disease? Without life, there can be no money; without disease, life can be preserved. Thus, life is paramount. Since Heaven cannot grant everyone longevity, nor provide sufficient wealth to completely exempt them from disease, doctors become even more crucial. The role of a doctor is to eliminate disease and preserve health. Regardless of their skill level, can they abandon money to save lives? Or does Heaven specifically endow doctors with wealth? Unfortunately, people in this world all make seeking money their primary goal, all prioritize their own financial gain, and all resent others doing the same. They treat even a single coin as if it were life itself; some even seek money at the expense of their lives, or having secured their lives, still covet wealth. This is a common malady of the world, which is precisely the cause of the decline of medicine. For those who are poor and helpless, persuasion might work, but surprisingly, the majority are the wealthy and powerful. This is extremely unkind. If one does not strive to practice the Golden Rule (Shu), how can good doctors emerge? Quack doctors kill countless people, yet this is actually self-deception by those who value money above all; it can even be called suicide. How much worse are those with superficial knowledge who discuss pathology without considering pulse diagnosis, or prescribe herbs without addressing the actual condition, thereby assisting the knife of death from the sidelines.
People say: "Medicine is about intention (Yi)." Meaning it relies on intuitive understanding. They also say: "Medicine is easy." Claiming it is a convenient and simple matter. These words are not only spoken by laymen but are statements that mislead doctors and harm all living beings. They fail to understand that the character "Yi" (Medicine) shares its root with "Yi" (Change/I Ching). Its subtlety and vastness are like the Dao of the I Ching. Indeed, combining the endeavors and scholarship of ancient and modern times, China and abroad, nothing is more difficult than this. Confucius said: "If a person lacks constancy, they cannot serve as a shaman or doctor." Constancy means permanence. Yi refers to hexagrams. It speaks of the way of Heaven and Earth, which is constant and unceasing. The sun and moon follow the Way of Heaven and shine eternally; the four seasons change yet achieve lasting results. Sages follow this Way and transform the world. By observing what is constant, one can perceive the nature of all things in Heaven and Earth. The significance of Constancy is so great; the Way of Medicine should be the same. Since Medicine was a profession admonished by Confucius, Disease became something he treated with caution. The principle of not daring to experiment until fully understanding implies how difficult and cautious it must be. Since Zhu Xi erroneously annotated that "small arts have their merits," interpreting small arts as farming, gardening, medicine, and divination, people thereafter regarded medicine as a trivial art and treated practitioners as lowly craftsmen. The highest remuneration was merely a few taels of gold, or sometimes just tens or hundreds of cash, where a call would bring them instantly. Some didn't even pay this meager amount. If the treatment failed, curses and slander followed. No act of unkindness is greater than this. Even stranger is that while treating doctors as trivial and lowly in daily life, people expect them to be like immortals when sick. Are there immortals playing among these trivial arts and lowly craftsmen? One would laugh silently upon introspection. (Medicine originates from the I Ching. Mr. Zhang Xugu discussed this in detail in *Yi Men Bang He*. Although the starting point here differs from his, leading to different arguments, there is no contradiction.)
The reputation of "trivial art" and "lowly craftsman," along with profits of tens or hundreds of cash, are extremely insignificant. Yet, expecting virtuous men to engage in this to secure good doctors for preserving life is not only unkind but also shows a disregard for good doctors. How can this succeed? Good doctors may not love profit, but they certainly cherish their reputation. Patients often think that diseases vary in severity and depth, asking why one must seek a good doctor for minor, mild, or superficial conditions. However, failing to encounter a good doctor means minor, mild, or superficial conditions will inevitably become major, severe, and deep, potentially reaching dangerous and incurable stages. This is the normal progression of disease. Those skilled in health preservation are meticulous and do not neglect mild or superficial illnesses. Therefore, sages treat disease before it arises, rather than after it has manifested—controlling chaos before it occurs and protecting the state before it becomes perilous. Alas, people today only value money. By the time the condition becomes dangerous and incurable, even capable healers are powerless. Moreover, at such times, most cannot bear to part with money to save a sliver of life, ultimately unable to take it to the underworld, leaving only ridicule from future generations. Oh, how pitiful!
Such pitiful situations are as numerous as grains of sand in the Ganges River since antiquity. The *Records of the Grand Historian* biography of Bian Que records that Bian Que learned techniques from Sang Jun, drank water from the upper pool, and gained the ability to see people on the other side of walls. Using this sight to diagnose, he could clearly see internal organ obstructions. He achieved miraculous effects in Zhao and Guo, and the world believed he could raise the dead. Upon arriving in Qi, Duke Huan of Qi hosted him. Bian Que entered the court and said, "You have a disease in the skin layers. If untreated, it will deepen." Duke Huan replied, "I am not ill." After Bian Que left, Duke Huan told his attendants, "Doctors love profit; they want to claim credit for curing the healthy." Five days later, Bian Que saw him again and said, "Your disease is in the blood vessels. Untreated, it may worsen." Duke Huan said, "I am not ill." Bian Que left, and Duke Huan was displeased. Five days later, Bian Que saw him again and said, "Your disease is in the stomach and intestines. Untreated, it will surely deepen." Duke Huan ignored him. Bian Que left, and Duke Huan remained displeased. Five days later, Bian Que saw him again, glanced at Duke Huan, and fled. Duke Huan sent someone to ask why. Bian Que said, "Disease in the skin layers is within reach of herbal decoctions and hot compresses; in the blood vessels, within reach of acupuncture and moxibustion; in the stomach and intestines, within reach of medicinal wines. Now it is in the bone marrow. Even Si Ming (the deity of life and death) cannot help. Therefore, I no longer request an audience." Five days later, Duke Huan fell ill and sent for Bian Que, but Bian Que had already fled. Duke Huan then died. If sages could foresee subtle signs, allowing good doctors to intervene early, diseases could be cured, and lives saved. People worry about the multitude of diseases, while doctors worry about the scarcity of medical knowledge. Thus, there are six types of untreatable cases: 1. Arrogant and unreasonable; 2. Disregarding health for wealth; 3. Inability to regulate diet and clothing; 4. Imbalance of Yin and Yang with unstable Zang-Fu Qi; 5. Emaciation preventing medication intake; 6. Trusting shamans over doctors. Having any one of these makes treatment difficult. Bian Que was a good doctor, and Duke Huan was a wealthy ruler. Even if Bian Que loved profit, Duke Huan could have paid. Besides, Bian Que had no such intent. His earnest advice was merely to demonstrate his profound skills and honor. He did not expect Duke Huan's prioritization of wealth over body to lead to suspicion of greed, resulting in an incurable condition. It is truly sorrowful.
Another example: Zhang Zhongjing met Wang Zhongxuan, a Minister of Palace Affairs, who was in his twenties. Zhang said, "You have a disease. Your eyebrows will fall out at forty, and you will die half a year after that. Taking Wushi Tang can prevent this." Zhongxuan found his words offensive, accepted the prescription but did not take it. Three days later, Zhang saw him again and asked, "Did you take the medicine?" Zhongxuan lied, "Yes." Zhang said, "Your complexion does not match the signs of taking the medicine. Why do you slight your life?" Zhongxuan remained silent. Twenty years later, his eyebrows indeed fell out, and he died 187 days later. These two cases illustrate the sage's principle of treating disease before it arises. I often earnestly advise patients regarding Stroke (Zhong Feng) and Consumption (Xu Lao), similar to Bian Que advising Duke Huan or Zhang Zhongjing advising Zhongxuan. Yet people either dismiss it as alarmist talk or suspect ulterior motives. Ultimately, they end up like Duke Huan and Zhongxuan. Alas! Today, there are few Bian Ques or Zhang Zhongjings, but countless Duke Huans and Zhongxuans. Do people not wish to avoid becoming Duke Huans or Zhongxuans? Or do they hope for more Bian Ques and Zhang Zhongjings? One must plan early.
If one insists on preserving both life and wealth, everyone must study and learn medicine as I describe it; otherwise, they must submit to doctors. Do doctors want to be good? Of course. As the saying goes, "You want the horse to run well but not eat grass." Such things don't exist in the world, yet many people harbor such desires, which is why divine steeds rarely appear.
I dare not say everyone values wealth, but since the decline of morals and rise of opportunism, bribery and nepotism have spread uncontrollably. People eagerly seek and spend thousands of coins, even bankrupting themselves or losing dignity. Yet, when facing doctors, they act oppositely. Even if the cost is only a tiny fraction of what they usually spend, they remain miserly. This is incomprehensible. Is it because they view profit-seeking as vital for survival and health preservation as secondary? Such imbalance is extreme.
I have seen people squander money like dirt on gambling and prostitution. When first ensnared, before bankruptcy, parents or teachers might reprimand or advise, but they ignore it. Yet, when facing doctors, they reverse this behavior, hoarding even small sums. Eventually, their wealth is lost to vice, possibly contracting serious diseases or turning to crime, even risking their lives without regret. This is even more inexplicable. This is merely the greatest harm of useless spending; smaller instances need not be mentioned. People should prohibit useless expenditure and redirect it to useful purposes.
Sages use wealth frugally for themselves but generously for others, strictly guarding the boundary between reason and desire. People do the opposite: they spend lavishly on desires but consider even small expenses on reason as excessive. This is why the Sage's Way declines, and worldly and medical ways deteriorate. Occasionally, people mix reason and desire, but this is still driven by a desire for fortune and avoidance of disaster, not true adherence to reason. For example, government medical bureaus and charity hospitals aim to help the poor. However, whether the doctors are truly competent is unknown. Some doctors see dozens or even over a hundred patients a day. Even sages cannot manage this; it is treated as a joke. While there may be occasional successes, failures outweigh them. Thus, establishing these institutions without proper methods is not truly benevolent, akin to "loving benevolence but not loving learning."
Medicine is inherently a benevolent art. Initiating charity hospitals stems from benevolence, but without proper method, benevolent hearts lead to non-benevolent outcomes. One good doctor can save millions; conversely, incompetence causes harm. Could millions of good doctors save the world? Predecessors touched upon this, emphasizing that doctors must improve themselves. Merely blaming doctors or opening schools and setting up hospitals everywhere is ineffective. *Yi Yi Yi* aims to support the infinite heart of the benevolent, preventing errors. It suggests securing funding, providing adequate salaries, hiring qualified doctors, and strictly evaluating performance. Regardless of the institution's size, limit each doctor to ten consultations per day. Detailed records of pulse, symptoms, treatments, and contraindications must be given to patients and archived. Monthly and annual summaries should be posted publicly for official inspection. Expanding this system from provincial capitals to counties and villages, ensuring doctors earn enough to support their families and eradicating previous attitudes of disdain, will result in good doctors everywhere and safe healing for all patients.
*Yi Yi Yi* hopes not only for a disease-free world with good doctors but also for everyone to become sages. Wealth and immortality are uncertain, but disease can be cured, and sages can be made. Diseases number in the millions, with complex manifestations; a slight error leads to huge mistakes. Generally, diseases fall into External Contraction (Wai Gan) and Internal Injury (Nei Shang). External contraction is caused by the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire). Internal injury stems from the Seven Emotions (Joy, Anger, Sorrow, Happiness, Love, Hate, Desire). Together, these are the Thirteen Causes. Proper lifestyle and temperature regulation can prevent external contraction. Except for specific severe cases like Cold Damage with dual invasion, Warm Epidemics, or Wind Stroke directly affecting organs, external contractions are generally survivable. Most deaths from external contraction are due to medical error. Internal injuries are often fatal because they involve the mind/spirit, which herbs alone cannot cure. I argue that Shennong, Huangdi, Qibo, and Zhang Zhongjing are masters of external contraction, while Confucius and Mencius are masters of internal injury. Later Neo-Confucians, Laozi, Zhuangzi, and Buddhists also excel in treating internal injury through regulating emotions and temperament. Their teachings are excellent remedies for internal injury. Sadly, few read and awaken to them, and fewer doctors understand them. Thus, many die from internal injury.
To illuminate the medical world, we must study the works of Qibo, Zhang Zhongjing, Confucius, Mencius, and great scholars. Integrating these insights allows comprehensive treatment of both external and internal issues. Mr. Lu Xinwu of the Ming Dynasty said: "Use bland diet as Er Chen Tang, use moderation of desires as Si Wu Tang, use clear mind and reduced affairs as Si Jun Zi Tang. The medicine has no formula, the doctor has no name; everything is taken from oneself." This aligns with my views, though underdeveloped. I often treat internal injury with "words as medicine," using emotion to heal emotion. People find this pedantic, refuse it, mock it, and rely solely on herbs. If people valued life over wealth, they would follow my advice, and good doctors would emerge. If they still prioritize wealth, they must study and learn medicine, integrating medical governance with self-cultivation to approach sagehood. This can mitigate the diseases of international competition and foster global harmony. Do not say sages cannot be made. Yan Yuan said, "What kind of person was Shun? What kind of person am I? Those who act can be like him." Gongming Yi said, "King Wen is my teacher. Would Zhou Gong deceive me?" Cao Jiao said, "Everyone can become Yao or Shun." Mencius said, "Yao and Shun are like ordinary people," and "Sages are of the same kind as us." These are the prescriptions for becoming sages. What is disease? If dismissed as empty talk, it is a failure to act, not inability. I can do nothing more.