人命所关亦大矣。凡害人之命者，无不立有报应。乃今之为名医者，既无学问，又无师
兼以心术不正，欺世盗名，害人无算，宜有天罚，以彰其罪。然往往寿考富浓，子孙繁昌，
全无殃咎，我殆甚不解焉。以后日与病者相周旋，而后知人之误药而死，半由于天命，半由
于病家，医者不过根据违顺命以成其死，并非造谋之人。故杀人之罪，医者不受也。何以言之
？夫医之妨否，有一定之高下。而病家则于医之良者，彼偏不信；医之劣者，反信而不疑。
言补益者以为良医，言攻散者以为庸医；言温热者以为有益，言清凉者以为伤生。或旁人互
生议论，或病患自改方药，而医者欲其术之行，势必曲从病家之意。病家深喜其如顺，偶然
或愈，医者自矜其功；如其或死，医者不任其咎。病家亦自作主张，隐讳其非，不复咎及医
人。故医者之曲从病家，乃邀攻避罪之良法也。既死之后，闻者亦相传，以为某人之病，因
误服某人之药而死，宜以为戒矣。及至自己得病，亦复如此。更有平昔最佩服之良医，忽然
自生疾病，反信平日所最鄙薄之庸医而伤其生者，是必有鬼神使之，此乃所谓命也。盖人生
死有定数，若必待人之老而自死，则天下皆寿考之人而命无权，故必生疾病，使之不以寿而
死。然疾病之轻重不齐，或其人善自保护，则六淫七情之所感甚轻。命本当死，而病浅不能
令其死，则命又无权，于是天生此等之医，分布于天下。凡当死者，少得微疾，医者必能令
其轻者重，重者死。而命之权于是独重，则医之杀人，乃隐然奉天之令，以行其罚，不但无
罪，且有微功，故无报也。惟世又有立心诈欺，卖弄聪明，造捏假药，以欺吓人，而取其财
者，此乃有心之恶，与前所论之人不同。其祸无不立至，我见亦多矣。愿天下之人细思之，
真凿凿可征，非狂谈也。
人的性命所系，关系重大。凡是害人性命的行为，无不立刻招致报应。然而当今那些被称为名医的人，既没有学问，又没有师承，加上心术不正，欺世盗名，害死的人数不胜数，理应受到天罚以彰显其罪行。但他们往往长寿富贵，子孙繁衍昌盛，完全没有灾祸殃及，我对此非常不解。
后来我日日与病人周旋相处，才明白人因误药而死，一半是由于天命，一半是由于病家（患者及其家属）。医者不过是顺应或违背病情、命运而导致其死亡，并非蓄意谋害之人。所以杀人的罪名，医者是不承担的。为什么这样说呢？
医术的高低优劣是有一定标准的。但病家对于医术高明者，偏偏不信；对于医术低劣者，反而深信不疑。认为说补益的是良医，说攻散（泻下、发散）的是庸医；认为说温热药有益，说清凉药伤生。或者旁人互相产生议论，或者病患自行更改方药。而医者想要自己的医术得以施行，势必会曲意顺从病家的心意。病家深深喜欢这种顺从，偶然治愈了，医者便自夸功劳；如果死了，医者也不承担罪责。病家也自作主张，隐瞒自己的错误，不再责怪医生。所以医者曲意顺从病家，是邀功避罪的良策。
人死后，听者也会相传，说某某人的病，是因为误服了某位医生的药而死，应该引以为戒。等到自己生病时，也是如此。更有甚者，平日最佩服的良医，忽然自己生了病，反而相信平日最鄙薄的庸医而丧命，这必定是有鬼神在支配，这就是所谓的“命”。
大概人生的生死有定数，如果一定要等人老自然死亡，那么天下都是长寿之人，命运就失去了权柄，所以必然会产生疾病，使人不能活到寿终正寝。然而疾病的轻重各不相同，如果那人善于自我保护，那么六淫（风、寒、暑、湿、燥、火六种外感病邪）和七情（喜、怒、忧、思、悲、恐、惊七种情志变化）的影响就很轻。命本该死，但病浅不足以致死，那么命运又失去了权柄。于是上天生出这类医生，分布于天下。凡是注定要死的人，稍微染上一点小病，医者必定能使轻的病变重，重的病死。于是命运的权柄因此独尊。那么医生杀人，实际上是暗中奉行上天的命令，执行惩罚，不但无罪，还有微小的功劳，所以没有报应。
只有世上又有存心欺诈，卖弄聪明，制造假药，用来欺骗恐吓以谋取钱财的人，这是有心之恶，与前面所讨论的人不同。他们的灾祸没有不立刻降临的，我也见过很多了。希望天下人仔细思考，这是确凿有据的，不是狂言乱语。
Human life is of paramount importance. Those who harm human life invariably face immediate retribution. Yet today, so-called famous physicians often lack learning and formal training, possess corrupt intentions, deceive the world to steal fame, and have caused countless deaths. They ought to suffer heavenly punishment to manifest their crimes. However, they often enjoy longevity, wealth, and prosperous descendants, suffering no calamity whatsoever. I find this deeply incomprehensible.
Through daily interaction with patients, I later came to understand that death due to medicinal error is half attributable to Heavenly Mandate (Tianming, 天命) and half to the patient's family (Bingjia, 病家). The physician merely facilitates death by following or opposing the natural course of fate; they are not the instigators of murder. Therefore, physicians do not bear the guilt of killing. Why is this?
The proficiency of medical practice has a definite standard of high and low quality. Yet patients often distrust skilled physicians while placing blind faith in incompetent ones. They regard those who prescribe tonics as skilled, and those who prescribe purgatives or dispersants as mediocre; they view warm-hot therapies as beneficial and cool-cold therapies as life-damaging. Surrounded by conflicting opinions from others, or when patients alter prescriptions themselves, physicians, desiring their methods to be accepted, inevitably compromise to suit the patient's wishes. The patient delights in this compliance; if recovery occurs by chance, the physician claims credit; if death occurs, the physician bears no blame. The patient also takes responsibility, conceals their own errors, and ceases to blame the physician. Thus, for the physician, compromising to please the patient is an excellent strategy to claim merit and avoid blame.
After death, rumors circulate: "Person X died because they took medicine prescribed by Doctor Y," serving as a warning. Yet when one falls ill oneself, the same behavior repeats. Even more strikingly, a person may hold a highly respected skilled physician in high esteem, but upon falling ill, trust a physician they usually despise, leading to their death. This must be orchestrated by spirits or deities; this is what is called Fate (Ming, 命).
Life and death have fixed numbers. If everyone were to die only of old age, the world would consist entirely of long-lived individuals, rendering Fate powerless. Therefore, diseases arise to prevent people from living out their full lifespan. However, the severity of diseases varies. If an individual protects themselves well, the influence of the Six Evils (Liuyin, 六淫 - Wind, Cold, Summerheat, Dampness, Dryness, Fire) and Seven Emotions (Qiqing, 七情 - Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) is minimal. If Fate decrees death, but the illness is too mild to cause it, Fate again loses its power. Consequently, Heaven produces such physicians and distributes them throughout the world. For those destined to die, even a minor ailment can be exacerbated by these physicians, turning mild cases severe and severe cases fatal. Thus, the authority of Fate is restored. In this sense, when a physician causes death, they are secretly executing Heaven's orders to administer punishment. They commit no crime and even perform a minor service to cosmic order; therefore, they incur no retribution.
However, there exist those with malicious intent who deceive, show off cleverness, manufacture fake medicines, and use fear to extort money. These are acts of intentional evil, distinct from the physicians discussed above. Their disasters arrive immediately, and I have witnessed many such cases. I urge all people to reflect carefully on this. It is firmly grounded in evidence, not mere wild talk.