今之学医者，皆无聊之甚，习此业以为及食计耳。孰知医之为道，乃古圣人所以泄天地
之秘
，夺造化之权，以救人之死。其理精妙入神，非聪明敏哲之人不可学也。黄帝、神农、越人
、仲景之书，文词古奥，披罗广远，非渊博通达之人不可学也；凡病情之传变，在于顷刻，
真伪一时难辨，一或执滞，生死立判，非虚怀灵变之人不可学也；病名以千计，病证以万计
，脏腑经络，内服外治，方药之书，数年不能竟其说，非勤读善记之人不可学也。又《内经
》以后，支分派别，人自为师，不无偏驳；更有怪僻之论，鄙俚之说，纷陈错立，淆惑百端
，一或误信，终身不返，非精鉴确识之人不可学也。故为此道者，必具过人之资，通人之识
；又能屏去俗事，专心数年，更得师之传授，方能与古圣人之心，潜通默契。若今之学医者
，与前数端，事事相反。以通儒毕世不能工之事，乃以无文理之人，欲顷刻而能之。宜道之
所以日丧，而枉死者遍天下也。
为医固难，而为名医尤难。何则？名医者，声价甚高，敦请不易，即使有力可延，又恐
往而
不遇。即或可遇，其居必非近地，不能旦夕可至。故病家凡属轻小之疾，不即延治；必病势
危笃，近医束手，举家以为危，然后求之，夫病势而人人以为危，则真危矣。又其病必迁延
日久，屡易医家，广试药石，一误再误，病情数变，已成坏证。为名医者，岂真有起死回生
之术哉？病家不明此理，以为如此大名，必有回天之力，若亦如他医之束手，亦何以异于人
哉？于是望之甚切，责之甚重。若真能操人生死之权者，则当之者难为情矣。若此病断然必
死，则明示以不治之故，定之死期，飘然而去，犹可免责。倘此症万死之中，犹有生机一线
，若用轻剂以塞责，致病患万无生理，则于心不安；若用重剂以背城一战，万一有变，则谤
议蜂起，前人误治之责，尽归一人。虽当定方之时，未尝不明白言之。然人情总以成败为是
非，既含我之药而死，其咎不容诿矣。又或大病瘥后，无气虚而余邪尚伏，善后之图，尤宜
深讲。病家不知，失于调理，愈后复发，仍有归咎于医之未善者，此类甚多。故名医之治病
，较之常医倍难也。知其难，则医者固宜慎之又慎；而病家及旁观之人，亦宜曲谅也。然世
又有获虚名之时医，到处误人；而病家反云此人治之而不愈，是亦命也。有杀人之实，无杀
人之名，此必其人别有巧术以致之，不在常情之内矣。
当今学习医学的人，大多是因为生活极度贫困，才把行医作为谋生的手段。他们哪里知道，医学这一道，是古代圣人用来揭示天地自然的奥秘，掌握造化变化的权柄，从而挽救人类生命的技术。其中的道理精妙绝伦，非聪明睿智、思维敏捷的人不能学习；黄帝、神农、扁鹊（越人）、张仲景的著作，文辞古奥深涩，义理广博深远，非学识渊博、见识通达的人不能学习；凡是病情的传变，往往在顷刻之间发生，真假虚实一时难以辨别，一旦固执拘泥，生死立刻分明，非心胸虚怀若谷、灵活多变的人不能学习；疾病的名称以千计，证候的表现以万计，脏腑经络的理论，内服外治的方法，方药的知识，数年也难以穷尽其说，非勤奋阅读、善于记忆的人不能学习。此外，《黄帝内经》之后，医学流派分支众多，各自为师，难免有偏颇驳杂之处；更有怪僻荒谬的言论，粗俗鄙陋的说法，纷纷陈列交错，混淆视听，一旦误信，终身无法回头，非具有精准鉴别力、确凿见识的人不能学习。因此，从事这门学问的人，必须具备超越常人的资质，通晓事理的见识；又能摒弃世俗琐事，专心钻研数年，再加上得到老师的传授，才能与古代圣人的心意暗中相通，默契领会。像当今那些学医的人，与上述几点要求事事相反。用通晓儒学的读书人毕生精力都不能精通的事情，却指望没有文化基础的人，在短时间内就能学会。难怪医学之道日益衰败，而因误诊枉死的人遍布天下啊。
做医生固然很难，但要做名医尤其困难。为什么呢？所谓名医，声望和身价都很高，病人敦请不易，即使有钱能邀请，又恐怕去了也遇不到合适的时机或信任。即便能够遇到，其居所必定不在近处，不能早晚随时到达。所以病人凡是有轻微小病，不会立即去延请治疗；一定要等到病情危急严重，附近的医生束手无策，全家都认为危险时，才会来求教。既然大家都认为病情危重，那确实是危重了。而且这种病往往拖延日久，多次更换医生，广泛尝试药物，一错再错，病情多次变化，已经形成难治的坏证。身为名医，难道真有起死回生的法术吗？病人家属不明白这个道理，认为如此大的名声，一定有挽回天命的力量，如果也像其他医生一样束手无策，那和别人有什么区别呢？于是对医生的期望非常迫切，责备也非常沉重。如果真能掌握人生死大权的人，面对这种情况会感到很难为情。如果这病确实必死无疑，那么明确告知不治的原因，定下死亡期限，潇洒离去，还可以免除责任。倘若这个病症在万分死寂中，还有一丝生机，如果用轻缓的药方来敷衍塞责，导致病患完全没有生机，那么内心不安；如果用猛烈的药方背水一战，万一出现变故，则诽谤议论蜂拥而起，前人误治的责任，全部归咎于一人。虽然在确定处方的时候，并非没有明白地说过风险。然而人情总是以成败来判断是非，既然吃了我的药而死，过错就不容推卸了。或者大病初愈后，虽然气虚已补，但余邪尚潜伏体内，善后调理的计划，尤其应该深入讲究。病人家属不知道这些，疏于调理，痊愈后复发，仍然有人归咎于医生医术不精，这类情况非常多。所以名医治病，比一般医生要难得多。知道其中的艰难，那么医者固然应该谨慎再谨慎；而病人家属及旁观者，也应该体谅宽容。然而世上又有获得虚名的庸医，到处害人；而病人家属反而说这个人治了没好，这是命数。有杀人的事实，却没有杀人的名声，这一定是那人另有巧妙的手段导致这样的结果，不在常理情理之内的了。
Those who study medicine today are mostly in dire straits, taking up this profession merely as a means of livelihood. How could they know that the Way of Medicine is what the ancient sages used to unveil the secrets of Heaven and Earth, seize the power of creation, and save people from death. Its principles are subtle and divine; only those who are intelligent, keen, and wise can study it. The works of Huangdi (Yellow Emperor), Shennong (Divine Farmer), Yue Ren (Bian Que), and Zhang Zhongjing feature archaic and profound language, with broad and far-reaching implications; only those who are erudite and versatile can study them. The transmission and transformation of diseases occur within moments, making it difficult to distinguish truth from falsehood at once; if one is rigid or inflexible, life and death are decided instantly. Thus, only those who are open-minded and adaptable can study it. Disease names number in the thousands, and syndromes in the tens of thousands; the theories of Zang-Fu organs and meridians, internal and external treatments, and books on prescriptions and herbs cannot be fully explained in a few years. Therefore, only those who read diligently and memorize well can study it. Furthermore, after the *Neijing* (Inner Canon), medical schools branched out, each acting as its own teacher, inevitably leading to biased and flawed theories. There are also bizarre arguments and vulgar sayings, presented chaotically and confusingly; if one believes them by mistake, they may never return to the right path. Hence, only those with precise discernment and solid insight can study it. Therefore, practitioners of this art must possess extraordinary aptitude and universal understanding; they must also set aside worldly affairs, devote themselves to study for several years, and receive instruction from a master, so that they can secretly connect and tacitly understand the minds of the ancient sages. However, those who study medicine today are opposite to all these requirements. They expect people without literary foundation to master in an instant what even learned Confucian scholars cannot achieve in a lifetime. No wonder the Way of Medicine declines daily, and the wrongly dead fill the world.
Being a doctor is indeed difficult, but being a famous doctor is even more so. Why? A famous doctor commands high prestige and price, and is hard to invite. Even if one has the means to hire him, there is fear that he may not be available or willing upon arrival. If he does come, his residence is likely far away, preventing immediate access morning or night. Consequently, patients do not seek treatment for minor ailments immediately; they wait until the condition is critical, local doctors have given up, and the whole family considers it hopeless, before seeking help. Since everyone deems the condition critical, it truly is critical. Moreover, such illnesses often persist for a long time, involving multiple changes of doctors and extensive trials of medicines, leading to repeated errors and complex transformations, resulting in complicated and refractory syndromes. Does a famous doctor truly possess the magic to revive the dead? Patients' families fail to understand this logic; believing that such great fame implies the power to reverse fate, they feel disappointed if the doctor is helpless like others. Thus, their expectations are intense, and their blame heavy. For a doctor who seemingly holds the power of life and death, this situation is awkward. If the disease is undoubtedly fatal, clearly explaining the reasons for untreatability and predicting the time of death, then leaving gracefully, allows one to avoid blame. However, if there is a sliver of hope in a desperate case, using mild prescriptions to shirk responsibility, leading to certain death, causes inner unrest; using strong prescriptions for a last stand, if complications arise, triggers swarms of criticism, placing all blame for prior mismanagement on oneself. Although risks are usually stated clearly when prescribing, public opinion judges right and wrong by success or failure. Having taken one's medicine and died, the fault cannot be denied. Or, after recovery from a major illness, although Qi deficiency is addressed, residual pathogens may remain; post-illness care requires deep attention. Families often neglect proper regulation, leading to relapse, and still blame the doctor for poor skill. Such cases are numerous. Thus, treating patients is twice as difficult for famous doctors as for ordinary ones. Knowing this difficulty, doctors should be extremely cautious; patients and bystanders should also show empathy. Yet, there are quacks gaining false reputations who harm people everywhere; families complain that treatment failed, attributing it to fate. These individuals commit murder in fact but escape the reputation of murder, implying they use some cunning methods beyond normal reasoning.