经义
望而知之谓之神，闻而知之谓之圣，问而知之谓之工，切而知之谓之巧。（《素问》）
医不三世，不服其药。（《礼记》）
三折肱知为良医。（《左传》）
人而无恒，不可以作巫医。（《论语》）
哲言
九折臂而成医。（《楚辞》）
不为良相，则为良医。（范文正）
人之所病病疾多，医之所病病道少。（扁鹊）
古之医者∶上医医国，中医医人，下医医病；上医听声，中医察色，下医诊脉；上医医未病，中医医欲病，
下医医已病。○今之医者，不思求经旨，以演其所知；各承家伎，始终循旧，省病问疾，务在口给，相对斯须，
便处汤药。按寸不及尺，握手不及足，人迎、趺阳，三部不参，动数发息，不满五十。短期未知，诊决九候，
曾无仿佛；明堂阙庭，尽不见察，所谓窥管而已。欲视死别生，固亦难矣，此皆医之深戒也。（《千金方》）
夫医者，非仁爱之士，不可托也；非聪明达理，不可任也；非廉洁明良，不可信也。是以古之用医，必选
其德能仁恕博爱，其智能宣畅曲解，能知天时运气之序，能明性命吉凶之数，处虚实之分，定顺逆之节，原疾
病之轻重，量药剂之多少，贯微洞幽，不失细小，如此乃谓良医。（《初学记》）
医之为道，非精不能明其理，非博不能致其约。是故前人立教，必使之先读儒书，明《易》理、《素》、
《难》、《本草》、《脉经》，而不少略者何？盖非四书，无以通义理之精微；非《易》，无以知阴阳之消长；
非《素问》，无以识病，非《本草》，无以识药；非《脉经》，无以诊候而知寒热虚实之证。（《医学集成》）
不知《易》者，不足以言太医。惟会理之精，故立论之确，即遗之万世而无弊。彼知医不知《易》者，
拘方之学，一隅之见也。以小道视医，以卜筮视《易》，亦蠡之测，豹之窥也，恶足以语此。（《医旨绪余》）
儒家有尧舜，医家有轩岐也。儒家有孔子，医家有仲景也。尧舜之道，非孔子而不传；轩岐之道，非仲景
而莫显。世未有不读孔子书而称儒者，多有不读仲景书而称医者。（程郊倩）
仓公神医，乃生五女而不生男。其师公乘阳庆，亦年七十余
无子，医乃无种子之术。（李濂《医史》）
医家切须自养精神，专心道业，勿涉一毫外务。盖医者意也，审脉、辨证、处方，全赖以意为主，倘精
神不足，则厌烦苟率，而艰于深心用意矣。○孙思邈之祝医者曰∶行欲方而智欲圆，心欲小而胆欲大。嗟乎！医
之神良尽于此矣。宅心醇谨，举动安和，忌心勿起，贪念罔生，毋忽贫贱，毋惮疲劳，检医典而精求，对疾苦
而悲悯，如是者谓之行方。禀赋有浓薄，年岁有老少，身形有肥瘦，性情有缓急，境地有贵贱，风气有柔强，天
时有寒热，昼夜有重轻，受病有新久，运气有太过不及，知常知变，能神能明，如是者谓之智圆。望、闻、问、
切宜详，补、泻、寒、温须辨，当思人命至重，冥报难逃，如是者谓之心小。补即补而泻即泻，热斯热而寒斯
寒，抵当、承气，时用回春，姜附、理中，恒投起死，如是者谓之胆大。四者似分而实合也。（《冯氏锦囊》）
医者根据也，有身者所倚赖以生全者也。想者由心识中想像前境，施设种种名、种种言者也。故将生全有身
者，当想定人身平常境界，及不平常境界而为治也。又云∶医者意也，而意之所变为想，以意想平治其不平常，
则平常境界，医所当想者矣，故作医想。（卢不远）
馆师无坐板气，地师无流艺气，禅师无杖拂气，炼师无丹汞气，医师无方术气，方是白描画手，本分师家。
○医有膏、粱、藜、藿之不同，原其传派多门，趋向不类，难与并为优劣。擅膏粱之术者，专一附桂名世；得
藜藿之情者，无非枳橘见长。第膏粱之治多难愈，以其奉养柔脆，痰涎胶固乎上，精神凋丧乎下，即有客邪，
非参无以助诸药之力；藜藿之患都易除，以其体质坚韧，表邪可以恣发，里邪可以峻攻，纵有劳伤，一术足以
资百补之功。（张路玉）
医不贵于能愈病，而贵于能愈难病；病不贵于能延医，而贵于能延真医。夫天下事，我能之，人亦能之，
非难事也；天下病，我能
愈之，人亦能愈之，非难病也。惟其事之难也，斯非常人之所能知；病之难也，斯非常医之所能疗。故必有
非常之人，而后可为非常之事；必有非常之医，而后可疗非常之病。第以医之高下，殊有相悬。譬之升高者，
上一层有一层之见，而下一层者，不得而知之；行远者，进一步有一步之闻，而近一步者，不得而知之。是以
错节盘根，必求利器。阳春白雪，和者为谁？○病家之要，难在择医，然而择医非难也，而难于任医。任医非
难也，而难于临事不惑，确有主持，而不致朱紫混淆者之为更难也。倘不知此，而偏听浮议，广簇医，则骐
骥不多得，何非冀北驽群？帷幄有神筹，几见圮桥杰竖？危急之际，奚堪庸妄之误投？疑似之秋，岂可纷纭之
错乱？一着之谬，此生付之矣。以故议多者无成，医多者必败。多何以败也？君子不多也。欲辨其多，诚非易
也；然而尤有不易者，则正在知医一节耳。夫任医如任将，皆安危之所关，察之之方，岂无其道？第欲以慎重
与否观其仁，而怯懦者实似之；颖悟与否观其智，而狡诈者实似之；果敢与否观其勇，而孟浪者实似之；浅深
与否观其博，而强辩者实似之。执拗者若有定见，夸大者若有奇谋。熟读几篇，便见滔滔不竭；道闻数语，何
非凿凿有凭？不反者，临涯已晚；自是者，到老无能。执两端者，冀自然之天功；废四诊者，犹瞑行之瞎马。
得稳当之名者，有耽搁之误；昧经权之妙者，无格致之明。有曰专门，决非通达；不明理性，何谓圣神？又若
以己之心度人之心者，诚接物之要道，其于医也则不可；谓人己气血之难符，三人有疑，从二同者，为决断
之妙方，其于医也亦不可；谓愚、智、寡、多之非类必也。小、大、方、圆全其才，神、圣、工、巧全其用，
能会精神于相与之际，烛幽隐于元冥之间者，斯足谓之真医，而可以当性命之任矣。○明哲二字，为见机自保也。
夫医患不明，明则治病何难哉？而所患者，在人情耳！人事之变，莫可名状。如我有独见，岂彼所知？使彼
果知，何藉于我？每有病临危剧，尚执浅见，从旁指示，某
可用某不可用，重之云太过，轻之言不及，一不合意，必有后言，是当见机之一也。有杂用不专，主见不定，
药已相投，渠不知觉，忽惑人言，舍此慕彼；凡后至者，欲显己长，必谈前短，及其致败，反以嫁谗，是当见
机之二也。有病入膏肓，势必难疗，怜其苦求，勉为举手，当此之际，使非破格出奇，何以济急？倘出奇无功，
徒骇人目，事后必招浮议，是当见机之三也。或有是非之场，争竞之所，利害所居，恐涉其患，是当见机之四
也。有轻医重巫，可无可有，徒用医名，以尽人事；尚有村鄙之夫，不以彼病为恳，反云为我作兴，吁！诚可
哂也，是当见机之五也。有议论繁杂者，有亲识要功者，有内情不协者，有任性反复者，皆医中所最忌，是当
见机之六也。凡此六者，俱当默识，而惟于缙绅之间，尤当加意。盖恐其不以为功，而反以为罪，何从辨哉？
虽曰∶吾尽吾心，非不好生。然势有不我由者，不得不见机进止，明哲自保，不可少也。（张景岳）
一医医不学无术之病。医以生人，亦以杀人；惟学则能生人，不学则适足以杀人。盖不学则无以广其识，
不学则无以明其理，不学则不能得其精，不学则不能通其权达其变，不学则不能正其讹、去其弊，如是则冒昧
从事，其不至杀人也几希矣！或曰∶医必有传，或传之于师，或传之于祖若父，皆学也。抑知恃此以为学，其
去学也远矣！彼仅恃其倾耳听受之逸，必不复有心思研究之劳。且既守其一成不易之规，则必昧乎神明变化之
理。一若历代诸贤圣，皆不如其师、其祖、若父之足信从也。一若历代贤圣垂训之书，皆不如其师、其祖、若
父之口语为足凭也。故善学人，无论有传无传，总非求得乎古昔圣贤之理不可也。自《灵》、《素》而下，以
及于近代诸书，无不细心探讨，识高理透，眼快心灵，凡遇一病，必认得真，拿得定，不为邪说所惑，不为假
象所欺，得心应手，起死回生。以此言学，则真学也。学真而术自神矣，岂仅仅得之听受之间，守其一成之规
者，遂得谓之学哉？若仅恃此以
为学，则必得其偏而失其全，得其浅而失其深，得其皮毛而失其神髓，得其俗套而失其真诠，及其临证施治，
非隔靴搔痒，即傍皮切血；非画饼充饥，即鸩酒解渴，此术之不精，由学之不足也。此不学无术之病，所宜急
医者也。○一医医脉证罔辨之病。凡医人用药，须先认证，认证须先审脉。审脉明，斯认证真；认证真，斯用
药当。凡有一证，即有一证之寒、热、虚、实。苟不有以辨之，其能不倒行而逆施乎？惟是证之重者，大寒偏似
热，大热偏似寒，大虚偏似实，大实偏似虚，若仅就其似者而药之，杀人在反掌间也。然则于何辨之？即于脉
辨之，如伤寒脉浮而紧数，按之有力者，知其证为阳邪在表也；若沉而急数，重按有力者，知其证为阳邪入里
也。又如沉而且迟细而且软者，知其证为纯阴无阳也；若浮大满指，按之如丝者，知其证为阴极似阳也。诸如
此类，宜细心辨别，斯临证无骑墙之见，用药无相左之虞。其奈近日医家，绝不言此，但曰某药可治某病，某
病当用其方，至问其病之为寒、为热、为虚、为实乎？则茫然罔辨也。即或辨之，又往往以虚为实，以寒为热，
是又甚于不能辨者也。其不能辨证者，由于不能辨脉也，医尝告人曰∶脉作不得准。更有何者可作准乎？从来
证之疑似难决者，须于脉决之，虽昔贤亦有从脉不从证，从证不从脉之论。抑知所谓不从者，正深于从也。如
沉细迟涩，乃阴寒脉也，而其证却烦躁作渴、面赤身热，若以为热证而清之，则毙矣；惟补之温之，不从其假
热之证，正从其真寒之证，而非真谓证有不必从者也。又如狂躁力雄，逾垣上屋，此火热证也，而其脉却伏入
骨，若以此为阴脉，而温之则危矣；惟清之、下之，不从其阴寒伏之脉，正从其热极反伏之脉，而非真谓脉有
不可从者也。总之，从其真不从其假，不从者其外貌，从者其神髓。医家苟不辨此，未有不颠倒错乱。一剂之
误，命即随之。此脉证罔辨之病，所宜急医者也。○一医医轻忽人命之病。谚云∶医家有割股之心。安得有轻
忽人命者哉？然观于今，而叹其言之不验也。
或者古昔之言，而于今不符也。今时之医，不惟无割股之心，若并无援手之意。病家殷勤延医，希冀医能疗疾
以安生，而医人若漠不相关，守定故智，以缓不切肤之药，期药之得效，病之得生。迨缓药渐死，又绝无引咎
之心，绝无愧悔之意，绝无矜怜之情，其残忍惨刻，不较之屠人而尤加烈哉？推其故，皆原于传受之讹耳！闻
名医之传人，曰药性毋浓，药数毋重，气薄剂轻，庶易于解手为之徒者，谨遵名医妙诀，谓病重切不可为人担
利害，仍留原病还他。嗟嗟！延医用药，原为去病，若仍留病，何贵乎医？既留病则必不能留命。若留一轻病，
必渐加重；若留一重病，必渐至死。还他者，听其从容自死之谓也。所以愈遵轻药易解之师传，共安于留病还
人之习向，一任急来，我惟缓受，往往有可生之机，必不用切当之药以相救，只恐失一己之名与利遂罔顾人之
死与生。此轻忽人命之病，所宜急医者也。○一医医遵守时套之病。天下事莫便于套，亦莫害于套。医而涉套，
则至便而尤至害者也。时套之学也至易，不必费心思之劳，不必多研究之苦，不烦按脉、切理，不待读书讲求，
不待深究药性，详察病情，只学一二最易入俗之语。凡视一病，便云是火。或病患自以为虚，则云虽虚却不可
补。或云∶只宜平补，不可过补。或云∶只宜清补兼施，不可温补。只此数语，便足投病患之机，动旁人之听
矣！而于药，则单择轻飘飘无力者三十余种，凡治一病，无论寒热虚实，男妇老幼，及轻浅危笃者，悉以此投
之。正如戴宽大之帽，不必各合人头；又如嚼屠门之肉，何须真充人腹？至若参、 、归、术等项，稍有益于
元气者，概行删去不用，诚恐味浓之药，一有不当，即显弊端，招人指责。不若轻清之味，虽不见功亦不见其
害，而孰知其大害存焉。邪炽不能为之攻，正衰不能为之辅，由是病患命登鬼录，而医人则病入膏肓矣。此遵
守时套之病，所宜急医者也。○一医医药似对证之病。甚哉！似之一字，为害匪轻也。孔子曰∶恶似而非者，
不恶其非。而恶其似而非，良有以也。夫医之权衡，在
于用药；药之妙用，期于对证。无如今之所谓对证者，正其不对证者也，何也？徒得其似故也。如发热，则用
经义
“望而知之谓之神，闻而知之谓之圣，问而知之谓之工，切而知之谓之巧。”（出自《素问》）
通过观察病人的神色形态就能诊断病情，称为神；通过听病人的声音、嗅病人的气味就能诊断病情，称为圣；通过询问病人的病史和感受就能诊断病情，称为工；通过切按病人的脉搏就能诊断病情，称为巧。
“医不三世，不服其药。”（出自《礼记》）
如果医生没有传承三代以上的医学经验，就不要服用他的药。
“三折肱知为良医。”（出自《左传》）
一个人如果多次折断手臂，在反复治疗中积累了经验，就能成为良医。
“人而无恒，不可以作巫医。”（出自《论语》）
做人如果没有恒心，就不能做巫师或医生。
哲言
“九折臂而成医。”（出自《楚辞》）
多次折断手臂，经过长期的实践和治疗，就能成为医生。
“不为良相，则为良医。”（范文正公范仲淹语）
如果不能做优秀的宰相，那就做优秀的医生。
“人之所病病疾多，医之所病病道少。”（扁鹊语）
病人担忧的是疾病繁多难治，医生担忧的是医学道理太少（难以穷尽）。
古之医者：上医医国，中医医人，下医医病；上医听声，中医察色，下医诊脉；上医医未病，中医医欲病，下医医已病。○今之医者，不思求经旨，以演其所知；各承家伎，始终循旧，省病问疾，务在口给，相对斯须，便处汤药。按寸不及尺，握手不及足，人迎、趺阳，三部不参，动数发息，不满五十。短期未知，诊决九候，曾无仿佛；明堂阙庭，尽不见察，所谓窥管而已。欲视死别生，固亦难矣，此皆医之深戒也。（出自《千金方》）
古代的医生：高明的医生治理国家（调理社会风气以预防疾病），一般的医生治疗普通人，低劣的医生只治疗具体的病症；高明的医生通过听声音来诊断，一般的医生通过观察气色来诊断，低劣的医生通过切脉来诊断；高明的医生治疗尚未发生的疾病（治未病），一般的医生治疗即将发生的疾病，低劣的医生治疗已经发生的疾病。○现在的医生，不思考探究经典医籍的宗旨，来推演扩展自己的知识；各自继承家传的技艺，始终沿袭旧法，诊治病人时，只致力于口才敏捷，面对面片刻之间，就开出处方用药。切脉时只按寸口而不及尺部，只握着手而不及足部，人迎穴、趺阳穴与寸口这三部脉象不互相参照，呼吸次数计算不足五十次。对于疾病的预后期限不知道，通过九候脉法来诊断决断，却毫无把握；面部明堂、阙、庭等部位的气色完全不加观察，这就像是从竹管里看天一样狭隘。想要区分生死，本来就很难了，这些都是医生应当深深警惕的。（出自《千金方》）
夫医者，非仁爱之士，不可托也；非聪明达理，不可任也；非廉洁明良，不可信也。是以古之用医，必选其德能仁恕博爱，其智能宣畅曲解，能知天时运气之序，能明性命吉凶之数，处虚实之分，定顺逆之节，原疾病之轻重，量药剂之多少，贯微洞幽，不失细小，如此乃谓良医。（出自《初学记》）
医生这个职业，如果不是仁爱之士，不可托付生命；如果不是聪明通达事理之人，不可任用；如果不是廉洁贤良之人，不可信任。因此古人选用医生，必定选择那些品德具备仁爱宽厚、博爱之心，智慧能够通晓事理、善于变通理解，能够知晓天时气候与五运六气的规律，能够明白生命本性与吉凶祸福的道理，能够处理虚证与实证的分别，确定顺证与逆证的节度，推究疾病的轻重程度，衡量药剂剂量的多少，洞察精微隐秘之处，不遗漏细微末节，像这样的人才叫做良医。（出自《初学记》）
医之为道，非精不能明其理，非博不能致其约。是故前人立教，必使之先读儒书，明《易》理、《素》、《难》、《本草》、《脉经》，而不少略者何？盖非四书，无以通义理之精微；非《易》，无以知阴阳之消长；非《素问》，无以识病，非《本草》，无以识药；非《脉经》，无以诊候而知寒热虚实之证。（出自《医学集成》）
医学这门学问，如果不精深就不能阐明其中的道理，如果不广博就不能达到简约的境界。所以前人设立教学规范，一定让他们先读儒家书籍，通晓《易经》的道理，以及《黄帝内经·素问》、《黄帝内经·难经》、《神农本草经》、《脉经》，而不稍有省略，这是什么原因呢？大概是因为不读《四书》，就无法通晓义理的精微之处；不读《易经》，就无法知晓阴阳的消长变化；不读《素问》，就无法认识疾病；不读《本草》，就无法认识药物；不读《脉经》，就无法通过诊察脉象来了解寒热虚实的证候。（出自《医学集成》）
不知《易》者，不足以言太医。惟会理之精，故立论之确，即遗之万世而无弊。彼知医不知《易》者，拘方之学，一隅之见也。以小道视医，以卜筮视《易》，亦蠡之测，豹之窥也，恶足以语此。（出自《医旨绪余》）
不了解《易经》的人，不足以称为太医。只有融会贯通了道理的精髓，所以建立的论点才确切，即使流传万世也没有弊端。那些只知道医术却不知道《易经》的人，是拘泥于固定方剂的学问，只是片面的见解。把医学看作小道，把《易经》看作卜筮之术，这也像是用贝壳测量大海、从竹管里看豹子一样狭隘，哪里足以谈论这些高深的道理呢？（出自《医旨绪余》）
儒家有尧舜，医家有轩岐也。儒家有孔子，医家有仲景也。尧舜之道，非孔子而不传；轩岐之道，非仲景而莫显。世未有不读孔子书而称儒者，多有不读仲景书而称医者。（程郊倩语）
儒家有尧帝和舜帝，医学界有轩辕黄帝和岐伯。儒家有孔子，医学界有张仲景。尧舜的道统，没有孔子就不会流传；黄帝岐伯的医学道统，没有张仲景就不会显著。世间没有不读孔子著作却自称儒者的，但有很多不读张仲景著作却自称医生的。（程郊倩语）
仓公神医，乃生五女而不生男。其师公乘阳庆，亦年七十余无子，医乃无种子之术。（李濂《医史》）
神医淳于意（仓公），生了五个女儿而没有儿子。他的老师公乘阳庆，也是七十多岁没有儿子，可见医学并不是保证生育儿子的法术。（李濂《医史》）
医家切须自养精神，专心道业，勿涉一毫外务。盖医者意也，审脉、辨证、处方，全赖以意为主，倘精神不足，则厌烦苟率，而艰于深心用意矣。○孙思邈之祝医者曰∶行欲方而智欲圆，心欲小而胆欲大。嗟乎！医之神良尽于此矣。宅心醇谨，举动安和，忌心勿起，贪念罔生，毋忽贫贱，毋惮疲劳，检医典而精求，对疾苦而悲悯，如是者谓之行方。禀赋有浓薄，年岁有老少，身形有肥瘦，性情有缓急，境地有贵贱，风气有柔强，天时有寒热，昼夜有重轻，受病有新久，运气有太过不及，知常知变，能神能明，如是者谓之智圆。望、闻、问、切宜详，补、泻、寒、温须辨，当思人命至重，冥报难逃，如是者谓之心小。补即补而泻即泻，热斯热而寒斯寒，抵当、承气，时用回春，姜附、理中，恒投起死，如是者谓之胆大。四者似分而实合也。（出自《冯氏锦囊》）
医生必须特别注重保养自己的精神，专心于医学事业，不要沾染丝毫的外界事务。因为医生靠的是意念（直觉与思维），审察脉象、辨别证候、开具处方，全都依赖意念为主导，如果精神不足，就会厌烦草率，难以深入用心思考。○孙思邈祝愿医生时说：行为要方正，智慧要圆融，心思要细致谨慎，胆量要宏大。唉！医生神奇良善的品质都包含在这里了。心地纯正严谨，举止安详平和，不起嫉妒之心，不生贪婪之念，不轻视贫贱之人，不畏惧劳累，查阅医典并精心探求，面对疾苦充满悲悯，像这样的人叫做行为方正。人的天赋有厚薄，年龄有老少，身形有肥瘦，性情有缓急，境遇有贵贱，地域风气有柔和刚强，天时气候有寒热，昼夜病情有轻重，患病有新旧，运气有太过与不及，懂得常规又懂得变通，能够神奇且明智，像这样的人叫做智慧圆融。望、闻、问、切四诊应当详细，补、泻、寒、温四种治法必须辨别，应当想到人命极其重要，阴间的报应难以逃脱，像这样的人叫做心思细致。该补就补，该泻就泻，该热治就热治，该寒治就寒治，抵当汤、承气汤等方剂，适时使用能使人起死回生，干姜、附子、理中丸等方剂，经常投用能救活垂危病人，像这样的人叫做胆量宏大。这四点看似分开，实则统一。（出自《冯氏锦囊》）
医者根据也，有身者所倚赖以生全者也。想者由心识中想像前境，施设种种名、种种言者也。故将生全有身者，当想定人身平常境界，及不平常境界而为治也。又云∶医者意也，而意之所变为想，以意想平治其不平常，则平常境界，医所当想者矣，故作医想。（卢不远语）
医生是患者的依靠，是有身体的人赖以生存保全的根本。“想”是指心中想象以往的情境，设定各种名称和言语。所以对于需要生存保全的身体，应当想象人体正常的状态，以及不正常的状态来进行治疗。又说：医生靠的是意念，而意念的变化就是“想”，用意念去平复治疗那些不正常的状态，那么正常状态就是医生应当想象的内容，所以称作“医想”。（卢不远语）
馆师无坐板气，地师无流艺气，禅师无杖拂气，炼师无丹汞气，医师无方术气，方是白描画手，本分师家。○医有膏、粱、藜、藿之不同，原其传派多门，趋向不类，难与并为优劣。擅膏粱之术者，专一附桂名世；得藜藿之情者，无非枳橘见长。第膏粱之治多难愈，以其奉养柔脆，痰涎胶固乎上，精神凋丧乎下，即有客邪，非参无以助诸药之力；藜藿之患都易除，以其体质坚韧，表邪可以恣发，里邪可以峻攻，纵有劳伤，一术足以资百补之功。（张路玉语）
私塾老师没有迂腐僵化的气息，风水先生没有江湖骗术的气息，禅师没有持杖挥拂尘的习气，炼丹师没有丹药汞毒的气息，医生没有拘泥于方技的气息，这才是像白描画家一样的高手，才是本分的师长。○医生治疗的病人有富贵（膏粱）和贫贱（藜藿）的不同，原本他们的传承门派众多，趋向不同，很难放在一起比较优劣。擅长治疗富贵病人的医生，专门依附于使用附子、肉桂等大热药物而闻名于世；擅长治疗贫贱病人的医生，无非是在使用枳壳、橘皮等理气药物上见长。但是治疗富贵病人大多难愈，因为他们生活优渥身体娇嫩，痰涎胶结在上焦，精神耗散在下焦，即使有外邪侵袭，不用人参就无法辅助其他药物的力量；贫贱病人的病患都容易去除，因为他们体质坚韧，表邪可以尽情发散，里邪可以猛烈攻逐，即使有劳损内伤，一种方法就足以起到百种补益的功效。（张路玉语）
医不贵于能愈病，而贵于能愈难病；病不贵于能延医，而贵于能延真医。夫天下事，我能之，人亦能之，非难事也；天下病，我能愈之，人亦能愈之，非难病也。惟其事之难也，斯非常人之所能知；病之难也，斯非常医之所能疗。故必有非常之人，而后可为非常之事；必有非常之医，而后可疗非常之病。第以医之高下，殊有相悬。譬之升高者，上一层有一层之见，而下一层者，不得而知之；行远者，进一步有一步之闻，而近一步者，不得而知之。是以错节盘根，必求利器。阳春白雪，和者为谁？○病家之要，难在择医，然而择医非难也，而难于任医。任医非难也，而难于临事不惑，确有主持，而不致朱紫混淆者之为更难也。倘不知此，而偏听浮议，广簇医，则骐骥不多得，何非冀北驽群？帷幄有神筹，几见圮桥杰竖？危急之际，奚堪庸妄之误投？疑似之秋，岂可纷纭之错乱？一着之谬，此生付之矣。以故议多者无成，医多者必败。多何以败也？君子不多也。欲辨其多，诚非易也；然而尤有不易者，则正在知医一节耳。夫任医如任将，皆安危之所关，察之之方，岂无其道？第欲以慎重与否观其仁，而怯懦者实似之；颖悟与否观其智，而狡诈者实似之；果敢与否观其勇，而孟浪者实似之；浅深与否观其博，而强辩者实似之。执拗者若有定见，夸大者若有奇谋。熟读几篇，便见滔滔不竭；道闻数语，何非凿凿有凭？不反者，临涯已晚；自是者，到老无能。执两端者，冀自然之天功；废四诊者，犹瞑行之瞎马。得稳当之名者，有耽搁之误；昧经权之妙者，无格致之明。有曰专门，决非通达；不明理性，何谓圣神？又若以己之心度人之心者，诚接物之要道，其于医也则不可；谓人己气血之难符，三人有疑，从二同者，为决断之妙方，其于医也亦不可；谓愚、智、寡、多之非类必也。小、大、方、圆全其才，神、圣、工、巧全其用，能会精神于相与之际，烛幽隐于元冥之间者，斯足谓之真医，而可以当性命之任矣。○明哲二字，为见机自保也。夫医患不明，明则治病何难哉？而所患者，在人情耳！人事之变，莫可名状。如我有独见，岂彼所知？使彼果知，何藉于我？每有病临危剧，尚执浅见，从旁指示，某可用某不可用，重之云太过，轻之言不及，一不合意，必有后言，是当见机之一也。有杂用不专，主见不定，药已相投，渠不知觉，忽惑人言，舍此慕彼；凡后至者，欲显己长，必谈前短，及其致败，反以嫁谗，是当见机之二也。有病入膏肓，势必难疗，怜其苦求，勉为举手，当此之际，使非破格出奇，何以济急？倘出奇无功，徒骇人目，事后必招浮议，是当见机之三也。或有是非之场，争竞之所，利害所居，恐涉其患，是当见机之四也。有轻医重巫，可无可有，徒用医名，以尽人事；尚有村鄙之夫，不以彼病为恳，反云为我作兴，吁！诚可哂也，是当见机之五也。有议论繁杂者，有亲识要功者，有内情不协者，有任性反复者，皆医中所最忌，是当见机之六也。凡此六者，俱当默识，而惟于缙绅之间，尤当加意。盖恐其不以为功，而反以为罪，何从辨哉？虽曰∶吾尽吾心，非不好生。然势有不我由者，不得不见机进止，明哲自保，不可少也。（张景岳语）
医生可贵之处在于能治愈疑难病症，而不是仅仅能治愈普通疾病；病人可贵之处在于能请到真正的医生，而不是仅仅能请到医院医生。天下的事情，我能做，别人也能做，这就不是难事；天下的病，我能治好，别人也能治好，这就不是难病。只有事情很难，这不是常人所能知道的；病很难，这不是普通医生所能治疗的。所以必须有非凡的人，然后才能做非凡的事；必须有非凡的医生，然后才能治疗非凡的病。只是医生的高下，相差悬殊。比如登高的人，上一层楼有一层的见识，在下面的人无法知道；走远路的人，进一步有一路的见闻，落后一步的人无法知道。所以遇到盘根错节的难题，必须寻求锋利的工具。高雅的音乐《阳春白雪》，能跟着唱和的人有多少？○病人家的关键，难点在于选择医生，然而选择医生并不难，难在于信任医生。信任医生并不难，难在于面对事情时不被迷惑，确实有主见，而不导致黑白混淆（朱紫混淆）的人更为难得。如果不懂这个道理，偏听浮泛的议论，聚集很多医生，那么千里马（良医）很少得到，哪里不是冀北的劣马群？军营中有神妙的计策，哪里见过在桥上等待豪杰的平庸之辈？在危急时刻，怎么能承受庸俗狂妄医生的误治？在疑似难辨的时候，怎么可以混乱不堪？一步棋走错，这一生就完了。所以议论多的人往往不成事，医生多的人必然失败。为什么多会失败？因为君子不随波逐流。想要分辨哪些是多餘的，确实不容易；然而尤其不容易的，就在于识别医生这一环节。任用医生如同任用将领，都关系到安危，考察他们的方法，难道没有门道吗？只是如果用是否慎重来观察他的仁德，但怯懦的人看起来很像慎重；如果用是否聪颖来观察他的智慧，但狡诈的人看起来很像聪颖；如果用是否果敢来观察他的勇敢，但鲁莽的人看起来很像果敢；如果用是否渊博来观察他的学识，但强词夺理的人看起来很像渊博。固执的人好像有定见，夸大的人好像有奇谋。熟读几篇文章，就见到滔滔不绝；听说几句话，哪里不是说得头头是道？不知反省的人，到了悬崖边已经晚了；自以为是的人，到老也无能。抓住两头摇摆不定的人，希望依靠自然的功劳；废除四诊的人，就像蒙着眼睛走的瞎马。得到稳妥名声的人，有耽误病情的错误；不明白经权变通奥妙的人，没有格物致知的明智。有人说自己是专家，绝不是通达之人；不明白医理，算什么神圣？又如用自己的心去揣测别人的心，这确实是待人接物的要道，但在医学上却不行；认为人与人的气血难以相符，三个人中有怀疑，听从两个相同的人的意见，作为决断的妙方，这在医学上也不行；认为愚笨与聪明、少数与多数必然不同类。小巧、宏大、方正、圆融兼备其才华，神、圣、工、巧发挥其作用，能够在交往中汇聚精神，在幽暗隐秘之处洞察真相的人，这才足以称为真医，才可以担当性命的重任。○“明哲”两个字，是为了看清时机以保全自己。如果医患之间不明朗，明朗了治病有什么难的？所担心的，是人情世故啊！人事的变化，无法形容。如果我有独到的见解，难道是他们所知道的？如果他们真的知道了，还需要我吗？每当病情危重时，还有人拿着浅薄的见解，在旁边指手画脚，说这个可用那个不可用，说太重了太过分，说太轻了不够，一旦不合心意，一定有后续的闲话，这是应当见机而退的第一种情况。有杂用药物不专注，主见不坚定，药已经对症，病人却不知道，忽然被别人的话迷惑，舍弃这个羡慕那个；凡是后来请到的医生，为了显示自己的长处，必定谈论前面医生的短处，等到导致失败，反而嫁祸于人，这是应当见机而退的第二种情况。有病入膏肓，势必难治，可怜他苦苦请求，勉强出手诊治，在这个时候，如果不是打破常规出奇招，怎么解救紧急？如果出奇招没有功效，只会吓到旁人，事后必然招来非议，这是应当见机而退的第三种情况。或者处于是非之地，争斗之所，涉及利害关系，恐怕牵连祸患，这是应当见机而退的第四种情况。有轻视医生重视巫术的，可有可无，只是借用医生的名义来尽人事；还有乡村粗鄙之人，不把病人的病当作恳求，反而说是为了让我出名，唉！真是可笑，这是应当见机而退的第五种情况。有议论繁杂的，有亲戚朋友邀功的，有内部情况不协调的，有任性反复无常的，都是医生最忌讳的，这是应当见机而退的第六种情况。以上六种情况，都应当默默记住，而对于士大夫阶层，尤其要多加留意。因为担心他们不认为是功劳，反而认为是罪过，从哪里辩解呢？虽然说：我尽了我的心，并非不爱惜生命。然而形势有时不由人控制，不得不看清时机进退，明哲保身，是不可少的。（张景岳语）
一医医不学无术之病。医以生人，亦以杀人；惟学则能生人，不学则适足以杀人。盖不学则无以广其识，不学则无以明其理，不学则不能得其精，不学则不能通其权达其变，不学则不能正其讹、去其弊，如是则冒昧从事，其不至杀人也几希矣！或曰∶医必有传，或传之于师，或传之于祖若父，皆学也。抑知恃此以为学，其去学也远矣！彼仅恃其倾耳听受之逸，必不复有心思研究之劳。且既守其一成不易之规，则必昧乎神明变化之理。一若历代诸贤圣，皆不如其师、其祖、若父之足信从也。一若历代贤圣垂训之书，皆不如师、其祖、若父之口语为足凭也。故善学人，无论有传无传，总非求得乎古昔圣贤之理不可也。自《灵》、《素》而下，以及于近代诸书，无不细心探讨，识高理透，眼快心灵，凡遇一病，必认得真，拿得定，不为邪说所惑，不为假象所欺，得心应手，起死回生。以此言学，则真学也。学真而术自神矣，岂仅仅得之听受之间，守其一成之规者，遂得谓之学哉？若仅恃此以为学，则必得其偏而失其全，得其浅而失其深，得其皮毛而失其神髓，得其俗套而失其真诠，及其临证施治，非隔靴搔痒，即傍皮切血；非画饼充饥，即鸩酒解渴，此术之不精，由学之不足也。此不学无术之病，所宜急医者也。○一医医脉证罔辨之病。凡医人用药，须先认证，认证须先审脉。审脉明，斯认证真；认证真，斯用药当。凡有一证，即有一证之寒、热、虚、实。苟不有以辨之，其能不倒行而逆施乎？惟是证之重者，大寒偏似热，大热偏似寒，大虚偏似实，大实偏似虚，若仅就其似者而药之，杀人在反掌间也。然则于何辨之？即于脉辨之，如伤寒脉浮而紧数，按之有力者，知其证为阳邪在表也；若沉而急数，重按有力者，知其证为阳邪入里也。又如沉而且迟细而且软者，知其证为纯阴无阳也；若浮大满指，按之如丝者，知其证为阴极似阳也。诸如此类，宜细心辨别，斯临证无骑墙之见，用药无相左之虞。其奈近日医家，绝不言此，但曰某药可治某病，某病当用其方，至问其病之为寒、为热、为虚、为实乎？则茫然罔辨也。即或辨之，又往往以虚为实，以寒为热，是又甚于不能辨者也。其不能辨证者，由于不能辨脉也，医尝告人曰∶脉作不得准。更有何者可作准乎？从来证之疑似难决者，须于脉决之，虽昔贤亦有从脉不从证，从证不从脉之论。抑知所谓不从者，正深于从也。如沉细迟涩，乃阴寒脉也，而其证却烦躁作渴、面赤身热，若以为热证而清之，则毙矣；惟补之温之，不从其假热之证，正从其真寒之证，而非真谓证有不必从者也。又如狂躁力雄，逾垣上屋，此火热证也，而其脉却伏入骨，若以此为阴脉，而温之则危矣；惟清之、下之，不从其阴寒伏之脉，正从其热极反伏之脉，而非真谓脉有不可从者也。总之，从其真不从其假，不从者其外貌，从者其神髓。医家苟不辨此，未有不颠倒错乱。一剂之误，命即随之。此脉证罔辨之病，所宜急医者也。○一医医轻忽人命之病。谚云∶医家有割股之心。安得有轻忽人命者哉？然观于今，而叹其言之不验也。或者古昔之言，而于今不符也。今时之医，不惟无割股之心，若并无援手之意。病家殷勤延医，希冀医能疗疾以安生，而医人若漠不相关，守定故智，以缓不切肤之药，期药之得效，病之得生。迨缓药渐死，又绝无引咎之心，绝无愧悔之意，绝无矜怜之情，其残忍惨刻，不较之屠人而尤加烈哉？推其故，皆原于传受之讹耳！闻名医之传人，曰药性毋浓，药数毋重，气薄剂轻，庶易于解手为之徒者，谨遵名医妙诀，谓病重切不可为人担利害，仍留原病还他。嗟嗟！延医用药，原为去病，若仍留病，何贵乎医？既留病则必不能留命。若留一轻病，必渐加重；若留一重病，必渐至死。还他者，听其从容自死之谓也。所以愈遵轻药易解之师传，共安于留病还人之习向，一任急来，我惟缓受，往往有可生之机，必不用切当之药以相救，只恐失一己之名与利遂罔顾人之死与生。此轻忽人命之病，所宜急医者也。○一医医遵守时套之病。天下事莫便于套，亦莫害于套。医而涉套，则至便而尤至害者也。时套之学也至易，不必费心思之劳，不必多研究之苦，不烦按脉、切理，不待读书讲求，不待深究药性，详察病情，只学一二最易入俗之语。凡视一病，便云是火。或病患自以为虚，则云虽虚却不可补。或云∶只宜平补，不可过补。或云∶只宜清补兼施，不可温补。只此数语，便足投病患之机，动旁人之听矣！而于药，则单择轻飘飘无力者三十余种，凡治一病，无论寒热虚实，男妇老幼，及轻浅危笃者，悉以此投之。正如戴宽大之帽，不必各合人头；又如嚼屠门之肉，何须真充人腹？至若参、 、归、术等项，稍有益于元气者，概行删去不用，诚恐味浓之药，一有不当，即显弊端，招人指责。不若轻清之味，虽不见功亦不见其害，而孰知其大害存焉。邪炽不能为之攻，正衰不能为之辅，由是病患命登鬼录，而医人则病入膏肓矣。此遵守时套之病，所宜急医者也。○一医医药似对证之病。甚哉！似之一字，为害匪轻也。孔子曰∶恶似而非者，不恶其非。而恶其似而非，良有以也。夫医之权衡，在于用药；药之妙用，期于对证。无如今之所谓对证者，正其不对证者也，何也？徒得其似故也。如发热，则用
Jingyi (Scriptural Principles)
"To diagnose by observation is called 'Shen' (Divine); to diagnose by listening and smelling is called 'Sheng' (Sage); to diagnose by inquiry is called 'Gong' (Skilled); to diagnose by palpation is called 'Qiao' (Dexterous)." (*Suwen*, *Yellow Emperor's Inner Canon*)
"If a physician has not practiced for three generations, do not take their medicine." (*Book of Rites*)
"After breaking one's arm three times, one knows how to be a good physician." (*Zuo Zhuan*)
"If a person lacks perseverance, they cannot serve as a shaman or physician." (*Analects*)
Zheyan (Philosophical Sayings)
"Breaking one's arm nine times leads to becoming a physician." (*Chu Ci*, *Songs of Chu*)
"If one cannot be an excellent chancellor, one should become an excellent physician." (Fan Zhongyan)
"What patients fear is the multitude of diseases; what physicians fear is the scarcity of medical principles." (Bian Que)
Ancient Physicians: The superior physician treats the state, the average physician treats the person, and the inferior physician treats the disease; the superior physician listens to sounds, the average physician observes complexions, and the inferior physician diagnoses pulses; the superior physician treats disease before it arises, the average physician treats disease before it manifests, and the inferior physician treats disease after it has occurred. ○ Modern physicians do not ponder the principles of the classics to expand their knowledge; each inherits family skills and follows old traditions. In examining illnesses and asking about ailments, they strive only for eloquence. Facing the patient briefly, they immediately prescribe decoctions. When palpating the pulse, they check the Cun position but neglect the Chi position; they grasp the hand but neglect the foot. They do not compare the Renying, Dicang, and Cun positions together. They count breaths for fewer than fifty cycles. They do not know the short-term prognosis, nor can they determine the condition through the Nine Pulse Positions, showing no understanding at all. They fail to observe the Mingtang, Que, and Ting areas of the face, which is like looking at the sky through a tube. To distinguish between death and life under such conditions is indeed difficult; these are deep warnings for physicians. (*Qianjin Fang*, *Essential Prescriptions Worth a Thousand Gold*)
A physician must be a man of benevolence and love; otherwise, lives cannot be entrusted to him. He must be intelligent and understand principles; otherwise, he cannot be employed. He must be honest and virtuous; otherwise, he cannot be trusted. Therefore, in ancient times, when selecting a physician, one would choose someone whose virtue included benevolence, forgiveness, and universal love, and whose intelligence allowed for clear communication and flexible understanding. Such a person could know the order of heavenly timing and the Six Qi movements, understand the numbers of life, death, fortune, and misfortune, distinguish between deficiency and excess, determine the rhythm of favorable and unfavorable conditions, assess the severity of diseases, measure the dosage of medicines, penetrate subtle mysteries, and not miss any details. Only such a person could be called a good physician. (*Chuxue Ji*, *Beginner's Records*)
The Way of Medicine requires precision to understand its principles and breadth to achieve simplicity. Therefore, predecessors established teaching methods requiring students to first read Confucian books, understand the principles of the *Yijing* (*Classic of Changes*), *Suwen* (*Basic Questions*), *Nanjing* (*Classic of Difficult Issues*), *Bencao* (*Materia Medica*), and *Maijing* (*Pulse Classic*), without omitting any. Why? Because without the Four Books, one cannot comprehend the subtleties of principles; without the *Yijing*, one cannot know the waxing and waning of Yin and Yang; without the *Suwen*, one cannot recognize diseases; without the *Bencao*, one cannot recognize herbs; and without the *Maijing*, one cannot diagnose and know the patterns of cold, heat, deficiency, and excess. (*Yixue Jicheng*, *Medical Integration*)
One who does not know the *Yijing* is unworthy of being called a Grand Physician. Only by mastering the essence of principles can one establish accurate theories that remain flawless for ten thousand generations. Those who know medicine but not the *Yijing* are confined to fixed formulas and hold partial views. Viewing medicine as a minor art and the *Yijing* as divination is like measuring the sea with a gourd or glimpsing a leopard through a tube; how can such people discuss this profound subject? (*Yizhi Xuyu*, *Remainders of Medical Intent*)
Confucianism has Yao and Shun; the medical field has Xuanyuan (Yellow Emperor) and Qibo. Confucianism has Confucius; the medical field has Zhang Zhongjing. The Way of Yao and Shun is not transmitted without Confucius; the Way of Xuanyuan and Qibo is not revealed without Zhang Zhongjing. There is no Confucian in the world who does not read Confucius's books, yet many claim to be physicians without reading Zhang Zhongjing's books. (Cheng Jiaoqian)
Cang Gong (Chunyu Yi), the divine physician, had five daughters but no sons. His teacher, Gongcheng Yangqing, was also over seventy years old and had no son. Thus, medicine is not a technique for producing heirs. (Li Lian, *History of Medicine*)
Physicians must carefully nurture their spirit, devote themselves to their profession, and avoid any external affairs. For a physician relies on "Yi" (mind/intuition). Examining pulses, differentiating syndromes, and prescribing medications all depend on this intuition. If the spirit is insufficient, one becomes impatient and careless, finding it difficult to apply deep thought. ○ Sun Simiao wished upon physicians: "Let your conduct be square, your wisdom round, your heart small, and your courage great." Alas! The divinity and excellence of medicine are contained herein. Having a pure and cautious heart, acting with calmness and harmony, avoiding jealousy, eliminating greed, not ignoring the poor and lowly, not fearing fatigue, consulting medical classics with precision, and feeling compassion for suffering—this is called "Square Conduct." Constitution varies in thickness, age in youth and old age, body in fat and thin, temperament in slow and quick, status in noble and base, local climate in gentle and strong, weather in cold and hot, day and night in heavy and light, illness in new and old, and Qi movement in excess and deficiency. Knowing the constant and the variable, being divine and enlightened—this is called "Round Wisdom." Observation, listening, inquiry, and palpation should be detailed; tonification, purgation, cold, and heat treatments must be distinguished. One must consider that human life is extremely important and karmic retribution is inescapable—this is called "Small Heart." Tonify when tonification is needed, purge when purgation is needed, treat heat with heat [sic: likely typo in source or specific context, usually heat with cold], treat cold with cold. Using Didang Tang or Chengqi Tang appropriately can bring back spring; using Ginger, Aconite, or Lizhong Wan frequently can revive the dying—this is called "Great Courage." These four seem separate but are actually united. (*Fengshi Jinnang*, *Feng's Brocade Pouch*)
Medicine is the foundation; those with bodies rely on it for survival. "Xiang" (Imagination/Thought) refers to imagining past situations within the mind and assigning various names and words. Therefore, for those needing survival, one must imagine the normal state of the human body and the abnormal state to provide treatment. It is also said: Medicine relies on "Yi" (Mind), and the transformation of "Yi" is "Xiang." Using imagination to normalize the abnormal means the normal state is what the physician should imagine; thus, it is called "Medical Imagination." (Lu Buyuan)
A tutor should not have a rigid air; a geomancer should not have a superficial air; a Zen master should not have a staff-and-fly-whisk air; an alchemist should not have a cinnabar-and-mercury air; a physician should not have a formula-and-technique air. Only then are they like a line-drawing artist, a true master. ○ Physicians encounter patients from rich (Gao Liang - fatty/sweet food) and poor (Li Huo - coarse grain) backgrounds. Their schools of thought differ, making it hard to compare them. Those skilled in treating the rich specialize in Fu Zi (Aconite) and Gui Zhi (Cinnamon Twig) to gain fame. Those attuned to the poor excel in Zhi Ke (Tangerine Peel) and Ju Hong (Pomelo Peel). However, treating the rich is often difficult because their constitutions are delicate due to luxurious living; phlegm and fluid accumulate above, and spirit declines below. Even with external pathogens, Ginseng is needed to support other herbs. Treating the poor is easier because their constitutions are tough; exterior pathogens can be freely released, and interior pathogens can be aggressively attacked. Even with劳伤 (labor injury), one method suffices for multiple tonifications. (Zhang Luyu)
A physician is valued not for curing diseases generally, but for curing difficult diseases. A patient is valued not for merely hiring a physician, but for hiring a true physician. Things that anyone can do are not difficult; diseases that anyone can cure are not difficult. Only when things are difficult are they beyond common knowledge; only when diseases are difficult are they beyond ordinary physicians. Thus, extraordinary people are needed for extraordinary deeds; extraordinary physicians are needed for extraordinary diseases. The difference between high and low physicians is vast. Like climbing higher, each level offers a new view unknown to those below; like traveling far, each step brings new insights unknown to those lagging behind. Therefore, for knotty problems, sharp tools are required. Who can sing along to the high song of *Yangchun Baixue*? ○ The key for patients lies in choosing a physician. Choosing is not hard; trusting is harder. Trusting is not hard; remaining unconfused in crisis, having firm leadership, and preventing confusion (mixing red and purple) is even harder. If one does not understand this and listens to floating rumors, gathering many physicians, one fails to find the Qiji (steed) and ends up with a herd of inferior horses from Jibei. Where are the heroes of the Pi Bridge in the strategic tent? In crises, how can one bear the errors of mediocre and reckless doctors? In times of doubt, how can one tolerate chaos? One wrong move costs a lifetime. Hence, too many opinions lead to failure; too many doctors lead to defeat. Why? Because gentlemen do not follow the crowd. Distinguishing the superfluous is hard; yet recognizing the true physician is hardest. Appointing a physician is like appointing a general; both concern safety and danger. Is there no method to examine them? If we judge benevolence by caution, the timid look similar; if we judge wisdom by acuity, the cunning look similar; if we judge courage by decisiveness, the rash look similar; if we judge erudition by depth, the argumentative look similar. Stubborn people seem to have definite views; exaggerators seem to have strange plans. Reading a few articles makes one speak endlessly; hearing a few words seems solid. Those who do not reflect arrive late at the cliff; those who are self-righteous are incompetent until old age. Those holding both extremes hope for natural merit; those abandoning the Four Diagnostics are like blind horses walking. Those gaining a reputation for stability cause delays; those ignorant of flexibility lack clarity. Claiming specialization is never truly comprehensive; not understanding reason and principle, how can one be sage-like? Judging others by oneself is a key way of interacting, but not in medicine. Assuming others' Qi and blood match one's own is flawed; relying on the majority opinion (two out of three) for decision-making is also flawed in medicine. Small, large, square, and round talents must be complete; Shen, Sheng, Gong, and Qiao functions must be utilized. One who gathers spirit in interaction and illuminates hidden truths in the mysterious depths is worthy of being called a true physician and can bear the responsibility of life and death. ○ "Mingzhe" (Wise and Clear-sighted) means seeing opportunities to protect oneself. If doctor and patient are not clear-minded, treating disease is easy. The problem lies in human relations! Human changes are indescribable. If I have unique insight, do they know it? If they knew, why would they need me? Often, when a disease is critical, people still offer shallow advice from the side, saying this herb is usable or not, criticizing doses as too heavy or too light. If displeased, they speak ill later. This is the first situation requiring discretion. Some use mixed medicines without focus, changing minds suddenly, abandoning effective treatment for others' suggestions. New doctors criticize previous ones to show off, and when failure occurs, blame others. This is the second situation. For terminal illnesses, pitying the patient's plea, one might try a breakthrough treatment. If it fails, it shocks people and invites criticism. This is the third situation. In places of dispute and interest, fearing involvement, one should retreat. This is the fourth situation. Some despise doctors and favor shamans, using doctors only nominally. Some villagers do not care about the illness but want to boost the doctor's reputation. This is laughable and the fifth situation. Complex discussions, relatives seeking credit, internal discord, and capriciousness are all taboo for doctors—the sixth situation. All six must be remembered, especially regarding officials, who might turn merit into crime. Although one says, "I did my best, I love life," circumstances may not allow it. One must see opportunities to advance or retreat and protect oneself wisely. (Zhang Jingyue)
One disease treated by physicians is "Ignorance and Incompetence." Medicine can save lives or take them. Only learning saves; ignorance kills. Without learning, one cannot broaden knowledge, clarify principles, attain precision, master flexibility, correct errors, or remove abuses. Acting rashly in such cases nearly guarantees killing the patient. Some say: Medicine is passed down from teachers or ancestors; this is learning. But relying solely on this is far from true learning. Relying on the ease of listening prevents mental research. Adhering to fixed rules obscures the principles of divine change. It implies past sages were less trustworthy than one's teacher or father. Good learners, regardless of lineage, seek the principles of ancient sages. From *Linghu* and *Suwen* to modern texts, they explore carefully, possessing high insight and clear logic. When encountering a disease, they identify it truly and firmly, not confused by false theories or deceived by illusions, achieving mastery and reviving the dying. This is true learning. True learning makes skills divine. Merely listening and following fixed rules is not learning. Relying on this leads to partiality, shallowness, superficiality, and vulgarity. In practice, treatment becomes ineffective (scratching an itch from outside a boot) or harmful (cutting skin/blood). It is like drawing a cake to satisfy hunger or drinking poison to quench thirst. This imprecision stems from insufficient learning. This disease of incompetence needs urgent cure. ○ Another disease is "Inability to Differentiate Pulses and Syndromes." Physicians must confirm the syndrome before prescribing, and confirm the syndrome by examining the pulse. Clear pulse diagnosis leads to true syndrome differentiation, which leads to appropriate medication. Every syndrome has cold, heat, deficiency, or excess. Without differentiation, one acts backwards. Severe cases may present with cold resembling heat, heat resembling cold, deficiency resembling excess, or excess resembling deficiency. Medicating based on resemblance kills instantly. How to differentiate? By the pulse. For example, in Cold Damage, a floating, tight, rapid pulse that is forceful indicates Yang pathogen in the exterior. A deep, rapid, forceful pulse indicates Yang pathogen entering the interior. A deep, slow, fine, soft pulse indicates pure Yin without Yang. A floating, large, thread-like pulse indicates extreme Yin resembling Yang. Careful differentiation prevents hesitation and conflicting treatments. However, modern physicians rarely discuss this, simply stating "Herb X treats Disease Y." When asked about cold/heat/deficiency/excess, they are茫然 (at a loss). Even if they differentiate, they often mistake deficiency for excess and cold for heat, worse than not differentiating at all. Their inability to differentiate syndromes stems from inability to differentiate pulses. Some physicians claim pulses are unreliable. What else is reliable? Historically, when syndromes are doubtful, pulses decide. Ancients spoke of "following pulse not syndrome" or "following syndrome not pulse." Understanding this, "not following" is actually deep "following." For instance, a deep, fine, slow, choppy pulse is Yin-Cold, but symptoms include irritability, thirst, red face, and fever. Treating as Heat and clearing would be fatal. One must tonify and warm, not following the fake Heat symptom but the real Cold syndrome. Similarly, mania and climbing walls indicate Fire-Heat, but a pulse buried deep suggests Yin. Treating as Yin-Cold and warming would be dangerous. One must clear and purge, not following the hidden Yin pulse but the pulse of extreme Heat hiding. In short, follow the truth, not the false appearance. Failing to discern this leads to chaos. One erroneous prescription costs a life. This inability to differentiate pulses and syndromes needs urgent cure. ○ Another disease is "Negligence of Human Life." Proverb says: Physicians have a heart willing to cut their own flesh. How can there be negligence? Observing today, this seems untrue. Perhaps ancient words don't fit today. Modern physicians lack not only the willingness to sacrifice but also the desire to help. Patients eagerly hire physicians hoping for healing, but physicians act indifferent, sticking to old habits, using slow-acting drugs, hoping for effect. As patients die slowly, physicians feel no guilt, remorse, or pity, being more cruel than butchers. The cause is erroneous transmission. Famous teachers teach: "Do not use strong herbs, do not use heavy doses, keep qi thin and dosage light, so apprentices can easily handle them." Following this, physicians believe taking risks for severe illness is bad, so they leave the original disease to the patient. Alas! Hiring a physician is to remove disease. Leaving the disease defeats the purpose. Leaving a mild disease worsens it; leaving a severe disease causes death. "Returning the patient" means letting them die calmly. Thus, adhering to light prescriptions and the habit of leaving disease harms patients. Ignoring urgency, using inappropriate drugs to save reputation and profit, disregarding life and death. This negligence needs urgent cure. ○ Another disease is "Adherence to Fashionable Templates." Templates are convenient but harmful. Medicine involving templates is most convenient and most harmful. Fashionable learning is easy: no mental labor, no research, no pulse checking, no reading, no deep study of herbs or diseases. Just learn a few clichés. Seeing a disease, call it Fire. If the patient feels deficient, say "Deficient but cannot tonify." Or "Only mild tonification, no excessive tonification." Or "Clear and tonify together, no warm tonification." These few words please patients and bystanders. For herbs, select thirty+ light, weak options. Treat all diseases—cold, heat, deficiency, excess, male, female, young, old, mild, or critical—with these. Like wearing a wide hat that doesn't fit everyone; like chewing meat at a butcher's shop without eating it. Ginseng, Dang Gui, Bai Zhu, etc., beneficial to Yuan Qi, are deleted for fear of strong flavors causing errors and criticism. Light, clear flavors show no merit but also no harm, yet hide great harm. They cannot attack pathogens or support declining Zheng Qi. Patients die, and physicians' skills become terminal. This adherence to templates needs urgent cure. ○ Another disease is "Medication That Seems Correct but Isn't." The character "Si" (Seem/Like) is dangerously harmful. Confucius said: "Hate what seems right but is not." Medicine's balance lies in medication; medication's妙用 (wonderful use) lies in matching the syndrome. Today's "matching" is non-matching because it only resembles. For example, fever...