丙辰秋。楚丘县贾君次子二十七岁。病四肢困倦。躁热自汗。气短。饮食减少。咳嗽痰涎。胸
膈不利。大便秘。形容羸削。一岁间更数医不愈。或曰。明医不如福医。某处某医。虽不精方书。
不明脉候。看证极多。治无不效。人目之曰福医。谚云。饶你读得王叔和。不如我见过病证多。颇
有可信。试命治之。医至。诊其脉曰。此病
予饱谙矣。治之必效。于肺 各灸三七壮。以蠲饮枳实丸消痰导滞。不数服。大便溏泄无度。加腹
痛。食不进。愈添困笃。其子谓父曰。病久瘦弱。不任其药。病剧遂卒。冬予从军回。其父以告予
。予曰。思内经云。形气不足。病气不足。此阴阳俱不足。泻之则重不足。此阴阳俱竭。血气皆尽
。五脏空虚。筋骨髓枯。老者绝灭。壮者不复矣。故曰。不足补之。此其理也。令嗣久病羸瘦。乃
形不足。气短促乃气不足。病潮作时嗜卧。四肢困倦。懒言语。乃气血皆不足也。补之惟恐不及。
反以小毒之剂泻之。虚之愈虚。损之又损。不死何待。贾君叹息而去。予感其事。略陈其理。夫高
医愈疾。先审岁时太过不及之运。察人之血气饮食勇怯。之殊病。有虚实浅深在经在脏之别。药有
君臣佐使大小奇偶之制。治有缓急因用引用返正之则。孙真人云。凡为太医。必须谙甲乙、素问、
黄帝针经、明堂流注、十二经、三部九候、五脏六腑、表里孔穴、本草、药对、仲景、叔和诸部经
方。又须妙解五行阴阳。精熟周易。如此方可为太医。不尔。则无目夜游。动致颠损。正五音者。
必取师旷之律吕。而后五音得以正。为方员者。必取公输之规矩。而后方员得以成。五音方员。特
末技耳。尚取精于其事者。况医者人之司命列于四科。非五音方员之比不精于医，不通于脉。不观
诸经本草。赖以命通运达而号为福医。病家遂委命于庸人之手。岂不痛哉。噫。医者之福。福于渠
者也。渠之福安能消病者之患焉。世人不明此理而委命于福医。至于伤生丧命。终不能悟。此惑之
甚者也。悲夫。
丙辰年秋天，楚丘县一位姓贾的商人的二儿子，二十七岁。他患病后四肢困倦乏力，烦躁发热且自汗，气短，饮食减少，咳嗽并有痰涎，胸膈部感觉不畅利，大便秘结，形体消瘦憔悴。这一年里更换了好几位医生治疗，但病情未愈。有人说：“明医不如福医。”某地有一位医生，虽然不精通方书，也不懂脉候诊断，但看过的病症极多，治疗没有不有效的，人们称他为“福医”。谚语说：“任凭你读得王叔和（《脉经》作者）的书再多，不如我见过的病证多。”这话颇有可信度。于是试着请这位医生来诊治。
医生来到后，诊察他的脉搏说：“这种病我早已熟知了，治疗必定有效。”他在患者的肺俞穴等穴位上各施灸法三七壮（21壮），并用蠲饮枳实丸来消除痰饮、导滞消积。没过几服药，患者大便溏泄无度，并伴有腹痛，无法进食，病情更加困顿危重。他的儿子对父亲说：“病人久病体瘦虚弱，承受不了这样的药力，病情加剧后便去世了。”
冬天我随军返回时，贾君把这件事告诉了我。我说：“思考《内经》中的话：‘形气不足，病气不足，此阴阳俱不足’。如果采用泻法，就会造成双重不足，导致阴阳俱竭，血气耗尽，五脏空虚，筋骨骨髓枯槁。老年人会因此死亡，青壮年也无法恢复。所以说，虚损之证应当用补法。这就是其中的道理。令郎久病羸弱消瘦，这是形气不足；气短急促，这是宗气不足；病情发作时喜欢躺卧，四肢困倦，懒于言语，这是气血皆不足的表现。此时应当进补，还担心补得不够，反而用小毒性的药剂去攻泻它，使得虚者更虚，损者更损，不死还要等到什么时候呢？”贾君叹息着离开了。
我感慨这件事，略述其理。高明的医生治愈疾病，首先要审察岁时气候的太过与不及，观察人的血气、饮食、勇怯等方面的差异。疾病有虚实、浅深、在经在脏的区别；药物有君臣佐使、大小、奇偶的配伍制度；治疗有缓急、因势利导、引用、返正的原则。孙思邈曾说：“凡是担任太医的人，必须精通《甲乙经》、《素问》、《黄帝针经》、《明堂流注》、十二经脉、三部九候、五脏六腑、表里孔穴、本草、药对，以及张仲景、王叔和等人的经方著作。还必须妙解五行阴阳，精熟《周易》。只有这样才可以称为太医。否则，就像盲人夜间行走，动不动就会遭受挫折损伤。正如校正五音的人，必须取法师旷的律吕，然后五音才能校正；制作方圆器物的人，必须取法公输班（鲁班）的规矩，然后方圆才能制成。五音和方圆，只是微小的技艺罢了，尚且要精通此事的人来处理，何况医学是掌管人类生命的学科，位列四科，不是五音方圆所能比拟的。如果不精通医学，不通晓脉理，不研读诸经和本草，却依靠运气通达而号称‘福医’，让病人把性命托付给庸人手中，这难道不令人痛心吗？唉！医生的‘福’，在于他自己的命运罢了。他个人的福气怎么能消除病人的祸患呢？世人不明白这个道理，而把性命托付给‘福医’，以至于伤生丧命，始终不能醒悟，这是非常迷惑的啊。可悲啊。”
In the autumn of the Bingchen year, the second son of a merchant named Jia in Chuqiu County, aged twenty-seven, suffered from fatigue and heaviness in the four limbs, irritability with spontaneous heat and sweating, shortness of breath, reduced appetite, coughing with phlegm-saliva, discomfort in the chest and diaphragm, constipation, and emaciation. Over the course of a year, he was treated by several physicians without recovery. Some said, "A 'Fortunate Doctor' is superior to a 'Clear-Sighted Doctor.'" There was a physician in a certain place who, although not proficient in formularies or pulse diagnosis, had seen many cases and achieved success in all treatments; people called him a "Fortunate Doctor." A proverb goes: "No matter how much you read Wang Shuhe (author of *Mai Jing*), it is not as good as having seen many diseases." This seemed quite credible. Thus, they tried to have him treat the patient.
Upon arrival, the physician examined the pulse and said, "I am well acquainted with this disease; treatment will certainly be effective." He applied moxibustion, thirty-seven moxa cones (21 cones) on each of the Feishu (BL13) acupoints, and administered Juan Yin Zhi Shi Wan (Phlegm-Dispelling Aurantium Pill) to resolve phlegm and guide out stagnation. After just a few doses, the patient experienced profuse loose stools, abdominal pain, inability to eat, and his condition became increasingly critical. His son said to his father, "The patient has been ill for a long time, is thin and weak, and cannot tolerate such medication. The disease worsened, and he eventually died."
In winter, upon returning from military service, Mr. Jia told me about this incident. I said, "Reflecting on the words of the *Neijing* (Inner Canon): 'When both physical constitution and vital energy are insufficient, and the pathogenic factor is also insufficient, this indicates a deficiency of both Yin and Yang.' If one applies purgative methods, it leads to double deficiency, causing exhaustion of Yin and Yang, depletion of blood and Qi, emptiness of the five zang organs, and withering of sinews, bones, and marrow. The elderly may perish, and even the vigorous may not recover. Therefore, it is stated that deficiency should be tonified. This is the principle. Your son's prolonged illness and emaciation indicate a deficiency of physical form; shortness of breath indicates a deficiency of Qi; lethargy during episodes, heaviness in the limbs, and reluctance to speak indicate a deficiency of both Blood and Qi. One should tonify, fearing insufficiency, yet instead, toxic agents were used to purge, making the deficient more deficient and the damaged more damaged. How could he not die?" Mr. Jia sighed and left.
Moved by this event, I briefly expound on its rationale. A skilled physician, before curing an illness, first examines the climatic influences of excess or deficiency in the seasons, observes differences in individuals' blood, Qi, diet, courage, and timidity. Diseases differ in excess or deficiency, superficiality or depth, involvement of meridians or zang organs. Medicines follow the principles of sovereign, minister, assistant, and courier roles, size, and odd/even formulations. Treatments adhere to principles of slowness or urgency, following indications, guiding mechanisms, and restoring correctness. Sun Simiao said, "Anyone serving as a Grand Physician must be proficient in the *Jia Yi Jing*, *Su Wen*, *Huangdi Zhenjing*, *Mingtang Liuzhu*, twelve meridians, three positions and nine inspections, five zang and six fu organs, interior-exterior acupoints, Materia Medica, drug pairs, and the classical formulas of Zhang Zhongjing and Wang Shuhe. Furthermore, one must master the Five Elements and Yin-Yang, and be familiar with the *Zhouyi*. Only then can one serve as a Grand Physician. Otherwise, it is like wandering at night without eyes, inevitably leading to disaster. Just as those who correct the five tones must take Shi Kuang's pitch pipes as standard to rectify the tones, and those who make squares and circles must take Gongshu Ban's compass and square to form them, these are merely minor skills, yet still require experts. How much more so medicine, which governs human life, ranks among the four disciplines, and is not comparable to tones or shapes? Without mastering medicine, understanding pulses, studying classics and materia medica, but relying merely on luck to claim the title of 'Fortunate Doctor,' and letting patients entrust their lives to incompetent hands—is this not painful? Alas! A doctor's 'fortune' lies in his own fate. How can his personal fortune eliminate the patient's calamity? People who fail to understand this principle and entrust their lives to 'Fortunate Doctors,' resulting in injury and death, never waking from this delusion. This is extreme confusion. How sorrowful."