余老友赵君晴初。生平手不释卷。尤邃于轩岐之学。初不以医自名。命剂辄效。有不可为者。顾能早决之。以是四
方求治者。接踵无虚日。君犹虑耳目之隘也。虚心访道。不惮涉历。孜孜焉。汲汲焉。盖靡刻不留意于活人济世。余
懵不知医。而乐与君游。尝聆其绪论。阐发义理。剀陈利弊。足以拓医家之胸臆。释病者之迷罔。非钻研深。阅历久。
不克臻是。每举其所话。以话于朋辈中之从事于医及见困于病者。惟恐其传之不能遍也。又恐君之苦酬应。不
遑燕居。而未尝笔之于书也。一日。见示是编。受而读之。则其活人济世之怀。俱蔼然流露于楮墨间。而知向之因
其所话以觇其平日之钻研阅历者。犹只十一二焉。今年秋。其友姚静庵广文请付剞劂以行世。余亟怂恿之。爰
不自揣谫陋。焉缀数语于简端。且曩者欲遍布其话而不可得。而今乃得家置一编焉。并以志余之喜也。
光绪辛巳冬月同邑孙垓
事有古守其常而今穷其变者。法家例医家方其是已。夫事物变无穷也。有其备之变。更出所备外。故变无穷。穷
其变者有穷。变无穷。穷其变者当与为无穷。自非挟百试之才。享神明之寿。多其阅历。神其 悟。鲜有能相 相
守。以穷无穷之变者。古锦充囊。积羽折轴。而成书出焉。晴初赵子。精于医。无虚日。年且老。成医话一书。其言曰。
意度者勿录也。道听者勿录也。袭古与违古勿录也。违古而适合乎古。食古而不泥乎古。时或拾古之遗。纠古之失。
补古之阙。释古之疑。或日一得焉。或月一得焉。或积日月而竟无得焉。盖四十年于兹矣。夫岐黄而下至于仲圣。
亦犹夫人耳。某药药某病。某病药某药。上古固无书读也。彼何师而得之与。得之病耳。问得其由。切得其象。而病
诏我矣。问得其象中由。切得其由中象。而病又诏我矣。虽然。中一矢而曰吾善射。捷一战而曰吾善兵。是强狱隶
着刑书也。神而明之存乎证。以问证切。以切证问。以甲证乙。以一证千。而同中之异出焉。夫是之为病证。证者。证
也。法家所谓比例。例者。比也。无以比诸。乌乎例诸。无以证诸。乌乎治诸。如晴初者。可谓老于证治。而善读书者
矣。顾自以为是焉可乎。误于两似而得其一真。悔于百非而衷于一是。是则穷其变而又善自变之说也。晴初之话
医也。暴其短。不炫其长。幸其得。犹悔其失。粹然儒者之言。其临证也。如驾危樯。行大川。守孤城。御 敌。一不
得当。而覆败随之。其生人杀人。不有甚于亭疑狱之平者乎。抑予更有感于天地之好生焉。虑阴阳饮食之杀吾生也。
苦不自知。而脉也贡之。又博生万物。俾各能入人而药之。向非圣人。又谁与起病者而试尝之。此造物之所以大
也。不明乎此。而假手于庸庸者流。几何而不蹈杀人之律乎哉。呜呼危哉。予向不能医。不幸而先人皆痛于沉痼。
其于病也。三折肱矣。读晴初书。为言天下事物之变之无穷而未易穷其变也。其见于一人之身者已如此。
时光绪癸未五月山阴陈锦作于蕺山讲舍
我的老朋友赵晴初先生，一生手不释卷。尤其精通黄帝内经与岐伯的医学理论（轩岐之学）。起初他并不以医生自居，但开出的药方往往有效；对于无法治愈的疾病，他能及早判断并告知患者。因此，四面八方前来求治的人络绎不绝，没有一天是空闲的。赵先生还担心自己的见识狭隘，于是虚心求教，不畏辛劳奔波，勤勉不懈，时刻都留心于救死扶伤、济世救人。
我愚钝不懂医术，却乐于与赵先生交往。曾经聆听他的言论，阐发医理，恳切陈述利弊，足以开阔医家的胸怀，解除病人的迷惑。如果不是钻研深厚、阅历长久，是不能达到这种境界的。我常常将他所谈论的内容讲给朋友圈中从事医疗工作以及被疾病困扰的人听，唯恐他的思想不能广泛传播。又担心他忙于应酬，无暇闲居著书，所以未曾将其记录下来。有一天，他向我展示这本书稿，我拿过来阅读，发现他救死扶伤的胸怀，都温和自然地流露在字里行间。由此可知，之前通过他的谈话来窥探他平日钻研和阅历的深度，还只了解到十分之一二。
今年秋天，他的朋友姚静庵广文请求刻印此书以流传于世。我急忙鼓励支持他，于是也不自量力地在这本书的开头写了几句话。况且从前想要广泛传播他的言论却不可得，如今却能家家拥有一编，这也表达了我的喜悦之情。
光绪辛巳年（1881年）冬天，同乡孙垓
世间有些事古人坚守常规，而今人则穷尽变化，医家处方用药正是如此。事物的变化是无穷的，有些变化超出了预先的准备，所以变化无穷无尽。要穷尽这些变化是有极限的，而变化本身是无穷的，穷尽变化的能力应当随着变化而无穷延伸。除非具备百试百灵的才能，享有神明般的寿命，拥有多重的阅历和神妙的悟性，很少有人能始终坚守原则，从而穷尽无穷的变化。就像古锦装满口袋，羽毛堆积压断车轴一样，最终汇集成书。
赵晴初先生精于医术，从未虚度一日，年事已高，写成《医话》一书。他说：“凭主观臆测的不要记录，道听途说的不要记录，盲目沿袭古人或违背古人的不要记录。违背古人却符合古法精神，食古而不拘泥于古，有时拾取古人的遗漏，纠正古人的失误，补充古人的缺漏，解释古人的疑惑。有时一天有所心得，有时一月有所心得，有时积累日月却毫无所得。这样坚持了四十年。”
从黄帝、岐伯到张仲景，也不过是人罢了。某药治某病，某病用某药，上古时代本来就没有书可读，他们向谁学习而获得这些知识的呢？是从病人那里获得的。询问得知病因，切脉得知脉象，疾病就启示我了。询问得知脉象中的病因，切脉得知病因中的脉象，疾病又启示我了。虽然如此，射中一箭就说自己善于射箭，打赢一场仗就说自己善于用兵，这就像是强迫监狱里的囚犯去编写刑法书籍一样。神妙之处在于对证候的理解，通过问诊和切脉来验证证候，通过切脉和问诊来验证证候，以此证彼，以一证推千证，从而发现相同病症中的差异。这就叫做“病证”。“证”，就是证据/证明。医家所说的“比例”，“例”就是类比。如果没有类比的基础，怎么运用法则？如果没有证候的依据，怎么进行治疗？像赵晴初这样的人，可以说是老于辨证治疗，且善于读书的人了。但是，可以自以为是吗？在两难相似中误判而得到其中一个真理，在百次错误后衷心地归于正确，这就是穷尽变化而又善于自我变革的说法。
赵晴初谈论医学，暴露自己的短处，不炫耀长处；庆幸自己的收获，仍悔恨自己的失误。这是纯粹儒者的言语。他临证时，如同驾驶危船渡过大河，守卫孤城，抵御敌人，一旦不当，覆灭败亡随之而来。他救人杀人，难道不比审判疑案更关乎生死吗？
此外，我对天地好生之德更有感触。担心阴阳失调和饮食不当杀害我们的生命，人们往往痛苦而不自知，于是将希望寄托于脉诊。天地又博生万物，使它们都能进入人体成为药物。若非圣人，又有谁能替病患者尝试百草呢？这是造物主的伟大之处。不明白这一点，而假手于平庸之辈，有多少人不触犯杀人的法律呢？呜呼，危险啊！
我以前不会医术，不幸的是祖先们都患有沉疴顽疾，我对疾病已经“三折肱”（比喻阅历多，经验丰富）。读赵晴初的书，他谈到天下事物变化无穷，难以穷尽其变。体现在一个人身上尚且如此复杂。
时光绪癸未年（1883年）五月，山阴陈锦在蕺山讲舍所作
My old friend, Mr. Zhao Qingchu, never let a book slip from his hands throughout his life. He was particularly profound in the study of *Huangdi Neijing* and Qibo's medical theories (Xuanqi Zhi Xue). Initially, he did not identify himself as a physician, yet the prescriptions he made were invariably effective; for conditions that were incurable, he could make early judgments and inform the patients. Consequently, people seeking treatment from all directions came continuously, with no day passing without visitors. Mr. Zhao still worried about the narrowness of his own vision and experience, so he humbly sought the Way, unafraid of hardship and travel, diligent and eager, paying attention to saving lives and benefiting the world at every moment.
I am ignorant of medicine, but I enjoy associating with Mr. Zhao. I have listened to his preliminary discussions, which elucidate principles and earnestly state pros and cons, sufficient to broaden the minds of physicians and dispel the confusion of patients. Such depth is not achievable without profound study and long-term experience. I often recounted what he discussed to friends engaged in medicine or those troubled by illness, fearing that his insights might not spread widely. I also worried that his busy social engagements left him no leisure to write them down. One day, he showed me this manuscript. Upon reading it, I found that his benevolent intention to save lives and benefit the world flowed naturally and gently through the ink on paper. I realized that my previous understanding of his daily study and experience, based merely on his conversations, had grasped only one or two parts out of ten.
This autumn, his friend, Scholar Yao Jing'an, requested the printing of this work for public circulation. I eagerly encouraged him and, presuming upon my own limited knowledge, wrote a few words at the beginning of this slim volume. Moreover, whereas before I desired to disseminate his words widely but could not, now everyone can possess a copy, which also expresses my joy.
Winter of the Xin-Si Year of Guangxu (1881), Sun Gai, fellow townsman
There are matters where ancients adhered to constants while moderns exhaust variations; the formulation of prescriptions by physicians exemplifies this. The changes in things are infinite; some changes occur beyond what is prepared for, hence changes are endless. To exhaust these changes has limits, but since changes are infinite, the capacity to exhaust them must also be infinite. Unless one possesses talent proven a hundred times, enjoys a lifespan like a deity, has extensive experience, and divine insight, few can maintain adherence to principles while exhausting infinite changes. Just as ancient brocade fills a bag and feathers accumulate until they break an axle, a book emerges.
Mr. Zhao Qingchu excelled in medicine, never wasting a day, and having reached old age, he completed a book of Medical Conversations (*Yi Hua*). He stated: "Do not record subjective speculations; do not record hearsay; do not record blind imitation of ancients or deviation from them. Deviate from ancients yet conform to their spirit; consume ancient knowledge yet do not be rigid by it. Occasionally pick up ancient omissions, correct ancient errors, supplement ancient deficiencies, and explain ancient doubts. Sometimes gaining insight in a day, sometimes in a month, sometimes accumulating days and months without gain. This has continued for forty years."
From Huangdi and Qibo down to Zhang Zhongjing, they were merely humans. Certain herbs treat certain diseases; certain diseases require certain herbs. In ancient times, there were no books to read. Who did they learn from? They learned from patients. By asking, they obtained the cause; by palpation, they obtained the pulse image, and the disease instructed them. By asking, they obtained the cause within the pulse image; by palpation, they obtained the pulse image within the cause, and the disease instructed them again. Nevertheless, hitting one target and claiming skill in archery, or winning one battle and claiming skill in warfare, is akin to forcing prison inmates to write penal codes. Divine illumination resides in the syndrome differentiation (*Zheng*). Through inquiry and palpation, verify the syndrome; through palpation and inquiry, verify the syndrome; use Syndrome A to verify Syndrome B, and use one syndrome to deduce thousands, thereby revealing differences within similarities. This is called "Disease-Syndrome" (*Bing Zheng*). "Syndrome" (*Zheng*) means evidence or proof. What physicians call "proportion" (*Bi Li*), "Example" (*Li*) means analogy. Without analogy, how can rules be applied? Without syndromic evidence, how can treatment proceed? Someone like Mr. Zhao can be said to be experienced in syndrome differentiation and treatment, and skilled in reading books. However, can one be self-righteous? Mistaking one truth amidst two similar possibilities, and regretting hundreds of errors to ultimately adhere to correctness—this is the theory of exhausting variations and being good at self-transformation.
When discussing medicine, Mr. Zhao exposes his shortcomings rather than boasting of strengths; he feels fortunate for gains yet regrets losses. These are the words of a pure Confucian scholar. When treating patients, he acted like navigating a dangerous ship across a great river, guarding a lonely city, or repelling enemies; any misstep led to ruin. Did his actions in saving or taking lives not carry greater weight than judging doubtful cases? Furthermore, I am moved by Heaven and Earth's love for life. I worry that Yin-Yang imbalance and dietary errors kill us; we suffer without knowing why, so we entrust ourselves to pulse diagnosis. Heaven and Earth produce myriad things, enabling them to enter the human body as medicines. If not for sages, who would test these herbs on behalf of the sick? This is the greatness of Creation. Failing to understand this, and relying on mediocre practitioners, how many would not tread the path of killing? Alas, how perilous!
I previously knew no medicine, but unfortunately, my ancestors all suffered from chronic ailments; thus, regarding illness, I have "broken my arm three times" (a metaphor for gaining experience through repeated failure). Reading Mr. Zhao's book, he speaks of the infinite changes in worldly affairs, difficult to fully exhaust. Even manifested in one person, it is thus complex.
May, Gui-Wei Year of Guangxu (1883), Chen Jin of Shanyin, written at Jishan Lecture Hall