夫曰有是病即有是脉者。此亦大概言之。其微渺未必皆可恃乎脉也。如目病。必视其目为内障。为外障。
内障有内障之症。外障有外障之症。必辨其为何症。所中所伤之浅深。果在何轮何廓。辨之明而后治之
当。今闺阁处子。暨夫贵介之族。但舒手于帷幔之外。诊其脉即欲治其病。且责其用药当而效之速。不知
即方脉之专重乎脉者。尤望闻问居其先。而切脉居于后。盖切而知之。仅谓之巧耳。况症之重者。关乎性
命。而惟恃巧以中之。何轻视乎性命耶。必精详审辨。而后治之可也。重性命者。当必以是言为然也。矧目
为五官之最要者哉。假令一瞽目。隐身于帷幔之中。舒其手于帷幔之外。其六脉未尝不与有目者相同
也。切脉者。从何脉辨知其为瞽耶。恐神于脉者。亦未易知。后学岂能臻此之妙。定其残好。必猜度拟议之。
而用药亦猜度拟议之药尔。欲其当而效之速。实难矣。较而论之。两误之中。病者之自误为尤甚也。兹特
摘出其弊。必于诊脉之外。更加详视。始不至有误矣。
复慧子曰。昔有客问先大人云。均一病也。其症不异。子何以治之不同。用药各异。其效有速有迟。有愈有
不愈者。有治之者。有辞而不治者。其故何也。大人闻而应之曰。夫古之善医。先精造乎学业。次通达乎人
事。见机而作。圆融变通。不拘一隅。不执一方。子谓予同病而异治。不知人事有种种不同者也。或男子妇
人。婴儿处女。鳏寡老弱。师尼婢外家。兼之胎前产后与夫情性之温暴。饮食之多寡。二便之通塞。四时之寒
暑温凉。病症之虚实冷热。岁月之远近浅深。有能节戒不能节戒者。服药曾伤元气未伤元气者。千态万
状。不可胜计。治之安可同于一辙乎。况富贵贫贱之殊途。盖富贵之人。其志乐。其性骄。或酒色之不戒。家
务之劳心。暴怒之伤肝。以致五火俱动。且药饵委诸童仆。火候或失宜。故取其效也不易。至于贫贱者。其
志苦。其形劳。或因薪谷之忧。忿怒之伤。或药饵力乏不继。欲愈其疾也更难。予之症同而治异者。盖为此
也。今就先大人之论思之。诚不可拘一隅。不可执一方也。但他恙之戒人酒色劳怒犹易。独目病之戒人
则难。他病身体无力。四肢疲倦。而念难起。惟病目者。身体强健。而念易动。动则精出窍矣。夫天地以日为
阳。雨为阴。人以火为阳。水为阴。人静则生阴。动则生阳。阳生岂不为火乎。至于怒。又为七情之一。最易伤
肝。肝伤则目必损。肝窍于目故也。恣酒助阳。动湿热而烁阴。纵色又为伤肾之要。人身脏腑皆火。单有肾
水一点以制之。岂可轻忽不慎。丹溪先生言。人心君火一动。相火即起。虽不交而精亦暗流矣。又有愚夫
愚妇。病目不知自爱。俱言假此以泄其火。愚谓此非去火。实乃抱薪救火也。将见火未熄。而焰愈炽矣。病
目者不知乎此。则轻症变重。重症变为不治之症者。靡不由乎此耳。业是科者。善为词以深戒之可也。
所谓“有这种病就有这种脉象”，这也是一般性的说法。其中细微奥妙之处，未必都能完全依赖脉诊来判断。比如眼病，必须观察眼睛是内障还是外障。
内障有内障的症状，外障有外障的症状，必须辨别清楚属于哪种症状，以及所受伤邪的深浅，究竟在哪个轮（五轮学说中的眼部特定区域）和廓（白睛等部位）。只有辨析明确，治疗才能得当。如今深闺女子及富贵人家，只是把手伸出帷幔之外，医生一摸脉就想治病，并且要求用药恰当且见效迅速。却不知道即使是专门重视脉诊的方脉医家，也强调望、闻、问排在前面，而切脉排在后面。因为仅靠切脉来诊断，只能算是技巧罢了。况且病情严重的，关乎性命，如果只依靠技巧来揣测，岂不是轻视了性命？必须精细详细地审察辨别，然后才能治疗。重视性命的人，应当认为这话是对的。更何况眼睛是五官中最重要的器官呢？假设一个盲人，躲在帷幔之中，把手伸出帷幔之外，他的六部脉象未尝不与有视力的人相同。切脉的人，从哪条脉能辨别出他是盲人呢？恐怕即使精通脉学的人，也不容易知道。后辈学者怎么能达到这种妙境呢？必定要猜测推度，用药也是猜测推度的药物。想要用药恰当且见效迅速，实在很难啊。比较而言，两次失误中，病人自己的误治更为严重。这里特意摘出其中的弊端，必须在诊脉之外，更加仔细地观察，才不至于出错。
又对慧子说：从前有客人问我的父亲说：“同样是疾病，症状没有差异，您为什么治疗不同，用药各异，有的见效快，有的见效慢，有的痊愈，有的不愈？有的治疗，有的拒绝治疗，这是什么原因？”父亲听后回答说：“古代善于行医的人，先精通医术，其次通晓人情世故。见机行事，圆融变通，不拘泥于一个角落，不固执于一个方子。你说我同病异治，不知道人事情况有种种不同啊。或者是男或女，婴儿或处女，寡妇或鳏夫，老人或体弱者，僧尼或婢女或外戚。再加上产前产后以及性情温和或暴躁，饮食多少，二便通畅或阻塞，四季寒暑温凉，病症虚实冷热，病程远近深浅，有的能节制戒除，有的不能节制戒除，服药是否损伤元气，千态万状，数不胜数。治疗怎么可以千篇一律呢？何况富贵与贫贱的途径不同。大概富贵之人，心志快乐，性格骄纵，或者不戒酒色，家务劳心，暴怒伤肝，导致五脏之火都发动，而且药物交给童仆煎煮，火候有时失当，所以取得疗效不容易。至于贫贱者，心志困苦，形体劳累，或许因为柴米粮食的忧虑，愤怒的伤害，或者药物力量匮乏无法继续，想要治愈他们的疾病更难。我症同而治异的原因，正是为此。现在回想先父的论述，确实不可拘泥于一隅，不可固执于一方。但是其他疾病告诫人戒酒色劳怒还比较容易，唯独眼病的告诫则难。其他疾病身体无力，四肢疲倦，念头难以兴起；唯有患眼病的人，身体强健，而念头容易动摇。一动念，精气就会从窍穴流失。天地以太阳为阳，雨水为阴；人以火为阳，水为阴。人静则生阴，动则生阳。阳生难道不是火吗？至于愤怒，又是七情之一，最容易伤肝。肝受伤则眼睛必然受损，因为肝开窍于目。放纵饮酒助长阳气，扰动湿热而灼烧阴液；纵欲更是伤肾的关键。人身脏腑都是火，仅有肾水一点来制约它，怎么可以轻忽不慎？丹溪先生曾说，人心君火一动，相火随即而起，即使不发生性交，精液也会暗中流失。又有愚昧的男子妇女，患眼病不知自爱，都说借此来泄火。我认为这不是去火，实际上是抱薪救火。将会看到火还没熄灭，火焰却更猛烈了。患眼病的人如果不明白这个道理，那么轻症变重症，重症变为不治之症，无不由此引起。从事这一科的人，善于用言辞深刻告诫他们就可以了。”
The statement "where there is this disease, there is this pulse" is a generalization. Its subtle nuances cannot necessarily be relied upon solely by pulse diagnosis (Qiezhen, cutting the pulse). For instance, in eye diseases (Mubing), one must observe whether it is an internal obstruction (Neizhang) or an external obstruction (Waizhang).
Internal obstructions have their own symptoms, and external obstructions have theirs. One must clearly distinguish which symptom pattern it is, the depth of the injury, and precisely which wheel (Lun, referring to the Five Wheels theory in ophthalmology) and area it affects. Only after clear differentiation can treatment be appropriate. Nowadays, women in secluded quarters and families of high status merely extend their hands outside the curtains; the physician takes the pulse and immediately intends to treat the disease, demanding that the medication be effective and act quickly. They do not realize that even physicians who specialize in pulse diagnosis emphasize inspection (Wang), listening/smelling (Wen), and inquiry (Wen) before palpation (Qie). Pulse diagnosis alone is merely considered a skill. Moreover, severe conditions concern life and death; relying solely on such skills to hit the mark is to slight life itself. One must examine and differentiate with precision and detail before treating. Those who value life should agree with this statement. How much more so since the eyes are the most important among the five sense organs? Suppose a blind person hides within the curtains and extends their hand outside; their six pulses would not differ from those of a person with sight. From which pulse can a practitioner know they are blind? Even a master of pulse diagnosis would find it difficult to ascertain. How could junior practitioners achieve such subtlety? They would inevitably resort to guessing and speculation, and the medications prescribed would also be based on speculation. To expect them to be accurate and quick-acting is truly difficult. Comparatively speaking, among two types of errors, the patient's self-mismanagement is even more severe. Here, I specifically highlight these flaws: one must look carefully in addition to taking the pulse to avoid mistakes.
I again said to Huizi: "Previously, a guest asked my father, 'It is the same disease, the symptoms are identical, why do you treat them differently and use different medicines? Why does efficacy vary—some fast, some slow, some cured, some not? Some are treated, while others are refused treatment. What is the reason?' My father replied upon hearing this: 'Ancient skilled physicians first mastered their profession and then understood human affairs. They acted according to circumstances, were flexible and adaptable, did not stick to one corner, and did not adhere rigidly to one formula. You say I treat the same disease differently; you do not realize that human circumstances vary greatly. There are men and women, infants and virgins, widowers and widows, the elderly and the weak, monks, nuns, maidservants, and relatives. Additionally, there are pre-natal and post-natal states, gentle or violent temperaments, varying amounts of diet, unobstructed or obstructed urination and defecation, the cold, heat, warmth, and coolness of the four seasons, the deficiency-excess and cold-heat nature of diseases, the duration and depth of the illness, whether one can or cannot maintain abstinence, and whether medication has damaged the primordial Qi (Yuanqi). These forms are myriad and countless. How can treatment be uniform? Furthermore, the paths of the rich and the poor differ. Generally, wealthy people have happy minds and proud dispositions; they may not abstain from alcohol and lust, worry over household affairs, or suffer liver injury from violent anger, causing fire in the five zang organs to flare up. Moreover, they entrust decoction to servants, leading to improper heat control, making it hard to achieve efficacy. As for the poor, their minds are bitter, their bodies laborious; they may suffer from worries about food and fuel or injuries from anger. Their financial resources for medicine may be insufficient, making it even harder to cure their ailments. The reason I treat the same symptoms differently is precisely due to these factors. Reflecting on my father's words, one indeed should not be confined to one aspect nor rigidly adhere to one formula. However, advising others to abstain from alcohol, lust, labor, and anger for other diseases is relatively easy; for eye diseases, it is difficult. In other diseases, the body feels weak and limbs tired, making distracting thoughts less likely. But in eye diseases, the body is strong, yet thoughts are easily stirred. Once stirred, essence flows out through the orifices. Heaven and Earth regard the sun as Yang and rain as Yin; humans regard fire as Yang and water as Yin. Stillness generates Yin, movement generates Yang. Does not generating Yang mean generating fire? Anger is also one of the Seven Emotions (Qiqing) and most easily injures the Liver. When the Liver is injured, the eyes are inevitably damaged because the Liver opens into the eyes. Indulging in alcohol boosts Yang, stirs damp-heat, and scorches Yin; indulging in lust is key to injuring the Kidney. All organs and bowels in the human body contain fire, restrained only by a drop of Kidney Water. How can one be negligent? Mr. Danxi stated, 'When the Minister Fire (Junhuo) of the Heart moves, the Ministerial Fire (Xianghuo) arises; even without sexual intercourse, essence secretly flows.' There are also ignorant men and women who, suffering from eye disease, do not cherish themselves, claiming this is a way to vent fire. I believe this is not removing fire but adding firewood to a blaze. The fire will not extinguish, but the flames will intensify. If those with eye diseases do not understand this, mild cases become severe, and severe cases become incurable, all due to this. Practitioners of this specialty should use words to warn them deeply.'"