从上古以至今时。一代有一代之医。虽神圣贤明。分量不同。然必不能舍规矩准绳。以为方圆平直也。
故治病必先识病。识病然后议药。药者所以胜病者也。识病。则千百药中。任举一二种用之且通神。不识病。
则歧多而用眩。凡药皆可伤人。况于性最偏驳者乎。迩来习医者众。医学愈荒。遂成一议药不议病之世界。其
夭枉不可胜悼。或以为杀运使然。不知天道岂好杀恶生耶。每见仕宦家。诊毕即令定方。以示慎重。初不论病
从何起。药以何应。致庸师以模棱迎合之术。妄为拟议。迨药之不效。诿于无药。非无药也。可以胜病之药。
以不识病情而未敢议用也。危哉。灵枢素问甲乙难经无方之书。全不考究。而后来一切有方之书。奉为灵宝。
如朱丹溪一家之言。其脉因症治一书。先论脉。次因次症。后乃论治。其书即不行。而心法一书。群方
错杂。则共宗之。又本草止述药性之功能。人不加嗜。及缪氏经疏。兼述药性之过劣。则莫不悬之肘后。不
思草木之性。亦取其偏以适人之用。其过劣不必言也。言之而弃置者众矣。曷不将本草诸药。尽行删抹。独
留无过之药五七十种而用之乎。其于周礼令医人采毒药。以供医事之旨。及历代帝王。恐本草为未
备。而博采增益之意。不大刺谬乎。欲破此惑。无如议病精详。病经议明。则有是病即有是药。病千变。
药亦千变。且勿论造化生心之妙。即某病之以某药为良。某药为劫者。至是始有定名。若不论病。则药之良毒
善恶。何从定之哉。可见药性所谓良毒善恶。与病体所谓良毒善恶不同也。而不知者。必欲执药性为
去取。何其陋耶。故昌之议病非得已也。昔人登 指顾。后效不
爽前言。聚米如山。先事已饶硕画。医虽小道。何独不然。昌即
不能变俗。实欲借此榜样。阐发病机。其能用不能用何计焉。
胡卣臣先生曰。先议病。后用药。真金匮未抽之论。多将 。不可
救药。是能议病者。若药不瞑眩。厥疾不瘳。是能用药者。
从上古时代到现在，每一代都有各自的医生。虽然他们的医术高低、境界深浅各不相同，但必然不能脱离规矩准绳（指中医诊疗的基本法则和规范）来判定方圆平直（比喻事物的正确与否）。
所以治病必须先认识疾病，认识了疾病然后才能讨论用药。药物是用来战胜疾病的工具。如果认识了疾病，在千百种药物中任意选用一两种，就能达到神奇的效果；如果不认识疾病，就会因为方向歧路众多而导致用药迷乱。凡是药物都可能伤害人体，何况那些药性最偏颇驳杂的药物呢？
近来学习医学的人很多，医学反而日益荒废，于是形成了一种只议论药物而不议论疾病的不良风气，由此导致的夭折和枉死不可胜数地令人哀悼。有人认为是杀劫所致，却不知道天道难道喜欢杀戮而厌恶生存吗？
我常看见官宦人家，诊脉结束后立即要求确定处方，以显示慎重。起初根本不讨论疾病从何而起，药物如何对应病情，致使平庸的医生用模棱两可、迎合患者心理的手段，胡乱拟定方剂。等到药物无效时，便推卸责任说是没有合适的药。其实并非没有药，而是有能战胜疾病的药，但因为不认识病情而不敢讨论使用罢了。这真是危险啊！
《灵枢》、《素问》、《甲乙经》、《难经》这些没有固定处方的经典著作，他们完全不加以考究；而对于后来一切有处方的书籍，却奉若珍宝。比如朱丹溪的一家之言，他的《脉因症治》一书，先论脉象，次论病因，再论症状，最后论述治疗，这本书却没有流行开来；而他的《心法》一书，方剂杂乱无章，众人却共同尊崇它。
另外，《本草》只叙述药物的性能功能，人们不重视；等到缪希雍的《本草经疏》兼述了药物性能的优劣之处，人们无不将其挂在肘后（随身携带）研读。却不思考草木的药性，也是取其偏性以适应人体的需要。药物的“过劣”之处不必多言，说了却被弃置不顾的人太多了。为什么不将《本草》中的各种药物全部删抹，只留下没有过错的五七十种药物来使用呢？这难道不与《周礼》中命令医生采集毒药以供医疗事务的宗旨，以及历代帝王担心《本草》记载不全而广泛采集增益的本意，大大相违背吗？
想要破除这种迷惑，不如精详地议论疾病。疾病经过议论明确之后，有什么样的病就有什么样的药。疾病千变万化，药物也随之千变万化。暂且不论造化生心的奥妙，就说某种疾病以某种药物为良药，某种药物为攻伐之药，到了这个时候才有确定的名称。如果不讨论疾病，那么药物的良毒善恶又从何确定呢？可见药物的所谓良毒善恶，与病体的所谓良毒善恶是不同的。而不知道这一点的人，一定要执着于药物的性质来决定取舍，这是多么浅陋啊！
所以我喻昌议论疾病是不得已而为之。古人登高望远，指点顾盼之间，后来的效果不差于前言；聚米成山，事先已有宏大的谋划。医学虽然是小小的技艺，为什么唯独不是这样呢？我即使不能改变世俗的风气，确实想借此榜样，阐发疾病的机理，至于能否被采用，我又何必计较呢？
胡卣臣先生说：“先议论疾病，后使用药物，这真是《金匮要略》未曾抽取出来的理论。大多数人对此漠然视之，导致不可救药。能够议论疾病的人，若能做到‘药不瞑眩，厥疾不瘳’（服药后若无剧烈反应，重病难以痊愈），才是真正懂得使用药物的人。”
From ancient times to the present, each era has had its own physicians. Although their sageliness, wisdom, and virtue differ in degree, none can abandon the compass, square, plumb line, and level (standard rules and norms) to determine what is round, square, flat, or straight.
Therefore, in treating disease, one must first identify the disease; only after identifying the disease can one discuss the use of medicines. Medicines are that which overcome the disease. If the disease is identified, among thousands of medicines, any one or two chosen at random can produce miraculous effects. If the disease is not identified, there will be many divergent paths leading to confusion in medication. All medicines can harm the human body, let alone those with the most biased and erratic properties.
In recent times, although many have studied medicine, medical knowledge has become increasingly neglected, resulting in a world where people discuss medicines without discussing diseases. The resulting premature deaths and wrongful losses are too numerous to mourn. Some attribute this to the influence of killing energies, not realizing that does the Way of Heaven enjoy killing and hate life? I often see officials and nobles who, after diagnosis, immediately demand a prescription to show caution, without initially considering where the disease originated or how the medicines should correspond to it. This allows mediocre physicians to employ ambiguous and flattering techniques to arbitrarily propose treatments. When the medicines prove ineffective, they blame it on the lack of suitable drugs. It is not that there are no drugs, but rather that there are drugs capable of overcoming the disease, yet due to a failure to understand the condition, they dare not discuss their use. How dangerous!
The classics such as *Ling Shu* (Spiritual Pivot), *Su Wen* (Basic Questions), *Jia Yi Jing* (Classified Classic of the Yellow Emperor), and *Nan Jing* (Classic of Difficult Issues), which contain no fixed prescriptions, are completely ignored. Meanwhile, later books containing prescriptions are revered as precious treasures. For instance, Zhu Danxi’s school of thought: his book *Mai Yin Zheng Zhi* (Pulse, Etiology, Symptoms, and Treatment), which discusses pulse first, then etiology, then symptoms, and finally treatment, did not gain popularity. However, his book *Xin Fa* (Essential Principles), despite its chaotic assortment of prescriptions, was widely respected.
Furthermore, *Ben Cao* (Materia Medica) only describes the functions and properties of herbs, so people do not value it. But when Miao Xi Yong’s *Ben Cao Jing Shu* (Elucidation of the Materia Medica) additionally described the inferiorities of herbal properties, everyone hung it by their elbow (kept it close at hand). They fail to realize that the nature of plants and herbs also relies on taking their bias to suit human needs. The inferiorities need not even be mentioned; many speak of them, yet they are discarded. Why not delete all the herbs in *Ben Cao*, retaining only fifty to seventy herbs considered faultless for use? Does this not greatly contradict the intent of the *Rites of Zhou*, which ordered physicians to collect toxic substances for medical practice, and the intention of emperors throughout history who feared *Ben Cao* was incomplete and thus extensively collected and added materials?
To break this delusion, nothing is better than discussing the disease with precision and detail. Once the disease is clarified through discussion, for every disease, there is a corresponding medicine. As diseases change in thousands of ways, so do medicines. Leaving aside the subtleties of natural creation, consider that for a specific disease, a specific herb is deemed beneficial, while another is deemed purgative or harsh; only then can definitive names be assigned. Without discussing the disease, how can the goodness, toxicity, superiority, or inferiority of medicines be determined? Thus, it is evident that the "goodness, toxicity, superiority, and inferiority" of medicinal properties differs from that of the diseased body. Those who do not understand this insist on selecting based solely on medicinal properties, which is extremely shallow. Therefore, my discussion of disease is out of necessity.
Ancients, by climbing high and looking far, guided others with clarity, and subsequent results matched their words. By piling rice like mountains, they made grand plans beforehand. Medicine may be a minor art, but why should it be different? Although I cannot change the customs, I truly wish to use this example to elucidate the mechanisms of disease. Whether it can be used or not, what does it matter?
Mr. Hu Youchen said: "Discussing the disease before prescribing medicine is indeed a theory extracted from the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet). Most people treat it indifferently, rendering it incurable. One who can discuss the disease, and ensures that 'if the medicine does not cause dizziness and nausea, the serious illness will not be cured,' is one who truly knows how to use medicine."