临证医案，非古也。古人视病不立案语，但书方药。自宋设医学科命题考试医生，取其学问高等者，入太医局。
自后医生诊病，相沿先立案语，后书方药，但随作随弃，无有辑之者。如宋之许知可、张季明，明之薛立斋、
陈维宜、孙文垣，以及国初喻嘉言、徐大椿辈，虽有医案类，皆因治疗效验，笔诸于书，其文
乃记事，非临证也。良以病多转变，方难一定，恐泥学人眼目，故作者恝置之。然余谓医之有方案，犹名法家之有
例案，文章家之有试牍。对病书方，因题立义，相对斯须，人之性命系焉，己
之得失亦系焉。虽不足为根柢之学，而病者之情形，医者之学识心思，尽在于是。苟能溯其脉证，观其变化，奚
啻与病者医者一堂共语，不大可触发手眼哉！故叶氏《临证指南》，海内风行。
然叶案语意高深，方多平淡，学人践其迹，未必入其室。因叶负一时重名，所视者非富贵膏粱，即病深气竭，贫贱
初病者寥寥焉。盖气体不同，方法即异，读其书而得其用者鲜矣！余旧得无
锡王泰林旭高先生方案二卷，爱而藏之，以篇页无多，未梓。更求二十余年，不可得。客春游梁溪访老友刘君石香，
石香出十卷示余，云新得于李氏者。亟假归读之，其心思之敏，见识之超，
清华而不高深，灵变而有矩 ，视叶案易于学步。且复诊甚多，前后推究，考其得失，尤足以资助学人。因并余所
藏者，去其重复，合而选之。间有字句冗沓率意处，略为删整，根据类编次，分
二十六门。每门附以拙论，略见大意。其有精警与未惬意者，复随案指出，正之有道，非敢有意毁誉也。原书十卷，
约得五六，厘为四卷，命儿辈录出，不敢自私，付之梓人，以公同学焉。
光绪二十三年丁酉孟春耕霞方氏序于倚云吟馆
临证医案，并非古已有之。古人诊治疾病不撰写病历记录，只书写处方药物。自从宋代设立医学科目，通过命题考试选拔医生，选取学问高深的人，进入太医局任职。
此后医生诊病，沿袭先写病历记录、后开处方的做法，但往往随手写作随手丢弃，没有人将其编辑成书。像宋代的许知可、张季明，明代的薛立斋、陈维宜、孙文垣，以及清初的喻嘉言、徐大椿等人，虽然也有医案类著作，但都是因为治疗有效，才笔录下来收入书中，其文字属于记事性质，并非真正的临证实录。确实因为病情多变，方药难以固定，恐怕会束缚学者的思路，所以作者们对此淡然置之。然而我认为，医生有治疗方案，就像法家有判例，文章家有应试范文一样。针对病症开具方药，依据题目确立义理，相对片刻之间，病人的性命系于此，医生的得失也系于此。虽然这不足以成为根本性的学问，但病人的具体情况、医生的学识与心思，都包含在其中。如果能够追溯其脉象与证候，观察其变化，何止是与病人和医生在堂上共同对话，不是更能启发手眼吗！所以叶氏《临证指南》，在海内广泛流行。
然而叶天士的医案语意高深，方药多平淡，学者追随其足迹，未必能进入其堂奥。因为叶天士享有当时的盛名，他所诊治的不是富贵人家吃精细饮食的人，就是病情深重、元气衰竭的病人，贫贱之人刚生病的就很少了。大概体质不同，方法也就各异，读他的书而能掌握其用法的很少啊！我过去得到无锡王泰林（即王旭高）先生的方案二卷，喜爱并收藏起来，因为篇幅不多，没有刊印。又寻求了二十多年，未能再得。某年春天游历梁溪拜访老朋友刘石香先生，石香拿出十卷给我看，说是刚从李家得到的。急忙借回家阅读，他心思敏捷，见识超群，文风清新高雅而不高深莫测，灵活变通而有规矩法度，比叶氏医案容易学习模仿。而且复诊记录很多，前后推究，考察其得失，尤其足以帮助学者。于是将我收藏的部分与他提供的合并，去除重复内容，选编而成。间或有字句冗长随意之处，略作删改整理，根据类别编排次序，分为二十六门。每门附上我的拙劣论述，大致显示主旨。其中有精辟警策或未尽如意的地方，随案指出，纠正有道，不敢有意褒贬。原书十卷，大约保留五六成的内容，厘定为四卷，命令儿辈抄录出来，不敢私自占有，交付刻工刊印，以公之于同好学者。
光绪二十三年丁酉年孟春（正月），耕霞方氏在倚云吟馆作序。
Clinical medical cases are not an ancient tradition. In ancient times, physicians did not write case records when examining patients; they only prescribed herbal formulas and medicines. Since the Song Dynasty established medical subjects and selected physicians through written examinations, choosing those with superior scholarly attainments to enter the Imperial Medical Bureau,
physicians thereafter followed the custom of first writing case records and then prescribing formulas and medicines. However, these records were often discarded immediately after being written, and no one compiled them into books. Figures such as Xu Zhike and Zhang Jiming of the Song Dynasty, Xue Lizhai, Chen Wei Yi, and Sun Wenyuan of the Ming Dynasty, as well as Yu Jiayan and Xu Dachun from the early Qing Dynasty, although they produced collections resembling medical cases, did so only because their treatments yielded effective results, which they then recorded in books. Their writings were essentially historical records, not true clinical consultations. Indeed, given that diseases often change and prescriptions cannot be fixed, authors likely avoided compiling such records for fear of limiting the perspectives of learners, thus treating the matter lightly. Nevertheless, I believe that a physician having treatment plans is akin to legal scholars having precedents or essayists having model examination papers. Prescribing formulas according to diseases and establishing principles based on specific problems, within a brief moment of consultation, the life of the patient hangs in the balance, as does the success or failure of the physician. Although this may not constitute fundamental scholarship, the condition of the patient and the knowledge and thought processes of the physician are fully revealed therein. If one can trace the pulse and symptoms and observe their changes, it is more than just conversing with the patient and physician in the same hall; is it not truly capable of stimulating one's clinical insight? Hence, Ye Tianshi's *Lin Zheng Zhi Nan* (Guide to Clinical Practice) has been widely circulated throughout the country.
However, the language and meaning in Ye's cases are profound and deep, while his prescriptions are often mild. Learners who merely follow his footsteps may not necessarily enter his inner sanctum of wisdom. Because Ye enjoyed great fame during his time, his patients were either wealthy individuals accustomed to rich diets or those with advanced disease and depleted vital energy; there were few poor and low-status patients at the onset of illness. Generally, constitutions differ, and thus methods vary; therefore, few readers could grasp the practical application of his book! I previously obtained two volumes of treatment plans by Mr. Wang Tailin (Wang Xugao) from Wuxi, cherished them, and kept them in my collection. Due to the small number of pages, I did not have them printed. For over twenty years, I sought more but could not find any. One spring, while traveling in Liangxi, I visited my old friend, Mr. Liu Shixiang. Shixiang showed me ten new volumes he had recently acquired from the Li family. I eagerly borrowed them to read at home. His mental agility and superior insight were evident; his style was elegant and refined yet not overly obscure, flexible and adaptive yet adhering to rules. Compared to Ye's cases, they were easier to learn and imitate. Moreover, there were many follow-up visits, allowing for thorough investigation from beginning to end, evaluating successes and failures, which greatly aids learners. Therefore, I combined my collected volumes with these, removed duplicates, and selected and edited them. Wherever sentences were verbose or careless, I made slight deletions and revisions. Organized by category into twenty-six sections, each section includes my humble commentary to briefly elucidate the main ideas. For parts that were particularly insightful or where I felt less satisfied, I pointed them out alongside the cases, offering corrections with due respect, without intending to praise or criticize arbitrarily. The original ten volumes were reduced to approximately half, condensed into four volumes. I instructed my sons to transcribe them. Not wishing to keep this to myself, I entrusted them to the printers to share with fellow scholars.
Preface written in the first month of spring in the Dingyou year (1897) of the Guangxu reign, by Fang Gengxia at the Yiyun Yin Guan."