予尝论治病有五难，辨疾、治疾、饮药、处方、别药，此五也，今之视疾者，惟候气口
六脉
行
五
以一二药书，其服饵之节，授之而已；古以治疾者，先知阴阳运历之变故，山林川泽之窍发
。而又视其人老少肥瘠，贵贱居养，性术好恶，忧喜劳逸，顺其所宜，违其所不宜，或药或
火，或刺或砭，或汤或液，矫易其故常，捭摩其性理，捣而索之，投几顺变，间不容发。而
又调其衣服，理其饮食，异其居处，因其情变，或治以天，或治以人，五运六气，冬寒夏暑
，雨电雹，鬼灵魇蛊，甘苦寒温之节，后先胜负之用，此天理也，盛衰强弱，五脏异禀，
循其所同，察其所偏，不以此形彼，亦不以一人例众人，此人事也。言不能传之于书，亦不
能喻之于口，其精过于承蜩，其察甚于刻棘，目不舍色，耳不舍声，手不释脉，犹惧其差也
，授药遂去，而希其十全，不亦难哉！此治疾之难二也。古之饮药者，煮炼有节，饮啜有宜
。药有可以久煮，有不可以久煮者，有宜炽火，有宜温火者，此煮炼之节也。宜温宜寒，或
缓或速，或乘饮食喜怒，而饮食喜怒为用者，有违饮食喜怒，而饮食喜怒为敌者，此饮啜之
宜也。而水泉有美恶，操药之人有勤惰，如此而责药之不效者，非药之罪也，此服药之难三
也。
知药
不测
搏漉
鱼以
酸者
以巴
不旋
疾者
妙，而
何哉？
蚊喙坼
步，则
其所宜
固未尝晰也。抑又取之有早晚，藏之有焙KT ，风雨燥湿，动有槁暴，今之处药。或有恶
火者，必日之而后咀。然安知采藏之家，不常烘煜哉，又不能必，此辨药之难五也。此五者，
大概而已。其微至于言不能宣，其详至于书不能载，岂庸庸之人，而可以易言医哉？予治方
最久，有方之良者，辄为疏之，世之为方者，称其治效，尝喜过实，《千金肘后》之类，犹
多溢言。使人不敢复信，予所谓《良方》者，必目睹其验，始着于篇，闻不预也。然人之疾，
如向所谓五难者，方岂能必良哉！一赌其验，即谓之良，殆不异乎刻舟以求遗剑者？予所以
详着其状于方尾，疾有相似者，庶几偶值云尔，篇无次序，随得随注，随以与人，极道贵速，
故不暇
我曾经论述过治病有五大难点：辨别疾病、治疗疾病、服用药物、开具处方、鉴别药材，这就是这五点。如今那些诊治疾病的人，只是通过诊察气口处的六脉，用一两味药写下方子，关于服药的节律和注意事项，仅仅口头传授给病人罢了；古代善于治疗疾病的人，首先通晓阴阳运行历法的变化，以及山林川泽中病邪产生的机理。并且观察病人的老少、肥瘦，地位的高低、居住环境的优劣，性格习惯的好恶，忧愁喜悦与劳逸情况，顺应适宜的因素，避免不适宜的因素，或者用药，或者用火疗，或者针刺，或者砭石，或者汤剂，或者液剂，纠正其原有的病理常态，梳理其生理性情，深入探究病因，把握时机顺应变化，其间细微之处不容毫发之差。并且调理他们的衣物，整理他们的饮食，改变他们的居住环境，根据他们的情志变化，有的顺应天时治疗，有的针对人事调整，五运六气，冬天的寒冷夏天的暑热，雨水雷电冰雹，鬼神惊魇蛊毒，甘甜苦涩寒温的节度，先后胜负的运用，这是天理；盛衰强弱，五脏禀赋不同，遵循共同的规律，观察各自的偏颇，不以此形推彼形，也不以一个人的情况类推众人，这是人事。言语无法在书中完全传达，也无法用口完全说明，其精妙超过承蜩（捕蝉），其洞察细致超过刻棘（雕刻荆棘），眼睛不离开面色，耳朵不离开声音，手不离开脉象，仍然担心出现差错，交付药物后就离开，而希望达到十全十美的疗效，不也是很难吗！这就是治病的第二个难点。古代服用药物的人，煎煮炼制有节度，饮用啜服有适宜的方法。药物有的可以久煮，有的不可以久煮，有的适合猛火，有的适合文火，这是煎煮炼制的节度。有的适宜温服有的适宜寒服，有的缓慢有的迅速，有的趁着饮食喜怒的情绪来发挥药效，有的违背饮食喜怒的情绪而与饮食喜怒相敌对，这是饮用啜服的适宜之处。而且水源泉水有美丑之分，抓药煎药的人有勤惰之别，像这样的情况却责怪药物没有疗效，这不是药物的过错，这是服药的第三个难点。
知道药材的深奥微妙，而不测度其变化，就像用酸味捕捉鱼一样，巴豆如果不旋转……疾速者……妙处何在？蚊子口器破裂……步伐……其所适宜的本来未曾清晰阐明。况且采集又有早晚之分，贮藏有烘焙之法，风雨燥湿，动作中有枯槁暴烈，如今的处置药材，有的厌恶火气，必须日晒之后才咬碎咀细。然而怎么知道采集贮藏的人家，不经常烘烤呢，又不能确定，这是鉴别药材的第五个难点。这五点，只是大概的情况。其精微之处以至于言语不能宣示，其详尽之处以至于书籍不能记载，难道是平庸之人，就可以轻易谈论医学吗？我从事方剂研究最久，遇到良方，就将其罗列出来，世间那些开方的人，称赞其治疗效果，常常喜欢夸大，《千金方》《肘后备急方》之类，还有很多溢美之词。使人不敢再相信，我所称的《良方》，一定是亲眼目睹其疗效，才开始记录在篇目中，道听途说的不予收录。然而人的疾病，如同前面所说的五大难点，方剂又怎能保证一定良效呢！一旦看到其疗效，就称之为良方，这几乎不同于刻舟求剑吗？所以我详细记录症状于方剂之后，如果有病情相似的，或许能偶然对应罢了，篇章没有固定次序，随得随注，随即送给别人，极言速度宝贵，所以来不及……
I have previously discussed that there are five difficulties in treating diseases: distinguishing the disease, treating the disease, administering medicine, prescribing formulas, and identifying herbs. These are the five points. Currently, those who diagnose diseases merely inspect the six pulses at the Qi Kou (radial artery pulse point), write down a prescription with one or two herbs, and only verbally instruct the patient on the rhythm and precautions of taking the medication; in ancient times, those skilled in treating diseases first understood the changes in the operation and calendar of Yin and Yang, as well as the mechanisms of pathogenic factors arising from mountains, forests, rivers, and marshes. Furthermore, they observed the patient's age (young or old), body constitution (fat or thin), social status (noble or humble), living environment, personality preferences, emotional states (worry or joy), and work-rest patterns, adhering to what was suitable and avoiding what was not. They might use herbal medicine, fire therapy, acupuncture, Bian stone (stone knives for bloodletting), decoctions, or liquid preparations, correcting the pathological norms, regulating physiological properties, investigating deeply into the causes, seizing opportunities to adapt to changes, where even a hair's breadth of error was intolerable. Additionally, they regulated clothing, managed diet, altered living quarters, and responded to emotional changes. Some treatments followed Heavenly principles (natural laws), while others addressed Human affairs (social/psychological factors). The movements of Five Yuns and Six Qi, winter cold and summer heat, rain, lightning, hail, ghostly possessions, nightmares, and Gu poison, the degrees of sweet, bitter, cold, and warm, and the application of precedence and defeat—these are Heavenly principles. Variations in prosperity and decline, strength and weakness, different endowments of the Five Zang organs, following commonalities, observing deviations, not inferring one form from another, nor generalizing one person to the masses—these are Human affairs. Words cannot fully convey this in books, nor can it be explained orally. Its subtlety surpasses catching cicadas (Cheng Tiao), its observation is more meticulous than carving thorns. Eyes do not leave the complexion, ears do not leave the voice, hands do not release the pulse, yet still fearing errors. After handing over the medicine and leaving, hoping for perfect cure—is this not difficult? This is the second difficulty of treating diseases. In ancient times, when administering medicine, boiling and refining had regulations, and drinking and swallowing had appropriateness. Some herbs could be boiled for a long time, some could not; some suited fierce fire, some suited gentle fire—this is the regulation of boiling and refining. Some were suitable for warm administration, some for cold; some slow, some fast; some utilized the emotions of diet and anger/joy, some opposed them—this is the appropriateness of drinking and swallowing. Moreover, water sources vary in quality, and those handling medicine vary in diligence or laziness. To blame the ineffectiveness of medicine under such circumstances is not the fault of the medicine; this is the third difficulty of taking medicine.
Knowing the profound subtleties of herbs without measuring their unpredictability... [Text fragmentary] ...like using acid to catch fish... Bahu (Croton seed) if not rotated... rapid cases... Where is the妙 (subtlety)? Mosquito proboscis splitting... steps... What is suitable has never been clearly clarified. Furthermore, collection has early and late timings, storage involves baking (KT likely refers to a specific drying/baking method), wind, rain, dryness, dampness, actions involve withering and sudden exposure. Current handling of herbs: some dislike fire, requiring sun-drying before crushing (Ju). However, how can one know if collectors/storage persons do not constantly bake them? This uncertainty makes it difficult to identify herbs accurately—this is the fifth difficulty. These five points are but the general outline. The subtle aspects are beyond words, the detailed aspects exceed book records. Could mediocre people easily discuss medicine? I have studied formulas for the longest time; encountering good formulas, I list them. Those who prescribe in the world praise therapeutic effects, often exaggerating. Works like *Qianjin Fang* (Thousand Gold Formulas) and *Zhouhou Beiji Fang* (Handbook of Prescriptions for Emergencies) contain much hyperbole, causing people to distrust them. My so-called *Liang Fang* (Good Formulas) only records what I have personally witnessed as effective, excluding hearsay. However, human diseases, given the aforementioned five difficulties, how can a formula guarantee efficacy? Seeing an effect and calling it a "good formula" is hardly different from carving a mark on the boat to find the lost sword. Therefore, I detail the symptoms after each formula. If conditions are similar, perhaps there will be occasional correspondence. The chapters have no fixed order; notes are added as found, and shared immediately. Speed is highly valued, hence I am too busy to...