徐东皋云俗云明医不如时医。盖谓时医虽不读书明理。以其有时运造化。亦能侥效。常自矜
云趁我十年运。有病快来医。又云饶尔熟读王叔和。不如我见病症多。里谚有云左心小肠肝
胆肾。时来每日有千钱。所谓明医不如时医。良以有此也。卫生宝鉴有一医者一人病四肢困
倦躁热。自汗气短。饮食少进。咳嗽痰涎。胸膈不利。大便秘。形羸。一岁更数医不愈。或
曰某处有时医虽不精方书。不明脉候。看症极多。治无不效患者信而延治。及至诊之曰此病
食滞。予治多矣。许必效。遂灸肺俞。药以蠲饮等丸并消导之剂。不数服大便泄泻。加以腹
痛。饮食不进而殁。经云形气不足。病气不足。泻之则重不足。此阴阳俱弱。血气皆尽。补
之惟恐不及。反以小毒之剂泻之虚之又虚损之又损不死何待夫明医治病先审岁运太过不及次
察形气勇怯之殊病有虚实浅深在脏在腑之别治有缓急反正之异况医为人之司命。不精则杀人
。今之患者不达此理。委命时医。其与自暴自弃。甘填沟壑者何异哉。嗟乎如此庸流。滔滔
皆是。其奈之何。
薛氏医案云辛丑年余在嘉兴屠渐山第有林二守不时昏愦。请余治之。谵语不绝。脉洪大
。按
之如无。此阳虚之病也。当用参附汤治之。有原医者阳喜而迎曰。先得我心所同然。遂服之
。即静睡而进食午后再剂神思如故。其脉顿敛。余返后。又诈云用附子多矣。吾以黄连解之
。阴仍用参附汤。窃观仲景先生治伤寒云桂枝下咽。阳盛则毙硝黄入胃。阴盛乃亡。不辨而
自明矣。吾恐前言。致误患者。故表而出之。此立斋先生言也。愚以为此乃奸诡小人。推是
念。何啻专务排挤操心谗妒已哉。或有窥病家之丰实。则朋谋而索质。假危言以示吓者。或
病本易治。故投峻剂。致令变症惊惶。从中诈财者。或病属危急。诱利不遂。姑投缓剂。因
致因循误死者。或值内乱之家。孤孽之子。 墙竞。产房帷妒宠。讦讼挟雠者乘病图害假手
进毒若辈唯利是图绝人之嗣丧人之生既坏心术复坏仁术密藏陷阱残忍穷HT 奸孰奸于此乎古人教
人延医煎药必素亲信者始可托。旨深矣。其操危虑患之夫。尤当谨毖。
徐东皋说，世俗有这样的话：“明医不如时医。”大概是指那些时医虽然不读书、不通晓医理，但凭借时运造化，也能侥幸取得疗效。他们常常自夸说：“趁着我这十年的好运气，有病快来找我治。”又说：“任凭你熟读王叔和的著作，也不如我见过的病症多。”民间谚语也说：“左心小肠肝胆肾，时来每日有千钱。”所谓“明医不如时医”，确实是因为存在这种情况。
《卫生宝鉴》记载有一位医者，治疗一名患者，该患者四肢困倦、躁热、自汗、气短、饮食减少、咳嗽痰多、胸膈不畅、大便秘结、身体消瘦。一年间更换多位医生都未痊愈。有人说某处有位时医，虽然对方书研究不精，也不懂脉候诊断，但看过的病极多，治疗没有不有效的。患者相信并延请他诊治。等到诊察后，他说：“这是食积停滞之病，我治过很多例，保证有效。”于是灸肺俞穴（位于背部，第3胸椎棘突下旁开1.5寸），用药用蠲饮等丸配合消导剂。服药不到几剂，患者出现大便泄泻，加上腹痛，饮食不进而死。《内经》说：“形气不足，病气不足，泻之则重不足。”这是阴阳俱弱，血气皆尽的情况，补益还唯恐不及，反而用小毒性的药物攻泻，使虚者更虚，损者更损，不死还要等待什么呢？明医治病，先审察岁运太过或不及，其次观察形体气质的勇怯差异；疾病有虚实、浅深、在脏在腑的区别；治疗有缓急、反正的不同。何况医生是人的命运主宰，不精通医术就会杀人。现在的患者不懂这个道理，将性命托付给时医，这与自暴自弃、甘愿填沟壑的人有什么区别呢？唉！像这样的庸医流俗，到处都是，对此又能怎么办呢？
薛氏医案记载：辛丑年，我在嘉兴屠渐山家中，遇到林二守不时昏愦。请我诊治，患者谵语不绝，脉象洪大，但重按却感觉如无。这是阳虚的病证，应当用参附汤（人参、附子组成的方剂）治疗。原来的医生阳喜而迎，说：“这正是我心里想的一样。”于是服用此药，患者立即安静入睡并能进食，午后再服一剂，神思恢复如常，脉象顿时收敛。我回去后，他又谎称用了过多的附子，我用黄连来解其毒。暗中仍使用参附汤。我私下观察张仲景先生治疗伤寒时说：“桂枝下咽，阳盛则毙；硝黄入胃，阴盛乃亡。”道理不辨自明。我担心他之前的言论误导患者，所以公开指出此事。这是立斋先生（薛己）所说的话。我认为这是奸诈诡计的小人，推究这种念头，何止是专门致力于排挤他人、心存嫉妒而已呢？有的窥探病家富裕，便勾结同谋索要财物；有的假借危言耸听来恐吓病人；有的病本易治，故意投以峻猛药剂，导致变症惊惶，从中骗取钱财；有的病情危急，因诱导利益未遂，暂且投以缓和药剂，因而导致延误死亡；有的正值家庭内乱之家，孤儿孽子之间争墙竞产，产房帷帐中嫉妒宠爱，揭发诉讼挟仇者趁机图害，假手进毒。这一类人唯利是图，断绝人家后代，丧人性命，既败坏心术，又败坏仁术，秘密隐藏陷阱，残忍至极，奸恶哪有比这更甚的呢？古人教导人们延请医生、煎煮药物，必须选择平素亲近信任的人才可以托付，旨意深远啊。那些操持危局、忧虑祸患的人，尤其应当谨慎警惕。
Xu Donggao said that there is a common saying: "A renowned physician is inferior to a contemporary physician." This likely refers to the fact that although contemporary physicians may not study books or understand medical principles, they can still achieve accidental success due to favorable circumstances. They often boast, "Taking advantage of my ten years of good fortune, come to me with your illnesses for treatment." They also say, "No matter how well you have memorized Wang Shuhe's works, it is not as good as my extensive experience in observing various diseases." A local proverb states, "With the heart, small intestine, liver, gallbladder, and kidney [aligned], one can earn a thousand coins daily when luck favors them." The notion that "a renowned physician is inferior to a contemporary physician" indeed stems from such phenomena.
*Weisheng Baojian* (Precious Mirror of Health Preservation) records a case where a physician treated a patient suffering from fatigue in the four limbs, restlessness and heat, spontaneous sweating, shortness of breath, reduced appetite, cough with excessive phlegm, chest and diaphragm discomfort, constipation, and emaciation. Despite changing multiple doctors over a year, the condition remained unresolved. Someone suggested consulting a contemporary physician at a certain location who, despite lacking proficiency in classical texts and pulse diagnosis, had seen numerous cases and achieved universal efficacy. Trusting this advice, the patient sought his treatment. Upon examination, the physician declared, "This is food stagnation. I have treated many such cases and guarantee effectiveness." He then moxibustioned Feishu (BL13, Lung Shu point) and prescribed Juan Yin Wan (Decoction to Eliminate Phlegm-Fluid) combined with digestive-promoting agents. Within a few doses, the patient developed diarrhea, abdominal pain, and inability to eat, ultimately dying. The *Classic of Difficult Issues* (Nanjing) states: "When both physical constitution and pathogenic qi are deficient, purging will exacerbate the deficiency." This indicates a state of dual yin-yang weakness and exhaustion of blood and qi; supplementation is urgently needed, yet instead, toxic purgatives were used, further depleting the already depleted body. How could death be avoided? A renowned physician, before treating disease, first assesses whether the annual cosmic influence is excessive or insufficient, then observes differences in physical robustness and qi strength; diseases vary in excess/deficiency, depth/shallowness, and involvement of zang/fu organs; treatments differ in urgency and approach. Since physicians hold the fate of patients in their hands, incompetence leads to death. Modern patients, failing to understand this principle, entrust their lives to contemporary physicians, which is no different from self-abandonment and accepting death willingly. Alas! Such mediocre practitioners are everywhere; what can be done about it?
The *Xue Shi Yi An* (Medical Cases of Master Xue) records: In the Xin Chou year, while at the residence of Tu Jianshan in Jiaxing, I was summoned to treat Lin Ershou, who suffered from frequent confusion and delirium. The patient exhibited continuous muttering and a surging, large pulse that felt empty upon deep pressure. This indicated a deficiency of yang, requiring treatment with Shen Fu Tang (Ginseng and Aconite Decoction). The attending physician welcomed this suggestion, stating, "This aligns perfectly with my own thoughts." After administration, the patient fell into a quiet sleep and resumed eating. Following a second dose at noon, mental clarity returned, and the pulse became restrained. Upon my return, he falsely claimed to have used excessive Aconite and neutralized it with Coptis Rhizome (Huanglian), while secretly continuing the Shen Fu Tang. Reflecting on Zhang Zhongjing’s teachings on cold damage: "If Guizhi Tang enters the throat and yang is exuberant, death ensues; if Xiaobai Huatan Tang or similar purgatives enter the stomach and yin is exuberant, death follows." The principle is self-evident without debate. Fearing his previous words might mislead patients, I publicly exposed this matter. These are the words of Master Lizhai (Xue Ji). I consider him a deceitful and treacherous person. Investigating such motives reveals nothing less than malicious exclusion and jealousy. Some, eyeing wealthy families, collude to extort property; others use alarmist language to frighten patients; some administer harsh remedies for easily treatable conditions, causing alarming complications to extort money; some, seeing profit opportunities unmet in critical cases, prescribe mild remedies deliberately, leading to fatal delays; some exploit chaotic households, orphaned children fighting for inheritance, or marital jealousies, using illness as an excuse to harm victims via poisoned medicine. These individuals pursue only profit, destroy lineages, take lives, corrupt both morality and medical ethics, hide traps, and exhibit unparalleled cruelty and treachery. The ancients taught that one should only entrust medical care to trusted acquaintances, a profound wisdom. Those managing precarious situations must remain especially vigilant.