医宁小道乎而习医之人则多小人也因人而轻医所从来矣至吮痈HT 痔。称曰疡医尤是卑庸之流
。世愈薄之。虽曰科分内外。症有表里。岂知皮毛肌肉。悉系五脏六腑十二经络。所联属灌
溉者而外之疮疡由内之感发也何可膜外视之每见外科之医。罔顾元气虚实。病机寒热。固执
成方。概投凉剂。夫在元气形气病气俱实者。用之则宜。设若俱虚。宁不伤生乎。若令外
科治外。内科治内。必察脉气完亏。庶免夭枉。若丹溪详言痈疽之治。义可知矣。
以上十三种医评。陋识如余不揣方人之讥。总缘生灵起见。特因其品行之贞邪。学识之
贤愚。
而直揭之。使世之患者识所慎择焉。
余壮岁挟少年结燕赵游。连镳驱驰。每见辕下畜。性甚颖。甫束鞍辔。待人乘骑。及粼
粼登
程。遵我周道。无迷岐路。遇小沟隙侧径。且能纡回屈曲而行。抵宿馆停蹄。及执鞭者至。
卸以 载。揭以鞍镫。便自扬扬然入厩索食矣。日复如是。余因询曰。何以一畜而灵慧乃尔
。比执鞭者曰。豢一骡驴可供三十年之用。每岁长途往反。不下六七度彼盖输蹄络绎积有岁
月故极熟于里道馆舍无烦鞭策耳越旬日过邯郸薪米腾贵。复惊寇至。余又询曰。是亦知此
乎执鞭者曰彼惟知求食耳安知食价腾涌彼惟知道可行厩可栖耳安知寇警HT 闻将谓贼亦人耳安知其
善恶攸殊物不得与人比也余因忆伏龙雏凤。同是物也。何以未出茅庐时。不及骡驴一一亲见
之多。反能知天下事。而天运之否泰。国祚之兴亡。人事之吉凶。乃无逃其神算者乎。似不
可解矣。偶因谈及。有客笑而言曰是足为明医隐医时医名医之喻耳余曰然。
医学难道是小道吗？然而学习医术的人中却有很多品行低劣之人，因为这些人而轻视医学由来已久了。至于那些舔吸脓疮、治疗痔疮的医生，被称为疡医，更是被视作卑下平庸之辈。社会更加轻薄他们。虽然说医学分科有内外科之分，病症有表里之别，但哪里知道皮毛肌肉，都关联着五脏六腑和十二经络，这些部位是气血灌注滋养的地方。外部的疮疡是由内部感受邪气而引发的，怎么可以将其视为身外之物而轻视呢？常常看到外科医生，不顾患者元气的虚实、病机的寒热，固执地坚持成方，一概投用寒凉药剂。如果对于元气、形气、病气都充实的患者，使用这种方法是适宜的；假如三者都虚弱，难道不会伤害生命吗？如果让外科治外部疾病，内科治内部疾病，必须诊察脉气的盈亏状况，这样才能避免夭折或枉死。如果像朱丹溪那样详细论述痈疽的治疗，其中的道理就可以知道了。
以上十三种对医生的评价，像我这样见识浅陋的人，不顾被行家讥笑，总归是为了百姓的生命着想，特意根据他们品行的正邪、学识的贤愚，直接揭露出来，使世间的患者能够谨慎选择。
我年轻时带着少年的意气，结伴游历燕赵之地，并驾齐驱，奔驰在道路上。每次看到车辕下的牲畜，性情非常聪颖。刚套上马鞍缰绳，等待被人骑乘时，一旦踏上行程，遵循大路行走，不迷失歧路；遇到小沟渠缝隙或偏僻小路，也能迂回曲折地前行。到达住宿馆舍停下蹄子后，等到执鞭的主人到来，卸下负载，揭开鞍镫，便自己得意洋洋地进入马厩索要食物了。日复一日都是这样。我问：“为什么一种牲畜却如此灵慧？”赶车的人说：“饲养一头骡驴可供三十年使用。每年长途往返，不下六七次。它们因为马蹄络绎不绝地走过，积累了岁月，所以极熟悉道路和馆舍，不需要烦劳鞭策罢了。”过了十天经过邯郸，柴米价格飞涨，又惊闻有寇盗来袭。我又问：“这牲畜也知道这些情况吗？”赶车的人说：“它只知道寻找食物，哪里知道食物价格飞涨？它只知道道路可行、马厩可栖，哪里知道有寇警的消息？它将贼人也是人，哪里知道善恶的巨大差异？物品不能与人相提并论啊。”我因此想起伏龙雏凤（指诸葛亮和司马徽等隐士），同样是生物，为什么在未出茅庐之前，不如骡驴那样一一亲眼见过那么多事物，反而能知晓天下大事，而天时运势的否泰、国家国运的兴亡、人事的吉凶，都没有逃脱他们的神妙算计呢？这似乎无法解释。偶然谈到此事，有位客人笑着说：“这足可以作为明医、隐医、时医、名医的比喻了。”我说：“是的。”
Is medicine a trivial art? Yet, among those who study medicine, there are many of petty character; it is because of such people that medicine has been slighted for a long time. As for those who suck abscesses and treat hemorrhoids, called *Yang Yi* (Surgical Physicians), they are regarded as the most base and mediocre group. Society holds them in even lower esteem. Although it is said that medical practice is divided into internal and external departments, and symptoms have exterior and interior aspects, how can one fail to know that the skin, hair, muscles, and flesh are all connected to the Zang-Fu organs and the Twelve Meridians, which are the sites where Qi and Blood are infused and nourished? External sores and ulcers arise from internal pathogenic influences; how can they be viewed merely as external matters and disregarded? I often see surgical physicians who disregard the deficiency or excess of Yuan Qi (Original Qi) and the cold-heat nature of the pathological mechanism, stubbornly adhering to established prescriptions and indiscriminately administering cooling agents. For patients whose Yuan Qi, Xing Qi (Formative Qi), and Bing Qi (Pathogenic Qi) are all substantial, this approach may be appropriate. However, if all three are deficient, will it not harm life? If surgical physicians treat external conditions and internal physicians treat internal conditions, one must examine whether the pulse Qi is complete or deficient, thereby avoiding premature death or wrongful demise. The principles elucidated by Zhu Danxi regarding the treatment of carbuncles and sores can illustrate this point.
The above thirteen evaluations of physicians, though offered by my shallow knowledge without fear of ridicule from experts, stem solely from concern for the lives of the people. I specifically expose them based on their moral integrity (righteousness vs. wickedness) and their scholarly wisdom (virtuous vs. foolish), so that patients in the world may choose carefully.
In my youth, accompanied by peers, I traveled through the Yan and Zhao regions, riding side by side and galloping along. I frequently observed animals under the carriage shafts possessing very acute nature. Once saddled and bridled, awaiting riders, upon embarking on the journey, they would follow the main roads without losing their way on diverging paths; encountering small ditches or narrow bypaths, they could navigate with flexibility and curvature. Upon reaching an inn to rest, when the driver arrived, after unloading burdens and removing saddles and stirrups, they would proudly enter the stable to seek food. Day after day, this routine continued. I asked, "Why is this animal so intelligent?" The driver replied, "Raising one mule or donkey serves for thirty years. They travel long distances back and forth at least six or seven times a year. Having trodden these paths continuously over years, they become extremely familiar with the roads and inns, requiring no urging." Ten days later, passing Handan, the price of firewood and rice soared, and news of bandits arrived. I asked again, "Does this animal also know this?" The driver said, "It only knows how to seek food; how could it know prices are soaring? It only knows the road is passable and the stable is available; how could it know of bandit alerts? It regards thieves as humans too; how could it distinguish between good and evil? Objects cannot be compared to humans." I then recalled the "Hidden Dragon" and "Chick Phoenix" (metaphors for reclusive talents like Zhuge Liang). Both are living beings. Why, before emerging from thatched cottages, did they not see as many things as the mules and donkeys, yet still know the affairs of the world? How could they foresee the fluctuations of heavenly fortune, the rise and fall of national dynasties, and the auspiciousness or inauspiciousness of human affairs, escaping no divine calculation? This seemed inexplicable. When discussing this incident, a guest laughed and said, "This suffices as a metaphor for Bright Physicians, Reclusive Physicians, Contemporary Physicians, and Famous Physicians." I replied, "Indeed."