病患之吉凶祸福。寄之于医。医者之任重。然权不操诸医。而操诸用医之人。何也。人
有大病。庸医束手无策。始求救于名医。名医入门诊毕。告以病从何来。当从何去。得那一
类药而增剧者何故。得那一类药除去那一病。而此外未能尽除者何故。病势虽觉稍愈。逾一
二日仍作。或逾一二日而更甚于前者又何故。一一为病家帮助。定其如此救误。如此温清攻
补。如此按法立方。服药后必见出何证。又见出何证则可愈。预断其愈于何日何时。病家能
一一信其言而不疑。且架中不藏本草备要、医方集解、万病回春、本草纲目、东医宝鉴、冯
氏锦囊、赤水玄珠、薛氏医按、景岳全书、石室秘录、辨证奇闻、临证指南之类。又无强不
知以为知之亲友与根据阿两可素称果子药之先生。朱紫不乱。则名医得以尽其所长。伤寒卒病
二三日可愈。最迟亦不出十八日之外。风痨臌膈一月可愈。最迟亦不出三月之外。否则病家
疑信参半。时医犹可勉强从事。俟其病气衰而自愈。若以名医自命者。断不可肩此重任。反
致取怨败名。余因热肠而备尝其苦。凡我同志。可以鉴此前车。今之方技家。恃在口给。见
有同我者引之。互相标榜。逊我者亦不却之。临深为高。至于穷本草经。读灵素。法仲景。
其立论为耳所未闻。其治效又目所仅见。遂谦让曰。我不能如此之神。亦不能如此之偏以取
胜也。若辈造此偏之一字。任令法高一丈。其奈魔高十丈。且谓古书不可以今用。即于多读
书处谓其偏。起死证而生之。即以出奇入险目其偏。以致病家先入为主。广集不偏之医。历
试罔效。不得已始延为破釜沉舟之计。
究竟终疑其偏。麻、桂、硝、黄。则曰汗下之太过也。姜、附、芩、连。则曰寒热之太
峻也。建中、理中、陷胸、十枣。则曰补泻之不留余地也。滋水之地黄。补元之人参。用应
多而反少。日食之枣子。至贱之甘草。用应少而反多。此等似是而非之言。更甚于恣肆不伦
于理之言。知几者正可以拂衣而去。乃犹曰病尚可为。不忍恝然而舍之。此虽活人无已之心。
而疑事无功。未能活人。且以误人。盖药之所以流行于经络脏腑。内外无有不到者。气为之
也。气不自到。心气主之。胆气壮之也。彼既疑我为偏。一见我之用药。又出于意想之外。
则心气乱。内经云。心者君主之官也。神明出焉。又云。主不明则十二官危是也。不独心气
乱。而且胆气亦因之而怯。内经云。胆者中正之官。决断出焉。又云。十二经皆取决于胆是
也。药乃草根树皮及一切金石之钝物。原藉人之真气以流行。今心气乱而妄行。胆气怯而不
行。如芩、连入口。其寒性随其所想而行。旋而皮毛鼓栗。而寒状作矣。姜、附入口。其热
性随其所想而行。旋而心烦面赤。而热状作矣。凡此之类。不过言其大略。不必淋漓痛切而
再言之。其中之所以然者。命也。我亦顺其自然而已矣。又何必多事为。凡我同志者。能以
余为前车之鉴。则道愈彰。而活人愈众。
病患的吉凶祸福，寄托在医生身上。医生的责任虽然重大，然而治病的权力并不掌握在医生手中，而是掌握在使用医生的患者及其家属手中。为什么呢？当人得了重病，庸医束手无策，才开始向名医求救。名医诊察完毕后，告知病情从何而来、应当如何治疗，哪一类药会使病情加重及其原因，哪一类药能去除哪种病证以及为何不能尽除其他病证。即使病势看似稍有好转，过一两天又复发，或者过一两天比之前更严重，这些情况都要一一为病人分析帮助，确定如此纠正误治，如此运用温法、清法、攻法、补法，如此依法处方。并预测服药后必然出现什么证候，又出现什么证候则可以痊愈，预先断定何时何日可以痊愈。如果病人能完全相信医生的话而不怀疑，且家中不收藏《本草备要》、《医方集解》、《万病回春》、《本草纲目》、《东医宝鉴》、《冯氏锦囊秘录》、《赤水玄珠》、《薛氏医案》、《景岳全书》、《石室秘录》、《辨证奇闻》、《临证指南医案》之类的书籍，又没有那些不懂装懂的亲友，以及那些模棱两可、素以开“果子药”（指无效或安慰性药物）闻名的先生干扰，使得患者不被杂学所惑，那么名医就能充分发挥其特长。伤寒卒病在两三天内可愈，最迟也不超过十八天；风痨臌膈（四种疑难重症）一个月可愈，最迟也不超过三个月。否则，病人对医生半信半疑，普通医生还可以勉强应付，等待病气衰退而自愈。但如果自命为名医的人，绝不可承担这种重任，反而会导致招致怨恨、败坏名声。我因为热心肠而尝尽了其中的苦楚，凡是志同道合的人，可以以此为前车之鉴。
现在的方技家（医生），倚仗口才好，见到赞同自己的人就拉拢，互相吹捧；对于不如自己的人也不拒绝。他们故作高深，直到穷尽《神农本草经》，研读《灵枢》、《素问》，效法张仲景。他们的立论是别人从未听过的，疗效也是别人亲眼仅见的，于是谦虚地说：“我不能像那样神奇，也不能那样偏激来取胜。”这些人造出“偏”这个字，任凭医术高一丈，无奈魔高一丈。并且说古书不可以用于今世，就在多读书的地方指责其“偏”。把起死回生的证候称为“偏”，把出奇制胜、险中求胜的治疗称为“偏”，导致病人先入为主，广泛召集所谓“不偏”的医生，尝试多次都无效，不得已才延请我作为破釜沉舟的最后手段。
究竟最终还是怀疑我的疗法“偏”。使用麻黄、桂枝、芒硝、大黄，就说这是发汗和攻下太过分；使用干姜、附子、黄芩、黄连，就说这是寒热药性太峻烈；使用小建中汤、理中汤、陷胸汤、十枣汤，就说这是补泻不留余地。滋补肾阴的地黄，大补元气的人参，应该多用却反而少用；日常食用的大枣，极其廉价的甘草，应该少用却反而多用。这些似是而非的话，比那些肆意荒谬不合情理的话更甚。懂得几微之理的人本来可以拂袖而去，却还说“病还可以治”，不忍心冷漠地抛弃它。这虽然是救人的好心，但疑虑的事情难以成功，不仅没能救人，反而误人。
药物之所以能在经络脏腑中流行，内外无处不到，是因为“气”的作用。气不能自己到达，由心气主宰，胆气壮盛来推动。既然病人怀疑我用药“偏”，一见我的用药出乎意料之外，就会使心气混乱。《内经》说：“心者君主之官也，神明出焉。”又说：“主不明则十二官危。”这不仅导致心气混乱，而且胆气也因此怯懦。《内经》说：“胆者中正之官，决断出焉。”又说：“十二经皆取决于胆。”药物不过是草根树皮及一切金石等钝物，原本依赖人的真气来流行。现在心气混乱而妄行，胆气怯懦而不行。如黄芩、黄连入口，其寒性随着病人的想法而行，随即皮毛鼓栗，寒状就出现了；干姜、附子入口，其热性随着病人的想法而行，随即心烦面赤，热状就出现了。凡此之类，不过是大略说明，不必淋漓痛切地再重复说。其中所以然的原因，是命运。我也只是顺应自然罢了。又何必多事呢？凡是志同道合的人，能以我为前车之鉴，那么医道会更加彰显，救人也会更多。
The auspiciousness or misfortune of patients is entrusted to physicians. Although the physician's responsibility is heavy, the power to treat does not lie with the physician, but with those who employ the physician (i.e., the patient and their family). Why is this? When a person suffers from a severe illness, quacks are at a loss and have no strategy, so they begin to seek help from famous doctors. After the famous doctor completes the consultation, they inform the patient where the disease originated and how it should be treated: why certain categories of medicines exacerbate the condition, and why certain categories remove specific diseases while failing to eliminate others. Even if the disease seems slightly improved, why does it recur after one or two days, or become worse than before after that period? The doctor must assist the patient in understanding each point, determining how to correct previous errors, how to apply warming, clearing, purging, and tonifying methods, and how to prescribe formulas according to principles. They predict what syndromes will appear after taking the medicine, what subsequent syndromes indicate recovery, and precisely when the patient will heal. If the patient believes these words without doubt, and if the household does not keep books such as *Bencao Beiyao* (Essentials of Materia Medica), *Yifang Jijie* (Collected Explanations of Medical Formulas), *Wanbing Huichun* (Revival for Ten Thousand Diseases), *Bencao Gangmu* (Compendium of Materia Medica), *Dongui Bogam* (Eastern Medical Treasure Mirror), *Fengshi Jinang Milu* (Secret Records of Feng’s Brocade Pouch), *Chishui Xuanzhu* (Dark Pearl of Chishui), *Xuexi Yi'an* (Medical Cases of Xue), *Jingyue Quanshu* (Complete Works of Jingyue), *Shishi Milu* (Secret Records of the Stone Chamber), *Bianzheng Qiwen* (Strange Questions on Syndrome Differentiation), *Linzheng Zhinan Yian* (Clinical Guide to Medical Cases), and others; and if there are no relatives and friends who pretend to know what they do not know, nor "gentlemen" known for prescribing ineffective "fruit medicines" (placebo-like remedies) who create ambiguity and confuse the patient with purple and red (metaphor for confusing right and wrong), then the famous doctor can fully exert their expertise. Acute febrile diseases (*Shanghan* and *Zubing*) can be cured within two or three days, at the latest within eighteen days. Difficult chronic conditions such as wind-stroke, consumption, ascites, and diaphragmatic obstruction can be cured within one month, at the latest within three months. Otherwise, if the patient is half-believing and half-doubting, ordinary doctors may barely cope, waiting for the pathogenic qi to decline and the disease to heal spontaneously. However, anyone claiming to be a famous doctor must absolutely not shoulder this heavy burden, lest they incur resentment and ruin their reputation. I have suffered greatly due to my warm-heartedness; all my colleagues should take this as a warning from past failures.
Current practitioners rely on their eloquence. They ally with those who agree with them, engaging in mutual flattery, and do not reject those inferior to them. They pose as profound experts, having exhausted the study of *Shennong Bencao Jing* (Divine Farmer's Materia Medica), read *Lingshu* and *Suzhen*, and modeled themselves after Zhang Zhongjing. Their theories are unheard of by others, and their curative effects are seen by few. Thus, they humbly say, "I cannot be so miraculous, nor can I win by being so biased." These people fabricate the concept of "bias" (pian). No matter how high their medical skill is (one zhang), the demonic forces are ten times higher (ten zhang). They claim that ancient texts cannot be applied today, labeling extensive reading as "biased." They label life-saving treatments as "biased," and ingenious, risky interventions as "biased." This leads patients to form preconceived notions, gathering numerous so-called "unbiased" doctors, trying them all to no avail. Only out of desperation do they invite me as a last resort (burning the boats).
Ultimately, they still suspect my treatment is "biased." Using *Mahuang* (Ephedrae Herba) and *Guizhi* (Cinnamomi Ramulus) is criticized as excessive sweating and purging; using *Ganjiang* (Zingiberis Rhizoma), *Fuzi* (Aconiti Lateralis Radix Praeparata), *Huangqin* (Scutellariae Radix), and *Huanglian* (Coptidis Rhizoma) is criticized as too harsh in cold and heat properties; using *Xiaojianzhong Tang* (Minor Construct the Middle Decoction), *Lizhong Tang* (Regulate the Middle Decoction), *Xianxiong Tang* (Pit-Obstructing Decoction), and *Shizao Tang* (Ten Date Decoction) is criticized for leaving no room in tonification and purgation. *Dihuang* (Rehmanniae Radix) for nourishing yin and *Renshen* (Ginseng Radix) for tonifying yuan qi are used less than appropriate; dates, commonly eaten daily, and *Gancao* (Glycyrrhizae Radix et Rhizoma), extremely cheap herbs, are used more than appropriate. Such seemingly reasonable but actually fallacious statements are even worse than arbitrary and irrational ones. Those who perceive subtle signs could simply leave in disgust, yet they say, "The disease is still treatable," and cannot bear to abandon the patient indifferently. Although this stems from an endless desire to save lives, doubtful actions yield no success; instead of saving people, they cause harm.
Medicines circulate through meridians and organs, reaching inside and outside, because of *Qi*. *Qi* does not move itself; it is directed by Heart *Qi* and strengthened by Gallbladder *Qi*. Since the patient suspects my treatment is "biased," seeing my prescriptions which are beyond their imagination causes their Heart *Qi* to become chaotic. The *Neijing* states: "The Heart is the monarch official, from whom spirit and consciousness emerge." It also says: "If the ruler is unclear, the twelve officials are in danger." Not only does Heart *Qi* become chaotic, but Gallbladder *Qi* also becomes timid. The *Neijing* states: "The Gallbladder is the upright official, from whom decision-making emerges." It also says: "All twelve meridians depend on the Gallbladder." Medicines are merely roots, barks, and inert minerals/metals; they originally rely on the body's true *Qi* to circulate. Now, with chaotic Heart *Qi* moving recklessly and timid Gallbladder *Qi* failing to move, if *Huangqin* and *Huanglian* enter the mouth, their cold nature follows the patient's thoughts, causing immediate chills and shivering, manifesting cold symptoms. If *Ganjiang* and *Fuzi* enter the mouth, their hot nature follows the patient's thoughts, causing immediate irritability and facial flushing, manifesting heat symptoms. These examples illustrate the general principle; there is no need to elaborate further with painful detail. The underlying reason is fate. I merely follow nature. Why bother further? If my colleagues can take me as a warning, the Dao will be more illuminated, and more people will be saved.