尝闻伊芳川先生有言∶士生斯世，而无功德及物，乃是天地间一蠹耳。因思范文正公云∶愿达则为
良相，穷则为良医。噫！大丈夫之不遇于时者，庶几有熊氏之风乎？然有志而未逮也。居无何，先人
患热症，病甚笃，遍求医。有荐者曰∶某良工也，某士行也，急延之。有毁者曰∶某贱工也，某不行
也，遂舍之。自主补之议皆曰高，而参、术之药入；自主泻之言俱称是，而硝、黄之剂投；自主热之
论共赞出奇，而附、桂之方用，自主寒之说佥云有理，而芩、连之汤进。薰莸莫辨，是非弗知，卒枉
死于药，为终天恨，此不知医之祸也。于是奋志医学，诵灵素，读金匮，探百家之菁英。究诸药之功
能，思起天下后世，沉 生理残障，而生全之，以稍偿百身莫赎之罪，岂为借区区一刀圭之术，以鸣一乡行
一时哉！故不惮劳 体，三十年来，焚膏继晷，孜孜屹屹，纂述医镜医要二编，冀振颓风，家贫剞劂
不克以自任，徒 志莫伸云尔。窃念今日──
医学舛谬疲癃每多涂炭，苟无人焉起而正之，将误天下苍生者何时而已耶！吾郡最称人材之薮，
其间通经论，识时务，出类拔萃者匪少，或独善己身而不言者有之，或恐招众谤而不言者有之，吁！
余何人斯，而敢为正医道之得失哉！
余思之，余再思之，设亦钳其口，结其舌，其自为计则得矣，如有救苍生夭枉之心，则不能矣。余，
之更为此论也，急欲以明道，盖不得已也。昔贾洛阳治安策，言当年时势，可为痛哭长叹息。余谓
今时医道之弊，有可为痛哭者三，可为长叹息者二，请试言之。如冬月正伤寒，世宗仲景韪矣，
而不知仲景生于汉时，风气犹浓，居于北土，地高严寒。故其发表俱用辛热重剂，若在南方，寒不甚
严，去古渐远，元气渐薄，凡用表散，只宜辛温轻剂；其春温夏热之解表，则宜辛凉辛寒之品，其法
则可师，而其药不可泥，非违仲景也，变而通之，以从时地也。许学士云∶吾读仲景书，宗仲景法，
未尝专用仲景方。景岳云∶余治伤寒，多非本门正方，随手辄应。斯真善学仲景者也。嘉言论仲景伤寒
篇中，所载辛热诸方，多为误汗吐下，故不得已而从权暂用以回阳，辨之甚明，人不细审，见为成法，
转相效尤，甚至春夏秋三时外感症中，亦恣用无忌。大概病家，辄称感风寒，受寒湿，见用温热，则情
投意合，更于酷暑时令，闭窗下帷，和衣复被，致病者躁扰无奈，欲饮冷水，欲投入井，反谓阴躁，禁
与寒凉，因枉其生，展转残害，尚不觉悟而不改过，乃犹沮他医之寒药，岂不愚哉！嗟夫！温热瘟疫等
病，皆热症也，从无感寒，阴自何来。即传经伤寒，亦系热病，虽传三阴，名为阴分，总属热邪，均宜
清解为主，有下症者则下之，与严冬寒邪，即直中少阴肾经而为阴症，应用干姜、附、桂者万万不同。
嘉言明有阳症忽变阴厥，万中无一，
古至今无一之说。吴又可有世间罕有阴症，若误引节庵冷过肘膝，脉来无力为阴之论，而竟投附、
桂，下咽必毙。余每宗治外感症，活者甚众，亦曾有白虎回生之说，谆谆相告，乃犹不加察，反讥
余之善用寒凉。一见手足厥冷，发呃吐蛔，筋跳肉动，仍疑为阴症，而投热剂，千中千死，万中万
死，间有一二脏浓耐毒不死，或素禀阴寒，或过用寒冷，与药偶合得生，遂为再造奇方，附、桂神
丹。此今时治外感之通弊，可为痛哭者一也。如杂症中之虚劳，尽属阴虚，大要宜壮水清金，培脾健
中，一以甘寒为主，大剂久服，才有裨益。向缘方书，气血阴阳，混列论治，是以后人漫无指归。每
见治斯症者，见其畏寒足冷，辄用八味引火归原，是抱薪救火，而上焦愈热。更有因泄泻而投以理中
之燥热，复助阳劫阴，补中之升提，愈使阴火上逆。又有因寒热鼻塞，头胀而微痛，遂用辛温升散以发
表，妇女骨蒸，血枯经闭，遂用辛热行血以通经，皆令促其速毙。又如肿胀一症，今人亦不审其因食因
痰，思所消之，因水因血，思所行之；菀气凝结，何药开之；脾肾虚弱，何方补之。彼曰我宗薛氏
也，此曰我宗赵氏也，不论寒热，弗分虚实，概投肾气、补中等汤，比比受害。又如膈症，实者可治，血
衰液耗火炎者，本难挽回，今复投以补气健脾，香燥开郁等剂，HT 求延挨时日，尚不可得。他如阴虚痰
火之用姜、半、星、术，胃热呕吐之用姜、半、藿、蔻，类中之概投六君、参附，下痢之妄施八味、理
中，中暑冷汗脉虚之误用温热，产后瘀血未尽之
遽用补益，常见服药之后，轻者益笃，重者即殒，此今时治杂症之种种通弊，可为痛哭者二也。
又如老人天真渐绝，只有孤阳。譬如树老则滋膏干少，今乃血枯精竭之躯，不补阴之是务，而反
用纯阳之桂、附，劫尽残阴，是犹枯木而加之以烈火也，祸也！福也！此言故亦自有说。赵氏
以人身譬之走马灯，火盛则动速，火微则动迟，火熄则不动。景岳亦言，真阳为人身之大宝。嘉言
于中寒门谓∶倘治病者以贵阴贱阳为药石，则治乖其治。复述高年外家多、服参附汤之如意，由是
肾虚补火之药，举国信用而不惑。独不思火之盛衰，系于油之多少。经曰∶五脏者主藏精者也，不
可伤，伤之则失守而阴虚，阴虚无气，无气，则死，非油尽则火灭之谓欤！又不考景岳复言∶余及
中年，方悟补阴之理，活人之效，不能尽述。又言∶阳和之火则生物，亢烈之火则害物。嘉言亦即于
中寒门复云∶辛热始先不得已而暂用，阳既安堵，即宜养阴，不可多服，转生他患。又言∶盏中加
油，则灯愈明。就二公之言以观，其意见皎然矣。故治老人大要，宜用添精填髓，血气有情之剂，峻
补其阴方是良法。今人未悟此理，而老人又自妄用桂、附，助阳逞欲，致令一团热火内燔，灼尽津液，
促其天年，此今时治老人之通弊，可为痛哭者三也。在昔轩辕帝而医，岐伯相而医，稚川洞宾仙而
医，弘景思邈隐君子而医，仲景孟铣士大夫而医。昔人云∶通天地人者曰太医，读书穷理者曰儒医。
医操性命之权，责极重而极难，故业医者虽文理明通，尚嗟灵素
之浑浑无涯，畏金匮之诘屈聱牙，今粗识文本，句解不明，偶拾几方，专恃口给，诡言神授，假托秘
传，亦俨然自附为医！试问其脉，果能辨浮沉迟数大小滑涩二十八脉之体象，及主用兼脉也？试问
其药，果能明诸品之升降寒热温平毒之性，及主治参互之宜遵，简误之宜避耶？试问其立方，果能
别奇偶大小缓急复七方之应用何方，宣通补泻轻重滑涩燥润十剂之应投何剂，以及君臣佐使之义耶
？试问其治病，果能分在表在里，为寒为热，属实属虚，是邪是正之八要，以及至虚似实，大实似虚
，阴极似阳，阳极似阴之疑症也？若斯之人，一理不能彻其底蕴，一症不能考其究竟。而乃庞然自
大，妄自称医，此可谓长叹息者此弊一也。昔狄梁公未第时，曾假以扶危，陆宣公解组归，尝集古方
以惠世，前朝王节斋王宇泰聂六吾。皆名掇科甲，身居当路，犹且究心医药，集《明医杂着》纂《症治
准绳》着《活动心法》泽被当时，功及后代，夫医诚士君子之经济，其道不可不重，其品不可不立。
故交际之间，不得不难于待下，而难于待上。大凡富多任性，贵多自专，顺之者是，逆之者非，自然
之理。但病有虚实，故方立补泻，虚者不可强而泻也，实者不可强而补也，由我则愈，不由我则殆。
设彼偏执已见，忠告弗听，或倨傲鲜腆，礼貌不恭，则卷舌渊其术，默其志，悠然而去，是则明哲士耳
。若富贵之家，延医满座，主见各持，则是者从之，非者婉辞辨析之，倘疏不间亲，寡不胜众，道
既不行，则宁为好好先生，唯唯而退，毋再较短论长，反贻妒贤嫉能量浅器小之讥！夫道之不明也。
是我丑也，道既明而弗用，是彼医之无良，病者之不遇也，吾何丑焉？今之医则反是。甚者巧言悦
听，谄媚取容，又甚者沿门求售，在市井之流，固不足论，而衣冠之辈，亦有蹈此者，虽因衣食交谪，
然士人安贫乐道之谓何？而忍为之也！稽之宋朝，有茅山道士，工医术，不轻售。一士乃衣仆
衣进谒，愿供弟子职，而始得就延医，其重道立品乃至如此，何业医者未之前闻，而更有为愈出愈奇，
难述难言之举动，乃至如此！贻学士大夫之耻笑，招庸人竖子之轻侮，医风扫地，此可为长叹息者
其弊二也。至如缙绅家眷，每忌望问，而无声色之参伍；恶详问，而避多言之庸劣。不知望、闻、问
、切，古圣尚不偏废，今舍三而取一，况有并一未明，而欲不失病情，万万不能。及有急性者遭迟病，
每更医杂投，欲速效而反速害；重病者用轻剂，如车薪杯水，不大胆而贻大祸。更堪笑者，如病已阴虚
咳嗽，反谓服地、冬、贝母、枇杷叶之类，则成虚劳；症属大实极热，金云宜参、 、归、术、附、桂
之品，恐防虚脱，尝见探疾亲切，自逞明鉴，言虚道实，指热称寒，摇乱人心，莫知所就，求卜无灵
，陷害死亡。每闻延医不至，或有气质相加，
果明良耶，其人必端，非能激之可致，如庸浅也，其术不工，何必强之使来。复奇病家，最喜议酬包
痊，自为一无妄费，深得胜算。而医者不料病变难测，但知惟贿是图，冀幸成功，多致重财损命，嗜利
者遭辱，或至追悔而无及。又如毁牌凌医之事，每出朱门，故富贵人病愈危笃，则药愈平淡，皆思免怨
避祸，谁愿养病害身。若宜温补者，或不至
死；倘应寒泻者，决难保生。如此之弊，难以悉数。余今披心腹，竭萤明，聊指诸讹，略陈积习，
伏冀业医仁人，卫生君子，不厌琐听，得赐周览，恕其狂妄，鉴此愚诚，附采刍荛，互相倡导，
共绍圣道之真传、同挽时俗之流弊，将见由近以及远，由今时以及将来，其德其功，宁有量哉！
而余之索愿，不亦惬乎？然犹有憾者，倘先大人有灵，尚必起九泉而责之曰∶小子何歧黄之义，
弗当年之是究，使我半百而杀于庸医之热药乎？呜呼！痛哉！惧哉！余故尝叹且泣下而言，凡为人
子者，不可以不知医。
太史徐道绩曰∶余因儿病痿，尝延松兄至舍，得以见其着述诗、文、医学，洵称三绝。余于此
论，三复读之，而知其存心之仁，好学之笃，立品之端，慕亲之孝，诚君子人也。
太史乔学斋曰∶余与松兄，友而戚也，交甚浓。每过吴门，辄至其家。余亦笃好岐黄书，尝抽奥
问难，松兄谈之凿凿，几忘寝食。性喜自适，淡于势利，从御医院告假归，下帷诵读，着述甚富。此
论畅发治疗之通弊，力挽习俗之嚣风，真救世药言，余极叹服。兹有赘者，如痈疽症，皆由荣家实热气
逆所结，治宜凉血活血，散结解毒，乃是常法。今外科开口，非说风寒，便云阴症，动辄桂枝、姜、
附，自居大方手笔。受害甚多，毫不觉悟。更有丧心宵人，故意酿成大患，勒索浓报，及至势笃不救，
委之天命，造孽莫忏。倘因余言知省，痛改前非，庶不至阎君殿下追悔无及。
孝廉曹枚颖曰∶吾甥松园，髫龄游庠，累试未第，苦攻
举业。身多羸疾，已有志学医。旋因先姊丈患时症，遍请名医，议投温补者十居五、六，因误听用之
，卒为参、附所误，深自悔恨，遂矢志岐黄，面壁九年，心得三昧，每立方疗治，无不奇中。兹论无
一段不快彻，无一语不确切，俱从其学识久而阅历深得之。
贰守叔殿旭曰∶先文康公以相业着宇宙，至今崇祀弗替，吾侄松园，以医书惠苍生，亦复垂名不
朽，昔贤云∶不为良相，当作良医。良相燮理阴阳，平治天下，良医燮理阴阳，挽回造化。今观此论，
不独挽回造化，直欲转移风俗。
我常听伊芳川先生说：“读书人生活在世上，如果不能建立功德惠及万物，那就是天地间的一个蛀虫。”于是想到范文正公曾说：“得志时就做良相，不得志时就做良医。”唉！那些生不逢时的大丈夫，大概只有效仿上古神医俞跗（即文中“有熊氏”，传说为黄帝臣子，善医术）的风范吗？然而有志向却未能实现。没过多久，先父患上热症，病情非常严重，到处求医。有人推荐说：“某人是良医，某人有德行，急忙请他。”有人诋毁说：“某人是低贱的工匠，某人品行不好，于是舍弃他们。”凡是主张用补法的人都说很高明，于是人参、白术等药被服用；凡是主张用泻法的人都说是正确的，于是芒硝、大黄等药剂被投下；凡是主张用热性药的人都称赞其出奇，于是附子、肉桂等方剂被使用；凡是主张用寒性药的人都认为有理，于是黄芩、黄连等汤剂被进服。好坏不分，是非不明，最终枉死于药物之下，成为终身的遗憾，这就是不懂医学带来的祸患。于是我发愤立志学习医学，诵读《灵枢》和《素问》，研读《金匮要略》，探求各家学说的精华。研究各种药物的功能，思考如何拯救天下后世患有生理残疾或重病的人，使他们得以保全生命，以此稍微偿还那百身难赎的罪过，难道只是为了凭借区区一点医术，在乡里一时出名吗！所以我不怕劳累，三十年来，日夜苦读，勤勉不懈，编纂了《医镜》和《医要》两本书，希望振兴衰败的医风。因为家里贫穷，无法承担刻印的费用，只能空怀壮志罢了。私下想如今——
医学谬误盛行，瘫痪、癃闭等病患者多受折磨，如果没有人起来纠正，那么误害天下百姓的情况什么时候才能停止呢！我们郡县最号称人才聚集之地，其中通晓经典理论、识时务、出类拔萃的人不少，有的独善其身而不说话，有的恐怕招致众人诽谤而不说话，唉！我是什么人，敢去评判医道的得失呢！
我反复思考，再反复思考，如果也闭上嘴，结住舌，对自己倒是算计好了，但如果怀着拯救苍生免受夭折枉死的心，那就不能这样做了。我之所以撰写这篇论述，急于阐明医道，实在是不得已啊。过去贾谊写《治安策》，谈论当时的形势，令人痛哭长叹。我认为当今医道的弊病，有值得痛哭的三件事，有值得长叹的两件事，请让我试着说说。比如冬天正当伤寒，世人尊崇张仲景是肯定的，但不知道仲景生于汉代，风气淳朴，居住在北方土地，地势高且严寒。所以他发表散的药物都用辛热重剂；如果在南方，寒冷不十分严厉，距离古代渐远，人的元气逐渐薄弱，凡是用表散的方法，只宜用辛温轻剂；至于春温夏热的解表，则宜用辛凉、辛寒的药物，他的法则可以效法，但他的药物不可拘泥，这不是违背仲景，而是变通以顺应时势和地域。许学士说：“我读仲景的书，宗法仲景的法，从未专用仲景的方。”张景岳说：“我治疗伤寒，大多不是本门的正方，随手应用就见效。这真是善于学习仲景的人。喻嘉言论及仲景《伤寒论》中记载的辛热诸方，多为误用汗、吐、下法后，不得已而权宜暂用以回阳救逆，辨析得很清楚，人们不仔细审查，视为成法，转相效仿，甚至春夏秋三季的外感症中，也肆意使用毫无顾忌。大抵病家，往往称感受风寒、受寒湿，见到用温热药，就觉得情投意合，更在酷暑时令，关窗拉帘，穿着衣服盖着被子，导致病人烦躁无奈，想喝冷水，想跳入井中，反而说是阴躁，禁止给予寒凉药，因而枉送性命，辗转残害，尚不觉悟不改过，还阻挠其他医生使用寒药，岂不愚昧！唉！温热瘟疫等疾病，都是热症，从来没有感受寒邪，阴证从何而来。即使是传经伤寒，也是热病，虽然传入三阴，名为阴分，总属热邪，都应以清解为主，有下证的就攻下，这与严冬寒邪，直接中于少阴肾经而成为阴证，应用干姜、附子、肉桂的情况万万不同。喻嘉言明确说有阳证忽然变为阴厥，万中无一，从古至今没有这种情况。吴又可说有世间罕有的阴证，如果错误地引用节庵关于冷过肘膝、脉来无力就是阴证的理论，而竟然投用附子、肉桂，咽下去必定死亡。我每次治疗外感症，救活的人很多，也曾有“白虎汤回生”的说法，谆谆告诫，然而人们不加考察，反而讥笑我善于使用寒凉药。一见手足厥冷，打呃吐蛔，筋跳肉动，仍怀疑为阴证，而投用热剂，千次治死千次，万次治死万次，偶尔有一两个脏腑浓厚耐毒不死，或者素体禀赋阴寒，或者过度使用寒冷药，与药物偶然吻合得以生存，就被奉为再造奇方，附子、肉桂神丹。这是当今治疗外感症的通病，值得痛哭的第一件事。
又如杂症中的虚劳，全属于阴虚，大要适宜壮水清金，培脾健中，一概以甘寒为主，大剂量久服，才有裨益。过去因为方书将气血阴阳混列论治，导致后人漫无目标。常见治疗这种病症的人，见到病人畏寒脚冷，就用八味丸引火归原，这是抱薪救火，而上焦更加发热。更有因为泄泻而投用理中丸的燥热药，进一步助阳劫阴，补中的升提药，更使阴火上逆。又有因为寒热鼻塞、头胀微痛，就用辛温升散药来发表，妇女骨蒸、血枯经闭，就用辛热行血药来通经，都加速他们的死亡。又如肿胀一症，今人也不审察是因为食积还是因为痰饮，想着用什么来消导，是因为水湿还是因为瘀血，想着用什么来通行；气郁凝结，用什么药来开解；脾肾虚弱，用什么方来补益。那个说我是宗法薛氏的，这个说我是宗法赵氏的，不论寒热，不分虚实，一概投用肾气丸、补中益气汤等，受害的人比比皆是。又如膈噎症，实证可治，血衰液耗火炎者，本来难挽回，现在又投用补气健脾、香燥开郁等剂，想要拖延时日，尚且不可得。其他如阴虚痰火用生姜、半夏、天南星、白术，胃热呕吐用生姜、半夏、藿香、豆蔻，中风概投六君子汤、参附汤，下痢妄施八味丸、理中丸，中暑冷汗脉虚误用温热药，产后瘀血未尽遽用补益药，常见服药之后，轻的病加重，重的立即死亡，这是当今治疗杂症的种种通病，值得痛哭的第二件事。
又如老人天真之气逐渐断绝，只有孤阳。比如树老了滋润的膏液就少，现在是血枯精竭的身体，不致力于补阴，反而用纯阳的桂枝、附子，劫尽残余的阴液，这就像枯木加上烈火一样，是祸还是福！这话原本也有说法。赵献可把人身比作走马灯，火盛则动得快，火微则动得慢，火熄则不动。张景岳也说，真阳是人身的大宝。喻嘉言在中寒门中说：“如果治病的人以贵阴贱阳作为用药原则，那么治疗就会违背规律。”又叙述高年外家多、服参附汤很如意，因此肾虚补火的药，举国信用而不疑惑。唯独不想火之盛衰，取决于油之多少。《内经》说：“五脏是主藏精的器官，不可损伤，损伤了就失守而阴虚，阴虚无气，无气，就会死，这不就是油尽则火灭的意思吗！”又不考察张景岳又说：“我到了中年，才领悟补阴的道理，救人的效果，不能尽述。”又说：“阳和之火能生物，亢烈之火能害物。”喻嘉言也在中寒门复说：“辛热药起初不得已而暂用，阳气既已安顿，就应养阴，不可多服，否则转生他患。”又说：“盏中加油，则灯愈明。”看这两位先生的言论，他们的意见是很清楚的。所以治疗老人的大要，适宜用添精填髓、血气有情之剂，峻补其阴才是良法。今人未悟此理，而老人又自己妄用桂枝、附子，助阳逞欲，致使一团热火内焚，灼尽津液，缩短寿命，这是当今治疗老人的通病，值得痛哭的第三件事。
在古代，轩辕帝行医，岐伯辅助行医，稚川、洞宾修仙而行医，弘景、思邈隐居君子而行医，仲景、孟铣士大夫而行医。古人说：“通天地人者叫太医，读书穷理者叫儒医。”医生掌握着生命的权力，责任极重而且极难，所以从事医学的人即使文理明通，还感叹《灵枢》《素问》浩瀚无边，畏惧《金匮要略》艰涩难懂，现在粗识文字，句解不明白，偶尔拾取几个方子，专恃口才，诡言神授，假托秘传，也俨然自称为医生！试问他们的脉象，果真能辨别浮沉迟数大小滑涩二十八脉的体象，以及主用兼脉吗？试问他们的药物，果真能明白各种药物的升降寒热温平毒性，以及主治相互适宜的遵循，简略错误的避免吗？试问他们的立方，果真能区别奇偶大小缓急复七方的应用何方，宣通补泻轻重滑涩燥润十剂的应投何剂，以及君臣佐使的意义吗？试问他们治病，果真能分辨在表在里，为寒为热，属实属虚，是邪是正的八要，以及至虚似实、大实似虚、阴极似阳、阳极似阴的疑症吗？像这样的人，一个道理不能透彻其底蕴，一个症状不能考究其究竟。却乃庞然大物自夸自大，妄自称医，这可以说是值得长叹息的第一个弊病。过去狄梁公未考中时，曾借医术扶危济困，陆宣公解职回家，曾收集古方以惠泽世人，前朝王节斋、王宇泰、聂六吾，都考取功名，身居要职，还用心研究医药，编集《明医杂著》、纂修《症治准绳》、著作《活动心法》，恩泽当时，功及后代，医生确实是士君子的经济之才，其道不可不重视，其品格不可不树立。所以在交际之间，不得不难于对待下属，而难于对待上级。大凡富人大多任性，贵人大多自专，顺从的是对的，违背的是错的，这是自然的道理。但病有虚实，所以方剂立补泻，虚者不可强行泻，实者不可强行补，由我治则痊愈，不由我治则危险。假如他们偏执己见，忠告不听，或者傲慢无礼，礼貌不恭，那么就收起舌头隐藏技艺，沉默志向，悠然离去，这才是明智的士人。如果是富贵之家，延请医生满座，主见各持，是对的就听从，错的就委婉辞别辨析，如果疏远者不能干预亲近者，少数不能战胜多数，道既不能施行，那么宁愿做个好好先生，唯唯诺诺地退下，不要再较短论长，反而招致嫉妒贤能、气量狭小的讥讽！道如果不彰明，是我的耻辱；道既彰明而不被采用，那是医生的不良，病人的不幸，我的耻辱在哪里呢？现在的医生则相反。严重的巧言令色取悦于人，谄媚讨好，更严重的沿街求售，在市井流辈之中，本来不值得讨论，而衣冠之辈，也有蹈此覆辙的，虽然因为衣食交迫，但是士人安贫乐道的意义何在？怎么能忍心这样做呢！查考宋朝，有茅山道士，精通医术，不轻易出售。有一个士人穿上仆人的衣服进见，愿意供弟子差遣，才得以被延请看病，他们尊重道义、树立品格竟到了如此地步，为什么从事医学的人以前没听说过，还有做出越来越奇特、难以描述的行为，竟到了如此地步！招致学士大夫的耻笑，招致庸人竖子的轻侮，医风扫地，这可以说是值得长叹息的第二个弊病。至于如缙绅家的眷属，往往忌讳望诊和问诊，而没有声色方面的参照；厌恶详细询问，而避开多言的庸劣。不知道望、闻、问、切，古代圣人尚且不偏废，现在舍弃三项而取一项，何况连一项都没弄明白，就想不错失病情，万万不能。又有急性病遭遇慢性病，经常更换医生乱投药，想求速效反而速害；重病者用轻剂，如同车薪杯水，不大胆而贻大祸。更可笑的是，如病已阴虚咳嗽，反而说服用地黄、麦冬、贝母、枇杷叶之类，就会变成虚劳；症属大实极热，却说宜用人参、黄芪、当归、白术、附子、肉桂等品，恐怕防止虚脱，常见探访疾病亲切，自逞明鉴，言虚道实，指热称寒，摇乱人心，莫知所措，求卜无灵，陷害死亡。每听说延请医生不到，或者有气质相加，果真明良耶，其人必端正，非能激之可致，如庸浅也，其术不工，何必强之使来。又奇怪病家，最喜欢议论酬金包治痊愈，自以为一无妄费，深得胜算。而医生不料病变难测，只知道惟利是图，侥幸成功，多致重财损命，嗜利者遭辱，或至追悔而无及。又如毁牌凌医之事，每每出自朱门，所以富贵人病愈危笃，则药愈平淡，都想免怨避祸，谁愿养病害身。如果宜温补者，或许不至于死；倘若应寒泻者，决难保生。这样的弊病，难以悉数。我今天披肝沥胆，竭尽聪明，聊指这些错误，略陈积习，伏望业医的仁人，卫生的君子，不厌琐碎听取，得以赐周览，恕其狂妄，鉴此愚诚，采纳刍荛之言，互相倡导，共绍圣道之真传、同挽时俗之流弊，将见由近以及远，由今时以及将来，其德其功，哪有数量呢！而我的索愿，不也满足了吗？然而还有遗憾的，倘若先父有灵，尚必从九泉之下责备我说：“小子为何不通晓岐黄之义，不钻研当年的医理，使我半百之年死于庸医的热药乎？”呜呼！痛哉！惧哉！所以我曾叹息且流泪地说，凡是为人子女者，不可以不知医。
太史徐道绩说：“我因为儿子患痿症，曾邀请松园兄到舍，得以看到他的著作诗、文、医学，确实称得上三绝。我在这篇论述上，反复读了三次，就知道他存心的仁爱，好学的笃厚，立品的端正，慕亲的孝顺，确实是君子人。”
太史乔学斋说：“我与松园兄，既是朋友又是亲戚，交情很深。每次经过吴门，就到他家。我也笃好岐黄之书，曾抽取奥妙之处问难，松园兄谈得确凿，几乎忘记寝食。性情喜欢自适，淡于势利，从御医院告假回来，闭门诵读，著作甚富。这篇论述畅发治疗的通病，力挽习俗的嚣风，真是救世的药言，我极叹服。这里有多余的话，如痈疽症，都由营气实热气逆所结，治疗宜凉血活血，散结解毒，乃是常法。现在外科开口，不是说风寒，便说是阴症，动辄桂枝、姜、附，自居大方手笔。受害甚多，毫不觉悟。更有丧心宵小，故意酿成大患，勒索重报，及至势笃不救，委之天命，造孽莫忏。倘若因我的话知道反省，痛改前非，庶不至阎君殿下追悔无及。”
孝廉曹枚颖说：“我外甥松园，幼年游庠，多次考试未第，苦攻举业。身体多羸疾，已有志学医。不久因为先姊丈患时症，遍请名医，议投温补者十居五六，因误听用之，卒为参、附所误，深自悔恨，遂矢志岐黄，面壁九年，心得三昧，每立方疗治，无不奇中。这篇论述没有一段不快彻，没有一句话不确切，都从其学识久而阅历深得之。”
贰守叔殿旭说：“先父文康公以相业著名宇宙，至今崇祀不停，我侄松园，以医书惠泽苍生，也复垂名不朽，昔贤说：‘不为良相，当作良医。’良相燮理阴阳，平治天下，良医燮理阴阳，挽回造化。现在看这篇论述，不只挽回造化，直欲转移风俗。”
I often heard Mr. Yifangchuan say: "A scholar living in this world, if he cannot establish merit and benefit all things, is but a pest in heaven and earth." Thus I recall Fan Zhongyan saying: "When successful, be a good prime minister; when unsuccessful, be a good physician." Alas! Great men who do not meet their time might only emulate the style of Youxiongshi (Yu Fu, a legendary ancient healer)? Yet they have ambition but fail to achieve it. Not long after, my father suffered from a heat syndrome, with severe illness, seeking doctors everywhere. Some recommended: "So-and-so is a skilled practitioner, so-and-so has virtue, hurry to invite them." Others slandered: "So-and-so is a lowly craftsman, so-and-so lacks integrity," thus discarding them. Whenever proposals for tonification were made, everyone said they were profound, leading to the administration of herbs like Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). Whenever proposals for purgation were made, everyone agreed, leading to the administration of formulas containing Mirabilite (Mangxiao) and Rheum Palmatum Root and Rhizome (Dahuang). Whenever theories advocating hot-natured drugs were praised as novel, formulas containing Aconiti Lateralis Radix Preparata (Fuzi) and Cinnamomi Cortex (Guizhi) were used. Whenever arguments for cold-natured drugs were deemed reasonable, decoctions containing Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian) were advanced. Unable to distinguish fragrant from foul, right from wrong, [my father] ultimately died wrongly due to medication, leaving an eternal regret. This is the disaster of ignorance of medicine. Thus, I resolved to study medicine, reciting *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions), reading *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), exploring the essence of various schools. Investigating the functions of various drugs, thinking how to save those in the world and future generations suffering from physiological disabilities or severe illnesses, preserving their lives, to slightly atone for sins that even a hundred bodies could not redeem. Was it merely to rely on trivial medical skills to gain fame in one's village for a moment? Therefore, I did not fear labor. For thirty years, burning oil day and night, diligent and steadfast, I compiled two volumes, *Yi Jing* (Medical Mirror) and *Yi Yao* (Medical Essentials), hoping to revive the declining medical ethos. Due to poverty, I could not bear the cost of printing, leaving only unfulfilled ambitions. Privately, I reflect that today—
Medical errors prevail, and patients with paralysis or strangury suffer greatly. If no one rises to correct this, when will the error harm the common people cease? Our prefecture is renowned as a source of talent, where many understand classics, recognize current affairs, and stand out. Some remain silent to cultivate themselves; others fear public criticism and stay silent. Alas! Who am I to dare judge the gains and losses of the medical path?
I pondered, and pondered again. If I also clamped my mouth and tied my tongue, it would suit my self-interest, but with a heart to save the people from premature death, I could not do so. I wrote this treatise, eager to clarify the Dao of medicine, out of necessity. In the past, Jia Yi wrote the *Policy on Pacifying the State*, discussing the times, evoking tears and sighs. I believe there are three aspects of current medical弊端 worthy of weeping bitterly, and two worthy of long sighs. Let me explain. For instance, winter cold damage (Shanghan), people revere Zhang Zhongjing, which is correct. But one must know Zhongjing lived in the Han Dynasty, when customs were pure, residing in the north where the land was high and cold. Thus, his exterior-releasing agents were heavy, acrid-hot formulas. In the south, cold is less severe, distance from antiquity increases, and vital qi thins. Exterior-releasing methods should use light, acrid-warm agents. For spring warmth and summer heat exterior release, acrid-cool or acrid-cold substances are appropriate. His principles can be modeled, but his drugs should not be rigidly applied. This does not violate Zhongjing but adapts to time and place. Xu Xueshi said: "I read Zhongjing's books, follow his methods, but never exclusively use his formulas." Zhang Jingyue said: "In treating cold damage, I rarely use standard formulas from the school; I apply them freely and they work. This is truly learning from Zhongjing." Yu Jiayan discussed the acrid-hot formulas in Zhongjing's *Treatise on Cold Damage*, noting they were mostly used reluctantly to restore yang after erroneous sweating, vomiting, or purging. People failed to examine closely, treating them as fixed rules, copying them, even using them recklessly in spring, summer, and autumn for exterior syndromes. Patients often claim wind-cold or cold-dampness. Seeing warm-hot drugs used, they feel satisfied. Even in midsummer, they close windows and curtains, wearing clothes under blankets. This causes patient restlessness, desire for cold water, desire to jump into wells. Instead of recognizing heat, it is called "yin restlessness," prohibiting cold-cool drugs, leading to wrongful death. They remain unrepentant, obstructing other doctors from using cold drugs. How foolish! Oh! Warm-heat and plague diseases are all heat syndromes; there is no cold damage, so where does yin come from? Even transmitted cold damage is a heat disease. Though entering the Three Yin levels, named yin divisions, it belongs to heat pathogens, requiring clearing and resolving as primary. If downward symptoms exist, purge them. This is vastly different from deep winter cold pathogens directly striking the Shaoyin Kidney meridian causing yin syndromes, requiring Dried Ginger (Ganjiang), Prepared Aconite Root (Fuzi), and Cinnamon Bark (Guizhi). Yu Jiayan clearly stated that yang syndromes suddenly turning into yin cold limbs occur once in ten thousand, never in history. Wu Youke mentioned rare yin syndromes in the world. If one mistakenly follows Jie'an's theory that cold extending past elbows and knees with weak pulse indicates yin, and administers Fuzi and Guizhi, death is certain upon swallowing. I often treat exterior syndromes, saving many, even claiming "Bai Hu Tang brings back life," advising earnestly. Yet people do not investigate, instead mocking my skill with cold-cool drugs. Upon seeing cold limbs, hiccups, vomiting roundworms, muscle twitching, they still suspect yin syndromes, administering hot agents. Thousand cures, thousand deaths; ten thousand cures, ten thousand deaths. Occasionally, one or two survive due to thick viscera resisting toxicity, innate yin-cold constitution, or accidental match with cold drugs. These are hailed as miraculous resurrection formulas, divine pills of Fuzi and Guizhi. This is the common malpractice in treating exterior syndromes today, worthy of bitter weeping—the first point.
Regarding miscellaneous diseases, deficiency consumptive diseases (Xu Lao) are all yin deficiency. The main principle is strengthening water and clearing metal, cultivating spleen and strengthening middle, primarily using sweet-cold agents in large doses over long periods for benefit. Previously, formularies mixed qi, blood, yin, and yang in discussion, leading later generations to lack direction. Treating such cases, seeing cold aversion and cold feet, practitioners use Ba Wei Wan (Eight-Ingredient Pill) to guide fire back to its source. This is adding firewood to save a fire, worsening upper jiao heat. For diarrhea, Lizhong Wan (Regulate the Middle Pill)'s drying-hot nature further aids yang and robs yin. Ascending and lifting agents in tonifying the middle cause yin fire to rebel upward. For chills, fever, nasal congestion, head distension and mild pain, acrid-warm ascending-dispersing agents are used to release the exterior. For women with bone-steaming fever, blood dryness, and amenorrhea, acrid-hot blood-moving agents are used to unblock menstruation. All accelerate death. Regarding swelling, modern practitioners do not examine if caused by food stagnation or phlegm, nor what to dissolve; if caused by water or blood stasis, nor what to move; if qi stagnation condenses, nor what to open; if spleen/kidney weak, nor what to tonify. One claims following Xue's method, another Zhao's method. Regardless of cold/heat or deficiency/excess, they indiscriminately administer Shen Qi Wan (Kidney Qi Pill) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Victims are numerous. Regarding Ge Syndrome (diaphragmatic obstruction), excess patterns are treatable; blood deficiency, fluid depletion, and flaming fire are hard to reverse. Yet now, qi-tonifying and spleen-strengthening, aromatic-drying and depression-resolving agents are administered. Seeking to prolong time is impossible. Other examples: Yin deficiency with phlegm-fire using Sheng Jiang (Fresh Ginger), Ban Xia (Pinellia), Tian Nan Xing (Arisaema), Bai Zhu (Atractylodes); Stomach heat vomiting using Sheng Jiang, Ban Xia, Huo Xiang (Pogostemon), Dou Kou (Black Cardamom); Stroke generally treated with Liu Jun Zi Tang (Six-Gentlemen Decoction) or Shen Fu Tang (Ginseng and Aconite Decoction); Dysentery wrongly treated with Ba Wei Wan or Lizhong Wan; Heatstroke with cold sweat and deficient pulse mistakenly treated with warm-hot drugs; Postpartum blood stasis not fully expelled, tonics hastily administered. Commonly, after taking medicine, mild cases worsen, severe cases die. These are the myriad common malpractices in treating miscellaneous diseases today, worthy of bitter weeping—the second point.
For the elderly, heavenly truth gradually ceases, leaving only isolated yang. Like old trees with little nourishing gum, now bodies with dried blood and exhausted essence. Not focusing on tonifying yin, but using purely yang Guizhi and Fuzi, robbing residual yin. This is like adding fierce fire to dead wood. Is it disaster or blessing? There is a reason. Zhao Xianke compared the body to a moving lantern lamp: strong fire moves fast, weak fire moves slow, extinguished fire stops. Jingyue also said true yang is the great treasure of the body. Jiayan in the Cold Strike chapter said: "If healers use precious yin and despise yang as treatment, therapy will deviate." He noted elderly relatives often took Shen Fu Tang successfully, leading nationwide trust in kidney-deficiency fire-tonifying drugs. Did they not consider fire's strength depends on oil quantity? The Classic says: "The five zang organs store essence; do not injure them. Injury leads to loss of control and yin deficiency. Yin deficiency leads to qi deficiency; qi deficiency leads to death. Is this not meaning 'oil exhausted, fire extinguished'?" Did they not examine Jingyue's later words: "Only in middle age did I comprehend tonifying yin, achieving results too numerous to recount"? And "Harmonious yang fire generates life; excessive fierce fire harms life"? Jiayan also said in Cold Strike: "Acrid-hot drugs are used reluctantly initially; once yang is settled, tonify yin. Do not take excessively, lest other disorders arise." And "Adding oil to the lamp makes it brighter." Observing these two masters, their views are clear. Thus, treating the elderly requires adding essence and filling marrow, using sentient substances (blood/meat-based tonics), vigorously tonifying yin. Modern people do not grasp this, and the elderly misuse Guizhi and Fuzi, aiding yang to indulge desires, causing internal blazing fire, scorching fluids, shortening lifespan. This is the common malpractice in treating the elderly today, worthy of bitter weeping—the third point.
In antiquity, Emperor Xuanyuan practiced medicine, Qibo assisted, Zhi Chuan and Dong Bin practiced as immortals, Hong Jing and Si Miao practiced as recluse gentlemen, Zhongjing and Meng Xian practiced as scholars. Ancients said: "One who understands Heaven, Earth, and Man is a Grand Physician; one who reads and exhausts principles is a Confucian Physician." Medicine holds the power of life and death, responsibility is heavy and difficult. Even scholars with clear literary skills lament the boundless depth of *Ling Su* and the obscurity of *Jin Gui*. Now, crude literacy, unclear sentence interpretation, picking up a few formulas, relying on eloquence, claiming divine revelation, pretending secret transmission, yet proudly calling oneself a doctor! Ask their pulse diagnosis: Can they truly distinguish the images of the twenty-eight pulses (floating, sinking, slow, rapid, large, small, slippery, rough) and their indications and combined pulses? Ask their pharmacology: Do they truly understand the ascending/descending, cold/hot/warm/neutral/toxic properties of each herb, their mutual indications, and contraindications? Ask their formula construction: Can they distinguish the Seven Forms (odd, even, large, small, slow, urgent, compound) and Ten Categories (dispersing, penetrating, tonifying, purging, heavy, light, slippery, rough, drying, moistening), and the roles of Sovereign, Minister, Assistant, and Courier? Ask their treatment: Can they differentiate exterior/interior, cold/heat, deficiency/excess, pathogen/righteousness (the Eight Essentials), and suspicious syndromes like extreme deficiency resembling excess, extreme excess resembling deficiency, extreme yin resembling yang, extreme yang resembling yin? Such people, unable to penetrate one principle or investigate one symptom, yet arrogantly call themselves doctors. This is worthy of long sighing—the first malpractice.
In the past, Di Lianggong used medicine to rescue crises before passing exams; Lu Xuangong collected ancient formulas to benefit the world after resigning. Former dynasties' Wang Jiezhai, Wang Yutai, Nie Liuwu, all passed imperial examinations, held high office, yet studied medicine, compiling *Ming Yi Za Zhu*, *Zheng Zhi Zhun Sheng*, writing *Huo Dong Xin Fa*, benefiting contemporaries and posterity. Medicine is indeed the economic talent of a gentleman; its way must be valued, its character established. In social interactions, one finds it hard to treat subordinates and superiors alike. The rich are often willful; the noble often autocratic. Compliance is right, opposition is wrong, natural law. But diseases have deficiency/excess, so formulas establish tonification/purgation. Deficiency must not be forcibly purged; excess must not be forcibly tonified. Follow me, you recover; ignore me, danger ensues. If they persist in their views, ignoring advice, or are arrogant and rude, then silence your skills, hide your intent, and leave calmly. This is the wise scholar. If a wealthy family invites many doctors, holding conflicting views, follow the correct ones, politely refute the incorrect ones. If outsiders cannot influence insiders, few cannot overcome many, and the Dao cannot be practiced, better to be a "good先生" (yes-man) and withdraw quietly, rather than argue and invite accusations of jealousy and narrow-mindedness. If the Dao is not clarified, it is my shame. If the Dao is clarified but not used, it is the doctor's bad character and the patient's misfortune. Where is my shame? Today's doctors are the opposite. Some flatter and please, some beg door-to-door, behaving like market vendors. Not worth discussing. But even well-dressed gentlemen tread this path. Though driven by livelihood needs, what is the meaning of a scholar being content with poverty and devoted to the Dao? How can they endure this! Checking Song Dynasty records, a Daoist priest from Maoshan excelled in medicine but did not sell easily. A scholar dressed as a servant to petition him, willing to serve as a disciple, only then was he invited. Their respect for the Dao and establishment of character reached such heights. Why have medical practitioners not heard of this before? Worse, some engage in bizarre, indescribable acts, bringing shame to scholars and contempt to fools. Medical ethics are swept away. This is worthy of long sighing—the second malpractice.
As for gentry families, they often avoid observation and inquiry, lacking reference from speech and appearance. They dislike detailed questioning, avoiding verbose mediocrity. Not knowing that Observation, Auscultation/Olfaction, Inquiry, and Palpation (Wang, Wen, Wen, Qie) were never neglected by ancient sages, now abandoning three for one. Moreover, failing to understand even one, expecting not to miss the disease condition is impossible. Acute patients with chronic conditions often change doctors and mix medications, seeking speed but hastening harm. Severe patients given light formulas are like a cartload of firewood on a cup of water; indecision brings great disaster. Laughable are those with yin deficiency coughing, told that taking Shu Di Huang (Rehmannia), Mai Dong (Ophiopogon), Bei Mu (Fritillaria), Pi Pa Ye (Loquat Leaf) will cause consumptive disease. Syndromes of extreme excess and heat are told to use Ren Shen (Ginseng), Huang Qi (Astragalus), Dang Gui (Angelica), Bai Zhu (Atractylodes), Fu Zi (Aconite), Gui Zhi (Cinnamon) to prevent collapse. Visiting patients intimately, showing off insight, speaking of deficiency as excess, pointing at heat as cold, confusing hearts, leaving people lost. Divination fails, leading to harm and death. Hearing doctors are not invited, or insults are exchanged. If truly excellent, the person must be upright; they cannot be forced. If mediocre, skills are poor, why force them? Strange also is that patients love to discuss fees and guarantee cures, thinking themselves frugal and winning. Doctors, not foreseeing unpredictable changes, only seek bribes, hoping for success, often costing wealth and life. Greedy doctors face humiliation or regret. Also, destroying signs and insulting doctors often comes from wealthy homes. When wealthy patients are critically ill, medicines become bland, wanting to avoid blame and disaster. Who wants to nurture disease and harm the body? If warming/tonifying is indicated, perhaps death is avoided; if cooling/purging is indicated, survival is unlikely. Such malpractices are countless. Today, I bare my heart, exhaust my wisdom, point out errors, state habits. I hope benevolent medical practitioners and health-preserving gentlemen, not tiring of trivial listening, will review this, forgive my arrogance, appreciate my sincerity, adopt humble advice, advocate together, inherit the true transmission of sage ways, reverse contemporary deviations. Seeing from near to far, from present to future, their virtue and merit will be immeasurable! Will not my wish be satisfied? Yet I have regret. If my late father had spirit, he would surely rise from the nine springs to reproach me: "Why did you not understand the meaning of Qi and Huang, why did you not study the year of my death, letting me die at fifty from庸医 (mediocre doctors') hot drugs?" Alas! Painful! Fearful! Thus I sigh and weep, saying: Any child must know medicine.
Grand Historian Xu Daoji said: "Because my son suffered from flaccidity syndrome, I invited Brother Song to my home, allowing me to see his writings in poetry, prose, and medicine. Truly a triple excellence. Reading this treatise three times, I know his benevolent heart, diligent study, upright character, and filial piety. He is truly a gentleman."
Grand Historian Qiao Xuezhai said: "Brother Song is both friend and relative to me, our bond is deep. Every time passing Wumen, I visit his home. I also deeply love Qi-Huang books, asking profound questions. Brother Song answers precisely, forgetting sleep and food. He likes self-contentment, indifferent to power and profit. After taking leave from the Imperial Hospital, he closed his curtains to read and write abundantly. This treatise openly discusses common treatment malpractices, forcefully reversing customary turbulence. Truly words of medicine saving the world. I admire it greatly. I add: For carbuncles and sores, they result from Ying qi excess and rebellious qi knotting. Treatment should cool blood, invigorate blood, dissipate knots, and resolve toxins, which is the usual method. Now surgeons opening wounds either blame wind-cold or claim yin syndrome, frequently using Guizhi, Ginger, and Fuzi, positioning themselves as grand masters. Many suffer, unaware. Worse, depraved villains intentionally cause major disasters, extorting heavy rewards. When condition becomes critical and incurable, they attribute it to fate, creating sin without repentance. If they reflect due to my words and改正 (correct) past mistakes, they might avoid regret before King Yanluo."
Xiaolian Cao Meiying said: "My nephew Songyuan studied in the academy in childhood, failed multiple exams, bitterly studying for civil service. His body was frail, already aspiring to learn medicine. Soon after, my elder sister's husband suffered a seasonal syndrome. Famous doctors were invited. Five or six proposed warm-tonifying treatments. Mistakenly following them, he was harmed by Renshen and Fuzi, deeply regretting. Thus he vowed to Qi-Huang, meditated for nine years, grasping the essence. Every formula he prescribed worked miraculously. This treatise has no paragraph not thoroughly explained, no sentence not precise, all stemming from long-term learning and deep experience."
Vice Prefect Shu Dianxu said: "My late father, Duke Wenkang, was famous for his statesmanship in the universe, still worshipped today. My nephew Songyuan benefits the people with medical books, also leaving immortal fame. Ancients said: 'If not a good prime minister, be a good physician.' Good prime ministers harmonize yin and yang, pacify the world. Good physicians harmonize yin and yang, restore creation. Viewing this treatise, it not only restores creation but aims to transform customs."