天下之病,误于医家者固多,误于病家者尤多。医家而,易良医可也;病家而误,其弊
不可
胜穷。遥不问医之高下,即延以治病,其误一也;有以耳为目,闻人誉某医即信为真,不考
其实,其误二也;有平日相熟之人,务取其便,又虑别延他人,觉情面有亏,而其人又叨任
不辞,希图酬谢,古人所谓以性命当人情,其误三也;有远方邪人假称名医,高谈阔论,欺
骗愚人,遂不复详察,信其欺妄,其误四也;有因至亲密友或势位之人,荐引一人,情分
难却,勉强延请,其误五也;更有病家戚友,偶阅医书,自以为医书颇通,每见立方,必妄
生议论,私改药味,善则归己,过则归人,或各荐一医互相毁谤,遂成党援,甚者各立门户
,如不人己,反幸灾乐祸,以期必胜,罔顾病者之死生,其误七也;又或病势方转,未收全
功,病者正疑见效太迟,忽而谗言蜂起,中道更改,又换他医,遂至危笃,反咎前人,其误
八也;又有病变不常,朝当桂附,暮当芩连;又有纯虚之体,其证反宜用硝、黄;大实之人
,其证反宜用参、术。病家不知,以为怪僻,不从其说,反信庸医,其误九也;又有吝惜钱
财,惟贱是取,况名医皆自作主张,不肯从我,反不若某某等和易近人,柔顺受商,酬谢可
略。扁鹊云∶轻身重财不治。其误十也。此犹其大端耳。其中更有用参、附则喜,用攻剂则
惧;服参、附而死则委之命,服攻伐而死则咎在医,使医者不敢过症用药。更有制药不如法
,煎药不合度,服药非其时,更或饮食起居,寒暖劳逸,喜怒语言,不进不节,难以枚举。
小病无害,若大病则有一不合,皆足以伤生。然则为病家者当何如?在谨择名医而信任之。
如人君之用宰相,择贤相而专任之,其理一也。然则择贤之法若何?曰∶必择其人品端方,
心术纯正,又询其学有根柢,术有渊源,历考所治,果能十全八九,而后延请施治。然医各
有所长,或今所患非其所长,则又有误。必细听其所论,切中病情,和平正大;又用药必能
命中,然后托之。所谓命中者,其立方之时,先论定此方所以然之故,服药之后如何效验;
或云必得几剂而后有效,其言无一不验,此所谓命中也。如此试医,思过半矣。若其人本无足
取,而其说又怪僻不经,或游移恍惚;用药之后,与其所言全不相应,则即当另觅名家,不
得以性命轻试。此则择医之法也。
Diseases in the world are often mismanaged by physicians, but even more frequently by patients' families (bingjia). If a physician is incompetent, it is possible to replace them with a good physician; however, if mismanagement arises from the errors of the patient's family, the detrimental consequences are countless.
The first error is engaging a physician without assessing their skill level and allowing them to treat the illness immediately.
The second error is relying on hearsay rather than observation: believing a physician is excellent simply because others praise them, without verifying their actual competence.
The third error involves hiring an acquaintance for convenience and out of social obligation, fearing that hiring someone else would cause offense. The acquaintance, eager for remuneration, accepts the responsibility. This is what ancients referred to as "treating life and death as a matter of social favor."
The fourth error is being deceived by charlatans from distant places who falsely claim to be famous physicians, engaging in grandiose talk to fool the ignorant, leading the family to trust their fraudulent claims without detailed investigation.
The fifth error is reluctantly engaging a physician recommended by close friends or influential figures due to inability to refuse social pressure.
The seventh error (note: the original text skips the sixth) involves relatives or friends of the patient who have casually read medical texts and believe they understand medicine. They interfere with prescriptions, arbitrarily altering herbs, claiming credit for success and blaming the physician for failure. They may recommend different physicians to slander each other, forming factions. In severe cases, they establish opposing schools of thought, acting like enemies, rejoicing in the conflict, and seeking victory regardless of the patient's life or death.
The eighth error occurs when the condition has just begun to improve but has not fully resolved. The patient doubts the slow progress, rumors arise, and the physician is changed midway, leading to a critical deterioration. The patient then blames the previous physician.
The ninth error stems from ignorance of complex pathologies. For instance, a case might require warm herbs like Guizhi Tang (Cinnamon Twig Decoction) and Fuzi (Prepared Aconite Root) in the morning, and cold herbs like Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) in the evening. A constitution of pure deficiency might paradoxically require purgatives like Xiaoshi (Natrii Sulfas) and Dahuang (Rhei Radix et Rhizoma). Conversely, a constitution of excess might require tonics like Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). Families, finding these approaches strange, reject the physician's advice and trust quacks instead.
The tenth error is stinginess, choosing only cheap physicians. Famous physicians often make independent decisions and do not cater to the family's whims, unlike mediocre ones who are compliant and offer reduced fees. As Bian Que stated, "Those who value wealth over health are incurable."
These are merely the major points. Other issues include psychological biases: families prefer warming tonics like Renshen (Ginseng Radix) and Fuzi (Prepared Aconite Root) and fear purgative treatments. If a patient dies after taking tonics, it is attributed to fate; if they die after taking purgatives, the physician is blamed. This discourages physicians from prescribing appropriate strong medications. Additionally, improper preparation of herbs, incorrect decoction methods, untimely administration of medicine, and lack of discipline in diet, daily routine, temperature regulation, rest, work, emotions, and speech can all harm the patient. Minor illnesses may not suffer from such negligence, but for serious diseases, any single deviation can be fatal.
Therefore, what should a patient's family do? They must carefully select a renowned physician and trust them completely. This is analogous to a ruler appointing a capable chancellor and granting them full authority. How does one select such a physician? One must choose someone of upright character and pure intentions, verify that their learning is foundational and their medical skills have a clear lineage, and examine their past records to ensure they achieve a high success rate (e.g., curing 80-90% of cases). Only then should they be engaged.
However, physicians have specialties. If the current illness is outside their specialty, errors may occur. Therefore, one must listen carefully to their analysis to see if it accurately addresses the condition with balanced and principled reasoning. Furthermore, their prescription must hit the mark. "Hitting the mark" means that upon prescribing, the physician explains the rationale behind the formula and predicts the expected effects after administration. For example, stating that improvement will occur after a specific number of doses, and this prediction proves accurate. By testing physicians in this manner, one gains significant insight. If a physician lacks merit, offers bizarre or inconsistent theories, or if the treatment results contradict their predictions, one should seek another expert rather than risking life on unproven methods. This is the method for selecting a physician.