议曰大凡人复处性愚鲁用心狠戾者不可以学医师不择善祸难逃迹其或秉志怯率为性懦弱
者亦
不可以言药素问有云人如舟也药如水也水能济舟亦能覆舟一丸一散对症尽善起活危困未足为
奇一有共利坏症伤候且过在尔其智拙钝非 药也学人读预究其纯粹施其精研克效斯时以副规
矩不可得而述者医之良工也夫医之用药将之用兵古人亦有言矣且如善医明症良将得策药能胜
病卒能守城若也将无计策医共证候病何以瘳城何以固今人皆知发药殊不究竟表里脏腑虚实冷
热经络荣卫投之不当反为它害亦不可执用一方一药且大HT 局四味理中丸小柴胡汤之类皆大
人药剂
所谓意到症见药无不验能者此理症候方药诸家所载无不应效但究竟不到有乎得共尽由攻乎异
端涉猎繁杂智性不专事在狂简确实与言更请思之
议曰医与调理其意等差参详虚实之宜究竟缓远之理若明疾之轻重当察病之远迩为其所患
得变
稍重症候稍逆直取其功而全其效者医之良工可以扶持循症解利宽缓服药次第瘳愈毋令加进克
日安苏此乃善能调治譬如水流就下迸溜迟疾澄则自清深则自润狭则自湍岸则自泻洄涡漩伏滩
濑奔流者乃自然而然不可得使之然也脉气之流行遇冷热寒凉风温燥湿亦由水之就坎也调理
谓
疾作尚未传变气行在乎怯弱膊变即循其法度怯弱即缓与扶持是以调谓守节理谓有序节者无太
过不及序者已得其所宜然后谓之理无太过不及可以谓之调调者而有度知度而在于形容理者须
可法正法而全于规矩譬之丝不及络头不得梳斯皆乱也络之取其条直梳之析其通解无毫发之遗
有纯复之庆者诚谓调理之工也夫苟以危而用急见愈而用缓者乃共度也斟酌权衡勿隘偏坠先约
其轻重察其进退药与病势相参病与丸散相及医自意设智与医同药与疾谐疾用药等用之无忽何
虑疾不瘳病不愈哉呜呼学人理幼勿恃其自能执其偏见事有优长须预学问尽心而后已
Discourse states: Generally, those who are dull in nature and malicious in intent should not learn to be physicians. If one does not choose goodness but commits evil, disaster is hard to escape. Those who are timid by disposition, straightforward in action but weak in character, also should not discuss the use of medicine. The *Suwen* (Basic Questions) states: "Humans are like boats, and medicines are like water." Water can float a boat, but it can also capsize it. If a pill or powder is correctly indicated and achieves perfect results, rescuing the critically ill from danger, this is not surprising. However, if harm occurs due to profit-seeking or the condition deteriorates, the fault lies with you. Your wisdom is clumsy and dull; it is not the medicine's fault. Students of medicine should study classics, explore their purity and subtlety, apply meticulous research, and strive for efficacy, thereby conforming to rules. What cannot be verbally described belongs to the realm of excellent physicians.
Ancients said that physicians using medicine is like generals using troops. For instance, a skilled physician who clearly diagnoses corresponds to a capable general who obtains correct strategies; medicine conquers disease just as soldiers defend the city. If a general has no strategy, and a physician faces syndromes and pathogens, how can diseases be cured? How can cities be secured? Nowadays, people know how to prescribe drugs but fail to investigate thoroughly. Regarding exterior and interior, zang-fu organs, deficiency and excess, cold and heat, meridians, and Ying-Wei (Nutritive and Defensive Qi), inappropriate administration may cause other harms. One must not rigidly stick to a single formula or herb. Even formulas such as Siwei Lizhong Wan (Four-Ingredient Spleen-Warming Pill) and Xiaochaihu Tang (Minor Bupleurum Decoction) are adult dosages. It is said that "when intention reaches and symptoms appear, medicines are invariably effective," which only capable persons can achieve. The principle is that although various texts record syndromes, formulas, and herbs that should theoretically be effective, few truly reach the ultimate perfection. Is it due to excessive attack? Or is it because one delves into heterodox teachings, has miscellaneous knowledge without focus, and acts recklessly and simplistically? Indeed, one must reflect deeply on this.
Discourse states: The intent of medical treatment and nursing care differs slightly, but both require examining the appropriateness of deficiency and excess, and thoroughly understanding the principles of urgency and slowness. If one understands the severity of the disease, one must observe whether the illness is recent or chronic. Based on the patient's condition, if symptoms are slightly severe and the course is slightly adverse, directly seeking efficacy while preserving therapeutic outcomes is the method of an excellent physician supporting the patient. One should explain the pros and cons according to the syndrome, administer medications in a relaxed sequence, promote recovery, prevent aggravation, and aim for early convalescence. This is being good at regulation and treatment.
For example, water flows downward; rapid or slow currents, clarity brings self-purification, depth brings self-nourishment, narrow channels become turbulent, banks allow drainage, eddies pool, and rapids rush—all occur naturally and cannot be forced. The circulation of pulse qi, when encountering cold, heat, chill, coolness, wind, warmth, dryness, and dampness, also flows naturally like water to low places. "Regulation" (Tiao) refers to the stage where the disease has manifested but not yet transmitted, and Qi circulation is still weak; changes then follow established laws. If Qi is weak, support it slowly. Thus, "Tiao" means observing limits, and "Li" (Reason/Order) means having order. "Limits" mean neither excess nor deficiency; "Order" means attaining the appropriate position. Only then is it called "Li." Without excess or deficiency, it can be called "Tiao." "Tiao" implies measure; knowing the measure lies in description. "Li" must be imitable; correct law fully conforms to rules. This is like silk without a head or hair that cannot be combed—this is chaos. Combing silk seeks straightness; combing hair resolves tangles without leaving any strand behind, bringing pure joy. This is indeed the skill of regulation and treatment.
If urgent methods are used for critical conditions, and slow methods are used when improvement is seen, this is excessive. One must deliberate and weigh, avoiding narrow bias. First, estimate the severity, observe the progression and regression of the disease. Medicines should correspond to the disease's momentum, and the disease should match the pills and powders. Physicians must design with intent, aligning wisdom with medical expertise, harmonizing medicine with pathology. When the disease matches the medication, use it without negligence. Why worry about the disease not healing? Alas! Students of pediatrics should not rely on self-confidence or hold prejudices. Recognize strengths, seek prior learning, and devote oneself completely before stopping.