俗云。熟读王叔和。不如临症多。或曰古今元气不同。古方不可以治今病。二说误尽后学不小。似业医者。可不必
深究古法。惟求临症多耳。此医道所以日趋而日下也。盖必先读书。而胸有成见。临症始知用方之变化。若不读
书而徒临症。虽多亦奚为哉。况病有虚实。变化万端。治有补泻。方不执一。如同一发热。而热有虚实。宜温宜补。宜
凉宜泻。不读书何以知彼虚而此实。如大匠之无绳墨。不几伥伥无之耶。学人务须深究古法。循其规矩。而后见
病知源。得心应手。盖古人立方之意。即是规矩所在。由规矩而生巧。方为真巧。若眩奇以弄巧。则巧反拙矣。孟子
云。大匠使人规矩。不能使人巧。是必先熟规矩。而乃能生巧。予谓学医必先读书。而后临症。此物此志也。
古云欲知其假。先识其真。若欲治病。必先知未病为要。盖人之脏腑经络气血。原本饮食传导。皆有一定之理。营
卫之循行。昼夜有常度。凭腰之上下。而分其清浊。七窍之中。在上受清阳之灌注。在下司浊阴之传导。呼吸应乎
开阖。动静分乎阴阳。如脉以四至五至为常。三至二至即为不及。不及则为虚为寒矣。六至七至即为太过。太过
则为实为热矣。脉之鼓动应乎肌中。如按之未及于肌而动应皮肤者。即为浮而病应在表。按之肌肉之分。而脉
尚未得。必重按至骨。而脉始应者。即应沉而病应在里。故必先知平素之脉。而后乃能识病脉。知表里虚实之大
纲。而更推之以部位时令。细切何部之独异。则病无遁情矣。故学医者。必须先读内经。是以素问详论脏腑营卫
色脉常变。靡不精细。夫常者一定之理变者化机万端。先知一定之常。而能应变化之万端。如治丝而不紊也。否
则乱绪纷纷。从何而下手耶。
俗话说：“熟读王叔和的著作，不如多进行临床实践。”或者有人说：“古今人的元气不同，古代的方剂不能治疗现在的疾病。”这两种说法对后辈学医者的误导不小。这似乎让从事医学的人认为，不必深究古代的治疗方法，只要追求临床经验多就可以了。这正是医术日益衰退的原因。
大概必须先读书，心中形成明确的见解，临症时才知道如何灵活变通使用方剂。如果不读书而仅仅依靠临床实践，即使经验再多又有什么用呢？况且疾病有虚证和实证之分，变化万千；治疗有补法和泻法之别，方药不能拘泥于一种。同样是发热，热证也有虚实之分，有的适宜用温法或补法，有的适宜用凉法或泻法。不读书怎么能知道哪个是虚、哪个是实呢？这就好比优秀的工匠没有墨线作为标准，岂不是茫然无措吗？
学医的人务必深入探究古代法则，遵循其规矩，然后才能见到病症就知道病源，做到得心应手。古人制定方剂的用意，就是所谓的“规矩”。从规矩中生出技巧，这才是真正的技巧。如果炫耀新奇来卖弄技巧，那么技巧反而变得笨拙了。孟子说：“高明的工匠教导人遵守规矩，但不能直接使人灵巧。”这说明必须先熟练掌握规矩，然后才能产生灵巧。我认为学医必须先读书，然后才能进行临床实践，就是这个道理。
古语说：“想要识别假的，先要认识真的。”如果想要治病，必须先知晓“未病”（健康状态）的状态才是关键。因为人的脏腑、经络、气血，原本都源于饮食的传导，都有一定的规律。营气和卫气的循行，昼夜都有固定的节律。以腰部为界，上下分别区分清阳和浊阴。七窍之中，上部受清阳之气的灌注，下部主管浊阴之气的传导。呼吸对应着开与阖，动静区分着阴与阳。
例如脉搏跳动，一呼一吸间脉跳四到五次为正常。如果只有三至或两次，即为不及，不及则属于虚证或寒证。如果六至或七次，即为太过，太过则属于实证或热证。脉搏的鼓动反应在肌肉中，如果轻按还没感觉到搏动，但重按皮肤表面就有搏动感，这就是浮脉，病位在表。如果按在肌肉层还感觉不到脉搏，必须重按至骨骼处才有脉搏感应，这就是沉脉，病位在里。所以必须先知晓平时的正常脉象，然后才能识别病脉，掌握表里虚实的大纲，再进一步结合部位和时令，仔细切诊哪一部脉象有独特异常，那么病情就无处隐藏了。
因此，学医的人必须先读《内经》。《素问》详细论述了脏腑、营卫、面色、脉象的正常与变化，无不精细。所谓“常”，是一定的规律；所谓“变”，是变化的机理万千。先知晓一定的常态，才能应对变化的万端，就像整理丝线一样不乱。否则就会乱绪纷纷，不知从何下手。
It is commonly said, "Being familiar with Wang Shuhe's works is inferior to having more clinical experience." Some argue that the vital energy (Yuan Qi) of ancient and modern times differs, so ancient prescriptions cannot treat contemporary diseases. These two views have misled subsequent generations significantly. This seems to suggest that medical practitioners need not deeply investigate ancient methods, but merely seek abundant clinical experience. This is precisely why the art of medicine has been declining day by day.
One must first study books to form clear insights in mind; only then can one know how to flexibly apply prescriptions during clinical practice. If one relies solely on clinical experience without studying, what use is even abundant experience? Moreover, diseases manifest as deficiency or excess, with myriad variations; treatments involve tonification or purgation, and prescriptions should not be rigidly fixed. For instance, regarding fever, heat syndromes also differ between deficiency and excess. Some are suitable for warming or tonifying methods, while others are suitable for cooling or purging methods. Without reading, how can one distinguish which is deficiency and which is excess? It is like a master craftsman lacking a plumb line or ink line; would they not be lost and directionless?
Students must thoroughly investigate ancient laws and follow their rules, so that upon seeing a disease, they can understand its origin and achieve ease and proficiency. The intention behind the ancients' formulation of prescriptions lies in these "rules." Skill generated from rules is true skill. If one flaunts novelty to show off cleverness, such cleverness becomes clumsiness. Mencius said, "A master carpenter teaches others to follow rules but cannot teach them to be skillful." This implies that one must first master the rules before skill can emerge. I believe that learning medicine requires studying books first, followed by clinical practice; this is the principle.
The ancients said, "To recognize the false, one must first know the true." To treat diseases, it is essential to first understand the state of "pre-disease" (health). The viscera, collaterals, qi, and blood of humans originally stem from the digestion and transmission of food and drink, all following certain principles. The circulation of Ying (Nutrient) Qi and Wei (Defensive) Qi follows constant rhythms day and night. Divided by the waist, upper and lower parts distinguish clear yang from turbid yin. Among the seven orifices, the upper part receives the infusion of clear yang, while the lower part governs the transmission of turbid yin. Respiration corresponds to opening and closing, and movement and stillness distinguish yin and yang.
For example, a normal pulse beats four to five times per breath cycle. Three or two beats indicate insufficiency, signifying deficiency or cold. Six or seven beats indicate excess, signifying excess or heat. Pulse pulsation responds within the muscles. If pressing lightly does not detect the pulse, but pressing the skin surface reveals pulsation, it is a Floating Pulse (Fu Mai), indicating the pathology is at the exterior. If pressing the muscle layer fails to detect the pulse, and one must press heavily to the bone to feel it, it is a Deep Pulse (Chen Mai), indicating the pathology is at the interior. Therefore, one must first know the usual pulse to identify pathological pulses, grasp the general outline of exterior-interior and deficiency-excess, and further deduce based on location and season, carefully palpating which specific area shows unique abnormalities, thus leaving no hidden details of the disease.
Therefore, students of medicine must first read the *Neijing* (Inner Canon). The *Suwen* (Basic Questions) details the normal and changing states of viscera, Ying and Wei Qi, complexion, and pulses with meticulous precision. "Normal" refers to fixed principles; "Changing" refers to myriad mechanisms of transformation. By first knowing the fixed normal state, one can respond to myriad changes, just as sorting silk threads without confusion. Otherwise, the threads become chaotic, and one would not know where to begin.