捶纲。漫凿也。例。逆凿也。赋。 凿也。注解。仆外家之凿耳。何足以与凿例。至若多凿纷纷。
凿以误凿。凿凿相寻者。难以枚数。淮南子曰。今释正而追曲。背是而从众。是与俗俪走而内行
无绳。习凿之谓也。医而至于习凿。生民之命县之凿手。言之可不痛心。然心此则爱。爱则仁。
仁则非道不行。此道之所以道也。不则忍。忍由徇己。己则何所不至。不流于凿不已也。此凿之
所以凿与。盖事无两适。出乎此。必入乎彼。出乎彼。必入乎此。此近时之医。所以又有凿燥为
糙者出也。夫燥。埽音也。凿之为糙。不陋甚乎。医之风。颓矣。后学君子。苟志于道。当先正
此颓风。夫然后。兹则庶乎其可也。
问任医。
曰。任医如任相。相受天子九锡之荣。而司天下万民之命。当正大体。不当亲细务。是故。
进退百官。调和鼎鼐。燮理阴阳。其要在于公天下之贤才。察识其所能而器用之于天下。以天下
利天下焉尔。天下无虞。则修礼乐以和乐之。设有警焉。则整干戈以戡定之。斟酌前代之成法。
而损益以因革之。不作聪明以生事于承平。不为贪鄙以幸祸于危乱。论语曰。危而不持。颠而不
扶。则将焉用彼相。不知此。不足与论任医之道。
问治病。
曰。治病如治寇。寇为天下害。不治则祸乱不息。鼠窃狗偷。一击或可。若夫云集而乌合。
蜂屯而蚁聚。其势至于据险守僻。称名僭号者。岂等闲师旅所可驱除哉。要必雄军大将。坚甲利
兵。捣穴破巢。枭渠磔 。收功端在于擒王。王擒而天下之事定矣。卒徒虽有逸者。旋可息伏。
若拘拘惟卒是图。不殄元恶。元恶既在。祸乱终当复起。离之上九曰。王用出征。有嘉折首。获
匪其丑。无咎。知夫此。而后可与辨夫治病之理。
问用药。
曰。用药如用兵。兵非可玩之器。文修武备。盛世长策。无事而动。不惟徒取费耗。殆将启
舋招尤。事不容已。兵兴师出。我既为师。彼则为敌。大敌在前。必察其情。虚实真伪。得其情
而可以无疑矣。毋骄兵以轻敌。毋慢兵以失机。顺天时。因地利。率人和。承物宜。旗 严明。
士卒用命。有定谋。有成算。整行阵。饬奇正。然后战胜攻取可必。不则憧憧御敌。其不败也鲜
矣。易曰。师出以律。否减凶。不知此。不足与言用药之义。
问立方。
曰。立方如立国。得国在得君。当纷乱扰攘之时。际臣佐使之会者。苟非立国。则无以安天下。
国不得君。则国非其国矣。盖济时主治。人君自有一代之真。非伪似者所可觊觎徼幸于其间也。
得其真。则鼓行列阵。可以收倒戈迎刃之功。失其真。则虽汗马血兵。不过徙为疽背噬脐之多事
耳。是故具正法眼者。的知沐猴井蛙之不足与定祸乱也。传曰。一正君而国定。知乎此。而后可
与议夫立方之法。
问春温夏暑秋凉冬寒者。四时之令气也。而素问言四气之所以为人病。则曰春伤于风。夏伤
于暑。秋伤于湿。冬伤于寒。
夫冬夏之伤于寒暑。无容议矣。乃春则不以温言。而言伤于风。秋则不以凉言。而言伤于湿。何也。
曰。冬伤于寒。春必病温。温在病矣。虽不言伤。而伤在不言之中可知也。且温主生。生则
亦不可以伤言。又可知也。然四时皆有风。何谓春独伤。曰。四时皆有风。唯春独动。动则万物
皆虫生。所以人亦伤也。夏生飧泄。何也。曰。风属木。木邪盛。则土受害。人身之土。脾胃是
也。脾主化输。胃廪水谷。飧泄者。水谷利也。古人谓水饭曰飧。民间水饭用于夏。长夏土令行。
木邪发而餐泄作者。物盛必衰。土败木贼也。秋何不以凉言。曰。盛夏酷暑。烁石流金。人如坐
甑中。得秋凉而解。且凉主收。彼方解而收。不伤人可知矣。故惟凉不伤人。人故无凉病。湿者
何。曰。黄梅雨节。五月则然。土润溽暑。大雨时行。长夏之令也。于此不以湿言。乃于秋气至。
凉风生。暑毒退。水痕收。天气清。地气爽之时。而曰伤于湿者。人病不外则内。以人身中之自
内出者言也。内出者何。曰万物至秋成。物成人味浓。味浓则痰多。痰。广韵胸上水病。湿莫湿
于水。水寒相搏。则咳。所以冬必咳嗽者。以岁言之。冬至子之半。水泉动也。若以日言。夜分亦
子之半。亦水泉动也。故人之病咳嗽者。以岁计。则冬半发。以日计。则夜分发。应水泉之动而
动也。不然。若以外入之湿言。病发则当为肿。为满。为胀。为痛。为痿。为痹。不当咳嗽也。呜
呼。道明必自物格始。传曰。物格而后知至。知至而后意诚。故又曰。诚则明矣。然不诚则无物。
有何道可言哉。
问人皆曰医者意也。意可以言医乎。
曰。意可以入医。亦足以乱医。不可以言医。何谓也。曰。医有道。道本乎天。意由诸己。
己则未免杂于妄。天则诚而已。故意正而诚。乃所以造道。邪而妄。适足以害道。不察害道之意。
而直指意以言医。是亦乱医云尔。乌可以言医乎。且意能害道。不独医为然。果斋李正叔曰。自
夫子设教洙泗。以博文约礼授学人。颜子曾子子思孟子相与共守之。未尝失坠。其后正学失传。
士各以意为学。其务于该洽者。既以闻见累积自矜。而流于泛滥驳杂之归。其溺于径约者。又谓
不立文本可以识心见性。而陷于旷荡空虚之域。儒之以意害道。盖闻其弊有如此矣。医自药始于
本草。理原于素灵。脉着于难经。中正之道成。乃剖腹则异于华。秘方又奇于仓。神农之家事芜。
帝伯之大道塞。人亦各皆以意为医。其务于阿世媚
俗。而以贾为事者。则借口于调胃补虚以悦人。其好为索隐行怪而以诡炫售者。则又放言谓通仙
如神以自诞。矜方玩法。析治分科以相嫌隙。先正谓医与相通道。而其所以坏。则又相符如此。
儒尚且尔。医何足怪哉。呜呼。是皆道之厄也。儒之厄周程张子起而辟之于前。朱子统而正之于
后。而后圣人之道如日中天。今则郁郁乎盛矣。医之厄。仲景起。方法一。道大备。论而正之。
方甫定。仲景死。其言未及韦而湮。不奈曲学丧心。懵经愎意。凿道营私。论经则讹其传而昧
其转。是非莫辨。致伤寒有七十二之妄言。久道则以子代父而占世。贤不肖。 使救敲之不暇者。
得以撒骄而自纵。厄则极矣。窃闻之物极则反。信斯言也。奚谓无挽邪。天将厌其极。则必有再
辟者出。出则此书者。非再辟之玑衡邪。故条辨之。盖亦庶几有补于将来缺略之万一云尔。若夫
删繁剔误。是则幸望后贤。问者俞俞爰付梓。
捶纲。漫凿也。例。逆凿也。赋。 凿也。注解。仆外家之凿耳。何足以与凿例。至若多凿纷纷。
凿以误凿。凿凿相寻者。难以枚数。淮南子曰。今释正而追曲。背是而从众。是与俗俪走而内行
无绳。习凿之谓也。医而至于习凿。生民之命县之凿手。言之可不痛心。然心此则爱。爱则仁。
仁则非道不行。此道之所以道也。不则忍。忍由徇己。己则何所不至。不流于凿不已也。此凿之
所以凿与。盖事无两适。出乎此。必入乎彼。出乎彼。必入乎此。此近时之医。所以又有凿燥为
糙者出也。夫燥。埽音也。凿之为糙。不陋甚乎。医之风。颓矣。后学君子。苟志于道。当先正
此颓风。夫然后。兹则庶乎其可也。
【译文】
“捶纲”（指机械地套用规则），是随意的穿凿附会。“例”（指僵化的先例），是违背常理的穿凿。“赋”（指强行赋予意义），也是穿凿。“注解”，不过是我作为门外汉的拙劣穿凿罢了，哪里值得拿来与那些所谓的“穿凿先例”相提并论？至于那些纷繁复杂的穿凿，用错误的穿凿去解释错误的穿凿，穿凿套着穿凿、相互纠缠的情况，多得难以一一列举。《淮南子》说：“如今舍弃正道而去追求邪曲，背离真理而顺从大众，这是与世俗同流合污，内心行为没有准则，这就是习惯于穿凿附会的表现。”医学如果到了习惯于穿凿附会的地步，百姓的生命就掌握在那些乱来的人手中，说起来怎能不让人痛心？然而，心中存有这种痛惜之情就是“爱”，有爱就是“仁”，有仁德就必然遵循正道行事，这就是“道”之所以成为“道”的原因。如果不这样，就会变得残忍，残忍源于顺从私欲，有了私欲还有什么做不出来的呢？不流向穿凿的深渊是不会停止的。这就是穿凿之所以成为穿凿的原因吧。大概事情不能同时兼顾两端，从这个角度出发，必然进入那个角度；从那个角度出发，必然进入这个角度。这就是为什么近时的医生中，又出现了把干燥当作粗糙（即混淆概念、粗制滥造）的人出现。所谓“燥”，读音同“扫”。把穿凿变成粗糙，不是更加鄙陋吗？医学的风气已经衰败了。后来的学者君子，如果立志于大道，应当首先纠正这种衰败的风气，然后，这些原则才差不多可以实行。
问任医。
曰。任医如任相。相受天子九锡之荣。而司天下万民之命。当正大体。不当亲细务。是故。
进退百官。调和鼎鼐。燮理阴阳。其要在于公天下之贤才。察识其所能而器用之于天下。以天下
利天下焉尔。天下无虞。则修礼乐以和乐之。设有警焉。则整干戈以戡定之。斟酌前代之成法。
而损益以因革之。不作聪明以生事于承平。不为贪鄙以幸祸于危乱。论语曰。危而不持。颠而不
扶。则将焉用彼相。不知此。不足与论任医之道。
【译文】
问：如何任用医生？
答：任用医生就像任用宰相。宰相承受天子赐予的最高荣誉，掌管天下万民的生命。应当把握大局，不应当亲自处理琐碎事务。因此，提拔或罢免百官，调和鼎鼐（比喻治理国家），协调阴阳，关键在于公正地选拔天下的贤才，识别他们的才能并在天下范围内加以任用，以此来造福天下。天下如果没有忧患，就修订礼乐来使百姓安乐；如果有警报（危机），就整顿兵器来平定它。斟酌前代的成熟法规，进行增减变革以适应时代。不在太平时期自作聪明而生出事端，不因贪婪卑鄙而在危难混乱中侥幸获利。《论语》说：“国家危险却不扶持，跌倒却不搀扶，那还要辅助者做什么呢？”不懂得这个道理，就不足以与他讨论任用医生的道理。
问治病。
曰。治病如治寇。寇为天下害。不治则祸乱不息。鼠窃狗偷。一击或可。若夫云集而乌合。
蜂屯而蚁聚。其势至于据险守僻。称名僭号者。岂等闲师旅所可驱除哉。要必雄军大将。坚甲利
兵。捣穴破巢。枭渠磔 。收功端在于擒王。王擒而天下之事定矣。卒徒虽有逸者。旋可息伏。
若拘拘惟卒是图。不殄元恶。元恶既在。祸乱终当复起。离之上九曰。王用出征。有嘉折首。获
匪其丑。无咎。知夫此。而后可与辨夫治病之理。
【译文】
问：如何治疗疾病？
答：治疗疾病就像讨伐贼寇。贼寇是天下的祸害，不治理则祸乱不会停止。对于像老鼠小偷那样零星的小盗，一次打击或许就可以解决。但是，对于那些像云聚集、乌鸦聚合，像蜜蜂屯集、蚂蚁聚拢一样大规模集结的敌人，他们的势力以至于占据险要、坚守偏僻之地，自称名号、僭越称帝的，难道是普通的军队可以轻易驱除的吗？必须依靠雄壮的大军和将领，坚固的铠甲和锋利的兵器，捣毁敌穴，打破巢穴，斩杀首领，分割肢体。建立功业的关键在于擒获首脑（擒王）。首脑被擒，天下的事情就安定下来了。即使士兵中有逃脱的，很快也可以平息降服。如果拘泥于只图消灭小卒，不消灭首恶，首恶既然存在，祸乱终究会再次兴起。《易经·离卦》上九爻辞说：“君王出兵征伐，有美好的战果，斩断首级，抓获的不是那些普通的小人，没有灾祸。”懂得这个道理，然后才可以与他辨析治疗的原理。
问用药。
曰。用药如用兵。兵非可玩之器。文修武备。盛世长策。无事而动。不惟徒取费耗。殆将启
舋招尤。事不容已。兵兴师出。我既为师。彼则为敌。大敌在前。必察其情。虚实真伪。得其情
而可以无疑矣。毋骄兵以轻敌。毋慢兵以失机。顺天时。因地利。率人和。承物宜。旗 严明。
士卒用命。有定谋。有成算。整行阵。饬奇正。然后战胜攻取可必。不则憧憧御敌。其不败也鲜
矣。易曰。师出以律。否减凶。不知此。不足与言用药之义。
【译文】
问：如何使用药物？
答：使用药物就像使用军队。军队不是可以玩弄的工具。修明文治，加强武备，是盛世长久的策略。没有战事却动用武力，不仅白白耗费资源，恐怕还会引发争端、招致怨恨。事情迫不得已，才发动战争，派出军队。我方既然是军队，对方就是敌人。强大的敌人在面前，必须考察敌情，辨别虚实真伪，掌握了敌情就可以没有疑虑了。不要骄傲轻敌，不要懈怠而错失战机。顺应天时，凭借地利，率领人和，顺应万物适宜的规律。旗帜严明，士兵听从命令。有确定的谋略，有成熟的计划，整顿阵型，调整奇兵正兵，然后战胜攻取才可以保证。否则，心神不定地抵御敌人，不败的情况很少见。《易经》说：“军队出动必须遵守纪律，否则减少凶险（注：原文‘否减凶’疑为‘否臧凶’之误，意为不善则凶，此处依原文直译或意译为若不严明纪律则有凶险）。”不懂得这个道理，就不足以与他谈论使用药物的义理。
问立方。
曰。立方如立国。得国在得君。当纷乱扰攘之时。际臣佐使之会者。苟非立国。则无以安天下。
国不得君。则国非其国矣。盖济时主治。人君自有一代之真。非伪似者所可觊觎徼幸于其间也。
得其真。则鼓行列阵。可以收倒戈迎刃之功。失其真。则虽汗马血兵。不过徙为疽背噬脐之多事
耳。是故具正法眼者。的知沐猴井蛙之不足与定祸乱也。传曰。一正君而国定。知乎此。而后可
与议夫立方之法。
【译文】
问：如何制定方剂？
答：制定方剂就像建立国家。得到国家关键在于得到君主。在纷乱扰攘的时候，面临臣下辅佐使者汇聚的局面，如果不是建立国家（确立核心），就无法安定天下。国家如果没有君主，就不是真正的国家了。大概救济时局、主持大局，君主自有他那一代的真谛，不是那些虚伪相似的人可以在其中窥探侥幸得到的。得到了真谛，那么击鼓列阵，就可以收到敌军倒戈、迎刃而解的功效；失去了真谛，那么即使是浴血奋战，也不过是自找麻烦，像背上生疽、咬脐救父那样多余且有害罢了。因此，具备正确眼光的人，清楚地知道那些像猴子戴帽子、井底之蛙一样浅薄的人不足以与他们一起平定祸乱。传记说：“端正君主（确立核心），国家就安定。”懂得这个道理，然后才可以与他议论制定方剂的方法。
问春温夏暑秋凉冬寒者。四时之令气也。而素问言四气之所以为人病。则曰春伤于风。夏伤
于暑。秋伤于湿。冬伤于寒。
夫冬夏之伤于寒暑。无容议矣。乃春则不以温言。而言伤于风。秋则不以凉言。而言伤于湿。何也。
曰。冬伤于寒。春必病温。温在病矣。虽不言伤。而伤在不言之中可知也。且温主生。生则
亦不可以伤言。又可知也。然四时皆有风。何谓春独伤。曰。四时皆有风。唯春独动。动则万物
皆虫生。所以人亦伤也。夏生飧泄。何也。曰。风属木。木邪盛。则土受害。人身之土。脾胃是
也。脾主化输。胃廪水谷。飧泄者。水谷利也。古人谓水饭曰飧。民间水饭用于夏。长夏土令行。
木邪发而餐泄作者。物盛必衰。土败木贼也。秋何不以凉言。曰。盛夏酷暑。烁石流金。人如坐
甑中。得秋凉而解。且凉主收。彼方解而收。不伤人可知矣。故惟凉不伤人。人故无凉病。湿者
何。曰。黄梅雨节。五月则然。土润溽暑。大雨时行。长夏之令也。于此不以湿言。乃于秋气至。
凉风生。暑毒退。水痕收。天气清。地气爽之时。而曰伤于湿者。人病不外则内。以人身中之自
内出者言也。内出者何。曰万物至秋成。物成人味浓。味浓则痰多。痰。广韵胸上水病。湿莫湿
于水。水寒相搏。则咳。所以冬必咳嗽者。以岁言之。冬至子之半。水泉动也。若以日言。夜分亦
子之半。亦水泉动也。故人之病咳嗽者。以岁计。则冬半发。以日计。则夜分发。应水泉之动而
动也。不然。若以外入之湿言。病发则当为肿。为满。为胀。为痛。为痿。为痹。不当咳嗽也。呜
呼。道明必自物格始。传曰。物格而后知至。知至而后意诚。故又曰。诚则明矣。然不诚则无物。
有何道可言哉。
【译文】
问：春温、夏暑、秋凉、冬寒，是四季的气候特征。而《素问》论述四季之气导致人生病的机理时，却说“春伤于风，夏伤于暑，秋伤于湿，冬伤于寒”。
对于冬季和夏季分别受寒、受暑，这无需多议。但是春天不用“温”来说，而说“伤于风”；秋天不用“凉”来说，而说“伤于湿”。为什么呢？
答：冬天受寒，春天必定发生温病（Wen Bing, 温热性疾病）。温病已经属于病症了，虽然不说“伤”，但伤害蕴含在不言中是可以知道的。而且“温”主生长，生长也不可以用“伤”来形容，这也是可以知道的。然而四季都有风，为什么说只有春天受伤？答：四季都有风，只有春天独自发动（风气主动）。发动则万物都滋生，所以人也随之受伤。夏天产生飧泄（Sun Xie, 完谷不化的腹泻），为什么呢？答：风属于木，木邪气旺盛，则土受到损害。人体中的土，指的是脾胃。脾主运化输送，胃储藏水谷。飧泄，就是水谷不化而下利。古人称水饭为“飧”。民间在夏天吃水饭。长夏（Chang Xia, 中医指夏末秋初湿气最盛的时节）土气当令。木邪发作而导致飧泄增多。事物极盛必然衰退，这是土气败坏而被木气克制（Wood overacting on Earth）的结果。秋天为什么不说是“凉”？答：盛夏酷暑，石头熔化，金属流淌，人就像坐在蒸笼里。得到秋天的凉爽才得以解脱。而且“凉”主收敛，刚刚解脱出来就进行收敛，不伤害人是显而易见的。所以只有“凉”不伤害人，人们因此没有“凉病”。什么是“湿”？答：梅雨季节，五月就是这样。土地湿润，湿热闷人，大雨时常流行，这是长夏的气候特征。在这个时候不说“湿”，而是在秋气到来，凉风产生，暑热毒素消退，水汽痕迹收起，天气清朗，地气清爽的时候，却说“伤于湿”，这是为什么呢？人的疾病不外乎外感和内伤。这里说的是从人体内发出的疾病。从内发出的是什么？答：万物到了秋天成熟，物体成熟后味道浓厚。味道浓厚则痰多。痰，根据《广韵》解释是胸上的水液病变。没有比水更湿的了，水与寒气相互搏击，就会产生咳嗽。所以冬天必定咳嗽，按年份来说，冬至是一年的中间，此时水泉开始涌动。按一天来说，半夜也是一天的中间，也是水泉涌动的时候。所以人患咳嗽病，按年计算，则在冬至前后发作；按日计算，则在半夜发作。这是响应水泉涌动的规律而发作的。不然的话，如果是外部侵入的湿邪，发病时应当表现为浮肿、痞满、腹胀、疼痛、痿证、痹证，而不应当是咳嗽。唉，道的阐明必然从格物（Gewu, 探究事物原理）开始。传记说：“格物之后知识才能达到极致，知识达到极致后意念才能真诚。”所以又说：“真诚就能明白。”然而不真诚就没有真实的事物，有什么道可以谈论呢？
问人皆曰医者意也。意可以言医乎。
曰。意可以入医。亦足以乱医。不可以言医。何谓也。曰。医有道。道本乎天。意由诸己。
己则未免杂于妄。天则诚而已。故意正而诚。乃所以造道。邪而妄。适足以害道。不察害道之意。
而直指意以言医。是亦乱医云尔。乌可以言医乎。且意能害道。不独医为然。果斋李正叔曰。自
夫子设教洙泗。以博文约礼授学人。颜子曾子子思孟子相与共守之。未尝失坠。其后正学失传。
士各以意为学。其务于该洽者。既以闻见累积自矜。而流于泛滥驳杂之归。其溺于径约者。又谓
不立文本可以识心见性。而陷于旷荡空虚之域。儒之以意害道。盖闻其弊有如此矣。医自药始于
本草。理原于素灵。脉着于难经。中正之道成。乃剖腹则异于华。秘方又奇于仓。神农之家事芜。
帝伯之大道塞。人亦各皆以意为医。其务于阿世媚
俗。而以贾为事者。则借口于调胃补虚以悦人。其好为索隐行怪而以诡炫售者。则又放言谓通仙
如神以自诞。矜方玩法。析治分科以相嫌隙。先正谓医与相通道。而其所以坏。则又相符如此。
儒尚且尔。医何足怪哉。呜呼。是皆道之厄也。儒之厄周程张子起而辟之于前。朱子统而正之于
后。而后圣人之道如日中天。今则郁郁乎盛矣。医之厄。仲景起。方法一。道大备。论而正之。
方甫定。仲景死。其言未及韦而湮。不奈曲学丧心。懵经愎意。凿道营私。论经则讹其传而昧
其转。是非莫辨。致伤寒有七十二之妄言。久道则以子代父而占世。贤不肖。 使救敲之不暇者。
得以撒骄而自纵。厄则极矣。窃闻之物极则反。信斯言也。奚谓无挽邪。天将厌其极。则必有再
辟者出。出则此书者。非再辟之玑衡邪。故条辨之。盖亦庶几有补于将来缺略之万一云尔。若夫
删繁剔误。是则幸望后贤。问者俞俞爰付梓。
【译文】
问：人们都说“医者，意也”（Yi Zhe, Yi Ye, 医生的诊断依赖于直觉/心意）。心意可以用来谈论医学吗？
答：心意可以进入医学领域，但也足以扰乱医学。不可以单凭心意来谈论医学。为什么呢？答：医学有“道”，道基于天道（Tiandao, 自然法则）。心意源于个人自我。自我难免夹杂虚妄，天道则是真诚而已。所以心意端正且真诚，这才是通往道的途径；如果邪僻且虚妄，恰好足以损害道。不考察损害道的心意，而直接指着“心意”来谈论医学，这也是扰乱医学罢了，怎么可以谈论医学呢？况且心意能损害道，不仅仅是医学如此。果斋的李正叔说：自从孔子在洙水、泗水之间设立教化，通过广博文献、约束礼仪来教导学生，颜回、曾参、子思、孟子共同守护它，未曾失传。后来正统学问失传，读书人各自凭自己的心意做学问。那些致力于渊博通达的人，既凭借见闻积累而自夸，最终流于泛滥驳杂；那些沉溺于简约直截的人，又认为不立文字就可以认识本心、见到本性，从而陷入空旷虚无的领域。儒家因为心意而损害道，大概听到弊端就像这样。医学自从药物始于《本草》，理论源于《素问》和《灵枢》，脉学显明于《难经》，中正之道形成。然而扁鹊（秦越人，传说曾剖开胸膛换心）则不同于华佗，仓公（淳于意）的秘方又很奇特。神农家的事业荒芜，帝王伯者的宏大道路堵塞。人们也都各自凭心意行医。那些致力于迎合世俗、以牟利为目的的人，就借口说调理脾胃、补益虚弱来取悦他人；那些喜欢探索隐秘、行为怪异并以诡异炫耀来售卖医术的人，又放肆地说自己通晓神仙之术如神一般来自我吹嘘。夸耀方剂，玩弄手法，分析治疗，分科行医以制造隔阂。先前的正人君子说医生和宰相的道路相通，而他们败坏的方式，竟然又如此相符。儒家尚且如此，医学又有什么奇怪的呢？唉，这都是道的灾难。儒家的灾难，周敦颐、程颢、程颐、张载在前面倡导辟邪，朱熹在后面统领纠正，然后圣人的道像太阳升在中天，现在非常兴盛了。医学的灾难，张仲景兴起，方法统一，道大大完备，论述并纠正它。刚刚稳定，张仲景去世，他的言论还没来得及等到韦编三绝（指书籍流传）就湮没了。无奈那些歪曲学问、丧失良心的人，蒙蔽经典，固执己见，穿凿附会以谋取私利。论述经典时讹传其说，使其转变模糊，是非无法辨别，导致关于伤寒有七十二种变证的荒谬言论。长久以来，甚至让儿子代替父亲占据地位，贤与不贤混杂，使得那些连救治都忙不过来的人，得以撒野骄傲、放纵自己。灾难到了极点。我私下听说物极必反，相信这句话，怎么能说没有挽救的办法呢？上天将要厌恶这种极端情况，就一定会有再次开辟的人出现。出现这样的人，这本书不就是再次开辟的权衡标准吗？所以我对条文进行辨析。大概也对将来缺失遗漏的情况有万一的补充吧。至于删除繁杂、剔除错误，那就希望后来的贤人了。提问者俞俞于是刻印出版。
"Chui Gang" (mechanically applying rules) is arbitrary and forced interpretation. "Li" (rigid precedents) is forced interpretation contrary to common sense. "Fu" (forcing meanings) is also forced interpretation. "Annotations" are merely my clumsy forced interpretations as an outsider. How can they be compared with those so-called "precedents of forced interpretation"? As for the myriad complicated forced interpretations, where wrong interpretations explain other wrong ones, and forced interpretations entangle with each other, there are too many to count. The *Huainanzi* states: "Now abandoning the right path to pursue crookedness, turning away from truth to follow the crowd—this is walking in step with vulgarity while having no internal standard; this is what is called being accustomed to forced interpretation." When medicine reaches the point of being accustomed to forced interpretation, the lives of the people hang in the hands of those who act arbitrarily. Speaking of this, how can one not feel heartbroken? However, harboring such pity is "love"; love constitutes "benevolence" (Ren); benevolence necessitates acting according to the Dao (Way). This is why the Dao is called the Dao. If not, one becomes cruel; cruelty stems from indulging selfish desires. Once selfish desires exist, what cannot be done? One will not cease flowing into the abyss of forced interpretation until it stops. This is why forced interpretation becomes forced interpretation. Generally, affairs cannot serve two masters at once; proceeding from one perspective inevitably leads to another, and vice versa. This is why, among contemporary physicians, there have emerged those who confuse dryness with coarseness (i.e., mixing concepts and producing crude work). "Zao" (dryness) sounds like "Sao" (sweep). Turning forced interpretation into coarseness is indeed even more vulgar. The ethos of medicine has declined. Scholars of later generations, if you aspire to the Dao, must first rectify this declining ethos; only then can these principles be practically implemented.
Question: How to appoint physicians?
Answer: Appointing a physician is like appointing a prime minister. The prime minister receives the highest honors from the Son of Heaven and manages the lives of all people under heaven. He should grasp the general principles and not attend to trivial details. Therefore, promoting or dismissing officials, harmonizing the state (symbolized by adjusting the cauldron), and coordinating Yin and Yang hinge on impartially selecting worthy talents from across the world, recognizing their abilities, and employing them for the benefit of the world. When there are no worries in the world, rituals and music are cultivated to bring harmony and joy. If there is a warning (crisis), weapons are prepared to quell it. Examining established laws of previous dynasties, making additions and subtractions to adapt to changes. Do not display cleverness to create trouble during times of peace, nor act greedily and basely to seek fortune amidst danger and chaos. The *Analects* says: "If the state is in danger and you do not support it, if it is stumbling and you do not help it, then what use is that assistant?" Not understanding this, one is unworthy of discussing the way of appointing physicians.
Question: How to treat diseases?
Answer: Treating disease is like suppressing bandits. Bandits are a disaster to the world; if not suppressed, turmoil will never cease. For petty thieves like rats and dogs, a single strike might suffice. But for enemies gathering like clouds and crows, swarming like bees and ants, whose power lies in occupying strategic positions and remote areas, claiming titles and usurping authority—can they be driven out by ordinary troops? It requires mighty armies and great generals, sturdy armor and sharp weapons, destroying dens and breaking nests, executing leaders, and dismembering bodies. Achieving success lies essentially in capturing the king (the ringleader). Once the king is captured, the affairs of the world are settled. Even if some soldiers escape, they can soon be subdued. If one is拘拘 (pedantic) and only plans for eliminating foot soldiers without annihilating the principal evildoer, as long as the principal evildoer exists, turmoil will eventually rise again. The top line of the *Li* hexagon in the *I Ching* says: "The king uses military force. There is praise for breaking the head. Capturing not the minor offenders. No blame." Knowing this, one can then discuss the principles of treatment.
Question: How to use medicinal herbs?
Answer: Using medicinal herbs is like using soldiers. Soldiers are not tools to be played with. Cultivating civil virtues and preparing military strength is a long-term strategy for prosperous ages. Moving without cause wastes resources and may provoke disputes and resentment. Only when circumstances leave no choice does war begin and troops march. We become the army, and they become the enemy. Facing a formidable enemy, one must investigate the situation, distinguishing between empty and full, true and false. Grasping the situation removes doubt. Do not let pride lead to underestimating the enemy; do not let negligence cause missed opportunities. Follow the timing of Heaven, utilize the advantages of Earth, lead the harmony of People, and accommodate the suitability of things. Flags must be clear and strict; soldiers must obey orders. There must be fixed strategies and mature calculations. Arrange formations, adjust surprise and orthodox tactics. Then victory and conquest can be ensured. Otherwise, fighting the enemy with a distracted mind, defeat is rare to avoid. The *I Ching* says: "When the army sets out, it must proceed with discipline; otherwise, misfortune ensues." Not knowing this, one is unworthy of discussing the meaning of using medicinal herbs.
Question: How to formulate prescriptions?
Answer: Formulating a prescription is like establishing a state. Gaining a state depends on gaining the ruler. In times of chaos and disturbance, when ministers and aides gather, if one does not establish a state (establish a core), the world cannot be pacified. A state without a ruler is not a true state. To save the times and manage the main issues, the ruler naturally possesses the authenticity of his era, which cannot be coveted or hoped for by those who are fake or superficial. Grasping this authenticity allows one to beat drums and form ranks, achieving the effect of the enemy surrendering and cutting through resistance effortlessly. Losing this authenticity means that even bloody battles are merely self-inflicted troubles, like having a boil on the back or biting one's own navel to save oneself. Therefore, those with correct vision know clearly that monkeys wearing hats and frogs in wells are insufficient to discuss pacifying turmoil with. The commentary says: "Rectify the ruler, and the state is settled." Knowing this, one can then discuss the methods of formulating prescriptions.
Question: Spring warmth, summer heat, autumn coolness, winter cold are the seasonal climate energies. Yet the *Suwen* discusses how these four energies cause human disease, stating: "Injury by wind in spring, injury by summer heat in summer, injury by dampness in autumn, injury by cold in winter."
Regarding winter injury by cold and summer injury by heat, there is no need for debate. But why does spring not speak of warmth but of injury by wind? Why does autumn not speak of coolness but of injury by dampness?
Answer: Winter injury by cold leads to Wen Bing (Warm Disease) in spring. Warm disease is already a pathology. Although it does not explicitly say "injury," the injury is implied and known. Moreover, "warmth" governs growth; growth cannot be described as "injury," which is also evident. However, wind exists in all four seasons. Why is only spring singled out for injury? Answer: Wind exists in all four seasons, but only in spring does it uniquely "move" (activate). Movement causes all things to generate life, so humans are also affected. Summer produces Sun Xie (diarrhea with undigested food). Why? Answer: Wind belongs to Wood. When Wood pathogenic factors are excessive, Earth suffers damage. In the human body, Earth refers to the Spleen and Stomach. The Spleen governs transformation and transportation; the Stomach stores grain and water. Sun Xie is diarrhea of undigested food. The ancients called rice mixed with water "Sun". People eat rice soup in summer. During Chang Xia (Late Summer, the humid period at the end of summer), Earth energy prevails. Wood pathogenic factors flare up, causing increased diarrhea. Things reach their peak and then decline; this is Earth failing and being attacked by Wood. Why is autumn not spoken of as coolness? Answer: Midsummer is extremely hot, melting stones and flowing metal; people sit in steaming pots. They find relief upon receiving autumn coolness. Furthermore, "coolness" governs gathering/restraining. Just after relief, gathering occurs, which is known not to harm people. Thus, only "coolness" does not harm people, so there is no "coolness disease." What is "dampness"? Answer: The plum rain season, occurring in the fifth month. The earth is moist, the heat is muggy, and heavy rains occur frequently; this is the command of Late Summer. At this time, we do not speak of dampness. Instead, when autumn energy arrives, cool winds arise, summer heat toxins recede, water traces gather, the sky becomes clear, and the earth feels refreshing, yet we say "injured by dampness." Human diseases are either external or internal. Here, it refers to diseases originating from within the body. What originates from within? Answer: All things mature in autumn. When objects mature, their flavors become strong. Strong flavors produce much phlegm. Phlegm, according to the *Guangyun*, is a water disease in the chest. Nothing is wetter than water. When water and cold fight, coughing results. Hence, winter inevitably brings coughing. Looking at the year, the Winter Solstice is halfway through the year, when springs begin to move. Looking at the day, midnight is halfway through the day, when springs also move. Therefore, people suffering from coughing develop symptoms around the middle of winter (by year) or at midnight (by day). This responds to the movement of springs. Otherwise, if it were externally invading dampness, the onset would manifest as edema, distension, bloating, pain, flaccidity, or bi-syndrome, not coughing. Alas, clarifying the Dao begins with Gewu (investigating things). The commentary says: "After investigating things, knowledge reaches its limit; after knowledge reaches its limit, intentions become sincere." It is also said: "Sincerity leads to clarity." However, without sincerity, there are no real things. What Dao can be discussed?
Question: People all say "The physician is intent/mind." Can intent be used to discuss medicine?
Answer: Intent can enter medicine, but it is also sufficient to disrupt medicine. It cannot be used to define medicine. What do I mean? Answer: Medicine has a Dao, which is based on Heavenly Dao. Intent comes from the self. The self inevitably mixes in delusion; Heavenly Dao is merely sincerity. Therefore, if intent is upright and sincere, it creates the Dao. If it is evil and deluded, it harms the Dao. Not examining the intent that harms the Dao, but directly pointing to "intent" to discuss medicine, is merely disrupting medicine. How can it be used to discuss medicine? Moreover, intent can harm the Dao, not just in medicine. Li Zhengshu of Guozhai said: Since Confucius established teaching by the Zhu and Si rivers, imparting broad learning and disciplined ritual to students, Yan Hui, Zengzi, Zisi, and Mencius guarded it together without losing it. Later, the orthodox learning was lost, and scholars studied according to their own intents. Those aiming for comprehensiveness boasted of accumulated knowledge and fell into泛滥 (flooding/eclecticism). Those addicted to simplicity claimed that non-establishment of texts could reveal the heart and nature, falling into emptiness. That Confucians harmed the Dao through intent, we have heard such drawbacks. Medicine began with herbs in the *Bencao*, theory originated in the *Suwen* and *Lingshu*, pulse diagnosis clarified in the *Nanjing*. The orthodox path was formed. Then Bian Que (who allegedly performed open-heart surgery) differed from Hua Tuo, and Cang Gong's secret recipes were unique. The legacy of Shennong became neglected, and the great Way of the Emperors and Hegemons was blocked. People each practiced medicine according to their own intent. Those seeking to flatter the world and cater to customs, making profit their business, used excuses like "regulating the stomach and tonifying deficiency" to please others. Those fond of exploring mysteries and acting strangely, selling through诡炫 (deceptive brilliance), freely claimed to communicate with immortals like gods to boast themselves. Boasting in formulas, playing with methods, analyzing treatments, dividing specialties to create rifts. Former sages said the paths of physicians and ministers are connected, and their corruption matches in this way. If Confucians are thus, what is strange about physicians? Alas, these are all disasters of the Dao. The disaster of Confucianism was countered by Zhou Dunyi, Cheng Hao, Cheng Yi, and Zhang Zai in front, and corrected by Zhu Xi behind, after which the Sage's Dao shone like the sun at noon, now flourishing greatly. The disaster of medicine rose with Zhang Zhongjing, unifying methods and greatly completing the Dao, discussing and correcting it. Just as it stabilized, Zhang Zhongjing died. His words were buried before they could be widely transmitted (Wei Bian San Jue). Unfortunate that heterodox learning corrupted hearts, obscuring classics and stubbornly following personal will, forcing interpretations for private gain. Discussing classics distorted traditions and confused transmissions, making right and wrong indistinguishable, leading to the absurd claim of seventy-two variations of Shanghan (Cold Damage). For a long time, sons replaced fathers to occupy status, mixing wise and foolish, allowing those too busy saving lives to indulge in arrogance. The disaster reached its extreme. I have heard that when things reach the extreme, they reverse. Believing this, how can one say there is no remedy? When Heaven tires of the extreme, there must emerge someone to reopen the path. Emerging, this book is not the standard for reopening? Therefore, I analyze and distinguish the clauses. Perhaps it will supplement the future omissions in some small measure. As for deleting complexity and removing errors, I hope for later sages. The questioner Yu Yu therefore had it printed.