甚哉：“似”之一字，为害非浅也。夫似则大远则不似者矣！岂非其似者之犹胜于不似耶？抑知不似之害，人易知；似之为害，人不易知。孔子曰：“恶似而非 ”者，不恶其非，而恶其似而非，良有已也。盖一于非，则人犹见其非，而非者可以改图；似，则人将信其是而莫辩其非，而非者终不知返，此似而非之为害甚于不似而非之为害也。若医之用药，坐此病者不少矣。夫医之权衡，在于用药。药之妙用，期于对症。在医人用药，安有不以为对症者哉？无如今之所谓对症者，正其不对症也。如人身有一病，即有一味药对之；人身有十病，即有十味药对之。逐味按之若无一味不对症也。识者从旁观之，却笑其无一味对症，何也？徒得其似故也。如发热，则用柴胡、黄芩、羌活、干葛之类。似也，至其热之为外感乎？为内伤乎？为阴虚、为中寒乎？不问也，但曰：此退热对症之药也。如头痛，则用川芎、藁本、菊花、秦艽之类，似也。至其头痛之为风寒乎？为血虚乎？为虚阳贯顶乎？阴症头痛如破乎？不问也，但曰：此止痛对症之药也。如腹胀，则用枳壳、大腹皮、厚朴、罗卜子之类，似也。至其胀之为食滞乎？为脾虚乎？为寒凝气结乎？阴水成鼓乎？不问也，但曰：此宽胀对症之药也。又如口渴，则用麦冬、花粉、知母、石膏之类，似也。至其渴之为实热乎？为虚炎乎？为阳邪入胃乎？为阴邪入肾乎？抑气虚无津，肾水不上升乎？不问也，但曰：此治渴对症之药也。如此之类，不胜枚举。彼所谓对症者，大都类此耳。岂知古人用药，中多变化，有似乎不对症而实对症者，不仅在形似之间也。其用药之法，有如上病下取，下病上取者，若用上药治上，下药治下，则似而非矣；又有从阳治阴，从阴治阳者，若以阳药治阳，阴药之阴，则似而非矣；又有通因通用，塞因塞用者，若以通药治塞，塞药治通，则又似而非矣。此皆貌似而实非者也。如阳虎貌似孔子，若徒取其貌之似，则阳虎亦大圣人矣！孰知其为大奸大恶也乎？药之似对症而实与症相反者，亦犹是也。无如业医者，不求其真，但求其似。以真者人不知，似者人易晓。故一得其似，而医人遂自负其明，病人遂深信其似，旁人无由见其误，他医亦莫得指其失。此“似”之一字，易于欺人，易于惑世，易于入俗，易于趋时，易于见售，易于盗名，易为人信而不为人疑，易为人喜而不为人畏。讵知其药与病全无涉者，此一“似”；药与病正相反者，此一“似”也；药不能去病反增病者，此一“似”也’药期以救命而适以送命者，此一“似”也。“似”之为害，可胜言哉！此药似对症之病，所宜急医者也。
六、医医曲顺人情之病：
医有为病人之喜近，为旁人所称扬，为群医所款洽，而实为医人之大病者，曲顺人情是也。病人何尝知医，遇病辄疑是风、是火；病人安知药性，对医自谓宜散、宜清。医人欲得病人之欢心，不必果是而亦以为是，未必相宜而亦以为宜。其曲顺病人之情有然也。或旁有邻居亲友来探问者，意念非不关切，医理未必精通。然每每自负知医，往往自出己见。但知病起何日，始于何因，，便相医人拟为何症；未知病是真相，抑是假象，轻象医人增减方药。而医人遂极口赞其高明，不敢自出主意。未举方，先谦恭请教；即举方，又依命增删。其曲顺旁人之清有然也。近医以随波逐浪为良法，以同流合污为趋时。前医用药有害，亦必不议其非；数医议论未善，闻其言亦必附和为是。不求病家有实效，只顾众医无间言。
是以千病一方，千医一例。无论缓急，总无敢异同。其曲顺医人之情，又有然也。夫其所以曲顺病人之情，旁人之情，医人之情者，何也？盖医人意欲取赀于病人，苟拂其情，则病人必谓是坚持独见，不通商量，由是推而远之，而主顾失矣；医人欲籍吹嘘于旁人，苟拂其情，则旁人皆议为偏执骄傲，不肯虚心，从兹望而却步，不复为之荐举矣；医人更欲互相标榜于医人，苟拂其情，则皆恶其攻人短，表己长，谗言布散，则声名减而财利去矣。此所以不得不曲顺人情也。然吾为医计，果能学识高，道理明，而又认症真、用药当，实能起沉疴、救危命，何妨特立独行。每制一方，用一药，如山岳之不可动摇。依用则生，不依用则死。如或病人疑畏，亦必剖心沥血，为之晰其疑、解其惑，使病人感悟，信服立效。在病人方称感不已，旁人自叹服不遑，医人即怀嫉妒，亦无从肆其萋斐之言。将不求名而名自至，不求利而利自归。又何必委屈周旋以图主顾、希荐举、避谗谤哉！无如医人未必能具卓然之见也。惟无卓然之见，而又恐获罪于人，失利于己，所以随风倒舵，唯唯诺诺，阿谀顺从，徒效妾妇之道，使人喜其谦和，忘乎司命之责，听人受误致死也。此曲顺人情之病，所宜急医者也。
七、医医轻药保名之病：
曩常见病家危急之际，竭忱尽力，延请名医。名医用药不效，又更一名医。其方药大都相似，皆系极轻浮无力者，每味三五分，合成一剂，共计不过三钱有零。以病不能除，命不能挽，心窃疑之，得非名医不能用此种药，非此种药不能成其为名医乎？乃亲友多为之解曰：此名医保名之妙用也。盖其医至今日，其名已成，其利以盈，更何所求？若复认真用性重之药，设一有误，岂不失名？所以只用轻轻数味，留其原病，不至医坏，则无过可指，而其名乃得不损。余闻之，不禁叹曰：有是哉，名医之无良一至此哉！病家延请之时，举家仰望，竭力支持。药赀之费几多，酒席之费几多，舆从工食之费几多，其为费亦不轻矣。在素封之家，不难措办；若寒俭之家非借贷即质典，总为救命计耳。而医人于此，不一念及，只期保名以为己，不想竭力以救人，不亦忍乎？抑思病家费如许心力，费如许赀财，岂请尔来保名乎？或是人子忧其亲，或是父母爱其子，哀痛迫切，跪拜求救。而名医绝无矜怜之心，只照寻常故套，予以不痛不痒之药少许，甚至有虚寒将绝之际，犹与以清润数味而去。病家茫然不知，只以此药出自名医，便捧为拱壁，珍若灵丹，急急煎服。其病尚缓者，服之不见功，则越日又复迎请；其病势甚急者，服之随逝，则曰名医自然不差，此药何得杀人，当是数尽，命自难保耳。嗟嗟！不保病人之命，而独保医人之名，此心安可问哉？切名医之计亦左矣。如果为名，则何不出其真实学问，审定病情，不可救则已，如可救则以重剂救之。况名医久为人推服，用药人必不疑。人所不敢用、不能用者，毅然用之，使病者起，危者安。人更啧啧称之曰，真医圣也，真药王也，此真名不虚传，高明迥出时流者也。岂不名益彰著，远近播闻。又何待兢兢乎恐药重有误，以为保名计乎？若用药有误岂犹得为名医乎？又岂不用药以救命乃得保名，能用药以救命反令失名乎？吾不能为之解也。或谓名医亦非专为保名，故意不肯用药。盖其所习惯者，此种不痛不痒之法，原非有真问、真胆识，故不能用药，不敢用药耳。世俗素重其名，欲为回护，故以保名之说，曲为之解也。此论良然，然欲为其全无保名之念，则又不可。彼始之浪得其名者，此伎俩；后之终保其名者，仍此伎俩。曾见名医嗔其子弟，偶用一二味厚之药，辄痛叱之曰：用此味厚之药，设一有误，岂不丧名！若是则名医实欲以此保名，而非他人代为之解也。呜呼！但欲自保其名，而不念病势之危急，人命之死生。良心丧尽，阴袭大伤。虽令阳受虚声，窃恐阴遭谴罚；名纵得保，而其不能保者多矣。此轻药保名之病，尤宜急医者也。
八、医医吝惜药料之病：
医人用药，有如用兵。兵不备，不能御敌；药不备，不能御疾。不能御敌则国危，不能御疾则命危。医故司命者也，凡御疾之药，无论贵贱，皆不可不备；备而善用之，善用之而又不吝不惜，乃可谓之良医。良者，善也；良医者，善于治病之谓也。又曰：良，良心也；医有良心，不虚受人财，不忍伤人性命者也。若今之医殊不然，药性即取其至轻，药料即取其至贱。惟是土产之物，每斤只值数分，每剂所值不过数文钱者，信手乱投； 若药料稍贵，每斤以两计、以钱计者，概置不用。即或不得已而用，所用不过二三分。而此二三分，犹不出自囊中，必另使病家自备。若他药虽贵无复有贵于人参者，且所用不过二三分，能值几何，亦必另病人自备耶？在病家何能预备，势必取之于市中。市人无疗病之责，只有取利之方，每以假借之物充之。病家不知审择，不辩真伪，增入剂中。其数既轻微，其质又低假，岂能应手奏效耶？不但此也，乡落无药肆之处 ，又须奔走道途，向他方采买，在病缓者，尤可缓图；若病势急者，不独低假不灵，亦切时日难待，往往有谋得药至，而人已不保者，此皆吝惜药料之罪也。若医果贫瘠，情有可原；乃有医已致富，而仍然吝惜不肯少用者，此其心果何心也？余常与人曰：欲精医术，先端心术。心术端则心存不忍，不忍自不贪，不贪自不吝。无问贵贱，凡当用之药，必备而用之。即多用之，屡用之，而皆不惜。救一富贵人命，吾固无所亏；救一贫寒人命，吾固有所快。彼贫者于求药无赀、求生无路之际，吾以药生之，我所费无几，而彼所生甚多，宁不快然于心乎？彼贫人即不能报，冥冥中必有代为报者，而况仁人君子之心，报与不报，具非所计也。此则真良医也。真有良心而又善用药以救人者也！如或不然忘其为活人术，而但以利为事，较镏铢，争毫末，一切假贵之药，吝惜工本，概不备用，而使缓急莫济，危困莫苏，虽不失利，却已失德。失利则失之东隅，旋收之桑榆；失德则不及其身，即及其子孙，良可畏也！此吝惜药料之病，所宜急医也者。
九、医医妒忌谗谤之病：
尝读《诗》至“巷伯”之章，有曰：取彼谮人，投畀豺豹。豺豹不食，投畀有北。有北不受，投畀有昊。因思《诗》三百篇，类皆温厚和平之语，虽怨而不怒，独此诗恶之深，怒之至，痛切言之，而绝无温厚和平之气，何也？良以彼谮人者，即妒忌谗谤之人也。以妒忌之心，肆谗谤之口，其为祸至烈，其为害至无穷也。斯人也，在朝则排斥忠良，在家则离间骨肉，处乡里则党邪攻正，处朋友则复雨翻云。或损人财物，或破人身家，或坏人行止。种种恶戾，其害无穷，然尤未即令人死。若在医道中，其害直令人死，何也？从来学识高明者，心愈谦虚；学识卑陋者，心多妒忌。妒忌者，恐高明之医功高而利厚，于己遂成冷淡生涯。故簧鼓其舌，颠倒是非，以惑乱人之听闻，使病人不趋彼而趋此，则其利可夺。若是则不过为利见耳，何尝欲令人死，而不知人之死实由之。余亲见夫妒忌而谗谤者矣，窥病家有欲延某医之意，彼即预为谤之，谓某医切不可近，某医之药切不可尝。言之醇切似是一片盛心，遂令病家畏而终止，而病由之渐深矣。迨病家既延某医，则又谤之曰：虽取效于目前，必遗祸于后日。后日一复，不可复救。有明达者，不为所惑，得收全功；若愚昧者，闻而惊惧，改途易辙，使已成之功复败，得救之命复倾。则是谗谤于未延医之先者，阻病人求生之路也；谗谤于既延医之际者，绝病人救死之药也；谗谤于取效之后者，复令生者归于必死之途而后已也。嗟嗟！彼即无活人之术，而又使病人无求生之路，无救命之药，而归于必死之途。其恶可胜诛哉？故曰：在医道中直令人死，其害为犹大也。夫所以为此者，无非欲损人益己耳。究之在人未必损，而在己亦未必益。彼活人之功昭昭耳目，虽一二人谤毁之，其如千百人称道之。即庸众之流，一时为所惑，久之窥破伎俩，方将讪笑之，吐骂之。虽复巧言如簧，讵复听之？徒然自丧其心，自作其孽，使人见而鄙之。其品益卑，其行益污，秽恶腥闻，真为豺豹所不食，有北所不受也。独不知有昊将何以处之耶？更有人焉，言甘如蜜，心毒如蝎。其妒忌之意隐而不彰；谗谤之言，曲而不觉。此不令人知其妒忌谗谤，而实深于妒忌谗谤者，均为诗人所深怒而欲取而投畀焉者也。此妒忌谗谤之病，更不可不医者也。
十、医医欺哄诈骗之病：
太可怕了！“似”这个字，造成的危害非常深重。所谓“似”，其实与真正的“是”相差甚远，但人们往往认为那些表面相似的（病症或治法）比完全不相似的要好一些。然而要知道，不相似的危害，人们容易察觉；而“似”带来的危害，人们却难以识别。孔子说：“厌恶那些像不像、非非的东西。”并不是厌恶那些明显的错误，而是厌恶那些看似正确实则错误的东西，这确实是有道理的。因为如果是明显的错误，人们还能看出它是错的，从而改正计划；但如果是“似”，人们就会相信它是正确的而无法辨别其错误，导致错误最终无法纠正。所以，“似而非”的危害比“不似而非”的危害更大。在医学用药方面，犯这种错误的医生不少。
医生的权衡在于用药，药物的妙用在于对症。作为医生，在使用药物时，难道有不认为是对症的吗？只是现在所谓的“对症”，恰恰是不对症。比如人身上一病，就有一味药对着它；身上有十病，就有十味药对着它。逐味检查似乎没有一味不对症的。有见识的人从旁观者角度看，却笑话他们无一味是对症的，为什么呢？只是因为徒有其表罢了。例如发热，就用柴胡、黄芩、羌活、干葛这类药。看起来是对的，至于这热是由于外感引起的呢？还是内伤引起的呢？是阴虚还是中寒呢？都不去问，只说：这是退热的对症药。例如头痛，就用川芎、藁本、菊花、秦艽这类药，看起来也是对的。至于这头痛是由于风寒呢？血虚呢？虚阳上贯头顶呢？阴证头痛剧烈如破呢？都不去问，只说：这是止痛的对症药。例如腹胀，就用枳壳、大腹皮、厚朴、萝卜子这类药，看起来也是对的。至于这胀是由于食积停滞呢？脾虚呢？寒凝气结呢？阴水形成的鼓胀呢？都不去问，只说：这是宽胸消胀的对症药。又如口渴，就用麦冬、花粉、知母、石膏这类药，看起来也是对的。至于这渴是由于实热呢？虚火呢？阳邪入胃呢？阴邪入肾呢？还是气虚无津液、肾水不能上升呢？都不去问，只说：这是治渴的对症药。像这样的例子，不胜枚举。那些所谓的“对症”，大多都是这样。哪里知道古人用药，其中多有变化，有的表面上看似不对症，实际上却是对症的，不仅仅是在形似之间。他们的用药方法，有上病下取、下病上取的；如果用上药治上病，下药治下病，那就是“似而非”了；又有从阳治阴、从阴治阳的；如果用阳药治阳证，阴药治阴证，那又是“似而非”了；还有通因通用、塞因塞用的；如果用通利药治疗闭塞，用固涩药治疗通泄，那就更是“似而非”了。这些都是外表相似而实质不同的情况。就像阳虎外貌像孔子，如果仅仅取其外貌相似，那么阳虎也就成了大圣人了！谁知道他是大奸大恶之人呢？药物表面看似对症，实际上却与病情相反的，也是如此。无奈从事医疗工作的人，不求求真，只求求似。因为真实的道理人们不了解，表面的相似人们容易明白。所以一旦得到一点表面的相似，医生就自认为高明，病人就深信不疑，旁人无从发现错误，其他医生也无法指出失误。这个“似”字，易于欺骗人，易于迷惑世人，易于迎合世俗，易于追随潮流，易于被采纳，易于盗取名声，易被人相信而不被人怀疑，易被人喜欢而不被人畏惧。哪里知道药与病完全无关的，这是一个“似”；药与病正相反的，这也是一个“似”；药不仅不能去除疾病反而增加疾病的，这也是一个“似”；药本来期望救命却恰好送命的，这也是一个“似”。“似”造成的危害，能说尽吗？这就是药看似对症的病，急需医治的情况。
六、医治医生曲意顺从人情之弊：
有些医生为了博得病人的喜爱，为了旁人的称赞，为了与其他医生相处融洽，而这实际上是行医的大毛病，就是曲意顺从人情。病人哪里懂医术，遇到生病就怀疑是风邪、是火邪；病人怎么知道药性，见到医生就说应该发散、应该清热。医生想要得到病人的欢心，不必确实是正确的也认为是正确的，未必适宜也认为适宜。这就是曲意顺从病人情意的表现。或者有邻居亲友来探视询问的，心意并非不关切，但医理未必精通。然而常常自负懂医，往往提出自己的见解。只知道病起于哪一天，始于什么原因，便猜测医生拟定的是什么证候；不知道病是真相还是假象，轻率地让医生增减方药。而医生于是极力称赞其高明，不敢自己拿主意。没开方之前，先谦虚恭敬地请教；即使开了方，又依命增删。这就是曲意顺从旁人清议的表现。现在的医生以随波逐流为良法，以同流合污为趋时。前一位医生用药有害，也必定不议论其非；几位医生议论不完善，听到这话也必定附和说是正确的。不求病家获得实效，只顾众医生没有闲话。因此千种病用一方，千位医生一个套路。无论病情缓急，总不敢有不同意见。这就是曲意顺从医生情意的表现。他之所以曲意顺从病人之情、旁人之情、医生之情，为什么呢？大概医生意图从病人那里获取钱财，如果违背了他们的情意，病人一定会认为这是坚持独见，不通情理商量，由此疏远推辞，主顾关系就失去了；医生想要借旁人之口吹嘘自己，如果违背了他们的情意，旁人都议论为偏执骄傲，不肯虚心，从此望而却步，不再为之推荐了；医生更想要在医生群体中互相标榜，如果违背了他们的情意，大家都讨厌他攻击别人的短处、宣扬自己的长处，谗言散布，名声减损而财利流失了。这就是不得不曲意顺从人情的原因。然而我为医生打算，如果真的学识高深，道理明确，又能准确辨证、用药得当，确实能治愈重病、挽救危命，何必特立独行？每制定一方，使用一药，如山岳般不可动摇。依照使用就能生，不依照使用就会死。如果病人怀疑畏惧，也必定剖心沥血，为他们辨析疑惑、解除困惑，使病人感悟信服并立即见效。在病人方面才称感激不尽，旁人自然叹服来不及，医生即使怀有嫉妒之心，也无从施展其毁谤之言。将不求名而名自至，不求利而利自归。又何必委屈周旋以图谋主顾、希求推荐、避免谗谤呢！无奈医生未必能具备卓越的见解。正因为没有卓越见解，又害怕得罪于人、失利于己，所以随风倒舵，唯唯诺诺，阿谀顺从，徒然效仿妾妇之道，使人喜欢他的谦和，忘记了他掌管生命的神圣职责，听任病人受误致死。这就是曲意顺从人情之弊，急需医治的情况。
七、医治医生轻视药物以保全名声之弊：
过去常见病家危急之际，竭尽诚心尽力，延请名医。名医用药无效，又更换一名医。他们的方药大都相似，都是极轻浮无力的药物，每味仅三五分，合成一剂，共计不过三钱多一点。因为病不能除，命不能挽，心里暗自怀疑，莫非名医不能用这种药，非这种药不能成其为名医吗？于是亲友多为之解说道：这是名医保全名声的妙用啊。大概这位医生到现在，名声已经形成，利益已经充盈，还有什么所求？如果再认真使用性重的药物，万一有一个错误，岂不是失去名声？所以只用轻轻几味药，保留原病，不至于治坏，就没有过错可指责，而他的名声才得以不受损。我听了这话，不禁叹息道：有这样的事情吗，名医的无良竟然到了这种地步！病家延请之时，全家仰望，竭力支持。药费多少，酒席费多少，车马随从工食费多少，花费也不轻啊。在富裕人家，不难筹措；若是寒俭之家，不是借贷就是典当，总是为了救命罢了。而医生在此，不念及这些，只希望保全名声为自己着想，不想着竭尽全力救人，岂不残忍？再想想病家耗费如此心力，耗费如此资财，难道是请你来保全名声的吗？或是为人子女担忧父母，或是父母爱护子女，哀痛迫切，跪拜求救。而名医绝无怜悯之心，只照寻常老套，给予不痛不痒的少许药物，甚至有虚寒将绝之际，还给予清润几味药而去。病家茫然不知，只以此药出自名医之手，便捧为拱壁，珍若灵丹，急急煎服。病情尚缓的，服用后不见功效，则过几天又再次迎请；病情危急的，服用后随即去世，则说名医自然不会错，这药怎么能杀人，定是寿命已尽，命难保罢了。唉！不保全病人的性命，而独自保全医生的名声，这良心哪里问得通？名医的计策也太拙劣了。如果真是为了名声，为什么不拿出真实学问，审定病情，不可救则罢，如可救则以重剂救治。况且名医久已被人推崇信服，用药病人必不怀疑。别人不敢用、不能用的药，毅然使用，使病人起死回生，危者安。人们更啧啧称赞说，真是医圣啊，真是药王啊，这才是真名不虚传，高明远超时流的人啊。岂不是名声更加彰显，远近播闻。又何须兢兢业业担心药重有误，以此来保全名声呢？如果用药有误，难道还能称为名医吗？又岂不用药救命才能保全名声，能用药救命反而令失去名声呢？我不能为此解释。有人说名医也并非专为保名，故意不肯用药。大概他们所习惯的，是这种不痛不痒的方法，原本没有真学问、真胆识，所以不能用药，不敢用药罢了。世俗一向重视其名，想要为他回护，所以用保名之说，曲意为之解释。这种说法确实有理，然而想要说他完全没有保名的念头，却又不可以。他起初浪得虚名，靠的是这套伎俩；后来最终保住名声，靠的仍是这套伎俩。曾见名医斥责子弟，偶然使用一两味厚重的药，就痛斥道：使用这种味厚的药，万一有一个错误，岂不是丧名！像这样，名医确实是想要以此保名，而不是他人代为之解释啊。呜呼！只想着自我保全名声，而不念及病势的危急，人命的死生。良心丧尽，阴德大伤。虽然令阳世获得虚名，窃恐阴间遭受谴罚；名声纵然得以保全，而不能保全的太多了。这就是轻视药物以保全名声之弊，尤其急需医治的情况。
八、医治医生吝惜药料之弊：
医生用药，如同用兵。军队不准备充分，不能抵御敌人；药物不准备充分，不能抵御疾病。不能抵御敌人则国家危险，不能抵御疾病则生命危险。医生掌管人命，凡抵御疾病的药物，无论贵贱，都不可不准备；准备了且善于使用，善于使用且不吝惜不吝啬，才可称为良医。良，就是善的意思；良医者，就是善于治病的意思。又说，良，就是良心；医生有良心，不虚受人财，不忍伤害人性命。如今的医生却不是这样，药性即选取最轻的，药料即选取最贱的。只要是土产之物，每斤只值几分，每剂所值不过几文钱的，信手乱投；如果药料稍贵，每斤以两计算、以钱计算的，一概置而不用。即使不得已而使用，使用的也不过二三钱。而这二三钱，还不出自医生囊中，必定另让病家自备。如果其他药虽贵，没有比人参更贵的了，且所用不过二三钱，能值多少钱，也必定另让病人自备吗？在病家哪里能预备，势必向市中购买。市井之人没有疗病的责任，只有取利的办法，每每以假借之物充数。病家不知审慎选择，不辨真伪，加入剂中。数量既轻微，质地又低劣虚假，怎么能应手奏效呢？不仅如此，乡村没有药店的地方，又须奔走道路，向其他地方采买，对于病情缓和者，还可以缓图；若病情危急者，不但低劣虚假不灵验，也急切时日难待，往往有谋划得到药时，人已不保的，这都是吝惜药料的罪过。如果医生果真贫瘠，情有可原；乃有医生已经致富，而仍然吝惜不肯少用的，这其心究竟是何心呢？我常对人说：欲精医术，先端心术。心术端正则心存不忍，不忍自然不贪，不贪自然不吝。不论贵贱，凡是应当用的药，必备而用之。即使多用之，屡用之，而皆不惜。救一个富贵人的性命，我固然无所亏欠；救一个贫寒人的性命，我固然有所快慰。那些贫穷者在求药无资、求生无路之际，我以药救活他，我所费的很少，而他所得生的很多，难道不快慰于心吗？那些穷人即使不能报答，冥冥中必有代为报答的，何况仁人君子的心，报与不报，都不是所计较的。这才是真正的良医。真正有良心而又善于用药救人的！如果不这样，忘记了这是救活人的技艺，而只把利益当回事，锱铢必较，争毫末，一切假贵之药，吝惜工本，一概不备用，而使缓急莫济，危困莫苏，虽然不失利，却已失德。失利则失之东隅，旋收之桑榆；失德则不及其身，即及其子孙，良可畏也！这就是吝惜药料之弊，急需医治的情况。
九、医治医生妒忌谗谤之弊：
曾经读《诗经》到“巷伯”这一章，有句话说：抓那个进谗言的人，扔给豺豹吃。豺豹不吃，扔给北方荒凉之地。北方荒凉之地不接受，扔给上天处置。想到《诗经》三百篇，大都是温厚和平的话语，虽有怨恨但不愤怒，唯独这首诗厌恶之深，愤怒之至，痛切言之，而绝无温厚和平之气，为什么呢？实在是因为那个进谗言的人，就是妒忌谗谤之人。怀着妒忌之心，肆行谗谤之口，其祸害极其猛烈，其危害极其无穷。这种人，在朝廷则排斥忠良，在家则离间骨肉，处在乡里则结党攻正，处在朋友之间则反复无常。或者损害他人财物，或者破坏他人身家，或者败坏他人品行。种种恶戾，其害无穷，然而还不即刻令人死。如果在医学之道中，其害直接令人死，为什么呢？从来学识高明的人，心越谦虚；学识卑陋的人，心多妒忌。妒忌的人，恐怕高明的医生功劳高而利润厚，对自己遂成冷淡生涯。所以煽动舌头，颠倒是非，以惑乱人们的听闻，使病人不趋向他而趋向此，则其利可夺。如果是这样，则不过是贪图利益罢了，何尝想令人死，却不知道人的死确实是由他造成的。我亲眼见过妒忌而谗谤的人了，窥探病家有想要延请某位医生的意思，他就预先诽谤说，某医生切不可亲近，某医生的药切不可尝试。话说得诚恳真切，似乎是一片盛心，遂令病家畏惧而终止，而病情由此逐渐加深了。等到病家既已延请某医生，他又诽谤说：虽然现在取得疗效，必定遗祸于日后。日后一旦复发，不可复救。有明达的人，不被他所惑，得以收全功；若愚昧的人，听到而惊惧，改途易辙，使已成之功复败，得救之命复倾。则是谗谤于未延医之先者，阻断了病人求生之路；谗谤于既延医之际者，断绝了病人救死之药；谗谤于取效之后者，又令生者归于必死之途而后止。唉！他即使没有救人的技术，又使病人没有求生之路，没有救命之药，而归于必死之途。其恶行岂能胜诛？所以说，在医学之道中直接令人死，其危害还是很大的。之所以这样做，无非是想损人益己罢了。究之在人未必损，而在己亦未必益。他救人的功德昭昭耳目，虽有一二人诽谤毁损，奈何千百人称道。即使是庸众之辈，一时被他所惑，久之看破伎俩，方才讥笑他，吐骂他。即使巧言如簧，谁还会听？徒然自丧其心，自作其孽，使人见而鄙之。其品益卑，其行益污，秽恶腥闻，真是豺豹所不食，有北所不受也。独不知上天将如何处置他呢？更有这种人，言语甘甜如蜜，内心毒辣如蝎。其妒忌之意隐而不彰；谗谤之言，曲折而不自觉。这种不令人知其妒忌谗谤，而实则深于妒忌谗谤的人，均为诗人所深怒而欲抓来扔给野兽的人。这就是妒忌谗谤之弊，更不可不医治的情况。
十、医治医生欺哄诈骗之弊：
It is terrifying! The character "si" (似, resembling/similar) causes profound harm. What is called "resembling" is actually far from the true "shi" (是, correct/true), yet people often believe that those things which superficially resemble the truth are better than those that do not resemble it at all. However, one must know that the harm of being "not resembling" is easily perceived by people; whereas the harm caused by "resembling" is difficult for people to recognize. Confucius said: "Detest that which appears to be but is not." It is not detesting the obvious error, but detesting that which appears correct but is actually incorrect, and this is indeed justified. For if something is obviously wrong, people can still see it as wrong and thus adjust their plans; but if it merely "resembles" correctness, people will believe it to be right and fail to discern its falsehood, leading to errors that ultimately cannot be corrected. Therefore, the harm of "appearing correct but being incorrect" (si er fei, 似而非) is greater than the harm of "being incorrect and not resembling" (bu si er fei, 不似而非). In the use of medicine by physicians, many commit this error.
The physician's judgment lies in prescribing medication, and the subtle efficacy of drugs lies in targeting the specific syndrome (duizheng, 对症). As a physician, when using medication, would there be any who do not consider it to be targeting the syndrome? Yet what is currently called "targeting the syndrome" is precisely failing to target the syndrome. For example, if there is one disease in the body, there is one herb prescribed against it; if there are ten diseases, ten herbs are prescribed. Checking each herb one by one, it seems no herb is mismatched. Those with insight, observing from the side, laugh that none of the herbs are actually appropriate. Why? Because they only possess superficial resemblance. For instance, in cases of fever (refa, 发热), herbs such as Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Qianghuo (Notopterygii Rhizoma et Radix), and Gange (Puerariae Radix) are used. This appears correct. But whether the heat is due to external contraction (waigan, 外感) or internal injury (neishang, 内伤); whether it is yin deficiency (yinxu, 阴虚) or middle cold (zhonghan, 中寒)—none of this is asked. They simply say: "These are herbs for reducing fever and targeting the syndrome." In cases of headache (toutong, 头痛), herbs such as Chuanxiong (Ligustici Chuanxiong Rhizoma), Gaoben (Ligustici Jingwei Rhizoma), Juhua (Chrysanthemi Flos), and Qinjiao (Gentianae Macrophyllae Radix) are used. This also appears correct. But whether the headache is due to wind-cold (fenghan, 风寒), blood deficiency (xuexu, 血虚), floating yang ascending to the top (xuyang guanding, 虚阳贯顶), or severe headache due to yin syndrome (yin zheng, 阴症)—none of this is asked. They simply say: "These are herbs for relieving pain and targeting the syndrome." In cases of abdominal distension (fuzhang, 腹胀), herbs such as Zhike (Aurantii Fructus), Dafupi (Arecae Pericarpium), Houpo (Magnoliae Officinalis Cortex), and Luobozhi (Raphani Semen) are used. This also appears correct. But whether the distension is due to food stagnation (shizhi, 食滞), spleen deficiency (pixu, 脾虚), cold coagulation and qi binding (hanning qijie, 寒凝气结), or drum-like distension due to yin water accumulation (yin shui cheng gu, 阴水成鼓)—none of this is asked. They simply say: "These are herbs for relieving distension and targeting the syndrome." Similarly, in cases of thirst (hekou, 口渴), herbs such as Maidong (Ophiopogonis Radix), Huafen (Trichosanthis Radix), Zhimu (Anemarrhenae Rhizoma), and Shigao (Gypsum Fibrosum) are used. This also appears correct. But whether the thirst is due to excess heat (shire, 实热), deficient fire (xuyan, 虚炎), yang pathogen entering the stomach (yang xie ru wei, 阳邪入胃), yin pathogen entering the kidney (yin xie ru shen, 阴邪入肾), or qi deficiency with lack of fluids and failure of kidney water to ascend (qi xu wu jin, shen shui bu shangsheng, 气虚无津，肾水不上升)—none of this is asked. They simply say: "These are herbs for treating thirst and targeting the syndrome." Such examples are too numerous to list. The so-called "targeting the syndrome" is mostly like this. How can one know that ancient physicians' prescriptions often involved variations, where some appeared mismatched but were actually appropriate, going beyond mere superficial resemblance? Their methods included treating upper diseases by acting on the lower, and lower diseases by acting on the upper; if one uses upper-acting herbs for upper diseases and lower-acting herbs for lower diseases, this is "appearing correct but incorrect." There are also methods of treating yin through yang, and yang through yin; if one uses yang herbs for yang syndromes and yin herbs for yin syndromes, this is again "appearing correct but incorrect." There are also methods of "using unblocking agents for unblocking conditions" (tong yin yong tong, 通因通用) and "using astringents for obstructive conditions" (sai yin yong sai, 塞因塞用); if one uses unblocking herbs for obstruction and astringent herbs for unblocking, this is even more "appearing correct but incorrect." These are all cases where appearance resembles reality but does not. Just as Yang Hu resembled Confucius in appearance, if one only takes the similarity in appearance, then Yang Hu would also be a great sage! Who would know he was a great villain? Medicines that appear to target the syndrome but are actually contrary to it are the same. Unfortunately, medical practitioners seek not the truth, but mere resemblance. Because the truth is unknown to people, while resemblance is easily understood. Thus, once obtaining a slight resemblance, the physician becomes self-satisfied, the patient believes deeply, bystanders cannot see the error, and other physicians cannot point out the mistake. This character "si" (resemblance) easily deceives people, easily confuses the world, easily caters to vulgarity, easily follows trends, easily gains acceptance, easily steals reputation, easily wins trust without suspicion, easily wins favor without fear. Little do they know that when the medicine has nothing to do with the disease, this is one "resemblance"; when the medicine is exactly opposite to the disease, this is another "resemblance"; when the medicine fails to cure the disease but instead aggravates it, this is another "resemblance"; when the medicine intended to save life happens to cause death, this is another "resemblance." Can the harm of "resemblance" be fully stated? This is the condition of medicines appearing to target the syndrome, which requires urgent correction.
Six, Treating the Disease of Physicians Curving to Follow Human Sentiments:
Some physicians, in order to gain the favor of patients, to receive praise from bystanders, and to get along well with other physicians, commit a major fault in their profession, which is curving to follow human sentiments. Patients hardly understand medicine; upon falling ill, they suspect it is wind or fire. Patients do not know drug properties; seeing the physician, they claim it should be dispersing or clearing. The physician, desiring to please the patient, accepts as correct what is not necessarily correct, and as suitable what is not necessarily appropriate. This is how curving to follow the patient's sentiment occurs. Sometimes neighbors or relatives come to inquire. Their intentions may be concerned, but their understanding of medical principles may not be proficient. Yet they often pride themselves on knowing medicine and offer their own opinions. Knowing only when the illness started and its initial cause, they guess what syndrome the physician has diagnosed; unaware of whether the illness presents true or false signs, they lightly suggest the physician add or reduce herbs. The physician then praises their brilliance excessively and dares not make independent decisions. Before presenting the prescription, they humbly ask for advice; after presenting it, they modify it according to orders. This is how curving to follow the sentiments of bystanders occurs. Current physicians regard following the tide as a good method and joining the crowd as conforming to the times. If the previous physician's medication was harmful, they definitely do not criticize it; if several physicians' discussions were inadequate, they certainly echo agreement. They do not seek effective results for the patient, only care that there are no complaints among the physicians. Thus, a thousand diseases treated with one formula, a thousand physicians following one pattern. Regardless of urgency, no one dares to differ. This is how curving to follow the sentiments of other physicians occurs. Why do they curve to follow the sentiments of patients, bystanders, and other physicians? Generally, physicians intend to gain profit from patients; if they offend these sentiments, patients will think them stubborn and unreasonable, distancing themselves, resulting in loss of clientele. Physicians want to rely on bystanders for promotion; if they offend these sentiments, bystanders will criticize them as biased and arrogant, unwilling to listen, ceasing recommendations. Physicians also wish to mutually promote each other within the medical community; if they offend these sentiments, others will dislike them for exposing faults and boasting, spreading slander, reducing reputation and profit. Hence, they feel compelled to curve to human sentiments. However, I advise physicians: if one truly possesses high knowledge, clear principles, accurate syndrome differentiation, and appropriate medication, capable of curing serious illnesses and saving critical lives, why not stand firm? Each prescription and herb used should be immovable as a mountain. Following it leads to life, ignoring it leads to death. If patients doubt or fear, one must pour out one's heart, clarifying doubts and resolving confusion, so that patients are moved, convinced, and experience immediate effect. Then patients will express endless gratitude, bystanders will sigh in admiration, and even jealous physicians will have no ground for slander. One will seek no fame, yet fame will arrive; seek no profit, yet profit will return. Why compromise and maneuver to secure clients, hope for recommendations, or avoid slander? Alas, physicians may not possess outstanding insights. Lacking such insights, and fearing offending others or losing profit, they drift with the wind, nodding in agreement, flattering and complying, merely imitating the way of concubines, making people appreciate their humility while forgetting their responsibility for life and death, allowing patients to suffer fatal errors. This disease of curving to follow human sentiments requires urgent treatment.
Seven, Treating the Disease of Physicians Using Light Medications to Preserve Reputation:
In the past, it was common to see families in critical situations, exerting utmost sincerity and effort to invite famous physicians. If the famous physician's medication failed, another famous physician was invited. Their prescriptions were mostly similar, consisting of extremely light and weak herbs, each weighing only three to five fen, totaling no more than three qian per dose. Since the illness could not be cured and life could not be saved, one secretly suspects: perhaps famous physicians cannot use such herbs, or non-use of such herbs defines them as famous physicians? Relatives and friends often explain: "This is the subtle art of famous physicians preserving their reputation." By now, the physician's reputation is established, and profits are abundant; what more could they seek? If they seriously used heavy-natured herbs, and made an error, wouldn't they lose their reputation? So they only use a few light herbs, leaving the original illness untreated but not worsened, so no fault can be pointed out, and their reputation remains undamaged. Hearing this, I cannot help but sigh: Is it true that the wickedness of famous physicians reaches such depths? When families invite physicians, the whole family looks up with hope, supporting with all efforts. How much is spent on medicine? How much on banquets? How much on carriages and servants? The cost is not light. For wealthy families, it is easy to manage; for poor families, it involves borrowing or pawning, all solely for saving life. Yet physicians here do not reflect on this, only hoping to preserve their reputation for themselves, not thinking of striving to save lives. Is this not cruel? Consider that families expend such mental energy and wealth; did they invite you to preserve your reputation? Perhaps a child worries about parents, or parents love children, in deep grief and urgency, kneeling and begging for salvation. Yet famous physicians show no compassion, only following routine, giving a small amount of harmless medication. Even in cases of extreme deficiency-cold approaching collapse, they still prescribe a few cooling and moistening herbs and leave. Families, ignorant and bewildered, believing the medicine comes from a famous physician, treat it as a precious treasure, like a spiritual elixir, and hastily decoct and take it. For slow-progressing illnesses, taking it shows no effect, so they invite the physician again after a day or two; for acute illnesses, the patient dies shortly after taking it, and they say: "The famous physician is naturally infallible; how could this medicine kill? It must be that fate has ended, and life is hard to maintain." Alas! Not preserving the patient's life, but solely preserving the physician's reputation—how can one ask this conscience? The famous physician's strategy is indeed flawed. If it were truly for reputation, why not demonstrate true learning, assess the condition accurately, and if incurable, let it be; if curable, use heavy doses to save? Moreover, since famous physicians are long trusted by people, patients will not doubt their medication. Herbs that others dare not use or cannot use, they resolutely use, causing the sick to rise and the critical to stabilize. People will exclaim: "Truly a medical sage! Truly a medicine king!" This is true reputation unmatched, surpassing contemporaries. Wouldn't reputation become more prominent, known far and wide? Why needlessly worry about heavy medications causing errors to preserve reputation? If medication causes error, can one still be called a famous physician? And is it not using medication to save life that preserves reputation, rather than using medication to save life causing loss of reputation? I cannot explain this. Some say famous physicians do not intentionally withhold medication to preserve reputation. Perhaps the method they are accustomed to is this harmless approach; lacking true learning and courage, they cannot use, nor dare to use, stronger herbs. The secular world values their reputation and wants to protect them, so they interpret this as preserving reputation. This argument has merit, but to say they have absolutely no thought of preserving reputation is impossible. Their initial acquisition of fame relied on this trick; their subsequent preservation of fame relies on the same trick. I have seen famous physicians scold their disciples for occasionally using one or two heavy herbs, shouting: "Using such heavy herbs, if there is an error, won't it ruin my reputation!" Like this, famous physicians indeed wish to preserve reputation this way, not having others explain it for them. Alas! Only wanting to preserve one's own reputation, without considering the urgency of the illness or the life and death of humans. Conscience is lost, hidden virtue greatly damaged. Although gaining empty fame in the sun, I fear receiving punishment in the shadows; even if reputation is preserved, much else cannot be preserved. This disease of using light medications to preserve reputation especially requires urgent treatment.
Eight, Treating the Disease of Physicians Hoarding Medicinal Materials:
Physicians using medication is like using troops. Without prepared troops, one cannot resist enemies; without prepared medication, one cannot resist diseases. Inability to resist enemies endangers the state; inability to resist diseases endangers life. Physicians hold the fate of life; therefore, all medication for resisting diseases, regardless of price, must be prepared. Prepared and used skillfully, used skillfully and without stinginess, this is called a good physician. "Liang" (良, good) means excellent; a "Liangyi" (良医, good physician) is one skilled in treating diseases. It is also said, "Liang" means conscience; a physician with conscience does not falsely accept wealth, nor endure harming human life. Today's physicians are different. They select the lightest drug properties and the cheapest materials. For local products worth only a few fen per jin, costing only a few wen per dose, they throw them in randomly. If the material is slightly expensive, costing taels or coins per jin, they generally do not use it. Even if forced to use it, they use only two or three fen. And this small amount is not from their own pocket, but must be provided separately by the patient. If other herbs are expensive, none is more so than Renshen (Ginseng Radix et Rhizoma), yet they use only two or three fen, worth little money, and still require the patient to provide it separately. How can patients prepare this? They must buy it in the market. Market vendors have no responsibility for curing diseases, only for profit, often passing off fake goods. Patients, unaware and unable to distinguish真假 (zhenjia, true and false), add them to the dose. With small quantities and low-quality fakes, how can they produce immediate effects? Furthermore, in rural areas without pharmacies, one must travel to purchase elsewhere. For slow illnesses, delay is possible; for acute illnesses, not only are fakes ineffective, time is also critical. Often, by the time the medicine is obtained, the patient has died. This is the fault of hoarding medicinal materials. If the physician is truly poor, it is understandable; but some physicians are already wealthy and still stingy, unwilling to use even a little. What is their heart? I often tell people: To refine medical skills, first straighten the mind. A straight mind holds compassion; compassion leads to non-greed; non-greed leads to non-stinginess. Regardless of price, all necessary herbs must be prepared and used. Even if used heavily or frequently, never stinted. Saving a rich person's life, I am not deprived; saving a poor person's life, I am delighted. When the poor face lack of funds for medicine and no path to survival, I give them life through medicine. My cost is minimal, but their gain is immense. Is this not delightful? Even if the poor cannot repay, the unseen forces will surely repay on their behalf. Moreover, the heart of a benevolent gentleman does not calculate repayment. This is the true good physician. Truly having conscience and skilled in using medication to save lives! If not so, forgetting this is the art of saving lives and focusing only on profit, haggling over every coin, stinging on costs for fake expensive herbs, refusing to prepare them, causing inability to help in emergencies and crises, although not losing profit, one loses virtue. Losing profit is a temporary loss, recoverable later; losing virtue affects oneself and descendants, truly to be feared! This disease of hoarding medicinal materials requires urgent treatment.
Nine, Treating the Disease of Physicians' Jealousy and Slander:
Having read the "Xiangbo" chapter of the *Shi Jing* (Classic of Poetry), it says: "Take that slanderer, cast him to jackals and leopards. Jackals and leopards refuse to eat him, cast him to the northern wastes. The northern wastes refuse him, cast him to Heaven." Reflecting on the *Shi Jing*, most verses are gentle and peaceful, expressing resentment without anger. Only this poem expresses deep hatred and extreme anger, speaking painfully, devoid of gentleness and peace. Why? Truly because the slanderer is the jealous and slandering person. Harboring jealousy, opening the mouth to slander, their disaster is fierce, their harm infinite. Such a person, in court, excludes the loyal and good; at home, sows discord among kin; in the neighborhood, gangs up on the righteous; among friends, is treacherous. They damage others' property, ruin others' families, corrupt others' conduct. Various evils, infinite harm, yet not immediately causing death. But in the medical field, their harm directly causes death. Why? Usually, those with high learning are humble; those with shallow learning are jealous. The jealous fear that the famous physician's high merit and thick profit will lead to their own cold career. Thus, they wag their tongues, reverse right and wrong, confusing public opinion, causing patients to avoid them and go to the rival, thereby stealing profit. If so, it is merely for profit, not intending to cause death, yet unaware that death indeed results from them. I have personally seen jealous slanderers. Peeking that a family intends to invite a certain physician, they pre-emptively slander: "That physician must not be approached; his medicine must not be tried." Speaking sincerely, seeming full of goodwill, causing the family to fear and stop, letting the illness deepen. Once the family invites the physician, they slander again: "Although effective now, it will bring disaster later. If it recurs, it cannot be saved." The wise are not confused and achieve success; the foolish are frightened, change course, ruining achieved progress and reversing saved lives. Thus, slandering before invitation blocks the patient's path to survival; slandering during invitation cuts off the patient's medicine for saving life; slandering after effectiveness sends the survivor back to the path of certain death. Alas! Even if lacking the skill to save lives, they cut off the patient's path to survival and medicine for saving life, leading to certain death. How can their evil not be punished? Therefore, in medicine, causing direct death, the harm is great. The reason for this is merely to harm others and benefit oneself. Ultimately, others may not be harmed, and oneself may not benefit. The merit of saving lives is evident; though one or two slander, how can it outweigh thousands praising? Even the mediocre, temporarily confused, will eventually see through the trick, mocking and cursing. No matter how eloquent, who will listen? Merely losing one's heart, creating one's own karma, making people despise them. Their character becomes lower, conduct more filthy, foul odor spreading, truly rejected by jackals and northern wastes. Does Heaven not know how to deal with them? There are also those whose words are sweet as honey, hearts poisonous as scorpions. Their jealousy is hidden; their slander is subtle. These who do not reveal their jealousy and slander, yet are deeply jealous and slandering, are all deeply hated by the poet and desired to be cast to beasts. This disease of jealousy and slander especially requires treatment.
Ten, Treating the Disease of Physicians Deceiving and Defrauding: