典藏书目

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.