余屈首受医，日惟有事于《素》、《难》、《病源》、《病机》、《甲乙》等书，俯而诵，仰而思，希心融贯
前哲秘旨而未逮也。若彼《局方》《袖珍》《惠济》等集，间用之参考，而不敢执泥。至临症，务虚心察
受病之因，始敢投剂，亦未尝执方以合病。以故执方之夫，往往见而骇之议之，谓如上方书之传，简易捷
径，大有便于后学,《素》、《难》诸书，固云精妙，乃涣漫艰深，力难究竟，胡子好难恶易，性与人殊？且
子诊病用药，类与方书悬异，有病同而剂异，有终始用一法而不殊，有三五变其方而不执，辄亦投剂获效
，此遵何道哉？或方书不足凭，而他有秘授欤，奚与诸医殊致也。余曰∶嘻！医何容易
谈哉。人之死生，关于呼吸间，余何敢师心自用，而HT 为也，古称用药如用兵，然齐步伐，肃部伍，
坐作进退，刺杀攻击，一定而不乱者，法也，胡可废也。乃若知己知彼，置伏设奇，临变不测，其
运用妙于一心。药之君臣佐使，味之甘苦寒凉，方之丸散汤引，着于载籍者，法也。察病之寒热虚实，
感之脏腑表里，所以君臣佐使，甘苦寒凉，补泻而丸散汤引者，不废方，亦可不执方也。故按图用兵
而不达变者，以卒与敌，执方治病而不察因者，未有能生人者也。虽然，不执方而又合法，亦匪易臻
也，脱非生平融通《素》、《难》、《本草》，仲景、洁古、守真、东垣、丹溪诸书，不可以语此秘密，医
何容易谈也！子徒以方书为快捷方式，盖亦未求之上古乎，上古之世无方，《扁鹊传》载长桑君以禁方
相授受，亦不载曰何方。春秋时秦缓医和，汉淳于公辈，以医名天下，亦未尝有方传也。至张仲景乃
始有方，是知东汉以前，医皆妙悟心法，察病投剂，未尝徇方也。彼岂私其方不欲授之人哉，诚惧后之
人拘执不变，必致误人尔。然立法处方，不过酌病机之详确，审经络之虚实，察药性之宜悖，明气味之
走守，合色脉，衍天和，调燮阴阳，参相造化，以一理贯之。理融则识真，识真则机顺，自然应变不胶
。方自吾心出，病可去而功可成，以成功而名方，谁曰不可。余何能，余仅守方而不执焉己，子宁以余
言为迂乎。
我低头开始学习医学，每天只致力于研读《素问》、《难经》、《诸病源候论》、《黄帝内经·素问·至真要大论》（此处指病机十九条相关理论）、《针灸甲乙经》等书籍，低头诵读，抬头思考，希望内心能够融会贯通前代哲人的隐秘旨趣，但自感未能完全达到。至于那些《太平惠民和剂局方》、《袖珍方》、《惠济方》等集子，偶尔用来参考，却不敢拘泥固执。到了临证诊疗时，务必虚心考察致病的原因，才敢投药处方，也从未机械地套用方剂来迎合病症。因此，那些拘执于固定方剂的医生，往往见到我的做法感到惊骇并议论纷纷，说：“像上面提到的那些方书流传下来，简易快捷，对后学大有便利，《素问》、《难经》等书固然精妙，但涣散漫延、艰深难懂，精力难以穷尽，胡先生喜好困难而厌恶容易，性情与常人不同吗？况且您诊病用药，常常与方书大相径庭，有病症相同而方剂不同的，有从头到尾使用同一种方法而不改变的，有三五次变更方剂而不拘泥的，却也能投药获得疗效，这是遵循什么道呢？或者是方书不足以凭借，而有其他的秘密传授吗？为什么与其他医生如此不同呢？”我说：“唉！医学哪里是轻易可以谈论的呢。人的生死，关乎呼吸之间，我怎么敢主观自用，而随意行事呢？古人称用药如同用兵，然而整齐步伐，严肃部伍，坐下起立、进退、刺杀攻击，有一定规则而不混乱，这是‘法’，怎么可以废弃呢？至于知己知彼，布置伏兵，设置奇谋，面对变化不可预测，其运用之妙在于一心。药物的君臣佐使配伍，味道的甘苦寒凉属性，方剂的丸散汤引剂型，记载在典籍中的，是‘法’。观察疾病的寒热虚实，感受邪气所在的脏腑表里，从而决定君臣佐使、甘苦寒凉、补泻以及丸散汤引的运用，不废弃方剂，但也不拘执于方剂。所以，按照地图用兵而不能变通的，士兵就会与敌人硬拼；拘执方剂治病而不考察病因的，从来没有能救活人的。虽然如此，不拘执方剂而又合乎法度，也不是轻易就能达到的，如果不是平生融通《素问》、《难经》、《本草纲目》（注：原文虽未明言李时珍，但孙一奎常参酌本草，此处依语境及常见引用推测为泛指本草类著作，或特指当时流行的本草知识体系，鉴于原文仅提《本草》，译为General Materia Medica），以及张仲景、洁古（张元素）、守真（刘完素）、东垣（李杲）、丹溪（朱震亨）等人的著作，不可以与此谈论这种秘密，医学哪里是轻易可以谈论的呢！你仅仅把方书当作快捷方式，大概也没有向上追溯上古时代吧？上古时代没有固定的方剂，《扁鹊传》记载长桑君将禁方传授给扁鹊，也没有记载说是哪个具体的方子。春秋时的秦越人（扁鹊）、医和，汉代的淳于意等人，以医术闻名天下，也未曾留下固定的方剂流传。直到张仲景才开始有方剂流传，由此可知东汉以前，医生都是靠妙悟心法，观察病情投药，不曾徇从固定方剂。他们难道是私藏方剂不想传授给别人吗？实在是害怕后人拘执不变，必定导致误人罢了。然而制定法则、设立方剂，不过是斟酌病机的详细确切，审察经络的虚实，观察药性的适宜与否，明确气味的归经走向，结合面色与脉象，推演天然和气，调和阴阳，参悟造化之机，用一个道理贯穿始终。道理融会贯通则认识真实，认识真实则时机顺遂，自然应变而不胶着。方剂出自吾心，病可去除而功效可达成，凭借成功的效果来命名方剂，谁说不可行呢？我有什么才能呢？我只是坚守方剂的原则而不拘执于方剂罢了，你难道认为我的话迂腐吗？
When I first bowed my head to study medicine, I devoted myself daily to the *Suwen* (Plain Questions), *Nanjing* (Classic of Difficult Issues), *Bingyuan* (Treatise on the Pathogenesis of Various Diseases), *Bingji* (Pathogenesis Principles), and *Jiayi* (The Systematic Classic of Acupuncture and Moxibustion). I recited with my head down and pondered with my head up, hoping to internally integrate the secret doctrines of the ancient sages, though I felt I had not yet fully attained this. As for collections such as the *Ju Fang* (Formulas of the Bureau of People's Welfare), *Xiuzhen* (Pocket Formulas), and *Hui Ji* (Beneficent Aid Formulas), I occasionally used them for reference but dared not adhere rigidly to them. When treating patients, I always humbly investigated the cause of the disease before prescribing, never mechanically applying formulas to fit diseases. Consequently, those who rigidly adhered to fixed formulas often reacted with shock and criticism upon seeing my methods, saying, "The formula books you mention are simple, quick, and highly beneficial for later learners. Although the *Suwen* and *Nanjing* are undoubtedly exquisite, they are diffuse, complex, and difficult to thoroughly master. Mr. Hu, do you prefer difficulty over ease? Your nature differs from others. Moreover, your diagnosis and prescription often differ significantly from standard formula books. There are cases where the disease is the same but the formula differs; there are cases where the same method is used from start to finish without change; there are cases where the formula is altered three or five times without rigidity, yet efficacy is still achieved. What Way do you follow? Are the formula books unreliable, and do you have other secret transmissions? Why do you differ so much from other physicians?"
I replied, "Alas! How difficult it is to discuss medicine. Human life and death hang in the balance of a breath. How dare I act subjectively and arbitrarily? The ancients said that using herbs is like using troops. However, marching in step, maintaining strict discipline, sitting, standing, advancing, retreating, stabbing, and attacking according to set rules without chaos—this is 'Fa' (Method/Law). How can this be discarded? Yet, knowing oneself and the enemy, setting ambushes, employing stratagems, and adapting to unpredictable changes—the subtlety of application lies in the mind. The roles of Sovereign, Minister, Assistant, and Envoy in herbal combinations, the flavors of sweet, bitter, cold, and cool, and the forms of pills, powders, decoctions, and teas recorded in texts constitute 'Fa'. Observing the cold, heat, deficiency, and excess of diseases, and the location of pathogens in the Zang-Fu organs and exterior/interior levels—determining the Sovereign-Minister-Assistant-Envoy roles, flavor properties, tonification/sedation, and pill/powder/decoction forms—does not discard formulas but also does not rigidly adhere to them. Therefore, one who uses troops according to a map without understanding adaptation will fight enemies with mere soldiers; one who treats diseases by rigidly adhering to formulas without investigating causes has never been able to save lives. Nevertheless, not adhering rigidly while still abiding by 'Fa' is not easily achieved. Unless one has thoroughly integrated the *Suwen*, *Nanjing*, *Bencao* (Materia Medica), and the works of Zhang Zhongjing, Jiegu (Zhang Yuansu), Shouzhen (Liu Wansu), Dongyuan (Li Gao), and Danxi (Zhu Zhenheng) throughout one's life, one cannot discuss these secrets. How easy is medicine to talk about! You merely view formula books as a shortcut, likely because you have not sought knowledge from antiquity. In ancient times, there were no fixed formulas. The *Biography of Bian Que* records Chang Sang Jun transmitting secret prescriptions to Bian Que, but does not specify which exact formula. Qin Huan (Bian Que) and Yi He in the Spring and Autumn period, and Chunyu Yi in the Han dynasty, were famous for their medical skills, yet left no fixed formulas behind. It was not until Zhang Zhongjing that formulas began to be transmitted. Thus, we know that before the Eastern Han Dynasty, physicians relied on intuitive insight and mental methods, observing diseases and prescribing accordingly, without following fixed formulas. Did they privately hoard formulas unwilling to teach others? No, they truly feared that later generations would become rigid and unchanging, inevitably leading to harm. However, establishing laws and formulating prescriptions merely involves carefully weighing the pathogenesis, examining the deficiency and excess of meridians, assessing the suitability or contradiction of drug properties, clarifying the directional movement of Qi and flavors, combining complexion and pulse, extending natural harmony, regulating Yin and Yang, and participating in the workings of creation, all unified by a single principle. When principles are integrated, true understanding arises; when true understanding arises, opportunities flow naturally, allowing for flexible adaptation without stagnation. The formula emerges from my heart; the disease can be cured, and merit achieved. If merit is achieved, why not name the formula? What ability do I possess? I merely uphold the principles of formulas without rigid adherence. Do you consider my words pedantic?"