以五味、五谷、五药养其病，以五气、五声、五色 其死生。两之以九窍之变，
参之以九脏之动。（五味醯、酒、饴蜜、姜、盐之属。五谷麻、黍、稷、麦、豆也。五药草、木、虫、石、谷也。养
犹治也。病由气胜，负而生气之羸，则攻之。其不足则养之也。五气者，肝气温，心气热，脾气和，肺气凉，肾气寒是
已。
五声者，肝声呼，心声叹，脾声歌，肺声哭，肾声呻是已。五色者，肝色青，心色赤，脾色黄，肺色白，肾色黑是已。
三者剧易之征见于外。察其盈虚休王，则吉凶可知矣。九窍者，阳窍七，两耳、两目、两鼻、一口也。阴窍二，大小
二府也。窍谓其有形而见于外者。两之谓阴阳，变谓阴阳之变。观其证之变而有通塞之二候。九脏者，正脏五，谓肺、
心、肝、脾、肾，及六腑中胃、膀胱、大肠、小肠四者。脏谓皆有形而藏于内者。参之谓阳阴与冲气。察其脉之动，
而有浮、中、沉之三部。以要而言，九脏皆不出于五脏，而上关九窍。两之参之而得其要。则五要可用，而医无过误之
失矣。）
凡民之有疾病者，分而治之。死终，则各书其所以而入于医师。（少者曰死，老者曰终，
所以谓治疾不愈之状也。入于医师者，医师得以制其禄，且以为后戒。）
疡医，掌肿疡、溃疡、金疡、折疡之祝药 杀之齐。（肿疡壅而上生创者。溃疡痈而含脓血者。
金疡刃创也。折疡 跌者。祝当为注，以药附之也。 ，刮去脓血也。杀，以药食其恶肉也。）
凡疗疡，以五毒攻之，以五气养之，以五药疗之，以五味节之。（止病曰疗。五毒，五
药之有毒者。今医方有五毒之药，作之合黄 ，置石胆、丹砂、雄黄、矾石、磁石其中，烧之三昼夜。其烟
上着，以鸡羽扫取之。以注创，恶肉破则骨尽出。 谓刮去败血。杀谓蚀去恶肉。盖肿者欲散，溃者
欲合，伤者欲复，断者欲续。故必先攻之以五毒，而后养之以五谷，疗之以五药，节之以五味也。）
凡药以酸养骨，以辛养筋，以咸养脉，以苦养气，以甘养肉，以滑养窍。凡有
疡者，受其药焉。（此言各以其类相养也。酸，木味。木根立地中似骨。辛，金味。金之缠合异物似筋。
咸，水味。水之流行地中似脉。苦，火味。火出入无形似气。甘，土味。土含载四者似肉。滑，滑石也。
凡诸滑物通利往来，似窍然。治疡以骨为主，而筋脉气不可以过盛，用药宜得其中焉。）
陶弘景曰∶今庸医处疗，皆耻看本草。或倚约旧方，或闻人传说，或遇其所忆，
便揽笔疏之。俄然戴面，以此表奇。其恶畏相反，故自寡昧。而药类违僻，分量参
差，亦不以为疑。脱或偶尔值瘥，则自信方验。若旬月未瘳，则言病源深结，了不
反求诸己，详思得失。虚构声称，多纳金帛，非惟在显宜贵，固将居幽贻谴矣。
张湛曰∶夫经方之难精，由来尚矣。今病有内同而外异，亦有内异而外同。故
五脏六腑之盈虚，血脉荣卫之通塞，固非耳目之所察，必先诊候以审之。而寸口关
尺，有浮沉弦紧之乱；俞穴流注，有高下浅深之差；肌肤筋骨，有浓薄刚柔之异。
惟用心精微者，始可与言于兹矣。今以至精至微之事，求之于至粗至浅之思，岂不
殆哉。若盈而益之，虚而彻之，塞而壅之，寒而滞之，是重加其疾而望其生，吾见其死矣。
孙真人曰∶凡古今病名，率多不同。缓急寻检，常致疑阻。若不判别，何以示
众。且如世人呼阴毒伤寒，最为剧病。尝深摭其由。然口称阴毒之名，意指少阴之
证，病实阴阳之候。命一疾而涉三病，以此为治，岂不茫昧。殊不知阴毒、少阴、
阴阳，自是三候，为治全别。古有方证，其说甚明。今而混淆，害人最急。又如肠
风、脏毒、咳逆、慢惊，遍稽方论，无此名称。深穷其状，肠风，乃肠痔下血。脏
毒，乃痢之蛊毒。咳逆者，哕逆之名，慢惊者，阴痫之病。若不知古知今，何以为
人司命？加以古之经方，言多雅奥，以利为滞下，以蹶为香港脚，以淋为癃，以实为
秘，以天行为伤寒，以白虎为历节，以膈气为膏肓，以喘嗽为咳逆，以僵直为 ，
以不语为 ，以缓纵为痱，以怔忪为悸，以痰为饮，以黄为瘅。诸如此论，可不讨
论？而况病有数候相类，二病同名者哉。宜其视伤寒、中风、热病、瘟疫，通曰伤
寒。肤胀、鼓胀、肠覃、石瘕，率为水气。疗中风专用平痰药，指滞下或以为劳疾，
伏梁不辨乎风根，中风不分乎时疾。此今天下医者之公患也，是以别白而言之。
古云∶不得为贤宰相，则为明医，甚者医之难明也。略举数事。一曰凉药治损
谬。其说盛于丹溪。谓人之一身，阳常有余，阴常不足。而用知母，黄柏等，谓之
滋阴。至今治虚劳者遵而用之。初服胃气尚强，久之则中寒而食减。阴未滋，阳已
竭矣。或曰∶泻南方，补北方，经语也。然不知经云∶东方实，西方虚。乃不治东
西，而唯泻南补北。肾为肝母，水旺则金不受熏而能制木，故曰母能令子虚也。为
金木谋则然，而非概治虚劳也。以王节斋之高明，亦因仍而不觉，岂一时之误否耶？
二曰炮制失宜谬。今人以童便浸参，曰肺热，还伤肺也。本草参忌卤与溲。卤，盐
也。溲，便溺也。何反用其忌也？又附子者，正取其勇悍之性，亦用童便煮之，至
三、五日。譬如用猛将以御劲敌，取其猛也。而损伤其手足，饥饿其体肤，乃使其
临阵，可乎？夫用药者，宜察其当用与否。如不当用，曷若已之。三曰认药舛错谬。
青皮则以小枳实混之，其枳壳则以香丸混之，石膏则以方解石混之。又另立软石膏、
软柴胡之说。犹未也，以五倍子为文蛤，以莲花须为莲花蕊，以山萝卜为沙参，皆
舛也。夫青皮入足厥阴经，故陈皮治高，青皮治低。小枳实，胸中药也，何由入厥
阴经也？余可类推矣。又枸杞子、地骨皮，根之于实，一树也。王节斋分属草木二
部，皆舛也。四率意处方谬。古人处方，慎重不苟。所有成方，如四君子、四物、
二陈、平胃等号玉笈三十六方，孙思邈真人传自龙宫，而杂布于诸方书中。名各皆
有深意，后人合宜则用，稍为增减出入，无不应者。乃今时处方，或散漫无纪，或
任便自用，或惯作平淡庸柔之剂。无大益，亦无大损者。将谓成则归功，败则无所
归咎，而不知紧要之疾，乃作误害矣。又王氏类方，最为精密。而四君子易甘草以
黄。夫临证处方，自无死法，而录刻古方，不宜变损。或古有之则可，古未
有，则仍旧为是。愚谓用药如用兵，兵本杀人，善用之则生人。医本生人，不
善用之则杀人。旨哉言乎，故孔子以战、疾并慎。而医家者言，则有四诊九候，
五科八要，诚慎之也。不然而平日不调习，临敌无节制，卤莽决裂，其不以兵为戏乎？
王忠文公 云∶李明之弟子多在中州，独刘守真之学，传之荆山浮图师。师至
江南，传之中人罗知悌，而南方之医皆宗之矣。及国朝，天下之言医者，非刘氏之
学，弗道也。刘李之法，虽攻补不同，会而通之，随证而用之，自中其病矣。近时
吾吴中称良医师，则以能持东垣者，谓之王；持张刘者，谓之伯。噫！尧舜以揖让，
汤武以干戈。苟合道济世，何必曰同。余尝病世之专于攻伐者，邪气未退，而真气
先然矣。专于补养者，或致气道壅塞，为祸不少，正气未复，而邪气愈炽。古人
有云∶药贵合宜，法当应变。泥其常者，人参反以杀人；通其变者，乌头可以活命。
孙真人所谓随时增损，物无定方，真知言哉。
震泽王文恪公云∶今之医者，祖述李明之、朱彦修，其处方不出参术之类，所
谓医之王道，信知本者矣。然病出于变，非术参辈所能效者，则药亦不得不变。可
变而不知变，则坐以待亡。变而失之毫厘，则反促其死，均之为不可也。故曰∶可与立，未可与权。
药而能权，可谓妙矣。明之、彦修未尝废权也。世医师其常，而不师其变，非用权之难乎？
孔志约云∶动植形生，因方舛性。春秋节变，感气殊功。离其本土，则质同而
效异。乖于采摘，乃物是而时非。名实既爽，寒温多谬。用之凡庶，其欺已甚。施之君父，逆莫大焉。
陈嘉谟曰∶医学贸易，多在市家。谚云∶卖药者，一眼。用药者，两眼。服药
者，无眼，非虚语也。古圹灰云死龙骨，苜蓿根为土黄 ，麝香捣荔核搀，藿香采
茄叶杂，煮半夏为玄胡索，盐松梢为肉苁蓉，草仁充草豆蔻，西呆代木香，熬广胶
入荞麦作阿胶，煮鸡子及鱼枕为琥珀，枇杷蕊代款冬花，驴脚胫作虎骨，松脂混麒
麟，番硝和龙脑香。巧诈百般，甘受其侮，甚至杀人，归咎用药，乃大关系，非比寻常，不可不慎也。
《陶贞白外传》云∶有弟子桓 ，先得道，将超升。弘景问曰∶某行教修道，勤
亦至矣，得非有过而淹延在世乎？桓 曰∶君之阴功着矣。所修本草，以虻虫、水
蛭为药，功虽及人而害于物命。以此一纪之后，当解形去世，署蓬莱都水监耳。言
讫乃去。弘景复以草木之药，可代物命者，着《别录本草》三卷，以赎其过焉。后
陶弘景果解形仙去，又为茅山上清第九代宗师也。
许胤宗曰∶医特意耳。思虑精则得之。脉之候幽而难明。吾意所解，口莫能宣
也。古之上医要在视脉，病乃可识。病与药值，惟用一物攻之，气纯而愈速。今之
人不善为脉，以情度病，多其物以幸有功。譬猎不知兔，广络原野，冀一人获之，
术亦疏矣。一药偶得，它味相制，弗能专力，此难愈之验也。脉之妙处不可传，虚
着方剂，终无益于世，此吾所以不着书也。
《太微仙君功过格》云∶以符法针药救重疾，一人为十功。小疾，一人为五功。
如受病家贿赂，则无功。施药一服，为一功。传人保益性命符法药术等，每一事为
五功。如受贿而传，则一功。凡有重疾告治，不为拯救者，一人为二过。小疾，
一人为一过。治不如法，为一过。不愈而受贿，百钱为一过，贯钱为十过。修合
毒药，欲害于人，为十过。害人性命，为百过。害人不死而病，为五十过。害一
切众生禽畜性命，为十过。害而不死，为五过。故伤杀人性命者，为百过。误伤
杀性命，为八十过。大明律，凡庸医为人用药针刺，误不根据本方，因而致死者，
责令别医辨验药饵穴道。如无故害之情者，以过失杀人论，不许行医。若故违
本方，诈疗疾病而取财物者，计赃，准窃盗论。因而致死，及因事故，用药杀人者斩。
樵谈有曰∶杀人者死，法也。庸医杀人，不死。猛将杀人，不死。酷吏杀人，不死。法在乎？
用五味（酸、苦、甘、辛、咸）、五谷（麻、黍、稷、麦、豆）和五药（草、木、虫、石、谷）来调养病人的疾病，通过观察五气（肝温、心热、脾和、肺凉、肾寒）、五声（呼、叹、歌、哭、呻）、五色（青、赤、黄、白、黑）来判断病人的生死。结合九窍（眼、耳、鼻、口、二阴）的变化，参照九脏（五脏加胃、膀胱、大肠、小肠）的脉动情况。（五味指醋、酒、饴糖、蜂蜜、姜、盐之类。五谷指大麻、黄米、小米、小麦、大豆。五药指草类、木类、虫类、石类、谷类。“养”在这里意为治疗。如果病邪气盛，导致正气虚弱，就用攻法；如果正气不足，就用补养法。五气是指：肝气温热，心气炎热，脾气平和，肺气清凉，肾气寒冷。五声是指：肝的声音是呼，心的声音是叹息，脾的声音是歌唱，肺的声音是哭泣，肾的声音是呻吟。五色是指：肝色青，心色赤，脾色黄，肺色白，肾色黑。这三种表现剧烈变化的征象反映在外部。观察其盈虚旺衰，就能知道吉凶了。九窍中，阳窍有七个，即两耳、两眼、两鼻孔、一口；阴窍有两个，即前阴和后阴。窍指的是那些有形且显露在外部的器官。“两之”指的是阴阳，“变”指的是阴阳的变化。观察证候的变化，可以看出通与塞两种脉候。九脏中，正脏五个，即肺、心、肝、脾、肾，加上六腑中的胃、膀胱、大肠、小肠四个。脏指的是都有形且藏于体内的器官。“参之”指的是阴阳与冲气的关系。观察其脉动的情况，可以分出浮、中、沉三部脉。总而言之，九脏都不超出五脏的范围，并且上连九窍。综合“两之”和“参之”的方法抓住要领，那么五种调养方法就可以运用得当，医生就不会有过失错误了。）
凡是百姓患有疾病的，分别进行治疗。对于死亡的人，要记录其死因并上报给医师。（年轻死的叫“死”，年老死的叫“终”，“所以”指治疗疾病未愈最终导致死亡的情况。上报给医师，是为了让医师根据结果决定俸禄，并作为以后的警戒。）
疡医（外科医生），掌管肿疡（壅滞而生疮者）、溃疡（痈疽化脓含血者）、金疡（刀箭创伤）、折疡（跌打骨折）的外敷药物和刮除腐肉的药剂。（肿疡是气血壅滞而表面生疮。溃疡是痈疽溃烂含有脓血。金疡是被刀刃造成的创伤。折疡是跌打损伤。祝通“注”，指将药物附着于患处。䘌（lǐ），指刮去脓血。杀，指用药腐蚀去除恶肉。）
凡是治疗疡疾，用五毒（有毒性的药物）来攻逐病邪，用五气来调养身体，用五药来治疗疾病，用五味来节制饮食。（“疗”指止住疾病。五毒，指五种有毒的药物。现在的医方中有五毒药，制作时将黄丹、石胆、丹砂、雄黄、矾石、磁石混合，烧制三昼夜。烟气附着在物体上，用鸡羽扫取收集。涂在创口上，恶肉脱落则骨头尽出。䘌指刮去败血。杀指腐蚀去除恶肉。大概肿胀的要使其消散，溃破的要使其愈合，受伤的要使其恢复，断裂的要使其接续。所以必须先以五毒攻邪，然后以五谷调养，以五药治疗，以五味节制。）
凡是药物，用酸味养骨，用辛味养筋，用咸味养脉，用苦味养气，用甘味养肉，用滑利之物养窍。凡是有疡疾的人，接受这些药物治疗。（这是说各以其同类相滋养。酸属木味，木根直立在地中像骨。辛属金味，金的缠合异物像筋。咸属水味，水的流行地中像脉。苦属火味，火的出入无形像气。甘属土味，土承载四物像肉。滑，指滑石。各种滑利的东西通畅往来，像窍一样。治疗疡疾以骨为主，但筋脉气不可以过盛，用药应当适中。）
陶弘景说：现在的普通医生开方治疗，都以不看本草为耻。有的依靠抄录旧方，有的听人传说，有的遇到自己记得的，就提笔写下来。一会儿戴上帽子，以此标榜奇特。他们厌恶的和需要的相反，所以自己见识浅薄。而且药物类别违背常理，分量参差不齐，也不以为疑。如果偶尔碰巧治愈，就自信方子有效。如果一个月没好，就说病源深结，完全不反思自己的得失。虚构名声，多收钱财，这不仅显贵之人应该责备，就是在地下也要受到谴责。
张湛说：经方（经典方剂）难以精通，由来已久了。现在疾病有内部相同而外部表现不同的，也有内部不同而外部表现相同的。所以五脏六腑的虚实，血脉营卫的通塞，本来就不是耳目所能察觉的，必须通过诊察来审察清楚。而寸口、关、尺三部脉，有浮、沉、弦、紧等混乱变化；腧穴的气血流注，有高下浅深的差异；肌肤筋骨，有浓薄刚柔的不同。只有用心精微的人，才可以和他们谈论这个了。现在用极其精深微妙的事情，去求之于粗浅的思维，难道不危险吗？如果实证反而补充它，虚证反而泻夺它，闭塞反而壅堵它，寒证反而凝滞它，这是加重病情却希望他生存，我看他是必死无疑了。
孙思邈说：古今的病名，大多不同。紧急查找检验，常常导致疑惑阻碍。如果不加以判别，怎么向众人展示。比如世人称呼阴毒伤寒，是最严重的病。我曾深入探究其原因。然而口称阴毒之名，意指少阴之证，病实际上是阴阳的候象。命名一个疾病却涉及三种病症，以此来治疗，岂不迷茫。殊不知阴毒、少阴、阴阳，自然是三种候象，治疗方法完全不同。古代有方证，说法很明确。现在混淆不清，害人最急迫。又如肠风、脏毒、咳逆、慢惊，遍查方论，没有这些名称。深入探究其症状，肠风，就是肠痔下血。脏毒，就是痢疾中的蛊毒。咳逆，就是哕逆的名称，慢惊，就是阴痫的疾病。如果不知道古代的也知道现代的，怎么能做救人的医生？再加上古代的经方，言辞大多高雅深奥，以利字表示滞下（痢疾），以蹶字表示香港脚（脚气病），以淋字表示癃闭，以实字表示便秘，以天行表示伤寒，以白虎表示历节（风湿痹痛），以膈气表示膏肓（重病），以喘嗽表示咳逆，以僵直表示痉病，以不语表示喑哑，以缓纵表示痱病，以怔忪表示心悸，以痰表示饮邪，以黄表示疸病。诸如此类的论述，怎能不讨论？更何况病有几候相似，两种病同名的呢。因此把伤寒、中风、热病、瘟疫，都统称为伤寒。肤胀、鼓胀、肠覃、石瘕，都率尔认为是水气。治疗中风专门用化痰药，指认滞下或以为是劳损疾病，伏梁不分辨风根，中风不分辨时行疾病。这是当今天下医生的共同弊病，所以我特意分辨说明。
古话说：不能做贤能的宰相，就要做明医，这更是说明医道的难懂。略举几件事。一是凉药治损谬误。这种说法在朱丹溪那里盛行。认为人的一身，阳常有余，阴常不足。而使用知母、黄柏等，叫做滋阴。至今治疗虚劳的人遵循并使用它。初服时胃气还强，时间久了则中焦受寒而食欲减退。阴还没滋补上，阳已经耗竭了。有人说：泻南方，补北方，是经典的话。然而不知道经文中说：东方实，西方虚。是不治东西，而只泻南补北。肾是肝的母亲，水旺则金不受熏蒸而能制约木，所以说母亲能使儿子虚弱。为金木谋划是这样，但不是概括治疗虚劳的方法。以王节斋的高明，也沿袭而不觉得，难道是一时的错误吗？二是炮制失宜谬误。现在的人用童便浸泡人参，说是肺热还伤肺。本草中说人参忌卤和溲。卤，是盐。溲，是大小便。为什么反而使用它所忌讳的呢？还有附子，正是取其勇悍的性质，也用童便煮它，直到三、五天。比如用猛将来抵御劲敌，是取其猛烈。而损伤它的手足，饥饿它的体肤，再让它上阵，可以吗？用药的人，应该考察是否应当使用。如果不应当使用，不如停止。三是认药舛错谬误。青皮用小枳实混淆，枳壳用香丸混淆，石膏用方解石混淆。又另立软石膏、软柴胡的说法。还不止这些，用五倍子冒充文蛤，用莲花须冒充莲花蕊，用山萝卜冒充沙参，都是错误的。青皮入足厥阴经，所以陈皮治上部，青皮治下部。小枳实是胸中药，怎么能入厥阴经呢？其余可类推。还有枸杞子、地骨皮，根和果实，是一棵树。王节斋分属于草木两部，都是错误的。四是随意处方谬误。古人开方，慎重不苟且。所有成方，如四君子、四物、二陈、平胃等号称玉笈三十六方，孙思邈真人从龙宫传来，混杂分布在各种方书中。名字各有深意，后人合宜则用，稍微增减出入，没有不应验的。然而现在的人开方，有的散漫无纪律，有的任意自用，有的惯作平淡庸柔的药剂。没有大益处，也没有大损害。将以为成功归功，失败无处归咎，却不知道紧要的疾病，就成了误害了。还有王氏类方，最为精密。而四君子汤把甘草换成黄芪。临证处方，自然没有死法，但记录刻印古方，不应该改变损害。或者古已有之则可以，古未有，则保持原样是对的。我认为用药如用兵，兵本来是杀人的，善于使用则救人。医本来是救人的，不善于使用则杀人。这话真深刻啊，所以孔子对战争和疾病都持谨慎态度。而医家的言论，有四诊九候，五科八要，确实是谨慎的表现。不然的话平日不调习，临敌无节制，鲁莽决裂，这不就是把打仗当儿戏吗？
王忠文公说：李东垣的弟子多在中州，唯独刘守真的学问，传给了荆山浮图师。浮图师到了江南，传给了中人罗知悌，而南方的医生都尊崇他了。到了本朝，天下谈论医学的人，如果不是刘氏的学说，就不谈论。刘完素和李东垣的方法，虽然攻补不同，融会贯通，随证施用，自然能击中病灶。近来我们吴中自称良医的，以能坚持东垣学说的称为王；坚持张元素、刘完素的称为伯。唉！尧舜以揖让治国，汤武以干戈征战。如果合乎道义救济世人，何必说相同。我曾经批评世上专于攻伐的医生，邪气未退，真气先耗尽了。专于补养的医生，可能导致气道壅塞，祸患不少，正气未恢复，邪气更炽盛。古人有话说：药贵在合适，法应当应变。拘泥于常规，人参反而杀人；通晓变化，乌头可以活命。孙思邈所说的随时增减，药物没有定方，真是知言啊。
震泽王文恪公说：现在的医生，祖述李东垣、朱彦修，他们的处方不出人参、白术之类，所谓的医之王道，确实是懂得根本的人。然而病出于变化，不是参、术辈所能奏效的，那么药也不得不变化。可以变化而不知道变化，就是坐以待毙。变化而失之毫厘，反而加速他的死亡，都是一样的不可取。所以说：可以与他确立原则，未必可以与他权变。药物如果能权变，可以说是妙极了。李东垣、朱彦修并没有废弃权变。世间的医生只守常规，不学习变化，这不是权变的困难吗？
孔志约说：动植物的形态生命，因为方剂不同而性质各异。春秋季节变化，感受的气候功效特殊。离开本土，则质地相同而疗效不同。违背采摘时节，则是物品正确而时间错误。名实既然差错，寒温多有谬误。用于平民百姓，欺骗已经很严重了。施用于君父，罪过没有比这更大的了。
陈嘉谟说：医学贸易，多在市集商家。谚语说：卖药的，一眼。用药的，两眼。服药的，无眼，不是虚话。古墓灰云死龙骨，苜蓿根当作土黄芩，麝香捣碎荔枝核搀杂，藿香采集茄叶掺杂，煮半夏当作玄胡索，盐松梢当作肉苁蓉，草仁冒充草豆蔻，西呆木代木香，熬广胶掺入荞麦作阿胶，煮鸡蛋及鱼枕当作琥珀，枇杷蕊代替款冬花，驴脚胫当作虎骨，松脂混充麒麟竭，番硝和龙脑香。巧诈百般，甘愿受其侮辱，甚至杀人，归咎于用药，这是大关系，不像寻常小事，不可不谨慎。
《陶贞白外传》说：有弟子桓某，先得道，将要超升。陶弘景问他说：我推行教化修道，勤奋也到了极点，是不是有过错而拖延在世？桓某说：您的阴德显著了。所修的本草，以虻虫、水蛭为药，功效虽惠及人但伤害了物命。以此一纪之后，应当脱形去世，署任蓬莱都水监罢了。说完就离开了。陶弘景又以草木之药可以替代物命的，著《别录本草》三卷，来赎罪过。后来陶弘景果然脱形仙去，又是茅山上清第九代宗师。
许胤宗说：医道只是意念罢了。思虑精微就能得到。脉的候象幽深难以明了。我所理解的，口中无法宣示。古代的上医关键在于看脉，病才能识别。病与药对应，只用一味药攻治，药气纯正而痊愈快。现在的人不善于切脉，凭主观推测病情，多用多种药物希望侥幸成功。比如打猎不知道兔子在哪，广泛包围原野，希望抓到一只兔子，技术也太疏漏了。一味药偶然有效，其他味道相互制约，不能专心用力，这是难愈的验证。脉的妙处不可传授，虚设方剂，终究对世道无益，这就是我为什么不著书的原因。
《太微仙君功过格》说：用符法针药救治重疾，一人算十功。小疾，一人算五功。如果收受病人贿赂，则无功。施药一服，算一功。传人保益性命符法药术等，每一事算五功。如果受贿而传，算一功。凡有重疾告治，不拯救的，一人算二过。小疾，一人算一过。治疗不合法度，算一过。没治好而受贿，百钱算一过，一贯钱算十过。修合毒药，想要害人，算十过。害人性命，算百过。害人不死而致病，算五十过。害一切众生禽畜性命，算十过。害而不死，算五过。所以伤杀人性命的，算百过。误伤杀性命，算八十过。大明律规定，凡是庸医为人用药针刺，失误不根据本方，因而致死的，责令其他医生辨验药饵穴道。如果没有故意害人的情节，以过失杀人论处，不许行医。如果故意违背本方，欺诈治疗疾病而取财物的，计算赃物，按窃盗论处。因而致死，以及因事故用药杀人的，斩首。
樵谈中说：杀人者死，是法律。庸医杀人，不死。猛将杀人，不死。酷吏杀人，不死。法律在哪里？
Using the Five Flavors (sour, bitter, sweet, pungent, salty), Five Grains (hemp, millet, broomcorn millet, wheat, soybean), and Five Medicinals (herbs, trees, insects, minerals, grains) to nourish and treat the patient's illness, one judges life and death by observing the Five Qi (liver warmth, heart heat, spleen harmony, lung coolness, kidney cold), Five Sounds (shouting, sighing, singing, weeping, groaning), and Five Colors (green, red, yellow, white, black). This is combined with the changes in the Nine Orifices (eyes, ears, nostrils, mouth, anterior and posterior orifices) and referenced against the movements of the Nine Zang Organs (the five regular Zang plus stomach, bladder, large intestine, small intestine). (The Five Flavors refer to vinegar, wine, maltose, honey, ginger, salt, etc. The Five Grains refer to hemp, foxtail millet, broomcorn millet, wheat, and soybeans. The Five Medicinals refer to herbs, trees, insects, minerals, and grains. "Nourish" here implies treatment. If pathogenic Qi is excessive, causing deficiency of healthy Qi, attack methods are used; if healthy Qi is deficient, nourishing methods are employed. The Five Qi refers to: liver Qi being warm, heart Qi being hot, spleen Qi being harmonious, lung Qi being cool, and kidney Qi being cold. The Five Sounds refers to: liver sound as shouting, heart sound as sighing, spleen sound as singing, lung sound as weeping, and kidney sound as groaning. The Five Colors refers to: liver color green, heart color red, spleen color yellow, lung color white, and kidney color black. These three manifestations of drastic change appear externally. Observing their fullness, emptiness, and prosperity allows one to know auspiciousness or inauspiciousness. Among the Nine Orifices, there are seven Yang orifices: two ears, two eyes, two nostrils, and one mouth; and two Yin orifices: the anterior and posterior orifices. Orifices refer to those that have form and are visible externally. "Two" refers to Yin and Yang; "change" refers to the transformation of Yin and Yang. By observing the changes in symptoms, one can discern the two states of unobstructedness and obstruction. Among the Nine Zang, there are five regular Zang: lung, heart, liver, spleen, and kidney, plus four from the Fu organs: stomach, bladder, large intestine, and small intestine. Zang refers to those that have form and are stored internally. "Reference" refers to the relationship between Yin/Yang and Chong Qi. By observing pulse movement, one can distinguish the three positions: floating, middle, and deep. In summary, the Nine Zang do not exceed the scope of the Five Zang, yet connect superiorly to the Nine Orifices. By mastering the essentials through "two" and "reference," the five nourishing methods can be applied correctly, and the physician will avoid errors.)
For common people suffering from diseases, they are treated separately. Upon death, the cause is recorded and reported to the physician. (Death at a young age is termed "si"; death at an old age is termed "zhong." "So yi" refers to the state where disease treatment failed, leading to death. Reporting to the physician allows for determining remuneration and serving as a warning for the future.)
Physicians specializing in sores (Yang Yi) manage external applications for swelling sores (accumulation leading to ulcers), ulcerative sores (abscesses containing pus and blood), metal wounds (blade injuries), and fracture wounds (falls/injuries). (Swelling sores involve qi and blood stagnation forming surface lesions. Ulcerative sores are abscesses ruptured with pus and blood. Metal wounds are injuries caused by blades. Fracture wounds are traumatic injuries. "Zhu" is a variant for "zhu" (apply), meaning applying medicine to the lesion. "Li" means scraping away pus and blood. "Sha" means using medicine to corrode and remove necrotic tissue.)
In treating sores, use Five Poisons (toxic medicines) to attack the pathogen, Five Qi to nourish the body, Five Medicinals to treat the disease, and Five Flavors to regulate diet. ("Liao" means to stop the disease. Five Poisons refer to five types of toxic medicines. Current medical formulas include Five Poison medicines, made by mixing realgar, bismuth ore, cinnabar, alum, magnetite, burning them for three days and nights. The smoke deposits on objects, which are collected with chicken feathers and applied to wounds, causing necrotic tissue to fall off. "Li" means scraping away bad blood. "Sha" means eroding evil flesh. Generally, swelling should be dispersed, ulcers healed, injuries restored, and fractures continued. Thus, one must first attack with Five Poisons, then nourish with Five Grains, treat with Five Medicinals, and regulate with Five Flavors.)
Medicines: Sour flavor nourishes bone, pungent flavor nourishes tendon, salty flavor nourishes vessel, bitter flavor nourishes qi, sweet flavor nourishes flesh, and slippery substances nourish orifices. Those with sores receive these treatments. (This speaks of mutual nourishment by category. Sour belongs to Wood; wood roots standing in earth resemble bones. Pungent belongs to Metal; metal binding foreign objects resembles tendons. Salty belongs to Water; water flowing in earth resembles vessels. Bitter belongs to Fire; fire entering and exiting invisibly resembles qi. Sweet belongs to Earth; earth carrying four elements resembles flesh. Slippery refers to talc. Various slippery things facilitate flow, resembling orifices. Treating sores focuses on bone, but tendons, vessels, and qi must not be excessive; medication should be moderate.)
Tao Hongjing said: Ordinary physicians today are ashamed to consult Materia Medica. Some rely on copying old formulas, some on hearsay, some on memory, and hastily write prescriptions. They then wear hats to display their uniqueness. Their aversions contradict their needs, resulting in ignorance. Drug categories deviate from norms, dosages vary inconsistently, yet they do not doubt it. If by chance a cure occurs, they claim efficacy. If no improvement after a month, they blame deep-seated pathology, never reflecting on their own errors. They fabricate reputations and extort money. This deserves condemnation among the living and punishment in the underworld.
Zhan Zhan said: The difficulty of mastering classic formulas has existed since ancient times. Diseases may share internal similarities but present differently externally, or vice versa. Therefore, the fullness or emptiness of the five Zang and six Fu organs, and the patency or blockage of blood vessels and Ying/Wei, cannot be perceived by eyes and ears alone; diagnosis is required. Pulse positions (Cun, Guan, Chi) show floating, sinking, wiry, or tight variations; acupoint flows differ in depth and level; skin, muscle, bone, and tendon vary in thickness and texture. Only those with refined minds can discuss this. Using coarse thinking for subtle matters is dangerous. Tonifying excess, purging deficiency, obstructing blockage, or stagnating cold only worsens the condition, leading to death.
Sun Simiao said: Ancient and modern disease names often differ, causing confusion during emergencies. Without clarification, how can one instruct others? For instance, "Yin Du Shang Han" is considered severe. However, the name "Yin Du" implies Sha Yin syndrome, while the pathology involves Yin-Yang patterns. Naming one disease involving three categories leads to confusion. Yin Du, Sha Yin, and Yin-Yang are distinct patterns requiring different treatments. Ancient texts clarify this; modern confusion harms patients. Terms like Chang Feng, Zang Du, Ke Ni, Man Jing lack standard definitions. Chang Feng is hemorrhoids bleeding; Zang Du is dysentery toxin; Ke Ni is hiccups; Man Jing is yin epilepsy. One must know both ancient and modern terms to save lives. Classic formulas use obscure terms: "Li" for dysentery, "Jue" for beriberi, "Lin" for strangury, "Shi" for constipation, "Tian Xing" for epidemic cold, "Bai Hu" for rheumatic arthritis, "Ge Qi" for critical illness, "Chuan Sou" for cough, "Jiang Zhi" for spasm, "Bu Yu" for aphonia, "Huan Zong" for flaccidity, "Zheng Song" for palpitations, "Tan" for fluid retention, "Huang" for jaundice. Such discussions are essential. Moreover, similar symptoms may have different names, or different symptoms share names. Today, doctors indiscriminately label wind-stroke, heat disease, and plague as "Shang Han"; edema, drum distension, intestinal tumors, and uterine masses as "water qi." Treating wind-stroke with phlegm-resolving drugs or misidentifying dysentery as consumption are common errors. I clarify these distinctions.
As the saying goes: "If not a wise chancellor, then a skilled physician," highlighting the difficulty of medicine. Errors include: 1. Using cooling drugs for deficiency, popularized by Danxi, who claimed yang is always excess and yin always deficient. Using Anemarrhena and Phellodendron for "nourishing yin" often damages spleen yang over time. 2. Improper processing: Soaking ginseng in child's urine contradicts materia medica warnings against salt and urine. Processing Aconite with urine destroys its potent nature, akin to weakening a general before battle. 3. Misidentification: Confusing Qing Pi with immature bitter orange, Shi Gao with calcite, or Gou Qi Zi with Di Gu Pi. 4. Arbitrary prescribing: Modern doctors often use bland, ineffective formulas without careful consideration, unlike ancients who used precise classic formulas like Si Jun Zi Tang. Medicine is like war; misuse kills.
Wang Zhongwen noted: Li Dongyuan's lineage spread in the Central Plains, while Liu Wansu's teachings passed through Daoist masters to Luo Zhiti in the South, becoming dominant in the Ming Dynasty. Liu and Li differed in attacking vs. tonifying, but integrating them suits various conditions. Wu doctors pride themselves on following Dongyuan or Zhang/Liu. However, rigid adherence is flawed. As Sun Simiao said, formulas must adapt to circumstances.
Wang Wenke stated: Modern doctors follow Li Dongyuan and Zhu Zhenheng, relying heavily on Ginseng and Atractylodes. While this represents the "Kingly Way" of medicine, diseases change, requiring formula adjustments. Rigid adherence leads to failure; slight deviations accelerate death. One must understand flexibility ("Quan").
Kong Ziyue warned: Plants and animals vary by region and season. Local substitutes often fail. Deceiving commoners is bad; deceiving rulers is a grave sin.
Chen Jiamo cited proverbs: Sellers of medicine have one eye, users two, patients none. Adulteration is rampant: fake dragon bone, musk mixed with lychee pits, horseradish instead of costus, donkey tendon as tiger bone. Such fraud harms patients and brings karmic retribution.
Tao Hongjing's biography recounts his disciple Huan telling him that using leeches and horseflies in his Materia Medica harmed life, delaying his ascension. Tao subsequently wrote a supplementary text using plant substitutes to atone.
Xu Yinzong argued: Pulse diagnosis is subtle and hard to verbalize. Ancient masters used single herbs for pure effect. Modern doctors use multiple herbs hoping for luck, diluting efficacy. He refused to write books because pulse wisdom cannot be transmitted via text.
The *Taiwei Xianjun Gongguo Ge* assigns merit/demerit for medical acts: saving lives earns merit; taking bribes nullifies it; harming others incurs heavy demerits. The *Great Ming Code* penalizes negligent or fraudulent medical practice severely, including execution for intentional harm.
The *Qiao Tan* concludes: Killing by sword carries the death penalty, but killing by medicine, military command, or tyranny often escapes legal justice, questioning the fairness of law.