柴胡、黄芩之类似也，至其热之为外感乎？为内伤乎？为阴虚乎？为中寒乎？不问也，但曰此退热对证之药也。
如头痛，则用川芎、 本之类似也，至其痛之为风寒乎？为血虚乎？为虚阳贯顶乎？阴证头痛如破乎？不问也，
但曰此止痛对证之药也。如腹胀，则用枳壳、浓朴之类似也，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，但曰此宽胀对证之药也。又如口渴，则用麦冬、花粉之类似也，至其渴之为实热乎？为
虚炎乎？为阳邪入胃乎？阴邪入肾乎？抑气虚无津，肾虚水不上升乎？不问也，但曰此治渴对证之药也。如此
之类，不胜枚举。岂知古人用药中多变化，有似乎不对证而实对证者，不仅在形似之间也。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，阴药治阴，
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。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，病患遂深信其是，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，易于盗名。讵知其药与病全无涉者，此一
似也；药与病正相反者，此一似也；药不能去病，而反增病者，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！此药似对证之病，所宜急医者也。○一医医曲顺人情之病。医有为病患所喜近，
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。病患何尝知医？遇病辄疑是风、是火；
病患安知药性，对医自谓宜散、宜清。医人欲得病患之欢心，不必果是，而亦以为是；未必相宜，而亦以为宜。
其曲顺病患之情有然也。或旁有亲友探问者，每每自负知医，往往欲出己见，而医人遂极口赞其高明，未举方
先谦恭请教，既举方又根据命增删，其
曲顺旁人之情有然也。近医以随波逐浪为良法，以同流合污为趋时。不求病家有实效，只愿众医无闲言。其曲
顺医人之情又有然也。夫其所以曲顺病患之情、旁人之情、医人之情者，何也？盖医人意欲取资于病患，苟拂
其情，则病患必谓是坚持独见，不通商量，由是推而远之矣；医人欲藉吹嘘于旁人，苟拂其情，则旁人皆议为
偏执骄傲，不肯虚心，不复为之荐举矣；医人更欲互相标榜，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。然吾为医者计，果能学识高，道理明，认证真，用药当，实
能起沉 ，救危命，何妨特立独行？每制一方，用一药，如山岳之不可动摇，根据用则生，不根据用则死，在病患
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，又何必委曲周旋，以图主顾，希荐举、
避谗谤哉？无如医人未必能具卓然之见，又恐获罪于人，夫利于己，所以随风倒舵，阿谀顺从，徒效外家妇之道。
此曲顺人情之病，所宜急医者也。（《医验录》）
为医固难，而为名医尤难。何则？名医者，声价高，敦请不易。即使有力可延，又恐往而不遇，即或可遇，
其居必非近地，不能旦夕可至。故凡轻小之疾，不即延治，必病势危笃，迁延日久，屡易医家，广试药石，一
误再误，已成坏证，然后求之。彼名医者，岂真有起死回生之术哉？病家不明此理，以为如此大名，必有回
天之力，若如他医之束手，亦何以异于人哉？于是望之愈切，而责之愈重。若其病断然必死，则明示以不治之
故，定之死期，飘然而去，犹可免责。倘万死之中，犹有生机一线，若用轻剂以冀图塞责，则于心不安；若用
重剂以背城一战，万一有变，则谤议蜂起，前医误之咎，尽归于己。虽当定方之时，未尝不明白言之，然人情
总以成败为是非，既含我药而死，其咎不容诿矣！又或大病瘥后，元气已虚，余邪尚伏，善后之图，尤宜深讲。
病家不知失于调理，愈后复发，仍有归罪于医之善未者，此类甚多。故名医之治病，较之常医倍难。知其难，
固宜慎之又慎，而病家及旁
人，亦宜曲谅也。然世又有获虚名之时医，到处误人，而病家反云∶此人治之不愈，是亦命也。有人杀之实，
无杀人之名。此必其人别有巧术以致之，不在常情之内矣。（徐灵胎）
尝见一医，方开小草，市人不知为远志之苗，而用甘草之细小者。又有一医，方开蜀漆，市人不知为常山
之苗，而令加干漆者。凡此之类，如写玉竹为葳蕤，乳香为薰陆，天麻为独摇草，人乳为蟠桃酒，鸽粪为左蟠
龙，灶心土为伏龙肝者，不胜枚举。但方书原有古名，而取用宜乎通俗，若图立异矜奇，致人眼生不解，危急
之际，难保无误。又有医人工于草书者，医案人或不识，所系尚无轻重；至于药名，则药铺中人，岂能尽识草
书乎？孟浪者约略撮之而贻误，小心者往返询问而羁延。可否相约同人，凡书方案，字期清爽，药期共晓。
（《吴医汇讲》）
柴胡与黄芩的功效看似相似，至于发热是源于外感、内伤、阴虚还是中寒，医生并不探究，只是说这是退热的对症药物。
就像头痛，就使用川芎、藁本等看似相似的药材，至于疼痛是由风寒、血虚、虚阳上冲，还是阴证头痛如破所致，医生并不探究，只是说这是止痛的对症药物。
比如腹胀，就使用枳壳、厚朴等看似相似的药材，至于胀满是由食积停滞、脾虚、寒凝气结，还是阴水导致鼓胀，医生并不探究，只是说这是消除胀满的对症药物。
又如口渴，就使用麦冬、天花粉等看似相似的药材，至于口渴是由实热、虚火、阳邪入胃、阴邪入肾，还是气虚无津液、肾虚水不上升所致，医生并不探究，只是说这是治疗口渴的对症药物。
像这样的例子，不胜枚举。哪里知道古人用药多有变化，有的看起来不对症但实际上是对症的，不仅仅在于表面的相似。有的采取上病下取、下病上取的方法，如果用上药治上病、下药治下病，那就似是而非了。有的采取从阳治阴、从阴治阳的方法，如果用阳药治阳证、阴药治阴证，那就又是似是而非了。有的采取通因通用、塞因塞用的方法，如果用通利药治疗闭塞、固涩药治疗通泄，那就更是似是而非了。无奈从事医疗行业的人，不探求真理，只追求表面相似，因为真理人们不了解，表面相似人们容易明白。所以一旦得到这种表面相似，医生就自认为高明，病人就深信不疑，旁人无法看出错误，其他医生也无法指出失误。这个“似”字，容易欺骗人，容易迷惑世人，容易迎合世俗，容易窃取名声。哪里知道药与病完全无关的，这是一种“似”；药与病正相反的，这也是一种“似”；药不能去除疾病，反而增加病情的，这也是一种“似”；药本来期望救命，却恰好送命的，这也是一种“似”。“似”带来的危害，能说尽吗？这是关于药物看似对症的疾病，急需医治的情况。
有一位医生，为了曲意顺从人情而治病。有医生因为被病患喜欢亲近，被旁人称赞赞扬，被众医家热情接待，但这实际上是行医的大害，就是曲意顺从人情。病患哪里懂得医学？遇到病就怀疑是风邪、是火邪；病患怎么知道药性，面对医生自称应该发散、应该清热。医生想要获得病患的欢心，即使确实不是（对症），也认为是；未必相宜，也认为相宜。这就是曲意顺从病患情意的表现。或者有旁人来亲友探望询问病情时，往往自负懂医，经常想发表自己的见解，于是医生就极力称赞其高明，在开方之前谦虚请教，开方之后又根据他们的命令增减，这就是曲意顺从旁人情意的表现。近来的医生把随波逐流当作良法，把同流合污当作趋时。不求病患家有实际疗效，只希望众医没有闲言碎语。这就是曲意顺从医生群体情意的表现。他之所以曲意顺从病患的情意、旁人的情意、医生的情意，为什么呢？大概是因为医生意图从病患那里获取资财，如果违背他们的心意，那么病患一定会认为这是坚持己见，不通情理商量，从而排斥疏远他；医生想要借助旁人的吹嘘来抬高自己，如果违背他们的心意，那么旁人都议论他是偏执骄傲，不肯虚心，不再为他推荐举荐了；医生更想要互相标榜，如果违背他们的心意，那么大家都厌恶他攻击别人的短处、宣扬自己的长处，谗言散布，那么名声减损，财利也就失去了。这就是不得不曲意顺从人情的原因。然而我作为医者考虑，如果真的学识高深，道理明了，辨证准确，用药得当，确实能起死回生，挽救危重生命，何必特立独行？每制定一方，使用一味药，如山岳般不可动摇，按照用法用则生，不按用法用则死，在病患方面称感激不尽，旁人自然叹服来不及，医生即使心怀嫉妒，也无从施展挑拨离间之言，又何必委曲求全周旋，以图保住主顾，希求推荐、避免谗谤呢？无奈医生未必具备卓越的见解，又恐怕得罪于人，为了自身利益，所以随风倒舵，阿谀顺从，徒然效仿市井妇人的手段。这是曲意顺从人情的弊病，也是急需医治的情况。（出自《医验录》）
做医生固然难，但做名医尤其难。为什么呢？所谓名医，声望价格高，聘请不容易。即使有能力延请，又担心去了却遇不到（病人或时机），或者虽然能遇到，但住所一定不在近地，不能早晚到达。所以凡是轻小的疾病，不立即延请治疗，一定要等到病势危重笃急，拖延日久，多次更换医生，广泛尝试药物，一误再误，已经形成坏证，然后才去求教。那些名医，难道真有起死回生的法术吗？病患家庭不明白这个道理，认为如此大名，必有回天之力，如果像其他医生那样束手无策，那和别人有什么区别呢？于是期望越迫切，责备就越重。如果这病断然必死，就明确告知不治的原因，定下死亡日期，飘然而去，还可以免除责任。如果在万死之中，还有一丝生机，如果用轻剂以求搪塞责任，心里不安；如果用重剂背城一战，万一有变故，那么诽谤议论蜂拥而起，前医误诊的罪责，全部归咎于自己。虽然在确定处方的时候，未曾不明白地说出来，然而人情总是以成败论是非，既然吃了我的药而死，罪责就不容推卸了！又或者大病痊愈后，元气已虚，余邪尚伏，善后调理的计划，尤其应该深入讲究。病患家庭不知道失于调理，愈后复发，仍有归罪于医生善后不好的，这类情况很多。所以名医治病，比常医加倍困难。知道困难，固然应该谨慎又谨慎，而病患及旁人，也应该体谅宽容。然而世上又有获得虚名的时俗医生，到处误人，而病患反而说：这个人治不好，这也是命啊。有人杀人的事实，却没有杀人的名声。这一定是那人另有巧妙的手段导致这样，不在常理之内了。（徐灵胎）
曾经见到一位医生，处方写“小草”，市井药商不知道这是远志的幼苗，而用了甘草的细小部分。又有一位医生，处方写“蜀漆”，市井药商不知道这是常山的幼苗，而让他加入干漆。凡此之类，比如写玉竹为葳蕤，乳香为薰陆，天麻为独摇草，人乳为蟠桃酒，鸽粪为左盘龙，灶心土为伏龙肝的，不胜枚举。但是方书原有古名，而取用应当通俗，如果图立异矜奇，导致别人眼生不解，在危急之际，难以保证不出错。又有医生擅长草书的，医案别人或许不认识，所关系的事情还没有轻重之分；至于药名，那么药铺中人，怎么能都认识草书呢？粗鲁大意的人大概撮合一下而造成延误，小心谨慎的人往返询问而耽误时间。是否可以相约同行，凡是书写方案，字迹期望清爽，药名期望共同知晓。（《吴医汇讲》）
Chai Hu (Bupleuri Radix) and Huang Qin (Scutellariae Radix) appear similar in efficacy. Whether the fever stems from external contraction, internal injury, yin deficiency, or middle cold is not investigated; it is merely stated that these are symptomatic antipyretic herbs.
Just as for headache, Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Ben Cao (Ligustici Sinensis Rhizoma) are used due to their apparent similarity. Whether the pain is caused by wind-cold, blood deficiency, floating yang ascending to the top, or severe headache of yin syndrome is not investigated; it is merely stated that these are symptomatic analgesic herbs.
For example, for abdominal distension, Zhi Ke (Aurantii Fructus) and Hou Po (Magnoliae Officinalis Cortex) are used due to their apparent similarity. Whether the distension is due to food stagnation, spleen deficiency, cold coagulation with qi binding, or drum-like distension due to yin water accumulation is not investigated; it is merely stated that these are symptomatic distension-relieving herbs.
Similarly, for thirst, Mai Dong (Ophiopogonis Radix) and Hua Fen (Trichosanthis Radix) are used due to their apparent similarity. Whether the thirst is caused by excess heat, deficient fire, yang pathogen entering the stomach, yin pathogen entering the kidney, or qi deficiency with lack of fluids, kidney deficiency with failure of water to ascend, is not investigated; it is merely stated that these are symptomatic thirst-treating herbs.
Such examples are too numerous to enumerate. How can one know that ancient physicians employed varied methods in prescribing? There are cases where a prescription appears mismatched but is actually appropriate, going beyond mere superficial resemblance. For instance, treating upper diseases by targeting the lower, or lower diseases by targeting the upper: if one uses upper-body herbs for upper diseases and lower-body herbs for lower diseases, it is merely superficially correct but fundamentally flawed. There are cases of treating yin through yang, or yang through yin: if one uses yang-tonifying herbs for yang syndromes and yin-nourishing herbs for yin syndromes, it is again superficially correct but fundamentally flawed. There are cases of "treating obstruction with unblocking agents" (Tong Yin Yong Tong) and "treating retention with astringent agents" (Sai Yin Sai Yong): if one uses purgatives for constipation and astringents for diarrhea, it is even more superficially correct but fundamentally flawed. Regrettably, many practitioners do not seek the truth but only pursue superficial similarity, because the truth is unknown to people, while superficiality is easily understood. Thus, once they achieve this superficial correctness, doctors pride themselves on their acumen, patients believe firmly in their efficacy, bystanders cannot see the error, and other physicians cannot point out the mistake. This concept of "similarity" deceases easily, confuses the world, caters to vulgarity, and steals reputation. Who would realize that when herbs have no relation to the disease, this is a form of "similarity"; when herbs are contrary to the disease, this is another form; when herbs fail to cure the disease but exacerbate it, this is yet another form; when herbs intended to save life instead hasten death, this is also a form. The harm caused by such "similarity" is incalculable! This situation regarding drugs appearing to match symptoms requires urgent medical attention.
One physician treated diseases by curving to accommodate human sentiments. A physician may be favored by patients, praised by bystanders, and warmly received by fellow doctors, yet this is actually a major malpractice in medicine: accommodating human sentiments. Patients hardly understand medicine; upon falling ill, they suspect wind or fire. How should patients know drug properties? They tell the doctor that dispersing or clearing methods are suitable. To win the patient's favor, the doctor accepts what is not necessarily correct as correct, and what is not necessarily suitable as suitable. This is accommodating the patient's sentiment. When relatives or friends visit to inquire about the condition, they often boast of their medical knowledge and offer opinions. The doctor then praises their brilliance excessively, humbly consulting before prescribing, and modifying the prescription according to their commands after prescribing. This is accommodating the bystander's sentiment. Recent physicians regard drifting with the tide as a good method and conforming to corruption as being timely. They do not seek actual effectiveness for the patient's family but only wish to avoid criticism from other doctors. This is accommodating the professional community's sentiment. Why do they accommodate the sentiments of patients, bystanders, and colleagues? Essentially, the doctor seeks financial gain from the patient. If they offend the patient's sentiment, the patient will claim the doctor is stubborn and inflexible, leading to alienation. The doctor relies on bystanders' recommendations for promotion. If they offend bystanders, they will be labeled as biased and arrogant, refusing to recommend them. Doctors also seek mutual endorsement. If they offend peers, they will be hated for exposing others' faults and highlighting their own strengths, leading to slander, loss of reputation, and loss of profit. Hence, they must accommodate human sentiments. However, I advise practitioners: if your knowledge is profound, principles clear, diagnosis accurate, and prescriptions appropriate, truly capable of reviving the dying and saving critical lives, why not stand firm? Each prescription and herb should be unwavering like a mountain. Follow the usage for life, deviate for death. Patients will express endless gratitude, bystanders will sigh in admiration, and even jealous colleagues will find no grounds for slander. Why compromise and maneuver to secure clients, seek recommendations, and avoid slander? Unfortunately, many doctors lack卓越 insights and fear offending others. Seeking self-interest, they drift with the wind, flatter, and comply, merely imitating the ways of worldly women. This pathology of accommodating human sentiments requires urgent correction. (From *Yi Yan Lu*)
Being a physician is difficult, but being a famous physician is even harder. Why? Famous physicians command high reputations and fees, making them hard to engage. Even if one has the means to hire them, there is a risk of missing the opportunity or finding them residing far away, inaccessible day or night. Therefore, minor illnesses are neglected initially. Only when the disease becomes critical, prolonged, and after multiple failed treatments by various doctors, resulting in irreversible damage, do patients seek out famous physicians. Do these famous physicians truly possess the art of bringing the dead back to life? Families ignorant of this logic assume that such great fame implies miraculous powers. If they were helpless like ordinary doctors, how would they differ from anyone else? Consequently, expectations rise, and demands become heavier. If the disease is inevitably fatal, the physician clearly states the reasons for incurability and predicts the time of death, leaving quietly to avoid blame. If there is a sliver of hope amidst certain death, using mild remedies to shirk responsibility causes inner unease; using heavy remedies for a last-ditch battle risks adverse reactions, triggering waves of criticism where all blame for previous errors falls on the current physician. Although the physician explains this clearly when prescribing, public opinion judges right and wrong by success or failure. Having died after taking the prescribed medicine, the blame cannot be shifted! Furthermore, after recovery from severe illness, vital energy is depleted, and residual pathogens remain hidden. Post-recovery care requires deep study. Families unaware of proper recuperation may suffer relapse, still blaming the doctor for inadequate follow-up. Such cases are numerous. Thus, famous physicians face twice the difficulty of ordinary ones. Knowing this difficulty, one must be extremely cautious. Patients and bystanders should also show understanding. However, there are also contemporary physicians who gain empty reputations and err everywhere, yet patients say, "This person could not cure me; it is fate." There is the reality of causing harm without the reputation of killing. This implies some hidden, cunning methods at play, outside normal circumstances. (Xu Lingtai)
I have seen a physician prescribe "Xiao Cao" (Herba Polygalae), which pharmacists did not recognize as the seedling of Yuan Zhi (Polygalae Radix), but rather used the small part of Gan Cao (Glycyrrhizae Radix). Another physician prescribed "Shu Qi" (Ramulus Daphnes Genkwa), which pharmacists did not recognize as the seedling of Chang Shan (Daphnes Genkwa Cortex), but added Gan Qi (Dry Lacquer). Examples include writing Yu Zhu (Polygonati Odorati Rhizoma) as Wei Rui, Ru Xiang (Olibanum) as Xun Lu, Tian Ma (Gastrodiae Rhizoma) as Du Yao Cao, Human Milk as Pan Tao Jiu, Pigeon Droppings as Zuo Pan Long, and Zao Xin Tu (Caulis Argillae Rubra) as Fu Long Gan. These are too numerous to list. Although classical texts use ancient names, practical usage should be common. If one seeks novelty and eccentricity, causing confusion among others, errors are inevitable in emergencies. Additionally, some physicians excel in cursive script. While illegible case notes may not cause serious issues, illegible herb names pose problems. Pharmacists cannot all read cursive script. Rash individuals may approximate the names and cause delays; careful individuals may ask repeatedly, causing further postponement. Is it possible to agree among colleagues that prescriptions should be written clearly, and herb names universally understood? (From *Wu Yi Hui Jiang*)