凡欲为大医，必须谙《素问》、《甲乙》、《黄帝针经》、明堂流注、十二经脉、三部九候
、五脏六腑、表里孔穴、本草药对，张仲景、王叔和、阮河南、范东阳、张苗、靳邵等诸部
经方，又须妙解阴阳禄命，诸家相法，及灼龟五兆、《周易》六壬，并须精熟，如此乃得为
大医。若不尔者，如无目夜游，动致颠殒。次须熟读此方，寻思妙理，留意钻研，始可与言
于医道者矣。又须涉猎群书，何者？若不读五经，不知有仁义之道。不读三史，不知有古今
之事。不读诸子，睹事则不能默而识之。不读《内经》，则不知有慈悲喜舍之德。不读《庄》
《老》，不能任真体运，则吉凶拘忌，触涂而生。至于五行休王，七耀天文，并须探赜。若
能具而学之，则于医道无所滞碍，尽善尽美矣。
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，
穴流注有高下浅深之差，肌肤筋骨有浓薄刚柔之异，唯用心精微者，始可与言于兹矣。今
以至精至微之事，求之于至粗至浅之思，其不殆哉！若盈而益之，虚而损之，通而彻之，塞
而壅之，寒而冷之，热而温之，是重加其疾而望其生，吾见其死矣。故医方卜筮，艺能之难
精者也。既非神授，何以得其幽微。世有愚者，读方三年，便谓天下无病可治；及治病三年，
乃知天下无方可用。故学人必须博极医源，精勤不倦，不得道听途说，而言医道已了，深
自误哉。
凡大医治病，必当安神定志，无欲无求，先发大慈恻隐之心，誓愿普救含灵之苦。若有
疾厄来求救者，不得问其贵贱贫富，长幼妍媸，怨亲善友，华夷愚智，普同一等，皆如至亲
之想。亦不得瞻前顾后，自虑吉凶，护惜身命，见彼苦恼，若己有之，深心凄怆，勿避险 ，
昼夜寒暑，饥渴疲劳，一心赴救，无作功夫形迹之心。如此可为苍生大医。反此则是含灵巨
贼。自古名贤治病，多用生命以济危急，虽曰贱畜贵人，至于爱命，人畜一也。损彼益己，
物情同患，况于人乎？夫杀生求生，去生更远，吾今此方，所以不用生命为药者，良由此也。
其虻虫、水蛭之属，市有先死者，则市而用之，不在此例。只如鸡卵一物，以其混沌未分，
必有大段要急之处，不得已隐忍而用之，能不用者，斯为大哲亦所不及也。其有患疮痍下痢，
臭秽不可瞻视，人所恶见者，但发惭愧、凄怜、忧恤之意，不得起一念蒂芥之心，是吾之志
也。
夫大医之体，欲得澄神内视，望之俨然，宽裕汪汪，不皎不昧，省病诊疾，至意深心，
详察形候，纤毫勿失，处判针药，无得参差。虽曰病宜速救，要须临事不惑，唯当审谛覃思，
不得于性命之上，率尔自逞俊快，邀射名节，甚不仁矣。又到病家，纵绮罗满目，勿左右顾
眄，丝竹凑耳，无得似有所娱，珍馐迭荐，食如无味， 兼陈，看有若无。所以尔者，夫
一人向隅，满堂不乐，而况病患苦楚，不离斯须，而医者安然欢娱，傲然自得，兹乃人神之
所共耻，至人之所不为，斯盖医之本意也。
夫为医之法，不得多语调笑，谈谑喧哗，道说是非，议论人物，炫耀声名，訾毁诸医，
自矜己德。偶然治瘥一病，则昂头戴面，而有自许之貌，谓天下无双，此医人之膏肓也。老
君曰∶人行阳德，人自报之；人行阴德，鬼神报之。人行阳恶，人自报之；人行阴恶，鬼神
害之。寻此二途，阴阳报施岂诬也哉。所以医人不得恃己所长，专心经略财物，但作救苦之
心，于冥运道中，自感多福者耳。又不得以彼富贵，处以珍贵之药，令彼难求，自炫功能，
谅非忠恕之道。志存救济，故亦曲碎论之。学人不可耻言之鄙俚也。
凡是想要成为大医的人，必须精通《素问》、《甲乙经》、《黄帝针经》、明堂流注（经络穴位分布与气血运行规律）、十二经脉（人体十二条主要经络）、三部九候（古代诊脉方法，分上中下三部，每部各三候）、五脏六腑（心肝脾肺肾为五脏，胆胃大肠小肠膀胱三焦为六腑）、表里孔穴（体表与体内相通的穴位）、本草药对（中药配伍规律），还要通晓张仲景、王叔和、阮河南、范东阳、张苗、靳邵等人的各种经方（经典处方），此外还必须巧妙理解阴阳禄命（命运学说）、各家相法（面相占卜），以及灼龟占卜五兆、《周易》六壬（一种占卜术），都要精通熟练，这样才能称为大医。如果不这样，就像没有眼睛在夜间行走，动不动就会跌倒摔死。其次必须熟读这部书，探寻思考其中的妙理，留心钻研，才可以与他谈论医道了。又必须广泛涉猎各类书籍，为什么呢？如果不读五经（儒家五种经典），就不知道有仁义的道理。不读三史（三种历史著作），就不知道古今的事情。不读诸子百家著作，遇到事情就不能默默记住并理解。不读《内经》，就不知道有慈悲喜舍（佛教四无量心）的德行。不读《庄子》《老子》，就不能顺应自然真性，那么吉凶禁忌就会处处束缚自己，到处产生困扰。至于五行休王（五行生克旺衰理论）、七耀天文（日月五星等天体运行），都必须深入探究。如果能全面学习这些，那么在医道上就没有阻碍，达到尽善尽美的境界了。
张湛说：经方之所以难以精通，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，所以五脏六腑的充盈与亏虚，血脉营卫（营气与卫气）的通塞，本来就不是耳目所能察觉的，必须先通过诊候来审察它。而且寸口、关、尺（手腕桡动脉的三个诊脉部位）有浮、沉、弦、紧（四种脉象）的混乱，穴位流注有高下浅深的差异，肌肤筋骨有浓薄刚柔的不同，只有用心精细微妙的人，才可以与他谈论这方面的学问了。现在用极其精微的事情，去追求粗浅的思维，这难道不危险吗！如果实证反而补益它，虚证反而损耗它，通畅反而阻滞它，闭塞反而壅堵它，寒证反而用冷药治它，热证反而用温药治它，这是加重病情却希望他存活，我看他是必死无疑了。所以医方和卜筮，是技艺中难以精通的。既然不是神授，怎么能得到其中的幽深微妙之处。世上有愚笨的人，读方书三年，就说天下没有病可治；等到治病三年，才知道天下没有现成的方子可用。所以学医的人必须博览医源，精心勤奋不知疲倦，不能道听途说，就说医道已经明白了，这是深深误导自己啊。
凡是大医治病，必须安定心神意志，没有私欲和贪求，首先发广大慈悲怜悯之心，发誓愿普遍拯救众生的痛苦。如果有疾苦厄难来求救的人，不问其贵贱贫富、长幼美丑、怨亲善友、华夏夷狄、愚笨聪明，一律平等对待，都当作至亲一样的想法。也不得瞻前顾后，为自己考虑吉凶，爱惜自身性命，看到别人的苦恼，就像自己有的一样，内心 deeply 悲伤凄怆，不躲避险阻，不顾昼夜寒暑、饥渴疲劳，一心奔赴救治，不要做那种讲究功夫形式、拘泥礼节的心。像这样就可以成为苍生大医。相反这就是众生的巨贼。自古以来的名贤治病，多用活物（动物药材）来救济危急，虽然说是轻视牲畜重视人类，但在爱惜生命这一点上，人和畜是一样的。损害别人来利益自己，万物之情同样遭受祸患，何况是人呢？杀害生命来求得生存，离真正的“生”更远，我现在的这个方书，所以不用活体生命作为药材的原因，确实是因为这个。那些虻虫、水蛭之类的，市场上有先死掉的，就购买使用，不在此例。只像鸡卵这一种东西，因为它混沌未分（胚胎未成形），必定有非常紧急重要的地方，不得已隐忍而使用它，能不用活物的，这才是大哲人，也是我所不及的。那些患有疮疡溃烂、下痢，臭秽不可观看，人们厌恶见到的，只要发起惭愧、凄怜、忧恤的意思，不得起一丝芥蒂之心，这是我的志向。
大医的风度仪态，想要做到澄澈精神内视，望之庄严端正，宽宏大量，不显赫也不晦暗，诊病查疾，全心全意，详细观察形体征候，丝毫不错失，处方判断针灸药物，没有差错。虽然说病情适宜速救，但必须临事不迷惑，只是应当审慎谛听深思，不能在性命之上，轻率地自我炫耀敏捷快速，以博取名声节操，很不仁德啊。又到病人家，即使满眼绮罗锦绣，也不要左右顾盼，耳边丝竹音乐凑响，不要好像有所娱乐，珍馐美味交替进献，吃起来像没味道一样，各种陈设，看它们像没有一样。之所以这样，因为一个人面向墙角哭泣，满堂的人都不快乐，何况病患的痛苦，片刻不离，而医者安然欢娱，傲然自得，这是人和神所共同羞耻的，是至人所不做的事，这大概是医道的本意。
行医的法度，不得多说话调笑，谈谑喧哗，搬弄是非，议论人物，炫耀声名，诋毁其他医生，自夸自己的德行。偶然治好一个病，就昂头戴面（昂首挺胸），有自许的样子，认为天下无双，这是医生的膏肓（难以治愈的毛病）。老君说：人施行阳德（公开的善行），人自然会报答他；人施行阴德（隐藏的善行），鬼神会报答他。人施行阳恶（公开的恶行），人自然会报复他；人施行阴恶（隐藏的恶行），鬼神会害他。寻思这两条路，阴阳报应难道会是虚假的吗。所以医生不得倚仗自己的长处，专心谋求财物，只要存有救苦的心，在冥运道中，自然感应到多福罢了。又不得因为对方富贵，就开处珍贵的药物，让他难以求得，以此炫耀自己的能力，这恐怕不是忠恕之道。志在救济世人，所以也琐碎地论述这些。学医的人不要因为话说得鄙陋而感到羞耻。
Anyone who wishes to become a Great Physician must be proficient in the *Suwen* (Plain Questions), *Jiayi Jing* (Systematic Classic of Acupuncture and Moxibustion), *Huangdi Zhenjing* (Yellow Emperor's Classic of Acupuncture), Mingtang Liuzhu (Distribution of Meridians, Points, and Flowing Qi), Twelve Primary Meridians (Shi'er Jingmai), Sanbu Jiuhou (Three Regions and Nine Positions for Pulse Diagnosis), Zangfu Organs (Five Zang and Six Fu Organs), Biao-Li Acupoints (Exterior-Interior Connecting Points), Bencao Duizhi (Herbal Pairing Principles), as well as the various classic formulas (Jingfang) of Zhang Zhongjing, Wang Shuhe, Ruan Henan, Fan Dongyang, Zhang Miao, Jin Shao, and others. Furthermore, one must skillfully understand Yin-Yang and Destiny (Yin-Yang Luming), various physiognomy methods, tortoise shell divination (Zhuo Gui Wu Zhao), and Zhouyi Liren (Six Ren Divination based on I Ching). All these must be thoroughly mastered; only then can one be called a Great Physician. If not, it is like walking at night without eyes, inevitably leading to stumbling and death. Secondly, one must read this text diligently, ponder its profound principles, and study it with care before one can discuss the Way of Medicine with them. One must also have a broad reading of various books. Why? Because if one does not read the Five Classics (Wujing), one will not know the way of Benevolence and Righteousness. If one does not read the Three Histories (Sanshi), one will not know past and present events. If one does not read the works of the Hundred Schools of Thought, one cannot silently comprehend situations upon encountering them. If one does not read the *Neijing* (Inner Canon), one will not know the virtues of Compassion, Sympathy, Joy, and Equanimity (Cibei Xishe). If one does not read the *Zhuangzi* and *Laozi*, one cannot embody true nature and follow natural operation, resulting in being bound by auspicious and inauspicious taboos, creating obstacles everywhere. Regarding the theory of Wuxing Xiuwang (The Rise and Fall of the Five Elements) and Qiyao Tianwen (Astronomy of the Seven Luminaries), one must explore their depths. If one can learn all these comprehensively, there will be no hindrance in the Way of Medicine, achieving perfection.
Zhang Zhan said: The difficulty in mastering classic formulas has existed for a long time. Currently, diseases may have internal similarities but external differences, or internal differences but external similarities. Therefore, the fullness or emptiness of the Zang-Fu organs, and the obstruction or patency of Blood and Ying-Wei (Nutritive and Defensive Qi), are certainly not things that can be perceived by ears and eyes alone; one must first use pulse diagnosis and observation to examine them. Moreover, the pulses at Cun, Guan, and Chi (three positions on the radial artery) may show confusion with floating, sunken, string-taut, or tight qualities; acupoint flow and distribution vary in height, depth, and shallowness; skin, flesh, sinews, and bones differ in thickness, softness, hardness, and suppleness. Only those who are meticulous and subtle in their attention can discuss these matters. To seek the most subtle matters with the roughest and shallowest thinking—is this not dangerous! If one tonifies when there is excess, reduces when there is deficiency, obstructs when there is patency, blocks when there is congestion, cools when there is cold, and warms when there is heat, this is merely adding to the disease while hoping for survival; I see only death. Thus, medical prescriptions and divination are arts difficult to master perfectly. Since they are not divinely bestowed, how can one attain their profound subtlety? There are foolish people in the world who, after reading prescriptions for three years, claim there are no untreatable diseases; yet after treating patients for three years, they realize there are no ready-made formulas available for every case. Therefore, students must extensively explore the sources of medicine, practicing with precision and diligence without tiring, and must not rely on hearsay to claim mastery of the medical way, which would deeply mislead themselves.
Whenever a Great Physician treats illness, one must calm the spirit and stabilize the will, having no desires or demands. One must first generate a great heart of compassion and pity, vowing to universally save sentient beings from suffering. When those afflicted with disease or distress come seeking help, one must not inquire about their nobility or poverty, age, beauty or ugliness, enmity or kinship, friendship, ethnicity, or intelligence. Treat them all equally, regarding them as close relatives. Do not hesitate or look back, worrying about personal fortune or misfortune, nor protect your own life. Seeing another's suffering should feel as if it were your own, evoking deep sorrow and empathy. Do not avoid danger, ignore day and night, cold and heat, hunger and thirst, or fatigue; devote yourself entirely to rescue. Do not act with a mindset focused on formalities or appearances. Only in this way can one be a Great Physician for the common people. Acting contrary to this makes one a great thief of sentient lives. Since ancient times, famous sages often used living creatures to relieve emergencies. Although it is said that beasts are despised and humans valued, in terms of cherishing life, humans and animals are the same. Harming others to benefit oneself is a grievance shared by all things, let alone humans. Killing life to preserve life moves further away from true "life." This is precisely why my current formulary does not use living creatures as medicinal materials. For creatures such as horseflies and leeches, if dead ones are available in the market, they may be purchased and used; this is an exception. Take chicken eggs as an example: since they are undifferentiated chaos (embryonic stage), there are certain critical emergency situations where, out of necessity, one must reluctantly use them. However, if one can avoid using them, that person is a great sage, surpassing even me. For patients suffering from sores, ulcers, or dysentery, whose excretions are foul and repulsive, causing disgust in others, the physician should only feel shame, pity, and concern, harboring no grudge or aversion in their heart. This is my aspiration.
The demeanor of a Great Physician should be characterized by a clear spirit and inward contemplation, appearing solemn and dignified, broad-minded and magnanimous, neither glaring nor obscure. In examining diseases and diagnosing ailments, one must be fully attentive and deeply focused, carefully observing physical signs and symptoms without missing any detail. In prescribing acupuncture and medication, there must be no discrepancy. Although it is said that illnesses require swift rescue, one must remain unconfused in the face of events, exercising careful deliberation and deep thought. One must not, over matters of life and death, rashly display one's agility or speed to gain fame and moral credit; this is highly unbenevolent. Upon arriving at a patient's home, even if surrounded by silks and brocades, do not glance left or right. Even if music fills the ears, do not appear entertained. Even if delicacies are served repeatedly, eat as if tasteless; regard decorations as if nonexistent. Why? Because if one person turns to the corner weeping, the whole hall becomes unhappy; how much more so when a patient suffers continuously, yet the physician remains joyful and self-satisfied? This is a source of shame for both humans and spirits, and something perfected individuals do not do. This is likely the original intent of medicine.
The code of conduct for physicians prohibits excessive joking, loud chatting, gossiping, criticizing others, boasting of one's reputation, disparaging other doctors, or arrogantly praising one's own virtue. If one accidentally cures a single disease, one should not stand tall with a self-congratulatory air, claiming uniqueness in the world; this is the incurable malady of physicians. Laozi said: "When a person performs public virtue (Yang De), people naturally repay him; when a person performs hidden virtue (Yin De), gods and spirits repay him. When a person commits public evil, people naturally retaliate; when a person commits hidden evil, gods and spirits harm him." Considering these two paths, is the retribution of Yin and Yang false? Therefore, physicians must not rely on their skills to greedily accumulate wealth, but should solely maintain a heart to relieve suffering, thereby naturally attracting good fortune through unseen karmic laws. Nor should one prescribe expensive medicines for the wealthy simply because they can afford them, making them hard to obtain, just to demonstrate one's ability; this is hardly the way of loyalty and reciprocity (Zhongshu). With the aim of relieving and saving others, I have discussed these details trivially. Students should not feel ashamed if the language seems vulgar.