闻之医者意也。一病当前。先以意为运量。后乃经之以法。纬之以方。内经所谓微妙在意是也。医孰无
意。而浅深繇是。枘凿繇是。径庭繇是。而病机之安危倚伏。莫不繇是。意之凝释。
剖判荒茫。顾不危耶。大学诚意之功。在于格致。而其辨尤严于欺慊之两途。盖以杀机每随于阴幽。而生机
恒苞于粹白。庄周曰。天地之道。近在胸臆。万一肺腑能语。升坠可怜。先儒人鬼
关之辨精矣。昌谓医事中之欺慊。即众人之人鬼关也。奈何世之业医者。辄艳而称儒。儒之诵读无灵者。辄徙而
言医。究竟无主之衷。二三杂揉。医与儒之门两无当也。求其拔类者。长沙一
人而已。代有 人。然比之仙释。则寥寥易于指数。岂非以小道自隘。莫溯三氏渊源乎。夫人生驱光逐景。
偶影同游。欣慨交心。况于生死安危。忍怀侥幸。芸芸者物也。何以不格。昭昭者知也。何以不致。惟虚惟
无。萌于太素者意也。何以不诚。格一物即致一知。尚恐逐物求知。乃终日勘病。不知病为何物。而欲
望其意之随举随当也。不亦难乎。昌于此道无他长。但自少至老。耳目所及之病。无不静气微心。呼吸与会。
始化我身为病身。负影只立。而呻吟愁毒。恍忽而来。既化我心为病心。苟见其生。实欲其可。而头骨脑髓。
捐之不惜。傥病多委折。治少精详。早已内照。他病未痊。我身先瘁。渊明所谓斯情无假。以故
不能广及。然求诚一念。多于生死轮上寂寂披回。不知者谓昌从纸上得之。夫活法在人。岂纸上所能与耶。
譬之兵法军机。马上且不能得。况于纸上妄说孙吴。但令此心勤密在先。冥灵之下。神挺自颖。迩年先议病后
用药。如射者引弓。预定中的之高下。其后不失。亦自可观。何必剜肠涤肺。乃称奇特哉。不揣欲
遍历名封。大彰其志。不谓一身将老。世态日纷。三年之久。不鸣一邑。幸值谏议卣臣胡老先生建言归里。一切修举。
悉从朝廷起见。即昌之一得微长。并蒙格外引契。参定俚案之近理者。命名寓意草。捐赀付梓。其意欲使四方周览之士。
大破成局。同心愍痛。以登斯民于寿域。而为圣天子中兴燮理之一助云。然则小试寓意。岂易易能哉。
崇祯癸未岁季冬月西昌喻昌嘉言甫识
听说医生这个职业，关键在于“意”（医生的思维判断与直觉）。当疾病摆在面前时，首先要运用心意进行权衡考量，然后才以法度为经线、以方药为纬线来制定治疗方案。这正是《黄帝内经》中所说的“奥妙之处在于心意”的意思。
哪一位医生没有“意”呢？但病情的深浅、治疗的契合程度以及是否南辕北辙，都取决于此；而病机的安危转化，也无不取决于此。心意的凝聚或涣散，能否在迷茫混乱中做出清晰判断，难道不危险吗？
《大学》中关于“诚意”的功夫，在于“格物致知”，而其辨别尤为严格地区分了“欺”（自欺）与“慊”（满足/无愧）两条路径。因为杀机往往伴随阴暗幽深而生，而生机则蕴含于纯粹洁白之中。庄子说：“天地的道理，近在胸臆之间。”如果万一肺腑能说话，那升降沉浮的可怜景象便可见了。先儒对于人鬼界限的辨析已经非常精微了。我认为，医事中的“欺”与“慊”，就是众人面临的人鬼关卡。
为何当今从事医疗行业的人，往往羡慕并自称是儒者；而那些读书诵读却无灵性的儒者，又转而谈论医学？最终导致内心没有主宰，二三混杂揉合，医学与儒学的门径两者都不相符合。想要从中脱颖而出的人，只有长沙（指张仲景）一人罢了。历代虽有人才，但比起仙释之道，却寥寥无几，容易数清。这难道不是因为他们将自己局限于小道，无法追溯三教渊源吗？
人生匆匆，追逐光影，偶尔影子一同出游，欣喜与感慨交织于心，更何况面对生死安危，怎忍心存侥幸心理？芸芸众生皆为物，为何不能通过“格物”来探究真理？昭昭之知，为何不能达到“致知”的境界？唯有虚静无为，萌发于太素（宇宙本原）的“意”，为何不能做到“诚”？
格一物即获得一知，尚且担心是逐物求知，如今整天诊察疾病，却不知道疾病究竟是什么，却希望他们的心意能够举手投足间都恰当无误，这不也是很难的吗？
我在这道术上并无其他长处，只是从年少到年老，对于耳闻目睹的疾病，无不静下心来，微敛心神，呼吸与之相应。起初将我的身体化为病人的身体，背负着影子独自站立，感受其呻吟愁苦和毒痛，恍惚间仿佛亲历；接着将我的心化为病人之心，只要见到他生存的希望，就真心希望他能好起来，甚至不惜捐献自己的头骨脑髓。倘若病情多曲折，治疗少精细详实，早已自我反省：其他病未痊愈，我的身心先已憔悴。正如陶渊明所说，这种情感没有虚假。因此，虽然未能广泛惠及众人，但我对“诚”的追求，多于在生死轮回中寂静徘徊。
不知的人以为我是从纸上得来的。然而活法的运用在人，岂是纸上所能给予的呢？这就好比兵法军机，在马背上尚且不能完全得到，何况在纸上妄谈孙武吴起呢？只要让这颗心在事前勤勉周密，在冥灵深处，神气自然挺拔颖悟。近年来，我主张先议病后用药，就像射手拉开弓，预先确定目标的高低远近，之后就不会失手，这也算是可观的成绩了。何必非要挖肠涤肺那样奇特，才能被称为高超呢？
我不揣冒昧，想要遍游各地名邦，大大彰显我的志向。没想到一身将老，世态日益纷乱。三年之久，在一个县邑未曾发声。幸好遇到谏议大夫卣臣胡老先生建言归乡，一切修缮举荐，都从朝廷的大局出发。就连我的一点微小特长，也蒙受格外引荐契合，参与审定那些接近事理的通俗医案，命名为《寓意草》，捐资刻印出版。其用意是想让四方周览的士人，大大打破成见格局，同心怜悯病痛，从而让百姓登上长寿之境，作为圣明天子中兴治理的一丝助力。
那么，小试牛刀运用“寓意”，难道是轻易就能做到的吗？
崇祯癸未年冬季十二月，西昌喻昌嘉言甫识。
It is heard that the essence of medicine lies in "Yi" (the physician's mental judgment and intuition). When a disease presents itself, one must first employ the mind to weigh and consider it, and only then establish the treatment plan by using principles as the warp and prescriptions as the weft. This corresponds to what the *Neijing* (Classic of Internal Medicine) states: "The subtlety lies in the mind."
Does any physician lack "Yi"? Yet, the depth or superficiality of the condition, the fit or mismatch of the treatment, and the divergence from the correct path all stem from this; likewise, the stability or danger of the disease mechanism, and its potential for transformation, all depend on this. Whether the mind is focused or scattered, and whether it can make clear judgments amidst confusion, is indeed perilous.
The effort of "Cheng Yi" (Sincerity of Will) in the *Daxue* (Great Learning) lies in "Ge Wu Zhi Zhi" (Investigating Things to Extend Knowledge), and its discrimination is particularly strict regarding the two paths of "Qi" (Self-deception) and "Qie" (Contentment/Integrity). For the mechanism of death often accompanies darkness and obscurity, while the mechanism of life is always contained within purity and whiteness. Zhuangzi said, "The way of heaven and earth is close within the chest and heart." If the internal organs could speak, the pitiable state of their rising and falling would be evident. The ancient Confucians' distinction between the realms of humans and ghosts was exquisite. I hold that the "Qi" and "Qie" in medical practice constitute the human-ghost boundary for ordinary people.
Why do those engaged in medicine today often envy and call themselves Confucians? And why do Confucians whose reading lacks efficacy turn to discuss medicine? Ultimately, lacking a central master, these elements are mixed haphazardly, resulting in neither medicine nor Confucianism being properly aligned. Those who stand out among them are few; there is only Changsha (referring to Zhang Zhongjing). Although talents appear in every generation, compared to Daoist immortals or Buddhist sages, they are so few they can be counted on fingers. Is this not because they limit themselves to minor arts and fail to trace the origins of the Three Teachings?
Human life chases light and shadows, occasionally accompanied by one's own shadow, with joy and sorrow intertwining in the heart. How much more so when facing life and death, safety and danger, should one dare to harbor侥幸心理 (fluke mentality)? All living beings are things; why cannot they undergo "Ge Wu" (investigation of things)? Clear knowledge; why cannot it reach "Zhi Zhi" (extension of knowledge)? Only through emptiness and non-being does "Yi" (intention/mind) sprout from Tai Su (the primordial substance). Why cannot it achieve "Cheng" (sincerity)? Investigating one thing yields one piece of knowledge; yet one still fears chasing objects to seek knowledge. Now, spending all day diagnosing diseases without knowing what a disease actually is, yet expecting the mind to be appropriate in every action—is this not difficult?
I have no other strengths in this path. From youth to old age, for every illness witnessed by my eyes and ears, I have calmed my breath and quieted my mind, harmonizing my breathing with the patient. First, I transform my body into the patient's body, standing alone with my shadow, feeling their groans, sorrow, and toxicity, as if hallucinating their presence. Then, I transform my heart into the patient's heart; seeing their desire to live, I truly wish for their recovery, even sparing no sacrifice of my own head, bone, brain, or marrow. If the illness is complex and the treatment lacks precision and detail, I reflect inwardly: before other illnesses are cured, my own body and mind become exhausted. As Tao Yuanming said, such feelings are never false. Therefore, although I could not extend my help widely, my single-minded pursuit of "Cheng" involved silent wandering upon the wheel of life and death.
Those who do not understand believe I derived this from books. However, flexible application resides in the person, how could it be provided merely by paper? It is like military strategy and tactics; even on horseback, they cannot be fully grasped, let alone discussing Sun Wu and Wu Qi recklessly on paper. As long as this mind is diligent and meticulous beforehand, beneath the mysterious spirit, divine clarity naturally emerges. In recent years, I have advocated discussing the disease before prescribing medication, like an archer drawing the bow, pre-determining the height and distance to hit the target, thereby ensuring no miss. This is already commendable. Why must one perform extreme acts like digging out intestines and washing lungs to be called extraordinary?
Presuming to travel extensively through famous regions to greatly manifest my aspirations, I did not expect to grow old while worldly affairs became increasingly chaotic. For three years, I remained silent in one county. Fortunately, Censor Youchen Hu Laoshi proposed returning home, and all restorations were initiated from the court's perspective. Even my slight expertise received exceptional recognition and connection. I participated in reviewing and determining popular medical cases that approached reason, naming them *Yuyi Cao* (Grass of Implied Meaning), and donated funds for their publication. The intent is to enable scholars everywhere to break through established patterns, share compassion for pain, and bring the people into the realm of longevity, serving as a small assistance to the Holy Son of Heaven's restoration and governance.
Thus, is it easy to apply "Yuyi" (implied meaning) on a small scale?
Recorded by Yu Chang, courtesy name Jiayan, from Xichang, in the winter month of Guiwei year of the Chongzhen era.