陈两家《易简方》四卷于苏州。其凡例首条云∶近来无论内外科，一病就诊，先求多衍时日，不肯使人速愈。在
有力者虽不惜费，不知病久体乏，受害端由于此；至于贫病，既不能一概送诊，务使早日痊愈，方可自食其力，
若亦久延，必至无力调治，奄息待毙，甚且因病废业，举室饥寒，忍乎不忍？愿行道者心存利济，力返积习，定获善报。
吕君慎庵所辑拙案《三编》，卷二第六页屠小苏令正案后附顾氏子证，蒙乌程汪谢城孝廉评云∶“覆杯即已”
下宜删去，以言过当也。若然则藜藿人温证、暑证，亦可用辛温矣。此评甚是，余极佩服。第杭城之饮食起居甲
于天下，虽苏、扬不及也，而席丰履浓人家之小儿，往往爱惜过分，因娇养而生饱暖之疾，亦甚于他处。非深历
其境者，不能悉知。余发此论，亦有为而言也。故下文特着“栉风沐雨”四字，如果“栉风沐雨”之人，虽感温
暑，似非一味清凉可治，当稍佐以辛散，始合机宜。又结以量体裁衣，勿胶瑟柱，正虑印定眼目，不敢说然也。
第二十二页所用之交泰丸，系黄连、桂心二物。吕君未注，亦附及之。
曩武进董兰痴鹾尹、贡海门茂才、四明项君新桥，咸谓余为袁简斋先生后身，余闻之愧不敢当。以袁公之聪
明孝友、政事文章，焉能望其万一，不过性情通脱有相类耳。定州杨素园明府云∶袁乃旷代之名医也。君之治胡
季槎茂材发背案，所引之语已括尽内外诸病治法，无余蕴矣，而千古无人会意。惟尊案不论用补、用清，悉以运
枢机、通经络为妙用。兰痴诸君之说，殆以此也。余谓此愚者之一得，偶合袁公之见耳。至其集中论议，无非入
理深谈。愚每因彼而悟此，事实有之。缘人身气贵流行，百病皆由愆滞，苟不知此，虽药已对证，往往格不相入，
岂但不足以愈病已耶？故录存拙案，不厌烦琐，谆谆以此告人。设知此义，则平易之药，轻淡之方，每可以愈重
证，纵必死之病，或可借以暂缓须臾。乃昧者谓余妙术仁声，播于迩遐，而病情千态万状，多人苦思力索所不能
中者，君辄以平淡常用之品而得之，毋乃医运之亨乎？余但笑而不答。然清夜扪心，惭无实学，而虚名幸获，隐匿殊多。
遂伏处穷乡，欲期寡过。惟痴肠未冷，饶舌何辞。嘻，定有慧心人会吾意也。
余亲家戴雪宾茂才之先德干斋先生，精于医，行道四十年。尝云医学一门，显则譬之有形之棋，应变无方，
能者多而精者少；隐则譬之无形之道，神明莫测，行之易而知之难。可谓说尽此中微妙矣。故先生年逾花甲，即
誓不临证，而乐善好施，虽家无储蓄，亦不倦也。寿至七十九而终。
山阴俞君仲华，下方桥陈念义之高弟也。人极豪爽，有侠气，饮酒谈兵，轻财好客，兼佞佛。久寓省垣，与
余交最深。惟谈医不合，闻余论景岳，辄怒形于色。余谅其信师过笃，不与较也。然遇时感重证，必嘱病家延余
主治。而其二子皆误于温补，虽余与故孝子张君养之极口苦谏，奈乔梓皆不悟，和而不同如此也。俞尝撰《结水
浒演义》一书，又名《荡寇志》，尊朝廷以诛盗贼，命意极正，惜笔力远逊耐庵；且误以扶阳抑阴之旨寓意于医，
适形偏谬。杨大令素园尝着论非之。夫以仲华之才之学谈医，而犹走入魔道，医岂易言哉！故录之，愿后人勿轻
言医。
扶阳抑阴，大《易》以喻君子小人，章虚谷谓但可以论治世，不可以论治病，韪矣。愚谓未尝不可以论治病，
特扶阳抑阴不可专藉热药耳。何也？人身元气犹阳也，外来邪气犹阴也。故热伤胃液，仲圣谓之无阳。医者欲扶
其阳，须充其液，欲抑其阴，须撤其热。虽急下曰存阴，而急下者下邪也，下邪即是抑阴，存阴者存正也，存正即是扶
阳。苟知此义，则易道医理原一贯也。赵养葵未明此义，仅知温补为扶阳之药，而不知阴阳乃邪正之喻，故其法但可以
治寒邪为病，阴盛格阳之证也。而乃书名《医贯》，以致后人惑之，误尽苍生，宜乎洄溪之力加呵斥也。
仁和许周生驾部云∶吴台卿笃信乩言，长斋礼拜，忘其体之羸，又受道士戒，百日不语，方夏暑火郁肺，遂
病血而死。因谓乩之术，始犹一二好事者信之，继则朴实之士信焉，继则聪明之士亦信焉。祸福以乩为筮，学问
以乩为师，疾病以乩为医。背阳而入阴，舍昭昭而即冥冥，其幽阴沉墨，足以消去人之精爽也。愚谓更有因此而
遭横祸者，历历可稽焉。大抵惑于此者，总由义利不明，心有妄冀。近日乩坛愈广，乩术愈新，竟有不堪缕述者，
尤可叹也。
《艮斋杂说》∶惩忿则火不上升，窒欲则水不下泄，水火既济，鼎道成矣。君子读损之象，得养生焉。
疫疠伤人，莫过于《谈往》所云之崇正十六年。有疙瘩瘟、羊毛瘟等名，呼病即亡，不留片刻。八、九两月，
疫死数百万。十月间有闽人晓解病由，看膝湾后有筋突起，紫者无救，红则速刺出血可活。至霜雪渐降，势亦渐
杀。愚谓此疫虽奇，杀人既速且多，然无非暑热毒瓦斯深入营分耳。故轻者刺之可活，而霜雪降病自衰也。考嘉兴
王肱《枕蚓庵琐语》及桐乡陈松涛《灾荒记事》，皆云崇正十四年大旱，十五、十六经年亢旱，通国奇荒，疫疠
大作。合三书而观之，则其为暑燥热毒之气可知。呼病即亡者，邪气直入于脏也。彼时设有余师愚其人者，或可
救全一二也。
童 庐云∶镇海钟景龙先生，精于痧痘，经其治者，百不失一，逆证决期，从无爽日。所用之药，初服大黄
者十居其五，后用补剂者十之七；至于攻发，惟僵蚕而已，全蝎、穿山甲、桑虫之类，从未一施；独地龙遇血热
毒盛，百余条不嫌多。尝曰∶小儿血气未充，脏腑娇嫩，痘疮不能起发，良由元虚不能足浆，浆不足则毒不泄，
若再以毒攻毒，不但毒不肯出，而正气更受其害，未有正虚而毒能化者也。语简理微，真济世之格言。愚谓亦有
因热极而浆不起者，以正气为壮火所食也。宜泻火，忌补托。至痘后生毒，多由妄投毒药，误用温补所致。
杨素园大尹云∶余见阜平赵功甫处方极轻。尝曰∶小儿之腹几何，须令其胃气足以运化药力，始能有效。亦
至理也。愚谓赵先生虽论小儿，即大人之病，亦须量其胃气而后权方剂。凡脆薄之人，竟与小儿同视可也。近世
惟休宁汪广期，治小儿专用轻剂。
吾乡管君荣棠，少服贾，天资颖异，自知体弱，恐不永年，乃潜心于疡科者十余年，遂精其术。性慷慨，施
药济人，能起危证。与余为莫逆交。丙辰季冬，忽患吐血而亡，年仅四十四，子才五龄耳。乡人咸惋惜之。余挽
以一联云∶“频年冷处存心，施药施粮，共叹君肠之热；一旦红尘撒手，斯人斯疾，可怜儿口犹黄。”其没前一
月，适余养 在里，尝携酒肴见饷，且以未完之稿示余。曰痈疽之生，昔人谓有三因，其实从乳岩、瘰 之外，
无所谓内因也。凡外感六淫，先作内病，如伤寒发汗不彻、温热分解不清，余邪逗留，为内痈，为痞结，为流注，
为附骨疽，皆内有伏热，外被寒凝所致。即胸背等痈，亦由湿热上升而成。所谓营气不从，逆于肉里，发为痈
肿。若云阴虚火炎而生痈疽者，千不得一。总之，疡证不外气血阻滞，即损伤致病，亦是血凝气滞使然皆无补法。
至服药之道，原不过为富贵人设法，以安其心耳。断不可通套徇俗，如见 肿而投内疏黄连，毒必黑陷；投犀角
地黄，舌必灰黑∶脾胃受戕，变证因而蜂起。但此义无论病家不知，即医家白首其间，亦未悉原委，迨证渐剧，
亦不自咎其用非所宜，反谓病势利害，药须加重，虽至于死，彼此不悟，悲夫！即诸家所刻治案，抄袭雷同，或
各是其是，各非其非，无足取法。若立斋辄用参、附，贫病则先倾其家，而命即随之矣。且今世疡医不知治法，
但以书方为能事，更造不服药必遗毒为害之言以惑人，推其意，无非要誉以敛财，罔顾其人生死。尝戏改《醉翁
亭记》二句云∶“医生之意不在病，在乎敛财而已矣。”一笑。自愧未尝学问，方剂药性，素所未谙，然每治人
之坏证，均不从服药中得手也。余览之，钦其见道之深，而所言皆得我心，正欲析疑商榷，不料其卒然溘逝，天
道不可尚矣。亟为节录如上，以传其人。
又云∶从来外科诸书图形名状，设想于鱼、虫、鸟、兽，最是可笑。如头部之鳝 头、蝼蛄串，唇部之龙泉
疽、虎髭毒，手部之蛇头疔、蜣螂蛀，腿部之上水鱼、泥鳅疽，并无解说；更不通者，足跟之牛程蹇，以人比畜，
近于谑矣。医者并罔顾名思义，妄立名目，以惑病家，而病家反以医人能呼其名为有识。遂相沿成习，牢不可破。
推其缘故，良由不能按穴立名，设此夜半之词以耸听耳。宜改牛程蹇为“行程蹇”，其余均以穴道名之。如不入
部位者，曰无名肿毒而已。若夫便毒，不尽生于怨旷，古书指为欲念不遂，殆不其然。即霉疮亦不仅淫毒为患，
必先有湿热内伏，乘淫邪而发作。若其人本无湿热，虽日游邪径，亦不传染也。苟湿热内甚者，虽不狎邪，感着其气即
染也。破伤成证亦然，皆不可执一而论。
又云∶外科蜡矾丸，本草载之，极言其解毒护心护膜之功，夫蜡极难化，矾又伤心而涩肠。病者进以甘旨，
尚难运动，反投以坚涩难化之物，必胃闭而不能食，证将因之而剧。即膜须蜡护，而吞入肠胃之间，蜡亦未必至
膜。方书之言，可尽信哉！
又云∶古书所载，有不尽然者。浓味生痈疽；膏粱之变，足生大疔。此“忌口”二字之所本也。余谓此为富
贵之说法，非所以论大概也。《千金》、《外台》无不以慎口腹为要务。东垣云∶痈疽食肉，乃自弃也。究之诸
公当日所交游者，皆富贵也。王氏自谓我术但治贫病，然以刺史之尊，于民间日用疾苦，相离尚远，其所称贫病，
非藜藿无告之贫也。若劳苦贫人，所患疡毒，皆由六淫外乘，而医者不知变通，甚至蔬腐不许入口，一餐之间，
有许多禁忌，几有绝食之苦，病患何以堪此？因之胃闭而病不能愈。此由见理不明，操技不精，藉“忌口”二字
为口实，以文过而饰非。及至用药，则蜈蚣、桑虫、甲片、蜂房、蛇蜕、角刺诸毒药，浪用无忌，何独于寻常食
品而严申禁戒乎？习而不察，曷胜浩叹！若能于富贵人退之，贫苦者进之，庶乎两得其平。盖胃气充足，病必易
愈，肌亦易生。设此义不知，亦焉能识病情而施妙治乎？
又云∶考古治疾，无分内外。刀、针、砭、刺、蒸、灸、熨、洗诸法并用，不专主于汤液一端。今诸法失传，
而专责之汤液，故有邪气隐伏于经络之间，而发为痈疽也。夫用药如用兵，若为将者，奉命伐暴，废其纪律，不
以摧坚破贼为己任，徒从事于文檄簿书之间，虚应故事，以待贼之自毙，养奸玩寇，滋蔓难图，至使与国俱亡而后已，
失其为将之道矣。乃医者治痈疽弃其刀针，不以决去脓腐为亟务，徒从事于方剂汤液之间，以待疽之自溃，因循姑息，
养痈贻患，至使与身俱亡而后已，失其为医之道矣。洄溪论外科曰∶手法必求传授。此言是已，但颖悟者自能心得，否
则虽授无益也。今针、砭诸法不行久矣，医者弃难而就易，病者畏痛而苟安，亦由今时之风气，尚虚声，喜浮誉，循名
而不责实。世道所以愈趋而愈下者，时也，势也。秦缓曰∶药之不达，针之不及。仲景治伤寒，用麻、桂以发汗，其汗
之不彻者，针刺出血以代汗。今人谓麻、桂不可用而代之，又禁刺法，谤为泄气，以致留邪不去，发为遗毒。如史传所
载，虽帝王将相之病而用刀针者，不胜缕指。试问今日遇之，尚敢出诸口乎？故曰∶时也，势也。可见在昔内证尚须外
治，今则疡科专以汤液治外疾。藉言补托，迁移时日，轻浅者糜帑劳师，深久者溃败决裂，或死无敛具，或残体破家。
医者自谓谨慎，而不知杀人无迹；病者乐于苟安，而至死不悟。此即子产所论水 弱，民狎而玩之则多死也。不意于医
道亦然，可不哀哉！彼医者岂设心欲杀人耶？实由不能辨其为脓为血也。亦有能辨之，而故缓之以敛财。亦有不能用刀
针，仅藉汤液数方，貌为爱护之言，以愚病家，反訾刀针为险事，而自护其短，指蒸脓发垫为内病，指重证为死证，果
死则可以显我之有断，幸而不死，又可邀功而索谢。吾谁欺？欺天乎！古人有戒用刀针之说者，盖谓脓未成而戒其早用，
非一概戒之也。然则决不可服药乎？曰∶始则不外汗之则疮已，若疮家不可发汗，指既成而言也，亦非一概戒之
也。善后不外理脾胃。数法之外，不必他求矣。愚谓外证初起，由于湿热内蕴，或痰饮留滞，以致气壅血凝者多，此宜
疏通清化为先。汗之则疮已，特为外感不净而发者言也。
又云∶《正宗》十日点破之说，不可泥定，总须辨其脓之成否为断。辨脓甚难，或一、二日已有脓而皮色不
变，或十余日无脓而皮色紫黑。“辨”之一字，谈何容易！刀针不敢轻用，由其审断不明也。始之以谨慎爱之者，
陈家的《易简方》四卷在苏州流传。其凡例的第一条说：近来无论是内科还是外科，医生接诊病人，首先追求的是延长病程，不愿意让病人迅速痊愈。对于富裕人家，虽然他们不惜花费钱财，但不知道病情拖延导致身体虚弱，受害的根源正在于此；至于贫穷的病人，既然不能一概免费诊治，务必使他们早日痊愈，才能恢复劳动能力自食其力，如果也长期拖延，必然导致无力调治，奄奄一息等待死亡，甚至因病荒废生计，全家陷入饥寒交迫，这忍心吗？希望行医的人心存利他济世之心，努力扭转这种积习，必定会获得善报。
吕慎庵先生所编辑的我本人的医案《三编》，卷二第六页屠小苏夫人的病例后附有顾氏儿子的证候记录，蒙乌程汪谢城孝廉评论说：“覆杯即愈”（指药到病除，喝完一杯药就好了）下面应该删去，因为言辞过于夸张。如果这样的话，那么贫苦百姓的温病、暑病，难道也可以用辛温药物了吗？这个评论非常正确，我非常佩服。只是杭州的饮食起居条件天下第一，即使是苏州、扬州也比不上，而那些富贵人家的孩子，往往过分爱惜，因娇生惯养而患上饱暖之疾，也比其他地方严重。不是亲身经历那种环境的人，不能完全了解。我发表这番议论，也是有感而发的。所以下文特意写上“栉风沐雨”（形容奔波劳碌，经受风雨）四个字，如果是那些经历风吹雨打的人，即使感受了温邪或暑邪，似乎也不是一味使用清凉药物可以治疗的，应当稍微配合辛散药物，才符合治疗机理。最后总结说要量体裁衣，不要拘泥固执，正是担心被固定的模式束缚眼睛，不敢轻易断言。第二十二页使用的交泰丸，是由黄连、桂心两味药组成。吕先生没有加注，我也顺便提及。
以前武进董兰痴盐运使、贡海门秀才、四明项新桥先生，都称我是袁枚（字子才，号简斋）先生的转世，我听了感到惭愧，不敢当。以袁公的聪明孝顺友爱、政绩文章，我怎么能够望其项背呢？只不过性情通达洒脱有些相似罢了。定州杨素园知府说：袁枚是旷代名医啊。您治疗胡季槎秀才发背的案例，所引用的话语已经概括尽了内外各科疾病的治疗方法，没有遗漏了，然而千年来没有人能领会其中的深意。只有您的医案，不论是用补法还是用清法，都以运转枢机、疏通经络为妙用。兰痴诸位先生的说法，大概就是因为这一点吧。我认为这只是愚者的一点心得，偶然与袁公的见解相合罢了。至于袁集中讨论议论的内容，无非是入理深刻的谈话。我常常通过他的观点而领悟到我的观点，事实确实如此。因为人身之气贵在流行通畅，百病都是由气机愆越停滞引起的，如果不知道这个道理，即使药物对症，往往也会格格不入，岂止是不能治愈疾病而已呢？所以收录保存我的拙劣医案，不厌其烦地琐碎，谆谆告诫人们这个道理。如果懂得这个义理，那么平易的药物、轻淡的方剂，常常可以治愈重症，即使是必死的病，或许也可以借此暂时延缓片刻。然而无知的人认为我医术高明、仁德之声远播近闻，而病情千态万状，许多人苦苦思索用力探究都不能治中的病，我却能用平淡常用的药物治好，这莫非是医运亨通吗？我只是笑笑不回答。然而在深夜扪心自问，惭愧没有真才实学，却侥幸获得虚名，隐瞒了很多不足。于是隐居在偏僻乡村，希望能减少过错。只是热心未冷，饶舌又何必推辞呢。唉，一定有慧心人能理解我的心意。
我的亲家戴雪宾秀才的先父干斋先生，精通医学，行医四十年。曾经说：医学这一门，显浅的一面比作有形的棋局，变化无穷，能干的人多，精通的人少；隐深的一面比作无形的道，神妙莫测，实行起来容易，理解起来难。可以说把其中的微妙之处都说尽了。所以先生年过六十，就发誓不再临证治病，而是乐于行善施舍，即使家里没有积蓄，也不疲倦。活到七十九岁去世。
山阴俞仲华先生，是下方桥陈念义的高徒。为人非常豪爽，有侠义之气，饮酒谈兵，轻视财物喜好宾客，并且信奉佛教。长久寓居省城，与我交情最深。只是谈论医学不合拍，听到我评论张景岳，就怒形于色。我体谅他尊师太过执着，不与计较。然而遇到时行感邪的重症，一定嘱咐病人家属请我主治。而他的两个儿子都被温补法误治，虽然我与已故孝子张养之先生极力苦口婆心地劝谏，无奈父子俩都不醒悟，像这样和而不同。俞曾撰写《结水浒传演义》一书，又名《荡寇志》，尊崇朝廷以诛杀盗贼，立意极正，可惜笔力远远不如施耐庵；而且错误地把扶阳抑阴的宗旨寓意于医学，恰好显得偏颇谬误。杨大令素园曾写文章批评他。凭仲华的才华学问来谈论医学，却还走入魔道，医学难道是容易说的吗！所以记录下来，希望后人不要轻易谈论医学。
扶阳抑阴，大《易经》用来比喻君子和小人，章虚谷说只可以用来论述治理国家，不可以用来论述治病，这是正确的。我认为并非不可以论述治病，特别是扶阳抑阴不可专门依赖热药罢了。为什么呢？人身元气就像阳，外来邪气就像阴。所以热邪损伤胃液，张仲景称之为无阳。医生想要扶助阳气，必须充盈津液；想要抑制阴邪，必须清除热邪。虽然说急下存阴，但急下是为了泻邪，泻邪就是抑制阴邪，存阴是为了保存正气，保存正气就是扶助阳气。如果懂得这个义理，那么易道和医理原本就是一贯的。赵养葵不明白这个义理，只知道温补是扶助阳气的药物，而不知道阴阳是邪正的比喻，所以他的方法只能治疗寒邪致病、阴盛格阳的证候。他却把书名定为《医贯》，致使后人困惑，误尽苍生，洄溪（徐灵胎）大力呵斥也是应该的。
仁和许周生驾部说：吴台卿笃信乩坛占卜之言，长斋礼拜，忘记自己身体瘦弱，又接受道士戒律，百日不说话，正值夏季暑火郁结于肺，于是患病吐血而死。因此说乩术之道，开始还只是一两个好事者相信它，接着朴实的人也相信它，接着聪明的人也相信它。祸福以乩为占卜，学问以乩为师，疾病以乩为医。背离阳气而进入阴晦，舍弃光明而趋向昏暗，那种幽阴沉墨的气象，足以消磨人的精神清明。我认为更有因此遭受横祸的，历历可查。大抵迷惑于此的人，总归是因为义利不明，心中存有妄想。近日乩坛越来越广，乩术越来越新，竟然有不堪细述的情况，尤其令人叹息。
《艮斋杂说》：克制愤怒则火气不上升，节制欲望则肾水不下泄，水火既济，炼丹之道就成功了。君子读《损卦》的卦象，得到养生的道理。
瘟疫伤人，没有比《谈往》中所说的崇祯十六年更严重的了。有疙瘩瘟、羊毛瘟等名称，叫出病名就死亡，不留片刻时间。八、九两个月，瘟疫致死数百万人。十月间有个福建人明白病因，看膝盖弯后面有筋突起，紫色的无法救治，红色的赶紧刺出血可以存活。到了霜雪渐渐下降，病情也逐渐减弱。我认为这种瘟疫虽然奇特，杀人既快又多，但无非是暑热毒瓦斯深入营分罢了。所以轻症的刺血可以存活，而霜雪降下病情自然衰退。考察嘉兴王肱《枕蚓庵琐语》及桐乡陈松涛《灾荒记事》，都说崇祯十四年大旱，十五、十六两年持续大旱，全国奇荒，瘟疫大作。综合三本书来看，就可以知道那是暑燥热毒之气。叫出病名就死亡，是因为邪气直接侵入内脏。当时如果有余师愚这样的人在，或许可以救活一二。
童庐说：镇海钟景龙先生，精通痧痘治疗，经他治疗的，百次不失一次，对逆证的判断期限，从未有过误差。所用的药物，初服大黄的患者占十分之五，后用补剂的占十分之七；至于攻散发汗，只用僵蚕而已，全蝎、穿山甲、桑虫之类，从未使用过；唯独地龙遇到血热毒盛时，用百余条也不嫌多。曾经说：小儿气血未充，脏腑娇嫩，痘疮不能起发，确实是由于元气虚弱不能充足化浆，浆液不足则毒邪不能排泄，如果再以毒攻毒，不但毒邪不肯排出，而且正气更受伤害，没有正气虚弱而毒邪能化解的。话语简练道理精微，真是济世的格言。我认为也有因为热极而导致浆液不起的，这是因为正气被壮火所消耗。应当泻火，忌用补托。至于痘后生毒，多由妄投毒药，误用温补所致。
杨素园大尹说：我见到阜平赵功甫开处方极其轻灵。曾经说：小儿的腹部有多大，必须让他的胃气足以运化药力，才能生效。这也是至理名言。我认为赵先生虽然是谈论小儿，即便是大人的病，也必须衡量其胃气而后权衡方剂。凡是体质脆薄的人，完全可以同小儿一样看待。近代只有休宁汪广期，治疗小儿专门使用轻剂。
我同乡管荣棠先生，年轻时做商人，天资聪颖特异，自知体弱，恐怕寿命不长，于是潜心研究疡科十余年，于是精通其技艺。性格慷慨，施药救人，能挽救危重证候。与我是不换之交。丙辰年冬季，忽然患吐血而死，年仅四十四岁，儿子才五岁而已。乡人都很惋惜。我挽联写道：“频年冷处存心，施药施粮，共叹君肠之热；一旦红尘撒手，斯人斯疾，可怜儿口犹黄。”在他去世前一个月，正好我在家休养，他曾带酒菜来看望我，并且把未完稿展示给我看。他说痈疽的产生，古人说是三因，其实除了乳岩、瘰疬之外，无所谓内因。凡是外感六淫，先造成内病，如伤寒发汗不彻底、温热分解不清晰，余邪逗留，形成内痈、痞结、流注、附骨疽，都是内有伏热，外被寒凝所致。即使是胸背等处的痈，也是由湿热上升而成。所谓营气不从，逆于肉里，发为痈肿。如果说阴虚火炎而生痈疽的，一千个里面不到一个。总之，疡证不外乎气血阻滞，即使是损伤致病，也是血凝气滞使然，都没有补法。至于服药的道理，原本不过是为富贵人想办法，以安定他们的心罢了。绝对不可以通套徇俗，比如见到肿就投用内疏黄连汤，毒邪必然黑陷；投用犀角地黄汤，舌头必然灰黑：脾胃受到戕害，变证因而蜂拥而起。但是这个道理无论病家不知道，就是医家长老在其中，也没有完全了解原委，等到证候逐渐加剧，也不自责用药不当，反而说病势利害，药物必须加重，即使到了死亡，彼此都不醒悟，可悲啊！就连各家刻印的治疗医案，抄袭雷同，或者各是其是，各非其非，不值得效法。如果像薛立斋那样动辄用人参、附子，贫穷病人则会先倾家荡产，而性命随即随之而去。况且当今世道的疡医不知道治疗方法，只把抄书方作为能事，更制造不服药必然遗毒为害的话来迷惑人，推究他们的意图，无非是要博取名誉以敛财，不顾病人的生死。曾经戏改《醉翁亭记》两句说：“医生的心意不在治病，在乎敛财罢了。”一笑。自愧未曾学问，方剂药性，向来不熟悉，然而每次治疗别人的坏证，都没有从服药中得手。我看了这些，钦佩他见道之深，而且所说的都合乎我的心意，正想分析疑惑商讨切磋，不料他突然离世，天道不可预测啊。急忙节录如上，以传扬其人。
又说：从来外科诸书图形名称形状，设想于鱼、虫、鸟、兽，最是可笑。如头部的鳝鱼头、蝼蛄串，唇部的龙泉疽、虎髭毒，手部的蛇头疔、蜣螂蛀，腿部的上水鱼、泥鳅疽，都没有解说；更不通的是，足跟的牛程蹇，拿人比牲畜，近乎戏谑了。医生并不管顾名思义，胡乱设立名目，来迷惑病家，而病家反而以为医生能叫出名字是有见识。于是相沿成习，牢不可破。推究其原因，实在是因为不能按穴位立名，设下半夜鬼话耸人听闻罢了。应该改牛程蹇为“行程蹇”，其余的都应以穴道命名。如果不入特定部位的，就叫无名肿毒而已。至于便毒，不尽生于怨偶分离，古书指为欲念不遂，大概不是这样的。即使梅毒也不仅是淫毒为患，必须先有湿热内伏，乘淫邪而发作。如果这个人本来没有湿热，即使每天走邪路，也不会传染。如果湿热内盛的，即使不亲近邪女，沾染其气息就会感染。破伤成证也是这样，都不可执一而论。
又说：外科蜡矾丸，本草记载，极力称赞其解毒护心护膜的功效，但是蜂蜡极难消化，明矾又伤心且涩肠。病人进食甘美食物，尚且难以运化，反而投入坚硬涩滞难消化的东西，必然导致胃闭而不能进食，病情将因此加剧。即使膜需要蜡保护，而吞入肠胃之间，蜡也未必能到达膜。方书的话，可以尽信吗！
又说：古书记载，有不尽然的。浓味生痈疽；膏粱之变，足生大疔。这就是“忌口”二字的本源。我认为这是针对富贵人的说法，不是用来论述一般情况的。《千金方》、《外台秘要》无不以谨慎饮食为要务。李东垣说：痈疽吃肉类，是自弃啊。究之各位先生当时交往的人，都是富贵之人。王氏自称我的技术只治疗贫病，然而以刺史的身份，与民间日常疾苦，相距还很远，他所称的贫病，并不是贫苦无助的平民。如果是劳苦穷人，所患疡毒，都是由六淫外乘引起，而医者不知变通，甚至不许吃蔬菜腐乳，一顿饭之间，有许多禁忌，几乎有绝食之苦，病患怎么承受得了？因此导致胃闭而病不能愈。这是由见理不明，操技不精，借“忌口”二字为借口，来掩饰过错。等到用药时，则蜈蚣、桑虫、甲片、蜂房、蛇蜕、角刺各种毒药，滥用无忌，为什么唯独对寻常食品严申禁戒呢？习惯而不察觉，怎能不胜浩叹！如果能对富贵人退避（慎用补药），对贫苦者进用（适当补益），差不多两得其平。因为胃气充足，病必易愈，肌肉也易生长。如果不知道这个义理，又怎么能识别病情而施行妙治呢？
又说：古代治疗疾病，不分内外。刀、针、砭、刺、蒸、灸、熨、洗各种方法并用，不专主于汤液一端。现在各种方法失传，而专门责求于汤液，所以有邪气隐伏于经络之间，而发为痈疽。夫用药如用兵，如果作为将领，奉命讨伐暴乱，废弃纪律，不把摧坚破贼作为己任，只从事于文书簿册之间，虚应故事，等待贼寇自毙，养奸玩寇，滋蔓难图，以至于与国家俱亡才停止，失去了为将之道。然而医生治疗痈疽放弃刀针，不把决去脓腐作为紧急事务，只从事于方剂汤液之间，等待疽疮自溃，因循姑息，养痈贻患，以至于与身体俱亡才停止，失去了为医之道。洄溪论外科说：手法必须求得传授。这话是对的，但聪明的人自然能心得，否则虽然传授也无益。现在针、砭等各种方法不行已久，医生放弃难的而选择容易的，病人害怕疼痛而苟且安适，也是因为当今的风气，崇尚虚声，喜欢浮誉，循名而不责实。世道所以越来越下，是时势啊。秦缓说：药力达不到，针力够不着。张仲景治伤寒，用麻黄、桂枝发汗，汗出不彻底的，针刺出血以代替发汗。现在的人说麻黄、桂枝不可用而替代它，又禁止刺法，诽谤为泄气，以致留邪不去，发为遗毒。如史传所载，即使是帝王将相的病用刀针的，数不胜数。试问今天遇到这种情况，还敢说出来吗？所以说：是时势啊。可见在过去内证还需要外治，现在则疡科专门以汤液治外疾。藉口补托，迁移时日，轻浅的糜费钱财劳师动众，深久的溃败决裂，或者死无敛具，或者残体破家。医生自谓谨慎，而不知道杀人无形；病人乐于苟安，而至死不悟。这就是子产所论述的水弱，民众轻慢它则多死啊。没想到在医道上也这样，可不悲哀吗！那些医生难道存心想要杀人吗？实在由不能辨别是脓是血。也有能辨别的，而故意拖延以敛财。也有不能用刀针，仅藉汤液几方，装作爱护的话，来愚弄病家，反而诋毁刀针为险事，而自我保护其短处，指蒸脓发垫为内病，指重证为死证，果真死了则可以显示我有决断，幸好没死，又可以邀功索谢。我欺骗谁呢？欺骗天吗！古人有戒用刀针的说法，大概是说脓未成而戒其早用，不是一概戒除的。那么决不可服药吗？回答说：开始不外乎汗之则疮已，如果疮家不可发汗，是指既成而言的，也不是一概戒除的。善后不外乎调理脾胃。这几法之外，不必他求了。我认为外证初起，由于湿热内蕴，或痰饮留滞，以致气壅血凝的多，这宜疏通清化为先。汗之则疮已，特为外感不净而发者言也。
又说：《正宗》十日点破的说法，不可拘泥固定，总须辨别脓是否形成来判断。辨别脓很难，或者一、二日已有脓而皮色不变，或者十余日无脓而皮色紫黑。“辨”一个字，谈何容易！刀针不敢轻用，由其审断不明也。开始之以谨慎爱之者，
The four volumes of *Yijian Fang* (Simple and Effective Prescriptions) by the Chen family were circulated in Suzhou. The first item in its preface states: Recently, whether in internal or external medicine, when a doctor receives a patient, they primarily seek to prolong the duration of the illness, unwilling to allow the patient to recover quickly. For those with means, although they do not spare expenses, they are unaware that a prolonged illness leads to physical depletion; the harm stems precisely from this. As for the poor who are ill, since they cannot all be treated free of charge, it is essential that they recover early so they can regain their ability to work and support themselves. If treatment is also delayed, they will inevitably lack the strength for further care, lie dying, and wait for death. Worse still, they may lose their livelihood due to illness, plunging their entire families into hunger and cold. Can one bear this? I hope practitioners maintain a mind dedicated to benefiting others and saving lives, strive to reverse this entrenched habit, and will surely receive good rewards.
Mr. Lu Shen'an compiled my medical cases in the *Third Compilation*. On page six of Volume Two, after the case of Lady Tu, wife of Magistrate Tu Xiaosu, there is an appendix regarding the symptoms of Mr. Gu’s son. The scholar Wang Xiecheng from Wucheng commented: "The phrase 'cured as soon as the cup is overturned' (implying immediate cure upon drinking the medicine) should be deleted below, as the statement is exaggerated." If this is the case, then could warm and acrid herbs be used for warm diseases and summerheat diseases among the poor? This comment is very correct, and I deeply admire it. However, the diet and lifestyle in Hangzhou are the best under heaven, surpassing even Suzhou and Yangzhou. Yet, children in wealthy families are often excessively cherished; due to pampering, they suffer from ailments caused by overeating and warmth more severely than elsewhere. Only those who have experienced such environments firsthand can fully understand this. My remarks here are made with specific reasons in mind. Therefore, I specifically wrote the four characters "combing wind and bathing in rain" (describing exposure to harsh elements) in the following text. For those who endure wind and rain, even if they contract warm pathogens or summerheat, it seems that pure cooling herbs alone are not sufficient for treatment. One should slightly assist with acrid-dispersing herbs to align with the therapeutic principle. Finally, concluding with "tailor the garment to the cloth" (adapt treatment to the individual) and "do not stick rigidly to fixed rules," I was worried about being blinded by preconceived notions and thus dared not speak definitively. The Jiaotai Pill (Harmony Pill) used on page twenty-two consists of two herbs: Huanglian (Coptidis Rhizoma) and Guixin (Cinnamomi Cortex). Mr. Lu did not annotate it, but I mention it briefly.
In the past, Dong Lanchi, Salt Commissioner of Wujin; Gong Haimen, a Shengyuan (licentiate); and Mr. Xiang Xinqiao of Siming, all claimed that I was the reincarnation of Mr. Yuan Jianzhai (Yuan Mei). Hearing this, I felt ashamed and dared not accept it. How could I possibly compare to Mr. Yuan’s intelligence, filial piety, fraternal duty, political achievements, and literary works? Our temperaments were merely somewhat similar in their openness and unconventionality. Yang Suyuan, Prefect of Dingzhou, said: "Yuan was a renowned physician of the age." In your case treating Scholar Hu Jicha’s carbuncle on the back, the quotes you cited already encompassed the treatment methods for all internal and external diseases without omission, yet no one for millennia has understood this. Only your cases, regardless of using tonification or clearing, employ the subtle art of regulating the pivot and unblocking collaterals. The comments from Mr. Lanchi and others likely stem from this. I consider this merely a trivial insight from a fool, coincidentally aligning with Mr. Yuan’s views. Regarding the discussions in his collected works, they are nothing but profound talks entering the principles. I often gain insights through his perspectives, which is indeed true. Because Qi in the human body values smooth circulation, all diseases arise from stagnation and obstruction. If one does not understand this, even if the medicine matches the syndrome, it often fails to interact effectively, let alone cure the disease. Therefore, in recording my humble cases, I do not shy away from verbosity, earnestly advising people of this truth. If one understands this principle, then mild medicines and light prescriptions can often cure severe conditions; even fatal diseases might be temporarily alleviated. Yet, ignorant people claim my miraculous skills and benevolent reputation spread far and wide. When patients present with myriad complex conditions that many struggle to diagnose despite intense effort, I resolve them with plain, commonly used substances. Is this not just good fortune in my medical career? I simply smile and do not answer. However, in the quiet of the night, examining my conscience, I feel ashamed of lacking substantial learning, yet I have fortunately acquired a false reputation, concealing much deficiency. Thus, I reside in a remote village, hoping to minimize errors. Yet, my passion remains undimmed, and why refrain from speaking? Alas, surely someone with wisdom will understand my intent.
My relative-in-law, Cai Xuabin, a Shengyuan, whose father, Mr. Gan Zhai, was proficient in medicine and practiced for forty years, once said: Medicine, in its apparent aspect, is like a tangible game of chess, responding to changes without fixed patterns; many are capable, but few are masters. In its hidden aspect, it is like the intangible Dao, divine and unfathomable; easy to practice, but difficult to truly know. He truly exhausted the subtleties of this field. Thus, after turning sixty, he vowed never to treat patients clinically again, preferring to engage in charity and kindness. Even without savings, he remained tireless. He lived to seventy-nine before passing away.
Mr. Yu Zhonghua from Shanyin was a senior disciple of Chen Nianyi from Xiafang Bridge. He was extremely generous, possessing a chivalrous spirit, enjoying drinking and discussing military strategy, valuing friendship over wealth, and devoutly practicing Buddhism. He resided long-term in the provincial capital and shared the deepest friendship with me. However, our views on medicine clashed; whenever I discussed Zhang Jingyue, anger would show on his face. I attributed this to his excessive loyalty to his teacher and did not argue. Nevertheless, when encountering severe seasonal epidemic diseases, he always instructed the patient's family to invite me for primary treatment. His two sons, however, were misdiagnosed and mistreated with warm-tonifying methods. Despite my urgent pleas and the strong admonitions of the late Filial Son Zhang Yangzhi, the father and sons remained unmoved. Such was our harmony in friendship but divergence in opinion. Mr. Yu once wrote a book titled *Jie Shuihu Yanyi* (Conclusion of the Water Margin Romance), also known as *Dangkou Zhi* (Chronicles of Pacifying Bandits), advocating for the court to suppress bandits, with a righteous intention. Unfortunately, his literary skill fell far short of Shi Nai'an's. Moreover, he erroneously applied the principle of "supporting Yang and suppressing Yin" to medicine, revealing a bias and error. Magistrate Yang Suyuan wrote an essay criticizing him. Given Mr. Zhonghua's talent and learning, yet still falling into heresy when discussing medicine, how can medicine be spoken of lightly! I record this to warn future generations not to discuss medicine casually.
"Supporting Yang and suppressing Yin" in the Great *I Ching* (Book of Changes) metaphorically refers to the gentleman versus the petty person. Zhang Xugu stated that this applies only to governing the world, not to treating disease, which is correct. I believe it can apply to treating disease, provided that supporting Yang and suppressing Yin does not rely solely on hot herbs. Why? Human primordial Qi is akin to Yang, while exogenous pathogenic factors are akin to Yin. Thus, heat damages stomach fluids, which Zhang Zhongjing calls "absence of Yang." To support Yang, one must replenish fluids; to suppress Yin (pathogens), one must eliminate heat. Although "urgent purgation preserves Yin," urgent purgation eliminates pathogens; eliminating pathogens is suppressing Yin, and preserving Yin preserves Zheng (Righteous Qi); preserving Zheng is supporting Yang. Understanding this, one sees that the principles of the *I Ching* and medicine are consistent. Zhao Yangkui failed to grasp this, knowing only that warm-tonifying drugs support Yang, unaware that Yin and Yang here metaphorize Pathogen and Righteous Qi. Consequently, his methods could only treat diseases caused by cold pathogens or syndromes of Yin excess repelling Yang. By naming his book *Yi Guan* (Medical Continuation), he confused later generations, harming countless people, justifying Xuxiling's (Xu Lingtai's) strong condemnation.
Xu Zhousheng, a Department Head from Renhe, said: Wu Taiqing firmly believed in divination via spirit-writing, kept long fasts, worshipped, ignored his emaciation, accepted Daoist precepts, and spoke not for a hundred days. In midsummer, summerheat-fire stifled his lungs, leading to hemoptysis and death. He therefore claimed that spirit-writing began with a few enthusiasts, then attracted simple folk, and eventually the intelligent. Misfortune and fortune are divined by it, knowledge is taught by it, and illness is treated by it. Turning away from Yang into Yin, abandoning clarity for darkness, its gloomy and heavy nature dissipates one's mental clarity. I believe there are even those who suffer calamity because of it, which can be verified. Generally, those bewitched by it fail to distinguish righteousness from profit and harbor delusional hopes. Recently, spirit-writing temples have expanded, and techniques have become newer, with some practices too abominable to recount, which is especially lamentable.
*Lengzhai Zasuo* (Miscellaneous Sayings from the Gen Study): Restrain anger so fire does not rise; curb desires so water does not leak downward. When water and fire interact and balance, the alchemical vessel is complete. The gentleman reads the image of the *Sun* hexagram (Decrease) and learns health preservation.
Plagues injure people most severely, as described in *Tangwang*, during the 16th year of Chongzhen. There were names like "Geda Plague" and "Yangmao Plague"; calling out the disease name led to immediate death, leaving no time. In August and September, millions died of plague. In October, a Fujianese man understood the cause: observing a protruding vein behind the knee crease, purple indicated incurability, while red indicated survival if blood was pricked out quickly. As frost and snow gradually descended, the epidemic subsided. I believe this plague, though strange, killed quickly and in large numbers because summerheat-toxic qi penetrated deeply into the Ying (Nutritive) level. Hence, light cases survived with pricking, and the disease declined with frost and snow. Examining Wang Gong's *Zhenyin'an Suoyu* from Jiaxing and Chen Songtao's *Zaihuan Jishi* from Tongxiang, both state that the 14th year of Chongzhen saw severe drought, and the 15th and 16th years continued with extreme drought, causing national famine and rampant plague. Synthesizing these three books, it is clear that this was summer-dryness-heat-toxic qi. "Calling the name leads to death" indicates pathogenic qi directly entering the Zang organs. Had someone like Yu Shiyu existed then, perhaps one or two could have been saved.
Tong Lu said: Mr. Zhong Jinglong from Zhenhai was proficient in treating smallpox and chickenpox. Of those he treated, none missed by more than one in a hundred; his predictions of prognosis for adverse cases were never inaccurate. His initial treatments involved Dahuang (Rhei Radix et Rhizoma) in five out of ten cases, followed by tonics in seven out of ten. For attacking and dispersing, he used only Jiangcan (Bombyx Batryticatus); he never used Quanxie (Scorpio), Chuanshanjia (Manis Squama), or Sangchong (Nepa Cinerea). Only Dilong (Pheretima) was used extensively, sometimes over a hundred earthworms, when blood-heat toxicity was severe. He once said: Children's Qi and Blood are not fully developed, and their Zang-Fu are delicate. Smallpox failing to erupt is indeed due to Yuan (Primordial) deficiency preventing sufficient pus formation. If pus is insufficient, toxins cannot be expelled. Using poison to attack poison not only fails to expel toxins but harms Zheng Qi further. There is no case where deficiency allows toxin transformation. His words were concise and profound, truly maxims for saving the world. I believe there are also cases where extreme heat prevents pus formation because Zheng Qi is consumed by vigorous fire. Fire should be drained, and tonification/resistance avoided. Sores after smallpox often result from reckless use of toxic drugs or mistaken warm-tonification.
Magistrate Yang Suyuan said: I have seen Dr. Zhao Gongfu from Fuping prescribe very lightly. He once said: A child's abdomen is small; one must ensure their Stomach Qi is sufficient to transform the medicinal power before it can be effective. This is also a profound truth. I believe that although Mr. Zhao spoke of children, adult illnesses also require weighing the Stomach Qi before adjusting prescriptions. Frail and thin individuals can be viewed similarly to children. In recent times, only Wang Guangqi from Xiuning treats children exclusively with light prescriptions.
My fellow townsman, Mr. Guan Rongtang, was a merchant in his youth, naturally intelligent, aware of his weak constitution and fearing a short life, he devoted himself to Surgery (Yangke) for over ten years, mastering the art. He was generous, distributing medicine to save people, able to rescue critical cases. We were bosom friends. In the winter of Bingchen year, he suddenly died of hemoptysis at age forty-four, leaving a son only five years old. Townspeople mourned him. I composed a couplet: "For years keeping a cold heart, giving medicine and grain, we sigh at your hot intestines; Once letting go of the red dust, this person and this illness, pity the yellow mouth of the child." One month before his death, while I was resting at home, he brought wine and food to visit and showed me his unfinished manuscript. He said: The origin of carbuncles and sores was traditionally attributed to three causes, but except for breast cancer and scrofula, there is no so-called internal cause. All exogenous Six Evils first cause internal disease. For example, incomplete sweating in Cold Damage or unclear resolution in Warm Diseases leaves residual pathogens lingering, forming internal abscesses, nodules, flowing deposits, or deep bone suppurations. These are caused by latent internal heat congealed by external cold. Even carbuncles on the chest and back arise from damp-heat rising. As stated, when Ying Qi does not flow smoothly and reverses in the flesh, carbuncles and swellings occur. Claims that Yin deficiency and flaming fire cause carbuncles account for less than one in a thousand. In summary, surgical disorders are nothing but Qi and Blood stagnation. Even trauma-induced disease is due to blood coagulation and Qi stagnation; there is no place for tonification. The purpose of taking medicine is originally to provide comfort for the wealthy, to calm their minds. One must absolutely avoid generic conformity. For instance, applying Neishu Huanglian Tang (Internal Drainage Coptis Decoction) to swelling causes toxins to turn black and sink; applying Xijiao Dihuang Tang (Rhino Horn and Rehmannia Decoction) turns the tongue gray-black. The Spleen and Stomach are damaged, and complications arise like swarms. Yet, this principle is unknown to patients, and even elderly physicians often do not understand the root cause. As the condition worsens, they do not blame their inappropriate medication but claim the disease is severe and requires heavier doses. They die without realizing anything, which is tragic! Even published case records are plagiarized or contradictory, offering no model for emulation. For example, Xue Lizhai frequently used Renshen (Ginseng Radix) and Fuzi (Aconiti Lateralis Radix Praeparata); for poor patients, this bankrupted families and took lives immediately. Moreover, modern surgeons ignore proper methods, relying solely on copying prescriptions, and spread the lie that refusing medication guarantees lingering toxins. Their intent is clearly fame and profit, disregarding life and death. I jokingly modified two lines from *Zuiweng Ting Ji*: "The doctor's intent is not in the disease, but in gathering wealth." A laugh. I regret my lack of study; I am unfamiliar with formulas and herb properties. Yet, whenever I treat ruined cases, success rarely comes from medication. Reading this, I admire his deep understanding, and his words resonate with my heart. I wished to discuss doubts, but alas, he passed suddenly. Heaven's way is unpredictable. I urgently excerpted the above to preserve his legacy.
He also said: It is ridiculous that traditional surgical texts name shapes based on fish, insects, birds, and beasts. Examples include "Eel Head" and "Mole Cricket String" on the head; "Dragon Spring Carbuncle" and "Tiger Whisker Toxicity" on the lips; "Snake Head Ding" and "Dung Beetle Bore" on hands; "Upper Softshell Turtle" and "Loach Abscess" on legs. None have explanations. More absurdly, "Niu Cheng Jian" (Ox's Step) on the heel compares humans to animals, bordering on mockery. Physicians ignore the meaning of names, inventing titles to confuse patients, who mistakenly view this nomenclature as expertise. This custom became entrenched and unbreakable. The reason is likely the inability to name based on acupoints, resorting to midnight tales to shock listeners. "Niu Cheng Jian" should be changed to "Xingcheng Jian" (Journey Impediment), and others named by acupoint. Those not in specific locations should simply be called "Wuming Zhongdu" (Nameless Swelling and Toxicity). Regarding "Biandu" (venereal buboes), they do not all stem from sexual frustration. Ancient texts attribute them to unfulfilled desires, which is likely incorrect. Even Syphilis is not solely caused by sexual toxins; damp-heat must be latent internally, triggered by sexual misconduct. If one lacks internal damp-heat, even frequent promiscuity will not lead to infection. If damp-heat is severe internally, infection can occur even without direct contact, merely by inhaling the pathogen's aura. Traumatic wounds becoming infected follow the same logic; one must not adhere to a single explanation.
He also said: The Surgical Wax and Alum Pill (Lafan Wan) is recorded in Materia Medica, extolling its detoxifying and heart/membrane-protecting effects. However, beeswax is extremely hard to digest, and alum damages the heart and binds the intestines. Patients consuming rich foods already struggle with digestion; introducing hard, binding, indigestible substances will certainly cause gastric closure and anorexia, worsening the condition. Even if wax protects membranes, swallowed into the gut, it may not reach the membrane. Can one trust prescription books entirely?
He also said: Ancient texts contain inaccuracies. Rich flavors cause carbuncles; changes from rich food produce large Ding sores. This is the basis for "dietary restrictions." I consider this advice tailored for the wealthy, not applicable generally. *Qianjin Yaofang* and *Waitai Miyao* emphasize dietary caution. Li Dongyuan said: Eating meat with carbuncles is self-abandonment. Ultimately, the contemporaries of these authors were all wealthy. Mr. Wang claims his skills treat only the poor, but as a Prefect, he was distant from common suffering. His "poor" were not the destitute laborers. Laborers' ulcers are caused by Six Evils invading externally. Ignorant doctors, unable to adapt, forbid vegetables and fermented bean curd, imposing numerous taboos per meal, causing near-starvation. Patients cannot endure this, leading to gastric closure and non-healing. This stems from unclear principles and imprecise skills, using "dietary restrictions" as an excuse to cover up faults. Yet, when prescribing, they recklessly use toxic herbs like Wugong (Scolopendra), Sangchong, Jiapian (Carapax Trionycis), Fengfang (Honeycomb), Shetui (Ophichthus Skin), and Jiaoci (Antler Spine). Why are ordinary foods strictly forbidden while these poisons are used freely? Habitual blindness invites deep sighs. If one restricts tonics for the wealthy and uses them appropriately for the poor, balance might be achieved. Sufficient Stomach Qi ensures easier recovery and tissue regeneration. Without this knowledge, how can one diagnose and treat effectively?
He also said: Ancient medicine did not distinguish between internal and external treatments. Knife, needle, Bian stone, puncture, steaming, moxibustion, ironing, and washing were all used, not relying solely on decoctions. Now these methods are lost, and reliance is placed entirely on decoctions. Thus, pathogens hide in collaterals, manifesting as carbuncles. Using medicine is like using troops. A general ordered to suppress rebels, abandoning discipline and failing to break enemy lines, merely handling paperwork, waiting for enemies to perish naturally, nurturing treachery and neglecting threats until the state falls, loses the way of a general. Similarly, surgeons abandoning knives and needles for carbuncles, failing to urgently drain pus and necrotic tissue, relying only on decoctions, waiting for spontaneous rupture, indulging in procrastination, nurturing the carbuncle until death ensues, lose the way of a physician. Xuxiling said regarding surgery: Manual techniques must be transmitted. This is true, but insightful students learn intuitively; otherwise, transmission is useless. Needles and Bian stones have been unused for long. Doctors choose the easy over the difficult; patients fear pain and seek comfort. This reflects current trends valuing empty reputation over substance. Society declines due to times and circumstances. Qin Qian said: "When medicine fails and needles cannot reach." Zhang Zhongjing treated Cold Damage with Mahuang and Guizhi for sweating; if sweat was incomplete, he used needle-pricking bleeding to substitute for sweating. Today, people say Mahuang and Guizhi are unusable and replace them, banning needling and slandering it as "draining Qi." This leaves pathogens trapped, causing lingering toxins. Historical records show emperors and generals treated with knives and needles, too numerous to list. Ask today's doctors if they would dare speak of this. Thus, it is the times and circumstances. In the past, internal diseases required external therapy; now, surgeons treat external diseases solely with decoctions. Excusing delay with tonification, mild cases waste resources, severe cases rupture or kill without burial shrouds. Doctors claim caution but kill invisibly; patients prefer comfort and die unawares. This is like Zichan's saying: "Water is weak; people play in it and drown." Unbelievable that medicine is the same. Do doctors intend to kill? No, they simply cannot distinguish pus from blood. Some can distinguish but delay for profit. Some cannot use knives/needles, relying on a few decoctions, feigning care to fool patients, denigrating needling as dangerous to hide their incompetence, labeling pustule-maturation as internal disease, and severe cases as fatal. If the patient dies, it proves their judgment; if they live, they claim credit and fees. Who am I deceiving? Heaven! Ancients warned against needling, meaning "avoid early use before pus forms," not a total ban. So, is medication forbidden? No. Initially, "sweating cures sores" applies to unresolved exogenous pathogens. "Do not sweat carbuncle patients" refers to formed sores, not a total ban. Post-care involves regulating Spleen and Stomach. Beyond these methods, no other search is needed. I believe early external lesions often stem from internal damp-heat accumulation or phlegm-fluid retention causing Qi stagnation and Blood coagulation. Clearing and resolving should come first. "Sweating cures sores" specifically addresses unresolved exogenous pathogens.
He also said: The *Zhengzong* rule of puncturing after ten days should not be rigidly applied. One must judge based on whether pus has formed. Judging pus is difficult; pus may form in one or two days without skin color change, or persist for ten-plus days with purple-black skin. The word "judge" is easy to say but hard to do! Fear of using knives/needles stems from unclear diagnosis. Starting with caution and love...