尝观世之同行,每多嫉妒,行行犹可,惟医道中最为甚焉。夫医以苏人之困,拯人之危,性命为重,功
利为轻,而可稍存嫉妒哉!奈何今之医者,气量狭窄,道不求精,见有一神其技者则妒之。妒心一起,害不
胜言,或谣言百出,或背地破道,或前用凉药,不分寒热而改热,前用热药,不别寒热而改凉,罔顾他人
之性命,惟逞自己之私心,总欲使有道者道晦,道行者不行,以遂其嫉妒之意。每见病家,患温热之病,医者
投以辛凉、甘凉,本不龃龉,但服一、二剂,未获深中,病者见热渴不已,心中疑惧,又换一医,且明告
曾延医治,而所换之医,遂不察其病因,见前有寒凉之药,便咎前医用寒凉之害,不辨证之寒热,脉之
迟数,舌苔黄白,小水清浊,竟乱投温热之方,不知温热之病,
得温热之药,无异火上添油,立刻津干液涸,而变生俄顷。倘
前用热药,以治其寒,亦咎其用热药之害,总不辨其为寒为热,乱用寒凉之方,不知寒证服寒凉,犹如雪
上加霜,立使阳亡气脱,而变在须臾,直至垂危,尚怨前医之误,可胜悼哉!然亦有明驳前医,暗师前法,而
获效者,竟尔居功,索人酬谢,若此重财轻命,只恐天理难容,奉劝医者,毋怀妒忌,大发婆心,则幸甚矣!
医者根据也,人之所倚赖也。医毋自欺,斯病家有倚赖焉!夫医之为道,先详四诊,论治当精,望色聆
音,辨其脏腑之病,审证切脉,别其虚实而医,若此可谓毋欺也。至临证之时,细分部候,知其何为浮主表
病,沉主里病,迟主寒病,数主热病,何为人迎脉大之外感,气口脉大之内伤,更须望其青、赤、黄、
白、黑五色之所彰,闻其角、征、宫、商、羽五音之所发,问其臊、焦、香、腥、腐五气之所喜,以明其肝、
心、脾、肺、肾五脏之病因,而用其酸、苦、甘、辛、咸五味之药饵,能如是者,何欺之有?
惟其一种庸流,欺人妄诞,见病患有寒热者,一疑其为外感,欺病家不知诊法也,不别其脉之虚实,而浪投发
散之剂。又见病患有咳嗽者,一疑其为虚损,欺病家不谙医理也,不辨其体之强弱,而恣用补益之方。至于五
色五音五气,一概不知审察,焉能明其五脏之病,而用其五味之药乎?如是者,不独欺人,实为自欺。……。
见人喜补者,遂谓虚衰,喜散者,遂云外感,畏热药者,便用寒凉,畏凉药者,便投温热,顺病患之情意,乱
用医方,意不读《灵》、《素》以下诸书,全用欺人之法。噫!医之为道,死生攸系,一有欺心,即药饵
妄投,存亡莫卜,奈何济人之方,竟视作欺人之术也,吾愿医者,必须志在轩岐,心存仲
景,究四诊而治病,毫不自欺,方不愧为医者也。
我曾观察世间的同行,大多心存嫉妒,其他行业尚且如此,唯独在医学界最为严重。医学的宗旨是解救人们的困苦,挽救人们的危难,以性命为重,以功利为轻,怎么可以稍存嫉妒之心呢!然而如今的医者,气量狭窄,不追求医术的精进,见到有技艺高超的人就嫉妒。嫉妒心一起,害处说不尽,有的散布谣言,有的在背后诋毁医德,有的之前用凉药,不分寒热就改为热药;之前用热药,不辨寒热就改为凉药,完全不顾及他人的性命,只逞自己的私心,总想让有道行的人道术晦暗,行道的人无法施行,以满足其嫉妒之意。
我常看到病家,患者患温热病,医生投以辛凉、甘凉的方剂,本来并无不妥,但服用一、二剂后,未能深中病机,患者见发热口渴不止,心中疑惧,又更换一位医生,并且明确告知曾请前医诊治过,而更换的这位医生,却不考察病因,见前面用了寒凉药物,便归咎于前医用寒凉药的害处,不辨证候的寒热,脉象的迟数,舌苔的黄白,小便的清浊,竟然乱投温热的方子,不知道温热病,得到温热的药,无异于火上浇油,立刻导致津液干枯,顷刻间发生变证。倘若之前用热药来治疗寒证,也归咎于用热药的害处,总是不辨别是寒是热,乱用寒凉的方子,不知道寒证服寒凉药,犹如雪上加霜,立即使阳气亡失、气脱,变化就在须臾之间,直到垂危,还怨恨前医误诊,真是令人悲痛啊!然而也有明里驳斥前医,暗中效法前法而获效的,竟然居功自傲,索取酬谢,像这样重财轻命,只怕天理难容,奉劝医者,不要怀有妒忌,大发慈悲之心,那就万幸了!
医者是患者的依靠,是人们所信赖的。医者不自欺,患者才有依靠!医学之道,先要详细进行四诊,论治应当精当,观察面色,聆听声音,辨别脏腑的疾病,审察证候,切按脉象,分辨虚实而后医治,像这样可以说是没有欺骗。到了临证之时,细致分部候脉,知道什么是浮脉主表病,沉脉主里病,迟脉主寒病,数脉主热病,什么是人迎脉大主外感,气口脉大主内伤,更须观察青、赤、黄、白、黑五色所显现的情况,听闻角、征、宫、商、羽五音所发出的声音,询问臊、焦、香、腥、腐五气所喜好(或厌恶)的情况,以明了肝、心、脾、肺、肾五脏的病因,而使用酸、苦、甘、辛、咸五味之药饵,能做到这样的,有什么可欺骗的呢?
只是那一种平庸之辈,欺人妄诞,见到患有寒热的病人,就怀疑是外感,欺骗病家不懂诊法,不辨别脉象的虚实,就浪投发散的药物。又见到患有咳嗽的病人,就怀疑是虚损,欺骗病家不懂医理,不辨别体质的强弱,就恣意使用补益的方子。至于五色、五音、五气,一概不知审察,怎么能明了五脏的疾病,而使用五味的药物呢?像这样的人,不仅是欺人,实为自欺。……。见到喜欢补药的人,就说他虚衰,喜欢发散的人,就说他是外感,畏惧热药的人,就用寒凉药,畏惧凉药的人,就投温热药,顺从病患的情意,乱用医方,意思是不读《灵枢》、《素问》以下诸书,全用欺人之法。唉!医学之道,关乎生死,一旦有欺心,就是药饵妄投,存亡不可预测,为什么救人的方法,竟视作欺人的手段呢,我希望医者,必须立志于轩辕、岐伯,心存张仲景,探究四诊而治病,毫不自欺,才不愧为医者。
I have observed that among contemporary practitioners, jealousy is prevalent; while this may be acceptable in other trades, it is most severe in the medical profession. The purpose of medicine is to relieve people's distress and save them from danger, prioritizing life over profit. How can one harbor even a slight sense of jealousy! Yet, modern physicians often possess narrow minds, do not strive for excellence in their art, and become jealous when they encounter someone with superior skills. Once jealousy arises, the harm is incalculable. Some spread rumors, others slander behind backs, some change cold-cooling medicines to hot-warming ones without distinguishing between cold and heat patterns, or vice versa, disregarding patients' lives to satisfy their selfish desires. Their goal is always to obscure the Dao of those who possess it and prevent its practice, thereby fulfilling their jealous intentions.
I frequently observe cases where patients suffer from warm-heat diseases (Wenre Bing). Physicians initially prescribe acrid-cooling (Xinliang) or sweet-cooling (Ganliang) formulas, which are appropriate. However, after one or two doses, if the treatment does not deeply address the pathogen, and the patient continues to experience fever and thirst, causing anxiety and fear, they switch doctors. Even if explicitly informed that previous treatment was administered, the new physician fails to investigate the etiology. Seeing prior use of cold-cooling herbs, they blame the previous doctor for using cold-cooling agents. Without differentiating the pattern's cold or heat nature, the pulse's slow or rapid quality, the tongue coating's yellow or white color, or the urine's clarity or turbidity, they recklessly prescribe hot-warming formulas. They fail to realize that treating a warm-heat disease with hot-warming medicine is like adding oil to fire, instantly depleting body fluids and causing sudden complications. Conversely, if hot-warming medicine was previously used for a cold pattern, they also blame the harm of hot-warming agents, never distinguishing between cold and heat, and recklessly prescribing cold-cooling formulas. They do not know that administering cold-cooling medicine for a cold pattern is like adding frost to snow, immediately causing Yang collapse and Qi depletion, with changes occurring in an instant until critical condition, yet still blaming the previous doctor. This is truly lamentable! There are also cases where a physician openly refutes the previous doctor but secretly follows their method and achieves efficacy, then arrogantly claims credit and demands payment. Such disregard for life in favor of wealth is hardly tolerated by heavenly principles. I advise physicians: do not harbor jealousy, but instead cultivate great compassion; this would be fortunate indeed!
Physicians serve as the foundation for patients and are relied upon by all. If physicians do not deceive themselves, patients will have true reliance. The Way of Medicine requires first detailing the Four Diagnostic Methods (Si Zhen), refining the treatment discussion, observing complexion and listening to voice to differentiate organ diseases, examining symptoms and palpating pulses to distinguish deficiency and excess before treating. Only thus can one claim non-deception. Upon clinical presentation, one must carefully analyze pulse positions: knowing that floating pulses indicate exterior diseases, sunken pulses indicate interior diseases, slow pulses indicate cold diseases, and rapid pulses indicate heat diseases; understanding that enlarged Renying pulses indicate external contraction, while enlarged Qikou pulses indicate internal injury. Furthermore, one must observe the manifestation of five colors (green, red, yellow, white, black), listen to the emission of five tones (jiao, zhi, gong, shang, yu), and inquire about preferences for five odors (pungent, scorched, fragrant, fishy, putrid) to clarify the etiology of the five Zang organs (Liver, Heart, Spleen, Lung, Kidney) and utilize the five flavors (sour, bitter, sweet, pungent, salty) in herbal prescriptions. Those who can achieve this, how could there be deception?
However, certain mediocre practitioners deceive others through absurdity. When encountering patients with alternating chills and fever, they suspect external contraction, deceiving the family by claiming ignorance of diagnostic methods, failing to differentiate pulse deficiency or excess, and recklessly administering dispersing agents. When encountering patients with cough, they suspect consumptive disease, deceiving the family by claiming ignorance of medical theory, failing to differentiate physical strength or weakness, and indiscriminately using tonifying formulas. Ignoring the examination of five colors, five tones, and five odors, how can they clarify Zang organ diseases and apply five-flavor medications? Such individuals not only deceive others but deceive themselves. ... Those who prefer tonics are labeled deficient; those preferring dispersants are labeled with external contraction; those fearing hot-warming drugs are given cold-cooling ones; those fearing cold-cooling drugs are given hot-warming ones. They cater to patients' preferences, recklessly applying formulas, having read no texts below the *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions), relying entirely on deceptive methods. Alas! The medical profession concerns life and death. A single deceitful thought leads to reckless medication, leaving survival uncertain. Why should the method of saving lives be treated as a technique for deception? I hope physicians will aspire to the standards of Xuanyuan and Qibo, keep Zhang Zhongjing in mind, investigate the Four Diagnostic Methods to treat diseases, and never deceive themselves, thus deserving the title of physician.