扁鹊论医病有六不治∶骄恣不论于理,一不治也;轻身重财,二不治也;衣食不
能适,三不治也;阴阳并脏气不定,四不治也;形羸不能服药,五不治也;信巫不
信医,六不治也。云林子曰∶越人之论,一、三、四、五、六是矣,二则于予心有未适
然者,何也?轻者,彼轻也,重者,彼重也,彼轻而我重之,则彼之生,可活矣。不
然彼以一吝而丧生,固病者之不智,予以一吝而不治,亦医者之不仁。噫!古之神
医如此意犹存,则世医可知矣。
(无名氏辑)
医士贫富一体,细心审察定方,疗一轻疾,不取酬。(一功。)疗一关系性命重疾,
虽取酬。(准十功。)不取酬者。(准百功。)若待极
贫人,并能施药不吝,照钱数记功。(虽一剂药不满十文,亦准一功。)倡募刻一济人善书。
(随缘乐助易,倡首劝募难,故特记五十功,助者以施之多寡记功。)为师就一人学业,品行兼全。(准
百功。)遇贫人危疾,助医药钱米。(百钱,准一功。贫人偶为之者,虽十钱、五钱与百钱同论。)疫
疠设局施药施医。(百钱,准一功。)普施应病丸散膏药。(百钱,准一功。)刻施经验良方。(百
钱,准一功。)秘一经验方。(二十过。)误一门人。(五十过。)
(山左邢尚卿讳朝耀辑)
诊脉不轻率。用药极慎重。虽贵药勿减分两,遇急病请到即行。不因钱少银低
迟滞。不因饮酒宴乐推辞。不因严寒暑雨,惮于远赴。不因错认病证,曲自回护。认
病不真实,必令邀医会议。细心询问病由,不可以病试药。不用霸道药,求其速效。不
用相反药,迟其痊愈。(疾本易治,故意延之,以图浓谢,外科尤甚,造恶莫大焉。)不因重病险疮,
背勒浓谢。不与同道水火,误及病患。(上二条医家尤多犯,此弊最宜痛戒。)不妄惊病家。不哄
用假药。(丸散尤戒。)不轻忽贫贱病患。肯捐药救治贫病。施效验方。禁打胎药。不先待
药资到手,然后发药。不定乘车轿费人财物。不图省便,将药同器浸制。不因行得
高抬声价难人。不方秘,不传假方与人。
扁鹊论述治病有六种情况是不予治疗的:骄傲放纵、不讲道理,这是第一种不予治疗的情况;轻视身体而看重钱财,这是第二种不予治疗的情况;饮食起居不能适应调节,这是第三种不予治疗的情况;阴阳失调且脏腑之气不稳定,这是第四种不予治疗的情况;身体极度消瘦虚弱以至于无法服药,这是第五种不予治疗的情况;信奉巫师而不信任医生,这是第六种不予治疗的情况。
云林子说:“越人(即扁鹊)的论述中,第一、第三、第四、第五、第六种情况是对的,但第二种情况让我心里有些不适,为什么呢?‘轻’和‘重’是患者自己的看法,如果患者看轻病情而我看重它,那么患者的生命就可以挽救了。否则,患者因为吝啬而丧命,固然是患者不明智;我因为患者吝啬就不去治疗,也是医者缺乏仁爱之心。唉!古代神医尚且存有这种心意,那么当代的医生就可想而知了。”
(无名氏辑录)
医生对待贫富患者应一视同仁,细心诊察以确定处方。治愈一种轻微疾病,不收取报酬。(记为一功。)治愈一种关乎性命的重要重症,即使收取报酬。(折算为十功。)完全不收取报酬的。(折算为一百功。)如果遇到极其贫困的人,并能慷慨施药,按照金钱数量记录功德。(即使一剂药不满十文钱,也折算为一功。)倡导募捐刻印一本济世救人的善书。(随缘乐善资助容易,带头劝募困难,所以特别记录五十功,协助者根据施舍的多寡记录功德。)收徒传授一人学业,且品行兼备。(折算为一百功。)遇到贫困者的危重疾病,资助医药费和米粮。(一百钱,折算为一功。贫困者偶然为之,即使是十钱、五钱与一百钱同等论处。)在瘟疫期间设立机构施药施医。(一百钱,折算为一功。)普遍施送对症的丸散膏药。(一百钱,折算为一功。)刻印并施送经验良方。(一百钱,折算为一功。)隐瞒一个经验方。(记为二十过。)误导一名门徒。(记为五十过。)
(山东邢尚卿名朝耀辑录)
诊脉不轻率。用药极慎重。虽然是贵重药材也不减少分量,遇到急病接到邀请立即前往。不因报酬少或银两成色低而拖延。不因饮酒宴乐而推辞。不因严寒酷暑雨天而害怕远行。不因误认病证而曲意自我庇护。对病症认识不真实,必定要求邀请其他医生共同会诊。细心询问病因,不可以用病人来试探药物。不使用霸道猛烈的药物以求速效。不使用相反相激的药物,从而延误痊愈。(疾病本来容易治疗,故意拖延以图厚谢,外科尤其严重,造下的罪恶没有比这更大的了。)不因重病险疮,背后勒索厚谢。不与同行结怨争斗,从而误及病患。(以上两条医生最容易犯,这种弊端最应当痛加戒除。)不随意惊吓病人家属。不用假药欺骗。(丸散类药物尤其要戒除。)不轻慢贫贱的病人。愿意捐药救治贫病之人。施送有效验方。禁止提供堕胎药物。不先等待药资到手,然后才发药。不贪图节省便利,将药物同器浸泡制作。不因行为高尚抬高声价而让人难堪。不秘方保密,不传假方给人。
Bian Que discussed six conditions under which diseases are not to be treated: arrogance and indulgence without regard for reason, this is the first condition for non-treatment; despising one's health while valuing wealth, this is the second condition for non-treatment; inability to adapt diet and daily life, this is the third condition for non-treatment; disorder of Yin and Yang with unstable Zang-Fu Qi (Vital Energy of the internal organs), this is the fourth condition for non-treatment; extreme emaciation and weakness such that medication cannot be taken, this is the fifth condition for non-treatment; believing in shamans but not trusting doctors, this is the sixth condition for non-treatment.
Yun Linzi said: "Among Yue Ren's (i.e., Bian Que's) discussion, the first, third, fourth, fifth, and sixth conditions are correct, but I feel somewhat uncomfortable with the second condition. Why? 'Light' and 'heavy' refer to the patient's own perception. If the patient considers their condition light but I consider it heavy, then the patient's life can be saved. Otherwise, if the patient loses their life due to stinginess, it is indeed the patient's lack of wisdom; but if I refuse to treat them because of their stinginess, it is also the doctor's lack of benevolence. Alas! Even ancient divine physicians harbored such sentiments, so one can imagine the state of contemporary physicians."
(Compiled by Anonymous)
Physicians should treat patients regardless of wealth or poverty equally, carefully examining to determine prescriptions. Curing a mild disease without accepting remuneration counts as one merit. Curing a severe, life-threatening illness, even if remuneration is accepted, counts as ten merits. Not accepting any remuneration counts as one hundred merits. When encountering extremely poor individuals and generously providing medicine, merit is recorded according to the monetary value. (Even if one dose costs less than ten wen, it counts as one merit.) Advocating and fundraising to carve and print a book of charitable deeds for saving people. (Voluntary donations are easy, but leading the fundraising is difficult, so fifty merits are specifically recorded; helpers record merits based on the amount donated.) Teaching one apprentice both academic skills and moral character counts as one hundred merits. Assisting with medical expenses and rice for poor patients in critical condition: one hundred coins count as one merit. For occasional acts by the poor, whether ten, five, or one hundred coins, they are judged equally. Setting up clinics to provide medicine and medical services during epidemics: one hundred coins count as one merit. Universally distributing effective pills, powders, ointments, and plasters for specific ailments: one hundred coins count as one merit. Carving and distributing proven good prescriptions: one hundred coins count as one merit. Concealing a proven prescription counts as twenty demerits. Misleading an apprentice counts as fifty demerits.
(Compiled by Xing Chaoyao from Shandong)
Pulse diagnosis is not done rashly. Medication use is extremely cautious. Even for expensive herbs, the dosage is not reduced. In cases of acute illness, one goes immediately upon invitation. One does not delay due to low remuneration or poor quality silver. One does not decline due to drinking banquets. One does not fear traveling far due to severe cold, heat, or rain. One does not cover up errors in diagnosing the condition. If the understanding of the disease is not accurate, other physicians must be invited for joint consultation. Carefully inquire about the cause of the illness; do not test drugs on patients. Do not use harsh/potent drugs seeking rapid effects. Do not use contradictory drugs that delay recovery. (Diseases may be easy to cure, but deliberately prolonging them to seek larger rewards is a great evil, especially in surgery.) Do not extort large rewards behind the scenes for severe illnesses or dangerous sores. Do not engage in rivalry with colleagues, thereby harming patients. (The above two points are frequently committed by physicians; this malpractice should be strictly warned against.) Do not casually frighten the patient's family. Do not deceive with fake medicines. (Especially avoid this for pills and powders.) Do not slight patients of humble status. Be willing to donate medicine to save the poor and sick. Distribute effective prescriptions. Prohibit abortion-inducing drugs. Do not wait for payment before dispensing medicine. Do not demand excessive travel fees or property. Do not save trouble or cost by soaking different medicines together in one vessel. Do not inflate one's reputation through arrogant behavior to make others uncomfortable. Do not keep formulas secret, nor give fake formulas to others.