或问∶古之上工，先精学业，次达人事，见机而作，圆融通变，所谓症同而治异者，有诸？曰∶夫人病有男
妇婴娃，鳏寡老弱，胎前产后，久因新感，虚实轻重，与夫平时之性气，近日之苦乐，曾否服药，已未成症，千
态万状，不可胜纪，安可一概而施。或曰∶今之时手，有易于富贵、难于贫贱，有贫更易于富、贵更难于贱，所
谓治同而效异者何为？曰∶纨绮之属，多志乐性骄，博奕饮酒，云雨不节，一有所忤，暴怒叫跳，再或好猎、好
地、好讼，不舍昼夜，致五内之火俱动，且汤液委之僮妇，煎制切恐失宜，责以近功速应，难矣。至若起居颐养，
从心所欲，堂上一呼，阶下百诺，则此似为易易。清操家命苦形劳，菽粟往往不继，遑计药料，一暴十寒，调燮
大费工程。
至若风露经惯，些须外邪，驱之便去，即藜藿素虚，随与甘温重剂，一补而愈。或曰∶人生斯世，行乐及时，维
情维欲，贤不肖皆不免而难戒。但他病肢体疲癃，诸缘放下，不戒犹戒也。目病虚实皆火，精力时与平居争强，
所可守者其身，而不可问者其心，戒犹未戒也。必不得已而去，不知何者为先，曰怒与色，下而赌。盖怒似风狂，
于象为雷，语曰雷自木发，枯根引之。且雷风相搏，非木不助其威。是以圣人作《易》，凡涉乎震体者，示警尤
严焉。色为情祖，一名肾贼，人身脏腑皆火，赖此一点真水以滋之，岂可暴殄。丹溪曰∶人心君火一动，相火即
起，虽不交而精亦暗流。彼阴虚火动，不自将息，反假房事以泄其火，转恐火未熄而焰愈炽，焰愈炽则势益举，
交益久，泄益多，宁有不竭之精，不丧之元者乎？赌博，犯法伤财，而游民浪子视若性命，庭镜实不能解。谓其
贪得使然，顾挥金若土，全不珍惜。谓其遣怀而致，却角气焦思，神常失守，甚而典买净尽，廉耻罔顾，其不为
梁上君子几希。夫目为肝肾外候，未有外病而内无恙者。不去乎此三事，则轻证变重，重证变为不治。司是业者，
当直言无隐，不则善为辞以讽之，或先是其所以取怒牵情之故，逮机投言进，徐徐以理劝其可止，自然气平心冷，
用药任错综变化，靡不合道，虽症有不同而治效则一，庶本科无不起之病云。
有人问：古代的良医，先精通医术，其次通晓人情世故，洞察时机而行动，灵活变通，这就是所谓的“症状相同但治疗方法不同”，有这样的情况吗？回答说：人的疾病有男女、婴儿儿童、单身、年老体弱之分，还有产前产后、久病新感、虚证实证、病情轻重，以及平时的性格脾气、近日的生活苦乐、是否服用过药物、病症是否已经形成等，千姿百态，数不胜数，怎么能一概而论地施治呢？
又有人说：现在的庸医，对富贵之人容易治疗，对贫贱之人难治；有的贫贱者反而比富贵者好治，富贵者更难治。所谓“治疗方法相同但疗效不同”是怎么回事？回答说：那些富贵子弟，大多志向享乐、性情骄纵，沉迷于赌博饮酒，房事不节制，一旦有所违逆，便暴怒狂跳，或者喜好打猎、争田产、打官司，日夜不休，导致五脏六腑之火都躁动不安。而且汤药交给童仆妇人煎煮，恐怕制作不当，还要求他们迅速见效，这很难做到。至于那些起居安逸，随心所欲，一声呼唤，百人应诺的人，看起来似乎很容易治疗。而那些清廉持家、生活困苦、形体劳损的人，连基本的饮食都常常接济不上，哪里顾得上药材费用，治疗断断续续，调养非常费力。
至于那些经受风霜雨露惯了的人，稍微有点外邪侵袭，驱散就痊愈了；即使是体质素来虚弱的人，只要给予甘温的重剂，一补就能痊愈。
又有人说：人生在世，及时行乐，情感和欲望，无论贤能还是不肖之人都难免，难以戒除。但是其他疾病只是肢体疲乏无力，各种杂念放下，不戒也如同戒了一样。唯独眼病，无论是虚证还是实证都涉及火邪，精力时常与平日的状态争夺强弱，身体可以守护，但内心却不可控，所以即使想戒也难以戒除。如果非要在这三者中去掉一个，不知道哪个应该优先，我说应该是愤怒和色欲，其次是赌博。大概愤怒像风一样疯狂，在卦象中对应雷，俗话说雷从木发，枯根引动它。而且雷风相搏，没有木的助长就没有威力。所以圣人作《易经》，凡是涉及震卦（代表雷、动）的内容，警示尤为严厉。色欲是情感的根源，又名肾贼，人身脏腑都是火，依赖这一点点真水来滋润，怎么可以肆意糟蹋。朱丹溪说：人心君火一动，相火随即而起，即使不发生性交，精液也会暗中流失。那些阴虚火旺的人，不自我调养，反而借房事来泄火，恐怕火没熄灭，火势反而更旺，火势越旺，势头越猛，交合时间越长，泄精越多，哪有精气不枯竭、元气不丧失的呢？赌博，既犯法又伤财，但游民浪子却视若性命，我黄庭镜实在无法理解。说是为了贪得，却又挥金如土，毫不珍惜。说是为了排遣情怀，却又争强好胜、焦虑思虑，精神经常失守，甚至典卖财产净尽，不顾廉耻，离成为梁上君子（小偷）不远了。眼睛是肝肾的外候，没有外部有病而内部安然无恙的。如果不戒除这三件事，轻症会变重，重症会变成不治之症。从事眼科治疗的医生，应当直言不讳，如果不这样，就要善于言辞来讽喻他，或者先指出引起愤怒和情感牵绊的原因，等到时机成熟再进言，慢慢用道理劝说他停止，自然气平心静，用药无论怎样错综变化，无不合乎道义，虽然症状不同但治疗效果一致，这样本学科就没有治不好的病了。
A person asked: "Do ancient excellent physicians first master their profession and then understand human affairs, acting upon opportunities with flexibility and adaptability? Is it true that 'the same symptoms may require different treatments'?" The reply was: "Diseases in humans vary by gender (male/female), age group (infants/children), marital status (widowed/single), and physical condition (elderly/weak). There are also distinctions between pre-natal/post-natal states, chronic versus acute conditions, deficiency versus excess patterns, severity of illness, as well as individual temperaments, recent life circumstances (suffering or joy), whether medication has been taken, and the stage of disease development. These present in thousands of forms, too numerous to record. How can one apply a uniform treatment?"
Another said: "Current mediocre physicians find it easier to treat the rich and noble but difficult to treat the poor and lowly; yet some find the poor easier than the rich, and the noble harder than the lowly. What is meant by 'the same treatment yields different effects'?" The reply continued: "Those from wealthy families often have indulgent minds and arrogant natures, engaging in gambling, drinking, and unregulated sexual activity. When provoked, they fly into violent rages. They may also indulge in hunting, land disputes, or litigation day and night, causing fire in the five zang organs to flare up. Moreover, herbal decoctions are prepared by servants or women, likely leading to improper processing. Demanding rapid results under such conditions is difficult. Conversely, those who live in comfort, doing as they please, with many attendants responding to their calls, seem easy to treat. In contrast, those who maintain integrity but suffer poverty and physical labor often lack even basic food supplies, let alone money for herbs. Their treatment is intermittent ('one day exposed to sun, ten days in cold'), making recuperation a massive undertaking."
"Furthermore, those accustomed to wind and rain recover quickly from minor external pathogens. Even those with inherent weakness can be cured with a single dose of heavy sweet-warm formulas. Another objection arises: 'Humans seek pleasure in this world; emotions and desires are unavoidable for both virtuous and unworthy people, making them hard to restrain.' However, for other diseases involving limb fatigue, once worldly concerns are set aside, restraint becomes natural. But eye diseases involve fire in both deficiency and excess patterns. Vital energy constantly competes with normal states. While the body can be guarded, the mind cannot be controlled; thus, restraint remains elusive. If forced to choose which to eliminate first among anger, lust, and gambling, I say anger and lust take precedence, followed by gambling. Anger resembles wild wind and corresponds to Thunder in the Bagua. As the saying goes, 'Thunder originates from Wood'; dry roots attract it. Thunder and Wind interact, gaining power from Wood. Therefore, in the *I Ching* (Book of Changes), warnings regarding the Zhen trigram (representing Thunder/Movement) are particularly strict. Lust is the ancestor of emotion and a thief of the Kidney. All internal organs contain fire, sustained only by a drop of True Water (Jin-Ye). How can one squander this? Zhu Danxi stated: 'When the Minister Fire of the Heart moves, the Ministerial Fire rises. Even without intercourse, essence flows secretly.' Those with Yin deficiency and hyperactive fire fail to rest themselves but instead use sexual activity to vent fire. This risks extinguishing the fire while simultaneously intensifying the flames. The stronger the fire, the greater the momentum; the longer the intercourse, the more essence is lost. Can essence remain inexhaustible and Yuan Qi (Original Qi) undamaged?"
"Gambling violates laws and depletes wealth, yet vagrants view it as life itself. Huang Tingjing finds this incomprehensible. One might argue it stems from greed, yet they spend gold like dirt without cherishing it. Or perhaps it is for emotional release, yet it leads to competitive anxiety and mental instability, resulting in total asset liquidation and disregard for dignity, coming close to becoming thieves. The eyes are the external manifestation of the Liver and Kidneys. No external pathology exists without internal imbalance. If these three vices are not abandoned, mild cases worsen, and severe cases become incurable. Practitioners must speak frankly without concealment. If not, they should use tactful language to admonish patients, first addressing the causes of anger and emotional attachment. When the time is right, gently persuade them with reason. Naturally, anger will subside and the heart will cool. Then, regardless of how complex the prescription changes, it will align with Dao principles. Although symptoms differ, therapeutic effects will be consistent, ensuring no disease in this specialty remains untreatable."