坡公曰天下之患。莫大于不知其然而然。不知其然而然者是拱手而待乱也。以故明者识
气化
于未然。及病已成。虚强半矣。始发方剧。盒饭急治。然邪在经者一剂可愈。传腑者数四方
瘳。至入脏则百无一生。故华君擅剖腹之能。秦缓鲜膏肪之治。非工之巧拙不同特病之浅深
悬殊耳。经云病势已过。命将难全。可不致思。
病机初发。盒饭择医。始若错治。终必败亡。今姑以伤寒阴阳二症言之。阳症初见。头痛如
破。腰背拘急。体热如焚。喘渴不休。狂谵时增。见者谁不惊危。但其脉与症合。得治即愈
。势固可忧。病实无害为只传经伤腑而非中藏也独是阴症始见。头不甚痛体不甚热。饮食失
常。脐腹微痛。大便不实。或呕吐便利。奄奄忽忽只见倦怠岂料藏气已亏脉少胃气隐中大异
若知急投温剂。何至因循丧生。乃医者不识便谓无虞非投发表。则用清解。稽延数日病已入
脏。渐次增剧。死机呈矣。虽有卢扁。莫能为也盖阳之气暴而阴之气缓阳之性刚而阴之性柔
阳之病在外浮而易见而阴之病在内沉而难觉故人常情但慎于阳而忽于阴而医者亦不识阴阳虚
实。见病治病。往往误人于死。何可胜数为此切告患者始病择医。不可不谨。生死系之矣。
愚按郭猷甫云深怪讳疾忌医之人分明怕死。又怕人知死。意以今日之病。恐仇人知则喜。或
贪淫所致。又恐亲人知则怒。故病已笃犹自回护。独不思事势到此。何不早言。或有病经过
者犹前车戒后辙。或有知某病经某明医者速求治疗。自然得愈。断不可因人喜怒。而戕自己
性命。语云∶才欲藏。病欲露。善夫。
苏轼说：天下的祸患，没有比不知道原因却任其发展更大的了。不知道原因却任其发展，就是拱手等待动乱发生。因此，明智的人在疾病尚未形成时就识别气化的变化。等到疾病已经形成时，人体的正气和邪气各占一半（虚实参半）。刚发病时病情正剧烈，应当立即治疗。然而，病邪在经络的，一剂药即可痊愈；传入腑的，用几个方子就能治愈；至于进入脏的，则百无一活。所以华佗擅长剖腹手术的技能，秦缓（扁鹊）很少有使用膏脂外治法的机会，这并不是医生技巧的高下不同，而是疾病的深浅悬殊罢了。《内经》说：病势已经过去，生命将难以保全。怎能不深思呢？
病机初发时，应当选择医生。如果开始误治，最终必然导致败亡。现在姑且以伤寒病的阴证和阳证来说明。阳证刚开始出现时，头痛如破，腰背拘急，身体发热如火烧，气喘口渴不止，狂躁谵语时常增加，看到的人谁会不惊惧危急？但是，只要脉象与症状相符，得到正确治疗即可痊愈。虽然形势令人担忧，但病实际上没有大害，因为只是传经伤腑，而不是损伤内脏。唯独阴证刚开始出现时，头不怎么痛，身体不怎么热，饮食失常，脐腹微痛，大便不成形，或者呕吐、大小便失禁，气息微弱恍惚，只见倦怠，哪里料到脏腑之气已经亏损？脉象中胃气隐伏，与阳证大不相同。如果知道立即投用温补药剂，怎么会因拖延而丧生？然而医生不认识（这是阴证），便认为没有危险，不是用发表的方法，就是用清解的方法，拖延数日，病已入脏，逐渐加重，死机呈现。即使有卢医（卢跗）和秦越人（扁鹊），也无能为力了。大概阳证的气暴烈，阴证的气缓慢；阳证的性质刚强，阴证的性质柔和；阳证的病在外，浮浅而易见，阴证的病在内，深沉而难觉。所以人们常情只谨慎对待阳证而忽视阴证，而医生也不认识阴阳虚实，见到病症就治疗病症，往往把人置于死地，这样的例子多得数不清。为此，恳切告诫患者，生病之初选择医生，不可不谨慎，生死系于此啊。
我按语：郭猷甫说，深深责怪那些讳疾忌医的人，明明怕死，又怕别人知道自己要死了。心想现在的病，恐怕仇人知道了会高兴，或者是贪淫所致；又恐怕亲人知道了会生气。所以病已经很重还自我掩饰。只是不想想事情到了这一步，为什么不早说。或者有病经过的人，还是前车之鉴后车之戒；或者有知道某种病经过某位名医治愈的，迅速求治，自然能痊愈。绝不能因为别人的喜怒，而残害自己的性命。俗话说：才想要隐藏，病想要显露。说得真好。
Su Shi said: The greatest disaster in the world is not knowing the cause yet allowing it to proceed. Not knowing the cause yet allowing it to proceed is equivalent to standing with hands folded, waiting for chaos. Therefore, the wise recognize changes in Qi transformation (气化) before the disease manifests. By the time the disease has formed, the body's deficiency and excess are balanced (虚强半). When the disease first erupts, it is intense, and urgent treatment is required. However, if the pathogenic factor is in the meridians (Jing), one dose can cure it; if it transmits to the Fu organs (Zang-Fu theory), a few prescriptions can bring relief. But once it enters the Zang organs, less than one in a hundred survives. Thus, Hua Tuo excelled in abdominal surgery, while Qin Huan (Bian Que) rarely had the opportunity to use plaster treatments. This is not due to differences in the skill of physicians, but rather the disparity in the depth of the diseases. The Classics state: "If the momentum of the disease has passed, life will be hard to preserve." How can one fail to reflect deeply on this?
When the pathogenesis initially emerges, one should carefully select a physician. If treated incorrectly at the beginning, failure and death will inevitably follow. Let us now discuss Yin and Yang syndromes of Cold Damage (Shanghan) as examples. At the initial stage of a Yang syndrome, symptoms include headache as if splitting, stiffness and tension in the waist and back, body heat like burning, incessant panting and thirst, and frequent episodes of mania and delirium. Who would not be alarmed by such signs? However, if the pulse matches the symptoms, proper treatment leads to recovery. Although the situation is worrying, the disease itself is not fatal, as it only transmits through the meridians and affects the Fu organs, without damaging the Zang organs. Conversely, when a Yin syndrome first appears, the headache is mild, the body heat is low, appetite is irregular, there is slight pain in the umbilical and abdominal regions, loose stools, or vomiting and incontinence. The patient appears weak and lethargic, unaware that the Qi of the Zang organs is already depleted. The pulse shows a hidden Stomach Qi (Wei Qi), significantly different from Yang syndromes. If warm tonifying formulas were administered immediately, how could one perish due to delay? Yet, physicians who do not recognize this condition assume there is no danger, using either diaphoretic methods (Fa Biao) or clearing and resolving methods (Qing Jie). After several days of delay, the disease enters the Zang organs, worsens gradually, and signs of death appear. Even with the skills of Lu Yi (Lu Fu) or Bian Que, nothing can be done. Generally, Yang Qi is rapid, while Yin Qi is slow; Yang nature is rigid, while Yin nature is soft; Yang diseases are external, floating, and easy to detect, whereas Yin diseases are internal, deep, and difficult to perceive. Therefore, people generally exercise caution regarding Yang conditions but neglect Yin conditions. Physicians who fail to distinguish between Yin/Yang and Deficiency/Excess, treating symptoms merely as symptoms, often lead patients to death, an occurrence too numerous to count. Hence, I earnestly advise patients: when selecting a physician at the onset of illness, one must be extremely cautious, for life and death depend on it.
In my commentary: Guo Youfu expressed deep astonishment at those who conceal their illness and fear medical treatment. They clearly fear death, yet also fear others knowing they are dying. They worry that enemies would rejoice upon hearing of their illness, perhaps caused by lustful indulgence, or that relatives would be angered. Thus, even when the illness is severe, they continue to cover it up. They fail to consider that at this stage, why not speak out early? Those who have experienced illness should serve as a warning to others. If one knows of a specific illness cured by a renowned physician, seeking treatment promptly naturally leads to recovery. One must never sacrifice one's own life due to the pleasure or anger of others. As the saying goes: "Conceal your intentions, but reveal your illness." How true this is.