荐医为生死攸系。语云贤不荐医诚重之也。余以为贤未始不荐医。特不荐不贤之医耳。
张景
岳曰有或见轻浅之偶中而为之荐者。有意气之私浓而为之荐者。有信其便便之谈而为之荐者
。有见其外饰之貌而为之荐者。又有贪得而荐者阴利其酬。关情而荐者别图异望。甚有斗筲
之辈。妄自骄矜。好人趋奉。熏犹不辨。擅肆品评。誉之则盗跖可为尧舜。毁之则鸾凤可为
鸱。洗垢索瘢。无所不至。而怀真抱德之士必其不侔。若此流者虽其发言容易。休戚无
关。其于淆乱人情。莫此为甚。多致明良有掣肘之叹。病家起刻骨之疑。是非之不明。总为
庸人扰之耳。荐医之关系。不可不察也。
世有半识之流。不知虚实补泻之理。平日略见一二医书。某病用某方。某方用某药。将
谓根据方治病。法无越此矣。又有自己素经有病。曾与医师商治粗晓方药遇有病患亦代胗脉。但见
浮动便曰无事沉伏便曰无脉。摇首咋舌。使人惊骇。真可发笑。噫庸工误人。固已不堪。如
此半识。谬妄尤甚。或主持于亲朋之际。或议论于贤愚之间。颠倒是非。妄高祸福。于是污
下之流。存两可而希苟容。高明之士。怀独见而终不合。纷纷筑室。掣肘贤良。此半识之为
害。不岌岌其危哉。
医为性命之学。生成之主。道大任钜。自唐书列之方技。而缙绅名士。每每不谭。宋太保
林亿公云以至精至微之理而付于至卑至贱之人求其能起人之疾者鲜矣。故世递降而术益鲜。率
多市井亡赖。空门孽秃。略识字画。素饶利辩者为之是人之辱医非医之辱人也若辈学医。初
只挟脉诀快捷方式。汤头歌括。不一二帙。乃就业于庸流之窃有虚名者。奉为明师。教习犯诵。
稍知浮沉迟数四纲。颇明温凉寒热各性。远则一年。近则半载。遂以为道尽传矣。诣已超矣
大开铺肆高揭榜额。不曰某某精传。则曰某某心授。又则曰世传神秘。离经叛道。执方待病
。轻浅偶中。自恃神奇。如是情迷垄断。计熟蝇头。而攀援之心萌矣。念以为非奉二三贵人
为我提掇。何由虚声日播乎。思得当道尊官。践任之后。岂乏延医。乃预谋之胥役隶卒之流
。贿托吹荐。及当道有请。何识贤愚。便信然从之。岂知此辈百凡布置。复密通消息于官衙
从仆。备询何人何证。预得病机。了了心中。及一入诊。语言吻合。根据病处药。治或得验。
俦不艳服为果精良乎。其始也介下役以为进身。今也奉尊官而为广扬。侥有题额。高悬户外
。往来见者承风趋影。亦争传曰彼名医也。甚至士大夫高慧。不免亦坠谷中。叠见疑难重恙
。被其枉死者多矣一遇识者烛破肺腑。词遁计拙。破绽方彰。呜呼如此竞逐邪流。心如青黑
之混。指若锋刃之险。初亦何事不可度活乃至轻易冒医杀人无算乎此古今之通弊也考昔刘伯
温公言曰杭有卖果者善藏柑。涉寒暑不溃。出之烨然玉质而金色。置于市价十倍。人争鬻之
。予买得其一。剖之如有烟扑口鼻。视其中则干若败絮。予怪而问之曰若所市于人者将以实
边豆。奉祭祀。供宾客乎。将 外以惑愚瞽也。甚矣哉为欺也。卖者笑曰吾业是有年矣。吾
业赖是以食吾躯。吾售之。人取之。未尝有言。而独不足子所乎。世之为欺者不少矣。而独
我也乎。此伯温公愤世嫉邪之言也今医者既 外以售柑矣而病者可愚瞽而受戮乎。
推荐医生关系到人的生死存亡。俗话说，贤能之人不轻易推荐医生，这确实是重视这一行为的表现。但我认为，贤能之人并非从不推荐医生，只是不推荐那些不贤能的医生罢了。
张景岳说：有的人因为偶尔碰巧治好了轻浅的病而被人推荐；有的人因为私人情谊深厚而加以推荐；有的人轻信其滔滔不绝的谈吐而推荐；有的人被其外表的修饰所迷惑而推荐；还有的人为了贪图利益而推荐，暗中谋取酬金；有的人出于私情而推荐，另有所图。更有甚者，是些见识短浅、气量狭小之辈，妄自尊大，喜欢别人阿谀奉承，连香草臭草都分辨不清，却擅自肆意品评人物。称赞时，把盗跖（古代大盗）说得像尧舜一样圣明；诋毁时，把鸾凤（神鸟）说得像猫头鹰一样凶恶。他们挑剔瑕疵，无所不用其极，而那些怀有真才实学、品德高尚的人士必然与他们格格不入。像这类人，虽然说话容易，但与他人的利害无关，但他们混淆是非、扰乱人心，没有比这更严重的了。这往往导致明智的良医受到掣肘，让病人家属产生刻骨铭心的怀疑。是非之所以不明朗，总归是被庸俗之人扰乱罢了。推荐医生的关系重大，不可不仔细考察。
世间有一类半吊子懂点医术的人，不知道虚实补泻的道理。平日里稍微看过一两本医书，知道某病用某方，某方用某药，就以为依据方剂治病，方法没有超过这个的了。又有的人自己曾经生过病，曾与医师商量治疗，粗略懂得一些方药，遇到病患也代诊脉。只要见到脉搏浮动就说没事，见到沉伏的脉搏就说无脉，摇头咋舌，使人惊骇，真是可笑。唉！庸医误人，已经不堪忍受，像这种半桶水式的“半识”之徒，谬误狂妄更是严重。他们在亲朋之间主持意见，在贤愚之间发表议论，颠倒是非，妄言祸福。于是，品行低下的人，抱着模棱两可的态度以求苟且容身；高明之士，怀着独到的见解却始终不被接纳。众人纷纷像“三人成虎”那样议论纷纭，掣肘贤良之士。这种“半识”的危害，难道不是岌岌可危吗？
医学是关于性命之学，是主宰生命生成的学问，道义宏大，责任艰巨。自从《唐书》将其列入“方技”一类后，士大夫名流们常常不再谈论它。宋朝太保林亿公曾说：“将极其精微的道理托付给地位最低贱的人，想要找到能治好别人疾病的人，太少了。”所以世风日益下降，医术也越来越稀少，大多是一些市井无赖、寺庙中破戒的僧人，稍微认识几个字，一向擅长利口辩说的人来从事这个行业。这是人的耻辱，而不是医生的耻辱。这些人学医，起初只拿着《脉诀》和《汤头歌括》等几卷书，就去拜师于那些窃据虚名的庸医门下，尊其为明师，教习诵读。稍知浮、沉、迟、数四纲脉象，颇明温、凉、寒、热各药性，远则一年，近则半年，就以为道术已尽，技艺已超群。于是大开铺肆，高挂招牌，不说某某精传，就是说某某心授，又说世代相传的神秘秘方。背离经典，违背正道，拿着固定的方子等待病症，对于轻浅之症偶尔奏效，便自恃神奇。像这样沉迷于垄断利润，算计微小的蝇头小利，攀附权贵之心就萌发了。心想如果不奉承几位贵人让我提携，怎么能使得虚名日日传播呢？想着当权高官上任之后，难道会缺乏延请医生的人吗？于是预先谋划，贿赂胥吏卒役之类的人，委托他们吹嘘推荐。等到当权者有请，哪里分得清贤愚？便相信并听从了他们。哪里知道这帮人百般布置，又秘密向官府中的随从仆役打听消息，详细询问是什么人、什么证候，预先摸清病情机理，心中了然。等到一入诊室，言语吻合，根据病情用药，治疗或许得到验证，谁不羡慕佩服他是果然精良呢？开始时借助下等差役作为进身的阶梯，现在奉承尊贵的官员以广扬名声，侥幸获得题写的匾额，高悬于户外。往来看见的人随风趋影，也争相传说：“那是名医啊！”甚至士大夫中高慧之人，也不免坠入陷阱之中。多次见到疑难重症，被他们枉害致死的人很多了。一旦遇到识者洞察肺腑，谎言遁形，计谋拙劣，破绽才显露出来。呜呼！如此竞相追逐邪流，心如青黑混杂般浑浊，手指如锋刃般险恶，起初有什么事不能度化活人，以至于轻易冒称医生杀人无数呢？这是古今的通病。考察过去，刘伯温公曾说：“杭州有个卖水果的人，善于储藏柑橘，经历寒暑而不腐烂，拿出来光亮如玉质金色。放在市场上，价格十倍于人，人们争着买它。我买了一个，剖开它，好像有烟扑入口鼻，看里面干枯得像破棉絮。我感到奇怪而问他：‘你卖给别人的东西，是用来充实祭器、供奉祭祀、招待宾客呢，还是用来外表迷惑愚蠢盲从的人呢？’欺骗的行为太过分了！”卖果的人笑着说：“我的职业已经多年了，我靠它吃饭，我卖它，人家买它，从未有人说过什么，只是不能满足你的要求罢了。世上欺骗的人不少了，难道只有我吗？”这是伯温公愤世嫉邪的话。现在的医生既然已经在外面像卖假柑一样行骗了，那病人就可以像愚昧盲从的人一样受戮吗？
Recommending physicians is a matter of life and death. As the saying goes, virtuous people do not readily recommend physicians; this indeed reflects the gravity of such an action. However, I believe that virtuous people are not those who never recommend physicians, but rather those who do not recommend unvirtuous ones.
Zhang Jingyue stated: Some are recommended because they occasionally hit upon a cure for a mild or superficial condition; some are recommended due to deep personal affection; some are recommended based on their eloquent speech; some are recommended because they are deceived by their outward appearance; others are recommended out of greed for profit, secretly seeking remuneration; still others are recommended out of personal favor, with ulterior motives. Even worse, there are those of narrow mind and small capacity who are arrogantly conceited, enjoy flattery, cannot distinguish between fragrant herbs and stinking weeds (Xun You, 熏犹), yet arbitrarily pass judgment on others. When praising, they portray Robber Zhi (Daozhi, 盗跖) as sage-like Yao and Shun (Yao Shun, 尧舜); when denigrating, they liken auspicious birds like Luan and Feng (Luan Feng, 鸾凤) to owls (Chi, 鸱). They scrutinize flaws without limit, while men of true talent and virtue inevitably clash with them. Such individuals, though speaking lightly and having no stake in others' fortunes or misfortunes, cause the greatest confusion in human affairs and sentiments. This often leads to wise and capable physicians being hindered, causing patients' families to harbor deep-seated doubts. The lack of clarity regarding right and wrong is entirely due to the disturbance caused by mediocre people. The implications of recommending physicians must be carefully examined.
There exists a class of half-knowledgeable individuals who do not understand the principles of deficiency/excess (Xu Shi, 虚实) and tonification/reduction (Bu Xie, 补泻). Having read one or two medical books, they believe that knowing which formula treats which disease and which herb treats which formula constitutes the entirety of medical practice. Others, having once been ill themselves and discussed treatment with physicians, merely grasp basic formulas and herbs, yet dare to diagnose pulses for others. Upon seeing a floating pulse (Fu Mai, 浮脉), they declare it harmless; upon feeling a deep pulse (Chen Mai, 沉脉), they claim there is no pulse. They shake their heads and click their tongues, causing alarm, which is truly laughable. Alas! Quack doctors harming people is already unbearable; such half-knowledgeable charlatans are even more erroneous and absurd. They dictate opinions among relatives and friends, debate between the wise and the foolish, overturning right and wrong, and recklessly predicting fortune and disaster. Consequently, low-character individuals adopt an ambiguous stance to seek acceptance, while enlightened scholars, holding unique insights, remain isolated. Like building a house amidst many voices (San Ren Cheng Hu, 三人成虎 - idiom for rumors gaining traction through repetition), they hinder the virtuous. The harm caused by such "half-knowledge" is indeed perilous.
Medicine is the study of life and destiny, the master of generation and survival. Its Dao is vast, and its responsibility immense. Since the *Book of Tang* categorized it under "Technical Arts" (Fang Ji, 方技), literati and famous scholars have often ceased discussing it. Lin Yi, Grand Guardian of the Song Dynasty, said, "Entrusting the most subtle and profound principles to those of the lowest status makes it rare to find someone capable of curing diseases." Thus, as society declined, medical skills became scarcer, mostly practiced by market ruffians and defrocked monks who could barely read and were skilled in persuasive speech. This is a disgrace to humanity, not to medicine itself. These individuals begin learning medicine by memorizing the *Pulse Rhymes* (Mai Jue, 脉诀) and *Formulas for Decoctions* (Tang Tou Ge Kuo, 汤头歌括). They then apprentice under quacks with false reputations, treating them as illustrious masters. After briefly understanding the four major pulse categories (Floating, Deep, Slow, Rapid - Fu Chen Chi Shu, 浮沉迟数) and the properties of warming, cooling, cold, and hot herbs, taking anywhere from six months to a year, they believe their knowledge is complete and superior. They open shops, hang large signs claiming secret transmissions or heart-to-heart teachings, deviating from classics and opposing orthodoxy. They apply fixed formulas to diseases, achieving occasional success with mild conditions, and pride themselves on their miraculous skills. Obsessed with monopolizing profits and calculating petty gains, their desire to climb social ladders arises. They think, "Without flattering a few nobles to promote me, how can my fame spread?" Anticipating that high officials will need doctors upon taking office, they bribe clerks and runners to spread recommendations. When officials request a doctor, unable to discern wisdom from folly, they accept these recommendations blindly. Unaware that these schemers coordinate with palace servants to learn the patient's identity and symptoms beforehand, ensuring their diagnosis matches the pre-learned pathology. Once diagnosed, their words align perfectly, and prescriptions may yield results, leading everyone to admire them as genuinely skilled. Initially using low-ranking clerks as stepping stones, they now flatter high officials for promotion, hoping to receive honorary plaques displayed outside. Passersby follow the trend, spreading rumors that "he is a famous physician." Even wise scholars fall into this trap, encountering difficult cases where many die unjustly at their hands. Only when an expert pierces through the deception do their lies fail and flaws appear. Alas! Competing in such corrupt streams, hearts muddy as black and green mixed together, fingers sharp as blades, what couldn't they achieve if they acted properly? Yet they recklessly pose as doctors, killing countless people. This is a universal flaw throughout history. Consider the words of Liu Bowen: "In Hangzhou, there was a fruit seller who preserved citrus fruits so well that they remained fresh through seasons, shining like jade and gold. Sold at ten times the price, people competed to buy them. I bought one, cut it open, and smoke hit my nose; inside, it was dry and rotten like broken cotton. I asked him, 'Do you sell this to fill ritual vessels, offer sacrifices, or entertain guests? Or do you deceive the ignorant with its appearance?' His deception is extreme!" The seller laughed, "I have done this for years; it feeds me. People buy it, no one complains. It just doesn't satisfy you. There are many deceivers in the world, am I the only one?" These were Liu Bowen's words expressing indignation against worldly evil. Today, since doctors deceive externally like selling fake citrus, can patients be allowed to suffer slaughter like the deceived?