今之称医宗者。则曰四大家。首仲景。次河间。次东垣。次丹溪。且曰仲景专于伤寒。自有明以来。
莫有易其言者也。然窃尝考神农着本草以后。神圣辈出。立君臣佐使之制。分大小奇偶之宜。于是不
称药而称方。如内经中所载半夏秫米等数方是已。迨商而有伊芳尹汤液之说。大抵汤剂之法。至商而盛。
非自伊芳尹始也。若扁仓诸公。皆长于禁方。而其书又不克传。惟仲景则独祖经方而集其大成。远接轩
皇。近兼众氏。当时着书垂教。必非一种。其存者有金匮要略及伤寒论两书。当宋以前。本合为一。
自林亿等校刊。遂分为两焉。夫伤寒乃诸病之一病耳。仲景独着一书者。因伤寒变证多端。误治者众。
故尤加意。其自叙可见矣。且伤寒论中一百十三方。皆自杂病方中检入。而伤寒之方。又无不可以治
杂病。仲景书具在。燎如也。若三家之书。虽各有发明。其去仲景相悬。不可以道里计。四家并称。
已属不伦。况云仲景专于伤寒乎。呜呼。是尚得为读仲景之书者乎。金匮要略。正仲景治杂病之方书
也。其方亦不必尽出仲景。乃历圣相传之经方也。仲景则汇集成书。而以己意出入焉耳。何以明之。
如首卷栝蒌桂枝汤。乃桂枝加栝蒌也。然不曰桂枝加栝蒌汤。而曰栝蒌桂枝汤。则知古方本有此名也。
六卷桂枝加龙骨牡蛎汤。即桂枝加龙骨、牡蛎也。乃不别名何汤。而曰桂枝加龙骨牡蛎汤。则知桂枝
汤为古方。而龙骨、牡蛎则仲景所加者也。如此类者。不可胜举。因知古圣治病方法。其可考者。惟
此两书。真所谓经方之祖。可与灵素并垂者。苟有心于斯
道。可舍此不讲乎。说者又曰。古方不可以治今病。执仲景之方。以治今之病。鲜效而多害。此则尤
足叹者。仲景之方。犹百钧之弩也。如其中的。一举贯革。如不中的。弓劲矢疾。去的弥远。乃射者
不恨己之不能审的。而恨弓强之不可以命中。不亦异乎。其有审病虽是。药稍加减。又不验者。则古
今之本草殊也。详本草惟神农本经为得药之正性。古方用药。悉本于是。晋唐以后诸人。各以私意加
入。至张洁古辈出而影响根据附。互相辩驳。反失本草之正传。后人遵用不易。所以每投辄拒。古方不
可以治今病。遂为信然。嗟乎。天地犹此天地。人物犹此人物。若人气薄则物性亦薄。岂有人今而药
独古也。故欲用仲景之方者。必先学古穷经。辨症知药。而后可以从事。尤君在泾。博雅之士也。自
少即喜学此艺。凡有施治。悉本仲景。辄得奇中。居恒叹古学之益衰。知斯理之将坠。因取金匮要略。
发挥正义。朝勤夕思。穷微极本。凡十易寒暑而后成。其间条理通达。指归明显。辞不必烦而意已尽。
语不必深而旨已传。虽此书之奥妙不可穷际。而由此以进。虽入仲景之室无难也。尤君与余有同好。属
为叙。余读尤君之书而重有感也。故举平日所尝论说者。识于端。尤君所以注此书之意。亦谓是乎。
雍正十年壬子阳月。松陵徐大椿叙。
如今被称为“医宗”（医学宗师）的人，说的是“四大家”。排在第一位的是张仲景，其次是刘河间，再次是李东垣，最后是朱丹溪。并且说张仲景专门研究《伤寒论》。自从明朝以来，没有人能改变这种说法。
然而，我私下曾考证过：自神农撰写《本草》之后，神圣般的医生相继出现，确立了君、臣、佐、使的组方制度，区分了大、小、奇、偶方的适宜用法。于是，不再单独称道药材，而是称道方剂，如《内经》中记载的半夏秫米汤等几个方子就是例子。等到商朝时，有了伊尹制作汤液的说法。大体上，汤剂的方法在商朝已经兴盛，并非从伊尹才开始。像扁鹊、仓公诸位先生，都擅长于禁方（秘传之方），但他们的书籍未能流传下来。只有张仲景独自尊崇经方（经典方剂）并集其大成，远接轩辕黄帝时代的医学传统，近兼采各家之长。他当时著书立说以教导后人，必定不止一种著作。现存下来的有《金匮要略》和《伤寒论》两本书。在宋朝以前，这两本书原本合为一部。自从林亿等人校订刊刻后，才分为两部。
其实，《伤寒论》只是众多疾病中的一种病证罢了。张仲景唯独为它写了一本书，是因为伤寒病的变证多种多样，误治的情况很多，所以他特别用心。这从他自己的序言中就可以看出来。而且，《伤寒论》中的一百一十三首方剂，都是从治疗杂病的方剂中检选收录进来的，而治疗伤寒的方剂，又没有不可以用来治疗杂病的。张仲景的书籍就在眼前，清晰明了。至于另外三家（河间、东垣、丹溪）的书籍，虽然各有发明创造，但与张仲景的水平相比，相差悬殊，无法用里程来计算。将这四家并列称呼，已经属于不伦不类，何况还说张仲景专门研究伤寒呢？唉！这还能算是读懂张仲景书籍的人吗？
《金匮要略》，正是张仲景治疗杂病的方书。其中的方剂也不一定全部出自张仲景之手，而是历代圣贤相传的经典方剂。张仲景则是将其汇编成书，并根据他自己的理解进行增减调整。凭什么这样说明呢？比如第一卷中的栝蒌桂枝汤，其实就是桂枝汤加上栝蒌。但它不叫“桂枝加栝蒌汤”，而叫“栝蒌桂枝汤”，由此可知古代方剂本来就有这个名字。第六卷中的桂枝加龙骨牡蛎汤，即是在桂枝汤基础上加入龙骨、牡蛎。但它没有另起一个名字，而称为“桂枝加龙骨牡蛎汤”，由此可知桂枝汤是古方，而龙骨、牡蛎则是张仲景所加的。像这样的情况，数不胜数。因此知道，古代圣人治病的方法，其中可以考证的，只有这两本书。真可以说是“经方之祖”，可以与《灵枢》、《素问》并垂不朽。如果有心于这门学问，难道可以舍弃这两本书不讲吗？
议论的人又说：“古方不能治疗今天的疾病。拿着张仲景的方子来治疗现在的病，很少有效且多有害处。”这一点更令人叹息。张仲景的方剂，就像百钧重的强弩一样。如果射中目标，一举就能穿透皮革；如果不射中目标，弓劲矢疾，反而离目标更远。这是射手不怨恨自己不能仔细瞄准目标，却怨恨弓太强而不能命中，难道不奇怪吗？那些辨证虽然正确，但药物稍微加减后就不见效的，是因为古今的本草（药物学）不同了。详细考察本草，只有神农的《本经》才得到了药物的正性。古方用药，完全依据于此。晋朝、唐朝以后的人们，各自凭私意加入内容，到了张洁古等人出现后，又附会影响，互相辩驳，反而失去了本草的正统传承。后人遵循使用不敢更改，所以每次投药往往被身体排斥拒受。“古方不可以治今病”，于是成了确凿无疑的信条。
唉！天地还是这样的天地，人物还是这样的人物。如果人的禀气薄弱，那么药物的性质也会显得薄弱，难道人现在是现代的，而药物就只能是古代的吗？所以想要使用张仲景的方子，必须先学习古代学问，穷究经典，辨别症状并了解药性，然后才可以从事医疗实践。
尤在泾先生，是一位博学典雅的人士。从小就开始喜欢学习这门技艺。凡是施治，都依据张仲景的理论，往往得到奇妙的疗效。他平时感叹古代学问日益衰微，知道这一道理即将坠落失传。于是选取《金匮要略》，发挥其中的正义（正确义理），早晨勤奋晚上思考，穷尽微妙，探究根本。历经十个寒暑才完成。书中的条理通达，主旨明显，言辞不必繁琐而意思已尽，语言不必深奥而旨趣已传达。虽然这本书的奥妙不可穷尽，但由此进阶，即使进入张仲景的堂室（指深得精髓）也不难。
尤先生与我志趣相投，嘱托我为此书作序。我读了尤先生的书而深有感触。所以举起平日曾经论述过的观点，写在开头。尤先生注释这本书的心意，大概也是这样的吧。
雍正十年壬子年阳月（农历十月），松陵徐大椿作序。
Those who are now referred to as the "Grand Masters of Medicine" (Yi Zong) speak of the "Four Great Schools." The first is Zhang Zhongjing, followed by Liu Wansu, then Li Dongyuan, and finally Zhu Danxi. They also claim that Zhang Zhongjing specialized exclusively in *Shanghan* (Cold Damage diseases). Since the Ming Dynasty, no one has dared to alter this statement.
However, I have privately investigated: since Shennong authored the *Bencao* (Materia Medica), divine and sagely physicians emerged successively, establishing the system of Sovereign, Minister, Assistant, and Courier (Jun-Chen-Zuo-Shi) for prescription composition, and distinguishing the appropriate uses of Major, Minor, Odd, and Even formulas. Consequently, instead of praising individual herbs alone, they praised formulas, such as the Banxia Shumi Decoction recorded in the *Neijing* (Inner Canon). By the time of the Shang Dynasty, there was the theory of Yi Yin creating decoctions (Tangye). Generally speaking, the method of decoctions flourished during the Shang Dynasty; it did not begin with Yi Yin. Figures such as Bian Que and Cang Gong were all proficient in secret prescriptions (Jin Fang), but their books failed to be transmitted. Only Zhang Zhongjing independently revered the Jingfang (Classic Formulas) and synthesized their greatest achievements, extending far back to the medical traditions of the Yellow Emperor (Xuanyuan Huangdi) and closely incorporating the strengths of various schools. When he wrote his books to instruct future generations, there must have been more than one work. What remains today are two books: the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) and the *Shanghan Lun* (Treatise on Cold Damage Diseases). Before the Song Dynasty, these two works were originally combined into one volume. It was only after Lin Yi and others collated and published them that they were separated into two distinct books.
In fact, *Shanghan* is merely one type among many diseases. Zhang Zhongjing dedicated a separate book to it because *Shanghan* presents diverse complications and errors in treatment are common; thus, he paid particular attention to it, as evident from his own preface. Moreover, the 113 formulas in the *Shanghan Lun* were all selected and included from formulas used for treating miscellaneous diseases (Zabing). Furthermore, the formulas for *Shanghan* can generally be applied to treat miscellaneous diseases as well. Zhang Zhongjing's works are available before our eyes, clear and obvious. As for the books of the other three masters, although each made unique contributions, their level differs vastly from Zhang Zhongjing's, a gap too great to measure in miles. To group these four schools together is already incongruous; how much more so to claim that Zhang Zhongjing specialized solely in *Shanghan*? Alas! Can such people be considered those who truly understand Zhang Zhongjing's writings?
The *Jingui Yaolue* is precisely Zhang Zhongjing's manual of formulas for treating miscellaneous diseases. The formulas within it do not necessarily all originate from Zhang Zhongjing himself, but are classic formulas passed down through sages across generations. Zhang Zhongjing compiled them into a book and adjusted them according to his own insights. How do we know this? For example, the Gualou Guizhi Decoction in the first volume is essentially the Guizhi Tang (Cinnamon Twig Decoction) with added Gualou (Trichosanthes Fruit). However, it is not called "Guizhi Jia Gualou Tang" (Guizhi Decoction plus Trichosanthes), but rather "Gualou Guizhi Tang," indicating that the ancient formula originally bore this name. The Guizhi Jia Longgu Muli Tang (Guizhi Decoction plus Dragon Bone and Oyster Shell) in the sixth volume is simply Guizhi Tang with added Longgu (Dragon Bone) and Muli (Oyster Shell). Yet, it does not receive a new name but retains the structure "Guizhi Jia Longgu Muli Tang," showing that Guizhi Tang is an ancient formula, while Longgu and Muli were additions by Zhang Zhongjing. Cases like these are countless. Thus, we know that among the methods of healing employed by ancient sages, the ones that can be verified are only these two books. They are truly the "Ancestors of Classic Formulas," worthy of standing alongside the *Lingshu* (Spiritual Pivot) and *Suwen* (Basic Questions). If one is serious about this path, can one afford to neglect these two texts?
Critics argue: "Ancient formulas cannot treat modern diseases. Using Zhang Zhongjing's formulas to treat contemporary illnesses yields few successes and often causes harm." This point is particularly lamentable. Zhang Zhongjing's formulas are like a powerful crossbow capable of drawing a hundred jun (a unit of weight). If it hits the target, it pierces through leather in one shot; if it misses, the strength of the bow and speed of the arrow cause it to fly even further away from the target. Is it not strange for the archer to blame the bow for being too strong rather than blaming oneself for failing to aim carefully? In cases where the syndrome differentiation is correct, but slight modifications to the herbs result in ineffectiveness, it is because the Bencao (Materia Medica) of ancient and modern times differ. A detailed examination reveals that only Shennong's *Benjing* (Original Classic) captured the true nature of medicinal substances. Ancient formulas relied entirely on this text. After the Jin and Tang dynasties, individuals added content based on personal opinions. When figures like Zhang Jiegu appeared, they further influenced interpretations, engaged in mutual refutations, and lost the orthodox transmission of the Bencao. Later practitioners adhered rigidly to these changes without alteration, causing treatments to be rejected by the body. Thus, "ancient formulas cannot treat modern diseases" became an accepted truth.
Alas! The heaven and earth remain the same, and human beings and creatures remain the same. If human vitality is weak, the properties of medicinal substances may also seem weak. How could humans be modern while medicines remained strictly ancient? Therefore, to use Zhang Zhongjing's formulas, one must first study ancient learning, exhaustively investigate the classics, differentiate syndromes accurately, and understand the properties of herbs before engaging in clinical practice.
Mr. You Zaijing is a learned and elegant scholar. From a young age, he enjoyed studying this art. Whenever he treated patients, he always based his approach on Zhang Zhongjing's principles, often achieving miraculous results. He frequently sighed at the decline of ancient scholarship and feared that this wisdom would soon be lost. Consequently, he selected the *Jingui Yaolue*, expounded upon its correct meanings, studied diligently day and night, explored subtleties, and probed fundamental principles. It took ten years of winter and summer to complete. The logic within is coherent, and the guidance is clear. The language need not be verbose for the meaning to be complete; it need not be obscure for the intent to be conveyed. Although the profundity of this book is inexhaustible, advancing from this foundation makes entering Zhang Zhongjing's inner sanctum (mastering his essence) effortless.
Mr. You shares my interests and requested a preface for his work. Having read Mr. You's book, I felt deeply moved. Thus, I present some points I have discussed previously at the beginning. Mr. You's intention in annotating this book is likely aligned with these sentiments.
Preface by Xu Dachun of Songling, in the tenth month of the Renzi Year, the 10th year of the Yongzheng Reign.