喻嘉言寓意草云。王岵翁深知医理。投剂咸中肯綮。所以长年久世。然苦耳鸣。不乐对
客。其左右侍从。谁能究心医药之事。前病获安。竞以为人参之力。而卸祸者反得居功。谓
其意中原欲用参。但不敢专主。姑进余商榷。以示详慎耳。于是善后之宜。一以诿之。曾不
顾夫一误再误也。前所患虚风症。余用甘寒药二剂稍效。俄焉更医而致危。不得已又召余视
之。虽用旋复代赭二剂回天。然前此虚风本症。尚无暇于驱除。而主家及医。其时方竞夸人
参之力。谓调理更宜倍用。无俟参酌。独不思虚风酝酿日深。他日再求良治。不能及矣。余
向为岵翁视病。言无不听。独患此大病。竟不乐与交谈。且日来喜食羊肉河豚以召风。然亦
不自由也。盖风煽胃中。如转丸之捷。食入易消。不得不借资于浓味。而不知胃中元气。久
从暗耗。设虚风止熄。即清薄之味尚不易化。况于肥甘乎。今之医家。全不究病前病后消息。
明语以虚风之证。竟不知虚风为何物。奈何言医耶。奈何言调摄耶。彼时余适有浙游。旋日
复得重恙。召诊时语余云。一病几危。今幸稍可。但彻夜撰改本章不辍。神乱奈何。余对曰。
胃风久炽。津液干槁。真火内燔。宜用知母一两。人参、甘草各一钱。日进二剂自安。众议
方中用参太少。且无补药佐之。全无取义。竟置不用。连进参、术大剂不效。越三日。剂中
人参竟加一两。服后顷刻气高不返而逝。
按读此案。以自知医理。与平时心服之人。忽为时医蛊惑。侍从尼阻。竟至不能用而死。
可知命之所定。非人力所能主也。嘉言既尽其道。可告无罪于王岵翁。而人言不足恤也。余
因之有感焉。天下事事后易为智。大病一愈。邀功者议补议温。纷纷不一。以致既愈之后。
仍留遗患者有之。垂成忽败者有之。夫大病自我愈之。而善后之计不复一商者。其故有二。
一以胜任有人也。一以酬谢可免也。偷薄之风。适以殒命。堪发一叹。
喻嘉言在《寓意草》中记载：王岵翁深谙医理，用药往往切中要害，因此得以长寿。然而他苦于耳鸣，不愿接待宾客。身边的侍从谁能专心研究医药之事？之前的病症痊愈后，大家都认为是人参的功效，而推卸责任的人反而居功自傲。他们声称，王岵翁原本就想用人参，只是不敢独自决定，姑且进献出来与大家商量，以显示详尽审慎罢了。于是，所有的善后调理事宜都推给别人，全然不顾一错再错的后果。
之前王岵翁患的是虚风证（因正气虚弱感受风邪所致的病证），我用甘寒性质的药物两剂，症状稍有缓解。不久换了医生治疗，导致病情危急，不得已又召我诊治。虽然我用旋复代赭汤（由旋覆花、代赭石等组成的方剂）两剂使病情回转，但此前虚风本症尚未有机会彻底清除。当时主人家和医生正竞相夸大人参的功效，认为调理时更应加倍使用，无需再行斟酌。他们唯独没考虑到，虚风之邪酝酿日久，日后即使寻求良医治疗，也来不及了。
我以前为岵翁看病，他说什么我都听，唯独这次患大病，竟不愿意与我交谈。而且连日来他喜欢吃羊肉和河豚来招致风邪，但这也不是他能自主控制的。因为风邪煽动胃气，消化速度如转丸般快捷，食物吃下去容易消化，不得不依赖浓烈的滋味，却不知道胃中的元气早已暗中消耗。如果虚风停止发作，即使是清淡稀薄的食物还不容易消化，何况是肥甘厚味呢？现在的医生，完全不探究发病前和发病后的机理，明明说是虚风证，却根本不知道什么是虚风，怎么能谈论医学呢？怎么能谈论调养摄生呢？
当时我正好要去浙江游历，几天后回来又得了重病。请我诊脉时，他对我说：“一次病差点死了，现在幸好稍微好转。但我整夜修改文章不停歇，神志混乱怎么办？”我回答说：“胃中风热久盛，津液干枯，真火在内焚烧，应用知母一两，人参、甘草各一钱，每天服用两剂自然安宁。”众人议论方中用人参太少，且没有补药辅助，完全没有取义，竟然放置不用。接连服用大量人参、白术无效，过了三天，方中人参竟然加到了一两，服下后片刻之间气息上逆不能返回而去世。
按语：读这个医案，因为自己懂医理，以及平时心服之人，忽然被当时的庸医蛊惑，侍从阻挠，竟然到了不能用对药而死的地步。可知命运所注定，不是人力所能主宰的。喻嘉言既然已经尽了他的道义，可以向王岵翁问心无愧，也不必理会别人的闲言碎语。我因此有所感慨：天下的事情，事后容易显得聪明。大病刚愈，邀功的人议论用补法、用温法，纷纷不一，导致病愈之后，仍然留下后遗症的患者有之，即将成功却突然失败的也有之。大病是我治好的，但善后的计划不再与患者商量的原因有两个：一是以为有人能胜任；二是为了免除酬谢。这种轻薄的风气，恰恰导致了丧命，令人叹息。
Yu Jiayan recorded in *Yuyi Cao* (Meaningful Grass): Wang Huweng had a profound understanding of medical principles, and his prescriptions often hit the mark precisely, allowing him to live a long life. However, he suffered from tinnitus (ringing in the ears) and was unwilling to receive guests. Who among his attendants could devote themselves to studying medicine? After his previous illness was cured, everyone attributed it to the power of Ginseng Radix et Rhizoma Rubra (Renshen, 人参), while those who had previously opposed its use claimed credit for it. They claimed that Wang Huweng originally intended to use Ginseng but dared not decide alone; he merely presented it for discussion to show thoroughness and caution. Thus, all matters of post-illness care were delegated to others, completely disregarding the consequences of repeated errors.
Previously, Wang Huweng suffered from Xu Feng syndrome (a condition caused by wind pathogen invading due to deficiency of healthy qi). I used two doses of sweet-cold natured herbs, which provided slight relief. Soon after, a different doctor treated him, leading to a critical condition, forcing us to summon me again. Although I used Xuanfu Daizhe Tang (Rehmannia and Hematite Decoction) for two doses to reverse the crisis, the original Xu Bing syndrome had not yet been fully eradicated. At that time, the host family and doctors were boasting about the efficacy of Ginseng, claiming that for convalescence, the dosage should be doubled without further consultation. They failed to consider that as the Xu Wind pathogen accumulated over time, even seeking excellent treatment later would be too late.
When I previously treated Wang Huweng, he listened to everything I said. However, for this serious illness, he refused to converse with me. Moreover, he had been eating mutton and pufferfish to induce wind pathogens, though this was not entirely within his control. The wind pathogen stirs the stomach qi, making digestion as swift as a rolling ball; food is easily digested, necessitating reliance on rich flavors. He did not realize that the primordial qi in his stomach had been secretly depleted. If the Xu Wind subsided, even light and thin foods would be difficult to digest, let alone rich and sweet ones. Current physicians do not investigate the mechanisms before and after the onset of disease. Even when explicitly diagnosing Xu Feng syndrome, they do not know what Xu Feng is. How can they discuss medicine? How can they discuss regimen and health preservation?
At that time, I was traveling to Zhejiang. A few days later, upon my return, I fell seriously ill myself. When summoned to diagnose him, he told me: "I nearly died from one illness; fortunately, I am slightly better now. But I have been revising chapters all night without stopping. What should I do about my chaotic spirit?" I replied: "Stomach wind-heat has persisted for a long time, drying up body fluids, with true fire burning internally. You should use Anemarrhenae Rhizoma (Zhimu, 知母) one liang, Ginseng Radix et Rhizoma Rubra (Renshen, 人参) and Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) each one qian. Taking two doses daily will bring peace." The crowd argued that the amount of Ginseng in the prescription was too small and lacked supporting tonic herbs, rendering it meaningless. They discarded it. Continuous administration of large doses of Ginseng and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) proved ineffective. Three days later, the Ginseng dosage in the prescription was increased to one liang. After taking it, he expired shortly thereafter with upward rushing of qi.
Commentary: Reading this case, despite his own knowledge of medical principles and his usual trust in me, he was suddenly bewitched by contemporary mediocre physicians and obstructed by attendants, ultimately dying because the correct medicine could not be administered. This shows that destiny is determined, not controlled by human effort. Yu Jiayan had fulfilled his duty and could face Wang Huweng with a clear conscience; there is no need to worry about gossip. I am moved by this. In worldly affairs, wisdom comes easily in hindsight. After a major illness recovers, those seeking credit argue for tonifying or warming methods, causing chaos. Consequently, some patients are left with sequelae after recovery, and others fail just as success seems imminent. The major illness was cured by me, yet the plans for convalescence were not discussed with the patient for two reasons: first, believing someone else could handle it; second, to avoid paying gratitude fees. This frivolous and shallow trend leads to death, worthy of a sigh.