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赠医者汤伯高序

[元]揭傒斯

          楚俗信巫不信医,自三代以来为然,今为甚。凡疾不计久近浅深,药一入口不效,即屏去。至于巫,反覆十数不效,不悔,且引咎痛自责,殚其财,竭其力,卒不效,且死,乃交责之曰,是医之误,而用巫之晚也。 终不一语加咎巫。故功恒归于巫,而败恒归于医。效不效,巫恒受上赏而医辄后焉。故医之欲急于利、信于人,又必假邪魅之侯以为容,虽上智鲜不惑。甚而沅湘之间用人以祭非鬼,求利益,被重刑厚罚而不怨恚,而巫之祸盘错深固不解矣。医之道既久不胜于巫,虽有良医且不得施其用,以成其名,而学者日以怠,故或旷数郡求一良医不可致。呜呼,其先王之道不明欤?何巫之祸至此也!人之得终其天年,不其幸欤!

         吾里有徐先生若虚者,郡大姓也。年十五举进士,即谢归业医。人有一方之良,一言之善,必重币不远数百里而师之,以必得乃止。历数十年,其学大成,著《易简归一》数十卷。辨疑补漏,博约明察,通微融敏,咸谓古人复生。其治以脉,不以证,无富贵贫贱不责其报信而治无不效其不治必先知之惟一用巫乃去不顾自是吾里之巫稍不得专其功矣。余行数千里莫能及,间一遇焉,又止攻一门,擅一长而已,无兼善之者。来旴江,得汤伯高,该明静深,不伐不矜,深有类于徐。余方忧巫之祸,医之道不明,坐视民命之夭阏而莫救,而爱高之学有类于徐,且试之辄效,故并书巫医之行利害及徐之本末以赠之。嗟夫,使世之医皆若虚、伯高,信之者皆吾里之人,巫其能久胜矣乎!

          伯高名尧,自号常静处士。若虚棪。闻庐山有郭氏,号南寄者,亦有名。

                                                                                                                                                                                                                              (选择自《揭傒斯全集》

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"Over the years the unthinkable hasbecome thinkable and today we sense we are close to being able to alter humanheredity œ#)." These were the words of David Baltimore of the CaliforniaInstitute of Technology, on December 1st, when he opened a three-day meeting inWashington to discuss the morality and use of human gene editing. Dr Baltimoreis an old hand at these sorts of discussions, for he was also a participant inthe Asilomar conference, in 1975, which brought scientists together to discussa safe way of using the then-new tcchnology of recombinant DNA, and whoserecommendations influenced a generation of biotechnology researchers.

Four decades on, the need for a similarsort of chin-wag has arisen. The InternationalSummit on Human Gene Editing has been held by the national scientific academiesof three countries — America, Britain and China. They are particularlyconcerned about whether gene editing should be used to make heritable changesto the human germ line, something Dr Baltimore described as a deep andtroubling question. Like those of Asilomar, the conclusions of this meetingwill not be binding. But the hope is that, again like Asilomar, a mixture ofcommon sense and peer pressure will create a world in which scientists aretrusted to regulate themselves, rather than having politicians and civilservants do it for them. The meeting is being held against a backdrop of rapidscientific advance, Since 2012 research into a new, easy-to-use editing tool calledCRISPR-Cas9 has blossomed. This technique involves a piece of RNA (a chemicalmessenger, which can be used to recognise a target section of DNA) and anenzyme (酶)called a nuclease that can snip unwanted genes out and paste new ones in.

Public interest was aroused in April,when Chinese scientists announced they had edited genes in non-viable ( 无活力的) humanembryos, and again in November when British researchers said they hadsuccessfully treated a one-year-old girl who had leukaemia ( 白血病),using gene-edited T-cells. T-cells are part of the immune system that attack,among other things, tumour cells. The researchers altered T-cells from ahealthy donor to encourage them to recognise and kill the patient's cancer, tomake them immune to her leukaemia drug, and to ensure they did not attack herhealthy cells.

In another recent development, a firmcalled Edit as Medicine, which is based in Cambridge, Massachusetts, has saidit hopes, in 2017, to start human clinical trials of CRISPR-Cas9 as a treatmentfor a rare genetic form of blindness known as Leber congenital amaurosis (伯氏先天性黑蒙).Though other companies are already testing gene-editing therapies, these employolder, clunkier forms of the technology that seem likely to have lesscommercial potential. Moreover, researchers at the Broad Institute, also inCambridge, said this week that they had made changes to CRISPR-Cas9 whichgreatly reduce the rate of editing errors — one of the main obstacles to thetechnique's medical use.

On the subject of germ-line editing,Eric Lander, the Broad's head, told the meeting it would be useful only in rarecases and said it might be a good idea to "exercise caution? before makingpermanent changes to the gene pool. The need for caution is advice that mightalso be heeded by those pursuing work in animals other than people, and inplants — subjects not being covered by the summit.