“The Torah gave permission, etc., and it is a mitzvah, etc.”: There is a difficulty: since in truth it is a mitzvah, why does it call it at first “permission”? It seems that this is the intent of the matter. True healing is through asking for mercy, for from Heaven he has healing, as it is written, “I have struck, and I will heal” (Devarim 32:39). But a person does not merit this; rather, he needs to make healing by the nature of the world, and Hashem agreed to this, and gave healing through the nature of remedies; and this is the giving of permission by HaKadosh Baruch Hu. And since the person has already come to this, there is an obligation on the doctor to do his healing. And this is explained in the Gemara, Perek HaRoeh (Berachos 60a), where Rav Acha said: One who goes in to let blood says, “May it be Your will that this undertaking be for healing for me, and heal me, for You are a faithful G-d, a healer, and Your healing is true; for it is not the way of people to heal.” Rashi explained: that is, they should not have occupied themselves with remedies, but asked for mercy. Abaye said: A person should not say this, for it was taught in the school of Rabbi Yishmael: “And he shall surely heal” (Shemos 21:19): from here, that permission was given to the doctor to heal. It seems that the explanation of the Gemara is this way. Rav Acha required [one] to say these words, “for it is not the way of people,” in the wording of the prayer that one who lets blood says; that is, he excuses himself for seeking healing through bloodletting, which is by nature, even though it is not fitting to do so, but rather to ask for mercy, to be saved by mercy from above: “Even so, since they have already become accustomed to make healing through nature, I too do so; and in any case I acknowledge that everything comes through You, ‘for You are a faithful G-d, a healer.’” And on this Abaye disagrees, [saying] that one should not say “since they have become accustomed,” for the Torah too agreed to this, that there be healing by nature; for the Torah came down to the level of a person’s mind, [knowing] that he will not be so worthy that his healing should come through a miracle from Heaven. And therefore one cannot say that this pasuk, “And he shall surely heal,” teaches us a mitzvah: for if a person were worthy, he would not need this; on the contrary, he would need specifically healing through Heaven. Rather, according to a person’s way, it is permission for him; and therefore now there is an obligation in the matter, and it is a mitzvah, since according to a person’s deeds his life depends on it. So it seems to me, correctly.