或以劳倦伤脾。或以忧思伤脾。或以饥饱伤脾。病有缓急。不得不以急者为先务。此真知杲者也。前有元好问序。
考遗山文集。有杲所着伤寒会要引一篇。备载其所治验，元史方伎传全取之。而此序独不见集中。意其偶有散佚
欤。又有罗天益后序一篇。天益字谦父。杲晚年弟子。尽得其传。元砚坚东垣老人传。称杲临终取平日所着书。
检勘卷帙。以次相从。列于几前。嘱谦父曰。此书付汝者。即其人也。
〔兰室秘藏〕国史经籍志三卷 存
四库全书提要曰。兰室秘藏三卷。金李杲撰。其曰兰室秘藏者。盖取黄帝素问藏诸灵兰之室语。前有至元丙
子罗天益序。在杲殁后二十五年。疑即砚坚所谓临终以付天益者。
也其治病分二十一。门以饮食劳倦居首。他如中满腹胀。如心腹痞。如胃脘痛诸门。皆谆谆于脾胃。盖其所独重也。
东垣发明内伤之类外感。实有至理。而以土为万物之母。脾胃为生化之源。脾虚损论一篇。极言寒凉峻利之害。
尤深切着明。盖预睹刘张两家末流攻伐之弊。而早防其渐也。至于前代医方。自金匮要略以下。大抵药味无多。
故唐书许允宗传。记允宗之言曰。病之于药。有正相当。惟须单用一味。直攻彼病。药力自专。病即立愈。今人
不能别脉。莫识病证。以情臆度。多安药味。譬之于猎。未知兔所。多发人马。空地遮围。或冀一人偶然逢也。
如此疗病。不亦疏乎。其言。历代医家。传为名论。惟杲此书。载所自制诸方。动至一二十味。而君臣佐使。相
制相用。条理井然。他人罕能效之者。斯则事由神解。不涉言诠。读是书者。能喻法外之意则善矣。
〔活法机要〕医藏目录一卷 存
〔医学发明）医藏目录一卷 存
〔万愈方〕医藏目录一卷 未见
〔医说辨惑论〕未见
熊均曰。李杲。字明之。自号东垣先生。洁古老人之门弟也。金亡值元。遂为元人。著作甚多。惟有用药珍
珠囊。脾胃论。内外伤辨。医学发明。五经活法机要。兰室秘藏。疮疡论。医说辨惑论等书。刊行。
〔东垣试效方〕九卷 存
砚坚序曰。医之用药。犹将之用兵。兵有法。良将不拘于法。药有方。良医不拘于方。非曰尽废其旧也。昔
人因病制方。邪之微甚。人之虚实。莫不详辨而参酌之。然后随其
六气所侵。脏腑所受。剂品小大。平毒多寡。适与病等。丝发不舛。故投之无不如意。后人不揣其本。而□其方。
但曰此方治此病。幸而中者时有之。不幸而误者。固多矣。谚云。□方三年。无病不治。医病三年。无方可治。
斯言□鄙。切中世医之病。东垣老人李君明之可谓用药不拘于方者也。凡求治者。以脉证别之。以语言察之。以
内经断之。对证设方。其□如响。问有不合者。略增损辄效。盖病之变无第。君之方□□无穷。所以万举万全也。
罗谦父受学其门。君尝而以□病所制方录之。其悉月增□益。浸以岁编。凡有闻于君者。又缀而为论。将板行以
世。以广君之道。抑予闻李君教人。讲释经书之暇。每令熟读本草。川陆所产。治疗所主。气味之浓薄。补泻之
轻重。根茎无用。华叶异宜。一一精究。初不以方示之。意盖有在矣。谦父不私所有。推以及人。善则善矣。李
君教人之本意。殆不然也。君所着医学发明。脾胃论。内外伤辨。药象论等书。皆平日究心。将以惠天下后世者。
必须合数书而观之。庶知君制方之旨。免泥而不通之患。若持此编。谓君之能尽在是。非李君望于后人也。至元
三年立春后五日。邙城砚坚序。
王博文序曰。东垣先生受学于易上老人张元素。真积力久。自得于心。其法大概有四。曰明经。别脉。识证。
处方而已。谓不明经。则无以知天地造化之蕴。不别脉。则无以察病邪之所在。气血之虚实。不识证。则不能必
其病之主名以疗之。不处方。则何以克其必救。故先生每治人之疾。先诊其脉。既别脉矣。必断之曰。此药证也。
则又历谓其难素诸经之旨。以明其证之无瘥。然后执□处方。以命其药味。君臣佐使之制。加减炮制之宜。或丸
或散。俾病者饵之。以
取其效。一洗世医胶柱鼓瑟。刻舟觅剑之弊。所以为一代名士者。以此也。今太医罗君谦夫。师先生有年矣。尽
传其平生之学。亦为当世闻人。今将此方。厘为九卷。锓梓以传。不独使其师之术业。表见于世。□亦惠天下后
学之士。俾获安全之利也。其用心之忠浓。诚可嘉尚。□为序其端。噫。先生此方。特立法之大□耳。不知变者。
按以治疾。或有不效。则尤之曰。此制方之不精也。则误矣。孟子曰。梓匠轮舆。能与人规矩。不能使人巧。又
曰。大匠不为拙工。改废绳墨。羿不为拙射变其彀率。引而不发。跃如也。中道而立。能者从之。吾于此书亦云。
先生姓李氏。讳杲。字明之。东垣其自号云。至元十七年岁次庚辰清明后二日。通议大夫燕南河北道提刑按察使
东鲁王博文序。
按明初吴县倪维德校订是书。刊行于世。见医史朱右。敕山老人传。及明史本传。
有的人因为过度劳累损伤了脾脏。有的人因为忧愁思虑损伤了脾脏。有的人因为饥饿或过饱损伤了脾脏。疾病有缓急之分，不得不以紧急的情况为优先处理的事务。这是真正了解李杲（字明之，号东垣老人）的人啊。此前有元好问写的序言。
考察元好问的文集，其中有一篇题为《伤寒会要引》的文章，是李杲所著，详细记载了他治疗验证的案例，《元史·方伎传》完全采纳了这些内容。然而这篇序言唯独没有出现在文集中。推测可能是偶然散失遗漏了吧。还有一篇罗天益写的后序。罗天益字谦父，是李杲晚年的弟子，完全继承了李杲的学术传承。元好问在《东垣老人传》中称，李杲临终时取出平日所著的书籍，检查核对卷册，按照次序排列在几案前，嘱咐罗天益说：“这本书交给你，就是那个人（指继承者）。”
〔兰室秘藏〕三卷，见于《国史经籍志》，现存。
《四库全书提要》说：《兰室秘藏》三卷，由金代李杲撰写。所谓“兰室秘藏”，大概是取自《黄帝内经·素问》中“藏诸灵兰之室”的话语。前面有至元丙子年（1276年）罗天益写的序言，是在李杲去世二十五年后。怀疑这就是元好问所说的临终交付给罗天益的那本书。
书中治病分为二十一个门类，以饮食劳倦为首。其他如中满腹胀、心腹痞塞、胃脘痛等门类，都反复强调脾胃的重要性，这大概是他特别重视的地方。
李杲阐发内伤类同于外感的理论，确实有深刻的道理。他以土为万物之母，脾胃为生化之源，撰写了一篇《脾虚损论》，极力陈述寒凉峻利药物的危害，尤其深刻明确。这大概是预先洞察到刘完素、张从正两家末流攻伐治疗的弊端，而早早防止其渐生蔓延。至于前代的医方，自《金匮要略》以下，大多药味不多。所以《唐书·许允宗传》记载许允宗的话说：“病与药，有正好相当的情况，只需单用一味药，直接攻击那个病，药力自然专一，病立刻就会痊愈。现在的人不能辨别脉象，不认识病证，凭主观臆测，往往添加很多药味。这就好比打猎，不知道兔子在哪里，却派出很多人马，在空地上包围拦截，或许侥幸能碰到一只兔子罢了。这样治疗疾病，不也太疏漏了吗？”这些话，历代医家流传成为名言。只有李杲的这本书，记载他自己制作的各方，动辄一二十味药，但君臣佐使，相互制约又相互利用，条理井然，别人很少能效仿的。这是因为事情源于神妙的理解，不涉及言语的解释。读这本书的人，如果能领悟法度之外的意蕴，那就好了。
〔活法机要〕一卷，见于《医藏目录》，现存。
〔医学发明〕一卷，见于《医藏目录》，现存。
〔万愈方〕一卷，见于《医藏目录》，未见。
〔医说辨惑论〕未见。
熊均说：李杲，字明之，自号东垣先生，是张洁古老人的门徒。金朝灭亡时正值元朝建立，于是成为元人。著作非常多，其中有《用药珍珠囊》、《脾胃论》、《内外伤辨》、《医学发明》、《五经活法机要》、《兰室秘藏》、《疮疡论》、《医说辨惑论》等书刊行。
〔东垣试效方〕九卷，现存。
元好问序说：医生用药，就像将领用兵。兵法有法则，优秀的将领不拘泥于法则；药方有定式，优秀的医生不拘泥于定式。并不是说要完全废弃旧有的东西。过去的人根据病情制定方剂，邪气的轻重、人体的虚实，没有不详细辨别并斟酌的，然后根据六气所侵犯的部位、脏腑所受的影响，决定药剂的大小、平和与毒性药物的多少，恰好与病情相等，毫厘不差，所以投药下去没有不如意的。后来的人不探究根本，就照搬方子，只说这个方子治这个病，侥幸有效的时有发生，不幸误治的固然很多。谚语说：“照搬方子三年，没有治不好的病；看病三年，没有可用的方子。”这话虽然粗鄙，却切中了当时医生的弊病。东垣老人李君明之可以说是用药不拘泥于成方的医生了。凡是求治的人，通过脉象和症状来辨别，通过语言交流来观察，依据《内经》来判断，针对病症设立方剂，反应灵敏如回声。如果有不符合的情况，稍微增减就能见效。因为病情变化无穷，李君的方剂也变化无穷，所以万举万全。
罗谦父（罗天益）师从他学习，李君曾经把治疗疾病所制的方子记录给他。他每个月增加补充，逐渐按年份编纂。凡是有听闻于李君的人，又缀连成论述，准备刻板印刷以传世，以此弘扬李君的道术。况且我听说李君教导学生，在讲解释经书的闲暇，常常让学生熟读《本草》，川陆所产的药物，主治功效，气味的浓薄，补泻的轻重，根茎与花叶的不同适宜之处，一一精心研究。起初并不把方子展示给学生，用意大概就在这里吧。罗谦父不私藏所学，推广给别人，善则善矣，但李君教导学生的本意，恐怕不是这样的。李君所著的《医学发明》、《脾胃论》、《内外伤辨》、《药象论》等书，都是平日用心钻研，打算惠及天下后世人的。必须合起来阅读这几本书，才能知道李君制方的宗旨，避免拘泥而不通的祸患。如果拿着这一编书，认为李君的本领全在这里面，那就不是李君对后人的期望了。至元三年立春后五日，邙城元好问序。
王博文序说：东垣先生师从易水老人张元素，真积力久，心得于心。他的方法大致有四条：曰明经、别脉、识证、处方而已。说不通晓经典，就无法知晓天地造化的奥秘；不辨别脉象，就无法察知病邪所在及气血的虚实；不认识证候，就不能确定疾病的主要名称来治疗它；不制定处方，凭什么能够挽救必救之危？所以先生每次治疗人的疾病，先诊察脉象，既然辨别了脉象，一定判断说：“这是某某药证。”然后又遍述《难经》、《素问》等经典的旨意，以阐明证候无误，然后执笔处方，确定药味。君臣佐使的制度，加减炮制的适宜，或者丸剂或者散剂，让病人服用，以取得疗效。彻底洗刷了世医胶柱鼓瑟、刻舟求剑的弊病，这就是他成为一代名士的原因。现在的太医罗君谦父，拜先生为师多年，完全传授了他一生的学问，也是当世的知名人士。现在将这些方子，整理为九卷，刻板印刷以流传，不仅让老师的技艺学业显扬于世，也将惠及天下的后学之士，使他们获得安全健康的利益。他的用心忠诚深厚，确实值得嘉奖推崇。特为序言于篇首。唉，先生的这些方子，只是确立大法的大纲罢了。不知变通的人，机械地按照它来治疗疾病，或许会有无效的时候，就指责说：“这是制方不精密。”那就错了。孟子说：“木匠和车匠，能给人规矩，但不能使人灵巧。”又说：“高明的工匠不因为笨拙的工人而改变或废除绳墨，后羿不因为笨拙的射手而改变拉弓的标准。拉开弓却不发射，做出跃跃欲试的样子。站在道路中间，有能力的人跟随他。”对于这本书，我也这样说。
先生姓李，名杲，字明之，东垣是他的自号。至元十七年岁次庚辰清明后二日，通议大夫燕南河北道提刑按察使东鲁王博文序。
按：明朝初年，吴县倪维德校订此书，刊行于世，见《医史》朱右《敕山老人传》及《明史》本传。
Some are injured in the Spleen due to overexertion and fatigue. Some are injured in the Spleen due to worry and excessive thinking. Some are injured in the Spleen due to irregular eating or overeating. Diseases have urgency and non-urgency; one must prioritize the urgent cases. This is truly someone who understands Li Gao (courtesy name Mingzhi, pseudonym Dongyuan Laoren). Previously, there was a preface by Yuan Haowen.
Examining Yuan Haowen's collected works, there is an article titled "Introduction to Compendium of Cold Damage" (Shanghan Huiyao Yin), authored by Li Gao, which fully records his verified treatments. The "Biographies of Artisans and Specialists" (Fangji Zhuan) in the *History of Yuan* (*Yuan Shi*) completely adopted this content. However, this preface alone is not found in the collection. It is speculated that it may have been accidentally lost or scattered. There is also a postface written by Luo Tianyi. Luo Tianyi, courtesy name Qianfu, was Li Gao's disciple in his later years and fully inherited his academic transmission. In the "Biography of Elder Dongyuan" written by Yuan Haowen (also known as Yanjian), it is stated that upon his deathbed, Li Gao took out the books he had written during his lifetime, checked and organized the volumes, arranged them in order on the table before him, and instructed Qianfu: "The person to whom I entrust this book is you."
[Lanshi Micang] (Secrets of the Orchid Chamber), 3 volumes. Recorded in *Guoshi Jingji Zhi*, extant.
The *Siku Quanshu Tiyao* (Brief Synopsis of the Complete Library of Four Treasuries) states: *Lanshi Micang*, 3 volumes, written by Li Gao of the Jin Dynasty. The title "Secrets of the Orchid Chamber" is likely derived from the phrase "stored in the chamber of Linglan" in the *Huangdi Neijing Suwen* (Yellow Emperor's Inner Canon: Basic Questions). There is a preface by Luo Tianyi dated Bingzi year of Zhiyuan (1276), twenty-five years after Li Gao's death. It is suspected that this is the book entrusted to Tianyi on his deathbed mentioned by Yanjian.
The book categorizes disease treatment into twenty-one sections, with dietary and labor-induced injuries placed first. Other sections such as abdominal fullness and distension, epigastric and abdominal stuffiness, and stomach pain all earnestly emphasize the Spleen and Stomach, reflecting his particular emphasis on them.
Li Gao's elucidation that internal injury resembles external contraction contains profound truth. He regarded Earth as the mother of all things and the Spleen and Stomach as the source of production and transformation. In his essay "On Spleen Deficiency Injury," he vigorously expounded on the harms of cold-natured and drastic purgative drugs, which was particularly profound and clear. This seems to be a foresight of the drawbacks of the aggressive attack methods prevalent in the later schools of Liu Wansu and Zhang Congzheng, aiming to prevent their gradual spread early on. Regarding medical prescriptions from previous dynasties, those below the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) generally contained few ingredients. Thus, the *Book of Tang* (*Tang Shu*), in the biography of Xu Yongzong, records Xu Yongzong's words: "When the disease and medicine correspond exactly, only one herb needs to be used singly to directly attack the disease; the medicinal power will be focused, and the disease will heal immediately. Nowadays, people cannot differentiate pulses or recognize syndromes, relying on subjective speculation and adding many herbs. This is like hunting without knowing where the rabbit is, sending out many men and horses to enclose an empty area, hoping by chance to encounter one. Is treating diseases in this manner not too negligent?" These words have been passed down through generations of physicians as famous theories. Only in Li Gao's book are the prescriptions he personally formulated recorded, often involving ten to twenty herbs, yet the Sovereign, Minister, Assistant, and Courier (Jun-Chen-Zuo-Shi) relationships are mutually restraining and utilizing, with clear logic. Few others can emulate this. This is because the matter stems from divine understanding, transcending verbal explanation. Those who read this book and can comprehend the meaning beyond the method would do well.
[Huofa Jiyao] (Essentials of Living Methods), 1 volume. Recorded in *Yicang Mulu*, extant.
[Yixue Faming] (Invention of Medicine), 1 volume. Recorded in *Yicang Mulu*, extant.
[Wanyu Fang] (Ten Thousand Cures Prescription), 1 volume. Recorded in *Yicang Mulu*, not seen.
[Yishuo Bianhuo Lun] (Discussion on Clarifying Confusion in Medical Sayings), not seen.
Xiong Jun said: Li Gao, courtesy name Mingzhi, self-styled Mr. Dongyuan, was a disciple of Old Man Jiegeng (Zhang Yuansu). When the Jin Dynasty fell and the Yuan Dynasty rose, he became a subject of the Yuan. His writings were numerous, including *Yongzhen Zhenzhunang* (Pearl Pouch of Medicinal Use), *Piwei Lun* (Treatise on Spleen and Stomach), *Neiwai Shang Bian* (Differentiation of Internal and External Injury), *Yixue Faming* (Invention of Medicine), *Wujing Huofa Jiyao* (Essentials of Living Methods of the Five Classics), *Lanshi Micang* (Secrets of the Orchid Chamber), *Chuangyang Lun* (Treatise on Sores and Ulcers), and *Yishuo Bianhuo Lun* (Discussion on Clarifying Confusion in Medical Sayings), among others, which were published.
[Dongyuan Shixiao Fang] (Trial-Efficacy Prescriptions of Dongyuan), 9 volumes, extant.
Preface by Yanjian (Yuan Haowen): A physician using medicine is like a general using troops. Troops have tactics; a good general does not rigidly adhere to tactics. Prescriptions have forms; a good physician does not rigidly adhere to forms. This does not mean abolishing all old practices. Former physicians created prescriptions based on illness, carefully distinguishing the severity of pathogens and the deficiency or excess of the patient's constitution, then considering the invasion of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire), the affected Zang-Fu organs, the size of the dosage, and the balance between mild and toxic herbs, ensuring exact correspondence with the disease, down to the finest detail, so that administration always met expectations. Later generations, failing to investigate the root, merely copied prescriptions, saying "this prescription treats this disease." Occasionally, success occurred by luck, but misdiagnosis and error were far more common. The proverb says, "Copy prescriptions for three years, no disease remains untreatable; treat patients for three years, no prescription remains usable." Though crude, this remark hits the nail on the head regarding the faults of contemporary physicians. Elder Dongyuan, Mr. Li Mingzhi, could be said to use medicine without being bound by fixed prescriptions. For any seeker of treatment, he differentiated via pulse and symptoms, observed via conversation, and judged according to the *Neijing* (Inner Canon). Setting prescriptions against syndromes, his responses were as immediate as echoes. If circumstances differed slightly, minor adjustments yielded efficacy. Because disease variations are infinite, and his prescriptions adapt infinitely, every attempt was successful.
Luo Qianfu studied under him. Mr. Li once recorded the prescriptions he made for treating illnesses for him. Luo added to them monthly, compiling them annually. He gathered accounts heard from Mr. Li, appended discussions, and prepared them for printing to disseminate them, thereby spreading Mr. Li's teachings. Moreover, I have heard that when Mr. Li taught students, besides explaining classics, he frequently ordered them to memorize and study the *Bencao* (Materia Medica) thoroughly: the origins from rivers and land, primary treatments, intensity of qi and flavor, degrees of tonification and purgation, and the distinct suitability of roots/stems versus flowers/leaves. Initially, he did not show them prescriptions, implying a deeper intention. Luo Qianfu did not keep these benefits private but shared them with others. While commendable, Mr. Li's original intent in teaching might have been different. Mr. Li's other works, such as *Yixue Faming*, *Piwei Lun*, *Neiwai Shang Bian*, and *Yaoxiang Lun*, were the result of lifelong dedication, intended to benefit future generations. One must read these books together to understand the principles behind his prescriptions, avoiding the pitfall of rigidity. If one holds this single compilation and believes it contains all of Mr. Li's abilities, it does not reflect Mr. Li's hopes for posterity. On the fifth day after Lichun (Start of Spring) in the third year of Zhiyuan, Preface by Yanjian of Mangcheng.
Preface by Wang Bowen: Master Dongyuan studied under Master Yishui (Zhang Yuansu). Through persistent accumulation and effort, he attained insight within himself. His methods generally consisted of four aspects: clarifying classics, differentiating pulses, recognizing syndromes, and formulating prescriptions. He believed that without clarifying classics, one cannot know the mysteries of heaven and earth's creation; without differentiating pulses, one cannot locate pathogens and assess the deficiency or excess of qi and blood; without recognizing syndromes, one cannot determine the primary name of the disease to treat it; without formulating prescriptions, how can one achieve necessary salvation? Therefore, whenever Master treated a patient, he first diagnosed the pulse. After differentiating the pulse, he would judge: "This corresponds to such-and-such medicine syndrome." Then he would cite the principles of the *Nanjing* (Classic of Difficult Issues) and *Suwen* to clarify the syndrome without error, before writing the prescription and determining the herbs. The structure of Sovereign, Minister, Assistant, and Courier, the appropriateness of additions/subtractions and processing, whether pills or powders, allowed patients to take them to achieve efficacy. This thoroughly washed away the faults of contemporary physicians who were rigid like a tuning peg stuck in place or carving a mark on a boat to find a sword. This is why he became a renowned scholar of his generation. Now, Grand Physician Luo Qianfu has been a student of the Master for many years, having fully transmitted his life's learning, and is also a prominent figure of the times. He has now compiled these prescriptions into nine volumes and had them printed, not only to make his teacher's skills and achievements visible to the world, but also to benefit scholars of future generations, enabling them to attain safety and health. His loyal and deep intention is truly commendable. I hereby write this preface. Alas, these prescriptions of the Master represent only the broad principles of establishing laws. Those who do not understand flexibility and mechanically apply them to treat diseases may find them ineffective, and then blame them, saying, "These prescriptions are not precise enough." That would be a mistake. Mencius said, "Carpenters and wheelwrights can give others rules and compasses, but they cannot make others skillful." He also said, "A master craftsman does not change or discard the plumb line for a clumsy worker; Yi the Archer does not change his drawing standard for a clumsy shooter. He draws the bow but does not release the arrow, appearing ready to leap. He stands in the middle of the path, and those capable follow him." Regarding this book, I say the same.
The Master's surname was Li, given name Gao, courtesy name Mingzhi. Dongyuan was his self-chosen pseudonym. On the second day after Qingming (Pure Brightness) in the Gengchen year, the seventeenth year of Zhiyuan, Preface by Wang Bowen of Donglu, Tongyi Dafu, Inspector-General of Yanan and Hebei Circuit.
Note: In the early Ming Dynasty, Ni Weide of Wu County collated and published this book, as seen in Zhu You's *Biography of Old Man Chishan* in *Yishi* (Medical History) and the *Biography* in *Ming Shi* (History of Ming).