仆幼自受《难》、《素》于易水张元素先生，讲诵既久，稍有所得；中年以来，更事颇多，诸所延医，
坦然不惑，曾撰《内外伤辨惑论》一篇，以证世人用药之误。陵谷变迁，忽成老境，神志既惰，懒于语
言，此论束之高阁十六年矣。昆仑范尊师曲相奖借，屡以活人为言，谓此书果行，使天下之人不致夭折，
是亦仁人君子济人利物之事，就令着述不已，精力衰耗，书成而死，不愈于无益而生乎！予敬受其言，仅
力疾就成之，虽未为完备，聊答尊师慈悯之志。师，宋文正公之后也。
丁未岁重九日东垣老人李杲明之题
曰甚哉！阴阳之证，不可不详也。遍观《内经》中所说，变化百病，其源皆由喜怒过度，饮食失节，
寒温不适，劳役所伤而然。夫元气、谷气、荣气、清气、卫气、生发诸阳上升之气，此六者，皆饮食
入胃，谷气上行，胃气之异名，其实一也。既脾胃有伤，则中气不足，中气不足，则六腑阳气皆绝于
外，故经言五脏之气已绝于外者，是六腑之元气病也。气伤脏乃病，脏病则形乃应，是五脏六腑真气皆
不足也。惟阴火独旺，上乘阳分，故荣卫失守，诸病生焉。其中变化，皆由中气不足，乃能生发耳。后
有脾胃以受劳役之疾，饮食又复失节，耽病日久，事息心安，饱食太甚，病乃大作。
概其外伤风寒，六淫客邪，皆有余之病，当泻不当补；饮食失节，中气不足之病，当补不当泻。举世
医者，皆以饮食失节，劳役所伤，中气不足，当补之
证，认作外感风寒，有余客邪之病，重泻其表，使荣卫之气外绝，其死只在旬日之间。所谓差之毫厘，谬
以千里，可不详辨乎？！
按《阴阳应象大论》云∶“天之邪气，感则害人五脏。”是八益之邪，乃风邪伤人筋骨。风从上受
之，风伤筋，寒伤骨，盖有形质之物受病也，系在下焦，肝肾是也。肝肾者，地之气。《难经》解云∶肝
肾之气，已绝于内，以其肝主筋，肾主骨，故风邪感则筋骨疼痛，筋骨之绝，则肝肾之本亦绝矣，乃有余
之证也。又云∶“水谷之寒热，感则害人六腑。”是七损之病，乃内伤饮食也。《黄帝针经》解云∶适饮食不
节，劳役所伤，湿从下受之。谓脾胃之气不足，而反下行，极则冲脉之火逆而上，是无形质之元气受病
也，系在上焦，心肺是也。心肺者，天之气。故《难经》解云∶心肺之气已绝于外，以其心主荣，肺主
卫。荣者血也，脉者血之府，神之所居也；卫者，元气七神之别名，卫护周身，在于皮毛之间也。肺绝
则皮毛先绝，神无所根据，故内伤饮食，则亦恶风寒，是荣卫失守，皮肤间无阳以滋养，不能任风寒也。
皮毛之绝，则心肺之本亦绝矣，盖胃气不升，元气不生，无滋养心肺，乃不足之证也。
计受病之人，饮食失节，劳役所伤，因而饱食内伤者极多，外伤者间而有之，世俗不知，往往将元气
不足之证，便作外伤风寒表实之证，而反泻心肺，是重绝其表也，安得不死乎？古人所谓实实虚虚，医杀
之耳！若曰不然，请以众人之耳闻目见者证之。
向者壬辰改元，京师戒严，迨三月下旬，受敌者凡半月，解围之后，都人之不受病者，万无一二，既病而
死者，继踵而不绝。都门十有二所，每日各门所送，多者二千，少者不下一千，似此者几三月，此百万人岂俱
感风寒外伤者耶？大抵人在围城中，饮食不节，及劳役所伤，不待言而知。由其朝饥暮饱，起居不时，寒温
失所，动经三两月，胃气亏乏久矣，一旦饱食大过，感而伤人，而又调治失宜，其死也无疑矣。非惟大梁为
然，远在贞 兴定间，如东平，如太原，如凤翔，解围之后，病伤而死，无不然者。余在大梁，凡所亲
见，有表发者，有以巴豆推之者，有以承气汤下之者，俄而变结胸、发黄，又以陷胸汤、丸及茵陈汤下
之，无不死者。盖初非伤寒，以调治差误，变而似真伤寒之证，皆药之罪也。往者不可追，来者犹可及，
辄以平生已试之效，着《内外伤辨惑论》一篇，推明前哲之余论，历举近世之变故，庶几同志者，审其
或中，触类而长之，免后人横夭耳！僭易之罪，将何所逃乎？
我自幼在易水张元素先生处受学《难经》与《素问》，经过长时间的讲习诵读，逐渐有所心得；中年以来，经历的事情很多，对于各种延请医生的情况，心里坦然明白而不迷惑，曾撰写了一篇《内外伤辨惑论》，用来证明世人用药的错误。山河变迁，忽然步入老年，神志已经懈怠，懒得说话，这篇论述被束之高阁十六年了。昆仑范尊师对我曲意夸奖借重，屡次以救活人为由劝说，说这本书如果刊行，能使天下的人不至于夭折，这也是仁人君子济助他人、利益万物的善事，即使因此著述不停，精力衰耗，书成而死，不是比无益地活着更好吗！我恭敬地接受了他的话，勉强带病完成它，虽然不够完备，姑且以此回应尊师慈悲怜悯的心意。范尊师是宋代文正公的后代。
丁未年重阳节，东垣老人李杲（字明之）题写。
唉！阴阳的证候，不可不详细辨别啊。遍观《内经》中所说的，变化多端的百病，其根源都由于喜怒过度、饮食失节、寒温不适、劳役所伤而导致的。元气、谷气、营气、清气、卫气、生发诸阳上升之气，这六者，都是饮食入胃后，谷气上行，胃气的不同名称，其实质是一样的。既然脾胃受到损伤，那么中气就会不足，中气不足，那么六腑的阳气都在体表衰竭，所以经文说“五脏之气已绝于外”，这是六腑的元气发生了病变。气受伤则脏腑生病，脏腑生病则形体出现反应，这是五脏六腑的真气都不足了。只有阴火独自旺盛，上乘于阳分，所以营卫失去固守，各种疾病由此产生。其中的变化，都是因为中气不足，才能发生。后来有脾胃遭受劳役的疾病，饮食又再次失节，患病日久，事情平息心情安定后，饱食太甚，疾病于是大作。
概括来说，外伤风寒，六淫客邪，都属于有余的病证，应当泻法而不应当补法；饮食失节，中气不足的病证，应当补法而不应当泻法。世间的医生，都把饮食失节、劳役所伤、中气不足、应当补法的证候，误认为是外感风寒、有余客邪的病证，重用泻法解表，使营卫之气在体表衰竭，死亡就在十天半月之间了。所谓差之毫厘，谬以千里，怎么能不详细辨别呢？！
按照《阴阳应象大论》说：“天之邪气，感则害人五脏。”这是八益之邪，乃是风邪伤人筋骨。风从上部受之，风伤筋，寒伤骨，这是有形质的物体受病，属于下焦，肝肾就是下焦。肝肾，是地之气。《难经》解释说：肝肾之气，已绝于内，因为肝主筋，肾主骨，所以风邪感受则筋骨疼痛，筋骨的衰竭，则肝肾的根本也衰竭了，这是有余的证候。又说：“水谷之寒热，感则害人六腑。”这是七损之病，乃是内伤饮食。《黄帝针经》解释说：饮食不节制，劳役所伤，湿从下部受之。说的是脾胃之气不足，反而下行，极则冲脉之火逆而上行，这是无形质的元气受病，属于上焦，心肺就是上焦。心肺，是天之气。所以《难经》解释说：心肺之气已绝于外，因为心主营，肺主卫。营者是血，脉是血的府库，是神居住的地方；卫者是元气的别名，护卫周身，在于皮毛之间。肺绝则皮毛先衰竭，神没有凭借，所以内伤饮食，也会恶风寒，这是营卫失去固守，皮肤间没有阳气来滋养，不能承受风寒。皮毛的衰竭，则心肺的根本也衰竭了，这是因为胃气不升，元气不生，无法滋养心肺，这是不足的证候。
计算受病的人，饮食失节，劳役所伤，因而饱食内伤的极多，外伤的偶尔才有，世俗之人不知道，往往将元气不足的证候，就当作外伤风寒表实的证候，反而泻心肺，这是使体表更加衰竭，怎么能不死呢？古人所说的实实虚虚，是医生杀死了病人啊！如果说不是这样，请用众人耳闻目睹的事情来证明。
先前壬辰年改元，京城戒严，等到三月下旬，受敌包围共半个月，解围之后，城里没有生病的人，一万个人里找不到一两个，既然后生病又死亡的，接踵而至不断绝。城门十二座，每天各门送来的尸体，多的两千，少的不下一千，像这样的情况持续了近三个月，这一百万人难道都是感受风寒外伤的吗？大抵人在围城中，饮食不节制，以及劳役所伤，不用说是显而易见的。因为他们早晨饥饿晚上饱食，起居没有定时，寒温失调，动辄两三个月，胃气亏乏很久了，一旦饱食太过，感受邪气伤人，再加上调治不当，他们的死亡是毫无疑问的了。不仅大梁是这样，远在贞祐、兴定年间，如东平，如太原，如凤翔，解围之后，因病伤而死，没有不是这样的。我在大梁，凡是亲眼所见的，有用发汗法治疗的，有用巴豆攻下的，有用承气汤泻下的，不久变成结胸、发黄，又用陷胸汤、丸及茵陈汤泻下，没有不死的。起初并不是伤寒，因为调治错误，变得像真伤寒的证候，这都是药物的罪过。过去的事无法追回，未来的事还可以补救，于是将我平生已验证有效的经验，写成《内外伤辨惑论》一篇，推明前代哲人的余论，列举近世的变故，希望志同道合的人，审慎其中或许正确的，触类旁通，免除后人横死夭折罢了！僭越轻率之罪，我将逃往何处呢？
I received instruction in the *Nanjing* (Classic of Difficult Issues) and *Suwen* (Basic Questions) from Master Zhang Yuansu of Yishui when I was young. After long years of lecturing and reciting, I gradually gained some understanding. Since middle age, having experienced many events and consulted numerous physicians, I remained clear-headed and unconfused. I once composed an essay titled *Bianhuo Lun Neiwai Shang* (Treatise on Distinguishing Internal and External Injuries to Clarify Confusion), to demonstrate the errors in medication used by the world. With the changes of landscape and time, I suddenly entered old age; my spirit and mind have become sluggish, and I am lazy with speech. This treatise has been shelved for sixteen years. Master Fan Zunshi of Kunlun offered me undue praise and encouragement, often speaking of saving lives, saying that if this book were published, it would prevent people throughout the world from dying prematurely. This is indeed a deed of benevolent gentlemen to aid others and benefit all things. Even if continuous writing exhausts my energy and I die upon its completion, is this not better than living uselessly? I respectfully accepted his words and barely managed to complete it while ill. Although not fully comprehensive, it serves merely to respond to Master’s compassionate intent. Master Fan is a descendant of the Song Dynasty’s Duke Wenzheng.
On the Double Ninth Day of the Dingwei year, Dongyuan Laoren Li Gao (courtesy name Mingzhi) inscribed.
Alas! The syndromes of Yin and Yang must be examined in detail. Scanning through what is said in the *Neijing* (Inner Canon), the myriad diseases arising from changes all originate from excessive joy or anger, irregular diet, inappropriate cold or warmth, and injury from overwork. Yuanqi (Primal Qi), Guqi (Grain Qi), Yingqi (Nutritive Qi), Qingqi (Clear Qi), Weiqi (Defensive Qi), and the Qi of generating and ascending various Yangs—these six are all different names for the Stomach Qi, which ascends after grain enters the stomach; their essence is actually one. Once the Spleen and Stomach are injured, the Middle Qi becomes insufficient. When Middle Qi is insufficient, the Yang Qi of the Six Fu Organs all fails at the exterior. Thus, the Classics state: “When the Qi of the Five Zang Organs is exhausted at the exterior,” this refers to a disease of the Yuan Qi of the Six Fu Organs. When Qi is injured, the Zang organs become diseased; when Zang organs are diseased, the physical form responds. This indicates that the True Qi of the Five Zang and Six Fu Organs is all insufficient. Only the Yin Fire burns alone, ascending to overcome the Yang regions, causing Ying and Wei to lose their guard, and various diseases arise. All these variations occur because of insufficient Middle Qi, which allows them to generate. Later, when the Spleen and Stomach suffer from injuries due to overwork, and diet again becomes irregular, lingering illness for a long time, followed by peace of mind and excessive fullness after eating, the disease erupts severely.
Generally speaking, external injuries from Wind-Cold and pathogenic factors of the Six Excesses are all syndromes of excess, requiring purgation rather than tonification. Diseases of insufficient Middle Qi due to irregular diet require tonification rather than purgation. Physicians of the world mistakenly identify syndromes of insufficient Middle Qi caused by irregular diet and overwork—which should be tonified—as external Wind-Cold invasion and pathogenic excess syndromes. They heavily purge the exterior, causing Ying and Wei Qi to fail at the surface, leading to death within ten days or half a month. As the saying goes, a miss is as good as a mile; how can one not distinguish carefully?!
According to the *Yinyang Yingxiang Dalun* (Great Treatise on Yin-Yang Corresponding to Images): “The evil qi of Heaven, when contracted, harms the Five Zang Organs.” This refers to the eight beneficial evils, specifically Wind Evil injuring the sinews and bones. Wind is contracted from above; Wind injures sinews, Cold injures bones. These are diseases affecting tangible substances, belonging to the Lower Jiao, namely the Liver and Kidney. Liver and Kidney represent the Qi of Earth. The *Nanjing* explains: “The Qi of Liver and Kidney is exhausted internally.” Because the Liver governs sinews and the Kidney governs bones, when Wind Evil contracts, it causes pain in sinews and bones. The exhaustion of sinews and bones implies the exhaustion of the root of Liver and Kidney; this is a syndrome of excess. It also states: “The cold and heat of water and grain, when contracted, harm the Six Fu Organs.” This refers to the seven detrimental diseases, namely internal injury from diet. The *Huangdi Zhenjing* (Yellow Emperor’s Classic of Acupuncture) explains: “When diet is not regulated and overwork causes injury, dampness is contracted from below.” This means that when Spleen and Stomach Qi is insufficient, it instead descends; at its extreme, the fire of the Chong Mai (Penetrating Vessel) rebels and ascends. This is a disease affecting intangible Yuan Qi, belonging to the Upper Jiao, namely the Heart and Lung. Heart and Lung represent the Qi of Heaven. Thus, the *Nanjing* explains: “The Qi of Heart and Lung is exhausted externally.” Because the Heart governs Ying and the Lung governs Wei. Ying is Blood; vessels are the residence of Blood and the dwelling place of Shen (Spirit). Wei is another name for Yuan Qi, protecting the entire body, residing between the skin and hair. When Lung fails, the skin and hair fail first, and Shen has no foundation. Therefore, internal injury from diet also leads to aversion to wind and cold. This is Ying and Wei losing their guard; there is no Yang in the skin to nourish it, making it unable to withstand wind and cold. The failure of skin and hair implies the failure of the root of Heart and Lung. This is because Stomach Qi does not ascend, Yuan Qi is not generated, and there is no nourishment for Heart and Lung; this is a syndrome of deficiency.
Considering those who contract disease, those with irregular diet and overwork leading to internal injury from fullness are extremely numerous, while external injuries are occasional. Laypeople do not understand this and often mistake syndromes of insufficient Yuan Qi for exterior excess syndromes of external Wind-Cold, thereby incorrectly purging Heart and Lung. This causes further failure at the exterior; how could they not die? The ancients said: “Reinforcing excess and depleting deficiency”—this is doctors killing patients! If you say otherwise, let us prove it with what the public has heard and seen.
Previously, during the Renchen year change of era name, the capital city declared martial law. By late March, the siege lasted half a month. After the siege was lifted, among the inhabitants of the capital, one in ten thousand did not fall ill. Those who fell ill and died followed each other without cease. There were twelve gates to the capital; daily, the number of corpses brought through each gate ranged from two thousand (many) to no less than one thousand (few). Such conditions persisted for nearly three months. Could these million people all have suffered from external Wind-Cold injury? Generally, people inside the besieged city suffered from irregular diet and injury from overwork, which needs no explanation. Due to hunger in the morning and fullness in the evening, irregular daily routines, and inappropriate clothing against temperature changes lasting two or three months, Stomach Qi had been deficient for a long time. Once they ate excessively, contracting pathogens, and combined with improper treatment, their death was inevitable. This was not only true for Daliang (Kaifeng); even during the Zhengyou and Xingding eras, such as in Dongping, Taiyuan, and Fengxiang, after sieges were lifted, deaths from illness and injury were invariably the same. In Daliang, what I personally witnessed included cases treated with diaphoresis, cases purged with Radix Euphorbiae Lathyridis (Badou), and cases purged with Chengqi Decoction. Soon after, they developed Jie Xiong (Chest Binding) and Jaundice, and were then purged with Xianxiong Decoction, Pills, and Yinchen Decoction. None survived. Initially, it was not Shanghan (Cold Damage); due to erroneous treatment, it transformed into symptoms resembling true Shanghan. This was the fault of the medicine. Past events cannot be retrieved, but future ones can be addressed. Therefore, relying on effects verified in my lifetime, I composed the *Bianhuo Lun Neiwai Shang* (Treatise on Distinguishing Internal and External Injuries to Clarify Confusion), expounding upon the remaining theories of former sages and listing recent incidents, hoping that like-minded individuals will scrutinize what may be correct, extend this knowledge by analogy, and spare later generations from premature death. What crime of presumption can I escape?