外科者。以其痈疽疮疡皆见于外。故以外科名之。然外科必本于内。知乎内。以求乎外
如视诸掌乎。经曰。膏粱之变。足生大疔。由膏粱蕴毒于内而生也。又曰。荣气不从。逆于肉理
。乃生痈肿。是痈肿由荣气逆于肉理之内而生也。有诸中。然后形诸外。治外遗内。所谓不揣
其本而齐其末。殆必己误于人。己尚不知。人误于己。人亦不悟。呜呼。己虽不知。天必知之
。人虽不悟。神必识之。异日明受天责。阴获神谴。不在于身。则在于子孙矣。予于是惧。因辑
此书。名曰外科理例。盖其中古人所论治。无非理也。学人能仿其例而推展之。于焉而求古
人不言之妙旨。庶几小不误己。大不误人。抑亦有补于将来矣。辑已成编。复得新甫薛先生
心法发挥读之。观其论治。亦皆一本于理。而予窃喜暗与之合。于是复采其说参于其中。庶
得以为全书。而学人无复有遗憾矣。是为序。
嘉靖辛卯冬十一月长至日祁门汪机识
夫天下之事。莫不有理。然有正、有偏、有常、有变。不可以概视也。譬之兵焉。声罪致
。正也。潜师掠境者。偏也。常则按图布阵。而守据险凭高之法。变则隐显出没。而有鬼神
不测之机。夫医之道。亦犹是焉。故望气听声。审症切脉。乃医理之正。执方治病。根据分处
剂。乃医学之偏。按脉辨症。审时制方。分经络。别表里。此医之处乎常也。或凭脉而不凭
。或凭症而不凭脉。或因情性而处方。或因形质而用药。此医之达乎变也。然正可守而偏可
。常可学而变难穷。医岂可以易言哉。何今之业外科者。惟视外之形症。疮之肿溃。而不察
其脉理虚实之殊。经络表里之异。欲其药全而无误也难矣。先生深为之惜。故辑此书。名曰
外科理例。盖以其正、偏、常、变之用。各有其例。而莫不同归于一理。学人诚能因是而求
未书之旨。扩其未言之妙。则其临病用药。必求诸理。而不至孟浪以杀人矣。此先生作书之
嘉靖丁酉孟春朔旦新安祁门石墅陈桷书
外科，是因为痈疽疮疡等病症都表现在体表，所以称为外科。然而，外科治疗必须以内治为本。通晓了内在的机理，就能像看手掌一样清楚地把握外在的病症。《内经》说：“膏粱之变，足生大疔。”这是由于饮食肥甘厚味在体内蕴结毒气而产生的。又说：“荣气不从，逆于肉理，乃生痈肿。”这说明痈肿是由于营气运行不畅，逆乱于肌肉纹理之间而产生的。有内在的病机，然后才表现为外在的症状。如果治疗外在病症而忽略内在根本，这就是所谓的“不揣其本而齐其末”（不探究根本却只追求表面整齐），这必定会误人，而且施治者自己尚且不知，被误治的人也不醒悟。唉！即使施治者自己不知道，上天必定知道；即使被误治的人不醒悟，神明必定识察。将来遭受上天的责罚、神明的谴责，要么报应在自己身上，要么报应在子孙身上。我对此感到恐惧，因此编纂了这本书，命名为《外科理例》。其中收录的古人对治疗的论述，无非都是阐述医理。学习的人如果能仿效这些体例并加以推演发挥，从中探求古人未曾明言的精妙旨意，或许能小到不误己，大到不误人，这对未来也大有补益。书稿编成后，我又得到了新甫薛先生关于心法发挥的著作，阅读后发现他的论治观点，也都一本于医理，我暗自欣喜这与我的见解相合，于是又采纳他的学说参入书中，希望以此成为一部完整的全书，让学习者不再有遗憾。这就是序言。
嘉靖辛卯年冬十一月冬至日，祁门汪机记述。
天下的事情，没有不包含道理的。然而道理有正与偏、常与变之分，不能一概而论。这就好比用兵：声讨罪状而出兵征伐，是“正”道；暗中出兵劫掠敌境，是“偏”道。常规情况下，按照地图布置阵势，坚守险要高地，这是“常”法；变化情况下，隐蔽行踪、忽隐忽现，运用如鬼神般不可测度的机变，这是“变”法。医学的道理也是如此。所以观察气色、听声音、审察症状、切脉，这是医理的“正”道；拘泥于固定方剂治病，机械地根据分数分配药量，这是医学的“偏”道。通过脉象辨别症状，审察时令制定方剂，区分经络，辨别表里，这是医生处于“常”规状态下的做法。或者凭脉象而不凭症状，或者凭症状而不凭脉象，或者根据患者的性情来处方，或者根据患者的体质形态来用药，这是医生通达“变”化的做法。然而，“正”可以坚守，“偏”可以权变，“常”可以学习，但“变”难以穷尽。医学难道是可以轻易谈论的吗？为什么现在从事外科的人，只看外表的症状和疮疡的肿胀溃破情况，却不考察脉理虚实的变化和经络表里的差异，想要做到用药周全而没有错误，是很难的。先生对此深感痛惜，因此编纂了这本书，命名为《外科理例》。大概是因为正、偏、常、变的应用，各有其体例，但最终都归于同一个医理。学习者如果能借此探求书中未写出的旨意，扩充其中未言明的妙处，那么他们在面对疾病用药时，必定会寻求医理依据，而不至于鲁莽行事以致害人性命。这就是先生撰写此书的缘由。
Surgery (Waike) is so named because conditions such as carbuncles (Yongju), ulcers, and sores manifest externally. However, surgical treatment must be rooted in internal medicine. By understanding the internal mechanisms, one can grasp external manifestations as clearly as looking at one's own palm. The Classics state: "Changes from rich and greasy foods can give rise to large carbuncles." This arises from toxins accumulating internally due to a diet of rich and greasy foods. It also states: "When Ying Qi (Nutritive Energy) does not flow smoothly and rebels within the muscle tissue, abscesses and swellings occur." Thus, abscesses and swellings arise from Ying Qi rebelling within the muscle tissue. Internal pathology manifests externally. Treating external symptoms while neglecting internal roots is described as "not examining the root but attempting to align the branches," which inevitably leads to error. The practitioner may remain unaware, and the patient may not realize they have been harmed. Alas! Even if the practitioner is unaware, Heaven knows; even if the patient does not realize it, the Spirits discern. Future retribution from Heaven or condemnation by the Spirits will fall either upon the individual or their descendants. Fearing this, I compiled this book, titled *Examples of Surgical Principles* (Waike Lili). The discussions on treatment recorded therein are all grounded in medical principles. If students can emulate these examples and extend them, seeking the subtle meanings not explicitly stated by the ancients, they may avoid minor errors for themselves and major errors for others, thereby benefiting future generations. Upon completing the compilation, I obtained Mr. Xue Xinpu's work on the elaboration of heart methods. Observing his discussions on treatment, I found them also firmly based on principles, and I was secretly pleased that my views aligned with his. Consequently, I incorporated his theories into the text, hoping to create a comprehensive work free of regret for learners. This is the preface.
Recorded by Wang Ji of Qimen on the Winter Solstice day of the eleventh month in the winter of the Xinmao year of the Jiajing era.
All affairs under heaven involve principles. However, there are correct and deviant aspects, and constant and variable elements; they cannot be viewed uniformly. Consider warfare: declaring war to punish crimes is the "correct" approach; secretly marching troops to raid enemy territory is the "deviant" approach. Under constant circumstances, one arranges formations according to maps and defends strategic high ground; under variable circumstances, one conceals movements and employs unpredictable strategies akin to ghosts and spirits. Medical practice is similar. Therefore, observing complexion, listening to sounds, examining symptoms, and palpating pulses constitute the "correct" aspect of medical principles. Rigidly applying fixed prescriptions and mechanically calculating dosages constitutes the "deviant" aspect. Differentiating symptoms via pulse diagnosis, adjusting formulas according to seasons, distinguishing meridians, and identifying exterior-interior relationships represent the "constant" approach. Relying on pulse rather than symptoms, or symptoms rather than pulse, prescribing based on temperament, or medicating based on physical constitution, represents the "variable" approach. While the "correct" can be adhered to, the "deviant" adapted, and the "constant" learned, the "variable" is difficult to exhaust. How can medicine be discussed lightly? Why do contemporary surgeons only observe external symptoms and the swelling or ulceration of sores, without investigating the differences in pulse deficiency-excess and meridian exterior-interior relations? It is difficult to achieve accurate medication without error. Deeply lamenting this, the Master compiled this book, naming it *Examples of Surgical Principles*. The rationale is that the applications of correct, deviant, constant, and variable approaches each have their examples, yet all converge on a single principle. If students can seek the unstated intentions and expand the unspoken subtleties through this framework, their clinical application of medicine will be guided by principles, preventing rash actions that harm lives. This is the reason for the Master's writing.
Written by Chen Jue of Shishu, Qimen, Xin'an, on the first day of the first month in the spring of the Dingyou year of the Jiajing era.