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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?