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Medicine is akin to governance; just as the state has military forces, medicine has surgeons. A skilled governor rectifies the officials and unifies the departments, ensuring that laws and regulations are not merely advocated through administrative means but utilized to quell disorder. When there is no unrest in times of peace, the fundamental measures we employ to prevent chaos are already meticulous, complete, and solid, leaving no loopholes. Thus, when emergencies arise, they are simply eradicated. Consequently, although the army undergoes drills, the vital energy (Yuan Qi) of the nation remains undiminished; the principle of medicine is the same. When a disease resides in the *Couli* (the interstitial spaces between skin and muscle), decoctions can reach it. When it resides in the stomach and intestines, purgative washings can reach it. But what of those conditions manifesting as protrusions on the skin, or even those too complex to describe? How else could they be treated but by piercing and striking (aggressive surgical intervention)? However, an attack must be backed by defense, and a strike must be prepared for. If one does not carefully examine minor ailments like tinea, they may easily become critical internal threats. Alas, how can one not be cautious? Therefore, only those who understand governance can discuss medicine with.

Many have excelled in surgery in recent times, yet none compare to my Master Lizhai. His family has practiced the arts of Qibo and Huangdi for generations, and he has mastered various schools of thought, thoroughly comprehending their subtle principles. He stated that without knowledge of surgery, one cannot understand the origins and details of meridians; without mastery of the *Neijing* (Inner Canon of the Yellow Emperor), one cannot investigate the variations and combinations of Yin and Yang. Although internal and external medicine differ in discipline, their underlying principles are identical. Thus, in treating diseases regardless of size, he prioritized addressing the root cause above all else. He sought neither rapid effects nor short-term results, acting with calmness and leisure, allowing the illness to heal spontaneously without excessive exertion.

He occasionally presented the compilation *Liyang Jiyao* (Essential Secrets of Leprosy and Ulcers), entrusting his friend, Mr. Shen, to print and disseminate it. Upon reading it, Mr. Shen generally corrected ancient formulas according to his own insights, verified treatment efficacy using medical cases, employed tonification and regulation as comprehensive defensive strategies, and used draining and resolving methods as expedient aggressive tactics. This approach remained within the realm of strategic planning, achieving the effect of clearing out pathogens without effort. If practitioners adhered to this, they would avoid stagnation and lack of flow, as well as superficiality and lack of foundation. They would not attack what they know while disparaging what they do not see. Alas, Master such as him can truly be said to be physicians who understand governance. Is this record not worthy of transmission?

Some might ask: "If this is true, are internal and external medicine not distinct professions? The *Rites of Zhou* lists both *Jiyi* (Physicians for Internal Diseases) and *Yangyi* (Surgeons). Why were both positions retained?" I reply: That is not what I mean. In ancient times, Bian Que, when practicing medicine, served as a pediatrician in Qin where children were valued, a gynecologist in Zhao where women were valued, and a physician for ear, eye, and bi syndrome in Zhou where the elderly were valued. One physician mastering three specialties did not imply his techniques were miraculously different, but that the underlying principles were uniform. The distinction in the *Rites of Zhou* was based on official duties, not a separation into two incompatible paths as seen in later eras. Ancient officials served as high ministers at home and generals abroad; the same person embodied both governance and military command. Who says internal and external medicine are indeed disconnected?

Written by Shen Qiyuan, Daoqing, of Xiuzhou, during the Mid-Autumn Festival of the Jiayin year of the Jiajing reign.