九， 针、员针、堤针、 针、铍针、员利针、毫针、长针、大针，亦随病所宜而用，一失其制，
则病不应。今则大者如员针，小者如毫针而已，岂能治痼疾暴气，此十失也。大端之失已
如此，而其尤要者更在神志专一，手法精严，经云∶神在秋毫，属意病者，审视血脉，刺之无
殆。又云∶经气已至，慎守勿失，深浅在志，远
所若一，如临深渊，手如握虎，神无营于众物。又云∶伏如横弩，起如发机，其专精敏妙如此。
今之医者随手下针，漫不经意，即使针法如古，志不凝而机不达，犹恐无效，况全与古法
相背乎？此外尚有先后之序，迎随之异，贵贱之殊，劳逸之分，肥瘦之度，多少之数，抉发难
数，果能潜心体察以合圣度，必有神功。其如人之畏难就易，尽违古法，所以世之视针甚
轻，而其术亦不行也。若灸法则较针所治之病不过十之一二，知针之理则灸又易易耳。此
《医学源流》所以郑重分明言之，不惮烦者，甚望学人勿误入歧途，而转失古圣之正传也。
医道最可怪而又可笑者，莫如内外分科，不知始于何时何人。试思人身不能外经络、躯
壳、筋骨、脏腑以成人，凡病变不外六淫七情以为病，试问外科之证，何一非经络脏腑所
发？原无所谓内外也。若不深明六气、七情、五运、六经经界，两科中皆不得立足，未有能
治内科而不能治外科，亦未有能治外科而不能治内科者也。在前人之分之者，不过以医道
繁难，通才不易，分之欲其专精。不谓世之各执其业者，竟如分门别户，不相通问，如画鸿
沟而东西卒之，专门名家皆不可得，似乎业内科者，可以不必多读书，只奉《医方合编》以为
秘本，即号精理内科。业外科者，更可不必多识字，只须略辨之无聊，记败毒、拔脓、生肌、
收口数方，即号精理外科。于是显然为内证者即属内科治之。显然为外证者即属外科治之。
其有病在腹中，内外皆未显然，而患又最深大，如所谓腹内痈者，则又将谁属哉？腹内之
痈，又有数证，有肺痈，有肝痈，有胃脘痈，有大小肠痈，有膀胱痈。唯肺痈咳吐腥痰，人犹
易辨，余则或以为痞结，或以为瘀血，或以为痰积、食积，医药杂投，卒莫知病，及至成脓，
治已无及。并有不及成脓而死者，病者医者始终不知何以致死，比比然也。今先为辨明痞
结、瘀血、痰积、食积之状。凡痞结瘀血，必有所因，且由渐而成。痰积则痛止无定，又必别
现痰证。食积则必有受伤之日，且三五日后大
便一通即解。唯外证则痛有常所，而迁延日甚，《金匮》云∶诸脉浮数，应当发热而反淅淅
恶寒，若有痛处当发其痈，以手按肿上热者有脓，不热者无脓。此数句乃内痈真谛也。又云∶
肠痈之为病，身甲错，腹皮急，按之濡如肿状，腹无积聚，身无热是也。若肝痈，则胁内隐隐
痛，日久亦吐脓血。小肠痈与大肠相似而位略高，膀胱痈则痛在少腹之下近毛际，着皮即
痛，小便亦艰而痛。胃脘痈者，有虚实二种，实者易消，若成脓必大吐脓血而愈；唯虚证则多
不治，先胃中痛胀，久而心下渐高，其坚如石，或有寒热，饮食不进，按之尤痛，形体枯瘦，此
乃思世伤脾之证，不待痈成即死。故凡腹中有一定痛处，恶寒蜷卧不能食者，皆当审察，防
成内痈，慎毋因循求治于不明之人，以致久而脓溃，自伤其生也。又有邪留经络致成刖足，
伤寒瘀留经络致成背胸奇痛等证，今之外科名手与西医之向称善治外证者，其知此乎？或
云跌打刀伤可属外科似也，然跌打刀伤之顷尚属外证，以后而溃气散，或血瘀气滞仍属内
科，盖人身只气血两端，终不能分内外也。唯望分业内外者仍合内外为一贯，而精深以求
之。至于妇人一科，不过多胎产两端，小儿一科则已七情之病，而世更有分之者，不唯不见
专精而转少，使因陋就简，又何为哉。
近年，闽广时疫流行，每至春夏之交尤甚，病发时寒热、呕吐、神昏、 语，或闷绝不
知人事，辄于项颈、两腋、两 之际发出恶核，有谓鼠疫者，有谓标蛇者，有谓天花毒者，又
有当痈疽治者种种，妄立名目，千百不救一二。患者沿门比户，互相传染，闻者心慌胆裂，
蛇影杯弓。医者既不知病名，何能知病源？只以方药杂投，或寒、或热、或攻、或散、或泻、或
表，皆无当于病情。西医则更可笑，或以冰压其胸，或以黄熏其体，更或以臭丸臭水洒满居
室，以刀割其核，以蛭吮其血，卒之亦无一效，而转速死不可胜计。殆至死后，并剖解视查，
究为何病，而亦不敢，恐其传染也。又有上吐下泻，转筋，类乎霍乱而实非霍乱者，间年流
行，亦与核证之恶且速相似，此则速用温补收摄之剂，偶有治疗一二，迟则不及。实则两病，
皆香港脚一病，不过来路不同耳。香港脚传于肝胆则发核，香港脚传于脾胃则吐泻，两病只要毒瓦斯
不攻心，无不可治，诸经方虽有香港脚之论，古人却少此病（香港脚之名，《金匾》已载，但患者
少）。自永嘉南渡，衣缨士人多有患者，有支法存、仰道人等，并留意经方，偏善此术，多获全
济。又宋齐之间，释门深师述二公等诸家旧方为二十卷，其香港脚一方近百余首，魏周之代亦
无此病。所以姚公《集验》殊不殷勤，徐王撰录未以为意，特以三方鼎峙，风教未一，霜露不
均，寒暑不等，关西河北，不识此疾，唐代开辟，无外南极之地，坐镇于彼，往往皆遭。元和
十二年二月，柳柳州得此病，夜半痞绝，两胁有核，块大如石，且死，困塞不知人事，三日，
荣阳郑洵美进杉木汤，服半日食顷，大小便三次，气通核散（方详《医医医外编》香港脚汤中）。
此病先从脚起，甚微，饮食如故，深师云脚弱，《内经》云缓风湿痹，一旦发泄，遂成恶疾。或
问∶风毒中人随处皆得，作病何偏着于脚？答曰∶人有五脏，心、肺经络所起在十手指，余三
脏经络所起在足十趾，地之寒暑风湿皆作蒸气，足常履之，所以寒暑风湿邪毒之中人，必
先中脚，久而不去，遍及四肢腹背头项，经云次传、间传是也。凡香港脚皆感风湿之毒所致，
人多不即觉，曾因它病一度始发，闽广皆当湿热之地，故每于春夏之交，一遇风邪暑邪触
动，遂即决裂而出，莫之能御。世医既不能多读古书，自不能多识病名，作余病治，罔不尽
弊。余于甲午之际，适在岭南，正值此证盛发之时，遂亟起而作《时疫辨治》一编，大声疾
呼，并汇集《千金》《外台》所述岭南恶核证治，以告病者医者，而皆藐藐置之，惟经延医者除
病，已入心及已误它药者，无不循法获救，愿以后遇是证时，医者悉于香港脚中求之，慎勿再
妄立名目以误人，而终自误。更以知怪病百出，总不外六气六经以为治也。
人禀天地之气以生，人亦因天地之气以
病，医者不明三才相应之理，侈口言医，是犹出门而不由户也。天地只此阴阳，化生五运六
气，人身亦只此阴阳，生成五脏六腑，万病莫不由五运六气五脏六腑所生。不深究夫气化
之源，而徒执乎中西之见，皆属梦中说梦耳。方今四海一家，五洲同轨，要使轸域俱化，有
无交通，酌剂盈虚，共由大道。欧西各国自入中土，不独声光电汽诸学矜能，即医学一道亦
诋中国为非，此虽中国近今医者苟且庸陋，有以启之，殊不知中国古圣之精确迥非西医所
能梦见。盖《内》《难》仲景之书，西医从未之闻，故以剖瞟实验自矜，然皆详形迹而昧气
化，未免得粗遗精。世之重视西医与从学西学人，尤皆耳食目论，道听途说，举凡五运六气，
人身阴阳，五脏所藏，五脏所主，六腑所合，五脏所开九窍，男女天癸，营卫生会，六经六气，
经气主治，十二经脉，奇经八脉，中国古圣言之凿凿者，晋唐以后中医且多不讲，近医尤多
不知，又何怪西医之 昧耶？西医以剖解脏腑，形迹列图，虽较中国旧图为详，然其说则
皆知其当然，而不知其所以然。且并有当然亦全不知者，因皆执死者之尸具为据，而云人是
炭等十四质凑合而成。夫彼所谓十四质，皆经剖解锻炼而得，而人之未死者，岂止此块
然之质哉？况生气已尽，何从知所谓气化耶？如西医动言脑筋，而不知脑是何物所化。又常
论髓，亦不知髓是何物所生。又云饮食之汁由吸管递运至颈会管，与心血混为赤色，此一混
字殊谬，岂有日日混入而赤色不日淡者乎？不知汁入颈会管即水交于火也，变为赤色，即奉
心火之化而为血也。又云血内有红白二轮，红多白少，不知其白者水液之本，形也，其红者
奉心所化之赤色也，即《内经》所云∶中焦受气取汁，变化而赤，谓血也。又云∶心有出血管，
导血出，又有回血管，导血入。西医名管，中国名脉，二而一也。脉气流经者，谓流行于各经
络而回复有常。又云∶心左房之血由出血管导行于周身，心体动跳不休，每一跳则周身之脉
应之而跳，血既行遍周身，则转入回血管，其
色变紫，以受炭气也。紫血由回血管递传复返于颈会管，得肺气呼出，则炭气出而紫色退，
复变为赤，入心右房，转至左房而又出也，则脉气流经之谓矣。时医有大络散众络、众络散
孙络之说，言其出而不言复，与流经二字尚不确切，故引西医之说证之。西医所图脉管详
矣，然不能分别十二经脉，奇经八脉，以为脉不足凭，《医林改错》亦然，不知彼皆割视死
人，安能复辨经脉。又其言回血不能知几时方回于心，唯内言一呼脉行三寸，一吸脉行三
寸，计昼夜一万三千五百息，脉行五十度，则能算出血行之时节，何时出者当何时回。西医
虽经剖视实验，何能如中国古圣之精确哉！至若六经六气，经气主治之理，西医则更全然不
知，治病焉能悉当。它如种种卤莽，不可殚论，虽其法皆本五禽图，然万不及其精细。蜀中唐
容川宗海曾着《中西汇通医经精义》一书，缕晰条分，层层互证，苦心孤诣，先得我心。惜其
书尚未盛行于世，又无善释者释之，与吾《医医医》三编及《内》《难》仲景诸经并以输入欧
西各国，使西医得以窥见吾国古圣之精法，而有以自悔其失，并以渐进衣冠文物，以为环球康
济，斯民之助。
治病犹治天下也，天下之乱，不过外患内忧，人身之病，不过外感内伤。风寒暑湿燥火
六气之疾，所谓外患也；喜怒忧思悲惊恐，七情之害，所谓内忧也。治外患者，以攻胜四郊
不靖而选将出师，速驱除之可也。临辟雍而讲礼乐，则敌在门矣。故邪气未尽而骤用补者，
必使邪气内陷而亡。治内伤者以养胜，纪纲不正而崇儒重道，徐化导之可也。若任刑罚而严
诛戮，则祸益深矣。故正气不足而轻用攻者，必致正气消尽而死。然而全盛之世，不无玩
民，故刑罚不废，则补中之攻也。如以小寇而遽起兵戎，是扰民矣。故补中之攻不可过也。
征诛之年亦修内政，故教养不弛，则攻中之补也。若以戎首而稍存姑息，则养寇矣。故攻中
之补不可误也。天下大事以天下全力为之，则事不堕，天下小事以一人从容处之，则事不
扰。患大病以大药制之，则病气无余，患小病以小方处之，则正气不伤。然又必大小有方，
先后有序，轻重有度，疏密有数，纯而不杂，整而不乱。所用之药，各得其性，则器使之道，所
处之方，各得其理，则调度之法上。古圣人治未病，更须于望形察色予为之防，即制治于未
乱，保邦于未危也。所谓医道通于治道，良相即是良医，大略如此。若夫临机应变，又必随
事参观，神而明之，存乎其人，不可执成见而为定论，此《医学源流》正义，用特引而伸之，
诚能朝廷变通，医官世界郑重重医，道医者，精通医学，悉以《医医医》三编方药分服之，而
各尽其道，且以开通外人，变齐变鲁以至于道。仁寿之宇，大同之世，不可睹哉！医医医，
噫噫噫！
九、针、员针、鍉针、锋针、铍针、员利针、毫针、长针、大针，也应根据病情适宜选用，一旦失去法度规范，疾病就不会好转。如今医生使用的针具，大的像员针，小的像毫针罢了，怎么能治疗顽固的急重病邪呢？这是第九种失误。大的方面失误已经如此，而其中最重要的更在于精神专注，手法精严。《内经》说：“神气细微如秋毫之末，意念集中在病人身上，审视血脉，针刺才没有危险。”又说：“经气已至，谨慎守护不要丢失，深浅在意念中把握，远近如一，如同面临深渊，手像握着老虎一样稳重，精神不被周围事物分散。”又说：“潜伏时像拉满的弓弩，发作时像触动机关射箭一样迅速，其专精敏捷美妙到了这种地步。”现在的医生随手下针，漫不经心，即使针法符合古法，如果意志不凝聚、时机把握不到，还恐怕无效，何况完全违背古法呢？此外还有先后顺序、迎随补泻的区别、体质贵贱的差异、劳逸程度的不同、肥瘦的度量、用针数量的多少，难以一一列举。如果能潜心体察以符合圣人的法度，必然有神奇的功效。然而人们畏惧困难、趋向容易，完全违背古法，所以世人轻视针灸，导致这门技艺无法推行。至于灸法，所治疗的疾病不过针灸的十分之一二，懂得针灸的道理，那么灸法就更容易掌握了。这就是《医学源流》之所以郑重分明地讲述这些内容，不辞烦琐的原因，非常希望学习者不要误入歧途，从而背离了古代圣贤的正统传承。
医道中最奇怪又可笑的，莫过于将内科和外科分科治疗，不知道是从什么时候、什么人开始的。试想人体不能脱离经络、躯壳、筋骨、脏腑而存在，凡是病变不外乎六淫（风、寒、暑、湿、燥、火）和七情（喜、怒、忧、思、悲、恐、惊）致病，试问外科的病证，哪一样不是由经络脏腑引发的？原本就没有所谓的内与外之分。如果不深明六气、七情、五运、六经的界限，内外两科都无法立足，从来没有能治内科而不能治外科的，也没有能治外科而不能治内科的。前人将它们分开，不过是认为医道繁难，通才不易，分开是为了让他们专精。没想到世上的从业者各自坚守自己的业务，竟然像分门别户一样，互不相通，就像画了鸿沟一样东西隔绝，连专门名家都做不到。似乎从事内科的人，可以不必多读书，只奉《医方合编》为秘本，就可以号称精通内科道理；从事外科的人，更可不必多识字，只需略懂一些无聊的知识，记住败毒、拔脓、生肌、收口这几个方子，就可以号称精通外科道理。于是，明显是内科病证的就归内科治疗，明显是外科病证的就归外科治疗。如果有病在腹中，内外表现都不明显，而且病情又深重巨大，比如所谓的腹内痈（腹腔内的化脓性炎症），那又归属谁呢？腹内的痈，又有几种证候：有肺痈，有肝痈，有胃脘痈，有大肠痈和小肠痈，有膀胱痈。只有肺痈咳吐腥臭痰液，人还容易辨别，其他的或者被误认为是痞结（气机阻滞形成的结块），或者被误认为是瘀血，或者被误认为是痰积、食积，药物杂乱投用，最终不知道是什么病，等到化脓形成，治疗已经来不及了。更有甚至还没到化脓阶段就死亡的，患者和医生始终不知道致死原因，比比皆是。现在先为你们辨明痞结、瘀血、痰积、食积的症状。凡是痞结和瘀血，必定有起因，而且是逐渐形成的。痰积则疼痛位置不定，又必须伴有其他痰证表现。食积则必定有受伤（饮食不节）的日子，且三到五天后大便一通就能缓解。只有外证则疼痛部位固定，且拖延一天比一天严重。《金匮要略》说：“各种脉象浮数，应当发热却反而淅淅恶寒，如果有疼痛的地方应当发生痈肿，用手按压肿胀处感觉热的就有脓，不热的就没有脓。”这几句话是内痈的真谛啊。又说：“肠痈这种疾病，身体皮肤粗糙如鳞甲交错，腹部皮肤紧张，按压柔软像肿胀的样子，腹部没有积聚包块，身体没有发热，就是这种情况。”如果是肝痈，则胁肋内部隐隐作痛，日久也会吐出脓血。小肠痈与大肠痈相似但位置略高，膀胱痈则疼痛在小腹下方靠近阴毛处，皮肤一碰就痛，小便也艰涩疼痛。胃脘痈有虚实两种，实证容易消散，如果化脓必然大口吐出脓血才能痊愈；唯独虚证大多无法治愈，先是胃中疼痛胀满，久而久之心窝部渐渐隆起，坚硬如石头，或有寒热症状，饮食不进，按压更加疼痛，形体枯瘦，这是思虑过度损伤脾脏的证候，不用等到痈脓形成就会死亡。所以凡是腹中有固定痛点，恶寒蜷缩卧倒不能进食的，都应当仔细审查，防止形成内痈，千万不要因为循规蹈矩去求治于不明医理的人，以至于时间久了脓液溃破，自己伤害生命。又有邪气留在经络导致截肢，伤寒瘀血留在经络导致背胸剧烈疼痛等证候，当今的外科名医和西医院里号称善于治疗外证的人，他们知道这些吗？有人说跌打刀伤可归属于外科，这似乎是对的，然而跌打刀伤当时尚属外证，之后如果溃烂气散，或者血瘀气滞，仍然属于内科范畴，盖人身只有气血两端，终究不能分为内外。只希望分业内外的人仍将内外视为一贯，精深地去探求它。至于妇人一科，不过是多涉及胎产两端；小儿一科则是多涉及七情之病，世上还有人将其进一步细分，不仅不见专精反而减少，使得因陋就简，这又是为什么呢？
近年来，福建、广东等地时疫流行，每到春夏之交尤其严重。发病时寒热往来、呕吐、神志昏迷、胡言乱语，或者闷绝不知人事，往往在项颈、两腋、两腘（膝盖后方）之际发出恶核（恶性肿块），有的说是鼠疫，有的说是标蛇（一种毒疮），有的说是天花毒，又有当作痈疽治疗的，种种妄立名目，千百人中救不活一二个。患者挨家挨户，互相传染，听到的人心慌胆裂，疑神疑鬼。医生既然不知道病名，怎么能知道病源？只是杂乱地投用方药，或寒或热，或攻或散，或泻或表，都没有切合病情。西医就更可笑了，有的用冰压胸部，有的用黄烟熏身体，更有的用臭丸臭水洒满居室，用刀割开肿块，用水蛭吮吸血液，最终也没有一个有效的，反而加速死亡的不计其数。等到死后，甚至不敢解剖查看，究竟是什么病，怕被传染。又有上吐下泻，转筋（肌肉痉挛），类似霍乱但实际上不是霍乱的，每隔几年流行一次，也与核证之恶且速相似，这时迅速使用温补收摄的药剂，偶尔能治疗一两个，迟了就来不及了。实际上这两种病，都是香港脚（脚气病）这一种病，只是来路不同而已。香港脚传入肝胆则发核，传入脾胃则吐泻，只要毒瓦斯不攻心，没有不可治的。虽然诸经方中有论述香港脚的，但古人很少有此病（“香港脚”之名，《金匮要略》已有记载，但患者少）。自从永嘉南渡以来，衣冠士人多有患此病的，有支法存、仰道人等，并留意经方，特别擅长此术，多获得保全救济。又在宋齐之间，释门僧人深师叙述二位公等诸家的旧方编成二十卷，其中香港脚一方近百余首，魏周时代也没有此病。所以姚公的《集验方》对此并不殷勤，徐王撰录也未以为意，特别是因为三方鼎立，风俗教化未统一，霜露不均，寒暑不等，关西河北地区，不认识这种疾疫，唐代开辟疆土，无外南极之地，坐镇在那里，往往都会遭遇。元和十二年二月，柳宗元得此病，半夜痞闷闭塞，两胁有核，块大如石，几乎死去，困塞不知人事，三天后，荥阳郑洵美进献杉木汤，服用半顿饭工夫，大小便三次，气通核散（方剂详见《医医医外编》香港脚汤中）。此病先从脚起，很轻微，饮食如故，深师称之为脚弱，《内经》称之为缓风湿痹，一旦发泄，遂成恶疾。有人问：风毒中人随处皆可，为何作病偏偏附着于脚？回答是：人有五脏，心、肺经络起始于十手指，其余三脏经络起始于足十趾，地面的寒暑风湿都化作蒸气，脚经常踩踏地面，所以寒暑风湿邪毒中人，必定先中脚，久了不去，遍及四肢腹背头项，经文所说的次传、间传就是这个意思。凡香港脚都是感风湿之毒所致，人大多不立即察觉，曾因其他疾病一度引发，闽广都是湿热之地，所以每当春夏之交，一遇风邪暑邪触动，随即决裂而出，无人能抵御。世医既然不能多读古书，自然不能多识病名，当作其他病治疗，无不弊端尽显。我在甲午年间，恰好在岭南，正值此证盛发之时，于是急忙撰写《时疫辨治》一篇，大声疾呼，并汇集《千金方》《外台秘要》所述岭南恶核证治，告知患者和医者，却都被轻视置之不理，只有经过延请医者除病，已经入心及已误服其他药的，无不遵循法度获救。愿以后遇到此证时，医者都在香港脚中寻求诊治，千万不要再妄立名目以误人，最终自误。更以此知晓怪病百出，总不外乎六气六经作为治疗依据。
人禀受天地之气而生，人也因天地之气而病，医生不明白三才相应的道理，夸夸其谈言医，这就像出门而不走门户一样。天地只有阴阳，化生五运六气，人身也只有阴阳，生成五脏六腑，万病莫不由五运六气、五脏六腑所生。不深究气化的源头，而仅仅执着于中西之见，都属于梦中说梦。当今四海一家，五洲同轨，要使视野俱化，有无交通，斟酌剂量盈虚，共同遵循大道。欧西各国进入中国后，不仅声光电汽诸学炫耀才能，就连医学一道也诋毁中国为非，这虽然是中国近代医者苟且庸陋，有所启发，但殊不知中国古代圣贤的精确远超西医所能梦见。因为《内经》《难经》及张仲景的书，西医从未听说过，所以他们以剖视实验自夸，然而都详于形迹而昧于气化，难免得粗遗精。世上重视西医与学习西学的人，尤皆耳食目论，道听途说，举凡五运六气，人身阴阳，五脏所藏，五脏所主，六腑所合，五脏所开九窍，男女天癸，营卫生会，六经六气，经气主治，十二经脉，奇经八脉，中国古圣言之凿凿的，晋唐以后的中医都已多不讲，近医尤多不知，又何必怪西医的愚昧呢？西医以剖解脏腑，形迹列图，虽然较中国旧图为详细，然而他们的说法只知道其然，而不知道其所以然。并且连当然也全然不知道的，因为他们都拿着死者的尸体作为依据，说人是碳等十四种物质凑合而成。他们所谓的十四质，都是经过剖解锻炼而得到的，而活着的人，岂止于此块然之质呢？况且生气已尽，从哪里知道所谓的气化呢？比如西医动不动谈论脑筋，却不知道脑是何物所化。又常论髓，也不知道髓是何物所生。又说饮食之汁由吸管递运至颈会管（静脉导管），与心血混为赤色，这一个“混”字特别谬误，难道日日混入而赤色不日渐变淡吗？不知道汁入颈会管即水交于火，变为赤色，即奉心火之化而为血。又说血内有红白二轮，红多白少，不知道白色是水液之本，形也，红色是奉心所化之赤色，即《内经》所说：中焦受气取汁，变化而赤，谓血也。又说：心有出血管，导血出，又有回血管，导血入。西医名为管，中国名为脉，二而一也。脉气流经者，谓流行于各经络而回复有常。又说：心左房之血由出血管导行于周身，心体动跳不休，每一跳则周身之脉应之而跳，血既行遍周身，则转入回血管，其色变紫，以受炭气也。紫血由回血管递传复返于颈会管，得肺气呼出，则炭气出而紫色退，复变为赤，入心右房，转至左房而又出也，则脉气流经之谓矣。时医有大络散众络、众络散孙络之说，言其出而不言复，与流经二字尚不确切，故引西医之说证明之。西医所绘图脉管详细矣，然而不能分别十二经脉，奇经八脉，以为脉不足凭，《医林改错》也是如此，不知道他们都是割视死人，怎能再分辨经脉。又其言回血不能知几时方回于心，唯中医言一呼脉行三寸，一吸脉行三寸，计昼夜一万三千五百息，脉行五十度，则能算出血行之时节，何时出者当何时回。西医虽经剖视实验，何能如中国古圣之精确哉！至于六经六气，经气主治之理，西医则更全然不知，治病焉能悉当。其他种种卤莽，不可尽论，虽然其法皆本五禽图，然而万万不及其精细。蜀中唐容川宗海曾著《中西汇通医经精义》一书，缕晰条分，层层互证，苦心孤诣，先得我心。可惜其书尚未盛行于世，又无善释者释之，与我《医医医》三编及《内》《难》仲景诸经一并输入欧西各国，使西医得以窥见我国古圣之精法，而有以自悔其失，并以渐进衣冠文物，以为环球康济，斯民之助。
治病犹治天下也，天下之乱，不过外患内忧，人身之病，不过外感内伤。风寒暑湿燥火六气之疾，所谓外患也；喜怒忧思悲惊恐七情之害，所谓内忧也。治外患者，以攻胜四郊不靖而选将出师，速驱除之可也。临辟雍而讲礼乐，则敌在门矣。故邪气未尽而骤用补者，必使邪气内陷而亡。治内伤者以养胜，纪纲不正而崇儒重道，徐化导之可也。若任刑罚而严诛戮，则祸益深矣。故正气不足而轻用攻者，必致正气消尽而死。然而全盛之世，不无玩民，故刑罚不废，则补中之攻也。如以小寇而遽起兵戎，是扰民矣。故补中之攻不可过也。征诛之年亦修内政，故教养不弛，则攻中之补也。若以戎首而稍存姑息，则养寇矣。故攻中之补不可误也。天下大事以天下全力为之，则事不堕，天下小事以一人从容处之，则事不扰。患大病以大药制之，则病气无余，患小病以小方处之，则正气不伤。然又必大小有方，先后有序，轻重有度，疏密有数，纯而不杂，整而不乱。所用之药，各得其性，则器使之道，所处之方，各得其理，则调度之法上。古圣人治未病，更须于望形察色予为之防，即制治于未乱，保邦于未危也。所谓医道通于治道，良相即是良医，大略如此。若夫临机应变，又必随事参观，神而明之，存乎其人，不可执成见而为定论，此《医学源流》正义，用特引而伸之，诚能朝廷变通，医官世界郑重重医，道医者，精通医学，悉以《医医医》三编方药分服之，而各尽其道，且以开通外人，变齐变鲁以至于道。仁寿之宇，大同之世，不可睹哉！医医医，噫噫噫！
9. The needle, Yuan needle (Round-pointed needle), Di needle (Blunt needle), Feng needle (Sharp needle), Pi needle (Sword needle), Yuanli needle (Round and sharp needle), Hao needle (Filiform needle), Chang needle (Long needle), and Da needle (Large needle) should also be used according to the suitability of the condition. If their regulation is lost, the disease will not respond. Today, the larger ones are like Yuan needles, and the smaller ones are like Hao needles; how can they treat stubborn diseases and sudden pathogenic qi? This is the ninth error. The major errors are already as described above, but the most crucial lies in spiritual concentration and rigorous manual technique. The *Classic* states: "The spirit is subtle as the autumn down; focus your intention on the patient, examine the blood vessels, and there will be no danger in needling." It also says: "When the Jing Qi has arrived, guard it carefully and do not lose it; depth is determined by your mind; distance and nearness are treated as one; act as if facing an abyss, hold the hand as if grasping a tiger, and let the spirit not be distracted by other things." It further says: "Be still like a drawn crossbow, strike like releasing the trigger; such is their specialization, agility, and subtlety." Today's physicians insert needles casually, without care. Even if the needle technique conforms to ancient methods, if the will is not concentrated and the timing is not grasped, efficacy is still doubtful, let alone when it completely contradicts ancient methods. Furthermore, there are sequences of priority, differences in Ying-Sui (following and opposing) manipulation, distinctions in constitution, divisions between labor and rest, degrees of fatness and thinness, and numbers of needles, which are difficult to enumerate. If one can devote oneself to observation and investigation to conform to the standards of the sages, miraculous effects will surely follow. However, people fear difficulty and seek ease, completely violating ancient methods. Therefore, the world regards acupuncture lightly, and the art cannot be practiced. Regarding moxibustion, the diseases it treats amount to only one-tenth or one-twentieth of those treated by acupuncture. Understanding the principles of acupuncture makes moxibustion even easier. This is why *Yixue Yuanliu* (Source Traces of Medicine) discusses these matters so solemnly and clearly, not sparing trouble, hoping earnestly that learners do not go astray and deviate from the orthodox transmission of the ancient sages.
The most strange and laughable aspect of the medical way is the division into internal and external departments; it is unknown when or by whom this began. Consider that the human body cannot exist without meridians, shell, bones, muscles, and zang-fu organs. All pathological changes arise from the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Pondering, Sorrow, Fear, Fright). Ask yourself: which external disease manifestation does not originate from meridians and zang-fu organs? Originally, there is no distinction between internal and external. Without a deep understanding of the boundaries of the Six Qi, Seven Emotions, Five Movements, and Six Channels, one cannot stand in either department. There is no one who can treat internal diseases but not external ones, nor one who can treat external diseases but not internal ones. The ancients divided them perhaps because the medical path is complex and difficult, and generalists are rare; dividing them was intended to foster specialization. Unexpectedly, practitioners today cling to their respective trades as if they were separate households, refusing to communicate, like drawing a border across the Hong River. Consequently, neither specialized experts nor famous masters can be found. It seems that those practicing internal medicine need not read much; merely holding *Yifang Hebian* (Collected Medical Prescriptions) as a secret text suffices to claim proficiency in internal principles. Those practicing external medicine need not even know many characters; merely knowing some trivialities and memorizing a few prescriptions for draining toxins, extracting pus, generating flesh, and closing wounds suffices to claim proficiency in external principles. Thus, obvious internal symptoms are treated internally, and obvious external symptoms are treated externally. But what if the disease is inside the abdomen, with no obvious internal or external signs, yet is deep and severe, such as so-called intra-abdominal abscesses? Who would handle such cases? Intra-abdominal abscesses include several types: Lung Abscess, Liver Abscess, Stomach/Epigastric Abscess, Large Intestine Abscess, Small Intestine Abscess, and Bladder Abscess. Only Lung Abscess, characterized by coughing up foul-smelling sputum, is relatively easy to identify. Others are mistaken for Pi Jie (obstruction and accumulation), Blood Stasis, Phlegm Accumulation, or Food Retention. Medicines are administered haphazardly, and ultimately, the disease remains unknown. By the time suppuration occurs, treatment is futile. Some die before suppuration even forms; patients and doctors alike remain ignorant of the cause of death, a common occurrence. Now, let us clarify the manifestations of Pi Jie, Blood Stasis, Phlegm Accumulation, and Food Retention. Both Pi Jie and Blood Stasis must have a cause and develop gradually. Phlegm Accumulation involves pain that shifts locations and must present with other phlegm symptoms. Food Retention must have a history of dietary injury, and usually resolves after bowel movement within three to five days. External diseases, however, feature fixed pain that worsens over time. The *Jin Gui Yao Lue* states: "When pulses are floating and rapid, fever should occur, but instead there is shivering aversion to cold. If there is a painful area, an abscess may develop. Pressing the swelling yields heat if pus is present, and no heat if absent." These sentences reveal the true essence of internal abscesses. It also states: "Intestinal Abscess presents with rough, scaly skin, tense abdominal wall, soft upon pressure resembling swelling, no abdominal masses, and no body heat." For Liver Abscess, there is dull pain in the hypochondrium, and eventually vomiting of pus and blood. Small Intestine Abscess is similar to Large Intestine Abscess but located slightly higher. Bladder Abscess causes pain in the lower abdomen near the pubic hair, tenderness upon touching the skin, and difficult, painful urination. Stomach/Epigastric Abscess has two types: excess and deficiency. Excess type is easily resolved; if suppuration occurs, vomiting large amounts of pus and blood leads to recovery. Deficiency type is mostly incurable; initially, there is stomach pain and distension, later a hard, stone-like elevation at the epigastrium, possibly with chills and fever, inability to eat, extreme tenderness upon pressure, and emaciation. This is a syndrome of spleen injury due to excessive thinking; death occurs before abscess formation. Therefore, any fixed abdominal pain accompanied by aversion to cold, curling up, and inability to eat requires careful examination to prevent internal abscesses. Do not delay seeking treatment from incompetent physicians, leading to rupture and self-harm. Other conditions include gangrene caused by pathogens lingering in meridians, or severe back and chest pain caused by cold damage and blood stasis in meridians. Do contemporary external medicine experts and Western physicians claiming expertise in external diseases understand this? Some argue that trauma and knife wounds belong to external medicine, which seems correct. However, immediately after trauma, it is an external condition; later, if ulceration disperses Qi, or if blood stasis and Qi stagnation persist, it belongs to internal medicine. The human body consists only of Qi and Blood; they cannot be strictly divided into internal and external. We hope those dividing professions into internal and external will unite them and pursue profound understanding. As for gynecology, it mainly concerns pregnancy and childbirth; pediatrics mainly concerns emotional disorders. Further subdivision by others achieves neither specialization nor reduction of complexity, leading to crudeness. Why do this?
In recent years, epidemic diseases have prevailed in Fujian and Guangdong, especially during the transition from spring to summer. Onset features alternating chills and fever, vomiting, coma, delirium, or sudden collapse with loss of consciousness. Malignant nodules often appear on the neck, axillae, and popliteal fossae. Some call it plague, some Biaoshe (a toxic sore), some smallpox toxin, others treat it as carbuncles and sores. Various false names are invented; out of thousands, hardly one or two survive. Patients infect each other household to household. Hearing of it causes panic and paranoia. Since doctors do not know the disease name, how can they know its source? They administer medicines indiscriminately—cold, hot, purgative, dispersing, draining, or releasing the exterior—all failing to match the condition. Western medicine is even more ridiculous: some press ice on the chest, some fumigate the body with yellow smoke, some sprinkle stinking pills and water in rooms, some cut open nodules, some use leeches to suck blood. Ultimately, none are effective, and accelerated deaths are countless. Even after death, they dare not dissect to determine the cause, fearing infection. There are also cases of vomiting, diarrhea, and muscle spasms resembling cholera but actually distinct, occurring periodically, similarly malignant and rapid. Rapid administration of warming, tonifying, and astringent agents occasionally saves one or two; delay means death. In reality, both diseases are the same entity: Hong Kong Jiao (Beriberi/Foot Qi), differing only in origin. When Hong Kong Jiao transmits to the Liver and Gallbladder, nodules develop; when it transmits to the Spleen and Stomach, vomiting and diarrhea occur. As long as the toxic vapor does not attack the Heart, all are treatable. Although classical formulas discuss Hong Kong Jiao, it was rare in ancient times (the term appears in *Jin Gui*, but patients were few). Since the Yongjia migration, many scholars suffered from it. Zhi Facun, Yang Daoren, and others studied classical formulas and excelled in treating it, saving many. During the Song and Qi dynasties, the monk Shenshi compiled twenty volumes of old formulas from various masters, including nearly a hundred prescriptions for Hong Kong Jiao. It was absent in the Wei and Zhou dynasties. Thus, Yao Gong’s *Jiyan Fang* did not emphasize it, and Xu Wang’s compilation ignored it. Specifically, during the tripartite division, customs were not unified, climate varied, and the disease was unknown in Guanzhong and Hebei. In the Tang Dynasty, expansion reached southern extremes, where it was common. In the second month of the 12th year of Yuanhe, Liu Zongyuan contracted this disease. At midnight, he suffered severe obstruction, nodules in both hypochondria as hard as stones, nearly died, confused and unconscious. Three days later, Zheng Xunmei of Xingyang administered Shanmu Tang (Cedar Wood Decoction). After half a meal's time, he had three bowel movements, Qi flowed, and nodules dispersed (see *Yiyi Yi Waibian* for details). This disease starts in the feet, very mildly, with normal diet. Shenshi called it "weak feet"; the *Neijing* calls it "wind-damp bi". Once erupted, it becomes a malignant disease. One asks: Wind-toxin affects everyone everywhere; why does it specifically attach to the feet? The answer is: Humans have five Zang organs. The meridians of the Heart and Lung originate in the ten fingers; the meridians of the other three Zang organs originate in the ten toes. Earth's cold, heat, wind, and dampness become vapors; feet constantly tread the ground. Thus, wind-cold-damp-toxin enters through the feet first. If lingering, it spreads to limbs, abdomen, back, head, and neck—the secondary and inter-transmission mentioned in the classics. All Hong Kong Jiao results from wind-damp toxicity. People rarely notice it immediately; it often erupts after another illness. Fujian and Guangdong are humid and hot regions. Upon encountering wind or summerheat pathogens in spring and summer, it erupts uncontrollably. Modern physicians, unable to read ancient books, fail to recognize disease names and treat them as other ailments, resulting in universal failure. During the Jiawu year, I was in Lingnan when this disease was rampant. I urgently wrote *Shiyi Bianzhi* (Differentiation and Treatment of Epidemics), shouting loudly, and compiled treatments for Lingnan malignant nodules from *Qianjin Yaofang* and *Waitai Miyao* to warn patients and doctors. They ignored me. Only those who followed proper methods after seeing competent doctors were saved. I wish future physicians would seek Hong Kong Jiao in such cases and stop inventing names to mislead people, thereby misleading themselves. Know that bizarre diseases always stem from the Six Qi and Six Channels.
Humans are born from the Qi of Heaven and Earth and fall ill due to the Qi of Heaven and Earth. Physicians who do not understand the correspondence of the Three Powers (Heaven, Earth, Man) and boast about medicine are like leaving home without using the door. Heaven and Earth possess only Yin and Yang, generating the Five Movements and Six Qi. The human body possesses only Yin and Yang, forming the Five Zang and Six Fu organs. All diseases arise from the Five Movements, Six Qi, Five Zang, and Six Fu. Not investigating the source of Qi transformation but clinging to Chinese-Western dichotomies is dreaming within a dream. Today, the world is united, and the five continents share tracks. Visions should merge, resources should exchange, dosages should be adjusted, and we should follow the Great Way. Since entering China, Western countries have boasted in acoustics, optics, electricity, and steam, and even disparage Chinese medicine. This is partly due to the mediocrity of modern Chinese physicians, but the precision of ancient Chinese sages is far beyond what Western medicine can imagine. Westerners have never heard of the *Neijing*, *Nanjing*, or Zhang Zhongjing’s works. They pride themselves on dissection and experiment but detail form while ignoring Qi transformation, thus capturing the coarse while missing the refined. Those who value Western medicine and study Western learning rely on hearsay and superficial observation. They ignore the Five Movements, Six Qi, Yin-Yang of the body, storage and governance of Zang organs, connections of Fu organs, openings of Zang organs to nine orifices, Tian Gui of men and women, meeting of Ying and Wei Qi, Six Channels and Six Qi, governance of Jing Qi, Twelve Regular Meridians, and Eight Extraordinary Vessels—all explicitly stated by ancient Chinese sages. Even post-Jin-Tang TCM physicians rarely discuss them, and modern physicians know little of them. How can one blame Western ignorance? Western medicine diagrams organs via dissection, appearing more detailed than old Chinese charts, but they know the "what" but not the "why," and sometimes not even the "what." They base theories on corpses, claiming humans are composed of carbon and fourteen elements. These elements are derived from dissected specimens; living humans are not merely inert matter. With life gone, how can one know Qi transformation? Westerners speak of the brain but do not know what transforms into it. They discuss marrow but do not know its origin. They claim nutrient fluid travels via lymphatic ducts to the thoracic duct, mixing with heart blood to become red. This "mixing" is erroneous; if mixed daily, why doesn't the red color dilute? Nutrient fluid entering the thoracic duct is Water interacting with Fire; turning red is transformation by Heart Fire into Blood. They claim blood has red and white circles, more red than white, not knowing white is the root of fluid/form, and red is Heart-transformed color. This matches the *Neijing*: "The Middle Jiao receives Qi, extracts juice, transforms it, and turns it red; this is called Blood." They claim the heart has efferent vessels guiding blood out and afferent vessels guiding blood in. Western "vessels" are Chinese "Mai" (Pulse/Vessels); they are one and the same. "Qi flows through meridians" means circulation returns regularly. They claim blood from the left atrium goes out via efferent vessels to the body; the heart beats continuously, causing pulse waves throughout. After circulating, blood enters afferent vessels, turns purple due to carbon dioxide absorption. Purple blood returns via afferent vessels to the thoracic duct, releases carbon dioxide via lung exhalation, turns red again, enters the right atrium, moves to the left atrium, and exits again. This is "Qi flowing through meridians." Contemporary physicians speak of large collaterals scattering into minor collaterals, then into sun collaterals, describing exit but not return, making "flowing through meridians" inaccurate. Hence, I cite Western theory to verify it. Western diagrams of vessels are detailed but fail to distinguish Twelve Regular and Eight Extraordinary Meridians, deeming them unreliable. *Yilin Gaicuo* agrees, not realizing dissection of corpses prevents meridian identification. They cannot determine when blood returns to the heart. TCM states: one exhalation, Qi moves three cun; one inhalation, Qi moves three cun. Over day and night, 13,500 breaths, Qi circulates fifty times, calculating blood flow timing precisely. Can Western dissection match the precision of ancient sages? Regarding Six Channels, Six Qi, and Jing Qi governance, Westerners know nothing, so their treatments cannot be accurate. Other absurdities are too numerous to list. Though their methods derive from the Five Animal Frolics, they are vastly inferior in subtlety. Tang Rongchuan Zonghai of Sichuan wrote *Zhongxi Huitong Yijing Jingyi* (Essence of Medical Classics in Chinese-Western Synthesis), analyzing and cross-verifying layer by layer, showing unique insight. Regrettably, it is not widely circulated, nor well-commented. Together with my *Yiyi Yi* trilogy and the *Neijing*, *Nanjing*, and Zhang Zhongjing’s classics, it should be introduced to Western countries, allowing Westerners to glimpse ancient Chinese precision, repent their errors, and promote cultural exchange for global health.
Treating disease is like governing the state. State chaos stems from external aggression and internal unrest; human illness stems from external contraction and internal injury. Diseases of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire) are external aggression; harm from the Seven Emotions (Joy, Anger, Worry, Pondering, Sorrow, Fear, Fright) is internal unrest. To treat external aggression, send troops to quell border disturbances and drive them out quickly. Discussing rites and music at the Biyong (Imperial Academy) when the enemy is at the gate is inappropriate. Thus, using tonification abruptly while pathogenic Qi remains causes internal collapse and death. To treat internal injury, use nourishment. If discipline is lax, promote Confucianism and Dao slowly to guide transformation. Using punishment and execution deepens disaster. Thus, using attack lightly when Righteous Qi is insufficient leads to exhaustion and death. However, even in prosperous times, there are unruly people; punishment is not abolished, representing attack within tonification. Raising armies for minor bandits disturbs the people; thus, attack within tonification must not be excessive. In years of conquest, internal administration is also repaired; education and nurturing are not neglected, representing tonification within attack. Showing leniency to aggressors breeds enemies; thus, tonification within attack must not be mistaken. Great affairs require total national effort to succeed; small affairs require calm individual handling to avoid disturbance. Major diseases require strong medicine to eliminate pathogenic Qi completely; minor diseases require small formulas to protect Righteous Qi. Formulas must be sized appropriately, sequenced correctly, weighted properly, and applied with appropriate density, pure and orderly. Medicines must suit their nature (appropriate use of agents), and formulas must follow principles (superior scheduling). Ancient sages prevented disease by observing form and color, preparing defenses before chaos arises, securing the state before danger emerges. The medical way connects to the governing way; a good minister is a good physician, roughly speaking. Adapting to situations requires observing events, illuminating them spiritually, depending on the individual, not sticking to preconceptions as fixed conclusions. This is the justice of *Yixue Yuanliu*, extended here. If the court reforms, medical officials value medicine, and physicians master the *Yiyi Yi* trilogy’s prescriptions and follow the Dao, opening minds to outsiders, transforming Qi and Lu into the Dao, an era of benevolence and longevity, the Great Unity, will be visible! Yiyi Yi, yiyiyi!