夫人之所受于天而得生者，本有全局，是即所谓天年也。余尝闻之岐伯曰∶上古之人，
其知道者，法于阴阳，和于术数，食饮有节，起居有常，不妄作劳，故能形与神俱，而尽终
其天年，度百岁乃去。又尝闻之老子曰∶生之徒，十有三；死之徒，十有三；民之生，动之
死地，亦十有三。余因此言，乃知失天之畀而不得尽其全者有如是。然则后天之养，其为在
人，可以养生家而不以此为首务乎！故常深慨于斯，而直穷其境，则若老氏所云十中之三者
，盖亦言其约耳。而三之倍倍，则尤有不忍言者，兹请得而悉之。
夫人生于地，悬命于天，可由此而生，亦可由此而死。故凡天亦杀人，有如寒暑不时，
灾荒荐至，或妖祥之横加，或百六之难避，是皆天刑之谓也。地亦杀人，则如旱潦无方，水
火突至，或阴毒最以贼人，或危险多能困毙，是皆地杀之谓也。人亦杀人，如争斗伤残，刀
兵屠戮，或嫁祸阴谋，或明欺强劫，是皆人祸之谓也。凡此三者，十中约去其几。再若三者
之外，则凡孽由自作而致不可活者，犹有六焉。何以见之？则如酒色财气，及功名之累，庸
医之害皆是也。故有困于酒者，但知米汁之味甘，安思曲 之性烈？能潜移祸福而人难避也
，能大损寿元而人不知也。及其病也，或血败为水，而肌肉为其浸渍，则鼓胀是也。或湿邪
侵土，而清浊苦于不分，则泻痢是也。或血不养筋，而弛纵拘挛，甚至眩晕卒倒，则中风是
也。或水泛为涎，而满闷不食，甚至脾败呕喘，则痰饮是也。耽而不节，则精髓胡堪久醉，
阴血日以散亡，未及中年，多见病变百出，而危于此者不知其几何人矣。
有困于色者，但图娇艳可爱，而不知倾国之说为何，伐命之说为何。故有因色而病者，
则或成劳损，或染秽恶，或相思之失心，或郁结之尽命。有因色而死者，则或以窃窥，或以
争夺，或以荡败无踪，或以惊吓丧胆。总之，好色之人必多淫溺，乐而忘返，安顾身家？孰
知实少花多，岂成瑞物，德为色胜，非薄则邪，未有贪之恋之而不招殃致败。凡受色中之害
者，吾又不知其几何人矣。
有困于财者，止知财能养命，岂识财能杀人。故鄙吝者，每以招尤。慢藏者，因多诲盗
。奔波不已者，多竭其力。贪得无厌者，常忘其身。顾利罔顾义，骨肉为之相残，聚敛尽膏
血，贾怨所以致败。盖财本通神，不容 剥，积则金精崇作，争则罄囊祸生。凡受利中
之害者，又不知其几何人矣。
有困于气者，每恃血气之强，只喜人不负我，非骄矜则好胜，人心不平，争端遂起，事
无大小，怨恨醉心，岂虞忿怒最损肝脾，而隔食气蛊，疼痛泄泻，厥逆暴脱等疾，犯者即危
。又或争竞相倾，公庭遘讼，宁趋势利以卑污，甘受丑凌于奴隶，及被他人之苛辱。既不敢
相抗于后，何若亲识之小忿。即涵容少逊于前，终身让路，不失一步，孰得孰失，孰知孰
愚？甚至破家荡产，骨肉分离之害，纤须不忍，悔时迟矣。夫气本无形，有何涯际，相谅则
无，偏执则有，历观往事，谁直谁非？使不能达观自策，则未免以我之躯，阴受人无申无诉
之蚀，而自愚自毙者，又不知其几何人矣。
有困于功名者，谁不有飞腾之念？谁不有功业之期？第既达者，或多鼎足之虞。未济者，
每遭监车之厄，受灯窗寒苦之负，望眼徒穿者有之。忆荣枯今昔之异，热肠为裂者有之。甚
至焦思切心，奔趋竭力，荣华杳然，泉壤遽及者有之。慨古伤今，凡受斯枉而湮没无闻，浩
气受抑者，又不知其几何人矣。
有困于医者，凡疾苦之望医，犹凶荒之望岁，其恳其切，其念何如。第此中神理，微妙
难言，使不有天人之学，绝伦之聪，则何以能闻于无声，见于无迹，直窥乎窈冥之乡，而必
得其情乎？使必得其人而后可以言医，则医不易谈，盖可征矣。既难其人，则次乎此者，虽
未知神，犹知形迹，此即今之上医也，然此医亦不易得。而舍此之外，则昧者居其八九。庸
医多，则杀人亦多，每见其寒热倒施，虚实谬认，一匕之讹，吉凶随应。困者莫知其然，虽
死不觉，明公鉴其多误，能无恻心？顾造化大权，本非凡庸所可窥弄。而性命重托，又岂浅
辈所宜轻付耶！第彼非无自，盖自《原病式》以来，祖述相传，日以滋甚，醉者不醒，逝者
无词，而黎元阴受此害者，盖不知若干若干人矣。而闻者未知其详，犹或未之信也。
由是乘除，则既有前三，又有后六，凡此淘汰之余，而得尽其天年者，果剩其几？吾故
曰∶老氏言十之三者，盖亦言其约耳。兴言及此，诚可为人生之痛哭者也。然徒悲何益？曷
亦为人之计乎，则惟上知者有可晓也。虽前之三者，或多出于莫测，则有可避者，有不可避
者，即听之天，无不可也。然知者见于未然，而得天者天庇之，得地者地庇之，得人者人庇
之。得此三庇，即得生之道也；失此三庇，则失生之道也。人道于此，岂曰尽无其权乎！至
于六杀之防，则全由乎我矣。酒杀可避，吾能不醉也。色杀可避，吾能不迷也。财杀可避，
吾能不贪也。气杀可避，吾能看破不认真也。功名之杀可避，吾能素其行藏也。庸医之杀可
避，吾能相知以豫也。夫如是而培以为善，存以无欺，守以不行险，戒以毋侥幸，则可全收
其效矣。孔子曰∶毋意，毋必，毋固，毋我。盖示人以无勉强也。广成子曰∶毋劳尔形，毋
摇尔精，乃可以长生。盖形言其外，精言其内，内外俱全，尽乎道矣。是皆古圣人垂念苍生
，至真至极之良方也，可不佩乎。或曰∶子言虽是，而实亦近迂，独不见有不识不知而偏跻
上寿者，又何人力之足恃耶？余曰∶此正所谓其知可及也，其愚不可及也。然予论诚迂矣，
倘亦蒙知者之相顾而咀之识之，或亦可为天年之一助否？
人从上天那里禀受而得以生存的根本，原本有一个完整的定数，这就是所谓的“天年”（自然寿命）。我曾经听岐伯说：上古时代的人，那些懂得养生之道的人，效法阴阳变化的规律，调和各种养生方法，饮食有节制，起居有常规，不妄加劳累，所以能够形体与精神俱备，从而享尽他们的自然寿命，活到一百岁才离世。我又曾经听老子说：属于长寿的一类人，占十分之三；属于早死的一类人，占十分之三；本来可以长寿，却因为行为不当而走向死亡的人，也占十分之三。我根据这些话，才知道违背上天的赐予而不能保全完整生命的人，竟然像这样多。既然这样，那么后天的调养，关键在于人自身，难道不是养生家应当首先致力于的事情吗！所以我常常对此深感感慨，并一直探究其究竟，像老子所说的十分之三的情况，大概也只是概括而言罢了。而这三分的倍数增长，更有让人不忍心去说的情况，现在让我详细地阐述它。
人生于大地，命运悬系于上天，可以由此而生，也可以由此而死。所以凡是天也能杀人，比如寒暑失调，灾荒接连到来，或者妖异吉祥之象横加于人，或者六十年一遇的厄运难以避免，这些都称为“天刑”（上天的刑罚）。地也能杀人，比如旱涝无常，水火突然降临，或者阴毒之气最伤害人，或者危险多能困毙人，这些都称为“地杀”。人也能杀人，比如争斗伤残，刀兵屠戮，或者嫁祸阴谋，或者明抢强劫，这些都称为“人祸”。大抵这三种情况，在十个人中大约要减去几个。再如果在这三种之外，还有凡是由自己造孽导致不可挽救的，又有六种。怎么知道呢？比如酒、色、财、气，以及功名的拖累，庸医的危害都是。所以有被酒所困的，只知道米汁的味道甘甜，哪里想过酒曲的性质猛烈？它能潜移默化地改变祸福而人们难以躲避，它能大大损害寿命而人们不知道。等到生病时，有的血液败坏变成水湿，肌肉被其浸渍，这就是鼓胀病。有的湿邪侵犯脾土，清浊之气苦于不能分清，这就是泻痢病。有的血不能滋养筋脉，导致弛缓或拘挛，甚至眩晕突然昏倒，这就是中风病。有的水泛化为痰涎，导致胸满闷不想进食，甚至脾败呕逆气喘，这就是痰饮病。沉溺其中不知节制，精髓怎能经得起长久醉酒？阴血一天天地散失消亡，不到中年，多见病变百出，而因此丧命的人不知有多少。
有被色所困的，只贪图娇艳可爱，却不知道倾国之说是什么意思，伐命之说是什么意思。所以有的因为女色而生病，就形成劳损，或者染上秽恶之疾，或者因相思而心神失常，或者因郁结而断送性命。有的因为女色而死，有的是因为偷窥，有的是因为争夺，有的是因为放荡败坏无踪，有的是因为惊吓丧胆。总之，好色的人必定多淫乱沉溺，快乐得忘记返回，哪里还顾得上身体和家庭？谁知道实少花多，岂能成为祥瑞之物，德行被女色胜过，不是轻薄就是邪恶，没有贪恋沉迷而不招致灾祸失败的。凡是受到女色危害的人，我又不知道有多少了。
有被财所困的，只知道钱财能养活生命，哪里认识钱财能杀人。所以鄙吝的人，常常因此招来怨恨。收藏不严密的人，往往招致盗窃。奔波不停的人，大多耗竭体力。贪得无厌的人，常常忘记自身安危。只顾利益不顾道义，骨肉亲人因此互相残害，聚敛耗尽膏血，积聚怨愤所以导致失败。大概钱财本通神灵，不容许被剥削，积累多了金精作祟，争抢起来空囊生祸。凡是受到利益危害的人，又不知道有多少了。
有被气所困的，常常倚仗血气的强壮，只喜欢别人不辜负自己，不是骄傲自满就是争强好胜，人心不平，争端于是兴起，事情无论大小，怨恨醉迷于心，哪里料到愤怒最损伤肝脾，而导致隔食、气蛊、疼痛、泄泻、厥逆暴脱等疾病，犯者立即就有危险。又或者争相倾轧，在公堂遭遇诉讼，宁愿趋附权势以卑污自处，甘愿忍受奴隶的丑恶欺凌，以及被他人的苛待侮辱。既然不敢在后面相抗，何如亲戚朋友间的小小忿怒。如果在前面稍微宽容谦逊一点，终身让路，不失一步，谁得谁失，谁知谁愚？甚至导致破家荡产，骨肉分离的危害，细微之处都不忍心看，后悔的时候已经晚了。气本来没有形状，有什么边际，相互谅解就没有，偏执就有，纵观往事，谁直谁非？如果不能豁达乐观地自我鞭策，那就未免用我的身躯，暗中承受别人无法申诉的侵蚀，而自己愚蠢自毙的人，又不知道有多少了。
有被功名所困的，谁没有飞黄腾达的念头？谁没有建功立业的期望？只是既然显达的人，多有鼎足之势的忧虑。尚未成功的人，常遭监车之厄，承受灯窗下寒苦读书的负担，望眼欲穿徒劳无功的有之。回忆荣枯今昔的差异，热心肠为之撕裂的有之。甚至焦虑思虑切心，奔走竭力，荣华杳然，泉壤（指死亡）突然降临的有之。慨叹古代悲伤当今，凡是遭受这种冤枉而湮没无闻，浩然之气受压抑的人，又不知道有多少了。
有被医者所困的，凡是疾病痛苦盼望医生，就像凶荒之年盼望丰收一样，那份恳切，那份念头是怎样的。只是其中的神妙道理，微妙难言，假使没有天人合一的学问，绝伦的智慧，怎么能做到闻于无声，见于无迹，直接窥探那幽深冥暗的境界，而必能得其真情呢？假使必须得到合适的人才才可以谈论医学，那么医学就不容易谈说了，这就可以证明了。既然难得其人，那么次一等的人，虽然不懂神妙，还知道形迹，这就是现在的上医了，然而这样的医生也不容易得到。而舍去这些之外，则是庸医占据八九成。庸医多，杀人也多，常见他们寒热辨证颠倒施治，虚实误认，一剂药的差错，吉凶随即应验。被困的病人不知道原因，虽然死了也不觉得，明智的人看到这么多错误，能不心生怜悯吗？但是造化的大权，本来就不是平凡庸碌之人可以窥探玩弄的。而性命的重托，又难道是浅薄之辈适宜轻易托付的吗？只是他们并非没有原因，大概自从《原病式》以来，沿袭相传，日益严重，醉者不醒，逝者无言，而百姓暗中受此危害的，大概不知道有多少人矣。而听说的人不知道详情，或许还不相信。
由此推算，既有前三类，又有后六类，凡是经过这些淘汰之后，还能享尽天年的人，果然还剩多少？所以我常说：老子说的十分之三，大概也是概略而言。说起这些，真可以说是为人生痛哭的事啊。然而仅仅悲伤有什么用？何不替人打算一下呢，只有上等智慧的人可以开导。虽然前面的三类，大多出于不可预测，但有可以躲避的，有不可以躲避的，即使听任天命，也没有不可以的。然而智者预见在未发生之前，得天庇佑的天庇护他，得地庇佑的地庇护他，得人庇佑的人庇护他。得到这三方面的庇佑，就是得到生的道路；失去这三方面的庇佑，就是失去生的道路。人道在这里，难道说完全没有主动权吗！至于防止六种杀害，则完全由我自己决定了。酒的杀害可以躲避，我能不喝醉。色的杀害可以躲避，我能不迷惑。财的杀害可以躲避，我能不贪婪。气的杀害可以躲避，我能看破不认真。功名的杀害可以躲避，我能保持素朴的行止。庸医的杀害可以躲避，我能预先相知防范。像这样培养善行，心存诚实不欺，坚守不行险招，戒除侥幸心理，就可以完全收到效果了。孔子说：不臆测，不绝对，不拘泥，不自私。这是示给人不要勉强。广成子说：不要劳累你的形体，不要摇动你的精气，才可以长生。形体说的是外在，精气说的是内在，内外俱全，就尽乎道了。这些都是古圣人垂念苍生，至真至极的良方，能不佩戴铭记吗？有人说：你说的话虽然对，但实际也接近迂腐，难道没看见有不识不知却偏偏达到高寿的人，又何必依赖人力呢？我说：这正是所谓他的智慧可以达到，但他的愚笨是达不到的。然而我的论述确实迂腐，倘若也能蒙受知情者的照顾而咀嚼识别它，或许也可以作为天年的一个帮助吧？
The foundation of life that humans receive from Heaven originally possesses a complete framework, which is what is referred to as "Tian Nian" (Natural Lifespan). I once heard from Qibo: In ancient times, those who understood the Way followed the laws of Yin and Yang, harmonized with methods of number (divination/health preservation), regulated their diet and drinking, maintained regular daily routines, and did not engage in reckless exertion. Therefore, they could maintain both form and spirit, thereby completing their natural lifespan and passing away after reaching one hundred years of age. I also once heard from Laozi: Of living beings, ten parts are of the type that live long; ten parts are of the type that die early; and among the people, ten parts move towards death due to their actions. Based on these words, I realized that there are indeed many who lose the endowment of Heaven and fail to preserve their wholeness. Thus, postnatal nourishment depends on human effort; should it not be the primary task for those engaged in health preservation? Hence, I often deeply lament this matter and have relentlessly pursued its essence. What Laozi said about the "ten parts" is merely a generalization. The multiplication of these three parts reveals even more distressing realities, which I will now elaborate upon.
Humans are born from Earth and their fate hangs from Heaven; thus, one can live through them or die through them. Therefore, Heaven can also kill, such as when cold and heat are out of season, disasters strike repeatedly, or unnatural omens are imposed arbitrarily, or inevitable calamities occur; these are called "Heavenly Punishments." Earth can also kill, such as through unpredictable droughts and floods, sudden fires and waters, or toxic yin energies harming people, or dangers causing demise; these are called "Earth Killings." Humans can also kill each other, such as through fights causing injury, warfare and slaughter, framing and conspiracy, or open robbery and force; these are called "Human Calamities." These three factors account for the loss of several lives out of every ten. Furthermore, beyond these three, there are six additional causes of death resulting from self-inflicted misdeeds that render survival impossible. How do we know this? They include addiction to alcohol, lust, wealth, anger, the burden of fame and success, and the harm caused by mediocre physicians.
Those trapped by alcohol only appreciate the sweet taste of rice wine but ignore the potent nature of yeast. It subtly alters fortune and misfortune, making it hard to avoid, and severely damages longevity without people realizing it. When illness arises, blood may degenerate into fluid, soaking muscles, resulting in abdominal distension (Gu Zhang). Dampness may invade the Spleen Earth, confusing clear and turbid qi, leading to diarrhea and dysentery. Blood may fail to nourish tendons, causing flaccidity or spasms, dizziness, and sudden collapse, known as Stroke (Zhong Feng). Water may transform into phlegm, causing fullness, poor appetite, spleen failure, vomiting, and wheezing, known as Phlegm-Fluid Retention (Tan Yin). Indulgence without restraint depletes essence and marrow; Yin blood scatters daily. Before middle age, myriad pathologies emerge, and countless perish.
Those trapped by lust seek only beauty, unaware of the sayings regarding nations falling or life being destroyed. Illnesses arising from lust include consumption (Lao Sun), infectious diseases, mental derangement from longing, or fatal depression. Deaths caused by lust involve voyeurism, conflict, dissipation, or fright-induced shock. Generally, those fond of lust indulge excessively, forgetting themselves and their families. Excessive desire leads to moral decay and evil, inevitably bringing disaster. The number of victims of lust is incalculable.
Those trapped by wealth believe it sustains life, failing to see it kills. Stinginess attracts resentment; careless storage invites theft; endless toil exhausts strength; insatiable greed forgets self-preservation. Pursuing profit over righteousness leads to familial strife; hoarding blood and sweat accumulates resentment, causing ruin. Wealth, though powerful, cannot be exploited without consequence; accumulation breeds arrogance; contention generates disaster. The number of victims of greed is incalculable.
Those trapped by anger rely on physical vigor, expecting others to never wrong them, leading to arrogance or competitiveness. Unbalanced hearts spark disputes. Regardless of size, resentment takes hold. Anger severely damages the Liver and Spleen, causing conditions like food stagnation, Qi-related abdominal masses, pain, diarrhea, syncope, and sudden collapse. Litigation and rivalry lead to humiliation and abuse. Failure to tolerate minor grievances results in broken homes and separated families. Regret comes too late. Anger is formless; mutual understanding dispels it, while stubbornness creates it. Observing history, who is right or wrong? Without broad-mindedness, one suffers unseen erosion, perishing foolishly. The number of such victims is incalculable.
Those trapped by fame and ambition desire rapid advancement and achievement. Those who succeed face political instability; those who fail endure hardship and frustration. Comparing past glory with present decline causes heartbreak. Anxiety and exhaustion lead to premature death. Many suffer injustice and obscurity, their righteous energy suppressed. The number of such victims is incalculable.
Those trapped by physicians seek medical help with the same urgency as famine victims seeking harvest. The subtleties of medicine are profound. Only those with transcendent wisdom can perceive the imperceptible and penetrate the obscure. If suitable doctors were easily found, medicine would be easy to practice. However, true masters are rare. Next best are those who understand forms and traces, considered "Superior Physicians," yet still hard to find. Most practitioners are mediocre. Their errors in distinguishing cold/heat and deficiency/excess lead to fatal mistakes. Patients die unaware. Wise observers feel compassion. Life and death are serious trusts, not to be given lightly to the incompetent. Since the era of *Yuan Bing Shi*, erroneous theories have propagated, harming countless commoners silently. Skeptics remain unconvinced.
Considering these factors—three external and six internal—the proportion of those surviving to their natural limit is tiny. Thus, Laozi's statement is an approximation. This reality warrants deep sorrow. Yet, mere grief is useless; one must plan. Only the wise can be guided. While some external factors are unavoidable, others can be avoided. Accepting fate is acceptable if one understands. The wise anticipate before events occur. Protection from Heaven, Earth, and People constitutes the path to life; losing them means losing the path to life. Human agency plays a crucial role here.
Regarding the prevention of the six internal killers: Alcohol can be avoided by abstaining from drunkenness. Lust can be avoided by avoiding confusion. Wealth can be avoided by avoiding greed. Anger can be avoided by letting go and not taking things seriously. Fame can be avoided by maintaining simplicity. Mediocre doctors can be avoided by seeking knowledge beforehand. By cultivating goodness, honesty, caution, and avoiding侥幸 (luck/chance), one achieves the desired effect. Confucius said: Do not speculate, do not be absolute, do not be rigid, do not be selfish. This teaches non-forcing. Guangchengzi said: Do not weary your form, do not agitate your Jing (Essence), and you can attain long life. Form refers to the exterior, Jing to the interior; mastering both fulfills the Dao. These are the supreme prescriptions of ancient sages for humanity. Should they not be cherished? Some argue that my views are pedantic, citing those who reach old age without conscious effort, questioning the value of human effort. I reply: This is precisely what is meant by "their wisdom is attainable, but their folly is unattainable." My discourse may seem pedantic, but if recognized by the wise, it may assist in preserving one's natural lifespan.