（本草思辨录甫授梓，适有客以彼都近事医会相告，窃不自揆，为发其 ，而余夙尝欲
辨不果者，至是亦纵言及之，名之曰绪说，列为卷首，欲学人知审择端趋向也。）
医虽艺术，而深诣甚难。西医挟形质之说，蔑视我中医；而中医之厌苦其难者，得彼说
则大喜，相与扬西而抑中。不思古圣垂示气化，实由洞明形质；而西医解剖形质，何从窥见
气化。故西医之在中国，能疗内证大证为遐迩传颂者，不少概见。乃求医者并不竞慕乎西，
而业医者反欲自弃其学。今且狂澜特起，有訾黄帝内经，神农本草，南阳先师伤寒论、金匮
要略，为谬、为荒诞、为羌无故实者矣。此等妄谈，岂足撼数千载而上悬诸日月不刊之圣经，
而
素问九卷，有王太仆补足者一卷。灵枢一经，或疑即王氏窃取素问为之。近人何西池，
尝静坐数息，每刻约得二百四十息，以灵枢日夜计一万三千五百息为不经。此类固间有伪托，
灵不如素，难经又不如灵素，要在人分别观之；而其中渊理不可思议，体之人而实万无不验
者，已数千载奉之为圭臬，岂癖嗜耶，抑别有所希耶。非人愚而我独智，盖彰彰明矣。今不
商量加邃，而徒以风会所趋，创为丧心病狂之举，诚世道之隐忧，可为太息者矣。
伤寒论、金匮要略，直可上拟圣经，不当与诸医书同论。医书汗牛充栋，大抵下驷十之
七，中驷十之二，上驷十之一。上中驷之书，无不由研求内经与仲圣书而出。今贱中医贵西
医，而治病则仍以中医，上中驷之书，已为彼所唾弃，其将于下驷书求进步乎，必不能矣。
医家故习，每好议前人之失，而己亦不能无失。然皆其人勇于卫道，矫枉过正，或隐奥
之义，所见不同者有之；未有毫无学问，医亦走方者流，因得见脏腑，遂谓道即在是，敢以
无理之诟争，上侮古帝昔圣，如着医林改错之王清任者，可谓谬妄之至矣。试历举而论之∶
第一篇脏腑记叙，开口即以宋元人脏腑图论，与内经混驳一番。脏腑图论原不足取，乃其与
内经并举，概称古人，其胸中无黑白可知。谓古人错误者不一而足，而不言其所以错误。忽
指称灵枢曰，手少阴三焦主乎上，足太阳三焦主乎下，而灵枢实无其文。尤可笑者，谓黄帝
虑生民疾苦，平素以灵枢之言，下问岐伯鬼臾区，故名素问。尤可忿者，谓二公如知之的确，
可对君言，知之不确，须待参考，何得妄对，遗祸后世。庄子有言∶哀莫大于心死。其殆言
未出而心先死者欤！第二篇会厌左气门右气守卫总管荣总管气腑血腑记，按此篇记其所见，
不为不详。谓出气入气吐痰饮津涎，与肺毫无干涉，古人误以咳嗽等证为肺病。肺管两旁，
有左右气门两管，下至肺管前半截处，归并一根入心。从心左后下行至肺左，过肺入脊，复
下行至卫总管。卫总管有对背心两管，有对腰两管，有腰下两管，腰上对脊正中，有十一短
管，痰饮在管中，由管中之气上攻行过心，由肺管前出左右气门，接卫总管之下。气管之多
如是，痰饮究从何管上至两气门，何者从左出，何者从右出，其不言者，是仍不知也。谓
卫总管俗名腰管，腰上长两管，一管通气腑，气腑是抱小肠存元气之物。元气即火，元气足
则食易化，虚则难化。然则元气在小肠外，能化小肠内之食。气管在肺外，肺不能化气管内
之痰饮，有是理耶。经言脏者藏精气而不泻，惟肺管清虚，故能运管外之痰饮，否则肺管已
为痰饮塞满，何问痰饮。清任不知此理，宜其以肺为无用之死脏也。第三篇津门津管遮食总
提珑管出水道记，接第一篇饮食由小肠化粪一段，宜并入此篇。与第四篇脑髓说，余俱有论
列下。第五篇气血合脉说，人之有脉，与脉之可以验病，断不出内难经所言。清任谓人身气
管出气，血管藏血。脉从气出，无与血事。手腕肉浓者脉短，薄者脉长。大小者虚实之分，
急慢者寒火之分。不知气与血若不相贯，则人为呆物；脉非指下难明，则人皆知医。又谓古
人论脉二十七字，余不肯深说者，非谓古人无容足之地，恐后人对证无谈脉之言。此冀掩其
短而适自暴其短，书中证治数十条，所以无一字言脉也。第六篇心无血说，西医谓心内有左
右四房，皆有管窍，为生血回血之用，正与内经说合。而清任以心为气出入之路，其中无血。
又云猪心刺破，则腔子内血，流入于心；不刺破之心，内并无血。是以盆盎之盛水比心。心
非腑，焉能盛血。清任于图内肝下亦注绝不能藏血五字。古书岂得呆看，经不又云脾脏肉乎，
吾知清任必更骇之矣。卷末附辨方效经错之源，论血化为汗之误一篇。仲圣麻黄桂枝两汤，
清任改其文为麻黄汤治头疼、身痛、项强、发热、恶寒、干呕、无汗，桂枝汤治证如前，而
有汗。谓伤寒初得，头疼、身痛、项强、发热、恶寒，未有两胳膊两手不疼痛发热恶寒者，
用麻黄汤，亦未有周身皆愈而独不愈两胳膊两手者。岂不是方虽效而经络实错之明证。改仲
圣文而又坐仲圣以过，何便宜乃尔。按项强为阳明病，四肢烦疼为太阴病，断非初得时所兼
有，时疫则有之，方不的对而病竟愈，亦往往有之。庸医所得以售技者在是，自矜者亦在是。
要知仲圣为天下后世立法，不能为庸医诡遇也。谓有汗是伤风，从未见桂枝汤治愈一人。伤
风岂定是有汗！？桂枝汤不能治伤风，近世医者多有此论，而不知其故由本领不济乎。清任
以桂枝汤不效，因头疼、身痛、发热、有汗非伤风证。此与桂枝汤别一条头痛、发热、汗出、
恶风者桂枝汤主之，似乎无异，而非无异也。仲圣不言脉者，以太阳病汗出恶风者脉自浮也。
为问果太阳病乎？脉浮恶风乎？不言身痛者，以太阳病头痛发热汗出恶风而又加身痛，则桂
枝汤宜加减也。何为而不加减乎？己不细审而遽责效于桂枝，可乎不可！又有奇者，清任用
桂枝汤而尚不知为何证。曰非伤寒证也，乃吴又可所论之瘟疫也。又教其侄曰，欲明伤寒，
须看吴又可论。是清任固尝读又可书者。又可因其时疫气流行，时师多以伤寒法误人，故着
瘟疫论一书。清任时亦疫气流行，胡为以桂枝汤治疫气。夫疫气与疫气不同，其殆用又可法
不应而用仲圣法，用仲圣法又不应而复用又可法乎。若然，则无往不误矣。谓目痛鼻干不得
眠，是邪热上攻头脑之证，仲圣以葛根汤治之，又是方效经错之明证。按伤寒论葛根汤证，
何尝如是。内经有阳明主肉，其脉挟鼻络于目，故身热目痛鼻干不得眠之文，活人书二问亦
有之，并不言宜葛根汤。葛根汤治此证，则是陶节庵全生集，于葛根汤加白芷升麻，云即葛
根解肌汤，其证尚有发热、头痛、微恶寒、无汗、脉微洪等字。清任既不知阳明病之脉证为
何，而又张冠李戴，妄诋仲圣，昏蒙殆无其比。谓人生气血两管，气管通皮肤有空窍故发汗，
血管通皮肤无空窍故不发汗。是知汗非血化，汗固非即是血。然汗为心液，亦血中之热气所
蒸而成。故夺汗者无血，夺血者无汗，试无不验。夫血既蒸为汗，则已由静之动，故能透毛
孔而出。若汗出而血亦出，或无汗而血自出，则血应静而不静，不为阳之守也。其义皆在内
经，清任何足以知是。
泰西一切艺术，竭其智能，孜孜不已，无废于半途。其医于内证虽未见擅场，苟参以中
国经训，探本穷源，亦必有登峰造极之诣，如中国卢扁其人者。吾中国医流，有恒者鲜，每
读一书，旨趣未得，辄生疑畏，故往往古籍遗亡，不可复见。至内科之有器，更未之前闻，
而不知古固有之。其在宋重医学之日也，四库全书提要载，周密齐东野语曰∶尝闻舅氏章叔
恭云∶昔 襄州日，尝获试针铜人，全象以精铜为之，腑脏无一不具。其外 穴，则错金书
穴名于旁，凡背面二器，相合则浑然全身，盖旧都用此以试医者，其法外涂黄蜡，中实以水，
俾医工以分折寸，案穴试针，中穴则针入而水出，稍差则针不可入矣，亦奇巧之器也。后赵
仲南归之内府，叔恭尝写二图刻梓以传焉，今宋铜人及章氏图皆不传。按此则西洋蜡人形，
不过具有体质，而兹并 穴用针之法，悉寓其中，智巧亦何逊西人。今虽不可见矣，然吾中
国近年杰士奋兴，创制奇器者，亦颇有之。苟其挽医学之颓波，复铜人之巧制，施之证治，
用彰明效，医林之幸，正不独医林之幸也。
唐氏容川所着中西汇通医经精义一书，持中西之平，阐造物之秘，洵为有功医学，余复
何赘。兹读中西书若有所得，有可以翼唐氏书者，敢抒其一得焉。阴者藏精而起亟，故肾之
精华，必聚于上，上为末而下为本，西人谓脑主知觉，心不主知觉，是但见其上之精华而不
见其下之蕴蓄也。是不知阴为阳守，阳为阴使也。阴阳动静之理，吾中医亦岂能测识，所幸
者有神圣之遗经耳。医至今日，可谓逸矣。西医自中国周烈王时即有解剖之学，至今析极毫
厘，何如其旁，而不知犹是迹象也。内科理法云∶凡人愈留心，则知觉之事愈明。又云∶凡
能留心者，视物较清，后亦易记。不曰留脑而曰留心，可见主权自属于心。又全体通考云∶
脑筋由心丛而来，其丛乃脊髓百结两根之所为。脑筋既根于心丛，自属心主知觉，脑髓听命
于心。此可譬之电线，心发电，脊过电，而脑其至所也。盖肾生精化髓而输于脑，心以阳而
为肾之使，理固如是。必泥迹象以求，则所谓铜山西崩洛钟东应者，西医必更斥其诞矣。饮
食入胃，厘清浊两路而出，非经中间泌别不可。唐氏引西说饮水入胃，即散走膜膈，以明水
之不入小肠。然小肠岂是专受谷食者。全体通考论胃与小肠篇，皆中有糜粥字，是胃与小肠
，明系水谷杂居，外受相火之蒸化，说较胜矣。而于水谷之纳入输出与泌别若何，则一字不
题，殆未能了了也。此当以我中国圣经为断，曰∶五谷入胃，其糟粕精液宗气，分为三隧；
又曰∶中焦亦并胃口出上焦之后，此所谓受气者，泌糟粕，蒸精液，化其精微，上注于肺。
按泌别在中焦，当即西医之谓连网，王清任之谓津门者是。水不尽散膜膈者，为其分三隧也
。夫水谷经胃与小肠蒸化而后，所余皆弃物，其扬帆直下可乎？而清浊有异也，又乌得不泌
别。此又圣经明告之矣，曰∶水谷者常并居于胃中，成糟粕而俱下于大肠，济泌别汁，循下
焦而渗入焉。杨上善注云∶下焦在脐下，当膀胱上口，主分别清浊而不纳。自来医家，从不
言有两泌别者，圣经实尝言之，理亦诚然。然则泌别在下焦何处乎？西医谓肾主生溺，其图
将肾竖割之，内有万锥漏斗肾盏等名，下有溺管，肾之外廓，亦无进溺之口，溺固为肾生矣
。然余不能无疑焉。凡人饮水多者溺多，少者溺少，明系溺由饮来，一也；所饮之水，若全
不化溺，必将有肿胀泄泻等病，二也；溺待肾生，势必不给，三也；肾生之而旋泻之，竟无
所用，四也。西医因何致误，殊不可晓。唐氏谓左右两肾系有窍最深，贯脊骨，通三焦，复
有两管下接膀胱。若然，则水从中焦下焦而下者，皆历肾系抵膀胱，肾系实为泌别之处。经
言少阳属肾，肾上连肺，故将两脏，是合三焦与肺之力以施其伎巧。故知此处泌别，最有关
系。内科理法云∶肺与皮肤出气多则溺少，出气少则溺多。此即内经气化斯出之理，膀胱惟
无上口，所以溺出必待气化。乃西医言有上口，而王清任曾谛视者，又言无上口，其殆有上
口亦在包
自西医脑髓司知觉之说，行于中国，而中国人不察，信之者众。试更论之。肾精生髓，
由脊入脑，犹草木果实之结于顶上。余考西医每云脑筋从某来者，多是上来至下，以本为末
，以末为本，其弊实由于是。然即其说还叩之，亦有可正其非者。肾有髓质，西医言之不一
，他处无有，肾上核则言脑筋极多，非髓由肾生而何？中国谓心系贯脊属肾，而西医亦谓心
丛乃脊髓百结两根之所为，非心与脑相通而何？西医言脑有透明之密质，心房之里膜，亦言
薄滑透明，非脑之明根于心之明而何？此皆见于全体通考者。抑内科理法不云乎，背脊髓不
通于脑髓，即不知觉。是又隐以脑髓为不司知觉矣。大凡西人之性，最长于化学，其习医亦
无非化学。诘以阴阳五行之理，人身十二经脉，奇经八脉，营卫溪谷之游行出入，则茫然无
知，即告
全体通考德贞氏自序，以中医为守旧，为妄作。实乃坐井观天之见。善守旧者，其旧皆
不可变之天道，惟笃守而精研之，新义斯出。今日之中医，非守旧乃弃旧耳。弃旧故妄作，
非德贞氏之所谓妄作。吾慨夫以西人之智而惟斤斤守解剖之学也！解剖至此，形于何遁，然
但见其所可见而不见其所不见。气之帅血，犹君之帅臣，夫之帅妇，此理岂尚有可议。乃德
贞氏不信，而转疑帅气之无物，盖剖胸则止见胸，剖腹则止见腹，局守形质之弊，必至于此
。自序又极诋中医脾动磨胃之说。脾磨曰动，此中医之谬谈，不出于古经。脾伤不磨则有之
（《本草思辨录》刚刻印成书，恰逢有客人告知我京城附近的医界近况，我不自量力，借此阐发其中道理。而我素来想要辨析却未能如愿的问题，至此也畅所欲言地提及了。将其命名为“绪说”，列为卷首，希望学习中医的人能审慎选择、端正趋向。）
医学虽然是一门技艺，但要达到高深的境界非常困难。西医凭借解剖形态学的理论，轻视我们中医；而中医里那些厌恶其难学的人，听到西医的说法则大喜过望，互相推崇西医而贬低中医。他们没想过，古代圣人展示的气化理论，实际上源于对形体结构的透彻了解；而西医通过解剖观察形体结构，又怎能窥见气化呢？因此，西医在中国，能够治疗内科疑难重症并远近传颂的，实在很少见到。然而求医者并不竞相羡慕西医，行医者反而想抛弃自己的学问。如今狂澜突起，有人诋毁《黄帝内经》、《神农本草经》、张仲景先师的《伤寒论》、《金匮要略》，称其为谬误、荒诞、毫无根据。这些狂妄的言论，哪里足以撼动数千年来如日月般永恒不可更改的经典呢？《素问》九卷中，有一卷是王冰（王太仆）补足的。《灵枢》一书，有人怀疑就是王冰窃取《素问》的内容编造的。近代人何西池，曾静坐数息，每刻钟大约得到二百四十息，认为《灵枢》中记载的一日一夜一万三千五百息是不合常理的。这类内容固然间或有伪托之作，《灵枢》不如《素问》，《难经》又不如《灵枢》、《素问》，关键在于人们要分别看待；但其中深奥的道理不可思议，亲身验证确实万无一失，已经被奉为圭臬数千年，难道只是怪癖嗜好吗，还是另有希冀呢？并不是别人愚笨而我独自聪明，这显然是显而易见的。现在不商量加深研究，却仅仅因为风气所趋，做出这种丧心病狂的举动，确实是世道的隐忧，令人长叹。
《伤寒论》、《金匮要略》，简直可以上比经典，不应与其他医书同等看待。医书多得汗牛充栋，大体上下等书占十分之七，中等书占十分之二，上等书占十分之一。上等和中等的书，无不是由深入研究《内经》和张仲景的书而得出的。如今贱视中医而重视西医，但在治病时仍然使用中医，上等和中等的书已经被他们唾弃，难道还要在下等的书中寻求进步吗？那是不可能的。
医家的旧习，喜欢议论前人的过失，而自己也不能没有过失。但这都是因为他们勇于维护正道，矫枉过正，或者是对隐奥的含义见解不同罢了；并没有那种毫无学问、属于走方郎中之流的人，因为看到了脏腑，就说道就在这里，敢于用无理的攻击争辩，轻侮古代的帝王和圣贤，像著《医林改错》的王清任这样的人，可以说是荒谬妄到了极点。试列举他的观点来论述：
第一篇《脏腑记叙》，开口就用宋元人的脏腑图论，与《内经》混驳一番。脏腑图论原本就不足取，但他与《内经》并举，一概称为古人，可知他心中没有黑白是非。他说古人错误的地方不止一处，却不说明为什么错误。忽然指着《灵枢》说：“手少阴三焦主乎上，足太阳三焦主乎下”，而《灵枢》实际上没有这句话。更可笑的是，他说黄帝担心百姓疾苦，平时拿《灵枢》的话向下询问岐伯、鬼臾区，所以名叫《素问》。更可愤恨的是，他说这两位大夫如果知道得确切，可以对君主言明；如果知道得不确切，必须等待参考，怎么能胡乱回答，遗祸后世。庄子说：“悲哀莫过于心死。”这大概说的是话未出口心已先死的人吧！
第二篇《会厌左气门右气守卫总管荣总管气腑血腑记》，这篇记录他所见到的情况，不算不详细。他说出气入气、吐痰饮津涎，与肺毫无关系，古人误将咳嗽等症状当作肺病。肺管两旁，有左右气门两管，下至肺管前半截处，归并一根进入心脏。从心脏左后下行至左肺，经过肺部进入脊柱，再下行至卫总管。卫总管有对着背部的两管，有对着腰部的两管，有腰部下方的两管，腰部上方对着脊柱正中，有十一根短管，痰饮在管中，由管中的气体向上攻行经过心脏，由肺管前出左右气门，接卫总管之下。气管如此之多，痰饮究竟从哪根管子上升到两气门，哪条从左出，哪条从右出，他不说的，就是仍然不知道。他说卫总管俗名腰管，腰部上方长出两管，一管通气腑，气腑是包裹小肠保存元气之物。元气就是火，元气充足则食物容易消化，虚弱则难以消化。既然元气在小肠外面，能消化小肠里面的食物。气管在肺外面，肺不能消化气管里面的痰饮，有这样的道理吗？经文说脏是贮藏精气而不泻出的，只有肺管清虚，所以能运化管外的痰饮，否则肺管已经被痰饮塞满，还谈什么痰饮。王清任不懂这个道理，难怪他把肺当作无用的死脏。
第三篇《津门津管遮食总提珑管出水道记》，承接第一篇饮食由小肠化粪的一段，应该并入此篇。与第四篇《脑髓说》，我都有评论在下面。
第五篇《气血合脉说》，人有脉搏，以及脉搏可以验证疾病，断然不出《内经》、《难经》所说的范围。王清任说人身气管出气，血管藏血。脉从气出，与血无关。手腕肉厚的人脉短，薄的人脉长。大小是虚实之分，急慢是寒热之分。不知道气与血如果不贯通，人就成了呆物；脉不在指下难以明白，那么人人都懂医术了。他又说古人论脉二十七字，我不肯深说的原因，不是说古人没有容身之地，而是恐怕后人面对证候没有谈论脉象的话语。这是想掩盖自己的短处却恰好暴露了自己的短处，书中证治几十条，所以没有一个字提到脉。
第六篇《心无血说》，西医说心脏内有左右四房，都有管窍，是用来生血和回血的，这与《内经》的说法相合。而王清任认为心是气出入的路径，里面没有血。又说猪心刺破，则腔子里的血流入心脏；不刺破的心脏，里面并没有血。他是用盆盎盛水来比喻心脏。心不是腑，怎么能盛血。王清任在图内肝脏下面也注上“绝不能藏血”五个字。古书岂能呆板地看，《内经》不是又说脾脏是肉吗？我知道王清任一定会对此感到惊骇的了。卷末附有辨别方效和《内经》错误来源的文章，讨论血化为汗的错误一篇。张仲景的麻黄汤、桂枝汤两方，王清任修改其文字为：麻黄汤治疗头疼、身痛、项强、发热、恶寒、干呕、无汗；桂枝汤治疗症状如上，但有汗。他说伤寒初得，头疼、身痛、项强、发热、恶寒，没有两只胳膊两手不疼痛、发热、恶寒的，用麻黄汤，也没有全身都好了唯独两只胳膊两手不好的。这岂不是方子虽然有效但经络实际搞错的明显证据。修改了张仲景的文字又指责张仲景有过错，怎么这么便宜呢？按项强是阳明病，四肢烦疼是太阴病，绝对不是初得病时所兼有的，时疫则有这种情况，方子不对症而病竟然好了，也往往有之。庸医得以施展伎俩就在于此，自我夸耀也在于此。要知道张仲景是为天下后世立法的，不能为了庸医的偶然巧合而改变。说有汗是伤风，从未见过桂枝汤治愈一人。伤风难道一定是有汗的吗？桂枝汤不能治伤风，近代医者多有这种论点，却不知道这是因为本领不够。王清任认为桂枝汤无效，是因为头疼、身痛、发热、有汗不是伤风证。这与桂枝汤另一条“头痛、发热、汗出、恶风者，桂枝汤主之”，似乎没有不同，但其实不同。张仲景不说脉，是因为太阳病汗出恶风的人脉自然浮。请问果真是太阳病吗？脉浮恶风吗？不说身痛，是因为太阳病头痛发热汗出恶风而又加上身痛，那么桂枝汤应当加减。为什么不加减呢？自己不仔细审视就急于责怪桂枝汤无效，可以吗不可以！还有更奇怪的，王清任用桂枝汤还不知道是什么证。说这不是伤寒证，是吴又可所论述的瘟疫。又教他的侄子说，要想明白伤寒，必须看吴又可的书。这说明王清任确实读过吴又可的书。吴可可是因为当时疫气流行，当时的医生多用伤寒法误人，所以写了《瘟疫论》一书。王清任当时也是疫气流行，为什么用桂枝汤治疗疫气。疫气与疫气不同，大概是用了吴又可的方法不灵验而用张仲景的方法，用了张仲景的方法又不灵验而复用吴又可的方法吗？如果是这样，那就无处不误了。说目痛鼻干不得眠，是邪热上攻头脑的证候，张仲景用葛根汤治疗它，又是方子有效但《内经》错误的明显证据。按《伤寒论》葛根汤证，何尝不是这样。《内经》有阳明主肉，其脉挟鼻络于目，所以身热目痛鼻干不得眠的条文，《活人书》二问也有，并不说适宜葛根汤。葛根汤治疗这个证候，那是陶节庵《全生集》，在葛根汤加白芷升麻，说是即葛根解肌汤，其证候还有发热、头痛、微恶寒、无汗、脉微洪等字。王清任既不知道阳明病的脉证是什么，又张冠李戴，妄加诋毁张仲景，昏蒙大概没有能比得上的。说人生气血两管，气管通皮肤有空窍所以发汗，血管通皮肤无空窍所以不发汗。这是知道汗不是血化成的，汗固然是血但不是就是血。然而汗为心液，也是血中的热气蒸腾而成的。所以夺汗者无血，夺血者无汗，试无不验。血既然蒸为汗，那就已由静变动，所以能透毛孔而出。如果汗出而血也出，或者无汗而血自出，那么血应该静而不静，不为阳的守持了。这些义理都在《内经》中，王清任怎么足以知道这些。
泰西一切技艺，竭尽他们的智能，孜孜不倦，没有半途而废的。他们的医学对于内科证候虽然未见擅长，但如果参酌中国的经训，探本穷源，也一定有登峰造极的境界，像中国卢扁那样的人物。我们中国的医流，有恒心的人很少，每读一本书，旨趣还没得到，就产生疑惧，所以往往古籍遗失亡佚，不可再见。至于内科有器械，更是前所未闻，却不知道古代本来就有。在宋代重视医学的时候，《四库全书提要》记载，周密《齐东野语》说：曾听舅父章叔恭说：以前在襄州任职时，曾获得试针铜人，完整形象是用精铜制作的，脏腑无一不具备。其外部穴位，则错金书写穴名在旁边，凡背面两个器具，相合则浑然成为全身，大概是旧都用来测试医生的，方法是外部涂黄蜡，内部装满水，让医工按照分寸，按穴位试针，扎中穴位则针入而水出，稍差一点则针不可入了，也是奇巧的器具。后来赵仲南归还给内府，叔恭曾画了两幅图刻印流传，现在宋铜人和章氏图都不传了。按此则西洋蜡人形，不过具有体质，而这个还包含针灸穴位用针的方法，全部寓含在其中，智巧又何逊于西方人。现在虽然看不见了，然而我国近年杰出人士奋起，创制奇特器具的，也有不少。如果能挽回医学的颓波，恢复铜人的巧妙制作，施用于证治，用以彰显明显的疗效，是医林的幸事，正不仅仅是医林的幸事啊。
唐氏容川所著的《中西汇通医经精义》一书，持平中西医，阐发造物主的秘密，确实在医学上有功劳，我又何必多言。这次读中西书若有所得，有可以辅助唐氏书的，敢抒发我的浅见。阴是贮藏精气而起作用的，所以肾的精华，必聚集在上部，上部为末而下部为本，西方人说脑主知觉，心不主知觉，这是只看到上面的精华而看不到下面的蕴蓄。这是不知道阴为阳守，阳为阴使的道理。阴阳动静的道理，我们中医难道能测识吗，所幸的是有神圣的遗留经典罢了。医学到今天，可以说安逸了。西医自从中国周烈王时候就有解剖学，到现在分析到毫厘，何其精细，却不知道这还是迹象。内科理法说：凡人越留心，则知觉的事情越明白。又说：凡是能留心的人，看东西比较清楚，以后也容易记住。不说留脑而说留心，可见主权自属于心。又说：脑筋由心丛而来，其丛乃脊髓百结两根所形成的。脑筋既然根于心丛，自然属于心主知觉，脑髓听命于心。这可以比作电线，心发电，脊过电，而脑是到达的地方。肾生精化髓而输送给脑，心以阳而为肾的使者，道理固然是这样。一定要拘泥于迹象来寻求，那么所谓铜山西崩洛钟东应的话，西医必定更斥责其荒诞了。饮食进入胃，分清浊两条路而出，不经中间泌别是不可的。唐氏引用西医说法饮水入胃，即散走膜膈，来说明水不入小肠。然而小肠难道是专门接受谷食的？《全体通考》论胃与小肠篇，都有“中有糜粥”字样，是胃与小肠，明显是水谷杂居，外受相火的蒸化，说法较胜。而对于水谷的纳入输出与泌别如何，则一字不提，大概没能弄清楚。这应当以我国的圣经为标准，说：五谷入胃，其糟粕精液宗气，分为三条隧道；又说：中焦也并胃口出上焦之后，这就是所谓的受气者，泌糟粕，蒸精液，化其精微，上注于肺。按泌别在中焦，当即西医所说的连网，王清任所说的津门。水不尽散膜膈，是因为它分三条隧道。水谷经过胃与小肠蒸化之后，所剩下的都是废弃物，能扬帆直下吗？而且清浊有不同，怎能不泌别。这又是圣经明确告诉我们的，说：水谷者常并居于胃中，成糟粕而俱下于大肠，济泌别汁，循下焦而渗入焉。杨上善注解说：下焦在脐下，当膀胱上口，主分别清浊而不纳。自来医家，从不说有两处泌别的，圣经确实说过，道理也确实如此。那么泌别在下焦何处呢？西医说肾主生溺，其图将肾竖割开，内有万锥漏斗肾盏等名称，下有溺管，肾的外廓，也没有进溺的口，溺固然是肾生的。然而我不能不怀疑。凡人喝水多的尿多，少的尿少，明显是尿由饮而来，这是一；所喝的水，如果完全不化尿，必将有肿胀泄泻等疾病，这是二；尿等待肾生，势必供应不上，这是三；肾生了它随即排泄掉，竟无所用，这是四。西医为何导致错误，实在不可晓。唐氏说左右两肾系有窍最深，贯脊骨，通三焦，又有两管下接膀胱。如果是这样，那么水从中焦下焦而下者，都经过肾系抵达膀胱，肾系实为泌别之处。经文说少阳属肾，肾上连肺，所以将两脏，是合三焦与肺之力来施展其技巧。所以知道此处泌别，最有关系。内科理法说：肺与皮肤出气多则尿少，出气少则尿多。这就是内经气化斯出的道理，膀胱惟无上口，所以尿出必须等待气化。然而西医说有上口，而王清任曾仔细查看的，又说无上口，大概有上口也在包……
自西医脑髓司知觉之说，流行于中国，而中国人不加考察，相信的人很多。试再论述一下。肾精生髓，由脊入脑，就像草木果实结在顶上。我考察西医常说脑筋从某处来的，多是上来至下，以本为末，以末为本，弊端实在由此产生。然而即使顺着他们的说法反问，也有可以纠正其错误的地方。肾有髓质，西医说法不一，他处没有，肾上核则说脑筋极多，不是髓由肾生又是什么呢？中国说心系贯脊属肾，而西医也说心丛乃脊髓百结两根所形成的，不是心与脑相通又是什么呢？西医说脑有透明之密质，心房之里膜，也说薄滑透明，不是脑的明根于心之明又是什么呢？这些都见于《全体通考》。况且内科理法不是说吗，背脊髓不通于脑髓，即不知觉。这又隐含地以脑髓为不司知觉了。大凡西人的性格，最长于化学，他们学医无非是化学。质问以阴阳五行之理，人身十二经脉，奇经八脉，营卫溪谷的游行出入，则茫然无知，即使告知……
《全体通考》德贞氏自序，以中医为守旧，为妄作。实则是坐井观天的见识。善于守旧的人，其旧皆是不可变的天道，只有笃守而精研之，新义才会出现。今日的中医，不是守旧而是弃旧。弃旧故妄作，不是德贞氏所说的妄作。我感慨西方人的智慧，却仅仅斤斤计较于解剖学！解剖到了这种地步，形体还能隐藏到哪里，然而只见其所可见而不见其所不见。气帅血，犹如君帅臣，夫帅妇，这个道理难道还有可议论的吗？然而德贞氏不信，反而怀疑帅气之无物，大概剖胸则止见胸，剖腹则止见腹，局守形质的弊病，必然至于此。自序又极力诋毁中医脾动磨胃的说法。脾磨曰动，这是中医的谬谈，不出于古经。脾伤不磨则有之……
(When *Bencao Sibian Lu* (Speculative Records of Materia Medica) was just printed, a guest happened to inform me of recent medical affairs in the capital. Presuming upon my limited ability, I took this opportunity to expound upon these matters. Issues I had long wished to clarify but failed to do so were now freely discussed. Titled "Preliminary Remarks" (Xu Shuo), it is placed at the beginning of the volume, hoping that students of medicine will learn to examine carefully and direct their efforts correctly.)
Although medicine is an art, reaching profound mastery is extremely difficult. Western medicine relies on morphological theories and looks down upon our Traditional Chinese Medicine (TCM). Meanwhile, those among TCM practitioners who find it too arduous hear Western theories with great joy, mutually elevating Western medicine while suppressing TCM. They fail to realize that the Qi transformation (Qi Hua) theory demonstrated by ancient sages actually stems from a thorough understanding of morphology; conversely, how can Western anatomy, which observes morphology, possibly perceive Qi transformation? Therefore, among Western medicine in China, those capable of treating internal complex diseases and achieving widespread acclaim are rarely seen. Yet, patients do not flock to Western medicine, while practitioners wish to abandon their own learning. Now, a wild surge has arisen where people slander the *Huangdi Neijing* (Yellow Emperor's Inner Canon), *Shennong Bencao Jing* (Divine Farmer's Materia Medica), Zhang Zhongjing’s *Shanghan Lun* (Treatise on Cold Damage), and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), calling them erroneous, absurd, and baseless. How can such reckless talk shake the sacred classics that have hung like the sun and moon for thousands of years without change? The nine volumes of *Suwen* (Basic Questions) include one volume supplemented by Wang Bing (Wang Taipu). The *Lingshu* (Spiritual Pivot) is suspected by some to be fabricated by Wang Bing stealing content from *Suwen*. The modern scholar He Xichi once sat quietly counting his breaths, obtaining approximately 240 breaths per quarter-hour, arguing that the *Lingshu*'s record of 13,500 breaths per day is unreasonable. While such contents may occasionally be spurious, with *Lingshu* being inferior to *Suwen*, and *Nanjing* (Classic of Difficult Issues) inferior to both, the key lies in distinguishing them. However, the profound principles within are inconceivable, and personal verification proves them infallible. They have been revered as standards for millennia. Is this merely a peculiar obsession, or is there another hope? It is not that others are foolish while I alone am wise; this is clearly evident. Instead of discussing deepening research, we blindly follow trends and commit acts of madness. This is indeed a hidden worry for the world, worthy of deep sighs.
*Shanghan Lun* and *Jingui Yaolue* can be compared directly to the sacred classics and should not be discussed on par with other medical texts. Medical books are numerous enough to fill carts and pile up to ox-height. Roughly, 70% are inferior, 20% are medium, and 10% are superior. Superior and medium books all stem from rigorous study of the *Neijing* and Zhang Zhongjing’s works. Today, TCM is despised while Western medicine is prized, yet treatment still relies on TCM. If the superior and medium books are discarded by them, how can progress be sought in inferior books? It is impossible.
It is a habit of physicians to criticize predecessors' errors, yet they themselves cannot be without error. However, these arise from courage to defend the Way, overcorrection, or differing views on obscure meanings. There are none who, lacking scholarship and belonging to the class of wandering doctors, seeing viscera through dissection, claim the Way lies therein, daring to use irrational accusations to insult ancient emperors and sages, like Wang Qingren who wrote *Yilin Gaicuo* (Correction of Errors in the Forest of Medicine). Such behavior is supremely absurd. Let us list his arguments:
In Chapter One, "Record of Viscera," he begins by mixing Song and Yuan dynasty visceral diagrams with the *Neijing*. These diagrams are unworthy, yet citing them alongside the *Neijing* and attributing them generally to ancients shows he lacks discernment. He claims many ancient errors without explaining why. He suddenly cites *Lingshu*: "Hand Shaoyin Sanjiao governs the upper, Foot Taiyang Sanjiao governs the lower," whereas *Lingshu* contains no such text. Even more laughable is his claim that the Yellow Emperor, worried about people's suffering, asked Qibo and Gui Yuzhou questions based on *Lingshu*, hence the name *Suwen*. Most infuriating is his assertion that if these two masters knew accurately, they could tell the ruler; if unsure, they must wait for reference, rather than answering rashly and harming future generations. Zhuangzi said, "There is no greater sorrow than the death of the heart." Does this describe those whose hearts died before speaking?
Chapter Two, "Record of Epiglottis, Left Air Gate, Right Air Guard, General Manager, Nutrient Manager, Qi Bowel, Blood Bowel," records his observations in detail. He claims exhalation, inhalation, expectoration of phlegm-fluids, saliva, and fluids have nothing to do with the Lung, and ancients wrongly attributed coughs to lung disease. He describes left and right air gates beside the lung tube merging into one entering the heart, descending from the heart's left rear to the left lung, passing through to the spine, then down to the "Guard General Manager." This manager has tubes opposite the back, waist, below waist, and eleven short tubes opposite the spine above the waist. Phlegm-fluids travel in these tubes, driven upward by gas past the heart, exiting via lung tubes to the air gates, connecting to the Guard General Manager. With so many tubes, which ones carry phlegm to the air gates, which exit left or right? His silence indicates ignorance. He calls the Guard General Manager the "Waist Tube," claiming two tubes grow above the waist: one connects to the Qi Bowel, which wraps the Small Intestine to preserve Yuan Qi (Original Qi). Yuan Qi is fire; sufficient Yuan Qi aids digestion, deficiency hinders it. Thus, Yuan Qi outside the Small Intestine digests food inside. Tubes are outside the Lung, so the Lung cannot digest phlegm-fluids inside the tubes—is this logical? The Classics state Zang organs store essence and do not drain. Only the Lung tube is clear and empty, thus able to transport external phlegm-fluids; otherwise, the tube would be blocked. Wang Qingren ignores this, treating the Lung as a useless dead organ.
Chapter Three, "Record of Jinmen, Jin Tube, Food Cover, General Lift, Long Tube, Water Channel," continues from Chapter One's section on feces formation in the Small Intestine and should be merged. It relates to Chapter Four, "Brain Marrow Theory," which I discuss below.
Chapter Five, "Theory of Qi and Blood Combined Pulse," states that pulses and their diagnostic value are strictly defined in the *Neijing* and *Nanjing*. Wang Qingren claims the body's Qi tubes exhale Qi, Blood vessels store Blood. Pulses derive from Qi, unrelated to Blood. Thick wrist flesh means short pulse, thin means long. Large/small indicate excess/deficiency, rapid/slow indicate cold/heat. Ignoring that Qi and Blood must interpenetrate, else humans are inert objects; if pulses are hard to understand without fingers, everyone would know medicine. He says he won't deeply explain the ancients' 27 characters on pulses, not because ancients lack space, but to prevent later generations from having no words on pulses when facing syndromes. This hides his weakness while exposing it; indeed, none of the dozens of case treatments mention pulses.
Chapter Six, "Theory of Heart Without Blood," notes Western medicine describes four chambers in the heart with openings for generating and returning blood, aligning with the *Neijing*. Wang Qingren argues the heart is a path for Qi entry/exit, containing no blood. He claims piercing a pig heart lets blood flow in, but un-pierced hearts contain no blood, comparing the heart to a vessel holding water. The heart is not a Fu organ, how can it hold blood? In his diagram, he notes under the Liver "Absolutely Cannot Store Blood." Can ancient texts be read so rigidly? The *Neijing* calls the Spleen "flesh"; Wang Qingren would surely be shocked. The appendix discusses sources of prescription efficacy and errors in *Neijing*, specifically the error of blood transforming into sweat. Wang modifies Zhang Zhongjing's formulas: Ma Huang Tang treats headache, body pain, neck stiffness, fever, aversion to cold, dry retching, and absence of sweating; Gui Zhi Tang treats similar symptoms but with sweating. He argues initial cold damage involves head/body/neck pain, fever, aversion to cold, but never excludes arms/hands from pain/fever/cold. Using Ma Huang Tang without affecting arms/hands proves the formula works but meridians are wrong. Modifying Zhang's text and blaming him is convenient. Neck stiffness is Yangming disease, limb pain is Taiyin disease; they don't co-occur initially unless in epidemic diseases. Formulas sometimes work despite mismatched indications. Quackery thrives here, as does self-praise. Zhang Zhongjing sets laws for posterity, not for quacks' coincidences. Claiming sweating indicates Wind Strike, yet Gui Zhi Tang never cures anyone. Does Wind Strike always involve sweating? Many modern doctors claim Gui Zhi Tang fails for Wind Strike due to incompetence. Wang claims Gui Zhi Tang fails because headache, body pain, fever, sweating are not Wind Strike. This contradicts the *Shanghan Lun* clause: "Headache, fever, sweating, aversion to wind—Gui Zhi Tang governs." Zhang omits pulse because Taiyang syndrome with sweating/aversion to wind naturally presents with floating pulse. Was it truly Taiyang? Floating pulse? Aversion to wind? Omission of body pain implies Taiyang with headache/fever/sweating/aversion to wind plus body pain requires modification of Gui Zhi Tang. Why not modify? Blaming Gui Zhi Tang without scrutiny is unjust. Worse, Wang uses Gui Zhi Tang without knowing the syndrome, claiming it's Wu Keyi's Plague, not Cold Damage. He advises his nephew to read Wu Keyi to understand Cold Damage, proving he read Wu's book. Wu wrote *Wenyi Lun* because contemporary doctors misused Cold Damage methods during epidemics. Why did Wang use Gui Zhi Tang for plague? Plagues differ. Perhaps Wu's method failed, so he used Zhang's, which also failed, reverting to Wu's? Then all attempts fail. Claiming eye pain, nasal dryness, insomnia are heat attacking the head, treated by Zhang with Ge Gen Tang, is cited as proof of formula efficacy but *Neijing* error. *Shanghan Lun* Ge Gen Tang indications do not match. *Neijing* states Yangming governs flesh, its meridian loops nose and connects to eyes, causing fever, eye pain, nasal dryness, insomnia. *Huoren Shu* agrees, neither suggesting Ge Gen Tang. Ge Gen Tang for this syndrome appears in Tao Jie'an's *Quansheng Ji*, adding Bai Zhi and Sheng Ma, describing fever, headache, slight aversion to cold, no sweat, slightly flooding pulse. Wang, ignorant of Yangming pulse/syndrome, misattributes and slanders Zhang, displaying unparalleled confusion. He claims Qi tubes connect to skin with pores for sweating, Blood vessels connect to skin without pores, preventing sweating. Thus, sweat is not transformed from blood, nor is it blood. Sweat is Heart fluid, steamed from heat in blood. Depriving sweat deprives blood; depriving blood deprives sweat. Verified always. Since blood steams to sweat, it moves from static to dynamic, penetrating pores. If sweat and blood exit together, or blood exits without sweat, blood is not static, failing to guard Yang. These principles are in the *Neijing*; how could Wang know?
Western arts exhaust intelligence tirelessly, never abandoning halfway. Though Western medicine lacks expertise in internal complex diseases, integrating Chinese classics to explore origins could reach peaks like ancient Chinese masters Lu Bian. Chinese physicians lack perseverance; reading a book, failing to grasp its purport, they doubt and fear, leading to loss of ancient texts. Internal medicine instruments are unheard of, though ancient ones existed. During Song Dynasty's emphasis on medicine, *Siku Quanshu Tiyao* cites Zhou Mi's *Qidong Yeyu*: Uncle Zhang Shugong mentioned acquiring a bronze man for acupuncture testing in Xiangzhou. Made of fine copper, complete with viscera. Acupoints marked with gold inlay. Front and back halves fit perfectly. Used to test doctors: coated externally with yellow wax, filled internally with water. Practitioners punctured points according to measurements; correct point allowed needle entry and water outflow; incorrect points blocked the needle. Ingenious. Later returned to the imperial treasury by Zhao Zhongnan; Zhang drew two diagrams for printing. Now lost. Western wax models only show form; this included acupuncture methods, rivaling Western ingenuity. Though lost, modern Chinese scholars create strange devices. Restoring the bronze man's craft for diagnosis/treatment would benefit medicine greatly, not just the profession.
Tang Rongchuan's *Zhongxi Huitong Yijing Jingyi* (Refined Meaning of Medical Classics in East-West Integration) balances East and West, revealing creation's secrets, benefiting medicine significantly. Reading these texts yielded insights aiding Tang's work. "Yin stores essence and rises urgently." Kidney essence gathers upwards; upper is end, lower is root. Westerners say brain governs perception, heart does not, seeing only upper essence, ignoring lower accumulation. They ignore Yin guarding Yang, Yang serving Yin. We TCM practitioners cannot fully fathom Yin-Yang dynamics, fortunately possessing sacred classics. Medicine today is comfortable. Western anatomy dates to King Lie of Zhou, analyzing to microns, yet remains superficial. Internal medicine theory states: careful attention clarifies perception. Those attentive see clearly and remember easily. Not "retain in brain" but "retain in heart," showing heart holds sovereignty. Another text says brain nerves come from cardiac plexus, formed by spinal cord knots. Brain roots in cardiac plexus, implying heart governs perception, brain obeys. Like wires: heart generates electricity, spine conducts, brain receives. Kidney generates essence/marrow, transports to brain; heart, as Yang, serves Kidney. Insisting on physical evidence makes "Bronze Mountain collapses, Luo bells ring" sound absurd to Westerners. Food enters stomach, separates clear/turbid paths; intermediate separation is essential. Tang cites Western view: water enters stomach, disperses in membranes, proving water doesn't enter Small Intestine. But isn't Small Intestine for grains? *Quanti Tongkao* on Stomach/Small Intestine mentions "gruel inside," indicating mixed water/grain, steamed by ministerial fire, a better explanation. Yet it omits input/output/separation mechanisms, showing confusion. We must judge by our classics: "Five grains enter stomach, dregs, fluids, and Zong Qi divide into three tunnels." Also: "Middle Jiao exits after Upper Jiao... receiving Qi, separating dregs, steaming fluids, refining essence, sending up to Lung." Separation in Middle Jiao corresponds to Western mesentery or Wang Qingren's Jinmen. Water doesn't fully disperse in membranes because it divides into three tunnels. After gastric/intestinal steaming, remaining waste shouldn't pass straight down; clear/turbid differ, requiring separation. Classics confirm: "Water/grain reside in stomach, become dregs, descend to Large Intestine, assist separation juice, circulate Lower Jiao, seep in." Yang Shangshan notes: Lower Jiao below navel, at bladder opening, governs separation, does not receive. Physicians never speak of two separations, yet Classics do, logically sound. Where is Lower Jiao separation? Westerners say kidneys produce urine, dissecting vertically showing funnel calyces, ureters, no inlet. Urine comes from kidneys. Doubts remain: More drinking yields more urine, less yields less; urine comes from drink (1). If water doesn't transform to urine, edema/diarrhea occur (2). Waiting for kidney generation causes insufficiency (3). Kidney generates then excretes immediately, useless (4). Western error is inexplicable. Tang says renal pedicles pierce spine, connect Sanjiao, two tubes join bladder. Thus water from Middle/Lower Jiao passes renal pedicles to bladder; pedicles are separation sites. Classics: Shaoyang belongs to Kidney, Kidney connects to Lung, combining Sanjiao/Lung power for skill. Separation here is crucial. Internal theory: Lung/skin exhalation high → urine low; exhalation low → urine high. Matches *Neijing* Qi transformation. Bladder lacks upper opening, requiring Qi transformation for urination. Westerners say upper opening exists; Wang Qingren verified no upper opening. Perhaps the upper opening is in the...
Since Western theory of brain governing perception spread in China, accepted uncritically, let us discuss further. Kidney essence generates marrow, enters brain via spine, like fruit on tree tops. Westerners say nerves come from below, reversing root/end, causing error. Questioning their logic corrects them. Kidneys have medullary substance, unique to kidneys; nuclear structures near kidneys suggest abundant nerves, implying marrow generates from kidney. TCM says Heart connection pierces spine to Kidney; Westerners say cardiac plexus forms from spinal knots, implying Heart-Brain connection. Westerners describe transparent brain matter; atrial lining is thin/smooth/transparent, implying brain clarity roots in heart clarity (*Quanti Tongkao*). Internal theory: Back spinal cord disconnected from brain marrow results in unconsciousness, implicitly denying brain sole governance of perception. Westerners excel in chemistry; their medicine is chemistry. Ask about Yin-Yang, Five Elements, twelve meridians, eight extraordinary vessels, Ying-Wei circulation, and they are ignorant. Even if told...
De Zhen's preface in *Quanti Tongkao* calls TCM conservative and arbitrary. This is frog-in-a-well thinking. True conservators uphold unchangeable Heavenly Dao; strict adherence yields new insights. Modern TCM abandons old traditions, leading to arbitrariness—not what De Zhen meant. I lament Western wisdom clinging to anatomy! Anatomy reveals form, but misses the invisible. Qi commands Blood like ruler commands subject, husband wife. This logic is indisputable. De Zhen denies it, suspecting Qi-commanding-Blood is void. Dissecting chest shows only chest, abdomen shows only abdomen; fixation on morphology leads here. Preface also attacks TCM's "Spleen moves to grind Stomach." Spleen moving is TCM error, not from classics. Spleen injury causing failure to grind is true...