夫医犹理也，医之有疡医，犹理之有兵也。善为理者，正其五官，齐其百司，使纪纲法
度，
非理之所尚也，将藉之以除乱也。彼其平居无事之时，而吾所以弭乱之本，既已缜密完固，
而无所疏漏，一旦有急则除之而已耳。故兵虽试而国家之元气不亏，医之为道也亦然。方其
病在腠理也，汤液之所及也。其在肠胃也，湔浣之所及也。若夫隆然皮肤之间，甚至不可名
状者，彼何为哉，其能不攻刺乎！其能不搏击乎！顾攻有守而后攻，击有备而后击。苟不谛
其
癣之疾，将不为腹心之患者几希，噫，可不慎乎。故明于理者，可与语医也。已世之以疡名
家者多矣，然孰有如我立斋先生者耶。盖先生以岐黄世业，旁通诸家，微词颐旨，靡不究竟
。其言以为不知外科者，无以通经络之原委。不精《内经》者，无以究阴阳之变合。内外殊
科，其揆一也。故其视病不问大小，必以治本为第一义。无急效，无近期，纾徐从容，不劳
而病自愈。间出《疠疡机要》一编，属其友沈生梓之以传。沈生读之，大率以己意而订古方
，以医案而验治效，以调补为守备之完策，以解利为攻击之权宜。盖不出乎庙堂之讦谟，而
坐得夫催陷廓清之术。假令业医者而执是焉，既不病于滞而不通，又不病于肤而无本，奚至
攻其所习，而毁所不见耶。噫！若先生者可谓医而通于理者矣。是录也，顾不可传哉。或者
曰∶诚若所言，则内外医分门异业者非欤。周官有疾医、疡医二职，并存何也？曰∶非是之
谓也。昔秦越人之为医也，闻秦贵小儿则小儿医，赵贵妇人则带下医，周贵老人则耳目痹医
。一医而三习，非其术诚奇幻，理固不殊也。若周官所存，则以其职言耳，岂知后世判为两
途，绝不相通者哉。古之任官，居则为命卿，而出则为命将。夫一人也，而理与兵兼焉，孰
谓内外医果不相通者哉。
嘉靖岁甲寅中秋，秀州沈启原道卿甫着。
医学如同治理国家，医生中的外科医生，就如同治国中的军队。善于治理的人，端正五官（指朝廷百官），统一各部门，使得法纪纲常制度，不是依靠治理手段来推崇的，而是借助它们来消除动乱。那些人在平时没有战事的时候，我们用来平息动乱的根本措施，已经严密完善坚固，没有任何疏漏，一旦有紧急事态，就将其清除罢了。所以军队虽然经过演练，但国家的元气并不亏损，医学的道理也是这样。当疾病在腠理（皮肤与肌肉之间的间隙）时，汤药可以到达；当疾病在肠胃时，洗涤（指攻下排毒）可以到达。至于那些隆起于皮肤之间，甚至无法用言语形容的病证，那该怎么办呢？能不进行攻刺吗？能不进行搏击（指强力治疗）吗？然而进攻要有防守作为后盾才能进攻，打击要有准备才能打击。如果不仔细审视这些癣疥之类的疾苦，那么成为腹心大患的就很少了，唉，怎么能不谨慎呢？所以通晓治理道理的人，可以与他谈论医学了。当代以外科闻名的专家很多，然而谁能像我立斋先生这样呢？大概先生以岐黄之术为家传世业，旁通各家学说，深奥的词旨，无不穷尽。他的言论认为，不懂外科的人，无法通晓经络的源流本末；不精通《黄帝内经》的人，无法探究阴阳的变化合和。内科和外科虽然科目不同，但其原理是一致的。所以他诊治疾病不问大小，一定以治本为第一要义。没有急效，不求近期效果，舒缓从容，不费力而病自然痊愈。偶尔拿出《疭疡机要》这一编书，嘱咐他的朋友沈生刻印以流传。沈生读后，大致以自己的意图订正古方，以医案来验证治疗效果，以调补作为防守完善的策略，以解利（疏通排泄）作为攻击的权宜之计。这都不超出朝廷谋划的范围，而坐享摧陷廓清（清除病灶）的方法。假使行医的人坚持这样做，既不会因滞塞不通而患病，也不会因肤浅而无根本，怎么会去攻击自己熟悉的，而诋毁自己没见过的呢？唉！像先生这样的人，可以说是医生中通晓治理道理的人了。这部书，难道不值得流传吗？有人问：确实像您所说的，那么内科和外科分门别类、从事不同职业的不是吗？《周礼》中有疾医、疡医两个职位，并存的原因是什么？回答说：不是这个意思。从前秦越人做医生的时候，听说秦国重视小儿就做大儿医，赵国重视妇人就做带下医，周国重视老人就做耳目痹医。一个医生兼修三种技艺，并非他的技术真正奇幻，道理本来就没有不同。至于《周礼》所记载的，是从职责角度说的罢了，哪里知道后世将其判分为两途，完全不相通的呢？古代担任官职的人，居家时是任命的高官，出仕时是任命的将领。是同一个人，却兼具治理与军事才能，谁说内科和外科果然不相通呢？
嘉靖甲寅年中秋节，秀州沈启原道卿甫撰写。
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.