医家内外科，并有起死之责，毫厘之误，人命系之。世人重内轻外，于疡科每易言之。
职是科者，又皆廉材肤学，不深明脉气浅深虚实之辨，药性君臣佐使之宜，墨守其术，以祈
投合。乌呼！其幸不败裂者亦仅矣。高子锦庭，系内外两科范圣学、杜云门之高弟，究心
《灵枢》《素问》，探索有年，洞垣一方，识其症结，盖其内外科之学，皆有心得。又悯疡
科之误人也。故专论之，亦仁人君子之用心矣。顷出所着见示，名曰《心得集》，标识形象
，而必探论本原，量其阴阳强弱，以施治疗。余按《周礼·天官》，疡医掌肿疡、溃疡、金
疡、折疡之祝药 杀之齐。注家谓∶ 者刮去脓血；杀者以药食其恶肉。又曰∶凡疗疡
以五毒攻之，以五气养之，以五药疗之，以五味节之。注谓∶既 杀攻尽其宿肉，然后养之
五气，盖五谷之误，节节成其药力，此可以见古者疡药攻补兼施之明证。今之业是者，惟持
攻毒之方，治其外而不知其内，循其末而不论其本，无怪乎学医人费也。高子是书出，使人
知必深明内科，始可言外科，不得仅执成方，率尔从事，其有功于世，岂浅鲜哉。
嘉庆十年小春下浣孙尔准书
一余禀性疏愚，见闻谫陋，岂于方书敢云博览。第三十年来，临证参详，颇有心得。兹
集中议论，时着鄙见，其有当于古人与否，未敢自必，望高明教之。
一是集论列诸证，不循疡科书旧例，每以两证互相发明，而治法昭然若揭。其中有两
证而同一治者，亦有两证而治各异者，如发背、搭疽、流注、腿痈，虽生两处，而治法则一
；如乳痈、乳痰及颈项火痰、 痰，即发一处，而治法各异。总以虚实阴阳寒热分别，临证
者务以意会之，审辨明确，然后用药始无所失。
一是集编次诸证，前后根据人身上中下为序例。他如痘毒、疯疮、广疮、结毒等类，发无
定处，不能属于何部者，另列于后，始不致牵率混淆，以便如例捡阅。
一是书未入内景经络之图，不详本草气味之论，以古人成书具在，考镜有资，毋庸赘述
。学人稽古证今，寻求此集，与前哲当有印合处，知虞初之本有自也。
一是集采摭古人外，俱系集腋成裘。间有一二录其原论者，则标其姓氏于首，余俱不及
著名，以难于备载也。并非掠美，识者谅诸。
一集中所举汤头丸散膏丹，有可通用者，有不可通用者，若于逐条论后详载，未免复出
繁冗，今概列于后，查阅较为简易。
一世俗每称我有秘方，我有不惜工本好药，每遇病即执秘方施治，不明药中气味，不识
疡发根源，阴阳寒热，药不对证，反受其误。是书悉究病因，用药不执板法，虽曰外科，实
从内治。窃以为得古圣贤之心法，故名之曰《心得》。
一大方中有四绝证，风、痨、臌、膈是也。疡科中亦有四绝证，谓失荣、舌疳、乳岩、
肾岩翻花是也。此外诸证，明其阴阳寒热，知其气血标本，俱可医治。然亦有不愈者，如脑
疽、发背、疔毒，正虚邪实，毒甚营枯，津液耗伤，正不敌邪，火毒内陷，致有神昏闭脱，
及阴证之肾俞虚痰、阴寒附骨，脓出清稀，日久不敛，精神疲乏，胃衰脾败，谷食渐减，形
神俱夺，气血不能来复，或潮热自汗，或昼夜热不退，致成损怯而毙，其论俱详叙集中，细
心求之，临证自有把握。
一是书凡有紧要外疡，俱已论列，其余零星细证，名目犹多，兹不繁载者，非敢为遗漏
也。盖以疡科之证，在上部者，俱属风温风热，风性上行故也；在下部者，俱属湿火湿热，
水性下趋故也；在中部者，多属气郁火郁，以气火之俱发于中也。其间即有互变，十证中不
过一二。集内所论，颇已详括，余证悉可参悟而得，毋俟再为拈示也。
一景岳先生《新方八阵》，悉皆平生心得经验之方，立法纯粹以精，能补前贤所未备。
习斯业者，日夕浸润而不觉，蒙其惠者，饮食仁寿而有余，惜无歌括成书，便人诵习。余师
圣学范先生，临证之暇，曾囊括成章，如汪 庵《汤头歌括》之例，然简而未备；兹表
兄吴鹤山复为增润，汇为一帙，因附刻于集后，以公同好，亦足为博古之一助云。
医家的内科和外科，都有起死回生的责任，毫厘之间的差错，关系着人的性命。世人重视内科而轻视外科，对于疡科（中医外科学）往往轻易谈论。
从事这一科的人，又都是才疏学浅之徒，不能深刻明白脉气深浅、虚实的变化区别，也不了解药物君臣佐使配伍的适宜原则，只是墨守成规地固守其医术，以祈求迎合世俗。唉！他们能够有幸不造成患者身体溃败死亡的，也是极少数的了。
高锦庭先生，是范圣学、杜云门两位先生在内外两科的高足弟子，他潜心研究《灵枢》和《素问》，探索多年，对脏腑内部情况洞若观火，能识别病症的关键所在，大概他的内外科学问，都有独到的心得。他又怜悯疡科误害人的现象。所以专门论述这一问题，这也是仁人君子的用心啊。
最近他拿出所著的书籍给我看，命名为《心得集》，标识出各种形象，并且一定要探讨论述疾病的本源，衡量患者的阴阳强弱，从而实施治疗。我查阅《周礼·天官》，记载疡医掌管肿疡、溃疡、金疡、折疡的祝药（涂抹药物）和杀齐（腐蚀药物）。注家解释说：镵（chán，音同“缠”，指用镵针刮除腐肉）是指刮去脓血；杀是指用药腐蚀掉恶肉。又说：凡是治疗疡病，用五毒攻伐它，用五气滋养它，用五药治疗它，用五味节制它。注解说：既然镵和杀攻尽了宿存的腐肉，然后才能用五气滋养它，这大概是“五谷”的误写，节节成就其药力，这可以看作是古代疡药攻补兼施的明证。
现在从事这一行业的人，只持有攻毒的方子，只治外表而不知道内在原因，遵循细枝末节而不讨论根本，难怪学习医学的人耗费巨大却成效甚微。高先生的这本书出来后，使人知道必须深刻明了内科，才可以谈论外科，不能仅仅拘执于现成的方剂，草率地从事医疗活动，他对世人的功劳，难道小吗？
嘉庆十年初冬下旬 孙尔准 书
一、我禀性疏懒愚钝，见闻浅陋，哪里敢在方书方面声称博览群书。三十年来，临证参详，颇有心得。现在集中议论的言论，时常带有我的鄙见，这些见解是否符合古人，不敢自定，希望高明之士指教。
二、这一集论述列举各种病症，不遵循疡科书籍的旧例，每两个病症互相阐发说明，从而使治疗方法像揭开盖子一样明显。其中有两个病症而治疗方法相同的，也有两个病症而治疗方法各异的，比如发背、搭疽、流注、腿痈，虽然生长在两处，但治疗方法相同；比如乳痈、乳痰以及颈项火痰、石痰，即使发生在一处，但治疗方法各异。总之以虚实、阴阳、寒热来分别，临证者务必用心去领会，审辨明确，然后用药才不会失误。
三、这一集编排次序各种病症，前后根据人体上、中、下部位为序例。其他如痘毒、疯疮、广疮、结毒等类别，发作没有固定位置，不能归属于哪一部，另外列在后面，这才不至于牵强混淆，以便按照体例检索查阅。
四、这本书没有录入内景经络图，不详述本草气味理论，因为古人的成书都在那里，考证借鉴有资源，不需要赘述。学人稽考古代验证今天，寻求这一集，与前代哲人应当有契合之处，知道虞初小说的本源是有来历的。
五、这一集采集摭拾古人内容之外，其余都是集腋成裘（比喻积少成多）。偶尔有一两条录用了他们的原论，则在开头标明其姓氏，其余都不及著名，因为难以全部记载。这并不是掠取别人的美名，懂行的人会谅解的。
六、集中所举的汤头丸散膏丹，有可以通用的，有不可以通用的，如果在逐条论述后详细记载，未免重复繁冗，现在一概列在后面，查阅较为简易。
七、世俗常常称我有秘方，我有不惜工本的好药，每次遇到疾病就拿着秘方施治，不明白药物的气味，不认识疡病发生的根源，阴阳寒热，药不对症，反而受到其误导。这本书彻底探究病因，用药不固执刻板的方法，虽然说是外科，实际上是从内治。我私下认为得到了古圣贤的心法，所以命名为《心得》。
八、大方中有四种绝症，风、痨、臌、膈是也。疡科中也有四种绝症，称为失荣、舌疳、乳岩、肾岩翻花是也。此外各种病症，明白其阴阳寒热，知晓其气血标本，都可以医治。然而也有治不好的，比如脑疽、发背、疔毒，正气虚弱邪气实盛，毒性严重营血枯槁，津液耗伤，正气不敌邪气，火毒内陷，导致神昏闭脱，以及阴证的肾俞虚痰、阴寒附骨，脓出清稀，日久不收敛，精神疲乏，胃衰脾败，谷食逐渐减少，形神俱夺，气血不能恢复，或者潮热自汗，或者昼夜热不退，致使成为损怯而死，这些论述都详细叙述在集中，细心寻求，临证自然有把握。
九、这本书凡是有紧要的外疡，都已经论述列举，其余零星细小的病症，名目还很多，现在不繁琐记载的，不是敢于遗漏。大概因为疡科的病症，在上部的，都属于风温风热，因为风性上行的缘故；在下部的，都属于湿火湿热，因为水性下趋的缘故；在中部的，多属于气郁火郁，因为气火都发于中部的缘故。其间即使有互相变化，十个病症中不过一两个。集中所论述的，颇为详尽概括，其余病症都可以参悟而得到，不需要再特意指出。
十、景岳先生的《新方八阵》，全都是平生心得经验的方剂，立法纯粹精当，能补充前贤所未具备的。学习这一行业的人，日夜浸润而不觉察，蒙受其恩惠的，饮食仁寿而有余，可惜没有歌括成书，便于人诵读学习。我老师圣学范先生，在临证之余，曾囊括成章，如同汪昂《汤头歌括》的体例，然而简单而未完备；这次表兄吴鹤山又加以增润，汇集成一册，因此附刻在集子后面，以公之于同好，也足以作为博古的一助罢了。
Internal and external medicine practitioners both bear the responsibility of rescuing the dying from death; a discrepancy of even a hair's breadth can determine life or death. The general public values internal medicine while neglecting external medicine, often treating Yangke (Traditional Chinese Medicine Surgery) with levity.
Practitioners of this specialty are frequently men of shallow talent and superficial learning, failing to deeply understand the distinctions in the depth, superficiality, deficiency, and excess of pulse qi, nor do they properly appreciate the appropriate roles of sovereign, minister, assistant, and envoy within herbal properties. They rigidly adhere to their techniques merely to seek approval. Alas! It is rare for them to avoid causing severe bodily destruction or death.
Mr. Gao Jinting is a distinguished disciple of Fan Shengxue and Du Yunmen in both internal and external medicine. He has devoted himself to studying the *Ling Shu* (Spiritual Pivot) and *Su Wen* (Basic Questions), exploring these texts for many years. He possesses profound insight into the internal organs, accurately identifying the crux of symptoms. His expertise in both internal and external medicine is undoubtedly grounded in personal comprehension. Moved by the harm caused by errors in Yangke, he dedicated himself to discussing it exclusively, demonstrating the heart of a benevolent gentleman. Recently, he presented his manuscript to me, titled *Xinde Ji* (Collection of Personal Insights). It illustrates various conditions and delves into their origins, assessing the patient's yin-yang balance and strength to guide treatment.
I consulted the *Rites of Zhou · Heavenly Officials*, which states that surgeons (Yangyi) manage sores and ulcers (Zhongyang), open ulcers (Youyang), metal wounds (Jinyang), and fractures (Zheyang) using "Zhu Yao" (medicinal applications) and "Sha Qi" (cauterizing/corrosive agents). Commentators explain: "Chan" refers to scraping away pus and blood; "Sha" refers to using medication to consume necrotic tissue. It further states: "In treating all sores, one attacks with five poisons, nourishes with five qi, treats with five medicines, and regulates with five flavors." The commentary notes: After the Chan and Sha have removed old necrotic tissue, one then nourishes with the five qi—likely a textual error for "five grains"—thereby gradually enhancing the medicinal efficacy. This serves as clear evidence that ancient surgical treatments combined attacking pathogens with tonifying the body.
Today's practitioners rely solely on formulas for attacking toxins, treating only the exterior while ignoring the interior, following trivial details without addressing the root cause. No wonder medical training is costly yet yields little result. With the publication of Mr. Gao's book, people will realize that one must thoroughly understand internal medicine before discussing external medicine, and cannot simply rely on established formulas to act rashly. His contribution to society is surely significant.
Sun Erzhun, written in the latter ten days of early winter, 10th year of the Jiaqing era.
1. I am naturally lazy and dull, with limited knowledge and experience. How dare I claim extensive reading of medical texts? Over the past thirty years, through clinical practice and detailed analysis, I have gained considerable insights. The discussions in this collection often reflect my humble opinions. Whether they align with ancient masters, I dare not presume; I hope those with superior wisdom will instruct me.
2. This collection discusses various conditions without following the old examples of Yangke books. Instead, it uses pairs of conditions to elucidate each other, making treatment methods clear as if uncovering a lid. There are cases where two different conditions share the same treatment, and cases where the same condition requires different treatments. For instance, Back Carbuncle (Fabei), Dajü Abscess, Flowing Deposit (Liuzhu), and Leg Carbuncle (Tuiyong), though occurring in different locations, share the same treatment method. Conversely, Breast Carbuncle (Ruyong), Breast Phlegm (Rutan), Neck Fire Phlegm (Jingxiang Huotan), and Stone Phlegm (Shitan), though occurring in the same area, require different treatments. Ultimately, differentiation is based on deficiency/excess, yin-yang, cold/heat. Practitioners must comprehend this mentally, distinguish clearly, and then prescribe medication to avoid error.
3. The arrangement of conditions in this collection follows the order of the upper, middle, and lower parts of the human body. Other conditions such as Smallpox Toxin (Doudou), Mad Sores (Fengchuang), Broad Sores (Guangchuang), and Knot Toxin (Jiedu), which appear in不定 locations and cannot be categorized into specific sections, are listed separately at the end to prevent confusion and facilitate reference.
4. This book does not include diagrams of internal meridians or detailed discussions on the flavors and properties of materia medica, as ancient texts already exist for reference and verification, making repetition unnecessary. Students who examine the past to verify the present and seek out this collection will find alignment with earlier sages, understanding that the origins of Yu Chu fiction (metaphorically referring to the roots of specialized knowledge) are well-founded.
5. Apart from excerpts from ancient sources, the rest of the collection is compiled from accumulated experiences. Occasionally, original theories are recorded, with the author's name indicated at the beginning; others are omitted due to space constraints. This is not plagiarism; knowledgeable readers will understand.
6. The decoctions, pills, powders, ointments, and elixirs mentioned in the collection vary in applicability. Listing them after every discussion would be redundant. Therefore, they are listed collectively at the end for easier reference.
7. The common folk often boast of having secret prescriptions or expensive, high-quality medicines. When illness strikes, they apply these secret remedies blindly, unaware of the medicinal properties and the root causes of sores, misjudging yin-yang and cold-heat patterns. Consequently, the medication does not match the syndrome, leading to further harm. This book thoroughly investigates etiology and avoids rigid prescribing methods. Although classified as external medicine, it essentially treats from the inside. I believe this captures the essence of ancient sages' wisdom, hence the title *Xinde* (Personal Insights).
8. In general medicine, there are four types of terminal illnesses: Wind (Feng), Consumption (Lao), Distension (Gu), and Diaphragmatic Obstruction (Ge). In Yangke, there are also four terminal illnesses: Shiying (Loss of Glory/Necrosis), Shegan (Tongue Ulcer), Ruyan (Breast Cancer), and Shenyan Fanhua (Penile Cancer/Elephantiasis). Other conditions, if their yin-yang, cold-heat, qi-blood, and root/branch relationships are understood, are treatable. However, some remain incurable, such as Brain Carbuncle (Naoju), Back Carbuncle (Fabei), and Ding Poison (Dingdu). These involve deficiency of righteous qi and excess of pathogenic factors, severe toxicity, depletion of Ying blood, and consumption of fluids. When righteous qi fails to overcome pathogens, fire-toxin sinks inward, causing coma, closure, or collapse. Similarly, Yin-type Kidney Shu Void Phlegm and Yin-Cold Bone-Attacking Cold present with thin pus, failure to heal over time, mental fatigue, stomach and spleen decline, reduced food intake, exhaustion of form and spirit, inability of qi-blood to recover, tidal fever, spontaneous sweating, or persistent day-and-night fever, eventually leading to consumptive weakness and death. These discussions are detailed in the collection; careful study will provide confidence in clinical practice.
9. All critical external sores are discussed herein. The remaining minor conditions are numerous but not exhaustively listed, not out of negligence, but because Yangke conditions in the upper part generally belong to Wind-Warmth and Wind-Heat due to the ascending nature of wind; those in the lower part belong to Damp-Fire and Damp-Heat due to the descending nature of water; and those in the middle part mostly belong to Qi Stagnation and Fire Stagnation, as qi and fire arise in the middle. Mutual transformations occur in only one or two out of ten cases. The discussions in this collection are comprehensive enough for readers to infer other conditions without further elaboration.
10. Mr. Jingyue’s *New Formulas Eight Arrays* consists entirely of his lifelong insightful and experienced prescriptions, formulated with purity and precision, supplementing what earlier sages lacked. Those practicing this profession benefit from daily immersion, gaining health and longevity. Unfortunately, no mnemonic verses were compiled for easy memorization. My teacher, Mr. Fan Shengxue, compiled chapters during his spare time from clinical experience, similar to Wang Ang’s *Decoction Mnemonics*, but it was simple and incomplete. My cousin, Wu Heshan, later expanded and refined it into a single volume. It is appended here for the enjoyment of fellow enthusiasts, serving as an aid to broadening historical knowledge.