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內外傷辨惑論

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Text ID
KR3eh009
Date
1232–1247
Dynasty
金

Nèiwài shāng biànhuò lùn 內外傷辨惑論

Discriminating the Confusion Between Internal and External Damage by 李杲 (Lǐ Gǎo, zì Míngzhī 明之, hào Dōngyuán lǎorén 東垣老人, 1180–1251)

About the work

Lǐ Gǎo’s foundational theoretical work, in 3 juǎn and 26 lùn, the doctrinal manifesto of the PíWèi 脾胃 (Spleen-and-Stomach / bǔtǔ 補土) school of Chinese medicine. Composed in the immediate aftermath of the Mongol siege of the Jīn capital Biànjīng 汴京 (Kāifēng) — drafted c. 1232 (Jīn Zhèngdà 9, xīnmǎo) and printed by Lǐ himself in 1247 (Yuán Yuánfú 4, dīngwèi), the only one of his works to receive author-supervised publication. The HXWD recension catalogued here is the same text as the WYG-source KR3e0052 of the same name in the Sìkù quánshū tradition.

Abstract

Lǐ Gǎo’s central diagnostic and therapeutic intervention is the discrimination of nèishāng 內傷 (internal damage) from wàishāng 外傷 (external damage). The two disease-categories produce superficially similar fever-and-fatigue presentations but require fundamentally different therapeutic strategies: the former (from spleen-and-stomach pathology, dietary irregularity, and exhaustion) requires bǔzhōng 補中 tonification; the latter (from environmental pathogenic invasion of cold, heat, wind) requires expelling-and-clearing. The clinical context — articulated in Lǐ’s own preface and elaborated by 孫一奎 Sūn Yīkuí in his late-Míng Yīzhǐ xùyú 醫旨緒餘 — was the JīnYuán transition’s epidemic mortality, in which famine, dislocation, and exhaustion produced widespread spleen-and-stomach exhaustion-syndromes that contemporary physicians repeatedly mis-treated as cold-damage with disastrous consequences. Robert Hymes (2021) has reconstructed the specific epidemiological context — the cluster of deaths Lǐ witnessed in Kāifēng during and after the 1232 siege — as the proximate trigger for Lǐ’s doctrinal innovation.

The three juǎn are: juǎn 1, thirteen essays distinguishing internal from external damage by yīnyáng, pulse, cold-heat, and the famous shǒuxīn shǒubèi 手心手背 (palm vs. back-of-hand) sign; juǎn 2, twenty-four prescriptions, principally the Bǔzhōng yìqì tāng 補中益氣湯 with huángqí, rénshēn, gāncǎo + shēngmá and cháihú to lift the clear yáng; juǎn 3, twenty-three xiāodǎo 消導 (digesting-and-dispersing) prescriptions for dietary damage, anchored by the Zhǐzhú wán 枳朮丸. Two closing essays treat the mùyù zé dá 木鬱則達 principle and the doctrine of supplementation-and-draining.

The Bǔzhōng yìqì tāng prescription, and the doctrinal foundation set out in this work, established the PíWèi school as the principal JīnYuán counterweight to 劉完素 Liú Wánsù’s cooling-fire and 張從正 Zhāng Cóngzhèng’s purgative-attack schools. The work’s transmission line — 張元素 Zhāng Yuánsù → Lǐ Gǎo → 王好古 / 羅天益 → 王履 Wáng Lǚ — is one of the most influential lineages in pre-modern Chinese medical history, and the Bǔzhōng yìqì tāng remains a standard formulation in modern TCM practice.

The catalog dynasty marker 金 reflects Lǐ’s primary lifework under the Jīn; the WYG parallel KR3e0052 uses 元 to mark the publication date. Both are defensible and conventionally attested.

Translations and research

  • See the parallel KR3e0052 entry for full bibliography. Principal references:
  • Robert P. Hymes, “A Tale of Two Sieges: Liu Qi, Li Gao, and Epidemics in the Jin-Yuan Transition,” Journal of Song-Yuan Studies (2021): 293–365 — the definitive English-language reconstruction of the epidemiological context.
  • 吳一立 Wú Yīyī (Yi-Li Wu), “A Medical Line of Many Masters: A Prosopographical Study of Liu Wansu and His Disciples from the Jin to the Early Ming,” Chinese Science 11 (1994): 36–65.
  • Yang Shou-zhong, Treatise on the Spleen and Stomach: A Translation of the Pi Wei Lun. Boulder: Blue Poppy Press, 2004 — translation of the companion Píwèi lùn.
  • Hinrichs & Barnes 2013, Chinese Medicine and Healing, pp. 130, 138, 177–198, on Lǐ Gǎo and the four JīnYuán Masters.
  • Paul U. Unschuld, Medicine in China: A History of Ideas. Berkeley: UC Press, 1985.

Other points of interest

This is the only one of Lǐ Gǎo’s works whose printing he supervised in his own lifetime; both the Píwèi lùn (KR3eh015 / KR3e0053, printed by 羅天益 Luó Tiānyì) and the Lánshì mìcáng (printed posthumously) were brought to press by his disciples. The Bǔzhōng yìqì tāng prescription is one of the most prescribed formulations in modern Chinese medical practice for spleen-deficiency syndromes, post-illness fatigue, prolapse-of-organs, chronic diarrhea, and immune-deficiency conditions.

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