《易》言∶天地自太虚至黄泉，有六位，《内经》言∶人之身，自头至足，亦有
六位，今余又言∶人胸腹之间，自肺至肾，又有六位，人与天地，造化五行，同一炉备，知
彼则知此矣。故立天之气，曰金与火，立地之气，曰土与水，立人之气，曰风与火，故金火
合则热而清，水土合则湿而寒，风火合则温而炎。
人胸腹之间，亦犹是也。肺最在上，为燥金，主清，心次，为君火，主热，肝又次之，
为风木，主温，胆又次之，为相火，主极热，脾又次之，为湿土，主凉，肾又次之，黄泉，
为寒水，主寒。故心肺象天，脾肾象地，肝胆象人。不知此者，不可与论人之病矣。
夫土为万物之本，水为万物之元，水土合德，以阴居阴，同处乎下，以立地气。
万物根于地，是故水土湿寒。若燥热阳实，则地之气不立，万物之根索泽，而枝叶枯矣。五
常政大论曰∶根于中者，命曰神机，是为动物，根本在于中也。根本者，脾、胃、肾也。（解经
牵强，经义不如此也。经文本有两义，一言动物之官骸，听命于中，是根于中也，植物之
枝叶，发生于下，是根于外也，一言人神明思虑发于中，故曰根于中，营术气血运于外，
故曰根于外也。中废则无知，外息则不动矣，非脾肾之谓也。后《原病式》所论，
极是。）
食入胃，则脾为布化气味，荣养五脏百骸，故酸入肝而养筋膜，苦入心而养血脉，甘入
脾而养肌肉，辛入肺而养皮毛，咸入肾而养骨髓。五气亦然，故清养肺，热养心，温养肝，湿养
脾，寒养肾也。凡此五味五气，太过则病，不及亦病，惟平则安矣。（观此则上文偏重湿寒，而
恶燥热，亦属未是。）故六节脏象论曰∶五味入口，藏于肠胃，味有所脏，以养五气，气和而生，
津液相成，神乃自生，是其理也。又，大阴阳明论云∶脾病而四肢不用者，何也？岐伯曰∶
四肢禀气于胃，而不得至经，必因于脾，乃得禀也。今脾病不能为胃行其津液，四肢不得禀水
谷气，气日以衰，脉道不利，筋骨肌肉皆无气以生，故不用焉。帝曰∶脾不主时何也？岐伯
曰∶脾者，土也，治中央，常以四时长四脏，各十八日寄治，不得独主于时也。脾脏者，常着
于胃土之精也，土者，生万物而法天地，故上下至颈足，不得独主于时也。帝曰∶脾与胃，
以膜相连尔，而能为之行其津液，何也？岐伯曰∶足太阴者，三阴也，其脉贯胃属脾络嗌，故太
阴为之行气于三阴。足阳明者，表也，五脏六腑之海也，亦为之行气于三阳。脏腑各因其经而
受气于阳明，故为胃行其津液。四肢不得禀水谷气，气日以衰，脉道不利，筋骨肌肉皆无气
以生，故不用焉。不用者，谓不能为之运用也。由是观之，则五脏六腑，四肢百骸，皆禀受
于脾胃，行其津液，相与濡润滋养矣。后之医者，欲以燥热之剂，以养脾胃，滋土之气，
不亦舛乎！况消渴之病者，本湿寒之阴气极衰，燥热之阳气太甚，更服燥热之药，则脾胃之气
竭矣。
叔世不分五运六气之虚实，而一概言热为实而虚为寒，彼但知心火阳热一气之虚实，而非
脏腑六气之虚实也。（热实寒虚，义亦本于《内经》，以人身发生之元气言，先生乃以五行之
生制言。二者之理，均所当究，未可互非。）盖肺本清，虚则温，心本热，虚则寒，肝本温，虚
则清，脾本湿，虚则燥，肾本寒，虚则热。假若胃冷为虚者，乃胃中阴水寒气实甚，而
阳火热气衰虚也，非胃土湿气之本衰，（此段义论精切，所谓五行各有阴阳也。）故当温补胃中
阳火之衰，退其阴水寒气之甚。又如，胃热为实者，乃胃中阳火实而阴水虚也，故当以
寒药泻胃中之实火，而养其水虚。然此皆补泻胃中虚热水火所乘之邪，非胃为湿者之本。其余
例同法。夫补泻脾胃湿土之本气者，润其湿者是补湿，燥其湿者是泻湿，土本湿故也。（指明
本气，是先生独得之秘，是从五行立论。）
凡脏腑诸气，不必肾水独当寒，心火独当热，要知每脏每腑，诸气和同，宣而平之可
也。故余尝谓∶五行之道，阴中有阳，阳中有阴。孤阴不长，独阳不成。但有一物，皆备五
行，递相济养，是谓和平，交互克伐，是谓衰盛，变乱失常，患害由行。故水少火多，
为阳实阴虚，而病热也，水多火少，为阴实阳虚，而病寒也。其为治者，泻实补虚，以平为
期而已矣。故治消渴者，补肾水阴寒之虚，而泻心火阳热之实，除肠胃燥热之甚，济一身
津液之衰，使道路散而不结，津液生而不枯，气血利而不涩，则病日已矣。（散结濡枯利涩，
为治消渴妙谛，亦治万病之准绳也。以上论脏腑五行之本气，为第一段。）况消渴者，本因
饮食服馆失宜，肠胃干涸，而气液不得宣平，或耗乱精神，过违其度，或因大病，阴气损
而血液衰虚，阳气悍而燥热郁甚之所成也。故《济众》云∶三消渴者，皆由久嗜咸物，
恣食炙 ，饮酒过度。亦有年少服金石丸散，积久食热，结于胸中，下焦虚热，血气不能
制石，热燥甚于胃，故渴而引饮。
若饮水多而小便多者，名曰消渴。若饮食多而不甚饥，小便数而渐瘦者，名曰消中。
若渴而饮水不绝，腿消瘦而小便有脂液者，名曰肾消。如此三消者，其燥热一也，但有微甚耳。
余闻世之方，多一方而通治三消渴者，以其善消水谷而喜渴也。然叔世论消渴者，
多不知本。其言消渴者，上实
热而下虚冷，上热故烦渴多饮，下寒故小便多出。本因下部肾水虚，而不能制其上焦心火，
故上实热而下虚冷。又曰∶水数一，万物之本，五行之先，故肾水者，人之本，命之元，不
可使之衰弱。根本不坚，则枝叶不茂，元气不固，则形体不荣。消渴病者，下部肾水极冷，
若更服寒药，则元气转虚而下部肾水转衰，则上焦心火亢甚，而难治也。但以暖药补养元气，
若下部肾水得实，而胜退上焦心火，则自然渴止，小便如常，而病愈也。若此之言，正与仲
景相反，所谓巧言似是，于理实违者也。非徒今日之误，亦已久哉。又如，蒋氏《药证病源》
中，（今无此书。）论消渴、消中、消肾病曰∶三焦五脏俱虚热，惟有膀胱冷似冰，又曰∶
腰肾虚冷日增重，又曰∶膀胱肾脏冷如泉。始言三焦五脏俱虚热，惟有膀胱冷似冰，复言肾脏
亦冷，且肾脏冰冷言为虚，其余热者，又皆言其虚，夫阴阳兴衰，安有此理！且其言自不相
副，其失犹小，至于寒热差殊，用率相反，过莫大焉。（先生之辩，固极有理，然虚热、
虚寒，常为病者所兼有，不独消渴也。《内经》亦曰∶气之所并为血虚，血之所并为气虚，
是无实乎？曰∶有者为实，无者为虚。故气并则无血，血并则无气，气血相失，故为虚焉。
故一身而兼有寒热之两虚者，亦非甚悖于理也。但用药从阴引阳，从阳引阴，须有权衡，
岂可谓火虚者必水实，阴盛者必阳衰耶！后来薛立斋辈，谓阳盛者不必抑阳，但益阴以配之，
阴盛者不必消阴，但助阳以配之。此即一偏之论也，未始非滥觞。于先生之说矣。）或又谓∶
肾与膀胱属水，虚则不能制火，虚既不能制火，故小便多者，愈失其远矣。彼谓水气实者必
能制火，虚则不能制火，故阳实阴虚，而热燥其液，小便淋而常少，阴实阳虚，不能制水，
小便利而常多，岂知消渴小便多者，非此谓也。何哉？盖燥热太甚，而三焦肠胃之腠理，
怫郁结滞，致密壅塞，而水液不能泄，浸润于外，荣养百骸，故肠胃之外，燥热太甚，虽复
多饮于中，终不能浸润于外，故渴不止。小便多出者，为其多饮，不能渗泄于肠胃之外，
故数溲也。（此段议论，精确绝伦，学人当能参透，即万病俱贯通矣。而徐灵胎、陈修园，
每诋叶天士通络之议，何也？一部《原病式》，只说得经络气化四字。）
故余着有《原病式》曰∶皮肤之汗孔者，谓泄汗之孔窍也。一名气门者，谓泄气
之门户也。一名腠理者，谓气液
之隧道纹理也。一名鬼门者，谓幽冥之门也。一名玄府者，谓玄微之府也。然玄府者，
无物不有，人脏腑、皮毛、肌肉、筋膜、骨髓、爪牙，至于万物，悉皆有之。乃出入升降，
道路门户也。故经曰∶出入废则神机化灭，升降息则气立孤危，故非出入则无以生长壮老已，
非升降则无以生长化收脏，是知出入升降，无器不有。故知人之眼、耳、鼻、舌、身、意、
神、识，能为用者，皆由升降出入之通利也。有所闭塞，则不能用也。若目无所见，耳无所
闻，鼻不闻香，舌不知味，筋痿骨痹，爪退齿腐，毛发堕落，皮肤不仁，肠胃不能渗泄者，悉
由热气怫郁，玄府闭塞，而致津液、血脉、营卫、清气不能升降出入故也。各随郁结微甚，
而为病之大小焉。病在表，则怫郁腠理，闭密阳气，不能散越，故燥而无汁，而气液不能出矣。
叔世不知其然，故见消渴数溲，妄言为下部寒尔，岂知肠胃燥热怫郁，使之然也，予所以
举此。
世谓消渴之证，乃肠胃之外燥热，痞闭其渗泄之道路，水虽入肠胃之内，不能渗泄于外，
故小便数而复渴。此数句，足以尽其理也，试取《内经》凡言渴者，尽明之矣。有言心肺气厥
而渴者，有言肝痹而渴者，有言脾热而渴者，有言肾热而渴者，有言胃与大肠热结而渴者，
有言肠痹而渴者，有言小肠瘅热而渴者，有因病疟而渴者，有因肥甘石药而渴者，有因醉饱入
房而渴者，有因远行劳倦遇大热而渴者，有因伤寒胃干而渴者，有因病热而渴者，有因病风
而渴者。虽五脏之部分不同，而病之所遇各异，其归燥一也。（以上发明病根，是本段之前半
截。下乃备引经义，以证其实而足其理。）
所谓心肺气厥而渴，厥论曰∶心移热于肺，传为膈消。注曰∶心热入肺，久而传化，内为
膈热，消渴多饮也。所谓肝痹而渴者，痹论曰∶肝痹者，夜卧则惊，多饮，数小便。所谓脾
热而渴者，痿论曰∶脾气热则胃干而渴，肌肉不仁，发为肉痿。所谓肾热而渴者，刺热论曰∶肾
热病者，先腰痛， 酸，苦渴数饮，身热，热论曰∶少阴脉贯肾，络于肺，系舌本，故口燥舌干
而渴。叔世惟言肾虚不能制心火，为上实热而下虚冷，以热药温补肾水，欲令胜退心火者，
未明阴阳虚实之道也。夫肾水属阴而本寒，虚则为热，心火属阳而本热，虚则为寒，若
肾水阴虚，则心火阳实，是谓
阳实阴虚，而上下俱热，明矣。故气厥论曰∶肾气衰，阳气独胜。宣明五气论曰∶肾恶燥，
由燥，肾枯水涸。脏气法时论曰∶肾苦燥，急食辛以润之。夫寒物属阴，能养水而泻火，
热物属阳，能养火而耗水，今肾水既不胜心火，则上下俱热，奈何以热药养肾水，欲令胜心
火？岂不缪哉！又如，胃与大肠热结而渴者，阴阳别论曰∶一阳结，谓之消。注曰∶二
阳结，胃及大肠俱热结也。肠胃菀热，善消水谷。又，气厥论曰∶大肠移热于胃，善食而瘦。
脉要精微论曰∶瘅成为中消，善食而瘦。如肠痹而渴者，数饮而不得中，气喘而争，（痹论
作数饮而出不得，中气喘争。今以不得中为句，是谓不得留于中，而即出也，恐非经旨。）
时发飧泄。夫数饮而不得中，其大便必不停留，然则消渴数饮而小便多者，止是三焦燥热
怫郁而气衰也，明矣，岂可以燥热毒药助其强阳，以伐弱阴乎！此真实实虚虚之罪也。夫
消渴者，多变聋盲、疮癣、痤 之类，皆肠胃燥热怫郁，水液不能浸润于周身故也。或热甚
而膀胱怫郁，不能渗泄，水液妄行，而面上肿也。如小肠痹热而渴者，举痛论曰∶热气留于小
肠，肠中痛，瘅热焦渴，则便坚不得出矣。注曰∶热渗津液，而大便坚矣。如因病疟而渴者，
疟论曰∶阳实则外热，阴虚则内热，内外皆热，则喘而渴，故欲饮冷也。然阳实阴虚而为病
热，法当用寒药养阴泻热，是为泻实补衰之道也。如因肥甘石药而渴者，奇病论曰∶有口甘者，
病名为何？岐伯曰∶此五气之所溢也，病名脾瘅。瘅为热也，脾热则四脏不禀，故五气上溢也。
（脾属土，土数五，故曰五气，非谓五脏之气也。）先因脾热，故曰脾瘅。又，经曰∶五味入口，
藏于胃，脾为之行其精气，津液在脾，故令人口甘也。此肥美之所发也，此人必数食甘美而
多肥也。肥者令人内热，甘者令人中满，故其气上溢，转而为消渴。通评虚实论曰∶消瘅、
仆击、偏枯、痿厥、气满发逆，肥贵之人，膏粱之疾也。或言∶人惟胃气为本，脾胃合为表里，
脾胃中州，当受温补，以调饮食。今消渴者，脾胃极虚，益宜温补，若服寒药，耗损脾胃，本
气虚乏，而难治也。此言乃不明阴阳、寒热虚责、补泻之道，故
妄言而无畏也。岂知腹中论云∶帝曰，夫子数言热中消中不可服芳草石药，石药发癫，
芳草发狂。注言∶多饮数溲，谓之热中。多食数溲，谓之消中。多喜曰癫。多怒曰狂。芳，
美味也。石谓英、乳，乃发热之药也。经又曰∶热中消中，皆富贵人也，今禁膏粱，是不合
《易经》说：从太虚到黄泉，天地有六个层次；《内经》说：人的身体，从头到足，也有六个层次。现在我又说：在人的胸腹之间，从肺到肾，又有六个层次。人与天地，造化五行，如同在一个熔炉中完备具备，了解彼处（天地）就能了解此处（人体）。所以，确立天的气，是金与火；确立地的气，是土与水；确立人的气，是风与火。因此，金和火结合则产生热而清，水和土结合则产生湿而寒，风和火结合则产生温而炎。
人的胸腹之间，也是同样的道理。肺在最上面，属燥金，主清；心次之，属君火，主热；肝又次之，属风木，主温；胆又次之，属相火，主极热；脾又次之，属湿土，主凉；肾又次之，位于黄泉，属寒水，主寒。所以心肺象征天，脾肾象征地，肝胆象征人。不了解这些道理的人，不可以与他讨论人的疾病了。
土是万物的根本，水是万物的源头，水土合德，以阴居阴，同处于下方，以此确立地气。万物根植于地，所以水土具有湿寒的特性。如果燥热阳实，那么地气就无法确立，万物的根系就会枯竭失去滋润，枝叶也就枯死了。《五常政大论》说：根于内部的，叫做神机，这是动物，根本在于内部。（对此经文的解释牵强，经文原意并非如此。经文原本有两层含义，一层是说动物的官骸肢体，听命于内部，所以说是根于中；植物的枝叶，发生于外部，所以说是根于外。另一层是说人的神明思虑发源于内部，所以说根于中；营卫气血运行于外部，所以说根于外。内部功能废弛则无知觉，外部气息停止则不运动，并不是指脾肾而言。后来《原病式》中的论述，非常正确。）
食物进入胃后，脾负责布散化生气味，滋养五脏百骸。所以酸味入肝而滋养筋膜，苦味入心而滋养血脉，甘味入脾而滋养肌肉，辛味入肺而滋养皮毛，咸味入肾而滋养骨髓。五气也是如此，所以清气养肺，热气养心，温气养肝，湿气养脾，寒气养肾。凡是这五味五气，太过则致病，不及也致病，只有平和才能安宁。（看这里可知上文偏重湿寒，而厌恶燥热，也是不正确的。）所以《六节脏象论》说：五味入口，藏于肠胃，味道有所归属，用以滋养五气，气和平和则生命产生，津液相互成就，神气自然生成，就是这个道理。另外，《大阴阳明论》说：脾病导致四肢不能运用，为什么呢？岐伯说：四肢禀受气于胃，但胃气不能直接到达经脉，必须依靠脾的转输，才能禀受。现在脾病不能为胃传输津液，四肢得不到水谷之气，气日渐衰败，脉道不利，筋骨肌肉都没有气来生长，所以不能运用。黄帝问：脾不单独主管一个季节，为什么呢？岐伯说：脾属土，治理中央，常在四季中滋养四脏，每季最后十八日寄治于脾，所以不能单独主管一个季节。脾脏，常附着于胃土的精微之上，土能生万物并效法天地，所以从上到下至颈足，不能单独主管一个季节。黄帝问：脾与胃，只是通过膜相连而已，却能为其传输津液，为什么呢？岐伯说：足太阴脾经，是三阴经之一，其脉贯串胃、属于脾、联络咽喉，所以太阴脾经为三阴经传输气。足阳明胃经，是表经，是五脏六腑的海，也为三阳经传输气。脏腑各循其经脉从阳明胃接受气，所以胃能为其传输津液。四肢得不到水谷之气，气日渐衰败，脉道不利，筋骨肌肉都没有气来生长，所以不能运用。所谓“不用”，是指不能为其运用。由此看来，五脏六腑、四肢百骸，都禀受于脾胃，由脾胃传输津液，相互濡润滋养。后来的医生，想用燥热的药剂来养护脾胃，滋长土气，不是荒谬吗！何况消渴病的患者，本是湿寒的阴气极度衰弱，燥热的阳气太过亢盛，如果再服用燥热的药物，那么脾胃之气就竭尽了。
近代医家不分五运六气的虚实，一概说热为实证而虚为寒证，他们只知心火阳热一气的虚实，而不是脏腑六气的虚实。（热实寒虚的道理也本于《内经》，是从人身发生之元气角度说的，而先生您是用五行生克的角度来说。两者的道理，都值得探究，不可互相非难。）肺本清，虚则温；心本热，虚则寒；肝本温，虚则清；脾本湿，虚则燥；肾本寒，虚则热。假如认为胃冷是虚证，那是胃中阴水寒气实甚，而阳火热气衰虚，并不是胃土湿气本身的衰弱，（这段义理论述精切，所谓五行各有阴阳。）所以应当温补胃中阳火的衰败，退去阴水寒气的亢盛。又如，胃热是实证，那是胃中阳火实而阴水虚，所以应当用寒药泻除胃中的实火，而滋养其阴水的不足。然而这些都是针对补泻胃中因虚热水火相乘而产生的邪气，并不是针对胃作为湿土的本气。（指明本气，是先生独得的秘密，是从五行立论的。）
凡是脏腑诸气，不必肾水独当寒，心火独当热，要知道每一脏每一腑，诸气调和，宣通而使之平和就可以了。所以我曾说：五行的道理，阴中有阳，阳中有阴。孤阴不长，独阳不成。只要有一物，都具备五行，递相济养，这就叫和平；交互克伐，这就叫衰盛；变乱失常，患害由此产生。所以水少火多，是阳实阴虚，而生病热；水多火少，是阴实阳虚，而生病寒。治疗的方法，就是泻实补虚，以平和为最终目标。所以治疗消渴，要补肾水阴寒的不足，而泻心火阳热的有余，清除肠胃燥热的严重状况，救济一身津液的衰败，使道路散开而不结滞，津液生成而不枯槁，气血流通而不涩滞，那么病就会日渐痊愈了。（散结、濡枯、利涩，是治疗消渴的妙谛，也是治疗万病的准绳。以上论述脏腑五行之本气，为第一段。）况且消渴病，本来是因为饮食起居失宜，导致肠胃干涸，气液不得宣通平和；或者耗乱精神，过度违背常规；或者因为大病，阴气受损而血液衰虚，阳气悍烈而燥热郁结严重所形成的。所以《济众书》说：三消渴，都是因为长久嗜好咸味食物，放纵食用烤炙之物，饮酒过度。也有年轻人服用金石丸散，积久食热，结于胸中，下焦虚热，血气不能制约金石，热燥甚于胃，所以口渴而引饮。
如果饮水多而小便也多，名叫消渴。如果饮食多但不怎么饥饿，小便频数而逐渐消瘦，名叫消中。如果口渴且饮水不止，腿脚消瘦而小便中有脂液，名叫肾消。这三种消渴病，其燥热本质是一样的，只是程度有轻微和严重之分。我听说世间的方子，大多一方通治三消渴，因为它们善于消耗水谷且喜欢口渴。然而近代论及消渴者，大多不知道本源。他们说消渴，是上实热而下虚冷，上热所以烦渴多饮，下寒所以小便多出。本源是因为下部肾水虚，不能制约上焦心火，所以上实热而下虚冷。又说：水数为一，是万物的根本，五行的先导，所以肾水是人的根本，生命的元始，不能使其衰弱。根本不坚固，则枝叶不茂盛；元气不固，则形体不荣润。消渴病患者，下部肾水极冷，如果再服用寒药，则元气更虚而下部肾水更衰，则上焦心火亢盛更甚，就很难治疗了。只用暖药补养元气，如果下部肾水得充实，而胜退上焦心火，则自然口渴停止，小便如常，病就好了。这样的话，正与张仲景相反，所谓花言巧语看似有理，实际上违背事理。不仅仅是今天的错误，也已经很久了。又如，蒋氏《药证病源》中（此书现已无存），论消渴、消中、肾病说：三焦五脏都虚热，只有膀胱冷得像冰；又说：腰肾虚冷日益加重；又说：膀胱肾脏冷如泉水。开始说三焦五脏都虚热，只有膀胱冷得像冰，接着又说肾脏也冷，而且说肾脏冰冷是虚，其余热的也都说是虚，阴阳兴衰，哪有这个道理！况且他的话自相矛盾，失误还小，至于寒热差异，用药率相反而行，过错没有比这更大的了。（先生的辩驳，固然极有理，然而虚热、虚寒，常常为患者兼有，不仅仅在消渴病中如此。《内经》也说：气之所并为血虚，血之所并为气虚，难道就没有实证了吗？回答说：有者为实，无者为虚。所以气并则无血，血并则无气，气血相失，所以为虚。因此一身兼有寒热两虚的情况，也并非极其违背事理。只是用药要从阴引阳，从阳引阴，须要有权衡，岂能说火虚者必水实，阴盛者必阳衰耶！后来的薛立斋等人，说阳盛者不必抑阳，只需益阴以配合它；阴盛者不必消阴，只需助阳以配合它。这是一种偏颇的言论，未尝不是滥觞于先生的学说。）有人又说：肾与膀胱属水，虚则不能制火，虚既然不能制火，所以小便多，这就更加失远了。他们认为水气实者必能制火，虚则不能制火，所以阳实阴虚，热燥其液，小便淋沥而量少；阴实阳虚，不能制水，小便利而量多。哪里知道消渴小便多，不是这个意思呢？为什么呢？因为燥热太甚，导致三焦肠胃的腠理，怫郁结滞，致密壅塞，而水液不能泄出浸润于外，滋养百骸，所以在肠胃之外，燥热太甚，虽然体内多喝，终究不能浸润于外，所以口渴不止。小便多出，是因为喝得多，但不能渗泄于肠胃之外，所以小便频数。（这段议论，精确绝伦，学人应当能参透，即万病都能贯通了。而徐灵胎、陈修园，每每诋毁叶天士的通络议论，为什么呢？一部《原病式》，只说了经络气化四个字。）
所以我著有《原病式》说：皮肤的汗孔，叫做泄汗的孔窍。一名气门，叫做泄气的门户。一名腠理，叫做气液的隧道纹理。一名鬼门，叫做幽冥之门。一名玄府，叫做玄微之府。然而玄府，无处不在，人的脏腑、皮毛、肌肉、筋膜、骨髓、爪牙，以至于万物，全都具备。它是出入升降的道路门户。所以经文说：出入废则神机化灭，升降息则气立孤危，所以没有出入就没有生长壮老已的过程，没有升降就没有生长化收藏的过程，由此知道出入升降，没有哪个器官不具备。所以知道人的眼、耳、鼻、舌、身、意、神、识，能够发挥作用，都是由于升降出入的通利。如果有闭塞，就不能发挥作用。如果眼睛看不见，耳朵听不到，鼻子闻不到香味，舌头尝不出味道，筋痿骨痹，指甲脱落牙齿腐烂，毛发堕落，皮肤麻木，肠胃不能渗泄，全都是由热气怫郁，玄府闭塞，导致津液、血脉、营卫、清气不能升降出入造成的。根据郁结的轻重，而产生大小不同的疾病。病在体表，则怫郁腠理，闭密阳气，不能散发越出，所以干燥而无汁，气液不能出。近代医家不知道这样，所以见到消渴尿频，妄说是下部寒，哪里知道是肠胃燥热怫郁导致的呢？我所以举出这个例子。
世人认为消渴证，是肠胃之外的燥热，痞闭了其渗泄的道路，水虽然进入肠胃之内，不能渗泄于外，所以小便频数而又口渴。这几句话，足以穷尽其中的道理，试取《内经》凡提到渴的，全部弄明白了。有的说心肺气厥而渴，有的说肝痹而渴，有的说脾热而渴，有的说肾热而渴，有的说胃与大肠热结而渴，有的说肠痹而渴，有的说小肠瘅热而渴，有的因病疟而渴，有的因肥甘石药而渴，有的因醉饱入房而渴，有的因远行劳倦遇大热而渴，有的因病伤寒胃干而渴，有的因病热而渴，有的因病风而渴。虽然五脏的部位不同，而病因各异，但其归于燥热是一致的。（以上发明病根，是本段的前半部分。下面乃备引经义，以证实并充足其道理。）
所谓心肺气厥而渴，《厥论》说：心移热于肺，传为膈消。注解说：心热入肺，久而传化，内为膈热，消渴多饮。所谓肝痹而渴，《痹论》说：肝痹者，夜卧则惊，多饮，数小便。所谓脾热而渴，《痿论》说：脾气热则胃干而渴，肌肉不仁，发为肉痿。所谓肾热而渴，《刺热论》说：肾热病者，先腰痛，髀酸，苦渴数饮，身热；《热论》说：少阴脉贯肾，络于肺，系舌本，故口燥舌干而渴。近代医家只说肾虚不能制心火，为上实热而下虚冷，用热药温补肾水，想要让它胜退心火，是不明白阴阳虚实的道理。肾水属阴而本寒，虚则为热；心火属阳而本热，虚则为寒。如果肾水阴虚，则心火阳实，这叫阳实阴虚，上下俱热，很明白了。所以《气厥论》说：肾气衰，阳气独胜。《宣明五气论》说：肾恶燥，由燥，肾枯水涸。《脏气法时论》说：肾苦燥，急食辛以润之。寒物属阴，能养水而泻火；热物属阳，能养火而耗水。现在肾水既不胜心火，则上下俱热，为什么还用热药养肾水，想要让它胜心火？岂不是荒谬吗！又如，胃与大肠热结而渴，《阴阳别论》说：一阳结，谓之消。注解说：二阳结，胃及大肠俱热结也。肠胃菀热，善消水谷。另外，《气厥论》说：大肠移热于胃，善食而瘦。《脉要精微论》说：瘅成为中消，善食而瘦。如肠痹而渴，《痹论》说：数饮而出不得，中气喘争（今以不得中为句，是谓不得留于中，而即出也，恐非经旨），时发飧泄。如果数饮而不得中，其大便必不停留，那么消渴数饮而小便多，止是三焦燥热怫郁而气衰罢了，很明白了，怎么能用燥热毒药助其强阳，以伐弱阴呢！这是真实实、虚虚的罪过啊。消渴病，多变为聋盲、疮癣、痤痱之类，都是肠胃燥热怫郁，水液不能浸润于周身所致。或者热甚而膀胱怫郁，不能渗泄，水液妄行，而面上肿。如小肠痹热而渴，《举痛论》说：热气留于小肠，肠中痛，瘅热焦渴，则便坚不得出矣。注解说：热渗津液，而大便坚矣。如因病疟而渴，《疟论》说：阳实则外热，阴虚则内热，内外皆热，则喘而渴，故欲饮冷也。然而阳实阴虚而为病热，法当用寒药养阴泻热，这是泻实补虚之道。如因肥甘石药而渴，《奇病论》说：有口甘者，病名为何？岐伯说：此五气之所溢也，病名脾瘅。瘅为热也，脾热则四脏不禀，故五气上溢也。（脾属土，土数五，故曰五气，非谓五脏之气也。）先因脾热，故曰脾瘅。另外，经文说：五味入口，藏于胃，脾为之行其精气，津液在脾，故令人口甘也。这是肥美之所发也，此人必数食甘美而多肥也。肥者令人内热，甘者令人中满，故其气上溢，转而为消渴。《通评虚实论》说：消瘅、仆击、偏枯、痿厥、气满发逆，肥贵之人，膏粱之疾也。有人说：人惟胃气为本，脾胃合为表里，脾胃中州，当受温补，以调饮食。现在消渴者，脾胃极虚，益宜温补，若服寒药，耗损脾胃，本气虚乏，而难治也。这种说法是不明白阴阳、寒热虚实、补泻之道，所以妄言而无畏。哪里知道《腹中论》说：黄帝问，夫子数言热中消中不可服芳草石药，石药发癫，芳草发狂。注解说：多饮数溲，谓之热中。多食数溲，谓之消中。多喜曰癫。多怒曰狂。芳，美味也。石谓英、乳，乃发热之药也。经文又说：热中消中，皆富贵人也，今禁膏粱，是不合……
The *Yijing* (Book of Changes) states: From the Great Void to the Yellow Springs, Heaven and Earth have six levels. The *Neijing* (Inner Canon) states: The human body, from head to foot, also has six levels. Now I say: Between the chest and abdomen of a person, from the Lung to the Kidney, there are another six levels. Humans and Heaven and Earth, in their creation and the Five Phases, possess the same completeness as in a single furnace; knowing the latter allows one to know the former. Therefore, the Qi establishing Heaven is Metal and Fire; the Qi establishing Earth is Earth and Water; the Qi establishing Humanity is Wind and Fire. Thus, when Metal and Fire combine, they produce Heat and Clarity; when Water and Earth combine, they produce Dampness and Cold; when Wind and Fire combine, they produce Warmth and Flare-up.
Similarly, within the human chest and abdomen. The Lung is at the highest position, belonging to Dry Metal, governing Clarity. The Heart follows, belonging to Sovereign Fire, governing Heat. The Liver follows again, belonging to Wind-Wood, governing Warmth. The Gallbladder follows again, belonging to Ministerial Fire, governing Extreme Heat. The Spleen follows again, belonging to Damp-Earth, governing Coolness. The Kidney follows again, located at the Yellow Springs, belonging to Cold-Water, governing Cold. Thus, the Heart and Lung symbolize Heaven, the Spleen and Kidney symbolize Earth, and the Liver and Gallbladder symbolize Humanity. Those who do not understand this cannot be discussed with regarding human diseases.
Earth is the root of all things, Water is the origin of all things. Earth and Water unite in virtue, residing in Yin within Yin, dwelling together below, thereby establishing the Qi of Earth. All things take root in the Earth; therefore, Earth and Water possess Dampness and Cold. If Dryness-Heat and Yang-Repletion were present, the Qi of Earth would not be established, the roots of all things would wither without moisture, and branches and leaves would dry up. The *Wu Chang Zheng Da Lun* (Great Treatise on the Five Constants and Policies) states: "Rooted within is called Shen-Ji (Spirit Mechanism), which pertains to animals, whose root lies within." (This interpretation of the classic is forced and does not reflect its true meaning. The classic originally has two meanings: one refers to animal organs and limbs obeying the center, hence rooted within; plants' branches and leaves originate externally, hence rooted outside. The other refers to human spirit and thought originating in the center, hence rooted within; Ying-Wei Qi and Blood circulate externally, hence rooted outside. If the center fails, there is no consciousness; if the exterior ceases, there is no movement; this does not refer to the Spleen and Kidney. The discussion in the later *Yuan Bing Shi* is extremely correct.)
When food enters the Stomach, the Spleen distributes and transforms its flavors and Qi to nourish the five Zang organs and hundred bones. Thus, Sour flavor enters the Liver and nourishes sinews and fascia; Bitter flavor enters the Heart and nourishes blood vessels; Sweet flavor enters the Spleen and nourishes muscles; Pungent flavor enters the Lung and nourishes skin and hair; Salty flavor enters the Kidney and nourishes bone marrow. The same applies to the five Qi: thus, Clear Qi nourishes the Lung, Heat nourishes the Heart, Warmth nourishes the Liver, Dampness nourishes the Spleen, and Cold nourishes the Kidney. Regarding these five flavors and five Qi, excess causes disease, deficiency also causes disease; only balance brings peace. (From this, it can be seen that the previous emphasis on Damp-Cold and aversion to Dry-Heat was incorrect.) Therefore, the *Liu Jie Zang Xiang Lun* (Treatise on Six Nodes and Viscera Manifestations) states: "Five flavors enter the mouth, store in the intestines and stomach; flavors have their respective destinations to nourish the five Qi. When Qi is harmonious, life arises; fluids and essence form together, and Spirit naturally generates." This is the principle. Furthermore, the *Da Yin Yang Ming Lun* (Treatise on Great Yin-Yang and Bright Yang) asks: "Why does Spleen disease cause the four limbs to be unusable?" Qibo replies: "The four limbs receive Qi from the Stomach, but Stomach Qi cannot reach the meridians directly; it must rely on the Spleen to be received. Now, due to Spleen disease, it cannot transport fluids for the Stomach; the four limbs do not receive water and grain Qi. Qi declines daily, meridians become obstructed, sinews, bones, muscles, and flesh lack Qi to grow, thus becoming unusable." The Emperor asks: "Why does the Spleen not govern a specific season?" Qibo replies: "The Spleen belongs to Earth, governs the Center, and constantly nourishes the four Zang organs during the four seasons, presiding over the last eighteen days of each season, so it cannot exclusively govern one season. The Spleen organ constantly adheres to the essence of Stomach-Earth. Earth generates all things and models itself on Heaven and Earth; thus, from top to bottom to neck and feet, it cannot exclusively govern one season." The Emperor asks: "The Spleen and Stomach are connected only by membranes, yet how can they transport fluids?" Qibo replies: "Foot-Taiyin (Spleen Meridian) is one of the Three Yin meridians; its vessel penetrates the Stomach, belongs to the Spleen, and connects to the throat, so Taiyin transports Qi to the Three Yin. Foot-Yangming (Stomach Meridian) is the Exterior, the Sea of the five Zang and six Fu organs, and also transports Qi to the Three Yang. The Zang and Fu organs each receive Qi from Yangming via their meridians; thus, the Stomach transports fluids for them. Because the four limbs do not receive water and grain Qi, Qi declines daily, meridians become obstructed, sinews, bones, muscles, and flesh lack Qi to grow, thus becoming unusable. 'Unusable' means unable to be utilized. From this, we see that the five Zang and six Fu organs, four limbs, and hundred bones all receive from the Spleen and Stomach, which transport fluids, mutually moistening and nourishing. Later physicians, wishing to use drying-hot agents to nourish the Spleen and Stomach and boost Earth Qi, are not mistaken! Especially for patients with Xiao Ke (Wasting-Thirst), whose fundamental pathology is extreme deficiency of Damp-Cold Yin Qi and excessive abundance of Dry-Heat Yang Qi. Taking more drying-hot medicines would exhaust the Qi of the Spleen and Stomach.
In recent generations, physicians fail to distinguish the deficiency and repletion of the Five Movements and Six Qi, generally stating that Heat is Repletion and Deficiency is Cold. They only understand the deficiency and repletion of the single Qi of Heart-Fire Yang-Heat, not the deficiency and repletion of the Six Qi of the Zang-Fu organs. (The principle of Heat-Repletion and Cold-Deficiency also originates from the *Neijing*, speaking from the perspective of the primordial Qi of human generation, whereas Mr. Li uses the perspective of Five Phase generation and control. Both principles deserve investigation and should not refute each other.) The Lung is fundamentally Clear; when deficient, it becomes Warm. The Heart is fundamentally Hot; when deficient, it becomes Cold. The Liver is fundamentally Warm; when deficient, it becomes Clear. The Spleen is fundamentally Damp; when deficient, it becomes Dry. The Kidney is fundamentally Cold; when deficient, it becomes Hot. For example, if Stomach cold is considered Deficiency, it is because Yin-Water Cold Qi is excessively Replete in the Stomach, while Yang-Fire Hot Qi is deficient, not because the fundamental Dampness of Stomach-Earth is deficient. (This argument is precise, illustrating that each of the Five Phases has both Yin and Yang.) Therefore, one should warm and tonify the decline of Yang-Fire in the Stomach and retreat the excess of Yin-Water Cold Qi. Conversely, if Stomach heat is considered Repletion, it is because Yang-Fire in the Stomach is Replete and Yin-Water is deficient. Thus, one should use cold medicines to drain the Replete Fire in the Stomach and nourish the deficient Water. However, these all address the pathogenic factors caused by deficiency and repletion of water and fire in the Stomach, not the fundamental nature of the Stomach as Damp-Earth. (Identifying the fundamental Qi is Mr. Li's unique secret, based on the Five Phases.)
Regarding the Qi of all Zang and Fu organs, one need not assume Kidney-Water exclusively corresponds to Cold or Heart-Fire exclusively to Heat. One must know that the Qi of every Zang and Fu organ should be harmonized and balanced through dissemination. Thus, I often say: The Way of the Five Phases contains Yin within Yang and Yang within Yin. Solitary Yin does not grow; solitary Yang does not form. Any single entity possesses the Five Phases, mutually supporting and nourishing, which is called Peace. Mutual overcoming leads to Decline and Abundance. Disorder and loss of normalcy bring harm. Therefore, less Water and more Fire constitutes Yang-Repletion and Yin-Deficiency, resulting in Heat disease. More Water and less Fire constitutes Yin-Repletion and Yang-Deficiency, resulting in Cold disease. The treatment method is to drain Repletion and tonify Deficiency, aiming for balance. Thus, treating Xiao Ke involves tonifying the deficiency of Kidney-Water Yin-Cold and draining the excess of Heart-Fire Yang-Heat, removing severe Dry-Heat from the intestines and stomach, and assisting the decline of whole-body fluids. This ensures pathways remain open and unobstructed, fluids generate without withering, and Qi and Blood flow smoothly without stagnation, causing the disease to heal daily. (Resolving nodules, moistening withering, and promoting smooth flow are the subtle truths of treating Xiao Ke and the standard for treating all diseases. The above discusses the fundamental Qi of Zang-Fu and Five Phases, constituting the first section.) Moreover, Xiao Ke arises primarily from improper diet and lifestyle, leading to dry intestines and stomach, preventing the smooth distribution of Qi and fluids. It may result from mental exhaustion and exceeding limits, or from major illnesses damaging Yin Qi and depleting Blood, leaving Yang Qi fierce and Dry-Heat severely constrained. Thus, *Ji Zhong Shu* states: San Xiao (Three Wastes-Thirst) results from long-term craving for salty foods, indulgence in roasted meats, and excessive alcohol consumption. Some young people take mineral pills and powders; accumulated heat settles in the chest, causing lower Jiao deficiency-heat. Blood and Qi cannot restrain the minerals, leading to severe Dry-Heat in the Stomach, causing thirst and excessive drinking.
If drinking water leads to excessive urination, it is named Xiao Ke. If eating large amounts without intense hunger, accompanied by frequent urination and gradual emaciation, it is named Xiao Zhong. If thirst persists despite continuous drinking, with emaciated legs and fatty substances in urine, it is named Shen Xiao (Kidney Waste). These three types of Xiao share the same Dry-Heat nature, differing only in degree. I hear that many prescriptions in the world treat all three types of Xiao Ke with a single formula, because they consume water and grain and cause thirst. However, modern discussions on Xiao Ke often ignore the root cause. They claim Xiao Ke involves Upper Excess-Heat and Lower Deficiency-Cold. Upper Heat causes irritability, thirst, and excessive drinking; Lower Cold causes excessive urination. The root is said to be deficiency of Lower Kidney-Water, failing to control Upper Heart-Fire, resulting in Upper Excess-Heat and Lower Deficiency-Cold. Others state: Water number is one, the root of all things and precursor of Five Phases; thus Kidney-Water is the human root and life's origin, and must not weaken. If the root is not firm, branches will not flourish; if Yuan Qi is not solid, the body will not prosper. In Xiao Ke patients, Lower Kidney-Water is extremely cold. Taking cold medicines further weakens Yuan Qi and depletes Lower Kidney-Water, causing Upper Heart-Fire to flare uncontrollably, making it difficult to treat. Using warm medicines to tonify Yuan Qi, if Lower Kidney-Water becomes solid and overcomes Upper Heart-Fire, thirst will stop, urination will normalize, and the disease will heal. Such statements contradict Zhang Zhongjing, offering clever words that seem plausible but violate logic. This error is not new but has existed for a long time. For instance, Jiang’s *Yao Zheng Bing Yuan* (now lost) discusses Xiao Ke, Xiao Zhong, and Kidney Disease, stating: "San Jiao and Five Zang are all deficiency-heat, only the Bladder is cold as ice"; also: "Lower back and Kidney deficiency-cold increases daily"; also: "Bladder and Kidney are cold as springs." Initially stating San Jiao and Five Zang are deficiency-heat while only the Bladder is cold, then claiming the Kidney is also cold, and describing Kidney coldness as deficiency, while calling other heats deficiency—how can Yin-Yang rise and fall work this way? Their statements are self-contradictory; the error is minor compared to the discrepancy in Cold and Heat, where treatments are largely opposite, a grave mistake. (Mr. Li's refutation is highly logical. However, deficiency-heat and deficiency-cold are often co-existent in patients, not just in Xiao Ke. The *Neijing* also says: "Where Qi combines, Blood is deficient; where Blood combines, Qi is deficient." Is there no Repletion? The answer is: Presence is Repletion, absence is Deficiency. Thus, Qi combining means absence of Blood, Blood combining means absence of Qi; Qi and Blood separating results in Deficiency. Therefore, having both Cold and Heat deficiencies in one body is not entirely illogical. However, medication must draw from Yin to guide Yang, and from Yang to guide Yin, requiring balance. One cannot say Fire deficiency implies Water repletion, or Yin excess implies Yang decline. Later figures like Xue Lizhai argued that Yang excess need not suppress Yang, but rather nourish Yin to match it; Yin excess need not dissipate Yin, but rather assist Yang to match it. This is a biased view, possibly stemming from Mr. Li's theory.) Others argue: Kidney and Bladder belong to Water; deficiency cannot control Fire. Since deficiency cannot control Fire, urination is excessive. This deviates even further. They believe Water Repletion controls Fire, while Water Deficiency cannot. Thus, Yang-Repletion and Yin-Deficiency cause Heat-Dryness of fluids, leading to scanty, dribbling urination; Yin-Repletion and Yang-Deficiency fail to control Water, leading to profuse, frequent urination. Who knows that excessive urination in Xiao Ke is not of this nature? Why? Because Dry-Heat is too severe, causing obstruction and stagnation in the pores of the San Jiao and intestines/stomach. Fluids cannot excrete and infiltrate outward to nourish the body. Outside the intestines and stomach, Dry-Heat is severe. Even with heavy internal drinking, fluids cannot infiltrate outward, so thirst persists. Excessive urination occurs because the ingested water cannot seep out of the intestines and stomach, leading to frequent urination. (This argument is exquisitely precise. Students should penetrate this to understand all diseases. Yet Xu Lingtai and Chen Xiuyuan often criticize Ye Tianshi's meridian-opening theories. Why? The entire *Yuan Bing Shi* only discusses meridian Qi transformation.)
Therefore, I wrote in *Yuan Bing Shi*: The sweat pores of the skin are called apertures for sweating. Also known as Qi Gates, portals for Qi release. Also known as Cili (interstices), tunnels and textures for Qi and fluid passage. Also known as Ghost Doors, gates of darkness. Also known as Xuanfu (Mysterious Factories), mansions of subtlety. Xuanfu exists everywhere: in human Zang-Fu, skin, hair, muscle, sinew, bone marrow, nails, teeth, and even in all things. They are the pathways for entry, exit, ascent, and descent. Thus, the classic states: "If entry and exit cease, Shen-Ji perishes; if ascent and descent stop, Qi-Standing stands alone." Without entry and exit, there is no growth, maturity, aging, and death; without ascent and descent, there is no growth, transformation, harvesting, and storage. Thus, entry and exit exist in every vessel. We know that the functions of eyes, ears, nose, tongue, body, mind, spirit, and consciousness depend on the smooth flow of ascent, descent, entry, and exit. Obstruction prevents function. Blindness, deafness, anosmia, ageusia, sinew flaccidity, bone bi, nail loss, tooth decay, hair loss, skin numbness, and intestinal inability to secrete—all result from Heat Qi constraint, Xuanfu obstruction, preventing Jin-Ye, Blood vessels, Ying-Wei, and Clear Qi from ascending, descending, entering, and exiting. Depending on the severity of the constraint, different diseases arise. Disease in the exterior constrains Cili, sealing Yang Qi, preventing dispersion, causing dryness without sweat, and blocking Qi and fluid exit. Modern physicians do not understand this, wrongly attributing frequent urination in Xiao Ke to Lower Cold, ignoring that intestinal and gastric Dry-Heat constraint causes it. I cite this example.
The world believes Xiao Ke syndrome involves Dry-Heat outside the intestines and stomach, blocking secretion pathways. Although water enters the intestines and stomach, it cannot secrete outward, causing frequent urination and thirst. These few sentences fully explain the principle. Examining all mentions of thirst in the *Neijing* clarifies this. Some attribute thirst to Heart-Lung Qi Jue; some to Liver Bi; some to Spleen Heat; some to Kidney Heat; some to Stomach and Large Intestine Heat binding; some to Intestinal Bi; some to Small Intestine Dan-Heat; some to Malaria; some to rich foods and mineral drugs; some to drunkenness, fullness, and sexual intercourse; some to long travel, fatigue, and great heat; some to Cold damage with dry Stomach; some to febrile disease; some to Wind disease. Although the locations of the five Zang differ and causes vary, they all return to Dry-Heat. (Above elucidates the disease root, the first half of this section. Below cites classics to verify and support the reasoning.)
Regarding Heart-Lung Qi Jue causing thirst, the *Jue Lun* states: "Heart transfers Heat to Lung, transmitting as Ge Xiao (Diaphragm Waste)." Commentary: "Heart Heat enters Lung, transforming over time, creating internal Diaphragm Heat, wasting-thirst with excessive drinking." Regarding Liver Bi causing thirst, the *Bi Lun* states: "Liver Bi involves waking startled at night, excessive drinking, frequent urination." Regarding Spleen Heat causing thirst, the *Wei Lun* states: "Spleen Heat causes dry Stomach and thirst, insensitivity of muscles, developing into Rou Wei (Flesh Flaccidity)." Regarding Kidney Heat causing thirst, the *Ci Re Lun* states: "Kidney Heat disease begins with lower back pain, thigh soreness, bitter thirst, frequent drinking, body heat." The *Re Lun* states: "Shaoyin vessel penetrates Kidney, connects to Lung, ties to tongue base, causing dry mouth and tongue and thirst." Modern physicians only say Kidney deficiency fails to control Heart Fire, causing Upper Excess-Heat and Lower Deficiency-Cold, using hot medicines to warm Kidney Water to overcome Heart Fire. This misunderstands Yin-Yang deficiency and repletion. Kidney Water belongs to Yin and is fundamentally Cold; deficiency leads to Heat. Heart Fire belongs to Yang and is fundamentally Hot; deficiency leads to Cold. If Kidney Water is Yin-deficient, Heart Fire is Yang-replete, meaning Yang-Repletion and Yin-Deficiency, resulting in upper and lower Heat. Clearly, the *Qi Jue Lun* states: "Kidney Qi declines, Yang Qi stands alone." The *Xuan Ming Wu Qi Lun* states: "Kidney detests Dryness; due to Dryness, Kidney withers and Water dries up." The *Zang Qi Fa Shi Lun* states: "Kidney suffers from Dryness; urgently eat Pungent to moisten it." Cold substances belong to Yin, nourishing Water and draining Fire. Hot substances belong to Yang, nourishing Fire and consuming Water. Now, since Kidney Water cannot overcome Heart Fire, resulting in upper and lower Heat, why use hot medicines to nourish Kidney Water to overcome Heart Fire? Is this not absurd? Regarding Stomach and Large Intestine Heat binding causing thirst, the *Yin Yang Bie Lun* states: "One Yang binds, called Xiao." Commentary: "Two Yang bind, Stomach and Large Intestine both have Heat binding. Intestinal and gastric congestion-Heat consumes water and grain well." Also, *Qi Jue Lun* states: "Large Intestine transfers Heat to Stomach, good appetite but emaciation." *Mai Yao Jing Wei Lun* states: "Dan develops into Zhong Xiao (Middle Waste), good appetite but emaciation." Regarding Intestinal Bi causing thirst, *Bi Lun* states: "Drinks frequently but output is blocked, middle breath struggles" (interpreted here as not staying inside but exiting immediately, likely not the original intent), occasional loose stools. If frequent drinking does not stay inside, stool does not linger. Thus, Xiao Ke frequent drinking and urination is merely San Jiao Dry-Heat constraint and Qi decline, clearly. How can one use drying-hot toxic drugs to aid strong Yang and attack weak Yin? This is the crime of truly reinforcing Repletion and falsely depleting Deficiency. Xiao Ke often changes into deafness, blindness, sores, tinea, acne, etc., all due to intestinal and gastric Dry-Heat constraint, preventing fluids from moistening the body. Or severe Heat causes Bladder constraint, preventing secretion, fluids move recklessly, causing facial swelling. Regarding Small Intestine Bi-Heat causing thirst, *Ju Tong Lun* states: "Heat Qi stays in Small Intestine, intestinal pain, Dan-Heat scorches thirst, stool becomes hard and cannot exit." Commentary: "Heat seeps fluids, stool becomes hard." Regarding thirst from Malaria, *Nue Lun* states: "Yang Repletion causes external Heat, Yin Deficiency causes internal Heat. Internal and external Heat cause panting and thirst, desiring cold drinks." However, Yang-Repletion and Yin-Deficiency causing Heat disease requires cold medicines to nourish Yin and drain Heat, the way of draining Repletion and tonifying Deficiency. Regarding thirst from rich foods and mineral drugs, *Qi Bing Lun* asks: "Someone has sweet taste in mouth, what is the disease name?" Qibo replies: "This is overflow of Five Qi, disease named Pi Dan (Spleen Dan)." Dan means Heat. Spleen Heat means four Zang do not receive, so Five Qi overflow upward. (Spleen belongs to Earth, Earth number is five, hence Five Qi, not referring to Five Zang Qi.) Primarily due to Spleen Heat, hence Pi Dan. Also, the classic states: "Five flavors enter mouth, store in Stomach, Spleen transports their essence. Fluids in Spleen cause sweet taste in mouth." This originates from rich foods. Such people must frequently eat sweet and fatty foods. Fatty foods cause internal Heat; sweet foods cause central fullness. Thus Qi overflows upward, turning into Xiao Ke. *Tong Ping Xu Shi Lun* states: "Xiao Dan, Pu Ji, Pian Ku, Wei Jue, Qi Man Fa Ni are diseases of rich and noble people, disorders of Gao Liang (rich food)." Some say: "Humans rely solely on Stomach Qi as root. Spleen and Stomach form Interior-Exterior. Spleen and Stomach, the Central Pivot, should receive warm tonification to regulate diet. Now Xiao Ke patients have extremely deficient Spleen and Stomach, further suitable for warm tonification. If taking cold medicines, they damage Spleen and Stomach, fundamental Qi becomes deficient, making it hard to treat." This statement ignores Yin-Yang, Cold-Heat, Deficiency-Repletion, and Tonification-Drainage principles, speaking recklessly. Does it not know the *Fu Zhong Lun* states: The Emperor asked, Master often says Re-Zhong and Xiao-Zhong cannot take Fang Cao (aromatic herbs) or Shi Yao (mineral drugs). Mineral drugs cause Dian (mania/euphoria); aromatic herbs cause Kuang (rage/insanity). Commentary: "Excessive drinking and frequent urination is called Re-Zhong. Excessive eating and frequent urination is called Xiao-Zhong. Excessive joy is Dian. Excessive anger is Kuang. Fang means delicious. Shi refers to Ying and Ru, heating drugs." The classic further states: "Re-Zhong and Xiao-Zhong are diseases of the wealthy and noble. Now prohibiting rich foods..."