虽有卢扁，难为力矣。张三锡曰∶劳伤五脏皆能成瘵，独肺劳莫治。盖肺中药饵难及，
滋阴清肺，在肺难见其功，于脾易增其病耳。
人身之阴，难成而易亏，所谓受于天，与谷气并而充身者也。然益阴之药，必无旦
夕之效。夫精气久己衰微，欲使水中之火，
温养胃气而滋化源，惟有缓以图之，不宜于助阳，亦不宜于抑阳。盖助阳必至亡阴，抑
阳必用纯阴，纯阴之剂，与胃气不相宜，更得秋冬肃杀之气矣。助阳之药能扶胃气于片
刻，饮食亦因而加倍，有似神强气旺，未有不骤喜者，久之阳愈盛而阴愈烁，故助阳抑
阳，岂可施于阴虚之人乎？先贤治劳，不敢过用参 ，正恐阳旺而阴消耳。
《精血篇》曰∶男子精未满而御女以通其精，则五脏有不满之处，异日必有难状之
病，诚至言也。有形之阳，与无形之阳，何也？无形之阳即命门之相火也。昼则动而施
用于心，夜则静而归藏于肾，生气之原，无形之虚，故曰无形也。有形之阳，即君主之
心火也，心火乃我后天日用之火，而生于命门，故心胞络系于命门，而相火附焉，经言
七节之旁，中有小心，正谓此也。然心火。若不生于命门，则《内经》不言益火之源，
以消阴翳。夫源字之义，有母字之理存焉，是以君火，乃有形之实，可以水灭湿折，相
火乃无形之虚，不可以水灭湿折，惟当从其性而伏之。由此观之，则无形之阳与有形之
阳，判然明白矣。
《经》曰∶二阳之病发心脾，有不得隐曲，女子不月。其传为风消，为息贲者，死
不治。谓二阳之病发于心脾，心脾之所以病者，在于不得隐曲，盖心主血，脾统血，妇
人百病皆自心生。若忧思抑郁，扼腕不可告人，以致心气结而心火燔，由是心血亏耗，
而出纳之用已竭，且母能令子虚，脾不健运而食少矣，食少则胃气益虚，肺失所养，气
乃滞而不行，水精不能四布，无以滋长肾阴。肾主二便，肾虚则大肠无所禀，而传道
失常。《经》云∶饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，大肠主津小
肠主液，肾少母阴，则心火转炽，而小肠之腑伤，脾不散精，则肺金少养，而大肠之腑
涸，所谓二阳之病发心脾也。盖水谷之气入胃，清者为荣，浊者为卫，人身荣血充溢，
以奉生身者，全赖谷气之盛，化其精微，荣于脏腑，令胃既少纳受，大肠少传送，则胃
与大肠之津液俱干，将何荣血而充经脉乎？此脉闭而经血涸，月事不以时下也。夫万物
遇风而萎瘪，风消者，肌肉尽削，如风消之也。息贲者，肺阴枯竭，胸中膻中之气，呼
吸壅塞，息贲而喘急也。病传至此，已属大危。若犹未也。庶可施治于未然，后贤有
云∶童男室女，积想在心，多致劳损。在男子则神色先散，女子则月水先闭，此之谓
欤。
阴阳交而天地泰，精气合而人身安，人身一小天地也。人中以上，眼与耳鼻窍俱
偶，即易之坤，人中以下，口暨二便窍俱奇，即易之干。阴在上，阳在下，所以保泰
也。阴主受而阳主施，所施过于所受，则病生焉，故贵节欲以保其天真，精气二字从
米，是精气皆生于米也。故曰∶得谷者昌，失谷者亡。人之所恃以生者，精气也，卫气
也，荣气也。精气也，从肾之所生；卫气者从肺之所生；荣气者，从肝心之所生。三者
之气，虽各有所自，然合而一之则均以脾胃为本，《经》曰∶脾者，孤脏以灌四旁；又
曰∶五脏皆禀气于胃，故古人有补肾不如补脾之论也。
八味丸者，张仲景所制之方也。君子观象于坎，而知肾中具水火之道焉。夫一阳居
于二阴为坎，此人生与天地相似也。今人入房盛而阳事易举者，阴虚火动也。阳事先萎
者，命门火衰也。真水竭则隆冬不寒，真火息则盛夏不热，是方也。熟地、山萸、丹
皮、泽泻、山药、茯苓，皆濡润之品，所以壮水之主，肉桂、附子，辛润之物，能干水
中补火，所以益火之原，水火得其养，则肾气复其天矣。益火之原，以消阴翳，即此方
也。益脾胃面培万物之母，其利搏矣。《精要》云∶久服必肥健而多子，见壮补精血之
验也。仲景曰∶气虚有火，用肾气丸补而逐之；又曰∶八味丸者，水泛为痰之圣药。丹
溪云∶久病阴火上升，津液生痰不生血，宜补血药以制相火其痰自除。易老云∶八味
九治脉耗而虚，西北二方之剂也。金弱水胜火少火亏，或脉鼓按之有力，服之亦效。
（张）按∶人身所生疾病，未有不因阴阳失调，水火偏胜，况痨怯本由脏腑气血内
起之病治之者，尤宜于阴阳水火，条分缕析，调之适之，以平为已，则病不攻而自
退。八味丸一方，诚如用兵之八阵，立法周匝不能出其范围也，盖无阳则阴无以生，所
以有桂附，无阴则阳无以生，所以有熟地、山茱，先天之真阴真阳，既已并补，更入茯
苓、山药，以助脾胃，使化源有自，而后天之生发无穷，牡丹皮以去阴分之伏热，泽泻
以泻龙雷之邪火宿水，更同茯苓淡渗，搬运诸药下趋。盖一泻一补，则补势得力、倘有
君无使则独力难行，其中变化神而明之，难以言尽。如左尺洪数，而阴甚不足者，熟地
可加；右尺微细而阳甚中不足者，桂附可加；左关无力，肝气不足者，山茱可加；右
关无力，脾胃不足者，茯苓、山药可加；胃火骨蒸倍甚者，丹皮可加；阳余阴亏之甚
者，桂附可减；胃弱中气虚寒之甚者，丹皮可去；燥涸有阳无阴者，泽泻可去；孤阳浮
越，肾气不能敛纳者，更加五味子，以助山茱之酸收；阳虚精血亏甚者，更加鹿茸、河
车，精血有情之品，以助峻补草木之功；肾虚不能纳气，气留上焦，上实下虚者，更入
牛膝以助下行；脾肾虚寒，不能蒸腐闭藏而为晨泻者，更入补骨脂菟丝子，以兼补脾肾
之阳，为先天后天之药，是皆佐使之所宜∶可以共剂而赞助成功者也。至白术、当归、
人参、黄 、仙茅、首乌之类，俱有大力，但性禀不同，所类非一，何能逐队争功？且
补气补血，与补真阴真阳，尚有异也。倘混施加入，各持己力，紊乱经络，彼此牵制，
非徒无益也。至如枸杞、覆盆、莲肉之类，力量太缓，多加一味，多缓一分，难图速效
矣。
八味丸有以淡盐汤送之者，取盐能润下而软坚，有虚火者，引而下之也。米汤送之
者，取脾果恬淡之真味，生精最速，因补肾以及脾也。白汤送之者，不疾不徐，不热不
燥也。温酒送之者，取行药力更快，冬天可以御外寒也。有煎补中益气汤送之者，必因
元气下陷之症，既欲固其根本，复虑走下太速，下实上虚，更提中气以升之，使三焦元
气常在也。煎理中汤以送下者，必脾肾沉寒，先理中宫，可能达下也。煎生脉散以送
之者，取金能生水，使子母相生，肺之气注于肾而为卫也。如此煎汤送丸，皆因病急不
能久延，标本须得并顾，故借药煎之锐气，以开前导之先功，运送水火之神丹，镇纳丹
田，以保元阳之永固，煎剂之功少过，丸饵之性复萌，从根本以及三焦，阳和常在，意
深远矣。况人生百病虽多，而最重莫大于风痨臌膈四症，是药久服，真火固注丹田，虚
风何由骤起，中风之症，可无虑矣。甘温能除大热，滋补精血易生，骨蒸伏热，无地可
容，痨症之成，自难牢固，真火既充于下，元气自长于中，健运如常，中满何有？臌症
之患更无虑也。釜下有火锅饭自熟，游溢精气，水精四布，燥涩膈噎，何患成之？大症
既可消弭，小病断难沉困，诚卫生之至室，立命之神丹。（张）特创此服法，以补古人
之未尽。
钱氏减桂附，名曰六味地黄丸，以治小儿，谓小儿纯阳故也。凡肾虚不能制火者，
此方主之，肾中非独水也，命门之火并焉。肾不虚则水足以制火，虚则无所制而热症生
矣。名曰阴虚火动，河间所谓肾虚则热是也。今人足心热，阴股热，腰脊痛，率是引
症，乃咳血之渐也。熟地、山茱味浓者也。《经》曰∶味浓为阴中之阴，故能补少阴滋
肾水。泽泻味咸，咸先入肾，地黄、山药、泽泻皆润物也。肾恶燥，须此润之，此方所
补之水，无形之水，物之润者亦无形，故用之，丹皮者，牡丹之根皮也。丹乃南方之
火，以牡而非牝属阳，味苦辛，故入肾而敛阴火，益少阴平虚热。茯苓味甘而淡，甘从
土化，土能防水淡能渗泄，故用之以制水脏之邪。熟地温而丹皮凉，山药涩而茯苓渗，
山茱收而泽泻泻，补胃而兼补脾，有补而复有所泻，相和相济，以成平补之功，乃平淡
之神奇，所以谓古今不易之良方，益脾胃而万物之母，壮水之主，以镇阳光，即此药
也。六味加五味子名曰都气丸，述类象形之意也。
滋阴降火者，乃谓滋其阴则火自降，当串讲不必降火也。盖二尺各有降阳水火，互
相生化，当于二脏中各分阴阳虚实，求其所属而平之。若本人脉虚弱而细数者，是左肾
之真阴不足也。用六味丸，右尺脉迟软，或沉细而数欲绝者，是命门之相火不足也。用
八味丸，至于两尺微弱，是阴阳俱虚，用十补丸，此皆滋其先天之肾源，实万世无穷之
利自世之补阴者，率用黄柏、知母，反戕脾胃多致不起，不能无遗害于世。
病热作渴，饮冷便秘，此属实热。恶寒发热，引衣蜷卧，此属逆冷。大便清利，此
属真寒。人皆知之，至于烦扰狂越，不欲近衣，欲坐卧泥水中，此属假热之症，甚者烦
极发躁，渴饮不绝，舌如芒刺，两 燥裂，面如涂朱，身如焚火，足心如烙，吐痰如涌
喘急咳嗽，大便秘结，小便淋沥，六脉洪大无伦，却似承气白虎汤症。然承气白虎，入
口即毙，此肾阴虚极，阳无所附，浮散于外，非实火也，当急以加减八味丸料一斤，
纳肉桂一两，水顿煎，五六碗，冰冷与饮，诸症自退，翊日必畏寒脉脱，真候自现矣。
当峻补其阳，急以附子八味丸料煎服自愈，此症与脉俱变其常，不可以常法治之者也。
若有产后及大失血后，阴血暴伤，必大发热，亦名阴虚发热，引阴字正谓气血之阴。
若以凉药正治立毙。正所谓象白虎汤症，误服白虎汤必死。然虽阴气大虚，亦不用四
物，盖有形之血不能速生，几希之气所当急固，须用独参汤类，使无形生出有形来，此
阳生阴长之妙用也。然气虚血虚均是内伤何以辨之？盖阴虚者，面必赤，无形之火戴于
上也。若是阳症，火入于内，面必不赤，其口渴甚，肾水干枯，引水自救也。口虽渴而
舌必滑，脉虽数而尺必无力，甚者，尺虽洪数而按之必不鼓，此为辨耳。虽然，若其人
曾服过凉药，脉必反有力而鼓指矣，是逼阳于外，假有力也。戴复庵云∶服凉药而脉反
加数者，火郁也。直升宜补切忌寒凉。犯之必死，毫厘之差，枉人性命，慎哉！
有肾虚火不归经，大热烦渴，目赤唇裂，舌上生刺，喉如烟火，足心如烙，脉洪
大无伦，按之微弱者，宜十全大补汤，吞八味丸，或问燥热如此复投桂附，不以火济火
乎？曰∶心胞相火，附于命门，男以藏精，女以系胞，因嗜欲竭之火无所附，故厥而上
炎，且火从肾出，是水中之火也。火可以水折，水中之火不可以水折，桂附之火同气而
味辛，开腠里，致津液，通气道，踞其窟宅，而招之同气相求，火必下降矣。是则桂
附者，固治火之正药欤。
坎，干水也，气也。即小而井，大而海也。兑，坤水也，形也。即微而露，大而雨
也。一阳陷于二阴为坎，坎为水气，潜行地中，为万物受命根本，故曰润万物者，莫润
乎水，一阴上彻于二阳为兑，兑以有形之水，普施于万物之上，为资生之利泽，故
曰∶说万物者，莫说乎泽，明此一水可以悟治火之道矣。心火者，有形之火也。相火
者，无形之火也。无形之火，内燥热而津液枯，以五行有形之兑水制之者，权也。吾身
自有上池真水气也。无形者也。以无形之水沃无形之火常而可久者也。是为真水真火升
降既宜，而我既济矣。医家不悟先天太极之真体，不穷无形火水之妙用，而不能用六味
八味之神剂者，其于医理，尚欠大半，此赵氏之论，深得水火之原，而得水火不易之治
法矣。
（张）按∶百病之来，莫不因火，而火之发，莫不阴虚，而虚之本，莫不由肾，盖
水为万物之原，火为万物之父，其原其父并根于肾也。凡肾元充足者，则万象俱安，而
疾病无矣。故有心病而兼肾者，脾病而兼肾者，肝病而兼肾者，肺病而兼肾者，四脏有
病，不脱乎肾，且人之赖以有生者，全仗阴阳水火为用，而肾乃阴阳水火之总根。设阴
阳失调水火偏胜，百病生焉。而治法之救阴者，无非壮水，补阳者，无非益火。然肾为
水脏，更为火脏，故救阴补阳者，不求水之主，火之原，舍水火之脏而弃六味八味，则
不得其门从何而入？犹植树者，而欲舍其根，焉可望其生发耶！惟脾胃骤虚且寒，则
温补自从中治，而有补中理中之设，久则亦责之于肾，更有八味加补骨脂、五味子之设
也。其余不论内外，眼目口齿，胎产男妇百病，且属阴虚阳虚及假阴假阳之症，莫不尊
此为圣药。
虽然拥有卢医和扁鹊那样的神医，也难以施展手脚了。张三锡说：劳损伤及五脏都能导致痨瘵（慢性消耗性疾病），唯独肺劳无法治愈。因为药物难以到达肺部，滋阴清肺的方法在肺部很难见效，反而容易损伤脾胃加重病情。
人体的阴精，难以形成却容易亏损，这是禀受于先天，并与后天水谷之气结合以滋养全身的物质。然而，补益阴精的药物，不可能在短时间内见效。既然精气已经长期衰微，想要通过温养胃气来滋生化之源，只能慢慢调理，不宜使用助阳药，也不宜过度抑制阳气。因为助阳会导致阴液耗竭，抑制阳气则必须使用纯阴之剂，而纯阴药剂与胃气不相适宜，再加上秋冬肃杀之气的克制，更加不利。助阳的药物能暂时扶持胃气，饮食因此加倍，看起来精神强盛、气血旺盛，没有不欣喜的，但久而久之阳气越盛，阴液就越被灼烧，所以助阳或抑阳的方法，怎么可以施用于阴虚之人呢？先贤治疗劳损，不敢过量使用人参，正是担心阳气过旺而导致阴液消亡。
《精血篇》说：男子精气未充盈时就纵欲泄精，那么五脏就会有亏虚之处，日后必定会有难以形容的疾病，这确实是至理名言。什么是“有形之阳”和“无形之阳”呢？无形之阳就是命门中的相火。白天它活动并施用于心，夜晚它静止并归藏于肾，它是生气的根源，因其无形无质，所以称为“无形”。有形之阳，就是君主的心火。心火是我们后天日常使用的火，但它生于命门，所以心包络系属于命门，相火依附于心包络，《内经》所说的“七节之旁，中有小心”，正是指这个意思。然而，如果心火不生于命门，《内经》就不会说“益火之源，以消阴翳”。“源”字的含义中，蕴含着“母”的道理。因此，君火是有形的实体，可以被水熄灭或被湿折服；相火是无形的虚体，不能被水直接熄灭或湿折服，只应当顺应它的本性而潜伏它。由此看来，无形之阳与有形之阳，区别是非常清楚明白的。
《内经》说：阳明经的病发于心脾，表现为有难言之隐（指情志抑郁或性功能问题），女子月经闭止。如果传变为风消（肌肉消瘦如被风吹枯）或息贲（呼吸急促胸满），则是死证，不可治愈。这里说二阳（阳明胃与大肠）的病发于心脾，心脾之所以生病，在于有情志郁结不得宣泄。心主血，脾统血，妇女的各种疾病多由心生。如果忧思抑郁，憋在心里无法诉说，导致心气郁结而心火亢盛，进而心血亏耗，心的出纳功能衰竭，且由于母病及子（心为脾之母，此处逻辑似有误，通常脾为心之母或心火不生脾土，原文意指心火亢盛耗伤脾气或心脾两虚），脾气不健运而食欲不振。食欲少则胃气更虚，肺失去滋养，气机停滞不行，水谷精微不能布散全身，无法滋长肾阴。肾主管大小便，肾虚则大肠无所禀受，传导功能失常。《内经》说：饮食进入胃，游溢精气，上输于脾，脾气散精，上归于肺，大肠主津，小肠主液。肾阴不足，则心火转炽，损伤小肠腑；脾不散精，则肺金缺乏滋养，导致大肠腑干燥。这就是所谓的“二阳之病发心脾”。大概水谷之气进入胃，清轻的部分化为营气，重浊的部分化为卫气。人身营血充溢以供养身体，全赖谷气旺盛，化生精微，荣养脏腑。既然胃纳减少，大肠传送也少，那么胃与大肠的津液都干枯，还有什么营血来充盈经脉呢？这就是脉道闭塞而经血枯竭，月经不能按时来潮的原因。万物遇到风就会萎瘪，所谓“风消”，就是肌肉完全消瘦，像被风吹干一样。“息贲”，是指肺阴枯竭，胸中膻中之气，呼吸壅塞，气息奔逆而喘急。病情传到这种地步，已经非常危险。如果还没有到这一步，还可以在未发病前进行干预。后辈贤人说：童男处女，积想在心中，多导致劳损。在男子则神色先散乱，在女子则月经先闭止，说的就是这种情况。
阴阳交泰则天地安泰，精气合和则人身平安，人身就像一个小天地。人中以上，眼耳鼻窍都是偶数（双数），对应易经中的坤卦；人中以下，口及二便窍都是奇数（单数），对应易经中的乾卦。阴在上，阳在下，所以能保持安泰。阴主受纳，阳主施予，如果施予超过受纳，就会产生疾病，所以贵在节制欲望以保全天真元气。“精气”二字从“米”字旁，说明精气都来源于米谷。所以说：得到谷气滋养的就昌盛，失去谷气滋养的就灭亡。人赖以生存的是精气、卫气、营气。精气，是从肾产生的；卫气，是从肺产生的；营气，是从肝心产生的。这三种气，虽然各自来源不同，但合而为一则以脾胃为本。《内经》说：脾是孤脏，灌溉四旁；又说：五脏都禀受胃气。所以古人有“补肾不如补脾”的说法。
八味丸，是张仲景所创制的方剂。君子观察坎卦（☵），就知道肾中包含水火之道。一个阳爻居于两个阴爻之间构成坎卦，这与人生和天地相似。现在的人房事过度而阳事易举的，是阴虚火动。阳事先痿软的，是命门火衰。真水枯竭则隆冬不寒，真火熄灭则盛夏不热。这个方剂中，熟地黄、山茱萸、牡丹皮、泽泻、山药、茯苓，都是滋润濡润的物品，用来壮水之主（滋补肾阴）；肉桂、附子，是辛润之物，能在水中补火，用来益火之原（温补肾阳）。水火得到滋养，肾气就恢复了天然状态。“益火之原，以消阴翳”，就是这个方剂的作用。益脾胃以培补万物的母亲，利益广大。《精要》说：久服必然身体肥健且多子，这是看到它补精血的验证。张仲景说：气虚有火，用肾气丸补而逐之；又说：八味丸是水泛为痰的圣药。朱丹溪说：久病阴火上升，津液生痰不生血，宜用补血药来制约相火，其痰自然消除。李东垣（易老）说：八味丸治疗脉象细弱而虚，是西北两地的方剂。金弱水胜火少火亏，或者脉象鼓按有力，服用也有效。
（张氏）按语：人身所生的疾病，没有不是因为阴阳失调、水火偏胜的，何况痨怯本来是由脏腑气血内部引起的疾病，治疗者，尤其应该对阴阳水火条分缕析，调理得当，以平衡为结束，那么病不攻自退。八味丸一方，确实像用兵的八阵图，立法周全，不能超出其范围。盖无阳则阴无以生，所以有肉桂、附子；无阴则阳无以生，所以有熟地黄、山茱萸。先天之真阴真阳，已经同时补益，再加入茯苓、山药，以辅助脾胃，使化源有出处，而后天的生发无穷无尽。牡丹皮去除阴分的伏热，泽泻泻去龙雷之邪火宿水，再同茯苓淡渗利湿，搬运诸药下行。盖一泻一补，则补的力量得力；如果有君药无使药则独力难行，其中的变化神妙莫测，难以言尽。比如左尺脉洪数，而阴甚不足的，可加熟地黄；右尺脉微细而阳甚不足的，可加肉桂、附子；左关无力，肝气不足的，可加山茱萸；右关无力，脾胃不足的，可加茯苓、山药；胃火骨蒸严重的，可加牡丹皮；阳有余阴亏严重的，可减少肉桂、附子；胃弱中气虚寒严重的，可去掉牡丹皮；燥涸有阳无阴的，可去掉泽泻；孤阳浮越，肾气不能敛纳的，再加五味子，以助山茱萸的酸收作用；阳虚精血亏虚严重的，再加鹿茸、紫河车，这些是有情之品，以助草木峻补之功；肾虚不能纳气，气留上焦，上实下虚的，再加入牛膝以助下行；脾肾虚寒，不能蒸腐闭藏而为晨泻的，再加入补骨脂、菟丝子，以兼补脾肾之阳，作为先天后天的药物，这些都是佐使之药，可以共同制剂而赞助成功。至于白术、当归、人参、黄芪、仙茅、首乌之类，都有大力，但性禀不同，类别不一，怎么能排队争功呢？而且补气补血，与补真阴真阳，还有区别啊。如果混在一起加入，各持己力，紊乱经络，彼此牵制，不仅无益。至于枸杞、覆盆子、莲肉之类，力量太缓，多加一味，就慢一分，难以求得速效。
八味丸有用淡盐汤送服的，取盐能润下而软坚，对于有虚火的，引火下行。用米汤送服的，取脾果恬淡的真味，生精最快，因补肾以及健脾。用白开水送服的，不疾不徐，不热不燥。用温酒送服的，取行药力更快，冬天可以抵御外寒。有用煎好的补中益气汤送服的，一定是因为元气下陷的症状，既想固其根本，又担心药力走下太快，出现下实上虚，更提升中气以升提之，使三焦元气常在。用煎好的理中汤送服的，一定是脾肾沉寒，先调理中宫，才能达于下焦。用煎好的生脉散送服的，取金能生水，使子母相生，肺之气注入肾中而化为卫气。如此煎汤送丸，都是因为病急不能久延，标本必须兼顾，所以借药煎剂的锐气，以开先导之功，运送水火的神丹，镇纳丹田，以保元阳的永固。煎剂的功效稍减，丸饵的药性复萌，从根本以及三焦，阳和之气常在，用意深远啊。况且人生百病虽多，而最重的莫过于风、痨、臌、膈四症。此药久服，真火固注丹田，虚风从哪里骤然兴起呢？中风之症，可以无忧虑了。甘温能除大热，滋补精血容易生成，骨蒸伏热，无处容身，痨症的成因，自然难以牢固。真火既充于下，元气自然长于中，健运如常，中满哪里有呢？臌胀之患更不用担心了。釜下有火锅饭自然熟，游溢精气，水精四布，燥涩膈噎，何必担心形成？大病既可消除，小病断难沉困，这确实是卫生的最高境界，立命的神丹。（张氏）特创此服法，以弥补古人的未尽之处。
钱乙减去肉桂、附子，命名为六味地黄丸，用于治疗小儿，说是因为小儿纯阳的缘故。凡是肾虚不能制火的，此方主治。肾中不只是有水，命门之火也在其中。肾不虚则水足以制火，虚则无所制而热症产生。名为阴虚火动，即刘河间所说的肾虚则热。现在人足心热，大腿内侧热，腰脊痛，都是这类症状，乃是咳血的征兆。熟地黄、山茱萸味道浓厚。《内经》说：味浓为阴中之阴，所以能补少阴滋肾水。泽泻味咸，咸先入肾，地黄、山药、泽泻都是润物。肾恶燥，须用此润之。此方所补之水，是无形之水，物的润者也是无形，所以使用它们。牡丹皮，是牡丹的根皮。丹乃南方之火，以牡而非牝属阳，味苦辛，所以入肾而敛阴火，益少阴平虚热。茯苓味甘而淡，甘从土化，土能防水，淡能渗泄，所以用它来制水脏之邪。熟地温而丹皮凉，山药涩而茯苓渗，山茱萸收而泽泻泻，补胃而兼补脾，有补又有泻，相互调和济助，以成平补之功，乃平淡中的神奇，所以被称为古今不易的良方，益脾胃以培补万物的母亲，壮水之主，以镇阳光，就是这个药。六味加五味子名为都气丸，取述类象形之意。
滋阴降火，是说滋其阴则火自降，应当串讲不必特意降火。盖两尺脉各有降阳水火，互相生化，应当在两脏中各分阴阳虚实，求其所属而平衡它。如果本人脉虚弱而细数，是左肾之真阴不足。用六味丸；右尺脉迟软，或沉细而数欲绝，是命门之相火不足。用八味丸。至于两尺微弱，是阴阳俱虚，用十补丸。这都是滋其先天之肾源，实为万世无穷的利益。自从世上的补阴者，大都用黄柏、知母，反而戕害脾胃，多导致不治，不能没有遗害于世。
病热作渴，饮冷便秘，这属实热。恶寒发热，拉衣蜷卧，这属逆冷。大便清稀通畅，这属真寒。人皆知道，至于烦扰狂越，不欲近衣，想坐卧泥水中，这属假热之症。严重者烦极发躁，渴饮不绝，舌如芒刺，两颧燥裂，面如涂朱，身如焚火，足心如烙，吐痰如涌，喘急咳嗽，大便秘结，小便淋沥，六脉洪大无伦，却看似承气汤或白虎汤症。然而承气汤、白虎汤，入口即毙。这是肾阴虚极，阳无所附，浮散于外，非实火也。当紧急用加减八味丸料一斤，纳入肉桂一两，水顿煎，五六碗，冰冷与饮，诸症自退。次日必畏寒脉脱，真候自然显现。当峻补其阳，紧急用附子八味丸料煎服自愈。此症与脉都变其常，不可以常法治之。
若有产后及大失血后，阴血暴伤，必大发热，也称阴虚发热，引“阴”字正谓气血之阴。若以凉药正治，立即致死。正所谓象白虎汤症，误服白虎汤必死。然而虽阴气大虚，也不用四物汤，盖有形之血不能速生，几希之气所当急固，须用独参汤之类，使无形生出有形来，这是阳生阴长的妙用。然而气虚血虚均是内伤，何以辨别？盖阴虚者，面必赤，无形之火戴于上也。若是阳症，火入于内，面必不赤。其口渴甚，肾水干枯，引水自救也。口虽渴而舌必滑，脉虽数而尺必无力，甚者，尺虽洪数而按之必不鼓，此为辨别耳。虽然，若其人曾服过凉药，脉必反有力而鼓指矣，是逼阳于外，假有力也。戴复庵说：服凉药而脉反加数者，火郁也。直升宜补切忌寒凉。犯之必死，毫厘之差，枉人性命，慎哉！
有肾虚火不归经，大热烦渴，目赤唇裂，舌上生刺，喉如烟火，足心如烙，脉洪大无伦，按之微弱者，宜十全大补汤，吞八味丸。有人问：燥热如此，又投桂附，不以火济火乎？回答说：心胞相火，附于命门，男以藏精，女以系胞，因嗜欲竭，火无所附，故厥而上炎。且火从肾出，是水中之火也。火可以水折，水中之火不可以水折。桂附之火同气而味辛，开腠理，致津液，通气道，踞其窟宅，而招之同气相求，火必下降矣。是则桂附者，固治火之正药欤。
坎，是干水也，气也。即小而井，大而海也。兑，是坤水也，形也。即微而露，大而雨也。一阳陷于二阴为坎，坎为水气，潜行地中，为万物受命根本，所以说：润万物者，莫润乎水。一阴上彻于二阳为兑，兑以有形之水，普施于万物之上，为资生之利泽，所以说：说万物者，莫说乎泽。明此一水，可以悟治火之道矣。心火者，有形之火也。相火者，无形之火也。无形之火，内燥热而津液枯，以五行有形之兑水制之者，权也。吾身自有上池真水气也。无形者也。以无形之水沃无形之火，常而可久者也。是为真水真火，升降既宜，而我既济矣。医家不悟先天太极之真体，不穷无形火水之妙用，而不能用六味八味之神剂者，其于医理，尚欠大半。此赵氏之论，深得水火之原，而得水火不易之治法矣。
（张氏）按语：百病之来，莫不因火，而火之发，莫不阴虚，而虚之本，莫不由肾。盖水为万物之原，火为万物之父，其原其父并根于肾也。凡肾元充足者，则万象俱安，而疾病无矣。故有心病而兼肾者，脾病而兼肾者，肝病而兼肾者，肺病而兼肾者，四脏有病，不脱乎肾。且人之赖以有生者，全仗阴阳水火为用，而肾乃阴阳水火之总根。设阴阳失调水火偏胜，百病生焉。而治法之救阴者，无非壮水，补阳者，无非益火。然肾为水脏，更为火脏，故救阴补阳者，不求水之主，火之原，舍水火之脏而弃六味八味，则不得其门从何而入？犹植树者，而欲舍其根，焉可望其生发耶！惟脾胃骤虚且寒，则温补自从中治，而有补中理中之设，久则亦责之于肾，更有八味加补骨脂、五味子之设也。其余不论内外，眼目口齿，胎产男妇百病，且属阴虚阳虚及假阴假阳之症，莫不尊此为圣药。
Although possessing divine physicians like Lu Que and Bian Que, it would be difficult to exert their efforts. Zhang Sanxi said: Labor injury affecting the five zang organs can all lead to *Lao Zhai* (chronic consumptive disease), but only Lung Labor is incurable. This is because medicinal herbs are difficult to reach the lungs; methods of nourishing yin and clearing lung heat are hard to show efficacy in the lungs, and may instead damage the spleen and exacerbate the condition.
The yin essence of the human body is difficult to form yet easy to deplete. It is what is received from heaven (congenital endowment) and combined with grain qi (postnatal nutrition) to fill the body. However, medicines that tonify yin cannot produce effects overnight. Since jing-qi (essence and qi) has been weak for a long time, to warm the stomach qi and nourish the source of transformation, one must plan slowly. One should not use yang-assisting drugs, nor should one suppress yang. Assisting yang will inevitably lead to the loss of yin; suppressing yang requires pure yin formulas. Pure yin preparations are incompatible with stomach qi, and compounded by the austere and killing qi of autumn and winter. Yang-assisting drugs can temporarily support stomach qi, causing food intake to double. It appears as if spirit is strong and qi is prosperous, and no one would not rejoice. But over time, yang becomes more excessive and yin is scorched more. Therefore, how can assisting or suppressing yang be applied to those with yin deficiency? Ancient sages treating labor did not dare to overuse Ginseng (*Ren Shen*), precisely fearing that excessive yang would cause yin to diminish.
The *Jing Xue Pian* (Chapter on Essence and Blood) states: If a man engages in intercourse before his essence is full, draining his essence, there will be places in the five zang organs that are incomplete, and in the future, there will certainly be diseases that are difficult to describe. This is truly a profound statement. What are "formative yang" and "formless yang"? Formless yang refers to the ministerial fire of the Mingmen (Gate of Life). During the day, it moves and exerts its function on the Heart; at night, it rests and returns to store in the Kidney. It is the root of generating qi. Because it is formless and void, it is called "formless." Formative yang refers to the heart fire of the Sovereign (Emperor). Heart fire is the fire used in our daily postnatal life, but it is born from the Mingmen. Therefore, the Pericardium Meridian is connected to the Mingmen, and ministerial fire attaches to it. The Classics state: "Beside the seventh vertebra, there is a small heart," which refers to this. However, if heart fire were not born from the Mingmen, the *Nei Jing* (Inner Canon) would not say "benefit the source of fire to eliminate yin shadows." The meaning of "source" contains the logic of "mother." Thus, sovereign fire is a formative reality, which can be extinguished by water or dampened. Ministerial fire is a formless void, which cannot be extinguished by water or dampened directly. One must follow its nature and subdue it. From this perspective, the distinction between formless yang and formative yang is clear and obvious.
The Classics say: Diseases of the Two Yang (Stomach and Large Intestine) originate in the Heart and Spleen, manifesting as unspoken difficulties (emotional depression or sexual dysfunction), and in women, amenorrhea. If transmitted to become *Feng Xiao* (wasting away like wind-dried plants) or *Xi Ben* (accumulated breathing/asthma), it is a death case, untreatable. It says that diseases of the Two Yang originate in the Heart and Spleen. The reason the Heart and Spleen become diseased lies in the inability to express hidden emotions. The Heart governs blood, and the Spleen controls blood. Women's myriad diseases all arise from the Heart. If one worries, thinks, and depresses, keeping secrets that cannot be told, heart qi becomes knotted and heart fire blazes. Consequently, heart blood is depleted, and the functions of reception and discharge are exhausted. Moreover, since the mother causes the child to be deficient (Heart is the mother of Spleen in some contexts, or here implying mutual influence), the Spleen fails to transport and transform, leading to poor appetite. Poor appetite makes stomach qi even more deficient. The Lungs lose nourishment, so qi stagnates and does not move. Water essences cannot distribute to the four directions, failing to nourish kidney yin. The Kidney governs the two lower orifices. When Kidney deficiency occurs, the Large Intestine lacks endowment, and transmission and transformation fail. The Classics say: Food enters the Stomach, overflowing with essence and qi, which is transported up to the Spleen. The Spleen scatters essences, sending them up to return to the Lungs. The Large Intestine governs fluids (Jin), and the Small Intestine governs liquids (Ye). With insufficient maternal yin in the Kidney, heart fire becomes intense, injuring the Small Intestine organ. With the Spleen failing to scatter essences, Lung Metal lacks nourishment, causing the Large Intestine organ to dry up. This is what is meant by "diseases of the Two Yang originating in the Heart and Spleen." Generally, when qi from water and grain enters the Stomach, the clear part becomes Ying (Nutrient) blood, and the turbid part becomes Wei (Defensive) qi. The body's Ying blood fills and supports the body, relying entirely on abundant grain qi transforming into subtle essences to nourish the zang-fu organs. Since the Stomach receives little and the Large Intestine transports little, the fluids of both the Stomach and Large Intestine dry up. How can Ying blood then fill the meridians? This is why the pulses close and menstrual blood dries up, causing menstruation to not arrive on time. All things wither when encountering wind. *Feng Xiao* means muscles are completely wasted away, as if blown dry by wind. *Xi Ben* refers to lung yin exhaustion, where qi in the chest (Danzhong) is obstructed in breathing, causing breath to rush and asthma to occur. When the disease transmits to this stage, it is already critically dangerous. If not yet there, treatment can still be applied preventatively. Later sages said: Young men and unmarried women, harboring thoughts in their hearts, often suffer from labor injuries. In men, spirit and color scatter first; in women, menstrual water closes first. This is what is meant.
When yin and yang interact, Heaven and Earth are peaceful; when essence and qi combine, the human body is safe. The human body is a small heaven and earth. Above the philtrum, the eyes, nose, and ears have even-numbered apertures, corresponding to Kun (Earth) in the I Ching. Below the philtrum, the mouth and two lower orifices have odd-numbered apertures, corresponding to Qian (Heaven). Yin is above, Yang is below, thus preserving peace. Yin receives, Yang acts. If action exceeds reception, disease arises. Therefore, one must value moderating desires to preserve true innate energy. The characters for "Jing Qi" contain the radical for rice, indicating that jing and qi are all generated from rice. Thus it is said: Those who obtain grain prosper; those who lose grain perish. What humans rely on for life is jing qi, wei qi, and ying qi. Jing qi is produced from the Kidneys; Wei qi is produced from the Lungs; Ying qi is produced from the Liver and Heart. Although these three types of qi have different origins, when combined into one, they all take the Spleen and Stomach as their root. The Classics say: The Spleen is the solitary organ that irrigates the four sides; it also says: All five zang organs receive qi from the Stomach. Therefore, ancient people had the theory that "tonifying the Spleen is better than tonifying the Kidney."
Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) is a formula created by Zhang Zhongjing. A gentleman observes the Kan hexagram (☵) and understands the way of water and fire within the Kidneys. One yang line situated between two yin lines forms Kan. This is similar to human life and heaven and earth. Nowadays, people who engage excessively in intercourse and easily achieve erections have yin deficiency with fire moving. Those whose erections fail prematurely have declining fire in the Mingmen. When true water is exhausted, deep winter is not cold; when true fire ceases, midsummer is not hot. In this formula, Shu Di Huang (Prepared Rehmannia Root), Shan Zhu Yu (Cornus Fruit), Mu Dan Pi (Moutan Cortex), Ze Xie (Alisma Rhizome), Shan Yao (Dioscorea Rhizome), and Fu Ling (Poria) are all moistening and lubricating substances, used to strengthen the master of water (nourish kidney yin). Rou Gui (Cinnamon Bark) and Fu Zi (Aconite Root) are pungent and moistening substances, capable of supplementing fire within water, used to benefit the source of fire (warm kidney yang). When water and fire are nourished, kidney qi recovers its natural state. "Benefiting the source of fire to eliminate yin shadows" refers to this very formula. Benefiting the Spleen and Stomach to cultivate the mother of all things yields great benefits. The *Jing Yao* says: Long-term use will surely result in a robust physique and many children, demonstrating its efficacy in tonifying essence and blood. Zhang Zhongjing said: For qi deficiency with fire, use Shen Qi Wan to tonify and expel; he also said: Ba Wei Wan is the holy medicine for phlegm caused by water flooding. Zhu Danxi said: For prolonged illness with yin fire rising, where fluids generate phlegm instead of blood, one should use blood-tonifying drugs to control ministerial fire, and the phlegm will remove itself. Li Dongyuan (Yi Lao) said: Ba Wei Jiu treats pulse depletion and deficiency; it is a formula for the northwest regions. When metal is weak, water is excessive, and fire is deficient, or when the pulse is forceful upon pressing, it is also effective.
(Zhang) Commentary: Diseases arising in the human body invariably stem from yin-yang imbalance and water-fire excess. Especially for Lao Qie (consumptive weakness), which originates internally from the zang-fu organs and qi-blood, the practitioner must analyze yin-yang and water-fire meticulously, regulating them appropriately until balance is achieved. Then the disease will retreat without direct attack. Ba Wei Wan is indeed like the Eight Arrays of military strategy; its legislation is comprehensive and encompassing. Without yang, yin cannot generate; hence, Rou Gui and Fu Zi are included. Without yin, yang cannot generate; hence, Shu Di Huang and Shan Zhu Yu are included. Both congenital true yin and true yang are simultaneously tonified. Poria and Dioscorea are added to assist the Spleen and Stomach, ensuring the source of transformation has a basis, so that postnatal generation is endless. Moutan Cortex removes latent heat in the yin level; Alisma drains the evil fire and stagnant water of the Dragon and Thunder; together with Poria's mild diuresis, they transport the other herbs downward. One draining and one tonifying allows the tonification to be effective. If there is a sovereign herb without an envoy, it is difficult to act alone. The changes within are divine and illuminating, impossible to exhaust in words. For example, if the left Chi pulse is surging and rapid with severe yin insufficiency, add Shu Di Huang; if the right Chi pulse is faint and thin with severe yang insufficiency, add Rou Gui and Fu Zi; if the left Guan pulse is powerless with liver qi deficiency, add Shan Zhu Yu; if the right Guan pulse is powerless with spleen-stomach deficiency, add Fu Ling and Shan Yao; if stomach fire and bone-steaming fever are severe, add Mu Dan Pi; if yang excess and yin deficit are severe, reduce Rou Gui and Fu Zi; if stomach weakness and middle qi deficiency-cold are severe, remove Mu Dan Pi; if dryness and drought present with yang but no yin, remove Ze Xie; if lone yang floats upward and kidney qi cannot gather and accept, add Wu Wei Zi to assist the astringent power of Shan Zhu Yu; if yang deficiency and essence-blood depletion are severe, add Lu Rong (Deer Antler) and He Che (Placenta Hominis), sentient substances to aid the vigorous tonification of herbal materials; if kidney deficiency fails to grasp qi, with qi lingering in the upper jiao causing upper excess and lower deficiency, add Niu Xi to assist descent; if spleen-kidney deficiency-cold fails to steam, rot, close, and store, causing morning diarrhea, add Gu Pu Zhi (Psoralea Fruit) and Tu Si Zi (Cuscuta Seed) to simultaneously tonify spleen-kidney yang, serving as drugs for both congenital and postnatal sources. These are appropriate assistant and guiding herbs that can work together to achieve success. As for Bai Zhu (Atractylodes Macrocephala Rhizome), Dang Gui (Angelica Sinensis Root), Ren Shen (Ginseng Root), Huang Qi (Astragalus Root), Xian Mao (Curculigo Rhizome), and Shou Wu (Polygonum Multiflorum Root), although powerful, their natures differ and categories vary. How can they compete for merit in a queue? Moreover, tonifying qi and blood differs from tonifying true yin and true yang. If mixed and added arbitrarily, each exerting its own force, disrupting the meridians and restraining each other, it will be of no benefit. As for Gou Qi (Goji Berry), Fu Pen Zi (Raspberry), and Lian Rou (Lotus Seed), their power is too slow. Adding one more ingredient slows it down further, making rapid effects difficult to achieve.
Ba Wei Wan can be taken with light salt water, taking advantage of salt's ability to moisten downward and soften hardness, guiding deficiency fire downward. It can be taken with rice soup, utilizing the bland true taste of the spleen-grain, which generates essence quickly, benefiting the spleen through kidney tonification. It can be taken with plain boiled water, neither fast nor slow, neither hot nor dry. It can be taken with warm wine, taking advantage of faster drug circulation, and warding off external cold in winter. It can be taken with decoction of Bu Zhong Yi Qi Tang, specifically for symptoms of yuan qi sinking. While wanting to secure the root, one also fears the drug acting too quickly downward, causing lower excess and upper deficiency. Thus, lifting the middle qi raises it, keeping the yuan qi of the three jiao constantly present. It can be taken with decoction of Li Zhong Tang, specifically for deep cold in the spleen and kidney. First regulating the central palace allows it to reach the lower jiao. It can be taken with decoction of Sheng Mai San, taking advantage of metal generating water, allowing mother and child to generate each other, with lung qi flowing into the kidney to become wei qi. Such decoction-wrapped pills are used because the disease is acute and cannot be delayed; both root and branch must be considered simultaneously. Thus, borrowing the sharp energy of the decoction to open the path, transporting the divine pill of water and fire to settle in the Dantian, preserving the permanence of yuan yang. The effect of the decoction is slight, while the nature of the pill re-emerges. From the root to the three jiao, harmonious yang is always present. The intention is profound. Moreover, although human diseases are numerous, none are more serious than Wind, Lao, Gu, and Ge syndromes. Long-term use of this drug solidifies true fire in the Dantian. How can deficiency wind rise suddenly? There is no need to worry about stroke. Sweet and warm can remove great heat; tonifying essence and blood facilitates generation. Bone-steaming latent heat has nowhere to reside. The formation of Lao syndrome becomes inherently unstable. With true fire filled below, yuan qi naturally grows in the middle. Transportation and transformation remain normal; how can abdominal distension exist? There is less worry about Gu syndrome. If there is a pot under the cauldron, the rice cooks itself; qi overflows and spreads, water essences distribute everywhere. How can dryness, obstruction, and dysphagia form? If major diseases can be eliminated, minor diseases are hardly entrenched. This is truly the highest realm of health preservation and the divine pill for establishing life. (Zhang) specially created this method of administration to supplement the未尽 (unfinished aspects) of the ancients.
Qian Yi removed Rou Gui and Fu Zi, naming it Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia), to treat children, stating that children are purely yang. This formula primarily treats cases where kidney deficiency fails to control fire. The Kidney contains not only water but also the fire of the Mingmen. If the Kidney is not deficient, water is sufficient to control fire; if deficient, there is nothing to control it, and heat syndromes arise. This is named yin deficiency with fire movement, which Liu Hejian referred to as heat due to kidney deficiency. Nowadays, people with hot soles, hot inner thighs, and lower back pain all exhibit these symptoms, which are precursors to hemoptysis. Shu Di Huang and Shan Zhu Yu have rich flavors. The Classics say: Rich flavor belongs to yin within yin, thus it can tonify Shaoyin and nourish kidney water. Ze Xie is salty; salt enters the Kidney first. Rehmannia, Dioscorea, and Alisma are all moistening substances. The Kidney dislikes dryness and requires this moistening. The water tonified by this formula is formless water; the moistening substances are also formless, hence they are used. Mu Dan Pi is the root bark of the peony. Dan represents fire of the South. Being male and not female, it belongs to yang. Its flavor is bitter and pungent, thus it enters the Kidney to astringe yin fire, benefiting Shaoyin and calming deficiency heat. Fu Ling is sweet and bland. Sweet transforms via Earth; Earth can control water, and bland can drain and seep. Thus, it is used to control pathogens in the water organ. Shu Di is warm and Mu Dan Pi is cool; Shan Yao is astringent and Fu Ling is draining; Shan Zhu Yu is gathering and Ze Xie is draining. It tonifies the Stomach and simultaneously the Spleen. Having tonification accompanied by draining, they harmonize and assist each other to achieve balanced tonification. It is the miracle of blandness, hence regarded as an excellent prescription unchanging through ancient and modern times. It benefits the Spleen and Stomach to cultivate the mother of all things, strengthens the master of water to calm solar flare, referring to this medicine. Adding Wu Wei Zi to Liu Wei creates Du Qi Wan, reflecting the meaning of describing categories and imitating forms.
"Nourishing yin to descend fire" means that by nourishing yin, fire descends naturally. One should understand this holistically rather than focusing solely on descending fire. The two Chi pulses each contain descending yin, water, and fire, mutually generating and transforming. One must differentiate yin-yang and deficiency-excess within these two organs and seek their belonging to balance them. If the person's pulse is weak, fine, and rapid, it indicates insufficiency of true yin in the left Kidney. Use Liu Wei Wan. If the right Chi pulse is slow and soft, or deep, fine, and nearly absent, it indicates insufficiency of ministerial fire in the Mingmen. Use Ba Wei Wan. If both Chi pulses are weak and minute, it indicates simultaneous deficiency of yin and yang. Use Shi Bu Wan. All these nourish the congenital kidney source, offering infinite benefits for generations. Since then, those tonifying yin mostly use Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhena Rhizome), which instead damage the spleen and stomach, often leading to untreatable conditions, leaving harmful legacies for the world.
Heat sickness with thirst, drinking cold fluids, and constipation belong to excess heat. Aversion to cold, fever, pulling clothes to curl up, belong to reverse cold. Clear and loose stools belong to true cold. Everyone knows this. As for restlessness, madness, aversion to clothing, desire to sit or lie in mud and water, these belong to false heat syndromes. Severe cases involve extreme restlessness, incessant thirst, tongue like thorns, dry and cracked cheeks, face painted red, body burning like fire, soles of feet like iron, vomiting phlegm like a surge, rapid breathing and coughing, severe constipation, scanty urination, and six pulses surging without measure. They resemble Cheng Qi Tang or Bai Hu Tang syndromes. However, Cheng Qi Tang and Bai Hu Tang would kill upon ingestion. This is extreme kidney yin deficiency, with yang having no attachment, floating and scattering externally. It is not real fire. One should urgently prepare one jin (approx. 500g) of modified Ba Wei Wan material, add one liang (approx. 30g) of Rou Gui, decoct rapidly in water, make five to six bowls, and drink cold. Various symptoms will recede. The next day, there will definitely be aversion to cold and pulse disappearance, revealing the true pattern. One must vigorously tonify yang. Urgently decoct and administer Fu Zi Ba Wei Wan material for self-healing. This syndrome and pulse deviate from the norm and cannot be treated with standard methods.
If there is postpartum hemorrhage or massive blood loss, sudden injury to yin-blood causes high fever, also named yin-deficiency fever. The character "yin" here refers to the yin of qi and blood. If treated with cooling drugs as a standard cure, death is immediate. It resembles Bai Hu Tang syndrome; misusing Bai Hu Tang leads to death. Although yin qi is greatly deficient, Si Wu Tang is not used. Formative blood cannot be generated quickly; the slightest amount of qi must be urgently secured. One must use Du Shen Tang (Single Ginseng Decoction) etc., to allow the formless to generate the formative. This is the wonderful application of yang generating yin. However, both qi deficiency and blood deficiency are internal injuries. How to distinguish them? Yin deficiency manifests with a red face, as formless fire crowns the upper body. If it is a yang syndrome, fire enters inward, and the face will not be red. Thirst is severe because kidney water is dried up, drawing water to save itself. Although thirsty, the tongue must be slippery. Although the pulse is rapid, the Chi position must be powerless. In severe cases, even if the Chi pulse is surging and rapid, pressing it reveals no rebound force. This is the differentiation. Although, if the person has previously taken cooling drugs, the pulse will counter-intuitively become forceful and rebounding, forcing yang outward, creating a false sense of strength. Dai Fu'an said: If the pulse becomes more rapid after taking cooling drugs, it is fire depression. Directly tonifying is appropriate; cold and cooling must be strictly avoided. Violating this leads to death. A difference of a hair's breadth costs lives. Be cautious!
For kidney deficiency with fire not returning to its vessel, presenting with high fever, irritability, thirst, red eyes, cracked lips, prickles on the tongue, throat feeling like smoke and fire, soles of feet like iron, surging and boundless pulse, weak upon pressure, use Shi Quan Da Bu Tang (Ten-Agent Great Tonifying Decoction) to swallow Ba Wei Wan. Someone asked: With such dryness and heat, how can you administer Gui and Fu again? Isn't this adding fire to fire? I reply: The pericardium ministerial fire attaches to the Mingmen. Men store essence with it; women connect the uterus with it. Due to excessive desires exhausting the fire, it has no attachment, thus rebels and flares upward. Moreover, fire emerges from the Kidney; it is fire within water. Fire can be broken by water, but fire within water cannot be broken by water. The fire of Gui and Fu shares the same qi and has a pungent flavor. It opens the interstices, promotes fluid secretion, and unblocks qi pathways. Occupying its lair, it attracts fire through similarity of qi, causing the fire to descend. Thus, Gui and Fu are indeed the correct medicines for treating fire.
Kan represents dry water, qi. It is small like a well, large like the sea. Dui represents kun water, form. It is slight like dew, large like rain. One yang trapped in two yins forms Kan. Kan is water qi,潜行 (hidden flow) underground, the fundamental root receiving destiny for all things. Hence it is said: Moistening all things, nothing moisters like water. One yin penetrating two yangs forms Dui. Dui uses formative water to generously bestow upon all things above, providing the benefit of life. Hence it is said: Delighting all things, nothing delights like marsh. Understanding this one water allows one to comprehend the way of treating fire. Heart fire is formative fire. Ministerial fire is formless fire. Formless fire causes internal dryness and heat and fluid exhaustion. Using formative Dui water of the Five Elements to control it is a temporary expedient. Our body possesses true water qi from Shangchi (Upper Pool). It is formless. Using formless water to irrigate formless fire is constant and enduring. This is true water and true fire; when ascending and descending are appropriate, we achieve Ji Ji (Completion). Physicians who do not comprehend the true substance of congenital Taiji, nor exhaust the wonderful applications of formless fire and water, and thus cannot use the divine agents of Liu Wei and Ba Wei, lack more than half of medical principles. This discussion by Zhao (Shu) deeply grasps the origin of water and fire and obtains the unchanging treatment methods for water and fire.
(Zhang) Commentary: The onset of hundred diseases stems from fire; the emergence of fire stems from yin deficiency; the root of deficiency stems from the Kidney. Water is the origin of all things; fire is the father of all things. Their origin and father are rooted in the Kidney. Whenever kidney yuan is sufficient, all phenomena are peaceful, and diseases cease. Thus, there are Heart diseases involving the Kidney, Spleen diseases involving the Kidney, Liver diseases involving the Kidney, and Lung diseases involving the Kidney. Diseases of the four zang organs do not escape the Kidney. Furthermore, what humans rely on for life is entirely dependent on the function of yin-yang and water-fire, and the Kidney is the total root of yin-yang and water-fire. If yin-yang is imbalanced and water-fire is excessive, hundred diseases arise. In treatment, saving yin involves strengthening water; tonifying yang involves benefiting fire. However, the Kidney is a water organ and also a fire organ. Therefore, those saving yin and tonifying yang, if they do not seek the master of water and the source of fire, abandoning the water-fire organs and rejecting Liu Wei and Ba Wei, how can they find the door to enter? It is like a tree planter wanting to abandon the roots and expecting growth! Only when the spleen and stomach suddenly become deficient and cold does warming and tonifying treat from the center, employing Bu Zhong and Li Zhong methods. Over time, responsibility shifts to the Kidney, employing Ba Wei plus Gu Pu Zhi and Wu Wei Zi. The rest, whether internal or external, eye and tooth issues, obstetrics and gynecology, and myriad diseases in men and women, especially those belonging to yin/yang deficiency and false yin/false yang syndromes, all revere this as a holy medicine.