补中益气汤
黄 （一钱） 当归 人参 炙甘草 陈皮 升麻 柴胡 白术
此方东垣所制。治内伤之方。古方只有黄 一钱。其余各三分。薛立斋常用参 各钱半。白术一钱。当
归一钱。陈皮七分。升柴各五分。进退加减。神应无穷。如病甚者。参 或三钱五钱。随证加用。凡脾胃喜
甘而恶苦。喜补而恶攻。喜温而恶寒。喜通而恶滞。喜升而恶降。喜燥而恶湿。此方得之。
或问曰。古今称补中益气汤。为万世无穷之利。其义云何。曰此发前人之所未发。继仲景河间而立。意义
深远也。世人一见发热。便以外感风寒暑湿之邪。非发散邪从何处解。又不能的见风寒暑湿对证施治。乃通
用解表之剂。如九味羌活汤败毒散十神汤之类。甚则凉膈白虎。杂然并进。因而致毙者多矣。东
垣深痛其害。创立此方。以为邪之所凑。其气必虚。内伤者多。外感者间有之。纵有外邪。亦是乘虚而入。
但补其中益其气。而邪自退听。不必攻邪。攻则虚者愈虚。而危亡随其后矣。倘有外
感。而内伤不甚者。即于本方中。酌加对证之药。而外邪自退。所谓仁义之师。无敌于天下也。至于饮食失节。
劳役过度。胃中阳气自虚。下陷于阴中而发热者。此阳虚自病。误作外感而发散之。益虚其虚矣。为害岂浅
哉。又有一种内伤真阴而发热者。与内伤阳气相似。此当补真阴。非四物汤之谓。又非坎离丸之类。详见先天
要论中者。心肺在上。肾肝在下。脾胃处于中州。为四脏之主气者。中焦无形之气。所以蒸腐水谷。升降出入。
乃先天之气。又为脾胃之主。后天脾土。非得先天之气不行。是方盖为此气因劳。而下陷于肾肝。清气不升。
浊气不降。故用升麻使由右腋而上。用柴胡使由左腋而上。非借参 之功。则升提
无力。是方所以补益后天中之先天也。
或问曰。余见先生动辄以先天后天立论。余考之易中先天后天之图。干南坤北离东坎西等卦位。于医道中
甚无所合。而先生屡言之不已。其义云何。曰怪乎子之问也。余所谓先天者。指一点无形之火气也。后天者。
指有形之体。自脏腑及血肉皮肤。与夫涕唾津液。皆是也。既曰先天。此时天尚未生。何况有干南坤北八卦对
待之图乎。曰。然则伏羲此图。何为而设也。余曰。此非先天之图。乃中天八卦之图。天位乎上。地位乎下。
日出乎东。水源于西。风雨在天上。山雷在地下。人与万物位乎中。余尝见邵子排列如此。有中天八卦数。其
当今所用者。止一文王后天图。出乎震。齐乎巽。相见乎离。致役乎坤。悦言乎兑。战乎干。劳乎坎。成乎
艮。以春秋昼夜十二时相配。因以定阴阳。决生死。推而天文地理星相医卜。无一不以此图为则。至于
先天者。无形可见。即易中帝出乎震之帝。神也者妙万物而为言之神是也。帝与神。即余先天要论中所称真君
真主。本系无形。不得已而强立此名。以为主宰先天之体。以为流行后天之
用。东垣先生独会其宗。而于补中益气方中。用柴胡升麻者。正
以升发先天之气。于脾土之中。真万世无穷之利。余所以谆谆为言也。盖人身以脾胃为主。人皆知之。而先天
隐于无形者。举世置而弗论。故余既立先天要论矣。后于后天论中。发明东垣脾胃论。亦用先天无形者为主。
读脾胃论者。读至人受水谷之气以生。所谓清气营气卫气元气谷气春升之气。皆胃气之别名。则可见矣。饮食
入胃。犹水谷在釜中。非火不熟。脾能化食。全借少阳相火之无形者。在下焦蒸腐。始能运化也。此时若用
寒凉之药。饮食亦不运化矣。盖脾胃中之火。土中之火。纳音所谓炉中火。养炉中火者。须频加煤炭。盖以热
灰温养其火。而火气自存。一经寒水。便成死灰。将以何者蒸腐水谷。以何者接引灯烛。举目皆地狱光景。
可不戒哉。经曰。劳者温之。损者温之。正取温养之义也。
东垣曰。岐伯曰有所劳倦。形气衰少。谷气不盛。上焦不行。下脘不通。而胃气热。热气熏胸中故内热。
举痛论云。劳则气耗。劳则喘且汗出。内外皆越。故气耗。夫喜怒不节。起居不时。有所劳伤。皆损其气。气
衰则火旺。火旺则乘其脾土。脾主四肢。故困热无气以动。懒于语言。动作喘乏。表热自汗。心烦
不安。当病之时。宜安心静坐。以养其气。以甘寒泻其热火。以酸味收其散气。以甘温补其中气。经言劳者温
之。损者温之是也。金匮要略云。平人脉大为劳。脉极虚亦为劳。夫劳之为病。其脉大。手足烦热。春夏剧。
秋冬瘥。以黄 建中汤治之。此亦温之之意也。盖人受水谷之气以生。所谓清气营气元气卫气春升之气。皆胃
气之别名也。夫胃气为水谷之海。饮食入胃。游溢精气。上输于脾。脾气散精。上归于肺。通调水道。下输膀
胱。水精四布。五经并行。合于四时。五脏阴阳。揆度以为常也。若饮食失节。寒温不适。脾胃乃伤。喜怒忧
恐。损耗元气。脾胃气衰。元气不足。而火独盛。火者阴火也。起于下焦。元气之贼也。壮
火食气。少火生气。火与元气不两立。一胜则一负。脾胃气虚。则下流肝肾。名曰重强。阴火得以乘其土位。
故脾证始得。则气高而喘。身热而烦。其脉洪大而头痛。或渴不止。其皮肤不任风寒。而生寒热。盖脾胃之气
下流。使谷气不得升浮。是春生之令不行。则无阳以护其荣卫。遂不任风寒。而生寒热。此皆脾胃之气不足所
致也。然与外感风寒之证。颇同而实异。内伤脾胃。乃伤其气。外感风寒。乃伤其形。伤其外则有余。有余者
泻之。伤其内则不足。不足者补之。汗之下之吐之克之之类。皆泻也。温之和之调之养之之类。皆补也。内伤
不足之病。苟误认作外感有余之证。而反泻之。则虚其虚也。实实虚虚如此死者。医杀之耳。然则奈何。唯当以
辛甘温剂补其中。而升其阳则愈矣。经曰。劳者温之。损者温之。又曰。温能除大热。大忌苦寒之药。损
其脾胃。今立补中益气汤主之。夫因饥饱劳役。损伤脾胃。或专因饮食不调。或专因劳力过度。或饥饱之后。
加之劳力。或劳力之后。加之饥饱。皆为内伤。脾胃一虚。肺气先绝。故用黄 以益皮毛而闭腠理。不令自
汗。损其元气。上喘气短。人参以补之。心火乘脾。须炙甘草之甘。以泻大热。而补脾胃中元气。若脾胃
急痛。并大虚腹中急缩者。宜多用之。经曰。急者缓之。白术苦甘温。除胃中热。利腰脐间血。胃中清气在
下。必加升麻柴胡以引之。引黄 甘草甘温之气味上升。能补卫气之散解而实其表也。又缓带脉之缩急。二味皆
苦平。味之薄者。阴中之阳。引胃中清气升于阳道。及诸经生发之气。以滋春气之和也。气乱于胸
中。为清浊相干。用去白陈皮以理之。清升而浊自降矣。胃气虚不能升浮。为阴火伤其生发之气。荣血大亏
。荣气不营。阴火炽起。日渐熬煎。血气日减。心主血。减则心无所养。致使心乱而烦。故以当归和之。如烦犹
未止。加服地黄丸。以补肾水。水旺而心火自降。以手扪之。而肌表热者。表证也。只服补中益
气汤一二服。得微汗则已。非止发汗。乃阴阳气和。自然汗出也。
如精神短少。倍加人参五味子。如头痛。加蔓荆子。如头痛有痰沉重。乃太阴痰厥头痛。加半夏天麻。如
腹中痛者。加白芍药。如恶寒冷痛。更加桂心。如恶热喜寒热痛。更加黄连。如腹中痛恶寒。而脉弦者。是木
来克土也。小建中汤主之。盖芍药味酸。于土中泻木为君。如脉沉细腹痛。以理中汤主之。干姜叶
热。于土中泻水。以为主也。
脐下痛者。加熟地黄。如不已。乃大寒也。更加肉桂。凡小腹痛。多属肾气奔豚。惟桂泄奔豚。故加之。
如胁痛。或胁下缩急。俱加柴胡芍药。如体重肢节痛。或腹胀自利。脉来濡缓者。湿胜也。加苍术浓朴主之。
如风湿相搏。一身尽痛。加羌活防风 本。别作一服。病去勿再服。以诸风药损人元气也。
如冬月恶寒发热无汗。脉浮而紧。本方加麻黄桂枝。（如麻黄五分用参 各一钱。）如冬月恶风发热有
汗。脉浮而缓。加桂枝芍药。伤寒必恶寒。伤风必恶风。伤食必恶食。伤寒恶寒。烈火不能热。重绵不能温。内伤
者。得就暖处。着绵温火。便不恶矣。内伤饮食。口不知味。不思饮食。伤寒者。虽不能食。未尝不知味也。
劳力内伤者。身体沉重。四肢困倦。百节烦疼。心满气短。懒于言语。若伤寒者。太阳则头痛。少阳则胁痛。
阳明则目痛。不若内伤之怠惰嗜卧也。伤寒发热。拂拂如羽毛之热。热在皮毛。内伤者。肌体壮热。扪之烙
手。右手气口脉大于左手人迎三倍。其气口脉急大而数。时一代而涩。涩是肺之本脉。代是气不相接。
乃脾胃不足之脉。大是洪大。洪大而数。乃心脉刑肺。急是弦急。乃肝木挟心火克肺金也。其右关脉属脾。
比五脉独大而数。数中时显一代。此不甚劳役。是饮食不时。寒温失所。胃脉损弱。隐而不见。惟
内显脾脉如此。若外伤。人迎脉大于气口也。
东垣以手扪热。有三法。以轻手扪之则热。重按之则不热。是热在皮毛血脉也。重按筋骨之间则热蒸
手。轻摸之则不热。是热在骨髓也。轻手扪之不热。重手按之亦不热。不轻不重按之而热者。是热在筋骨之
上。皮毛血肉之下。乃热在肌肉。肌肉间热者。正内伤劳倦之热也。若余于内伤真阴者。以手扪热。亦
有二。扪之烙手骨中如炙者。肾中之真阴虚也。扪之烙手。按之筋骨之下。反觉寒者。肾中真阳虚也。面必
赤者。阴盛于下。逼阳于上也。口必渴者。肾水干枯。引水自救也。若口吐痰多。如清水者。肾水泛上为痰。
口必不渴也。口咯痰如沫者。水沸为痰。阴火熬煎。口必渴也。腰胁痛者。肾肝虚也。足心如烙者。涌泉涸竭
也。膝以下冷者。命门衰绝。上气必喘也。尺脉必数者。阴火旺也。尺脉数而无力。或欲绝者。真阳衰也。骨
痛如折者。肾主骨。骨衰乘火也。此阳虚阴虚之辨。而阴虚之中。又有真阴真阳之不同。其治法详于先天论中。
或问曰。丹溪云东南之人。阳气易以升。不可服补中益气汤。当今江以南之人。果尽不当服乎。曰此东
南指人之脏腑而言也。盖东方属肝。南方属心。肝与心有火者。不可服。恐木火愈旺也。若黄帝起四方之问。
岐伯有四治之能。此东南西北方指地位也。既不可服东南二方之剂。其人上盛者。必下虚。其肾气大虚矣。急
须填补北方先天之元气为要。总而言之。先天后天不得截然两分。上焦元阳不足者。下陷于肾中也。当取之至
阴之下。下焦真阴不足者。飞越于上部也。焉可不引而归原耶。是以补中益气汤。与肾气丸并用。朝服补阳。
暮服补阴。互相培养。但先后轻重之分。明者知之。不必详述。
或问肾气丸中。以地黄为君。恐其泥膈。或于脾胃有妨乎。
曰肾气丸中。尽是肾经的药。并无一味脾胃药杂其中。径入肾
经。焉能泥膈。凡用药须要分得阴阳水火清净。如朝廷有六部。一部有一部之事。一部有一部用事之人。今欲
输纳钱粮。而可与天曹用事之人同议乎。曰若如所言。予正谓肾经水部。不可与脾经户部相杂之谓耳。曰余所
谓不杂者。谓肾水药中。不可杂脾土药。脾胃药中。不得杂肾经药。如四君子汤。脾经药也。杂地黄其中。则
泥膈矣。八味地黄丸。肾经药也。加人参则杂矣。若论肾与脾胃。水土原是一气。人但知土之为地。而不知土
亦水也。自天一生水。而水之凝成处。始为土。土之坚者为石。此后天卦位坎之后。继之艮。艮为山为土。艮
土者。先天之土。水中之主也。土无定位。随母寄生。随母而补。故欲补太阴脾土。先补肾中少阳相火。若
水谷在釜中。非釜底有火则不熟。补肾者。补肾中火也。须用八味丸。医不达此。而日从事于人参白
术。非探本之术。盖土之本初原是水也。世谓补肾不如补脾。余谓补脾不如补肾。
补中益气汤
黄芪（一钱） 当归 人参 炙甘草 陈皮 升麻 柴胡 白术
此方由李东垣所创制，是治疗内伤病的方剂。古方中仅用黄芪一钱，其余各药三分。薛立斋常用党参、黄芪各一钱半，白术一钱，当归一钱，陈皮七分，升麻、柴胡各五分，根据病情进退加减，疗效神奇无穷。如果病重者，人参、黄芪可用到三钱或五钱，随证加入使用。大凡脾胃喜欢甘味而厌恶苦味，喜欢补益而厌恶攻伐，喜欢温煦而厌恶寒凉，喜欢通畅而厌恶停滞，喜欢升发而厌恶下降，喜欢燥湿而厌恶潮湿。此方正符合这些特性。
有人问：古今都称补中益气汤为万世无穷的利法，其中的道理是什么？回答说：这是阐发了前人未曾阐发的道理，继承张仲景和刘河间的学术思想而立论，意义深远。世人一见发热，就认为是外感风寒暑湿之邪，认为不通过发散邪气从哪里能解除？又不能确切地辨别风寒暑湿而对症施治，于是通用解表剂，如九味羌活汤、败毒散、十神汤之类。甚至用凉膈散、白虎汤等，杂乱并进，因而导致死亡的人很多了。李东垣深切痛恨这种危害，创立此方，认为“邪之所凑，其气必虚”，内伤者多，外感者间或有之。即使有外邪，也是乘虚而入。只要补益其中气、增益其元气，邪气自然退却听命，不必攻邪。攻邪则使虚弱者更虚，危亡随即到来。如果有外感，但内伤不严重的，就在本方中酌情加入对症的药物，外邪自然退去。这就是所谓的仁义之师，无敌于天下。至于饮食失节，劳役过度，胃中阳气自虚，下陷于阴分而发热的，这是阳虚自病，误作外感而用发散法，更加虚损其虚，危害难道浅吗？又有一种内伤真阴而发热的，与内伤阳气相似，这应当补真阴，不是四物汤所说的，也不是坎离丸之类的，详见《先天要论》。心肺在上，肾肝在下，脾胃处于中州，作为四脏之主气的是中焦无形之气，所以能蒸腐水谷，升降出入，这是先天之气，又是脾胃的主宰。后天脾土，不得先天之气不能运行。这个方子正是为了这种气因劳累而下陷于肾肝，清气不升，浊气不降，所以用升麻使其从右腋而上行，用柴胡使其从左腋而上行。如果不借人参、黄芪的功效，则升提无力。此方所以能补益后天中的先天之气。
有人问：我见先生动不动就用先天后天立论，我考察《易经》中先天后天的图，干南坤北、离东坎西等卦位，在医道中甚不相合，而先生屡次谈论不停，其中的道理是什么？回答说：奇怪你的问题啊。我所说的先天，是指一点无形之火气。后天，是指有形的躯体，从脏腑到血肉皮肤，以及涕唾津液，都是。既然叫先天，此时天尚未生，何况有干南坤北八卦对待的图呢？问：那么伏羲的这个图，为什么设立呢？我说：这不是先天之图，乃是中天八卦之图。天位乎上，地位乎下，日出乎东，水源于西，风雨在天上，山雷在地下，人与万物位乎中。我曾见邵子排列如此，有中天八卦数。当今所用的，止有一个文王后天图，出乎震，齐乎巽，相见乎离，致役乎坤，悦言乎兑，战乎干，劳乎坎，成乎艮。以春秋昼夜十二时相配，因此定阴阳，决生死，推演天文地理星相医卜，无一不以此图为准则。至于先天，无形可见，即《易经》中帝出乎震的帝，神也者妙万物而为言之神是也。帝与神，就是我《先天要论》中所称的真君真主，本来系无形，不得已而强立此名，以为主宰先天之体，以为流行后天之用。李东垣先生独会其宗旨，而在补中益气方中，用柴胡、升麻，正是为了升发先天之气，于脾土之中，真是万世无穷的利法，所以我谆谆告诫。大概人身以脾胃为主，人皆知道，而先天隐于无形的，举世置之不论。所以我既立了《先天要论》，后来在《后天论》中，发明李东垣的《脾胃论》，也用先天无形者为主。读《脾胃论》的人，读到“人受水谷之气以生”，所谓清气、营气、卫气、元气、谷气、春升之气，都是胃气的别名，就可以明白了。饮食入胃，犹如水谷在釜中，没有火就不熟。脾能化食，全借少阳相火的无形者，在下焦蒸腐，始能运化。此时如果用寒凉之药，饮食也不能运化了。大概脾胃中的火，土中之火，纳音所谓炉中火，养炉中火，须频加煤炭，盖以热灰温养其火，而火气自存。一经寒水，便成死灰，将以何者蒸腐水谷，以何者接引灯烛？举目皆地狱光景，可不戒哉！《内经》说：“劳者温之，损者温之。”正是取温养之义。
李东垣说：岐伯说有所劳倦，形气衰少，谷气不盛，上焦不行，下脘不通，而胃气热，热气熏胸中故内热。《举痛论》说：劳则气耗。劳则喘且汗出，内外皆越，故气耗。夫喜怒不节，起居不时，有所劳伤，皆损其气。气衰则火旺，火旺则乘其脾土。脾主四肢，故困热无气以动，懒于语言，动作喘乏，表热自汗，心烦不安。当病之时，宜安心静坐，以养其气，以甘寒泻其热火，以酸味收其散气，以甘温补其中气。《内经》说“劳者温之，损者温之”就是此意。《金匮要略》说：平人脉大为劳，脉极虚亦为劳。夫劳之为病，其脉大，手足烦热，春夏剧，秋冬瘥，以黄芪建中汤治之。这也是温之的意思。大概人受水谷之气以生，所谓清气、营气、元气、卫气、春升之气，都是胃气的别名。夫胃气为水谷之海，饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四布，五经并行，合于四时，五脏阴阳，揆度以为常也。若饮食失节，寒温不适，脾胃乃伤，喜怒忧恐，损耗元气，脾胃气衰，元气不足，而火独盛。火者阴火也，起于下焦，元气之贼也。壮火食气，少火生气。火与元气不两立，一胜则一负。脾胃气虚，则下流肝肾，名曰重强。阴火得以乘其土位，故脾证始得，则气高而喘，身热而烦，其脉洪大而头痛，或渴不止，其皮肤不任风寒，而生寒热。盖脾胃之气下流，使谷气不得升浮，是春生之令不行，则无阳以护其荣卫，遂不任风寒，而生寒热。此皆脾胃之气不足所致也。然而与外感风寒之证，颇同而实异。内伤脾胃，乃伤其气；外感风寒，乃伤其形。伤其外则有余，有余者泻之；伤其内则不足，不足者补之。汗之下之吐之克之之类，皆泻也；温之和之调之养之之类，皆补也。内伤不足之病，苟误认作外感有余之证，而反泻之，则虚其虚也。实实虚虚，如此死者，医杀之耳。然则奈何？唯当以辛甘温剂补其中，而升其阳则愈矣。《内经》说：“劳者温之，损者温之。”又说：“温能除大热。”大忌苦寒之药，损其脾胃。今立补中益气汤主之。夫因饥饱劳役，损伤脾胃，或专因饮食不调，或专因劳力过度，或饥饱之后，加之劳力，或劳力之后，加之饥饱，皆为内伤。脾胃一虚，肺气先绝，故用黄芪以益皮毛而闭腠理，不令自汗，损其元气。上喘气短，人参以补之。心火乘脾，须炙甘草之甘，以泻大热，而补脾胃中元气。若脾胃急痛，并大虚腹中急缩者，宜多用之。《内经》说：“急者缓之。”白术苦甘温，除胃中热，利腰脐间血。胃中清气在下，必加升麻、柴胡以引之，引黄芪、甘草甘温之气味上升，能补卫气之散解而实其表也。又缓带脉之缩急。二味皆苦平，味之薄者，阴中之阳，引胃中清气升于阳道，及诸经生发之气，以滋春气之和也。气乱于胸中，为清浊相干，用去白陈皮以理之，清升而浊自降矣。胃气虚不能升浮，为阴火伤其生发之气，荣血大亏，荣气不营，阴火炽起，日渐熬煎，血气日减。心主血，减则心无所养，致使心乱而烦，故以当归和之。如烦犹未止，加服地黄丸，以补肾水，水旺而心火自降。以手扪之，而肌表热者，表证也。只服补中益气汤一二服，得微汗则已。非止发汗，乃阴阳气和，自然汗出也。
如精神短少，倍加人参、五味子。如头痛，加蔓荆子。如头痛有痰沉重，乃太阴痰厥头痛，加半夏、天麻。如腹中痛者，加白芍药。如恶寒冷痛，更加桂心。如恶热喜寒热痛，更加黄连。如腹中痛恶寒，而脉弦者，是木来克土也，小建中汤主之。盖芍药味酸，于土中泻木为君。如脉沉细腹痛，以理中汤主之。干姜叶热，于土中泻水，以为主也。
脐下痛者，加熟地黄。如不已，乃大寒也，更加肉桂。凡小腹痛，多属肾气奔豚，惟桂泄奔豚，故加之。如胁痛，或胁下缩急，俱加柴胡、芍药。如体重肢节痛，或腹胀自利，脉来濡缓者，湿胜也，加苍术、浓朴主之。如风湿相搏，一身尽痛，加羌活、防风、藁本，别作一服。病去勿再服，以诸风药损人元气也。
如冬月恶寒发热无汗，脉浮而紧，本方加麻黄、桂枝。（如麻黄五分用参、芪各一钱。）如冬月恶风发热有汗，脉浮而缓，加桂枝、芍药。伤寒必恶寒，伤风必恶风，伤食必恶食。伤寒恶寒，烈火不能热，重绵不能温。内伤者，得就暖处，着绵温火，便不恶矣。内伤饮食，口不知味，不思饮食。伤寒者，虽不能食，未尝不知味也。劳力内伤者，身体沉重，四肢困倦，百节烦疼，心满气短，懒于言语。若伤寒者，太阳则头痛，少阳则胁痛，阳明则目痛，不若内伤之怠惰嗜卧也。伤寒发热，拂拂如羽毛之热，热在皮毛。内伤者，肌体壮热，扪之烙手。右手气口脉大于左手人迎三倍，其气口脉急大而数，时一代而涩。涩是肺之本脉，代是气不相接，乃脾胃不足之脉。大是洪大，洪大而数，乃心脉刑肺。急是弦急，乃肝木挟心火克肺金也。其右关脉属脾，比五脉独大而数，数中时显一代。此不甚劳役，是饮食不时，寒温失所，胃脉损弱，隐而不见，惟内显脾脉如此。若外伤，人迎脉大于气口也。
李东垣以手扪热，有三法。以轻手扪之则热，重按之则不热，是热在皮毛血脉也。重按筋骨之间则热蒸手，轻摸之则不热，是热在骨髓也。轻手扪之不热，重手按之亦不热，不轻不重按之而热者，是热在筋骨之上，皮毛血肉之下，乃热在肌肉。肌肉间热者，正内伤劳倦之热也。若余于内伤真阴者，以手扪热，亦有二。扪之烙手骨中如炙者，肾中之真阴虚也。扪之烙手，按之筋骨之下，反觉寒者，肾中真阳虚也。面必赤者，阴盛于下，逼阳于上也。口必渴者，肾水干枯，引水自救也。若口吐痰多，如清水者，肾水泛上为痰，口必不渴也。口咯痰如沫者，水沸为痰，阴火熬煎，口必渴也。腰胁痛者，肾肝虚也。足心如烙者，涌泉涸竭也。膝以下冷者，命门衰绝，上气必喘也。尺脉必数者，阴火旺也。尺脉数而无力，或欲绝者，真阳衰也。骨痛如折者，肾主骨，骨衰乘火也。此阳虚阴虚之辨，而阴虚之中，又有真阴真阳之不同，其治法详于《先天论》中。
有人问：朱丹溪说东南之人，阳气易以升，不可服补中益气汤。当今江以南之人，果尽不当服乎？回答说：此东南指人之脏腑而言也。盖东方属肝，南方属心。肝与心有火者，不可服，恐木火愈旺也。若黄帝起四方之问，岐伯有四治之能，此东南西北方指地位也。既不可服东南二方之剂，其人上盛者，必下虚，其肾气大虚矣。急须填补北方先天之元气为要。总而言之，先天后天不得截然两分。上焦元阳不足者，下陷于肾中也，当取之至阴之下。下焦真阴不足者，飞越于上部也，焉可不引而归原耶？是以补中益气汤，与肾气丸并用，朝服补阳，暮服补阴，互相培养。但先后轻重之分，明者知之，不必详述。
有人问：肾气丸中，以地黄为君，恐其泥膈，或于脾胃有妨乎？
回答说：肾气丸中，尽是肾经的药，并无一味脾胃药杂其中，径入肾经，焉能泥膈？凡用药须要分得阴阳水火清净。如朝廷有六部，一部有一部之事，一部有一部用事之人。今欲输纳钱粮，而可与天曹用事之人同议乎？问：若如所言，予正谓肾经水部，不可与脾经户部相杂之谓耳。回答说：我所说不杂者，谓肾水药中，不可杂脾土药；脾胃药中，不得杂肾经药。如四君子汤，脾经药也，杂地黄其中，则泥膈矣。八味地黄丸，肾经药也，加人参则杂矣。若论肾与脾胃，水土原是一气。人但知土之为地，而不知土亦水也。自天一生水，而水之凝成处，始为土。土之坚者为石，此后天卦位坎之后，继之艮。艮为山为土，艮土者，先天之土，水中之主也。土无定位，随母寄生，随母而补。故欲补太阴脾土，先补肾中少阳相火。若水谷在釜中，非釜底有火则不熟。补肾者，补肾中火也，须用八味丸。医不达此，而日从事于人参、白术，非探本之术。盖土之本初原是水也。世谓补肾不如补脾，余谓补脾不如补肾。
Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
Huangqi (Radix Astragali, one qian) Danggui (Radix Angelicae Sinensis) Renshen (Radix Ginseng) Zhi Gancao (Prepared Radix Glycyrrhizae) Chenpi (Pericarpium Citri Reticulatae) Shengma (Rhizoma Cimicifugae) Chaihu (Radix Bupleuri) Baizhu (Rhizoma Atractylodis Macrocephalae)
This formula was created by Li Dongyuan. It is a formula for treating internal injury diseases. In ancient formulas, only Huangqi (Radix Astragali) was used at one qian, while the other herbs were each used at three fen. Xue Lizhai commonly used Renshen (Radix Ginseng) and Huangqi (Radix Astragali) at one and a half qian each, Baizhu (Rhizoma Atractylodis Macrocephalae) at one qian, Danggui (Radix Angelicae Sinensis) at one qian, Chenpi (Pericarpium Citri Reticulatae) at seven fen, and Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri) at five fen each. Adjusting and adding/subtracting according to the condition yields miraculous and infinite effects. If the disease is severe, Renshen (Radix Ginseng) and Huangqi (Radix Astragali) may be increased to three or five qian, added according to the syndrome. Generally, the Spleen and Stomach prefer sweet flavors and dislike bitter ones; they favor tonification and oppose purgation; they prefer warmth and dislike cold; they favor unblocking and oppose stagnation; they favor ascending and dislike descending; they prefer dryness and oppose dampness. This formula aligns with these preferences.
A question arose: Since ancient times, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) has been praised as an infinitely beneficial remedy for all generations. What is its rationale? The answer is: It elucidates insights not previously expressed by predecessors, continuing the traditions of Zhang Zhongjing and Liu Wan'er, with profound significance. When people see fever, they immediately attribute it to external pathogenic factors such as Wind-Cold, Summer-Heat, or Dampness, believing that pathogens can only be resolved through dispersing methods. However, they fail to accurately distinguish between Wind-Cold, Summer-Heat, and Dampness to apply targeted treatments. Instead, they universally use exterior-resolving formulas, such as Jiu Wei Qiang Huo Tang (Nine-Ingredient Notopterygium Decoction), Bai Du San (Detoxicate Powder), or Shi Shen Tang (Ten-God Decoction). Even worse, they indiscriminately combine formulas like Liang Ge San (Cool the Diaphragm Powder) and Bai Hu Tang (White Tiger Decoction), leading to many deaths. Li Dongyuan deeply lamented this harm and established this formula, based on the principle that "where pathogenic factors gather, Qi must be deficient." Internal injuries are common, while external invasions are occasional. Even when external pathogens exist, they enter due to deficiency. By tonifying the middle and augmenting Qi, pathogens naturally retreat without needing direct attack. Attacking pathogens would further weaken the already deficient state, leading to imminent danger. If there is an external invasion but the internal injury is mild, appropriate herbs can be added to this base formula, allowing external pathogens to recede spontaneously. This is akin to a benevolent army, invincible in the world. Regarding fevers caused by irregular diet and overexertion, where Yang Qi of the Stomach becomes deficient and sinks into the Yin level, this is a self-induced illness due to Yang deficiency. Misdiagnosing this as an external invasion and using dispersing methods exacerbates the deficiency, causing significant harm. There is another type of fever caused by internal injury to True Yin, which resembles internal injury to Yang Qi. This requires tonifying True Yin, not using Si Wu Tang (Four Substances Decoction) or Kan Li Wan (Kan-Li Pill); details are found in *Xian Tian Yao Lun* (Essential Discussion on Pre-Heaven). The Heart and Lung are located above, the Kidney and Liver below, while the Spleen and Stomach reside in the Central Region, acting as the masters of Qi for the four Zang organs. The formless Qi of the Middle Jiao steeps and decomposes food and drink, governing ascending, descending, exiting, and entering. This is Pre-Heaven Qi, which also serves as the master of the Spleen. Post-Heaven Spleen Earth cannot function without Pre-Heaven Qi. This formula addresses the situation where Qi, due to fatigue, sinks into the Kidney and Liver, preventing clear Qi from ascending and turbid Qi from descending. Therefore, Shengma (Rhizoma Cimicifugae) is used to guide Qi upward via the right axilla, and Chaihu (Radix Bupleuri) guides Qi upward via the left axilla. Without the efficacy of Renshen (Radix Ginseng) and Huangqi (Radix Astragali), the lifting power would be insufficient. Thus, this formula tonifies the Pre-Heaven within the Post-Heaven.
A question arose: I observe that you frequently establish theories based on Pre-Heaven and Post-Heaven. I examined the diagrams of Pre-Heaven and Post-Heaven in the *I Ching*, such as Qian in the South, Kun in the North, Li in the East, and Kan in the West. These trigram positions seem incompatible with medical theory, yet you discuss them incessantly. What is the meaning? The answer is: Your question is peculiar. By Pre-Heaven, I refer to a trace of formless Fire Qi. By Post-Heaven, I refer to the有形 (form) body, including Zang-Fu organs, flesh, blood, skin, and fluids like saliva and mucus. Since it is called Pre-Heaven, Heaven had not yet formed at that time, so how could there be a diagram of Qian in the South and Kun in the North? Question: Then why did Fuxi establish this diagram? Answer: This is not the Pre-Heaven diagram, but the Zhong Tian (Middle Heaven) Bagua diagram. Heaven is above, Earth is below, the sun rises in the East, water originates in the West, wind and rain are in the sky, mountains and thunder are underground, and humans and all things occupy the center. I once saw Shao Yong arrange it thus, with numbers for the Zhong Tian Bagua. Today, only Wen Wang's Post-Heaven diagram is used: emerging from Zhen, balancing with Xun, meeting at Li, serving at Kun, speaking joyfully at Dui, battling at Qian, laboring at Kan, and completing at Gen. It corresponds to the twelve hours of spring/autumn and day/night to determine Yin and Yang, decide life and death, and deduce astronomy, geography, astrology, medicine, and divination, all following this diagram. As for Pre-Heaven, it is formless and invisible, corresponding to the "Emperor" who emerges from Zhen in the *I Ching*. "Shen" (Spirit) refers to the spirit that wondrously creates all things. The Emperor and Spirit are what I call the True Lord and True Master in *Xian Tian Yao Lun* (Essential Discussion on Pre-Heaven). They are originally formless, but names were reluctantly assigned to serve as the substance governing Pre-Heaven and the function circulating in Post-Heaven. Mr. Li Dongyuan uniquely grasped this essence. In Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), he used Chaihu (Radix Bupleuri) and Shengma (Rhizoma Cimicifugae) precisely to ascend and generate Pre-Heaven Qi within Spleen Earth, truly benefiting all generations. Hence my earnest exhortations. Everyone knows the human body relies on the Spleen and Stomach, but Pre-Heaven, hidden in formlessness, is ignored by the world. Thus, after establishing *Xian Tian Yao Lun* (Essential Discussion on Pre-Heaven), in *Hou Tian Lun* (Discussion on Post-Heaven), I expounded on Li Dongyuan's *Pi Wei Lun* (Treatise on the Spleen and Stomach), emphasizing Pre-Heaven formlessness as the core. Readers of *Pi Wei Lun* (Treatise on the Spleen and Stomach), upon reaching the phrase "humans are born from the Qi of water and grain," will understand that Clear Qi, Ying (Nutrient) Qi, Wei (Defensive) Qi, Yuan (Original) Qi, Gu (Grain) Qi, and Chun Sheng (Spring Ascending) Qi are all aliases of Stomach Qi. Food entering the stomach is like grain in a pot; without fire, it does not cook. The Spleen transforms food entirely relying on the formless Shaoyang Ministerial Fire steaming and decomposing in the Lower Jiao. If cold-cooling herbs are used at this time, food and drink cannot be transformed. The fire in the Spleen and Stomach, the fire in Earth, corresponds to "Fire in the Furnace" in Na Yin. To maintain furnace fire, coal must be added frequently, keeping it warm with hot ashes so the fire energy remains. Once exposed to cold water, it becomes dead ash. How then can one steam and decompose food or light candles? All around is hellish scenery; one must beware! The Classics say: "For exhaustion, use warmth; for deficiency, use warmth." This takes the meaning of warming and nourishing.
Li Dongyuan said: Qibo stated that labor and fatigue cause decline in form and Qi, insufficiency of Grain Qi, failure of the Upper Jiao to function, and blockage of the lower stomach, leading to heat in the Stomach. This heat steams the chest, causing internal fever. *Ju Tong Lun* (Treatise on Pain) states: Labor causes Qi consumption. Labor leads to panting and sweating, with Qi escaping internally and externally, hence Qi consumption. Unregulated emotions, irregular living habits, and any labor injury damage Qi. Qi deficiency leads to Fire hyperactivity; Fire hyperactivity attacks Spleen Earth. Since the Spleen governs the limbs, one feels fatigued, weak, reluctant to speak, panting and exhausted during movement, with surface fever, spontaneous sweating, and restlessness. During illness, one should sit quietly to nurture Qi, use Sweet-Cold herbs to drain Fire-Heat, use Sour herbs to collect scattered Qi, and use Sweet-Warm herbs to tonify Middle Qi. The Classic saying "For exhaustion, use warmth; for deficiency, use warmth" applies here. *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: A normal person with a large pulse indicates labor; an extremely empty pulse also indicates labor. The disease of labor presents with a large pulse, vexatious heat in hands and feet, worsening in spring/summer, and improving in autumn/winter. It is treated with Huangqi Jianzhong Tang (Astragalus Decoctum Medium Decoction). This also reflects the intent of warming. Humans are born from the Qi of water and grain; Clear Qi, Ying (Nutrient) Qi, Yuan (Original) Qi, Wei (Defensive) Qi, and Chun Sheng (Spring Ascending) Qi are all aliases of Stomach Qi. The Stomach Qi is the sea of water and grain. Food enters the Stomach, floating and overflowing with essence, transported upward to the Spleen. The Spleen scatters essence, returning it upward to the Lung. The Lung regulates water passages, transporting downward to the Bladder. Water essence distributes in four directions, flowing through the five meridians, harmonizing with the four seasons, maintaining the balance of Yin and Yang in the five Zang organs. If diet is irregular, or cold/heat inappropriate, the Spleen and Stomach are injured. Joy, anger, worry, and fear deplete Original Qi. Spleen and Stomach Qi declines, Original Qi is insufficient, and Fire alone thrives. This Fire is Yin Fire, originating in the Lower Jiao, the thief of Original Qi. Vigorous Fire consumes Qi, while mild Fire generates Qi. Fire and Original Qi cannot coexist; if one wins, the other loses. Spleen and Stomach Qi deficiency allows Qi to flow downward to the Liver and Kidney, termed "Chong Qiang" (Heavy Strength). Yin Fire attacks the Earth position, initiating Spleen syndromes: high breathing and panting, body heat and vexation, a洪大 (Surging-Large) pulse with headache, or unquenchable thirst. The skin cannot withstand Wind-Cold, generating chills and fever. Because Spleen and Stomach Qi flows downward, Grain Qi cannot ascend and float, failing the command of Spring generation. Without Yang to protect Ying and Wei, one cannot withstand Wind-Cold, generating chills and fever. All these result from insufficient Spleen and Stomach Qi. However, this differs significantly from external Wind-Cold syndromes. Internal injury to the Spleen and Stomach damages Qi; external Wind-Cold damages Form. Damage to the exterior results in excess, which is purged; damage to the interior results in deficiency, which is tonified. Sweating, purging, vomiting, and attacking are purging methods; warming, harmonizing, regulating, and nourishing are tonifying methods. If an internal deficiency disease is mistakenly diagnosed as an external excess syndrome and treated with purgation, it further depletes deficiency. Depleting the deficient and reinforcing the excess leads to death; such deaths are murders committed by physicians. So what should be done? One must use Pungent-Sweet-Warm agents to tonify the middle and ascend Yang to achieve recovery. The Classics say: "For exhaustion, use warmth; for deficiency, use warmth." Also: "Warmth can eliminate great heat." Bitter-Cold herbs must be strictly avoided as they damage the Spleen and Stomach. Now, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is established. Whether due to irregular eating and labor, dietary imbalance, excessive physical exertion, labor after eating, or eating after labor, all constitute internal injuries. Once the Spleen and Stomach are deficient, Lung Qi is first severed. Therefore, Huangqi (Radix Astragali) is used to benefit the skin and hair and close the interstices, preventing spontaneous sweating that would damage Original Qi. For shortness of breath and panting, Renshen (Radix Ginseng) is used to tonify. When Heart Fire attacks the Spleen, Zhi Gancao (Prepared Radix Glycyrrhizae) is used for its sweetness to drain great heat and tonify Original Qi in the Spleen and Stomach. For acute abdominal pain and severe deficiency with abdominal contraction, it should be used in larger amounts. The Classic says: "For urgency, use relaxation." Baizhu (Rhizoma Atractylodis Macrocephalae) is Pungent-Bitter-Warm, clearing heat in the Stomach and benefiting blood in the waist and umbilical region. Since Clear Qi of the Stomach sinks below, Shengma (Rhizoma Cimicifugae) and Chaihu (Radix Bupleuri) must be added to guide it, leading the Pungent-Sweet-Warm aromas of Huangqi (Radix Astragali) and Gancao (Radix Glycyrrhizae) upward. This can tonify dispersed Wei (Defensive) Qi and solidify the exterior. It also relaxes the tension of the Dai Mai (Girdle Vessel). Both herbs are Bitter-Ping, thin in flavor, Yang within Yin, guiding Clear Qi of the Stomach to ascend to the Yang pathways and the generating Qi of various meridians, nourishing the harmony of Spring Qi. When Qi is chaotic in the chest, with Clear and Turbid interfering, Chenpi (Pericarpium Citri Reticulatae) with the white pith removed is used to regulate it; as Clear ascends, Turbid descends spontaneously. Stomach Qi deficiency prevents ascending and floating; Yin Fire injures its generating Qi, causing severe depletion of Ying (Nutrient) Blood and failure of Ying Qi to nourish. Yin Fire flares up, burning day by day, reducing Blood and Qi daily. The Heart governs Blood; when reduced, the Heart lacks nourishment, causing chaos and vexation. Therefore, Danggui (Radix Angelicae Sinensis) is used to harmonize. If vexation persists, Dihuang Wan (Rehmannia Pill) is added to tonify Kidney Water; as Water flourishes, Heart Fire naturally descends. Palpating the body surface reveals heat indicating an exterior syndrome. Taking Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) for one or two doses induces slight sweating. This is not merely inducing sweat, but the natural sweating resulting from the harmony of Yin and Yang Qi.
If mental energy is short, double the dosage of Renshen (Radix Ginseng) and Wuzi (Fructus Schisandrae). For headache, add Manjingzi (Fructus Viticis). For headache with heavy phlegm, it is Taiyin Phlegm-Jue Headache; add Banxia (Rhizoma Pinelliae) and Tianma (Rhizoma Gastrodiae). For abdominal pain, add Baishao (Radix Paeoniae Alba). For aversion to cold and painful cold, add Guixin (Cortex Cinnamomi). For aversion to heat, preference for cold, and painful heat, add Huanglian (Rhizoma Coptidis). For abdominal pain with aversion to cold and a wiry pulse, Wood is overcoming Earth; Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment. Baishao (Radix Paeoniae Alba) is Sour, overcoming Wood within Earth as the sovereign herb. For a deep-thin pulse with abdominal pain, Lizhong Tang (Regulate the Middle Decoction) is the primary treatment. Ganjiang (Rhizoma Zingiberis) is Leaf-Hot, overcoming Water within Earth as the primary agent.
For pain below the navel, add Shudihuang (Prepared Radix Rehmanniae). If it does not resolve, it is severe Cold; add Rougui (Cortex Cinnamomi). Small abdominal pain often belongs to Kidney Qi Ben Tun (Rushing Pig); only Cinnamon drains Ben Tun, hence it is added. For hypochondriac pain or contraction under the ribs, add both Chaihu (Radix Bupleuri) and Baishao (Radix Paeoniae Alba). For heavy body and joint pain, or abdominal distension with spontaneous diarrhea, and a soggy-slow pulse, Dampness is excessive; Cangzhu (Rhizoma Atractylodis) and Houpo (Cortex Magnoliae Officinalis) are the primary treatments. For Wind-Dampness intertwining causing whole-body pain, add Qianghuo (Rhizoma Notopterygii), Fangfeng (Radix Saposhnikoviae), and Gaoben (Radix Ligustici Chuanxiong), prepared separately. Do not continue服用 after the disease resolves, as Wind herbs damage Human Original Qi.
In winter, if there is aversion to cold, fever, no sweat, and a floating-tight pulse, add Mahuang (Herba Ephedrae) and Guizhi (Ramulus Cinnamomi) to the base formula. (If Mahuang (Herba Ephedrae) is five fen, use Renshen (Radix Ginseng) and Huangqi (Radix Astragali) at one qian each.) In winter, if there is aversion to wind, fever, sweat, and a floating-slow pulse, add Guizhi (Ramulus Cinnamomi) and Baishao (Radix Paeoniae Alba). Shanghan (Cold Damage)必然 involves aversion to cold; Shangfeng (Wind Injury)必然 involves aversion to wind; Shangshi (Food Injury)必然 involves aversion to food. Shanghan aversion to cold is such that fierce fire cannot warm it, and heavy cotton cannot heat it. For internal injury, seeking warmth, wearing cotton, and applying warm fire removes the aversion. Internal injury from diet causes loss of taste and lack of desire to eat. In Shanghan, although one cannot eat, one still perceives taste. Labor-induced internal injury causes heavy body, tired limbs, painful joints, chest fullness, shortness of breath, and reluctance to speak. In contrast, Shanghan presents with headache in Taiyang, hypochondriac pain in Shaoyang, and eye pain in Yangming, unlike the lethargy and desire to lie down in internal injury. Shanghan fever feels like feathers brushing the skin, heat in the skin and hair. Internal injury fever is intense body heat, burning to the touch. The Right Qi Kou pulse is three times larger than the Left Ren Ying pulse. The Qi Kou pulse is urgent, large, and rapid, occasionally intermittent and choppy. Choppy is the native pulse of the Lung; intermittent indicates disconnected Qi, characteristic of Spleen-Stomach insufficiency. Large refers to Surging-Large; Surging-Large and rapid indicates Heart Fire punishing the Lung. Urgent means wiry-urgent, indicating Liver Wood accompanying Heart Fire to overcome Lung Metal. The Right Guan pulse belongs to the Spleen; among the five pulses, it is uniquely large and rapid, showing intermittence amidst rapidity. This suggests mild labor, irregular diet, improper cold/heat, damaging the Stomach pulse until it hides, revealing only the Spleen pulse. In external injury, the Ren Ying pulse is larger than the Qi Kou pulse.
Li Dongyuan described three methods of palpating heat. Light palpation reveals heat, heavy pressure reveals no heat: heat is in the skin and blood vessels. Heavy pressure between sinews and bones reveals steaming heat, light touch reveals no heat: heat is in the bone marrow. Light palpation reveals no heat, heavy pressure reveals no heat, but moderate pressure reveals heat: heat is above the sinews/bones and below the skin/flesh, i.e., in the muscles. Heat in the muscles is precisely the heat of internal injury from fatigue. For internal injury to True Yin, palpating heat has two types. Burning to the touch, feeling like roasting in the bones: True Yin deficiency in the Kidney. Burning to the touch, but feeling cold when pressing below the sinews/bones: True Yang deficiency in the Kidney. Red face indicates Yin excess below forcing Yang upward. Thirst indicates dried-up Kidney Water seeking self-rescue. Profuse expectoration of clear water-like phlegm indicates Kidney Water flooding upward as phlegm; mouth will not be thirsty. Expectoration of foamy phlegm indicates boiling water creating phlegm, burned by Yin Fire; mouth will be thirsty. Waist and hypochondriac pain indicate Kidney-Liver deficiency. Soles of feet burning like iron indicate exhaustion of Yongquan (KI1). Coldness below the knees indicates衰竭 of Mingmen (Gate of Life), leading to upper Qi panting. Chi pulse must be rapid: Yin Fire is vigorous. Rapid but forceless or nearly absent Chi pulse indicates True Yang decline. Bone pain like breaking indicates Kidney governs bones; bone decline allows Fire to prevail. This distinguishes Yang deficiency from Yin deficiency; within Yin deficiency, there are differences between True Yin and True Yang. Treatment methods are detailed in *Xian Tian Lun* (Discussion on Pre-Heaven).
A question arose: Zhu Danxi said people in the Southeast have Yang Qi that easily ascends and should not take Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Are people south of the Yangtze River truly all unsuitable for taking it? Answer: Here, Southeast refers to the Zang-Fu organs of people. The East belongs to the Liver, the South to the Heart. Those with Fire in the Liver and Heart should not take it, fearing Wood and Fire will become even more vigorous. If Huangdi asked questions about the four directions, and Qibo had abilities for four treatments, this refers to geographical positions. If one cannot take formulas for the Southeast, and the person has excess above, they must have deficiency below, with severe Kidney Qi deficiency. It is urgent to tonify the Pre-Heaven Original Qi of the North. In summary, Pre-Heaven and Post-Heaven cannot be strictly separated. Insufficiency of Yuan Yang in the Upper Jiao sinks into the Kidney; it should be taken from the lowest Yin. Insufficiency of True Yin in the Lower Jiao flies to the upper part; how can one not guide it back to its origin? Therefore, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is used together with Shenqi Wan (Kidney Qi Pill): morning dose tonifies Yang, evening dose tonifies Yin, mutually cultivating. The distinction of precedence and weight is known by the wise; no need for detailed explanation.
A question arose: In Shenqi Wan (Kidney Qi Pill), Dihuang (Radix Rehmanniae) is the sovereign. Does it risk clogging the diaphragm or harming the Spleen and Stomach?
Answer: Shenqi Wan (Kidney Qi Pill) contains only Kidmeridian herbs, with none mixed from the Spleen/Stomach meridian, entering the Kidney meridian directly. How could it clog the diaphragm? Medicines must clearly distinguish Yin/Yang and Water/Fire purity. Like the imperial court having six ministries, each has its affairs and personnel. Would you discuss tax collection with officials of the Heavenly Ministry? Question: If so, I mean the Kidney Water Ministry should not mix with the Spleen Household Ministry. Answer: By "not mixing," I mean Kidney Water herbs should not mix with Spleen Earth herbs; Spleen/Stomach herbs should not mix with Kidney herbs. For example, Sijunzi Tang (Four Gentlemen Decoction) is a Spleen meridian herb; mixing Dihuang (Radix Rehmanniae) into it causes clogging. Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) is a Kidney meridian herb; adding Renshen (Radix Ginseng) makes it mixed. Regarding Kidney and Spleen/Stomach, Earth and Water are originally one Qi. People know Earth as ground, but do not know Earth is also Water. From Heaven generating Water, where Water condenses, Earth begins. Solid Earth becomes Stone. After Kan (Water) in the Post-Heaven Bagua comes Gen (Mountain). Gen is Mountain and Earth; Gen Earth is Pre-Heaven Earth, the master within Water. Earth has no fixed position, parasitically growing with its mother, supplementing with its mother. Thus, to tonify Taiyin Spleen Earth, one must first tonify Shaoyang Ministerial Fire in the Kidney. If water and grain are in a pot, without fire underneath, they do not cook. Tonifying the Kidney means tonifying the Fire in the Kidney, requiring Bawei Wan (Eight-Ingredient Pill). Physicians who do not understand this and daily focus on Renshen (Radix Ginseng) and Baizhu (Rhizoma Atractylodis Macrocephalae) are not seeking the root. Earth's origin is Water. The world says tonifying the Kidney is better than tonifying the Spleen; I say tonifying the Spleen is better than tonifying the Kidney.