经曰∶水火者，阴阳之征兆也。肾为坎卦，一阳居二阴之间，故须阴得其平，然后阳藏
于密
，童年知识已开，阴精早泄，此致病之大端。及壮，血气方刚，尚不觉其所苦，人四十而阴
气自半，起居日衰，精神不充，蝉联疾作。诊脉尺虚细涩，寸关大于平时，按尺为肾部，脉
见细涩，肾虚奚疑。寸关大于平时，阴弱阳浮之象耳。夫医之治病，不以用补为难，而以分
别水火气血为难。冯氏书云∶小病治气血，大病治水火。盖气血者，后天有形之阴阳也。水
火者，先天无形之阴阳也。太极之理，无形而生有形，是治大病，可不以水火为首重耶。请
以不寐言之，人知其为心病，而不知其为肾病也。心虽为神舍，而坎离尤贵交通。越人以阳
不入阴，令人不寐，岂非水火未济，坎离失交之故乎，内经又有头痛巅疾，下虚上实，过在
足少阴巨阳之语。形容厥晕，病机最切。方书
称风、称火、称痰，漫无定见。景岳师其意，以为无虚不作眩，治当上病疗下，滋苗灌根。
精矣精矣。暂服煎剂，再订丸方。王道无近功，内观颐养为要。旧患眩晕，怔忡不寐，遗泄
，本属心肾两亏，水火失济，曾订煎丸，服经十载。兹诊脉候平和，精神矍铄，此亦颐养之
功，非全关草木之力也。惟食多尚难运化，腰膂时痛，遗泄间或有之。药物所需，仍不可缺
。考古人用药，有攻病保躬两途，攻病则或凉或热，当取其偏，保躬则适其寒温，宜用其平
。盖温多恐助相火，精关不藏，润多虑伤脾阳，坤元失健，如云食蜜，便即溏泻。脾虚不胜
润滑之征。青娥丸固能治肾虚腰痛，但故纸胡桃味辛性温，久而增气，恐其助火，且常服丸
药，亦须分别气候。夏令炎热，远刚近柔，以防金水之伤。冬令严寒，远柔近刚，以遂就温
之意。将交夏至，一阴初变，元精不足之时，商以益阴保金，兼调脾胃，秋季再为斟酌。
《黄帝内经》说：水和火，是阴阳的外在征象。肾对应八卦中的坎卦，一阳爻居于两个阴爻之间，因此必须使阴气保持平衡，阳气才能潜藏固密。如果在童年时期智力发育过早，导致阴精提前耗泄，这是致病的主要原因。到了壮年，虽然血气正旺盛，尚不觉得痛苦，但人到了四十岁，阴气自然减半，日常生活能力日渐衰退，精神不再充沛，疾病便接连发作。诊察脉象，尺部脉虚细涩，寸部和关部的脉比平时大，按尺部对应肾脏，脉象出现细涩，肾虚无疑。寸部和关部脉象比平时大，这是阴弱阳浮的表现。
医学治疗疾病，难处不在于使用补法，而在于分辨水火与气血的关系。冯氏的书中说：小病治疗气血，大病治疗水火。因为气血，是后天有形的阴阳；水火，是先天无形的阴阳。太极的道理，是从无形生出有形，所以治疗大病，能不把水火放在首位吗？以失眠为例，人们只知道它是心病，却不知道它也是肾病。心虽然是神志居住的地方，但坎（肾）与离（心）尤其需要交通互济。扁鹊说过，阳气不能入于阴分，会导致人失眠，这难道不是水火未能既济、坎离失去交泰的缘故吗？《黄帝内经》又有“头痛和头顶部的疾病，是由于下虚上实，病位在足少阴肾经和足太阳膀胱经”的说法。这形容厥逆眩晕的病机最为贴切。医书常称风、称火、称痰，没有固定的见解。张景岳继承了这个意思，认为没有虚证就不会产生眩晕，治疗应当上病下治，滋养根本。说得真好啊。暂时服用汤剂，再制定丸药方子。王道疗法没有立竿见影的功效，内省修养才是关键。
旧有的眩晕、心悸、失眠、遗精滑泄，本来属于心肾两亏，水火失济，曾经制定过汤剂和丸药，服用了十年。现在诊察脉象平和，精神矍铄，这也是修养的功劳，并不完全依靠药物的力量。只是吃得多了还难以运化，腰背时常疼痛，遗精偶尔还有发生。药物所需，仍然不可缺。考察古人的用药，有攻治病邪和保养身体两条途径。攻治病邪则或凉或热，应当取其偏性；保养身体则适应寒温，宜用平和之品。因为温热药多恐怕助长相火，导致精关不固；滋润药多担心损伤脾阳，导致脾胃运化功能失职，比如吃蜂蜜就会立即腹泻，这是脾虚不能耐受润滑的表现。青娥丸固然能治疗肾虚腰痛，但补骨脂、胡桃肉味辛性温，久服会增强其气，恐怕助长火势，而且常服丸药，也必须区分季节气候。夏季炎热，远离刚燥近于柔润，以防伤及肺金和肾水。冬季严寒，远离柔润近于刚燥，以顺应趋暖的意愿。即将进入夏至，一阴初生，正是元精不足的时候，商量着采用益阴保肺金，兼调脾胃的方法，等到秋季再行斟酌。
The *Classic of Internal Medicine* states: Water and fire are the manifestations of Yin and Yang. The Kidney corresponds to the Kan trigram, with one Yang line situated between two Yin lines; therefore, Yin must be balanced so that Yang can be stored securely. If intellectual activity opens up too early in childhood, leading to premature leakage of Yin essence, this is a major cause of disease. In adulthood, although Qi and Blood are vigorous, one may not yet feel the suffering. However, by age forty, Yin Qi naturally halves, daily living capacity declines, spirit becomes insufficient, and diseases occur in succession. Pulse diagnosis reveals the Chi (Cun-Kuan-Chi) position as deficient, fine, and choppy, while the Cun and Guan positions are larger than usual. Palpating the Chi position corresponds to the Kidney region; a fine and choppy pulse leaves no doubt about Kidney deficiency. The Cun and Guan positions being larger than usual is a sign of weak Yin and floating Yang.
In treating diseases, the difficulty for physicians lies not in the use of tonification, but in distinguishing between Water/Fire and Qi/Blood. Feng's book states: "Treat Qi and Blood for minor illnesses; treat Water and Fire for major illnesses." This is because Qi and Blood are the postnatal, tangible Yin and Yang, whereas Water and Fire are the prenatal, intangible Yin and Yang. The principle of Taiji dictates that the tangible arises from the intangible; thus, when treating major illnesses, should we not prioritize Water and Fire? Let us take insomnia as an example. People know it as a Heart disease, but do not realize it is also a Kidney disease. Although the Heart is the residence of the Spirit, communication between Kan (Kidney) and Li (Heart) is particularly precious. Bian Que stated that if Yang does not enter Yin, it causes insomnia; is this not due to the failure of Water and Fire to achieve Ji Ji (Completion/Interaction), and the loss of exchange between Kan and Li? The *Internal Classic* also mentions: "Headache and disorders of the vertex are caused by deficiency below and excess above, affecting the Foot Shaoyin (Kidney) and Foot Taiyang (Bladder) meridians." This description fits the pathogenesis of Jue (reversal) and dizziness most accurately. Medical texts often attribute these to Wind, Fire, or Phlegm, lacking fixed views. Zhang Jingyue inherited this idea, believing that "no dizziness occurs without deficiency," and treatment should address the lower body for upper symptoms, nourishing the root. Excellent, excellent. Temporarily take decoctions, and later formulate pills. The Way of Kings yields no immediate results; introspection and nurturing are essential.
Previous conditions of dizziness, palpitations, insomnia, and seminal emission originally belonged to dual deficiency of the Heart and Kidney, with Water and Fire failing to interact. Decoctions and pills were prescribed previously and taken for ten years. Now, the pulse is peaceful, and the spirit is vigorous; this is also the merit of nurturing, not solely dependent on herbal power. However, excessive food intake remains difficult to transform, the waist and back occasionally hurt, and seminal emissions still occur intermittently. Medicinal requirements remain indispensable. Examining ancient medication practices, there are two paths: attacking disease and preserving the body. Attacking disease involves using cold or hot properties, taking advantage of their bias; preserving the body requires adapting to cold and heat, using balanced properties. Excessive warmth may assist Ministerial Fire, causing the Essence gate to lose control; excessive moisture may damage Spleen Yang, impairing Kun Yuan (Spleen/Stomach) transformation, such as honey causing loose stools immediately, indicating Spleen deficiency unable to tolerate lubrication. Qing'e Wan can indeed treat Kidney deficiency lumbar pain, but Gu Zhi (Psoraleae Fructus) and Hu Tao Ren (Juglandis Semen) are acrid and warm; long-term use increases their Qi, potentially aiding Fire. Furthermore, long-term pill consumption must consider seasonal climates. In summer heat, avoid rigid/dry and approach soft/moist to prevent injury to Metal (Lung) and Water (Kidney). In winter cold, avoid soft/moist and approach rigid/dry to follow the intent of seeking warmth. As Summer Solstice approaches, one Yin begins to change, a time of insufficient Original Essence. It is proposed to benefit Yin and protect Metal, while regulating the Spleen and Stomach, to be reconsidered in autumn.