凡病偏着于一处，必有致病之本，在于脏腑之中，宜求其本而治之，非可泛治也。即如
鼻生
息肉，手指麻木胀痛，症虽见于极杪，根乃发于至深。何则?以其气行于专经而不旁及也。
若外邪所伤，岂能如是之专乎?亦有外邪伤于专部而为病者，此必滞入血脉，发为肿痛，则
有之。若气分之病，而偏着不移，久而不愈，或时愈时发者，未有不根于内者也。或邪气由
脏腑而溢于本经，或脏腑不足，以致经气不充，而邪气乘虚中之也。各视兼证，以辨虚实而
治之。凡由五内外溢者，大致于神明之间必有变动，或饮食、二便有异也。
世但知大便滑利之伤气，而不知小便滑利之更伤气也；但知小便频数之伤阴，而不知以
二苓
、泽泻、木通等强利小便，而小便并不能利者之更伤阳也。近日医家，惑于前人治病以小便
清利为快捷方式之语，不拘何病，率用二茯、泽泻，往往真气下脱，邪气内陷，缠绵不解。殊不
知前人之意，是谓三焦气化通畅，即自小水通行，所谓里和也，以小便清利为里和之标验
也。后人只当求所以和里之法，不当但利小便。盖膀胱贴切命门，为命门元气发嘘之第一关
隘。《内经》谓∶三焦膀胱，应于毫毛腠理。以元气行于膀胱，充于三焦，达于毛理也。今
泻膀胱，是直泻元气发嘘之根矣。故阴虚之人不可利小便，阳虚之人尤不可利小便。
钱仲阳曰∶小热解毒，大热利小便。李东垣曰∶肺受热邪，津液气化之源绝，则寒水断
流，
膀胱受湿热，癃闭约束，则小便不通，宜木通以治之。朱二允曰∶小便利，则诸经火邪皆从
小便而下降矣。夫火蓄于内，有宜通大便者，是热结于肠胃之渣滓，在浊道，不在清道也；
有宜利小便者，是热邪淫溢于三焦之血脉，清道为热浊所搏，宜以养阴之药，如生地、花粉
之类，复其津液，使热邪浮动，从血脉退出于津水之中，而以渗药利之而俱下，故小便利者
，阴生而火退也。亦有热邪清浊两结者，张子和有玉烛散，陶节庵有黄龙汤，皆四物、承气
合方，胡宗宪更谓先养阴活血，使毒不沾连于肝，然后可以承气下之。是又分先后治法也。
故水蓄于内，宜利小便；火蓄于内，亦不外利小便。
仲景治伤寒蓄水，用五苓散，多饮暖水者，岂所蓄之水不足利耶?盖此证虽云蓄水，亦
兼蓄
热，水与热各搏于一偏，泽、茯、暖水并进，使两邪一齐并去，不致水去热起。且其时表邪
未净，方中桂枝既宣膀胱气化，亦以清理表邪也。邪水不能作汗，必借暖水之精，以蒸动作
汗也，手法之密何如耶?以一方一法，而两解里邪，一解表邪，手法之迅何如耶?
古人利小便法，不可胜纪，大致不外养阴、理气两途，是利小便之先，正有大段事在
，而
小便之利，特其征验耳!今人不求所以利小便之故，不拘何病而混用之；又不求所以利小便
之法，仅取泽、茯而直用之，在外感则邪气内陷，在内伤则真阳下泄，抑更有丧心之说焉。
小便一利，表气乍陷，升气乍匿，病形必为之暂隐，遂指为病减，以欺病家，旋即推手，以
卸祸于后来之医也。误用麻、桂而汗脱，误用硝、黄而泄脱，世皆知之；误用泽、茯而渗脱
，独无有知者，以其虽用渗药，而小便不必见利，元气脱于无形故也。此祸近日儿科尤甚，
不问何病，一利之后，垂头丧气，中气不续，不能自言，旋变喘促；更谓气拥而破降之，遂
四肢微掣，目胞下垂，额冷汗出，而魂不返矣。大抵小儿病，平日多是风寒、乳滞，或久卧
湿褥，身伤于湿也；夏月拥抱太久，是大人身上热气、汗气，逼入小儿身中、腹中也。治宜
宣开疏化，佐以清降，其渗利敛涩，皆未可轻试。
凡是疾病偏注于身体某一处，必定有导致疾病的根本原因，位于脏腑之中，应当探求其根本而治疗，不能泛泛地治疗。就像鼻部长息肉、手指麻木胀痛，症状虽然表现在极细微之处，病根却发源于极深的地方。为什么呢？因为邪气行走在特定的经脉而不波及他处。如果是外邪所伤，难道能如此专一吗？也有外邪伤害特定部位而致病的，这一定是邪气滞留进入血脉，引发肿痛，这种情况是存在的。如果是气分方面的疾病，却偏注不移，久治不愈，或者时好时发，没有不是根源于体内的。或者是邪气由脏腑溢出到本经，或者是脏腑虚弱，导致经气不充盈，邪气乘虚侵入。根据各种兼证，来辨别虚实并治疗。凡是邪气由五脏六腑溢出的，大致在神明的变化中必有变动，或者饮食、大小便有异常。
世人只知道大便滑利会损伤正气，却不知道小便滑利更损伤正气；只知道小便频数会损伤阴液，却不知道用茯苓、猪苓、泽泻、木通等药强行利小便，结果小便并不能通畅，反而更损伤阳气。近日医家，被前人“治病以小便清利为快捷方式”的说法迷惑，不管什么病，都普遍使用二茯（茯苓、猪苓）、泽泻，往往导致真气下脱，邪气内陷，缠绵难愈。他们不知道前人的意思，是说三焦气化通畅，自然从小便通行，这就是所谓的“里和”，是以小便清利作为“里和”的标志验证。后人只应当寻求调和内部的方法，不应当仅仅利小便。因为膀胱紧贴命门，是命门元气呼出吸入的第一道关隘。《内经》说：三焦和膀胱，对应毫毛腠理。是因为元气行于膀胱，充盛于三焦，通达于皮毛。现在泻膀胱，就是直接泻掉元气呼出吸入的根本。所以阴虚的人不可利小便，阳虚的人尤其不可利小便。
钱乙说：小热毒宜解毒，大热宜利小便。李东垣说：肺受热邪，津液气化的源头断绝，则寒水断流；膀胱受湿热，癃闭约束，则小便不通，宜用木通来治疗。朱二允说：小便利，则各经的火邪都从小便下降排出。火邪蓄积于体内，有的适宜通大便，这是热结在肠胃的糟粕，在浊道，不在清道；有的适宜利小便，这是热邪淫溢在三焦的血脉，清道被热浊阻滞，适宜用养阴的药物，如生地、天花粉之类，恢复其津液，使热邪浮动，从血脉退出于津水之中，再用渗湿药利之而一起下行，所以小便利，阴生而火退。也有热邪与清浊之气两相结聚的，张子和有玉烛散，陶节庵有黄龙汤，都是四物汤与承气汤合方，胡宗宪更说先养阴活血，使毒邪不牵连肝脏，然后可以用承气汤攻下。这又是分先后治疗的法则。所以水蓄积于内，宜利小便；火蓄积于内，也不外乎利小便。
仲景治疗伤寒蓄水证，用五苓散，让患者多饮暖水，难道是所蓄积的水不足以利吗？大概这个证候虽然叫蓄水，也兼蓄热，水与热各自搏结在一侧，泽泻、茯苓、暖水并进，使两种邪气一齐去除，不至于水去热起。而且此时表邪未净，方中的桂枝既宣通膀胱气化，也用来清理表邪。邪水不能作汗，必须借助暖水的精气，以蒸腾作用出汗。手法多么严密啊！用一方一法，同时解除里邪，又解除表邪，手法多么迅速啊！
古人利小便的方法，不可胜数，大致不外乎养阴、理气两条途径，这是在利小便之前，正有大段功夫要做，而小便的通利，只是其中的征验罢了！今人不探究利小便的缘故，不管什么病都混用；又不探究利小便的方法，仅取泽泻、茯苓而直接使用，在外感病中则导致邪气内陷，在内伤病中则导致真阳下泄，更有丧心病狂的说法存在。小便一利，表气突然下陷，升发之气暂时隐匿，病症表现必然暂时隐退，于是指为病情减轻，以此欺骗病人家属，随即推卸责任给后来的医生。误用麻黄、桂枝导致汗脱，误用芒硝、大黄导致泄脱，世人都知道；误用泽泻、茯苓导致渗脱，唯独没有人知道，因为虽然用了渗湿药，但小便不一定见利，元气在无形中脱失的缘故。这种祸害近日在儿科尤为严重，不问什么病，一旦利小便后，患儿垂头丧气，中气接续不上，不能说话，随即变为喘促；更有人说气拥滞而用破降之法，于是四肢轻微抽搐，眼睑下垂，额头冷汗出，魂魄不归了。大抵小儿的病，平日多是风寒、乳食停滞，或久卧湿褥，身体受伤于湿气；夏天拥抱太久，是大人身上的热气、汗气，逼入小儿身体、腹部中。治疗宜宣开疏化，佐以清降，那些渗利收敛固涩的药，都不可轻易尝试。
In all diseases that localize to a specific area, there must be a root cause located within the Zang-Fu organs. One should seek the root and treat it accordingly, rather than treating generically. For instance, nasal polyps or numbness and distending pain in the fingers: although the symptoms appear at the most superficial extremities, the root originates from the deepest levels. Why is this? Because the pathogenic factor travels along a specific meridian without spreading elsewhere. If injured by external pathogens, how could it be so localized? There are cases where external pathogens injure a specific part causing disease; this occurs when stagnation enters the blood vessels, resulting in swelling and pain. However, for disorders of the Qi level that localize persistently, fail to heal over time, or recur intermittently, they invariably have an internal root. This may be due to pathogenic factors overflowing from the Zang-Fu into their corresponding meridians, or due to deficiency of the Zang-Fu leading to insufficient meridian Qi, allowing pathogens to invade the void. Treatment depends on observing accompanying symptoms to differentiate excess and deficiency. Generally, when pathogens overflow from the Zang-Fu, there are changes in Shen (Spirit/Mind), manifesting as abnormalities in diet, urination, or defecation.
The world knows only that slippery diarrhea damages Qi, but does not know that slippery diuresis damages Qi even more; it knows that frequent urination damages Yin, but does not know that using strong diuretics such as Poria (Fuling, 茯苓), Alisma (Zexie, 泽泻), and Akebia (Mutong, 木通) which fail to promote urination, damages Yang even more. Recently, physicians have been confused by the saying that "promoting clear and smooth urination is a quick method for treating disease." Regardless of the condition, they indiscriminately use Poria (Fuling, 茯苓) and Polyporus (Zhuling, 猪苓) along with Alisma (Zexie, 泽泻). This often leads to the collapse of True Qi sinking downward and pathogens sinking inward, resulting in lingering, unresolved conditions. They do not understand that the ancients' intent was that when the Qi transformation of the Sanjiao (Triple Burner) is smooth, urine flows naturally; this is called "Harmony of the Interior" (Li He). Clear and smooth urination is merely a sign of this harmony. Later generations should seek methods to harmonize the interior, not merely promote urination. The Bladder is closely attached to the Mingmen (Gate of Vitality); it is the first pass where the Yuan Qi (Original Qi) of the Mingmen exudes and inhales. The *Nei Jing* (Inner Canon) states that the Sanjiao and Bladder correspond to the hair pores and interstices. This is because Yuan Qi circulates in the Bladder, fills the Sanjiao, and reaches the skin and hair. Now, draining the Bladder is directly draining the root of Yuan Qi's exhalation. Therefore, those with Yin deficiency should not undergo diuresis, and those with Yang deficiency especially should not.
Qian Yizhi said: For minor heat-toxins, resolve toxicity; for major heat, promote urination. Li Dongyuan said: When the Lung is affected by heat pathogens, the source of fluid metabolism and Qi transformation is cut off, causing cold water flow to cease; when the Bladder is affected by damp-heat, causing retention and constriction, leading to inability to urinate, Mutong (Akebia Caulis, 木通) should be used. Zhu Eryun said: When urination is smooth, fire pathogens from all meridians descend and exit via the urine. Fire accumulating internally may require unblocking the large intestine if heat is bound in the gut residues (turbid pathway, not clear pathway); or it may require promoting urination if heat pathogens overflow into the blood vessels of the Sanjiao, blocking the clear pathway. In such cases, Yin-nourishing herbs like Rehmannia (Shengdi Huang, 生地) and Trichosanthes Root (Tian Hua Fen, 花粉) should be used to restore fluids, making the heat pathogen float and retreat from the blood vessels into the fluid medium, then drained out together with diuretic herbs. Thus, smooth urination generates Yin and retards Fire. There are also cases where heat and turbidity bind together. Zhang Zhongjing had Yuzhu San, and Tao Jie'an had Huanglong Tang, both combining Siwu Tang (Four Substances Decoction) and Chengqi Tang (Order the Qi Decoction). Hu Zongxian further stated that one should first nourish Yin and invigorate blood to prevent toxins from adhering to the Liver, before using Chengqi Tang to purge. This represents sequential treatment methods. Thus, water accumulation internally requires promoting urination; fire accumulation internally also essentially involves promoting urination.
Zhang Zhongjing treated Cold Damage water accumulation with Wuling San (Five-Ling Powder), advising patients to drink warm water abundantly. Was the accumulated water insufficient to be drained? Actually, this syndrome, though called water accumulation, also involves heat accumulation. Water and heat each bind to one side. Using Alisma (Zexie, 泽泻), Poria (Fuling, 茯苓), and warm water together allows both pathogens to be expelled simultaneously, preventing heat from rising after water is removed. Moreover, since exterior pathogens were not yet cleared, Guizhi (Cinnamon Twig, 桂枝) in the formula both promotes Bladder Qi transformation and clears exterior pathogens. Pathogenic water cannot induce sweating; it must borrow the essence of warm water to vaporize and induce sweat. How meticulous is this technique! Using one formula and method to resolve interior pathogens while also resolving exterior pathogens—how rapid is this approach!
Ancient methods for promoting urination are countless, generally falling into two categories: nourishing Yin and regulating Qi. Before promoting urination, substantial work must be done; smooth urination is merely a verification sign. Today's physicians do not seek the reason for promoting urination, applying it indiscriminately to any disease; nor do they seek the method, using only Alisma (Zexie, 泽泻) and Poria (Fuling, 茯苓) directly. In exterior contraction, this causes pathogens to sink inward; in interior injury, it causes True Yang to leak downward. Worse still are absurd theories. Once urination is promoted, Wei Qi suddenly sinks, ascending Qi hides, and symptoms temporarily vanish. Physicians claim the disease has improved, deceiving the patient's family, then shirk responsibility to subsequent doctors. Everyone knows that misusing Mahuang (Ephedra Herb, 麻黄) and Guizhi (Cinnamon Twig, 桂枝) causes sweating collapse, and misusing Xiaoshi (Mirabilite, 芒硝) and Dahuang (Rhubarb Root, 大黄) causes purgative collapse. But no one knows about "seeping collapse" from misusing Zexie (Alisma, 泽泻) and Fuling (Poria, 茯苓). Although seeping herbs are used, urination may not visibly increase; Yuan Qi collapses invisibly. This disaster is particularly severe in pediatrics today. Regardless of the disease, once diuresis is applied, the child becomes listless, Middle Qi fails, speech ceases, and wheezing ensues. Physicians then attribute this to Qi stagnation and use descending/purging methods, leading to slight convulsions, drooping eyelids, cold sweat on the forehead, and loss of Hun (Ethereal Soul). Generally, childhood illnesses are mostly Wind-Cold, milk stasis, or prolonged lying on wet mats causing dampness injury. Summer excessive hugging transfers adult body heat and sweat qi into the child's body and abdomen. Treatment should focus on dispersing, opening, and transforming, assisted by clearing and descending. Seeping, draining, astringent, and binding herbs should never be lightly tried.