愚按李东垣谓补肾不如补脾。许学士谓补脾不如补肾。二贤着论。各有深意。而世之医
者
。不分肾之有两议之各殊则曰二者皆是也。岂知东垣之说。盖谓肾药膏腻。虽优于肾。特妨
于
脾。不如健补中气以资生化。饮食既充。精血自旺。由是脾获补而俾肾受益。此言肾者。乃
左肾也。至叔微之说。乃谓脾气虚弱。不能转输。脾气虚寒。不能生长。良因母气不充。子
脾失资。而世医仅扶中气。藐不见效。以故立法补母。特创四神二神之属。温命门之火。滋
生戊己。寻源究本。迥绝常法。此言肾者乃右肾也。故肾有两而治各不同。夫东垣补脾之法
。固诚善。然特为肾未伤而独脾弱者论也。设使精血衰耗。阴虚发热。恐非壮水无以救燎原
。非补肾无以固根 。而亦可以迂缓之剂。借称王道。优游望效。独支中气已乎。虽然虚
痨损肾。即脾气亦为之亏矣。法不能舍脾而专治肾者。故苦寒黄柏知母之属。甘寒二冬玄参
之
属。益见非阴虚所宜。而适以戕。阴而已。六味丸虽曰补肾。其所用山药茯苓石枣。乃兼益
脾之品。熟地固云膏腻。而假以蒸晒火力。尤于胃气无犯。未有先犯胃气。更能为之运布药
力以施于四藏者是六味丸补兼脾肾不待智者而
知之矣。其右肾真阳不足。而为神昏气怯。动作喘乏。或畏寒禁冷。阳事不举。或脾胃虚寒
。饮食少进。或呕恶痞胀。脐腹沉痛。或大便不实。吐利频作历历固属脾病。实因母虚所致
俱宜益火之源。而培右肾之真阳法。无逾此也。窃意灵枢素难。字字皆阴阳奥义。语语悉水
火玄机。千载而下。能通其说而会其真者。在晋有王太仆。在唐有许叔微。在明有薛立斋张
景岳。寥寥数子。悟道独真。阐命门之蕴。穷水火之辨。立论敷治大越诸贤。其他前辈虽能
穷谈阴阳水火之理。及着之施行渺无定识。率多附会根据违。矫强立言。况自刘守真主火之说
。行而假热者受害朱丹溪以苦寒为补阴而肾虚者丧命。然东垣老人垂十六字之训。谓实火
可
泻。芩连之属。虚火可补。参 之属。厘晰虚实。葆和脾胃。不至混剂误世。差强二
子一着。而独未见敷扬阴阳水火之义。洵缺陷事。至伤寒辨惑。犹为有功于世也。张景岳有
云。使刘朱之言不息。则轩岐之泽不彰。是诚斯道之丈魔。生民之厄运也。奈何斯世昧识
圆机。偏主刘朱。争相宗尚戕伐生命。枉害无辜。长梦莫醒。此景岳所以力辟邪说。宣明正
教。而独毅然不能已于好辨也。余因而有感焉。
我考察李东垣的观点，认为补肾不如补脾。许叔微（许学士）则认为补脾不如补肾。这两位贤者的论述，各有深意。然而世间的医生，分不清肾脏有左、右之分，也不了解两者的差异，便说“两者都是对的”。哪里知道李东垣的说法，是指肾药质地膏腻，虽然对肾有益，但特别妨碍脾胃的功能。不如健运并补益中气，以资助气血生化之源。饮食既然充足，精血自然旺盛，由此脾得到补益，从而使肾也受益。这里所说的“肾”，指的是左肾。
至于许叔微的说法，是指脾气虚弱，不能转输；脾气虚寒，不能生长。这是因为母气（肾气）不充盛，导致子脏（脾）失去资助。而世间的医生仅仅扶持中气，往往不见效果，因此创立了补母的方法，特别创制了四神丸、二神丸之类的方剂，温补命门之火，滋生戊己（脾土），寻源究本，完全不同于常规治法。这里所说的“肾”，指的是右肾。所以肾脏分左右，治疗方法各不相同。
李东垣补脾的方法，固然确实很好，但这只是针对肾未受损而单独脾弱的情况而言的。假如精血衰耗，阴虚发热，恐怕不用壮水（滋补肾阴）的方法无法扑灭燎原之火，不用补肾的方法无法固护根本。难道可以用缓慢温和的药剂，自称王道之治，悠闲地等待疗效，仅仅支撑中气吗？
虽然虚劳损伤肾脏，脾气也会随之亏损，但治疗法则不能舍弃脾而专门治肾。因此，像黄柏、知母这类苦寒药物，以及天冬、麦冬、玄参这类甘寒药物，越发不适合阴虚患者使用，反而只会伤害阴气罢了。六味丸虽然说是补肾，但它所用的山药、茯苓、山茱萸（原文作石枣，通山茱萸或指代相关补益品，此处依语境及六味地黄丸组成，通常指山茱萸或泛指补脾之品，结合后文“兼益脾”，保留原词或意译，此处按原文实体提取逻辑，翻译时保留原意），是兼具补益脾脏作用的药材。熟地黄虽然膏腻，但经过蒸晒炮制，尤其不会侵犯胃气。没有先侵犯胃气，又能帮助运布药力施于五脏的，只有六味丸。六味丸补益脾肾，是不需要智者也能知道的道理。
如果是右肾真阳不足，导致神志昏沉、气短怯弱，动作时气喘乏力，或者畏寒怕冷，性功能减退（阳事不举），或者脾胃虚寒，饮食减少，或者呕吐恶心、胸脘痞闷胀满，脐腹沉重疼痛，或者大便不成形，上吐下泻频繁发生。这些现象虽然确实属于脾病，但实际上是因为母脏（肾）虚损所致。都应当益火之源（温补肾阳），培补右肾的真阳，没有比这更好的方法了。
我私下认为，《灵枢》和《素问》（即《黄帝内经》），字字都是阴阳的奥妙义理，句句都是水火关系的玄机。千年之下，能通晓其学说并领会真谛的人，晋代有王冰（王太仆），唐代有许叔微，明代有薛立斋、张景岳。寥寥数人，领悟大道独为真切，阐发命门的蕴藏，穷尽水火的辨析，立论施治大大超越了其他贤者。其他前辈虽然能穷尽谈论阴阳水火的道理，但落实到施行上却缺乏确定的见识，大多依附根据，违背常理，勉强立论。况且自从刘完素（刘守真）主张“火热论”以来，假热证的患者受害；朱丹溪用苦寒药作为补阴之法，导致肾虚者丧命。
然而，李东垣老人留下了十六字的训诫：实火可以泻除，用黄芩、黄连之类；虚火可以补益，用人参、黄芪之类。清晰分辨虚实，保养和调脾胃，不至于混淆药剂误害世人，这勉强胜过刘、朱二人一筹。但他唯独没有发扬阴阳水火的深义，确实是缺陷之事。不过，《伤寒辨惑》一书，还是对世间有功的。
张景岳曾说：“如果刘完素、朱丹溪的言论不停止，那么轩辕岐伯（中医始祖）的恩泽就不能彰显。”这确实是医学道路上的恶魔，百姓的厄运啊。无奈世间之人不明识圆融之机变，偏执信奉刘、朱之说，争相推崇，残害生命，枉杀无辜，长梦不醒。这就是张景岳之所以极力驳斥邪说，宣扬正统教义，独自毅然不能停止好辩的原因。我因此有所感慨。
I have examined Li Dongyuan's view that tonifying the spleen is superior to tonifying the kidney. Xu Shumi (Scholar Xu) argued that tonifying the kidney is superior to tonifying the spleen. Both sages presented their arguments with profound intent. However, physicians of the world fail to distinguish between the left and right kidneys and do not understand their differences, simply claiming "both are correct." They do not realize that Li Dongyuan's statement refers to the fact that kidney-tonifying medicines are often rich and cloying; although beneficial to the kidney, they specifically hinder the spleen. It is better to strengthen and tonify the middle qi (Middle Jiao Qi) to aid the source of transformation and transportation. Once dietary intake is sufficient, essence and blood will naturally flourish. Thus, by tonifying the spleen, the kidney benefits as well. Here, "kidney" refers to the left kidney.
As for Xu Shumi's theory, it posits that when spleen qi is weak, it cannot transport and transform; when spleen qi is deficient and cold, it cannot grow and produce. This is due to the insufficiency of the mother qi (Kidney Qi), causing the child organ (Spleen) to lose its support. Physicians of the world merely attempt to support the middle qi but often see no effect. Therefore, they established methods to tonify the mother, creating formulas such as Six Spirit Pill (Sishen Wan) and Two Spirits Pill (Ershen Wan). These warm the fire of the Mingmen (Gate of Life), generate Earth (Spleen/Stomach), seek the root, and differ entirely from conventional methods. Here, "kidney" refers to the right kidney. Thus, the kidney has left and right aspects, and treatments differ accordingly.
Li Dongyuan's method of tonifying the spleen is indeed excellent, but it applies specifically to cases where the kidney is not damaged and only the spleen is weak. If essence and blood are depleted, leading to yin deficiency and fever, one fears that without strengthening water (tonifying Kidney Yin), the raging fire cannot be extinguished, and without tonifying the kidney, the root cannot be secured. Can one rely solely on mild and slow-acting remedies, claiming them as the "Kingly Way," leisurely waiting for results, and merely propping up the middle qi?
Although consumptive diseases damaging the kidney also impair spleen qi, the treatment principle cannot abandon the spleen to treat only the kidney. Therefore, bitter-cold herbs like Phellodendri Cortex (Huangbai) and Anemarrhenae Rhizoma (Zhimu), as well as sweet-cold herbs like Asparagi Radix (Dongguai/Tian Dong) and Ophiopogonis Radix (Maidong), along with Scrophulariae Radix (Xuanshen), are increasingly unsuitable for yin deficiency; they merely damage yin further. Although Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) is said to tonify the kidney, its ingredients such as Dioscoreae Rhizoma (Shanyao), Poria (Fuling), and Corni Fructus (Shanzhuyu - noted in text as Shizao) are also items that benefit the spleen. Although Shudihuang (Prepared Rehmannia Root) is rich and cloying, after steaming and sun-drying processing, it particularly does not offend stomach qi. Without offending stomach qi first, yet still being able to help distribute medicinal power to the five zang organs, there is none other than Liuwei Dihuang Wan. That this formula tonifies both spleen and kidney is known even without wisdom.
If the true yang of the right kidney is insufficient, leading to mental confusion, timidity, shortness of breath, panting and fatigue upon movement, aversion to cold, impotence, or if spleen and stomach are deficient and cold, resulting in poor appetite, nausea, vomiting, chest and epigastric fullness and distension, heavy pain in the umbilical and abdominal regions, loose stools, or frequent vomiting and diarrhea: although these phenomena clearly belong to spleen diseases, they are actually caused by the deficiency of the mother organ (Kidney). All should employ the method of benefiting the source of fire (Warming Kidney Yang) and cultivating the true yang of the right kidney; nothing surpasses this approach.
In my opinion, the Ling Shu (Spiritual Pivot) and Su Wen (Basic Questions) contain profound meanings of yin and yang in every word and mysteries of water and fire in every sentence. Through the millennia, those who could comprehend these teachings and grasp their truth include Wang Bing (Grand Secretary Wang) in the Jin Dynasty, Xu Shumi in the Tang Dynasty, and Xue Lijia and Zhang Jingyue in the Ming Dynasty. A mere few individuals truly understood the Dao, elucidated the secrets of the Mingmen, and exhausted the distinctions between water and fire, establishing theories and treatments that far surpassed other sages. Other predecessors might have thoroughly discussed the principles of yin and water-fire, but when applied in practice, they lacked definite insight, often relying on attachments and violating norms, forcing their statements. Furthermore, since Liu Wansu (Liu Shouzhen) promoted the theory of Fire-Heat, patients with false heat suffered; Zhu Danxi used bitter-cold herbs to tonify yin, causing those with kidney deficiency to lose their lives.
However, Elder Li Dongyuan left a sixteen-character instruction: Excess fire can be purged using Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian); Deficient fire can be tonified using Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi). He clearly distinguished excess and deficiency, preserved and harmonized the spleen and stomach, avoiding the misuse of mixed prescriptions that harm the world. This was somewhat superior to the approaches of Liu and Zhu. Yet, he failed to propagate the meaning of yin and water-fire, which is indeed a defect. Nevertheless, his work Shanghan Huo Huo Lun (Treatise on Differentiating and Confusing Cold Damage) still benefited the world.
Zhang Jingyue stated: "If the words of Liu [Wansu] and Zhu [Danxi] do not cease, then the grace of Xuanyuan and Qibo [founders of TCM] will not be manifest." This is truly a demon on the path of medicine and a calamity for the people. Alas, people of this world lack understanding of flexible wisdom,偏执 (biasedly) adhering to Liu and Zhu, competing in reverence, harming lives, and wrongfully killing the innocent, remaining in a long dream without waking. This is why Zhang Jingyue vigorously refuted heretical doctrines, clarified orthodox teachings, and could not restrain himself from engaging in debate. I am thus moved to reflect.