成，火生土而后脾成，土生金而后肺成，五脏既成，六腑随之，四肢乃具，百骸乃全。未有此身，先有
两肾，故肾为脏腑之本，十二脉之根，呼吸之本，三焦之原，而人资之以为始者也，故曰先天之本在肾。
何以为后天之本？盖婴儿初生，一日不再食则饥，七日不食，则肠胃涸绝而死。经曰∶安谷则昌，绝谷
则亡，犹兵家之饷道也，饷道一绝，万众立散，胃气一败，百药难施，一有此身，必资谷气，谷入于胃，
洒陈于六腑、调和于五脏，以生气血，而人资之以为生者也，故曰后天之本在脾。
人有五脏，曰∶心肝脾肺肾，皆为阴也。内经发明三阴为病之义，独不及心肝二脏者，盖心为
君主，邪不可伤，伤则必死。肝为将军官，木气多强，故皆不详言其病。舍此二者，则肾为藏精之
本，肺为藏气之本，脾为水谷之本。水病则及肺，金病则及脾，盗母气也；土病则败及诸脏，失化、
生之原也。凡犯三阴亏损者，皆在此三脏耳，三脏俱伤，鲜能免矣。
古称乙癸同源，肾肝同治，其说维何？盖火分君相，君火者，居乎上而主静，相火者，处乎下
而主动。君火唯一，心主是也，相火有二，乃肾与肝。肾应北方壬癸，于卦为坎，于象为龙，龙潜海
底，龙起而火随之；肝应东方甲乙，于卦为震，于象为雷，雷藏泽中，雷起而火随之。泽也海
也，莫非水也，莫非下也，故曰乙癸同源。东方之木，无虚、不可补，补肾即所以补肝∶北方之水，无
实不可泻，泻肝即所以泻肾。至乎春升，龙不现则雷无声，及其秋降，雷未收则龙不藏，但使龙归海底
，必无迅发之雷，但使雷藏泽中，必无飞腾之龙，故曰肾肝同治。
昔人云∶肝常有，肾常不足。然肝既无虚，又言补肝者，肝气不可亢，肝血自当养也。血不足者，
濡之以水之属也∶壮水之原，木赖以荣。肾既无实，又言泻肾者，肾阴不可亏，而肾气不可亢也。气有余
者伐之，木之属也，伐木之干，水赖以安。
用古方疗今病，譬之拆旧料，改新屋，不再经匠氏之手，其可用乎？是有察于古今元气之不同也。
当天地初开。气化浓密，则受气常强，及其久也，气化渐薄，则受气常
溺。故东汉之世，仲景出方，辄以两计，宋元而后，东垣、丹溪，不过钱计而已。今去朱李之世，又
五百年，元气转薄，乃必然之理。所以抵当、承气，日就减削，归脾、六味，日就增添，论症施治，
多事调养，专防克伐，此今时治法之变通也。假令病宜用热，亦当先之以温，病宜用寒，亦当先之以
清，纵有积宜消，必须先养胃气，纵有邪宜祛，必须随时发散，不得过剂以伤气血，气血者，人之所赖
以生者也，气血充盈，则百邪外御，病安从来？气血虚损，则诸邪辐辏，百病簇。嗟乎？世人之
病，十有九虚，医师之药，百无一补，宁知投剂一差，实者即虚，虚者即死。故临症之顷。宜加战兢，
若执成方，或矜家秘，惟知尽剂，罔顾本元，惟知古法，不审时宜，皆读书而过，未窥元会运世之微
旨也。
凡用药太过不及，皆非适中，而不及尚可加治，太过则病去药存，为害更烈。
大抵富贵之人多劳心，劳心则中虚，而筋柔骨脆，贫贱之人多劳力，劳力则中实，而骨劲筋强。富
贵者，膏粱自奉，其脏腑恒娇，贫贱者，藜藿苟充，其脏腑恒固。富贵者，曲房广厦，玄腑疏而六淫
易客，贫贱者，陋巷茅茨。腠理密而外邪难干。故富贵之疾，宜于补正，贫贱之疾，利于攻邪。虽然贫
贱之家，亦有宜补，但攻多而补少，富贵之家亦有宜攻，但攻少而补多，是又当以方宜为辨，禀受为
别，老幼为衡，虚实为度，不得胶于居养之一途，而概为施治也。
有偏，阴偏阳者，此气禀也。太阳之人，虽冬月，身不须绵，口常饮水，色欲无度，大便数日一行，芩、
连、栀、柏、硝、黄，恬不知怪。太阴之人，虽暑月不离复衣，食饮稍凉，便觉腹痛泄泻，参、术、
姜、桂，时不绝口，一有欲事，呻吟不已，故医者治人于平素之偏禀阴阳，极宜审察。
人之受病，以偏得之，感于热则偏于热，感于寒则偏于寒。故以寒治热，以热治寒，此正法也。今
之为医者，不细辨明，而制为不寒不热之方，辄称曰稳当，又言王道，噫！何以补其偏而救其弊哉！
天之大宝，只此一丸红日，人之大宝，只此一息真阳，天无此日，则六合尽冰壶，乾坤皆地狱矣。
人是小乾坤，得阳则生，故凡通体之温者阳气也，四肢之运用者阳气也，五脏五官之神明不测者阳气
也，失阳则死，则身冷如冰，寂然。不动，灵觉尽灭。可见死生之本，全在阳气。故欲固其阳，须培根
本，根本者何？命门是也。婴儿初生，先两肾，两肾中间，是曰命门。先天之生我者，由此而受，后
天之生我者，由此而裁。夫生之门，即死之户，所以人之盛衰安危，皆系乎此者，以其为生气之源，而
气强则强，气衰则病，此虽至阴之地，而实真阳之宅。世之养身者，不知保养节欲，而日夜戕贼此真阳
，既已阳衰成病矣，治病者不知温补真
阳，而反用苦寒伐此真阳，欲保生命，岂可得乎？
阳气以潜藏为贵，潜则弗亢，潜则可久，易道也。故盏中加油，则灯愈明，炉中复炭，则火不熄。
肾中真阳，得水以济之，则留恋不脱，得土以堤之，则蛰藏不露。
真阳以肾为窟宅，而潜伏水中，凝然不动，嘿与一身相管摄，是以足供百年之用。惟夫纵欲无
度，肾水日竭，真阳之面目始露矣。阳者清上者也，至于露则魄汗淋漓，目中有光，面如渥丹。故治
之者，当兼用三法∶一者以涩固脱，一者以重治怯，一者以补理虚。缘真阳散越于外，如求亡子，不得
不多方图之。更有治本一法，实有神巧之妙。盖蓄鱼千尾者，必置介类于池中，否则其鱼乘雷雨，冉
冉腾散。鱼虽潜物，而性乐于动，以介类沉重下伏之物，而引鱼之潜伏不动，同气相求也。故治真阳之
飞腾散越，不以龟鳖之类引之下伏，不能也。
故阴凑于上，开窍于目则为泪，开窍于鼻则为涕，开窍于口则为涎、为唾。经曰∶五十始衰，谓阴气
始衰也。至此阴气衰，故不能自主，而从阳上行，其屑越者，皆身中之至宝。可见下虚者，不但真阴虚，究
竟下元真阳亦虚，向非收摄归元，将何底极，是以事亲养老诸方，皆以温补下元为务。〔如熟地、肉苁蓉
、枸杞、菟丝、五味、山萸、人胞、
鹿角胶，羊肉之属，不必定附、桂也。〕诚有见于老少不同。治少年人，惟恐有火，高年人惟恐
无火，无火则运化艰而易衰，有火则精伸健而难老，是火者老人维命之根，未可以水〔苦寒之品。〕
轻折也。
或问冬至一阳生，当渐向暖和，何为腊月大寒？夏至一阴生，当渐向清凉，何为三伏酷热？
曰∶此论将来者进，成功者退之理则然。然隐微之际，未易明也。盖阳伏于下，逼阴于上，井水气蒸，
而坚冰至也；阴盛于下，逼阳于上，井水寒而雷电合也。故人有病面红口渴，〔不喜饮水。〕烦躁〔
神静不昏。〕喘咳者，谁不曰火盛之极，抑熟知其为肾中阴寒所逼乎？〔小便必清利，右尺必微细。〕
若不大剂加减八味丸料，〔即六味加五味子、肉桂。〕煎汤冷冻饮料以引之归元，而反进寒凉之剂，必致
危亡。如既引火归元之后，当急培中土，须必以参、 、归、杞之甘温平养之，则焰和而不复上炀，
烈炭得炉灰而性藏也。
人身之有阴阳也，水一而已，火则二焉，是禀受之始，阳常有余，阴常不足，故自少至老，所
生疾病，靡不由于真阴不足者，其恒也。若夫真阳不足之病，千百中一、二而已。今之医师，不揣其
本，凡遇病症，概投温补，参、 、二术，视同食物，佐以姜、桂，若啖五辛，倘遇惫剧，辄加
附子，于是轻者重，重者毙，接踵死亡，全无悔悟，余所目击甚多，故特着其误，以为世戒。
夫病。变非一，何独重阴；有弗达者，必哂为谬，试言其
略。如寒邪伤人，本为表症，而汗液之化，必由乎阴也，中风为病，身多偏枯，而筋脉之败，必由乎
阴也。虚劳生火，非壮水何以救其燎原；泻利亡阴，非补肾何以固其门户∶鼓胀由乎水邪，主水者须
求水脏；关格本乎阴虚，急救阴尚虞阴脱。此数者，乃疾病中最大之纲领，明者觉之，可因斯
而三反之。
阳邪之至，害必归阴，五脏之伤，穷必及肾，知救其原，则回天之手矣。
经言胃之大络，名曰虚里，贯隔络肺，出于左乳下，其动应衣，宗气泄也。故虚里跳动，最为虚损
病本。凡患阴虚劳怯，则心下多有跳动，及为惊悸慌张者，是即此症。人止知其心跳，而不知为虚里
之动也。但动之微者病常微，动之甚者病则甚。凡患此者，余常以纯甘壮水之剂，填补真阴，活者颇
多。然经言宗气之泄，而余谓真阴之虚，其说似左，请析其义。夫谷入胃，以传于肺，五脏六腑，皆以受
气，是曰胃气，而上为宗气也。气为水母，气聚则水生，是由肺气而下生肾水也。今胃气传之肺，而
肾虚不能纳，故宗气泄于上，则肾水竭于下，肾愈虚则气愈无所归，气不归则阴愈虚矣。气水同类，当
求于济，故凡欲纳气归元者，惟有补阴以配阳之法。
人之声音，出自肺金，清浊轻重，丹田所系，不求其原，徒事于肺，抑末也。今之言补肺者，人
参、黄 ，清肺者黄芩、麦冬，敛肺者五味、诃子，泻肺者葶苈、枳壳。病之轻者，岂无一效，若本原
亏损，毫不相干。盖人肺金之
气，夜卧则归藏于肾水之中，丹家谓之母藏子宫，子荫母胎。此一脏名曰娇脏，畏热畏寒，肾中
有火，则金畏火刑而不敢归，肾中无火，则水冷金寒而不敢归，或为喘胀，或为咳嗽，或为不卧，或
为不食。斯时也，欲补其母以益子，喘胀愈甚，清之泻之，肺金日消，死期迫矣！惟收敛者，仅
似有理，然不得其门，从何而入。《立斋直指》云∶肺出气也，肾纳气也，肺为气之主，肾为气之
本。凡气从脐下逆奔而上者，此肾虚不能纳气归原也，毋徒从事于肺，宜壮水之主，或有因火衰者，
是当益火之原也。
凡为广嗣之计者，其用药准绳，但取纯王以召和，无取杂品以兆戾也。经言∶凡阴阳之要，阳密
乃固。不知此段经文，乃是明言男女交会之法度，欲使阳气秘密，乃得坚固不泻；然而阴阳贵相和，
必阴得其平，而无过不及，然后阳得其秘而不走泻也。故欲阳之秘密，不得不予其权于阴，正以
阳根于阴，培阴所以培阳之基也。今人以峻烈之药，劫尽其阴以为培阳，益以房帏重耗，渐至髓消肉
减，神昏气夺，毛悴色夭，尚不知为药所误，可胜悼哉。
经言女子二七，男子二八，而后天癸至。夫天癸者阴气也。小儿之阴气未至，故曰纯阳，原非阳气
有余之谓，特稚阳耳。不知稚阳之阳甚微，世医辄称小儿纯阳，恣用苦寒，妄攻其热。夫阴既不足
，又伐其阳，多致阴阳俱败，脾肾俱伤。又节斋云∶小儿无补肾法，谓男至十六，两肾始充
满，既满之后，妄用亏损，则可用药补之。若受胎之时，禀之不足，则无可补，禀之原足，又何待
于补也。呜呼！此何说耶！夫小儿之阴气未成，即肾虚也，或父母多欲，而所禀水亏，亦肾虚也。阴
既不足，而不知补之，阴绝则孤阳亦灭矣，何谓无可补耶。
凡禽畜之类，有肺者有尿，无肺者无尿，故水道不利而成胀满，以清肺为急。
久，嗽不愈，缘于肺虚有火，当清肺润肺，忌用涩燥闭气之药，设若误用粟壳、诃子，俾火壅于肺，
不得下降，若再兼参、术、半夏、即死不旋踵矣。世医多蹈此弊，特表示戒。
咳嗽吐血，时时发热，未必成瘵也，服四物、黄柏、知母之类不已，则瘵成矣；胸满膨胀，悒悒不
快，未必成胀也，服山楂、神曲之药不已，则胀成矣；气滞膈塞，未必成噎也，服青皮、枳壳、宽快之药
不已，则噎成矣。成则不治，嗟何及矣！
失血家须用下剂破血，盖施之于妄逆之初；亡血家不可下，盖戒之于亡血之后。
禁药者，津液内亡作渴，禁用淡渗五芩，汗多禁利小便，小便多禁发汗，咽痛禁发汗利小便，大便快
利，禁服栀子，大便秘涩，禁用燥药，吐多不得复吐，而上气壅滞，大便不通，止可宣散上气，禁利大
便。脉弦禁服平胃而虚虚，
脉缓禁服建中而实实。
人身不过表里，表里不过阴阳，阴阳即荣卫，荣卫即血气。脏腑筋骨居于内，赖荣气以资之，皮
毛分肉居于外，赖卫气以煦之，而后内而精髓，外而发肤，无弗得养者，皆荣卫之化也，荣虽主血而在
内，然亦何尝无气，卫虽主气而在外，然亦何尝无血，故荣中未必无卫，卫中未必无荣，但行于内者，便
谓之荣，行于外者，便谓之卫，分之则二，合之则一而已。
脉有经络，经在内，络在外。气有荣卫，荣在内，卫在外。今饮酒者，其气自内达外，似宜先经而
后络，兹乃经言先络而后经者何也？盖卫为水谷之悍气，酒亦为水谷之悍气，其 疾之性亦然，故经言饮
酒者，必随卫气，先行皮肤，先充经脉，而后荣气乃满，经脉大盛。
（脏腑生成）火生土，然后脾脏形成；土生金，然后肺脏形成。五脏既已成形，六腑随之而成，四肢才得以具备，全身骨骼形体才告完整。在身体形成之前，先有两肾存在，所以肾是脏腑的根本，十二经脉的根源，呼吸的根本，三焦的原气所在，人依靠它作为生命的起始，所以说先天之本在于肾。
什么是后天之本呢？婴儿刚出生，一天不吃就会饥饿，七天不吃，肠胃干枯断绝而死。医经说：“能进食则昌盛，不能进食则死亡”，这就像兵家的粮道一样，粮道一旦断绝，数万军队立刻溃散；胃气一旦败坏，各种药物都难以施用。有了这个身体，必须依赖谷气生存，谷物进入胃中，散布于六腑，调和于五脏，从而化生气血，人依靠它来维持生命，所以说后天之本在于脾。
人有五脏，即心、肝、脾、肺、肾，都属于阴。《内经》阐明了三阴经发病的道理，唯独没有详细论述心和肝两脏的病证，这是因为心为君主之官，邪气不可伤害，若伤害了必然致死。肝为将军之官，木气多强盛，所以都不详细言及其病证。除了这两脏之外，肾是藏精的根本，肺是藏气的根本，脾是水谷的根本。水病则会波及肺，金病则会波及脾，这是盗取母脏之气；土病则会败坏及于其他各脏，失去了化生之源。凡是犯了三阴亏损的，都在这三脏身上，如果这三脏都受伤，很少能幸免的。
古人称“乙癸同源”，肾与肝同治，这种说法依据是什么呢？盖因火分君火和相火，君火居上而主静，相火居下而主动。君火只有一，就是心主；相火有二，分别是肾和肝。肾对应北方的壬癸水，在八卦中属于坎卦，在物象上对应龙，龙潜伏在海底，龙兴起时火随之而起；肝对应东方的甲乙木，在八卦中属于震卦，在物象上对应雷，雷潜伏在沼泽中，雷兴起时火随之而起。沼泽和海，无非都是水，无非都在下方，所以说乙癸同源。东方的木，没有虚证，不可补，补肾就是用来补肝的；北方的水，没有实证，不可泻，泻肝就是用来泻肾的。至于春季阳气升发，龙不出现则雷无声响；到了秋季阳气下降，雷未收敛则龙不潜藏。只要让龙回归海底，必定不会有迅猛爆发的雷；只要让雷藏在泽中，必定不会有飞腾的龙，所以说肾肝同治。
过去的人说：“肝常有余，肾常不足。”既然肝没有虚证，又为什么说补肝呢？是因为肝气不可亢盛，肝血自然应当滋养。血不足的，用水属的药物来濡润它；壮旺水的源头，木才能依赖其繁荣。既然肾没有实证，又为什么说泻肾呢？是因为肾阴不可亏虚，而肾气不可亢盛。气有余的，用木属的药物去伐泄它；伐木的树干，水才能依赖其安宁。
用古方治疗今病，好比拆除旧料改建新屋，如果不经过工匠之手重新加工，那还能用吗？这是因为要考察古今元气的不同。当天地初开时，气化浓密，人禀受的元气通常很强盛；等到时间久了，气化逐渐淡薄，人禀受的元气就常常虚弱。所以在东汉时期，张仲景开出药方，往往以“两”为单位计量；宋元以后，李东垣、朱丹溪的药方，不过以“钱”为单位计量罢了。现在距离朱熹、李侗的时代，又有五百年了，元气更加淡薄，这是必然的道理。所以抵当汤、承气汤等峻猛之剂日益减少，归脾汤、六味地黄丸等滋补之剂日益增多，论症施治，大多注重调养，专门防止克伐损伤，这是当今治疗方法的变化通融之处。假如病症适宜用热药，也应当先用温药；病症适宜用寒药，也应当先用清药。纵然有积滞需要消除，必须先养胃气；纵然有邪气需要祛除，必须随时发散，不得过量以免损伤气血。气血是人赖以生存的根本，气血充盈，就能抵御外邪，病从哪里来呢？气血虚损，各种邪气就会聚集，百病丛生。唉！世人的病，十有九个是虚证，医生的药，百无一补。怎知投药稍有差错，实证就变成虚证，虚证就会死亡。所以临症之时，应当战战兢兢，如果拘执成方，或者夸耀家传秘方，只知道用尽药量，不顾及人体本源，只知道古法，不审察时宜，这都是读书读通了却未窥探宇宙运行微妙旨意的人啊。
凡是用药太过或不及，都不是适中，而不及还可以再加治疗，太过则病去了药还在，危害更猛烈。
大体上说，富贵之人多劳心，劳心则中气虚弱，筋柔骨脆；贫贱之人多劳力，劳力则中气充实，骨劲筋强。富贵者，以膏粱厚味自奉，他们的脏腑通常娇嫩；贫贱者，以粗茶淡饭苟且充饥，他们的脏腑通常坚固。富贵者，住在深宅大院，腠理疏松，六淫邪气容易侵袭；贫贱者，住在陋巷茅草屋，腠理致密，外邪难以干犯。所以富贵人的病，适宜于补益正气；贫贱人的病，利于攻逐邪气。虽然如此，贫贱之家也有适宜补益的情况，但攻多补少；富贵之家也有适宜攻逐的情况，但攻少补多，这又应当根据地域习俗来辨别，根据体质禀受来区别，根据老幼来衡量，根据虚实来决定，不能拘泥于居住供养条件这一种途径，而一概施治。
人有偏颇，有阴偏阳者，这是气质禀赋所致。太阳之人，即使在冬天，身体也不需穿棉衣，口中常想饮水，色欲无度，大便数日一行，服用黄芩、黄连、栀子、黄柏、芒硝、大黄等寒凉药，安然不知怪异。太阴之人，即使在暑天也不离厚衣，饮食稍凉，就觉得腹痛泄泻，人参、白术、干姜、肉桂等温热药，口中不绝，一有房事，就呻吟不止。所以医生在治疗平时就有阴阳偏颇禀赋的人时，极应仔细审察。
人得病，是由于偏颇而感邪，感受热邪则偏于热，感受寒邪则偏于寒。所以用寒药治热病，用热药治寒病，这是正法。现在的医生，不仔细辨明，而制定不寒不热的方子，就自称稳妥，又说这是王道疗法。唉！怎么能纠正偏颇而补救弊端呢！
天的最大宝物，只是这一轮红日；人的最大宝物，只是这一息真阳。天没有这个太阳，那么六合尽是冰壶，乾坤皆成地狱。人是小乾坤，得到阳气则生，所以凡是全身温暖的，是阳气；四肢运用的，是阳气；五脏五官神明变化莫测的，也是阳气。失去阳气则死，身体冷如冰，寂静不动，灵觉全部消灭。可见生死根本，全在阳气。所以要固护阳气，必须培补根本。根本是什么？就是命门。婴儿初生，先有两肾，两肾中间，叫做命门。先天由它而生我，由此接受；后天由它而生我，由此裁制。生的门户，也就是死的户牖，所以人的盛衰安危，都系于此，因为它是生气的源头，气强则身强，气衰则生病。这里虽然是至阴之地，但实际上是真阳的宅舍。世上养生的人，不知道保养节欲，日夜残害这个真阳，已经导致阳衰成病了；治病的人不知道温补真阳，反而用苦寒药伐伤这个真阳，想要保全生命，怎么可能呢？
阳气以潜藏为贵，潜藏则不亢奋，潜藏则可持久，这是易道的道理。所以盏中加油，灯就更明亮；炉中覆盖炭灰，火就不熄灭。肾中的真阳，得水来济助，则留恋而不脱失；得土来堤防，则蛰伏隐藏而不显露。
真阳以肾为窟宅，潜伏在水中，凝然不动，默默总管一身，因此足以供应百年的使用。只有那些纵欲无度的人，肾水一天天枯竭，真阳的面目才显露出来。阳是清轻上浮的，一旦显露，就会魄汗淋漓，眼中发光，面色红润如涂丹砂。所以治疗时，应当兼用三种方法：一是用涩药固脱，二是用重镇药治怯，三是用补药理虚。因为真阳散越于外，如同寻找走失的孩子，不得不多方图谋。更有治本的一法，实在有神巧之妙。大概蓄养千尾鱼的人，必须在池中放置介类（如贝壳、龟鳖），否则鱼乘着雷雨，冉冉腾飞散去。鱼虽然是潜游之物，但本性乐于活动，用介类这种沉重下伏之物，来引导鱼的潜伏不动，这是同气相求的缘故。所以治疗真阳的飞腾散越，不用龟鳖之类引导它下伏，是不可能的。
所以阴气凑集于上，开窍于目则为泪，开窍于鼻则为涕，开窍于口则为涎、为唾。医经说：“五十岁开始衰老”，是指阴气开始衰退。至此阴气衰退，所以不能自主，而从阳上行，其屑越（耗散）的，都是身中的至宝。可见下虚者，不但真阴虚，究竟下元真阳也虚，如果不是收摄归元，将有什么底止呢？所以侍奉双亲养老的各种方子，都以温补下元为务。（如熟地、肉苁蓉、枸杞、菟丝子、五味子、山萸肉、人胞、鹿角胶、羊肉之类，不一定非要用附子、肉桂。）确实看到了老少不同。治疗少年人，惟恐有火；高年人惟恐无火。无火则运化艰难而易衰老，有火则精神健旺而难老，这火是老人维系生命的根本，不可以用水（苦寒之品）轻易折损。
有人问：冬至一阳生，应当渐渐向暖和转变，为什么腊月是大寒？夏至一阴生，应当渐渐向清凉转变，为什么三伏天酷热？回答说：这是论述将来者进、成功者退的道理是这样。然而在隐微之际，不容易明白。盖因阳伏于下，逼迫阴于上，井水气蒸，而坚冰到来；阴盛于下，逼迫阳于上，井水寒冷而雷电交合。所以人有病见面红口渴（但不喜欢饮水），烦躁（但神志安静不昏沉），喘咳的，谁不说这是火盛到了极点，谁知这是因为肾中阴寒逼迫所致呢？（小便必清利，右尺脉必微细）。如果不大量加减八味丸料（即六味地黄丸加五味子、肉桂），煎汤冷冻饮料以引导其归元，反而进用寒凉药剂，必定导致危亡。如果在引火归元之后，应当急培中土，必须用人参、甘草、当归、枸杞的甘温平养之药，则火势平和而不再上炎，像烈炭得到炉灰覆盖而性质隐藏。
人身有阴阳，水只有一种，火却有二种，这是禀受之初，阳常有余，阴常不足，所以从少到老，所生的疾病，无不由于真阴不足，这是常态。至于真阳不足的病，千百中只有一两个而已。现在的医生，不揣测根本，凡遇到病症，一概投用温补，人参、黄芪、白术、苍术，视同食物，佐以生姜、肉桂，好像吃五辛一样，倘若遇到疲惫严重的，就加上附子，于是轻病变重，重病致死，接踵死亡，全然无悔悟，我亲眼目睹很多，所以特意写出这些错误，作为世人的警戒。
夫病变化不一，为何独独重视阴？有不通达的人，一定会嘲笑这是谬论，试说说其中的大略。如寒邪伤人，本是表症，但汗液的化生，必须由阴来完成；中风为病，身体多偏枯，但筋脉的败坏，必须由阴引起。虚劳生火，不壮水怎能救其燎原之势；泻利亡阴，不补肾怎能固守其门户；鼓胀由于水邪，主管水者须求之于水脏（肾）；关格本乎阴虚，急救阴尚且担心阴脱。这几条，是疾病中最大的纲领，明智的人觉察到这一点，可以由此反复推究。
阳邪的到来，危害必然归于阴；五脏受伤，穷尽必然及于肾。知道救护其本源，就有回天之力了。
医经说胃的大络，名叫虚里，贯穿膈肌联络肺，出于左乳下，跳动应衣，这是宗气外泄。所以虚里跳动，最为虚损病的根本。凡是患阴虚劳怯的，心下多有跳动，以及惊悸慌张的，就是这个症候。人们只知道是心跳，而不知道是虚里的跳动。但跳动轻微的病常轻微，跳动严重的病则严重。凡是患此症的，我常用纯甘壮水的药剂，填补真阴，治愈者颇多。然而医经说宗气外泄，而我说是真阴之虚，说法似乎相反，请分析其义。谷物进入胃，传给肺，五脏六腑都以此受气，这叫胃气，而上成为宗气。气为水之母，气聚则水生，这是由肺气而下生肾水。现在胃气传给肺，而肾虚不能纳气，所以宗气泄于上，则肾水竭于下，肾越虚则气越无所归，气不归则阴越虚。气水同类，应当寻求济助，所以凡想纳气归元的，只有补阴以配阳的方法。
人的声音，出自肺金，清浊轻重，系于丹田，不求其本源，徒然从事于肺，是舍本逐末。现在说补肺的，用人参、黄芪；清肺的用黄芩、麦冬；敛肺的用五味子、诃子；泻肺的用葶苈子、枳壳。病轻的，难道没有一点效果？如果本源亏损，就毫不相干了。大概人的肺金之气，夜卧则归藏于肾水之中，道家称之为母藏子宫，子荫母胎。这一脏名叫娇脏，畏热畏寒，肾中有火，则金畏火刑而不敢归；肾中无火，则水冷金寒而不敢归，或者为喘胀，或者为咳嗽，或者为不卧，或者为不食。这时，想补其母（肾）以益子（肺），喘胀会更甚；清之泻之，肺金日渐消减，死期迫近了！只有收敛的方法，看似有理，但如果不得其门路，从何而入？《立斋直指》说：肺出气，肾纳气，肺为气之主，肾为气之本。凡气从脐下逆奔而上的，这是肾虚不能纳气归原，不要徒然从事于肺，应当壮水之主，如果有因火衰的，那是应当益火之原。
凡是做广嗣（生育后代）打算的人，用药准绳，只取纯正温和以召致和谐，不取杂品以兆示乖戾。医经说：凡阴阳的要领，阳密乃固。不知道这段经文，乃是明确说明男女交会的方法，要使阳气秘密，才能坚固不泻；然而阴阳贵在相和，必须阴得其平，而无过不及，然后阳得其秘而不走泻。所以想让阳秘密，不得不把权柄给予阴，正因为阳根于阴，培阴所以是培阳的基础。现在的人用峻烈之药，劫尽其阴以为培阳，再加上房帏重耗，渐至髓消肉减，神昏气夺，毛悴色夭，还不知道是药物所误，岂不令人悲痛！
医经说女子二七（14岁），男子二八（16岁），而后天癸至。所谓天癸，是阴气。小儿的阴气未至，所以叫纯阳，原不是指阳气有余的意思，特指稚阳罢了。不知道稚阳之阳非常微弱，世医辄称小儿纯阳，恣意用苦寒药，妄攻其热。既然阴已不足，又伐其阳，多导致阴阳俱败，脾肾俱伤。又节斋说：小儿无补肾法，谓男性到十六岁，两肾始充满，既满之后，若妄用亏损，则可用药补之。若在受胎之时，禀受不足，则无可补；禀受原本充足，又何待于补呢？唉！这是什么说法呢！小儿的阴气未成，就是肾虚，或者父母多欲，而所禀水亏，也是肾虚。阴既不足，而不知道补之，阴绝则孤阳亦灭矣，何谓无可补耶。
凡禽畜之类，有肺的有尿，无肺的无尿，所以水道不利而成胀满，以清肺为急。
久嗽不愈，缘于肺虚有火，当清肺润肺，忌用涩燥闭气之药，假如误用粟壳、诃子，使火壅于肺，不得下降，如果再兼用参、术、半夏，即刻就会死亡。世医多蹈此弊，特此表示警戒。
咳嗽吐血，时时发热，未必成痨瘵，服四物汤、黄柏、知母之类不已，则痨瘵成了；胸满膨胀，郁郁不快，未必成鼓胀，服山楂、神曲之药不已，则鼓胀成了；气滞膈塞，未必成噎膈，服青皮、枳壳宽快之药不已，则噎膈成了。成了则不治，唉，怎么来得及呢！
失血家须用下剂破血，是在施之于妄逆之初；亡血家不可下，是在戒之于亡血之后。
禁药者：津液内亡作渴，禁用淡渗的五苓散；汗多禁利小便；小便多禁发汗；咽痛禁发汗利小便；大便快利，禁服栀子；大便秘涩，禁用燥药；吐多不得复吐，而上气壅滞，大便不通，止可宣散上气，禁利大便。脉弦禁服平胃散而虚虚，脉缓禁服建中汤而实实。
人身不过表里，表里不过阴阳，阴阳即营卫，营卫即血气。脏腑筋骨居于内，赖营气以资之，皮毛分肉居于外，赖卫气以煦之，而后内而精髓，外而发肤，无不得养的，都是营卫的化育。营虽主血而在内，然亦何尝无气；卫虽主气而在外，然亦何尝无血。所以营中未必无卫，卫中未必无营，但行于内的，便谓之营，行于外的，便谓之卫，分之则二，合之则一而已。
脉有经络，经在内，络在外。气有营卫，营在内，卫在外。现在饮酒的人，其气自内达外，似应先经而后络，兹乃医经说先络而后经的是什么原因？盖因卫是水谷的悍气，酒也是水谷的悍气，其剽疾之性亦然，所以医经说饮酒者，必随卫气，先行皮肤，先充经脉，而后营气乃满，经脉大盛。
(Generation of Zang-Fu Organs) Fire generates Earth, and then the Spleen is formed; Earth generates Metal, and then the Lungs are formed. Once the Five Zang organs are formed, the Six Fu organs follow suit, the four limbs are thereby equipped, and the entire skeletal structure is completed. Before this body exists, there are already two Kidneys; therefore, the Kidney is the root of the Zang-Fu organs, the root of the twelve meridians, the root of respiration, and the source of the San Jiao (Triple Burner). Humans rely on it as the beginning of life; thus, it is said that the congenital root lies in the Kidney.
What is the acquired root? When an infant is first born, if it does not eat for one day, it becomes hungry; if it does not eat for seven days, the intestines and stomach dry up and perish. The Classics state: "Abundance of food leads to prosperity, absence of food leads to death." This is like the supply lines of an army; once the supply lines are cut, tens of thousands of soldiers disperse immediately. Once the Stomach Qi fails, all medicines become ineffective. With this body, one must rely on grain Qi for survival. Grain enters the Stomach, is distributed throughout the Six Fu organs, and harmonized within the Five Zang organs, thereby generating Qi and Blood. Humans rely on this for life; thus, it is said that the acquired root lies in the Spleen.
Humans have five Zang organs: Heart, Liver, Spleen, Lungs, and Kidneys, all belonging to Yin. The *Nei Jing* (Inner Canon) elucidates the principles of disease in the Three Yin meridians but does not specifically detail diseases of the Heart and Liver. This is because the Heart is the Monarch, and pathogenic factors cannot injure it; if injured, death is certain. The Liver is the General; its Wood Qi is often strong. Therefore, their diseases are not discussed in detail. Excluding these two, the Kidney is the root of storing Essence, the Lungs are the root of storing Qi, and the Spleen is the root of water and grain. Water disease affects the Lungs; Metal disease affects the Spleen, which is stealing Qi from the Mother organ. Earth disease ruins other Zang organs, losing the source of transformation and generation. Any deficiency affecting the Three Yin primarily involves these three Zang organs. If all three are injured, survival is rare.
The ancients stated that "Yi and Gui share the same source" (Liver and Kidney treat together). What is the basis for this? Fire is divided into Ministerial Fire (Jun Huo) and Official Fire (Xiang Huo). Ministerial Fire resides above and is still; Official Fire resides below and is active. There is only one Ministerial Fire, which is the Heart Master. There are two Official Fires: the Kidney and the Liver. The Kidney corresponds to the North Ren-Gui waters, the Kan trigram, and the image of the Dragon. The Dragon hides at the bottom of the sea; when the Dragon rises, fire follows. The Liver corresponds to the East Jia-Yi woods, the Zhen trigram, and the image of Thunder. Thunder hides in the marsh; when Thunder rises, fire follows. Marshes and seas are both water, both located below; hence, Yi and Gui share the same source. Eastern Wood has no deficiency and needs no tonification; tonifying the Kidney is how one tonifies the Liver. Northern Water has no excess and needs no purgation; purging the Liver is how one purges the Kidney. In spring, when Yang ascends, if the Dragon does not appear, Thunder makes no sound. In autumn, when Yang descends, if Thunder is not retracted, the Dragon does not hide. If the Dragon returns to the sea, there will be no sudden Thunder; if Thunder hides in the marsh, there will be no soaring Dragon. Thus, the Liver and Kidney are treated together.
Ancients said: "The Liver is often in excess, the Kidney is often deficient." Since the Liver has no deficiency, why speak of tonifying it? It is because Liver Qi should not be hyperactive, and Liver Blood should be nourished. For blood deficiency, use water-natured herbs to moisten; strengthen the source of Water so that Wood may flourish. Since the Kidney has no excess, why speak of purging it? It is because Kidney Yin should not be deficient, and Kidney Qi should not be hyperactive. For Qi excess, use wood-natured herbs to subdue; cutting the trunk of Wood allows Water to remain peaceful.
Using ancient formulas to treat modern diseases is like dismantling old materials to build a new house; without the craftsman's hand to process them, can they be used? This requires observing the differences in Yuan Qi (Original Qi) between ancient and modern times. When heaven and earth first opened, Qi transformation was dense, so humans received strong Qi. As time passed, Qi transformation became thinner, so humans received weaker Qi. In the Eastern Han dynasty, Zhang Zhongjing prescribed formulas measured in *liang*. After the Song and Yuan dynasties, Li Dongyuan and Zhu Danxi prescribed formulas measured in *qian*. Now, five hundred years have passed since the era of Zhu Xi and Li Tong; Yuan Qi has become even thinner, which is inevitable. Therefore, harsh formulas like Didang Tang and Chengqi Tang are used less frequently, while tonifying formulas like Guipi Tang and Liuwei Dihuang Wan are used more. Treatment focuses on nourishment and prevention of depletion, representing the adaptive changes in modern medical practice. If a disease requires hot medicine, start with warm medicine; if it requires cold medicine, start with clearing medicine. Even if stagnation needs resolving, first nourish Stomach Qi; even if pathogens need expelling, disperse them gradually. Do not overdose and damage Qi and Blood. Qi and Blood are what humans rely on for life. When Qi and Blood are abundant, external evils are repelled, and where would disease come from? When Qi and Blood are deficient, various evils gather, and hundreds of diseases arise. Alas! Ninety percent of people's diseases are deficiency. Doctors' prescriptions rarely tonify. One slight error in prescription turns excess into deficiency, and deficiency into death. Therefore, when treating patients, one must be cautious. Clinging to fixed formulas, boasting of family secrets, using full doses without regard for the patient's constitution, or knowing only ancient methods without considering current conditions—these are scholars who have read books but failed to grasp the subtle principles of cosmic cycles.
Medication that is too excessive or insufficient is not moderate. Insufficiency can be corrected by adding treatment; excess leaves the pathogen gone but the drug remains, causing greater harm.
Generally, wealthy people labor with their minds, leading to middle Jiao deficiency, soft sinews, and fragile bones. Poor people labor with their bodies, leading to middle Jiao solidity, strong bones, and tough sinews. The wealthy consume rich foods, making their Zang-Fu organs delicate. The poor eat coarse food, making their Zang-Fu organs solid. The wealthy live in deep houses with loose pores, making them susceptible to the Six Evils. The poor live in huts with tight pores, protecting them from external pathogens. Thus, diseases of the wealthy should be treated by tonifying righteousness; diseases of the poor should be treated by attacking pathogens. However, the poor also have cases requiring tonification (mostly attack, little tonification), and the wealthy have cases requiring attack (mostly tonification, little attack). Differentiation must be based on geography, constitution, age, and excess/deficiency, not solely on lifestyle.
People have constitutional biases. The Taiyang type, even in winter, does not need cotton, drinks water constantly, indulges in sex, has bowel movements every few days, and takes cold herbs like Huang Qin, Huang Lian, Zhi Zi, Huang Bo, Mang Xiao, Da Huang without surprise. The Taiyin type, even in summer, wears thick clothes, feels abdominal pain and diarrhea from cool food, and takes warm herbs like Ren Shen, Bai Zhu, Sheng Jiang, Rou Gui constantly, groaning after sexual activity. Physicians must carefully examine such constitutional biases.
Disease arises from bias: contracting heat makes one biased toward heat; contracting cold makes one biased toward cold. Treating heat with cold and cold with heat is the correct method. Modern physicians, failing to distinguish clearly, create neutral formulas claiming stability and "Kingly Way." How can this correct bias and remedy defects?
The greatest treasure of Heaven is the Red Sun; the greatest treasure of Man is his True Yang. Without the Sun, the universe is ice; without True Yang, life ends. Warmth of the body, movement of limbs, and spirit of the Zang-Fu are all Yang. Loss of Yang means death: body cold as ice, motionless, consciousness lost. Life and death depend entirely on Yang. To secure Yang, one must cultivate the root—the Ming Men (Gate of Life). In infants, the two Kidneys exist first; between them is the Ming Men. Congenital life receives from here; acquired life is governed by here. It is the source of vitality. Though a place of extreme Yin, it is the residence of True Yang. Those who cultivate health fail to conserve essence, damaging True Yang daily. Physicians who treat disease fail to warm and tonify True Yang, instead using bitter-cold herbs to destroy it. How can life be preserved?
Yang values concealment. Concealment prevents hyperactivity and ensures longevity. Oil in a lamp makes it brighter; charcoal covering coals keeps fire burning. True Yang in the Kidney is retained by Water and hidden by Earth. True Yang resides in the Kidney, hiding in Water, quietly governing the body for a century. Only through excessive lust does Kidney Water deplete, revealing True Yang. Yang is light and floats upward. When revealed, sweat pours, eyes shine, face turns red. Treatment requires three methods: astringing to prevent collapse, heavy sedatives for fearfulness, and tonifying for deficiency. True Yang scattering outward is like finding a lost child; many methods are needed. A fundamental treatment involves using tortoise and turtle shells to guide Yang downward, similar to how shellfish keep fish submerged due to shared nature.
Yin gathering above manifests as tears (eyes), mucus (nose), saliva/spittle (mouth). The Classic says aging begins at fifty due to Yin decline. When Yin declines, it cannot control itself and floats upward with Yang. These losses are precious. Lower deficiency involves not just Yin but also True Yang of the Lower Jiao. Without gathering and returning to the source, where would it end? Elder care formulas focus on warming and tonifying the Lower Jiao (e.g., Shu Di Huang, Rong Rui Gou Qi Zi, Tu Si Zi, Wu Wei Zi, Shan Zhu Yu, Ren Bao, Lu Jiao Jiao, Lamb). Young people fear fire; elderly fear lack of fire. Lack of fire hinders transformation and causes aging; presence of fire maintains vigor but delays aging. Fire is the root of life for the elderly; do not easily suppress it with bitter-cold herbs.
Why is late December extremely cold despite "One Yang born at Winter Solstice"? Why is mid-summer extremely hot despite "One Yin born at Summer Solstice"? This reflects the principle that advancing elements push back retiring ones. Yang hiding below forces Yin up (well water steams, ice forms); Yin dominating below forces Yang up (well water cold, thunder occurs). Patients with red faces, thirst (but dislike drinking), irritability (but calm mind), and coughing are often mistaken for extreme fire, but are actually forced by Kidney Cold (clear urine, faint right Chi pulse). Without large doses of Modified Ba Wei Wan (Liu Wei plus Wu Wei Zi and Rou Gui) chilled to guide Yang back, cold herbs cause danger. After guiding fire back, tonify Middle Jiao with Ren Shen, Gan Cao, Dang Gui, Gou Qi Zi.
In humans, Water is one, Fire is two. At conception, Yang is often in excess, Yin is often deficient. Most diseases from youth to old age stem from True Yin deficiency. True Yang deficiency is rare. Modern doctors, ignoring the root, indiscriminately use tonics like Ren Shen, Huang Qi, Bai Zhu, Cang Zhu, Sheng Jiang, Rou Gui, and Fu Zi. Light illness becomes heavy; heavy illness causes death. I have witnessed much of this error and write to warn others.
Disease variations are numerous, yet Yin is emphasized. Cold invading the exterior requires Yin for sweat production. Stroke paralysis involves Yin damage. Deficiency consumption generates fire, requiring Water tonification. Diarrhea loses Yin, requiring Kidney tonification. Ascites involves Water evil, requiring Kidney treatment. Guan Ge stems from Yin deficiency, requiring urgent Yin rescue. These are major principles.
Yang pathogens eventually harm Yin; Zang injuries ultimately reach the Kidney. Knowing to save the root saves the patient.
The Great Luo of the Stomach, named Xu Li, crosses the diaphragm to the Lungs, emerging below the left breast. Pulsation here indicates leakage of Zong Qi (Gathering Qi). In Yin deficiency consumptive diseases, pulsation under the heart indicates this condition. People mistake it for heart palpitations. Mild pulsation means mild disease; severe pulsation means severe disease. I treat this with pure sweet, water-strengthening herbs to fill True Yin. Although the Classic speaks of Zong Qi leakage, I attribute it to True Yin deficiency. Grain enters the Stomach, transmits to the Lungs, generating Wei Qi and Zong Qi. Qi is the mother of Water; Qi accumulation generates Water (Lung Qi generating Kidney Water). If Stomach Qi transmits to Lungs, but Kidney fails to receive, Zong Qi leaks upward, and Kidney Water dries below. Qi and Water are related; seeking balance requires tonifying Yin to match Yang.
Voice comes from Lung Metal, influenced by Dantian. Tonifying Lung uses Ren Shen, Huang Qi; Clearing Lung uses Huang Qin, Mai Dong; Astringing Lung uses Wu Wei Zi, He Zi; Purging Lung uses Ting Li Zi, Zhi Ke. These work for mild cases but fail for root deficiency. Lung Qi returns to Kidney Water at night. If Kidney has Fire, Metal fears destruction and does not return; if Kidney lacks Fire, Water is cold and Metal does not return. Symptoms include wheezing, cough, insomnia, anorexia. Tonifying Mother (Kidney) helps Child (Lung). Clearing/Purging harms Lung Metal. Astringents seem logical but lack direction. *Lizhi Zhizhi* states: Lung exhales, Kidney inhales. Lung is master of Qi, Kidney is root of Qi. Qi rushing up from umbilicus indicates Kidney failure to receive Qi. Do not focus only on Lung; strengthen Water source. If due to Fire deficiency, tonify Fire source.
For fertility, use pure, gentle herbs to invite harmony, avoiding harsh substances. The Classic states: "The key to Yin-Yang is secret Yang ensuring solidity." This refers to sexual intercourse: Yang must be secret to prevent emission. Yin-Yang must harmonize; Yin must be balanced so Yang remains secret. Tonifying Yang requires empowering Yin, as Yang roots in Yin. Using harsh drugs to exhaust Yin for Yang tonification, combined with sexual excess, leads to marrow depletion, emaciation, and death. Physicians err here.
Classic: Girls 14, Boys 16, Tian Gui arrives. Tian Gui is Yin. Children have not reached Yin, hence "Pure Yang," meaning tender Yang, not excess Yang. Physicians misuse bitter-cold herbs on children, damaging Yin and Yang, harming Spleen and Kidney. Jiezhai said: No Kidney tonification for children until 16 when Kidneys fill. If deficient at conception, nothing can help; if sufficient, no need to help. This is wrong. Immature Yin in children is Kidney deficiency. Parental excess desire causes deficient Water in offspring, also Kidney deficiency. If Yin is deficient and not tonified, Yin extinction leads to Yang extinction. How can it be untonifiable?
Animals with lungs urinate; those without lungs do not. Obstructed waterways cause distension; clearing Lungs is urgent.
Chronic cough due to Lung deficiency with fire requires clearing and moistening Lungs. Avoid astringent-dry herbs. Misuse of Su Qiao and He Zi traps fire in Lungs. Combined with Ren Shen, Bai Zhu, Ban Xia, death ensues quickly. Physicians repeat this error; warning issued.
Coughing blood with fever is not necessarily Tuberculosis (Zhai). Unchecked use of Si Wu Tang, Huang Bo, Zhi Mu causes Zhai. Chest fullness is not necessarily Distension. Unchecked use of Shan Zha, Shen Qu causes Distension. Qi stagnation is not necessarily Dysphagia (Ye Ge). Unchecked use of Qing Pi, Zhi Ke causes Ye Ge. Once established, untreatable.
Blood loss patients need purgatives/blood-breaking herbs initially. Post-blood-loss patients must avoid purgatives.
Contraindications: Dry mouth from fluid loss forbids Diuresis (Wu Ling San). Profuse sweating forbids Diuresis. Frequent urination forbids Sweating. Sore throat forbids Sweating/Diuresis. Loose stools forbid Zhi Zi. Constipation forbids Drying herbs. Vomiting forbids further vomiting; upper Qi stagnation with constipation forbids Bowel purgation, only disperse upper Qi. Wiry pulse forbives Ping Wei San (causes deficiency). Slow pulse forbids Jian Zhong Tang (causes excess).
Body has Exterior/Interior, Yin/Yang, Ying/Wei, Blood/Qi. Interior Zang-Fu rely on Ying Qi; Exterior Skin/Muscles rely on Wei Qi. Ying governs Blood inside but contains Qi; Wei governs Qi outside but contains Blood. Divided they are two; united they are one.
Pulse has Meridians (Jing, interior) and Collaterals (Luo, exterior). Qi has Ying (interior) and Wei (exterior). Alcohol's Qi moves from interior to exterior. Why does the Classic say alcohol affects Collaterals before Meridians? Wei Qi is fierce Qi of grain; Alcohol is also fierce Qi of grain. They share rapid nature. Alcohol follows Wei Qi, entering skin first, filling Meridians, then Ying Qi fills, and Meridians become full.