人之一身。不外阴阳。而阴阳二字。即是水火。水火二字。即是气血。水即化气。火即化血。何以言水即化气
哉。气着于物。复还为水。是明验也。盖人身之气。生于脐下丹田气海之中。脐下者肾与膀胱。水所归宿之
地也。此水不自化为气。又赖鼻间吸入天阳。从肺管引心火。下入于脐之下。蒸其水使化为气。如易之坎
卦。一阳生于水中。而为生气之根。气既生。则随太阳经脉为布护于外。是为卫气。上交于肺。是为呼吸。五
脏六腑。息以相吹。止此一气而已。然气生于水。即能化水。水化于气。亦能病气。气之所至。水亦无不至焉。
故太阳之气达于皮毛则为汗。气挟水阴而行于外者也。太阳之气。上输于肺。膀胱肾中之水阴。即随气
升腾。而为津液。是气载水阴而行于上者也。气化于下。则水道通而为溺。是气行水亦行也。设水停不化。
外则太阳之气不达。而汗不得出。内则津液不生。痰饮交动。此病水而即病气矣。又有肺之制节不行。气
不得降。因而癃闭滑数。以及肾中阳气。不能镇水。为饮为泻。不一而足。此病气即病水矣。总之。气与水本
属一家。治气即是治水。治水即是治气。是以人参补气。以其生于北方。水中之阳。甘寒滋润。大生津液。津
液充足。而肺金濡润。肺主气。其叶下垂以纳气。得人参甘寒之阴。内具阳性。为生气化水之良品。故气得
所补益焉。即如小柴胡。仲景自注云。上焦得通。津液得下。胃气因和。是通津液即是和胃气盖津液足。则
胃上输肺。肺得润养。其叶下垂。津液又随之而下。如雨露之降。五脏戴泽。莫不顺利。而浊阴全消。亢阳不
作。肺之所以制节五脏者如此。设水阴不足。津液枯竭。上则痿咳。无水以济之也。下则闭结。制节不达于
下也。外则蒸热。水阴不能濡于肌肤也。凡此之证。皆以生水为治法。故清燥救肺汤。生津以补肺气。猪苓
汤。润利以除痰气。都气丸。补水以益肾气。即如发汗。所以调卫气也。而亦戒火攻以伤水阴。故用白芍之
滋阴。以启汗源。用花粉之生津。以救汗液。即此观之。可知滋水即是补气。然补中益气汤。六君子。肾气丸。
是皆补气之方也。何以绝不滋水哉。盖无形之水阴。生于下而济于上。所以奉养是气者也。此水则宜滋
有形之水质。入于口而化于下。所以传道是气者也。此水则宜泻。若水质一停。则气便阻滞。故补中汤。用
陈术以制水。六君子。用苓半以利水。肾气丸。亦用利水之药。以佐桂附。桂附以气药化水。苓泽即以利水
之药以化气。真武汤尤以术苓利水为主。此治水之邪。即以治气。与滋水之阴。即以补气者。固并行而不
悖也。且水邪不去。则水阴亦不能生。故五苓散去水邪。而即能散津止渴。并能发汗退热。以水邪去。则水
阴布故也。然水阴不滋。则水邪亦不能去。故小柴胡通达津液。而即能下调水道。总见水行则气行。水止
则气止。能知此者。乃可与言调气矣。何以言火即化血哉。血色。火赤之色也。火者心之所主。化生血液。以
濡周身。火为阳。而生血之阴。即赖阴血以养火。故火不上炎。而血液下注。内藏于肝。寄居血海。由冲任带
三脉。行达周身。以温养肢体。男子则血之转输。无从觇验。女子则血之转输。月事时下。血下注于血海之
中。心火随之下济。故血盛而火不亢烈。是以男子无病。而女子受胎也。如或血虚。则肝失所藏。木旺而愈
动火。心失所养。火旺而益伤血。是血病即火病矣。治法宜大补其血。归地是也。然血由火生。补血而不清
火。则火终亢而不能生血。故滋血必用清火诸药。四物汤所以用白芍。天王补心丹所以用二冬。归脾汤
所以用枣仁。仲景炙甘草汤所以用二冬阿胶。皆是清水之法。至于六黄汤。四生丸。则又以大泻火热为
主。是火化太过。反失其化。抑之即以培之。清火即是补血。又有火化不及。而血不能生者。仲景炙甘草汤
所以有桂枝。以宣心火。人参养荣汤所以用远志肉桂。以补心火。皆是补火生血之法。其有血寒血痹者。
则用桂枝细辛艾叶干姜等。禀受火气之药。以温达之。则知治火即是治血。血与火原一家。知此乃可与
言调血矣。夫水火气血。固是对子。然亦互相维系。故水病则累血。血病则累气。气分之水阴不足。则阳气
乘阴而干血。阴分之血液不足。则津液不下而病气。故汗出过多则伤血。下后亡津液则伤血。热结膀胱
则下血。是水病而累血也。吐血咳血。必兼痰饮。血虚则精竭水结。痰凝不散。失血家往往水肿。瘀血化水。
亦发水肿。是血病而兼水也。盖在下焦。则血海膀胱。同居一地。在上焦。则肺主水道。心主血脉。又并域而
居。在躯壳外。则汗出皮毛。血循经脉。亦相倚而行。一阴一阳。互相维系。而况运血者即是气。守气者即是
血。气为阳。气盛即为火盛。血为阴。血虚即是水虚。一而二。二而一者也。人必深明此理。而后治血理气。调
阴和阳。可以左右逢源。又曰血生于心火。而下藏于肝。气生于肾水。而上主于肺。其间运上下者。脾也。水
火二藏。皆系先天。人之初胎。以先天生后天。人之既育。以后天生先天。故水火两藏。全赖于脾。食气入胃。
脾经化汁。上奉心火。心火得之。变化而赤。是之谓血。故治血者。必治脾为主。仲景炙甘草汤。皆是此义。以
及大黄下血。亦因大黄秉土之色。而大泄地道故也。地黄生血。亦因地黄秉土之润。而大滋脾燥故也。其
余参 。运血统血。皆是补脾。可知治血者。必以脾为主。乃为有要。至于治气。亦宜以脾为主。气虽生于肾
中。然食气入胃。脾经化水。下输于肾。肾之阳气。乃从水中蒸腾而上。清气升而津液四布。浊气降而水道
下行。水道下行者。犹地有江河。以流其恶也。津液上升者。犹土膏脉动。而雨露升也。故治气者必治脾为
主。六君子汤。和脾利水以调气。真武汤。扶脾镇水以生气。十枣陷胸等汤。攻脾夺水以通气。此去水邪以
补气之法也。又有水津不灌。壮火食气。则用人参滋脾以益气。花粉清脾以和气。凡治气者。亦必知以脾
为主。而后有得也。李东垣治病。以气为主。故专主脾胃。然用药偏于刚燥。不知脾不制水固宜燥。脾不升
津则宜滋。气分不可留水邪。气分亦不可无水津也。朱丹溪治病以血为主。故用药偏于寒凉。不知病在
火脏宜寒凉。病在土脏宜甘缓也。此论不专为失血立说。然治血者。必先知之。而后于调气和血。无差爽云。
The entire human body is nothing but Yin and Yang. The terms "Yin and Yang" refer to Water and Fire; the terms "Water and Fire" refer to Qi (Vital Energy) and Blood. Water transforms into Qi, and Fire transforms into Blood. Why do we say that Water transforms into Qi? Because Qi attaches to matter and reverts to Water, which is clear evidence. Generally speaking, the Qi of the human body is generated in the Dantian (Elixir Field) and Qihai (Sea of Qi), located below the navel. This area below the navel corresponds to the Kidney and Bladder, which are the destinations where Water gathers. However, this Water cannot transform into Qi on its own; it relies on the Heavenly Yang Qi inhaled through the nose, guided by the Lung channel to draw down Heart Fire, entering below the navel to steam the Water, causing it to transform into Qi. This is like the Kan trigram (☵) in the *I Ching* (Book of Changes), where one Yang line is born within Water, serving as the root of generating Qi. Once Qi is generated, it spreads and protects the exterior along the Taiyang (Greater Yang) meridian, becoming Wei Qi (Defensive Qi). It ascends to communicate with the Lung, becoming respiration. The Zang and Fu organs breathe into each other, relying solely on this one Qi. However, since Qi is born from Water, it can also transform Water; since Water is transformed by Qi, it can also cause disease. Wherever Qi reaches, Water also reaches. Therefore, when Taiyang Qi penetrates the skin and hair, it becomes sweat; this is Qi carrying Yin-Water to the exterior. When Taiyang Qi transports upward to the Lung, the Yin-Water from the Bladder and Kidneys ascends with the Qi to become Jin-Ye (Body Fluids); this is Qi carrying Yin-Water to the upper body. When Qi undergoes transformation in the lower Jiao (Lower Burner), the water passages open, leading to urination; this demonstrates that when Qi moves, Water moves. If Water stagnates and fails to transform, externally, Taiyang Qi cannot penetrate, preventing sweating; internally, Jin-Ye fails to generate, leading to the interaction of Phlegm and Fluid retention. This is a case of Water pathology affecting Qi. Furthermore, if the Lung's regulatory function fails, Qi cannot descend, resulting in urinary retention or frequent/rapid urination. If Kidney Yang Qi fails to control Water, it leads to fluid retention or diarrhea, among other conditions. This is a case of Qi pathology affecting Water. In summary, Qi and Water belong to the same family; treating Qi is treating Water, and treating Water is treating Qi. Therefore, Ren Shen (Ginseng Root) tonifies Qi because it grows in the North, possessing the Yang within Water. Its sweet and cold nature moistens and generates abundant Jin-Ye. When Jin-Ye is sufficient, Lung Metal is nourished. Since the Lung governs Qi and its leaves hang downward to receive Qi, receiving the Yin nature of Ren Shen's sweetness and coldness, while containing Yang properties, makes it an excellent agent for generating Qi and transforming Water. Thus, Qi is replenished. For example, Xiao Chai Hu Tang (Minor Bupleurum Decoction), as Zhang Zhongjing annotated: "When the Upper Jiao is unblocked, Jin-Ye descends, and Stomach Qi harmonizes." This implies that unblocking Jin-Ye is harmonizing Stomach Qi. When Jin-Ye is sufficient, Stomach Qi uploads to the Lung; the Lung is nourished, its leaves hang downward, and Jin-Ye descends further, like rain and dew falling, benefiting all Zang organs, eliminating turbid Yin, and suppressing hyperactive Yang. This is how the Lung regulates the Zang organs. If Yin-Water is insufficient and Jin-Ye is depleted, upward symptoms include flaccidity and cough due to lack of Water to assist; downward symptoms include constipation due to failed regulation reaching the lower body; outward symptoms include steaming heat due to Water failing to moisten the skin and muscles. All such syndromes are treated by generating Water. Thus, Qing Zao Jiu Fei Tang (Clear Dryness Rescue the Lung Decoction) generates Jin-Ye to tonify Lung Qi; Zhu Ling Tang (Polyporus Decoction) moistens and promotes urination to eliminate Phlegm-Fluids; Du Qi Wan (All-Qi Pill) supplements Water to benefit Kidney Qi. Regarding diaphoresis (sweating), it regulates Wei Qi, but one must avoid fire therapy that damages Yin-Water. Therefore, Bai Shao (White Peony Root) is used to nourish Yin to open the source of sweat, and Hua Fen (Trichosanthes Root) is used to generate Jin-Ye to rescue sweat fluids. From this, we see that nourishing Water is tonifying Qi. However, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Liu Jun Zi Tang (Six Gentlemen Decoction), and Shen Qi Wan (Kidney Qi Pill) are all formulas for tonifying Qi, yet they do not explicitly nourish Water. This is because formless Yin-Water is generated in the lower body and assists the upper body to nourish this Qi; this type of Water should be nourished. Formless substance-water enters the mouth and transforms in the lower body to transmit this Qi; this type of Water should be purged. If substance-water stagnates, Qi becomes obstructed. Therefore, Bu Zhong Tang uses Chen Pi (Tangerine Peel) and Bai Zhu (Atractylodes Macrocephala Rhizome) to control dampness; Liu Jun Zi Tang uses Fu Ling (Poria) and Ban Xia (Pinellia Tuber) to promote urination; Shen Qi Wan also uses diuretic herbs to assist Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root). Gui Zhi and Fu Zi use Qi-moving herbs to transform Water, while Fu Ling and Ze Xie (Alisma Rhizome) use diuretics to transform Qi. Zhen Wu Tang (True Warrior Decoction) focuses mainly on Bai Zhu and Fu Ling to drain dampness. This treats Water pathologies to address Qi, just as nourishing Yin-Water addresses Qi; these two approaches run parallel without contradiction. Moreover, if Water pathogens are not removed, Yin-Water cannot be generated. Therefore, Wu Ling San (Five-Ingredient Powder with Poria) removes Water pathogens, thereby dispersing Jin-Ye to stop thirst, and inducing sweating to reduce fever, because removing Water pathogens allows Yin-Water to distribute. Conversely, if Yin-Water is not nourished, Water pathogens cannot be removed. Thus, Xiao Chai Hu Tang unblocks Jin-Ye, thereby regulating the water passages. It is evident that when Water flows, Qi flows; when Water stops, Qi stops. One who understands this can discuss regulating Qi.
Why do we say that Fire transforms into Blood? The red color of blood is the color of Fire. Fire is governed by the Heart, which generates Blood to moisten the whole body. Fire is Yang, and the Yin required to generate Blood relies on Yin-Blood to nourish Fire. Thus, Fire does not flare upward, and Blood descends, storing internally in the Liver, residing in the Blood Sea, and circulating throughout the body via the Chong, Ren, and Dai meridians to warm and nourish the limbs. In men, the circulation of Blood is difficult to observe directly; in women, the circulation of Blood is evidenced by menstruation occurring monthly. Blood descends into the Blood Sea, and Heart Fire descends with it. Thus, when Blood is abundant, Fire is not hyperactive, allowing men to remain healthy and women to conceive. If Blood is deficient, the Liver loses its storage capacity, Wood becomes hyperactive and agitates Fire further; the Heart loses nourishment, Fire becomes hyperactive and injures Blood more. This is Blood pathology affecting Fire. The treatment method should greatly tonify Blood, using Dang Gui (Angelica Sinensis Root) and Di Huang (Rehmannia Root). However, since Blood is generated by Fire, if one tonifies Blood without clearing Fire, Fire will remain hyperactive and fail to generate Blood. Therefore, nourishing Blood requires clearing Fire herbs. Si Wu Tang (Four Substance Decoction) uses Bai Shao to clear Fire; Tian Wang Bu Xin Dan (Emperor of Heaven's Special Pill to Tonify the Heart) uses Dong Gen (Asparagus Tuber) and Mai Dong (Ophiopogon Tuber); Gui Pi Tang (Restore the Spleen Decoction) uses Suan Zao Ren (Ziziphus Seed); Zhang Zhongjing's Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) uses Dong Gen, Mai Dong, and E Jiao (Donkey-Hide Glue). These are all methods of clearing Fire. Meanwhile, Huang Lian Jie Du Tang (Coptis Decoction to Relieve Toxicity, referred to here as Liu Huang Tang) and Si Sheng Wan (Four Raw Ingredients Pill) focus on purging intense Heat and Fire. This occurs when Fire transformation is excessive, losing its generative function; suppressing it is cultivating it; clearing Fire is tonifying Blood. Conversely, if Fire transformation is insufficient, Blood cannot be generated. Zhi Gan Cao Tang includes Gui Zhi to circulate Heart Fire; Ren Shen Yang Rong Tang (Ren Shen Nourishing the Vigor Decoction) uses Yuan Zhi (Polygala Root) and Rou Gui (Cinnamon Bark) to tonify Heart Fire. These are methods of tonifying Fire to generate Blood. For cases of Cold-Blood or Blood Bi (Obstruction), herbs like Gui Zhi, Xi Xin (Asarum), Ai Ye (Mugwort Leaf), and Gan Jiang (Dried Ginger), which possess Fire energy, are used to warm and unblock. Thus, treating Fire is treating Blood; Blood and Fire are originally one family. Understanding this allows one to discuss regulating Blood.
Although Water/Fire and Qi/Blood are paired concepts, they sustain each other. Water pathology affects Blood, and Blood pathology affects Qi. Insufficiency of Yin-Water in the Qi aspect allows Yang Qi to invade Blood; insufficiency of Yin-Blood in the Yin aspect prevents Jin-Ye from descending, causing Qi pathology. Excessive sweating injures Blood; purgative-induced loss of Jin-Ye injures Blood; Heat binding in the Bladder causes hematuria; this is Water pathology affecting Blood. Hematemesis (vomiting blood) and hemoptysis (coughing blood) often involve Phlegm-Fluids; Blood deficiency leads to Essence depletion and Water stagnation, with凝 (coagulated) Phlegm failing to dissipate; patients with chronic bleeding often develop edema; Blood stasis transforming into Water also causes edema; this is Blood pathology involving Water. In the Lower Jiao, the Blood Sea and Bladder share the same location; in the Upper Jiao, the Lung governs water passages and the Heart governs blood vessels, sharing the same region; outside the body, sweat exits the skin/hair, and Blood circulates in the meridians, moving in reliance on each other. Yin and Yang sustain each other. Moreover, the mover of Blood is Qi, and the guardian of Qi is Blood. Qi is Yang; excess Qi is excess Fire. Blood is Yin; Blood deficiency is Water deficiency. They are one divided into two, and two united as one. One must deeply understand this principle to effectively treat Blood and regulate Qi, harmonize Yin and Yang, and achieve success in all endeavors.
It is said: Blood is generated by Heart Fire and stored in the Liver; Qi is generated by Kidney Water and governed by the Lung. The organ that mediates between the upper and lower is the Spleen. Both Water and Fire organs belong to Pre-Heaven (Innate Constitution). In early fetal development, Pre-Heaven generates Post-Heaven (Acquired Constitution); after birth, Post-Heaven sustains Pre-Heaven. Therefore, both Water and Fire organs rely entirely on the Spleen. When food enters the Stomach, the Spleen channels transform juices, sending them upward to Heart Fire. Heart Fire transforms them into red Blood. Thus, those treating Blood must prioritize treating the Spleen. Zhang Zhongjing's Zhi Gan Cao Tang embodies this principle. Da Huang (Rhubarb Rhizome) promotes blood evacuation because it inherits the color of Earth and strongly drains the Earthly pathways. Di Huang (Rehmannia Root) generates Blood because it inherits the moisture of Earth and strongly moistens Spleen dryness. Other herbs like Ren Shen (Ginseng) and Huang Qi (Astragalus) transport and unify Blood, all functioning by tonifying the Spleen. Thus, treating Blood must prioritize the Spleen to be effective. Similarly, treating Qi should prioritize the Spleen. Although Qi is generated in the Kidneys, when food enters the Stomach, the Spleen channels transform Water, sending it downward to the Kidneys. Kidney Yang Qi then steams upward from the Water. Clear Qi ascends, distributing Jin-Ye everywhere; Turbid Qi descends, lowering the water passages. Descending water passages are like rivers on earth, flushing away filth; ascending Jin-Ye is like moist soil pulsating, raising rain and dew. Therefore, treating Qi must prioritize the Spleen. Liu Jun Zi Tang harmonizes the Spleen and promotes urination to regulate Qi; Zhen Wu Tang supports the Spleen and stabilizes Water to generate Qi; Shi Zao Tang (Ten Date Pill) and Xiong Dan Tang (Chest Trap Decoction) attack the Spleen and drain Water to unblock Qi. These are methods of removing Water pathogens to tonify Qi. When Jin-Ye fails to irrigate and Strong Fire consumes Qi, Ren Shen is used to nourish the Spleen and augment Qi, and Hua Fen (Trichosanthes Root) is used to clear the Spleen and harmonize Qi. Anyone treating Qi must know to prioritize the Spleen to succeed.
Li Dongyuan treated diseases focusing on Qi, thus emphasizing the Spleen and Stomach. However, his medications tended toward acrid-warm and drying. He did not realize that while the Spleen needs drying to control Water, it needs moistening to ascend Jin-Ye. The Qi aspect cannot retain Water pathogens, nor can it lack Jin-Ye. Zhu Danxi treated diseases focusing on Blood, thus using cold-cooling medications. He did not realize that pathology in the Fire Organ requires cold-cooling, while pathology in the Earth Organ requires sweet-moderating. This discussion is not exclusively for hemorrhage, but those treating Blood must know this first, so that in regulating Qi and harmonizing Blood, there will be no errors.