妇人有骨蒸夜热，遍体火焦，口干舌燥，咳嗽吐沫，难于生子者。人以为阴虚火动也，谁知是骨髓内热乎！夫
寒阴之地，固不生物，而干旱之田，岂能长养。然而骨髓与胞胎何相关切，而骨髓之热，即能使人不嗣，此前贤未
言者也。山一旦创言之，不几为世俗所骇乎？而要知不必骇也，此中实有其理焉。盖胞胎，为五脏外之一脏耳。以
其不阴不阳，所以不列于五脏之中。所谓不阴不阳者，以胞胎上系于心包，下系于命门。系心包者通于心，心者，
阳也；系命门者通于肾，肾者，阴也。是阴之中有阳，阳之中有阴，所以通于变化，或生男或生女，俱从此出。然
必阴阳协和，不偏不枯，始能变化生人，否则否矣。况胞胎既通于肾，而骨髓亦肾之所化也。骨髓热，由于肾之热，
肾热而胞胎亦不能不热。且胞胎非骨髓之养，则婴儿无以生骨。骨髓过热，则骨中空虚，惟存火烈之气，又何能成
胎？治法必须清骨中之热，然骨热由于水亏，必补肾之阴，则骨热除，珠露有滴濡之喜矣。壮水之主，以制阳光，此
之谓也。
方用清骨滋肾汤。
地骨皮（一两，酒洗） 丹皮（五钱） 沙参（五钱） 麦冬（五钱，去心） 元参（五钱，酒洗） 五味子（五
分，炒研） 白术（三钱，土炒） 石斛（二钱）
水煎，连服三十剂而骨热解。再服六十剂自受孕。此方之妙，补肾中之精，凉骨中之热，不清胞胎，而胞胎自
无大热之患。然阴虚内热之人，原易受孕，今因骨髓过热，所以受精而变燥，以致难于育子，本非胞胎之不能受精，
所以稍补其肾，以杀其火之有余，而益其水之不足，便易种子耳。
眉批∶治骨髓热所以不用熟地方极善，用者万勿加减。凡峻药，病去七分即止，不必拘泥三十剂、六十剂之
数，三元生人不一，余类推。
歌括∶骨蒸夜热似火焚，不孕一生徒雨云。
口干舌燥咳吐沫，骨髓内热虚火熏。
清骨滋肾用地骨，丹皮麦冬术石斛。
沙参元参五味子，久服自然肾水足。
妇女有骨蒸潮热、夜间发热，全身如火烧焦，口干舌燥，咳嗽吐白沫，难以怀孕的。人们认为这是阴虚火旺所致，谁知道这其实是骨髓内部发热呢！寒冷阴湿的地方，固然不能生长万物，而干旱贫瘠的田地，又怎能滋养作物。然而骨髓与胞胎（子宫）有什么关系密切到骨髓发热就会导致不孕？这是前代贤人未曾论述过的。我傅山一旦提出这个观点，岂不是会让世俗之人感到惊骇吗？但要知道不必惊骇，这其中确实有其道理。
盖胞胎（子宫），是五脏之外的一个脏器。因为它既不完全属阴也不完全属阳，所以不列入五脏之中。所谓“不阴不阳”，是指胞胎上连接心包络，下连接命门。连接心包络则通达于心，心属阳；连接命门则通达于肾，肾属阴。因此阴中有阳，阳中有阴，所以能通于变化，或生男或生女，都由此而出。但是必须阴阳和谐，不偏颇不枯竭，才能化生人类，否则就不行。况且胞胎既然通达于肾，而骨髓也是由肾所化生的。骨髓发热，是由于肾热引起的，肾热则胞胎也不能不热。而且如果胞胎得不到骨髓的滋养，婴儿就无法生成骨骼。骨髓过热，则骨骼中空虚，只存有猛烈之火气，又怎么能成胎呢？治疗方法必须清除骨头中的热邪，然而骨热是由于肾水亏虚引起的，必须补肾之阴，那么骨热自除，就像珠露滴落滋润大地一样喜悦了。“壮水之主，以制阳光”（通过滋补肾阴来抑制亢盛的虚火），说的就是这个道理。
方剂用清骨滋肾汤。
地骨皮（一两，酒洗） 丹皮（五钱） 沙参（五钱） 麦冬（五钱，去心） 元参（五钱，酒洗） 五味子（五分，炒研） 白术（三钱，土炒） 石斛（二钱）
用水煎服，连续服用三十剂后骨热解除。再服用六十剂自然受孕。此方的妙处在于，补益肾中的精气，凉解骨中的热邪，虽然不清理胞胎，但胞胎自然没有大热的隐患。然而阴虚内热的人，原本容易受孕，现在因为骨髓过热，导致受精后变得燥热，以致难以孕育子女，这本来不是胞胎不能受精的问题，所以稍微补益其肾，以削减有余的火气，并增益不足的水液，就容易种子了。
眉批：治疗骨髓热所以不用熟地黄极好，使用者千万不要加减药物。凡是峻猛的药物，病去七分就停止，不必拘泥于三十剂、六十剂的数量，三元生人的情况不一，其余类推。
歌括：骨蒸夜热似火焚，不孕一生徒雨云。
口干舌燥咳吐沫，骨髓内热虚火熏。
清骨滋肾用地骨，丹皮麦冬术石斛。
沙参元参五味子，久服自然肾水足。
Women who suffer from bone-steaming tidal fever, night fevers, a body feeling as if scorched by fire, dry mouth and tongue, coughing with frothy sputum, and infertility. People assume this is due to Yin deficiency with hyperactive fire, but who would know it is actually heat within the bone marrow! Cold and yin-damp places certainly cannot generate life, nor can drought-stricken fields nourish crops. However, what is the close relationship between bone marrow and the Chong Palace (uterus) such that heat in the bone marrow causes infertility? This is something former sages had not discussed. If I, Fu Shan, propose this theory today, will it not shock the secular world? Yet one must know there is no need for shock, for there is indeed reason behind it.
The Chong Palace (uterus) is an organ outside the Five Viscera. Because it is neither purely Yin nor purely Yang, it is not listed among the Five Viscera. What is meant by "neither Yin nor Yang" is that the upper part of the Chong Palace connects to the Pericardium, and the lower part connects to the Mingmen (Gate of Life). Connecting to the Pericardium allows communication with the Heart, which is Yang; connecting to the Mingmen allows communication with the Kidney, which is Yin. Thus, there is Yang within Yin and Yin within Yang, enabling transformation, whether giving birth to a male or female, all proceeding from here. However, only when Yin and Yang are harmonious, neither biased nor depleted, can human life be generated; otherwise, it fails. Moreover, since the Chong Palace communicates with the Kidney, and bone marrow is also transformed by the Kidney, heat in the bone marrow stems from Kidney heat. If the Kidney is hot, the Chong Palace cannot help but be hot. Furthermore, if the Chong Palace does not receive nourishment from the bone marrow, the infant cannot form bones. If the bone marrow is excessively hot, the bones become hollow, containing only fierce fire qi, how then can conception occur? The treatment method must clear the heat within the bones. Since bone heat arises from Water deficiency, one must tonify Kidney Yin. Then the bone heat will dissipate, bringing joy like dew drops nourishing the earth. "Strengthening the master of Water to control the sunlight" (nourishing Kidney Yin to suppress hyperactive fire), this is what is referred to.
Prescribe Qing Gu Zi Shen Tang (Clear Bone and Nourish Kidney Decoction).
* *Lycii Cortex* (Di Gu Pi) - 1 liang, washed with wine
* *Moutan Cortex* (Dan Pi) - 5 qian
* *Glehniae Radix* (Sha Shen) - 5 qian
* *Ophiopogonis Radix* (Mai Dong) - 5 qian, heart removed
* *Scrophulariae Radix* (Yuan Shen) - 5 qian, washed with wine
* *Schisandrae Fructus* (Wu Wei Zi) - 5 fen, stir-fried and ground
* *Atractylodis Macrocephalae Rhizoma* (Bai Zhu) - 3 qian, stir-fried with soil
* *Dendrobii Caulis* (Shi Hu) - 2 qian
Decoct in water. Take continuously for thirty doses until the bone heat resolves. Continue taking for sixty more doses to conceive naturally. The brilliance of this formula lies in tonifying the essence within the Kidney and cooling the heat within the bones. Although it does not directly clear the Chong Palace, the Chong Palace will naturally be free from severe heat issues. However, individuals with Yin deficiency and internal heat are originally prone to conception. Now, due to excessive bone marrow heat, conception becomes dry and difficult to nurture offspring. This is not because the Chong Palace cannot conceive, but rather because slightly tonifying the Kidney reduces the excess fire and replenishes the insufficient Water, making conception easier.
Marginal Note: It is excellent that Shu Di Huang (Prepared Rehmannia Root) is not used for treating bone marrow heat. Users must not add or subtract ingredients. For potent medicines, stop when the disease is reduced by seventy percent; do not rigidly adhere to the number of thirty or sixty doses. Cases vary; apply similar logic to others.
Verse:
Bone-steaming night fever feels like burning fire,
Infertility lasts a lifetime, clouds of rain in vain.
Dry mouth and parched tongue, coughing up froth,
Heat within bone marrow, smoldering with deficient fire.
To clear bone heat and nourish the Kidney, use Di Gu Pi,
Dan Pi, Mai Dong, Bai Zhu, and Shi Hu.
Sha Shen, Yuan Shen, and Wu Wei Zi,
Long-term use naturally fills the Kidney Water.