《易》曰∶天道下济而光明，地道卑而上行，故上下升降而气乃和。古人制方用药，一
本升
降浮沉之理，不拘寒热补泻之迹者，宋元以来，东垣一人而已。盖四时之气，春升、夏浮、
秋降、冬沉，而人身之气，莫不由之。然升降浮沉者，气也，其所以升降浮沉者，人之中，
犹天之枢也。今人饥饱、劳役，损伤中气，于是当升者不得升，当降者不得降，而发热、困
倦、喘促、痞塞等症见矣。夫内伤之热，非寒可清；气陷之痞，非攻可去。惟阴阳一通，而
寒热自已；上下一交，而痞隔都损。此东垣之学，所以能为举其大欤！李频湖曰∶升降浮沉
则顺之，寒热温凉则逆之，故春宜辛温，夏宜辛热，长夏宜甘苦辛温，秋宜酸温，冬宜苦寒
。愚谓升降浮沉则顺之者，所以顺天时之气也；寒热温凉则逆之者，所以救气化之过也。李
氏辛甘酸苦之用是已，若春宜温、夏宜热、冬宜寒之谓，是助之也，岂逆之谓哉！
客曰∶五行生克之说，非圣人之言也，秦汉术士之所伪撰也。余曰∶于何据也？曰∶《
易》
言八卦，而未及五行，《洪范》言五行，而未及生克，是以知其为无据之言也。曰∶子曷不
观诸河图、洛书乎？河图之数∶一、六居下，水也；二、七居上，火也；三、八居左，木也
；四、九居右，金也；五、十居中，土也。洛书之数∶戴九、履一。一，水之生数也；一之
右七，七，火之成数也；七之右为九，九，金之成数也；九之右为三，三，木之成数也；五
居于中，五，土之成数也。夫河图逆而左旋，以次相生；洛书顺而右转，以次相克。克者反
顺，生者反逆，此造化之妙也。且河图左旋相生，而其对待则皆相克；洛书右转相克，而其
对待则皆相生。是以生机恒寓于消落之中，而生气每藏于盛长之内。生而无克，则有进无退
而气易尽；克而无生，则消者不长而机以穷。生也克也，天地自然之理，莫如其然，而不得
不然者也。子又何疑焉？
曰∶河图、洛书，古未必有此，亦秦汉人所撰，以神其说者乎！曰∶《易》不云乎，河
出图
，洛出书。圣人则之，何子之不察也？且五行生克，天地之数也；河图、洛书、亦天地之数
也。未有图、书以前，天地之数，昭然已备；即图、书至今不出，而图、书之象，昭然亦备
。图、书可假，天地之数不可假也。夏之暑，肇于春之温，冬之寒，始于秋之凉，气之默运
然也；一阳转而土膏僭动，天气肃而海水西盛，杲日出而霜露立消，凉风至而万木凋落，象
之显呈也。而又何疑于图焉？
曰∶水生于天者也，岂生于金乎？方诸取水，月为水母，月亦生于金乎？水生木，未有木
生于
江湖波涛者！水辅土以生木，而专归之水可乎？曰∶天者，干之体也；月者，金之精也；坤也
者，万物皆致养焉。五行皆不能离土而生，独木然也哉！
曰∶岱石出火，汉井出烟，是土生火也；海中阴晦，波如火燃，是水生火也；火热而水
干，
是火反克水也；水冲而土溃，是水反克土也；丛灶燎原，火亦克木；锄圊耜田，金亦克土。
生克之道，不亦乱而无序乎？曰∶河图、洛书，水上，火下，木东，金西；天地之位，前南
，后北，左东，右西。其序秩然而不可紊乱者也。其序秩然不可紊乱，则其生、其克，亦循
序旋转而不可紊乱者也。若深井有火，高原出泉，则二气相更之妙耳！火燃水干，水冲土溃
，则盛衰胜复之常耳！是以穷五行之变则可，以为是即五行之事则不可也。且所谓相克者，
不过制其太过，而使归于平，非斩绝灭竭之谓也。又以抑其浮盛，而使还于根，以为生发之
兆，虽相克而实相成也。若金斫、土掩、火燃、水冲，此立尽之数，岂足语造化生成之妙哉
！
《易经》说：天道向下滋润万物而显得光明，地道卑下却向上运行，所以上下升降使得气机调和。古人制定方剂和使用药物，完全依据升降浮沉的原理，不拘泥于寒热补泻的表象，从宋元以来，只有李东垣一人做到了这一点。大概四季的气候，春天升发、夏天浮越、秋天肃降、冬天沉潜，而人体的气机，没有不顺应这一规律的。然而，升降浮沉的是气，而决定气之所以升降浮沉的关键，在于人的中焦脾胃，它就像天体的枢纽一样重要。现在的人因为饮食饥饱不均、过度劳累，损伤了中气，于是该升的气不能升，该降的气不能降，从而出现发热、困倦、气喘急促、痞满堵塞等症状。这种内伤引起的发热，不能用寒凉药来清解；因气陷导致的痞塞，不能用攻伐药来去除。只有阴阳通畅，寒热自然消除；上下交通，痞隔阻滞自然消散。这就是李东垣的学说，所以能抓住治病的大纲啊！李频湖说：“对于升降浮沉应当顺应它，对于寒热温凉应当逆治它。”因此春天适宜用辛温药，夏天适宜用辛热药，长夏适宜用甘苦辛温药，秋天适宜用酸温药，冬天适宜用苦寒药。我认为，“顺应升降浮沉”是为了顺应天时之气；“逆治寒热温凉”是为了纠正气化之偏颇。李氏所用辛、甘、酸、苦等药性正是此意。至于说春天宜温、夏天宜热、冬天宜寒的说法，这是助长时令之气，哪里算是逆治呢？
客人说：“五行生克的理论，不是圣人的言论，而是秦汉时期方术之士伪造的。”我说：“你根据什么这么说？”他说：“《易经》讲八卦，却没提到五行；《尚书·洪范》讲五行，却没提到生克，因此知道这是没有依据的话。”我说：“你为什么不看看河图和洛书呢？河图的数理：一、六在下，属水；二、七在上，属火；三、八在左，属木；四、九在右，属金；五、十在中，属土。洛书的数理：头顶是九，脚踩是一。一，是水的生数；一的右边是七，七，是火的成数；七的右边是九，九，是金的成数；九的右边是三，三，是木的成数；五居于中间，五，是土的成数。河图之数逆时针向左旋转，依次相生；洛书之数顺时针向右旋转，依次相克。克者反而顺行，生者反而逆行，这是造化的奥妙所在。而且河图左旋相生，但其相对之位皆相克；洛书右转相克，但其相对之位皆相生。因此生机恒常寓于消亡之中，生气每每藏在盛长之内。只有生没有克，就只有前进没有后退，气容易耗尽；只有克没有生，那么消亡者不再生长，生机就会穷尽。生与克，是天地自然的道理，没有什么比这更理所当然、不得不如此的了。你又怀疑什么呢？
客人说：“河图、洛书，古代未必有这些，也是秦汉人编撰出来，用来神化他们的学说的吧！”我说：“《易经》不是说过吗，黄河出图，洛水出书。圣人效法它们，你怎么这么不细心考察呢？况且五行生克，是天地固有的数理；河图、洛书，也是天地固有的数理。在河图、洛书出现之前，天地固有的数理已经清晰完备；即使河图、洛书至今没有出现，其象征意义也清晰完备。图、书可以伪造，但天地固有的数理不可伪造。夏天的暑热，肇始于春天的温暖；冬天的寒冷，开始于秋天的凉爽，这是气在默默运化；阳气初转则土壤松动活跃，天气肃杀则海水向西旺盛，太阳升起则霜露立即消融，凉风到来则万木凋落，这是象在明显呈现。你又对图有什么可怀疑的呢？
客人说：“水是生于天的，难道是水生于金吗？方诸（一种取露器具）取水，月亮是水的母亲，月亮也是生于金吗？水生木，从未见过树木生长在江湖波涛之中！水辅助土以生木，如果专门归于水可以吗？”我说：“天，是乾卦的实体；月，是金的精华；坤卦，万物都从中获取滋养。五行都不能离开土而生存，难道只有木例外吗！
客人说：“岱山岩石冒出火，汉井冒出烟，这是土生火；海中阴暗晦涩，波浪像火燃烧，这是水生火；火热导致水干涸，这是火反克水；水冲导致土溃败，这是水反克土；丛灶大火燎原，火也克木；锄头粪铲耕田，金也克土。生克的道理，不也是混乱而无序的吗？”我说：“河图、洛书中，水上火下，木在东，金在西；天地的位置，前南后北，左东右西。它们的秩序井然且不可紊乱。既然秩序井然不可紊乱，那么它们的生、克，也是循着次序旋转且不可紊乱的。如果是深井中有火，高原上出泉水，那是二气相互更替的奥妙罢了！火烧水干，水冲土溃，那是盛衰胜复的常态罢了！因此探究五行的变化是可以的，但认为这就是五行的全部事情就不对了。况且所谓的相克，不过是制约太过，使其回归平衡，并不是斩草除根、灭绝枯竭的意思。又是通过抑制其浮盛，使其回归根本，作为生发的征兆，虽然说是相克，实际上却是相辅相成。如果是金砍削、土掩埋、火燃烧、水冲刷，这是立刻毁灭的数量，哪里足以谈论造化生成的奥妙呢！”
The *I Ching* (Book of Changes) states: "The Way of Heaven descends to nourish and thereby shines brightly; the Way of Earth, though humble, ascends." Thus, through the ascending and descending movements, Qi (vital energy) achieves harmony. In ancient times, when formulating prescriptions and administering herbs, practitioners strictly adhered to the principles of ascending, descending, floating, and sinking, without being constrained by the superficial manifestations of cold, heat, tonification, or purgation. Since the Song and Yuan dynasties, only Li Dongyuan (Li Gao) has exemplified this approach. Generally, the Qi of the four seasons ascends in spring, floats in summer, descends in autumn, and sinks in winter. The Qi of the human body follows this pattern without exception. However, while ascending, descending, floating, and sinking refer to the movement of Qi, the determinant of why Qi moves in these ways is the Middle Jiao (Middle Burner, primarily referring to the Spleen and Stomach), which serves as the pivot of the body, analogous to the celestial axis.
Today, people often damage their Middle Qi due to irregular eating habits, overwork, and physical exertion. Consequently, Qi that should ascend fails to do so, and Qi that should descend fails to do so, leading to symptoms such as fever, fatigue, shortness of breath, and abdominal distension or blockage. The heat caused by internal injury cannot be cleared with cold-natured herbs; the bloating caused by Qi sinking cannot be removed with purgative methods. Only when Yin and Yang are unblocked will cold and heat resolve naturally; only when the upper and lower Jiao communicate will the obstruction dissipate. This is why Li Dongyuan’s learning is able to grasp the fundamental principles of treatment! Li Pinhu stated: "One should follow the tendencies of ascending, descending, floating, and sinking, but counteract the tendencies of cold, heat, warmth, and coolness." Therefore, in spring, acrid-warm herbs are suitable; in summer, acrid-hot herbs are suitable; during the late summer season, sweet-bitter-acrid-warm herbs are suitable; in autumn, sour-warm herbs are suitable; and in winter, bitter-cold herbs are suitable. I believe that "following ascending, descending, floating, and sinking" is done to align with the Qi of the seasons, while "counteracting cold, heat, warmth, and coolness" is done to correct deviations in physiological transformation. The use of acrid, sweet, sour, and bitter properties by Mr. Li illustrates this point. As for the notion that spring requires warmth, summer requires heat, and winter requires cold, this merely assists the seasonal Qi rather than counteracting it.
A guest remarked: "The theory of the generation and restriction among the Five Elements is not the words of the sages, but a fabrication by Daoist alchemists during the Qin and Han dynasties." I asked: "On what basis do you say this?" He replied: "The *I Ching* discusses the Eight Trigrams but does not mention the Five Elements; the *Hong Fan* (Great Plan) discusses the Five Elements but does not mention generation and restriction. Therefore, I know this claim lacks evidence." I said: "Have you not examined the He Tu (River Chart) and Luo Shu (Luo Writing)? In the He Tu numbers: One and Six reside below, belonging to Water; Two and Seven reside above, belonging to Fire; Three and Eight reside on the left, belonging to Wood; Four and Nine reside on the right, belonging to Metal; Five and Ten reside in the center, belonging to Earth. In the Luo Shu numbers: Nine crowns the top, One treads the bottom. One is the generating number of Water; to the right of One is Seven, which is the completing number of Fire; to the right of Seven is Nine, which is the completing number of Metal; to the right of Nine is Three, which is the completing number of Wood; Five resides in the center, which is the completing number of Earth. The He Tu rotates counter-clockwise to the left, following the order of generation; the Luo Shu rotates clockwise to the right, following the order of restriction. Restriction proceeds in the direction of順 (smoothness/order), while generation proceeds in the direction of 逆 (reverse/unconventional); this is the subtlety of creation. Moreover, although the He Tu rotates leftward in generation, its opposing positions restrict each other; although the Luo Shu rotates rightward in restriction, its opposing positions generate each other. Thus, the seed of life is always embedded within decline, and vital energy is often hidden within full growth. If there were generation without restriction, there would be advancement without retreat, causing Qi to exhaust easily; if there were restriction without generation, the declining would not regenerate, and the mechanism of life would reach a dead end. Generation and restriction are the natural laws of Heaven and Earth, nothing is more appropriate or inevitable than this. Why do you doubt it?
The guest said: "The He Tu and Luo Shu may not have existed in ancient times; they might also be fabrications by Qin and Han scholars used to mystify their theories!" I replied: "Does not the *I Ching* say, 'The River produced the Chart, and the Luo produced the Writing. The Sages modeled themselves upon them'? Why are you so negligent in your observation? Furthermore, the generation and restriction of the Five Elements are the numbers of Heaven and Earth; the He Tu and Luo Shu are also the numbers of Heaven and Earth. Before the appearance of the Charts and Writings, the numbers of Heaven and Earth were already clearly complete; even if the Charts and Writings had never appeared until today, their symbolic representations would still be clearly complete. The Charts and Writings can be forged, but the numbers of Heaven and Earth cannot be fabricated. The summer heat originates from the spring warmth; the winter cold begins with the autumn coolness; this is the silent operation of Qi. When Yang Qi turns, the soil becomes active; when the weather becomes austere, the seawater swells westward; when the bright sun rises, frost and dew vanish immediately; when the cool wind arrives, all trees wither and fall. These are obvious manifestations. What is there to doubt about the Charts?
The guest asked: "Water is born from Heaven, is it not? Does it not come from Metal? Fangzhu (a device for collecting dew) collects water, and the Moon is the mother of water; is the Moon also born from Metal? Water generates Wood, yet we have never seen trees growing in rivers and lakes! Water assists Earth to generate Wood; can it solely return to Water?" I answered: "Heaven is the substance of Qian (Heaven); the Moon is the essence of Metal; Kun (Earth) provides nourishment for all things. Can any of the Five Elements survive without Earth? Is Wood the only exception!
The guest argued: "Fire emerges from rocks in Mount Dai; smoke rises from wells in Han; this indicates Earth generates Fire. The sea appears dark and murky, waves burn like fire; this indicates Water generates Fire. Intense heat dries up water; this indicates Fire restricts Water. Water floods and destroys earth; this indicates Water restricts Earth. A dense stove fire spreads across the plains; Fire also restricts Wood. Hoes and spades till the fields; Metal also restricts Earth. Are not the principles of generation and restriction chaotic and disordered?" I replied: "In the He Tu and Luo Shu, Water is above, Fire is below, Wood is East, Metal is West; the positions of Heaven and Earth are Front South, Back North, Left East, Right West. Their order is distinct and cannot be confused. Since their order is distinct and immutable, their generation and restriction also rotate in sequence and cannot be confused. If there is fire in deep wells or springs on high plateaus, this is merely the subtle interaction of two Qi types! If fire burns and dries water, or water floods and destroys earth, these are normal phenomena of prosperity, decline, victory, and recovery. Therefore, it is acceptable to explore the variations of the Five Elements, but it is incorrect to equate these specific extreme events with the entirety of Five Elements theory. Moreover, what is meant by 'restriction' is merely controlling excess to restore balance, not extermination or extinction. It involves suppressing excessive floating and returning to the root, serving as a兆 (omen/sign) for new growth. Although termed restriction, it is actually mutual completion. If we consider Metal chopping, Earth burying, Fire burning, and Water flooding as immediate destruction, how can we discuss the subtleties of creative generation?!"