十七、又问右肾既为六脏之一矣何十二经中不以右肾之有形者足其数固乃以手心主当之此其故何哉
生生子曰∶详乎哉问也。《难经》虽有右肾命门为一脏之说，然外无经络所属，且又云“其气与肾通
”，则亦皆肾而已矣，其习坎之谓欤。《黄庭经》曰∶北方黑色，入通于肾，开窍于二阴，左肾为壬，
右肾为癸（壬癸皆水也）。《内经·六节藏象论篇》曰∶“肾者主蛰，封藏之本，精之处也。”受脏腑之
精而藏之也（精亦水也）。因其皆属水，故以足少阴之经统而属之，此二而一，一而二者也。彼手心主
者，外有手厥阴之经络，属于相火，隶于手经。顾手足经阴阳配合之势，手不与足配，火不与水配，阴不
与阴配，是故不得与十二经之数也。且火高水下，水火不相射也。
二十九、论痰为津液、脾湿所生、亦有因于火、因于虚、因于气、因于食者、而二陈峻利之剂、不可以概用也
生生子曰∶痰者，津液所生也。《经》曰∶“饮食入胃，游溢精气，上输于脾，脾气散精，上归于
肺，通
调水道，下输膀胱，水精四布，五经并行，合于四时五脏阴阳，揆度以为常也。”若脾虚停湿，则
失其健运之常，不能致精于肺，遂而成痰，此脾湿而生痰者也。有阴血不足，阴火上逆，肺受火侮，
不得清肃下行，由是津液凝浊，生痰不生血者，此又因阴虚火动而成痰者也。由是知痰之为物，皆
脾湿、津液所成明矣。治痰者，要当察其所来之源，世俗例以二陈统治诸痰，不分寒热。因于湿者，
固亦宜矣。盖半夏燥脾湿，陈皮利肺气，茯苓入手太阴利水下行，甘草调和诸性，入脾为使。三味皆
燥湿刚悍之剂，使水行气下，湿去土燥，痰斯殄矣，脾斯健矣；使脾无寒湿，则何以当之？由是知二
陈之治痰者，非治痰也，是治痰之因于湿也。至于火刑肺金，不得下降，而用二陈者，此又失之疏也。
因于火则治火，火降金清，秋令乃行，水无壅遏，痰安从生。丹溪曰∶“黄芩治热痰，假其下火”，
正谓此也。若一例而以二陈治之，吾知脾愈燥而火愈动，非惟病不能去，而反增其喉痛声哑，咳嗽盗
汗，烦躁口渴也已。又有食积痰者，饮食过饱则伤脾，脾伤则气馁，气馁则湿停，湿停则痰生矣，宜以
保和丸类治之。又有气郁生痰者，严用和云∶“人之气道贵乎顺，
顺则津液流通，决无痰饮之患。”是以治痰必先利气者，谓痰之所从来，皆由七情郁结，气道不清
，气积生涎，今利其气，使郁结开而气道畅，抑何痰饮之有？宜七气汤、越鞠丸之类治之是也。又
有风痰者，由表虚皮腠不密，风邪得以乘之，肺气不利，邪郁为热，是以浊涕稠粘，治宜散风利气，
如杏仁、枳壳、紫苏。前胡之类是也。有惊痰者，惊则神不守舍，气乱胸中，清浊相干，脉道壅塞
，痰遂生焉。故惊痰者，多生心痛颠疾，以牛黄镇心丸之类治之是也。有冷痰者，由脾胃虚弱，不
能运化精微，气馁行迟，津液凝滞所致。治宜温暖脾胃，脾充而津液行矣，如干姜、白术之属是也
。又有肾虚不能制火，津液生痰，不能生血者，缘肺主出，肾主纳，今肾虚不能纳气归原，出而不纳
则积，积而不散则痰生焉。以金匮肾气丸之类治之是也。内有茯苓、泽泻，利水下行，使湿去而痰绝
；地黄、山萸，补实肾水，水升则火自降，而全收藏之职矣。至于中气不足，痰因积聚，胃中亦赖所
养，不可峻用利药，恐胃一伤，凶变莫测，宜当温补，使脾胃充实，痰自流动，如六君子之类是也。
此丹溪所以谆谆戒人峻用利药之失也。若夫流饮、支饮、伏饮、悬饮、溢饮，积年累月，胶固难治者，
当视其形气何如，或汗、或吐、或下、或熔，随其所宜，劫而去之，痰去则当补养，务使中气充实，
庶无峻利之失矣，学人亮
之。
或曰∶丹溪云∶“实脾土，燥脾湿，是治痰之本也。”又曰∶“二陈汤，一身之痰都管，治痰之要药
也。欲上行，加引上药；欲下行，加引下药。”吾子以此言非丹溪语耶？余曰∶此盖指脾胃湿化之痰也。
脾胃为水谷之海，五脏六腑之所受气者也。人之七情居处，不能一一中节，稍有悒郁，则气血凝滞，津
液不行，痰斯生矣，故丹溪每以实脾土燥脾湿而言也。如“痰在胁下，非白芥子不能达。痰在四肢，非竹
沥不行。痰在皮里膜外，非姜汁竹沥不除。气虚之人有痰，非竹沥不开”。又曰∶“痰结核在咽喉，燥
不得出，以化痰药加咸能软坚之味，栝蒌仁、杏仁、海石、桔梗、连翘，少佐以朴硝，以姜汁蜜丸噙化”
。又曰∶“天花粉大能降上膈热痰。海粉，热痰能降，湿痰能燥，结痰能软，顽痰能消。枳实治痰，能
冲墙壁。人中黄能降阴火，而清食积之痰”。又曰∶“痰因火盛逆上，治火为先，白术、黄芩、石膏之类
。久病阴火上升，津液生痰不生血，宜补血制相火，其痰自除”。丹溪未尝纯倚二陈为用矣，以上述治
痰之药，亦不为不多矣，丹溪何尝固执于此，盖
以意立法耳。医者贵乎贯通达变则得之，否则何以异于刻舟求剑也。
十七、又问：右肾既然已经是六脏之一，为什么在十二经脉中不以右肾的有形实体来补足其数量，反而用心包络（手厥阴心包经）来代替呢？这是什么缘故呢？
生生子说：问得详细啊。《难经》虽然有右肾与命门合为一脏的说法，但它外部没有所属的经络，而且又说“它的精气与肾相通”，那么其实也都只是肾罢了，这大概就是所谓“习坎”（重险之象，喻指水德深藏）的意思吧。《黄庭经》说：“北方黑色，内通于肾，开窍于前后二阴，左肾属壬，右肾属癸（壬和癸都属水）。”《黄帝内经·六节藏象论篇》说：“肾主蛰伏，是封藏的根本，是精气的居所。”接受脏腑的精气而贮藏起来（精也属于水）。因为这些都属水，所以用足少阴肾经统领并归属于它，这是二合一、一含二的关系。至于手厥阴心包络，外部有手厥阴经络，归属于相火，隶属于手经。考虑到手足经脉阴阳配合的形势，手经不与足经相配，火不与水相配，阴不与阴相配，因此不能计入十二经脉之数。况且火性炎上居上，水性润下居下，水火不相侵射。
二十九、论述痰是由津液和脾湿所生，也有因火、因虚、因气、因食而生的，但二陈汤这样峻烈攻伐的药物，不可以一概使用。
生生子说：痰，是由津液生成的。《内经》说：“饮食进入胃中，游溢精气，向上输送给脾，脾气散布精微，向上归于肺，通调水道，向下输送到膀胱，水精四布，五脏经脉并行，符合四时五脏阴阳的变化，以此作为常度。”如果脾虚导致湿气停滞，就失去了健运的常态，不能将精微送达于肺，于是形成痰，这是脾湿而生痰的情况。有阴血不足，阴火上逆，肺受到火的克制，不能清肃下行，因此津液凝浊，只生痰而不生血，这又是因阴虚火动而成痰的情况。由此可知，痰这种物质，都是由脾湿和津液形成的，是很明显的了。治疗痰证，应当考察其产生的源头。世俗惯例用二陈汤统管各种痰证，不分寒热。如果是因湿引起的，固然适宜。因为半夏能燥脾湿，陈皮能利肺气，茯苓入太阴肺经使水液下行，甘草调和诸药性质，入脾作为引经药。这三味药都是燥湿刚悍的药物，使水行气降，湿去土燥，痰才能消灭，脾才能强健；但如果脾没有寒湿，怎么能承受得了呢？由此可知，二陈汤治疗痰，不是治疗所有的痰，而是治疗因湿引起的痰。至于火邪刑克肺金，导致肺气不得下降，却使用二陈汤的，这就失之于粗疏了。因火引起的就要治火，火降则肺金清肃，秋令（收敛之气）才能运行，水液没有壅遏，痰从哪里产生呢？朱丹溪说：“黄芩治疗热痰，是借其降火之力”，正是说的这个意思。如果一律用二陈汤治疗，我知道脾会更干燥而火更躁动，不仅病不能去除，反而会增加喉痛声哑、咳嗽盗汗、烦躁口渴等症状。又有食积导致的痰，饮食过饱则损伤脾胃，脾伤则元气虚弱，元气虚弱则湿气停滞，湿气停滞则生痰，适宜用保和丸之类的药物治疗。又有气郁生痰的情况，严用和说：“人的气道贵在顺畅，顺畅则津液流通，决不会有痰饮的祸患。”因此治疗痰必须先理气，说是痰的来源，都是由七情郁结，气道不清，气积而生涎沫，现在理顺气机，使郁结打开而气道通畅，哪里还有痰饮呢？适宜用七气汤、越鞠丸之类的药物治疗。又有风痰，由表虚腠理不密，风邪得以乘虚而入，肺气不利，邪气郁结化为热，因此浊涕稠粘，治疗宜散风理气，如杏仁、枳壳、紫苏、前胡之类。有惊痰，受惊则神不守舍，气乱于胸中，清浊相干，脉道壅塞，痰遂生成。所以惊痰多引发心痛癫疾，用牛黄镇心丸之类的药物治疗。有冷痰，由脾胃虚弱，不能运化精微，元气虚弱运行迟缓，津液凝滞所致。治疗宜温暖脾胃，脾充实而津液运行，如干姜、白术之类。又有肾虚不能制约火，津液生痰，不能生血的情况，缘于肺主呼气，肾主纳气，现在肾虚不能纳气归元，出而不纳则积聚，积聚不散则生痰。用金匮肾气丸之类的药物治疗。方中有茯苓、泽泻，利水下行，使湿去而痰绝；地黄、山茱萸，补实肾水，水升则火自降，从而完成收藏的功能。至于中气不足，痰因积聚，胃中也依赖痰所化的营养，不可峻用利水药物，恐怕胃一旦受伤，凶变难以预测，应当温补，使脾胃充实，痰自然流动，如六君子汤之类。这就是丹溪之所以谆谆告诫人们不要峻用利水药物的原因。至于流饮、支饮、伏饮、悬饮、溢饮，积年累月，胶固难治的，应当视其形体气质如何，或用汗法、或吐法、或下法、或熔法（此处疑为‘消’或特定疗法，原文作‘熔’，暂译作相应疗法），随其所宜，强力祛除，痰去之后应当补养，务必使中气充实，才不会有峻利攻伐的过失，学者明鉴。
有人说：丹溪说：“实脾土，燥脾湿，是治痰的根本。”又说：“二陈汤，总管一身之痰，是治痰的要药。想上行，加引上行的药；想下行，加引下行的药。”您认为这些话不是丹溪说的吗？我说：这大概是指脾胃湿化而成的痰。脾胃是水谷之海，是五脏六腑所受气的地方。人的七情起居，不能一一合乎节度，稍有抑郁，则气血凝滞，津液不行，痰就产生了，所以丹溪常常强调实脾土、燥脾湿。比如“痰在胁下，非白芥子不能到达；痰在四肢，非竹沥不能通行；痰在皮里膜外，非姜汁竹沥不能消除；气虚之人有痰，非竹沥不能开通”。又说：“痰结核在咽喉，干燥不能咳出，用化痰药加上咸能软坚的味道，如栝蒌仁、杏仁、海浮石、桔梗、连翘，少许佐以朴硝，用姜汁蜜丸含化”。又说：“天花粉大能降上膈热痰。海粉，能降热痰，燥湿痰，软结痰，消顽痰。枳实治痰，能冲墙壁。人中黄能降阴火，清食积之痰”。又说：“痰因火盛逆上，治火为先，用白术、黄芩、石膏之类。久病阴火上升，津液生痰不生血，宜补血制相火，其痰自除”。丹溪从未单纯倚仗二陈汤使用，以上所述治痰的药物，也不为不多，丹溪何曾固执于此，不过是根据意旨确立治法罢了。医生贵在贯通达变才能成功，否则与刻舟求剑有什么区别呢？
XVII. Question: Since the right kidney is already one of the five zang organs, why is its tangible form not counted to complete the number in the twelve meridians, but instead replaced by the pericardium (Hand-Jueyin Pericardium Meridian)? What is the reason for this?
Shengshengzi said: Your inquiry is detailed. Although the *Nan Jing* (Classic of Difficult Issues) states that the right kidney and Mingmen (Gate of Life) constitute one zang organ, it has no meridians and vessels externally belonging to it. Furthermore, it says "its qi communicates with the kidney," implying that they are essentially just the kidney. This may refer to the concept of "Xi Kan" (repeated danger/deep water, symbolizing the deep storage of water virtue). The *Huang Ting Jing* (Yellow Court Classic) states: "The color of the North is black, internally connecting to the Kidney, opening at the two yin orifices. The left kidney belongs to Ren, the right kidney belongs to Gui (both Ren and Gui belong to Water)." The *Su Wen* (Basic Questions), Chapter 6 "Zang-Xiang Theory," states: "The Kidney governs hibernation, is the root of sealing and storing, and is the residence of essence." It receives and stores the essence of the zang and fu organs (essence also belongs to Water). Because these all belong to Water, they are collectively governed and attributed to the Foot-Shaoyin Kidney Meridian. This represents a unity of two and a duality within one. As for the Hand-Jueyin Pericardium, it has external meridians and vessels, belongs to Ministerial Fire, and is affiliated with the hand meridians. Considering the pattern of yin-yang pairing between hand and foot meridians, hand does not pair with foot, fire does not pair with water, and yin does not pair with yin. Therefore, it cannot be included in the number of the twelve meridians. Moreover, fire rises and stays high, while water descends and stays low; water and fire do not intrude upon each other.
XXIX. Discussion on Phlegm being generated from body fluids and spleen dampness, as well as arising from fire, deficiency, qi stagnation, and food retention. However, strong and purgative formulas like Er Chen Tang should not be used indiscriminately.
Shengshengzi said: Phlegm is generated from body fluids. The Classics state: "When food and drink enter the stomach, their essence floats and overflows, transmitting upwards to the Spleen. The Spleen scatters the essence, sending it upwards to return to the Lung. [The Lung] regulates the water passages, transmitting downwards to the Bladder. Water essence distributes throughout the four directions, running through the five meridians in accordance with the four seasons and the yin-yang of the five zang organs, serving as the standard measure." If spleen deficiency leads to dampness stagnation, the normal function of vigorous transportation is lost. It fails to deliver essence to the Lung, thus forming phlegm. This is phlegm generated by spleen dampness. In cases of insufficient yin blood, ministerial fire rebels upward, insulting the Lung so that it cannot descend clearly and purely. Consequently, body fluids become turbid and coagulate, generating phlegm instead of blood. This is phlegm formed due to yin deficiency and fire agitation. From this, we know that phlegm, as a substance, is clearly composed of spleen dampness and body fluids. When treating phlegm, one must investigate its source. Secular practice commonly uses Er Chen Tang to treat all types of phlegm without distinguishing cold from heat. For phlegm caused by dampness, this is indeed appropriate. Ban Xia (Pinelliae Rhizoma) dries spleen dampness; Chen Pi (Citri Reticulatae Pericarpium) benefits lung qi; Fu Ling (Poria) enters the Taiyin Lung meridian to promote downward flow of water; Gan Cao (Glycyrrhizae Radix et Rhizoma) harmonizes the properties of the herbs and acts as an envoy to the Spleen. These three ingredients are drying and damp-resolving agents with rigid and fierce properties. They cause water to move and qi to descend, removing dampness and drying the earth, thereby eliminating phlegm and strengthening the spleen. However, if the spleen lacks cold-dampness, how can it withstand such treatment? Thus, Er Chen Tang treats phlegm not generally, but specifically phlegm caused by dampness. Regarding phlegm where fire injures Lung Metal, preventing descent, using Er Chen Tang is negligent. If caused by fire, treat the fire; once fire subsides, Lung Metal clears, the autumnal energy (descending) functions, water flows without obstruction, and from where would phlegm arise? Zhu Danxi said: "Huang Qin (Scutellariae Radix) treats hot phlegm by borrowing its fire-descending power," which refers precisely to this. If Er Chen Tang is used uniformly, I fear the spleen will become drier and fire more agitated. Not only will the disease persist, but symptoms such as sore throat, hoarseness, coughing, night sweats, irritability, and thirst will increase. There is also phlegm due to food retention. Overeating damages the Spleen; spleen damage leads to qi deficiency; qi deficiency causes dampness stagnation; dampness stagnation generates phlegm. One should use formulas like Bao He Wan (Preserve Harmony Pill). There is also phlegm generated by qi stagnation. Yan Yonghe stated: "The qi pathway in humans values smoothness. Smoothness allows body fluids to circulate freely, preventing phlegm-fluid disorders." Therefore, treating phlegm requires first benefiting qi. The origin of phlegm lies in emotional depression, unclear qi pathways, and qi accumulation producing saliva/phlegm. By regulating qi, opening depressions, and smoothing the qi pathway, where would phlegm-fluid remain? Formulas like Qi Qi Tang (Seven Qi Decoction) or Yue Ju Wan (Relieve Depression Pill) are appropriate. There is also wind-phlegm, caused by exterior deficiency and loose interstices allowing wind pathogens to invade. Lung qi becomes obstructed, pathogenic factors stagnate and transform into heat, resulting in thick, sticky turbid nasal discharge. Treatment should scatter wind and benefit qi, using herbs such as Xing Ren (Armeniacae Semen Amarum), Zhi Ke (Aurantii Fructus), Zi Su (Perillae Folium), and Qian Hu (Peucedani Radix). There is fright-phlegm. Fright causes the spirit to lose its dwelling, qi becomes chaotic in the chest, clear and turbid interfere with each other, pulse channels become obstructed, and phlegm is generated. Fright-phlegm often causes heart pain and epilepsy. Treatments include Niu Huang Zhen Xin Wan (Calming Heart Pill with Calculus Bovis). There is cold-phlegm, caused by spleen and stomach weakness failing to transport and transform fine essences. Qi deficiency leads to slow movement, causing body fluid stagnation. Treatment should warm the spleen and stomach. Once the spleen is robust, body fluids circulate. Herbs such as Gan Jiang (Zingiberis Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma) are suitable. There is also phlegm due to kidney deficiency failing to control fire. Body fluids generate phlegm and fail to produce blood. The Lung governs exhalation, and the Kidney governs inhalation. Now, kidney deficiency fails to grasp qi and return it to its origin. Exhalation without inhalation leads to accumulation; accumulation without dispersion generates phlegm. Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) is used. It contains Fu Ling (Poria) and Ze Xie (Alismatis Rhizoma) to promote downward water flow, eliminating dampness and cutting off phlegm; Di Huang (Rehmanniae Radix) and Shan Yu (Corni Fructus) tonify and fill kidney water. As water rises, fire naturally descends, fulfilling the function of storage. Regarding insufficiency of middle qi leading to phlegm accumulation, the stomach also relies on nourishment. Strong draining medicines should not be used harshly, lest stomach injury lead to unpredictable ominous changes. Warm tonification is preferred to enrich the spleen and stomach, allowing phlegm to flow naturally, such as Liu Jun Zi Tang (Six Gentlemen Decoction). This is why Danxi earnestly warned against the misuse of strong draining medicines. For Li Yin, Zhi Yin, Fu Yin, Xuan Yin, and Yi Yin (types of fluid retention) that have persisted for years and are stubbornly difficult to treat, one must assess the patient's constitution. Depending on suitability, employ sweating, vomiting, purging, or melting/dissolving methods to forcibly remove them. After phlegm removal, tonification and nourishment are necessary to ensure the middle qi is substantial, avoiding the errors of harsh purgation. Scholars should understand this.
Someone asked: Danxi said, "Solidifying spleen earth and drying spleen dampness is the root of treating phlegm." He also said, "Er Chen Tang manages phlegm throughout the body and is the essential medicine for treating phlegm. To direct it upward, add guiding herbs; to direct it downward, add descending herbs." Do you consider these words not to be Danxi's? I replied: These likely refer to phlegm generated from spleen-stomach dampness transformation. The spleen and stomach are the sea of water and grain, receiving qi from the five zang and six fu organs. Human emotions and living habits cannot always adhere to moderation. Slight depression causes qi and blood stagnation, body fluids fail to circulate, and phlegm is generated. Hence, Danxi often emphasizes solidifying spleen earth and drying spleen dampness. For example: "Phlegm in the hypochondrium cannot reach without Bai Jie Zi (Brassicae Semenis); phlegm in the four limbs cannot pass without Zhu Li (Bambusae Succus); phlegm inside the skin and outside the membranes cannot be removed without Jiang Zhi (Zingiberis Juice) and Zhu Li; phlegm in qi-deficient persons cannot be opened without Zhu Li." He also said: "Phlegm nodules in the throat, dry and unable to expectorate, should be treated with phlegm-resolving herbs added with salty substances that soften hardness, such as Gua Lou Ren (Trichosanthis Semen), Xing Ren (Armeniacae Semen), Hai Shi (Calcium Carbonatum), Jie Geng (Platycodonis Radix), Lian Qiao (Forsythiae Fructus), with a little Po Xiao (Natrii Sulfas), made into pills with ginger juice and honey to be held in the mouth." He further stated: "Tian Hua Fen (Trichosanthis Radix) greatly descends upper jiao hot phlegm. Hai Fen (Sea Powder/Calculus Bovis or similar) descends hot phlegm, dries damp phlegm, softens knotted phlegm, and eliminates stubborn phlegm. Zhi Shi (Aurantii Fructus Immaturus) treats phlegm, capable of breaking through walls. Ren Zhong Huang (Human Middle Yellow/Nitrum) descends yin fire and clears food-retention phlegm." He also said: "When phlegm rebels upward due to excessive fire, treating fire is primary, using Bai Zhu (Atractylodis Macrocephalae Rhizoma), Huang Qin (Scutellariae Radix), Shi Gao (Gypsum Fibrosum). In chronic illness with rising yin fire, where body fluids generate phlegm instead of blood, one should tonify blood and control ministerial fire; the phlegm will resolve itself." Danxi never relied solely on Er Chen Tang. The aforementioned phlegm-treating herbs are numerous. Did Danxi ever adhere rigidly to this? No, he established methods based on clinical reasoning. Physicians must achieve thorough understanding and adaptability; otherwise, what distinguishes them from carving a mark on a boat to find a sword?