脏气有实有虚。若阳盛水哀而动者，则从河间治法，泻热救水；若阳虚不足而动者，则阳愈虚，当从
东垣必补胃气，次泻其火。阳虚不安其位而火乘于阴，根据东垣自阴升阳提而出之；阳盛入于阴者，遵仲景下
之。阴虚不胜夫火动者，用先生益精血、壮肾水以安之；或脏气盛与火齐发，先泻其盛；本脏气血不足，先
补其虚，次泻其火；火与气相持，郁伏不行，则发脏
气（云云）。其半则散火为主，脏气郁其火。
大抵溲血、淋血、便血三者，虽前后阴窍所出不同，然于受病不一，故治法分标本一也。其散血、止
血之药无下数十品，惟引导佐使各走其乡者小异耳！溺血为热客下焦，本草何仍用菟丝子、肉苁蓉、续
断、鹿角辈温补壮阳为主？《内经》谓邪之所凑，其气必虚。东垣谓火与元气不两立，一胜则一负。火者，
热也。肾气因热而走，亦必用是脏真之药，始可补其虚，以固卫气之散走也。气血相须为用，又何疑乎？
《内经》有脾胃湿土太过，为积饮痞膈与饮积于中者数条，未有痰之名也。至仲景始分饮为四∶一
曰痰饮，二曰悬饮，三曰溢饮，四曰支饮。而痰之义始见河间，分五运六气之病，于火淫条下则云∶中风、
风癞等病痰涎，因水衰热甚，津液涌溢，聚于胸膈，热燥以为痰涎，初虞世言涎者，乃遍身之脂脉津液。于
湿土条下云∶湿气自甚，则为积饮痞膈、中满霍乱。又云∶喘嗽之痰，为因外感风寒，寒化为热，热则生痰。
张戴人谓留饮一症，不过蓄水而已。又谓四饮者，观病之形状而定名也。其来有五，有 郁而得之者，其
气抑郁不伸，则肝气乘脾，脾气不濡，故为留饮；有劳役乘困饮水，脾胃力衰，因时睡卧，不能布
散于脉，亦为留饮；肝主虑，久虑不决则肝气不行，脾主思，久思不已则脾气结，亦为留饮；饮酒过多，
以乘燥金，胞不渗泄，亦为留饮；隆暑津液焦涸，喜饮寒水过多，逸而不动，亦为留饮。又谓痰有五∶曰
风痰，曰热，曰湿，曰酒，曰食。五者先生遵张、刘之说，谓痰饮之初起也，或饮食不谨，或外伤六淫，
或内感七情，或食味过浓，皆致谷气不升资发，荣卫先郁滞而成膈热，故津液不行，易于攒聚，因气成积，
积气成痰。痰饮既聚，展转传变，生病不一，为呕吐，为反胃，为喘满，为咳逆，为膈噫，为吞酸，为嘈杂，
为膨胀，为痞，为痛，为泄利，为不食冲上，为头痛，为眩运、嗌下，为足肿，为 疝；散于表为寒热，
为肿，为肢节痛，聚于心为狂，为癫昏仆，为不语。凡人之病，皆痰为邪，此数家叙痰为病之始末也。
后世论治痰饮，必得温乃行，及有痰因火热反见水化，而觉其冷乃不知其热也。先生故多不取，独称长沙治
四饮之法，可表者汗之，可下者利之，滞者导之，郁者扬之，热者寒
之，寒者温之，塞者通之，虚者补而养之，深得《内经》各随攸利所治之意。窃谓痰饮之生，有生于脾
胃，有生于六经，所起不同，若论感邪与为病之形症则一也。至于治之，必先从其邪之所起，而后及于病
之所止。曰∶痰饮因太阴湿土之化，生于脾胃，宁不生于六经乎？初虞世谓涎为遍身之脂脉津液也，此非
六经中之津液灌注于内外者欤？原其在经脉之由，即《内经》所谓饮入于胃，游溢精气，散精于脾，上归
于肺，通调水道，下输膀胱，水精四布，五经并行。又谓水入于经，其血乃成。谓五脏化五液∶心为汗，
肝为泣，肺为涕，脾为涎，肾为唾。故经脉之津液与血者，皆四布水精之所化。然经脉以胃气为本，则其
所化，亦六经中胃气土德之冲和者以成之，由是同归乎湿，滋育百体者矣。苟不善于化，则水积不行，亦如
湿漂之为害。故其水盛与血杂混，而不滋荣气之运，或不化液而不从卫气之用，聚于经脉以为病，冷则清如
其饮，热则浊如其痰，设值风火之迫，则涌溢而起，无处不到，痰饮为病莫大于此。
脏腑之气有实证也有虚证。如果是阳气亢盛、阴水亏虚而导致的妄动，就遵循刘河间的治法，泻热以救阴水；如果是阳气虚弱不足而导致的妄动，则阳气越虚，应当遵循李东垣的学说，先补益胃气，其次再清泻其火。若是阳气虚弱不能安守本位，导致火热之邪乘袭阴分，根据李东垣的理论，应从阴分升提阳气将其引出；若是阳热之邪深入阴分，则遵从张仲景的方法，采用攻下法。若是阴精亏虚无法制约火热而导致的妄动，使用朱丹溪先生益精血、壮肾水的方法来安定它；或者是脏腑之气亢盛与火热同时发作，先泻其亢盛之气；若是本脏气血不足，先补其虚损，其次再清泻其火；若是火热与气机相互搏结，郁伏而不行，就会引发脏腑之气（的病变）。其中病情较轻者，以疏散火热为主，因为脏腑之气郁结导致了火热。
大抵而言，尿血、淋血、便血这三种病，虽然从前阴或后阴窍道排出的途径不同，但由于致病原因不一，所以治疗上区分标本的原则是一致的。用于散血、止血的药物不下数十种，只是引导药和佐使药各走不同的经络部位略有差异罢了！尿血是由于热邪客居在下焦，本草书中为何仍用菟丝子、肉苁蓉、续断、鹿角等温补壮阳的药物作为主药？《内经》说：邪气聚集的地方，正气必然虚弱。李东垣说：火与元气不两立，一方胜则另一方负。火，就是热。肾气因热而妄行，也必定要用该脏真阴的药物，才能补其虚损，以固护卫气的散失。气血相互依存为用，这有什么可怀疑的呢？
《内经》中有脾胃湿土太过，导致积饮、痞膈以及饮邪停滞于中部的几条论述，但没有“痰”这个名称。到了张仲景才开始将饮分为四类：一是痰饮，二是悬饮，三是溢饮，四是支饮。而“痰”的含义才在刘河间那里出现，他在分析五运六气病症时，在火淫条下说道：中风、风癞等病的痰涎，是因为水衰热甚，津液涌溢，聚于胸膈，因热燥而形成痰涎。初虞世说：涎，是遍布全身的脂脉津液。在湿土条下说道：湿气自盛，就会成为积饮、痞膈、中满霍乱。又说：喘嗽之痰，是因为外感风寒，寒邪化为热，热则生痰。张戴人认为留饮这一症，不过是蓄水而已。他又说四饮，是根据病症的形状来定名的。留饮的产生有五种情况：有因气郁而得的，气机抑郁不伸，则肝气乘脾，脾气不濡润，所以成为留饮；有因劳役困倦饮水，脾胃力衰，因时而睡卧，不能布散于血脉，也成为留饮；肝主谋虑，久虑不决则肝气不行，脾主思，久思不已则脾气结滞，也成为留饮；饮酒过多，克制燥金，膀胱不渗泄，也成为留饮；盛夏时节津液焦涸，喜欢喝过多的寒水，安逸不动，也成为留饮。他又说痰有五种：叫作风痰、热痰、湿痰、酒痰、食痰。这五种，朱丹溪先生遵循张子和、刘河间的学说，认为痰饮初起时，或因饮食不慎，或外伤六淫，或内感七情，或口味过浓，都导致谷气不升资发，营卫先郁滞而成膈热，所以津液不行，易于攒聚，因气形成积，积气形成痰。痰饮既已聚集，辗转传变，生病不一，表现为呕吐，反胃，喘满，咳逆，膈噫，吞酸，嘈杂，膨胀，痞，痛，泄利，不食冲上，头痛，眩晕、咽喉不利，足肿，疝气；散于体表则为寒热，肿，肢节痛；聚于心则为狂，癫昏仆，不语。凡人的疾病，都是痰为邪气，这几家叙述了痰致病的始末。后世论治痰饮，认为必须得温才能运行，以及有痰因火热反而见水化，而觉得冷却不知其热的情况。朱丹溪先生因此大多不取这些观点，唯独推崇长沙太守张仲景治疗四饮的方法，可表证的用汗法，可下证的用利法，滞涩的用导法，郁结的用扬法，热证的用寒法，寒证的用温法，闭塞的用通法，虚弱的用补养法，深得《内经》各随其所宜而治的意思。我认为痰饮的产生，有生于脾胃的，有生于六经的，所起之处不同，若论感受邪气与发病的症状则是一样的。至于治疗，必须先从邪气产生的地方入手，然后及于病邪停留的地方。说：痰饮因太阴湿土的转化，生于脾胃，难道不是生于六经吗？初虞世说涎是遍布全身的脂脉津液，这不是六经中的津液灌注于内外的表现吗？推究其在经脉中的来源，就是《内经》所说的饮入于胃，游溢精气，散精于脾，上归于肺，通调水道，下输膀胱，水精四布，五经并行。又说水入于经，其血乃成。谓五脏化生五液：心为汗，肝为泣，肺为涕，脾为涎，肾为唾。所以经脉的津液与血，都是水精四布所化生的。然而经脉以胃气为本，那么其所化生的，也是六经中胃气土德冲和的部分所成就的，因此同归于湿，滋育百体。如果不善于化生，则水积不行，也像湿漂一样为害。所以其水盛与血杂混，而不滋荣气之运行，或不化液而不从卫气之用，聚于经脉以为病，冷则清如饮，热则浊如痰，假如遇到风火的逼迫，则涌溢而起，无处不到，痰饮为病没有比这更大的了。
Visceral Qi has both excess and deficiency patterns. If the disturbance is caused by flourishing Yang and declining Yin water, follow Liu Hejian’s treatment method: purge heat to rescue Yin water. If the disturbance is due to insufficient Yang deficiency, the more deficient the Yang becomes, one should follow Li Dongyuan’s approach: first tonify Stomach Qi, then clear and drain the fire. If Yang deficiency fails to keep its position and fire attacks the Yin, according to Li Dongyuan’s theory, raise Yang from the Yin level to extract it; if flourishing Yang enters the Yin, follow Zhang Zhongjing’s method of purgation. If Yin essence deficiency cannot control the moving fire, use Master Zhu Danxi’s method of benefiting essence and blood, strengthening Kidney water to calm it. If visceral Qi excess and fire occur simultaneously, first purge the excess; if the affected organ’s Qi and blood are deficient, first tonify the deficiency, then clear the fire; if fire and Qi contend and stagnate without moving, it will trigger visceral Qi disorders (etc.). In milder cases, the main approach is to scatter fire, as visceral Qi stagnation causes the fire.
Generally speaking, hematuria (blood in urine), strangury with blood, and hematochezia (blood in stool) differ in that they exit through different orifices (anterior or posterior), yet because their pathological origins vary, the treatment principle of distinguishing root and branch remains consistent. There are dozens of herbs for dispersing blood and stopping bleeding; the only slight difference lies in the guiding and assistant herbs targeting specific meridians. Hematuria is caused by heat lodging in the Lower Jiao. Why do materia medica still use warm-tonifying and yang-strengthening herbs like Cuscutae Semen (Tusizi, 菟丝子), Cynomorii Herba (Roucongrong, 肉苁蓉), Dipsaci Radix (Xuduan, 续断), and Cervi Cornu (Lujiao, 鹿角) as main ingredients? The *Neijing* states: "Where pathogenic factors gather, Qi must be deficient." Li Dongyuan stated: "Fire and Yuan Qi are incompatible; when one prevails, the other declines." Fire is heat. Since Kidney Qi runs wild due to heat, one must use true Yin herbs of this organ to tonify deficiency and secure the scattering Wei Qi. Since Qi and Blood rely on each other for function, what is there to doubt?
The *Neijing* contains several passages on excessive damp-earth of Spleen and Stomach leading to fluid accumulation, fullness, and diaphragmatic obstruction, but does not mention the term "Tan" (Phlegm). It was Zhang Zhongjing who first divided fluid retention into four categories: 1. Tan-Yin (Phlegm-Fluid), 2. Xuan-Yin (Hanging Fluid), 3. Yi-Yin (Overflowing Fluid), 4. Zhi-Yin (Supporting Fluid). The meaning of "Tan" appeared later with Liu Hejian. In his analysis of the Six Qi and Five Movements, under the section on Exuberant Fire, he stated: Phlegm-saliva in conditions like wind-stroke and wind-leprosy arises because Yin water is deficient and heat is severe, causing body fluids to surge and accumulate in the chest and diaphragm; heat and dryness transform these into phlegm-saliva. Chu Yushi said: Saliva is the fluid of the fatty meridians throughout the body. Under the section on Damp-Earth, he stated: When dampness is excessive, it leads to fluid accumulation, fullness, diaphragmatic obstruction, abdominal distension, and cholera-like vomiting/diarrhea. He also said: Phlegm in wheezing and coughing results from external contraction of wind-cold, which transforms into heat, and heat generates phlegm. Zhang Dairen considered retained fluid merely as accumulated water. He further stated that the four types of fluid retention are named based on clinical manifestations. There are five ways retained fluid arises: 1. Due to Qi depression: stagnant Qi allows Liver Qi to invade Spleen, causing Spleen Qi to fail in moistening, resulting in retained fluid; 2. Due to fatigue and drinking: exhaustion weakens Spleen-Stomach power; lying down after drinking prevents dispersion into vessels, causing retained fluid; 3. Due to emotional strain: prolonged worry stagnates Liver Qi; prolonged overthinking knots Spleen Qi, causing retained fluid; 4. Due to excessive alcohol: alcohol damages Metal (Lung/Intestines), bladder fails to secrete, causing retained fluid; 5. Due to summer heat and cold drinks: scorching heat dries fluids; excessive intake of cold water combined with inactivity causes retained fluid. He also classified phlegm into five types: Wind-Phlegm, Heat-Phlegm, Damp-Phlegm, Wine-Phlegm, and Food-Phlegm. Following Zhang and Liu, Zhu Danxi believed that at the onset of phlegm-fluid, whether due to improper diet, external six excesses, internal seven emotions, or rich flavors, grain Qi fails to ascend and nourish, causing Ying and Wei Qi to stagnate and generate upper jiao heat. Thus, body fluids fail to circulate, accumulate easily, form masses via Qi, and become phlegm. Once phlegm-fluid accumulates, it transforms and spreads, causing various diseases: vomiting, reverse regurgitation, wheezing/fullness, coughing/reversal of Qi, diaphragmatic belching, acid regurgitation, heartburn, abdominal distension, epigastric fullness, pain, diarrhea, inability to eat with upward rushing, headache, vertigo, throat obstruction, foot swelling, hernia; spreading to the exterior causes chills/fever, swelling, joint pain; gathering in the Heart causes mania, epilepsy/fainting, muteness. All human diseases involve phlegm as a pathogen; these masters described the origin and progression of phlegm disease. Later generations argued that treating phlegm-fluid requires warmth to move it, or that phlegm caused by fire appears as water transformation, feeling cold while actually being hot. Zhu Danxi largely rejected these views, exclusively praising Changsha’s (Zhang Zhongjing’s) methods for the four fluid types: exterior patterns treated with sweating, interior excess with purging/draining, stagnation with guiding, depression with raising, heat with cooling, cold with warming, blockage with unblocking, deficiency with tonifying/nourishing. This deeply aligns with the *Neijing*’s principle of treating according to suitability. I believe phlegm-fluid originates either from Spleen-Stomach or the Six Meridians; though origins differ, the pathogenesis and symptoms are similar. Treatment must address the source of the pathogen before addressing the site of disease. One might ask: Phlegm-fluid arises from Taiyin damp-earth transformation in Spleen-Stomach; does it not also arise from the Six Meridians? Chu Yushi said saliva is the fluid of fatty meridians throughout the body; is this not the infusion of fluids from the Six Meridians internally and externally? Tracing its origin in the meridians, as the *Neijing* states: Drink enters the Stomach, floats and overflows with essence, scatters essence to the Spleen, ascends to return to the Lung, regulates water passages, descends to transport to the Bladder; water essence distributes everywhere, traversing the Five Meridians. It also states: Water entering the meridians forms blood. The Five Zang transform five fluids: Heart produces sweat, Liver produces tears, Lungs produce nasal mucus, Spleen produces saliva, Kidneys produce spittle. Thus, meridian fluids and blood are all transformed from distributed water essence. However, meridians rely on Stomach Qi as their root; therefore, what is transformed is also the harmonious Earth virtue of Stomach Qi within the Six Meridians, thus returning to dampness and nourishing the hundred bodies. If transformation is poor, water accumulates and fails to move, causing harm like floating dampness. Thus, when abundant water mixes with blood, failing to nourish Qi movement, or failing to transform into fluid for Wei Qi use, it gathers in meridians to cause disease: cold makes it clear like fluid, heat makes it turbid like phlegm. If subjected to wind-fire pressure, it surges and reaches everywhere; no phlegm-fluid pathology is greater than this.