问曰∶上言热与火异，
今言肾生之热亦合于三焦之火，何也？
答曰∶此可分亦可合，非截然分膈也。天之阳可以助
地之火，地之火亦可以助天之阳，所以少阴之热可并于三焦肝胆，而三焦肝胆之火亦能入少
阴心肾。故凡暑热瘟疫，皆感于天之热气者也，其初发热口渴，则但属热，用石膏等以清之，
其后并于三焦胆火，入心包，则兼火，治宜牛黄、黄连、黄芩、黄柏、栀子、牛黄，系牛之
病多生肝胆中，或生心膈间，或生角中，能自行吐出。盖火发于肝胆而走于膜膈，以达周身，
故牛黄生无定处，皆是其膜膈中之火所生也。因火生痰结而为黄，是盖牛之痰积也，以牛之
痰积治人之痰积，为同气相求以敌诱敌之妙剂。其黄由火而生，故成为火味而苦。火之所生
者，土也，痰亦脾土所化，故结为黄，且气香，以其成于土，故色黄气香土成则火退，故用
以退泻人身中之火气。香善走，故透达经络脏腑而无所不到。其祛痰者，火降则痰顺也。问
曰∶何以知牛黄是秉火之性而生？
答曰∶牛有黄，用火烘之，牛前置水一盆，欲饮不得，则
黄自吐出，因火之逼。思水而吐出，则如黄是火所生。
问曰∶既系牛病，何以又为良药？答
曰∶秉异气得间味，故灵变在牛，为病而以之治人，又为良药。如乳香、血竭是树脂外注，
亦树病也，而即以为良药。僵蚕风死，乃虫病也，而亦为良药，总以气化相治，不可拘于形
迹。
问曰∶六淫外感之药，既得闻矣。而七情之病生于脏腑内者，药当如何？
答曰∶上所论
之脏腑气化，
问曰∶外感内伤古既分门，至今岂可缺。论七情内生之疾，用药自当有别，尚求
一剖示
之。
答曰∶理只一贯，而病或百出，岂能屡陈。今子即请问，无已不得不举其大略也，
可遵
丹溪之法分血气痰郁四字，以赅举之。然血气二者，予于卷首已详论矣，故吾不欲再议焉。
问曰∶血气二者，虽前文已论，然前系通外感内伤而言。今单论内伤，则不得不
再详血
气，请再为弟子申论之。
答曰∶血者，肾中之津液上于胃，与五谷所化之汁并腾于肺，以上
入心，化为赤色，即成血矣。心象离卦，汁液入心，象离内之阴爻；化为赤血，象离外之阳
爻。故血者，阳中之阴，木交于火即化为血也。西医谓血有铁气，用铁酒补血。余按铁本水
金之性，当属肾经。血有铁气，即是肾水交于火而为血也。然或水气交于心，而心火不能化
之，则亦不能生血。故仲景复脉汤既用胶地以滋水，而又用桂枝以助心火，洵得生血之法。
西药用铁水，必造作酒服，亦以酒属阳，能助心火也。西医知其当然，但未明其所以然，今
为指出血所生化之理，乃知当归正是补血药。其味辛温，火也；其汁油润，水也。一物而具
二者，是水交于火所化之物也。恰与血之生化相同，故主补血。川芎辛温得火之气味而无汁
液，故但能助火以行血，而不能生血也。地黄有汁液不辛温，故但能益水液滋血之源，而不
能变化以成赤色，桂枝色赤入心助火，正是助其化赤之令。丹皮色赤味苦泻火，即能泻血。
白芍味苦能泻血，其色白故又能行气分之水。红花色能生血，而味苦又能泻血。桃花红属血
分，仁在核中，又象人心，味苦有竹气，是正入心中，能行血能生血。心中血液中含灵光，
即神也。神为血乱，则癫狂乱语，以行气者入心导之。则远志、菖蒲麝香皆能开心窍，而丹
皮、桃仁、干漆皆能去心血。又有痰迷心神者，不在此例。血竭乃树脂注结而成，气香散故
能散结血。乳香、没药亦树脂，象人血又香散，故行血。蒲黄生于水中，其花黄色而香，是
属气分不属血分也，其能止血者，盖以气行则血行。火交于水而化气，气着于物还为水，气
行于血中而包乎血外，故行血赖于行气，而行气即是行水。白茅根利水行气，故能行血也。
凡吐血必咳痰，痰为气分，盖必气逆水升，然后引出其血也。故用尖贝、杏仁降气行痰，气
降则血降矣。气滞血瘀、寒热身疼，女子经闭不通，亦当行血中之气。香附、灵脂、元胡、
郁金、川芎、乳香、降香为主，胎血下漏必先漏水，以其水气先行而后血行气，即水也。宜
升麻、参 以升补之。苎麻根以滋之，苎根汁本白而能转红色，故生血，是水交于火化血之
义也。藕节亦然。藕生于水而上发花，花秉火色，是水上交于火之象。藕汁能转红色，又是
火化为血之象。藕汁之气化与人血之气化相同，所以清火而化瘀血。盖清火之药是水交于火
也，故能止血，芩连是矣。补火之药是火能化水也，故能行血，姜艾是矣。
问曰∶发名血余，今拔其发根下微有白水而无血，何也？
答曰∶此理最微，知发之生化
即知血之原委矣。人身之血由后天饮食之汁入心化赤，循冲任下入胞宫，与先天肾水相交，
于是化而为精，由肾系入背脊，循行而上入脑，遂化为髓，以生骨，故人死皮肉化而骨不腐。
盖皮肉或单秉气而生，则遇阴则化；或单秉血而生，则遇阳即化。惟骨由精髓而生，秉秉气
血之全，故不腐化，所以补骨必补髓，而补髓又在补精。鹿茸为气血之最，强通肾脉，故补
精髓以强骨。地黄、黄 气血双补，皆能化精以补髓也。牛骨髓、猪脊髓皆是以髓补髓。夫
补髓先补精，精为气血所化。肾气丸、菟丝子等药皆气血双补，能化精者也，精化为髓，而
脑髓中有寒，则用附子、细辛从督脉上脑以治之，由气分而入脑也。脑髓中有风有热，则用
羚羊、犀角、吴萸、薄荷、荆芥、天麻、黄柏、青蒿、苍耳子以治之，从厥阴肝脉由血分而
上脑，此则脑髓之治法。吾子虽以治之，未问及。然髓是气血合化者，今与子论血合气之理，
故并论之。髓中藏精主记事，心神上合于髓精乃能知识用事。故髓气不清则神亦乱，癫
狂其多病此；髓不足则知识不强，治法可以上引经之药以类求之矣。夫骨秉气血二者，故不
腐化，毛发亦入土不腐化。盖血生于后天，属任豚，下交胞宫，合气化精则生髓。若夫气则
生于先天，肾中者也。气生于先天，属肾脉，下交胞宫，合血变精达于冲任二脉。化而上行
，循经脉，则绕唇而生须。充皮毛，则生周身之毛。随太阳经上头，则生头发。应肝之部位
，则生腋下前后阴之毛。人之面部、额上属肺，目属肝，眉居目上，正当肝肺交界处。肝主
血，肺主气，血气相交，是以生眉毛。总见毛发者，血随气化之物也，故发名血余，以其秉
血而生也。拔其发根，下只有白水，水者气也，是气化其血之验也。然则毛发亦秉气血之全
，故不腐化，制发为药，可以补血，以其为血之余也。又能利下水，以其为气所化也。《本
经》言仍自还神，化此四字，无人能解。不知神者，心所司，谓发之性能还于心为神，复能
化血以下交于水，相为循环也。草木亦然。阳木遇阴则化，阴木遇阳则化。惟棕象人之毛发
，亦入土不腐化。盖草木亦有气血，秉天者为气，秉地者为血。棕象毛发而秉草木气血之全
，阴阳合化之所生，故不腐化。且棕之性与发略同，功能利水又能止血，此可知血气相合之
理矣。其他治血化气之药，皆可从此类推。
问曰∶人参、黄 之补气，卷首已明言矣。而茯苓亦云化气，何也？
答曰∶气者，水中
之阳。人饮水得肾阳化之，则水质下行而气上升。茯苓秉土之精而味淡利水，水行则气升，
且下有茯苓、上有威喜芝，乃茯苓苗在松巅上，与茯苓悬绝，而茯苓虽在土中，其气自能贯
之。茯苓之气所以能上升也，所以性能化气者，此也。然滋生元气，不如人参。扶达元气，
不如黄 也。
问曰∶经云状火食气，少火生气，此又何说？
答曰∶气者，水所化而复还为水，
上退场门鼻为津，外出皮毛为汗，下出二便为液。设火太甚伤其津液，则失其冲和。则气虚而
喘，五味、麦冬以润之，气泄而盗汗，生地、丹皮、浮麦、地骨皮、龙骨以清敛之；气滞便
涩，肉苁蓉、当归、火麻仁、杏仁以滑之。且如肾阳有余，阴气不能蓄之，则喘咳虚劳之证
作，非大滋其阴不可。故用熟地、龟板、元参等以水配火，不使状火食气，斯气纳矣。凡入
饮水入胃，渗入三焦膜中，而下入膀胱。命门之真火，所从胞室，蒸动膀胱之水，而气于是
乎出。此真火随气上行，其路道即在焦膜之中，遇水所过，火即蒸之，皆化为气，以充周身，
故年少气盛者，其小便少水皆化而为气故也。此真火不寒不烈，故称少火，乃人身生气
之源，观仲景八味丸独以肾气名之。盖有桂附又有萸地，阴中之阳诚为少火生气之方。桂枝
化气，亦是此理。故只温而不烈，色黑入肾，正能生气，桂附性烈，须济以阴药。然使其人
本有阴寒，则又须桂附纯阳之品，乃能化之也。又凡气上脱者，则喘促，属阴虚，宜滋阴以
敛真火。气下脱者，则汗泄大小便不禁，属阳虚，宜补火，以收元气。然无论阴阳，皆当利
水，水化则气生，火交于水，则气化。知乎此者，可以探造化之微。
问：上文说“热”与“火”不同，现在又说肾所生的热也合于三焦之火，这是为什么？
答：这既可以分开看，也可以合并看，并不是截然分开的。天的阳气可以助长地的火，地的火也可以助长天的阳，所以少阴（心、肾）的热可以并入三焦和肝胆的火，而三焦和肝胆的火也能进入少阴的心肾。因此，凡是暑热瘟疫，都是感受了天的热气所致。初起时发热口渴，只属于“热”，用石膏等药来清热；后来并入三焦胆火，进入心包，就兼有“火”的性质，治疗宜用牛黄、黄连、黄芩、黄柏、栀子。牛黄是牛生病时多生于肝胆中，或生在心膈间，或生在角中，能自行吐出。因为火发源于肝胆而游走于膜膈之间，通达全身，所以牛黄生长在无常处，都是其膜膈中的火所生成的。因为火产生痰结而成黄色，这是牛的痰积，用牛的痰积来治人的痰积，是同气相求、以敌诱敌的妙方。那黄色由火而生，所以呈现火的味道而味苦。火所生的是土，痰也是脾土所化，所以结成黄色，且气味芳香，因为它成于土，所以色黄气香。土成则火退，所以用它来退泻人体内的火气。香气善于走窜，所以能透达经络脏腑而无所不到。它祛痰的作用，是因为火降则痰顺。
问：怎么知道牛黄是秉受火的性质而生的？
答：牛如果有黄，用火烘烤它，在牛前面放一盆水，牛想喝却喝不到，就会把黄吐出来，这是因为被火逼迫。想着喝水而吐出黄，说明黄是火所生的。
问：既然是牛的病，为什么又是良药？
答：因为它禀受了异样的气，得到了特殊的味道，所以灵性变化在于牛身上，作为病邪却用来治疗人，又成了良药。比如乳香、血竭是树脂外注，也是树的病，但立即就被用作良药。僵蚕因风而死，是虫病，但也成为良药，总之以气化相治，不能拘泥于形迹。
问：六淫外感的药物，已经听说了。那么七情之病生于脏腑内部的，用药应当如何？
答：上面论述的脏腑气化……
问：外感和内伤古人既然分门别类，到现在怎么能缺少呢？论及七情内生之疾，用药自然应当有别，恳请进一步剖析示教。
答：道理只有一条，但病症可能千变万化，岂能屡屡陈述。既然你请问，不得已不得不举其大略，可以遵循丹溪的方法，分为血、气、痰、郁四个字来概括。然而血和气这两者，我在卷首已经详细论述过了，所以我不想再议论。
问：血和气这两者，虽然前文已论，但前文是通论外感和内伤而言。现在单论内伤，则不得不再次详述血气，请再为弟子申述论证。
答：血，是肾中的津液上行至胃，与五谷所化的汁液一起腾跃于肺，以上入心，化为赤色，就成为了血。心象离卦，汁液入心，像离卦中间的阴爻；化为赤血，像离卦外面的阳爻。所以血是阳中之阴，木交于火就化为血。西医认为血含有铁气，用铁酒补血。我考察铁本具有水和金的性质，应当归属于肾经。血含有铁气，就是肾水交于火而化为血。然而如果水气交于心，而心火不能化它，也就不能生血。所以张仲景的复脉汤既用阿胶、地黄来滋水，又用桂枝来助心火，确实得到了生血的方法。西药用铁和水，必须造作酒服用，也是因为酒属阳，能助心火。西医知道其必然性，但未明白其所以然，现在我指出血生化之理，才知道当归正是补血药。它的味道辛温，属火；它的汁液油润，属水。一物兼具二者，是水交于火所化的东西。恰好与血的生化相同，所以主治补血。川芎辛温，得火的气味但没有汁液，所以只能助火以行血，而不能生血。地黄有汁液但不辛温，所以只能益水液滋血之源，而不能变化以成赤色。桂枝色赤入心助火，正是帮助其化赤的命令。丹皮色赤味苦泻火，即能泻血。白芍味苦能泻血，其色白所以又能行气分的水。红花色能生血，而味苦又能泻血。桃花红属血分，仁在核中，又象人心，味苦有竹气，正是入心中，能行血能生血。心中的血液中含灵光，就是神。神被血扰乱，就会癫狂乱语，用行气的药入心引导它。那么远志、菖蒲、麝香都能开心窍，而丹皮、桃仁、干漆都能去心血。又有痰迷心神者，不在此例。血竭乃树脂注结而成，气香散所以能散结血。乳香、没药也是树脂，象人血又香散，所以行血。蒲黄生于水中，其花黄色而香，是属于气分不属于血分，它能止血，大概是因为气行则血行。火交于水而化气，气附着于物还为水，气行于血中而包乎血外，所以行血依赖于行气，而行气即是行水。白茅根利水行气，所以能行血。凡吐血必咳痰，痰为气分，必定是气逆水升，然后引出其血。所以用贝母、杏仁降气行痰，气降则血降矣。气滞血瘀、寒热身疼，女子经闭不通，也应当行血中之气。香附、五灵脂、延胡索、郁金、川芎、乳香、降香为主药。胎血下漏必先漏水，因为其水气先行而后血行气，即水也。宜用升麻、人参以升补之。苎麻根以滋养之，苎根汁本白而能转红色，所以生血，是水交于火化血的意义。藕节也是如此。藕生于水而上发花，花秉火色，是水上交于火的象征。藕汁能转红色，又是火化为血的象征。藕汁的气化与人血的气化相同，所以清火而化瘀血。盖清火之药是水交于火也，所以能止血，黄芩、黄连是了。补火之药是火能化水也，所以能行血，生姜、艾叶是了。
问：头发名叫血余，现在拔其发根下微有白水而无血，为什么呢？
答：这个原理最微妙，知道头发的生化就知道血的源委了。人身之血由后天饮食之汁入心化赤，循冲任二脉下入胞宫，与先天肾水相交，于是化而为精，由肾系入背脊，循行而上入脑，遂化为髓，以生骨，所以人死后皮肉化而骨不腐。盖皮肉或单秉气而生，则遇阴则化；或单秉血而生，则遇阳即化。惟独骨由精髓而生，秉受气血之全，所以不腐化，所以补骨必补髓，而补髓又在补精。鹿茸为气血之最，强通肾脉，故补精髓以强骨。地黄、黄芪气血双补，皆能化精以补髓也。牛骨髓、猪脊髓皆是以髓补髓。夫补髓先补精，精为气血所化。肾气丸、菟丝子等药皆气血双补，能化精者也，精化为髓，而脑髓中有寒，则用附子、细辛从督脉上脑以治之，由气分而入脑也。脑髓中有风有热，则用羚羊角、犀角、吴茱萸、薄荷、荆芥、天麻、黄柏、青蒿、苍耳子以治之，从厥阴肝脉由血分而上脑，此则脑髓之治法。吾子虽以治之，未问及。然髓是气血合化者，今与子论血合气之理，故并论之。髓中藏精主记事，心神上合于髓精乃能知识用事。故髓气不清则神亦乱，癫狂其多病此；髓不足则知识不强，治法可以上引经之药以类求之矣。夫骨秉气血二者，故不腐化，毛发亦入土不腐化。盖血生于后天，属任脉，下交胞宫，合气化精则生髓。若夫气则生于先天，肾中也。气生于先天，属肾脉，下交胞宫，合血变精达于冲任二脉。化而上行，循经脉，则绕唇而生须。充皮毛，则生周身之毛。随太阳经上头，则生头发。应肝之部位，则生腋下前后阴之毛。人之面部、额上属肺，目属肝，眉居目上，正当肝肺交界处。肝主血，肺主气，血气相交，是以生眉毛。总见毛发者，血随气化之物也，故发名血余，以其秉血而生也。拔其发根，下只有白水，水者气也，是气化其血之验也。然则毛发亦秉气血之全，故不腐化，制发为药，可以补血，以其为血之余也。又能利下水，以其为气所化也。《本经》言仍自还神，化此四字，无人能解。不知神者，心所司，谓发之性能还于心为神，复能化血以下交于水，相为循环也。草木亦然。阳木遇阴则化，阴木遇阳则化。惟棕象人之毛发，亦入土不腐化。盖草木亦有气血，秉天者为气，秉地者为血。棕象毛发而秉草木气血之全，阴阳合化之所生，故不腐化。且棕之性与发略同，功能利水又能止血，此可知血气相合之理矣。其他治血化气之药，皆可从此类推。
问：人参、黄芪之补气，卷首已明言矣。而茯苓亦云化气，何也？
答：气者，水中之阳。人饮水得肾阳化之，则水质下行而气上升。茯苓秉土之精而味淡利水，水行则气升，且下有茯苓、上有威喜芝，乃茯苓苗在松巅上，与茯苓悬绝，而茯苓虽在土中，其气自能贯之。茯苓之气所以能上升也，所以性能化气者，此也。然滋生元气，不如人参。扶达元气，不如黄芪也。
问：经云壮火食气，少火生气，此又何说？
答：气者，水所化而复还为水，上退场门鼻为津，外出皮毛为汗，下出二便为液。设火太甚伤其津液，则失其冲和。则气虚而喘，五味子、麦冬以润之，气泄而盗汗，生地、丹皮、浮小麦、地骨皮、龙骨以清敛之；气滞便涩，肉苁蓉、当归、火麻仁、杏仁以滑之。且如肾阳有余，阴气不能蓄之，则喘咳虚劳之证作，非大滋其阴不可。故用熟地、龟板、元参等以水配火，不使壮火食气，斯气纳矣。凡入饮水入胃，渗入三焦膜中，而下入膀胱。命门之真火，所从胞室，蒸动膀胱之水，而气于是乎出。此真火随气上行，其路道即在焦膜之中，遇水所过，火即蒸之，皆化为气，以充周身，故年少气盛者，其小便少水皆化而为气故也。此真火不寒不烈，故称少火，乃人身生气之源，观仲景八味丸独以肾气名之。盖有桂附又有萸地，阴中之阳诚为少火生气之方。桂枝化气，亦是此理。故只温而不烈，色黑入肾，正能生气，桂附性烈，须济以阴药。然使其人本有阴寒，则又须桂附纯阳之品，乃能化之也。又凡气上脱者，则喘促，属阴虚，宜滋阴以敛真火。气下脱者，则汗泄大小便不禁，属阳虚，宜补火，以收元气。然无论阴阳，皆当利水，水化则气生，火交于水，则气化。知乎此者，可以探造化之微。
Q: The text above states that "heat" (Re) and "fire" (Huo) are different, yet now it is said that the heat generated by the Kidney also merges with the fire of the San Jiao (Triple Burner). Why is this?
A: This can be viewed separately or together; they are not strictly separated. The Yang Qi of Heaven can assist the Fire of Earth, and the Fire of Earth can assist the Yang Qi of Heaven. Therefore, the heat of Shao Yin (Heart and Kidney) can merge with the fire of the San Jiao, Liver, and Gallbladder, and the fire of the San Jiao, Liver, and Gallbladder can enter the Heart and Kidney of Shao Yin. Thus, all cases of summer-heat and plague are caused by contracting the hot Qi of Heaven. In the initial stage, fever and thirst indicate only "heat," treated with drugs like Shi Gao (Gypsum Fibrosum) to clear heat. Later, when it merges with the Gallbladder fire of the San Jiao and enters the Pericardium, it involves "fire." Treatment should use Niu Huang (Calculus Bovis), Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Huang Bo (Phellodendri Cortex), and Zhi Zi (Gardeniae Fructus). Niu Huang is a pathological product often found in the Liver and Gallbladder, or between the Heart and Diaphragm, or in the horns, which the ox can expel on its own. Since fire originates in the Liver and Gallbladder and moves through the membranous septa to reach the whole body, Niu Huang grows in不定 places, generated by the fire within these membranes. Because fire generates phlegm condensation resulting in yellow color, this is the ox's phlegmatic accumulation. Using the ox's phlegmatic accumulation to treat human phlegmatic accumulation is a subtle method of using similar Qi to attract and lure the enemy. The yellow color arises from fire, hence it tastes bitter like fire. Fire generates Earth; phlegm is also transformed from Spleen Earth, so it condenses into yellow and has an aromatic fragrance because it is formed by Earth. When Earth is established, Fire retreats; thus, it is used to drain fire from the human body. Fragrance travels easily, penetrating meridians and viscera without obstruction. Its ability to resolve phlegm stems from the principle that when fire descends, phlegm flows smoothly.
Q: How do we know that Niu Huang is born of the nature of fire?
A: If an ox has calculus, heating it causes the ox to place a basin of water in front of it. Unable to drink, the ox expels the calculus due to the pressure of fire. Thinking of water leads to expulsion, indicating that the calculus is generated by fire.
Q: Since it is a disease of the ox, why is it also a good medicine?
A: It possesses unique Qi and special flavors, so its spiritual transformation lies within the ox. Although it is a pathology in the ox, when used to treat humans, it becomes a fine medicine. For example, Ru Xiang (Olibanum) and Xue Jie (Sanguis Draconis) are resin exudates, representing tree diseases, yet they are immediately used as medicines. Jiang Can (Bombyx Batryticatus) dies from wind, representing insect disease, yet it is also a medicine. Generally, treatment relies on the interaction of Qi transformations, not being confined to physical traces.
Q: I have heard about drugs for external contraction by the six excesses. What about diseases arising internally from the seven emotions affecting the viscera? How should drugs be chosen?
A: The Qi transformations of the viscera discussed above...
Q: Ancients classified external contractions and internal injuries into separate categories. How can this omission exist today? Discussing diseases generated internally by the seven emotions requires distinct medication. I request further elucidation.
A: The principle is consistent, but symptoms may vary infinitely. It is impossible to state them repeatedly. Since you ask, I will briefly outline the general principles. You can follow Dan Xi’s method, categorizing them under four characters: Blood (Xue), Qi (Qi), Phlegm (Tan), and Stagnation (Yu). However, Blood and Qi were already discussed in detail in the first volume, so I do not wish to reiterate.
Q: Although Blood and Qi were discussed previously, that was in the context of both external and internal injuries. Now discussing internal injuries alone necessitates a detailed explanation of Blood and Qi again. Please elaborate for your disciple.
A: Blood is the fluid essence from the Kidney ascending to the Stomach, merging with the juices transformed from the five grains, rising to the Lung, then entering the Heart, transforming into red color, thus becoming blood. The Heart corresponds to the Li Trigram. Fluid essence entering the Heart resembles the Yin line inside Li; transforming into red blood resembles the Yang line outside Li. Therefore, blood is Yin within Yang. Wood interacting with Fire transforms into blood. Western medicine believes blood contains iron qi and uses iron wine to tonify blood. I observe that Iron (Tie) possesses the nature of Water and Metal and belongs to the Kidney meridian. Blood containing iron qi means Kidney Water interacting with Fire to form blood. However, if Water Qi interacts with the Heart but Heart Fire cannot transform it, blood cannot be generated. Therefore, Zhang Zhongjing’s Fu Mai Tang uses E Jiao (Colla Corii Asini) and Di Huang (Rehmanniae Radix) to nourish Water, and Gui Zhi (Cinnamomi Ramulus) to assist Heart Fire, truly obtaining the method of generating blood. Western medicine uses iron and water, always prepared with wine, because wine is Yang and assists Heart Fire. Western medicine knows the necessity but not the rationale. Now pointing out the principle of blood generation, we see that Dang Gui (Angelicae Sinensis Radix) is indeed a blood-tonifying drug. Its taste is pungent and warm (Fire); its juice is oily and moist (Water). One substance possessing both is the product of Water interacting with Fire. This matches the generation of blood, so it primarily tonifies blood. Chuan Xiong (Ligustici Chuanxiong Rhizoma) is pungent and warm, possessing the aroma of Fire but lacking juice, so it can only assist Fire to move blood, not generate it. Di Huang has juice but is not pungent and warm, so it only benefits Water fluids and nourishes the source of blood, unable to transform into red color. Gui Zhi is red, enters the Heart, and assists Fire, exactly aiding the command to transform into red. Mu Dan Pi (Moutan Cortex) is red and bitter, draining fire, thus draining blood. Bai Shao (Paeoniae Radix Alba) is bitter, draining blood; its white color allows it to move Water in the Qi level. Hong Hua (Carthami Flos) is red, generating blood, but bitter, also draining blood. Tao Hua (Persicae Flos) is red, belonging to the Blood level; the kernel is in the pit, resembling the human heart; its bitter taste has bamboo-like air, entering the Heart directly, capable of moving and generating blood. The blood in the Heart contains spiritual light, which is Shen (Spirit). If Shen is disturbed by chaotic blood, mania and delirium occur. Moving Qi drugs enter the Heart to guide it. Yuan Zhi (Polygalae Radix), Chang Pu (Acori Tatarinowii Rhizoma), and She Xiang (Moschus) can open the orifices of the Heart, while Mu Dan Pi, Tao Ren (Persicae Semen), and Gan Qi (Resina Ferulae) can remove stagnant blood from the Heart. Cases of phlegm confusing the Heart Spirit are not included here. Xue Jie is formed by resin condensation; its aromatic dispersal resolves stagnant blood. Ru Xiang and Mo Yao (Myrrhae Resina) are resins, resembling human blood and aromatic, thus moving blood. Pu Huang (Typhae Pollen) grows in water; its flowers are yellow and fragrant, belonging to the Qi level, not Blood. Its hemostatic effect is because moving Qi moves Blood. Fire interacting with Water transforms into Qi; Qi attaching to matter returns to Water. Qi moving within blood surrounds it externally; thus, moving blood relies on moving Qi, and moving Qi is moving Water. Bai Mao Gen (Imperatae Rhizoma) promotes urination and moves Qi, thus moving blood. Hematemesis always involves coughing up phlegm; phlegm belongs to the Qi level. Only when Qi rebels and Water rises is blood expelled. Therefore, Bei Mu (Fritillariae Bulbus) and Xing Ren (Armeniacae Semen) are used to descend Qi and move phlegm; when Qi descends, blood descends. Qi stagnation and blood stasis, chills and fever, body pain, and amenorrhea in women require moving Qi within blood. Xiang Fu (Cyperi Rhizoma), Ling Zhi (Trogopterori Copra), Yuan Hu (Corydalis Rhizoma), Yu Jin (Curcumae Radix), Chuan Xiong, Ru Xiang, and Jiang Xiang (Aquilariae Lignum Resinatum) are main drugs. Leakage of fetal blood must first involve leakage of water, as Water Qi moves first, then Blood and Qi move. Sheng Ma ( Cimicifugae Rhizoma) and Ren Shen (Ginseng Radix) should be used to ascend and tonify. Zhu Ma Gen (Boehmeriae Caulis) nourishes it. Zhu Gen juice is originally white but turns red, thus generating blood, symbolizing Water interacting with Fire to transform blood. Ou Jie (Nelumbinis Node) is similar. Ou (Nelumbinis Rhizoma) grows in water but blooms upward; the flower bears Fire color, symbolizing Water interacting with Fire. Ou juice turning red symbolizes Fire transforming into blood. The Qi transformation of Ou juice is identical to human blood, clearing fire and resolving blood stasis. Drugs clearing fire represent Water interacting with Fire, thus stopping bleeding; Huang Qin and Huang Lian are examples. Drugs tonifying fire represent Fire transforming Water, thus moving blood; Sheng Jiang (Zingiberis Rhizoma Recens) and Ai Ye (Artemisiae Argyi Folium) are examples.
Q: Hair is named "Blood Remainder" (Xue Yu). When pulling out hair roots, there is slightly white water but no blood. Why?
A: This principle is subtle. Knowing the generation of hair reveals the origin of blood. Human blood, derived from postnatal dietary juices, enters the Heart, transforms red, follows the Chong and Ren meridians down to the Uterus, interacts with prenatal Kidney Water, transforms into Essence (Jing), enters the spine via the Kidney system, ascends to the Brain, transforms into Marrow (Sui), and generates bone. Hence, after death, flesh decays but bones remain. Flesh and blood may be generated solely by Qi (transforming in Yin) or solely by Blood (transforming in Yang). Only bone, generated from marrow essence, possesses complete Qi and Blood, hence does not decay. Tonifying bone requires tonifying marrow, which requires tonifying essence. Lu Rong (Cervi Cornu Pantotrichum) is supreme in Qi and Blood, strengthening the Kidney meridian, thus tonifying marrow essence to strengthen bone. Di Huang and Huang Qi (Astragali Radix) tonify both Qi and Blood, transforming essence to tonify marrow. Cow bone marrow and Pig spinal cord tonify marrow with marrow. Tonifying marrow begins with tonifying essence, which is transformed from Qi and Blood. Shen Qi Wan (Kidney Qi Pill) and Tu Si Zi (Cuscutae Semen) tonify both Qi and Blood and transform essence. Essence transforms into marrow. If cold exists in brain marrow, Fu Zi (Aconiti Lateralis Radix Preparata) and Xi Xin (Asari Radix et Rhizoma) are used to ascend to the brain via the Du Meridian, entering from the Qi level. If wind and heat exist in brain marrow, Ling Yang Jiao (Capricornis Cornu), Xi Jiao (Rhinocerotis Cornu), Wu Zhu Yu (Evodiae Fructus), Bo He (Menthae Haplocalycis Herba), Jing Jie (Schizonepetae Spica), Tian Ma (Gastrodiae Rhizoma), Huang Bo, Qing Hao (Artemisiae Annuae Herba), and Cang Er Zi (Xanthii Fructus) are used, ascending to the brain via the Jue Yin Liver Meridian from the Blood level. This is the treatment for brain marrow, though you did not ask. However, since marrow is a combination of Qi and Blood, and I am discussing the principle of Blood combining with Qi, I mention it together. Marrow stores essence and governs memory; when Heart Spirit combines with marrow essence, knowledge and function arise. If marrow Qi is unclear, Shen is chaotic, leading to much mania; if marrow is insufficient, knowledge is weak. Treatment can seek similar drugs to guide upwards. Bone possesses both Qi and Blood, hence does not decay. Hair also does not decay in soil. Blood is generated postnatally, belongs to the Ren Meridian, interacts downward with the Uterus, combines with Qi to transform essence, generating marrow. Qi is generated prenatally, residing in the Kidney. Qi generated prenatally belongs to the Kidney Meridian, interacts downward with the Uterus, combines with Blood to transform essence, reaching the Chong and Ren meridians. Transforming and ascending along meridians, it grows beard around the lips. Filling skin and hair, it grows body hair. Ascending with the Tai Yang Meridian to the head, it grows scalp hair. Corresponding to the Liver's location, it grows armpit and genital hair. The face and forehead belong to the Lung; eyes belong to the Liver; eyebrows sit above eyes at the junction of Liver and Lung. Liver governs Blood, Lung governs Qi; their interaction produces eyebrows. All hair is Blood transformed by Qi, hence named "Blood Remainder" because it is born of Blood. Pulling hair roots yields only white water; water is Qi, verifying that Qi transforms Blood. Thus, hair possesses complete Qi and Blood, hence does not decay. Prepared as medicine, it can tonify Blood as the remainder of Blood. It can also promote urination as it is transformed by Qi. The *Shennong Ben Cao Jing* says "returns to spirit, transforms." No one understands these four characters. Spirit is governed by the Heart. It means hair's nature returns to the Heart as Spirit, then transforms blood to interact downward with Water, forming a cycle. Plants are the same. Yang wood transforms in Yin; Yin wood transforms in Yang. Only Zong (Arecae Catenuatae Pericarpium) resembles human hair and does not decay in soil. Plants also have Qi and Blood; what inherits from Heaven is Qi, what inherits from Earth is Blood. Zong resembles hair and possesses complete plant Qi and Blood, born of Yin-Yang interaction, hence does not decay. Moreover, Zong's nature is similar to hair; it promotes urination and stops bleeding. This reveals the principle of Qi and Blood combining. Other drugs treating blood and transforming Qi can be inferred similarly.
Q: The Qi-tonifying effects of Ren Shen and Huang Qi were clearly stated in the first volume. Why is Fu Ling (Poria) also said to transform Qi?
A: Qi is the Yang within Water. When humans drink water, Kidney Yang transforms it; water quality descends while Qi ascends. Fu Ling inherits the essence of Earth, has a bland taste, and promotes urination. When water moves, Qi ascends. There is Fu Ling below and Wei Xi Zhi (Poria with Pine Root) above; Wei Xi Zhi is the sprout of Fu Ling on pine tops, distinct from Fu Ling itself. Although Fu Ling is in the earth, its Qi naturally penetrates it. This is why Fu Ling's Qi can ascend and why its nature transforms Qi. However, it does not generate primal Qi as well as Ren Shen, nor support primal Qi as well as Huang Qi.
Q: The Classics say "Strong Fire consumes Qi, Mild Fire generates Qi." What is this saying?
A: Qi is transformed from Water and returns to Water. Excreted from mouth and nose as saliva, from skin as sweat, from bowels and bladder as fluid. If Fire is too strong, damaging fluids, harmony is lost. Qi deficiency causes panting; Wu Wei Zi (Schisandrae Fructus) and Mai Dong (Ophiopogonis Radix) moisten it. Qi leakage causes night sweats; Sheng Di Huang (Rehmanniae Radix), Mu Dan Pi, Fu Xiao Mai (Tritici Fructus Levigatus), Di Gu Pi (Lycii Cortex), and Long Gu (Os Draconis) clear and astringe it. Qi stagnation causes difficult urination; Rou Cong Rong (Cistanches Radix), Dang Gui, Huo Ma Ren (Cannabis Semen), and Xing Ren are used to lubricate it. If Kidney Yang is excessive and Yin Qi cannot contain it, panting, coughing, and consumptive syndromes arise, requiring massive Yin tonification. Thus, Shu Di Huang (Prepared Rehmanniae Radix), Gui Ban (Testudinis Carapax et Plastrum), and Xuan Shen (Scrophulariae Radix) are used to pair Water with Fire, preventing Strong Fire from consuming Qi, allowing Qi to be retained. Drinking water enters the Stomach, seeps into the San Jiao membranes, and descends to the Bladder. The True Fire of Ming Men, originating from the uterus, steams Bladder water, causing Qi to emerge. This True Fire ascends with Qi; its path is within the Jiao membranes. Wherever water passes, Fire steams it, transforming it into Qi to fill the body. Hence, young people with vigorous Qi have less urine because water is transformed into Qi. This True Fire is neither cold nor fierce, called "Mild Fire," the source of generating Qi in the body. Observing Zhang Zhongjing’s Ba Wei Wan (Eight-Ingredient Pill with Rehmannia), named Kidney Qi Pill, it contains Gui Zhi and Fu Zi along with Shan Zhu Yu (Corni Fructus) and Di Huang. The Yang within Yin is truly a formula for Mild Fire generating Qi. Gui Zhi transforming Qi follows this logic. It is warm but not fierce, black entering the Kidney, truly generating Qi. Gui Zhi and Fu Zi are fierce; they must be balanced with Yin drugs. However, if a person inherently has Yin Cold, pure Yang drugs like Gui Zhi and Fu Zi are needed to transform it. Furthermore, Qi escaping upward causes panting, belonging to Yin deficiency; tonifying Yin to restrain True Fire is appropriate. Qi escaping downward causes sweating and incontinence, belonging to Yang deficiency; tonifying Fire to gather primal Qi is appropriate. Regardless of Yin or Yang, promoting urination is necessary. When Water transforms, Qi generates; Fire interacting with Water results in Qi transformation. Understanding this allows one to probe the subtleties of creation.