尝读赵先生《医贯》书，发明先天水火之论，深得守真先生《保命》阴阳微旨，此轩岐
堂上，独契玄提，而有此出类之见。然其论先天水火，诚为万世准绳。至于论症论治之中，
敢为先生一二指陈。如首论《内经》十二官论，谓心主之官非心也，别有一心主，在无极无
形之际，以命门为君主。夫先生之论，先天无形之水火，《内经》之论，后天有形之脏象也
。今以无形先天之理，以论后天，反使后学差误。又云世之养生者，宜加意于补火，而比类
于鳌山之灯，火熄则不动，火旺则动速。独不思火不宜动，动则病矣；速则易终而易坏；火
太旺，则一炬成烬矣。故养生家，务静不务动。今云火旺动速，是妄开后世偏于补火过端。
夫阴阳之道，不可偏废，阴旺则阳亏，阳旺则阴竭，二者一有偏胜，则为病矣。今先生立有
阳无阴之论，有偏于补阳之弊。至论伤寒一症，于口燥口渴条中，独重地黄之滋阴，但伤寒
末后之时为虚热，初起之时为实热，今以地黄腻膈之味，施以初起口渴症中，则邪热凝滞，
食气不消，其渴愈甚。且口干作渴，皆属阳明气分之病，今先生不分气分血分之所属，竟云
滋补肾中真阴，不知邪热未去，虽日进滋阴，无益于病。仲景先生不设滋阴补血之方于口燥
咽干条内，良以滋阴之药，治血虚发热之内伤症，非治热邪为患之外感法也。至于血症论中
，往往以外感内伤，混一立论，将《内经》太阳司天，寒淫所胜，民病呕血血泄之论，引《
金匮》外感吐血方中麻黄桂枝等汤主治。不知《内经》所论寒淫所胜，言人表有六淫之寒邪
，壅遏发热，邪热郁于太阳之经，不得发越，故血从口鼻而出。是以《伤寒论》有太阳伤寒
，失与麻黄汤发汗，遂成衄血吐血之语。今先生误认太阳寒淫所胜之寒，乃是虚寒之寒，而
以温热施治，又不着明外感内伤，此等立法，最为误事。至论相火龙雷，更有疵谬。夫龙雷
之理，独详《周易》，龙雷天象，卦属于干，实主纯阳。初九为潜，九二为见，上九为亢，
以明初阳在下，未可施用，必待上行九五，方得刚健居尊之体，至上九又为阳居过极，而为
亢龙有悔矣。至雷属于震，于位属东，甲木所主，盖一阳初动于二阴之下，则曰震动其地，
及其二阳见上，卦成乎巽，而龙雷皆得其令矣。古人以肝肾之火喻之者，以二经一主乎木
，一主乎水，然皆有相火存乎其中，故乙癸同源。二经真水不足，则阳旺阴亏，相火因之而
发，治宜培养肝肾真阴以制之，不使其阳居过极，为干之上九，离之九四是矣。今先生云得
湿则 ，遇水则炽，以火遂之则焰灼自消，而独以桂附辛热之药，温补天真之火。不知
龙雷之火，惟春分以后，秋分以前，少阳相火，少阴君火，太阴湿上，三气合而行令，一土
不胜二火，一阴为二阳所逼，上下皆阳，一阴独寓于中，于卦成离，于是炎暑时行，天之热
气下降，地之湿气上蒸，或龙从海起，水自天生，或龙从天降，水自地起，震动其地而雷出
，离丽乎天而电生，上下相合，则火雷鼓颔作声，而成噬嗑之象矣。及其云行雨施，则天气
分而清凉，龙雷各自隐伏。古人所谓移星易宿，龙蛇起陆，惟夏月见之。今先生云∶冬时阳
气在下，龙雷就火气之同类而居于下；夏月阴气在下，龙雷不能安其身而出于上。果尔，则
龟鳖阴类之物，夏伏何处，冬见何地乎。夫龙雷何故独见于春夏，而独属于震离也？震属东
方生升之位，天干甲乙，地支寅卯；离属南方明丽之位，天干丙丁，地支巳午，夫火长生
于寅，临官于巳，帝旺于午也；夫子丑为开辟之初，坎为方萌之阳，包藏于二阴之间，未能
发动。至寅则阴气始剥，有震动发生震惊百里之象；及至天下雷行，卦为无妄，然后万物皆
生。至巽则二阳皆生于上，万物皆齐。至离则上下皆阳，万物相见。故曰出乎震，齐乎巽，
相见乎离也。夫泽天为 ， 尽成干，干复南方先天之位，然后一阴始生于五阳之下
，而成天风之 。阳极阴生，阴生渐长，火动于上，泽动于下，火泽为睽，于是泽遇于
火，水火相息，泽火相革，然后一阴上进，二阳下伏，说以利贞，方成乎兑，而龙雷潜隐，
直至剥尽成坤，坤复北方先天之位，然后阳往复反，一阳始生五阴之下，而雷在地中复也。
夫阴终于 ， 尽成干，阳终于剥，剥尽成坤，则知龙雷之火，发见于五阳成卦之泽
天，收藏于五阴成卦之山地剥也。是则龙雷之火，其纯阳之象无疑矣。是以东垣云∶
以火吸水，水能上腾，热天龙见，水从地起，不可谓寒也。今先生用辛热摄伏，岂不误哉。
夫引火归源而用附桂，实治真阳不足无根之火，失守上炎，如戴阳阴躁之症，非龙雷之谓也
；龙雷之火，肝肾之真阴不足，肝肾之相火上炎，水亏火旺，自下冲上，突如其来，如焚死
弃；若虚阳上浮，真阳不足，剥床剥肤，乃为阴邪所逼，一同乎五阳在下，一阴将尽于上之
纯阳；一同乎五阴在下，一阳将尽于上之纯阴；一如干之上九，亢龙有悔；一如坤之上六，
龙战于野，阳极阴极，二者天渊。夫肝属于木，火本所生；肾属于水，火本先天，然二者之
火，俱赖真阴相配，水润木荣，此火安其宅，真阴耗损，则木失所养，转柔为刚，水竭木燥
，燎原可畏。但此火真水不足，相火偏胜为患，不比六淫之邪，天外加临之火，而用苦寒直
折者，又不可宗火郁发之而用升阳散火之法。治宜养阴制火，如盏中添油，灯焰自熄，用家
秘肝肾丸、六味丸，合滋肾丸是也。古人云，壮水之主，以镇阳光，阳光者，龙雷之火也；
壮水者，滋阴降火之谓也。今先生云治以辛热，乃是益火之源，以消阴翳矣。乌乎可。
我曾阅读赵先生（赵献可）的《医贯》一书，书中阐发了先天水火关系的理论，深得刘守真先生《素问病机气宜保命集》中关于阴阳精微奥妙的旨意，这在轩辕、岐伯以来的医学殿堂中，是独得玄妙要领、具有超群见解的。然而，他论述先天水火，确实可以作为万世的准则。但在论述病症和治疗的方法上，我斗胆为先生指出其中的一二疏漏之处。
比如首先论述《内经》中的“十二官”理论时，他说心主的官职并非心脏本身，而是另外有一个“心主”，存在于无极无形的境界之中，以命门作为君主。先生的观点，讲的是先天无形的水火；而《内经》的观点，讲的是后天有形的脏腑象数。现在用先天的无形之理来论述后天的病症，反而使后学者产生差错和误解。
他又说，世间养生的人，应当注意补火，并将其比作鳌山上的灯：火熄灭了就不动，火旺盛了就动得快。只是没考虑到火是不宜动的，动了就会生病；动得太快就容易终结和败坏；火太旺，一根蜡烛瞬间就烧成灰烬了。所以养生家，务必追求静而不追求动。现在先生说火旺则动速，这是妄开后世偏重于补火的弊端。
阴阳之道，不可偏废，阴旺则阳亏，阳旺则阴竭，二者只要有一方偏胜，就会成为疾病。现在先生建立了只有阳没有阴的理论，存在偏重于补阳的弊病。
至于论述伤寒这一病症，在口燥口渴的条目中，特别重用熟地黄来滋阴。但是，伤寒末期才是虚热，初起之时是实热。现在用熟地黄这种滋腻碍胃的药味，施用于初起口渴的症状中，会导致邪热凝滞，饮食之气不消，其口渴反而更严重。况且口干作渴，都属于阳明气分的病证，现在先生不分气分和血分的归属，竟然说是滋补肾中的真阴。不知道邪热尚未去除，虽然每天进服滋阴药，对病情也没有益处。张仲景先生在口燥咽干的条文中，没有设立滋阴补血的方剂，实在是因为滋阴的药物，是用来治疗血虚发热之内伤症的，而不是治疗热邪为患之外感病的法则。
至于血症论中，往往将外感和内伤混在一起立论，引用《内经》中太阳司天、寒邪淫盛导致百姓呕吐血液和大便下血的论述，又引用《金匮要略》中外感吐血方中麻黄汤、桂枝汤等方剂主治。不知道《内经》所论述的寒邪淫盛，是说人体体表有六淫之寒邪，壅遏导致发热，邪热郁结在太阳经脉，不能发散，所以血液从口鼻而出。因此《伤寒论》中有太阳伤寒，如果误治未给予麻黄汤发汗，遂造成衄血吐血的记载。现在先生错误地认为太阳寒邪淫盛的寒，乃是虚寒之寒，而用温热法治疗，又不明确区分外感和内伤，这种立法，最容易误事。
至于论述相火如龙雷之火，更有瑕疵谬误。龙雷的道理，详细记载于《周易》。龙雷的天象，卦属于乾，实际上主宰纯阳。初九爻为潜藏，九二爻为显现，上九爻为亢极，以此说明初生的阳气在下，不可施用，必须等到上行至九五，才具备刚健居尊的地位，到了上九又是阳气居于过极的位置，从而出现“亢龙有悔”的情况。至于雷属于震卦，方位属东，由甲木所主，大概是一阳初动于二阴之下，就说震动大地，等到二阳见于上，卦变成巽，那么龙和雷都得其时令了。古人用肝肾之火来比喻它，是因为这两经一主乎木，一主乎水，然而都有相火存在于其中，所以乙癸同源。这两经的真水不足，则阳旺阴亏，相火因此发作，治疗应当培养肝肾真阴来制约它，不让其阳气居于过极，就像乾卦的上九爻，离卦的九四爻那样正确。现在先生说龙雷之火“得湿则晦，遇水则炽，以火遂之则焰灼自消”，而只用肉桂、附子等辛热药物，温补天真之火。不知道龙雷之火，只有在春分以后，秋分以前，少阳相火、少阴君火、太阴湿气这三气合而行令，一土不胜二火，一阴被二阳逼迫，上下皆阳，一阴独自寓于中间，卦象形成离卦，于是炎暑盛行，天的热气下降，地的湿气上蒸，或者龙从海起，水自天生，或者龙从天降，水自地起，震动大地而雷出，离卦附着于天而电生，上下相合，则火雷鼓颔发声，形成噬嗑卦的象。等到云行雨施，天气分开而清凉，龙雷各自隐伏。古人所说的移星易宿，龙蛇起陆，只在夏月见到。现在先生说：冬天阳气在下，龙雷就随着同类的气居于下；夏月阴气在下，龙雷不能安身而出于上。果真如此，那么龟鳖这类阴类之物，夏天潜伏在哪里，冬天出现在哪里呢？龙雷为何唯独见于春夏，而唯独属于震卦和离卦呢？震卦属东方生升之位，天干甲乙，地支寅卯；离卦属南方明丽之位，天干丙丁，地支巳午，火长生在寅，临官在巳，帝旺在午啊！子丑是开辟之初，坎卦是方萌发的阳气，包藏在二阴之间，未能发动。到了寅月，阴气开始剥落，有震动发生、震惊百里的景象；等到天下雷行，卦象为无妄，然后万物皆生。到了巽卦，二阳都生于上，万物皆整齐。到了离卦，上下皆阳，万物相见。所以说“出乎震，齐乎巽，相见乎离”。泽天为夬卦，夬尽变成乾卦，乾复归南方先天之位，然后一阴始生于五阳之下，而成天风姤卦。阳极阴生，阴生渐长，火动于上，泽动于下，火泽为睽卦，于是泽遇于火，水火相息，泽火相革，然后一阴上进，二阳下伏，兑卦利于贞正，才形成兑卦，而龙雷潜隐，直到剥尽变成坤卦，坤复归北方先天之位，然后阳往复反，一阳始生五阴之下，而雷在地中复卦。阴终于夬，夬尽成乾，阳终于剥，剥尽成坤，则知道龙雷之火，发见于五阳成卦的泽天夬，收藏于五阴成卦的山地剥。这样看来，龙雷之火，其纯阳的象无疑了。所以李东垣说：以火吸水，水能上腾，热天龙见，水从地起，不可谓寒也。现在先生用辛热药物摄伏，难道不是错误吗？
所谓引火归源而用附子、肉桂，实际上是治疗真阳不足导致的无根之火，失守上炎，如戴阳、阴躁等症状，并不是指龙雷之火；龙雷之火，是肝肾的真阴不足，肝肾的相火上炎，水亏火旺，自下冲上，突如其来，如同焚烧死弃；如果是虚阳上浮，真阳不足，剥床及肤，乃是阴邪所逼，一同乎五阳在下，一阴将尽于上的纯阳状态；一同乎五阴在下，一阳将尽于上的纯阴状态；一如乾卦的上九，亢龙有悔；一如坤卦的上六，龙战于野，阳极阴极，二者有天渊之别。肝属于木，火本是其所生；肾属于水，火本是先天，然而这两种火，都赖真阴相配，水润木荣，此火安其宅，真阴耗损，则木失所养，转柔为刚，水竭木燥，燎原可畏。但这火因真水不足，相火偏胜为患，不比六淫之邪，是天外加临的火，而用苦寒直折者，也不可宗奉火郁发之而用升阳散火之法。治疗应当养阴制火，如盏中添油，灯焰自熄，使用家秘肝肾丸、六味丸，合滋肾丸就是这样的方法。古人说，壮水之主，以镇阳光，阳光者，就是龙雷之火；壮水者，就是滋阴降火的意思。现在先生说用辛热治疗，那就是益火之源，以消阴翳了。这怎么可以呢？
I once read Mr. Zhao's (Zhao Xianke) book *Yi Guan* (Canon of Medicine), which elucidates the theory of innate Water and Fire, deeply grasping the subtle principles of Yin and Yang from Master Liu Shouzhen's *Suwen Bingji Qi Yi Baoming Ji*. This represents a unique insight that aligns with the profound teachings of Xuanyuan and Qibo, standing out as an exceptional view in the hall of medicine. However, while his discussion on innate Water and Fire can indeed serve as a standard for all generations, I dare to point out a few errors in his discussion of symptoms and treatments.
For instance, in his initial discussion of the "Twelve Officials" theory from the *Neijing* (Classic of Internal Medicine), he claims that the official of the Heart is not the Heart itself, but rather another "Heart Master" existing in the formless realm of Wuji, with the Mingmen (Gate of Life) serving as the monarch. Mr. Zhao's argument concerns the formless Water and Fire of the innate state, whereas the *Neijing* discusses the有形 (form/have-shape) zang-fu organs of the postnatal state. Now, using the formless principle of the innate state to discuss postnatal conditions only leads to confusion and error for later learners.
He further states that those who practice health preservation should pay attention to tonifying Fire, comparing it to a lamp on Mount Ao: when the fire is extinguished, there is no movement; when the fire is vigorous, movement is rapid. He fails to consider that Fire should not be active; activity leads to disease. Rapid movement leads to premature exhaustion and decay; if Fire is too vigorous, a single torch turns to ashes instantly. Therefore, practitioners of health preservation must pursue stillness rather than activity. To say that vigorous Fire leads to rapid movement is to recklessly encourage the bias towards excessive Fire tonification in later generations.
The Way of Yin and Yang cannot be neglected or biased. If Yin is vigorous, Yang becomes deficient; if Yang is vigorous, Yin is exhausted. If either side becomes excessive, disease arises. Mr. Zhao establishes a theory of "Yang without Yin," which has the drawback of biasing towards tonifying Yang.
Regarding the discussion of Shanghan (Cold Damage), specifically under the item of dry mouth and thirst, he places heavy emphasis on Rehmanniae Radix Preparata (Shudihuang) for nourishing Yin. However, late-stage Shanghan involves deficiency heat, while early-stage Shanghan involves excess heat. Using the cloying and stagnation-inducing nature of Rehmanniae Radix Preparata in the early stage of thirst caused by Shanghan will cause pathogenic heat to stagnate, hinder the digestion of food qi, and worsen the thirst. Moreover, dry mouth and thirst belong to disorders of the Yangming Qi level. Mr. Zhao fails to distinguish between Qi and Blood levels, claiming instead to nourish the True Yin of the Kidney. Ignoring that the pathogenic heat has not yet been eliminated, daily administration of Yin-nourishing herbs is of no benefit to the condition. Zhang Zhongjing did not include formulas for nourishing Yin and blood in the items regarding dry mouth and throat because such herbs are intended for treating internal injuries characterized by blood deficiency and fever, not for external contractions caused by pathogenic heat.
In his discussion of blood disorders, he often conflates external contractions and internal injuries. He cites the *Neijing*'s statement that when Taiyang governs the year and Cold dominates excessively, people suffer from vomiting blood and bloody diarrhea, and then applies this to formulas like Mahuang Tang (Ephedra Decoction) and Guizhi Tang (Cinnamon Twig Decoction) from *Jingui Yaolue* for treating hematemesis due to external contraction. He does not realize that the "Cold dominating excessively" discussed in the *Neijing* refers to Six Excesses of Cold pathogens on the body surface, causing obstruction and fever. The pathogenic heat stagnates in the Taiyang channel and cannot vent outward, leading to bleeding from the mouth and nose. Thus, the *Shanghan Lun* (Treatise on Cold Damage) states that if Taiyang Shanghan is not treated with Mahuang Tang to induce sweating, it may lead to epistaxis and hematemesis. Mr. Zhao mistakenly interprets the Cold of Taiyang dominance as deficiency-cold and treats it with warm methods, failing to clearly distinguish between external and internal causes. Such legislation is most likely to cause harm.
His discussion on ministerial fire resembling dragon and thunder fires contains further flaws. The principles of dragons and thunder are detailed in the *Zhouyi* (Book of Changes). The celestial imagery of dragons and thunder belongs to the Qian trigram, representing pure Yang. The first line (Chiu Jiu) represents hiding; the second line (Jiu Er) represents appearing; the top line (Shang Jiu) represents hyperactivity. This illustrates that initial Yang at the bottom should not be utilized until it rises to the fifth line (Jiu Wu), attaining the position of strength and dignity. At the top line, Yang is at its extreme, resulting in "Hyperactive Dragon brings regret." Thunder belongs to the Zhen trigram, associated with the East and Wood (Jia). It signifies one Yang moving initially beneath two Yins, shaking the earth. When two Yangs appear above, the hexagram becomes Xun, and both Dragon and Thunder act according to their season. Ancients compared this to Fire in the Liver and Kidney because these two organs govern Wood and Water respectively, yet both contain Ministerial Fire, hence "Yi and Gui share the same source." When True Water of these two organs is insufficient, Yang becomes vigorous and Yin deficient, causing Ministerial Fire to flare up. Treatment should cultivate the True Yin of the Liver and Kidney to restrain it, preventing Yang from reaching extremes, similar to the dynamics of Qian's top line and Li's nine-four line.
Mr. Zhao claims that Dragon-Thunder Fire "dims when wet, blazes when meeting water, and self-extinguishes when fed with fire," advocating the use of acrid-hot drugs like Cinnamomi Cortex (Guizhi) and Aconiti Lateralis Radix Preparata (Fuzi) to warm-tonify True Fire. He ignores that Dragon-Thunder Fire operates only after the Spring Equinox and before the Autumn Equinox, when Shaoyang Ministerial Fire, Shaoyin Sovereign Fire, and Taiyin Dampness combine. One Earth element cannot overcome two Fires; one Yin is pressured by two Yangs. With Yang above and below and Yin residing solely in the middle, the hexagram forms Li. Heat prevails, heavenly Qi descends, and earthly dampness ascends. Dragons rise from the sea, water falls from heaven, or vice versa, shaking the earth and producing thunder. Lightning generates as Li attaches to Heaven. Upper and lower combine, causing Fire and Thunder to roar, forming the Xihe (Biting Through) hexagram. When clouds move and rain falls, the weather cools, and Dragon-Thunder hides. Ancients noted that dragons and snakes emerging occurs only in summer. Mr. Zhao argues that in winter, Yang is below, so Dragon-Thunder stays below following similar Qi; in summer, Yin is below, so Dragon-Thunder cannot settle and rises above. If true, where do turtles and tortoises (Yin creatures) hide in summer and appear in winter? Why do Dragon-Thunder fires appear exclusively in spring and summer and belong exclusively to Zhen and Li? Zhen belongs to the East, rising position, Heavenly Stems Jia/Yi, Earthly Branches Yin/Mao. Li belongs to the South, bright position, Heavenly Stems Bing/Ding, Earthly Branches Si/Wu. Fire is born in Yin, enters office in Si, and peaks in Wu. Zi and Chou represent the beginning of creation; Kan represents nascent Yang hidden between two Yins, unable to activate. In Yin month, Yin begins to peel away, showing signs of vibration and shock. When thunder rolls across the world, the hexagram is Wuwang (Innocence), and all things grow. In Xun, two Yangs are above, and all things are orderly. In Li, Yang is above and below, and all things meet. Hence, "Emerging from Zhen, Aligning at Xun, Meeting at Li."
Guai (Breakthrough) ends with Qian (Creative); Qian returns to the Southern innate position, then one Yin is born below five Yangs, forming Gou (Coming to Meet). Yang extreme yields Yin; Yin grows gradually. Fire moves above, Lake moves below, forming Kui (Opposition). Lake meets Fire, Water and Fire extinguish each other, Lake and Fire transform, then one Yin advances, two Yangs retreat, forming Dui (Joyous). Dragon-Thunder hides until Bo (Splitting Apart) completes Kun (Receptive). Kun returns to the Northern innate position, Yang reverses, one Yang is born below five Yins, forming Fu (Return). Yin ends at Guai, Guai completes Qian; Yang ends at Bo, Bo completes Kun. Thus, Dragon-Thunder Fire emerges in Ze Tian Guai (Lake over Heaven, five Yangs) and stores in Shan Di Bo (Mountain over Earth, five Yins). Clearly, Dragon-Thunder Fire is pure Yang. Dongyuan said: "Fire draws water up; water rises, hot dragon appears, water rises from earth; it cannot be called cold." Using acrid-hot drugs to suppress this is erroneous.
"Guiding Fire back to its source" using Fuzi and Guizhi treats True Yang deficiency causing rootless Fire to float upward, as seen in Daiyang (Floating Yang) or Yin restlessness, not Dragon-Thunder Fire. Dragon-Thunder Fire stems from Liver-Kidney True Yin deficiency, causing Ministerial Fire to flare up. Water is deficient, Fire is vigorous, rushing from below to above suddenly, like burning waste. Conversely, floating deficient Yang and True Yang deficiency involve peeling bed and skin, forced by Yin pathogens. This resembles Five Yangs below with one Yin nearly exhausted above (Pure Yang), or Five Yins below with one Yang nearly exhausted above (Pure Yin). Like Qian's top line ("Hyperactive Dragon brings regret") or Kun's top line ("Dragon fights in the wild"), Extreme Yang and Extreme Yin are worlds apart. Liver belongs to Wood, from which Fire is born; Kidney belongs to Water, the origin of Fire. Yet both rely on True Yin pairing. Water moistens Wood, allowing Fire to reside safely. If True Yin is depleted, Wood loses nourishment, turning soft to hard; Water dries, Wood parches, leading to uncontrollable flames. This Fire, due to True Water deficiency and Ministerial Fire excess, differs from Six Excess pathogens or external added Fire treated with bitter-cold purgatives. Nor should one follow "Fire depression requires dispersion" using ascending-dispersing methods. Treatment should nourish Yin to control Fire, like adding oil to a lamp to let the flame extinguish naturally. Using secret Liver-Kidney Pill, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), combined with Zishen Wan (Nourish Kidney Pill) is appropriate. Ancients said: "Strengthen the master of Water to calm Solar Light." Solar Light refers to Dragon-Thunder Fire; Strengthening Water means Nourishing Yin and Descending Fire. Mr. Zhao advocates acrid-hot treatment, which is "Tonifying the source of Fire to eliminate Yin shadows." How can this be acceptable?