五味子∶性温,五味俱备,酸、咸居多。其酸也能敛肺,故《神农本草经》谓主咳逆上气;其咸也能滋肾,
故《神农本草经》谓其强阴益男子精。其酸收之力,又能固摄下焦气化,治五更泄
泻、梦遗失精,及消渴小便频数,或饮一溲一,或饮一溲二。其至酸之味,又善入肝,肝开窍于目,故五味
子能敛瞳子散大。然其酸收之力甚大,若咳逆上气挟有外感者,须与辛散之药同用(若干姜、生姜、麻黄、细
辛诸药),方能服后不至留邪。凡入煎剂宜捣碎,以其仁之味辛与皮之酸味相济,自不至酸敛过甚,服之作胀满也。
邹润安曰∶“《伤寒论》中,凡遇咳者,总加五味子、干姜,义甚深奥,经云‘脾气散精,上归于肺,’
是故咳虽肺病,而其源实主于脾,惟脾家所散上归之精不清,则肺家通调水道之令不肃,后人治咳但知润肺消
痰,不知润肺则肺愈不清,消痰则转能伤脾,而痰之留于肺者究莫消也。干姜温脾肺,是治咳之来路,来路清
则咳之源绝矣;五味使肺气下归于肾,是治咳之去路,去路清则气肃降矣。合两药而言,则为一开一阖,当开
而阖是为关门逐盗;当阖而开则恐津液消亡,故小青龙汤及小柴胡汤、真武汤、四逆散之兼咳者皆用之,不嫌
其表里无别也。”
萆 ∶味淡,性温。为其味淡而温,故能直趋膀胱温补下焦气化,治小儿夜睡遗尿,或大人小便频数,
致大便干燥。其温补之性,兼能涩精秘气,患淋证者禁用,醒脾升陷汤后曾详论之。
萆 为治失溺要药不可用之治淋。《名医别录》谓萆 治阴萎、失溺、老人五缓。盖失溺之证实因膀胱
之括约筋少约束之力,此系筋缓之病,实为五缓之一,萆 善治五缓,所以治之。拙拟醒脾升陷汤中,曾重用
萆以治小便频数不禁,屡次奏效,是萆 为治失溺之要药可知矣。乃萆 厘清饮竟用之以治膏淋,何其背
谬若是?愚在籍时,邻村有病淋者,医者投以萆 厘清饮,两剂,其人小便滴沥不通。再服各种利小便药,皆
无效。后延愚延医,已至十日,精神昏愦,毫无知觉,脉数近十至,按
之即无,因谓其家人曰∶“据此脉论,即小便通下,亦恐不救。”其家人恳求甚切,遂投以大滋真阴之剂,以
利水之药佐之。灌下移时,小便即通,床褥皆湿。再诊其脉,微细欲无,愚急辞归。后闻其人当日即亡。近又
在津治一淋证,服药十剂已愈,隔两月病又反复,时值愚回籍,遂延他医治疗,方中亦重用萆 。服两剂,小
便亦滴沥不通,服利小便药亦无效。遂屡用西法引溺管兼服利小便之药,治近一旬,小便少通滴沥,每小便一
次,必须两小时。继又服滋阴利水之药十剂始全愈。
Schisandrae Fructus (Wuweizi): Its nature is warm, and all five flavors are present, with sour and salty flavors being predominant. Its sour flavor can astringe the Lung Qi; therefore, *Shennong Bencao Jing* (Divine Farmer's Materia Medica) states that it primarily treats cough with counterflow qi (ke ni shang qi). Its salty flavor can nourish Kidney Yin; therefore, *Shennong Bencao Jing* states that it strengthens Yin and benefits male essence. The astringing power of its sourness can also secure the Qi transformation of the Lower Jiao, treating dawn diarrhea (wugeng xie xie), seminal emission during dreams, and frequent urination due to Xiao Ke (wasting-thirst syndrome), or cases where one drinks once and urinates once (yin yi sou yi), or even drinks once and urinates twice (yin yi sou er). Its extremely sour taste enters the Liver channel effectively. Since the Liver opens into the eyes, Schisandrae Fructus can constrict dilated pupils. However, its astringing power is very strong. If cough with counterflow qi is accompanied by an external pathogen, it must be used together with acrid-dispersing herbs (such as Dry Ginger/Sheng Jiang, Fresh Ginger/Sheng Jiang, Ephedra Herb/Mahuang, and Asarum Root/Xixin). Only then will it not retain pathogens after administration. When decocted, it should be crushed because the acrid flavor of its kernel balances the sour flavor of its skin, preventing excessive astringency which would cause abdominal distension upon ingestion.
Zou Run'an said: "In *Shanghan Lun* (Treatise on Cold Damage), whenever cough appears, Schisandrae Fructus and Dry Ginger are always added. The principle is profound. The classics state: 'The Spleen scatters essence, which ascends to return to the Lung.' Therefore, although cough is a Lung disease, its source is actually governed by the Spleen. Only when the essence scattered by the Spleen and ascending to the Lung is not clear does the Lung's command to regulate water passages fail to descend. Later practitioners treat cough only knowing how to moisten the Lung and eliminate phlegm. They do not realize that moistening the Lung makes it even less clear, and eliminating phlegm further damages the Spleen, leaving the phlegm retained in the Lung unable to be eliminated. Dry Ginger warms the Spleen and Lung, addressing the origin of cough; when the origin is cleared, the source of cough is cut off. Schisandrae Fructus causes Lung Qi to descend and return to the Kidney, addressing the exit of cough; when the exit is cleared, Qi descends properly. Combining these two herbs represents one opening and one closing. When opening is required but closing is applied, it is like locking the door to chase away thieves; when closing is required but opening is applied, it risks consuming body fluids. Thus, in Xia Qing Long Tang (Minor Green Dragon Decoction), Xiao Chai Hu Tang (Minor Bupleurum Decoction), Zhen Wu Tang (True Warrior Decoction), and Si Ni San (Four Counterflow Powder), if cough is present, they are all used, regardless of whether the pathology is exterior or interior."
Bianxu (Dioscoreae Hypoglaucae Rhizoma): Its taste is bland, and its nature is warm. Because its taste is bland and nature is warm, it can directly target the Bladder to warm and tonify the Qi transformation of the Lower Jiao. It treats nocturnal enuresis in children or frequent urination in adults, leading to dry stools. Its warming and tonifying properties also astringe essence and secure Qi. It is contraindicated for patients with Lin Syndrome (strangury). This was discussed in detail after Xing Pi Sheng Xian Tang (Spleen-Reviving and Yang-Raising Decoction).
Bianxu is a key herb for treating urinary incontinence (shi ni) and should not be used to treat Lin Syndrome. *Mingyi Bielu* (Record of Famous Physicians) states that Bianxu treats impotence, urinary incontinence, and the Five Slownesses (wu huan) in the elderly. Generally, the condition of urinary incontinence is indeed due to the lack of constraining force in the sphincter muscles of the Bladder. This is a disease of muscle laxity and is actually one of the Five Slownesses. Bianxu excels at treating the Five Slownesses, hence its use. In my proposed Xing Pi Sheng Xian Tang, I heavily used Bianxu to treat frequent and uncontrollable urination, achieving repeated success. This confirms that Bianxu is a key herb for treating urinary incontinence. Yet, Bianxu Li Qing Yin (Bianxu Clearing Turbidity Decoction) uses it to treat Gao Lin (chyluria). How can this be so contradictory? While residing in my hometown, a neighbor suffered from Lin Syndrome. The physician prescribed Bianxu Li Qing Yin. After two doses, the patient experienced dribbling inability to urinate. Subsequent administration of various diuretic herbs was ineffective. Later, he sought my treatment. Ten days had passed; his spirit was confused, and he had no sensation. His pulse was rapid, approaching ten beats per breath, and vanished upon pressure. I told his family, "Based on this pulse, even if urination resumes, rescue may be impossible." His family pleaded earnestly, so I administered a formula to greatly nourish True Yin, assisted by diuretic herbs. After infusion, urination resumed shortly, wetting the bed and bedding. Upon re-examination, the pulse was faint and thin, nearly imperceptible. I urgently took leave and returned home. Later, I heard the patient died that day. Recently, while treating a Lin Syndrome case in Tianjin, the patient recovered after ten doses. Two months later, the illness relapsed. At that time, I was back in my hometown, so another physician was consulted. The prescription also heavily used Bianxu. After two doses, the patient again experienced dribbling inability to urinate, and diuretics were ineffective. Western methods, including catheterization combined with oral diuretics, were repeatedly employed. After nearly ten days, urination became slightly patent but still dribbled, requiring two hours between each voiding. Finally, after taking yin-nourishing and diuretic herbs for ten doses, full recovery was achieved.