地骨皮,专退有汗骨蒸劳热,肾肺伏火,补益正气,凉血凉骨,五内邪气,热中
消褐,及去肌热,利大小便,此与牡丹皮主治骨蒸同功,但丹皮解无汗者,地骨皮解有
汗者,较之知柏苦寒伤胃,何如骨皮甘寒,勿伤胃气也。
主治(痘疹合参) 药性同前,更治在里无定风邪者,谓肾水不足则火旺,肝木不
宁则风淫,风热内生,不与外感同类也。
按∶枸杞、骨皮,均为肾家之剂,热淫于内,泻以甘寒,地骨皮是也。精不足者补
之以味,枸杞是也。肠滑者禁枸杞子,中寒者忌地骨皮。
感天之清气,得地之苦味,故味苦寒。大寒,无毒,入手太阴、手少阴、足阳明
经,为泻一切有余火热之药。脾胃虚弱,血虚发热者忌之。如治实热,同三黄之类暂
用,宜生。如治鼻衄肺热,同生地丹皮之类宜炒黑。如劫心胃火痛,姜汁拌炒用。
山栀子,留皮,治肌表热,去皮治心胸热,治至高之分,泻肺火,解热郁,行结
气,除烦满,治湿热兼利水,而使小便曲曲下行,总去五内邪气,胃中热气,心中客
热,而虚烦不得眠者,丹溪用以和姜汁拌炒,劫胃脘火痛如神。
主治(痘疹合参) 宜酒炒,用凉心肺。治衄血,散客热,利小便,疗虚烦,劫心
痛,凡痘壮热。吐血衄血暂用。然苦寒伤胃,慎之。
枝栀子,轻飘象肺,故独人肺家,泄有余之火,种种功用,皆从肺旁及者也。大苦
大寒损胃伐气,虚人忌之,世人每用治血,不知血寒则凝,反成败症,治实火之吐血,
顺气为先,气行则血自归经,治虚火之吐血,养正为先,气壮则自能摄血,此治疗之
大法,不可稍违者也。如误用栀子,受其害也必矣。
地骨皮,专门清除伴有出汗的骨蒸劳热(阴虚发热),清泄肾与肺中潜伏的火邪,补益正气,凉血并退骨中虚热,清除五脏内的邪气,治疗内热消渴,以及去除肌肤之热,通利大小便。这与牡丹皮主治骨蒸的功效相同,但牡丹皮适用于无汗者,而地骨皮适用于有汗者。相较于知母、黄柏等苦寒药物容易损伤胃气,地骨皮性味甘寒,不会伤害胃气。
主治(痘疹合参):药性与前述相同,更能治疗病位在里且风邪不定的情况。所谓肾水不足则火旺,肝木失宁则风邪内生,这种风热是体内自生的,与外感风寒不同。
按语:枸杞和地骨皮,都是针对肾脏的药物。对于热邪蕴结于内部的情况,用甘寒之品来泻热,地骨皮就是此类;对于精血亏虚的情况,用厚味的药物来滋补,枸杞就是此类。大便滑泄者禁用枸杞子,脾胃虚寒者忌用地骨皮。
山栀子,感受天的清气,得地的苦味,所以味道苦寒。大寒,无毒,归入手太阴肺经、手少阴心经、足阳明胃经,是泻除一切有余火热邪气的药物。脾胃虚弱、血虚发热者忌用。如治疗实热,可与三黄(黄连、黄芩、黄柏)之类同用,暂时使用,宜生用;如治疗鼻衄(鼻出血)及肺热,可与生地、丹皮之类同用,宜炒黑;如缓解心胃火痛,可用姜汁拌炒后使用。
山栀子,保留果皮,可治疗肌表之热;去掉果皮,可治疗心胸之热。它能治疗身体最高部位的热邪,泻肺火,解除热郁,疏通郁结之气,消除烦闷胀满,治疗湿热兼有利尿作用,使小便顺畅下行,总体能清除五脏内的邪气、胃中的热气、心中的客热,以及因虚烦导致的失眠。朱丹溪常用姜汁拌炒,治疗胃脘火痛效果神速。
主治(痘疹合参):宜酒炒,用以清凉心肺。治疗鼻衄,散除客热,通利小便,疗治虚烦,缓解心痛。凡是痘疮壮热、吐血、鼻衄者可暂时使用。然而其苦寒易伤胃气,需谨慎使用。
山栀枝,质地轻飘象肺,所以独入肺经,泻除有余之火。种种功用,都是从肺经波及其他的。山栀子大苦大寒,损伤胃气和元气,体虚之人忌用。世人常用来治疗出血症,却不知道血遇寒则凝滞,反而会导致败症。治疗实火引起的吐血,以顺气为先,气行则血自然回归经脉;治疗虚火引起的吐血,以扶正养气为先,气壮则自然能统摄血液。这是治疗的根本大法,不可稍有违背。如果误用栀子,必然受到其害。
Dugupi (Cortex Lycii), specifically clears bone-steaming tidal fever accompanied by sweating, drains latent fire in the Kidney and Lung, tonifies righteous Qi, cools blood and bone, eliminates pathogenic qi within the five zang organs, treats internal heat with polydipsia (Xiao Ke), removes heat from the muscle layer, and promotes urination and defecation. Its efficacy in treating bone-steaming is similar to that of Mudanpi (Cortex Moutan), but Mudanpi is indicated for cases without sweating, whereas Dugupi is indicated for cases with sweating. Compared to Zhi Mu (Rhizoma Anemarrhenae) and Huang Bo (Cortex Phellodendri), which are bitter-cold and damage the Stomach Qi, Dugupi is sweet-cold and does not injure the Stomach Qi.
Indications (Integration of Smallpox and Rashes): The nature is the same as mentioned above; it further treats wind-pathogens located internally without fixed patterns. This refers to the condition where insufficient Kidney Water leads to hyperactive Fire, and restless Liver Wood leads to endogenous Wind. Endogenous wind-heat is different from external contractions.
Commentary: Gouqi (Fructus Lycii) and Dugupi are both remedies targeting the Kidney. For heat pathogens rampant internally,甘甜-cold herbs are used to drain heat, such as Dugupi. For insufficiency of essence, substances with substantial flavor are used to tonify, such as Gouqi. Gouqi is contraindicated in patients with loose stools; Dugupi is contraindicated in those with Middle Jiao Cold.
Shanzhizi (Fructus Gardeniae), absorbing the clear qi of Heaven and the bitter taste of Earth, possesses a bitter and cold nature. It is extremely cold, non-toxic, enters the Hand-Taiyin Lung Meridian, Hand-Shaoyin Heart Meridian, and Foot-Yangming Stomach Meridian. It is an herb that drains all excess fire and heat. It is contraindicated in patients with Spleen-Stomach deficiency weakness or fever due to Blood deficiency. When treating excess heat, it may be temporarily used in combination with Sanhuang (the three yellows: Huang Lian, Huang Qin, Huang Bo); raw use is preferred. When treating epistaxis and Lung heat, it should be combined with Shengdi (Radix Rehmanniae Preparata) and Mudanpi and stir-fried until blackened. To alleviate heart and stomach fire pain, it is used after being stir-fried with ginger juice.
Shanzhizi, when the pericarp is retained, treats heat at the muscle surface; when the pericarp is removed, it treats heat in the chest and heart. It addresses heat in the highest regions, drains Lung fire, resolves heat stagnation, moves stagnant Qi, relieves irritability and fullness, treats damp-heat while promoting diuresis allowing urine to flow smoothly downwards, and generally eliminates pathogenic qi within the five zang organs, gastric heat, guest heat in the heart, and insomnia caused by deficiency-irritability. Zhu Danxi often used it stir-fried with ginger juice, achieving miraculous results in treating epigastric fire pain.
Indications (Integration of Smallpox and Rashes): Should be wine-stir-fried to cool the Heart and Lung. Treats epistaxis, dissipates guest heat, promotes urination, treats deficiency-irritability, alleviates heart pain. It may be temporarily used for high fever in smallpox, hematemesis, and epistaxis. However, its bitter-cold nature damages the Stomach, so caution is advised.
Zhizhi (Ramulus Gardeniae), light and floating resembling the Lung, therefore exclusively enters the Lung Meridian to drain excess fire. Various functions extend from the Lung. Shanzhizi is extremely bitter and cold, damaging the Stomach and depleting Qi; it is contraindicated in deficient persons. People often use it to treat bleeding disorders, unaware that cold congeals blood, potentially leading to disastrous outcomes. In treating hematemesis due to excess fire, regulating Qi is paramount; once Qi moves, blood naturally returns to its vessels. In treating hematemesis due to deficiency fire, nourishing righteousness is paramount; once Qi is strong, it can naturally control blood. These are the fundamental principles of treatment and must not be violated. Misuse of Zhizi will inevitably cause harm.