通，行水
苦泄滞，淡利窍，甘助阳。入膀胱、肾经。升而能降，开腠发汗，利便行水，与茯苓同
而不补。
治伤寒、温疫大热，（《经疏曰∶大热利小便，亦分消之意），懊 消渴，肿胀淋浊，泻
痢疟（疟多由暑，暑必兼湿。经曰∶夏伤于暑，秋必 疟）。然耗津液，多服损肾昏目（肾
水不足则目昏。仲景五苓散，猪苓、茯苓、泽泻、白术、桂，为治水之总剂。昂按∶经曰∶
膀胱者，州都之官，津液藏焉，气化则能出矣。用肉桂辛热引入膀胱，所以化其气也。除桂
名四苓散。《资生经》曰∶五苓散能生津液，亦通大便。曾世荣治惊风，亦用五苓散。白茯
苓安心神，泽泻导小便，小肠利而心气平，木得桂而枯，能抑肝而风自止，可谓善用五苓者
矣）。
多生枫树下，块如猪屎故名（马屎曰通，猪屎曰苓。苓即屎也，古字通用）。肉白而实
者良。去皮用。
泻相火，补肾水
苦寒微辛，沉阴下降。泻膀胱相火（足太阳引经药），补肾水不足，坚肾润燥（《发明》
曰∶非真能补也。肾苦燥，急食辛以润之，肾欲坚，急食苦以坚之也，相火退而肾固，则无
狂荡之患矣。按∶肾本属水，虚则热矣；心本属火，虚则寒矣），除湿清热。
疗下焦虚，骨蒸劳热（阴虚生内热），诸痿瘫痪（热胜则伤血，血不荣筋，则软短而为
拘。湿胜则伤筋，筋不束骨，则弛长而为痿。合苍术名二妙散，清热利湿，为治痿要药。或
兼气虚、血虚、脾虚、肾虚、湿痰、死血者，当随证加治），目赤耳鸣（肾火），消渴便闭，
黄胆水肿（王善夫病便闭，腹坚如石，腿裂出水，饮食不下，治以利小便药，遍服不效。东
垣曰∶此奉养太过，膏梁积热，损伤肾水，致膀胱干涸，小便不化，火又逆上，而为呕哕，
《难经》所谓关则不得小便，格则吐逆者。《内经》所谓无阴则阳无以化也。遂处以北方大
苦寒之剂，黄柏、知母各一两，酒洗焙研，桂一钱为引，名滋肾丸，每服二百丸，未几，前
阴如刀刺火烧，溺出床下成流，肿胀遂消）。水泻热痢，痔血肠风，漏下赤白（皆湿热为病），
诸疮痛痒，头疮（研末敷之）口疮（蜜炒研含。凡口疮用凉药不效者，乃中气不足，虚火上
炎。宜用反治之法，参、术、甘草补上之虚，干姜散火之际。甚者加附子，或噙官桂，引火
归元），杀虫安蛔。久服伤胃，尺脉弱者禁用（若虚火上炎，服此苦寒之剂，有寒中之变。
时珍曰∶知母佐黄柏，滋阴降火，有金水相生之义。古云黄柏无知母，犹水母之无虾也。盖
黄柏能制命门、膀胱阴中之火，知母能清肺金、滋肾水之化源。丹溪曰∶君火者，人火也，
心火也。可以水灭，可以直折，黄连之属，可以制之。相火者，天火也，龙雷之火也。阴火
也，不可以水湿制之，当从其性而伏之，惟黄柏之属，可以降之。按∶火有虚火、实火、燥
火、湿火、郁火、相火之异。虚火宜补，实火宜泻，燥火宜滋润，郁火宜升发。湿火由湿郁
为热，多病 肿。经所谓诸腹胀大，皆属于热；诸病 肿，皆属于火是也。宜利湿清热而兼
补脾。相火寄于肝肾，乃龙雷之火，非苦寒所能胜，宜滋阴养血，壮水之主，以制阳光。又
按∶诸病之中，火证为多，有本经自病者，如忿怒生肝火，焦思生心火之类是也；有子母相
克者，如金火克肺金，肝木克脾火之类是也；有脏腑相移者，如肺火咳嗽，久则移热于大肠
而泄泻，心火烦焦，久则移热于小肠，而为淋闭之类是也。又有别经相移者，有数经合病者，
当从其重者而治之）。
川产、肉浓色深者良。生用降实火，蜜炙则不伤胃，炒黑能止崩带。酒制治上，蜜制治
中，盐制治下（又末乳调，能涂冻疮）。
【猪苓】
性味通利，能行水气。苦味能泄滞，淡味能通利窍道，甘味能助阳。归入膀胱经和肾经。其气升发但又能下降，能开发腠理、发散汗液，通利小便、行水利湿，与茯苓功效相似但不具有补益作用。
治疗伤寒、温疫引起的大热（《经疏》说：大热时利小便，也是分消邪气的意思），心中烦闷懊恼、消渴、肿胀、淋证、尿浊、泻痢、疟疾（疟疾多由暑邪引起，暑邪必然兼夹湿气。经文说：夏季损伤于暑邪，秋季必定发生疟疾）。但是会耗伤津液，多服会损伤肾脏、导致视力昏花（肾水不足则眼睛昏花。张仲景的五苓散，由猪苓、茯苓、泽泻、白术、桂枝组成，是治疗水病的总方剂。汪昂按语：经文说：膀胱是州都之官，津液藏存在这里，气化功能正常才能排出尿液。使用肉桂的辛热之性引入膀胱，所以能化气行水。去掉肉桂名为四苓散。《资生经》说：五苓散能生津液，也能通大便。曾世荣治疗惊风，也使用五苓散。白茯苓能安心神，泽泻能引导小便下行，小肠通畅则心气平和，树木遇到桂枝就会枯萎，能抑制肝风而风自止，这可以说是善于运用五苓散的人了）。
猪苓多生长在枫树下，形状像猪屎所以得名（马屎叫“通”，猪屎叫“苓”。苓就是屎的意思，古字通用）。肉质白色且质地坚实的为好。使用时需去皮。
【黄柏】
功效：泻相火，补肾水。
性味苦寒微辛，性质沉降阴寒，向下行走。能泻膀胱中的相火（足太阳膀胱经的引经药），补肾水不足，坚固肾脏、润燥（《本草发明》说：并不是真正能补。肾怕干燥，急需食用辛味来滋润它；肾想要坚固，急需食用苦味来坚固它。相火退去而肾气坚固，就没有狂乱荡越的祸患了。按语：肾本属水，虚则生热；心本属火，虚则生寒），能除湿清热。
治疗下焦虚损、骨蒸劳热（阴虚产生内热），各种痿证瘫痪（热盛则伤血，血不能滋养筋脉，则筋脉短缩而为拘挛。湿盛则伤筋，筋不能约束骨骼，则筋脉弛长而为痿软。与苍术合用名为二妙散，清热利湿，是治疗痿证的要药。如果兼有气虚、血虚、脾虚、肾虚、湿痰、瘀血等情况，应当根据证候加减治疗），目赤耳鸣（肾火所致），消渴、便秘，黄疸水肿（王善夫患病，小便不通，腹部坚硬如石头，腿部裂开流出水液，饮食无法下咽，医生用利小便的药治疗，遍服无效。李东垣说：这是奉养太过，膏粱厚味积热，损伤肾水，导致膀胱干涸，小便不能气化，火气又逆向上冲，从而出现呕吐呃逆，《难经》所说的关则不得小便，格则吐逆的情况。《内经》所说的无阴则阳无以化的情况。于是处方北方大苦寒的药物，黄柏、知母各一两，酒洗后焙干研粉，桂枝一钱作为引经药，名为滋肾丸，每次服用二百丸，不久，前阴如刀刺火烧般疼痛，尿液流出床下成流，肿胀随即消退）。水样腹泻、热痢，痔血、肠风，漏下赤白带下（都是湿热引起的疾病），各种疮疡痛痒，头疮（研末外敷），口疮（蜂蜜炒后研粉含服。凡是口疮用凉药无效的，是中气不足，虚火上炎。宜用反治法，人参、白术、甘草补上部的虚损，干姜在散火的同时使用。严重的加附子，或含服官桂，以引火归元），杀虫安蛔。久服损伤胃气，尺脉虚弱者禁用（如果虚火上炎，服用这种苦寒药物，会有中寒的变化。李时珍说：知母佐使黄柏，滋阴降火，有金水相生的意义。古语说黄柏如果没有知母，就像水母没有虾一样。因为黄柏能制约命门、膀胱阴中之火，知母能清肺金、滋肾水的化源。朱丹溪说：君火是人火，即心火。可以用水灭掉，可以直折，黄连这类药物可以制约它。相火是天火，龙雷之火，也是阴火。不可以用水湿制约，应当顺从其本性而伏藏它，只有黄柏这类药物，可以降伏它。按语：火有虚火、实火、燥火、湿火、郁火、相火的区别。虚火宜补，实火宜泻，燥火宜滋润，郁火宜升发。湿火由湿郁结化为热，多病浮肿。经文所说诸腹胀大，皆属于热；诸病浮肿，皆属于火，就是这个意思。宜利湿清热兼补脾。相火寄居于肝肾，是龙雷之火，不是苦寒所能战胜的，宜滋阴养血，壮水之主，以制阳光。又按语：在各种疾病中，火证居多，有本经自病的，如愤怒生肝火，焦思生心火之类；有子母相克的，如金火克肺金，肝木克脾火之类；有脏腑相传的，如肺火咳嗽，久了则移热于大肠而泄泻，心火烦躁，久了则移热于小肠，而为淋闭之类。又有别经相传的，有数经合病的，应当从重者而治之）。
四川产、肉质浓厚颜色深的为好。生用降实火，蜜炙则不伤胃，炒黑能止崩漏带下。酒制治上部，蜜制治中部，盐制治下部（另外研末调涂，能治疗冻疮）。
[Polygoni Multiflori Caulis (Zhuling)]
Nature and Flavor: Unblocking, promotes water metabolism. Bitter flavor drains stagnation, bland flavor opens orifices, sweet flavor assists Yang. Enters the Bladder and Kidney meridians. Ascending yet capable of descending, opens interstices and induces sweating, promotes urination and moves water. Similar to Poria Cocos (Fuling) but lacks tonifying properties.
Treats high fever caused by Cold Damage (Shanghan) and warm epidemics (Jing Shu states: Promoting urination during high fever is also a method of dispersing and eliminating pathogens), mental restlessness and regret, thirst, edema, stranguria, turbid urine, dysentery, and malaria (Malaria is often caused by summerheat, which invariably combines with dampness. The Classics state: Injury by summerheat in summer leads to malaria in autumn). However, it consumes body fluids; excessive use damages the kidneys and causes blurred vision (Insufficient Kidney Water leads to blurred vision. Zhang Zhongjing's Wuling San, composed of Polygoni Multiflori Caulis (Zhuling), Poria Cocos (Fuling), Alismatis Rhizoma (Zexie), Atractylodis Macrocephalae Rhizoma (Baizhu), and Cinnamomi Ramulus (Guizhi), is the general formula for treating water disorders. Wang Ang notes: The Classics state: The Bladder is the official of the capital, where fluids are stored; only through Qi transformation can they be excreted. Using the acrid-hot nature of Cinnamomi Cortex (Rougui) to guide into the Bladder facilitates Qi transformation. Removing Rougui yields Siling San. Zisheng Jing states: Wuling San can generate body fluids and also unblock the bowels. Zeng Shirong used Wuling San to treat convulsions. White Poria Cocos (Baifuling) calms the mind spirit; Alismatis Rhizoma (Zexie) guides urination downward. When the Small Intestine is unblocked, Heart Qi becomes peaceful. Wood withers when encountering Cinnamon Twig, suppressing Liver Wind so wind stops naturally. This exemplifies proficient use of Wuling San).
Polygoni Multiflori Caulis (Zhuling) grows mostly under maple trees; its name derives from resembling pig feces (Horse feces is called "Tong", pig feces is called "Ling". Ling means feces; these characters were interchangeable in ancient times). Those with white flesh and solid texture are superior. Use after peeling.
[Phellodendri Cortex (Huangbai)]
Efficacy: Drains Ministerial Fire, tonifies Kidney Water.
Nature and Flavor: Bitter, cold, slightly acrid; heavy, yin, descending. Drains Ministerial Fire in the Bladder (Meridian guiding herb for Foot-Taiyang), tonifies insufficient Kidney Water, consolidates the Kidneys and moistens dryness (Bencao Faming states: It does not truly tonify. The Kidney dislikes dryness, urgently needing acrid flavors to moisten it; the Kidney desires consolidation, urgently needing bitter flavors to consolidate it. When Ministerial Fire retreats and the Kidney consolidates, there is no risk of manic dissipation. Note: The Kidney belongs to Water; deficiency generates heat. The Heart belongs to Fire; deficiency generates cold), dispels dampness and clears heat.
Treats deficiency of the Lower Jiao, bone-steaming consumptive fever (Yin deficiency generates internal heat), various atrophy syndromes and paralysis (Excessive heat injures Blood; if Blood fails to nourish sinews, they become short and contracted. Excessive dampness injures sinews; if sinews fail to bind bones, they become flaccid and elongated. Combined with Atractylodis Rhizoma (Cangzhu), it forms Ermiao San, clearing heat and draining dampness, a key herb for treating atrophy. If accompanied by Qi deficiency, Blood deficiency, Spleen deficiency, Kidney deficiency, damp-phlegm, or dead blood, modifications should be made according to the syndrome), red eyes and tinnitus (Kidney Fire), thirst and constipation, jaundice and edema (Wang Shanfu suffered from urinary retention, abdomen hard as stone, legs cracking and oozing fluid, inability to eat or drink. Doctors treated with diuretics without effect. Li Dongyuan said: This results from excessive indulgence, accumulation of heat from rich food damaging Kidney Water, leading to dry Bladder, failure of urination, and rebellious fire causing vomiting. As stated in Nan Jing: Guan implies inability to urinate, Ge implies vomiting. As stated in Nei Jing: Without Yin, Yang cannot transform. He prescribed a great bitter-cold formula from the North: Huangbai and Anemarrhenae Rhizoma (Zhimu) each 1 liang, washed with wine, baked and powdered, with 1 qian of Cinnamomi Ramulus (Guizhi) as a guide, named Zishen Wan. After taking 200 pills, the anterior orifice felt like knife-stabbing and burning, urine flowed onto the bed, and swelling subsided). Watery diarrhea, hot dysentery, hemorrhoidal bleeding, intestinal wind, leukorrhea with blood and discharge (all caused by damp-heat), pain and itching of various sores, head sores (powder applied externally), mouth ulcers (honey-fried, powdered, and held in mouth. Mouth ulcers unresponsive to cooling herbs indicate insufficient Middle Qi and defluxion of deficient fire. Use counter-treatment: Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), and Glycyrrhizae Radix et Rhizoma (Gancao) tonify upper deficiency; dried ginger scatters fire. Severe cases add Aconiti Lateralis Radix Praeparata (Fuzi) or hold Cinnamomi Cortex (Guigui) to guide fire back to its source), kills parasites and calms roundworms. Long-term use damages Stomach Qi; contraindicated in weak Chi pulse (If deficient fire defluxes upward, using bitter-cold herbs may cause Middle Cold injury. Li Shizhen says: Anemarrhenae Rhizoma (Zhimu) assists Phellodendri Cortex (Huangbai) to nourish Yin and descend fire, embodying the principle of Metal generating Water. Ancient saying: Huangbai without Zhimu is like a jellyfish without a shrimp. Huangbai controls fire in the Yin of Mingmen and Bladder; Zhimu clears Lung Metal and nourishes the source of Kidney Water. Zhu Danxi says: Ruler Fire is human fire, i.e., Heart Fire. It can be extinguished by water or directly suppressed, as with Coptidis Rhizoma (Huanglian). Ministerial Fire is heavenly fire, dragon-thunder fire, also Yin fire. It cannot be controlled by water-dampness; one must follow its nature to subdue it. Only Phellodendri Cortex (Huangbai) can descend it. Note: Fires differ: deficient, excess, dry, damp, stagnant, ministerial. Deficient fire requires tonification; excess fire requires purging; dry fire requires moistening; stagnant fire requires ascending. Damp-fire arises from dampness transforming into heat, often causing edema. The Classics state: All abdominal distensions belong to heat; all edemas belong to fire. Treat by promoting dampness, clearing heat, and supplementing the Spleen. Ministerial Fire resides in Liver and Kidney, is dragon-thunder fire, unconquerable by bitter-cold; nourish Yin and Blood, strengthen the Master of Water to control Yang. Further note: Among diseases, fire syndromes are common. Some originate in their own meridian, e.g., anger generates Liver Fire, anxiety generates Heart Fire. Some involve mother-son mutual overcoming, e.g., Metal-Fire overcomes Lung Metal, Liver Wood overcomes Spleen Fire. Some transfer between organs, e.g., Lung Fire cough transfers heat to Large Intestine causing diarrhea; Heart Fire irritability transfers heat to Small Intestine causing stranguria. Some transfer between other meridians, some involve multiple meridians simultaneously. Treat according to the severity).
Produced in Sichuan; those with thick flesh and deep color are superior. Raw use descends excess fire; honey-fried use does not damage the Stomach; charred use stops metrorrhagia and leukorrhea. Wine-processing treats the Upper Jiao; honey-processing treats the Middle Jiao; salt-processing treats the Lower Jiao (Also, powder mixed with milk can be applied to frostbite).