〔害〕辛温,走而不守,经事先期,虚而崩漏,产后虚运,均忌之。
〔利〕辛苦而温,入心包、肺、脾、肝,能行血中气滞,气中血滞,调经脉,利产后暴
血上
冲,折伤积血,疗疝舒筋,理通身诸痛,止肠痛心疼,为活血利气之药也。
〔修治〕立夏掘取,今多出浙江笕桥。根如半夏,黄色而坚。产东阳者,粒头细,生用
破血
,炒用调血,酒炒行血,醋炒止血。
〔害〕柴胡为阴,必阴气不舒,致阳气不达者,乃为恰对。若阴已虚者,阳方无倚而欲
越,
更用升阳发散,是速其毙矣。故凡元气下脱,病属虚,而气升者,忌之。呕吐及阴虚发热
,火炽炎上,不因血凝气阻为寒热者,近此正如砒鸩之毒也。疟非少阳经者勿用。治疟必用
柴胡,其说误解。恶皂角,畏女菀、藜芦。
〔利〕苦微寒,入肝、胆、三焦、心包四经,为少阳表药,故治疟发表和里退热,主清
阳上
行;解郁调经,宣畅气血,主阳气下陷。治上焦肝气,前胡半夏为使;行三焦胆经,黄芩为
佐;行心包肝经,黄连为佐。
〔修治〕二月八月采得,去须及头,用铜刀削去赤薄皮少许,以粗布拭净,切用。勿令
犯火
,立使无效也。酒炒则升,蜜炒则和。按柴胡有二种∶色白黄而大者,为银胡,以劳疟骨蒸
虚劳疳热;色微黑者,以解表发散。本经无分别,但用银州者为最,则知其优于升散,而非
除虚热之药明矣,衍义所载甚详,故表而分之。
〔附录一〕
李中梓云∶柴胡,少阳经半表半里之药。病在太阳者,服之太早,则引贼入门;病在阴
经者
,复用柴胡,则重伤其表。世俗不知柴胡之用,每遇伤寒传经未明,以柴胡汤为不汗不吐不
下,可以藏拙,辄混用之,杀人不可胜数矣。劳证惟在肝经者用之。若气虚者不过些小助参
,非用柴胡退热也。若遇劳证,便用柴胡,不死安待。惟此一味,贻祸极多,表而出之。
〔附录二〕
温病忌用柴胡论(山阳丁寿昌撰)温病四时皆有而春令尤甚。经云∶冬伤于寒春必病温。
凡冬
令受寒,即时发者为伤寒;不即时发,留连于经络,至春则寒化为热而为病温。伤寒者,伤
于寒也,是为阴伤阳,当助其阳,治以辛温。温病者,伤于温也。是为阳伤阴,当救其阴,
治以甘寒。凡温病初起或外感风寒,如荆防薄杏之类不妨少用,而佐以甘寒之品,清热养阴
。外感本轻,而身热不退、或初起脉洪、口中作渴,则是温病而非伤寒。一切辛温解表之药
,皆不可用。轻者用桑菊饮,重者用银翘散,温病夹有斑疹者用犀角地黄汤,口渴脉洪壮热
日甚者用白虎汤,脉虚者加人参,舌有芒刺、身热脉沉、神昏谵语、六七日不大解者用大小
调胃承气汤。视人之强弱,病之缓急,酌量用之。此在淮阴吴鞠通先生所撰《温病条辨》中
言之最悉。医家但留心此书,按症服药,自无差谬。《温病条辨》中力戒温病不可用辛温发
表,而柴胡为尤甚,何也?柴胡入足少阳,为发表升阳之剂。温病初起,在太阳,而本病则
在阳明,用柴胡则引入少阳,谓之诛伐无过。且当春少阳司令之际,人多病温。温病者,阳
伤
阴也。当救其阴,而反以柴胡升少阳之气,益助其阳,阳火上腾,则阴水下涸。是以柴胡下
咽,则大汗神昏,遂成不治之症。汗者阴液。汗能亡阳,亦能亡阴。无汗而强发其汗,伤阴
而重亡其阴。温病用柴胡,杀人不旋踵。余目击心伤,因撰此论以示人。惟愿留心斯道者,
不吝改过。普发慈心,少用一剂柴胡即多活一人性命。即不得已而用表散,柴胡之外,药品
尚多,治以辛凉,佐以甘寒,庶不至重伤其阴,致变他症。有病之家,亦宜慎重。凡药用柴
胡及辛温发表重剂,皆弃而不用,亦保安性命之一道也。
〔附录三〕
案∶柴胡之有副作用,与不同品种之有毒性,近年来屡有报道。如《煤矿医学》(3-4)
25,
1980,载柴胡注射液过敏回应报告。《中华内科杂志》(812)130-1979,药
物不良回应的综
合报道中,亦载柴胡注射液之毒性回应。又如《黑龙江医药》15:48,1978,谈到
大叶柴胡
有毒,曾引起死亡事故。黑龙江祖国医学研究所,曾有大叶柴胡毒性之探讨,记载有三例因
严重中毒而死亡。特附录于此,提起有关方面注意。
【危害】柴胡性味辛温,其气走窜而不能固守。对于月经提前来潮、因虚损导致的崩漏(非正常大量阴道出血),以及产后气血虚弱引起的头晕目眩者,均禁止使用。
【功效】柴胡味辛苦而性温,归心包经、肺经、脾经、肝经。它能疏通血中的气滞和气中的血滞,调理经脉,治疗产后突然发生的血上冲逆,消散跌打损伤留下的积血,治疗疝气并舒缓筋脉,调理全身各种疼痛,停止肠道疼痛和心痛,是一味具有活血行气作用的药物。
【炮制与采集】立夏时节挖掘根部,现在大多产自浙江笕桥。根状如半夏,颜色黄且质地坚硬。产自东阳的柴胡,颗粒细小。生用可破血,炒用可调血,酒炒可行血,醋炒可止血。
【危害】柴胡属于阴药,只有当阴气不舒畅,导致阳气不能通达时,使用才恰如其分。如果阴液已经亏虚,阳气正失去依附而欲外越,此时再用升阳发散的药物,是加速其死亡的做法。因此,凡是元气下脱、病属虚证且气机上逆者,禁用柴胡。呕吐及阴虚发热、火气炽盛炎上,并非因血凝气阻引起的寒热往来者,误用此药如同服用砒霜或鸩毒般危险。疟疾若不属于少阳经病症者,勿用柴胡。认为治疟必用柴胡的说法是对经典的误解。柴胡恶皂角,畏女菀、藜芦。
【功效】柴胡味苦微寒,入肝、胆、三焦、心包四经,为少阳经解表药,故能治疗疟疾,发表和解里以退热,主要引导清阳上行;能解郁结、调经血,宣畅气血,主治阳气下陷。治疗上焦肝气郁结,以前胡、半夏为使药;作用于三焦胆经,以黄芩为佐药;作用于心包肝经,以黄连为佐药。
【炮制与采集】二月和八月采收,去除须根和头部,用铜刀削去少许红色薄皮,用粗布擦拭干净后切片使用。切勿让柴胡接触火烤,否则会立即失效。酒炒则药力上升,蜜炒则药性缓和。据观察,柴胡有两种:颜色白黄且个头大的,称为银胡,用于治疗劳疟、骨蒸、虚劳、疳积发热;颜色微黑的,用于解表发散。《神农本草经》中未加区分,但指出使用银州产的柴胡最为上乘,可知其优势在于升散,而非清除虚热的药物,这一点在《本草衍义》中记载得很详细,故在此列出并加以区分。
【附录一】
李中梓说:柴胡是少阳经半表半里的药物。病在太阳经时,过早服用柴胡,会将邪气引入体内;病在阴经时,再用柴胡,则会严重损伤体表正气。世俗之人不懂柴胡的用途,每当伤寒传经情况不明时,认为柴胡汤既不发汗、也不催吐、更不泻下,可以掩盖自己的无知,于是胡乱使用,导致杀人无数。虚劳证只有在病在肝经时才使用柴胡。如果是气虚患者,仅少量辅助人参使用,并非用柴胡来退热。如果遇到虚劳证就使用柴胡,不死还等什么?唯独这一味药,造成的祸害极多,特此列出以示警。
【附录二】
论温病忌用柴胡(山阳丁寿昌撰写):温病四季都有,但春季尤为严重。经典云:“冬季感受寒邪,春季必定发生温病。”凡是冬季受寒,立即发病的为伤寒;若不立即发病,邪气留连于经络,到了春天寒邪化为热邪而发病的,称为温病。伤寒,是伤于寒邪,这是阴伤阳,应当扶助阳气,用辛温药物治疗。温病,是伤于温邪,这是阳伤阴,应当救阴液,用甘寒药物治疗。凡温病初起或兼有外感风寒,如荆芥、防风、薄荷、杏仁等药物不妨少量使用,但要配合甘寒之品,清热养阴。如果外感症状本来轻微,但身热不退,或者初起时脉象洪大、口中作渴,则是温病而不是伤寒。一切辛温解表的药物,都不可使用。轻症用桑菊饮,重症用银翘散,温病夹杂斑疹的用犀角地黄汤,口渴脉洪大、壮热日渐加重的用白虎汤,脉虚者加人参,舌有芒刺、身热脉沉、神志昏迷胡言乱语、六七天不大便的用大小调胃承气汤。根据人的强弱、病的缓急,酌情使用。这在淮阴吴鞠通先生撰写的《温病条辨》中阐述得最详尽。医家只要留心这本书,按症状服药,自然没有差错。《温病条辨》中极力告诫温病不可用辛温发汗解表,其中对柴胡的禁忌尤为严格,为什么呢?柴胡入足少阳经,是发表升阳的药剂。温病初起,病位在太阳经,而本病实质在阳明经,使用柴胡则是将病邪引入少阳经,这叫做“诛伐无过”(攻打没有过错的地方)。况且正值春季少阳主令之时,人多患温病。温病是阳伤阴,应当救阴,反而用柴胡提升少阳之气,更加助长阳气,阳火上腾,则阴水下涸。因此,柴胡一下咽,就会导致大汗淋漓、神志昏迷,最终成为不治之症。汗是阴液。出汗既能亡阳,也能亡阴。无汗而强行发汗,会损伤阴液并再次耗竭阴液。温病使用柴胡,杀人就在眨眼之间。我亲眼目睹,心中悲伤,因此撰写这篇论述以警示世人。希望从事医学的人,不惜改正错误。普遍发出慈悲之心,少用一剂柴胡就能多救活一条性命。即使不得已要用解表散邪药,除了柴胡之外,药品还有很多,治疗应以辛凉为主,辅以甘寒,这样才不至于重伤阴液,导致变生他症。患病家庭,也应慎重。凡是药用柴胡及辛温解表重剂的,都应弃而不用,这也是保全性命的方法之一。
【附录三】
案语:柴胡的副作用,以及不同品种柴胡的毒性,近年来屡有报道。如《煤矿医学》(3-4)25页,1980年,载有柴胡注射液过敏反应报告。《中华内科杂志》(8/12)130页,1979年,药物不良反应的综合报道中,也载有柴胡注射液的毒性反应。又如《黑龙江医药》15:48,1978年,提到大叶柴胡有毒,曾引起死亡事故。黑龙江祖国医学研究所,曾有大叶柴胡毒性的探讨,记载有三例因严重中毒而死亡。特附录于此,提请有关方面注意。
[Harm] Chai Hu (Bupleuri Radix) is acrid and warm in nature. Its qi moves freely but does not stay fixed. It is contraindicated for women with premature menstruation, those suffering from metrorrhagia due to deficiency, and postpartum dizziness caused by deficiency of Qi and Blood.
[Benefits] Chai Hu (Bupleuri Radix) is acrid, bitter, and warm. It enters the Pericardium Meridian of Hand-Jueyin, Lung Meridian of Hand-Taiyin, Spleen Meridian of Foot-Taiyin, and Liver Meridian of Foot-Jueyin. It can move Qi stagnation in Blood and Blood stagnation in Qi, regulate the menses, treat sudden upward rushing of Blood after childbirth, resolve accumulated Blood from traumatic injuries, treat hernia and relax sinews, relieve various pains throughout the body, stop intestinal pain and heart pain. It is a herb that invigorates Blood and promotes the movement of Qi.
[Processing and Collection] The roots are dug up at the Start of Summer. Currently, they are mostly produced in Jianqiao, Zhejiang. The roots resemble Ban Xia (Pinelliae Rhizoma), are yellow in color and hard in texture. Those produced in Dongyang have small granules. Raw use breaks Blood; stir-fried use regulates Blood; wine-stir-fried use promotes Blood circulation; vinegar-stir-fried use stops bleeding.
[Harm] Chai Hu (Bupleuri Radix) belongs to Yin. It is appropriate only when Yin Qi is not free-flowing, causing Yang Qi to be unable to reach its destination. If Yin fluid is already deficient, and Yang Qi is losing its anchor and attempting to escape, using ascending and dispersing herbs like Chai Hu (Bupleuri Radix) will hasten death. Therefore, it is contraindicated for conditions involving the collapse of Yuan Qi (Original Qi), deficiency patterns, and upward reversal of Qi. It is also contraindicated for vomiting, fever due to Yin deficiency, blazing Fire rising upward, and chills and fever not caused by Blood stasis and Qi obstruction. Misusing this herb in such cases is as dangerous as consuming arsenic or poison. Do not use Chai Hu (Bupleuri Radix) for malaria that does not belong to the Shaoyang Meridian. The belief that Chai Hu (Bupleuri Radix) must be used to treat malaria is a misunderstanding of the classics. Chai Hu (Bupleuri Radix) is antagonistic to Zao Jiao (Gleditsiae Fructus Spina) and fears Nu Wan (Stemonae Radix) and Li Lu (Veratri Radix).
[Benefits] Chai Hu (Bupleuri Radix) is bitter and slightly cold. It enters the Liver, Gallbladder, Sanjiao (Triple Burner), and Pericardium meridians. As a exterior-releasing herb for the Shaoyang stage, it treats malaria by releasing the exterior, harmonizing the interior, and reducing fever. It primarily guides Clear Yang upwards; resolves depression, regulates menstruation, and unblocks Qi and Blood; and treats sinking of Yang Qi. For treating Liver Qi stagnation in the Upper Jiao, Qian Hu (Peucedani Radix) and Ban Xia (Pinelliae Rhizoma) serve as guiding herbs. For acting on the Sanjiao and Gallbladder meridians, Huang Qin (Scutellariae Radix) serves as an assistant herb. For acting on the Pericardium and Liver meridians, Huang Lian (Coptidis Rhizoma) serves as an assistant herb.
[Processing and Collection] Harvest in February and August. Remove the rhizome head and rootlets. Use a copper knife to peel off a small amount of the reddish thin skin. Wipe clean with coarse cloth and slice. Do not expose to fire, as this will immediately render it ineffective. Wine-processing enhances its ascending action; honey-processing moderates its properties. There are two types of Chai Hu (Bupleuri Radix): those that are white-yellow and large are called Yin Hu (Silver Bupleurum), used for labor-related malaria, bone-steaming fever, consumptive disease, and infantile malnutrition fever; those that are slightly black are used for releasing the exterior and dispersing pathogens. The *Shennong Bencao Jing* did not distinguish between them, but stated that Chai Hu (Bupleuri Radix) from Yinzhou is superior, indicating its strength lies in ascending and dispersing, rather than clearing deficiency heat. This is detailed in *Bencao Yan Yi* (Extension of Materia Medica), so I list and differentiate them here.
[Appendix 1]
Li Zhongzi said: Chai Hu (Bupleuri Radix) is a herb for the half-exterior, half-interior stage of the Shaoyang Meridian. If the disease is in the Taiyang Meridian, taking it too early will lead the pathogen into the interior. If the disease is in the Yin meridians, using Chai Hu (Bupleuri Radix) will severely damage the exterior Zheng Qi (Upright Qi). Laypeople do not understand the use of Chai Hu (Bupleuri Radix). Whenever the transmission of Cold Damage is unclear, they assume Chai Hu Tang (Bupleurum Decoction) neither induces sweating, nor causes vomiting, nor purges, allowing them to hide their ignorance. They mix it indiscriminately, killing countless people. Chai Hu (Bupleuri Radix) should only be used for consumptive diseases located in the Liver Meridian. For Qi deficiency, it is used only in small amounts to assist Ren Shen (Ginseng Radix et Rhizoma), not to reduce fever. Using Chai Hu (Bupleuri Radix) for any consumptive disease invites death. This single herb has caused immense harm; I list it here as a warning.
[Appendix 2]
On the Contraindication of Chai Hu (Bupleuri Radix) in Warm Diseases (Written by Ding Shouchang of Shanyang): Warm diseases occur in all seasons but are most severe in Spring. The Classics state: "Cold injured in Winter leads to Warm Disease in Spring." Cold contracted in Winter that manifests immediately is Cold Damage (Shang Han); if it does not manifest immediately but lingers in the meridians and transforms into Heat by Spring, it becomes a Warm Disease (Wen Bing). Cold Damage is injury by Cold (Yin injuring Yang), requiring assistance to Yang with Acrid-Warm herbs. Warm Disease is injury by Warmth (Yang injuring Yin), requiring preservation of Yin with Sweet-Cold herbs. In the early stage of Warm Disease, or if accompanied by external Wind-Cold, herbs like Jing Jie (Schizonepetae Herba), Fang Feng (Saposhnikoviae Radix), Bo He (Menthae Haplocalycis Herba), and Xing Ren (Armeniacae Semen Amarum) may be used sparingly, combined with Sweet-Cold herbs to clear Heat and nourish Yin. If external symptoms are mild but fever persists, or if the pulse is surging and thirst is present at onset, it is a Warm Disease, not Cold Damage. All Acrid-Warm exterior-releasing herbs are contraindicated. Mild cases use Sang Ju Yin (Mulberry Leaf and Chrysanthemum Decoction); severe cases use Yin Qiao San (Honeysuckle and Forsythia Powder); Warm Disease with macules and papules uses Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction); thirst, surging pulse, high fever worsening daily uses Bai Hu Tang (White Tiger Decoction), adding Ren Shen (Ginseng Radix et Rhizoma) if the pulse is empty; tongue with prickles, deep pulse despite fever, coma and delirium, no bowel movement for six to seven days uses Da or Xiao Tiao Wei Cheng Qi Tang (Major or Minor Regulate the Stomach and Order the Qi Decoction). Use according to the patient's strength and the urgency of the disease. This is elaborated in Wu Jutong's *Wen Bing Tiao Bian* (Systematic Differentiation of Warm Diseases). Physicians who study this book and prescribe according to symptoms will avoid errors. *Wen Bing Tiao Bian* strongly warns against using Acrid-Warm exterior-releasing herbs for Warm Diseases, especially Chai Hu (Bupleuri Radix). Why? Chai Hu (Bupleuri Radix) enters the Foot Shaoyang Gallbladder Meridian and is an exterior-releasing, Yang-ascending agent. In early Warm Disease, the pathogen is in the Taiyang, but the root pathology is in the Yangming. Using Chai Hu (Bupleuri Radix) introduces the pathogen into the Shaoyang, which is termed "punishing the innocent." Furthermore, during Spring when Shaoyang governs, many suffer from Warm Disease. Warm Disease injures Yin; one should preserve Yin, but Chai Hu (Bupleuri Radix) ascends Shaoyang Qi, further aiding Yang. Rising Yang Fire dries up Yin Water. Thus, upon swallowing Chai Hu (Bupleuri Radix), profuse sweating and coma ensue, becoming incurable. Sweat is Yin fluid. Sweating can cause loss of Yang or loss of Yin. Forcing sweat when none exists damages and depletes Yin. Using Chai Hu (Bupleuri Radix) in Warm Disease kills swiftly. I witnessed this with sorrow and wrote this treatise to warn others. May practitioners correct their mistakes. Show compassion: using one less dose of Chai Hu (Bupleuri Radix) saves one life. Even if exterior release is necessary, there are many herbs other than Chai Hu (Bupleuri Radix). Treat with Acrid-Cool herbs assisted by Sweet-Cold herbs to avoid damaging Yin and causing complications. Patients' families should also be cautious. Discarding Chai Hu (Bupleuri Radix) and heavy Acrid-Warm exterior-releasing formulas is a way to ensure survival.
[Appendix 3]
Case Note: Side effects of Chai Hu (Bupleuri Radix) and toxicity associated with different varieties have been reported frequently in recent years. For example, *Coal Mine Medicine* (3-4) p.25, 1980, reports allergic reactions to Chai Hu (Bupleuri Radix) injection. *Chinese Journal of Internal Medicine* (8/12) p.130, 1979, includes adverse drug reactions to Chai Hu (Bupleuri Radix) injection in a comprehensive report. Additionally, *Heilongjiang Medicine* 15:48, 1978, mentions that Da Ye Chai Hu (Bupleuri Radix Macrophyllum) is toxic and has caused deaths. The Heilongjiang Institute of Traditional Chinese Medicine investigated the toxicity of Da Ye Chai Hu (Bupleuri Radix Macrophyllum), recording three deaths from severe poisoning. This is appended here to draw attention from relevant authorities.