本经与陶隐居抱朴子皆甚言楮实之功，而方书用于补剂者，杨氏还少丹外不多见。大抵
以其物贱，而修真秘旨又言久服成骨软，与济生秘览治骨哽，遂不复重。诸家亦未有发明其
所以然者。窃思补益与软骨，并不相背，特其义殊奥耳。种楮必杂以麻，冬则赖麻作暖，春
又烧麻以肥楮，三年即成大树，而枝叶皆有白汁，皮可为纸可为布，实则色深红而煎之如饴。
夫
最为切合。若肾中阳虚而阴有余，阴虚而阳易升，与阴阳并虚之证，皆非所宜。此本经主阴
痿之旨也。夫补阴而又能伸阳者，其所补之阴，未始不随阳以俱伸，与纯阴填补有别。水肿
者，阴不与阳化而水聚也。肌肤不充者，阳不得阴济而气乏也。目不明者，阴不升而阳无光
也。本经所胪，楮实皆足以任之。然则其能软骨何故？骨属肾，甘能损肾。肾伤于湿者，腰
脚为之酸软，湿亦阴也。楮实甘寒益阴而不能益阳，久服骨何能不软。此审证制剂之不善，
于楮实夫何尤。识此义而用于喉痹骨哽，则正见其功。至吴廷绍治烈祖食饴而噎，以楮实具
阴体而得阳用，足释少阴壅蔽之气，又以甘导甘，宜其效矣。惟大明谓壮筋骨，则似是实非，
不免于误人尔。
别录枳实破结实，消胀满。是其满为坚满，破结实即下宿食之谓，似不如浓朴之散湿满，
兼可治上矣。然枳实气药而味苦酸，胸胁之坚满，亦其所司。故别录于胸胁曰除痰癖，不曰
除痰饮。水者柔物亦动物。然水至于停，则与肠胃之水谷相比为奸，而非可以渗之利之者。
故别录于除胸胁痰癖下，又继之以逐停水而不隶于胸胁。盖即坚满之在肠胃，有需于枳实者
矣。大小承气汤与枳实薤白桂枝汤用枳实之义，已详浓朴不赘。
更以别录心下急痞痛逆气胁风痛绎之。夫泻心诸汤治心痞，大小陷胸治结胸，枳实宜可
用矣，而皆不抡入，曷故？盖痞为虚邪，宜轻散不宜实攻；结胸虽属实邪，而涤热泄水别有
专药；小陷胸则与泻心不殊，但以连夏泻心，加栝蒌降痰浊而已得，皆无俟枳实代筹。枳实
所司维何？曰∶胸痹与结胸，皆按之而痛，其所以异者，一则为热结，而一则为阳微也。虽
然，枳实不气向下乎，气向下则胸膈非停驻之所；非寒药乎，寒药则于阳微有妨。不知仲圣
有因材而使之妙焉。橘枳生姜汤，以橘姜化气于上，枳实从而泄之。桂枝生姜枳实汤，以桂
姜化气于上，枳实从而泄之。要非气塞与悬痛有坚满可泄，亦不用枳实。方名不以冠首者，
以枳实为佐理也。大柴胡汤，柴胡芩夏能治胸满，不能治心中痞硬、心下满痛，得枳实则痛
硬除，以枳实能泄坚满也。按全方为表里兼治之剂，大黄枳实芍药，所以攻里，柴胡芩夏姜
枣，所以解表。生姜加多，又使与枳实化心中之痞硬，即橘枳生姜汤治胸痹之法。是枳实于
诸药皆与有功，而方名顾不之及者何也？抑知其往来寒热之为少阳病乎，柴胡乃少阳主药，
且能去肠胃中结气，自当推以冠军；曰大者，以非小柴胡之常法也。枳术汤，以白术消水饮，
枳实泄心下坚大，枳实气向下，而以味甘而浓之白术载之使不速下，既回翔于心，遂渐及于
腹，至腹 而收功，此以枳实治心下之又一法也。别录所言，殆亦由仲圣诸方 绎而得之者
欤。
《神农本草经》与陶弘景的《抱朴子》都极力推崇楮实子的功效，但在方书中将其用于补益剂的场合，除了杨氏还少丹之外并不多见。大抵是因为它物产廉价，而且修真秘旨中说长期服用会使骨骼变软，以及济生秘览中用其治疗骨哽，所以不再被重视。各家也没有阐明其中的原因。我私下思考，补益与使骨变软并不矛盾，只是其中的道理非常深奥罢了。种植楮树必须混杂种植麻，冬天依靠麻来保暖，春天又烧掉麻来肥沃楮树，三年就能长成大树，枝叶都有白色汁液，树皮可以造纸也可以织布，果实颜色深红，煎煮后像饴糖一样粘稠。这（指其甘寒滋腻之性）最为切合。如果是肾中阳虚而阴气有余，或者阴虚而阳气容易上升，以及阴阳俱虚的证候，都不适宜使用。这正是《本经》主治阳痿的宗旨所在。凡是既能补阴又能助阳的药物，其所补之阴，未尝不随着阳气一同伸展，这与纯阴填补的药物不同。水肿病，是阴气不能与阳气化合而导致水液停聚；肌肤不丰满，是阳气得不到阴气的资助而气力匮乏；眼睛不明亮，是阴气不能上升而阳气没有光泽。《本经》所列举的这些病症，楮实子都足以胜任。那么它为什么能让人骨头变软呢？骨属于肾，甘味药能损伤肾气。肾脏被湿邪所伤，腰脚就会酸软，湿也属于阴。楮实子甘寒能滋阴但不能助阳，长期服用骨头怎么能不变软。这是辨证用药不当，对楮实子有什么责备的呢？认识到这个道理并用于喉痹和骨哽的治疗，就能看到它的功效。至于吴廷绍治疗烈祖吃饴糖导致噎食，认为楮实子具备阴体而获得阳用，能够解除少阴经壅蔽的气机，又以甘味引导甘味，所以疗效显著。只有李时珍《本草纲目》引大明之说称其能壮筋骨，这似是而非，不免误导人罢了。
《名医别录》记载枳实能破除结实，消除胀满。这里的“满”是指坚硬的胀满，“破结实”就是指下宿食的意思，似乎不如厚朴那样能疏散湿气引起的胀满，且厚朴兼可治疗上部病症。然而枳实是行气药，味道苦酸，胸胁部位的坚硬胀满也是它所主管的。所以《别录》在提到胸胁时说“去除痰癖”，而不说“去除痰饮”。水是柔性的物体，也是流动的物质。但是水一旦停滞，就会与肠胃中的水谷相互勾结作乱，而不是可以通过渗湿利水的方法治疗的。所以《别录》在“去除胸胁痰癖”之后，紧接着说“驱逐停积之水”，且不将其归属于胸胁部位。这大概就是指肠胃中需要枳实来处理的坚硬胀满了。大小承气汤与枳实薤白桂枝汤中使用枳实的意义，已经在论述厚朴时详细说明，此处不再赘述。
再结合《别录》中关于心下急迫痞痛、逆气、胁风痛的描述来推演。那些泻心汤类药物治疗心痞，大小陷胸汤治疗结胸，枳实似乎都可以使用，但都没有入选，为什么呢？因为痞证属于虚邪，宜于轻散而不宜于实攻；结胸虽然属实邪，但清热泄水另有专用药物；小陷胸汤与泻心汤没有太大区别，只是用黄连、半夏配合泻心，加上瓜蒌来降化痰浊而已，都已经足够，无需枳实来筹划。枳实所主管的是什么？我说：胸痹与结胸，按压时都会疼痛，它们的不同之处在于，一个是热结，一个是阳气微弱。虽然如此，枳实不是具有向下行的气吗？气向下行则胸膈就不是停留驻守的地方；它不是寒性药吗？寒性药则会妨碍阳气微弱的情况。不知道仲景有因材施用的妙处啊。橘枳生姜汤，用橘皮、生姜在上部化气，枳实随之疏导下行。桂枝生姜枳实汤，用桂枝、生姜在上部化气，枳实随之疏导下行。如果不是气塞与悬痛有坚硬胀满可以疏导，也不会使用枳实。方名不以枳实冠首的原因，是因为枳实作为佐使药。大柴胡汤中，柴胡、黄芩、半夏能治疗胸满，但不能治疗心中痞硬、心下满痛，加入枳实后痛硬就消除了，因为枳实能疏导坚硬胀满。按全方来看，这是一张表里兼治的药剂，大黄、枳实、芍药用来攻里，柴胡、黄芩、半夏、生姜、大枣用来解表。生姜加多，又使得它与枳实化解心中的痞硬，这就是橘枳生姜汤治疗胸痹的方法。这样看来，枳实在诸药中都有功劳，但方名却不提及它，为什么呢？或许知道往来寒热属于少阳病，柴胡乃是少阳经的主药，且能去除肠胃中的结气，自然应当推举它为君药；称为“大”者，是因为这不是小柴胡汤的常规用法。枳术汤中，用白术消除水饮，枳实泄去心下的坚硬胀大，枳实行气向下，但凭借味甘厚重的白术承载它使其不迅速下行，先在心脏周围回旋，逐渐波及腹部，到了腹部才收功，这是用枳实治疗心下病的另一种方法。《别录》所说的内容，大概也是由仲景的这些方剂推演得来的吧。
Shen Nong Ben Cao Jing (Divine Farmer's Materia Medica) and Tao Hongjing's Baopuzi both highly praise the efficacy of Broussonetia papyrifera fruit (Chushi, 楮实子). However, in prescription books, its use in tonifying formulas is rarely seen outside of Yang Shi's Huan Shao Dan (Restore Youth Pill). This is largely because it is inexpensive, and Daoist cultivation texts state that long-term consumption softens bones, while Jisheng Milan treats bone obstruction with it, leading to its neglect. No one has elucidated the reason behind this. I ponder that tonification and bone softening are not contradictory; the principle is simply profound. When planting paper mulberry, hemp must be interplanted. In winter, hemp provides warmth; in spring, burning hemp fertilizes the mulberry. Within three years, it grows into a large tree with white latex in branches and leaves, bark usable for paper and cloth, and deep red fruits that become sticky like maltose when decocted. This property aligns perfectly with certain conditions. However, for patterns of Kidney Yang deficiency with excess Yin, Yin deficiency with easy rising of Yang, or simultaneous deficiency of both Yin and Yang, it is unsuitable. This is the essence of Shen Nong Ben Cao Jing stating it treats impotence. A herb that tonifies Yin and extends Yang ensures that the tonified Yin rises with Yang, differing from pure Yin-filling herbs. Edema occurs when Yin fails to transform with Yang, causing water accumulation. Emaciated skin and muscles result from Yang lacking Yin support, leading to Qi deficiency. Blurred vision stems from Yin failing to ascend, leaving Yang without luster. The symptoms listed in Shen Nong Ben Cao Jing can all be addressed by Chushi. Then why does it soften bones? Bones belong to the Kidney; sweet flavors can damage the Kidney. When the Kidney is injured by Dampness, the waist and legs become sore and weak; Dampness is also Yin. Chushi is sweet and cold, nourishing Yin but not assisting Yang. Long-term use inevitably softens bones. This is due to improper syndrome differentiation and prescription formulation; what blame can be placed on Chushi? Understanding this principle allows its correct use for throat bi and bone obstruction, revealing its true merit. Wu Tingshao treated Emperor Liezu’s choking on maltose by using Chushi, which possesses Yin substance but Yang function, releasing the obstructed Qi of Shaoyin, and using sweet to guide sweet, hence its efficacy. Only Li Shizhen’s citation of Da Ming claiming it strengthens sinews and bones is misleading.
Mingyi Bielu records that Zhi Shi (Immature Bitter Orange) breaks solid accumulations and reduces distension. Here, "distension" refers to hard fullness; "breaking solid accumulation" implies purging retained food, seemingly less effective than Hou Po (Magnolia Bark) in dispersing Dampness-related distension, whereas Hou Po also treats upper jiao issues. However, Zhi Shi is an Qi-moving herb with bitter and sour flavors, governing hard distension in the chest and hypochondrium. Thus, Mingyi Bielu specifies "removing phlegm-pi" rather than "phlegm-fluid" for the chest/hypochondrium. Water is soft and mobile. But when stagnant, it colludes with food and fluids in the intestines and stomach, resisting simple diuresis. Hence, after mentioning removing chest/hypochondrial phlegm-pi, Mingyi Bielu adds "driving away stagnant water," not limited to the chest/hypochondrium. This likely refers to hard fullness in the intestines/stomach requiring Zhi Shi. The rationale for using Zhi Shi in Da Cheng Qi Tang and Xiao Cheng Qi Tang, as well as Zhi Shi Xie Bai Gui Zhi Tang, was detailed under Hou Po and will not be repeated.
Considering Mingyi Bielu’s mention of urgent epigastric pain, rebellious Qi, and wind-pain in the hypochondrium: Xiexin Decoctions treat Xin Pi (epigastric stuffiness), Da/Xiao Xianxiong Tang treat Jie Xiong (chest binding); Zhi Shi seems applicable but is excluded. Why? Pi is a deficient pathogen, suitable for mild dispersion, not aggressive attack. Jie Xiong is an excess pathogen, but clearing heat and draining water has specific herbs. Xiao Xianxiong Tang differs little from Xiexin formulas, merely adding Gua Lou (Trichosanthes Fruit) to descend turbid phlegm alongside Lian Ban Xia (Coptis and Pinellia); thus, Zhi Shi is unnecessary. What does Zhi Shi govern? Chest Bi and Jie Xiong both present with tenderness on pressure. The difference lies in one being Heat binding and the other Yang deficiency. Although Zhi Shi directs Qi downward (making the chest an unlikely site for retention) and is cold (potentially harming deficient Yang), Zhang Zhongjing employs it skillfully according to material properties. Ju Zhi Sheng Jiang Tang uses Tangerine Peel and Ginger to transform Qi upward, with Zhi Shi following to drain downward. Gui Zhi Sheng Jiang Zhi Shi Tang uses Cinnamon Twig and Ginger to transform Qi upward, with Zhi Shi following to drain. It is only used when Qi stagnation or hanging pain presents with hard fullness to drain. It is not named first because it serves as an assistant herb. In Da Chai Hu Tang, Chai Hu, Huang Qin, and Ban Xia treat chest fullness but cannot resolve epigastric hardness/pain; adding Zhi Shi resolves this because it drains hard fullness. The formula treats both exterior and interior: Da Huang, Zhi Shi, and Bai Shao attack the interior; Chai Hu, Huang Qin, Ban Xia, Sheng Jiang, and Da Zao release the exterior. Increased Sheng Jiang helps Zhi Shi resolve epigastric hardness, mirroring Ju Zhi Sheng Jiang Tang’s method for Chest Bi. Thus, Zhi Shi contributes significantly, yet is omitted from the name. Perhaps recognizing alternating chills and fever as Shaoyang disease, Chai Hu is the chief herb for Shaoyang, resolving Qi knots in the gut, justifying its leadership; "Da" indicates deviation from Xiao Chai Hu Tang’s standard method. In Zhi Zhu Tang, Bai Zhu eliminates fluid retention, while Zhi Shi drains hard fullness below the heart. Zhi Shi’s downward Qi is carried by sweet, heavy Bai Zhu to prevent rapid descent, lingering around the heart before reaching the abdomen, where it takes effect. This is another method of using Zhi Shi for subcardiac issues. Mingyi Bielu’s descriptions likely derive from deducing Zhang Zhongjing’s formulas.