大水面目四肢浮肿，因在内而证在外也，以苦瓠之瓤与子治之，则弃其外而取其内也。
瓤与子为一瓠之津液所储，迨其渐干渐敛，气遒力浓，炼津液为精华，以此驭人身梗化之水，
自无归命投诚，一遵约束。然则瓠其何以处之，其气味则苦寒也，性则就下也，瓠既就下，
而他有不就下者乎，此本经所由殿之以下水也。
（桑耳，木耳之生于桑者，虽有五色，今但论黑。）
桑为箕星之精，迨其朽也，经盛夏湿热之蒸腾，结而为耳。犹肾液之上朝，故色黑。具
好风之本性，故入肝。是以于血分之湿热，最能效力。血分之湿热，惟女子为易成病。漏下
赤白汁者，阴为阳迫而下泄也。血病症瘕积聚者，阴为阳遏而致壅也。阴通阴伤寒热者，阴
为阳负而思竞也。此阴之不足，非阳之有余。但当化阴以升阴，不必抑阳以损阳。桑耳性凉
润而蒸腾上出，所以能化阴以升阴也。
杏有脉络为心果，仁则主通脉络之气而为肺果。其性直降而兼横扩，横扩与直降，互相
牵制而不得逞，故非加他药不能横扩不能直降。然用杏仁于横扩，有兼取其直降者。用杏仁
于直降，有兼取其横扩者。证若两有所需，杏仁亦两呈其技也。
麻黄汤者，伤寒之汗剂也。既用麻黄何以又加杏仁，则以杏仁兼能下气止喘也。表实而
邪不得解固喘，邪解而气不得下亦喘，杏仁既走表而复入里，则外散之气，亦相与由中道而
下，是故麻杏甘石汤有麻黄又有杏仁，则为治喘，葛根汤有麻黄无杏仁，则证本无喘。然而
麻黄非不治喘，小青龙汤云，喘去麻黄加杏仁，又何以有宜不宜之别耶？盖麻黄者，上发心
液亦下通肾气，小青龙心下之水，已与肾脏之水相吸引，若再以麻黄动其肾气，喘将愈不能
止。杏仁肺药非肾药，故去彼加此，所谓用杏仁于横扩兼取其直降者此也。
大陷胸丸者，伤寒之下剂也。结胸而云项亦强如柔痉状，是项强外与大陷胸汤无异，而
证则较重。故彼可速攻而愈，此必变丸而缓攻。杏仁一味，专为项强而设。项强由阳邪烁液
所致，杏仁研之如脂而性兼横扩。再佐以芒硝之津润，白蜜之和甘，何难化强为柔。然结胸
之项强，非下不和，亦非下不陷。杏仁固大黄之功臣，葶苈甘遂之益友也，所谓用杏仁于直
降兼取其横扩者此也。
伤寒发汗，以麻黄为主，杏仁为辅；治喘以杏仁为主，麻黄为辅；故二物并用，其效始
捷。夫喘在伤寒，为表实肺郁。在杂证，则有热喘、有虚喘、有饮气喘，不止一端。小青龙
喘去麻黄加杏仁，即非治伤寒之喘，故其方亦多用于杂证。然而仲圣用药之道，但于配合异
同分数多寡之中，一为转移，便大不相侔。大青龙，伤寒最要之方也。麻杏并用，岂为治喘。
其故则在麻黄加麻黄汤一倍，杏仁减七十个为四十，又得生姜之升，石膏之寒，杏仁自随麻
黄而横扩，不致驰思于直降。推此以求，麻杏并用而非为治喘者，又得四方焉∶一曰麻黄加
术汤，湿家身烦疼，为寒湿之气郁于肌表，麻黄汤正与相宜。病由于湿，故加白术以收湿。
而中气既固，则杏仁亦只为利肺气之用而已。一曰麻黄杏仁薏苡甘草汤，伤于风湿而至发热
日晡所剧，非麻杏所能独治矣。薏苡清热去湿，治久风湿痹，故加之。但其分数，则麻黄只
用麻黄汤六中之一，杏仁七中之一，薏苡亦与麻黄相埒，此小制治上之法，杏仁所以无直降
之权也。一曰文蛤汤，此即大青龙去桂枝盖文蛤，贪饮由于热甚，故用文蛤石膏特多，麻黄
减大青龙一半者，以表邪微而不欲其过汗也。若无蛤膏之咸寒，则麻黄恐尚不用至三两。然
则用麻黄而复佐以生姜杏仁，自无不汗之理。杏仁虽兼有直降之长，制之以蛤膏，其与麻姜
比而与蛤膏远者，势固然也。一曰浓朴麻黄汤，此即小青龙加减而治亦大异，曰咳而脉浮而
不详其证，则试以本方药味测之∶干姜五味细辛，治寒咳之药也，而咳因于寒可知；麻杏与
浓朴并用，浓朴亦温散之药也，而表有寒邪宜发可知；有细辛又加半夏，则必以之蠲饮；有
五味又加小麦，则既治咳自当安肺；此必因肺痿已见一斑，故加石膏以存津而化燥，与小青
龙加石膏之意颇同。然彼为肺胀已成，故驱寒饮使下行，此为肺痿始萌，故乘脉浮之际，亟
解其表邪。桂枝芍药，所以用于彼而不用于此。浓朴用至五两，又无芍药，则杏仁又何能效
其直降之职。是为去杏仁之直降而取其横扩。
杏仁直降横扩，虽同无狠力，有借于他药，而以二者权之，直降之力，差优于横扩，故
甄权主发汗，而本经不主发汗主下气。茯苓杏仁甘草汤，注家多以杏仁为散结，愚独以为下
气。何以言之？胸痹胸中气塞短气，看似甚剧，实则较前条用枳实薤白桂枝汤为轻。此盖痰
饮为患，阳尚不虚，无取薤桂。稀饮治以是汤，胶痰则主橘枳生姜汤。稀饮而致气塞短气者，
必因小便不利而饮停于胸，胸膈或素不舒，饮停则痹。本经茯苓主胸胁逆气、心下结痛、利
小便，可知散停饮之结，茯苓实司其职。茯苓淡渗散结，是有形之饮。杏仁苦温下降，是无
形之气。二者合而痹者斯开，塞者斯通。然他方治胸痹无甘草，而此有之者，以二物皆下行，
非以甘草载之，则势不少驻而去疾不尽耳。外台走马汤，下剂也。中恶心痛腹胀大便不通，
徐忠可谓客忤，沈目南谓绞肠乌痧。按方用巴豆，自当有恶毒之邪，壅塞脏腑，须臾即毙之
势。故以巴豆逐有形之实邪，杏仁下无形之虚气，为急救之策。与茯苓杏仁甘草汤之用杏仁
，取资无异。是为去杏仁之横扩而取其直降。
有以杏仁辅麻黄发汗而可用于寒剂者。伤寒论治黄胆之方凡三∶茵陈蒿汤使湿热从小便
去，以小便不利腹微满，阳明病之宜下解者也。栀子柏皮汤身黄发热非太阳发热比，柏皮为
阳明经腑之药，故以清肌表之湿热（别录疗肌肤热赤起，邹氏谓柏皮之用正在表里之间），
而佐以栀子甘草，亦下行利小便之轻剂也。此皆于杏仁无与者。麻黄连翘赤小豆汤，云瘀热
在里，身必发黄，而无小便不利与发热等证，则其里为太阳之里（说本柯氏），太阳瘀热非
汗不解，但发表不远热，而阳黄之湿热，则非热药所宜。惟以连翘梓皮赤小豆彻热利湿，当
治里之巨任，而后麻黄杏仁散之于表，湿热得以汗解。此治太阳瘀热发黄，非治头痛发热身
疼骨痛，故麻黄杏仁，视麻黄汤减少其数，而用于寒剂，亦不以掣寒剂之肘也。
有以杏仁治肿而正取其不发汗者，水去呕止其人形肿一条（痰饮篇）。尤氏谓胃气已和
而肺壅未通，麻黄可以通之，甚是。惟于不用麻黄用杏仁之故，则疏之未当。夫麻黄发阳犹
之发汗，以血虚而不敢发汗，犹之夺血者无汗。盖形肿必通血络，麻黄与杏仁所同有是能也。
麻黄
有以杏仁治喘而不用于汗剂者，桂枝加浓朴杏仁汤，太阳病误下，无结胸下利诸变证而
但微喘，喘既微，则表实之不解者亦仅矣。桂枝汤固不解表实，以麻黄施于微实之表邪，又
岂得为当。惟浓朴温散胜于桂枝，与桂枝汤协以解表，则不至有大汗之虞。然不大汗，表固
已解，而表解而气不下，则喘犹不止。夫优于下气，而解表亦兼有所资者，杏仁是也。退麻
黄而进杏仁，殆以是夫。
杏仁研之如脂，以濡润之物而擅横扩直降之长，故于伤寒杂证皆多所资藉。麻仁丸用杏
仁，则于濡润中兼取其直降也。麻仁与杏仁，皆能润液化燥，而麻仁扩脾之约，杏仁抑肺使
下（说详大麻仁），不可谓无通便之功矣。大黄 虫丸用杏仁，则于濡润中兼取其横扩也。
是方种种治法，无非为补虚缓中之计。惟引地黄入脉络以行滋柔之化者，非杏仁而何，虽桃
仁亦只与 虫辈比烈矣。抑有但取其濡润以佐他药，而横扩与直降两无所见者，矾石丸是也。
子脏中有坚癖干血，纵以桃仁干漆 虫辈为坐药，未必遂能去之，况横扩直降，第恃有杏仁
乎。夫曰∶经水闭不利者，有闭时有不闭时，不闭时亦不如平人之利也。脏坚癖不止（医宗
金鉴∶不止，不去也）中有干血下白物者，子脏中有坚癖不可去之物，实为干血，而不能如
干血急治也。有干血，则经之蓄泄不以时，而湿热酿为白物则自下也，此当置干血而先治其
白物。矾石却湿除热，剧者不过再内而愈。然非佐杏仁白蜜以缓之和之，未必收效如是之捷。
蛇床子散亦坐药也，彼治阴寒但任蛇床子，佐白粉为以柔济刚；此治白物但任矾石，佐杏仁
为以润济燥。杏仁润而不腻，不致减矾石之力则有之，若云协以散结，岂仲圣意哉。
杏仁横扩不及麻黄之峻，而于风虚之证，却正相宜，又最宜于头面之风。洁古云治上焦
风热。东垣云除肺中风热。石顽云气下则热自解风自散。窃谓风散则热自解，并非以热药治
热风。考千金杏酥治风虚头痛，杏仁捣膏涂头面风肿，治头中痛身热风热，治头面上风，治
头中风痒白屑各方中，皆有杏仁。又薯蓣汤、薯蓣丸，亦皆有杏仁。其所治之证，皆有头目
眩冒。由是推之，即金匮薯蓣丸风药颇多，何尝不以杏仁治头面风，所谓风气百疾者，固无
一不虑之周也。
大水面目四肢浮肿，是因病邪在体内而症状表现在体表，用苦瓠的瓤和子来治疗，就是舍弃其外表而取其内部精华。
瓤与子是葫芦这一植物所储存的津液所在，等到它们逐渐干燥、收敛，药气强劲、药力浓厚，将津液炼化为精华，以此驾驭人体内停滞不化的水湿，自然能使水湿归顺，完全遵循药物的约束。那么葫芦是如何发挥作用的？它的气味是苦寒的，性质是趋下的。葫芦既然具有趋下的特性，还有什么是不能趋下的呢？这就是《神农本草经》将其列为下水利水药的原因。
（桑耳，是生长在桑树上的木耳，虽然有五种颜色，这里只讨论黑色的。）
桑树是箕星的精气所化，等到它腐朽时，经过盛夏湿热之气的蒸腾，凝结而成木耳。这就像肾中阴液向上朝注于肺，所以颜色发黑。木耳具有喜好风的本性，所以入肝经。因此，对于血分中的湿热，它能发挥最大的效力。血分中的湿热，只有女子容易患病。漏下赤白汁液的，是因为阴液被阳热逼迫而下泄；血证形成瘕聚积聚的，是因为阴液被阳热遏制而导致壅滞；阴通阴伤寒热的，是因为阴液被阳热负累而想要抗争。这是阴液不足，并非阳热有余。应当通过化解阴邪来提升阴液，不必压制阳热而损伤阳气。桑耳性质凉润且具有蒸腾上出的特性，所以能够化解阴邪以提升阴液。
杏仁有脉络，属于心之果；其仁则主要疏通脉络之气，属于肺之果。它的性质直接下降且兼有横向扩张的作用，横向扩张与直接下降互相牵制而不能充分发挥，所以如果不加入其他药物，既不能横向扩张也不能直接下降。然而使用杏仁进行横向扩张时，往往兼取其直接下降的功效；使用杏仁进行直接下降时，也兼取其横向扩张的功效。如果病症同时需要这两方面，杏仁也能同时展现这两种技艺。
麻黄汤，是治疗伤寒的发汗剂。既然已经用了麻黄，为什么又要加杏仁？因为杏仁兼能下气平喘。表实而邪气不得解除固然会导致气喘，邪气解除但气机不得下行也会导致气喘。杏仁既能走表又能入里，那么向外发散的气机，也会随之从中道向下行，所以麻杏甘石汤既有麻黄又有杏仁，是用来治疗气喘的；葛根汤有麻黄没有杏仁，是因为病症原本就没有气喘。然而麻黄并非不治气喘，小青龙汤中说“气喘去掉麻黄加杏仁”，这又是怎么回事呢？原来麻黄上发心液，下通肾气，小青龙汤证中心下之水，已与肾脏之水相互吸引，如果再使用麻黄触动肾气，气喘将更加无法停止。杏仁是治肺的药，不是治肾的药，所以去掉麻黄加上杏仁，这就是所谓在使用杏仁进行横向扩张时兼取其直接下降功效的情况。
大陷胸丸，是治疗伤寒的下法方剂。结胸症说颈部僵硬像柔痉的样子，这说明颈部僵硬外在大陷胸汤证无异，但病情更重。所以大陷胸汤可以迅速攻下而愈，此方必须改为丸剂以缓攻。杏仁一味药，专门针对颈部僵硬而设。颈部僵硬是由阳邪灼烧津液所致，杏仁研碎如脂且性质兼有横向扩张。再辅以芒硝的津液滋润，白蜜的调和甘甜，何难将僵硬化为柔和。然而结胸症的颈部僵硬，不下法不行，不陷下也不行。杏仁固然是大黄的功臣，葶苈子、甘遂的益友，这就是所谓在使用杏仁进行直接下降时兼取其横向扩张功效的情况。
伤寒发汗，以麻黄为主，杏仁为辅；治疗气喘，以杏仁为主，麻黄为辅；所以两药并用，疗效才迅速。气喘在伤寒中，属于表实肺郁。在杂病中，则有热喘、虚喘、饮气喘等，不止一种情况。小青龙汤中气喘去麻黄加杏仁，即非治疗伤寒的气喘，所以该方也多用于杂病。然而张仲景用药之道，仅仅在配伍异同和剂量多寡之间稍作调整，效果就大不相同。大青龙汤，是伤寒最重要的方剂之一。麻黄和杏仁并用，难道是为了治喘吗？原因在于麻黄用量比麻黄汤增加一倍，杏仁从七十个减为四十个，再加上生姜的升散，石膏的寒凉，杏仁自然跟随麻黄进行横向扩张，不至于专注于直接下降。由此推究，麻黄和杏仁并用而非为了治喘的，还有四方：一是麻黄加术汤，湿家身体烦疼，是寒湿之气郁结在肌表，麻黄汤正相适宜。病由于湿，所以加白术以收湿。而中气既已稳固，那么杏仁也只是用来利肺气罢了。二是麻黄杏仁薏苡甘草汤，伤于风湿而至发热，日晡时分加剧，不是麻黄和杏仁所能单独治疗的。薏苡仁清热祛湿，治疗久风湿痹，所以加入其中。但其剂量，麻黄只用麻黄汤的六分之一，杏仁用七分之一，薏苡仁也与麻黄相当，这是小制治上的方法，杏仁所以没有直接下降的权力。三是文蛤汤，这就是大青龙汤去掉桂枝。贪饮是由于热甚，所以用文蛤、石膏特别多，麻黄减少大青龙汤的一半，是因为表邪轻微而不希望过度发汗。如果没有蛤粉、石膏的咸寒，麻黄恐怕还要用到三两。然而使用麻黄又辅以生姜、杏仁，自然没有不发汗的道理。杏仁虽然兼有直接下降的长处，但受到蛤粉、石膏的制约，它与麻黄、生姜相比而与蛤粉、石膏距离较远，这是形势使然。四是浓朴麻黄汤，这就是小青龙汤加减而治法也大不相同。说咳嗽而脉浮，不详述具体证候，那么试着用本方药味推测：干姜、五味子、细辛，是治疗寒咳的药物，可知咳嗽因于寒；麻黄、杏仁与浓朴并用，浓朴也是温散的药物，可知表有寒邪宜于发散；有细辛又加半夏，则必定是用它们来祛除痰饮；有五味子又加小麦，则既然治疗咳嗽自然应当安肺；这一定是因为肺痿已见端倪，所以加石膏以保存津液而化燥，与小青龙汤加石膏的意思颇为相同。然而小青龙汤证是肺胀已成，所以驱除寒饮使其下行，此方是肺痿始萌，所以乘脉浮之际，亟需解其表邪。桂枝、芍药，所以用于彼方而不用于此方。浓朴用到五两，又没有芍药，那么杏仁又怎能发挥其直接下降的职责。这是去掉杏仁的直接下降而取其横向扩张。
杏仁直接下降和横向扩张，虽然都没有猛烈之力，但有赖于其他药物，而以这两者权衡，直接下降的力量，略优于横向扩张，所以甄权主张发汗，而《神农本草经》不主张发汗而主张下气。茯苓杏仁甘草汤，注家多以杏仁为散结，我独自认为它是下气。为什么呢？胸痹胸中气塞短气，看似很严重，实际上比前条用枳实薤白桂枝汤证要轻。这大概是痰饮为患，阳气尚不虚，不需要薤白、桂枝。稀饮用此汤治疗，胶痰则主用橘枳生姜汤。稀饮导致气塞短气的，必定是因为小便不利而饮停于胸，胸膈或素来不舒，饮停则痹阻。《神农本草经》说茯苓主治胸胁逆气、心下结痛、利小便，可知消散停饮之结，茯苓确实承担其职。茯苓淡渗散结，是针对有形之饮。杏仁苦温下降，是针对无形之气。二者合用，痹阻得以开通，气塞得以通畅。然而其他方剂治疗胸痹没有甘草，而此方有，是因为二药皆下行，不用甘草载之，则药势稍微停留而去疾不尽。外台走马汤，是下法方剂。中恶心痛腹胀大便不通，徐忠可说是客忤，沈目南说是绞肠乌痧。按方用巴豆，自然应有恶毒之邪，壅塞脏腑，须臾即毙之势。所以用巴豆驱逐有形之实邪，杏仁下无形之虚气，作为急救之策。与茯苓杏仁甘草汤中使用杏仁，取资是一样的。这是去掉杏仁的横向扩张而取其直接下降。
有用杏仁辅助麻黄发汗而可用于寒剂的。伤寒论治疗黄疸的方剂共三个：茵陈蒿汤使湿热从小便去，因为小便不利腹微满，是阳明病宜于下解的。栀子柏皮汤身黄发热非太阳发热可比，柏皮是阳明经腑的药，所以清肌表之湿热（《名医别录》疗肌肤热赤起，邹氏谓柏皮之用正在表里之间），而佐以栀子甘草，也是下行利小便的轻剂。这些都与杏仁无关。麻黄连翘赤小豆汤，说瘀热在里，身必发黄，而没有小便不利与发热等证，则其里为太阳之里（说法源自柯琴），太阳瘀热非发汗不解，但发表不远热，而阳黄的湿热，则不适合热药。唯有以连翘、梓皮、赤小豆彻热利湿，担当治里的重任，而后麻黄、杏仁散之于表，湿热得以汗解。这是治疗太阳瘀热发黄，不是治疗头痛发热身疼骨痛，所以麻黄、杏仁，视麻黄汤减少其数量，而用于寒剂，也不至于牵制寒剂的作用。
有用杏仁治疗水肿而正是取其不发汗的，水去呕止其人形肿一条（出自痰饮篇）。尤在泾说胃气已和而肺壅未通，麻黄可以通之，甚是。只是对于不用麻黄用杏仁的缘故，则分析不当。夫麻黄发阳犹之发汗，以血虚而不敢发汗，犹之夺血者无汗。盖形肿必通血络，麻黄与杏仁所共同具有的这种能力。
有用杏仁治疗气喘而不用于发汗剂的，桂枝加厚朴杏子汤，太阳病误下，无结胸下利诸变证而但微喘，喘既轻微，则表实之不解者亦仅矣。桂枝汤固然不解表实，以麻黄施于微实之表邪，又岂得为当。惟厚朴温散胜于桂枝，与桂枝汤协以解表，则不至有大汗之虞。然不大汗，表固已解，而表解而气不下，则喘犹不止。夫优于下气，而解表亦兼有所资者，杏仁是也。退麻黄而进杏仁，殆以是夫。
杏仁研之如脂，以濡润之物而擅横扩直降之长，故于伤寒杂证皆多所资藉。麻仁丸用杏仁，则于濡润中兼取其直降也。麻仁与杏仁，皆能润液化燥，而麻仁扩脾之约，杏仁抑肺使下（说详大麻仁），不可谓无通便之功矣。大黄 虫丸用杏仁，则于濡润中兼取其横扩也。是方种种治法，无非为补虚缓中之计。惟引地黄入脉络以行滋柔之化者，非杏仁而何，虽桃仁亦只与 虫辈比烈矣。抑有但取其濡润以佐他药，而横扩与直降两无所见者，矾石丸是也。子脏中有坚癖干血，纵以桃仁干漆 虫辈为坐药，未必遂能去之，况横扩直降，第恃有杏仁乎。夫曰∶经水闭不利者，有闭时有不闭时，不闭时亦不如平人之利也。脏坚癖不止（医宗金鉴∶不止，不去也）中有干血下白物者，子脏中有坚癖不可去之物，实为干血，而不能如干血急治也。有干血，则经之蓄泄不以时，而湿热酿为白物则自下也，此当置干血而先治其白物。矾石却湿除热，剧者不过再内而愈。然非佐杏仁白蜜以缓之和之，未必收效如是之捷。蛇床子散亦坐药也，彼治阴寒但任蛇床子，佐白粉为以柔济刚；此治白物但任矾石，佐杏仁为以润济燥。杏仁润而不腻，不致减矾石之力则有之，若云协以散结，岂仲圣意哉。
杏仁横扩不及麻黄之峻，而于风虚之证，却正相宜，又最宜于头面之风。洁古云治上焦风热。东垣云除肺中风热。石顽云气下则热自解风自散。窃谓风散则热自解，并非以热药治热风。考千金杏酥治风虚头痛，杏仁捣膏涂头面风肿，治头中痛身热风热，治头面上风，治头中风痒白屑各方中，皆有杏仁。又薯蓣汤、薯蓣丸，亦皆有杏仁。其所治之证，皆有头目眩冒。由是推之，即金匮薯蓣丸风药颇多，何尝不以杏仁治头面风，所谓风气百疾者，固无一不虑之周也。
When there is severe edema of the face, eyes, and limbs, it is because the pathogen is internal while the symptoms manifest externally. Using the pulp and seeds of *Cucumis melo var. flexuosus* (Ku Hu) to treat it means discarding the exterior and utilizing the interior essence.
The pulp and seeds are where the fluid essence of the melon is stored. As they gradually dry and contract, their qi becomes vigorous and their medicinal power concentrated, refining the fluid essence into pure extract. Using this to control the stagnant water in the human body will naturally cause the water to submit and obey constraints. So how does the melon function? Its flavor is bitter and cold, and its nature is descending. Since the melon has a descending nature, what could be more fitting for descending? This is why the *Shennong Bencao Jing* lists it at the end under drugs for draining downward water.
(Sang Er, wood ear fungus growing on mulberry trees. Although there are five colors, we discuss only the black variety here.)
Mulberry trees are the refined essence of the Ji Star. When they rot, through the steaming and vaporization of summer heat and dampness, they condense into ears (fungi). This is akin to kidney yin fluids ascending to the lungs, hence the black color. Possessing the innate nature of favoring wind, it enters the Liver channel. Therefore, it is most effective for damp-heat in the Blood level. Damp-heat in the Blood level is prone to disease in women. Leukorrhea with red and white discharge occurs when Yin is forced downward by Yang heat. Blood stasis forming masses and accumulations occurs when Yin is obstructed by Yang heat leading to stagnation. Yin-type cold-heat disorders occur when Yin is burdened by Yang heat and seeks to struggle. This indicates Yin deficiency, not Yang excess. One should transform Yin to raise Yin, rather than suppress Yang to damage Yang. Sang Er has a cool, moistening nature with ascending and vaporizing properties, thus it can transform Yin to raise Yin.
Xing Ren (Apricot Seed) possesses meridians, making it a fruit associated with the Heart; its kernel primarily unblocks Qi in the meridians, making it a fruit associated with the Lung. Its nature is directly descending and also laterally expanding. Lateral expansion and direct descent constrain each other, preventing either from fully exerting itself; therefore, without adding other herbs, it cannot laterally expand nor directly descend. However, when using Xing Ren for lateral expansion, one often simultaneously utilizes its direct descent. When using Xing Ren for direct descent, one often simultaneously utilizes its lateral expansion. If a condition requires both, Xing Ren can demonstrate both skills.
Ma Huang Tang is a sweating formula for treating Shang Han (Cold Damage). Since Ma Huang is already used, why add Xing Ren? Because Xing Ren can also direct Qi downward and stop wheezing. Exterior excess with unresolved pathogens causes wheezing; even after pathogens resolve, if Qi fails to descend, wheezing persists. Xing Ren travels to the exterior and enters the interior; thus, the Qi dispersed outward will also descend via the central pathway. Hence, Ma Xing Gan Shi Tang contains both Ma Huang and Xing Ren to treat wheezing. Ge Gen Tang contains Ma Huang but no Xing Ren because the condition originally lacked wheezing. However, Ma Huang does treat wheezing. Xiao Qing Long Tang states "remove Ma Huang and add Xing Ren for wheezing." Why the difference? Ma Huang ascends to emit Heart fluids and descends to unblock Kidney Qi. In Xiao Qing Long Tang syndrome, water below the heart attracts water from the Kidneys. If Ma Huang is used again to stir Kidney Qi, wheezing will become uncontrollable. Xing Ren treats the Lung, not the Kidney, so removing Ma Huang and adding Xing Ren is appropriate. This illustrates using Xing Ren for lateral expansion while taking advantage of its direct descent.
Da Xian Xiong Wan is a purgative formula for Shang Han. Chest binding with neck stiffness resembling Rou Ji (soft spasm) indicates that while the external neck stiffness resembles Da Xian Xiong Tang syndrome, the condition is more severe. Thus, Da Xian Xiong Tang can attack rapidly to cure, whereas this formula must change to pills for slow attack. Xing Ren alone is specifically set for neck stiffness. Neck stiffness is caused by Yang pathogens scorching fluids. Xing Ren, ground like paste, has a nature of lateral expansion. Assisted by Mang Xiao's moisture and Bai Mi's sweetness, transforming stiffness into flexibility is easy. However, chest binding neck stiffness requires purging and sinking. Xing Ren is indeed a merit-worthy assistant to Da Huang and a beneficial friend to Ting Li and Gan Sui. This illustrates using Xing Ren for direct descent while taking advantage of its lateral expansion.
For sweating in Shang Han, Ma Huang is primary and Xing Ren secondary; for treating wheezing, Xing Ren is primary and Ma Huang secondary. Thus, using them together yields rapid effects. Wheezing in Shang Han is due to exterior excess and Lung constraint. In miscellaneous diseases, there are heat wheezing, deficiency wheezing, and fluid-wheezing, among others. Removing Ma Huang and adding Xing Ren in Xiao Qing Long Tang implies it is not treating Shang Han wheezing, so the formula is often used for miscellaneous diseases. However, Zhang Zhongjing's method of medication relies on subtle shifts in combination and dosage to achieve vastly different results. Da Qing Long Tang is a crucial formula for Shang Han. Are Ma Huang and Xing Ren used together for wheezing? No. The reason is that Ma Huang dose is doubled compared to Ma Huang Tang, while Xing Ren is reduced from 70 to 40 grains. With Sheng Jiang's ascending dispersion and Shi Gao's cold nature, Xing Ren follows Ma Huang in lateral expansion rather than focusing on direct descent. By inference, there are four other formulas where Ma Huang and Xing Ren are used together not for wheezing:
1. Ma Huang Jia Zhu Tang: For damp patients with body ache, cold-damp is constrained in the muscle layer. Ma Huang Tang is suitable. Adding Bai Zhu absorbs dampness. With strengthened Middle Qi, Xing Ren merely benefits Lung Qi.
2. Ma Huang Xing Ren Yi Yi Gan Cao Tang: For wind-damp injury causing fever worsening at dusk. Ma Huang and Xing Ren alone cannot treat this. Yi Yi Ren clears heat and removes dampness, treating chronic wind-damp bi. Dosages are small: Ma Huang is 1/6 of Ma Huang Tang dose, Xing Ren is 1/7, Yi Yi Ren matches Ma Huang. This is a small dose treating upper jiao, so Xing Ren lacks the power of direct descent.
3. Wen Ge Tang: This is Da Qing Long Tang minus Gui Zhi. Thirst is due to intense heat, so Wen Ge and Shi Gao are abundant. Ma Huang is halved because exterior pathogens are mild and excessive sweating is unwanted. Without the salty-cold Wen Ge and Shi Gao, Ma Huang might reach 3 liang. But with Sheng Jiang and Xing Ren assisting Ma Huang, sweating is inevitable. Although Xing Ren has direct descent, it is controlled by Wen Ge/Shi Gao, distancing it from Ma Huang/Sheng Jiang dynamics.
4. Nong Po Ma Huang Tang: A modification of Xiao Qing Long Tang with different treatment. Cough with floating pulse: Gan Jiang, Wu Wei Zi, Xi Xin treat cold cough, indicating cold etiology. Ma Huang, Xing Ren, and Nong Po are warm dispersants, indicating exterior cold requiring release. Xi Xin plus Ban Xia dispels fluid. Wu Wei Zi plus Xiao Mai calms the Lung. This suggests early Fei Wei (Lung萎), so Shi Gao preserves fluids and transforms dryness, similar to Xiao Qing Long Tang plus Shi Gao. However, Xiao Qing Long Tang treats established Fei Zhang (Lung distension) by driving cold-fluid downward, while this treats early Fei Wei by resolving exterior pathogens during floating pulse. Gui Zhi and Bai Shao are used in the former but not this. Nong Po at 5 liang without Bai Shao prevents Xing Ren from performing direct descent. Here, Xing Ren's lateral expansion is taken while its direct descent is discarded.
Xing Ren's direct descent and lateral expansion are neither fierce, relying on other herbs. Weighing the two, direct descent is slightly superior. Hence, Zhen Quan advocated sweating, while the *Bencao Jing* advocates directing Qi downward. Fu Ling Xing Ren Gan Cao Zhu: Commentators view Xing Ren as resolving nodules, but I believe it directs Qi downward. Why? Chest Bi with Qi obstruction and shortness of breath seems severe but is milder than the Zhi Shi Ye Bai Gui Zhi Tang syndrome. This is Phlegm-Fluid pathology with sufficient Yang, needing no Ye Bai or Gui Zhi. Thin fluid uses this formula; thick phlegm uses Ju Pi Zhi Sheng Jiang Tang. Thin fluid causing obstruction stems from difficult urination and fluid retention in the chest. *Bencao Jing* says Fu Ling treats reverse Qi in chest/hypochondrium, epigastric knotting pain, and promotes urination. Thus, Fu Ling resolves retained fluid nodules. Fu Ling's light permeability resolves tangible fluid. Xing Ren's bitter-warm descent addresses intangible Qi. Together, they open Bi and unblock obstruction. Other formulas for Chest Bi lack Gan Cao, but this one includes it because both Fu Ling and Xing Ren descend; without Gan Cao to hold them, they would pass through too quickly. Waitu Zou Ma Tang is a purgative. Sudden heart pain, abdominal fullness, constipation. Xu Zhongke calls it Ke Wu; Shen Munan calls it Jiao Chang Wu Sha. Ba Dou expels tangible solid pathogens; Xing Ren directs intangible deficient Qi downward as an emergency measure. This is similar to using Xing Ren in Fu Ling Xing Ren Gan Cao Tang, taking advantage of direct descent over lateral expansion.
There are cases where Xing Ren assists Ma Huang in sweating within cold formulas. There are three formulas for Jaundice in Shang Han Lun: Yin Chen Hao Tang drains damp-heat via urine for Yangming excess with difficult urination and slight abdominal fullness. Zhi Zi Bai Pi Tang treats yellow skin and fever; Bai Pi treats Yangming channels/organs, clearing surface damp-heat (Bielu notes it treats skin heat/redness; Zou says it acts between interior/exterior), assisted by Zhi Zi and Gan Cao as a mild downward diuretic. These do not involve Xing Ren. Ma Huang Lian Qiao Chi Xiao Dou Tang states "stagnant heat in the interior causes jaundice" without difficult urination or fever, implying Taiyang interior (per Ke Qin). Taiyang stagnant heat requires sweating. Surface-releasing herbs are rarely cold, but Yangming damp-heat dislikes hot herbs. Lian Qiao, Zi Pi, and Chi Xiao Dou handle interior heat/dampness, allowing Ma Huang and Xing Ren to disperse to the surface, resolving damp-heat via sweat. This treats Taiyang stagnant heat jaundice, not headache/body ache, so Ma Huang/Xing Ren doses are reduced from Ma Huang Tang and used in a cold formula without hindering its cooling action.
There are cases where Xing Ren treats edema precisely by NOT sweating. "Water gone, vomiting stopped, patient has facial edema" (Tan Yin Pian). You Shi says Stomach Qi is harmonized but Lung congestion remains; Ma Huang can unblock it. However, his explanation for using Xing Ren instead of Ma Huang is flawed. Ma Huang releases Yang like sweating; blood deficiency precludes sweating ("loss of blood means no sweat"). Edema requires unblocking blood collaterals, which both Ma Huang and Xing Ren can do.
There are cases where Xing Ren treats wheezing without sweating formulas. Gui Zhi Jia Nong Po Xing Ren Tang: Taiyang disease treated incorrectly with purgatives, no chest binding or diarrhea, only slight wheezing. Since wheezing is slight, exterior excess is minimal. Gui Zhi Tang does not resolve exterior excess; using Ma Huang for mild exterior excess is inappropriate. Nong Po disperses warmth better than Gui Zhi; combined with Gui Zhi Tang to resolve exterior, it avoids excessive sweating. However, if exterior resolves but Qi does not descend, wheezing persists. Xing Ren excels at directing Qi downward and aids exterior resolution. Replacing Ma Huang with Xing Ren is likely for this reason.
Xing Ren ground like paste is moistening, possessing both lateral expansion and direct descent, benefiting both Shang Han and miscellaneous diseases. Ma Ren Wan uses Xing Ren for direct descent amidst moistening. Ma Ren and Xing Ren both moisten dryness; Ma Ren expands Spleen constraints, Xing Ren suppresses Lung to direct downward (see Da Ma Ren), contributing to bowel movement. Da Huang Zhe Chong Wan uses Xing Ren for lateral expansion amidst moistening. This formula tonifies deficiency and moderates the Middle. Only Xing Ren guides Di Huang into collaterals for nourishing transformation; even Tao Ren is too harsh compared to insect drugs. Some use Xing Ren merely for moistening assistance, seeing neither expansion nor descent: Fan Shi Wan. Hard dry blood in the uterus cannot be removed by Tao Ren, Gan Qi, or insects as suppositories, let alone relying solely on Xing Ren for expansion/descent. Menstrual irregularity with intermittent flow and leukorrhea indicates hard dry blood in the uterus that cannot be urgently treated. Dry blood causes irregular menstruation; damp-heat ferments into leukorrhea. Treat leukorrhea first. Fan Shi dries dampness and clears heat. Without Xing Ren and Bai Mi to moderate and harmonize, efficacy would not be so rapid. She Chuang Zi San is also a suppository. It treats Yin cold with She Chuang Zi and Bai Fen (softening hardness); this treats leukorrhea with Fan Shi and Xing Ren (moistening dryness). Xing Ren is moist but not cloying, not reducing Fan Shi's power. Claiming it helps resolve nodules contradicts Zhang Zhongjing's intent.
Xing Ren's lateral expansion is less fierce than Ma Huang, suitable for Wind-Deficiency conditions, especially Wind on the head and face. Jie Gu said it treats Upper Jiao Wind-Heat. Dong Yuan said it eliminates Wind-Heat in the Lung. Shi Wan said "when Qi descends, Heat resolves and Wind scatters." I believe Wind scattering resolves Heat; it is not treating Wind-Heat with hot herbs. Kaibian's Xing Su treats Wind-Deficiency headache; Xing Ren paste applied to head/face treats Wind swelling; various formulas for head pain, body heat, Wind on head, and scalp itching/scaling all contain Xing Ren. Shu Yu Tang and Shu Yu Wan also contain Xing Ren. Their indicated conditions include dizziness and vertigo. Inferring from this, even though Jin Gui Shu Yu Wan has many Wind-dispersing herbs, it undoubtedly uses Xing Ren for Head/Face Wind. Regarding "Wind Qi causing hundred illnesses," thorough consideration of Xing Ren is essential.