（卵生）宣皮肤风湿
蚕沙（专入肝脾。兼入胃）。即晚蚕所出之屎也。玩书所着治功。多有祛风除湿之能。
所述治
症。多是肢节不遂。皮肤顽痹。腰膝冷痛。冷血瘀血。肠鸣消渴。烂弦风眼。缘蚕食而不饮
。其食出则气燥。燥则可以胜湿去风。凡一切皮肤等疾。因于风湿而至者。（上症俱就风湿
而言。）无不得此以为调治。且味辛而兼甘。故凡水火相激而见肠鸣。得此甘以和之。燥热
而
见消渴不止。得此辛以润之。（燥渴仍属风邪。故辛可以得润。）是以用此炒黄。袋盛浸酒。
以去风缓不随。皮肤顽痹。（冠氏曰。醇酒三升。拌蚕沙五斗。蒸热铺暖室席上。令患冷风
气痹人。以患处就卧。浓覆取汗。不愈。间日再作。须防昏闷。）暨烂弦风眼。用此油浸涂
患即愈。（汪昂曰。目上下胞属脾。脾有风湿则虫生弦烂。用新瓦炙为末。少加雄黄麻油调
敷。又治蛇串疮。有人食乌梢蛇浑身变黑。渐生鳞甲。见者惊缩。郑奠一令日服晚蚕沙五
钱。尽一二斗。久之乃愈。）昔史国公用此浸酒。（色清味美。）以治风痹。义多根此。然惟
晚者为良。早蚕者不堪入药。以饲火烘。故有毒也。
病之切于人身者。非其火之有余。即其水之不足。火衰则水益胜。水衰则火益炽。昔人
云。
火偏盛者。补水配火。不必去火。水偏多者。补火配水。不必去水。譬之天乎？此重彼轻。
其重于一边者勿补。则只补足轻者之一边也！决不凿去砝马。审是则凡水火偏胜。决无凿去
砝马用泻之理。推是禀体素浓。脏气偏胜。并或外邪内入。阻遏生机。如湿气流行。土受水
制。在初湿气内盛。能毋渗而泄乎？久而水气横逆。泛流莫御。能无决而去乎。此水之宜渗
宜泻者然也。火气内炽。一火发动。众火剂起。冲射搏激。莫可名状。此火之不得不泻者也
。热气内蒸。水受煎熬。苟不乘势即解。则真阴立槁。此又热之不得不泻者也。至于或热
或火。结而为痰。或热或火。盈而为气。痰之微者。或从渗湿泻湿之药以去。若使痰甚而涌
。宜用苦宜苦咸之药以降。气之微者。或用泻火泻热之药以消。若使气盛而迫。须用苦寒苦
劣之药以下。其有禀受素亏。邪气不甚。则止酌以平剂以投。不可概用苦寒。以致胃气有损
。又按湿为阴邪。凡人坐卧卑地。感受湿蒸。及或好食生冷。遏其元阳。郁而为热。在初受
邪未深。不必竟用重剂。惟取轻淡甘平以渗。然渗亦须分其脏腑。如扁豆山药陈仓米茯苓浮
萍通草鸭肉鲫鱼鲤鱼泽兰。是渗脾胃之湿者也。但茯苓则兼肺肾以同治。通草则止合肾以共
理。鲫鱼则止合肾以皆渗。故暑湿熏蒸。三焦混乱。宜用扁豆以除之。胃气不平。烦渴不止
。宜用仓米以止之。脾虚热泄。宜用山药以渗之。水肿不消。宜用浮萍以利之。淋闭不通。
宜用通草以开之。肠风下血。膈气吐食。宜用鲫鱼以理之。陈气不化。宜用泽兰以去之。
虚痨嗽肿。宜用鸭肉以平之。肿嗽泄泻。宜用茯苓以利之。水肿香港脚。宜用鲤鱼以治之。又
如榆白皮冬葵子神曲石钟乳。是渗肠胃之湿者也。故五淋肿满。胎产不下。宜用榆白皮冬葵
子以服之。乳汁不通。宜用石钟乳以通之。又如茯神萱草。是渗心经之湿者也。故惊悸健忘
。水湿内塞。宜用茯神以利之。消渴心烦。宜用萱草以释之。他如肾有邪湿。症见心气不交
。则有桑螵蛸以治之。症见杨梅毒结。则有土茯苓以导之。但土茯苓则兼诸脏之湿同理。肺
有邪湿。汗闭不泄。则有姜皮以发之。肺气不降。则有通草以通之。肝有邪湿。而见子肿风
痨。则用天仙藤以治之。至于湿热稍胜。药非轻剂可治。则又另有泻剂。而非斯药所能尽者
也。
（卵生）宣散皮肤风湿。
蚕沙（专入肝、脾经，兼入胃经）。即晚蚕所排出的粪便。考察书籍所载的治疗功效，多有祛除风邪、除湿气的功能。
所述治疗的病症，多是肢体关节活动不利，皮肤麻木不仁，腰膝冷痛，寒凝血瘀，肠鸣音亢进，消渴病，眼睑边缘溃烂的风眼症。因为蚕只吃桑叶而不饮水，其排泄物则气性燥烈，燥性能胜湿祛风。凡是所有皮肤等疾患，因风湿引起的，（上述症状均从风湿角度而言），没有不能借此来调理治疗的。况且其味辛而兼甘，所以凡是水火相激而出现肠鸣的，得到它的甘味可以调和它；燥热导致消渴不止的，得到它的辛味可以滋润它。（燥渴仍属于风邪所致，所以辛味可以达到润的效果。）因此用此药炒黄后，装入袋中浸泡酒内，以去除风邪导致的肢体缓纵无力、皮肤顽痹。（冠氏说：用三升纯酒，拌和五斗蚕沙，蒸热后铺在温暖房间的席子上，让患有冷风气痹症的病人躺在上面，厚盖取汗，若未痊愈，隔日再做一次，须防止昏闷。）以及治疗烂弦风眼，用此药浸油涂抹患处即可痊愈。（汪昂说：眼睛上下眼睑属脾，脾有风湿则生虫致眼睑边缘溃烂，用新瓦烤干研为粉末，少加雄黄、麻油调敷。又治蛇串疮，有人吃了乌梢蛇后浑身变黑，逐渐生出鳞甲，见者惊恐退缩，郑奠一令其每日服用晚蚕沙五钱，服完一二斗，久而久之便痊愈了。）昔日史国公曾用此药浸泡酒饮，（酒色清味道美），以治疗风痹，道理大多基于此。然而只有晚蚕沙为佳，早蚕沙不堪入药，因为是用火烘烤干燥的，所以有毒。
疾病切近人身者，不是火的有余，就是水的不足。火衰则水更盛，水衰则火更炽。古人说：火偏盛的，补水以配火，不必去火；水偏多的，补火以配水，不必去水。这就像天平吗？这边重那边轻，对于重的一边不要补，只需补足轻的一边就行了！绝不会凿去砝码（比喻直接泻实）。明白了这个道理，那么凡是水火偏胜，决没有凿去砝码用泻法的道理。推及于此，如果禀赋体质素来浓厚，脏气偏胜，或者外邪内入，阻遏生机，如湿气流行，土受水制，在初起时湿气内盛，能不通过渗利而泄出吗？时间久了，水气横逆，泛滥无法控制，能不通过决堤而去掉它吗。这就是水适宜渗利、适宜泻下的原因。火气在内炽盛，一旦火发动，众火随之而起，冲射搏激，无法形容。这是火不得不泻的原因。热气在内蒸腾，水受到煎熬，如果不乘势立即解除，那么真阴立刻枯竭。这又是热不得不泻的原因。至于有的热或火，凝结而成痰，有的热或火，充盈而成气。痰轻微的，或用渗湿泻湿的药物去除；如果痰很盛而上涌，宜用苦味、咸味的药物以降逆；气轻微的，或用泻火泻热的药物以消散；如果气盛而逼迫，须用苦寒、苦劣的药物以下气。那些禀受素来亏虚，邪气不盛的，则酌情给予平剂投予，不可一概使用苦寒药物，以致损伤胃气。又按：湿为阴邪，凡人坐卧低洼之地，感受湿蒸，或者喜好食用生冷食物，遏制元阳，郁结而为热，在初受邪气未深时，不必竟用重剂，只需取轻淡甘平的药物以渗利。然而渗利也须区分脏腑。如扁豆、山药、陈仓米、茯苓、浮萍、通草、鸭肉、鲫鱼、鲤鱼、泽兰，是渗利脾胃之湿的药物。但茯苓则兼肺肾一同治理，通草则只合肾共同调理，鲫鱼则只合肾一起渗利。所以暑湿熏蒸，三焦混乱，宜用扁豆以清除它；胃气不平，烦渴不止，宜用仓米以止住它；脾虚热泄，宜用山药以渗利它；水肿不消，宜用浮萍以利水它；淋闭不通，宜用通草以开通它；肠风下血，膈气吐食，宜用鲫鱼以调理它；陈气不化，宜用泽兰以去除它；虚劳嗽肿，宜用鸭肉以平复它；肿嗽泄泻，宜用茯苓以利水它；水肿脚气，宜用鲤鱼以治疗它。又如榆白皮、冬葵子、神曲、石钟乳，是渗利肠胃之湿的药物。所以五淋肿满，胎产不下，宜用榆白皮、冬葵子来服用；乳汁不通，宜用石钟乳来通利。又如茯神、萱草，是渗利心经之湿的药物。所以惊悸健忘，水湿内塞，宜用茯神以利水它；消渴心烦，宜用萱草以缓解它。其他如肾有邪湿，症见心气不交，则有桑螵蛸来治疗；症见杨梅毒结，则有土茯苓来疏导。但土茯苓则兼诸脏之湿共同调理。肺有邪湿，汗闭不泄，则有姜皮来发散；肺气不降，则有通草来通利。肝有邪湿，而见子肿风痨，则用天仙藤来治疗。至于湿热稍胜，药物非轻剂可治，则又有另外的泻剂，而不是这些药物所能穷尽的了。
(Silkworms are) oviparous; [Cicada Slough] disperses wind-dampness from the skin.
Can Sha (Silkworm Excrement) (Enters primarily the Liver and Spleen meridians, and secondarily the Stomach meridian). It is the feces excreted by late-season silkworms. Examining the therapeutic functions recorded in books, it possesses the ability to dispel wind and eliminate dampness.
The symptoms described for treatment are mostly limb and joint immobility, cutaneous numbness and obstruction, cold pain in the waist and knees, cold blood and blood stasis, borborygmus, Xiao Ke (Wasting and Thirsting Syndrome), and rotten margin wind-eye (blepharitis with ulcerated eyelid margins). This is because silkworms feed but do not drink; their excrement has a dry nature. Dryness can overcome dampness and dispel wind. For all kinds of skin and other diseases caused by wind-dampness, (the above symptoms are discussed from the perspective of wind-dampness), none cannot be regulated and treated using this. Furthermore, its flavor is pungent and sweet. Therefore, for cases where fire and water clash resulting in borborygmus, its sweetness harmonizes them; for excessive dryness-heat causing persistent Xiao Ke (Wasting and Thirsting Syndrome), its pungency moistens them. (Dryness-thirst still belongs to wind-pathogen, so pungency can achieve moistening.) Thus, it is used after being stir-fried until yellow, placed in a bag, and soaked in wine to dispel wind and relieve flaccidity and cutaneous obstruction. (Guan Shi said: Mix three sheng of pure wine with five dou of Can Sha, steam until hot, spread on mats in a warm room, and have patients suffering from cold-wind bi-syndrome lie on it, covering thickly to induce sweating. If not cured, repeat every other day. Beware of dizziness and fainting.) And for treating rotten margin wind-eye, soaking this herb in oil and applying it to the affected area brings cure. (Wang Ang said: The upper and lower eyelids belong to the Spleen; if the Spleen has wind-dampness, worms grow causing eyelid margin ulcers. Roast new tiles until hot, grind into powder, add a little Xiong Huang (Realgar) and Ma You (Sesame Oil), mix and apply. It also treats Snake String Sores (Herpes Zoster); someone ate Wushao She (Zaocys dhumnades) and turned black all over, gradually growing scales, shocking those who saw it. Zheng Dianyi instructed daily consumption of 5 qian of late-season Can Sha, finishing one or two dou, and after a long time, they recovered.) In the past, Shi Guo Gong used this to soak wine (clear color, fine taste) to treat Wind-Bi syndrome; the rationale is largely based on this. However, only late-season silkworm excrement is good; early-season ones are unsuitable for medicinal use as they are dried by fire and thus toxic.
Diseases closely affecting the human body are either due to excess Fire or deficiency of Water. When Fire declines, Water becomes more dominant; when Water declines, Fire becomes more blazing. Ancients said: When Fire is excessively strong, tonify Water to balance Fire, without removing Fire; when Water is excessively abundant, tonify Fire to balance Water, without removing Water. It is like a scale? One side heavy, the other light. Do not tonify the heavy side; simply tonify the light side! One certainly does not chisel away the weights (metaphor for direct purging). Understanding this, for any imbalance of Fire and Water, there is absolutely no logic to chiseling away weights and using purgative methods. Extending this reasoning, if constitution is naturally robust, organ Qi is biased, or external pathogens enter internally obstructing vital energy, such as Dampness spreading, Earth controlled by Water, initially when internal Dampness is abundant, can it not be drained through leeching and purging? Over time, if Water Qi rebels horizontally, flooding uncontrollably, can it not be discharged by opening the dike? This is why Water is suitable for leeching and purging. When Fire Qi blazes internally, once one Fire moves, many Fires arise, charging and clashing indescribably. This is why Fire must be purged. When Heat steams internally, Water is boiled; if not resolved immediately upon opportunity, True Yin will wither instantly. This is another reason why Heat must be purged. As for Heat or Fire condensing into Phlegm, or Heat or Fire filling to form Qi: slight Phlegm may be removed with herbs that leech or purge Dampness; if Phlegm is severe and surging, bitter and salty herbs should be used to descend it. Slight Qi issues may be dissipated with herbs that purge Fire and Heat; if Qi is excessive and pressing, bitter-cold and bitter-bitter herbs should be used to drain it. For those with inherent deficiency and mild pathogenic factors, moderate formulas should be酌情 (discretionarily) administered; one must not indiscriminately use bitter-cold herbs, thereby damaging Stomach Qi. Furthermore, Dampness is a Yin pathogen. People sitting or lying in low places contract Damp-Miasma, or those fond of raw/cold foods suppress Yuan Yang, leading to郁 (stagnation) transforming into Heat. Initially, when the pathogen is shallow, heavy formulas need not be used; light, bland, sweet, and neutral herbs should be taken to leech. However, leeching must distinguish the Zang-Fu organs. Such as Bian Dou (Lablab Seed), Shan Yao (Chinese Yam), Chen Cang Mi (Aged Rice), Fu Ling (Poria), Fu Ping (Azolla), Tong Cao (Tetrapanax Pith), Ya Rou (Duck Meat), Ji Yu (Crucian Carp), Li Yu (Common Carp), Ze Lan (Lycopus Herb) are herbs that leech Dampness from the Spleen and Stomach. But Fu Ling also treats Lung and Kidney together; Tong Cao only coordinates with the Kidney; Ji Yu only works with the Kidney for leeching. Therefore, for Summer-Heat and Dampness miasma confusing the San Jiao (Triple Burner), Bian Dou is suitable to remove it; for uneven Stomach Qi and unquenchable thirst, Chen Cang Mi is suitable to stop it; for Spleen deficiency with heat-diarrhea, Shan Yao is suitable to leech it; for edema that does not resolve, Fu Ping is suitable to promote urination; for stranguria and retention, Tong Cao is suitable to open it; for Intestinal Wind bleeding and chest fullness with vomiting, Ji Yu is suitable to regulate it; for stale Qi failing to transform, Ze Lan is suitable to remove it; for consumptive cough and swelling, Ya Rou is suitable to calm it; for swelling, cough, and diarrhea, Fu Ling is suitable to promote urination; for edema and Hong Kong Foot (Gout/Charcot foot), Li Yu is suitable to treat it. Again, Yu Bai Pi (Elm Bark), Dong Kui Zi (Malva Seed), Shen Qu (Medicated Leaven), Shi Zhong Ru (Fossilized Bone/Shark Tooth) are herbs that leech Dampness from the Intestines and Stomach. Thus, for Wu Lin (Five Strangurias) and distension/fullness, or difficult labor/delivery, Yu Bai Pi and Dong Kui Zi are suitable to take; for blocked lactation, Shi Zhong Ru is suitable to unblock it. Again, Fu Shen (Poria with Hostwood), Xuan Cao (Daylily Root) are herbs that leech Dampness from the Heart Meridian. Thus, for palpitations and amnesia, or internal blockage by Water-Dampness, Fu Shen is suitable to promote urination; for Xiao Ke and vexation, Xuan Cao is suitable to relieve it. Others: if the Kidney has pathogenic Dampness presenting as lack of communication between Heart Qi, Sang Piao Xiao (Mantis Egg Case) is used for treatment; if presenting as Syphilitic toxin accumulation, Tu Fu Ling (Smilax Glabra Rhizome) is used to guide it out. But Tu Fu Ling also coordinates Dampness from various organs. If the Lung has pathogenic Dampness with closed sweat pores, Jiang Pi (Ginger Peel) is used to disperse it; if Lung Qi fails to descend, Tong Cao is used to unblock it. If the Liver has pathogenic Dampness presenting with fetal edema or Wind-Lao (consumptive disease), Tian Xian Teng (Aristolochia Vine) is used for treatment. As for cases where Damp-Heat is slightly dominant, where light formulas are insufficient, there are other purgative formulas, which these specific herbs cannot fully cover.