橙枳橘柑之辨 橙叶有两刻。枳叶似之。橘与枳皆多刺。其叶两头尖。非一叶而有两刻
者。橘叶久而有两刻化为枳也。柑与橘无异。但少刺耳。然则柑树与橘之分在刺。橘与橙枳
之分在叶也。
枳为木实。后人因实之小者。性酷而速。又呼其老而大者为枳壳。原一物。 枳壳大而
色黄紫。多穣。枳实小而色青。中实少穣。 壳主高。实主下。高者主气。下者主血。主气
者在胸膈。主血者在心腹。
〔论〕 枳实枳壳。因采有后先。而气别峻缓。枳木春生白花。至秋成实。气凝于正秋。
正以降为用者。枳实采于七八月。乘金令之旺气。故其降甚峻。枳壳采于九十月。则金气退
泄。而性自微缓也。
壳
味苦辛酸。气微寒。气浓味薄。浮升而降。沉也。阴也。入肺胃大肠肝四经。 主泻肺
脏。宽大肠胸腹结气。两胁虚胀。关膈壅塞。下气宽胸痞。及肺气水肿。并大肠风痔疾。泄
痢里急后重。能消一切瘴。 枳壳破气。胜湿化痰。多用损胸中至高之气。止可二三服而已
。禀受素壮而气刺痛者。看在何经部分。以别药导之。（洁古） 朱肱治痞。先用桔梗枳壳
汤。一开提。一降泄。盖知气缘误下而将陷。故先用此。使不致于痞。非即以治痞也。若已
成痞而用之。不惟不能消痞。反损胸中之气矣。（好古） 枳壳导散风壅之气。可常服者。
不似枳实之决壅破结也。（衍义） 壳实皆能利气。气下则痰喘止。气行则痞胀消。气通则
刺痛除。气利则后重愈。乃后贤有壳高实下之分矣。而仲景以实治胸痹痞满。诸方又以壳治
下血痔痢肠秘里急后重。然则枳实不独治下。而枳壳不独治高也。（自飞门至魄门。皆肺主
之。三焦相通。一气而已。） 枳壳气徐性纾。不遽下行。能入胸膈肺胃之分。因及大肠。
不如枳实气全而性速。其下达无前也。（仲淳） 和中须合桔梗。理气更佐二陈。盖气行而
不下。则浊气上而喘嗽气盛之证作。气下而不行。则清气陷而肠鸣飧泄之病生。所以枳桔二
陈。义有取也。（能） 同桔梗陈皮木香苏子香附白蔻。治上焦壅气胀满因于寒。 同黄连
槐花干葛防风荆芥芍药黄芩生地当归地榆侧柏叶。治肠风下血初起者。神效。 同荆芥防风
苦参苍耳草败蒲。煎汤浴。治风疹作痒。同槟榔芍药升麻葛根黄连甘草红曲滑石。治滞下里
急后重。 得人参麦冬。治气虚大便不快。 同肉桂。治右胁痛。 肠风下血。不论远年近
日。枳壳烧黑存性五钱。羊胫炭五钱。为末。五更米饮服。如人行五里。再一服。当日见效。
又方。用枳壳一两。黄连五钱。水一钟。煎减半。空心服。 胁肾疼痛。因惊伤肝者。麸炒
枳壳一两。桂枝半两。为细末。每服二钱。姜枣汤下。
〔论〕 枳壳与实。味苦而辛。苦多辛少。又含酸意。夫苦酸涌泄。其气且寒。本由上
降下之性味。更结于降令时。故取降泄者无逾兹物矣。夫人身正气。非可降泄。其宜降泄者。
正气为邪所伤。有壅塞处而不能降也。然壅塞有轻重。虽总是气病。却有阴阳之不同。如因
气以及于血。则气之阴者伤。而病乎结实。不止病于 无形之阳也。枳实性烈而速。一往
直前。凡 之气不能详缓以散。而结实着手之处。乃能决之溃之。枳壳性稍缓。辛味稍多。
故能从统气之肺。于 无形而疏利之。不以溃决为功也。此一物而分气血之义。细绎乎此
。则不必执定所列治效。凡热伤正气使不得降。抑或湿热为病而不得降者。伏其所伤之邪
而用此佐之。以下归于寒水之化。岂曰不宜。若不责其所因。而漫为泄滞气之主剂。则惑矣。
然则枳壳治心下坚痞。其说非欤。讵知肺气不降入心。则胃气病而不能生血。即不能化血。
此之泻肺气以下降。乃能使之生。遂能化也。以此义思枳壳之用。不同于实之溃坚决壅。岂
不然哉。其治胁痛也。以两胁为肝胆所经。苦中有酸。自能降肝胆之逆气。所谓得降令之金
以平木者。义固不爽耳。大抵治气之不降。宜于气为热伤者。若寒湿滞气。则温散而气自行。
不则寒湿久而化热者
缪氏。肺气虚弱者。忌之。脾虚中气不运。而痰壅喘急者。忌之。咳嗽不因气壅者。服
之反剧。若阴虚火嗽者。立致危殆。胎前产后咸不宜。古人八九月服瘦胎饮。乃奉养太过而
气实者。不可混用。
〔修治〕 产江右者良。取翻肚如盆口状。其气味辛苦而腥。并有隙油者。 陈久者为
上。 去穣。麸炒。待麸黑焦出用。
实
味苦酸辛。气寒。气味俱浓。沉也。阴也。入足阳明太阴经。 消实痞。破坚积。除胸
胁痰癖。逐停水。（蜜炙则破水积）散逆气。心下急痞痛。胀满胁风痛。并消宿食败血。除
寒热结。去胃中湿热。 盖脾胃气滞。则不能运化精微。而痰癖停水。结实胀满。所自来矣。
胃之上口。曰贲门。贲门与心相连。胃气壅则心下亦自急痞痛。邪塞中焦。则升降不舒而气
上逆。肝木郁于地下。则不能条达而胁痛。得其破散冲走之力。则诸证悉除。（仲淳） 洁
古用逐脾经积血。以脾无积血。则心下不痞也。 滑窍破气之药。其泻痰有冲墙倒壁之力。
（丹溪） 心下痞及宿食不消。并宜枳实黄连。 脾胃湿热生痰。有积者。入白术中四分之
一。（丹溪） 仲景治心下坚大如盘水饮。用枳实七枚。术三两。水一斗。煎三升。分三服。
腹中
枳实安胃气止。溏泄者。如伤寒下腹胀实结有承气。治胸中痞痛有陷胸。洁古疗心下痞满有
枳术诸法。壅滞既去。则胃气自安。溏泄亦止矣。（仲淳） 益气则佐以参术干姜。破气则
佐以硝黄牵牛。加苍术则气清膈宽。并麦芽而和中消导。合芩连清湿中之热。同二陈化痰涎
之壅。 同三棱蓬术青皮槟榔。为消磨坚积之剂。然须脾健能食方可用。 同白术陈皮浓朴
砂仁甘草。为枳术丸。治心下痞满因于食。
〔论〕 枳实本苦寒下行之性。禀降令乘旺之气。其就下至阴也。气烈而速。凡热邪结
于
其阴完而阳伤之也。无形而痛者。其阳完而阴伤之也。然则有痞而坚大。乃阴邪有以结阳。
受病在阳也。宜健阳。如仲景枳实白术之治。用枳实所以助阳之健也。有痞而痛急。乃阳邪
有以结阴。受病在阴也。宜清阴。如洁古黄连枳实之治。用枳实所以助阴之清也。审此则枳
实虽入阴分。而邪之分阴阳者。又当从而消息之矣。
此药性专消泄。破气损真。凡中气虚寒。劳倦伤脾。发为痞满者。必不可用。胀满非实
邪结于中下焦。手不可按。七八日不更衣者。必不可用。挟热下痢。非燥粪留结者。必不可
用。伤食停积。多因脾虚不能运化。如元气壮实有积滞者。不得已用一二剂。病已即去之。
（仲淳）
〔辨治〕 择如鹅眼。并年久色黑者用。微绿者不堪入药。
【橙、枳、橘、柑的辨析】
橙树的叶子有两道刻痕。枳树的叶子与之相似。橘树和枳树都多刺，它们的叶子两头尖细，并非像橙叶那样一道叶子有两道刻痕。有人说橘树叶子久了会变成枳树叶子，这是错误的。柑树与橘树没有区别，只是刺较少罢了。那么，柑树与橘树的区别在于刺的有无；橘树与橙树、枳树的区别在于叶子的形态。
枳是树木的果实。后人因为果实小的那个，药性猛烈且迅速，又把老而大的那个称为“枳壳”。它们原本是一物。枳壳个头大，颜色黄紫，果肉多；枳实个头小，颜色青，内部充实而果肉少。枳壳主治上部（高），枳实主治下部（下）。治上部的主要调理气分，治下部的主要调理血分。气分的病变多在胸膈，血分的病变多在心腹。
〔论述〕
枳实和枳壳，因为采摘时间有先后，所以药气的峻烈与缓和不同。枳树春天生出白花，到秋天结果实。药气凝聚在初秋时节，正是以“降”为用的时候。枳实在七八月采摘，趁着金气旺盛的时候，所以它的下降作用非常峻猛。枳壳在九十月采摘，此时金气开始退散泄出，所以药性自然变得微缓。
【枳壳】
味苦、辛、酸。气微寒。气浓味薄，具有浮升又下降的特性，属于沉性，属阴。入肺、胃、大肠、肝四经。主要泻肺脏之气，宽畅大肠、胸腹的结滞之气，治疗两胁虚胀、关膈壅塞、下气宽胸痞闷，以及肺气水肿，还有大肠风痔疾、泄痢引起的里急后重。能消除各种瘴气。枳壳破气，胜湿化痰，但多用会损伤胸中至高之气，只能服用二三剂而已。禀赋素来强壮且因气刺痛的人，需看在哪条经络的哪个部位，用其他药物引导它。（洁古）朱肱治疗痞证，先用桔梗枳壳汤，一开提，一降泄。大概是因为知道气因为误用下法而将要下陷，所以先用此方，使不至于形成痞证，并不是直接用来治疗已成之痞。如果已经形成痞证再用它，不仅不能消痞，反而损伤胸中之气。（好古）枳壳疏导疏散风邪壅滞之气，可以常服，不像枳实那样决断壅塞、破除结聚。（衍义）壳和实都能利气，气下行则痰喘止息，气运行则痞胀消除，气通畅则刺痛去除，气利则里急后重痊愈。这是后世贤者有了壳治高、实治下的区分。然而张仲景用枳实治疗胸痹痞满，各方又用枳壳治疗下血、痔痢、肠秘、里急后重。那么，枳实不仅仅治下，枳壳也不仅仅治高。（从鼻窍至肛门，都由肺所主，三焦相通，只是一气而已。）枳壳气徐性缓，不急于下行，能进入胸膈、肺、胃的分野，进而涉及大肠。不如枳实气全而性速，其下达之力无前。
和中需要配合桔梗，理气更辅助二陈汤。大概因为气行而不向下，则浊气上逆而引发喘嗽气盛的病证；气下而不运行，则清气下陷而引发肠鸣飧泄的病。所以枳桔和二陈汤，是有取义的。（能）同桔梗、陈皮、木香、苏子、香附、白蔻，治疗上焦壅气胀满因于寒。同黄连、槐花、干葛、防风、荆芥、芍药、黄芩、生地、当归、地榆、侧柏叶，治疗初起的肠风下血，神效。同荆芥、防风、苦参、苍耳草、败蒲，煎汤洗浴，治疗风疹瘙痒。同槟榔、芍药、升麻、葛根、黄连、甘草、红曲、滑石，治疗滞下里急后重。得人参、麦冬，治疗气虚大便不畅。同肉桂，治疗右胁痛。肠风下血，不论远年近日，将枳壳烧黑存性五钱，羊胫炭五钱，研为末，五更天用米饮送服。如人行走五里的时间，再服一次，当天见效。又一方，用枳壳一两，黄连五钱，水一钟，煎至减半，空腹服用。胁肾疼痛，因惊吓伤肝的，用麸炒枳壳一两，桂枝半两，研为细末，每服二钱，姜枣汤送下。
〔论述〕
枳壳与枳实，味苦而辛，苦多辛少，又含有酸意。苦酸涌泄，其气且寒，本是由上降下的性味，更凝结于降令之时，所以取降泄作用的没有超过此物的了。人体的正气，不是可以随意降泄的。适宜降泄的，是正气被邪气所伤，有壅塞之处而不能降。然而壅塞有轻重，虽然总是气病，却有阴阳的不同。如因气影响到血，则是气的阴分受伤，而病在结实，不仅仅是病在无形的阳分。枳实性烈而速，一往无前，凡是无形之气不能详细缓慢消散，而在结实着手之处，才能决断溃散它。枳壳性稍缓，辛味稍多，所以能从统领气的肺，在无形之中疏利它，不以溃决为功效。这一物而分气血的意义，仔细推究于此，就不必执着于所列出的疗效。凡是热伤正气使其不得降，或者湿热为病而不得降的，伏其所伤的邪气而用此作为佐助，以下归于寒水的化生，难道说不宜吗？如果不追究病因，而漫然作为泄滞气的主剂，那就迷惑了。那么，说枳壳治疗心下坚痞，难道不对吗？岂不知肺气不降入心，则胃气病而不能生血，即不能化血。这种泻肺气以下降，乃能使胃气生，遂能化血。以此义思考枳壳的作用，不同于枳实的溃坚决壅，难道不是这样吗？其治疗胁痛，是因为两胁为肝胆所经过的地方，苦中有酸，自然能降肝胆的逆气，所谓得到降令的金气以平木气，道理确实不差。大抵治疗气之不降，适宜于气为热伤的，如果是寒湿滞气，则温散而气自行，否则寒湿久留化热的……缪氏认为，肺气虚弱者，忌用。脾虚中气不运，而痰壅喘急者，忌用。咳嗽不因气壅的，服用反而加重。若阴虚火嗽的，立即导致危殆。胎前产后都不适宜。古人八九月服用瘦胎饮，乃是奉养太过而气实的人，不可混用。
〔修治〕
产于江右（江西）的为好。选取翻肚如盆口状的，其气味辛苦而腥，并有隙油的。陈久的为上品。去瓤，麸炒，待麸皮黑焦时取出使用。
【枳实】
味苦、酸、辛。气寒。气味俱浓，属沉，属阴。入足阳明、太阴经。消实痞，破坚积，除胸胁痰癖，逐停水。（蜜炙则破水积）散逆气，治疗心下急痞痛、胀满胁风痛，并消宿食败血，除寒热结，去胃中湿热。大概脾胃气滞，则不能运化精微，而痰癖停水、结实胀满，由此而来。胃的上口，叫贲门。贲门与心相连，胃气壅则心下也自然急痞痛。邪塞中焦，则升降不舒而气上逆。肝木郁于地下，则不能条达而胁痛。得到其破散冲走的力量，则诸证悉除。（仲淳）洁古用其逐脾经积血，因为脾无积血，则心下不痞。滑窍破气之药，其泻痰有冲墙倒壁之力。（丹溪）心下痞及宿食不消，并宜用枳实配黄连。脾胃湿热生痰，有积的，加入白术的四分之一。（丹溪）张仲景治疗心下坚大如盘的水饮，用枳实七枚，白术三两，水一斗，煎取三升，分三次服。腹中……枳实安胃气止溏泄，如伤寒下腹胀实结有承气汤，治胸中痞痛有陷胸汤，洁古疗心下痞满有枳术丸诸法。壅滞既去，则胃气自安，溏泄亦止矣。（仲淳）益气则佐以参、术、干姜，破气则佐以硝、黄、牵牛。加苍术则气清膈宽，并麦芽而和中消导。合芩、连清湿中之热，同二陈化痰涎之壅。同三棱、蓬术、青皮、槟榔，为消磨坚积之剂。然须脾健能食方可用。同白术、陈皮、浓朴、砂仁、甘草，为枳术丸，治疗心下痞满因于食。
〔论述〕
枳实本具苦寒下行之性，禀受降令乘旺之气，其就下至阴。气烈而速。凡热邪结于……其阴完而阳伤之也。无形而痛的，是其阳完而阴伤之也。然而有痞而坚大的，乃阴邪有以结阳，受病在阳，宜健阳，如张仲景枳实白术之治，用枳实所以助阳之健。有痞而痛急的，乃阳邪有以结阴，受病在阴，宜清阴，如洁古黄连枳实之治，用枳实所以助阴之清。审察此理，则枳实虽入阴分，而邪之分阴阳者，又当从而消息之矣。
此药性专消泄，破气损真。凡中气虚寒，劳倦伤脾，发为痞满的，必不可用。胀满非实邪结于中下焦，手不可按，七八日不大便的，必不可用。挟热下痢，非燥粪留结的，必不可用。伤食停积，多因脾虚不能运化，如元气壮实有积滞的，不得已用一二剂，病已即去之。（仲淳）
〔辨治〕
选择如鹅眼状，并年久色黑的用。微绿的不堪入药。
[Differentiation of Orange, Zhi (Bitter Orange), Mandarin, and Kumquat]
The leaves of the orange tree have two notches. The leaves of Zhi (Bitter Orange) resemble them. Both the mandarin and Zhi trees are thorny, and their leaves are pointed at both ends; they do not have a single leaf with two notches like the orange leaf. It is said that mandarin leaves turn into Zhi leaves over time, which is incorrect. The kumquat tree is no different from the mandarin, except for having fewer thorns. Thus, the distinction between kumquat and mandarin lies in the presence or absence of thorns; the distinction between mandarin and orange/Zhi lies in the morphology of the leaves.
Zhi is the fruit of the tree. Later generations, because the smaller fruit has a fierce and rapid nature, called the older and larger one "Zhi Qiao" (Pericarpium Citri Reticulatae). They are originally the same substance. Zhi Qiao is large, yellow-purple in color, and has much pulp. Zhi Shi (Fructus Aurantii) is small, green in color, solid inside with little pulp. Zhi Qiao governs the upper part (high), while Zhi Shi governs the lower part (low). The one governing the upper regulates Qi, and the one governing the lower regulates Blood. Qi disorders are mostly in the chest and diaphragm, while Blood disorders are mostly in the heart and abdomen.
[Discussion]
Zhi Shi and Zhi Qiao differ in the fierceness and mildness of their Qi due to different harvesting times. The Zhi tree produces white flowers in spring and fruits in autumn. The medicinal Qi condenses in early autumn, which is the time when "descending" is the primary function. Zhi Shi is harvested in July and August, taking advantage of the prosperous Qi of Metal, so its descending action is very fierce. Zhi Qiao is harvested in September and October, when the Qi of Metal begins to recede and dissipate, so its nature naturally becomes milder.
[Zhi Qiao]
Taste: Bitter, Pungent, Sour. Nature: Slightly Cold. The Qi is dense, the taste is thin; it has floating/rising and descending properties, belonging to the sinking category, and is Yin. Enters the Lung, Stomach, Large Intestine, and Liver meridians. Primarily drains Lung organ Qi, widens and unblocks stagnant Qi in the Large Intestine, chest, and abdomen; treats empty distension in both hypochondria, obstruction in the esophagus/diaphragm, descends Qi and relieves chest stuffiness, as well as pulmonary edema, wind-hemorrhoids of the Large Intestine, dysentery with tenesmus. It can eliminate various miasmas. Zhi Qiao breaks Qi, overcomes dampness, and transforms phlegm, but excessive use damages the highest Qi in the chest; it should only be taken for 2-3 doses. For those with robust constitution and stabbing pain due to Qi stagnation, one must determine which meridian and region are affected and guide it with other herbs. (Jiegu) Zhu Gong treated Pi syndrome (痞证 - glomus/stuffiness) by first using Jiegeng Zhiqiao Tang (Platycodon and Bitter Orange Decoction), one lifting and one descending. This is likely because he knew that Qi was about to sink due to improper purgative treatment, so he used this formula first to prevent Pi syndrome, rather than treating an already established Pi. If used after Pi has formed, it will not only fail to resolve the Pi but also damage the Qi in the chest. (Haogu) Zhi Qiao guides and disperses Wind-stagnant Qi and can be taken regularly, unlike Zhi Shi which breaks through obstructions and resolves accumulations. (Yanyi) Both Qiao and Shi can benefit Qi; when Qi descends, phlegm-wheezing stops; when Qi moves, stuffiness and distension vanish; when Qi flows freely, stabbing pain is removed; when Qi benefits, tenesmus heals. This led later scholars to distinguish Qiao as treating the high and Shi as treating the low. However, Zhang Zhongjing used Zhi Shi to treat Chest Bi (胸痹 - chest impediment) and Pi fullness, while other formulas use Zhi Qiao to treat lower bleeding, hemorrhoids, dysentery, intestinal constipation, and tenesmus. Therefore, Zhi Shi does not only treat the lower, nor does Zhi Qiao only treat the high. (From the nose orifices to the anus, all are governed by the Lung; the Triple Burner is connected, consisting of only one Qi.) Zhi Qiao has slow-moving Qi and a mild nature, not rushing downward; it enters the chest, diaphragm, Lung, and Stomach regions, extending to the Large Intestine. It is not like Zhi Shi, whose Qi is complete and nature rapid, with unrestrained descending power.
To harmonize the Middle, it must be combined with Jiegeng (Platycodon Root); to regulate Qi, it is further assisted by Er Chen Tang (Two-Cured Decoction). Because if Qi moves but does not descend, turbid Qi rises causing wheezing, coughing, and abundant Qi; if Qi descends but does not move, clear Qi sinks causing borborygmus and undigested food diarrhea. Thus, there is meaning in combining Zhi, Jiegeng, and Er Chen. Combined with Jiegeng, Chenpi (Aged Tangerine Peel), Muxiang (Costus Root), Su Zi (Perilla Seed), Xiangfu (Cyperus Rhizome), and Ba Dou (White Cardamom), it treats Upper Jiao Qi stagnation and distension due to Cold. Combined with Huanglian (Coptis Rhizome), Huaihua (Sophora Flower), Gange (Kudzu Root), Fangfeng (Saposhnikovia Root), Jingjie (Schizonepeta Spike), Shaoyao (Peony Root), Huangqin (Scutellaria Root), Shengdi (Rehmannia Root), Danggui (Angelica Sinensis), Diyu (Sanguisorba Root), and Cebaiye (Biota Top), it is miraculous for initial intestinal wind bleeding. Combined with Jingjie, Fangfeng, Kushen (Sophora Root), Can'ercao (Xanthium Herb), and Baipu (Decayed Cattail Pollen), decocted for bathing, it treats wind-rash with itching. Combined with Binglang (Areca Seed), Shaoyao, Shengma (Cimicifuga Rhizome), Gegen (Pueraria Root), Huanglian, Gancao (Licorice Root), Hongqu (Red Yeast Rice), and Huashi (Talcum), it treats dysentery with tenesmus. Obtaining Renshen (Ginseng Root) and Maidong (Ophiopogon Tuber) treats Qi deficiency with slow bowel movements. Combined with Rougui (Cinnamon Bark), it treats right hypochondriac pain. For intestinal wind bleeding, regardless of duration, burn 5 qian of Zhi Qiao until black but retaining its nature, mix with 5 qian of Sheep Tibia Charcoal, powder them, and take at dawn with rice water. After walking for the distance a person covers in five li, take another dose; effects appear on the same day. Another prescription: Use 1 liang of Zhi Qiao and 5 qian of Huanglian, decoct in one zhong of water until half remains, take on an empty stomach. For hypochondriac and kidney pain due to fright injuring the Liver, use bran-fried 1 liang of Zhi Qiao and 0.5 liang of Guizhi (Cinnamon Twig), powder finely, take 2 qian per dose with Ginger and Jujube decoction.
[Discussion]
Zhi Qiao and Zhi Shi are bitter and pungent, with more bitter than pungent, containing sour qualities. Bitter and sour induce vomiting and purging; their nature is cold. Originally, they possess a descending nature from above. Since they condense during the descending command period, nothing surpasses this herb for descending and purging functions. Human righteous Qi cannot be arbitrarily descended or purged. What is suitable for descending/purging is when Righteous Qi is injured by Pathogenic Factors, causing obstruction where it cannot descend. Obstruction varies in severity; although always a Qi disorder, it differs in Yin and Yang. If Qi affects Blood, then the Yin aspect of Qi is injured, leading to solid accumulation, not just affecting formless Yang. Zhi Shi is fierce and rapid, advancing straight ahead; where formless Qi cannot slowly disperse, and at the site of solid accumulation, it can break and溃散 (disintegrate) it. Zhi Qiao is slightly slower, with more pungent flavor, so it can soothe and benefit from the Lung, which governs Qi, in the formless realm, without relying on breaking force. This single herb distinguishes the meanings of Qi and Blood. Carefully studying this, one need not rigidly adhere to listed indications. Whenever Heat injures Righteous Qi preventing descent, or Damp-Heat causes pathology preventing descent, suppressing the pathogenic factor and using this as an assistant to return to the transformation of Cold Water, is it not appropriate? If one does not investigate the cause and blindly uses it as the main agent for draining stagnant Qi, one is confused. Then, is it wrong to say Zhi Qiao treats subcardiac hardness and Pi? One must know that if Lung Qi does not descend into the Heart, Stomach Qi becomes diseased and cannot generate or transform Blood. This draining of Lung Qi to facilitate descent enables generation and transformation. Considering the use of Zhi Qiao in this light, how is it not different from Zhi Shi's role in breaking and resolving obstructions? Regarding treating hypochondriac pain, since the hypochondrium is the pathway of the Liver and Gallbladder, the bitterness containing sourness naturally descends the rebellious Qi of the Liver and Gallbladder. This is known as using the Metal of the descending command to level Wood; the principle is indeed sound. Generally, for treating Qi that does not descend, it is suitable for Qi injured by Heat. If it is Cold-Damp stagnant Qi, warming and dispersing allows Qi to move itself; otherwise, if Cold-Damp lingers and transforms into Heat... Miao's school believes those with weak Lung Qi should avoid it. Those with Spleen deficiency, failing to transport Central Qi, with Phlegm obstruction and急促 (rapid) wheezing should avoid it. Cough not due to Qi obstruction worsens with use. Those with Yin deficiency and Fire-cough face immediate danger. It is unsuitable before and after childbirth. Ancients used Shoutai Yin (Fetus-Thinning Decoction) in the 8th and 9th months for those who were overly nourished and had excess Qi; it should not be mixed indiscriminately.
[Processing]
Those produced in Jiangyou (Jiangxi) are good. Select those turned inside out like a basin mouth, with a bitter-pungent and fishy smell, and containing oily gaps. Aged ones are superior. Remove the pulp. Stir-fry with bran until the bran is black and scorched, then use.
[Zhi Shi]
Taste: Bitter, Sour, Pungent. Nature: Cold. Both Qi and Taste are dense; sinking, Yin. Enters the Foot-Yangming and Foot-Taiyin meridians. Dissolves solid Pi, breaks firm accumulations, removes chest/hypochondriac Phlegm-Pi, drives away retained water. (Honey-fried to break water accumulations) Disperses rebellious Qi, treats urgent subcardiac Pi pain, distension, hypochondriac wind-pain, eliminates old food retention and ruined blood, removes Cold-Heat knots, clears Damp-Heat in the Stomach. Basically, if Stomach-Spleen Qi stagnates, it cannot transport and transform fine essences, leading to Phlegm-Pi, retained water, firm accumulation, and distension. The upper opening of the Stomach is called Benmen (Cardia). Benmen connects to the Heart; if Stomach Qi is obstructed, subcardiac urgency and Pi pain occur naturally. Pathogens blocking the Middle Jiao cause uncomfortable ascending/descending and rebellious Qi. Liver Wood depressed below cannot flow smoothly, causing hypochondriac pain. Its breaking, scattering, and rushing power removes all these symptoms. (Zhongchun) Jiegu used it to drive out accumulated blood in the Spleen meridian, because if the Spleen has no accumulated blood, the subcardiac area is not Pi. Slippery orifice-breaking and Qi-breaking drugs have the power to crash through walls and topple battlements in draining Phlegm. (Danxi) Subcardiac Pi and indigestion of old food are suitable for Zhi Shi combined with Huanglian. For Spleen-Stomach Damp-Heat generating Phlegm with accumulation, add 1/4 amount of Baizhu (Atractylodes Macrocephala Rhizome). (Danxi) Zhang Zhongjing treated subcardiac hardness and largeness like a plate of water-drink using 7 pieces of Zhi Shi and 3 liang of Baizhu, decocted in 1 dou of water to yield 3 sheng, divided into three doses. Abdominal... Zhi Shi stabilizes Stomach Qi and stops loose stools; for example, Taiyang disease with lower abdominal fullness and knotting uses Chengqi Tang; treating chest Pi pain uses Xiaoxin Tang; Jiegu treated subcardiac Pi fullness with Zhiju Wan methods. Once obstruction is removed, Stomach Qi naturally calms, and loose stools stop. (Zhongchun) To tonify Qi, assist with Renshen, Baizhu, Ganjiang (Dried Ginger); to break Qi, assist with Xiaoshi (Mirabilite), Dahuang (Rhubarb Root), Qianniu (Pharbitis Seed). Adding Cangzhu (Atractylodes Lancea Rhizome) clears Qi and widens the diaphragm; combining with Maiya (Sprouted Barley) harmonizes the Middle and aids digestion. Combining with Huangqin and Huanglian clears Heat in Dampness; combining with Er Chen Tang drains Phlegm-Saliva obstruction. Combined with Sanleng (Sparganium Rhizome), Pengze (Curcuma Zedoaria Rhizome), Qingpi (Green Tangerine Peel), and Binglang, it forms a formula to grind down firm accumulations. However, it can only be used if the Spleen is strong and appetite exists. Combined with Baizhu, Chenpi, Houpo (Magnolia Bark), Sharen (Amomum Fruit), and Gancao, it forms Zhiju Wan, treating subcardiac Pi fullness due to food.
[Discussion]
Zhi Shi inherently possesses bitter-cold descending nature, inheriting the prosperous Qi of the descending command, tending toward the lower and extreme Yin. Its Qi is fierce and rapid. Whenever Heat pathogens knot in... If Yin is intact and Yang is injured... Formless pain indicates Yang is intact and Yin is injured. However, Pi that is hard and large indicates Yin pathogens knotting Yang, with pathology in Yang; it should strengthen Yang, such as Zhang Zhongjing's Zhi Shi Baizhu treatment, using Zhi Shi to assist in strengthening Yang. Pi that is painful and urgent indicates Yang pathogens knotting Yin, with pathology in Yin; it should clear Yin, such as Jiegu's Huanglian Zhi Shi treatment, using Zhi Shi to assist in clearing Yin. Examining this, although Zhi Shi enters the Yin branch, regarding the differentiation of pathogens into Yin and Yang, one must consider and adjust accordingly.
This drug specializes in dissolving and draining, breaking Qi and damaging True Qi. It must absolutely not be used for Central Qi deficiency and Cold, fatigue injuring the Spleen, manifesting as Pi fullness. Distension not caused by solid pathogens knotting in the Middle/Lower Jiao, where hands cannot press, and no bowel movement for 7-8 days, must absolutely not be used. Dysentery with Heat, not caused by dry feces retention, must absolutely not be used. Food injury and stagnation often result from Spleen deficiency failing to transport and transform; only if Yuan Qi is robust and there is stagnation, use 1-2 doses out of necessity, and stop immediately after the illness resolves. (Zhongchun)
[Differentiation and Treatment]
Select those resembling goose eyes and dark from age. Those slightly green are unsuitable for medicine.