黄连性苦燥大寒。疗诸热湿热。及毒痢。与胃经吐血藏毒下血。佐以他药。最为有功。
然必惟患实热元气
胃气未伤者。用之相宜。但中病即止。亦未可久服也。自本草浓肠胃之言一出。举世医者不
分虚实。拘执
经文。混行施治岂知斯言盖为毒痢积热熏蒸肠胃致肠垢刮削而下用连以解热热既消则肠胃
撤消
而自浓所谓浓肠胃者以此若人赋禀不实。虽有热症。用之则反败胃。渐耗真阳。甚有火衰虚
火之症
而亦妄用何也。故东垣曰实火可泻。芩连之属。虚火可补。参 之属。而薛立斋一部医案
。记其误殁于芩
连苦寒之剂者。不可胜纪。虽然立斋治实火。何曾废芩连不用。所贵乎立斋以异于刘朱者。
为其善甄
别虚实真假。故投药如环。而愈出愈奇耳。经云阳生阴长。无阳则阴无以生。
又云少火生气从未有沉阴无火之属而能生长万物者自此一经唤醒。当勿仍前执迷。
凡诸经实热。宜用苦寒治之。病少愈当即止。否则恐妨胃气。用药须察何经。如黄芩栀
子泻肺火。黄不外
温养阳气。勤培土母。蕃息日昌至精盈血裕真阴复盛而假热虚火不扑自灭若概投以黄柏知母
之属
是阴血未生脾阳先败假热愈炽法窍身殆此非补阴乃贼阴也王太仆云大热而甚。寒之不寒。是
无水也。
宜用六味地黄丸壮水之主。以制阳光。薛立斋云总论阴阳二症。虽有阴阳气血之分。实则皆
因脾胃之
阳气不足所致。若用黄柏知母沉阴之物。反泄真阳。多致不起。则凡苦寒之属。委非阴虚所
宜。设使阴未虚而实热为患。暂用之何害。嗟夫丹溪一代名哲也。而乃不察病本。混同立论
。遗害生民良可慨已。
黄连药性苦燥且大寒。能治疗各种热证、湿热证，以及毒痢。对于胃经引起的吐血、内脏蕴毒导致的便血，配合其他药物使用，最为有效。
然而，必须只在患者患有实热证且元气、胃气尚未受损的情况下，使用才适宜。只要病愈就应停药，也不可以长期服用。自从《本草》中“厚肠胃”的说法出现后，世间的医生不分虚实，拘泥固执于经文，混淆施行治疗。哪里知道这句话原本是针对毒痢积热熏蒸肠胃，导致肠垢刮削而下，用黄连来清热，热既消除则肠胃收缩而自然变厚，所谓的“厚肠胃”就是指的这个意思。如果人体禀赋不实，虽然有热症，使用黄连反而会败坏胃气，逐渐耗损真阳。甚至有火衰虚火的病症，也胡乱使用，这是为什么呢？所以李东垣说：实火可以泻，属于黄芩、黄连这类药；虚火可以补，属于人参这类药。而薛立斋的一部医案中，记载因误服黄芩、黄连苦寒药剂而死的人，数不胜数。虽然如此，薛立斋治疗实火时，何曾废弃黄芩、黄连不用呢？薛立斋之所以不同于刘完素、朱丹溪的地方，在于他善于甄别虚实真假，所以投药如环无端，疗效愈出愈奇罢了。经典说：“阳生阴长”，没有阳就没有阴的生长。又说：“少火生气”，从未有过沉阴无火的事物能够生长万物。从此经唤醒之后，应当不要再像从前那样执迷不悟。
凡是各经的实热证，适宜用苦寒药治疗。病情稍有好转就应立即停药，否则恐怕会妨碍胃气。用药必须察明是哪一经病变。例如黄芩、栀子泻肺火。如果不外乎温养阳气，勤于培补脾土（土为金之母），蕃息日益昌盛，直到精气充盈、血液丰裕、真阴复盛，那么假热和虚火不扑自灭。如果一概投以黄柏、知母这类药物，是阴血未生而脾阳先败，假热更加炽盛，身体几乎危险了。这并非补阴，而是贼害阴精。王太仆说：大热至极，用寒药治不好，这是无水（肾阴亏虚）的表现。适宜用六味地黄丸壮水之主，以制阳光。薛立斋说：总论阴阳两症，虽然有阴阳气血之分，实则都是因为脾胃阳气不足所致。如果使用黄柏、知母这种沉阴的药物，反而泄掉真阳，多导致无法救治。那么凡属苦寒的药物，确实不是阴虚所适宜的。假设阴未虚而实热为患，暂时使用它有什么妨害呢？唉！朱丹溪是一代名哲，却不察病本，混同立论，遗害百姓，实在令人感慨。
Huanglian (Coptidis Rhizoma) is bitter, drying, and extremely cold. It treats various heat syndromes, damp-heat syndromes, and toxic dysentery. For hematemesis originating from the Stomach Meridian and lower bleeding caused by internal toxin accumulation, when used in combination with other herbs, it yields significant merit.
However, it should only be used when the patient suffers from excess heat syndrome and their Yuan Qi (Original Qi) and Stomach Qi have not yet been damaged. It is appropriate to stop using it once the disease is cured; it should not be taken for a long time. Since the statement in the Materia Medica regarding "thickening the intestines and stomach" was published, physicians worldwide, without distinguishing between excess and deficiency, have rigidly adhered to this text and applied treatments indiscriminately. They fail to realize that this statement originally referred to cases where toxic dysentery and accumulated heat steamed and scorched the intestines and stomach, causing intestinal mucus to scrape off and discharge. Using Huanglian to clear heat, once the heat subsides, the intestines and stomach contract and naturally become thicker; thus, "thickening the intestines and stomach" refers to this mechanism. If a person's constitution is deficient, even if there are heat symptoms, using Huanglian will instead damage the Stomach Qi and gradually deplete True Yang. There are even cases of Fire decline and Deficient Fire syndromes where it is recklessly used. Why is this so? Therefore, Li Dongyuan stated: Excess Fire can be purged using herbs like Huangqin (Scutellariae Radix) and Huanglian; Deficient Fire can be tonified using herbs like Renshen (Ginseng Radix et Rhizoma). In Xue Lizhai's medical case records, those who died due to misusing the bitter-cold formulas of Huangqin and Huanglian are too numerous to recount. Nevertheless, when treating Excess Fire, did Xue Lizhai ever abandon the use of Huangqin and Huanglian? The value of Xue Lizhai lies in his distinction from Liu Wansu and Zhu Danji, specifically his skill in differentiating between true and false, excess and deficiency. Thus, his prescription logic is seamless, and his curative effects are increasingly remarkable. The Classics state: "Yang generates, Yin grows"; without Yang, Yin cannot grow. It also states: "Lesser Fire generates Qi." There has never been an entity of profound Yin without Fire capable of generating all things. Awakened by this classic teaching, one should no longer remain obstinate and deluded as before.
For excess heat in any meridian, bitter-cold herbs are suitable. When the condition improves slightly, administration must cease; otherwise, it may hinder Stomach Qi. Medication requires identifying the affected meridian. For instance, Huangqin and Zhizi (Gardeniae Fructus) purge Lung Fire. [Contextual correction based on flow]: If one fails to warm and nourish Yang Qi and diligently cultivate the Earth element (Spleen/Stomach, the mother of Metal), vitality will flourish daily until Essence is abundant, Blood is rich, and True Yin recovers fully, causing False Heat and Deficient Fire to extinguish spontaneously. However, if one indiscriminately administers herbs like Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma), Yin Blood will not be generated while Spleen Yang collapses first, making the False Heat more intense and endangering the body. This is not tonifying Yin but robbing Yin. Wang Taipu said: "Extreme heat that does not respond to cold treatment indicates Water deficiency." One should use Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to strengthen the master of Water to control the Sunlight. Xue Lizhai stated: Regarding the general discussion of Yin and Yang syndromes, although there are distinctions among Yin, Yang, Qi, and Blood, they are essentially caused by insufficient Yang Qi of the Spleen and Stomach. If one uses sinking-yin substances like Huangbai and Zhimu, it will further drain True Yang, often leading to untreatable conditions. Therefore, bitter-cold herbs are indeed unsuitable for Yin deficiency. Assuming Yin is not deficient but Excess Heat is the problem, what harm is there in temporary use? Alas! Zhu Danxi was a renowned philosopher of his generation, yet he failed to examine the root of the disease and conflated his theories, harming the people, which is truly lamentable.