全禀地中火土燥烈之气，兼得乎天之热气，故其气味皆大辛大热，微兼甘苦，而有
大毒。气浓味薄，阳中之阴，降多升少，浮中有沉，无所不至，入手厥阴命门，手少阳
三焦，兼入足少阴太阴经，其性走而不守，为峻补元阳，而除风寒湿三邪之要药。
附子母为乌头，附生者为附子，连生者为侧子，细长者为天雄，两岐者为鸟喙，五
物同出异名。以川产皮黑体圆底平，重一两以上者佳。大者力大，小者力微，宜制熟
用，方多补益。主五脏沉寒，四肢厥逆，壮元阳元火，散阴湿阴寒，功专走而莫守，引
诸药通行诸经，暖腰膝，健步坚筋骨，强阴。三阴寒毒非此不回，三阳厥逆舍此莫
挽，风寒咳逆邪气，温中破 坚积聚，寒湿痿 拘挛，冷弱脚疼膝痛，腰脊心腹冷痛，
霍乱转筋，下痢中寒，中风，气厥，痰厥，阴毒腹痛，寒疟风痹；虚人隔噎肿胀，寒痛
麻痛，奔豚，暴泻脱阳，脾泄久痢，虚阳上浮，阴寒在下，肾厥头痛，阳虚血证，小儿
惊慢，痘疮灰白，痈疽不敛，一切沉寒痼冷之症，并不可缺。如阴经真中真寒，生附投
剂可御。孕妇忌用，堕胎甚速。乌头者，即附子之母也，或云春采为乌头，冬采为附子，
非也。附子性重滞，温脾以逐寒。乌头性轻疏，温脾以祛风。寒症用附子，风症用
乌头，均补下焦，治各稍异。乌圆尖，吐风痰，治癫痫，取其锐气，直达病所。侧子发
散四肢，充达皮毛，治手足风湿诸痹。若天雄者，形大则长，主寒湿冷痹，历节拘挛，
开关利窍，无非取其辛热走窜，与乌头功用相等。有曰∶补虚寒，须用附子；散风湿多
用天雄。有曰∶天雄之性不肯下，就而上行，所以能发散，而补上焦之阳虚；有曰∶
天雄、乌头，气壮性雄，俱是补下焦命门阳虚之药，补下即所以益上也。若上焦阳虚，
乃心肺之分，则为元气之元阳，而非真阳之真火，其补当参 之属矣。岂宜雄附耶？且
乌附性热害走，借以通达沉寒痼闭，温中散寒则可。若欲温而兼补，必君人参，或自本
气分之药，用之而始能。盖阳，即气壮也，热也、行也；阴，即气虚极也；寒也、止
也。惟温补气分之药，可以壮而行之，可以温而达之，温补之法，施于此也。其温热回
阳之功在乌附，而补益元气之功重参术，如温补者有参附汤，术附汤，如平补者有独参
汤、白术膏，从未有独附汤以治沉寒虚脱之症也。盖温经不兼补益，则气弱难以宣通，
虽暂得温行，终多壅滞，况书曰∶引补气药以追失散之元阳，引养血药以扶不足之真
阴，引发散药以逐在表之风邪，引温暖药以祛在里之寒湿，则知随引异功者明矣。更
曰∶熟则峻补，故熟附配麻黄，发中有补，生则发散，故生附配干姜，补中有散，是又
以生熟而有异功矣。若附之无干姜不热，得甘草则性缓，得肉桂则补命门，此一定之成
法。其变通之妙，存乎其人。若以附子大热，大黄大寒，疑忌不用，则遇极寒极热之
危症，将何大力之药挽回垂绝乎！善用兵者天下无弱卒，善用药者天下无毒味。故书
曰∶病缓而用急药，急则拂乱其经；病剧须用急药。缓收援生不及。况病有虚而寒，有
虚而热，从未有寒而不虚者，是以治热有凉补、有凉泻，而治寒必温补相兼，风可发
散，从尽寒日，温中救里也。
主治（痘疹合参） 主沉寒四肢厥逆。凡痘寒不起，泄泻不止，灰白痒塌，寒战咬
牙，气虚沉寒之症并用。宜以童便湿粗纸包裹，慢火中煨令极熟，方去皮脐，切作十字
样四块，再以防风甘草黑豆煎汤，乘热浸过晒干用，或单以三味煎浓汁煮透用，亦可不
必用童便浸煨也。盖过制则性太缓耳。
按∶附子禀雄壮之质，有斩关之能，必重用参术驾驱，不则为祸不小。试思古人参
附， 附、术附等汤，其理可见。譬如虽勇将当先，必军粮继后，方能成功矣。是以丹
溪曰∶气虚热甚者稍加附子，以行参 之功，肥大多湿亦用。《集验》曰∶肿因积生，
积去而肿再作，若再用利药，小肿愈闭，医多束手，盖中焦气不升降，为寒所隔，惟服
附子，小便自通，吴绶曰∶伤寒传变三阴，及中寒夹阴，身虽大热，而脉沉者必用附
子，厥冷腹痛，脉沉细，唇青囊缩者，急用之，有起死之功。近人不明病情，复昧药
性，持疑不用，直至阴极阳竭而后用，用亦迟矣。殊不知书云∶阳气一分不尽则不死，
要知阳者，人生之根本而挽回垂绝之要领，亦虚寒对症之常药，何足矜疑？惟阴虚内
热，及内真热而外假寒者，不可误服。（宜于肉桂按内参看）。
附子完全禀受了地中火土燥烈之气，又兼得天之热气，所以它的气味都是大辛大热，略微带有甘苦味，并且有大毒。它的药气浓厚而药味较薄，属于阳中之阴，沉降作用多于升浮作用，在浮中有沉的特性，药力无所不到，主要进入手厥阴心包经和命门、手少阳三焦经，同时兼入足少阴肾经和足太阴脾经。它的药性走窜而不守静，是峻补元阳（人体最根本的阳气），并祛除风、寒、湿三种邪气的关键药物。
附子的母体是乌头，单独生长出来的称为附子，连带生长的称为侧子，细长形状的称为天雄，分叉成两岐形状的称为鸟喙，这五种药材同出一源但名称不同。以四川产、皮黑、形体圆、底部平坦、重量在一两以上的为佳。大的附子药力强劲，小的附子药力微弱，应当经过炮制煮熟后使用，这样多具有补益功效。它主治五脏深处的沉寒，四肢厥冷逆乱，能壮旺元阳元火，消散阴湿阴寒。其功效专门在于走窜而不守静，能引导其他药物通行于各条经络，温暖腰膝，强健步履，坚固筋骨，强固阴精。三阴经的寒毒非此药不能回阳救逆，三阳经的厥逆证候舍此药不能挽回。对于风寒引起的咳嗽气逆、邪气滞留，温中散寒、破除坚积，寒湿导致的痿软、拘挛，冷痛引起的脚疼膝痛，腰脊心腹冷痛，霍乱转筋，下痢中寒，中风，气厥，痰厥，阴毒腹痛，寒疟，风痹；虚人出现的隔噎肿胀，寒痛麻痛，奔豚气，暴泻脱阳，脾泄久痢，虚阳上浮，阴寒在下，肾厥头痛，阳虚导致的血证，小儿惊风慢脾，痘疮颜色灰白，痈疽不收敛，一切沉寒痼冷（深重顽固的寒症）的症状，都不可缺少的药物。如果是阴经真中真寒的证候，生附子投药可以抵御寒邪。孕妇忌用，会导致堕胎且速度很快。
乌头就是附子的母体。有人说春天采摘的是乌头，冬天采摘的是附子，这种说法是不对的。附子药性重浊滞涩，温脾以驱逐寒邪。乌头药性轻扬疏达，温脾以祛除风邪。寒症用附子，风症用乌头，两者都补益下焦，但治疗侧重略有不同。乌头形状圆尖，能吐出风痰，治疗癫痫，取其锐利之气，直达病所。侧子发散于四肢，充盈皮毛，治疗手足风湿等各种痹症。至于天雄，形体大而长，主治寒湿冷痹，历节疼痛拘挛，开通关窍，无非是取其辛热走窜的特性，与乌头的功用相等。有人说：补虚寒，须用附子；散风湿多用天雄。有人说：天雄的药性不肯下行，反而向上运行，所以能发散，并补益上焦的阳虚；有人说：天雄、乌头，气壮性雄，都是补益下焦命门阳虚的药物，补下焦即所以益上焦。如果上焦阳虚，那是心肺的分野，属于元气中的元阳，而非真阳中的真火，其补益应当用人参之类的药物了。哪里适宜用雄烈的附子呢？况且乌头和附子性热且有害走窜之弊，借它们来通达沉寒痼闭，温中散寒是可以的。如果想要温补兼施，必须用人参作为君药，或者从本气分的药物入手，使用之后才能做到。所谓阳，就是气壮、热、行；阴，就是气虚极、寒、止。只有温补气分的药物，才可以使其壮盛而行，可以使其温通而达，温补的方法，就应用在这里。其温热回阳的功效在于乌附，而补益元气的功效重在参术。如温补的方剂有参附汤、术附汤，如平补的方剂有独参汤、白术膏，从来没有单用附子汤来治疗沉寒虚脱症状的。因为温经如果不兼补益，那么气弱难以宣通，虽然暂时得到温通，最终多有壅滞。况且医书说：引导补气药以追回失散的元阳，引导养血药以扶持不足的真阴，引导发散药以驱逐在表的风邪，引导温暖药以祛除在里的寒湿，由此可知随证引经的不同功效是很明显的。又说：熟附子峻补，所以熟附配麻黄，发汗中有补益；生附子发散，所以生附配干姜，补益中有发散，这是又因生熟不同而有不同的功效。如果附子没有干姜就不够热，得到甘草则药性缓和，得到肉桂则补命门，这是一定的成法。其变通的奥妙，存乎使用者的心智。如果因为附子大热、大黄大寒而怀疑忌讳不用，那么遇到极寒极热的危重病症，将用什么大力量的药物来挽回垂绝的生命呢？善于用兵的人，天下没有弱兵；善于用药的人，天下没有毒药。所以医书说：病情缓慢性急药，会扰乱经脉；病情剧烈必须用急药。病情缓慢性急药收效援救生命来不及。况且病有虚寒，有虚热，从来没有寒而不虚的情况，所以治热有凉补、有凉泻，而治寒必温补兼施，风邪可发散，从尽寒日（冬至等极寒之日）温中救里。
主治（痘疹合参）：主治沉寒导致的四肢厥逆。凡是痘疮因寒不起发，泄泻不止，颜色灰白瘙痒塌陷，寒战咬牙，气虚沉寒的症状，都用此药。宜用童子尿浸湿粗纸包裹，在慢火中煨至极熟，然后去皮脐，切成十字样四块，再用防风、甘草、黑豆煎汤，趁热浸泡过后晒干使用，或者单用这三味药煎浓汁煮透使用，也可以不必用童子尿浸泡煨制。因为过度炮制则药性太缓慢。
按语：附子禀赋雄壮的本质，有斩关夺隘的能力，必须重用参、术来驾驭，否则就会造成不小的祸患。试看古人使用的参附、附术等汤剂，其中的道理可见一斑。譬如虽然是勇将打先锋，必须有军粮在后面继进，才能成功。所以朱丹溪说：气虚发热严重的稍加附子，以推行人参的功效，肥大多湿的人也适用。《集验》说：肿胀因积滞产生，积滞去除后肿胀再发，如果再用利水药，小肿会更加闭塞，医生多束手无策，这是因为中焦气机不升降，被寒邪阻隔，只有服用附子，小便自然通畅。吴绶说：伤寒传变至三阴，以及中寒夹阴，身体虽然大热，但脉象沉者必须用附子，四肢厥冷腹痛，脉象沉细，嘴唇青紫、阴囊收缩的，急用附子，有起死回生的功效。近代人不明白病情，又糊涂药性，持疑不用，直到阴极阳竭之后才用，用的时候也晚了。殊不知医书说：阳气一分不尽则不死，要知道阳气是人生的根本，也是挽回垂绝生命的关键要领，也是虚寒对症的常药，有什么值得矜持怀疑的呢？只有阴虚内热，以及内真热而外假寒的证候，不可误服。（宜参考肉桂条目下的内参内容）。
Fuzi (Aconiti Lateralis Radix Praeparata) completely inherits the dry and fierce qi of fire and earth in the ground, and additionally receives the hot qi from heaven. Therefore, its flavor is greatly pungent and hot, slightly sweet and bitter, and possesses great toxicity. Its qi is dense while its taste is thin; it belongs to yin within yang, with descending action predominating over ascending, floating yet containing sinking qualities, reaching everywhere. It enters the Hand Jueyin Pericardium Meridian and Mingmen (Gate of Vitality), the Hand Shaoyang Sanjiao Meridian, and concurrently enters the Foot Shaoyin Kidney Meridian and Foot Taiyin Spleen Meridian. Its nature is mobile and unstatic, making it a crucial herb for vigorously tonifying Yuan Yang (the body's fundamental Yang energy) and expelling Wind, Cold, and Dampness pathogens.
The mother plant of Fuzi is Wutou (Aconiti Radix). The one growing separately is called Fuzi; those growing attached are called Cizi (Aconiti Lateralis Radix); the slender ones are called Tianxiong (Aconiti Radix); those bifurcated into two prongs are called Wuhui (Aconiti Radix). These five substances originate from the same source but have different names. Those produced in Sichuan, with black skin, round shape, flat base, and weighing more than one tael, are considered superior. Larger Fuzi has stronger potency, while smaller ones have weaker potency. They should be processed and cooked before use, which enhances their tonifying effects. It primarily treats deep-seated cold in the five zang organs and cold reversal of the four limbs; it strengthens Yuan Yang and Yuan Fire, dissipates Yin-dampness and Yin-cold. Its efficacy specializes in moving without staying static, guiding other herbs to circulate through all meridians, warming the waist and knees, strengthening gait and bones/tendons, and fortifying Yin. For cold toxins in the Three Yin meridians, only this herb can restore Yang; for cold reversal in the Three Yang meridians, no other herb can rescue the condition. It treats wind-cold cough and adverse Qi, warms the middle jiao, breaks up hardness and accumulations, treats cold-damp flaccidity and spasms, cold pain in feet/knees, cold pain in waist/spine/heart/abdomen, cholera with tendon twitching, dysentery due to middle-jiao cold, stroke, Qi syncope, Phlegm syncope, Yin-toxin abdominal pain, cold malaria, wind-bi syndrome; for deficiency patients with dysphagia/swelling, cold pain/numbness, Ben Tun (rushing pig qi), sudden diarrhea with Yang collapse, spleen diarrhea with chronic dysentery, floating deficient Yang, Yin-cold below, Kidney-Jue headache, Yang-deficiency blood disorders, pediatric convulsions/slow spleen, gray-white pustules, non-healing carbuncles/fistulas, and all symptoms of deep-seated stubborn cold, it is indispensable. In cases of true invasion and true cold in the Yin meridians, raw Fuzi can be used to resist the pathogen. Pregnant women must avoid it as it causes abortion rapidly.
Wutou is the mother of Fuzi. Some claim spring harvest yields Wutou and winter harvest yields Fuzi, which is incorrect. Fuzi has a heavy and stagnant nature, warming the Spleen to drive out Cold. Wutou has a light and dispersing nature, warming the Spleen to dispel Wind. For Cold syndromes, use Fuzi; for Wind syndromes, use Wutou. Both tonify the Lower Jiao, but their therapeutic focuses differ slightly. Wutou is round and pointed, expectorates Wind-Phlegm, treats epilepsy, utilizing its sharp Qi to reach the disease site directly. Cizi disperses to the four limbs and fills the skin/hair, treating various Bi syndromes of the hands and feet due to Wind-Dampness. Tianxiong is large and long, treating cold-damp cold-Bi, joint pain and spasms, opening orifices and benefiting cavities, relying on its pungent-hot moving properties, equal in function to Wutou. Some say: to tonify deficiency-cold, use Fuzi; to disperse Wind-Dampness, use Tianxiong. Others say: Tianxiong’s nature refuses to descend and moves upward, thus it can disperse and tonify Upper Jiao Yang deficiency. Still others say: Tianxiong and Wutou have vigorous Qi and heroic nature, both are herbs tonifying Lower Jiao Mingmen Yang deficiency; tonifying the lower benefits the upper. If Upper Jiao Yang deficiency occurs (involving Heart and Lung), it pertains to Yuan Yang of Yuan Qi, not the True Fire of True Yang; tonification should involve herbs like Renshen (Ginseng). Why use heroic Fuzi? Moreover, Wutou and Fuzi are hot and harmful if they move recklessly; borrowing them to penetrate deep-seated cold and stubborn closure is acceptable for warming the middle and dispersing cold. However, if one desires warming combined with tonification, Renshen must be the sovereign herb, or herbs acting on the fundamental Qi level, to achieve this. Yang refers to vigorous Qi, heat, and movement; Yin refers to extreme Qi deficiency, cold, and stagnation. Only herbs that warm and tonify the Qi level can make it vigorous and moving, warm and penetrating. This is where the method of warming and tonifying applies. Their function of warming and restoring Yang lies in Wutou and Fuzi, while their function of tonifying Yuan Qi relies heavily on Renshen and Baizhu. For example, warming-tonifying formulas include Shenfu Tang (Ginseng and Aconite Decoction) and Zhufu Tang (Atractylodes and Aconite Decoction); mild-tonifying formulas include Dushen Tang (Single Ginseng Decoction) and Baizhu Gao (Atractylodes Paste). There is never a case of using single Fuzi Decoction to treat deep-cold deficiency collapse. Because warming meridians without tonification means weak Qi cannot circulate freely; although temporary warmth may occur, stagnation often remains. As the books state: guide Qi-tonifying herbs to chase lost Yuan Yang; guide Blood-nourishing herbs to support insufficient True Yin; guide dispersing herbs to expel exterior Wind pathogens; guide warming herbs to remove interior Cold-Dampness. Thus, the distinct merits of guiding herbs are clear. Furthermore: cooked Fuzi vigorously tonifies, so cooked Fuzi paired with Mahuang (Ephedra) provides tonification within dispersion; raw Fuzi disperses, so raw Fuzi paired with Ganjiang (Dried Ginger) provides dispersion within tonification. This shows different efficacies based on raw vs. cooked states. If Fuzi lacks Ganjiang, it is not hot enough; with Gancao (Licorice), its nature becomes mild; with Rougui (Cinnamon Bark), it tonifies Mingmen. These are established rules. The subtlety of variation depends on the practitioner. If one avoids Fuzi (greatly hot) and Dahuang (greatly cold) due to suspicion, how will one rescue critical conditions of extreme cold or heat? A skilled soldier makes no weak troops; a skilled physician sees no toxic herbs. Thus, books say: using urgent drugs for slow diseases disturbs the meridians; severe diseases require urgent drugs. Slow response fails to save life. Diseases can be deficiency-cold or deficiency-heat, but there is never cold without deficiency. Therefore, treating heat involves cooling-tonification or cooling-purgation, while treating cold requires warming-tonification combination. Wind can be dispersed; during extreme cold days, warm the middle and rescue the interior.
Main Indications (Combined Analysis with Smallpox/Rashes): Treats deep-cold causing cold reversal of four limbs. Used for any smallpox/rash cases failing to erupt due to cold, unremitting diarrhea, gray-white color with itching/collapse, chattering teeth due to cold, and Qi-deficiency deep-cold syndromes. It is best wrapped in coarse paper moistened with child’s urine, slowly roasted over low fire until thoroughly cooked, then peel off skin and umbilical scar, cut into four cross-shaped pieces. Soak in a decoction of Fangfeng (Saposhnikoviae Radix), Gancao (Licorice Root), and Heidou (Black Soybean) while hot, then dry and use. Alternatively, boil thoroughly in a concentrated decoction of these three alone, without needing child’s urine soaking. Over-processing makes the nature too mild.
Commentary: Fuzi possesses a heroic quality and the ability to breach gates. It must be driven by heavy doses of Renshen and Baizhu; otherwise, it causes significant harm. Consider ancient formulas like Shenfu Tang and Zhufu Tang; the principle is evident. Like a brave vanguard general, success requires logistical support behind him. Thus, Danxi stated: For Qi deficiency with severe heat, add a little Fuzi to facilitate the action of Renshen; it is also used for obese individuals with much dampness. "Ji Yan" states: Swelling arises from accumulation. If swelling recurs after accumulation is removed, using purgatives again will close minor swelling further, leaving doctors helpless. This is because Middle Jiao Qi fails to ascend/descend, blocked by Cold. Only taking Fuzi allows urination to resume naturally. Wu Shou stated: When Shanghan transmits to the Three Yin meridians, or Cold invades with Yin involvement, even if the body has high fever, if the pulse is deep, Fuzi must be used. For cold reversal, abdominal pain, deep-thin pulse, blue lips, and retracted scrotum, use it urgently; it has the power to revive the dead. Modern practitioners fail to understand disease patterns and drug properties, hesitating to use it until Yin is exhausted and Yang is depleted, at which point usage is too late. They do not know the book says: "As long as a fraction of Yang Qi remains, death does not occur." One must realize Yang is the root of life, the key to rescuing impending death, and a common herb for deficiency-cold indications. What is there to hesitate about? However, it must not be mistakenly taken for Yin deficiency with internal heat, or true internal heat with false external cold. (Refer to the commentary on Rougui for internal details).