栝蒌∶味甘，性凉。能开胸间及胃口热痰，故仲景治结胸有小陷胸汤，栝蒌与连、夏并用；治胸痹有栝蒌
薤白等方，栝蒌与薤、酒、桂、朴诸药并用，若与山甲同用，善治乳痈（栝蒌两个，山甲二钱煎服）；若与赭
石同用，善止吐衄（栝蒌能降胃气胃火故治吐衄）。若但用其皮，最能清肺、敛肺、宁嗽、定喘（须用新鲜者
方效）；若但用其瓤（用温水将瓤泡开，拣出仁，余煎一沸，连渣服之），最善滋阴、润燥、滑痰、生津，若
但用其仁（须用新炒熟者，捣碎煎服），其开胸降胃之力较大，且善通小便。
【附案】邻村高××子，年十三岁，于数日之间，痰涎郁于胸中，烦闷异常，剧时气不上达，呼吸即停，
目翻身挺，有危在顷刻之状。连次用药，分毫无效，敢乞往为诊视，施以良方。时愚有急务未办，欲迟数点钟
再去，彼谓此病已至极点，若稍迟延恐无及矣。于是遂与急往诊视，其脉关前浮滑，舌苔色白，肌肤有热，知
其为温病结胸，俾用栝蒌仁四两，炒熟（新炒者其气香而能通）捣碎，煎汤两茶盅，分两次温饮下，其病顿愈。
隔数日，其邻高
姓童子，亦得斯证，俾用新炒蒌仁三两，苏子五钱，煎服，亦一剂而愈。盖伤寒下早成结胸，温病未经下亦可
成结胸，有谓栝蒌力弱，故小陷胸汤中必须伍以黄连、半夏始能建功者，不知栝蒌力虽稍弱，重用之则转弱为
强，是以重用至四两，即能随手奏效，挽回人命于顷刻也。
栝蒌：味甘，性凉。能够清除胸膈间及胃脘部的热痰，因此张仲景在治疗结胸证（邪热与痰水互结于胸胁的病证）时使用了小陷胸汤，其中栝蒌与黄连、半夏并用；治疗胸痹（胸部闷痛、喘息咳唾的病证）时使用了栝蒌薤白白酒汤等方剂，其中栝蒌与薤白、酒、桂枝、厚朴等药并用。如果栝蒌与穿山甲同用，善于治疗乳痈（乳房急性化脓性感染）（用法：栝蒌两个，穿山甲二钱，煎服）；如果栝蒌与代赭石同用，善于止住吐血和衄血（栝蒌能降泄胃气和胃火，所以能治疗吐衄）。如果只用栝蒌皮，最能清肺、敛肺、止咳、平喘（必须使用新鲜的才有效）；如果只用栝蒌瓤（用温水将瓤泡开，拣出仁，剩下的渣滓再煮一沸，连同渣滓一起服用），最擅长滋阴、润燥、滑利痰液、生津液；如果只用栝蒌仁（必须用新炒熟的，捣碎后煎服），其开胸降胃的力量较大，且善于通利小便。
【附案】邻村高某的儿子，十三岁，在几天之内，痰涎郁积在胸中，烦闷异常，发作剧烈时气机不能上达，呼吸随即停止，眼球上翻，身体挺硬，有危在旦夕的样子。连续多次用药，分毫无效，于是恳请我去诊治，给予良方。当时我有紧急事务未办，想推迟几个小时再去，那人说这个病已经到了极点，如果稍微迟延恐怕就来不及了。于是我立即前往诊视，他的脉象关前浮滑，舌苔色白，肌肤发热，我知道这是温病导致的结胸证，便让他用栝蒌仁四两，炒熟（新炒的香气足且能通利）捣碎，煎成两茶盅汤，分两次温服，病立刻痊愈。过了几天，邻居高家的童子，也得了这种病，让他用新炒的栝蒌仁三两，苏子五钱，煎服，也是一剂就痊愈了。大概伤寒因攻下过早而成结胸，温病未经攻下也可成结胸，有人说栝蒌药力弱，所以小陷胸汤中必须配合黄连、半夏才能建功，不知道栝蒌药力虽然稍弱，但重用则转弱为强，所以我重用至四两，就能随手奏效，在顷刻间挽回人命。
Trichosanthes Fruit (Gualou): Sweet in taste, cool in nature. It can clear heat-phlegm from the chest and epigastrium. Therefore, Zhang Zhongjing used it in Xiao Xianxiong Tang (Small Inhibiting Chest Decoction) for treating Jie Xiong syndrome (a syndrome where pathogenic heat and phlegm-water interlock in the chest and hypochondrium), combining Gualou with Huanglian (Coptis Rhizome) and Banxia (Pinellia Tuber); he also used it in formulas such as Gualou Xiebai Baizhu Tang for treating Xiong Bi syndrome (chest bi-syndrome characterized by chest oppression, pain, wheezing, and coughing with sputum), combining Gualou with Xiebai (Allium Macrostemon Bulb), wine, Guizhi (Cinnamon Twig), Houpo (Magnolia Bark), etc. If combined with Shanjia (Pangolin Scales), it is effective for treating Ru Yong (acute suppurative mastitis) (Usage: two Trichosanthes fruits, 2 qian of Pangolin scales, decocted and taken orally); if combined with Zhe Shi (Hematitum), it effectively stops hematemesis (vomiting blood) and epistaxis (nosebleed) (because Gualou descends stomach qi and stomach fire, thus treating these conditions). If only the peel is used, it is best at clearing the lung, astringing the lung, calming cough, and relieving asthma (fresh ones must be used to be effective); if only the pulp is used (soak the pulp in warm water, remove the seeds, boil the remaining residue for one boil, and take it with the dregs), it excels at nourishing yin, moistening dryness, lubricating phlegm, and generating fluids; if only the seed is used (must be newly stir-fried until cooked, crushed, decocted, and taken), its power to open the chest and descend stomach qi is greater, and it is also good at promoting urination.
[Attached Case] The son of Mr. Gao from the neighboring village, aged thirteen, suffered from phlegm-fluid retention in the chest over a few days, causing extreme restlessness and oppression. During severe episodes, his qi failed to ascend, breathing would stop, his eyes would roll back, and his body would become rigid, appearing critical and on the verge of death. Multiple treatments had been ineffective. They begged me to visit and prescribe a remedy. At that time, I had urgent matters to attend to and wished to delay my visit by a few hours. However, they insisted that the condition was at its peak and any delay might be fatal. Thus, I went immediately to examine him. His pulse was floating and slippery anterior to the guan position; his tongue coating was white; and his skin felt hot. I diagnosed this as Jie Xiong syndrome caused by warm disease. I prescribed four liang of Trichosanthes Seed (Gualou Ren), stir-fried until fresh and fragrant (to enhance its unblocking properties), crushed, and decocted into two teacups of soup, to be taken warm in two doses. The illness was instantly cured. A few days later, a young boy from the same family, Mr. Gao, contracted the same condition. I prescribed three liang of newly stir-fried Trichosanthes Seed and five qian of Perilla Seed (Suzi), decocted and taken. One dose resulted in a cure. Generally, Jie Xiong syndrome arises from premature purgation in cold damage syndromes, or even without purgation in warm disease syndromes. Some argue that Gualou has weak efficacy, so it must be combined with Huanglian and Banxia in Xiao Xianxiong Tang to be effective. They fail to realize that although Gualou's potency is slightly weak, heavy dosage transforms weakness into strength. Therefore, using a heavy dose of four liang allows it to act promptly, saving lives in an instant.