天花粉∶栝蒌根也,色白而亮者佳,味苦微酸,性凉而润。清火生津,为止渴要药(《伤寒论》小柴胡汤,
渴者去半夏加栝蒌根,古方书治消渴亦多用之)。为其能生津止渴,故能润肺,化肺中燥痰,宁肺止嗽,治肺
病结核。又善通行经络,解一切疮家热毒,疔痈初起者,与连翘、山甲并用即消,疮疡已溃者,与黄 、甘草
(皆须用生者)并用,更能生肌排脓,即溃烂至深旁串他处,不能敷药者,亦可自内生长肌肉,徐徐将脓排出
(有案附载黄 解下可参观)。大凡藤蔓之根,皆能通行经络,而花粉又性凉解毒,是以有种种功效也。
干姜,味辛,性热。为补助上焦、中焦阳分之要药。为其味至辛,且具有宣通之力,与浓朴同用,治寒饮
杜塞胃脘,饮食不化;与桂枝同用,治寒饮积于胸中,呼吸短气;与黄 同用,治寒饮渍于肺中,肺痿咳嗽;
与五味子同用,治感寒肺气不降,喘逆迫促;与赭石同用,治因寒胃气不降,吐血、衄血;与白术同用,
治脾寒不能统血,二便下血,或脾胃虚寒,常作泄泻;与甘草同用,能调其辛辣之味,使不刺戟,而其温补之
力转能悠长。《神农本草经》谓其逐风湿痹,指风湿痹之偏于寒者而言也,而《金匮》治热瘫痫,亦用干姜,
风引汤中与石膏、寒水石并用者是也。此乃取其至辛之味,以开气血之凝滞也。有谓炮黑则性热,能助相火
者,不知炮之则味苦,热力即减,且其气轻浮,转不能下达。
徐灵胎曰∶“凡味浓之药主守,气浓之药主散,干姜气味俱浓,故散而能守。夫散不全散,守不全守,则
旋转于经络脏腑之间,驱寒除湿、和血通气所必然矣,故性虽猛峻,不妨服食。”
【附案】邻村高某年四十余,小便下血,久不愈。其脉微细而迟,身体虚弱恶寒,饮食减少。知其脾胃虚
寒,中气下陷,黄坤载所谓血之亡于便溺者,太阴不升也。为疏方∶干姜、于术各四钱,生山药、熟地各六钱,
乌附子、炙甘草各三钱,煎服一剂血见少,连服十余剂全愈。
天花粉:即栝蒌根,颜色白而光亮者品质佳,味道苦微酸,性质凉润。具有清火生津的功效,是治疗口渴的重要药物(《伤寒论》中的小柴胡汤,若患者口渴则去掉半夏加入栝蒌根,古代方书治疗消渴症也多用此药)。因为它能生津止渴,所以能够润肺,化解肺中的燥痰,安定肺气以止咳,治疗肺部结核。此外,它善于通行经络,解除各种疮疡患者的热毒,对于疔疮痈肿初起者,与连翘、穿山甲同用即可消散;对于已经溃破的疮疡,与生黄芪、生甘草同用,更能促进肌肉生长并排出脓液,即使溃烂深重且向周围蔓延无法外敷药物的情况,也能从内部生长肌肉,缓慢将脓液排出(相关医案附在黄芪条解下可供参考)。大凡藤蔓类的根部,都能通行经络,而天花粉又兼具性凉解毒的特性,因此拥有种种功效。
干姜:味道辛,性质热。是补助上焦和中焦阳分的重要药物。因为它的味道极辛,且具有宣通之力,与厚朴同用,可治疗寒饮阻塞胃脘、饮食不消化的病症;与桂枝同用,可治疗寒饮积聚于胸中导致的呼吸短气;与黄芩同用,可治疗寒饮浸渍于肺中引起的肺痿咳嗽;与五味子同用,可治疗因受寒导致肺气不降、气喘急促的病症;与代赭石同用,可治疗因寒导致胃气不降引起的吐血、鼻衄;与白术同用,可治疗脾寒不能统摄血液导致的二便下血,或脾胃虚寒常作泄泻的病症;与甘草同用,能调和其辛辣之味,使其不产生刺激,而其温补之力反而更加持久悠长。《神农本草经》说它能驱除风湿痹痛,指的是针对偏于寒性的风湿痹证而言;而《金匮要略》治疗热瘫痫时,也使用干姜,例如风引汤中与石膏、寒水石同用的情况。这是取其极辛的味道,来开通气血的凝滞。有人说炮制变黑后性质更热,能助长相火,却不知道炮制后味道变苦,热力即会减弱,且其气味轻浮,反而不能下达下焦。
徐灵胎说:“凡是味道浓厚的药物主要起守中的作用,气味浓厚的药物主要起发散作用,干姜气味都浓厚,所以既能发散又能固守。发散而不完全发散,固守而不完全固守,从而旋转于经络脏腑之间,驱寒除湿、和血通气是其必然的效果,所以虽然药性猛烈峻急,不妨碍服用。”
【附案】邻村高某,四十多岁,小便下血,久治不愈。其脉象微细而迟,身体虚弱怕冷,饮食减少。判断为脾胃虚寒,中气下陷,正如黄坤载所说,大小便出血是因为太阴脾土不升。于是开具处方:干姜、白术各四钱,生山药、熟地黄各六钱,乌附子、炙甘草各三钱,煎服一剂后见血量减少,连续服用十余剂后痊愈。
Tianhuafen (Trichosanthes Root): This is the root of Trichosanthes kirilowii. Those that are white and lustrous are of superior quality. It tastes bitter with a slight sourness, and its nature is cool and moistening. It clears fire and generates fluids, making it an essential herb for relieving thirst (In Xiaochaihu Tang from Shanghan Lun, Banxia is removed and Gualougen [Tianhuafen] is added if the patient is thirsty; ancient formularies also frequently used it to treat Xiaoke [wasting-thirst syndrome]). Because it can generate fluids and stop thirst, it can moisten the lungs, resolve dry phlegm in the lungs, calm lung Qi to stop coughing, and treat pulmonary tuberculosis. Furthermore, it excels at unblocking meridians and collaterals, resolving heat-toxin in all types of sores and ulcers. For early-stage Dingyong (carbuncles and furuncles), when used together with Lianqiao (Forsythiae Fructus) and Shan Jia (Pangolin Scales), it can dissipate the swelling. For already ulcerated sores, when used together with Sheng Huangqi (Astragali Radix) and Sheng Gancao (Glycyrrhizae Radix et Rhizoma), it can further promote tissue regeneration and expel pus. Even in cases of deep ulceration spreading to surrounding areas where external application is impossible, it can regenerate muscle tissue from within and slowly expel pus (see the case study attached under the explanation of Huangqi). Generally, roots of vine plants can unblock meridians and collaterals, and since Tianhuafen has a cool nature and detoxifying properties, it possesses various efficacies.
Ganjiang (Dried Ginger): It tastes pungent and its nature is hot. It is an essential herb for tonifying the Yang aspect of the Upper and Middle Jiao. Due to its intense pungency and dispersing power, when used with Houpo (Magnoliae Officinalis Cortex), it treats cold-fluid retention obstructing the epigastrium and indigestion; when used with Guizhi (Cinnamomi Ramulus), it treats cold-fluid accumulation in the chest causing shortness of breath; when used with Huangqin (Scutellariae Radix), it treats feiwei (lung atrophy) and cough caused by cold-fluid soaking into the lungs; when used with Wuweizi (Schisandrae Fructus), it treats wheezing and urgency due to failure of Lung Qi to descend after catching cold; when used with Zheshi (Magnetitum), it treats hematemesis and epistaxis caused by failure of Stomach Qi to descend due to cold; when used with Baizhu (Atractylodis Macrocephalae Rhizoma), it treats bleeding from the bowels or urine due to Spleen-cold failing to control blood, or frequent diarrhea due to deficiency-cold of the Spleen and Stomach; when used with Gancao (Glycyrrhizae Radix et Rhizoma), it harmonizes its pungent-spicy taste to prevent irritation, allowing its warming and tonifying power to become more enduring. The Shennong Bencao Jing states that it drives out wind-damp bi-obstruction, referring specifically to wind-damp bi-syndromes biased towards cold. However, the Jin Gui Yao Lue also uses Ganjiang to treat heat-induced paralysis and epilepsy, such as in Fengyin Tang where it is used together with Shigao (Gypsum Fibrosum) and Hanshuishi (Halloysitum Rubrum). This utilizes its intense pungency to open up stagnation of Qi and Blood. Some claim that when charred black, its nature becomes hotter and aids Ministerial Fire; however, one does not realize that processing makes it bitter, reducing its heat, and its aroma becomes light and floating, preventing it from descending to the Lower Jiao.
Xu Lingtai said: "Generally, herbs with strong flavors tend to anchor and retain, while those with strong aromas tend to disperse. Ganjiang has both strong flavor and aroma, so it can disperse yet retain. Since it disperses without fully dispersing and retains without fully retaining, it rotates between meridians and zang-fu organs, inevitably driving out cold and dampness, harmonizing blood and unblocking Qi. Therefore, although its nature is fierce and峻急 (urgent/strong), it is safe for consumption."
[Attached Case]: Mr. Gao from the neighboring village, over forty years old, suffered from hematuria that persisted for a long time without healing. His pulse was faint, fine, and slow; his body was weak and aversive to cold, with reduced appetite. I diagnosed this as deficiency-cold of the Spleen and Stomach with sinking of Middle Qi, as described by Huang Kunzai: bleeding from the bowels or urine occurs because Taiyin [Spleen] fails to ascend. I prescribed a formula: Ganjiang (Dried Ginger) and Baizhu (Atractylodis Macrocephalae Rhizoma) each 4 qian, Sheng Shanyao (Dioscoreae Rhizoma) and Shu Dihu (Rehmanniae Radix Preparata) each 6 qian, Wufuzi (Aconiti Lateralis Radix Preparata) and Zhi Gancao (Glycyrrhizae Radix et Rhizoma Preparata) each 3 qian. After taking one decoction, the bleeding decreased; after continuously taking more than ten doses, he was completely cured.