（即名学医随笔。从董显臣本抄附。）
昆布。本是纶布。纶音关。误纶为昆。故呼昆布。东垣肥气痞气用之。大抵千金有破积聚之
语。读广济方有治膀胱结气。急宜下气。用昆布下。调和制作菜食。极能下气。然则昆布乃太阳
正药。与缪氏云咸能软坚。其性润下。寒能治热散结。故主十二种水肿瘿瘤。聚结 疮。是又三
阳并用者。然五方独于肥气丸及加减痞气丸。用昆布。其余皆不用。是又因其滑能破积血也。
广术即莪术。凡行气破血。消积散结。皆用之。属足厥阴肝经气分药。大破气中之血。气血不足
者服之。为祸不浅。好古言孙尚药用治气短不能接续。（经言短气不足息者下之。盖此之谓也。
然中气虚实天渊。最宜详审。）此短字乃是胃中为积所壅。舒气不长。似不能接续。非中气虚短
不能接续也。若不足之短而用此。宁不杀人。又言其入气药。能发诸
香。是又能入阳明也。
川乌辛温大毒。性轻疏。温脾去风。寒用附子。风用乌头。能随诸药为佐使。功同附子而稍
缓。海藏云。补命门不足肝气虚。
巴豆。一名刚子。一名走阳子。出巴蜀而形如豆。故名。辛温有毒。肠胃药也。东璧言气热味
辛。生猛熟缓。能吐能下。能止能行。可升可降。峻用则有戡乱劫病之功。微用亦有抚绥调中之
妙。惟畏大黄黄连。而前人治积方。往往同用。是即抚绥调中之谓与。又为咽喉要药。取其辛能
散结。猛烈之气。 能劫痰而开通道路也。先大夫言大黄去积水。荡之也。巴豆去积火。燎之也。
非气实者不可妄用。用之须去心皮。熬令黄黑。捣膏入药。壳与油皆可用以治病。新者佳。
皂荚。即皂角。维HT 。乌犀。悬刀。皆其名也。辛咸温。有小毒。手太阴阳明经气分药。海
藏云入厥阴经气分。以其能利上窍通二便。有疏泄之义也。故又言搜肝风泻肝气。然海藏本南阳
正阳散内用皂角引入厥阴。故有此说。东璧言皂角属金。其味辛。其性燥。金胜木。燥胜风。故
兼入足厥阴也。按正阳散活人止言治阴毒伤寒云云。列症不及囊缩。即海藏引用厥阴例。方云活
人论厥阴药。并见阴症论并不以正阳治囊缩也。再考活人囊缩问答条中。又不及正阳散。然则海
藏举正阳散为厥阴例。何所见也。海藏论厥阴烦满
囊缩。只曰宜温之下之。亦不及正阳散。至王损庵论。囊缩论首载扁鹊孙真人。次活人。次海藏
。而序方则止正阳回阳二方。确以正阳为治囊缩之的方矣。亦不知何所见也。岂因海藏以正阳属
厥阴。而囊缩是厥阴中之一症。便以之通治与。又十八问阴症内列四方。亦不及正阳。独二十问
手足厥冷脐腹筑冷一条为一见。又言脉一息七至以来。灸关元二三百壮。兼服正阳散。为二见。活人
本以囊缩为厥阴死症。仲景原无治法。故但言遂以意寻比方仿治。而究不列方也。于是来阳伯徐
春沂辈。亦不复有所更定参论。而但属之阴毒下耳。海藏引属厥阴。大抵以阴毒者。谓阴气独盛
。阳气暴绝。则为阴毒。三阴皆有之。但书列正阳。所治有面青。张口出气。心下硬。身不热。
只额上有汗。烦渴不止。舌黑。多睡。四肢俱冷等症。是厥阴为多。故列于厥阴门。遂于汤液中
有正阳散内用皂角引入厥阴之说也。
正阳散
附子 干姜 麝香 皂角 甘草
（这段文字出自《学医随笔》，是从董显臣的版本中抄录附上的。）
昆布。原本叫纶布。纶的读音同“关”。因为误将“纶”写成了“昆”，所以称为昆布。李东垣在治疗肥气、痞气时使用它。大抵《千金方》中有破除积聚的说法。读《广济方》可知治疗膀胱结气，急需用下气之法，使用昆布来下气。调和制作成菜肴食用，极能下气。既然如此，昆布乃是太阳经的正药。与缪希雍所说咸味能软坚散结，其性润下，寒性能治热散结相符。因此主治十二种水肿、瘿瘤、聚结疮。这又是三阳经并用的药物。然而五方独在肥气丸及加减痞气丸中使用昆布，其余都不使用。这是因为它滑利能破积血。
莪术。即广术。凡是行气破血、消积散结的药物，都使用它。属于足厥阴肝经的气分药。大破气中之血。气血不足的人服用它，祸害不浅。李时珍说孙尚药用它治疗气短不能接续。（《内经》说短气不足以息者用下法，大概指的就是这种情况。然而中气的虚实相差如天地悬殊，最应当详细审察。）这个“短”字是指胃中被积滞所壅塞，呼吸之气不畅，似乎不能接续，并非中气虚弱导致的短气不能接续。如果是虚损导致的短气而使用此药，岂不是会杀人？又说它进入气分药中能发散各种香气，这也是它能入阳明经的缘故。
川乌。辛温，有大毒。性质轻疏，温脾去风。寒证用附子，风证用乌头。能随其他药物作为佐使。功效同附子但稍缓。张元素说能补命门不足和肝气虚。
巴豆。一名刚子，一名走阳子。出产于巴蜀地区且形状像豆子，所以得名。辛温有毒。是肠胃药。李时珍说气味热味辛，生用猛烈熟用缓和。能催吐也能泻下，能止也能行，可升可降。峻猛使用时有平定混乱、劫除病邪的功效；微量使用时也有安抚调理中焦的妙处。只畏惧大黄、黄连，但前人治疗积滞的方剂中，往往一起使用。这就是所谓安抚调理中焦的意思吧。又作为咽喉的要药，取其辛味能散结，猛烈之气能劫除痰涎而开通道路。先父说大黄去除积水，是荡涤的作用；巴豆去除积火，是燎原的作用。不是气实的人不可妄用。使用必须去掉心皮，熬至黄黑色，捣成膏入药。壳和油都可以用来治病，新的为佳。
皂荚。即皂角。维HT（此处原文可能有误或为特定版本异文，暂按原文保留），乌犀，悬刀，都是它的名字。辛咸温，有小毒。是手太阴肺经、手阳明大肠经的气分药。张元素说入足厥阴肝经气分。因为它能利上窍通二便，有疏泄的意义。所以又说搜肝风泻肝气。然而张元素本是在南阳正阳散的方解中说用皂角引入厥阴，所以有此说法。李时珍说皂荚属金，其味辛，其性燥，金克木，燥胜风，所以兼入足厥阴肝经。考《活人书》止言治疗阴毒伤寒等症，列举症状不及囊缩。即使是张元素引用厥阴的例子，方论《活人书》也见于阴症论，并不以正阳散治疗囊缩。再考证《活人书》囊缩问答条中，也不及正阳散。那么张元素举正阳散作为厥阴的例子，有什么依据呢？张元素论述厥阴烦满囊缩，只说宜温之下之，也不及正阳散。到了王好古的论述，囊缩论首先记载扁鹊、孙思邈，其次是《活人书》，再次是张元素，而序方则只有正阳散、回阳散两个方子，确实以正阳散为治疗囊缩的确切方剂了。也不知道他有什么依据。难道是因为张元素将正阳散归属于厥阴，而囊缩是厥阴中的一个症状，就以此通治吗？又在十八问阴症内列出四方，也不及正阳散。唯独二十问手足厥冷脐腹筑冷一条为一见，又说脉一息七至以上，灸关元二三百壮，兼服正阳散，为二见。《活人书》本来以囊缩为厥阴死症，张仲景原本没有治法，所以只是说于是凭心意寻找方子仿效治疗，但最终没有列出方子。于是来阳伯徐春沂等人，也不再有所更定参论，而只是将其归入阴毒下等症。张元素引属厥阴，大抵认为阴毒是指阴气独盛，阳气暴绝，则为阴毒。三阴经都有这种情况。但书中列出的正阳散，所治有面青、张口出气、心下硬、身不热、只额上有汗、烦渴不止、舌黑、多睡、四肢俱冷等症状，是厥阴证居多，所以列于厥阴门。于是在汤液中有正阳散内用皂角引入厥阴的说法。
(This text is from *Xueyi Suibi* [Notes on Learning Medicine], copied and attached from the version by Dong Xianchen.)
*Kunbu* (Thallus Laminariae seu Eckloniae). Originally called *Lunbu*. "Lun" is pronounced like "Guan". Due to a miswriting of "Lun" as "Kun", it came to be called *Kunbu*. Li Dongyuan used it for treating *Feiqi* (masses in the hypochondrium) and *Piqi* (epigastric masses). Generally, the *Qianjin Fang* [Essential Prescriptions Worth a Thousand Gold] contains statements about breaking up accumulations. Reading the *Guangji Fang* [Broad Relief Formulas], one finds it treats bladder qi stagnation, urgently requiring qi-descending methods; *Kunbu* is used to descend qi. When harmonized and prepared as food, it is extremely effective in descending qi. Thus, *Kunbu* is a principal herb for the Taiyang channel. This aligns with Mi Xiyong's statement that salty flavors can soften hardness, its nature is moistening and downward-flowing, and its cold property can treat heat and dissipate nodules. Therefore, it governs twelve types of edema, goiter, and clustered sores. This represents the combined use of the three Yang channels. However, among the five formulas, *Kunbu* is used only in *Feiqi Wan* and *Jiajian Piqi Wan*, and not elsewhere. This is because its slipperiness can break accumulated blood.
*Ezhu* (Rhizoma Curcumae). Also known as *Guangshu*. It is used for moving qi, breaking blood, eliminating accumulations, and dissipating nodules. It belongs to the Qi level of the Foot-Jueyin Liver Channel. It strongly breaks blood within qi. For those with deficient qi and blood, taking it causes significant harm. Li Shizhen states that Sun Shangyong used it to treat shortness of breath where breathing cannot continue (*Duanqi*). The *Neijing* says: "For shortness of breath insufficient for respiration, use purgation." This likely refers to this condition. However, the deficiency or excess of Middle Qi differs as much as heaven and earth; it must be examined in detail. This character "short" refers to the stomach being obstructed by accumulation, causing breath to be unsmooth and seemingly unable to continue; it is not shortness of breath due to deficiency of Middle Qi. If one uses this herb for deficiency-induced shortness of breath, would it not kill the patient? It is also said to enter Qi herbs and emit the fragrance of various aromatics, indicating it can also enter the Yangming channel.
*Chuanwu* (Radix Aconiti Kusnezoffii). Pungent, warm, highly toxic. Its nature is light and dispersing; it warms the spleen and expels wind. For cold conditions, *Fuzi* is used; for wind conditions, *Wutou* is used. It can serve as an assistant or guide alongside other herbs. Its efficacy is similar to *Fuzi* but slightly milder. Zhang Yuansu stated it tonifies insufficiency of the Gate of Vitality and deficiency of Liver Qi.
*Badou* (Semen Crotonis). Also named *Gangzi* and *Zouyangzi*. It originates from Bashu and resembles a bean in shape, hence the name. Pungent, warm, toxic. It is a gastrointestinal herb. Li Shizhen stated its nature is hot and flavor pungent; raw it is fierce, cooked it is mild. It can induce vomiting or purging, stop or promote movement, ascend or descend. Used aggressively, it has the merit of quelling chaos and seizing disease; used mildly, it has the subtlety of soothing and regulating the Middle Jiao. It fears *Dahuang* and *Huanglian*, yet predecessors' formulas for treating accumulations often use them together. Is this the meaning of soothing and regulating the Middle? It is also a key herb for the throat, utilizing its pungency to dissipate nodules and its fierce energy to seize phlegm and open pathways. My late father said *Dahuang* removes accumulated water through scouring; *Badou* removes accumulated fire through blazing. It should not be used recklessly by those without robust Qi. When used, the heart and skin must be removed, stewed until yellow-black, pounded into paste, and added to medicine. The husk and oil can both be used to treat illness; fresh ones are best.
*Zaojia* (Fructus Gleditsiae Sinensis). Also known as *Zaojiao*. [Text error/variant: Weihu], *Wuxi*, *Xuandao* are all its names. Pungent, salty, warm, slightly toxic. It is a Qi-level herb of the Hand-Taiyin Lung Channel and Hand-Yangming Large Intestine Channel. Zhang Yuansu said it enters the Qi level of the Foot-Jueyin Liver Channel. Because it benefits the upper orifices and opens the two bowels, it has the meaning of draining and venting. Thus, it is also said to search out Liver wind and drain Liver Qi. However, Zhang Yuansu originally mentioned using *Zaojia* to introduce into the Jueyin channel in the context of the *Zhengyang San* formula, hence this view. Li Shizhen stated *Zaojia* belongs to Metal, its flavor is pungent, its nature is dry. Metal overcomes Wood, dryness overcomes wind, thus it also enters the Foot-Jueyin channel. Examining the *Renhuo* [Manual of Experience], it only mentions treating Yin-Du Cold Damage, listing symptoms does not include retraction of the genitals. Even if Zhang Yuanshu cited the Jueyin example, the formula commentary in *Renhuo* appears in the Yin Syndrome discussion and does not use *Zhengyang San* to treat genital retraction. Further checking the *Renhuo* Q&A section on genital retraction, *Zhengyang San* is also not mentioned. Then what was Zhang Yuansu's basis for citing *Zhengyang San* as a Jueyin example? In his discussion of Jueyin irritability, fullness, and genital retraction, he only said warmth and purgation were suitable, again not mentioning *Zhengyang San*. In Wang Haogu's discussion, the section on genital retraction first cites Bian Que and Sun Simiao, then *Renhuo*, then Zhang Yuansu, but lists only two formulas: *Zhengyang San* and *Huiyang San*, indeed treating *Zhengyang San* as the specific formula for genital retraction. One wonders what his basis was. Was it because Zhang Yuansu attributed *Zhengyang San* to Jueyin, and since genital retraction is a symptom of Jueyin, he used it to treat it generally? In the Eighteen Questions on Yin Syndromes, four formulas are listed, none including *Zhengyang San*. Only in the Twenty Questions, under the item "cold limbs and umbilical/abdominal throbbing cold," it appears once. It also states: if the pulse beats seven times per breath or more, moxa the Guanyuan point 200-300 moxibustions, and concurrently take *Zhengyang San*; this is the second appearance. *Renhuo* originally considered genital retraction a fatal Jueyin syndrome. Zhang Zhongjing originally had no treatment method, so he merely said he sought formulas based on intuition to imitate treatment, but ultimately did not list any. Consequently, Xu Chunyi and others from Laiyang Bo did not make further revisions or discussions, but simply classified it under lower Yin-Du. Zhang Yuansu's attribution to Jueyin largely stems from the definition of Yin-Du: excessive Yin Qi alone, sudden extinction of Yang Qi constitutes Yin-Du. This can occur in all three Yin channels. But the *Zhengyang San* listed in the book treats symptoms such as blue face, gasping with mouth open, hardness below the heart, body not hot, only sweat on the forehead, incessant irritability and thirst, black tongue, excessive sleepiness, and cold limbs in all four extremities. These are predominantly Jueyin symptoms, so it is listed in the Jueyin section. Thus, there is the saying in decoctions that *Zhengyang San* uses *Zaojia* to introduce into the Jueyin channel.
*Zhengyang San* (Urging Yang Powder)
*Fuzi* (Prepared Lateral Root of Aconite) *Ganjiang* (Dried Ginger) *Shexiang* (Musk) *Zaojia* (Fructus Gleditsiae Sinensis) *Gancao* (Licorice Root)