即天花粉与栝蒌
栝蒌根实本经俱苦寒，李氏谓根甘微苦酸微寒，实甘寒，辨之致审。
草木之根 ，其性上行；实则性复下降。栝蒌根能起阴气上滋，故主燥热之烦渴；实能
导
栝蒌根与葛根同主消渴身热，而仲圣治痉，则一用葛根，一用栝蒌根何故？盖无汗而小
便反少，气冲口噤，是风寒湿之邪，相搏于太阳阳明之交而不解，用葛根则能随麻黄辈散之
于外。栝蒌根无解表之长，而证是身体强KT KT 然，俾与桂芍诸物养筋脉则适相当，此
其所以攸异也。
栝蒌根本治热治渴，乃牡蛎泽泻散并不言渴，而其所伍者为泻水之物，是大病瘥后，虚
热不免，而水去则阴复伤，以栝蒌根润液而补虚，除病即兼善后也。栝蒌瞿麦丸，上虽为渴
而下则有寒，下寒故膀胱不利而水蓄，水蓄于下则阳浮于上，是渴为标寒为本，故以薯附温
肺肾
栝蒌实之长，在导痰浊下行，故结胸胸痹非此不治。然能导之使行，不能逐之使去。盖
其性柔，非济之以刚，则下行不力。是故小陷胸汤则有连夏，栝蒌薤白等汤则有薤酒桂朴，
皆伍以苦辛迅利之品，用其所长，又补其所短也。
葛根与栝蒌根，本经皆主消渴。而葛根起阴气，栝蒌根不言起阴气。张隐庵以栝蒌蔓延
，结实之时，根粉尽消，结实既成，根复成粉。又凡草木根 ，性必上行，遂谓栝蒌根能起
阴气上滋。邹氏亦韪之。愚窃以为不然，用葛根者皆知为升阳明之药，栝蒌根无用之为升者
。虽凡根皆寓有升意，而用根之药不尽属能升，且以粉消为升，则有粉方掘，正在升力已退
之时。盖其所以主消渴者，为其性濡润而味苦寒，皮黄肉白，能劫肺胃之热，润肺胃之燥耳
。别名天花瑞雪，亦正取寒润下降之意。葛根则异乎是矣，味甘平，为阳明之正药。内色洁
白，则能由胃入肺。外色紫黑，则又由肺达太阳。味甘兼辛，则擅发散之长，层递而升，复
横溢而散。升则升胃津以滋肺，散则散表邪以解肌。故栝蒌根治身热，是以寒胜热；葛根治
身热，是以辛散热。栝蒌根止渴，是增益其所无；葛根止渴，是挹彼以注兹。用葛根而过，
有竭
葛根汤以桂枝汤加麻黄，讵不足发太阳之邪，而犹必重用葛根者，盖麻桂二方之证，均
无项背强KT KT ，太阳病而至项背不柔，则风寒已化热烁液，将入阳明，麻桂皆燥药，
未足专任，能入阳明起阴气，滑泽其骨节，而又能化肌表之热者，舍葛根奚属。此葛根所以
为一方之冠
凡寒阻于经，欲化未化而有表热之证，葛根能外达而解之。若已化热入里，或其热不应
外解
《神农本草经》记载栝蒌的根和实都是苦寒之性，李氏认为根是甘微苦酸、微寒，实是甘寒，辨析得非常详尽。
草木的根，其药性趋向于上行；果实则药性又趋向于下降。栝蒌根能够升发阴气上滋，所以主治燥热引起的烦渴；栝蒌实能够引导痰浊下行，所以治疗结胸证和胸痹证非它不可。然而，它能引导痰浊运行，却不能强行驱逐痰浊去除。因为它的性质柔润，如果不配合刚猛的药物，下行之力就不够强劲。因此，小陷胸汤中配伍黄连、半夏，栝蒌薤白白酒汤等方剂中配伍薤白、酒、桂枝、厚朴，都是配合使用苦辛迅利之品，发挥它的长处，又弥补它的短处。
栝蒌根与葛根都主治消渴病和身体发热，但张仲景治疗痉病时，一个用葛根，一个用栝蒌根，这是什么缘故呢？大概是因为无汗而小便反而少，气冲逆导致口噤不开，这是风寒湿邪在太阳经和阳明经交界处相搏结而不能解散，使用葛根就能随着麻黄等药物将邪气发散到体表。栝蒌根没有解表的优势，而病症表现为身体强直僵硬，让它配合桂枝、芍药等药物滋养筋脉就正好相当，这就是它们不同的原因。
栝蒌根本来就是主治热症和口渴的，但在牡蛎泽泻散中并没有提到口渴，而它所配伍的都是泻水药物，这是因为大病初愈后，虚热难免存在，而水湿去除了阴液就会再次受损，用栝蒌根滋润津液并补益虚弱，在祛除疾病的同时也兼顾了善后调理。栝蒌瞿麦丸，上面虽然有口渴的症状，下面却有寒象，下焦有寒所以膀胱气化不利而水液蓄积，水蓄积在下焦则阳气浮越在上焦，这是口渴为标、寒为本，所以用薯蓣、附子温补肺肾。
葛根与栝蒌根，《神农本草经》都主治消渴。而葛根能升发阴气，栝蒌根却不提能升发阴气。张隐庵认为栝蒌藤蔓蔓延，结实的时候，根部的淀粉全部消耗掉，果实结成之后，根部又重新生成淀粉。再加上凡是草木的根，药性必然上行，于是说栝蒌根能升发阴气上滋。邹氏也赞同这个观点。我私下里认为不是这样，使用葛根的人都知道它是升提阳明经气的药物，而栝蒌根没有作为升提药使用的情况。虽然凡是根类药材都蕴含上升之意，但使用根类药材并不全都属于能升提的药，而且如果以淀粉消散作为“升”，那么当淀粉正在消散时，正是升提之力已经减退的时候。大概栝蒌根之所以主治消渴，是因为它的性质濡润且味道苦寒，皮黄色肉白色，能够清劫肺胃的热邪，滋润肺胃的干燥。别名“天花粉”、“瑞雪”，也正是取寒凉滋润下降的意思。葛根则与此不同，它味甘平，是阳明经的正药。内部颜色洁白，所以能从胃进入肺。外部颜色紫黑，所以又能从肺通达太阳经。味甘兼有辛味，所以擅长发散，层层递进而上升，又横向溢散。上升则提升胃中的津液以滋润肺，发散则疏散体表的邪气以解除肌腠之热。所以栝蒌根治身热，是用寒凉胜热；葛根治身热，是用辛散散热。栝蒌根止渴，是增益其所缺乏的津液；葛根止渴，是将下面的津液汲取上来注于上部。如果使用葛根过量，会导致津液枯竭。
葛根汤是在桂枝汤基础上加麻黄，难道不足以发散太阳经的邪气吗？却还要重用葛根，大概是因为麻黄汤和桂枝汤所治的证候，都没有项背强直不适的症状，太阳病发展到项背不柔和，说明风寒已经化热灼伤津液，将要传入阳明经，麻黄、桂枝都是燥烈之药，不足以单独胜任，只有葛根能入阳明经升发阴气，使骨节滑利，并且能化解肌表的热邪，除了葛根还能是谁呢。这就是葛根成为一方之首的原因。
凡是寒气阻滞于经络，想要化热但尚未完全化热而有表热证的，葛根能向外达表而解散它。如果已经化热入里，或者其热不应通过解表来消除……
This refers to Trichosanthis Radix (Tianhuafen) and Trichosanthis Fructus (Gualou Shi).
Both the root and fruit of Gualou are recorded in the *Shennong Bencao Jing* as bitter and cold. Mr. Li stated that the root is sweet, slightly bitter and sour, and slightly cold, while the fruit is sweet and cold; his differentiation is very thorough.
The roots of herbs and trees generally have an ascending nature, whereas fruits tend to descend. Trichosanthis Radix can raise Yin Qi to moisten upwards, thus it primarily treats dryness-heat causing vexation and thirst. Trichanthis Fructus guides turbid phlegm downward, making it essential for treating Jie Xiong (Chest Binding) and Xiong Bi (Chest Obstruction). However, it can guide movement but cannot forcibly expel. Its nature is soft and moist; without the assistance of firm/drastic agents, its descending power is insufficient. Therefore, Xiao Xian Xiong Tang combines it with Huanglian (Coptidis Rhizoma) and Banxia (Pinelliae Rhizoma), while Gualou Xiebai Baijiu Tang combines it with Xiebai (Allii Macrostemonis Bulbus), Jiuniu (Alcohol), Guizhi (Cinnamomi Ramulus), and Houpo (Magnoliae Officinalis Cortex). These combinations utilize its strengths and compensate for its weaknesses by pairing it with bitter, acrid, and rapid-acting substances.
Trichosanthis Radix and Puerariae Radix (Ge Gen) both treat Xiao Ke (Wasting-Thirst) and body heat. However, when Zhang Zhongjing treated Jing Bing (Spasm Disease), he used Ge Gen in one case and Trichosanthis Radix in another. Why? Generally, if there is no sweating and urine output is unexpectedly low, with Qi rushing upward causing mouth lock, this indicates pathogenic wind-cold-dampness struggling at the intersection of the Taiyang and Yangming meridians without resolving. Using Ge Gen allows it to be dispersed outward along with Mahuang (Ephedrae Herba) and others. Trichosanthis Radix lacks the advantage of releasing the exterior. In cases where the body is stiff and rigid, pairing it with Guizhi (Cinnamomi Ramulus) and Shaoyao (Paeoniae Radix) to nourish the sinews is appropriate. This is the distinction between them.
Trichosanthis Radix fundamentally treats heat and thirst. Yet, in Muli Zexie San, thirst is not mentioned, despite its ingredients being water-draining agents. This is because after a major illness subsides, deficient heat remains inevitable. As water drains, Yin is further injured. Trichosanthis Radix moistens fluids and tonifies deficiency, thereby handling post-illness care alongside disease elimination. In Gualou Qumei Wan, although there is thirst above, there is cold below. Cold in the lower jiao causes Bladder Qi transformation dysfunction and water accumulation. Water accumulating below causes Yang to float above. Thus, thirst is the branch manifestation, while cold is the root cause. Shanyao (Dioscoreae Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) are used to warm the Lung and Kidney.
Regarding the strength of Trichosanthis Fructus, it lies in guiding turbid phlegm downward, making it indispensable for Jie Xiong and Xiong Bi. However, it guides movement but does not forcefully expel. Its nature is soft; without firm partners, its descending force is weak. Hence, Xiao Xian Xiong Tang pairs it with Lian (Huanglian) and Xia (Banxia), while formulas like Gualou Xiebai Tang pair it with Xie, wine, Gui (Guizhi), and Po (Houpo), utilizing bitter-acrid and swift agents to leverage its strengths and offset its shortcomings.
Both Ge Gen and Trichosanthis Radix are recorded in the *Bencao Jing* as treating Xiao Ke. Ge Gen raises Yin Qi, whereas Trichosanthis Radix is not described as raising Yin Qi. Zhang Yinan argued that Gualou vines spread widely, and when fruits set, the starch in the roots is consumed. Once fruits are formed, the roots regenerate starch. Combined with the general rule that herb roots ascend, he concluded Trichosanthis Radix raises Yin Qi to moisten upwards. Mr. Zou agreed. I disagree. Practitioners know Ge Gen as an agent that ascends Yangming Qi. Trichosanthis Radix is never used for ascending purposes. Although all roots contain ascending potential, not all root drugs are ascending. If "ascending" meant starch consumption, this occurs when ascending power has already faded. The reason Trichosanthis Radix treats Xiao Ke is its moistening nature and bitter-cold taste. With yellow skin and white flesh, it clears Heat from the Lung and Stomach and moistens their dryness. Its aliases "Tian Hua Fen" (Heavenly Flower Powder) and "Rui Xue" (Auspicious Snow) imply cold, moistening, and descending properties. Ge Gen is different: it is sweet and neutral, a primary drug for the Yangming channel. Internally white, it moves from Stomach to Lung; externally purple-black, it moves from Lung to Taiyang. Sweet and acrid, it excels at dispersing, ascending layer by layer and spreading horizontally. Ascending, it raises Stomach fluids to moisten the Lung; dispersing, it releases exterior pathogens to relieve the muscle layer. Thus, Trichosanthis Radix treats body heat by overcoming heat with cold; Ge Gen treats body heat by dissipating heat with acridity. Trichosanthis Radix stops thirst by replenishing what is lacking; Ge Gen stops thirst by drawing fluid from below to above. Overuse of Ge Gen can deplete fluids.
Ge Gen Tang adds Mahuang to Guizhi Tang. Is this insufficient to release Taiyang pathogens? Yet Ge Gen is heavily used. This is because neither Mahuang Tang nor Guizhi Tang indications feature stiff neck and back. When Taiyang disease progresses to stiffness in the neck and back, wind-cold has transformed into heat, consuming fluids, and is about to enter Yangming. Mahuang and Guizhi are drying agents, insufficient alone. Only Ge Gen can enter Yangming, raise Yin Qi, lubricate joints, and resolve exterior heat. Thus, Ge Gen is the chief ingredient.
When cold obstructs the meridians, intending to transform but not yet fully transformed, presenting with exterior heat, Ge Gen can reach the exterior and resolve it. If heat has already transformed and entered the interior, or if the heat should not be resolved via the exterior...