大黄泄血闭而下热，葶苈泄气闭而逐水。凡水气坚留一处有碍肺降者，葶苈悉主之。惟
泄肺
甘遂味苦甘，所治在中与下，能利水谷之道，故治留饮宿食，葶苈味苦辛，所治在上与
表，但利水道，故主结气饮食寒热。试以大陷胸汤丸证之，大黄荡实涤热，上中下咸到，性
极峻厉，故汤丸皆以为君，为陷胸之主药。陷胸汤加芒硝甘遂，而一则煮一两沸，一则内末
者，以二物皆下趋极易，欲其回翔胸膈，化水食而软坚也。陷胸丸之证，曰项亦强如柔痉状
。项强二字，实此证之主脑。按素问太阴在泉项似拔。项似拔者，湿上冲也。此强而非拔，
为水结在肺无疑。曰如柔痉状，则与柔痉相似而不同可知。然则何以治之？夫结胸由于误下
，误下故正虚邪入，水饮宿食，遂互结而不下，要其所入之邪，太阳病未解之阳邪也。阳邪
劫液，故筋失所养而项强，是宜泄其为患之水，濡以柔筋之液，而大逐其心胃之热实，故用
大黄硝遂无二致，而法则有变，药亦宜加矣。杏硝合研，所以润液而柔项；遂蜜同煮，所以
安正而化结；葶苈泻肺水，为是方水结之专任，变汤为丸者，以项强不可以急图也。葶苈与
甘遂，
车前即 莒，神仙服食经云∶善疗孕妇难产及令人有子。陆机云∶嫩苗作茹大滑，今人
不复啖之。苗滑如是，其子治难产，自亦取其滑胎。惟令人有子，似未足信。不知虚弱之妇
，无子贵补冲任，否则反是。车前子非他，盖为治难产之令人有子也。
车前子为输泄膀胱湿热之药，本经主气癃、止痛、利水道、通小便，别录明目、疗赤痛
，其
昔人谓车前子利水窍而固精窍，似即补肾之谓。然茯苓利水不必有热，车前子则非热不
治。茯苓尚伐肾邪，则车前子之固精窍，为何如之固精窍，可深思矣。
大黄能通泄血分瘀闭并下行清除热邪，葶苈子能通泄气分瘀闭并驱逐水饮。凡是水气坚硬停留在一处，阻碍肺气肃降的情况，葶苈子都能主治。
甘遂味苦、甘，所治疗的病位在中焦与下焦，能够通利水谷的通道，所以用于治疗留饮和宿食；葶苈子味苦、辛，所治疗的病位在上焦与体表，只通利水道，所以主治气机郁结、饮食停滞以及寒热错杂之证。可以用大陷胸汤（Major Xiongxia Decoction）和大陷胸丸来验证这一点：大黄荡涤实邪、清除热毒，作用范围涵盖上、中、下三焦，药性极为峻猛，所以无论是汤剂还是丸剂都以它为主药，作为攻陷胸膈实邪的主要药物。在大陷胸汤中加入芒硝（Natrii Sulfas, Mangxiao）和甘遂（Kansui Radix, Gansui），其中一剂只煮一两沸，另一剂是将药末直接纳入，这是因为这两味药都容易下行趋下，为了让它们在胸膈部位回旋停留，化解水饮和食物积滞并使坚硬的结块软化。大陷胸丸证的描述中提到“项部僵硬，像柔痉（Roujing, Soft Spasm）的样子”。“项强”这两个字，实际上是这个证候的关键所在。查阅《素问·太阴阳明论》提到“项似拔”，所谓“项似拔”，是湿气向上冲逆所致。这里的僵硬不是那种被拔引的感觉，而是水饮结聚在肺部无疑。说“像柔痉的样子”，说明它与柔痉相似但又有不同。那么该如何治疗呢？结胸证是由于误用下法导致的，因为误下导致正气虚弱而邪气内入，水饮和宿食相互结聚而不能下行，追究其进入体内的邪气，是太阳病未解的阳热之邪。阳热之邪劫夺津液，导致筋脉失去滋养而出现项强，这时应当泄除造成危害的水饮，用滋润筋脉的津液来濡养，同时大力逐除心胃部位的实热，所以使用大黄、芒硝、甘遂没有两样，但治法有所变化，药物也应当增加。杏仁与芒硝合研，是为了滋润津液以缓解项部僵硬；甘遂与蜂蜜同煮，是为了安定正气并化解结聚；葶苈子泻除肺部的积水，是这个方剂中针对水结的专用药物，将汤剂改为丸剂，是因为项强不可以急于求成。葶苈子与甘遂……
车前草即“莒”，《神仙服食经》说：善于治疗孕妇难产以及使人有子嗣。陆机说：嫩苗作为蔬菜食用非常滑利，现在的人不再吃它了。苗叶如此滑利，它的种子治疗难产，自然也是取其滑利胎产的特性。至于说使人有子嗣，似乎不足以相信。不知道体虚的妇女，无子的关键在于补益冲脉和任脉，否则反而会导致不孕。车前子的作用并非其他，大概是通过治疗难产来达到使人有子嗣的目的。
车前子是输泄膀胱湿热之药，《神农本草经》主治气癃（Qi Long, Urinary Difficulty）、止痛、利水道、通小便，《名医别录》记载其明目、治疗眼部红肿疼痛。前人认为车前子利水窍而固精窍，这似乎就是补肾的意思。然而茯苓利水不一定需要有热邪，车前子则非有热邪不治疗。茯苓尚且能伐除肾邪，那么车前子所谓的“固精窍”，究竟是怎样的固精窍，值得深思。
Dahuang (Rhei Radix et Rhizoma) purges blood stasis and descends to clear heat; Tinglizi (Descurainiae Semen Lepidii Semens, Periplocae Semen) purges qi obstruction and drives out water. For any condition where pathogenic water is hard and stagnant in one location, obstructing the descending function of the Lung, Tinglizi is indicated for all such cases.
Gansui (Kansui Radix) has a bitter and sweet taste; its therapeutic scope is in the middle and lower jiao, capable of promoting the drainage of fluids and food channels; therefore, it treats retained fluid and old food retention. Tinglizi has a bitter and acrid taste; its therapeutic scope is in the upper jiao and the exterior, only promoting the drainage of water passages; therefore, it treats qi stagnation, dietary accumulation, and alternating cold and heat. This can be verified by the indications for Daxiexiong Tang (Major Xiongxia Decoction) and Daxiexiong Wan: Dahuang sweeps away excess and washes away heat, reaching the upper, middle, and lower jiao simultaneously; its nature is extremely harsh and severe, so it serves as the sovereign drug in both the decoction and the pill, acting as the primary medicine to break through chest congestion. In Daxiexiong Tang, Mangxiao (Natrii Sulfas) and Gansui are added; one is boiled for only one or two boils, while the other involves adding the powder directly; this is because both substances tend to descend rapidly, and the intention is to make them linger in the chest and diaphragm to transform water and food accumulations and soften hardness. The indication for Daxiexiong Wan states that the neck is stiff, resembling Roujing (Soft Spasm). The term "neck stiffness" is indeed the core of this syndrome. According to the *Suwen* (Basic Questions), when Taiyin governs the interior, the neck feels like it is being pulled. "Neck feeling like being pulled" refers to dampness rushing upward. Here, the stiffness is not a pulling sensation but rather water binding in the Lung without doubt. It says "resembling soft spasm," indicating similarity yet difference from soft spasm. Then how should it be treated? Chest congestion arises from erroneous use of purgatives; due to this error, healthy qi becomes deficient and pathogens enter, causing water-fluids and old food to bind together and fail to descend. Tracing back the entering pathogen, it is the yang pathogen from the unresolved Taiyang disease. Yang pathogens consume body fluids, causing the sinews to lose nourishment and resulting in neck stiffness. At this point, one should drain the harmful water, moisten with fluids to soften the sinews, and vigorously purge the excess heat in the heart and stomach. Thus, the use of Dahuang, Mangxiao, and Gansui is consistent, but the method varies, and additional herbs are suitable. Xiren (Prunus Armeniaca Seed) and Mangxiao ground together serve to moisten fluids and soften the neck; Gansui boiled with honey serves to stabilize healthy qi and resolve bindings; Tinglizi drains lung water and is the specialized agent in this formula for resolving water binding. Changing the decoction to a pill is because neck stiffness cannot be treated hastily. Tinglizi and Gansui...
Cheqiancao (Plantaginis Herba), also known as "Ju", is described in *Shenxian Fushi Jing* (Classic of Immortals' Dietary Therapy) as effective in treating difficult labor in pregnant women and enabling conception. Lu Ji stated that young shoots eaten as vegetables are very slippery; nowadays, people no longer consume them. Since the shoots are so slippery, its seeds treating difficult labor naturally derive their efficacy from lubricating the fetus for delivery. However, the claim that it enables conception seems unconvincing. One must realize that for weak women suffering from infertility, the priority is tonifying the Chong and Ren vessels; otherwise, it may have the opposite effect. Cheqianzi (Plantaginis Semen) does not do anything else; its ability to enable conception is essentially derived from its treatment of difficult labor.
Cheqianzi is an herb that drains damp-heat from the Bladder. The *Shennong Bencao Jing* (Divine Farmer's Materia Medica) indicates it treats Qi Long (urinary difficulty), relieves pain, promotes water pathways, and facilitates urination. The *Mingyi Bielu* (Record of Famous Physicians) records its ability to brighten the eyes and treat redness and pain. Ancients believed that Cheqianzi benefits the water gate while securing the essence gate, which seems to imply kidney tonification. However, Fuling (Poria) promotes urination regardless of whether heat is present, whereas Cheqianzi is only indicated when heat is present. If Fuling can still attack kidney pathogens, then what kind of "securing of the essence gate" does Cheqianzi perform? This deserves deep reflection.