栝蒌实,味苦,气寒,降也,阴也,无毒。入肺、胃二经。最能下气涤秽,尤消郁开胃,
能
治伤寒结胸,祛痰,又解渴生津,下乳。但切戒轻用,必积秽滞气结在胸上,而不肯下者,
始可用之以荡涤,否则,万万不可孟浪。盖栝蒌实最消人之真气,伤寒结胸,乃不得已用之
也。苟无结胸之症,何可轻用,至于消痰、解渴、下乳,只可少少用之,亦戒不可重任。他
本言其能治虚怯劳嗽,此杀人语,断不可信,总惑于补肺之说也。夫栝蒌乃攻坚之药,非补
虚之品。
天花粉,即栝蒌之根,而性各不同。盖栝蒌实其性最悍,非比天花粉之缓,用栝蒌实,
不若
以天花粉代之。天花粉,亦消痰降气,润渴生津,清热除烦,排脓去毒,逐瘀定狂,利小便
而通月水。其功用多于栝蒌实,虚人有痰者,亦可少用以解燥而滋枯,又何必轻用栝蒌实哉
。
或问栝蒌实能陷胸中之邪,为伤寒要药,而吾子切切戒之,何不删去栝蒌,独存天花粉
之为
当哉?曰∶医道必王、霸并用,而后出奇制胜,始能救生死于顷刻。结胸之症,正死在须臾
也,用天花粉以消痞满,其功迟,用栝蒌以消痞满,其功捷。但结胸之痞满不同,小痞小满
之症,不妨用天花粉以消之;大痞大满之症,非栝蒌断然不可。又在人临症细辨,非栝蒌之
竟可不用也。(〔批〕真通权达变之言。)
或疑栝蒌推胸中之食,荡胃中之邪,其势甚猛。伤寒至结胸,其正气已大丧矣,又用此
以推
荡之,不虚其虚乎?先生又谓不可用天花粉相代,岂伤寒之虚,可以肆然罔顾乎?曰∶伤寒
不
顾其虚,则邪且铄尽人之元气,顷刻即死矣,乌可肆然罔顾乎。用栝蒌以陷胸,正所以顾其
虚也。夫陷胸之成,由于邪退之时,而亟用饮食,则邪仍聚而不肯散。夫邪之所以散者,
由于胃中空虚,邪无所得,故有不攻而散之意,邪甫离胃,而胃气
自开,以致饥而索食,此时而能坚忍半日,则邪散尽矣。无如邪将散,而人即索食,食
甫下
喉,而邪复群聚而逐矣。仲景张夫子所以又立陷胸汤,用栝蒌为君,突围而出,所向无前,
群邪惊畏,尽皆退舍,于是,渐次调补,而胸胃之气安焉。是推荡其邪气,非即急救其正气
之明验乎。倘畏首畏尾,不敢轻用栝蒌,虽久则食消,亦可化有事为无事。然所伤正气多矣
,此栝蒌之宜急用,而不可失之观望耳。
或问栝蒌陷胸,以救胃中之正气是矣,然吾恐栝蒌祛邪以入脾,走而不守,则脾当其害。
不
犹以邻国为壑乎?曰∶栝蒌但能陷胸,而不能陷腹。胸中之食,可推之以入于腹,脾中之食
,不必荡之以入于肠。盖脾主出而易化,胃主纳而难消也。
或问栝蒌陷胸中之邪,抑陷胸中之食耶?曰∶结胸之症,未有不因食而结者也。陷胸汤
乃陷
食,而非陷邪也。虽然,邪因食而复聚,虽邪不入于胃之
中,而邪实布于胃之口。陷胸中之食而邪解散,即谓之陷邪亦可也。然而食可陷,而邪不可
陷。食陷必入于脾,邪陷必入于肾。入脾者,栝蒌可乘胜而长驱,入肾者,栝蒌不能入肾,
势必变生不测。今用陷胸,而食消邪散,是陷胸汤实陷食,而非陷邪也。但止陷食而不陷邪
,而邪何以竟散耶?是结胸之症因得食而结,则陷胸之汤,其邪亦因陷食而散也。
或疑陷胸汤用栝蒌,不止陷胸中之邪,亦陷腹中之邪也,邪在腹中,安知不祛之入肾乎?
曰
∶陷胸汤势最捷,邪逢栝蒌即散,安在又入于肾乎。况邪已在腹,与在胸者有别,在胸者,
居高临下,恐有走失入肾之虞;在腹者,邪趋大肠,其势甚便,岂返走于肾经哉。
或问栝蒌与天花粉,同为一本,何以天花粉反不似栝蒌之迅扫胸中之邪耶。曰∶天花粉
消痞
满,其功缓;栝蒌实消痞满,其功捷,余前条已言,但未言其所以缓与捷也。夫栝蒌为天花
粉之子,而天花粉为栝蒌之根,子悬于天下,而性实顾根,故趋于下者甚急。根藏于地中,
而性实恋子,故育于上者自缓。缓捷之故,分于此,而陷消之功,亦别于此。故宜缓者用天
花粉,宜急者用栝蒌实,又何虑功效之不奏哉。
栝蒌实,味苦,气寒,主降,属阴,无毒。归肺、胃二经。最能下气涤秽,尤善消郁开胃,能治伤寒结胸(外感病邪热内陷与痰水互结于胸膈的病证),祛痰,又能解渴生津,通乳。但务必切忌轻率使用,只有当积滞的秽浊之气凝结在胸上,不肯下行时,才可以用它来荡涤清除;否则,万万不可鲁莽行事。因为栝蒌实最易耗伤人的真气,治疗伤寒结胸,是不得已而为之的办法。如果没有结胸的症状,怎么可以轻易使用?至于化痰、解渴、通乳的功效,只可少量使用,也切忌不可重用。其他本草书籍说它能治疗虚劳咳嗽,这是害人的话,绝对不可相信,这完全是被“补肺”的说法所迷惑。其实栝蒌是攻坚破结的药物,并非补虚的药材。
天花粉,就是栝蒌的根,但药性各不相同。大概栝蒌实的药性最为猛烈,不像天花粉那样缓和。使用栝蒌实,不如用天花粉替代。天花粉也能消痰降气,润燥解渴生津,清热除烦,排脓去毒,逐瘀定狂,利小便并通调月经。它的功效比栝蒌实更多,体虚而有痰的人,也可以少量使用以解燥滋枯,又何必轻率使用栝蒌实呢?
有人问:栝蒌实能陷下胸中之邪,是治疗伤寒的要药,而你却极力告诫不要轻用,为什么不删去栝蒌,只保留天花粉更为恰当呢?回答说:医学之道必须王道(温和调理)与霸道(峻猛攻邪)并用,才能出奇制胜,从而在顷刻间挽救生死。结胸之症,正是死在须臾之间。用天花粉来消除痞满,其功效迟缓;用栝蒌来消除痞满,其功效敏捷。但是结胸的痞满情况不同,小痞小满的症状,不妨用天花粉来消除;大痞大满的症状,非用栝蒌断然不行。这在于医生临证时仔细辨别,并不是说栝蒌竟然可以不用。(批注:真是懂得权变通达的话。)
有人怀疑:栝蒌推荡胸中的食物,扫荡胃中的邪气,其势头非常猛烈。伤寒发展到结胸阶段,正气已经大伤,再用此药推荡,岂不是使虚者更虚吗?先生又说不能用天花粉替代,难道伤寒的虚弱状态就可以肆意不顾吗?回答说:伤寒如果不顾及其虚损,那么邪气就会烧尽人的元气,顷刻间就会死亡,怎么可以肆意不顾呢?使用栝蒌来陷胸,正是为了顾护其虚损啊。形成陷胸证,是因为邪气退去之时,急于进食,导致邪气重新聚集而不肯消散。邪气之所以能消散,是因为胃中空虚,邪气无处依附,所以有自行解散的意思。邪气刚离开胃,胃气自然开通,以致感到饥饿而索要食物,此时如果能忍耐半天不吃,邪气就完全散尽了。无奈邪气将要散去时,人立即索要食物,食物刚咽下喉,邪气又重新聚集追逐。张仲景夫子因此又创立陷胸汤,以栝蒌为君药,突围而出,所向无前,群邪惊畏,全部退避,于是逐渐进行调补,胸胃之气得以安宁。这推荡邪气的做法,不正是急救正气的明显证据吗?如果畏首畏尾,不敢轻用栝蒌,虽然时间久了食物消化,也可以将有事化为无事。然而所损伤的正气已经很多了,这就是栝蒌应当急用,而不能观望迟疑的原因。
有人问:栝蒌陷胸,是为了救胃中的正气,这没错,但我担心栝蒌祛除邪气后进入脾脏,走而不守,那么脾脏会遭受危害。这岂不是把祸害推给邻国吗?回答说:栝蒌只能陷下胸中之邪,不能陷下腹中之邪。胸中的食物,可以推入腹部;脾中的食物,不必荡涤进入肠道。因为脾主运化输出且容易消化,胃主受纳且难以消化。
有人问:栝蒌陷胸,是陷胸中的邪气,还是陷胸中的食物呢?回答说:结胸之症,没有不是因为饮食停滞而形成的。陷胸汤乃是陷下食物,而非陷下邪气。虽然如此,邪气因食物而重新聚集,即使邪气未进入胃中,实则散布在胃的入口处。陷下胸中的食物而邪气解散,称之为陷下邪气也可以。然而食物可以被陷下,而邪气不能被陷下。食物陷下必然进入脾脏,邪气陷下必然进入肾脏。进入脾脏的,栝蒌可以乘胜长驱直入;进入肾脏的,栝蒌不能进入肾脏,势必产生不可测的变化。现在使用陷胸汤,食物消亡邪气散尽,这说明陷胸汤实际上是陷下食物,而不是陷下邪气。但如果只陷下食物而不陷下邪气,那邪气为什么竟然散尽了呢?这是因为结胸之症因得食而结聚,那么陷胸汤的邪气也因陷下食物而散尽。
有人怀疑陷胸汤使用栝蒌,不仅陷下胸中的邪气,也陷下腹中的邪气,邪气在腹中,怎么知道不会将其驱逐进入肾脏呢?回答说:陷胸汤的势头最敏捷,邪气遇到栝蒌即行消散,怎么会再进入肾脏呢?况且邪气已在腹中,与在胸中的情况不同。在胸中的,居高临下,恐怕有走失进入肾脏的忧虑;在腹中的,邪气趋向大肠,形势非常便利,难道还会反向走入肾经吗?
有人问:栝蒌与天花粉,同出一源,为什么天花粉反而不像栝蒌那样迅猛地扫荡胸中之邪呢?回答说:天花粉消除痞满,其功效缓慢;栝蒌实消除痞满,其功效敏捷,我前面的条目已经说过,只是没说明为什么缓与捷。栝蒌是天花粉的果实,而天花粉是栝蒌的根。果实悬挂于树上,其本性眷顾根部,所以趋向下的力量非常急切。根藏于地下,其本性眷恋果实,所以在上的生长自然缓慢。缓慢与敏捷的原因,区别于此,陷下与消除的功效,也区别于此。所以适宜缓慢的用天花粉,适宜敏捷的用栝蒌实,又何须担忧功效不显现呢?
Gualou Shi (Trichosanthes Fruit), bitter in taste, cold in nature, descending and yin, non-toxic. Enters the Lung and Stomach meridians. It is most capable of directing qi downward and cleansing filth, especially resolving stagnation and opening the appetite. It can treat Shaoyang Jie Xiong (a syndrome in Cold Damage diseases where pathogenic heat and phlegm-fluids bind in the chest), dispel phlegm, relieve thirst and generate fluids, and promote lactation. However, one must strictly avoid using it lightly. It should only be used to purge when accumulated filth and stagnant qi are bound in the upper chest and refuse to descend; otherwise, one must never act rashly. This is because Gualou Shi easily depletes true qi. Using it for Shaoyang Jie Xiong is a measure of last resort. If there is no Jie Xiong syndrome, how can it be used lightly? As for its effects of dispelling phlegm, relieving thirst, and promoting lactation, it should only be used in small amounts, and heavy dosage must be avoided. Other materia medica texts claim it treats deficiency-type consumption coughs; this is harmful advice and absolutely unreliable, stemming from confusion with the idea of "tonifying the lungs." In fact, Gualou is a drug for breaking hard accumulations, not a product for tonifying deficiency.
Tianhuafen (Trichosanthes Root) is the root of Gualou, but their properties differ significantly. Gualou Shi has the most fierce nature, unlike the mildness of Tianhuafen. When using Gualou Shi, it is better to substitute it with Tianhuafen. Tianhuafen also dispels phlegm and directs qi downward, moistens dryness to relieve thirst and generate fluids, clears heat and removes irritability, expels pus and removes toxins, drives out blood stasis and calms mania, promotes urination, and regulates menstruation. Its functions are more numerous than those of Gualou Shi. For deficient individuals with phlegm, it can also be used in small amounts to resolve dryness and nourish withered tissues; why then use Gualou Shi lightly?
Someone asked: Gualou Shi can trap pathogens in the chest and is an essential herb for treating Cold Damage, yet you strongly caution against its use. Would it not be more appropriate to delete Gualou and retain only Tianhuafen? I replied: The medical way requires combining the "King's Way" (gentle regulation) and the "Hegemon's Way" (aggressive attack) to achieve victory through surprise and save life and death in an instant. The Jie Xiong syndrome is fatal within moments. Using Tianhuafen to eliminate fullness works slowly; using Gualou works swiftly. However, the fullness of Jie Xiong varies. For minor fullness, Tianhuafen may suffice; for major fullness, Gualou is indispensable. This depends on the physician's careful differentiation at the bedside; it does not mean Gualou is entirely unnecessary. [Comment: Truly words that understand flexibility and adaptation.]
Someone doubted: Gualou pushes food from the chest and sweeps pathogens from the stomach with great force. By the time Cold Damage reaches Jie Xiong, the righteous qi is already greatly depleted. Using such a pushing agent would not make the deficient even more deficient? You also said Tianhuafen cannot replace it; can the deficiency of Cold Damage be ignored so casually? I replied: If Cold Damage ignores deficiency, pathogens will consume all the body's yuan qi, leading to death in an instant; how can it be ignored? Using Gualou to trap the chest is precisely to protect the deficiency. The formation of the trapping chest condition occurs because, when pathogens retreat, eating too soon causes pathogens to re-aggregate. Pathogens dissipate because the stomach becomes empty, leaving them nowhere to attach, thus allowing them to scatter naturally. Once pathogens leave the stomach, stomach qi opens, causing hunger. If one can endure without eating for half a day, pathogens will fully dissipate. Unfortunately, people crave food as soon as pathogens begin to scatter. Once food enters the throat, pathogens re-accumulate. Therefore, Zhang Zhongjing established the Xiaoxiong Tang (Chest-Trapping Decoction), using Gualou as the sovereign herb to break through, advancing unimpeded. Frightened by this, pathogens retreat. Then, gradual tonification restores peace to the chest and stomach qi. Thus, pushing away pathogens is clear evidence of urgently saving righteous qi. If one hesitates and dares not use Gualou lightly, although food may eventually digest and problems resolve, much righteous qi will have been damaged. This is why Gualou must be used urgently, without hesitation.
Someone asked: Gualou traps the chest to save stomach qi, which is correct. But I fear Gualou, after removing pathogens, moves into the Spleen, moving without staying, thereby harming the Spleen. Is this not shifting disaster to a neighbor state? I replied: Gualou can only trap pathogens in the chest, not in the abdomen. Food in the chest can be pushed into the abdomen; food in the Spleen need not be swept into the intestines. The Spleen governs output and transforms easily, while the Stomach governs reception and digests with difficulty.
Someone asked: Does Gualou trap pathogens or food in the chest? I replied: The Jie Xiong syndrome invariably forms due to food retention. Xiaoxiong Tang traps food, not pathogens. Although pathogens re-aggregate due to food, even if pathogens do not enter the stomach, they actually distribute at the entrance of the stomach. Trapping the food in the chest leads to the dispersal of pathogens, so calling it "trapping pathogens" is acceptable. However, food can be trapped, but pathogens cannot. Food trapped enters the Spleen; pathogens trapped enter the Kidney. What enters the Spleen, Gualou can drive through victoriously; what enters the Kidney, Gualou cannot reach, potentially causing unpredictable changes. Now, using Xiaoxiong Tang eliminates food and scatters pathogens, proving that Xiaoxiong Tang actually traps food, not pathogens. But if it only traps food and not pathogens, how do pathogens completely scatter? Because the Jie Xiong syndrome forms due to food, the pathogens in the Xiaoxiong Tang formula also scatter due to the trapping of food.
Someone suspected that Xiaoxiong Tang using Gualou traps not only chest pathogens but also abdominal pathogens. If pathogens are in the abdomen, how do we know they won't be driven into the Kidneys? I replied: The momentum of Xiaoxiong Tang is most swift; pathogens encounter Gualou and scatter immediately. How could they enter the Kidneys? Moreover, pathogens in the abdomen differ from those in the chest. Those in the chest are high and low, fearing loss into the Kidneys; those in the abdomen tend toward the Large Intestine, a convenient path. Would they reverse course into the Kidney meridian?
Someone asked: Gualou and Tianhuafen come from the same source, why does Tianhuafen not sweep chest pathogens as swiftly as Gualou? I replied: Tianhuafen resolves fullness slowly; Gualou Shi resolves fullness swiftly, as stated earlier, though I did not explain why. Gualou is the fruit of Tianhuafen, and Tianhuafen is the root of Gualou. The fruit hangs from the tree, its nature tending toward the root, so its downward movement is urgent. The root hides in the earth, its nature clinging to the fruit, so its upward growth is slow. The reason for slowness and swiftness lies here, and the functions of trapping and eliminating also differ here. Therefore, use Tianhuafen when slowness is suitable, and Gualou Shi when swiftness is required. Why worry about efficacy not manifesting?