苦参，味苦，气寒，沉也，纯阴，无毒。入心、肝、肾、大肠之经。治肠风下血，热痢
刮痛
难当，疗狂言心燥，结胸垂死；赤癞眉脱者，祛风有功；黄胆遗溺者，逐水立效。扫遍身痒
疹，止卒暴心疼，杀疥虫，破症瘕，散结气，明目止泪，解渴生津，利九窍，通大便。第过
于迅利，宜少用为佐使，不宜多用为君臣。至称益肾、安五脏、定心志，不可信之辞也。
或问苦参非益肾之药，夫人而知之也，但未知其所以损肾之故乎？苦参之不益肾，岂待
问哉
。沉寒败肾，必有五更泄利之病；苦寒泻肾，必有少腹作痛之 。苦参味苦而寒，气沉而降
，安得不败肾而泻肾乎。而五更泄利，小腹作痛，必不能免矣。败泻肾气，而反言益肾，殊
不可解，愿吾子勿信也。
牵牛，味辛而苦，气寒，有毒。虽有黑、白二种，而功用则一。入脾与大小肠，兼通膀
胱。
除壅滞气急，及 癖蛊毒，利大小便难，并脚满水肿，极验。但迅利之极，尤耗人元气，不
可轻用。虽然不言其所以不可轻用之故，而概置不用，亦一偏之辞也。夫牵牛利下焦之湿，
于血中泻水，极为相宜，不能泻上焦之湿。于气中泻水，未有不损元气者也。李东垣辨之至
明，似无容再辨，但未论及中焦也。中焦居于气血之中，牵牛既利血中之水，安在中焦不可
半利其血中之水乎。嗟乎！水湿乃邪也，牵牛既能利水，岂分气血。但水从下受，凡湿邪从
下受者，乃外来之水邪，非内伤之水邪也。牵牛只能泻外来之水，而不能消内伤之湿。上焦
之水肿，乃气虚不能化水，故水入之而作胀，久则与水肿无异，故用牵牛，往往更甚。下焦
之水肿，若是气虚，用牵牛迅逐，亦每无功，与上焦正相同。是真正水邪，用牵牛利之，始
效验如响。可见，牵牛只可治外来之水，而不能治内伤之湿也明矣，非止治血中之水，而不
治气中之水也。然则，外来之水与内伤之水，何以辨之？亦辨之于皮内而已。外邪之水，手
按皮肉必然如泥。内伤之水，手按皮肉必随按随起，即或按之不起，必不如泥而可团捻也，
按之或起或下。起者又有分别，按之即起者，气虚而犹有命门之火也；按之久而不起者，气
虚极而并少命门之火矣。按之如泥者，必须用牵牛以泻水；按之不如泥，而或起或不起者，
必须用补肾中先天之气，而又加健脾开胃，以益后天
之气，始能奏功。倘亦用牵牛，岂特耗气而已，有随利水而随亡者矣，可不慎乎。予所以表
牵牛之功，而并辨东垣论药之误也。
牵牛治外来之水，而不治内伤之湿，余已明辨之矣。然而牵牛治外来之水，又各有异。
夫外
来之水，有从下而外入者，有从中而外入者。从下而外入者，乃从脚而入也；从中而外入者
，乃从腰脐而入也。世人只知外邪之水，从脚而入，未知从腰脐入也。从脚入者，其脚先肿
，人易识；从腰脐入者，其腰重而脐肿，人难识也。水肿不分脚与腰脐，而概以牵牛泻水之
湿，毋怪其有不效也。然则用牵牛之法，又乌可不分别之乎。凡治水从脚入者，用牵牛、甘
遂以消之。若水从腰脐入者，用牵牛于白术之中，一剂而腰重除而脐肿平，三剂而腰脐俱利
矣。
苦参，味道苦，性质寒凉，质地沉降，属于纯阴之品，没有毒性。它进入心、肝、肾、大肠的经络。治疗肠风下血（因风邪侵袭肠道导致的便血），热痢（湿热蕴结肠道所致的痢疾）引起的剧烈腹痛难以忍受；治疗胡言乱语、心中烦躁，以及结胸证（邪气结于胸膈脘腹的病证）濒临死亡的状态；对于患有赤癞（一种皮肤顽疾，眉毛脱落）的人，祛除风邪有显著功效；对于患有黄疸（身目发黄）且伴有遗尿的人，逐水退黄立竿见影。它能扫除全身瘙痒和皮疹，制止突发的心痛，杀灭疥虫，破除症瘕积聚（腹内结块的病证），消散郁结之气，明目止泪，解渴生津，通畅九窍，通利大便。但是苦参药性过于迅猛锋利，应当少量使用作为佐使药，不宜大量使用作为君臣主药。至于那些称其能益肾、安五脏、定心志的说法，是不可信的言论。
有人问：苦参并非益肾的药物，这是人人都知道的，只是不知道它损伤肾脏的原因罢了？苦参不益肾，难道还需要问吗？沉寒之性败坏肾阳，必然导致五更泄泻（黎明前腹泻）的疾病；苦寒之性泻损肾气，必然导致小腹部疼痛的症状。苦参味道苦而性寒，气机沉降而降泄，怎么能不败坏肾气而泻损肾气呢？那么五更泄泻和小腹作痛，是必然不能避免的。既然败坏了肾气、泻损了肾气，反而说它能益肾，实在令人无法理解，希望你不要相信这种说法。
牵牛子，味道辛而苦，性质寒凉，有毒。虽然有黑色和白色两种，但功效是一样的。它进入脾经和大、小肠经，兼通膀胱经。它能消除壅滞之气引起的急喘，以及癖积（胁下痞块）、蛊毒，通利大小便困难，并治疗脚部肿胀和水肿，效果极佳。但是它的药性极其迅猛锋利，尤其会耗损人的元气，不可轻易使用。虽然不说清楚为什么不可轻易使用的原因，而一概不用，也是一种偏颇的看法。牵牛子能利下焦的湿气，在血分中泻下水湿，非常适宜，但不能利上焦的湿气。在气分中泻下水湿，没有不损伤元气的。李东垣对此辨析得非常明白，似乎不需要再辩论，只是他没有论及中焦的问题。中焦位于气血之间，牵牛子既然能利血分中的水湿，怎么能在中焦不可以半利其血分中的水湿呢？唉！水湿乃是邪气，牵牛子既然能利水，难道还区分气血吗？只是水湿从下部受入，凡是湿邪从下部受入的，是外来的水湿邪气，不是内伤的水湿邪气。牵牛子只能泻除外来的水湿，而不能消除内伤的湿气。上焦的水肿，是因为气虚不能化水，所以水液进入体内导致胀满，时间久了与水肿没有区别，因此使用牵牛子，往往病情加重。下焦的水肿，如果是气虚所致，用牵牛子迅猛逐水，也常常没有效果，与上焦的情况完全相同。只有真正的外来水邪，使用牵牛子利水，才开始见效如响应声。由此可见，牵牛子只可治疗外来的水湿，而不能治疗内伤的湿气，这是很明显的，不仅仅是治血分中的水而不治气分中的水。那么，外来的水湿和内伤的水湿，如何辨别呢？也是在皮肉之间进行辨别而已。外邪引起的水湿，用手按压皮肉必然像泥一样凹陷不起。内伤引起的水湿，用手按压皮肉必然随按随起，即使有时按之不起，也一定不像泥那样可以团捏成形，按下去有的起有的不起。起的又有分别，按之即起的，是气虚但还有命门之火；按之久不起的，是气虚至极并且连命门之火也没有了。按之像泥一样的，必须使用牵牛子来泻水；按之不像泥，或者起或者不起的，必须使用补肾中先天之气，而又加上健脾开胃，以补益后天之气，才能奏效。如果也用牵牛子，岂止是耗气而已，会有随着利水而元气随之亡失的危险啊，能不谨慎吗？我之所以表彰牵牛子的功效，并同时辨析李东垣论药的错误。
牵牛子治疗外来的水湿，而不治疗内伤的湿气，我已经明确辨析过了。然而牵牛子治疗外来的水湿，又各有不同。外来的水湿，有从下部向外侵入的，有从中部向外侵入的。从下部向外侵入的，是从脚部进入的；从中部向外侵入的，是从腰部和肚脐进入的。世人只知道外邪的水湿从脚部进入，不知道从腰部和肚脐进入。从脚部进入的，脚先肿胀，人们容易识别；从腰部和肚脐进入的，腰部沉重而肚脐肿胀，人们难以识别。水肿如果不区分是从脚部还是腰脐进入，而一概用牵牛子泻水除湿，难怪会有无效的情况。那么使用牵牛子的方法，又怎能不加以区分呢？凡是治疗水湿从脚部进入的，使用牵牛子和甘遂来消除它。如果水湿从腰部和肚脐进入的，在使用牵牛子时配合白术，一剂药后腰部沉重感消除且肚脐肿胀平复，三剂药后腰部和肚脐都通畅了。
Radix Sophorae Flavescentis (Kushen, 苦参), bitter in taste, cold in nature, heavy and sinking, purely yin, non-toxic. It enters the meridians of the Heart, Liver, Kidney, and Large Intestine. It treats intestinal wind with hematochezia (bleeding from the rectum due to wind pathogen), severe abdominal pain caused by heat-dysentery (dysentery caused by damp-heat accumulation in the intestines) that is unbearable; it cures delirious speech and mental restlessness, and the critical condition of chest binding (a syndrome where pathogens bind in the chest and epigastrium). For those suffering from erythema leprosy (a stubborn skin disease characterized by loss of eyebrows), it has merit in dispelling wind. For those with jaundice (yellowing of the skin and eyes) accompanied by enuresis, it produces immediate effects in draining water. It sweeps away whole-body itching and rashes, stops sudden acute heart pain, kills scabies mites, breaks up masses and accumulations (abdominal lumps), dissipates stagnant qi, brightens the eyes and stops tearing, relieves thirst and generates fluids, unblocks the nine orifices, and promotes bowel movements. However, its action is overly swift and sharp; it should be used sparingly as an assistant or guide herb, not in large doses as a sovereign or minister herb. Claims that it tonifies the Kidney, calms the Five Zang organs, and stabilizes the mind are unreliable statements.
One might ask: Everyone knows that Radix Sophorae Flavescentis does not tonify the Kidney, but few know the reason why it damages the Kidney. Does the fact that it does not tonify the Kidney need asking? Its heavy cold nature destroys Kidney Yang, inevitably leading to five-watch diarrhea (diarrhea occurring before dawn); its bitter-cold nature drains Kidney Qi, inevitably causing pain in the lower abdomen. Since Radix Sophorae Flavescentis is bitter and cold, with a sinking and descending qi mechanism, how can it fail to destroy and drain Kidney Qi? Consequently, five-watch diarrhea and lower abdominal pain are inevitable. To claim it tonifies the Kidney after destroying and draining Kidney Qi is incomprehensible; I urge you not to believe such claims.
Semen Persicae (Qianniu, 牵牛子), pungent and bitter in taste, cold in nature, toxic. Although there are black and white varieties, their functions are identical. It enters the Spleen, Large Intestine, and Small Intestine meridians, and also connects to the Bladder meridian. It removes stagnation and qi-related urgency/dyspnea, treats flaccid masses (subcostal lumps) and gu poison, facilitates difficult urination and defecation, and effectively treats leg fullness and edema. However, its action is extremely swift and sharp, consuming the body's primordial Qi (Yuan Qi, 元气), so it must not be used lightly. While omitting the reasons for not using it lightly and avoiding it entirely is also a biased view, Semen Persicae benefits the dampness of the Lower Jiao by draining water within the Blood level, which is very appropriate. It cannot drain dampness of the Upper Jiao. Draining water within the Qi level invariably damages primordial Qi. Li Dongyuan analyzed this clearly, leaving little room for further debate, yet he did not discuss the Middle Jiao. The Middle Jiao resides between Qi and Blood; since Semen Persicae can drain water from the Blood level, why could it not partially drain water from the Blood level in the Middle Jiao? Alas! Water-dampness is a pathogen. If Semen Persicae can promote urination, why distinguish between Qi and Blood? However, water-dampness enters from below. Damp-pathogens entering from below are external water pathogens, not internal injury water pathogens. Semen Persicae can only purge external water but cannot eliminate internal dampness. Edema of the Upper Jiao results from Qi deficiency failing to transform water, causing bloating upon water intake; over time, it resembles general edema. Thus, using Semen Persicae often exacerbates the condition. For Lower Jiao edema due to Qi deficiency, using Semen Persicae for rapid purging is also often ineffective, similar to the Upper Jiao case. Only true external water pathogens respond well to Semen Persicae's diuretic action. Thus, it is clear that Semen Persicae treats only external water, not internal dampness—not merely treating water in the Blood but not in the Qi. How then to distinguish external water from internal injury water? This distinction lies within the skin. External pathogenic water yields to pressure like mud. Internal injury water rebounds immediately after pressure; even if it does not rebound immediately, it cannot be molded like clay, showing variable responses to pressure. Immediate rebound indicates Qi deficiency but preserved Mingmen Fire (Gate of Life Fire); prolonged non-rebound indicates extreme Qi deficiency and loss of Mingmen Fire. Cases yielding like mud require Semen Persicae to drain water. Cases not yielding like mud, whether rebounding or not, require tonifying the Pre-heaven Qi of the Kidney combined with strengthening the Spleen and opening the stomach to benefit Post-heaven Qi (Hou Tian Zhi Qi, 后天之气) to achieve efficacy. Using Semen Persicae here would not only consume Qi but risk fatal Qi loss alongside fluid drainage. One must be cautious. I highlight the merits of Semen Persicae while correcting errors in Li Dongyuan’s herbal theories.
I have clarified that Semen Persicae treats external water but not internal dampness. However, its treatment of external water varies. External water enters from below (feet) or from the middle (waist and umbilicus). People recognize foot-entry edema easily due to initial foot swelling, but miss waist-and-umbilicus entry, characterized by heavy waist and swollen umbilicus. Failing to distinguish these sources and universally applying Semen Persicae explains its occasional ineffectiveness. Therefore, methods of using Semen Persicae must differ. For water entering from the feet, use Semen Persicae together with Kansui Radix (Gansui, 甘遂) to resolve it. For water entering from the waist and umbilicus, combine Semen Persicae with Atractylodis Macrocephalae Rhizoma (Baizhu, 白术). After one dose, waist heaviness resolves and umbilical swelling subsides; after three doses, both areas become clear.