（毒草）吐心下疟痰积饮
常山（专入心下。）辛苦而寒。有毒。功专引吐行水。为除疟疾老痰积饮要药。盖疟无
不挟痰
挟热以成。然亦有风痰寒热食气之分。（风痰宜于星乌。寒痰宜于姜附。热痰宜于贝母。食
痰宜于楂曲。气痰宜于乌药。痰在膈上经络。非吐不解。痰在四肢皮里膜外。非姜汁竹沥不
达。痰在胁下。非白芥子不除。痰在骨节眼黑步艰。非萆 苦参不祛。痰在手臂肩背酸痛。
非导痰加姜黄木香桂枝不和。痰在肠胃实结。非用下药不愈。）治须分其阴阳虚实表里以定
。如疟果因伤寒寒热。及时气温疫。而致黄涎聚于胸中。心下牢固不解。则当用此引吐。然
亦须在发散表邪。及提出阳分之后而用之。其用又当审其所见部位。及药佐使以治。如常山
得
甘草则吐。水在上焦者宜之。得乌梅山甲则入肝。水在胁下者宜之。得大黄则利水。邪热交
结而成内实者宜之。得小麦竹叶则入心。得秫米麻黄则入肺。得龙骨附子则入肾。得草果槟
榔则入脾。然此阴毒之草。其性悍暴。虽有破瘴逐饮之能。而亦终损真气。所以仲景治疟方
中。从无及此。（经曰。太阴在泉。湿胜所淫。民病积饮。又曰。岁土太过。雨湿流行。甚
则饮发。盖饮有五。流于肺为支饮。于肝为悬饮。于心为伏饮。于经络为溢饮。于肠胃为痰
饮。）而夏伤于暑。秋必瘅疟。及疟在三阴。元气虚寒人。则常山等药皆为戈戟。或问吐药
甚多。何以疟疾必用常山蜀漆？盖以常山性兼逐疫。疟疾本于湿疫。故于常山蜀漆则宜。犹
之瓜蒂乌附尖莱菔子藜芦皆为吐剂。而瓜蒂则止宜于热痰。乌尖附则止宜于湿痰。莱菔子则
止宜于气痰。藜芦则止宜于风痰也。酒浸炒用。根即蜀漆。功用略同。但苗性轻扬。其于上
焦邪结。治之更宜。
常山（专入心下部位。）味辛苦，性寒。有毒。功效专门在于引导呕吐、行利水湿，是治疗疟疾老痰和积饮的重要药物。大概疟疾无不挟带痰邪，且多挟热而形成。然而也有风痰、寒痰、食气痰的区别。（风痰适宜用天南星、川乌；寒痰适宜用干姜、附子；热痰适宜用贝母；食痰适宜用山楂、神曲；气痰适宜用乌药。痰在膈上及经络部位，非涌吐法不能解除；痰在四肢皮里膜外，非姜汁、竹沥不能到达；痰在胁下，非白芥子不能祛除；痰在骨节间隙导致行走困难，非萆薢、苦参不能祛除；痰在手臂肩背引起酸痛，非导痰汤加姜黄、木香、桂枝不能调和；痰在肠胃实结，非使用泻下药不能痊愈。）治疗时必须分辨其阴阳、虚实、表里来确定治法。例如疟疾如果是因为伤寒引起的寒热，或因时气温疫，导致黄涎聚集于胸中，心下部位牢固不解，则应当使用此药来引导呕吐。但也必须在发散表邪，以及将病邪提出阳分之后才使用它。用药时又应当审察病变部位，以及药物的佐使配伍来进行治疗。例如常山得到甘草配合则能引起呕吐，适用于水饮在上焦的情况；得到乌梅、穿山甲配合则入肝经，适用于水饮在胁下的情况；得到大黄配合则通利水湿，适用于邪热交织而成内实的情况；得到小麦、竹叶配合则入心经；得到秫米、麻黄配合则入肺经；得到龙骨、附子配合则入肾经；得到草果、槟榔配合则入脾经。然而这是阴毒之草，药性悍烈暴戾，虽然有破除瘴气、驱逐水饮的能力，但最终会损伤真气。所以张仲景在治疗疟疾的方剂中，从来没有用到过这味药。（《内经》说：太阴在泉之时，湿气偏胜所致的淫邪，民众易患积饮病。又说：岁土太过之年，雨湿流行，严重时会导致饮病发作。大概饮邪有五种：流注于肺称为支饮，留于肝称为悬饮，伏于心称为伏饮，溢于经络称为溢饮，停留于肠胃称为痰饮。）而且夏季伤于暑气，秋季必定发生瘅疟。以及疟疾病在三阴经，元气虚寒的人，那么常山等药物都如同戈戟一样有害。有人问：涌吐的药物很多，为什么治疗疟疾一定要用常山、蜀漆？大概因为常山的药性兼有驱逐疫气的功能，而疟疾本源于湿疫，所以对于常山、蜀漆是适宜的。这就好比瓜蒂、乌头尖、附子尖、莱菔子、藜芦都是涌吐剂，但瓜蒂只适宜于热痰，乌头尖、附子尖只适宜于湿痰，莱菔子只适宜于气痰，藜芦只适宜于风痰。用酒浸泡后炒制使用。根部就是蜀漆，功用大致相同。只是苗叶的药性轻扬升散，对于上焦邪气结聚的治疗更为适宜。
(Venomous Herb) Induces Vomiting to Expel Malaria Phlegm and Fluid Retention in the Epigastrium
Changshan (Dichroa Radix, 常山) (Specifically enters the epigastric region.) Bitter and acrid in flavor, cold in nature. Toxic. Its function is specifically to induce vomiting and promote water metabolism. It is a crucial herb for eliminating stubborn phlegm and fluid retention associated with malaria. Generally, malaria invariably involves phlegm, which forms accompanied by heat. However, there are distinctions among wind-phlegm, cold-phlegm, food-stagnation phlegm, and qi-phlegm. (Wind-phlegm is suitable for processing with Acori Tatarinowii Rhizoma, Tian Nan Xing, and Aconiti Lateralis Radix Praeparata, Zhi Wu Tou; cold-phlegm is suitable for Ginger, Gan Jiang, and Aconiti Radix Praeparata, Zhi Fu Zi; heat-phlegm is suitable for Fritillariae Cirrhosae Bulbus, Bei Mu; food-stagnation phlegm is suitable for Crataegi Fructus, Shan Zha and Malt, Shen Qu; qi-phlegm is suitable for Linderae Radix, Wu Yao. If phlegm is located above the diaphragm and in the meridians, it cannot be resolved without inducing vomiting; if phlegm is located in the skin and between the muscles of the four limbs, it cannot reach these areas without Ginger Juice, Jiang Zhi and Asparagi Rhizoma, Zhu Li; if phlegum is located in the hypochondrium, it cannot be eliminated without Brassicae Semen Album, Bai Jie Zi; if phlegm is in the joint spaces causing difficulty in walking, it cannot be dispelled without Dioscoreae Hypoglaucae Rhizome, Bi Xie and Sophorae Flavescentis Radix, Ku Shen; if phlegm causes soreness and pain in the arms, shoulders, and back, it cannot be harmonized without Dao Tan Tang plus Curcumae Longae Rhizoma, Jiang Huang, Aucklandiae Radix, Mu Xiang, and Cinnamomi Ramulus, Gui Zhi; if phlegm-solidification exists in the intestines and stomach, it cannot be cured without using purgatives.) Treatment must determine the method based on differentiation of yin and yang, deficiency and excess, exterior and interior. For instance, if malaria results from Cold Damage (Shang Han) with alternating chills and fever, or due to seasonal warm pathogens and epidemics, leading to yellow saliva accumulating in the chest and firmly resisting resolution in the epigastrium, then this herb should be used to induce vomiting. However, it must only be employed after releasing the pathogenic factors from the exterior and drawing the pathogen out from the Yang level. The administration should also consider the specific site of the lesion and the coordinating and guiding properties of accompanying herbs. For example, when Changshan is combined with Glycyrrhizae Radix et Rhizoma, Gan Cao, it induces vomiting, making it suitable for fluid retention in the Upper Jiao. When combined with Mume Fructus, Wu Mei and Pangolin Scales, Chuan Shan Jia, it enters the Liver channel, suitable for fluid retention in the hypochondrium. When combined with Rheismi Radix et Rhizoma, Da Huang, it promotes urination/drainage of water, suitable for internal excess formed by the intermingling of evil heat. When combined with Tritici Semen, Xiao Mai and Bambusae Folium, Zhu Ye, it enters the Heart. When combined with Milii Glutinis Semen, Shu Mi and Ephedrae Herba, Ma Huang, it enters the Lung. When combined with Draconis Os, Long Gu and Aconiti Radix Praeparata, Zhi Fu Zi, it enters the Kidney. When combined with Amomi Fructus Rotundus, Cao Guo and Arecae Semen, Bing Lang, it enters the Spleen. However, this is a venomous herb of Yin nature, with a fierce and violent character. Although it has the ability to break through miasma and drive out fluid retention, it ultimately damages the True Qi. Therefore, Zhang Zhongjing never included this herb in his formulas for treating malaria. (The Classic says: When Taiyin governs the lower heaven, dampness prevails as the excessive influence, and the people suffer from fluid accumulation diseases. It also says: In years where Earth energy is excessive, rain and dampness circulate widely, and severe cases result in the onset of fluid diseases. Generally, there are five types of fluid retention: those flowing into the Lung are called Branch Fluid (Zhi Yin); those remaining in the Liver are called Suspended Fluid (Xuan Yin); those hidden in the Heart are called Hidden Fluid (Fu Yin); those overflowing into the meridians are called Overflowing Fluid (Yi Yin); and those staying in the intestines and stomach are called Phlegm-Fluid (Tan Yin).) Furthermore, summer injury by heat leads to severe malaria in autumn. For malaria affecting the Three Yin channels, or in individuals with deficient and cold Yuan Qi, herbs like Changshan become harmful like halberds. One might ask: There are many emetic herbs, why must Changshan and Shuqi be used for malaria? This is because Changshan possesses the property of expelling epidemic pathogens, and since malaria originates from damp-epidemic pathogens, Changshan and Shuqi are appropriate. Just as Genggenis Rhizoma, Gua Di, Aconiti Lateralis Radix, Wujian, Aconiti Radix, Fuzi Jian, Raphani Semen, Laifuzi, and Veratrum Viride, Lilü, are all emetics, yet Gua Di is only suitable for heat-phlegm, Wujian and Fuzi Jian are only suitable for damp-phlegm, Laifuzi is only suitable for qi-phlegm, and Lilü is only suitable for wind-phlegm. Use after soaking in wine and stir-frying. The root is Shuqi, with similar functions. However, the leaves have a light and ascending nature, making them more suitable for treating pathological accumulations in the Upper Jiao.