（隰草）凉血滋阴
干地黄（即生地黄之干者也。专入肾。并入心脾）。味苦而甘。性阴而寒。考诸长洲张
璐谓其
心紫入心。中黄入脾。皮黑归肾。味浓气薄。内专凉血滋阴。外润皮肤索泽。病患虚而有热
者。咸宜用之。（无热须用熟地。）戴原礼曰。阴微阳盛。相火炽强。来乘阴位。日渐煎熬。
阴虚火旺之症。宜地黄以滋阴退阳。同人参茯苓石蜜。名琼玉膏。治虚劳咳嗽唾血。（专补
肺阴。）同天麦门冬熟地人参。名固本丸。治老人精血枯槁。（兼固肾本。）于固本丸中加枸
杞煎膏。名集灵膏。治虚羸喘咳乏力。（诸脏兼固。）其琼玉膏须用鲜者捣汁。桑火熬膏。散
中寓止。与干者无异。固本丸集灵膏并用干者。而集灵变丸作膏。较之固本差胜。易简方曰
。男子多阴虚。宜熟地黄。女子多血热。宜生地黄。（因人酌施。）虞抟云。生地黄凉血。而
胃气弱者恐妨食。熟地黄补血。而痰饮多者恐泥膈。（妨食泥膈两症。最宜计较。何后人临
症。全不于此问及。）或言生地黄酒炒则不妨胃。熟地黄姜制则不泥膈。然须详病患元气病
气之浅深而用之。（治病须明脏气为要。）若产后恶食泄泻。小腹结痛。虚劳脾胃薄弱。大便
不实。胸腹多痰。气道不利。升降窒塞者。咸须远之。（以其有损胃气故耳！）浙产者专于凉
血润燥。病患元气本亏。因热邪闭结而舌干焦黑。大小便秘。不胜攻下者。用此于清热药中
。通其秘结最佳。以其有润燥之功而无滋润之患也。愚按本经地黄虽列上品。而实性禀阴柔
。与乡愿不异。譬诸宵人内藏隐隙。外示优容。（描画阴药情势殆尽。）是以举世名家。靡不
藉为滋阴上品。止血神丹。（历今弊仍不改。）虽或用非其宜。得以稍清旺气。服之仍得暂安
。非若人参之性禀阳明。象类君子。有过必知。（阳药性劣。于病不合便知。）是以师家敛手
不敢用。病家缄口不敢尝。故宁用以地黄门冬阴柔最甚之属。以至于死不觉。（用阴药杀人
。人多不觉。故宁以阴为主。）张璐所论如此。然非深究病情。通达世故。洞悉药品。亦安
有讨论而如斯乎！生于江浙者阳气力微。生于北方者纯阴力大。生于怀庆肥大菊花心者良。
酒制则上行外行。姜制则不泥膈。恶贝母。畏芜荑。忌莱菔葱蒜铜铁器。得酒门冬丹皮当归
良。
干地黄，就是干燥的生地黄。（专门入肾经，同时也并入心经和脾经。）味道苦而甘，性质属阴且寒。考察长洲人张璐的观点，认为其中心色紫入心经，中间色黄入脾经，外皮色黑归肾经。它气味浓郁但气薄，内部专门用于凉血滋阴，外部能润泽皮肤使其有光泽。对于体内虚弱而有热邪的患者，都适宜使用它。（如果没有热象，则应当使用熟地黄。）戴原礼说：阴气微弱而阳气盛，相火炽盛强旺，侵犯阴位，日渐煎熬，导致阴虚火旺的症状，适宜用地黄来滋阴以退阳。与人参、茯苓、石蜜同用，名为琼玉膏，治疗虚劳咳嗽、咳血。（专门补益肺阴。）与天冬、麦冬、熟地黄、人参同用，名为固本丸，治疗老年人精血枯竭。（兼固肾之本源。）在固本丸中加入枸杞煎膏，名为集灵膏，治疗身体虚弱羸瘦、气喘咳嗽、乏力。（五脏兼固。）其中琼玉膏必须用鲜品捣汁，用桑柴火熬制成膏，散中有止，与干品的效果无异。固本丸和集灵膏都用干品，而集灵膏将丸剂改为膏剂，比固本丸效果更好。《易简方》说：男子多阴虚，适宜用熟地黄；女子多血热，适宜用生地黄。（应根据个人情况斟酌施用。）虞抟说：生地黄能凉血，但胃气虚弱的人恐怕会妨碍饮食；熟地黄能补血，但痰饮多的人恐怕会阻滞膈部。（妨碍饮食和阻滞膈部这两个症状，最需要注意权衡，为何后人临症时，完全不在这里询问考虑？）有人说生地黄用酒炒制就不妨碍胃气，熟地黄用姜制就不阻滞膈部。然而必须详细考察患者的元气和病气的深浅来决定使用。（治病必须以明白脏腑之气为关键。）如果是产后恶食泄泻，小腹结聚疼痛，虚劳导致脾胃薄弱，大便不成形，胸腹多痰，气道不利，升降窒塞的情况，都必须远离这些药物。（因为会损伤胃气啊！）浙江产的地黄专门用于凉血润燥。患者元气本来亏损，因热邪闭结导致舌干焦黑，大小便不通，不能耐受攻下疗法时，将此药加入清热药中，通利秘结效果最佳。因为它有润燥的功效而没有滋腻的弊端。我认为《本经》虽将地黄列为上品，但其实际禀性属于阴柔，与伪善之人无异，就像小人内心隐藏间隙，外表示以宽容。（把阴药的态势描绘得淋漓尽致。）因此举世名医，无不借它作为滋阴的上品，止血的灵丹。（至今弊端仍未改变。）虽然有时使用不当，也能稍微清降旺盛的气火，服用后仍能暂时安宁。不像人参禀性属阳明，形象像君子，有过错必定知晓。（阳药如果性质恶劣，与病情不合就能立刻知道。）因此医生束手不敢用，病人闭口不敢尝。所以宁愿使用地黄、麦冬等阴柔最甚的药物，以至于死了也不觉得。（用阴药杀人，人们大多不觉察，所以宁愿以阴药为主。）张璐的论述就是这样。然而如果不是深入研究病情，通达世故，洞悉药品特性，又怎么能讨论得如此透彻呢！生长在江浙一带的地黄阳气力微，生长在北方地黄纯阴力大，生长在怀庆地区肥大且有菊花心的品质优良。酒制则药力上行外行，姜制则不阻滞膈部。忌与贝母同用，畏芜荑，忌莱菔、葱、蒜及铜铁器。与酒、麦冬、丹皮、当归同用效果好。
(Xi Cao) Cools the blood and nourishes Yin.
Dried Rehmanniae Radix (Gan Di Huang), which is the dried form of Fresh Rehmanniae Radix (Sheng Di Huang). It specifically enters the Kidney meridian, and also enters the Heart and Spleen meridians. Its taste is bitter and sweet; its nature is Yin and cold. According to Zhang Lu from Changzhou, the purple center enters the Heart, the yellow middle enters the Spleen, and the black skin returns to the Kidney. With a rich flavor but thin Qi, it internally specializes in cooling the blood and nourishing Yin, while externally moistens the skin to restore luster. For patients who are deficient internally yet have heat, it is generally suitable for use. (If there is no heat, Cooked Rehmanniae Radix (Shu Di Huang) should be used.) Dai Yuanli stated: When Yin is weak and Yang is exuberant, with Ministerial Fire (Xiang Huo) blazing strong and invading the Yin position, causing gradual consumption, leading to symptoms of Yin deficiency with fire hyperactivity, it is appropriate to use Rehmannia to nourish Yin and retreat Yang. Combined with Ginseng Radix et Rhizoma (Renshen), Poria (Fuling), and rock sugar (Shimi), it is named Qiongyu Paste (Qiongyu Gao), treating consumptive disease with cough and hemoptysis. (Specifically tonifies Lung Yin.) Combined with Asparagus Fern Root (Tian Dong), Ophiopogon Tuber (Mai Dong), Cooked Rehmanniae Radix (Shu Di Huang), and Ginseng Radix et Rhizoma (Renshen), it is named Guben Pill (Guben Wan), treating elderly individuals with exhaustion of essence and blood. (Simultaneously secures the root of the Kidney.) Adding Goji Berry Paste (Gouqi Jiang) to Guben Pill creates Jiling Paste (Jiling Gao), treating emaciation, wheezing, cough, and fatigue. (Simultaneously secures all Zang organs). Qiongyu Paste must be made by crushing fresh herbs for juice and boiling into paste using mulberry wood fire; the dispersing action contains a restraining quality, making it no different from the dried form. Both Guben Pill and Jiling Paste use dried herbs, but changing Jiling from pill to paste yields better results than Guben. *Yijian Fang* states: Men often suffer from Yin deficiency, so Cooked Rehmanniae Radix (Shu Di Huang) is suitable; women often suffer from blood heat, so Fresh Rehmanniae Radix (Sheng Di Huang) is suitable. (Use should be adjusted according to the individual.) Yu Tun said: Fresh Rehmanniae Radix (Sheng Di Huang) cools the blood, but may hinder digestion in those with weak Stomach Qi; Cooked Rehmanniae Radix (Shu Di Huang) tonifies blood, but may cause stagnation in the epigastrium for those with abundant phlegm-fluids. (These two issues—hindering digestion and causing stagnation—are critical considerations, yet why do later practitioners rarely inquire about them during clinical practice?) Some say that stir-frying Fresh Rehmanniae Radix (Sheng Di Huang) with wine prevents hindering Stomach Qi, and processing Cooked Rehmanniae Radix (Shu Di Huang) with ginger prevents epigastric stagnation. However, one must carefully examine the depth of the patient's primal Qi and pathogenic factors before use. (Understanding Zang-Fu Qi is essential for treatment.) In cases of postpartum aversion to food and diarrhea, binding pain in the lower abdomen, consumptive disease with weak Spleen and Stomach, loose stools, excessive phlegm in the chest and abdomen, obstructed Qi mechanism, and blocked ascending and descending functions, these herbs must be avoided. (Because they damage Stomach Qi!) Rehmannia produced in Zhejiang specializes in cooling blood and moistening dryness. For patients whose primal Qi is originally deficient, but due to heat-pathogen closure causing a dry, scorched-black tongue and constipation of both stool and urine, where aggressive purgation cannot be tolerated, adding this herb to heat-clearing formulas is optimal for unblocking constipation. This is because it has the function of moistening dryness without the drawback of being cloying. I observe that although *Shennong Bencao Jing* lists Rehmannia as a superior grade drug, its actual nature is Yin and soft, akin to a hypocrite, like a villain hiding flaws inside while showing tolerance outside. (This vividly describes the tendency of Yin-tonifying drugs.) Thus, renowned physicians throughout history have relied on it as a superior agent for nourishing Yin and a divine elixir for stopping bleeding. (The drawbacks remain unchanged to this day.) Although sometimes used inappropriately, it can slightly clear exuberant Qi, providing temporary relief after ingestion. Unlike Ginseng Radix et Rhizoma (Renshen), which possesses Yangming nature and resembles a gentleman, knowing faults immediately. (If a Yang-drug is unsuitable, it is readily apparent.) Therefore, physicians hesitate to use it, and patients dare not take it. Consequently, people prefer using highly Yin-softening substances like Rehmannia and Ophiopogon Tuber, even unto death, without realizing it. (Using Yin-drugs to kill people goes unnoticed by many, hence the preference for Yin as the primary approach.) Zhang Lu’s discussion is as follows. However, unless one deeply investigates pathological conditions, understands worldly affairs, and thoroughly comprehends medicinal properties, how could such profound discussion exist? Rehmannia grown in Jiangsu and Zhejiang has weak Yang energy; Rehmannia grown in the North has pure Yin and strong potency; Rehmannia grown in Huaiqing that is plump with a chrysanthemum-heart pattern is of good quality. Wine-processing directs the action upward and outward; ginger-processing prevents epigastric stagnation. It clashes with Fritillaria Bulb (Beimu) and is wary of Prunus Seed (Wuyi). It avoids Radish (Laifu), green onion, garlic, and copper/iron vessels. It works well when combined with wine, Ophiopogon Tuber (Maidong), Moutan Cortex (Danpi), and Angelicae Sinensis Radix (Danggui).