名金铃子。产蜀川者佳。三四月开花红紫。结实如弹。生青熟黄。十二月采之。酸而纯
苦。气寒。气薄味浓。降也。入心肝肾小肠膀胱经。 楝实为阴中之阳。然用之乃从阳入阴。
故得致其阳于阴也。 主治热厥心痛。上下部腹痛。疝气。利水道。疗虫痔。 方书多主疝
证。次遗精喘。诸逆冲上头痛。心胁胃脘腰痛。积聚小便数淋。溲血下血。前阴诸疾。齿病。
楝实为下焦气分药。（阆风） 解热散结之剂。（蒿） 脐之上下痛与心暴痛者。均是气滞与
火。楝实酸苦。能涌泄之。（类明） 楝实治阴虚阳厥。如心痛胃脘痛证。又治阴胜阳陷。
如疝证。 同牛膝木瓜橘红荔枝核杜仲巴戟乌 树子茴香。治肾虚疝气。 疝肿痛。有五制
四制七制用者。俱见濒湖纲目。丈夫疝气。本脏气伤。膀胱连小肠等气。楝实百枚。温汤浸
过。去皮。巴豆二百枚。微打破。以面二升。同置铜铛内。炒至楝实赤色为度。放冷取出。
去核为末。巴面不用。每服三钱。热酒或醋汤调服。一方。入盐炒茴香半两。 肾消膏淋。
病在下焦。苦楝子茴香等分。炒
〔论〕 楝实禀天之阴气。得地之苦味。苦应入心。然肾为心火对化。又味从乎气。故
凡苦寒之属。类入于肾。而楝实独入心。如东垣所说。（东垣云。入心与小肠。）何哉。缘其
味初尝有酸。后乃纯苦。禀苦寒之性。以下行逐热。实兼木火之原。以导气达阳。故解热散
结。与诸苦寒之直折降热者。殊有不同。盖本木火以致于苦寒。则能引阳而归之。是以阴气
衰于下。而为热厥心痛者。非此不除。（如但以为清热。则苦寒之归。下者。安能补阴气之
衰耶。）至其为下焦气分药。而治疝率多用之。亦此义耳。疝之为患。多在肾肝部分。而受
病则惟寒郁热之因。寒固肾与膀胱之气。热则厥阴相火之气也。此味根君火之对化。自应入
肾。兼木火之气化。自应彻肝。所谓导气达阳。而兼解热散结者也。（彻肝之义。即本木火
以致于苦寒之义也。洁古治茎中痛。用生甘草梢。却加延胡苦楝子。尤妙。又治淋证茎痛引
胁者。有参苓琥珀汤。以苦楝为君。内经云。足厥阴循阴器而络于肝。又足厥阴之别者。循
胫上睾。结于茎。信乎此味为入肝的剂矣。）诸方有同莱菔牵牛斑蝥炒。藉其破坚溃郁之气。
以助此味散结之功者。有引以故纸茴香。寒因热用。直入寒中之热。以竟此味逐热之功者。
则其主治。概可睹矣。第疝证或即曰小肠气。间曰膀胱气。是以小肠膀胱之气病。便是疝也。
不知离小肠膀胱以治疝。固无是理。即小肠膀胱以为疝。究有未宜。盖人身惟是水火二气。
心肾者水火之匡廓。而小肠膀胱则心肾气化之府也。使病于疝者。抹却肾及小肠膀胱。而独
以肝为言。则试思肝之所以能由阴而达阳于天。复由阳而蟠阴于地者。如不藉水火之气化。
动而不 。若小肠膀胱之用。（手太阳丙火上行。足太阳壬水下行。）将一阴何以为独使乎。
故曰。离小肠膀胱以治疝。无是理也。若止病于小肠膀胱。而未及病于肝。则治法固别。盖
病于肝者。乃寒水之脏腑。郁其水中真阳。而肝升之阳郁。即以病同处于下之脾。卒之寒湿
合化。厥阴益不得达。而病于任者愈甚。如东垣所云也。（东垣云。足太阳膀胱之气逆。上
迎手太阳小肠之脉下行。致足厥阴之脉不得伸其任脉。并厥阴之脉逆。如巨川之水。使阳气
下坠。致两睾肿大。谓之曰疝。大甚则为 也。） 至于小肠膀胱之自为病。或火淫而水虚。
或水泛而火虚。治此者更宜适事为故。岂得漫同于治疝之法耶。总之。楝实之用。所治者疝
。而奏功之地在膀胱。其能奏功于膀胱者。又始于小肠。即其三四月已毕。历夏至冬而后采
实。是固本木火之气。以致于寒水而功乃成耳。夫寒水之气大郁。不根木火之元气以达之开
之。而谓疝可疗乎。矧外痼之积冷。不从以苦寒。能使木火之气。浸入于凝寒中以导气乎。
犹恐其不开。或借巴豆气以和苦寒而彻阳矣。至东垣谓其入小肠。且先之入心。何也。人身
之火。原出水中。水为火之元。心为火之主。楝实本木火之气以致于寒水。故下之阴虚而阳
厥者。用火之主。以归之。如热厥心痛是。盖阳归于阴。则阴自为阳守也。下之阴翳而阳陷
者。用火之主以彻之。如寒郁热为疝是。盖阳彻于阴。则阴自不痼阳矣。其功皆奏于下。而
所以归之彻之者。乃在上。故首言入心。 又按。本木火以致苦寒。则木火入手。不与温补
之味相逆。渐入而致苦寒。则与虚寒之气骤得温补者。因有同气之先导。而温补乃可以奏功。
如治阳虚于下而遗泄者。用以佐补阳虚。正是此义。知此则阴虚阳虚病于他证者。可以类推
而治矣。
脾胃虚寒者。不宜。（仲淳）
〔修事〕 酒浸蒸软。去皮核。取净肉晒干。 或酒煮。或盐煮。或麸炒。或巴豆炒。
或单炒。或不制。随证所宜。
苦楝皮根及木皮
味苦。气微寒。有小毒。 主治游风热毒。风疹恶疮疥癞。小儿壮热（并煎汤浸洗） 消
渴有虫。苦楝根取新白皮（日华子言。雄者根赤。有毒。吐泻杀人。）一握。切焙。入麝香
少许。水二碗。煎至一碗。空心饮之。虽困顿。不妨。自后下虫三四条。类 而色红。其渴
顿止。乃知消渴一证。有虫耗其津液。
〔辨治〕 雄者根赤。不可用。雌者色白。入药。 每一两。可入糯米五十粒。同煎杀
毒。若泻者。以冷粥止之。不泻者。以热葱粥发之。
【楝实】又名金铃子。产自蜀川的质地最佳。三四月间开出红紫色的花，结出的果实像弹丸一样大小，生时呈青色，成熟后变黄，十二月采收。味道酸而纯苦，药性寒凉，气薄味浓，具有沉降之性。归入心、肝、肾、小肠、膀胱经。
楝实属于阴中之阳，但使用时是从阳进入阴，因此能够引导阳气入于阴分。主治热厥引起的心痛，上下腹部的疼痛，疝气，通利水道，治疗虫痔。医书中多主张用其治疗疝证，其次用于遗精、气喘，各种逆气冲上引起的头痛，心胁胃脘腰痛，积聚病，小便频数淋沥，尿血便血，前阴各类疾病，牙齿疾病。
楝实是下焦气分的药物。（阆风注）具有解热散结的功效。（蒿注）脐部上下疼痛以及突发心痛，都是由于气滞与火邪所致。楝实味酸苦，能涌吐泄热。（类明注）楝实治疗阴虚导致的阳厥，如心痛、胃脘痛等证；又治疗阴盛阳陷，如疝证。
与牛膝、木瓜、橘红、荔枝核、杜仲、巴戟天、乌树子、茴香同用，可治疗肾虚疝气。治疗疝气肿痛，有五种炮制方法、四种炮制方法和七种炮制方法，均见于李时珍《本草纲目》。丈夫疝气，是本脏气机受损，涉及膀胱连及小肠等气机。取楝实一百枚，用温水浸泡，去皮；巴豆二百枚，轻微打破，用面粉二升，一同放入铜锅中，炒至楝实变成赤色为止，放冷后取出，去掉核研为细末，巴豆和面粉不用。每次服用三钱，用热酒或醋汤调服。另一方：加入盐炒过的茴香半两。
【论】楝实禀受天的阴气，得地之苦味。苦味对应入心，然而肾是心火的对化（制约关系），且味道随气而行，所以凡是苦寒的药物，大多入肾，而楝实唯独入心，正如李东垣所说。（李东垣说：入心与小肠经。）为什么呢？因为它的味道初尝有酸，后来才变为纯苦，禀受苦寒的性质，以下行逐热为主，实际上兼有木火的本源，以引导气机通达阳气，所以能解热散结，这与那些苦寒药物直接折降热势的做法截然不同。大概是因为本于木火之气而转化为苦寒，所以能引导阳气回归。因此当下焦阴气衰弱而出现热厥心痛时，非此药不能消除。（如果仅仅认为它是清热药，那么苦寒直下的药物，怎么能补益下焦衰弱的阴气呢？）至于它作为下焦气分药，治疗疝气大多使用它，也是基于这个道理。疝气的病患，多在肾肝部位，而致病原因则是寒郁化热。寒邪固结于肾与膀胱之气，热邪则是厥阴相火之气。这种药根于心火的对化，自然应入肾；兼有木火的气化，自然应彻达肝脏。这就是所说的引导气机通达阳气，并兼有解热散结的作用。（“彻肝”的含义，即本于木火之气而转化为苦寒的含义。张洁古治疗茎中痛，用生甘草梢，却加上延胡索、苦楝子，尤其巧妙。又治疗淋证茎痛牵引胁肋者，有用参苓琥珀汤，以苦楝子为君药。《内经》说：足厥阴肝经循行阴器而络属肝脏。又说足厥阴之别脉，循胫骨上行至睾丸，结于阴茎。确实证明此药是入肝的要药。）各方中有同莱菔子、牵牛子、斑蝥一起炒制的，借助它们破坚溃郁的气机，来辅助此药散结的功效；有引以故纸（补骨脂）、茴香的，采用寒因热用的方法，直入寒中之热，来完成此药逐热的功效。那么它的主治作用，大致可以看到了。只是疝证有时就直接称为小肠气，间或称为膀胱气，以为小肠膀胱的气病就是疝气。却不知道离开小肠膀胱去治疝，固然没有这个理；即使仅把小肠膀胱当作疝，终究也不适宜。盖人身只有水火二气，心肾是水火的匡廓（主体），而小肠膀胱则是心肾气化功能的府库。假如患疝病的人，抹去了肾及小肠膀胱，而独独谈论肝脏，那么试思考肝脏之所以能从阴通达阳气于天，又从阳气蟠回阴气于地，如果不借助水火的气化，动而不止，依靠小肠膀胱的作用（手太阳丙火上行，足太阳壬水下行），那么一阴如何能成为独使呢？所以说，离开小肠膀胱去治疝，是没有道理的。如果仅仅是小肠膀胱生病，而未波及肝脏，那么治疗方法自然不同。盖病在肝脏，乃是寒水之脏腑，郁遏了水中的真阳，导致肝升发的阳气郁结，进而使得同样处于下焦的脾也患病，最终寒湿合化，厥阴之气更加不得通达，而导致任脉的病更加严重，正如李东垣所说的那样。（李东垣说：足太阳膀胱之气逆行，向上迎接手太阳小肠之脉下行，致使足厥阴之脉不能伸展其任脉，并且厥阴之脉逆行，如同巨川之水，使阳气下坠，导致两侧睾丸肿大，称之为疝。大甚则成为瘕积。）至于小肠膀胱自身的病变，或是火淫而水虚，或是水泛而火虚，治疗这些情况更应当根据具体情况处理，怎么能随意等同于治疗疝的方法呢？总之，楝实的用途，所治疗的是疝，而奏效的地方在于膀胱，它能奏功于膀胱，又始于小肠。也就是从三四月开花结果，历经夏至到冬天而后采收果实，这确实是本于木火之气，而致于寒水，功效才得以完成。如果寒水之气大加郁结，不凭借木火的元气来通达开启它，难道能说疝气可以治愈吗？况且外部的顽固积冷，如果不借助苦寒之性，能使木火之气浸入凝寒之中以导气吗？还担心其不开通，或许借巴豆之气来调和苦寒而通达阳气。至于李东垣说它入小肠，且先入心，为什么呢？人身之火，原本出于水中，水是火的源头，心是火的主宰。楝实本于木火之气而致于寒水，所以对于下焦阴虚而阳厥的情况，用火之主（心）来引导回归，如热厥心痛即是。既然阳气归于阴，那么阴自然能为阳守持。对于下焦阴翳遮蔽而阳气下陷的情况，用火之主来通达彻除，如寒郁热形成的疝气即是。既然阳气通达于阴，那么阴自然不再固结阳气。其功效都奏效于下焦，而所以引导回归、通达彻除的关键却在上面，所以首先说入心。
另外按语：本于木火之气而转化为苦寒，则木火之气入手，不与温补的药物性质相逆。逐渐进入而转化为苦寒，则与虚寒之气突然得到温补者不同，因为有同气的先导，所以温补才能奏效。如治疗下焦阳虚导致的遗泄，用它来佐助补阳虚，正是这个意思。知晓这一点，那么阴虚阳虚病发于其他证候的，就可以类推而治了。
【修事】用酒浸泡蒸软，去皮核，取净肉晒干。或者酒煮，或者盐煮，或者麸炒，或者巴豆炒，或者单炒，或者不炮制，随证候适宜而定。
【苦楝皮根及木皮】
味苦，气微寒，有小毒。主治游风热毒，风疹恶疮疥癞，小儿壮热（并煎汤浸洗）。消渴伴有寄生虫，取苦楝根的新白皮（日华子说：雄性的根呈红色，有毒，会导致吐泻甚至杀人）。取一握，切碎焙干，加入少许麝香，水两碗，煎至一碗，空腹饮用，虽然身体困顿也无妨。之后排出虫子三四条，形状类似蚕而颜色红，口渴顿时停止，这才知道消渴这一证候，是有虫子消耗了其津液。
【辨治】雄性根部呈红色的不可用，雌性根部颜色白的入药。每一两药，可加入糯米五十粒，同煎以杀毒性。如果服药后腹泻，用冷粥止泻；如果不腹泻，用热葱粥发汗发散。
[Litsea Fructus] Also known as Jinlingzi. The variety produced in Shuchuan is of the best quality. It blooms with red-purple flowers in March and April. The fruit is like a bullet in size, green when raw and yellow when ripe, harvested in December. Its taste is sour and purely bitter, its nature is cold, its qi is thin while its flavor is strong, possessing a descending property. It enters the Heart, Liver, Kidney, Small Intestine, and Bladder meridians.
Litsea Fructus belongs to "Yang within Yin," but when used, it moves from Yang into Yin, thereby capable of guiding Yang Qi into the Yin aspect. It mainly treats heat-jue (cold extremities due to internal heat) causing heart pain, abdominal pain in the upper and lower regions, hernia, promotes urination, and treats parasitic hemorrhoids. Medical texts mostly advocate its use for hernia syndromes,其次 (secondarily) for spermatorrhea and asthma, various rebellious Qi rising upward causing headaches, pain in the heart, hypochondrium, epigastrium, and lower back, accumulations, frequent urination with strangury, hematuria, hematochezia, diseases of the anterior yin, and dental diseases.
Litsea Fructus is a medicine for the Qi aspect of the Lower Jiao. (Note by Langfeng) It is an agent that resolves heat and dissipates nodules. (Note by Hao) Pain above and below the umbilicus, as well as sudden heart pain, are all due to Qi stagnation and Fire. Litsea Fructus is sour and bitter, capable of inducing vomiting and purging heat. (Note from Leiming) Litsea Fructus treats Yin deficiency leading to Yang-jue, such as heart pain and epigastric pain syndromes; it also treats Yin excess with Yang sinking, such as hernia syndromes.
When combined with Achyranthes Root (Niuxi), Papaya (Mugua), Tangerina Peel (Juhong), Lychee Seed (Lizhihe), Eucommia Bark (Duzhong), Morinda Root (Bajitian), Tree Fruit (Wushuizi), and Fennel (Huixiang), it treats Kidney deficiency hernia. For hernia swelling and pain, there are five, four, and seven processing methods, all recorded in Li Shizhen's *Bencao Gangmu*. In men, hernia originates from injury to the organ's own Qi, involving the Bladder connecting to the Small Intestine Qi. Take one hundred Litsea fruits, soak in warm water, remove the peel; take two hundred Cardamom seeds (Badou), slightly broken, and two sheng of flour. Place them together in a copper pot, stir-fry until the Litsea fruits turn reddish-brown, then remove and cool. Remove the pits and grind into powder. Discard the Badou and flour. Take three qian per dose, mixed with hot wine or vinegar water. Another prescription: add half liang of salt-stir-fried Fennel.
For treating Ren Xiao (Kidney Xiao) and Gao Lin (Chyluria), where the disease is in the Lower Jiao, use equal parts of Bitter Chinaberry (Kulianzi) and Fennel, stir-fried.
[Discussion] Litsea Fructus inherits the Yin Qi of Heaven and obtains the bitter flavor from Earth. Bitter corresponds to entering the Heart. However, since the Kidney is the counter-transformation of Heart Fire, and flavor follows Qi, generally speaking, bitter-cold substances tend to enter the Kidney, yet Litsea Fructus uniquely enters the Heart, as stated by Li Dongyuan. (Li Dongyuan said: Enters the Heart and Small Intestine.) Why? Because its initial taste is sour, becoming purely bitter later. It inherits the bitter-cold nature, primarily descending to expel heat. Essentially, it combines the origin of Wood and Fire, guiding Qi to reach Yang, thus resolving heat and dissipating nodules. This differs significantly from other bitter-cold herbs that directly suppress heat. Generally, originating from Wood and Fire to achieve bitter-cold allows it to guide Yang back. Therefore, when Yin Qi declines at the lower part causing heat-jue heart pain, this herb is indispensable. (If it were merely considered a heat-clearing herb, how could bitter-cold downward-draining herbs supplement the declining Yin Qi?) As a medicine for the Qi aspect of the Lower Jiao, it is frequently used for hernia, based on this principle. Hernia pathology mostly occurs in the Kidney and Liver regions, but the cause is Cold stagnation transforming into Heat. Cold consolidates the Qi of the Kidney and Bladder, while Heat relates to the Ministerial Fire of the Jueyin. This herb, rooted in the counter-transformation of Sovereign Fire, naturally enters the Kidney; combining with Wood-Fire Qi transformation, it naturally penetrates the Liver. This is what is meant by guiding Qi to reach Yang and simultaneously resolving heat and dissipating nodules. (The meaning of "penetrating the Liver" is the same as originating from Wood-Fire to achieve bitter-cold. Zhang Jiegü treated pain in the urethra using raw Licorice root tip, but added Corydalis Rhizome and Bitter Chinaberry, which was particularly effective. For strangury with pain radiating from the urethra to the hypochondrium, he used Shen Ling Hu Po Tang, with Bitter Chinaberry as the sovereign herb. The *Neijing* states: The Foot-Jueyin meridian circulates around the external genitalia and connects to the Liver. It also states: The collateral of the Foot-Jueyin ascends along the tibia to the testis and knots at the penis. This confirms this herb is a specific agent for entering the Liver.) Some prescriptions stir-fry it with Radish Seed (Laifu), Morning Glory Seed (Qianniu), and Mylabris (Banmao), borrowing their Qi to break hardness and resolve depression to assist this herb's nodule-dissipating function. Others guide it with Psoralea Fruit (Guzhi) and Fennel, employing "treating cold with heat" to penetrate the heat within the cold, completing this herb's heat-expelling function. Thus, its main indications can be understood. However, hernia is sometimes called Small Intestine Qi or Bladder Qi, implying that Qi disease of the Small Intestine and Bladder constitutes hernia. One must not treat hernia apart from the Small Intestine and Bladder, nor should one equate hernia solely with them. The human body possesses only Water and Fire Qi. The Heart and Kidney are the vessels of Water and Fire, while the Small Intestine and Bladder are the mansions of Heart-Kidney Qi transformation. If those suffering from hernia ignore the Kidney, Small Intestine, and Bladder and speak only of the Liver, consider how the Liver can transmit Yin to Yang reaching Heaven, and Yang to Yin coiling into Earth, without relying on Water-Fire Qi transformation and movement. Relying on the function of the Small Intestine and Bladder (Hand-Taiyang Bing Fire ascending, Foot-Taiyang Ren Water descending), how can a single Yin serve as the sole envoy? Hence, treating hernia apart from the Small Intestine and Bladder is illogical. If the disease is confined to the Small Intestine and Bladder without affecting the Liver, the treatment method is indeed different. Disease in the Liver involves the Cold-Water organs suppressing the True Yang within the Water, causing the Liver's ascending Yang to stagnate. This affects the Spleen, also located inferiorly, leading to Cold-Dampness synthesis, further obstructing Jueyin Qi, worsening Ren Mai disease, as described by Li Dongyuan. (Li Dongyuan stated: Rebellious Qi of the Foot-Taiyang Bladder ascends to meet the Hand-Taiyang Small Intestine meridian descending, preventing the Foot-Jueyin meridian from extending the Ren Mai. The Jueyin meridian rebels like a great river, causing Yang Qi to sink, resulting in bilateral testicular swelling, termed hernia. Severe cases become masses.) As for diseases originating in the Small Intestine and Bladder themselves, whether due to excessive Fire and deficient Water, or flooding Water and deficient Fire, treatment should be tailored to the specific situation, not casually equated with hernia treatment. In summary, Litsea Fructus treats hernia, but its efficacy manifests in the Bladder, which begins with the Small Intestine. From flowering and fruiting in March-April, through Summer Solstice to winter harvest, it essentially utilizes Wood-Fire Qi to achieve Cold-Water effects, completing its function. If Cold-Water Qi is heavily stagnant, without utilizing Wood-Fire Yuan Qi to open and guide it, how can hernia be cured? Moreover, for external stubborn cold accumulation, without bitter-cold properties, how can Wood-Fire Qi penetrate condensed cold to guide Qi? Perhaps Ba Dou Qi is borrowed to harmonize bitter-cold and penetrate Yang. Regarding Li Dongyuan's statement that it enters the Small Intestine and first enters the Heart: Human Fire originates from Water; Water is the source of Fire, and the Heart is the master of Fire. Litsea Fructus uses Wood-Fire Qi to achieve Cold-Water effects. Thus, for lower Jiao Yin deficiency with Yang-jue, it uses the Master of Fire (Heart) to guide return, as seen in heat-jue heart pain. When Yang returns to Yin, Yin guards Yang. For lower Jiao Yin shadowing with Yang sinking, it uses the Master of Fire to penetrate, as seen in cold-stagnation-heat hernia. When Yang penetrates Yin, Yin no longer binds Yang. Its efficacy acts in the lower part, but the mechanism of guiding/penetrating lies in the upper part, hence it is first stated to enter the Heart.
Furthermore: Originating from Wood-Fire to achieve bitter-cold means Wood-Fire Qi enters the hand, not conflicting with warming-tonifying flavors. Gradually entering to achieve bitter-cold differs from sudden warming-tonification of deficiency-cold, as there is a guiding Qi of similar nature, allowing tonification to succeed. For example, treating lower Jiao Yang deficiency causing leakage, using it to assist tonifying Yang deficiency follows this principle. Understanding this allows extrapolation for treating Yin/Yang deficiency in other syndromes.
Not suitable for Spleen-Stomach deficiency-cold. (Note by Zhongchun)
[Processing] Soak in wine, steam until soft, remove peel and pits, take pure flesh, dry in sun. Or boil in wine, boil in salt, stir-fry with bran, stir-fry with Ba Dou, stir-fry alone, or do not process, according to syndrome suitability.
[Bark, Root Bark, and Wood Bark of Bitter Chinaberry]
Taste bitter, nature slightly cold, slightly toxic. Mainly treats wandering wind-heat toxin, wind-rash, malignant sores, scabies, and childhood high fever (decocted for washing). Treats Xiao Ke (wasting-thirst) with parasites. Take fresh white bark of Bitter Chinaberry root (Ri Hua Zi said: Male roots are red, toxic, causing vomiting/diarrhea and death). Take one handful, cut and bake, add a little Musk, two bowls of water, decoct to one bowl. Drink on an empty stomach. Even if weak, it is acceptable. Afterwards, pass three or four worms, resembling silkworms but red. Thirst stops instantly. This reveals that Xiao Ke syndrome involves parasites consuming body fluids.
[Differentiation and Treatment] Red male roots are unusable; white female roots are used for medicine. For every one liang of herb, add fifty grains of glutinous rice, decoct together to reduce toxicity. If diarrhea occurs, stop it with cold congee; if no diarrhea, induce sweating with hot scallion congee.