性寒味苦。气味俱浓。沉而降。阴也。入足少阴经。为足太阳引经药。属金而有水与
火。并走手厥阴经。（丹溪）主泻膀胱相火。补肾水不足。壮肾坚骨髓。治男子阴痿。下焦
诸
由湿
利。治
也。黄柏
上能洗
不离土
数丈。
阳之气最
聚而发生
内热诸证。
可以湿伏。可以水灭。用黄连之属直折之。相火者。天火也。龙雷之火也。（火出水中。故
名。）阴火也。不
湿药中不可缺。
者。（又）凡邪热在
下焦血分。不渴而小
足膝气力涌出。和苍术
谟）黄柏固为肾药。然
下。佐牛膝枸杞地黄五
得猪胆汁水银粉。主诸热虫疮久不合口。得铅丹。生肌止痛。得木瓜茯苓二术石斛地黄。除
湿健步。佐白芍甘草。主火热腹痛。脏毒痔漏。下血不止。川
蜜人乳糯米泔各浸透。炙干。切研。廪米饭丸。每空心温酒下
三五十行。用柏根黄浓者。蜜炒令焦。为末。大蒜煨熟。去皮
米饮下三五十丸。日三服。清心丸。主积日梦遗。心忪恍惚。
一钱。炼蜜丸梧子大。每服十五丸。麦冬汤下。（大智师）凤髓
甘草五钱。为泻相火益肾水之妙剂。 疮热疮。黄柏末一两。轻
〔论〕 丹溪谓黄柏有补阴泻火之功。然非阴中之火。不可用。夫阴火即水中之火。
乃人身元气之根蒂。宜温养。不宜寒泻者也。如先天元阴虚而相火炽。不独恃此味以获济。
惟是后天气血。或六淫七情以伤之。致累及元阴。元阴受伤。则水不配火。元阳不得元阴以
宅之。于是少火化为壮火。举三焦元气。尽为之病矣。所谓阴虚则无气是也。此味本北方寒
水所化。藉其同气相求。以助阴。而即以伏阳。（丹溪所谓从其性而伏之）助阴以育阳。则
气食少火。元气回而肾阳自壮。骨髓自坚。所以能疗下焦痿厥也。不宁惟是。凡阴伤而阳亢。
亢阳即还以蚀阴。如骨蒸遗精失血等证。胥借此为要药矣。至于湿热之治。观本经首言五脏
肠胃中结热。此便可参。盖水土合德以立地。而胃之三脘。皆根于任脉。肾之阴气不足。则
热自结于胃。胃壅结热。则湿土之阴气无从施化。而还病于湿。是阴气不足。由肾及脾。肾
与脾合病。斯五脏肠胃病于湿热之证多矣。本经所列黄胆肠痔泄痢及漏下赤白。固为病于湿
热。即下焦痿厥瘫痪诸证。亦未有不合于中土之湿以为患者。丹溪治痿独取阳明。正为此也。
故味丹溪就其性而伏之一语。则知用黄柏非以水胜火。乃以水养火。味丹溪治痿独取阳明之
义。则知用黄柏非止以肾阴得达于胃。更欲使胃阳得化于肾也。（盖热之结者。胃阳不得化。
肾阴达于胃。而胃阳化矣。）由肾合脾。何以取责于胃。盖柏皮达肾阴于脾。脾得为胃行三
阳三阴之气。而肠胃之结热乃清。但三阳三阴之气。脾固为胃行之。而能行三阳三阴之气者。
则属之胃。故取责于胃耳。又元阴乃后天营血之母气。故丹溪酒炒末为潜行散入血分。最妙。
罗周彦曰。有先天元气之阴。即肾水母气所禀。元精之气是也。其真阴本体。则深藏于左肾
之中。而真阴妙用。则默运于精神之内。是谓无形者也。后天元气之阴。即身中所化营血之
母气。先天有形元气之阴也。此亦天赋自然之真。其体附藏于脾胃中。化见于人迎。故其脉
在心部。而其用则见于血也。又曰。元阴不甚损。其有形肾水之阴暴伤。致相火动而乘于阴
精之分为患者。知柏滋阴降火之法。可任用之。至于肾水中母气。先天元阴之精受伤。以致
无根虚火为病。若妄投之。必反损其元而绝其生机矣。合二论观之。所谓损其元阴者。由伤
其生身之精。损其肾水之母气也。肾水之阴暴伤。由病于后天之气血。而暴伤有形营血之母
气也。盖肾水之阴。即营血之母。此处分晰极确。而后黄柏之可用不可用。庶乎无误。不至
久用而寒中。亦不至当投而敛手。以致剂不中病也。
缪氏云。阴阳两虚之人。病兼脾胃薄弱。或泄泻恶冷。上热下寒。小便不禁者。咸忌。
〔辨治〕 蜀产皮浓二三分。色鲜黄者良。 生用降实火。熟用不伤胃。酒制治上。盐
制治
性寒，味苦。气味都非常浓厚。药性沉降而向下，属于阴。入足少阴肾经。作为足太阳膀胱经的引经药。属性属金，但兼具水与火的特性。（朱丹溪）主治泻除膀胱中的相火（寄居于肝肾、具有生理功能的命门之火），补益肾水的不足，强壮肾脏并坚固骨髓。治疗男子阳痿，以及下焦因湿热引起的各种病症。黄柏生长在泥土中，高达数丈，聚集阳气而发生内热诸证。其性质可以被湿气潜伏，也可以被水熄灭。对于此类情况，使用黄连等药物直接折降火势。所谓相火，是天火，也是龙雷之火。（因为火出于水中，所以得名）。也是阴火。在湿药中不可缺少的药材。（又）凡是邪热在下焦血分，患者不口渴且小便……（此处原文有残缺，推测为“短赤”或类似描述）足膝部位感觉气力涌出。与苍术配合使用。（李东垣/罗周彦等医家观点）黄柏虽然是补肾的药物，然而……下面佐以牛膝、枸杞、地黄等五味药。可以加入猪胆汁、水银粉，主治各种热毒虫疮久不愈合的伤口；加入铅丹，可生肌止痛；加入木瓜、茯苓、白术、苍术、石斛、地黄，可除湿健步；佐以白芍、甘草，主治火热腹痛、脏毒、痔漏、下血不止。用川黄柏，分别用蜜、人乳、糯米泔水浸泡透后，炙干，切碎研末，用廪米饭制成丸剂。每次空腹时温酒送服三五十丸。用柏根皮厚色黄者，蜜炒至焦黑，研为粉末。大蒜煨熟，去皮……米饮送服三五十丸，每日三次。清心丸，主治积日梦遗、心慌恍惚。一钱，炼蜜制成梧桐子大小的丸剂，每次服用十五丸，麦冬汤送下。（大智师）凤髓方：甘草五钱，是泻相火、益肾水的妙剂。疮热疮，黄柏末一两，轻……
〔论〕 朱丹溪认为黄柏具有补阴泻火的功效，然而如果不是阴中之火，则不可使用。所谓的阴火即水中之火，乃是人身元气的根本，应当温养，不宜寒凉泻下。如果是先天元阴虚导致相火炽盛，不仅仅依靠这一味药就能获得救济。只有后天气血，或者被六淫七情所伤，进而累及元阴。元阴受伤，则水不能配火，元阳没有元阴作为居所，于是少火转化为壮火，导致全身三焦元气都为之患病。这就是所说的“阴虚则无气”。这味药本由北方寒水所化，借助同气相求的原理，来辅助阴，从而伏藏阳气。（正如丹溪所说“顺从其本性而伏藏之”）。辅助阴以养育阳，则气食少火，元气恢复而肾阳自然强壮，骨髓自然坚固，所以能治疗下焦痿厥。不仅如此，凡是阴伤而阳亢，亢盛的阳气反过来侵蚀阴液，如骨蒸、遗精、失血等证候，都借此作为要药。至于湿热病的治疗，参考《本经》首先提到的五脏肠胃中结热，这里就可以参悟。大概水土合德以立地，而胃的三个脘部，都根源于任脉。如果肾的阴气不足，则热自结于胃。胃中壅滞结热，则湿土的阴气无法施化，反而生病于湿。这是阴气不足，由肾波及到脾，肾与脾合病，所以五脏肠胃患湿热证的很多。《本经》所列的黄疸、肠痔、泄痢以及漏下赤白，固然都是病于湿热，即使下焦痿厥瘫痪诸证，也没有不是结合中土之湿而患病的。丹溪治疗痿证独取阳明，正是为此缘故。因此从丹溪“就其性而伏之”这句话，就知道使用黄柏不是以水胜火，而是以水养火。从丹溪“治痿独取阳明”的意义来看，就知道使用黄柏不仅仅是为了让肾阴达于胃，更希望使胃阳得化于肾。（因为热结者，胃阳不得化，肾阴达于胃，胃阳才能化）。由肾合脾，为什么取责于胃？大概柏皮能将肾阴达于脾，脾得以为胃运行三阳三阴之气，而肠胃的结热乃清。但是三阳三阴之气，脾固然为胃运行，而能够运行三阳三阴之气的，则归属于胃。所以取责于胃罢了。另外，元阴是后天营血之母气，所以丹溪将酒炒的黄柏末称为潜行散，入血分，最为奇妙。罗周彦说：有先天元气之阴，即肾水母气所禀赋，是元精之气。其真阴本体，深藏于左肾之中，而真阴妙用，则默运于精神之内，这是谓无形的。后天元气之阴，即身中所化生的营血之母气，是先天有形元气之阴。这也是天赋自然的真，其体附藏于脾胃中，化见于人迎脉，所以其脉在心部，而其用则见于血。又说：如果元阴不甚受损，只是有形肾水之阴暴伤，导致相火动而乘于阴精之分而患病，知柏滋阴降火之法，可以任用。至于肾水中的母气，先天元阴之精受伤，以致无根虚火为病，如果妄投此药，必然反损其元气而绝其生机。综合两篇论述来看，所谓损伤元阴的，是由损伤其生身之精，损伤其肾水之母气。肾水之阴暴伤，是由病于后天之气血，而暴伤有形营血之母气。大概肾水之阴，就是营血之母。此处分析极其确切，那么黄柏的可可用与否，才不至于有误，不至于久用而寒中，也不至于当投而敛手，致使药不对症。
Nature is cold, flavor is bitter. The qi and flavor are both dense. It sinks and descends, belonging to Yin. It enters the Foot Shaoyin (Kidney) Meridian. It serves as a guiding herb for the Foot Taiyang (Bladder) Meridian. Its nature belongs to Metal but possesses characteristics of Water and Fire. (Zhu Danxi) It primarily clears excess fire in the Bladder (Xiang Huo - Ministerial Fire residing in Liver/Kidney), tonifies insufficiency of Kidney Water, strengthens the Kidneys, and solidifies bone marrow. It treats male impotence and various disorders of the Lower Jiao caused by damp-heat. Huangbai grows in soil, reaching several zhang in height, gathering Yang Qi to generate internal heat syndromes. Its nature can be subdued by dampness or extinguished by water. For such conditions, herbs like Huanglian (Coptis Rhizome) are used to directly subdue the fire. The so-called Xiang Huo (Ministerial Fire) is Heavenly Fire, also known as Dragon-Lei Fire. (Because fire emerges from water, it is named so.) It is also Yin Fire. It is an indispensable herb in damp-resolving formulas. (Furthermore) Whenever pathogenic heat resides in the Blood aspect of the Lower Jiao, with patients not feeling thirsty and having... [text fragment] sensation of energy surging in the feet and knees. Combined with Cangzhu (Atractylodes Rhizome)... Huangbai is indeed a Kidney herb, however... below, assisted by Niuxi (Achyranthes Root), Gouqi (Goji Berry), Dihuang (Rehmannia Root), and five other herbs. It can be combined with Zhudanshi (Swine Gallbladder Bile) and Shuiyinfen (Mercuric Oxide Powder) to treat various hot-toxic insect sores that fail to heal for a long time; combined with Qiandan (Lead Tetroxide), it generates flesh and stops pain; combined with Mugua (Chaenomeles Fruit), Fuling (Poria), Baizhu (Atractylodes Macrocephala Rhizome), Cangzhu, Shihu (Dendrobium Stem), and Dihuang, it removes dampness and strengthens walking; assisted by Baishao (White Peony Root) and Gancao (Licorice Root), it treats abdominal pain due to fire-heat, Zangdu (visceral toxin), hemorrhoids and fistulas, and continuous bleeding. Use Chuan Huangbai, soaked thoroughly respectively in honey, human milk, and rice wash water, then roasted dry, cut, and ground into powder. Form pills using Linmi fan (stored rice flour). Take thirty to fifty pills each time on an empty stomach with warm wine. Use thick-skinned, yellow-colored Cui Gen (Cinnamomum bark? Context suggests Huangbai root bark), stir-fried with honey until charred, ground into powder. Roast garlic until soft, peel... take thirty to fifty pills with rice drink, three times daily. Qingxin Wan (Clear Heart Pill) treats persistent nocturnal emissions, palpitations, and mental confusion. One qian, formed into pills the size of wutong seeds with refined honey. Take fifteen pills each time, washed down with Maidong (Ophiopogon Decoction). (Master Dazhi) Fengsui Formula: Gancao (Licorice Root) five qian, is a wonderful formula for clearing ministerial fire and benefiting Kidney water. For hot sores, one liang of Huangbai powder, lightly...
[Discussion] Zhu Danxi stated that Huangbai has the efficacy of tonifying Yin and clearing fire. However, it should not be used if it is not fire within Yin. The so-called Yin fire is fire within water, which is the root of Yuan Qi (Original Qi) in the human body. It should be warmed and nourished, not cleared with cold herbs. If congenital Yuan Yin deficiency leads to blazing Xiang Huo (Ministerial Fire), relying solely on this herb is insufficient for relief. Only when acquired Qi and Blood are damaged by the Six Excesses or Seven Emotions, thereby affecting Yuan Yin, does Yuan Yin become injured. When Yuan Yin is injured, Water cannot coordinate with Fire, and Yuan Yang lacks Yuan Yin as its residence. Thus, Shao Huo (Lesser Fire) transforms into Zhuang Huo (Exuberant Fire), causing illness throughout the San Jiao (Triple Burner) Original Qi. This is what is meant by "Yin deficiency leads to lack of Qi." This herb originates from Northern Cold Water. By leveraging the principle of similar energies seeking each other, it assists Yin, thereby subduing Yang. (As Danxi said, "subduing it according to its nature"). Assisting Yin to nurture Yang allows Qi to feed on Shao Huo, restoring Yuan Qi, strengthening Kidney Yang, and solidifying bone marrow. Therefore, it can treat Wei Jue (flaccidity and coldness) of the Lower Jiao. Not only that, whenever Yin is damaged and Yang becomes hyperactive, the hyperactive Yang inversely erodes Yin. Syndromes such as bone-steaming fever, nocturnal emission, and blood loss all rely on this herb as a key remedy. Regarding the treatment of damp-heat, referring to the *Shennong Ben Cao Jing*'s mention of "accumulated heat in the Five Zang organs and intestines/stomach," this can be understood. Earth and Water combine virtue to establish the land, and the three regions of the Stomach all root in the Ren Mai (Conception Vessel). If Kidney Yin Qi is insufficient, heat accumulates in the Stomach. Stomach stagnation and accumulated heat prevent the Yin Qi of Damp Earth from transforming, leading back to dampness pathology. This indicates that Yin Qi insufficiency spreads from Kidney to Spleen. When Kidney and Spleen diseases combine, many disorders of the Five Zang and intestines/stomach arise from damp-heat. The jaundice, intestinal hemorrhoids, diarrhea, dysentery, and leukorrhea listed in the *Ben Cao Jing* are indeed diseases of damp-heat. Even the flaccidity, paralysis, and coldness of the Lower Jiao are rarely without involvement of Central Earth dampness. Danxi's principle of treating Wei syndrome by exclusively focusing on Yangming (Stomach/Spleen) is precisely for this reason. Thus, from Danxi's phrase "subduing it according to its nature," we know that using Huangbai is not about Water overcoming Fire, but Water nourishing Fire. From Danxi's meaning of "treating Wei syndrome by exclusively focusing on Yangming," we know that using Huangbai is not merely to allow Kidney Yin to reach the Stomach, but also to enable Stomach Yang to transform within the Kidney. (Because where heat is accumulated, Stomach Yang cannot transform; when Kidney Yin reaches the Stomach, Stomach Yang transforms). Since Kidney combines with Spleen, why is responsibility placed on the Stomach? Generally, Cui Pi (Huangbai bark) delivers Kidney Yin to the Spleen. The Spleen then acts to transport the Qi of the Three Yang and Three Yin meridians for the Stomach, clearing the accumulated heat in the intestines and stomach. Although the Spleen transports the Qi of the Three Yang and Three Yin for the Stomach, the organ capable of transporting the Qi of the Three Yang and Three Yin is attributed to the Stomach. Hence, responsibility is placed on the Stomach. Furthermore, Yuan Yin is the mother Qi of acquired Ying Blood. Therefore, Danxi's Jiuchao Mo (wine-fried powder) called Qianxing San (Hidden Walking Powder) entering the Blood aspect is most exquisite. Luo Zhouyan said: There is congenital Yuan Qi Yin, which is endowed by the mother Qi of Kidney Water, being the Qi of Yuan Essence. Its true Yin essence is deeply hidden within the Left Kidney, while its subtle function operates silently within spirit and mind; this is termed formless. Acquired Yuan Qi Yin is the mother Qi of Ying Blood transformed in the body, which is the congenital formable Yuan Qi Yin. This is also the natural truth endowed by Heaven. Its substance hides within the Spleen and Stomach, manifesting transformation at the Renying pulse point. Thus, its pulse appears in the Heart region, and its function manifests in the Blood. He also said: If Yuan Yin is not severely damaged, but the formable Kidney Water Yin is suddenly injured, causing Xiang Huo to move and attack the Yin Essence division, resulting in disease, the method of Zhibai Dihuang Wan (Anemarrhena, Phellodendron, Rehmannia Pill) to nourish Yin and descend fire can be freely used. However, regarding the mother Qi in Kidney Water, if the congenital Yuan Yin essence is injured, leading to rootless deficient fire pathology, administering this herb recklessly will inevitably damage Yuan Qi and sever vital energy. Observing both discussions together, what is meant by damaging Yuan Yin is damaging the essence that generates the body and the mother Qi of Kidney Water. Sudden injury to Kidney Water Yin results from disease in acquired Qi and Blood, suddenly injuring the mother Qi of formable Ying Blood. Essentially, Kidney Water Yin is the mother of Ying Blood. This distinction is extremely accurate. Thus, the appropriateness of using Huangbai will not be erroneous, avoiding long-term use causing cold in the middle, nor withholding it when needed, ensuring the prescription hits the disease.
Mou Shi stated: For individuals with both Yin and Yang deficiency, complicated by weak Spleen and Stomach, or diarrhea and aversion to cold, upper heat and lower cold, and urinary incontinence, these cases are all contraindicated.
[Differentiation and Treatment] Those produced in Shu (Sichuan) with bark thickness of two to three fen and bright yellow color are superior. Raw use reduces excess fire; cooked use does not injure the Stomach; wine-processing treats the upper body; salt-processing treats the lower body.