肉豆蔻温中消食。止泄治积心腹冷痛。霍乱呕吐解酲下气。赤白虚痢。为暖脾胃固大肠
之要
药。盖脾喜暖恶寒。喜香恶臭。故肉蔻之温香。能治一切前症。寇宗 曰亦善下气。多服则
泄气。得中则和平其气朱丹溪曰属金与土温中补脾日华子称其下气以脾得补而善运化。气自
下也。非若陈皮香附之快泄。寇氏不详其实。遂以为不可多服也。误矣。
大黄性苦寒无毒。一名将军。一名火参。东垣曰推陈致新。如戡定祸乱。以致太平。故
有将
军之号。主平胃下气。逐瘀血。破 瘕积聚留饮去痰实。泻诸实热不通。除三焦湿热。心下
痞满。下痢赤白里急腹痛小便淋沥。谵语黄胆火疮诸症此药乃足太阴手足阳明手足厥阴五经
血分之药若在气分者用之。是谓诛伐无过矣。苏颂曰古人用毒药攻病。必随人之虚实寒热而
处置。非一切轻用也。梁武帝因发热。欲服大黄姚僧坦曰大黄乃是快药至尊年高。不可轻用
。帝弗从。几至委顿。梁元帝常有心腹疾。诸医咸谓宜用平药。可渐宣通。僧坦曰脉洪而实
此有宿妨。非用大黄无瘥理。帝从之。遂愈。以此言之。今医用一毒药而攻众病。其偶中者
便谓此方神奇。其差误则不言用药之失。可不戒哉。薛氏医案云判官汪天锡年六十余。患
痢
腹痛后重。热渴引饮。饮食不进。用芍药汤内加大黄一两四剂稍应。仍用前药大黄减半。数
剂而愈。此等元气百仅一二夫立斋治病固专主温补第药随病施抑何曾废攻伐不用乎。葛可久
武勇绝伦。因挽百石大弓。病内伤。治用大黄八两。其子惮其峻厉。阴减半。病不尽蠲。可
久曲询。始知其故曰。吾明年当死矣。至期果殁此又病有轻重不得以毒药衰其大半而论也崇
祯戊寅岁余客汴梁为一郡王治宫人产后发呃症。因言及其先生壮龄时。患疟痢翻胃。遍治不
瘥。自料无生理。一草医亦精于脉者。连投五剂。用大黄七两。始能食。再投十余剂计大黄
斤许。前症渐愈。后日服滚痰丸。两旬方得全痊越年余连举五嗣。寿至九十三而薨。如此赋
禀。是亦东南所不概见者。甲申夏余表侄钟仲章。因为其先人营HT 。暑月汗泄劳力冒寒。一
医投解表药。内加大黄一钱。未终剂而神思困顿。呕逆不堪。再延茅复阳投对症药。未尝不
善。第胃气已伤。亦不见愈。余以补中益气汤。加减数服渐愈。稍劳便复淹延。三月方瘥。
窃观仲景伤寒承气方旨。必惟三阴里症。燥满实坚全具者。始可用。奈何三阳表症而遽混投
之宁不犯阴盛阳虚汗之则愈下之则死之戒乎又况为劳力伤寒耶。大凡药禀偏寒偏热。而非中
和上品者。尤须经心酌用。非可逞意轻率也。
肉豆蔻能温中焦、消食积。用于止泻、治疗积滞引起的心腹冷痛，以及霍乱呕吐、酒醉后不适、气逆上冲。对于赤白痢疾及虚损性痢疾，它是温暖脾胃、固涩大肠的重要药物。大概脾脏喜欢温暖而厌恶寒冷，喜欢香气而厌恶臭味。所以肉豆蔻的温性和香气，能够治疗上述所有病症。寇宗奭说它善于降气，但多服会耗散正气。如果服用得当，其药性平和。朱丹溪认为它属金与土，能温中补脾。日华子称它能降气，是因为脾得到补益后运化功能良好，气自然下行。这不同于陈皮、香附那种快速泄气的功效。寇氏没有详查其实质，就认为不可多服，这是错误的。
大黄性味苦寒，无毒。别名将军，别名火参。李东垣说它能推陈出新，如同平定祸乱以达成太平，所以有“将军”的称号。主治平胃气、降逆气，驱逐瘀血，破除癥瘕积聚、留饮和痰实，泻除各种实热不通之症，清除三焦湿热，治疗心下痞满、下痢赤白伴有里急后重腹痛、小便淋沥不尽、谵语、黄疸、火疮等各种症状。此药是足太阴脾经、手阳明大肠经、足阳明胃经、手厥阴心包经、足厥阴肝经这五经血分的药物。如果在气分病变中使用它，就叫做诛伐无罪之人（误治）。苏颂说古人使用毒药攻治病邪，必定根据病人的虚实寒热来处置，不是一概轻率使用的。梁武帝因发热，想服用大黄。姚僧坦说：“大黄乃是峻猛之药，陛下年事已高，不可轻用。”皇帝没有听从，几乎导致身体极度虚弱。梁元帝常有心腹疾病，众医生都说应当使用平和的药物，可以逐渐宣通。姚僧坦说：“脉象洪大而实，这是有宿食停滞，不用大黄无法痊愈。”皇帝听从了他的建议，于是病愈。由此而言，现在医生用一种毒药去攻击多种疾病，偶尔奏效就说这个方子神奇，一旦出错却不说是用药失误，怎能不引以为戒呢？薛己医案记载：判官汪天锡六十多岁，患痢疾腹痛、后重感，口渴想喝水，饮食不进。使用芍药汤内加大黄一两，服用四剂后稍有反应，仍用前方，大黄减半，服用数剂后痊愈。像这样的人元气十中仅存一二，李中梓治病固然主张温补，但药物随病情施用，何曾废弃攻伐之法不用呢？葛可久武艺绝伦，因为拉百石大弓，导致内伤。治疗使用大黄八两。他的儿子害怕药性峻烈，暗中减半，结果病邪未完全清除。葛可久仔细询问，才知道原因，说：“我明年将会死去。”到期果然去世。这又是病情轻重不同，不能一概而论说毒药只需减去大半即可的道理。崇祯戊寅年，我客居汴梁，为一郡王府上的宫人治疗产后呃逆症。谈及她的丈夫壮年时，患疟疾、痢疾、翻胃，遍治不愈，自料无生还希望。一位精通脉理的草医，连续投药五剂，使用大黄七两，才开始能进食；再投十余剂，累计大黄约一斤，前症逐渐痊愈。后来每日服用滚痰丸，二十天后才完全康复。过了一年多，接连生育五个儿子，寿命九十三岁去世。如此体质禀赋，也是东南地区所不多见的。甲申年夏天，我的表侄钟仲章，为其先人营造房屋，暑月出汗劳累，又冒受寒气。一位医生投予解表药，内加大黄一钱，药未服完，病人神思困顿，呕吐逆乱不堪。再次延请茅复阳诊治，投予对症药物，并非不好，只是胃气已经受损，也不见好转。我用补中益气汤，加减服用数剂，逐渐好转，稍加劳累便复发拖延，三个月才好。私下观察张仲景《伤寒论》承气汤的宗旨，必须是三阴里证，燥、满、实、坚全部具备者，才可以应用。奈何三阳表证却贸然混投承气汤，难道不犯“阴盛阳虚，汗之则愈，下之则死”的戒律吗？更何况是劳力后感冒伤寒呢？大凡药性偏寒偏热，而非中和上品者，尤其需要用心斟酌使用，不可以逞意轻率。
Nutmeg (Myristicae Semen) warms the middle jiao and promotes digestion. It stops diarrhea and treats abdominal cold pain caused by food stagnation, as well as cholera-like vomiting, hangover discomfort, and rebellious qi. For dysentery with red and white discharge and deficiency-type dysentery, it is a key herb for warming the spleen and stomach and consolidating the large intestine. Generally, the spleen favors warmth and dislikes cold, favors fragrance and dislikes foul odors. Therefore, the warmth and fragrance of Nutmeg can treat all the aforementioned conditions. Kou Zongshi stated that it is good at descending qi, but excessive use depletes healthy qi. If taken in moderation, its nature is balanced. Zhu Danxi considered it to belong to Metal and Earth, capable of warming the middle and tonifying the spleen. Ri Hua Zi claimed it descends qi because, once the spleen is tonified and transportation/transformation functions improve, qi naturally descends. This differs from the rapid purgative effects of Chenpi (Citri Reticulatae Pericarpium) or Xiangfu (Cyperi Rhizoma). Kou's failure to investigate the reality led him to believe it should not be used in large quantities, which was an error.
Rhubarb (Rhei Radix et Rhizoma) has a bitter and cold nature and is non-toxic. Also known as "General" (Jiangjun) and "Fire Root" (Huoshen). Li Dongyuan said it eliminates the old and generates the new, akin to quelling chaos to bring about peace, hence the title "General." It primarily regulates stomach qi, directs rebellious qi downward, expels blood stasis, breaks up masses and accumulations, retains fluids, removes phlegm-dampness, purges various excess heat obstructions, clears damp-heat from the three jiao, treats epigastric fullness and stuffiness, dysentery with red and white discharge accompanied by tenesmus and abdominal pain, scanty and painful urination, delirium, jaundice, and fire-toxemias such as sores. This herb acts on the blood level of the Foot-Taiyin Spleen Meridian, Hand-Yangming Large Intestine Meridian, Foot-Yangming Stomach Meridian, Hand-Jueyin Pericardium Meridian, and Foot-Jueyin Liver Meridian. Using it when the pathology is in the qi level constitutes punishing the innocent (misdiagnosis/mistreatment). Su Song noted that ancients used toxic herbs to attack disease, always adjusting according to the patient's deficiency/excess and cold/heat patterns, never using them lightly. Emperor Wu of Liang, suffering from fever, wished to take Rhubarb. Yao Shengtan said, "Rhubarb is a drastic medicine; Your Majesty is advanced in age and must not use it lightly." The Emperor did not listen and nearly became prostrate. Emperor Yuan of Liang often suffered from heart and abdominal ailments. All physicians suggested using mild medicines to gradually promote circulation. Yao Shengtan said, "The pulse is surging and excess; this indicates retained food stagnation. Without Rhubarb, there is no hope of recovery." The Emperor agreed and recovered. From this, we see that modern physicians sometimes use one toxic herb to attack various diseases; if it occasionally works, they claim the prescription is miraculous, but if it fails, they do not admit the error in medication. Should one not be wary?
Xue Ji's medical records state: Pan Guan Wang Tianxi, over sixty years old, suffered from dysentery with abdominal pain and tenesmus, thirst with desire to drink, and inability to eat. He was prescribed Shaoyao Decoction (Peony Decoction) with one liang of Rhubarb. After four doses, there was slight improvement. The same prescription was continued with half the dose of Rhubarb, and after several doses, he recovered. Such patients have only one or two parts of their original vital energy remaining. Li Zhongzi, while advocating warm tonification in treating diseases, nevertheless applied drugs according to the condition and never abandoned purgative methods. Ge Kejiu possessed extraordinary martial prowess. Due to pulling a heavy bow, he suffered internal injury. The treatment involved eight liang of Rhubarb. His son, fearing the harshness, secretly halved the dose. The illness was not fully resolved. Ge questioned him carefully and discovered the reason, stating, "I will die next year." Indeed, he died at that time. This illustrates that one cannot generalize that toxic herbs need only be reduced by half, depending on the severity of the illness.
In the Wuyin year of the Chongzhen era, I was staying in Bianliang and treated a palace maid for postpartum hiccups. She mentioned her husband, in his prime, suffered from malaria, dysentery, and regurgitation. Despite extensive treatment, he did not recover and believed he would not survive. A herbalist skilled in pulse diagnosis administered five doses consecutively, using seven liang of Rhubarb, after which he could finally eat. Another ten-plus doses were given, totaling approximately one jin of Rhubarb, and the previous symptoms gradually resolved. Later, he took Gutan Wan (Phlegm-Purging Pills) daily and fully recovered within twenty days. Over the next year and a half, he fathered five sons and lived to ninety-three years before passing away. Such constitution is rare in the southeast.
In the summer of the Jiashen year, my cousin's nephew, Zhong Zhongzhang, asked me to treat his ancestor who had built a house during the hot season. The ancestor sweated heavily from labor and caught cold. A physician prescribed exterior-releasing herbs with one qian of Rhubarb. Before the decoction was finished, the patient became mentally exhausted and severely nauseous/vomiting. Another physician, Mao Fuyang, was consulted and prescribed appropriate herbs, which were not incorrect, but the stomach qi was already damaged, so recovery was slow. I used Buzhong Yiqi Tang (Tonify the Middle and Augment Qi Decoction) with modifications. After several doses, he gradually improved, but relapsed with slight exertion, taking three months to fully recover.
Observing Zhang Zhongjing's principles in Chengqi Decoctions (Gastrointestinal Purging Formulas) from Shanghan Lun, they should only be used when Taiyin, Shaoyin, or Jueyin interior syndromes present with dryness, fullness, excess, and hardness simultaneously. How can one rashly administer these for Yangming exterior syndromes? Does this not violate the warning: "In cases of yin excess and yang deficiency, sweating leads to cure, but purgation leads to death"? Especially in cases of fatigue-induced cold damage. Generally, herbs with extreme cold or hot natures, which are not of the harmonious superior grade, require careful consideration and should not be used recklessly.