本经沙参主血积、惊气、除寒热。血积二字，惟徐氏最为得解，云沙参为肺家气分中理
血之药，色白体轻，疏通而不燥，润泽而不滞，血阻于肺者，非此不能清之。曰理血，曰血
阻，曰清之，恰合沙参治血之分际。与桃仁为肺药而主瘀血之闭者，大有不同。热伤其气，
斯气阻而血亦阻，心以扰乱而有惊气，营卫愆其度而有寒热，非甚重之证，故得以沙参主之
。别
沙参生于沙碛而气微寒，色白而折之有白汁。茎抽于秋，花开于秋，得金气多。味微甘
则补肺中之土，微苦则导肺气而下之，金主攻利，寒能清热，复津润而益阴。故肺热而气虚
者得之斯补，血阻者得之斯通，惊气寒热，咸得之而止。
肺恶寒，咳嗽由肺寒者多，故徐氏戒用沙参；然卫生方用沙参一味治肺热咳嗽。曰肺热
，则
桔梗能升能降，能散能泄，四者兼具。故升不逮升柴，降不逮枳朴，散不逮麻杏，泄不
逮硝黄。盖其色白，味辛，气微温，纯乎肺药（肺恶寒恶热）。而中心微黄，味又兼苦，则
能由肺以达肠胃。辛升而散，苦降而泄，苦先辛后，降而复升，辗转于咽喉胸腹肠胃之间。
本经所
桔梗实不入肾，仲圣桔梗汤治少阴病咽痛，是肾家邪热循经而上，肺为热壅，以桔梗开
提肺气，佐甘草以缓之，自然热散痛止，并非治肾，邹氏之论极是。气为血帅，气利则血亦
利，故桔梗汤并主血痹。推之排脓与治肺痈，治结胸，仲圣诸方，无不与本经吻合。即肘后
方治肠内瘀血，丹溪治痢疾腹痛，亦只如其分以任之耳。
物理至微，古圣何能尽言，得其旨而扩之，方为善读古书。易老舟楫之剂载药不沉之说，
大为张隐庵所訾。其实桔梗降而复升，性与肺比，不易下沉，外科于上焦痈疡，所以非此不
可，洄溪评外科正宗无异言。且易老以为舟楫之剂者，与甘草同用也。桔梗得甘草，自更羁
留于上，名之为舟楫何害。至备要表散寒邪一语，桔梗岂胜发汗之任，骤阅之不无可诧，然
古方表剂固多用之。盖其开提气血，通窍宣滞，与羌防橘半等为伍，殊有捷效，鼻塞尤宜。
惟属以偏裨之任则可，若竟恃为表剂，则不能无弊。又徐氏谓咳证用桔梗，是宋以后法，升
提究非所宜。不知肺苦气上逆，而气逆之因不一。若肺感风寒，气不得宣而逆而咳，非开肺
郁而提出之，曷云能瘳。况桔梗白散治咳而胸满，载在外台。洄溪盖尝讥叶氏未阅外台者，
何遂忘之谓是宋后法也。
桔梗与芍药，皆能治痢疾腹痛。惟桔梗是治肺气之郁于大肠，散而上行。芍药是治脾家
血中之气结，破而下行。若非滞下之痢，二者皆不相宜。伤寒金匮两书，凡云利者即是泻，
非今之所谓痢，痢则必加下重字以别之。故真武汤若下利者去芍药，四逆散治泄利下重不去
，通脉四逆汤治下利清谷本无芍药，腹中痛始加之，以其为姜附之佐，于里寒无伤也。咽痛
去之者，芍药不能散上结之阳也。桔梗之加，全为咽痛。虽不治利而利时不去，与芍药不去
之意正同。利不止，无怪脉之不出，利止而脉不出，则桔梗之散，大有妨于生脉，与芍药之
有妨咽痛亦同。故必须去之而加生脉之人参，此仲圣或去或加之所以然也。邹氏不达，而谓
芍药止腹痛下利，桔梗亦止腹痛下利，误之至矣。
《神农本草经》记载沙参主治血积、惊气、除寒热。关于“血积”二字，唯有徐氏的解释最为透彻，他说沙参是肺脏气分中调理血液的药物，其色白体轻，疏通而不燥烈，润泽而不滞涩，对于肺气阻滞导致的血行不畅，非此药不能清除。说它理血、说血阻、说清除，恰好符合沙参治疗血证的分寸。这与桃仁作为肺药而主要治疗瘀血闭塞的情况，大有不同。热邪损伤了气，导致气机阻滞，进而血行也受阻；心神因受扰而产生惊悸之气；营卫失调而有寒热症状，这些都不是极重的病证，所以可以用沙参来主治。
另外，沙参生长在沙石之地，气味微寒，颜色洁白，折断后有白色汁液。茎在秋季抽长，花在秋季开放，得金气较多。味道微甘则能补益肺中的土气（脾土生肺金），味微苦则能引导肺气下行。金性主于攻利，寒性能清热，又能生津润燥并滋养阴液。所以，肺热且气虚的人得到它就能得到补益，血行阻滞的人得到它就能通畅，惊气和寒热症状，都能因此停止。
肺恶寒，咳嗽多由肺寒引起，所以徐氏告诫慎用沙参；然而《卫生家宝方》用沙参一味治疗肺热咳嗽。既然说是肺热，那么……
桔梗既能升提又能下降，既能发散又能泄降，这四种功效兼备。所以它的升提之力不及升麻、柴胡，下降之力不及枳实、厚朴，发散之力不及麻黄、杏仁，泄降之力不及芒硝、大黄。大概因为它的颜色白，味道辛，气微温，纯粹是入肺的药（肺既恶寒也恶热）。而其中间微黄，味道又兼苦，所以能由肺脏通达肠胃。辛味主升散，苦味主降泄，先苦后辛，降而复升，辗转作用于咽喉、胸腹、肠胃之间。
《神农本草经》所记载的……
桔梗实际上并不入肾经，张仲景的桔梗汤治疗少阴病咽痛，这是肾脏的邪热循经而上，导致肺被热邪壅塞，用桔梗开提肺气，配合甘草来缓和它，自然热散痛止，并不是治疗肾脏本身，邹氏的观点非常正确。气为血之帅，气机通畅则血行也通畅，所以桔梗汤同时也主治血痹。推而言之，排脓和治疗肺痈、治疗结胸，张仲景的各个方剂，无不与《本经》的记载相吻合。即使是《肘后备急方》治疗肠内瘀血，朱丹溪治疗痢疾腹痛，也只是恰如其分地运用罢了。
医理精微，古代圣人怎能完全言尽？领会其宗旨并加以扩充，才是善于阅读古书。易老（李东垣）关于桔梗是“舟楫之剂”载药不沉的说法，被张隐庵大为指责。其实桔梗降而复升，性质与肺相近，不易下沉，外科在治疗上焦痈疡时，所以非此药不可，王清任（洄溪）评价《外科正宗》时也无异议。而且易老认为它是舟楫之剂，是因为它与甘草同用。桔梗得到甘草，自然更停留于上部，称之为舟楫有什么妨害呢？至于《备要》中说它能表散寒邪，桔梗哪里能承受发汗的重任，乍看之下令人惊讶，然而古方中的解表剂确实多用它。大概因为它能开提气血，通窍宣滞，与羌活、防风、橘皮、半夏等药物配伍，确有捷效，鼻塞尤其适宜。只把它当作辅助角色是可以的，如果竟依靠它作为主要的解表剂，那就难免有弊端。另外徐氏说咳嗽证使用桔梗，是宋代以后的治法，升提终究不合适。不知道肺苦于气机上逆，而气逆的原因不止一种。如果肺感受风寒，气不得宣发而上逆导致咳嗽，不开宣肺郁并提举出来，怎么能痊愈呢？况且桔梗白散治疗咳嗽且胸满，记载在《外台秘要》中。王清任曾经讥笑叶天士没有读过《外台》，怎么反而忘记这一点，说这是宋以后的法度呢？
桔梗与芍药，都能治疗痢疾腹痛。只是桔梗是治疗肺气郁结在大肠，使其散而上行；芍药是治疗脾脏血中的气结，破结而下行的。如果不是痢疾这种伴有里急后重的病症，这两种药都不适宜。《伤寒论》和《金匮要略》两书中，凡是说“利”的就是指腹泻，不是现在所说的痢疾，痢疾一定会加上“下重”（里急后重）字来区别。所以真武汤如果出现下利，去掉芍药；四逆散治疗泄利伴里急后重，不去掉芍药；通脉四逆汤治疗下利清谷，本来就没有芍药，只有腹中痛时才加入，因为它是干姜、附子的佐使，对于里寒没有伤害。咽痛时去掉芍药，是因为芍药不能疏散上部的阳结。加入桔梗，完全是为了治疗咽痛。虽然桔梗不治痢疾，但在痢疾时也不去掉，与芍药不去掉的用意正相同。如果痢疾不止，脉象不出是正常的；如果痢疾止了而脉象仍不出，那么桔梗的升散作用，对恢复脉象大有妨碍，这与芍药对咽痛有妨碍是一样的道理。所以必须去掉芍药而加入生脉散中的人参，这就是张仲景有时去掉有时加入的原因。邹氏不理解，认为芍药止腹痛下利，桔梗也止腹痛下利，错误至极。
*Shennong Bencao Jing* (Divine Farmer's Materia Medica) records that Shashen (Adenophorae Radix, 沙参) treats blood accumulation (Xueji, 血积), fright qi (Jingqi, 惊气), and eliminates chills and fever. Regarding the term "blood accumulation," only Xu Shi’s interpretation is most accurate; he stated that Shashen is a herb that regulates blood within the Qi aspect of the Lung organ. Its color is white and its body is light; it unblocks without being drying, and moistens without causing stagnation. For blood obstruction in the Lung, this herb alone can clear it. To say it regulates blood, to speak of blood obstruction, and to speak of clearing it, all precisely fit the measure of Shashen’s treatment of blood disorders. This is vastly different from Taoren (Persicae Semen, 桃仁), which is a Lung herb primarily treating the closure of blood stasis (Yuxue, 瘀血). Heat injures Qi, leading to Qi obstruction and subsequently blood obstruction; the Heart becomes disturbed, generating fright qi; Ying and Wei (Nutritive and Defensive Qi, 营卫) exceed their proper limits, resulting in chills and fever. These are not extremely severe conditions, so Shashen can be used to treat them.
Additionally, Shashen grows in sandy deserts and has a slightly cold nature; its color is white, and when broken, it exudes a white juice. Its stems elongate in autumn, and flowers bloom in autumn, absorbing much Metal Qi (Jin Qi, 金气). Its slightly sweet taste tonifies the Earth element within the Lung (Earth generates Metal); its slightly bitter taste guides Lung Qi downward. The Metal element governs penetrating and draining actions; cold nature clears heat; it further generates fluids, moistens, and benefits Yin. Therefore, those with Lung heat and Qi deficiency benefit from it; those with blood obstruction find it unblocking; fright qi and chills/fever are all stopped by it.
The Lung dislikes cold, and coughs often arise from Lung cold; thus, Xu Shi warned against using Shashen. However, *Weisheng Fang* (Prescriptions for Health Preservation, 《卫生方》) uses Shashen alone to treat Lung heat cough. Since it specifies Lung heat...
Jiegeng (Platycodonis Radix, 桔梗) possesses the abilities to ascend and descend, to disperse and drain, combining all four functions. Thus, its ascending power does not match Shengma (Cimicifugae Rhizoma, 升麻) and Chaihu (Bupleuri Radix, 柴胡); its descending power does not match Zhishi (Aurantii Fructus Immaturus, 枳实) and Houpo (Magnoliae Officinalis Cortex, 厚朴); its dispersing power does not match Mahuang (Ephedrae Herba, 麻黄) and Xingren (Armeniacae Semen Amarum, 杏仁); its draining power does not match Xiaoshi (Natrii Sulfas, 芒硝) and Dahuang (Rhei Radix et Rhizoma, 大黄). Generally, because its color is white, taste is pungent, and nature is slightly warm, it is purely a Lung herb (the Lung dislikes both cold and heat). However, its center is slightly yellow, and its taste includes bitterness, allowing it to reach the Intestines and Stomach from the Lung. Pungency ascends and disperses; bitterness descends and drains. Bitterness acts first, then pungency; descending followed by ascending, it circulates through the throat, chest, abdomen, and intestines.
What is recorded in *Benjing*...
Jiegeng actually does not enter the Kidney channel. Zhang Zhongjing’s Jiegeng Tang treats Shaoyin disease sore throat; this occurs when pathogenic heat from the Kidney travels up the channel, causing the Lung to be congested by heat. Jiegeng opens and lifts Lung Qi, assisted by Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) to moderate it, naturally dissipating heat and stopping pain. It does not treat the Kidney itself; Zou Shi’s argument is very correct. Qi is the commander of Blood; when Qi flows smoothly, Blood also flows smoothly. Therefore, Jiegeng Tang also primarily treats Blood Bi (Blood Obstruction, 血痹). Extending this reasoning, regarding pus discharge, treating Lung Abscess (Feiyong, 肺痈), and treating Chest Complex (Jieiong, 结胸), Zhang Zhongjing’s various formulas all align perfectly with *Benjing*. Even *Zhouhou Fang* (Handbook of Prescriptions for Emergencies, 《肘后方》) treating intra-intestinal blood stasis, or Zhu Danxi treating dysentery abdominal pain, merely apply the herb appropriately according to its function.
Medical principles are subtle; how could ancient sages have expressed everything? Grasping the essence and expanding upon it is the way to read ancient books well. Yi Lao (Li Dongyuan, 李东垣)’s theory that Jiegeng is a "boat and keel" agent that carries drugs upward without sinking was heavily criticized by Zhang Yinan. In reality, Jiegeng descends and then ascends; its nature is akin to the Lung, making it difficult to sink. In surgery, for upper Jiao abscesses, this herb is indispensable; Huixi (Wang Qingren, 王清任) had no objection when reviewing *Waike Zhengzong* (Standard Text on Surgery, 《外科正宗》). Moreover, Yi Lao considered it a boat-and-keel agent because it is used together with Gancao. When Jiegeng meets Gancao, it naturally stays in the upper part; calling it a boat-and-keel agent causes no harm. As for the statement in *Beiyao* that it can release exterior cold pathogens, how could Jiegeng bear the burden of inducing sweating? At first glance, this may seem surprising, but ancient exterior-releasing formulas indeed often use it. Generally, because it opens and lifts Qi and Blood, unblocks orifices, and disseminates stagnation, when combined with Qianghuo (Notopterygii Rhizoma et Radix, 羌活), Fangfeng (Saposhnikoviae Radix, 防风), Juqpi (Citri Reticulatae Pericarpium, 橘皮), and Banxia (Pinelliae Rhizoma, 半夏), it yields rapid effects, especially for nasal congestion. It is acceptable to assign it a subordinate role; however, relying on it entirely as an exterior-releasing agent would inevitably have drawbacks. Additionally, Xu Shi claimed that using Jiegeng for cough is a post-Song dynasty method, and lifting is ultimately inappropriate. One must understand that the Lung suffers from Qi rebellion, but the causes of Qi rebellion vary. If the Lung contracts Wind-Cold, and Qi cannot diffuse, leading to rebellion and cough, one cannot claim recovery without opening Lung depression and lifting it out. Furthermore, Jiegeng Bai San (Jiegeng White Powder, 桔梗白散) treats cough with chest fullness, recorded in *Waitai Miyao* (Essential Prescriptions Worth a Thousand Gold for Emergencies, 《外台秘要》). Huixi once mocked Ye Tianshi for not having read *Waitai*; how could he forget this and call it a post-Song method?
Both Jiegeng and Shaoyao (Paeoniae Radix Alba, 芍药) can treat dysentery abdominal pain. However, Jiegeng treats Lung Qi depression in the Large Intestine, dispersing and moving upward; Shaoyao treats Qi knotting in the Blood of the Spleen, breaking stagnation and moving downward. If it is not true dysentery (Lixia, 痢疾) characterized by tenesmus, neither herb is suitable. In *Shanghan Lun* (Treatise on Cold Pathogenic Diseases, 《伤寒论》) and *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet, 《金匮要略》), whenever "Li" (benefit/diarrhea) is mentioned, it refers to diarrhea, not modern dysentery. Dysentery is distinguished by adding the character "Zhong" (heaviness/tenesmus, 下重). Therefore, in Zhenwu Tang (True Warrior Decoction, 真武汤), if there is diarrhea, Shaoyao is removed; in Sixian San (Four Reversal Powder, 四逆散) treating diarrhea with tenesmus, Shaoyao is not removed; in Tongmai Sini Tang (Pulse-Reviving Sini Decoction, 通脉四逆汤) treating diarrhea with undigested food, Shaoyao is originally absent; it is added only if there is abdominal pain, because it serves as an assistant to Jiang (Zingiberis Rhizoma, 干姜) and Fu (Aconiti Lateralis Radix Praeparata, 附子), causing no harm to interior cold. Shaoyao is removed for sore throat because it cannot scatter the Yang knot in the upper region. Jiegeng is added specifically for sore throat. Although Jiegeng does not treat diarrhea, it is not removed during diarrhea, consistent with the intention of not removing Shaoyao. If diarrhea persists, the absence of pulse is understandable; if diarrhea stops but the pulse remains absent, Jiegeng’s dispersing action greatly hinders the generation of pulse, just as Shaoyao hinders the relief of sore throat. Therefore, one must remove Shaoyao and add Ren Shen (Ginseng Radix, 人参) from Sheng Mai San (Generate Pulse Powder, 生脉散). This explains why Zhang Zhongjing sometimes removes and sometimes adds herbs. Zou Shi failed to understand, claiming that Shaoyao stops abdominal pain and diarrhea, and Jiegeng also stops abdominal pain and diarrhea; this error is extreme.