愚谓痰火之证，本于亡血夺精，而其精之与血，皆真水真阴，有形有质，难成易亏者也
。夫所谓痰火者，言末而忘本也。盖真水既亏，则相火随炽，壅迫津液为痰，故曰痰者火之
标。然以痨瘵之证，谓曰阴虚火动者，盖以一言而括尽病之标本矣。《内经》曰∶阴虚生内
，盖热者火之微，火者热之极，火迫津液而为痰，则阴虚正谓致火致痰之本，而东垣所谓先
受病为本，次受病为标者，非此谓乎？今之治者，惟曰清痰降火，则殊昧治病必求其本之论
矣。或曰∶滋阴降火者，固为所宜，迨考所用之剂，母乃四物增以知、柏、芩、连苦寒之
味，殊不知阴得寒愈消，脾得寒愈败，病者得之，宁不减食而胀泄乎？又宁不阴消而肉削乎
？然曰滋阴降火者，谓益水而胜火也。盖以龙雷之火，不可以水伏，不可以直折，法宜甘温
以补母，人参、山药、五味之属，以苦坚之，知母之属，以苦佐之，黄柏之属，岂不闻萧丘
之火乎？按古之治痨诸方，鲜有不主参、 者，盖古人以血脱者益其气，所谓阴藉阳以生
之义耳。如妇人产后去血过多，上气喘急，命在须臾者，名曰孤阳绝阴，此阴虚之极者也。
法当补阴，然而不主四物等剂，而用参苏饮，剂中惟人参、苏木二味其用也，岂古人之愚乎
？盖亦本诸《内经》之旨也。夫苦寒之用，胎于王氏一言之差，遂为万世之妨，愚考《本草
正
寒
阴，阴虚火动，劳嗽、吐血、咳血等证勿用之。盖人参入手太阴，能补火，故肺受火邪者忌
之，
阴消，惟宜苦甘寒之药，生血降火，世人不识，往往服参、 为补而死者多矣。言闻曰∶孙
真人夏月服参脉散、肾沥汤三剂，则百病不生。李东垣亦谓生脉散，清暑益气汤，乃泻火益
金
积，岂有发心 之理。观仲景治腹中寒气上冲，有头足，上下痛，不可触迫，呕不能食者
，用
能补肺火，阴虚火动失血诸病，服之必死。二家之说皆偏矣。夫人参能补元阳，生阴血，
而泻阴火，东垣李氏之帮助矣。仲景张氏言亡血血虚者，并加人参。又言肺寒者，去人参加
干姜，无令气壅。丹溪朱氏亦言虚火可补参、 之属，实火可泻芩、连之属也。二家不
察三氏之精微，而曰人参补火，谬哉！夫火与元气不两立，元气胜则火邪退，人参既补元气
，而又补火邪，是反复小人，何以与甘草、苓、术谓之四君子耶？虽然，二家之言，不可
尽废也。惟其语有滞，故守之者泥而执一，遂视人参如蛇蝎，则不可也。凡人面白面黄面青
黧悴者，皆脾肺肾气不足，可用也。面赤面黑者，气壮神强，不可用也。脉之浮而芤濡虚大
，迟缓无力，沉而迟涩弱细结代无力者，皆虚而不足，可用也。若弦长紧实滑数有力者，皆
火郁内实，不可用也。洁古谓喘嗽勿用者，痰实气壅之喘也。若肾虚气短喘促者，必用也。
仲景谓气寒而喘勿用者，寒束热邪，壅郁在肺之咳也，若自汗恶寒而嗽者，必用也。东垣谓
病火郁在肺勿用者，乃火郁于内，宜发不宜补也。若肺虚火旺，气短自汗，必用也。丹溪言
诸痛不可骤用者，乃邪气方锐，宜散不宜补也。若里虚吐利，及久病胃弱，虚痛喜按者，必
用也。节斋谓阴虚火旺勿用者，乃血虚火亢能食，脉弦而数，凉之则伤胃，温之则伤肺，不
受补者也。若自气短肢冷脉虚者，必用也。如此详审，则人参可用不可用，思过半矣。东垣
节斋之说，本于海藏，但论又过于矫激。丹溪言虚火可补，须用参、 。又云阴虚潮热，
喘嗽吐血盗汗等证，四物加人参、黄柏、知母。又云好色之人，肺肾受伤，咳嗽不愈，琼玉
膏主之，是阴虚痨瘵之证，未尝不用人参也。节斋私淑丹溪者也，而乃相反如此，斯言一出
，印定后人眼目，凡遇前症，不问宜用不宜用，辄举以借口，致使良工掣肘，惟求免去病家
之怨，病家亦以此说横之胸中，甘受苦寒，虽至上呕下泄，去死不远，亦不悟也。古今治
痨，莫过于葛可久，其独参汤、保真汤，何尝废人参而不用耶？节斋之说，诚未之深思也
。杨起曰∶人参载本草，人所共知，近因病者吝财薄医，医复算本惜费，不肯用人参疗病，
以致轻者至重，重者至危。然有肺寒、肺热、中满、血虚、四证，只宜散寒消肿，补营，
不
，则谬矣。古方治肺寒以温肺汤，肺热以清肺汤，中满以分消汤，血虚以养营汤，皆有人参
在焉。所谓邪之所凑，其气必虚。又曰∶养正邪自除，阳旺则生阴血，贵配合得宜耳。庸医
每谓人参不宜轻用，诚哉其为庸也。好生君子，不可轻命薄医，医亦不可计利不用，盖病者
薄医，实所以自轻其生，医者计利苟且，所以自乖其行也。书此奉勉，幸毋曰迂。
我认为痰火这类病证，根源在于失血和耗损精气，而精与血，都是真水、真阴，是有形有质的物质，难以形成却容易亏损。所谓“痰火”，是只说了表象而忘记了根本。因为真水既然亏损，相火（寄居于肝肾的命门之火）就会随之炽盛，逼迫津液凝聚成痰，所以说“痰”是火的表象。然而对于痨瘵（一种慢性消耗性疾病，类似肺结核）这种病证，说它是“阴虚火动”，大概是用一句话概括了疾病的标本关系。《黄帝内经》说：“阴虚生内热”，其中热是火的轻微表现，火是热的极端表现，火逼迫津液形成痰，那么“阴虚”正是导致火旺和生痰的根本原因，这难道不是李东垣所说的先受病为本、后受病为标的含义吗？现在的医生治疗，只是说清化痰热、降泻实火，这就严重违背了治病必须探究根本的原则。
有人问：滋阴降火的方法，固然适宜，但考察所用的方剂，无非是在四物汤（补血基础方）基础上增加知母、黄柏、黄芩、黄连等苦寒的药物，却不知道阴液遇到寒凉药会更加消减，脾胃遇到寒凉药会更加败坏，病人服用后，难道不会减少食欲并导致腹胀腹泻吗？难道不会导致阴液消亡而肌肉消瘦吗？然而所谓“滋阴降火”，意思是补益肾水以制约心火。因为龙雷之火（指下焦虚火上炎），不能用水来压制，也不能直接折服，治疗方法应当用甘温药物来补益母脏（脾土），如人参、山药、五味子之类，用苦味药物来坚阴，如知母之类，用苦味佐助，如黄柏之类。难道没听说过萧丘之火（比喻虚火不可直折）吗？
查阅古代治疗痨病的各方，很少有不用人参、白术的，这是因为古人认为“血脱者益其气”，这是“阴依靠阳来生成”的道理。例如妇女产后失血过多，出现上气喘急，性命垂危的情况，名叫“孤阳绝阴”，这是阴虚到了极点。治疗方法应当补阴，然而不采用四物汤等方剂，而是使用参苏饮，方中主要用人参、苏木两味药，这难道是古人的愚笨吗？这也是遵循《黄帝内经》的宗旨。
苦寒药物的滥用，源于王好古（或指王氏医家）一句话的错误，从而成为万世的祸害。我考证《本草正》指出：阴虚火动，劳嗽、吐血、咳血等证候不要使用苦寒药。因为人参入太阴肺经，能补气（注：原文此处可能有误或特定语境，通常人参补元气，此处依文意译为补火/气），所以肺受火邪者忌用；[此处原文似有缺漏或排版错误，结合上下文推测意为] 若误用苦寒导致阴消，只宜用苦甘寒的药物，以生血降火。世人不懂这个道理，往往把人参、白术当作补药而死者很多。
闻人氏说：孙思邈在夏天服用生脉散、肾沥汤各三剂，就能百病不生。李东垣也说生脉散、清暑益气汤，是泻火益金（补肺气）的方子，怎么会有引发心火积聚、发心痛的道理？看张仲景治疗腹中寒气上冲，有头足感，上下疼痛，不能触碰压迫，呕吐不能进食的情况，使用[附子理中汤类]，能补肺火（注：此处原文逻辑较绕，意指温阳），阴虚火动失血诸病，服用必死。这两家的说法都有偏颇。其实人参能补元阳，生阴血，而泻阴火，这是李东垣等人的帮助。张仲景说亡血血虚者，加用人参。又说肺寒者，去人参加干姜，不要让气机壅滞。朱丹溪也说虚火可用人参、白术之类补益，实火可用黄芩、黄连之类泻火。这两家不考察这三家（张、李、朱）的精微之处，却说人参补火，真是荒谬！
火与元气不两立，元气胜则火邪退，人参既然补元气，又怎么会补火邪呢？这就像反复无常的小人，怎么能和甘草、茯苓、白术被称为“四君子汤”呢？虽然如此，这两家的话也不能完全废弃。只是因为他们的言语有局限，所以坚守的人拘泥固执，于是视人参如蛇蝎，这样是不可以的。凡是面色白、面黄、面青且憔悴的人，都是脾肺肾气不足，可以使用人参。面色红黑、气壮神强的人，不可使用。脉象浮而芤、濡、虚、大，迟缓无力，沉而迟、涩、弱、细、结代无力者，都是虚而不足，可以使用。如果脉弦长紧实滑数有力者，都是火郁内实，不可使用。
洁古（张元素）说喘嗽勿用人参，是指痰实气壅的喘证。如果是肾虚气短喘促者，必须使用。张仲景说气寒而喘勿用人参，是指寒束热邪，壅郁在肺的咳嗽，如果是自汗恶寒而咳嗽者，必须使用。李东垣说病火郁在肺勿用人参，是指火郁于内，宜发散不宜补益。如果是肺虚火旺，气短自汗者，必须使用。朱丹溪说诸痛不可骤用人参，是指邪气方锐，宜散不宜补。如果是里虚吐利，以及久病胃弱，虚痛喜按者，必须使用。节斋（虞抟）说阴虚火旺勿用人参，是指血虚火亢能食，脉弦而数，凉之则伤胃，温之则伤肺，不受补的情况。如果是气短肢冷脉虚者，必须使用。如此详细审察，那么人参可用不可用，就明白一大半了。
李东垣、虞节斋的说法，本源于王好藏（海藏），但论述又过于矫激。朱丹溪说虚火可补，须用人参、白术。又说阴虚潮热，喘嗽吐血盗汗等证，用四物汤加人参、黄柏、知母。又说好色之人，肺肾受伤，咳嗽不愈，用琼玉膏主治，这说明对于阴虚痨瘵的病证，未尝不用人参。虞节斋私淑朱丹溪，竟然如此相反，这句话一出，印定了后人的眼光，凡遇到前症，不问宜用不宜用，就拿这话当借口，致使良医束手束脚，只求免去病家的怨恨，病家也以此说横亘胸中，甘心受苦寒药，即使导致上呕下泄，离死不远，也不醒悟。古今治疗痨病，没有超过葛可久的，他的独参汤、保真汤，何曾废除人参不用呢？虞节斋的说法，确实没有深思熟虑。
杨起说：人参记载在本草中，是人所共知的，近来因为病人吝啬钱财轻视医生，医生又计算成本吝惜费用，不肯用人参治病，以致轻病变重，重病变危。然而有肺寒、肺热、中满、血虚四种证候，只宜散寒消肿，补营血，如果不加人参，那就错了。古方治疗肺寒用温肺汤，肺热用清肺汤，中满用分消汤，血虚用养营汤，这些方子里都有人参。所谓“邪之所凑，其气必虚”。又说“养正邪自除”，阳气旺盛则能生阴血，贵在配合得当罢了。庸医常说人参不宜轻用，这确实是庸医啊。爱惜生命的君子，不可轻视生命、薄待医生；医生也不可计较利益而不肯用药，因为病人薄待医生，实际上是自己轻视自己的生命；医生计较利益苟且行事，实际上是违背了自己的医德。写下这些用来劝勉，希望不要说这是迂腐之言。
I believe that the syndrome of Phlegm-Fire (Tan Huo) originates from blood loss and essence depletion. Essence and blood are both True Water (Zhen Shui) and True Yin (Zhen Yin), which have form and substance, are difficult to generate but easy to deplete. The term "Phlegm-Fire" refers to the branch (biao) while forgetting the root (ben). Since True Water is depleted, Ministerial Fire (Xiang Huo) flares up accordingly, forcing body fluids to condense into phlegm; thus, it is said that "phlegm is the manifestation of fire." However, regarding the syndrome of Tuberculous Consumption (Lao Zhai), describing it as "Yin Deficiency with Fire Hyperactivity" (Yin Xu Huo Dong) seems to encompass both the root and branch of the disease in a single phrase. The *Nei Jing* states: "Yin deficiency generates internal heat." Heat is the mild degree of fire, while fire is the extreme degree of heat. When fire forces body fluids to become phlegm, "Yin deficiency" is precisely the root cause leading to fire and phlegm generation. Is this not what Li Dongyuan meant by "the initially affected pathogen is the root, and the subsequently affected is the branch"?
Current practitioners merely advocate clearing phlegm and descending fire, which severely violates the principle that treating a disease requires seeking its root. One might ask: Although nourishing Yin and descending fire is appropriate, examining the prescribed formulas reveals they are mostly Si Wu Tang (Four Substances Decoction) augmented with bitter-cold herbs such as Anemarrhenae Rhizoma (Zhimu), Phellodendri Cortex (Huangbai), Scutellariae Radix (Huangqin), and Coptidis Rhizoma (Huanglian). They fail to realize that Yin fluid diminishes further when exposed to cold, and the Spleen deteriorates when exposed to cold. Would not patients taking these suffer from reduced appetite, abdominal distension, and diarrhea? Would they not experience Yin consumption and emaciation?
However, "nourishing Yin and descending fire" implies benefiting Water to overcome Fire. The Fire of Dragon and Thunder (Long Lei Zhi Huo, referring to deficient fire rising from the lower Jiao) cannot be subdued by water nor directly broken. The method should employ sweet-warm herbs to tonify the Mother organ (Spleen), such as Ginseng Radix et Rhizoma (Renshen), Dioscoreae Rhizoma (Shanyao), and Schisandrae Fructus (Wuweizi); use bitter herbs to firm Yin, such as Anemarrhenae Rhizoma (Zhimu); and use bitter assistants, such as Phellodendri Cortex (Huangbai). Have you not heard of the fire at Xiao Qiu? Examining ancient formulas for treating consumption, few omit Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). This is because ancients believed that in cases of blood loss, one should benefit Qi, following the principle that "Yin relies on Yang for generation." For example, when women suffer excessive postpartum blood loss, leading to panting and impending death, named "Solitary Yang and Absolute Yin," this represents extreme Yin deficiency. The treatment should tonify Yin, yet instead of using Si Wu Tang, they used Shen Su Yin (Ginseng and Dalbergia Odorifera Decoction), primarily utilizing only Ginseng Radix et Rhizoma (Renshen) and Dalbergia Odorifera Xylum (Sumu). Was this ancient foolishness? No, it followed the tenets of the *Nei Jing*.
The abuse of bitter-cold herbs stems from a mistaken statement by Wang Haozou (or a Wang physician), becoming a hindrance for generations. I consulted *Bencao Zheng* which states: For Yin deficiency with fire hyperactivity, labor cough, hematemesis, and hemoptysis, do not use bitter-cold herbs. Because Ginseng Radix et Rhizoma (Renshen) enters the Taiyin Lung Meridian and tonifies [Qi/Fire contextually], it is contraindicated for those with Lung fire pathogens; [text gap inferred] if Yin is consumed, only bitter-sweet-cold herbs should be used to generate blood and descend fire. People who do not understand this often die from mistakenly using Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) as tonics.
Wenren said: Sun Simiao took three doses of Sheng Mai San (Generate Pulse Powder) and Shen Li Tang (Kidney Drip Decoction) in summer, preventing all diseases. Li Dongyuan also stated that Sheng Mai San and Qing Shu Yi Qi Tang clear fire and benefit Metal (Lung Qi); how could they cause heart fire accumulation or heart pain? Zhang Zhongjing treated abdominal cold qi rushing upward, with sensations of heads and feet, upper and lower pain, untouchable, vomiting and inability to eat, using [Fuzi Lizhong Tang category], which can tonify Lung fire. For Yin deficiency with fire hyperactivity and bleeding disorders, taking it would be fatal. Both schools' views are biased. In fact, Ginseng Radix et Rhizoma (Renshen) tonifies Primordial Yang, generates Yin blood, and drains Yin fire, assisting Li Dongyuan's theories. Zhang Zhongjing added Ginseng Radix et Rhizoma (Renshen) for blood loss and blood deficiency. He also said for Lung cold, remove Ginseng Radix et Rhizoma (Renshen) and add dried ginger to prevent Qi stagnation. Zhu Danxi also stated that deficient fire can be tonified with Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu), while excess fire can be drained with Scutellariae Radix (Huangqin) and Coptidis Rhizoma (Huanglian). These two schools failed to examine the subtleties of the three masters (Zhang, Li, Zhu) and claimed Ginseng Radix et Rhizoma (Renshen) tonifies fire, which is absurd!
Fire and Yuan Qi (Primal Qi) cannot coexist; when Yuan Qi prevails, fire pathogens recede. If Ginseng Radix et Rhizoma (Renshen) tonifies Yuan Qi, how could it tonify fire pathogens? It would be like a fickle person, how can it be grouped with Glycyrrhizae Radix et Rhizoma (Gancao), Poria (Fuling), and Atractylodis Macrocephalae Rhizoma (Baizhu) to form Si Jun Zi Tang (Four Gentlemen Decoction)? Nevertheless, their words should not be entirely discarded. Their statements were limited, so adherents became rigid, viewing Ginseng Radix et Rhizoma (Renshen) as venom, which is incorrect. Those with white, yellow, or cyan faces appearing haggard have insufficient Spleen, Lung, and Kidney Qi and may use Ginseng Radix et Rhizoma (Renshen). Those with red or black faces, strong Qi and spirit, should not use it. Pulses that are floating and knotted, soggy, deficient, large, slow, weak, deep, delayed, choppy, thin, intermittent, or forceless indicate deficiency and may use Ginseng Radix et Rhizoma (Renshen). Pulses that are string-taut, long, tight, solid, slippery, rapid, or forceful indicate internal fire stagnation and excess, and should not use it.
Jiegu (Zhang Yuansu) said avoid Ginseng Radix et Rhizoma (Renshen) for panting and cough due to phlegm excess and Qi stagnation. But for Kidney deficiency causing shortness of breath and panting, it must be used. Zhang Zhongjing said avoid Ginseng Radix et Rhizoma (Renshen) for cold Qi panting, referring to cold binding heat pathogens stagnant in the Lung cough. But for spontaneous sweating, aversion to cold, and cough, it must be used. Li Dongyuan said avoid Ginseng Radix et Rhizoma (Renshen) for fire stagnation in the Lung, meaning fire is stagnant internally, suitable for dispersal not tonification. But for Lung deficiency with fire hyperactivity, shortness of breath, and spontaneous sweating, it must be used. Zhu Danxi said avoid sudden use of Ginseng Radix et Rhizoma (Renshen) for various pains, meaning pathogens are sharp, suitable for dispersal not tonification. But for interior deficiency with vomiting/diarrhea, chronic stomach weakness, and deficiency pain preferring pressure, it must be used. Jiezai (Yu Tun) said avoid Ginseng Radix et Rhizoma (Renshen) for Yin deficiency with fire hyperactivity, referring to blood deficiency with fire hyperactivity, good appetite, string-taut and rapid pulse, where cooling harms Stomach and warming harms Lung, making it unable to accept tonification. But for shortness of breath, cold limbs, and deficient pulse, it must be used. Such detailed examination clarifies half the logic of when Ginseng Radix et Rhizoma (Renshen) is applicable.
Li Dongyuan and Jiezai's theories originated from Haicang (Wang Haozou), but their arguments were overly radical. Zhu Danxi said deficient fire can be tonified with Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu). He also stated for Yin deficiency tidal fever, panting, cough, hemoptysis, and night sweats, use Si Wu Tang plus Ginseng Radix et Rhizoma (Renshen), Phellodendri Cortex (Huangbai), and Anemarrhenae Rhizoma (Zhimu). He also said for those indulging in sex, damaging Lung and Kidney, with persistent cough, use Qiongyu Gao (Jade Pearl Paste), indicating that for Yin deficiency consumption, Ginseng Radix et Rhizoma (Renshen) was indeed used. Jiezai, a private disciple of Danxi, contradicted him so sharply. Once this saying spread, it fixed later generations' perspectives. Encountering these symptoms, regardless of suitability, they used it as an excuse, hampering skilled physicians who sought only to avoid patient resentment. Patients, holding this view, endured bitter-cold herbs even until vomiting, diarrhea, and near-death, without realizing their error. In treating consumption since ancient times, none surpassed Ge Kejiu. His Du Shen Tang (Single Ginseng Decoction) and Bao Zhen Tang (Preserve Truth Decoction) never abandoned Ginseng Radix et Rhizoma (Renshen). Jiezai's view lacked deep thought.
Yang Qi said: Ginseng Radix et Rhizoma (Renshen) is recorded in Bencao, known to all. Recently, due to patients being stingy with money and despising doctors, and doctors calculating costs and sparing expenses, refusing to use Ginseng Radix et Rhizoma (Renshen) for treatment, mild cases became severe, and severe cases became critical. However, for Lung cold, Lung heat, middle Jiao fullness, and blood deficiency, one should only disperse cold, reduce swelling, and tonify Ying Blood. Omitting Ginseng Radix et Rhizoma (Renshen) here would be wrong. Ancient formulas for Lung cold used Wen Fei Tang, for Lung heat Qing Fei Tang, for middle Jiao fullness Fen Xiao Tang, for blood deficiency Yang Ying Tang, all containing Ginseng Radix et Rhizoma (Renshen). As stated: "Where pathogens gather, Qi is deficient." And "Nourish righteousness, and pathogens will eliminate themselves." When Yang is vigorous, Yin blood is generated; the key lies in proper combination. Quack doctors often say Ginseng Radix et Rhizoma (Renshen) should not be used lightly; truly, they are quacks. Benevolent gentlemen should not slight life or despise doctors; doctors should not calculate profit and refuse treatment. Patients despising doctors actually slight their own lives; doctors acting unethically for profit violate their professional conduct. I write this to encourage, hoping no one calls it pedantic.