主治心下痞坚、痞硬、支结也。旁治不食呕吐、喜唾、心痛、腹痛、烦悸。
考 证
木防己汤证曰∶心下痞坚。
以上一方，人参四两。
人参汤证曰∶心中痞；又曰∶喜唾、久不了了。
桂枝人参汤证曰∶心下痞硬。
半夏泻心汤证曰∶呕而肠鸣、心下痞。
生姜泻心汤证曰∶心下痞硬、干噫食臭。
甘草泻心汤证曰∶心下痞硬而满、干呕、心烦；又曰∶不欲饮食、恶闻食臭。
小柴胡汤证曰∶默默不欲饮食、心烦、喜呕。又云∶胸中烦。又云∶心下悸。又云腹中
痛。
大半夏汤证曰∶
呕而心下痞硬。
茯苓饮证曰∶气满、不能食。
干姜黄连黄芩人参汤证曰∶食入口即吐。
桂沉加芍药生姜人参新加汤证，不具也。（说在互考中）
六物黄芩汤证曰∶干呕。
白虎加人参汤证，不具也。（说在互考中）
生姜甘草汤证曰∶咳唾涎沫不止。
以上十四方，人参皆三两。
柴胡桂枝汤证曰∶心下支结。
干姜人参半夏丸证曰∶呕吐不止。
四逆加人参汤证，不具也。（说在互考中）
以上三方，其用人参者，或一两半，或一两，而亦三两之例。
附子汤证，不具也。（说在互考中）
黄连汤证曰∶腹中痛、欲呕吐。
旋复花代赭石汤证曰；心下痞硬、噫气不除。
大建中汤证曰∶心胸中大寒痛、呕不能饮食。
以上四方，人参皆二两。
上历观此诸方，人参主治心下结实之病也。故能治心下痞坚、痞硬、支结。而旁治不食、
呕
为则按∶人参、黄连、茯苓三味，其功大同而小异也。人参治心下痞硬而悸也，黄连治
心中烦而悸也，茯苓治肉 筋惕而悸也，不可不知矣。
互 考
木防己汤条曰∶心下痞坚，愈复发者，去石膏、加茯苓芒硝汤主之；是人参芒硝，分治
心下痞硬之与痞坚也。于是乎可见古人用药不苟也。盖其初，心下痞坚犹缓，谓之痞硬亦可，
故投以人参也。复发不愈，而痞之坚必矣，故投以芒硝也。半夏泻心汤，脱硬字也。甘草泻
心汤，此方中倍甘草。生姜泻心汤，加生姜之汤也。而共云治心下痞硬，则此方脱硬字也明
矣。吴茱萸汤、茯苓饮、干姜黄连黄芩人参汤、六物黄芩汤、生姜甘草汤，皆人参三两。而
云治咳唾涎沫、呕吐下利，不云治心下痞硬。于是综考仲景治咳唾涎沫，呕吐下利方中，其
无人参者，有居八九。今依人参之本例，用此五汤施之于心下痞硬，而咳唾涎沫呕吐下利者，
其
桂枝加芍药生姜人参新加汤，其证不具也。其云∶发汗后身疼痛，是桂枝汤证也；然则
芍药、生姜、人参之证，阙也。说在《类聚方》。
白虎加人参汤四条之下，俱是无有人参之证。盖张仲景之用人参三两，必有心下痞硬之
证。
半夏丸，依本治之例，试推其功。心下有结实之毒，而呕吐不止者实是。主之大抵与大半夏
汤之所主治也大同小异，而有缓急之别。
四逆加人参汤，其证不具也。恶寒脉微而复利，是四逆汤之所主；而不见人参之证也。
此方虽加人参仅一两，无见证，则何以加之？是脱心下之病证也明矣。附子汤证不具也。此
方之与真武汤，独差一味。而其于方意也，大有迳庭。附子汤，术、附君药，而主身体疼痛，
或小便不利，或心下痞硬者。真武汤，茯苓、芍药君药，而主肉 筋惕，拘挛呕逆，四肢沉
重疼痛者。
旋复花代赭石汤，其用人参二两，而有心下痞硬之证，此小半夏汤加减之方也。二两疑
当作三两也。
辨 误
甄权曰∶参补虚。误矣，此言一出，流毒千载。昔者张仲景之用参也，防己汤莫多焉。
其证曰∶支饮喘满、心下痞坚、面色黧黑。未尝见言补虚者也。又曰∶虚者即愈，实者三日
复发。复与而不愈者，去石膏、加茯苓芒硝汤主之。此其所由误者乎？则有大不然。盖汉以
降，字诂不古者多矣，则难其解。古语曰∶有为实也，无为虚也，故用防己汤。而心下痞坚
已，虚而无者，则即愈也，虽则即愈也，心下痞坚，犹实而有者，三日复发，复与防己汤而
不愈者，非特痞硬，即是坚也，非参之所主，而芒硝主之，故参如故，而加芒硝、茯苓。由
是观之，不可谓参补虚也。孙思邈曰∶无参，则以茯苓代之，此说虽误，然参不补虚，而治
心下疾也，亦足以征耳。盖参补虚之说， 于甄权。滔滔者天下皆是，本草终引广雅五行，
记是参之名义，而岂参之实乎，学人详诸。余读本草，至参养元气，未尝不发书而汉也。曰∶
呜呼，可悲哉，人之惑也。所谓元气者，天地根元之一气也，动为阳，静为阴，阴阳妙合，
斯生万物，命其主宰，曰造化之神也。而人也者，非造化之神也，故人生于人，而神不能生
人，况于元气乎？夫人之元气也，免身之初，所资以生，医家所谓先天之气也。养之以谷肉
果菜，所谓后天之气也。虽然，元气之说，圣人不言，故经典不载焉。战国以降，始有斯言
。冠子曰∶天地成于元气。董仲舒《春秋繁露》曰∶王正则元气和顺。扬雄解嘲曰∶大气
含元气。孔安国《虞书注》曰∶昊天谓元气广大。《汉书·律历志》曰∶大极元气，函为一
。班固《东都赋》曰∶降烟 ，调元气。此数者，皆言天地之元气，而非人之元气也。《素
问》曰∶天之大气举之，言系地于中而不坠也。又曰∶三焦者，原气之别使。言皮肤毫毛之
末，温缓之气也。此犹可言也。然论说之言也，于疾医何益之有？又曰∶养精以谷肉果菜，
是古之道也，未闻以草根木皮，而养人之元气，盖其说出于道家，道家所雅言延命长寿，故
立无气以为极也。秦汉以降，道家降盛，而阴阳五行元气之说，蔓延不可芟，医道湮晦，职
此之由，岂可不欢哉！夫医术人事也，元气天事也，故仲景不言矣。养精以谷肉果菜，而人
参养元气，未尝有言之。由此观之，其言养元气者，后世之说也，不可从矣。
东垣李氏曰∶张仲景云∶病患汗后，身热亡血、脉沉迟者，下利身凉、脉微血虚者，并
加人参也。古人之治血脱者，益气也。血不自生，须生阳气。盖阳气生，则阴长而血乃旺也。
今历考《伤寒论》中曰∶利止亡血也，四逆加人参汤主之，李氏其据此言乎？然而加人参仅
仅一两也。四逆加人参汤，更加茯苓，此为茯苓四逆汤，而不举血证，则人参之非为亡血也，
可以见已。且也仲景治吐血、衄血、产后亡血，方中无有人参，则益足证也，李氏之说妄哉
！自后苟有血脱者，则不审其证，概用人参，亦益妄哉！或问曰∶吾子言仲景用人参治心下
痞硬，而大黄黄连泻心汤之属，无有人参，岂亦有说乎？曰∶有之。何子读书之粗也？大黄
黄连泻心汤曰∶心下痞，按之濡。其于人参，则诸方皆曰心下痞硬。硬濡二字，斯可以见其
异矣。
品 考
人参 出上党者，古为上品，朝鲜次之。今也，上党不出，而朝鲜亦少也。其有自朝鲜
来者，味甘，非其真性。故试诸仲景所谓心下痞硬，而无效也，不可用矣。源顺和名抄云人
参，此言久末乃伊芳。盖本邦之俗，谓熊胆为久末乃伊芳，而亦号人参，则以其味名也。由是观
之，本邦古昔所用者，其味苦也亦明矣。今试取朝鲜之苗，而树艺诸本邦者，其味亦苦也。
然则其苦也者，是人参之正味。而桐君雷公之所同试也，乃今余取产于本邦诸国者用之，大
有效于心下痞硬。其产于本邦诸国者，五叶三 ，其于形状也，亦与所产于朝鲜同矣。产于
本邦诸国者，于和州金峰者最良。去土气而锉用，谨勿杀苦也。
主治心下痞坚、痞硬、支结。旁治不食呕吐、喜唾、心痛、腹痛、烦悸。
考证：
木防己汤证表现为：心下痞坚。
以上一方，人参用量为四两。
人参汤证表现为：心中痞；又说：喜唾、久不了了（长期不好）。
桂枝人参汤证表现为：心下痞硬。
半夏泻心汤证表现为：呕而肠鸣、心下痞。
生姜泻心汤证表现为：心下痞硬、干噫食臭（打嗝有食物腐臭味）。
甘草泻心汤证表现为：心下痞硬而满、干呕、心烦；又说：不欲饮食、恶闻食臭（厌恶食物的气味）。
小柴胡汤证表现为：默默不欲饮食、心烦、喜呕。又说：胸中烦。又说：心下悸。又说腹中痛。
大半夏汤证表现为：
呕而心下痞硬。
茯苓饮证表现为：气满、不能食。
干姜黄连黄芩人参汤证表现为：食入口即吐。
桂枝加芍药生姜人参新加汤证，症状不全。（详见互考部分）
六物黄芩汤证表现为：干呕。
白虎加人参汤证，症状不全。（详见互考部分）
生姜甘草汤证表现为：咳唾涎沫不止。
以上十四方，人参用量均为三两。
柴胡桂枝汤证表现为：心下支结。
干姜人参半夏丸证表现为：呕吐不止。
四逆加人参汤证，症状不全。（详见互考部分）
以上三方，其用人参者，或一两半，或一两，但也符合三两的规律。
附子汤证，症状不全。（详见互考部分）
黄连汤证表现为：腹中痛、欲呕吐。
旋复花代赭石汤证表现为：心下痞硬、噫气不除（打嗝不止）。
大建中汤证表现为：心胸中大寒痛、呕不能饮食。
以上四方，人参用量均为二两。
综上观察这些方剂，人参主治的是心下结实之病。所以能治疗心下痞坚、痞硬、支结。并旁治不食、呕吐。
按语：人参、黄连、茯苓三味药，功效大同小异。人参治疗心下痞硬而悸，黄连治疗心中烦而悸，茯苓治疗肌肉筋惕而悸，不可不知。
互考：
木防己汤条文中说：心下痞坚，痊愈后又复发者，去石膏、加茯苓芒硝汤主之；这说明人参和芒硝分别治疗心下痞硬与痞坚。由此可见古人用药严谨。起初，心下痞坚尚缓，称为痞硬也可以，所以投以人参。若复发不愈，则痞必坚，所以投以芒硝。半夏泻心汤，脱去了“硬”字。甘草泻心汤，此方中加倍使用甘草。生姜泻心汤，是加了生姜的汤剂。都说治疗心下痞硬，那么此方脱去“硬”字是很明显的。吴茱萸汤、茯苓饮、干姜黄连黄芩人参汤、六物黄芩汤、生姜甘草汤，都用人参三两。但说治疗咳唾涎沫、呕吐下利，不说治疗心下痞硬。于是综合考察张仲景治疗咳唾涎沫、呕吐下利的方剂中，没有用人参的占八九成。现在依据人参的本例，用这五汤施用于心下痞硬且伴有咳唾涎沫呕吐下利的患者，应该有效。
桂枝加芍药生姜人参新加汤，其证候不全。文中说：发汗后身疼痛，这是桂枝汤证；然而芍药、生姜、人参的证候，缺失了。说法在《类聚方》中。
在白虎加人参汤四条之下，都没有用人参的证候。大概张仲景用人参三两，必定有心下痞硬的证候。
半夏丸，依据本治疗的例子，推测其功效。心下有结实的毒邪，而呕吐不止的，确实是它的主治。大体上与大半夏汤所主治的大同小异，但有缓急的区别。
四逆加人参汤，其证候不全。恶寒脉微而复利，是四逆汤的主治；而不见人参的证候。此方虽然仅加人参一两，若无见证，为何要加？很明显是脱去了心下的病证。附子汤证也不全。此方与真武汤，只差一味药。但在方意上，大有径庭。附子汤，术、附为君药，主治身体疼痛，或小便不利，或心下痞硬者。真武汤，茯苓、芍药为君药，主治肌肉筋惕，拘挛呕逆，四肢沉重疼痛者。
旋复花代赭石汤，其用人参二两，而有心下痞硬的证候，这是小半夏汤加减的方剂。二两疑当作三两。
辨误：
甄权说：人参补虚。错了，这话一出，流毒千年。昔日张仲景用人参，莫过于防己汤。其证候说：支饮喘满、心下痞坚、面色黧黑。未曾见说补虚的。又说：虚者即愈，实者三日复发。再服而不愈者，去石膏、加茯苓芒硝汤主之。这就是导致误解的原因吗？其实不然。大概汉代以后，文字训诂不如古时准确，难以理解。古语说：有为实也，无为虚也，所以用防己汤。而心下痞坚已消，虚而无实者，就痊愈了；即使痊愈了，如果心下痞坚仍然实而有者，三天后复发，再服防己汤而不愈者，不仅仅是痞硬，而是坚了，这不是人参所主的，而是芒硝所主的，所以人参照旧，而加芒硝、茯苓。由此看来，不能说人参补虚。孙思邈说：无参，则以茯苓代之，这种说法虽错，但人参不补虚，而治心下疾，也足以证明。大概人参补虚的说法，始于甄权。滔滔者天下皆是，本草最终引用广雅五行，记录的是人参的名义，而不是人参的实质，学者请详察。我读本草，读到人参养元气，未尝不掩卷叹息。说：呜呼，可悲啊，人们的迷惑。所谓元气，是天地根元的一气，动为阳，静为阴，阴阳妙合，才生万物，称其主宰，叫造化之神。而人，不是造化之神，所以人生于人，神不能生人，何况元气呢？人的元气，出生之初，赖以生存，医家所谓先天之气。用谷肉果菜滋养，所谓后天之气。虽然如此，元气之说，圣人不言，所以经典不载。战国以后，始有此言。冠子曰：天地成于元气。董仲舒《春秋繁露》说：王正则元气和顺。扬雄解嘲说：大气含元气。孔安国《虞书注》说：昊天谓元气广大。《汉书·律历志》说：太极元气，函为一。班固《东都赋》说：降烟煴，调元气。这几位，都是说天地的元气，而非人的元气。《素问》说：天之大气举之，言系地于中而不坠也。又说：三焦者，原气之别使。言皮肤毫毛之末，温缓之气也。这还可以说。然而论说之言，对疾医有什么益处呢？又说：养精以谷肉果菜，是古之道也，未闻以草根木皮，而养人之元气，大概其说出于道家，道家所雅言延命长寿，故立无气以为极也。秦汉以后，道家兴盛，而阴阳五行元气之说，蔓延不可剪除，医道湮晦，职此之由，岂可不叹！夫医术人事也，元气天事也，所以仲景不言。养精以谷肉果菜，而人参养元气，从未有过这样的说法。由此看来，其言养元气者，是后世的说法，不可听从。
李东垣说：张仲景云：病患汗后，身热亡血、脉沉迟者，下利身凉、脉微血虚者，并加人参也。古人之治血脱者，益气也。血不自生，须生阳气。盖阳气生，则阴长而血乃旺也。今历考《伤寒论》中曰：利止亡血也，四逆加人参汤主之，李氏其据此言乎？然而加人参仅仅一两也。四逆加人参汤，更加茯苓，此为茯苓四逆汤，而不举血证，则人参之非为亡血也，可以见已。况且仲景治吐血、衄血、产后亡血，方中无人参，则更足证明，李氏之说妄哉！自后若有血脱者，则不审其证，概用人参，更是妄哉！有人问：您说仲景用人参治心下痞硬，而大黄黄连泻心汤之类，无人参，难道也有说法吗？回答说：有的。您读书太粗疏了。大黄黄连泻心汤说：心下痞，按之濡。对于人参，其他方都说心下痞硬。硬、濡二字，可以看出其差异了。
品考：
人参出产在上党的，古为上品，朝鲜次之。现在，上党不出产，而朝鲜也少了。其中有从朝鲜来的，味甘，不是其真性。所以试用于仲景所说的心下痞硬，而无效，不可用。源顺和名抄云人参，此言久末乃伊芳。大概本邦的习俗，谓熊胆为久末乃伊芳，而也叫人参，则是以其味命名。由此看来，本邦古昔所用者，其味苦也是明确的。现在试着取朝鲜的苗，种植在本邦，其味也是苦的。那么其苦，是人参的正味，也是桐君雷公所共同验证的。如今我取产于本邦诸国的使用，对心下痞硬大有效。产于本邦诸国的，五叶三梗，其形状也与产于朝鲜的同。产于本邦诸国的，于和州金峰者最良。去土气而锉用，切勿杀其苦味。
Treats primarily *xin xia pi jian* (fullness and hardness in the epigastrium), *pi ying* (epigastric fullness and hardness), and *zhi jie* (subcostal binding). Secondarily treats anorexia, vomiting, excessive salivation, heart pain, abdominal pain, irritability, and palpitations.
**Textual Verification:**
The syndrome of *Mufangji Tang* (Stephania Tetrandra Decoction) presents with: *xin xia pi jian* (fullness and hardness in the epigastrium).
In the above one formula, the dosage of Renshen is four liang.
The syndrome of *Renshen Tang* (Ginseng Decoction) presents with: *xin zhong pi* (epigastric fullness); it also states: excessive salivation, lingering indefinitely.
The syndrome of *Guizhi Renshen Tang* (Cinnamon Twig and Ginseng Decoction) presents with: *xin xia pi ying* (epigastric fullness and hardness).
The syndrome of *Banxia Xiexin Tang* (Pinellia Heart-Draining Decoction) presents with: vomiting with borborygmus, and *xin xia pi* (epigastric fullness).
The syndrome of *Shengjiang Xiexin Tang* (Fresh Ginger Heart-Draining Decoction) presents with: *xin xia pi ying* (epigastric fullness and hardness), dry belching with a smell of spoiled food.
The syndrome of *Gancao Xiexin Tang* (Licorice Heart-Draining Decoction) presents with: *xin xia pi ying er man* (epigastric fullness, hardness, and distension), dry vomiting, mental restlessness; it also states: aversion to eating, dislike of the smell of food.
The syndrome of *Xiao Chaihu Tang* (Minor Bupleurum Decoction) presents with: taciturnity, anorexia, mental restlessness, frequent vomiting. It also states: chest mental restlessness. It also states: *xin xia ji* (palpitations in the epigastrium). It also states: abdominal pain.
The syndrome of *Da Banxia Tang* (Major Pinellia Decoction) presents with:
vomiting with *xin xia pi ying* (epigastric fullness and hardness).
The syndrome of *Fuling Yin* (Poria Drink) presents with: qi fullness, inability to eat.
The syndrome of *Ganjiang Huanglian Huangqin Renshen Tang* (Dried Ginger, Coptis, Scutellaria, and Ginseng Decoction) presents with: vomiting immediately after swallowing food.
The syndrome of *Guizhi Jia Shaoyao Shengjiang Renshen Xinjia Tang* (Cinnamon Twig Decoction Modified by Adding Peony, Fresh Ginger, and Ginseng), symptoms are incomplete. (See Mutual Verification).
The syndrome of *Liuyu Huangqin Tang* (Six-Ingredient Scutellaria Decoction) presents with: dry vomiting.
The syndrome of *Baitu Jia Renshen Tang* (White Tiger Decoction Plus Ginseng), symptoms are incomplete. (See Mutual Verification).
The syndrome of *Shengjiang Gancao Tang* (Fresh Ginger and Licorice Decoction) presents with: incessant coughing and spitting of saliva and froth.
In the above fourteen formulas, the dosage of Renshen is three liang in all.
The syndrome of *Chaihu Guizhi Tang* (Bupleurum and Cinnamon Twig Decoction) presents with: *xin xia zhi jie* (subcostal binding).
The syndrome of *Ganjiang Renshen Banxia Wan* (Dried Ginger, Ginseng, and Pinellia Pill) presents with: incessant vomiting.
The syndrome of *Sini Jia Renshen Tang* (Recovery Decoction Plus Ginseng), symptoms are incomplete. (See Mutual Verification).
In the above three formulas, when Renshen is used, the dosage is either one-and-a-half liang or one liang, which also conforms to the pattern of three liang.
The syndrome of *Fuzi Tang* (Aconite Decoction), symptoms are incomplete. (See Mutual Verification).
The syndrome of *Huanglian Tang* (Coptis Decoction) presents with: abdominal pain, desire to vomit.
The syndrome of *Xuanfuhua Daizheshi Tang* (Inula and Hematite Decoction) presents with: *xin xia pi ying* (epigastric fullness and hardness), persistent belching.
The syndrome of *Da Jianzhong Tang* (Major Construct the Middle Decoction) presents with: severe cold pain in the heart and epigastrium, vomiting, inability to eat.
In the above four formulas, the dosage of Renshen is two liang in all.
Having reviewed these formulas comprehensively, Renshen primarily treats diseases of solidity in the epigastrium. Therefore, it can treat *xin xia pi jian*, *pi ying*, and *zhi jie*. And secondarily treats anorexia and vomiting.
**Commentary:**
Renshen, Huanglian, and Fuling have similar but slightly different efficacies. Renshen treats *xin xia pi ying* with palpitations; Huanglian treats mental restlessness in the heart with palpitations; Fuling treats muscle twitching with palpitations. This must be known.
**Mutual Verification:**
The text on *Mufangji Tang* states: *xin xia pi jian*; if it heals but recurs, remove Shigao, add Fuling and Mangxiao Tang as the main treatment; this indicates that Renshen and Mangxiao separately treat *xin xia pi ying* and *pi jian*. Thus, it is evident that ancient physicians did not use herbs carelessly. Initially, the *pi jian* in the epigastrium was mild, so calling it *pi ying* was acceptable, hence Renshen was administered. If it recurs and does not heal, the *pi* becomes hard, hence Mangxiao is administered. *Banxia Xiexin Tang* omits the character "ying" (hard). In *Gancao Xiexin Tang*, Gancao is doubled. *Shengjiang Xiexin Tang* adds Shengjiang. Since they all claim to treat *xin xia pi ying*, it is clear that the character "ying" is omitted in this formula. *Wuzhuyu Tang*, *Fuling Yin*, *Ganjiang Huanglian Huangqin Renshen Tang*, *Liuyu Huangqin Tang*, and *Shengjiang Gancao Tang* all use three liang of Renshen. However, they state they treat coughing/spitting of saliva/froth, vomiting, and diarrhea, without mentioning treating *xin xia pi ying*. Consequently, examining Zhang Zhongjing's formulas for coughing/spitting of saliva/froth, vomiting, and diarrhea, those without Renshen account for eight or nine out of ten. Now, applying these five formulas according to the primary example of Renshen to patients with *xin xia pi ying* accompanied by coughing/spitting of saliva/froth, vomiting, and diarrhea, should be effective.
*Guizhi Jia Shaoyao Shengjiang Renshen Xinjia Tang*: its syndrome is incomplete. It states: body pain after sweating, which is a *Guizhi Tang* syndrome; however, the syndromes for Shaoyao, Shengjiang, and Renshen are missing. See *Leiju Fang*.
Below the four entries for *Baitu Jia Renshen Tang*, there are no syndromes indicating the use of Renshen. Generally, when Zhang Zhongjing uses three liang of Renshen, there must be a syndrome of *xin xia pi ying*.
For *Banxia Wan*, inferring its efficacy based on the principle of treatment here: toxicity of solidity in the epigastrium causing incessant vomiting is indeed its main indication. It is largely similar but slightly different from the main indication of *Da Banxia Tang*, differing in urgency.
*Sini Jia Renshen Tang*: its syndrome is incomplete. Aversion to cold, faint pulse, and recurrent diarrhea are the indications for *Sini Tang*; there is no indication for Renshen. Although this formula adds only one liang of Renshen, without an indication, why add it? It is clear that the syndrome of the epigastrium is omitted. The syndrome of *Fuzi Tang* is also incomplete. This formula differs from *Zhenwu Tang* by only one herb, but their therapeutic intents are vastly different. *Fuzi Tang* uses Baizhu and Fuzi as sovereign herbs, mainly treating body pain, or difficulty in urination, or *xin xia pi ying*. *Zhenwu Tang* uses Fuling and Shaoyao as sovereign herbs, mainly treating muscle twitching, spasms, vomiting and regurgitation, and heavy painful limbs.
*Xuanfuhua Daizheshi Tang*: uses two liang of Renshen and has the syndrome of *xin xia pi ying*; this is a modified version of *Xiao Banxia Tang*. Two liang is suspected to be a typo for three liang.
**Correcting Errors:**
Zhen Quan said: Renshen tonifies deficiency. This is wrong. Once this statement was made, it caused harm for a millennium. In the past, Zhang Zhongjing's use of Renshen was most prominent in *Fangji Tang*. The syndrome states: fluid retention causing wheezing and fullness, *xin xia pi jian*, dark complexion. There is no mention of tonifying deficiency. It also states: those who are deficient will heal immediately; those who are excess will recur in three days. If re-administered and it does not heal, remove Shigao, add Fuling and Mangxiao Tang as the main treatment. Is this the source of the error? Not necessarily. Since the Han dynasty, textual interpretations have deviated from antiquity, making them difficult to understand. Ancient language says: existence is excess, non-existence is deficiency. Hence, *Fangji Tang* is used. When *xin xia pi jian* disappears, becoming deficient and non-existent, healing occurs immediately. Even if healed, if *xin xia pi jian* remains solid and existent, it recurs in three days. If re-administered *Fangji Tang* and it does not heal, it is no longer just *pi ying*, but *jian* (hardness). This is not what Renshen treats, but Mangxiao treats. Therefore, Renshen remains unchanged, while Mangxiao and Fuling are added. From this perspective, one cannot say Renshen tonifies deficiency. Sun Simiao said: if Renshen is unavailable, replace it with Fuling. Although this view is mistaken, the fact that Renshen does not tonify deficiency but treats epigastric disease is sufficient evidence. The theory that Renshen tonifies deficiency originated with Zhen Quan. It is prevalent everywhere. Materia Medica eventually cites *Guangya* and Five Elements, recording the nominal meaning of Renshen, not its actual nature. Scholars should examine this carefully. When I read Materia Medica stating that Renshen nourishes Yuan Qi, I cannot help but close the book and sigh. Alas, how pitiable is human confusion! What is called Yuan Qi is the single Qi of the root origin of Heaven and Earth. Movement is Yang, stillness is Yin. Through the subtle union of Yin and Yang, all things are born. Its ruler is called the Spirit of Creation. Humans are not the Spirit of Creation; thus, humans are born from humans, and the Spirit cannot create humans, let alone Yuan Qi. Human Yuan Qi is what sustains life at birth, what medical practitioners call Pre-heaven Qi. Nourishing it with grains, meats, fruits, and vegetables is Post-heaven Qi. Nevertheless, the sages did not speak of Yuan Qi, so classics do not record it. Since the Warring States period, this discourse began. Guan Zi said: Heaven and Earth were formed from Yuan Qi. Dong Zhongshu's *Chunqiu Fanlu* said: When the king is upright, Yuan Qi is harmonious. Yang Xiong's *Jie Zhao* said: Great Qi contains Yuan Qi. Kong Anguo's commentary on *Yu Shu* said: Hao Tian refers to the vastness of Yuan Qi. *Han Shu · Lüli Zhi* said: Taiji Yuan Qi encompasses unity. Ban Gu's *Dongdu Fu* said: Descending mist, regulating Yuan Qi. These all refer to the Yuan Qi of Heaven and Earth, not human Yuan Qi. *Suwen* said: The great Qi of Heaven supports it, referring to keeping the earth suspended in the center without falling. It also said: Sanjiao is the special envoy of Yuan Qi, referring to the warm, gentle Qi at the ends of skin and hair. This can be discussed. However, such theoretical discussions benefit physicians little. It also said: Nourish Jing with grains, meats, fruits, and vegetables; this is the ancient way. I have never heard of using roots and bark to nourish human Yuan Qi. This theory likely originated from Daoism, which advocates longevity and established non-Qi as the ultimate. Since Qin and Han, Daoism flourished, and theories of Yin-Yang, Five Elements, and Yuan Qi spread uncontrollably, obscuring medical arts. This is the cause. Should we not lament? Medical art concerns human affairs; Yuan Qi concerns heavenly affairs. Hence, Zhongjing did not speak of it. Nourishing Jing with grains, meats, fruits, and vegetables—no one has ever said Renshen nourishes Yuan Qi. From this, the claim that it nourishes Yuan Qi is a later theory and should not be followed.
Li Dongyuan said: Zhang Zhongjing stated: After sweating, if the patient has fever, blood loss, deep slow pulse, or diarrhea with cool body, faint pulse, and blood deficiency, add Renshen. Ancients treated blood depletion by boosting Qi. Blood does not generate itself; it requires the generation of Yang Qi. When Yang Qi generates, Yin grows, and blood becomes abundant. Now, reviewing *Shanghan Lun*, it says: Diarrhea stops, blood is lost, treat with *Sini Jia Renshen Tang*. Did Li base this on that statement? However, only one liang of Renshen is added. *Sini Jia Renshen Tang* plus Fuling becomes *Fuling Sini Tang*, and blood syndromes are not mentioned, showing Renshen is not for blood loss. Moreover, Zhongjing's formulas for hematemesis, epistaxis, and postpartum blood loss contain no Renshen, further proving Li's theory false. Since then, for any blood depletion, using Renshen indiscriminately without examining the syndrome is even more absurd. Someone asked: You say Zhongjing used Renshen for *xin xia pi ying*, but formulas like *Dahuang Huanglian Xiexin Tang* contain no Renshen. Is there an explanation? I say: Yes. Why is your reading so superficial? *Dahuang Huanglian Xiexin Tang* states: *xin xia pi*, soft upon pressure. For other formulas involving Renshen, they all state *xin xia pi ying*. The characters "ying" (hard) and "ru" (soft) reveal the difference.
**Product Verification:**
Renshen produced in Shangdang was anciently considered top grade, followed by Korea. Currently, Shangdang produces none, and Korea produces little. Those coming from Korea have a sweet taste, which is not their true nature. Therefore, testing them on the *xin xia pi ying* described by Zhongjing yields no effect; they should not be used. *Yunshun Hameicho* mentions Renshen, referring to "Kumonoi". This is because our country's custom calls bear gallbladder "Kumonoi", and also names it Renshen, due to its bitter taste. Thus, it is clear that what was used in our country in ancient times had a bitter taste. Now, taking Korean seedlings and cultivating them in our country, their taste is also bitter. Therefore, bitterness is the true taste of Renshen, verified by Tongjun and Leigong. Now, I use Renshen produced in various countries of our country, which is highly effective for *xin xia pi ying*. Those produced in our country have five leaves and three stems, and their shape is also the same as those from Korea. Among those produced in our country, the best comes from Jin Feng in Hezhou. Remove soil impurities and slice for use; do not destroy the bitterness.