愚按李言闻曰∶孙真人云∶夏月服生脉饮肾沥汤三剂。则百病不生。东
垣亦
言生脉饮清暑益气汤。乃三伏泻火益金之圣药。而雷 反谓发心 久病。非矣。 乃脐旁积
气。非心病也。人参能养正破坚积。岂有发 之理。观仲景治腹中寒气上冲。有头足上下痛
不可触近。呕不能食者。用大建中汤可知矣。又海藏言人参补阳泄阴。肺寒宜用。肺热不宜
用。王节斋因而和之。谓参 能补肺火。阴虚火动。失血诸病。多服必死。夫人参能补元
阳。生阴血。而泻阴火。东垣之帮助矣。仲景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。东垣又言虚火可补。参 之属。实火可泻。苓连之属。乃二子不察张李之精
微而谓人参补火。谬哉夫火与元气不两立。元气胜则邪火退人参既补元气而又补邪。火是反
复之小人矣。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。仲景谓肺寒而咳勿用者。寒束热邪。壅
郁在肺之咳也。若自汗恶寒而咳者必用也。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。若自汗气短。肢寒脉虚者必用也。
如此详审则人参之可用不可用。思过半矣。汪机曰∶王节斋之说。本于王海藏。但节斋又过
于矫激。东垣言虚火可补。须用参 。丹溪云∶阴虚潮热喘嗽吐血盗汗等症。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。又云肺肾虚极者独参汤主之。
是知阴虚痨瘵之症。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。凡问此症。不论病之宜用不宜用。辄举以借口。致使良工掣肘。惟求免夫病家之怨
。病家亦以此说横之胸中。甘受苦寒。虽至下呕下泄。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。愚按上古
人乏粒食。窠居穴处。茹毛饮血。迨神农氏出。始尝草别谷。教民耕艺。得味之正而为五谷
以养民生。又别药良毒。取性温凉寒热分用升降补泻以救民疾。但百药各具偏性只宜治病。
若执迷久服。便有偏胜偏绝之患。人参禀质中和。虽云补益亦惟体虚者宜之。盖人有阴脏阳
脏之殊。故阳脏受病可任凉泻少啖参术便增烦闷。亦犹阴脏之取资姜附最惮芩连者也。阳脏
而阳气本盛非芩连无以折其有余之焰。实非芩连之能滋阴也。阴脏而阴寒沉痼。非姜附无以
消其不足之医实。
非姜附之能益阳也昔夏英公饵硫黄附子。莫知纪极。其外家父盗服数粒。发狂而死。太原甘
始食天门冬
寒滑之物。得寿三百余龄。杜紫微亦饵冬而御外家八十。寿亦逾百。又神仙传缙云服黄连而
飞跸上 。王微亦
赞黄连有久饵轻身之功。数说岂尽诬。特因人而用耳。今世风日偷。赋禀渐漓六气有加真
元便脱故非
参术归苓。无以刮复生机。每见虚而受补者什居八九。实而耐攻者什仅二三。反此则实者不
妨少谬。虚者未可略瘥。经云邪之所凑。其气必虚未有元气虚而复虚而命不倾者也治虚之道。舍参奚适
。但恐有虚而似实。不知补虚而已极不任补斯难矣。
我考察李言闻的观点说：孙思邈曾说，夏季服用生脉饮和肾沥汤各三剂，就能百病不生。李东垣也说生脉饮和清暑益气汤是清除暑热、泻火益金的圣药。而雷氏反而认为人参会引发心疾，这是错误的。那是脐旁积气，并非心病。人参能够扶正破坚积，怎么会有引发心疾的道理呢？观察张仲景治疗腹中寒气上冲，出现头足上下疼痛不可触碰，呕吐不能进食的情况，使用大建中汤可知（人参在此类虚寒证中的作用）。另外，张元素（海藏）说人参补阳泄阴，肺寒适宜使用，肺热不适宜使用。王节斋因此附和，认为人参能补肺火，阴虚火动、失血等病症，多服必死。其实人参能补元阳，生阴血，而泻阴火，这是李东垣的帮助（佐证）。张仲景说亡血血虚者并加人参，又说肺寒者去人参加干姜，以免气机壅滞。李东垣又说虚火可补，用人参之类；实火可泻，用黄芩、黄连之类。这两个人没有仔细考察张元素和李东垣的精深微妙之处，却认为人参补火，真是荒谬啊！火与元气不两立，元气胜则邪火退。如果人参既补元气又补邪火，那它就成了反复无常的小人了。怎么能和黄芩、白术、甘草一起被称为“四君子”呢？虽然如此，这两家的言论也不能完全废弃。只是他们的言语有局限，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、面青黑憔悴的人，都是脾肺肾不足，可以使用人参。面色赤、面黑的人，气壮神强，不可以使用。脉象浮而芤、濡、虚、大、迟缓无力，沉而迟、涩、弱、细、结代无力，都是虚而不足，可以使用。如果是弦长紧实滑数有力，都是火郁内实，不可以使用。洁古说喘嗽勿用，是指痰实气壅的喘咳。如果是肾虚气短喘促，必须使用。张仲景说肺寒而咳勿用，是指寒束热邪，壅郁在肺的咳嗽。如果是自汗恶寒而咳，必须使用。丹溪说诸痛不可骤用，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，必须使用。节斋说阴虚火旺勿用，是指血虚火亢能食，脉弦而数，凉之伤胃，温之伤肺，不受补的情况。如果是自汗气短，肢寒脉虚，必须使用。如此详细审察，那么人参可用与不可用的道理，就明白大半了。
汪机说：王节斋的说法，本源于王海藏。但节斋又过于矫激。东垣说虚火可补，须用人参。丹溪说：阴虚潮热、喘嗽、吐血、盗汗等症状，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。又说肺肾虚极者，独参汤主治。由此可知，对于阴虚痨瘵的病症，并未尝不用人参。节斋私淑于丹溪，竟然如此相反。这种说法一出，印定了后人的眼光。凡问此症，不论病情是否适宜使用，就以此作为借口，致使良医束手无策，只求免除病家的怨恨。病家也以此说横亘胸中，甘愿受苦寒之药，即使导致下呕下泄，离死不远，也不醒悟。古今治疗劳损，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？节斋的说法，确实是没有深思熟虑啊。
我考察上古之人缺乏粮食，居住在巢穴之中，吃毛喝血。等到神农氏出现，才开始品尝草药辨别谷物，教导百姓耕种，获得味之正的五谷来养育民生。又辨别药物的良毒，取性温凉寒热分用升降补泻来救治百姓的疾病。但是各种药物都具备偏性，只适宜治病。如果执迷不悟长期服用，就会有偏胜偏绝的祸患。人参禀赋性质中和，虽说补益，也只适宜体质虚弱的人。大概人有阴脏、阳脏的区别，所以阳脏受病可以承受凉泻，少服参术就会增加烦闷，这也如同阴脏之人取资于姜附，最忌惮黄芩、黄连一样。阳脏而阳气本盛，非黄芩、黄连无以折其有余之焰，实在不是黄芩、黄连能滋阴。阴脏而阴寒沉痼，非姜附无以消其不足之实，实在不是姜附能益阳。从前夏英公服用硫黄、附子，不知节制。他的岳父偷服几粒，发狂而死。太原甘始食用天门冬这类寒滑之物，得寿三百余岁。杜紫微也服用天门冬，抵御外戚（或指抵御外邪/保养身体），八十岁时岳父（此处原文可能有误，结合语境应指本人或相关人物）八十，寿命也超过百岁。又有《神仙传》记载缙云服用黄连而飞升上天。王微也称赞黄连有久服轻身的功效。这些说法难道全是诬陷吗？只是因人而异使用罢了。当今世风日下，天赋禀赋逐渐淡薄，六气侵袭，真元便脱失，所以非人参、白术、当归、茯苓，无法刮复生机。常见虚而受补者十居八九，实而耐攻者十仅二三。反过来，实证不妨稍有误治，虚证未可稍微延误。经书说：邪之所凑，其气必虚。未有元气虚而复虚而命不倾覆的。治疗虚证之道，除了人参还有什么可去的呢？只恐怕有虚而似实，不知道补虚而已，到了极点不能承受补益，这就难办了。
I have examined Li Yanwen's statement: Sun Simiao said, "In summer, taking three doses of Shengmai Yin (Pulse-Generating Drink) and Shenli Tang (Kidney Dripping Decoction) prevents all diseases." Li Dongyuan also stated that Shengmai Yin and Qingshu Yiqi Tang (Clear Summerheat and Boost Qi Decoction) are holy medicines for clearing summerheat, purging fire, and benefiting metal (lungs). However, Lei [Shizhen] argued that ginseng causes heart disease, which is incorrect. It is qi accumulation beside the navel, not heart disease. Ginseng can nourish righteousness and break down firm accumulations; how could it cause heart disease? Observing Zhang Zhongjing treating cold qi in the abdomen rushing upward, causing pain throughout the head and feet that cannot be touched, with vomiting and inability to eat, using Dajianzhong Tang (Great Construct the Middle Decoction), we can understand [the role of ginseng]. Furthermore, Zhang Yuansu (Haicang) said ginseng tonifies yang and drains yin; it is suitable for lung cold but not for lung heat. Wang Jiezhai echoed this, claiming ginseng tonifies lung fire, and for conditions like yin deficiency with fire hyperactivity and bleeding disorders, excessive use leads to death. In fact, ginseng tonifies primal yang, generates yin blood, and drains yin fire, as supported by Li Dongyuan. Zhang Zhongjing stated that for those who lost blood or have blood deficiency, add ginseng; for lung cold, remove ginseng and add Ganjiang (Dried Ginger) to prevent qi stagnation. Li Dongyuan further stated that deficient fire can be tonified with ginseng-type herbs, while excess fire can be purged with Huangqin (Scutellaria Root) and Huanglian (Coptis Rhizome) types. These two failed to examine the subtleties of Zhang Yuansu and Li Dongyuan, yet claimed ginseng tonifies fire—how absurd! Fire and primal qi do not coexist; when primal qi prevails, pathogenic fire retreats. If ginseng tonifies both primal qi and pathogenic fire, it would be a fickle villain. How can it be called one of the "Four Gentlemen" alongside Gancao (Licorice Root), Huangqin, and Baizhu (White Atractylodes Rhizome)? Although so, the words of these two schools cannot be entirely discarded. Their statements were limited, leading adherents to be rigid and dogmatic, viewing ginseng as venomous snakes and scorpions, which is unacceptable. For those with white, yellow, or dark/dull complexions, indicating spleen, lung, and kidney insufficiency, ginseng may be used. For those with red or black complexions, indicating strong qi and spirit, ginseng should not be used. Pulse floating with kong (hollow), ru (flaccid), xu (deficient), da (large), chi (slow), man (late), wuli (weak force); or deep with chi, se (choppy), ruo (weak), xi (fine), jie (intermittent), dai (interrupted), wuli—these indicate deficiency and insufficiency, and ginseng may be used. If the pulse is xian (wiry), chang (long), jin (tight), shi (solid), hua (slippery), shuo (rapid), youli (strong force)—these indicate fire depression and internal excess, and ginseng should not be used. Jiegu said avoid ginseng for wheezing and coughing refers to wheezing/coughing due to phlegm excess and qi stagnation. For kidney deficiency causing shortness of breath and rapid breathing, ginseng must be used. Zhang Zhongjing said avoid ginseng for lung cold coughing refers to coughing due to cold binding heat pathogens obstructing the lungs. For spontaneous sweating, aversion to cold, and coughing, ginseng must be used. Danxi said avoid sudden use of ginseng for various pains refers to acute pathogenic factors where dispersal is preferred over tonification. For interior deficiency with vomiting/diarrhea, or chronic stomach weakness with dull pain relieved by pressure, ginseng must be used. Jiezhai said avoid ginseng for yin deficiency with fire hyperactivity refers to blood deficiency with fire hyperactivity, good appetite, wiry-rapid pulse, where cooling harms the stomach and warming harms the lungs, making them unable to tolerate tonification. For spontaneous sweating, shortness of breath, cold limbs, and deficient pulse, ginseng must be used. Such detailed examination clarifies more than half of the principles regarding when ginseng is usable or not.
Wang Ji said: Wang Jiezhai's theory originates from Wang Haicang. But Jiezhai was overly radical. Dongyuan said deficient fire can be tonified using ginseng. Danxi said: For symptoms like yin deficiency tidal fever, wheezing/coughing, hematemesis, and night sweats, use Siwu Tang (Four Substances Decoction) plus Renshen (Ginseng), Huangbai (Phellodendron Bark), and Zhimu (Anemarrhena Rhizome). He also said for people indulging in lust, damaging lungs and kidneys with persistent coughing, Qiongyu Gao (Jade Essence Paste) is indicated. For extreme lung/kidney deficiency, Dushen Tang (Single Ginseng Decoction) is indicated. Thus, we know ginseng is indeed used for yin deficiency and consumption diseases. Jiezhai privately studied under Danxi, yet contradicted him so sharply. Once this saying spread, it fixed later generations' perspectives. Whenever asking about such conditions, regardless of whether the disease suits ginseng, they use it as an excuse, hindering skilled physicians who merely seek to avoid patient resentment. Patients also hold this belief, willingly enduring bitter-cold medicines, even if leading to vomiting/diarrhea and near death, without realizing their error. In ancient and modern times, no one surpassed Ge Kejiu in treating consumption. His Dushen Tang and Baozhen Tang never abandoned ginseng. Jiezhai's view certainly lacked deep thought.
I observe that in ancient times, people lacked grains, lived in nests and caves, eating raw meat and drinking blood. When Shennong appeared, he tasted herbs, distinguished grains, taught farming, obtained the correct flavors of five grains to nourish people, and distinguished drug toxicity, using warm/cool/cold/hot properties, ascending/descending, tonifying/draining methods to cure diseases. However, each herb has biased properties, suitable only for curing illness. Obsessive long-term use leads to bias excess or deficiency. Ginseng possesses neutral nature; although tonifying, it is only suitable for the weak. People differ in yin/yang constitutions. Those with yang constitutions suffering illness can tolerate cooling/draining; slight use of Renshen and Baizhu increases irritability, just as those with yin constitutions rely on Jiang (Ginger) and Fuzi (Aconite Root) and dread Huangqin and Huanglian. Yang constitutions with inherent strong yang need Huangqin/Huanglian to curb excess flame—not because Huangqin/Huanglian tonify yin. Yin constitutions with entrenched cold need Jiang/Fuzi to eliminate deficiency—NOT because Jiang/Fuzai tonify yang. Formerly, Xia Yinggong took sulfur and aconite without limit. His father-in-law stole a few pills, went mad, and died. Gan Shi of Taiyuan ate Tianmendong (Asparagus Fern Tuber), a cold/slippery substance, living over 300 years. Du Ziwei also took winter melon/tuber, resisting external factors at eighty, living past a hundred. The Biography of Immortals records Jinyun taking Huanglian (Coptis Rhizome) to ascend to heaven. Wang Wei praised Huanglian for lightening the body with long-term use. Are these sayings all lies? They are simply used differently according to the person. Today, customs decline, endowment deteriorates, six qi invade, and primal yuan escapes. Thus, without Renshen, Baizhu, Danggui (Angelica Sinensis), and Fuling (Poria), vital energy cannot be restored. I often see nine out of ten cases responding well to tonification, while only two or three tolerate aggressive treatment. Conversely, slight errors in excess cases are tolerable, but delaying treatment in deficiency cases is dangerous. The Classics state: "Where pathogenic factors gather, qi is necessarily deficient." There is no case where primal qi becomes deficient repeatedly without life being endangered. The way to treat deficiency is nothing other than ginseng. Only fear that deficiency mimics excess, and one does not know to tonify deficiency until it reaches the point of intolerable tonification—that is difficult.