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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.