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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.