人参∶无论野山、移山、种秧,其色鲜时皆白,晒干则红,浸以白冰糖水,晒干则微红,若浸之数次,虽
晒于亦白矣。野山之参,其芦头(生苗之处,亦名露土)长而细,极长者可至二寸,细若韭莛,且多龃龉,有
芦头短者则稍粗。至秧参之芦头,长不过七八分,其粗则过于箸矣。
人参之鲜者,皆有粗皮,制时用线七八条作一缕为弓弦,用此弦如拉锯状,来回将其粗皮磨去,其皮色始
光润,至皮上之横纹以细密而深者为佳。野山之参一寸有二十余纹,秧参则一寸不
过十余纹,且其纹形破裂,有似刀划,野山参之纹则分毫无破裂。然无论野参、秧参,其纹皆系生成,非人力
所能为也。
人参之须以坚硬者为贵,盖野参生于坚硬土中,且多历岁月,其须自然坚硬。若秧参则人工种植,土松年
浅,故其须甚软也。
至于野参之性温和,秧参之性燥热,人所共知,究其所以然之故,非仅在历年之浅深也。因种秧参者多撒
砒石末于畦中,以防虫蚁之损伤,参得砒石之气故甚燥热,是以愚于治寒温方中当用参者,从不敢投以秧参,
恒以野党参代之,亦能立起沉 。至于西洋参,多系用秧参伪制,此愚在奉目睹,用者亦当审慎也。
山西党参,种植者多,野生者甚少。凡野生者其横纹亦如辽人参,种植者则无横纹,或芦头下有横纹仅数
道,且种者皮润肉肥,野者皮粗肉松,横断之中心有纹作菊花形。其芦头以粗大者为贵,名曰狮头党参,为其
历年久远,屡次自芦头发生,故作此形。其参生于五台山者名台党参,色白而微黄,生于潞州太行紫团山者名
潞党参,亦名紫团参,色微赤而细,以二参较之,台党参力稍大,潞党参则性平不热,以治气虚有热者甚宜。
然潞党参野生者甚少,多系人种植者,至辽东所出之党参(为其形若党参,故俗名东党参)。状若台党参,皆
系野生,其功用与山西之野台党参相近。
【附案】邑中高某年四十许,于季春得温病。屡经医者调治,大热已退,精神益惫,医者诿为不治。病
家亦以为气息奄奄,待时而已。乃迟旬日而病状如故,始转念或可挽回。迎愚诊视,其两目清白无火,竟昏愦
不省人事,舌干如磋,却无舌苔,问之亦不能言,抚其周身皆凉,其五六呼吸之顷,必长出气一口,其脉左右
皆微弱,至数稍迟,知其胸中大气因服开破降下药太过而下陷也。盖大气不达于脑中则神昏,大气不潮于舌本
则舌干。神昏舌干,故问之不能言也;其周身皆凉者,大气陷后不能宣布营卫
也;其五六呼吸之顷必长出气者,大气陷后胸中必觉短气,故太息以舒其气也。遂用野台参一两、柴胡二钱,
煎汤灌之,一剂见轻,两剂全愈。
外甥王××年二十时,卧病数月不愈,精神昏愦,肢体酸懒,微似短气,屡次延医服药莫审病因,用药亦无
效验。一日忽然不能喘息,张口呼气外出而气不上达,其气蓄极下迫肛门突出,约二十呼吸之顷,气息方通,
一昼夜间如是者八九次。诊其脉关前微弱不起,知其胸中大气下陷,不能司肺脏呼吸之枢机也。遂投以人参一
两,柴胡三钱,知母二钱,一剂而呼吸顺,又将柴胡改用二钱,知母改用四钱,再服数剂宿病亦愈。
愚治大气下陷多重用生黄 ,取其补气兼能升气也。而此案与前案皆重用参者,因一当外感之余,津液铄
耗,人参兼能滋津液;一当久病之余,元气亏损,人参兼能固元气也。
吐血过多者,古方恒治以独参汤,谓血脱者先益其气也。然吐血以后,多虚热上升,投以独参汤恐转助其
虚热,致血证仍然反复。愚遇此等证,亦恒用人参而以镇坠凉润之药辅之(保元寒降汤一案可参阅)。
人参之性,用之得宜,又善利小便(济阴汤后一案可参阅)。
人参:无论是野山参、移山参还是种秧参,新鲜时颜色都是白色的,晒干后变成红色,用白冰糖水浸泡后再晒干则呈微红色;如果反复浸泡多次,即使晒干了也变回白色。野山参的芦头(生苗的地方,也叫露土)长而细,最长的可达二寸,细得像韭菜茎一样,而且多有扭曲,芦头短的则稍粗一些。至于秧参的芦头,长度不过七八分,但粗细超过筷子。
新鲜的人参都有粗糙的外皮,加工时用七八根线搓成一股作为弓弦,像拉锯子一样来回摩擦以磨去其粗皮,这样皮色才会变得光滑润泽,至于皮上的横纹,以细密且深者为佳。野山参一寸有二十多道纹路,秧参一寸不超过十余道,而且其纹路形状破裂,像刀划的一样,野山参的纹路则分毫不破裂。然而无论野参还是秧参,其纹路都是天生形成的,不是人力所能做到的。
人参的须根以坚硬者为珍贵,因为野参生长在坚硬的土壤中,且经历岁月漫长,其须根自然坚硬。如果是秧参则是人工种植,土壤松软且年份浅,所以其须根非常软。
至于野参药性温和,秧参药性燥热,这是人所共知的,究其根本原因,不仅仅在于历年深浅不同。因为种植秧参的人多在田畦中撒入砒石粉末,以防虫蚁损伤,参吸收了砒石的气味所以显得非常燥热。因此我在治疗寒温病方剂中需要用人参时,从不敢使用秧参,常常用野党参代替,也能立刻起效救治危重病人。至于西洋参,多是利用秧参伪制而成的,这是我亲眼在奉天目睹的,使用者也应当审慎对待。
山西的党参,种植的很多,野生的很少。凡是野生的,其横纹也像辽人参一样,种植的则没有横纹,或者芦头下只有几道横纹,而且种植的皮润肉肥,野生的皮粗肉松,横断之后中心有纹路呈菊花形。其芦头以粗大者为贵,名叫狮头党参,是因为它经历年代久远,屡次从芦头发生新芽,所以形成这种形状。生长在五台山的党参名叫台党参,颜色白而微黄;生长在潞州太行紫团山的党参名叫潞党参,也叫紫团参,颜色微红且细。比较这两种参,台党参的药力稍大,潞党参则药性平和不热,用于治疗气虚伴有发热者非常适宜。然而潞党参野生者很少,多为人工种植。至于辽东出产的党参(因为其形状像党参,所以俗名东党参),状如台党参,都是野生的,其功用与山西的野生台党参相近。
【附案】县里的高某,四十岁左右,在晚春得了温病。经过多位医生调理治疗,大热已经退去,精神却更加疲惫,医生推脱说无法医治。病人家属也认为他气息奄奄,只是等待死亡而已。过了十几天病情依然如故,才开始转念或许还能挽回。请我诊治,见他两眼清白无火气,竟然昏沉糊涂不省人事,舌头干燥如磋磨过一般,却没有舌苔,问他也不能说话,抚摸他全身都凉,在他五六次呼吸之间,必须长出气一口,左右脉象都微弱,至数稍迟,我知道他是胸中大气因服用开破降下药太过而下陷。因为大气不能通达于脑则神志昏迷,大气不能滋润于舌本则舌头干燥。神志昏迷、舌头干燥,所以问他不能回答;他全身发凉,是因为大气下陷后不能宣发布散营卫之气;他在五六次呼吸间必长出气,是因为大气下陷后胸中必然觉得短气,所以通过太息来舒展气机。于是我用野台参一两、柴胡二钱,煎汤灌服,一剂见效,两剂全愈。
外甥王××,二十岁时,卧病数月不愈,精神昏沉糊涂,肢体酸懒,微微感觉短气,屡次请医服药都不清楚病因,用药也没有疗效。一天忽然不能喘息,张口呼气外出而气不上达,气蓄积极盛向下压迫导致肛门突出,大约二十次呼吸之间,气息才通畅,一昼夜夜间如此情况八九次。诊察他的脉象关前微弱不起,知道他是胸中大气下陷,不能主持肺脏呼吸的枢机。于是投用人参一两,柴胡三钱,知母二钱,一剂后呼吸顺畅,又将柴胡改为二钱,知母改为四钱,再服用几剂宿疾也好了。
我治疗大气下陷多重用生黄芪,取其补气兼能升气的功效。而这两个案例都重用人参,是因为第一个案例是在外感病余邪未尽之时,津液耗损,人参兼能滋养津液;第二个案例是在久病之后,元气亏损,人参兼能固护元气。
吐血过多的人,古方常用独参汤治疗,说是血脱者先益其气。然而吐血之后,多有虚热上升,投以独参汤恐怕会助长虚热,导致血证仍然反复。我遇到这类证候,也常用人参而以镇坠凉润的药物辅助(保元寒降汤一案可参阅)。
Ginseng (Renshen): Whether it is wild ginseng, transplanted wild ginseng, or cultivated seedling ginseng, its color when fresh is white; after sun-drying, it turns red. If soaked in white rock sugar water and then dried, it becomes slightly red; if soaked repeatedly several times, even after drying, it returns to white. For wild ginseng, the rhizome (the place where the sprout grows, also known as "Lu Tu") is long and thin, with the longest reaching two cun, as thin as a leek stalk, and often twisted; those with shorter rhizomes are slightly thicker. As for seedling ginseng, its rhizome is no more than seven or eight fen long, but its thickness exceeds that of a chopstick.
Fresh ginseng all have rough outer bark. During processing, seven or eight strands of thread are twisted into one strand to serve as a bowstring; this string is used like a saw blade, rubbing back and forth to remove the rough bark, so that the skin color becomes smooth and lustrous. Regarding the horizontal wrinkles on the skin, those that are fine, dense, and deep are considered superior. Wild ginseng has more than twenty wrinkles per cun, whereas seedling ginseng has no more than ten wrinkles per cun, and its wrinkle shapes are broken, resembling knife scratches, while the wrinkles of wild ginseng are completely unbroken. However, regardless of whether it is wild or seedling ginseng, these wrinkles are naturally formed and cannot be achieved by human effort.
The rootlets of ginseng are prized for their hardness, because wild ginseng grows in hard soil and endures many years, making its rootlets naturally hard. In contrast, seedling ginseng is artificially planted in loose soil for a short time, so its rootlets are very soft.
It is well known that wild ginseng has a mild nature, while seedling ginseng has a dry and hot nature. The reason for this is not merely due to the difference in the number of years. Because those who cultivate seedling ginseng often sprinkle arsenic powder in the beds to prevent damage from insects and ants, the ginseng absorbs the qi of arsenic, thus becoming very dry and hot. Therefore, when I use ginseng in formulas treating cold-heat diseases, I dare not use seedling ginseng, and always substitute it with wild Codonopsis (Dangshen), which can also immediately rescue critical patients. As for American ginseng (Xiyangshen), it is mostly counterfeit using seedling ginseng, which I witnessed personally in Fengtian; users should also exercise caution.
Codonopsis (Dangshen) from Shanxi is mostly cultivated, with few wild specimens. Those that are wild have horizontal wrinkles similar to Liaoning ginseng, while cultivated ones lack horizontal wrinkles, or have only a few near the rhizome. Cultivated Codonopsis has moist skin and plump flesh, whereas wild Codonopsis has rough skin and loose flesh; when cut horizontally, the center shows a chrysanthemum-shaped pattern. The rhizome is prized for being thick and large, named "Lion Head Codonopsis," because it has endured many years and sprouted repeatedly from the rhizome, forming this shape. Codonopsis growing on Mount Wutai is called Tai Dangshen, with a white color slightly tinged with yellow. Codonopsis growing on Zituan Mountain in Taihang, Luzhou, is called Lu Dangshen, also known as Zituan Shen, with a slightly reddish color and slender shape. Comparing these two, Tai Dangshen has slightly stronger efficacy, while Lu Dangshen has a neutral nature without heat, making it very suitable for treating Qi deficiency with heat. However, wild Lu Dangshen is rare, mostly cultivated. As for Codonopsis produced in Liaodong (named Dong Dangshen colloquially because its shape resembles Codonopsis), it resembles Tai Dangshen, is wild, and its efficacy is similar to that of wild Tai Dangshen from Shanxi.
[Attached Case 1] Gao, a resident of the county, was about forty years old when he contracted a warm disease in late spring. After treatment by several physicians, the high fever had subsided, but his spirit became increasingly exhausted. The physicians declared it incurable. The patient's family also believed he was gasping for breath and merely waiting for death. Ten days later, the condition remained unchanged, and they began to think perhaps it could still be salvaged. They invited me to examine him. His eyes were clear and white without signs of fire, yet he was confused and unconscious. His tongue was dry as if rubbed with pumice, with no coating. When asked questions, he could not speak. Touching his whole body, it was cold. Between every five or six breaths, he would take a long sigh. His pulse was weak and slow on both sides. I determined that his Upper Jiao Qi (Zhongqi/Chest Qi) had sunk due to excessive use of dispersing, breaking, and descending medicines. Since Upper Jiao Qi failing to reach the brain causes mental confusion, and failing to moisten the base of the tongue causes dryness, his confusion and dry tongue prevented him from speaking. His whole body was cold because, after the sinking of Upper Jiao Qi, it could no longer distribute Ying and Wei (Nutritive and Defensive Qi). He sighed deeply between breaths because, after the sinking of Upper Jiao Qi, he felt shortness of breath in the chest, so he sighed to relieve the Qi stagnation. I prescribed one liang of wild Tai Codonopsis and two qian of Bupleurum (Chaihu), decocted in water and administered orally. After one dose, he improved; after two doses, he was fully recovered.
[Nephew Wang XX], at age twenty, suffered from an illness for months without recovery. His spirit was confused, limbs were sore and lazy, and he felt slight shortness of breath. Repeated medical consultations and medications failed to identify the cause or produce effects. One day, he suddenly could not breathe, opening his mouth to exhale but the air did not rise up. The Qi accumulated excessively and pressed downward, causing the anus to protrude. It took about twenty breaths for his breathing to normalize. This happened eight or nine times during the day and night. Palpating his pulse, the position before the Guan (Cun) was weak and unrising. I diagnosed Sinking of Upper Jiao Qi, which failed to govern the pivot mechanism of lung respiration. I prescribed one liang of Ginseng, three qian of Bupleurum, and two qian of Anemarrhena (Zhimu). After one dose, his breathing smoothed out. I then reduced Bupleurum to two qian and increased Anemarrhena to four qian. After taking several more doses, his chronic illness was cured.
In my treatment of Sinking of Upper Jiao Qi, I heavily rely on raw Astragalus (Huangqi) for its ability to tonify Qi and lift it simultaneously. In these two cases, however, I heavily relied on Ginseng because: in the first case, following an external contraction, fluids were depleted, and Ginseng can nourish fluids; in the second case, following a prolonged illness, Yuan Qi (Original Qi) was damaged, and Ginseng can consolidate Original Qi.
For patients with massive hematemesis (vomiting blood), ancient formulas often treat them with Single Ginseng Decoction (Dushen Tang), stating that in cases of blood loss, one should first tonify Qi. However, after hematemesis, there is often rising deficient heat. Administering Single Ginseng Decoction might exacerbate this deficient heat, causing the bleeding to recur. In such cases, I often use Ginseng assisted by sedating, cooling, and moistening herbs (see the case of Baoyuan Hanjiang Tang for reference).
When used appropriately, Ginseng also effectively promotes urination (see the case following Ji Yin Tang for reference).