伤寒病有宜用人参入药者。其辨不可不明。盖人受外感之邪。必先发汗以驱之。其发汗时。惟元气大旺
者。外邪始乘药势而出。若元气素弱之人。药虽外行。气从中馁。轻者半出不出。留连为困。重者随元气缩
入。发热无休。去生远矣。所以虚弱之体。必用人参三五七分。入表药中。少助元气。以为驱邪之主。
使邪气得药。一涌而去。全非补养虚弱之意也。即和解药中有人参之大力者居间。外邪遇正。自不争而退舍。
设无大力者当之。而邪气足以胜正气。其猛悍纵恣。安肯听命和解耶。故和解中之用人参。不过藉之以得其
平。亦非偏补一边之意也。而不知者。方谓伤寒无补法。邪得补弥炽。断不敢用。岂但伤寒一证。即痘疹初发
不敢用。疟痢初发不敢用。中风中痰中寒中暑。及痈疽产后。初时概不敢用。而虚人之遇重病。一切可生之机。
悉置之不理矣。古今诸方。表汗用五积散参苏饮败毒散。和解
用小柴胡汤白虎汤竹叶石膏汤等方。都用人参。皆藉人参之力。领出在内之邪。不使久留。乃得速愈为快。奈
何世俗不察耶。独不见感入体虚之人。大热呻吟。数日间烁尽津液。身如枯柴。初非不汗之。汗之热不退。后
非不和之下之。和之下之。热亦不退。医者技穷。委身而去。不思内经所言。汗出。不为汗衰者死。三下而不
应者死。正谓病患元气已漓。而药不应手耳。夫人得感之初。元气未漓也。惟壮热不退。灼干津液。元气始
漓。愚哉愚哉。倘起先药中用人参三五七分。领药深入驱邪。即刻热退神清。何致汗下不应耶。况夫古今时势
不同。膏粱藜藿异体。李东垣治内伤兼外感者。用补中益气。加表药一二味。热服而散外邪。有功千古。姑置
不论。止论伤寒专科。从仲景以至于今。明贤方书充栋。无不用人参在内。何为今日医家。单单除去人参不用。
以阿谀求容。全失一脉相传宗旨。其治体虚病感之人。百无一活。俟阎君对簿日知之。悔无及矣。乃市并不知
医者。又交口劝病患不宜服参。目睹男女亲族死亡。曾不悟旁操鄙见害之也。谨剖心沥血相告。且誓之曰。今后
有以发表和中药内。不宜用人参之言误人者。死入犁耕地狱。盖不当用参而用之杀人者。皆是与黄 白术当归
干姜肉桂大附子等药。同行温补之误所致。不与羌独柴前芎桔芷芩膏半等药。同行汗和之法所致也。汗和药中
兼用人参。从古至今。不曾伤人性命。安得视为砒鸩刀刃。固执不思耶。最可恨者。千百种药中。独归罪人参君
主之药。世道人心。日趋于疾视长上。其酝酿皆始于此。昌安敢与乱同事。而不一亟辨之乎。
附人参败毒散注验 嘉靖己未。五六七月间。江南淮北。在处患时行瘟热病。沿门阖境。传染相似。用本
方倍人参。去前胡独活。服者尽效。全无过失。万历戊子己丑年。时疫盛行。凡服本方发表者。无不全活。又
云。饥馑兵荒之余。饮食不节。起居不常。致患时气者。宜同此法。昌按彼时用方之意。倍加人参
者。以瘟气易染之人。体必素虚也。其用柴胡即不用前胡。用羌活即不用独活者。以体虚之人不敢用复药表汗
也。饥馑兵荒之余。人已内虚久困。非得人参之力以驱邪。邪必不去。所以服此方者。无不全活。今崇祯辛巳
壬午。时疫盛行。道 相藉。各处医者。发汗和中药内。惟用人参者。多以活人。更有发 一证最毒。惟用人
参入消 药内。全活者多。此人人所共见共闻者。而庸愚之人。泥执不破。诚可哀也。又有富贵人。平素全赖
参术补助。及遇感发。尚不知而误用。譬之贼已至家。闭门攻之。反遭
凶祸者有之。此则误用人参为温补。不得借之为口实也。
胡卣臣先生曰。将伤寒所以用人参之理。反复辩论。即妇人孺子闻之。无不醒然。此立言之善法也。
伤寒病中有适宜在药物中加入人参的情况。对此的辨别不可不明确。大概人受到外感邪气的侵袭，必须先通过发汗来驱除它。在发汗的时候，只有元气旺盛的人，外邪才能借助药势排出体外。如果是元气素来虚弱的人，虽然药物作用于体表，但体内的气却因虚弱而馁退。轻症者，邪气半出半不出，滞留体内造成困扰；重症者，邪气随着元气的退缩而内陷，导致发热不止，离死亡就不远了。所以，对于体质虚弱的人，必须在解表药中加入三五分至七分的人参，稍微辅助元气，作为驱除邪气的主导力量，使邪气得到药力的推动，一涌而出。这完全不是为了补养虚弱的意图。即使在和解药中有人参这样大力量的药物居中调和，外邪遇到正气，自然不再争斗而退避。假如没有大力量的药物抵挡，而邪气足以战胜正气，那么邪气猛烈放肆，怎肯听从和解的指挥呢？因此，和解药中使用人参，不过是借助人参的力量来达到平衡，也不是偏重于补益某一方面的意思。然而不懂的人却说，治疗伤寒没有补法，邪气得到补益会更加炽盛，绝对不敢使用。岂止是伤寒这一种病症，即使是痘疹初发、疟疾痢疾初发都不敢用，中风、中痰、中寒、中暑，以及痈疽、产后初期，一概都不敢用人参。结果，体虚之人遭遇重病时，所有可以生存的机会，都被置之不理了。
古今的各种方剂，在发表（发汗）时使用的五积散、参苏饮、败毒散，在和解时使用的如小柴胡汤、白虎汤、竹叶石膏汤等方剂，都使用了人参。这都是借助人参的力量，引领体内的邪气排出，不使其久留，从而得以快速痊愈。奈何世俗之人不能明察呢？难道没看见那些感受邪气且体质虚弱的人，高热呻吟，几天之内津液被烧干，身体像枯柴一样。起初并非没有发汗，但发汗后热不退；后来并非没有使用和法或下法，但使用和法或下法后，热也不退。医生技艺穷尽，只好弃患者而去。却不思考《内经》所说的：“出汗后，热度不因汗出而减退的会死；三次攻下后，病情仍无反应的会死。”这正是说病患的元气已经枯竭，而药物无法见效啊。人在刚感受邪气时，元气尚未枯竭。只有壮热不退，灼干津液，元气才开始枯竭。真是愚蠢啊，太愚蠢了！如果在起初用药时就加入三五分至七分的人参，引导药力深入以驱除邪气，立刻就会热退神清，怎么会导致汗法和下法都不见效呢？
况且古今时势不同，富贵者与贫贱者的体质各异。李东垣治疗内伤兼有外感的人，使用补中益气汤，加入一两味解表药，热服以发散外邪，功效流传千古。暂且不提这一点，只论伤寒专科，从张仲景到现在，名医的方书堆积如山，没有不在方中加入人参的。为什么今天的医家，单单除去人参不用，以此阿谀求容，完全失去了脉相传的宗旨？他们治疗体质虚弱又感染疾病的人，百无一活，等到去见阎王对质时才知晓，后悔也来不及了。于是市井中不懂医术的人，又交口劝告病人不宜服用参类。目睹男女亲族死亡，竟然不明白这是旁人的鄙见害了他们。我谨剖心沥血相告，并且发誓说：今后如果有人以“发表和中药内不宜用人参”的话误导他人，死后将堕入犁耕地狱。盖不当用人参而用人参杀人的，都是与黄耆、白术、当归、干姜、肉桂、大附子等药物同行温补的错误所致，而不是与羌活、独活、柴胡、前胡、川芎、桔梗、白芷、黄芩、石膏、半夏等药物同行汗法和和法的错误所致。在汗法和和法中兼用人参，从古至今，不曾伤害人性命，怎么能将其视为砒霜鸩酒、刀刃一般，固执地不加思考呢？
最可恨的是，千百种药物中，唯独归罪于人参这位“君主之药”。世道人心日益趋向于轻视尊长，这种风气的酝酿皆始于此。我喻昌怎敢与乱臣贼子同流合污，而不亟需辨明此事呢？
附：人参败毒散注验
嘉靖己未年，五六七月间，江南淮北各地流行瘟热病，沿门阖境，传染相似。使用本方加倍人参，去掉前胡、独活，服用者全部有效，全无过失。万历戊子、己丑年，时疫盛行，凡是服用本方进行发表的，无不保全性命。又说，在饥荒兵乱之后，饮食不节制，起居无常致患时气病的，适宜采用同样的方法。我喻昌分析当时使用方剂的用意，加倍加入人参，是因为容易感染瘟气的人，体质必定素来虚弱。其中使用柴胡即不用前胡，使用羌活即不用独活，是因为体质虚弱的人不敢再用重复的药性来发汗。饥荒兵乱之后，人们内部虚弱已久且困苦不堪，非得有人参的力量来驱除邪气，邪气必然无法去除。所以服用此方的人，无不保全性命。如今崇祯辛巳、壬午年，时疫盛行，道路上尸体互相枕藉，各处医者，在发汗和和解药中，惟独使用人参的，大多能救活病人。更有发斑一证最为凶险，惟独将人参加入消斑解毒药内，保全性命的人很多。这是人人所共见共闻的，而那些庸俗愚昧的人，拘泥固执不知变通，实在令人悲哀。又有富贵人，平素全赖人参、白术补助，及至遇到感冒发作，尚不知道而误用其他药物。这就好比贼已到家，闭门攻之，反而遭受凶祸的情况。这是误用人参作为温补药物的错误，不能借此作为口实。
There are cases in Shanghan (Cold Damage) disease where it is appropriate to include Ginseng Radix et Rhizoma (Renshen, 人参) in the prescription. The differentiation regarding this must be clear. Generally, when a person is invaded by exogenous pathogenic factors, sweating therapy must first be employed to expel them. During the process of inducing sweating, only those with robust Yuan Qi (Primary Qi) can have the exogenous pathogens expelled along with the therapeutic effect of the herbs. If a person has inherently weak Yuan Qi, although the medicine acts on the exterior, the internal Qi becomes depleted and faltering. In mild cases, the pathogen is half-expelled and half-retained, lingering and causing distress; in severe cases, the pathogen retreats inward following the collapse of Yuan Qi, resulting in unceasing fever, bringing the patient far from survival. Therefore, for individuals with weak constitutions, three to five fen or seven fen of Ginseng Radix et Rhizoma (Renshen, 人参) must be added to exterior-releasing formulas to slightly assist Yuan Qi, serving as the primary force to drive out pathogens. This allows the pathogen to be expelled in a surge upon receiving the medicinal power. This is entirely not for the purpose of tonifying weakness. Even in harmonizing formulas, if there is a powerful agent like Ginseng Radix et Rhizoma (Renshen, 人参) mediating between the exterior and interior, the exogenous pathogen, encountering righteous Qi, will naturally cease fighting and withdraw. If there were no powerful agent to withstand it, and the pathogen was strong enough to overcome the righteous Qi, how could such fierce and unrestrained pathogens obey the command to harmonize? Thus, the use of Ginseng Radix et Rhizoma (Renshen, 人参) in harmonizing formulas is merely to borrow its strength to achieve balance, not to bias towards tonifying one side. However, ignorant people claim that there is no tonification method for treating Shanghan, and that tonification will make the pathogen more intense, so they dare not use it at all. Not only in Shanghan, but also in the initial stages of smallpox/rubeola (Douzhen, 痘疹), malaria (Nüeli, 疟痢), wind-stroke (Zhongfeng, 中风), phlegm-stroke (Zhongtan, 中痰), cold-stroke (Zhonghan, 中寒), heat-stroke (Zhongshu, 中暑), as well as during the initial stages of carbuncles/ulcers (Yongju, 痈疽) and postpartum conditions, they generally dare not use Ginseng Radix et Rhizoma (Renshen, 人参). Consequently, when weak individuals encounter serious illnesses, all opportunities for recovery are ignored.
In ancient and modern prescriptions, formulas used for releasing the exterior such as Wuji San (Five Accumulations Powder), Sushu Yin (Ginseng and Perilla Leaf Decoction), and Baidu San (Detoxication Powder), and formulas used for harmonizing such as Xiaochaihu Tang (Minor Bupleurum Decoction), Baihu Tang (White Tiger Decoction), and Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction), all include Ginseng Radix et Rhizoma (Renshen, 人参). They all rely on the power of Ginseng Radix et Rhizoma (Renshen, 人参) to lead the internal pathogens out, preventing them from lingering, thereby achieving rapid recovery. Why do worldly people fail to perceive this? Have you not seen those who contract pathogens and have weak constitutions, suffering from high fever and groaning, their body fluids consumed within a few days until their bodies resemble dry firewood? Initially, sweating was attempted, but the fever did not subside; later, harmonizing and purging methods were tried, yet the fever remained. Physicians exhausted their skills and abandoned the patients. They failed to reflect on what the *Neijing* (Inner Canon) states: "Those whose fever does not decrease after sweating will die; those whose condition does not respond after three purgations will die." This refers precisely to the situation where the patient's Yuan Qi (Primary Qi) is already depleted, and the medicine fails to take effect. When a person first contracts a pathogen, the Yuan Qi is not yet depleted. It is only when persistent high fever burns up the body fluids that the Yuan Qi begins to deplete. How foolish! If Ginseng Radix et Rhizoma (Renshen, 人参) had been included in the initial prescription at three to five fen or seven fen to guide the medicine deep into the body to drive out pathogens, the fever would have subsided and consciousness cleared immediately. How could it have reached the point where both sweating and purging were ineffective?
Moreover, circumstances differ between ancient and modern times, and constitutions vary between those accustomed to rich foods and those to coarse grains. Li Dongyuan treated internal injury complicated by external contraction using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with one or two exterior-releasing herbs, taken hot to disperse external pathogens, a contribution lasting through the ages. Setting that aside, let us discuss the specialized field of Shanghan. From Zhang Zhongjing to the present day, medical texts by enlightened sages are piled high, and none omit Ginseng Radix et Rhizoma (Renshen, 人参). Why do contemporary physicians single-handedly exclude Ginseng Radix et Rhizoma (Renshen, 人参) to flatter others, completely losing the essence of the transmitted lineage? Their treatment of weak individuals contracting illness results in nearly all deaths; they will realize this only when facing judgment before King Yan (the God of Death), too late for regret. Meanwhile, laypeople who do not understand medicine advise patients against taking Ginseng Radix et Rhizoma (Renshen, 人参). Witnessing the death of relatives and friends, they fail to realize that these base opinions caused the harm. I earnestly confess my heart and blood to inform you, and I swear: henceforth, anyone who misleads others by claiming that "Ginseng Radix et Rhizoma (Renshen, 人参) should not be used in exterior-releasing or harmonizing formulas" shall fall into the hell of plowing fields after death. Those who kill by improperly using Ginseng Radix et Rhizoma (Renshen, 人参) do so due to errors in concurrent warm-tonification with herbs such as Astragali Radix (Huangqi, 黄芪), Atractylodis Macrocephalae Rhizoma (Baizhu, 白术), Angelicae Sinensis Radix (Danggui, 当归), Zingiberis Rhizoma (Ganjiang, 干姜), Cinnamomi Cortex (Rougui, 肉桂), and Aconiti Lateralis Radix Praeparata (Fuzi, 附子), not due to errors in concurrent sweating or harmonizing with herbs such as Notopterygii Rhizoma et Radix (Qianghuo, 羌活), Ligustici Chuanxiong Rhizoma (Chuanxiong, 川芎), Bupleuri Radix (Chaihu, 柴胡), Peucedani Radix (Qianhu, 前胡), Saposhnikoviae Radix (Fangfeng, 防风 - implied contextually though not explicitly listed in the specific herb string 'Qiang Du Chai Qian Xiong Ju Zhi Qin Gao Ban', usually Fangfeng is paired with Qianghuo/Duhuo, here 'Du' likely refers to Duhuo), Scutellariae Radix (Huangqin, 黄芩), Gypsum Fibrosum (Shigao, 石膏), and Pinelliae Rhizoma Preparatum (Banxia, 半夏). Using Ginseng Radix et Rhizoma (Renshen, 人参) concurrently in sweating and harmonizing formulas has never harmed human life from ancient times to now. How can it be viewed as arsenic, poison, blades, or swords, held onto stubbornly without thought?
What is most hateful is that among thousands of herbs, blame is placed solely on Ginseng Radix et Rhizoma (Renshen, 人参), the "Sovereign Herb." The morals of society and humanity are deteriorating towards disrespecting superiors, and this brewing attitude starts here. How dare Yu Chang associate with such chaos without urgently clarifying this matter?
Appendix: Verification Notes on Ginseng Baidu San
In the Jiajing era, year Jiwei, during the fifth, sixth, and seventh months, epidemic febrile diseases prevailed throughout Jiangnan and Huaibei, spreading door-to-door and village-wide with similar symptoms. Using this formula with doubled Ginseng Radix et Rhizoma (Renshen, 人参), removing Peucedani Radix (Qianhu, 前胡) and Angelicae Pubescentis Radix (Duhuo, 独活), all who took it were effective, with no errors. In the Wanshi era, years Wuzi and Jichou, epidemics were rampant. All who used this formula to release the exterior were fully saved. It is also said that after famines and wars, where irregular diet and lifestyle cause seasonal qi diseases, the same method is suitable. I, Yu Chang, analyze the intent of the formula used then: doubling Ginseng Radix et Rhizoma (Renshen, 人参) because those susceptible to epidemic qi must have inherently weak constitutions. Using Chaihu instead of Qianhu, and Qianghuo instead of Duhuo, because weak constitutions cannot tolerate redundant exterior-releasing herbs. After famines and wars, people have been internally weak and distressed for a long time; without the power of Ginseng Radix et Rhizoma (Renshen, 人参) to drive out pathogens, the pathogens will certainly not leave. Hence, all who took this formula were saved. Now, in the Chongzhen era, years Xin si and Ren wu, epidemics are prevalent, corpses litter the roads. Physicians in various places who use Ginseng Radix et Rhizoma (Renshen, 人参) in exterior-releasing and harmonizing formulas mostly save lives. Furthermore, in the case of macule eruption (Fabang, 发斑), which is extremely toxic, including Ginseng Radix et Rhizoma (Renshen, 人参) in macule-resolving formulas saves many lives. This is widely seen and heard. Yet vulgar and ignorant people remain rigidly attached to their views, which is truly pitiable. There are also wealthy people who rely on Ginseng Radix et Rhizoma (Renshen, 人参) and Atractylodis Macrocephalae Rhizoma (Baizhu, 白术) for daily supplementation. When they contract illness, they mistakenly avoid them. This is like locking the door to fight thieves who have already entered the house, leading to disaster. This is an error of mistaking Ginseng Radix et Rhizoma (Renshen, 人参) for warm tonification, and cannot be used as an excuse.
Mr. Hu Youchen said: "Repeatedly debating the rationale for using Ginseng Radix et Rhizoma (Renshen, 人参) in Shanghan makes even women and children awaken to understanding. This is an excellent method of discourse."