大补元气，泻火
生甘苦微凉（甘补阳，微苦微寒，又能补阴），熟甘温。大补肺中元气（东坦曰∶肺主
气，肺气旺，则四脏之气皆旺，精自生而形自盛。十剂曰补可去弱，人参羊肉之属是也。人
参补气，羊肉补形），泻火（得升麻补上焦，泻肺火；得茯苓补下焦，泻肾火；得麦冬泻火
而生脉；得黄 、甘草，乃甘温退大热。东垣曰∶参、 、甘草，泻火之圣药，合用名黄
汤。按烦劳则虚而生热，得甘温以益元气，而邪热自退，故亦谓之泻），益土（健脾）、生金
（补肺）。明目，开心益智，添精神，定惊悸（邪火退，正气旺，则心肝宁而惊悸定），除烦
渴（泻火故除烦、生津故止渴），通血脉（气行则血行，贺汝瞻曰∶生脉散用之者，以其通
经活血，则脉自生也，古方解散药、行表药多用之，皆取其通经而走表也），破坚积（气运
则积化），消痰水（气旺则痰行水消）。
治虚劳内伤（伤于七情、六欲、饮食、作劳为内伤；伤于风寒、暑、湿为外感。如内
伤发热，时热时止；外感发热，热甚无休。内伤恶寒，得暖便解；外感恶寒，絮火不除。内
伤头痛，乍痛乍歇；外感头痛，连痛无停。内伤则手心热，外感则手背热。内伤则口淡无味，
外感则鼻塞不通。内伤则气口脉盛，多属不足，宜温、宜补、宜和；外感则人迎脉盛，多属
有余，宜汗、宜吐、宜下。盖左人迎主表，右气口主里也！昂按∶东垣辨内伤外感最详，恐
人以治外感者治内伤也。今人缘东垣之言，凡外伤风寒发热咳嗽者，概不轻易表散，每用润
肺退热药，间附秦艽、苏梗、柴胡、前胡一二味，而羌活、防风等绝不敢用。不思秦艽阳明
药，柴胡少阳药，于太阳有何涉乎？以致风寒久郁，嗽热不止，变成虚损，杀人多矣。此又
以内伤治外感之误也，附此正之），发热自汗（自汗属阳虚，盗汗属阴虚，亦有过服参、
而汗反盛者，以阳盛阴虚，阳愈补而阴愈亏也，又宜清热养血，而汗自止），多梦纷纭，呕
哕反胃，虚咳喘促（《蒙筌》曰∶歌有肺热还伤肺之句，惟言寒热，不辨虚实，若肺中实热
者忌之，虚热者服之何害？又曰∶诸痛无补法，不用参 。若久病虚痛，何尝忌此耶），疟
痢滑泻（始痢宜下，久痢宜补，治疟意同。丹溪曰∶叶先生患痢，后甚逼迫，正合承气证，
予曰气口脉虚，形虽实而面黄白，必过饱伤胃，与参、术、陈、芍十余帖，三日后胃气稍完，
再与承气汤二帖而安。又曰∶补未至而下，则病者不能当；补已至而弗下，则药反添药。匪
急匪徐，其间间不容发，噫，微哉！昂按∶此先补后下法之变者也，非胸有定见者，不可轻
用，然后学亦宜知之。大承气汤，大黄、芒硝、枳实、浓朴），淋沥胀满（《发明》云∶胸胁
逆满，由中气不足作胀者宜补之，而胀自除，经所谓塞因塞用也。俗医泥于作饱不敢用，不
知少服反滋壅，多服则宣通，补之，正所以导之也。皇甫嵩，着《本草发明》），中暑、中风
及一切血证（东垣曰∶古人治大吐血，脉芤洪者，并用人参。脱血者先益其气，盖血不自生
，须得生阳气之药乃生，阳生则阴长之义也。若单用补血药，血无由而生矣。凡虚劳吐血，
能受补者易治，不能受补者难治）。
黄润紧实，似人形者良。去芦用。补剂用熟，泻火用生。炼膏服，能回元气于无何有
之乡（有火者，天冬膏对服）。参生时背阳向阴，不喜风日，宜焙用，忌铁。茯苓为使。畏
五灵脂。恶皂荚、黑豆、紫石英、人溲、咸卤。反藜芦（言闻曰∶东垣理脾胃，泻阴火，交
泰丸内用人参、皂荚，是恶而不恶也；古方疗月闭，四物汤加人参、五灵脂，是畏而不畏也。
又疗痰在胸膈、人参藜芦同用，而取其涌越，是激其怒性也。非洞奥达权者不能知）。
人参芦能涌吐痰涎，体虚人用之，以代瓜蒂（丹溪曰∶人参入手太阴、补阳中之阴。
芦反能泻太阴之阳，亦犹麻黄根、苗不同。痰在膈，在经络，非吐不可，吐中就有发散之义。
一妇性躁味浓，暑月因怒而病呃，作则举身跳动，昏不知人。其人形气俱实，乃痰因
怒郁，气不得降，非吐不可。以参芦半两，逆流水煎服，吐顽痰数碗，大汗昏睡而安）。
生用人参味甘、苦，性微凉（甘味能补益阳气，微苦微寒之性又能补益阴液），熟用人参味甘，性温。大补肺中元气（李东垣说：肺主司气，肺气旺盛，则其他四脏之气皆旺，精血自然化生而形体强健。十剂理论说：补法可以去除虚弱，人参和羊肉这类药物就是代表。人参补气，羊肉补形）。清泻火邪（配伍升麻可补上焦、清泻肺火；配伍茯苓可补下焦、清泻肾火；配伍麦冬可清泻火邪并滋养脉道；配伍黄芪、甘草，即为甘温除大热之法。李东垣说：人参、黄芪、甘草是清泻火邪的圣药，合用名为黄芪汤。按：烦劳会导致虚而生热，得甘温之药以益元气，邪热自然消退，所以也称其为“泻”）。健脾（益土）、补肺（生金）。明目，开心益智，增添精神，安定惊悸（邪火退去，正气旺盛，则心肝安宁而惊悸自定）。除烦渴（因清泻火邪故能除烦，因生津液故能止渴）。通血脉（气行则血行，贺汝瞻说：生脉散中使用它，是因为它能通经活血，脉道自然生成，古方中解表发散药、走表药多用此药，都是取其通经而走表的作用）。破除坚积（气机运行则积滞化解）。消痰水（气旺则痰行水消）。
治疗虚劳内伤（七情、六欲、饮食、劳累所伤为内伤；风寒、暑湿所伤为外感。如内伤发热，时热时止；外感发热，高热持续无休。内伤恶寒，得暖便解；外感恶寒，虽近火取暖也不缓解。内伤头痛，痛时停时；外感头痛，连续疼痛不停。内伤则手心热，外感则手背热。内伤则口淡无味，外感则鼻塞不通。内伤则人迎脉盛，多属不足，宜温、宜补、宜和；外感则气口脉盛，多属有余，宜汗、宜吐、宜下。盖左人迎主表，右气口主里啊！汪昂按：李东垣对内伤与外感的辨别最为详细，恐怕有人用治外感的方法治内伤。如今的人因为李东垣的话，凡是外伤风寒导致发热咳嗽的，一概不轻易使用发汗解表药，每用润肺退热药，偶尔附带秦艽、苏梗、柴胡、前胡一两味，而羌活、防风等药绝不敢用。不想想秦艽是阳明经药，柴胡是少阳经药，这与太阳经有什么关系呢？以致风寒久郁，咳嗽发热不止，变成虚损，害死很多人了。这又是用治内伤的方法误治外感，附在此处予以纠正）。治疗发热自汗（自汗属于阳虚，盗汗属于阴虚，也有过服人参、黄芪后汗反而增多的，这是因为阳盛阴虚，阳气越补阴液越亏，此时宜清热养血，汗自然停止）。多梦纷纭，呕吐呃逆反胃，虚咳喘促（《蒙筌》说：歌诀中有“肺热还伤肺”的句子，只言寒热，不分虚实，若肺中实热者忌用，虚热者服用有何妨害？又说：各种疼痛没有补法，不用人参、黄芪。如果是久病导致的虚痛，何曾忌讳这些药呢？）。治疗疟疾、痢疾、滑泄（初起痢疾宜攻下，久痢宜补，治疟道理相同。朱丹溪说：叶先生患痢疾，后来病情非常急迫，正符合承气汤证，我说他气口脉虚，形体虽然充实但面色黄白，一定是过饱伤了胃，给予人参、白术、陈皮、白芍十余帖，三日后胃气稍复，再给承气汤两帖而安。又说：补法未到就攻下，病人承受不住；补法已到却不攻下，药力反而会添病。不急不徐之间，时机容不得丝毫差错，唉，微妙啊！汪昂按：这是先补后下法的变通，不是胸有定见的人不可轻用，但后学也应该知道。大承气汤由大黄、芒硝、枳实、厚朴组成）。治疗淋沥、胀满（《本草发明》说：胸胁逆满，由中气不足导致胀气的，宜用补法，胀气自然消除，这就是经文所说的“塞因塞用”。俗医拘泥于作饱（指补药可能导致腹胀）而不敢用，不知道少量服用反而滋腻壅滞，大量服用则宣通，补益正是为了疏导。皇甫嵩著《本草发明》）。治疗中暑、中风及一切出血证（李东垣说：古人治疗大吐血，脉象芤或洪大的，都用人参。脱血者先益其气，因为血不能自行生成，必须依靠生发阳气的药物才能生成，这是“阳生则阴长”的道理。如果单用补血药，血无法生成。凡是虚劳吐血，能受补的容易治疗，不能受补的难治）。
黄色润泽、质地紧实、形状像人形的为佳。去掉芦头使用。用于补剂时用熟人参，用于清泻火邪时用生人参。炼成膏服用，能在极度虚弱时挽回元气（体内有火者，可与天冬膏对服）。人参生长时背部向阳、腹部向阴，不喜欢风吹日晒，宜焙干使用，忌铁器。茯苓作为使药。畏五灵脂。恶皂荚、黑豆、紫石英、人尿、咸卤水。反藜芦（言闻说：李东垣调理脾胃、清泻阴火，在交泰丸内用人参、皂荚，这是恶而不恶；古方治疗月经闭止，四物汤加人参、五灵脂，这是畏而不畏。又治疗痰在胸膈，人参藜芦同用，是取其涌越作用，这是激发其烈性。不是深奥通达权变的人不能知晓）。
人参芦能涌吐痰涎，体虚之人用它，以代替瓜蒂（朱丹溪说：人参入手太阴肺经，补阳中之阴。芦头反而能泻太阴之阳，也就像麻黄根和麻黄苗不同一样。痰在膈部、经络，非吐不可，吐法中就有发散的含义。一位妇女性格急躁口味浓重，暑月因愤怒而患呃逆，发作时全身跳动，昏迷不知人事。其人形体气息都实证表现，乃是痰因怒郁，气不得降，非吐不可。用人参芦半两，逆流水煎服，吐出顽痰数碗，大汗昏睡后痊愈）。
Greatly tonifies Yuan Qi (Primordial Qi), clears and drains Fire.
Raw Ren Shen (Ginseng Radix) is sweet, bitter, and slightly cool (sweet flavor tonifies Yang, while slight bitterness and coolness also tonify Yin); cooked Ren Shen is sweet and warm. It greatly tonifies the Yuan Qi of the Lung (Li Dongyuan stated: The Lung governs Qi; when Lung Qi is vigorous, the Qi of the other four Zang organs becomes vigorous, Essence naturally generates, and the physical form becomes robust. The Ten Categories theory states: Tonification can remove weakness; Ren Shen and mutton are examples. Ren Shen tonifies Qi, mutton tonifies the Form). It clears and drains Fire (when combined with Sheng Ma (Cimicifugae Rhizoma), it tonifies the Upper Jiao and drains Lung Fire; when combined with Fu Ling (Poria), it tonifies the Lower Jiao and drains Kidney Fire; when combined with Mai Dong (Ophiopogonis Radix), it drains Fire and generates the Pulse; when combined with Huang Qi (Astragali Radix) and Gan Cao (Licorice Root), it employs sweet-warm methods to retreat high fever. Li Dongyuan stated: Ren Shen, Huang Qi, and Gan Cao are the holy medicines for draining Fire; combined, they are named Huang Qi Tang (Astragalus Decoction). Note: Fatigue leads to deficiency generating heat; obtaining sweet-warm herbs to benefit Yuan Qi causes pathogenic heat to recede spontaneously, hence it is also called "draining"). It benefits Earth (strengthens Spleen) and generates Metal (tonifies Lung). It brightens the eyes, opens the mind and enhances intelligence, adds spirit, and stabilizes palpitations and fright (as pathogenic Fire recedes and Righteous Qi becomes vigorous, the Heart and Liver calm, and palpitations/fright stabilize). It removes vexation and thirst (due to draining Fire, it removes vexation; due to generating fluids, it stops thirst). It unblocks the Blood vessels (when Qi moves, Blood moves; He Ruzhan stated: In Sheng Mai San (Generate the Pulse Powder), it is used because it unblocks meridians and invigorates Blood, so the Pulse naturally generates; ancient formulas for releasing the exterior and moving on the surface often use it, taking advantage of its ability to unblock meridians and move to the surface). It breaks down hard accumulations (when Qi circulates, accumulations dissolve). It resolves Phlegm and Water retention (when Qi is vigorous, Phlegm moves and Water dissipates).
It treats Xu Lao (Consumptive Disease) and internal injury (injury from Seven Emotions, Six Desires, diet, and overwork is internal injury; injury from Wind-Cold, Summerheat, and Dampness is external contraction. For example, in internal injury fever, heat comes and goes; in external contraction fever, heat is severe and continuous. In internal injury aversion to cold, warmth relieves it; in external contraction aversion to cold, sitting near fire does not relieve it. In internal injury headache, pain starts and stops; in external contraction headache, pain is continuous. In internal injury, the palms are hot; in external contraction, the dorsum of the hands is hot. In internal injury, the mouth tastes bland; in external contraction, nasal congestion occurs. In internal injury, the Qi Kou pulse at the radial artery is full/excessive, mostly indicating deficiency, suitable for warming, tonifying, and harmonizing; in external contraction, the Ying Xing pulse is full/excessive, mostly indicating excess, suitable for sweating, vomiting, or purging. The left Ying Xing governs the Exterior, the right Qi Kou governs the Interior! Wang Ang notes: Li Dongyuan's differentiation between internal injury and external contraction is most detailed, lest people treat internal injury as external contraction. Nowadays, people, following Li Dongyuan's words, generally do not lightly use diaphoretic herbs for external Wind-Cold causing fever and cough, instead using moistening Lung and reducing fever herbs, occasionally adding Qin Jiao (Gentianae Macrophyllae Radix), Su Geng (Perillae Caulis), Chai Hu (Bupleuri Radix), Qian Hu (Peucedani Radix), but never using Qiang Huo (Notopterygii Rhizoma et Radix) or Fang Feng (Saposhnikoviae Radix). They fail to realize that Qin Jiao is a Yangming meridian herb, Chai Hu is a Shaoyang meridian herb, what relevance do they have to the Taiyang meridian? This leads to prolonged stagnation of Wind-Cold, incessant cough and heat, transforming into consumptive disease, killing many. This is another error of treating external contraction with internal injury methods; I attach this to correct it). It treats fever with spontaneous sweating (spontaneous sweating belongs to Yang deficiency, night sweating belongs to Yin deficiency; however, there are cases where excessive use of Ren Shen and Huang Qi causes sweat to increase, due to Yang excess and Yin deficiency, where tonifying Yang further depletes Yin; in such cases, clearing Heat and nourishing Blood is appropriate, and sweat will stop). It treats numerous dreams, vomiting, belching, and regurgitation, deficiency cough with panting (Meng Quan stated: The song says "Lung Heat still injures the Lung," mentioning only Cold and Heat without distinguishing Deficiency and Excess; if Lung has Excess Heat, it is contraindicated, but for Deficiency Heat, what harm is there in taking it? It also says: There is no tonification method for various pains, and Ren Shen/Huang Qi should not be used. If it is chronic deficiency pain, why avoid these?). It treats malaria, dysentery, and slippery diarrhea (initial dysentery should be purged, chronic dysentery should be tonified; the principle for malaria is similar. Zhu Danxi stated: Mr. Ye suffered from dysentery, which became very urgent, fitting the Cheng Qi Tang pattern. I said his Qi Kou pulse was deficient, though his form seemed solid, his face was yellowish-white, indicating stomach injury from overeating. I gave him Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Bai Shao (Paeoniae Radix Alba) for over ten doses. After three days, Stomach Qi recovered slightly, then gave two doses of Cheng Qi Tang, and he was safe. He also said: If purging is done before tonification reaches, the patient cannot bear it; if tonification reaches but purging is not done, the medicine adds to the illness. Between urgency and slowness, there is no room for error; ah, how subtle! Wang Ang notes: This is a variation of the "tonify first, purge later" method; those without firm insight should not use it lightly, but students should know it. Da Cheng Qi Tang consists of Da Huang (Rhei Radix et Rhizoma), Mang Xiao (Natrii Sulfas), Zhi Shi (Aurantii Fructus Immaturus), and Hou Po (Magnoliae Officinalis Cortex)). It treats strangury, distension, and fullness (Ben Cao Fa Ming states: Reversal fullness in the chest and hypochondrium caused by insufficient Middle Qi leading to bloating should be treated with tonification, and bloating will naturally resolve; this is what the Classic calls "treating obstruction with obstruction." Vulgar doctors stick to the fear of "making one feel full" and dare not use it, not knowing that small doses cause stagnation, while large doses promote circulation; tonifying is precisely guiding. Huangfu Song wrote Ben Cao Fa Ming). It treats Summerheat stroke, Wind stroke, and all blood disorders (Li Dongyuan stated: Ancients treated massive hematemesis with Kun or Hong pulses using Ren Shen. In blood loss, one first benefits Qi, because Blood does not generate itself; it requires herbs that generate Yang Qi to produce Blood, based on the principle that "Yang generation leads to Yin growth." If only blood-nourishing herbs are used, Blood cannot generate. For consumptive hematemesis, those who can tolerate tonification are easy to treat; those who cannot are difficult).
Yellow, lustrous, tight, and solid, resembling a human shape, is good. Remove the rhizome (Lu). Use cooked for tonification formulas, raw for draining Fire. Processed into paste for oral administration, it can return Yuan Qi from the realm of nothingness (for those with Fire, take against Tian Dong Gao (Asparagi Rhizoma Paste)). When growing, Ren Shen faces away from the sun towards shade, dislikes wind and sunlight, should be baked for use, and avoids iron. Fu Ling (Poria) is the assistant herb. It fears Wu Ling Zhi (Trogopterori Faeces). It clashes with Zao Jia (Gleditsiae Sinensis Spina), Hei Dou (Sojae Semen Nigrum), Zi Shi Ying (Fluorite), Ren Sou (Human Urine), and Xian Lu (Brine). It is inversely affected by Li Lu (Veratri Rhizoma) (Yan Wen stated: Li Dongyuan regulated Spleen and Stomach and drained Yin Fire, using Ren Shen and Zao Jia in Jiao Tai Wan, showing that "clashing" does not mean absolute incompatibility; ancient formulas for amenorrhea added Ren Shen and Wu Ling Zhi to Si Wu Tang, showing that "fear" does not mean absolute contraindication. Also, for Phlegm in the chest/diaphragm, Ren Shen and Li Lu are used together to induce vomiting, exploiting their stimulating nature. Only those who deeply understand profound principles and adaptability can know this).
Ren Shen Lu (Ginseng Rhizome) can induce vomiting to expel Phlegm-Saliva; for weak patients, it can replace Gua Di (Melonis Fructus Seed). Zhu Danxi stated: Ren Shen enters the Hand-Taiyin Lung Meridian and tonifies Yin within Yang. The Lu head, conversely, drains Yang of the Taiyin, just as Ma Huang Gen (Ephedrae Herba Cum Caulibus) and Ma Huang Miao differ. Phlegm in the diaphragm or meridians must be vomited; vomiting contains the meaning of dispersing. A woman with an irritable temperament and strong taste preferences suffered from hiccups in summer due to anger. During attacks, her whole body trembled, and she fell into unconsciousness. Her form and Qi both showed excess signs; it was Phlegm due to anger-induced stagnation, with Qi unable to descend, requiring vomiting. She took half liang of Ren Shen Lu decocted in reverse-flowing water, vomited several bowls of stubborn Phlegm, sweated profusely, slept, and recovered.)