升麻，味苦、甘，气平、微寒，浮而升，阳也，无毒。入足阳明、太阴之经。能升脾胃
之气
。得白芷、葱白同用，又入手阳明、太阴二经，其余他经，皆不能入。能辟疫气，散肌肤之
邪热，止头、齿、咽喉诸痛，并治中恶，化斑点疮疹，实建奇功。疗肺痈有效，但必须同气
血药共用。可佐使，而亦不可以为君臣。世人虑其散气，不敢多用是也，然而，亦有宜多用
之时。本草如《纲目》、《经疏》，尚未及言，况他书乎。夫升麻之可多用者，发斑之症也
。凡热不太甚，必不发斑，惟其内热之甚，故发出于外，而皮毛坚固，不能遽出，故见斑而
不能骤散也。升麻原非退斑之药，欲退斑，必须解其内热。解热之药，要不能外元参、麦冬
与
芩、连、栀子之类。然元参、麦冬与芩、连、栀子，能下行，而不能外走，必藉升麻，以引
诸药出于皮毛，而斑乃尽消。倘升麻少用，不能引之出外，势必热走于内，而尽趋于大、小
肠矣。夫火性炎上，引其上升者易于散，任其下行者难于解。此所以必须多用，而火热之毒
，随元参、麦冬与芩、连、栀子之类而行，尽消化也。（〔批〕阐义甚精。）大约元参、麦冬
用至一、二两者，升麻可多用至五钱，少则四钱、三钱，断不可只用数分与一钱已也。
或问升麻能止衄血，先生置而不讲，岂仲景张夫子非欤？曰∶以升麻为止血之药，此不
知仲
景夫子用升麻之故也。夫吐血出于胃，衄血出于肺。止血必须地黄，非升麻可止。用升麻者
，不过用其引地黄，入于肺与胃耳，此等病，升麻又忌多用，少用数分，便能相济以成功，
切不可多至于一钱之外也。
又问升麻升而不降，何以大便闭结反用升提，必取于升麻，岂柴胡不可代耶？曰∶升麻
与柴
胡，同是升提之药，然一提气而一提血。大便燥急，大肠经之火也。大肠有火，又由于肾水
之涸也。欲润大肠，舍补血之药无由，而补血又责之补肾，使肾之气通于大肠，而结闭之症
可解。然则通肾之气，以生血可也，而必加升麻于补肾、补血之中者，盖阴之性凝滞而不善
流动，取升麻而升提其阴气，则肺金清肃之令行。况大肠与肺又为表里，肺气通，而大肠之
气亦通，肺气通，而肾之气更通，所以闭者不闭，而结者不结也。若用柴胡，虽亦入肝，能
提升血分之气，终不能入于大肠，通于肺、肾之气，此柴胡之所以不可代升麻也。（〔批〕
讲得细微入神。）
或问升麻与犀角迥殊，何以古人有无犀角，用升麻代之之语，以升麻、犀角同属阳明也，
然
否？夫升麻虽与犀角同属阳明，而仲景夫子用升麻以代犀角，非特为其同属阳明也。犀角地
黄汤所以治肺经之火也，犀角引地黄以至于肺，而升麻亦能引地黄以至于肺也。肺与大肠为
表里，清肺而大肠阳明之火自降，瘀血必从大便而出，是升麻清肺，正所以清阳明也。
或问升麻用之于补中益气汤中，岂虑柴胡不能升举，故用之以相佐耶？曰∶柴胡、升麻
同用
之补中益气汤者，各升提其气，两不相顾，而两相益也。柴胡从左而升气，升麻从右而提气
，
古人已言之矣。然而柴胡左升气，而右未尝不同提其气，升麻右提气，而左亦未尝不共升其
气，又两相顾，而两相益也。
升麻，味苦、甘，气平、微寒，药性浮而上升，属阳，无毒。归入足阳明胃经和足太阴脾经。能提升脾胃之气。若与白芷、葱白同用，又能入手阳明大肠经和手太阴肺经，其余其他经络则均不能进入。能辟除疫疠之气，疏散肌肤表面的邪热，止住头部、牙齿、咽喉等各处的疼痛，并治疗中恶（突然感受秽浊毒邪所致之病），化解斑疹疮疡，确实建有奇功。治疗肺痈（肺部化脓性病变）有效，但必须与补气养血药共同使用。可作为佐使药，但不可以作为君臣主药。世人担心它耗散正气，不敢多用，这是对的；然而，也有适宜多用的时候。像《本草纲目》、《医宗金鉴·经疏》等本草著作，都尚未提及这一点，何况其他书籍呢？
所谓升麻可以多用的情况，是指发斑（出疹）的病症。凡是热势不太严重的，必然不会发斑；只有因为体内热毒极盛，所以向外发散，而皮毛坚固，不能迅速透出，因此出现斑点而不能骤然消散。升麻原本不是退斑的药物，想要退斑，必须解除体内的热毒。解热的药物，离不开玄参、麦冬以及黄芩、黄连、栀子之类。然而玄参、麦冬与黄芩、黄连、栀子，药性下行，不能向外走散，必须借助升麻，来引导这些药物出于皮毛，这样斑点才能完全消退。如果升麻用量少，就不能引导药力外出，势必导致热邪向内走窜，全部趋向于大肠和小肠。火性炎上，引导其上升的容易消散，任由其下行的难以化解。这就是为什么必须多用升麻，让火热之毒随着玄参、麦冬与黄芩、黄连、栀子等药物一起，被彻底消化清除。（批注：阐发义理非常精妙。）
大约玄参、麦冬用到一两至二两时，升麻可多用至五钱，最少也要四钱、三钱，绝对不可以只用几分或一钱罢了。
有人问：升麻能止鼻衄血，先生为何搁置不讲？难道张仲景先生不对吗？回答说：把升麻当作止血药，这是不了解张仲景先生使用升麻的缘故。吐血源于胃，鼻衄血源于肺。止血必须用地黄，升麻不能直接止血。使用升麻，不过是利用它引导地黄进入肺与胃而已。这类疾病，升麻又忌讳多用，只需少量用几分，便能相辅相成取得成功，切不可多超过一钱。
又问：升麻只升不降，为什么大便闭结反而使用升提法，必定选用升麻，难道柴胡不可代替吗？回答说：升麻与柴胡，同样是升提的药物，然而一个提气，一个提血。大便燥急，是大肠经的火气。大肠有火，又由于肾水枯竭所致。想要润燥大肠，除了补血药别无他法，而补血又责成补肾，使肾的气机通达于大肠，那么闭结的症状就可以解除。既然如此，通过通肾气来生血是可以的，但在补肾、补血药中加入升麻的原因，是因为阴的性质凝滞而不善于流动，取升麻来升提阴气，那么肺金清肃的功能就能行使。况且大肠与肺互为表里，肺气通畅，大肠之气也就通畅；肺气通畅，肾的气机也更通畅，所以闭者不再闭，结者不再结。如果使用柴胡，虽然也入肝经，能提升血分之气，终究不能进入大肠，通达肺、肾的气机，这就是柴胡之所以不能代替升麻的原因。（批注：讲解得细微入神。）
有人问：升麻与犀角截然不同，为什么古人说没有犀角时用升麻代替？这是因为升麻、犀角同属阳明经吗？是否如此？回答说：升麻虽然与犀角同属阳明，但张仲景先生用升麻代替犀角，不仅仅是因为它们同属阳明。犀角地黄汤是用来治疗肺经火气的，犀角引导地黄到达肺部，而升麻也能引导地黄到达肺部。肺与大肠互为表里，清泻肺热则大肠阳明之火自然下降，瘀血必然从大便排出，这是升麻清肺，正是为了清阳明经的热。
有人问：升麻用在补中益气汤中，难道是担心柴胡不能升举阳气，所以用它来辅助吗？回答说：柴胡、升麻同用的补中益气汤，是各自升提其气，两者互不干扰，却又互相增益。柴胡从左路升气，升麻从右路提气，古人已经说过了。然而柴胡左升气，右边也未尝不同时提气；升麻右提气，左边也未尝不共同升气，又是互相照顾，互相增益。
Shengma (Rhizoma Cimicifugae), with a bitter and sweet taste, and a neutral to slightly cold nature, has a floating and ascending property, belonging to Yang. It is non-toxic. It enters the Foot-Yangming Stomach Meridian and the Foot-Taiyin Spleen Meridian. It can ascend the Qi of the Spleen and Stomach. When used together with Baizhi (Radix Angelicae Dahuricae) and Congbai (Stem and Bulb of Allium fistulosum), it also enters the Hand-Yangming Large Intestine Meridian and the Hand-Taiyin Lung Meridian; it does not enter other meridians. It can ward off epidemic pathogens, disperse pathogenic heat in the skin and muscles, relieve pain in the head, teeth, and throat, treat Zhong'e (sudden illness caused by foul and turbid pathogens), resolve macules and rashes, and indeed achieve remarkable results. It is effective for treating Fei Yong (Lung Abscess), but must be used jointly with Qi- and Blood-nourishing herbs. It can serve as an assistant or guide herb, but should not be used as a sovereign or minister herb. People worry that it disperses Qi and dare not use it in large doses, which is correct; however, there are times when it is appropriate to use it in larger doses. Materia Medica texts such as *Bencao Gangmu* (Compendium of Materia Medica) and *Jingshu* (Elucidation of the Classics) have not yet mentioned this, let alone other books.
The condition where Shengma can be used in larger doses refers to the disease of Fa Ban (eruption of macules/rashes). Whenever the heat is not severe enough, Fa Ban will certainly not occur; only when the internal heat is extremely severe does it manifest outwardly. Because the skin and hair follicles are tight, the heat cannot emerge rapidly, resulting in macules that cannot dissipate suddenly. Shengma is originally not a herb for resolving macules; to resolve them, one must clear the internal heat. Herbs for clearing heat include Yuan Shen (Radix Scrophulariae), Maidong (Tuber of Ophiopogon), Huang Qin (Radix Scutellariae), Huang Lian (Rhizoma Coptidis), and Zhi Zi (Fructus Gardeniae). However, Yuan Shen, Maidong, Huang Qin, Huang Lian, and Zhi Zi have a descending action and cannot move outward; they must rely on Shengma to guide these herbs to the skin and hair follicles, so that the macules may completely disappear. If Shengma is used in small doses, it cannot guide the medicinal action outward, and the heat will inevitably move inward, concentrating entirely in the Large Intestine and Small Intestine. The nature of Fire is to flare upwards; guiding it upward makes it easier to dissipate, while allowing it to descend makes it difficult to resolve. This is why Shengma must be used in larger doses, allowing the toxic heat to be thoroughly digested and cleared along with Yuan Shen, Maidong, Huang Qin, Huang Lian, and Zhi Zi. (Comment: The elucidation of principles is very profound.)
Generally, when Yuan Shen and Maidong are used in doses of 1 to 2 liang, Shengma can be used in larger doses up to 5 qian; the minimum should be 4 qian or 3 qian. It is absolutely inadmissible to use only a few fen or 1 qian.
Someone asked: "Shengma can stop epistaxis (nosebleed). Why did you omit discussing this? Is Master Zhang Zhongjing incorrect?" I replied: "To regard Shengma as a hemostatic herb is to misunderstand the reason Master Zhang Zhongjing used Shengma. Hematemesis originates from the Stomach, while epistaxis originates from the Lung. To stop bleeding, one must use Dihuang (Radix Rehmanniae); Shengma cannot stop bleeding directly. The use of Shengma here is merely to guide Dihuang into the Lung and Stomach. For such diseases, Shengma should be avoided in large doses; using only a few fen is sufficient to assist and achieve success. It must not exceed 1 qian."
Another question arose: "Shengma ascends but does not descend. Why is an ascending method used for constipation, specifically choosing Shengma? Could Chai Hu not substitute it?" I replied: "Shengma and Chai Hu are both ascending herbs, but one ascends Qi and the other ascends Blood. Dryness and urgency in defecation is due to Fire in the Large Intestine Meridian. Fire in the Large Intestine stems from the depletion of Kidney Water. To moisten the Large Intestine, there is no way other than using Blood-nourishing herbs, and nourishing Blood requires tonifying the Kidney, so that the Qi of the Kidney communicates with the Large Intestine, resolving the obstruction. Thus, generating Blood by unblocking Kidney Qi is feasible. However, the reason for adding Shengma among Kidney-tonifying and Blood-nourishing herbs is that the nature of Yin is stagnant and not prone to flow. By using Shengma to ascend and lift the Yin Qi, the purifying and descending function of Metal (Lung) can be executed. Moreover, the Large Intestine and Lung are exterior-interior partners; when Lung Qi is unblocked, Large Intestine Qi is also unblocked; when Lung Qi is unblocked, Kidney Qi becomes even more unblocked. Therefore, obstructions cease to be obstructed, and knots cease to be knotted. If Chai Hu were used, although it enters the Liver and can elevate Qi in the Blood level, it ultimately cannot enter the Large Intestine or communicate with the Qi of the Lung and Kidney. This is why Chai Hu cannot substitute Shengma." (Comment: The explanation is subtle and divine.)
Someone asked: "Shengma and Xijiao (Cornu Rhinocerotis) are vastly different. Why do ancient texts say that if Xijiao is unavailable, Shengma can be used as a substitute? Is it because both belong to the Yangming Meridian?" I replied: "Although Shengma and Xijiao both belong to the Yangming, Master Zhang Zhongjing used Shengma to substitute Xijiao not merely because they share the same meridian. Xijiao Dihuang Tang treats Fire in the Lung Meridian. Xijiao guides Dihuang to the Lung, and Shengma can also guide Dihuang to the Lung. Since the Lung and Large Intestine are exterior-interior partners, clearing Lung Heat causes the Fire of the Yangming in the Large Intestine to naturally subside, and stasis will exit through the stool. Thus, Shengma clearing the Lung is precisely how it clears Yangming."
Someone asked: "When Shengma is used in Buzhong Yiqi Tang, is it because we fear Chai Hu cannot sufficiently raise the Qi, so we use it as an assistant?" I replied: "In Buzhong Yiqi Tang, where Chai Hu and Shengma are used together, each ascends its respective Qi. They do not interfere with each other but mutually benefit each other. Chai Hu ascends Qi from the left, and Shengma lifts Qi from the right, as stated by the ancients. However, while Chai Hu ascends Qi from the left, it does not fail to lift Qi on the right; while Shengma lifts Qi from the right, it does not fail to ascend Qi on the left. Thus, they mutually attend to each other and mutually benefit each other."