者。皆脾肺肾气不足。可用也。面赤面黑者。气壮神强。不可用也。脉之浮而芤濡虚大。迟
缓无力。沉而迟涩弱细。结代无力者。皆虚而不足。可用也。若弦长紧实。滑数有力者。皆
火郁内实。不可用也。（以上合色脉）洁古谓喘嗽勿用者。痰实气壅之喘也。若肾虚气短喘
促者。必用也。仲景谓肺寒而咳勿用者。寒束热邪。壅郁在肺之咳也。若自汗恶寒而咳者。
必用也。东垣谓久病郁热在肺勿用者。乃火郁于内。宜发不宜补也。若肺虚火旺。气短自汗
者。必用也。丹溪言诸痛不可骤用者。乃邪气方锐。宜散不宜补也。若里虚吐利。及久病胃
弱。虚痛喜按者。必用也。节斋谓阴虚火旺勿用者。乃血虚火亢。能食。脉弦而数。凉之则
伤胃。温之则伤肺。不受补者也。若自汗气短。肢寒脉虚者。必用也。如此详审。则人参之
可用不可用。思过半矣。（以上辨形证）
〔后论〕 先哲云。虚火可补。参 之属。实火可泻。芩连之属。四语还费商酌。必须
精晰火与热之辨而后可。夫寒暑燥湿风火。天之阴阳也。而人合之。（风寒在下。燥热在上。
湿气在中。火游行其间。）经云。东方生风。南方生热。西方生燥。北方生寒。中央生湿。
各正其位。而独火无所主者。岂非由阴而生阳。即由阳而化阴。游行于风热湿燥寒之间以为
用乎。人身惟阳之由阴而生。复由阴而化者。始名为少火。若离阴以为阳生。则生之原绝。
离阴以为阳化。则化之机穷。得不谓之壮火乎。故少火能生气者。阴合阳而气生也。壮火反
食气者。阳离阴而气尽也。经故曰。阴虚则无气。无气则死矣。即斯以明虚火实火之治。假
如形证与脉俱处其不足。只属阳分之虚。而无干于阴虚。是为虚热。（即后阳虚生寒。寒生
湿。湿生热。）可补阳也。（参 任用）若由真阴之虚以致阳不足者。是谓虚火。（即后阴虚
生火。火生燥。燥生风是也。）必补阴而并裕阳。苦寒固未宜。若竟以参 补之。恐甘温只
以益阳。反损其阳生之源也。是则可投参 者。乃止属阳分之虚。名为虚热。不名为虚火也。
又如形证与脉俱据其有余。止属阳分之实。而无干于阴虚。是为实热。可泻阳也。（芩连任
用）若由至阳之盛以致阴不足者。是谓实火。必抑阳而并滋阴。辛热固不宜。即概以芩连泻
之。恐苦寒反致劫阴。先绝其阳化之源也。是则可用芩连者。乃止属阳分之实。名为实热。
不名为实火也。总之。虚实两治。一干于阴虚。便费商酌有如此者。更专言虚火之治。凡人
身半以下属阴。身半以上属阳。假如阴分阳虚。不由真阴之虚而致之。则当直补先天之真阳
。如桂附之属。参 可以佐之。一由于阴虚而致者。即当以养阴为主。而寓扶阳之义。独任
参。非的剂也。又如阳分阴虚。不由至阳之盛而致之。则当滋益后天之元阴。如归芍之类。
参
至阴阳各分之中。又各有阴阳。何者。劳倦饮食。损伤气分。固有阴气阳气之分。而思虑色
欲。损伤血分。又有阴血阳血之异。盖血阴气阳者。分阴分阳之义。而气血各有阴阳者。阴
阳互根之理也。大法阳气虚者。宜桂附兼参 峻补。阴气虚者。参术甘草缓而益之。阴分血
虚者。生地元参龟板知柏补之。阳分血虚者。茯苓参归远志之类补之。此实前人之所未发也
。统治诸证。总先明于火与热之分。先哲言阳虚生寒。寒生湿。湿生热。阴虚生火。火生燥
。燥生风。此火热之介。然而不移者。火固热也。第所谓少火者。乃阴中之真阳。不指气之
热者以名火也。若指气之热者以为火。是属壮火而非少火矣。所谓肺热还伤肺者。乃肺热干
于阴之证。此属虚火不可投参者也。所谓养正邪自除者。乃肺热无干于阴分之证。此属虚热
可以投参者也。大都人身诸病。干于阴分者居其强半。故肺热还伤肺之言。未可概非。至人
身虚病无干于阴分。而止属阳分者虽少。亦确有之。故养正邪自除之言。间亦中的。总先明
于虚热虚火之辨而可已。参之用舍。惟血证最宜分明。仁斋云。人身之血。赖气升降。气清
则和。气浊则乱。故凡治血逆者。莫先清气。又云。血遇热则宣流。故止血多用凉药。然亦
有气虚挟寒。阴阳不能相守。荣气虚散。血亦错行。所谓阳虚阴必走是也。此证必外有虚冷
之状。法当温中。使血自归于经络。统绎二义。其治悬若冰炭。然同是血帅于气。气为血先
之义耳。所谓气清则和者。阳得阴以为守。则阳中之阴降。阴降而阳随之。是之谓和。和则
不逆矣。浊者阳不得阴以为守。因僭越而上亢。是之谓乱。乱则何所不至而成逆矣。至于气
虚者。血不得其统驭之主而亦妄行。犹所谓无主乃乱也。同是血逆。而治有不得不异者。故
肺热干于阴。与无干于阴。固参用舍之分。至于血证虽有异治。然俱已伤其阴矣。又惟气浊
气虚之分。必从主乎血者以为治柄也。气之清浊虚实。最关于血者。其义何如。曰。凡人气
有营卫之分。气之阳属卫。阴属营。阳先而阴从之。故卫气先行皮肤。先充脉络。脉络先盛。
卫气已平。营气乃满。而经脉乃大盛。即此可知阳为阴之先。血乃气之充。气之清浊虚实。
最与血相关也。治血证辄言引血归经。归经者云何。经曰。胃者水谷气血之海。胃之所出气
血者。（如行路从某道出之出）经隧也。经隧者。五脏六腑之大络也。又曰。五脏之道。皆
出于经隧。以行血气。血气不和。百病乃生。是故守经隧焉。即此观之。则气之浊。气之虚
者。即所谓血气不和。而百病生者也。皆不得至于经而行其血气者也。然必本于气。能化血
之脏以取责焉。盖气之浊与气之虚。举不能入心而为血之主。入脾而为血之统。入肝而为血
之藏。又焉能入于经隧。以归五脏六腑之大络乎。人身之血。固无处不周。然脏腑之络。系
于经络。而经隧之能通血气者。尤在于气为之主。此所以责其本而治肺也。然则归经是其末
图。求本惟在治肺。是乃所谓善守经隧者矣。
〔修治〕 以其生时背阳。故不喜见风日。凡生用宜 咀。熟用宜隔纸焙之。或熟酒润
透。 咀焙熟用。并忌铁器。
参芦 气味苦温。人参入手太阴补阴中之阳者也。芦则反是。大泻太阴之阳。主吐虚劳
痰饮。（弱者以参芦代瓜蒂）一女子性躁。味浓。炎月因大怒而呃作。举身跳动。昏不知人。
丹溪用人参芦半两。逆流水一盏半。煎一碗饮之。大吐顽痰数碗。大汗。昏睡一日而安。此
证暴因怒逆。肝木乘火侮肺。故呃大作而神昏。参芦善吐痰。尽则气降而火衰。金气复位。
即此可见大泻太阴之阳。一人作劳发疟。服疟药变为热病。舌短痰嗽。六脉洪数而滑。此痰
蓄胸中。非吐不愈。以参芦汤加竹沥二服。涌出胶痰三块。次与人参黄 当归。煮服半月乃
安。
（人参的适用情况）都是由于脾、肺、肾之气不足，可以使用。面色发红或发黑的人，是气壮神强，不可使用。脉象浮而芤、濡、虚大，迟缓和无力；或者沉而迟、涩、弱、细，结代且无力的，都是虚而不足，可以使用。如果脉象弦长紧实，滑数有力，都是火郁内实，不可使用。（以上结合面色和脉象判断）洁古说喘嗽者勿用，是指痰实气壅导致的喘促。如果是肾虚导致的气短喘促，则必须使用。仲景说肺寒咳嗽者勿用，是指寒邪束表、热邪壅郁在肺导致的咳嗽。如果有自汗、恶寒并伴有咳嗽的，则必须使用。东垣说久病郁热在肺者勿用，是因为火郁于内，宜发散而不宜补益。如果是肺虚火旺、气短自汗的，则必须使用。丹溪说各种疼痛不可骤用人参，是因为邪气正盛锐利，宜散不宜补。如果是里虚吐泻，以及久病胃弱、虚痛喜按的，则必须使用。节斋说阴虚火旺者勿用，是指血虚火亢，能进食，脉弦而数，凉药会伤胃，温药会伤肺，身体不接受补益。如果有自汗、气短、四肢寒冷、脉虚的，则必须使用。如此详细审察，那么人参可用与不可用的道理，就明白大半了。（以上辨析形体与证候）
〔后论〕 先哲说：虚火可补，属于人参这类药物；实火可泻，属于黄芩、黄连这类药物。这四句话还需要斟酌，必须精确辨析“火”与“热”的区别之后才能确定。风寒暑湿燥火，是天的阴阳变化，而人与之相合。（风寒在下，燥热在上，湿气在中，火游行其间）。《内经》说：东方生风，南方生热，西方生燥，北方生寒，中央生湿。各安其位，唯独火没有固定的主宰，这难道不是由阴而生阳，即由阳而化阴，游行于风、热、湿、燥、寒之间以发挥作用吗？人身中只有那种由阴而生，又由阴而化的阳气，才称为少火。如果离开阴来产生阳，那么生的本源就断绝了；离开阴来转化阳，那么转化的机制就穷尽了，这能不称为壮火吗？所以少火能生气，是因为阴合阳而气生；壮火反而食气，是因为阳离阴而气尽。《内经》因此说：阴虚则无气，无气则死矣。由此可以明了虚火与实火的治法。假如形体证候与脉象都显示不足，只属于阳分的虚，而与阴虚无关，这叫虚热。（即后文所说的阳虚生寒，寒生湿，湿生热），可以补阳。（人参任用以补阳）。如果是由真阴之虚导致阳不足的，这叫虚火。（即后文所说的阴虚生火，火生燥，燥生风），必须补阴并兼顾阳。苦寒固然不适宜，如果竟用人参等甘温药物补之，恐怕甘温只会益阳，反而损伤其阳生的本源。这种情况下可以投用人参的，乃是只属于阳分的虚，名为虚热，不名为虚火。又如形体证候与脉象都依据其有余，只属于阳分的实，而与阴虚无关，这叫实热，可以泻阳。（黄芩、黄连任用以泻阳）。如果是由至阳之盛导致阴不足的，这叫实火，必须抑制阳并兼滋阴。辛热固然不适宜，如果一概用黄芩、黄连泻之，恐怕苦寒反而会劫夺阴液，先断绝其阳化的本源。这种情况下可用黄芩、黄连的，乃是只属于阳分的实，名为实热，不名为实火。总之，虚实两种治法，一旦涉及阴虚，便需要如此斟酌。再专门谈论虚火的治法。凡人身半以下属阴，身半以上属阳。假如阴分阳虚，不是由真阴之虚导致的，则应当直接补先天之真阳，如肉桂、附子这类药物，人参可以作为辅助。一旦是由于阴虚导致的，就应当以养阴为主，而寓含扶阳的意义。独用人参，并非确切的方剂。又如阳分阴虚，不是由至阳之盛导致的，则应当滋益后天之元阴，如当归、白芍之类。至于阴阳各分之中，又各有阴阳。什么是这样呢？劳倦饮食损伤气分，固有阴气、阳气之分；而思虑色欲损伤血分，又有阴血、阳血之别。盖血为阴、气为阳，这是区分阴分、阳分的意义；而气血各有阴阳，这是阴阳互根的道理。大法则是：阳气虚者，宜用肉桂、附子兼人参峻补；阴气虚者，用人参、白术、甘草缓补以益之；阴分血虚者，用地黄、玄参、龟板、知母、黄柏补之；阳分血虚者，用茯苓、人参、当归、远志之类补之。这确实是前人未曾阐发的理论。统摄各种证候，总要先明辨火与热的区别。先哲说阳虚生寒，寒生湿，湿生热；阴虚生火，火生燥，燥生风。这是火热之间的界限，然而不可移易的是：火固然是热。只是所谓的少火，乃是指阴中之真阳，不指气的热而言火。如果指气的热作为火，那就属于壮火而非少火了。所谓“肺热还伤肺”，乃是指肺热干犯阴分的证候，这属于虚火，不可投用人参。所谓“养正邪自除”，乃是指肺热未干犯阴分的证候，这属于虚热，可以投用人参。大抵人身诸病，干犯阴分的占大多数，所以“肺热还伤肺”的话，不可一概认为不对。至于人身虚病未干犯阴分，而只属于阳分的虽然少见，但也确实存在，所以“养正邪自除”的话，偶尔也切中要害。总之，先明辨虚热与虚火的区别就可以了。人参的使用与否，在血证中最宜分明。仁斋说：人身之血，赖气升降，气清则和，气浊则乱。所以凡是治疗血逆者，莫先于清气。又说：血遇热则宣流，所以止血多用凉药。然而也有气虚挟寒，阴阳不能相守，营气虚散，血亦错行，所谓阳虚阴必走的情况。此证必定外有虚冷之状，治法当温中，使血自然归于经络。综合这两种意义，其治疗似乎冰炭不同，但都是基于“血帅于气，气为血先”的道理罢了。所谓气清则和，是指阳得阴以为守，则阳中之阴降，阴降而阳随之，这就叫和，和则不逆。气浊是指阳不得阴以为守，因僭越而上亢，这就叫乱，乱则无所不至而成逆。至于气虚者，血失去统驭之主而妄行，也就是所谓无主乃乱。同样是血逆，而治法不得不异。所以肺热干犯阴分，与不干犯阴分，固然是人参用与不用的区别。至于血证虽有异治，然而都已伤其阴了。又只有气浊、气虚的区别，必须从主乎血的角度来把握治疗的枢纽。气的清浊虚实，最关乎血，其中的道理如何？回答说：凡人气有营卫之分，气之阳属卫，气之阴属营，阳先而阴从之。所以卫气先行于皮肤，先充盈脉络，脉络先盛，卫气已平，营气乃满，而经脉乃大盛。由此可知阳为阴之先导，血乃气之充实。气的清浊虚实，最与血相关。治疗血证辄言引血归经，归经是什么意思？《内经》说：胃是水谷气血之海，胃所出气血的地方，就是经隧。经隧，是五脏六腑的大络。又说：五脏之道，皆出于经隧，以行血气。血气不和，百病乃生。所以要守护经隧。由此观之，气之浊、气之虚，就是所谓的血气不和，而百病生，都不能进入经隧而行其血气。然而必须本于气，能化血的脏腑来承担责任。因为气之浊与气之虚，完全不能入心而为血之主，入脾而为血之统，入肝而为血之藏，又怎能进入经隧，归于五脏六腑的大络呢？人身之血，固无处不到，然而脏腑之络，系于经络，而经隧能通血气，尤其在于气为之主宰。这就是追究根本而治肺的原因。然而归经是其末节，求本惟在治肺，这才是所谓的善于守护经隧。
〔修治〕 因为人参生长时背阳，所以不喜欢见风日。凡生用宜切碎，熟用宜隔纸焙干，或用熟酒润透，切碎焙熟后用。并忌用铁器。
参芦 气味苦温。人参入手太阴肺经，补阴中之阳。参芦则相反，大泻太阴之阳，主治吐虚劳痰饮。（体弱者以参芦代替瓜蒂）。有一女子性情急躁，口味浓重，盛夏时节因大怒而呃逆发作，全身跳动，昏不知人。丹溪用人参芦半两，逆流水一盏半，煎取一碗饮用，大吐顽痰数碗，大汗出，昏睡一日而安。此证暴因怒逆，肝木乘火侮肺，故呃逆大作而神昏。参芦善于吐痰，痰尽则气降而火衰，金气复位，由此可见其大泻太阴之阳。一人劳作后患疟疾，服疟药后变为热病，舌短痰嗽，六脉洪数而滑，这是痰蓄胸中，非吐不愈。用参芦汤加竹沥，服用两次，涌出胶痰三块，随后给予人参、黄芪、当归，煮服半月乃安。
(Applicability of Ginseng) These cases are all due to insufficiency of Qi in the Spleen, Lung, and Kidney, and Ginseng may be used. For those with a red or black complexion, their Qi is robust and Spirit is strong; Ginseng must not be used. If the pulse is floating and knotted (Kou), soft (Ru), deficient and large, slow and weak; or sunken, slow, choppy (Se), thin, bound (Jie), and intermittent without force, these indicate deficiency and insufficiency, and Ginseng may be used. If the pulse is wiry, long, tight, and solid, slippery and rapid with force, these indicate internal excess of Fire stagnation, and Ginseng must not be used. (Above: Combining complexion and pulse) Jiegu stated that "do not use for wheezing and cough" refers to wheezing caused by phlegm excess and Qi obstruction. If it is wheezing and shortness of breath due to Kidney deficiency, Ginseng must be used. Zhongjing stated that "do not use for cold-Lung cough" refers to cough caused by cold binding and heat pathogen obstructing and stagnating in the Lung. If there is spontaneous sweating, aversion to cold, and cough, Ginseng must be used. Dongyuan stated that "do not use for chronic disease with stagnant heat in the Lung" because Fire is stagnant internally, requiring dispersion rather than tonification. If it is Lung deficiency with hyperactive Fire, shortness of breath, and spontaneous sweating, Ginseng must be used. Danxi stated that "do not suddenly use for various pains" because the pathogenic factor is sharp and vigorous, requiring dispersion rather than tonification. If there is interior deficiency with vomiting and diarrhea, or chronic illness with weak Stomach and pain that prefers pressure (deficiency pain), Ginseng must be used. Jiezhai stated that "do not use for Yin deficiency with hyperactive Fire" referring to Blood deficiency with hyperactive Fire, where the patient can eat, and the pulse is wiry and rapid; cooling herbs would damage the Stomach, and warming herbs would damage the Lung, making the body unable to accept tonification. If there is spontaneous sweating, shortness of breath, cold limbs, and a deficient pulse, Ginseng must be used. By such detailed examination, one can understand more than half of the principles regarding when Ginseng is applicable or not. (Above: Differentiating form and syndrome)
[Post-discussion] The sages said: "Deficient Fire can be tonified, belonging to Ginseng-type herbs; Excess Fire can be purged, belonging to Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma)-type herbs." These four phrases require deliberation; one must precisely differentiate between "Fire" and "Heat" before proceeding. Wind, Cold, Summer-heat, Dampness, Dryness, and Fire are the Yin and Yang of Heaven, and humans correspond to them. (Wind and Cold are below, Dryness and Heat are above, Dampness is in the middle, Fire moves among them). The Classic states: "The East generates Wind, the South generates Heat, the West generates Dryness, the North generates Cold, the Center generates Dampness." Each occupies its proper position, yet Fire has no specific master. Is this not because Fire arises from Yin and transforms into Yin, moving among Wind, Heat, Dampness, Dryness, and Cold to perform its functions? In the human body, only the Yang that arises from Yin and transforms through Yin is called Shao Huo (Lesser Fire). If Yang arises apart from Yin, the source of generation is cut off; if Yang transforms apart from Yin, the mechanism of transformation is exhausted. Can this not be called Zhuang Huo (Greater Fire)? Therefore, Shao Huo generates Qi because Yin combines with Yang to produce Qi; Zhuang Huo consumes Qi because Yang separates from Yin, leading to the exhaustion of Qi. The Classic thus says: "Yin deficiency leads to lack of Qi; lack of Qi leads to death." From this, the treatment of Deficient Fire and Excess Fire can be understood. Suppose the physical signs and pulse both indicate insufficiency, belonging only to Yang deficiency without involving Yin deficiency; this is called Deficient Heat (i.e., Yang deficiency generates Cold, Cold generates Dampness, Dampness generates Heat). One may tonify Yang (using Ginseng to tonify Yang). If it is Yang insufficiency caused by True Yin deficiency, this is called Deficient Fire (i.e., Yin deficiency generates Fire, Fire generates Dryness, Dryness generates Wind). One must tonify Yin and simultaneously benefit Yang. Bitter-cold herbs are certainly inappropriate; if one were to use Ginseng's sweet-warm nature to tonify, it might only benefit Yang and conversely damage the source of Yang generation. In such cases, Ginseng may be administered only if it belongs solely to Yang deficiency, named Deficient Heat, not Deficient Fire. Conversely, suppose the physical signs and pulse both indicate excess, belonging only to Yang excess without involving Yin deficiency; this is called Excess Heat, and one may purge Yang (using Huangqin and Lianzi to purge Yang). If it is Yin insufficiency caused by extreme Yang excess, this is called Excess Fire. One must suppress Yang and simultaneously nourish Yin. Pungent-hot herbs are certainly inappropriate; if one were to generally use Huangqin and Lianzi to purge, the bitter-cold might conversely rob Yin, severing the source of Yang transformation first. In such cases, Huangqin and Lianzi may be used only if it belongs solely to Yang excess, named Excess Heat, not Excess Fire. In summary, regarding the two treatments of deficiency and excess, once Yin deficiency is involved, such deliberation is necessary. Speaking specifically of treating Deficient Fire: The lower half of the body belongs to Yin, the upper half to Yang. If there is Yang deficiency in the Yin aspect, not caused by True Yin deficiency, one should directly tonify the True Yang of the congenital foundation, such as Guizhi (Cinnamomi Ramulus) and Fuzi (Aconiti Lateralis Radix Praeparata), with Ginseng as an assistant. If it is caused by Yin deficiency, one should focus on nourishing Yin while incorporating the meaning of supporting Yang. Using Ginseng alone is not the precise formula. Similarly, if there is Yin deficiency in the Yang aspect, not caused by extreme Yang excess, one should nourish the primordial Yin of the acquired foundation, such as Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix). Within each division of Yin and Yang, there are further divisions of Yin and Yang. What does this mean? Fatigue and dietary injury damage the Qi aspect, which has distinctions between Yin-Qi and Yang-Qi; while excessive thinking and sexual indulgence damage the Blood aspect, having distinctions between Yin-Blood and Yang-Blood. Blood is Yin and Qi is Yang; this distinguishes the meanings of Yin and Yang aspects. That Qi and Blood each have Yin and Yang reflects the principle of mutual root of Yin and Yang. The general rule is: For Yang-Qi deficiency, use Guizhi and Fuzi combined with Ginseng for severe tonification; for Yin-Qi deficiency, use Ginseng, Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) for gentle tonification; for Yin-aspect Blood deficiency, use Shengdi (Rehmanniae Radix), Xuanshen (Scrophulariae Radix), Guiban (Testudinis Carapax et Plastrum), ZhiMu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex); for Yang-aspect Blood deficiency, use Fuling (Poria), Ginseng, Danggui, and Yuanzhi (Polygalae Radix). This is indeed a theory not previously expounded by predecessors. To govern all syndromes, one must first clarify the distinction between Fire and Heat. The sages said: Yang deficiency generates Cold, Cold generates Dampness, Dampness generates Heat; Yin deficiency generates Fire, Fire generates Dryness, Dryness generates Wind. This is the boundary between Fire and Heat, yet immovable is that Fire is essentially Heat. However, the so-called Shao Huo refers to the True Yang within Yin, not referring to the heat of Qi as Fire. If one refers to the heat of Qi as Fire, it belongs to Zhuang Huo, not Shao Huo. The phrase "Lung Heat injures the Lung again" refers to a syndrome where Lung Heat invades the Yin aspect; this belongs to Deficient Fire, and Ginseng must not be used. The phrase "Nourish the Righteous, and the Evil will eliminate itself" refers to a syndrome where Lung Heat does not invade the Yin aspect; this belongs to Deficient Heat, and Ginseng may be used. Generally, most diseases in the human body invade the Yin aspect, so the statement "Lung Heat injures the Lung again" cannot be considered entirely incorrect. Although cases of deficiency diseases not invading the Yin aspect but belonging only to the Yang aspect are rare, they do exist; thus, the statement "Nourish the Righteous, and the Evil will eliminate itself" occasionally hits the mark. In summary, one must first clarify the distinction between Deficient Heat and Deficient Fire. The use or rejection of Ginseng is most clear in Blood syndromes. Renzhai said: "Blood in the human body relies on Qi for ascending and descending; if Qi is clear, it is harmonious; if Qi is turbid, it is chaotic. Therefore, in treating blood rebellion, nothing comes before clearing the Qi." He also said: "Blood flows freely when encountering heat, so hemostasis often uses cooling herbs." However, there are cases of Qi deficiency with Cold, where Yin and Yang cannot maintain each other, Ying-Qi (Nutritive Qi) is deficient and scattered, and Blood also moves erratically, known as "Yang deficiency causes Yin to escape." This syndrome definitely presents with external signs of deficiency and cold; the treatment method should warm the Middle to allow Blood to return to the collaterals naturally. Synthesizing these two meanings, their treatments seem like ice and charcoal, yet both rely on the principle that "Blood is commanded by Qi, and Qi precedes Blood." The phrase "Qi is clear, then it is harmonious" means that Yang obtains Yin as its guardian, so the Yin within Yang descends; as Yin descends, Yang follows. This is called harmony, and harmony means no rebellion. Turbidity means Yang lacks Yin as its guardian, leading to usurpation and rising upward; this is called chaos, and chaos leads to rebellion. As for Qi deficiency, Blood loses its governing master and acts recklessly, which is what is meant by "without a master, there is chaos." Although both are blood rebellion, the treatments must differ. Thus, whether Lung Heat invades the Yin aspect or not is indeed the distinction between using or rejecting Ginseng. Although Blood syndromes have different treatments, they all involve injury to Yin. Furthermore, the distinction lies in turbid vs. clear Qi and deficiency vs. excess, requiring one to grasp the treatment handle based on what governs the Blood. How does the clarity, turbidity, deficiency, and excess of Qi relate most closely to Blood? I answer: Human Qi has the distinction of Ying (Nutritive) and Wei (Defensive). Yang Qi belongs to Wei, Yin Qi belongs to Ying; Yang goes first, and Yin follows. Thus, Wei Qi first moves in the skin, first fills the collaterals; when collaterals are full, Wei Qi stabilizes, Ying Qi becomes abundant, and the meridians become greatly filled. From this, we know that Yang is the precursor to Yin, and Blood is the enrichment of Qi. The clarity, turbidity, deficiency, and excess of Qi are most related to Blood. When treating Blood syndromes, people often speak of "guiding Blood back to the meridians." What does "returning to the meridians" mean? The Classic says: "The Stomach is the sea of water and grain and Qi and Blood." The places where Qi and Blood emerge from the Stomach are the Jing Sui (Meridian Channels). The Jing Sui are the great collaterals of the Zang-Fu organs. It also says: "The pathways of the five Zang organs all emerge from the Jing Sui to circulate Qi and Blood. If Qi and Blood are not harmonious, hundreds of diseases arise. Therefore, guard the Jing Sui." From this, we see that turbid Qi and deficient Qi constitute the so-called disharmony of Qi and Blood, giving rise to hundreds of diseases; they cannot enter the Jing Sui to circulate Qi and Blood. However, one must hold the Qi accountable, specifically the organs that transform Qi into Blood. Because turbid and deficient Qi cannot enter the Heart to serve as the master of Blood, enter the Spleen to serve as the commander of Blood, or enter the Liver to serve as the storage of Blood, how can they enter the Jing Sui to return to the great collaterals of the Zang-Fu organs? Blood in the human body permeates everywhere, but the collaterals of the Zang-Fu organs are connected to the meridians, and the ability of the Jing Sui to circulate Qi and Blood depends especially on Qi acting as the master. This is why we seek the root and treat the Lung. Thus, guiding Blood back to the meridians is the superficial approach; seeking the root lies in treating the Lung. This is what is meant by skillfully guarding the Jing Sui.
[Processing] Because Ginseng grows facing away from the sun, it dislikes wind and sunlight. For raw use, it should be crushed/chopped; for cooked use, it should be baked through paper, or moistened with cooked wine, then chopped and baked for use. Iron vessels must be avoided.
Ginseng Root Tip (Shenlu) Taste and Nature: Bitter, Warm. Ginseng enters the Taiyin Lung Meridian and tonifies the Yang within Yin. The root tip is the opposite; it severely drains the Yang of the Taiyin. It treats vomiting due to deficiency labor and phlegm-fluid retention. (For weak patients, Shenlu replaces Goudi (Melongenae Fructus)). A woman with an irritable temperament and preference for rich flavors developed hiccups during midsummer due to sudden anger, with whole-body twitching and unconsciousness. Danxi used half liang of Ginseng Root Tip, decocted in counter-flowing water (one and a half cups) until one cup remained, and drank it. She vomited several bowls of stubborn phlegm, sweated profusely, slept for a day, and recovered. This case was caused by sudden anger causing Liver Wood to attack Fire and insult the Lung, resulting in severe hiccups and coma. Ginseng Root Tip is good at inducing vomiting of phlegm; once the phlegm is exhausted, Qi descends and Fire declines, restoring the Metal Qi. This demonstrates its severe draining of Taiyin Yang. Another person developed malaria after overwork, which turned into a heat disease after taking malaria medicine. Symptoms included short tongue, phlegm cough, and six pulses that were flooding, rapid, and slippery. This indicated phlegm accumulation in the chest, curable only by vomiting. Using Ginseng Root Tip Decoction plus Zhuli (Bambusa Textilis Caulis Juice), two doses brought up three pieces of gelatinous phlegm. Subsequently, Ginseng, Huangqi (Astragali Radix), and Danggui were decocted and taken for half a month until recovery.