黄 白术人参。此三者虽为补气之药。第主治之属。脏腑之殊。则迥然不同也。本草虽
未详
晰。而余请为备列之。盖 专主卫气。白术主脾胃中州之气。人参则益脾肾之元气。合三者
兼用。又通益上中下。三焦表里脏腑诸气也。何以言 专主卫气乎。 质轻气薄。色白微黄
。味淡略甘。乃肺脾上中二焦阳分之药。而主治则固自汗。治虚喘。解肌热。疗痈疽。只此
数
症。尚须佐以参术。方能着功。王节斋云∶内伤发热。是阳气自伤。不能升达。降下阴分而
为内热。乃阳虚也。故其脉大而无力。属肺脾。立斋云∶当用补中益气汤治之。第此汤以
为君。参术为臣。少佐升柴。则独疗沉陷发热之虚阳。与劳役过度及阳虚自汗者宜之。东垣
曰∶灵枢云卫气者所以温分肉而充皮毛。肥腠理而司开阖。黄 既补三焦实卫气。与桂同功
。特比桂甘平不辛热为异耳。但桂则通血脉能破血而实卫气。 则益气也。又黄 与人参甘
草三味。为除燥热肌热之圣药。脾胃一虚。肺气先绝。必用黄 温分肉。益皮毛。实腠理不
令汗出。以益元气而补三焦。陈嘉谟曰∶人参补中。黄 实表。凡内伤脾胃发热。恶寒吐泻
。怠卧胀满痞塞。神短脉微者。当以人参为君。黄 为臣。若表虚自汗亡阳。溃疡痘疹阴疮
者。当以黄 为君。人参为臣。不可执一也。丹溪曰∶黄 补元气。肥白而多汗者为宜。若
面黑形实而瘦者。服之令人胸满。宜以三拗汤泻之。张元素曰∶黄 甘温纯阳。无汗则发
之。有汗则止之。以上诸说皆言 为益卫气之药。盖卫气之疏。总由于胃气元气之虚。必兼
以参术而扶胃气元气以充卫气则相须为用耳。若舍 而用参术。独补中气犹可。是治其本
也。舍参术而专用 。径塞汗孔。不令疏泄。从理其标。谓能实卫则不可也。丹溪谓黄 补
元气。此非补元气。乃补卫气也。为卫气升由元气耳。大凡肥白多汗者元气便虚。元气既虚
。未有卫气能独实者。谓曰。补元气亦可补元气即补卫气也。如面黑形瘦实者。非元气实
乎。元气既实。卫气自然不虚。敢用此而犯实实乎。丹溪格致论言一病者妄自加黄 。致腹
纹已隐胀满不堪。 固补物。误用且能为害。况他药乎。虽曰 能止汗。设元气暴绝。症主
亡阳。亦能为力耶。丹溪又治一人无汗者。佐以葛根能令汗泄。则 又不专止汗耳。故善
用者。有汗能止无汗能发。盖止汗不专一 。而病汗亦非专卫虚也。若夫白术则健中气而
益脾胃者也。东垣曰∶脾胃虚陈皮白术补之。脾胃实黄连枳实泻之。东垣虽以陈皮白术为补
脾。乃施于不甚虚者。陈皮多用。尚能泄气其虚者。非参不能资益虚之甚者。非佐桂附骨脂
勤培土母不能复转输生化之。常区区治子得乎。参为中和之品。味甘质重。膏润不濡。味甘
协土。质重归肾。韩飞霞云人参炼膏服固元气于无何有之乡。此诚深知参者矣。故字从参者
以其有参赞化育之妙。与天地相参伍。而其功不甚伟欤。参少用反能停膈作胀多。用有彻上
彻下彻内彻外之功。佐以黄 防风肉桂。则补卫气。佐以白术归苓炙草。则补脾胃中气。佐
以附子肉桂。则追复元气。佐以血药则补血。佐以气药则补气。故欲提下陷之阳气以上升
则
当以黄 为君参术为臣。纳上脱之真气以归源则当以人参为君桂附为佐一主上升一主下降。
病气虽同治法则异毫厘不容混也。余犹有说焉。若上中焦阳气下陷。元气尚未伤也。枝叶萎
而根本自坚。纵治少瘥。或亦无妨。故四君补中归脾之属。任即杂投。随试随效。至于元气
上脱。根将离土虽用参术而不急佐以桂附安能纳气归宿命门乎。第参术仅只补中而命门为元
气归宿之地。可缓桂附乎。桂附为命门土母之剂。土母者何真火也。真火即元气也。元气为
人生命之本。人得气则生离气则死。气离原则脱未有元气脱而人不死者也。设若元气甫脱尚
未
遽绝。即需桂附而不君以人参。岂知桂附性窜奔突愈耗。真阳也。亦有惮桂附只用参术。徒
使留连不降。终至于死。特少延旬日耳。然用桂附必君以参。盖性相制而功相须也。甚有气
本上脱。复投以黄 升达之品。益令萦膺作胀。烦闷难支。且曰参 滋补。为功未到。是岂
药之咎乎。噫若 若参若术若桂附。随宜运用。应缓则缓。应急则急。灵变从人。幸勿胶柱
可也。内云 固补物。误用亦能为害者。非 之能害人也。 有黄 硕之称。与国老人甘
草
。参术之君子。皆为朝堂中正人仁人。主宰造化。生成万物。岂有害人之理。特人误用。自
致于害耳。吾恐学人致疑。故复详及。
黄（黄芪）与白术、人参。这三味药虽然都是补气的药物，但各自主治的脏腑不同，功效便截然不同。本草书中虽未详尽阐述，但我请为各位详细列举说明。盖因黄专主卫气；白术主治脾胃中焦之气；人参则补益脾肾之元气。将三者合用，又能通补上、中、下三焦以及表里脏腑的各种气机。为什么说黄专主卫气呢？因为黄质地轻、气味薄，颜色白而微黄，味道淡略带甘，是肺、脾及上中二焦阳分的药物，其主治病症包括自汗、虚喘、解肌热、治疗痈疽等。仅凭这几项症状，尚需辅以参、术，才能显效。王节斋说：内伤发热，是由于阳气自我损伤，不能升达，反而降入阴分而形成内热，这属于阳虚。所以其脉象大而无力，病位在肺脾。李东垣（立斋）说：应当用补中益气汤来治疗。此方以黄为君药，参、术为臣药，少加升麻、柴胡，则专门治疗因沉陷发热导致的虚阳，适用于劳役过度及阳虚自汗者。李东垣说：《灵枢》记载，卫气的作用是温煦肌肉、充实皮毛、肥厚腠理并主管开阖。黄既然能补三焦、实卫气，功效与桂枝相同，只是比桂枝性味甘平而不辛热罢了。但是桂枝能通行血脉、破血而实卫气，黄则是补气。另外，黄与人参、甘草这三味药，是清除燥热、肌热的圣药。脾胃一旦虚弱，肺气先绝，必须用黄温煦肌肉、充实皮毛、固密腠理以防汗出，从而补益元气并补益三焦。陈嘉谟说：人参补中焦，黄固表。凡是内伤脾胃引起的发热、恶寒、吐泻、倦怠嗜卧、胀满痞塞、神疲脉微者，当以人参为君药，黄为臣药。若是表虚自汗、亡阳，或溃疡、痘疹、阴疮患者，当以黄为君药，人参为臣药，不可固执一端。朱丹溪说：黄补元气，身体肥胖色白且多汗的人适宜服用。若面色黑、形体结实而瘦者，服用后会令人胸满，宜用三拗汤泻之。张元素说：黄性甘温纯阳，无汗时能发汗，有汗时能止汗。以上诸家说法都指出黄是补益卫气的药物。盖因卫气疏泄，总归是因为胃气和元气的虚弱，必须兼用人参、白术来扶助胃气和元气，以充养卫气，这样二者才能相辅相成。如果舍弃黄而只用参、术，单独补中气还可以，这是治本；若舍弃参、术而专用黄，强行闭塞汗孔，不让其疏泄，这是治标，说它能实卫气是不准确的。朱丹溪说黄补元气，这并非补元气，而是补卫气。因为卫气的升发依赖于元气。大凡身体肥胖色白多汗的人，元气往往偏虚；元气既已虚弱，没有卫气能独自充实的道理。如果说“补元气即是补卫气”，那么像面色黑、形体瘦实的人，难道不是元气充实吗？元气既然充实，卫气自然不虚，岂敢用黄去犯“实实”之戒（即对实证误用补法）？朱丹溪在《格致余论》中提到有人妄自加用黄，导致腹部纹路消失、胀满难忍。黄虽是补益之物，误用尚且能为害，何况其他药物呢？虽说黄能止汗，但若元气暴脱，症见亡阳，黄又能有什么作为呢？朱丹溪又曾治疗一名无汗的患者，佐以葛根令其汗出，可见黄又不专于止汗。因此善于使用者，对有汗能止，无汗能发。盖因止汗并不专靠黄，而且病理性出汗也不全是卫气虚所致。至于白术，则是健运中气、补益脾胃的药物。李东垣说：脾胃虚损用陈皮、白术补之；脾胃实滞用黄连、枳实泻之。李东垣虽以陈皮、白术为补脾之法，但这适用于虚损不甚的情况。陈皮多用尚能泄气，对于极度虚损者，非人参不能资助；若非佐以桂枝、附子、骨碎补等药勤勉培补土母（肾），也不能恢复转输生化之功。仅仅局限于治子（脾）怎么行呢？人参是中和之品，味甘质重，膏润而不湿腻。味甘协合土性，质重归于肾。韩飞霞说：人参炼成膏服用，能在虚无之境稳固元气，这确实是深知人参的人啊。所以“参”字之所以得名，是因为它有参赞化育的妙用，与天地相参伍，其功效不是很伟大吗？人参少用反而能停膈作胀，多用则有彻上彻下、彻内彻外的功效。佐以黄、防风、肉桂，则补卫气；佐以白术、当归、茯苓、炙甘草，则补脾胃中气；佐以附子、肉桂，则追复元气；佐以血药则补血；佐以气药则补气。所以想要提升下陷的阳气使其上升，当以黄为君，参、术为臣；想要收纳上脱的真气使其归源，当以人参为君，桂、附为佐。一主上升，一主下降，病气虽同，治法则异，毫厘不容混淆。我还有话说：如果是上中焦阳气下陷，元气尚未受伤，枝叶枯萎而根本自坚，即使治疗稍有好转，或者也无妨。所以四君子汤、补中益气汤、归脾汤之类的方剂，随意投用，随试随效。至于元气上脱，根基将离土壤，虽然使用参、术，若不紧急佐以桂、附，怎能纳气归宿于命门呢？况且参、术仅只补中焦，而命门是元气归宿之地，能缓用桂、附吗？桂、附是补益命门土母（肾）的药剂。所谓土母是什么？就是真火。真火即元气。元气是人的生命之本，人得气则生，离气则死。气离原则脱，没有元气脱失而人不死的。假设元气刚刚脱失，尚未立即断绝，此时即需桂、附，若不以人参为君药，岂不知桂、附性窜奔突，愈耗真阳？也有畏惧桂、附而只用参、术者，徒然使气留连不降，最终致死，只不过稍微延缓了几天死亡而已。然而使用桂、附必须以人参为君，这是因为药性相互制约而功效相互依存。更有甚者，气本已上脱，又投以黄等升达之品，更加令气萦绕胸膈、胀闷难支，还说：“参、黄滋补，是药效未到。”这难道是药的过错吗？唉！对于黄、参、术、桂、附等药，应随宜运用，该缓则缓，该急则急，灵活变通，切勿拘泥固执。文中提到“黄固补物，误用亦能为害”，并非黄能害人，而是黄有黄芪硕大之称，与国老甘草、参术之君子，皆为朝堂中正之人、仁人，主宰造化，生成万物，岂有害人之理？特因人误用，自招其害罢了。我恐怕学者产生疑惑，故再次详细说明。
Huangqi (Astragali Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), and Renshen (Ginseng Radix et Rhizoma). Although these three herbs are all Qi-tonifying medicines, their primary indications differ according to the specific Zang-Fu organs they target, resulting in distinctly different effects. Although Materia Medica texts do not elaborate extensively on this, I will list them comprehensively here. Huangqi specifically governs Wei Qi (Defensive Qi); Baizhu governs the Qi of the Spleen and Stomach in the Middle Jiao; and Renshen tonifies the Yuan Qi (Original Qi) of the Spleen and Kidney. Using all three together can also benefit the Qi of the Upper, Middle, and Lower Jiao as well as the interior and exterior of the Zang-Fu organs. Why is it said that Huangqi specifically governs Wei Qi? Because Huangqi is light in texture and thin in aroma, white with a slight yellow hue, and has a bland taste with a hint of sweetness. It is a medicine for the Yang aspect of the Lung, Spleen, and the Upper and Middle Jiao. Its primary indications include spontaneous sweating, deficiency-type wheezing, resolving muscle-heat, and treating carbuncles and sores. For these few symptoms alone, one must still assist with Renshen and Baizhu to achieve efficacy. Wang Jiezhai stated: "Internal injury fever arises from self-injury of Yang Qi, which fails to ascend and instead descends into the Yin aspect, causing internal heat. This belongs to Yang deficiency. Therefore, the pulse is large but forceless, and the pathology involves the Lung and Spleen." Li Dongyuan (Lizhai) stated: "One should use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to treat it. In this formula, Huangqi serves as the Sovereign herb, Renshen and Baizhu as Ministers, with small amounts of Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix). Thus, it specifically treats deficiency-Yang caused by sinking and fever, making it suitable for those with excessive labor and spontaneous sweating due to Yang deficiency." Li Dongyuan said: "The Ling Shu states that Wei Qi warms the flesh, fills the skin and hair, thickens the interstices, and controls opening and closing. Since Huangqi tonifies the San Jiao and solidifies Wei Qi, its function is similar to Guizhi (Cinnamomi Ramulus), except that Huangqi is sweet and neutral rather than acrid and hot. However, Guizhi unblocks blood vessels and breaks blood stasis to solidify Wei Qi, whereas Huangqi tonifies Qi. Furthermore, the combination of Huangqi, Renshen, and Gancao (Glycyrrhizae Radix et Rhizoma) is a sacred prescription for clearing dryness-heat and muscle-heat. When the Spleen and Stomach are deficient, Lung Qi is first exhausted. One must use Huangqi to warm the flesh, fill the skin, and solidify the interstices to prevent sweating, thereby benefiting Yuan Qi and tonifying the San Jiao." Chen Jiamo said: "Renshen tonifies the Middle; Huangqi solidifies the exterior. For internal injuries to the Spleen and Stomach causing fever, aversion to cold, vomiting and diarrhea, lethargy, distension, fullness, obstruction, shortness of spirit, and a faint pulse, one should use Renshen as the Sovereign and Huangqi as the Minister. If there is exterior deficiency with spontaneous sweating, Yang collapse, ulcers, smallpox, or yin sores, one should use Huangqi as the Sovereign and Renshen as the Minister. One must not adhere rigidly to one approach." Zhu Danxi said: "Huangqi tonifies Yuan Qi and is suitable for those who are fat, pale, and prone to sweating. If one is dark-complexioned, physically solid yet thin, taking it will cause chest fullness; in such cases, San'ao Tang (Three Unblocking Decoction) should be used to drain it." Zhang Yuansu said: "Huangqi is sweet, warm, and purely Yang. It induces sweating when there is none, and stops sweating when there is some." All the above theories state that Huangqi is a medicine that benefits Wei Qi. The looseness of Wei Qi generally stems from the deficiency of Stomach Qi and Yuan Qi. One must combine Renshen and Baizhu to support Stomach Qi and Yuan Qi to replenish Wei Qi, so that they work synergistically. If one abandons Huangqi and uses only Renshen and Baizhu, solely tonifying Middle Qi is acceptable; this treats the root. If one abandons Renshen and Baizhu and uses only Huangqi, forcibly blocking the sweat pores to prevent excretion, this treats the branch. To say it can solidify Wei Qi is inaccurate. Zhu Danxi claimed Huangqi tonifies Yuan Qi; this is not tonifying Yuan Qi, but tonifying Wei Qi. Wei Qi ascends based on Yuan Qi. Generally, those who are fat, pale, and sweaty have deficient Yuan Qi. Once Yuan Qi is deficient, Wei Qi cannot be independently solid. To say 'tonifying Yuan Qi is equivalent to tonifying Wei Qi' implies that if someone is dark-complexioned, thin, and physically solid, is their Yuan Qi not solid? If Yuan Qi is solid, Wei Qi is naturally not deficient. How could one dare use Huangqi to commit the error of 'treating excess with excess'? Zhu Danxi's Gezhi Lun mentions a case where someone recklessly added Huangqi, causing abdominal patterns to disappear and unbearable distension. Although Huangqi is a tonic, misuse can cause harm, let alone other drugs. Although it is said that Huangqi can stop sweating, if Yuan Qi suddenly collapses and the syndrome is Yang collapse, what can Huangqi do? Zhu Danxi also treated a patient with no sweating; by adding Gegen (Puerariae Radix), he induced sweating. Thus, Huangqi does not exclusively stop sweating. Therefore, a skilled practitioner can stop sweating when present and induce sweating when absent. This is because stopping sweating does not rely solely on Huangqi, and pathological sweating is not exclusively due to Wei Qi deficiency. As for Baizhu, it strengthens Middle Qi and benefits the Spleen and Stomach. Li Dongyuan said: "For Spleen and Stomach deficiency, use Chenpi (Citri Reticulatae Pericarpium) and Baizhu to tonify; for Spleen and Stomach excess, use Huanglian (Coptidis Rhizoma) and Zhishi (Aurantii Fructus Immaturus) to drain." Although Li Dongyuan used Chenpi and Baizhu to tonify the Spleen, this applies only to mild deficiency. Excessive use of Chenpi can still drain Qi. For severe deficiency, only Renshen can aid it; without assisting with Guizhi, Fuzi (Aconiti Lateralis Radix Praeparata), and Gubujie (Drynariae Rhizoma) to diligently cultivate the Mother of Earth (Kidney), the transformation and transportation functions cannot be restored. Can one merely focus on treating the Child (Spleen)? Renshen is a harmonizing agent, sweet in taste and heavy in substance, pasty and moist but not sticky. Sweetness harmonizes with Earth, and heaviness directs to the Kidney. Han Feixia said: "Taking refined Renshen paste stabilizes Yuan Qi in the realm of nothingness. This truly demonstrates a deep understanding of Renshen." Hence, the character 'Shen' (参) derives its meaning from its miraculous ability to assist in creation, participating with Heaven and Earth, and its merit is indeed great. A small dose of Renshen may cause stagnation and distension; a larger dose has the effect of penetrating up, down, inside, and outside. Assisted by Huangqi, Fangfeng (Saposhnikoviae Radix), and Rougui (Cinnamomi Cortex), it tonifies Wei Qi; assisted by Baizhu, Danggui (Angelicae Sinensis Radix), Fuling (Poria), and Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), it tonifies Spleen and Stomach Middle Qi; assisted by Fuzi and Rougui, it rescues Yuan Qi; assisted by Blood-invigorating herbs, it tonifies Blood; assisted by Qi-moving herbs, it tonifies Qi. Therefore, to lift sinking Yang Qi upward, one should use Huangqi as the Sovereign and Renshen/Baizhu as Ministers; to gather escaping True Qi back to its source, one should use Renshen as the Sovereign and Guizhi/Fuzi as Assistants. One primarily promotes ascent, the other descent. Although the pathogenic Qi may be similar, the treatment principles differ; even a millimeter cannot be confused. I have more to say: If Yang Qi of the Upper and Middle Jiao sinks but Yuan Qi is not yet injured, although the branches wither, the root remains firm. Even if treatment brings slight improvement, it may be acceptable. Thus, formulas like Sijunzi Tang (Four Gentlemen Decoction), Buzhong Yiqi Tang, and Guipi Tang (Restore the Spleen Decoction) can be administered freely, yielding immediate effects. However, if Yuan Qi escapes upward and the root is about to detach from the soil, even using Renshen and Baizhu, without urgently assisting with Guizhi and Fuzi, how can Qi be gathered and returned to the Mingmen (Gate of Life)? Moreover, Renshen and Baizhu only tonify the Middle, while Mingmen is the destination of Yuan Qi. Can one delay using Guizhi and Fuzi? Guizhi and Fuzi are agents for tonifying the Mother of Earth (Kidney). What is the Mother of Earth? It is the True Fire. True Fire is Yuan Qi. Yuan Qi is the foundation of human life. Humans live with Qi and die without it. When Qi separates from the principle, it escapes; there is no case of Yuan Qi escaping while the person remains alive. If Yuan Qi has just escaped but not yet completely severed, one needs Guizhi and Fuzi. But if one does not use Renshen as the Sovereign, one fails to realize that Guizhi and Fuzi are pungent and volatile, consuming True Yang further. Some fear Guizhi and Fuzi and use only Renshen and Baizhu, leaving Qi lingering and unable to descend, ultimately leading to death, merely delaying it by a few days. However, when using Guizhi and Fuzi, one must use Renshen as the Sovereign, because their properties restrain each other and their functions complement each other. Worse still, if Qi is already escaping upward, administering ascending herbs like Huangqi causes Qi to linger in the chest, creating unbearable distension and irritability, yet the patient claims, 'Renshen and Huangqi are nourishing; the effect has not arrived.' Is this the fault of the herbs? Alas! For Huangqi, Renshen, Baizhu, Guizhi, and Fuzi, one should apply them flexibly: slow when appropriate, urgent when necessary. Be agile and adaptable; do not be rigid. The text mentioned earlier, 'Huangqi is a tonic, but misuse can cause harm,' does not mean Huangqi harms people. Huangqi, known for its robust nature, along with Guolao (Old Man) Gancao, and the gentlemen Renshen and Baizhu, are upright figures in the court, benevolent persons who govern creation and generate all things. How could they have the intent to harm? It is merely human misuse that leads to harm. I fear scholars may doubt this, so I explain it in detail again.