虚劳之另一含义，渭在虚损基础L，更兼内热渐起、虚火日炽，焦灼气血，致血瘀不行，日久化而为虫，啮人脏腑而发为痨病，或感染痨虫而发病者。如《风劳臌膈四大证治》曰：“虚是气血不足，损是五脏亏损，劳是火炎于上。劳瘵者，既虚且损，复竭其力，而动于火以成其劳也。虚而未劳，但名不足；虚而且劳，其成瘵成蒸无不至矣。”又曰：“故劳者，必因于虚，虚极必至于劳。”又《研经言》曰：“今之所谓虚劳，古之所谓蒸也；古之所谓虚劳，今之所谓脱力也。”则虚劳一词，包括虚损与劳瘵在内。故《中医大辞典》对“虚劳”之释义即取此义：虚劳“包括气血、脏腑等正气损伤所致的虚弱症和某些具传染性、表现为虚弱证候的疾病。后世多将前者称为虚损，后者称为劳瘵或传尸劳。”
二、成因
虚劳之成，《理虚元鉴》列有六因：“有先天之因，有后天之因，有痘疹及病后之因，有外感之因．有境遇之因，有医药之因。”所渭先天之因者指秉赋及遗传因素。后天之因为劳累过度及摄养不善，痘疹、病后以及外感乃疾病因素。境遇为精神因素，而医药之因则为误药致病。
本病纵有六因之分，且体质、精神因素与外感、疾病，境遇诸因可相互为病，但终不出内外二因。外因中以感受外邪失于解散，邪气久留最为主要。如《笔花医镜》“虚劳论治”指出：虚劳之症“固由真阴亏损，虚火烁金而然。而其始大半由于外感，感邪在肺则作咳嗽。治失其宜，则咳不已。久咳则伤肺金，金伤不能生水，则肾水日枯，肾火日炽，上灼于肺。再复嗜色欲、受外邪，以竭其水，而虚劳成矣。”
外感成劳《内经》已有论述，尤怡于《医学读书记》中释经文“劳风法在肺下”节后，慨然曰：“读此，可悟伤风不解成痨之故。劳风者，既劳而又受风也劳则火起于上，而风又乘之”。“设不出，则风火留积肺中而肺伤，肺伤则喘咳声嘶，渐及五脏，而虚劳之病成矣。”感受外邪为虚劳病之重要成因，无怪乎绮石先生不禁大声疾呼：“伤风不醒便成劳。”
内因成劳不外水亏火旺、土弱金伤诸候。如《笔花医镜》曰：“间有本元不足，思虑太过，而心血耗、心火旺，肾水干、肺金痿者，其受病不同，及其成劳一也。”内因成劳实已包括《理虚元鉴》所述六因中后天、疾病、境遇、医药诸因素，亦与先天秉受与体质强弱密切相关。
无论外因抑或内因，当着意于防范，切勿因循以使病成，然后渴而穿井、斗而铸兵，亦已晚矣。平素当窒情欲以积精全神、节饮食以调护后天，惩忿怨以颐养天年。倘感外邪速进药饵，亟使解散，以保安康。
由此可知，感受外邪且留着不去，为虚劳病之一大成因，则临证凡遇外感之病宜加重视，勿以病小而忽之，亟予及时、正确、高效之治疗，务使迅速、彻底解散病邪，毋使留着变生他患以遗殃于日后，斯为善矣。
三、证候
本病之证候，《巢氏病源》提出五劳、六极、七伤之病变，并详列不同证候凡七十五论。后世医家，多宗是说，然五劳、六极、七伤之具体内容，诸家未尽相同。如《巢源》曰：“夫虚劳者，五劳六极七伤也。”其中五劳与七伤均含两类不同内容，如五劳之第一类以劳伤情志为主，“一曰志劳，二曰思劳，三曰心劳，四曰忧劳，五曰瘦劳。”第二类，则以五脏归纳证候：“肺劳者，短气而肿，鼻不闻香臭。肝劳者，面目干黑，口苦，精神不守，恐畏不能独卧，目视不明。心劳者，忽忽喜忘，大便苦难，或时鸭溏，口内生疮。脾劳者，舌本苦直，不得咽唾。肾劳者，背难以俯仰，小便不利，色赤面黄有余沥，茎内痛，阴湿，囊生疮，小腹满急”而清代无名氏所著之《杂症治要秘录》则采《内经》之文，以“久视伤血，久卧伤气，久坐伤肉，久行伤筋，久立伤骨”为五劳。五劳之内容诸书虽有参差，但终不越劳伤五脏及精、气、神、思、形五者。
又如七伤，《巢氏病源》亦有两义：第一义为“一曰阴寒；二曰阴萎；三曰里急；四曰精连连；五曰精少，阴下湿；六曰精清；七曰小便苦数，临事不卒。”另一义为：“一曰大饱伤脾，脾伤善噫，欲卧，面黄；二曰大怒气逆伤肝，肝伤血少目暗；三曰强力举重、久坐湿地伤肾，肾伤少精，腰背痛．厥逆下冷；四曰形寒、寒饮伤肺，肺伤少气，咳嗽鼻鸣；五曰忧愁思虑伤心，心伤，苦惊喜忘善怒；六曰风雨寒暑伤形，形伤发肤枯夭；七曰大怒恐不节伤志，志伤恍惚不乐”第一义侧重下焦及肾精亏损，而第二义亦以五脏伤损为主要病理。
人体由五劳、七伤成病，加之失治、误治等因素，病变由浅而深，由轻渐重，终成“气极、血极、筋极、骨极、肌极、精极”之六极，病情发展至此，已成虚损重证，治之非易。
六极所现之证候。据《巢氏病源》载为：“一曰气极，令人内虚，五脏不足，邪气多，正气少，不欲言；二曰血极．令人无颜色，眉发堕落，忽忽喜忘；三曰筋极，令人数转筋，十指爪甲皆痛，苦倦不能久立；四曰骨极，令人酸削，齿苦痛，手足烦痛，不可以主，不欲行动；五曰肌极，令人赢瘦无润泽，饮食不生肌肤；六曰精极，令人少气嗡嗡然内虚，五脏气不足，发毛落，悲伤喜忘。”
对于五劳、七伤、六极之认识，清代莫枚士见解甚卓，其于《研经言》中曰：“古有五劳、七伤、六极之目，皆言虚也，核之则劳、极二端而已。劳是过用其气，极则几乎无气，其浅深不同。以《病源》所记言之，五劳中志劳、心劳、忧劳、是过用其神；其疲劳是过用其形。七伤则房劳之病，亦劳属也，以其病多，故别出之。然精为七神之一，是亦过用其神也。约之，特形、神二者尽之矣。若风寒暑湿及·切病之久而不去，甚虚其气者，皆极也。极有气、血、筋、骨、肌、精六症者，谓病于气，其极也小欲言；病于血，其极也无颜色，眉发堕落，喜忘。余皆仿此。然约之亦不外形、神也。大抵劳言其始，极言其终，分别截然。”
《难经》对虚劳证候不以五劳七伤六极归类，而主以“五损”。《难经》第十四难曰：“一损损于皮毛，皮聚而毛落；二损损于血脉，血脉虚少，不能荣于五脏六腑；三损损于肌肉，肌肉消瘦，饮食不能为肌肤；四损损于筋，筋缓不能自收持；五损损于骨，骨痿不能起于床。”《难经》之五损叙证皆在形体，未及精神情志及五脏六腑，其实“五损”之证皆本五脏：一损本于肺，二损本于心，三损本于脾，四损本于肝，五损本于肾。与五劳七伤六极仍属一致，并无原则区别，仅有证情轻重程度之异。至于五损与劳伤之关系，乃依病情由轻而重逐步递进。清代张鲁峰于《馤塘医话》中曰：“人之不足，由虚而损，由损而劳，(孟城注：此劳字含五劳七伤在内)由劳而极。”
其实，无论为虚、为损、为劳、为极，总不离“阴阳、气血、脏腑亏损”之基本病理。故虚劳之病，当以人身阴、阳、气、血四者之虚衰为经，以五脏之亏损为纬，则病无遁情、治无不中矣。
如近人恽铁樵于《风劳鼓病论》中曰：“五脏虽分，五脏所藏无非精气，其所以致损者有四：曰气虚，曰血虚，曰阳虚，曰阴虚。”气、血、阴、阳五脏皆具，而病变既成，必有侧重，并不等量齐观。如恽氏又曰：“而气血阴阳各有专主，认得真确，方可施治。”如气虚虽五脏皆有，而虚劳病中以脾肺两经为重点；同样，血虚以心肝两经为重点；阳虚以心脾肾为重点；而阴虚则以肺肾为重点。现将相关病证摘要列之于下：
气虚：肺气虚者症见短气、自汗、气怯音低，时寒时热。可兼咳嗽，易患感冒。舌质淡，脉软无力。脾气虚者症见食欲不振，饮食减少，食后胃脘不舒，平素四肢困乏，懒于言语，色萎便溏。舌淡苔薄，脉软无力。
血虚：心血虚者症兀尢心悸怔忡，健忘失眠，多梦纷纷，面色少华。舌淡，脉细或结。肝血虚者症见头晕目眩，耳鸣胁痛，易于惊惕。妇人月事不调，甚者经闭。舌淡，脉弦细或细涩。
阳虚：心阳虚者心悸、气短，动则气促，神倦嗜寐，心胸憋痛，面色苍白，舌淡或紫黯，脉细弱或结而无力，或虚大无力。脾阳虚者症见面萎食少，纳减腹胀，腹中冷痛，喜温喜按，四肢不温，大便稀溏。甚则完谷不化，舌淡白，脉虚弱无力。肾阳虚者症见面色苍白无华，形寒肢冷，腰膝冷痛，阳痿早泄，或五更泄泻，尿多或小便失禁。舌体淡胖，边多齿印，苔白，脉沉迟。
阴虚：肺阴虚者症见于咳，少痰，咽燥口干，潮热盗汗，甚则失音或痰中带血。舌干少津，甚则舌红无苔，脉细涩，或细数。肾阴虚者症见眩晕耳鸣，甚则耳聋，潮热颧红，腰膝酸软，口干不欲饮，咽痛舌疮，甚则失音赢瘦，两足痿弱无力。舌干少津，甚则舌红，脉沉细无力。
虚劳独特之脉，仲景于《金匮要略》中已有论述：“男子平人，脉大为劳，极虚亦为劳。”论者每以脉大无力之劳为气虚，极虚之劳为肾虚。喻嘉言则曰：“虚劳之脉多见浮大。”又曰：“浮大弦紧，外象有余，其实中藏不足。”而《馤塘医话》于“补编”中所言虚劳之脉，大符临床实际：“虚劳之脉必数，而有浮大、细小之别。浮大而数，阴虚甚也；细小而数，阴中之阳绝矣。又有一种阳虚者，脉不数，但缓而大不收，奄奄无力。”可供临证参考。
四、治疗原则
虚劳之治，当宗《内经》“损者益之”、“劳者温之”及“形不足者温之以气，精不足者补之以味”为基本法则。总以调补患者气血阴阳之虚损，使致充实平衡以恢复健康为目的。
喻子嘉言曰：“秦越人发明虚损一证，优入圣域，虽无方可考，然其论治损之法：损其肺者益其气；损其心者调其荣卫；损其肾者益其精，即此便是正法眼藏。”虽虚劳之症，五脏皆可致病，然五脏之中，以肺脾肾三脏更为首要。《理虚元鉴》曰：“治虚有三本，肺脾肾是也。肺为五脏之天，脾为百骸之母，肾为性命之根，治肺，治脾，治肾，治虚之道毕矣。”而肺脾肾三者之中，又以脾肾更为着重。
《医门法律》云：“治法当以脾肾两脏为要，肾乃系元气者也，脾乃养形体者也。”明代薛己《医宗摘要》亦云：“治虚劳，当以脾肾两脏为要。”
关于治脾，不仅脾胃为后天之本，生化气血以营养五脏六腑、四肢百骸。土居中州，万物所归，有执中央以灌四旁之能。且脾土于虚损症中自有其特殊地位与作用。医书对虚劳有上损下损之说，如秦伯未先生于《内科纲要》中曰：“自上损下者，一损损于肺，二损损于心，三损损于脾，过于脾则不可治。自下损上者，一损损于肾，二损损于肝，三损损于胃，过于胃则不可治。所谓过于脾胃者，吐泻是也。”更引古人之言曰：“不问阴阳与冷热，先将脾胃与安和。”虚劳患者，如若脾胃渐健，纳谷渐馨，饮食畅进，气血由生，必臻病去正复，五脏安和之佳境，何虑虚劳之不治哉。清代名医程杏轩精于歧黄，经验宏富，其于“医案辑录”中直抉心源：“稽古补虚之法，千蹊万经，为其关键，总以脾胃为之主脑。”
肾为先天之本，中含水火二质、阴阳二气，肾阴肾阳即真阴真阳，为人身阴阳之基础，亦即生命之根本所在。凡五脏有虚损者，病久必及于肾。故治虚损者，舍肾脏于不顾则非其治矣。景岳于《全书》“虚损”病篇“论治”条，开宗明义，慨然而论曰：“病之虚损，变态不同，因有五劳七伤，证有荣卫脏腑，然总之则人赖以生者，惟此精气。而病为虚损者，亦惟此精气。气虚者即阳虚也，精虚者即阴虚也。凡病有火盛水亏而见荣卫燥、津液枯者，即阴虚之证也。有水盛火亏而见脏腑寒、脾肾败者，即阳虚之证也。”故治虚劳者，必察肾气之盛衰，倘有损伤，宜速弭平。
余临证所见，凡虚损者久病理其脾而仍无起色者，莫不与肾有关。且肾阴虚者远较肾阳虚者为多，更多兼见虚火旺盛，是以《十药神书》有“肾虚精极、火盛金衰”之论。无论阴虚阳虚，治疗之关键在于固精，若漏卮不堵，虽日进龟鹿参杞，与病何益!
固精堵漏虽属重要，而更其要者尤在保精以自珍摄。较之徒恃药力，更为上乘。
《笔花医镜》曰：“惟在屏弃一切，不近女色，调饮食、慎风寒、息嗔怒，静养二、三年，服药可，不服药亦可。自然生机徐转，复其天和，非旦夕所能效也。”此外，如能完善自我之品德修养与加强精神调护，则善之又善也。如《馤塘医话》曰：“凡患此者，修德为上，制药次之；治心为上，治身次之。”此保养调摄之道，亦属“勿药元诠”，不用药饵，胜于药饵，于虚损劳伤诸证，不啻上池之水也。
痨瘵试析
一、释名
古医籍中，痨瘵亦作劳瘵。盖本病每以虚损劳伤为其病理基础，故昔贤常用“劳”字，余则以本病必有痨虫传染，且已形成独立病名，为与虚损、劳伤区别故，选用“痨”字为名。本病于古籍中名称特多，如飞尸、鬼注、传尸痨、尸注、复连、骨蒸、劳极、无辜等，要皆痨瘵之病。
The other meaning of Xu Lao (Deficiency Labour, a syndrome characterized by chronic deficiency and exhaustion) refers to the situation where, on the basis of Xu Sun (Deficiency Damage), there is additionally an emerging internal heat and intensifying Deficient Fire (Xu Huo), which scorches Qi and Blood, leading to Blood Stasis that fails to circulate. Over time, this transforms into parasites that gnaw at the Zang-Fu organs, resulting in Lao Bing (Tuberculous Disease), or it may be caused by infection with Lao Chong (Tuberculosis Parasites). As stated in *Feng Lao Gu Ge Si Da Zheng Zhi* (Treatment of the Four Major Syndromes: Wind, Labour, Distension, and Dysphagia): "Xu refers to insufficiency of Qi and Blood; Sun refers to damage of the Five Zang organs; Lao refers to Fire blazing upwards. Lao Zhai (Chronic Consumptive Disease) involves both Xu and Sun, further exhausting strength, and stirring up Fire to form Lao. If one is Xu but not Lao, it is merely called 'Insufficiency'; if one is Xu and Lao, then development into Zhai or Steaming Bone Syndrome (Zheng) becomes inevitable." It also states: "Therefore, Lao must originate from Xu; when Xu reaches its extreme, it inevitably leads to Lao." Furthermore, *Yan Jing Yan* (Remarks on Studying Classics) says: "What is now called Xu Lao was formerly called Zheng (Steaming); what was formerly called Xu Lao is now called Tuo Li (Exhaustion of Strength)." Thus, the term "Xu Lao" encompasses both Xu Sun and Lao Zhai. Therefore, the definition of "Xu Lao" in the *Chinese Medicine Dictionary* adopts this meaning: Xu Lao "includes weak syndromes caused by damage to the body's righteous Qi such as Qi, Blood, and Zang-Fu organs, as well as certain infectious diseases manifesting as weak syndromes. Later generations mostly referred to the former as Xu Sun and the latter as Lao Zhai or Chuan Shi Lao (Transmissible Corpse Labour)."
II. Etiology
Regarding the formation of Xu Lao, *Li Xu Yuan Jian* (Original Records on Managing Deficiency) lists six causes: "There are congenital causes, acquired causes, causes related to smallpox/rash and post-illness conditions, external contraction causes, environmental/psychological causes, and medical treatment causes." The so-called congenital cause refers to innate constitution and genetic factors. Acquired causes include overexertion and poor nursing/care. Smallpox/rash, post-illness conditions, and external contractions are disease factors. Environmental causes refer to psychological factors, while medical causes refer to illness induced by erroneous medication.
Although this disease has these six categories of causes, and factors such as constitution, psychological state, external contractions, diseases, and environment can interact to cause illness, they ultimately fall into two categories: internal and external causes. Among external causes, the failure to resolve external pathogenic factors after contraction, allowing pathogens to remain for a long time, is the most significant. For instance, *Bi Hua Yi Jing* (Medical Mirror of Pen Flowers) in its section on "Treatment Principles of Xu Lao" points out: "The syndrome of Xu Lao naturally results from the depletion of True Yin and Deficient Fire scorching Metal (Lung). However, initially, it largely stems from external contraction. When pathogens affect the Lung, coughing occurs. If treatment is inappropriate, the cough persists. Prolonged coughing damages Lung Metal; once Metal is damaged, it cannot generate Water (Kidney), causing Kidney Water to wither daily and Kidney Fire to blaze increasingly, burning upwards into the Lung. Coupled with indulgence in sexual desires and exposure to external pathogens, depleting Water further, Xu Lao is formed."
External contraction leading to Lao is discussed in the *Nei Jing* (Inner Canon). You Yi, in his commentary on the verse "Lao Feng (Labour Wind) typically resides below the Lung" in *Yi Xue Du Shu Ji* (Records Read in Medical Study), sighs: "Reading this, one can understand why unresolved wind-cold turns into Lao. Lao Feng means labour combined with wind exposure. Labour generates Fire upwards, and Wind takes advantage of this." "If sweat does not emerge, Wind and Fire accumulate in the Lung, damaging it. Lung damage leads to wheezing, coughing, and hoarseness, gradually affecting the Five Zang organs, thus forming Xu Lao." It is no wonder that Mr. Qi Shi loudly proclaimed: "An unresolved wind-cold easily turns into Lao."
Internal causes leading to Lao mainly involve Water Insufficiency with Fire Hyperactivity, Earth Weakness, and Metal Damage. As *Bi Hua Yi Jing* states: "Occasionally, due to insufficient original essence and excessive mental exertion, Heart Blood is consumed, Heart Fire blazes, Kidney Water dries up, and Lung Metal withers. Although the onset differs, the result of forming Lao is the same." Internal causes encompass the acquired, disease-related, environmental, and medical factors mentioned in *Li Xu Yuan Jian*, and are also closely related to innate constitution and physical strength.
Whether external or internal causes, prevention is key. One must not procrastinate until illness sets in, only to dig a well when thirsty or forge weapons when fighting begins, which would be too late. Normally, one should restrain desires to conserve Essence and preserve Spirit, regulate diet to support the Post-Heaven foundation, and curb anger to nurture natural lifespan. If external pathogens are contracted, administer medicine promptly to disperse them quickly, ensuring health and safety.
From this, we know that contracting external pathogens and their lingering presence is a major cause of Xu Lao. Therefore, in clinical practice, any case of external contraction should be taken seriously, not dismissed as minor. Prompt, correct, and efficient treatment is essential to rapidly and thoroughly dispel pathogens, preventing them from lingering and causing future complications. This is the ideal approach.
III. Clinical Manifestations
Regarding the manifestations of this disease, *Chao Shi Bing Yuan* (Source of Diseases by Master Chao) proposes the pathological changes of Wu Lao (Five Labours), Liu Ji (Six Extremes), and Qi Shang (Seven Injuries), detailing 75 different syndromes. Later physicians generally followed this view, although the specific contents of Wu Lao, Liu Ji, and Qi Shang varied among schools. For example, *Chao Yuan* states: "Xu Lao consists of Wu Lao, Liu Ji, and Qi Shang." Both Wu Lao and Qi Shang contain two distinct categories. The first category of Wu Lao focuses on emotional labour: "First is Zhi Lao (Will Labour), second is Si Lao (Thinking Labour), third is Xin Lao (Heart Labour), fourth is You Lao (Worry Labour), fifth is Shou Lao (Emaciation Labour)." The second category categorizes syndromes by the Five Zang organs: "Lung Lao presents with shortness of breath and swelling, loss of smell. Liver Lao presents with dry black complexion, bitter taste, unsettled spirit, fearfulness preventing solitary sleep, and blurred vision. Heart Lao presents with sudden forgetfulness, difficult stool, or loose duck-like stool, and mouth ulcers. Spleen Lao presents with a stiff tongue base, inability to swallow saliva. Kidney Lao presents with difficulty bending and stretching the back, dysuria, reddish urine, sallow complexion with dribbling, pain inside the penis, damp genitals, sores on the scrotum, and fullness/urgency in the lower abdomen." Conversely, the anonymous Qing dynasty work *Za Zheng Zhi Yao Mi Lu* (Secret Record of Essential Treatments for Miscellaneous Diseases) cites the *Nei Jing*, defining Wu Lao as: "Prolonged viewing damages Blood, prolonged lying damages Qi, prolonged sitting damages Flesh, prolonged walking damages Sinews, prolonged standing damages Bones." Although books vary on the content of Wu Lao, it ultimately revolves around the labour-damage of the Five Zang organs and the five aspects of Essence, Qi, Spirit, Thought, and Form.
Similarly, Qi Shang in *Chao Shi Bing Yuan* has two meanings: The first is "First is Yin Cold; Second is Yin Flaccidity; Third is Interior Urgency; Fourth is Continuous Semen Leakage; Fifth is Scanty Semen with Damp Genitals; Sixth is Clear Semen; Seventh is Painful Frequent Urination and Impotence." The second meaning is: "First is Excessive Fullness Damaging Spleen (Spleen damage leads to belching, desire to lie down, sallow face); Second is Great Anger Reversing Qi Damaging Liver (Liver damage leads to scanty Blood and dim vision); Third is Forceful Lifting/Sitting on Wet Ground Damaging Kidney (Kidney damage leads to scanty Essence, lower back pain, cold extremities); Fourth is Body Cold/Cold Drinks Damaging Lung (Lung damage leads to scanty Qi, coughing, nasal congestion); Fifth is Worry/Thought Damaging Heart (Heart damage leads to fright-induced forgetfulness and irritability); Sixth is Wind/Rain/Cold/Heat Damaging Form (Form damage leads withered skin/hair); Seventh is Unrestrained Great Anger/Fear Damaging Will (Will damage leads to confusion and unhappiness)." The first meaning focuses on Lower Jiao and Kidney Essence depletion, while the second emphasizes Zang-Fu damage as the primary pathology.
When the human body develops illness from Wu Lao and Qi Shang, compounded by missed or erroneous treatment, the pathology progresses from superficial to deep, from mild to severe, eventually becoming the "Six Extremes": Qi Extreme, Blood Extreme, Sinew Extreme, Bone Extreme, Muscle Extreme, and Essence Extreme. At this stage, the condition is a severe deficiency damage, making treatment difficult.
According to *Chao Shi Bing Yuan*, the manifestations of the Six Extremes are: "First, Qi Extreme causes internal emptiness, insufficiency of Five Zang, excess pathogenic Qi, deficient righteous Qi, and reluctance to speak. Second, Blood Extreme causes lack of luster, falling eyebrows/hair, and sudden forgetfulness. Third, Sinew Extreme causes frequent cramps, pain in all ten fingernails/toenails, and fatigue preventing prolonged standing. Fourth, Bone Extreme causes soreness/emaciation, toothache, vexing pain in hands/feet, inability to bear weight, and reluctance to move. Fifth, Muscle Extreme causes emaciation/lack of luster, and food failing to nourish flesh. Sixth, Essence Extreme causes scanty Qi, internal buzzing/emptiness, insufficiency of Five Zang Qi, falling hair, and sadness/forgetfulness."
Mr. Mo Meishi of the Qing dynasty offered profound insights into Wu Lao, Qi Shang, and Liu Ji in *Yan Jing Yan*: "Anciently, Wu Lao, Qi Shang, and Liu Ji were all described as Xu (deficiency). Examining them, they reduce to two ends: Lao and Ji. Lao is overuse of Qi; Ji is nearly having no Qi left, differing in depth. According to *Bing Yuan*, Zhi Lao, Heart Lao, and You Lao in Wu Lao represent overuse of Spirit; Fatigue Lao represents overuse of Form. Qi Shang includes sexual labour diseases, also belonging to Lao, but listed separately due to variety. Since Essence is one of the Seven Spirits, it is also overuse of Spirit. Summarizing, it covers Form and Spirit. If Wind, Cold, Summer-heat, Dampness, and all chronic illnesses severely deplete Qi, they are Ji. The six symptoms of Ji (Qi, Blood, Sinew, Bone, Muscle, Essence) correspond to: Qi Ji implies reluctance to speak; Blood Ji implies lack of luster, falling hair, forgetfulness. Others follow suit. Summarizing, they do not exceed Form and Spirit. Generally, Lao refers to the beginning, Ji to the end, clearly distinguished."
*Nan Jing* (Classic of Difficult Issues) classifies Xu Lao syndromes not by Wu Lao/Qi Shang/Liu Ji, but primarily by "Wu Sun" (Five Damages). Chapter 14 of *Nan Jing* states: "First Damage affects Skin/Hair (skin gathers, hair falls); Second Damage affects Blood Vessels (vessels become deficient, failing to nourish Zang-Fu); Third Damage affects Muscle (muscle wastes, food fails to build flesh); Fourth Damage affects Sinews (sinews relax, unable to hold themselves); Fifth Damage affects Bone (bone flaccid, unable to rise from bed)." The descriptions of Wu Sun in *Nan Jing* focus on the physical form, neglecting spirit/emotions and Zang-Fu specifics. However, the "Five Damages" are fundamentally based on the Five Zang: First Damage originates in Lung, Second in Heart, Third in Spleen, Fourth in Liver, Fifth in Kidney. This is consistent with Wu Lao, Qi Shang, and Liu Ji, with no principled difference, only varying severity. The relationship between Wu Sun and Labour-Damage follows a progression from mild to severe. Zhang Lufeng in Qing dynasty's *Di Tang Yi Hua* (Medical Conversations from Di Pond) states: "Human insufficiency progresses from Xu to Sun, from Sun to Lao (Note: Lao here includes Wu Lao and Qi Shang), and from Lao to Ji."
In reality, whether termed Xu, Sun, Lao, or Ji, the basic pathology never deviates from "Yin-Yang, Qi-Blood, and Zang-Fu Deficiency." Therefore, treating Xu Lao should take the deficiency of Yin, Yang, Qi, and Blood as the longitudinal axis, and Zang-Fu damage as the transverse axis, ensuring no hidden pathology escapes detection and treatment hits the mark.
As the modern physician Yun Tieqiao stated in *Feng Lao Gu Bing Lun* (Discussion on Wind, Labour, and Distension Diseases): "Although the Five Zang are divided, what they store is nothing but Essence and Qi. The four reasons for damage are: Qi Deficiency, Blood Deficiency, Yang Deficiency, and Yin Deficiency." Qi, Blood, Yin, and Yang exist in all Five Zang, but once pathology forms, there must be a focus, not equal distribution. Yun further stated: "Qi, Blood, Yin, and Yang each have specific dominances; accurate identification allows for proper treatment." For instance, although Qi Deficiency can occur in any Zang, in Xu Lao, the Spleen and Lung are key; similarly, Blood Deficiency focuses on Heart and Liver; Yang Deficiency on Heart, Spleen, and Kidney; and Yin Deficiency on Lung and Kidney. Relevant syndromes are summarized below:
Qi Deficiency: Lung Qi Deficiency presents with shortness of breath, spontaneous sweating, timid voice, alternating chills and fever. May accompany coughing and susceptibility to colds. Tongue pale, pulse soft/weak. Spleen Qi Deficiency presents with poor appetite, reduced food intake, epigastric discomfort after eating, general limb fatigue, reluctance to speak, sallow complexion, and loose stools. Tongue pale with thin coating, pulse soft/weak.
Blood Deficiency: Heart Blood Deficiency presents with palpitations, anxiety, insomnia, vivid dreams, and lackluster complexion. Tongue pale, pulse fine or knotted. Liver Blood Deficiency presents with dizziness, tinnitus, hypochondriac pain, and easy startle. In women, irregular menstruation or amenorrhea. Tongue pale, pulse wiry-fine or fine-choppy.
Yang Deficiency: Heart Yang Deficiency presents with palpitations, shortness of breath, panting on exertion, mental fatigue/drowsiness, chest tightness/pain, sallow complexion, pale or purplish-dark tongue, and fine/weak or knotted/weak pulse, or empty/large/weak pulse. Spleen Yang Deficiency presents with sallow complexion, poor appetite, reduced intake with abdominal distension, cold pain in abdomen relieved by warmth/pressure, cold limbs, and loose stools. Severe cases show undigested food in stool. Tongue pale-white, pulse weak/empty. Kidney Yang Deficiency presents with sallow/lifeless complexion, aversion to cold/cold limbs, cold pain in lower back/knees, impotence/premature ejaculation, or morning diarrhea, polyuria or urinary incontinence. Tongue pale-swollen with teeth marks, white coating, deep/slow pulse.
Yin Deficiency: Lung Yin Deficiency presents with dry cough, scanty sputum, dry throat/mouth, tidal fever/night sweats, potentially hoarseness or blood-tinged sputum. Tongue dry with little fluid, potentially red without coating, pulse fine-choppy or fine-rapid. Kidney Yin Deficiency presents with dizziness/tinnitus, potentially deafness, tidal fever/flushed malar region, sore/weak lower back/knees, dry mouth without desire to drink, sore throat/mouth ulcers, potentially hoarseness/emaciation, and weakness in both feet. Tongue dry with little fluid, potentially red, deep/fine/weak pulse.
Unique pulses for Xu Lao were discussed by Zhang Zhongjing in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet): "For a healthy man, a large pulse indicates Lao, and an extremely empty pulse also indicates Lao." Commentators often attribute large/weak pulses to Qi Deficiency Lao, and extremely empty pulses to Kidney Deficiency Lao. Yu Jiayan stated: "Pulses in Xu Lao often appear floating and large." He also said: "Floating, large, wiry, and tight pulses suggest excess externally, but reveal insufficiency internally." *Di Tang Yi Hua* in its "Supplement" describes Xu Lao pulses fitting clinical reality: "Pulses in Xu Lao must be rapid, varying between floating/large and fine/small. Floating/large and rapid indicates severe Yin Deficiency; fine/small and rapid indicates extinction of Yang within Yin. Another type, Yang Deficiency, shows non-rapid pulses, but slow, large, uncontained, and extremely weak pulses." These are useful for clinical reference.
IV. Treatment Principles
Treatment of Xu Lao should follow the *Nei Jing* principles: "Restore those who are diminished," "Warm those who are laboured," and "Warm form insufficiency with Qi, tonify essence insufficiency with flavour." The general goal is to regulate and tonify the patient's deficient Qi, Blood, Yin, and Yang, restoring balance and health.
Yu Jiayan stated: "Qin Yueren elucidated the syndrome of deficiency damage, reaching sage-like proficiency. Although no specific formulas remain, his method of treating damage is: Tonify Qi for Lung damage; harmonize Ying and Wei for Heart damage; benefit Essence for Kidney damage. This is the orthodox eye-storehouse of law." Although any of the Five Zang can cause Xu Lao, the Lung, Spleen, and Kidney are paramount. *Li Xu Yuan Jian* states: "There are three roots in treating deficiency: Lung, Spleen, and Kidney. The Lung is the sky of the Five Zang; the Spleen is the mother of the hundred bones; the Kidney is the root of life and destiny. Treating Lung, Spleen, and Kidney completes the way of treating deficiency." Among these three, Spleen and Kidney are emphasized more.
*Yi Men Fa Lü* (Legal Methods of Medicine) states: "Treatment should focus on the Spleen and Kidney. The Kidney anchors Original Qi; the Spleen nourishes the physical form." Xue Ji of the Ming dynasty in *Yi Zong Yao Miao* also said: "Treating Xu Lao must focus on the Spleen and Kidney."
Regarding Spleen treatment: Not only is the Spleen/Stomach the Post-Heaven foundation, generating Qi and Blood to nourish Zang-Fu and limbs, but Earth resides in the Central Plains, gathering all things, possessing the ability to irrigate the four directions from the center. Moreover, Spleen Earth holds a special status in deficiency syndromes. Medical texts discuss Upper Damage descending and Lower Damage ascending. Mr. Qin Bowei in *Nei Ke Gang Yao* (Outline of Internal Medicine) states: "Upper damage descending: First damages Lung, second Heart, third Spleen; if it passes Spleen, it is incurable. Lower damage ascending: First damages Kidney, second Liver, third Stomach; if it passes Stomach, it is incurable. Passing Spleen/Stomach manifests as vomiting/diarrhea." He further quotes ancients: "Regardless of Yin/Yang or Cold/Heat, first soothe and harmonize the Spleen/Stomach." If a Xu Lao patient's Spleen/Stomach gradually strengthens, appetite improves, food enters smoothly, Qi and Blood generate, the patient will surely reach a state of recovered righteousness and harmonious Zang-Fu. Why worry about untreatable Xu Lao? The famous Qing dynasty physician Cheng Anxuan, experienced in Huangdi and Qibo's teachings, pinpointed the source in his "Case Records": "Examining ancient methods of tonifying deficiency, thousands of paths and scriptures exist, but the key always centers on the Spleen/Stomach."
The Kidney is the Pre-Heaven foundation, containing Water and Fire qualities, and Yin and Yang energies. Kidney Yin and Yang are True Yin and True Yang, the foundation of the body's Yin-Yang and the root of life. Any Zang with deficiency damage will eventually affect the Kidney over time. Thus, ignoring the Kidney in treating deficiency damage is incorrect. Jingyue, in the "Discussion on Treatment" section of the "Deficiency Damage" chapter in his *Quan Shu* (Complete Works), opens with: "Disease variations in deficiency damage differ, caused by Wu Lao and Qi Shang, manifesting in Ying-Wei and Zang-Fu. However, essentially, what sustains life is only this Essence and Qi. And what constitutes deficiency damage is also only this Essence and Qi. Qi Deficiency is Yang Deficiency; Essence Deficiency is Yin Deficiency. Diseases with excessive Fire and deficient Water showing dry Ying-Wei and withered fluids are Yin Deficiency syndromes. Diseases with excessive Water and deficient Fire showing cold Zang-Fu and Spleen/Kidney failure are Yang Deficiency syndromes." Therefore, treating Xu Lao requires observing the flourishing or decline of Kidney Qi; if damaged, it must be quickly healed.
In my clinical experience, whenever deficiency damage patients treated for the Spleen for a long time show no improvement, it is invariably related to the Kidney. Moreover, Kidney Yin Deficiency is far more common than Kidney Yang Deficiency, often accompanied by vigorous Deficient Fire. Hence, *Shi Yao Shen Shu* (Divine Book of Ten Medicines) discusses "Kidney Deficiency, Essence Extreme, Fire Blazing, Metal Declining." Whether Yin or Yang Deficiency, the key to treatment is securing Essence. If the leaky vessel is not plugged, even daily consumption of Tortoise, Deer, Ginseng, and Goji berries benefits nothing.
While securing Essence and plugging leaks is important, preserving Essence through self-care is even more crucial. This is superior to relying solely on medicinal power.
*Bi Hua Yi Jing* states: "It depends on discarding everything, avoiding sexual contact, regulating diet, guarding against wind/cold, calming anger, and resting quietly for two or three years. Taking medicine is optional; not taking it is also fine. Naturally, vital energy will slowly turn, restoring Heavenly Harmony. Effects cannot be seen overnight." Additionally, perfecting moral character and strengthening mental care is excellent. As *Di Tang Yi Hua* states: "For those suffering from this, cultivating virtue is primary, preparing medicine secondary; treating the mind is primary, treating the body secondary." This path of maintenance belongs to "Wu Yao Yuan Quan" (Original Meaning of No Medicine); not using drugs is better than using drugs. For various deficiency and labour-damage syndromes, it is like water from Shangchi (legendary healer Bian Que's spring).
Analysis of Lao Zhai
I. Etymology
In ancient medical texts, Lao Zhai is also written as Lao Zhai. Since this disease often has deficiency damage and labour as its pathological basis, past sages commonly used the character "Lao." I use "Lao" (Tuberculosis) because this disease necessarily involves transmission by Lao Chong (tuberculosis bacilli) and has formed an independent disease name, distinguishing it from general deficiency and labour. This disease has many names in ancient texts, such as Fei Shi (Flying Corpse), Gui Zhu (Ghost Attachment), Chuan Shi Lao (Transmissible Corpse Labour), Shi Zhu (Corpse Attachment), Fu Lian (Repeated Connection), Gu Zheng (Bone Steaming), Lao Ji (Labour Extreme), Wu Gu (Innocent), etc., all referring to Lao Zhai.