骨蒸发热，脉数而虚。热而涩小，必殒其躯。
骨蒸发热者，热自骨起，蒸发于外，内伤虚劳之热也。脉数而虚，是其本然。
盖以数为热，虚为劳耳。若蒸热而见涩小之脉，涩则精血少，小则元气衰。真阴日
损，邪火日增，不至于殒躯不已也。（方参看劳极门。）
劳极诸虚，浮软微弱。土败双弦。火炎急数。
劳极者，五劳六极也。巢氏病源云∶五劳者，一曰志劳、二曰思劳、三曰心劳、
四曰忧劳、五曰瘦劳。（瘦当是肝劳。）又云∶肺劳者，短气而面肿，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，舌苦直，不得咽唾。肾劳者，背难以俯仰，
小便不利，色赤黄而有余沥，茎内痛，阴湿囊生疮，小腹满急。此五劳各见五脏气
化，及经络诸证，亦甚明显。但与前五劳，不甚符合。姑存此，俟再考也。六极者，
一曰气极，令人内虚，五脏不足，邪气多，正气少，不欲言。（宜四君子汤、补中益气汤、参
术膏之类。）二曰血极，令人无颜色，眉发堕落，忽忽喜忘。（宜四物汤、六味丸、八珍汤、圣愈汤之
类。）三曰筋极，令人数转筋，十指爪甲皆痛，苦倦，不能久立。（宜四物汤、圣愈汤、济生续
断汤、木瓜散之类。）四曰骨极，令人 削，齿苦痛，手足烦疼，不可以立，不欲行动。（宜六
味丸、鹿角丸、保命金刚丸、丹溪虎潜丸之类。）五曰肌极，令人羸瘦无润泽，饮食不生肌肤。（宜四
君子汤、保命黑地黄丸、资生丸之类。）六曰精极，令人少气， 然内虚，五脏气不足，发毛
落，悲伤喜忘。（宜六味丸、还少丹、龟鹿胶之类。）是即五脏所合之病，虚损而至于极处者也。
肾则多一精极，故为六极。其证与五脏配合，甚为有理，此巢氏之三昧论也。诸虚
者，言一切虚损不足，即五劳六极，更有七伤，俱该在内。巢氏云∶七伤者，一曰
阴寒，二曰阴痿，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。又云∶七伤者，一曰大饱伤脾。脾伤善噫、欲卧、面黄。（宜资生
丸、保和丸、平胃散之类。）二曰大怒气逆伤肝。肝伤少血、目暗。（宜四物汤、元戎逍遥散之
类。）三曰强力举重、久坐湿地伤肾。肾伤少精、腰背痛、厥逆下冷。（宜黑地黄丸、肾着汤、八味丸、宝
鉴天真丹之类。）四曰形寒寒饮伤肺。肺伤少气、咳嗽鼻鸣。（宜小青龙汤、麻黄汤之类。）五曰忧愁
思虑伤心。心伤苦惊，喜忘善怒。（宜天王补心丸、朱砂安神丸、朱雀丸之类。）六曰风雨寒暑伤形。
形伤发肤枯夭。（宜人参养荣汤之类。）七曰大恐惧不节伤志。（言大恐惧而不节于欲也。）志伤恍惚不
乐。（宜天王补心丸、安神丸之类。）是云七伤。亦合于五脏，但多一形志，故云七伤。较前所
云七伤，此为得理。盖前七伤，大抵俱属肾证。人身感疾，触处可伤，岂独一肾。
若云肾有七伤则可。正文不言七伤而注录者，欲其便于查考耳。夫劳极损伤，气血
日耗，形体渐衰。所见之脉，随病呈象。如空虚之浮、不鼓之软、欲绝之微、无力
之弱。虽云病脉，然与病犹相宜也。至若双弦，乃知土败。急数定为火炎。盖弦为
肝木，双弦则木太盛。久病之土，何堪其侮，故知其必败也。数已为热。急数，则
躁疾直强，略无半点和柔。邪火炎炎，真阴自绝。两皆不治之证。
Bone-steaming fever presents with a rapid and deficient pulse. If there is steaming fever accompanied by a choppy and small pulse, death is inevitable.
Bone-steaming fever refers to heat arising from the bones and steaming outward; it is the heat syndrome caused by internal injury and deficiency consumption (Xu Lao). A rapid and deficient pulse is its natural presentation.
This is because "rapid" indicates heat, and "deficient" indicates exhaustion. If steaming fever is seen with a choppy and small pulse, a choppy pulse signifies a scarcity of essence and blood, while a small pulse signifies a decline of primordial qi. As true yin is daily depleted and pathogenic fire daily increases, the condition will not cease until the body perishes. (For formulas, refer to the section on Extreme Exhaustion.)
Various deficiency syndromes of extreme exhaustion present with floating, soft, and weak pulses. A double wiry pulse indicates the failure of Earth (Spleen); an urgent and rapid pulse indicates flaming fire (Heart).
Extreme exhaustion refers to the Five Labors and Six Extremes. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states: The Five Labors are: first, Labor of Will (Zhi Lao); second, Labor of Thought (Si Lao); third, Labor of Heart (Xin Lao); fourth, Labor of Worry (You Lao); fifth, Labor of Emaciation (Shou Lao) [Note: "Shou" should likely be "Liver Labor"]. It further states: In Lung Labor, there is shortness of breath and facial swelling, and the nose cannot perceive odors. In Liver Labor, the face and eyes are dry and dark, there is bitter taste in the mouth, spirit fails to remain anchored, fear prevents sleeping alone, and vision is unclear. In Heart Labor, there is mental confusion and forgetfulness, difficult and hard stools, or sometimes loose duck-dung-like diarrhea, and sores in the mouth. In Spleen Labor, the tongue is stiff and straight, making swallowing of saliva difficult. In Kidney Labor, the back is difficult to bend forward or backward, urination is obstructed, urine is red-yellow with dribbling, there is pain inside the penis, dampness in the genitalia with sores on the scrotum, and fullness and urgency in the lower abdomen. These five labors manifest the dysfunction of the Qi transformation of the five Zang organs and various meridian symptoms, which are quite obvious. However, they do not fully match the previous description of the five labors. This is retained here for future verification. The Six Extremes are: first, Extreme of Qi, causing internal emptiness, insufficiency of the five Zang organs, excess of pathogenic factors, scarcity of righteous Qi, and reluctance to speak. (Suitable formulas include Si Jun Zi Tang [Four Gentlemen Decoction], Bu Zhong Yi Qi Tang [Tonify the Middle and Augment the Qi Decoction], and Shen Zhu Gao [Ginseng and Atractylodes Paste].) Second, Extreme of Blood, causing lack of luster in the complexion, falling eyebrows and hair, mental confusion and forgetfulness. (Suitable formulas include Si Wu Tang [Four Substance Decoction], Liu Wei Wan [Six-Ingredient Pill with Rehmannia], Ba Zhen Tang [Eight Treasure Decoction], and Sheng Yu Tang [Nourish Life Decoction].) Third, Extreme of Tendons, causing frequent muscle spasms, pain in all ten fingers and nails, severe fatigue, and inability to stand for long periods. (Suitable formulas include Si Wu Tang, Sheng Yu Tang, Ji Sheng Xu Duan Tang [Ji Sheng Continuation-of-Tendons Decoction], and Mu Gua San [Papaya Powder].) Fourth, Extreme of Bones, causing emaciation, painful teeth, vexing pain in hands and feet, inability to stand, and reluctance to move. (Suitable formulas include Liu Wei Wan, Lu Jiao Wan [Deer Antler Pill], Bao Ming Jin Gang Wan [Life-Preserving Diamond Pill], and Dan Xi Hu Qian Wan [Danxi Tiger-Hiding Pill].) Fifth, Extreme of Flesh/Muscles, causing emaciation without moisture/luster, and food failing to transform into flesh/muscle. (Suitable formulas include Si Jun Zi Tang, Bao Ming Hei Di Huang Wan [Life-Preserving Black Earth Rehmannia Pill], and Zi Sheng Wan [Nourishing Life Pill].) Sixth, Extreme of Essence, causing shortness of breath, sweating with internal emptiness, insufficiency of Qi in the five Zang organs, falling hair, sadness, and forgetfulness. (Suitable formulas include Liu Wei Wan, Hai Shao Dan [Return to Youth Elixir], and Gui Lu Jiao [Tortoise and Deer Glue].) These are diseases associated with the five Zang organs, representing deficiency reaching the extreme. The Kidney has one additional category, Extreme of Essence, hence the term Six Extremes. The correlation of symptoms with the five Zang organs is logical; this is the profound insight of Chao Yuanfang. The term "various deficiencies" refers to all types of deficiency and insufficiency, encompassing the Five Labors, Six Extremes, and also the Seven Injuries. Chao Yuanfang states: The Seven Injuries are: first, Yin Cold; second, Impotence; third, Internal Urgency; fourth, Continuous seminal emission; fifth, Scanty essence and dampness in the Yin region; sixth, Clear essence; seventh, Painful frequency of urination and inability to complete sexual intercourse. He also states: The Seven Injuries are: first, Overeating injures the Spleen. Spleen injury leads to belching, desire to lie down, and yellow complexion. (Suitable formulas include Zi Sheng Wan, Bao He Wan [Harmonize the Stomach Pill], and Ping Wei San [Calm the Stomach Powder].) Second, Great anger with counterflow injures the Liver. Liver injury leads to reduced blood and dim vision. (Suitable formulas include Si Wu Tang and Yuan Rong Xiao Yao San [Yuan Rong Free and Easy Wanderer Powder].) Third, Straining to lift heavy objects and sitting long in damp places injures the Kidney. Kidney injury leads to scanty essence, lower back and back pain, cold extremities, and coldness in the lower jiao. (Suitable formulas include Hei Di Huang Wan, Shen Zhuo Tang [Kidney-Dampness Decoction], Ba Wei Wan [Eight-Ingredient Pill], and Bao Jian Tian Zhen Dan [Precious Mirror True Nature Elixir].) Fourth, External cold and cold drinks injure the Lungs. Lung injury leads to shortness of breath, cough, and nasal congestion. (Suitable formulas include Xiao Qing Long Tang [Minor Green Dragon Decoction] and Ma Huang Tang [Ephedra Decoction].) Fifth, Worry and overthinking injure the Heart. Heart injury causes distress from fright, forgetfulness, and irritability. (Suitable formulas include Tian Wang Bu Xin Wan [Heavenly Emperor Heart-Nourishing Pill], Zhu Sha An Shen Wan [Cinnabar Calming Spirit Pill], and Zhu Que Wan [Vermilion Bird Pill].) Sixth, Wind, rain, cold, and heat injure the Form. Form injury leads to withered skin and premature aging. (Suitable formula includes Ren Shen Yang Rong Tang [Ginseng Nourishing Vigor Decoction].) Seventh, Great fear without moderation injures the Will (Zhi). (Meaning great fear combined with unmoderated desires.) Will injury leads to mental confusion and unhappiness. (Suitable formulas include Tian Wang Bu Xin Wan and An Shen Wan [Calming Spirit Pill].) This is called the Seven Injuries. It also corresponds to the five Zang organs, but adds the aspect of Form and Will, hence the name Seven Injuries. Compared to the previously mentioned Seven Injuries, this explanation is more logical. Because the previous Seven Injuries largely belonged to Kidney syndromes. When the human body contracts disease, any part can be injured; how could it be only the Kidney? It would be acceptable to say the Kidney has seven injuries. The main text does not mention the Seven Injuries, but the commentary records them for ease of reference. Extreme exhaustion damages Qi and Blood, which are daily consumed, and the physical form gradually declines. The observed pulses reflect the pathology. For example, floating pulse that feels empty, soft pulse that lacks pulsation force, minute pulse that seems to vanish, and weak pulse that lacks strength. Although these are pathological pulses, they are appropriate to the disease state. However, a double wiry pulse indicates the failure of Earth. An urgent and rapid pulse definitely indicates flaming fire. Since the wiry pulse belongs to Liver Wood, a double wiry pulse means Liver Wood is excessive. How can the Earth of a chronic patient withstand such suppression? Thus, we know it must fail. A rapid pulse already indicates heat; an urgent and rapid pulse is frantic and rigid, lacking any gentleness. Pathogenic fire blazes, and true yin naturally severs. Both are untreatable conditions.