喻昌曰∶虚劳之脉，皆不足之候，为精气内夺。与邪气外入之实脉，常相反也。黄帝问何谓重虚？岐伯对以脉气上
虚尺虚，是谓重虚，谓其上下皆虚也。气虚者，言无常也，谓其脉之无常也。尺虚者，行步 然，谓其步履之不正也。
脉虚者，不象阴也，谓其脉全不似手太阴脉之充盛也，皆易明也。独脉之无常，从来谓是上焦阳气虚，故其脉无常。果
尔，则下焦阴气虚，脉更无常矣。观下文云∶如此者，滑则生，涩则死。涩脉且主死，而寸脉之无常，宁复有人理哉？
故气虚者，言无常也，此一语明谓上气之虚，由胸中宗气之虚，故其动之应手者无常耳。乃知无常之脉，指左乳下之动
脉为言。有常则宗气不虚，无常则宗气大虚，而上焦之气始恹恹不足也。后之论脉者，失此一段精微，但宗越人所述损
脉，而引伸触类曰∶脉来软者为虚，缓者为虚，滞为虚，芤为中虚，弦为中虚。脉来细而微者，血气俱虚。脉小者血气
俱虚。脉沉小迟者脱气。虚损之脉，似可一言而毕，实未足以尽其底里。赖仲景更其名为虚劳，虚劳之脉，多兼浮大，
当于前人论脉合参，浮大与否？所以谓男子平人，脉大为劳，极虚亦为劳。又谓脉浮者里虚，又谓劳之为病，其脉浮大
手足烦，春夏剧，秋冬瘥。男子脉浮弱而涩为无子，脉得诸芤动微紧，男子失精，女子梦交。脉极虚芤迟，为清谷亡血
失精。脉虚弱细微者，善盗汗。而总结其义曰∶脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，虚寒相搏，此
名为革。妇人则半产漏下，男子则亡血失精。可见浮大弦紧，外象有余，其实中藏不足。不颛泥迟缓微弱一端以验脉，
而脉之情状，莫逃于指下。即病之疑似，莫眩于胸中。仲景之承前启后，岂苟焉而已哉！昌不揣愚陋，已着大气论于卷
首，发明胸中大气宗气所关之重，因辨岐伯所指脉气上虚为宗气之虚，以见重虚之脉，乳下宗气在所当诊。固堂下指陈，
未必堂上首肯，然不可谓门外汉也。《针经》云∶形气不足，病气不足，此阴阳俱不足也。不可刺之，刺之重不足，重
不足则阴阳俱竭。气血皆虚，五脏空虚，筋骨髓枯，老者绝灭，壮者不复矣。
按∶形者，形骸也。气者，口鼻呼吸之气也。形骸消瘦，视壮盛者迥殊。气息喘促，或短而不足以息，视劳役形体，
气不急促者迥殊。病气不足，懒语困弱，是正气内亏，视外邪暗助，精神反增者迥殊。此不可刺，宜补之以甘药，甘药
正稼穑作甘，培补中央，以灌输脏腑百脉之良药，此法惟仲景遵之，其次则东垣丹溪亦宗之。但东垣引以证内伤，而不
及外感；丹溪引以证阴虚，而不及阳损。此圣域贤关之分量也。
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；损其脾者
调其饮食，适其寒温；损其肝者缓其中；损其肾者益其精，即此便是正法眼藏。使《八十一难》，俱仿此言治，何患后人
无具耶？
原气虚与虚损不同∶原气虚可复，虚损难复也。至虚损病，亦有易复难复两候。因病致虚者，缓调自复。因虚致损
者，虚上加虚，卒难复也。故因病致虚，东垣丹溪法，在所必用。若虚上加虚而至于损，原气索然，丹溪每用人参膏至
十余斤，多有得生者。其见似出东垣之右，然则丹溪补阴之论，不过救世人偏于补阳之弊耳。岂遇阳虚一病，而不捷于
转环耶。
饮食劳倦，为内伤元气，真阳下陷，内生虚热，东垣发补中益气之论，用人参、黄 等甘温之药，大补其气，而提
其下陷，此用气药以补气之不足也。若劳心好色，内伤真阴，阴血既伤，则阳气偏盛，而变为火矣，是谓阴虚火旺痨瘵
之证。故丹溪发阳有余阴不足之论，用四物加知母、黄柏补其阴而火自降，此用血药以补血之不足也。益气补阴，一则
因阳气之下陷，而补其气以升提之。一则因阳火之上升，而滋其阴以降下之。一升一降，迥然不同，亦医学之两大法门，
不可不究悉之也。
丹溪论痨瘵主乎阴虚者，盖自子至已属阳，自午至亥属阴，阴虚则热在午后子前。寤属阳，寐属阴，阴虚则汗从寐
时盗出也。升属阳，降属阴，阴虚则气不降，气不降则痰涎上逆而连绵不绝也。脉浮属阳，沉属阴，阴虚则浮之洪大，
沉之空虚也。此皆阴虚之证，用四物汤加黄柏、知母主之，然用之多不效何哉？盖阳既虚矣，火必上炎，而当归、川芎，
皆气辛味大温，非滋虚降火之药。又川芎上窜，尤非虚炎短乏者所宜。地黄泥膈，非胃热食少痰多者所宜。黄柏、知母，
苦辛大寒，虽曰滋阴，其实燥而损血；虽曰降火，其实苦先入心，久而增气，反能助火，至其败胃，所不待言。不若用
薏苡仁、百合、天冬、麦冬、桑白皮、地骨皮、牡丹皮、枇杷叶，五味子、酸枣仁之属，佐以生地黄汁、藕汁、人乳汁、
童便等。如咳嗽则多用桑白皮、枇杷叶，有痰则增贝母，有血则多用薏苡仁、百合，增阿胶。热盛则多用地骨皮。食少
则用薏苡仁至七八钱，而麦冬常为之主，以保肺金而滋生化之源，往往应手而效。盖诸药皆禀燥降收之气，气之薄者，
为阳中之阴，气薄则发泄，辛甘淡平寒凉是也。以施于阴虚火动之证，犹当溽暑伊芳郁之时，而商 一动，炎 如失矣，
与治暑热用白虎汤同意。然彼是外感，外感为有余，故用寒沉藏之药，而后能补其偏。此是内伤，内伤为不足，但用燥
降收之剂，而已得其下矣，此用药之权舆也。
虚劳之疾，百脉空虚，非粘腻之物填之，不能实也。精血枯涸，非滋湿之物濡之，不能润也。宜用人参、黄 、地
黄、二冬、枸杞、五味之属，各煎膏。另用青蒿，以童便熬膏，及生地汁、白莲藕汁、乳汁、薄荷汁，隔汤炼过，酌定
多少，并麋角胶、霞天膏，合和成剂。每用一匙，汤化服之。如欲行瘀血，加入醋制大黄末、元明粉、桃仁泥、韭汁之
属。欲止血，加入京墨之属。欲行痰，加入竹沥之属。欲降火，加入童便之属。
凡虚劳之证，大抵心下引胁俱疼，盖滞血不消，新血无以养之。尤宜用膏子加韭汁、桃仁泥。
呼吸少气，懒言语，无力动作，目无精光，面色 白，皆兼气虚。用麦冬、人参各三钱，陈皮、桔梗、炙甘草各半
两，五味子二十一粒，为极细末，水浸油饼为丸，如鸡豆子大。每服一丸，细嚼津唾咽下，名补气丸。
气虚则生脉散，不言白术。血虚则三才丸，不言四物。
前言薏苡仁之属，治肺虚。后言参 地黄膏子之类，治肾虚。盖肝心属阳，肺肾属阴，阴虚则肺肾虚矣，故补肺肾
即是补阴，非四物、黄柏、知母之谓也。
陈藏器诸虚用药凡例 虚劳头痛复热，加枸杞、葳蕤。虚而欲吐，加人参。虚而不安，亦加人参。
虚而多梦纷纭，加龙骨。
虚而多热，加地黄、牡蛎、地肤子、甘草。
虚而冷，加当归、川芎、干姜。
虚而损，加钟乳、棘刺、苁蓉、巴戟天。
虚而大热，加黄芩、天冬。
虚而多忘，加茯苓、远志。
虚而口干，加麦冬、知母。虚而吸吸，加胡麻、覆盆子、柏子仁。
虚而多气兼微咳，加五味子、大枣。
虚而惊悸不安，加龙齿、沙参、紫石英、小草。若冷，则用紫石英、小草。若客热，则用沙参、龙齿。不冷不热皆
用之。
虚而身强，腰中不利，加磁石、杜仲。
虚而多冷，加桂心、吴茱萸、附子、乌头。
虚而劳，小便赤，加黄芩。
虚而客热，加地骨皮、黄 。
虚而冷，加黄 。
虚而痰复有气，加生姜、半夏、枳实。
虚而小肠利，加桑螵蛸、龙骨、鸡 。
虚而小肠不利，加茯苓、泽泻。
虚而损，溺白，加浓朴。
髓竭不足，加地黄、当归。
肺气不足，加二冬、五味子。
心气不足，加人参、茯苓、菖蒲。
肝气不足，加天麻、川芎。
脾气不足，加白术、白芍、益智。
肾气不足，加熟地、远志、丹皮。
胆气不足，加细辛、酸枣仁、地榆。
神昏不足，加朱砂、预知子、茯神。
劳瘵兼痰积，其证腹胁常热，头面手足，则于寅卯时分，乍有凉时。宜以霞天膏入竹沥，加少姜汁，调玄明粉行之。
若顽痰在膈上，胶固难治者，必以吐法吐之，或沉香滚痰丸，透膈丹之类下之，甚则用倒仓法。若肝有积痰瘀血，结热
而劳瘵者，其太冲脉必与冲阳脉不相应，宜以补阴药，吞当归龙荟丸。
古方柴胡饮子，防风当归饮子麦煎散，皆用大黄，盖能折炎上之势，而引之下行，莫速乎此！然惟大便实者乃可。
若溏泄，则虽地黄之属亦不宜，况大黄乎？
病劳有一种真藏虚损，复受邪热者，如经验方中，治劳热青蒿煎丸，用柴胡正合宜耳。热去即须急已。若无邪热，
不死何待？又大忌芩、连、柏，骤用纯苦寒药，反泻其阳。但当用琼玉膏之类，大助阳气，使其复还寅卯之位，微加泻
阴火之药是也。
有重阴复其阳，火不得伸，或洒洒恶寒，或志意不乐，或脉弦数，四肢五心烦热者。火郁汤，柴胡升麻汤，病去即
已，不可过剂。
服寒凉药，证虽大减，脉反加数者，阳郁也。宜升宜补，大忌寒凉，犯之必死。
治法当以脾肾二藏为要，肾乃系元气者也。脾乃养形体者也。《经》曰∶形不足者，温之以气。气谓真气，有少火
之温，以生育形体。然此火不可使之热，热则壮，壮则反耗真气也。候其火之少壮，皆在两肾间。《经》又曰∶精不足
者，补之以味。五味入胃，各从所喜之藏而归之，以生津液输纳于肾者。若五味一有过节，反成其藏有余，胜克之祸起
矣。候其五味之寒热，初在脾胃，次在其所归之藏。即当补其不足，泻其有余，谨守精气，调其阴阳，夫是故天枢开发，
而胃和脉生矣。
劳疾久而嗽血，咽疼无声，此为下传上。若不嗽不疼，久而溺浊脱精，此为上传下，皆死证也。
夫传尸劳者，男子自肾传心，心而肺，肺而肝，肝而脾。女子自心传肺，肺而肝，肝而脾，脾而肾，五脏复传六腑
而死矣。虽有诸候，其实不离乎心阳肾阴也。若明阴阳用药，可以起死回生。
苏游论曰∶传尸之候，先从肾起，初
受之两胫酸疼，腰背拘急，行立脚弱，饮食减少，两耳飕飕，直似风声，夜卧遗泄，阴汗痿弱。肾既受讫，次传于心，
心初受气，夜卧心惊，或多恐怖，心悬悬气吸吸欲尽，梦见先亡，有时盗汗，饮食无味，口内生疮，心气烦热，惟欲眠
卧，朝轻夕重，两颊口唇，悉皆纹赤，如敷胭脂，有时手足五心烦热。心受已，次传于肺，肺初受气，咳嗽上气，喘卧
益甚，鼻口干燥，不闻香臭，如或忽闻惟觉朽腐气，有时恶心欲吐，肌肤枯燥，时或疼痛，或似虫行，干皮细起，状如
麸片。肺既受已，次传于肝，肝初受气，两目胱胱，面无血色，常欲颦眉，视不能远，目常干涩，又时赤痛，或复睛黄，
常欲合眼，及时睡卧不着。肝既受已，次传于脾，脾初受气，两胁虚胀，食不消化，又时泻利，水谷生虫，有时肚痛，
腹胀雷鸣，唇口焦干，或生疮肿，毛发干耸，无有光润，或时上气，撑肩喘息，利赤黑汁，见此证者，乃不治也。
紫庭方云∶传尸、伏尸皆有虫，须用乳香熏病患之手，乃仰手掌以帛覆其上，熏良久，手背上出毛长寸许。白而黄
者可治，红者稍难，青黑者即死。若熏之良久无毛者，即非此证，属寻常虚劳证也。又法烧安息香令烟出，病患吸之嗽
不止，乃传尸也，不嗽非传尸也。
合论《金匮》桂枝龙骨牡蛎汤天雄散二方 本文云∶夫失精家，少腹强急，阴头寒，目眩发落，脉极虚芤迟，
为清谷亡血失精；脉得诸芤动微紧，男子失精，女子梦交，桂枝龙骨牡蛎汤主之。（天雄散，本文无。）
按∶前一方，用桂枝汤调其荣卫羁迟，脉道虚衰，加龙骨、牡蛎，涩止其清谷亡血失精，一方而两扼其要，诚足宝
也。《短剧》又云∶虚羸浮热汗出者，除桂加白薇、附子各三分，故曰二加龙骨汤。得此一加减法，后之用是方者，更
思
过半矣。可见桂枝虽调荣卫所首重，倘其人虚阳浮越于外，即当加附子、白薇以回阳，而助其收涩，桂枝又在所不取也。
后一方以上中二焦之阳虚，须用天雄以补其上，白术以固其中，用桂枝领药行荣卫上焦，并建回阳之功。方下虽未述证，
其治法指掌易见，然则去桂枝加白薇、附子，得非仿此以治中下二焦之阳虚欲脱耶，精矣。
论《金匮》小建中汤黄 建中汤二方 本文云∶虚劳里急，悸，衄，腹中痛，梦失精，四肢酸疼，手足烦热，
咽干口燥，小建中汤主之。虚劳里急诸不足，黄 建中汤主之。 按∶虚劳病而至于亡血失精，消耗精液，枯槁四出，
难为力矣。《内经》于针药所莫制者，调以甘药，《金匮》遵之，而用小建中汤、黄 建中汤，急建其中气。俾饮食增而
津液旺，以至充血生精，而复其真阴之不足，但用稼穑作甘之本味，而酸辛咸苦，在所不用，盖舍此别无良法也。然用
法者贵立于无过之地，宁但呕家不可用建中之甘，即服甘药，微觉气阻气滞，更当虑甘药太过，令人中满，早用橘皮、
Yu Chang stated: The pulse of consumptive fever (Xu Lao) is always a sign of deficiency, resulting from the internal depletion of essence and qi. It is usually opposite to the excess pulse caused by external invasion of pathogenic factors. The Yellow Emperor asked, "What is called 'double deficiency'?" Qibo replied that when both the upper pulse qi and the chi position (pulse at the wrist near the crease) are deficient, it is called double deficiency, meaning both upper and lower are deficient. Deficiency of qi manifests as incoherent speech, referring to the irregularity of the pulse. Deficiency at the chi position manifests as unsteady gait, referring to abnormal walking. Deficiency of the pulse means it does not resemble yin pulses, specifically that it completely lacks the fullness of the Hand Taiyin Lung meridian pulse; these are easy to understand. However, the irregularity of the pulse has traditionally been attributed to deficiency of yang qi in the upper jiao, hence the irregularity. If this were true, then deficiency of yin qi in the lower jiao would make the pulse even more irregular. Looking at the following text: "In such cases, if the pulse is slippery, there is life; if choppy, death." Since a choppy pulse indicates death, how could an irregular cun pulse possibly belong to a living person? Therefore, "deficiency of qi manifests as incoherent speech" clearly refers to deficiency of upper qi due to deficiency of Zong Qi (Gathering Qi) in the chest, causing the palpable movement to be irregular. Thus, the irregular pulse refers to the pulsation under the left breast. Regularity indicates Zong Qi is not deficient; irregularity indicates severe deficiency of Zong Qi, leading to initial insufficiency of upper jiao qi. Later pulse diagnosticians missed this subtlety, relying only on Bian Que's description of damage pulses and extending it: soft pulses indicate deficiency, slow pulses indicate deficiency, stagnant pulses indicate deficiency, knotted (Kou) pulses indicate middle deficiency, wiry pulses indicate middle deficiency. Fine and minute pulses indicate simultaneous deficiency of blood and qi. Small pulses also indicate simultaneous deficiency of blood and qi. Deep, small, and slow pulses indicate loss of qi. Consumptive pulses seem summarizable in one phrase, yet fail to capture their depth. Fortunately, Zhang Zhongjing renamed it consumptive fever (Xu Lao). Pulses of consumptive fever often accompany floating and large qualities. One should combine them with previous theories on pulses: Is it floating and large? It is said that for a healthy man, a large pulse indicates consumption; extreme weakness also indicates consumption. It is also said that a floating pulse indicates interior deficiency. It is further said that in consumption disease, the pulse is floating and large, with vexing heat in the hands and feet, worsening in spring and summer, and improving in autumn and winter. For men, a floating, weak, and choppy pulse indicates infertility; various knotted, moving, fine, and tight pulses in men indicate seminal emission, while in women they indicate nocturnal emissions of dreams. Extreme weakness, knotted, and slow pulses indicate clear undigested food in stool, blood loss, and seminal emission. Weak, deficient, fine, and minute pulses indicate night sweats. Summarizing its meaning: A wiry and large pulse; wiry indicates reduction, large indicates knotted; reduction indicates cold, knotted indicates deficiency; deficiency and cold clashing together is named a革 (Ge/Leather-like) pulse. In women, it causes miscarriage and bleeding; in men, blood loss and seminal emission. Thus, floating, large, wiry, and tight pulses appear excessive externally but hide insufficiency internally. One should not solely rely on slow, weak, and minute pulses to verify the pulse condition; the nuances of the pulse escape no finger perception. Even doubtful diseases do not confuse the mind. Was Zhang Zhongjing's role of connecting past and future merely casual! I, Yu Chang, presumptuously wrote the "Treatise on Great Qi" at the beginning of the volume to elucidate the importance of Great Qi and Zong Qi in the chest. Thus, I distinguish Qibo's "upper pulse qi deficiency" as Zong Qi deficiency, showing that for double deficiency pulses, the Zong Qi under the breast must be examined. Although my humble statements below may not be approved by those above, they cannot be dismissed as ignorance of an outsider. The *Needle Classic* states: When form-qi is insufficient and disease-qi is insufficient, this is simultaneous deficiency of yin and yang. Acupuncture is contraindicated; acupuncture will worsen the deficiency. Worsening deficiency leads to exhaustion of yin and yang. Blood and qi become deficient, five zang organs empty, sinews, marrow, and bones wither; the elderly perish, and the strong do not recover.
Note: Form refers to the physical body. Qi refers to breath through mouth and nose. Physical emaciation is distinctly different from robustness. Panting or shortness of breath differs distinctly from normal breathing after physical labor. Disease-qi insufficiency, characterized by reluctance to speak and fatigue, indicates internal deficiency of righteous qi, distinct from external pathogens secretly assisting spirit and increasing energy. These conditions are contraindicated for acupuncture; instead, sweet medicines should be used to tonify. Sweet medicines, like grains making sweetness, nourish the central spleen and stomach, serving as excellent medicine to irrigate the five zang organs and hundred vessels. This method was followed only by Zhang Zhongjing, followed by Li Dongyuan and Zhu Danxi. However, Li Dongyuan cited it to prove internal injury, neglecting external contraction; Zhu Danxi cited it to prove yin deficiency, neglecting yang damage. This marks the difference in magnitude between sages and worthies.
Bian Que elucidated the syndrome of consumption, reaching the sage domain. Although no prescriptions are recorded, his treatment principles for damage are: Damage the lung, benefit its qi; damage the heart, regulate Ying and Wei; damage the spleen, regulate diet and adjust cold/warmth; damage the liver, soothe its center; damage the kidney, benefit its essence. This is the orthodox teaching. If the *Eighty-One Difficulties* all followed these words for treatment, why worry about later generations lacking insight?
Original qi deficiency differs from consumption: Original qi deficiency can be restored; consumption is difficult to restore. Regarding consumption disease, there are two conditions: easy to restore and difficult to restore. Consumption caused by disease restores slowly with gentle regulation. Consumption caused by deficiency, adding deficiency upon deficiency, is suddenly difficult to restore. Therefore, for disease-caused deficiency, the methods of Li Dongyuan and Zhu Danxi are essential. If deficiency adds up to damage, with original qi exhausted, Zhu Danxi often used Ren Shen Paste (Ginseng Paste) up to ten-plus jin, with many survivors. His insights seemed superior to Li Dongyuan's. However, Zhu Danxi's theory of tonifying yin merely corrected the world's bias toward tonifying yang. Would he not quickly reverse course for yang deficiency?
Dietary indiscretion and overwork damage original qi, causing true yang to sink and generating internal deficient heat. Li Dongyuan proposed tonifying the middle and boosting qi, using sweet-warm herbs like Ren Shen and Huang Qi to greatly tonify qi and lift sinking qi. This uses qi-tonifying herbs to supplement qi insufficiency. If mental exertion and sexual indulgence damage true yin, and yin-blood is injured, yang qi becomes excessive and transforms into fire. This is the syndrome of yin deficiency with hyperactive fire (Lao Zhai). Thus, Zhu Danxi proposed the theory of "Yang Excess, Yin Insufficiency," using Si Wu Tang plus Zhi Mu and Huang Bai to tonify yin so fire naturally descends. This uses blood-tonifying herbs to supplement blood insufficiency. Tonifying qi and yin: one lifts qi due to sinking yang; the other nourishes yin to descend rising yang-fire. One ascending, one descending, vastly different; these are the two major gateways of medicine, requiring thorough investigation.
Zhu Danxi argued that Lao Zhai is primarily yin deficiency. From Zi to Si hours belongs to Yang; from Wu to Hai hours belongs to Yin. Yin deficiency causes heat in the afternoon before Zi hour. Awakening is Yang, sleeping is Yin; yin deficiency causes sweat during sleep (night sweats). Ascending is Yang, descending is Yin; yin deficiency prevents qi descent, causing phlegm-fluids to rebel upward continuously. Floating pulse is Yang, deep pulse is Yin; yin deficiency makes the pulse floating and large on superficial pressure, empty on deep pressure. These are all yin deficiency syndromes, treated with Si Wu Tang plus Huang Bai and Zhi Mu. Yet, why does it often fail? Because if yang is deficient, fire must flare upward. Dang Gui and Chuan Xiong are acrid and warm, not suitable for nourishing deficiency and descending fire. Chuan Xiong ascends, unsuitable for deficient flaring fire. Di Huang is cloying, unsuitable for those with stomach heat, poor appetite, and much phlegm. Huang Bai and Zhi Mu are bitter, pungent, and very cold. Though said to nourish yin, they actually dry and damage blood; though said to descend fire, bitterness enters the heart first, and long-term use increases qi, potentially aiding fire. Their damaging the stomach goes without saying. Better to use Yi Yi Ren, Bai He, Tian Dong, Mai Dong, Sang Bai Pi, Di Gu Pi, Mu Dan Pi, Pi Pa Ye, Wu Wei Zi, Suan Zao Ren, etc., assisted by Sheng Di Huang juice, Ou juice, human milk, and Tong Bian (child's urine). For cough, use more Sang Bai Pi and Pi Pa Ye; for phlegm, add Bei Mu; for blood, use more Yi Yi Ren and Bai He, add E Jiao. For intense heat, use more Di Gu Pi. For poor appetite, use Yi Yi Ren up to 2-3 qian, with Mai Dong as principal, to protect Lung Metal and nourish the source of transformation and generation, often effective immediately. These drugs possess drying, descending, and astringent qi. Thin qi is yin within yang; thin qi disperses, including acrid, sweet, bland, neutral, cool, and cold properties. Applying this to yin deficiency with fire movement is like the Shang Yang wind in humid summer heat, extinguishing blazing fire, similar to using Bai Hu Tang for summerheat. However, that is external contraction (excess), so cold, heavy, storing drugs correct the imbalance. This is internal injury (deficiency); using drying, descending, and astringent formulas achieves the goal of descending. This is the flexibility of medication.
Consumptive disease involves emptiness of all vessels; sticky substances are needed to fill it. Withered essence and blood require moistening substances to hydrate. Use Ren Shen, Huang Qi, Di Huang, Er Dong (Tian Dong, Mai Dong), Gou Qi, Wu Wei Zi, etc., decocted into paste. Separately, use Qing Hao decocted with Tong Bian into paste, along with Sheng Di Huang juice, White Lotus Root juice, milk, and Bo He juice, refined over water. Mix with Mi Jiao (Deer Antler Glue) and Xia Tian Gao. Take one spoonful dissolved in water. To move blood stasis, add Vinegar-processed Da Huang powder, Yuan Ming Fen, Tao Ren paste, Jiu Zhi. To stop bleeding, add Jing Mo. To resolve phlegm, add Zhu Li. To descend fire, add Tong Bian.
Generally, consumptive syndromes involve pain radiating from the epigastrium to the hypochondrium due to stagnant blood preventing new blood nourishment. Pastes with Jiu Zhi and Tao Ren paste are especially suitable.
Shortness of breath, reluctance to speak, weakness, dull eyes, pale complexion indicate concurrent qi deficiency. Use Mai Dong and Ren Shen 3 qian each, Chen Pi, Jie Geng, Zhi Gan Cao 0.5 liang each, Wu Wei Zi 21 grains. Grind to fine powder. Make pills soaked in water with oil cakes, size of chicken beans. Chew one pill thoroughly with saliva and swallow. Named Bu Qi Wan.
For qi deficiency, use Sheng Mai San, omitting Bai Zhu. For blood deficiency, use San Cai Wan, omitting Si Wu Tang.
Previously mentioned Yi Yi Ren treats lung deficiency. Later mentioned Ren Shen and Di Huang pastes treat kidney deficiency. Liver and Heart belong to Yang; Lung and Kidney belong to Yin. Yin deficiency leads to Lung and Kidney deficiency. Thus, tonifying Lung and Kidney is tonifying yin, not referring to Si Wu Tang, Huang Bai, or Zhi Mu.
Chen Cangqi's General Rules for Medicines in Various Deficiencies:
Consumptive headache with recurrent fever, add Gou Qi, Wei Rui.
Deficiency with desire to vomit, add Ren Shen.
Deficiency with restlessness, also add Ren Shen.
Deficiency with frequent chaotic dreams, add Long Gu.
Deficiency with much heat, add Di Huang, Mu Li, Di Fu Zi, Gan Cao.
Deficiency with cold, add Dang Gui, Chuan Xiong, Gan Jiang.
Deficiency with damage, add Zhong Ru, Ji Ci, Rong蓉, Ba Ji Tian.
Deficiency with great heat, add Huang Qin, Tian Dong.
Deficiency with forgetfulness, add Fu Ling, Yuan Zhi.
Deficiency with dry mouth, add Mai Dong, Zhi Mu.
Deficiency with shallow breathing, add Hu Ma, Fu Pen Zi, Bai Zi Ren.
Deficiency with much qi and slight cough, add Wu Wei Zi, Da Zao.
Deficiency with palpitations and unrest, add Long Chi, Sha Shen, Zi Shi Ying, Xiao Cao. If cold, use Zi Shi Ying and Xiao Cao. If external heat, use Sha Shen and Long Chi. Used regardless of cold or heat.
Deficiency with stiff body and lumbar stiffness, add Ci Shi, Du Zhong.
Deficiency with much cold, add Gui Xin, Wu Zhu Yu, Fu Zi, Wu Tou.
Deficiency with labor and red urine, add Huang Qin.
Deficiency with external heat, add Di Gu Pi, Huang Qi.
Deficiency with cold, add Huang Qi.
Deficiency with phlegm and qi rebellion, add Sheng Jiang, Ban Xia, Zhi Shi.
Deficiency with loose stools (small intestine), add Sang Piao Xiao, Long Gu, Ji Nei Jin.
Deficiency with difficult urination, add Fu Ling, Ze Xie.
Deficiency with damage and white urine, add Hou Po.
Marrow exhaustion insufficiency, add Di Huang, Dang Gui.
Lung qi insufficiency, add Er Dong, Wu Wei Zi.
Heart qi insufficiency, add Ren Shen, Fu Ling, Chang Pu.
Liver qi insufficiency, add Tian Ma, Chuan Xiong.
Spleen qi insufficiency, add Bai Zhu, Bai Shao, Yi Zhi.
Kidney qi insufficiency, add Shu Di, Yuan Zhi, Dan Pi.
Gallbladder qi insufficiency, add Xi Xin, Suan Zao Ren, Di Yu.
Spirit confusion insufficiency, add Zhu Sha, Yu Zhi Zi, Fu Shen.
Lao Zhai with phlegm accumulation: Abdominal and hypochondriac heat, head/face/hands/feet feel cool at Yin-Mao hours. Use Xia Tian Gao with Zhu Li, add ginger juice, mix with Xuan Ming Fen to promote movement.
If stubborn phlegm is stuck in the diaphragm, hard to treat, induce vomiting. Or use Chen Xiang Gun Tan Wan, Tou Ge Dan to purge. Severe cases use Dao Cang Fa.
If liver has accumulated phlegm and blood stasis, binding heat and Lao Zhai, Tai Chong pulse will not correspond with Chong Yang pulse. Use yin-tonifying medicine to swallow Dang Gui Long Hui Wan.
Ancient formulas Chai Hu Yin Zi, Fang Feng Dang Gui Yin Zi, Mai Jian San all use Da Huang, likely to suppress flaming upward momentum and guide it downward, nothing faster! But only for solid stools.
If loose stools, even Di Huang is unsuitable, let alone Da Huang?
One type of Lao disease involves true zang deficiency damaged by pathogenic heat. Like the experienced formula Qing Hao Jian Wan for consumption heat, Chai Hu is perfectly suitable. Stop immediately after heat clears. Without pathogenic heat, death awaits! Also strictly avoid Huang Qin, Lian Lian, Bai, sudden use of pure bitter-cold drugs reversely drains yang. Instead, use Qiong Yu Gao to greatly assist yang qi, restoring it to the Yin-Mao position, slightly adding drugs to drain yin fire.
When heavy yin restores yang, fire cannot extend, causing shivering chills, depression, wiry-numerous pulse, or vexing heat in four limbs and palms/soles. Use Huo Yu Tang or Chai Hu Sheng Ma Tang. Stop when disease resolves; do not overdose.
Taking cold-cooling drugs, symptoms reduce greatly but pulse becomes rapid: Yang is depressed. Should ascend and tonify. Strictly avoid cold-cooling; violation leads to death.
Treatment should focus on Spleen and Kidney. Kidney connects to original qi. Spleen nourishes form. *Jing* says: "For form insufficiency, warm with qi." Qi refers to True Qi, with mild fire warmth to generate form. This fire must not be hot; heat makes it vigorous, which consumes True Qi. Observe the mild/vigorous fire between the two kidneys. *Jing* also says: "For essence insufficiency, tonify with flavor." Five flavors enter the stomach, return to their preferred zang, generating fluids transported to the kidney. If five flavors exceed limits, they cause zang excess, leading to destructive overcoming. Observe the cold/hot nature of five flavors, initially in Spleen/Stomach, then in their target zang. Tonify insufficiency, drain excess, guard essence/qi, regulate yin/yang. Then Tianshu opens, Stomach harmonizes, and pulses generate.
Lao disease lasting long with coughing blood and silent sore throat is transmission from lower to upper. No cough/pain, but prolonged turbid urine and seminal loss is transmission from upper to lower; both are death signs.
Regarding Transmitted Corpse Lao: Men transmit from Kidney to Heart, Heart to Lung, Lung to Liver, Liver to Spleen. Women transmit from Heart to Lung, Lung to Liver, Liver to Spleen, Spleen to Kidney. Five zang transmit to six fu then death. Despite various symptoms, it essentially revolves around Heart Yang and Kidney Yin. Understanding yin/yang medication can revive the dead.
Su You discussed: Transmitted Corpse starts from Kidney. Initial symptoms: sore legs, back stiffness, weak walking, reduced appetite, buzzing ears like wind, nocturnal emission, damp/weak genitals. After Kidney, transmits to Heart. Heart initial symptoms: fear at night, terror, feeling of heart hanging, gasping, dreaming of deceased, night sweats, tasteless food, mouth ulcers, heart irritability/heat, desire to sleep, lighter morning/heavier evening, red cheeks/lips like rouge, vexing heat in limbs. After Heart, transmits to Lung. Lung initial symptoms: cough, rebellious qi, worse lying down, dry nose/mouth, loss of smell, smelling rot, nausea, dry skin, pain, bug sensations, peeling skin like bran. After Lung, transmits to Liver. Liver initial symptoms: cloudy eyes, pale face, frowning, distant vision difficulty, dry/itchy/red/painful eyes, yellow sclera, desire to close eyes, insomnia. After Liver, transmits to Spleen. Spleen initial symptoms: distended hypochondrium, indigestion, diarrhea, worms in stool, abdominal pain, rumbling bloat, dry/scaly lips/mouth, ulcers, dry hair, lackluster, rebellious qi, shoulder-panting, black/red stool. Seeing this is untreatable.
Zi Ting Formula says: Transmitted Corpse and Hidden Corpse have insects. Smoke patient's hand with Ru Xiang. Cover palm with cloth. After long smoking, inch-long hair appears on back of hand. White/yellow is treatable; red is harder; green/black is death. If no hair after long smoking, it is ordinary consumptive fever. Another method: Burn An Xi Xiang smoke. Patient inhales. Continuous cough indicates Transmitted Corpse; no cough is not.
Combined discussion on *Jin Gui* Gui Zhi Long Gu Mu Li Tang and Tian Xiong San: Text says: Those prone to seminal emission, with lower abdomen tension/cold, cold glans, dizziness, hair loss, extreme weak/knotted/slow pulse indicating undigested food, blood loss, seminal emission; or knotted/moving/fine/tight pulses indicating seminal emission in men, dream emission in women, are treated with Gui Zhi Long Gu Mu Li Tang. (Tian Xiong San not in text.)
Note: The first formula uses Gui Zhi Tang to regulate Ying/Wei stagnation. Pulse channel deficiency/depletion adds Long Gu/Mu Li to astringe undigested food/blood/seminal emission. One formula addresses two key points, truly precious. *Duan Ju* adds: For emaciation, floating heat, sweating, remove Gui Zhi, add Bai Wei and Fu Zi 3 fen each, called Er Jia Long Gu Tang. With this modification, users of this formula think half as much. Although Gui Zhi is primary for regulating Ying/Wei, if deficient yang floats outward, add Fu Zi/Bai Wei to restore yang and aid astringency; Gui Zhi is then excluded.
The second formula addresses upper/middle jiao yang deficiency. Use Tian Xiong to tonify upper, Bai Zhu to secure middle, Gui Zhi to lead medicine through Ying/Wei upper jiao and restore yang. Although symptoms aren't listed, treatment logic is clear. Removing Gui Zhi and adding Bai Wei/Fu Zi might imitate this to treat middle/lower jiao yang deficiency impending collapse. Excellent.
Discussion on *Jin Gui* Xiao Jian Zhong Tang and Huang Qi Jian Zhong Tang: Text says: Consumptive fever with interior tension, palpitations, epistaxis, abdominal pain, dream seminal emission, limb soreness, vexing heat in hands/feet, dry throat/mouth, treated with Xiao Jian Zhong Tang. Consumptive fever with interior tension and general insufficiency, treated with Huang Qi Jian Zhong Tang.
Note: Consumptive fever progressing to blood/seminal loss, consuming essence, withering everywhere, is hard to treat. *Nei Jing* says for conditions beyond needle/drug control, regulate with sweet medicine. *Jin Gui* follows this, using Xiao Jian Zhong Tang and Huang Qi Jian Zhong Tang to urgently build middle qi. Let diet increase and fluids flourish, filling blood/generating essence, restoring true yin insufficiency. Only use grain-sweet basic flavors, avoiding sour/pungent/salty/bitter. There is no other good method. However, users must stand in error-free ground. Not only should vomiters avoid sweet Jian Zhong, but if sweet medicine causes slight qi obstruction/stagnation, one must worry about excessive sweetness causing fullness. Early use of Ju Pi...