素问云。邪之所凑。其气必虚。阴虚者阳必凑之。邪气盛则实。精气夺则虚。脉气上虚尺虚。
是谓重虚。气虚者。言无常也。尺虚者。行步 然。脉虚者。不象阴也。此滑则生。涩则死也。
形不足者。温之以气。精不足者。补之以味。
金匮云。劳之为病。其脉浮大。手足烦。春夏剧。秋冬瘥。阴寒精自出。酸削不能行。
其脉大者。劳伤阳气也。手足烦者。脾主四肢也。春夏阳气升腾而阴火僭逆。故剧。秋冬阴
气收藏而虚阳敛遏。故
瘥。皆劳伤元气之证。下言阴寒精自出。酸削不能行。此则劳伤精气。肾肝失职之候也。
夫失精家。少腹弦急。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。
脉虚芤迟者。亡血失精。本虚之脉也。芤动微紧者。本虚中伏有微邪。肝气内动。所以魂梦
不宁也。夫亡血失精。皆虚劳内因之证。举世皆用滋补血气之药。而仲景独举桂枝汤。其义何居。
盖人身之气血。全赖后天水谷以资生。水谷入胃。其清者为营。浊者为卫。营气不营。则上热而
血溢。卫气不卫。则下寒而精亡。是以调和营卫为主。营卫和。则三焦各司其职。而火自归根。
热者不热。寒者不寒。水谷之精微输化。而精血之源有赖矣。以其亡脱既惯。恐下焦虚滑不禁。
乃加龙骨、牡蛎以固敛之。盖龙骨入肝敛魂。牡蛎入胃固精。皆收敛精魂之品。后世鲜有用之者。
每每疑其止涩而非之。殊不知二味入于石脂、钟乳、巴戟、苁蓉、金樱、益智之类。则为劫剂。
入于桂枝汤中。则为固蛰封藏之本药也。至于虚劳失精。悸衄腹痛。烦热口燥。则于本方加胶饴
为小建中。虚劳里急。为营卫枯槁。更加黄 为黄 建中。此皆后天不足所致。故以调和营卫为
主治也。后人专用滋阴降火误治。遗害未至于剧者。用此悉能挽回。若夫先天肾虚致病者。又当
八味肾气丸。其虚烦不得眠。主以酸枣汤。内有干血。主以大黄 虫丸。以上诸治。除酸枣汤外。
后世皆所切禁。非特不敢效用。亦无齿及之者。良可慨夫。
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。
上条言虚劳失精。而里急腹痛。烦热悸衄。明系阳气内夺之候。故用小建中以和之。下条言
虚劳里急诸不足。较上条虚证更剧。故于前方更加黄 以大补卫中阳气也。按虚劳而至于亡血失
精。消耗津液。枯槁四出。难为力矣。内经于针药莫制者。调以甘药。金匮遵之。而用小建中汤、
黄建中汤以急建其中气。俾饮食增而津液旺也。后人乐令建中。并用前胡、细辛以退表热。十
四味建中。兼用熟附、苁蓉以补下虚。均失建中之义。
虚劳腰痛。少腹拘急。小便不利者。八味肾气丸主之。
治虚劳腰痛。少腹拘急。纯属肾肝虚寒无疑。而小便不利一证。又似虚中有热。岂桂、附所
宜用乎。殊不知肝既失其疏泄之权。肾亦伤其生发之气。水道自难流利。故以八味肾气之桂、附
以导火归源。设非辛温蒸其至极之阳。则沉冱有加无已。乃于补阴药中稍加阳药。使阴阳适均。
无偏胜之虞。斯其所以为至治也。
虚劳诸不足。风气百疾。薯蓣丸主之。
按薯蓣丸专主表邪不解。误用凉药。伤犯肺胃自上而下之虚劳。若房劳伤精。郁火伤神。自
下而上由中所发之证。咸非所宜。其立方全以桂枝汤和营散邪。合理中丸兼理药误。君以薯蓣大
理脾肺。毫不及乎补益肾肝。医门法律以为虚劳不足。最易生风生气。殊失金匮立方本旨。
虚劳虚烦不得眠。酸枣汤主之。
虚烦者。肝虚而火气乘之也。故特取枣仁以安肝胆为主。略加芎 调血以养肝。茯苓、甘草
培土以荣木。知母降火以除烦。此平调土木之剂也。
五劳虚极羸瘦。腹满不能饮食。食伤。忧伤。饮伤。房室伤。饥伤。劳伤。经络营卫气伤。内有
干血。肌肤甲错。两目黯黑。缓中补虚。大黄 虫丸主之。
举世皆以参、 、归、地等为补虚。仲景独以大黄、 虫等补虚。苟非神圣。不能行是法也。
夫五劳七伤。多缘劳动不节。气血凝滞。郁积生热。致伤其阴。世俗所称干血劳是也。所以仲景
乘其元气未漓。先用大黄、 虫、水蛭、虻虫、蛴螬等蠕动啖血之物。佐以干漆、生地、桃、杏
仁行去其血。略兼甘草、芍药以缓中补虚。黄芩以开通热郁。酒服以行药势。待干血行尽。然后
纯行缓中补虚收功。其授陈大夫百劳丸一方。亦以大黄、 虫、水蛭、虻虫为主。于中除去干漆、
蛴螬、桃、杏仁。而加当归、乳香、没药以散血结。即用人参以缓中补虚。兼助药力以攻干血。
栀子以开通热郁。服用劳水者。取其行而不滞也。仲景按证用药。不虑其峻。授人方术。已略为
降等。犹恐误施。故方下注云。治一切劳瘵积滞疾。不经药坏者宜服。可见慎重之至也。
李士材病机沙篆云。古称五劳七伤六极二十三蒸。证状繁多。令人眩惑。但能明先天后天二
种根本之证。无不痊安。夫人之虚。非气即血。五脏六腑。莫能外焉。而血之源头在乎肾。气之
源头在乎脾。脾为肺母。肺为生气之宫。故肺气受伤者。必求助于脾土。肾为肝母。肝为藏血之
地。故肝血受伤者。必借资于肾水。补肾补脾。法当并行。然以甘寒补肾。恐妨肾气。以辛温扶
脾。恐妨肾水。须辨缓急而为之施治。或补肾而助以沉香、砂仁。或扶脾而杂以山药、五味。机
用不可不活也。
虚劳之证。扶脾保肺。多不可缺。然脾性喜温喜燥。而温燥之剂。不利于保肺。肺性喜凉喜
润。而凉润之剂。不利于扶
脾。两者并列而论。脾有生肺之机。肺无扶脾之力。故曰土旺而生金。勿拘拘于保肺。泻火之亢。
以全阴气。壮水之主。以制阳光。法当并行。然泻火之剂。多寒而损阳气。壮水之剂。多平而养
阴血。两者并列而论。苦寒过投。将有败胃之忧。甘平恒用。却无伤中之害。故曰。水盛而火自
熄。勿汲汲乎寒凉。
治虚邪者。当先顾正气。正气存。则不致于害。且补中自有攻意。盖补阴即所以攻热。补阳
即所以攻寒。世未有正气复而邪不退者。亦未有正气竭而命不倾者。如必不得已。亦当酌量缓急。
暂从权宜。从少从多。寓战于守。斯可矣。此治虚之道也。治实证者。当去其邪。邪去则身安。
但法贵精专。便臻速效。此治实之道也。惟是假虚之证不多见。而假实之证最多也。假寒之证不
难治。而假热之治多误也。然实者多热。虚者多寒。如丹溪曰。气有余便是火。故实能受寒。而
余续之曰。气不足便是寒。故虚能受热。世有不辨真假本末。而曰知医者。则未敢许也。
凡阴虚多热者。最嫌辛燥。恐助阳邪也。尤忌苦寒。恐伐生气也。惟喜纯甘壮水之剂。补阴
以配阳。虚火自降。而阳归于阴矣。阳虚多寒者。是嫌凉润。恐助阴邪也。尤忌辛散。恐伤阴气
也。只宜甘温益火之品补阳以消阴。沉寒自敛。而阴从乎阳矣。不知者。惟知以热治寒。以寒治
热。所以阴虚不宜降者。则服寒反热。阳虚不宜耗者。则服热反寒。此无他。皆以专治旺气。故
其病反如此。春夏之令主生长。秋冬之令主肃杀。人知之矣。殊不知药之温者。行天地发育之德。
药之寒者。象天地肃杀之刑。如四物汤加黄柏、知母。名坎离丸。举世奉之以为滋阴上剂。降火
神丹。不知秋冬之气。非所以生万物者。凉血之药常腻膈。非痰多食少者所宜。凉血之药多滋润。
多用必致泄泻。尝见虚劳之死。多死于泄泻。泄泻之因。多因于清润。况
黄柏苦寒。苦先入心。久而增气。反能助火。至其败胃。所不待言。川芎上窜。非火炎上气者所
宜。知母滑肠。岂元气下陷者可服。丹溪云。实火可泻。虚火可补。试问虚劳之火。属之虚乎。
属之实乎。泻之可乎。昔人云。畏知、柏如鸩毒。恐其伐我命根耳。虽然。病初起而相火正隆。
苦燥渴。而右尺滑大。暂投亦是无妨。久用断乎不可。故用温补。病不增。即是减。内已受补故
也。用寒凉病不减。即是增。内已受伐故也。盖温暖之药。像阳明君子。苟有过。人皆见之。寒
凉之药。类阴柔小人。国祚已危。人犹莫觉其非。虚损之证。皆下寒上热。所谓水火不交者也。
其重感于寒者则下焦作痛。不感寒者则不痛。至于上焦燥热则一也。上焦方苦烦热。得寒凉之药
则暂快。遂以为药有功。故喜服之。不知寒凉之药。不久下注。则下元愈寒。火为寒逼上行。则
上焦之热愈甚。展转反复。遂至沉锢而不救。是以寒凉补阴。非徒无益。而且有损也。
气有余便是火。补虚而用益气之药。能无助火为害乎。夫火与元气。势不两立。一胜则一负。
正气旺则邪无所容矣。即血虚而用血药。亦必兼气药为主。经曰。无阳则阴无以生。血脱者益气。
为血不自生。须得阳和之药乃生。阳生则阴长也。若单用血药。血无由而生。反有伤犯中州之患
矣。东垣云。人参甘温。补肺气。肺气旺。则四脏之气皆旺。精自生而形自盛也。白飞霞云。人
参多服。回元气于无何有之乡。凡病后气虚及肺虚喘嗽者。并宜用之。人参补气。功载本草。人
所共知。王好古谓肺热还伤肺。王节斋谓虚劳服参、 必死。以故天下皆称有毒如蝎。殊不知肺
家本有火。右寸大而有力。东垣所谓郁热在肺者。诚当勿用。若肺虚而虚火乘之。肺方被难。非
人参何以救之。古方治肺寒以温肺汤。肺热以清肺汤。中满以分消汤。血虚以养营汤。皆用人参。
自内经以至诸贤。谆谆言之。以气药有生血之功。
血药无益气之理。可谓深切着明。人亦奈何不悟耶。
内经论风寒暑湿燥火六气之变。皆能失血。各当求责。若不察其所因。概与凉药折之。变乃
生矣。服寒凉后。证虽大减。脉反加数者。阳郁也。宜升宜补。大忌寒凉。而执迷不省复用寒凉
不彻者。必死而后已。七情妄动。形体疲劳。阳火相迫。致血错行。脉洪多热。口干便涩。宜行
凉药。若使气虚挟寒。阴阳不相为守。血亦妄动。必有虚冷之状。盖阳虚阴必走是也。更验其血
之色。必瘀晦不稠。非若火盛迫血妄行之血色。浓浓紫赤也。宜理中加肉桂收摄之。因气而发者。
加木香、乌药。或饮食伤胃。逆上吐衄。加香、砂、楂、曲。咳嗽有红。用固本丸、集灵膏。脾
胃虚而大便不实者。琼玉膏。劳嗽吐红。上热下寒。四味鹿茸丸、济生鹿茸丸选用。肾虚风袭。
下体痿弱。骨节疼痛。喘嗽失精。腰腹腿膝胫踝作痛不能起立者。安肾丸。久病虚劳失血。血枯
发热及女人经闭血枯者。宜素问四乌贼骨一芦茹丸。或四物换生地加桃仁、虻虫。作丸服。吐血
成升斗者。花蕊石散。然必阳虚不能制阴。阴气暴逆者为宜。着气盛血随火涌者。误用必殆。宜
十灰散。若胃脘蓄血上溢。犀角地黄汤加大黄下逐之。吐血初起。多宜大黄下之。失血以下行为
顺。上行为逆。又言亡血虚家禁下。何也。大抵宜行者。行之于蓄妄之初。禁下者。禁之于亡脱
之后。不可不明察也。积劳吐血者。血病之余吐血者。吐血多而久不止者。并宜独参汤主之。气
虚有热。保元汤加童便、藕汁。即有血亦无碍。一切失血。或血虚烦渴。躁热不宁。五心烦热。
圣愈汤。血证既久。古人多以胃药收功。异功散加丹皮、山药、泽泻。咳嗽更加葳蕤。此虚家神
剂也。凡失血。无论衄血出于经。咳血出于心。嗽血出于肺。吐血出于胃。咯血出于肾。呕血出
于肝。唾血出于脾。但以色紫黑者。为瘀积久血。色鲜红者为暴伤新血。色淡清者为气虚挟痰。
总属炎火沸
腾。故治血以降火下行为首务。不可骤用酸寒收敛。使瘀积发热。转增上炎之势。先用瑞金丹。
次用童真丸。引血与火下行最速。若血色正赤。吐出即凝。剔起成片如柿皮者。此守藏之血。因
真阴受损而脱。虽能食倍常。必骤脱而死。若吐淡红如肉如肺者。谓之咳白血。此肺胃并伤虽淹
岁月。亦终不救。
虚劳精滑无度。或交寅刻梦泄。气少力微。日渐瘦削。目视不明者。因房劳太过。督任不交。
不能约制阴火也。阳虚者鹿茸丸、龟鹿二仙膏。阴虚者六味丸加鳔胶、五味或六味丸杂聚精丸一
分合服。饮食减少。难于克运者。纳气丸。阴阳俱虚者。十补丸。脾胃阴阳俱虚者。香茸八味丸。
皆兼补先后天药也。男子精未充满。色欲过度。泄出多有半精半血者。此竭力伤肝。肝伤不能藏
血也。盖少阴常少血多气。厥阴常多血少气。少阴之精气既竭。则厥阴之血气亦伤。是以并血泄
出。肾主闭藏。肝司疏泄。气竭肝伤。中空无主。所以二脏俱辟。其治总不出上法也。若夫思欲
不遂。郁火无制。精为火扰而亡脱者。又当清利泻火为主。设与固敛。其滑愈甚矣。
沈朗仲曰。阴虚多火人。偶感客邪。其蒸热咳嗽。虽异平时。然察其脉。不能便显浮紧之象。
The *Suwen* (Basic Questions) states: Where pathogenic factors gather, the healthy qi must be deficient. When yin is deficient, yang pathogenic factors will inevitably gather there. Excess of pathogenic factors manifests as excess syndromes; depletion of essence and qi manifests as deficiency syndromes. Pulse qi deficient in the upper position and cunchi (inch position) deficient is called double deficiency. Those with qi deficiency speak intermittently; those with cunchi deficiency walk unsteadily; those with pulse deficiency do not exhibit the characteristics of yin pulses. A slippery pulse indicates survival, while a choppy pulse indicates death.
For deficiency of form, warm it with qi-tonifying methods. For deficiency of essence, tonify it with flavorful substances.
The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) states: In diseases of consumption/labor injury, the pulse is floating and large, the hands and feet are vexed and hot, the condition worsens in spring and summer, and improves in autumn and winter. Internal cold causes spontaneous emission of essence, and acid soreness prevents walking. A large pulse indicates labor injury damaging yang qi. Vexed hands and feet occur because the spleen governs the four limbs. In spring and summer, yang qi ascends while yin fire rebels, causing worsening; in autumn and winter, yin qi stores while deficient yang is restrained, causing improvement. These are all signs of labor injury to primordial qi. The subsequent mention of internal cold causing spontaneous emission of essence and acid soreness preventing walking refers to labor injury damaging essence and qi, indicating dysfunction of the Kidney and Liver.
In cases of chronic seminal emission, there is tension and urgency in the lower abdomen, coldness at the glans penis, dizziness, and hair loss. The pulse is extremely deficient, knotted (kong), and slow, indicating leakage of undigested food, blood loss, and seminal emission. If the pulse presents various knotted, agitated, faint, or slightly tight qualities, men suffer from seminal emission, and women from nocturnal emissions with sexual dreams. Guizhi Longgu Muli Tang (Cinnamon Twig Decoction with Dragon Bone and Oyster Shell) is the primary treatment.
A deficient, knotted, and slow pulse reflects the root deficiency of blood and essence loss. A knotted, agitated, faint, and slightly tight pulse indicates that within the root deficiency, there lies latent slight pathogenic factors, and liver qi moves internally, causing restless soul and dreams. Blood loss and seminal emission are both internal cause syndromes of consumptive disease. The world generally uses herbs to tonify blood and qi, yet Zhang Zhongjing alone proposes Guizhi Tang. What is the rationale?
Generally, the body's blood and qi rely entirely on postnatal water and grain for nourishment. When water and grain enter the stomach, the pure part becomes Ying (Nutritive) Qi, and the turbid part becomes Wei (Defensive) Qi. If Ying Qi fails to nourish, heat arises above and blood overflows; if Wei Qi fails to protect, cold arises below and essence is lost. Therefore, harmonizing Ying and Wei is the main principle. When Ying and Wei are harmonized, the Sanjiao (Triple Burner) performs its duties, and fire returns to its source. Heat ceases to be hot, cold ceases to be cold, and the fine essences of water and grain are transformed and transported, ensuring the source of essence and blood. Because the patient has habitually suffered depletion, fearing that the lower jiao is deficient, slippery, and unable to contain, Longgu (Dragon Bone) and Muli (Oyster Shell) are added to consolidate and astringe. Longgu enters the Liver to collect the soul, and Muli enters the Stomach to secure essence; both are substances that collect and secure essence and soul. Later generations rarely use these herbs, often suspecting them as mere astringents and criticizing them. Little do they know that when combined with Shizhi (Kaolin), Zhongru (Calcium Carbonate), Bajitian (Morinda Root), Rongsheng (Cistanche), Jinyingzi (Cherokee Rose Fruit), and Yizhiren (Bitter Apricot Seed), they become drastic purgatives; but when combined in Guizhi Tang, they become fundamental medicines for consolidating hibernation and sealing storage. As for consumptive disease with seminal emission, palpitations, epistaxis, abdominal pain, vexatious heat, and dry mouth, add Yi (Maltose) to the base formula to create Xiaojianzhong Tang (Minor Construct the Middle Decoction). For consumptive disease with interior tension and deficiency due to withered Ying and Wei, further add Huangqi (Astragalus) to create Huangqi Jianzhong Tang (Astragalus Minor Construct the Middle Decoction). These are all caused by postnatal insufficiency, so harmonizing Ying and Wei is the primary treatment. Later generations mistakenly used only yin-nourishing and fire-reducing methods, causing harm that could be reversed by these methods if not severe. For diseases caused by congenital Kidney deficiency, Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) should be used. For vexatious deficiency and insomnia, Suanzaoren Tang (Sour Jujube Seed Decoction) is indicated. For dry blood inside, Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) is indicated. Among these treatments, except for Suanzaoren Tang, later generations strictly prohibited the others, not daring to use them nor even mentioning them, which is truly lamentable.
For consumptive disease with interior tension, palpitations, epistaxis, abdominal pain, nocturnal seminal emission, limb soreness, vexed heat in hands and feet, dry throat, and dry mouth, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is indicated. For consumptive disease with interior tension and various deficiencies, Huangqi Jianzhong Tang (Astragalus Minor Construct the Middle Decoction) is indicated.
The first clause discusses consumptive seminal emission with interior tension, abdominal pain, vexatious heat, palpitations, and epistaxis, clearly indicating internal deprivation of yang qi, hence Xiaojianzhong Tang is used to harmonize it. The second clause discusses consumptive interior tension and various deficiencies, which is more severe than the previous deficiency syndrome, hence Huangqi is added to the previous formula to greatly tonify the yang qi in the Wei level. Note: When consumptive disease progresses to blood loss and seminal emission, consuming fluids and causing withering and emaciation, it is difficult to treat. The *Neijing* (Classic of Internal Medicine) states that for conditions resistant to acupuncture and medicine, sweet medicines should be used to regulate. The *Jingui Yaolue* follows this, using Xiaojianzhong Tang and Huangqi Jianzhong Tang to urgently establish middle qi, thereby increasing food intake and flourishing fluids. Later generations who love "Jianzhong" often add Qianhu (Peucedanum) and Xixin (Asarum) to reduce exterior heat; or combine Shu Fuzi (Prepared Aconite) and Rongsheng (Cistanche) in Sixteen-Ingredient Jianzhong to tonify lower deficiency, all losing the true meaning of Jianzhong.
For consumptive disease with lumbar pain, lower abdominal tension, and difficulty urinating, Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) is indicated.
Treating consumptive lumbar pain and lower abdominal tension is undoubtedly purely Kidney and Liver deficiency-cold. However, the symptom of difficulty urinating seems to indicate deficiency with heat, raising the question: are Guizhi (Cinnamon Twig) and Fuzi (Aconite) appropriate? It is unknown that when the Liver loses its power of dispersion and excretion, and the Kidney damages its generating qi, the water passages naturally struggle to flow smoothly. Thus, Guizhi and Fuzi in Bawei Shenqi Wan guide fire back to its source. Without pungent-warm herbs steaming the extreme yang, sinking cold would increase endlessly. By adding slight yang herbs to yin-nourishing herbs, yin and yang are balanced without excessive dominance, representing the highest treatment.
For consumptive disease with various deficiencies and hundred wind diseases, Shuyu Wan (Dioscorea Pill) is indicated.
Note: Shuyu Wan specifically treats consumptive disease arising from unresolved exterior pathogens and mistaken use of cooling herbs injuring Lung and Stomach, progressing downward. It is unsuitable for conditions arising upward from the middle caused by sexual exhaustion damaging essence or stifled fire damaging spirit. Its formulation relies entirely on Guizhi Tang to harmonize Ying and disperse pathogens, combined with Lizhong Wan principles to correct medicinal errors. Dioscorea (Shuyu) is the sovereign herb to greatly regulate Spleen and Lung, completely avoiding tonification of Kidney and Liver. *Yimen Falü* (Legal Principles of Medical Gate) argues that consumptive deficiency easily generates wind and qi, missing the original intent of the *Jingui Yaolue*.
For consumptive vexatious deficiency and insomnia, Suanzaoren Tang (Sour Jujube Seed Decoction) is indicated.
Vexatious deficiency is caused by Liver deficiency allowing fire qi to invade. Hence, Sour Jujube Seed (Suanzaoren) is specially selected to calm Liver and Gallbladder, slightly combined with Chuanxiong (Ligusticum) to regulate blood and nourish Liver, Poria (Fuling) and Licorice (Gancao) to fortify Earth and nurture Wood, and Anemarrhena (Zhimu) to descend fire and relieve vexation. This is a formula to peacefully regulate Wood and Earth.
When Five Labors cause extreme deficiency, emaciation, abdominal fullness, inability to eat, due to dietary injury, emotional injury, drinking injury, sexual injury, hunger injury, labor injury, and damage to meridians, Ying, Wei, and qi, resulting in internal dry blood, crusty skin resembling fish scales, and dark eyes, Huanzhong Buxu (Slowly Tonify Middle and Nourish Deficiency) is achieved with Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill).
The world generally uses Ginseng, Atractylodes, Angelica, and Rehmannia to tonify deficiency, yet Zhang Zhongjing uniquely uses Rhubarb and Ground Beetle to tonify deficiency. Only a sage could employ such methods.
Five Labors and Seven Injuries often stem from unregulated labor, causing qi and blood stagnation, stifling and generating heat, thereby damaging yin. This is what the secular world calls Dry Blood Consumption. Thus, Zhang Zhongjing, taking advantage of uncorrupted primordial qi, first uses Rhubarb, Ground Beetle, Leech, Horsefly, and Silphium Larva—creatures that feed on blood—to expel blood, assisted by Dried Lacquer, Rehmannia, Peach Kernel, and Apricot Kernel to move blood, slightly combined with Licorice and White Peony to slowly tonify the middle and nourish deficiency, Scutellaria to open heat stagnation, taken with wine to promote drug action. Once dry blood is expelled, pure slow tonification concludes the treatment. His prescription of Bailao Wan for Doctor Chen also prioritizes Rhubarb, Ground Beetle, Leech, and Horsefly, removing Dried Lacquer, Silphium Larva, Peach Kernel, and Apricot Kernel, adding Angelica, Frankincense, and Myrrh to dissipate blood clots, using Ginseng to slowly tonify the middle and assist drug power, Gardenia to open heat stagnation, and taken with Lao Water (water stored for a long time) for its non-stagnant nature. Zhang Zhongjing prescribes according to symptoms, not fearing harshness. Even when teaching formulas, he lowered the potency slightly, yet still warned against misuse, noting: "Suitable for all consumption and accumulation diseases not ruined by improper medication." This shows utmost caution.
Li Shicai in *Bingji Shazhuan* (Sand Seal of Pathogenesis) says: Ancient texts mention Five Labors, Seven Injuries, Six Extremes, and Twenty-Three Steams, with numerous symptoms causing confusion. However, understanding the two fundamental syndromes of Congenital and Postnatal sufficiency ensures recovery. Human deficiency is either qi or blood, involving all zang-fu organs. The source of blood is the Kidney; the source of qi is the Spleen. Spleen is the mother of Lung; Lung is the palace of qi generation. Thus, Lung qi injury requires Spleen earth support. Kidney is the mother of Liver; Liver is the storehouse of blood. Thus, Liver blood injury requires Kidney water support. Tonifying Kidney and Spleen should proceed together. However, sweet-cold tonification of Kidney may hinder Kidney qi, and pungent-warm support of Spleen may hinder Kidney water. One must distinguish urgency and treat accordingly: tonify Kidney assisting with Agaricus and Amomum, or support Spleen mixing with Dioscorea and Schisandra. Flexibility in application is essential.
In consumptive disease, supporting Spleen and protecting Lung is indispensable. However, Spleen likes warmth and dryness, while warming-drying herbs disadvantage Lung protection. Lung likes coolness and moisture, while cooling-moistening herbs disadvantage Spleen support. Comparing the two, Spleen generates Lung, but Lung does not support Spleen. Thus, "Earth prosperous generates Metal." Do not rigidly focus on protecting Lung by suppressing hyperactive fire to preserve yin, or strengthening the master of water to control sunlight. Both methods should run parallel. However, fire-suppressing herbs are often cold and damage yang qi; water-strengthening herbs are often neutral and nourish yin blood. Comparing the two, excessive bitter-cold risks damaging Stomach qi, while constant sweet-neutral usage harms no middle. Thus, "Water abundant extinguishes fire." Do not eagerly use cooling herbs.
To treat deficiency pathogens, one must first protect healthy qi. If healthy qi exists, harm is avoided. Tonification inherently contains attack; tonifying yin attacks heat, tonifying yang attacks cold. There is no case where healthy qi recovers but pathogens remain, nor where healthy qi exhausts but life is preserved. If unavoidable, judge urgency, temporarily compromise, start small and increase, embedding battle within defense. This is the way to treat deficiency. To treat excess, remove pathogens; once removed, health returns. Methods must be precise for rapid effect. This is the way to treat excess. False deficiency is rare, but false excess is common. False cold is easy to treat, but false heat is often misdiagnosed. Excess usually involves heat; deficiency usually involves cold. As Danxi said, "Excess qi is fire," so excess can tolerate cold. I add, "Deficient qi is cold," so deficiency can tolerate heat. Those who do not distinguish true/false and root/branch claim medical knowledge, I dare not agree.
For yin deficiency with much heat, pungent-dry herbs are most disliked as they aid yang pathogens. Bitter-cold is especially taboo as it destroys vital qi. Pure sweet water-strengthening herbs are preferred to nourish yin and match yang, causing deficient fire to descend and yang to return to yin. For yang deficiency with much cold, cooling-moist herbs are disliked as they aid yin pathogens. Pungent-dispersing herbs are especially taboo as they damage yin qi. Sweet-warm fire-benefiting herbs are suitable to tonify yang and eliminate yin, causing deep cold to converge and yin to follow yang. Ignorant people only know to treat cold with heat and heat with cold. Thus, yin deficiency unsuited for descending takes cold and becomes hot; yang deficiency unsuited for dispersing takes heat and becomes cold. This is because they specifically treat vigorous qi, causing reverse pathology. Spring and summer govern growth; autumn and winter govern肃杀 (harvest/death). People know this but fail to realize that warm herbs emulate heaven and earth's developmental virtue, while cold herbs emulate heaven and earth's punitive severity. For example, Siwu Tang plus Phellodendron and Anemarrhena is named Kanli Wan, revered worldwide as a top yin-nourishing and fire-descending divine pill. Yet autumn/winter qi does not generate all things. Cooling-blood herbs often cloy the diaphragm, unsuitable for those with much phlegm and little appetite. They are moistening; overuse causes diarrhea. Many consumptive deaths result from diarrhea, often caused by clearing-moistening herbs. Moreover, Phellodendron is bitter-cold; bitterness enters Heart first, and long-term use increases qi, potentially aiding fire. Damaging the Stomach is self-evident. Chuanxiong ascends, unsuitable for fire flaming upward. Anemarrhena slides the intestines, unsuitable for sinking yuan qi. Danxi said, "Excess fire can be purged, deficient fire can be tonified." Ask yourself: Is consumptive fire deficient or excess? Can it be purged? Ancients said, "Fear Anemarrhena and Phellodendron like poison," fearing they destroy the root of life. Although, if the disease begins with flourishing ministerial fire, bitter dryness/thirst, and slippery-large right chi pulse, temporary use is harmless, but long-term use is absolutely forbidden. Thus, using warm tonics: if the disease does not worsen, it is improving, because the interior has received tonification. Using cold/cool: if the disease does not improve, it is worsening, because the interior has been attacked. Warm herbs resemble the Junzi (gentleman) of Yangming; faults are visible. Cold/cool herbs resemble the yin-ruffian; the state is perilous, yet people remain unaware. Consumptive diseases are lower cold and upper heat, known as failure of water-fire interaction. Those re-exposed to cold experience lower jiao pain; those not exposed do not. Upper jiao dry-heat remains the same. Upper jiao suffers vexatious heat; cold herbs bring temporary relief, leading patients to believe the herbs work and prefer them. Unaware that cold herbs eventually sink, making lower yuan colder, forcing fire upward, worsening upper heat. This cycle leads to incurable stagnation. Thus, cold-cooling yin-nourishment is not only useless but harmful.
"Excess qi is fire." Using qi-tonifying herbs for deficiency, can it avoid aiding fire? Fire and primordial qi cannot coexist; one wins, the other loses. Vigorous healthy qi leaves no room for pathogens. Even when using blood herbs for blood deficiency, qi herbs must be primary. The Classics state: "Without yang, yin cannot generate." In blood loss, tonify qi, because blood does not generate itself; it needs yang-warm herbs to generate. Yang generates, then yin grows. Single use of blood herbs prevents blood generation and harms the middle jiao. Li Dongyuan said: Ginseng is sweet-warm, tonifies Lung qi. When Lung qi is vigorous, qi of the four viscera becomes vigorous, essence generates, and form flourishes. Bai Feixia said: Ginseng, in excess, restores primordial qi from nowhere. Suitable for post-illness qi deficiency and Lung deficiency wheezing/cough. Ginseng tonifies qi, recorded in Materia Medica, universally known. Wang Haogu said: Lung heat injures Lung again. Wang Jiezhai said: Consumptive disease patients taking Ginseng and Astragalus will die. Thus, the world calls it toxic as a scorpion. Unknowingly, Lung houses fire; if right cun pulse is large and forceful, indicating Li Dongyuan's "stifled heat in Lung," it indeed should not be used. But if Lung is deficient with deficient fire invading, Lung is suffering; how else to save it with Ginseng? Ancient formulas for Lung cold used Wenfei Tang, Lung heat Qingfei Tang, middle fullness Fenxiao Tang, blood deficiency Yangying Tang, all using Ginseng. From Neijing to sages, earnestly stated: qi herbs have the merit of generating blood; blood herbs lack the logic of tonifying qi. This is profound and clear. Why do people not awaken?
Neijing discusses how changes in Wind, Cold, Summer-Heat, Dampness, Dryness, and Fire (Six Qi) can all cause bleeding, each requiring investigation of cause. If causes are not observed and cooling herbs are indiscriminately used, complications arise. After taking cold/cool herbs, if symptoms decrease greatly but pulse accelerates, it is yang depression. Ascension and tonification are indicated; cold/cool is strictly taboo. Persistence in using cold/cool leads to death. Wild movements of Seven Emotions, physical fatigue, and mutual pressure of yang fire cause blood to flow incorrectly. Pulse is洪 (surging) with much heat, dry mouth, and difficult urination; cooling herbs are suitable. If qi deficiency with cold causes yin-yang separation, blood also flows wrongly, showing deficiency-cold signs, because "yang deficiency leads to yin fleeing." Verify blood color: it will be dark and thin, unlike the thick purple-red color of blood forced by excess fire. Lizhong Tang plus Cinnamon Bark is suitable for consolidation. If caused by qi, add Aucklandia and Lindera. If dietary injury to Stomach causes regurgitation/vomiting blood, add Cyperus, Amomum, Hawthorn, and Malt. Cough with blood: Guben Wan or Jiling Gao. Spleen-Stomach deficiency with loose stools: Qiongyu Gao. Labor cough with hemoptysis, upper heat lower cold: Siwei Lurong Wan or Jisheng Lurong Wan. Kidney deficiency with wind invasion, lower body flaccidity, joint pain, wheezing/cough with seminal emission, pain in waist/abdomen/legs/knees/shins/ankles preventing standing: Anshen Wan. Chronic consumptive blood loss, blood枯 (withered) fever, and female amenorrhea due to blood withering: Suwen Si Wumeigu Yilu Ru Wan (Four Cuttlebone and Rubia Pill) or Siwu Tang replacing Shengdi with Peach Kernel and Horsefly, made into pills. Vomiting blood in liters: Huarui Shi San (Flower Coral Stone Powder). Suitable only for yang deficiency failing to control yin and violent yin rebellion. If qi excess and blood surge with fire, misuse is dangerous; Shihui San (Ten Ash Powder) is suitable. If gastric cavity accumulates blood overflowing up, Xijiao Dihuang Tang plus Rhubarb to purge downwards. Early hematemesis often benefits from Rhubarb purgation. Downward flow is favorable in blood loss; upward is adverse. It is said consumptive blood-loss patients forbid purgation. Why? Generally, purgation is applied at the beginning of accumulation/wrongful flow; forbidding purgation applies after massive depletion. This must be clearly distinguished. Accumulated labor hematemesis, residual hematemesis from blood disease, and prolonged uncontrollable hematemesis: all treated with Dushen Tang (Single Ginseng Decoction). Qi deficiency with heat: Baoyuan Tang plus Child's Urine and Lotus Juice. Even with blood, it is harmless. All blood loss, or blood deficiency with vexation/thirst, restlessness, five-center heat: Shengyu Tang. For long-standing blood syndromes, ancients often concluded treatment with Stomach herbs: Yigong San plus Moutan, Dioscorea, and Alisma. Add Polygonatum for cough. This is a divine agent for deficiency. Regarding all blood loss: whether epistaxis from meridians, hemoptysis from Heart, cough-sputum blood from Lung, hematemesis from Stomach, spitting blood from Kidney, vomiting blood from Liver, or spittle blood from Spleen, purple-black color indicates old accumulated stasis; bright red indicates acute fresh injury; pale/clear indicates qi deficiency with phlegm. All belong to boiling inflammation/fire. Thus, treating blood prioritizes descending fire and blood. Do not abruptly use sour-cold astringents to cause stasis-heat and increase upward flare. First use Ruijin Dan, then Tongzhen Wan, to rapidly guide blood and fire downward. If blood is bright red, coagulates upon spitting, and forms slices like persimmon skin, this is stored blood escaping due to true yin damage. Despite increased appetite, sudden death will occur. If spitting pale red like meat or lung, called "coughing white blood," this indicates simultaneous Lung and Stomach injury; despite long duration, it is ultimately incurable.
Consumptive seminal slipperiness without limit, or nocturnal emission at Yin hour, with shortness of breath, weakness, daily emaciation, and blurred vision, results from excessive sexual activity, failure of Du and Ren channels to intersect, and inability to restrain ministerial fire. For yang deficiency: Lurong Wan or Guilu Erxian Gao. For yin deficiency: Liuwei Wan plus Colla Corii Asini and Schisandra, or mixed with Ju Jing Wan. For reduced diet and poor digestion: Naqi Wan. For dual yin-yang deficiency: Shibei Wan. For dual Spleen-Stomach yin-yang deficiency: Xiangrong Bawei Wan. All tonify congenital and postnatal sources. Men whose essence is not fully formed engaging in excessive lust may ejaculate half-essence half-blood. This is exhausting the Liver; Liver injury fails to store blood. Shaoyin usually has less blood and more qi; Jueyin usually has more blood and less qi. When Shaoyin essence/qi is exhausted, Jueyin blood/qi is also injured. Hence, mixed blood emission. Kidney governs closure/storage; Liver governs dispersion/excretion. Qi exhaustion and Liver injury leave the center empty and leaderless, causing both viscera to fail. Treatment generally follows the above methods. If frustrated desires and uncontrolled stifled fire disturb essence causing depletion, clearing and draining fire is primary. Using astringents would worsen slipperiness.
Shen Langzhong said: In yin-deficient individuals with much fire, occasional exposure to external pathogens causes steaming heat and cough. Although different from usual, the pulse does not show floating-tight qualities.