虚损劳瘵之异 凡损伤元气者本皆虚证，而古方以虚损劳瘵各分门类，则病若有异，亦所宜辨。盖虚
损之谓，或有发见于一证，或有困惫于临时，凡在经在脏，但伤元气，则无非虚损病也。至若劳瘵之有不同者，
则或以骨蒸，或以干嗽，甚至吐血吐痰，营卫俱败， 羸日甚，此其积渐有日，本末俱竭而然。但虚损之虚，
有在阴分，有在阳分，然病在未深，多宜温补；若劳瘵之虚，深在阴中之阴分，多有不宜温补者。然凡治虚证
宜温补者，病多易治；不宜温补者，病多难治。此虚劳若乎有异，而不知劳瘵之损，即损之深而虚之甚者耳。
凡虚损不愈，则日甚成劳矣，有不可不慎也。（《景岳》）
脉候 诊其脉，甚数甚急，甚细甚弱甚微，甚涩甚滑，甚短甚长，甚浮甚沉，甚紧甚弦，甚洪甚实，
皆生于劳伤。（《中藏经》）
虚劳之脉，大抵多弦（按∶严子礼亦云然），或浮大，或数，皆虚劳之候也。大者易治，血气未衰（按∶
原文衰作定，今从《简易方》），可敛而正也。弦者难治，血气已耗，未易调补之。若带双弦，则为贼邪侵脾，
此尤难治，加
数（按∶原文此下有剂字，今从《简易方》删）则殆矣。（《直指》）
虚损之脉（按∶原文此下有《中藏经》文），然无论浮沉大小，但渐缓则渐有生意，若弦甚者病必甚，数
甚者病必危，若以弦细而再加紧数，则百无一生矣。（《景岳》）
劳脉，初起见洪大或细数，皆忌也。然投以滋补之剂尚能应手，而脉亦渐转微弱，数亦渐退，犹为可治；
若证转而脉不转，即不可治，所谓无胃气也。（《医学指要》）
紧数之脉，表里俱虚，紧为寒伤营，数为血不足。脉见短数，则无胃气，细数紧数，俱非吉祥。脉洪大按
之虚者，须防作泻。凡见数脉难治，病久脉数，尤非所宜。脉忽浮涩而数，忽沉弱而缓，变易不常，虚火之故
也。虚损转潮热泄泻，脉短数者不治。虚损脉浮大者，属阳虚；细数者，属阴虚。芤为失血，若两手俱芤，而
中有一部独弦者，为有瘀蓄未尽，当散瘀为先，不可骤补。若见数大者，为火旺，必难治；若见涩脉来至者，
亦不可治也。弦数为骨蒸，自上而下者，必寸口浮数；自下而上者，必尺中弦急。若关尺俱弦细而急，如循弦
缕者，不治。又尺中弦强者，必因房室发热，加之误服寒凉，故脉如是。然虚损之人，虽远房室，其尺脉之弦
强，必不能便软。若更犯房室，明日反和，此阴阳得交，故尔暂软。后日诊之，其弦强必愈甚。诊察之际，不
可不辨也。（《医通》）
辨爪 凡劳损之病，本属阴虚，阴虚必血少，而指爪为精血之余，故凡于诊候之际，但见其指爪干黄，
觉有枯槁之色，则其发肤营气，具在吾目中矣。此于脉色之外，便可知其有虚损之候，而损之微甚，亦可因之
以辨也。（《景岳》）
五劳六极七伤 （互见前源由总说中）夫虚劳者，五劳六
极七伤是也。五劳者, 一曰志劳，二曰思劳，三曰心劳，四曰忧劳，五曰瘦劳。又肺劳者，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，舌本苦直，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。六极者，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，手足烦疼，不可以立，不欲行动。五曰肌极（按∶《千金》作髓极），令人羸瘦无润泽，饮食不
生肌肤。六曰精极，令人少气， 然内虚，五脏气不足，发毛落，悲伤喜忘。七伤者，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。又一曰，大饱伤脾，脾伤
善噫，欲卧面黄。二曰大怒气逆伤肝，肝伤少血目暗。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。七曰大恐惧不节伤志，志伤恍惚不乐。（《病源论》）
证候概略 五劳者，五脏之劳也。皆因不量才力，勉强运为，忧思过度，嗜欲无节，或病失调将，积
久成劳。其病头旋眼晕，身疼脚弱，心怯气短，自汗盗汗，或发寒热，或五心常热，或往来潮热，或骨蒸作热，
夜多恶梦，昼少精神，耳内蝉鸣，口苦无味，饮食减少，此皆劳伤之证也。（《要诀》）
其证百节烦疼，腰酸脚软，或胸闷短气，心烦不安，或耳鸣目眩，咳嗽寒热，或盗汗遗精，白浊飧泄，或
食少无
味，不作肌肤，或睡中惊悸，午后发热，或怠倦无力，四肢不收，或虚火上攻，面赤喘急，此皆虚损之症，
有一症见，即当因其病而药之可也。但视其症之不大，茶饭可餐，起居可动，作为可施，自以为生，孰知其后
卧床不起，去死不远，若欲收救，不可得也。（《医林绳墨》）
咳嗽痰喘不绝声者，急则治其标也。阴虚火动而微嗽者，缓则治其本也。阴虚发热，嗽血大便结者，此虚
火盛也。咳嗽吐血，喘急不能食者，脾肺虚损也。痰嗽喘热而泄泻者，此脾惫也。痰嗽喘热而痢疾者，脾肾俱
惫也。痰嗽喘热，脾虚饱闷发肿者，难治也。（《回春》）
日晡头痛眩晕，阴血虚也。头晕头痛，或痰喘气促，肾虚不纳气也。自汗内热口干，胃气虚也。盗汗内热
口干，阴血虚也。茎痛而便不利，精内竭也。愈痛则愈欲便，愈便则愈痛，精复竭也。食少体倦，口干饮热，
小便黄短，脾肺虚热也。发热饮热，大便秘，内热也。发热饮冷，便秘，内热涩滞，肝热也。饮食少思，胃气
虚也。饮食不化，脾气虚也。劳役而小便黄，元气下陷也。体倦头痛眩晕，中气虚也。四肢逆冷，肾气虚寒也。
面目赤色，烦热作渴，脉大而虚，血脱发燥也。善思体痛，无寐盗汗，肝脾血虚也。寝寐而出汗，肾气也。平
人饮食出汗，是食反助其胃火也。平人饮食，额上蒸大汗如雨，此名蒸笼头。睡觉饱而出汗，宿食也。胸满多
痰，脾气虚也。晡热多痰，肾亏津液泛上也。忿怒胸痞，脾气滞也。倦怠胸痞，中气虚也。倦怠寒热往来，肝
脾气虚也。口苦寒热往来，肝火血虚也。内热晡热，或寒热往来，阴血虚也。畏寒，或寒热往来，肝气滞也。
妇人劳怒，夜发热，或谵语，或经适行，热在血分。怔忡惊悸，心血虚也。思虑怔忡，惊悸便勤，内有痰也。
（《医彀》）
虚损两颧红赤或唇红者，阴虚于下，逼阳于上也。仲景曰∶其面戴阳者，下虚故也。虚而多渴者，肾水不
足，引水自救也。喑唾声不出者，由肾气之竭，盖声出于喉而根于肾，经曰，内夺而厥，则为喑俳，此肾虚也。
虚而喘急者，阴虚肺格，气无所归也。喉干咽痛者，真水下亏，虚火上浮也。不眠恍惚者，血不养心，神不能
藏也。时多烦躁者，阳中无阴，柔不济刚也。易生嗔怒，或筋急酸痛者，水亏木燥，肝失所资也。饮食不甘，
肌肉渐消者，脾元失守，化机日败也。心下跳动，怔忡不宁者，气不归精也。经曰∶胃之大络，名曰虚里，出
于左乳下，其动应衣，宗气泄也。盗汗不止者，有火则阴不能守，无火则阳不能固也。虚而多痰，或如清水，
或多白沫者，此水泛为痰，脾虚不能制水也。骨痛如折者，肾主骨，真阴败竭也。腰胁痛者，肝肾虚也。膝
以下冷者、命门衰绝，火不归源也。小水黄涩淋沥者，真阴亏竭，气不化水也。足心如烙者，虚火烁阴，涌泉
涸竭也。（《景岳》）
桃花蛀 郁劳 有面色如故，肌体自充，外看如无病，内实虚损，俗呼为桃花蛀，宜看其何证，于前
药审而用之。（《要诀》）（按∶前药即建中、大补之类。）。面色不衰，肌肤日瘦，外如无病，内实虚伤，
俗名桃花疰。其证必蒸热咳嗽，或多汗，或无汗，或多痰，或无痰，或经闭，或泄精，或吐血，或衄血，或善
食，或泄泻，须察其所现何证、何脏受伤而治之。然此皆为阴火煎熬之证，治多不效。室女过时不嫁，男子过
时不娶，及少寡者，多犯此证。以阴火虽乘阳位，非但不能消烁阳分之津液，阴分之津液，反竭力上供阳火
之消烁，故肢体日削，而面色愈加鲜泽也。轻者嫁娶后渐愈，重者虽暂愈一两月，向后必
死，以其躯体柔脆，精气先枯，不能胜其发泄也。惟少寡再醮者，每多自愈，以其躯体堪任也。郁火既散，津
液既通，可不药而愈矣。（《医通》）
婺妇师尼，所欲未遂，阴阳离绝，郁火亢极，不得发泄而成失合证者，较之房劳更甚。始则肝木郁热，继
则龙火上煽，致心肺受病，而喘嗽烦热，甚则迫血骤亡者有之，经闭不行而吐衄者有之。此证宜开郁降火，增
损柴胡汤、加味逍遥散选用。阴火亢极者，可用滋肾丸、玉烛散先泻郁火，后服滋养之药如乌骨鸡丸之类。若
郁火不泄，血气不荣而发痈疽者，去生远矣。（同上）
各证杂说 丈夫无子者，其精清如水，冷如冰铁，皆为无子之候。又泄精精不射出，但聚于阴头，亦
无子。无此之候，皆有子。（《病源论》）
劳伤则血气虚，使阴阳不和，互有胜弱故也。阳胜则热，阴胜则寒，阴阳相乘，故发寒热。（同上）
有无故身体瘦软，绝无力气，别无他证，此平日作劳太过，血气虚而筋失养，宜劫劳散，或和气汤倍芎归
（按∶《类方》和气饮，于五积散去桂、麻、朴、芎，加干葛、大黄、升麻者，此岂其方乎）。又有言语读诵，
过耗神气，致成虚损，是为叫呼走气，宜于十全大补汤等药选用。虚人老人病中，忽一旦语言不出，扣之不应，
此不是哑风，久久药力到，补调功成，自复应矣。有于坐卧之中，似欲得人按捻，意方始安者，此亦虚证也。
外有因动作劳力，或发寒热，或身疼气短，或劳倦嗜卧，乃一时发劳，却非五劳者比，宜和气饮。有咳嗽痰多
者，名曰劳嗽，与感风寒壅热之嗽不同，此乃有本有标，本在肾而标在肺。（《要诀》）
有重阴覆其阳，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。（《六要》）（按∶火郁汤、柴胡
升麻汤，俱系东垣方，今不录。）
《慎柔》云∶尝治虚损，脉和缓而五六至，但咳嗽发热，无恶寒、咽痛喉哽等证，以为可治，服保元、四
君之类十余剂，咳嗽略可，热亦微退，至二十剂外，咳嗽反盛，热复如前，而身反不能转侧，足渐无力，至不
能行而蜷，此何也？缘下焦肾气衰惫，无津液滋养百骸，阳气不能四运，脾肺之气不能下输，故足无力而蜷，
药虽有效，病虽暂减，终不可治。若初服四君、保元十余剂，而脉细如丝，其数不改，决不可治。如细而不数
者，此犹有胃气，无腹痛作泻，而饮食如常，可用保元、参、术调理。须二三年方愈。若服药后，数脉渐减，
和缓有神，虽曰可治，亦得三月见功，年半方可全愈。又须看年力之衰壮、精神脾胃之强弱断之。若服药后，
脉虽和缓，而腿渐无力，如前所述，且痰嗽不止，脉虽缓治之无益。又或如前证，足虽无力而热退嗽减，饮食
如平人，此脾胃尚强，犹可迁延岁月。（《医通》）
似损非损 凡似损非损之证，惟外感寒邪者乃有之。盖以外邪初感，不为解散，而误作内伤，或用清
凉，或用消导，以致寒邪郁伏，久留不散，而为寒热往来，或为潮热咳嗽，其证则全似劳损，若用治损之法以
治此证，则滋阴等剂，愈以留邪，热蒸既久，非损成损矣。余尝治愈数人，皆其证也。欲辨此者，但当详察表
里而审其致病之由。盖虚损之证，必有所因，而外感之邪，其来则骤。若或身有疼痛，而微汗则热退，无汗则
复热，或见大声咳嗽，脉虽弦紧而不甚数，或兼和缓等证，则虽病至一两月，而邪有不解，病终
不退者，本非劳损，毋误治也。（《景岳》）
死证 （互见《骨蒸》中，宜参。）病劳人，脱肛，骨肉相失，声散呕血，阳事不禁，梦寐交侵，呼吸
不相从，昼凉夜热者死，吐脓血者亦死。其脉不数有根蒂者，及颊不赤者生。（《中藏》）
劳疾，久而嗽血，咽疼无声，此病自下而传上；若不嗽不疼，久而溺浊脱精，此为自上传下，皆死证也。
（《要诀》）
大抵虚劳起于 丧者，肝肾过劳，多致亡血失精、强中阴竭而死。起于郁结者，内火烁津，多致血结干咳、
嗜食发痈而死。起于药误者，脾肺受病居多，多致饮食减少、喘嗽泄泻而死。（《医通》）
虚劳不受补者，不治。（《丹溪》）
病患久虚，内有宿积旧痰，用参术补之，久乃吐出臭痰或绿色痰，当不治。盖积之久，而脾胃虚极不运，
故郁臭耳。（《慎柔五书》）
[Distinction between Xu Sun (Deficiency Damage) and Lao Zhai (Consumption)]
All conditions that damage Yuan Qi (Original Qi) are fundamentally deficiency syndromes. However, ancient medical texts classified Xu Sun (Deficiency Damage) and Lao Zhai (Consumption) into separate categories, indicating that although the diseases may appear different, they should be distinguished. The term "Xu Sun" refers to conditions where symptoms may manifest at a specific time or where exhaustion is felt during clinical presentation. Regardless of whether the disease affects the meridians or the zang-fu organs, as long as Yuan Qi is damaged, it belongs to Xu Sun diseases. As for the differences in "Lao Zhai," some present with bone-steaming fever, some with dry cough, and even hemoptysis (coughing up blood) or expectoration of phlegm, with both Ying (Nutritive) and Wei (Defensive) qi deteriorating, leading to progressive emaciation. This results from gradual accumulation over time, where both the root and branches are exhausted. However, deficiency in Xu Sun can be in the Yin aspect or the Yang aspect. When the disease is not deep, warm tonification is generally suitable. In contrast, deficiency in Lao Zhai is deeply rooted in the Yin within Yin, and warm tonification is often unsuitable. Generally, deficiency syndromes suitable for warm tonification are easier to treat, while those unsuitable are harder to treat. Thus, Xu and Lao seem different, but it is unknown that the damage in Lao Zhai is simply deeper damage and more severe deficiency. If Xu Sun does not heal, it worsens daily and becomes Lao; this must be handled with caution. (From *Jingyue Quanshu*)
[Pulse Diagnosis]
When diagnosing the pulse, if it is extremely rapid and urgent, extremely fine, weak, or minute, extremely choppy or slippery, extremely short or long, extremely floating or deep, extremely tight or wiry, extremely surging or excess, these all arise from labor injury. (From *Zhongzang Jing*)
The pulse of Xu Lao (Deficiency Consumption) is generally wiry (as Yan Zili also stated), or floating and large, or rapid; these are all signs of Xu Lao. A large pulse indicates easy treatment because Blood and Qi have not yet declined (the original text says "fixed," now corrected according to *Jianyi Fang*), and can be gathered and normalized. A wiry pulse indicates difficult treatment because Blood and Qi have already been depleted and are hard to regulate and tonify. If the pulse presents as double-wiry, it indicates pathogenic factors invading the Spleen, which is particularly difficult to treat. If a rapid pulse is added (the character "ji" in the original text is deleted according to *Jianyi Fang*), it is perilous. (From *Zhizhi Fang*)
Regarding the pulse of Xu Sun (Deficiency Damage), regardless of whether it is floating, deep, large, or small, if it gradually becomes moderate, there is gradually a sign of life. If the wiry pulse is severe, the disease is severe; if the rapid pulse is severe, the disease is critical. If it is wiry and fine, further complicated by tight and rapid, there is less than one chance in a hundred of survival. (From *Jingyue Quanshu*)
For the pulse of Lao (Consumption), if it initially appears surging and large or fine and rapid, these are contraindications. However, if tonifying agents are administered and respond effectively, and the pulse gradually turns weak and the rapidness subsides, it is still treatable. If the symptoms change but the pulse does not, it is untreatable, which is referred to as "lack of Stomach Qi." (From *Yixue Zhiyao*)
A tight and rapid pulse indicates deficiency in both interior and exterior; tightness is due to Cold damaging the Ying level, and rapidness is due to Blood insufficiency. A short and rapid pulse indicates lack of Stomach Qi; fine, rapid, and tight pulses are all inauspicious. A surging and large pulse that feels empty upon pressure requires vigilance against diarrhea. Any appearance of a rapid pulse is difficult to treat; a prolonged illness with a rapid pulse is especially unfavorable. A pulse that suddenly becomes floating, choppy, and rapid, then suddenly deep, weak, and slow, changing unpredictably, is due to Deficient Fire. If Xu Sun progresses to tidal fever and diarrhea with a short and rapid pulse, it is untreatable. A floating and large pulse in Xu Sun belongs to Yang deficiency; a fine and rapid pulse belongs to Yin deficiency. A knotted (Kou) pulse indicates blood loss; if both hands show a Kou pulse, but one section alone shows a wiry pulse, it indicates residual blood stasis, which should be dispersed first before sudden tonification. If a rapid and large pulse appears, it indicates flourishing Fire and is difficult to treat; if a choppy pulse appears, it is also untreatable. Wiry and rapid pulses indicate bone-steaming; if the pathology moves from top to bottom, the Cun (inch) position must be floating and rapid; if from bottom to top, the Chi (cubit) position must be wiry and urgent. If both Guan and Chi positions are wiry, fine, and urgent, like touching a string, it is untreatable. Furthermore, a strong wiry pulse at the Chi position is likely due to heat from sexual activity compounded by the mistaken use of cold-cooling herbs. However, even if a person with Xu Sun abstains from sex, the wiry strength of the Chi pulse cannot immediately soften. If sex is resumed, the pulse may soften the next day due to the interaction of Yin and Yang, but upon re-examination later, the wiry strength will likely increase. Careful differentiation is essential during diagnosis. (From *Yitong*)
[Observation of Nails]
All Lao Sun (Consumption Damage) diseases belong to Yin deficiency, and Yin deficiency inevitably leads to Blood deficiency. Since fingernails are the surplus of Essence and Blood, during diagnosis, if the nails appear dry, yellow, and withered, one can observe the condition of the hair, skin, and Ying Qi. Beyond pulse and complexion, this allows one to identify signs of Xu Sun and assess the severity of the damage. (From *Jingyue Quanshu*)
[Wu Lao (Five Labors), Liu Ji (Six Extremes), and Qi Shang (Seven Injuries)]
(See the general explanation of origins earlier.) Xu Lao is essentially Wu Lao, Liu Ji, and Qi Shang. Wu Lao includes: 1. Zhi Lao (Mental Labor), 2. Si Lao (Overthinking), 3. Xin Lao (Heart Labor), 4. You Lao (Worry), 5. Shou Lao (Emaciation Labor). Additionally: Lung Lao presents with shortness of breath and facial edema, and inability to smell odors. Liver Lao presents with dry, dark face and eyes, bitter taste, unsettled spirit, fear preventing solitary sleep, and blurred vision. Heart Lao presents with forgetfulness, difficulty defecating or loose stools resembling duck feces, and mouth ulcers. Spleen Lao presents with a stiff tongue base and inability to swallow saliva. Kidney Lao presents with difficulty bending and extending the back, dysuria, reddish-yellow urine with dribbling, internal penile pain, dampness in the genital area with sores on the scrotum, and fullness/urgency in the lower abdomen.
Liu Ji (Six Extremes) includes: 1. Qi Ji (Qi Extreme), causing internal weakness, insufficient Zang-Fu, excess pathogens, deficient righteous Qi, and reluctance to speak. 2. Xue Ji (Blood Extreme), causing pallor, falling eyebrows/hair, forgetfulness. 3. Jin Ji (Tendon Extreme), causing frequent muscle cramps, pain in fingers/nails, extreme fatigue preventing standing. 4. Gu Ji (Bone Extreme), causing soreness/emaciation, toothache, limb pain preventing standing/movement. 5. Ji Ji (Muscle Extreme, or Sui Ji/Marrow Extreme in *Qianjin*), causing emaciation without luster, failure of diet to nourish flesh. 6. Jing Ji (Essence Extreme), causing shortness of breath, internal weakness, insufficient Zang-Fu Qi, falling hair, sadness, and forgetfulness.
Qi Shang (Seven Injuries) includes: 1. Yin Cold, 2. Impotence, 3. Internal urgency, 4. Continuous seminal emission, 5. Scanty essence, 6. Damp genitals, 7. Clear essence, 8. Painful frequent urination, 9. Inability to complete intercourse. Another view: 1. Overeating injures Spleen (belching, desire to lie down, yellow face). 2. Great anger injures Liver (less blood, dim vision). 3. Heavy lifting/sitting on wet ground injures Kidney (scanty essence, back/waist pain, cold extremities). 4. Cold form/cold drink injures Lung (shortness of breath, cough, nasal congestion). 5. Worry/thought injures Heart (fright, forgetfulness, irritability). 6. Wind/rain/cold/heat injures Form (withered skin/hair). 7. Great fear/incontinence injures Zhi (will), causing confusion and unhappiness. (From *Bingyuan Lun*)
[Overview of Symptoms]
Wu Lao refers to the labor of the five Zang organs. It results from exceeding one's capacity, forced exertion, excessive worry/thought, unregulated desires, or improper convalescence after illness, accumulating into consumption. Symptoms include dizziness, blurred vision, body ache, weak legs, palpitations, shortness of breath, spontaneous/diaphoresis, chills/fever, constant heat in the five centers, alternating tidal fever, bone-steaming heat, night terrors, daytime lethargy, tinnitus, bitter taste, anorexia. These are all signs of labor injury. (From *Yaojue*)
Symptoms include joint pain, sore waist/weak legs, chest tightness/shortness of breath, restlessness, tinnitus/blurred vision, cough/chills, night sweats/spermatorrhea, white turbidity/undigested stool, anorexia, failure to build flesh, nocturnal palpitations, afternoon fever, fatigue/limb flaccidity, Deficient Fire attacking causing red face/asthma. Any single symptom warrants treatment based on the disease. However, patients who appear functional (eating, moving, working normally) despite underlying issues may suddenly collapse and die; rescue is then impossible. (From *Yilin Shengmo*)
Unceasing cough/phlegm/wheezing requires treating the branch urgently. Mild cough due to Yin deficiency and Fire movement requires treating the root slowly. Yin deficiency with fever, hemoptysis, and constipation indicates flourishing Deficient Fire. Cough/hemoptysis with asthma/anorexia indicates Spleen-Lung deficiency. Phlegm-cough/wheezing/heat with diarrhea indicates Spleen exhaustion. Phlegm-cough/wheezing/heat with dysentery indicates Spleen-Kidney exhaustion. Phlegm-cough/wheezing/heat with Spleen deficiency, fullness, and edema is difficult to treat. (From *Huichun*)
Afternoon headache/dizziness indicates Yin Blood deficiency. Headache/dizziness with phlegm-cough/shortness of breath indicates Kidney deficiency failing to grasp Qi. Spontaneous sweat/internal heat/dry mouth indicates Stomach Qi deficiency. Night sweat/internal heat/dry mouth indicates Yin Blood deficiency. Penile pain with difficult urination indicates depletion of Essence. Increased pain/urination cycle indicates repeated Essence depletion. Low appetite/fatigue/dry mouth/thirst for hot drinks/yellow-short urine indicates Spleen-Lung Deficient Heat. Fever/thirst for hot drinks/constipation indicates internal heat. Fever/thirst for cold drinks/constipation indicates internal heat stagnation/Liver Heat. Lack of desire to eat indicates Stomach Qi deficiency. Indigestion indicates Spleen Qi deficiency. Yellow urine after labor indicates sinking of Yuan Qi. Fatigue/headache/dizziness indicates Middle Qi deficiency. Cold extremities indicate Kidney Qi deficiency/Cold. Red face/restlessness/thirst/large-empty pulse indicates Blood loss/dryness. Excessive thinking/body pain/no sleep/night sweats indicates Liver-Spleen Blood deficiency. Sweating during sleep relates to Kidney Qi. Sweating after eating in healthy people indicates food aiding Stomach Fire. Profuse sweating on the forehead after eating is called "Steaming Basket Head." Sweating after waking/full meal indicates retained food. Chest fullness/phlegm indicates Spleen Qi deficiency. Afternoon fever/phlegm indicates Kidney deficiency with fluid reflux. Anger/chest stuffiness indicates Spleen Qi stagnation. Fatigue/chest stuffiness indicates Middle Qi deficiency. Fatigue/alternating chills-fever indicates Liver-Spleen Qi deficiency. Bitter taste/alternating chills-fever indicates Liver Fire/Blood deficiency. Internal heat/afternoon fever/alternating chills-fever indicates Yin Blood deficiency. Aversion to cold/alternating chills-fever indicates Liver Qi stagnation. Female labor/anger/night fever/delirium/recent menstruation indicates heat in the Blood level. Palpitations/fright indicate Heart Blood deficiency. Thought-induced palpitations/frequent urination indicate internal phlegm. (From *Yigou*)
Red cheeks/lips in Xu Sun indicate Yin deficiency below forcing Yang upward. Zhang Zhongjing said: Facial flushing (Dai Yang) is due to lower deficiency. Excessive thirst in deficiency indicates insufficient Kidney Water seeking self-rescue. Hoarseness/loss of voice indicates Kidney Qi exhaustion (voice roots in Kidney). Asthma in deficiency indicates Yin deficiency with Lung obstruction and Qi having no return. Dry throat/sore throat indicates true water decline and floating Deficient Fire. Insomnia/confusion indicates Blood failing to nourish Heart and Shen failing to reside. Frequent irritability indicates Yang lacking Yin, rigidity lacking softness. Irritability/tendon stiffness/pain indicates Water deficiency causing Wood dryness and Liver deprivation. Poor appetite/muscle wasting indicates Spleen Yuan instability and declining transformation. Palpitations indicate Qi failing to condense. The Stomach's great collateral, Xuli, located under the left breast, pulsating visibly, indicates leakage of Zong Qi. Unstopping night sweats: Fire prevents Yin from holding; lack of Fire prevents Yang from securing. Excess phlegm (clear/white foam) in deficiency indicates Water flooding transforming into Phlegm due to Spleen failure to control Water. Bone pain like breaking indicates Kidney ruling bones and True Yin exhaustion. Waist/flank pain indicates Liver-Kidney deficiency. Cold below knees indicates Mingmen decline and Fire failing to return to source. Yellow-choppy dribbling urine indicates True Yin exhaustion and Qi failing to transform Water. Burning soles indicate Deficient Fire scorching Yin and Yongquan depletion. (From *Jingyue Quanshu*)
[Taohua Zhu / Yu Lao]
Some individuals have normal complexion and body mass, appearing healthy externally but suffering internal Xu Sun, commonly called "Taohua Zhu" (Peach Blossom Borer). Treatment depends on identifying the specific syndrome among previous formulas (e.g., Jianzhong Tang, major tonics). Others have undiminished complexion but wasting muscles, appearing healthy but internally damaged, called "Taohua Zhu" (Peach Blossom Taint). Symptoms include steaming fever/cough, hyperhidrosis/anhydrosis, excess/absence of phlegm, amenorrhea, spermatorrhea, hemoptysis, epistaxis, polyphagia, or diarrhea. One must examine the presenting syndrome and injured Zang. These are syndromes of Yin Fire simmering, often resistant to treatment. Virgins marrying late, men marrying late, widows/widowers are prone. Yin Fire attacks Yang positions, consuming Yin fluids rather than Yang fluids, causing emaciation while maintaining a ruddy complexion. Mild cases improve after marriage; severe cases may temporarily improve but eventually die due to fragile constitution and depleted Essence unable to withstand excretion. Widows remarrying often recover spontaneously due to physical resilience. Once Yu Fire disperses and fluids flow, recovery occurs without medicine. (From *Yitong*)
Widows/nuns with unfulfilled desires experience separation of Yin and Yang, extreme Yu Fire, and "Shihe Syndrome" (syndrome of mismatched union), worse than sexual labor. Initially Liver Wood stagnates with heat, then Dragon Fire flares up, affecting Heart-Lung, causing asthma/cough/fever, potentially sudden blood loss or amenorrhea with bleeding. Treat with opening depression and descending fire: Zengsun Chaihu Tang or Jiawei Xiaoyao San. For extreme Yin Fire, use Zishen Wan or Yuzhu San to drain fire first, then tonify with Wujitu Wan. If Yu Fire remains unvented, causing abscesses due to poor Blood/Qi nourishment, death is near. (Same source)
[Miscellaneous Comments on Syndromes]
Male infertility: Clear semen like water, cold like ice, or ejaculation without expulsion (semen pooling at glans) indicates infertility. Absence of these signs suggests fertility. (From *Bingyuan Lun*)
Labor injury causes Blood/Qi deficiency and Yin-Yang disharmony. Yang excess causes heat, Yin excess causes cold; mutual overcoming causes chills/fever. (Same source)
Sudden emaciation/weakness without other symptoms indicates excessive prior labor depleting Blood/Qi and starving tendons. Use Jie Lao San or Heqi Tang with increased Chuanxiong and Danggui. Verbal exertion depleting Spirit causes Xu Sun ("calling/shouting losing Qi"); use Shiquan Dabu Tang. Sudden aphonia in elderly/deficient patients is not Wind-Stroke; proper tonification restores speech. Desire for massage indicates deficiency. Acute labor from physical exertion (chills/fever/pain/shortness of breath/lethargy) differs from Wu Lao; use Heqi Tang. Chronic cough with phlegm is "Lao Sou" (Labor Cough), distinct from Wind-Cold heat cough; its root is Kidney, branch is Lung. (From *Yaojue*)
Heavy Yin covering Yang, blocking Fire, causes chills, depression, wiry-rapid pulse, and five-center heat. Use Huoyu Tang or Chaihu Shengma Tang until cured; do not overdose. (Note: Both are Li Dongyuan's formulas, omitted here.) (From *Liuyao*)
*Shenrou Shu* records: Treating Xu Sun with moderate-slow pulse (5-6 beats per breath) and cough/fever (no chills/sore throat) seemed treatable. After 10+ doses of Baoyuan Tang and Sijunzi Tang, cough/fever improved slightly. After 20+ doses, cough worsened, fever returned, and patient became immobile/leg-weakened. Reason: Lower Jiao Kidney Qi exhaustion, no fluids to nourish bones, Yang cannot circulate, Spleen-Lung Qi cannot descend. Untreatable despite temporary relief. If pulse becomes thread-like and rapid after initial doses, it is untreatable. If fine but not rapid, with normal digestion/no diarrhea, Baoyuan Tang with Renshen and Baizhu can be used for 2-3 years. If pulse slows and becomes moderate/vivid, improvement takes 3 months, full recovery 1.5 years. Prognosis depends on age/strength/Spleen-Stomach. If pulse moderates but legs weaken/cough persists, treatment is futile. If legs weaken but fever/cough subside and appetite returns, Spleen-Stomach is strong, allowing extended management. (From *Yitong*)
[Seeming Damage but Not Damage]
Syndromes resembling Xu Sun but not being so occur only with external Cold invasion. If external pathogen is not resolved and mistakenly treated as internal injury with cooling or resolving agents, Cold becomes trapped, causing alternating chills/fever or tidal fever/cough, mimicking consumption. Using tonifying/nourishing herbs traps the pathogen, turning simple heat into true consumption. I have cured several such cases. Differentiate by examining exterior/interior and etiology. Xu Sun has a cause; external pathogens strike suddenly. If body pain resolves with slight sweating and returns without sweat, or loud cough with wiry-tight but not rapid pulse, or moderate pulse, even after 1-2 months, it is not consumption. Do not mistreat. (From *Jingyue Quanshu*)
[Death Syndromes]
(See *Guzheng* for details.) Death in Lao patients: rectal prolapse, flesh/bone separation, scattered voice, hematemesis, uncontrollable erections, nocturnal emissions, irregular breathing, day-cool/night-hot, or expectoration of pus/blood. Survival: pulse not rapid with root, or non-red cheeks. (From *Zhongzang Jing*)
Lao disease with chronic hemoptysis and silent sore throat (transmitting bottom-up) or chronic turbid urine/spermatorrhea without cough/pain (transmitting top-down) are death syndromes. (From *Yaojue*)
Xu Sun from bereavement: Liver-Kidney overwork leads to blood loss/essence depletion/death. From depression: Internal Fire scorches fluids, leading to blood-stasis/dry cough/polyphagia/abscess/death. From medication error: Spleen-Lung damage leads to anorexia/asthma/diarrhea/death. (From *Yitong*)
Xu Sun intolerant to tonification is untreatable. (From *Danxi Xinfa*)
Chronic deficiency with old phlegm retention: Tonifying with Renshen/Baizhu may eventually expel foul/green phlegm; this is untreatable due to extreme Spleen-Stomach deficiency failing to transport, causing stagnation and odor. (From *Shenrou Wushu*)