阳虚阴虚治法有等 古人论治，以阴虚阳虚为两大纲。辨其阳虚，则温补之。辨其阴虚，则滋养之。
岂非开示后学之法门耶。然余阅历多年，会心先觉。审知阳虚有二，而阴虚有三，试为拈出，以示吾徒。所谓
阳虚有二者。有胃中之阳，后天所生者也。有肾中之阳，先天所基者也。胃中之阳喜升浮，虚则反陷于下，再
行敛降，则生气遏抑不伸。肾中之阳贵凝降，劳则反游于上。若行升发，则真气消亡立至，此阳虚之治有不同
也。所谓阴虚有三者，如肺胃之阴，则津液也。心脾之阴，则血脉也。肾肝之阴，则真精也。液生于气，惟清
润之品，可以生之。精生于味，非粘腻之物，不能填之。血生于水谷，非调补中州，不能化之。此阴虚之治有
不同也。（《病机汇论》）
气血调养例 治法大要，潮热者，不可过用寒凉；秘结
者，不可骤兴疏泄；嗽喘者，不可妄施发散；咯血者，不可错认以为热。但以滋养荣血为上，调平藏气次之，
某病某药，又于养血调气之中而增益也。其或骨间有热，以至四肢缓弱不举，此则骨痿，欲斯疾之有瘳也，艰
哉。虽然，当归、地黄、黄 、芍药，固养血之上药也，亦当以益胃消痰辈佐之。盖人以谷气为本，所谓精气
血气，由谷气而生，古人以五味五谷五药养其病者，不无先后于其间也。当归、地黄恋膈引痰，黄 、芍药多
则伤胃，是可胶柱调瑟而测量轻重之不审乎。（《直指》）
有患精血不足，明知当补肾，方欲一求之归 等药，其人素减食，又恐不利于脾；方欲理脾气，则不免用
疏刷之药，又恐愈耗肾水；全一举而两得之功，莫若鹿茸橘皮煎丸为第一（按∶鹿茸橘皮煎丸，系于阳阴双补。
方冗杂难用，今所不取），故曰精不足补之以味，又曰补肾不如补脾，以脾上交于心，下交于肾故也。若肾元
大段虚损，病势困笃，则肾不容少缓，又不拘于此说。要知于滋肾之中，佐以砂仁、澄茄之类，于壮脾之中，
参以北五味、黄 之属，此又临时审病用药之后法。（《要诀》）
夫人之虚，不属于气，即属于血，五脏六腑莫能外焉，而独举脾肾者，水为天一之元，土为万物之母，二
脏安和，诸经各治，百疾不生。盖脾具土德，脾安则土为金母，金实水源，且土不侮水，水安其位，故脾安则
肾愈安也。肾兼水火，肾安则水不挟肝上泛而凌湿土，火能益土，蒸腐而化精微，故肾安则脾愈安也。救肾者
必本于阴血，血主濡之，阴本下降，虚则上逆，当敛而抑，六味丸是也。救脾者，必本于阳气，气主煦之，阳
本上升，虚则下陷，当升而举，补中益气汤是也。近世治痨，专以四物、二冬、黄柏、知母，不
知皆行秋冬之令，非所以生万物者也。且血药常滞，必妨痰而减食；血药常润，必滑肠而泄泻。况黄柏苦寒，
尤能减食，知母甘寒，尤能滑肠，二味俱泻肾经虚火。丹溪有言曰∶实火可泻，虚火可补。痨症之火，虚乎实
乎，泻之可乎。即知其宜补，而用药颇多疑难，如补脾保肺，法当兼行，然脾喜温燥，肺喜清润，保肺则妨脾
，保脾则妨肺。须知燥热而甚，能食而不泻者，润肺当急，而补脾亦不可缺也。若虚羸而甚，食少肠滑，虽多
嗽喘，但当补脾，而清润宜戒矣。脾有生肺之能，肺无扶脾之力，故补脾尤要于保肺也。尝见痨症多死于泄泻，
泄泻多由于寒凉，此至着至确者也。又如补肾扶脾，法当兼行，然甘寒补肾，又恐不利于脾，辛温快脾，又恐
愈伤其本，两者并衡，脾土较重，以土能生金，金为水母故也。若肾大虚者，又不可拘。但补肾之中，不脱扶
脾，壮脾之中，不忘养肾可耳。（《颐生微论》）（按∶《必读》曰∶若肾大虚而势困笃者，又不可拘，要知
滋肾之中，佐以砂仁、沉香，壮脾之中，参以五味、肉桂，随时活法可耳。）
治当审冷热 《养生必用方》论虚劳不得用凉药，如柴胡、鳖甲、青蒿、麦门冬之类皆不用服，唯服
黄建中汤。有十余岁女子，因发热，咳嗽喘急，小便少，后来成肿胀，用利水药得愈。然虚羸之甚，遂用黄
建中汤，日一服，三十余日遂愈。盖人禀受不同，虚劳小便白浊阴脏人，服橘皮煎黄 建中汤，获愈者甚众。
至于阳脏人，不可用暖药，虽建中汤不甚热，然有肉桂，服之稍多，亦反为害。要之用药，亦量其所禀，审其
冷热，而不可一概以建中汤治虚劳也，谨之。（《医说》引《医余》）
治不可过热过凉 凡虚劳之疾，皆缘情欲过度，荣卫劳
伤，致百脉空虚，五脏衰损，邪气乘袭，致生百疾。圣人必假药石，以资血气，密腠理，以御诸邪。肌肉之虚
，犹物体之轻虚，如马勃、通草、蒲梢、灯心之属是也，非滋润粘腻之物以养之，不能实也。故前古方中，鹿
角胶、阿胶、牛乳、鹿髓、羊肉、饴糖、酥酪、杏仁煎、酒蜜、人参、当归、地黄、门冬之类者，盖出此意。
《本草经》云∶补可去弱，羊肉、人参之属是也。所谓虚劳者，因劳役过甚而致虚损，故谓之虚劳。今人才见
虚弱疾证，悉用燥热之药，如伏火金石附子姜桂之类，致五脏焦枯，血气干涸（按∶《直指》此下曰∶心肾不
交，故火炎于上，为痰嗽，为咯血，为口干，为五心热。水走于下，为脚弱，为遗精，为赤白浊，为小便滑
数。误矣哉）而致危困，皆因此也。如虚而兼冷者，止可于诸虚劳方中，加诸温热药为助可也，如此即不失古
人之意。（《鸡峰》）
若阳虚阴极之证，当用姜、附、三建诸丹之类，或参或沉为之佐使，欲其刚多于柔，不致太僭，庶免炎上
之患，用药在乎稳重故也。（《济生续方》）
凡滋补之药，当用平和，不可骤用峻补。缘肾水枯竭，不足以当之，又恐愈甚上炎之患，慎之慎之。
（《袖珍》）
五脏虽皆有劳，心肾为多。心主血，肾主精，精竭血燥，则劳生焉。治劳之法，当以调心补肾为先，不当
用峻烈之剂，惟当温养滋补，以久取效。天雄附子之类，投之太多，适足以发其虚阳。缘内无精血，不足当此
猛剂。然不可因有热，纯用甜冷之药，以伤其肾气。独用热药者，犹釜中无水而进火也；过用冷药者，犹釜下
无火而添水也。非徒无益，又害之耳。宜十全大补汤，或双和散，或养荣汤、七珍散、乐令建中汤皆可选用，
间进双补丸。（《要诀》）
补阳方法 凡虚损之症，不可专指肾脏一家而言。至病之甫成，脉才见端，惟急建其中气为主，俾饮
食增而津液旺，以至气充血生精，而复其真阴之不足，此根本之治也。（《集验良方》）
石顽治颜汝玉女，病虚羸寒热，腹痛里急，自汗喘嗽者，三月余，屡更医药不愈，忽然吐血数口。前医转
邀石顽，同往诊候，其气口虚涩不调，左皆弦微而尺微尤甚，令与黄 建中，加当归、细辛。前医曰∶虚劳失
血，曷不用滋阴降火，反行辛燥乎？余曰∶不然。虚劳之成，未必皆本虚也，大抵多由误药所致。今病欲成劳，
乘其根蒂未固，急以辛温之药，提出阳分，庶几挽回前失。若仍用阴药，则阴愈亢而血愈逆上矣。从古治劳，
莫若《金匮》诸法，如虚劳里急诸不足，用黄 建中，原有所祖，即腹痛悸衄，亦不出此。更兼内补建中之制，
加当归以和营血，细辛以利肺气，毋虑辛燥伤血也。遂与数帖，血止，次以桂枝人参汤数服，腹痛寒热顿除，
后以六味丸，以枣仁易萸肉，或时间进保元、异功，当归补血之类，随证调理而安。余治虚劳，尝屏绝一切虚
劳之药，使病气不致陷入阴分，深得《金匮》之力也。（《医通》）
黄 汤，治虚劳不足，四肢烦疼，不欲食，食即胀，汗出方。
黄 芍药 桂心 麦门冬（各三两） 五味子 甘草 当归 细辛 人参（各一两） 大枣（二十枚）
前胡（六两） 茯苓（四两） 生姜 半夏（各八两）
上十四味 咀，以水一斗四升，煮取三升，每服八合，日二服。（《千金》）又乐令黄 汤，于本方去五
味子，加橘皮。（《和剂》）名乐令建中汤。按∶《医通》曰∶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。此说未为当。）
《古今录验》调中汤，疗虚劳，补益气力方。
麦门冬（半两） 干枣（一两） 茯苓（半两） 甘草（半两炙） 桂心（半两） 当归（半两） 芍药
（半两）
上七味切，以水八升，煮取三升，去滓分服一升，日三，忌生葱、海藻、菘菜、醋物。（《外台》）（按∶
此亦建中汤之类方，故列于此。）
《短剧》黄 汤，疗虚劳少腹急，小便赤余沥，临事不起，阴下湿，或小便白浊伤多方。（节录）
黄 （三两） 人参（一两） 芍药（二两） 生姜（半斤） 桂肉（三两）
大枣（十四枚） 当归（一两） 甘草（一两炙）
上八味切，以水一斗，煮取四升，分四服。有寒，加浓朴二两。忌生葱、海藻、菘菜。《经心录》同。
（同上）又深师黄 汤，疗大虚不足，小腹里急，劳寒拘引，脐气上冲胸，于本方，去当归，加半夏。
深师大建中汤，疗内虚绝，里急少气，手足厥逆，少腹挛急，或腹满弦急，不能食，起即微汗出，阴缩，
或腹中寒痛，不堪劳苦，唇口舌干，精自出，或手足乍寒乍热，而烦苦酸疼，不能久立，多梦寤，补中益气方。
黄 （四两） 人参（二两） 大枣（二十枚劈） 当归（二两） 桂心（六两） 生姜（一斤） 半夏
（一升洗） 芍药（四两） 附子（一两炮） 甘草（二两炙）
上十味切，以水一斗二升，煮取四升，分四服。先服后食，忌海藻、菘菜、生葱、猪羊肉、饧、冷水等。
（同上）（按∶《千金》大建中汤，与此不同，出后补兼宁心。）《圣惠》治虚劳，能益气，补不足，建中散，
于本方去人
参、半夏，加白术、木香、熟干地黄，水煎去滓，下饴糖如枣大，更煎一两沸，于食前温服。又治虚劳里急，
四肢不和，身体疼痛，不欲吃食，白术散，于本方加白术。《和剂》十四味建中汤，治荣卫不足，腑脏俱伤，
积劳虚损，形体羸瘠，脾肾久虚，饮食全亏，于本方加白术、肉苁蓉、麦门冬、白茯苓、川芎、熟地黄。
真武汤，不惟阴证伤寒可服，若虚劳之人，憎寒壮热，咳嗽下痢，皆宜服之，因易名固阳汤。（《易简》）
补中益气汤，治中气不足，或误服克伐，四肢倦怠，口干发热，饮食无味，或饮食失节，劳倦身热，脉洪
大而无力，或头痛恶寒自汗，或气高而喘，身热而烦，脉微细软弱，自汗体倦少食，或中气虚弱而不能摄血，
或饮食劳倦而患疟痢等症，因脾胃虚而不能愈者，或元气虚弱，感冒风寒，不胜发表，宜用此代之。或入房而
后劳役感冒，或劳役感冒而后入房者，急加附子。愚谓人之一身，以脾胃为主，脾胃气实，则肺得其所养，肺
气既盛，水自生焉，水升则火降，水火既济而合天地交泰之令矣。脾胃既虚，四脏俱无生气，故东垣先生，着
脾胃、内外伤等论，谆谆然皆以固脾胃为本，所制补中益气汤，又冠诸方之首，观其立方本旨可知矣。故曰补
肾不若补脾，正此谓也。前所言治症，概举其略，余当仿此而类推之。（此据《回春录》）
黄 （劳役病热甚者一钱） 甘草（炙以上各五分） 人参（去芦）
升麻 柴胡 橘皮 当归身（酒浸） 白术（以上各三分）
上件 咀，都作一服，水二盏，煎至一盏，去渣，早饭后温服。（《内外伤辨》）如腹中痛者，加白芍药
五分，炙甘草三分。如久病痰嗽者，去人参。如夏月病嗽，加五味子三＋二枚，麦门冬去心二分或三分。
（《脾胃论》）《试效
方》调中益气汤，治因饥饱劳役，损伤脾胃，元气不足，于本方加五味子、芍药。如时显燥热，是下元阴火蒸
蒸然发也，加生地黄二分。东阳邑庠郑掌教先生一证，发大汗战，鼓栗振掉，片时许发澡热，身如火烧，又片
时许，出大汗如雨，身体若冰冷。而就发寒战如前，寒后又热，热后又汗，三病继作而昼夜不息。庠生卢明夫
与作疟证治，不效。召予，诊其右手，阳脉数而浮洪无力，阴脉略沉小而亦虚，左三部比右差小而亦浮软。予曰
∶此阳虚证也。用补中益气汤，倍参 ，减升、柴一半，加尿浸生附子一钱半，炒黄柏三分，干姜、薄桂各五
分，大枣一枚，同煎服。一服而病去三分，二服而减半，四服寒热止而身尚有微汗，减去桂、附、干姜一半，
服二帖全愈。（《正传》）本方加黄柏生地，名补中益气加黄柏生地汤，治阴火乘阳，发热昼甚，自汗短气，
口渴无味。（《集解》）
生脉散，气极者，正气少，邪气多，多喘少言，此方主之。（《医方考》）（生脉散方见《中暑》中）呼
吸少气，懒言语，无力动作，目无精光，面色 白，皆兼气虚，用麦门冬、人参各三钱，橘红、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，如鸡头子大，每服一丸，细嚼津唾咽下，名补气丸。
（《准绳》）
人参膏。
The treatment principles for Yang deficiency and Yin deficiency differ. Ancient scholars discussed treatment methods, taking Yin deficiency and Yang deficiency as the two major guidelines. If Yang deficiency is identified, warming and tonifying methods are used; if Yin deficiency is identified, nourishing and moistening methods are used. Is this not a method to open the path for future students? However, through years of experience and insight, I have come to realize that there are two types of Yang deficiency and three types of Yin deficiency. I will list them here to show my disciples.
What is meant by the two types of Yang deficiency: One is the Yang Qi in the Stomach, which is generated from postnatal dietary essence; the other is the Yang Qi in the Kidney, which is the foundation of congenital life. The Yang Qi in the Stomach prefers to ascend and float. If it is deficient and sinks downward, using astringent and descending drugs will suppress the generating Qi, preventing it from extending. The Yang Qi in the Kidney values condensing and descending. If due to overwork it floats upward instead, using ascending and dispersing drugs at this time will cause the True Qi to perish immediately. This is why the treatment of Yang deficiency differs.
What is meant by the three types of Yin deficiency: The Yin of the Lungs and Stomach refers to Body Fluids (Jin Ye); the Yin of the Heart and Spleen refers to Blood Vessels; the Yin of the Kidneys and Liver refers to True Essence (Zhen Jing). Body fluids are generated by Qi, and only clear and moistening agents can generate them. Essence is formed from flavors, and only sticky and thick substances can fill it. Blood is generated from water and grain, and without regulating and tonifying the Middle Jiao (Spleen/Stomach), it cannot be transformed. This is why the treatment of Yin deficiency differs. (From *Bing Ji Hui Lun*)
Principles of Regulating Qi and Blood: The general rule of treatment is: for tidal fever, do not overuse cold and cool drugs; for constipation, do not suddenly use purgative drugs; for cough and asthma, do not recklessly apply dispersing drugs; for hemoptysis, do not mistakenly identify it as heat. Nourishing Ying Blood (Nutritive Blood) should be the highest priority, followed by regulating Zang-Fu Qi. Specific drugs for specific diseases are added upon the foundation of nourishing blood and regulating qi. If there is bone-steaming fever leading to flaccidity and weakness of the four limbs, this is Bone Wei (Bone Atrophy). Curing such a disease is extremely difficult. Although Dang Gui (Angelicae Sinensis Radix), Di Huang (Rehmanniae Radix), Huang Qi (Astragali Radix), and Bai Shao (Paeoniae Radix Alba) are indeed superior drugs for nourishing blood, they should be assisted by drugs that benefit the Stomach and resolve phlegm. Humans rely on Grain Qi as their root; so-called Jing Qi and Blood Qi are all generated from Grain Qi. When ancients used five flavors, five grains, and five medicines to treat illness, there was an order of precedence. Dang Gui and Di Huang tend to stagnate in the chest and induce phlegm; excessive use of Huang Qi and Bai Shao damages the Stomach Qi. How can one rigidly adhere to formulas without carefully weighing the severity? (From *Zhi Zhi Fang*)
A patient with insufficient Essence and Blood knows he needs to tonify the Kidneys and seeks drugs like Dang Gui. However, since his appetite is usually poor, he fears harming the Spleen. If he tries to regulate Spleen Qi, he inevitably uses draining and sweeping drugs, fearing further depletion of Kidney Water. To achieve both benefits in one move, Lu Rong Ju Pi Jian Wan (Deer Antler and Tangerine Peel Decoction Pill) is considered the best choice (Note: Lu Rong Ju Pi Jian Wan tonifies both Yin and Yang. The formula is complex and difficult to use, so it is not adopted now). Thus it is said, "When Essence is insufficient, tonify with flavor," and also, "Tonifying the Spleen is better than tonifying the Kidneys," because the Spleen connects upward to the Heart and downward to the Kidneys. If Kidney Yuan is severely damaged and the condition is critical, the Kidneys cannot wait, and one must not stick to this theory. It is important to know that when tonifying the Kidneys, assist with drugs like Sha Ren (Amomi Fructus) and Cheng Qie (Litseae Fructus); when strengthening the Spleen, include Bei Wu Wei Zi (Schisandrae Chinensis Fructus) and Huang Qi. This is a secondary method based on real-time diagnosis. (From *Yao Jue*)
Human deficiency belongs either to Qi or to Blood; no Zang-Fu organ is excluded. Yet, only the Spleen and Kidneys are emphasized because Water is the Origin of Tian Yi (Heaven One), and Earth is the Mother of All Things. If these two organs are harmonious, the meridians function properly, and hundred diseases do not arise. The Spleen possesses the virtue of Earth. When the Spleen is peaceful, Earth becomes the mother of Metal (Earth generates Metal), Metal enriches the Water source, and Earth does not insult Water, allowing Water to remain in its place. Thus, when the Spleen is peaceful, the Kidneys become more peaceful. The Kidneys contain both Water and Fire. When the Kidneys are peaceful, Water does not carry Liver Qi upward to invade damp Earth, and Fire benefits Earth, steaming and rotting food into essence. Thus, when the Kidneys are peaceful, the Spleen becomes more peaceful. To rescue the Kidneys, one must base treatment on Yin and Blood. Blood provides nourishment; Yin naturally descends, but when deficient, it rebels upward, requiring astringency and suppression. Liu Wei Wan (Six-Ingredient Pill with Rehmannia) is such a formula. To rescue the Spleen, one must base treatment on Yang Qi. Qi provides warmth; Yang naturally ascends, but when deficient, it sinks downward, requiring lifting and raising. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is such a formula. In recent times, treating Lao (Consumption) focuses solely on Si Wu Tang (Four-Substance Decoction), Er Dong (Tian Dong and Mai Dong), Huang Bo (Phellodendri Cortex), and Zhi Mu (Anemarrhenae Rhizoma). These drugs execute the commands of Autumn and Winter, which are not suitable for generating all things. Moreover, blood-tonifying drugs are often stagnant, hindering phlegm resolution and reducing appetite; they are often moistening, causing loose stools and diarrhea. Furthermore, Huang Bo is bitter and cold, significantly reducing appetite; Zhi Mu is sweet and cold, significantly causing loose stools. Both drain Empty Fire in the Kidney Meridian. Dan Xi said, "Excess Fire can be drained, Deficient Fire should be tonified." Is the fire in Lao disease excess or deficient? Can it be drained? Knowing that tonification is appropriate, yet drug selection is difficult. For example, tonifying the Spleen and protecting the Lungs should be done simultaneously. However, the Spleen likes warm and dry, while the Lungs like clear and moist. Protecting the Lungs hinders the Spleen; protecting the Spleen hinders the Lungs. One must know that if Dry-Heat is severe, appetite is good, and no diarrhea occurs, Lung-moistening is urgent, but Spleen-tonification is indispensable. If Emaciation is severe, appetite is poor, and bowels are slippery, even with chronic cough and asthma, one should only tonify the Spleen and avoid moistening drugs. The Spleen has the ability to generate the Lungs, but the Lungs lack the power to support the Spleen. Therefore, tonifying the Spleen is more important than protecting the Lungs. I have seen many Lao patients die from diarrhea, which is often caused by cold-cool drugs. This is a very obvious and accurate fact. Regarding tonifying the Kidneys and supporting the Spleen, both should be done. However, sweet-cold Kidney-tonifying drugs may harm the Spleen, while acrid-warm Spleen-stimulating drugs may damage the Root. Weighing both, Spleen Earth is heavier because Earth generates Metal, and Metal is the mother of Water. If the Kidneys are greatly deficient, one need not be rigid. Just ensure that while tonifying the Kidneys, Spleen-support is not abandoned, and while strengthening the Spleen, Kidney-nourishment is not forgotten. (From *Yi Sheng Wei Lun*) (Note: *Bi Du* says: If the Kidneys are greatly deficient and the condition is critical, one need not be rigid. Know that in tonifying the Kidneys, assist with Sha Ren and Chen Xiang; in strengthening the Spleen, include Wu Wei Zi and Rou Gui. Adapt flexibly according to the situation.)
Treatment must examine Cold and Heat: *Yang Sheng Bi Yong Fang* states that Lao should not use cooling drugs like Chai Hu (Bupleuri Radix), Bie Jia (Testudinis Carapax et Plastrum), Qing Hao (Artemisiae Annuae Herba), or Mai Men Dong (Ophiopogonis Tuber). Only Huang Qi Jian Zhong Tang (Astragalus Decoction to Establish the Middle) should be taken. A girl in her teens had fever, cough, asthma, and oliguria, later developing edema, cured by diuretics. Due to extreme emaciation, she was given Huang Qi Jian Zhong Tang once daily, curing her in over thirty days. People have different constitutions. For Yin-constitution individuals with Lao and white turbid urine, Ju Pi Jian Huang Qi Jian Zhong Tang (Tangerine Peel and Astragalus Decoction to Establish the Middle) has cured many. For Yang-constitution individuals, warm drugs are contraindicated. Although Jian Zhong Tang is not very hot, it contains Rou Gui (Cinnamomi Cortex). Taking too much can cause harm. In short, medication must consider constitution and examine cold/heat. One cannot universally treat Lao with Jian Zhong Tang. Be cautious. (*Yi Shuo* citing *Yi Yu*)
Treatment must not be too hot or too cold: All Lao diseases stem from excessive sexual desire, damaging Ying and Wei (Defensive and Nutritive), leading to empty meridians, damaged Zang-Fu, and invasion of pathogenic factors causing various diseases. Sages use medicine to supplement Qi and Blood, secure the Cou Li (pores/skin texture), and resist pathogens. Muscle deficiency is like an empty object; drugs like Ma Bo (Fumitis Spora), Tong Cao (Tetrapanacis Medulla), Pu Shao (Typhae Pollen), and Deng Xin Cao (Junci Medulla) are light and void. They cannot solidify deficiency; moistening and sticky substances are needed to nourish it. Hence, ancient formulas used Lu Jiao Jiao (Colla Cornus Cervi), E Jiao (Colla Corii Asini), Cow Milk, Lu Sui (Deer Marrow), Lamb Meat, Yi Tang (Maltose), Su Lao (Butter/Cheese), Xing Ren Jian (Almond Decoction), Wine/Honey, Ren Shen (Ginseng Radix et Rhizoma), Dang Gui, Di Huang, and Men Dong. This intent is reflected in *Ben Cao Jing*: "Tonification removes weakness; Lamb meat and Ginseng are examples." Lao is called so because overwork causes deficiency. Nowadays, people see weakness and use drying-hot drugs like Fu Huo Jin Shi (calcined minerals), Fu Zi (Aconiti Lateralis Radix Preparata), Jiang (Zingiberis Rhizoma), and Gui (Cinnamomi Cortex), causing the Five Zang to scorch and Qi/Blood to dry up (Note: *Zhi Zhi* adds below: Heart-Kidney non-interaction causes Fire flaming upward, leading to phlegm-cough, hemoptysis, dry mouth, five-palm heat. Water flows downward, leading to weak legs, spermatorrhea, red/white turbidity, frequent slippery urination. This is erroneous!) resulting in danger. If deficiency accompanies cold, add warm-hot drugs to Lao formulas as assistance. This preserves the ancients' intent. (From *Ji Feng Pu Ji Fang*)
For syndromes of Extreme Yang Deficiency and Yin Extremity, use drugs like Jiang (Zingiberis Rhizoma), Fu (Aconiti Radix), and San Jian Dan (Three Establishments Pills). Use Ren Shen or Chen Xiang as assistants. The goal is for Yang (firmness) to exceed Yin (softness) to prevent excessive rebellion, avoiding inflammatory complications. Medication must be steady. (From *Ji Sheng Xu Fang*)
All tonic drugs should be mild. Do not suddenly use harsh tonics. Because Kidney Water is depleted and cannot withstand them, worsening the upward flaming risk. Be cautious. (From *Xiu Zhen Ben Cao*)
Although all Five Zang can suffer from Lao, the Heart and Kidneys are most affected. The Heart governs Blood, the Kidneys govern Essence. When Essence is exhausted and Blood is dry, Lao arises. Treating Lao should prioritize regulating the Heart and tonifying the Kidneys. Harsh agents should be avoided; gentle nourishment and tonification should be used for long-term effect. Using too much Tian Xiong (Aconiti Radix) or Fu Zi causes the Deficient Yang to flare because there is no Essence/Blood to anchor these猛剂 (fierce drugs). However, due to heat, one should not purely use sweet-cold drugs that damage Kidney Qi. Using only hot drugs is like adding fire to an empty pot; using too many cold drugs is like adding water to a pot without fire. Neither helps; both harm. Suitable choices include Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), Shuang He San (Double Harmony Powder), Yang Rong Tang (Nourish the Vigor Decoction), Qi Zhen San (Seven Treasures Powder), or Le Ling Jian Zhong Tang. Occasionally administer Shuang Bu Wan (Double Tonifying Pill). (From *Yao Jue*)
Method of Tonifying Yang: For deficiency syndromes, do not focus solely on the Kidneys. When the disease just begins and pulse signs appear, urgently establish Middle Qi. This increases diet intake and fluid production, leading to abundant Qi, Blood, and Essence, thereby restoring insufficient True Yin. This is treating the root. (From *Ji Yan Liang Fang*)
Shi Wen treated the daughter of Yan Ruyu, who suffered from emaciation, alternating chills and fever, abdominal pain with urgency, spontaneous sweating, cough, and asthma for over three months. Multiple treatments failed. Suddenly, she vomited blood several times. The previous doctor invited Shi Wen. Pulse at the Qi Kou was deficient, choppy, and irregular; left pulses were wiry and faint, especially the Chi (Kidney) position. Prescribed Huang Qi Jian Zhong Tang with Dang Gui and Xi Xin (Asari Radix). The previous doctor asked, "For Lao with blood loss, why not use Yin-nourishing and Fire-descending drugs, but use acrid-dry ones?" I replied, "Incorrect. Lao formation is not always primary deficiency; mostly it results from misprescription. Now that Lao is forming, while the root is not yet solid, urgently use acrid-warm drugs to extract Yang from the exterior, perhaps reversing the error. If Yin drugs are used, Yin becomes hyperactive and Blood rebels upward." Since ancient times, no method surpasses *Jin Gui Yao Lue*. For Lao with interior tension and insufficiency, Huang Qi Jian Zhong Tang is the ancestor. Abdominal pain, palpitations, and epistaxis also fall under this. Adding Dang Gui harmonizes Ying Blood; Xi Xin benefits Lung Qi. There is no need to worry about acrid-dry drugs damaging Blood. After a few doses, bleeding stopped. Then Gu Zhi Ren Shen Tang (Cinnamon Twig and Ginseng Decoction) relieved abdominal pain and chills/fever. Later, Liu Wei Wan (with Suan Zao Ren replacing Shan Zhu Yu) or Bao Yuan Tang, Yi Gong San, Dang Gui Bu Xue Tang were used according to symptoms until recovery. In treating Lao, I discard all standard Lao drugs to prevent pathogenic Qi from sinking into the Yin aspect, deeply benefiting from *Jin Gui*. (From *Yi Tong*)
Huang Qi Tang: Treats Lao insufficiency, painful limbs, anorexia, postprandial bloating, and sweating.
Huang Qi, Bai Shao, Gui Xin, Mai Men Dong (each 3 liang); Wu Wei Zi, Gan Cao, Dang Gui, Xi Xin, Ren Shen (each 1 liang); Da Zao (20 pieces); Qian Hu (6 liang); Fu Ling (4 liang); Sheng Jiang, Ban Xia (each 8 liang).
Chop the 14 ingredients. Boil in 14 sheng of water to obtain 3 sheng. Take 8 he per dose, twice daily. (From *Qian Jin Fang*)
Le Ling Huang Qi Tang: Remove Wu Wei Zi from the above formula, add Ju Pi. (From *He Ji Ju Fang*). Named Le Ling Jian Zhong Tang. Note: *Yi Tong* states that later versions of Le Ling Jian Zhong use Qian Hu and Xi Xin to release exterior heat, and the 14-ingredient Jian Zhong Tang uses Shu Fu Zi and Cong Rong to tonify lower deficiency, both losing the true meaning of Jian Zhong. This view is debatable.
*Gu Jin Lu Yan* Tiao Zhong Tang: Treats Lao, tonifies Qi and strength.
Mai Men Dong (0.5 liang), Gan Zao (1 liang), Fu Ling (0.5 liang), Zhi Gan Cao (0.5 liang), Gui Xin (0.5 liang), Dang Gui (0.5 liang), Bai Shao (0.5 liang).
Chop 7 ingredients. Boil in 8 sheng of water to obtain 3 sheng. Strain and take 1 sheng per dose, three times daily. Avoid raw green onion, Hai Zao, Song Cai, and vinegar foods. (From *Wai Tai Mi Yao*) (Note: This is also a variant of Jian Zhong Tang, listed here.)
*Duan Ju* Huang Qi Tang: Treats Lao with lower abdominal urgency, red urine with dribbling, impotence, dampness in the genital area, or white turbid urine.
Huang Qi (3 liang), Ren Shen (1 liang), Bai Shao (2 liang), Sheng Jiang (0.5 jin), Rou Gui (3 liang), Da Zao (14 pieces), Dang Gui (1 liang), Zhi Gan Cao (1 liang).
Chop 8 ingredients. Boil in 10 sheng of water to obtain 4 sheng. Divide into 4 doses. If cold, add Hou Po (2 liang). Avoid raw green onion, Hai Zao, Song Cai. Same as *Jing Xin Lu*.
Shen Shi Huang Qi Tang: Treats severe deficiency, lower abdominal urgency, cold-spasm牵引, Qi rushing from umbilicus to chest. Remove Dang Gui from the above formula, add Ban Xia.
Shen Shi Da Jian Zhong Tang: Treats internal emptiness, interior tension, shortness of breath, cold extremities, lower abdominal cramping, abdominal fullness/tightness, anorexia, slight sweating upon rising, retraction of genitals, cold pain in abdomen, intolerance to labor, dry lips/mouth/tongue, spontaneous seminal emission, alternating cold/heat in limbs, irritability, soreness/pain, inability to stand long, frequent dreams. Tonify Middle and Augment Qi Formula.
Huang Qi (4 liang), Ren Shen (2 liang), Da Zao (20 pieces, split), Dang Gui (2 liang), Gui Xin (6 liang), Sheng Jiang (1 jin), Ban Xia (1 sheng, washed), Bai Shao (4 liang), Pao Fu Zi (1 liang), Zhi Gan Cao (2 liang).
Chop 10 ingredients. Boil in 12 sheng of water to obtain 4 sheng. Divide into 4 doses. Take medicine before food. Avoid Hai Zao, Song Cai, raw green onion, pork/lamb, maltose, cold water. (Same as above) (Note: *Qian Jin Fang*'s Da Jian Zhong Tang differs; see later for heart-calming addition.)
*Sheng Hui Fang* Jian Zhong San: Treats Lao, benefits Qi, tonifies insufficiency. Remove Ren Shen and Ban Xia from the above formula, add Bai Zhu, Mu Xiang, Shu Di Huang. Decoct, strain, add Yi Tang (size of a date), boil briefly. Take warm before meals.
Bai Zhu San: Treats Lao with interior tension, limb disharmony, body pain, anorexia. Add Bai Zhu to the above formula.
*He Ji Ju Fang* Shi Si Wei Jian Zhong Tang: Treats Ying/Wei insufficiency, Zang-Fu damage, accumulated Lao deficiency, emaciation, chronic Spleen/Kidney deficiency, total lack of diet. Add Bai Zhu, Rou Cong Rong, Mai Men Dong, Bai Fu Ling, Chuan Xiong, Shu Di Huang to the above formula.
Zhen Wu Tang: Not only for Yin-pattern Shang Han, but also for Lao patients with aversion to cold, high fever, cough, and dysentery. Renamed Gu Yang Tang. (From *Yi Jian Fang*)
Bu Zhong Yi Qi Tang: Treats Middle Qi insufficiency, or damage from overusing draining drugs, leading to limb fatigue, dry mouth, fever, anorexia, or irregular diet/fatigue causing fever, surging but forceless pulse, headache, aversion to cold, spontaneous sweating, high breathing/asthma, fever/irritability, fine/weak pulse, spontaneous sweating, fatigue, poor appetite, or Middle Qi weakness failing to control Blood, or malaria/dysentery due to Spleen/Stomach deficiency, or Yuan Qi weakness unable to handle Wind-Cold invasion (use this instead of releasing exterior). Or after intercourse followed by labor/cold, or vice versa, urgently add Fu Zi. I believe the body relies on Spleen/Stomach. If Spleen/Stomach Qi is solid, Lungs are nourished; strong Lung Qi generates Water; Water rises, Fire descends, achieving Water-Fire balance and Heaven-Earth harmony. If Spleen/Stomach is deficient, Four Zang lack generating Qi. Thus, Dong Yuan's treatises on Spleen/Stomach and internal/external injury emphasize securing Spleen/Stomach. Bu Zhong Yi Qi Tang is placed first among his formulas. This shows the principle: "Tonifying Spleen is better than Tonifying Kidney." The symptoms mentioned earlier are summarized; others can be inferred similarly. (Based on *Hui Chun Lu*)
Huang Qi (1 qian for severe fatigue-fever), Zhi Gan Cao (5 fen each), Qu Lu Ren Shen.
Sheng Ma, Chai Hu, Ju Pi, Jiu Jin Dang Gui Shen, Bai Zhu (each 3 fen).
Chop all. One dose. Boil in 2 zhan of water to 1 zhan. Strain. Take warm after breakfast. (*Nei Wai Shang Bian Huo Lun*)
If abdominal pain, add Bai Shao (5 fen), Zhi Gan Cao (3 fen).
If chronic phlegm-cough, remove Ren Shen.
If summer cough, add Wu Wei Zi (30-2 pieces), Qu Xin Mai Men Dong (2-3 fen). (*Pi Wei Lun*)
*Shi Xiao Fang* Tiao Zhong Yi Qi Tang: Treats Spleen/Stomach damage from hunger/fullness/labor, insufficient Yuan Qi. Add Wu Wei Zi, Bai Shao to the above formula. If dry-heat appears (indicating Lower Yuan Yin Fire steaming), add Sheng Di Huang (2 fen).
Case of Mr. Zheng Zhang Jiao from Dong Yang: Profuse sweating, tremors, shaking, then bathing-fever, body burning hot, then profuse sweating like rain, body cold. Then chills again, then heat, then sweat. Three symptoms cycling day and night. Student Lu Mingfu treated as Malaria, ineffective. I diagnosed right hand: Yang pulse rapid, floating, surging, forceless; Yin pulse slightly deep/small, deficient. Left three positions smaller than right, floating/soft. I said, "This is Yang Deficiency." Used Bu Zhong Yi Qi Tang, doubled Ren Shen/Huang Qi, halved Sheng Ma/Chai Hu, added Niao Jin Sheng Fu Zi (1.5 qian), Chao Huang Bo (3 fen), Gan Jiang (5 fen), Bo Gui (5 fen), Da Zao (1 piece). Decoct together. First dose: 30% improvement. Second dose: half improved. Fourth dose: chills/fever stopped, slight sweat remaining. Halved Gui/Fu/Gan Jiang. Two more doses: fully recovered. (*Zheng Chuan*)
Formula + Huang Bo/Sheng Di = Bu Zhong Yi Qi Jia Huang Bo Sheng Di Tang. Treats Yin Fire attacking Yang, worse fever during day, spontaneous sweating, shortness of breath, thirst, tastelessness. (*Ji Jie*)
Sheng Mai San: Treats extreme Qi deficiency, little Righteous Qi, much Pathogenic Qi, frequent panting, few words. (From *Yi Fang Kao*) (See *Zhong Shu* for formula).
Shortness of breath, reluctance to speak, weakness, dull eyes, pale complexion indicate Qi deficiency. Use Mai Men Dong, Ren Shen (each 3 qian), Ju Hong, Jie Geng, Zhi Gan Cao (each 0.5 liang), Wu Wei Zi (21 grains). Pound to fine powder. Make pills with soaked oil cake, size of chicken head. Chew one pill with saliva and swallow. Named Bu Qi Wan. (*Zhun Sheng*)
Ren Shen Gao (Ginseng Paste).