润肺膏，治久嗽，肺燥，肺痿。羊肺一具、杏仁净研、柿霜、真酥、真粉各一钱，白蜜二两。上将羊肺洗
净，次将五味入水搅粘，灌入肺中，白水煮熟，如常服食。周扬俊云∶血去则燥，燥则火旺肺枯，欲从肾滋水，
而不先滋水之母，有是理乎？然肺为多气少血之脏，故一切血药，概不欲用。以羊肺为主，诸味之润者佐之，
人所易能也。若以真粉之甘凉，不独清金，且以培土，人所未知也，此治上损之主剂也。肺热叶焦之痿，饮不
解渴之上消，并可仿为此法，可为治损圣手，故叶氏治吐血诸证皆宗之。奈后人多从《医贯》入手，不分上损
下损，惟六味、八味等方而已，宜其无效也。
燮理十全膏，平补阴阳，调剂气血。人参、炙 各三两，白术六两，熟地八两，当归、白芍、川芎各二两，
炙草一两，熬膏将成，入龟鹿胶四两，收之窨内，去火气，每开水调服数钱。此薛一瓢方也，其方论云∶古人
治无形之劳怠，必培以甘温，人参为君，白术为臣，黄 为佐，甘草为使。有形之劳倦，必助以辛温，归、芎
是也；资以酸甘，芍、地是也。故以八味为首旨，而拘HT 以肉之，特如鹿之勤，能通肾脉，龟之净，能通任脉。
此二胶者，各禀一德，草木力微，赖以神其用也。阴阳两虚者，服之无偏胜，无不及。又或陈皮、半夏以利枢
机，先为主道之剂。凡培养元气，方之宜简而纯。简则脏腑易承，气血亦易行，纯则温浓和平，可以补偏救弊，
俾自相灌注，循环之理无端，生生不已，以合其先天所赋流行之道。若稍穿凿，非本然之理矣。
杜劳方，专治骨蒸劳热，羸弱神疲，腰脊酸痛，四肢痿软，遗精吐血，咳嗽吐痰，一切阴虚火动之症。轻
者，二三料全愈；重者，四五料除根。若先天不足之人，不论男女，未病先服，渐可强壮。以其性味中和，久
任亦无偏胜之弊，勿以平淡而忽之。枇杷叶五十六片，刷去毛，鲜者尤良，去皮切片，大枣八两，熟后去皮，
炼白蜜一两，便燥多加，溏泻勿用。先将枇杷叶放砂锅内，煎透去渣，绢取清汁，后将果蜜同拌入锅铺平，取
枇杷叶汁浸之，煮半炷香，翻转再煮半炷香，收器内，每日随意温热连汁食。咳嗽多痰，加川贝母末一两，起
时加入，一二滚即收。吐血加藕汁同煮。
虚劳欲火∶甘梨汁，胡桃肉研，各一斤，芽茶五两，生地、当归末各六钱，熬至滴水成珠，入鸡子清一枚，
收瓷内封好，冷水浸去火毒，每服一匙。
《慎柔五书》曰∶损病六脉俱数，声哑口中生疮，昼夜发热无间。经云∶数则脾气虚。此真阴虚也，用四
君加黄 、山药、莲肉、白芍、五味子、麦冬，去头煎不服，服第二三煎，此养脾虚之法也。服十余日，发热
退，口疮渐好。方用丸剂，如参苓白术散，亦去头煎，晒干为末，陈米锅焦，打糊为丸如绿豆大。每服三钱，
或上午一钱，白滚汤下。盖煎去头煎，则燥气皆去，遂成甘淡之味，淡养胃气，微甘养脾阴。此师相授受之语，
无轻忽焉。
黄锦芳治一女，患虚劳症，脉虽数而不甚，是尚可治。但饱不思饮食，痰涎甚多。索前医单视之，用白术、
地黄，以补脾清火；广、半、附子，以除痰固虚。意颇周密，但病多水壅，白术之滞，地黄之湿，皆所不宜。
改用香、砂、橘、半以疏其脾，饮食渐加。至三剂，微见阴火起，随用龟板、阿胶潜伏之味，而火渐息，食渐
加，痰渐少。以后随病增减，总以疏脾滞为要，遂愈。此乃阳伤六七，阴伤二三，劳在将成未成之际，故尚可
治。若再用白术、地黄，必不救矣。凡虚劳症，脾肺俱损者，即为难治。脾喜燥而恶湿，肺苦燥而喜润，饮食不
进，宜用香、砂，则于肺燥不宜；咳血吐血，宜用胶、地，则于脾湿不宜。惟燥热甚而能食不泻者，润肺当急，
而补脾之药，亦不可缺也。倘虚极不食而泻多，虽咳嗽不宁，亦必以补脾为急，而滑润之品，不可轻投。盖脾
有生肺之能，肺无补脾之力，故补脾之药，尤要于补肺也。至于脾肾俱伤者，尤难措手。方欲以甘寒补肾，而
食少不化，又恐不利于脾；方欲以辛温快脾，而阴气耗竭，又恐愈损其水。两者并衡，而卒以健脾为急者，以
脾上交于心，下交于肾也。要知，滋肾之中，扶以砂仁、沉香，壮脾之中，参以牛膝、菟丝、龟板，随时活法
以治之，庶几有济。葛可久曰∶劳症施治宜早，若至脾败不食，则万无一生。故治劳须于平时力救脾胃为佳。
尤在泾曰∶风劳骨蒸，久而咳嗽吐血，脉来弦数者，柴胡梅连散主之。盖邪气久积于表里之间而不退，非可一
汗而去者，故用柴胡之辛散，必兼乌梅之酸收。而久积之风，内蕴骨髓者，已变风之体而为热，则宜用黄连、
前胡之苦寒以清之。然兵无向导，则不达贼境，药无引使，则不通病所。新病且然，况伏邪乎！故胆以合胆，
髓以合骨，薤白之通阳，童便之通阴，而表里肌肤之邪，庶尽出欤。
罗氏秦艽鳖甲散，与柴胡梅连同意，亦治风劳骨蒸肌热之症。然减前胡之泄气，而加当归之和血，去黄连
之苦寒，而用青蒿之辛凉，气味为较和矣。久病之人，未必不宜缓法也。
阳虚者，气多陷而不举，故补中益气多用参、 、术、草，甘温益气，而以升、柴辛平助以上升。阴虚
者，气每上而不下，故六味丸多用熟地、萸肉、山药。浓味体重者，补阴益精，而以茯苓、泽泻之甘淡，
引之下降。气陷者多滞，陈皮之辛，所以和滞气。气浮者多热，丹皮之寒，所以清浮热。六味之有苓、泽，
犹补中之有升、柴也。补中之有陈皮，犹六味之有丹皮也。其参、 、归、术、甘草，犹地黄、茱萸、山
药也。法虽不同，而理可通也。
归脾汤兼补心脾，而意专治脾。观其于甘温补养药中，加木香醒脾行气，可以见矣。龙眼、远志，虽曰补
火，实以培土。盖欲使心火下通脾土，而脾益治，五脏受气以其所生也，故曰归脾。
虚劳之人，气血枯耗，生气不荣，则内生寒冷，张鸡峰所谓冷劳是也。宜建中、复脉、八味肾气之属，甘
温辛润，具生阳化阴之能者治之。亦有邪气淹滞，经络瘀郁者，《元珠》所谓体虚之人，最易感于邪气，当先
和解微利微下之，次则调之。医不知而遽行补剂，往往致使邪气不解。是故虚劳之治，固不必专以补阴降火为事也。
罗氏论虚劳之症，都因邪伏血郁而得，不独阴亏一端。至晚寒热时减时增，其为阳陷入阴可知。滋肾生肝，
最为合法，略加损益，不必更张也。熟地、白术、丹皮、茯苓、淮山药、柴胡、鳖甲、炙草。
真阳气弱，不荣于筋则阴缩，不固于里则精出，不卫于表则汗泄，三者每相因而见。其病在三阴之枢，非
后世方法可治。古方八味丸，专服久服，当有验也。
肺实于上，肾虚于下，脾困于中之候也。然而实不可攻，姑治其虚。虚不可燥，姑温其下。且肾为胃关，
而火为土母，或有小补，未可知也。（《金匮》肾气丸。）
裴兆期曰∶补虚之最切要者，在扶胃气，胃气强则饮食进，饮食进则气血生，补何如之。今之不善补者，
概用归、地、参、术、甘草、黄 等类，以为补虚之法，莫此若矣。不知此等品类，皆甜腻壅膈之物，胃强者
尚可，胃弱者服之，不胀则泻，不泻则呕吐而不能食矣。病不转加者，未之有也。
一宦室外家，年二旬，不甚得所，抑屈伤脾，饮食渐减，几半岁。后乃月事不来，日晡潮热，医以养血滋阴
为治，寝至肌肉消烁，喘息不眠，恶心不能食，大便不通，脉来数弦，右关特细。《素问》云∶二阳之病发心
脾，有不得隐曲，女子不月。其传为风消，为息贲者，即此类也。在法不治，旬余果卒。夫二阳者，胃与大肠
也。病者传化失常，饮食少进也。发心脾者，治于脾心也。因不得遂其隐曲之情，心脾屈结而发也。心生血，
脾统血，肠胃既病，则心脾无所资而血脉枯，故不月。血既枯，则阴不胜阳而生热，热盛则生风，而肌肉消烁
矣，故曰风消。肺属金主气，金为热迫，则气上贲，喘息不宁，故曰息贲。初起时，即宜开导肠胃中积滞，使
真气流通，胸膈宽利。能饮能食，始用血分等药，调月事之不来，退日晡之潮热，方为正治。乃不审二阳，因
抑屈久而积滞不行，为受病之根，漫执月事不来，日晡潮热，是血少阴虚，不用逍遥则用四物，朝餐暮饵，而
卒至于死，良可叹也。女子患此者甚多，余故详着其证，并释经义云。
或曰∶养血滋阴之药，世皆用之以补虚劳不足者也。予且谓有伤脾之患，而大补丸，反多耗气之品，何以
取之？曰∶此深有当于脾胃元气本然之妙，干干不息者也。昼夜循环于脏腑肢体关窍间，若天行之健，而未始
或息停者也。细思此方，虽用人参、白术补气为君，而又以渗湿消痰之茯苓、半夏为臣，更以开滞疏壅之枳实、
山楂、陈皮、浓朴、木香、砂仁、黄连、神曲、谷芽为佐使，名为大补，而实无有所谓大补之药。为使脾胃通
调，胸膈和利，能饮能啖，不失其常，降浊升清，时靡有间，旋推以陈，旋致以新，助彼干干不息之妙而已矣。
虽无所谓大补之药，而大补之理实具焉。以故每施之脾胃气衰之人，为胀为肿，为痞为痰，为久疟久痢，与高
年百损，产后诸虚，而不克加餐等病，屡获奇效。不然，则山楂、枳实、浓朴、陈皮等药，耗元气者也，曷有
补于人哉？
一宦者，以积劳后，间发往来之热，渐至形神枯槁，懒于动止，饮食日损，不知味累月矣。医作脾虚治，
用补中、归脾、参苓散、大补脾丸等药皆罔效。余视之，六脉涩且濡，而尺为甚，此肾气虚而脾无所禀也。治
当于两肾中，培化源之本，则脾始充，而病斯已矣。用紫河车一具为君，熟地二两为臣，杜仲、生萸肉、破故
纸、山药、芡实各一两，茯苓、益智、砂仁、青盐各八钱为佐使。即以河车、地黄二味，酒煮捣丸如桐子
大，服不逾月，而形气饮啖俱如初。盖急欲下达以固肾而救脾，故不但用辛能润肾之砂仁为向导，而又加咸能
下降之青盐为直入之兵，毫不敢杂他脏之药，以分其势。若加入参、术、势必顾恋中州，而下行之力反缓，安
能直入肾以培土而捷效乎？
或问∶劳瘵痰嗽，治以二冬、二母、款冬、紫、荆、菀之属，十九不效者何也？曰∶劳瘵痰嗽，非肺病也。
原于先天肾阴亏败不能制火，火无所畏，亢而刑金，金极则鸣耳。此谓水泛为痰之嗽，非风痰、热痰、痰饮、
痰涎诸症可比，法当峻补真阴，佐以味咸下降之品，徐徐引之归元，始为善法。然则补阴下降之物，其孰为优？
则惟童便一味为上药耳。童便味咸性温，温可养元气，咸则归肾速而引火下行，实人身中之气血药也。用治本
元亏损之病，则同气有情而易入。褚氏谓服寒凉者，百不一生。服溲便者，百不一死，良以此也。
一人年三十余，积病而多欲，遂起热兼旬，无盗汗，六脉饮食不减，此劳症之微而未深者也，正与养血滋
阴治法相合。药用生地三钱，醋炙鳖甲二钱，知母、当归、柴胡、丹皮、山萸肉各一钱，黄芩六分，煎服六剂
而热平。随灸百劳、膏肓二穴，以杜其根。更以河车丸与之调理，不百日形气饮食脉候俱如初而愈。葛可久曰∶
劳症最为难治，当治于微病之时，莫治于已病之后。今此病正当微发之时，故能取效于旦夕间耳。若不早为之
治，必至干咳声嘶，肌消肠滑，脉来细数，而莫能挽回矣。患此者，不可不防微而杜渐也。
昔王好古论人参曰∶肺热用之则伤肺。王节斋论人参曰∶阴血虚血证忌服，服之过多必不治。余深味之，
皆千古不可移易之绳墨，何后之妄议其非者纷然耶？是岂词不足以发其理，而人莫之解欤？非也。唱和成风，
耳热心痼，遂不复有揭其理，而正其误者，谓非吾道之一大不幸哉。夫所谓肺热者，即阴虚之肺热也；所谓阴
虚者，即阴虚也。盖肺热谓阳独盛，阴虚谓阴独虚，则阴独虚不足以化阳为火炽，火则烁金，而咳血、咯血、
干嗽、声嘶，诸肺热之候所从出矣。此症有阳无阴之病，治当曲尽养阴之法，以化阳而救热，遽用人参助其阳
气，则肺愈热而阴愈虚，嗽喘痰血不愈甚乎。此两先生所以谆谆垂戒也。
藜按∶方书于虚劳症，无不执阳生阴长之说，主用参、 ，然投之阴虚火旺之躯，无不辄败。想诸老于此
等病症，皆付之不治之列，故未尝躬亲阅历细心体验也。《理虚元鉴》独持清金保肺之谕，可称卓见。然
其用药亦斥节斋为缪论，实不免随声附和之失。裴公此谕，与归重脾胃一着，皆治虚劳之要法，具见高出
前人远甚，学人不可不细参也。原文反复辨论，其说甚详，然精意已在于此，故节之。
虚劳病惟于起初时，急急早灸膏肓等穴为上策。外此，则绝房室、息妄想、戒恼怒、慎起居、节饮食，以
助火攻之不逮。一或稍迟，脉旋增数，虽有良工，莫可为矣。至于药饵，则贵专而少，不贵泛而多。万不可漫
听名流，积月穷年，不废润肺滋阴之药。盖此等药，其名虽美，酿祸极深，不可不知，不可不慎。
Runfei Gao (Lung-Moistening Paste), treating chronic cough, lung dryness, and fei wei (lung atrophy). Take one sheep lung, cleaned and ground apricot kernels (Xingren), persimmon frost (Shishuang), true animal fat (Zhen Su), and true rice flour (Zhen Fen), each 1 qian; white honey 2 liang. First wash the sheep lung clean, then put the five ingredients into water, stir until viscous, and pour into the lung. Boil in plain water and consume as usual. Zhou Yangjun said: When blood is lost, dryness ensues; when dry, fire flares up and the lung withers. If one wishes to nourish water from the kidney but does not first nourish the mother of water (metal generates water, so the lung is the mother of the kidney), is this logical? However, the lung is an organ abundant in qi and deficient in blood, therefore all blood-invigorating drugs are generally avoided. Using the sheep lung as the principal agent, assisted by various moistening substances, is something people can easily achieve. The sweet and cool nature of true rice flour not only clears metal (lungs) but also fortifies earth (spleen); this is unknown to many. This is the main formula for treating upper damage (upper jiao deficiency). For fei wei caused by lung heat scorching the leaves, and shang xiao (upper consumption) where drinking does not quench thirst, this method can be imitated. It can be considered a sage's method for treating damage; thus, Ye Tianshi respected this method for treating hemoptysis and other syndromes. Regrettably, later practitioners mostly started from *Yi Guan* (Canon of Medicine), failing to distinguish between upper and lower damage, using only formulas like Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia), which explains their ineffectiveness.
Xieli Shiquan Gao (Perfect Ten Harmony Paste), peacefully tonifying yin and yang, regulating qi and blood. Ren Shen (Ginseng Root), Zhi Huang Qi (Honey-fried Astragalus Root) each 3 liang, Bai Zhu (Atractylodes Macrocephala Rhizome) 6 liang, Shu Di Huang (Prepared Rehmannia Root) 8 liang, Dang Gui (Angelica Sinensis Root), Bai Shao (White Peony Root), Chuan Xiong (Sichuan Lovage Rhizome) each 2 liang, Zhi Gan Cao (Honey-fried Licorice Root) 1 liang. When boiling into paste near completion, add Gui Ban Jiao (Tortoise Shell Glue) and Lu Jiao Jiao (Deer Antler Glue), 4 liang each. Store in a sealed container to remove "fire energy" (heatiness). Take several qian mixed with boiled water each time. This is a prescription by Xue Yupiao. His commentary states: Ancients treated formless fatigue and lassitude by necessarily fortifying with sweet and warm herbs. Ren Shen is the sovereign herb, Bai Zhu is the minister, Huang Qi (Astragalus Root) is the assistant, and Gan Cao is the envoy. For tangible fatigue, one must assist with pungent and warm herbs, such as Dang Gui and Chuan Xiong; nourish with sour and sweet herbs, such as Bai Shao and Shu Di Huang. Thus, these eight herbs are the primary focus. Specifically relying on flesh-based substances, diligent like the deer to unblock the Kidney Meridian, and pure like the tortoise to unblock the Ren Mai (Conception Vessel). These two glues each possess a unique virtue; herbal forces are weak, relying on them to divine their efficacy. For those with dual deficiency of yin and yang, taking it causes no excess or insufficiency. Alternatively, adding Chen Pi (Tangerine Peel) and Ban Xia (Pinellia Tuber) to facilitate the pivot mechanism serves as a preliminary main path agent. Generally, formulas for cultivating primordial qi should be simple and pure. Simplicity allows organs and bowels to accept it easily, and qi and blood to circulate smoothly; purity ensures warmth and peace, correcting deviations and saving deficiencies, allowing mutual infusion and endless circulation, conforming to the innate flow. Any forced manipulation deviates from natural principles.
Dulao Fang (Formula for Resisting Asthenia), specifically treating bone-steaming fever, emaciation and mental fatigue, soreness and pain in the waist and spine, flaccidity of limbs, spermatorrhea and hemoptysis, cough with sputum, and all symptoms of yin deficiency with hyperactive fire. Mild cases recover after two or three doses; severe cases root out the disease after four or five doses. For those with congenital insufficiency, regardless of gender, taking it before illness onset gradually strengthens the body. Due to its neutral nature and flavor, long-term use has no side effects of bias; do not neglect it because it seems bland. Loquat leaves (Pipa Ye) 56 pieces, brushed clean of hairs (fresh ones are better), skin removed and sliced; Jujube (Da Zao) 8 liang, skin removed after cooking; refined white honey 1 liang (increase if constipated, avoid if loose stools). First, boil loquat leaves in a clay pot until thoroughly extracted, remove dregs, and filter clear juice through silk cloth. Then mix fruit and honey in the pot, spread flat, soak with loquat leaf juice, boil for half an incense stick's time, flip and boil another half incense stick's time. Store in a vessel. Warm and consume with juice as desired daily. For cough with much sputum, add 1 liang of Chuan Bei Mu (Fritillaria Cirrhosa Bulb) powder at the end, boil once or twice then stop. For hemoptysis, cook with fresh lotus root juice.
Xu Lao Yu Huo (Asthenia with Desire-Fire): Sweet pear juice, crushed walnut meat, each 1 jin; young tea 5 liang; Sheng Di Huang (Raw Rehmannia Root), Dang Gui powder each 6 qian. Boil until drops form pearls. Add one egg white, store in porcelain, seal well. Soak in cold water to remove fire toxicity. Take one spoonful per dose.
*Shen Rou Wu Shu* states: In damage diseases, if all six pulses are rapid, voice is hoarse, mouth ulcers appear, and fever persists day and night without interval. The Classics say: Rapid pulse indicates Spleen qi deficiency. This is true yin deficiency. Use Si Jun Zi Tang (Four Gentlemen Decoction) plus Huang Qi, Shan Yao (Chinese Yam), Lian Rou (Lotus Seed Flesh), Bai Shao, Wu Wei Zi (Schisandra Berry), Mai Dong (Ophiopogon Tuber). Discard the first decoction and take the second and third. This is the method for nourishing Spleen deficiency. After ten-plus days, fever subsides, mouth ulcers heal. Use pill form, such as Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), also discarding the first decoction. Dry, powder, mix with scorched rice porridge crust paste to make pills the size of mung beans. Take 3 qian per dose, or 1 qian in the morning, washed down with plain boiled water. Discarding the first decoction removes dryness, resulting in a sweet and bland flavor; blandness nourishes Stomach qi, slight sweetness nourishes Spleen yin. This is a master-to-disciple transmission; do not disregard it lightly.
Huang Jinfang treated a female patient with Xu Lao (asthenia syndrome). Her pulse was rapid but not extreme, indicating treatability. However, she felt full yet had no appetite, with excessive phlegm-saliva. Reviewing the previous doctor's prescription, he used Bai Zhu and Di Huang to tonify Spleen and clear fire; Guang Pi (Tangerine Peel), Ban Xia, and Fu Zi (Aconite Lateral Root) to resolve phlegm and consolidate deficiency. The intent was thorough, but the pathology involved water accumulation/stagnation; Bai Zhu's cloying nature and Di Huang's dampness were unsuitable. He switched to Xiang Fu (Cyperus Rhizome), Sha Ren (Amomum Fruit), Ju Hong (Red Tangerine Peel), and Ban Xia to soothe Spleen stagnation; diet gradually improved. By the third dose, slight Yin fire emerged; he immediately used Gui Ban (Tortoise Shell) and E Jiao (Donkey-Hide Glue) to subdue it. Fire subsided, diet increased, phlegm decreased. Subsequent adjustments focused on soothing Spleen stagnation, leading to recovery. This was Yang injury (60-70%) and Yin injury (20-30%), asthenia in the pre-onset stage, hence treatable. Reusing Bai Zhu and Di Huang would have been fatal. In general, Xu Lao involving both Spleen and Lung is difficult to treat. The Spleen likes dryness and dislikes dampness; the Lung suffers from dryness and likes moisture. If food intake is poor, Xiang Fu and Sha Ren are suitable but unsuitable for Lung dryness; if coughing blood occurs, E Jiao and Di Huang are suitable but unsuitable for Spleen dampness. Only when dry-heat is severe and the patient eats without diarrhea should Lung-moistening be urgent, while Spleen-tonifying herbs remain indispensable. If extremely deficient, unable to eat, and with frequent diarrhea, even with persistent cough, Spleen-tonifying is urgent, and slippery/moistening products must not be lightly administered. The Spleen has the ability to generate the Lung, but the Lung cannot tonify the Spleen; thus, Spleen-tonifying is more critical than Lung-tonifying. When both Spleen and Kidney are injured, treatment is particularly difficult. One may wish to tonify Kidney with sweet-cold herbs, but poor digestion makes this risky for the Spleen; one may wish to invigorate Spleen with pungent-warm herbs, but depleted Yin makes this harmful to Water. Balancing both, prioritizing Spleen-tonification is key because the Spleen connects upward to the Heart and downward to the Kidney. Know that within Kidney-nourishing, add Sha Ren and Chen Xiang (Agarwood); within Spleen-strengthening, add Niu Xi (Achyranthes Root), Tu Si Zi (Cuscuta Seed), and Gui Ban. Adapt flexibly to succeed. Ge Kejiu said: Treatment of asthenia should be early; if Spleen fails and eating stops, survival is impossible. Therefore, protecting Spleen and Stomach during normal times is best.
You Zaijing said: For wind-lao, bone-steaming, with prolonged cough and hemoptysis, and a wiry-rapid pulse, use Chaihu Meilian San (Bupleurum, Plum, and Coptis Powder). Pathogenic factors accumulated long-term between exterior and interior cannot be expelled by sweating alone. Thus, Chai Hu (Bupleurum Root)'s pungent dispersal is combined with W Mei (Dark Plum)'s astringent gathering. Wind accumulated long-term in marrow transforms into heat; thus, Huang Lian (Coptis Rhizome) and Qian Hu (Peucedanum Root)'s bitter-cold properties clear it. Without guides, troops cannot reach the enemy; without guiding herbs, medicine cannot reach the disease site. This applies to new diseases, let alone latent pathogens. Gallbladder matches gallbladder, marrow matches bone, Xie Bai (Allium Macrostemon Stem) unblocks Yang, Tong Bian (Child's Urine) unblocks Yin, allowing exterior-interior and muscle-skin pathogens to exit.
Luo Shi's Qin Jiao Bie Jia San (Gentian and Turtle Shell Powder) shares intent with Chaihu Meilian San, treating wind-lao, bone-steaming, and muscular heat. It reduces Qian Hu's qi-draining effect, adds Dang Gui's blood-harmonizing effect, removes Huang Lian's bitter-coldness, and uses Qing Hao (Artemisia Annua Herb)'s pungent-coolness, making the aroma and flavor milder. Chronic patients may indeed benefit from gentle methods.
In Yang deficiency, qi sinks and fails to rise; thus, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) uses Ren Shen, Huang Qi, Bai Zhu, Gan Cao for sweet-warm qi tonification, aided by Sheng Ma (Cimicifuga Rhizome) and Chai Hu for pungent-level ascending action. In Yin deficiency, qi floats upward instead of descending; thus, Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) uses Shu Di Huang, Shan Zhu Yu (Cornelian Cherry Fruit), Shan Yao for rich/heavy yin and essence tonification, aided by Fu Ling (Poria) and Ze Xie (Alisma Rhizome) for sweet-bland descending guidance. Sinking qi often stagnates; Chen Pi's pungency harmonizes stagnation. Floating qi often generates heat; Mu Dan Pi (Moutan Cortex)'s coldness clears floating heat. Liu Wei Di Huang Wan's Fu Ling and Ze Xiang correspond to Bu Zhong Yi Qi Tang's Sheng Ma and Chai Hu. Bu Zhong Yi Qi Tang's Chen Pi corresponds to Liu Wei Di Huang Wan's Mu Dan Pi. Ren Shen, Huang Qi, Dang Gui, Bai Zhu, Gan Cao correspond to Shu Di Huang, Shan Zhu Yu, Shan Yao. Methods differ, but principles connect.
Gui Pi Tang (Restore the Spleen Decoction) tonifies both Heart and Spleen, focusing on the Spleen. Adding Mu Xiang (Aucklandiae Root) to awaken Spleen and move qi among sweet-warm tonics demonstrates this. Long Yan Rou (Longan Aril) and Yuan Zhi (Polygala Root), though termed "tonifying fire," actually fortify Earth. The aim is to allow Heart fire to descend to Spleen Earth, improving Spleen function, as the Five Zang receive qi from what generates them; hence "Return to Spleen."
In Xu Lao, qi and blood are exhausted, vital qi fails to nourish, causing internal cold, known as Leng Lao (Cold Asthenia) by Zhang Jifeng. Treat with Jian Zhong Tang (Establish the Middle Decoction), Mai Mai Gan Cao Tang (Licorice Decoction with Repeated Brewing), or Ba Wei Shen Qi Wan (Eight-Ingredient Kidney Qi Pill)—sweet-warm and pungent-moist agents capable of generating Yang and transforming Yin. Some cases involve pathogen stagnation and meridian blood stasis. *Yuan Zhu* states: Weak bodies easily contract pathogens; first harmonize and mildly purge/drain, then regulate. Doctors who blindly use tonics often fail to resolve pathogens. Thus, treating Xu Lao need not solely focus on tonifying Yin and lowering fire.
Luo Shi argued that Xu Lao arises from latent pathogens and blood stagnation, not just Yin deficiency. Evening chills and fever fluctuating indicate Yang sinking into Yin. Nourishing Kidney to generate Liver is most appropriate, with minor modifications. Formula: Shu Di Huang, Bai Zhu, Mu Dan Pi, Fu Ling, Huai Shan Yao, Chai Hu, Bie Jia (Turtle Shell), Zhi Gan Cao.
True Yang Qi weakness fails to nourish sinews causing Yin retraction, fails to secure interior causing essence loss, fails to guard exterior causing sweat leakage; these three often occur together. The pathology lies in the pivot of the Three Yin meridians, beyond later methods. Ancient Ba Wei Wan (Eight-Ingredient Pill), taken exclusively long-term, should be effective.
Lung excess above, Kidney deficiency below, Spleen困 (trapped) in middle. Excess cannot be attacked; temporarily treat deficiency. Deficiency cannot be dried; temporarily warm the lower. Kidney is the gate of Stomach; Fire is the mother of Earth; slight improvement is possible. (*Jin Gui* Shen Qi Wan.)
Pei Zhaoqi stated: The most crucial aspect of tonifying deficiency is supporting Stomach qi. Strong Stomach qi leads to good appetite; good appetite generates qi and blood. How could tonification be better? Modern incompetent tonifiers use Dang Gui, Di Huang, Ren Shen, Bai Zhu, Gan Cao, Huang Qi indiscriminately, thinking this is the best method. They do not know these are sweet, cloying, and obstructive. Those with strong Stomach tolerate them; those with weak Stomach suffer bloating, diarrhea, vomiting, and anorexia. Disease worsening is inevitable.
A eunuch's relative, aged twenty, suffered emotional suppression damaging the Spleen; diet decreased over half a year. Menstruation stopped, afternoon tidal fever developed. Doctors treated with blood-nourishing and Yin-moistening herbs, leading to muscle wasting, panting, insomnia, nausea, anorexia, constipation, rapid-wiry pulse, especially fine at Right Guan. *Su Wen* says: Diseases of Er Yang (Stomach and Large Intestine) originate in Heart and Spleen; hidden grievances cause amenorrhea in women. Progression leads to Feng Xiao (Wind Emaciation) and Xi Ben (Breath Distension). This case was untreatable; she died ten days later. Er Yang refers to Stomach and Large Intestine. Dysfunction in transformation leads to poor intake. Originating in Heart/Spleen implies treating these organs. Emotional suppression causes Heart/Spleen knotting. Heart generates blood; Spleen controls blood. Gastrointestinal disease deprives Heart/Spleen of resources, drying blood vessels, causing amenorrhea. Blood exhaustion leads to Yin failing to control Yang, generating heat; intense heat generates wind, wasting muscles—hence Feng Xiao. Lung belongs to Metal, governs Qi. Heat forces Metal, causing Qi to rush upward, panting—hence Xi Ben. Initially, clearing gastrointestinal stagnation to free True Qi and widen chest/diaphragm was needed. Only after restoring appetite should blood-forming herbs regulate menstruation and reduce fever. Ignoring Er Yang, attributing symptoms to blood/Yin deficiency, using Xiao Yao San or Si Wu Tang continuously led to death. Many women suffer this; I detail the syndrome and explain the Classics.
Someone asked: Blood-nourishing and Yin-moistening herbs are widely used for Xu Lao deficiency. You claim they harm the Spleen, yet Da Bu Wan (Great Tonifying Pill) contains qi-consuming herbs. Why use it? Answer: This aligns deeply with the innate wonder of Spleen/Stomach primordial qi, ceaselessly active. Circulating day and night in organs and joints, vigorous like Heaven's movement, never stopping. Analyzing this formula: Ren Shen and Bai Zhu tonify qi as sovereign; Fu Ling and Ban Xia drain dampness and resolve phlegm as ministers; Zhi Shi (Immature Bitter Orange), Shan Zha (Hawthorn Fruit), Chen Pi, Hou Po (Magnolia Bark), Mu Xiang, Sha Ren, Huang Lian, Shen Qu (Medicated Leaven), Gu Ya (Sprouted Grain) open stagnation and relieve obstruction as assistants/envoys. Named "Great Tonifying," it lacks actual great tonics. Its purpose is to smooth Spleen/Stomach, harmonize chest/diaphragm, restore normal eating/drinking, descend turbidity, ascend clarity, constantly renewing, aiding ceaseless activity. Though lacking "great tonics," the principle of great tonification exists. Thus, applied to Spleen/Stomach qi decline causing bloating, swelling,痞 (fullness), phlegm, chronic malaria/dysentery, elderly debility, postpartum deficiency, or inability to eat, it achieves miraculous results. Otherwise, Shan Zha, Zhi Shi, Hou Po, Chen Pi consume primordial qi; how could they tonify?
An eunuch, after accumulated labor, developed intermittent alternating fever, progressing to physical/mental emaciation, lethargy, declining diet, and loss of taste for months. Doctors treated Spleen deficiency with Bu Zhong Yi Qi Tang, Gui Pi Tang, Shen Ling Bai Zhu San, Da Bu Pi Wan, all ineffective. Pulse was choppy and soggy, worst at Chi (Kidney position), indicating Kidney qi deficiency failing to nourish Spleen. Treatment should cultivate the source in both Kidneys to fill Spleen. Sovereign: Zi He Che (Placenta Hominis) one unit. Minister: Shu Di Huang 2 liang. Assistants/Envoys: Du Zhong (Eucommia Bark), Sheng Shan Zhu Yu, Po Gu Zhi (Cuscuta Seed), Shan Yao, Qian Shi (Euryale Seed) each 1 liang; Fu Ling, Yi Zhi Ren (Alpinia Oxyphylla Fruit), Sha Ren, Qing Yan (Green Salt) each 8 qian. Boil Placenta and Rehmannia in wine, grind, make pills like wisteria seeds. Within a month, physique, qi, diet, and taste returned to normal. Urgently directing downward to secure Kidney and save Spleen, using pungent-moistening Sha Ren as guide and salty-descending Qing Yan as direct troops, avoiding other organ herbs to concentrate force. Adding Ren Shen/Bai Zhu would linger in Middle Jiao, slowing descent, preventing direct Kidney access for rapid Spleen-soil cultivation.
Question: Why do treatments for Lao Zhai (consumption) cough with phlegm using Er Dong (Winter Melon/Ophiopogon), Er Mu (Fritillaria/Pear), Kuan Dong Hua (Coltsfoot Flower), Zi Wan (Aster Root), Jing Jie (Schizonepeta), and Zhan Zhu Wan (Helenium) fail in 90% of cases? Answer: Lao Zhai cough is not a Lung disease. It originates from congenital Kidney Yin failure failing to control fire; unrestrained fire attacks Metal; Metal extremes ring (cough). This is "water flooding creating phlegm" cough, distinct from wind-phlegm, heat-phlegm, fluid retention, or saliva disorders. Method: vigorously tonify True Yin, assist with salty-descending herbs to slowly guide back to origin. Among Yin-nourishing descending agents, Tong Bian (Child's Urine) is supreme. Salty and warm, warmth nourishes primordial qi, salt returns quickly to Kidney and directs fire downward; it is a qi-blood herb within the body. Treating primordial depletion, similar affinity facilitates entry. Chu Shi said: Taking cold-cool herbs, one in a hundred survives; taking urine, one in a hundred dies. This explains it.
A man, thirty-plus, with chronic illness and excessive desire, developed fever for ten days, no night sweats, normal pulse/appetite. This is mild, shallow asthenia, matching blood-nourishing/Yin-moistening methods. Prescription: Sheng Di Huang 3 qian, Vinegar-processed Bie Jia 2 qian, Zhi Mu (Anemarrhena Rhizome), Dang Gui, Chai Hu, Mu Dan Pi, Shan Zhu Yu each 1 qian, Huang Qin (Scutellaria Root) 6 fen. Six doses平息ed fever. Moxibustion applied to Bai Lao and Gao Huang acupoints to prevent recurrence. Given He Che Wan (Placenta Pill) for regulation. Within 100 days, physique, qi, diet, and pulse recovered. Ge Kejiu said: Asthenia is hardest to treat; treat at mild stages, not after onset. This case was mild, hence quick success. Without early treatment, it progresses to dry cough, hoarseness, muscle wasting, intestinal sliding, fine-rapid pulse, incurable. Prevention is essential.
Wang Haogu discussed Ren Shen: Using it for Lung heat damages the Lung. Wang Jiezhai discussed Ren Shen: Contraindicated in Yin-blood deficiency hemorrhagic syndromes; overdose is incurable. I deeply appreciate these immutable truths. Why do later critics argue against them? Is it lack of expression or understanding? No. Echoing trends and stubbornness prevent correcting errors, a misfortune for our tradition. "Lung heat" here means Yin-deficient Lung heat; "Yin deficiency" means isolated Yin deficiency. Lung heat implies Yang excess; Yin deficiency implies Yin scarcity. Insufficient Yin fails to transform Yang, leading to blazing fire scorching Metal, causing hemoptysis, dry cough, hoarseness. This syndrome has Yang without Yin; treatment must exhaustively nourish Yin to transform Yang and save heat. Suddenly using Ren Shen to boost Yang worsens Lung heat and Yin deficiency, increasing cough/hemoptysis. Hence the strict warnings.
Li Annotates: Formulas for Xu Lao adhere to "Yang generates Yin," prioritizing Ren Shen and Huang Qi. Yet administering these to Yin-deficient/fire-flaring constitutions always fails. Old masters likely deemed these untreatable, lacking personal experience. *Li Xu Yuan Jian* uniquely advocates clearing Metal and protecting Lung, a brilliant view. However, rejecting Jiezhai's theory as erroneous shows blind following. Pei Gong's advice and emphasis on Spleen/Stomach are essential Xu Lao methods, far surpassing predecessors. Students must study carefully. The original text argues extensively, but the core idea is summarized here.
For Xu Lao, early moxibustion on Gao Huang etc. is best strategy. Additionally, abstain from sex, cease delusions, avoid anger, regulate lifestyle, moderate diet to aid fire-treatment. Delay allows pulse to become rapid; even skilled doctors cannot help. Medicines should be few and specific, not numerous and vague. Never blindly follow celebrities using Lung-moistening/Yin-nourishing herbs for years. Though named beautifully, these drugs brew deep disaster; know and beware.