（论一首脉证九条方九首）
问曰。血痹病。从何得之。师曰。夫尊荣人。骨弱肌肤盛。重困疲劳。汗出。卧不时动摇。
加被微风。遂得之。但以脉自微涩。在寸口关上小紧。宜针引阳气。今脉和。紧去则愈。
〔补注〕阳所以统夫阴者也。统阴则血必随气行矣。乃经言血痹。而不言气。何哉。
不知血之痹。由于气之伤也。经曰。入于脉则血凝而不流。夫所以不流者。气为
邪阻也。然邪之足以伤者。必因于作劳。则卫气不能固外。而后邪得以入之。故
仲景发其不流之故。以明得病之由。言天下惟尊荣人。为形乐志苦。形乐。故肌
肤盛。志苦。故骨弱。骨弱则不耐劳。肌盛则气不固。稍有劳困。汗易出也。夫汗者。
血之液也。卫不固。斯汗出。汗出斯阳气虚。虽微风且得以袭之。则血为之痹。故
一见脉微。则知其阳之不足。一见脉涩。则知其阴之多阻。此血痹之本脉也。而
其邪入之处。则自形其小紧。小为正气拘抑之象。紧为寒邪入中之征。然仲景
明言微风。何以反得寒脉耶。盖邪随血脉上下。阻滞汁沫。未有不痛者。故痛为
脉紧也。针以泄之。引阳外出。则邪去而正自伸也。否则终于痹也。然则固外之
阳。所重惜也。富贵者能知阳气素不自强。则不敢作劳。即不获已而劳。或亦有
以知节而不至于汗出。汗出矣。不致卧后动摇。又何致虚风痹血耶。仲景言虚
劳。乃以血痹发其先。良有以也。
血痹阴阳俱微。寸口关上微。尺中小紧。外证身体不仁。如风痹状。黄 桂枝五物汤主之。
黄 桂枝五物汤方
黄 （三两） 桂枝（三两去皮） 芍药（三两） 生姜（三两） 大枣（十二枚）
上五味。以水六升。煮取二升。去滓。温服七合。日三服。
〔补注〕此条是由上条既痹之后。未能针引以愈。遂令寸口微者。今则阴阳俱微。
且寸关俱微矣。且尺中小紧矣。夫小紧既见于尺。则邪之入也。愈深。而愈不得
出何也。正虚之处。便是容邪之处也。脉经内外谓之阴阳。上下亦谓之阴阳。今
尺既小紧。则微属内外也明矣。若言证以不仁概之。盖身为我身。则体为我体。
而或为疼痛。或为麻木。每与我相阻。其为不仁甚矣。故以风痹象之。非真风痹
也。经曰。风寒湿三者合而成痹。然何以单言风痹也。邪有兼中。人之受者必有
所偏。如多于风者。则其痛流行不常。淫于四末。盖血以养筋。血不通行。则筋节
为之阻塞。且血藏于肝。肝为肾子。肾既受邪。则血无不壅滞。于是以黄 固卫。
芍药养荣。桂枝调和荣卫。托实表里。驱邪外出。佐以生姜宣胃。大枣益脾。岂非至当不易者乎。
夫男子平人。脉大为劳。极虚亦为劳。
〔补注〕虚劳为不足之病。则必为不足之脉也。经云。烦劳则张。精绝。正以劳则阳
气外张。举之有余也。然其余也。既非内蕴之充。又岂外邪之助。以是大为劳也。
至问脉之重虚。对以上虚尺虚。言上下皆虚也。又云。脉虚者。不象阴也。不似手
太阴之充盛也。故极虚者亦云劳。然则大者固为劳力饥饱。而极虚者则不免于房劳矣。
男子面色薄者。主渴及亡血。卒喘悸脉浮者。里虚也。
〔补注〕此仲景出望之法以教人也。经曰。心者生之本。神之变。其华在面。而其充
在血脉。故手少阴为君主之官。神明出焉。然使忧愁思虑。则足以伤之。夫神伤
则体弱。体弱则所生者不足。自未能荣于色矣。盖心所以生血。而色者。神之旗
也。阴血既少。则津液自枯。故主渴也。渴必引水以自救。而渴不复为水止。则饮
多而停于心下。阻其呼吸之隧而为喘。失其君火之司而为悸。所不免也。若此
者脉必浮。岂非所生之血。不足鼓其脉于外乎。心所以合脉者也。于是知其心气之虚于里焉也。
男子脉虚沉弦。无寒热。短气里急。小便不利。面色白。时目瞑。兼衄。少腹满。此为劳使之然。
〔补注〕人之身以阳气为主。惟作劳则动伤元气。故于此先言脉。并言证。以见男
子之阳虚也。夫虚者。劳之本脉也。举按不实之中。而复见少厥二阴之象。则其
为内伤阳气何如。而阳虚者必恶寒。内伤者多发热。故脉经云。假令寸口脉微。
名曰阳不足。阴气上入阳中。则洒淅恶寒也。假令尺脉弱。名曰阴不足。阳气下
陷入阴中。则发热也。今三部同等。已非上入下陷之候。则其无寒热可知。然膻
中者。气之海也。谷之精气。浊者化卫。而一为宗气。行胸中以司呼吸。于是呼出
者心肺主之。吸入者肾肝主之。心肺阳也。肾肝阴也。夫以举按豁然之脉。而只
见其有阴无阳。是中之宗气不能为之资。斯呼者无以壮其出。而吸者不能深
其入。遂令升降无力。而短气不足以息也。中州之气既虚。使水谷未能消腐。而
清气不能上升。则肾阳未旺。肝气下乘。故频圊而里急。膀胱为州都之官。气不
化而水道不出。至如经谓十二经脉。三百六十五络。皆上于面。然肺为气之总
司。若气虚则肺亦虚。故面虽诸阳之会。而色独如金也。且阴气盛则目瞑。今阳
衰。有不为之目瞑者乎。兼衄者。阳络伤则血外溢而为衄也。少腹满者。因小便
不利也。此为劳伤元气。所以至此。然则仲景即不言治法。自当调以甘药。培中
土以益元阳。不待言矣若舍黄 建中。又何以为法耶。
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。
〔补注〕夫脉之大有二。一曰大为实。一曰大则为芤。芤则为虚。今属之于劳。则所
伤在元气。而无血以和之也。然伤者在气而何损于血也。经曰。阳生则阴长。故
无阳则阴无以生。无阴则阳无以化。举按之间。但觉其大。而非有力于去来也。
然何以他脉不兼见。夫惟不兼见。故盛于外者。非由于素养之得宜。只因营卫
之气。满于中焦。致火不生土而太阴病。故手足烦者。脾属四肢也。经曰。烦劳则
张。精绝。辟积于夏。使人煎厥。故逢收藏之时而稍瘥。不似春夏之散见也。经曰。
强力举重则伤肾。又曰。肾者精之处也。其充在骨。夫既真阳不能守。而阴精有
不外遗者乎。酸削不能行。亦所必至也。
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。
桂枝龙骨牡蛎汤方
桂枝（一两） 芍药（一两） 甘草（二两炙） 生姜（一两）
大枣（十二枚） 龙骨（三两） 牡蛎（三两）
上七味。以水七升。煮取三升。分温三服。
〔补注〕经曰。肾主水。受五脏六腑之精而藏之。又曰。厥气接于阴器。则梦接内。盖
阴器。宗筋之所系也。而脾胃肝胆之筋亦皆聚焉。故厥阴主筋。则诸筋统于肝
也。肾为阴。主藏精。肝为阳。主疏泄。故肾之阴虚。则精不藏。肝之阳强。则气不固。
若遇阴邪客之。与所强之阳相感。则或梦或不梦。而精脱矣。是肾虚则无有不
虚者也。膀胱与肾为表里。故少腹弦急为阴结。而气不化者可知。水不生木。则
血不养筋。致宗筋惫而阴头寒。以致虚风生则目眩。血不会则发脱。种种虚状。
悉本诸此。而其脉则为虚为芤为迟。可想而知也。夫阳虚则水谷不化。阴虚则
亡血失精。故芤为阴虚。复阴阳相搏而为动。微则阳微。又微紧相搏而为邪。皆
脉经所云至虚者也。然则男子失精。女子梦交。何能已哉。此病之原。皆起于肾
之不固。遂令三焦皆底于极虚矣。斯于法必以固精为主治也。于是以桂枝和
荣卫。芍药收阴。生姜散寒。甘草、胶、枣益脾补气。更用龙骨以涩其阳。牡蛎以涩
其阴。庶肾肝既固。荣卫调和。而诸证自愈尔。
男子脉浮弱而涩。为无子。精气清冷。（此条一本在夫失精家之前）
〔补注〕浮、为阳脉也。举之有。按之无也。乃于举之时未见其力。则浮兼弱矣。浮弱。
阳气之虚也。若涩。阴脉也。为阴血不足。脉经曰。荣为根。卫为叶。荣卫俱微。则枝
叶枯槁。是生气微矣。又何能必其有子乎。正以精气之清冷也。其在诗曰。洌彼
下泉。浸彼苞稂。谓伤其生也。
男子平人。脉虚弱细微者。善盗汗也。
〔补注〕虚弱细微。绝不见阳。阳虚甚矣。经云。阴气有余。身寒多汗。然所谓有余者。
非诚余也。即阳之不足言之也。故肺主气。又合皮毛。司腠理。惟阳气衰。则卫不
固而自汗出。邪在于内。则元府不闭。而汗从腑脏出。邪在于外。则腠理不致。而
汗从经络出。脏腑之阴捍格。卫气浮散于外。无所根据从。则汗出卫虚。水谷气散
脱者汗自出。此皆不因动作而自出之汗也。至盗汗则阳衰因卫虚。而所虚之
卫行于阴。当目瞑之时。无气以庇之。故腠开而汗。若一觉则行阳之气。复散于
表而汗止矣。故曰盗汗也。夫至盗汗。而其虚可胜道哉。
人年五六十。其病脉大者。痹挟背行。苦肠鸣。马刀侠瘿者。皆为劳得之。
〔补注〕人生五十始衰。六十天癸竭。则已精少肾衰矣。使复有动作。遂令阳虚而
邪得以客之。痹太阳经道。盖太阳行于背者也。经谓阳气者。精以养神。柔以养
筋。开阖不得。寒气从之。乃生大偻。故病痹挟背行也。又云。中气不足。肠为之苦
鸣。至陷脉为 。留连肉腠。为马刀侠瘿。瘿者。即瘰 也。以其形长如蛤。为马刀。
或在耳前后。连及颐颔头下。或下连缺盆。以及胸胁。皆谓之马刀。此手足少阳
经主之也。总以动作忿怒。忧忿气郁过甚。而为风邪内腠。故其脉则大而举按
不实。其因则劳而元气不足。仲景言之。恐后人复疑为有余而误攻其邪耳。
脉沉小迟。名脱气。其人疾行则喘喝。手足逆寒。腹满。甚则溏泄。食不消化也。
〔补注〕人之所以运动无苦。四体温和。食入自化者。皆吾身之真阳为之也。故阳
固则流行于脉中者。各安其部。而无阳衰阴见之象。今沉。少阴脉也。以其所处
之位至下也。若寸关皆见。则各腑脏之阳何在乎。况其兼者。曰小曰迟。脉经云。
小者气血俱少。又云迟为荣中寒。彼此俱阴。绝不见阳。则其气已大泄矣。故名
脱也。夫尺虚之人。行走 然。象其步履之不正也。而况于气脱者乎。故行稍疾
上喘喝。虽曰呼出心肺。吸入肾肝。自非宗气行其呼吸。则升降出入。且无以安
于自然矣。况勉强以动其气乎。是故人之阳。盛于中焦者也。脾之阳不固。则四
肢上逆而冷矣。且脾之阳。又原于下焦者也。肾之真阳大虚。则不足以消腐水
谷。为腹满。为溏泄。正未有已也。
脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。寒虚相搏。此名为革。妇人则
半产漏下。男子则亡血失精。
〔补注〕伤寒论中有此条。方中行先生注。寒言阳气减损而不足。芤言阴血衰竭
而空虚。革言革易常度也。妇人阴血充足而能化。则得坤顺之常。半产漏下。则
不足以言坤之资生矣。男子阳精充盛而能化。则得干健之常。亡血失精。则不
足以言干之资始矣。故天地之大德曰生。男不足以言资始。女不足以言资生。
则人道大坏。故曰革也。一说革读亟。变而促迫也。亦通。
愚按、礼曰。夫子之病革矣。不可以变。即音亟也。
虚劳里急。悸衄。腹中痛。梦失精。四肢 疼。手足烦热。咽干口燥。小建中汤主之。
小建中汤方
芍药（六两） 桂枝（三两去皮） 甘草（三两炙） 生姜（三两）
大枣（十二枚） 胶饴（一升）
上六味。以水七升。煮取三升。去滓。内胶饴。更上微火消解。温服一升。日三服。呕
家不可用建中汤。以甜故也。
〔补注〕经云。形气不足。病气不足。此阴阳俱不足也。不可刺之。刺之为重虚。盖气
不足者。如中气不健。频欲更衣。心下悸。或阳明内热而血外溢。或腹中痛。或梦
接内而遗。种种悉气之不足为之也。形不足者。即如四肢不但不强健而 疼。
甚至手足烦热。津液少而干燥。种种皆形之不足为之也。经谓不可刺。以重虚
者。宜补之以甘药。此其意惟仲景遵之。培中央以灌输腑脏百脉。主以小建中。正稼穑作甘之意也。
然观此证。则肾虚为多。水亏当壮水之主。以镇阳光。火衰则益火之源。以消阴翳。独仲景不屑
于此。而惟以树立中气为第一义者何居。圣人曰。精、谷气也。可见肾为藏精之处。伎巧出焉。苟非有五谷
之养。五味之调。则亦从何而生。然经又曰。精不足者。补之以味。假使胃不能纳。脾不能运。又
如之何。故圣人以建中主治。使中州之土。已坏复起。将饮食入胃者。游溢精气。上输于脾。
脾气散精。上归于肺。如经所云者。则五脏百脉自裕矣。岂但已病乎
哉。
虚劳里急诸不足。黄 建中汤主之。
黄 建中汤方
黄 （三两） 桂枝（三两） 芍药（六两） 甘草（三两）
生姜（三两） 胶饴（一升） 大枣（十一枚）
上七味。用水七升。煮取三升。去滓。温服一升。日三服。
〔补注〕不足之证不一。未有不因于气虚者。夫阳生阴长。气苟不充。则日就于损
(One general discussion, nine pulse-syndrome articles, and nine prescriptions)
Question: How is Blood Bi (Blood Obstruction Syndrome) contracted? The Master said: Those who live in comfort and luxury have weak bones but abundant flesh. If they become exhausted from heavy labor and sweat, and while sleeping their body moves restlessly, adding to the invasion of slight wind, they will contract this disease. If the pulse is merely slightly choppy and tight at the Cunkou (radial artery at the wrist) and Guan positions, it is appropriate to use acupuncture to guide Yang Qi outward. If the pulse becomes harmonious and the tightness disappears, the disease will be cured.
[Supplementary Note]: Yang Qi governs Yin Blood. When Yin Blood is governed, blood flows with Qi. Since the classic mentions "Blood Bi" but not "Qi," why is this? It is unknown that Blood Bi occurs due to injury to Qi. The classic states: "When pathogenic factors enter the vessels, blood coagulates and fails to flow." The reason for failure to flow is that Qi is obstructed by pathogens. However, pathogens capable of causing injury must do so because exertion causes Wei Qi (Defensive Qi) to fail to secure the exterior, allowing pathogens to enter. Thus, Zhang Zhongjing clarifies the cause of blood stasis to explain the origin of the disease. He states that only those living in comfort and luxury are physically comfortable but mentally distressed. Physical comfort leads to abundant flesh; mental distress leads to weak bones. Weak bones cannot withstand fatigue; abundant flesh means Qi is not secured. With slight exertion, sweating occurs easily. Sweat is the fluid of blood. When Wei Qi is not secured, sweat occurs; when sweat occurs, Yang Qi becomes deficient. Even slight wind can then invade, causing Blood Bi. Therefore, seeing a slight pulse indicates insufficient Yang; seeing a choppy pulse indicates much obstruction in Yin Blood. This is the fundamental pulse of Blood Bi. At the site where pathogens enter, a slight tightness manifests. "Slight" indicates the restraint of healthy Qi; "tight" indicates the entry of Cold pathogens. However, Zhongjing explicitly says "slight wind," yet why does one obtain a Cold pulse? Generally, pathogens follow the blood vessels up and down, obstructing fluids, which inevitably causes pain; thus, pain manifests as a tight pulse. Acupuncture can drain pathogens and guide Yang outward; once pathogens leave, healthy Qi naturally extends. Otherwise, it will ultimately result in Bi syndrome. Therefore, securing external Yang is of great importance. If wealthy individuals knew that Yang Qi was never strong, they would dare not overexert themselves. Even if forced to exert, or knowing to moderate so as not to sweat, and if sweating occurred, avoiding restless movement during sleep, how could deficiency-wind cause Blood Bi? Zhongjing discusses Consumption (Xu Lao) starting with Blood Bi, which has its reasons.
In Blood Bi, both Yin and Yang pulses are slight. The Cunkou and Guan pulses are slight, while the Chi pulse is slightly tight. Externally, the symptom is numbness of the body, resembling Wind Bi. Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary treatment.
Huangqi Guizhi Wuwu Tang Prescription
Huangqi (Astragali Radix) (3 liang), Guizhi (Cinnamomi Ramulus) (3 liang, bark removed), Shaoyao (Paeoniae Radix Alba) (3 liang), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Dazao (Jujubae Fructus) (12 pieces).
The above five ingredients are boiled in 6 sheng of water to obtain 2 sheng. Strain and take 7 he of the decoction warm, three times daily.
[Supplementary Note]: This article refers to a case where Blood Bi, described in the previous article, failed to heal via acupuncture guiding Yang, resulting in a slight Cunkou pulse. Now, both Yin and Yang pulses are slight, and the Cunkou and Guan pulses are both slight, with the Chi pulse being slightly tight. Since slight tightness appears at the Chi position, the pathogen has entered deeper and is harder to expel. Why? Where healthy Qi is deficient, there is a place for pathogens to reside. The Pulse Classic calls internal/external Yin/Yang, and upper/lower also Yin/Yang. Now that the Chi pulse is slightly tight, it is clear that the slightness belongs to deficiency internally and externally. If we summarize the symptoms as "numbness," the body is my body, and limbs are my limbs, yet sometimes painful, sometimes numb, often resisting me. This is profound numbness. Hence, it is likened to Wind Bi, though it is not true Wind Bi. The classic states that Wind, Cold, and Dampness combine to form Bi. Why mention only Wind Bi? Pathogens may invade jointly, and the recipient has biases. If Wind predominates, pain migrates frequently, flooding the four extremities. Blood nourishes sinews; if blood does not circulate, sinew joints become blocked. Blood resides in the Liver, and Liver is the child of Kidney. If Kidney is affected, blood stagnates. Thus, Huangqi secures Wei Qi, Shaoyao nourishes Ying Blood, Guizhi harmonizes Ying and Wei, strengthens interior and exterior, and drives pathogens out. Assisted by Shengjiang to diffuse Stomach Qi and Dazao to benefit Spleen Qi, is this not the most appropriate method?
In men who are normally healthy, a large pulse indicates Consumptive Disease (Lao); an extremely deficient pulse also indicates Consumptive Disease.
[Supplementary Note]: Consumptive Disease is a deficiency condition, thus necessarily presenting with deficiency pulses. The classic says: "Excessive labor causes Yang to expand, leading to essence exhaustion." This is because labor causes Yang Qi to expand outward, appearing excessive upon lifting. However, this "excess" is neither internal abundance nor external pathogenic aid, hence called "large pulse indicates Lao." Regarding the double deficiency pulse mentioned later, it refers to deficiency in both upper and lower. It also says: "A deficient pulse does not resemble Yin [pulses]; it lacks the fullness of the Hand-Taiyin Lung channel." Thus, an extremely deficient pulse is also called Lao. While a large pulse relates to physical labor or hunger/fullness, an extremely deficient pulse implies sexual excess.
In men with a pale complexion, thirst and blood loss are indicated. Sudden panting and palpitations with a floating pulse indicate interior deficiency.
[Supplementary Note]: This presents Zhongjing's inspection method. The classic states: "The Heart is the root of life and the change of Spirit; its brilliance shows on the face, and its substance fills the blood vessels." The Hand-Shaoyin Heart channel is the Sovereign Official, from which Spirit emerges. However, worry and overthinking damage it. Spirit damage leads to physical weakness; physical weakness leads to insufficiency in generation, failing to nourish the complexion. The Heart generates blood, and complexion is the banner of Spirit. With insufficient Yin blood, fluids dry up, causing thirst. Thirst leads to drinking water for self-rescue, but if thirst persists despite drinking, excessive water stops in the epigastrium, blocking the respiratory passage causing panting, and losing the control of Minister Fire causing palpitations. In such cases, the pulse must be floating. Is this not because the generated blood is insufficient to propel the pulse outward? The Heart combines with the pulse. Thus, Heart Qi deficiency in the interior is known.
In men with a deficient, deep, and wiry pulse, without chills or fever, shortness of breath, abdominal urgency, difficult urination, pale complexion, frequent dizziness/blinking eyes, occasional epistaxis, and hypogastric fullness, this is caused by Consumptive Disease.
[Supplementary Note]: The human body relies on Yang Qi as the master; only labor damages Yuan Qi. Here, pulse and symptoms are discussed first to show male Yang deficiency. Deficiency is the fundamental pulse of Lao. Within the pulse that feels empty upon lifting and pressing, images of Shaoyin and Jueyin appear, indicating severe internal damage to Yang Qi. Yang deficiency causes aversion to cold; internal injury often causes fever. The Pulse Classic says: "If the Cunkou pulse is slight, it is named Yang insufficiency; Yin Qi enters Yang, causing shivering aversion to cold." If the Chi pulse is weak, it is named Yin insufficiency; Yang Qi sinks into Yin, causing fever. Now, all three positions are equal, ruling out rising/sinking patterns, so absence of chills/fever is known. Danzhong is the Sea of Qi. Essence from grain transforms into Wei Qi and Zong Qi (Gathering Qi). Zong Qi travels in the chest to govern respiration. Exhalation is governed by Heart/Lung (Yang); inhalation by Kidney/Liver (Yin). With a hollow pulse showing only Yin without Yang, the Zong Qi in the middle cannot support it. Exhalation lacks strength, inhalation is shallow, leading to weak ascending/descending and shortness of breath. Middle Jiao Qi deficiency prevents digestion of food and rising of clear Qi. Kidney Yang is unprosperous, Liver Qi descends excessively, causing frequent defecation with urgency. Bladder is the Officer of Storage; without Qi transformation, water pathways fail. As stated, all meridians ascend to the face, but Lung is the master of Qi. If Qi is deficient, Lung is deficient. Although the face is the meeting of Yang meridians, the complexion is pale like metal. Yin excess causes eye blinking; now Yang declines, causing eye blinking. Epistaxis occurs because Yang collaterals are injured, causing blood to overflow. Hypogastric fullness results from difficult urination. This is due to labor damaging Yuan Qi. Although Zhongjing does not state the treatment here, one should naturally regulate with sweet medicines, cultivating Central Earth to benefit Yuan Yang. Without Huangqi Jianzhong Tang, what else could serve as the method?
In Consumptive Disease, the pulse is large and floating, hands and feet are vexed-hot, symptoms worsen in Spring/Summer and improve in Autumn/Winter. There is spontaneous emission of semen due to Yin-cold, and soreness/weakness in the legs preventing walking.
[Supplementary Note]: A large pulse has two meanings: large indicates excess, or large indicates a hollow (Kou) pulse, which indicates deficiency. Here attributed to Lao, the damage is to Yuan Qi without blood to harmonize. Although damage is in Qi, does it harm Blood? The classic says: "Yang generates, then Yin grows." Without Yang, Yin cannot generate; without Yin, Yang cannot transform. Upon lifting and pressing, the pulse feels large but lacks force in its movement. Why no other pulses accompany it? Because it does not accompany others, the excess outwardly is not due to proper cultivation, but rather Ying and Wei Qi filling the Middle Jiao, causing Fire to fail to generate Earth, leading to Taiyin disease. Thus, vexed-hot hands/feet occur because Spleen governs the four limbs. The classic says: "Labor causes Yang to expand, essence exhausts; accumulating into summer causes 'Jian Jue' (Frying Convulsion)." Thus, symptoms ease in storage seasons (Autumn/Winter) unlike the dispersion in Spring/Summer. The classic says: "Forceful lifting weights injures the Kidney." Also: "Kidney is the residence of essence, filling the bones." If True Yang cannot hold, how can Yin essence not leak? Leg soreness and inability to walk are inevitable.
For those habitually losing essence, there is cord-like tension in the hypogastrium, coldness at the glans penis, dizziness, hair loss, and a pulse that is extremely deficient, hollow, and slow, accompanied by undigested food in stool. For blood loss and essence loss, a pulse exhibiting various hollow, moving, slight, or tight qualities in men indicates seminal emission, and in women, nocturnal emissions with sexual dreams. Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction) is the primary treatment.
Guizhi Longgu Muli Tang Prescription
Guizhi (Cinnamomi Ramulus) (1 liang), Shaoyao (Paeoniae Radix Alba) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (2 liang, honey-fried), Shengjiang (Zingiberis Rhizoma Recens) (1 liang), Dazao (Jujubae Fructus) (12 pieces), Longgu (Fossilia Ossis Mastodi) (3 liang), Muli (Concha Ostreae) (3 liang).
The above seven ingredients are boiled in 7 sheng of water to obtain 3 sheng. Divide into three warm doses.
[Supplementary Note]: The classic states: "Kidney governs Water and receives/stores essence from all Zang-Fu organs." Also: "Jue Qi contacting the genitalia causes dreams of intercourse." The genitalia are connected to the General Sinew, where sinews of Spleen, Stomach, Liver, and Gallbladder gather. Jueyin governs sinews, so all sinews are controlled by Liver. Kidney is Yin, governing storage of essence; Liver is Yang, governing coursing and discharge. Kidney Yin deficiency leads to insecure essence; Liver Yang hyperactivity leads to insecure Qi. If Yin pathogens invade and interact with the hyperactive Yang, dreams or non-dreams occur, leading to essence depletion. Kidney deficiency implies universal deficiency. Bladder and Kidney are interior-exterior pairs; thus, hypogastric tension indicates Yin binding, and lack of Qi transformation is evident. Water failing to generate Wood means blood fails to nourish sinews, causing General Sinew fatigue and cold glans. Deficiency-wind generates dizziness; blood failing to gather causes hair loss. All these deficiency signs originate here. The pulse is deficient, hollow, and slow. Yang deficiency leads to indigestion; Yin deficiency leads to blood/essence loss. Hollow indicates Yin deficiency; interaction of Yin-Yang creates moving pulse; slight indicates Yang deficiency; slight-tight interaction creates pathogenic signs. These are extreme deficiencies per the Pulse Classic. How can seminal emission in men and dream-intercourse in women cease? The root lies in Kidney insecurity, leading to extreme deficiency in Sanjiao. Treatment must focus on securing essence. Guizhi harmonizes Ying-Wei; Shaoyao collects Yin; Shengjiang disperses Cold; Gancao, Jiaoyi, Dazao benefit Spleen and boost Qi. Longgu astrings Yang; Muli astrings Yin. Thus, Kidney-Liver are secured, Ying-Wei harmonized, and symptoms resolve.
In men, a floating, weak, and choppy pulse indicates infertility due to clear and cold Jing-Qi. (This article appears before "Those habitually losing essence" in some editions.)
[Supplementary Note]: Floating is a Yang pulse, present on lifting, absent on pressing. If force is lacking upon lifting, floating combines with weakness. Floating-weak indicates Yang Qi deficiency. Choppy is a Yin pulse, indicating insufficient Yin blood. The Pulse Classic says: "Ying is the root, Wei is the leaf." If Ying and Wei are both slight, branches and leaves wither, and vital Qi is weak. How can one guarantee offspring? Precisely because Jing-Qi is clear and cold. As the Shi Jing says: "Cold is the lower spring, soaking the barnyard grass." This denotes damage to vitality.
In men who are normally healthy, a weak, deficient, fine, and minute pulse indicates susceptibility to night sweats.
[Supplementary Note]: Weak, deficient, fine, and minute pulses show absolutely no Yang, indicating severe Yang deficiency. The classic says: "Excess Yin causes cold body and profuse sweating." However, this "excess" is not true excess, but rather insufficient Yang. Lung governs Qi and combines with skin/hair, controlling interstices. Only when Yang declines does Wei Qi fail to secure, causing spontaneous sweating. If pathogens are internal, Yuan pores do not close, and sweat exits from Zang-Fu; if external, interstices are not dense, and sweat exits from meridians. Internal Yin obstruction causes Wei Qi to float outward without basis, leading to sweat and Wei deficiency, scattering Grain Qi, causing spontaneous sweat. These are sweats not caused by movement. Night sweats occur because Yang decline leads to Wei deficiency; the deficient Wei travels into Yin. During sleep, there is no Qi to protect, so interstices open and sweat occurs. Upon waking, Yang Qi returns to the exterior, and sweat stops. Hence, "night sweat." Once night sweats occur, the deficiency is severe.
In people aged fifty or sixty, if the disease presents with a large pulse, Bi syndrome runs along the back, suffering from borborygmus, and having "horse knife" (scrofula) and "collar goiter" (cervical lymphadenopathy), all are caused by Consumptive Disease.
[Supplementary Note]: Humans begin declining at fifty; Tian Gui exhausts at sixty, meaning essence is scarce and Kidney declines. Further exertion causes Yang deficiency, allowing pathogens to invade. Bi blocks the Taiyang meridian, which runs along the back. The classic states: "Yang Qi nourishes Spirit with clarity and sinews with flexibility." If opening/closing fails, Cold enters, causing severe curvature. Thus, Bi runs along the back. Also: "Middle Qi deficiency causes borborygmus." If sinking into meridians, lingering in flesh, it forms horse knife and collar goiter. Goiter refers to scrofula. Elongated like a clam, it is called horse knife. Located around ears/jaw or connecting to clavicle/chest/ribs, all are horse knife, governed by Hand/Foot-Shaoyang meridians. Ultimately, excessive exertion, anger, or depression allows Wind pathogens to enter interstices. The pulse is large but empty on pressure. The cause is labor and insufficient Yuan Qi. Zhongjing mentions this to prevent later generations from mistaking it for excess and attacking pathogens incorrectly.
A deep, small, and slow pulse is named Tuō Qì (Qi Escape). The person pants heavily when walking quickly, has cold hands and feet, abdominal fullness, and in severe cases, loose stools and undigested food.
[Supplementary Note]: Human movement without pain, warmth of limbs, and digestion rely on True Yang. If Yang is secure, Qi flows safely in vessels without signs of Yang decline. Deep is Shaoyin pulse, located lowest. If seen at Cunkou/Guan, where are the Yang Qi of organs? Moreover, accompanying small and slow pulses indicate both Qi and Blood are scant, and Cold in Ying. Both are Yin, showing no Yang, meaning Qi is greatly leaked. Hence, "Qi Escape." Those with Chi deficiency walk unsteadily; how much more so for Qi escape? Thus, quick walking causes panting. Although exhalation is Heart/Lung and inhalation Kidney/Liver, without Zong Qi governing respiration, ascending/descending cannot be natural. How much less can one force Qi movement? Yang is abundant in Middle Jiao. If Spleen Yang is insecure, limbs turn cold. Spleen Yang originates from Lower Jiao. If Kidney True Yang is severely deficient, it cannot digest food, causing abdominal fullness and loose stools.
A wiry and large pulse: Wiry indicates reduction; Large indicates hollow. Reduction indicates Cold; Hollow indicates Deficiency. Cold and Deficiency interacting is named Ge (Leather) pulse. In women, it indicates miscarriage and dripping bleeding; in men, blood loss and seminal emission.
[Supplementary Note]: In Shanghan Lun, Fang Zhongxing notes: Cold refers to reduced/insufficient Yang Qi; Hollow refers to exhausted/empty Yin Blood; Leather refers to changing normal degrees. Women with sufficient Yin Blood transform according to Kun (Earth) harmony. Miscarriage/dripping bleeding fails to represent Kun's generative power. Men with abundant Yang Essence transform according to Qian (Heaven) vigor. Blood loss/seminal emission fails to represent Qian's initiating power. Heaven and Earth's great virtue is Life. If men cannot initiate and women cannot generate, human way is ruined. Hence, "Leather." Alternatively, Leather is read as Ji (urgent), meaning abrupt change, which is also valid. I note: Liji states: "Master's illness was critical (Ge), unable to change." Pronounced Ji.
In Consumptive Disease with abdominal urgency, palpitations, epistaxis, abdominal pain, dream emission, limb soreness/pain, vexed-hot hands/feet, dry throat/mouth, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment.
Xiaojianzhong Tang Prescription
Shaoyao (Paeoniae Radix Alba) (6 liang), Guizhi (Cinnamomi Ramulus) (3 liang, bark removed), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (3 liang, honey-fried), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Dazao (Jujubae Fructus) (12 pieces), Jiaoyi (Mell) (1 sheng).
The above six ingredients are boiled in 7 sheng of water to obtain 3 sheng. Strain, add Jiaoyi, and melt over low heat. Take 1 sheng warm, three times daily. Vomiting patients should not use Jianzhong Tang due to sweetness.
[Supplementary Note]: The classic states: "Form and Qi are insufficient, disease Qi is insufficient; this is dual deficiency of Yin and Yang. Do not needle; needling causes double deficiency." Qi insufficiency manifests as weak Middle Qi, frequent urge to defecate, palpitations, Yangming internal heat causing blood overflow, abdominal pain, or dream emission—all due to Qi insufficiency. Form insufficiency manifests as limbs not just weak but sore/painful, even vexed-hot hands/feet, scant fluids causing dryness—all due to Form insufficiency. The classic forbids needling for double deficiency, recommending tonification with sweet medicine. Zhongjing follows this, cultivating the Center to irrigate Zang-Fu and hundred vessels, primarily using Xiaojianzhong Tang, embodying the principle of "Earth produces Sweet."
However, observing these symptoms, Kidney deficiency is predominant. If Water is deficient, strengthen the Master of Water to calm Yang Fire; if Fire is deficient, benefit the Source of Fire to dispel Yin Shadows. Why does Zhongjing disdain this and prioritize establishing Middle Qi? The Sage says: "Essence is Grain Qi." Kidney stores essence and produces skill. Without grain nourishment and flavor modulation, how is essence generated? The classic also says: "For essence deficiency, tonify with flavor." If Stomach cannot accept and Spleen cannot transport, what then? Thus, the Sage uses Jianzhong as main treatment to restore Central Earth. Food entering Stomck yields essence, transported to Spleen, dispersed to Lung. As stated, Zang-Fu and hundred vessels become abundant. Does this not address existing disease?
For Consumptive Disease with abdominal urgency and various deficiencies, Huangqi Jianzhong Tang (Astragalus Minor Construct the Middle Decoction) is the primary treatment.
Huangqi Jianzhong Tang Prescription
Huangqi (Astragali Radix) (3 liang), Guizhi (Cinnamomi Ramulus) (3 liang), Shaoyao (Paeoniae Radix Alba) (6 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (3 liang), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Jiaoyi (Mell) (1 sheng), Dazao (Jujubae Fructus) (11 pieces).
The above seven ingredients are boiled in 7 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm, three times daily.
[Supplementary Note]: Deficiency syndromes vary, none occurring without Qi deficiency. Yang generates, Yin grows; if Qi is not filled, it diminishes daily.