论一首 脉证九条（当作十条。） 方九首（当作十首）
按医门法律曰。虚劳之证。金匮叙于血痹之下。可见劳则必劳其精血也。魏氏以为血痹当编次于中风之后。后
人误叙。与虚劳同篇。喻氏强牵入虚劳中。可谓刻舟求剑。二说未知何是。程氏稍与喻同意。
问曰。血痹病。从何得之。（圣惠方。盛重。作充盛。千金。 。作涩。在上。更有涩字。徐曰小字上。该有
微尺中三字。此说难从。）
按历节血痹。金鉴所辨不允。历节有风血相搏。即疼痛如掣文。则可知亦伤及血。血痹有针引阳气文。则可知
阳气亦闭矣。又徐沈程周。并肌肤盛为句。重字接下读。魏鉴重字连上句。当考。稻叶元熙曰。重因。赵本作重困。
似是。贾谊新书。民临事而重困。则难为上矣。仓公传。为重困于俞。忿发为疽。此皆言累困也。
血痹阴阳俱微。
按伤寒论所谓脉之阴阳。皆以部位而言。然此条则自有寸口关上尺中文。故金鉴以浮沉解之。亦犹六难阴盛阳
虚阳盛阴虚之意。伤寒论多称脉阴阳。（桂枝汤条。不揭脉字。）而此无脉字。故沈氏以阴阳营卫俱微释之。盖此条
阴阳。义可两通。故辑义并二说而存之。徐曰。阴阳。寸口人迎也。尤曰。阴阳俱微。该人迎趺阳太溪为言。
并误。又圣济。尺中上。补或字。三因方曰。脉当阴阳俱微。尺中少紧。身体如风痹状。
黄 桂枝五物汤方
〔朱〕如桂枝汤。本为太阳中风和营卫之要药。兹特去甘草之和缓。而君以黄 之峻补者。统率桂芍姜枣。由
中达外。俾无形之卫气。迅疾来复。有形之营血。渐次鼓荡。则痹可开。而风亦无容留之处矣。
按此说稍是。然黄 取之托阳逐邪。不取峻补矣。
夫男子平人。脉大为劳。
医学纲目曰。胗脉浮而大。或大而弦。皆为虚劳者。盖阳盛阴虚之症也。暮多见之。
男子面色薄者。（重。赵。作里。诸本同。宜从。鉴曰。脉浮者。里虚也。当是衍文。误矣。）
按沈曰。色乃神之旗。营卫之标。若面色薄者。是白而娇嫩无神。乃气虚不统营血于面也。此说与魏氏异趣。
男子脉虚沉弦。
〔周〕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。
按无寒热。又见短气。吐血。瘀血。及妊娠中。俱言无外邪。金鉴恐凿。瞑。眩。通用。后条云。目眩。然则
目瞑。即目眩也。男子字。又出消渴。及黄胆中。宜参。
医学纲目曰。诊脉虚微细弦。为虚劳者。盖阴阳俱虚之症也。晨多见之。
劳之为病。其脉浮大。
〔鉴〕手足烦。即今之虚劳五心烦热。阴虚不能藏阳也。阴寒精自出。即今之虚劳遗精。阴虚不能固守也。酸
削不能行。即今之虚劳膝酸削瘦。骨痿不能起于床也。
按兰室秘藏。举此条曰。以黄 建中汤治之。此亦温之之意也。
夫失精家。少腹弦急。
按据巢源。脉极虚芤迟以下。当为一截看。
脉得诸芤动微紧。
先兄曰。芤与微反。动与紧反。盖芤动与微紧。自是二脉。则上文脉大为劳。极虚亦为劳之意。故下一诸字也。
按魏氏以为此上有假热。而下有真寒者。其说颇辨。然熟绎经文。似不必上热者。
天雄散方
按此方白术殊多。故徐氏以为中焦阳虚之治。（沈氏同）然天雄实为补下之品。则其说恐未核。要之配合之理。
殆为难晰已。又朱氏曰。然使真阴亏损。亡血失精。二方皆非其任矣。须用八味肾气丸法。斯言殆然。
男子平人。脉虚弱细微者。
〔周〕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。
〔魏〕男子平人失精亡血之虚劳。年少而体方柔脆。故易至夭折。年五六十感邪成痹之虚劳。年老而体已坚硬。
故可以终其天年。是虚劳而成痹。终是经络病。虚劳而成失精亡血。则为脏腑病矣。经络病可以引年。脏腑病难于
延岁也。此仲景引虚劳之类。以明虚劳也。
按沈氏曰。虚阳上浮则脉大。营卫不充于躯壳相循背之经隧。曰痹侠背行。朱氏曰。大为虚阳外鼓之大。而非
真气内实之大也。三阳皆虚。痹而不用。并与尤魏异义。
又按马刀。陶隐居曰。李云。生江汉中。长六七寸。禹锡等谨按蜀本图经云。生江湖中。细长小蚌也。长三四
寸。阔五六分。侠缨。太素。作侠婴。杨上善注曰。颈前曰婴也。外台引。婴。作缨。考段氏注说文。缨。冠系也。
。颈饰也。婴。绕也。益知作缨者为是。而侠缨者。侠冠系之谓。即颔骨下际。至人迎两旁也。（结缨必于颐下。
段氏可考。）
脉弦而大。弦则为减。大则为芤。（按此条。亦见于吐衄中。）
按玉编。芤。苦候切。（集韵。此有病脉二字。）徐氏脉诀云。按之即无。举之来至。旁实中央空者。名曰芤。
（徐氏不知何人。隋志。有徐氏脉经。崇文书目。有徐裔指诀。）此本于脉经。未为当。宜参先君子撰脉学辑要。（戴
起宗脉诀刊误曰。芤。草名。其叶类葱中空。又本草纲目。以为葱一名。俱未审何据。）成氏曰。革者。言其既寒
且虚。则气血改革。不循常度。又方氏。尤氏。并有说。俱未妥。
虚劳里急。悸衄。
按此条。即虚劳之正证。实属斫丧太过。虚火上亢者。筋失所养。故里急。血脉衰乏。故悸。（悸。即动筑。
验之病者。知其非心动。）
血随火上。故衄。寒盛于下。故腹中痛。下元不固。而心神不宁。故失精。血道涩滞。故四肢酸疼。（犹桂枝
加芍药生姜人参新加汤证。身疼痛之理。）虚阳外泛。故手足烦热。上焦液枯。故咽干口燥。皆是莫不自阴虚所致。
阴虚故不与阳相谐。是以用小建中汤。和调阴阳。盖桂枝汤。营卫均和。而此方则倍芍药。专滋其阴。以配于阳。
为虚劳正对之治矣。
又徐氏。沈氏。及汪缵功所论。颇为精凿。文繁不录。宜阅。（汪说。出吴医汇讲。）
小建中汤方
肘后。凡男女因积劳虚损。或大病后不复常。若四体沉滞。骨肉疼酸。吸吸少气。行动喘 。或小腹拘急。腰
背强痛。心中虚悸。咽干唇燥。面体少色。或饮食无味。阴阳废弱。悲忧惨戚。多卧少起。久者积年。轻者才百日。
渐至瘦削。五脏气竭。则难可复振。治之汤方。（即本方）
劳虚腰痛。少腹拘急。
按此证阴虚颇重。而无上炎之势。故纯补下元。而无取于建中和谐之法矣。
又按寇宗 朱震亨王履李时珍并论此方之理。王李俱驳寇氏。然寇说似长。今具列于左。以备参考。盖茯苓泽
泻。或引接桂附。以达下焦。如消渴所用。是也。或藉力桂附。以通水淤。如转胞所用。是也。今如此条。则引接
通利。俱兼取之矣。五苓散之桂。或以发表。或以散寒。药与病对。其方则一。而其用有异者。是仲景方法之妙致
也。
寇氏本草衍义曰。泽泻。其功尤长于行水。张仲景八味丸用之者。亦不过引接桂附等。归就肾经。别无他意。
朱氏本草衍义补遗曰。仲景八味丸。附子为少阴之向导。其补自是地黄。后世因以附子为补。误矣。附子走而
不守。取健悍走下之性。以行地黄之滞可致远。亦若乌头天雄。皆气壮形博。可为下部药之佐。
李氏本草纲目曰。仲景地黄丸。用茯苓泽泻者。乃取其泻膀胱之邪气。非引接也。古人用补药。必兼泻邪。邪
去则补药得力。一辟一阖。此乃玄妙。后世不知此理。专一于补。所以久服必至偏胜之害也。（按此说。本于王氏
HT洄集。王说文繁不录。）
按先兄绍翁曰。牡丹皮之性。较诸桃人虻蛭。则不唯其力之缓。若单与之。难以溃坚破瘀。盖其为功。唯是行
血通经。仍以配于桃仁大黄。可增除涤之力。合于当归地黄阿胶等。能引滋液和血之品。而荣养阴分。故参之补泻
之药。未有所碍。复足以赞其不逮矣。此说能阐前古之秘。
薯蓣圆方
〔尤〕其用薯蓣最多者。以其不寒不热。不燥不滑。兼擅补虚去风之长。故以为君。谓必得正气理。而后风气
可去耳。
按本草。薯蓣。味甘温。主伤中。补虚羸。除寒热邪气。补中益气力。长肌肉。（白字）豆黄卷。别不着其功。
然大豆则味甘平。逐水胀。除胃中热痹。伤中淋露。（黑字）麴。味甘大暖。疗脏腑中风气。调中下气。（新补）白
蔹。味苦平。散结气。（白字）幼幼新书。养生必用。治风劳气冷百疾。薯蓣丸。并治风眩背拘倦。胸满短气。羸
瘦饮食少。小儿泄利。多汗发热方。
即本方。（内不用枣。）浓煎枣汤。空心嚼一丸。日午再服。有热人。即丸如桐子大。空心日午。米饮下二十丸。
止于三十丸。
酸枣汤方
按此方释意。医通为优。（辑义所引。肝虚者三字。剩。）本草黑字。酸枣下云。烦心不得眠。补中益肝气。又
茯苓之功。本草经。称主惊邪恐悸。孙真人曰。治心烦闷。及心虚惊悸。安定精神。盖以其质重。亦能镇缒。此方
所取。正在于此。圣惠。治虚劳烦热。不得眠卧。黄芩散。
于本方。去芎 。加黄芩。羚羊角屑。
五劳虚极。羸瘦腹满。
按此条证。即后世所谓劳瘵也。据程注。五劳虚极一句。是一章题目。羸瘦腹满。不能饮食。是其证候。食伤。
忧伤。饮伤。房室伤。饥伤劳伤。是其所因。盖有一于此诸因。皆足以致经络营卫气伤。而血脉凝积。以致内有干
血。遂为五劳虚极。更有肌肤甲错。两目黯黑二证。俱为干血之征。盖其脉数蒸热。亦可概知也。
又按五劳。言五脏劳。盖忧伤。劳伤。以劳心肝。食伤。饮伤。饥伤。以劳脾。房室伤。以劳肾。而诸劳之极。
又必劳肺。且此条所言。不是五劳兼备者。盖言有一所伤。而劳一脏。以致经络营卫气伤。遂为此病。（辑义引巢
源。思劳下。刊脱心劳二字。）尔雅。 。 。注。谓木皮甲错。（辑义引山海经。文有讹脱。曰。 羊。其脂可以
已腊。注。治体皴。腊。音昔。）又十四难。损其肝者。缓其中。滑氏曰。缓者。和也。（百劳丸。原出医垒元戎。
曰。许州陈大夫传。张仲景百劳丸。）缓中补虚。程注甚当。张说非是。
程氏曰。妇人虚劳。大半内有干血。男子亦间有之。审其可攻而攻之。则厥疾可愈。魏氏曰。此在妇人女子。
寡妇女尼。因不月渐成虚劳者。尤所宜投也。
大黄 虫丸方（大黄十分。宜作二两十二铢。黄芩一两。诸本。作二两。）
按本草经。蛴螬。味咸微温。主恶血血瘀痹气。破折血在胁下坚满痛。月闭。图经云。张仲景治杂病方。大
虫丸（按黄字脱。）中用蛴螬。以其主胁下坚满也。又 虫条。图经云。张仲景治杂病方。主久瘕积结。有大黄
虫丸。
又大鳖甲丸中。并治妇人药。并用 虫。以其有破坚积下血之功也。
医学纲目曰。结在内者。手足脉必相失。宜此方。然必兼大补剂琼玉膏之类服之。
幼幼新书。婴孺。治小儿身体面目悉黄。此是荣卫气伏热于内所为。蛴螬丸方。
于本方。去大黄。桃仁。干漆。加大枣。（按此证。犹用本方为佳。）
附方
千金翼。炙甘草汤。（宜参肺痿附方。）
按此方。仲景滋阴之正方。而千金翼文。出于仲景。必有其征。故宋人取附于此也。医学入门。称一切滋补之
剂。皆自此方而变化之者。其言为当。盖此方。炙甘为君。生姜。大枣。为臣。地黄。麻仁。阿胶。麦门为佐。专
以滋阴润燥为务。然惧其粘腻凉湿。不利中土。故人参桂枝为使。更用清酒。并以扶护元阳。旁宣达诸药之力。与
肾气丸之桂附。救肾中之阳。其趣似异而实同。如后世滋阴诸方。徒裒合群队凉润之品。诚非知制方之旨者矣。徐
氏曰。后人只喜用胶麦等。而畏姜桂。岂知阴凝燥气。非阳不能化耶。此言得之。又按地黄。此方。及大黄 虫丸。
肾气丸等。比之他药。分两殊多。盖以体重之故。不必君药之谓。宜参药治通义。方剂分量下。
小儿卫生总微论。国老丸。治瘦瘠虚羸。 少气。右以甘草。炙焦黄。杵末。炼蜜和丸绿豆大。每服五丸。
温水下。日三服。一岁儿五丸。以上者七八丸。以意加减。无时。
肘后。獭肝散。〔朱〕獭为阴邪之兽。而肝独应月增减。是得太阴之正气。其性独温。故宜于冷劳。又主鬼疰
一门相染者。以阴入阴。以邪逐邪。同气相求之义也。
按本草。图经云。张仲景有治冷劳獭肝丸方。又主鬼疰一门相染者。取肝一具。火炙之。水服方寸匕。日再。
崔氏治九十种虫疰。（云云）獭肝丸。二方俱妙。又圣惠方。载冷劳证。文繁不录。
又按本草诸条。图经云。肚。主骨蒸热劳。血脉不行。补羸助气。四季宜食。张仲景有猪肚黄连丸。是也。猪
肚黄连丸。未详其方。当考。
〔余述〕魏氏曰。失精于下者。可成虚劳矣。脱气则成虚劳于上者焉。秦越人之论虚损。其言阳虚而阴盛。损
则自上而下。一损损于肺。二损损于心。三损损于胃。即仲景所谓脱气之虚劳也。其言阴虚而阳盛。损则自下而上。
One Treatise, Nine Pulse and Syndrome Articles (Should be ten articles). Nine Formulas (Should be ten formulas).
According to *Yi Men Fa Lü* (Legal Principles of Medicine): The syndromes of Xu Lao (Deficiency Consumption) are narrated in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) after Xue Bi (Blood Bi). This shows that fatigue inevitably damages Jing Blood (Essence and Blood). Wei believed that Xue Bi should be arranged after Zhong Feng (Wind Stroke), but later authors mistakenly placed it in the same chapter as Xu Lao. Yu forcibly linked it into Xu Lao, which can be described as carving a mark on the boat to find the sword (acting rigidly without regard to changing circumstances). It is unknown which of these two theories is correct. Cheng's view is slightly consistent with Yu's.
Question: From where does Xue Bi disease arise? (*Sheng Hui Fang* reads "Sheng Zhong" as "Chong Sheng". *Qian Jin Fang* places "Se" above, with another "Se" character. Xu says there should be three characters "Wei Chi Zhong" above the small text; this theory is difficult to accept.)
Note: The differentiation between Li Jie (Joint Pain) and Xue Bi by *Yi Zong Jin Jian* (Golden Mirror of Medicine) is not satisfactory. Li Jie involves wind and blood fighting each other, resulting in pain like pulling or twitching, indicating that blood is also injured. Xue Bi contains the text "needle draws out Yang Qi," indicating that Yang Qi is also blocked. Furthermore, Xu, Shen, Cheng, and Zhou punctuate "Ji Fu Sheng" (Skin and flesh are full/plump), reading "Zhong" (Heavy/Severe) with the following sentence; *Yi Zong Jin Jian* reads "Zhong" with the preceding sentence, which requires verification. Inaba Motohiro states: "Zhong" means "due to." Zhao's edition reads "Zhong Kun" (Heavily troubled), which seems plausible. Jia Yi's *Xin Shu* states: "The people face difficulties and are heavily troubled," so interpreting "Nan" (Difficult) as "Shang" (Above) is likely incorrect. *Cang Gong Zhuan* states: "Heavily troubled at the acupoints, anger erupted into carbuncles," all referring to exhaustion and trouble.
In Xue Bi, both Yin and Yang pulses are minute.
Note: The "Yin and Yang" of pulses mentioned in *Shang Han Lun* (Treatise on Cold Damage) refers to locations. However, this article explicitly mentions Cun Kou (Radial artery proximal part), Guan (Middle position), and Chi (Distal part). Therefore, *Yi Zong Jin Jian* interprets it via Floating and Sinking, similar to the meaning in *Nan Jing* (Classic of Difficult Issues) Chapter 6 regarding Yin excess/Yang deficiency and Yang excess/Yin deficiency. *Shang Han Lun* often refers to "Pulse Yin Yang" (The Gui Zhi Tang article does not explicitly state "Pulse"). Since this article lacks the word "Pulse," Shen interprets it as Yin-Yang, Ying-Wei (Nutritive and Defensive Qi) all being minute. The meaning of "Yin-Yang" in this article allows for both interpretations, so *Ji Yi* preserves both theories. Xu states: Yin-Yang refers to Cun Kou and Ren Ying (Carotid artery). You states: Yin-Yang being minute includes Ren Ying, Fu Yang, and Tai Xi pulses; this is mistaken. Additionally, *Sheng Ji Zong Lu* adds "Huo" (Or) before "Chi Zhong". *San Yin Fang* states: The pulse should be Yin-Yang minute, Chi slightly tight, and the body feels like Wind-Bi.
Huang Qi Gui Zhi Wu Wu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) Formula
[Zhu] This formula is like Gui Zhi Tang (Cinnamon Twig Decoction), which is the essential medicine for treating Tai Yang Wind Strike and harmonizing Ying and Wei. Here, the harmonizing and moderating property of Gan Cao (Licorice Root) is specifically removed, and Huang Qi (Astragalus Root), a potent tonic, is made the sovereign herb. It leads Gui Zhi (Cinnamon Twig), Bai Shao (White Peony Root), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) from the interior to the exterior, enabling the formless Wei Qi (Defensive Qi) to recover swiftly and the formed Ying Blood (Nutritive Blood) to gradually surge. Thus, the Bi obstruction can open, and there is no place for Wind to remain.
Note: This explanation is somewhat correct. However, Huang Qi is used here to support Yang and expel pathogens, not for its potent tonifying effect.
In a healthy man, a large pulse indicates Lao (Fatigue/Consumption).
*Yi Xue Gang Mu* (Outline of Medical Science) states: A pulse that is floating and large, or large and string-taut, all indicate Xu Lao (Deficiency Consumption). This is likely a syndrome of Yang excess and Yin deficiency. It is commonly seen in the evening.
In men, a pale complexion...
[Note: "Zhong" (Heavy), Zhao edition and others read "Li" (Interior), which should be followed. *Jin Jian* states: "Floating pulse indicates interior deficiency," considering the previous text an interpolation, which is wrong.]
Note: Shen states: Complexion is the flag of Shen (Spirit) and the marker of Ying and Wei. If the complexion is pale/thin, it appears white, delicate, and spiritless, indicating Qi deficiency failing to control Ying Blood in the face. This view differs from Wei's.
In men, a pulse that is empty, deep, and string-taut...
[Zhou] This results from Lao Shang (Fatigue Injury) damaging Yuan Qi (Original Qi). Therefore, even if Zhang Zhongjing does not explicitly state the treatment method, one should naturally regulate with Sweet Medicines to cultivate the Middle Earth (Spleen/Stomach) and benefit Yuan Yang. This goes without saying. If one abandons Huang Qi Jian Zhong Tang, what else could serve as the method?
Note: The absence of Chao Re (Alternating chills and fever) is also mentioned in articles on Shortness of Breath, Hematemesis, Blood Stasis, and Pregnancy, all stating the absence of external pathogens. *Jin Jian* fears this is too forced. "Ming" (Closing eyes/dizziness) and "Xuan" (Dizziness) are used interchangeably; the later article says "Mu Xuan" (Eye dizziness), so "Mu Ming" is "Mu Xuan." The term "Nan Zi" (Man) also appears in the Xiao Ke (Wasting-Thirst) and Huang Dan (Jaundice) chapters; reference is needed.
*Yi Xue Gang Mu* states: A pulse that is empty, minute, fine, and string-taut indicates Xu Lao. This is likely a syndrome of both Yin and Yang deficiency. It is commonly seen in the morning.
The disease of Lao (Fatigue), its pulse is floating and large.
[Jian] "Shou Zu Fan" (Vexation and heat in hands and feet) is the modern "Five Centers Heat" of Xu Lao, caused by Yin deficiency failing to store Yang. "Yin Han Jing Zi Chu" (Spontaneous emission of essence due to cold) is modern nocturnal emission in Xu Lao, caused by Yin deficiency failing to consolidate. "Suan Xiao Bu Neng Xing" (Soreness, emaciation, inability to walk) is modern knee soreness and emaciation in Xu Lao, bone萎 (Wei - flaccidity) unable to rise from bed.
Note: *Lan Shi Mi Cang* cites this article stating: Treat with Huang Qi Jian Zhong Tang. This is also an intention of warming.
For those who constantly lose essence, the lower abdomen is tense and urgent...
Note: According to *Bing Yuan* (Source of Diseases), from "Mai Ji Xu Kou Chi" (Pulse extremely empty, knotted, slow) onwards, should be read as one section.
Obtaining various Kou (Knotted/Hollow), Dong (Fluttering), Wei (Minute), and Jin (Tight) pulses...
My elder brother said: Kou and Wei are opposite; Dong and Jin are opposite. Thus, Kou-Dong and Wei-Jin are naturally two types of pulses. Hence, the previous text "Large pulse indicates Lao" and "Extremely empty also indicates Lao," using the character "Zhu" (Various) below.
Note: Wei believes there is false heat above and true cold below; his analysis is quite distinct. However, carefully studying the classic text, it seems unnecessary to interpret it as having heat above.
Tian Xiong San (Heavenly雄 Powder) Formula
Note: This formula contains a large amount of Bai Zhu (Atractylodes Rhizome), so Xu considers it a treatment for Middle Jiao Yang deficiency (Shen agrees). However, Tian Xiong (Aconite Lateral Root) is actually a tonic for the Lower Jiao, so his theory is likely inaccurate. In summary, the logic of combination is probably difficult to clarify. Zhu states: If there is True Yin depletion, loss of blood, and loss of essence, neither of these two formulas is suitable. One must use the method of Ba Wei Shen Qi Wan (Eight-Ingredient Kidney Qi Pill); this statement is likely correct.
In a healthy man, a pulse that is weak, empty, fine, and minute...
[Zhou] When Dao Han (Night sweats) occurs, it is because Yang deficiency due to Wei deficiency causes the deficient Wei Qi to enter the Yin. During sleep (when eyes close), there is no Qi to protect, so pores open and sweat ensues. Upon waking, the Qi moving to Yang disperses to the exterior again, and sweating stops. Hence, it is called night sweats. Once night sweats occur, how can the extent of deficiency be overstated?
At age fifty or sixty, if the disease pulse is large...
[Wei] Xu Lao of men with normal health but losing essence and blood: Young people have soft and fragile bodies, so they easily die young. Xu Lao of men aged fifty or sixty who contracted pathogens causing Bi: Old people have hard and tough bodies, so they can live out their natural lifespan. Xu Lao becoming Bi ultimately affects the Meridians; Xu Lao becoming loss of essence and blood affects the Zang-Fu organs. Meridian diseases can prolong life; Zang-Fu diseases make extending years difficult. This is Zhang Zhongjing citing Xu Lao categories to explain Xu Lao.
Note: Shen states: Floating of Deficient Yang causes a large pulse. Ying and Wei do not fill the meridians circulating along the back of the body shell, called "Bi Xia Bei Xing" (Bi along the back). Zhu states: Large refers to the expansion of Deficient Yang pushing outward, not the fullness of True Qi internally. All three Yang meridians are deficient, leading to Bi and dysfunction, differing from You and Wei's views.
Furthermore, Ma Dao (Scrofula): Tao Hongjing states: Li Yun says it grows in the Jiang-Han region, six to seven cun long. Yuxi et al. cautiously note: Shu Ben Tu Jing says it grows in rivers and lakes, a slender small clam, three to four cun long, five to six fen wide,挟 (clamping) the Ying (cord/tassel). *Tai Su* reads "Xia Ying" (Clamping the neck/front of throat). Yang Shangshan notes: The front of the neck is called Ying. *Wai Tai* cites "Ying" as "Ying" (Cord). Examining Duan Yu's commentary on *Shuo Wen*: "Ying" is the cord of a cap; neck ornament. "Ying" means to surround. Thus, "Ying" is correct, and "Xia Ying" means clamping the cap cord, i.e., below the jawbone to both sides of the Ren Ying acupoint. (Tying the cap cord must be below the chin; Duan's work can verify this.)
The pulse is String-taut and Large; String-taut implies reduction; Large implies Kou (Hollow). (Note: This article also appears in the Hematemesis/Epistaxis chapter.)
Note: *Yu Bian* states: Kou, pronounced Ku Hou Qie. (*Ji Yun*: There are two characters "Bing Mai" [Disease Pulse] here.) Xu's *Mai Jue* states: Pressing makes it vanish; lifting brings it up; solid on sides, empty in center is named Kou. (Xu's identity is unknown; *Sui Zhi* has Xu's *Mai Jing*; *Chong Shu* has Xu Yi's *Zhi Jue*.) This originates from *Mai Jing*, which may not be entirely appropriate; refer to my father's *Mai Xue Ji Yao*. (Dai Qizong's *Mai Jue Kan Wu* states: Kou is a plant name, leaves like scallion, hollow inside. *Ben Cao Gang Mu* also says Scallion is named Kou; neither basis is verified.) Cheng Wuji states: Ge (Leather) pulse means it is both cold and deficient, so Qi and Blood reform and do not follow normal patterns. Fang Youzhi and You Zaijing also have explanations, none of which are fully satisfactory.
Xu Lao with Li Ji (Internal tension/urgency), Ji (Palpitations), Nu (Epistaxis)...
Note: This article represents the standard syndrome of Xu Lao, actually resulting from excessive consumption and hyperactive Deficient Fire. Tendons lack nourishment, hence internal tension. Blood vessels are depleted, hence palpitations. (Palpitation here refers to throbbing/pulsation, verified by patients, knowing it is not heart movement.)
Blood follows fire upward, hence epistaxis. Cold is abundant below, hence abdominal pain. Lower Yuan is unconsolidated, Spirit is unsettled, hence loss of essence. Blood pathways are obstructed, hence soreness and pain in limbs. (Similar to the mechanism of body pain in Gui Zhi Jia Shao Yao Sheng Jiang Ren Shen Xin Jia Tang). Deficient Yang floats outward, hence vexation and heat in hands and feet. Upper Jiao fluids are dry, hence dry throat and mouth. All stem from Yin deficiency. Yin deficiency fails to harmonize with Yang, hence Xiao Jian Zhong Tang is used to harmonize Yin and Yang. Gui Zhi Tang harmonizes Ying and Wei equally, but this formula doubles Shao Yao to specifically nourish Yin to match Yang, serving as the direct treatment for Xu Lao.
Additionally, the discussions by Xu, Shen, and Wang Zuangong are quite precise and accurate; the text is too long to record, please consult. (Wang's theory is from *Wu Yi Hui Jiang*.)
Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) Formula
*Zhou Hou Bei Ji Fang*: For men and women suffering from accumulated fatigue and deficiency damage, or failure to return to normal after severe illness, if limbs are heavy and stagnant, bones and muscles ache, breathing is short, movement causes panting, lower abdomen is constrained and urgent, waist and back are stiff and painful, heart feels empty and palpitates, throat is dry and lips parched, face and body lack color, taste is lost, Yin and Yang are wasted and weak, sadness and grief prevail, sleeping much but rising little, lasting years or merely a hundred days, gradually becoming emaciated, Five Zang Qi exhausted, then difficult to revive. Treatment decoction formula. (This is the present formula.)
Lao Xu (Fatigue Deficiency) lower back pain, lower abdomen constraint and urgency.
Note: This syndrome involves significant Yin deficiency without upward flaming, so it purely tonifies the Lower Yuan, without using the method of constructing the Middle and harmonizing.
Furthermore, Kou Zongshi, Zhu Zhenheng, Wang Lv, and Li Shizhen all discuss the principle of this formula. Wang and Li refute Kou, yet Kou's argument seems stronger. Listed below for reference. Generally, Fu Ling (Poria) and Ze Xie (Alisma) either guide Gui (Cinnamon) and Fu Zi (Aconite) to reach the Lower Jiao, as used in Xiao Ke (Wasting-Thirst), which is correct. Or they borrow the power of Gui and Fu Zi to clear water stasis, as used in Zhuan Pao (Bladder Retention), which is correct. In this case, guiding, connecting, and promoting urination are all utilized. The Gui in Wu Ling San is either for releasing the exterior or dispelling cold; the drug matches the disease, the formula is the same, but the usage differs. This is the subtlety of Zhang Zhongjing's methods.
Kou's *Ben Cao Yan Yi* states: Ze Xie excels in promoting urination. Zhang Zhongjing uses it in Ba Wei Wan (Eight-Ingredient Pill) merely to guide Gui and Fu Zi to the Kidney meridian, with no other intent.
Zhu's *Ben Cao Yan Yi Bu Yi* states: In Zhang Zhongjing's Ba Wei Wan, Fu Zi is the guide for the Shaoyin meridian; the tonification comes from Di Huang (Rehmannia Root). Later generations mistook Fu Zi for a tonic. Fu Zi moves but does not stay; utilizing its vigorous and descending nature to move the stagnation of Di Huang allows it to reach distant areas. Similarly, Wu Tou (Aconite Mother Root) and Tian Xiong are strong in Qi and form, serving as assistants for lower-body medicines.
Li's *Ben Cao Gang Mu* states: Zhang Zhongjing uses Fu Ling and Ze Xie in Di Huang Wan to drain pathogenic Qi from the Bladder, not for guidance. Ancients using tonics always combined them with draining herbs; once pathogens are gone, tonics work effectively. Opening and closing, this is the profound mystery. Later generations did not understand this, focusing solely on tonification, leading to imbalance from long-term use. (Note: This theory originates from Wang's *Hui Xi Yi Ji*; Wang's text is too verbose to record.)
Note: My elder brother Shaoweng stated: Compared to Tao Ren (Peach Kernel), Meng Chong (Leech), and Ting Li (Ground Beetle), Mu Dan Pi (Moutan Bark) is not only milder in strength; alone, it cannot break hardness and stasis. Its function is merely to move blood and unblock meridians. Combined with Tao Ren and Da Huang (Rhubarb), it enhances cleansing power; combined with Dang Gui (Angelica Root), Di Huang, and E Jiao (Donkey-hide Gelatin), it guides nourishing and blood-harmonizing herbs to nourish the Yin aspect. Thus, when combined with tonifying and draining drugs, it causes no harm and supplements deficiencies. This theory elucidates ancient secrets.
Shu Yao Yuan (Dioscorea Pill) Formula
[You] It uses the most Shu Yao (Dioscorea Rhizome) because it is neither cold nor hot, neither drying nor slippery, excelling in tonifying deficiency and expelling wind. Thus, it serves as the sovereign herb. One must ensure Zheng Qi (Upright Qi) is regulated before Wind Qi can be expelled.
Note: *Ben Cao* states: Shu Yao, sweet and warm. Treats injury to the middle, tonifies deficiency and emaciation, eliminates cold-heat pathogens, benefits the middle, boosts Qi and strength, and fleshes out muscles. (White text) Dou Huang Juan (Fermented Soybean) does not specify its efficacy. But Da Dou (Soybean) is sweet and neutral, drives out water distension, eliminates stomach heat-bi, treats middle injury and dripping discharge. (Black text) Qu (Medicated Leaven) is sweet and very warm, treats Wind Qi in Zang-Fu, regulates middle and descends Qi. (New supplement) Bai Lian (Bletilla Rhizome) is bitter and neutral, dissipates knotting Qi. (White text) *You You Xin Shu*, *Yang Sheng Bi Yong*: Treats Wind-Lao, Qi-Cold, and hundred diseases; Shu Yao Yuan also treats Wind-Xuan, back stiffness and fatigue, chest fullness and shortness of breath, emaciation and poor appetite, pediatric diarrhea, excessive sweating and fever formula.
This is the present formula. (Do not use Jujube inside.) Decoct Jujube soup strongly, chew one pill on an empty stomach, take again at noon. For those with heat, make pills sized like Sophora seeds, take on an empty stomach at noon with rice drink, twenty pills, up to thirty pills.
Suan Zao Ren Tang (Sour Jujube Seed Decoction) Formula
Note: The interpretation in *Yi Tong* is superior. (The three characters "Gan Xu Zhe" [Liver Deficiency Ones] cited in *Ji Yi* are superfluous.) *Ben Cao* black text under Suan Zao states: Vexation and insomnia, tonifies middle and benefits Liver Qi. Regarding Fu Ling's efficacy, *Ben Cao Jing* states it treats fright, evil, fear, and palpitations. Sun Simiao states: Treats heart vexation and stuffiness, and heart-deficiency fright and palpitations, calming the spirit. Likely due to its heavy quality, it can also anchor and descend. The purpose of this formula lies precisely here. *Sheng Hui Fang*: Treats Xu Lao vexation and heat, inability to sleep, Huang Qin San (Scutellaria Powder).
To this formula, remove Chuan Xiong (Sichuan Lovage Rhizome), add Huang Qin (Scutellaria Root) and Ling Yang Jiao (Antelope Horn).
Wu Lao Xu Ji (Five Fatigues Extremely Deficient), Emaciation and Abdominal Fullness.
Note: This syndrome is what later generations call Lao Zhai (Tuberculosis/Consumption). According to Cheng's annotation, "Wu Lao Xu Ji" is the title of the chapter; "Emaciation, abdominal fullness, inability to eat" are the symptoms. "Food injury, Emotional injury, Drink injury, Sexual injury, Hunger injury, Labor injury" are the causes. Having any of these injuries is sufficient to damage the meridians, Ying, Wei, and Qi, causing blood stasis, leading to internal Dry Blood, thus becoming Wu Lao Xu Ji. Additionally, skin resembling scales (Jia Cuo) and dark eyes are signs of Dry Blood. The rapid steaming fever pulse can also be inferred.
Furthermore, Wu Lao refers to the labor of the Five Zang. Emotional and Labor injuries fatigue Heart and Liver; Food, Drink, and Hunger injuries fatigue Spleen; Sexual injury fatigues Kidney. Extreme fatigue of all injuries must also fatigue Lung. Moreover, this article does not describe all five fatigues simultaneously, but rather one injury affecting one Zang, damaging meridians, Ying, Wei, and Qi, leading to this disease. (*Ji Yi* cites *Bing Yuan*, omitting "Xin Lao" [Heart Fatigue] under Si Lao). *E Ya* annotation: Refers to bark scaling. (*Ji Yi* cites *Shan Hai Jing*, text has errors/omissions: Says "Sheep, its fat can cure La"; Annotation: Treats skin roughness. La, pronunciation Xi.) Also *Nan Jing* Chapter 14: Damage the Liver, soften the middle. Shi Bo Ren states: Softening means harmonizing. (Bai Lao Wan, originally from *Yi Lei Yuan Rong*, says: Transmitted by Dr. Chen of Xuzhou, Zhang Zhongjing's Bai Lao Wan.) Softening the middle and tonifying deficiency, Cheng's annotation is very appropriate; Zhang's theory is incorrect.
Cheng states: Women with Xu Lao mostly have internal Dry Blood; men occasionally have it too. Assess if attackable and attack it, then the chronic disease can be cured. Wei states: This is especially suitable for women, widows, and nuns who develop Xu Lao gradually due to amenorrhea.
Da Huang Che Zhong Wan (Rhubarb and Ground Beetle Pill) Formula (Da Huang ten parts, should be two liang twelve zhu; Huang Qin one liang, all editions say two liang.)
Note: *Ben Cao Jing* states: Qi Qiao (Woodlworm), salty and slightly warm. Treats bad blood, blood stasis, and Bi Qi; breaks broken blood in the hypochondrium causing hardness, fullness, and pain; amenorrhea. *Tu Jing* states: Zhang Zhongjing's miscellaneous disease formula, Da Chong Wan (Missing "Huang") uses Qi Qiao because it treats hypochondriac hardness and fullness. Also, under the Che Zhong article, *Tu Jing* states: Zhang Zhongjing's miscellaneous disease formula, treating long-standing masses and accumulations, has Da Huang Che Zhong Wan.
Also in Da Bie Jia Wan, used for women's diseases, Che Zhong is used because of its ability to break hardness, accumulate, and promote menstruation/blood discharge.
*Yi Xue Gang Mu* states: If accumulation is internal, hand and foot pulses must be discordant; this formula is suitable. However, it must be taken with major tonics like Qiong Yu Gao.
*You You Xin Shu*: Infants, treat pediatric jaundice of body and face, caused by Ying and Wei Qi hiding heat internally. Qi Qiao Wan Formula.
To this formula, remove Da Huang, Tao Ren, Gan Qi (Dry Lacquer), add Da Zao (Jujube). (Note: For this syndrome, using the original formula is still better.)
Attached Formulas
*Qian Jin Yi Fang*: Zhi Gan Cao Tang (Honey-Fried Licorice Decoction). (Refer to Fei Wei [Lung Withering] attached formula.)
Note: This formula is Zhang Zhongjing's orthodox formula for nourishing Yin. The text in *Qian Jin Yi Fang* derives from Zhang Zhongjing and must have its basis, so Song dynasty authors attached it here. *Yi Xue Ru Men* states that all tonifying agents vary from this formula; this statement is appropriate. In this formula, Zhi Gan Cao is Sovereign, Sheng Jiang and Da Zao are Ministers, Di Huang, Ma Ren, E Jiao, and Mai Men Dong are Assistants, dedicated to nourishing Yin and moistening dryness. Fearing its cloying, cool, and damp nature harming the Middle Earth, Ren Shen and Gui Zhi are Envoys. Qing Jiu (Clear Wine) is added to protect Yuan Yang and disseminate the power of other drugs. This is similar to Gui and Fu Zi in Shen Qi Pill saving Kidney Yang; the intent seems different but is essentially the same. Later Yin-nourishing formulas merely combine cooling and moistening herbs, truly lacking understanding of formula principles. Xu states: Later generations only like using Jiao and Mai, fearing Jiang and Gui. How do they know that Yin coagulation and dryness cannot be transformed without Yang? This statement is correct. Furthermore, Di Huang in this formula, as well as in Da Huang Che Zhong Wan and Shen Qi Pill, has a significantly larger dosage compared to other drugs due to its weight, not necessarily because it is the Sovereign herb. Refer to *Yao Zhi Tong Yi* under Formula Dosages.
*Xiao Er Wei Sheng Zong Wei Lun*: Guo Lao Wan, treats emaciation, deficiency, weakness, and shortness of Qi. Take Gan Cao, honey-fry until yellow, pound into powder, mix with refined honey to make pills size of mung beans. Take five pills each time, down with warm water, three times a day. One-year-old infants take five pills; older children take seven or eight pills, adjust according to intention, anytime.
*Zhou Hou Bei Ji Fang*: Ta Gan San (Otter Liver Powder). [Zhu] Otter is a beast of Yin pathogen, and its liver uniquely increases and decreases with the moon, obtaining the righteous Qi of Tai Yin. Its nature is uniquely warm, thus suitable for Cold Lao. It also treats Gui Zhu (Ghost Tethering) infecting a whole family. Using Yin to enter Yin, using pathogen to expel pathogen, follows the principle of seeking same Qi.
Note: *Ben Cao*, *Tu Jing* states: Zhang Zhongjing had a formula for Cold Lao Otter Liver Pill. Also treats Ghost Tethering infecting a family. Take one liver, roast over fire, take one cubic inch with water, twice a day. Cui Shi treats ninety types of Chong Zhu. (Etc.) Both Otter Liver Pills are excellent. Also *Sheng Hui Fang* records Cold Lao syndrome; text too long to record.
Furthermore, *Ben Cao* various articles, *Tu Jing* states: Du (Stomach), treats Bone Steaming Heat Lao, blood vessel obstruction, tonifies weakness and assists Qi, suitable for food in all seasons. Zhang Zhongjing has Zhu Du Huang Lian Wan (Pork Stomach and Coptis Pill), which is it. Zhu Du Huang Lian Wan, the formula is unknown, requires verification.
[Additional Notes] Wei states: Loss of essence below can become Xu Lao. Loss of Qi becomes Xu Lao above. Qin Yue Ren's discussion on Xu Sun (Deficiency Damage): He states Yang deficiency and Yin excess, damage proceeds from top to bottom: First damage to Lung, second to Heart, third to Stomach, which is Zhang Zhongjing's so-called Luo Qi (Loss of Qi) Xu Lao. He states Yin deficiency and Yang excess, damage proceeds from bottom to top,