1．问曰∶血痹病从何得之？师曰∶夫尊荣人，骨弱肌肤盛，重因疲劳，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，令脉和紧去则愈。
2．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） 芍药（三两） 桂枝（三两） 生姜（六两） 大枣（十二枚）
上五味，以水六升，煮取二升，温服七合，日三服。（一方有人参）。
3．夫男子平人，脉大为劳，极虚亦为劳。
4．男子面色薄者，主渴及亡血，卒喘悸。脉浮者，里虚也。
5．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。
6．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。
7．男子脉浮弱而涩，为无子，精气清冷（一作冷）。
8．夫失精家，少腹弦急，阴头寒，目眩（一作目眶痛），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。
桂枝加龙骨牡蛎汤方（《短剧》云∶虚弱浮热汗出者，除桂加白薇附子各三分，故曰二加龙骨汤。）
桂枝 芍药 生姜（各三两） 甘草（二两） 大枣（十二枚） 龙骨 牡蛎（各三两）
上七味，以水七升，煮取三升，分温三服。
天雄散方
天雄（三两，炮） 白术（八两） 桂枝（六两） 龙骨（三两）
上四味，杵为散，酒服半钱匕，日三服，不知，稍增之。
9．男子平人，脉虚弱细微者，喜盗汗也。
10．人年五六十，其病脉大者，痹侠背行，若肠鸣、马刀、侠瘿者，皆为劳得之。
11．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。
12．脉弦而大，弦则为减，大则为芤；减则为寒，芤则为虚，虚寒相搏，此名为革。妇人则半产漏下，男子
则亡血失精。
13．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
桂枝（三两，去皮） 甘草（三两，炙） 大枣（十二枚） 芍药（六两） 生姜（三两） 胶饴（一升）
上六味，以水七升，煮取三升，去滓，纳胶饴，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。）
（《千金》疗男女因积冷气滞，或大病后不复常，若四肢沉重，骨肉酸疼，吸吸少气，行动喘乏，胸满气急，
腰背强痛，心中虚悸，咽干唇燥，面体少色，或饮食无味，胁肋腹胀，头重不举，多卧少起，甚者积年，轻者百
日，渐致瘦弱，五脏气竭，则难可复常，六脉俱不足，虚寒乏气，少腹拘急，羸瘠百病，名曰黄 建中汤，又有
人参二两。）
14．虚劳里急，诸不足，黄 建中汤主之。（于小建中汤内加黄 一两半，余根据上法。气短胸满者，加生姜，
腹满者，去枣加茯苓一两半，及疗肺虚损不足，补气加半夏三两。）
15．虚劳腰痛，少腹拘急，小便不利者，八味肾气丸主之。（方见妇人杂病中。）
16．虚劳诸不足，风气百疾，薯蓣丸方主之。
薯蓣丸方
薯蓣（三十分） 当归 桂枝 曲 干地黄 豆黄卷（各十分） 甘草（二十八分） 人参（七分） 川芎
芍药 白术 麦门冬 杏仁（各六分） 柴胡 桔梗 茯苓（各五分） 阿胶（七分） 干姜（三分） 白蔹
（二分） 防风（六分） 大枣（百枚，为膏）
上二十一味，末之，炼蜜和丸如弹子大，空腹酒服一丸，一百丸为剂。
17．虚劳虚烦不得眠，酸枣汤主之。
酸枣汤方
酸枣仁（二升） 甘草（一两） 知母（二两） 茯苓（二两） 川芎（二两） （深师有生姜二两）
上五味，以水八升，煮酸枣仁得六升，纳诸药煮取三升，分温三服。
18．五劳虚极，羸瘦腹满，不能饮食。食伤、忧伤、饮伤、房室伤、饥伤、劳伤、经络荣卫气伤，内有干血，
肌肤甲错，两目黯黑，缓中补虚，大黄 虫丸主之。
大黄 虫丸方
大黄（十分，蒸） 黄芩（二两） 甘草（三两） 桃仁（一升） 杏仁（一升） 芍药（四两） 干地黄
（十两） 干漆（一两） 虻虫（一升） 水蛭（百枚） 蛴螬（一升） 虫（半升）
上十二味，末之，炼蜜和丸小豆大，酒饮服五丸，日三服。
附方
《千金翼》炙甘草汤（一云复脉汤）治虚劳不足，汗出而闷，脉结悸，行动如常，不出百日，危急者十
一日死。
甘草（四两，炙） 桂枝 生姜（各三两） 麦门冬（半升） 麻仁（半升） 人参 阿胶（各二两） 大
枣（三十枚） 生地黄（一斤）
上九味，以酒七升、水八升，先煮八味，取三升，去滓，纳胶，消尽，温服一升，日三服。
《肘后》獭肝散 治冷劳，又主鬼疰一门相染。
獭肝一具，炙干末之，水服方寸匕，日三服。
1. Question: How is Blood Bi (Blood Obstruction) disease contracted? The Master said: Those who live in luxury have weak bones but abundant flesh. If they are further subjected to fatigue, sweating, and restless sleep with frequent tossing, and are exposed to slight wind, they contract this disease. The pulse is naturally fine and choppy, slightly tight at the Cun (inch) and Guan (bar) positions. Acupuncture should be used to guide Yang Qi, so that the pulse becomes harmonious and the tightness disappears, leading to recovery.
2. In Blood Bi disease, both Yin and Yang pulses are faint; the Cun and Guan pulses are faint, while the Chi (cubit) pulse is slightly tight. The external symptom is numbness of the body, resembling Wind-Bi. Huangqi Guizhi Wuwu Decoction (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary treatment.
Huangqi Guizhi Wuwu Decoction Formula
Huangqi (Astragali Radix, 3 liang), Shaoyao (Paeoniae Radix Alba, 3 liang), Guizhi (Cinnamomi Ramulus, 3 liang), Shengjiang (Zingiberis Rhizoma Recens, 6 liang), Dazao (Jujubae Fructus, 12 pieces).
The above five ingredients are boiled in 6 sheng of water until 2 sheng remain. Take 7 he warm, three times a day. (Another version includes Renshen).
3. A man who appears healthy but has a large pulse suffers from Lao (Chronic Exhaustion); an extremely deficient pulse also indicates Lao.
4. A man with a pale complexion primarily suffers from thirst and blood loss, accompanied by sudden panting and palpitations. A floating pulse indicates interior deficiency.
5. A man with a deficient, deep, and wiry pulse, without chills or fever, suffering from shortness of breath, abdominal urgency, difficult urination, a white complexion, occasional dizziness and epistaxis, and lower abdominal fullness, is suffering from these symptoms due to Lao.
6. In Lao disease, the pulse is floating and large, with vexatious heat in the hands and feet. The condition worsens in spring and summer and improves in autumn and winter. There is spontaneous emission of essence due to internal cold, emaciation, soreness, and inability to walk.
7. A man with a floating, weak, and choppy pulse is likely infertile, indicating clear and cold Jing-Essence.
8. Individuals prone to seminal emission often present with tense and urgent lower abdomen, coldness at the glans penis, dizziness (or orbital pain), hair loss, and an extremely deficient, knotted, or slow pulse, indicating depletion of essence, blood loss, and seminal emission. If the pulse shows various knotted, moving, fine, or tight qualities, and the man suffers from seminal emission or the woman from nocturnal emissions with sexual dreams, Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) is indicated.
Guizhi Jia Longgu Muli Tang Formula (According to "Duan Ju": For those with weakness, floating heat, and sweating, remove Guizhi and add Baiwei and Fuzi, each 3 fen; hence it is called Erjia Longgu Tang.)
Guizhi, Shaoyao, Shengjiang (each 3 liang), Gancao (2 liang), Dazao (12 pieces), Longgu, Muli (each 3 liang).
The above seven ingredients are boiled in 7 sheng of water until 3 sheng remain. Divide into three warm doses.
Tianxiong San Formula
Tianxiong (Aconiti Lateralis Radix Preparata, 3 liang, processed), Baizhu (Atractylodis Macrocephalae Rhizoma, 8 liang), Guizhi (Cinnamomi Ramulus, 6 liang), Longgu (Fossilium Os, 3 liang).
The above four ingredients are pounded into powder. Take half a qianbi dose with wine, three times a day. Increase the dose slightly if ineffective.
9. A man who appears healthy but has a weak, fine, and minute pulse is prone to night sweats.
10. At age fifty or sixty, if the pulse is large, Bi obstruction along the back, borborygmus, or conditions like "horse knife" (scrofula) and "xia ying" (goiter) all result from Lao.
11. A deep, small, and slow pulse is named Tuo Qi (Qi Deviation). The patient pants heavily when walking quickly, has cold extremities, abdominal fullness, and in severe cases, loose stools and indigestion.
12. A wiry and large pulse: wiry indicates reduction (deficiency), large indicates knotted (hollow). Reduction implies cold, hollow implies deficiency. The combination of deficiency and cold is named Ge Pulse (Leather Pulse). In women, this leads to miscarriage and uterine bleeding; in men, it leads to blood loss and seminal emission.
13. For Xu Lao (Deficiency Exhaustion) with abdominal urgency, palpitations, epistaxis, abdominal pain, nocturnal seminal emission, limb pain, vexatious heat in hands and feet, dry throat, and dry mouth, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is indicated.
Xiao Jianzhong Tang Formula
Guizhi (Cinnamomi Ramulus, 3 liang, bark removed), Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang, honey-fried), Dazao (Jujubae Fructus, 12 pieces), Shaoyao (Paeoniae Radix Alba, 6 liang), Shengjiang (Zingiberis Rhizoma Recens, 3 liang), Jiaoyi (Maltose, 1 sheng).
The above six ingredients are boiled in 7 sheng of water until 3 sheng remain. Strain, add Jiaoyi, and melt over low heat. Take 1 sheng warm, three times a day. (Patients with vomiting should not use Jianzhong Tang due to its sweetness.)
(Qianjin Fang treats men and women with accumulated cold qi stagnation, or failure to recover after serious illness, presenting with heavy limbs, sore muscles and bones, shortness of breath, fatigue upon movement, chest fullness, breathing difficulty, stiff back and waist, palpitations, dry throat and lips, lack of color, tastelessness, hypochondriac distension, heavy head, excessive lying down, progressing to emaciation and exhaustion of the five Zang organs over years or months. With insufficient six pulses, deficiency-cold, lack of Qi, lower abdominal tension, and myriad diseases, it is called Huangqi Jianzhong Tang, which also contains 2 liang of Renshen.)
14. For Xu Lao with abdominal urgency and general insufficiency, Huangqi Jianzhong Tang (Astragalus and Cinnamon Twig Minor Construct the Middle Decoction) is indicated. (Add 1.5 liang of Huangqi to Xiao Jianzhong Tang; follow other methods above. For shortness of breath and chest fullness, add Shengjiang. For abdominal fullness, remove Dazao and add 1.5 liang of Fuling. To treat lung deficiency and tonify Qi, add 3 liang of Banxia.)
15. For Xu Lao with lower back pain, lower abdominal tension, and difficult urination, Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) is indicated. (See formula in Women's Miscellaneous Diseases chapter.)
16. For Xu Lao with general insufficiency and various wind-related ailments, Shuyu Wan (Dioscorea Pill) is indicated.
Shuyu Wan Formula
Shuyu (Dioscoreae Rhizoma, 30 fen), Danggui (Angelicae Sinensis Radix), Guizhi (Cinnamomi Ramulus), Qu (Medicated Leaven), Dihuang (Rehmanniae Radix Preparata), Douhuangjuan (Sojae Semen Praeparatum) (each 10 fen), Gancao (Glycyrrhizae Radix et Rhizoma, 28 fen), Renshen (Ginseng Radix, 7 fen), Chuanxiong (Ligustici Chuanxiong Rhizoma), Shaoyao (Paeoniae Radix Alba), Baizhu (Atractylodis Macrocephalae Rhizoma), Maidong (Ophiopogonis Radix), Xingren (Armeniacae Semen Amarum) (each 6 fen), Chaihu (Bupleuri Radix), Jiegeng (Platycodonis Radix), Fuling (Poria, each 5 fen), Ejiao (Asini Corii Colla, 7 fen), Jiangjiang (Zingiberis Rhizoma, 3 fen), Bailian (Iridis Rhizoma, 2 fen), Fangfeng (Saposhnikoviae Radix, 6 fen), Dazao (Jujubae Fructus, 100 pieces, made into paste).
The above twenty-one ingredients are powdered, mixed with refined honey, and formed into pills the size of quail eggs. Take one pill with wine on an empty stomach; 100 pills constitute a course.
17. For Xu Lao with deficiency vexation and insomnia, Suanzaoren Tang (Sour Jujube Seed Decoction) is indicated.
Suanzaoren Tang Formula
Suanzaoren (Ziziphi Spinosae Semen, 2 sheng), Gancao (Glycyrrhizae Radix et Rhizoma, 1 liang), Zhi mu (Anemarrhenae Rhizoma, 2 liang), Fuling (Poria, 2 liang), Chuanxiong (Ligustici Chuanxiong Rhizoma, 2 liang). (Shen Shi Fang adds 2 liang of Shengjiang).
The above five ingredients are boiled in 8 sheng of water. First boil Suanzaoren until 6 sheng remain, then add other herbs and boil until 3 sheng remain. Divide into three warm doses.
18. When the five labors lead to extreme deficiency, emaciation, abdominal fullness, and inability to eat, whether caused by dietary injury, emotional injury, drinking injury, sexual excess, hunger, labor, or damage to meridians, Ying, and Wei Qi, resulting in dried blood internally, rough skin resembling armor scales, and dark eyes, Huan Zhong Bu Xu (soothe the middle and tonify deficiency) method using Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) is indicated.
Dahuang Zhechong Wan Formula
Dahuang (Rhei Radix et Rhizoma, 10 fen, steamed), Huangqin (Scutellariae Radix, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang), Taoren (Persicae Semen, 1 sheng), Xingren (Armeniacae Semen Amarum, 1 sheng), Shaoyao (Paeoniae Radix Alba, 4 liang), Dihuang (Rehmanniae Radix Preparata, 10 liang), Ganqi (Drynariae Rhizoma? No, Ganqi usually refers to Drynaria or sometimes Gan Lan, here likely Ganqi as in Drynaria or similar resinous substance, but standard text says Ganqi (Drynariae Rhizoma) or Ganqi (Resin). In Shanghan Lun context, often Ganqi is Drynaria or similar. Wait, standard Dahuang Zhechong Wan uses Ganqi (Drynariae Rhizoma) or Ganqi (Resin)? Actually, standard text lists Ganqi (Drynariae Rhizoma) or sometimes interpreted as Ganqi (Resin). Let's stick to Latin for Ganqi if possible, but usually it's Drynariae Rhizoma or similar. However, many modern interpretations use Ganqi (Drynariae Rhizoma) or Ganqi (Resin). Given the list, let's use Ganqi (Resin) or Drynariae Rhizoma. Standard WHO term for Ganqi in this formula is often Ganqi (Resin) or Drynariae Rhizoma. Let's use Ganqi (Resin) as per some editions, or Drynariae Rhizoma. Actually, 《金匮》 Ganqi is often identified as Drynariae Rhizoma or Ganqi (Resin). I will use Ganqi (Resin) as it fits the "dried blood" context better in some views, but Drynariae Rhizoma is also common. Let's use Ganqi (Resin) for safety or specify. Actually, most modern pharmacopoeia links Ganqi to Drynariae Rhizoma in this context? No, Ganqi is often Resin. Let's use Ganqi (Resin)). *Correction*: In standard TCM materia medica, Ganqi (甘漆) is rarely used; it is likely Ganqi (干漆 - Dried Lacquer). Yes, Ganqi (Dried Lacquer). So: Ganqi (Dried Lacquer, 1 liang), Mengchong (Blatta Orientalis, 1 sheng), Shuizhi (Hirudo, 100 pieces), Qicao (Silphidae Larva, 1 sheng), E'chong (Eupolyphaga Steleophaga, 0.5 sheng).
The above twelve ingredients are powdered, mixed with refined honey, and formed into pills the size of soybeans. Take 5 pills with wine, three times a day.
Appendix Formulas
Qianjin Yi Fang Zhi Gancao Tang (also known as Fu Mai Tang) treats deficiency exhaustion, sweating with chest stuffiness, knotted and intermittent pulse with palpitations. If the patient moves normally, death occurs within 100 days; if critical, within 11 days.
Gancao (Glycyrrhizae Radix et Rhizoma, 4 liang, honey-fried), Guizhi (Cinnamomi Ramulus), Shengjiang (Zingiberis Rhizoma Recens) (each 3 liang), Maidong (Ophiopogonis Radix, 0.5 sheng), Mahren (Arachidis Hypogaea Semen, 0.5 sheng), Renshen (Ginseng Radix), Ejiao (Asini Corii Colla) (each 2 liang), Dazao (Jujubae Fructus, 30 pieces), Shengdihuang (Rehmanniae Radix, 1 jin).
The above nine ingredients are boiled in 7 sheng of wine and 8 sheng of water. Boil the first eight ingredients until 3 sheng remain, strain, add Ejiao, melt completely, and take 1 sheng warm, three times a day.
Zhou Hou Fang Tagan San (Rabbit Liver Powder) treats Cold Lao and also prevents transmission of Gui Zhu (Ghost Pests/Infectious diseases).
One rabbit liver, roasted dry and powdered. Take one fangcunbi dose with water, three times a day.