肺虚损不足乎。补气加半夏。更为匪彝所思。今之医师。请各陈其所见。）
虚劳腰痛。（为肾气虚而不行。）小腹拘急。小便不利者。（为膀胱之气。虚而
不化。以）八味肾气丸主之。
此补言下焦之证治也。八味肾气丸为温肾化气之良方。若小便多者。大为禁剂。自
王太仆着元和经。极赞其功。然用者颇少。至薛立斋以之统治百病。赵养葵之医贯。奉
为神丹。李士材张景岳因之。以治
本一说。文其模糊两可之术。误人不少。又按、金匮于桂枝龙骨牡蛎汤后。突出天雄散
一方。与前后文不相连贯。论中并无一言及之。以致各注家疑为后人所附。而不知此方
绝大议论。方中白术为补脾圣药。最得土旺生金。水源不竭。纳谷者昌。精生于谷之
义。且又得桂枝化太阳之水腑。天雄温少阴之水脏。水哉水哉。其体本静。而川流不息
者。气之动。火之用也。更佐以龙骨者。盖以龙属阳。而宅于水。同气相求。可以敛纳
散漫之火而归根。以成阴阳平秘之道。金匮于虚劳证。穷到阴阳之总根。而归之于肾。
曰腰痛。曰小腹拘急。曰小便不利。略拈数证。以为一隅之举。恐八味肾气丸之力量不
及。又立此方。诚为炼石补天手段。其证治方旨。俱未发明者。即内经禁方之意。重其
道而不轻泄也欤。
八味肾气丸方 （见妇人杂病）
虚劳诸不足。风气百疾。薯蓣丸主之。
此方虚劳内外。皆见不足。不止上节所谓里急诸不足也。不足者补之。前有建中黄
建中等法。又合之桂枝加龙牡等法。似无剩义。然诸方补虚则有余。去风则不足。凡
人初患伤风。往往不以为意。久则邪气渐微。亦或自愈。第恐既愈之后。余邪未净。与
正气混为一家。或偶有发热。偶有盗汗。偶有咳嗽等证。妇人经产之后。尤易招风。凡
此皆为虚劳之根蒂。治者不可着意补虚。又不可着意去风。若补散兼用。亦驳杂而滋弊。
惟此丸探其气味化合所以然之妙。故取效如神。
薯蓣丸方
薯蓣（三十分） 人参（七分） 白术（六分） 茯苓（五分） 甘草（二十分）
当归（十分） 芍药（六分） 白蔹（二分） 芎 （六分） 麦冬（六分） 阿胶
（七分） 干姜（三分） 大枣（百枚为膏） 桔梗（五分） 杏仁（六分） 桂枝（
十分） 防风（六分） 神曲（十分） 柴胡（五分） 豆黄卷（十分） 干地黄（十
分）
上二十一味。末之。炼蜜为丸。如弹子大。空腹酒服一丸。一百丸为剂。
（又有一种心火炽盛。实由肝郁而成。木能生火。火盛则肝魂不安。此虚劳兼见之
症。亦虚劳常有之症。故特为之分别曰。）虚劳。虚烦不得眠。（以）酸枣仁汤主之。
此以挟火不得眠者。另作一节。上承风气。下起瘀血。如制义之小过渡法。行文之
变换如此。
酸枣仁汤方
酸枣仁（二升） 甘草（一两） 知母 茯苓（各二两） 芎 （一两）
上五味。以水八升。煮酸枣仁得六升。内诸药。煮取三升。分温三服。
（气血肉骨筋劳伤。名为五劳。）五劳虚极。（一身）羸瘦。腹满。不能饮食。（
伤在脾胃故也。原其受伤之因。或）食伤。忧伤。饮伤。房室伤。饥伤。劳伤。以致
经络营卫气伤。（劳热煎熬。）内有干血。肌肤（不润。如鳞）甲（之交）错。（目得
血而能视。血干则）两目黯黑。（凡里急由于干血者。以法）缓（其）中（虚羸由于干
血者。以法）补（其）虚。（其法维何。）大黄 虫丸主之。
尤在泾云、虚劳证。有挟外邪者。如上所谓风气百疾是也。有挟瘀郁者。则此所谓
五劳诸伤。内有干血者是也。夫风气不去。则足以贼正气。而生长不荣。干血不去。则
足以留新血。而渗灌不周。故去之不可
不早也。此方润以濡其干。虫以动其瘀。通以去其闭。而仍以地黄芍药甘草和其虚。
攻血而不专主于血。一如薯蓣丸之去风。而不着意于风也。喻氏曰、此世俗所称干血劳
之良治也。血瘀于内。手足脉相失者宜之。兼入琼玉膏补润之剂。尤妙。
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
（百枚） 虫（半升）
上十二味。末之。炼蜜和丸。小豆大。酒服五丸。日三服。（按 虫取其蠕动吸血。
今药铺不备。阙之亦可。惟虻虫水蛭。必不可缺。医者必预蓄于平日。否则仓卒难觅
矣。干漆宜炒至烟尽。或以川三七代之。）
愚按、金匮治虚劳证。通篇分两截看。上半篇言病之自内而出。以阴阳二证为两扇。
间有阴阳二证之互见者。为阴阳互根之道。论中用笔神妙。须当细心体会。村学师谈
制义。谓为罗纹体。而汉文早已备其法耳。下半篇言病之自外而来。以风气百疾。劳伤
血瘀二证。分为两扇。盖以风气不去。则正气日衰。瘀血不去。则新血不生。久则致成
劳证。风气固自外而来。而血瘀证。虽在于内。而久视伤血。久卧伤气。久坐伤肉。久
立伤骨。久行伤筋。名为五劳。大饱伤脾。大怒气逆伤肝。强力举重。坐湿地。伤肾。
形寒饮冷伤肺。忧愁思虑伤心。风雨寒暑伤形。大怒。恐惧不节。伤志。名为七伤。金
匮止云食伤忧伤饮伤房室伤饥饱伤劳伤六者。详略稍异。而大旨则同。盖以劳与伤。皆
由外及内。以致内有干血。外形甲错等证。此
上下截四扇。为劳证之大纲也。中间以虚烦不得眠证。另叙作一小顿。行文变换。非大
作家不能领会。至于附方千金翼。补入先生炙甘草汤一方。为热极而燥者。指出救阴滋
养之中。必用姜桂大辛以鼓其气。气之所至。水亦至焉。肘后方。补入先生獭肝散一方。
为冷极成劳者。指出阴邪根据附之患。必得獭肝应月而增减。正阴得位。而阴邪化焉。
此二证。时医一目为百日劳。一目为劳瘵病。万死中犹寻出一线生路。古圣贤济人无已
之心。数千年来。无一人发挥得出。诚一大可恨事。
附方
千金翼炙甘草汤 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。内胶消尽。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。（按獭肉性寒。肝独温。所以此治冷
劳。）
徐忠可云、劳无不热。而独言冷者。阴寒之气。与邪为类。故邪挟寒入肝。而搏其
魂气。使少阳无权。生生气绝。故无不死。又邪气根据正气而为病。药力不易及。故难愈。
獭者。阴兽也。其肝独应月而增减。是得太阴之正。肝与肝为类。故以此治冷劳。邪
遇正而化也。獭肉皆寒。惟肝性独温。故尤宜冷劳。又主鬼疰一
门相染。总属阴邪。须以正阳化之耳。
Is the Lung deficient and insufficient? Adding Pinellia Rhizoma (Banxia) to a Qi-tonifying formula is truly unimaginable and incomprehensible. Physicians of today, please each state your views.)
Deficiency consumption with lower back pain. (This is due to Kidney Qi deficiency failing to circulate.) Accompanied by urgency and tension in the lower abdomen and difficulty in urination. (This is because Bladder Qi is deficient and fails to transform fluids. Treat with) Ba Wei Shen Qi Wan (Eight-Ingredient Rehmannia Pill).
This section supplements the discussion on the syndrome and treatment of the Lower Jiao. Ba Wei Shen Qi Wan is an excellent prescription for warming the Kidney and transforming Qi to promote diuresis. If the patient has frequent urination, this formula is strictly contraindicated. Since Wang Tai Pu wrote *Yuan Ji Yuan Bing Shi* (Note: Original text says "He Yuan Jing", likely a typo for Wang Bing's commentary or related work), highly praising its efficacy, few people actually use it. Later, Xue Lizhai used it to govern all diseases, and Zhao Yangkui revered it as a divine pill in his *Yi Guan*. Li Shicai and Zhang Jingyue followed this view, using such ambiguous theories to cover up, misleading many people. Furthermore, examining the *Jin Gui Yao Lue*, after the Guizhi Longgu Muli Tang, the Tianxiong San formula is abruptly listed, disconnected from the preceding and following texts, with no explanation in the treatise itself. This led commentators to suspect it was added by later generations, not realizing that this formula contains profound theoretical arguments. Atractylodis Macrocephalae Rhizoma (Baizhu) in the formula is the holy medicine for tonifying the Spleen, best embodying the principle that "when Earth is prosperous, Metal is generated," ensuring the water source does not dry up, promoting grain intake, and reflecting the meaning that "essence is born from grain." Moreover, it utilizes Cinnamon Twig (Guizhi) to transform the Water Fu organ of the Taiyang, and Aconitum Lateral Preparatum (Tianxiong) to warm the Water Zang organ of the Shaoyin. Oh, Water! Its substance is originally still, but its continuous flow is the movement of Qi and the function of Fire. Assisted by Dragon Bone (Longgu), since Dragon belongs to Yang and dwells in Water, seeking similar energies, it can gather scattered Fire and return it to its root, achieving the balance and secrecy of Yin and Yang. The *Jin Gui Yao Lue*, regarding deficiency consumption, explores to the total root of Yin and Yang and attributes it to the Kidney. Mentioning lower back pain, urgency in the lower abdomen, and difficulty in urination, it only picks a few symptoms as an example. Perhaps fearing the power of Ba Wei Shen Qi Wan is insufficient, this formula was established. It is indeed a method of mending the heavens with five-colored stones. The reason why these syndromes, treatments, and formulas are not fully elucidated may be the intent of the secret prescriptions in the *Nei Jing*: valuing the Dao without lightly revealing it.
Ba Wei Shen Qi Wan Formula (See Chapter on Miscellaneous Diseases of Women)
Various deficiencies in deficiency consumption, along with hundred diseases caused by Wind-Qi, should be treated with Shuyu Wan (Dioscorea Pill).
This formula addresses cases where both internal and external aspects of deficiency consumption show insufficiency, not just the internal urgency and various deficiencies mentioned in the previous section. Insufficiency requires tonification. Previously, there were methods like Jianzhong Tang and Huangjianzhong Tang, combined with Guizhi Longgu Muli Tang, seemingly leaving no room for further improvement. However, previous formulas were sufficient for tonifying deficiency but insufficient for dispelling wind. When people first catch a cold, they often do not pay attention; over time, the pathogenic factor becomes weak and may resolve spontaneously. But one must fear that after recovery, residual pathogens remain mixed with healthy Qi, causing occasional fever, night sweats, or coughs. Women after menstruation or childbirth are especially prone to catching wind. All these are the roots of deficiency consumption. In treatment, one cannot focus solely on tonifying deficiency, nor solely on dispelling wind. Using both tonification and dispersion together results in a messy approach with side effects. Only this pill explores the subtle combination of flavors and properties, thus achieving miraculous effects.
Shuyu Wan Formula
Dioscoreae Rhizoma (Shuyu, 30 fen)
Ginseng Radix et Rhizoma (Renshen, 7 fen)
Atractylodis Macrocephalae Rhizoma (Baizhu, 6 fen)
Poria (Fuling, 5 fen)
Glycyrrhizae Radix et Rhizoma (Gancao, 20 fen)
Angelicae Sinensis Radix (Danggui, 10 fen)
Paeoniae Radix Alba (Shaoyao, 6 fen)
Belamcandae Rhizoma (Bailian, 2 fen)
Ligustici Chuanxiong Rhizoma (Chuanxiong, 6 fen)
Ophiopogonis Tuber (Maidong, 6 fen)
Colla Corii Asini (Ejiao, 7 fen)
Zingiberis Rhizoma Recens (Ganjiang, 3 fen)
Ziziphi Jujubae Fructus (Dazao, 100 pieces made into paste)
Platycodonis Radix (Jiegeng, 5 fen)
Pruni Semen (Xingren, 6 fen)
Cinnamomi Ramulus (Guizhi, 10 fen)
Saposhnikoviae Radix (Fangfeng, 6 fen)
Fermented Soybean Product (Shenqu, 10 fen)
Bupleuri Radix (Chaihu, 5 fen)
Sojae Semen Praeparatum (Douhuangjuan, 10 fen)
Rehmanniae Radix Preparata (Shengdihuang, 10 fen)
The above twenty-one ingredients are powdered, mixed with refined honey to form pills the size of a bullet. Take one pill with wine on an empty stomach. One hundred pills constitute one dose.
(There is another type of excessive Heart Fire, actually caused by Liver Stagnation. Wood generates Fire; when Fire is excessive, the Liver Soul is unsettled. This is a concurrent symptom of deficiency consumption, also a common one, so it is specifically distinguished as:) Deficiency consumption with vexation and inability to sleep. (Treat with) Suanzaoren Tang (Sour Jujube Decoction).
This addresses insomnia caused by accompanying Fire, creating a separate section. It connects upwards to Wind-Qi and downwards to Blood Stasis, like a minor transition in essay writing. Such textual variation demonstrates great literary skill.
Suanzaoren Tang Formula
Ziziphi Spinosae Semen (Suanzaoren, 2 sheng)
Glycyrrhizae Radix et Rhizoma (Gancao, 1 liang)
Anemarrhenae Rhizoma (Zhimu)
Poria (Fuling, 2 liang each)
Ligustici Chuanxiong Rhizoma (Chuanxiong, 1 liang)
The above five ingredients are boiled in 8 sheng of water. First boil Suanzaoren until reduced to 6 sheng, then add other herbs. Boil to obtain 3 sheng. Divide into three warm doses.
(Labor injuries to Qi, Blood, Flesh, Bone, and Sinews are called the Five Labors.) Extreme deficiency from the Five Labors. (The whole body is) emaciated and thin, abdominal fullness, inability to eat. (Because the Spleen and Stomach are injured. Investigating the cause of injury, it may be) dietary injury, sorrowful injury, drinking injury, sexual injury, hunger injury, or labor injury, leading to injury of meridians, Ying, Wei, Qi, and Blood. (Labor heat boils internally.) Dry blood remains inside, skin is rough like scales, nails are crisscrossed. (Eyes need blood to see; when blood is dry,) eyes appear dark. (For internal urgency caused by dry blood, use the method to) moderate (the middle); for emaciation caused by dry blood, use the method to) tonify (deficiency). What is the method?) Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) treats this.
You Zaijing said: Deficiency consumption syndromes include those with exterior pathogens, such as the aforementioned hundred diseases of Wind-Qi; and those with stasis and stagnation, i.e., the dry blood inside mentioned here resulting from the Five Labors and various injuries. If Wind-Qi is not removed, it harms healthy Qi, hindering growth and flourishing. If Dry Blood is not removed, it retains new blood, hindering proper circulation. Therefore, removal should not be delayed. This formula uses moistening agents to hydrate dryness, insects to move stasis, and unblocking agents to remove closure, while still using Rehmanniae Radix Preparata, Paeoniae Radix Alba, and Glycyrrhizae Radix et Rhizoma to harmonize deficiency. It attacks blood without focusing solely on blood, just as Shuyu Wan dispels wind without focusing solely on wind. Yu Jia Yan said: This is the excellent treatment for the worldly known "Dry Blood Labor." It is suitable for internal blood stasis where pulse conditions of hands and feet do not match. Combined with Qiongyu Gao (Jade Elixir Paste) for tonification and moistening, it is particularly wonderful.
Dahuang Zhechong Wan Formula
Rhei Radix et Rhizoma (Dahuang, 10 fen, steamed)
Scutellariae Radix (Huangqin, 2 liang)
Glycyrrhizae Radix et Rhizoma (Gancao, 3 liang)
Persicae Semen (Taoren, 1 sheng)
Pruni Semen (Xingren, 1 sheng)
Paeoniae Radix Alba (Shaoyao, 4 liang)
Rehmanniae Radix Preparata (Shengdihuang, 10 liang)
Lac Dragontii (Ganqi, 1 liang)
Blattidae (Mengchong, 1 sheng)
Hirudo (Shuizhi, 100 pieces)
Otiorrhynchi Larva (Qicao, 100 pieces)
Eupolyphaga seu Steleophaga (Zhechong, 0.5 sheng)
The above twelve ingredients are powdered, mixed with refined honey to form pills the size of small beans. Take five pills with wine, three times a day. (Note: Zhechong is valued for its wriggling and sucking blood nature; it is not always available in pharmacies now, so omission is acceptable. However, Mengchong and Shuizhi are indispensable. Physicians must stock them regularly, otherwise they will be hard to find in emergencies. Ganqi should be stir-fried until smoke ceases, or Sichuan Panax Notoginseng Radix et Rhizoma (Chuan Sanshi) can be used as a substitute.)
My commentary: The *Jin Gui Yao Lue* treats deficiency consumption by dividing the chapter into two parts. The first half discusses pathology originating from within, divided into Yin and Yang syndromes, with some overlap illustrating the mutual root of Yin and Yang. The writing is subtle and requires careful appreciation. Village teachers discuss eight-legged essays as "rope-pattern" structures, but Han dynasty texts already possessed this method. The second half discusses pathology coming from without, divided into Hundred Diseases of Wind-Qi and Labor Injury with Blood Stasis. If Wind-Qi is not removed, healthy Qi declines daily; if Blood Stasis is not removed, new blood is not generated, eventually leading to labor syndromes. Wind-Qi comes from outside, while Blood Stasis is internal. However, prolonged viewing injures Blood, prolonged lying injures Qi, prolonged sitting injures Flesh, prolonged standing injures Bone, and prolonged walking injures Sinews—this is called the Five Labors. Overeating injures the Spleen, excessive anger injuring the Liver, heavy lifting/sitting on wet ground injuring the Kidney, cold exposure/cold drinks injuring the Lung, worry/overthinking injuring the Heart, wind/rain/cold/heat injuring the Form, and excessive anger/fear/incontinence injuring the Will—this is called the Seven Injuries. The *Jin Gui Yao Lue* only mentions six: dietary, sorrowful, drinking, sexual, hunger/fullness, and labor injuries. The details differ slightly, but the main idea is the same. Labor and injury originate externally and affect internally, leading to internal dry blood and external scaly skin. These four sections (two halves) are the general outline of labor syndromes. The "vexation and inability to sleep" syndrome is narrated separately as a pause, showing textual variation that only a master writer can appreciate. Regarding the appended *Qianjin Yi Fang*, it adds the Zhigancao Tang (Prepared Licorice Decoction) for extreme heat and dryness, pointing out that in rescuing Yin and nourishing, one must use pungent-hot Ginger and Cinnamon to boost Qi; where Qi goes, Water follows. The *Zhou Hou Fang* adds the Talei San (Badger Liver Powder) for extreme cold leading to labor, pointing out the danger of Yin pathogens attaching to healthy Qi. One must rely on Badger Liver varying with the moon phases to establish correct Yin, thereby resolving Yin pathogens. These two syndromes are currently diagnosed by physicians as "Hundred-Day Labor" or "Consumption Disease," finding a sliver of hope amidst death. The boundless compassion of ancient sages has not been fully expounded upon for thousands of years, which is truly regrettable.
Appendix Formulas
Qianjin Yi Fang Zhigancao Tang (Prepared Licorice Decoction from Essential Prescriptions Worth a Thousand Gold)
Treats deficiency consumption insufficiency, sweating with chest stuffiness, knotted and palpitating pulse. Action is normal, death within 100 days; critical cases die in 11 days.
Glycyrrhizae Radix et Rhizoma (Gancao, 4 liang, roasted)
Cinnamomi Ramulus (Guizhi)
Zingiberis Rhizoma Recens (Shengjiang, 3 liang each)
Ophiopogonis Tuber (Maidong, 0.5 sheng)
Perillae Semen (Maren, 0.5 sheng)
Ginseng Radix et Rhizoma (Renshen)
Colla Corii Asini (Ejiao, 2 liang each)
Ziziphi Jujubae Fructus (Dazao, 30 pieces)
Rehmanniae Radix Recens (Shengdihuang, 1 jin)
The above nine ingredients are boiled in 7 sheng of wine and 8 sheng of water. First boil the first eight ingredients to obtain 3 sheng, strain, add Ejiao until dissolved. Take 1 sheng warm, three times a day.
Zhou Hou Fang Talei San (Badger Liver Powder from Handbook of Prescriptions to Keep in the Sleeve)
Treats Cold Labor, and also Ghost Tethering (infectious tuberculosis-like disease) transmitted within families.
One Badger Liver, roasted dry and powdered. Take one cun-bi (square inch spoonful) with water, three times a day. (Note: Badger meat is cold-natured, but the liver alone is warm-natured, hence this treats Cold Labor.)
Xu Zhongke said: Labor syndromes are invariably hot, yet here it speaks of cold. This is because Yin-Cold Qi is of the same category as the pathogen, so the pathogen enters the Liver with cold, binding the Hun Qi, rendering Shaoyang powerless, cutting off vital energy, hence inevitably fatal. Furthermore, pathogens attach to healthy Qi, making medicinal force ineffective, hence difficult to cure. The badger is a Yin beast; its liver varies with the moon, obtaining the correct Qi of Taiyin. Liver matches Liver, so it treats Cold Labor, transforming pathogens through contact with correct Qi. Badger meat is all cold, but the liver is uniquely warm, making it especially suitable for Cold Labor. It also treats Ghost Tethering transmission, which belongs to Yin pathogens, requiring Correct Yang to transform them.