间三症。是从色脉之诊处。而逆推其病情。故曰主。主字。直贯三句。犹言主渴。主亡血。主喘悸之谓。
五条 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。
人身上下两焦。即易之太极图也。上焦之阳气具白象。而心脏之血。阳中之阴极也。下焦之阴精具黑象。而
肾脏之气。阴中之阳极也。黑白不相为用。而其所以牵引控制者。惟是两极互胎。而相为消长于其际耳。比
如男子以肾精为根蒂。肾主水而色黑。肾精下足。则癸黑充腴。而其中壬白之阳极。积浓流光。由肝木之上
升。而化为丙丁盛大之气。轻便健立。施应无穷。复何病劳之有。若精衰极渺。则心肺间之宗气。遂致短浅亏
空。此树木之根株不植。而枝叶自萎之理也。将一身之肢体。犹或不能自支。而况被之以劳乎。此病劳之所
由作也。但劳之为病。其症多端。而其道路。不外乎四者。盖劳则残阳馁气。反浮张于在上在外。而作烦热。以
致咽干喉痛者。一也。劳则中气内虚。不能鼓努传送。因而大便艰难。小水不利。且两便下停。而逆气上乘胸
中之空。遂致痰喘咳逆。吐血衄血等候者。二也。又劳则心气上虚。欲得肾气以自实者势也。肾虚不能从肝
而顺生。睡则由肺而逆责以吸之。夫心火之见肾水。为夫之象。心火之见肺金。为妻之象。因而梦接鬼交。每
致遗泄者。三也。且劳则上焦之天气。失包裹提挈之权。而精汁虚脱。更因泄注下空。而上中二焦衰薄之气。
乘机下陷。而为失气洞利者。四也。悉此四者。则自本条及后文十四条。其序症立方。针锋逼对之精意。昭如
日月矣。脉虚就微按而言。上面犹有一浮字在。于下沉弦字。便可见矣。夫虚脉为阴精内耗。弦脉为阳气
外削之诊。今浮虚。是上焦之阳气。空于无阴。沉弦。是下焦之阴精。馁于生阳。可知也。别以男子者。以妇人女
子之浮虚沉弦。为行经及经后之脉。则血虚于上。而气削于下者。平脉。非病脉故也。但此浮虚、沉弦之脉。又
与少阳受风邪而下逆。以致心下悸。而腹痛者相同。然系少阳。当往来寒热矣。而今又无此。则其非少阳之
邪可知矣。然则其所以短气者。上虚逆动。而吸气不能深入也。里急。如有大便而不得。有小便而不利者。中
气虚而不能鼓努传送也。面色白者。精血虚于内。而气薄于诸阳之会也。时目瞑者。气机之根蒂内疲。而神
光时欲掩伏也。所以兼衄者。二便浮停而不下通。则冲气上逆。而逼经血于巅顶也。少腹满者。即里急小便
不利之义。而知关元气海之转运无权矣。谓非房劳而下伤元精。上伤宗气之所致乎。故曰劳使之然也。
六条 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。
此前条注中。所谓因劳而残阳馁气。反浮张于在上在外而作烦热者也。浮为无底。大为无里。其脉浮大。皆
阴虚而微阳浮越之诊也。手足。指手心足心而言。以手足之心。为心肾之内应故也。烦则阴精虚耗。不能胜
劳热之自焚耳。春夏为天地生发之时。精竭者。根株不足应枝叶之分荣。故剧。秋冬为万物归藏之候。气劳
者。力役今始沐余闲之暂息。故瘥也。阴者。指男子之前阴而言。前阴为宗筋。阳气之根蒂也。劳则阳浮而不
下贯。故阴寒。又劳则气张而不下提。故无事而精脱自出矣。夫足胫为肾之府。而所以强立健行者。以精气
充之之故也。今阴寒。则阳气不下充而削弱可知。精自出。则髓不内实而酸热又可知。既酸且削。其不能行
也可必矣。
七条 男子脉浮弱而涩。为无子。精气清冷。
夫人之所以有子者。分阴阳有余之化。而盛满流行以种之者也。浮、为阴不能固。弱、为阳不能充。加之以涩。
涩脉体短神散而机滞。故为无子之诊。所以然者。因浮主阴虚。阴虚则精清而不浓。弱主阳虚。阳虚则气冷
而不温。又涩、则射精过气。常不及子宫故也。此条因病房室劳者。其精清而无醇浓之生气。故推展言之。
而并及天生之精冷者。非论劳之正文也。盖病劳者竟能有子。但殇于痘者十之七。殇于痞者十之三。有子
与无子同耳。惟天生精冷之人。形如被宫刑而色青夭。脉果浮弱而涩。则真无子者也。余诊视三十年中。试
之屡矣。冠以男子者。因妇人女子浮弱而涩。为行经后三四日之善脉。正宜子之诊故也。盖经后三四日。
其少火生气之势。初还于上、故浮。旧血去。而新血未复。故弱而涩也。
八条 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。
人身之阴阳。尝相须以为用。阴为阳之根蒂。阳为阴之主令。阴虚则阳失根蒂而上衰。阳虚则阴无主令而
下脱。精血者阴也。亡血失精。则阴伤而气馁。气馁不胜则劳矣。故劳之为症虽多。而其大概不越乎四种。曰
房室劳。曰想劳。曰动作劳。曰失血劳而已。房室劳者。用药相交。或腾那勒马。经久不泄。宗气劳热。汗淋胸背。
已而元精下丧。则上气又因下泄而益卑。是精与气之标本两伤矣。以妄为常而不知节。则精日损而气日
削。此一节赶成。又名女劳色劳者。十居其半焉。想劳者。目有所见。心有所思。魂荡神扬。一往不返。甚至叫真
真于画上。幻见容颜。拟燕燕于怀中。虚闻 发。初则心驰而气亡。因之关开而精滑。及阴虚于下。而上气之
不可复问者。亦十居其一也。动作劳者。大抵俱根于房劳。但精气虽虚。尚未至于枯竭耳。或以簿书鞅掌等
类。而伤其神气。或以支持鼓努等类。而伤其膈气。下焦逆动。而致痼痰久嗽者。亦十之三也。失血劳者。其人
之精气。原无亏损。因一时之惊恐忧思。以及大呕大吐等类。损削其胸中之神气。则上焦以空虚而招下焦
之来侮。于是风起水涌。血随冲气而上行。从肺管胃脘而直出浊道者。则见于吐。从两胁及经络而旁出清
道者。则见于衄。成盆成碗。而不可遏者。以虚吸实张。两就之势使之也。然精血俱为阴类。以养阳气者。亡血
以泄气。与失精而泄气者相同。故其致劳亦同者。亦十之一也。前第四条。所谓亡血之劳也。下条所言。想劳
也。此特言房室之劳耳。家。指夙病而言。犹风家淋家疮家衄家之义。失精家。凡多欲及梦遗滑脱者皆是。
少腹应天地之黄泉。阳气虚于上。而肝肾之虚寒。凝敛于黄泉之下。不得阳气以自和。故殊觉切责而弦急
也。阴头寒者。阳虚而不能下充外贯也。目为水火之双苗。故流动光明并见焉。眩者。水虚不能摄火。而微明
几几有上脱之象也。发生于血而固于气。血短气脱。故落也。脉极虚。即芤迟是也。芤为有表无里。血虚之应。
迟为去不易来。气虚之应。芤而兼迟。血气两虚。故曰极虚也。清谷者。完谷不化之谓。亡血兼吐衄而言。此条
原是专论失精之脉症。而并及清谷亡血者。以泄泻日久。胃中精汁消亡。而悍气日削。既与失精家之脉症
相同。且精血之在人身。其象如天地之水。精为地轴中之暗泉。血为江河中之明脉。原有贯通根据辅之妙。此
亡血家之脉症。亦与失精家同。故推展言之耳。
九条 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 龙骨 牡蛎 芍药 生姜（各三两） 甘草（二两） 大枣（十二枚）
上七味。以水七升。煮取三升。分温三服。
此言两寸口之脉也。水 名芤。即今之野菩荠草也。上下两旁俱有脉。按之中空、如芤草之状。故曰芤。左寸
见芤。是心中藏血虚短之诊。动者。以实乘虚而击撞之。则虚者自动。左寸见动。是心血短而心气上虚。下气
逆乘而击撞之之象也。微者。阳气虚馁。不能鼓满之应。右寸见微。是肺中真气衰颓之诊。紧即弦紧。其脏应
肝。其气应木。右寸见紧。是胸中之阳。不足以御下。而肝木以阴寒之气上侵阳位也。夫心藏神。肺藏魄者也。
脉得芤而心血虚。则神不安于其宅。脉得微而肺气虚。则魄不宁于其居。又得动紧之下气凑之。凡五脏之
气。相见于魂梦。除虚劳者无生我我生之顺境。其所胜所不胜。以及比和者。皆夫妻子女之象也。况因种妄
情。缘生幻境。如影随形。此男子失精。女子梦交之道也。主本汤者。以号召阳精阳气之桂枝汤。填心肺之空。
所以责其芤脉微脉也。加龙骨者。取其镇重而通山龙之灵脉。所以宁其心神肺魄也。加牡蛎者。以动脉、紧
脉。为下阴上乘之诊。故以沉潜招摄之性。敛伏其冲气耳。不啜热粥如桂枝汤之服法者。恐汗泄上焦之阳
精阳气故也。七味药中。凡鬼交梦接。而致下泄下脱者。九转还丹。不足以拟其神妙。真圣人之奇制。而其如
千百年之不识何哉。
十条 男子平人。脉虚弱细微者。善盗汗也。
平人。注见前。脉虚。为阴血不充。脉弱。为卫阳不实。气削于外。则细。阳衰于里。则微。夫既为无故之平人。
而见此虚弱细微之脉。则其命门之火。既虚于里。而其卫外之阳。复衰于表。合之无故血虚。岂非气不能外固。因
而汗越之所致乎。故知善盗汗也。盖阳气者。昼行于表。夜行于里。寤则衰阳犹有把持之势。寐则尽情内伏。
而护卫之气解散。且阳气内伏。又蒸其虚阴于外。故汗出如盗矣。
十一条 人年五六十。其病脉大者。痹侠背行。苦肠鸣。马刀侠瘿者。皆为劳得之。
脉大。即前第三条脉大者为劳之义。女以七七为期。男以八八为期。人年五六十。是天癸已衰之候。其脉渐
当微小为顺。若病脉大。则与年五六十不相符矣。此必精血竭于里。而虚阳以无辅而外鼓之所致也。痹病。
注见胸痹血痹。皆阳虚之候。背行者。除中行督脉外。其左右凡四行。俱太阳之经也。夫阳胎于阴。气根于血。
里虚则表气亦虚。今虽以无辅而虚阳外鼓。然其卫气。终不能匀满。太阳者卫气之所会。故知其背行必有
痹处也。凡人饮食。必得呼吸之气以压之。而后能下于喉嗓。中气充足者。饮食既下。托住客气。而还为饱嗳
者常也。今气虚于胸分。不能上送客气。而与饮食同入于胃。而下历于肠。客气走注于空虚之腑。故苦肠鸣
也。马刀者。尖长而形似之。故名。侠与挟同。言挟于腋下也。瘿者。如槐柳楷木。舒发之性不畅。而凝结为繁丝
乱绺之瘿瘤也。言尖长如马刀之瘿瘤。挟于腋下之谓。盖气劳则生虚热。而肝胆之逆气。无阳神以冲和化
导之。则结为顽核。久而皮溃。不可完合矣。皆字。指痹及肠鸣、并侠瘿而言。三者皆气虚之症。故曰皆为劳得
之。此及上文盗汗一条。言虚劳之先见。而为轻症外症者。
十二条 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。
气微于里。则脉沉。气削于外。则脉小。气衰于伏。而不能续鼓。则脉迟。脱气。非与里阴离脱之谓。如水干脱岸。
果干脱壳之义。盖气在人身。充周遍满。如粘连于四塞者。常也。今其脉里微外削。而几几有不易连续之势。
则其气短浅。而不及于躯壳之四塞。如水脱岸。果脱壳之象。故名脱气。夫疾行之所用者。宗气也。气脱于胸
中。而不及上接。故疾行则喘声如喝矣。此就脉沉者之不能上充而言。手足为阳气之充。气脱于四末而不
及外贯。故逆寒也。此就脉小者之不能旁鼓而言。脾气虚而疲于运化分布。故腹满。失分布之甚者。则水谷
不别而溏泄。失运化之甚者。则食不消化而清谷矣。此就脉迟者之不能健运而言。仲景之言脉症相对处。
其细密每如此。
十三条 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。
注见血门。此条凡三见。入血门者重亡血。入此者重失精。入妇人门者重半产漏下。其义则一也。
十四条 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） 芍药（六两） 甘草（三两炙） 大枣（十二枚） 生姜（三两） 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。
精血虚于里与下。则阳气馁于上与外。气不能胜劳。此病劳之因也。自第一条骨弱。肌肤盛。重困疲劳三句。
言劳之由来。除却一条二条。被微风而言血痹之外。其三条言劳之脉。四条言失血以致劳之色。五六两条。
又兼言劳脉劳症。七八两条。推言所以骨弱而致劳之故。九条言失精之治例。十条。十一条。言劳之外症。十
二条。言劳之里症。十三条。又广言男女上虚下脱之脉。自此条至后文十五、十六、十七、十八、共五条。杂言三
焦因虚成劳之症。并其治例。故俱直序之曰虚劳也。里急者。呼吸喘急于里之谓。盖上虚而逆气乘之。故使
吸气不得深入而喘急也。悸。详惊悸下衄。注见血门。并本篇四条面色薄注。皆上虚下实之候也。腹中痛者。
Interspersed discussion of three symptoms. This is deducing the condition from the diagnosis of complexion and pulse, hence termed "Zhu" (Main/Primary). The character "Zhu" runs through these three sentences, meaning primarily treating thirst, primarily treating blood loss, and primarily treating panting and palpitations.
Article 5: In men, if the pulse is deficient and deep-wiry, without aversion to cold or fever, accompanied by shortness of breath, abdominal urgency and discomfort, difficult urination, a pale facial complexion, occasional dizziness, epistaxis, and hypogastric fullness, this is caused by consumptive disease (Lao).
The upper and lower Jiao of the human body are like the Taiji diagram of the I Ching. The Yang Qi of the Upper Jiao possesses the symbolism of white, while the Blood of the Heart is the extreme of Yin within Yang. The Yin Essence of the Lower Jiao possesses the symbolism of black, while the Qi of the Kidney is the extreme of Yang within Yin. Black and White do not function for each other directly, but what connects and controls them is the mutual gestation of the two poles, waxing and waning between them. For instance, in men, Kidney Essence serves as the root. The Kidney governs Water and its color is black. If Kidney Essence is sufficient, then Gui Water (Kidney Yin) is abundant and plump, and the Ren Water (extreme Yang within it) accumulates with rich flowing light. Through the ascending nature of Wood (Liver), it transforms into the vigorous Qi of Bing-Ding (Heart Fire), making the body light and strong, responding endlessly, where would there be consumptive disease? If Essence declines to an extreme degree, the Zong Qi (Gathering Qi) between the Heart and Lung becomes shallow and empty. This is like the principle that if the roots of a tree are not planted firmly, the branches and leaves will naturally wither. If one cannot even support the limbs of the whole body, how much more so when subjected to labor? This is how consumptive disease arises. However, the symptoms of Lao are manifold, but the pathological pathways do not exceed four aspects. Generally, labor causes residual Yang Qi to become depleted and float outward and upward, causing irritability and heat, leading to dry throat and sore throat; this is the first aspect. Labor causes internal deficiency of Middle Qi, unable to promote and transport, resulting in difficult defecation, difficult urination, stagnation of both excretions, and rebellious Qi attacking the empty chest, leading to phlegm-panting, coughing, asthma, hematemesis, and epistaxis; this is the second aspect. Furthermore, labor causes deficiency of Heart Qi in the upper part, creating a necessity to seek Qi from the Kidney to fill itself. If the Kidney is deficient and cannot follow the generative cycle of Liver Wood, during sleep, it reversely demands inhalation from Lung Metal. The meeting of Heart Fire with Kidney Water is like a husband meeting his wife; the meeting of Heart Fire with Lung Metal is like a wife meeting her husband. Thus, dreaming of sexual intercourse with ghosts often leads to seminal emission; this is the third aspect. Additionally, labor causes the Upper Jiao Heaven Qi to lose its power of enveloping and lifting, leading to depletion of essence fluids. Due to leakage downward, the thin Qi of the Upper and Middle Jiao sinks opportunistically, causing flatulence and watery diarrhea; this is the fourth aspect. Understanding these four points makes the precise intent of matching symptoms with formulas in this article and the following fourteen articles as clear as the sun and moon. "Deficient pulse" refers to slight pressure; above it lies a "floating" character, visible in the "deep-wiry" description. A deficient pulse indicates internal consumption of Yin Essence, while a wiry pulse indicates external weakening of Yang Qi. Current floating-deficiency indicates Upper Jiao Yang Qi is empty without Yin fluid attachment; deep-wiry indicates Lower Jiao Yin Essence is depleted and unable to generate Yang Qi. Regarding the term "men": women's floating-deficient and deep-wiry pulses during menstruation or post-menstruation represent normal pulses of blood deficiency above and Qi weakness below, not pathological pulses. However, these floating-deficient and deep-wiry pulses resemble those of Shaoyang syndrome affected by wind pathogen descending, causing subcostal palpitation and abdominal pain. Yet, Shaoyang syndrome should present with alternating chills and fever. Since this is absent, it is clearly not Shaoyang pathogen. Therefore, the shortness of breath is due to upper deficiency and rebellious movement, preventing deep inhalation. Abdominal urgency resembles the urge to defecate or urinate without success, caused by Middle Qi deficiency failing to promote transport. Pale complexion indicates internal deficiency of Essence and Blood, with Qi being thin at the convergence of all Yang meridians. Occasional dizziness indicates fatigue of the Qi mechanism's root internally, causing divine light to occasionally hide. Epistaxis occurs because stagnation of excretions prevents downward flow, causing Chong Qi to rebel upward and force blood to the head. Hypogastric fullness is the meaning of abdominal urgency and difficult urination, indicating failure of Guanyuan and Qi Hai to transform and transport. Is this not caused by sexual excess injuring Yuan Jing below and Zong Qi above? Hence it is said to be caused by Lao.
Article 6: In consumptive disease, the pulse is floating and large, hands and feet are irritable and hot, symptoms worsen in spring and summer, and improve in autumn and winter. There is coldness in the yin region, spontaneous seminal emission, and soreness/emaciation of the legs preventing walking.
This refers to the previous note stating that labor causes residual Yang Qi to float outward and upward, generating irritability and heat. Floating means lacking foundation; Large means lacking interior substance. A floating-large pulse indicates Yin deficiency with floating of slight Yang. "Hands and feet" refers to the palms and soles, as they correspond internally to the Heart and Kidney. Irritability results from Yin Essence depletion, unable to withstand self-burning from labor-heat. Spring and Summer are times of heaven and earth's generation; those with exhausted Essence lack root strength to nourish branches and leaves, so symptoms worsen. Autumn and Winter are times of storage; those with Qi exhaustion begin to rest from physical labor, so symptoms improve. "Yin" refers to the male anterior yin. The anterior yin is the tendon sheath and the root of Yang Qi. Labor causes Yang to float without descending, resulting in coldness in the yin region. Also, labor causes Qi to expand without lifting downward, leading to spontaneous seminal emission even without activity. The calves are the mansion of the Kidney; strength and walking ability depend on Essence and Qi sufficiency. Now, with coldness in the yin, Yang fails to descend and strengthen, which is evident. With spontaneous emission, marrow fails to fill internally, causing soreness and heat, which is also evident. Being both sore and emaciated, inability to walk is certain.
Article 7: In men, a pulse that is floating, weak, and choppy indicates infertility and clear/cold essence.
Human reproduction depends on the transformation of surplus Yin and Yang, filled and flowing to plant life. Floating indicates Yin cannot consolidate; Weak indicates Yang cannot fill. Added to this is the Choppy pulse, which is short, scattered in spirit, and sluggish in mechanism, indicating infertility. Why? Floating signifies Yin deficiency, leading to clear rather than dense essence; Weak signifies Yang deficiency, leading to cold rather than warm Qi. Choppy indicates ejaculation occurs before Qi arrives, often failing to reach the uterus. This article discusses patients with sexual excess, whose essence is clear lacking vigorous vitality, thus extending the discussion to those with congenital cold essence, though this is not the main text on Lao. Generally, those with consumptive disease can have children, but seven-tenths die from smallpox, three-tenths from痞 (Pi syndrome); having children is similar to not having them. Only those with congenital cold essence, appearing castrated with a sallow complexion and a truly floating-weak-choppy pulse, are truly infertile. In my thirty years of practice, I have verified this repeatedly. The term "men" is used because women's floating-weak-choppy pulse after menstruation (days 3-4) is a favorable pulse for conception. After menstruation, the mild fire generating Qi returns upward (floating); old blood is gone, new blood not yet restored (weak and choppy).
Article 8: Those who frequently lose essence have tight and urgent hypogastric tension, coldness at the glans penis, dizziness, hair loss, and a pulse that is extremely deficient, knifelike (Kou), and slow. These indicate undigested food in stool, blood loss, and essence loss.
Yin and Yang in the human body rely on each other. Yin is the root of Yang; Yang is the master command of Yin. Yin deficiency causes Yang to lose its root and decline upward; Yang deficiency causes Yin to lose its master and collapse downward. Essence and Blood belong to Yin. Blood loss and essence loss injure Yin and deplete Qi. Depleted Qi cannot bear burden, leading to Lao. Although Lao symptoms are many, they generally fall into four types: Sexual Lao, Mental Lao, Physical Lao, and Hemorrhagic Lao. Sexual Lao involves prolonged intercourse without emission, causing Zong Qi heat and sweating on chest/back, followed by loss of Yuan Jing below, further weakening Upper Qi. This damages both root and branch of Essence and Qi. Treating recklessness as habit without moderation daily damages Essence and weakens Qi. This accounts for half of cases known as Female-Labor Color Lao. Mental Lao involves visual stimuli and mental thoughts, scattering soul and spirit, even hallucinating faces or hearing voices. Initially, heart scatters and Qi escapes, opening gates and causing seminal slipperiness. Later, Yin deficiency below and irreparable Upper Qi accounts for one-tenth. Physical Lao usually stems from sexual Lao, but Essence/Qi is not yet exhausted. It may stem from mental stress damaging Shen-Qi, or physical exertion damaging Diaphragm Qi, leading to stubborn phlegm and chronic cough (one-third). Hemorrhagic Lao involves original Essence/Qi intact, but sudden fright/worry or severe vomiting damages Chest Shen-Qi. Upper Jiao emptiness invites Lower Jiao invasion. Wind rises, water surges, blood follows Chong Qi upward. From lung/stomach channels, it exits via turbid orifices (hematemesis); from flanks/meridians, via clear orifices (epistaxis). Massive bleeding occurs due to vacuum suction and solid expansion forces. Since Essence/Blood nourish Yang, blood loss releasing Qi is same as essence loss releasing Qi, leading to similar Lao (one-tenth). Previous Article 4 discussed Blood Loss Lao; next article discusses Mental Lao; this specifically discusses Sexual Lao. "Jia" (Family/Habitual) refers to chronic disease, like Feng Jia (Wind patient), Lin Jia (Strangury patient). Shi Jing Jia includes those with excessive desire, nocturnal emissions, or slipperiness. Hypogastrium corresponds to Earth's Yellow Springs. Yang deficiency above and Liver/Kidney cold below condenses in Yellow Springs without Yang harmony, causing tight urgency. Cold glans indicates Yang deficiency failing to descend and penetrate. Eyes are dual sprouts of Water/Fire, showing flow and brightness. Dizziness indicates Water deficiency failing to control Fire, with faint light threatening to escape. Hair growth relies on Blood and consolidation by Qi; Blood shortage and Qi collapse cause hair loss. Extremely deficient pulse is Kou-Slow. Kou (knifelike) is superficial without depth, reflecting blood deficiency. Slow is hard to come, reflecting Qi deficiency. Kou plus Slow indicates dual Blood/Qi deficiency, hence "Extremely Deficient". Qing Gu (Clear Grain) means undigested food in stool. Wang Xue includes hematemesis and epistaxis. This article focuses on Shi Jing pulse/symptoms but extends to Qing Gu/Wang Xue because chronic diarrhea consumes stomach fluids and fierce Qi, resembling Shi Jing Jia. Essence and Blood are like Earth's dark springs and Rivers' bright veins, interconnected. Thus, Wang Xue Jia shares similar pulse/symptoms with Shi Jing Jia.
Article 9: Pulses presenting various Kou, Moving, Fine, and Tight characteristics indicate seminal emission in men and dream intercourse in women. Gui Zhi Long Gu Mu Li Tang is the primary formula.
Gui Zhi Long Gu Mu Li Tang Formula: Cinnamon Twig (Guizhi), Dragon Bone (Longgu), Oyster Shell (Muli), White Peony Root (Shaoyao), Fresh Ginger (Shengjiang) [each 3 liang], Licorice Root (Gancao) [2 liang], Jujube (Dazao) [12 pieces].
Boil seven ingredients in 7 sheng of water, reduce to 3 sheng, divide into three warm doses.
This discusses the Cun (inch) positions of both wrists. Kou (hollow) resembles wild shepherd's purse grass. Pulse has sides but is hollow in center when pressed, like Kou grass. Left Cun Kou indicates Heart Blood deficiency. Moving (Dong) pulse occurs when excess attacks deficiency, causing vibration. Left Cun Dong indicates Heart Blood deficiency and Upper Heart Qi deficiency, with Lower Qi rebelling and striking. Fine (Wei) pulse indicates Yang Qi deficiency failing to fill. Right Cun Wei indicates Lung True Qi decline. Tight (Jin) is wiry-tight, corresponding to Liver/Wood. Right Cun Jin indicates insufficient Chest Yang to resist Lower Yin-Cold invading Yang position. Heart stores Shen (Spirit); Lung stores Po (Ethereal Soul). Kou pulse with Heart Blood deficiency makes Shen unsettled; Wei pulse with Lung Qi deficiency makes Po uneasy. Combined with Moving/Tight Lower Qi, Five Zang Qi appear in dreams. Except for Lao's harmonious cycles, winning/losing relationships appear as spouses/children. Driven by delusional emotions, illusions arise like shadows. This explains male seminal emission and female dream intercourse. Gui Zhi Tang calls forth Yang Essence/Qi to fill Heart/Lung voids, addressing Kou/Wei pulses. Adding Longgu stabilizes and connects spiritual veins to calm Shen/Po. Adding Muli addresses Moving/Tight pulses as Lower Yin invasion, using sinking/collecting nature to restrain Chong Qi. Unlike Gui Zhi Tang, no hot porridge is taken to prevent sweating out Upper Yang Essence/Qi. Among these seven herbs, for ghost intercourse causing leakage, Nine-Turn Elixir cannot match its efficacy. Truly a sage's miraculous prescription, why unrecognized for millennia?
Article 10: Men who are healthy (Ping Ren) with deficient, weak, fine, and minute pulses are prone to night sweats (Dao Han).
Ping Ren refers to previously noted healthy individuals. Deficient pulse indicates insufficient Yin Blood. Weak pulse indicates unsolidified Wei Yang. Qi weakened externally causes Fine pulse; Yang declining internally causes Minute pulse. In a healthy person without obvious cause, such a pulse indicates Mingmen Fire deficient internally and Wei Yang weak externally. Combined with uncaused Blood deficiency, Qi fails to secure exterior, causing sweat leakage. Hence prone to night sweats. Yang Qi travels exterior by day, interior by night. While awake, slight Yang holds control; while asleep, Yang retreats fully, dispersing guarding Qi. Internal Yang steams deficient Yin outward, causing sweat like a thief.
Article 11: At age 50-60, if the pathological pulse is Large, bi-syndrome affects the back, intestinal borborygmi are distressing, and horse-knife/goiter-like masses appear under arms. All are caused by Lao.
Large pulse refers to Article 3's "Large pulse indicates Lao." Women complete cycles at 7x7, men at 8x8. Age 50-60 marks decline of Tian Gui. Pulse should gradually become small/fine. Pathological Large pulse contradicts age. This indicates Essence/Blood exhausted internally, with deficient Yang bulging outward without support. Bi-syndrome (see Chest Bi/Blood Bi) indicates Yang deficiency. Back involvement involves four columns besides Du Meridian, all Taiyang meridians. Yang conceives in Yin; Qi roots in Blood. Internal deficiency causes external Qi deficiency. Though deficient Yang bulges outward, Wei Qi cannot be uniform. Taiyang gathers Wei Qi, so back bi is expected. Digestion requires respiratory Qi to press food down. Sufficient Middle Qi supports guest Qi, causing belching. Here, Chest Qi deficiency fails to send guest Qi up, mixing with food into Stomach/Intestines. Guest Qi moves through empty fu organs, causing borborygmi. "Horse-knife" refers to sharp, long shapes. "Xia" means alongside. Goiter refers to knotted masses like locust trees. Sharp-long goiters alongside armpits result from Qi-labor generating deficiency heat. Liver/Gallbladder rebellious Qi lacks Yang Spirit to harmonize, forming hard nodules that ulcerate over time. "All" refers to bi, borborygmi, and goiters. All are Qi deficiency symptoms, hence caused by Lao. Along with Article 10's night sweats, these show early, mild, external signs of Xu Lao.
Article 12: Pulse Deep, Small, and Slow is named Tuo Qi (Escaping Qi). The person pants heavily when walking fast, has cold extremities, abdominal fullness, and in severe cases, loose stools and indigestion.
Qi deficient internally causes Deep pulse. Qi weakened externally causes Small pulse. Qi declining in hiding, unable to continue pulsing, causes Slow pulse. Tuo Qi does not mean separation from Interior Yin (like water drying from bank), but rather Qi normally fills the body like adhesion to boundaries. Now, inner pulse is subtle, outer is cut, showing discontinuity. Qi is shallow, failing to reach body boundaries, like water leaving bank or fruit leaving shell, hence Tuo Qi. Fast walking uses Zong Qi. Qi escaping Chest fails to connect upward, causing panting when walking fast. This relates to Deep pulse failing to ascend. Extremities fill with Yang Qi; Qi escaping extremities fails to penetrate outward, causing cold extremities. This relates to Small pulse failing to expand laterally. Spleen Qi deficiency fatigues transportation/distribution, causing abdominal fullness. Severe distribution failure causes watery stools (indistinguishable water/grain). Severe transportation failure causes undigested food (Qing Gu). This relates to Slow pulse failing to move vigorously. Zhang Zhongjing's pulse-symptom correspondence is always this meticulous.
Article 13: Pulse Wiry and Large. Wiry indicates reduction; Large indicates Kou. Reduction indicates Cold; Kou indicates Deficiency. Deficiency and Cold clashing is named Ge (Leather) pulse. In women, it indicates miscarriage or dripping uterine bleeding; in men, blood loss and seminal emission.
Note see Blood Gate. This article appears three times. In Blood Gate, emphasis is on Blood Loss; here, emphasis is on Essence Loss; in Women's Gate, emphasis is on Miscarriage/Dripping Bleeding. The meaning is identical.
Article 14: Xu Lao, abdominal urgency, palpitations, epistaxis, abdominal pain, dream seminal emission, limb soreness/pain, irritability/hotness of hands and feet, dry throat, dry mouth. Xiao Jian Zhong Tang is the primary formula.
Xiao Jian Zhong Tang Formula: Cinnamon Twig (Guizhi) [3 liang, peeled], White Peony Root (Shaoyao) [6 liang], Licorice Root (Gancao) [3 liang, roasted], Jujube (Dazao) [12 pieces], Fresh Ginger (Shengjiang) [3 liang], Malt Sugar (Jiao Yi) [1 sheng].
Boil six ingredients in 7 sheng water, reduce to 3 sheng, remove dregs, add Malt Sugar, heat gently until dissolved. Warm dose 1 sheng, three times daily.
Essence/Blood deficient internally/lower causes Yang Qi depleted upper/external. Qi cannot overcome Lao, this is the cause of Lao disease. Starting from Article 1 "Weak bones, lush skin, heavy fatigue," explaining Lao's origin. Excluding Articles 1-2 (Wind affecting Blood Bi), Article 3 discusses Lao pulse, Article 4 discusses complexion from Blood Loss Lao, Articles 5-6 discuss Lao pulse/symptoms, Articles 7-8 explain why weak bones lead to Lao, Article 9 treats seminal emission, Articles 10-11 discuss external Lao symptoms, Article 12 discusses internal Lao symptoms, Article 13 broadly discusses upper deficiency/lower collapse pulses in men/women. From this article to Articles 15-18 (five total), miscellaneous discussions on Three Jiao Lao due to deficiency and treatments. Hence directly titled Xu Lao. "Abdominal urgency" refers to panting/urgency inside. Upper deficiency allows rebellious Qi to attack, preventing deep inhalation, causing panting. Palpitations see under Jing Ji. Epistaxis see Blood Gate and Article 4 pale face note. All indicate upper deficiency/lower excess patterns. Abdominal pain...