（前论俯首从时不过于时，法中录其可以姑从者为浅病立法。余复续此论从《内经》“劳者温之、损者温之”两言，
悟入左右逢源，取效捷如影响。至于痰饮、咳嗽、怔忡、不寐及妇人经水不调等病，皆虚痨中必有之症，已详各门，毋
庸再赘，宜参考之。）
虚痨症，宋元诸家，分类别名，繁而无绪，如治丝而棼也。丹溪颇有把柄，专主补阴，用四物汤，
加黄柏、知母之类，后世非之。明。薛立斋出以六君子、四君子、归脾汤、补中益气汤、加味逍遥散之类，与六味丸、
八味丸、养荣汤之类间服。开口便以先后天立论，虽视诸家颇高一格，其实开后人便易之门。到张景岳出，专宗薛氏先
天之旨，而先天中分出元阴、元阳，立左右归饮丸，及大补元煎之类。有补无泻，自诩专家。虽论中有气虚、精虚之辨，
而大旨以气化为水，水化为气，阴阳互根，用方不甚分别，惟以熟地一味，无方不有，无病不用。是于简便之中，又开
一简便之门。且有着《药性》云∶地黄生于中州沃土，色黄味甘，谓非脾胃正药，吾不信也。此论一出，而《本经》《金
匮》诸圣训，扫地尽矣。夫薛氏书，通共二十四种，吾不能一一摘其弊。而观其案中所陈病源，俱系臆说，罕能阐《灵》、
《素》不言之秘；所用方法，不出二十余方，加减杂沓，未能会《本经》性味之微。时贤徐灵胎目为庸医之首，实不得
已而为此愤激之言也。即景岳以阴虚阳虚，铺张满纸，亦属浮泛套谈。能读《金匮》者，便知余言不谬也。详考虚劳治
法，自《内经》而外，扁鹊最精。上损从阳，下损从阴。其于针砭所莫治者，调以甘药。《金匮》因之，而立建中诸方。
意以营卫之道，纳谷为宝。居常调营卫以安其谷，寿命之本，积精自刚。居常节欲以生其精，及病之甫成，脉才见端，
惟恃建中复脉为主治。皆稼穑作甘之善药，一遵“精不足者，补之以味”之义也。景岳亦会得甘温之理，或变而为甘寒
至静之用，视惯用苦寒戕伐中土者颇别。然方方重用熟地，自数钱以及数两，古法荡然矣。且熟地之用滞，非胃所宜。（《经》
云∶六腑者，传化物而不藏，以通为用。）其性湿，非脾所喜。彼盖取滋润以填补其精，而不知精生于谷，脾胃伤则谷少
久而不生其血，血少自不能化精，而虚劳日甚。况虚劳之人，必有痰嗽，亦最易感冒，若重用频用熟地，又佐之以参、
术，则风寒闭于皮毛而不出，痰火壅滞于胸膈而不清，药入病增，谓非人人之共见乎！予于此症，每力争治法，无如医
友及病家，心服薛氏、景岳诸法，以六味、八味、左归、右归、补中、逍遥、六君、四君、大补元煎之类，谓不寒不燥
之品，先入为主，至死不悔，亦斯民之厄也。戊申秋闱后，抑郁无聊，取《内经》、《金匮》等书，重加研究，参之平时
所目击之症，如何而愈，如何而剧而死，大有所悟。知虚痨之病，死于病者少，死于药者多。侃侃不阿，起立斋，景岳
于今日，当亦许为直友也。请略陈方治于下，以为耳食治虚痨者，脑后下一针。
（前文论述俯首顺应时俗，不过分拘泥于时俗，在治法中收录那些可以暂时顺应的内容，为浅表疾病确立法则。我随后续写此论，依据《内经》中“劳者温之、损者温之”这两句话，领悟到治疗左右逢源，取效迅速如影随形。至于痰饮、咳嗽、怔忡、不寐及妇人经水不调等疾病，都是虚痨病中必然伴随的症状，已在各门类中详细论述，无需再赘述，应当参考。）
虚痨症，宋元时期的各位医家，分类别名繁多而无条理，就像梳理丝线却越理越乱。朱丹溪颇有见解，专门主张补阴，使用四物汤，加入黄柏、知母之类的药物，后世对此非议纷纷。明代薛立斋出现后，以六君子汤、四君子汤、归脾汤、补中益气汤、加味逍遥散等方剂，与六味丸、八味丸、养荣汤等方剂交替服用。他开口便从先天和后天立论，虽然比各家高明一筹，但实际上是开启了后人图方便的门路。到了张景岳出现，专门尊崇薛氏关于先天的宗旨，而在先天之中又分出元阴、元阳，创立了左归饮、左归丸，以及大补元煎等方剂。只有补益没有泻法，自诩为专家。虽然在论述中有气虚、精虚的辨别，但主旨认为气化生为水，水生化为气，阴阳互为根本，使用方剂并不十分区分，只是无论什么方子都含有熟地黄一味药，无论什么病都使用它。这便在简便之中，又开启了一扇更简便的门。况且有人著《药性》说：地黄生长在中州的肥沃土地上，颜色黄味道甜，如果说它不是脾胃的正药，我不相信。这种言论一出，而《本经》《金匮》等圣人的训诫，便扫地无余了。薛立斋的书，总共有二十四种，我不能一一摘取它的弊端。但看他在医案中陈述的病源，都是主观臆测，很少能阐发《灵枢》、《素问》中未曾明言的秘密；所使用的方法，不出二十多个方剂，加减杂乱，未能领会《本经》药性的微妙之处。当时的贤者徐灵胎将其视为庸医之首，实在是不得已才说出这样愤激的话。即使张景岳将阴虚阳虚铺陈满纸，也属于浮泛的套话。能读懂《金匮要略》的人，就知道我的话没有谬误。详细考证虚劳的治法，除了《内经》之外，扁鹊最为精通。上部的损伤从阳论治，下部的损伤从阴论治。对于针灸无法治疗的，用甘味药物调理。《金匮要略》沿袭了这一思想，创立了建中诸方。意思是营卫之道，以纳谷为宝。平时调理营卫以安顿饮食，这是寿命的根本；平时节制欲望以滋生精气，精气充足自然刚强。等到病症刚刚形成，脉象才露出端倪，只依靠建中汤、复脉汤作为主要治疗方法。这些都是稼穑作甘性质的善药，完全遵循“精不足者，补之以味”的含义。张景岳也领会了甘温的道理，或者将其变化为甘寒至静的用法，与惯用苦寒药物戕伐中土的人颇为不同。然而他的方剂中重用熟地黄，从几钱到几两，古法荡然无存。而且熟地黄的用法滋腻，不适合胃。（《内经》说：六腑，传导化物而不贮藏，以通降为用。）它的性质湿滞，不是脾脏所喜欢的。他大概是取滋润之意来填补精气，却不知道精气生于谷物，脾胃受伤则谷物减少，长久不能生成血液，血液少自然不能化生精气，从而虚劳日益严重。况且虚劳病人，一定有痰嗽，也最容易感冒，如果重用、频用熟地黄，又佐以人参、白术，那么风寒闭阻于皮毛而不能发散，痰火壅滞于胸膈而不能清利，药物进入体内反而使病情加重，这不是人人都看得见的吗！我对这个病症，每次都极力争辩治法，无奈医生朋友及病人家属，心中信服薛氏、张景岳等人的方法，认为六味丸、八味丸、左归丸、右归丸、补中益气汤、逍遥散、六君子汤、四君子汤、大补元煎等，是不寒不燥的药物，先入为主，至死不悔，这也是百姓的灾厄啊。戊申年秋闱之后，抑郁无聊，取出《内经》、《金匮》等书，重新加以研究，结合平时亲眼目睹的病症，如何痊愈，如何加剧而死，大有感悟。知道虚痨病，死于疾病本身的少，死于药物的多。直言不讳，不阿谀奉承，如果让薛立斋、张景岳活在今天，他们也应该允许我为直率的朋友吧。请在下面简要陈述方治，作为给那些耳食之言治疗虚痨者脑后的一针。
(The previous discussion addressed conforming to contemporary trends without excessive adherence, recording methods that could be temporarily adopted to establish principles for superficial diseases. I subsequently continued this discourse, drawing inspiration from the two phrases in the *Neijing* (Classic of Internal Medicine): "For exhaustion, use warmth; for deficiency, use warmth." This led me to a state of versatile mastery, achieving effects as swiftly as shadows and echoes. As for conditions such as phlegm-fluid retention (Tan Yin), cough, palpitations (Zheng Chong), insomnia (Bu Mei), and irregular menstruation in women, these are symptoms inevitably present in consumptive disease (Xu Lao). They have been detailed in their respective sections and need not be repeated here; readers should refer to them.)
In the Song and Yuan dynasties, various physicians classified consumptive disease (Xu Lao) with numerous subtypes and names, creating chaos without order, akin to trying to untangle silk threads only to make them more knotted. Zhu Danxi had his own insights, specifically advocating for nourishing Yin. He utilized Siwu Tang (Four Substances Decoction) supplemented with herbs such as Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma). Later generations criticized this approach. In the Ming Dynasty, Xue Lizhai emerged, employing formulas such as Liu Junzi Tang (Six Gentlemen Decoction), Sijunzi Tang (Four Gentlemen Decoction), Guipi Tang (Restore the Spleen Decoction), Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), and Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), alternating them with Liuwei Wan (Six-Ingredient Pill with Rehmannia), Bawei Wan (Eight-Ingredient Pill), and Yangrong Tang (Nourish the Blood Decoction). He invariably framed his arguments around the concepts of Congenital Constitution (Xian Tian) and Acquired Constitution (Hou Tian). Although his approach was superior to others, it essentially opened a door for later practitioners to seek convenience. When Zhang Jingyue appeared, he exclusively followed Xue’s emphasis on the Congenital Constitution but further divided it into Primordial Yin (Yuan Yin) and Primordial Yang (Yuan Yang). He established formulas such as Zuogui Yin (Left Restoring Drink), Zuogui Wan (Left Restoring Pill), and Dabu Yuanjian (Great Tonification of the Origin Decoction). His method consisted solely of tonification without purgation, claiming expertise. Although his discussions distinguished between Qi deficiency and Essence deficiency, his main thesis posited that Qi transforms into Water and Water transforms into Qi, with Yin and Yang rooting each other. Consequently, he did not differentiate much among formulas, universally including Shudi (Prepared Rehmanniae Radix) in every prescription and applying it to every disease. Thus, within the realm of simplicity, he opened an even simpler path. Furthermore, someone wrote in *Yaoxing* (Properties of Medicinals): "Rehmannia grows in the fertile lands of the Central Plains; its color is yellow and taste sweet. If one says it is not a primary herb for the Spleen and Stomach, I do not believe it." With this assertion, the sacred teachings of the *Shennong Bencao Jing* (Divine Farmer's Materia Medica) and *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) were completely disregarded. Xue Lizhai authored twenty-four works in total; I cannot critique every flaw. However, observing the disease origins he cited in his case records, they were mostly subjective speculations, rarely elucidating the unspoken secrets of the *Lingshu* (Spiritual Pivot) and *Suwen* (Basic Questions). The methods he employed relied on no more than twenty formulas, with chaotic modifications that failed to grasp the subtle properties described in the *Bencao Jing*. The contemporary scholar Xu Lingtai labeled him the head of quack doctors, which was an expression of justified indignation. Even Zhang Jingyue’s extensive writings on Yin and Yang deficiency were merely superficial clichés. Those who can read the *Jingui Yaolue* will know my words are not erroneous. A detailed examination of treatments for consumptive disease reveals that, apart from the *Neijing*, Bian Que was the most proficient. Upper damage should be treated via Yang, and lower damage via Yin. For conditions beyond the reach of acupuncture and moxibustion, he recommended regulating with sweet medicines. The *Jingui Yaolue* adopted this principle, establishing the Jianzhong (Build the Middle) formulas. The idea is that the way of Ying and Wei (Defensive and Nutritive Qi) treasures food intake. Normally, regulating Ying and Wei stabilizes digestion, which is the root of longevity; normally, restraining desires generates Essence, and abundant Essence leads to strength. When the disease has just begun and pulse signs are emerging, treatment relies primarily on Jianzhong Tang (Middle-Building Decoction) and Fumai Tang (Restore the Pulse Decoction). These are all herbs with the nature of "sweetness generated by sowing and reaping," strictly following the principle: "When Essence is insufficient, tonify it with flavor." Zhang Jingyue also understood the principle of sweet-warmth, sometimes varying it into sweet-cold and tranquil applications, which differed significantly from those who habitually used bitter-cold herbs to damage the Middle Jiao. However, his formulas heavily relied on Shudi, ranging from several qian to several liang, completely abandoning ancient methods. Moreover, the cloying nature of Shudi is unsuitable for the Stomach. (The *Jingui* states: The Six Fu Organs transmit and transform substances without storing them; their function is based on free flow.) Its moist and stagnant nature is not favored by the Spleen. He likely intended to use its moisturizing property to replenish Essence, unaware that Essence is generated from Grain. If the Spleen and Stomach are injured, Grain intake decreases, and over time, Blood cannot be generated. Since Blood is insufficient, it cannot transform into Essence, causing consumptive disease to worsen daily. Furthermore, patients with consumptive disease invariably have phlegm and cough and are prone to catching colds. If Shudi is used heavily and frequently, assisted by Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma), then Wind-Cold will be trapped in the skin and hair without dispersing, and Phlegm-Fire will stagnate in the chest and diaphragm without clearing. It is evident to everyone that such medication increases the disease rather than curing it. Regarding this condition, I have always strongly advocated for specific treatment methods. However, physician colleagues and patients' families firmly believed in the methods of Xue Lizhai and Zhang Jingyue. They considered formulas like Liuwei Wan, Bawei Wan, Zuogui Wan, Zuogui Yin, Buzhong Yiqi Tang, Xiaoyao San, Liu Junzi Tang, Sijunzi Tang, and Dabu Yuanjian to be neither cold nor dry, adopting these views preconceivedly and refusing to repent until death. This is indeed a calamity for the people. After the autumn examinations in the year Wushen, feeling depressed and bored, I retrieved the *Neijing*, *Jingui Yaolue*, and other texts for further study. Combining this with clinical observations of how patients recovered or deteriorated to death, I gained profound insights. I realized that in consumptive disease, few die from the illness itself, while many die from improper medication. Speaking frankly and without flattery, if Xue Lizhai and Zhang Jingyue were alive today, they would likely accept me as a candid friend. Below, I briefly present my therapeutic approaches as a wake-up call for those treating consumptive disease based on hearsay.]