骨蒸发热，脉数而虚。热而涩小，必殒其躯。
骨蒸发热者，热自骨起，蒸发于外，内伤虚劳之热也。脉数而虚，是其本然。
盖以数为热，虚为劳耳。若蒸热而见涩小之脉，涩则精血少，小则元气衰。真阴日
损，邪火日增，不至于殒躯不已也。（方参看劳极门。）
劳极诸虚，浮软微弱。土败双弦。火炎急数。
劳极者，五劳六极也。巢氏病源云∶五劳者，一曰志劳、二曰思劳、三曰心劳、
四曰忧劳、五曰瘦劳。（瘦当是肝劳。）又云∶肺劳者，短气而面肿，鼻不闻香臭。肝劳者，
面目干黑，口苦，精神不守，恐畏不能独卧，目视不明。心劳者，忽忽喜忘，大便
苦难，或时鸭溏，口内生疮。脾劳者，舌苦直，不得咽唾。肾劳者，背难以俯仰，
小便不利，色赤黄而有余沥，茎内痛，阴湿囊生疮，小腹满急。此五劳各见五脏气
化，及经络诸证，亦甚明显。但与前五劳，不甚符合。姑存此，俟再考也。六极者，
一曰气极，令人内虚，五脏不足，邪气多，正气少，不欲言。（宜四君子汤、补中益气汤、参
术膏之类。）二曰血极，令人无颜色，眉发堕落，忽忽喜忘。（宜四物汤、六味丸、八珍汤、圣愈汤之
类。）三曰筋极，令人数转筋，十指爪甲皆痛，苦倦，不能久立。（宜四物汤、圣愈汤、济生续
断汤、木瓜散之类。）四曰骨极，令人 削，齿苦痛，手足烦疼，不可以立，不欲行动。（宜六
味丸、鹿角丸、保命金刚丸、丹溪虎潜丸之类。）五曰肌极，令人羸瘦无润泽，饮食不生肌肤。（宜四
君子汤、保命黑地黄丸、资生丸之类。）六曰精极，令人少气， 然内虚，五脏气不足，发毛
落，悲伤喜忘。（宜六味丸、还少丹、龟鹿胶之类。）是即五脏所合之病，虚损而至于极处者也。
肾则多一精极，故为六极。其证与五脏配合，甚为有理，此巢氏之三昧论也。诸虚
者，言一切虚损不足，即五劳六极，更有七伤，俱该在内。巢氏云∶七伤者，一曰
阴寒，二曰阴痿，三曰里急，四曰精连连，五曰精少、阴下湿，六曰精清，七曰小
便苦数，临事不卒。又云∶七伤者，一曰大饱伤脾。脾伤善噫、欲卧、面黄。（宜资生
丸、保和丸、平胃散之类。）二曰大怒气逆伤肝。肝伤少血、目暗。（宜四物汤、元戎逍遥散之
类。）三曰强力举重、久坐湿地伤肾。肾伤少精、腰背痛、厥逆下冷。（宜黑地黄丸、肾着汤、八味丸、宝
鉴天真丹之类。）四曰形寒寒饮伤肺。肺伤少气、咳嗽鼻鸣。（宜小青龙汤、麻黄汤之类。）五曰忧愁
思虑伤心。心伤苦惊，喜忘善怒。（宜天王补心丸、朱砂安神丸、朱雀丸之类。）六曰风雨寒暑伤形。
形伤发肤枯夭。（宜人参养荣汤之类。）七曰大恐惧不节伤志。（言大恐惧而不节于欲也。）志伤恍惚不
乐。（宜天王补心丸、安神丸之类。）是云七伤。亦合于五脏，但多一形志，故云七伤。较前所
云七伤，此为得理。盖前七伤，大抵俱属肾证。人身感疾，触处可伤，岂独一肾。
若云肾有七伤则可。正文不言七伤而注录者，欲其便于查考耳。夫劳极损伤，气血
日耗，形体渐衰。所见之脉，随病呈象。如空虚之浮、不鼓之软、欲绝之微、无力
之弱。虽云病脉，然与病犹相宜也。至若双弦，乃知土败。急数定为火炎。盖弦为
肝木，双弦则木太盛。久病之土，何堪其侮，故知其必败也。数已为热。急数，则
躁疾直强，略无半点和柔。邪火炎炎，真阴自绝。两皆不治之证。
所谓骨蒸发热，是指热感从骨骼深处发出，向外蒸腾，这是内伤虚劳所致的热证。脉象数而虚，是其本来的表现。
因为“数”主热，“虚”主劳损罢了。如果蒸热却出现涩小的脉象，涩脉表示精血亏少，小脉表示元气衰败。真阴日益损耗，邪火日益亢盛，不致于身体毁灭是不会停止的。（方剂参考查看劳极门。）
劳极的各种虚证，脉象浮软微弱。若见双弦脉，说明脾土败坏；若见急数脉，说明心火炎上。
所谓劳极，指的是五劳和六极。巢元方《诸病源候论》说：五劳，一是志劳，二是思劳，三是心劳，四是忧劳，五是瘦劳（“瘦”字应当是“肝”劳）。又说：肺劳的症状，是气短且面部浮肿，鼻子闻不到香味和臭味。肝劳的症状，是面目干枯发黑，口苦，精神不能守舍，恐惧害怕不能独自睡觉，视力模糊不清。心劳的症状，是恍惚健忘，大便干结困难，有时像鸭粪一样稀溏，口中生疮。脾劳的症状，是舌体僵硬挺直，不能吞咽唾液。肾劳的症状，是背部难以俯仰，小便不利，颜色赤黄且有淋漓不尽的感觉，阴茎内部疼痛，阴部潮湿且囊生疮疡，小腹胀满急迫。这五种劳损各自表现出五脏的气化功能异常，以及经络的各种症状，也非常明显。但这与前文提到的五种劳损不太符合。姑且保留此说，等待以后考证。六极，一是气极，使人内脏虚弱，五脏不足，邪气多而正气少，不想说话。（适宜用四君子汤、补中益气汤、参术膏之类的方剂。）二是血极，使人面色无华，眉毛头发脱落，恍惚健忘。（适宜用四物汤、六味丸、八珍汤、圣愈汤之类的方剂。）三是筋极，使人频繁发生转筋，十个手指和指甲都疼痛，极度疲倦，不能久站。（适宜用四物汤、圣愈汤、济生续断汤、木瓜散之类的方剂。）四是骨极，使人身体消瘦，牙齿痛苦疼痛，手足烦疼，不能站立，不想活动。（适宜用六味丸、鹿角丸、保命金刚丸、丹溪虎潜丸之类的方剂。）五是肌极，使人羸弱消瘦没有润泽，饮食不能转化为肌肉。（适宜用四君子汤、保命黑地黄丸、资生丸之类的方剂。）六是精极，使人气短，汗出且内脏空虚，五脏之气不足，毛发脱落，悲伤且健忘。（适宜用六味丸、还少丹、龟鹿胶之类的方剂。）这就是五脏所合的疾病，虚损到了极点。肾脏则多出一个精极，所以称为六极。其症状与五脏配合，非常有道理，这是巢元方的精妙论述。所谓的“诸虚”，是说一切虚损不足，即五劳六极，再加上七伤，都包含在内。巢元方说：七伤，一是阴寒，二是阳痿，三是里急，四是精液连连滑泄，五是精少、阴部潮湿，六是精液清稀，七是小便频数痛苦，行房事不能完成。又说：七伤，一是饱食过度伤脾。脾受伤容易嗳气、想躺卧、面色发黄。（适宜用资生丸、保和丸、平胃散之类的方剂。）二是大怒气逆伤肝。肝受伤血液减少、眼睛昏暗。（适宜用四物汤、元戎逍遥散之类的方剂。）三是强力举重、久坐湿地伤肾。肾受伤精液减少、腰背疼痛、四肢厥冷下焦寒冷。（适宜用黑地黄丸、肾着汤、八味丸、宝鉴天真丹之类的方剂。）四是形体受寒、喝冷饮伤肺。肺受伤气短、咳嗽鼻鸣。（适宜用小青龙汤、麻黄汤之类的方剂。）五是忧愁思虑伤心。心受伤苦于惊恐，喜欢遗忘且易怒。（适宜用天王补心丸、朱砂安神丸、朱雀丸之类的方剂。）六是风雨寒暑伤害形体。形体受伤导致皮肤枯槁夭折。（适宜用人参养荣汤之类的方剂。）七是大恐惧而不节制欲望伤志。（意思是大恐惧且不节制情欲。）志受伤表现为恍惚不乐。（适宜用天王补心丸、安神丸之类的方剂。）这就叫七伤。这也符合五脏，只是多了一个形志，所以叫七伤。比起前面所说的七伤，这个说法更有道理。因为前面的七伤，大体上都属于肾虚证。人身感受疾病，触处皆可受伤，难道只有肾脏吗？如果说肾有七伤还可以。正文没有提及七伤而注释中收录，是为了便于查阅考证。劳极损伤，气血日渐耗损，形体逐渐衰弱。所见到的脉象，随着病情呈现形象。如空虚之浮脉、不鼓动之软脉、似绝之微脉、无力之弱脉。虽然说是病脉，但与病情还是相适应的。至于双弦脉，就知道是脾土败坏。急数脉必定是火炎上。因为弦脉属肝木，双弦则肝木太盛。久病的脾土，怎能承受这种克制，所以知道它必然败坏。数脉已经是热，急数脉则躁疾直强，完全没有半点柔和之意。邪火炎炎，真阴自然断绝。这两者都是不治之证。
Bone-steaming fever presents with a rapid and deficient pulse. If there is steaming fever accompanied by a choppy and small pulse, death is inevitable.
Bone-steaming fever refers to heat arising from the bones and steaming outward; it is the heat syndrome caused by internal injury and deficiency consumption (Xu Lao). A rapid and deficient pulse is its natural presentation.
This is because "rapid" indicates heat, and "deficient" indicates exhaustion. If steaming fever is seen with a choppy and small pulse, a choppy pulse signifies a scarcity of essence and blood, while a small pulse signifies a decline of primordial qi. As true yin is daily depleted and pathogenic fire daily increases, the condition will not cease until the body perishes. (For formulas, refer to the section on Extreme Exhaustion.)
Various deficiency syndromes of extreme exhaustion present with floating, soft, and weak pulses. A double wiry pulse indicates the failure of Earth (Spleen); an urgent and rapid pulse indicates flaming fire (Heart).
Extreme exhaustion refers to the Five Labors and Six Extremes. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states: The Five Labors are: first, Labor of Will (Zhi Lao); second, Labor of Thought (Si Lao); third, Labor of Heart (Xin Lao); fourth, Labor of Worry (You Lao); fifth, Labor of Emaciation (Shou Lao) [Note: "Shou" should likely be "Liver Labor"]. It further states: In Lung Labor, there is shortness of breath and facial swelling, and the nose cannot perceive odors. In Liver Labor, the face and eyes are dry and dark, there is bitter taste in the mouth, spirit fails to remain anchored, fear prevents sleeping alone, and vision is unclear. In Heart Labor, there is mental confusion and forgetfulness, difficult and hard stools, or sometimes loose duck-dung-like diarrhea, and sores in the mouth. In Spleen Labor, the tongue is stiff and straight, making swallowing of saliva difficult. In Kidney Labor, the back is difficult to bend forward or backward, urination is obstructed, urine is red-yellow with dribbling, there is pain inside the penis, dampness in the genitalia with sores on the scrotum, and fullness and urgency in the lower abdomen. These five labors manifest the dysfunction of the Qi transformation of the five Zang organs and various meridian symptoms, which are quite obvious. However, they do not fully match the previous description of the five labors. This is retained here for future verification. The Six Extremes are: first, Extreme of Qi, causing internal emptiness, insufficiency of the five Zang organs, excess of pathogenic factors, scarcity of righteous Qi, and reluctance to speak. (Suitable formulas include Si Jun Zi Tang [Four Gentlemen Decoction], Bu Zhong Yi Qi Tang [Tonify the Middle and Augment the Qi Decoction], and Shen Zhu Gao [Ginseng and Atractylodes Paste].) Second, Extreme of Blood, causing lack of luster in the complexion, falling eyebrows and hair, mental confusion and forgetfulness. (Suitable formulas include Si Wu Tang [Four Substance Decoction], Liu Wei Wan [Six-Ingredient Pill with Rehmannia], Ba Zhen Tang [Eight Treasure Decoction], and Sheng Yu Tang [Nourish Life Decoction].) Third, Extreme of Tendons, causing frequent muscle spasms, pain in all ten fingers and nails, severe fatigue, and inability to stand for long periods. (Suitable formulas include Si Wu Tang, Sheng Yu Tang, Ji Sheng Xu Duan Tang [Ji Sheng Continuation-of-Tendons Decoction], and Mu Gua San [Papaya Powder].) Fourth, Extreme of Bones, causing emaciation, painful teeth, vexing pain in hands and feet, inability to stand, and reluctance to move. (Suitable formulas include Liu Wei Wan, Lu Jiao Wan [Deer Antler Pill], Bao Ming Jin Gang Wan [Life-Preserving Diamond Pill], and Dan Xi Hu Qian Wan [Danxi Tiger-Hiding Pill].) Fifth, Extreme of Flesh/Muscles, causing emaciation without moisture/luster, and food failing to transform into flesh/muscle. (Suitable formulas include Si Jun Zi Tang, Bao Ming Hei Di Huang Wan [Life-Preserving Black Earth Rehmannia Pill], and Zi Sheng Wan [Nourishing Life Pill].) Sixth, Extreme of Essence, causing shortness of breath, sweating with internal emptiness, insufficiency of Qi in the five Zang organs, falling hair, sadness, and forgetfulness. (Suitable formulas include Liu Wei Wan, Hai Shao Dan [Return to Youth Elixir], and Gui Lu Jiao [Tortoise and Deer Glue].) These are diseases associated with the five Zang organs, representing deficiency reaching the extreme. The Kidney has one additional category, Extreme of Essence, hence the term Six Extremes. The correlation of symptoms with the five Zang organs is logical; this is the profound insight of Chao Yuanfang. The term "various deficiencies" refers to all types of deficiency and insufficiency, encompassing the Five Labors, Six Extremes, and also the Seven Injuries. Chao Yuanfang states: The Seven Injuries are: first, Yin Cold; second, Impotence; third, Internal Urgency; fourth, Continuous seminal emission; fifth, Scanty essence and dampness in the Yin region; sixth, Clear essence; seventh, Painful frequency of urination and inability to complete sexual intercourse. He also states: The Seven Injuries are: first, Overeating injures the Spleen. Spleen injury leads to belching, desire to lie down, and yellow complexion. (Suitable formulas include Zi Sheng Wan, Bao He Wan [Harmonize the Stomach Pill], and Ping Wei San [Calm the Stomach Powder].) Second, Great anger with counterflow injures the Liver. Liver injury leads to reduced blood and dim vision. (Suitable formulas include Si Wu Tang and Yuan Rong Xiao Yao San [Yuan Rong Free and Easy Wanderer Powder].) Third, Straining to lift heavy objects and sitting long in damp places injures the Kidney. Kidney injury leads to scanty essence, lower back and back pain, cold extremities, and coldness in the lower jiao. (Suitable formulas include Hei Di Huang Wan, Shen Zhuo Tang [Kidney-Dampness Decoction], Ba Wei Wan [Eight-Ingredient Pill], and Bao Jian Tian Zhen Dan [Precious Mirror True Nature Elixir].) Fourth, External cold and cold drinks injure the Lungs. Lung injury leads to shortness of breath, cough, and nasal congestion. (Suitable formulas include Xiao Qing Long Tang [Minor Green Dragon Decoction] and Ma Huang Tang [Ephedra Decoction].) Fifth, Worry and overthinking injure the Heart. Heart injury causes distress from fright, forgetfulness, and irritability. (Suitable formulas include Tian Wang Bu Xin Wan [Heavenly Emperor Heart-Nourishing Pill], Zhu Sha An Shen Wan [Cinnabar Calming Spirit Pill], and Zhu Que Wan [Vermilion Bird Pill].) Sixth, Wind, rain, cold, and heat injure the Form. Form injury leads to withered skin and premature aging. (Suitable formula includes Ren Shen Yang Rong Tang [Ginseng Nourishing Vigor Decoction].) Seventh, Great fear without moderation injures the Will (Zhi). (Meaning great fear combined with unmoderated desires.) Will injury leads to mental confusion and unhappiness. (Suitable formulas include Tian Wang Bu Xin Wan and An Shen Wan [Calming Spirit Pill].) This is called the Seven Injuries. It also corresponds to the five Zang organs, but adds the aspect of Form and Will, hence the name Seven Injuries. Compared to the previously mentioned Seven Injuries, this explanation is more logical. Because the previous Seven Injuries largely belonged to Kidney syndromes. When the human body contracts disease, any part can be injured; how could it be only the Kidney? It would be acceptable to say the Kidney has seven injuries. The main text does not mention the Seven Injuries, but the commentary records them for ease of reference. Extreme exhaustion damages Qi and Blood, which are daily consumed, and the physical form gradually declines. The observed pulses reflect the pathology. For example, floating pulse that feels empty, soft pulse that lacks pulsation force, minute pulse that seems to vanish, and weak pulse that lacks strength. Although these are pathological pulses, they are appropriate to the disease state. However, a double wiry pulse indicates the failure of Earth. An urgent and rapid pulse definitely indicates flaming fire. Since the wiry pulse belongs to Liver Wood, a double wiry pulse means Liver Wood is excessive. How can the Earth of a chronic patient withstand such suppression? Thus, we know it must fail. A rapid pulse already indicates heat; an urgent and rapid pulse is frantic and rigid, lacking any gentleness. Pathogenic fire blazes, and true yin naturally severs. Both are untreatable conditions.