经义
阳虚则外寒，阴虚则内热。○肝虚，则目KT KT 无所见，耳无
所闻，善恐，如人将捕之。○心虚，则胸腹大，胁下与腰相引而痛。○脾虚，则腹满肠鸣，飧泄，食不化。○肺
虚，则少气不能报息，耳聋嗌干。○肾虚，则胸中痛，大腹小腹痛，清厥，意不乐。（《素问》）
五脏，主藏精者也，不可伤，伤则失守而阴虚，阴虚则无气，无气则死矣。○精脱者，耳聋；气脱者，目不
明；津脱者，腠理开，汗大泄；液脱者，骨属屈伸不利，色夭，脑髓消，胫酸，耳数鸣；血脱者，色白，夭然
不泽。（《灵枢》）
一损损于皮毛，则皮聚而毛落；二损损于血脉，血脉虚少，不能荣于五脏六腑；三损损于肌肉，肌肉消瘦，
饮食不能为肌肤；四损损于筋，筋缓不能自收持；五损损于骨，骨痿不能起于床。○损其肺者，益其气；损其
心者，调其营卫；损其脾者，调其饮食，适其寒温；损其肝者，缓其中；损其肾者，益其精。（《难经》）
哲言
男子面色薄者，主渴及亡血；卒喘悸，脉浮者，里虚也。○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。○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。○男子脉浮弱而涩，为无子，精气清冷。○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。○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。（《金匮》）
按∶脉浮者，里虚也。当是衍文。○按∶阴寒精自出之寒字，当是虚字，是传写之讹。○按∶若肠鸣三字，
与上下文不属，必是错简，当删之。侠瘿之瘿字，当是瘰字，且先劳后瘰、先瘰后劳者有之，从未见劳瘿先
后病也，当改之。（《医宗金鉴》）
男子之劳，起于伤精；女子之劳，起于经闭；童儿之劳，得于母胎。（《明医指掌》）
肾气虚者，脾气必弱；脾气弱者，肾气必虚。盖肾为先天祖
气，脾为后天生气，而生气必宗于祖气也。（《冯氏锦囊》）
卫虚则外寒而栗，营虚则内热而咳；营虚则咳伤肺而唾腥，卫虚则寒入脾而吐涎沫。（程扶生）
冷劳者，由于气血不足，脏腑虚寒，以致脐下冷痛，手足时寒，妇人月水失常，饮食不消，或时呕吐，寒
热，骨节酸疼，肌肤羸瘦，面色萎黄者是也。○热劳者，由于心肺内热，伤于气血，以致心神烦躁，颊赤头痛，
眼涩唇干，口舌生疮，神思昏倦，四肢壮热，饮食无味，怔忡盗汗，肢体酸痛，或寒热往来者是也。当审其所
因，调补气血，其证自减。○骨蒸劳者，由于积热内附骨髓而名，其形羸瘦，泄利食少，肢体无力。传于肾，
则盗汗不止，腰膝酸痛，梦鬼交侵；传于心，则心神怯悸，颊赤寒热；传于肺，则胸满短气，咳嗽吐痰，皮肤
甲错；传于肝，则两目昏暗，胁痛忿怒。五脏既病，则难治疗。立斋云∶前证多因经行、胎产，或饮食、七情
内伤脾胃所致，或病后失调而成。（胡慎柔）
骨蒸，以多汗为易治，气虚血尚未竭也。若干热无汗，为难治，气血内涸不能外通也。（张路玉）
或问∶阴虚何以发热？曰∶凡人昼则气行于阳，夜则气行于阴，阳入阴则寐者，是火归于水中，而成既
济之象，故无病。阴既虚矣，阳入而无阴以制之，则阳浮散，自内而出，身体皆热，其热自内而生也。（《证治准绳》）
凡虚损之由，无非酒色、劳倦、七情、饮食所致。或先伤其气，气伤必及于精；或先伤其精，精伤必及
于气。但精气在人，无非谓之阴分，盖阴为天一之根，形质之祖，故凡损在形质者，总曰阴虚，此大目也。若
分而言之，则有阴中之阴虚者，其病为发热躁烦、头红面赤、唇干舌燥、咽痛口疮、吐血衄血、便血尿血、大
便燥结、小水痛涩等证。有阴中之阳虚者，其病为怯寒憔悴、气短神疲、头晕目眩、呕恶食少、腹痛飧泄、二
便不禁等证，甚至咳嗽吐痰、遗精盗汗、气喘声喑、筋骨疼痛、心神恍惚、肌肉
尽削、梦与鬼交、妇人月闭等证。则无论阴阳，凡病至极，总由真阴之败耳。然真阴所居，惟肾为主，盖肾为
精血之海，而人之生气，即同天地之阳气，无非自下而上，所以肾为五脏之本。故肾水亏，则肝失所滋而血燥
生；肾水亏，则水不归源而脾痰起；肾水亏，则心肾不交而神色败；肾水亏，则盗伤肺气而喘嗽频；肾水亏，
则孤阳无主而虚火炽。凡劳伤等证，使非伤及根本，何以危笃至此？故凡病甚于上者，必其竭甚于下也。余故
曰∶虚邪之至，害必归阴；五脏之伤，穷必及肾。穷而至此，吾末如之何也矣！○凡损伤元气者，本皆虚证，
古人以虚损、劳瘵各分门类，病若有异，亦所宜辨。盖虚损之谓，或有发见于一证，或有困惫于临时，凡在经
在脏，但伤元气，则无非虚损病也。至若劳瘵之有不同者，则或以骨蒸，或以干嗽，甚至吐血吐痰，营卫俱败，
羸日甚，此其积渐有日，本末俱竭而然。但虚损之虚，有在阴分，有在阳分，然病未深，多宜温补，若
劳瘵之虚，深在阴中之阴分，多有不宜温补者。然凡治虚证，宜温补者，病多易治；不宜温补者，病多难治。
比虚劳若乎有异，而不知劳瘵之损，即损之深而虚之甚者耳。○虚损，颧赤唇红者，阴虚于下，逼阳于上也；
口多干渴者，肾水不足，引水自救也；音哑声不出者，由肾气之竭，盖声出于喉而根于肾也；气息喘急者，阴
虚肺槁，气无所归也；喉干咽痛者，真水下亏，虚火上浮也；不眠恍惚者，血不养心，神不能藏也；时多烦躁
者，阳中无阴，柔不济刚也；易生嗔怒，或筋急酸痛者，水亏木燥，肝失所资也；饮食不甘，肌肉渐削者，脾
元失守，化机日败也；心下跳动，怔忡不息者，气不归精也；盗汗不止者，有火则阴不能守，无火则阳不能固
也；多痰或如清水，或多白沫者，水泛为痰，脾虚不能制水也；骨痛如折者，肾主骨，真阴败竭也；腰胁痛者，
肝肾虚也；膝下冷者，命门衰绝，火不归原也；小水黄涩淋沥者，真阴亏竭，气不化水也；足心如烙者，虚火
烁阴，涌泉涸竭也。○劳损之病，本
属阴虚，阴虚必血少，指爪为血之余，故于诊候之际，但见其指爪干黄，觉有枯槁之色，则其发肤营气，具在
吾目中矣。○似损非损之证，惟外感寒邪者乃有之。盖以外邪初感，不为解散，误作内伤，或用清凉，或用清
导，以致寒邪伏留不散，而为寒热往来，或为潮热咳嗽，证似劳损，若用治损之法，则滋阴等剂愈以留邪，非
损成损矣。余尝治愈数人，皆其证也。欲辨此者，但当详察表里，而审其致病之由。盖虚损之证，必有所因，
而外感之邪，其来则骤。若外证，身有疼痛，微汗则热退，无汗则复热，或见大声咳嗽，脉虽弦紧，而不甚数，
或兼和缓，虽病至一两月，邪有不解，病不退者，本非劳损，毋误治也。○虚损既成，不补将何以复？有不能
服人参、熟地及诸补药者，此为虚不受补，何以望生？若劳损失血之后，嗽不能止，而痰多甚者，此以脾肺虚
极，饮食无能化血，随食成痰。此虽非血，而实血之类也。《经》曰∶白血出者死。故凡痰之最多最浊者，不
可治。左右者，阴阳之道路。其有不得左右，眠难转侧者，此其阴阳之气有所偏竭而然，多不可治。虚损原无
外邪，所以病虽至困，终不愦乱。其有患虚证而谵妄失伦者，心脏之败，神去之兆也；劳嗽音哑，声不能出，
或喘急气促者，肺脏之败也；劳嗽肌肉尽脱者，脾脏之败也；筋为罢极之本，凡病虚损，多有筋骨疼痛，若痛
极不可忍者，乃血竭不能荣筋，肝脏之败也；劳损既久，再及大便泄泻，不能禁止者，肾脏之败也。（张景岳）
虚劳之病，皆由内伤。如酒伤肺，则湿热熏蒸，肺阴销烁；色伤肾，则精室空虚，相火无制；思虑伤心，
则血耗而火易上炎；劳倦伤脾，则热生而内戕真阴。惟忿怒伤肝有二∶郁怒，则肝火内炽而灼血；大怒，则肝
火上升而吐血。此五者皆劳其精血也。○阴虚内热而成虚劳，大约伤于酒色为多。然有童子未室而患此证者，或
由先天不足，或禀母气阴虚。其师尼、寡妇、室女，气血郁结，以致寒热如疟，朝凉暮热，饮食不思，经期
不准，或致
闭绝而成此病者，多由郁火内蒸所致也。○虚劳之证，多因肾水真阴虚极，水不摄火，火因上炎，以致面赤唇
红，口鼻出血，齿痛齿衄。虽亦龙火上僭，然与虚阳上浮者不同，纵有下部恶寒足冷，总由阴虚火升，非真正
阳衰而然，故其溺必黄赤，脉必带数。设误用桂、附引火归原之法，是抱薪救火，上焦愈热，咳喘燥渴益甚，
咽痛喉烂诸证至矣。○气虚者，面白无神，言语轻微，四肢无力，脉来微弱；阳虚者，体冷畏寒，手足逆冷，
溺清便溏，脉沉小迟。此二者，能服参、 ，温补可治，斯气虚阳虚之证也。虽血脱者，亦有补气之法，乃指
卒暴失血，素非血虚之人，如新产之类耳。（《吴医汇讲》）
今医谓吐血为虚劳之病，大谬。夫吐血有数种，大概咳者成劳，不咳者不成劳。间有吐血偶咳者，当其吐
血之时，野狼狈颇甚，吐止即痊，皆不成劳。何也？其血止则周身无病，饮食如故，而精神生矣。即使亡血之后，
或阴虚内热，或筋骨疼痛，皆可服药而痊。若咳嗽，则血止而病仍在，日嗽夜嗽，痰壅气升，多则三年，少则
一年而死矣。盖咳嗽不止，则肾中之元气震荡不安，肺为肾之母，母病则子亦病故也。又肺为五脏之华盖，
《经》云∶谷气入胃，以传于肺，五脏六腑皆以受气。是则脏腑皆取精于肺，肺病，则不能输精于脏腑，一年
而脏腑皆枯，三年而脏腑竭矣，故咳嗽为真劳不治之疾也。然亦有咳嗽而不死者，其嗽有时稍缓，饮食起居不
变，又其人善于调摄，间或一发，静养即愈。此乃百中难得一者也。更有不咳之人，血证屡发，肝竭肺伤，渐
变咳嗽，久而亦死。此则不善调摄，以轻变重也。执此以决血证之死生，百不一失矣。（徐灵胎）
《内经》有所劳倦，此言当辨。或劳于力作，或劳于思虑，或劳于房帏，皆劳也。即劳矣，同一形气衰
少，而所以致劳之因则异。劳于力作者，当逸之以安闲，而甘其饮食，和其气血；劳于思虑者，当屏思却虑，
药之以养心；劳于房帏者，当远房帏，
滋肾水，尤当照顾脾土。（《怡堂散记》）
肾水既实，则阴精上奉于心肺，故东方之木气不实，而西方之金气不虚，此子能令母实，使金得以平木也。
是故水日以盛，而火日以亏，此阴精所奉于上，而令人寿也。若夫肾水一虚，则无以制南方之心火，故东方实
而西方虚，其命门与包络之相火，皆挟心火之势而来侮所不胜之水，使水日亏而火日盛，此阳精所降于下，故
令人夭折也。（虞天民）
近世阴虚火动之疾，患者十无一活，何也？盖其始也，饮食如常，起居如故，惟痰嗽一二声，自谓无恙，
讳疾忌医，滋蔓日久，倒卧于床，不可复救。余意揆之，方疾之始，必致谨于三事而后可。三事维何？一要遇
明医；二要肯服药；三要守禁戒。三事缺一，不可治也。（《医鉴》）
劳瘵既久，其气必伤，不能运化精微，痰瘀稽留，变幻生虫。在肝为毛虫，食人筋膜；在心为羽虫，食
人血脉；在脾为裸虫，食人肌肉；在肺为介虫，食人肤膏；在肾为鳞虫，食人骨髓。（《医学正传》）
传尸九虫，六虫传代，三虫不传， 、蛔、寸白也。六虫所致，或五脏种毒而生，或亲戚习染而传。大
率一旬之中，遍行四穴，周而复始，三日一食，五日一退。方其作苦，虫之食也；退则还穴醉睡，一醉五日，
其病乍静，俟其退醉之时，乃可用药。一虫在身，占十二穴，六虫共占七十二穴。一月之中，上旬十日，从
心至头游四穴，虫头向上；中旬十日，从心至脐游四穴，虫头向内；下旬十日，从脐至足游四穴，虫头向下。
阳日长雄，阴日长雌。食脏腑脂膏，其虫色白。五脏六腑一经食损，即皮聚毛脱，妇人月信不行，血脉皆损；
七十日后，食人血肉，其虫黄赤，饮食不为肌肤，筋缓不能收持；一百二十日外，血肉食尽，其虫色紫，即食
精髓，传于肾中，其虫色黑，食髓即骨痿不能起床。诸虫久则生毛，毛色杂花，钟孕五脏五行之气，传之三人，即自能
飞，传入肾经，不可救治。利药下虫，验其虫色白，可三十日服药补之；其虫黄赤，可六十日服药补之；其虫
紫黑，此病已深，可百二十日服药补之。六十日内，治者十得七、八；八十日内，治者十得三、四；过此已往，
未知全生。（《道德经》）
虚劳，粪门生疖，名曰 疮。脉不数者，尚不可为，况脉数乎？盖肺为吸门司上，大肠为肛门司下，肺与
大肠，脏腑相通，肺为气之主，阳气当升，虚则下陷，所谓物极则反。今病内热燔灼，肺气久伤，故下陷肛门
而生 疮，肺伤极矣，非药能济，此即《经》云陷脉为痿之病也。（汪石山）
【经典论述】
阳气虚弱则体表发寒，阴液亏损则体内生热。○肝脏虚损，则视力模糊看不清东西，听力下降听不见声音，容易恐惧，感觉像被人追捕一样。○心脏虚损，则胸腹部胀大，胁下与腰部相互牵引疼痛。○脾脏虚损，则腹部胀满、肠鸣音亢进，完谷不化的泄泻，食物不能消化。○肺脏虚损，则气短不足以深呼吸，耳聋咽喉干燥。○肾脏虚损，则胸部疼痛，大腹和小腹疼痛，四肢厥冷，心情不愉快。（出自《素问》）
五脏是贮藏精气的器官，不可损伤，损伤了就会失守而导致阴虚，阴虚就没有气，没有气就会死亡。○精气脱失的，表现为耳聋；气脱失的，表现为视物不明；津液脱失的，表现为腠理开泄，大汗淋漓；体液（浓稠部分）脱失的，表现为关节屈伸不利，面色枯槁，脑髓消减，小腿酸软，耳朵经常鸣响；血液脱失的，表现为面色苍白，干枯无光泽。（出自《灵枢》）
第一层损害损伤皮毛，则皮肤聚缩而毛发脱落；第二层损害损伤血脉，血脉虚少，不能滋养五脏六腑；第三层损害损伤肌肉，肌肉消瘦，饮食不能转化为肌肤营养；第四层损害损伤筋脉，筋脉松弛不能自主收持；第五层损害损伤骨骼，骨痿软弱不能起床。○对于肺受损的，要补益其气；对于心受损的，要调和营卫；对于脾受损的，要调节饮食，适应寒温变化；对于肝受损的，要舒缓其中焦郁结；对于肾受损的，要填补其精。（出自《难经》）
【名家言论】
男子面色淡白无华的，主病为口渴及失血；突然气喘心悸，脉象浮的，是里虚的表现。○男子脉象虚沉弦，没有恶寒发热症状，但感到气短、心里急迫，小便不利，面色白，时常眼前发黑兼有鼻出血，小腹胀满，这是劳损导致的。○劳损这类疾病，脉象浮大，手足烦热，春夏季节加重，秋冬季节减轻，阴寒导致精液自出，身体酸痛消瘦无法行走。○男子脉象浮弱而涩，表示无子嗣，精气清冷。○人到了五六十岁，如果生病脉象大的，出现痹症沿背部行走，或者肠鸣，马刀侠瘿（颈侧淋巴结肿大等），都是因劳损引起的。○脉象沉小迟，称为脱气。其人疾走则喘息有声，手足逆冷，腹部胀满，严重时溏泄，食物不消化。（出自《金匮要略》）
按语：脉浮者里虚也，这应该是衍文（多余的文字）。○按语：“阴寒精自出”中的“寒”字，应当是“虚”字，这是传抄的错误。○按语：“若肠鸣”这三个字，与上下文不连贯，必定是错简（竹简顺序错乱），应当删除。“侠瘿”的“瘿”字，应当是“瘰”字（瘰疬），而且先有劳损后有瘰疬、先有瘰疬后有劳损的情况都有，从未见过劳瘿先后发病的，应当改正。（出自《医宗金鉴》）
男子的劳损，起于耗伤精气；女子的劳损，起于月经闭止；儿童的劳损，得之于母胎。（出自《明医指掌》）
肾气虚的人，脾气必然虚弱；脾气虚弱的人，肾气必然虚损。因为肾是先天祖气，脾是后天生气，而后天生气必须依托于先天祖气。（出自《冯氏锦囊》）
卫气虚则体表发寒而战栗，营气虚则体内生热而咳嗽；营气虚则咳嗽损伤肺络而唾吐腥臭痰，卫气虚则寒气入脾而呕吐涎沫。（程扶生）
冷劳病，是由于气血不足，脏腑虚寒，导致脐下冷痛，手足时常寒冷，妇女月经失常，饮食不消化，有时呕吐，寒热交替，骨节酸痛，肌肤瘦弱，面色萎黄的就是这种病。○热劳病，是由于心肺内热，损伤气血，导致心神烦躁，脸颊发红头痛，眼睛干涩嘴唇干燥，口舌生疮，神思昏倦，四肢壮热，饮食无味，怔忡盗汗，肢体酸痛，或寒热往来的就是这种病。应当审察其原因，调补气血，病症自然会减轻。○骨蒸劳病，是由于积热内附骨髓而得名，形体瘦弱，腹泻食少，肢体无力。传到肾，则盗汗不止，腰膝酸痛，梦遗鬼交；传到心，则心神怯悸，脸颊发红寒热交替；传到肺，则胸满气短，咳嗽吐痰，皮肤粗糙如鳞甲；传到肝，则两眼昏暗，胁痛易怒。五脏都病了，就难以治疗。立斋说：前面的证候多因经期、胎产，或饮食、七情内伤脾胃所致，或病后失调而成。（胡慎柔）
骨蒸劳，以多汗为易治，因为气虚但血尚未枯竭。如果是干咳无汗，为难治，因为气血在内枯竭不能外通。（张路玉）
有人问：阴虚为什么会发热？回答说：凡人白天阳气行于阳分，夜晚阳气行于阴分，阳气进入阴分则睡眠，这是火归于水中，形成既济卦象，所以无病。阴既然虚了，阳气进入却没有阴来制约，则阳气浮散，从内而出，全身皆热，这热是从内部产生的。（出自《证治准绳》）
凡是虚损的原因，无非是酒色、劳倦、七情、饮食导致的。有的先伤气，气伤必波及精；有的先伤精，精伤必波及气。但精气在人身上，总称为阴分，因为阴是天一的根基，形质的祖先，所以凡是损伤在形质上的，总称为阴虚，这是大纲领。如果细分来说，有阴中之阴虚，其病表现为发热烦躁、头红面赤、唇干舌燥、咽痛口疮、吐血衄血、便血尿血、大便燥结、小便痛涩等证。有阴中之阳虚，其病表现为怯寒憔悴、气短神疲、头晕目眩、呕恶食少、腹痛泄泻、二便不禁等证，甚至咳嗽吐痰、遗精盗汗、气喘声哑、筋骨疼痛、心神恍惚、肌肉尽削、梦与鬼交、妇女月经闭止等证。那么无论阴阳，凡是病到极点，总归是真阴败坏罢了。然而真阴所居，只有肾为主宰，因为肾是精血的海洋，而人的生气，就像天地的阳气一样，无非是从下往上，所以肾是五脏的根本。因此肾水亏，则肝失去滋润而生血燥；肾水亏，则水不归源而生脾痰；肾水亏，则心肾不交而神色败坏；肾水亏，则盗伤肺气而喘嗽频繁；肾水亏，则孤阳无主而虚火炽盛。凡是劳伤等证，如果不是伤及根本，怎么会危重到这种地步？所以凡是病势在上严重的，必然是下部枯竭严重。我所以说：虚邪到来，危害必然归于阴；五脏受伤，穷尽必然涉及肾。穷尽到这种地步，我也无能为力了！○凡是损伤元气的人，本来都是虚证，古人将虚损、劳瘵分别归类，病虽然有异，也是应该辨别的。所谓虚损，或许表现在一个证候上，或许困惫于当时，凡是在经络在脏腑，只要伤了元气，就都是虚损病。至于劳瘵的不同，则是或者有骨蒸，或者有干咳，甚至吐血吐痰，营卫俱败，日益消瘦，这是积累渐久，本末都枯竭造成的。但是虚损的虚，有的在阴分，有的在阳分，然而病未深，多宜温补；如果劳瘵的虚，深在阴中之阴分，多有不宜温补的。然而凡是治疗虚证，宜温补的，病多易治；不宜温补的，病多难治。比较虚劳似乎有差异，但不知道劳瘵的损，就是损得深而虚得厉害罢了。○虚损，颧赤唇红的，是阴虚于下，逼阳于上；口多干渴的，是肾水不足，引水自救；音哑声不出来的，是由于肾气枯竭，因为声音出于喉而根于肾；气息喘急的，是阴虚肺槁，气无所归；喉干咽痛的，是真水下亏，虚火上浮；不眠恍惚的，是血不养心，神不能藏；时常烦躁的，是阳中无阴，柔不济刚；易生嗔怒，或筋急酸痛的，是水亏木燥，肝失所资；饮食不甘，肌肉渐削的，是脾元失守，化机日渐败坏；心下跳动，怔忡不息的，是气不归精；盗汗不止的，是有火则阴不能守，无火则阳不能固；多痰或如清水，或多白沫的，是水泛为痰，脾虚不能制水；骨痛如折的，是肾主骨，真阴败竭；腰胁痛的，是肝肾虚；膝下冷的，是命门衰绝，火不归原；小便黄涩淋沥的，是真阴亏竭，气不化水；足心如烙的，是虚火烁阴，涌泉涸竭。○劳损的病，本属阴虚，阴虚必血少，指爪是血的余绪，所以在诊候时，只要看到指爪干黄，觉得有枯槁之色，那么他的发肤营气，都在我眼中了。○似损非损的证候，只有外感寒邪的人才有。因为外邪初感，如果不解散，误作内伤，或用清凉药，或用清导药，导致寒邪伏留不散，而为寒热往来，或为潮热咳嗽，证候似劳损，如果用治损的方法，则滋阴等药剂更加留邪，不是损变成损了吗。我曾经治愈过几个人，都是这种证候。想要辨别这个，只当详细察看表里，而审察致病的原因。因为虚损的证候，必有原因，而外感之邪，来得突然。如果有外证，身体疼痛，微汗则热退，无汗则复热，或见大声咳嗽，脉虽弦紧，但不甚数，或兼和缓，虽然病至一两个月，邪有不解，病不退的，本来不是劳损，不要误治。○虚损已成，不补怎么能恢复？有的人不能服人参、熟地及诸补药，这叫虚不受补，怎么指望生存？如果劳损失血之后，咳嗽不能止，而痰多严重的，这是因为脾肺虚极，饮食不能化血，随食成痰。这虽然不是血，但实际上是血的同类。《内经》说：白血出的死。所以凡是痰最多最浊的，不可治。左右，是阴阳的道路。有不能左右，睡觉难转侧的，这是阴阳之气有所偏竭造成的，多不可治。虚损原本没有外邪，所以病虽然困顿，最终不会神志昏乱。有患虚证而谵妄失伦的，是心脏败坏，神去之兆；劳嗽音哑，声不能出，或喘急气促的，是肺脏败坏；劳嗽肌肉尽脱的，是脾脏败坏；筋是罢极之本，凡是病虚损，多有筋骨疼痛，如果痛极不可忍受的，乃血竭不能荣筋，是肝脏败坏；劳损既久，再及大便泄泻，不能禁止的，是肾脏败坏。（张景岳）
虚劳的病，都是由内伤引起。如酒伤肺，则湿热熏蒸，肺阴销烁；色欲伤肾，则精室空虚，相火无制；思虑伤心，则血耗而火易上炎；劳倦伤脾，则热生而内戕真阴。只有忿怒伤肝有两种情况：郁怒，则肝火内炽而灼血；大怒，则肝火上升而吐血。这五种情况都是劳损精血。○阴虚内热而成虚劳，大约多伤于酒色。但有童子未娶妻而患此证的，或由先天不足，或禀受母气阴虚。师尼、寡妇、室女，气血郁结，以致寒热如疟，早晨凉晚上热，饮食不思，经期不准，或致闭绝而成此病的，多由郁火内蒸所致。○虚劳的证候，多因肾水真阴虚极，水不摄火，火因上炎，以致面赤唇红，口鼻出血，齿痛齿衄。虽然也是龙火上僭，但与虚阳上浮者不同，纵有下部恶寒足冷，总由阴虚火升，不是真正阳衰而然，所以其小便必黄赤，脉必带数。假如误用桂枝、附子引火归原的方法，是抱薪救火，上焦更热，咳喘燥渴更严重，咽痛喉烂诸证就到了。○气虚的人，面白无神，言语轻微，四肢无力，脉来微弱；阳虚的人，体冷畏寒，手足逆冷，小便清长大便溏薄，脉沉小迟。这两种人，能服人参、黄芪，温补可治，这就是气虚阳虚的证候。虽然血脱者，也有补气的方法，那是指突然大量失血，平时并非血虚之人，如新产后之类。（出自《吴医汇讲》）
现在的医生认为吐血是虚劳的病，大错特错。夫吐血有好几种，大概咳嗽的成劳，不咳嗽的不成劳。间或有吐血偶尔咳嗽的，当其吐血之时，狼狈得很，吐止即痊愈，都不成劳。为什么呢？血止则周身无病，饮食如故，而精神恢复了。即使亡血之后，或阴虚内热，或筋骨疼痛，都可服药而痊愈。如果咳嗽，则血止而病仍在，日嗽夜嗽，痰壅气升，多则三年，少则一年而死。因为咳嗽不止，则肾中之元气震荡不安，肺为肾之母，母病则子亦病故也。又肺为五脏之华盖，《内经》说：谷气入胃，以传于肺，五脏六腑皆以受气。这意味着脏腑都取精于肺，肺病，则不能输精于脏腑，一年而脏腑皆枯，三年而脏腑竭矣，所以咳嗽是真劳不治之疾。然而也有咳嗽而不死的，其嗽有时稍缓，饮食起居不变，又其人善于调摄，间或一发，静养即愈。这是百中难得一者也。更有不咳的人，血证屡发，肝竭肺伤，渐变咳嗽，久而亦死。这是不善调摄，以轻变重也。执此以决血证之死生，百不一失矣。（徐灵胎）
《内经》有所谓劳倦，这话应当辨析。或劳于力作，或劳于思虑，或劳于房帏，都是劳。即使劳了，同一形气衰少，而所以致劳之因则异。劳于力作的，应当逸之以安闲，而甘其饮食，和其气血；劳于思虑的，应当屏思却虑，药之以养心；劳于房帏的，应当远房帏，滋肾水，尤其应当照顾脾土。（出自《怡堂散记》）
肾水既实，则阴精上奉于心肺，故东方之木气不实，而西方之金气不虚，此子能令母实，使金得以平木也。是故水日以盛，而火日以亏，此阴精所奉于上，而令人寿也。若夫肾水一虚，则无以制南方之心火，故东方实而西方虚，其命门与包络之相火，皆挟心火之势而来侮所不胜之水，使水日亏而火日盛，此阳精所降于下，故令人夭折也。（虞天民）
近世阴虚火动之疾，患者十无一活，为什么呢？盖其始也，饮食如常，起居如故，惟痰嗽一二声，自谓无恙，讳疾忌医，滋蔓日久，倒卧于床，不可复救。余意揆之，方疾之始，必致谨于三事而后可。三事维何？一要遇明医；二要肯服药；三要守禁戒。三事缺一，不可治也。（出自《医鉴》）
劳瘵既久，其气必伤，不能运化精微，痰瘀稽留，变幻生虫。在肝为毛虫，食人筋膜；在心为羽虫，食人血脉；在脾为裸虫，食人肌肉；在肺为介虫，食人肤膏；在肾为鳞虫，食人骨髓。（出自《医学正传》）
传尸九虫，六虫传代，三虫不传，蛲、蛔、寸白也。六虫所致，或五脏种毒而生，或亲戚习染而传。大率一旬之中，遍行四穴，周而复始，三日一食，五日一退。方其作苦，虫之食也；退则还穴醉睡，一醉五日，其病乍静，俟其退醉之时，乃可用药。一虫在身，占十二穴，六虫共占七十二穴。一月之中，上旬十日，从心至头游四穴，虫头向上；中旬十日，从心至脐游四穴，虫头向内；下旬十日，从脐至足游四穴，虫头向下。阳日长雄，阴日长雌。食脏腑脂膏，其虫色白。五脏六腑一经食损，即皮聚毛脱，妇人月信不行，血脉皆损；七十日后，食人血肉，其虫黄赤，饮食不为肌肤，筋缓不能收持；一百二十日外，血肉食尽，其虫色紫，即食精髓，传于肾中，其虫色黑，食髓即骨痿不能起床。诸虫久则生毛，毛色杂花，钟孕五脏五行之气，传之三人，即自能飞，传入肾经，不可救治。利药下虫，验其虫色白，可三十日服药补之；其虫黄赤，可六十日服药补之；其虫紫黑，此病已深，可百二十日服药补之。六十日内，治者十得七、八；八十日内，治者十得三、四；过此已往，未知全生。（出自《道德经》注疏类文献，此处疑为后世医家引用或伪托，原文标注《道德经》可能指代某部医书或注疏，按原文输出）
虚劳，肛门生疖，名曰肛痈。脉不数的，尚不可为，况脉数乎？盖肺为吸门司上，大肠为肛门司下，肺与大肠，脏腑相通，肺为气之主，阳气当升，虚则下陷，所谓物极则反。今病内热燔灼，肺气久伤，故下陷肛门而生肛痈，肺伤极矣，非药能济，此即《内经》云陷脉为痿之病也。（汪石山）
[Classical Discourse]
When Yang Qi is deficient, exterior cold occurs; when Yin fluid is deficient, interior heat arises. ○ When the Liver is deficient, vision becomes blurred and objects cannot be seen, hearing diminishes and sounds cannot be heard, fearfulness prevails, feeling as if being pursued by someone. ○ When the Heart is deficient, the chest and abdomen become distended, and pain draws between the hypochondrium and the lower back. ○ When the Spleen is deficient, abdominal fullness and borborygmus occur, food unrotted diarrhea (Sun Xie) appears, and food fails to digest. ○ When the Lung is deficient, there is shortness of breath and inability to take a deep breath, deafness, and dry throat. ○ When the Kidney is deficient, there is pain in the chest, pain in the large and small abdomen, cold extremities (Qing Jue), and unhappiness of mind. (From *Su Wen*)
The Five Zang organs are responsible for storing Essence (Jing); they must not be injured. If injured, they lose their hold, leading to Yin deficiency. Yin deficiency leads to lack of Qi, and lack of Qi leads to death. ○ When Essence escapes, deafness results; when Qi escapes, vision becomes unclear; when Jin Ye (body fluids) escape, the interstices open and profuse sweating occurs; when Ye (thick fluids) escape, joints become stiff and difficult to flex, complexion becomes sallow, brain marrow diminishes, calves ache, and ears ring frequently; when Blood escapes, the complexion becomes pale and withered without luster. (From *Ling Shu*)
First-degree damage injures skin and hair, causing skin to gather and hair to fall out; second-degree damage injures blood vessels, making them deficient and unable to nourish the Five Zang and Six Fu organs; third-degree damage injures muscles, causing muscle emaciation so that food cannot transform into flesh; fourth-degree damage injures sinews, causing flaccidity and inability to control movement; fifth-degree damage injures bones, causing bone atrophy and inability to rise from bed. ○ For Lung damage, benefit its Qi; for Heart damage, regulate Ying and Wei (Nutritive and Defensive Qi); for Spleen damage, regulate diet and adapt to cold and warmth; for Liver damage, soothe its center; for Kidney damage, replenish its Essence. (From *Nan Jing*)
[Masters' Remarks]
In men, a pale and thin complexion indicates thirst and blood loss. Sudden panting and palpitations with a floating pulse indicate interior deficiency. ○ In men, a pulse that is deficient, deep, and wiry, without chills or fever, accompanied by shortness of breath, interior urgency, dysuria, pale complexion, occasional dimming of vision with epistaxis, and lower abdominal fullness, is caused by consumptive disease (Lao). ○ The pulse in consumptive disease is floating and large, with vexation in the hands and feet, worsening in spring and summer and improving in autumn and winter. Cold in the yin region causes spontaneous emission of essence, and acid soreness prevents walking. ○ A floating, weak, and choppy pulse in men indicates infertility due to clear and cold essence. ○ In people aged fifty or sixty, a large pulse in illness indicates Bi syndrome along the back, borborygmus, or scrofula and goiter (Ma Dao Xia Ying), all resulting from consumption. ○ A deep, small, and slow pulse is called Qi exhaustion. The patient pants heavily upon rapid walking, has cold extremities, abdominal fullness, and severe loose stools with indigestion. (From *Jin Gui Yao Lue*)
Note: "Floating pulse indicates interior deficiency" is likely an interpolation. ○ Note: The character "cold" in "cold in the yin causes spontaneous emission of essence" should be "deficiency," a transcription error. ○ Note: "If borborygmus" does not fit the context and is likely a misplaced bamboo slip; it should be deleted. The character "Ying" in "Xia Ying" should be "Luo" (scrofula). There are cases of Lao followed by Luo, or Luo followed by Lao, but never simultaneous Lao-Ying disease; this should be corrected. (From *Yi Zong Jin Jian*)
Male consumptive disease originates from injury to Essence; female consumptive disease originates from amenorrhea; pediatric consumptive disease originates from the maternal womb. (From *Ming Yi Zhi Zhang*)
When Kidney Qi is deficient, Spleen Qi must be weak; when Spleen Qi is weak, Kidney Qi must be deficient. The Kidney is the ancestral Qi of the pre-heaven, and the Spleen is the generating Qi of the post-heaven; post-heaven Qi relies on ancestral Qi. (From *Feng Shi Jin Nang*)
When Wei Qi is deficient, exterior cold and shivering occur; when Ying Qi is deficient, interior heat and cough arise. Ying deficiency leads to cough damaging the Lung, resulting in bloody sputum; Wei deficiency allows cold to enter the Spleen, resulting in vomiting of saliva. (Cheng Fusheng)
Cold Lao is caused by deficiency of Qi and Blood and cold-deficiency of the Zang-Fu, leading to cold pain below the umbilicus, cold hands and feet, irregular menstruation in women, indigestion, occasional vomiting, alternating chills and fever, joint soreness, emaciated skin, and sallow complexion. ○ Heat Lao is caused by interior heat in the Heart and Lung damaging Qi and Blood, leading to mental restlessness, red cheeks and headache, dry eyes and lips, mouth and tongue ulcers, mental fatigue, intense heat in the four limbs, loss of taste, palpitations, night sweats, limb soreness, or alternating chills and fever. One must examine the cause and tonify Qi and Blood to reduce symptoms. ○ Bone-steaming Lao is named because accumulated heat attaches to the bone marrow, causing emaciation, diarrhea with little food intake, and limb weakness. If it transmits to the Kidney, there is unremitting night sweats, soreness and pain in the waist and knees, and nocturnal emissions with dreams of sexual intercourse; if it transmits to the Heart, there is mental timidity and palpitations, red cheeks, and alternating chills and fever; if it transmits to the Lung, there is chest fullness, shortness of breath, cough with phlegm, and rough, scaly skin; if it transmits to the Liver, there is dim vision, hypochondriac pain, and irritability. Once the Five Zang are diseased, treatment is difficult. Lizhai stated: These conditions often result from menstruation, childbirth, dietary injuries, or emotional injuries damaging the Spleen and Stomach, or improper recovery after illness. (Hu Shenrou)
Bone-steaming Lao is easier to treat if there is profuse sweating, indicating Qi deficiency but Blood not yet exhausted. If there is dry heat without sweating, it is difficult to treat, as Qi and Blood are exhausted internally and cannot circulate externally. (Zhang Luyu)
Question: Why does Yin deficiency cause fever? Answer: During the day, Qi moves in the Yang aspect; at night, Qi moves in the Yin aspect. When Yang enters Yin, sleep occurs, representing Fire returning to Water (Ji Ji hexagram), hence health. If Yin is deficient, Yang enters but lacks Yin to restrain it, causing Yang to float and scatter outward from within, heating the whole body. This heat arises from within. (From *Zheng Zhi Zhun Sheng*)
All causes of deficiency damage stem from alcohol, sexual indulgence, overwork, emotional disturbances, and diet. Some injure Qi first, which then affects Essence; some injure Essence first, which then affects Qi. Essence and Qi in the human body are collectively referred to as the Yin aspect, as Yin is the root of Tian Yi and the ancestor of form. Thus, any damage to form is generally termed Yin deficiency, which is the major category. Specifically, there is Yin-within-Yin deficiency, manifesting as fever, restlessness, red head and face, dry lips and tongue, sore throat, mouth ulcers, hematemesis, epistaxis, hematochezia, hematuria, dry constipation, and painful, difficult urination. There is Yang-within-Yin deficiency, manifesting as aversion to cold, emaciation, shortness of breath, mental fatigue, dizziness, vertigo, nausea, poor appetite, abdominal pain, diarrhea, and incontinence of urine and feces, even progressing to cough with sputum, seminal emission, night sweats, asthma, hoarseness, bone and joint pain, mental confusion, extreme muscle wasting, dreams of sexual intercourse, and amenorrhea in women. Regardless of Yin or Yang, when disease reaches its extreme, it is always due to the collapse of True Yin. True Yin resides primarily in the Kidney, which is the sea of Essence and Blood. Human vital Qi is like the Yang Qi of Heaven and Earth, rising from below; thus, the Kidney is the root of the Five Zang. Therefore, if Kidney Water is deficient, the Liver loses nourishment and Blood becomes dry; if Kidney Water is deficient, water fails to return to its source and Spleen phlegm arises; if Kidney Water is deficient, Heart and Kidney fail to interact and spirit and color deteriorate; if Kidney Water is deficient, it damages Lung Qi causing frequent asthma and cough; if Kidney Water is deficient, solitary Yang has no master and deficiency fire blazes. How can consumptive diseases become so critical unless the root is injured? Thus, severe disease above implies severe depletion below. I say: When deficiency pathogens arrive, harm returns to Yin; when Five Zang are injured, exhaustion reaches the Kidney. At this point, I am powerless. ○ All who damage Yuan Qi suffer from deficiency. Ancients classified Xu Sun (Deficiency Damage) and Lao Zhai (Consumptive Disease) separately; although different, they should be distinguished. Xu Sun may appear in one symptom or cause temporary exhaustion; any injury to Yuan Qi in meridians or Zang-Fu is Xu Sun. Lao Zhai differs: it may involve bone steaming or dry cough, even hematemesis and hemoptysis, with both Ying and Wei failing and daily emaciation, resulting from gradual accumulation and total depletion of root and branch. However, Xu Sun deficiency can be in Yin or Yang aspects; if shallow, warm tonification is suitable. Lao Zhai deficiency is deep in Yin-of-Yin, often unsuitable for warm tonification. Generally, deficiency diseases suitable for warm tonification are easy to treat; those unsuitable are difficult. Although Xu Lao seems different, Lao Zhai damage is simply deeper damage and more severe deficiency. ○ In Xu Sun, red malar flush and red lips indicate Yin deficiency below forcing Yang upward; excessive dry thirst indicates insufficient Kidney Water seeking self-rescue through water intake; hoarseness indicates exhaustion of Kidney Qi, as voice originates in the Kidney; rapid breathing indicates Yin deficiency and Lung desiccation with Qi having no return; dry throat and sore throat indicate deficiency of True Water with floating deficiency fire; insomnia and confusion indicate Blood failing to nourish the Heart and Spirit failing to reside; frequent irritability indicates Yang lacking Yin, softness failing to balance hardness; anger and tendon stiffness/soreness indicate Water deficiency and Wood dryness, with Liver losing support; poor appetite and muscle wasting indicate Spleen Yuan failing and transformation mechanism declining; palpitations indicate Qi failing to condense into Essence; unremitting night sweats indicate Fire preventing Yin from holding or Yang failing to secure without Fire; copious phlegm or clear/white foam indicates Water flooding as Phlegm due to Spleen deficiency failing to control Water; bone pain like breaking indicates Kidney ruling bones and True Yin exhaustion; waist and hypochondriac pain indicate Liver and Kidney deficiency; cold below knees indicates Ming Men decline and Fire failing to return to origin; yellow, astringent, dribbling urine indicates True Yin exhaustion and Qi failing to transform Water; burning soles indicate deficiency fire scorching Yin and Yongquan exhaustion. ○ Lao damage belongs to Yin deficiency, which necessarily means Blood deficiency. Fingernails are the surplus of Blood; thus, during diagnosis, dry yellow nails with a withered appearance reveal the state of hair, skin, and Ying Qi. ○ Conditions resembling damage but not true damage occur only in initial external cold invasion. If external pathogen is not resolved initially and mistaken for internal injury, treated with cooling or purgative herbs, cold pathogen remains latent, causing alternating chills and fever or tidal cough, mimicking Lao. Using damage-treatment methods like Yin-nourishing agents will retain the pathogen, turning non-damage into damage. I have cured several such cases. To distinguish, carefully inspect exterior and interior and determine the cause. Xu Sun has a specific cause, while external pathogens come suddenly. If there are exterior signs, body pain, fever subsiding with slight sweating and returning without sweat, or loud cough, pulse wiry-tight but not rapid or slightly harmonious, even after one or two months with unresolved pathogen and persistent disease, it is not Lao; do not misdiagnose. ○ Once Xu Sun is established, how can it recover without tonification? Some cannot tolerate Ren Shen (Ginseng), Shu Di Huang (Prepared Rehmannia Root), or other tonics, called "deficiency unable to accept tonification." How can life be expected? After Lao causes blood loss, if cough persists and phlegm is profuse, it is due to extreme Spleen and Lung deficiency failing to transform food into Blood, forming phlegm from food. Though not blood, it is related to blood. *Jing* says: Death follows white blood emission. Thus, most profuse and turbid phlegm is untreatable. Left and right are pathways of Yin and Yang. Inability to turn left or right in sleep indicates partial exhaustion of Yin and Yang Qi, mostly untreatable. Xu Sun originally has no external pathogen; thus, despite severe debility, consciousness remains clear. Delirium and incoherence in deficiency indicate Heart failure and departure of Spirit; hoarse cough with inability to speak or rapid breathing indicates Lung failure; extreme muscle wasting in chronic cough indicates Spleen failure; sinews are the root of fatigue; bone/joint pain in deficiency is common, but unbearable pain indicates Blood exhaustion failing to nourish sinews, signifying Liver failure; prolonged Lao with uncontrollable diarrhea indicates Kidney failure. (Zhang Jingyue)
Xu Lao arises from internal injury. Alcohol injures the Lung, causing damp-heat steaming and consuming Lung Yin; sexual excess injures the Kidney, emptying the essence chamber and unrestricting Minister Fire; worry injures the Heart, depleting Blood and allowing Fire to flare upward; overwork injures the Spleen, generating heat and destroying True Yin internally. Anger injures the Liver in two ways: constrained anger causes Liver Fire to blaze internally and scorch Blood; sudden anger causes Liver Fire to rise and induce hematemesis. These five types all consume Essence and Blood. ○ Yin deficiency with interior heat causing Xu Lao is mostly due to alcohol and sex. However, unmarried youths may suffer from congenital insufficiency or inherited maternal Yin deficiency. Nuns, widows, and unmarried women may suffer from Qi and Blood stagnation, causing malaria-like chills and fever, morning coolness and evening heat, anorexia, irregular menstruation, or amenorrhea, mostly due to internal stagnation-fire steaming. ○ Xu Lao symptoms often result from extreme deficiency of True Kidney Water, failing to control Fire, causing Fire to flare upward, leading to red face and lips, nose and mouth bleeding, toothache, and gingival bleeding. Although this resembles Dragon Fire usurping upwards, it differs from floating deficiency Yang. Even with cold lower body and cold feet, it is due to Yin deficiency and rising Fire, not true Yang decline; thus, urine is yellow-red and pulse is rapid. Mistakenly using Gui Zhi Tang (Cinnamon Twig Decoction) and Fu Zi (Aconite Root) to guide Fire back to its origin is like adding firewood to a fire, worsening upper jiao heat, cough, asthma, dryness, thirst, sore throat, and throat rot. ○ Qi deficiency manifests as pale, spiritless complexion, faint speech, weak limbs, and weak pulse; Yang deficiency manifests as cold body, aversion to cold, cold extremities, clear urine, loose stools, and deep-small-slow pulse. Both can be treated with Ren Shen (Ginseng) and Huang Qi (Astragalus Root) via warm tonification. Even in Blood loss, tonifying Qi is applicable, specifically for sudden massive hemorrhage in those not chronically blood-deficient, such as postpartum women. (From *Wu Yi Hui Jiang*)
Modern physicians wrongly consider hematemesis as Xu Lao. Hematemesis has several types: those with cough develop Lao; those without do not. Occasionally, hematemesis is accompanied by cough, but once bleeding stops, the patient recovers fully, not developing Lao. Why? Bleeding cessation restores systemic health, normal diet, and spirit. Even after blood loss, if Yin deficiency with interior heat or bone/joint pain occurs, medication can cure it. If cough persists, disease remains after bleeding stops; day and night coughing with phlegm obstruction and Qi rising leads to death in one to three years. Unremitting cough shakes Yuan Qi in the Kidney; Lung is Mother of Kidney, so Mother's illness affects Son. Lung is the canopy of the Five Zang. *Jing* states: Grain Qi enters the Stomach and transmits to the Lung, nourishing all Zang-Fu. If Lung is diseased, it cannot transmit essence to Zang-Fu; in one year, Zang-Fu wither; in three years, they exhaust. Thus, cough is a truly incurable Lao disease. However, some with cough survive if symptoms ease, diet/lifestyle remain stable, and they practice proper regulation, recovering with rest. This is rare. Others without cough suffer recurrent blood disorders, exhausting Liver and injuring Lung, gradually developing cough and dying from poor regulation. Judging prognosis of blood disorders by this criterion is highly accurate. (Xu Lingtai)
*Nei Jing*'s mention of labor-fatigue requires distinction. Labor can be physical exertion, mental worry, or sexual activity. Although all cause Qi and form decline, the causes differ. Physical labor requires rest, bland diet, and harmonizing Qi and Blood; mental labor requires eliminating thoughts and medicating to nourish the Heart; sexual labor requires abstinence, nourishing Kidney Water, and caring for Spleen Earth. (From *Yi Tang San Ji*)
When Kidney Water is sufficient, Yin Essence ascends to Heart and Lung, ensuring Liver Wood is not excessive and Lung Metal is not deficient. This "Child strengthens Mother" allows Metal to calm Wood. Thus, Water grows daily, Fire declines daily; this ascending Yin Essence promotes longevity. If Kidney Water is deficient, it cannot control Heart Fire in the South, causing Liver Wood to be excessive and Lung Metal deficient. Minister Fire in Ming Men and Pericardium, aided by Heart Fire, insults the unconquerable Water, causing Water to decline and Fire to grow daily. This descending Yang Essence causes premature death. (Yu Tianmin)
In recent times, diseases of Yin deficiency with Fire agitation rarely survive. Why? Initially, diet and routine are normal, with only slight phlegm-cough; patients consider themselves healthy, avoid doctors, and delay treatment. Eventually, they lie bedridden and untreatable. I believe that at the onset, three matters must be attended to: 1. Meet a wise physician; 2. Be willing to take medicine; 3. Observe prohibitions. Missing one makes it untreatable. (From *Yi Jian*)
Prolonged Lao Zhai injures Qi, failing to transport refined essence, causing phlegm and stasis to accumulate and transform into parasites. In the Liver, they are hair-parasites eating sinews; in the Heart, feather-parasites eating blood vessels; in the Spleen, naked-parasites eating muscles; in the Lung, shell-parasites eating skin fat; in the Kidney, scale-parasites eating bone marrow. (From *Yi Xue Zheng Zhuan*)
Among the nine parasites of Chuan Shi, six transmit generations, three do not: Enterobius vermicularis (Nuo), Ascaris lumbricoides (Hui), and Taenia saginata/cysticercus (Cun Bai). The six transmitted parasites arise from Zang toxicity or familial infection. Roughly, within ten days, they traverse four acupoints, cycling every three days to feed and five days to retreat. When active, they feed; when retreating, they sleep in the acupoints for five days, during which symptoms quiet down, allowing medication. Each parasite occupies twelve acupoints; six occupy seventy-two. In a month: first ten days, from Heart to Head (parasite head up); middle ten days, from Heart to Umbilicus (head inward); last ten days, from Umbilicus to Feet (head down). Yang days favor males, Yin days females. Parasites eating organ fat are white. After damaging Zang-Fu, skin gathers, hair falls, menstruation stops, and vessels are damaged. After seventy days, eating flesh and blood, parasites are yellow-red; food fails to nourish flesh, sinews relax. After one hundred twenty days, eating flesh/blood completely, parasites are purple; eating marrow, transmitting to Kidney, parasites are black; eating marrow causes bone atrophy and inability to rise. Long-term parasites grow multicolored hair, absorbing Five Zang/Five Element Qi; transmitting to three people, they can fly. Entering Kidney Meridian is untreatable. Purging parasites: if white, supplement for thirty days; if yellow-red, for sixty days; if purple-black, deeply diseased, supplement for one hundred twenty days. Within sixty days, seven or eight out of ten are cured; within eighty days, three or four out of ten; beyond this, survival is uncertain. (Attributed to *Dao De Jing* commentary/medical text)
In Xu Lao, boils appearing at the anus are called Gang Yong (Anal Abscess). If the pulse is not rapid, it is still serious; if rapid, it is worse. Lung governs the upper opening (Xi Men), Large Intestine governs the lower opening (An Men); they are internally-externally related. Lung is master of Qi; Yang Qi should ascend. Deficiency causes sinking, as things reverse at extremes. Now, internal heat burns, Lung Qi is long injured, sinking into the anus causing Gang Yong. Lung injury is extreme; medicine cannot save it. This is what *Jing* calls "sunken meridians causing Wei syndrome." (Wang Shishan)