虚劳，起于斫丧，肝肾过伤，多致亡血失精，阴竭而死；起于郁结，内火灼津，多致血结干咳，发痈而死；
起于药误，脾胃受病俱多，每至饮食减少，喘嗽泄泻而死。若面色不衰，肌肉日瘦，外如无病，内实虚伤，俗
名桃花疰，以阴火乘于阳位，不但销烁阳分之津液，而阴分之津液反竭力上供阳火之销烁，故肌肉日削，而面
色愈加鲜泽也。（《张氏医通》）
补编
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；脉得诸芤动微紧，男子失精，
女子梦交，桂枝龙骨牡蛎汤主之。○虚劳里急，悸衄，腹中痛，梦遗失精，四肢酸疼，手足烦热，咽干口燥，
小建中汤主之。○虚劳里急，诸不足，黄 建中汤主之。○虚劳腰痛，少腹拘急，小便不利者，八味肾气丸主
之。○虚劳，虚烦不得眠，酸棘仁汤主之。○五劳虚极，羸瘦腹满，不能饮食，食伤，忧伤，饮伤，房室伤，
饥伤，经络营卫气伤，内有干血，肌肤甲错，两目黯黑，缓中补虚，大黄 虫丸主之。○虚劳诸不足，风气百
疾，薯蓣丸主之。○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。○肘后獭肝散，治冷劳。又主鬼疰，一门传染。（《金匮》）
按∶缓中补虚四字，当在不能饮食之下，必传写之讹。（《医宗金鉴》）
劳瘵主乎阴虚者，盖自子至巳属阳，自午至亥属阴，阴虚则热在午后子前。寤属阳，寐属阴，阴虚则汗从
寐时盗出也。升属阳，降属阴，阴虚则气不降，气不降则痰涎上逆，而连绵不绝也。脉浮属阳，沉属阴，阴虚
则浮之洪大，沉之空虚也。此皆阴虚之证，主以四物、知、柏。世医遵用不效者，何哉？盖阴虚火必上炎，芎、
归气辛味温，非滋降虚火之药，且川芎辛窜，尤非虚炎短乏者所宜；地黄泥膈，亦非胃热食少痰多者所宜。知、
柏苦辛大寒，虽曰滋阴，其实燥而耗血；虽曰降火，其实苦先入心，久而增气，反能助火。至其败胃，所不待
言。（朱丹溪）
劳者劳也，劳损其气血之谓也。既劳损其气血，则大虚矣，故名虚劳。既名为虚为劳，则当补当养，不
待言矣。奈何近世治此证者，若忘其名为虚劳，竟易其名为火劳，绝无补养之功，一以清火为事，且不独易其
名为火劳，更认其证为实火，不但清火为事，更以降气为先，清则元参、花粉、知、柏，恣用不休，且更有芩、
连者；降则桑皮、白前、苏子、旋复，信手轻投，且更有用枳壳、 子者。虚劳必吐血，止血则曰茜根、小
蓟；虚劳必咳嗽，止嗽则曰紫菀、百部、枇杷叶；虚劳必吐痰，消痰则曰麦冬、贝母；虚劳必潮热，退热则曰
青蒿、鳖甲、地骨皮、银柴胡。服之至脾损腹胀，食少作泻，则以谷芽、石斛为助脾之灵丹；服之使肺损气喘，
不能侧卧，则以百合、沙参为保肺之神剂。服之无效，更多服之，多服不惟无效，且濒于危，尤令服之不已，
使气血日亏，真元削尽，脉仅一丝，气存一息，犹曰有火不可补。呜呼！补固不可，死独可乎？在丹溪医学多
精到处，独以六味知柏为治劳之方，实足贻祸于后世。然犹未若此日用如许清降损真之毒药也。不知其出自何
书？得何传受？一见失血、咳嗽、发热等证，动以此种套药投之，一医有然，更数医皆然，庸流有然，
即名医亦无不然。使患此证者，以为此外更无他法，安心守定此药，直服至死而后已。屡死而医若罔闻，终不
知变计，良可叹矣！余值此证，惟是脉已细数，形消肉脱，两侧不能卧者，肝肺损，脾肾绝，不能复救，亦付
之无可如何而已。否则相其虚之轻重而补之养之，往往得生，不可谓非明效大验矣。而医者犹必曰有火不可补，
病患亦自谓有火不可补，要知此有火不可补五字，便是必死不可救五字。试思世之以清降治劳者多矣，其远者
勿论，即耳目所及者，细数之，千百人中有一二得生者乎？盖有之矣，我未之见也。（吴天士）
夫人之虚，不属于气，即属于血，五脏六腑莫能外焉。而独举脾肾者，水为万物之元，土为万物之母，
二脏安和，一身皆治，百疾不生。夫脾具土德，脾安则土为金母，金实水源，且土不凌水，水其安位，故脾安
则肾愈安；肾兼水火，肾安则水不挟肝上泛而凌湿土，火能益土营运而化精微，故肾安则脾愈安。孙思邈云∶
补脾不如补肾。许学士云∶补肾不如补脾。两先生深知二脏为人生之根本，有相赞之功能，故其说似背，而其
旨实同也。救肾者，必本于阴血，血主濡之，血属阴，主下降，虚则上升，当敛而抑之，六味丸是也；救脾者，
必本于阳气，气主煦之，气为阳，主上升，虚则下陷，当升而举之，补中汤是也。近世治劳，专以四物汤加知
柏，不知秋冬之气非所以生万物者也。丹溪有言∶实火可泻，虚火可补。劳证之火，虚乎？实乎？泻之可乎？
矫其偏者，辄以桂、附为家常茶饭，此惟火衰者宜之。若血虚气热之人，能无助火为害哉？大抵虚劳之证，疑
难不少，如补脾保肺，法当兼行，然脾喜温燥，肺喜清润，保肺则碍脾，补脾则碍肺，惟燥热而甚，能食而不
泻者，润肺当急，而补脾之药亦不可缺也。倘虚羸而其食少泻多，虽喘嗽不安，但以补脾为急，而清润之品
宜戒矣。脾有生肺之能，肺无扶脾之力，故补脾之药尤要于保肺也。又如补肾理脾，法当兼行，然方欲以甘寒
补肾，其人食减，
恐不利于脾；方欲以辛温快脾，其人阴伤，恐愈耗其水。两者并衡而较重脾者，以脾土上交于心，下交于肾故
也。若肾大虚，而势困笃者，又不可拘，随时活法可耳。又如无阳则阴无以生，无阴则阳无以化，宜不可偏也。
然东垣曰∶甘温能除大热。又曰∶血脱补气，独阴不长，虚者必补以人参之甘温，阳生阴长之理也。且虚劳受
补者可治，不受补者不治，故葛可久治劳十方，用参者七；丹溪专主滋阴，治劳方案，用参者亦十之七。自好
古肺热伤肺、节斋服参必死之说印定眼目，甘用苦寒，直至上呕下泄，犹不悔悟，良可悲已！不知肺热脉实者，
与参诚不相宜，若火来乘金，脉虚金伤者，非参不保。前哲有言曰∶土旺则金生，勿拘拘于保肺；水壮则火熄，
毋汲汲于清心。可谓洞达《经》旨，深窥根本之治者也。（李士材）
治虚有三本∶肺、脾、肾是也。肺为五脏之天，脾为百骸之母，肾为性命之根，治虚之道毕矣。夫东垣论
脾胃为四家之首，丹溪法滋阴为劳证之宗，立斋究明补火，谓太阳一照，阴火自弥。斯三先生皆振古之贤，然
皆主于一偏，而不获全体之用。是《脾胃论》出于东垣，则无弊，若执东垣以治者，未免以燥剂补土，有损于
清肃之金。滋阴之说出于丹溪，已有弊，若执丹溪以治者，全以苦寒降火，有碍于中州之化。至于阳常有余，
阴常不足，此实一偏之见，后人沿习成风，凡遇阴虚阳亢之疾，辄以知柏补肾清金，未能生水，而反灭火。夫
肾者坎也，一阳陷于二阴，二阴者真水也，一阳者真火也。肾中真水生肝木，肝木生心火；肾中真火生脾土，
脾土生肺金。生人之本，从下而起，如羲皇之画卦然。肾脏合水火二气而为脏腑之根，真水不可灭，真火独可
熄乎？然又有执立斋补火之说，动用苁蓉、鹿茸、桂、附等类，而罔顾其人之有无郁火郁热，更不虑其曾经伤
肺与否？夫虚火可补，理固诚然，如补中益气汤用参、 、术、草之甘温以除大热。苟非清阳下陷，犹不敢轻
加升、柴，而辛热太过之品，乃反施之郁火郁
热之证，奚啻抱薪救火乎？予惟执两端以用中，合三部以平调，一曰清金保肺，无犯中州之土。此用丹溪而不
泥于丹溪也。一曰培土调中，不损至高之气。此用东垣而不泥于东垣也。一曰金行清化，水自流长，乃合金
水于一致也。但主脾主肾，先贤颇有发明，而清金保肺一着，尚未有透达其精微者，故予于论肺独详。此治
劳之三本宜究也。（何德修）
虚劳之证，《金匮》叙于血痹之下，可见劳则必劳其精血也。营血伤，则内热起，五心常热，目中生花见
火，耳内蛙聒蝉鸣，乃至饮食不为肌肤，怠惰嗜卧，骨软足酸，营行日迟，卫行日疾，营血为卫气所迫，不能
内守，而脱出于外，或吐或衄，或出二阴之窍，血出既多，火热迸入，逼迫煎熬，漫无休止，营血有立尽而已。
更有劳之之极，而血痹不行者，血不脱于外，而但蓄于内，蓄之日久，周身日走之隧道悉痹不流，惟就干涸，
皮鲜滑泽，面无荣润，于是气之所过，血不为动，徒蒸血为热，或日晡，或子午，始必干热，俟热蒸气散，微
汗而热解，热蒸不已，瘵病成焉。亦有始因脱血，后遂血痹者，血虚血少，艰于流布，发热致痹尤易易也。
《内经》凡言虚病，不及于劳，然于大骨枯槁，大肉陷下，胸中气高，五脏各见危证，则固已言之。秦越人始
发虚损之论，谓虚而感寒，则损其阳，阳虚则阴盛，损则自上而下；虚而感热，则损其阴，阴虚则阳盛，损则
自下而上。自上而下者，过于胃，则不可治；自下而上者，过于脾，则不可治。盖饮食多，自能生血，饮食少，
则血不生，血不生则阴不足以配阳，势必五脏齐损。越人归重脾胃，旨哉言矣。至《金匮》之文，大意谓精
生于谷，谷入少而不生其血，血自不能化精。《内经》于精不足者，必补之以味，补以味而节其劳，则精贮渐
富，大命不倾，所以垂训十则，皆以无病男子精血两虚为言，而虚劳之候，焕若指掌矣。故血不化精，则血痹
矣，血痹则营虚，营虚则发热，热久则蒸其所瘀之血化而为虫，遂成传尸瘵证。故狐惑之证，声
哑嗄，劳瘵之证，亦声哑嗄，是则声哑者，气管为虫所蚀明矣。仲景于男子平人，谆谆致戒，无非谓营卫之道，
纳谷为实。居常调营卫，以安其谷，寿命之本，积精自刚；居常节嗜欲，以生其精，至病之甫成，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，补之以味之旨也。后人诸方，千蹊万径，以治虚
劳，何反十无一全？及其痹不行，仲景亟驱其旧，生其新，几希于劳瘵将成未成之间，诚有一无二之圣法。试
观童子脏腑脆嫩，才有寒热积滞，易于结癖成疳，待其血痹不行，气蒸发热，即不可为；女子血干经闭，发热
不止，劳瘵之候更多，待其势成，治之无及。傥能服膺仲景几先之哲，吃力于瘵病将成未成之界，其活人之功，
皆是起白骨而予以全生矣。○虚损病，亦有易复难复两候∶因病至虚者，缓调自复；因虚致损者，虚上加虚，
卒难复也。故因病致虚，东垣、丹溪法在所必用；若虚上加虚而至于损，元气索然，丹溪每用人参膏至十余斤，
多有得生者。（喻嘉言）
虚损伤阴，本由五脏，虽五脏各有所主，然证治有可分者，有不可分者。如诸气之损，其治在肺；神明之
损，其治在心；饮食肌肉之损，其治在脾；诸血筋膜之损，其治在肝；精髓之损，其治在肾。此其可分者也。
然气主于肺，而化于精；神主于心，而化于气；肌肉主于脾，而土生于火；诸血藏于肝，而生化于脾胃；精髓
主于肾，而受之于五脏。此其不可分者也。及乎既甚，则标本相传，连及脏腑，此又方之不可执也。故凡补虚
之法，但当明其阴阳升降、寒热温凉之性，精中有气、气中有精之因。且凡上焦阳气不足者，必下陷于肾，当
取之至阴之下；下焦真阴不足者，多飞越于上，可不引之归原乎？治病求本，方为尽善。（张景岳）
先天之阳虚，补命门；后天之阳虚，温胃气。先天之阴虚，补肾水；后天之阴虚，补心肝。○古称劳役
发热为劳发者，盖谓
辛劳不能收摄，以致元阳浮越于外，即东垣所谓内伤也。若一发散，不更元阳脱尽？若一苦寒，不更虚阳顿亡？
○真阴不足，则孤阳无根据，火易浮越，故宜甘温甜静之剂以养之，酸咸敛纳之味以藏之。人但知气有余便是火，
不知火有余即是气，或为喘满，或为烦闷。有余者，病气也。病气之有余，正气之不足也。凡饮食之滞气，可
以利之、行之、顺之、理之。若浮越之阳气，惟宜导之、纳之、敛之、塞之，以补为消。此气乃生身之本，非同饮食
之滞也。若用顺气之药，适足以走泄元气；辛燥之药，反足以耗竭津液；即芍、归、陈皮之类，辛香而润，亦
可引动无根之气，升越失走之火。其元气既伤，胃气必弱，香美之食，入口未甘，何况异味药饵？虽有开胃扶
脾之益，保无伤脾倒胃之虞？故尤宜切忌也。○极虚之证，对面人事不清，而户外之事反能知之，及见亡人鬼
怪者，此皆阳亡之象，名曰游魂。速为补虚敛纳，神魂安，见闻灭矣。○虚证临危，索肉饭饱食而逝者，此脾
虚津华竭绝，肉食力小，不能挽之。盖脾虚则求助于谷食，津涸则求救于脂膏，斯时惟浓浓参汤，庶乎可挽。
若谷肉之物，止填有迹之空虚，焉能补无形之竭绝哉？（冯楚瞻）
虚劳，起因于过度纵欲耗损，导致肝肾严重受损，多引起失血、遗精，最终因阴液枯竭而死亡；起因于情志抑郁结滞，内火灼伤津液，多引起血液瘀结、干咳，甚至发为痈疽而死亡；起因于用药失误，脾胃受病情况很多，往往发展到饮食减少、气喘咳嗽、腹泻而死亡。如果面色不显衰败，肌肉日渐消瘦，外表看似无病，内部实则虚损，俗称桃花疰，这是因为阴火乘袭阳位，不仅消耗阳分的津液，而且阴分的津液也竭力上供以承受阳火的销蚀，所以肌肉日渐削瘦，而面色反而更加鲜泽。（出自《张氏医通》）
补编：
凡是经常失精的人，少腹拘急紧绷，阴头寒冷，头晕目眩，头发脱落，脉象极虚、芤或迟，这是清谷（完谷不化）、失血、失精的证候；脉象出现各种芤、动、微、紧的表现，男子失精，女子梦交，用桂枝加龙骨牡蛎汤主治。○虚劳伴有腹部拘急不适，心悸鼻衄，腹中疼痛，梦中遗精，四肢酸痛，手足烦热，咽干口燥，用小建中汤主治。○虚劳伴有腹部拘急不适，诸般不足，用黄芪建中汤主治。○虚劳伴有腰痛，少腹拘急，小便不利，用八味肾气丸主治。○虚劳伴有心烦失眠，用酸枣仁汤主治。○五劳虚极，身体羸瘦，腹部胀满，不能进食，这是由于食伤、忧伤、饮伤、房室劳伤、饥伤，导致经络营卫之气受伤，体内有干血，肌肤粗糙如鳞甲，两眼暗黑，治宜缓中补虚，用大黄䗪虫丸主治。○虚劳诸般不足，感受风邪引发多种疾病，用薯蓣丸主治。○千金翼方的炙甘草汤，治疗虚劳不足，汗出且胸闷，脉结代、心悸，行动如常者，不出百日可愈，危急者，十一日死。○肘后备急方中的獭肝散，治疗冷劳。又主治鬼疰（一种具有传染性的慢性消耗性疾病），一家之中互相传染。（出自《金匮要略》）
按语：缓中补虚这四个字，应当位于“不能饮食”之下，这一定是传抄过程中的错误。（出自《医宗金鉴》）
劳瘵主要属于阴虚，因为从子时到巳时属阳，从午时到亥时属阴，阴虚则热在午后和子前发作。醒着属阳，睡觉属阴，阴虚则汗液在睡眠时盗出。升属阳，降属阴，阴虚则气不下降，气不下降则痰涎上逆，连绵不绝。脉浮属阳，沉属阴，阴虚则轻取洪大，重按空虚。这些都是阴虚的证候，主治用四物汤加知母、黄柏。世间的医生遵照使用却无效，为什么呢？因为阴虚火必然上炎，川芎、当归气味辛温，不是滋降虚火的药物，况且川芎辛散走窜，尤其不适合虚火短乏的患者；地黄滋腻碍胃，也不适合胃热食少痰多的患者。知母、黄柏苦寒大寒，虽然说是滋阴，其实燥烈而耗血；虽然说是降火，其实苦味先入心，久服会增加心气，反而助火。至于它们败坏胃气，是不言而喻的。（朱丹溪）
劳，就是劳损，指劳损了气血。既然劳损了气血，那就是大虚，所以叫虚劳。既然名为虚和劳，就应当补益调养，这不用多说。为什么近代医生治疗这个病证，好像忘记了它叫虚劳，竟然改名叫火劳，完全没有补养的功夫，一味以清火为事，而且不只是改名叫火劳，更把它的证候认作实火，不但以清火为事，更以降气为先，清火则随意使用玄参、花粉、知母、黄柏，降气则随手投用桑白皮、白前、苏子、旋覆花，更有用枳壳、莱菔子的。虚劳必定吐血，止血就说用茜草根、小蓟；虚劳必定咳嗽，止咳就说用紫菀、百部、枇杷叶；虚劳必定吐痰，消痰就说用麦冬、贝母；虚劳必定潮热，退热就说用青蒿、鳖甲、地骨皮、银柴胡。服用这些药直到脾损腹胀，食少泄泻，就用谷芽、石斛作为帮助脾胃的灵丹；服用这些药使肺损气喘，不能侧卧，就用百合、沙参作为保肺的神剂。服用无效，反而更多服用，多服不仅无效，而且接近危险，仍然让人不停服用，使气血日益亏损，真元耗尽，脉仅一丝，气存一息，还说有火不可补。唉！补固然不可以，难道死就可以吗？在丹溪医学有很多精妙之处，唯独以六味丸加知母、黄柏作为治疗劳证的方子，实在足以祸害后世。然而还不如这些人日常使用这么多清降损真的毒药。不知道这些方法出自哪本书？得到什么传承？一见失血、咳嗽、发热等证候，就动不动用这种套药投治，一个医生这样，换几个医生也都这样，庸医是这样，即使是名医也没有不这样的。使得患此病的人，认为除此之外没有别的方法，安心坚守此药，一直服到死才停止。多次致死而医生若无其事，始终不知道改变策略，真是令人叹息！我遇到这种证候，只有当脉已细数，形体消瘦肌肉脱失，两侧都不能卧倒的，这是肝肺损伤，脾肾衰竭，不能再救治，也就只好听之任之罢了。否则，观察虚损的轻重而进行补养，往往能够存活，不能说不是明显的疗效。但是医生还一定说有火不可补，病人也自谓有火不可补，要知道这“有火不可补”五个字，就是“必死不可救”五个字。试想世上用清降法治疗劳证的人多了，远的不用说，就在眼前看到的，仔细数来，千百人中有一两个能活下来的吗？大概是有吧，但我没见过。（吴天士）
人的虚损，不属于气，就属于血，五脏六腑都不能例外。而特别提出脾肾，是因为水是万物的本源，土是万物的母亲，这两脏安和，全身都能治理，百病不生。脾具有土的德行，脾安和则土成为金的母亲，金充实水源，且土不凌侮水，水就能安守其位，所以脾安和则肾更安和；肾兼含水火，肾安和则水不挟带肝木上泛而凌侮湿土，火能益助脾土运化而化生精微，所以肾安和则脾更安和。孙思邈说：补脾不如补肾。许学士说：补肾不如补脾。这两位先生深知两脏是人生的根本，有相互辅助的功能，所以他们的说法似乎相反，但宗旨其实是相同的。救肾，必须基于阴血，血主濡润，血属阴，主下降，虚则上升，应当收敛抑制它，六味丸就是这类药；救脾，必须基于阳气，气主温煦，气为阳，主上升，虚则下陷，应当升提举托它，补中益气汤就是这类药。近代治疗劳证，专门用四物汤加知母、黄柏，不知道秋冬的气候不是用来生长万物的。丹溪说过：实火可以泻，虚火可以补。劳证之火，是虚还是实？可以用泻法吗？纠正偏颇的人，往往把肉桂、附子当作家常便饭，这只适合火衰的人。如果是血虚气热的人，能不助火为害吗？大体上虚劳的证候，疑难不少，如补脾保肺，治法应当兼行，但是脾喜温燥，肺喜清润，保肺则妨碍脾，补脾则妨碍肺，只有燥热很甚，能食而不泄泻的，润肺应当紧急，而补脾的药也不可缺。如果虚羸而且食少泄泻多，即使喘嗽不安，也只以补脾为急，而清润的药物应该戒除。脾有生肺的能力，肺没有扶脾的力量，所以补脾的药比保肺更重要。又如补肾理脾，治法应当兼行，但是正要甘寒补肾时，那人食量减少，恐怕不利于脾；正要辛温快脾时，那人阴分受伤，恐怕更耗损肾水。两者权衡而更重视脾，是因为脾土上交于心，下交于肾的缘故。如果肾大虚，病情危重的，又不可拘泥，随时变通即可。又如没有阳则阴无法生成，没有阴则阳无法化生，适宜不可偏废。但是东垣说：甘温能除大热。又说：血脱补气，独阴不长，虚者必须用人参的甘温来补，这是阳生阴长的道理。而且虚劳能受补的可以治，不受补的不治，所以葛可久治疗劳证的十方中，用人参的有七方；丹溪专门主张滋阴，治疗劳证的方案中，用人参的也有十分之七。自从李东垣说肺热伤肺、节斋说服参必死的说法印定眼目后，甘用苦寒，直到上呕下泄，还不悔悟，真是可悲啊！不知道肺热脉实的，与人参确实不相宜，如果是火来乘金，脉虚金伤的，不用人参就不能保全。前辈有话说：土旺则金生，不要拘泥于保肺；水壮则火熄，不要急切于清心。可以说是透彻通达《内经》旨意，深深窥探到根本治法的人。（李士材）
治疗虚损有三个根本：肺、脾、肾是也。肺是五脏的天盖，脾是百骸的母亲，肾是性命的根柢，治疗虚损的道理就在这里了。东垣论述脾胃为四大家之首，丹溪的法则是滋阴为劳证之宗，立斋探究明白补火，说太阳一照，阴火自然熄灭。这三位先生都是古代的贤人，但都侧重于一个方面，而不能获得全面的应用。因此《脾胃论》出于东垣，如果没有弊端还好，如果执着东垣的理论去治疗，未免用燥剂补土，损害清肃的金气。滋阴之说出于丹溪，已有弊端，如果执着丹溪的理论去治疗，全用苦寒降火，妨碍中州的运化。至于阳常有余，阴常不足，这实在是一偏之见，后人沿袭成风，凡遇到阴虚阳亢的疾病，就用知母、黄柏补肾清金，不能生水，反而灭火。肾是坎卦，一阳陷于二阴之中，二阴是真水，一阳是真火。肾中的真水生肝木，肝木生心火；肾中的真火生脾土，脾土生肺金。生人的根本，是从下而起的，就像伏羲画卦一样。肾脏合水火二气而为脏腑的根本，真水不可灭，真火独可熄吗？然而又有执着立斋补火的说法，动辄使用肉苁蓉、鹿茸、桂枝、附子等类，而不顾其人是否有郁火郁热，更不考虑其是否曾经伤肺？虚火可以补，道理确实如此，如补中益气汤用人参、黄芪、白术、甘草的甘温来除大热。如果不是清阳下陷，尚且不敢轻易加入升麻、柴胡，何况是辛热太过之品，反而施用于郁火郁热的证候，这岂不是抱薪救火吗？我主张执两端以用中，合三部以平调，一是清金保肺，不犯中州之土。这是用丹溪而不拘泥于丹溪。二是培土调中，不损至高之气。这是用东垣而不拘泥于东垣。三是金行清化，水自流长，乃合金水于一致。只是主脾主肾，先贤颇有发明，而清金保肺这一着，还没有透彻达到其精微的人，所以我对于论肺特别详细。这是治疗劳证的三本应该研究的。（何德修）
虚劳的证候，《金匮要略》叙述在血痹之下，可见劳则必定劳损其精血。营血受伤，则内热起，五心常热，眼中生花见火，耳内蛙鸣蝉噪，乃至饮食不能化为肌肤，怠惰嗜卧，骨软足酸，营行日迟，卫行日疾，营血被卫气所迫，不能内守，而脱出于外，或吐或衄，或从二阴窍道流出，血出既多，火热迸入，逼迫煎熬，漫无休止，营血就会立刻耗尽。更有劳损至极，而血痹不行的，血不脱于外，而只蓄积于内，蓄积日久，周身运行的隧道全部痹阻不通，逐渐干涸，皮肤虽滑泽，面无荣润，于是气所经过的地方，血不为动，徒蒸血为热，有时在日晡时，有时在子午时，开始必干热，等到热气散开，微汗而热解，热蒸不已，瘵病就形成了。也有开始因脱血，后来遂致血痹的，血虚血少，难以流布，发热致痹更容易。《内经》凡是言及虚病，不及于劳，然而在描述大骨枯槁，大肉陷下，胸中气高，五脏各见危证时，就已经说到了。秦越人开始发表虚损的论述，说虚而感寒，则损其阳，阳虚则阴盛，损则自上而下；虚而感热，则损其阴，阴虚则阳盛，损则自下而上。自上而下的，超过胃，则不可治；自下而上的，超过脾，则不可治。大概饮食多，自能生血，饮食少，则血不生，血不生则阴不足以配阳，势必五脏齐损。越人重视脾胃，这话很有意义。至《金匮》的文章，大意是说精生于谷，谷入少而不生其血，血自不能化精。《内经》对于精不足的，一定要用味道厚味的药物来补，补以味而节制劳损，则精贮渐富，大命不倾，所以留下十则训诫，都是以无病男子精血两虚而言，而虚劳的征候，清晰如指掌。所以血不化精，则血痹矣，血痹则营虚，营虚则发热，热久则蒸其所瘀之血化而为虫，遂成传尸瘵证。所以狐惑的证候，声音嘶哑，劳瘵的证候，也是声音嘶哑，那么声音嘶哑的，就是气管被虫所蚀明的证据。仲景对于男子平人，谆谆告诫，无非是说营卫之道，纳谷为实。居常调营卫，以安其谷，这是寿命的根本，积精自刚；居常节制嗜欲，以生其精，到病刚开始形成，脉才见端倪。只依靠建中汤、复脉汤为主治，都是稼穑作甘的善药，完全遵循精不足者，补之以味的旨意。后人的各方，千蹊万径，以治虚劳，为什么反而十无一全？等到痹阻不行，仲景亟驱其旧，生其新，几乎在劳瘵将成未成之间，确实有无二的圣法。试看童子脏腑脆嫩，才有寒热积滞，易于结癖成疳，等到血痹不行，气蒸发热，就不可为；女子血干经闭，发热不止，劳瘵的征候更多，等到势成，治之无及。如果能信奉仲景几先的智慧，吃力于瘵病将成未成的界限，那救人的功劳，都是起白骨而予以全生啊。○虚损病，也有易复难复两种情况：因病至虚者，缓调自复；因虚致损者，虚上加虚，卒难复也。所以因病致虚，东垣、丹溪的法在所必用；若虚上加虚而至于损，元气索然，丹溪每用人参膏至十余斤，多有得生者。（喻嘉言）
虚损伤阴，本来由五脏引起，虽然五脏各有所主，然而证治有可分的，有不可分的。如诸气的损伤，其治在肺；神明的损伤，其治在心；饮食肌肉的损伤，其治在脾；诸血筋膜的损伤，其治在肝；精髓的损伤，其治在肾。这是可分的。然而气主于肺，而化于精；神主于心，而化于气；肌肉主于脾，而土生于火；诸血藏于肝，而生化于脾胃；精髓主于肾，而受之于五脏。这是不可分的。等到病势严重，则标本相传，连及脏腑，这又是方剂不可固执的原因。所以凡是补虚的方法，只应当明辨其阴阳升降、寒热温凉之性，精中有气、气中有精的原因。而且凡上焦阳气不足的，必下陷于肾，应当取之于至阴之下；下焦真阴不足的，多飞越于上，可不引之归原乎？治病求本，方为尽善。（张景岳）
先天之阳虚，补命门；后天之阳虚，温胃气。先天之阴虚，补肾水；后天之阴虚，补心肝。○古称劳役发热为劳发者，大概是指辛劳不能收摄，以致元阳浮越于外，即东垣所谓内伤也。若一发散，不更令元阳脱尽？若一用苦寒，不更令虚阳顿亡？○真阴不足，则孤阳无根据，火易浮越，故宜用甘温甜静之剂来养它，用酸咸敛纳之味来藏它。人们只知道气有余便是火，不知道火有余即是气，或为喘满，或为烦闷。有余者，是病气。病气之有余，是正气之不足。凡是饮食之滞气，可以用利之、行之、顺之、理之的方法。若是浮越之阳气，只宜导之、纳之、敛之、塞之，以补为消。此气乃是生身之本，不同于饮食之滞也。如果用顺气之药，适足以走泄元气；辛燥之药，反足以耗竭津液；即使是芍药、当归、陈皮之类，辛香而润，也可引动无根之气，升越失走之火。其元气既伤，胃气必弱，香美之食，入口未甘，何况异味药饵？虽有开胃扶脾之益，保无伤脾倒胃之虞？所以尤其应该切忌。○极虚之证，对面人事不清，而户外之事反能知之，及见亡人鬼怪者，这都是阳亡之象，名叫游魂。速为补虚敛纳，神魂安，见闻灭矣。○虚证临危，索肉饭饱食而逝者，这是脾虚津华竭绝，肉食力小，不能挽之。盖脾虚则求助于谷食，津涸则求救于脂膏，斯时惟浓浓参汤，庶乎可挽。若谷肉之物，止填有迹之空虚，焉能补无形之竭绝哉？（冯楚瞻）
Xu Lao (Consumptive Disease), originating from excessive debauchery and depletion, causes severe damage to the Liver and Kidney, often leading to loss of blood and essence, ultimately resulting in death due to Yin exhaustion; originating from emotional depression and stagnation, internal fire scorches body fluids, often leading to blood stasis and dry cough, developing into carbuncles and death; originating from medication errors, the Spleen and Stomach suffer various diseases, often progressing to reduced appetite, wheezing and coughing, diarrhea, and death. If the complexion does not appear declining, muscles waste away daily, externally appearing healthy but internally truly deficient, commonly known as Tao Hua Zhu (Peach Blossom Plague), this is because Yin fire attacks Yang positions, not only consuming fluids of the Yang aspect, but also forcing fluids of the Yin aspect to desperately supply the Yang fire for consumption, thus muscles waste away daily while the complexion appears increasingly lustrous. (From *Zhang Shi Yi Tong*)
Supplement:
For those who frequently lose essence, there is tightness and urgency in the lower abdomen, coldness at the glans penis, dizziness, hair loss, and a pulse that is extremely deficient, cun Kou (hollow) or slow, indicating clear feces (undigested food in stool), loss of blood, and loss of essence; if the pulse presents with various cun Kou, moving, faint, or tight characteristics, with men losing essence and women experiencing sexual dreams, Gui Zhi Long Gu Mu Li Tang (Cinnamon Twig Decoction with Dragon Bone and Oyster Shell) is the primary treatment. ○ For Xu Lao accompanied by abdominal tightness and discomfort, palpitations, epistaxis, abdominal pain, nocturnal emission, soreness and pain in the four limbs, vexation and heat in the hands and feet, dry throat and mouth, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) is the primary treatment. ○ For Xu Lao accompanied by abdominal tightness and deficiency of all aspects, Huang Qi Jian Zhong Tang (Astragalus Decoction to Construct the Middle) is the primary treatment. ○ For Xu Lao accompanied by lower back pain, tightness and urgency in the lower abdomen, and difficulty urinating, Ba Wei Shen Qi Wan (Eight-Ingredient Kidney Qi Pill) is the primary treatment. ○ For Xu Lao accompanied by vexation and insomnia, Suan Zao Ren Tang (Sour Jujube Seed Decoction) is the primary treatment. ○ When the Five Labors lead to extreme deficiency, emaciation, abdominal fullness, inability to eat, caused by dietary injury, emotional injury, drinking injury, sexual injury, and hunger injury, damaging meridians, Ying Blood, and Wei Qi, with dry blood inside, rough skin like scales, and dark eyes, the treatment should moderate the middle and tonify deficiency, using Da Huang Ze Chong Wan (Rhubarb and Ground Beetle Pill). ○ For Xu Lao with various deficiencies and susceptibility to wind pathogens causing myriad diseases, Shu Yu Wan (Dioscorea Pill) is the primary treatment. ○ Qian Jin Yi Fang's Zhi Gan Cao Tang (Honey-Fried Licorice Decoction) treats Xu Lao deficiency with sweating and chest oppression, knotted and intermittent pulse, and palpitations; if movement is normal, recovery occurs within 100 days; if critical, death occurs in 11 days. ○ Zhou Hou Fang's Ta Gan San (Rabbit Liver Powder) treats Cold Lao (Cold Consumptive Disease) and also Ghost Zhu (Plague transmitted among family members). (From *Jin Gui Yao Lue*)
Note: The phrase "moderate the middle and tonify deficiency" should be placed after "inability to eat"; this is likely a transcription error. (From *Yi Zong Jin Jian*)
Lao Zhai (Tuberculosis-like disease) primarily belongs to Yin deficiency. From Zi hour to Si hour belongs to Yang, from Wu hour to Hai hour belongs to Yin; Yin deficiency leads to heat occurring in the afternoon and before Zi hour. Being awake belongs to Yang, sleeping belongs to Yin; Yin deficiency leads to night sweats during sleep. Ascension belongs to Yang, descent belongs to Yin; Yin deficiency leads to Qi failing to descend, causing phlegm and saliva to rebel upward continuously. Floating pulse belongs to Yang, deep pulse belongs to Yin; Yin deficiency leads to a surging and large pulse on superficial pressure and emptiness on deep pressure. These are all signs of Yin deficiency, primarily treated with Si Wu Tang (Four Substances Decoction) plus Zhi Mu (Anemarrhena Rhizome) and Huang Bai (Phellodendron Bark). Physicians follow this without effect; why? Because Yin deficiency causes fire to flare upward; Chuan Xiong (Sichuan Lovage Rhizome) and Dang Gui (Angelica Sinensis) have acrid-warm properties, not suitable for nourishing and descending deficient fire; moreover, Chuan Xiong is acrid and dispersing, unsuitable for those with deficient fire and shortness of Qi; Di Huang (Rehmannia Root) is cloying and obstructs the diaphragm, unsuitable for those with stomach heat, poor appetite, and much phlegm. Zhi Mu and Huang Bai are bitter and cold; although said to nourish Yin, they are actually drying and deplete blood; although said to descend fire, bitterness enters the Heart first, and long-term use increases Qi, potentially aiding fire. Their damaging the Stomach goes without saying. (Zhu Danxi)
"Lao" means labor/damage, referring to the damage of Qi and Blood. Since Qi and Blood are damaged, it is great deficiency, hence named Xu Lao (Deficiency-Labor). Since it is named deficiency and labor, tonification and nourishment are necessary. Why do modern physicians treat this condition as if forgetting its name, renaming it Huo Lao (Fire Labor), lacking any tonifying function, focusing solely on clearing fire, and further misidentifying it as Excess Fire, prioritizing directing Qi downward? They indiscriminately use Xuan Shen (Scrophularia Root), Hua Fen (Trichosanthes Powder), Zhi Mu, and Huang Bai for clearing fire, and Sang Bai Pi (Mulberry Root Bark), Bai Qian (Cynanchum Root), Su Zi (Perilla Seed), Xuan Fu Hua (Inula Flower), Zhi Ke (Aurantium Fruit), and Lai Fu Zi (Radish Seed) for directing Qi downward. For hemoptysis in Xu Lao, they use Qian Gen (Rubia Root) and Xiao Ji (Cirsium Herba); for cough, Zi Wan (Aster Root), Bai Bu (Stemona Root), Pi Pa Ye (Loquat Leaf); for expectoration, Mai Dong (Ophiopogon Tuber), Bei Mu (Fritillaria Bulb); for tidal fever, Qing Hao (Artemisia Annua), Bie Jia (Carapax Trionycis), Di Gu Pi (Lycium Bark), Yin Chai Hu (Stellaria Root). Taking these until Spleen damage causes abdominal distension, poor appetite, and diarrhea, they add Gu Ya (Sprouted Grain) and Shi Hu (Dendrobium Stem) as spiritual pills for the Spleen; taking these until Lung damage causes asthma and inability to lie on either side, they add Bai He (Lily Bulb) and Sha Shen (Glehnia Root) as divine agents for protecting the Lung. If ineffective, they continue administering them, worsening the condition until critical, with Qi and Blood daily depleted, True Yuan exhausted, pulse barely a thread, breath lingering, yet still claiming "fire exists, cannot tonify." Alas! Tonification may be contraindicated, but is death acceptable? Although Danxi excelled in medicine, his prescription of Liu Wei Di Huang Wan plus Zhi Mu and Huang Bai for consumptive disease has harmed future generations. Yet this is less harmful than the daily use of so many cooling, descending, and damaging drugs. Where do these methods come from? Upon seeing hemoptysis, cough, or fever, doctors blindly apply these standard formulas. This applies to quacks and famous physicians alike. Patients believe there is no other method, persist until death. Doctors remain indifferent, never changing strategy, which is lamentable. In my practice, for cases with fine-rapid pulse, emaciation, inability to lie on either side, indicating Liver-Lung damage and Spleen-Kidney failure, I leave them to fate. Otherwise, observing the degree of deficiency and tonifying/nourishing often results in survival, proving effective. But doctors insist "fire exists, cannot tonify," and patients agree. Knowing these five words means "inevitable death, incurable." Consider how many use cooling/descending methods for Lao; among hundreds, how many survive? I have seen none. (Wu Tianshi)
Human deficiency involves either Qi or Blood, encompassing all Zang-Fu organs. Specifically highlighting Spleen and Kidney is because Water is the origin of all things, Earth is the mother of all things; if these two organs are harmonious, the body is governed, and diseases do not arise. The Spleen possesses Earth virtue; when Spleen is harmonious, Earth becomes the mother of Metal, Metal solidifies Water source, and Earth does not overwhelm Water, allowing Water to reside peacefully. Thus, Spleen harmony ensures Kidney harmony. The Kidney contains both Water and Fire; when Kidney is harmonious, Water does not carry Liver Wood upward to overwhelm damp Earth, and Fire benefits Spleen Earth in transportation and transformation, generating essences. Thus, Kidney harmony ensures Spleen harmony. Sun Simiao said: Tonifying Spleen is better than tonifying Kidney. Xu Xueshi said: Tonifying Kidney is better than tonifying Spleen. Both masters understood these two organs as the root of life, having mutual assistance functions; their statements seem contradictory but share the same essence. To save the Kidney, one must base on Yin Blood; Blood moistens, belongs to Yin, and descends; deficiency causes ascending, requiring astringency and suppression, such as Liu Wei Wan (Six-Ingredient Pill). To save the Spleen, one must base on Yang Qi; Qi warms, belongs to Yang, and ascends; deficiency causes sinking, requiring lifting and raising, such as Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). Modern treatments for Lao focus solely on Si Wu Tang plus Zhi Mu and Huang Bai, ignoring that autumn/winter energies do not generate all things. Danxi stated: Excess fire can be purged, deficient fire can be tonified. Is the fire in Lao excess or deficient? Can it be purged? Correcting bias by using Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root) regularly suits only those with fire decline. For those with blood deficiency and Qi heat, this will surely aid fire harm. Generally, Xu Lao has many difficulties. Tonifying Spleen and protecting Lung should proceed together, but Spleen likes warm-dry, Lung likes clear-moist; protecting Lung hinders Spleen, tonifying Spleen hinders Lung. Only in severe dry-heat with good appetite and no diarrhea should Lung moistening be urgent, while Spleen tonification remains essential. If emaciated with poor appetite and frequent diarrhea, even with asthma/cough, prioritize Spleen tonification and avoid clear-moist agents. Spleen generates Lung; Lung does not support Spleen; thus Spleen tonification is more important. Regarding tonifying Kidney and regulating Spleen, both should be done, but sweet-cold for Kidney may harm Spleen if appetite is low; acrid-warm for Spleen may consume Water if Yin is damaged. Weighing both, prioritize Spleen because Earth connects to Heart above and Kidney below. If Kidney is severely deficient and critical, flexibility is needed. As "without Yang, Yin cannot generate; without Yin, Yang cannot transform," balance is key. Dongyuan said: Sweet-warm can remove great heat. Also: Blood loss requires tonifying Qi; solitary Yin does not grow; deficiency requires Ginseng's sweet-warm to tonify, following the principle of Yang generating Yin. Those who can accept tonification are treatable; those who cannot are not. Ge Kejiu used Ginseng in 7 of 10 Lao prescriptions; Danxi used Ginseng in 7 of 10. After Li Dongyuan's theory of Lung heat damaging Lung and Jiezhai's claim that Ginseng causes death, many stubbornly use bitter-cold until vomiting/diarrhea occur, which is tragic. Lung heat with excess pulse is incompatible with Ginseng, but Fire attacking Metal with deficient pulse requires Ginseng to preserve. Ancients said: Earth prosperous generates Metal, do not obsess over protecting Lung; Water strong extinguishes Fire, do not rush to clear Heart. This thoroughly understands the Classics' intent and grasps fundamental treatment. (Li Shicai)
Treating deficiency has three roots: Lung, Spleen, and Kidney. Lung is the sky of the five Zang organs, Spleen is the mother of the hundred bones, Kidney is the root of life and nature; the way to treat deficiency is complete. Dongyuan emphasized Spleen-Stomach as paramount; Danxi emphasized Yin-nourishing as the root of Lao treatment; Lizhai clarified tonifying Fire, stating that once the sun shines, Yin fire naturally dissipates. These three sages were virtuous but focused on one aspect, lacking comprehensive application. Therefore, Dongyuan's *Pi Wei Lun* (Treatise on Spleen and Stomach) is sound, but rigid adherence uses drying agents to tonify Earth, harming Clear-Metal. Danxi's Yin-nourishing theory has flaws; rigid adherence uses bitter-cold to descend fire, hindering Central Earth transformation. "Yang is often sufficient, Yin is often insufficient" is a biased view; followers use Zhi Mu and Huang Bai for Yin-deficient Yang-hyperactivity, failing to generate Water and instead extinguishing it. Kidney is Kan trigram, one Yang trapped in two Yins; two Yins are True Water, one Yang is True Fire. True Water generates Liver Wood, Liver Wood generates Heart Fire; True Fire generates Spleen Earth, Spleen Earth generates Lung Metal. Life originates from below, like Fuxi's Bagua. Kidney combines Water and Fire as the root of Zang-Fu; True Water cannot be extinguished, nor can True Fire alone be quenched. However, some rigidly follow Lizhai's fire-tonifying theory, using Cong Rong (Cistanche), Lu Rong (Deer Antler), Gui Zhi, and Fu Zi, ignoring郁火 (stagnant fire/heat) or prior Lung damage. Deficient fire can be tonified, e.g., Bu Zhong Yi Qi Tang uses sweet-warm herbs to remove great heat. Without clear Yang sinking, Sheng Ma and Chai Hu are avoided; using overly acrid-hot herbs for stagnant fire is like adding fuel to fire. I advocate holding both ends to use the mean, balancing three regions: First, clear Metal and protect Lung without offending Central Earth (using Danxi without rigidity). Second, cultivate Earth and regulate Middle without damaging high Qi (using Dongyuan without rigidity). Third, Metal clears and transforms, Water flows long, integrating Metal and Water. While Spleen and Kidney are well-expounded, Lung protection lacks depth, so I elaborate on Lung. These are the three roots of treating Lao to investigate. (He Dexiu)
The *Jin Gui* places Xu Lao under Blood Bi, showing that Lao inevitably damages Jing and Blood. Ying Blood injury causes internal heat, constant heat in five centers, visual disturbances, tinnitus, food failing to nourish flesh, lethargy, weak bones/sore feet, slow Ying flow, fast Wei flow. Ying Blood, pressured by Wei Qi, fails to stay inside, leaking out via vomiting, epistaxis, or orifices. Massive blood loss allows fire to enter, boiling and scorching endlessly, leading to immediate exhaustion of Ying Blood. Extreme Lao causes Blood Bi where blood accumulates internally rather than leaking. Long accumulation blocks all channels, causing dryness. Skin may be smooth, face lacks luster. Qi passes but blood does not move, steaming blood into heat, occurring at dusk or midnight. Initial dry heat resolves with slight sweat, but continuous steaming forms Zhai disease. Initial blood loss later causes Blood Bi; blood deficiency makes stasis easy. Fever exacerbates bi. *Nei Jing* mentions deficiency but not specifically Lao, though descriptions of skeletal wasting and muscle collapse imply it. Qin Yueren initiated theories on Xu Sun (Deficiency Damage): Cold invasion damages Yang (top-down); Heat invasion damages Yin (bottom-up). Top-down exceeding Stomach is incurable; bottom-up exceeding Spleen is incurable. Abundant diet generates blood; scarce diet stops blood generation, leading to Yin-Yang imbalance and five Zang damage. Yueren valued Spleen-Stomach highly. *Jin Gui* states essence comes from grain; little grain means little blood, little blood means no essence. *Nei Jing* says: Essence deficiency requires flavor-rich tonics. With dietary regulation and rest, essence stores enrich, preserving life. Ten maxims address young men with dual deficiency. Blood failing to transform essence causes Blood Bi; Bi causes Ying deficiency; deficiency causes heat; prolonged heat steams stasis into worms, forming Chuan Shi Zhai (Transmissible Tuberculosis). Huo Er (Erosive ulcers) and Lao Zhai both cause hoarseness, indicating worm erosion of airways. Zhang Zhongjing warned healthy men about Ying-Wei之道 (Way), emphasizing grain intake for solidity. Regulating Ying-Wei stabilizes grain; accumulating essence strengthens constitution. Regulating desires generates essence. At early stages, Jian Zhong and Fu Mai decoctions (sweet/grain-based) follow "tonify essence with flavor." Later methods fail frequently. When Bi sets in, Zhongjing expels old to generate new, intervening before Lao Zhai fully forms—a unique holy method. Children's fragile organs easily form masses from cold/heat/stagnation; waiting for Bi/fever is too late. Women with dry blood amenorrhea and fever show more Lao signs; waiting is futile. Following Zhongjing's preemptive wisdom saves lives, resurrecting the dead. ○ Xu Sun has easy and difficult recovery: Illness-induced deficiency recovers slowly; deficiency-induced damage is hard to recover. Illness-to-deficiency uses Dongyuan/Danxi methods; deficiency-to-damage with exhausted Yuan Qi requires Danxi's massive Ginseng Paste doses for survival. (Yu Jiayan)
Xu Lao damages Yin, originating from five Zang organs. Each Zang has specific governance, but treatment is divisible and indivisible. Qi damage treats Lung; Spirit damage treats Heart; Diet/Muscle damage treats Spleen; Blood/Tendon damage treats Liver; Essence/Marrow damage treats Kidney. This is divisible. However, Qi governs Lung but transforms from Essence; Spirit governs Heart but transforms from Qi; Muscle governs Spleen but Earth generates from Fire; Blood stores in Liver but generates from Spleen-Stomach; Essence/Marrow governs Kidney but receives from five Zang. This is indivisible. Severe cases transmit between root and branch, affecting multiple organs, making fixed formulas impossible. Tonification must clarify Yin-Yang ascent/descent and hot/cold natures, understanding essence contains Qi and Qi contains Essence. Upper Jiao Yang deficiency sinks to Kidney, requiring extraction from lowest Yin; Lower Jiao True Yin deficiency floats upward, requiring guidance back to origin. Seeking the root is perfect treatment. (Zhang Jingyue)
Congenital Yang deficiency tonifies Ming Men; Acquired Yang deficiency warms Stomach Qi. Congenital Yin deficiency tonifies Kidney Water; Acquired Yin deficiency tonifies Heart and Liver. ○ Ancient "Lao Fa" (Labor Fever) refers to fatigue preventing consolidation, causing Yuan Yang to float outward (Dongyuan's Internal Injury). Dispersion exhausts Yuan Yang; Bitter-Cold kills deficient Yang. ○ True Yin deficiency leaves solitary Yang unrooted, prone to floating; treat with sweet-warm/quiet agents to nourish, sour-salty/astringent agents to store. People know "excess Qi is fire," but not "excess fire is Qi," manifesting as asthma/fullness or vexation. Excess here refers to pathogenic Qi, indicating righteous Qi deficiency. Dietary stagnation can be promoted/drained/smoothed/regulating. Floating Yang requires guiding/nestling/astringing/sealing, using tonification as elimination. This Qi is the root of life, unlike dietary stagnation. Promoting Qi drugs leak Yuan Qi; Acrid-Dry drugs deplete fluids; even acrid-moist drugs like Shao Yao, Dang Gui, Chen Pi can stir rootless Qi and rising fire. Damaged Yuan Qi weakens Stomach Qi; fragrant foods taste bad then; medicinal flavors are worse. Despite opening appetite benefits, risk of damaging Spleen/Stomach exists; thus strictly avoid. ○ Extreme deficiency with confusion regarding nearby people but awareness of distant events, or seeing ghosts/dead, indicates Yang collapse called You Hun (Wandering Soul). Urgently tonify and astringe; when Shen-Hun settles, visions cease. ○ Critical deficiency dying after craving meat/rice indicates Spleen deficiency and fluid exhaustion; meat lacks power to rescue. Spleen deficiency seeks grain help; fluid exhaustion seeks fat/grease help. Only thick Ginseng Soup can rescue. Grain/meat fill tangible voids but cannot replenish intangible exhaustion. (Feng Chuzhan)