喻嘉言曰∶虚劳之症，伤于精血。营血伤则内热起，五心常热，目中生花见火，耳内蛙聒蝉鸣，口舌糜
烂，不知正味，鼻孔干燥，呼吸不利，乃至饮食不为肌肤，怠惰嗜卧，骨软足酸，荣行日迟，卫行日疾，
营血为卫气所迫，不能守内
而脱出于外，或吐或衄，或出二阴之窍。血出既多，大热进入，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，但蓄于内，蓄之日久，周身血走之隧道，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，蒸热不已，
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》云大肉枯
槁，大骨陷下，胸中气高，以致真脏脉见。然枯槁已极，即真脏脉不见，亦宁有不危者乎？
秦越人发虚损之论，谓虚而感寒则损其阳，阳虚则阴盛，损则自上而下∶一损损于肺，皮聚毛落；
二损损于心，血脉不能荣养脏腑；三损损于胃，饮食不为肌肤。虚而感热则损其阴，阴虚则阳盛，损则自下
而上∶一损损于肾，骨痿不能起于床；二损损于肝，筋缓不能收持；三损损于脾，饮食不能消化。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，势必至于五脏齐损。越人归重脾胃，旨哉言矣。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，味者五谷之味也。补以味而节其劳，则积贮渐富，大命不倾。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，血痹则新血不生，并素有之血淤积不行，血淤则荣虚，荣虚则发热，热久则
蒸其所淤之血，化而为虫，遂成传尸瘵症。以故伤寒狐惑之症声哑嗄，劳瘵之症亦声哑嗄，是则声哑者，
营气为虫所蚀明矣。
巢氏《病源》不察，遂有种种分门异治，后人以其歧路之多，茫无所适，讳其名曰痰火，又谓有虚有
实，肺虚用某
药，肺实用某药，及心、肝、脾，肾，咸出虚实两治之法。是以虚损虚劳中，添出实损实痨矣，岂不
谬哉。
仲景于男子平人，谆谆致戒，无非谓荣卫之道，纳谷为宝，居常调荣卫以安其谷；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。夫建中、复脉，皆稼穑作甘之善
药，一遵精不足者补之以味之旨也。后人补肾诸方，千蹊万径，以治虚劳，反十无一全。仲景及其血痹不行，
为驱其旧、生其新，诚有一无二之圣法，第牵常者不能用耳。
然秦越人发明虚损一症，优入圣域。其论治损之法，损其肺益其气；损其心者，调其荣卫；损其脾，调
其饮食，适其寒温；损其肝，缓其中；损其肾，益其精。即此便是正法眼藏矣。
凡虚劳病多有夺血而无汗者，若认为阳实，而责其汗，必动其血，是名下厥上竭。又最防脾气下溜，
若过用寒凉，其人必至清谷。且骨蒸发热，热深在里，一切轻扬之药，禁不可用。用之反引热势外出，而增
其炽，灼干津液，肌肉枯槁四出，安望除热止病乎？
李士材曰∶治劳之法，以《内经》为式，以脾肾为主。水为万化之源，土为万物之母。故脾安则土生金
母，金实水源，且土不凌水，水安其位，肾亦安矣。肾兼水火，肾安则水不挟肝上泛而凌上湿，火能益土而
化精微，故肾安则脾愈安也。
救肾者必本于阴血，血属阴，主下降，虚则上升，当敛而抑，六味丸是也；救脾者必本于阳气，气为阳
，主上升，虚则下陷，当升而举，补中益气是也。
近世治劳，专以四物加黄柏、知母。不知四物皆阴，行秋冬之令，非所以生万物者也。且血药常滞，
非痰多食少者
所宜；血药常润，久行必致滑肠。黄柏、知母，其性苦寒，能泻实火，实燥而伤阴。又苦先入心，久
能增气，反能助火。至其败胃，所不待言。然矫其偏者，又辄以桂、附为家常茶饭，此惟以火衰者宜之，
若血气燥热之人，能无助火为害哉。
大抵虚劳之症，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。倘虚羸而甚，食少泻多，虽喘嗽不
宁，但以补脾为急，而清肺之品宜戒矣。肺无扶脾之力，脾有生肺之能，故补脾之药，尤要于保肺也。尝见
劳症之死，多死于泄泻；泄泻之因。多因于清润，司命者能不为之兢兢耶？
又如补肾、理脾，法当兼行。然方欲以甘寒补肾，其人减食，又恐不利于脾；方欲以辛温快脾，其人阴
伤，又恐愈耗其水。两者并衡而校重脾者，以脾土上交于心，下交于肾故也。若肾水大虚而势困笃者，又不可
拘。要知滋肾之中，佐以砂仁、沉香；壮脾之中，参以五味、肉桂，随时治法可耳。
又如无阳则阴无以生，无阴则阳无以化，宜不可偏也。东垣曰甘温能除大热，又曰血脱益气，又曰独
阴不长。虚者必补以人参之甘温，阳生阴长之理也。
且虚劳症，受补者可治，不受补者不治。故葛可久治劳，神良素着，所垂十方，用参者七。丹溪专
主滋阴，所述治劳方案，用参者亦十之七。不用参者，非其新伤，必其轻浅者耳。
自好古肺热伤肺，节斋服参必死之说，印定后人眼目，甘用苦寒，直至上呕下泄，犹不悔悟，良可悲
矣。幸李濒湖、汪石山详为之辨。而宿习难返，贻祸未已。不知肺经自有热者，肺脉按之而实，与参诚
不相宜。若火来乘金者，肺脉按之而
虚，金气大伤，非参不保。前哲有言曰∶土旺而金生，勿拘拘于保肺；水旺而火息，毋汲汲于清心。可谓
洞达《内经》之旨，深窥根本之治也。
张景岳曰∶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，阴为天一之根，形质之祖，凡损形质者，总曰阴虚。
然分而言之，则有阴中之阴虚，其病为发热烦躁，头红面赤，唇干舌燥，咽痛口疮，吐血衄血，便血尿
血，大便燥结，小水痛涩等症；有阴中之阳虚，其病为怯寒憔悴，气短神疲，头运目眩，呕恶食少，腹痛飧
泄，二便不禁等症。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
月闭等症。凡病至极，皆所必至，总由真阴之败耳。
然真阴所居，惟肾为主，而人之生气，同天地元阳，无非自下而上。故肾水一亏，则肝失所滋而燥生，
水不归源而脾痰起，心肾不交而神色败，盗伤脾气而喘嗽频，孤阳无主而虚火炽，凡劳伤等症，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。夫亦贵其知微而已。
凡人心耽欲念，肾必应之。凡君火动于上，则相火必应于下。夫相火者，水中之火也，静而守位，则为阳
气，炽而无制，则为龙雷，涸泽燎原，无所不至。故其在肾，则为遗、淋、带、浊。水液渐以干枯，炎上
入肝，则逼血妄行，为吐为衄。或为营虚，筋骨疼痛。又上入脾，脾阴受伤，或为发热，饮食悉化痰涎。再
上至肺，皮毛无以扃固，亡阳嗽喘，哑喑声嘶。是皆无根虚火，阳不守舍，而火焰诣天，自下而上，
由肾而肺，本源渐槁，上实下虚，诚剥极之象也。又师尼室女，失偶之辈，私情系恋，所愿不得，则欲火
摇心，真阴日削，遂致不救。五劳之中，莫此为甚。
经曰∶尝贵后贱，虽不中邪，病从内生，名曰脱荣。常富后贫，名曰失精。故五脏之伤，惟心为本。
思生于心，脾必应之。思之不已，劳伤在脾。脾气结，则为噎膈，为呕吐，饮食不能运，气血日消
，肌肉日削，四肢不为用，而生胀满、泄泻等症，此伤心脾之阳也。然思本伤
脾，尤亦伤脾。经曰∶脾愁忧而不解则伤意，意伤则 乱，四肢不举。七情伤肾，恐亦居多。经曰∶恐惧而
不解则伤精，精伤则骨酸痿厥，精时自下。又常见猝恐者必阴缩，或遗尿，是皆伤肾之征也。然恐伤肾，
怒亦伤肾。经曰∶肾盛怒而不止则伤志，志伤则喜忘其前言，腰背不可以腑仰屈伸。是知盛怒不惟伤肝，
肾亦受害也。
怒生于心，肝必应之。经曰∶怒伤肝。怒则气逆，甚则呕血及飧泄，故气上矣。盖肝为阴中之阳脏，
故肝之为病，有阴阳。如火因怒动而逼血妄行，以致气逆于上而胀痛喘急者，此伤阴气；以怒伤而木郁无伸，
致侵脾土气陷，为呕为胀，为泄为痛，为饮食不行，此伤阳。然怒本伤肝，而悲哀亦最伤肝。经曰∶悲哀动
中则伤魂，魂伤则狂妄不精，阴缩筋挛，两胁骨不举。盖盛怒伤肝，肝气实也；悲哀伤肝，肝气虚也。实
不终实，而虚则终虚耳。
惊本入心，实通于肝胆。经曰∶惊则心无所根据，神无所归，虑无所定，故气乱矣。然胆为中正之官，
十一脏阳刚之气，皆取决焉。又为少阳生气所居，若或损之，则诸脏生气皆消索致败。故惊畏日积，或一
时大惊损胆，致胆汁泄，通身发黄，默默无言者，皆不可救。
虚损两颊红赤，或唇红者，阴虚于下，逼阳于上也。仲景曰，其面戴阳者，下虚故也。虚而多渴者，
肾水不足，引水自救也。喑哑声不出者，由肾气之竭。盖声出于喉而根于肾。经曰∶内夺而厥，则为喑痱。此
肾虚也。虚而喘急者，阴虚肺格，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，或筋急酸疼者，水亏木燥，肝失所
资也。饮食不甘，肌肉渐削者，脾元不守，化机日败也。心下跳动，怔仲不宁者，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。虚而多痰，或如清水，或白沫者，此水泛为痰，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。膝以下冷，命门衰绝，火不归原也。小水黄涩淋
沥者，真阳亏竭，气不化水也，足心如烙者，虚火烁阴，涌泉涸竭也。
虚损之脉，凡甚急、甚数、甚细、甚弱、甚涩、甚滑、甚短、甚长、甚浮、甚沉、甚弦、甚紧、甚洪、
甚实，皆劳伤之脉。然无论浮、沉、大、小，但渐缓则渐有生意。若弦甚，病必甚；数甚病必危。若以弦细
而再加紧数，则百无一生矣。《要略》曰∶脉芤者为血虚，沉迟而小者为脱气，大而无力为阳虚，数而无力
为阴虚，脉大而芤者为血虚。平人脉大为劳，虚极亦为劳。脉微细者盗汗，寸弱而软者为上虚，尺弱软涩
为下虚，尺脉滑疾为血虚，两关沉细为胃虚。又《脉经》曰∶脉来软者为虚，缓者为虚，弱者为虚，弦者为
中虚，细而微小者气血俱虚。
人赖以生，惟此精气。气虚即阳虚，凡病有水盛火亏，而见脏腑寒、脾肾败者是也。故病见虚弱，别
无热症者，便是阳虚，即当温补元气，使真元自复，万勿兼清凉寒滑之品，以
残此发生之气。精虚者即阴虚，凡病有火盛水亏，而见营卫燥、津液枯者是也。故见病多热燥，水不济火
者，便是阴虚。欲滋其阴，惟宜甘凉醇静之物，凡阴中有火，大忌辛温。然阴虚者，因其水亏，而水亏又
忌寒凉。盖苦劣之流，断非滋补之物。其有火盛之甚，不得不从清凉者，亦当兼壮水之剂，相机间用。
一、虚损咳嗽，虽五脏皆有，然专主则在肺肾。盖肺为金脏，所畏者火，化邪者燥，燥则必痒，痒则
必嗽。正以肾水不能制火，所以克金，阴精不能化气，所以病燥，故为咳嗽喘促，咽痛声哑，喉痒喉疮等
症。治此宜甘凉至静之剂，滋养金水，使肺肾相生，真阴渐复。
一、虚损吐血者，伤其阴也。但当察其火有与无，及火之微甚而治之。凡火之盛，而火戴血上，脉症
之间自有热证可辨。急则治标，暂用芩、连、栀、柏、竹叶、童便之属。血止即当养血，不宜过用寒凉也。
若无实火，而金属伤阴，则阴虚水亏，血由伤动。此宜甘纯养阴之品，以静制动，以和治伤，使阴气安静，
得养则血自归经，若阴虚于下，格阳于上，六脉无根，而大吐大衄者，此火不归源，真阳失守而然，万不可
用凉药。若大吐大衄，六脉细脱，手足厥冷，危在倾刻，厥逆昏愦者，速当益气，以固生机，若过用寒凉
即死。总之，失血吐血，阴分大伤，使非加意元气，培养真阴，而专用寒凉，血虽得止，病必自败。
一、虚损伤阴，本由五脏。然五脏症治，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。至气主于肺，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，
而血化于脾胃；精髓主于肾，而受之于五脏。此其不可分者也。及乎既盛，则标本相传，连及脏腑，
喻嘉言说：虚劳这种病症，是由于精血受损引起的。营血受伤则体内产生内热，手心、脚心和心口常感发热，眼睛视物出现幻觉如见火花，耳朵里有像青蛙鸣叫和蝉鸣一样的噪音，口腔和舌头糜烂溃疡，尝不出食物的正常味道，鼻孔干燥，呼吸不畅，甚至饮食无法转化为肌肤的营养，身体倦怠懒惰，喜欢躺着睡觉，骨骼软弱，双脚酸软，营气运行日渐迟缓，卫气运行日渐快速，营血被卫气逼迫，不能固守在内而脱出体外，表现为吐血或鼻出血，或者从前后二阴窍道出血。血液流失过多后，大热之邪乘虚而入，逼迫煎熬，漫无休止，营血很快就会耗尽。
更有因过度劳累导致血痹不通的，血液不从外部脱失，而是蓄积在内部，积蓄日久，全身血液运行的通道全部痹阻不流，血液逐渐干涸，皮肤虽然鲜亮滑泽，但面部没有光泽润泽，于是气经过的地方，血液不再随之流动，只能徒然蒸腾血液化为热邪，有时在下午（日晡时），有时在子午时，蒸热不止，形成痨瘵病。也有开始因为失血，后来导致血痹的，血虚血少，难以流通，发热导致痹阻，这非常容易发生。《内经》说：大肌肉枯槁萎缩，大骨凹陷下陷，胸中气逆喘促，以致出现真脏脉。然而如果已经枯槁到了极点，即使没有出现真脏脉，难道还会有不危险的吗？
秦越人（扁鹊）提出虚损的理论，认为虚证感受寒邪则损伤阳气，阳虚则阴盛，虚损自上而下发展：一损损伤肺，皮毛聚缩脱落；二损损伤心，血脉不能荣养脏腑；三损损伤胃，饮食不能转化为肌肤营养。虚证感受热邪则损伤阴液，阴虚则阳盛，虚损自下而上发展：一损损伤肾，骨痿不能起床；二损损伤肝，筋脉松弛不能收持约束；三损损伤脾，饮食不能消化。自上而下发展的，如果超过胃的阶段就不可治了；自下而上发展的，如果超过脾的阶段就不可治了。大概饮食充足自然能生血，饮食减少则血不生，血不生则阴不足以配合阳，势必导致五脏都受损。越人重视脾胃，这话很有道理。他说精由谷气生成，谷食摄入少就不能生血，血自然不能化精。《内经》对于精不足的，一定要用五味来补益，五味就是五谷的味道。用五味补益并节制劳累，那么精气储备逐渐丰富，生命就不会倾覆。他留下的十则训诫，都是针对无病的男子精血两虚而言，虚劳的症状，就像指掌一样清晰明了。
所以血不能化精就会血痹，血痹则新血不生，加上原本就有的瘀血停滞不行，血瘀则营气虚弱，营虚则发热，热久则蒸腾所瘀积的血液，化为虫，遂成传尸瘵症。因此伤寒狐惑病的症状声音嘶哑，劳瘵病的症状也声音嘶哑，这说明声音嘶哑，是营气被虫蚀害的明证。
巢元方《诸病源候论》没有察辨清楚，于是有种种分门别类的异治方法，后人因为歧路太多，茫然无所适从，避讳其名称为痰火，又说有虚有实，肺虚用某药，肺实用某药，以及心、肝、脾、肾，都分出虚实两种治法。因此在虚损虚劳中，添出了实损实劳，这难道不是谬误吗？
张仲景对健康的男子谆谆告诫，无非是说营卫之道，以纳谷为宝，平时调理营卫以安顿谷气；寿命的根本，在于积精自刚，平时节制嗜欲以滋生精气。到疾病刚刚形成，脉象才露端倪，只依靠建中汤、复脉汤作为主治。建中、复脉，都是稼穑作甘性质的善药，完全遵循“精不足者，补之以味”的宗旨。后人补肾的各种方剂，千蹊万径，用来治疗虚劳，反而十无一全。仲景针对血痹不行，采取驱除旧瘀、生发新血的方法，确实是一无二的圣法，只是拘泥常规的人不能用罢了。
然而秦越人阐发虚损这一病症，造诣高超。他论述治疗虚损的方法：损及肺的，益其气；损及心的，调其营卫；损及脾的，调节饮食，适应寒温；损及肝的，舒缓其中气；损及肾的，益其精。这就是正法眼藏啊。
凡是虚劳病大多有夺血而无汗的情况，如果认为是阳实证，而责求发汗，必定扰动血液，这叫下厥上竭。又最需防止脾气下陷，如果过用寒凉药物，病人必定至大便清谷完谷不化。况且骨蒸发热，热深在里，一切轻扬升散的药物，绝对禁止使用。用了反而引热势外出，增加其炽烈，灼干津液，肌肉枯槁四散，哪里指望能除热止病呢？
李士材说：治疗劳病的方法，以《内经》为准则，以脾肾为主。水是万化的源头，土是万物的母亲。所以脾安则土生金母，金实水源，且土不凌水，水安其位，肾也就安了。肾兼水火，肾安则水不挟肝上泛而凌犯上部湿气，火能益土而化生精微，所以肾安则脾更安。
救肾必须本于阴血，血属阴，主下降，虚则上升，应当收敛而抑制，六味丸就是这类药；救脾必须本于阳气，气为阳，主上升，虚则下陷，应当升举，补中益气汤就是这类药。
近代治疗劳病，专门用四物汤加黄柏、知母。不知道四物汤全是阴药，行秋冬肃杀之令，不是用来生发万物的。而且血药常滞涩，不适合痰多食少的人；血药常滋润，久服必致滑肠腹泻。黄柏、知母，性质苦寒，能泻实火，实则燥而伤阴。又苦味先入心，久服能增气，反而助火。至于败坏胃气，是不用说的了。然而纠正其偏颇的人，又动辄把桂枝、附子当作家常茶饭，这只有对于火衰的人适宜，如果是血气燥热的人，能不助火为害吗？
大体上虚劳病症，疑难不少。如补脾、保肺，方法应当兼行，然而脾喜温燥，肺喜清润，保肺则碍脾，补脾则碍肺。只有燥热非常严重，能进食而不腹泻的，润肺当紧急，而补脾的药也不可缺。如果虚羸非常严重，食少泻多，虽然喘嗽不安，但以补脾为急，而清肺的药物宜戒除。肺没有扶脾的力量，脾有生肺的功能，所以补脾的药，比保肺更重要。曾见劳症之死，多死于泄泻；泄泻的原因，多因于清润药物，医生能不为此兢兢业业吗？
又如补肾、理脾，方法应当兼行。然而正要甘寒补肾，其人减食，又恐不利于脾；正要辛温快脾，其人阴伤，又恐愈耗其水。两者权衡比较，重脾者，因为脾土上交于心，下交于肾的缘故。如果肾水大虚而病情困笃的，又不可拘泥。要知道滋肾之中，佐以砂仁、沉香；壮脾之中，参以五味子、肉桂，随时治法即可。
又如无阳则阴无以生，无阴则阳无以化，应该不可偏废。东垣说甘温能除大热，又说血脱益气，又说独阴不长。虚证必须用人参之甘温来补，这是阳生阴长的道理。
而且虚劳症，受补者可治，不受补者不治。所以葛可久治疗劳病，神效素著，留下的十方中，用参的有七方。丹溪专主张滋阴，所述治劳方案中，用参的也是十分之七。不用参的，不是新近受伤，一定是轻浅的病罢了。
自从好古说肺热伤肺，节斋说服参必死之说，印定了后人的眼光，甘用苦寒，直至上呕下泄，仍不悔悟，实在可悲啊。幸好李濒湖、汪石山详细为之辩驳。但宿习难返，贻祸未已。不知道肺经自有热者，肺脉按之而实，与人参诚然不相宜。如果是火来乘金者，肺脉按之而虚，金气大伤，非人参不能保全。前哲有话说：土旺而金生，不要拘泥于保肺；水旺而火息，不要急切于清心。可谓透彻通达《内经》的宗旨，深深窥探根本的治疗啊。
张景岳说：凡虚损的原因，无非是酒色、劳倦、七情、饮食所致。或者先伤其气，气伤必及于精；或者先伤其精，精伤必及于气。只要精气在人身上，无非称之为阴分，阴是天一的根，形质的祖，凡是损伤形质的，总称为阴虚。
然而分别来说，则有阴中之阴虚，其病为发热烦躁，头红面赤，唇干舌燥，咽痛口疮，吐血衄血，便血尿血，大便燥结，小便痛涩等症状；有阴中之阳虚，其病为怯寒憔悴，气短神疲，头晕目眩，呕恶食少，腹痛飧泄，二便不禁等症状。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，妇人月经闭止等症状。凡是病至极点，都是必然发生的，总由真阴败坏所致。
然而真阴所居，以肾为主，而人的生气，同天地元阳一样，无非是自下而上。所以肾水一亏，则肝失所滋而生燥，水不归源而脾痰起，心肾不交而神色败，暗中伤及脾气而喘嗽频，孤阳无主而虚火炽，凡是劳伤等症，如果不是伤及根本，怎么会危笃到这种地步？所以凡是病势甚于上的，必定是下焦衰竭甚于下。我所以说：虚邪的到来，危害必归于阴，五脏的损伤，穷尽必及于肾。这也贵在知晓细微之处罢了。
凡是人心沉迷欲念，肾必应之。凡是君火动于上，则相火必应于下。那相火，是水中之火，静而守位，则为阳气，炽盛而无制，则为龙雷之火，涸泽燎原，无所不至。所以在肾，则为遗精、淋浊、带下、白浊。水液逐渐干枯，炎上入肝，则逼血妄行，为吐为衄。或者为营虚，筋骨疼痛。又上入脾，脾阴受伤，或为发热，饮食悉化痰涎。再上至肺，皮毛无以扃固，亡阳嗽喘，哑喑声嘶。这些都是无根虚火，阳不守舍，而火焰诣天，自下而上，由肾而肺，本源逐渐枯槁，上实下虚，确实是剥极之象。又有师尼室女，失偶之辈，私情系恋，所愿不得，则欲火摇心，真阴日削，遂致不救。五劳之中，没有比这更严重的了。
经文说：尝贵后贱，虽不中邪，病从内生，名叫脱荣。常富后贫，名叫失精。所以五脏的损伤，以心为本。思虑生于心，脾必应之。思虑不已，劳伤在脾。脾气结，则为噎膈，为呕吐，饮食不能运化，气血日消，肌肉日削，四肢不为所用，而生胀满、泄泻等症状，这是伤心脾之阳。然而思本伤脾，尤亦伤脾。经文说：脾愁忧而不解则伤意，意伤则智乱，四肢不举。七情伤肾，恐惧居多。经文说：恐惧而不解则伤精，精伤则骨酸痿厥，精时自下。又常见猝恐者必阴缩，或遗尿，这都是伤肾的征象。然而恐伤肾，怒亦伤肾。经文说：肾盛怒而不止则伤志，志伤则喜忘其前言，腰背不可以俯仰屈伸。是知盛怒不惟伤肝，肾亦受害也。
怒生于心，肝必应之。经文说：怒伤肝。怒则气逆，甚则呕血及飧泄，故气上矣。盖肝为阴中之阳脏，故肝之为病，有阴阳。如火因怒动而逼血妄行，以致气逆于上而胀痛喘急者，此伤阴气；以怒伤而木郁无伸，致侵脾土气陷，为呕为胀，为泄为痛，为饮食不行，此伤阳。然而怒本伤肝，而悲哀亦最伤肝。经文说：悲哀动中则伤魂，魂伤则狂妄不精，阴缩筋挛，两胁骨不举。盖盛怒伤肝，肝气实也；悲哀伤肝，肝气虚也。实不终实，而虚则终虚耳。
惊本入心，实通于肝胆。经文说：惊则心无所根据，神无所归，虑无所定，故气乱矣。然而胆为中正之官，十一脏阳刚之气，皆取决焉。又为少阳生气所居，若或损之，则诸脏生气皆消索致败。所以惊畏日积，或一时大惊损胆，致胆汁泄，通身发黄，默默无言者，皆不可救。
虚损两颊红赤，或唇红者，阴虚于下，逼阳于上也。仲景说，其面戴阳者，下虚故也。虚而多渴者，肾水不足，引水自救也。喑哑声不出者，由肾气之竭。盖声出于喉而根于肾。经文说：内夺而厥，则为喑痱。此肾虚也。虚而喘急者，阴虚肺格，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，或筋急酸疼者，水亏木燥，肝失所资也。饮食不甘，肌肉渐削者，脾元不守，化机日败也。心下跳动，怔忡不宁者，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。虚而多痰，或如清水，或白沫者，此水泛为痰，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。膝以下冷，命门衰绝，火不归原也。小水黄涩淋沥者，真阳亏竭，气不化水也，足心如烙者，虚火烁阴，涌泉涸竭也。
虚损之脉，凡是甚急、甚数、甚细、甚弱、甚涩、甚滑、甚短、甚长、甚浮、甚沉、甚弦、甚紧、甚洪、甚实，都是劳伤之脉。然而无论浮、沉、大、小，只要渐渐缓和则渐渐有生机。如果弦甚，病必甚；数甚病必危。如果以弦细而再加紧数，则百无一生矣。《要略》说：脉芤者为血虚，沉迟而小者为脱气，大而无力为阳虚，数而无力为阴虚，脉大而芤者为血虚。平人脉大为劳，虚极亦为劳。脉微细者盗汗，寸弱而软者为上虚，尺弱软涩为下虚，尺脉滑疾为血虚，两关沉细为胃虚。又《脉经》说：脉来软者为虚，缓者为虚，弱者为虚，弦者为中虚，细而微小者气血俱虚。
人赖以生存，唯有此精气。气虚即阳虚，凡是病有水盛火亏，而见脏腑寒、脾肾败者是也。所以病见虚弱，别无热症者，便是阳虚，即当温补元气，使真元自复，万勿兼清凉寒滑之品，以残害此发生之气。精虚者即阴虚，凡是病有火盛水亏，而见营卫燥、津液枯者是也。所以见病多热燥，水不济火者，便是阴虚。欲滋其阴，惟宜甘凉醇静之物，凡阴中有火，大忌辛温。然而阴虚者，因其水亏，而水亏又忌寒凉。盖苦劣之流，断非滋补之物。其有火盛之甚，不得不从清凉者，亦当兼壮水之剂，相机间用。
一、虚损咳嗽，虽五脏皆有，然专主则在肺肾。盖肺为金脏，所畏者火，化邪者燥，燥则必痒，痒则必嗽。正以肾水不能制火，所以克金，阴精不能化气，所以病燥，故为咳嗽喘促，咽痛声哑，喉痒喉疮等症状。治此宜甘凉至静之剂，滋养金水，使肺肾相生，真阴渐复。
一、虚损吐血者，伤其阴也。但当察其火有与无，及火之微甚而治之。凡火之盛，而火戴血上，脉症之间自有热证可辨。急则治标，暂用芩、连、栀、柏、竹叶、童便之属。血止即当养血，不宜过用寒凉也。若无实火，而金属伤阴，则阴虚水亏，血由伤动。此宜甘纯养阴之品，以静制动，以和治伤，使阴气安静，得养则血自归经，若阴虚于下，格阳于上，六脉无根，而大吐大衄者，此火不归源，真阳失守而然，万万不可用凉药。若大吐大衄，六脉细脱，手足厥冷，危在倾刻，厥逆昏愦者，速当益气，以固生机，若过用寒凉即死。总之，失血吐血，阴分大伤，使非加意元气，培养真阴，而专用寒凉，血虽得止，病必自败。
一、虚损伤阴，本由五脏。然五脏症治，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。至气主于肺，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，而血化于脾胃；精髓主于肾，而受之于五脏。此其不可分者也。及乎既盛，则标本相传，连及脏腑，
Yu Jiayan said: The syndrome of deficiency consumption (Xu Lao) is caused by injury to essence and blood. When Ying-blood (nutritive blood) is injured, internal heat arises; the five centers (palms, soles, and chest) are constantly hot; visual hallucinations such as seeing sparks occur in the eyes; tinnitus resembling frog croaking and cicada chirping is heard in the ears; the mouth and tongue suffer from ulceration; the normal taste of food is unrecognizable; the nostrils are dry; breathing is difficult; even diet fails to nourish the muscles and skin; there is lethargy and a desire to lie down; bones feel soft and feet sore; Ying-qi (nutritive qi) circulation slows day by day, while Wei-qi (defensive qi) circulation accelerates day by day. Ying-blood, pressured by Wei-qi, cannot remain within and escapes outward, manifesting as hematemesis or epistaxis, or bleeding from the anterior and posterior orifices. Once blood loss is excessive, intense heat enters, forcing and simmering without cessation, causing Ying-blood to be exhausted almost immediately.
Furthermore, extreme overwork can lead to Blood Bi (blood stasis with obstruction), where blood does not escape outward but accumulates internally. After long accumulation, all channels for blood circulation throughout the body become obstructed and stagnant, leading to gradual desiccation. Although the skin may appear fresh and smooth, the face lacks luster and vitality. Consequently, where Qi passes, Blood no longer moves with it, merely steaming the blood into heat. This steaming heat may persist at specific times, such as late afternoon (Ri Bu) or during Zi-Wu hours, eventually forming Zhai disease (consumptive tuberculosis). There are also cases starting with hemorrhage that later develop Blood Bi; due to blood deficiency and scarcity, flow becomes difficult, and fever induces obstruction, which is very easy to occur. The *Neijing* states: "When large muscles waste away and large bones sink, and there is shortness of breath in the chest, leading to the appearance of True Zang pulses." However, if wasting is extreme, even without True Zang pulses appearing, how could it not be critical?
Qin Yueren (Bian Que) expounded on deficiency damage, stating that when deficiency encounters cold, Yang is damaged; Yang deficiency leads to Yin excess, and damage proceeds from top to bottom: First damage affects the Lung, causing skin contraction and hair loss; second damage affects the Heart, causing blood vessels to fail to nourish the Zang-Fu organs; third damage affects the Stomach, causing food intake to fail to nourish muscles and skin. When deficiency encounters heat, Yin is damaged; Yin deficiency leads to Yang excess, and damage proceeds from bottom to top: First damage affects the Kidney, causing bone flaccidity inability to rise from bed; second damage affects the Liver, causing sinews to relax and inability to hold/support; third damage affects the Spleen, causing inability to digest food. For damage proceeding from top to bottom, if it exceeds the Stomach stage, it is incurable; for damage proceeding from bottom to top, if it exceeds the Spleen stage, it is incurable. Generally, sufficient diet naturally generates blood; insufficient diet fails to generate blood. If blood is not generated, Yin is insufficient to balance Yang, inevitably leading to damage of all five Zang organs. Yueren emphasized the Spleen and Stomach; his words are profound. He stated that essence is born from grain; if grain intake is low, blood is not generated, and thus essence cannot be transformed. The *Neijing* teaches that for insufficiency of essence, one must supplement with flavors; flavors refer to the taste of the five grains. Supplementing with flavors and regulating labor will gradually enrich reserves, ensuring life is not endangered. His ten precepts all address men without illness who have dual deficiency of essence and blood, making the signs of deficiency consumption clear as palm lines.
Therefore, if blood fails to transform into essence, Blood Bi occurs; if Blood Bi occurs, new blood is not generated, and existing stagnant blood remains unmoved. Blood stasis leads to Ying deficiency; Ying deficiency leads to fever; prolonged fever steams the stagnant blood, transforming it into parasites, resulting in Chuan Shi Zhai syndrome (transmissible consumptive disease). Thus, both Shanghan Huxu syndrome and Lao Zhai syndrome present with hoarseness; this indicates that hoarseness is clearly due to Ying-qi being eroded by parasites.
Chao Yuanfang’s *Zhubing Yuanhou Lun* failed to investigate this clearly, leading to various categorized different treatments. Later generations, confused by the many divergent paths, avoided the name and called it Tan Huo (Phlegm-Fire), claiming it has both deficiency and excess patterns, using certain herbs for Lung deficiency and others for Lung excess, and similarly distinguishing deficiency and excess treatments for the Heart, Liver, Spleen, and Kidney. Thus, "Excess Damage" and "Exhaustion" were added to Deficiency Damage and Consumption, which is surely erroneous.
Zhang Zhongjing earnestly warned healthy men, emphasizing that the way of Ying and Wei relies on grain intake as treasure; ordinarily, regulate Ying and Wei to settle the grain. The root of longevity lies in accumulating essence to achieve firmness; ordinarily, restrain desires to generate essence. When disease first forms and pulse signs just appear, reliance should be placed primarily on Jianzhong Tang (Middle-Building Decoction) and Fumai Tang (Restore Pulse Decoction). Both are excellent medicines with the nature of "Jia Se Zuo Gan" (sweet flavor generated from earth/grain), strictly following the principle: "For insufficiency of essence, supplement with flavor." Later generations used myriad methods to tonify the Kidney for deficiency consumption, yet rarely achieved success. Zhongjing’s method for Blood Bi—driving out old stasis to generate new blood—is indeed a unique sage method, only unusable by those bound by convention.
However, Qin Yueren’s elucidation of deficiency damage reached supreme proficiency. His treatment principles for damage are: For Lung damage, benefit Qi; for Heart damage, regulate Ying and Wei; for Spleen damage, regulate diet and adapt to cold/warmth; for Liver damage, soothe the interior; for Kidney damage, benefit essence. This constitutes the orthodox method.
Most deficiency consumption cases involve blood loss without sweating. If mistaken for Yang excess and treated with diaphoretics, blood will be disturbed, termed "Lower Jue and Upper Exhaustion." One must also guard against Spleen Qi sinking; overuse of cold-cooling herbs will cause clear undigested stool in feces. Furthermore, Bone Steaming Fever indicates deep internal heat; all light, ascending, and dispersing herbs are strictly prohibited. Using them draws heat outward, increasing its intensity, scorching fluids, and causing muscle wasting, failing to eliminate heat or cure the disease.
Li Shicai said: The method for treating Lao disease follows the *Neijing*, focusing on the Spleen and Kidney. Water is the source of all transformations; Earth is the mother of all things. Thus, if the Spleen is secure, Earth generates Metal (Lung); Metal solidifies Water sources; Earth does not oppress Water, allowing Water to rest in its place, securing the Kidney. The Kidney contains both Water and Fire; if the Kidney is secure, Water does not carry Liver Wood upward to invade upper dampness, and Fire benefits Earth to transform essence and micro-nutrients. Thus, Kidney security ensures greater Spleen security.
To rescue the Kidney, one must base treatment on Yin-blood. Blood belongs to Yin, governing descent; deficiency causes ascent, requiring astringency and suppression; Liuwei Wan (Six-Ingredient Pill) is an example. To rescue the Spleen, one must base treatment on Yang-Qi. Qi belongs to Yang, governing ascent; deficiency causes sinking, requiring lifting and raising; Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) is an example.
In recent times, treating Lao disease focuses on Siwu Tang (Four Substance Decoction) plus Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome). They do not realize that Siwu Tang consists entirely of Yin herbs, acting like autumn and winter commands, unsuitable for generating all things. Moreover, blood-invigorating herbs are often cloying/stagnant, unsuitable for those with much phlegm and little appetite; they are often moistening, and long-term use causes loose stools. Huangbai and Zhimu are bitter and cold, clearing excess fire but drying and injuring Yin. Bitterness enters the Heart first; long-term use increases Qi, potentially aiding fire. Their damaging effect on the Stomach goes without saying. Conversely, those correcting this bias often use Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) as daily staples. This is suitable only for those with fire decline; for those with dry-hot blood and qi, will it not aid fire and cause harm?
Generally, deficiency consumption presents many difficulties. Tonifying the Spleen and protecting the Lung should be done concurrently, yet the Spleen prefers warm-dryness while the Lung prefers clear-moisture. Protecting the Lung hinders the Spleen; tonifying the Spleen hinders the Lung. Only in cases of severe dry-heat with good appetite and no diarrhea should lung-moistening be urgent, though spleen-tonifying herbs are still necessary. In cases of severe emaciation with poor appetite and frequent diarrhea, even with restless coughing/asthma, tonifying the Spleen is urgent, and lung-clearing herbs should be avoided. The Lung lacks the power to support the Spleen, but the Spleen has the ability to generate the Lung. Therefore, spleen-tonifying herbs are more critical than lung-protecting ones. I have seen deaths from Lao disease often due to diarrhea; diarrhea is often caused by cooling-moistening herbs. Should physicians not be vigilant?
Similarly, tonifying the Kidney and regulating the Spleen should be concurrent. Yet, using sweet-cold to tonify the Kidney may reduce appetite and harm the Spleen; using acrid-warm to invigorate the Spleen may injure Yin and deplete Water. Weighing both, prioritizing the Spleen is key because Spleen Earth communicates upward with the Heart and downward with the Kidney. However, if Kidney Water is severely deficient and the condition is critical, one must not be rigid. Know that in nourishing the Kidney, add Amomum Fruit (Sharen) and Agarwood (Chenxiang); in strengthening the Spleen, add Schisandra Berry (Wuweizi) and Cinnamon Bark (Rougui), adapting to the timing.
Also, without Yang, Yin cannot generate; without Yin, Yang cannot transform; neither should be neglected. Dongyuan stated that sweet-warm can remove great heat, blood loss requires benefiting Qi, and solitary Yin does not grow. Deficient conditions must be supplemented with Ren Shen (Ginseng Root) sweet-warm nature, following the principle of Yang generating Yin.
Moreover, deficiency consumption cases accepting tonification are treatable; those rejecting it are untreatable. Ge Kejiu, famous for treating Lao disease, left ten prescriptions, seven containing Ginseng. Danxi focused on nourishing Yin, yet seven out of ten of his Lao prescriptions contained Ginseng. Those without Ginseng were either recent injuries or mild cases.
Since Haogu claimed Lung heat damages the Lung and Jiezai claimed Ginseng causes death, this biased later generations toward bitter-cold herbs until vomiting and diarrhea occurred, without repentance, which is tragic. Fortunately, Li Binhu and Wang Shishan refuted this. But old habits die hard, and harm continues. Those with inherent Lung heat have a solid pulse upon pressure, incompatible with Ginseng. However, if Fire insults Metal, the Lung pulse is weak upon pressure, indicating severe Metal injury, requiring Ginseng for preservation. Ancients said: "When Earth prospers, Metal generates; do not rigidly protect the Lung. When Water prospers, Fire extinguishes; do not anxiously clear the Heart." This thoroughly penetrates the *Neijing*’s purport and deeply probes fundamental treatment.
Zhang Jingyue said: All deficiency damage stems from alcohol, sexual indulgence, fatigue, emotional disturbances, and diet. Either Qi is injured first, affecting Essence; or Essence is injured first, affecting Qi. Essence and Qi in humans are referred to as the Yin aspect. Yin is the root of Heavenly One and the ancestor of form. Any damage to form is generally termed Yin deficiency.
Specifically, there is Yin-within-Yin deficiency, manifesting as fever, irritability, red head/face, dry lips/tongue, sore throat/mouth ulcers, hematemesis/epistaxis, hematochezia/hematuria, dry constipation, painful/difficult urination. There is Yang-within-Yin deficiency, manifesting as aversion to cold, emaciation, shortness of breath, mental fatigue, dizziness, nausea/poor appetite, abdominal pain/undigested stool diarrhea, incontinence. Even cough/sputum, nocturnal emission/sweating, asthma/hoarseness, bone/joint pain, mental confusion, muscle wasting, dreams of sexual intercourse with spirits, and amenorrhea in women—all extremes of disease—are inevitable, stemming from the collapse of True Yin.
True Yin resides primarily in the Kidney. Human vital energy, like Heaven and Earth’s primal Yang, rises from below. Thus, once Kidney Water is deficient, the Liver loses nourishment and generates dryness; Water fails to return to its source, causing Spleen phlegm; Heart-Kidney non-interaction leads to deterioration of spirit and complexion; secret Spleen Qi injury causes frequent cough/asthma; solitary Yang without master leads to blazing deficiency fire. Why are Lao injuries so critical unless the root is damaged? Thus, diseases severe above indicate exhaustion below. I say: When deficiency pathogens arrive, harm returns to Yin; when five Zang organs are injured, exhaustion reaches the Kidney. It is crucial to perceive subtle signs.
Whenever the mind indulges in desire, the Kidney responds. Whenever Minister Fire moves above, Minister Fire (Xiang Huo) responds below. Minister Fire is fire within water. Quiet and stationary, it is Yang Qi; blazing and unchecked, it is Dragon-Thunder fire, drying marshes and burning plains, reaching everywhere. In the Kidney, it causes emission, strangury, leukorrhea, turbid urine. Fluids dry up; inflammation ascends to the Liver, forcing reckless blood movement, causing vomiting/epistaxis. Or causing Ying deficiency, bone/joint pain. Ascending to the Spleen, injuring Spleen Yin, causing fever, turning diet into phlegm-saliva. Reaching the Lung, pores lose closure, causing Yang-loss cough/asthma, hoarseness. These are all rootless deficiency fire, Yang leaving its residence, flames reaching heaven, rising from below, from Kidney to Lung, origin gradually drying, upper excess/lower deficiency, truly a sign of extreme peeling. Nuns, virgin women, widows, attached to illicit love, unfulfilled desires, have desire-fire shaking the heart, True Yin daily depleted, leading to untreatable states. Among Five Labors, none is worse.
The Classics state: Formerly noble, now humble, though not struck by evil, disease arises internally, named Tuo Rong (Falling Glory). Formerly rich, now poor, named Shi Jing (Loss of Essence). Thus, injury to five Zang organs originates in the Heart. Thought arises from the Heart; the Spleen responds. Unceasing thought injures the Spleen. Spleen Qi stagnation causes dysphagia, vomiting, inability to transport food, daily depletion of Qi/blood, muscle wasting, limb dysfunction, distension, diarrhea—this is injury to Heart-Spleen Yang. Though thought primarily injures the Spleen, it also injures the Spleen. The Classics state: "If Spleen sorrow/unresolved worry injures Yi (Intellect), Intellect injury causes confusion, limbs unable to move." Seven emotions injure the Kidney, mostly fear. The Classics state: "Unresolved fear injures Essence; Essence injury causes bone soreness/flaccidity/cold, spontaneous essence loss." Sudden fear causes penile retraction or enuresis, signs of Kidney injury. Anger also injures the Kidney. The Classics state: "Unrestrained anger injures Zhi (Willpower); Willpower injury causes forgetfulness, inability to bend/extend back/waist." Thus, excessive anger injures not only the Liver but also the Kidney.
Anger arises from the Heart; the Liver responds. The Classics state: "Anger injures the Liver." Anger causes Qi reversal; severely, hematemesis and undigested stool diarrhea, so Qi ascends. The Liver is a Yang organ within Yin. Liver diseases have Yin/Yang aspects. If fire moves due to anger, forcing reckless blood, causing Qi reversal, distension/pain, asthma/urgency, this injures Yin Qi. If anger causes Wood depression without extension, invading Spleen Earth, causing Qi sinking, vomiting/distension/diarrhea/pain, food stagnation, this injures Yang. Though anger primarily injures the Liver, grief also severely injures the Liver. The Classics state: "Grief moving internally injures Hun (Ethereal Soul); Hun injury causes madness/inattention, penile retraction, sinew contraction, inability to lift ribs." Excessive anger makes Liver Qi excess; grief makes Liver Qi deficiency. Excess does not remain excess; deficiency remains deficiency.
Fear enters the Heart but connects to Liver/Gallbladder. The Classics state: "Fear causes Heart to lack foundation, Spirit to lack return, thoughts to lack certainty, so Qi becomes chaotic." The Gallbladder is the official of justice; Yang-gang Qi of eleven organs depends on it. It houses Shaoyang vital Qi. If damaged, vital Qi of all organs dissipates. Accumulated fear or sudden shock damaging the Gallbladder causes bile leakage, whole-body jaundice, silence—these are incurable.
Deficiency consumption with red cheeks or lips indicates Yin deficiency below forcing Yang upward. Zhongjing said: "Face wearing Yang" is due to lower deficiency. Deficiency with thirst indicates insufficient Kidney Water seeking self-rescue via drinking. Hoarseness/vocal loss indicates Kidney Qi exhaustion. Voice originates in the throat but roots in the Kidney. The Classics state: "Internal depletion and厥 (cold extremities) lead to aphasia and paralysis (Yin Fei)." This is Kidney deficiency. Deficiency with rapid breathing indicates Yin deficiency repelling Lung, Qi having no return. Dry throat/sore throat indicates True Water deficit, deficiency fire floating up. Insomnia/confusion indicates blood failing to nourish Heart, Spirit unable to reside. Frequent irritability indicates Yang lacking Yin, softness not balancing hardness. Irritability/spasm/soreness indicates Water deficit/Wood dryness, Liver lacking resources. Poor appetite/muscle wasting indicates Spleen Yuan unguarded, transformation mechanism failing daily. Palpitations/restlessness indicate Qi failing to consolidate essence. Unstopping night sweats: with fire, Yin cannot guard; without fire, Yang cannot secure. Deficiency with much phlegm (clear water or white foam) indicates Water flooding as phlegm, Spleen deficiency failing to control Water. Bone pain like breaking indicates Kidney governs bones, True Yin exhausted. Waist/flank pain indicates Liver/Kidney deficiency. Cold below knees indicates Mingmen decline, Fire failing to return to origin. Yellow/scanty/dribbling urine indicates True Yang exhaustion, Qi failing to transform Water. Soles feeling like branding indicate deficiency fire scorching Yin, Yongquan spring dried up.
Pulses in deficiency consumption: extremely rapid, frequent, thin, weak, choppy, slippery, short, long, floating, deep, wiry, tight, surging, full—all are labor-injury pulses. Regardless of floating/deep/large/small, if gradually slowing, life returns. If extremely wiry, disease is severe; if extremely frequent, disease is critical. If wiry-thin plus tight-frequent, survival is unlikely. *Jingui Yaolue* states: Choppy pulse indicates blood deficiency; deep-slow-small indicates Qi loss; large-weak indicates Yang deficiency; frequent-weak indicates Yin deficiency; large-choppy indicates blood deficiency. Healthy people with large pulses have Lao; extreme deficiency is also Lao. Micro-thin pulses indicate night sweats; Cun weak-soft indicates upper deficiency; Chi weak-soft-choppy indicates lower deficiency; Chi slippery-rapid indicates blood deficiency; Guan double deep-thin indicates Stomach deficiency. *Mai Jing* states: Soft pulse is deficiency; slow is deficiency; weak is deficiency; wiry is middle deficiency; fine-minuscule is dual Qi-blood deficiency.
Human life relies on Qi-Essence. Qi deficiency is Yang deficiency, manifesting as water excess/fire deficit, cold Zang-Fu, Spleen/Kidney failure. Weakness without heat signs is Yang deficiency; treat with warming-tonifying Yuan Qi to restore True Yuan. Never use cooling-cold-slippery herbs to destroy this generative Qi. Essence deficiency is Yin deficiency, manifesting as fire excess/water deficit, dry Ying-Wei, withered fluids. Heat-dryness, water failing to assist fire, is Yin deficiency. To nourish Yin, use sweet-cool-pure-still substances. If Yin contains fire, strictly avoid acrid-warm. However, Yin deficiency due to water deficit should avoid cold-cooling. Bitter-inferior flows are not tonics. If fire is extremely excessive requiring cooling, combine with water-strengthening agents, using opportunistically.
1. Deficiency consumption cough involves all five Zang but primarily Lung/Kidney. Lung is Metal organ, fears Fire, transforms pathogenic factors via dryness. Dryness causes itching, itching causes cough. Because Kidney Water fails to control Fire, Fire insults Metal; Yin-Essence fails to transform into Qi, causing dryness. Symptoms: cough/asthma, sore throat/hoarseness, itchy throat/throat ulcers. Treat with sweet-cool-still agents, nourishing Metal-Water, promoting Lung-Kidney mutual generation, gradually restoring True Yin.
2. Deficiency consumption hematemesis injures Yin. Observe presence/severity of fire. If fire is strong, driving blood upward, pulse/symptoms show heat. Treat symptoms urgently, temporarily using Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), Zhizi (Gardenia Fruit), Huangbai (Phellodendron Bark), Zhuye (Bamboo Leaf), Tongbian (Child's Urine). Once bleeding stops, nourish blood; avoid excessive cold-cooling. If no excess fire, but Metal injuring Yin, then Yin deficiency/Water deficit, blood moved by injury. Use pure sweet-yin-nourishing agents, using stillness to control movement, harmony to treat injury, calming Yin Qi. Nourished, blood returns to vessels. If Yin deficiency below repelling Yang above, six pulses rootless, massive hematemesis/epistaxis, this is fire failing to return to source, True Yang losing guard. Absolutely do not use cooling drugs. If massive bleeding, six pulses fine-depleted, cold extremities, imminent danger, syncope/confusion, quickly benefit Qi to secure life force; excessive cold-cooling causes death. In short, blood loss severely injures Yin. Unless attention is paid to Yuan Qi and True Yin cultivation, relying solely on cold-cooling may stop blood but ruins the disease.
3. Deficiency consuming Yin originates in five Zang. Treatment can be separated or integrated. Qi damage treats Lung; Spirit damage treats Heart; Diet/Muscle damage treats Spleen; Blood/Tendon damage treats Liver; Marrow/Essence damage treats Kidney. This is separable. However, Qi dominates Lung but transforms from Essence; Spirit dominates Heart but transforms from Qi; Muscle dominates Spleen but Earth generates from Fire; Blood stores in Liver but transforms from Spleen/Stomach; Marrow/Essence dominates Kidney but receives from five Zang. This is inseparable. Once advanced, root and branch transmit, involving Zang-Fu,