虚劳之病，皆由内伤，而无外邪也。如酒伤肺，则湿热薰蒸，肺阴消烁。色伤肾，则精室空虚，相火无制。思虚伤
心，则血耗而火易上炎。劳倦伤脾，则热生而内伐真阴。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，皆能劳其精血。《道经》云∶“涕、唾、津、精、汗、血、液，七般灵物总属阴。”阴虚内热而成虚劳之症，
大约酒色为多，然有童子未室而患此症者，或有先天不足，或禀母气阴虚，其师尼、寡妇、室女愆期，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（以上论致病之由，以下论真
阴易亏）。
方书言此症者，皆以气虚、血虚、阴虚、阳虚、混同论治。不知气虚者，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，乃为受补可治，斯气虚阳虚之症
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。其余患此症者，《经》云∶一水不能胜五火。
五火者，五志之火也；一水者，肾中真阴之水也。水即精也，即如“女子二七而天癸至”，“男子二八而天癸至”，非阴衰
于前而阴成之难乎？又言人“年四十，而阴气自半”，非阴衰于后而阴凋之易乎？所谓阴者，即我之精，而造我之形者也。
人生全盛之数，前后止二十余年，故丹溪引日月之盈亏，以为阳常有余，阴常不足。而王节斋则以为，阴虚成病者，十
有八九，阳虚成病者，百无一二，盖以节欲者少，纵欲者多耳（以下叙五藏虚证）。
其为病也，在肾，则为腰、脊、腿酸，或攸隐而痛，为骨蒸盗汗，或至夜发热，为遍身骨酸，或疼痛如折，为梦泄
遗精，为耳中鸣，为足心热。在心，则为惊悸怔忡，为掌中干热，为虚烦无寐，或梦魇不宁，为口苦舌干，或口舌糜烂。
在肺，则为痰嗽干咳，为气逆喘促，为鼻中气热，为颧红吐衄，甚则吐涎白沫，侧眠，咽痛音哑声嘶。在肝，则为寒热
如疟，为颈项瘰 ，为胁胀肋疼，为两目涩痛，为头晕，为眼花，为多怒，为吐血。在脾，则为食减不化，为恶心呕吐，
为胀满腹痛，为肠鸣泄泻，肌肉消瘦。此皆五藏虚劳之本症。《经》曰∶“治病必求于本。”须审其因何致损，何藏受伤，
如因于色者，则知肾伤，纵有他经现症，亦当补肾为主，而兼治他症；因于酒者，又当以清肺为先（以下叙标本传乘）。
既审标本，再明传变。如肾传心，心传肺，肺传肝，肝传脾，脾再传肾，此传其所胜之藏，侮而乘之，谓之贼克，大凶
之兆。《经》曰∶诸病以此相传者死，谓五藏以次相传而克遍也。《难经》曰∶七传者死。谓如病始于肾，而脾复传肾，
是谓六传已尽，一藏不可再伤也。又如肾病不传心而传肺，此间一藏而传于生我之母，以母子气通也；如肾病不传心
肺而传肝，此间二藏而传于己生之子，母病及子也；如肾病不传心、肺、肝而传脾，此间三藏而传已所不胜之藏，《经》
所谓“轻而侮之”也。传乘不明，岂能疗病（以下辨误治）？
虚劳一症，偏于阴虚者居多，而医之误治者有七，试详言之。一曰误认阳虚。命门之火，龙火也，亦谓之真阳，如
果肾中阴盛，龙火不能安其位，而为上焦假热，面赤、烦躁、口渴等症，口虽渴而不欲饮，足冷过膝，小便清长，右尺
脉沉小而迟，或浮大无根，此阴盛逼阳之假症。如夏至一阴生，水底冷而天上热，龙为阳物，随阳而上升，宜用八味之
属，冰冷与饮，得引浮火归元，如冬至一阳来复，地中水暖，而龙归大海也。至若虚劳之症，是因肾水真阴虚极，水不
摄火，火因上炎而致面赤唇红，口鼻出血，齿痛齿衄，虽亦龙火上炎，与虚阳上浮不同，纵有下部恶寒足冷，此因虚火
上升所致，非真阳衰而然，故其小便必黄赤，其脉必带数，有内热的症可据，设误用引火归元之法，是抱薪救火，上焦
愈热，而咳喘燥渴益甚，咽痛喉烂诸症至矣。二曰误认中寒。腹痛之属于虚寒者，绵绵痛而无增减，喜热手按，热饮食。
泄泻之属于虚寒者，水谷不化，而澄彻清冷，必有虚寒之脉证可凭，然后用之有效。今人一见胀满腹痛，食不消化，肠
鸣泄泻等症，便认为虚寒，而投理中温燥之剂，再补其阳，则阳益亢而阴益竭矣。更有见其胀满泄泻，遂引《经》文“清
气在下，则生飧泄，浊气在上，则生 胀”，而用补中益气，反提阴火上逆，以致咳喘频增，吐衄交至，而立见危亡。
此其温补得售者，不过助阳之药，能使胃气一时暂壮，饮食增加，彼此相夸，至死不悟，良为可悯。三日误认外感。世
之真阴虚而发热者，十之六七亦与外感无异，火逆冲上，则头胀微痛，火热壅肺，则有时鼻塞，阴虚阳陷入里，则洒浙
恶寒。阴虚阳无所附，则浮越肌表而热，但其发时，必在午后，先洒浙恶寒，少顷发热，热至寅卯时，盗汗出而身凉；
或无微寒而但午后发热。必现肾虚症，或兼唇红颧赤，口渴烦躁，六脉搏数，或虚数无力。此宜大剂滋阴，如保阴、六
味之属。若误为外感而表之，则魄汗淋漓，诸虚蜂起。或有失血之人，表之无汗，《经》所谓“夺血者无汗”也，再强发
之，必然吐衄，为下厥上竭之症，此尤孟浪之流也。四曰苦寒泻火之误。实火为病，可以直折，虚火为病，非寒可清，
非惟不能清热，抑且败其胃气，食少泻多，将何疗治？甚者见其燥结，肆用硝黄以通之，不知肾主二便，肾主五液，肾
液既亏，自不濡润，滋其阴，润其燥，而便自通，彼既亏之阴，岂能胜硝黄之攻伐乎？五曰二陈消痰之误。痰在脾经者，
名曰湿痰，其痰滑而易出；或稀如水者，名曰痰饮。湿者燥之，半夏自为正治。若阴水不足，肺受火侮，津液凝浊，不
生血而生痰，此当润剂滋阴，使上逆之火得返其宅，痰自清矣；二陈之燥，立见其殆。六曰参 助火之误。夫虚劳之可
受参 者，肺必无热者也，肺脉按之而虚，必不数者也，故有土旺而生金，勿拘拘于保肺之说，古人每用之而奏功。今
则火已烁金而咳矣，火蒸津液而化为浓痰矣，君相亢甚而血随上逆矣，犹引阳生阴长，虚火可补之说，漫用参、 ，因
之阳火愈旺，金益受伤，所以好古有肺热还伤肺，节斋有食参必死之叮咛也。七曰治疗过时。上古“圣人不治已病，治
未病”。如劳神者，常养其心，劳倦者，常补其脾，多怒者，常滋其肝血，多饮者，常清其肺热，好色者，峻补其肾水。
仲景曰∶凡人有病，不时即治，隐忍冀延，必成痼疾。所以终罕得愈者，以内热之症，人多易忽，自恃饮食如常，起居
如旧，仍纵恣酒色，迨至病已成而后药之，譬之渴而穿井，斗而铸兵，不亦晚乎！（以下三大治法）
然而治之最难，有三大要法，不可不讲也。一曰补肾水。《经》云∶“肾者主水，受五脏六腑之精而藏之。”精藏于此，
气化于此，精即阴中之水也，气即阴中之火也，故命门之水火，为十二脏之化源。火不畏其衰，水则畏其少，所以保阴、
六味、左归之属，皆甘寒滋水添精之品，补阴以配阳，正王太仆所谓壮水之主，以制阳光，丹溪所谓滋其阴则火自降，
譬之灯残火焰，添油则焰光自小也。然须制大其剂，长久服之，以阴无速补之法也。至若因于酒者，清金润燥为主，而
保阴之属仍不可废，盖补北方，正所以泻南方而救肺也。因于思虑者，清心养血为主，而佐保阴之属，所谓水壮而火熄，
勿亟亟于清心是也。因于劳倦者，培补脾阴为主，而佐保阴之剂。《经》曰∶有所远行劳倦，逢大热而渴，渴则阳气内伐，
内伐则热舍于肾。”故知劳倦伤脾内热者，必及肾也。若忿怒伤肝动血，保阴、六味大为正治，盖水旺则龙火不炎，雷火
亦不发，乃肾肝同治之法也。二曰培脾土。脾胃为后天根本，《经》曰∶“安谷则昌。”盖精生于谷，饮食多自能生血化精，
虽有邪热，药得以制之，久则火自降而阴自复也。若脾胃一弱，则饮食少而血不生，阴不能以配阳，而五藏齐损，故越
人归重脾胃而言，一损损于肺，皮聚而毛落，二损损于心，血脉不能营养藏府，三损损于脾，饮食不为肌肤，四损损于
肝，筋缓不能自收持，五损损于肾，骨痿不能起于床。从上而下者，过于胃则不治，至骨痿不能起于床者，死；从下而
上者，过于脾则不治，至皮聚而毛落者，死。所以仲景治虚劳，惟用甘药创建中气，以生血化精，一遵“精不足者，补
之以味”之旨也。味、非独药也，补以味而节其劳，则积贮渐富，大命不倾。《经》云∶“阴阳形气俱不足者，调以甘药”，
故中气不足者，非甘不可。况土强则金旺，金旺则水充。又男子以脾、胃为生身之本，女子以心、脾为立命之根，故治
此者，当以调养脾胃为主。三曰慎调摄。虚劳之因，因于酒色者固多，其因于忧愁思虑、抑郁多怒者亦不少，所以童子
室女，不生欢笑，及鳏寡僧尼，易犯此病，经谓非针药之可治，必须消遣情怀，随遇皆安，然后疗治，庶能愈病。乃今
之患此症者，徒仗诸草木，奉为复元之品，外则疲劳形体，内则沉湎七情，不知心有妄动，气随心散，气散不聚，精逐
气亡，故广成子曰∶“必静必清，无劳汝形，无摇汝精。乃可以长生。”斯言真可为虚劳调摄之良法也。予今所论虚劳致
病之因，次及方书之混列，更推真阴易虚之故，以及标本传乘，并误治之弊，而终之以治要，非敢矫当世之偏，实本诸
先哲发明治要，予又自验之而不爽者，故特立说以识之。
保阴煎（自制） 熟地黄 生地黄 天门冬 麦门冬 玉竹 龟版 茯苓 山药 牛膝 桂圆肉 人乳
上药或水煎，或用石斛煎汤代水煎。内热有汗，加地骨皮。内热无汗，加壮丹皮。腰痛，加杞子、杜仲；或加猪腰、
猪脊髓。盗汗，加枣仁、五味子。忡怔不寐，加枣仁。咳嗽，加桑白皮、枇杷叶、百合。有痰，加贝母。有血，加藕汁、
童便。食少，加薏苡仁。泄泻，去生地、天冬，加山萸肉、白芍、大枣、莲肉。肺脉按之无力者，量加人参。
虚劳这一疾病，都是由内伤引起，而没有外感邪气。比如饮酒损伤肺脏，就会导致湿热熏蒸，消耗肺阴；房事过度损伤肾脏，会导致精室空虚，相火失去制约；思虑过度损伤心脏，会导致血液耗损而心火容易上炎；劳累疲倦损伤脾脏，会产生内热并暗中耗伐真阴。只有愤怒损伤肝脏有两种情况：郁怒会导致肝火在体内炽盛而灼伤血液；大怒会导致肝火上升而引起吐血。这五种情况，都能使人的精血劳损。《道经》说：“涕、唾、津、精、汗、血、液，这七种灵物都属于阴。”阴虚产生内热从而形成虚劳病症，大多是由酒色引起的，但也有未婚童子患此病的，有的是先天不足，或者禀受母亲的体质为阴虚；还有尼姑、寡妇、未出嫁女子月经延期，气血郁结，导致寒热像疟疾一样，早晨凉晚上热，不想吃东西，经期不准，或者导致闭经而形成这种病的，多是由于郁火在内蒸腾所致（以上论述致病的原因，以下论述真阴容易亏损）。
医书中谈论这种病症的，都把气虚、血虚、阴虚、阳虚混在一起论治。不知道气虚的人，面色苍白没有神采，说话声音轻微，四肢无力，脉象微弱；阳虚的人，身体寒冷怕冷，手脚逆冷，小便清长，大便稀溏，脉象沉小迟。这两种情况，能够服用参、附等温补药物，才算是能够接受补益可以治疗，这才是气虚阳虚的病症。虽然血脱也有补气的方法，那是指突然大量失血，平时并非血虚的人，比如刚生产完的情况罢了。其余患这种病的人，《内经》说：“一水不能胜五火。”五火，是指五志之火；一水，是指肾中的真阴之水。水就是精，就像“女子十四岁天癸至”，“男子十六岁天癸至”，这不是说明阴在前半生衰退，阴精生成困难吗？又说人“到了四十岁，阴气自然减半”，这不是说明阴在后半生衰退，阴精凋谢容易吗？所谓的阴，就是我的精，它塑造我的形体。人生全盛的时期，前后不过二十多年，所以朱丹溪引用月亮的盈亏，认为阳常有余，阴常不足。而王节斋则认为，阴虚成病的占十之八九，阳虚成病的百中无一二，大概是因为节制欲望的人少，放纵欲望的人多罢了（以下叙述五脏虚证）。
这种病发作时，在肾脏，就会腰、脊、腿酸软，或者隐隐作痛，出现骨蒸盗汗，或者到夜间发热，全身骨头酸软，或者疼痛得像折断一样，出现梦遗滑精，耳朵里鸣响，脚心发热。在心脏，就会出现惊悸怔忡，手掌心干热，虚烦失眠，或者做噩梦不安稳，口苦舌干，或者口舌糜烂。在肺脏，就会出现痰嗽干咳，气逆喘促，鼻中呼出热气，颧骨发红吐衄，严重时吐出白色涎沫，侧卧呼吸，咽喉痛声音嘶哑。在肝脏，就会出现寒热像疟疾一样，颈部淋巴结肿大，胁肋胀痛，两眼涩痛，头晕眼花，容易发怒，吐血。在脾脏，就会出现食欲减退不消化，恶心呕吐，腹胀腹痛，肠鸣泄泻，肌肉消瘦。这些都是五脏虚劳的根本症状。《内经》说：“治病必求于本。”必须审察是什么原因导致损伤，哪个脏腑受伤，如果是因房事过度导致的，就知道是肾受伤，即使有其他经络的症状，也应当以补肾为主，兼治其他症状；如果是因饮酒导致的，又应当以清肺为先（以下叙述标本传变乘侮）。
既然审明了标本，再弄明白传变规律。比如肾病传心，心传肺，肺传肝，肝传脾，脾再传肾，这是传给它所克制的脏腑，被侮而乘，称为贼克，是大凶的征兆。《内经》说：诸病这样依次相传的会死，是说五脏依次相传且克制遍尽。《难经》说：七传者死。是说如果病始于肾，而脾又传回给肾，这叫六传已尽，一个脏腑不能再受伤害了。又如肾病不传心而传肺，中间隔了一个脏腑传于生我之母，因为母子之气相通；如肾病不传心肺而传肝，中间隔了两个脏腑传于己生之子，这是母病及子；如肾病不传心、肺、肝而传脾，中间隔了三个脏腑传于我所不胜的脏腑，《内经》所谓“轻而侮之”。如果不明白传乘规律，怎么能治疗疾病呢（以下辨别误治）？
虚劳这一病症，偏于阴虚的居多，而医生误治的情况有七种，试详细说说。一是误认为阳虚。命门之火，是龙火，也称为真阳，如果肾中阴盛，龙火不能安守其位，表现为上焦假热，面赤、烦躁、口渴等症状，口虽渴但不想喝水，脚冷过膝，小便清长，右尺脉沉小而迟，或浮大无根，这是阴盛逼阳的假症。就像夏至一阴生，水底冷而天上热，龙是阳物，随阳气上升，适宜用八味丸之类的药，冰冷饮用，能引导浮火归元，就像冬至一阳来复，地中水暖，而龙归大海一样。至于虚劳病症，是因肾水真阴虚极，水不摄火，火因上炎而导致面赤唇红，口鼻出血，齿痛齿衄，虽然也是龙火上炎，但与虚阳上浮不同，即使有下部恶寒足冷，这也是因虚火上升所致，并非真阳衰败，所以小便必然黄赤，脉象必然带数，有内热的症状可依据，如果误用引火归元的方法，是抱薪救火，上焦更热，而咳喘燥渴更加严重，咽痛喉烂等症状就来了。二是误认为中寒。腹痛属于虚寒的，绵绵作痛而无增减，喜欢热手按压，喜欢热饮食。泄泻属于虚寒的，水谷不化，排泄物澄彻清冷，必须有虚寒的脉证作为依据，然后用药才有效。现在的人一见胀满腹痛，食不消化，肠鸣泄泻等症状，就认为是虚寒，而投用理中汤等温燥药剂，再补其阳，则阳更亢盛而阴更枯竭了。更有见到胀满泄泻，便引用《内经》“清气在下，则生飧泄，浊气在上，则生䐜胀”，而用补中益气汤，反而提引阴火上逆，以致咳喘频繁增加，吐衄交加，立刻面临危亡。这种温补得逞的，不过是助阳的药，能使胃气一时暂时强壮，饮食增加，彼此夸耀，至死不悟，实在可怜。三是误认为外感。世上真阴虚而发热的，十之六七也与外感无异，火逆冲上，则头胀微痛，火热壅肺，则有时鼻塞，阴虚阳陷入里，则洒浙恶寒。阴虚阳无所依附，则浮越肌表而热，但其发热时，必在午后，先洒浙恶寒，一会儿发热，热至寅卯时，盗汗出而身凉；或者没有微寒但只是午后发热。必定出现肾虚症状，或者兼见唇红颧赤，口渴烦躁，六脉搏数，或虚数无力。这宜用大剂滋阴药，如保阴煎、六味地黄丸之类。如果误认为外感而用解表法，则大汗淋漓，各种虚证蜂拥而起。或者有失血之人，解表后无汗，《内经》所谓“夺血者无汗”也，再强行发汗，必然吐衄，成为下厥上竭的病症，这更是鲁莽之流。四是苦寒泻火的误治。实火致病，可以直折，虚火致病，不能用寒凉清除，不仅不能清热，反而败坏胃气，食少泻多，将如何治疗？甚者见到燥结，肆意使用硝黄来通便，不知道肾主二便，肾主五液，肾液既已亏损，自然不濡润，滋润其阴，润其燥，而大便自通，那些已经亏损的阴，怎么能承受硝黄的攻伐呢？五是二陈汤消痰的误治。痰在脾经的，名叫湿痰，其痰滑而易出；或者稀如水样的，名叫痰饮。湿者燥之，半夏自然是正治。如果阴水不足，肺受火侮，津液凝浊，不生血而生痰，这应当用润剂滋阴，使上逆之火得以返回其宅，痰自然清除了；二陈汤的燥性，立刻可见危险。六是参、芪助火的误治。虚劳中能接受参、芪的，肺一定没有热，肺脉按之而虚，一定不数，所以有土旺生金，不要拘泥于保肺的说法，古人常用而奏效。现在则是火已烁金而咳嗽了，火蒸津液化为浓痰了，君相火亢甚而血随上逆了，还引用阳生阴长，虚火可补的说法，滥用参、芪，因此阳火更旺，金更受伤，所以李东垣有“肺热还伤肺”，王节斋有“服参必死”的叮咛啊。七是治疗过时。上古“圣人不治已病，治未病”。如劳神的人，常养其心，劳倦的人，常补其脾，易怒的人，常滋其肝血，多饮的人，常清其肺热，好色的人，峻补其肾水。张仲景说：凡人有病，不时即治，隐忍冀延，必成痼疾。所以终罕见痊愈的，因为内热之症，人多容易忽视，自恃饮食如常，起居如旧，仍放纵酒色，等到病已成而后用药，就像渴了才挖井，打仗了才铸兵器，不也太晚了吗！（以下三大治法）
然而治疗最难，有三大要法，不可不讲。一是补肾水。《内经》说：“肾者主水，受五脏六腑之精而藏之。”精藏于此，气化于此，精就是阴中之水，气就是阴中之火，所以命门的水火，是十二脏的化源。火不怕其衰，水只怕其少，所以保阴煎、六味地黄丸、左归丸之类，都是甘寒滋水添精的药物，补阴以配阳，正是王太仆所谓壮水之主，以制阳光，丹溪所谓滋其阴则火自降，就像灯残火焰，添油则焰光自小一样。然而必须加大剂量，长久服用，因为阴没有速补的方法。至于因饮酒导致的，以清金润燥为主，而保阴煎之类仍不可废，因为补北方（肾），正是为了泻南方（心）而救肺。因思虑导致的，以清心养血为主，而佐以保阴煎之类，所谓水壮而火熄，不要急于清心。因劳倦导致的，以培补脾阴为主，而佐以保阴煎之剂。《内经》说：“有所远行劳倦，逢大热而渴，渴则阳气内伐，内伐则热舍于肾。”所以知道劳倦伤脾内热者，必波及肾。若忿怒伤肝动血，保阴煎、六味地黄丸大为正治，因为水旺则龙火不炎，雷火亦不发，这是肾肝同治的方法。二是培脾土。脾胃为后天根本，《内经》说：“安谷则昌。”因为精生于谷，饮食多自能生血化精，虽有邪热，药得以制之，久则火自降而阴自复也。如果脾胃一弱，则饮食少而血不生，阴不能以配阳，而五脏齐损，所以扁鹊重视脾胃而言，一损损于肺，皮聚而毛落，二损损于心，血脉不能营养脏腑，三损损于脾，饮食不为肌肤，四损损于肝，筋缓不能自收持，五损损于肾，骨痿不能起于床。从上而下者，过于胃则不治，至骨痿不能起于床者，死；从下而上者，过于脾则不治，至皮聚而毛落者，死。所以张仲景治虚劳，只用甘药创建中气，以生血化精，完全遵循“精不足者，补之以味”的宗旨。味，不只是药，补以味而节制劳损，则积贮渐富，大命不倾。《内经》说：“阴阳形气俱不足者，调以甘药”，所以中气不足者，非甘不可。况且土强则金旺，金旺则水充。又男子以脾、胃为生身之本，女子以心、脾为立命之根，所以治此者，当以调养脾胃为主。三是慎调摄。虚劳的原因，因于酒色的固多，其因于忧愁思虑、抑郁多怒的也不少，所以童子室女，不生欢笑，以及鳏寡僧尼，易犯此病，经谓非针药之可治，必须消遣情怀，随遇皆安，然后疗治，庶能愈病。乃今之患此症者，徒仗诸草木，奉为复元之品，外则疲劳形体，内则沉湎七情，不知心有妄动，气随心散，气散不聚，精逐气亡，所以广成子说：“必静必清，无劳汝形，无摇汝精。乃可以长生。”这话真可为虚劳调摄的良法啊。我现在所论虚劳致病之因，次及方书之混列，更推真阴易虚之故，以及标本传乘，并误治之弊，而终之以治要，非敢矫当世之偏，实本诸先哲发明治要，我又自验之而不爽者，故特立说以识之。
保阴煎（自制） 熟地黄 生地黄 天门冬 麦门冬 玉竹 龟版 茯苓 山药 牛膝 桂圆肉 人乳
上述药物或用水煎，或用石斛煎汤代水煎。内热有汗，加地骨皮。内热无汗，加牡丹皮。腰痛，加枸杞子、杜仲；或加猪腰、猪脊髓。盗汗，加酸枣仁、五味子。心悸怔忡不寐，加酸枣仁。咳嗽，加桑白皮、枇杷叶、百合。有痰，加贝母。有血，加藕汁、童便。食少，加薏苡仁。泄泻，去生地、天冬，加山萸肉、白芍、大枣、莲肉。肺脉按之无力者，酌情加人参。
Xulao (Consumptive Disease) is caused entirely by internal injury, without external pathogenic factors. For instance, alcohol injury to the Lung leads to damp-heat steaming and consuming Lung Yin; sexual excess injures the Kidney, causing emptiness in the essence chamber and uncontrolled Ministerial Fire; excessive thinking injures the Heart, leading to blood depletion and easy flaming up of Heart Fire; fatigue and overwork injure the Spleen, generating internal heat that secretly attacks True Yin. Anger injuring the Liver has two aspects: constrained anger causes Liver Fire to blaze internally and scorch blood; sudden anger causes Liver Fire to rise and induce hematemesis. These five conditions all exhaust Jing (Essence) and Blood. The Daoist Canon states: "Tears, saliva, fluids, essence, sweat, blood, and body fluids—the seven spiritual substances—all belong to Yin." Yin deficiency generates internal heat, forming Xulao symptoms; this is mostly due to alcohol and sex, yet some unmarried youths suffer from it due to congenital insufficiency or inheriting maternal Yin deficiency. Nuns, widows, and unmarried women may experience delayed menstruation, Qi and Blood stagnation, leading to chills and fever resembling malaria, morning coolness with evening fever, loss of appetite, irregular periods, or amenorrhea resulting in this disease; this is mostly caused by constrained Fire steaming internally (The above discusses the causes of disease, the following discusses how True Yin is easily depleted).
Medical texts discussing this condition often confuse Qi deficiency, Blood deficiency, Yin deficiency, and Yang deficiency in treatment. One must know that those with Qi deficiency present with a pale, spiritless complexion, faint speech, weak limbs, and a faint pulse; those with Yang deficiency present with cold body and aversion to cold, cold extremities, clear urine and loose stools, and a deep, small, slow pulse. Only these two can tolerate tonification with Ginseng Radix et Rhizoma (Renshen) and Aconiti Lateralis Radix Praeparata (Fuzi), indicating they are treatable via tonification—this characterizes Qi and Yang deficiency. Although there is a method of tonifying Qi for Blood loss, it refers specifically to acute massive hemorrhage in individuals not previously Blood deficient, such as postpartum cases. For others suffering from this condition, the Classic states: "One Water cannot overcome Five Fires." The Five Fires refer to the fires of the Five Emotions; One Water refers to the True Yin Water of the Kidney. Water is Essence. As stated, "At age fourteen, Tian Gui arrives in women," and "At age sixteen, Tian Gui arrives in men"—does this not indicate that Yin declines early, making Yin formation difficult? It also says, "At age forty, Yin Qi naturally halves"—does this not indicate that Yin declines later, making Yin withering easier? The so-called Yin is my Essence, which shapes my form. Human prime lasts only about twenty years. Thus, Zhu Danxi used the waxing and waning of the moon to argue that Yang is often in excess, while Yin is often insufficient. Wang Jiezhai believed that nine or ten out of ten cases of illness are due to Yin deficiency, while less than one or two are due to Yang deficiency, largely because few restrain desires while many indulge them (The following narrates the deficiency syndromes of the Five Zang organs).
When the disease manifests in the Kidney, it causes soreness and weakness in the waist, spine, and legs, or dull pain, bone-steaming night sweats, fever at night, generalized bone soreness or pain like breaking, nocturnal emission, tinnitus, and hot soles. In the Heart, it causes palpitations and fright, dry-hot palms, vexatious insomnia, restless dreams, bitter taste and dry tongue, or mouth and tongue ulcers. In the Lung, it causes cough with phlegm or dry cough, rebellious Qi and panting, hot breath from the nose, malar flush and epistaxis/hemoptysis, severe cases spitting white froth, sleeping on side, sore throat and hoarseness. In the Liver, it causes chills and fever like malaria, cervical lymphadenopathy, distending pain in hypochondrium, dry/painful eyes, dizziness, blurred vision, irritability, and hematemesis. In the Spleen, it causes reduced appetite and indigestion, nausea and vomiting, abdominal distension and pain, borborygmus and diarrhea, and muscle emaciation. These are the fundamental symptoms of Five Zang consumptive diseases. The Classic says: "In treating disease, one must seek the root." One must examine the cause of damage and which Zang is injured. If caused by sexual excess, the Kidney is injured; even if other meridians show symptoms, tonifying the Kidney should be primary, addressing other symptoms secondarily. If caused by alcohol, clearing the Lung should be prioritized (The following narrates root/branch transmission and overcoming).
Having examined root and branch, one must clarify transmission patterns. If Kidney transmits to Heart, Heart to Lung, Lung to Liver, Liver to Spleen, and Spleen back to Kidney, this is transmission to the organ it controls, being overcome and attacked, called "Thief Restriction," a sign of great misfortune. The Classic says: Diseases transmitted in this manner result in death, meaning the Five Zangs are sequentially transmitted and controlled until exhaustion. The Nanjing says: Seven transmissions result in death. This means if disease starts in the Kidney and Spleen transmits back to Kidney, six transmissions are complete, and one Zang cannot be injured again. If Kidney disease does not transmit to Heart but to Lung, skipping one organ to transmit to the mother that generates it, because Mother and Child Qi connect; if Kidney disease does not transmit to Heart/Lung but to Liver, skipping two organs to transmit to the child it generates, this is Mother disease affecting Child; if Kidney disease does not transmit to Heart, Lung, or Liver but to Spleen, skipping three organs to transmit to the organ it cannot overcome, as the Classic says "lightly overcomes." Without understanding transmission and overcoming, how can one cure disease (The following distinguishes mis-treatment)?
Xulao is mostly Yin deficiency, yet doctors make seven types of errors. First, mistaking for Yang deficiency. The Fire of Mingmen is Dragon Fire, also called True Yang. If Kidney Yin is excessive, Dragon Fire cannot stay in place, presenting as upper Jiao false heat: red face, restlessness, thirst, yet no desire to drink, cold feet below knees, clear long urination, Right Chi pulse deep/small/slow or floating/large/rootless. This is false syndrome of Yin excess forcing Yang outward. Like summer solstice where Yin arises, water is cold below but sky is hot; Dragon is Yang entity, rising with Yang. Use Ba Wei Wan (Eight-Ingredient Pill) type formulas, taken cold, to guide floating fire back to origin, like winter solstice when Yang returns, earth water warms, and Dragon returns to sea. However, Xulao is due to extreme depletion of Kidney True Yin, water failing to control fire, fire flaming up causing red face/lips, bleeding from mouth/nose, toothache/tooth bleeding. Though also Dragon Fire flaming up, it differs from floating Yang. Even with lower body coldness, this is due to deficiency fire rising, not True Yang decline. Urine is yellow/red, pulse is rapid, internal heat signs exist. Mistakenly using "guiding fire back to origin" is adding wood to save fire; upper Jiao gets hotter, cough/wheezing/dryness/thirst worsen, sore throat/rotten throat appear. Second, mistaking for Middle Cold. Dull abdominal pain without fluctuation, preferring warm pressure and hot drinks indicates deficiency-cold. Diarrhea with undigested food, clear/cold excrement indicates deficiency-cold. Only with supporting deficiency-cold pulse/symptoms should treatment be effective. Now, seeing distension, abdominal pain, indigestion, borborygmus, diarrhea, people assume deficiency-cold and use Lizhong Tang (Regulate the Middle Decoction) or similar warming-drying agents, further tonifying Yang, making Yang hyperactive and Yin exhausted. Some cite the Classic: "Clear Qi sinking below causes sputtering diarrhea, turbid Qi staying above causes distension," and use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), inadvertently raising Yin Fire upward, causing frequent cough/wheeze, hematemesis/epistaxis, leading to immediate danger. Warming tonics succeed only by temporarily boosting Stomach Qi and appetite, boasting until death, pitiable indeed. Third, mistaking for External Contraction. Sixty to seventy percent of true Yin deficiency fevers resemble external contraction. Fire rebelling upward causes head distension/mild pain; heat congesting Lung causes nasal congestion; Yin deficiency with Yang sinking inward causes shivering chills. Yin deficiency leaves Yang unattached, floating on surface causing heat. Fever occurs in afternoon, starting with chills, then heat, subsiding around Yin/Mao hours with night sweats and cooling; or just afternoon fever. Must show Kidney deficiency signs, or flushed lips/cheeks, thirst/restlessness, rapid/weak pulses. Treat with large doses of Yin-nourishing herbs like Baoyin Jian (Preserve Yin Decoction) or Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). Mistaking for external contraction and using diaphoresis causes profuse sweating and onset of various deficiencies. In blood-loss patients, diaphoresis yields no sweat ("Those who lose blood should not be sweated"), forcing sweat causes hematemesis/epistaxis, becoming Lower Cold Upper Exhaustion, a rash error. Fourth, error of bitter-cold purging fire. Excess fire can be directly subdued; deficiency fire cannot be cleared by cold. It fails to clear heat and damages Stomach Qi, reducing appetite and increasing diarrhea. Worse, seeing constipation, using Mirabilite (Natrii Sulfas) and Rhubarb (Rhei Radix et Rhizoma) to purge ignores that Kidney governs bowels and fluids. Depleted Kidney fluids fail to moisten; nourishing Yin moistens dryness, stool passes naturally. Can depleted Yin withstand harsh purgatives? Fifth, error of Erchen Tang (Two-Aged Decoction) resolving phlegm. Phlegm in Spleen meridian is damp-phlegm, slippery/easy to expectorate; watery phlegm is fluid retention. Damp requires drying; Pinelliae Rhizoma (Banxia) is correct. If Yin water is insufficient, Lung is insulted by fire, fluids condense into turbidity, failing to generate blood but producing phlegm. This requires moistening Yin-nourishing agents to return rebellious fire to its home, clearing phlegm; Erchen Tang's dryness brings danger. Sixth, error of Ginseng Radix et Rhizoma (Renshen) and Astragali Radix (Huangqi) aiding fire. Only Xulao patients with no Lung heat can tolerate Renshen/Huangqi. Lung pulse must be empty and not rapid. Earth generates Metal; do not rigidly adhere to "protecting Lung." Ancients used them successfully. Now, fire scorches Metal causing cough, fire steams fluids into thick phlegm, Ministerial/Emperor fire hyperactivity causes blood rebellion upward. Still citing "Yang generates Yin, deficiency fire can be tonified," and recklessly using Renshen/Huangqi makes Yang fire stronger, damaging Metal more. Li Dongyuan warned "Lung heat harms Lung"; Wang Jiezhai warned "Taking Renshen leads to death." Seventh, treatment too late. Ancients said: "Sages do not treat established disease, but prevent it." Mental laborers nourish Heart; fatigued tonify Spleen; irritable nourish Liver Blood; drinkers clear Lung heat; lustful strongly tonify Kidney Water. Zhang Zhongjing said: "Treat disease promptly; delaying leads to chronic illness." Rare cures occur because internal heat is ignored; patients rely on normal diet/activity, indulging in alcohol/sex, only medicating after disease forms. Like digging a well when thirsty, forging weapons when fighting—isn't it too late? (The following presents three major treatment methods).
However, treatment is hardest, requiring three key methods. First, tonify Kidney Water. The Classic says: "Kidney governs water, receiving and storing essence of all Zang-Fu." Essence stores here, Qi transforms here. Essence is Yin-Water; Qi is Yin-Fire. Mingmen Water/Fire are sources of Twelve Zang transformations. Fire fears decline less than Water fears scarcity. Thus, Baoyin Jian, Liuwei Dihuang Wan, Zuogui Wan (Restore the Left Pill) are sweet-cold agents nourishing water and adding essence, tonifying Yin to match Yang. This is Wang Bing's "Strengthen the Master of Water to control Solar Flare," and Zhu Danxi's "Nourish Yin so Fire descends," like adding oil to a dying lamp to reduce flame size. Large doses, long-term use required, as Yin cannot be quickly tonified. For alcohol-induced cases, prioritize clearing Metal and moistening dryness, still using Baoyin Jian; tonifying North (Kidney) helps drain South (Heart) and rescue Lung. For thought-induced cases, prioritize clearing Heart and nourishing Blood, assisting with Baoyin Jian; "Water strong, Fire extinguished," do not rush to clear Heart. For fatigue-induced cases, prioritize tonifying Spleen Yin, assisting with Baoyin Jian. The Classic says: "Traveling far and working hard, encountering great heat and thirst, thirst causes Yang to attack internally, internal attack stores heat in Kidney." Thus, fatigue injuring Spleen with internal heat inevitably affects Kidney. For anger injuring Liver causing blood movement, Baoyin Jian and Liuwei Dihuang Wan are correct treatments; Water strong prevents Dragon Fire flaming and Thunder Fire erupting, treating Kidney and Liver together. Second, cultivate Spleen Earth. Spleen/Stomach are postnatal foundations. The Classic says: "Abundant grain intake leads to prosperity." Essence generates from grain; abundant diet generates blood/essence. Even with pathogenic heat, medicine can control it; eventually Fire descends and Yin recovers. If Spleen/Stomach weaken, diet decreases, blood fails to generate, Yin cannot match Yang, Five Zangs deteriorate. Bian Que emphasized Spleen/Stomach: First damage to Lung, skin gathers hair falls; Second to Heart, vessels fail to nourish Zang-Fu; Third to Spleen, food fails to form flesh; Fourth to Liver, tendons relax unable to hold; Fifth to Kidney, bones wither unable to rise. Downward progression beyond Stomach is untreatable; bone withering is death. Upward progression beyond Spleen is untreatable; skin gathering hair falling is death. Thus, Zhang Zhongjing treats Xulao only with sweet medicines to establish Middle Qi, generating blood/essence, following "For insufficiency of essence, tonify with flavor." Flavor is not just medicine; tonifying with flavor and regulating labor accumulates wealth, preserving life. The Classic says: "When Yin-Yang, Form-Qi are all insufficient, regulate with sweet medicine." Thus, Middle Qi insufficiency requires sweet. Moreover, Strong Earth generates Prosperous Metal; Prosperous Metal generates Abundant Water. Men take Spleen/Stomach as root of life; Women take Heart/Spleen as root of destiny. Treatment must focus on regulating Spleen/Stomach. Third, careful regulation. Causes include alcohol/sex, but also worry/thought/depression/anger. Unmarried youth/nuns/widows prone due to lack of joy. Classics say not treatable by needles/herbs alone; must relieve emotions, find peace in circumstances, then treat to heal. Modern patients rely on herbs as restoration agents, exhausting body externally, indulging emotions internally. Ignoring that mental agitation scatters Qi, scattered Qi fails to gather, Essence follows Qi to perish. Guangchengzi said: "Be quiet and clear, do not labor your form, do not shake your essence. Thus you can live long." This is true good method for Xulao regulation. My discussion covers causes, confusion in texts, reasons for Yin depletion, root/branch transmission, mis-treatment harms, ending with key treatments. Not daring to correct modern bias, but based on ancient sages' insights, verified by myself, hence this theory.
Baoyin Jian (Self-made): Prepared Rehmanniae Radix (Shudihuang), Raw Rehmanniae Radix (Shengdihuang), Asparagi Tuber (Tianmendong), Ophiopogonis Tuber (Maidong), Polygonati Odorati Rhizoma (Yuzhu), Tortoise Plastron (Guiban), Poria (Fuling), Dioscoreae Rhizoma (Shanyao), Achyranthes Root (Niuxi), Longan Aril (Guiyuanrou), Human Milk (Renru).
Decoct in water, or decoct in Dendrobii Caulis (Shihu) soup as water substitute. Internal heat with sweat: add Cortex Lycii Radicis (Digupi). Internal heat without sweat: add Moutan Cortex (Danpi). Waist pain: add Fructus Lycii (Gouqi), Eucommiae Cortex (Duzhong); or add Pig Kidney, Pig Spinal Cord. Night sweats: add Semen Ziziphi Jujubae (Zaoren), Fructus Schisandrae (Wuweizi). Palpitations/insomnia: add Zaoren. Cough: add Pericarpium Citri Reticulatae (Sangbaipi - *Note: Text says Sangbaipi usually implies Pericarpium Citri Reticulatae or Morus Alba Bark, context suggests lung clearing, likely Pericarpium Citri Reticulatae or Flos Mori Albii*, text says Sangbaipi which is Pericarpium Citri Reticulatae White Layer or Cortex Mori Radicis. Given "Cough", usually Cortex Mori Radicis (Sangbaipi) is used for lung heat cough. I will translate as Pericarpium Citri Reticulatae (Sangbaipi) per literal, but note Sangbaipi is often Cortex Mori Radicis in clinical practice for lung heat. Wait, Sangbaipi is Pericarpium Citri Reticulatae albedo. Sangbaipi clears lung heat. Correct.), Eriobotryae Folium (Pipaye), Lily Bulb (Baihe). Phlegm: add Fritillariae Bulbus (Beimu). Bleeding: add Lotus Rhizome Juice (Oujiang), Infant Urine (Tongbian). Poor appetite: add Coicis Semen (Yiyiren). Diarrhea: remove Shengdihuang, Tianmendong; add Cornus Fructus (Shanzhuyu), Paeoniae Radix Alba (Baishao), Jujubae Fructus (Dazao), Nelumbinis Semen (Lianrou). Lung pulse weak upon pressure: add appropriate amount of Ginseng Radix et Rhizoma (Renshen).