语云∶百闻不如一见。固有着书盈栋，而见之施行，则胶瑟罔效。宋义谭兵，非不娓娓
一用辄蹶，曾不如一小卒之久于行间者，迹所睹闻，恒为七书韬略所未经道，此无他，其所
回来，千书万轴，数言可了，更为躬行体验，要语无多，发前人之未发，开后人之津梁，
慎柔固有功于今古哉！故为列虚劳历例，次于师训云。
尝治虚损，脉缓五六至，但咳嗽、发热、无恶寒、喉痛、喉梗等症，以为可治。服保元
君之类十余剂，咳嗽略可，热亦微退。至二十剂外，咳嗽反甚，热又如故，而身反不能展侧
，两足渐无力，至不能行而足 。此何也？缘下焦肾气衰惫，而百骸间无津液涵溉，且
阳气不能四达，脾肺之气不能下输。（数语实括尽虚损机关，但保元、四君、八味、补中，
断难治此大症，偶有治愈者，必其血分犹未甚虚甚痹也。）故足无力而蜷，虽药有效，病难
暂减，终不治也。
尝治虚损，六脉俱数，有神和缓，虽数至十余至，不妨可治，初用四君加黄 、五味子
数剂后，数脉渐减，仍带和缓意，可治之。若退出，细如丝，尚数，决不可治。又有退出如
丝而不数，此犹有胃气，无肚疼作泻，（肚疼为血死，作泻为气脱。）而饮食如常，亦可保元
、参、术调理，二三年愈。然所云服药后数脉渐减，和缓有神为可治者，亦须三月见功，年
半方全愈。又须看年力之衰壮，及精神脾胃之强弱也。若服药后，脉虽和缓，而腿足渐无力
，如前所述，且痰嗽不止，脉虽缓，治之无益焉。然或如前症，足虽无力，而热已退，嗽减
，饮食如平人，此脾气尚弱，犹可迁延岁月。又有如前症，六脉俱和缓，服前剂，热退而脉
渐弦，反作泻下血，此平时经络留血，为火热煎熬而成者也。（此凉药遏血，伏阳灼而败之
，即仲景平脉篇热气所过血为痈脓义。）下半月或十日五日自愈。下血时，能饮食，不死；
不能饮食，精神倦怠，死可立待。其用药，健脾保元气为主。腹痛、脉弦，理中汤；恶心、
饮食少，六君子汤。无此二症，用四君、保元治之。盖下血者，邪气从下窍而出也；又有变
作伤风状者，邪气从上窍而出也，宜温肺助脾之药，亦得半月而愈。又有六脉俱和缓，数八
九至，服前剂，先右三脉退去二三至，左脉尚数不退，是右表先退，左里未退也。至数脉尽
退，病将痊愈，左脉犹比右脉多一至，足见表退而里未和耳。《难知》云∶伤寒以左为表，
右为里；杂病以右为表，左为里。信然。（看元气之存亡在左，看元气之轻重在右，百不爽
慎斋师尝云∶凡病求汗不出者，不治。虚损，六脉俱数，服滋阴降火之品，不及四、五十剂
者，犹可治之。如服至数十剂及百剂者，真元耗尽，虽脉大洪缓，中已无神，因用补剂即退
去，洪缓变为细数，即渐痿困不起而毙矣。戴人∶年少不妄服药，易治。正此谓也。又或服
寒凉未多，用保元、四君加生姜一二钱，一二十剂。求汗不出，而洪缓之脉不退，亦属难救，或虽无汗，而洪缓
渐减，病亦渐去，且能饮食，则无妨矣。如此脉，大抵秋冬易治，春夏难疗也。
凡虚损，三四月，脉虽数，尚和缓，六七至。若逢春夏火令，津液枯槁，肾水正行死绝之乡
，肺绝脾燥，无有不死者。若秋冬，火令已退，金水正旺，脉虽数，可治也。然使病者，骨
立、喉哑、喉痛、寒热、脉细数、肚疼作泻，亦不治。如前症求治，初用补剂，病当反重，
何也？病已延至三四月，服药已多，其不效者，必过用寒凉，病者五脏愈虚，邪火愈炽，初
用补剂，或数帖，或一二十帖，邪火一退，反觉头眩、恶心、骨疼、脚酸、神气昏懒、不思
食。（亦有宣肺疏肝健脾滋肾反见火大者，初为凉剂遏其真阳下伏，接用振阳安阴法即愈，
以根气尚稳也。）倘脉不细数，而带和缓，急用保元、四君大剂连服之，便安寝半日或一日
，睡觉即精神顿爽。再一剂，再寝，饮食渐增，则可治矣。倘脉细如丝，肚饱昏愦，即属难治。
凡虚损病久，脉虽和缓，未可决其必疗。盖久病之人，元气虚弱，脉气和缓者，假气也。
（真气涣散，不能鼓动而怠缓也。）过七、八月，间服补剂，病得渐减，此生机也。或延至十
一月，一阳初动，阳气渐升，内气空虚，无以助升发之机，则变憎寒壮热。（久病忽见寒热
如新感者，乃生死关头也。得微汗而体轻气旺，为阳气振；或微汗，或不汗热退而体重气弱
，为阳气脱；或肢困不能反侧，或胸痹饮食日减，是皆奇经已败之绝证。）服补药十余帖，
寒热渐退，犹可延挨，调理至二三月不变，得生矣，否则不治。缘春木旺，脾肺久病气衰，
不能敌时令矣。
尝医新病，或痢或杂病，初时有邪，脉浮数。用按脉病药数剂，数脉即退，病亦向安。
剂，即倦，脉反觉浮数，此时不可谓尚有邪也。盖邪退而神气初转，故浮，只宜保元汤养元
气。浮数之脉，得微汗而退，此乃阳气升，元神足，而邪自退之法也。倘不识此，仍以祛邪
之药治之。精神日损，肌肉日消，久之变为虚劳矣。
凡病遇时节则变换不定，或又加者，盖遇时节，则天地之气或升或降，而人身之气亦应
病者精气尚充，犹能与时令相应。若元气久虚之人，无以助升降之气，上升则头眩、呕哕，
下降则足热、身寒，反为气候所牵，而身不能为之主矣。（病随节气而动者，气败也；随月
之盈亏而动者，血败也。故重病朔望有加即不治。本文是专指升降太过，更有当升不得升，
当降不得降，身气与天地参差者，其实亦是一般机括。）
脾胃病，十分虚，死于初春，亦有望春而死者；八分虚，死于孟春；五、六分虚，死仲春。
及医之不得其当者，虽原无死道，而业已医坏，至季春不能挨矣。清明前后二、三日，尤为
肺肾病，起于春，十分虚，死于初夏，亦有望夏而死者；八分虚，死于仲夏，六分虚，死于季夏。
凡久病，服药后六脉俱和，偶一日诊之，或细加数，或虚弱，或变怪异常，即当细问起居之故
，或有一晚不睡而变者，或因劳碌恼怒，或感冒风寒，各随其感而治之。治之而脉终不和，
此为难治。一晚不睡或劳伤者，则用补中助元；伤饮食，则用盐汤探吐，后以二陈加减消食
之品佐之。若房劳者，脉虽变而病不变者，犹可以平日调补治之。倘病与脉俱变，调之不和
，决难救矣。秋冬尚可冀幸，春夏万不可为。若伤暑者，宜少撤帷闭，以治暑法治之。若冒风
寒，以温肺加风药散之，一、二剂即和，乃可；若不转，亦不治。大抵易于秋冬，而难于春
夏，亦观人脾胃元气而消息之，不可轻忽，妄许人以易治。
尝治一产后妇人，素有劳症，一年前，以八物汤愈，然连连绵绵，未为全去。次年得产，正癸
亥，属戊癸化火之年，天气炎甚，时医虽用人参，仍以山楂能解参毒间之，致寒热作泻。
余诊之，脉数九至，尚不短，用保元加干姜、熟附一分，四剂，数脉退减。再清晨诊之，按
下浮缓，但去着骨，指下细弦如丝，数脉如故。（此又以浮缓中有一条为败脉矣，可知前卷
一条之说，只是脉中之脊，非别一条也，神理全不同。）予曰∶不可为矣。彼恳求不已，用
桂制白芍五分，炙草五分，参、 各五分，作建中汤之意，服至八剂，数脉退，几六至。又
四剂，几五至。彼以为愈矣，遂止药。此四、五、六月后，脉转弦细而殁，此案有裨前论，
故附之。
（凡诊虚损，无不留心生死关头者。然生死在脉，死之迟速在证，其中颇有难决者。以脉言
之，一则两寸短弱，两尺软长，起伏如一，极似无病，而两旁边际萧条，与肌肉不相入也；
二则右寸短弱，左关沉陷，右尺细长，左尺软长，极似有根也；三则午前脉和似无病，午后
硬大似病重，而其证无甚增减也。以证言之，一则体重不能反侧，或两肋支满，或起动汗出
而神清音朗也；二则胸痹似结，痰不能出，饮食日减，而亦有不减也；三则忽发寒热如新感
，旋即热退，更加体倦气弱，语声拖放也。至于脉之细数芤散革牢，先数后缓，先硬忽软，
先细忽大；证之喑哑哕噫，更无不知其逆者，欲以此决其死之何日何时，终难灼见。曾诊两
人，一壮年冬月寒伤于足，以麻黄发其上，气逆足 稍动即喘，不能饮食，正月诸症稍减。
诊之，脉久不来，来如雀啄，仅在皮毛，五、七啄后，即盘旋于皮毛之上而不能去，去又如
弦之绝，从中分断，不能返入，两手并诊，又彼此相避，来去不齐。此元气已断，危在旦夕
。因饮食步履未改，决在立夏，竟延夏至何也？一老年平气弱音低，忽增胸痹、体倦、行步
乏力，饮食日减，夜不成眠，脉来雀啄，参伍不调，模糊无力，但不盘旋，不中断，不两手
相避，其歇在已去之后，而不能来耳，亦无寒热。时方冬月，用温补大剂，保肾安肝，兼行
痰血，并于饮食加意调摄。脉旋转正，犹虑肾涸木枯，及春生发之令，难免摧折。乃至次年
冬月，脉又结代，复以法调之，至今四年安健，此又何也？元气退而药食进之，其势必有相
及者，特其机微而难喻耳。究竟死期迟速，总不外脏气、天时、五行互克，即不十全，不失
八、九。《内经》曰∶别于阳者，知病处也；别于阴者，知死生之期。阳脉知病，阴脉知死
，阴阳之脉，岂可不别乎？）
俗话说：百闻不如一见。确实有人著书等身，但将其应用于临床实践时，却像胶瑟（一种错误的比喻，指方法不当或工具不匹配）一样毫无效果。宋义谈论兵法，并非不详尽细致，但一用兵就失败，还不如一个久经沙场的小卒。这是因为他们所看到的、听到的，往往是那些兵书韬略中未曾提及的实际情况。这没有别的原因，是因为他们缺乏亲身实践和体验。回来想想，千卷万册的书，几句话说清楚就够了。更重要的是亲身践行和体验，言语不多，却能发掘前人未发的道理，为后人开辟道路，慎柔我对古今医学难道没有功劳吗！所以列出虚劳病的历例（病程演变规律），附在师训之后。
曾经治疗虚损病，脉象缓而每息五六至，只有咳嗽、发热、不怕冷、喉咙痛、喉咙梗塞等症状，认为可以治愈。服用保元汤之类的药物十余剂后，咳嗽稍微好转，热势也略微减退。到了二十剂以后，咳嗽反而加重，热势又像以前一样，而且身体反而不能翻身侧卧，两脚逐渐无力，甚至无法行走且足部蜷缩。这是为什么呢？因为下焦肾气衰败，全身骨骼关节间没有津液滋润灌溉，而且阳气不能通达四肢，脾肺之气不能下行输布。（这几句话实际上概括了虚损病的关键机理，但仅靠保元汤、四君子汤、八味丸、补中益气汤，很难治愈这种重症，偶尔有治愈的，一定是其血分还没有极度虚弱和痹阻。）所以脚无力而蜷曲，虽然药有效，但病情难以暂时减轻，最终无法治愈。
曾经治疗虚损病，六脉都数（快），但脉有神气且和缓，即使数到每息十余至，也不妨碍可以治疗。起初用四君子汤加黄芪、五味子，服用数剂后，数脉逐渐减少，仍然带有和缓之意，可以治疗。如果脉象退去后变得细如丝线，虽然还数，则绝对不可治。又有脉象退去后细如丝线但不数的，这还有胃气，如果没有肚子疼和腹泻（肚子疼是血死，腹泻是气脱），而且饮食正常，也可以用保元汤、人参、白术调理，二三年可以痊愈。然而所说的服药后数脉逐渐减少，和缓有神为可治者，也必须三个月见效，半年才能完全痊愈。还要看患者年力的衰壮，以及精神脾胃的强弱。如果服药后，脉象虽然和缓，但腿脚逐渐无力，像前面所述那样，而且痰嗽不止，脉象虽然缓，治疗也没有益处。然而或者像前面的症状，脚虽然无力，但热已退，咳嗽减少，饮食像正常人一样，这说明脾气尚弱，还可以拖延时日。又有像前面的症状，六脉都和缓，服用前面的药剂后，热退而脉象逐渐变弦，反而出现腹泻下血，这是平时经络中有留血，被火热煎熬而成的。（这是凉药遏制血液，伏阳灼烧而败坏它，即张仲景《平脉篇》中热气所过导致血成痈脓的道理。）下半月或五到十天自愈。下血时，如果能饮食，就不会死；如果不能饮食，精神倦怠，死亡就在眼前。用药以健脾保元气为主。腹痛、脉弦，用理中汤；恶心、饮食少，用六君子汤。没有这两个症状，用四君子汤、保元汤治疗。大概下血，是邪气从下窍排出；又有变成伤风状的，是邪气从上窍排出，宜用温肺助脾的药物，也能半个月痊愈。又有六脉都和缓，每息八九至，服用前面的药剂后，先右手的三脉退去二三至，左脉还数不退，这是右表先退，左里未退。等到数脉全部退去，病将痊愈，左脉还比右脉多一至，足以说明表退而里未和。《难知》说：伤寒以左为表，右为里；杂病以右为表，左为里。确实如此。（看元气存亡在左脉，看元气轻重在右脉，百发百中。）
慎斋老师曾经说：凡是求汗不出来的病，不治。虚损病，六脉都数，服用滋阴降火的药物，不到四五十剂的，还可以治疗。如果服到几十剂及上百剂的，真元耗尽，虽然脉象大洪缓，中间已经没有神气，因为用补剂就会退去，洪缓变为细数，就逐渐痿困不起而死了。戴人说：年少不妄自服药，容易治。正是这个意思。又或者服用寒凉药不多，用保元汤、四君子汤加生姜一二钱，一二十剂。求汗不出，而洪缓之脉不退，也属于难救，或者虽然没有汗，但洪缓之脉逐渐减少，病也逐渐去除，而且能饮食，就没有妨害了。这样的脉，大体上秋冬易治，春夏难疗。
凡是虚损病，三四月，脉虽然数，还和缓，六七至。如果遇到春夏火令，津液枯槁，肾水正行死绝之乡，肺绝脾燥，没有不死的。如果是秋冬，火令已退，金水正旺，脉虽然数，可以治疗。然而如果病人，骨立、喉哑、喉痛、寒热、脉细数、肚子疼腹泻，也不治。像前面的症状求治，初用补剂，病应当反而加重，为什么？病已经延续到三四月，服药已多，其无效的，一定是过用寒凉，病人五脏更虚，邪火更炽，初用补剂，或者数帖，或者一二十帖，邪火一退，反而觉得头眩、恶心、骨疼、脚酸、神气昏懒、不想吃东西。（也有宣肺疏肝健脾滋肾反而见火大的，初为凉剂遏制其真阳下伏，接着用振阳安阴法就痊愈了，因为根气还稳。）如果脉不细数，而带和缓，急用保元汤、四君子汤大剂连服，就能安睡半天或一天，醒来即精神顿爽。再一剂，再睡，饮食渐增，就可以治疗了。如果脉细如丝，肚子饱闷昏愦，就属难治。
凡是虚损病久，脉虽然和缓，不可断定一定能疗。因为久病的人，元气虚弱，脉气和缓的，是假气。（真气涣散，不能鼓动而怠缓。）过七、八月，间服补剂，病得渐减，这是生机。或者延至十一月，一阳初动，阳气渐升，内气空虚，无以助升发之机，则变憎寒壮热。（久病忽见寒热如新感者，乃生死关头也。得微汗而体轻气旺，为阳气振；或微汗，或不汗热退而体重气弱，为阳气脱；或肢困不能反侧，或胸痹饮食日减，是皆奇经已败之绝证。）服补药十余帖，寒热渐退，犹可延挨，调理至二三月不变，得生矣，否则不治。缘春木旺，脾肺久病气衰，不能敌时令矣。
曾经医治新病，或者是痢疾或者是杂病，初时有邪气，脉浮数。用按脉病药数剂，数脉即退，病亦向安。剂，即倦，脉反觉浮数，此时不可谓尚有邪也。盖邪退而神气初转，故浮，只宜保元汤养元气。浮数之脉，得微汗而退，此乃阳气升，元神足，而邪自退之法也。倘不识此，仍以祛邪之药治之。精神日损，肌肉日消，久之变为虚劳矣。
凡病遇时节则变换不定，或又加者，盖遇时节，则天地之气或升或降，而人身之气亦应 病者精气尚充，犹能与时令相应。若元气久虚之人，无以助升降之气，上升则头眩、呕哕，下降则足热、身寒，反为气候所牵，而身不能为之主矣。（病随节气而动者，气败也；随月 之盈亏而动者，血败也。故重病朔望有加即不治。本文是专指升降太过，更有当升不得升， 当降不得降，身气与天地参差者，其实亦是一般机括。）
脾胃病，十分虚，死于初春，亦有望春而死者；八分虚，死于孟春；五、六分虚，死仲春。 及医之不得其当者，虽原无死道，而业已医坏，至季春不能挨矣。清明前后二、三日，尤为 肺肾病，起于春，十分虚，死于初夏，亦有望夏而死者；八分虚，死于仲夏，六分虚，死于季夏。
凡久病，服药后六脉俱和，偶一日诊之，或细加数，或虚弱，或变怪异常，即当细问起居之故 ，或有一晚不睡而变者，或因劳碌恼怒，或感冒风寒，各随其感而治之。治之而脉终不和， 此为难治。一晚不睡或劳伤者，则用补中助元；伤饮食，则用盐汤探吐，后以二陈加减消食 之品佐之。若房劳者，脉虽变而病不变者，犹可以平日调补治之。倘病与脉俱变，调之不和 ，决难救矣。秋冬尚可冀幸，春夏万不可为。若伤暑者，宜少撤帷闭，以治暑法治之。若冒风 寒，以温肺加风药散之，一、二剂即和，乃可；若不转，亦不治。大抵易于秋冬，而难于春 夏，亦观人脾胃元气而消息之，不可轻忽，妄许人以易治。
曾经治疗一个产后妇人，素有劳症，一年前，以八物汤愈，然连连绵绵，未为全去。次年得产，正癸 亥，属戊癸化火之年，天气炎甚，时医虽用人参，仍以山楂能解参毒间之，致寒热作泻。 余诊之，脉数九至，尚不短，用保元加干姜、熟附一分，四剂，数脉退减。再清晨诊之，按 下浮缓，但去着骨，指下细弦如丝，数脉如故。（此又以浮缓中有一条为败脉矣，可知前卷 一条之说，只是脉中之脊，非别一条也，神理全不同。）予曰∶不可为矣。彼恳求不已，用 桂制白芍五分，炙草五分，参、 各五分，作建中汤之意，服至八剂，数脉退，几六至。又 四剂，几五至。彼以为愈矣，遂止药。此四、五、六月后，脉转弦细而殁，此案有裨前论， 故附之。
（凡诊虚损，无不留心生死关头者。然生死在脉，死之迟速在证，其中颇有难决者。以脉言 之，一则两寸短弱，两尺软长，起伏如一，极似无病，而两旁边际萧条，与肌肉不相入也； 二则右寸短弱，左关沉陷，右尺细长，左尺软长，极似有根也；三则午前脉和似无病，午后 硬大似病重，而其证无甚增减也。以证言之，一则体重不能反侧，或两肋支满，或起动汗出 而神清音朗也；二则胸痹似结，痰不能出，饮食日减，而亦有不减也；三则忽发寒热如新感 ，旋即热退，更加体倦气弱，语声拖放也。至于脉之细数芤散革牢，先数后缓，先硬忽软， 先细忽大；证之喑哑哕噫，更无不知其逆者，欲以此决其死之何日何时，终难灼见。曾诊两 人，一壮年冬月寒伤于足，以麻黄发其上，气逆足 稍动即喘，不能饮食，正月诸症稍减。 诊之，脉久不来，来如雀啄，仅在皮毛，五、七啄后，即盘旋于皮毛之上而不能去，去又如 弦之绝，从中分断，不能返入，两手并诊，又彼此相避，来去不齐。此元气已断，危在旦夕 。因饮食步履未改，决在立夏，竟延夏至何也？一老年平气弱音低，忽增胸痹、体倦、行步 乏力，饮食日减，夜不成眠，脉来雀啄，参伍不调，模糊无力，但不盘旋，不中断，不两手 相避，其歇在已去之后，而不能来耳，亦无寒热。时方冬月，用温补大剂，保肾安肝，兼行 痰血，并于饮食加意调摄。脉旋转正，犹虑肾涸木枯，及春生发之令，难免摧折。乃至次年 冬月，脉又结代，复以法调之，至今四年安健，此又何也？元气退而药食进之，其势必有相 及者，特其机微而难喻耳。究竟死期迟速，总不外脏气、天时、五行互克，即不十全，不失 八、九。《内经》曰∶别于阳者，知病处也；别于阴者，知死生之期。阳脉知病，阴脉知死 ，阴阳之脉，岂可不别乎？）
As the saying goes: Hearing a hundred times is not as good as seeing once. Indeed, there are those who fill their houses with books, yet when applied to clinical practice, they are as ineffective as playing a lute with glue (a metaphor for inappropriate methods or tools). Song Yi discussed military strategy, not without being detailed and eloquent, yet whenever he employed it, he failed. He was not even as competent as a low-ranking soldier experienced in warfare. This is because what they saw and heard were often matters not previously mentioned in strategic treatises. There is no other reason; it is due to their lack of personal practice and experience. Reflecting on this, thousands of scrolls can be summarized in a few words. More importantly, through personal practice and experience, with few words, one can uncover truths not yet revealed by predecessors and open pathways for successors. Does Shenrou have no merit to the past and present in medicine! Therefore, I list the historical examples (course of disease evolution) of deficiency consumption (Xu Lao), appended after the master's teachings.
I once treated a case of deficiency consumption. The pulse was slow (Huan) at five to six beats per respiration. The symptoms were limited to cough, fever, aversion to cold absent, sore throat, and throat obstruction. I considered it curable. After administering about ten doses of Baoyuan Tang (Preserve the Prime Decoction) and similar formulas, the cough slightly improved, and the fever subsided marginally. However, beyond twenty doses, the cough worsened, the fever returned to its previous state, and the body became unable to turn over or lie on its side. The legs gradually lost strength, eventually becoming unable to walk and curling up. Why? Because the Kidney Qi in the lower Jiao was exhausted, and there was no fluid (Jin Ye) to nourish and irrigate the bones and joints throughout the body. Furthermore, Yang Qi could not reach the four extremities, and the Qi of the Spleen and Lung could not descend and transmit downwards. (These few words actually encompass the key mechanism of deficiency consumption. However, relying solely on Baoyuan Tang, Si Jun Zi Tang (Four Gentlemen Decoction), Ba Wei Wan (Eight-Ingredient Pill), or Bu Zhong Yi Qi Tang would hardly cure such a severe condition. If occasionally cured, it must be because the Blood aspect had not yet become extremely deficient or obstructed.) Thus, the legs were weak and curled. Although the medicine had some effect, the illness was difficult to alleviate temporarily and ultimately proved incurable.
I once treated another case of deficiency consumption where all six pulses were rapid (Shu) but possessed spirit (Shen) and appeared harmonious and slow (He Huan). Even if the rate reached more than ten beats per respiration, it was still considered treatable. Initially, I used Si Jun Zi Tang added with Huang Qi (Astragalus Root) and Wu Wei Zi (Schisandra Berry). After several doses, the rapid pulse gradually decreased, retaining a sense of harmony and slowness, indicating treatability. If the pulse retreated to become fine like a thread but remained rapid, it was absolutely untreatable. In cases where the pulse retreated to be fine like a thread but was not rapid, the Stomach Qi was still present. Provided there was no abdominal pain or diarrhea (abdominal pain indicates death of blood; diarrhea indicates collapse of Qi) and dietary intake remained normal, treatment with Baoyuan Tang, Ren Shen (Ginseng Root), and Bai Zhu (Atractylodes Rhizome) could lead to recovery within two to three years. However, regarding the statement that a gradual reduction in the rapid pulse to a harmonious, spirited state indicates treatability, one must also expect results within three months and full recovery within half a year. One must also assess the patient's age and physical vigor, as well as the strength of their spirit and Spleen-Stomach function. If, after medication, the pulse becomes harmonious but the legs and feet gradually lose strength as described above, and phlegm-cough persists despite the slow pulse, treatment is futile. Conversely, if the patient presents with leg weakness but the fever has subsided, cough has reduced, and diet is normal, it indicates that Spleen Qi is still weak but the condition can be managed over time. In another scenario, if all six pulses are harmonious, and after taking the previous formula the fever subsides but the pulse becomes wiry (Xian), accompanied by diarrhea and bloody stool, this is due to stagnant blood in the meridians from previous heat-fire scorching. (This occurs when cooling medicines suppress blood flow, and latent Yang scorches and ruins it, consistent with Zhang Zhongjing's principle in the Ping Mai Pian [Chapter on Pulse Diagnosis] that excessive heat causes blood to form abscesses and pus.) It may heal spontaneously in the second half of the month or within five to ten days. If the patient can eat during bleeding, they will not die; if they cannot eat and appear spiritually fatigued, death is imminent. Treatment should focus on strengthening the Spleen and preserving Yuan Qi. For abdominal pain and wiry pulse, use Lizhong Tang (Regulate the Middle Decoction); for nausea and poor appetite, use Liu Jun Zi Tang (Six Gentlemen Decoction). Without these two symptoms, use Si Jun Zi Tang and Baoyuan Tang. Generally, bleeding represents the exit of pathogenic factors through the lower orifices; if it manifests as wind-cold symptoms, it represents the exit through the upper orifices. In such cases, warming the Lungs and assisting the Spleen with appropriate herbs can lead to recovery in half a month. In another case, if all six pulses are harmonious at eight to nine beats per respiration, and after taking the previous formula, the three right-hand pulses decrease by two to three beats while the left pulse remains rapid, this indicates that the exterior (Right) has retreated first, while the interior (Left) has not. When the rapid pulse completely retreats and the disease is nearly cured, if the left pulse is still one beat faster than the right, it shows that the exterior has retreated but the interior is not yet harmonized. Nan Zhi states: In Shang Han (Cold Damage), the Left is exterior and the Right is interior; in miscellaneous diseases, the Right is exterior and the Left is interior. This is true. (The Left pulse reflects the presence or absence of Yuan Qi; the Right pulse reflects its severity. This holds true without fail.)
Master Shenzhai once said: Any disease where sweat cannot be induced is untreatable. In deficiency consumption, if all six pulses are rapid, it is still treatable if fewer than forty to fifty doses of Yin-nourishing and fire-descending medications have been taken. If dozens or hundreds of doses have been taken, the True Yuan is exhausted. Even if the pulse appears large, surging, and slow, lacking spirit internally, using tonifying agents will cause the pulse to change from large/surging/slow to fine/rapid, leading to gradual emaciation, incapacitation, and death. Dairen stated: "Young people who do not take medicine recklessly are easier to treat." This is precisely what is meant. Alternatively, if cold-cooling medicines have not been taken excessively, using Baoyuan Tang and Si Jun Zi Tang with one or two qian of fresh ginger for ten to twenty doses might induce sweating. If sweating is not achieved and the surging-slow pulse does not recede, it is also difficult to save. However, if although no sweat is produced, the surging-slow pulse gradually decreases, the illness gradually resolves, and the patient can eat, then there is no harm. Such pulses are generally easier to treat in autumn and winter and harder in spring and summer.
In general, for deficiency consumption lasting three to four months, if the pulse is rapid but still harmonious at six to seven beats per respiration, encountering the fire season of spring and summer leads to dried-up fluids. With Kidney Water entering a realm of death and extinction, Lung exhaustion and Spleen dryness occur, resulting in inevitable death. However, in autumn and winter, when the fire season has passed and Metal and Water are prosperous, a rapid pulse is treatable. Nevertheless, if the patient exhibits emaciation, hoarseness, sore throat, alternating chills and fever, fine-rapid pulse, abdominal pain, and diarrhea, it is untreatable. If seeking treatment for such symptoms, initial use of tonics may worsen the condition. Why? Because the disease has persisted for three to four months with extensive prior medication. Ineffectiveness likely stems from the overuse of cold-cooling medicines, further weakening the Five Viscera and intensifying pathogenic fire. Initial use of tonics, whether a few or ten-plus doses, may cause the pathogenic fire to retreat, leading to dizziness, nausea, bone pain, leg soreness, mental fatigue, and loss of appetite. (There are also cases where dispersing the Lungs, soothing the Liver, strengthening the Spleen, and nourishing the Kidneys exacerbate fire; initially suppressed by cold medicines hiding the True Yang, subsequent application of methods to振奋 Yang and calm Yin leads to recovery because the root Qi is stable.) If the pulse is not fine-rapid but harmonious, urgently administer large doses of Baoyuan Tang and Si Jun Zi Tang continuously. The patient will sleep peacefully for half a day or a day, waking up with refreshed spirit. Another dose induces sleep again, dietary intake increases, and the condition becomes treatable. If the pulse is fine as a thread and the abdomen feels full and dizzy, it is difficult to treat.
For chronic deficiency consumption, even if the pulse is harmonious, one cannot definitively declare it curable. Patients with long-standing illness have weak Yuan Qi; a harmonious pulse may be a false sign. (True Qi is scattered and fails to drive the pulse, causing sluggishness.) If, after seven to eight months, intermittent tonic use gradually reduces the illness, this indicates vitality. If it extends to the eleventh month, when Yang Qi begins to move and rise, internal emptiness may fail to support this ascending mechanism, leading to aversion to cold and high fever. (Sudden appearance of chills and fever resembling a new onset in chronic illness is a critical juncture of life and death. Mild sweating with light body and vigorous Qi indicates Yang revitalization; mild sweating or no sweating with fever resolution but heavy body and weak Qi indicates Yang collapse; limb stiffness preventing turning over, or chest bi with decreasing food intake, are terminal signs of failing extraordinary vessels.) Taking ten-plus doses of tonics may gradually reduce chills and fever, allowing survival. If stable for two to three months, recovery is possible; otherwise, it is untreatable. This is because Spring Wood is prosperous, and the Spleen and Lung, weakened by long illness, cannot withstand the seasonal influence.
I once treated a new illness, either dysentery or a miscellaneous disease, where pathogenic factors were present initially, indicated by a floating-rapid pulse. After several doses of medication matching the pulse and disease, the rapid pulse receded, and the illness stabilized. However, after further doses, the patient felt fatigued, and the pulse reverted to floating-rapid. At this point, one should not assume pathogens remain. Rather, the pathogens have retreated, and the Spirit Qi is just beginning to recover, hence the floating quality. Only Baoyuan Tang should be used to nourish Yuan Qi. A floating-rapid pulse resolving with mild sweating is a method where rising Yang Qi and sufficient Yuan Spirit naturally expel pathogens. If this is misunderstood and pathogen-expelling drugs are still used, Spirit will daily diminish, muscles will waste away, and eventually, deficiency consumption will develop.
Diseases often change unpredictably or worsen with seasonal changes. Encountering specific seasons causes Heaven and Earth Qi to ascend or descend, and the body's Qi responds accordingly. If the patient's Essence and Qi are still sufficient, they can align with the seasonal timing. However, in individuals with long-term Yuan Qi deficiency, there is insufficient energy to assist this ascending/descending movement. Ascending improperly causes dizziness and vomiting; descending improperly causes hot feet and cold body. The body becomes controlled by climate rather than ruling itself. (Illness moving with solar terms indicates Qi failure; moving with lunar phases indicates Blood failure. Thus, worsening on New Moon or Full Moon in serious illness is untreatable. This text specifically refers to excessive ascent/descent. There are also cases where ascent/descent is blocked, or body Qi is discordant with Heaven and Earth, which essentially shares the same mechanism.)
For Spleen-Stomach disease, if ten parts deficient, death occurs in early spring (or looking toward spring); eight parts deficient, death in early spring (Meng Chun); five to six parts deficient, death in mid-spring. If medical treatment is inappropriate, even if originally non-fatal, the damage done makes survival until late spring impossible. Two or three days around Qingming are particularly critical for Lung-Kidney disease starting in spring. If ten parts deficient, death occurs in early summer (or looking toward summer); eight parts deficient, death in mid-summer; six parts deficient, death in late summer.
For long-standing illness, if after medication all six pulses are harmonious, but on a random day the diagnosis shows fine-rapid, weak, or abnormally changed pulses, one must carefully inquire about lifestyle. Changes may result from a single night of sleeplessness, labor, anger, or wind-cold exposure. Treat according to the specific cause. If the pulse remains unharmonious after treatment, it is difficult. For sleep deprivation or labor, use Buzhong Yiqi Tang to assist Yuan Qi; for dietary injury, use salt water to induce vomiting, followed by Er Chen Tang modifications to digest food. For sexual exhaustion, if the pulse changes but the disease does not, standard conditioning tonics can be used. If both disease and pulse change and cannot be harmonized, rescue is unlikely. Autumn and winter offer hope; spring and summer do not. For summerheat injury, keep curtains open and treat according to summerheat protocols. For wind-cold, warm the Lungs and disperse with wind-dispelling herbs; improvement in one or two doses is acceptable; if no change, it is untreatable. Generally, easier in autumn/winter, harder in spring/summer. Observe the patient's Spleen-Stomach Yuan Qi and adjust accordingly. Do not neglect this or falsely promise easy cures.
I once treated a postpartum woman with a history of consumption. She recovered a year ago with Ba Wu Tang (Eight Substance Decoction), but the condition lingered incompletely. The following year, she gave birth in a Gui-Hai year, associated with Wu-Gui transforming into Fire. The weather was extremely hot. Contemporary physicians used Ren Shen but interspersed Shan Zha (Hawthorn Fruit), believing it could counteract Ren Shen toxicity, leading to alternating chills, fever, and diarrhea. My diagnosis showed a rapid pulse at nine beats per respiration, not short. I used Baoyuan Tang added with Gan Jiang (Dried Ginger) and Shu Fu Zi (Prepared Aconite Root, 1 fen) for four doses, reducing the rapid pulse. Upon morning examination, pressing down revealed a floating-slow pulse, but removing pressure showed a fine-wiry pulse like a thread, with the rapid pulse unchanged. (This indicates a failing pulse within the floating-slow pattern. As noted in previous volumes, this "single line" refers to the spine of the pulse, not a separate vessel; the spiritual principle is entirely different.) I said, "It is incurable." She pleaded persistently. I prescribed Gui Zhi (Cinnamon Twig) processed Bai Shao (White Peony Root, 5 fen), Zhi Gan Cao (Honey-fried Licorice Root, 5 fen), Ren Shen (Ginseng, 5 fen), and Huang Qi (Astragalus, 5 fen), intending the effect of Jianzhong Tang. After eight doses, the rapid pulse retreated to nearly six beats. After four more doses, nearly five beats. She believed she was cured and stopped medication. Later, in the fourth, fifth, and sixth months, her pulse became wiry and fine, and she died. This case supports the previous discussion, so I append it.
(When diagnosing deficiency consumption, one must always pay attention to the critical junctures of life and death. Life and death depend on the pulse; the speed of death depends on the symptoms, making judgment difficult. Regarding pulses: First, short-weak Cun pulses and soft-long Chi pulses, rising and falling uniformly, appearing very healthy, yet the sides are desolate and disconnected from the flesh. Second, short-weak Right Cun, sunken Left Guan, long-thin Right Chi, soft-long Left Chi, appearing deeply rooted. Third, harmonious pulse in the morning appearing healthy, hard-large pulse in the afternoon appearing severe, with little change in symptoms. Regarding symptoms: First, heavy body unable to turn over, or distension in hypochondrium, or sweating upon movement with clear spirit and loud voice. Second, chest bi feeling like knotting, inability to expectorate phlegm, decreasing food intake, or no decrease. Third, sudden chills and fever resembling new onset, quickly subsiding, followed by increased fatigue and weak Qi, dragging speech. As for fine-rapid-kou-san-ge-lao pulses, rapid-then-slow, hard-then-soft, fine-then-large; symptoms of aphonia, belching, hiccups—none are unknown as adverse signs. Determining the exact day and hour of death based on these is ultimately difficult. I once diagnosed two people. One young man suffered foot cold injury in winter, treated with Ma Huang to induce sweating. Qi rebelled, feet moved slightly causing panting, unable to eat. Symptoms slightly reduced in January. Pulse was absent for a long time, coming like a sparrow pecking, only on the skin surface. After five to seven pecks, it circled on the skin surface without leaving, then departed like a breaking string, severed in the middle, unable to return. Both hands examined, they avoided each other, irregular arrival and departure. This indicates broken Yuan Qi, critical danger. Because diet and walking were unchanged, I predicted death at Li Xia (Start of Summer), yet it extended to Xia Zhi (Summer Solstice). Why? An elderly person with normally weak Qi and low voice suddenly developed chest bi, fatigue, walking difficulty, decreasing diet, insomnia. Pulse came like sparrow pecking, irregular, vague, weak, but did not circle, break, or avoid each other; the pause occurred after departure and failed to return, without chills or fever. It was winter. I used large doses of warming-tonifying herbs to protect Kidney and calm Liver, moving phlegm and blood, with careful dietary regulation. The pulse rotated back to normal, but I feared Kidney depletion and Liver wood drying, vulnerable to Spring growth commands. By the next winter, the pulse became knotted and intermittent. Regulating with method again, he has been healthy for four years since. Why? As Yuan Qi retreats, medicine and food advance; their forces must meet, though the mechanism is subtle and hard to explain. Ultimately, the delay or speed of death depends on Zang Qi, Heavenly Timing, and Mutual Overcoming of Five Elements. Even if not perfect, it is rarely off by more than two or three days. The Nei Jing states: 'Distinguishing Yang reveals the location of disease; distinguishing Yin reveals the period of life and death.' Yang pulses know the disease; Yin pulses know death. How can one fail to distinguish Yin and Yang pulses?)