扁鹊曰∶损脉之为病若何？一损损于皮毛，皮聚而毛落；二损损于血脉，血虚不能荣于
；三损损于肌肉，肌肉消瘦，饮食不能为肌肤；四损损于筋，筋缓不能自收持；五损损于骨
，骨痿不能起于床。反此者，至脉为病也。从上下者，骨痿不能起于床者死；从下上者，皮聚而毛落者死。
扁鹊曰∶一呼二至，一呼一至，名曰损。人虽能行，独未着床，血气皆不足矣。再呼一
至，再吸一至，名曰无魂，无魂者当死。人虽能行，名曰行尸。
扁鹊曰∶治损之法若何？损其肺者益其气，损其心者调其荣卫，损其脾者调其饮食、适
其寒温，损其肝者缓其中，损其肾者益其精气。
汪石山云∶余治一人，年二十余，病咳嗽、呕血、盗汗，或肠鸣作泄，午后发热。诊其脉，
细数无伦次。语之曰∶《难经》云∶七传者，逆经传也。初因肾水涸竭，是肾病矣。肾邪传
之于心，故发热而夜重；心邪传之于肺，故咳嗽而汗泄；肺邪传之于肝，故胁痛而气壅；肝邪
传之于脾，故肠鸣而作泄；脾邪复传之于肾，而肾不能再受邪矣。今病兼此数者，死不出旬
日之外，果期而殁。所云邪者因自病之极，不能自安而侵凌于上也。（随笔承制生化论∶自
虚为人所乘其势顺；自病而反能乘人，其势逆，即此义。）
经曰∶肉脱热甚者死，嗽而加汗者死，嗽而下泄、上喘者死，嗽而左不得眠者肝胀，嗽而右
不得眠者肺胀，俱为死症。（当云∶胀在肋上近腋属肺，肋下近腰属肝。上下俱胀，气血
《灵枢》云∶皮寒热，不可附席，毛发焦，鼻槁，腊不得汗，取三阳之络，以补手太阳
寒热者，肌肉毛发焦，而唇槁，腊不得汗，取三阳于下，以去其血者，补足太阴，以出其汗
。骨寒热者，病无所安，汗注不休，齿未槁，取其少阴于阴股之络；齿已槁，死不治，厥
刘河间曰∶虚损之疾，寒热因虚而感也。感寒则损阳，阳虚则阴盛，损自上而下，治之宜以
辛甘淡，过于胃则不可治也；感热则损阴，阴虚则阳盛，故损自下而上，治之宜以苦酸咸，
过于脾则不可治也。自上而下者，由肺而心而胃；自下而上者，由肾而肝而脾。论曰∶心
肺损而色敝，肾肝损而形痿。谷不能化而脾损，渐渍之深，皆为虚劳。
扁鹊说：虚损脉象导致的疾病是怎样的？第一层损伤在皮毛，表现为皮肤皱缩、毛发脱落；第二层损伤在血脉，血虚不能滋养五脏（此处原文缺字，据《难经》补为“五脏”）；第三层损伤在肌肉，肌肉消瘦，饮食无法转化为肌肤营养；第四层损伤在筋，筋脉松弛无力，不能自主收持肢体；第五层损伤在骨，骨痿软弱，不能起床。反之，如果是从下往上发展的“至脉”病证，则情况不同。
如果病情从上往下发展，出现骨痿不能起床的，预后不良，主死；如果病情从下往上发展，出现皮肤皱缩、毛发脱落的，预后不良，主死。
扁鹊说：一呼之间脉搏跳动两次，或一呼之间脉搏跳动一次，称为“损”。病人虽然还能行走，但尚未卧床不起，这是因为气血都已不足。如果再加重，一呼一吸各仅跳动一次，称为“无魂”，无魂的病人将会死亡。病人虽然还能行走，但这只是“行尸走肉”般的状态。
扁鹊说：治疗虚损的方法是怎样的？肺受损的，要补益其气；心受损的，要调和营卫；脾受损的，要调节饮食、适应寒温变化；肝受损的，要舒缓其中焦郁结；肾受损的，要补益精气。
汪石山说：我治疗过一个人，二十多岁，患有咳嗽、呕血、盗汗，有时肠鸣腹泻，午后发热。诊察他的脉象，细数且毫无规律。我对他说：《难经》中说：“七传”是指逆经相传。起初是因为肾水枯竭，这是肾病。肾邪传给心，所以发热且夜间加重；心邪传给肺，所以咳嗽且出汗；肺邪传给肝，所以胁痛且气机壅滞；肝邪传给脾，所以肠鸣且腹泻；脾邪又传回给肾，而肾已经不能再承受邪气了。现在他的病兼有上述几种情况，不出十天就会死亡，果然如期去世。所说的“邪”，是因为自身病变至极，不能自我安宁而侵凌上部。（随笔承制生化论中提到：因自虚而被他人所乘，其势顺；因病极反而能乘袭他人，其势逆，就是这个道理。）
医经说：肌肉脱失且高热严重的会死；咳嗽且出汗加重的会死；咳嗽伴腹泻、气喘上逆的会死；咳嗽且左侧无法安卧的是肝胀；咳嗽且右侧无法安卧的是肺胀，这些都是死症。（应当注明：胀满在肋上近腋部属肺，肋下近腰部属肝。上下都胀满，是气血……《灵枢》说：皮寒热，身体不能贴近席子，毛发焦枯，鼻干萎缩，像腊月一样无汗，应取三阳经的络穴，以补手太阳经；肌寒热，肌肉毛发焦枯，嘴唇干枯，像腊月一样无汗，应取三阳经在下部的穴位，以放血泄热，补足太阴经以发汗；骨寒热，病人坐卧不安，汗水直流不止，如果牙齿还没有干枯，可取足少阴经在大腿内侧的络穴；如果牙齿已经干枯，则死不治，属于厥证。）
刘河间说：虚损的疾病，是因为虚弱而感受寒热邪气所致。感受寒邪则损伤阳气，阳虚则阴盛，损伤自上而下发展，治疗宜用辛、甘、淡味药，如果损伤超过胃腑，则不可治；感受热邪则损伤阴液，阴虚则阳盛，所以损伤自下而上发展，治疗宜用苦、酸、咸味药，如果损伤超过脾脏，则不可治。自上而下发展的，是由肺传到心再到胃；自下而上发展的，是由肾传到肝再到脾。论述说：心肺受损则面色败坏，肾肝受损则形体痿弱。谷气不能运化则是脾受损，浸渍日久，都成为虚劳。
Bian Que said: What are the diseases caused by the pulse of depletion (Sun Mai)? The first degree of depletion affects the skin and hair, manifesting as wrinkled skin and falling hair; the second degree affects the blood vessels, where blood deficiency fails to nourish the Zang organs; the third degree affects the muscles, resulting in emaciation where food intake cannot transform into muscle tissue; the fourth degree affects the sinews, causing flaccidity and inability to control movement; the fifth degree affects the bones, leading to bone atrophy and inability to rise from bed. Conversely, if the disease progresses upwards, it is termed "Zhi Mai" (Pulse of Arrival).
If the disease progresses from top to bottom, bone atrophy with inability to rise from bed indicates a fatal prognosis; if it progresses from bottom to top, wrinkled skin and falling hair indicate a fatal prognosis.
Bian Que said: A pulse rate of two beats per exhalation or one beat per exhalation is called "Depletion" (Sun). Although the patient can still walk, they have not yet become bedridden, indicating that both Qi and Blood are deficient. If it worsens to one beat per exhalation and one beat per inhalation, it is called "Soulless" (Wu Hun), and such patients will die. Although the patient can still walk, this state is akin to a "walking corpse."
Bian Que said: What is the method for treating depletion? For lung depletion, benefit its Qi; for heart depletion, harmonize Ying and Wei (Nutritive and Defensive Qi); for spleen depletion, regulate diet and adapt to cold and warmth; for liver depletion, soothe the middle Jiao; for kidney depletion, benefit Essence and Qi.
Wang Shishan said: I treated a patient in his twenties who suffered from cough, hematemesis, night sweats, borborygmus with diarrhea, and afternoon fever. His pulse was fine, rapid, and irregular. I told him: The *Nan Jing* states that "Seven Transmissions" refers to counter-clockwise transmission along the meridians. Initially, due to the exhaustion of Kidney Water, this is a Kidney disease. Kidney pathogenic factors transmit to the Heart, causing fever worse at night; Heart pathogenic factors transmit to the Lung, causing cough and sweating; Lung pathogenic factors transmit to the Liver, causing hypochondriac pain and Qi stagnation; Liver pathogenic factors transmit to the Spleen, causing borborygmus and diarrhea; Spleen pathogenic factors transmit back to the Kidney, but the Kidney can no longer accept the pathogen. Since the disease involves all these aspects, death will occur within ten days, which indeed happened. The term "pathogen" here refers to the extreme self-disease invading upwards because the body cannot maintain internal stability. (The *Suibi Chengzhi Shenghua Lun* notes: When weakness allows others to exploit it, the trend is smooth; when extreme illness allows the body to attack others, the trend is contrary, which applies here.)
The Classics state: Death occurs with muscle wasting and severe heat; death occurs with worsening cough and sweating; death occurs with cough accompanied by diarrhea and upper asthma (wheezing/shortness of breath). Cough with inability to lie on the left side indicates Liver Distension; cough with inability to lie on the right side indicates Lung Distension; both are fatal signs. (Note: Distension above the ribs near the armpit belongs to the Lung; distension below the ribs near the waist belongs to the Liver. Distension in both upper and lower regions indicates Qi and Blood... The *Ling Shu* states: In Skin Cold-Heat, the body cannot rest on the mat, hair is scorched, the nose is dry and shriveled, and there is no sweat like in mid-winter; treat by taking the collaterals of the Three Yang meridians and supplementing the Hand Taiyang meridian. In Muscle Cold-Heat, muscle and hair are scorched, lips are dry, and there is no sweat like in mid-winter; treat by taking points on the lower Three Yang meridians to remove blood stasis, and supplement the Foot Taiyin meridian to induce sweating. In Bone Cold-Heat, the patient is restless with continuous profuse sweating; if teeth are not yet dry/shriveled, take the collateral of the Foot Shaoyin meridian in the inner thigh; if teeth are already dry/shriveled, it is untreatable and fatal, belonging to Jue syndrome.)
Liu Hejian said: Diseases of deficiency-depletion arise from feeling cold or heat due to deficiency. Feeling cold damages Yang; Yang deficiency leads to Yin excess, and damage proceeds from top to bottom, treated with acrid, sweet, and bland herbs; if damage exceeds the Stomach, it is untreatable. Feeling heat damages Yin; Yin deficiency leads to Yang excess, so damage proceeds from bottom to top, treated with bitter, sour, and salty herbs; if damage exceeds the Spleen, it is untreatable. Top-to-bottom progression goes from Lung to Heart to Stomach; bottom-to-top progression goes from Kidney to Liver to Spleen. It is stated: Damage to Heart and Lung causes sallow complexion; damage to Kidney and Liver causes physical atrophy. Failure to transform grain indicates Spleen damage; deep infiltration results in Deficiency Labor (Xu Lao).