虚劳之病，大端不过于阳虚阴虚，而治之之法，亦不外于补阳补阴。然其实属阴虚者为多，则仲景用建中
汤扶阳以配阴者，固有妙旨存焉；而后世滋补诸方，亦所不可缺。今芟烦存要，区而别之，以便学人酌用焉。
源由总说 《难经》论损，从皮毛至于筋骨者，此乃辨气脉浅深次第也。原其所因，属不内外，或大病
未复，便合阴阳，或疲极筋力，饥饱失节，尽神度量，叫呼走气。所以诸证蜂起，百 交作，吐血衄血，便血
泻血，遗泄白浊，冷滑洞泻，白汗黄汗，呕吐咯 ，涎沫痰饮。遂使荣卫走本，虚羸损伤，皆自此始，盖由背
于人身常理而致然也。况妇人产蓐，过于大病，虚损尤多，不可不知。（《三因》）
虚生百病，实则少病。凡在孩提之时，已有胎气不足，致一脏一腑之偏虚者，自五六岁至三十上下，婚与
未婚，肌肉薄瘠。面体少色，一虚也。血虚则发热，每有病则热难退，手足烦热，二虚也。阴虚者阳必凑之，
男女夜多盗汗者，三虚也。此皆禀受不足，疾病易生，非必知欲而后虚也。（按∶此文本出《养生必用方》，
录在后阴虚为劳条。）而失血则肝虚，思虑则心虚，饥饱则脾虚，多言则肺虚，房劳则肾虚，男子病后则气虚，
妇人产后则血虚，喜怒哀乐则神虚，劳动不息则形虚。夫肝虚则目暗脚弱，心虚则惊悸自汗，脾虚则吐泻肿满，
肺虚则喘嗽上气，肾虚则齿痛耳聋，气虚则发厥，血虚则发热，形虚则肤革薄瘠，神虚则心志颠
倒，此其大略也。（《管见》）
医经载五劳六极之证，非传尸骨蒸之比，多由不能卫生，始于过用，逆于阴阳，伤于荣卫，遂成五劳六极
之病焉。盖尽力谋虑成肝劳，应乎筋极；曲运神机成心劳，应乎脉极；意外过思成脾劳，应乎肉极；预事而忧
成肺劳，应乎气极；矜持志节成肾劳，应乎骨极。此五劳应乎五极者也。（按∶此说本于《三因》，然彼以六极
应六腑，盖严氏嫌其拘也。）然精极者，五脏六腑之气衰，形体皆极，眼视无明，齿焦发落，体重耳聋，行履
不正，邪气逆乎六腑，厥于五脏，故成精极。（《济生》）
蒙庄有言，精太用则竭，神太劳则惫，借是可以论病矣。夫人所以根本此性命者，气与血也。若男若女，
气血均有，独不能保而有之，终日役役，神倦力疲，饥饱越常，喜怒失节，形寒饮冷，纵欲恣情，遂使五脏气
血俱虚，此五劳之所从始也，六极七伤类焉。故心家虚，则便浊汗多；肝家虚，则筋挛目眩；肾家虚，则腰痛
泄精；肺家虚，则咳嗽哄热；脾胃虚，则呕吐不食，日就羸黄，或乃胃热消谷，饮食虽多，亦不生肌肉而转加
瘦悴矣。是前数证，其间大抵心下引胁俱疼，盖滞血不消，新血无以养之也。（《直指》）
夫人之生，皆禀天地氤氲之气而为人，在乎保养真元，固守根本，则一病不生，四体俱健。若曰不养真元，
不守根本，病皆生焉。真元根本，即气血精液也。予闻先师之教，万病莫若劳证，最难治之。劳证之由，盖因
人壮年气血完聚、精液充满之际，不务养守，惟务酒色，岂分饥饱，日夜耽嗜，无有休息，以致耗散真元，虚
败精液，则呕血吐痰，心炽肺痿，骨蒸体热，肾虚精竭，面白颊红，口干咽燥，白浊白带，遗精盗汗，饮食难
进，气力全无，谓之火乘金也。
候重则半年而毙，候轻则一载而倾。（《十药神书》）
劳病根因，各自不同。酒伤肺，色伤肾，思虑伤心，劳倦饮食伤脾，忿怒伤肝。此五者，皆能致劳也，大
约酒色成劳者多耳。
肺劳∶肺如华盖，其气轻清，既不受寒，亦不受热。然酒性本热，多饮则肺受火邪，熏蒸日久，以致郁遏
不清，胀大不敛，或喘或咳，渐至音哑，骨蒸寒热，皮毛焦干，如之何其可救也。肾劳∶人之五火，皆赖肾水
制之。色欲过度，则肾水虚，虚则热矣。肾脉贯肝膈入肺中，循喉咙系舌本。所以肾虚之人，先动肾火，延入
肝膈，遂挟相火，便入肺中，始则咳嗽，久则发热，盗汗遗精，骨痿肉脱，甚至伤脾，泻泄作而危殆矣。心劳∶
心者血之原，荣卫发动之所始也。心不妄役，则真血日生。惟劳心焦思，日久不置，则思虑过度。由是心血日
耗，肝无所秉，脏腑无所润，筋脉无所养，荣气不行，邪热随作，经所谓阴虚生内热者是也。热甚克金，金衰
身瘦，日见销铄而危亡待矣，此症不得志者多有之。脾劳∶元气静则神藏，动则消亡。若劳倦过甚，饮食不节，
二者皆使脾之元气受伤，不能舒发，以致饮食不化，泄泻频作，血气不生，肌肉不长。况脾者肺之母，脾气衰
惫，则肺失所资，津液不生，日成枯涸，咳嗽殊甚而劳斯成，不可救矣。肝劳∶大怒则血菀于上，令人暴绝，
名曰煎厥。故多怒之人，肝火屡动，而所藏之血，随火上逆，大吐不止，稍久则并脏腑膻中之血，尽吐不留，
所谓相火一动，则五火相煽而动，火动则血随之，真血去多，身成空廓，以致金不制木，木火凌肺，经所谓侮
其所不胜者也。如是则发热咳嗽，胁痛喘急，而劳日剧矣。由是观之，劳病同名，根因不一，治者当究其始末，
明在何经，不可模糊泛治也。（《苍生司命》）
思虑致劳 夫人之生，以气血为本，人之病，未有不先伤其气血者。世有童男室女，积想在心，思虑
过当，多致劳损，男则神色先散，女则月水先闭，何以致然？盖愁忧思虑则伤心，心伤则血逆竭，血逆竭故神
色先散而月水先闭也。火既受病，不能荣养其子，故不嗜食。脾既虚则金气亏，故发嗽。嗽既作，水气绝，故
四肢干。木气不充，故多怒，鬓发焦，筋痿。俟五脏传遍，故卒不能死，然终死矣。此一种，于诸劳中最为难
治，盖病起于五脏之中，无有已期，药力不可及也。若或自能改易心志，用药扶接，如是则可得九死一生。举
此为例，其余诸劳，可按脉与证而治之。（《本草衍义》）
诸虚出于心肾 夫人之一身，肾之液谓之精，意之所存谓之志，故经曰，肾藏精与志也。生性之本，
元气之根，精神之所舍，名曰精神，故《灵枢经》曰肾藏精精舍志者是也。人有精而后有神，今人之虚损，皆
出于心肾，其盗汗其白浊之类，奚可容乎。且心之液则为汗，肾之液则为精。今有虚乏之人，夜多异梦，心之
液自梦中出，觉来则汗如雨，未几便干，此则为盗汗。肾之液泄，自小便中出，停久浊如泔，或上有脂油，或
为梦泄，则气体怯弱，神情倦怠，眼目昏花，精既脱矣，乌得而有神哉。且心者神藏之，肾者精藏之。今心既
受病，则神不守舍，日则有怔忡健忘、恍惚失志之证，夜则有登高涉险、火发追捕之梦。肾既受于病，则髓海
枯竭，遂有脚膝软弱，精神倦怠，夜梦鬼交，便溲白浊，消渴瘦瘁。诸虚百损，莫不自心肾而然。（《治病活
法秘方》）
阳虚阴虚 病之虚损，变态不同，因有五劳七伤，证有
营卫脏腑。然总之则人赖以生者，惟此精气，而病为虚损者，亦惟此精气。气虚者，即阳虚也；精虚者，即阴
虚也。凡病有火盛水亏，而见荣卫燥、津液枯者，即阴虚之证也；有水盛火亏，而见脏腑寒、脾肾败者，即阳
虚之证也。此惟阴阳偏困，所以致然。凡治此者，但当培其不足，不可伐其有余。夫既缘虚损，而再去所余，
则两败俱伤矣，岂不殆哉。惟是阴阳之辨，犹有不易，谓其阴阳之中，复有阴阳。其在似阳非阳、似阴非阴者，
使非确有真见，最易惑人，此不可不详察也。且复有阴阳俱虚者，则阳为有生之本，而所重者又单在阳气耳。
知乎此，则虚损之治，如指诸掌矣。
（《景岳》）
夫男子之劳，起于伤精；女子之劳，起于经闭；小儿之劳，得于母胎。盖男子十六而精通，女子十四而天
癸至，然未充也。后生少年辈，淫欲太早， 丧真元，真阴内亏，虚火炽焰，肺金受伤，无以生肾水，肾水枯
竭，无以济心火。心火一旺，肾火从之，而梦遗鬼交之病作；肺气一虚，则腠理疏豁而盗汗自汗之病作；火动
其血，血随火升，而咳嗽吐红之病作。考之《内经》及上古诸家之说，一曰劳瘵，一曰劳极，一曰阴虚，一曰
不足，一曰虚损。然因名以责实，不过气虚血虚阴虚之异耳。凡脾肺不足，皆气虚也；心肝不足，皆血虚也；
肾水有亏，即阴虚也。气属阳，血属阴，血虚亦属阴虚。（《订补明医指掌》）
古称五劳、七伤、六极、二十三蒸，证状繁多，令人眩惑，但能明先天后天二种根本之治，无不痊安，盖简
而不繁，约而无漏者也。夫人之虚，非气即血，五脏六腑，莫能外焉。而血之源头，则在乎肾，盖水为天一之
元，而人资之以为始者也。气之源头，则在乎脾，盖土为万物之母，而人
资之以为生者也。故曰二脏安和，则百脉受调；二脏虚伤，则千 竞起。至哉斯言，可为后学指南也。（《病
机沙篆》）
阴虚为劳 虚劳而热者，是阴气不足，阳气有余，故内外生于热，非邪气从外来乘也。（《巢源》）
《古今录验养生必用方》中卷曰∶经云∶气虚则发厥，血虚则发热（按∶《素调经论》曰∶经言阳虚则外
寒，阴虚则内热。初氏或谓此也）。必然之理也。又曰∶饮食则阴受之（按∶《太阴阳明论》曰∶食饮不节，
起居不时者，阴受之）。譬犹物化而为土也。阴气衰则血不荣，血不荣则肌肉薄，阴衰则阳胜，此血虚所以发
热也，故瘦人多热。又阴虚者阳必凑之，故阴虚多热也。产妇既产，多热烦躁，以新产亡血多也。医乃不知，
又投以寒药，以此致死者，不可胜数。夫病有标本，医亦知之。其人阴虚，本于血不足，故标发热。医投以寒
药，是治标不治本也。但以温和益气养血药，其热自愈。熙宁甲寅、乙卯间，杜方叔自郓波召入京师，在翰林。
予时奉亲客都下。一日杜谓予曰∶青蒿麦煎柴胡鳖甲散，天下通行，小儿被害，不可胜记。予始怪其词，年来
更事渐多，方知杜之言为有本。男女自五六岁，至二十上下，婚与未婚，肌肉薄者，面体少色，一虚也。血虚
则发热，肢体手足烦热，二虚也。阴虚者阳必凑之，故发热汗出，男女眠睡有汗，三虚也。所谓虚者，气血禀
受有足有不足，加以柔弱未定而疾病易生，非必待知男女大欲然后虚也。气体既虚，又投以柴胡、鳖甲、门冬
诸冷药，不旬日间，饮食已不入，迤渐腹痛，至于大肠滑泄，虚人至此，亦已危矣。方叔于医，可谓知本。童
男室女小儿，肌瘦有汗，但用平和养气血温药，自无虞。（《万安方引》）（按∶此下又有云∶古人立方，亦
用温药，如建中之属。且据《医说》引《医余》，则此所谓平和养气血温药，即指建中而言。）
大抵此症，阴虚者多。盖人禀天地阴阳之气以生，形肖天地，阳常有余，阴常不足。况劳动虽是伤气，殊
不知诸动皆属于火，火盛则阴愈消，学人不可不识。视其病久，多劳怯咳嗽发热，阴虚火动可见，学人宜详辨
焉。（《医学原理》）
凡虚损之由，无非酒色劳倦七情饮食所致。故或先伤其气，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。盖阴为天一之根，形质之祖，故凡损在形质者，总曰阴虚，此大目也。若分而言
之，则有阴中之阴虚者，其病为发热躁烦，头红面赤，唇干舌燥，咽痛口疮，吐血衄血，便血尿血，大便燥结，
小水痛涩等证。有阴中之阳虚者，其病为怯寒惟悴，气短神疲，头运目眩，呕恶食少，腹痛飧泄，二便不禁等
证。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，妇人月闭等证，则无
论阴阳，凡病至极，皆所必至，总由真阴之败耳。然真阴所居，惟肾为主，盖肾为精血之海，而人之生气，即
同天地之阳气，无非自下而上，所以肾为五脏之本。故肾水亏，则肝失所滋而血燥生；肾水亏，则水不归源而
脾痰起；肾水亏，则心肾不交而神色败；肾水亏，则盗伤肺气而喘嗽频；肾水亏，则孤阳无主而虚火炽。凡劳
伤等证，使非伤入根本，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，穷而至此，吾末如之何也矣。夫所贵乎君子者，亦贵其知微而已。（《景岳》）
虚劳之证，《金匮》叙于血痹之下，可见劳则必劳其精血也。营血伤则内热起，五心常热，目中生花见火，
耳内蛙聒蝉鸣，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，营行日迟，卫行日疾，营血为卫气所迫，不能内守而脱出于外，或吐或
衄，或出二阴之窍，血出既多，火热迸入，逼迫煎熬，漫无休止，营血有立尽而已，不死何待耶。更有劳乏之
极而血痹不行者，血不脱于外而但蓄于内，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，始必干热，俟蒸气散，微汗而热解，热蒸
不已，瘵病成焉，不死又何待耶。（《医门法律》）
虚劳这一类疾病，大体上不过分为阳虚和阴虚两类，而治疗的方法，也不外乎补阳和补阴。然而实际上属于阴虚的占多数，所以张仲景使用建中汤（小建中汤）来扶助阳气以配平阴气，其中确实蕴含着精妙的旨意；而后世的各种滋补方剂，也是不可缺少的。现在删去繁杂的内容保留要点，分类整理，以便于学习者斟酌选用。
关于病因源流的总论：《难经》论述“损”证，从皮毛到筋骨的过程，这是辨别气脉深浅的次第。追溯其起因，属于不内外因，或者大病初愈未恢复时便行房事，或者筋力极度疲劳，饥饱失调，精神过度消耗，大声呼喊耗散元气。因此各种病症蜂拥而起，百病交作，出现吐血、鼻衄、便血、泻血、遗精、白浊、冷滑洞泻、自汗、黄汗、呕吐、咯血、涎沫痰饮等症状。这使得营卫之气背离本源，导致身体虚弱消瘦损伤，都由此开始，大概是因为违背了人身正常的生理规律所致。何况妇女在产褥期，比大病更甚，虚损尤其多，不可不知道。（出自《三因极一病证方论》）
虚证容易生百病，实证则少病。凡是孩童时期，就有胎气不足，导致某一脏或某一腑偏虚的情况，从五六岁到三十岁左右，无论婚否，肌肉瘦薄，面色无华，这是一虚。血虚则发热，每次生病后热势难退，手足烦热，这是二虚。阴虚则阳气必会凑合其上，男女夜间多盗汗，这是三虚。这些都是禀赋不足，疾病容易发生，并非一定要等到有性欲之后才会产生虚损。（按语：这段文字原本出自《养生必用方》，收录在后文“阴虚为劳”条下。）而如果失血则肝虚，思虑过多则心虚，饥饱失常则脾虚，言语过多则肺虚，房劳过度则肾虚，男子病后则气虚，妇人产后则血虚，喜怒哀乐情绪波动则神虚，劳动不停息则形虚。肝虚则视力昏暗、脚部无力，心虚则惊悸、自汗，脾虚则呕吐腹泻、肿胀痞满，肺虚则气喘咳嗽、气逆上冲，肾虚则牙齿疼痛、耳聋，气虚则昏厥，血虚则发热，形虚则皮肤肌肉瘦薄，神虚则心神颠倒错乱，这大概是其中的大略情况。（出自《医说管见》）
医经记载的五劳六极的证候，不同于传尸骨蒸（指具有传染性的痨瘵），大多是由于不能保养身体，始于过度使用，违背阴阳规律，损伤营卫，从而形成五劳六极的病证。大致来说，尽力谋划思虑造成肝劳，对应筋极；曲意运用心智造成心劳，对应脉极；意外过度思虑造成脾劳，对应肉极；预先担忧事情造成肺劳，对应气极；矜持志节造成肾劳，对应骨极。这就是五劳对应五极的情况。（按语：这种说法本于《三因方》，但该书以六极对应六腑，大概是严用和嫌弃它拘泥的缘故。）然而精极，是指五脏六腑之气衰败，形体极度疲惫，视物不明，牙齿焦枯，头发脱落，身体沉重，耳聋，行走不稳，邪气逆乱于六腑，厥逆于五脏，所以形成精极。（出自《济生方》）
庄子曾说，精气过度使用就会枯竭，精神过度劳累就会疲惫，借此可以论述疾病了。人之所以以此性命为根本，在于气和血。无论男女，气血都有，只是不能保全拥有它们，终日忙碌，神倦力疲，饥饱超越常度，喜怒失去节制，受寒饮冷，纵欲恣情，致使五脏气血俱虚，这就是五劳的开始，六极七伤也类似于此。所以心家虚，则小便浑浊、汗多；肝家虚，则筋脉挛急、目眩；肾家虚，则腰痛、泄精；肺家虚，则咳嗽、潮热；脾胃虚，则呕吐、不食，日渐羸弱发黄，或者是胃热消谷，饮食虽然多，也不能生成肌肉反而更加瘦弱。这些前面的几种证候，其中大部分是心下牵引胁肋疼痛，这是因为瘀血停滞不消，新血无法滋养它。（出自《直指方》）
人的生存，都是禀受天地氤氲之气而成，在于保养真元，固守根本，那么就不会生病，四肢健壮。如果说是不养真元，不守根本，病就都会产生。真元根本，就是气血精液。我听先师的教诲，万病没有比劳证更难治的。劳证的成因，大概是因为人在壮年气血完备聚集、精液充满的时候，不致力于保养，只致力于酒色，不分饥饱，日夜沉溺嗜好，没有休息，以致耗散真元，虚败精液，于是出现呕血、吐痰、心火炽盛、肺叶痿弱、骨蒸体热、肾虚精竭、面白颊红、口干咽燥、白浊白带、遗精盗汗、饮食难进、气力全无，这叫作火乘金（火克金）。
如果病情重，半年而死；病情轻，一年而亡。（出自《十药神书》）
劳病的根因，各自不同。酒伤肺，色欲伤肾，思虑伤心，劳倦饮食伤脾，忿怒伤肝。这五种，都能导致劳病，大约酒色成劳的比较多。
肺劳：肺像华盖一样，其气轻清，既不受寒，也不受热。然而酒性本热，多饮则肺受火邪熏蒸日久，以致郁遏不清，胀大不收敛，或者喘或者咳，逐渐至声音嘶哑，骨蒸寒热，皮毛焦干，怎么能救治呢？
肾劳：人的五火，都依赖肾水来制约。色欲过度，则肾水虚，虚则热。肾脉贯穿肝脏膈膜进入肺中，沿着喉咙系舌本。所以肾虚的人，先动肾火，延入肝膈，于是挟带相火，便进入肺中，起初是咳嗽，久了则发热，盗汗遗精，骨痿肉脱，甚至伤脾，腹泻发作而危殆。
心劳：心是血的源头，营卫发动的起始处。心不妄加役使，则真血每日生长。只有劳心焦思，日久不止，则思虑过度。由此心血每日消耗，肝无所秉受，脏腑无所滋润，筋脉无所供养，营气不行，邪热随之发作，这就是经书上所说的阴虚生内热。热甚克金，金衰身瘦，日渐销铄而危亡将至，这种症状不得志的人多有之。
脾劳：元气静则神藏，动则消亡。如果劳倦过甚，饮食不节，这两者都使脾之元气受伤，不能舒发，以致饮食不化，泄泻频作，血气不生，肌肉不长。况且脾是肺之母，脾气衰惫，则肺失去所资，津液不生，日渐枯涸，咳嗽非常严重而劳病形成，不可救药。
肝劳：大怒则血郁积于上，使人突然昏绝，名叫煎厥。所以多怒的人，肝火屡次发动，而所藏的血液，随火上逆，大吐不止，稍久则连脏腑膻中之血，全部吐出不留，所谓相火一动，则五火相煽而动，火动则血随之，真血去多，身体成为空廓，以致金不制木，木火凌肺，经书上所说的侮其所不胜（反克）的情况。像这样则发热咳嗽，胁痛喘急，而劳病日益加剧。由此看来，劳病同名，根因不一，医者应当探究其始末，明确在何经，不可模糊泛治。（出自《苍生司命》）
思虑致劳：人的生存，以气血为本，人的病，没有不先伤其气血的。世间有童男室女，积想在心，思虑过当，多致劳损，男子则神色先散，女子则月经先闭，为什么这样？大概愁忧思虑则伤心，心伤则血逆竭，血逆竭故神色先散而月经先闭。火既然受病，不能荣养其子（脾土），故不嗜食。脾既虚则金气亏，故发嗽。嗽既作，水气绝，故四肢干。木气不充，故多怒，鬓发焦，筋痿。等到五脏传遍，所以最终不能死，然终究会死。这一种，在诸劳中最为难治，因为病起于五脏之中，没有已期，药力不可及。如果能自己改变心志，用药扶持接续，这样可得九死一生。举此为例，其余诸劳，可按脉与证而治。（出自《本草衍义》）
诸虚出于心肾：人的一身，肾的液叫做精，意念所存叫做志，所以经上说，肾藏精与志。生性的根本，元气的根，精神的居所，名叫精神，所以《灵枢经》说肾藏精精舍志是人如此。人有精然后有神，现在人的虚损，都出于心肾，那些盗汗、白浊之类，怎么可以容忍呢？而且心的液则是汗，肾的液则是精。现在有虚乏之人，夜里多异梦，心的液从梦中出，醒来则汗如雨下，不久便干，这就是盗汗。肾之液泄，从小便中出，停久浊如米泔水，或者上有脂油，或者为梦泄，则气体怯弱，神情倦怠，眼目昏花，精既脱矣，哪里还有神呢？且心是神藏之所，肾是精藏之所。现在心既受病，则神不守舍，白天则有怔忡健忘、恍惚失志的证候，晚上则有登高涉险、火发追捕的梦。肾既受病，则髓海枯竭，遂有脚膝软弱，精神倦怠，夜梦鬼交，便溲白浊，消渴瘦悴。诸虚百损，没有不是从心肾而来的。（出自《治病活法秘方》）
阳虚阴虚：病的虚损，变态不同，原因有五劳七伤，证候有营卫脏腑之分。但总之而言，人赖以生存的，只有这个精气，而病为虚损的，也只有这个精气。气虚者，即阳虚也；精虚者，即阴虚也。凡是有火盛水亏，而见到营卫燥、津液枯的，就是阴虚的证候；有水盛火亏，而见到脏腑寒、脾肾败的，就是阳虚的证候。这只是阴阳偏困，所以导致这样。凡是治疗这个，只应当培补其不足，不可攻伐其有余。既然缘于虚损，再去所余，则两败俱伤，岂不危险吗？只是阴阳的辨别，还有不容易的地方，谓其阴阳之中，复有阴阳。在那些似阳非阳、似阴非阴的情况下，如果不是确有真知灼见，最容易迷惑人，这里不可不详察。况且又有阴阳俱虚的，则阳为有生之本，而所重的又单在阳气耳。懂得这个，则虚损的治疗，就像看手掌上的东西一样清楚。（出自《景岳全书》）
男子的劳病，起于伤精；女子的劳病，起于经闭；小儿的劳病，得于母胎。大概男子十六岁精通，女子十四岁天癸至，然而尚未充盈。后来年轻一辈，淫欲太早，丧失真元，真阴内亏，虚火炽焰，肺金受伤，无以生肾水，肾水枯竭，无以济心火。心火一旺，肾火从之，而梦遗鬼交的病发作；肺气一虚，则腠理疏豁而盗汗自汗的病发作；火动其血，血随火升，而咳嗽吐红的病发作。考据《内经》及上古诸家的说法，一个叫劳瘵，一个叫劳极，一个叫阴虚，一个叫不足，一个叫虚损。然而因名以责实，不过是气虚、血虚、阴虚的差异罢了。凡是脾肺不足，皆气虚也；心肝不足，皆血虚也；肾水有亏，即阴虚也。气属阳，血属阴，血虚亦属阴虚。（出自《订补明医指掌》）
古称五劳、七伤、六极、二十三蒸，证状繁多，令人眩惑，但只要能明白先天后天两种根本的治疗，无不痊愈安康，可谓简而不繁，约而无漏。人的虚损，不是气就是血，五脏六腑，没有能外于此的。而血的源头，则在肾，因为水是天一的元，而人依靠它作为开始。气的源头，则在脾，因为土是万物之母，而人依靠它作为生命。所以说二脏安和，则百脉受调；二脏虚伤，则千病竞起。这话真是好啊，可为后学指南。（出自《病机沙篆》）
阴虚为劳：虚劳而发热的，是阴气不足，阳气有余，所以内外生于热，并非邪气从外来侵犯。（出自《诸病源候论》）
《古今录验养生必用方》中卷说：经云：气虚则发厥，血虚则发热（按：《素问·调经论》说：经言阳虚则外寒，阴虚则内热。陈氏或许指的是这个）。这是必然的道理。又说：饮食则阴受之（按：《素问·太阴阳明论》说：食饮不节，起居不时者，阴受之）。譬如物体化为土。阴气衰则血不荣，血不荣则肌肉薄，阴衰则阳胜，这就是血虚所以发热的缘故，所以瘦人多热。又阴虚者阳必凑之，所以阴虚多热。产妇既产，多热烦躁，因为新产亡血多。医生却不知道，又投以寒药，因此致死的，不可胜数。病有标本，医生也知道。其人阴虚，本于血不足，所以标发热。医生投以寒药，是治标不治本。只用温和益气养血药，其热自愈。熙宁甲寅、乙卯年间，杜方叔从郓波被召入京师，在翰林院。我当时奉养父母客居京城。一天杜对我说：青蒿麦煎柴胡鳖甲散，天下通行，小儿受害，不可胜记。我开始奇怪他的话，年来经历的事渐多，才知道杜的话是有根据的。男女从五六岁，到二十上下，婚与未婚，肌肉薄的，面色无华，是一虚。血虚则发热，肢体手足烦热，是二虚。阴虚者阳必凑之，所以发热汗出，男女睡眠有汗，是三虚。所谓的虚，是气血禀受有足有不足，加上柔弱未定而疾病易生，并非一定要等到知道男女大欲之后才虚。身体既然虚，又投以柴胡、鳖甲、门冬诸冷药，不到十天，饮食已不入，逐渐腹痛，至于大肠滑泄，虚人到了这种地步，也已经危险了。方叔对于医道，可以说是知本。童男室女小儿，肌瘦有汗，只用平和养气血温药，自然无忧。（出自《万安方引》）（按：此处下面又有说：古人立方，也用温药，如建中汤之类。且据《医说》引《医余》，则此所谓平和养气血温药，即指建中汤而言。）
大抵这个症，阴虚者多。大概人禀受天地阴阳之气以生，形肖天地，阳常有余，阴常不足。况且劳动虽然是伤气，殊不知诸动皆属于火，火盛则阴愈消，学习者不可不认识。看其病久，多劳怯咳嗽发热，阴虚火动可见，学习者宜详辨。（出自《医学原理》）
凡是虚损的原因，无非是酒色劳倦七情饮食所致。所以或先伤其气，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。因为阴是天一的根，形质之祖，所以凡是损在形质的，总曰阴虚，这是大目。若分而言之，则有阴中之阴虚者，其病为发热躁烦，头红面赤，唇干舌燥，咽痛口疮，吐血衄血，便血尿血，大便燥结，小便痛涩等证。有阴中之阳虚者，其病为怯寒惟悴，气短神疲，头晕目眩，呕恶食少，腹痛飧泄，二便不禁等证。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，妇人月闭等证，则无论阴阳，凡病至极，皆所必至，总由真阴之败耳。然而真阴所居，惟肾为主，因为肾为精血之海，而人的生气，即同天地之阳气，无非自下而上，所以肾为五脏之本。所以肾水亏，则肝失所滋而血燥生；肾水亏，则水不归源而脾痰起；肾水亏，则心肾不交而神色败；肾水亏，则盗伤肺气而喘嗽频；肾水亏，则孤阳无主而虚火炽。凡是劳伤等证，如果不是伤入根本，怎么会危笃至此。所以凡是病甚于上者，必其竭甚于下也。我所以说：虚邪之至，害必归阴，五脏之伤，穷必及肾，穷而至此，我也无可奈何了。君子所贵，也贵在知微而已。（出自《景岳全书》）
虚劳的证候，《金匮要略》叙述在血痹之下，可见劳则必劳其精血。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，营行日迟，卫行日疾，营血为卫气所迫，不能内守而脱出于外，或吐或衄，或出二阴之窍，血出既多，火热迸入，逼迫煎熬，漫无休止，营血有立尽而已，不死何待耶。更有劳乏之极而血痹不行者，血不脱于外而但蓄于内，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，始必干热，俟蒸气散，微汗而热解，热蒸不已，瘵病成焉，不死又何待耶。（出自《医门法律》）
Xulao (Consumptive Disease) is generally categorized into Yang Deficiency and Yin Deficiency, and its treatment methods are essentially limited to Tonifying Yang and Tonifying Yin. However, in reality, cases of Yin Deficiency are more common. Therefore, Zhang Zhongjing's use of Jianzhong Tang (Middle-Building Decoction) to support Yang to harmonize with Yin contains profound principles; meanwhile, various tonifying formulas from later generations are also indispensable. Herein,繁琐 details are omitted to retain the essentials, classified for easy reference by learners.
**General Discussion on Etiology:** The *Nan Jing* (Classic of Difficult Issues) discusses "Damage" (Sun), ranging from skin and hair to bones and sinews, which distinguishes the sequence of depth in Qi and pulses. Tracing the causes, they belong to non-external/non-internal factors, such as engaging in sexual intercourse before recovery from a major illness, extreme physical exhaustion, irregular eating habits, excessive mental exertion, or shouting that dissipates Yuan Qi. Consequently, various symptoms arise simultaneously, including hematemesis, epistaxis, hematochezia, melena, spermatorrhea, leukorrhea, cold diarrhea, spontaneous sweating, yellow sweat, vomiting, hemoptysis, salivary foam, and phlegm-fluid retention. This causes Ying (Nutritive) and Wei (Defensive) Qi to deviate from their origin, leading to emaciation and damage, all stemming from violating normal physiological laws. Furthermore, women during the postpartum period suffer even greater deficiency than after severe illnesses, a fact that must be known. (From *San Yin Fang*)
Deficiency leads to myriad diseases, while excess results in fewer illnesses. From childhood, insufficient fetal Qi may cause specific Zang-Fu organs to be deficient. From ages five to thirty, regardless of marital status, individuals may exhibit thin muscles and lackluster complexion—this is the first deficiency. Blood deficiency causes fever, often lingering after illness, with hot palms and soles—this is the second deficiency. When Yin is deficient, Yang inevitably encroaches, causing nocturnal sweating in both men and women—this is the third deficiency. These result from constitutional insufficiency, making one prone to disease, not necessarily requiring sexual desire to induce deficiency. (Note: This text originates from *Yangsheng Biyong Fang*, recorded under the section "Yin Deficiency as Consumptive Disease".) Loss of blood leads to Liver deficiency; excessive thinking leads to Heart deficiency; irregular diet leads to Spleen deficiency; excessive talking leads to Lung deficiency; sexual exhaustion leads to Kidney deficiency; post-illness weakness in men leads to Qi deficiency; postpartum condition in women leads to Blood deficiency; emotional extremes lead to Shen (Spirit) deficiency; and ceaseless labor leads to Xing (Form) deficiency. Liver deficiency causes dim vision and weak legs; Heart deficiency causes palpitations and spontaneous sweating; Spleen deficiency causes vomiting, diarrhea, distension, and fullness; Lung deficiency causes wheezing, coughing, and rebellious Qi; Kidney deficiency causes toothache and deafness; Qi deficiency causes syncope; Blood deficiency causes fever; Form deficiency causes thin skin and muscle; Shen deficiency causes mental confusion. These are the general outlines. (From *Guanjian*)
Medical classics describe the syndromes of Five Exhaustions (Wu Lao) and Six Extremes (Liu Ji), which differ from infectious tuberculosis (Chuan Shi Gu Zheng). They mostly arise from failure to maintain health, starting with overuse, violating Yin-Yang balance, and damaging Ying and Wei Qi. Specifically: excessive planning damages the Liver (Liver Exhaustion), corresponding to Sinew Extreme; intricate mental manipulation damages the Heart (Heart Exhaustion), corresponding to Pulse Extreme; unexpected excessive worry damages the Spleen (Spleen Exhaustion), corresponding to Flesh Extreme; anticipatory anxiety damages the Lung (Lung Exhaustion), corresponding to Qi Extreme; rigid moral striving damages the Kidney (Kidney Exhaustion), corresponding to Bone Extreme. Thus, Five Exhaustions correspond to Five Extremes. (Note: This theory stems from *San Yin Fang*, but Yan Yonghe adapted it to correspond Six Extremes to Six Fu Organs, likely to avoid rigidity.) However, Jing (Essence) Extreme refers to the衰败 of Qi in all Zang-Fu organs, resulting in extreme physical fatigue, blurred vision, dry teeth, hair loss, heavy body, deafness, unsteady gait, pathogenic Qi reversing in the Six Fu, and Jue in the Five Zang. (From *Jisheng Fang*)
Zhuangzi stated: "If Essence is used excessively, it will be exhausted; if Spirit is labored excessively, it will be fatigued." This explains pathology. The root of life lies in Qi and Blood. Whether male or female, although possessing Qi and Blood, one fails to preserve them, leading to daily busyness, mental fatigue, physical exhaustion, irregular diet, emotional imbalance, exposure to cold, consumption of cold drinks, and indulgence in desires. This exhausts the Qi and Blood of the Five Zang, initiating the Five Exhaustions, similar to the Six Extremes and Seven Injuries. Heart deficiency causes turbid urine and excessive sweating; Liver deficiency causes tendon spasms and dizziness; Kidney deficiency causes lower back pain and seminal emission; Lung deficiency causes cough and tidal fever; Spleen-Stomach deficiency causes vomiting, anorexia, gradual emaciation and sallow complexion, or Stomach Heat causing polyphagia without weight gain. Most of these syndromes involve pain radiating from the epigastrium to the hypochondrium, caused by stagnant blood preventing nourishment by new blood. (From *Zhizhi Fang*)
Human life is formed by inheriting the chaotic Qi of Heaven and Earth. Preserving True Yuan and securing the root ensures health. If True Yuan is neglected, disease arises. True Yuan is essentially Qi, Blood, Essence, and Fluids. My master taught that among all diseases, Consumptive Disease is the hardest to treat. It occurs when young adults, whose Qi, Blood, and Essence are abundant, neglect preservation, indulging in alcohol and sex, ignoring hunger and satiety, day and night without rest. This dissipates True Yuan and corrupts Essence, leading to hematemesis, expectoration, blazing Heart Fire, Lung萎 (Flaccidity), bone-steaming fever, Kidney Essence depletion, pale face with red cheeks, dry mouth and throat, leukorrhea, spermatorrhea, nocturnal sweating, difficulty eating, and total loss of strength. This is called "Fire Overcoming Metal" (Fire insulting Metal). Severe cases die within six months; mild cases within a year. (From *Shiyao Shenshu*)
The root causes of Consumptive Disease vary. Alcohol injures the Lung; sexual excess injures the Kidney; thinking injures the Heart; labor and dietary irregularities injure the Spleen; anger injures the Liver. All can cause consumptive disease, but those caused by alcohol and sex are most common.
**Lung Exhaustion:** The Lung is like a canopy, its Qi light and clear, resistant to cold and heat. However, alcohol is hot; excessive drinking exposes the Lung to Fire pathogens. Long-term steaming causes stagnation, distension, wheezing, coughing, hoarseness, bone-steaming fever, and dry skin/hair, making it incurable.
**Kidney Exhaustion:** The Five Fires rely on Kidney Water for control. Sexual excess depletes Kidney Water, causing Heat. The Kidney Meridian passes through the Liver and Diaphragm into the Lung, along the throat to the tongue base. Kidney deficiency ignites Kidney Fire, spreading to the Liver/Diaphragm, carrying Ministerial Fire into the Lung, causing initial cough, followed by fever, nocturnal sweating, spermatorrhea, bone flaccidity, and muscle wasting, eventually injuring the Spleen with diarrhea and critical danger.
**Heart Exhaustion:** The Heart is the source of Blood and the start of Ying/Wei movement. Without undue strain, True Blood grows daily. Chronic mental strain consumes Heart Blood, leaving the Liver unsupported, organs unmoistened, and tendons/nerves unnourished. Ying Qi stagnates, pathogenic Heat arises, known as "Yin Deficiency generating Internal Heat." Excessive Heat damages Metal (Lung), causing emaciation and impending death, common in frustrated individuals.
**Spleen Exhaustion:** Yuan Qi hides when still, dissipates when active. Excessive labor and irregular diet injure Spleen Yuan Qi, impairing digestion, causing frequent diarrhea, lack of Blood/Qi production, and no muscle growth. Since the Spleen is the Mother of the Lung, Spleen weakness deprives the Lung of resources, stopping Jin-Ye production, leading to dryness, severe cough, and incurable consumptive disease.
**Liver Exhaustion:** Great anger causes Blood to pool upward, leading to sudden collapse, called "Frying Jue." Frequent anger moves Liver Fire, causing stored Blood to rebel upward, leading to massive hematemesis. Eventually, all Blood in organs and chest is vomited out. As Ministerial Fire moves, all Five Fires fan the flames, moving Blood. Massive Blood loss leaves the body empty, allowing Wood/Fire to insult Metal (Lung), causing fever, cough, hypochondriac pain, and worsening consumptive disease. Thus, although named similarly, root causes differ; physicians must investigate thoroughly and treat according to the affected meridian, avoiding vague treatments. (From *Cangsheng Siming*)
**Consumption Caused by Thinking:** Life relies on Qi and Blood; disease begins by injuring them. Chaste youths and maidens with excessive thoughts often suffer consumptive damage. Men show scattered spirit and complexion first; women show amenorrhea first. Why? Worry and thinking injure the Heart; Heart injury causes Blood rebellion and depletion; thus spirit/complexion scatters and menstruation stops. Fire being diseased cannot nourish its child (Spleen), causing anorexia. Spleen deficiency weakens Metal (Lung), causing cough. Cough exhausts Water (Kidney), drying limbs. Wood Qi deficiency causes anger, dry hair, and tendon flaccidity. After transmission through all Zang, death ensues. This type is the hardest to treat as it originates deep within the Zang, beyond medicinal reach. If the patient changes their mindset and uses medicine to support them, survival is possible. Other consumptions should be treated based on pulse and syndrome. (From *Bencao Yan Yi*)
**All Deficiencies Originate from Heart and Kidney:** The Kidney stores Essence and Will. It is the root of vitality and Yuan Qi, the residence of Spirit. As *Ling Shu* states, the Kidney stores Essence and houses Will. Spirit follows Essence. Modern deficiencies stem from Heart and Kidney, manifesting as nocturnal sweating and leukorrhea. The Heart's fluid is Sweat; the Kidney's fluid is Essence. A deficient person dreaming at night may leak Heart fluid (Sweat) upon waking, known as nocturnal sweating. Kidney fluid leaking via urine becomes turbid like rice water or oily, or leaks via dream emission, causing weak constitution, fatigue, blurry eyes, and loss of Spirit due to Essence depletion. Heart disease causes Spirit to wander, leading to daytime palpitations, forgetfulness, and confusion, and nighttime dreams of climbing heights or being chased. Kidney disease causes marrow sea depletion, leading to weak knees, fatigue, nocturnal emissions, cloudy urine, thirst, and emaciation. All deficiencies originate from Heart and Kidney. (From *Zhibing Huofang Mifang*)
**Yang Deficiency and Yin Deficiency:** Deficiency syndromes vary due to Five Exhaustions and Seven Injuries, affecting Ying/Wei and Zang/Fu. Ultimately, life depends on Qi and Essence; deficiency affects these. Qi Deficiency is Yang Deficiency; Essence Deficiency is Yin Deficiency. Fire excess and Water deficiency causing dry Ying/Wei and withered fluids indicate Yin Deficiency. Water excess and Fire deficiency causing cold organs and Spleen/Kidney failure indicate Yang Deficiency. This is due to Yin-Yang imbalance. Treatment should tonify deficiency, never attack excess. Attacking excess in a deficient state causes mutual destruction. Distinguishing Yin and Yang is difficult because Yin/Yang contain Yin/Yang. Cases appearing neither clearly Yang nor Yin are confusing without true insight. Also, simultaneous Yin and Yang deficiency exists; since Yang is the root of life, emphasis is placed on Yang Qi. Understanding this clarifies the treatment of consumptive disease. (From *Jingyue Quanshu*)
Male consumptive disease starts from Essence injury; female from amenorrhea; pediatric from maternal womb. Men typically experience ejaculation at 16, women menstruation at 14, but maturity is incomplete. Early sexual activity in youth damages True Yuan, causing internal Yin deficiency and blazing Deficient Fire. Lung Metal is injured, failing to generate Kidney Water; Kidney Water dries up, failing to cool Heart Fire. Blazing Heart Fire triggers Kidney Fire, causing nocturnal emissions and demonic intercourse dreams. Lung Qi deficiency opens pores, causing spontaneous and nocturnal sweating. Fire agitates Blood, raising it upward, causing hemoptysis. Ancient texts call this Lao Zhai, Lao Ji, Yin Deficiency, Insufficiency, or Xu Sun. Essentially, these are variations of Qi, Blood, and Yin Deficiency. Spleen/Lung insufficiency is Qi Deficiency; Heart/Liver insufficiency is Blood Deficiency; Kidney Water deficit is Yin Deficiency. Qi is Yang, Blood is Yin; Blood Deficiency is also Yin Deficiency. (From *Dingbu Mingyi Zhizhang*)
Ancient terms include Five Exhaustions, Seven Injuries, Six Extremes, and Twenty-Three Steams, creating complex symptoms. However, understanding the treatment of the two fundamental roots (Pre-Heaven and Post-Heaven) ensures cure. Human deficiency is either Qi or Blood, affecting all Zang-Fu. Blood's source is the Kidney (Water, the Origin of One); Qi's source is the Spleen (Earth, Mother of All). If these two organs are harmonious, hundred vessels are regulated; if damaged, myriad diseases arise. This is a guide for students. (From *Bingji Shazhuan*)
**Yin Deficiency as Consumptive Disease:** Fever in Xulao indicates insufficient Yin and excess Yang, generating internal/external heat not from external pathogens. (From *Zhubing Yuanhou Lun*)
*Gu Jin Luyan Yangsheng Biyong Fang* states: "Qi deficiency causes syncope; Blood deficiency causes fever." This is logical. Diet affects Yin. Yin deficiency fails to nourish Blood, leading to thin muscles and Yang dominance, causing fever (hence thin people are prone to heat). "When Yin is deficient, Yang encroaches," causing heat. Postpartum women often have fever and irritability due to blood loss. Doctors mistakenly use Cold herbs, causing death. Illness has Root (Ben) and Branch (Biao). Yin deficiency's root is Blood insufficiency; fever is the branch. Using Cold herbs treats the branch, not the root. Warm, Qi-tonifying, Blood-nourishing herbs cure the heat naturally. Du Fangshu warned against the widespread use of Qinghao Maijian Chaihu Biejia San (Artemisia, Wheat, Decoction, Bupleurum, Turtle Shell) for children, noting it caused harm. He observed that youths aged 5-20 with thin muscles and lackluster faces have Blood Deficiency (fever, hot extremities) and Yin Deficiency (night sweats). This deficiency exists regardless of sexual activity. Using Cold herbs like Bupleurum, Turtle Shell, and Ophiopogon on already deficient bodies leads to anorexia, abdominal pain, and diarrhea within days, endangering the patient. Du Fangshu understood the Root. For chaste youths and children with thinness and sweating, only mild, warm, Qi-and-Blood-nourishing herbs should be used. (From *Wan'an Fang*)
Generally, this syndrome is mostly Yin Deficiency. Humans inherit Yin-Yang Qi; form mirrors heaven and earth. Yang is often in excess, Yin often insufficient. Labor injures Qi, but all movements belong to Fire; Fire excess further consumes Yin. Physicians must recognize this. Prolonged illness with cough and fever indicates Yin Deficiency and Fire Movement. (From *Yixue Yuanli*)
All deficiencies stem from alcohol, sex, labor, emotions, and diet. Qi injury affects Essence; Essence injury affects Qi. Both are considered Yin aspects. Yin is the root of form. Deficiencies in form are termed Yin Deficiency. Subtypes include:
**Yin with Yang Deficiency:** Fever, irritability, red head/face, dry lips/tongue, sore throat, mouth ulcers, bleeding, constipation, painful urination.
**Yin with Yin Deficiency (Cold):** Fear of cold, despair, shortness of breath, fatigue, dizziness, nausea, poor appetite, abdominal pain, diarrhea, incontinence.
Severe cases include cough, spermatorrhea, nocturnal sweating, asthma, hoarseness, bone/joint pain, mental confusion, muscle wasting, dream emissions, and amenorrhea. Regardless of Yin/Yang labels, extreme illness results from the collapse of True Yin. The Kidney houses True Yin and is the Sea of Essence/Blood. Kidney Water deficiency leads to Liver Blood dryness, Spleen Phlegm, Heart-Kidney non-interaction, Lung Qi damage, and unchecked Deficient Fire. Upper symptoms indicate lower exhaustion. "Pathogenic deficiency returns to Yin; Zang injury ultimately reaches the Kidney." At this stage, treatment is futile. The gentleman values subtle understanding. (From *Jingyue Quanshu*)
*Xuebi* (Blood Bi) in *Jin Gui Yao Lue* implies consumptive disease involves Jing and Blood. Ying Blood injury causes internal heat, hot palms/soles, visual disturbances, tinnitus, mouth ulcers, loss of taste, dry nose, breathing difficulty, poor nutrition, lethargy, soft bones, and weak feet. Ying Qi slows, Wei Qi speeds. Ying Blood is forced outward by Wei Qi, causing bleeding (vomiting, nosebleeds, genital bleeding). Massive blood loss allows Fire to penetrate and boil remaining Blood, leading to rapid death. Alternatively, extreme fatigue causes Blood Bi stagnation internally. Blood accumulates, blocking channels, drying up. Skin becomes smooth but lusterless. Qi passes but Blood does not move, steaming Blood into Heat. Heat peaks at specific times (dusk or noon/midnight), resolving slightly with sweat. Continuous steaming forms Tuberculosis (Zhai), leading to death. (From *Yimen Falü*)