经言∶精气夺则虚。凡营虚卫虚，上损下损，不外精与气而已。精气内夺，则积虚成损，积损成劳，甚
而为瘵，乃精与气虚惫之极也。《素问》论五劳，谓久视伤血，久卧伤气，久坐伤肉，久立伤骨，久行伤筋。
《金匮》论五劳，谓肺劳损气，心劳损神，脾劳损食，肝劳损血，肾劳损精。越人谓自上损下者，一损肺，
劳嗽。二损心，盗汗。三损胃，食减。四损肝，郁怒。五损肾，淋漏。过胃则不治。自下损上者，一损肾，
遗浊经闭。二损肝，胁痛。三损脾，胀泻。四损心，惊悸不寐。五损肺，喘咳。过脾则不治。诚以脾胃为精与气
生化之源也，故治虚劳，以能食为主。考《难经》治法，损其肺者益其气，保元汤。损其心者调其营卫，八
珍汤。损其脾者调其饮食，适其寒温，四君子汤。损其肝者缓其中，牛膝丸。损其肾者益其精，金刚丸、
煨肾丸。此固治损之要矣，尤必辨其阳虚阴虚。经曰∶阳虚生外寒，阴虚生内热。凡怯寒少气，自汗喘乏，
食减无味，呕胀飧泄，皆阳虚症也。此脾肺亏损，由忧思郁结，营卫失和，惟四君、保元、养营、归脾诸汤宜
之。若怔忡盗汗，咳血吐衄，淋遗崩漏，经闭骨蒸，皆阴虚症也。此心肝肾亏损，由君相火炎，精髓枯竭，惟
补心、三才、六味、大造、固本诸汤宜之。又若肾中真阳虚者，右尺必弱。宜甘温益火之品，补阳以配阴，
八味丸。或景岳右归饮，右归丸。所谓益火之源，以消阴翳也。肾中真阴虚者，左尺细数。宜纯甘补水之品，滋
阴以配阳，六味丸加杞子、鱼膘。或景岳左归饮，左归丸。所谓壮水之主，以镇阳光也。阳虚不复，久则吸
短偏卧，脉弱阳痿；宜参、术、归、 、杞子、山药、胡桃、龙眼、莲、枣、沙苑子、骨脂、人乳、鹿茸、
鹿胶、羊肉、羊肾、海参。阴虚不复，久则咽疮音哑，色悴肌羸，宜麦、味、杏、贝、熟地、
首乌、苁蓉、燕窝、乌鸡、阿胶、淡菜、秋石、河车、猪羊髓、龟胶、白蜜。而劳瘵成矣。由是火炎于上，
为嗽血，宜五汁膏。为潮热；宜清骨散。火动于下，为遗浊，宜龙齿丸。为泄泻，宜三白广生汤。而治疗难矣。
夫水为万物之元，孙真人所以云补脾不若补肾；土为万物之母，许学士所以云补肾不若补脾。然喜燥者脾，喜
凉者肾；欲补肾，易伤脾；欲补脾，易伤肾。不知土为金母，金为水母。劳瘵至阳虚泄泻，宜温以补脾，然
补脾须不碍肺；劳瘵至阴虚嗽热，宜润以滋肾，然滋肾须不妨脾。补脾佐以五味、杞子。滋肾佐以莲实、
砂仁。不得偏用辛温以助火，桂附之属。亦不得偏用苦寒以戕胃。知柏之属。且虚劳以受补为可治，不受补为
不治。如人参之甘温，则大热可除，乃阳生阴长之理，所谓血脱者益，而葛可久治劳十方，用参术者七也。
故曰∶土旺而金生，勿拘拘于保肺；水壮而火熄，勿汲汲于清心。
夫五劳者，劳伤五脏，乃虚损之源。而六极七伤，又虚损之流极，劳瘵之深根也。如皮毛枯槁，为肺劳；
人参黄 散。血脉不荣，为心劳；大五补丸。食少肌瘦，为脾劳；橘皮煎，血虚筋缓，为肝劳；黑丸。腹肿
足弱，为肾劳。肾气丸。六极者，数转筋，指甲痛，为筋极；滋补营养丸、酒煮木瓜粥。牙痛踵痛，不耐久立，
为骨极；茸珠丸。面色无华，头发坠落，为血极；补营汤。肤如虫行，体肉干黑，为肉极；参苓丸。肌无膏泽，
目无精光，羸瘦肌痒，搔则成疮，为精极；巴戟丸。胸胁逆满，吸短难言，为气极。益气丸。七伤者，一阴寒，
二阴痿，三里急，四精漏，五精少，六精滑，七窍数。并宜锁阳丹，九龙丹。
几虚损症，多起于脾胃。劳瘵症，多起于肾经。虚损潮热，多起于内伤。劳瘵阴虚火动，多起于伤风似疟。
虚损蒸蒸发热，按至皮肤间甚热，不能食，不觉瘦，脉豁大，重按无力。劳瘵骨蒸，按之皮肤不热，按之筋骨
乃热，能食而瘦，脉弦数。虚损转潮热泄泻，脉短数者，不治。劳瘵转阴虚火动，喉痛脉细数死。虚症颊赤或
唇红，阴虚逼阳于上也。音喑，肾气竭也。咳而喘急，肺虚气不归肾也。喉干咽痛，真水涸，虚火炎也。
不眠恍惚，血不养心，神不能藏也。时多烦躁，阳中无阴，柔不济刚也。饮食
不甘，肌肉渐消，脾元败也。盗汗不止，有火则阴不能摄，无火则阳不能固也。骨痛如折，肾主骨，真阴竭
也。筋急酸痛，水亏木燥，肝失养也。足心如烙，虚火烁阴，涌泉涸也。
医经中说：精气耗损就会表现为虚证。凡是营气虚弱或卫气虚弱，上部受损或下部受损，都不外乎是精与气的亏损罢了。精气在内部被耗夺，就会积累虚弱而成“损”，积累“损”而成“劳”，严重了甚至成为“瘵”，这是精与气极度虚惫的表现。《素问》论述五劳，说久视伤血，久卧伤气，久坐伤肉，久立伤骨，久行伤筋。《金匮要略》论述五劳，说肺劳损伤气，心劳损伤神，脾劳损伤饮食运化，肝劳损伤血，肾劳损伤精。扁鹊（越人）说从上往下传的损证，一损肺，出现劳嗽；二损心，出现盗汗；三损胃，食欲减退；四损肝，情绪抑郁易怒；五损肾，出现淋浊遗精。如果病势传到胃，就无法治疗了。从下往上传的损证，一损肾，出现遗精尿浊、月经闭止；二损肝，胁肋疼痛；三损脾，腹胀腹泻；四损心，惊悸失眠；五损肺，气喘咳嗽。如果病势传到脾，就无法治疗了。确实因为脾胃是精与气生化产生的源头，所以治疗虚劳，以患者能够进食为主要判断标准。考察《难经》的治疗法则，损及肺的益其气，用保元汤；损及心的调和营卫，用八珍汤；损及脾的调理饮食，适应寒温，用四君子汤；损及肝的舒缓其中焦郁结，用牛膝丸；损及肾的填补精髓，用金刚丸、煨肾丸。这固然是治疗损证的关键，但尤其必须辨别阳虚还是阴虚。医经说：阳虚产生外寒，阴虚产生内热。凡是怯冷怕寒、气短、自汗、气喘乏力、食欲减退味觉缺失、呕吐腹胀、完谷不化的泄泻，都是阳虚的症状。这是脾肺亏损，由忧思郁结导致，营卫不和，适宜使用四君子汤、保元汤、养营汤、归脾汤等方剂。如果是怔忡、盗汗、咳血吐衄、淋浊遗精、崩漏、月经闭止、骨蒸潮热，都是阴虚的症状。这是心肝肾亏损，由君火相火炎上，精髓枯竭导致，适宜使用补心汤、三才汤、六味地黄丸、大造丸、固本丸等方剂。另外如果是肾中真阳虚，右尺脉必弱。适宜用甘温益火的药物，补阳以配阴，用八味丸（金匮肾气丸）。或者张景岳的右归饮、右归丸。这就是所说的“益火之源，以消阴翳”。肾中真阴虚者，左尺脉细数。适宜用纯甘补水之品，滋阴以配阳，用六味地黄丸加枸杞子、鱼鳔。或者张景岳的左归饮、左归丸。这就是所说的“壮水之主，以制阳光”。阳虚不能恢复，时间久了会出现吸气短促、偏卧、脉弱、阳痿；适宜用人参、白术、当归、[缺字]、枸杞子、山药、胡桃、龙眼、莲子、大枣、沙苑子、骨碎补、人乳、鹿茸、鹿角胶、羊肉、羊肾、海参。阴虚不能恢复，时间久了会出现咽喉生疮、声音嘶哑、面色憔悴、肌肉消瘦，适宜用麦冬、五味子、杏仁、贝母、熟地黄、何首乌、肉苁蓉、燕窝、乌鸡、阿胶、淡菜、秋石、紫河车、猪羊骨髓、龟板胶、白蜜。这样就形成了劳瘵。由此火炎于上，出现咳嗽吐血，适宜用五汁膏；出现潮热，适宜用清骨散。火动于下，出现遗精尿浊，适宜用龙齿丸；出现泄泻，适宜用三白广生汤。这时候治疗就困难了。水为万物的本源，孙真人所以说补脾不如补肾；土为万物的母亲，许学士所以说补肾不如补脾。然而脾喜燥，肾喜凉；想要补肾，容易伤脾；想要补脾，容易伤肾。不知道土是金的母亲，金是水的母亲。劳瘵发展到阳虚泄泻，适宜用温法补脾，但是补脾必须不碍肺；劳瘵发展到阴虚咳嗽发热，适宜用润法滋肾，但是滋肾必须不妨碍脾。补脾时佐以五味子、枸杞子。滋肾时佐以莲子肉、砂仁。不得偏用辛温药物来助长火势，如桂枝、附子之类。也不得偏用苦寒药物来伤害胃气，如知母、黄柏之类。而且虚劳以能够受补为可治，不能受补为不治。像人参的甘温，可以消除大热，这是阳生阴长的道理，所谓血脱者益气，而葛可久治疗劳证的十方中，用人参、白术的有七个。所以说：土旺则金生，不要拘泥于只保肺；水壮则火熄，不要急切地只清心。
所谓的五劳，是劳伤五脏，这是虚损的源头。而六极七伤，又是虚损的流变和极致，是劳瘵的深根。比如皮毛枯槁，是肺劳；用人参黄芪散。血脉不荣，是心劳；用大五补丸。食少肌瘦，是脾劳；用橘皮煎。血虚筋缓，是肝劳；用黑丸。腹肿足弱，是肾劳；用肾气丸。六极是指：手足转筋，指甲痛，是筋极；用滋补营养丸、酒煮木瓜粥。牙痛踵痛，不耐久立，是骨极；用茸珠丸。面色无华，头发坠落，是血极；用补营汤。皮肤像虫行，身体肌肉干黑，是肉极；用参苓丸。肌肤没有光泽，眼睛没有神采，消瘦且肌肉瘙痒，搔抓后成疮，是精极；用巴戟丸。胸胁胀满逆气，吸气短促难以言语，是气极；用益气丸。七伤是指：一阴寒，二阴痿，三里急，四精漏，五精少，六精滑，七窍数。都适宜用锁阳丹、九龙丹。
大凡虚损症，多起于脾胃。劳瘵症，多起于肾经。虚损引起的潮热，多起于内伤。劳瘵引起的阴虚火动，多起于伤风类似疟疾的症状。虚损引起的蒸蒸发热，按压到皮肤间感觉甚热，不能进食，不觉消瘦，脉象豁大，重按无力。劳瘵引起的骨蒸，按压皮肤不热，按压筋骨才热，能进食但消瘦，脉象弦数。虚损转为潮热泄泻，脉短数的，无法治疗。劳瘵转为阴虚火动，喉痛脉细数的，预后不良致死。虚症见两颊发红或嘴唇红，是阴虚逼迫阳气上浮。声音嘶哑，是肾气竭绝。咳嗽且喘急，是肺虚气不归肾。喉咙干咽痛，是真水枯竭，虚火上炎。失眠恍惚，是血不养心，神不能藏。时常烦躁，是阳中无阴，柔不济刚。饮食不甘，肌肉逐渐消瘦，是脾元败坏。盗汗不止，有火则阴不能摄纳，无火则阳不能固守。骨痛如折断，肾主骨，是真阴竭绝。筋急酸痛，是水亏木燥，肝失滋养。足心如烙铁烫，是虚火灼烧阴液，涌泉穴枯竭。
The medical classics state: "When essence and qi are depleted, deficiency occurs." Whether it is a deficiency of Ying (Nutrient) Qi or Wei (Defensive) Qi, whether the damage is in the upper or lower body, it essentially boils down to the depletion of Essence and Qi. When Essence and Qi are internally depleted, accumulated deficiency becomes "Sun" (Damage), accumulated damage becomes "Lao" (Exhaustion), and severely, it becomes "Zhai" (Consumption/TB-like disease). This represents the extreme exhaustion of Essence and Qi. The *Suwen* discusses the Five Exhaustions, stating that prolonged looking damages Blood, prolonged lying down damages Qi, prolonged sitting damages Flesh, prolonged standing damages Bones, and prolonged walking damages Sinews. The *Jingui Yaolue* discusses the Five Exhaustions, stating that Lung Exhaustion damages Qi, Heart Exhaustion damages Shen (Spirit), Spleen Exhaustion damages digestion/appetite, Liver Exhaustion damages Blood, and Kidney Exhaustion damages Essence. Yue Ren (Bian Que) stated that for damage transmitting from top to bottom: First damage to the Lung causes chronic cough; second to the Heart causes night sweats; third to the Stomach causes reduced appetite; fourth to the Liver causes depression and anger; fifth to the Kidney causes stranguria and leakage. If it reaches the Stomach, it is incurable. For damage transmitting from bottom to top: First damage to the Kidney causes seminal emission/turbid urine and amenorrhea; second to the Liver causes hypochondriac pain; third to the Spleen causes abdominal distension and diarrhea; fourth to the Heart causes palpitations and insomnia; fifth to the Lung causes wheezing and cough. If it reaches the Spleen, it is incurable. Indeed, because the Spleen and Stomach are the source of production and transformation for Essence and Qi, treating Xu Lao (Deficiency and Exhaustion) prioritizes the ability to eat. Examining the treatment methods in the *Nan Jing*: Damage to the Lung benefits Qi, using Baoyuan Tang (Preserve Origin Decoction); Damage to the Heart regulates Ying and Wei, using Bazhen Tang (Eight Treasure Decoction); Damage to the Spleen regulates diet and adapts to cold/warmth, using Sijunzi Tang (Four Gentlemen Decoction); Damage to the Liver soothes the center, using Niuxi Wan (Achyranthes Pill); Damage to the Kidney tonifies Essence, using Jingang Wan (Diamond Pill) and Weishen Wan (Roasted Kidney Pill). These are indeed key treatments for Sun, but one must distinguish between Yang Deficiency and Yin Deficiency. The classics say: "Yang deficiency generates external cold, Yin deficiency generates internal heat." Symptoms such as aversion to cold, shortness of breath, spontaneous sweating, asthenia, reduced appetite with loss of taste, vomiting, abdominal distension, and undigested stool diarrhea are all symptoms of Yang Deficiency. This is due to Spleen and Lung damage caused by worry and thought leading to stagnation, resulting in disharmony of Ying and Wei; formulas such as Sijunzi Tang, Baoyuan Tang, Yangying Tang (Nourish Camp Decoction), and Guipi Tang (Restore the Spleen Decoction) are suitable. If there are palpitations, night sweats, hemoptysis, epistaxis, stranguria, seminal emission, metrorrhagia, amenorrhea, and bone-steaming fever, these are symptoms of Yin Deficiency. This is due to Heart, Liver, and Kidney damage caused by the flaming up of Ministerial Fire, leading to exhaustion of Essence and Marrow; formulas such as Buxin Tang (Tonify Heart Decoction), Santian Tang (Three Heavens Decoction), Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Dazao Wan (Great Creation Pill), and Guben Tang (Solidify Root Decoction) are suitable. Furthermore, if there is true Yang deficiency in the Kidney, the Right Chi pulse will be weak. It is appropriate to use sweet-warm herbs to benefit fire, tonifying Yang to harmonize with Yin, using Bajiaowan (Eight-Ingredient Pill, i.e., Jin Gui Shenqi Wan). Or Zhang Jingyue's Yougui Yin (Right Restoration Drink) and Yougui Wan (Right Restoration Pill). This is what is meant by "Benefiting the source of fire to eliminate shadowy yin." If there is true Yin deficiency in the Kidney, the Left Chi pulse will be fine and rapid. It is appropriate to use purely sweet water-nourishing substances, nourishing Yin to harmonize with Yang, using Liuwei Dihuang Wan plus Gouqizi (Goji Berry) and Yubiao (Fish Maw). Or Zhang Jingyue's Zuogui Yin (Left Restoration Drink) and Zuogui Wan (Left Restoration Pill). This is what is meant by "Strengthening the master of water to suppress blazing yang." If Yang deficiency does not recover, over time it leads to short inhalation, sleeping on one side, weak pulse, and impotence; suitable herbs include Renshen (Ginseng), Baizhu (Atractylodes Macrocephala), Danggui (Angelica Sinensis), [missing character], Gouqizi, Shanyao (Dioscorea), Hetao (Walnut), Longyan (Longan), Lianzi (Lotus Seed), Dazao (Jujube), Shayuanzi (Astragalus Complanatus), Guzhi (Bone Breaker/Drynaria), Renru (Human Milk), Lurong (Deer Antler), Lu jiao jiao (Deer Antler Glue), Yangrou (Mutton), Yangshen (Kidney), Haishen (Sea Cucumber). If Yin deficiency does not recover, over time it leads to throat ulcers, hoarseness, sallow complexion, and emaciation; suitable substances include Maidong (Ophiopogon), Wuweizi (Schisandra), Xingren (Apricot Kernel), Beimu (Fritillaria), Shudihuang (Prepared Rehmannia), Shouwu (Polygonum Multiflorum), Congrong (Cistanche), Yanwo (Swallow Nest), Wuji (Black Chicken), Ejiao (Donkey-hide Gelatin), Dancai (Mussel), Qiushi (Mineral Salt), Chehe (Placenta), Zhu Yang sui (Pig/Sheep Bone Marrow), Guijiao (Tortoise Shell Glue), and Baimi (White Honey). Thus, Lao Zhai (Consumption) forms. Consequently, if fire flares upward causing cough and blood-streaked sputum, Wuzhi Gao (Five Juices Paste) is suitable; if tidal fever occurs, Qinggu San (Clear Bone Powder) is suitable. If fire moves downward causing seminal emission, Longchi Wan (Dragon Tooth Pill) is suitable; if diarrhea occurs, Sanbai Guangsheng Tang (Three Whites Prolong Life Decoction) is suitable. At this stage, treatment becomes difficult. Water is the origin of all things, hence Sun Simiao said tonifying the Spleen is not as good as tonifying the Kidney; Earth is the mother of all things, hence Xu Xue士 (Scholar Xu) said tonifying the Kidney is not as good as tonifying the Spleen. However, the Spleen prefers dryness, while the Kidney prefers coolness; attempting to tonify the Kidney may easily injure the Spleen, and attempting to tonify the Spleen may easily injure the Kidney. One must not forget that Earth is the mother of Metal, and Metal is the mother of Water. In Lao Zhai progressing to Yang-deficiency diarrhea, warm methods should be used to tonify the Spleen, but tonifying the Spleen must not obstruct the Lung. In Lao Zhai progressing to Yin-deficiency cough and heat, moistening methods should be used to nourish the Kidney, but nourishing the Kidney must not hinder the Spleen. When tonifying the Spleen, add Wuweizi and Gouqizi as assistants. When nourishing the Kidney, add Lianshi (Lotus Seed) and Sharen (Amomum) as assistants. Do not exclusively use acrid-warm herbs to aid fire, such as Guizhi (Cinnamon Twig) and Fuzi (Aconite). Nor do you exclusively use bitter-cold herbs to destroy the stomach, such as Zhimu (Anemarrhena) and Huangbai (Phellodendron). Moreover, Xu Lao is treatable if it can accept tonification, and untreatable if it cannot. For example, the sweet-warm nature of Renshen can remove severe heat, following the principle of Yang generating Yin. This is what is meant by "In cases of blood loss, benefit Qi"; among Ge Kejiu's Ten Formulas for Treating Consumption, seven contain Renshen and Baizhu. Therefore, it is said: When Earth is prosperous, Metal is generated; do not rigidly focus only on protecting the Lung. When Water is strong, Fire is extinguished; do not anxiously focus only on clearing the Heart.
The so-called Five Exhaustions refer to the laborious injury of the Five Zang Organs, which is the source of deficiency and damage. The Six Extremities and Seven Injuries are further the flow and extremity of deficiency and damage, and the deep root of Lao Zhai. For instance, withered skin and hair indicate Lung Exhaustion; Ren Shen Huang Qi San (Ginseng and Astragalus Powder) is used. Unnourished blood vessels indicate Heart Exhaustion; Da Wu Bu Wan (Great Five Tonification Pill) is used. Poor appetite and emaciation indicate Spleen Exhaustion; Ju Pi Jian (Tangerine Peel Decoction) is used. Blood deficiency with lax sinews indicates Liver Exhaustion; Hei Wan (Black Pill) is used. Abdominal swelling and weak legs indicate Kidney Exhaustion; Shen Qi Wan (Kidney Qi Pill) is used. The Six Extremities are: frequent muscle cramps and nail pain indicate Sinew Extremity; Zibu Yingyang Wan (Nourish and Support Nutrition Pill) and Jiuzhu Mugua Zhou (Wine-boiled Papaya Porridge) are used. Toothache and heel pain, inability to stand for long periods indicate Bone Extremity; Rongzhu Wan (Velvet Pearl Pill) is used. Lackluster complexion and hair loss indicate Blood Extremity; Buying Tang (Tonify Camp Decoction) is used. Skin feeling like insects crawling, dry black flesh indicate Flesh Extremity; Shen Ling Wan (Ginseng and Poria Pill) is used. Lackluster muscles, eyes lacking spirit, emaciation with itchy skin that ulcerates upon scratching indicate Essence Extremity; Bajie Wan (Morinda Pill) is used. Chest and hypochondriac fullness/reversal, short inhalation and difficulty speaking indicate Qi Extremity; Yiqi Wan (Benefit Qi Pill) is used. The Seven Injuries are: 1. Yin Cold, 2. Yin Impotence, 3. Three Li Urgency, 4. Essence Leakage, 5. Essence Scarcity, 6. Essence Slippery/Emission, 7. Orifices Frequent. Suoyang Dan (Cynomorium Pill) and Jiulong Dan (Nine Dragons Pill) are suitable for all.
Generally, Xu Deficiency syndromes often originate from the Spleen and Stomach. Lao Zhai syndromes often originate from the Kidney Meridian. Tidal fever in Xu Deficiency often originates from internal injury. Yin-deficiency fire agitation in Lao Zhai often originates from wind-cold resembling malaria. Xu Deficiency steaming heat feels very hot when pressed to the skin, accompanied by an inability to eat, no obvious weight loss, a wide and empty pulse that is forceless upon heavy pressure. Lao Zhai bone-steaming feels not hot on the skin but hot when pressing the bones and sinews, accompanied by ability to eat but weight loss, and a wiry and rapid pulse. If Xu Deficiency turns into tidal fever and diarrhea with a short and rapid pulse, it is untreatable. If Lao Zhai turns into Yin-deficiency fire agitation with sore throat and fine-rapid pulse, death ensues. Red cheeks or red lips in deficiency syndromes indicate Yin deficiency forcing Yang upward. Hoarseness indicates exhaustion of Kidney Qi. Cough with wheezing and urgency indicates Lung deficiency with Qi failing to return to the Kidney. Dry throat and sore throat indicate exhaustion of True Water and flaming of deficient fire. Insomnia and confusion indicate Blood failing to nourish the Heart and Shen failing to reside. Frequent irritability indicates Yang without Yin, softness failing to balance hardness. Food lacking flavor and gradual muscle wasting indicate failure of Spleen Yuan (Source). Continuous night sweats indicate that with fire, Yin cannot retain; without fire, Yang cannot secure. Bone pain as if broken indicates Kidney governs bones and True Yin is exhausted. Tight and painful sinews indicate Water deficiency and Wood dryness, with Liver losing nourishment. Soles of feet feeling like burning iron indicates deficient fire scorching Yin and exhaustion of Yongquan (KI1).