问曰∶血痹病从何得之？师曰∶夫尊荣人，骨弱肌肤盛，重困疲劳，汗出，卧不时动
摇，加被微风，遂得之。但以脉自微涩，在寸口关上小紧。宜针引阳气，令脉和紧去则愈。
【注】历节属伤气也，气伤痛，故疼痛也。血痹属伤血也，血伤肿，故麻木也。前以明
邪气聚于气分，此以明邪气凝于血分，故以血痹名之也。尊荣人，谓膏粱之人。素食甘
肥，故骨弱肌肤盛，是以不任疲劳，疲劳则汗出，汗出则腠理开。亦不胜久卧，卧则不
时动摇，动摇即加被微风，亦遂得以干之。此言膏粱之人，外盛内虚，虽微风小邪，易为
病也，然何以知病血痹也？但以身体不仁，脉自微涩，则知邪凝于血故也。寸口关上小紧，
亦风寒微邪应得之脉也。针能导引经络取诸痹，故宜针引气血，以泻其邪，令脉不涩而
和，紧去邪散，血痹自通也。
【集注】周扬俊曰∶天下惟尊荣人为形乐志苦。形乐故肌肤盛，志苦故骨弱，骨弱则
不耐劳，肌盛则气不固，稍有劳困即汗出也，汗出而阳气虚，虽微风且得以袭之，则血为
之痹。故一见脉微，则知其阳之不足，一见脉涩，则知其阴之多阻，此血痹之本脉也。而
其邪入之处，则自形其小紧，小为正气拘抑之象，紧为寒邪入中之征。然仲景明言微风，
何以反得寒脉也？盖邪随血脉上下，阻滞汁沫，未有不痛者，故痛为紧脉也，针以泄之，
引阳外出，则邪去而正自伸也。
血痹，阴阳俱微，寸口关上微，尺中小紧，外证身体不仁，如风痹状，黄 桂枝五
物汤主之。
【注】此承上条互详脉证，以明其治也。上条言六脉微涩，寸口关上小紧，此条言阴
阳寸口关上俱微，尺中亦小紧，合而观之，可知血痹之脉浮沉，寸口、关上、尺中俱微、俱
涩、俱小紧也。微者虚也，涩者滞也，小紧者邪也，故血痹应有如是之诊也。血痹外证，
亦身体顽麻，不知痛痒，故曰∶如风痹状。但不似风痹历关节流走疼痛也。主黄 桂枝五
物汤者，调养荣卫为本，祛风散邪为末也。
【集注】周扬俊曰∶此申上条既痹之后，未能针引以愈，遂令寸口微者。今则阴阳俱
微，且寸关俱微矣，且尺中小紧矣。夫小紧既见于尺，则邪之入也愈深而愈不得出，何
也？正虚之处，便是容邪之处也。脉经内外，谓之阴阳，上下亦谓之阴阳，今尺既小紧，则
微属内外也明矣。若言证以不仁概之，则疼痛麻木，每与我相阻，其为不仁甚矣，故以
风痹象之，非真风痹也。于是以黄 固卫，芍药养阴，桂枝调和荣卫，托实表里，驱邪外
出，佐以生姜宣胃，大枣益脾，为至当不易之治也。
黄 桂枝五物汤方
黄 （三两） 芍药（三两） 桂枝（三两） 生姜（六两） 大枣（十二枚）
上五味，以水六升，煮取二升，温服七合，日三服（一方有人参。）
夫男子平人，脉大力劳。极虚亦为劳。
【注】男子平人，应得四时五脏平脉，今六脉大而极虚，非平人之脉也。然大而无力，
劳役伤脾气也；极虚者，内损肾阴精也。此皆欲作虚劳之候，故有如是之诊也。
【集注】李 曰∶平人者，形如无病之人，经云∶脉病患不病者是也。劳则体疲于外，气
耗于中，脉大非气盛也，重按必空濡，乃外有余而内不足之象，脉极虚则精气耗矣。盖
大者，劳脉之外暴者也；极虚者，劳脉之内衰者也。
魏荔彤曰∶夫男子平人，脉大为劳，极虚亦为劳，脉大者，邪气盛也，极虚者，精
气夺也。以二句揭虚劳之总，而未尝言其大在何脉？虚在何经？是在主治者，随五劳七
伤之故而谛审之也。
人年五六十，其病脉大者，痹侠背行。若肠鸣、马刀、侠瘿者，皆为劳得之。
【按】“若肠鸣”三字，与上下文不属，必是错简。侠瘿之“瘿”字，当是“瘰”字。每
经此证，先劳后瘰、先瘰后劳者有之，从未见劳瘿先后病也，必是传写之讹。
【注】平人年二三十，常得大脉者，则多病劳。若人年已五六十，其脉亦大，不即病
劳者，以气血虽虚，而火自微也，火微故不病劳也。虽不病劳，然气血荣卫虚痹不行，故
为马刀、鼠疮、侠瘰也。此发明脉大虽同，为病不同之义也。
劳之为病，其脉浮大，手足烦，春夏剧，秋冬瘥，阴寒精自出，酸削不能行。
【按】阴寒精自出之“寒”字，当是“虚”字，是传写之讹。
【注】此言浮大为劳，以详其证也。手足烦，即今之虚劳，五心烦热，阴虚不能藏阳也。
阴虚精自出，即今之虚劳遗精，阴虚不能固守也。酸削不能行，即今之虚劳膝酸，削瘦骨痿
不能起于床也。夫春夏阳也，阴虚不胜其阳，故剧；秋冬阴也，阴虚得位自起，故瘥。
【集注】徐彬曰∶脉大既为劳矣，更加浮，其证则手足烦，盖阴既不足而阳必盛也。于
是春夏助其阳则剧，秋冬助其阴则瘥。阴虚而精自出者，久则酸削不能行矣。
程林曰∶“寒”字作“虚”字看，阴虚则气不守，而精自出矣。
李 曰∶脉浮大者，里虚而气暴于外也。四肢者，诸阳之本，劳则阳耗，阴虚而生内
热，故手足烦。凡劳伤多属阴虚。当春夏木火盛炎之际，气浮于外则里愈虚，故剧；秋
冬金水相生之候，气敛于内则外不扰，故瘥也。肾藏精，精自出者，肾水不藏也；肾主
骨，故酸削而不能行也。
男子脉虚沉弦，无寒热，短气里急，小便不利，面色白，时目瞑兼衄，少腹满，此
为劳使之然。
【注】此复申虚极为劳，以详其证之义也。脉虚沉弦，阴阳俱不足也；无寒热，是阴阳
虽不足而不相乘也；短气面白，时瞑兼衄，乃上焦虚而血不荣也；里急，小便不利，少腹
满，乃下焦虚而气不行也。凡此脉证，皆因劳而病也，故曰∶此为劳使之然。
男子面色薄者，主渴及亡血，卒喘悸。脉浮者，里虚也。
【按】“脉浮者，里虚也”当是衍文。
【注】此复申虚劳面色白，互详其证之义也。面色白不因衄者，是血不内生也；因衄
者，是血亡于外也。今曰面色薄，谓面色浅淡不华，亦不足之色也。故主津液不足之渴
及吐衄亡血、气虚卒喘，血虚卒悸也。
【集注】李 曰∶此节以亡血为主。《内
经》云∶精明五色者，气之华也。又云∶心之华在面，其充在血脉。劳则气耗火动，逼
血妄行，必致亡血。盖血主濡之，血亡则精采夺而面色薄，津液去而烦且渴矣。又劳者，
气血俱耗，肺主气，气虚则喘，心主血，血虚则悸。卒者，猝然见此病也。
男子脉浮弱而涩，为无子，精气清冷。
【注】男子之脉浮大而虚者，为虚劳也。浮弱而涩者，则为精气清冷，故为无子也。
夫失精家，少腹弦急，阴头寒，目眩，发落，脉极虚、芤、迟，为清谷亡血失精。脉
得诸芤动微紧，男子失精，女子梦交，桂枝龙骨牡蛎汤主之。
【按】此条“亡血失精”之下等句，与上文义不属，当另作一条在后。
【注】失精家，谓肾阳不固精者也。少腹弦急，虚而寒也。阴头寒，阳气衰也。目眩，
精气亏也。发落，血本竭也，若诊其脉极虚而芤迟者，当知极虚为劳，芤则亡血，迟则
为寒，故有清谷、亡血、失精之证也。
【集注】程林曰；肾主闭藏，肝主疏泄，失精则过于疏泄，故少腹弦急也，阴头宗筋
之所聚，真阳日亏，故阴头寒也。目眩则精衰，发落则血竭，是以脉虚芤迟也。虚主失
精，芤主亡血，迟主下利清谷也。
李 曰∶肝主藏血，肾主藏精，亡血失精，则肝肾俱虚矣。少腹看，肝、肾之部，今
少腹弦急，以肝肾两亏，则里气虚而张急加弦也。肝主筋，前阴者，宗筋之所聚，肝衰
故阴头寒也。肝藏血，开窍于目，肾主骨，骨之精为瞳子，又肾之华在发，发者血之余，此
肝肾两虚，故目眩发落也。芤脉者，浮沉有，中间无，似中空芤草，故名芤脉，此亡血之
脉，以脉者血之府，血虚则脉亦虚也。迟为在脏，迟则为寒，脉极虚芤迟，则其证亦虚。
清谷者，大便完谷不化也。此虚劳在肝、肾二经者也。
男子平人，脉虚弱细微者，善盗汗也。
【按】此节脉证不合，必有脱简，故不释。
脉沉、小，迟，名脱气。其人疾行则喘喝，手足逆寒，腹满，甚则溏泄，食不消化
也。
【注】脉沉、小、迟，则阳大虚，故名脱气。脱气者，谓胸中大气虚少，不充气息所
用，故疾行喘喝也。阳虚则寒，寒盛于外，四末不温，故手足逆冷也。寒盛于中，故腹满
溏泄，食不消化也。
【集注】徐彬曰∶脉沉，小、迟，其为阳衰无疑。沉、小、迟三脉相并，是阳气全亏，
故名脱气。其躯为空壳，疾行则气竭而喘喝，四肢无阳而寒，腹中无阳而满，甚则胃虚极
而溏泄，脾虚极而食不化也。
李 曰∶此脾、肺、肾三经俱病也。肺主气，气为阳，沉、小，迟皆阳气虚衰之脉，
故为脱气。疾行则喘喝，以肺主出气，而肾主纳气，为生气之原，呼吸之门，若真元耗损，则气虚不
能续息，肺无所出，肾无所纳，故喘喝，此肺肾病也。又脾主四肢，四肢者，诸阳之本。逆寒者，
阳虚不温四末也。腹满者，脾经入腹，气虚中满也。溏泄食不化者，此脾虚不能运磨水谷，
多见骛溏飧泄之证也。
脉弦而大，弦则为减，大则为芤；减则为寒，芤则为虚，虚寒相搏，此名为革。妇
人则半产漏下，男子则亡血失精。
【注】详见《伤寒论·辨脉法》中，不复释。
脉得诸芤动微紧，男子失精，女子梦交，桂枝龙骨牡蛎汤主之。
【注】脉得诸芤动微紧者，谓概虚劳之诸脉而为言也，非谓芤动微紧，仅主男子失精，
女子梦交之候也。通举男女失精之病，而用桂枝龙骨牡蛎汤者，调阴阳和荣卫，兼固涩
精液也。
【集注】徐彬曰∶失精之家，脉复不一，苟得诸芤动微紧，是男子以虚阴而挟火则失
精，女子以虚阴而挟火则梦交。主以桂枝龙骨牡蛎汤者，盖阴虚之人，大概当助肾，故
以桂枝，芍药通阳固阴，甘草、姜、枣和中，龙骨、牡蛎固精也。
桂枝加龙骨牡蛎汤方
桂枝 芍药 生姜（各三两） 甘草（二两） 大枣（十二枚） 龙骨 牡蛎（各三两）
上七味，以水七升，煮取三升，分温三服。
虚劳里急，悸衄，腹中痛，梦失精，四肢酸疼，手足烦热，咽干口燥，小建中汤主
之。
【注】虚劳云云者，概虚劳之证而言也，非谓虚劳之证，止于此也，故下文有诸不足
之说也。均主以小建中汤者，欲小小创建中虚之意，合下六节，皆论虚劳，各有所主之
方也。
小建中汤方
桂枝（三两） 甘草（炙，三两） 大枣（十二枚） 芍药（六两） 生姜（二两） 胶饴（
一升）
上六味，以水七升，煮取三升，去滓，内胶饴，更上微火消解，温服一升，日三服。呕
家不可用建中汤，以甜故也。
虚劳里急，诸不足，黄 建中汤主之。
【注】所谓虚劳里急诸不足者，亦该上条，诸不足证之谓也。黄 建中汤，创建中外两
虚，非单谓里急一证之治也。桂枝龙骨牡蛎汤，即桂枝汤加龙骨、牡蛎；小建中汤，即桂枝汤
加胶饴；黄 建中汤即桂枝汤加胶饴、黄 也。故尝因是而思仲景以一桂枝汤出入加减，无往
不利如此。何后世一见桂枝，即为伤寒发汗之剂。是但知仲景用桂枝汤治伤
寒，而不知仲景用桂枝汤治虚劳也。若知桂枝汤治虚劳之义，则得仲景心法矣，盖桂枝
汤辛甘而温之品也，若啜粥温覆取汗，则发散荣卫以逐外邪，即经曰∶辛甘发散为阳，是
以辛为主也∶若加龙骨、牡蛎。胶饴、黄 ，则补固中外以治虚劳，即经曰∶劳者温之，甘
药调之，是以温以甘为主也。由此推之，诸药之性味功能加减出入，其妙无穷也。
【集注】魏荔彤曰∶气虚甚，加黄 ，津枯甚，加人参，以治虚劳里急。此言里急非
单指里急之谓也，乃虚劳诸不足腹痛之谓也。故名其方为建中，正所以扶持其中气，使渐
生阴阳，达于荣卫，布于肢体也。
尤怡曰∶里虚脉急，腹中当引痛也。诸不足者，阴阳诸脉俱不足，而眩悸喘喝，失
精亡血等证，相因而至也。急者缓之必以甘，不足者补之必以温，而充虚塞空，则黄 尤
有专长也。
黄 建中汤方
于小建中汤内，加黄 一两半，余根据上法。若气短胸满者，加生姜；腹满者，去枣
加茯苓一两半，及疗肺虚损不足补气，加半夏三两。
虚劳腰痛，少腹拘急，小便不利者，八味肾气丸主之。
【注】虚劳之人腰痛，肾气虚而不行也，少腹拘急，小便不利，膀胱气虚不化也，主
以八味肾气丸温补下焦。肾与膀胱表里之气足，而腰痛，少腹拘急，小便不利，未有不
愈者也。
【集注】程林曰∶腰者肾之外候，肾虚则腰痛；肾与膀胱为表里，不得三焦之阳气以
决渎，则小便不利而少腹拘急矣。与是方以益肾间之气，气强则便尿行，而少腹拘急亦
愈矣。
尤怡曰∶虚劳之人，损伤少阴肾气，是以腰痛，少腹拘急，小便不利。以八味肾气
丸补阴之虚，可以生气，助阳之弱，可以化
水，乃补下治下之良剂也。
问：血痹病是如何得的？老师说：那些养尊处优的人，骨骼柔弱而肌肉丰盛，如果过度疲劳导致出汗，睡觉时身体不时翻动，再加上受到微风的侵袭，就会得这种病。只要脉象微涩，在寸口和关部出现轻微紧象，适宜用针刺来引导阳气，使脉象调和、紧象消失，病就能痊愈。
【注】历节病属于伤气，气受伤则痛，所以表现为疼痛。血痹属于伤血，血受伤则肿（此处指气血凝滞导致的麻木感），所以表现为麻木。前文阐明邪气聚集在气分，此文阐明邪气凝结在血分，所以称为血痹。所谓“尊荣人”，是指饮食精细肥甘的人。因为长期食用甘甜肥腻的食物，所以骨骼柔弱而肌肉丰盛，因此不能耐受疲劳；疲劳就会出汗，出汗则腠理开泄。也经不起长时间卧床，卧着时身体不时翻动，翻动时就容易受到微风的侵袭，从而致病。这是说那些生活优裕的人，外表看似强壮而内部虚弱，即使是微风小邪，也容易致病。然而怎么知道是血痹呢？只要身体麻木不仁，脉象微涩，就知道是邪气凝结在血分了。寸口和关部的轻微紧象，也是风寒小邪应有的脉象。针刺能够导引经络治疗各种痹证，所以适宜用针刺引导气血，以泻除邪气，使脉象不再涩滞而调和，紧象消失、邪气散去，血痹自然通畅。
【集注】周扬俊说：天下只有养尊处优的人是形体安逸而精神困苦。形体安逸所以肌肉丰盛，精神困苦所以骨骼柔弱，骨骼柔弱就不能耐劳，肌肉丰盛则卫气不固，稍有劳累困倦就会出汗。出汗后阳气虚弱，即使是微风也能侵袭它，从而使血液痹阻。所以一见脉微，就知道阳气不足；一见脉涩，就知道阴血多有阻滞，这是血痹的根本脉象。而邪气侵入的地方，则表现出轻微的紧象，“小”是正气被拘束抑制的征象，“紧”是寒邪入中的标志。然而仲景明确说是微风，为什么反而得到寒脉呢？大概是因为邪气随着血脉上下运行，阻滞津液汁沫，没有不痛的，所以疼痛表现为紧脉。用针刺来泄邪，引导阳气外出，那么邪气去除而正气自然伸展。
血痹病，阴阳脉象都微弱，寸口和关部脉微，尺中脉小紧，外在症状是身体麻木不仁，像风痹的样子，用黄芪桂枝五物汤主治。
【注】此条承接上一条互相详细阐述脉证，以说明治疗方法。上一条说六脉微涩，寸口关部小紧，这一条说阴阳寸口关部都微，尺中也小紧，合起来看，可知血痹的脉象在浮沉、寸口、关部、尺中都表现为微、涩、小紧。微代表虚，涩代表滞，小紧代表邪，所以血痹应该有这样的诊察结果。血痹的外在症状，也是身体顽麻，不知痛痒，所以说“像风痹的样子”。只是不像风痹那样流走于各个关节并疼痛。主治黄芪桂枝五物汤，是以调养营卫为本，祛风散邪为末。
【集注】周扬俊说：这是申述上一条既然已经发生痹证之后，未能通过针刺引导而痊愈，导致寸口脉微的情况。现在则是阴阳俱微，且寸关俱微，尺中也小紧。既然小紧出现在尺部，说明邪气侵入得更深而更难排出，为什么呢？正气虚弱的地方，就是邪气容纳的地方。脉经内外，称为阴阳，上下也称为阴阳，现在尺部既见小紧，那么微属内外之虚就明确了。如果说症状仅用“不仁”概括，那么疼痛和麻木往往与我（患者）相阻隔，其麻木程度非常严重，所以用风痹来比喻，并非真正的风痹。于是用黄芪固护卫气，芍药滋养阴血，桂枝调和营卫，充实表里，驱邪外出，佐以生姜宣通胃气，大枣补益脾气，这是最恰当不可改变的治法。
黄芪桂枝五物汤方
黄芪（三两） 芍药（三两） 桂枝（三两） 生姜（六两） 大枣（十二枚）
以上五味药，用水六升，煮取二升，温服七合，每日三次服用（另一版本有人参）。
【注】男子平时身体健康，应得到顺应四时五脏的正常脉象，现在六脉大而极虚，不是健康人的脉象。但是大而无力的脉，是劳役损伤脾气所致；极虚的脉，是内部损耗肾阴精所致。这些都是即将形成虚劳的征兆，所以有如此的诊察结果。
【集注】李中梓说：平人，是指外形像没有生病的人，《内经》说：“脉象有病而人无症状”就是这种情况。劳损则身体疲乏于外，气耗散于内，脉大并不是气盛，重按必然空软，这是外有余而内不足的征象，脉极虚则是精气耗竭的表现。大概，“大”是劳损脉象在外表的暴现；“极虚”是劳损脉象在内里的衰败表现。
魏荔彤说：男子平时身体健康，脉大为劳，极虚也为劳。脉大，是邪气盛；极虚，是精气夺。用这两句话揭示虚劳的总纲，却未说明大在何脉、虚在何经，这需要主治医生根据五劳七伤的具体情况仔细审察。
人到了五六十岁，脉象大的，会出现痹症沿着背部行走的症状。如果有肠鸣、马刀疮、侠瘿（颈侧淋巴结肿大）等症状，都是因为劳损引起的。
【按】“若肠鸣”三个字，与上下文不连贯，必定是简册错乱。“侠瘿”的“瘿”字，应当是“瘰”字。每当遇到这个病症，有先劳损后生瘰疬、或先有瘰疬后劳损的情况，从未见过劳损和瘿瘤先后发病的，必定是传写错误。
【注】二三十岁的普通人，常得大脉的，多患劳病。如果人已经五六十岁，脉象也大，却不立即患劳病，是因为虽然气血虚弱，但火气自微，火微故不患劳病。虽然不患劳病，但气血营卫虚弱痹阻不行，所以会出现马刀、鼠疮、侠瘰等症状。这是阐发脉象虽同为“大”，但病因不同的道理。
劳损病的症状，脉象浮大，手足烦热，春夏季节加重，秋冬季节缓解，阴寒（应为阴虚）导致精液自行滑出，肢体酸痛消瘦不能行走。
【按】“阴寒精自出”的“寒”字，应当是“虚”字，是传写错误。
【注】这里说浮大脉主劳损，以详细说明其症状。手足烦热，即现在的虚劳五心烦热，是阴虚不能潜藏阳气。阴虚导致精液自行滑出，即现在的虚劳遗精，是阴虚不能固守。肢体酸痛消瘦不能行走，即现在的虚劳膝酸，消瘦骨痿不能起床。春夏属阳，阴虚不胜其阳，所以病情加重；秋冬属阴，阴虚得位（顺应阴气）自然缓解，所以病情好转。
【集注】徐彬说：脉大已经是劳损了，再加上浮象，症状则是手足烦热，大概是因为阴既不足而阳必盛。于是在春夏助长阳气时病情加重，在秋冬助长阴气时病情缓解。阴虚而精液自行滑出，时间久了就会肢体酸痛消瘦不能行走。
程林说：“寒”字当作“虚”字理解，阴虚则气不守，精液就会自行滑出。
李中梓说：脉浮大，是里虚而气暴越于外。四肢是诸阳之本，劳损则阳气耗散，阴虚而生内热，所以手足烦热。凡是劳伤多属于阴虚。当春夏木火盛炎之际，气浮于外则里更虚，所以病情加重；秋冬金水相生之时，气敛于内则外不扰，所以病情缓解。肾藏精，精液自行滑出，是肾水不藏；肾主骨，所以肢体酸痛消瘦而不能行走。
男子脉象虚沉弦，没有寒热症状，短气、心里急迫、小便不利、面色白、时常头晕眼花兼有鼻出血、少腹胀满，这是因为劳损造成的。
【注】这里再次申述虚极即为劳损，以详细说明其症状的道理。脉象虚沉弦，说明阴阳都不足；没有寒热，说明阴阳虽然不足但不相乘克；短气面白，时常头晕眼花兼有鼻出血，是上焦虚而血不荣养；心里急迫、小便不利、少腹胀满，是下焦虚而气不行。所有这些脉证，都是因为劳损而患病，所以说“这是因为劳损造成的”。
男子面色浅淡无华，主要症状是口渴及失血，突然气喘心悸。脉浮，是里虚。
【注】这里再次申述虚劳面色白，互相详细阐述其症状的道理。面色白不是因为鼻出血的，是血不能内生；因为鼻出血的，是血亡于外。现在说面色薄，是指面色浅淡不光泽，也是不足的颜色。所以主要症状是津液不足的口渴，以及吐血鼻衄失血、气虚突然气喘、血虚突然心悸。
【集注】李中梓说：这一节以失血为主。《内经》说：精明五色，是气的荣华。又说：心的荣华在面，充实在血脉。劳损则气耗火动，逼迫血液妄行，必然导致失血。大概血主濡润，血亡则神采被夺而面色浅淡，津液去则烦躁且口渴。又劳损者，气血俱耗，肺主气，气虚则喘，心主血，血虚则悸。卒，是猝然出现这些病症。
【注】男子的脉象浮大而虚，是虚劳。浮弱而涩，则是精气清冷，所以导致无子。
凡是经常失精的人，少腹弦急，阴头寒冷，头晕眼花，脱发，脉象极虚、芤、迟，这是大便完谷不化、失血、失精的表现。脉象出现各种芤、动、微、紧，男子失精，女子梦交，用桂枝加龙骨牡蛎汤主治。
【按】此条“亡血失精”以下的句子，与上文意义不连贯，应当另作一条放在后面。
【注】失精家，是指肾阳不固摄精液的人。少腹弦急，是虚而寒。阴头寒冷，是阳气衰微。头晕眼花，是精气亏损。脱发，是血本枯竭。如果诊察其脉象极虚而芤迟，应当知道极虚为劳损，芤则亡血，迟则为寒，所以有大便完谷不化、失血、失精的症状。
【集注】程林说：肾主闭藏，肝主疏泄，失精则过于疏泄，所以少腹弦急。阴头是宗筋汇聚之处，真阳日渐亏虚，所以阴头寒冷。头晕眼花则精衰，脱发则血竭，所以脉象虚芤迟。虚主失精，芤主亡血，迟主下利完谷不化。
李中梓说：肝主藏血，肾主藏精，亡血失精，则肝肾俱虚。少腹是肝、肾的部位，现在少腹弦急，是因为肝肾两亏，里气虚而张急加上弦象。肝主筋，前阴是宗筋汇聚之处，肝衰故阴头寒冷。肝藏血，开窍于目，肾主骨，骨的精华为瞳子，又肾的荣华在发，发是血的余绪，这是肝肾两虚，所以头晕眼花、脱发。芤脉，浮沉有中，中间无，似中空芤草，故名芤脉，这是亡血的脉象，因为脉是血之府，血虚则脉亦虚。迟为在脏，迟则为寒，脉极虚芤迟，则其证也是虚。清谷，是大便完谷不化。这是虚劳在肝、肾二经的表现。
【按】这一节的脉证不合，必定有脱简，所以不解释。
脉象沉、小、迟，名为脱气。其人疾走则气喘喝斥，手足逆冷，腹满，严重时溏泄，食物不消化。
【注】脉象沉、小、迟，则阳气大虚，所以名为脱气。脱气，是指胸中大气虚少，不能充塞气息所用，所以疾走气喘喝斥。阳虚则寒，寒盛于外，四肢末端不温，所以手足逆冷。寒盛于中，所以腹满溏泄，食物不消化。
【集注】徐彬说：脉沉、小、迟，其为阳衰无疑。沉、小、迟三脉相并，是阳气全亏，所以名为脱气。其躯壳为空壳，疾走则气竭而气喘喝斥，四肢无阳而寒，腹中无阳而满，严重时胃虚极而溏泄，脾虚极而食不化。
李中梓说：这是脾、肺、肾三经都病了。肺主气，气为阳，沉、小、迟都是阳气虚衰的脉象，所以为脱气。疾走则气喘喝斥，因为肺主出气，而肾主纳气，是生气之源，呼吸之门，若真元耗损，则气虚不能续息，肺无所出，肾无所纳，所以气喘喝斥，这是肺肾病。又脾主四肢，四肢是诸阳之本。逆寒，是阳虚不能温煦四肢末端。腹满，是脾经入腹，气虚中满。溏泄食不化，是脾虚不能运磨水谷，多见骛溏飧泄的症状。
脉弦而大，弦则为减，大则为芤；减则为寒，芤则为虚，虚寒相搏，这名为革脉。妇人则半产漏下，男子则亡血失精。
【注】详见《伤寒论·辨脉法》中，不再解释。
脉象出现各种芤、动、微、紧，男子失精，女子梦交，用桂枝加龙骨牡蛎汤主治。
【注】脉象出现各种芤、动、微、紧，是说概略论述虚劳的各种脉象，并不是说芤、动、微、紧仅主治男子失精、女子梦交的证候。通举男女失精的病，而用桂枝加龙骨牡蛎汤，是为了调阴阳和营卫，兼固涩精液。
【集注】徐彬说：失精之家，脉象不一，如果得到各种芤、动、微、紧，是男子因虚阴而挟火则失精，女子因虚阴而挟火则梦交。主治用桂枝加龙骨牡蛎汤，大概阴虚之人，大多应当补肾，所以用桂枝、芍药通阳固阴，甘草、姜、枣和中，龙骨、牡蛎固精。
桂枝加龙骨牡蛎汤方
桂枝 芍药 生姜（各三两） 甘草（二两） 大枣（十二枚） 龙骨 牡蛎（各三两）
以上七味药，用水七升，煮取三升，分三次温服。
虚劳里急，心悸鼻衄，腹中痛，梦遗失精，四肢酸痛，手足烦热，咽干口燥，用小建中汤主治。
【注】虚劳云云，是概略论述虚劳的症状，并不是说虚劳的症状只限于此，所以下文有“诸不足”的说法。都主治用小建中汤，是想小小建立中气虚的意思，结合下面六节，都是论述虚劳，各有主治的方剂。
小建中汤方
桂枝（三两） 甘草（炙，三两） 大枣（十二枚） 芍药（六两） 生姜（二两） 胶饴（一升）
以上六味药，用水七升，煮取三升，去滓，加入胶饴，再上火微火溶化，温服一升，每日三次。呕吐的人不可用建中汤，因为甜的缘故。
【注】所谓虚劳里急诸不足，也包括上一条所说的诸不足证。黄芪建中汤，是建立中外两虚，不仅仅是针对里急一证的治法。桂枝加龙骨牡蛎汤，即桂枝汤加龙骨、牡蛎；小建中汤，即桂枝汤加胶饴；黄芪建中汤即桂枝汤加胶饴、黄芪。所以我曾因此思考仲景以一桂枝汤出入加减，无往不利如此。为何后世一见桂枝，就认为是伤寒发汗之剂。这是只知道仲景用桂枝汤治伤寒，而不知道仲景用桂枝汤治虚劳。如果知道桂枝汤治虚劳的意义，就得到仲景的心法了，大概桂枝汤是辛甘而温的药物，如果喝热粥温覆取汗，则是发散营卫以驱逐外邪，即经所说：辛甘发散为阳，是以辛为主；如果加龙骨、牡蛎、胶饴、黄芪，则是补固中外以治虚劳，即经所说：劳者温之，甘药调之，是以温以甘为主。由此推之，诸药的性味功能加减出入，其妙无穷。
【集注】魏荔彤说：气虚甚，加黄芪，津枯甚，加人参，以治虚劳里急。这里说的里急不仅仅指里急，而是指虚劳诸不足腹痛。所以命名其方为建中，正是为了扶持其中气，使阴阳渐生，达于营卫，布于肢体。
尤怡说：里虚脉急，腹中应当牵引疼痛。诸不足，是阴阳诸脉俱不足，而眩晕心悸气喘喝斥、失精亡血等证，相继而至。急者缓之必用甘，不足者补之必用温，而充虚塞空，则黄芪尤为专长。
黄芪建中汤方
在小建中汤内，加黄芪一两半，其余依照上面的方法。如果气短胸满的，加生姜；腹满的，去枣加茯苓一两半，以及治疗肺虚损不足补气，加半夏三两。
【注】虚劳之人腰痛，是肾气虚而不行；少腹拘急，小便不利，是膀胱气虚不化，主治用八味肾气丸温补下焦。肾与膀胱表里之气充足，而腰痛、少腹拘急、小便不利，没有不愈的。
【集注】程林说：腰是肾之外候，肾虚则腰痛；肾与膀胱为表里，不得三焦之阳气以决渎，则小便不利而少腹拘急。给予此方以益肾间之气，气强则小便行，而少腹拘急也愈。
尤怡说：虚劳之人，损伤少阴肾气，所以腰痛，少腹拘急，小便不利。用八味肾气丸补阴之虚，可以生气，助阳之弱，可以化水，是补下治下的良剂。
Question: How is Blood Bi (Blood Obstruction) disease acquired? The Master said: Those who live in comfort and luxury have weak bones but abundant flesh. If they become overly fatigued, sweat, and toss and turn during sleep, adding the invasion of a slight breeze, they will contract this disease. One should only look for a pulse that is slightly choppy and fine, with a slight tightness at the Cunkou (radial artery at the wrist) and Guan positions. It is appropriate to use acupuncture to guide Yang Qi, allowing the pulse to harmonize and the tightness to disappear, whereupon the patient will recover.
[Annotation] Lijie (Joint Striding) disease belongs to Qi injury; Qi injury causes pain, hence the manifestation of pain. Blood Bi belongs to Blood injury; Blood injury causes swelling (here referring to numbness due to stagnation), hence the manifestation of numbness. The previous text clarified that pathogenic factors gather in the Qi level; this text clarifies that pathogenic factors coagulate in the Blood level, hence it is named Blood Bi. "Those who live in comfort" refers to people who consume rich and sweet foods. Because they habitually eat sweet and fatty foods, their bones are weak and their flesh is abundant, making them unable to tolerate fatigue. Fatigue leads to sweating, and sweating opens the Couli (pores). They also cannot endure long periods of lying down; lying down leads to tossing and turning, which exposes them to slight breezes, thereby contracting the disease. This describes how people of high status, appearing robust externally but deficient internally, are susceptible even to slight wind pathogens. However, how do we know it is Blood Bi? By observing body numbness and a pulse that is slightly choppy and fine, we know the pathogen has coagulated in the Blood. The slight tightness at Cunkou and Guan is also the pulse corresponding to slight Wind-Cold pathogens. Acupuncture can guide meridians to treat various Bi syndromes; thus, it is appropriate to use acupuncture to guide Qi and Blood to drain the pathogen, making the pulse smooth and harmonious, eliminating tightness, dispersing the pathogen, and allowing Blood Bi to clear naturally.
[Collected Annotations] Zhou Yangjun said: Among all people, only those living in comfort experience physical ease but mental distress. Physical ease leads to abundant flesh; mental distress leads to weak bones. Weak bones mean one cannot bear labor; abundant flesh means Wei Qi (Defensive Qi) is not solid. Slight fatigue or distress leads to sweating. Sweating depletes Yang Qi, allowing even slight breezes to invade, causing Blood obstruction. Thus, seeing a slight pulse indicates insufficient Yang; seeing a choppy pulse indicates much obstruction in Yin/Blood. These are the fundamental pulses of Blood Bi. At the site of pathogen entry, a slight tightness manifests. "Slight" represents the image of Zheng Qi (Upright Qi) being constrained; "tight" is the sign of Cold pathogen entering. Yet Zhang Zhongjing explicitly mentions slight wind, why does one get a Cold pulse? Generally, pathogens follow the blood vessels up and down, obstructing fluids and juices, inevitably causing pain; hence pain manifests as a tight pulse. Using acupuncture to drain the pathogen and guide Yang outward allows the pathogen to leave and Zheng Qi to extend naturally.
In Blood Bi, both Yin and Yang pulses are slight. The Cunkou and Guan pulses are slight, while the Chi position is slightly tight. The external symptom is body numbness, resembling Feng Bi (Wind Bi). Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary treatment.
[Annotation] This clause continues from the previous one, detailing pulses and symptoms to clarify treatment. The previous clause mentioned six pulses being slight/choppy with slight tightness at Cunkou/Guan; this clause states Yin/Yang, Cunkou, and Guan are all slight, and Chi is also slightly tight. Viewing them together, one can understand that in Blood Bi, the pulses at floating/sinking depths and at Cunkou, Guan, and Chi positions all manifest as slight, choppy, and slightly tight. "Slight" indicates deficiency; "choppy" indicates stagnation; "slightly tight" indicates pathogen. Thus, Blood Bi should present such diagnostic signs. The external symptoms of Blood Bi are also body stiffness/numbness and insensitivity to pain/itch, hence described as "resembling Feng Bi." However, it differs from Feng Bi in that it does not wander through joints with pain. Huangqi Guizhi Wuwu Tang is used because it nourishes Ying (Nutritive) and Wei (Defensive) Qi as the root, and dispels Wind and drains pathogens as the branch.
[Collected Annotations] Zhou Yangjun said: This elaborates on the situation after Bi has set in, where needle guidance failed to cure it, leading to a slight Cunkou pulse. Now, Yin and Yang are both slight, Cunkou and Guan are both slight, and Chi is slightly tight. Since slight tightness appears at Chi, the pathogen has entered deeper and is harder to expel. Why? Where Zheng Qi is deficient, there is room for the pathogen. Pulse internal/external is called Yin/Yang; upper/lower is also called Yin/Yang. Since Chi shows slight tightness, the slightness clearly pertains to internal/external deficiency. If symptoms were summarized merely by "numbness," pain and numbness would be distinct from sensation, indicating severe numbness; hence it is likened to Feng Bi, though not true Feng Bi. Therefore, Huangqi secures Wei Qi, Shaoyao nourishes Yin, Guizhi harmonizes Ying and Wei, strengthens interior/exterior, and drives pathogens out. Ginger promotes Stomach Qi, and Dates tonify Spleen Qi. This is the most appropriate and unchangeable treatment.
Huangqi Guizhi Wuwu Tang Formula
Huangqi (Astragali Radix) (3 liang), Shaoyao (Paeoniae Radix Alba) (3 liang), Guizhi (Cinnamomi Ramulus) (3 liang), Shengjiang (Zingiberis Rhizoma Recens) (6 liang), Dazao (Jujubae Fructus) (12 pieces).
The above five herbs are boiled in 6 sheng of water to yield 2 sheng. Take 7 he of warm decoction three times daily (another version includes Renshen).
In men who are otherwise healthy, a large pulse indicates Lao (Exhaustion/Labor). An extremely empty pulse also indicates Lao.
[Annotation] A healthy man should have normal pulses conforming to the four seasons and five Zang organs. Now, if the six pulses are large yet extremely empty, it is not a healthy pulse. A large but forceless pulse indicates Spleen Qi damage from overwork; an extremely empty pulse indicates internal depletion of Kidney Yin and Essence. These are all precursors to Xu Lao (Deficiency Consumption), hence such diagnostic findings.
[Collected Annotations] Li Zhongzi said: "Ping Ren" (healthy person) refers to someone whose appearance shows no illness. The Classics say: "Pulse shows disease, but the person feels well." Labor exhausts the body externally and depletes Qi internally. A large pulse does not indicate abundant Qi; deep pressure reveals emptiness and softness, indicating excess externally and deficiency internally. An extremely empty pulse indicates exhaustion of Essence and Qi. Generally, "large" is the external manifestation of the Lao pulse; "extremely empty" is the internal decline of the Lao pulse.
Wei Litong said: In healthy men, a large pulse indicates Lao, and an extremely empty pulse also indicates Lao. Large indicates pathogenic abundance; extremely empty indicates Essence/Qi depletion. These two sentences reveal the general principle of Xu Lao without specifying which pulse is large or which meridian is empty. This requires the treating physician to examine carefully according to the causes of the Five Labors and Seven Injuries.
At age fifty or sixty, if the pulse is large, Bi may travel along the back. If there is intestinal borborygmus, Hashimoto's goiter (Madao), or lateral neck lumps (Xiaying), these are all caused by Lao.
[Note] The phrase "If there is intestinal borborygmus" does not fit the context and is likely a textual error. The character "Ying" in "Xiaying" should be "Luo" (referring to scrofula/lymph node enlargement). There are cases of Lao followed by Luo, or Luo followed by Lao, but never Lao and Goiter occurring sequentially. This must be a transcription error.
[Annotation] For ordinary people aged twenty or thirty, a constant large pulse often leads to Lao disease. If a person aged fifty or sixty has a large pulse but does not immediately develop Lao, it is because although Qi and Blood are deficient, the Fire is mild; mild Fire does not cause Lao. Although not suffering from Lao, the deficiency and obstruction of Qi, Blood, Ying, and Wei lead to Madao, Shuchuang (rat sores/scrofula), and Xi Luo. This illustrates that while the pulse "large" is the same, the diseases differ.
The disease of Lao presents with a floating and large pulse, vexation in the hands and feet, worsening in Spring and Summer, and improvement in Autumn and Winter. Yin deficiency leads to spontaneous emission of essence, soreness and wasting of the limbs preventing walking.
[Note] The character "Han" (Cold) in "Yin Han Jing Zi Chu" should be "Xu" (Deficiency); this is a transcription error.
[Annotation] This explains that a floating-large pulse indicates Lao, detailing the symptoms. Vexation in hands and feet refers to the modern concept of Xu Lao with five-palm heat, caused by Yin deficiency failing to anchor Yang. Yin deficiency leading to spontaneous emission refers to modern Xu Lao with nocturnal emissions, caused by Yin deficiency failing to secure. Soreness and wasting preventing walking refers to modern Xu Lao with knee soreness, emaciation, and bone weakness preventing getting out of bed. Spring and Summer belong to Yang; Yin deficiency cannot overcome Yang, hence worsening. Autumn and Winter belong to Yin; Yin deficiency finds its place (harmony with Yin), hence improvement.
[Collected Annotations] Xu Bin said: A large pulse already indicates Lao; adding floating makes the symptoms include hand/foot vexation. Since Yin is insufficient, Yang must be excessive. Thus, in Spring/Summer when Yang assists Yang, the condition worsens; in Autumn/Winter when Yin assists Yin, the condition improves. Yin deficiency with spontaneous emission eventually leads to limb soreness/wasting and inability to walk.
Cheng Lin said: Read "Han" as "Xu". Yin deficiency means Qi fails to hold, leading to spontaneous emission.
Li Zhongzi said: A floating-large pulse indicates interior deficiency with Qi surging outward. The four limbs are the root of all Yang; labor consumes Yang, Yin deficiency generates internal heat, hence hand/foot vexation. Most injuries from labor belong to Yin deficiency. During Spring/Summer when Wood/Fire is flourishing, Qi floats outward, making the interior more deficient, hence worsening. During Autumn/Winter when Metal/Water generate each other, Qi gathers inward, keeping the exterior undisturbed, hence improving. The Kidney stores Essence; spontaneous emission indicates Kidney Water failing to store. The Kidney governs bones, hence soreness/wasting and inability to walk.
In men, a pulse that is empty, deep, and wiry, without chills or fever, accompanied by shortness of breath, epigastric fullness/tightness, dysuria, pale complexion, occasional dizziness/blurred vision combined with epistaxis, and lower abdominal fullness, is caused by Lao.
[Annotation] This reiterates that extreme deficiency constitutes Lao, detailing the symptoms. An empty, deep, wiry pulse indicates insufficiency of both Yin and Yang. Absence of chills/fever indicates that although Yin/Yang are insufficient, they are not clashing. Shortness of breath, pale face, occasional dizziness/blurred vision, and epistaxis indicate Upper Jiao deficiency with Blood failing to nourish. Epigastric tightness, dysuria, and lower abdominal fullness indicate Lower Jiao deficiency with Qi failing to move. All these pulse and symptom patterns result from Lao, hence "this is caused by Lao."
Men with a pale, thin complexion primarily suffer from thirst and blood loss, sudden panting, and palpitations. A floating pulse indicates interior deficiency.
[Note] "A floating pulse indicates interior deficiency" is likely a redundant text.
[Annotation] This reiterates the pale complexion of Xu Lao, detailing symptoms. Pale complexion not due to epistaxis indicates Blood failing to generate internally; due to epistaxis indicates Blood lost externally. "Thin complexion" means pale and lusterless, indicating insufficiency. Thus, the main symptoms are thirst due to fluid insufficiency, vomiting/epistaxis with blood loss, sudden panting due to Qi deficiency, and sudden palpitations due to Blood deficiency.
[Collected Annotations] Li Zhongzi said: This section focuses on blood loss. The Inner Classic says: "The five colors of the face are the brilliance of Qi." Also: "The heart's brilliance is in the face,充盈 in the blood vessels." Labor depletes Qi and stirs Fire, forcing Blood to move recklessly, leading to blood loss. Blood moistens; loss of Blood deprives spirit/luster, causing pale complexion; loss of fluids causes vexation and thirst. Furthermore, labor depletes both Qi and Blood. The Lung governs Qi; Qi deficiency causes panting. The Heart governs Blood; Blood deficiency causes palpitations. "Sudden" means these symptoms appear abruptly.
In men, a pulse that is floating, weak, and choppy indicates infertility, due to cold and clear Essence and Qi.
[Annotation] In men, a floating, large, and empty pulse indicates Xu Lao. A floating, weak, and choppy pulse indicates cold/clear Essence and Qi, hence infertility.
For those who frequently lose essence, there is tightness in the lower abdomen, coldness at the glans penis, dizziness, hair loss, and a pulse that is extremely empty, Kous (Bowl-like/Hollow), and slow. This indicates loose stools with undigested food, blood loss, and essence loss. If the pulse shows various Kou, Dong (Fluttering), slight, and tight qualities, men suffer essence loss, and women suffer dream intercourse. Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction) is the primary treatment.
[Note] The text following "blood loss and essence loss" does not connect logically with the preceding text and should be treated as a separate clause placed later.
[Annotation] "Frequent essence loser" refers to those with insecure Kidney Yang failing to consolidate essence. Tightness in the lower abdomen indicates deficiency and cold. Coldness at the glans indicates declining Yang. Dizziness indicates depleted Essence. Hair loss indicates exhausted Blood. If the pulse is extremely empty, Kou, and slow, one should know that extreme empty indicates Lao, Kou indicates blood loss, and slow indicates cold, hence symptoms of loose stools, blood loss, and essence loss.
[Collected Annotations] Cheng Lin said: The Kidney governs closure/storage; the Liver governs dispersion. Excessive dispersion in essence loss causes lower abdominal tightness. The glans is the gathering point of Zong Jin (Major Sinews); daily depletion of True Yang causes coldness there. Dizziness indicates essence decline; hair loss indicates blood exhaustion, hence the empty/Kou/slow pulse. Empty indicates essence loss; Kou indicates blood loss; slow indicates loose stools with undigested food.
Li Zhongzi said: The Liver stores Blood; the Kidney stores Essence. Blood loss and essence loss mean both Liver and Kidney are deficient. The lower abdomen is the region of the Liver and Kidney. Lower abdominal tightness occurs because Liver/Kidney deficiency leads to interior Qi deficiency and tension, adding wiriness. The Liver governs sinews; the anterior yin is the gathering of Zong Jin; Liver decline causes glans coldness. The Liver stores Blood and opens into the eyes; the Kidney governs bones, and bone essence forms the pupil; the Kidney's brilliance is in the hair, and hair is the surplus of Blood. This Liver/Kidney dual deficiency causes dizziness and hair loss. The Kou pulse is hollow in the middle, like a reed stem, hence the name; it is the pulse of blood loss, as the pulse is the house of Blood, and Blood deficiency leads to pulse deficiency. Slow indicates involvement of the Zang organs; slow indicates cold. Extremely empty, Kou, and slow pulses indicate deficiency symptoms. Qinggu (clear grains) refers to undigested food in stool. This is Xu Lao affecting the Liver and Kidney meridians.
In men who are otherwise healthy, a pulse that is weak, empty, and fine indicates susceptibility to night sweats.
[Note] The pulse and symptoms in this section do not match; there must be missing text, so it is not explained.
A pulse that is deep, small, and slow is named Tuo Qi (Qi Collapse/Depletion). The person pants heavily when walking quickly, has cold hands and feet, abdominal fullness, and in severe cases, loose diarrhea and indigestion.
[Annotation] Deep, small, and slow pulses indicate significant Yang deficiency, hence named Tuo Qi. Tuo Qi means the Great Qi in the chest is deficient and scant, unable to support respiration, hence panting when walking quickly. Yang deficiency leads to cold; cold prevailing externally causes cold extremities. Cold prevailing internally causes abdominal fullness, loose stools, and indigestion.
[Collected Annotations] Xu Bin said: Deep, small, and slow pulses undoubtedly indicate Yang decline. The combination of these three pulses indicates total Yang deficiency, hence Tuo Qi. The body is like an empty shell; walking quickly exhausts Qi causing panting; limbs lack Yang causing cold; abdomen lacks Yang causing fullness. Severe stomach deficiency causes loose stools; severe Spleen deficiency causes indigestion.
Li Zhongzi said: This involves disease in the Spleen, Lung, and Kidney meridians. The Lung governs Qi, which is Yang. Deep, small, and slow are all pulses of Yang Qi deficiency, hence Tuo Qi. Panting when walking quickly occurs because the Lung governs exhalation and the Kidney governs inhalation; they are the source of generated Qi and the gate of respiration. If Yuan Qi is depleted, Qi deficiency fails to sustain breathing; the Lung has nothing to exhale, the Kidney has nothing to inhale, hence panting. This is Lung/Kidney disease. The Spleen governs the four limbs, which are the root of all Yang. Reverse cold indicates Yang deficiency failing to warm the extremities. Abdominal fullness indicates Spleen meridian entering the abdomen with Qi deficiency causing central fullness. Loose stools and indigestion indicate Spleen deficiency failing to transport and transform water/grain, often presenting as watery or incomplete digestion diarrhea.
A pulse that is wiry and large: Wiry indicates reduction; large indicates Kou (hollow). Reduction indicates Cold; Kou indicates Deficiency. Deficiency and Cold interacting is named Ge (Leather) pulse. In women, it indicates miscarriage and bleeding; in men, it indicates blood loss and essence loss.
[Annotation] See detailed explanation in "Shanghan Lun · Bian Mai Fa" (Differentiating Pulse Methods), not repeated here.
If the pulse shows various Kou, Dong, slight, and tight qualities, men suffer essence loss, and women suffer dream intercourse. Guizhi Longgu Muli Tang is the primary treatment.
[Annotation] "Various Kou, Dong, slight, and tight" refers generally to the various pulses of Xu Lao, not implying that these specific pulses exclusively indicate male essence loss or female dream intercourse. Universally applying Guizhi Longgu Muli Tang for male/female essence loss aims to harmonize Yin/Yang and Ying/Wei, while astringing essence.
[Collected Annotations] Xu Bin said: Those with frequent essence loss have varied pulses. If Kou, Dong, slight, and tight are found, it indicates men lose essence due to Yin deficiency with accompanying Fire, and women have dream intercourse due to Yin deficiency with accompanying Fire. Using Guizhi Longgu Muli Tang: generally, Yin-deficient individuals need Kidney support. Thus, Guizhi and Shaoyao unblock Yang and secure Yin; Gancao, Ginger, and Dates harmonize the Middle; Longgu and Muli secure essence.
Guizhi Jia Longgu Muli Tang (Cinnamon Twig Plus Dragon Bone and Oyster Shell Decoction) Formula
Guizhi, Shaoyao, Shengjiang (each 3 liang), Gancao (2 liang), Dazao (12 pieces), Longgu, Muli (each 3 liang).
The above seven herbs are boiled in 7 sheng of water to yield 3 sheng. Divide into three warm doses.
In Xu Lao with interior tightness, palpitations, epistaxis, abdominal pain, dream loss of essence, limb soreness/pain, hand/foot vexation/heat, dry throat, and dry mouth, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment.
[Annotation] "Xu Lao..." generally describes Xu Lao symptoms, not limiting Xu Lao to only these. Hence the subsequent mention of "various deficiencies." All are treated with Xiao Jianzhong Tang to "minorly construct" the deficiency of the Middle Jiao. Combining with the next six sections, all discuss Xu Lao, each with its specific formula.
Xiao Jianzhong Tang Formula
Guizhi (3 liang), Gancao (Roasted, 3 liang), Dazao (12 pieces), Shaoyao (6 liang), Shengjiang (2 liang), Jiaoyi (Malt Sugar, 1 sheng).
The above six herbs are boiled in 7 sheng of water to yield 3 sheng. Remove dregs, add Jiaoyi, and simmer gently until dissolved. Take 1 sheng warm, three times daily. Patients with vomiting should not use Jianzhong Tang due to its sweetness.
In Xu Lao with interior tightness and various deficiencies, Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction) is the primary treatment.
[Annotation] "Xu Lao interior tightness and various deficiencies" includes the deficiencies mentioned in the previous clause. Huangqi Jianzhong Tang constructs both interior and exterior deficiency, not just treating interior tightness. Guizhi Longgu Muli Tang is Guizhi Tang plus Longgu/Muli; Xiao Jianzhong Tang is Guizhi Tang plus Jiaoyi; Huangqi Jianzhong Tang is Guizhi Tang plus Jiaoyi and Huangqi. I have often reflected on how Zhang Zhongjing uses variations of Guizhi Tang with infinite efficacy. Why do later generations see Guizhi only as a sweating agent for Shanghan? They only know Zhang Zhongjing used Guizhi Tang for Shanghan, not for Xu Lao. Understanding Guizhi Tang's role in treating Xu Lao reveals Zhang Zhongjing's core method. Guizhi Tang is acrid-sweet and warm. If taken with hot porridge and covered to induce sweat, it disperses Ying/Wei to drive out external pathogens (Acrid-Sweet disperses Yang, focusing on Acrid). If plus Longgu/Muli, Jiaoyi, Huangqi, it tonifies and secures interior/exterior to treat Xu Lao (Labor requires warming, Sweet medicines regulate, focusing on Warm/Sweet). From this, one can deduce the infinite subtleties of modifying drug properties and functions.
[Collected Annotations] Wei Litong said: For severe Qi deficiency, add Huangqi; for severe fluid depletion, add Renshen, to treat Xu Lao interior tightness. Here, "interior tightness" does not solely refer to tightness, but to abdominal pain from various Xu Lao deficiencies. Hence named "Jianzhong" (Construct Middle), precisely to support Middle Qi, allowing Yin/Yang to gradually generate, reach Ying/Wei, and distribute to the limbs.
You Yi said: Interior deficiency with wiry pulse causes牵引 pain in the abdomen. "Various deficiencies" means all Yin/Yang pulses are deficient, leading to dizziness, palpitations, panting, essence loss, and blood loss. To soothe tightness, one must use Sweet; to tonify deficiency, one must use Warm. To fill voids, Huangqi is particularly effective.
Huangqi Jianzhong Tang Formula
Add 1.5 liang of Huangqi to Xiao Jianzhong Tang. Follow the remaining methods above. If there is shortness of breath and chest fullness, add Shengjiang. If there is abdominal fullness, remove Dates and add Fuling (1.5 liang). To treat Lung deficiency/inadequacy and tonify Qi, add Banxia (3 liang).
In Xu Lao with lower back pain, lower abdominal拘急 (tightness/spasm), and dysuria, Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) is the primary treatment.
[Annotation] In Xu Lao, lower back pain is due to Kidney Qi deficiency failing to move. Lower abdominal tightness and dysuria are due to Bladder Qi deficiency failing to transform. Bawei Shenqi Wan is used to warm and tonify the Lower Jiao. When the interrelated Qi of the Kidney and Bladder is sufficient, lower back pain, lower abdominal tightness, and dysuria will surely resolve.
[Collected Annotations] Cheng Lin said: The lower back is the external indicator of the Kidney; Kidney deficiency causes back pain. The Kidney and Bladder are exterior-interior partners; without Sanjiao Yang Qi to regulate water passages, dysuria and lower abdominal tightness occur. This formula benefits Qi in the Kidney gate; strong Qi allows urination to flow and resolves lower abdominal tightness.
You Yi said: In Xu Lao, Shaoyin Kidney Qi is damaged, causing back pain, lower abdominal tightness, and dysuria. Bawei Shenqi Wan tonifies Yin deficiency to generate Qi, and assists weak Yang to transform water. It is an excellent formula for treating the Lower Jiao.