百病惟痨瘵为最重。迩来患者既多。治者愈舛。若朱丹溪以苦寒补阴。戕伐生命。百载
而下
。屡有非之者固无庸喙矣。至乎葛可久之十药神书。王宇泰之证治准绳。无论贤愚皆称为善
。余独以为非也。夫病者既误投剑戟丛中。而医者复操刀挟矢而蹑其后。安望其有复苏之理
乎。盖瘵乃虚怯之。谓亦犹年荒岁歉而又缺坏不完之意也。婴疾到此。黄泉日近。何啻膏肓
之笃。可不凛然寒心哉。夫病有轻重深浅之不同也。始曰弱。继曰虚。曰衰。曰损。曰瘵。
但瘵甚于损。损甚于衰。衰甚于虚。虚甚于弱。初起因循不治而弱必至于虚。虚必至于衰。
衰必至于损。损必至于瘵。至瘵则已入死。法而又不即死者也。然病又有经络脏腑之不同也。
脏深于腑腑深于经。经深于络。其初起也。则必由络入经。由经入腑。由腑入脏。至入脏则
生机已绝。 待尽矣。虽然脏有五而肾为要。肾有两而左为重。盖左肾为元阳之母。为真
阴之主。为天乙之宗。为生化之源。储精握血造命生身此处一伤根本。倾摇矣。而吾又详究
其致病之因。与夫诸家治法之谬也。经云∶五脏者主藏精者也。不可伤。伤则失守而阴虚。
阴
虚则无气。无气则死。又曰肾属水。受五脏六腑之精而藏之。又曰主蛰。封藏之本。肾之处
也。故凡男子色欲过度。施泄无禁。而或先天禀薄。胎瘗虚瘦。精血未满。早被斫丧。或
沉湎
醉乡。毒溃骨髓。盖由肾属阴而主水。水即精也。水竭火盛势必然也。火盛烁金。金水不能
相生。虚阳失制。发而为燎原。假热之火。此火为壮火。为邪火。为龙雷之火。为无根之火
。而非君火。凡火可得以苦寒。沉阴黄柏知母之属。而直折之也。其发热也或倏忽往来。时
作
时止。或昼见夜伏。夜见昼止。不时而动。或唾痰咯血。喘嗽不休。或喉痒燥渴。或失汗遗
精。或二便不调。或饮食少进。或肌肉日脱。总缘精枯水涸因致见症。令人疑惑难以名状是
。皆阴不足以制阳病在阴中之水也。王太仆曰∶寒之
不寒。责其无水。又曰∶壮水之主。以制阳光。立斋先生曰∶无水者宜用六味地黄丸。填补
真阴。张景岳亦用纯甘至静之剂。二贤无失化源之治。灼有千古独识。然真阴损竭。而非熟
地
膏腻。石枣温润。滋补空虚。何以复生精血乎。经曰。精不足者补之。以味是也。抑阴既亏
矣。真阳无附。脾失资生。故用甘平之山药茯苓。扶益胃气。枸杞阿胶巴戟甘草。皆壮水之
品。或可臣佐。但非侑以人参。则无阳而阴无以生也。丹皮固骨蒸所需。泽泻为利水而设。
性主补泻兼行。亦须斟酌采择。水旺则骨蒸自除。何必行血之丹皮。金盛而上源既裕。宁资
通淋之泽泻。又未有阴虚。而脾胃能独实者也。天麦二冬。虽云疗嗽。独其冷滑泻阳。不宜
轻用。玄参地骨。固优退热。亦属甘寒犯胃。是所必忌。桑白乃泻肺火之有余。独不思火既
有余。水便不足而可重泻其表乎。若生地藕汁。童便人乳。此亦寒滑妨脾。在治实火得矣。
独不思龙雷虚焰。遇水愈炽。而可混投乎。薏苡仁乃理香港脚。除风湿消肺痈之药。而此阴虚
咳嗽。金水俱败。可用渗利乎。痰为肾津不能四布。挟虚火以上溢。乃如痰而非真痰也。奈
何妄用泄郁之。贝母乎。甚至橘红款冬。亦敢乱施。枇杷叶轻飘薄质。果能滋肾保金耶。虚
烦莫寐。火烁阴也。而与疗胆热不眠之枣仁何干。再详麦冬固清肺金。虽同五味人参为生脉
之饮。独不思孙真人立此方者。为因暑月火热伤气。而非可借以治土败金亏之嗽也。甚至投
薄荷汁以清热。取杏仁膏而治喘。乃复用此苦辛泄阳香燥伤阴之味。愈支离莫解矣。竹沥清
郁火之痰涎也。与此肾津上溢者何关乎。大黄玄明粉为治伤寒胃府燥满实坚之热症也。桃仁
韭汁乃破瘀行血之峻剂也。而可施于阴虚肝脏已败胁肋俱疼之危候乎。奈何尚不知熟地黄之
为挽阴回生之圣药乎。生地初固甘寒滞胃。而
假以九转功夫。鼎炉变化。精微妙用。大能健土生精。则曰泥膈难化。或因火候未足。制炼
乖方耳。岂识此药面目哉。喘甚者虚里应衣。火不归源也。何又妄投腹皮萝卜苏子葶苈之
属
哉。病一饮寒。热益燎原。忍复益以连翘栀子三黄之类。大泻真阳耶。柴胡乃解少阳表热。
治此则反令汗出。愈伤元气。青蒿味苦主泄。果能令几微胃气。护保无虞乎。穴灸四花。徒
接内火以升焱。药投蕊石。反能停瘀而生灾以上盖葛可久王宇泰诸家治痨之妄法也。切此乃
真藏为患而非经府之病也。根本已亏。而非枝叶之雕也。真阴缺坏不完而非气血虚弱之
媲也。五脏有伤至肾为极，真阴已败元阳亦灭而又有水盛火衰与。夫阴阳两虚之病不可不
察
。如何今昔诸家。昧本徇标。见病治病。非惟搏刮无术。致今速死有期。呜呼种杏乎。种棘
乎。一部治世奇书。几为宜府鬼 矣。王宇泰曰∶丹溪论劳瘵主乎阴虚者。盖自子至巳属阳
。自午至亥属阴。阴虚则热在午后子前。寤属阳。寐属阴。阴虚则汗泛寐时盗出也。升属阳
。降属阴。阴虚则气不降。气不降则痰涎上逆。而连绵吐出不绝也。脉浮属阳。沉属阴。阴
虚则浮之洪大。沉之空虚也。此皆阴虚之症。用四物汤加黄柏知母主之。然世医遵用治疾。
乃百无一效者何哉。盖阴既虚矣。心火上炎。而当归川芎。皆味辛气大温。非滋阴降火之药
。
又川芎上窜。尤非虚炎短乏者所宜。地黄泥鬲。非胃弱食少痰多者所宜。黄柏知母。苦辛大
寒。虽曰滋阴。其实燥而损血。虽曰降火。其实苦先入心。久而增气反能助火。至其败胃
。
所不待言。用药如此。乌能奏功哉。余每用薏苡仁百合天门冬麦门冬桑白皮地骨皮枇杷叶五
味子酸枣仁之属。佐以生地藕汁乳汁童子小便。如咳嗽则多用桑皮枇杷叶。有痰则增贝母。
有血则多用苡仁百合。增阿胶。热甚则多用地骨皮。食少则用苡仁。至八九钱。而麦门冬常
为之主。以保肺金而滋生化之源。无不应手而效。盖诸药皆禀燥降收之气。气之薄者为阳中
之阴。气薄则发泄辛甘淡平寒凉是也。以施于阴虚火动之症。犹当溽暑伊芳郁之时。而商 飒
然倏动炎。敲如失矣。与治白虎汤同意。然彼是外感而有余。故用寒沉藏之药。而后能辅其
偏
。此是内伤为不足。但用燥降收之药。而已得其平矣。此用药之权衡也。又云∶虚劳之疾。
百脉空虚。非粘腻之物填之。不能实也。精血枯涸。非滋湿之物润之。不能润也。宜用人参
黄地黄天麦门冬枸杞子五味子之属。各煎膏。另用青蒿以童便熬膏。及生地汁白莲藕汁
。人乳汁。薄荷汁。隔汤炼过。酌定多少。并麋角胶。霞天膏。合和成剂。每用数匙汤化服
之。如欲行瘀血。加入醋制大黄末子玄明粉桃仁泥韭汁之属。欲止血。加入金墨之属。欲行
痰。加入竹沥之属。凡虚劳之症。大抵心下引胁俱疼。盖滞血不消。新血无以养之也。尤宜
用膏加韭汁桃仁泥。大略前言苡仁之属治肺虚。后言参 地黄膏子之类治肾虚。盖肝心属阳
。肺肾属阴。阴虚则肺肾虚矣。故补肺肾则是补阴。非四物黄柏知母之类也。又云∶治虚劳
当以脾肾二脏为要。何以言之。肾乃系元气也。脾乃养形体者也。经曰。形不足温之以气者
也。谓真气有少火之温以生育形体。然此火不可使之热。热则壮。壮则反耗真气也。候其火
之壮少皆在两肾间。经又曰。精不足者补之以味。五味入胃。各从所喜之藏而归之。以生津
液输纳于肾者。若五味一有过节。反成其藏有余。胜克之祸起矣。候其五味之寒热。初在脾
胃
。次在其所归之藏。即当补其不足。泻其有余。谨守精气。调其阴阳。使神内藏。夫如是则
天枢开发。而胃和脉生。故荣卫以周于内外。无不被滋养而病愈矣。 李黄暗斋曰。以上数
条。乃王宇泰先生治虚痨之法。迥异时流。予曾遵服亦有效。故并志之也。窃谓宇泰先生。
文章品望。业已标鹄中原。而留心方技。着集准绳一书。无非惠济群生。其用心亦可谓仁而
勤矣。独是业非专习。至夫虚劳一症。治率从标。且黄暗斋先生又从而附会之。强称为美不
揣政恐天下后世。庸工俗子。念以为此方法。出自名公大人。拘守遵用。遗误非少。至十药
神书。编定甲乙丙丁十号。兼投针灸金石。执方待病。尤属谬戾。及遍阅诸家方书。所称
痨注二十四种。三十六种。或九十九种。病机丛繁。皆创言诡幻。巧立名色。欺世惑人。好事
者为之。岂知万病皆生于寒热。寒热总由于水火。水火偏胜原本一亏。便成不可捉摸而为弥
。天亘地之势矣。不全此处根究更从何地着力。故特表而出之。为之驳正。
百病之中，只有痨瘵（慢性消耗性疾病）最为严重。近来患者众多，治疗者却愈发错误。比如朱丹溪主张用苦寒药物来补阴，这实际上是在戕害生命。百年以来，反对他的人固然很多，无需多言。至于葛可久的《十药神书》、王宇泰的《证治准绳》，无论贤愚都称赞它们好。我却认为这是错误的。这就好比病人已经误入剑戟丛中，而医生又拿着刀箭跟在后面追击，哪里还能指望他有复苏的道理呢？
所谓“瘵”，就是虚怯的意思，就像年成荒歉、岁数歉收且残缺不完一样。患病到了这种地步，离死亡（黄泉）日益临近，比膏肓之疾还要严重，怎能不让人凛然寒心呢？
疾病有轻重深浅的不同。起初叫“弱”，接着叫“虚”，再叫“衰”，再叫“损”，最后叫“瘵”。但瘵比损严重，损比衰严重，衰比虚严重，虚比弱严重。起因如果因循拖延不治疗，弱必然导致虚，虚必然导致衰，衰必然导致损，损必然导致瘵。到了瘵的阶段，虽然还没立即死亡，但也已接近死路了。
然而疾病又有经络脏腑的不同。脏比腑深，腑比经深，经比络深。初起时，必然由络进入经，由经进入腑，由腑进入脏。一旦进入脏，生机就已经断绝，只剩等待死亡罢了。
虽然五脏都有关系，但肾最为重要。肾有两个，左肾更为关键。因为左肾是元阳的母亲，是真阴的主人，是天乙的宗祖，是化生的源头，储存精气、把握血液、创造生命、生成身体。这里一旦受伤，根本就会动摇倾覆。
我又详细探究致病的原因以及各家治疗方法的谬误。《内经》说：“五脏是主藏精气的器官，不可损伤。损伤了就会失守而导致阴虚。阴虚就没有气，没有气就会死亡。”又说：“肾属水，接受五脏六腑的精气而储藏它。”又说：“肾主蛰伏，是封藏的根本。”所以凡是男子色欲过度，施泄没有节制，或者先天禀赋薄弱，胎里虚弱消瘦，精血未满就过早被斫丧；或者沉湎酒乡，毒气溃烂骨髓。这都是因为肾属阴而主水，水即精液。水枯竭则火旺盛，这是必然的趋势。
火旺盛会灼伤肺金（金），导致金水不能相生，虚阳失去制约，发作成为燎原之势。这是假热之火，称为壮火、邪火、龙雷之火、无根之火，而不是君火。这种火不能用苦寒、沉阴的黄柏、知母之类的药物直接折服。
其发热症状，有的忽冷忽热，时作时止；有的白天出现晚上潜伏，晚上出现白天停止；不时而动。有的咳唾痰液、咯血，喘嗽不停；有的喉咙痒、口干渴；有的自汗、遗精；有的大小便不调；有的饮食减少；有的肌肉日渐消瘦。总原因是精枯水涸导致这些症状显现，令人疑惑难以名状。这都是因为阴不足以制阳，病在阴中之水。
王太仆说：“觉得寒而不寒，是因为无水。”又说：“壮水之主，以制阳光。”立斋先生（薛己）说：“无水的人适宜用六味地黄丸，填补真阴。”张景岳也使用纯甘至静的方剂。这两位贤人没有违背化源的治疗原则，确实有千古独见的见识。然而真阴亏损枯竭，如果不是熟地黄的膏腻滋润，石枣（山茱萸等）的温润滋补空虚，怎么能恢复精血呢？《内经》说：“精不足者，补之以味。”说的就是这个道理。
但是阴既然亏损了，真阳就没有依附，脾脏失去资生之源。所以要用甘平的山药、茯苓，扶益胃气；枸杞、阿胶、巴戟天、甘草，都是壮水的药物，可以作为臣佐辅助。但如果不用人参，就没有阳气，阴也就无法生成。丹皮固然是骨蒸潮热所需要的，泽泻是为了利水而设的，性质主补泻兼行，也必须斟酌选用。水旺则骨蒸自然消除，何必用行血的丹皮？金盛而上源既充足，哪里还需要通淋的泽泻？况且没有阴虚而脾胃能单独充实的情况。天冬、麦冬，虽然说能治疗咳嗽，但它们性冷滑，会泻阳，不宜轻用。玄参、地骨皮，固然优良退热，但也属于甘寒犯胃，是必须忌讳的。桑白皮是泻肺火有余的，难道没考虑到火既然有余，水便不足，还可以重泻其表吗？至于生地、藕汁、童便、人乳，这也是寒滑妨脾，在治疗实火时可以用，难道没考虑到龙雷虚焰，遇水更炽烈，可以混投吗？薏苡仁是治疗脚气、除风湿、消肺痈的药物，而这种阴虚咳嗽，金水俱败，可以用渗利药吗？痰是肾津不能四布，挟带虚火上溢，像痰但不是真痰。为什么妄用泄郁的贝母呢？甚至橘红、款冬花，也敢乱用。枇杷叶质地轻飘薄，真的能滋肾保金吗？
虚烦不能入睡，是火烁阴的结果，这与治疗胆热不眠的酸枣仁有什么关系？再仔细分析，麦冬固然清肺金，虽然同五味子、人参组成生脉饮，但难道没考虑到孙真人设立这个方子，是因为暑月火热伤气，而不是用来治疗土败金亏的咳嗽的？甚至投用薄荷汁清热，取杏仁膏治喘，却又复用这些苦辛泄阳、香燥伤阴的药物，更加支离破碎无法解释。竹沥是清除郁火痰涎的，这与肾津上溢有什么关系？大黄、玄明粉是治疗伤寒胃府燥满实坚的热症，桃仁、韭汁是破瘀行血的峻剂，怎么可以用在阴虚肝脏已败、胁肋俱疼的危候上呢？为什么还不知道熟地黄是挽回阴气、回生救命的圣药呢？生地起初固然甘寒滞胃，但如果经过九转功夫，鼎炉变化，精微妙用，大能健土生精，如果说它泥膈难化，那可能是因为火候未足、制炼方法不当罢了。哪里认识此药的真面目呢？
喘得厉害的是虚里应衣，火不归源，为什么又妄投腹皮、萝卜、苏子、葶苈子之类的药物呢？病本来就怕喝冷水，热势更加燎原，忍心再增加连翘、栀子、三黄之类的大泻真阳的药吗？柴胡是解少阳表热的，治疗这个病症反而令出汗，更加损伤元气。青蒿味苦主泄，真的能让微弱的胃气护保无虞吗？穴灸四花穴，只是徒劳地接引内火上升燃烧；药投钟乳石，反而能停滞瘀血而生灾祸。以上这些都是葛可久、王宇泰诸家治疗痨病的妄法。切莫以为这是真脏为患，而非经腑的病；根本已亏，而非枝叶凋零；真阴缺坏不完，而非气血虚弱的比拟。
五脏有伤，到肾为极。真阴已败，元阳亦灭，又有水盛火衰与阴阳两虚的病，不可不察。为何今昔诸家，昧于根本而顺从表象，见病治病，不仅搏刮无术，致使速死有期。呜呼！是种杏还是种棘？一部治世奇书，几乎成了宜府鬼物了。
王宇泰说：“丹溪论劳瘵主乎阴虚，大概是从子时到巳时属阳，从午时到亥时属阴。阴虚则热在午后子前。醒属阳，睡属阴。阴虚则汗泛寐时盗出。升属阳，降属阴。阴虚则气不降，气不降则痰涎上逆，而连绵吐出不绝。脉浮属阳，沉属阴。阴虚则浮之洪大，沉之空虚。这些都是阴虚的症状，用四物汤加黄柏、知母主治。然而世医遵用治疾，乃百无一效，为什么呢？盖阴既虚矣，心火上炎，而当归、川芎，皆味辛气大温，非滋阴降火之药。又川芎上窜，尤非虚炎短乏者所宜。地黄泥鬲，非胃弱食少痰多者所宜。黄柏、知母，苦辛大寒，虽曰滋阴，其实燥而损血；虽曰降火，其实苦先入心，久而增气反能助火。至其败胃，所不待言。用药如此，乌能奏功哉？”
我每次用薏苡仁、百合、天门冬、麦门冬、桑白皮、地骨皮、枇杷叶、五味子、酸枣仁之类的药物，佐以生地、藕汁、乳汁、童子小便。如咳嗽则多用桑皮、枇杷叶；有痰则增贝母；有血则多用苡仁、百合，增阿胶；热甚则多用地骨皮；食少则用苡仁，至八九钱，而麦门冬常为之主，以保肺金而滋生化之源，无不应手而效。盖诸药皆禀燥降收之气，气之薄者为阳中之阴。气薄则发泄，辛甘淡平寒凉是也。以施于阴虚火动之症，犹当溽暑伊芳郁之时，而商颿飒然倏动炎，敲如失矣。与治白虎汤同意。然彼是外感而有余，故用寒沉藏之药，而后能辅其偏。此是内伤为不足，但用燥降收之药，而已得其平矣。此用药之权衡也。
又云：“虚劳之疾，百脉空虚，非粘腻之物填之，不能实也。精血枯涸，非滋湿之物润之，不能润也。宜用人参、黄芪、地黄、天冬、麦冬、枸杞子、五味子之属，各煎膏。另用青蒿以童便熬膏，及生地汁、白莲藕汁、人乳汁、薄荷汁，隔汤炼过，酌定多少，并麋角胶、霞天膏，合和成剂。每用数匙汤化服之。如欲行瘀血，加入醋制大黄末子、玄明粉、桃仁泥、韭汁之属。欲止血，加入金墨之属。欲行痰，加入竹沥之属。凡虚劳之症，大抵心下引胁俱疼，盖滞血不消，新血无以养之也。尤宜用膏加韭汁桃仁泥。大略前言苡仁之属治肺虚，后言参芪地黄膏子之类治肾虚。盖肝心属阳，肺肾属阴。阴虚则肺肾虚矣。故补肺肾则是补阴，非四物黄柏知母之类也。”
又云：“治虚劳当以脾肾二脏为要。何以言之？肾乃系元气也。脾乃养形体者也。经曰：‘形不足，温之以气者也。’谓真气有少火之温以生育形体。然此火不可使之热，热则壮，壮则反耗真气也。候其火之壮少皆在两肾间。经又曰：‘精不足者，补之以味。’五味入胃，各从所喜之藏而归之，以生津液输纳于肾者。若五味一有过节，反成其藏有余，胜克之祸起矣。候其五味之寒热，初在脾胃，次在其所归之藏，即当补其不足，泻其有余，谨守精气，调其阴阳，使神内藏。夫如是则天枢开发，而胃和脉生，故荣卫以周于内外，无不被滋养而病愈矣。”
李黄暗斋说：“以上数条，乃王宇泰先生治虚痨之法，迥异时流。予曾遵服亦有效，故并志之也。”窃谓宇泰先生，文章品望，业已标鹄中原，而留心方技，着集准绳一书，无非惠济群生，其用心亦可谓仁而勤矣。独是业非专习，至夫虚劳一症，治率从标。且黄暗斋先生又从而附会之，强称为美。不揣政恐天下后世，庸工俗子，念以为此方法出自名公大人，拘守遵用，遗误非少。至十药神书，编定甲乙丙丁十号，兼投针灸金石，执方待病，尤属谬戾。及遍阅诸家方书，所称痨注二十四种、三十六种，或九十九种，病机丛繁，皆创言诡幻，巧立名色，欺世惑人，好事者为之。岂知万病皆生于寒热，寒热总由于水火。水火偏胜，原本一亏，便成不可捉摸而为弥天之势矣。不全此处根究，更从何地着力？故特表而出之，为之驳正。
Among all diseases, only *Lao Zhai* (consumptive disease) is the most severe. Recently, there are many patients, yet the treatments are increasingly erroneous. For instance, Zhu Danxi advocated using bitter-cold herbs to nourish Yin, which actually damages life. For a hundred years, those who have opposed him are numerous, so there is no need for further comment. As for Ge Kejiu's *Shi Yao Shen Shu* (Divine Book of Ten Medicines) and Wang Yutai's *Zheng Zhi Zhun Sheng* (Standard for Diagnosis and Treatment), whether wise or foolish, they are all praised as good. I alone consider them incorrect. It is like a patient having mistakenly fallen into a thicket of swords and spears, while the doctor follows behind wielding knives and arrows; how can one expect any possibility of recovery?
The term "Zhai" refers to deficiency and timidity, similar to the meaning of a bad harvest year that is incomplete and damaged. When illness reaches this stage, one is daily approaching death (Huang Quan), being even more critical than diseases in the Gao Huang (deep interior) regions. How can one not feel a chill of fear?
Diseases vary in severity and depth. Initially called "Ruo" (weakness), then "Xu" (deficiency), then "Shuai" (decline), then "Sun" (damage), and finally "Zhai". However, Zhai is worse than Sun, Sun is worse than Shuai, Shuai is worse than Xu, and Xu is worse than Ruo. If the initial cause is neglected and untreated, Ruo inevitably leads to Xu, Xu to Shuai, Shuai to Sun, and Sun to Zhai. Once it reaches Zhai, although death does not occur immediately, it is already on the path to death.
However, diseases also differ by Meridians and Zang-Fu organs. Zang organs are deeper than Fu organs, Fu organs are deeper than Jing (Main) meridians, and Jing meridians are deeper than Luo (Connecting) vessels. In the early stages, it must enter from Luo to Jing, from Jing to Fu, and from Fu to Zang. Once entering the Zang, vital energy is severed, leaving only waiting for death.
Although all five Zang organs are involved, the Kidney is the most important. The Kidneys are two, with the left Kidney being more significant. The left Kidney is the mother of Yuan Yang (Original Yang), the master of True Yin, the ancestor of Tian Yi (Heavenly One), and the source of transformation and generation. It stores Essence, controls Blood, creates life, and generates the body. If this foundation is injured, it will shake and collapse.
I have also carefully investigated the causes of disease and the errors in various treatment methods. The Classic says: "The Five Zang organs store Essence; they must not be injured. Injury leads to loss of control and Yin Deficiency. Yin Deficiency leads to lack of Qi. Lack of Qi leads to death." It also states: "The Kidney belongs to Water, receiving and storing the Essence of the Five Zang and Six Fu organs." It further says: "The Kidney governs hibernation and is the root of sealing and storing." Therefore, for men who indulge in sexual excess without restraint, or who have weak congenital constitution, fetal weakness and emaciation, insufficient Essence and Blood, and are prematurely damaged; or who are addicted to alcohol, causing toxins to rot the bone marrow—all this occurs because the Kidney belongs to Yin and governs Water. Water is Essence. When Water is exhausted, Fire becomes prosperous, which is inevitable.
Prosperous Fire scorches Metal (Lung), preventing Metal and Water from generating each other. Floating Yang loses control, erupting like a prairie fire. This is false heat, known as Prosperous Fire, Evil Fire, Dragon-Thunder Fire, or Rootless Fire, rather than Sovereign Fire. Such Fire cannot be directly suppressed by bitter-cold, heavy-Yin herbs like Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma).
The fever may come and go suddenly, starting and stopping intermittently; or appear during the day and hide at night, appearing at night and hiding during the day; moving irregularly. There may be coughing up phlegm and blood, incessant wheezing and coughing; itchy throat and dry thirst; spontaneous sweating and seminal emission; irregular urination and defecation; reduced appetite; and daily muscle wasting. The total reason is the exhaustion of Essence and drying of Water leading to these symptoms, which are confusing and hard to describe. All this is because Yin is insufficient to control Yang, and the disease lies in the Water within Yin.
Wang Tai said: "Feeling cold but not becoming cold is due to lack of Water." He also said: "Strengthen the master of Water to control the sunlight." Li Lizhai (Xue Ji) said: "Those lacking Water should use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to fill True Yin." Zhang Jingyue also used purely sweet and tranquil formulas. These two sages did not deviate from the treatment of preserving the Source of Transformation, truly possessing unique insight through the ages. However, when True Yin is depleted, unless one uses the rich and greasy Shu Di Huang (Prepared Rehmanniae Radix) for moistening, and Shi Zao (Cornus Fructus, etc.) for warming and moistening to tonify emptiness, how can Essence and Blood be restored? The Classic says: "When Essence is insufficient, tonify with flavor." This refers to this principle.
But since Yin is deficient, True Yang has no attachment, and the Spleen loses its source of nourishment. Therefore, one should use sweet and neutral Shan Yao (Dioscoreae Rhizoma) and Fu Ling (Poria) to support Stomach Qi; Gou Qi Zi (Lycii Fructus), E Jiao (Asini Corii Colla), Ba Ji Tian (Morindae Officinalis Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma) are all herbs that strengthen Water and can serve as assistant ministers. But without Ren Shen (Ginseng Radix), there is no Yang, and thus Yin cannot generate. Dan Pi (Moutan Cortex) is indeed needed for bone-steaming fever, and Ze Xie (Alismatis Rhizoma) is set for promoting urination; their nature combines tonification and draining, so they must be chosen with care. When Water is abundant, bone-steaming will naturally disappear; why use blood-moving Dan Pi? When Metal is prosperous and the upper source is sufficient, why still rely on urine-promoting Ze Xie? Moreover, there is no case where Yin is deficient but the Spleen and Stomach remain independently solid. Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix), although said to treat cough, are cold and slippery, draining Yang, and should not be used lightly. Xuan Shen (Scrophulariae Radix) and Di Gu Pi (Lycii Cortex) are excellent for reducing heat but belong to sweet-cold damaging the Stomach, which must be avoided. Sang Bai Pi (Mori Cortex) drains excess Lung Fire, but one must not forget that if Fire is excessive, Water is insufficient; can one heavily drain the exterior? As for Sheng Di Huang (Rehmanniae Radix), Lotus Root Juice, Child's Urine, and Human Milk, these are also cold and slippery, hindering the Spleen. They may work for treating Excess Fire, but one must not forget that Dragon-Thunder false flames burn fiercer with water; how can they be mixed indiscriminately? Yi Yi Ren (Coicis Semen) treats Hong Kong Foot (Gout/Arthritis), removes Wind-Dampness, and eliminates Lung Abscess. Can渗利 (draining-dampness) herbs be used for this Yin-deficient cough where both Metal and Water are failing? Phlegm is Kidney Fluid that cannot distribute to four directions, carrying false fire upward; it looks like phlegm but is not true phlegm. Why rashly use Bei Mu (Fritillariae Bulbus) to vent stagnation? Even Ju Hong (Citri Reticulatae Pericarpium Rubrum) and Kuan Dong Hua (Sonchi Flos) dare to be used randomly. Pi Pa Ye (Loquat Leaf) has a light and thin quality; can it really nourish the Kidney and protect Metal?
Empty irritability and insomnia result from Fire scorching Yin; what does this have to do with Suan Zao Ren (Ziziphi Spinosae Semen) used for Gallbladder Heat insomnia? Further analysis shows that Mai Dong clears Lung Metal. Although combined with Wu Wei Zi (Schisandrae Fructus) and Ren Shen to form Sheng Mai Yin (Generate the Pulse Drink), one must not forget that Sun Simiao established this formula because Summer Heat and Fire damage Qi, not to treat coughs caused by Earth failure and Metal deficiency. Even using Bo He (Menthae Haplocalycis Herba) juice to clear heat, and Xing Ren (Armeniacae Semen) paste to treat wheezing, yet reusing these bitter-pungent Yang-draining and aromatic-dry Yin-damaging flavors makes the logic even more fragmented and inexplicable. Zhu Li (Bambusae Succus) clears stagnant Fire phlegm; what does this have to do with overflowing Kidney Fluid? Da Huang (Rhei Radix et Rhizoma) and Xuan Ming Fen (Mirabilite) treat Heat syndromes of Dryness, Fullness, Excess, and Hardness in the Stomach Fu from Cold Damage; Tao Ren (Persicae Semen) and Jiu Zhi (Allii Tuberosi Juice) are harsh agents for breaking stasis and moving blood. How can they be applied to the critical condition of Yin deficiency, Liver failure, and pain in the hypochondrium? Why is it that one does not know that Shu Di Huang is the holy medicine for rescuing Yin and restoring life? Sheng Di Huang is initially sweet-cold and cloying to the Stomach, but if subjected to nine transformations and changes in the cauldron, with subtle and profound applications, it greatly strengthens Earth to generate Essence. To say it blocks the chest and is hard to digest is due to insufficient firing power or improper processing methods. How can one recognize the true face of this herb?
Severe wheezing indicates the Xu Li (Vital Gate) pulsating against the clothes, meaning Fire does not return to its source. Why rashly administer Fu Pi (Tugeliae Pericarpium), Luobo (Raphani Fructus), Su Zi (Perillae Fructus), and Ting Li Zi (Lepidii Semen)? The disease already fears cold drinks, making the heat spread like a prairie fire; how can one bear to add Lian Qiao (Forsythiae Fructus), Zhi Zi (Gardeniae Fructus), and San Huang (Three Yellows) to severely drain True Yang? Chai Hu (Bupleuri Radix) releases Shaoyang exterior heat; treating this condition causes sweating and further damages Yuan Qi. Qing Hao (Artemisiae Annuae Herba) is bitter and primarily draining; can it truly protect the微弱 (faint) Stomach Qi? Moxibustion on Si Hua points merely connects internal Fire to rise and blaze; administering Zhong Shi (Calcitum) instead causes stasis to stagnate and create disaster. Above are the erroneous methods of Ge Kejiu, Wang Yutai, and others in treating Lao.
Do not think this is a disease of the True Zang rather than Jing/Fu; the root is already deficient, not just withered branches; True Yin is broken and incomplete, not merely a comparison of Qi and Blood weakness. Among injuries to the Five Zang, reaching the Kidney is the extreme. When True Yin fails and Yuan Yang extinguishes, there are also conditions of Water excess and Fire decline, and Yin-Yang dual deficiency, which must not be overlooked. Why do past and present physicians ignore the root for the branch, treating symptoms rather than the disease? Not only do they lack effective scraping methods, but they hasten death. Alas! Are we planting apricots (healing) or thorns (harm)? A miraculous book for governing the world has almost become a ghost tool.
Wang Yutai said: "Danxi argued that Lao Zhai is mainly Yin Deficiency. From Zi to Si hours belongs to Yang; from Wu to Hai hours belongs to Yin. Yin Deficiency leads to heat in the afternoon before Zi hour. Waking is Yang, sleeping is Yin. Yin Deficiency leads to sweating during sleep (night sweats). Ascending is Yang, descending is Yin. Yin Deficiency leads to Qi not descending; Qi not descending leads to phlegm-fluids reversing upward, resulting in continuous spitting. Pulse floating is Yang, sinking is Yin. Yin Deficiency leads to floating pulse being large and forceful, sinking pulse being empty. These are all Yin Deficiency symptoms, treated with Si Wu Tang (Four Substance Decoction) plus Huang Bo and Zhi Mu. However, why do doctors following this achieve zero success out of a hundred? Since Yin is deficient, Heart Fire flares up. Dang Gui (Angelicae Sinensis Radix) and Chuan Xiong (Chuanxiong Rhizoma) are pungent and warm in nature, not herbs for nourishing Yin and descending Fire. Furthermore, Chuan Xiong ascends, unsuitable for those with false flames and shortness of Qi. Di Huang clogs the chest, unsuitable for those with weak Stomach, poor appetite, and much phlegm. Huang Bo and Zhi Mu are bitter, pungent, and very cold. Though said to nourish Yin, they actually dry and damage Blood; though said to descend Fire, bitterness enters the Heart first, and long-term use increases Qi, actually assisting Fire. Their damaging the Stomach goes without saying. With such medication, how can it succeed?"
I often use Yi Yi Ren, Bai He (Lilii Bulbus), Tian Men Dong, Mai Men Dong, Sang Bai Pi, Di Gu Pi, Pi Pa Ye, Wu Wei Zi, Suan Zao Ren, etc., assisted by Sheng Di Huang, Lotus Root Juice, Milk, and Child's Urine. If coughing, use more Sang Pi and Pi Pa Ye; if phlegm, add Bei Mu; if blood, use more Yi Yi Ren and Bai He, adding E Jiao; if heat is severe, use more Di Gu Pi; if poor appetite, use Yi Yi Ren, up to 30-45 grams, with Mai Men Dong as the main herb to protect Lung Metal and nourish the source of transformation and generation. This works effectively. These herbs possess the Qi of dryness, descent, and gathering. The thin Qi is Yin within Yang. Thin Qi disperses; pungent, sweet, bland, neutral, cold, and cool are examples. Applying this to Yin Deficiency with Fire movement is like a cool breeze blowing away heat during humid summer. This is consistent with treating Bai Hu Tang syndrome. However, that is Exterior Excess, so heavy, cold, and storing herbs are used to correct the bias. This is Interior Deficiency, so using dry, descending, and gathering herbs achieves balance. This is the weighing of medication.
It is also said: "In Lao disease, all pulses are empty; only sticky and cloying substances can fill them. Essence and Blood are dried up; only moist and wet substances can lubricate them. Use Ren Shen, Huang Qi (Astragali Radix), Di Huang, Tian Men Dong, Mai Men Dong, Gou Qi Zi, Wu Wei Zi, etc., decocted into paste separately. Also use Qing Hao decocted with Child's Urine into paste, along with Sheng Di Juice, White Lotus Root Juice, Human Milk, and Bo He Juice, refined over water bath, mixed in appropriate amounts, combined with Lu Jiao Jiao (Cervi Cornus Colla) and Xia Tian Gao (Gelatinized Poria), formed into a pill/paste. Take several spoons dissolved in hot water. To move blood stasis, add Vinegar-processed Da Huang powder, Xuan Ming Fen, Tao Ren paste, Jiu Zhi. To stop bleeding, add Jin Mo (Gold Ink). To move phlegm, add Zhu Li. Generally, Lao symptoms involve pain radiating from below the heart to the hypochondrium, due to stagnant blood not resolving, preventing new blood from nourishing. It is especially suitable to use paste with Jiu Zhi and Tao Ren paste. Briefly, the former mention of Yi Yi Ren treats Lung Deficiency; the latter mention of Ren Shen, Huang Qi, Di Huang paste treats Kidney Deficiency. Liver and Heart belong to Yang; Lung and Kidney belong to Yin. Yin Deficiency leads to Lung and Kidney Deficiency. Thus, tonifying Lung and Kidney is tonifying Yin, not using Si Wu Tang, Huang Bo, and Zhi Mu."
It is also said: "Treating Lao should focus on the Spleen and Kidney. Why? The Kidney relates to Yuan Qi. The Spleen nourishes the physical form. The Classic says: 'For insufficiency of form, warm with Qi.' This means True Qi has the warmth of Minor Fire to generate the form. However, this Fire must not be made hot; if hot, it becomes Prosperous, and Prosperous Fire consumes True Qi. Observe the strength of this Fire between the two Kidneys. The Classic also says: 'When Essence is insufficient, tonify with flavor.' The Five Flavors enter the Stomach and return to their preferred Zang organs to generate fluids and transport to the Kidney. If the Five Flavors exceed moderation, they cause excess in the Zang, leading to destructive overcoming. Observe the cold and heat of the Five Flavors, initially in the Spleen and Stomach, then in the target Zang. Tonify deficiency, drain excess, guard Essence and Qi, regulate Yin and Yang, and keep the Spirit stored internally. Thus, Tian Shu opens, Stomach harmonizes, and pulses generate. Ying and Wei circulate inside and out, all are nourished, and the disease heals."
Li Huang Anzhai said: "The above points are Mr. Wang Yutai's methods for treating虛勞 (Deficiency Consumption), distinct from current trends. I have followed and taken them with effect, so I record them together." I secretly believe Mr. Wang Yutai's literary reputation and moral standing were outstanding in the Central Plains. His attention to medical arts and his book *Zhun Sheng* aim to benefit all living beings; his intention can be called benevolent and diligent. However, his profession was not specialized. For the symptom of Lao, treatment generally follows the branch. Moreover, Mr. Huang Anzhai appended and flattered it, forcibly calling it beautiful. I fear that future mediocre practitioners might think this method comes from famous officials, strictly follow it, and cause much harm. Regarding *Shi Yao Shen Shu*, numbered Jia, Yi, Bing, Ding... ten categories, combining acupuncture and minerals, holding prescriptions waiting for diseases, is particularly erroneous. After reviewing various medical books, mentioning 24, 36, or 99 types of Lao and Zhu (infectious/parasitic diseases), the pathology is complex, all creating strange illusions, inventing names, deceiving the world, done by busybodies. Who knows that all diseases arise from Cold and Heat, and Cold and Heat stem from Water and Fire. If Water and Fire are imbalanced and the original is deficient, it becomes ungraspable and vast as heaven and earth. Without thoroughly investigating here, where else can effort be applied? Therefore, I specifically highlight and refute this.