（一名伤寒夹虚痨）
【因】痨之一症。皆因气虚怯弱之人。困乏劳伤之后。中气不足。下流肝肾。阴火独旺则发热头痛。
营卫失守。则恶风恶寒。或兼感风寒。内外生热。其势更剧。
【证】头痛发热。或肌肤壮热。恶风恶寒。须渴引饮。日晡转甚。或昼夜不息。证似阳明白虎。
但脉不长实洪数为异。或气短而烦。气高而喘。怠惰嗜卧。而四肢不收。自汗不敛。而口不知味。亦有
阴火沸腾。歇息凉处。阳气抑遏而不行。无以卫外。故不任风寒。与外感相似。惟气息短促。懒言困倦
有别。凡元气不足。而心火独旺。上乘阳分。
则头痛口渴。烦躁肌热。脉虽洪大。重按无力。名曰热中。若脾胃久虚。阳气衰少。则骨乏无力。足不
任身。不渴不烦。而多溺多汗。脉盛大而涩。名曰寒中。阴病则胃冷恶心。饮食难化。痰涎倦怠。溏
泻溺多。阳病则口干声哑。咽痛心烦。嗜味燥结溺赤。蒸上则喘咳痰血。唇焦面红。耳鸣目眩。
肺痿肺痈。蒸中则胁肋疼胀。肢体倦怠。多食易饥。善食消瘦。蒸下则阳强盗汗。腰痛脚 。燥结便闭。
淋浊遗精。盖思虑劳倦。外感等症则伤阳。伤于阳者。病必自上而下也。色欲醉饱。内伤等症则伤阴。
伤于阴者。病必自下而上也。自上而下者。先伤乎气。故一损损于肺。而病在声息肤腠。肺主皮毛。
故皮聚毛落。二损损于心。而病在血脉颜色。心主血脉。血脉虚少。不能荣于五脏六腑。三损损于
胃。而病在饮食不调。胃主肌肉。故肌肉消瘦。饮食不润肌肤。四损损于肝。而病为螈 疼痛。肝主筋。
筋缓不能自收持。五损损于肾。肾主骨。故骨痿不能起于床。肾司二便。故二便不禁。此先伤乎阳。
后及乎阴。阳竭于下。则孤阴无以独存。而不可为也。自下而上者。先伤乎精。故一损于肾。而病
为泉源干涸。二损于肝。而病为血动筋枯。三损于脾。而病为痰涎壅盛。四损于心。而病为神魂失守。
五损于肺。而病为短气喘呼。此先伤乎阴。后及乎阳。阴竭于上。则孤阳无以独存。而不可为也。
然二者之损。又皆以脾胃为生死之大关。盖脾胃者。土也。万物之本也。若上过乎此。则传肝传肾
不可治矣。下过乎此。则传心传肺。不可治矣。故曰心肺损而神衰。肝肾损而形敝。脾胃损而饮食不
归血气。迨其传变已深。而希望回生。不亦戛戛乎其难哉。
【脉】内伤从内而出。故右脉阔大。外感从外而入。故左脉浮盛。平人脉大为劳。脉虚极亦为劳。
内伤劳倦。豁大不禁。若损胃气。则隐而难寻。劳损之脉。或弦或大。大而无力为阳虚。甚则脉细。
弦而无力为阴虚。甚则脉数。
大者易治。血气未竭。犹可敛而正之。弦者难治。血气已耗。挽回补救需难。尺脉洪大。为阴虚火旺。左细
右劲。为正虚邪盛。脉细而数。或濡而散者。皆不治。
【治】外感风寒。是伤其形。内伤脾胃。乃伤其气。伤其形为有余。有余可泻。伤其气为不足。不足当
补。故汗之、吐之、消之、皆泻也。温之、和之、养之、调之、皆补也。如虚劳兼挟外感。宜扶正祛邪而治之。
大抵劳伤脾胃。兼夹外感。以补中益气汤。随六经见证。加减治之。若肝肾阴虚。复感表邪。宜滋阴降火汤。
或四物汤加味为治。故治劳过用大寒。则愈虚其中。过用大热。则愈竭其阴。惟滋阴降火。以澄其源。化痰和
血。以洁其流。虽有外感表邪。解表之中。仍须理劳。若外感轻微而心虚者。主以归脾汤。脾虚补中益气汤。
肺虚生脉散。肝虚逍遥散。肾虚地黄汤。若肺脾兼病。邪郁劳嗽。食少痰多。便溏溺涩。清宁膏。（生地十两、
麦冬六两、制白术六两、桔梗四两、米仁十两、炒川贝二两去心、橘红一两、薄荷三两、桂圆十两、去壳核、
米仁川贝薄荷、研细末、桂圆捣烂、余药煎去、滓搅和收炼成膏、噙化咽下。）肝肾俱虚生熟地黄丸。生地
熟地各五两、白芍、茯苓、天麻、地骨皮、元参各一两五钱、川芎一两、当归、石斛、黑豆各三两、为末
蜜丸、白汤送下三钱。心肺俱虚。人参养荣汤（方见前）气血两虚八珍汤。（方见前）任劳伤肾。困乏
精虚。阴阳两虚者。十补丸（熟地八两、莲肉、淮药各四两、附子、肉桂、泽泻、丹皮、五味子各一两、鹿
茸三两、制为末、炼蜜捣千下丸、滚水下三五钱）至脾肾俱虚者。补脾之中。加以沉香、砂仁。壮肾之中。
加以五味、肉桂。若风劳郁劳。当辨脉证调治。传尸劳瘵。以黑虎丹三方。初服黑虎丹。下诸般劳虫。
黄白可治。青黑不治。（真西黄一钱、真阿魏一钱、南木香三钱、鸡内金焙二钱、真雷丸三钱、为细末、用
使君子二两、研细和前药一两、面糊
为丸任用。）次服小红丸。通肠逐虫。继前药之不及。脉数实者可用。（锦纹大黄一两、晒脆为末、和前
药末一两、炼白蜜丸、朱砂为衣听用。）三服打虫化积丸。逐虫未尽。脉沉实者可用。（大黄末三两、和
槟榔末三两、黑丑末三两、面糊为丸听用。）以此三方。取下恶物。烧以烈火。埋之深坑。葱粥调养。
以希徐复其元。各随脏腑见证用药。当滋补药中。加青蒿、百部、乌梅、朱砂之类。近世多有以四物加知柏
治劳。不知四物皆阴。行秋冬之令。非所以生万物者也。且血药常腻。非痰多食少者所宜。血药常润。
久用必致滑肠。况知柏苦寒。能泄实火。名曰滋阴。其实燥而损血。名曰降火。其实苦先入心。久而增气。
反能助火。至其败胃。固不待言。亦不可不知也。
【秀按】大抵外感寒热。齐作无间。兼内伤寒热。间作不齐。外感头痛。如破中裂。兼内伤头痛。时作时
止。外感恶寒。虽近烈火不除。兼内伤恶寒。得就温暖即解。外感恶风。不耐一切贼风。兼内伤恶风。偏恶些
少隙风。外感发热。无有休息。直待汗下方退。内伤发热。昼夜不常。略自袒裸似凉。外感筋骨疼痛难支。便
着床褥。内伤四肢不收。无力倦怠。间有气衰火旺。日久变成骨消筋缓。为痼疾也。内伤神思昏倦。语言懒
惰。先重而后轻。外感神思壮猛。语言强健。先轻而后重。内伤手心热。手背不热。外感手背热。手心不热。
内伤证显在口。故口不知味。外感证显在鼻。故鼻息不利。此劳伤兼外感。外证之鉴别法也。阴虚于下。逼阳
于上。两颧发红。面唇亦红。即仲景云。其面戴阳者。下虚故也。
【廉勘】虚劳之辨证尤详者。莫如汪缵功之论曰。虚劳一证。皆由内伤。如酒伤肺。则湿热薰蒸。肺阴消
烁。好色伤肾。则精血空虚。相火无制。思虑伤心则血耗。而火易上炎。劳倦伤脾则热生。而内伐真阴。惟忿
怒伤肝有二。郁怒则肝火内炽而灼血。大怒则肝火上升而吐血。此五者。皆能劳其精血。《道经》云。涕唾津
精汗血液。七般灵物皆属阴。阴虚内热。而成虚劳之证。大约酒色为多。然有童子未室。而患此证者。或由先天不
足。或禀母气阴虚。其师尼寡妇。室女愆期。气血郁结。致寒热如疟。朝凉暮热。饮食不思。经期不准。或致
闭绝。而成此病者。多由郁火内蒸也。方书言此证者。皆以气虚血虚。阴虚阳虚。混同论治。不知气虚者。面
白无神。言语轻微。四肢乏力。脉来微弱。阳虚者。体冷畏寒。手足逆冷。溺清便溏。脉沉小迟。此二者。能
服参 温补。乃为受补可治。此气虚阳虚之证也。虽血脱亦有补气之法。乃指卒暴失血。素非血虚之人。如妇
人新产之类耳。其余患此证者。皆纵欲伤阴居多。其为病也。在肾则为腰脊腿 。或攸隐而痛。为骨蒸盗汗。
或至夜发热。为遍身骨 。或疼痛如折。为梦泄遗精。或耳中鸣。为足心热。在心则为惊悸怔忡。为掌中干
热。为虚烦不寐。或梦魇不宁。为口苦舌干。或口舌糜烂。在肺则为痰嗽干咳。为气逆喘促。为鼻中气热。为
颧红吐衄。甚则吐涎白沫。侧眠咽痛。音哑声嘶。在肝则为寒热如疟。为颈项瘰 。为胁胀肋疼。为两目涩
痛。为头晕眼花。为多怒。为吐血。在脾则为食减不化。为恶心呕吐。为胀满腹疼。为肠鸣泄泻。肌肉消瘦。
此皆五脏虚劳之本证。《经》云。治病必求其本。须审其因何致损。何脏受伤。如因于色者。则知肾伤。纵有他经
夹证。亦当补肾为主。而兼治夹证。若因于酒者。以清肺为先也。
【炳章按】景岳曰。虚损之症。必有所因。而似损非损之症。其来则骤。盖以外感风寒不为解散。而误作内
伤。或用温补。或用清凉。或用消导。以致外邪郁伏。久留不散。而为寒热往来。及为潮热咳嗽。其证全似劳
损。若用治损之法。滋阴等剂以治。愈更留邪。热蒸日久。非损成损矣。欲辨此者。但当审其并无积渐之因。
或身有疼痛。而微汗则热退。无汗则复热。或见大声咳嗽。脉虽弦紧。而不甚数。或兼和缓等症。则虽病至一
二月。而邪有不解。病终不退者。本非劳损。误治以假弄真也。如寒热往来不止者。宜用一二三四五柴胡等
饮。斟酌用之。兼咳嗽者。柴陈煎。若脾肾气虚。而兼咳嗽者。金水六君煎。或邪有未解。而兼寒热者。仍加
柴胡。（诸方均见景岳《新方八阵》。）有一种血分郁滞。气行而血不行。徒为蒸热。俟蒸气散。微汗而热退者。
此宜活血为主。总之外感多而虚劳少者。以解外感表邪为重。惟避忌刚燥伤阴之味足矣。若外感轻微内虚甚
者。则阳虚护阳。阴虚滋阴。见证施治。必须详辨属虚属实。属寒属热。斟酌尽善。庶几不误治矣。
又按吴又可曰。凡人向有他病 羸。或久疟。或内伤瘀血。或吐血。便血。咳血。男子遗精白浊。
精气枯涸。女人崩漏带下。血枯经闭之类。以致肌肉消烁。邪火独存。故脉近于数也。此际稍感疫气。
医家病家。见其谷食暴绝。更加胸膈痞闷。身疼发热。彻夜不寐。指为原病加重。误以绝谷为脾虚。以身
痛为血虚。以不寐为神虚。遂投参、术、归、地、茯神、枣仁之类。愈进愈危。知者稍以疫法治之。发热
减半。不时得睡。谷食渐进。但数脉不去。肢体时疼。胸胁锥痛。过期不愈。医以杂药频试。补之则邪火愈
炽。泻之则损脾坏胃。滋之则胶邪愈固。散之则经络益虚。疏之则精气愈耗。守之则日削近死。盖但知其伏邪
已溃。表里分传。里证虽除。不知正气衰微。不能托出。表邪留而不去。因与血脉合而为一。结为痼疾也。
肢体时疼者。邪与荣气搏也。脉数身热不去者。邪火病郁也。胁下锥痛者。火邪结于膜膈也。过期不愈者。凡
疫邪交卸。近在一七。远在二七。甚至三七。过此不愈者。因非其治。不为坏症。即为痼疾也。夫痼疾者。所
谓客邪胶固于血脉。主客交浑。最难得解。且愈久益固。治法当乘其大肉未消。真元未败。急用三甲散。（鳖甲、
龟甲炙各一钱、炒穿甲、蝉衣、僵蚕、 牡蛎、当归各五分、 虫三个、炒白芍七分、甘草三分、为末、水二
钟、煎八分、滤清温服。）多有得生者。若素有老疟。或瘅疟者。加牛膝首乌各一钱。若胃弱作泻者。各药宜
用九蒸九晒。若素有郁痰者。加贝母一钱。老痰者。加栝蒌霜五分。若呕者勿用。若咽干作痒者。加花粉知母
各五分。若素有干咳者。加甜杏仁捣烂二钱五分。若素有内伤瘀血者。倍 虫。加桃仁研一钱。是证外感夹体
虚。若非审慎周详。一或误治。死生随之。
【荣斋按】本节俞氏所讲，侧重内伤虚劳，对于“夹劳伤寒”很少提及，形成脱离主题的一篇作品。廉臣先
生引汪缵功一段学说，更是单纯的虚劳文本。我认为“夹劳伤寒”，首先应明确的是虚劳病患而患了伤寒；既
不是因伤寒而变成的虚劳，更不是单纯的虚劳症。确定了主题，再帮助夹劳伤寒的证治，自然不致“喧宾夺主”
了。为了要搞清这个问题，特转录戴麟郊的四损、四不足两篇文本，以作补正。《四损篇》说∶“大劳、大欲、大
病、久病后为四损，气血两虚，阴阳并竭，复受温邪，正虚则邪入愈深，邪深则传化难出，汗下伤正而正脱，
补助郁邪而邪锢，多不可治。当此两难之际，于是乎有补泻合用之法，有先补后泻之法，先泻后补之法。凡人
参败毒散，黄龙汤，竹叶石膏汤，皆补泻合用之法也；先用补剂，后施汗下，先补后泻之法也；先用汗下，后
施补剂，先泻后补之法也”。四不足篇说∶“四损由人事，四不足由天禀，四损在临时，四不足在平素；然四
不足亦有由四损而来者，不得谓四损外便无不足也。四不足者，气、血、阴、阳也。气不足者，气不足以息，
语言难出也；感邪虽重，反不成胀满痞塞，凡遇此症，纵宜宣伐，必以养气为主。血不足者，面色痿黄，唇口
刮白也；感邪虽重，面目反无阳色，纵宜攻利，必以养血为主。阳不足者，或四肢厥逆，或肌体恶寒，恒多泄
泻，至夜益甚，或口鼻气冷，受邪虽重，反无发热苔刺烦渴等证；纵宜攻利清热，必先之以温补，待其虚回，
实证全见，然后以治热之法治之。阴不足者，自然五液干枯，肌肤甲错，感邪虽重，应汗不汗，应厥不厥，纵
（又名伤寒夹虚劳）
【病因】虚劳这一病症，都是因为气虚怯弱之人，在过度劳累损伤之后，中气不足，下陷于肝肾。阴火独自亢盛则出现发热、头痛；营卫之气失守，则出现怕风、怕冷；或者又兼感风寒之邪，导致内外生热，病情更加严重。
【证候】头痛发热，或者肌肤高热，怕风怕冷，口渴想喝水，傍晚时分症状加重，或者昼夜不停歇，证状类似阳明病的白虎汤证。但是脉象不像白虎汤证那样长实洪数，这是不同之处。或者气短而烦躁，气逆而上喘促，怠惰嗜睡，四肢无力不能收持，自汗不止，口不知味。也有因阴火沸腾，在凉处休息时，阳气被抑制而不能运行，无法护卫体表，所以不耐受风寒，这与外感病相似。只是气息短促、懒言困倦有所不同。凡是元气不足，而心火独旺，上乘于阳分，则出现头痛、口渴、烦躁、肌肉发热，脉象虽然洪大，但重按无力，这叫做“热中”。如果脾胃长期虚弱，阳气衰少，则骨乏无力，双腿不能支撑身体，不渴不烦，而多尿多汗，脉象盛大而涩，这叫做“寒中”。阴病则胃冷恶心，饮食难消化，痰涎倦怠，大便溏泄，小便多；阳病则口干声哑，咽痛心烦，嗜好味道燥结，小便赤黄。热气上蒸则喘咳、痰中带血，嘴唇焦裂，面色红，耳鸣目眩，形成肺痿或肺痈；热气在中则胁肋疼痛胀满，肢体倦怠，多吃却容易饥饿，善于进食却消瘦；热气在下则阳强易举、盗汗，腰痛脚软，大便燥结闭阻，淋浊遗精。大概思虑、劳倦、外感等病症会伤阳，伤于阳的，病势必然自上而下发展。色欲、醉饱、内伤等病症会伤阴，伤于阴的，病势必然自下而上发展。自上而下发展的，先伤气，所以一损损于肺，病在声音气息和皮肤腠理，肺主皮毛，所以毛发脱落；二损损于心，病在血脉颜色，心主血脉，血脉虚少，不能滋养五脏六腑；三损损于胃，病在饮食不调，胃主肌肉，所以肌肉消瘦，饮食不能滋润肌肤；四损损于肝，病为抽搐疼痛，肝主筋，筋缓不能自主收持；五损损于肾，肾主骨，所以骨痿不能起床，肾司二便，所以大小便失禁。这是先伤阳，后及于阴，阳气竭于下，则孤阴无法独存，就无法救治了。自下而上发展的，先伤精，所以一损损于肾，病如泉源干涸；二损损于肝，病为血动筋枯；三损损于脾，病为痰涎壅盛；四损损于心，病为神魂失守；五损损于肺，病为短气喘呼。这是先伤阴，后及于阳，阴竭于上，则孤阳无法独存，也无法救治了。然而这两种损耗，都以脾胃为生死的关键大关。因为脾胃属土，是万物的根本。如果病势超过这个界限向上发展，则传至肝、肾，不可治了；向下发展，则传至心、肺，不可治了。所以说心肺受损则神衰，肝肾受损则形败，脾胃受损则饮食不能转化为血气。等到传变已经深入，希望起死回生，不是非常困难吗？
【脉象】内伤病由内而生，所以右脉阔大；外感病由外而入，所以左脉浮盛。正常人脉大为劳损，脉极虚也是劳损。内伤劳倦，脉象豁大不禁；如果损伤了胃气，则脉象隐伏难寻。劳损的脉象，或弦或大，大而无力为阳虚，甚则脉细；弦而无力为阴虚，甚则脉数。大的脉象容易治疗，因为血气未竭，还可以收敛纠正；弦的脉象难治，因为血气已耗，挽回补救很难。尺脉洪大，为阴虚火旺；左脉细右脉劲，为正虚邪盛。脉细而数，或濡而散的，都是不治之症。
【治法】外感风寒，是损伤形体；内伤脾胃，是损伤气机。损伤形体属于有余，有余可以泻；损伤气机属于不足，不足应当补。所以发汗、催吐、消导，都属于泻法；温补、和解、滋养、调理，都属于补法。如虚劳兼挟外感，宜扶正祛邪来治疗。大抵劳伤脾胃，兼夹外感，用补中益气汤，根据六经见证加减治疗。如果肝肾阴虚，又感受表邪，宜用滋阴降火汤，或者四物汤加味治疗。所以治疗劳病，过用大寒药，则会更加虚其中焦；过用大热药，则会更加竭其阴液。只有滋阴降火以澄清源头，化痰和血以清洁流源，虽然有外感表邪，在解表的同时，仍须调理虚劳。如果外感轻微而心虚者，主用归脾汤；脾虚用补中益气汤；肺虚用生脉散；肝虚用逍遥散；肾虚用地黄汤。如果肺脾兼病，邪郁劳嗽，食少痰多，便溏溺涩，用清宁膏。（生地十两、麦冬六两、制白术六两、桔梗四两、薏苡仁十两、炒川贝母二两去心、橘红一两、薄荷三两、桂圆肉十两去壳核，将薏苡仁、川贝母、薄荷研成细末，桂圆捣烂，其余药物煎煮去渣，搅拌混合炼制成膏，含化咽下。）肝肾俱虚用生熟地黄丸。生地、熟地各五两、白芍、茯苓、天麻、地骨皮、玄参各一两五钱、川芎一两、当归、石斛、黑豆各三两，研成末，蜜丸，白开水送服三钱。心肺俱虚用人参养荣汤（方见前）；气血两虚用八珍汤（方见前）。任劳伤肾，困乏精虚，阴阳两虚的用十补丸（熟地八两、莲肉、淮山药各四两、附子、肉桂、泽泻、丹皮、五味子各一两、鹿茸三两，研为末，炼蜜捣千下制成丸剂，滚水送服三五钱）。到了脾肾俱虚者，在补脾之中，加入沉香、砂仁；壮肾之中，加入五味子、肉桂。如果是风劳、郁劳，应当辨别脉证调治。对于传尸劳瘵，用黑虎丹三方。初服黑虎丹，排出各种劳虫，黄白色可治，青黑色不治。（真牛黄一钱、真阿魏一钱、南木香三钱、鸡内金焙干二钱、真雷丸三钱，研为细末，用使君子二两研细与前药末一两混合，面糊为丸，任意服用。）次服小红丸，通肠逐虫，接续前药之不及，脉数实者可用。（锦纹大黄一两，晒脆为末，与前药末一两混合，炼白蜜为丸，朱砂为衣听用。）三服打虫化积丸，逐虫未尽，脉沉实者可用。（大黄末三两，和槟榔末三两、黑丑末三两，面糊为丸听用。）以此三方，取下恶物，用烈火焚烧，埋入深坑，用葱粥调养，希望能慢慢恢复元气。各随脏腑见证用药，应当在滋补药中加入青蒿、百部、乌梅、朱砂之类。近代人多用四物汤加知母、黄柏治疗劳病，不知道四物汤皆属阴，行秋冬之令，不是用来生养万物的。而且血药常腻，不适合痰多食少的人；血药常润，久用必致滑肠。何况知母、黄柏苦寒，能泄实火，名为滋阴，其实燥而损血；名为降火，其实苦先入心，久而增气，反而能助火。至于败坏胃气，更是不用说了，也不可不知道啊。
【秀按】大抵外感寒热，齐作无间，兼内伤的寒热，间作不齐。外感头痛，如破中裂；兼内伤头痛，时作时止。外感恶寒，虽近烈火不除；兼内伤恶寒，得就温暖即解。外感恶风，不耐一切贼风；兼内伤恶风，偏恶些许隙风。外感发热，无有休息，直待汗下方退；内伤发热，昼夜不常，略自袒裸似凉。外感筋骨疼痛难支，便着床褥；内伤四肢不收，无力倦怠，间有气衰火旺，日久变成骨消筋缓，成为痼疾。内伤神思昏倦，语言懒惰，先重而后轻；外感神思壮猛，语言强健，先轻而后重。内伤手心热，手背不热；外感手背热，手心不热。内伤证显在口，故口不知味；外感证显在鼻，故鼻息不利。这是劳伤兼外感，外证的鉴别方法。阴虚于下，逼阳于上，两颧发红，面唇亦红，即仲景所说：其面戴阳者，下虚故也。
【廉勘】虚劳的辨证尤其详细的，莫过于汪缵功的论述说：虚劳一证，皆由内伤。如酒伤肺，则湿热薰蒸，肺阴消烁；好色伤肾，则精血空虚，相火无制；思虑伤心则血耗，而火易上炎；劳倦伤脾则热生，而内伐真阴。只有愤怒伤肝有两种情况：郁怒则肝火内炽而灼血，大怒则肝火上升而吐血。这五种情况，都能劳损其精血。《道经》说：涕唾津精汗血液，七般灵物皆属阴。阴虚内热，而成虚劳之证。大约酒色致病居多。然而有童子未婚，而患此证的，或由先天不足，或禀受母气阴虚。其师尼寡妇、室女经期推迟，气血郁结，致寒热如疟，朝凉暮热，饮食不思，经期不准，或致闭绝，而成此病的，多由郁火内蒸所致。方书言此证的，都以气虚血虚、阴虚阳虚混同论治，不知道气虚者，面白无神，言语轻微，四肢乏力，脉来微弱；阳虚者，体冷畏寒，手足逆冷，溺清便溏，脉沉小迟。这两者，能服人参、附子温补，乃为受补可治。这是气虚阳虚之证。虽然血脱也有补气之法，那是指突然大量失血，素非血虚之人，如妇人新产之类罢了。其余患此证的，皆纵欲伤阴居多。其为病，在肾则为腰脊腿酸，或隐隐而痛，为骨蒸盗汗，或至夜发热，为遍身骨节酸痛，或疼痛如折，为梦泄遗精，或耳中鸣，为足心热；在心则为惊悸怔忡，为掌中干热，为虚烦不寐，或梦魇不宁，为口苦舌干，或口舌糜烂；在肺则为痰嗽干咳，为气逆喘促，为鼻中气热，为颧红吐衄，甚则吐涎白沫，侧眠咽痛，音哑声嘶；在肝则为寒热如疟，为颈项瘰疬，为胁胀肋疼，为两目涩痛，为头晕眼花，为多怒，为吐血；在脾则为食减不化，为恶心呕吐，为胀满腹疼，为肠鸣泄泻，肌肉消瘦。这都是五脏虚劳的本证。《内经》说：治病必求其本。须审其因何致损，何脏受伤。如因于色的，则知肾伤，纵有其他经夹证，亦当补肾为主，而兼治夹证。若因于酒的，以清肺为先也。
【炳章按】景岳说：虚损之症，必有所因，而似损非损之症，其来则骤。盖以外感风寒不为解散，而误作内伤，或用温补，或用清凉，或用消导，以致外邪郁伏，久留不散，而为寒热往来，及为潮热咳嗽。其证全似劳损，若用治损之法，滋阴等剂以治，愈更留邪，热蒸日久，非损成损矣。欲辨此者，但当审其并无积渐之因，或身有疼痛，而微汗则热退，无汗则复热；或见大声咳嗽，脉虽弦紧，而不甚数，或兼和缓等症，则虽病至一二个月，而邪有不解，病终不退者，本非劳损，误治以假弄真也。如寒热往来不止者，宜用一二三四五柴胡等饮，斟酌用之。兼咳嗽者，柴陈煎。若脾肾气虚，而兼咳嗽者，金水六君煎。或邪有未解，而兼寒热者，仍加柴胡。（诸方均见景岳《新方八阵》。）有一种血分郁滞，气行而血不行，徒为蒸热，俟蒸气散，微汗而热退者，此宜活血为主。总之外感多而虚劳少者，以解外感表邪为重，惟避忌刚燥伤阴之味足矣。若外感轻微内虚甚者，则阳虚护阳，阴虚滋阴，见证施治，必须详辨属虚属实，属寒属热，斟酌尽善，庶几不误治矣。
又按吴又可说：凡人向有他病羸弱，或久疟，或内伤瘀血，或吐血、便血、咳血，男子遗精白浊，精气枯涸，女人崩漏带下，血枯经闭之类，以致肌肉消烁，邪火独存，故脉近于数也。此际稍感疫气，医家病家，见其谷食暴绝，更加胸膈痞闷，身疼发热，彻夜不寐，指为原病加重，误以绝谷为脾虚，以身痛为血虚，以不寐为神虚，遂投参、术、归、地、茯神、枣仁之类，愈进愈危。知者稍以疫法治之，发热减半，不时得睡，谷食渐进，但数脉不去，肢体时疼，胸胁锥痛，过期不愈，医以杂药频试，补之则邪火愈炽，泻之则损脾坏胃，滋之则胶邪愈固，散之则经络益虚，疏之则精气愈耗，守之则日削近死。盖但知其伏邪已溃，表里分传，里证虽除，不知正气衰微，不能托出，表邪留而不去，因与血脉合而为一，结为痼疾也。肢体时疼者，邪与荣气搏也。脉数身热不去者，邪火病郁也。胁下锥痛者，火邪结于膜膈也。过期不愈者，凡疫邪交卸，近在一七，远在二七，甚至三七，过此不愈者，因非其治，不为坏症，即为痼疾也。夫痼疾者，所谓客邪胶固于血脉，主客交浑，最难得解，且愈久益固。治法当乘其大肉未消，真元未败，急用三甲散。（鳖甲、龟甲炙各一钱、炒穿山甲、蝉衣、僵蚕、煅牡蛎、当归各五分、土鳖虫三个、炒白芍七分、甘草三分，为末，水二钟，煎八分，滤清温服。）多有得生者。若素有老疟，或瘅疟者，加牛膝、首乌各一钱。若胃弱作泻者，各药宜用九蒸九晒。若素有郁痰者，加贝母一钱。老痰者，加栝蒌霜五分。若呕者勿用。若咽干作痒者，加花粉、知母各五分。若素有干咳者，加甜杏仁捣烂二钱五分。若素有内伤瘀血者，倍土鳖虫，加桃仁研一钱。是证外感夹体虚，若非审慎周详，一或误治，死生随之。
【荣斋按】本节俞氏所讲，侧重内伤虚劳，对于“夹劳伤寒”很少提及，形成脱离主题的一篇作品。廉臣先生引汪缵功一段学说，更是单纯的虚劳文本。我认为“夹劳伤寒”，首先应明确的是虚劳病患而患了伤寒；既不是因伤寒而变成的虚劳，更不是单纯的虚劳症。确定了主题，再帮助夹劳伤寒的证治，自然不致“喧宾夺主”了。为了要搞清这个问题，特转录戴麟郊的四损、四不足两篇文本，以作补正。《四损篇》说：“大劳、大欲、大病、久病后为四损，气血两虚，阴阳并竭，复受温邪，正虚则邪入愈深，邪深则传化难出，汗下伤正而正脱，补助郁邪而邪锢，多不可治。当此两难之际，于是乎有补泻合用之法，有先补后泻之法，先泻后补之法。凡人参败毒散，黄龙汤，竹叶石膏汤，皆补泻合用之法也；先用补剂，后施汗下，先补后泻之法也；先用汗下，后施补剂，先泻后补之法也”。四不足篇说：“四损由人事，四不足由天禀，四损在临时，四不足在平素；然四不足亦有由四损而来者，不得谓四损外便无不足也。四不足者，气、血、阴、阳也。气不足者，气不足以息，语言难出也；感邪虽重，反不成胀满痞塞，凡遇此症，纵宜宣伐，必以养气为主。血不足者，面色痿黄，唇口刮白也；感邪虽重，面目反无阳色，纵宜攻利，必以养血为主。阳不足者，或四肢厥逆，或肌体恶寒，恒多泄泻，至夜益甚，或口鼻气冷，受邪虽重，反无发热苔刺烦渴等证；纵宜攻利清热，必先之以温补，待其虚回，实证全见，然后以治热之法治之。阴不足者，自然五液干枯，肌肤甲错，感邪虽重，应汗不汗，应厥不厥，纵...”
(Also known as Cold Damage complicated with Deficiency Consumption)
[Etiology] The syndrome of Consumption (Xulao, a chronic wasting disease characterized by deficiency and heat) is caused by individuals with Qi deficiency and weakness. After excessive labor and injury, the Middle Qi (Spleen and Stomach energy) becomes insufficient and sinks into the Liver and Kidney. When Yin Fire (pathogenic fire arising from Yin deficiency) flares up alone, it causes fever and headache. When Ying (Nutritive) and Wei (Defensive) Qi lose their guard, wind aversion and cold aversion occur. If additionally affected by Wind-Cold pathogens, internal and external heat are generated, making the condition more severe.
[Symptoms] Headache and fever, or high fever on the skin, wind aversion, and cold aversion, accompanied by thirst and desire to drink. Symptoms worsen in the late afternoon (Dibang), or persist day and night. The presentation resembles Yangming Disease treated with Baihu Tang (White Tiger Decoction). However, the pulse differs as it is not long, full, surging, and rapid. Alternatively, there may be shortness of breath with irritability, upward rushing of Qi with wheezing, lethargy and desire to sleep, limbs that cannot support themselves, spontaneous sweating that does not stop, and loss of taste. There is also the case where Yin Fire boils over; resting in cool places suppresses Yang Qi, preventing it from circulating and protecting the exterior, leading to intolerance to Wind-Cold, which mimics external contraction. The distinction lies in shortness of breath, reluctance to speak, and fatigue. Whenever Yuan Qi (Original Qi) is insufficient and Heart Fire flares up alone, ascending to the Yang aspect, headache, thirst, irritability, and muscle heat occur. Although the pulse is surging and large, it is powerless upon heavy pressure; this is called "Heat in the Middle" (Re Zhong). If Spleen and Stomach have been deficient for a long time, with declining Yang Qi, bones feel weak, legs cannot support the body, there is no thirst or irritability, but frequent urination and sweating occur. The pulse is large and rough; this is called "Cold in the Middle" (Han Zhong). Yin pathology involves cold stomach, nausea, difficulty digesting food, phlegm-drool, fatigue, loose stools, and frequent urination. Yang pathology involves dry mouth, hoarseness, sore throat, irritability, craving for flavors, dryness and constipation, and dark urine. Heat steaming upwards causes wheezing, coughing, blood in sputum, cracked lips, red face, tinnitus, and vertigo, leading to Lung萎 (Fei Wei, lung atrophy) or Lung Abscess (Fei Yong). Heat steaming in the middle causes distending pain in the hypochondrium and ribs, limb fatigue, polyphagia with easy hunger, and emaciation despite good appetite. Heat steaming downwards causes hypersexuality, nocturnal emission, lower back pain, soft legs, dryness and constipation, strangury, turbid urine, and spermatorrhea. Generally, mental worry, labor, and external contraction injure Yang; injuries to Yang manifest descending from above. Sexual indulgence, drunkenness, and internal injury injure Yin; injuries to Yin manifest ascending from below. Descending injury first affects Qi: First damage to Lung affects voice and skin/cou-li; Lung governs skin and hair, so hair falls out. Second damage to Heart affects blood vessels and complexion; Heart governs blood vessels, so vessels become deficient and fail to nourish Zang-Fu. Third damage to Stomach affects diet; Stomach governs muscles, so muscles waste away. Fourth damage to Liver affects spasms and pain; Liver governs sinews, so sinews relax and cannot hold. Fifth damage to Kidney affects bones; Kidney governs bones, so bone atrophy prevents rising from bed; Kidney controls two passages, so incontinence occurs. This is first injuring Yang, then affecting Yin. If Yang exhausts below, isolated Yin cannot survive alone, and it becomes incurable. Ascending injury first affects Essence: First damage to Kidney dries up the source. Second damage to Liver causes blood movement and sinew withering. Third damage to Spleen causes phlegm-drool congestion. Fourth damage to Heart causes loss of Shen (Spirit) guard. Fifth damage to Lung causes shortness of breath and panting. This is first injuring Yin, then affecting Yang. If Yin exhausts above, isolated Yang cannot survive alone, and it becomes incurable. However, both types of damage take Spleen and Stomach as the critical pass of life and death. Spleen and Stomach belong to Earth, the root of all things. If the disease passes above this point, transmitting to Liver and Kidney, it is incurable. If it passes below, transmitting to Heart and Lung, it is incurable. Thus, it is said: Lung and Heart damage leads to Shen decline; Liver and Kidney damage leads to form deterioration; Spleen and Stomach damage prevents food from transforming into Blood and Qi. Once transmission is deep, hoping for revival is extremely difficult.
[Pulse] Internal injury arises from within, so the Right pulse is broad and large. External contraction enters from outside, so the Left pulse is floating and flourishing. A normal person with a large pulse indicates Labor (Lao). An extremely deficient pulse also indicates Labor. Internal injury from labor shows a wide and uncontrolled pulse; if Stomach Qi is damaged, the pulse becomes hidden and hard to find. Labor consumption pulses may be wiry or large. Large and powerless indicates Yang deficiency, potentially becoming fine. Wiry and powerless indicates Yin deficiency, potentially becoming rapid. Large pulses are easier to treat as Blood and Qi are not exhausted and can be gathered and corrected. Wiry pulses are difficult to treat as Blood and Qi are depleted, making recovery hard. Chi (Cun-Kou) pulse surging and large indicates Yin deficiency with Fire flourishing. Left fine and Right strong indicates Righteous Qi deficiency and Pathogenic Excess. Fine and rapid, or soggy and scattered pulses, are untreatable.
[Treatment] External contraction of Wind-Cold damages the Form; internal injury to Spleen and Stomach damages Qi. Damaging Form is Excess, which can be purged. Damaging Qi is Deficiency, which must be tonified. Therefore, sweating, vomiting, and reducing are purgative methods. Warming, harmonizing, nourishing, and regulating are tonifying methods. For Deficiency Consumption complicated with external contraction, one should support the Righteous and expel the Pathogen. Generally, for Spleen-Stomach injury complicated with external contraction, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), modified according to Six Meridian syndromes. If Liver-Kidney Yin deficiency is complicated by exterior pathogens, use Ziyin Jianghuo Tang (Nourish Yin and Descend Fire Decoction) or Siwu Tang (Four Substances Decoction) with modifications. Treating consumption with excessive Great Cold medicines further empties the Middle; excessive Great Hot medicines further deplete Yin. One must Nourish Yin and Descend Fire to clear the source, resolve Phlegm and Harmonize Blood to clean the flow. Even with exterior pathogens, while releasing the exterior, one must still manage the consumption. If external contraction is mild and Heart is deficient, primarily use Guipi Tang (Restore the Spleen Decoction). For Spleen deficiency, use Buzhong Yiqi Tang. For Lung deficiency, use Shengmai San (Generate the Pulse Powder). For Liver deficiency, use Xiaoyao San (Free and Easy Wanderer Powder). For Kidney deficiency, use Dihuang Tang (Rehmannia Decoction). For combined Lung-Spleen disease with pathogenic stagnation, consumption cough, poor appetite, abundant phlegm, loose stools, and scanty urine, use Qingning Gao (Clearing and Calming Paste): Shengdi Huang (Radix Rehmanniae Preparata) 10 liang, Maidong (Herba Ophiopogonis) 6 liang, Zhi Baizhu (Rhizoma Atractylodis Macrocephalae Preparata) 6 liang, Jiegeng (Radix Platycodonis) 4 liang, Yiyiren (Semen Coicis) 10 liang, Chuan Bei Mu (Bulbus Fritillariae Cirrhosae) 2 liang peeled, Juhong (Pericarpium Citri Reticulatae Rubrum) 1 liang, Bohe (Herba Menthae) 3 liang, Longyan Rou (Arillus Longan) 10 liang peeled. Grind Yiyiren, Chuan Bei Mu, and Bohe into fine powder. Mash Longyan Rou. Decoct other herbs, remove dregs, mix with powder and mashed fruit, refine into paste. Hold in mouth and swallow. For combined Liver-Kidney deficiency, use Shengshu Dihuang Wan (Raw and Prepared Rehmannia Pill): Sheng Di Huang and Shu Di Huang each 5 liang, Baishao (Radix Paeoniae Alba), Fuling (Sclerotium Poriae), Tianma (Rhizoma Gastrodiae), Digupi (Cortex Lycii), Xuanshen (Radix Scrophulariae) each 1.5 liang, Chuanxiong (Rhizoma Chuanxiong) 1 liang, Danggui (Radix Angelicae Sinensis), Shihu (Caulis Dendrobii), Heidou (Semen Sojae Nigrum) each 3 liang. Grind into powder, make honey pills, take 3 qian with warm water. For combined Lung-Heart deficiency, use Renshen Yangrong Tang (Ginseng Nourishing Vigor Decoction - see previous). For dual Qi-Blood deficiency, use Bazhen Tang (Eight Treasures Decoction - see previous). For kidney injury from labor, exhaustion, essence deficiency, and dual Yin-Yang deficiency, use Shibai Wan (Ten Tonics Pill): Shu Di Huang 8 liang, Lianrou (Semen Nelumbinis), Huaiyao (Rhizoma Dioscoreae) each 4 liang, Fuzi (Radix Aconiti Lateralis Preparata), Rougui (Cortex Cinnamomi), Zexie (Rhizoma Alismatis), Danpi (Cortex Moutan), Wuweizi (Fructus Schisandrae) each 1 liang, Lurong (Cornu Cervi Pantotrichum) 3 liang. Grind into powder, refine honey, pound thousand times to make pills, take 3-5 qian with boiling water. For Spleen-Kidney dual deficiency, add Chenxiang (Lignum Aquilariae Resinatum) and Sharen (Fructus Amomi Rotundus) to Spleen tonification; add Wuweizi and Rougui to Kidney strengthening. For Wind-Labor or Stagnation-Labor, differentiate pulse and symptoms. For Chuanshi Laozhai (Infectious Consumption/Tuberculosis), use Heihu Dan (Black Tiger Pill) formulas. First take Heihu Dan to expel labor worms; yellow/white stool is treatable, black/green is not. (Zhen Xihuang [Calculus Bovis] 1 qian, Zhenawei [Resina Ferulae] 1 qian, Nanmuxiang [Lignum Saussurae] 3 qian, Jinneijin (Endothelium Corneum Gigeriae Galli) roasted 2 qian, Zhen Leiwang (Semen Visceriae) 3 qian. Grind fine. Mix with crushed Shijunzi (Fructus Quisqualis) 2 liang and previous powder 1 liang. Make pills with flour paste.) Next take Xiaohong Wan (Little Red Pill) to purge intestines and expel worms, supplementing previous treatment; usable for rapid and solid pulses. (Jinwen Dahuang [Radix et Rhizoma Rhei Preparata] 1 liang, dried and ground, mixed with previous powder 1 liang. Make pills with refined white honey, coat with Zhusha [Cinnabaris].) Third take Dachong Huaji Wan (Worm-Beating and Accumulation-Resolving Pill) for remaining worms; usable for deep and solid pulses. (Dahuang powder 3 liang, Binglang powder 3 liang, Heiqiu powder 3 liang. Make pills with flour paste.) Use these three formulas to expel foul matter, burn with fierce fire, bury in deep pit, nourish with scallion porridge to hope for gradual recovery. Medicate according to Zang-Fu syndromes. Add Qinghao (Herba Artemisiae Annuae), Baibu (Herba Stemonae), Wumei (Fructus Mume), Zhusha (Cinnabaris) to tonifying drugs. Modern practitioners often use Siwu Tang plus Zimu and Huangbai for consumption, not knowing Siwu Tang is purely Yin, acting like Autumn/Winter, not generating things. Blood-invigorating drugs are often cloying, unsuitable for those with much phlegm and little food. They are moistening; long-term use causes loose bowels. Moreover, Zimu and Huangbai are bitter-cold, clearing excess fire. Named "Nourishing Yin," they actually dry and damage Blood. Named "Descending Fire," bitterness enters Heart first; long-term use increases Qi, actually assisting Fire. Their damaging effect on Stomach goes without saying; this must be known.
[Commentary by Xiu] Generally, external contraction of cold and heat starts simultaneously without pause; internal injury cold and heat start intermittently. External contraction headache feels like splitting; internal injury headache comes and goes. External contraction cold aversion persists even near fire; internal injury cold aversion resolves with warmth. External contraction wind aversion cannot tolerate any thief-wind; internal injury wind aversion dislikes slight drafts. External contraction fever has no rest, subsiding only after sweating; internal injury fever varies day and night, feeling cool when slightly exposed. External contraction bone/joint pain is unbearable, forcing bed rest; internal injury limbs cannot support, causing weakness and fatigue. Sometimes Qi deficiency and Fire flourishing lead to bone dissolution and sinew relaxation, becoming chronic. Internal injury Shen is confused and tired, speech lazy, starting heavy then light; external contraction Shen is vigorous, speech strong, starting light then heavy. Internal injury palm hot, back of hand not hot; external contraction back of hand hot, palm not hot. Internal injury signs show in mouth, hence loss of taste; external contraction signs show in nose, hence nasal obstruction. This is the differentiation method for external signs of Labor complicated with external contraction. Yin deficiency below forces Yang upward, causing red malar flush and red face/lips. As Zhang Zhongjing said: "Face wearing Yang" is due to lower deficiency.
[Commentary by Lian] Regarding detailed differentiation of Deficiency Consumption, Wang Zuangong's discussion is unparalleled. He states: Consumption is all due to internal injury. Wine damages Lung, causing damp-heat steaming and Lung Yin consumption. Lust damages Kidney, causing essence/blood emptiness and unrestrained Ministerial Fire. Worry damages Heart, consuming Blood and allowing Fire to flare. Labor damages Spleen, generating heat and devouring True Yin. Anger damages Liver in two ways: Depressed anger causes internal Liver Fire blazing and burning Blood; sudden anger causes Liver Fire ascending and hematemesis. These five consume Essence/Blood. Daoist Scripture says: Tears, saliva, Jing, Essence, Sweat, Blood are seven spiritual substances belonging to Yin. Yin deficiency with internal heat forms Consumption. Mostly caused by wine and lust. However, unmarried youths suffer this due to congenital insufficiency or maternal Yin deficiency. Nuns, widows, or virgins with delayed periods suffer Qi/Blood stagnation, causing malaria-like chills/fever, morning cool/evening hot, anorexia, irregular menses, amenorrhea, forming this disease, mostly due to internal stagnant Fire. Medical texts confuse Qi/Blood/Yin/Yang deficiency treatments. Not knowing Qi deficiency presents with pale face, dull spirit, weak speech, weak limbs, weak pulse. Yang deficiency presents with cold body, fear of cold, cold extremities, clear urine, loose stools, deep/small/slow pulse. These two respond to Ginseng/Aconite warming tonification and are treatable. This is Qi/Yang deficiency. Although Blood loss uses Qi tonification, it refers to sudden massive hemorrhage in non-deficient persons, like postpartum women. Others suffering this mostly indulge lust, damaging Yin. Kidney symptoms: lower back/leg pain, bone-steaming night sweats, night fever, bone joint pain like breaking, nocturnal emission, tinnitus, hot soles. Heart symptoms: palpitations, dry hot palms, vexation insomnia, nightmares, bitter/dry mouth, oral ulcers. Lung symptoms: phlegm cough, dry cough, rebellious Qi/wheezing, hot nasal breath, malar flush/hemoptysis, white foam sputum, side-sleeping sore throat, hoarseness. Liver symptoms: malaria-like chills/fever, cervical lymphadenopathy, hypochondriac distension/pain, dry/painful eyes, dizziness/blurred vision, irritability, hematemesis. Spleen symptoms: poor appetite/indigestion, nausea/vomiting, abdominal distension/pain, borborygmus/diarrhea, muscle wasting. These are fundamental Zang-Fu consumption syndromes. Classic says: Treat disease seeking its root. Determine cause and injured Zang. If due to lust, know Kidney is injured; even with other meridian complications, prioritize Kidney tonification while treating complications. If due to wine, prioritize Lung clearing.
[Commentary by Bingzhang] Jingyue said: Consumption must have a cause. Syndromes resembling consumption but not true consumption appear suddenly. Due to unresolved external Wind-Cold misdiagnosed as internal injury, or treated with warming, cooling, or resolving, causing pathogen stagnation. This leads to alternating chills/fever and tidal cough, mimicking consumption. Using consumption treatments like Yin-nourishing agents retains pathogen, causing heat steaming, turning false consumption into true consumption. To differentiate, check for lack of gradual cause. If body pain subsides with slight sweat and returns without sweat; or loud cough with wiry/tight but not rapid pulse, or harmonious pulse; even after 1-2 months, if pathogen doesn't resolve and disease doesn't retreat, it is not consumption, but misdiagnosis. For persistent alternating chills/fever, use Chaihu drinks (1-5),酌情. For cough, use Chaichen Jian. For Spleen-Kidney Qi deficiency with cough, use Jinshui Liujun Jian. If pathogen unresolved with chills/fever, add Chaihu. (All formulas in Jingyue's New Formulas Eight Arrays.) For blood-stasis stagnation where Qi moves but Blood doesn't, causing steaming heat resolved by slight sweat, prioritize invigorating Blood. Generally, for more external than consumption, prioritize releasing exterior, avoiding drying-damaging-Yin foods. For mild external/severe internal, protect Yang if Yang deficient, nourish Yin if Yin deficient, treat based on syndrome, distinguishing deficiency/excess and cold/heat carefully to avoid error.
Wuke also said: People with prior weakness, chronic malaria, internal blood stasis, hematemesis/hematochezia/hemoptysis, male spermatorrhea/cloudy urine, essence depletion, female metrorrhagia/leukorrhea/blood dryness/amenorrhea, leading to muscle wasting and sole pathogenic fire, have near-rapid pulses. If slightly infected with epidemic Qi, doctors/patients see sudden anorexia, chest oppression, body pain, fever, insomnia, attributing to worsening original disease. Mistaking anorexia for Spleen deficiency, body pain for Blood deficiency, insomnia for Shen deficiency, they administer Ginseng, Atractylodes, Angelica, Rehmannia, Poria, Ziziphus. Condition worsens. Knowledgeable doctors treat with epidemic methods: fever halves, sleep returns, food intake increases, but rapid pulse persists, body pain continues, hypochondriac stabbing pain, prolonged non-healing. Doctors try miscellaneous drugs: Tonifying increases pathogenic fire; Purging damages Spleen/Stomach; Moistening fixes pathogen; Dispersing damages meridians; Regulating consumes essence; Guarding leads to daily decline near death. They know latent pathogen has erupted, transmitting interior/exterior, interior cleared, but don't know Righteous Qi is weak, unable to push out, so exterior pathogen remains, merging with Blood vessels, forming chronic disease. Body pain: pathogen fights Ying Qi. Rapid pulse/fever: pathogenic fire/stagnation. Hypochondriac stabbing: Fire knotting in diaphragm. Prolonged non-healing: Epidemic exchange takes 7 days to 21+ days; beyond this, improper treatment leads to bad syndrome or chronic disease. Chronic disease means guest pathogen firmly stuck in blood vessels, host-guest confusion, hardest to resolve, harder with time. Treatment:趁 flesh not wasted, Yuan not failed, urgently use Sanjia San (Biejia and Guijia calcined each 1 qian, Chuan Shan JIA roasted, Chan Yi, Jiang Can, Mu Li calcined, Danggui each 5 fen, Tu Bie Chong 3, Baishao roasted 7 fen, Gancao 3 fen. Grind. Water 2 zhong, decoct to 8 fen, filter, warm drink.) Many survive. If old malaria or Dan malaria, add Niuxi and Shouwu each 1 qian. If weak stomach/diarrhea, use nine-steamed-nine-dried herbs. If stagnant phlegm, add Beimu 1 qian. Old phlegm, add Gualou Shuang 5 fen. If vomiting, do not use. If dry/itchy throat, add Huafen and Zhimu each 5 fen. If chronic dry cough, add sweet Xingren mashed 2.5 qian. If internal blood stasis, double Tu Bie Chong, add Taoren ground 1 qian. This syndrome is external contraction with body deficiency; if not careful, misdiagnosis leads to death or life.
[Commentary by Rongzhai] Yu's section focuses on internal deficiency consumption, rarely mentioning "Consumption-complicated Cold Damage," becoming off-topic. Lianchen's citation of Wang Zuangong is pure consumption text. I believe "Consumption-complicated Cold Damage" must first clarify: a consumption patient contracting Cold Damage; not Cold Damage turning into consumption, nor pure consumption. With theme established, treating this syndrome won't overshadow the main topic. To clarify, I transcribe Dai Linjiao's "Four Damages" and "Four Insufficiencies." "Four Damages": Great labor, great lust, great illness, post-long illness are four damages. Dual Qi-Blood deficiency, dual Yin-Yang exhaustion, re-infected with Warm Pathogen. Righteous deficiency allows deep pathogen entry; deep pathogen makes transmission hard. Sweating/Purging damages Righteous leading to collapse; Tonifying traps Pathogen. Mostly incurable. In this dilemma, combine Tonify/Purge, Tonify then Purge, or Purge then Tonify. Ren Shen Baidu San, Huanglong Tang, Zhuye Shigao Tang are combined methods. Tonify then sweat/purge is Tonify-Purge. Sweat/purge then tonify is Purge-Tonify. "Four Insufficiencies": Four Damages from human affairs, Four Insufficiencies from congenital endowment. Damages are temporary, Insufficiencies are habitual. But Insufficiencies can come from Damages. Four Insufficiencies are Qi, Blood, Yin, Yang. Qi insufficiency: shortness of breath, difficulty speaking; even with heavy pathogen, no distension/oppression; even if purging indicated, prioritize Qi nourishment. Blood insufficiency: sallow face, pale lips/mouth; even with heavy pathogen, no Yang color; even if attacking indicated, prioritize Blood nourishment. Yang insufficiency: cold extremities, cold body, frequent diarrhea worse at night, cold breath; even with heavy pathogen, no fever/thirst/coated tongue; even if clearing indicated, first warm-tonify, wait for deficiency recovery and full excess signs, then treat heat. Yin insufficiency: five fluids dry, skin rough; even with heavy pathogen, should sweat but doesn't, should have cold limbs but doesn't, even..."