（论一首脉证九条方九首）
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。今脉和。紧去则愈。
〔补注〕阳所以统夫阴者也。统阴则血必随气行矣。乃经言血痹。而不言气。何哉。
不知血之痹。由于气之伤也。经曰。入于脉则血凝而不流。夫所以不流者。气为
邪阻也。然邪之足以伤者。必因于作劳。则卫气不能固外。而后邪得以入之。故
仲景发其不流之故。以明得病之由。言天下惟尊荣人。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。汗易出也。夫汗者。
血之液也。卫不固。斯汗出。汗出斯阳气虚。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。何以反得寒脉耶。盖邪随血脉上下。阻滞汁沫。未有不痛者。故痛为
脉紧也。针以泄之。引阳外出。则邪去而正自伸也。否则终于痹也。然则固外之
阳。所重惜也。富贵者能知阳气素不自强。则不敢作劳。即不获已而劳。或亦有
以知节而不至于汗出。汗出矣。不致卧后动摇。又何致虚风痹血耶。仲景言虚
劳。乃以血痹发其先。良有以也。
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。
黄 桂枝五物汤方
黄 （三两） 桂枝（三两去皮） 芍药（三两） 生姜（三两） 大枣（十二枚）
上五味。以水六升。煮取二升。去滓。温服七合。日三服。
〔补注〕此条是由上条既痹之后。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。盖身为我身。则体为我体。
而或为疼痛。或为麻木。每与我相阻。其为不仁甚矣。故以风痹象之。非真风痹
也。经曰。风寒湿三者合而成痹。然何以单言风痹也。邪有兼中。人之受者必有
所偏。如多于风者。则其痛流行不常。淫于四末。盖血以养筋。血不通行。则筋节
为之阻塞。且血藏于肝。肝为肾子。肾既受邪。则血无不壅滞。于是以黄 固卫。
芍药养荣。桂枝调和荣卫。托实表里。驱邪外出。佐以生姜宣胃。大枣益脾。岂非至当不易者乎。
夫男子平人。脉大为劳。极虚亦为劳。
〔补注〕虚劳为不足之病。则必为不足之脉也。经云。烦劳则张。精绝。正以劳则阳
气外张。举之有余也。然其余也。既非内蕴之充。又岂外邪之助。以是大为劳也。
至问脉之重虚。对以上虚尺虚。言上下皆虚也。又云。脉虚者。不象阴也。不似手
太阴之充盛也。故极虚者亦云劳。然则大者固为劳力饥饱。而极虚者则不免于房劳矣。
男子面色薄者。主渴及亡血。卒喘悸脉浮者。里虚也。
〔补注〕此仲景出望之法以教人也。经曰。心者生之本。神之变。其华在面。而其充
在血脉。故手少阴为君主之官。神明出焉。然使忧愁思虑。则足以伤之。夫神伤
则体弱。体弱则所生者不足。自未能荣于色矣。盖心所以生血。而色者。神之旗
也。阴血既少。则津液自枯。故主渴也。渴必引水以自救。而渴不复为水止。则饮
多而停于心下。阻其呼吸之隧而为喘。失其君火之司而为悸。所不免也。若此
者脉必浮。岂非所生之血。不足鼓其脉于外乎。心所以合脉者也。于是知其心气之虚于里焉也。
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。
〔补注〕人之身以阳气为主。惟作劳则动伤元气。故于此先言脉。并言证。以见男
子之阳虚也。夫虚者。劳之本脉也。举按不实之中。而复见少厥二阴之象。则其
为内伤阳气何如。而阳虚者必恶寒。内伤者多发热。故脉经云。假令寸口脉微。
名曰阳不足。阴气上入阳中。则洒淅恶寒也。假令尺脉弱。名曰阴不足。阳气下
陷入阴中。则发热也。今三部同等。已非上入下陷之候。则其无寒热可知。然膻
中者。气之海也。谷之精气。浊者化卫。而一为宗气。行胸中以司呼吸。于是呼出
者心肺主之。吸入者肾肝主之。心肺阳也。肾肝阴也。夫以举按豁然之脉。而只
见其有阴无阳。是中之宗气不能为之资。斯呼者无以壮其出。而吸者不能深
其入。遂令升降无力。而短气不足以息也。中州之气既虚。使水谷未能消腐。而
清气不能上升。则肾阳未旺。肝气下乘。故频圊而里急。膀胱为州都之官。气不
化而水道不出。至如经谓十二经脉。三百六十五络。皆上于面。然肺为气之总
司。若气虚则肺亦虚。故面虽诸阳之会。而色独如金也。且阴气盛则目瞑。今阳
衰。有不为之目瞑者乎。兼衄者。阳络伤则血外溢而为衄也。少腹满者。因小便
不利也。此为劳伤元气。所以至此。然则仲景即不言治法。自当调以甘药。培中
土以益元阳。不待言矣若舍黄 建中。又何以为法耶。
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。
〔补注〕夫脉之大有二。一曰大为实。一曰大则为芤。芤则为虚。今属之于劳。则所
伤在元气。而无血以和之也。然伤者在气而何损于血也。经曰。阳生则阴长。故
无阳则阴无以生。无阴则阳无以化。举按之间。但觉其大。而非有力于去来也。
然何以他脉不兼见。夫惟不兼见。故盛于外者。非由于素养之得宜。只因营卫
之气。满于中焦。致火不生土而太阴病。故手足烦者。脾属四肢也。经曰。烦劳则
张。精绝。辟积于夏。使人煎厥。故逢收藏之时而稍瘥。不似春夏之散见也。经曰。
强力举重则伤肾。又曰。肾者精之处也。其充在骨。夫既真阳不能守。而阴精有
不外遗者乎。酸削不能行。亦所必至也。
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。
桂枝龙骨牡蛎汤方
桂枝（一两） 芍药（一两） 甘草（二两炙） 生姜（一两）
大枣（十二枚） 龙骨（三两） 牡蛎（三两）
上七味。以水七升。煮取三升。分温三服。
〔补注〕经曰。肾主水。受五脏六腑之精而藏之。又曰。厥气接于阴器。则梦接内。盖
阴器。宗筋之所系也。而脾胃肝胆之筋亦皆聚焉。故厥阴主筋。则诸筋统于肝
也。肾为阴。主藏精。肝为阳。主疏泄。故肾之阴虚。则精不藏。肝之阳强。则气不固。
若遇阴邪客之。与所强之阳相感。则或梦或不梦。而精脱矣。是肾虚则无有不
虚者也。膀胱与肾为表里。故少腹弦急为阴结。而气不化者可知。水不生木。则
血不养筋。致宗筋惫而阴头寒。以致虚风生则目眩。血不会则发脱。种种虚状。
悉本诸此。而其脉则为虚为芤为迟。可想而知也。夫阳虚则水谷不化。阴虚则
亡血失精。故芤为阴虚。复阴阳相搏而为动。微则阳微。又微紧相搏而为邪。皆
脉经所云至虚者也。然则男子失精。女子梦交。何能已哉。此病之原。皆起于肾
之不固。遂令三焦皆底于极虚矣。斯于法必以固精为主治也。于是以桂枝和
荣卫。芍药收阴。生姜散寒。甘草、胶、枣益脾补气。更用龙骨以涩其阳。牡蛎以涩
其阴。庶肾肝既固。荣卫调和。而诸证自愈尔。
男子脉浮弱而涩。为无子。精气清冷。（此条一本在夫失精家之前）
〔补注〕浮、为阳脉也。举之有。按之无也。乃于举之时未见其力。则浮兼弱矣。浮弱。
阳气之虚也。若涩。阴脉也。为阴血不足。脉经曰。荣为根。卫为叶。荣卫俱微。则枝
叶枯槁。是生气微矣。又何能必其有子乎。正以精气之清冷也。其在诗曰。洌彼
下泉。浸彼苞稂。谓伤其生也。
男子平人。脉虚弱细微者。善盗汗也。
〔补注〕虚弱细微。绝不见阳。阳虚甚矣。经云。阴气有余。身寒多汗。然所谓有余者。
非诚余也。即阳之不足言之也。故肺主气。又合皮毛。司腠理。惟阳气衰。则卫不
固而自汗出。邪在于内。则元府不闭。而汗从腑脏出。邪在于外。则腠理不致。而
汗从经络出。脏腑之阴捍格。卫气浮散于外。无所根据从。则汗出卫虚。水谷气散
脱者汗自出。此皆不因动作而自出之汗也。至盗汗则阳衰因卫虚。而所虚之
卫行于阴。当目瞑之时。无气以庇之。故腠开而汗。若一觉则行阳之气。复散于
表而汗止矣。故曰盗汗也。夫至盗汗。而其虚可胜道哉。
人年五六十。其病脉大者。痹挟背行。苦肠鸣。马刀侠瘿者。皆为劳得之。
〔补注〕人生五十始衰。六十天癸竭。则已精少肾衰矣。使复有动作。遂令阳虚而
邪得以客之。痹太阳经道。盖太阳行于背者也。经谓阳气者。精以养神。柔以养
筋。开阖不得。寒气从之。乃生大偻。故病痹挟背行也。又云。中气不足。肠为之苦
鸣。至陷脉为 。留连肉腠。为马刀侠瘿。瘿者。即瘰 也。以其形长如蛤。为马刀。
或在耳前后。连及颐颔头下。或下连缺盆。以及胸胁。皆谓之马刀。此手足少阳
经主之也。总以动作忿怒。忧忿气郁过甚。而为风邪内腠。故其脉则大而举按
不实。其因则劳而元气不足。仲景言之。恐后人复疑为有余而误攻其邪耳。
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。
〔补注〕人之所以运动无苦。四体温和。食入自化者。皆吾身之真阳为之也。故阳
固则流行于脉中者。各安其部。而无阳衰阴见之象。今沉。少阴脉也。以其所处
之位至下也。若寸关皆见。则各腑脏之阳何在乎。况其兼者。曰小曰迟。脉经云。
小者气血俱少。又云迟为荣中寒。彼此俱阴。绝不见阳。则其气已大泄矣。故名
脱也。夫尺虚之人。行走 然。象其步履之不正也。而况于气脱者乎。故行稍疾
上喘喝。虽曰呼出心肺。吸入肾肝。自非宗气行其呼吸。则升降出入。且无以安
于自然矣。况勉强以动其气乎。是故人之阳。盛于中焦者也。脾之阳不固。则四
肢上逆而冷矣。且脾之阳。又原于下焦者也。肾之真阳大虚。则不足以消腐水
谷。为腹满。为溏泄。正未有已也。
脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。寒虚相搏。此名为革。妇人则
半产漏下。男子则亡血失精。
〔补注〕伤寒论中有此条。方中行先生注。寒言阳气减损而不足。芤言阴血衰竭
而空虚。革言革易常度也。妇人阴血充足而能化。则得坤顺之常。半产漏下。则
不足以言坤之资生矣。男子阳精充盛而能化。则得干健之常。亡血失精。则不
足以言干之资始矣。故天地之大德曰生。男不足以言资始。女不足以言资生。
则人道大坏。故曰革也。一说革读亟。变而促迫也。亦通。
愚按、礼曰。夫子之病革矣。不可以变。即音亟也。
虚劳里急。悸衄。腹中痛。梦失精。四肢 疼。手足烦热。咽干口燥。小建中汤主之。
小建中汤方
芍药（六两） 桂枝（三两去皮） 甘草（三两炙） 生姜（三两）
大枣（十二枚） 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。
〔补注〕经云。形气不足。病气不足。此阴阳俱不足也。不可刺之。刺之为重虚。盖气
不足者。如中气不健。频欲更衣。心下悸。或阳明内热而血外溢。或腹中痛。或梦
接内而遗。种种悉气之不足为之也。形不足者。即如四肢不但不强健而 疼。
甚至手足烦热。津液少而干燥。种种皆形之不足为之也。经谓不可刺。以重虚
者。宜补之以甘药。此其意惟仲景遵之。培中央以灌输腑脏百脉。主以小建中。正稼穑作甘之意也。
然观此证。则肾虚为多。水亏当壮水之主。以镇阳光。火衰则益火之源。以消阴翳。独仲景不屑
于此。而惟以树立中气为第一义者何居。圣人曰。精、谷气也。可见肾为藏精之处。伎巧出焉。苟非有五谷
之养。五味之调。则亦从何而生。然经又曰。精不足者。补之以味。假使胃不能纳。脾不能运。又
如之何。故圣人以建中主治。使中州之土。已坏复起。将饮食入胃者。游溢精气。上输于脾。
脾气散精。上归于肺。如经所云者。则五脏百脉自裕矣。岂但已病乎
哉。
虚劳里急诸不足。黄 建中汤主之。
黄 建中汤方
黄 （三两） 桂枝（三两） 芍药（六两） 甘草（三两）
生姜（三两） 胶饴（一升） 大枣（十一枚）
上七味。用水七升。煮取三升。去滓。温服一升。日三服。
〔补注〕不足之证不一。未有不因于气虚者。夫阳生阴长。气苟不充。则日就于损
（本篇包含一条总论、九条脉证论述和九个方剂）
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，如果因过度疲劳而汗出，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，在寸口和关上部位出现轻微紧象，适宜用针刺引导阳气运行。如果脉象调和，紧象消失，病就会痊愈。
〔补注〕阳气是统摄阴血的。统摄阴血，血液就会随着气机运行。既然经文提到“血痹”，却不提“气”的问题，为什么呢？不知道血痹的发生，是由于气机受损所致。经文说：“邪气进入血脉，就会导致血液凝滞而不流动。”之所以不流动，是因为气被邪气阻滞。然而，足以伤人的邪气，必定是因为劳作导致卫气不能固护体表，邪气才得以侵入。所以张仲景阐明血液不流动的原因，以说明发病的缘由。他说天下只有那些养尊处优的人，形体安逸而精神苦闷。形体安逸，所以肌肉丰盛；精神苦闷，所以骨骼柔弱。骨骼柔弱就不能耐受劳累，肌肉丰盛则气机不固，稍有劳困就容易出汗。汗是血的津液，卫气不固则汗出，汗出则阳气虚，即使是微风也能乘虚侵袭，从而导致血痹。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。而邪气侵入的部位，则表现为轻微紧象。“小”是正气受拘抑的现象，“紧”是寒邪入中的征象。然而仲景明明说是“微风”，为什么反而得到寒脉呢？大概是因为邪气随血脉上下运行，阻滞津液，没有不疼痛的，所以疼痛表现为脉紧。针刺可以泄邪，引导阳气外出，邪去则正气自伸，否则最终会导致痹症。那么，固护体表的阳气是非常重要的。富贵之人如果能知道阳气本来就不强壮，就不敢过度劳累；即使不得已而劳累，或者也知道节制而不至于汗出；汗出了，也不至于睡觉时翻动身体，又怎么会因为虚风而导致血痹呢？仲景谈论虚劳，却先从血痹发端，是有其道理的。
血痹病阴阳脉俱微弱，寸口和关上脉微，尺中脉轻微紧，外证表现为身体麻木不仁，像风痹的症状一样。用黄芪桂枝五物汤主治。
黄芪桂枝五物汤方
黄芪（三两） 桂枝（三两，去皮） 芍药（三两） 生姜（三两） 大枣（十二枚）
以上五味药，用水六升，煮取二升，去渣，温服七合，每日三次服用。
〔补注〕这一条是由于上一条所述的血痹之后，未能通过针刺引导阳气而痊愈，导致寸口脉微，现在是阴阳脉俱微，且寸关脉俱微，尺中脉轻微紧。既然小紧脉出现在尺部，说明邪气侵入更深，更难排出。为什么呢？正气虚弱的地方，就是邪气停留的地方。《脉经》称内外为阴阳，称上下也为阴阳。现在尺部脉小紧，那么微脉属于内外俱虚是明显的。如果用“不仁”来概括症状，身体是我的身体，肢体是我的肢体，但有时疼痛，有时麻木，常常与我相阻隔，这就是“不仁”了。所以用风痹来形容它，并不是真正的风痹。经文说风寒湿三气杂至合而为痹，为什么单说风痹呢？邪气有兼夹侵犯，人感受邪气必有偏颇。如风邪多，则疼痛游走不定，流淫于四肢末端。因为血能养筋，血不通行，则筋节为之阻塞。且血藏于肝，肝为肾之子脏，肾既受邪，则血无不壅滞。于是用黄芪固护卫气，芍药滋养营血，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，这难道不是最恰当不可改变的方法吗？
〔补注〕虚劳是属于不足的病，必然出现不足的脉象。经文说：“烦劳则阳气外张，精竭。”正是因为劳累导致阳气外张，举之有余。然而这种“有余”，既不是内蕴的充盛，也不是外邪的帮助，所以称为“大为劳”。至于问脉的重虚，是针对上虚和下虚而言，指上下皆虚。又说：“脉虚者，不像阴脉那样充盛。”不像手太阴肺脉那样充盛。所以极虚脉也称为劳。那么，大脉固然与劳力、饥饱有关，而极虚脉则不免与房劳有关。
男子面色淡白无华，主渴及失血。突然气喘心悸，脉浮的，是里虚。
〔补注〕这是仲景提出望诊方法以教导后人。经文说：“心是生命的根本，神明的变化所在，其荣华表现在面部，其充实在血脉。”所以手少阴心经是君主之官，神明由此发出。然而忧愁思虑足以损伤心神。神伤则体弱，体弱则生化之源不足，自然不能荣润面色。心主生血，而面色是神的旗帜。阴血既少，津液自然枯涸，所以主渴。口渴必饮水自救，但如果喝水后口渴仍不止，则饮水过多停聚于心下，阻碍呼吸通道而致喘，失去君火的统司而致悸，这都是难免的。如果是这种情况，脉必浮，难道不是因为所生之血不足，无法鼓动脉搏于外吗？心主合脉，由此可知心气在里是虚的。
男子脉象虚沉弦，无寒热症状，短气，腹中急迫，小便不利，面色白，时常眼花，兼有鼻衄，少腹胀满，这是劳损导致的。
〔补注〕人的身体以阳气为主，只有劳作才会动伤元气。所以在这里先讲脉，再讲证，以显示男子的阳虚。虚脉是劳损的根本脉象。在举按不实之中，又见到少阴、厥阴的脉象，那么内伤阳气到什么程度呢？阳虚的人一定怕冷，内伤者多发热。所以《脉经》说：“假如寸口脉微，名叫阳不足，阴气上入阳中，就会洒淅恶寒。”假如尺脉弱，名叫阴不足，阳气下陷入阴中，就会发热。现在三部脉同等，已经不是上入下陷的征候，那么无寒热是可以知道的。然而膻中是气海，谷物的精气，浊的部分化为卫气，清的部分化为宗气，行于胸中以主管呼吸。呼出由心肺主导，吸入由肾肝主导。心肺属阳，肾肝属阴。以举按豁然空虚的脉象，只见有阴无阳，是中焦的宗气不能资助，呼气无力，吸气不能深沉，遂令升降无力，短气不足以息。中焦之气既虚，使水谷不能腐熟消化，清气不能上升，则肾阳未旺，肝气下乘，所以频繁排便且腹中急迫。膀胱是州都之官，气不化则水道不出。至于经文说十二经脉、三百六十五络都上行于面，然而肺是气的总司，若气虚则肺亦虚，所以面部虽然是诸阳之会，但面色独如金色般苍白。且阴气盛则眼花，现在阳气衰，能不眼花吗？兼有鼻衄，是因为阳络受伤则血外溢而为衄。少腹胀满，是因为小便不利。这是劳伤元气，所以导致这些症状。然而仲景即不言治法，自然应当用甘药调理，培补中土以益元阳，是不言而喻的。如果舍弃黄芪建中汤，又用什么作为法则呢？
劳损的病，脉象浮大，手足烦热，春夏季节加重，秋冬季节减轻。阴寒，精液自出，两腿酸削不能行走。
〔补注〕脉大有两种情况，一是大为实证，一是大则为芤脉，芤脉则为虚证。现在归属于劳损，则是损伤在元气，而无血来调和。然而伤在气，对血有什么损害呢？经文说：“阳生则阴长。”所以无阳则阴无以生，无阴则阳无以化。举按之间，只觉其大，而非有力于往来。然而为什么其他脉象不兼见？正因为不兼见，所以盛于外的，并非由于平时修养得当，只因营卫之气满于中焦，导致火不生土而太阴生病。所以手足烦热，因为脾属四肢。经文说：“烦劳则阳气外张，精竭，积累到夏天，使人发生煎厥。”所以在收藏之时稍减，不像春夏之发散严重。经文说：“强力举重则伤肾。”又说：“肾是精的居所，其充实在骨。”既然真阳不能守持，阴精有不外遗的吗？两腿酸削不能行走，也是必然的结果。
凡是失精的人，少腹弦急，阴头寒冷，目眩，脱发，脉象极虚芤迟，伴有完谷不化，亡血失精，脉象出现诸芤、动、微、紧，男子失精，女子梦交，用桂枝加龙骨牡蛎汤主治。
桂枝加龙骨牡蛎汤方
桂枝（一两） 芍药（一两） 甘草（二两，炙） 生姜（一两）
大枣（十二枚） 龙骨（三两） 牡蛎（三两）
以上七味药，用水七升，煮取三升，分三次温服。
〔补注〕经文说：“肾主水，受五脏六腑之精而藏之。”又说：“厥气接于阴器，则梦交接。”阴器是宗筋所系，而脾胃肝胆之筋也都汇聚于此。所以厥阴主筋，诸筋统于肝。肾为阴，主藏精；肝为阳，主疏泄。所以肾阴虚则精不藏，肝阳强则气不固。如果遇到阴邪客居，与所强之阳相感，则或梦或不梦，而精脱矣。肾虚则无有不虚的。膀胱与肾为表里，所以少腹弦急为阴结，气不化是显而易见的。水不生木，则血不养筋，导致宗筋疲惫而阴头寒冷。以致虚风生则目眩，血不会聚则发脱。种种虚状，都本源于此。而其脉则为虚、为芤、为迟，可想而知。阳虚则水谷不化，阴虚则亡血失精。所以芤脉为阴虚，复因阴阳相搏而为动脉，微脉则阳微，又微紧相搏而为邪，都是《脉经》所说的至虚之脉。然而男子失精，女子梦交，怎么能停止呢？此病的根源，都起于肾之不固，遂令三焦都达到极虚。所以在治法上必须以固精为主治。于是用桂枝调和营卫，芍药收敛阴气，生姜散寒，甘草、胶饴、大枣补益脾气补气。更用龙骨以涩其阳，牡蛎以涩其阴，使肾肝既固，营卫调和，而诸证自愈。
男子脉浮弱而涩，主无子，精气清冷。（这一条在某些版本中位于“夫失精家”之前）
〔补注〕浮是阳脉，举之有，按之无。如果在举的时候未见其力，则浮兼弱。浮弱，是阳气之虚。若涩，是阴脉，为阴血不足。《脉经》说：“荣为根，卫为叶。”荣卫俱微，则枝叶枯槁，生气微弱，又怎能保证有子呢？正是因为精气清冷。正如《诗经》所说：“冽彼下泉，浸彼苞稂。”谓损伤其生机。
男子平素健康，脉象虚弱细微的，容易盗汗。
〔补注〕虚弱细微，绝不见阳象，阳虚很严重了。经文说：“阴气有余，身寒多汗。”然而所谓有余，并非真正有余，即从阳之不足来说。所以肺主气，又合皮毛，司腠理。只有阳气衰，则卫气不固而自汗出。邪在于内，则元府不闭，汗从脏腑出；邪在于外，则腠理不致密，汗从经络出。脏腑之阴捍格，卫气浮散于外，无所根据从，则汗出卫虚，水谷之气散脱者汗自出。这些都是不因动作而自出的汗。至于盗汗，则是阳衰因卫虚，而所虚之卫行于阴，当闭眼睡觉时，无气以庇护，所以腠理开而汗出。若一觉醒，则行阳之气，复散于表而汗止。所以叫盗汗。到了盗汗的地步，其虚损可以说得很明白了。
人年五十或六十，其病脉大的，痹症挟背部而行，苦于肠鸣，马刀侠瘿的，都是因为劳损得的。
〔补注〕人生五十开始衰老，六十天癸竭，则已精少肾衰。如果再有所动作，遂令阳虚而邪得以客居。痹阻太阳经道，因为太阳行于背。经文说：“阳气者，精以养神，柔以养筋。”开阖不得，寒气从之，乃生大偻。所以病痹挟背而行。又说：“中气不足，肠为之苦鸣。”至于陷脉为瘘，留连肉腠，为马刀侠瘿。瘿，即瘰疬。因其形长如蛤，称为马刀。或在耳前后，连及颐颔头下，或下连缺盆，以及胸胁，都称为马刀。这是手足少阳经所主的。总之是因为动作忿怒，忧忿气郁过甚，而为风邪内腠。所以其脉则大而举按不实。其因则是劳而元气不足。仲景言之，是恐后人复疑为有余而误攻其邪。
脉沉小迟，名叫脱气。其人疾行则喘喝，手足逆寒，腹满，甚则溏泄，食不消化。
〔补注〕人之所以运动无痛苦，四体温和，食入自化，都是吾身的真阳所为。所以阳固则流行于脉中者，各安其部，而无阳衰阴见之象。现在脉沉，是少阴脉，以其所处之位至下也。如果寸关都见到，那么各脏腑之阳在哪里呢？何况兼有的，是小脉和迟脉。《脉经》说：“小者气血俱少。”又说：“迟为荣中寒。”彼此俱阴，绝不见阳，则其气已大泄。所以名叫脱气。尺虚之人，行走跛然，象征其步履不正。何况是气脱的人呢？所以行走稍快则上气喘喝。虽然曰呼出由心肺主，吸入由肾肝主，但如果没有宗气行其呼吸，则升降出入，且无以安于自然。何况勉强以动其气呢？因此人之阳，盛于中焦。脾之阳不固，则四肢上逆而冷。且脾之阳，又原于下焦。肾之真阳大虚，则不足以消腐水谷，为腹满，为溏泄，正未有已也。
脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，寒虚相搏，此名为革。妇人则半产漏下，男子则亡血失精。
〔补注〕《伤寒论》中有此条，方中行先生注：寒言阳气减损而不足，芤言阴血衰竭而空虚，革言革易常度也。妇人阴血充足而能化，则得坤顺之常。半产漏下，则不足以言坤之资生矣。男子阳精充盛而能化，则得干健之常。亡血失精，则不足以言干之资始矣。故天地之大德曰生。男不足以言资始，女不足以言资生，则人道大坏。故曰革也。一说革读亟，变而促迫也，也通。
愚按：《礼记》说：“夫子之病革矣，不可以变。”即音亟也。
虚劳里急，悸，衄，腹中痛，梦失精，四肢酸疼，手足烦热，咽干口燥，用小建中汤主治。
小建中汤方
芍药（六两） 桂枝（三两，去皮） 甘草（三两，炙） 生姜（三两）
大枣（十二枚） 胶饴（一升）
以上六味药，用水七升，煮取三升，去渣，内入胶饴，更上火微火消解。温服一升，每日三次。呕吐的人不可用建中汤，因为甜的缘故。
〔补注〕经文说：“形气不足，病气不足，此阴阳俱不足也。不可刺之。刺之为重虚。”盖气不足者，如中气不健，频欲更衣，心下悸，或阳明内热而血外溢，或腹中痛，或梦接内而遗，种种悉是气之不足为之。形不足者，即如四肢不但不强健而酸疼，甚至手足烦热，津液少而干燥，种种皆形之不足为之。经文谓不可刺，以重虚者，宜补之以甘药。此其意惟仲景遵之，培中央以灌输腑脏百脉，主以小建中，正是稼穑作甘之意。
然而观此证，则肾虚为多。水亏当壮水之主，以镇阳光；火衰则益火之源，以消阴翳。唯独仲景不屑于此，而惟以树立中气为第一义，为什么呢？圣人曰：“精，谷气也。”可见肾为藏精之处，伎巧出焉。苟非有五谷之养，五味之调，则亦从何而生？然经又曰：“精不足者，补之以味。”假使胃不能纳，脾不能运，又如何？故圣人以建中主治，使中州之土，已坏复起，将饮食入胃者，游溢精气，上输于脾。脾气散精，上归于肺。如经所云者，则五脏百脉自裕矣。岂但已病乎哉？
黄芪建中汤方
黄芪（三两） 桂枝（三两） 芍药（六两） 甘草（三两）
生姜（三两） 胶饴（一升） 大枣（十一枚）
以上七味药，用水七升，煮取三升，去渣，温服一升，每日三次。
〔补注〕不足之证不一，未有不因于气虚者。夫阳生阴长，气苟不充，则日就于损。
(One general discussion, nine pulse-syndrome articles, and nine prescriptions)
Question: How is Blood Bi (Blood Obstruction Syndrome) contracted? The Master said: Those who live in comfort and luxury have weak bones but abundant flesh. If they become exhausted from heavy labor and sweat, and while sleeping their body moves restlessly, adding to the invasion of slight wind, they will contract this disease. If the pulse is merely slightly choppy and tight at the Cunkou (radial artery at the wrist) and Guan positions, it is appropriate to use acupuncture to guide Yang Qi outward. If the pulse becomes harmonious and the tightness disappears, the disease will be cured.
[Supplementary Note]: Yang Qi governs Yin Blood. When Yin Blood is governed, blood flows with Qi. Since the classic mentions "Blood Bi" but not "Qi," why is this? It is unknown that Blood Bi occurs due to injury to Qi. The classic states: "When pathogenic factors enter the vessels, blood coagulates and fails to flow." The reason for failure to flow is that Qi is obstructed by pathogens. However, pathogens capable of causing injury must do so because exertion causes Wei Qi (Defensive Qi) to fail to secure the exterior, allowing pathogens to enter. Thus, Zhang Zhongjing clarifies the cause of blood stasis to explain the origin of the disease. He states that only those living in comfort and luxury are physically comfortable but mentally distressed. Physical comfort leads to abundant flesh; mental distress leads to weak bones. Weak bones cannot withstand fatigue; abundant flesh means Qi is not secured. With slight exertion, sweating occurs easily. Sweat is the fluid of blood. When Wei Qi is not secured, sweat occurs; when sweat occurs, Yang Qi becomes deficient. Even slight wind can then invade, causing Blood Bi. Therefore, seeing a slight pulse indicates insufficient Yang; seeing a choppy pulse indicates much obstruction in Yin Blood. This is the fundamental pulse of Blood Bi. At the site where pathogens enter, a slight tightness manifests. "Slight" indicates the restraint of healthy Qi; "tight" indicates the entry of Cold pathogens. However, Zhongjing explicitly says "slight wind," yet why does one obtain a Cold pulse? Generally, pathogens follow the blood vessels up and down, obstructing fluids, which inevitably causes pain; thus, pain manifests as a tight pulse. Acupuncture can drain pathogens and guide Yang outward; once pathogens leave, healthy Qi naturally extends. Otherwise, it will ultimately result in Bi syndrome. Therefore, securing external Yang is of great importance. If wealthy individuals knew that Yang Qi was never strong, they would dare not overexert themselves. Even if forced to exert, or knowing to moderate so as not to sweat, and if sweating occurred, avoiding restless movement during sleep, how could deficiency-wind cause Blood Bi? Zhongjing discusses Consumption (Xu Lao) starting with Blood Bi, which has its reasons.
In Blood Bi, both Yin and Yang pulses are slight. The Cunkou and Guan pulses are slight, while the Chi pulse is slightly tight. Externally, the symptom is numbness of the body, resembling Wind Bi. Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary treatment.
Huangqi Guizhi Wuwu Tang Prescription
Huangqi (Astragali Radix) (3 liang), Guizhi (Cinnamomi Ramulus) (3 liang, bark removed), Shaoyao (Paeoniae Radix Alba) (3 liang), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Dazao (Jujubae Fructus) (12 pieces).
The above five ingredients are boiled in 6 sheng of water to obtain 2 sheng. Strain and take 7 he of the decoction warm, three times daily.
[Supplementary Note]: This article refers to a case where Blood Bi, described in the previous article, failed to heal via acupuncture guiding Yang, resulting in a slight Cunkou pulse. Now, both Yin and Yang pulses are slight, and the Cunkou and Guan pulses are both slight, with the Chi pulse being slightly tight. Since slight tightness appears at the Chi position, the pathogen has entered deeper and is harder to expel. Why? Where healthy Qi is deficient, there is a place for pathogens to reside. The Pulse Classic calls internal/external Yin/Yang, and upper/lower also Yin/Yang. Now that the Chi pulse is slightly tight, it is clear that the slightness belongs to deficiency internally and externally. If we summarize the symptoms as "numbness," the body is my body, and limbs are my limbs, yet sometimes painful, sometimes numb, often resisting me. This is profound numbness. Hence, it is likened to Wind Bi, though it is not true Wind Bi. The classic states that Wind, Cold, and Dampness combine to form Bi. Why mention only Wind Bi? Pathogens may invade jointly, and the recipient has biases. If Wind predominates, pain migrates frequently, flooding the four extremities. Blood nourishes sinews; if blood does not circulate, sinew joints become blocked. Blood resides in the Liver, and Liver is the child of Kidney. If Kidney is affected, blood stagnates. Thus, Huangqi secures Wei Qi, Shaoyao nourishes Ying Blood, Guizhi harmonizes Ying and Wei, strengthens interior and exterior, and drives pathogens out. Assisted by Shengjiang to diffuse Stomach Qi and Dazao to benefit Spleen Qi, is this not the most appropriate method?
In men who are normally healthy, a large pulse indicates Consumptive Disease (Lao); an extremely deficient pulse also indicates Consumptive Disease.
[Supplementary Note]: Consumptive Disease is a deficiency condition, thus necessarily presenting with deficiency pulses. The classic says: "Excessive labor causes Yang to expand, leading to essence exhaustion." This is because labor causes Yang Qi to expand outward, appearing excessive upon lifting. However, this "excess" is neither internal abundance nor external pathogenic aid, hence called "large pulse indicates Lao." Regarding the double deficiency pulse mentioned later, it refers to deficiency in both upper and lower. It also says: "A deficient pulse does not resemble Yin [pulses]; it lacks the fullness of the Hand-Taiyin Lung channel." Thus, an extremely deficient pulse is also called Lao. While a large pulse relates to physical labor or hunger/fullness, an extremely deficient pulse implies sexual excess.
In men with a pale complexion, thirst and blood loss are indicated. Sudden panting and palpitations with a floating pulse indicate interior deficiency.
[Supplementary Note]: This presents Zhongjing's inspection method. The classic states: "The Heart is the root of life and the change of Spirit; its brilliance shows on the face, and its substance fills the blood vessels." The Hand-Shaoyin Heart channel is the Sovereign Official, from which Spirit emerges. However, worry and overthinking damage it. Spirit damage leads to physical weakness; physical weakness leads to insufficiency in generation, failing to nourish the complexion. The Heart generates blood, and complexion is the banner of Spirit. With insufficient Yin blood, fluids dry up, causing thirst. Thirst leads to drinking water for self-rescue, but if thirst persists despite drinking, excessive water stops in the epigastrium, blocking the respiratory passage causing panting, and losing the control of Minister Fire causing palpitations. In such cases, the pulse must be floating. Is this not because the generated blood is insufficient to propel the pulse outward? The Heart combines with the pulse. Thus, Heart Qi deficiency in the interior is known.
In men with a deficient, deep, and wiry pulse, without chills or fever, shortness of breath, abdominal urgency, difficult urination, pale complexion, frequent dizziness/blinking eyes, occasional epistaxis, and hypogastric fullness, this is caused by Consumptive Disease.
[Supplementary Note]: The human body relies on Yang Qi as the master; only labor damages Yuan Qi. Here, pulse and symptoms are discussed first to show male Yang deficiency. Deficiency is the fundamental pulse of Lao. Within the pulse that feels empty upon lifting and pressing, images of Shaoyin and Jueyin appear, indicating severe internal damage to Yang Qi. Yang deficiency causes aversion to cold; internal injury often causes fever. The Pulse Classic says: "If the Cunkou pulse is slight, it is named Yang insufficiency; Yin Qi enters Yang, causing shivering aversion to cold." If the Chi pulse is weak, it is named Yin insufficiency; Yang Qi sinks into Yin, causing fever. Now, all three positions are equal, ruling out rising/sinking patterns, so absence of chills/fever is known. Danzhong is the Sea of Qi. Essence from grain transforms into Wei Qi and Zong Qi (Gathering Qi). Zong Qi travels in the chest to govern respiration. Exhalation is governed by Heart/Lung (Yang); inhalation by Kidney/Liver (Yin). With a hollow pulse showing only Yin without Yang, the Zong Qi in the middle cannot support it. Exhalation lacks strength, inhalation is shallow, leading to weak ascending/descending and shortness of breath. Middle Jiao Qi deficiency prevents digestion of food and rising of clear Qi. Kidney Yang is unprosperous, Liver Qi descends excessively, causing frequent defecation with urgency. Bladder is the Officer of Storage; without Qi transformation, water pathways fail. As stated, all meridians ascend to the face, but Lung is the master of Qi. If Qi is deficient, Lung is deficient. Although the face is the meeting of Yang meridians, the complexion is pale like metal. Yin excess causes eye blinking; now Yang declines, causing eye blinking. Epistaxis occurs because Yang collaterals are injured, causing blood to overflow. Hypogastric fullness results from difficult urination. This is due to labor damaging Yuan Qi. Although Zhongjing does not state the treatment here, one should naturally regulate with sweet medicines, cultivating Central Earth to benefit Yuan Yang. Without Huangqi Jianzhong Tang, what else could serve as the method?
In Consumptive Disease, the pulse is large and floating, hands and feet are vexed-hot, symptoms worsen in Spring/Summer and improve in Autumn/Winter. There is spontaneous emission of semen due to Yin-cold, and soreness/weakness in the legs preventing walking.
[Supplementary Note]: A large pulse has two meanings: large indicates excess, or large indicates a hollow (Kou) pulse, which indicates deficiency. Here attributed to Lao, the damage is to Yuan Qi without blood to harmonize. Although damage is in Qi, does it harm Blood? The classic says: "Yang generates, then Yin grows." Without Yang, Yin cannot generate; without Yin, Yang cannot transform. Upon lifting and pressing, the pulse feels large but lacks force in its movement. Why no other pulses accompany it? Because it does not accompany others, the excess outwardly is not due to proper cultivation, but rather Ying and Wei Qi filling the Middle Jiao, causing Fire to fail to generate Earth, leading to Taiyin disease. Thus, vexed-hot hands/feet occur because Spleen governs the four limbs. The classic says: "Labor causes Yang to expand, essence exhausts; accumulating into summer causes 'Jian Jue' (Frying Convulsion)." Thus, symptoms ease in storage seasons (Autumn/Winter) unlike the dispersion in Spring/Summer. The classic says: "Forceful lifting weights injures the Kidney." Also: "Kidney is the residence of essence, filling the bones." If True Yang cannot hold, how can Yin essence not leak? Leg soreness and inability to walk are inevitable.
For those habitually losing essence, there is cord-like tension in the hypogastrium, coldness at the glans penis, dizziness, hair loss, and a pulse that is extremely deficient, hollow, and slow, accompanied by undigested food in stool. For blood loss and essence loss, a pulse exhibiting various hollow, moving, slight, or tight qualities in men indicates seminal emission, and in women, nocturnal emissions with sexual dreams. Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction) is the primary treatment.
Guizhi Longgu Muli Tang Prescription
Guizhi (Cinnamomi Ramulus) (1 liang), Shaoyao (Paeoniae Radix Alba) (1 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (2 liang, honey-fried), Shengjiang (Zingiberis Rhizoma Recens) (1 liang), Dazao (Jujubae Fructus) (12 pieces), Longgu (Fossilia Ossis Mastodi) (3 liang), Muli (Concha Ostreae) (3 liang).
The above seven ingredients are boiled in 7 sheng of water to obtain 3 sheng. Divide into three warm doses.
[Supplementary Note]: The classic states: "Kidney governs Water and receives/stores essence from all Zang-Fu organs." Also: "Jue Qi contacting the genitalia causes dreams of intercourse." The genitalia are connected to the General Sinew, where sinews of Spleen, Stomach, Liver, and Gallbladder gather. Jueyin governs sinews, so all sinews are controlled by Liver. Kidney is Yin, governing storage of essence; Liver is Yang, governing coursing and discharge. Kidney Yin deficiency leads to insecure essence; Liver Yang hyperactivity leads to insecure Qi. If Yin pathogens invade and interact with the hyperactive Yang, dreams or non-dreams occur, leading to essence depletion. Kidney deficiency implies universal deficiency. Bladder and Kidney are interior-exterior pairs; thus, hypogastric tension indicates Yin binding, and lack of Qi transformation is evident. Water failing to generate Wood means blood fails to nourish sinews, causing General Sinew fatigue and cold glans. Deficiency-wind generates dizziness; blood failing to gather causes hair loss. All these deficiency signs originate here. The pulse is deficient, hollow, and slow. Yang deficiency leads to indigestion; Yin deficiency leads to blood/essence loss. Hollow indicates Yin deficiency; interaction of Yin-Yang creates moving pulse; slight indicates Yang deficiency; slight-tight interaction creates pathogenic signs. These are extreme deficiencies per the Pulse Classic. How can seminal emission in men and dream-intercourse in women cease? The root lies in Kidney insecurity, leading to extreme deficiency in Sanjiao. Treatment must focus on securing essence. Guizhi harmonizes Ying-Wei; Shaoyao collects Yin; Shengjiang disperses Cold; Gancao, Jiaoyi, Dazao benefit Spleen and boost Qi. Longgu astrings Yang; Muli astrings Yin. Thus, Kidney-Liver are secured, Ying-Wei harmonized, and symptoms resolve.
In men, a floating, weak, and choppy pulse indicates infertility due to clear and cold Jing-Qi. (This article appears before "Those habitually losing essence" in some editions.)
[Supplementary Note]: Floating is a Yang pulse, present on lifting, absent on pressing. If force is lacking upon lifting, floating combines with weakness. Floating-weak indicates Yang Qi deficiency. Choppy is a Yin pulse, indicating insufficient Yin blood. The Pulse Classic says: "Ying is the root, Wei is the leaf." If Ying and Wei are both slight, branches and leaves wither, and vital Qi is weak. How can one guarantee offspring? Precisely because Jing-Qi is clear and cold. As the Shi Jing says: "Cold is the lower spring, soaking the barnyard grass." This denotes damage to vitality.
In men who are normally healthy, a weak, deficient, fine, and minute pulse indicates susceptibility to night sweats.
[Supplementary Note]: Weak, deficient, fine, and minute pulses show absolutely no Yang, indicating severe Yang deficiency. The classic says: "Excess Yin causes cold body and profuse sweating." However, this "excess" is not true excess, but rather insufficient Yang. Lung governs Qi and combines with skin/hair, controlling interstices. Only when Yang declines does Wei Qi fail to secure, causing spontaneous sweating. If pathogens are internal, Yuan pores do not close, and sweat exits from Zang-Fu; if external, interstices are not dense, and sweat exits from meridians. Internal Yin obstruction causes Wei Qi to float outward without basis, leading to sweat and Wei deficiency, scattering Grain Qi, causing spontaneous sweat. These are sweats not caused by movement. Night sweats occur because Yang decline leads to Wei deficiency; the deficient Wei travels into Yin. During sleep, there is no Qi to protect, so interstices open and sweat occurs. Upon waking, Yang Qi returns to the exterior, and sweat stops. Hence, "night sweat." Once night sweats occur, the deficiency is severe.
In people aged fifty or sixty, if the disease presents with a large pulse, Bi syndrome runs along the back, suffering from borborygmus, and having "horse knife" (scrofula) and "collar goiter" (cervical lymphadenopathy), all are caused by Consumptive Disease.
[Supplementary Note]: Humans begin declining at fifty; Tian Gui exhausts at sixty, meaning essence is scarce and Kidney declines. Further exertion causes Yang deficiency, allowing pathogens to invade. Bi blocks the Taiyang meridian, which runs along the back. The classic states: "Yang Qi nourishes Spirit with clarity and sinews with flexibility." If opening/closing fails, Cold enters, causing severe curvature. Thus, Bi runs along the back. Also: "Middle Qi deficiency causes borborygmus." If sinking into meridians, lingering in flesh, it forms horse knife and collar goiter. Goiter refers to scrofula. Elongated like a clam, it is called horse knife. Located around ears/jaw or connecting to clavicle/chest/ribs, all are horse knife, governed by Hand/Foot-Shaoyang meridians. Ultimately, excessive exertion, anger, or depression allows Wind pathogens to enter interstices. The pulse is large but empty on pressure. The cause is labor and insufficient Yuan Qi. Zhongjing mentions this to prevent later generations from mistaking it for excess and attacking pathogens incorrectly.
A deep, small, and slow pulse is named Tuō Qì (Qi Escape). The person pants heavily when walking quickly, has cold hands and feet, abdominal fullness, and in severe cases, loose stools and undigested food.
[Supplementary Note]: Human movement without pain, warmth of limbs, and digestion rely on True Yang. If Yang is secure, Qi flows safely in vessels without signs of Yang decline. Deep is Shaoyin pulse, located lowest. If seen at Cunkou/Guan, where are the Yang Qi of organs? Moreover, accompanying small and slow pulses indicate both Qi and Blood are scant, and Cold in Ying. Both are Yin, showing no Yang, meaning Qi is greatly leaked. Hence, "Qi Escape." Those with Chi deficiency walk unsteadily; how much more so for Qi escape? Thus, quick walking causes panting. Although exhalation is Heart/Lung and inhalation Kidney/Liver, without Zong Qi governing respiration, ascending/descending cannot be natural. How much less can one force Qi movement? Yang is abundant in Middle Jiao. If Spleen Yang is insecure, limbs turn cold. Spleen Yang originates from Lower Jiao. If Kidney True Yang is severely deficient, it cannot digest food, causing abdominal fullness and loose stools.
A wiry and large pulse: Wiry indicates reduction; Large indicates hollow. Reduction indicates Cold; Hollow indicates Deficiency. Cold and Deficiency interacting is named Ge (Leather) pulse. In women, it indicates miscarriage and dripping bleeding; in men, blood loss and seminal emission.
[Supplementary Note]: In Shanghan Lun, Fang Zhongxing notes: Cold refers to reduced/insufficient Yang Qi; Hollow refers to exhausted/empty Yin Blood; Leather refers to changing normal degrees. Women with sufficient Yin Blood transform according to Kun (Earth) harmony. Miscarriage/dripping bleeding fails to represent Kun's generative power. Men with abundant Yang Essence transform according to Qian (Heaven) vigor. Blood loss/seminal emission fails to represent Qian's initiating power. Heaven and Earth's great virtue is Life. If men cannot initiate and women cannot generate, human way is ruined. Hence, "Leather." Alternatively, Leather is read as Ji (urgent), meaning abrupt change, which is also valid. I note: Liji states: "Master's illness was critical (Ge), unable to change." Pronounced Ji.
In Consumptive Disease with abdominal urgency, palpitations, epistaxis, abdominal pain, dream emission, limb soreness/pain, vexed-hot hands/feet, dry throat/mouth, Xiaojianzhong Tang (Minor Construct the Middle Decoction) is the primary treatment.
Xiaojianzhong Tang Prescription
Shaoyao (Paeoniae Radix Alba) (6 liang), Guizhi (Cinnamomi Ramulus) (3 liang, bark removed), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (3 liang, honey-fried), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Dazao (Jujubae Fructus) (12 pieces), Jiaoyi (Mell) (1 sheng).
The above six ingredients are boiled in 7 sheng of water to obtain 3 sheng. Strain, add Jiaoyi, and melt over low heat. Take 1 sheng warm, three times daily. Vomiting patients should not use Jianzhong Tang due to sweetness.
[Supplementary Note]: The classic states: "Form and Qi are insufficient, disease Qi is insufficient; this is dual deficiency of Yin and Yang. Do not needle; needling causes double deficiency." Qi insufficiency manifests as weak Middle Qi, frequent urge to defecate, palpitations, Yangming internal heat causing blood overflow, abdominal pain, or dream emission—all due to Qi insufficiency. Form insufficiency manifests as limbs not just weak but sore/painful, even vexed-hot hands/feet, scant fluids causing dryness—all due to Form insufficiency. The classic forbids needling for double deficiency, recommending tonification with sweet medicine. Zhongjing follows this, cultivating the Center to irrigate Zang-Fu and hundred vessels, primarily using Xiaojianzhong Tang, embodying the principle of "Earth produces Sweet."
However, observing these symptoms, Kidney deficiency is predominant. If Water is deficient, strengthen the Master of Water to calm Yang Fire; if Fire is deficient, benefit the Source of Fire to dispel Yin Shadows. Why does Zhongjing disdain this and prioritize establishing Middle Qi? The Sage says: "Essence is Grain Qi." Kidney stores essence and produces skill. Without grain nourishment and flavor modulation, how is essence generated? The classic also says: "For essence deficiency, tonify with flavor." If Stomach cannot accept and Spleen cannot transport, what then? Thus, the Sage uses Jianzhong as main treatment to restore Central Earth. Food entering Stomck yields essence, transported to Spleen, dispersed to Lung. As stated, Zang-Fu and hundred vessels become abundant. Does this not address existing disease?
For Consumptive Disease with abdominal urgency and various deficiencies, Huangqi Jianzhong Tang (Astragalus Minor Construct the Middle Decoction) is the primary treatment.
Huangqi Jianzhong Tang Prescription
Huangqi (Astragali Radix) (3 liang), Guizhi (Cinnamomi Ramulus) (3 liang), Shaoyao (Paeoniae Radix Alba) (6 liang), Gancao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (3 liang), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Jiaoyi (Mell) (1 sheng), Dazao (Jujubae Fructus) (11 pieces).
The above seven ingredients are boiled in 7 sheng of water to obtain 3 sheng. Strain and take 1 sheng warm, three times daily.
[Supplementary Note]: Deficiency syndromes vary, none occurring without Qi deficiency. Yang generates, Yin grows; if Qi is not filled, it diminishes daily.