虚劳之受病,惟房劳伤、思郁伤、医药伤三者而已。其见症也,骨蒸咳嗽吐血泄泻,男
子失
精,女子不月,五者皆本病之常。房劳伤者,断丧太过,而精气受伤也。其症从下而上,由
肾肝而至于脾,或先失血,或见遗精,次见咳嗽骨蒸等症。真阳亏者,乏气少食,后见泄泻
而危。真阴亏者,火旺血瘀,必发痈肿而毙。思郁伤者,情志不遂,而神气受伤也。此病起
于肾,关于心而迫肺,伤肝及脾,再交水火,谓之七传。初起骨蒸干咳,继则亡血失精,女
子不月,至死而面色不衰,以阴火蒸腾津液于上,所以肢体日削,而神采愈鲜也。最为难治
。医药伤者,表邪未清,留于肺络,误服寒凉清降,邪必从皮毛陷入。亦有因寒凉伤胃,胃
输寒气于肺,皆能令人咳嗽不休。或风热误投辛散,而伤少阴之经,必先吐脓血,而后泄泻
,或汗下失于调养,而伤其营卫,必先微寒数热,而后咳嗽。若兼目疾房劳伤者,治以六味
八味为主。思郁伤者,治以逍遥归脾为主。医药伤者,治以调补元气为主。然在初起之时,
尚可图救,延至末传,终难取效,慎之慎之。
鼓胀当辨明虚实寒热,然后施治,方不错误。假如溺赤便闭,脉数有力,色紫暗,气粗
厉,
口渴饮冷,唇焦舌燥,所谓诸腹肿大,皆属于热是也。溺清便溏,脉迟无力,色 白,气短
促,喜饮热汤,舌润口和,所谓诸病水液,澄澈清冷,皆属于寒是也。按之不痛,时胀时减
者,为虚。按之愈痛,腹胀不减者,为实。东垣治法,枳术补中二方,出入加减,随症取效
。此症痰湿素盛,中气先伤,或为血蛊,或为水肿,见症不一,或宜开鬼门,或宜洁净府,
或宜除陈 ,前人论之甚详,所谓上下分消其势也。如有兼目疾者,未有不两胞肿胀,眵泪
赤涩,须察其本病之由,而以照顾脾胃为主。盖土败则木贼,木能生火,火又生风,眉睫之
间,变端不测矣。若新感时邪,天行赤热,只以常法治之,不必过虑也。
虚劳病之所以发生,无非是房事过度损伤、思虑忧郁损伤、用药不当损伤这三种情况罢了。其表现出的症状中,骨蒸潮热、咳嗽、吐血、泄泻,男子遗精滑精,女子闭经,这五种都是本病的常见症状。因房事过度而伤者,是因为纵欲无度,导致精气受损。其病症从下往上发展,由肾肝波及脾脏,或者先出现失血,或者出现遗精,随后出现咳嗽、骨蒸等症状。真阳亏损者,气短乏力、食欲不振,后来出现泄泻而病情危重。真阴亏损者,虚火旺盛导致血液瘀滞,必然引发痈肿而死亡。因思虑忧郁而伤者,是因为情志不畅,导致神气受损。此病起于肾,涉及心并压迫肺,损伤肝和脾,再交杂水火之邪,称为“七传”。初起时骨蒸干咳,继则亡血失精,女子闭经,直到死前面色不显衰败,这是因为阴火蒸腾津液上行,所以肢体日渐消瘦,而神采反而更加鲜明。这是最难治疗的。因用药不当而伤者,表邪未清,滞留于肺络,误服寒凉清降药物,邪气必从皮毛陷入体内。也有因为寒凉药物损伤胃气,胃将寒气输送给肺,都能导致人咳嗽不止。或者风热证误用辛散药物,损伤少阴经脉,必须先吐脓血,而后出现泄泻;或者汗法、下法使用不当且缺乏调养,损伤营卫之气,必须先出现微恶寒、频繁发热,而后出现咳嗽。如果兼有眼疾的房劳伤者,治疗以六味丸、八味丸为主。思郁伤者,治疗以逍遥散、归脾汤为主。医药伤者,治疗以调补元气为主。然而在疾病初起之时,尚可设法救治,拖延到末期传变,终究难以取得疗效,务必谨慎,务必谨慎。
鼓胀病应当辨明虚实寒热,然后施治,才不会出错。假如小便赤红、大便闭塞,脉象数而有力,面色紫暗,气息粗厉,口渴想喝冷水,嘴唇焦裂、舌干口燥,这就是所说的“各种腹部肿大,都属于热证”的情况。假如小便清长、大便溏薄,脉象迟而无力,面色白,气短急促,喜欢喝热汤,舌润口中和缓,这就是所说的“各种水液病变,清澈寒冷,都属于寒证”的情况。按压腹部不痛,时胀时减的,属于虚证。按压疼痛加剧,腹胀不减的,属于实证。李东垣的治疗法则,枳术丸与补中益气汤两个方剂,根据病情出入加减,随症取效。此症患者素来痰湿盛,中气先已受伤,或者成为血蛊,或者成为水肿,表现出的症状不一,有的适宜开鬼门(发汗),有的适宜洁净府(利小便),有的适宜除陈莝(攻逐积滞),前人论述得很详细,这就是所谓的上下分消病势的方法。如果有兼有眼疾的,没有不出现两胞肿胀、眼屎多、流泪、眼睛红涩的,必须考察其本病的缘由,而以顾护脾胃为主。因为土(脾)败则木(肝)贼,木能生火,火又生风,眉睫之间,变化莫测。如果是新感时邪,天行赤眼热病,只按常规方法治疗即可,不必过分忧虑。
The pathology of Xu Lao (Deficiency Consumption) arises from only three causes: injury due to sexual excess, injury due to excessive thinking and depression, and injury due to improper medical treatment. The presenting symptoms include bone-steaming fever, coughing, hemoptysis, diarrhea, seminal emission in men, and amenorrhea in women; these five are common manifestations of the primary disease. Injury due to sexual excess results from excessive indulgence, damaging Jing and Qi. The pathology ascends from below, affecting the Kidney and Liver before involving the Spleen; it may initially present with blood loss or seminal emission, followed by symptoms such as coughing and bone-steaming fever. In cases of True Yang deficiency, there is a lack of energy and appetite, eventually leading to diarrhea and critical illness. In cases of True Yin deficiency, vigorous fire leads to blood stasis, inevitably resulting in carbuncles and death. Injury due to excessive thinking and depression stems from unfulfilled emotions, damaging Shen and Qi. This disease originates in the Kidney, involves the Heart and compresses the Lung, damages the Liver and Spleen, and further complicates with Water and Fire interactions, known as "Seven Transmissions." Initially, it presents with bone-steaming and dry coughing; subsequently, it leads to blood loss, seminal emission, and amenorrhea in women. Until death, the complexion does not appear wan because Yin fire steams fluids upward; thus, the limbs waste away daily while the spirit appears increasingly vibrant. This is the most difficult to treat. Injury due to improper medical treatment occurs when exterior pathogens remain unresolved and lodge in the Lung collaterals; misusing cold and cooling descending herbs causes pathogens to sink from the skin and hair into the interior. Alternatively, cold herbs damage the Stomach, transmitting cold qi to the Lung, both causing persistent coughing. If wind-heat is mistakenly treated with acrid-dispersing herbs, the Shaoyin meridian is damaged, first presenting with purulent bloody vomiting followed by diarrhea. Or, if sweating and purging methods are misused without proper aftercare, Ying and Wei are damaged, first presenting with slight chills and frequent fevers, followed by coughing. If accompanied by eye diseases in cases of sexual excess, treatment focuses on Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia). For injuries due to thinking and depression, treatment focuses on Xiao Yao San (Free and Easy Wanderer Powder) and Gui Pi Tang (Restore the Spleen Decoction). For injuries due to medical mishandling, treatment focuses on regulating and tonifying Yuan Qi. However, at the initial stage, rescue is possible; if delayed until terminal transmission, efficacy is ultimately hard to achieve. Exercise extreme caution.
For Gu Zhang (Drum Distension), one must clearly differentiate between deficiency/excess and cold/heat before administering treatment to avoid errors. For instance, if urine is dark red, stool is constipated, pulse is rapid and forceful, complexion is purple and dull, breath is coarse, thirst drives one to drink cold water, lips are cracked, and tongue is dry, this corresponds to the principle that "all abdominal swellings belong to Heat." Conversely, if urine is clear, stool is loose, pulse is slow and weak, complexion is white, breath is short and hurried, one prefers hot drinks, tongue is moist, and mouth feels harmonious, this corresponds to the principle that "all fluid pathologies that are clear and cold belong to Cold." Abdominal distension that is painless upon pressure and fluctuates in severity indicates Deficiency. Distension that worsens with pain upon pressure and does not subside indicates Excess. Li Dongyuan's therapeutic approach involves modifying the two formulas Zhi Zhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) according to specific symptoms. This condition typically involves pre-existing phlegm-dampness and prior injury to Middle Qi, potentially manifesting as Blood Gu (Blood Parasite/Distension) or Edema, with varied presentations. Treatments may include Kai Gui Men (opening the ghost gate/sweating), Jing Jian Fu (cleansing the clean mansion/diuresis), or Chu Chen Cuo (removing old accumulation/purgation), as detailed by predecessors, representing the method of dispersing pathogenic momentum from above and below. If accompanied by eye diseases, swelling of both eyelids, excessive discharge, tearing, redness, and astringency are invariably present. One must investigate the root cause of the primary disease and prioritize protecting the Spleen and Stomach. Since Earth (Spleen) failure allows Wood (Liver) to attack, and Wood generates Fire, which in turn generates Wind, unpredictable changes may occur around the eyebrows and lashes. If it is a new contraction of seasonal pathogens causing Tian Xing Chi Re (Epidemic Red Eye Heat), standard treatment suffices, and no excessive worry is needed.