都是盲医矣。 建中汤去糖加人参。
尹（四九）中年衰颓。身动喘嗽。脉细无神。食减过半。乃下元不主纳气。五液蒸变粘涎。未老先衰。即
是劳病。（肾气不纳）
人参 坎 紫衣胡桃 炒菟丝子 茯苓 五味 炒砂仁 山药浆丸。
金（七十）寤则心悸。步履如临险阻。子后冲气上逆。此皆高年下焦空虚。肾气不纳所致。 八味丸
三钱。先服四日。
淡苁蓉（一两） 河车胶（一具） 紫石英（二两） 小茴（五钱） 杞子（三两） 胡桃肉（二两）
牛膝（一两半） 五味（一两） 茯苓（二两） 沙苑（一两半） 补骨脂（一两） 桑椹子（二两）
红枣肉丸。
王 久客劳伤。气分痹阻。则上焦清空诸窍不利。初病在气。久则入血。身痛目黄。食减形瘦。由
病患及乎元虚。攻补未能除病。思人身左升属肝。右降属肺。当两和气血。使升降得宜。若再
延挨。必瘀滞日甚。结为腑聚矣。（气血滞升降阻）旋复花汤加桃仁归须蒌皮。
郁（氏）失血咳嗽。继而暮热不止。经水仍来。六七年已不孕育。乃肝肾冲任皆损。二气不交。延为
劳怯。治以摄固。包举其泄越。（肝肾冲任皆虚）
鲜河车胶 黄柏 熟地 淡苁蓉 五味 茯神 蜜丸
屠（二八）劳力伤阳。延三年。损伤延及中宫。状如反胃。诸气欹斜。交会失序。遂有寒热。脱力损伤脾
胃。牛属坤土。当以霞天膏。（劳力伤脾胃）
朱（十二）奔走之劳。最伤阳气。能食不充肌肤。四肢常自寒冷。乃经脉之气。不得贯串于四末。有童
损之忧。（劳动伤经脉）
苁蓉（二两） 当归（二两） 杞子（一两） 茯苓（二两） 川芎（五钱） 沙苑（五钱）
黄鳝一条为丸。
邢（四四）努力伤。身痛无力。 归桂枝汤去姜加五加皮。
虚损之症。经义最详。其名不一。考内经论五脏之损。治各不同。越人有上损从阳。下损从
阴之议。其于针砭所莫治者。调以甘药。金匮遵之而立建中汤。急建其中气。俾饮食增而
津血旺。以致充血生精。而复其真元之不足。但用稼穑作甘之本味。而酸辛咸苦在所不
用。盖舍此别无良法可医。然但能治上焦阳分之损。不足以培下焦真阴之本也。（赖先生）
引伸三才。固本。天真。大造。桂枝龙骨牡蛎。复脉等汤。以及固摄诸方。平补足三阴法。为兼
治五脏一切之虚。而大开后人聋聩。可为损症之一助也。夫金匮又云。男子脉大为劳。极
虚亦为劳。夫脉大为气分泄越。思虑郁结。心脾营损于上中。而营分萎顿。是归脾。建中。养
营。四君。五味。异功等汤之所宜也。脉极虚亦为劳。为精血内夺。肝肾阴不自立。是六味。八
味。天真。大造。三才。固本。复脉等汤。以及平补足三阴。固摄诸法所宜也。然仲景以后。英贤
辈出。岂无阐扬幽隐之人。而先生以上。又岂无高明好学之辈。然欲舍仲景先生之法。而
能治虚劳者。不少概见。即如东垣丹溪辈。素称前代名医。其于损不肯复者每以参术为
主。有用及数斤者。其意谓有形精血难复。急培无形之气为要旨。亦即仲景建中诸汤。而
扩充者也。又厥后张景岳以命门阴分不足。是为阴中之阴虚。以左归饮。左归丸为主。命
门阳分不足者。为阴中之阳虚。以右归饮。右归丸为主。亦不外先生所用三才。固本。天真。
大造等汤。以及平补足三阴。固摄诸法。而又别无所见也。故后人称仲景先生善治虚劳
者。得其旨矣。（邹滋九）
久虚不复谓之损。损极不复谓之劳。此虚劳损三者。相继而成也。参其致病之由。原非一
种。所现之候。难以缕析。大凡因烦劳伤气者。先生用治上治中。所以有甘凉补肺胃之清。
津。柔剂养心脾之营液。或甘温气味。创建中宫。不使二 日偏。营卫得循行之义。又因纵
欲伤精者。当治下而兼治八脉。又须知填补精血精气之分。益火滋阴之异。或静摄任
阴。温理奇阳之妙处。若因他症失调。蔓延而致者。当认明原委。随其机势而调之。揣
先生之用意。以分其体质之阴阳为要领。上中下见症为着想。传变至先后天为生死断
诀。若逐节推求。一一有根 可考。非泛泛然而凑用几味补药。漫言为治也。（邵新甫）
徐评 此老治虚劳之法。不外清肺养胃滋肾。虽无大害。而毫无意义。轻者可愈。重者病日增
而已。至其所遵仲景之法。又大失先贤本旨。当时仲景之所谓虚劳者。乃虚寒之症。故其脉浮
大芤迟。又方中用饴糖。乃因腹中痛而设。今日之所谓虚劳。乃阴竭而浮火上炎。脉皆细数。与
建中汤正相反。乃亦以此为治。此所谓耳食之学也。余曾目睹此老治阴虚火升之人。与建中
而变喉痹血冒者。不下数人。当时此老竟不悟也。故附记于此。
尹（四十九岁）中年身体衰颓。身体一动就气喘咳嗽。脉象细弱没有神气。食欲减半减少了一半。这是下元不能收纳气息。体内的津液蒸腾变化成为粘稠的痰涎。未老先衰，这就是劳病。（肾气不能纳气）
人参、坎炁（胎衣）、紫衣胡桃、炒菟丝子、茯苓、五味子、炒砂仁、山药，制成浆丸。
金（七十岁）醒着的时候心悸。走路时感觉像面临危险阻碍一样。子时之后冲气上逆。这都是因为高龄导致下焦空虚，肾气不能纳气所致。服用八味丸三钱。先服四天。
淡苁蓉（一两）、河车胶（一具）、紫石英（二两）、小茴香（五钱）、枸杞子（三两）、胡桃肉（二两）、牛膝（一两半）、五味子（一两）、茯苓（二两）、沙苑蒺藜（一两半）、补骨脂（一两）、桑椹子（二两），红枣肉为丸。
王 长期客居他乡导致劳伤。气分痹阻，那么上焦清虚之窍就不利。初起病在气分，久了则进入血分。身体疼痛，眼睛发黄，食欲减退，形体消瘦。由于病患波及到元气虚弱，攻邪和补虚都不能除去疾病。思考人体左边上升属于肝，右边下降属于肺，应当调和气血，使升降适宜。如果再拖延，必然瘀滞日益严重，结聚形成腑聚了。（气血滞涩，升降受阻）旋复花汤加桃仁、归须、瓜蒌皮。
郁（某氏）失血咳嗽。接着夜间发热不止。月经仍然来潮。六七年已经不能孕育。这是肝肾和冲任二脉都受损。阴阳二气不交合，拖延成为劳怯病。治疗以摄固为主，包举其外泄越出的正气。（肝肾冲任皆虚）
鲜河车胶、黄柏、熟地黄、淡苁蓉、五味子、茯神，蜜丸。
屠（二十八岁）因劳累损伤阳气。拖延三年。损伤延及中宫（脾胃）。症状像反胃。各种气机倾斜不正。交会失去秩序。于是出现寒热交替。过度劳累损伤了脾胃。牛属坤土（脾），应当使用霞天膏。（劳累损伤脾胃）
朱（十二岁）奔走劳作，最伤阳气。能吃但不能充实肌肤。四肢经常自感寒冷。这是经脉之气，不能贯通到四肢末端。有童损（先天不足或早衰）的忧虑。（劳动损伤经脉）
苁蓉（二两）、当归（二两）、枸杞子（一两）、茯苓（二两）、川芎（五钱）、沙苑蒺藜（五钱）、黄鳝一条，制成丸剂。
邢（四十四岁）用力过猛导致受伤。身体疼痛无力。归桂枝汤去掉生姜，加入五加皮。
虚损这类病症，《内经》论述得非常详细。名称不一。考察《内经》论述五脏的损伤，治疗方法各不相同。扁鹊（越人）有上损从阳治、下损从阴治的议论。对于针灸所不能治疗的，用甘药调理。《金匮要略》遵循这一原则建立了建中汤，急切地建立中气，使得饮食增加而津血旺盛，以致充血生精，恢复真元的不足。只使用稼穑作甘的本味，而酸、辛、咸、苦在所不用。大概除了这个方法别无良法可医。然而只能治疗上焦阳分的损伤，不足以培补下焦真阴的根本。（赖先生评论）
引申出三才汤、固本丸、天真丸、大造丸、桂枝龙骨牡蛎汤、复脉汤等方剂，以及固摄诸方，平补足三阴的方法，作为兼治五脏一切虚损的辅助，从而大开后人的耳目，可以作为治疗损症的一个帮助。《金匮要略》又说：男子脉大为劳，极虚也为劳。脉大是因为气分外泄越出，思虑郁结，心脾营血在上中焦受损，而营分萎顿，这是归脾汤、建中汤、养营汤、四君子汤、五味子汤、异功散等方剂适宜的证候。脉极虚也为劳，是因为精血内夺，肝肾阴气不能自立，这是六味地黄丸、八味丸、天真丸、大造丸、三才汤、固本丸、复脉汤等方剂，以及平补足三阴、固摄等方法适宜的证候。然而张仲景以后，英才辈出，难道没有阐扬幽深隐微道理的人吗？而在先生之前，又难道没有高明好学之辈吗？然而想要舍弃张仲景先生的方法，却能治疗虚劳病的，很少见到概貌。就像李东垣、朱丹溪之辈，素称前代名医，他们对于亏损不能恢复的病症，每以人参、白术为主，有用到几斤重的。他们的意思认为有形的精血难恢复，急切培补无形的气才是主旨，这也即是张仲景建中诸汤的扩充。后来张景岳认为命门阴分不足，是阴中之阴虚，以左归饮、左归丸为主；命门阳分不足者，为阴中之阳虚，以右归饮、右归丸为主。这也不外乎先生所用的三才汤、固本丸、天真丸、大造丸等方剂，以及平补足三阴、固摄诸法，而又没有什么新的见解。所以后人称赞张仲景先生善于治疗虚劳，是得其宗旨了。（邹滋九评论）
长久虚弱不能恢复叫做损，损到极致不能恢复叫做劳。这三者（虚、劳、损），相继而成。参究其致病的原因，原本不是一种。所表现的症状，难以一一列举分析。大凡因为烦劳伤气的，先生用治上焦和中焦的方法，所以有甘凉补益肺胃的清津，柔润剂滋养心脾的营液，或者甘温气味，创建中宫，不让阴阳二气偏颇，营卫得以循行的意义。又因为纵欲伤精的，应当治下焦并兼治奇经八脉。又要知道填补精血与精气之分，益火与滋阴的差异。或者静摄任脉之阴，温理奇经之阳的妙处。如果因为其他病症失调，蔓延而导致虚劳的，应当认清原委，随着其机势而调理。揣测先生的用意，以分辨体质的阴阳为要领，以上中下见症为着想，传变至先后天作为生死断诀。如果逐节推求，一一有根可考，不是泛泛然地凑用几味补药，漫言为治。（邵新甫评论）
徐评 这位老先生治疗虚劳的方法，不外乎清肺、养胃、滋肾。虽然没什么大害，但毫无意义。轻的可以痊愈，重的病情日益加重而已。至于他所遵循的张仲景之法，又大失先贤的本旨。当时张仲景所说的虚劳，乃是虚寒之症，所以他的脉象浮大芤迟，而且方中使用饴糖，是因为腹中痛而设的。今日所谓的虚劳，乃是阴竭而浮火上炎，脉象皆细数，与建中汤正相反，却也用这个来治疗。这就是所谓耳食之学（盲从听闻而不求实）。我曾目睹这位老先生治疗阴虚火升的人，给予建中汤而变成喉痹、血冒的，不下数人。当时这位老先生竟然没有醒悟。所以附记在这里。
They are all ignorant physicians. Use Jianzhong Tang (Cinnamon Twig and Licorice Decoction), remove the sugar, and add Ren Shen (Ginseng Radix).
Yin (49 years old) is in middle age but shows signs of physical decline. Movement induces wheezing and coughing. The pulse is fine and lacks spirit. Appetite has decreased by half. This indicates that the lower yuan fails to grasp qi. The body fluids are steamed and transformed into sticky phlegm. Premature aging constitutes a Lao disease (consumptive disease). (Kidney qi fails to grasp qi).
Ren Shen (Ginseng Radix), Kan Qi (Placenta), Zi Yi Hu Tao (Walnut with purple skin), Chao Tu Si Zi (Fried Cuscutae Semen), Fu Ling (Poria), Wu Wei Zi (Schisandrae Fructus), Chao Sha Ren (Fried Amomi Fructus), Shan Yao (Dioscoreae Rhizoma), made into pills with yam paste.
Jin (70 years old) experiences palpitations when awake. Walking feels like facing dangerous obstacles. After midnight (Zi hour), Chong qi (Penetrating vessel qi) rebels upward. All this is caused by deficiency of the lower jiao due to advanced age, leading to kidney qi's failure to grasp qi. Take Bawei Wan (Eight-Ingredient Pill) 3 qian. Take it for four days first.
Dan Cong Rong (Cistanche Herba, 1 liang), He Che Jiao (Human Placenta, 1 piece), Zi Shi Ying (Hematitum, 2 liang), Xiao Hui (Foeniculi Fructus, 5 qian), Qi Zi (Lycii Fructus, 3 liang), Hu Tao Rou (Juglandis Semen, 2 liang), Niu Xi (Achyranthis Bidentatae Radix, 1.5 liang), Wu Wei Zi (Schisandrae Fructus, 1 liang), Fu Ling (Poria, 2 liang), Sha Yuan (Astragali Complanati Semen, 1.5 liang), Bu Gu Zhi (Psoraleae Fructus, 1 liang), Sang Shen Zi (Mori Fructus, 2 liang), made into pills with red date flesh.
Wang: Long-term sojourn causes labor injury. Bi obstruction in the qi level leads to dysfunction of the clear orifices in the upper jiao. Initially, the disease is in the qi level; after a long time, it enters the blood level. Body pain, yellow eyes, reduced appetite, and emaciation occur because the illness affects the primordial deficiency. Neither attacking pathogens nor tonifying can eliminate the disease. Considering that the left side ascending belongs to the Liver and the right side descending belongs to the Lung, one should harmonize qi and blood to ensure proper ascending and descending. If delayed further, blood stasis will worsen daily, forming abdominal masses. (Qi and blood stagnation, obstruction of ascending and descending). Xuanfu Hua Tang (Inula Flower Decoction) plus Tao Ren (Persicae Semen), Gui Xu (Angelicae Sinensis Radix Stems), Lou Pi (Benincasae Pericarpium).
Yu (Mrs.): Hemoptysis and coughing followed by persistent evening fever. Menstruation continues. Infertility for six or seven years. This indicates damage to the Liver, Kidney, Chong Mai (Penetrating Vessel), and Ren Mai (Conception Vessel). Yin and Yang qi do not intersect, progressing into Lao Qie (consumptive weakness). Treatment focuses on securing and consolidating, containing the leakage and dispersion. (Liver, Kidney, Chong, and Ren deficiencies).
Xian He Che Jiao (Fresh Human Placenta), Huang Bo (Phellodendri Cortex), Shu Di (Rehmanniae Radix Preparata), Dan Cong Rong (Cistanche Herba), Wu Wei Zi (Schisandrae Fructus), Fu Shen (Poria with Hostwood), made into honey pills.
Tu (28 years old): Labor injury damages yang qi. Persisting for three years, the injury extends to the Middle Palace (Spleen and Stomach). Symptoms resemble regurgitation. Qi mechanisms are tilted and disordered. Intersections lose their sequence, resulting in alternating chills and fever. Overexertion injures the Spleen and Stomach. Ox belongs to Kun Earth (Spleen); use Xia Tian Gao (Beef Gelatin Paste). (Labor injury damages Spleen and Stomach).
Zhu (12 years old): Running and exertion most injure yang qi. Able to eat but unable to fatten the muscles. Limbs are often cold. This is because qi in the meridians cannot penetrate to the extremities. There is concern about Tong Sun (childhood deficiency/congenital weakness). (Labor injures meridians).
Cong Rong (Cistanche Herba, 2 liang), Dang Gui (Angelicae Sinensis Radix, 2 liang), Qi Zi (Lycii Fructus, 1 liang), Fu Ling (Poria, 2 liang), Chuan Xiong (Ligustici Chuanxiong Rhizoma, 5 qian), Sha Yuan (Astragali Complanati Semen, 5 qian), one eel, made into pills.
Xing (44 years old): Strain injury. Body pain and weakness. Guizhi Tang (Cinnamon Twig Decoction) minus Ginger, plus Wu Jia Pi (Acanthopanacis Cortex).
Regarding deficiency and damage syndromes, the *Neijing* discusses them in detail. Their names vary. Examining the *Neijing*'s discussion on damage to the five zang organs, treatments differ. Yue Ren (Bian Que) proposed treating upper damage from yang and lower damage from yin. For conditions unresponsive to acupuncture and moxibustion, sweet medicine is used to regulate. The *Jinkui Yaolue* follows this principle to establish Jianzhong Tang, urgently building middle qi so that food intake increases, generating abundant fluids and blood, thereby filling blood and generating essence to restore the insufficiency of true yuan. Only using the sweet taste inherent in grains (Jia Se), while avoiding sour, acrid, salty, and bitter tastes, is considered the only effective method. However, this can only treat damage to the yang aspect of the upper jiao, insufficient to nourish the root of true yin in the lower jiao. (Comment by Mr. Lai)
Extending to Sancai Tang (Three Powers Decoction), Guben Wan (Solidify the Root Pill), Tianzhen Wan (Heavenly Innocence Pill), Dazao Wan (Great Creation Pill), Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction), Fumai Tang (Restore Pulse Decoction), as well as various securing formulas and methods for gently tonifying the three yin meridians of the foot, these serve as auxiliary treatments for all kinds of deficiency affecting the five zang organs, greatly enlightening later generations and assisting in the treatment of damage syndromes. The *Jinkui* also states: "In men, a large pulse indicates Lao; an extremely deficient pulse also indicates Lao." A large pulse indicates qi leaking outward due to worry and depression, damaging Heart and Spleen Ying (Nutritive) qi in the upper and middle jiao, leading to languishing Ying level; this suits Guipi Tang (Restore the Spleen Decoction), Jianzhong Tang, Yangying Tang (Nourish Ying Decoction), Sijunzi Tang (Four Gentlemen Decoction), Wuweizi Tang (Schisandra Decoction), Yigong San (Extraordinary Efficacy Powder), etc. An extremely deficient pulse indicates internal loss of essence and blood, with Liver and Kidney yin failing to stand independently; this suits Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), Bawei Wan, Tianzhen Wan, Dazao Wan, Sancai Tang, Guben Wan, Fumai Tang, as well as methods for gently tonifying the three yin meridians of the foot and securing. Since Zhang Zhongjing, many heroes have emerged. Was there no one to elucidate hidden truths before him? Nor were there no high-minded scholars before Mr. Ye. Yet, abandoning Zhang Zhongjing's methods to treat Xu Lao (deficiency-lao) successfully is rarely seen. Like Li Dongyuan and Zhu Danxi, renowned ancient physicians, they primarily used Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala Rhizoma) for irrecoverable damage, sometimes using several jin. Their intent was that tangible essence and blood are hard to restore, so urgently tonifying intangible qi is key. This expands upon Zhang Zhongjing's Jianzhong decoctions. Later, Zhang Jingyue argued that insufficiency of Mingmen (Gate of Life) yin constitutes yin deficiency within yin, treated mainly with Zuogui Yin (Left Restoring Decoction) and Zuogui Wan (Left Restoring Pill); insufficiency of Mingmen yang constitutes yang deficiency within yin, treated mainly with Yougui Yin (Right Restoring Decoction) and Yougui Wan (Right Restoring Pill). These do not exceed the formulas mentioned above (Sancai, Guben, Tianzhen, Dazao) and methods for tonifying the three yin meridians and securing, offering no new insights. Thus, later generations praise Zhang Zhongjing for mastering Xu Lao treatment, having grasped its essence. (Comment by Zou Zijiu)
Long-standing deficiency without recovery is called Sun (damage); extreme damage without recovery is called Lao (lao). These three (Xu, Lao, Sun) occur sequentially. Investigating the causes of disease, they are not uniform. The symptoms presented are difficult to analyze item by item. Generally, for those injured by mental/physical fatigue damaging qi, Mr. Ye uses treatments for the upper and middle jiao, employing sweet-cool agents to tonify Lung and Stomach clear fluids, and soft agents to nourish Heart and Spleen Ying fluids, or sweet-warm agents to build the Middle Palace, preventing deviation of yin and yang, allowing Ying and Wei (Defensive) qi to circulate properly. For those injured by excessive sexual activity damaging essence, treatment should focus on the lower jiao and involve the eight extraordinary vessels. One must distinguish between replenishing essence/blood and qi/essence, and between warming fire and nourishing yin. Or utilize the subtleties of statically preserving Ren yin and warmly regulating odd yang. If caused by dysregulation of other diseases spreading, one must identify the origin and adjust according to the trend. Speculating on Mr. Ye's intent, distinguishing constitution's yin and yang is the key, considering symptoms in upper/middle/lower regions, and judging life/death based on transmission to pre-heaven/post-heaven. If analyzed step-by-step, each point has roots to verify, rather than casually combining a few tonics and speaking loosely of treatment. (Comment by Shao Xinpu)
Mr. Xu comments: This old man's method for treating Xu Lao involves nothing more than clearing the Lung, nourishing the Stomach, and tonifying the Kidney. While not causing major harm, it lacks profound meaning. Mild cases may heal; severe cases will only worsen day by day. Furthermore, his adherence to Zhang Zhongjing's methods largely misses the original intent of the sages. Zhang Zhongjing's "Xu Lao" referred to deficiency-cold syndromes, hence the pulse was floating, large, hollow, and slow, and Yi Tang (Maltose) was used in the formula for abdominal pain. Today's "Xu Lao" refers to yin exhaustion with floating fire flaming upward, with pulses being fine and rapid, which is contrary to Jianzhong Tang. Using it here is what is called "ear-food learning" (blindly following hearsay). I have personally witnessed several cases where this old man treated patients with yin deficiency and flaming fire with Jianzhong Tang, resulting in throat bi (obstruction) and hematemesis/hemoptysis. At the time, he did not realize his error. Therefore, I record this here.