虚劳之症，无外邪相干，皆由内伤脏腑所致。如酒伤肺，湿热熏蒸，则肺阴消烁；色
伤肾，
伐真阴；怒气伤肝，郁怒则肝火内炽而灼血，大怒则肝火上冲而吐血。此五者，皆能劳其精
血。《道经》云∶涕、唾、精、津、汗、血、液，七般灵物总属阴。阴虚则内热生而成虚劳
之症。大约酒色成劳者多，然有童子亦患此者，则由于先天禀受之不足，而禀于母气者尤多
。其师尼、寡妇、室女，思欲不遂，气血郁结，以致寒热如疟，朝凉暮热，饮食不思，经期
不准，或闭绝不行，成此病者甚多，多由郁火所蒸而致。方书之言虚劳，皆言气虚、血虚、
阳虚、阴虚，混同立治。是以学人，漫无指归。不知气虚者，面目无神，语言轻微，四肢无
力，脉来微弱；阳虚者，体冷畏寒，手足逆冷，溺清溏泄，脉沉小迟，可投温补。故谓虚劳
之，可服参、 受补者，为可治，气虚阳虚之症也；虚劳之不能服参 不受补者，为不可治
，血虚、阴虚之症也。虽血脱有补气之法，此指卒暴失血，素非血虚之人。如新产症之类，
皆非所论于血因火燥致虚之症。夫火之所以燥者，水虚无以制之也，故经曰∶一水不能胜五
火。五火者，五志之火也；一水者，肾中真阴之水，即精也。人生全盛之数，前后止二十余
年耳！故丹溪引日月之盈亏，以为阳常有余，阴常不足。王节斋亦以为阴虚成病，十之八九
，阳虚成病，百无一二。盖以节欲少，纵欲者多耳！夫人但知纵欲劳精，孰知阴精日损，饮
食无味，转劳转虚，脉从内变，色不外华，其为病也。在肾则为腰脊腿胫酸软，或攸隐而痛
，为骨蒸内热盗汗，或至夜发热，为遍身骨疼，或疼痛如折，为梦遗滑泄，为耳中鸣，足心
热。在心则为惊悸怔忡，为掌中干热，为虚烦无寐，为魇梦不宁，为口苦舌干，为口舌糜烂
。在肺则为咳嗽多痰，或干咳少痰，为胸满气逆，或喘或促，为两颧红若脂，为鼻中气如火
，为咳血衄血，甚则吐白沫，一边不能睡，咽痛喉烂，声嘶音哑。在肝则为寒热如疟，为颈
项瘰 ，为胁肋作胀作疼，为两目或涩或痛，为头晕眼花，为多怒，为吐血。在脾则为饮食
少思，恶心呕吐，为胀满腹痛，食不消化，为肠鸣泄泻，肌肉消瘦。皆五脏虚劳之本症。经
云∶治病求其本。须审其因何致损？何脏受伤？如因于色者，则知其伤在肾，纵有他经现症，
亦当以补肾为主，而兼治他经之症。其因于酒者，又当以清肺为先。标本既审，而病之传
变，尤宜熟察。如肾传心，心传肺，五脏相传，必侮而乘之，谓之贼克，大凶之兆。经云∶
诸病以次传者死。谓五脏克遍也。《难经》云∶七传者死。诸病始于肾，而脾又传肾，谓六
经已尽，一脏不可再伤也。如肾病不传心而传肺，此间一脏，以子病及母也。如不传心肺而
传肝，此间二脏，以母病及子也。如不传心肺肝而传脾，此间三脏而传于己之所不胜，所谓
轻而侮之也。传乘不明，岂能治病！世医不知阴虚者，多将气血阴阳模糊调治，岂不误哉？试
言之，其误有七∶一、引火归元之误。命门之龙火，谓之真阳。如果衰弱，肾中阴盛，龙火不
能安其位，浮越于上，而为上焦假热，面赤、烦躁、口渴，甚则舌苔。但口虽渴而不欲饮水
，苔虽有而舌必滑软，小便清长，足冷过膝，其右尺必沉小而迟，或浮大无根，此阴盛于下
，逼阳于上之假症。如夏至一阴生，水底冷而天上热也。正宜八味之属，引之归元。如冬至
一阳生，而地中水暖，龙归大海也。至若虚劳症，是因肾水真阴虚热，水不摄火，火因上炎
，而致面赤唇红，口鼻出血，齿痛、齿浮、齿衄，种种上焦虚热之症，虽亦龙火上炎，与浮
阳上泛不同，纵有下部恶寒足冷，此因虚火上升所致，非真阳衰而然，故小便必黄赤，脉必
带数，有内热的症之可据。误用桂附引火归元之法，是抱薪救火，上焦愈热，而咳嗽燥渴，
咽痛喉烂诸症至矣。二、理中温补之误。如果虚寒腹痛绵绵，痛无增减，喜热手按，热饮食
，虚寒泄泻，水谷不化，而澄澈清冷，必有虚寒之脉症可凭，然后用之有效。今人一见胀满
腹痛，食不消化，肠鸣泄泻等症，便认为虚寒，而投以白术之香燥，又济以干姜之辛热。不
知虚劳之症，患在伤阴，再补其阳，则阳益亢而阴益竭，是促之也。更有见其胀满泄泻，遂引
经文。清气在下则生飧泄，浊气在上则生 胀。而用补中益气，以升清降浊。误施升柴，反
促阴火上逆，以致咳嗽增，吐衄至，而危亡见矣。三、参、 助火之误。夫肺脉按之虚而不
数，肺中不热，参 可受，故有土旺生金，弗拘保肺之说。而今火已烁金而咳矣，火蒸津液
而化为浓痰矣！君相亢甚，而血随上逆矣，犹引无阳则阴无以生，虚火可补参、 之属，富
贵之家，大剂投之，因之阳火愈亢而金益伤矣。四、苦寒泻火之误。实火为病，可以苦寒直
折之，然须热去即止，不可过用。虚火阴亏，岂知、柏苦寒之剂所可清？非惟不能清火热，
抑且有损真阴，徒败胃气，食少泄多，将何疗治？甚者见其大便燥结，则用硝、黄以通之，
不知肾主二便，更主精液，肾之精液即竭，自然不能濡润。滋其阴，润其燥，而便自通。彼
既虚之阴，岂能胜硝、黄之攻击乎？故士材之论，人徒从其温补，岂知其深戒苦寒之不可妄
用也。五、二陈消痰之误。脾痰为湿痰，滑而易出，或稀如饮水，湿者燥之，半夏为正治之药
。若阴水不足，阴火上升，肺受火侮，不得清肃下行，由是津液凝浊，不生血而生痰，此当以
润剂滋其阴，使上逆之火，得返其宅，而痰自清矣。二陈岂可轻用哉！六、辛剂发散之误。
世之真阴虚而发热者，十之六七，亦与外感无异。火逆冲上，则头胀微痛；火升壅肺，则有
鼻塞；阴虚阳陷入里，则洒淅恶寒；阴虚阳无所附，则浮越肌表发热。但其发时，必在午后
，先洒淅恶寒，少顷发热，热至鸡鸣，寅卯时盗汗出而身凉，或不微寒，而但午后发热，必
现前列肾虚诸症，或兼唇红颧赤，口渴烦躁，六脉弦数，或虚数无力，此宜大剂补阴，如
保阴六味之属。若认为外感，而用风药以表散之，则魄汗淋漓，诸虚蜂起。或有失血之人
，表之无汗，所谓夺血者，无汗也，若强发之，血必从口鼻中出，为下厥上竭之症，难治矣
。今人一见发热，便用表散，更以为邪尚未清，禁其饮食，以致胃气馁败，至于不起，能不
为之寒心哉！七、治疗过时之误。上古治未病，如劳神者常养其心，劳倦者常补其脾，多怒
者常滋其肝血，多饮者常清其肺热，好色者峻补其肾水，及病之方萌，即为补救。今人以内
热之症而忽之，虚症渐见，犹不求治，自恃饮食如常，毫不加意，迨至病日深而后求治，亦
已晚矣。盖治之甚难，有三大要焉∶一曰补肾水。夫肾主水，受五脏六腑之精而藏之。故五
液皆归于精，而五精皆统于肾。肾有精室，是即命门，精藏于此，气化于此。精即阴中之水
也，气即阴中之水火也，故命门之水火，为十二脏之化源。然火不患其衰，水则患其少。王
节斋云∶少年肾水正旺，似不必补，然施泄太过，岂能充满？中年欲心虽减，然少年斫丧太
多，岂能复实？及至老年，天真渐绝，只有孤阳。凡人自少至老，所生疾病，大半由于真阴
不足。即童子禀赋弱者，幼即填补，亦有可复之天。所以补阴之药，人生一日不可缺，况
虚劳之因入房太甚而得者乎！故保阴、六味、左归之属，皆甘寒滋水添精之品，补阴以配
阳，正所谓壮水之主，以制阳光也。滋其阴则火自降，譬之残灯火焰，添油则焰光自小也。
然须制大剂长久服之，盖益阴之药，必无旦夕之效，以阴无速补之法也。若因于酒者，清金
润荣为主，而保阴之属，仍不可废。何则？好饮之人，仍有不患虚劳者，以肾水不虚也。虚则
心寡于畏，而复灼久伤之，肺焉得不病？补北方所以泻南方也。因于思虑者，清心养血为
主，而保阴之属，仍不可废，所谓水壮而火熄，弗急急于泻心是也。因于劳倦者，培补脾阴为主，
而佐以保阴之剂。经云∶
于肾也。若忿怒伤肝动血，保阴六味为正治之品，盖水旺则龙火不炎，而雷火亦不炎，乃肾
肝同治之法也。二曰培脾土。脾胃为后天之本。经云∶安谷则昌。盖饮食多，自能化精生血
。虽有邪热，药得治之，久则火自降而阴自复。若脾胃一损，则血不生，而阴不足以配阳。
故越人归重脾胃，而言一损损于肺，皮聚毛落；二损损于心，血脉不能荣养脏腑；三损损于
脾，饮食不为肌肤；四损损于肝，筋缓不能自收持；五损损于肾，骨痿不能起于床。从上而
下者，过于胃则不治，至骨痿不能起于床者死；从下而上者，过于脾则不治，至皮聚毛落者
死。所以仲景治虚劳，惟用甘药创建中气，以生血化精，为复虚劳之良法。又精不足者，补
之以味。味，旨味，非独药也，五谷之味，皆味也。补以味而节其劳，则渐有余矣。经云∶
阴阳形气俱不足者，调以甘药。盖脾胃之强弱，动关五脏，况土强则金旺，金旺则水充。又
男
为主。三曰慎调摄。虚劳之因于酒色者固多，其因于忧思郁怒者亦不少。如僧尼寡妇，童男
室女，及不得意之人，必须消遣情怀，善于自解，非全仗草木之力也。今人患此者，徒恃药
力，不知屏欲，间者有知戒酒色而不知节劳逸，能节劳逸，而于七情多所难释。不知心有妄
动，气随心散，气散不聚，精随气亡。故广成子曰∶必静必清，毋劳尔形，无摇尔精，乃可
长生。斯言可谓虚劳调摄之良法也。今观世人之患之者多，而保之者少，以病者治之不早，
医者治之不善也。故特发明阴虚成病之因，次及方书之混列，更推其真阴易虚之故，以及标
本传乘并治之误，而终之以治要。其指归如是，非敢矫当世之偏，实本诸先哲及先世之发明
，余生平之经验合之，以为心传云尔！
虚劳这一病症，没有外邪干扰，都是由内部损伤脏腑所导致。比如饮酒损伤肺，湿热熏蒸，就会消耗肺阴；房事过度损伤肾，会耗伐真阴；怒气损伤肝，郁怒则肝火在内炽盛而灼伤血液，大怒则肝火上冲而导致吐血。这五种情况，都能使精气血液劳损。《道经》说：涕、唾、精、津、汗、血、液，这七种灵物都属于阴。阴虚就会产生内热，从而形成虚劳病症。大都是因酒色导致的虚劳较多，但也有童子患此病的，这是由于先天禀赋不足，且多受母体之气影响所致。那些僧尼、寡妇、未婚女子，因思虑欲望不能遂愿，气血郁结，导致寒热像疟疾一样，早晨凉晚上热，不想饮食，月经不准时，或者闭经不行，因此得这种病的人很多，大多是由郁火蒸腾所致。医书关于虚劳的论述，都说气虚、血虚、阳虚、阴虚，混在一起治疗。所以学习的人，茫然没有方向。不知道气虚的症状是面目无神，语言轻微，四肢无力，脉象微弱；阳虚的症状是身体冷怕冷，手脚逆冷，小便清长大便稀溏，脉象沉小迟，可以用温补法。所以说虚劳症，能服用参、芪等药并受得住补益的，是可以治疗的，这是气虚阳虚的病症；虚劳症不能服用参、芪且受不了补益的，是不可治疗的，这是血虚阴虚的病症。虽然血脱有补气的方法，但这指的是突然大量失血，平时并非血虚的人。如新产后病症之类，都不属于因火燥导致血虚的病症讨论范围。火之所以燥，是因为水虚无以制约它，所以经文说：一水不能胜五火。五火，是指五志之火；一水，是指肾中的真阴之水，也就是精。人生命的全盛时期，前后只有二十多年罢了！所以朱丹溪引用月亮的盈亏，认为阳常有余，阴常不足。王节斋也认为阴虚成病占十之八九，阳虚成病百无一二。大概是因为节制欲望的人少，放纵欲望的人多啊！人们只知道纵欲劳累精气，谁知道阴精日渐损耗，饮食无味，越劳累越虚弱，脉象从内部变化，面色不荣华，这就是它的病症表现。在肾则为腰脊腿胫酸软，或隐隐作痛，为骨蒸内热盗汗，或者到了夜间发热，为全身骨头疼痛，或者疼痛如折断，为梦遗滑精，为耳鸣，脚心热。在心则为惊悸怔忡，为手掌心干热，为虚烦失眠，为噩梦不宁，为口苦舌干，为口舌糜烂。在肺则为咳嗽多痰，或者干咳少痰，为胸满气逆，或者喘促，为两颧红得像涂了脂粉，为鼻中气息如火，为咳血鼻衄，甚至吐白沫，只能侧卧一边，咽痛喉烂，声音嘶哑。在肝则为寒热像疟疾，为颈部瘰疬，为胁肋胀疼，为两眼干涩或疼痛，为头晕眼花，为易怒，为吐血。在脾则为饮食少想，恶心呕吐，为胀满腹痛，食物不消化，为肠鸣泄泻，肌肉消瘦。这都是五脏虚劳的本症。经文说：治病求其本。必须审查是什么原因导致损伤？哪一脏受伤？如果是因为房事过度的，就知道伤在肾，即使有其他经络的症状，也应当以补肾为主，兼治其他经络的症状。如果是因为饮酒的，又应当以清肺为先。标本既然审查清楚，疾病的传变，尤其需要仔细考察。比如肾传心，心传肺，五脏相传，必定相侮相乘，称为贼克，是大凶的征兆。经文说：诸病按顺序传变的会死。是说五脏都被克制遍了。《难经》说：七传者死。诸病始于肾，而脾又传肾，说是六经已尽，一脏不可再伤了。如果肾病不传心而传肺，中间隔了一脏，是以子病及母。如果不传心肺而传肝，中间隔了两脏，是以母病及子。如果不传心肺肝而传脾，中间隔了三脏而传于己之所不胜，所谓轻而侮之。传乘关系不明白，怎么能治病！世间的医生不知道阴虚症，大多将气血阴阳模糊调治，难道不是错误吗？试说说，其错误有七种：一是引火归元的错误。命门的龙火，称为真阳。如果真的衰弱，肾中阴盛，龙火不能安守其位，浮越于上，而为上焦假热，面赤、烦躁、口渴，甚至舌苔异常。但口虽渴却不欲饮水，苔虽有但舌必滑软，小便清长，脚冷过膝，右尺脉必沉小而迟，或浮大无根，这是阴盛于下，逼阳于上的假症。就像夏至一阴生，水底冷而天上热。正适宜用八味丸之类的药，引火归元。就像冬至一阳生，地中水暖，龙归大海。至于虚劳症，是因肾水真阴虚热，水不摄火，火因上炎，而导致面赤唇红，口鼻出血，齿痛、齿浮、齿衄，种种上焦虚热的症状，虽然也是龙火上炎，但与浮阳上泛不同，纵然有下部恶寒足冷，这也是因虚火上升所致，并非真阳衰败，所以小便必黄赤，脉必带数，有内热的症状可依据。误用桂枝、附子引火归元的方法，是抱薪救火，上焦更热，而咳嗽燥渴，咽痛喉烂等症状就来了。二是理中温补的错误。如果是虚寒腹痛绵绵，痛无增减，喜欢热手按压，喜热饮食，虚寒泄泻，水谷不化，且澄澈清冷，必须有虚寒的脉症可凭，然后使用才有效。现在的人一见胀满腹痛，食不消化，肠鸣泄泻等症状，便认为是虚寒，而投以白术的香燥，又加上干姜的辛热。不知道虚劳症，患在伤阴，再补其阳，则阳更亢而阴更竭，这是加速他的死亡。更有见到其胀满泄泻，于是引用经文“清气在下则生飧泄，浊气在上则生䐜胀”，而用补中益气汤，以升清降浊。误施升麻、柴胡，反而促使阴火上逆，以致咳嗽加重，吐衄发生，而危亡出现了。三是参、芪助火的错误。肺脉按之虚而不数，肺中不热，参、芪可以受用，所以有土旺生金，不拘泥于保肺的说法。而现在火已经烁金而咳了，火蒸津液而化为浓痰了！君相之火亢盛，而血随之上逆了，还引用“无阳则阴无以生，虚火可补”的说法，富贵人家，大剂量投用参、芪，因此阳火更亢而金更伤了。四是苦寒泻火的错误。实火致病，可以用苦寒直折，但须热去即止，不可过用。虚火阴亏，哪里知道知母、黄柏苦寒之剂可以清除？不仅不能清火热，而且有损真阴，徒然败坏胃气，食少泄多，将用什么来治疗？甚者见到其大便燥结，则用芒硝、大黄来通下，不知道肾主二便，更主精液，肾的精液枯竭，自然不能濡润。滋其阴，润其燥，而大便自通。他既已虚之阴，怎么能承受芒硝、大黄的攻伐呢？所以士材的论述，人们只跟随他的温补，哪里知道他深戒苦寒不可妄用的意思呢。五是二陈消痰的错误。脾痰为湿痰，滑而易出，或者稀如水饮，湿者燥之，半夏是正治的药物。如果阴水不足，阴火上升，肺受火侮，不得清肃下行，因此津液凝浊，不生血而生痰，这应当用润剂滋其阴，使上逆之火，得以返回其宅，而痰自然清了。二陈汤岂可轻用呢！六是辛剂发散的错误。世间真阴虚而发热的人，十之六七，也与外感无异。火逆冲上，则头胀微痛；火升壅肺，则有鼻塞；阴虚阳陷入里，则洒淅恶寒；阴虚阳无所附，则浮越肌表发热。但其发作时，必在午后，先洒淅恶寒，一会儿发热，热至鸡鸣，寅卯时盗汗出而身凉，或者不微寒，而只是午后发热，必现前列肾虚诸症，或兼唇红颧赤，口渴烦躁，六脉弦数，或虚数无力，这宜用大剂补阴，如保阴煎、六味地黄丸之类。如果认为是外感，而用风药来表散，则魄汗淋漓，诸虚蜂起。或者有失血之人，发汗无汗，所谓夺血者无汗也，如果强行发汗，血必从口鼻中出，成为下厥上竭的病症，难治了。现在的人一见发热，就用表散，更以为邪气尚未清除，禁止其饮食，以致胃气馁败，以至于不起，能不让人寒心吗！七是治疗过时的错误。上古时候治未病，如劳神的人常养其心，劳倦的人常补其脾，多怒的人常滋其肝血，多饮的人常清其肺热，好色的人峻补其肾水，等到病刚萌芽，就进行补救。现在的人以内热症状而忽视它，虚症渐见，还不求治，自恃饮食如常，毫不加意，等到病日深而后求治，也已经晚了。大概治疗很难，有三大纲要：一是补肾水。肾主水，受五脏六腑之精而藏之。所以五液皆归于精，而五精皆统于肾。肾有精室，就是命门，精藏于此，气化于此。精就是阴中之水，气就是阴中之水火，所以命门的水火，是十二脏的化源。然而火不患其衰，水则患其少。王节斋说：少年肾水正旺，似乎不必补，然而施泄太过，怎能充满？中年欲望虽减，然而少年斫丧太多，怎能复实？到了老年，天真渐绝，只有孤阳。凡人自少至老，所生疾病，大半由于真阴不足。即使是童子禀赋弱者，幼时即填补，也有可恢复的天年。所以补阴的药，人生一日不可缺，何况虚劳是因入房太甚而得的呢！所以保阴煎、六味地黄丸、左归丸之类，都是甘寒滋水添精的物品，补阴以配阳，正所谓壮水之主，以制阳光也。滋其阴则火自降，譬如残灯火焰，添油则焰光自小也。然而须制成大剂长久服用，因为益阴的药，必无旦夕之效，因为阴无速补之法。如果是因饮酒导致的，以清金润荣为主，而保阴煎之类，仍不可废。为什么呢？好饮酒的人，仍有不患虚劳的，因为肾水不虚。虚则心寡于畏，而又灼久伤之，肺焉得不病？补北方（肾）所以泻南方（心）。如果是因思虑导致的，以清心养血为主，而保阴煎之类，仍不可废，所谓水壮而火熄，不急于泻心。如果是因劳倦导致的，以培补脾阴为主，而佐以保阴之剂。经文说：损其肾者，益其精。如果是忿怒伤肝动血，保阴六味地黄丸是正治之品，盖水旺则龙火不炎，而雷火亦不炎，乃肝肾同治之法。二是培脾土。脾胃为后天之本。经文说：安谷则昌。大概饮食多，自能化精生血。虽然有邪热，药得治之，久则火自降而阴自复。如果脾胃一损，则血不生，而阴不足以配阳。所以越人重视脾胃，而言一损损于肺，皮聚毛落；二损损于心，血脉不能荣养脏腑；三损损于脾，饮食不为肌肤；四损损于肝，筋缓不能自收持；五损损于肾，骨痿不能起于床。从上而下者，过于胃则不治，至骨痿不能起于床者死；从下而上者，过于脾则不治，至皮聚毛落者死。所以张仲景治虚劳，只用甘药创建中气，以生血化精，为复虚劳的良法。又精不足者，补之以味。味，旨味，不单指药，五谷的味道，都是味。补以味而节其劳，则渐有余矣。经文说：阴阳形气俱不足者，调以甘药。大概脾胃的强弱，动关五脏，况且土强则金旺，金旺则水充。又以男子为主。三是慎调摄。虚劳因于酒色的固然多，因于忧思郁怒的也不少。如僧尼寡妇，童男室女，以及不得意的人，必须消遣情怀，善于自解，不全仗草木之力。现在的人患此病，只依赖药力，不知道屏除欲望，间歇期有的知道戒酒色而不知道节劳逸，能节劳逸，而对于七情多所难释。不知道心有妄动，气随心散，气散不聚，精随气亡。所以广成子说：必静必清，毋劳尔形，无摇尔精，乃可长生。这话可以说是虚劳调摄的良法。现在看世人患此病的多，而保养的少，是因为病人治之不早，医生治之不善。所以特别阐明阴虚成病的成因，其次涉及医书混列的问题，更推究真阴易虚的缘故，以及标本传乘和治疗错误的方面，最后以治疗纲要结束。其指向如此，不敢矫正当世的偏颇，实在基于先哲及先世的发明，结合我生平的经验，作为心传云尔！
The syndrome of Xu Lao (Consumptive Disease) involves no external pathogens interfering; it is entirely caused by internal injury to the Zang-Fu organs. For instance, alcohol damages the Lung; damp-heat steaming and熏蒸 (fuming) consumes Lung Yin. Sexual excess damages the Kidney, depleting True Yin. Anger damages the Liver; pent-up anger causes Liver Fire to blaze internally and scorch Blood, while sudden rage causes Liver Fire to rush upward leading to hematemesis. These five factors can all exhaust Essence and Blood. The *Dao Jing* states: "Tears, saliva, essence, fluids, sweat, blood, and body fluids—these seven spiritual substances all belong to Yin." When Yin is deficient, internal heat arises, forming the syndrome of Xu Lao. Generally, Xu Lao caused by alcohol and sex is common, yet even young boys may suffer from it due to congenital insufficiency, often influenced more by the mother's Qi. Monks, nuns, widows, and unmarried women, whose desires remain unfulfilled, experience Qi and Blood stagnation, resulting in chills and fever resembling malaria, morning coolness with evening fever, loss of appetite, irregular menstruation, or amenorrhea. Many develop this disease, mostly due to steaming by stagnant fire. Medical texts on Xu Lao discuss Qi deficiency, Blood deficiency, Yang deficiency, and Yin deficiency indiscriminately, treating them together. Thus, students are left without clear guidance. One must not confuse the symptoms: Qi deficiency presents as a spiritless complexion, faint voice, weak limbs, and a faint pulse; Yang deficiency presents as cold body aversion to cold, cold extremities, clear urine and loose stools, and a deep, small, slow pulse, which can be treated with warming tonification. Therefore, if a patient with Xu Lao can tolerate Ginseng (*Ren Shen*) and Astragalus (*Huang Qi*) and responds well to tonification, it is treatable and indicates Qi/Yang deficiency. If they cannot tolerate these herbs and reject tonification, it is untreatable and indicates Blood/Yin deficiency. Although there is a method of tonifying Qi for Blood loss, this refers to acute massive hemorrhage in individuals not previously suffering from Blood deficiency, such as postpartum conditions. It does not apply to cases where Blood deficiency is caused by Fire dryness. The reason Fire becomes dry is that Water is insufficient to control it; hence the classic says, "One Water cannot overcome Five Fires." The Five Fires refer to the fires of the Five Emotions; One Water refers to the True Yin Water of the Kidney, which is Essence. The peak period of human life lasts only about twenty years! Thus, Zhu Danxi used the waxing and waning of the moon to argue that "Yang is often in excess, Yin is often deficient." Wang Jiezhai also believed that 80-90% of diseases stem from Yin deficiency, while less than 1-2% stem from Yang deficiency, largely because few restrain their desires while many indulge them. People know that indulging in sex exhausts Essence, but few realize that daily depletion of Yin Essence leads to loss of taste, increasing weakness with exertion, internal changes in the pulse, and lackluster complexion. In the Kidney, symptoms include soreness/weakness of the lower back, spine, legs, and calves, or dull pain; bone-steaming internal heat with night sweats; fever at night; generalized bone pain or pain as if broken; nocturnal emission and spermatorrhea; tinnitus; and hot soles. In the Heart, symptoms include palpitations and fright; dry heat in palms; vexatious insomnia; restless dreams; bitter taste and dry tongue; and mouth/tongue ulcers. In the Lung, symptoms include cough with profuse sputum or dry cough with little sputum; chest fullness and rebellious Qi, possibly with asthma or rapid breathing; malar flush like rouge; hot breath from nose; hemoptysis and epistaxis; spitting white foam; inability to lie on one side; sore throat and rotten gums; hoarseness. In the Liver, symptoms include chills and fever like malaria; scrofula on the neck; distension and pain in hypochondrium; dry/painful eyes; dizziness and blurred vision; irritability; and hematemesis. In the Spleen, symptoms include poor appetite, nausea, vomiting; abdominal distension and pain, indigestion; borborygmus and diarrhea; and emaciation. These are the fundamental syndromes of the Five Zang organs' Xu Lao. The Classic states: "In treating disease, seek the root." One must examine the cause of damage and which organ is injured. If caused by sexual excess, the injury is in the Kidney; even if other meridians show symptoms, treatment should focus on tonifying the Kidney while addressing others. If caused by alcohol, clearing the Lung should come first. Once the root and branch are identified, the transmission of disease must be carefully observed. For example, Kidney transmitting to Heart, Heart to Lung, etc., constitutes mutual insulting and overcoming (Zei Ke), a sign of great misfortune. The Classic says: "Diseases transmitted in sequence lead to death," meaning all Five Zang have been overcome. The *Nan Jing* says: "Seven transmissions lead to death." If disease starts in the Kidney and transmits to the Spleen, then back to the Kidney, it means the Six Channels are exhausted, and one Zang cannot be injured again. If Kidney disease transmits to Lung skipping the Heart, it is "Child disease affecting Mother." If it skips Heart/Lung to transmit to Liver, it is "Mother disease affecting Child." If it skips Heart/Liver to transmit to Spleen, it transmits to what it cannot overcome, called "light insulting." Without understanding transmission, how can one treat disease? Modern physicians often blur the lines between Qi, Blood, Yin, and Yang when treating Yin deficiency, which is erroneous. There are seven specific errors:
1. Error of Guiding Fire Back to its Source: The Dragon Fire of the Mingmen is called True Yang. If truly deficient, with Yin excess in the Kidney, Dragon Fire cannot stay in place, floats upward causing false heat in the Upper Jiao (red face, restlessness, thirst). However, though thirsty, the patient does not want to drink; tongue coating exists but tongue is slippery/soggy; urine is clear/profuse; feet are cold past knees; Right Chi pulse is deep/small/slow or floating/large/rootless. This is false heat due to Yin excess pushing Yang up, like summer where water is cold but sky is hot. Ba Wei Wan (Eight-Ingredient Pill) is appropriate to guide fire back. Conversely, in Xu Lao, true Yin deficiency causes internal heat; Water fails to control Fire, Fire flares up causing red face/lips, bleeding from mouth/nose, toothache/swelling/bleeding, etc. Though similar to Dragon Fire flaming up, it differs from floating Yang. Even with cold feet, this is due to deficient Fire rising, not True Yang failure. Urine is yellow/scanty, pulse is rapid, indicating internal heat. Using Gui Zhi Tang (Cinnamon Twig Decoction) and Fu Zi (Aconite Root) to guide fire back is like adding firewood to save a fire, worsening upper Jiao heat, cough, dryness, and throat rot.
2. Error of Lizhong Warming Tonification: If there is continuous dull abdominal pain relieved by heat/pressure, cold clear diarrhea with undigested food, and corresponding pulse/symptoms, warming is effective. However, modern doctors see distension, pain, indigestion, and diarrhea, assume Cold Deficiency, and use aromatic/dry Bai Zhu (Atractylodes Macrocephala Rhizome) and pungent/hot Gan Jiang (Dried Ginger). They fail to realize Xu Lao harms Yin; tonifying Yang further exhausts Yin, hastening death. Some cite the Classic "Clear Qi sinking causes diarrhea, Turbid Qi rising causes distension" and use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Clear and descend Turbid. Misusing Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root) instead promotes Yin Fire rebellion, worsening cough and bleeding, leading to danger.
3. Error of Ren Shen/Astragalus Assisting Fire: If Lung pulse is deficient but not rapid, and Lung is not hot, Ren Shen and Huang Qi are acceptable ("Earth generates Metal"). But if Fire has scorched Metal causing cough, and steamed fluids into thick phlegm, with Ministerial Fire hyperactivity causing blood to rebel upward, citing "Without Yang, Yin cannot generate" to use large doses of Ren Shen/Huang Qi in wealthy patients only increases Yang Fire and injures Metal further.
4. Error of Bitter-Cold Draining Fire: Excess Fire can be directly drained with bitter-cold herbs, but stop once heat is gone. Yin deficiency with deficient Fire cannot be cleared by Zhi Mu (Anemarrhena Rhizome) and Huang Bai (Phellodendron Bark). Not only do they fail to clear heat, they damage True Yin and harm Stomach Qi, causing poor appetite and diarrhea. If constipation occurs due to dryness, using Xiao Shi (Sodium Sulfate) and Da Huang (Rhubarb Root) is wrong because Kidney governs bowels and fluids; if Kidney fluids are exhausted, lubrication fails. Nourishing Yin moistens dryness naturally. Can deficient Yin withstand the attack of Xiao Shi/Da Huang? Shi Cai warned against bitter-cold misuse, yet people follow his warming tonification blindly.
5. Error of Er Chen Phlegm Resolution: Spleen phlegm is Damp-Phlegm, slippery/easy to expectorate, or watery; dampness requires drying, making Ban Xia (Pinellia Tuber) correct. But if Yin Water is insufficient, Yin Fire rises, insulting Lung, preventing descending/clearing action, condensing fluids into phlegm instead of generating Blood, one must use moistening agents to nourish Yin, allowing Fire to return home, clearing phlegm naturally. Er Chen Tang (Two-Aged Powder) should not be used lightly.
6. Error of Pungent Dispersal: 60-70% of fevers in Yin deficiency resemble exterior patterns. Fire rebelling upward causes head distension/pain; Fire congesting Lung causes nasal obstruction; Yin deficiency with Yang sinking inward causes shivering chills; Yin deficiency with Yang having no anchor causes floating heat on skin. However, onset is usually afternoon: first chills, then fever until dawn, sweating during sleep (night sweats) cooling the body, or just afternoon fever. Symptoms include prior Kidney deficiency signs, red lips/cheeks, thirst/restlessness, wiry/rapid or deficient/weak pulses. Large dose Yin-nourishing formulas like Bao Yin Jian (Preserve Yin Decoction) or Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) are suitable. Mistaking this for exterior pattern and using wind/herbs to disperse causes profuse sweating and multiple deficiencies. In blood-loss patients, forcing sweat yields none ("Those who lose blood cannot sweat"); forcing it causes oral/nasal bleeding, a difficult-to-treat condition of lower collapse and upper exhaustion. Modern doctors see fever and disperse, restrict diet thinking pathogen remains, starving Stomach Qi until collapse. How chilling!
7. Error of Delayed Treatment: Ancient times practiced preventive treatment: nourish Heart for mental labor, tonify Spleen for physical fatigue, nourish Liver Blood for anger, clear Lung Heat for drinking, tonify Kidney Water for lust. Remedy at萌芽 (sprouting). Moderns ignore internal heat, delay treatment until deficiency shows, relying on normal appetite, until disease deepens, too late. Treatment is hard, requiring three essentials:
First: Tonify Kidney Water. Kidney governs Water, storing Essence from all Zang-Fu. Five fluids return to Essence; Five Essences are governed by Kidney. The Kidney's essence chamber is Mingmen, where Essence stores and Qi transforms. Essence is Water within Yin; Qi is Fire/Water within Yin. Mingmen's Fire/Water are sources for Twelve Organs. Fire rarely declines, but Water often lacks. Wang Jiezhai said: Youth Kidney Water is strong, seemingly不需补 (no need to tonify), but excessive release prevents fullness. Middle age desire decreases, but youth depletion prevents recovery. Old age sees fading Tian Zhen, leaving only solitary Yang. Most diseases from youth to old age stem from True Yin insufficiency. Even weak congenital constitutions can recover if filled early. Yin-tonifying herbs are essential daily, especially for Xu Lao from excessive sex. Bao Yin Jian, Liu Wei Di Huang Wan, Zuo Gui Wan are sweet-cold agents to nourish Water/add Essence, tonifying Yin to match Yang—"Strengthen the Master of Water to control Solar Flare." Nourishing Yin lowers Fire, like adding oil to a dying lamp reducing flame size. Must take large doses long-term; Yin has no quick tonification method. For alcohol-induced cases, clear Metal/moisten Ying primarily, but keep Bao Yin Jian. Why? Drinkers without Xu Lao have intact Kidney Water. Deficiency makes Heart fearless, burning injured Lung. Tonifying North (Kidney) drains South (Heart). For thought-induced cases, clear Heart/nourish Blood primarily, keeping Bao Yin Jian ("Water strong extinguishes Fire, do not rush to drain Heart"). For fatigue-induced cases, tonify Spleen Yin primarily, assisting with Bao Yin agents. Classic: "Damage to Kidney benefits Essence." For anger injuring Liver causing bleeding, Bao Yin Liu Wei is correct; Water abundance calms Dragon/Thunder Fire, treating Liver/Kidney together.
Second: Cultivate Spleen Earth. Spleen/Stomach are Post-Heaven Root. Classic: "Abundant grain leads to prosperity." More food generates Essence/Blood. Even with pathogenic heat, medicine treats it; eventually Fire lowers, Yin recovers. If Spleen/Stomach damage, Blood/Essence fail to generate, Yin cannot match Yang. Yue Man emphasized Spleen/Stomach: First damage affects Lung (skin/hair fall); Second affects Heart (vessels fail to nourish); Third affects Spleen (food fails to form flesh); Fourth affects Liver (tendons relax); Fifth affects Kidney (bones atrophy, unable to rise). Downward transmission: beyond Stomach is untreatable; bone atrophy is death. Upward transmission: beyond Spleen is untreatable; skin/hair fall is death. Zhang Zhongjing treated Xu Lao with Sweet Medicine to establish Middle Qi, generating Blood/Essence, a good method. "Insufficient Essence is supplemented by Flavor." Flavor includes grains. Supplement with flavor and rest labor to gradually restore. Classic: "When Yin/Yang/Form/Qi are all insufficient, regulate with Sweet Medicine." Spleen/Stomach strength affects all Zang; Earth strong makes Metal strong, Metal strong fills Water. Focus on men.
Third: Careful Regulation. Xu Lao from alcohol/sex is common, but also from worry/thought/anger. Monks/widows/unmarried/disappointed people must relieve emotions, understand themselves, not rely solely on herbs. Moderns rely on medicine, ignoring desire abstinence. Some quit alcohol/sex but don't regulate labor/rest; some regulate labor/rest but struggle with Seven Emotions. Unaware that妄动 (wild movement) of Heart scatters Qi, scattered Qi fails to gather, Essence follows Qi to perish. Guangchengzi said: "Be still and clear, do not exhaust your form, do not shake your essence, thus you can live long." This is excellent regulation for Xu Lao. Many suffer, few preserve, due to late treatment by patients and poor treatment by doctors. I clarify causes of Yin-deficiency disease, critique indiscriminate text classifications, explore why True Yin easily deficiences, and detail transmission/errors, ending with treatment essentials. This is my heart-transmission, based on ancients and my experience, not to correct modern bias arbitrarily.