真阴不足，则孤阳无根据，游火易于浮越，故宜甘温甜静之剂以养之，酸咸敛纳之
味以藏之。人但知气有余便是火，不知火之余即是气，或为喘满，或为烦闷，有余者病
气也。病气之有余，正气之不足也。凡饮食之气滞，可以利之、行之、顺之、理之。若
浮越之阳气，惟宜导之、纳之、敛之、塞之，以补为消，此气乃生身之本，非同饮食
之滞也。若用顺气之药，适足以开走泄元气之端，辛燥之药，反足以致耗竭律液之患，
即芎归陈皮之类，辛香而润，亦可引动无根之气，升越失守之火，上乘而为患也，故并
宜戒之。且元气既伤胃气必弱，香美之食人口未甘，何况异味药饵？虽开胃扶脾之品，
宁无伤脾倒胃之虞！故尤宜切忌。异香恶味之药，到口便伤胃气，何能人腹奏功？此
（张）之鄙见也。
四物以补血，四君子以补气，四君子温药也。补气而兼能生血，四物滞剂也。未能
补血，先伤胃气，且味辛温，不能以补真阴。（张）长沙用人参生新血，阳生阴长也，
以血难骤补，恐缓不及事，故血脱而补气。夫参色黄白，而味甘温，形色气味，俱能补
气生血，近世以其难得，而以 术代之，孰知力小难成大功，且性味更相悬绝，盖黄
固表，专升卫气，白术燥湿，能闭浊气，非若人参之冲和而纯粹。可以补接真神，而为，
虚灵之用也，诸虚以人参为君，犹人以谷气为主，但视虚实为增损耳。长沙治伤寒之
圣，外感且然，而况于内伤者乎？气虚则生脉散，不言 术，血虚则三才丸，不言四
物，洞然于中矣。
丹溪治阴虚发热，于血药四物汤，亦分阴阳，血药之动者为阳，芎归是也。血药之
静者为阴，地芍是也。血之阴不足者，虽芎归辛温，亦不用。血之阳不足者，虽姜桂辛
热，亦用之，此深得补阴之旨者矣。然天地之道，阳常有余，阴常不足，而人身亦然。
故血者，难成而易亏，况草木无情，安能生血？不过以地芍能养五脏之阴，芎归能调营
中之气，阴阳调和，而血自生耳。若夫失血太多，气息几微之际，慎勿与之！盖四物阴
类，非所以生物者也，当重用参、 ，故曰脱血者，先益其气，盖有形之血，不能速
生，而无形之气所当急固。若与四物则芎归辛窜，耗气动血，反致气血俱亡而死矣。故
诸虚损及胃虚气弱之人，皆不宜多服。
夫精生于血，而阴从阳长，故补气补血均不可少。然气有生血之功，血无益气之
理，故曰∶独阴不长；又曰∶血脱补气；又曰∶甘温能除大热。皆以春夏之令可以发
育，秋冬之气不能生长，且虚痨受补者可治，不受补者不治，葛可久神于治痨，其方
多用人参，丹溪专主滋阴。然用人参者，十有六七。自好古肺热伤肺之说一起，从而和
之者有人，以致后学持疑莫决，殊不知金气大伤，非参不能保之，且土旺而金生，勿拘
拘于保肺，木旺而火熄，毋汲汲于清心，要知火与元气，势不两立，一胜则一负，非此
空中生出有形之药，何能以嘘既败之阳和，而挽回垂绝哉！若不知虚火宜补，而误投苦
寒，受症百出，莫可救矣。
吴鹤皋曰∶凡人之身，有真火焉，寄于右肾，行于三焦，出入于甲胆，听命于天
君，所以温百骸，养脏腑，充九窍者，皆此火也，为万物之父，若此火一息，犹万物无
父，故其肉衰而瘠，血衰而枯，骨衰而齿落，筋衰而肢倦，气衰而言微矣。
神方不啻百种，而大法不出有三，曰阳虚、曰阴虚、曰中气虚。阳虚者，先天禀受
之真阳也。即火衰不能蒸腐水谷，以致饮食难化，腿膝无力，小便频，白不禁，脉沉缓
无力者是也。须益火之原，八味地黄丸。阴虚者，天一真阴亏损也。咳嗽夜热，盗汗沾
衣，脉多弦数者是也，须壮水之主，六味地黄丸。中气虚者，脾胃受伤，手心热，怠惰
懒食，气口脉大无力，即东垣内伤不足之症是也，须补中益气汤。如此则析理明而用治
当矣。
痨而久嗽，肺虚可知，即有热症，皆虚火也。海藏以保肺为君，故用紫菀、阿胶，
以清火为臣，故用知母、贝母，以参苓为佐者，扶土以生金，以甘桔为使者，载药以入
肺，五味子滋肾经不足之水，敛肺家耗散之金，久嗽者所必收也。用滋阴凉血者常也。
但生地、阿胶、麦冬、丹皮之类，皆性寒而润，胃虚食少者用之，则复伤脾胃后天之元
气。痨瘵而惟丹溪有气病补血，虽不中病，亦无害也之语，而不知其病已伏于中，渐至
胸膈痞闷，饮食减少，变症百出，此皆阴滞之性，损其冲和之气也。至若虚极之症，细
心调摄，药惟纯粹，止可保其和平，久则可望气血渐长。若调摄稍失药性少有低昂，病
情寻窦变生，便有莫可能御之势，盖因中气甚弱，无力可以抵当，犹小船不能重载；微
寒则寒病生，微热则热病起，微润则泻，微燥则涸，少偏气分，肺病为殃，少偏血分，
脾病乃起兢兢调摄，难见其功，少有偏枯，即生人患，何况气病补血而无害者乎？
骨蒸发热，脉细数而咳嗽，午后甚者，秦艽鳖甲散最效，按∶秦艽柴胡风药也。热
极生风，骨蒸非此不能引邪从毫窍而出，鳖属阴而用甲者，骨以及骨之义，乌梅味酸，
引诸骨入骨，而收其热。青蒿味苦能泄热，而杀虫。当归味辛能活血，而宣滞。地骨
皮，地为阴骨为里皮为表，自阴自表，以治在外，无汗之骨蒸也。知母上清肺金而泻
火，下润肾燥而滋阴，故治有汗之骨蒸也。立方周匝工稳极矣。骨蒸初起血液未至干涸
者，宜之。
痨瘵主乎阴虚，凡自子至已属阳，自午至亥属阴，阴虚则热在午后子前。寤属阳，
寐属阴，阴虚则盗汗，从寐时出升属阳，降属阴，阴虚则气不降，痰涎上逆，吐出不
绝，脉浮属阳，沉属阴，阴虚则浮之洪大沉之空虚，宜用滋阴降火之剂，又须远嗜欲，
薄滋味静心调养以助之。
（张）常治极虚之症，对面人事不清，而户外之事，反能知之，及见亡人鬼怪者，
此皆阳亡不足之象，而即自己游魂所致，但与补虚挽救，而兼敛纳，则神魂安而见闻灭
矣。
紫河车，真阴不足之人，可煮而食之，甚有奇功，但男用女胎，女用男胎为妙，否
则，若得雄壮妇人者亦可。凡病似呆非呆，似痴非痴，精神不正，以此食之，功效不可
尽述。
有临危索肉索饭，饱食而逝者，此脾虚津华竭绝，肉食力小，不能以挽之也。盖脾
虚则救助于谷食，津涸则求救于脂膏，惟浓浓参汤，可以挽之。若肉食者，止填有迹之
空虚，焉能补无形之竭绝哉！
虚劳不服参 ，为不受补者，死。劳嗽声哑者死，一边不能睡者，死。大肉去者，
死。吐血浅红色，似肉似肺谓之咳白血，心死。从上下者，久泻者，死。骨痿不能起于
床者，死，谓从肺病而之肾也。从下上者，
皮聚而毛落者，死，谓从肾病而之肺也。久而嗽血，咽痛无声，为自下传上，不嗽不
痛，久而溺浊，脱精泄泻，为自上传下，皆死证也。久病脉沉细数者，死。骨肉相失，
声散呕血，阳事不禁，日凉夜热者，死。脉结者，三年内，死。脉代者，三月内死。左
手脉细，右手浮大，劲急，为正虚邪盛，必死。脉细数骨蒸，干咳声哑，寒热似疟者，
必死。
《脉经》曰∶呼出心与肺，吸入肾与肝，盖言心肺浮而在上，浮者主出，故呼出心与
肺焉，肝肾沉而在下，沉者主入，故吸入肾与肝焉。脾位居中，其脉在浮沉之中，故浮
沉候阳，沉取候阴，凡六部重手沉取损小，轻手浮取实大，谓之阳盛阴虚。轻手浮取损
小，重手沉取实大，谓之阴盛阳虚。以尺寸论之，则阳主寸，阴主尺，寸浮者损小，尺
沉者实大，谓之阴盛阳虚。寸浮者实大，尺沉者损小，谓之阳盛阴虚。
寸口脉浮而迟，浮则为虚，迟则为劳。脉大为劳，极虚亦为劳。凡诊虚弱细弦，皆
为不足，阴阳俱虚之脉，惟平旦见之日中则洪数矣。浮而大浮而弦者，皆为火盛阴虚之
脉，暮多见之，至数多而数者，为至脉，即阴虚劳症也。至脉缓而无力，属气虚，数而
无力属血虚。
久病形肉俱脱，脉来虽似和缓，亦多不治，盖迁延日久，客病无矣。元阳亏极火气
微矣。虽无六淫攻袭之苦。然气血断难恢愎，几希一线牵带未完，故脉疾徐得次，虽
是和缓。然实无神也。况肌肉者，脾之所主，土为万物之母，形肉脱者，土崩而脾绝
矣。《经》曰∶形肉已脱，九候虽调犹死也。虚痨热毒积久，则生恶虫，食人脏腑，其证
蒸热，咳嗽胸闷背痛，两目不明，四肢无力，腰膝酸疼，卧不能寐，面色 白，两
颊时红，常怀忿怒，梦与鬼交，同气连枝，多遭传染，甚而灭门，法当补虚以复其元，
杀虫以绝其根，能杀其虫，虽病者不生，亦可绝其传疰，凡视此病者，不宜饥饿近之，
虚者，须服补药，宜佩安息麝香之类，则虫邪不敢侵袭也。
真阴不足，则孤阳失去依附，虚火容易浮越上冲，因此适宜使用甘温、甘甜且性质宁静的药物来滋养它，以及酸味和咸味的药物来收敛固摄。人们只知道气有余就会变成火，却不知道火的余烬其实就是气，（这种气）有时表现为喘促胀满，有时表现为烦闷，这属于病气的有余。病气的有余，正是正气的不足。凡是饮食之气停滞，可以通过利导、行散、顺降、调理的方法处理。如果是浮越的阳气，只适宜引导、纳归、收敛、固塞，以补益的方法来消除虚火，这才是生命之本的气，不同于饮食停滞。如果使用顺气药，恰恰开启了元气耗散的开端；辛燥的药物，反而会导致津液枯竭的祸患，即使是川芎、当归、陈皮这类辛香而滋润的药，也能引动无根之气，使失守之火升越上冲，造成危害，所以都应当禁忌。况且元气既已受伤，胃气必然虚弱，香气美味的食物入口尚且不觉得甘甜，何况味道奇特的药物呢？虽然有益胃扶脾的药物，难道没有损伤脾胃、导致胃气上逆的担忧吗！因此尤其应当切忌。气味异香或恶臭的药物，入口便伤害胃气，怎么能进入腹部发挥疗效呢？这是我的浅见。
四物汤用来补血，四君子汤用来补气，四君子汤是温性药物。补气同时又能生血，四物汤是滞腻的药物。未能补血，先伤了胃气，而且味道辛温，不能补益真阴。张仲景用人参来生新血，这是“阳生阴长”的道理，因为血液难以迅速补充，担心缓慢来不及救治，所以在血脱时采用补气法。人参色黄白，味甘温，其形色气味都能补气生血。近代人因为人参难得，用白术代替，谁知道白术力小难成大功，而且性味相差悬殊。黄芪固表，专主升发卫气；白术燥湿，能闭塞浊气，不像人参那样冲和纯粹，可以补接真神，发挥虚灵的作用。各种虚损病症以人参为君药，就像人依靠谷气为主一样，只需根据虚实进行增减即可。张仲景是治疗伤寒的圣人，外感病尚且如此，何况内伤疾病呢？气虚则用生脉散，不说用白术；血虚则用三才丸，不说用四物汤，其中道理显而易见。
朱丹溪治疗阴虚发热，在血药四物汤中，也区分阴阳。血药中动的属阳，即川芎、当归；血药中静的属阴，即地黄、芍药。血之阴不足的，即使川芎、当归辛温，也不用。血之阳不足的，即使干姜、肉桂辛热，也用之，这深得补阴的宗旨。然而天地之道，阳常有余，阴常不足，人身也是如此。所以血，难成而易亏，何况草木无情，怎能直接生血？不过是用地黄、芍药能滋养五脏之阴，川芎、当归能调畅营中之气，阴阳调和，血自然生成罢了。如果失血太多，气息微弱的时刻，千万不要给服四物汤！因为四物汤属阴类，不是用来生发气血的，应当重用参、芪，所以说“脱血者，先益其气”，因为有形之血不能速生，而无形之气应当急固。如果与四物汤同用，则川芎、当归辛窜，会耗气动血，反而导致气血俱亡而死。所以各种虚损及胃虚气弱的人，都不宜多服。
精生于血，而阴随阳长，所以补气补血都不可少。然而气有生血的功效，血没有益气的作用，所以说：“独阴不长”；又说：“血脱补气”；又说：“甘温能除大热”。这都是因为春夏之气可以发育，秋冬之气不能生长。而且虚劳病受补的可以治，不受补的不可治。葛可久在治疗痨病方面技艺高超，他的方子多用人参，朱丹溪专门主张滋阴。然而用人参的占十之六七。自从李东垣提出“肺热伤肺”的说法后，附和的人有之，导致后学怀疑不决，殊不知金气大伤，非人参不能保全，而且土旺则金生，不要拘泥于保肺；木旺则火熄，不要急切于清心。要知道火与元气，势不两立，一胜则一负，如果不是这种空中生出有形之药，怎么能吹嘘已经败坏的阳气，挽回垂绝的生命呢？如果不知道虚火宜补，而误投苦寒药物，症状百出，无法挽救了。
吴鹤皋说：凡人的身体，有真火存在，寄居在右肾，运行于三焦，出入于胆经，听命于心（天君），所以温暖百骸，滋养脏腑，充实九窍的，都是这股火，它是万物的父亲，如果这股火熄灭，就像万物没有父亲，所以肌肉消瘦，血液枯槁，骨骼衰败牙齿脱落，筋脉衰败肢体疲倦，气衰声音微弱。
神妙的方剂不止百种，但大法不出三种，即阳虚、阴虚、中气虚。阳虚，是先天禀受的真阳不足。即火衰不能蒸腐水谷，导致饮食难化，腿膝无力，小便频数，白带不禁，脉象沉缓无力等，这是阳虚证。必须益火之源，用八味地黄丸。阴虚，是天一真阴亏损。咳嗽夜热，盗汗沾衣，脉象多弦数等，这是阴虚证。必须壮水之主，用六味地黄丸。中气虚，是脾胃受伤，手心热，怠惰懒食，气口脉大无力，这就是李东垣所说的内伤不足之症，必须用补中益气汤。这样就能分析清楚医理，用药得当。
痨病而长期咳嗽，可知肺虚，即使有热症，也都是虚火。张元素以保肺为君药，所以用紫菀、阿胶；以清火为臣药，所以用知母、贝母；以人参、茯苓为佐药，扶助脾胃以生肺金；以甘草、桔梗为使药，载药入肺；五味子滋补肾经不足之水，收敛肺家耗散之金，这是久嗽者必须收涩的。通常使用滋阴凉血的药物。但是生地、阿胶、麦冬、丹皮之类，都是性寒而润的，胃虚食少的人服用，则会再次损伤脾胃后天之元气。痨瘵病只有朱丹溪说过“气病补血，虽不中病，亦无害也”的话，却不知道病邪已经潜伏在中焦，逐渐导致胸膈痞闷，饮食减少，变症百出，这都是阴滞的性质，损伤了冲和之气。至于极度虚弱的病症，细心调养摄护，药物只要纯粹，只能保持平和，久了才能期望气血渐长。如果调养稍有失误，药性稍有偏差，病情随即变化滋生，就有无法抵御的形势，这是因为中气很弱，无力抵挡，就像小船不能重载；微寒则寒病产生，微热则热病兴起，微润则腹泻，微燥则干枯，稍微偏于气分，肺病受害；稍微偏于血分，脾病发生。兢兢业业地调养，很难见到功效，稍有偏枯，就产生病患，何况说气病补血而无害呢？
骨蒸发热，脉细数而咳嗽，午后加重，秦艽鳖甲散最有效。按语：秦艽、柴胡是风药。热极生风，骨蒸非此不能引导邪气从毛孔而出；鳖属阴，用其甲，取“骨以及骨”的意思；乌梅味酸，引导诸骨入骨，而收敛其热；青蒿味苦能泄热，而杀虫；当归味辛能活血，而宣通滞气；地骨皮，地为阴，骨为里，皮为表，自阴自表，以治疗在外、无汗的骨蒸；知母上清肺金而泻火，下润肾燥而滋阴，所以治疗有汗的骨蒸。立方周密稳妥极了。骨蒸初起，血液未至干涸的，适宜使用。
痨瘵主要在于阴虚，凡从子时到巳时属阳，从午时到亥时属阴，阴虚则热在午后子前。醒属阳，睡属阴，阴虚则盗汗，从睡眠时出汗；升属阳，降属阴，阴虚则气不降，痰涎上逆，吐出不止；脉浮属阳，沉属阴，阴虚则浮取洪大，沉取空虚，适宜使用滋阴降火的药剂，又须远离嗜欲，清淡饮食，静心调养以辅助。
张元素常治疗极度虚弱的病症，患者对面人事不清，而户外之事，反而能知道，甚至见到亡人鬼怪，这都是阳气亡失不足的征象，也是自己游魂所致，只要给予补虚挽救，并兼用收敛固摄的方法，则神魂安定，幻觉消失。
紫河车，真阴不足的人，可以煮熟食用，很有奇效，但男用女胎，女用男胎为妙，否则，如果得到雄壮妇人的胎盘也可以。凡是病似呆非呆，似痴非痴，精神不正，以此食用，功效不可尽述。
有临危索要肉食饭菜，饱食后去世的，这是脾虚津液精华竭绝，肉食力量微小，不能挽救。因为脾虚则求助于谷食，津液枯竭则求救于脂膏，只有浓浓的参汤，可以挽救。如果吃肉，只是填补有形的空虚，怎么能补益无形的竭绝呢？
虚劳不服人参、黄芪，为不受补者，死。劳嗽声哑者死，一边不能睡者死。大肉消脱者死。吐血浅红色，似肉似肺谓之咳白血，心死。从上往下传变的，久泻者死。骨痿不能起床者死，谓从肺病传到肾。从下往上传变的，皮毛聚拢而毛发脱落者死，谓从肾病传到肺。久而咳嗽带血，咽痛无声，为自下上传，不嗽不痛，久而尿浊，脱精泄泻，为自上传下，都是死证。久病脉沉细数者死。骨肉相失，声音散乱呕血，阳事不禁，日凉夜热者死。脉结者，三年内死。脉代者，三月内死。左手脉细，右手浮大，劲急，为正虚邪盛，必死。脉细数骨蒸，干咳声哑，寒热似疟者，必死。
《脉经》说：呼出由心和肺主管，吸入由肾和肝主管，是说心肺浮而在上，浮者主出，所以呼出由心和肺主管；肝肾沉而在下，沉者主入，所以吸入由肾和肝主管。脾位居中，其脉在浮沉之间，所以浮取候阳，沉取候阴。凡六部重手沉取脉小，轻手浮取脉实大，称为阳盛阴虚。轻手浮取脉小，重手沉取脉实大，称为阴盛阳虚。以尺寸论，则阳主寸，阴主尺，寸脉浮取损小，尺脉沉取实大，称为阴盛阳虚。寸脉浮取实大，尺脉沉取损小，称为阳盛阴虚。
寸口脉浮而迟，浮则为虚，迟则为劳。脉大为劳，极虚也为劳。凡诊察虚弱细弦，皆为不足，阴阳俱虚的脉象，只有在平旦出现，到了中午就会变得洪数。浮而大、浮而弦的，都是火盛阴虚的脉象，多在傍晚出现，至数多而数的，称为至脉，即阴虚劳症。至脉缓而无力，属气虚；数而无力属血虚。
久病形体肌肉都脱失，脉来虽然似乎和缓，也多不治，因为迁延日久，外邪已去，元阳亏极，火气微弱。虽然没有六淫攻袭的痛苦，但气血断难恢复，仅一线牵带未完，所以脉疾徐得次，虽然和缓，但实际上无神。况且肌肉是脾所主，土为万物之母，形肉脱失，就是土崩而脾绝了。《内经》说：形肉已脱，九候虽调犹死也。虚劳热毒积久，则生恶虫，吃人脏腑，其证蒸热，咳嗽胸闷背痛，两目不明，四肢无力，腰膝酸疼，卧不能寐，面色㿠白，两颊时红，常怀忿怒，梦与鬼交，同气连枝，多遭传染，甚而灭门，法当补虚以复其元，杀虫以绝其根，能杀其虫，虽病者不生，亦可绝其传疰，凡视此病者，不宜饥饿近之，虚者，须服补药，宜佩安息麝香之类，则虫邪不敢侵袭也。
When True Yin is insufficient, solitary Yang loses its foundation, and wandering fire easily floats upward. Therefore, it is appropriate to use sweet, warm, and tranquil agents to nourish it, and sour and salty flavors to astringe and store it. People only know that excess Qi transforms into fire, but do not realize that the remnant of fire is essentially Qi. This may manifest as wheezing and fullness, or irritability and oppression; this excess belongs to pathogenic Qi. The excess of pathogenic Qi indicates the insufficiency of healthy Qi. For stagnation of dietary Qi, one can employ methods to promote drainage, circulation, smooth flow, and regulation. However, for floating Yang Qi, one should only guide, anchor, astringe, and seal it, using tonification to eliminate deficiency-fire. This Qi is the root of life, distinct from dietary stagnation. If Qi-moving medicines are used, they merely open the door for healthy Qi leakage; acrid and drying medicines instead cause fluid depletion. Even herbs like Xiong Gui Chen Pi (Ligusticum Chuanxiong Rhizome, Angelica Sinensis Radix, and Tangerine Peel), which are acrid-aromatic and moistening, can stir up rootless Qi and cause lost-to-control fire to ascend, causing harm; thus, they should all be avoided. Moreover, if healthy Qi is damaged, Stomach Qi must be weak. Fragrant and delicious foods may not even be palatable upon entry, let alone strange-tasting medicinal substances. Although there are herbs that open the appetite and support the Spleen, could they not risk damaging the Spleen and reversing Stomach Qi? Therefore, they are especially contraindicated. Herbs with exotic fragrances or foul tastes damage Stomach Qi upon contact with the mouth; how can they enter the abdomen and take effect? This is my humble opinion.
Si Wu Tang (Four Substances Decoction) is used to tonify Blood, and Si Jun Zi Tang (Four Gentlemen Decoction) is used to tonify Qi. Si Jun Zi Tang consists of warm herbs. Tonifying Qi can simultaneously generate Blood. Si Wu Tang is a cloying/stagnant formula. It fails to tonify Blood and first damages Stomach Qi; furthermore, its acrid-warm nature cannot tonify True Yin. Zhang Zhongjing used Ren Shen (Ginseng Radix et Rhizoma) to generate new Blood, following the principle of "Yang generates Yin." Because Blood is difficult to replenish rapidly, fearing that slow action would miss the critical moment, he employed Qi-tonification in cases of Blood collapse. Ren Shen is yellowish-white and has a sweet, warm flavor; its color, form, and taste all tonify Qi and generate Blood. In recent times, due to the scarcity of Ren Shen, Bai Zhu (Atractylodis Macrocephalae Rhizoma) has been used as a substitute. Who knows that Bai Zhu has weak power and cannot achieve great success, and its nature and flavor are vastly different. Huang Qi (Astragali Radix) consolidates the exterior and specifically raises Wei Qi (Defensive Qi); Bai Zhu dries dampness and can obstruct turbid Qi. Neither is as harmonious and pure as Ren Shen, which can supplement and connect True Shen (Spirit), serving its ethereal functions. For various deficiencies, Ren Shen serves as the sovereign herb, just as humans rely on Gu Qi (Grain Qi) as their mainstay; dosage is simply adjusted according to deficiency or excess. Zhang Zhongjing was the sage of treating Shang Han (Cold Damage); if this applies to external contraction, how much more so for internal injury? For Qi deficiency, Sheng Mai San (Generate the Pulse Powder) is used, without mentioning Bai Zhu; for Blood deficiency, San Cai Wan (Three Immortals Pill) is used, without mentioning Si Wu Tang. The profound reasoning is clear within.
Zhu Danxi treated Yin-deficiency fever by dividing the blood-tonifying Si Wu Tang into Yin and Yang. The moving blood herbs are Yang, namely Chuan Xiong (Ligusticum Chuanxiong Rhizome) and Dang Gui (Angelica Sinensis Radix). The still blood herbs are Yin, namely Di Huang (Rehmanniae Radix) and Bai Shao (Paeoniae Radix Alba). When Yin-blood is insufficient, even the acrid-warm Chuan Xiong and Dang Gui are not used. When Yang-blood is insufficient, even the acrid-hot Sheng Jiang (Zingiberis Rhizoma Recens) and Rou Gui (Cinnamomi Cortex) are used. This deeply grasps the essence of tonifying Yin. However, the way of Heaven and Earth is that Yang is often in excess and Yin is often insufficient, and the human body is the same. Thus, Blood is hard to form and easy to deplete. Furthermore, plants are unfeeling; how can they directly generate Blood? They merely use Di Huang and Bai Shao to nourish the Yin of the Five Zang Organs, and Chuan Xiong and Dang Gui to regulate Ying Qi (Nutritive Qi) within the vessels. When Yin and Yang are harmonized, Blood generates itself. However, when blood loss is excessive and breath is nearly imperceptible, one must strictly avoid giving this! Si Wu Tang belongs to the Yin category and is not suitable for generating life. One should heavily use Ren Shen and Huang Qi (Astragali Radix). Hence it is said: "In cases of Blood collapse, first benefit the Qi," because tangible Blood cannot be generated quickly, while intangible Qi must be urgently secured. If given with Si Wu Tang, the acrid-penetrating nature of Chuan Xiong and Dang Gui will consume Qi and disturb Blood, leading to death from the exhaustion of both Qi and Blood. Therefore, those with various deficiencies and weak Stomach Qi should not take it frequently.
Jing (Essence) is born from Blood, and Yin grows with Yang. Thus, neither tonifying Qi nor tonifying Blood should be neglected. However, Qi has the function of generating Blood, while Blood has no function of benefiting Qi. Hence it is said: "Solitary Yin does not grow"; also: "In Blood collapse, tonify Qi"; also: "Sweet-warm can remove great heat." All these refer to the fact that the energies of Spring and Summer allow development, while those of Autumn and Winter do not promote growth. Moreover, consumptive diseases that accept tonification can be treated; those that do not accept tonification are incurable. Ge Kejiu was skilled in treating Lao (Consumption); his formulas mostly used Ren Shen, while Zhu Danxi specialized in nourishing Yin. Yet, six or seven out of ten used Ren Shen. Since Li Dongyuan's theory of "Lung Heat Damaging the Lung" arose, many have echoed it, causing later students to hesitate. Little do they know that when Metal Qi is severely damaged, only Ren Shen can protect it. Moreover, when Earth is prosperous, Metal is generated; do not rigidly focus on protecting the Lung. When Wood is prosperous, Fire is extinguished; do not anxiously focus on clearing the Heart. Know that Fire and Yuan Qi (Original Qi) are mutually exclusive; when one wins, the other loses. Without such herbs seemingly emerging from the void, how can one breathe life back into ruined Yang and salvage impending death? If one does not understand that deficiency-fire requires tonification and mistakenly administers bitter-cold herbs, myriad symptoms will arise, and rescue will be impossible.
Wu Hegao said: In the human body, there is True Fire, residing in the Right Kidney, circulating through the San Jiao (Triple Burner), entering and exiting the Gallbladder channel, and obeying the Tian Jun (Heavenly Lord/Heart). This fire warms the hundred bones, nourishes the Zang-Fu organs, and fills the nine orifices. It is the father of all things. If this fire ceases, it is like all things having no father; thus, flesh becomes emaciated, blood withered, bones decayed with teeth falling out, sinews weakened with limbs tired, and Qi deficient with faint speech.
There are countless miraculous formulas, but the major principles fall into three categories: Yang Deficiency, Yin Deficiency, and Middle Qi Deficiency. Yang Deficiency refers to the congenital True Yang being insufficient. It manifests as fire failing to steam and rot food and drink, leading to indigestion, weakness in legs and knees, frequent urination, involuntary leukorrhea, and a deep, slow, forceless pulse. One must benefit the source of fire using Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill). Yin Deficiency refers to the depletion of Tian Yi True Yin. It manifests as cough, night fever, night sweats soaking clothes, and a wiry, rapid pulse. One must strengthen the master of water using Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). Middle Qi Deficiency refers to injury to the Spleen and Stomach, with hot palms, lethargy, poor appetite, and a large, forceless pulse at the Qi Kou (Radial Artery). This is the syndrome of internal injury and insufficiency described by Li Dongyuan. One must use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). In this way, the analysis of principles is clear, and treatment is appropriate.
In Lao disease with chronic cough, Lung deficiency is evident. Even if there are heat symptoms, they are all deficiency-fire. Zhang Congzheng took protecting the Lung as the sovereign strategy, using Zi Wan (Asteli Radix) and E Jiao (Colla Corii Asini) for this purpose. He took clearing fire as the minister strategy, using Zhi Mu (Anemarrhenae Rhizoma) and Bei Mu (Fritillariae Thunbergii Bulbus). He used Ren Shen and Fu Ling (Poria) as assistants to support Earth to generate Metal. He used Gan Cao (Glycyrrhizae Radix) and Jie Geng (Platycodonis Radix) as guides to carry the medicine to the Lung. Wu Wei Zi (Schisandrae Fructus) nourishes the insufficient Water of the Kidney meridian and astringes the dissipating Metal of the Lung; this is essential for chronic cough. Using herbs to nourish Yin and cool Blood is common. However, herbs like Sheng Di Huang (Rehmanniae Radix), E Jiao, Mai Dong (Ophiopogonis Radix), and Mu Dan Pi (Moutan Cortex) are cold and moistening. If used by those with weak Stomach Qi and poor appetite, they will further damage the Post-Heaven Yuan Qi of the Spleen and Stomach. Zhu Danxi stated regarding Lao disease: "Treating Qi disease by tonifying Blood, though not hitting the target, causes no harm." But he did not realize that the pathogen had already潜伏 (lurked) in the middle, gradually causing chest and diaphragm stuffiness, reduced diet, and myriad changes. These are due to the cloying nature of Yin, which damages the harmonious Qi. For extremely deficient syndromes, careful nursing and pure medicines can only maintain peace; over time, gradual growth of Qi and Blood may be hoped for. If nursing is slightly negligent or the drug property slightly deviates, the condition will change and arise, becoming uncontrollable. This is because Middle Qi is very weak and lacks strength to resist, like a small boat unable to bear heavy loads. Slight cold generates cold disease; slight heat generates heat disease; slight moisture causes diarrhea; slight dryness causes dehydration. Slight deviation in the Qi level harms the Lung; slight deviation in the Blood level harms the Spleen. Diligent nursing yields little visible result; slight imbalance produces illness. How then can one claim that tonifying Blood for Qi disease is harmless?
For bone-steaming fever with fine, rapid pulse and cough, worsening in the afternoon, Qin Jiao Bie Jia San (Gentian and Turtle Shell Powder) is most effective. Note: Qin Jiao (Gentianae Macrophyllae Radix) and Chai Hu (Bupleuri Radix) are wind-dispelling herbs. Extreme heat generates wind; bone-steaming cannot expel pathogens from the hair follicles without them. Bie Jia (Testudinis Carapax et Plastrum) belongs to Yin; using the shell implies reaching the bone. W Mei (Mume Fructus) is sour, guiding bones into the bone and astringing heat. Qing Hao (Artemisiae Annuae Herba) is bitter, clearing heat and killing parasites. Dang Gui is acrid, invigorating Blood and dispersing stagnation. Di Gu Pi (Lycii Cortex) uses Earth for Yin, Bone for interior, and Skin for exterior, treating external, anhidrotic bone-steaming. Zhi Mu clears Lung Metal and drains fire above, moistens Kidney dryness and nourishes Yin below, thus treating hyperhidrotic bone-steaming. The prescription is thorough and stable. It is suitable for early-stage bone-steaming where Blood fluids have not yet dried up.
Lao disease primarily involves Yin deficiency. From Zi hour to Si hour belongs to Yang; from Wu hour to Hai hour belongs to Yin. In Yin deficiency, heat occurs after noon and before Zi hour. Awakening belongs to Yang, sleep belongs to Yin; in Yin deficiency, night sweats occur during sleep. Ascending belongs to Yang, descending belongs to Yin; in Yin deficiency, Qi fails to descend, phlegm-saliva rebels upward, and expectoration is incessant. Floating pulse belongs to Yang, sinking pulse belongs to Yin; in Yin deficiency, floating is surging and large, while sinking is empty. One should use Yin-nourishing and fire-descending agents, and also avoid sexual desires, eat bland foods, and rest quietly to assist recovery.
Zhang Yuansu often treated extreme deficiency syndromes where patients were confused about people facing them but aware of events outside, or saw ghosts and spirits. These are signs of Yang collapse and insufficiency, caused by their own wandering Hun (Ethereal Soul). By providing deficiency-tonification and rescue, combined with astringency and anchoring, the Hun and Shen (Spirit) settle, and hallucinations cease.
Zi He Che (Human Placenta) can be boiled and eaten by those with True Yin insufficiency, yielding remarkable results. It is best for men to use female placenta and for women to use male placenta; otherwise, placenta from robust women is also acceptable. For illnesses resembling dementia or foolishness, with disordered spirit, eating this yields indescribable efficacy.
Those who, near death, crave meat and rice, and die after eating their fill, suffer from Spleen deficiency and exhaustion of Jin Ye (Body Fluids) and Hua Qi (Splendor Qi). Meat has weak power and cannot rescue them. Spleen deficiency seeks relief from grain; fluid exhaustion seeks relief from fat. Only thick Ren Shen Tang (Ginseng Decoction) can rescue them. Meat only fills tangible emptiness; how can it replenish intangible exhaustion?
In Xu Lao (Deficiency Consumption), refusal to take Ren Shen and Huang Qi indicates inability to accept tonification, leading to death. Labor cough with hoarseness leads to death. Inability to lie on one side leads to death. Emaciation of large muscles leads to death. Coughing up light red blood resembling meat or lung tissue is called "coughing white blood," indicating Heart death. Progression from upper to lower parts, or chronic diarrhea, leads to death. Bone atrophy preventing rising from bed leads to death, indicating transmission from Lung to Kidney. Progression from lower to upper parts, with gathering skin and falling hair, leads to death, indicating transmission from Kidney to Lung. Chronic cough with blood, sore throat, and voice loss indicates transmission from lower to upper; chronic turbid urine, seminal emission, and diarrhea without cough or pain indicates transmission from upper to lower; both are death signs. Chronic illness with deep, fine, rapid pulse leads to death. Loss of flesh and bone, scattered voice, hematemesis, involuntary erection, cool days and hot nights lead to death. Ji Mai (Knotted Pulse) indicates death within three years. Dai Mai (Intermittent Pulse) indicates death within three months. Fine Left Hand pulse with surging, large, tense Right Hand pulse indicates Healthy Qi deficiency and Pathogenic Excess, leading to certain death. Fine, rapid pulse with bone-steaming, dry cough, hoarseness, and malaria-like chills and fever indicate certain death.
The Mai Jing (Pulse Classic) states: Exhalation is governed by the Heart and Lung; inhalation is governed by the Kidney and Liver. This means the Heart and Lung are floating and superior; floating governs exit, hence exhalation is governed by the Heart and Lung. The Kidney and Liver are sinking and inferior; sinking governs entry, hence inhalation is governed by the Kidney and Liver. The Spleen resides in the center, its pulse between floating and sinking. Thus, floating palpation examines Yang, and sinking palpation examines Yin. If all six positions are small upon heavy sinking pressure but solid and large upon light floating pressure, it is called Yang Excess and Yin Deficiency. If light floating pressure reveals smallness and heavy sinking pressure reveals solidity and largeness, it is called Yin Excess and Yang Deficiency. Discussing Cun (Inch) and Chi (Cubit) positions: Yang governs Cun, Yin governs Chi. If Cun floating is small and Chi sinking is large, it is Yin Excess and Yang Deficiency. If Cun floating is large and Chi sinking is small, it is Yang Excess and Yin Deficiency.
Cun Kou pulse floating and delayed: Floating indicates deficiency; delayed indicates labor/exhaustion. Large pulse indicates labor; extremely deficient pulse also indicates labor. Weak, fine, and wiry pulses all indicate insufficiency. The pulse of dual Yin-Yang deficiency appears only at dawn; by midday, it becomes surging and rapid. Floating-large and floating-wiry pulses are both signs of Fire Excess and Yin Deficiency, commonly seen in the evening. A pulse with many beats and rapidity is called Zhi Mai (Arriving Pulse), indicating Yin-deficiency Lao syndrome. Zhi Mai that is slow and forceless indicates Qi deficiency; rapid and forceless indicates Blood deficiency.
In chronic illness with complete wasting of form and flesh, even if the pulse seems harmonious, it is often untreatable. After prolonged delay, external pathogens are gone, but Yuan Yang (Original Yang) is extremely depleted, and Fire Qi is微弱 (weak). Although there is no suffering from Six Evils attacking, Qi and Blood are hardly recoverable. Only a thin thread remains connected. Thus, although the pulse rhythm is regular and seems harmonious, it actually lacks Shen (Spirit). Moreover, muscles are governed by the Spleen; Earth is the mother of all things. Wasting of form and flesh signifies Earth collapsing and Spleen perishing. The Jing (Classic) states: "If form and flesh are exhausted, even if the nine pulses are harmonious, death ensues." Long-standing heat-toxin in Xu Lao generates evil insects that devour viscera. Symptoms include steaming fever, cough, chest tightness, back pain, blurred vision, limb weakness, soreness and ache in waist and knees, insomnia, pale complexion, occasional malar flush, frequent anger, dreams of intercourse with spirits, and high contagion potential, potentially wiping out families. The method is to tonify deficiency to restore Yuan Qi and kill insects to eradicate the root. Killing the insects may not save the patient but can stop transmission. Those attending this disease should not approach while hungry. The deficient should take tonic medicines and wear An Xi She Xiang (Benzoin and Musk) amulets, so that insect pathogens dare not invade.