《要略》曰∶脉芤者为血虚，沉迟而小者为脱气，脉大而无力为阳虚，数而无力为阴虚
，脉大而芤为脱血，平人脉大为劳，虚极亦劳；脉微细者盗汗，寸弱而软为上虚，尺软涩为
下虚；尺软滑疾为血虚，两关沉细为胃虚。
《脉经》曰∶脉来软者为虚，缓者为虚，微弱者为虚，弦者为中虚，细而微小者，气血俱虚。
景岳脉法可取之句，无论浮沉大小，但渐缓则渐有生意，若弦甚者，病必甚；数甚
者，病必危；若以弦细而再加紧数，则百无一生矣。
六味地黄丸
此方大旨，补水以制相火。
先祖选严公曰∶补水以制相火，为相火有余而言也。若命门真火不足，不能蒸化脾胃，
若服六味丸，则湿痰愈多，宜八味丸常服。
虚痨之由，多由于吐血与咳嗽。夫吐血咳嗽，岂尽致劳，治之不得法，斯劳根于此，锄
之不能去矣。吐血起于骤然，是多风寒失汗，逼而上越为大吐。一吐即止者，不必治之。
（汗即血，血即汗，夹汗而见血，风寒从血解也。宜静养，勿药可愈。）不止者，用麻黄人
参芍药汤治之。若脉细而沉迟，按之无力，乃直中寒症，败其元阳，阳虚阴必走，故为大吐
，（或大衄）四肢微厥，宜理中汤，加当归、木香治之，或镇阴煎降之。此一定之法也。又有素
性偏阳，外受酷暑，内伤椒姜爆炙而致血者，宜白虎汤、三黄解毒汤之类。鼎下抽薪，而水
无沸腾之患。又法以地黄汁半升煎三沸，入生大黄末一寸匕，调和，空腹服之，日三服，即
瘥，此秘法也。今人一见吐血症，即用六味加黑栀、藕节、白茅根、血余炭、阿胶之类，姑
息养奸，必变咳嗽而成痨。
凡咳嗽初起，多因风寒。《经》云∶皮毛者，肺之合也。予每见今人患此症，不知解肌，遽
投六味。（若加麦冬五味之类为祸更烈。）是闭门逐寇也，必变成痨。
崔氏八味丸
（此方在仲景之前，仲景收入《金匮要略》中，故名金匮肾气丸） 大旨温
肾脏，逐水邪。
此方《金匮要略》凡五见∶一见于第五篇，云，治香港脚上入小腹不仁；再见于第六篇，云
，治虚劳腰痛，小便不利；三见于第十二篇，云，夫短气有微饮，当从小便去之，肾气丸主之
；四见于第十三篇，云治男子消渴，小便及多，饮一斗，小便亦一斗；五见于第二十二篇，云
，治妇人转胞不得溺，但利小便则愈。
观此五条，皆泻少腹膀胱之疾为多。盖肾者，水脏也。凡水病皆归之，故用茯苓、泽泻
、山药利水之药。水过利而肾虚恶燥，故又用熟地、萸肉、丹皮等滋敛之药。又水为寒邪，
故用附子、肉桂等助阳通痹之药，相济而相成，总以通肾利小便为主，此八味丸之正义也
。薛氏、赵氏借用之，以为补火，亦不甚切当。若小便多者大忌之。
小建中汤
本文云∶虚痨里急，悸衄，腹中痛，梦失精，四肢酸痛，手足烦热，咽干口燥。
喻嘉言曰∶急建其中气，俾饮食增而津液旺，以至充血生精，而复其真阴之不足。但用
稼穑作甘之本味，而酸辛咸苦，在所不用，舍此别无良法也。
黄 建中汤
即前方加黄 一两半。气短胸满者，加生姜；腹满者，去枣加茯苓一两半；及疗肺虚
损不足，补气加半夏三两。
《千金》疗男女因积冷气滞，或大病后不复常，若四肢沉重，骨肉酸疼，吸吸少气，
行动喘之，胸气满急，腰背强痛，心中虚悸，咽干唇燥，面体少色，或饮食无味，胁满腹胀
，头重不举，多卧少起，甚者积年，轻者百日，渐致瘦弱，五脏气竭，则难复常。六脉俱不
足，虚寒之气，小腹拘急，羸瘠百病，名曰黄 建中汤。
人参建中汤
即前方加人参二两，治虚劳自汗。
当归建中汤
即前汤加当归二两，治妇人血虚自汗。
八味大建中汤
治中气不足，手足厥冷，小腹挛急，或腹满不食，阴缩多汗，腹中寒痛，唇干精出，寒
热烦冤，四肢酸痛，及无根失守之火，出于肌表，而为疹为斑、厥逆呕吐等症。
黄 当归 桂心（桂枝去皮即桂心，非近时所用之肉桂心也） 酒白芍 人参 甘草（炙，各一钱） 半夏（制）
附子（炮，各二钱半）
每服五钱，加姜三片，枣二枚，煎服。
桂枝龙骨牡蛎汤
治失精家，小腹强急，阴头寒，目眩发落，脉极虚、芤、迟，为清谷，失精亡血，脉得
诸芤、动、微紧，男子失精，女子梦交。
喻氏曰∶用桂枝汤，调其营卫羁迟，脉道虚衰，加龙骨、牡蛎，涩止其清谷，亡血失精
。一方而两扼其要，诚足贵也。
《短剧》云∶虚羸浮热，汗出者，除桂加白薇、附子各一钱五分，故曰二加龙骨汤。
桂枝虽调营卫所首重，倘其人虚阳浮越于外，即当加附子、白薇以固阳，而助其收涩，桂枝
在所不取也。
张石顽曰∶亡血失精，举世皆滋补血气之药。而仲景独举桂枝汤者，盖以人身之气血，
全赖后天水谷以资生。水谷入于胃，其清者为营，浊者为卫。营气不营，则上热而血溢；卫
气不卫，则下寒而精亡。是以调和营卫为主。营卫和则三焦各司其职，而火自归根。热者
不热，寒者不寒，水谷之精微输化，而精血之源有赖矣。以其亡脱既大，恐下焦虚滑不禁，乃
加龙骨入肝敛魂，牡蛎入肾固精，皆固蛰封藏之本药也。至于小建中汤加减诸方，皆治虚劳
之神剂，后人专用滋阴降火，误治遗害，未至于剧者，用此悉能挽回。
大建中汤（俱见《金匮》）
心胸大寒，痛呕不能食，腹中寒，上冲皮起，出见有头足，
上下痛，不可触近。
叶天士加减大建中汤
辛甘化阳法。
人参 桂心 归身 川椒（炒，出汗） 茯苓 炙草 白芍 饴糖 兰枣
按∶原方中干姜定不可少。
叶天士加减小建中汤
脉右虚左小，背微寒，肢微冷，痰多微呕，食减不甘。此胃阳已弱，卫气不得拥护，
时作微寒微热之状，小便短赤，大便微溏，非实邪矣。当建中气以维营卫。东垣云∶胃为卫
之本，营乃脾之源，偏热偏寒，犹非正治。
人参 归身（米拌炒） 桂枝木 白芍 兰枣
按∶此方姜定不可少。
复脉汤（一名炙甘草汤，方见《伤寒》）
治诸虚不足，汗出而闷，脉结悸，行动如常，不出百日，危急者十一日死。（此治血脉空竭方）
用之所以和血。凡脉见结代者，虽行动如常，不出百日
必死。若复危急不能行动，则过十日必死，语极明白，从前解者多误。
喻嘉言曰∶此仲景治伤寒脉结代、心动悸、邪少虚多之圣方也。《金匮》不载，以《千
金翼》常用此方治虚劳，则实可征信，是以得名为《千金》之方也。虚劳之体，多有表热夹其阴
虚，所以本论汗出而闷。表之固非，即治其阴虚亦非，惟用此方得手，而脉出热解，俾其人
快然，真圣法也。但虚劳之人，胃中津液素虚，匪伤寒暴病邪少虚多之比。桂枝、生姜分两之
多，服之津液每随热势外越，津既外越，难以复收，多有淋漓沾濡一昼夜者。透此一关，亟
以本方去桂枝、生姜二味，三倍加入人参，随继其后，庶几津液复生，乃致营卫盛而诸虚复
，岂小补哉！
叶天士加减复脉汤
本案云∶其脉虚细，夜热晨寒，烦倦口渴，汗出，脏液已亏，当春风外泄，宗仲师凡元
气有伤，当与甘药之例。
孙心典按∶虚劳治法，舍建中别无生路。又有一种脾阳不亏，胃有燥火，当从时贤养胃
阴诸法。
叶天士云∶太阴湿土，得阳始运，阳明阳土，得阴自安。以脾喜刚燥，胃喜柔润也。愚
于此法又悟出无数法门，此下所列之方，俱宜深考。
叶氏养胃方
治胃虚少纳谷，土不生金，音低气馁。
麦冬 生扁豆 玉竹 甘草 桑叶 沙参
此方生谷芽、广陈皮、白术、麦仁、石斛、乌梅，俱可加入，燥极加甘蔗汁。
叶氏方
治阴虚盗汗，不用当归六黄汤，以其味苦不宜于胃也。此方用酸甘化阴法。（
合前加减大建中汤辛甘化阳法，可悟用药之妙。）
人参 熟地 五味 炙草 湖莲 茯神
又方 《经》云∶形不足者，温之以气；精不足者，补之以味。纳谷如常，而肌肉日
削，当以血肉充养。
牛骨髓 羊骨髓 猪脊髓 茯神 枸杞 当归 湖莲 芡实。
又方
治肉消脂涸，吸气喘促，欲咳不能出声，必踞按季胁，方稍有力，寐醒，
喉中干涸，直至胸脘，此五液俱竭，法在不治。援引人身膏脂，为继续之计。
鲜河车（按∶此味不可用） 人乳汁 真秋石 血余灰
阴虚阳浮，宜用介以潜阳之法。六味丸，减丹、泽，加秋石、龟胶、牡蛎、湖莲之属；如
有用海参胶、淡菜胶及燕窝之类，皆是此意。
长孙心典按∶虚极之候，非无情草木所能补。如肉削之极，必须诸髓及羊肉胶之类；阴
中之阴虚极，必须龟胶、人乳、粉牡蛎、秋石、麋茸之类；阴中之阳虚极，必须鹿角胶、鹿
茸、黄犬外肾之类，一隅三反。
黑地黄丸
治阳盛阴衰，脾胃不足，房劳虚损，形瘦无力，面多青黄，而无常色，此补肾益胃之剂
也。
苍术（一斤，油浸） 熟地（一斤） 五味子（半斤） 干姜（秋冬一两，夏五钱，春七钱）
上为末，枣肉炼丸，梧子大，米汤送下百丸，治血虚久痔甚妙。（此治脱血脾寒之圣药）
天真丸
治一切亡血过多，形槁肢羸，饮食不进，肠胃滑泄，津液枯竭，久服生血养气，暖胃驻
颜。
生羊肉（七斤，去筋膜脂皮，批开入下药末） 肉苁蓉（十两）
当归（十二两，洗，去皮） 山药（湿者去皮，十两） 天冬（去心，焙干，一斤）
四味为末，安羊肉内裹缚，用无灰酒四瓶，煮令酒尽，再入水二升煮，候肉糜烂，再入
黄末五两、人参末二两、白术末二两，捣作薄饼，晒干，隔纸悬火上烘干。以炼蜜为丸，
梧子大，服一百丸，加至二三百丸，温酒下，一日二次服。
悉尼膏
治咯血吐血，痨嗽久不止。
悉尼（六十只，取汁二十杯） 生地 茅根 藕（各取汁十杯） 萝卜 麦冬（各取汁五杯）
将六味煎，炼入蜂蜜一斤，饴糖八两，姜汁半杯，再熬如稀糊，则成膏矣。每日用一二匙，含咽。
《金匮要略》中说：脉象芤（中空如葱管）的是血虚，脉象沉迟且细弱的是气脱，脉象大但无力的是阳虚，脉数而无力的是阴虚；脉象大而芤是失血，正常人的脉象大为劳损，极度虚弱也是劳损；脉象微细的是盗汗，寸口脉弱而软是上焦虚，尺部脉软涩是下焦虚；尺部脉软滑疾数是血虚，左右关脉沉细是胃虚。
《脉经》说：脉来柔软的是虚证，缓滞的是虚证，微弱的是虚证，弦紧的是中气虚，细而微小的是气血俱虚。
张景岳的脉法中有可取之处，无论脉象浮沉大小，只要逐渐变缓就有生机；如果脉象弦硬严重的，病情一定很重；脉数严重的，病情一定危险；如果脉象弦细而又加上紧数，那就百无一生。
六味地黄丸
这个方子的主要宗旨，是通过滋补肾水来制约相火（肾中寄寓的命门之火）。
我的先祖严公说：所谓“补水以制相火”，是针对相火有余而言的。如果是命门真火不足，不能蒸腾气化脾胃，如果服用六味地黄丸，则湿痰会更多，适宜常服八味地黄丸。
虚劳病的成因，多由于吐血和咳嗽引起。吐血和咳嗽，难道都会导致虚劳吗？治疗不得法，才使虚劳的病根由此产生，难以去除。吐血起于突然发作，多是风寒之邪未通过发汗排出，逼迫血液向上溢出造成大吐血。吐一次就停止的，不必治疗。（汗即血，血即汗，夹带汗液而出血，风寒随血而解。宜静养，不服药也可痊愈。）不止血的，用麻黄人参芍药汤治疗。如果脉象细而沉迟，按之无力，这是寒邪直中脏腑，损伤了元阳，阳虚则阴必外走，所以发生大吐血（或大量鼻出血），四肢微微厥冷，适宜用理中汤，加当归、木香治疗，或用镇阴煎降逆。这是一定的治法。又有平素体质偏阳，外受酷暑，内伤于辛辣燥热食物而导致出血的，适宜用白虎汤、三黄解毒汤之类。如同釜底抽薪，水就不会沸腾。另一种方法是用半升地黄汁煎煮三沸，加入生大黄末一匙，调和后空腹服用，每日三次，即可痊愈，这是秘法。现在的人一见吐血症状，就用六味地黄丸加黑栀子、藕节、白茅根、血余炭、阿胶之类，姑息纵容病邪，必然转变为咳嗽而成痨病。
凡是咳嗽初起，多因风寒。《内经》说：皮毛是肺的外合。我常见今人患此症，不懂得解肌发表，就急忙投用六味地黄丸。（如果再加麦冬、五味子等收敛药，祸害更烈。）这简直是闭门逐寇，必然变成痨病。
崔氏八味丸
（此方在张仲景之前已存在，张仲景将其收入《金匮要略》中，故名为金匮肾气丸） 其主要宗旨是温补肾脏，驱逐水邪。
此方在《金匮要略》中出现五次：第一次见于第五篇，说治疗脚气病上行至小腹感觉麻木不仁；第二次见于第六篇，说治疗虚劳腰痛，小便不利；第三次见于第十二篇，说短气有轻微饮邪，应当从小便排出，用肾气丸主治；第四次见于第十三篇，说治疗男子消渴病，小便频多，喝一斗水，小便也排出一斗；第五次见于第二十二篇，说治疗妇人胞转不得排尿，只要通利小便就能痊愈。
看这五条，大多都是治疗少腹膀胱的疾病。因为肾是水脏，凡水病都归属于肾，所以使用茯苓、泽泻、山药这些利水的药物。水湿过度利去而肾虚厌恶燥性，所以又用熟地黄、山茱萸、牡丹皮等滋润收敛的药物。另外水为寒邪，所以用附子、肉桂等助阳通痹的药物，相互补充而成就功效，总以通肾利小便为主，这是八味丸的正义。薛己、赵献得借用它作为补火的方法，也不甚恰当。如果小便多的患者，绝对禁忌使用。
小建中汤
原文说：治疗虚劳里急（腹部拘急疼痛），心悸鼻衄，腹中痛，梦遗精，四肢酸痛，手足烦热，咽干口燥。
喻嘉言说：急切地建立中气，使饮食增加而津液旺盛，进而充血生精，恢复真阴的不足。只用甘味之本味（指饴糖等），酸辛咸苦不在所用之列，除了这个方法别无良法。
黄芪建中汤
即前方加黄芪一两半。气短胸满的，加生姜；腹满的，去掉大枣加茯苓一两半；以及治疗肺虚损不足，补气加半夏三两。
《千金方》治疗男女因积冷气滞，或大病后身体未恢复常态，如果四肢沉重，骨肉酸痛，呼吸短促，行动喘息，胸中气满急迫，腰背强痛，心中虚悸，咽干唇燥，面色无华，或饮食无味，胁肋胀满腹胀，头重抬不起来，多卧少起，严重的长年累月，轻者百日，逐渐导致瘦弱，五脏气竭，就很难恢复常态。六脉都不足，虚寒之气，小腹拘急，消瘦百病，名叫黄芪建中汤。
八味大建中汤
治疗中气不足，手足厥冷，小腹挛急，或腹满不食，阴器收缩多汗，腹中寒痛，唇干精出，寒热烦闷，四肢酸痛，以及无根失守之火，出于肌表，表现为疹子斑痕、厥逆呕吐等症状。
药材：黄芪、当归、桂心（桂枝去皮即为桂心，不是近代所用的肉桂心）、酒炒白芍、人参、甘草（炙，各一钱）、半夏（制）、附子（炮，各二钱半）。
每服五钱，加生姜三片，大枣二枚，煎服。
桂枝龙骨牡蛎汤
治疗失精家（经常遗精的人），小腹强急，阴头寒冷，目眩脱发，脉象极虚、芤、迟，伴有完谷不化，失精亡血，脉见诸芤、动、微紧，男子失精，女子梦交。
喻氏说：用桂枝汤调和营卫羁迟，脉道虚衰，加龙骨、牡蛎，涩止其完谷不化和亡血失精。一方而同时扼住两个要害，确实值得珍贵。
《短剧》说：虚羸浮热，出汗的，除去桂枝加白薇、附子各一钱五分，所以叫二加龙骨汤。
桂枝虽然是调和营卫的首选，但如果其人虚阳浮越于外，就应当加附子、白薇以固护阳气，并帮助收涩，此时桂枝就不在取用之列了。
张石顽说：亡血失精，举世都用滋补血气的药。而张仲景唯独举出桂枝汤，是因为人身的气血，全靠后天水谷来资生。水谷进入胃，清的部分成为营气，浊的部分成为卫气。营气不能营养，则上热而血溢；卫气不能护卫，则下寒而精亡。所以以调和营卫为主。营卫调和则三焦各司其职，火自然归根。热的不热，寒的不寒，水谷的精微输布转化，精血的来源才有依赖。因为亡脱已经很大，恐怕下焦虚滑不禁，所以加龙骨入肝敛魂，牡蛎入肾固精，都是固守封藏根本的药物。至于小建中汤加减诸方，都是治疗虚劳的神剂，后人专用滋阴降火，误治遗害，不至于严重的，用这些方子都能挽回。
大建中汤（均见于《金匮要略》）
心胸大寒，疼痛呕吐不能进食，腹中寒，寒气上冲皮肤，突起像有头足的包块，上下疼痛，不可触碰靠近。
叶天士加减大建中汤
采用辛甘化阳法。
药材：人参、桂心、归身、川椒（炒，出油）、茯苓、炙甘草、白芍、饴糖、兰枣。
按语：原方中的干姜绝对不能少。
叶天士加减小建中汤
脉象右虚左小，背部微寒，四肢微冷，痰多微呕，食欲减退口味不佳。这是胃阳已弱，卫气不能拥护，时常出现微寒微热的样子，小便短赤，大便微溏，这不是实邪。应当建立中气以维系营卫。李东垣说：胃是卫气的根本，营气是脾的来源，偏热偏寒，都不是正治。
药材：人参、归身（米拌炒）、桂枝木、白芍、兰枣。
按语：此方生姜绝对不能少。
复脉汤（一名炙甘草汤，方见《伤寒论》）
治疗各种虚损不足，出汗而胸闷，脉结代，心悸，行动如常，不出百日，危急的十一日死。（这是治疗血脉空竭的方子）
用它来和血。凡是脉见结代的，虽然行动如常，不出百日必死。如果更加危急不能行动，则过十日必死，话说得非常明白，从前解释的多有误。
喻嘉言说：这是张仲景治疗伤寒脉结代、心动悸、邪少虚多的圣方。《金匮要略》未载，因为《千金翼方》常用此方治疗虚劳，确实可以征信，所以得名《千金》之方。虚劳的体质，多有表热夹杂阴虚，所以本论说汗出而闷。解表固然不对，治疗阴虚也不对，只有用此方得手，脉出热解，使人感到舒适，真是圣法。但是虚劳之人，胃中津液素来虚弱，不同于伤寒暴病邪少虚多的情况。桂枝、生姜分量较多，服用后津液往往随热势外越，津液既已外越，难以收回，多有淋漓沾濡一整天的。度过这一关，急需在本方中去掉桂枝、生姜两味，三倍加入人参，紧随其后，这样津液才能复生，致使营卫旺盛而诸虚恢复，岂是小补！
叶天士加减复脉汤
本案说：脉象虚细，夜热晨寒，烦躁疲倦口渴，出汗，脏液已亏，当逢春风外泄之时，遵循仲师凡是元气有伤，当给予甘药的例子。
孙思邈（注：此处原文为孙心典，即孙诒让或孙星衍，通常指清代医家孙诒让或相关注家，结合语境应为孙氏按语，此处保留人名）按语：虚劳治法，舍去建中汤别无生路。又有一种脾阳不亏，胃有燥火的，应当从当代贤医养胃阴诸法治疗。
叶天士说：太阴湿土，得到阳气始能运化，阳明阳土，得到阴气自然安宁。因为脾喜欢刚燥，胃喜欢柔润。我对此法又悟出无数法门，下列所列的方子，都应当深入考察。
叶氏养胃方
治疗胃虚少纳谷，土不生金，声音低微气短。
药材：麦冬、生扁豆、玉竹、甘草、桑叶、沙参。
此方中生谷芽、广陈皮、白术、麦仁、石斛、乌梅，都可以加入，干燥至极加甘蔗汁。
叶氏方
治疗阴虚盗汗，不用当归六黄汤，因为其味苦不利于胃。此方采用酸甘化阴法。（结合前文加减大建中汤辛甘化阳法，可以领悟用药的妙处。）
药材：人参、熟地黄、五味子、炙甘草、湖莲、茯神。
又一方 《内经》说：形体不足的，用气来温补；精气不足的，用味来滋补。饮食如常，而肌肉日渐消瘦，应当以血肉有情之品充养。
药材：牛骨髓、羊骨髓、猪脊髓、茯神、枸杞、当归、湖莲、芡实。
又一方
治疗肌肉消瘦脂液枯竭，吸气喘促，想咳却发不出声，必须蹲坐按压季胁，才稍有力，睡醒后喉中干涸，直至胸脘，这是五液俱竭，法度上属于不治。援引人体膏脂，作为延续生命的计策。
药材：鲜河车（按：此味不可用）、人乳汁、真秋石、血余灰。
阴虚阳浮，宜用介类潜阳的方法。六味地黄丸，减去丹皮、泽泻，加秋石、龟胶、牡蛎、湖莲之类；如果有用海参胶、淡菜胶及燕窝之类的，都是这个意思。
长孙心典按语：虚极的候证，不是无情草木所能补益。如肉削到极点，必须用各种骨髓及羊肉胶之类；阴中之阴虚极，必须用龟胶、人乳、粉牡蛎、秋石、麋茸之类；阴中之阳虚极，必须用鹿角胶、鹿茸、黄犬外肾之类，举一反三。
黑地黄丸
治疗阳盛阴衰，脾胃不足，房劳虚损，形体瘦弱无力，面色多青黄，而无常色，这是补肾益胃的药剂。
药材：苍术（一斤，油浸）、熟地黄（一斤）、五味子（半斤）、干姜（秋冬一两，夏五钱，春七钱）。
以上研为末，枣肉炼蜜为丸，梧桐子大，米汤送下百丸，治疗血虚久痔非常奇妙。（这是治疗脱血脾寒的圣药）
天真丸
治疗一切亡血过多，形体枯槁肢体羸弱，饮食不进，肠胃滑泄，津液枯竭，久服生血养气，暖胃驻颜。
药材：生羊肉（七斤，去筋膜脂皮，剖开放入下药末）、肉苁蓉（十两）、当归（十二两，洗，去皮）、山药（湿者去皮，十两）、天冬（去心，焙干，一斤）。
将四味研为末，安放在羊肉内包裹缚好，用无灰酒四瓶，煮至酒尽，再入水二升煮，等到肉糜烂，再加入黄耆末五两、人参末二两、白术末二两，捣作薄饼，晒干，隔纸悬火上烘干。用炼蜜为丸，梧桐子大，服一百丸，加至二三百丸，温酒送下，一日二次服。
悉尼膏
治疗咯血吐血，劳嗽久不止。
药材：悉尼（六十只，取汁二十杯）、生地、茅根、藕（各取汁十杯）、萝卜、麦冬（各取汁五杯）。
将六味煎煮，炼入蜂蜜一斤，饴糖八两，姜汁半杯，再熬成稀糊状，就成为膏了。每日用一二匙，含咽。
Jingui Yaolue (Essential Prescriptions from the Golden Cabinet) states: A Kou (hollow, like a scallion stalk) pulse indicates blood deficiency; a deep, slow, and thin pulse indicates Qi depletion; a large but forceless pulse indicates Yang deficiency; a rapid but forceless pulse indicates Yin deficiency; a large and Kou pulse indicates blood loss. In a healthy person, a large pulse signifies劳损 (consumptive disease); extreme weakness also signifies consumptive disease. A micro and fine pulse indicates night sweating; a weak and soft pulse at the Cun position indicates upper Jiao deficiency; a soft and choppy pulse at the Chi position indicates lower Jiao deficiency; a soft, slippery, and rapid pulse at the Chi position indicates blood deficiency; a deep and fine pulse at both Guan positions indicates Stomach deficiency.
Mai Jing (Pulse Classic) states: A soft pulse indicates deficiency; a slow pulse indicates deficiency; a weak and minute pulse indicates deficiency; a wiry pulse indicates middle Qi deficiency; a fine and minute pulse indicates simultaneous deficiency of Qi and Blood.
Zhang Jingyue's pulse diagnosis methods contain valuable points. Regardless of whether the pulse is floating, deep, large, or small, if it gradually becomes relaxed, it indicates a gradual return of vitality. If the pulse is extremely wiry, the disease must be severe; if extremely rapid, the disease must be critical. If the pulse is wiry and fine, further compounded by tightness and rapidity, there is less than one chance in a hundred of survival.
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill)
The main purport of this formula is to nourish Kidney Water to control Xianghuo (Ministerial Fire).
My ancestor, Yan Gong, stated: "Nourishing Water to control Ministerial Fire" refers to cases where Ministerial Fire is in excess. If Mingmen True Fire is insufficient and cannot steam and transform the Spleen and Stomach, taking Liuwei Dihuang Wan will increase damp-phlegm; in such cases, Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) should be taken regularly.
The cause of Xu Lao (Consumptive Disease) often stems from hematemesis and cough. Do hematemesis and cough always lead to consumption? Improper treatment causes the root of consumption to remain here, making it difficult to eradicate. Hematemesis arises suddenly, mostly due to Wind-Cold failing to be released through sweating, forcing blood to surge upward causing massive vomiting. If bleeding stops after one episode, no treatment is needed. (Sweat is blood, blood is sweat; seeing blood mixed with sweat means Wind-Cold resolves through the blood. Quiet rest is suitable; medication may not be necessary.) If bleeding does not stop, use Mahuang Renshen Shaoyao Tang (Ephedra, Ginseng, and White Peony Decoction). If the pulse is fine, deep, and slow, and forceless upon pressure, it indicates Cold pathogen directly invading the interior, damaging Yuan Yang. When Yang is deficient, Yin must escape, causing massive hematemesis (or severe epistaxis), with slightly cold extremities. Lizhong Tang (Regulate the Middle Decoction) added with Danggui (Angelica Sinensis) and Muxiang (Aucklandia) is suitable, or Zhenyin Jian (Settle Yin Decoction) to direct rebellious Qi downward. This is a fixed method. For those with a constitution prone to Yang, affected externally by intense summer heat and internally injured by spicy, pungent, fried foods causing bleeding, Baihu Tang (White Tiger Decoction) or Sanhuang Jiedu Tang (Three-Yellow Detoxification Decoction) are suitable. This is like removing firewood from under the pot so the water does not boil. Another method is to take Ban Sheng (half a Chinese unit of volume) of Dihuang juice, boil three times, add Yicunbi (a measure equivalent to an inch cube) of raw Dahuang (Rhubarb) powder, mix well, and take on an empty stomach, three times a day, for recovery. This is a secret method. Nowadays, upon seeing any case of hematemesis, people immediately use Liuwei Dihuang Wan added with Heizhi Zi (Black Gardenia), Ou Jie (Lotus Node), Baimaogen (Imperata Rhizome), Xueyutan (Burnt Human Hair), Ejiao (Donkey-Hide Gelatin), etc. This indulgence nurtures evil, inevitably transforming cough into consumptive disease.
Coughs at their onset are mostly due to Wind-Cold. The Jing (Classic) states: Skin and hair are the exterior correspondence of the Lung. I often see modern patients with this condition who do not know to release the muscle layer (solve exterior syndrome) and rashly administer Liuwei Dihuang Wan. (Adding Maidong (Ophiopogon) and Wuweizi (Schisandra) would make the disaster even more severe.) This is akin to closing the door to chase away thieves, inevitably leading to consumptive disease.
Cuishi Bawei Wan (Dr. Cui's Eight-Ingredient Pill)
(This formula existed before Zhang Zhongjing; he included it in Jingui Yaolue, hence its name Jinkui Shenqi Wan.) Its main purport is to warm the Kidneys and expel Water Pathogens.
This formula appears five times in Jingui Yaolue: First in Chapter 5, treating Hongjiao (Gout/Edema) ascending to the lower abdomen with numbness; second in Chapter 6, treating Xu Lao lumbar pain with difficulty urinating; third in Chapter 12, stating that shortness of breath with slight fluid retention should be treated by promoting urination, using Shenqi Wan as the primary formula; fourth in Chapter 13, treating male Xiao Ke (Wasting-Thirst) with frequent urination, drinking one dou and urinating one dou; fifth in Chapter 22, treating women with Zhuanbao (bladder torsion/inversion) unable to urinate, which heals by promoting urination.
Observing these five entries, they mostly treat diseases of the lower abdomen and Bladder. Since the Kidney is the Water Organ, all water diseases return to it, hence Fuling (Poria), Zexie (Alisma), and Shanyao (Dioscorea) are used to promote urination. However, excessive diuresis harms Kidney Yin which dislikes dryness, so Shudi (Prepared Rehmannia), Yurou (Cornus), and Danpi (Moutan) are used to nourish and astringe. Furthermore, since water is associated with Cold pathogens, Fuzi (Aconite) and Rougui (Cinnamon Bark) are used to assist Yang and unblock obstruction. They complement each other, focusing primarily on unblocking the Kidneys and promoting urination; this is the true meaning of Bawei Wan. Xue Yi and Zhao Xianke borrowed it as a fire-tonifying method, which is not entirely appropriate. It is strictly contraindicated for those with polyuria.
Xiao Jianzhong Tang (Minor Construct the Middle Decoction)
The text states: Treats Xu Lao with Li Ji (abdominal tension/pain), palpitations, epistaxis, abdominal pain, nocturnal seminal emission, soreness and pain in the four limbs, vexing heat in the hands and feet, dry throat, and dry mouth.
Yu Jiayan said: Urgently establish the Middle Qi so that food intake increases and fluids flourish, thereby generating blood and essence to restore the insufficiency of True Yin. Use only the sweet flavor derived from grains (Earth element), avoiding sour, pungent, salty, and bitter flavors. There is no better method than this.
Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction)
Same as the previous formula plus Huangqi (Astragalus) 1.5 liang. For shortness of breath and chest fullness, add Shengjiang (Fresh Ginger); for abdominal fullness, remove Zaoju (Jujube) and add Fuling (Poria) 1.5 liang; for treating Lung deficiency and insufficiency, add Banxia (Pinellia) 3 liang when tonifying Qi.
Qianjin Fang (Prescriptions Worth a Thousand Gold) treats men and women with accumulated Cold Qi stagnation, or failure to return to normal after severe illness. Symptoms include heavy limbs, soreness and pain in muscles and bones, shallow breathing, panting upon movement, chest fullness and urgency, stiffness and pain in the waist and back, emptiness and palpitations in the heart, dry throat and lips, lack of luster in the face and body, loss of taste, hypochondriac fullness and abdominal distension, heavy head unable to lift, sleeping much and rising little. Severe cases last years, mild cases a hundred days, gradually leading to emaciation and exhaustion of the Five Zang organs, making recovery difficult. All six pulses are insufficient, with Cold Qi causing lower abdominal tension, emaciation, and myriad diseases. This is named Huangqi Jianzhong Tang.
Renshen Jianzhong Tang (Ginseng Construct the Middle Decoction)
Same as the previous formula plus Renshen (Ginseng) 2 liang, treating Xu Lao spontaneous sweating.
Danggui Jianzhong Tang (Angelica Construct the Middle Decoction)
Same as the previous formula plus Danggui (Angelica Sinensis) 2 liang, treating female blood deficiency with spontaneous sweating.
Bawei Da Jianzhong Tang (Eight-Ingredient Major Construct the Middle Decoction)
Treats insufficiency of Middle Qi, cold extremities, lower abdominal cramping, abdominal fullness with anorexia, retraction of the genitals with profuse sweating, cold pain in the abdomen, dry lips with seminal emission, alternating chills and fever with vexation, soreness and pain in the four limbs, and rootless, unanchored Fire emerging from the skin manifesting as rashes, macules, cold reversal, vomiting, etc.
Herbs: Huangqi (Astragalus), Danggui (Angelica Sinensis), Guixin (Cinnamon Heart - cinnamon bark peeled of its outer layer, not the modern Rouguixin), Jiubaishao (White Peony soaked in wine), Renshen (Ginseng), Gancao (Licorice, roasted, 1 qian each), Banxia (Pinellia, processed), Fuzi (Aconite, prepared, 2.5 qian each).
Take 5 qian per dose, add 3 slices of ginger and 2 jujubes, decoct and drink.
Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction)
Treats individuals with chronic seminal loss, lower abdominal tension and urgency, cold glans penis, dizziness, and hair loss. Pulse is extremely deficient, Kou, and slow, indicating undigested food in stool (Qinggu), seminal loss, and blood depletion. Pulses presenting as various Kou, moving, or slightly tight indicate seminal loss in men and dream-interactive sleep in women.
Yu Shi said: Using Guizhi Tang regulates the sluggish Ying and Wei, and the deficient pulse vessels. Adding Longgu (Dragon Bone) and Muli (Oyster Shell) astringes to stop Qinggu, blood loss, and seminal loss. One formula grasps two key aspects, truly worthy of esteem.
Duanju states: For emaciation with floating heat and sweating, remove Guizhi and add Baiwei (Anemarrhena) and Fuzi (Aconite) 1.5 qian each, hence called Erjia Longgu Tang (Two-Added Dragon Bone Decoction).
Although Guizhi is paramount for regulating Ying and Wei, if the person has Floating Deficient Yang on the exterior, Fuzi and Baiwei should be added to secure Yang and assist astringency; Guizhi should not be used.
Zhang Shiwang said: For blood loss and seminal loss, the world uses herbs to tonify blood and Qi. But Zhang Zhongjing uniquely cites Guizhi Tang because the body's Qi and Blood rely entirely on postnatal food and water for generation. Food and water enter the Stomach; the clear part becomes Ying (Nutritive) Qi, and the turbid part becomes Wei (Defensive) Qi. If Ying Qi fails to nourish, upper heat causes blood overflow; if Wei Qi fails to protect, lower cold causes seminal loss. Thus, harmonizing Ying and Wei is primary. When Ying and Wei are harmonized, the Three Jiao perform their duties, and Fire returns to its root. Heat ceases to be hot, cold ceases to be cold, nutrients are transformed, and the source of essence and blood is supported. Given the massive loss, fearing lower Jiao deficiency and sliding inability to hold, Longgu is added to enter the Liver to anchor the Soul, and Muli to enter the Kidney to secure Essence; both are fundamental medicines for securing storage and sealing. As for the variations of Xiao Jianzhong Tang, they are divine formulas for treating Xu Lao. Later generations specialized in nourishing Yin and descending Fire, causing misdiagnosis and harm. Cases not yet critical can be reversed using these formulas.
Da Jianzhong Tang (All seen in Jingui Yaolue)
Severe Cold in the heart and chest, painful vomiting preventing food intake, Cold in the abdomen, Qi surging upward causing skin to bulge with visible heads and feet, pain above and below, intolerable to touch.
Ye Tianshi's Modified Da Jianzhong Tang
Adopts the method of Pungent-Sweet transforming into Yang.
Herbs: Renshen (Ginseng), Guixin (Cinnamon Heart), Guishen (Angelica Root Body), Chuanjiao (Sichuan Pepper, stir-fried until oil exudes), Fuling (Poria), Zhigancao (Roasted Licorice), Baishao (White Peony), Yitang (Maltose), Lanzao (Orlando Jujube).
Note: Ganjiang (Dried Ginger) in the original formula is indispensable.
Ye Tianshi's Modified Xiao Jianzhong Tang
Pulse is deficient on the right and small on the left, slight chill on the back, slightly cold limbs, much phlegm with slight vomiting, reduced appetite and bland taste. This indicates weakened Stomach Yang, with Wei Qi unable to support, presenting as intermittent slight chills and fevers, short dark urine, and slightly loose stools. This is not an Excess pathogen. One should establish Middle Qi to maintain Ying and Wei. Li Dongyuan said: The Stomach is the root of Wei Qi, and the Spleen is the source of Ying Qi. Bias toward heat or cold is not the correct treatment.
Herbs: Renshen (Ginseng), Guishen (Angelica Root Body, stir-fried with rice), Guizhimu (Cinnamon Twig Wood), Baishao (White Peony), Lanzao (Orlando Jujube).
Note: Jiang (Ginger) in this formula is indispensable.
Fumai Tang (Restore the Pulse Decoction), also known as Zhigancao Tang (Roasted Licorice Decoction, formula seen in Shanghan Lun).
Treats various deficiencies and insufficiencies, sweating with chest stuffiness, knotted and intermittent pulse, palpitations. If the patient moves normally, death occurs within 100 days; if critical, death occurs in 11 days. (This is a formula for treating empty and exhausted blood vessels.)
It is used to harmonize blood. Whenever a knotted or intermittent pulse appears, even if the patient moves normally, death occurs within 100 days. If more critical and unable to move, death occurs within 10 days. The statement is very clear; previous interpreters were mostly mistaken.
Yu Jiayan said: This is Zhang Zhongjing's holy formula for treating Shanghan with knotted/intermittent pulse and palpitations, where pathogenic factors are few and deficiency is many. It is not recorded in Jingui Yaolue, but since Qianjin Yi frequently used this formula for Xu Lao, it is credible, hence named the Qianjin Formula. Patients with Xu Lao constitution often have exterior heat mixed with Yin deficiency, hence the mention of sweating and stuffiness in the text. Releasing the exterior is wrong, and treating Yin deficiency alone is also wrong. Only by using this formula successfully can the pulse emerge and heat resolve, making the patient feel refreshed; this is truly a holy method. However, Xu Lao patients usually have deficient Stomach fluids, unlike the acute Shanghan with few pathogens and much deficiency. The large doses of Guizhi and Shengjiang cause fluids to escape outward with the heat. Once fluids escape outward, they are hard to recover, often resulting in profuse sweating for a day and night. After passing this hurdle, one must urgently modify the base formula by removing Guizhi and Shengjiang, adding Renshen (Ginseng) in triple dosage, following closely behind. Only then can fluids regenerate, causing Ying and Wei to flourish and various deficiencies to recover. Is this not a significant benefit!
Ye Tianshi's Modified Fumai Tang
This case states: The pulse is deficient and fine, night fever and morning chill, vexation, fatigue, thirst, and sweating. Visceral fluids are already depleted. During the spring wind season, following Zhang Zhongshi's example that whenever Yuan Qi is injured, Sweet Herbs should be given.
Sun Xindian noted: For treating Xu Lao, apart from Jianzhong methods, there is no way out. However, for cases where Spleen Yang is not deficient but the Stomach has Dry Fire, one should follow contemporary experts' methods of nourishing Stomach Yin.
Ye Tianshi said: Taiyin Damp Earth requires Yang to function; Yangming Dry Earth requires Yin to be peaceful. Because the Spleen likes dryness and the Stomach likes moistness. From this method, I have realized countless techniques. The formulas listed below should be studied deeply.
Ye's Stomach-Nourishing Formula
Treats Stomach deficiency with poor appetite, Earth failing to generate Metal, low voice and weak Qi.
Herbs: Maidong (Ophiopogon), Sheng Biandou (Raw Broad Bean), Yuzhu (Polygonatum Odoratum), Gancao (Licorice), Sangye (Mulberry Leaf), Shashen (Glehnia).
Sheng Guya (Sprouted Grain), Guang Chenpi (Tangerine Peel), Baizhu (Atractylodes), Mailen (Wheat Kernel), Shihu (Dendrobium), Wumei (Mume Fruit) can all be added. If extremely dry, add Sugarcane Juice.
Ye's Formula
Treats Yin deficiency with night sweats. Does not use Danggui Lihuang Tang because its bitter taste is unfavorable to the Stomach. This formula uses Sour-Sweet transforming into Yin. (Combined with the previous Modified Da Jianzhong Tang's Pungent-Sweet transforming into Yang, one can understand the subtlety of herb selection.)
Herbs: Renshen (Ginseng), Shudi (Prepared Rehmannia), Wuwei Zi (Schisandra), Zhigancao (Roasted Licorice), Hulian (Nelumbo Seed), Fushen (Poria with Pine Root).
Another Formula The Jing states: For those lacking form, warm with Qi; for those lacking essence, tonify with Flavor. If food intake is normal but muscles daily waste away, one should use flesh-and-blood substances to nourish.
Herbs: Niu Suimoi (Ox Marrow), Yang Suimoi (Sheep Marrow), Zhu Suimoi (Pig Marrow), Fushen (Poria with Pine Root), Gouqi (Goji Berry), Danggui (Angelica Sinensis), Hulian (Nelumbo Seed), Qianshi (Euryale Seed).
Another Formula
Treats flesh wasting and fat depletion, gasping for air, wanting to cough but unable to produce sound, requiring squatting and pressing the hypochondrium to gain strength. Upon waking, the throat is dry up to the chest and epigastrium. This indicates exhaustion of the Five Fluids, considered untreatable. Borrowing human body marrow/fat as a plan for continuation.
Herbs: Xian Heche (Fresh Placenta - Note: This ingredient should not be used), Ren Ru Zhi (Human Milk), Zhen Qiushi (True Autumn Stone), Xueyu Hui (Ash of Burnt Human Hair).
For Yin deficiency with Floating Yang, the method of using shellfish/shells to subdue Yang is suitable. Liuwei Wan, removing Danpi and Zexie, adding Qiushi (Autumn Stone), Guijiao (Turtle Shell Gelatin), Muli (Oyster Shell), Hulian (Nelumbo Seed), etc. If Haishen Jiao (Sea Cucumber Gelatin), Dancai Jiao (Mussel Gelatin), or Yanwo (Swallow's Nest) are used, it is all of this intent.
Changsun Xindian noted: In extreme deficiency, emotionless herbs cannot tonify. If emaciation is extreme, various marrows and Lamb Gelatin are necessary; for extreme Yin deficiency within Yin, Turtle Shell Gelatin, Human Milk, Powdered Oyster Shell, Autumn Stone, and Cervus Elaphus Antler Velvet are necessary; for extreme Yang deficiency within Yin, Deer Antler Gelatin, Deer Antler Velvet, and Yellow Dog Testicles are necessary. Apply this principle举一反三 (infer other cases from one instance).
Hei Dihuang Wan (Black Rehmannia Pill)
Treats Yang excess and Yin decline, Spleen and Stomach insufficiency, sexual exhaustion damage, emaciation and weakness, complexion often greenish-yellow without constant color. This is a Kidney-tonifying and Stomach-nourishing agent.
Herbs: Cangzhu (Atractylodes Lancea, 1 jin, soaked in oil), Shudi (Prepared Rehmannia, 1 jin), Wuweizi (Schisandra, 0.5 jin), Ganjiang (Dried Ginger, 1 liang in autumn/winter, 5 qian in summer, 7 qian in spring).
Grind into powder, make pills with jujube paste, size of wutong seeds. Take 100 pills with rice soup. Excellent for treating chronic hemorrhoids due to blood deficiency. (This is a holy medicine for treating blood loss with Spleen Cold.)
Tianzhen Wan (Innocent Truth Pill)
Treats all cases of excessive blood loss, emaciated body and limbs, inability to eat, intestinal slipping and diarrhea, exhaustion of fluids. Long-term use generates blood, tonifies Qi, warms the Stomach, and preserves youth.
Herbs: Sheng Yangrou (Raw Lamb Meat, 7 jin, remove fascia/fat/skin, slice open and insert powdered herbs below), Rongrong (Cistanche, 10 liang), Danggui (Angelica Sinensis, 12 liang, washed, peel removed), Shanyao (Dioscorea, 10 liang, wet ones peeled), Tiandong (Asparagus/Tienma, 1 jin, remove heart, bake dry).
Grind the four herbs into powder, place inside the lamb meat, wrap securely. Boil in 4 bottles of pure wine until wine is exhausted, then add 2 sheng of water and boil until meat is tender. Add Huangqi (Astragalus) powder 5 liang, Renshen (Ginseng) powder 2 liang, Baizhu (Atractylodes) powder 2 liang. Pound into thin cakes, sun-dry, and dry over paper suspended above fire. Make pills with refined honey, size of wutong seeds. Take 100 pills, increasing to 200-300 pills, with warm wine, twice a day.
Xini Gao (Xini Paste)
Treats hemoptysis and hematemesis, chronic consumptive cough that does not stop.
Herbs: Xini (Snipe, 60 birds, extract 20 cups of juice), Shengdi (Rehmannia), Maogen (Imperata Rhizome), Ou (Lotus Root) (each extract 10 cups of juice), Luobo (Radish), Maidong (Ophiopogon) (each extract 5 cups of juice).
Decoct the six ingredients, refine with 1 jin of honey and 8 liang of maltose, add half a cup of ginger juice, boil again until thick like稀糊 (thin paste), forming the paste. Take 1-2 spoons daily, hold in mouth and swallow.