于小建中汤内，加黄耆一两半，余根据上法。
若气短胸满者，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。
@@@
虚劳腰痛，少腹拘急，小便不利者，八味肾气丸主之。
【注】
虚劳之人腰痛肾气虚而不行也。少腹拘急，小便不利，膀胱气虚不化也。主以八味肾
气丸温补下焦。肾与膀胱表里之气足，而腰痛，少腹拘急，小便不利，未有不愈者也
。
【集注】
程林曰：腰者肾之外候，肾虚则腰痛，肾与膀胱为表里，不得三焦之阳气以决渎，则
小便不利而少腹拘急矣。与是方以益肾间之气，气强则便溺行，而少腹拘急亦愈矣。
尤怡曰：虚劳之人，损伤少阴肾气，是以腰痛，少腹拘急，小便不利。以八味肾气丸
补阴之虚，可以生气，助阳之弱，可以化水，乃补下治下之良剂也。
（见妇人杂病中）
@@@
虚劳虚烦不得眠，酸枣汤主之。
【注】
因虚劳而烦，是虚烦也。因虚烦而不得眠，是虚烦不得眠也。故主以酸枣仁汤，专治
虚烦，烦去则得眠也。
【集注】李□曰：虚烦不得眠者，血虚生内热，而阴气不敛也。『内经』云：气行于
阳，阳气满，不得入于阴，阴气虚，故目不得瞑；酸枣汤养血虚而敛阴气也。
酸枣仁二升 甘草一两 知母二两 茯苓二两 芎藭二两
右五味，以水八升，煮酸枣仁，得六升，内诸药，煮取三升，分温三服。
@@@
五劳极虚，羸瘦腹满，不能饮食，食伤、忧伤、饮伤、房室伤、饥伤、劳伤，经络荣
卫气伤，内有干血，肌肤甲错，两目黯黑，缓中补虚，大黄□虫丸主之。
【按】
「缓中补虚」四字，当在不能饮之下，必是传写之□。
【注】
五劳所伤，久之令人极虚羸瘦，腹中虚满，不能饮食，宜缓中补虚，如前之建中等方
也。原其所伤之道，不止过劳伤气，房室伤精也，即饮食伤胃，饥过伤脾，渴过伤肾
，忧思伤心，悲极伤肝，过言伤肺，皆令人经络荣卫气伤。是以劳热煎熬，内有干血
，故肌肤不润，甲错如鳞也。两目不荣，黯黑不明也。似此干血之证，非缓中补虚之
剂所能治，故主以大黄□虫丸，攻热下血，俾瘀积去而虚劳可复也。
【集注】
程林曰：此条单指内有干血而言。夫人或因七情，或因饮食，或因房劳，皆令正气内
伤，血脉凝积，致有干血积于中，而尪羸见于外也。血积则不能以濡肌肤，故肌肤甲
错；不能荣于目，则两目黯黑，与大黄□虫丸以下干血，则邪除正王矣，非大黄□虫
丸能缓中补虚也。
尤怡曰：内有干血不去，适足以留新血而渗灌不周，故去之不可不早也。此方润以濡
其干，虫以动其瘀，通以去其闭，而以地黄芍药甘草和养其虚，攻血而仍滋夫血也。
在小建中汤的基础上，加入黄耆一两半，其余按照上述方法煎服。
如果气短、胸部胀满的，加生姜；腹部胀满的，去掉大枣，加入茯苓一两半；以及治疗肺虚损不足以补气时，加入半夏三两。
@@@
虚劳病出现腰痛，少腹拘急不舒，小便不通利的，用八味肾气丸主治。
【注】
虚劳病人腰痛，是因为肾气虚弱而不能运行。少腹拘急，小便不利，是膀胱气虚不能气化所致。主治用八味肾气丸温补下焦。肾与膀胱表里之气充足，那么腰痛、少腹拘急、小便不利这些症状，没有不痊愈的。
【集注】
程林说：腰是肾的外候，肾虚则腰痛，肾与膀胱互为表里，若得不到三焦阳气来决渎水道，就会小便不利而少腹拘急。给予这个方子以补益肾间之气，气强盛则小便通利，而少腹拘急也会痊愈。
尤怡说：虚劳病人，损伤了少阴肾气，所以腰痛、少腹拘急、小便不利。用八味肾气丸补阴之虚，可以生发阳气，助阳之弱，可以化行水液，这是补下治下的良剂。
（见妇人杂病篇中）
@@@
虚劳病人心中虚烦不得安眠，用酸枣汤主治。
【注】
因为虚劳而导致心烦，这叫虚烦。因为虚烦而导致不能安眠，这叫虚烦不得眠。所以主治用酸枣仁汤，专门治疗虚烦，烦热去除就能安眠了。
【集注】李□说：虚烦不得眠，是因为血虚产生内热，而阴气不能收敛。《内经》说：气行于阳分，阳气满盛，不能入于阴分，阴气虚弱，所以眼睛不能闭合入睡；酸枣汤能养血虚而收敛阴气。
酸枣仁二升 甘草一两 知母二两 茯苓二两 芎藭二两
以上五味药，用水八升，先煮酸枣仁，得到六升药液，再加入其他药物，煮取三升药液，分三次温服。
@@@
五劳极度虚弱，身体消瘦，腹部胀满，不能进食，无论是饮食所伤、忧思所伤、饮酒所伤、房事所伤、饥饿所伤、劳累所伤，导致经络营卫之气受损，体内有干血停滞，肌肤粗糙如鳞甲交错，两眼暗黑无光，需要缓中补虚的，用大黄□虫丸主治。
【按】
“缓中补虚”这四个字，应当位于“不能饮食”之下，肯定是传抄过程中的脱漏或错误。
【注】
五劳所伤，久而久之使人极度虚弱消瘦，腹中虚满，不能饮食，应当缓中补虚，像前面的建中汤等方剂那样。追溯其受伤的原因，不仅仅是过劳伤气、房室伤精，还有饮食伤胃，饥饿过度伤脾，口渴过度伤肾，忧思伤心，悲伤过度伤肝，言语过度伤肺，这些都使人经络营卫之气受损。因此劳热煎熬，体内形成干血，所以肌肤不润泽，像鳞甲一样交错。两眼得不到气血荣养，显得暗黑不明。像这种干血的证候，不是缓中补虚的药剂所能治疗的，所以主治用大黄□虫丸，攻逐热邪下行瘀血，使瘀积去除而虚劳得以恢复。
【集注】
程林说：这一条单指体内有干血而言。人或许因为七情，或许因为饮食，或许因为房劳，都令正气内伤，血脉凝滞积聚，导致干血积结在体内，而羸瘦表现在外。血积结则不能濡润肌肤，所以肌肤粗糙如鳞甲交错；不能荣养双目，则两眼暗黑，用大黄□虫丸来攻下干血，则邪气去除正气旺盛，并不是大黄□虫丸能缓中补虚。
尤怡说：体内干血不去，只会阻碍新血生成且灌溉周身不周，所以去除它不可不早。此方用滋润药来濡养干燥，用虫类药来松动瘀血，用通利药来去除闭塞，并用生地、芍药、甘草来调和滋养其虚损，攻逐瘀血的同时仍然滋补血液。
In the formula of Xiao Jianzhong Tang (Minor Construct the Middle Decoction), add Huangqi (Astragali Radix) one tael and a half, and follow the method described above for the rest.
If there is shortness of breath and chest fullness, add Shengjiang (Zingiberis Rhizoma Recens); if there is abdominal fullness, remove Zao (Jujubae Fructus) and add Fuling (Poria) one tael and a half; as well as when treating lung deficiency and insufficiency to tonify Qi, add Banxia (Pinelliae Rhizoma) three taels.
@@@
For Xu Lao (Deficiency Consumption) presenting with lower back pain, tension and urgency in the lower abdomen, and difficulty in urination, Ba Wei Shen Qi Wan (Eight-Ingredient Rehmannia Pill) is the primary treatment.
[Note]
The lower back pain in patients with Xu Lao (Deficiency Consumption) is due to Kidney Qi deficiency and failure to circulate. The tension and urgency in the lower abdomen and difficulty in urination are due to Bladder Qi deficiency and failure to transform fluids. The primary treatment is Ba Wei Shen Qi Wan (Eight-Ingredient Rehmannia Pill) to warm and tonify the Lower Jiao (Lower Burner). When the exterior-interior Qi of the Kidney and Bladder is sufficient, symptoms such as lower back pain, tension and urgency in the lower abdomen, and difficulty in urination will invariably heal.
[Collected Notes]
Cheng Lin said: The waist is the external manifestation of the Kidney; Kidney deficiency leads to lower back pain. The Kidney and Bladder are exterior-interior partners; without the Yang Qi of the San Jiao (Triple Burner) to regulate water passages, urination becomes difficult and the lower abdomen feels tense and urgent. Administer this formula to benefit the Qi between the Kidneys; when Qi strengthens, urination flows, and the tension and urgency in the lower abdomen also resolve.
You Yi said: Patients with Xu Lao (Deficiency Consumption) have damaged the Shaoyin (Lesser Yin) Kidney Qi, hence lower back pain, tension and urgency in the lower abdomen, and difficulty in urination. Ba Wei Shen Qi Wan (Eight-Ingredient Rehmannia Pill) tonifies Yin deficiency to generate Qi, and assists weak Yang to transform water; it is an excellent agent for tonifying the lower and treating the lower.
(See in the chapter on Miscellaneous Diseases of Women)
@@@
For Xu Lao (Deficiency Consumption) presenting with empty irritability and inability to sleep, Suan Zao Tang (Sour Jujube Decoction) is the primary treatment.
[Note]
Irritability caused by Xu Lao (Deficiency Consumption) is called empty irritability (Xu Fan). Inability to sleep caused by empty irritability is called empty irritability with insomnia. Therefore, the primary treatment is Suan Zao Ren Tang (Sour Jujube Seed Decoction), which specifically treats empty irritability; once irritability is removed, sleep can be attained.
[Collected Notes] Li [Name Missing] said: Empty irritability with inability to sleep is due to Blood deficiency generating internal heat, while Yin Qi fails to consolidate. The *Neijing* (Classic of Internal Medicine) states: Qi moves in the Yang aspect; when Yang Qi is excessive, it cannot enter the Yin aspect. With Yin Qi deficient, the eyes cannot close for sleep; Suan Zao Tang nourishes Blood deficiency and consolidates Yin Qi.
Suan Zao Ren (Zizyphi Semen) two sheng
Gancao (Glycyrrhizae Radix et Rhizoma) one tael
Zhimu (Anemarrhenae Rhizoma) two taels
Fuling (Poria) two taels
Xiongqiong (Chuanxiong Rhizoma) two taels
These five ingredients are boiled in eight sheng of water. First boil Suan Zao Ren (Zizyphi Semen) until six sheng remain, then add the other medicines, and boil until three sheng remain. Divide into three doses and take warm.
@@@
When Wu Lao (Five Exhaustions) causes extreme deficiency, emaciation, abdominal fullness, and inability to eat, whether injured by diet, sorrow/worry, drinking, sexual activity, hunger, or labor, damaging the meridians, Ying (Nutritive) and Wei (Defensive) Qi, with dry blood stagnating internally, rough skin resembling scales (Jia Cuo), and darkened eyes, requiring gentle middle-tonification and deficiency-supplementation, Da Huang Zhe Chong Wan (Rhubarb and Beetle Pill) is the primary treatment.
[Analysis]
The four characters "gentle middle-tonification and deficiency-supplementation" should likely appear after "inability to eat"; this is certainly a transcription error or omission.
[Note]
Damage from Wu Lao (Five Exhaustions) eventually leads to extreme deficiency, emaciation, false abdominal fullness, and inability to eat. One should gently tonify the middle and supplement deficiency, using formulas like the aforementioned Jianzhong Tangs. Tracing the cause of injury, it is not only over-labor damaging Qi and sexual excess damaging Essence, but also diet damaging the Stomach, excessive hunger damaging the Spleen, excessive thirst damaging the Kidney, worry and thought damaging the Heart, extreme grief damaging the Liver, and excessive speech damaging the Lung. All these damage the meridians, Ying (Nutritive) and Wei (Defensive) Qi. Thus, labor-heat simmering creates dry blood internally, causing the skin to lose moisture and become rough like scales. The eyes lose nourishment, appearing dark and dim. Such conditions of dry blood cannot be treated by agents that merely gently tonify the middle and supplement deficiency; therefore, Da Huang Zhe Chong Wan (Rhubarb and Beetle Pill) is used to attack heat and purge blood downward, allowing stasis to dissipate so that Xu Lao (Deficiency Consumption) may recover.
[Collected Notes]
Cheng Lin said: This passage refers solely to the presence of dry blood internally. People may suffer internal damage to righteous Qi due to seven emotions, diet, or sexual fatigue, leading to coagulation and accumulation of blood vessels, resulting in dry blood accumulating internally and emaciation manifesting externally. Blood accumulation prevents moistening of the skin, hence rough skin resembling scales; it prevents nourishment of the eyes, hence darkened eyes. Using Da Huang Zhe Chong Wan (Rhubarb and Beetle Pill) to purge dry blood removes pathogenic factors and strengthens righteous Qi; it is not that Da Huang Zhe Chong Wan (Rhubarb and Beetle Pill) itself gently tonifies the middle and supplements deficiency.
You Yi said: If dry blood remains internally, it merely retains new blood and prevents thorough irrigation, so removing it must not be delayed. This formula uses moistening agents to hydrate dryness, insect drugs to mobilize stasis, and unblocking agents to open closures, while using Dihuang (Rehmanniae Radix), Shaoyao (Paeoniae Radix), and Gancao (Glycyrrhizae Radix et Rhizoma) to harmonize and nourish deficiency. It attacks blood while still nourishing blood.