虚者血气不足也，久则肌肤脏腑亦渐消损，故曰虚损。劳者久为病苦，不得安
息，如劳苦不息者然。又其病多为劳心、劳力、房劳所致。又其证多属火，劳字从
力、从二火，故曰劳也。瘵者败也，证至于劳则败坏矣。前人分为五劳∶曰肺劳，
其证面浮气短，皮枯毛悴，洒淅恶寒，咳嗽不宁；曰心劳，其证血脉虚少，男子面
无血色，女子月经不通；曰脾劳，其证饮食减少，肌肉消削，大便溏泄；曰肝劳，
其证口苦目病，胸胁引痛，筋病不能行；曰肾劳，其证骨痿不能久立，腰背不利，
午后发热，盗汗骨蒸，小便黄赤而有余沥，茎中痛，小腹满急。又分六极∶曰气极，
肺病极也，喘促冲胸，恒欲怒，气少不足以言；曰血极，心病极也，面无血色，头
发堕落，心痛，唇舌红赤；曰肉极，脾病极也，肌肉消瘦，四肢倦弱，身上常如鼠
走；曰筋极，肝病极也，数转筋，爪甲枯痛，手足拘挛，胁下痛；曰骨极，肾病极
也，手足痛，脊腰痛，不能久立，牙齿动；曰精极，脏腑皆虚极也，身无膏泽，眼
无精光，耳常聋鸣，精神短乏，遗精白浊，骨髓空虚。又分七伤∶曰阴寒；曰阴痿；
曰里急；曰精速；曰精少，阴下湿；曰精滑；曰小便苦数，临事不举。又曰大饱伤
脾；大怒气逆伤肝；强力举重，久坐湿地伤肾；形寒饮冷伤肺；忧愁思虑伤心；风
雨寒暑伤形；大恐惧不节伤志。盖积伤而成劳，积劳而致极，非一朝一夕之故矣。
旧说感寒则损阳，（阳虚而复感外寒，则损阳分也。）感热则损阴，（阴虚更生内热，则损阴分。）损阳
者自上而下。初损肺，皮聚毛落；二损心，血脉空虚；三损脾，饮食不为肌肤；四
损肝，胁痛筋病；五损肾，骨痿不能起床，损至肾则死矣，所谓五脏之伤，穷必及
肾。损阴则反此，自下而上，至肺而死，所谓内伤以有咳嗽为重。（详咳嗽门。）然寒损阳，
热损阴，及肺肾上下，皆举隅之论耳。盖风寒湿三者并能郁肺气成热，暑火燥三者
亦并能伤肺气致热。悲伤亦动肺火，固不独形寒饮冷能伤肺也。肾水虚则热，火虚
则寒，强力举重、房劳不节、恐惧不解等皆能伤肾，固不止于热也。又或饮食先伤其
脾，思虑先伤其心，郁怒先伤其肝，然后以次传及诸脏者有矣，宁必先伤肺与肾哉？
大纲须分气血阴阳。气虚者，四君子汤、补中益气汤、（并见气。）保元汤等，不外扶脾
保肺。血虚者，四物汤、当归补血汤、（并见血。）地骨皮饮、六物汤、（血虚而热，宜之。）加
味四物汤（血虚寒热往来，宜之）等，（二方并见血。）不外养肝清心。气血两虚者、十全大补汤、
人参养荣汤等。所谓阴阳，皆指肾言，阳虚者，肾中之火虚也，脉右尺必弱，八味
丸主之。阴虚者，肾中之水虚也，脉必细数，六味丸主之。辨证之法，阴虚者常热，
大便燥结，小便赤涩，足心如烙，形体消瘦；阳虚者多寒，（亦有戴阳、格阳等证，身体大热，
不恶寒反恶热者，然是临时有此，非常常如是。）大便时溏，小便清白，腰足冷，神气短怯。肝伤，
补肝汤、逍遥散；（见郁。）肺伤，加味救肺饮；心伤，天王补心丹；脾伤，归脾汤。（见
血。）此大概也。五脏之伤，肾为最重，肾虚则骨蒸潮热，（或午后或子后潮热。）自汗盗汗，
形体消瘦，口干咽燥，声嘶音哑，消渴淋浊，遗精失血，易生嗔怒，干咳痰嗽，
不眠烦躁，恍惚怔忡，皆水虚火炎所致，六味地黄汤为主。劳嗽加五味子，或合生
脉散。（见中暑。）热甚暂加知、柏。大抵水虚者十之八九，附、桂勿轻用也。丹溪主乎
阴虚，故午后发热，（午后属阴，阴虚故午后发热也。）盗汗，痰涎上逆频吐不绝，（升属阳，降属阴，
阴虚火炎，气不得降。）脉浮取则洪大，沉取则空虚，用四物加知、柏。后人遵用而不
效，何也？盖归、芎皆辛香上窜，非降火之药∶知、柏苦寒泻实火，虚火则非所宜，
徒然伤胃故也。改用薏苡仁、百合、二冬、桑根白皮、地骨皮、丹皮、枇杷叶、五
味子、酸枣仁之属，佐以生地汁、藕汁、乳汁、童便，有痰加贝母以保肺而滋水
源，无不应手取效。盖诸药皆禀燥（当凉寄看）降收之气，气之薄者。为阳中之阴，从阳
分而下降，则能降上升之火。又其气清凉，如当暑热之时而商飙倏动，则炎
HT如失,与治暑证用白虎汤（见发热。）同意。然彼是外感证，属有余，故用沉寒之品；
此为内伤，证属不足，但用燥降收之剂足矣，此用药之权衡也。故曰气虚则生脉散
（见中暑），不言白术。血虚则三才丸，不言四物。凡治水虚者，以脾肾兼顾为难。盖水虚宜
用凉润以补肺肾，而每滞脾，故过用寒凉者脾必败，观劳证多死于泄泻可知也。须
间进甘温之品，或行滞快气之药，以扶脾，然不得过于辛燥，以反耗肾水。若火虚
者，脾肾皆寒，一味温补，无所顾忌，故曰受温补者易治。人参一味，除肺壅热脉
洪数者不宜外，余证皆不可少。王节斋服参必死之说，大是误人。（再按人参生凉熟
温，本非热品，又质重气薄，当是益阴之品。本草谓是补气，当是阳根于阴之义，请质之高明。）病久虚弱，厌
厌不能食，和中丸。（见不能食。）男子肌瘦气弱，咳嗽，渐成劳瘵，猪肚丸，服之即肥。
服寒凉药，证虽大减，脉反加数者，阳郁也，宜升宜补，大忌寒凉，犯之必死。有
重阴覆其阳，火不得伸，洒洒恶寒，或志不乐，或脉弦数，四肢五心烦热者，火郁
汤、柴胡升麻汤，（并见发热。）病去即已。有面色如故，肌体自充，外看如无病，内实
虚损，俗呼为桃花蛀，当看有何证，如法治之。虚劳之疾，百脉空虚，非粘腻之物
填之，不能实也；精血枯涸非滋润之物濡之，不能润也。宜参、 、地黄、二冬、
枸杞、五味之属，各煎成膏。另用青蒿以童便熬膏，及生地、白莲藕、薄荷等汁，
人乳，隔汤炼过，酌定多少，并麋角胶、霞天膏（见积聚）和合成膏。每用数匙，汤化服。
如欲行瘀血，加入醋制大黄末、玄明粉、桃仁泥、韭汁之属；欲止血，加入京
墨之属；欲行痰，加入竹沥之属；欲降火，加入童便之属。凡虚劳之证，大抵心下
引胁俱疼，盖滞气不散，新血不行也，尤宜用膏子加韭汁、桃仁泥。柴胡为升清散
郁之品，故骨蒸用以透肌解热，用银州者佳，然不可常服，为其疏散故也。阴虚火
动，阳常举，皮硝放手心，两手合住自化，阳既痿矣。证本阴虚，若呼吸少气，懒
言语，无力动作，目无精光，面色 白，乃兼阳虚也，人参、麦冬各三钱，五味子
二十一粒，橘皮、桔梗、炙甘草各五钱，为末，水浸油饼为丸，如鸡头子大，每服
一丸，嚼津咽下。虚损久为劳瘵，积热骨蒸，（热深入骨髓中，蒸达于外。）咳嗽唾血，肌肤
甲错，（干涩枯槁，如鳞甲之相错。）面目黑黯无光，偏睡，声哑，咽痛，颈生瘰 ，两胁疼
痛，转筋拘急，或周身筋骨皆痛，夜梦鬼交，（即梦遗。）时多忿怒，五心烦热，头发作
穗，面唇时红，如敷胭脂，大便不调，小便淋浊，此肾水竭，肝血亏，无以制火使
然。火灼血干，虽用滋阴之剂亦不得效，以死血不去，则经脉壅塞，气血无以流通，
热终不除也。若其人能食而大便结者，尚堪攻下，急用大黄 虫丸（陈大夫传仲景百劳丸，
可与此丸互用。）以行其死血。即无死血，而积热不除，非下行无以折其势，亦当暂用大
黄青蒿煎导之，（古方柴胡饮子、防风当归饮子、麦煎散，皆用大黄以折上炎之势也。）然后随证调理。
若不能食而泄泻，不堪攻下者，必死。劳瘵日久，或生恶虫，（败血湿热所化。）蛀蚀脏腑，
久而通灵，变化无常，身死之后，传染子孙，甚而灭门，名曰传尸劳。宜癸亥日二
更后，灸两腰眼各七壮，（见针灸。）后服传尸将军丸。膏肓四花穴可灸。（见针灸。）獭肝一
具，阴干为末，水服方寸匕，日三服，效。未知再服。大抵以保养精血为上，去虫
次之。安息、苏合、阿魏、麝香、犀角、丹砂、雄黄，固驱邪之品，亦须加天灵盖
于中。盖传尸之虫，鬼气也，伏而未起，一得枯骸，则鬼气飞越附之，不复着人。
可泻而出。外此则虎牙、鲤鱼头骨亦可，此乃食人之物，鬼所畏者也。先用芎归血
余散吞北斗符，次用鳖甲生犀散取虫，余法详《准绳》。虚损劳瘵属阴虚者多，必形
消着骨而后死，可见也。以阴主形，阴全竭而后形全毁也。若是阳虚，则有形盛而
脱死者矣。以阳主气，气脱者不必待其形之脱也。真脏脉见者，即形肉尚存，亦不
久矣。大骨枯槁，（颧、股、腰之骨，痿痛不能支。）大肉陷，（头、项、四肢大肉消陷成坑。）动作精神
衰，即真脏脉不见，亦不过一岁死。若更喘满动形，半年死。若更痛引肩胸，（五脏内
损。）一月死。若更破 ，（消陷之处枯燥破裂。）身热不已，十日死。兼以真脏脉见，目
眶下陷，视不见人，即死矣。若能见人，为神尚未去，至所不胜之日时而死。虚劳
危证不受补，大便泄泻，筋骨痛极，偏睡，失音，脉弦数，皆危证也。
虚，是指血和气不足；日久则肌肤和脏腑也会逐渐消耗损伤，所以称为虚损。劳，是指长久遭受病痛折磨，不得安宁休息，就像劳苦不停歇一样。另外，这种病多由用心过度、用力过度、房事过度所致。而且其证候多属于火（热），"劳"字由"力"和两个"火"组成，所以称为劳。瘵，是败坏的意思，病情发展到劳的程度，身体就已经败坏了。前人将劳分为五劳：叫肺劳，其症状是面部浮肿、气短、皮肤干枯、毛发憔悴、怕冷发抖、咳嗽不安；叫心劳，其症状是血脉虚弱稀少，男子面色无血色，女子月经不通；叫脾劳，其症状是饮食减少、肌肉消瘦、大便稀溏；叫肝劳，其症状是口苦、眼疾、胸胁牵引疼痛、筋脉病变导致行走困难；叫肾劳，其症状是骨痿不能久站、腰背不利、午后发热、盗汗骨蒸、小便黄赤且有余沥、尿道疼痛、小腹胀满急迫。又分为六极：叫气极，是肺病到了极点，气喘急促冲击胸部，经常想发怒，气少到不足以说话；叫血极，是心病到了极点，面无血色，头发脱落，心痛，嘴唇舌头红赤；叫肉极，是脾病到了极点，肌肉消瘦，四肢疲倦无力，身上常感觉像有老鼠在爬动；叫筋极，是肝病到了极点，频繁转筋，指甲枯痛，手足拘挛，胁下疼痛；叫骨极，是肾病到了极点，手足疼痛，脊腰疼痛，不能久站，牙齿松动；叫精极，是脏腑都极度虚弱，身体没有光泽，眼睛没有神采，耳朵经常鸣响，精神疲乏，遗精白浊，骨髓空虚。又分为七伤：叫阴寒；叫阳痿；叫里急（腹部拘急）；叫精速（射精过快）；叫精少，阴部潮湿；叫滑精；叫小便频数痛苦，行房时不能勃起。又说：饱食过度伤脾；大怒气逆伤肝；强力举重、久坐湿地伤肾；形体受寒、饮用冷水伤肺；忧愁思虑伤心；风雨寒暑伤形体；大惊恐惧不节制伤志。大概是积累损伤而成劳，积累劳倦而致极，这不是一朝一夕的原因。旧说认为感受寒邪则损伤阳气，（阳虚而又感受外寒，就会损伤阳分。）感受热邪则损伤阴液，（阴虚又产生内热，就会损伤阴分。）损伤阳气的病，是从上往下传变。初损肺，皮毛聚敛脱落；二损心，血脉空虚；三损脾，饮食不能化为肌肤；四损肝，胁痛筋病；五损肾，骨痿不能起床，损伤到肾就会死亡，这就是所谓五脏的损伤，穷尽必然波及肾脏。损伤阴液则与此相反，从下往上发展，到肺而死，这就是所谓内伤病以咳嗽为重。（详见咳嗽门。）然而寒损阳、热损阴，以及肺肾上下之分，都只是举例说明罢了。大概风寒湿三者都能郁滞肺气化热，暑火燥三者也都能损伤肺气导致发热。悲伤也能触动肺火，并不只是形寒饮冷才能伤肺。肾水虚则生热，命门火虚则生寒，强力举重、房劳不节、恐惧不解等都能伤肾，并不只限于热证。或者有的先因饮食损伤脾，先因思虑损伤心，先因郁怒损伤肝，然后依次传给其他脏器的情况也有，难道一定是先伤肺和肾吗？治疗的大纲必须分清气血阴阳。气虚者，用四君子汤、补中益气汤、保元汤等，不外乎扶持脾胃、保护肺气。血虚者，用四物汤、当归补血汤、地骨皮饮、六物汤、加味四物汤等，不外乎滋养肝脏、清心安神。气血两虚者，用十全大补汤、人参养荣汤等。所谓的阴阳，都是指肾脏而言，阳虚者，是肾中的火虚，脉象右尺部必定弱，用八味丸主治。阴虚者，是肾中的水虚，脉象必定细数，用六味丸主治。辨证的方法，阴虚者通常发热，大便干燥结硬，小便赤涩，脚心像被烫烙，形体消瘦；阳虚者多畏寒，（也有戴阳、格阳等证候，身体大热，不怕冷反而怕热的，但这是暂时有此表现，不是常常如此。）大便时而稀溏，小便清白，腰足冷，神气短少怯懦。肝受伤，用补肝汤、逍遥散；肺受伤，用加味救肺饮；心受伤，用天王补心丹；脾受伤，用归脾汤。这只是一般情况。五脏的损伤，肾虚最重，肾虚则出现骨蒸潮热、自汗盗汗、形体消瘦、口干咽燥、声音嘶哑失音、消渴淋浊、遗精失血、容易发怒、干咳痰嗽、失眠烦躁、恍惚怔忡，这些都是肾水虚、虚火上炎所致，以六味地黄汤为主方。劳嗽加五味子，或者合用生脉散。热甚暂时加知母、黄柏。大抵水虚的情况占十之八九，附子、肉桂不要轻易使用。朱丹溪主张阴虚，所以午后发热、盗汗、痰涎上逆频频呕吐不止、脉浮取洪大沉取空虚，用四物汤加知母、黄柏。后人遵照使用却不效验，为什么呢？大概当归、川芎都是辛香上窜的药，不是降火的药；知母、黄柏苦寒泻实火，对于虚火就不适宜，徒然损伤胃气罢了。改用薏苡仁、百合、天冬麦冬、桑根白皮、地骨皮、牡丹皮、枇杷叶、五味子、酸枣仁之类的药，佐以生地汁、藕汁、人乳、童便，有痰加贝母以保肺滋水源，没有不随手见效的。大概这些药物都禀受凉、降、收的气，气比较薄，属于阳中之阴，从阳分下降，就能降上升的火。又因为它们的性质清凉，就像在暑热之时忽然刮起秋风，炎热立刻消失，这与治疗暑证用白虎汤意思相同。然而那是外感证，属于有余（实证），所以用沉寒的药物；这是内伤病，证候属于不足（虚证），只用凉降收的药物就够了，这是用药的权衡。所以说气虚用生脉散，不说白术。血虚用三才丸，不说四物汤。凡是治疗水虚，兼顾脾肾很难。因为水虚宜用凉润药补肺肾，但往往阻碍脾气，所以过用寒凉药脾必败，看劳证多死于泄泻就知道了。须要间或进服甘温的药物，或者行滞快气的药，来扶助脾胃，但不能过于辛燥，以免反耗肾水。如果是火虚者，脾肾都寒，一味温补，无所顾忌，所以说接受温补的容易治。人参一味药，除了肺壅热、脉洪数者不宜外，其余证候都不可少。王节斋说服参必死的说法，大大误导了人。（再按：人参生性凉熟性温，本不是热药，又质地重气机薄，应当是益阴的药物。本草说是补气，应当是阳根于阴的道理，请高明之士指正。）病久虚弱，食欲不振，用和中丸。男子肌瘦气弱，咳嗽，渐渐成为劳瘵，用猪肚丸，服用后即能长胖。服用寒凉药，证候虽然大减，脉象反而加快，这是阳气郁结，宜升宜补，大忌寒凉，犯了必死。有重阴覆盖阳气，火不能伸展，洒洒恶寒，或者心情不乐，或者脉弦数，四肢及手心脚心烦热的，用火郁汤、柴胡升麻汤，病去就停止。有面色如常，肌体充实，外表看像没病，内部实际是虚损，俗呼为桃花蛀，应当看有什么证候，依法治疗。虚劳的疾病，百脉空虚，不用粘腻的东西填补，不能充实；精血枯涸不用滋润的东西濡养，不能润泽。宜用人参、地黄、天冬麦冬、枸杞、五味子之类，各煎成膏。另用青蒿以童便熬膏，以及生地、白莲藕、薄荷等汁，人乳，隔水炼过，酌定多少，并加入鹿角胶、霞天膏和合成膏。每次用几匙，开水化服。如果想行瘀血，加入醋制大黄末、玄明粉、桃仁泥、韭汁之类；想止血，加入京墨之类；想行痰，加入竹沥之类；想降火，加入童便之类。凡是虚劳的证候，大抵心下牵引胁肋都疼，这是因为滞气不散，新血不行，尤其宜用膏剂加韭汁、桃仁泥。柴胡是升清散郁的药物，所以骨蒸用它来透肌解热，用银州产的为佳，但不可以常服，因为它有疏散作用。阴虚火动，阳气常举，把朴硝放在手心，两手合住自然融化，阳气就萎软了。证本是阴虚，如果呼吸短气，懒言，无力动作，眼睛无神，面色㿠白，这是兼有阳虚，用人参、麦冬各三钱，五味子二十一粒，橘皮、桔梗、炙甘草各五钱，研为末，用水浸油饼为丸，如鸡头子大，每服一丸，嚼碎津液咽下。虚损久了成为劳瘵，积热骨蒸，咳嗽唾血，肌肤甲错，面目黑黯无光，偏睡，声哑，咽痛，颈生瘰疬，两胁疼痛，转筋拘急，或者周身筋骨皆痛，夜梦鬼交，时常多忿怒，五心烦热，头发成穗状，面唇时时发红，像涂了胭脂，大便不调，小便淋浊，这是肾水枯竭，肝血亏虚，无法制约火气所致。火灼血干，虽然用滋阴的药剂也不得效，因为死血不去，经脉壅塞，气血无法流通，热终不能除。如果其人能吃而大便结硬的，还可以攻下，急用大黄䗪虫丸（陈大夫传仲景百劳丸，可与这个丸剂互换使用）来行其死血。即使没有死血，而积热不除，不下行就无法折其势头，也应当暂时用大黄青蒿煎剂导下，（古方柴胡饮子、防风当归饮子、麦煎散，都用大黄来折上炎的势头。）然后随证调理。如果不能食而泄泻，不堪攻下的，必死。劳瘵日久，或者生出恶虫，（由败血湿热所化。）蛀蚀脏腑，久了通灵，变化无常，身死之后，传染子孙，甚至灭门，名叫传尸劳。宜在癸亥日二更后，灸两腰眼各七壮，后服传尸将军丸。膏肓穴、四花穴可灸。獭肝一具，阴干研末，水服方寸匕，每日三次，有效。未知是否再服。大抵以保养精血为上策，驱虫次之。安息香、苏合香、阿魏、麝香、犀角、丹砂、雄黄，虽然是驱邪的药物，也必须加入天灵盖在其中。大概传尸的虫，是鬼气，潜伏未起，一旦得到枯骨，鬼气就飞越附着在上面，不再着人，可以泻出。除此之外，虎牙、鲤鱼头骨也可以，这是吃人的东西，鬼所畏惧的。先用芎归血余散吞服北斗符，次用鳖甲生犀散取虫，其余方法详见《准绳》。虚损劳瘵属阴虚的多，一定形体消瘦至骨而后死，可见一斑。因为阴主形，阴完全枯竭后形体才完全毁坏。如果是阳虚，则有形体丰盛而脱气死亡的。因为阳主气，气脱的不必等到形体脱。真脏脉出现的，即使形肉尚存，也不久了。大骨枯槁，大肉陷下，动作精神衰败，即使真脏脉不见，也不过一年死。如果再加喘满动形，半年死。如果再加痛引肩胸，一月死。如果再加破溃，身热不已，十日死。兼以真脏脉见，眼眶下陷，视而不见人，即死。如果能见人，说明神尚未去，到所不胜的日子时死。虚劳危证不受补，大便泄泻，筋骨痛极，偏睡，失音，脉弦数，都是危证。
Xu (Deficiency) refers to the insufficiency of Xue (Blood) and Qi (Vital Energy); over time, the skin, muscles, and Zang-Fu organs gradually deteriorate, hence it is called Xu Sun (Deficiency Damage). Lao (Exhaustion) refers to enduring illness for a long time without rest, akin to relentless toil. Furthermore, this disease is often caused by mental exertion, physical labor, or sexual excess. Its manifestations are mostly related to Fire (Heat); the character "Lao" consists of "Li" (Power) and two "Huo" (Fire) radicals, thus named Lao. Zhai (Consumption) means decay; when the condition reaches the stage of Lao, the body has already deteriorated. Ancients divided Lao into Five Lao: Fei Lao (Lung Exhaustion), with symptoms of facial edema, shortness of breath, dry skin, brittle hair, chills, and restless cough; Xin Lao (Heart Exhaustion), with symptoms of deficient and scanty blood vessels, pallor in men, and amenorrhea in women; Pi Lao (Spleen Exhaustion), with symptoms of reduced appetite, muscle wasting, and loose stools; Gan Lao (Liver Exhaustion), with symptoms of bitter taste, eye diseases, radiating pain in the chest and hypochondrium, and tendon disorders causing difficulty walking; Shen Lao (Kidney Exhaustion), with symptoms of bone atrophy preventing prolonged standing, back stiffness, afternoon fever, night sweats, bone-steaming sensation, yellow-red urine with dribbling, urethral pain, and lower abdominal fullness and urgency. It is also divided into Six Ji (Extremes): Qi Ji (Qi Extreme), which is Lung disease at its extreme, characterized by panting rushing to the chest, frequent anger, and insufficient Qi to speak; Xue Ji (Blood Extreme), which is Heart disease at its extreme, characterized by pallor, hair loss, heart pain, and red lips and tongue; Rou Ji (Flesh Extreme), which is Spleen disease at its extreme, characterized by muscle wasting, weak limbs, and a sensation like mice crawling on the body; Jin Ji (Tendon Extreme), which is Liver disease at its extreme, characterized by frequent muscle spasms, dry and painful nails, contracture of hands and feet, and hypochondriac pain; Gu Ji (Bone Extreme), which is Kidney disease at its extreme, characterized by pain in hands and feet, spine and waist pain, inability to stand long, and loose teeth; Jing Ji (Essence Extreme), where all Zang-Fu organs are extremely deficient, characterized by lack of luster in the body, dull eyes, tinnitus, mental fatigue, spermatorrhea, white turbid discharge, and empty marrow. It is further divided into Seven Injuries: Yin Cold; Impotence; Inner Urgency (abdominal tension); Rapid Ejaculation; Scant Essence with damp genitals; Slippery Essence; Painful Frequent Urination and failure during intercourse. It is also said that excessive fullness injures the Spleen; great anger and reversed Qi injure the Liver; forceful lifting and sitting long in damp places injure the Kidneys; cold exposure and drinking cold liquids injure the Lungs; worry and overthinking injure the Heart; wind, rain, cold, and heat injure the Form; great fear and lack of moderation injure the Will (Zhi). Generally, accumulated injuries lead to Lao, and accumulated Lao leads to Ji; this does not happen overnight. Old theories state that contracting cold damages Yang (deficient Yang contracting external cold damages the Yang aspect), and contracting heat damages Yin (deficient Yin generating internal heat damages the Yin aspect). Damage to Yang proceeds from top to bottom: first damaging the Lung (skin gathers, hairs fall); second damaging the Heart (blood vessels become empty); third damaging the Spleen (food cannot transform into flesh); fourth damaging the Liver (hypochondriac pain and tendon disorders); fifth damaging the Kidney (bone atrophy preventing getting out of bed); damage reaching the Kidney leads to death, as stated: "Injuries to the five Zang organs inevitably reach the Kidney when exhausted." Damage to Yin proceeds oppositely, from bottom to top, leading to death at the Lung, as internal injury is serious when accompanied by cough (see Cough section). However, cold damaging Yang, heat damaging Yin, and the upper-lower distinction between Lung and Kidney are merely illustrative examples. Wind, cold, and dampness can all stagnate Lung Qi and generate heat; summer heat, fire, and dryness can all damage Lung Qi and cause fever. Grief can also stir Lung Fire, not just cold exposure and cold drinks injuring the Lung. Kidney Water deficiency generates heat; Mingmen Fire deficiency generates cold; forceful lifting, sexual excess, and unresolved fear can all injure the Kidney, not limited to heat syndromes. Sometimes diet first injures the Spleen, overthinking first injures the Heart, and stagnant anger first injures the Liver, then sequentially transmits to other Zang organs; why must it always be the Lung and Kidney first? The general principle requires distinguishing Qi, Blood, Yin, and Yang. For Qi deficiency, use Si Jun Zi Tang (Four Gentlemen Decoction), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Bao Yuan Tang (Protect the Origin Decoction), etc., which essentially support the Spleen and protect the Lung. For Blood deficiency, use Si Wu Tang (Four Substance Decoction), Dang Gui Bu Xue Tang (Angelica Tonify Blood Decoction), Di Gu Pi Yin (Cortex Lycii Decoction), Liu Wu Tang (Six Substance Decoction), Jia Wei Si Wu Tang (Modified Four Substance Decoction), etc., which essentially nourish the Liver and clear the Heart. For dual Qi and Blood deficiency, use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), Ren Shen Yang Rong Tang (Ginseng Nourish Ying Decoction), etc. When referring to Yin and Yang here, they specifically refer to the Kidney. Yang deficiency refers to deficiency of Fire in the Kidney, with a weak pulse at the Right Chi position, treated with Ba Wei Wan (Eight-Ingredient Pill). Yin deficiency refers to deficiency of Water in the Kidney, with a fine and rapid pulse, treated with Liu Wei Wan (Six-Ingredient Pill). Differentiation methods: Yin deficiency typically presents with heat, dry constipation, red and scanty urine, burning soles, and emaciation; Yang deficiency typically presents with cold, though there may be Dai Yang (Floating Yang) or Ge Yang (Repelling Yang) syndromes with severe heat, aversion to heat rather than cold, but these are temporary, not constant. Yang deficiency usually involves intermittent loose stools, clear and copious urine, cold waist and feet, and shortness of spirit with timidity. Liver injury is treated with Bu Gan Tang (Tonify Liver Decoction) and Xiao Yao San (Free and Easy Wanderer Powder); Lung injury with Jia Wei Jiu Fei Yin (Modified Rescue Lung Decoction); Heart injury with Tian Wang Bu Xin Dan (Emperor of Heaven's Special Pill to Tonify the Heart); Spleen injury with Gui Pi Tang (Restore the Spleen Decoction). This is the general approach. Among injuries to the five Zang organs, Kidney deficiency is the most critical. Kidney deficiency causes bone-steaming tidal fever, spontaneous and night sweats, emaciation, dry mouth and throat, hoarseness, Xiao Ke (Wasting-Thirst) and Lin Zhuo (Dribbling Turbidity), spermatorrhea, hemoptysis, irritability, dry cough with sputum, insomnia, restlessness,恍惚 (fluctuation), and palpitations, all caused by Kidney Water deficiency and flaming up of Deficient Fire, primarily treated with Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill). For Lao Sou (Consumption Cough), add Wu Wei Zi (Schisandra Berry) or combine with Sheng Mai San (Generate the Pulse Powder). If heat is severe, temporarily add Zhi Mu (Anemarrhena Rhizome) and Huang Bai (Phellodendron Bark). Generally, Water deficiency accounts for 80-90% of cases; Fu Zi (Aconite) and Gui Zhi (Cinnamon Twig) should not be used lightly. Zhu Danxi emphasized Yin deficiency, so afternoon fever (afternoon belongs to Yin, so Yin deficiency causes afternoon fever), night sweats, frequent vomiting of phlegm due to rebellious Qi (ascending belongs to Yang, descending belongs to Yin; Yin deficiency with flaming fire prevents Qi descent), and a pulse that is surging and large upon superficial palpation but empty upon deep palpation, are treated with Si Wu Tang plus Zhi Mu and Huang Bai. Why do later generations follow this without effect? Because Dang Gui (Angelica Sinensis) and Chuan Xiong (Sichuan Lovage Rhizome) are acrid and aromatic, ascending in nature, not herbs that subdue fire; Zhi Mu and Huang Bai are bitter and cold, clearing Excess Fire, unsuitable for Deficient Fire, merely damaging the Stomach Qi. Instead, use Yi Yi Ren (Coix Seed), Bai He (Lily Bulb), Dong Tian/Dong Bei (Asparagus Tuber), Sang Bai Pi (Mulberry Root Bark), Di Gu Pi (Cortex Lycii), Mu Dan Pi (Moutan Cortex), Pi Pa Ye (Loquat Leaf), Wu Wei Zi, Suan Zao Ren (Ziziphus Seed), etc., assisted by Sheng Di Jiang (Rehmannia Juice), Ou Jiang (Lotus Root Juice), Ru Zhi (Human Milk), Tong Bian (Child's Urine). Add Bei Mu (Fritillaria Bulb) if there is phlegm to protect the Lung and nourish the Water source, yielding immediate results. These herbs possess cooling, descending, and astringent properties, with thin Qi, belonging to Yin within Yang. Descending from the Yang aspect, they subdue rising Fire. Their cool nature is like a sudden autumn breeze in summer heat, extinguishing inflammation, similar to using Bai Hu Tang (White Tiger Decoction) for Summerheat syndromes. However, Summerheat is an External Contraction syndrome, belonging to Excess, hence heavy cold herbs are used; this is Internal Injury, belonging to Deficiency, so cooling, descending, and astringent agents suffice. This is the balance of medication. Thus, for Qi deficiency, Sheng Mai San is used, not Bai Zhu (Atractylodes Macrocephala Rhizome). For Blood deficiency, San Cai Wan (Three Talents Pill) is used, not Si Wu Tang. Treating Water deficiency while considering both Spleen and Kidney is difficult because cooling and moistening herbs for Lung and Kidney often stagnate the Spleen; thus, overuse of cold herbs destroys the Spleen, as seen in many consumption deaths from diarrhea. One must occasionally administer sweet-warm herbs or Qi-moving herbs to support the Spleen, but avoid being too acrid-dry to prevent consuming Kidney Water. If Fire deficiency exists, both Spleen and Kidney are cold; pure warming and tonification can be used without hesitation, hence those receiving warm tonification are easier to treat. Ren Shen (Ginseng Root) is indispensable for all conditions except Lung congestion with heat and surging-rapid pulse. Wang Jiezhai's claim that taking Ginseng leads to death is greatly misleading. (Note: Raw Ginseng is cool, cooked is warm, not a hot herb; heavy substance and thin Qi suggest it is a Yin-nourishing herb. Materia Medica calls it Qi-tonifying, implying Yang roots in Yin; please verify with experts.) For chronic weakness and anorexia, use He Zhong Wan (Harmonize Middle Pill). For men with emaciation, weak Qi, and cough progressing to consumption, use Zhu Du Wan (Pig Stomach Pill), which restores flesh. If taking cold herbs reduces symptoms but the pulse accelerates, it indicates Yang depression; raising and tonifying are indicated, cold herbs are strictly contraindicated, and violation leads to death. If Heavy Yin covers Yang, trapping Fire, causing chills, depression, wiry-rapid pulse, and heat in four extremities, use Huo Yu Tang (Depressed Fire Decoction) or Chai Hu Sheng Ma Tang (Bupleurum and Cimicifuga Decoction), stopping when the disease resolves. If the complexion is normal, body is robust, appearing healthy externally but deficient internally,俗称 "Peach Wood Borer," treat according to specific symptoms. Consumption diseases involve emptiness of all vessels, requiring sticky and cloying substances to fill them; dried essence and blood require moistening substances to hydrate them. Use Ren Shen, Di Huang (Rehmannia Root), Dong Tian/Dong Bei, Gou Qi (Goji Berry), Wu Wei Zi, etc., decocted into paste. Separately, boil Qing Hao (Artemisia Annua) in child's urine into paste, mix with Sheng Di juice, fresh lotus root juice, Bo He (Mint), human milk, refine over water, adjust quantity, and add Lu Rong Jiao (Deer Antler Glue) and Xia Tian Gao (Cloud Sky Paste) to form a final paste. Take several spoons dissolved in water. To move blood stasis, add Vinegar-processed Da Huang (Rhubarb Rhizome), Xuan Ming Fen (Mirabilite), Tao Ren (Peach Kernel) paste, Jiu Zhi (Leek Juice). To stop bleeding, add Jing Mo (Beijing Ink). To resolve phlegm, add Zhu Li (Bamboo Sap). To descend fire, add Tong Bian. Most consumption syndromes involve pain radiating from the epigastrium to the hypochondrium due to stagnant Qi and unmoving new blood; pastes with Leek Juice and Peach Kernel paste are especially suitable. Chai Hu (Bupleurum Root) raises clear Qi and disperses depression, used for bone-steaming to vent heat from the muscles; Yinzhou origin is best, but not for long-term use due to its dispersing nature. For Yin deficiency with stirring Fire and persistent erections, place Xiao Ming (Mirabilite) in the palm, clasp hands until it melts, causing flaccidity. If the syndrome is fundamentally Yin deficiency but includes shortness of breath, reluctance to speak, weakness, dull eyes, and pale complexion, it involves concurrent Yang deficiency. Use Ren Shen and Mai Dong (Ophiopogon Tuber) 3 qian each, Wu Zi 21 grains, Chen Pi (Tangerine Peel), Jie Geng (Platycodon Root), Zhi Gan Cao (Prepared Licorice Root) 5 qian each, powder, make pills with oil-soaked pancakes, size of chicken eggs. Take one pill, chew with saliva and swallow. Chronic deficiency becoming consumption with accumulated heat and bone-steaming, coughing blood, rough skin like fish scales, dark and lusterless face, sleeping on one side, hoarseness, sore throat, scrofula on neck, hypochondriac pain, spasms, generalized bone/joint pain, nocturnal emissions ("dream intercourse"), irritability, five-palm heat, frizzy hair, flushed cheeks like rouge, irregular bowels, and turbid urination are caused by exhaustion of Kidney Water and Liver Blood failing to control Fire. Fire scorching and drying blood makes even Yin-nourishing formulas ineffective because dead blood remains, blocking meridians and preventing Qi-Blood circulation, so heat persists. If the patient can eat and has constipation, purgatives can be used; urgently apply Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) to move dead blood. Even without dead blood, if accumulated heat persists, downward movement is needed to curb its momentum; temporarily use Da Huang and Qing Hao decoction to guide it down (ancient formulas like Chai Hu Yin Zi, Fang Feng Dang Gui Yin Zi, Mai Jian San all use Rhubarb to curb upward flaming Qi), then regulate according to symptoms. If unable to eat and suffering diarrhea, purgatives are contraindicated, leading to death. Long-standing consumption may produce evil worms (transformed from decaying blood and damp-heat) that bore into Zang-Fu organs, gaining spiritual power and changing unpredictably, transmitting to descendants after death, even wiping out families, called Chuan Shi Lao (Transmitting Corpse Consumption). Moxibustion on both Yao Yan (Waist Eyes) points, seven moxa cones each, after midnight on Gui Hai day, followed by Chuan Shi Jiang Jun Wan (Transmitting Corpse General Pill). Gao Huang and Si Hua points can be moxibusted. One dried Wild Cat Liver, powdered, taken with water, one cun bi daily three times, effective; repeat if unsure. Generally, preserving essence and blood is paramount,驱虫 (expelling worms) secondary. An Xi (Benzoin), Su He (Styrax), A Wei (Ferula Resin), She Xiang (Musk), Xi Jiao (Rhino Horn), Dan Sha (Cinnabar), Xiong Huang (Realgar) are expelling pathogens, but Tian Ling Gai (Human Skull Cap) must be added. The worm of Chuan Shi is ghostly Qi; latent until it attaches to dry bones, then the ghostly Qi flies away, no longer attaching to humans, and can be purged. Tiger teeth and carp skull bones are also effective as they are predator items feared by ghosts. First, swallow Be Dou Fu (Big Dipper Talisman) with Xiong Gui Xue Yu San (Ligusticum, Angelica, and Blood Remainder Powder); second, use Bie Jia Sheng Xi San (Softshell Turtle and Fresh Rhino Horn Powder) to extract worms; other methods detailed in *Zhun Sheng*. Most consumption cases are Yin deficiency, leading to death only after emaciation to the bone, showing Yin governs form; only when Yin is completely exhausted is form completely destroyed. If Yang deficiency, death occurs from Qi collapse despite robust form, as Yang governs Qi; Qi collapse does not wait for form collapse. Appearance of Zhen Zang Mai (True Organ Pulse) indicates imminent death even if flesh remains. Severe bone atrophy, sunken flesh, decline in movement and spirit indicate death within a year even without True Organ Pulse. With panting and fullness moving the body, death in six months. With pain radiating to shoulders and chest, death in one month. With ulceration and persistent fever, death in ten days. Combined with True Organ Pulse, sunken eye sockets, and blindness, death is immediate. If the patient can see people, Shen (Spirit) has not yet departed; death occurs on the day of the element that overcomes the patient's element. Critical signs of consumption unresponsive to tonification include diarrhea, extreme bone/joint pain, sleeping on one side, aphonia, and wiry-rapid pulse.