砂仁以行之可也，不然甘药又不可恃，更将何所恃哉。后人多用乐令建中汤，十四味建中汤，虽无过甘之弊，然乐令方
中，前胡、细辛为君，意在退热。而阴虚之热，则不可退。十四味方中，用附、桂、苁蓉，意在复阳。而阴虚之阳，未
必可复，又在用方者之善为裁酌矣。
论八味肾气丸方 本文云∶虚劳腰痛，少腹拘急，小便不利者，八味肾气丸主之。
《金匮》之用八味肾气丸，屡发于前矣。消渴之关门大开，水病之关门不开，用此方蒸动肾气，则关门有开有阖，
如晨门者与阳俱开，与阴俱阖，环城内外赖以安堵也。其治香港脚上入，少腹不仁，则借以培真阴真阳根本之地，而令浊
阴潜消，不得上乾清阳耳。今虚劳病桂附本在所不用，而腰痛少腹拘急，小便不利三证，皆由肾中真阳内微所致，其病
较阴虚发热诸证，迥乎不同。又不可不求其有，而反责其无矣。
论薯蓣丸方 本文云∶虚劳诸不足，风气百疾，薯蓣丸主之。 按∶虚劳不足之病，最易生风生气，倘风气不
除，外证日见有余，中藏日见虚耗，神头鬼脸，不可方物，有速毙而已。故用此方除去其风气，兼培补其空虚也。
论酸枣仁汤方 本文云∶虚劳虚烦，不得眠，酸枣仁汤主之。 按∶《素问》云∶阳气者，烦劳则张、精绝，
积于夏，使人煎厥。已详论卷首答问条矣。可见虚劳虚烦，为心肾不交之病，肾水不上交心火，心火无制，故烦而不
得眠，不独夏月为然矣。方用酸枣仁为君，而兼知母之滋肾为佐，茯苓、甘草调和其间，芎 入血分，而解心火
之躁烦也。
论大黄 虫丸方 本文云∶五劳虚极，羸瘦，腹满不能饮食，食伤、忧伤、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∶七伤《金匮》明谓食伤、忧伤、饮食伤、房
室伤、饥伤、劳伤、经络荣卫气伤及房劳伤，但居其一，后人不知何见？谓七伤者阴寒、阴痿、里急精速、精少阴下湿、
精滑小便苦数、临事不举，似乎颛主肾伤为言，岂有五劳分主五脏，而七伤独主一藏之理。虽人生恣逞伤肾者恒多，要
不可为一定之名也。所以虚劳证凡本之内伤者，有此七者之分。故虚劳发热，未有不由瘀血者，而瘀血若无内伤，则荣
卫营运，不失其次，瘀从何起？是必饮食起居，过时失节，荣卫凝泣，先成内伤，然后随其气所阻塞之处，血为瘀积，
瘀积之久，牢不可拔，新生之血，不得周灌，与日俱积，其人尚有生理乎？仲景施活人手眼，以润剂润其血之干，以蠕
动啖血之物行死血，名之曰缓中补虚，岂非以行血去瘀，为安中补虚上着耶？然此特世俗所称干血劳之良治也。血结在
内，手足脉相失者宜之，兼入琼玉膏润补之药同用尤妙。昌细参其证，肌肤甲错，面目黯黑，及羸瘦不能饮食，全是荣
血瘀积胃中，而发见于肌肤面目，所以五脏失中土之灌溉而虚极也。此与五神藏之本病不同，故可用其方，而导去其胃
中之血，以内谷而通流荣卫耳。许州陈大夫传仲景百劳丸方云∶治一切痨瘵积滞，不经药坏证者，宜服。与世俗所称干
血劳亦何以异，大夫其长于谋国者欤。方用当归、乳香、没药各一钱，虻虫十四个，人参二钱、大黄四钱、水蛭十四个、
桃仁十四个，浸去皮尖，上为细末，炼蜜为丸，桐子大。都作一服，可百丸，五更用百劳水下，取恶物为度，服白粥十
日，百劳水即仲景甘澜水，以杓扬百遍者也。
论《金匮》附《千金翼》炙甘草汤方 一名复脉汤，治虚劳不足，汗出而闷，脉结悸，行动如常，不出百日，
危急者十一日死。 按∶此仲景治伤寒脉代结，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，所以其证汗出而闷，表之固非，即治其阴虚
亦非，惟用此方得汗而脉出热解，俾其人快然，真圣法也。但虚劳之人，胃中津液素虚，非伤寒暴病，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，乃致劳卫盛而诸虚尽复，岂小补哉！
论《金匮》附《肘后》獭肝散方 本文云∶治冷劳∶又主鬼疰，一门相染。 按∶许叔微《本事方》云∶葛稚
川言鬼疰者，是五尸之一疰。诸鬼邪为害，其变动不一，大约使人寒热淋漓，沉沉默默，不的知其所苦，而无处不恶，
累年积月，渐就顿滞，以至于死，传于傍人，乃至灭门。觉知是证者，急治獭肝一具，阴干取末，水服方寸匙，日三服
效。未知再服，此方神良。再按长桑君所授越人禁方，各传其徒一人者，至华元化毙狱，其传遂泯，仲景医中之圣，诸
禁方讵不尽窥底蕴，然而有其理无其事者，不足尚也。有其事无其理者，不足尚也。即有其理，有其事矣，而用意罕几
先之哲，尤不足尚也。如獭肝散非不可以杀虫，而未可以行血逐瘀，所以制缓中补虚大黄 虫丸一方，自出手眼。而授
陈大夫百劳丸一方，加入人参，只作一服，以取顿快。盖于此时而用力，可图十全其五也。迨至束手无策，而取用獭肝
以去其虫，虫去其人可独存乎？然虫亦不可不去也，《金匮》之附《肘后》一方，岂无意哉！
附论李东垣补中益气汤益胃升阳汤二方 东垣所论饮食劳倦，内伤元气，则胃脘之阳不能升举，并心肺之气，
陷入于中焦，而用补中益气治之。方中佐以柴胡、升麻二味，一从左旋，一从右旋，旋转于胃之左右，升举其上焦所陷
之气，非自腹中而升举之也。其清气下入腹中，久为飧泄，并可多用升、柴，从腹中而升举之矣。若阳气未必陷下，反
升举其阴气，干犯阳位，为变岂小哉！更有阴气素惯上乾清阳，而胸中之肉隆耸为 ，胸间之气漫散为胀者，而误施此
法，天翻地覆，九道皆塞，有濒于死而坐困耳。后人相传，谓此方能升清降浊，有识者亦咸信之，医事尚可言哉！夫补
其中气，以听中气之自为升降，不用升柴可也，用之亦可也，若以升清之药，责其降浊之能，岂不痴乎？
附论朱丹溪大补阴丸四物加黄柏知母汤二方 虚劳之证，阴虚者，十常八九；阳虚者，十之一二而已。丹溪着
阳有余阴不足之论，而定二方。与东垣补中益气之法，旗鼓相当。气下陷而不能升，则用东垣。火上升而不能降，则用
丹溪。二老入理深谭，各造其极，无容议也。前论补中益气，能升清阳，设误用之，反升浊阴，以致其叮咛矣。而丹溪
之法，用之多不效者，可不深维其故哉。昌谓立法者无过，而用法者不得法中之奥，过端四出，盖于阳常有余，阴常不
足二语，未常细心推辨耳。夫阳之有余，得十之七；阴之不足，得十之三，此所谓真有余真不足也。阳真有余，一切补
阴之药，直受之而无恐，多用之亦无害，是则补阴在所必需矣。若阴之不足者，十存其三，而阳之有余者，十存四五，
亦名有余而实则非真有余也，究亦同归不足而已。补阴寒凉之药，尚敢恣用乎？不知此义而恣用之，岂但不效，其后转
成阴盛阳虚，清谷盗汗等患，究竟阴基已坏于前，即欲更补其气，其如味之不能载何，故再致叮咛，俾用昔人法，如持
权在手，较量于轻重之间可矣。
附论严和用 附汤参附汤二方 虚劳之属，阳虚者十中岂无一二，严氏二方，似不可少。其方从《金匮》术附
汤生出，投之得当，通于神明。其虚劳失血，宜之者尤多，以其善治龙雷之阴火耳。但以参 为君，附子为佐，虽每服
一两，不嫌其多，方中止用 附各半、人参五钱、附子一两、分三服，能无倒乎？
【律十条】
凡虚劳病，畏寒发热者，卫虚则畏寒，荣虚则发热耳。当缓调其荣卫，俾不相亢战，则寒热自止。若以外感少阳经
主寒热，用小柴胡汤治之，乃至汗多而卫伤于外，便溏而荣伤于内，寒热转加，医之罪也。
凡虚劳病，多有发热者，须辨其因之内外，脉之阴阳，时之早晚，而定其治。若通套退热之药，与病即不相当，是
谓诛伐无过，邪反不服，乃至热久血干津竭，十死不救，医之罪也。
凡虚劳病，多有夺血而无汗者，若认为阳实而责其汗，必动其血，是名下厥上竭，医之罪也。
凡虚劳病，最防脾气下溜，若过用寒凉，致其人清谷者，医之罪也。
凡治骨蒸发热，热深在里，一切轻扬之药，禁不可用。用之反引热势外出而增其炽，灼干津液，肌肉枯槁四出，求
其止在内里，时蒸时退，且不可得，安望除热止病乎？医之罪也。
凡治痨瘵发热，乘其初成，胃气尚可胜药，急以峻剂加入人参，导血开囊，退热行瘀，全生保命，所关甚大。迟则
其人胃虚气馁，羸瘠不堪，即医良法妙，亦何为哉。此非医罪，绳趋尺步，昧于行权，隐忍不言，欲图侥幸，反为罪也。
凡治小儿五疳，即大人五劳也。幼科知用五疳之成方，而不知五劳曲折次第。初起者，治之可以得效。胃虚者，服
之有死而已。盖胆草、芦荟、宣胡黄连，极苦大寒，儿不能胜耳。大方亦然，谓五脏有虚劳实劳，恣用苦寒，罪莫逃也。
妇女痨瘵，十中二三，冲为血海，瘀积不行，乃至血干经断，骨蒸潮热，夜梦鬼交，宜急导其血，加人参以行之，
成功旦夕可也。若以丸药缓治，王道缓图，坐以待毙，医之罪也。
常富后贫，名曰脱荣。常贵后贱，名曰失精。脱荣失精，非病关格，即病虚劳，宜以渐治其气之结，血之凝，乃至
流动充满，成功计日可也。医不知此，用补用清，总不合法，身轻骨瘦，精神其能久居乎？此非医罪，迁延贻误，薄乎
云尔。
妇人遭其夫离绝，菀结不解，亦多成关格虚劳二证。此与二阳之病发心脾大同，月事时下，知未甚也。亦如前法，
成功百日。气血流行，可无患也。不月者，亦须成功千日，从事空王，消除积恨可也。此亦非医罪，但以其势缓而姑任
之，不早令其更求良治，迁延图利，心孽难除耳。
砂仁用来行气是可以的，否则甘味药物又不可依赖，还能依靠什么呢？后人多用乐令建中汤、十四味建中汤，虽然没有了过用甘味的弊端，但在乐令方中，以前胡、细辛为君药，意在退热。然而阴虚产生的热，是不能通过这种方法退去的。在十四味方中，使用附子、肉桂、肉苁蓉，意在恢复阳气。但阴虚导致的阳虚，未必能恢复，这又在于用药者善于权衡斟酌了。
论述八味肾气丸方：原文说：“虚劳腰痛，少腹拘急，小便不利者，八味肾气丸主之。”
《金匮要略》中应用八味肾气丸的情况，在前面已经多次提及。消渴病（糖尿病类疾病）的关门大开，水气病（水肿类疾病）的关门不开，使用此方蒸动肾气，那么关门就有开有合，就像早晨的门一样，与阳气俱开，与阴气俱合，环城内外都依赖它而安宁。治疗脚气上冲，少腹麻木不仁，则是借此来培补真阴真阳的根本之地，从而使浊阴潜藏消散，不得上犯清阳。如今治疗虚劳病，桂枝、附子本在所不用之列，但腰痛、少腹拘急、小便不利这三个症状，都是由肾中真阳内部微弱所致，这种病情与阴虚发热等证候截然不同。又不可以不求其有，反而责怪其无。
论述薯蓣丸方：原文说：“虚劳诸不足，风气百疾，薯蓣丸主之。”
按语：虚劳不足的病证，最容易生风生气，如果风气不除，外证日渐显得有余，内脏日渐虚耗，形容憔悴，不可名状，只有加速死亡罢了。所以使用此方除去风气，兼以培补空虚。
论述酸枣仁汤方：原文说：“虚劳虚烦，不得眠，酸枣仁汤主之。”
按语：《素问》说：“阳气者，烦劳则张，精绝，积于夏，使人煎厥。”已在卷首答问条中详细论述过。可见虚劳虚烦，是心肾不交的病证，肾水不能上交于心火，心火失去制约，所以烦躁而不能入睡，并不只在夏季发生。方中以酸枣仁为君药，兼用知母滋肾作为佐药，茯苓、甘草调和其间，川芎入血分，以解除心火的躁烦。
论述大黄䗪虫丸方：原文说：“五劳虚极，羸瘦，腹满不能饮食，食伤、忧伤、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，大黄䗪虫丸主之。”
按语：七伤，《金匮要略》明确说是食伤、忧伤、饮食伤、房室伤、饥伤、劳伤、经络荣卫气伤及房劳伤，只要具备其中一种即可，后人不知是何见解？认为七伤是指阴寒、阳痿、里急精速、精少阴下湿、精滑小便频数苦痛、临事不举，似乎专门指肾脏受伤而言，难道有五劳分别主管五脏，而七伤唯独主管一脏的道理吗？虽然人生放纵伤肾者恒多，但不可定为一定之名。所以虚劳证凡是源于内伤的，有此七者的分类。因此虚劳发热，没有不是由瘀血引起的，而瘀血如果没有内伤，那么营卫运行就不会失序，瘀血从何而起？一定是饮食起居，过时失节，导致营卫凝滞，先形成内伤，然后随着气机阻塞之处，血液瘀积，瘀积久了，牢固不可拔除，新生的血液无法周身灌溉，日日积累，这人还有生机吗？仲景施展活人的手段，用润剂滋润干燥的血液，用蠕动啖血的虫类药推动死血，命名为“缓中补虚”，难道不是以行血去瘀，作为安中补虚的上策吗？但这只是世俗所称的干血劳的良好治法。血结在内，手足脉象不相顺应的适宜使用，兼用琼玉膏润补的药物同用尤其妙。我仔细参究其证候，肌肤甲错，面目黯黑，以及羸瘦不能饮食，全是营血瘀积在胃中，而发见于肌肤面目，所以五脏失去了中土脾胃的灌溉而极度虚弱。这与五神藏的本病不同，所以可以用此方，导去胃中的瘀血，以通利谷气而流通营卫。许州陈大夫传承仲景百劳丸方说：“治疗一切痨瘵积滞，未经药物误治的证候，适宜服用。”这与世俗所称的干血劳有什么不同呢？这位大夫大概是擅长谋国的人吧。方用当归、乳香、没药各一钱，虻虫十四个，人参二钱、大黄四钱、水蛭十四个、桃仁十四个，浸泡后去皮尖，研成细末，炼蜜为丸，如梧桐子大。一次全部服完，约一百丸，五更天用百劳水下服，以排出恶物为度，服药后吃白粥十日，百劳水就是仲景所说的甘澜水，用勺子扬一百遍制成的。
论述《金匮要略》附《千金翼方》炙甘草汤方：一名复脉汤，治疗虚劳不足，汗出而闷，脉结代悸动，行动如常，不出百日，危急者十一日死。
按语：这是仲景治疗伤寒脉代结、心动悸，邪少虚多的圣方。《金匮要略》未收录，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。虚劳体质，多有表热夹杂阴虚，所以其证见汗出而闷，解表固然不对，即使治疗阴虚也不对，唯有使用此方得汗而脉出热解，使病人舒适，真是圣法啊。但是虚劳之人，胃中津液素来虚弱，不像伤寒暴病那样邪少虚多，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，多有淋漓沾濡一昼夜的。度过这一关，亟需在本方中去掉桂枝、生姜两味，三倍加入人参，紧随其后，这样津液才能再生，致使营卫旺盛而诸虚尽复，岂是小补！
论述《金匮要略》附《肘后备急方》獭肝散方：原文说：“治疗冷劳；又主治鬼疰，一门相染。”
按语：许叔微《本事方》说：葛稚川说鬼疰，是五尸之一的疰病。各种鬼邪为害，其变动不一，大约使人寒热淋漓，沉沉默默，不知道哪里痛苦，而无处不厌恶，累年积月，逐渐导致顿滞，以至于死，传染给旁人，乃至灭门。觉察到这个证候的，急治獭肝一枚，阴干取末，水服方寸匙，每日三次有效。未知再服，此方神良。再按长桑君所传授给越人（扁鹊）的禁方，各传其徒弟一人，到华元化死于狱中，其传承就断绝了，仲景是医中之圣，各种禁方难道没有尽窥底蕴吗？然而有其理无其事者，不值得推崇。有其事无其理者，不值得推崇。即有其理，有其事了，而用意很少赶上先哲的，更不值得推崇。如獭肝散并非不可以杀虫，但不能用于行血逐瘀，所以制定缓中补虚的大黄䗪虫丸一方，自出手眼。而传授给陈大夫百劳丸一方，加入人参，只作一服，以求顿快。盖在这个时候用力，可以图谋十全其五。等到束手无策时，才取用獭肝以去除其虫，虫去了人还能独存吗？然而虫也不可不去，《金匮要略》附录《肘后备急方》的一方，难道没有深意吗！
附录论李东垣补中益气汤、益胃升阳汤二方：东垣所论述的饮食劳倦，内伤元气，则胃脘之阳不能升举，并心肺之气，陷入于中焦，而用补中益气汤治疗。方中佐以柴胡、升麻两味药，一从左旋，一从右旋，旋转于胃的左右，升举其上焦所陷之气，不是从腹中升举的。其清气下入腹中，久为飧泄，才可以多用升麻、柴胡，从腹中升举。如果阳气未必陷下，反而升举其阴气，干犯阳位，变化难道小吗！更有阴气素惯上犯清阳，而胸中之肉隆耸为瘿，胸间之气漫散为胀的，如果误施此法，天翻地覆，九道皆塞，有濒临死亡而坐困的。后人相传，说此方能升清降浊，有见识的人也深信不疑，医事还可言吗！夫补其中气，以听任中气自己升降，不用升麻、柴胡也可以，用了也可以，如果用升清的药，责求其降浊的功能，岂不是痴愚吗？
附录论朱丹溪大补阴丸、四物加黄柏知母汤二方：虚劳的证候，阴虚者，十常八九；阳虚者，十之一二而已。丹溪著阳有余阴不足之论，而定立二方。与李东垣补中益气之法，旗鼓相当。气下陷而不能升，则用李东垣的方法。火上升而不能降，则用朱丹溪的方法。两位老前辈入理深谭，各造其极，无需议论。前论补中益气，能升清阳，假设误用之，反升浊阴，以致其叮咛了。而丹溪的方法，用之多不效，可不深思其故吗？我认为立法者无过错，而用法者不得法中之奥妙，过错端点四处出现，大概是因为对“阳常有余，阴常不足”这两句话，未曾细心推辨耳。夫阳之有余，得十之七；阴之不足，得十之三，这才是所谓的真有余真不足。阳真有余，一切补阴的药，直接受之而无恐，多用之亦无害，是则补阴在所必需矣。若阴之不足者，十存其三，而阳之有余者，十存四五，也名为有余而实则非真有余也，究亦同归不足而已。补阴寒凉之药，尚敢恣用乎？不知此义而恣用之，岂但不效，其后转成阴盛阳虚，清谷盗汗等患，究竟阴基已坏于前，即欲更补其气，其如味之不能载何，故再致叮咛，俾用昔人法，如持权在手，较量于轻重之间可矣。
附录论严和用附汤、参附汤二方：虚劳的属类，阳虚者十中岂无一二，严氏二方，似不可少。其方从《金匮要略》术附汤生出，投之得当，通于神明。其虚劳失血，宜之者尤多，以其善治龙雷之阴火耳。但以人参为君，附子为佐，虽每服一两，不嫌其多，方中止用附子半两、人参五钱、附子一两、分三服，能无误吗？
【律十条】
凡是虚劳病，畏寒发热的，卫虚则畏寒，营虚则发热耳。应当缓调其营卫，使不相亢战，则寒热自止。若以外感少阳经主寒热，用小柴胡汤治疗，乃至汗多而卫伤于外，便溏而营伤于内，寒热转加，是医生的罪过。
凡是虚劳病，多有发热的，须辨别其原因之内外，脉之阴阳，时间之早晚，而定其治法。若通套退热之药，与病即不相当，是谓诛伐无过，邪反不服，乃至热久血干津竭，十死不救，是医生的罪过。
凡是虚劳病，多有夺血而无汗的，若认为是阳实而责其汗，必动其血，这是名下厥上竭，是医生的罪过。
凡是虚劳病，最防脾气下溜，若过用寒凉，致其人清谷（完谷不化）的，是医生的罪过。
凡是治疗骨蒸发热，热深在里，一切轻扬之药，禁止不可用。用之反引热势外出而增其炽，灼干津液，肌肉枯槁四出，求其止在内里，时蒸时退，且不可得，安望除热止病乎？是医生的罪过。
凡是治疗痨瘵发热，乘其初成，胃气尚可胜药，急以峻剂加入人参，导血开囊，退热行瘀，全生保命，所关甚大。迟则其人胃虚气馁，羸瘠不堪，即医良法妙，亦何为哉。这不是医生的罪过，绳趋尺步，昧于行权，隐忍不言，欲图侥幸，反而是罪过。
凡是治疗小儿五疳，即大人五劳也。幼科知道用五疳的成方，而不知道五劳曲折次第。初起者，治之可以得效。胃虚者，服之有死而已。盖胆草、芦荟、宣胡黄连，极苦大寒，儿不能胜耳。大方亦然，谓五脏有虚劳实劳，恣用苦寒，罪莫逃也。
妇女痨瘵，十中二三，冲为血海，瘀积不行，乃至血干经断，骨蒸潮热，夜梦鬼交，宜急导其血，加人参以行之，成功旦夕可也。若以丸药缓治，王道缓图，坐以待毙，是医生的罪过。
常富后贫，名曰脱荣。常贵后贱，名曰失精。脱荣失精，非病关格，即病虚劳，宜以渐治其气之结，血之凝，乃至流动充满，成功计日可也。医生不知道这个，用补用清，总不合法，身轻骨瘦，精神其能久居乎？这不是医生的罪过，迁延贻误，薄乎云尔。
妇人遭其夫离绝，菀结不解，亦多成关格虚劳二证。此与二阳之病发心脾大同，月事时下，知未甚也。亦如前法，成功百日。气血流行，可无患也。不月者，亦须成功千日，从事空王，消除积恨可也。此亦非医生罪过，但以其势缓而姑任之，不早令其更求良治，迁延图利，心孽难除耳。
Cardamom (Amomi Fructus) can be used to promote Qi movement; otherwise, if sweet-natured medicines cannot be relied upon, what else can one rely on? Later generations often use Le Ling's Jianzhong Decoction and Shisiwei Jianzhong Decoction. Although these avoid the drawback of excessive sweetness, in Le Ling's formula, Peucedani Radix (Qianhu) and Asari Radix et Rhizoma (Xixin) are used as sovereign drugs with the intent to reduce fever. However, heat caused by Yin deficiency cannot be reduced this way. In the Shisiwei formula, Aconiti Lateralis Radix Praeparata (Fuzi), Cinnamomi Ramulus (Guizhi), and Cistanches Herba (Roucongrou) are used with the intent to restore Yang. Yet, Yang deficiency resulting from Yin deficiency may not necessarily be restored; this depends on the prescriber's ability to weigh and adjust appropriately.
Discussion on the Formula of Eight-Ingredient Kidney Qi Pill: The text states: "For consumptive disease with lower back pain, urgency and tightness in the hypochondrium, and difficulty in urination, the Eight-Ingredient Kidney Qi Pill governs."
The application of the Eight-Ingredient Kidney Qi Pill in *Jinkui Yaolue* has been mentioned frequently before. In cases of Xiao Ke (Wasting-Thirst/Diabetes-related conditions) where the "gate" is wide open, or in Water Disease (Edema-related conditions) where the "gate" is closed, using this formula steams and activates Kidney Qi, so that the gate opens and closes like a morning door, opening with Yang and closing with Yin, relying on it for peace within and without the city walls. For treating Jiao Qi ascending into the chest with numbness in the lower abdomen, it borrows this method to cultivate the root of True Yin and True Yang, allowing turbid Yin to subside and dissipate secretly, preventing it from harassing Clear Yang. Nowadays, in treating consumptive disease, Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) are generally excluded, but the three symptoms of lower back pain, hypogastric tension, and dysuria are all caused by the internal weakness of True Yang in the Kidneys. This pathology is distinctly different from various syndromes of Yin-deficiency heat. One should not seek existence where there is none, nor blame absence where there is presence.
Discussion on the Formula of Shuyu Pill: The text states: "For various deficiencies in consumptive disease and myriad diseases caused by wind pathogens, the Shuyu Pill governs."
Commentary: Consumptive deficiency syndromes easily generate Wind and Qi disturbances. If Wind pathogens are not eliminated, external signs will increasingly appear excess, while internal organs will increasingly suffer depletion, leading to emaciation and indescribable suffering, accelerating death. Thus, this formula is used to eliminate Wind pathogens and simultaneously tonify emptiness.
Discussion on the Formula of Suanzaoren Tang: The text states: "For consumptive deficiency vexation and insomnia, the Suanzaoren Tang governs."
Commentary: *Suwen* states: "When Yang Qi is subjected to excessive fatigue, it expands; when Essence is exhausted and accumulates in summer, it causes Jian Jue (Fainting due to Overexertion)." This was discussed in detail in the Q&A section at the beginning of the volume. It is evident that consumptive deficiency vexation is a syndrome of Heart-Kidney non-interaction. When Kidney Water fails to ascend to control Heart Fire, Heart Fire becomes unregulated, causing vexation and insomnia, not limited to summer months. The formula uses Sour Jujube Seed (Suanzaoren) as the sovereign drug, assisted by Anemarrhenae Rhizoma (Zhimu) to nourish the Kidney, Poria (Fuling) and Licorice (Gancao) to harmonize, and Ligusticum Chuanxiong Rhizome (Chuanxiong) entering the Blood level to relieve Heart Fire-induced restlessness.
Discussion on the Formula of Dahuang Zhechong Wan: The text states: "In cases of extreme exhaustion from Five Labors, emaciation, abdominal fullness with inability to eat, injuries from diet, emotion, sexual activity, hunger, labor, and damage to meridians, Ying, and Wei Qi, with dry blood inside, rough skin resembling fish scales, dark eyes, and the need to gently centralize and tonify deficiency, the Dahuang Zhechong Wan governs."
Commentary: The "Seven Injuries" in *Jinkui Yaolue* explicitly list injuries from diet, emotion, food, sexual activity, hunger, labor, meridians/Ying/Wei Qi, and sexual overexertion; having any one of these suffices. Why do later generations interpret the Seven Injuries as cold yin, impotence, urgency with rapid ejaculation, scanty essence with dampness below, seminal emission with frequent painful urination, and failure during intercourse, seemingly focusing solely on Kidney injury? Is there logic in Five Labors governing five Zang organs while Seven Injuries govern only one? Although people often injure their Kidneys through indulgence, it cannot be defined rigidly. Therefore, consumptive syndromes originating from internal injuries have these seven classifications. Consequently, consumptive fever almost always arises from blood stasis. Without internal injury, Ying and Wei circulation would remain orderly, and how would stasis arise? It must be that irregular diet and lifestyle cause Ying and Wei stagnation, forming internal injury first. Then, following blocked Qi pathways, blood accumulates as stasis. Long-standing stasis becomes fixed and unremovable; new blood cannot circulate fully, accumulating daily. Can such a person survive? Zhang Zhongjing employed skilled methods: using moistening agents to hydrate dry blood and vermifuge-like substances to move dead blood, naming it "Gently Centralizing and Tonifying Deficiency." Is this not prioritizing moving blood and removing stasis as the supreme strategy for stabilizing the center and tonifying deficiency? This is merely the excellent treatment for the secularly known "Dry Blood Consumption." It is suitable when blood knots internally and pulse relationships between hands and feet are lost; combining it with Qiongyu Gao for moistening tonification is especially effective. Upon careful examination, rough skin, dark complexion, emaciation, and anorexia indicate Ying-Blood stasis accumulated in the Stomach, manifesting on skin and face, causing the Five Zang organs to lose irrigation from the Earth element (Spleen/Stomach) and become extremely deficient. This differs from primary diseases of the Five Spirit Stores, hence this formula can be used to guide out Stomach blood, thereby promoting grain digestion and circulating Ying and Wei. Physician Chen from Xuzhou transmitted Zhang Zhongjing's Bailao Wan formula, stating: "It treats all phthisis and accumulation stagnation in patients not worsened by prior medication." How does this differ from secular Dry Blood Consumption? Perhaps this physician excels in statecraft. The formula uses Angelica Sinensis Radix (Danggui), Frankincense (Ruxiang), and Myrrh (Moyao) each 1 qian, Blister Beetle (Mengchong) 14 pieces, Ginseng (Renshen) 2 qian, Rhubarb (Dahuang) 4 qian, Leech (Shuizhi) 14 pieces, and Peach Kernel (Taoren) 14 pieces. After soaking and removing skins/pits, grind to fine powder, mix with refined honey into pills the size of paulownia seeds. Take all at once, approximately 100 pills, administered at dawn with Bailao Water, aiming to expel foul matter. Follow with white rice porridge for ten days. Bailao Water is the same as Zhongjing's Ganlan Water, made by stirring water vigorously with a ladle 100 times.
Discussion on *Jinkui Yaolue* appended *Qianjin Yifang* Zhi Gancao Tang Formula: Also known as Fumai Tang, it treats consumptive deficiency with sweating, chest oppression, knotted and intermittent pulse with palpitations. Patients acting normally may die within 100 days; critical cases may die within 11 days.
Commentary: This is Zhang Zhongjing's sacred formula for treating Taiyang disease with intermittent/knotted pulse and palpitations, where pathogenic factors are few and deficiency is predominant. Although not recorded in *Jinkui Yaolue*, its frequent use in *Qianjin Yifang* for consumptive disease provides credible evidence, justifying its name as a "Thousand-Gold Formula." Consumptive constitutions often have exterior heat mixed with Yin deficiency, causing sweating and chest oppression. Exterior-releasing is incorrect; treating only Yin deficiency is also incorrect. Only this formula achieves sweating, pulse restoration, and heat resolution, bringing comfort—a truly sacred method. However, consumptive patients have chronically deficient Stomach fluids, unlike acute Taiyang diseases with few pathogens and predominant deficiency. High doses of Cinnamon Twig (Guizhi) and Ginger (Shengjiang) cause fluids to escape outward with heat. Once escaped, fluids are hard to recover, often leading to profuse sweating for a day and night. After passing this hurdle, one must urgently modify the base formula by removing Guizhi and Shengjiang, tripling the dose of Ginseng (Renshen), and administering it subsequently. This allows fluid regeneration, strengthening Ying and Wei to restore all deficiencies—a significant benefit!
Discussion on *Jinkui Yaolue* appended *Zhouhou Beiji Fang* Tagan San Formula: The text states: "Treats Cold Consumption; also governs Gui Zhu (Ghost Transmission), infecting entire households."
Commentary: Xu Shuwai's *Benshi Fang* cites Ge Chichuan: "Gui Zhu is one of the Five Corpse Pathogens. Various evil spirits cause varied changes, typically inducing alternating chills and fever, lethargy, unknown specific pains, universal aversion, progressing over years to stagnation and death, spreading to others, even wiping out families. Upon recognizing this syndrome, urgently treat with one dried Otter Liver, dried in shade, powdered, taken orally with water (one cun spoonful), three times daily until effective. Unknown if further doses are needed; this formula is miraculous." Furthermore, regarding the secret formulas taught by Chang Sang Jun to Yue Ren (Bian Que), passed to one disciple each, which vanished after Hua Yuanhua's imprisonment. Zhang Zhongjing, the Sage of Medicine, surely understood the principles behind these secrets. However, theories without practice, practices without theory, or intentions failing to match ancient sages are not worthy of emphasis. While Tagan San can kill parasites, it cannot move blood or resolve stasis. Hence, the formulation of Dahuang Zhechong Wan for gently centralizing and tonifying deficiency demonstrates unique insight. Transmitting the Bailao Wan to Dr. Chen, adding Ginseng for a single dose to achieve rapid relief, utilizes force effectively, potentially achieving five successes out of ten. When helpless, resorting to Otter Liver to remove parasites—can the patient survive alone after parasite removal? Parasites must be removed. Does *Jinkui Yaolue*'s inclusion of the *Zhouhou* formula lack profound meaning?
Appendix on Li Dongyuan's Buzhong Yiqi Tang and Yiwei Shengyang Tang: Dongyuan discussed that dietary and labor fatigue damages Primordial Qi, preventing Stomach Yang from ascending, causing Heart and Lung Qi to sink into the Middle Jiao, treated with Buzhong Yiqi Tang. The formula assists with Bupleurum Radix (Chaihu) and Cimicifugae Rhizoma (Shengma), rotating left and right around the Stomach to lift sunken Upper Jiao Qi, not lifting from the abdomen. If clear Qi sinks into the abdomen causing chronic diarrhea, Shengma and Chaihu can be used more heavily to lift from the abdomen. If Yang Qi is not sunken, forcibly lifting Yin Qi to harass Yang positions causes severe complications. Moreover, if Yin Qi habitually harasses Clear Yang, causing thyroid swelling (Ying) and chest distension from scattered Qi, misapplying this method leads to chaos, blockage of nine passages, and near-death distress. Later generations claim this formula raises Clear and lowers Turbid, widely believed by experts—is medicine still discussable? Tonifying Middle Qi allows natural ascent and descent; using Shengma and Chaihu is optional. Using clearing-lifting herbs to demand lowering functions is foolish.
Appendix on Zhu Danxi's Dabu Yin Wan and Siwu Tang plus Huangbai and Zhimu: In consumptive diseases, Yin deficiency accounts for eight or nine out of ten; Yang deficiency only one or two. Danxi proposed "Yang is often in excess, Yin is often deficient," establishing these two formulas, rivaling Dongyuan's Buzhong Yiqi method. For sinking Qi unable to ascend, use Dongyuan. For rising Fire unable to descend, use Danxi. Both masters explored deep principles, reaching perfection; no debate needed. Previously noted that Buzhong Yiqi raises Clear Yang; misuse raises Turbid Yin, hence the caution. Why does Danxi's method often fail? Deep reflection is required. I believe the legislator erred not, but practitioners missed the essence, leading to errors due to insufficient analysis of "Yang often excess, Yin often deficient." True excess is 70%; true deficiency is 30. True Yang excess tolerates Yin-tonifying herbs well; excessive use is harmless, making Yin tonification necessary. But if Yin deficiency leaves only 30%, and apparent Yang excess is actually 40-50% (not true excess), both ultimately return to deficiency. Dare one recklessly use cold Yin-tonifying herbs? Ignorance leads to inefficacy, then Yin excess and Yang deficiency, diarrhea, night sweats. With Yin foundation ruined, attempting Qi tonification fails because flavors cannot carry. Hence repeated warnings: use ancient methods like holding weights, balancing carefully.
Appendix on Yan Heyong's Fufu Tang and Shenfu Tang: Among consumptives, Yang deficiency occurs occasionally. Yan's two formulas seem indispensable, derived from *Jinkui Yaolue* Baifu Tang. Properly applied, they work miraculously. Especially suitable for consumptive hemorrhage due to their efficacy in treating Dragon-Lei Yin Fire. However, using Ginseng as sovereign and Aconite as assistant, even taking 1 liang per dose seems high. The formula uses half Aconite, 5 qian Ginseng, 1 liang Aconite, divided into three doses. Could this not cause error?
[Ten Laws]
1. For consumptive disease with chills and fever: Wei deficiency causes chills; Ying deficiency causes fever. Slowly regulate Ying and Wei to prevent conflict, and chills/fever will cease. Treating as Shaoyang exterior syndrome with Xiaochaihu Tang causes excessive sweating injuring Wei externally and loose stools injuring Ying internally, worsening chills/fever. This is the physician's fault.
2. For consumptive disease with fever: Differentiate internal/external causes, pulse Yin/Yang, and timing. Generic antipyretics mismatch the disease, attacking the innocent, failing to subdue pathogens, leading to prolonged heat, dry blood, and exhausted fluids—ten deaths, no cure. This is the physician's fault.
3. For consumptive disease with blood loss and no sweat: Mistaking this for Yang excess and forcing sweat moves blood, causing Lower Jue and Upper Exhaustion. This is the physician's fault.
4. For consumptive disease: Guard against Spleen Qi sinking. Overuse of cold/bitter herbs causing undigested food in stool is the physician's fault.
5. For treating bone-steaming fever (deep interior heat): Light, ascending herbs are forbidden. They draw heat outward, increasing intensity, burning fluids, causing muscle wasting. Seeking to stop heat internally is impossible; curing the disease is hopeless. This is the physician's fault.
6. For treating phthisis fever: Act early while Stomach Qi can withstand strong medicine. Urgently use potent formulas with Ginseng to guide blood, open capsules, reduce heat, move stasis, save life. Delay leads to weak Stomach and Qi, emaciation; even good methods fail. Not the physician's fault if rigidly following rules without flexibility, hiding silence, seeking luck, which becomes fault.
7. Pediatric Withering Syndrome (Wu Gang) corresponds to Adult Five Labors. Pediatricians know formulas for Wu Gang but ignore the complexity of Five Labors. Early stage responds to treatment; Spleen-Stomach deficiency leads to death. Gentiana, Aloe, and Scutellaria are extremely bitter/cold, unsuitable for children. Same applies to adult prescriptions. Claiming Five Zang have deficiency/excess labors and recklessly using bitter-cold herbs incurs unavoidable guilt.
8. Female phthisis (2-3 in 10): Chong Mai is the Sea of Blood. Stagnation leads to dry blood, amenorrhea, bone-steaming tidal fever, nocturnal emissions. Urgently guide blood, add Ginseng to promote movement; success comes quickly. Slow pill therapy waits for death. This is the physician's fault.
9. Wealth-to-poverty is called Tuorong; Status-to-lowliness is called Shijing. These are either Guan Ge (Obstruction) or consumptive disease. Gradually resolve Qi knotting and Blood coagulation until flow restores; success is imminent. Physicians ignoring this, using tonics/clearing incorrectly, result in thin bones and fading spirit. Not physician's fault, but delay and negligence are minor sins.
10. Women divorced/separated with unresolved depression often develop Guan Ge or consumptive disease. Similar to Two-Yang diseases affecting Heart/Spleen. If menstruation continues, condition is mild. Apply previous methods; success in 100 days ensures healthy Qi/Blood flow. If amenorrheic, requires 1000 days, engaging with spiritual practices to dissolve resentment. Not physician's fault, but assuming slow progress allows neglect, delaying proper treatment for profit creates karmic debt.