（论二首 法三十一条 律十条）
喻昌曰∶虚劳之证，《金匮》叙于血痹之下，可见劳则必劳其精血也。荣血伤，则内热起，五心常热，目中生花见
火，耳内蛙聒蝉鸣，口舌糜烂，不知五味，鼻孔干燥，呼吸不利，乃至饮食不生肌肤，怠惰嗜卧，骨软足疲。荣行日迟，
卫行日疾，荣血为卫气所迫，不能内守而脱出于外，或吐或衄，或出二阴之窍，血出既多，火热迸入，逼迫煎熬，漫无
休止，荣血有立尽而已，不死何待耶！更有劳之之极，而血痹不行者，血不脱于外，而但蓄于内。蓄之日久，周身血走
之隧道，悉痹不流，惟就干涸，皮鲜滋润，面无荣泽。于是气之所过，血不为动，徒蒸血为热，或日晡，或子午，始必
干热，俟蒸气散微汗而热解，热蒸不已，瘵病成焉，不死又何待耶？亦有始因脱血，后遂血痹者，血虚血少，艰于流布，
发热致痹，尤易易也。《内经》凡言虚病不及于劳，然以大肉枯槁，大骨陷下，胸中气高，五脏各见危证，则固已言之。
未有劳之之极，而真藏脉不见者也。然枯槁已极，即真藏脉不见，亦宁有不死者乎？秦越人始发虚损之论，谓虚而感寒，
则损其阳，阳虚则阴盛，损则自上而下。一损损于肺，皮聚而毛落；二损损于心，血脉不能荣养脏腑；三损损于胃，饮
食不为肌肤；虚而感热，则损其阴，阴虚则阳盛，损则自下而上。一损损于肾，骨痿不起于床；二损损于肝，筋缓不
能自收持；三损损于脾，饮食不能消化；自上而下者，过于胃则不可治。自下而上者，过于脾则不可治。盖饮食多自能
生血，饮食少则血不生，血不生则阴不足以配阳，势必五脏齐损，越人归重脾胃，旨哉言矣。至仲景《金匮》之文，昌
细会其大意，谓精生于谷，谷入少而不生其血，血自不能化精，《内经》于精不足者，必补之以味。味者，五谷之味也，
补以味而节其劳，则积贮渐富，大命不倾。设以鸡口之入，为牛后之出，欲其不成虚劳，宁可得乎？所以垂训十则，皆
以无病男子，精血两虚为言，而虚劳之候，焕若指掌矣。夫男子平人，但知纵欲劳精，抑孰知阴精日损，饮食无味，转
劳转虚，转虚转劳，脉从内变，色不外华，津液衰而口渴小便少。甚则目瞑衄血，阴精不交自走，盗汗淋漓，身体振摇，
心胆惊怯者比比然也。故血不化精，则血痹矣。血痹则新血不生，并素有之血，亦瘀积不行。血瘀则荣虚，荣虚则发热，
热久则蒸其所瘀之血，化而为虫，遂成传尸瘵证。穷凶极厉，竭人之神气而养虫之神气，人死则虫亦死。其游魂之不死
者，传亲近之一脉，附入血隧，似有如无，其后虫日荣长，人日凋悴，阅三传而虫之为灵，非符药所能制矣。医和视晋
平公疾曰∶是近女室，晦而生内热蛊惑之疾，非鬼非食，不可为也。惑即下唇有疮，虫食其肛，其名为惑之蛊。蛊字取
义，三虫共载一器，非鬼非食，明指虫之为厉，不为尊者讳也。以故狐惑之证声哑嗄，瘵劳之证亦声哑嗄，是则声哑
者，气管为虫所蚀明矣。男子前车之覆，古今不知几千亿人矣。《巢氏病源》不察，谓有虚劳，有蒸病，有注病，劳有
五劳六极七伤，蒸有五蒸二十四蒸，注有三十六种，九十九种，另各分门异治。后人以歧路之多，茫然莫知所适，且讳
其
名曰痰火。而梦梦者遂谓痰火，有虚有实，乃至充栋诸方，妄云肺虚用某药，肺实用某药，以及心肝脾肾，咸出虚实两
治之法。是于虚损、虚劳中，添出实损实劳矣，鄙陋何至是耶！仲景于男子平人，谆谆致戒，无非谓荣卫之道，纳谷
为宝。居常调荣卫以安其谷，寿命之本，积精自刚，居常节嗜欲以生其精。至病之甫成，脉才见端，惟恃建中、复脉为
主治。夫建中、复脉，皆稼穑作甘之善药，一遵精不足者补之以味之旨也，岂有泉之竭矣，不云自中之理哉。后人补肾
诸方，千蹊万径，以治虚劳，何反十无一全，岂非依样葫芦，徒资话柄耶？及其血痹不行，仲景亟驱其旧，生其新，几
希于痨瘵将成未成之间，诚有一无二之圣法，第牵常者不能用耳。试观童子脏腑脆嫩，才有寒热积滞，易于结癖成
疳，待其血痹不行，气蒸发热，即不可为。女子血干经闭，发热不止，痨瘵之候更多。待其势成，纵有良法，治之无及。
傥能服膺仲景几先之哲，吃力于男子、童子、女子，瘵病将成未成之界，其活人之功，皆是起白骨而予以生全，为彼苍
所眷注矣。
（论述两篇 法则三十一条 戒律十条）
喻昌说：虚劳这一病证，《金匮要略》将其叙述在血痹之后，可见劳累必然耗损人的精血。营血受损，则体内产生内热，五心（两手心、两足心及心胸）常感发热，眼中出现闪光或见火，耳内有如蛙鸣蝉叫的噪音，口舌糜烂，尝不出五味滋味，鼻孔干燥，呼吸不畅，甚至饮食无法转化为肌肤营养，身体倦怠懒惰，嗜睡，骨骼软弱，双脚疲乏。营气运行日渐迟缓，卫气运行日渐疾速，营血被卫气所逼迫，不能在内守持而脱逸于外，或者吐血，或者鼻衄，或者从前后二阴窍道出血，血液流出既多，火热之邪乘势侵入，逼迫煎熬，漫无休止，营血很快就会枯竭殆尽，不死还等待什么呢！更有劳累到了极点，导致血痹不通的，血液不向外脱失，只是蓄积在体内。蓄积日子久了，周身血液运行的隧道，全部痹阻不流，只趋向干涸，皮肤缺乏滋润，面部没有光泽。于是气经过的地方，血液不为气所推动，徒然蒸灼血液化为热，有时在日晡时（下午3-5点），有时在子午时（半夜11点-凌晨1点，中午11点-下午1点），起初必定是干热，等到蒸气散发微汗后热才解除，热蒸不止，痨瘵病就形成了，不死又等待什么呢？也有开始因为失血，后来导致血痹的，血虚血少，难以流通布散，发热导致痹阻，这是很容易发生的。《内经》凡是谈论虚病，不涉及劳累，然而如果大肌肉枯槁，大骨陷下，胸中气逆高起，五脏各自出现危重证候，那确实已经说到了。没有劳累到了极点，而真脏脉不出现的。然而枯槁已经到了极点，即使真脏脉不出现，难道有不死的吗？秦越人（扁鹊）开始发起虚损的论述，认为虚而感受寒邪，则损伤其阳气，阳虚则阴盛，损伤自上而下发生。一损损伤于肺，皮毛聚缩而毛发脱落；二损损伤于心，血脉不能荣养脏腑；三损损伤于胃，饮食不能化生肌肤；虚而感受热邪，则损伤其阴液，阴虚则阳盛，损伤自下而上发生。一损损伤于肾，骨痿不能起床；二损损伤于肝，筋缓弛纵不能自我收持；三损损伤于脾，饮食不能消化；自上而下发展的，超过胃部就不可治疗。自下而上发展的，超过脾部就不可治疗。大概饮食多自然能生血，饮食少则血不生，血不生则阴不足以配合阳，势必五脏都受损，越人重视脾胃，这话真是深刻啊。至于仲景《金匮要略》的文字，我仔细领会其大意，认为精生于谷，谷物摄入少而不能生血，血自然不能化精，《内经》对于精不足的，一定用厚味来补益。厚味，就是五谷的味道，用厚味补益并节制劳累，那么积蓄逐渐丰富，生命就不会倾覆。假如让入口的东西像鸡口那样少，出口的东西像牛后那样多，想要它不成为虚劳，怎么可能呢？所以留下训诫十则，都是以无病的男子，精血两虚为言谈对象，而虚劳的征候，就像指掌一样清晰了。那些正常的男子，只知道纵欲劳累精气，又有谁知道阴精日益损耗，饮食无味，越是劳累越是虚弱，越是虚弱越是劳累，脉象从内部变化，面色不外显光华，津液衰少而口渴小便少。严重时眼睛昏花鼻衄，阴精不交而自行走失，盗汗淋漓，身体颤抖摇晃，心惊胆战害怕的人比比皆是。所以血不能化精，就会形成血痹。血痹则新血不生，连同素有的血液，也瘀积不行。血瘀则营血虚，营血虚则发热，热久则蒸灼所瘀积的血液，化而为虫，遂成传尸瘵证（具有传染性的痨病）。穷凶极厉，耗尽人的神气来供养虫的神气，人死则虫也死。那游魂般不死的，传播给亲近的一脉，附着进入血隧，似有似无，后来虫子日益繁荣生长，人日益凋谢憔悴，经过三次传播后，虫子的灵性，就不是符咒药物所能控制了。医和诊治晋平公的疾病时说：这是接近女色，晦暗而生内热蛊惑的疾病，不是鬼神也不是食物造成的，不可治了。惑就是下唇有疮，虫子吃肛门，它的名字叫惑之蛊。蛊字取义，三只虫子共同载在一个器皿里，不是鬼神也不是食物，明确指向虫子为害，不为尊者避讳。因此狐惑证的声哑嗄，痨劳证也是声哑嗄，这样看来声哑的，气管被虫子侵蚀是明显的了。男子的前车之鉴，古今不知几千几亿人矣。《巢氏病源》没有考察清楚，说有虚劳，有蒸病，有注病，劳有五劳六极七伤，蒸有五蒸二十四蒸，注有三十六种，九十九种，另外各自分门别类治疗。后人因为歧路太多，茫然不知道适从，并且忌讳它的名字叫做痰火。而糊涂的人于是说痰火，有虚有实，以至于堆积如山的方书，胡乱说肺虚用某药，肺实用某药，以及心肝脾肾，都出虚实两种治疗方法。这是在虚损、虚劳中，添出了实损实劳了，鄙陋怎么到了这种地步呢！仲景对于正常男子，谆谆告诫，无非是说营卫之道，以纳谷为宝。平时调理营卫来安顿谷物，这是寿命的根本，积蓄精液自然刚强，平时节制嗜欲来生成精液。到病刚刚形成，脉象才露端倪，只依靠建中汤、复脉汤作为主治。夫建中汤、复脉汤，都是稼穑作甘（脾胃属土，其味为甘）的好药，完全遵循精不足者补之以味的旨意，哪有泉水枯竭了，不从中补救的道理呢？后人补肾的各种方剂，千条万径，用来治疗虚劳，为什么反而十无一全，岂不是依样画葫芦，徒然成为话柄呢？等到血痹不行，仲景急切地驱逐旧的瘀血，生成新的血液，几乎在痨瘵将成未成之间，这确实是一无二的圣法，只是拘泥常规的人不能用罢了。试看童子脏腑脆嫩，才有寒热积滞，易于结癖成疳，等到血痹不行，气蒸发热，就不可治了。女子血干经闭，发热不止，痨瘵的征候更多。等到病势形成，纵然有良法，治疗也来不及了。如果能信奉仲景先见之明，在男子、童子、女子身上，在瘵病将成未成的界限上努力，那救人的功劳，都是使白骨复活给予生存，为上天所眷顾了。
(Liang essays, thirty-one rules and methods, ten prohibitions)
Yu Chang said: The syndrome of Xu Lao (Consumptive Disease), as narrated in the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) following Xue Bi (Blood Bi Syndrome), shows that overwork inevitably damages Jing (Essence) and Xue (Blood). When Ying Blood (Nutritive Blood) is injured, internal heat arises; the five centers (both palms, both soles, and the chest) are often hot; one sees flashes or fire in the eyes; there is a buzzing sound like frogs and cicadas in the ears; the mouth and tongue are ulcerated; the flavors of the five tastes are not perceived; the nostrils are dry; respiration is difficult; even food cannot transform into muscle and flesh; the body is lethargic and lazy, prone to sleep; bones are soft, and feet are fatigued. Ying Qi (Nutritive Qi) moves slowly day by day, while Wei Qi (Defensive Qi) moves rapidly day by day. Ying Blood is forced by Wei Qi, unable to remain within, and escapes outward, resulting in hematemesis (vomiting blood), epistaxis (nosebleed), or bleeding from the anterior and posterior orifices. Once blood loss is significant, pathogenic fire bursts in, forcing and simmering without cessation. Ying Blood will be exhausted immediately; why wait for death! Furthermore, when overwork reaches its extreme, causing Xue Bi (Blood Bi Syndrome), blood does not escape outward but accumulates internally. After accumulating for a long time, all the tunnels through which blood flows in the entire body become bi-zu (blocked and stagnant), tending toward dryness. The skin lacks moisture, and the face loses luster. Thus, where Qi passes, blood does not move, merely steaming the blood into heat. This may occur at dusk (Shen and You hours) or at midnight and noon (Zi and Wu hours). Initially, it is dry heat; only after vapor dissipates with slight sweating does the heat resolve. If steaming continues unceasingly, Zhai Bing (Tuberculous Disease) forms; why wait for death! There are also cases starting with blood loss, later leading to Xue Bi. Due to blood deficiency and scarcity, circulation is difficult; fever causes bi-zu, which is very easy to happen. The *Nei Jing* (Inner Canon) generally states that Xu diseases do not involve overwork. However, if large muscles are withered, large bones are sunken, Qi rises high in the chest, and each of the Five Zang Organs shows critical signs, this has indeed been discussed. There is no case of extreme overwork without the appearance of Zhen Zang Mai (True Organ Pulse). Yet, if withering is extreme, even if Zhen Zang Mai does not appear, can one expect survival? Qin Yue Ren (Bian Que) first proposed the theory of Xu Sun (Deficiency Damage), stating that deficiency with cold invasion damages Yang; Yang deficiency leads to Yin excess, and damage proceeds from top to bottom. First damage affects the Lung, causing skin contraction and hair loss; second damage affects the Heart, preventing blood vessels from nourishing the Zang-Fu organs; third damage affects the Stomach, preventing food from forming flesh. Deficiency with heat invasion damages Yin; Yin deficiency leads to Yang excess, and damage proceeds from bottom to top. First damage affects the Kidney, causing bone flaccidity inability to rise from bed; second damage affects the Liver, causing tendon laxity inability to hold oneself; third damage affects the Spleen, preventing food digestion. Damage proceeding from top to bottom becomes incurable once it exceeds the Stomach. Damage proceeding from bottom to top becomes incurable once it exceeds the Spleen. Generally, abundant diet naturally generates blood; scant diet fails to generate blood. Without blood generation, Yin cannot balance Yang, inevitably leading to damage of all Five Zang Organs. Yue Ren emphasized the Spleen and Stomach; his words were profound. Regarding Zhong Jing’s text in *Jin Gui*, I carefully grasped its main idea: Essence is generated from grain. If grain intake is low and blood is not generated, blood cannot transform essence. The *Nei Jing* states that for insufficiency of essence, one must supplement with flavor. Flavor refers to the taste of the five grains. Supplementing with flavor and regulating overwork allows accumulation to gradually enrich, and life will not collapse. If what enters is small like a chicken’s beak, and what exits is large like a cow’s anus, how could it not become Xu Lao? Therefore, the ten admonitions all speak of healthy men with dual deficiency of Jing and Xue, making the signs of Xu Lao clear as pointing to the palm. Healthy men know only to indulge in desire and overwork essence, but who knows that Yin Essence is daily damaged, food loses flavor, turning overwork into deficiency and deficiency into overwork? The pulse changes internally, color lacks external brilliance, fluids decline causing thirst and scanty urination. Severely, eyes dim and nosebleeds occur; Yin Essence fails to interact and leaks spontaneously; night sweats drench the body; the body trembles; heart and gallbladder are fearful—such cases are common. Thus, if blood fails to transform essence, Xue Bi occurs. With Xue Bi, new blood is not born, and existing blood also stagnates and fails to flow. Blood stasis leads to Ying deficiency; Ying deficiency leads to fever; prolonged fever steams the stagnant blood, transforming it into worms, thus forming Chuan Shi Zhai Zheng (Infectious Tuberculosis). Extremely vicious, it exhausts human Shen Qi (Spiritual Energy) to nourish the worm’s Shen Qi. When the person dies, the worm also dies. Those wandering souls that do not die transmit to a close relative, attaching to blood tunnels, seeming present yet absent. Later, worms grow prosperous, humans wither. After three transmissions, the worm’s spirituality cannot be controlled by talismans or medicines. Yi He diagnosed Duke Ping of Jin’s illness, saying: “This is due to proximity to women, generating internal heat and confusion in darkness. It is neither ghost nor food, and is incurable.” ‘Huo’ refers to sores on the lower lip, worms eating the anus, named Huo Gu. The character Gu implies three worms carried in one vessel, neither ghost nor food, clearly pointing to worms as the cause, not hiding it for the honorable. Therefore, Hu Huo syndrome features hoarseness, and Zhai Lao syndrome also features hoarseness. Thus, hoarseness clearly indicates tracheal erosion by worms. The lessons of men before us number thousands and millions in ancient and modern times. *Chao Shi Bing Yuan* (Source of Diseases by Master Chao) failed to investigate, claiming there is Xu Lao, Zheng Bing (Steaming Disease), Zhu Bing (Transmitting Disease); Lao has Wu Lao Liu Ji Qi Shang (Five Overworks, Six Extremes, Seven Injuries); Zheng has Wu Zheng Er Shi Si Zheng (Five Steams, Twenty-Four Steams); Zhu has Thirty-Six Types and Ninety-Nine Types, each classified separately for treatment. Later generations, confused by many divergent paths, did not know where to turn, and tabooed the name, calling it Tan Huo (Phlegm-Fire). Ignorant people then claimed Phlegm-Fire has Xu and Shi aspects. Consequently, bookshelves full of prescriptions recklessly stated: for Lung Xu use this herb, for Lung Shi use that herb, and for Heart, Liver, Spleen, Kidney, all provided two treatments for Xu and Shi. This added Shi Sun and Shi Lao to Xu Sun and Xu Lao; how baseless and vulgar! Zhong Jing earnestly warned healthy men, emphasizing that the way of Ying and Wei treasures grain intake. Usually regulating Ying and Wei to settle grain is the root of longevity; accumulating essence makes one naturally strong. Usually restraining desires generates essence. When disease just begins, and pulse shows only hints, relying solely on Jian Zhong Tang (Middle-Building Decoction) and Fu Mai Tang (Pulse-Recovering Decoction) as main treatments. Both Jian Zhong and Fu Mai are excellent herbs of “Jia Se Zuo Gan” (Earth’s nature is sweet), strictly following the principle of supplementing essence with flavor. How can one say that when a spring is exhausted, one should not seek to replenish it from within? Later generations’ kidney-tonifying formulas, taking myriad paths to treat Xu Lao, why are they rarely successful? Is this not copying the gourd, merely providing material for gossip? When Xue Bi sets in, Zhong Jing urgently expels the old and generates the new, acting almost between the formation and non-formation of Lao Zhai. This is truly a unique sage method, only unusable by those clinging to convention. Observe children: their Zang-Fu are fragile. Even slight cold-heat stagnation easily forms masses and malnutrition. Wait until Xue Bi occurs, Qi evaporates causing fever, and it is incurable. Women with dried blood and amenorrhea, continuous fever, have more signs of Lao Zhai. Wait until the condition forms, and even with good methods, treatment is too late. If one could heed Zhong Jing’s foresight, exert effort on men, children, and women at the threshold of Zhai Bing formation, the merit of saving lives would be raising the dead back to life, favored by Heaven.