（天士改）
按《内经》之言虚劳，惟是气血两端，至《巢氏病源》始分五脏之劳，七情之伤，甚
六极三十二蒸，本事方更分传尸、鬼疰，至于九十九种，其凿空附会，重见复出，固无论已
，且使学人感于多歧，伊芳谁之咎乎？盖以《内经》为式，第以脾肾分主气血，约而该，确而
可守也。夫人之虚，不属于气，即属于血，五脏六腑，莫能外焉。而独居脾肾者，水为万物
之元，土属万物之母，二脏安和，一身皆治，百病不生。夫脾具土德，脾安则土为金丹，金
实水深，且土不陵水，水安其位，故脾安则肾愈安也。肾兼水火，肾安则火不挟肝上泛而凌
土
湿，火能益土，营运而化精微，故肾安则脾愈安也。孙思邈云∶补脾不如补肾。许学士云∶
补肾不如补脾。两先生深知二脏为生人之根本，又知二脏有相赞之功能，故其说似背，其旨
实同也。救肾者，必本于阴血，血主濡之，血属阴，主下降，虚则上升，当敛而抑，六味丸
是也。救脾者，必本于阳气，气主煦之，气为阳，主上升，虚则下陷，当升而举也，补中益
气汤是也。近世治劳，专以四物汤加知、柏，不知血药常滞，非痰多食少所宜；血药常润，
久行必至滑肠。且知、柏性苦寒，能泻实火，名曰滋阴，其实燥而损血，且苦先入心，久而
增气，反能助火，至其败胃，所不待言。丹溪有言实火可泻，虚火可补，劳证之火，虚乎实
乎？泻之可乎？矫其遍者，辄以桂、附为家常茶饭，此惟火衰者宜之。若气血燥实之人，能无
助火为害哉？大抵虚劳之证，疑难不少。如补脾补肺，法当兼行，然脾喜温燥，肺喜清润，
保肺则碍脾，补脾则碍肺，惟热燥而甚。能食而不泻者，润肺当急，而补脾之药不可厥也。
倘虚羸而甚，食少泻多者，虽喘嗽不宁，但以补脾为急，而润肺之药宜戒矣。常见劳证之死
，多死于泄泻。泄泻之因，多因于清润，司命者，能不为之兢兢耶？又如补肾补脾，法当兼
行，然方欲以甘寒补肾，其人减食，又恐不利于脾，方欲以辛温快脾，其人阴阳，又恐愈耗
其水。两考衡量，而较重脾者，以脾土上交于心，下交于肾也。若肾大虚而势危笃，又不可
拘执，当随时参活法耳。前哲有言土旺而金生，勿拘拘于保肺，水壮而火熄，毋汲汲于清心
，可谓洞达《内经》之旨，深窥根本之治者也。
（天士修改）
按《内经》中关于虚劳的论述，仅涉及气和血两个方面。到了《巢氏病源》，才开始区分五脏之劳、七情之伤，甚至提到六极和三十二蒸。《本事方》更进一步将其分为传尸、鬼疰，多达九十九种。这些说法凭空捏造、牵强附会，重复出现，本来就不必多谈。况且这会让学习者感到困惑歧路，这是谁的过错呢？大概是以《内经》为准则，仅仅通过脾和肾来分别主宰气和血，既简约又全面，确切且可遵循。
人的虚弱，不属于气，就属于血，五脏六腑都不能超出这个范围。而特别强调脾和肾的原因在于：水是万物的本源，土是万物的母亲。这两脏安宁调和，全身就能治理好，百病就不会产生。脾具有土的德行，脾安宁则土成为金丹（指稳固的基础），金实水深，而且土不凌驾于水之上，水安守其位，所以脾安宁则肾更加安宁。肾兼含水火，肾安宁则火不挟带肝气上泛而克制脾土导致湿困；火能温养脾土，促进运化并转化为精微物质，所以肾安宁则脾更加安宁。孙思邈说：“补脾不如补肾。”许学士说：“补肾不如补脾。”这两位先生深知这两脏是生命的根本，又知道这两脏有相互辅助的功能，所以他们的说法看似相反，宗旨其实相同。
救治肾脏，必须以阴血为本。血主濡润，血属阴，主下降，虚损时容易上升，应当收敛并抑制它，六味丸就是这类方剂。救治脾脏，必须以阳气为本。气主温煦，气属阳，主上升，虚损时容易下陷，应当升提并举起它，补中益气汤就是这类方剂。
近代治疗虚劳，专门使用四物汤加入知母、黄柏，却不知道血类药物通常滋腻滞涩，不适合痰多食少的人；血类药物通常滋润，长期使用必然导致滑肠腹泻。况且知母、黄柏性味苦寒，能泻实火，名义上是滋阴，实际上燥烈而损伤血液，而且苦味先入心，久服会增加心气，反而助长火势，至于败坏胃气，更是不用说了。丹溪曾说实火可以泻，虚火可以补，虚劳证的火，是虚还是实？可以泻吗？矫枉过正的人，动不动就把肉桂、附子当作家常便饭，这只有火衰的人适宜。如果是气血燥实的人，难道不会助火为害吗？
大抵虚劳的病症，疑难之处不少。比如补脾和补肺，方法应当同时进行，然而脾喜欢温燥，肺喜欢清润，保肺的药物会妨碍脾，补脾的药物会妨碍肺，只有在热燥严重，能吃但不腹泻的情况下，润肺才当务之急，而补脾的药物不可偏废。如果身体极度虚弱消瘦，吃得少且腹泻多，即使气喘咳嗽不停，也应以补脾为急务，而润肺的药物应该戒除。常见虚劳证死亡的患者，多死于泄泻。泄泻的原因，多因于使用了清润的药物。医生能不为此兢兢业业、小心谨慎吗？又如补肾和补脾，方法应当同时进行，然而正要使用甘寒药物补肾时，担心患者食欲减退，又不利于脾；正要使用辛温药物快脾时，担心患者的阴阳两虚，又会进一步耗损肾水。经过反复考量衡量，认为应更重视脾，是因为脾土上交于心，下交于肾。如果肾大虚且病情危急，又不可拘泥固执，应当随时参考灵活的方法。前哲有言：“土旺则金生，不要拘泥于保肺；水壮则火熄，不要急切于清心。”这可以说是透彻理解了《内经》的宗旨，深刻窥探到根本治疗法则的人。
(Tianshi revised)
According to the *Neijing* (Classic of Internal Medicine), the discussion on Xu Lao (Deficiency and Emaciation Syndrome) involves only two aspects: Qi (Vital Energy) and Blood. It was not until the *Chao Shi Bing Yuan* (Source of Diseases by Chao Yuanfang) that the concept began to differentiate between the Five Zang Organs' deficiency, injuries from Seven Emotions, and even mentioned Liu Ji (Six Extremes) and San Shi Er Zheng (Thirty-two Steaming Syndromes). The *Benshi Fang* (Formulas of Ability) further categorized them into Chuan Shi (Transmissible Corpse Disease) and Gui Zhu (Ghost Tethering), totaling ninety-nine types. These theories are fabricated and far-fetched, repetitive and redundant, which need not be discussed. Moreover, they confuse learners with too many divergent paths; whose fault is this? Essentially, taking the *Neijing* as the standard, focusing solely on the Spleen and Kidney to govern Qi and Blood respectively is concise, comprehensive, accurate, and practicable.
Human deficiency either belongs to Qi or to Blood; the Five Zang and Six Fu organs cannot exist outside this framework. The reason for emphasizing the Spleen and Kidney alone is that Water is the origin of all things, and Earth is the mother of all things. If these two organs are harmonious and peaceful, the whole body is regulated, and a hundred diseases do not arise. The Spleen possesses the virtue of Earth; when the Spleen is at peace, Earth becomes like golden elixir (a solid foundation). Metal is substantial and Water is deep; furthermore, Earth does not encroach upon Water, allowing Water to remain in its proper position. Thus, when the Spleen is at peace, the Kidney is even more at peace. The Kidney encompasses both Water and Fire; when the Kidney is at peace, Fire does not carry Liver Qi upward to overwhelm the Spleen Earth causing dampness. Fire can benefit Spleen Earth, promoting transportation and transformation into essence and nutrients. Thus, when the Kidney is at peace, the Spleen is even more at peace. Sun Simiao said, "Tonifying the Spleen is not as good as tonifying the Kidney." Scholar Xu said, "Tonifying the Kidney is not as good as tonifying the Spleen." Both masters deeply understood that these two organs are the root of human life, and also knew that they have a mutually assisting function. Therefore, their statements seem contradictory, but their intent is actually the same.
To treat the Kidney, one must base it on Yin Blood. Blood provides nourishment; Blood belongs to Yin and tends to descend. When deficient, it may float upward, requiring consolidation and suppression; Liu Wei Wan (Six-Ingredient Pill with Rehmannia) is an example. To treat the Spleen, one must base it on Yang Qi. Qi provides warmth; Qi belongs to Yang and tends to ascend. When deficient, it may sink downward, requiring lifting and raising; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is an example.
In recent times, treating Xu Lao has focused exclusively on Si Wu Tang (Four Substance Decoction) added with Zhi Mu (Anemarrhenae Rhizoma) and Huang Bai (Phellodendri Cortex). They fail to realize that blood-tonifying herbs are often cloying and stagnating, unsuitable for those with excessive phlegm and poor appetite; blood-tonifying herbs are often moistening, and long-term use inevitably leads to loose stools. Furthermore, Zhi Mu and Huang Bai are bitter and cold, capable of draining excess fire. Although named "nourishing Yin," they are actually drying and damaging to blood. Bitterness enters the Heart first; prolonged use increases Heart Qi, potentially aiding fire. Their damage to the Stomach goes without saying. Danxi stated that excess fire can be drained, while deficient fire should be supplemented. Is the fire in Xu Lao deficiency or excess? Can it be drained? Those who overcorrect frequently use Rou Gui (Cinnamomi Cortex) and Fu Zi (Aconiti Lateralis Radix Preparata) as daily staples; this is suitable only for those with deficient fire. For individuals with dry and excess Qi and Blood, would this not aid fire and cause harm?
Generally, Xu Lao cases present many difficulties. For instance, tonifying the Spleen and Lung should ideally be done concurrently. However, the Spleen prefers warm and dry properties, while the Lung prefers clear and moist properties. Nourishing the Lung hinders the Spleen, and tonifying the Spleen hinders the Lung. Only in cases of severe heat and dryness, where the patient eats well but does not have diarrhea, is nourishing the Lung urgent, though Spleen-tonifying herbs should not be neglected. Conversely, if the patient is severely emaciated with poor appetite and frequent diarrhea, even if wheezing and coughing are restless, tonifying the Spleen should be the priority, and Lung-nourishing herbs should be avoided. It is common to see deaths from Xu Lao due to diarrhea. The cause of such diarrhea is often the use of clearing and moistening herbs. Physicians should certainly be vigilant about this. Similarly, tonifying the Kidney and Spleen should be done concurrently. However, when intending to use sweet and cold herbs to tonify the Kidney, one worries about reduced appetite harming the Spleen; when intending to use acrid and warm herbs to invigorate the Spleen, one worries about consuming Yin and Yang, further depleting Kidney Water. After careful consideration, prioritizing the Spleen is justified because Spleen Earth communicates upward with the Heart and downward with the Kidney. If the Kidney is severely deficient and the condition is critical, one must not be rigid but should adapt flexibly according to circumstances. Former sages said, "When Earth is prosperous, Metal is generated; do not rigidly focus on protecting the Lung. When Water is strong, Fire is extinguished; do not anxiously focus on clearing the Heart." This demonstrates a thorough understanding of the *Neijing*'s principles and a deep insight into fundamental treatment.