虚损一证，或从上而损下，如金衰卫弱，而多外感之来，则气伤而肺损，肺损则不能制
木，
用六味、七味，则脾益伤而病益重矣，当以四君、保元加减。或从下而损上，如因情欲抑郁
所致，则精伤而损肾，肾损则木枯而生火，此由下而上，故有足痿、口干、寒热等证。斯时
若遽投四君、保元补中，则多滞而火起，病益增矣。当用六味、金匮等方，而后以保元、白
术散调之，然白术、白茯苓泄阴伤水，亦当慎用。凡由上损下、由下损上，最要一关，皆在
脾胃。脾胃一伤，便不可救；脾胃不伤，虽百病杂出，不过阴火为患。故杂证不必顾，久近
亦不论，生死凶吉，只视脾、胃二经也。
凡虚损之病，命门火旺，肾水不足，阳明化燥火，肝气与胃气相联，胃火旺，故肝火亦
旺，木燥土干，心火炎上，金无养，水无生，五火交炽之时，若用黄柏、知母滋阴降火，是犹干
锅炼红，倾以一杯之水，激助火势，立地碎裂矣！甚可畏也。若脉带缓，是胃气未绝，犹可
调理，用四君加山药，引入脾经，单补脾阴，再随所兼之证而用之，俟脾之气旺，旺则上能
生金，金转能生水，水升而火自降矣，此合三之治法也。若脉见短数、紧数、细数者，断不
火与元气势不两立，一胜则一负。盖元气藏于二肾之中，静则为水，动则化而为火。肾
者，肝之母也，元气足则肝子以承乎心主，神明出焉，为化为育而生生不息。若房劳辛苦之人，
七情六欲损伤元气，心神失养，相火亢烈，亢烈之火不能生土，则脾土有伤矣。脾伤则金气
不足，不能平肝木，木转以克土，则后天伤；金气不足，则水无从以生，而先天伤；二天俱
伤，则不能转相滋养，五脏失其生成之职，相火不期燃而燃矣。水竭无以制之则死，其中亦
有可救者，胃气不绝，用药力以养脾胃，生脉散加黄 ，兼滋生之药佐之，或保元汤加减。
但见潮热，宜补中益气汤专用，火炽宜升阳散火汤发之。若不治其脾，则五六相煽，不可治
矣！若虚而不泻，宜血分中补气，保元汤加滋降之药。若作泻困热，宜气分中补血，保元、
四君加白芍、炒松花。如自汗乃阳虚，宜加附子。胸中火烁痛如刀割，用四圣丸，痛愈则止
。久泻伤肾，用保元兼四神丸；或腹胀，和中散合补中益气汤。脉见平和而病不愈，药力未
至也，不可更换；倘脉见细数、紧数，皆邪脉变异，若兼呕吐，不祥之兆也。又口失滋味，
不思饮食，不可看作胃绝，是胃有虚火，当滋生元阴之气。若用燥药，以火投火而心失其所
养，则上无以益下，下无以奉上，五脏空燥，反用燥药，不死而何？盖万物赖脾以生，脾气
一伤，则九窍不通，诸病生焉。治病不愈，必寻到脾胃之中，方无误也。
虚损久病，皆是伤脾，脾伤则肺先受之，肺病则不能管摄一身，脾病则四肢不能为用，
当养胃气。胃非善食之谓，要有生发之气，以养万物生化之原也。养者，保元气为主，以温佐之
也。火旺者，乃血虚也，十全大补汤，再随证加减用之。但前从疟、痢、吐泻而来，纵有变
证，只从脾胃治法，保元兼温脾血药。虽有杂证，火旺不必治火，有痰不必治痰，宜参苓白
术散，随证加减。吐加炮姜；腰腹痛加益智、吴茱萸少许，腹中痛胀亦宜；嗳气加神曲。盖
久病心火为主，火为养命之原也。又凡病急者缓治，攻则离散。书曰∶大毒治病，十去二三
，中毒治病，十去其五，无毒治病，十去八九，余以饮食谷味养之也。
虚损由内伤而起，先因饮食不节，劳役所伤，房欲所损。病初起与外感相似，但外感头
痛、发热、恶寒，其脉浮紧有力，治宜汗解；从表入里，脉洪大，大便燥，治宜通利之。内伤亦
头痛，痛而不盛，发热恶寒，其脉紧数无力，宜补中益气汤加羌活、防风。不表之表，若表
之太过，汗至颈而还，一日一次，似疟又似痢，若作疟、痢治之，发热更加，有似伤寒矣。
但伤寒脉洪大有力，内伤脉豁大似洪而无力。若用清凉汗下，大伤脾胃，必致肺脏亦亏，又
增咳嗽、吐痰、吐血等证；又作阴虚火动治之，则脾胃更伤。杂证多端，潮热似疟，皆因脾
火盛脾阴不足，血枯之证，滋阴不宜，救阴可也，阴从阳生，阳从阴长。用人参、白术
、莲
宜。）汗多加黄 ，恶寒加肉桂。（吐血者不宜。）若泄泻而诸药不效。胃虚难以受药，用陈
腊肉骨灰、锅心饭焦各三钱，炒松花一钱，米糊丸，人参看轻重虚实，用以煎汤，送下六、
七十丸。此法治人多效。
验案
一女人吐血发热，热甚而喘，用生脉散热更甚，脉或大，或小，或浮，或数，或弦，或
涩，变易不常，知其脾阴虚而脉失信也。脉者，血之府，脾统血，血枯故变易不常耳。用保
元汤加五味子、山药、杞子，白茯苓，人参重用至五钱，二帖而效，二十帖而愈。
虚损这一病证，有的是从上焦向下焦损伤，比如肺气虚弱、卫气不固，导致容易感受外邪，这样会伤及气而损害肺脏。肺受损后就不能制约肝木，此时如果使用六味地黄丸或七味白术散，反而会进一步损伤脾胃，使病情加重，应当用四君子汤或保元汤进行加减治疗。有的则是从下焦向上焦损伤，比如因情志抑郁、房事过度所致，这会耗伤精血而损害肾脏。肾受损后，肝木失去滋养而干枯，进而化生虚火，这是由下向上的病变，所以会出现足部痿软、口干、寒热往来等症状。这时候如果急于投用四君子汤、保元汤来补益中焦，往往会导致气机壅滞而生内火，使病情更加严重。应当先用六味地黄丸、金匮肾气丸等方剂，然后再用保元汤、白术散来调理。然而，白术和白茯苓有渗利之性，容易耗伤阴液，使用时也应当谨慎。凡是上损及下、下损及上的情况，最关键的一环都在脾胃。脾胃一旦受伤，就难以救治；只要脾胃不伤，即使出现各种杂症，也不过是阴火为患罢了。因此，对于杂症不必过分顾虑，病程长短也不必深究，生死吉凶，完全取决于脾、胃二经的状态。
大凡虚损之病，多是命门火旺、肾水不足，阳明胃经化燥生火，肝气与胃气相连，胃火旺盛，所以肝火也随之旺盛。木燥土干，心火上炎，肺金得不到滋养，肾水得不到生源，在五种火邪交炽的时候，如果使用黄柏、知母来滋阴降火，这就好比在烧红的干锅里倒一杯水，不仅不能灭火，反而激助火势，导致锅立刻碎裂！这非常可怕。如果脉象带缓，说明胃气尚未断绝，还可以调理，可用四君子汤加山药，引导药力进入脾经，专门补益脾阴，再根据兼夹的症状用药，等到脾气旺盛，就能上生肺金，肺金转而生肾水，肾水上升而心火自然下降，这符合“培土生金、金水相生”的治疗法则。如果脉象表现为短数、紧数、细数，说明元气与邪势势不两立，一胜则一负。因为元气藏于两肾之中，静止时表现为水，运动时化为火。肾是肝的母亲，元气充足，则肝木得以承奉心主，神明由此产生，化育万物，生生不息。如果是房劳辛苦之人，因七情六欲损伤元气，心神失养，相火亢烈，亢烈的火气不能生助脾土，则脾土受损。脾伤则肺金之气不足，不能平抑肝木，肝木反过来克制脾土，则后天之本受伤；肺金气不足，则肾水无从滋生，先天之本亦伤。先后天都受伤，就不能相互滋养，五脏失去生成和维持的功能，相火就会不由自主地燃烧起来。肾水枯竭无法制约相火则会死亡，其中也有可救的情况，若胃气不绝，可用药物力以养护脾胃，用人参、麦冬、五味子组成的生脉散加黄芪，并佐以滋生的药物，或者用保元汤加减。但见潮热者，宜专用补中益气汤；火邪炽盛者，宜用升阳散火汤发散。如果不治脾胃，则五脏之火互相煽动，就无法治愈了。若虚损但不腹泻，宜在血分中补气，用保元汤加滋阴降火的药物。若作腹泻且困倦发热，宜在气分中补血，用保元汤、四君子汤加白芍、炒松花粉。如果是自汗，属于阳虚，宜加附子。胸中如火灼痛如刀割，用四圣丸，疼痛停止即停药。久泻伤肾，用保元汤兼四神丸；或者腹胀，用和中散合补中益气汤。脉象平和但病不愈，是药力未到，不可更换方药；倘若脉象见细数、紧数，都是邪脉变异，若兼有呕吐，是不祥的征兆。另外，口不知滋味，不思饮食，不可看作是胃气绝灭，这是胃中有虚火，应当滋生气阴。如果使用燥湿药，是以火投火，导致心神失养，则上不能益下，下不能奉上，五脏空虚干燥，再用燥药，不死又能怎样？大概万物依赖脾胃而生，脾气一伤，则九窍不通，各种疾病由此产生。治病不愈，必须探寻到脾胃之中，才不会出错。
虚损久病，都是损伤脾胃，脾伤则肺先受累，肺病则不能统摄一身，脾病则四肢不能正常运作，应当养胃气。所谓养胃，并非指善于进食，而是要有生发之气，以滋养万物生化之源。所谓的“养”，是以保护元气为主，辅以温补。火旺者，乃是血虚所致，可用十全大补汤，再随证加减使用。但是此前因疟疾、痢疾、吐泻而来的虚损，纵有变证，只从脾胃治法入手，用保元汤兼温脾血药。虽有杂症，火旺不必治火，有痰不必治痰，宜用参苓白术散，随证加减。呕吐加炮姜；腰腹痛加益智仁、吴茱萸少许，腹中痛胀也适宜；嗳气加神曲。大概久病以心火为主，火是养命的根本。又凡是病急者宜缓治，攻伐则正气离散。医书说：用大毒药物治疗，病去十分之二三；用中毒药物治疗，病去十分之五；用无毒药物治疗，病去十分之八九，剩下的靠饮食谷味来调养。
虚损由内伤而起，先是因饮食不节，劳役所伤，房事过度所损。病初起与外感相似，但外感病头痛、发热、恶寒，脉象浮紧有力，治疗宜发汗解表；若由表入里，脉象洪大，大便干燥，治疗宜通利腑气。内伤也头痛，但痛势不剧烈，发热恶寒，脉象紧数无力，宜用补中益气汤加羌活、防风。这种不通过发汗而解表的方法，如果发汗太过，汗出至颈部而止，一天一次，似疟疾又似痢疾，若当作疟疾、痢疾治疗，发热会更加严重，有点像伤寒。但伤寒脉洪大有力，内伤脉豁大似洪却无力。如果用清凉发汗或攻下之法，会大伤脾胃，必然导致肺脏也亏损，又增加咳嗽、吐痰、吐血等症状；若又当作阴虚火动治疗，则脾胃更伤。杂症多端，潮热似疟，都是因为脾火盛、脾阴不足，属于血枯之证，滋阴不宜，救阴即可，阴从阳生，阳从阴长。用人参、白术、莲子（原文此处似有缺漏，结合上下文推测可能涉及健脾益气之品，如山药等，但依原文翻译）、茯苓等。汗多加黄芪，恶寒加肉桂（吐血者不宜）。若泄泻而诸药不效，胃虚难以受药，可用陈腊肉骨灰、锅巴各三钱，炒松花一钱，米糊为丸，人参视轻重虚实，煎汤送下六七十丸。此法治人多有效验。
验案
有一位女性吐血发热，热势甚重且气喘，用生脉散后热势更甚，脉象时而大，时而小，时而浮，时而数，时而弦，时而涩，变化无常，可知是脾阴虚而脉象失真。脉是血的府库，脾统血，血枯故脉象变化无常。用保元汤加五味子、山药、枸杞子、白茯苓，人参重用至五钱，服两帖见效，二十帖痊愈。
Xu Sun (Deficiency and Damage) is a syndrome that may progress from the upper jiao to the lower jiao. For instance, when Lung Qi is deficient and Wei Qi (Defensive Qi) is weak, external pathogens easily invade, damaging Qi and injuring the Lungs. Once the Lungs are injured, they lose their ability to control Liver Wood. In such cases, using Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) or Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) will further injure the Spleen and Stomach, aggravating the disease. Instead, one should use Sijunzi Tang (Four Gentlemen Decoction) or Baoyuan Tang (Preserve Origin Decoction) with modifications. Alternatively, Xu Sun may progress from the lower jiao to the upper jiao, caused by emotional depression or excessive sexual activity, leading to Essence depletion and Kidney injury. When the Kidneys are injured, Liver Wood becomes dry and generates Fire. This downward-to-upward pathology presents with symptoms such as flaccidity of the legs, dry mouth, and alternating chills and fever. At this stage, if one hastily administers Sijunzi Tang or Baoyuan Tang to tonify the Middle Jiao, it often causes stagnation and ignites Fire, worsening the condition. One should first use Liuwei Dihuang Wan or Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet), followed by regulation with Baoyuan Tang or Baizhu San (Atractylodes Macrocephala Powder). However, Baizhu (Atractylodes Macrocephala Rhizome) and Baifuling (Poria with Atractylodes) have diuretic properties that can drain Yin fluids, so they must be used with caution. The critical link in both upward-to-downward and downward-to-upward damage lies in the Spleen and Stomach. If the Spleen and Stomach are injured, the condition is incurable; if they remain intact, even if various mixed syndromes appear, they are merely due to Deficient Fire. Therefore, one need not worry excessively about mixed syndromes or the duration of the illness; life and death, auspiciousness and misfortune, depend solely on the meridians of the Spleen and Stomach.
Generally, Xu Sun diseases involve hyperactive Mingmen Fire (Gate of Life Fire) and insufficient Kidney Water, with the Yangming Stomach channel transforming into Dryness-Fire. Since Liver Qi connects with Stomach Qi, strong Stomach Fire leads to strong Liver Fire. With dry Wood and parched Earth, Heart Fire flares upward, leaving Metal without nourishment and Water without generation. During this time of intense interaction among the Five Fires, using Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) to nourish Yin and descend Fire is like pouring a cup of water onto a red-hot dry wok; it will only intensify the fire and cause the wok to shatter instantly! This is terrifying. If the pulse is slow and relaxed, it indicates that Stomach Qi has not yet perished, and regulation is still possible. Use Sijunzi Tang added with Shanyao (Dioscorea Rhizome) to guide the medicine into the Spleen meridian, specifically tonifying Spleen Yin. Then, treat according to accompanying symptoms. Once Spleen Qi becomes robust, it generates Lung Metal; Lung Metal then generates Kidney Water. As Water rises, Fire naturally descends, aligning with the treatment method of "Earth generating Metal and Metal generating Water." If the pulse appears short, rapid, tight, or fine-rapid, it signifies that Yuan Qi (Original Qi) and Pathogenic factors are mutually exclusive; victory for one means defeat for the other. Yuan Qi resides in the two Kidneys; in a static state, it manifests as Water, and in motion, it transforms into Fire. The Kidney is the mother of the Liver. When Yuan Qi is sufficient, Liver Wood supports the Heart Master, allowing Spirit (Shen) to emerge, facilitating transformation and nurturing, thus sustaining endless life. For those suffering from sexual exhaustion and hard labor, damage to Yuan Qi by the Seven Emotions and Six Desires leads to malnourishment of the Heart Spirit and hyperactivity of Ministerial Fire. This excessive Fire fails to generate Earth, thereby injuring Spleen Earth. Spleen injury results in insufficient Lung Metal Qi, which cannot pacify Liver Wood; conversely, Liver Wood overacts on Earth, injuring the Acquired Foundation. Insufficient Lung Metal Qi prevents the generation of Kidney Water, injuring the Congenital Foundation. When both foundations are injured, mutual nourishment ceases, the five Zang organs lose their generative functions, and Ministerial Fire ignites spontaneously. If Kidney Water is exhausted and cannot restrain Fire, death ensues; however, some cases are salvageable. If Stomach Qi remains, use medicinal force to nourish the Spleen and Stomach: Shengmai San (Generate Pulse Powder) added with Huangqi (Astragalus Root), assisted by herbs that generate fluids, or modified Baoyuan Tang. For tidal fever, specialize in Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for blazing Fire, use Shengyang Sanhuo Tang (Raise Yang and Scatter Fire Decoction) to disperse it. If the Spleen is not treated, the five viscera's fires will fan each other, making the condition untreatable. For deficiency without diarrhea, tonify Qi within the Blood level using Baoyuan Tang plus herbs that nourish and descend. For diarrhea with fatigue and heat, tonify Blood within the Qi level using Baoyuan Tang and Sijunzi Tang added with Baishao (White Peony Root) and fried Songhua (Pine Pollen). For spontaneous sweating indicating Yang deficiency, add Fuzi (Prepared Aconite Root). For burning pain in the chest like knife cuts, use Sisheng Wan (Four Saints Pill) until pain subsides. For chronic diarrhea injuring the Kidneys, use Baoyuan Tang combined with Sishen Wan (Four Spirits Pill); for abdominal distension, combine Hezhong San (Harmonize the Middle Powder) with Buzhong Yiqi Tang. If the pulse is peaceful but the illness persists, the medicinal force has not yet reached its target; do not change the prescription. If the pulse becomes fine-rapid or tight-rapid, these are aberrant pathogenic pulses; if accompanied by vomiting, it is an ominous sign. Furthermore, loss of taste and lack of appetite should not be mistaken for Stomach Qi extinction; rather, it indicates Deficient Fire in the Stomach, requiring the generation of Original Yin Qi. Using drying herbs would be adding fire to fire, causing the Heart to lose its nourishment, resulting in an inability to benefit the lower from above or assist the upper from below, leaving the five Zang organs empty and dry. Using more drying herbs would lead to death. All things rely on the Spleen for growth; once Spleen Qi is injured, the nine orifices become blocked, and various diseases arise. If treatment fails, one must investigate the Spleen and Stomach to avoid error.
Chronic Xu Sun diseases all injure the Spleen. Spleen injury affects the Lungs first; Lung disease impairs the control of the whole body; Spleen disease renders the limbs useless. One must nourish Stomach Qi. Nourishing the Stomach does not mean promoting appetite, but fostering a generating Qi to sustain the source of biological transformation. "Nourishing" primarily involves preserving Yuan Qi, assisted by warming methods. Hyperactive Fire indicates Blood deficiency; use Shiquan Dabu Tang (Ten Substance Great Tonification Decoction) with modifications. However, for Xu Sun originating from malaria, dysentery, vomiting, or diarrhea, even if complications arise, treat only from the perspective of the Spleen and Stomach, using Baoyuan Tang combined with herbs that warm the Spleen and Blood. Even with mixed syndromes, if Fire is hyperactive, do not treat the Fire; if Phlegm exists, do not treat the Phlegm directly. Instead, use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) with modifications. Add Paogjiang (Processed Ginger) for vomiting; add YiZhiRen (Alpinia Oxyphylla Fruit) and Wuzhuyu (Evodia Fruit) for waist and abdominal pain, also suitable for abdominal pain and distension; add Shenqu (Medicated Leaven) for belching. Generally, chronic diseases center on Heart Fire, as Fire is the origin of life maintenance. Moreover, acute illnesses should be treated slowly; aggressive attack scatters Zheng Qi (Upright Qi). The classics state: treating with highly toxic herbs removes two or three parts of ten; with moderately toxic herbs, five parts; with non-toxic herbs, eight or nine parts. The remainder is nourished by food and grain.
Xu Sun arises from internal injury, initially due to irregular diet, physical overexertion, and sexual excess. Early stages resemble external contraction. External contraction presents with headache, fever, aversion to cold, and a floating, tight, forceful pulse, requiring diaphoresis (sweating therapy). If it moves from exterior to interior, presenting with a surging pulse and dry stool, purgation is indicated. Internal injury also causes headache, but the pain is mild; fever and aversion to cold occur with a tight, rapid, and forceless pulse. Treat with Buzhong Yiqi Tang added to Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root). This is "releasing the exterior without sweating." If sweating is excessive, sweat stops at the neck, occurring once daily, resembling malaria or dysentery. Treating it as malaria or dysentery will worsen the fever, mimicking Shanghan (Cold Damage). However, Shanghan has a surging, forceful pulse, whereas internal injury has a hollow, surging-like but forceless pulse. Using cooling diaphoretics or purgatives severely damages the Spleen and Stomach, inevitably depleting the Lungs, adding cough, expectoration, and hemoptysis. Treating it as Yin deficiency with hyperactive Fire further injures the Spleen and Stomach. Mixed syndromes vary; tidal fever resembling malaria is due to盛 Spleen Fire and insufficient Spleen Yin, a condition of Blood exhaustion. Nourishing Yin is inappropriate; saving Yin is key. Yin generates from Yang, and Yang grows from Yin. Use Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Lianzi (Lotus Seed), etc. Add Huangqi for excessive sweating; add Rougui (Cinnamon Bark) for aversion to cold (contraindicated in hemoptysis). If diarrhea persists despite various medicines, and the Stomach is too weak to accept medication, use three qian of aged cured meat bone ash and three qian of scorched rice crust, mixed with one qian of fried pine pollen, formed into pills with rice paste. Take 60-70 pills washed down with decoction made from Renshen, adjusted according to severity and deficiency/excess. This method is often effective.
Case Record
A woman suffered from hemoptysis and fever. Her fever was severe with panting. After using Shengmai San, her fever worsened. Her pulse varied between large, small, floating, rapid, wiry, and choppy, changing unpredictably. This indicated Spleen Yin deficiency and deceptive pulse signs. The pulse is the residence of Blood; the Spleen governs Blood. Blood exhaustion causes unpredictable pulse variations. Prescribed Baoyuan Tang added with Wuweizi (Schisandra Berry), Shanyao, Gouqi (Goji Berry), and Baifuling. Used a heavy dose of Renshen, five qian. Effective after two doses; cured after twenty doses.