一切久怯极虚惫，咳嗽吐痰，咯血发热。
黑嘴白鸭（一只） 大京枣（二升） 参苓平胃散（一升） 陈煮酒（一瓶）
上将鸭缚定脚，量患人饮酒多少，随量以酒烫温，将鸭项割开，滴血入酒，搅匀饮之，
直入
实纳参苓平胃散末，填满鸭肚中，用麻扎定，以砂瓶一个，置鸭在内，四围用火慢煨，将陈
酒煮作三次添入，煮干为度，然后食枣子，阴干，随意用参汤化下，后服补髓丹，则补髓生
津，和血顺气。
参苓平胃散一升，京枣二升酒一瓶，黑嘴白毛肥鸭一，照方如法制来斟。
陈修园按∶怯而日久，虚极而惫，而且咳嗽不已，则肺日因嗽而动扰矣。吐痰不已，则
肺因
之草木所能治。故用黑嘴白鸭一只为君，盖以毛白者味较清而入肺，嘴黑者骨亦黑而入肾，
取金水相生之义，亦资异类有情之物以补之也。最妙入京枣二升，取其甘温以补胃。平胃散
一升，取其消导以转胃，胃为五脏六腑之本，胃安则脏腑俱安，与保真汤佐以浓朴同义。叶
天士于此书亦参透其旨，但其方随症加入，以致学徒刊刻汇案，用浓朴者，于虚痨门止收一
方，意者，中人以下不可以语上，重其道而不轻传欤，修园则异于是。
久痨虚惫，髓干精竭，血枯气少，服煎药愈后，服此药。
猪脊膂（一条） 羊脊膂（一条） 团鱼（一枚） 乌鸡（一只）
四味制净，去骨存肉，用酒一大碗，于沙瓮内煮熟擂细，再用后药。
大山药（五条） 莲肉（半斤） 京枣（一百枚） 霜柿（十个）
四味修制净，用井花水一大瓶，于沙瓮内煮熟擂细，于前熟肉一处，用慢火熬之，却下
明胶（四两） 黄蜡（三两）
上二味逐渐下，与前八味和一处，研成膏子，和平胃散末，四君子汤末，并知母黄柏末
各一
梧桐子大，每服一百丸，不拘时候，枣汤下。
猪羊脊膂鸡团鱼，煮擂宜当去骨需。霜柿十枚京枣百，建莲八两五条薯。熟和前味熬文
火，黄蜡明胶渐入诸。知柏四君平胃末，各和一两制丸茹。
陈修园按∶久痨虚惫，髓干精竭等症，服煎药愈后，服此药二十字，是为虚痨既愈症，
筹一
不历试。初服间或少效，久之无不增剧，名医俱束手无策。然药以治病，食以养人，二语参
透，大有妙议。盖得病日久，日在药中，禾黍之肠，改充杂草，肠胃之所恶者药也，若更以
药投之，是重困之而不能堪矣。先生用山药、莲肉、京枣、霜柿，取日食之果菜，以悦脾胃
之性情，用猪髓、羊髓、团鱼、乌鸡、牛胶，日用之肉食，以充脾胃之虚馁，即扁鹊所谓损
其脾者，调其饮食。《内经》所谓精不足者，补之以味是也。惟方中黄蜡一味，俗医见之，无
不惊骇。《本草备要》谓服此物，着于肠胃，令人泻利不止
威喜丸用此熔化为丸。王晋三注云∶黄蜡性味缓涩，有续绝补髓之功，专调斫丧之阳，分理
溃乱之精，故为元阳虚惫，遗浊带下之神品。俗传本草之害人，往往如此，况此丹尽属骨肉
有情之品，温养吾身之气血，与无情之草木悬殊。叶天士用人乳粉、秋石霜、血余灰之类，
引人身之膏脂，以为继续之计，亦由此方中悟出。若紫河车污秽有毒，服之无不发热减食，
岂非惑于以人补人之说，忍心害理，适以自KT 也耶？又按∶明胶是取嫩肥黄牛皮，以河水制
造为之，或用牛肉煎法去滓，再熬成膏，每斤入姜制半夏末二两，名为霞天膏，治痨伤久嗽
。乾隆丁未，余肄业鳌峰书院，孟瓶庵师言其督学四川时，患嗽数月，同寅制馈，原素不食
牛，拜受而不敢尝。署中阅卷张友，患痰症二十余载，喜而尝之，胶痰成块，吐出甚多，半
月全愈，身体立见壮健，附志之以广其传。
王节斋云∶人若色欲过度，伤损精血，必生阴虚火动之病，睡中盗汗，午夜发热，哈哈
咳嗽
肉消瘦，此名痨瘵，最重难治。轻者用药数十服，重者期以岁年，然必须病患惜命，坚心定
志，绝房室，息妄想，戒恼怒，节饮食，以自培其根，此谓内外交治，可获全功。
潘按∶古人所谓虚劳，皆是纯虚无阳之症，与近日之阴虚火旺者，吐血咳嗽正自相反，
误用
致害人为幸甚。
周氏总注∶予读此十方，俱出人意表，其间次第缓急，可为千百世法，即不必十方并用
，要
血症者，辄用六味地黄增减，冀其收功，皆由《医贯》入手，而未尝从《神书》体会者也。
彼之肾水衰，（足少阴）则火炎为患，壮水之主，可镇阳光，孰知人之患此病者，阴虚（肾）固
多，而他因者，亦复不少。假如从劳役饥饱而得者，其伤在足太阴（脾）矣；从忧患而得者，
其伤在手少阴（心）矣；从嗜饮而得者，其伤在手太阴（肺）矣；从愤怒而得者，其伤又在足厥
阴（肝）矣。此足致吐血、咳血、咯血等症，岂一壮水可以胜其任乎？总之，人身之血，附气
而行者也。一脏伤，则气必不调，而血遂溢于外。故逆则上出，坠则下行，滞则阻痛，寒则
凝，热则散，此自然之势也。后之君子，于诊视之际，闻问之余，斟酌而得其情否乎？果能
于此着眼，视其病之所伤在何脏？脉之所伤在何部？时之所值在何季？思过半矣。曾治一咯血
之人，平日极劳，每咯紫黑色俱成小块者，然必是饱食则多，少食则少，不食或少或无，余
以韭汁童便制大黄治之，二服可安，后以补中益气汤加血药而愈。知者以为怪妄，予谓极平
常，盖实从《神书》究心，而置《医贯》为谈料者也。
黑嘴白鸭（一只） 大红枣（二升） 参苓平胃散（一升） 陈年煮酒（一瓶）
先将鸭子绑住脚，根据病人能饮酒的量，随量将酒烫温，割开鸭颈，让鸭血滴入酒中，搅拌均匀后饮用，药力直入体内。填入参苓平胃散的药末，填满鸭肚，用麻绳扎紧，取一个砂瓶，将鸭子放入其中，四周用火慢煨，分三次加入陈酒，煮至酒干为止，然后吃枣子，阴干，随意用参汤送服，之后再服用补髓丹，就能补髓生津，调和气血。
参苓平胃散一升，京枣二升，酒一瓶，黑嘴白毛肥鸭一只，按照方子依法制作斟饮。
陈修园按语：怯弱日久，极度虚弱疲惫，而且咳嗽不止，那么肺就会因为咳嗽而日益动荡受扰。吐痰不止，那么肺也会因此受损，这是草木药物所能治疗的。所以用黑嘴白鸭一只作为君药，因为羽毛白色的味道较清而入肺，嘴巴黑色的骨头也黑而入肾，取金水相生的意义，也是借助异类有情之物来补益人体。最妙的是加入京枣二升，取其甘温以补胃。平胃散一升，取其消食导滞以运转胃气，胃是五脏六腑的根本，胃安则脏腑都安，这与保真汤佐以厚朴的意义相同。叶天士对此书也参透了其旨意，但他的方子随症加入，导致学徒刊刻汇案时，使用厚朴的，在虚劳门只收录一方，大概是因为中等资质以下的人不可以谈论高深的道理，重视其道而不轻易传授吗？陈修园则与此不同。
久患痨病，身体虚弱疲惫，骨髓干枯，精气竭绝，血液枯少，气也稀少，服用煎药痊愈后，服用此药。
猪脊骨（一条） 羊脊骨（一条） 甲鱼（一枚） 乌鸡（一只）
这四味药处理干净，去骨留肉，用一大碗酒，在沙瓮内煮熟后捣细，再用下面的药。
大山药（五条） 莲子肉（半斤） 大红枣（一百枚） 经霜柿子（十个）
这四味药修整处理干净，用一大瓶井花水，在沙瓮内煮熟后捣细，与前熟肉混合一处，用慢火熬制，再加入明胶（四两） 黄蜡（三两）
以上两味药逐渐加入，与前八味药合在一起，研成膏状，和平胃散药末、四君子汤药末、知母黄柏药末各一两，制成梧桐子大小的丸药，每次服用一百丸，不拘时候，用枣汤送下。
猪羊脊骨鸡和甲鱼，煮后捣细应当去骨需要。霜柿十枚京枣百颗，建莲八两山药五条。熟和前味熬文火，黄蜡明胶逐渐加入诸药。知母黄柏四君平胃散末，各和一两制成丸茹。
陈修园按语：久患痨病，身体虚弱疲惫，骨髓干枯，精气竭绝等症状，服用煎药痊愈后，服用此药二十个字，是说虚劳已经痊愈后的症状，筹划一种不经过尝试的方法。初服之间可能稍见效，久了没有不加重加剧的，名医们都束手无策。然而药是用来治病的，食物是用来养人的，这两句话参透，大有妙议。大概得病日久，日日在药中，肠胃如同禾黍之肠改充杂草，肠胃所厌恶的是药，如果再以药投之，是重重困顿而不能承受了。先生用山药、莲子肉、京枣、霜柿，取日常食用的果菜，以愉悦脾胃的性情，用猪髓、羊髓、甲鱼、乌鸡、牛胶，日常食用的肉食，以充实脾胃的虚馁，这就是扁鹊所说的损伤脾脏的，调理其饮食。《内经》所说的精不足的，用味厚之物来补益，就是这个意思。只有方中的黄蜡一味，俗医见到它，无不惊骇。《本草备要》说服用此物，附着于肠胃，让人泻利不止。威喜丸用此熔化做丸。王晋三注解说：黄蜡性味缓涩，有接续断绝、补髓的功效，专门调理耗损的元阳，分理溃乱的精气，所以是元阳虚惫、遗浊带下的神品。世俗流传的本草害人的情况，往往如此，何况此丹尽是骨肉有情之品，温养我们的气血，与无情的草木悬殊很大。叶天士用人乳粉、秋石霜、血余灰之类，引入人身之膏脂，作为继续之计，也是从这个方子中悟出的。如果紫河车污秽有毒，服用后无不发热减食，岂不是惑于以人补人的说法，忍心害理，恰好是自取祸害吗？又按：明胶是取嫩肥黄牛皮，用河水制造为之，或者用牛肉煎法去滓，再熬成膏，每斤加入姜制半夏末二两，名为霞天膏，治疗痨伤久咳。乾隆丁未年，我在鳌峰书院学习，孟瓶庵老师说他督学四川时，患咳嗽数月，同僚制作馈赠，原本不吃牛肉，拜受而不敢尝。署中阅卷张友，患痰症二十多年，喜欢而尝之，胶痰成块，吐出很多，半月全愈，身体立即见壮健，附记以此广传。
王节斋说：人如果色欲过度，伤损精血，必生阴虚火动之病，睡中盗汗，午夜发热，哈哈咳嗽，肌肉消瘦，这名叫痨瘵，最重难治。轻者用药数十服，重者期待以岁年，然而必须病患惜命，坚心定志，绝房室，息妄想，戒恼怒，节饮食，以自培其根，这叫内外交治，可获全功。
潘按语：古人所谓的虚劳，都是纯虚无阳的症状，与近日之阴虚火旺者，吐血咳嗽正自相反，误用致害人为幸甚。
周氏总注：我读这十方，都出人意表，其间次第缓急，可为千百世法，即使不必十方并用，要治疗血症者，辄用六味地黄加减，希望其收功，皆由《医贯》入手，而未尝从《神书》体会者也。那人的肾水衰（足少阴），则火炎为患，壮水之主，可镇阳光，孰知人之患此病者，阴虚（肾）固多，而他因者，亦复不少。假如从劳役饥饱而得者，其伤在足太阴（脾）矣；从忧患而得者，其伤在手少阴（心）矣；从嗜饮而得者，其伤在手太阴（肺）矣；从愤怒而得者，其伤又在足厥阴（肝）矣。这足以致吐血、咳血、咯血等症状，岂是一味壮水可以胜任的吗？总之，人身之血，附气而行者也。一脏伤，则气必不调，而血遂溢于外。故逆则上出，坠则下行，滞则阻痛，寒则凝，热则散，这是自然之势也。后之君子，于诊视之际，闻问之余，斟酌而得其情否乎？果能于此着眼，视其病之所伤在何脏？脉之所伤在何部？时之所值在何季？思过半矣。曾治一咯血之人，平日极劳，每咯紫黑色俱成小块者，然必是饱食则多，少食则少，不食或少或无，余以韭汁童便制大黄治之，二服可安，后以补中益气汤加血药而愈。知者以为怪妄，予谓极平常，盖实从《神书》究心，而置《医贯》为谈料者也。
For all chronic deficiency, extreme exhaustion, accompanied by coughing with expectoration, hemoptysis, and fever.
Black-beaked white duck (one) Large jujubes (two sheng) Shenling Pingwei San (one sheng) Aged boiled wine (one bottle)
Tie the duck's feet firmly first. Measure the amount of wine the patient can drink, warm the wine according to that amount, cut open the duck's neck, let the blood drip into the wine, stir evenly, and drink it. The medicinal power enters directly into the body. Fill the duck's stomach with the powder of Shenling Pingwei San until full, tie it tightly with hemp rope, place a clay pot, put the duck inside, and slow-roast around it with fire. Add aged wine three times, boil until the wine is dry. Then eat the jujubes, dry them in the shade, and take them at will with ginseng decoction. Afterwards, take Busui Dan, which will tonify marrow, generate fluids, harmonize blood, and smooth qi.
Shenling Pingwei San one sheng, large jujubes two sheng, one bottle of wine, one black-beaked white-feathered fat duck, prepare and serve according to the prescription.
Chen Xiuyuan's commentary: Deficiency lasting for a long time, extreme weakness and exhaustion, coupled with incessant coughing, causes the Lung to be increasingly disturbed due to coughing. Incessant expectoration further damages the Lung, which is treatable by herbal medicines. Therefore, use one black-beaked white duck as the sovereign drug. White feathers indicate a clear taste entering the Lung; a black beak indicates black bones entering the Kidney, taking the meaning of Metal generating Water, and also utilizing sentient beings of different species to tonify the body. Most ingeniously, add two sheng of large jujubes, taking their sweet and warm nature to tonify the Stomach. One sheng of Pingwei San takes its function of resolving stagnation and transforming Stomach Qi. The Stomach is the root of the five Zang and six Fu organs; if the Stomach is peaceful, all organs are peaceful. This shares the same meaning as Baozhen Tang supplemented with Houpo (Magnolia Bark). Ye Tianshi also penetrated the purport of this book, but his prescriptions were added according to symptoms, leading apprentices to compile cases where only one formula using Houpo was collected in the consumptive disease section. Perhaps those of average intelligence cannot be spoken to about higher principles, valuing the way without lightly transmitting it? Chen Xiuyuan differs from this.
For chronic consumption with weakness and exhaustion, dry marrow, exhausted essence, withered blood, and scanty qi, after recovery from decoction medicine, take this medicine.
Pig spinal cord (one strip) Sheep spinal cord (one strip) Soft-shelled turtle (one) Black-bone chicken (one)
Process these four ingredients cleanly, remove bones keeping the meat, cook thoroughly in a large bowl of wine in a clay urn, then pound finely. Use the following herbs next.
Large Chinese yam (five strips) Lotus seeds (half jin) Large jujubes (one hundred pieces) Frost persimmons (ten pieces)
Process these four ingredients cleanly, cook thoroughly in a large bottle of well water in a clay urn, then pound finely. Mix with the previously cooked meat, simmer over slow fire. Then gradually add Mincollagen (four liang) Beeswax (three liang).
Mix these two with the previous eight ingredients, grind into a paste, and mix with Pingwei San powder, Sijunzi Tang powder, and Zhimu Huangbai powder, each one liang. Form pills the size of paulownia seeds. Take one hundred pills per dose, at any time, washed down with jujube decoction.
Pig and sheep spinal cords, chicken, and soft-shelled turtle; boiling and pounding requires bone removal. Ten frost persimmons, one hundred large jujubes, eight liang of Jianlian lotus seeds, five strips of yam. Simmer the cooked mixture with gentle fire, gradually adding beeswax and collagen. Mix with powders of Zhimu, Huangbai, Sijunzi, and Pingwei San, one liang each, to form pills.
Chen Xiuyuan's commentary: For chronic consumption with weakness and exhaustion, dry marrow, and exhausted essence, after recovery from decoction medicine, taking this medicine addresses the post-recovery state of consumptive disease, planning a method not tested empirically. Initial doses may show slight effect, but prolonged use inevitably worsens the condition, leaving famous doctors helpless. However, medicine treats disease, food nourishes people. Penetrating these two phrases reveals profound wisdom. Having been ill for a long time, daily immersed in medicine, the intestines and stomach become like weeds replacing grain; what the gastrointestinal tract detests is medicine. To administer more medicine would be to burden it beyond endurance. The master uses Chinese yam, lotus seeds, large jujubes, and frost persimmons, selecting daily fruits and vegetables to please the spleen and stomach's temperament. Using pig marrow, sheep marrow, soft-shelled turtle, black-bone chicken, and beef glue, daily meat products, to fill the spleen and stomach's deficiency. This aligns with Bian Que's saying: "For damage to the spleen, regulate diet." And the *Neijing* saying: "For insufficiency of essence, tonify with flavor." Only the beeswax in the formula startles ordinary physicians. *Bencao Bei Yao* states that consuming this substance adheres to the intestines and stomach, causing persistent diarrhea. Weixi Wan uses melted beeswax for pills. Wang Jinshan annotated: Beeswax has a slow and astringent nature, possessing the power to reconnect severed parts and tonify marrow, specifically regulating depleted primal yang and sorting chaotic essence, making it a divine product for primal yang deficiency, seminal emission, turbid discharge, and leukorrhea. The harm caused by popularized materia medica is often like this. Moreover, this pill consists entirely of sentient flesh and bone products, warming and nourishing our qi and blood, vastly different from insentient herbs. Ye Tianshi used human milk powder, autumn stone frost, and burnt hair ash, introducing bodily lipids as a continuation strategy, also inspired by this formula. If Ziheche (placenta) is dirty and toxic, causing fever and loss of appetite upon ingestion, is it not bewitched by the theory of supplementing humans with humans, acting against reason and harming oneself? Note: Mingjiao (collagen) is made from tender, fatty yellow cowhide using river water, or by boiling beef, removing dregs, and boiling into a paste. Adding two liang of ginger-processed Banxia powder per jin creates Xiatiang Gao, treating consumption-induced chronic cough. In the Dingwei year of Qianlong, while studying at Aofeng Academy, my teacher Meng Ping'an said that when serving as Education Commissioner in Sichuan, he suffered from cough for months. Colleagues prepared gifts, but since he did not eat beef, he accepted gratefully but dared not taste it. Zhang You, an examiner in the office suffering from phlegm disease for over twenty years, liked it and tasted it. The collagen-phlegm formed clumps, expelled in large quantities, cured completely in half a month, with immediate improvement in physical strength. I record this to spread its transmission.
Wang Jiezai said: If one indulges excessively in sexual desire, damaging essence and blood, one must develop Yin deficiency with hyperactive fire. Symptoms include night sweats during sleep, midnight fever, hacking cough, and emaciation. This is called Laozai (consumption), the most severe and difficult to treat. Mild cases require dozens of doses; severe cases may take years. However, the patient must cherish life, strengthen resolve, abstain from sex, cease delusions, avoid anger, and regulate diet to cultivate their root internally. This is internal and external combined treatment, achieving complete success.
Pan's note: The ancient concept of Xu Lao (deficiency labor) refers to pure deficiency without Yang, opposite to recent cases of Yin deficiency with fire hyperactivity presenting with hematemesis and cough. Misuse leads to harm, which is fortunate.
Zhou's General Commentary: Reading these ten formulas, they are all unexpected. Their sequence and urgency can serve as a model for thousands of generations. Even if not all ten are used together, those treating blood disorders often modify Liuwei Dihuang Wan, hoping for efficacy, starting from *Yi Guan*, without experiencing the *Shen Shu*. When Kidney Water (Foot Shaoyin) is deficient, Fire flares up as a disaster. Strengthening the Master of Water can suppress excessive Yang. Who knows that among those suffering from this disease, Yin deficiency (Kidney) is indeed common, but other causes are also numerous. If contracted from labor and hunger/fullness, the injury is in Foot Taiyin (Spleen); from worry and grief, the injury is in Hand Shaoyin (Heart); from excessive drinking, the injury is in Hand Taiyin (Lung); from anger, the injury is in Foot Jueyin (Liver). These can lead to hematemesis, hemoptysis, and spitting blood. Can merely strengthening Water suffice? In short, blood in the human body travels attached to Qi. Injury to one Zang causes Qi imbalance, leading to blood overflowing outward. Thus, rebellion causes upward exit, sinking causes downward flow, stagnation causes obstruction and pain, cold causes coagulation, heat causes dispersion. This is the natural trend. Future scholars, during diagnosis and inquiry, do they weigh and grasp the true situation? If one focuses on this, observing which Zang is injured by the disease, which pulse position is damaged, and which season corresponds to the time, one has thought through more than half. I once treated a person with hemoptysis who worked extremely hard, always spitting small purple-black clots. It was definitely more after full meals, less after eating little, and none or very little after fasting. I treated him with Chive juice, child's urine, and processed Rhubarb. Two doses brought relief, followed by Buzhong Yiqi Tang added with blood-invigorating herbs, resulting in cure. Those who know consider it strange and absurd; I say it is extremely ordinary. Truly, I studied deeply from *Shen Shu* and treated *Yi Guan* as mere talk material.