答曰。夫有劳役之劳。有劳伤之劳。役之劳。所用太过。脏腑之气失其常度所以致疾。虚则
已有所亏。劳则因有所损。其积之有渐。成之有日。岂一朝一夕而骤致哉。巢氏云。五劳六
极七伤。 谓之虚劳也。今寻原指要而论之。若腹胁有块。大小成形。按之不动。推之不移
。久久令人寒热如疟。咳嗽。面目浮肿。动辄微喘。日就羸瘦。此繇暴怒惊恐。气上而不下
。动伤于肝。气聚而不散。结而成形。结久而变劳。又有日顿羸瘦。气短乏力。腰背牵急。
膝胫酸痿。小便或赤。或白而浊。带下不禁。梦与鬼交。翕翕如热。骨肉烦疼。此繇房劳过
度。精耗气竭。得之于肾。为劳尤速也。
柏子仁丸。治妇人血闭不通。渐成痨瘵。
柏子仁(别研) 当归(洗) 熟地 白茯苓 丹皮 卷柏 白芍药 石斛 巴戟(去心) 肉苁
蓉(酒浸) 山药 杜仲 白薇 蒲黄 枳壳 肉桂 京三棱(煨) 莪术(煨) 覆盆子 枸杞
子(各一两) 附子(炮去皮脐半两)
上为细末。炼蜜丸梧桐子大。每服五十丸。温酒或米饮下。空心食前。人参锉散。去热解劳
。调顺经水。滋养新血。药性中和。退热。无大寒极冷之剂。
黄 (三分) 黄芩 赤茯苓 白术 熟地 赤芍药 麦冬(各一两) 柴胡(半两) 人参 知
母当归 甘草(炙各三钱五分)
上并生锉如麻豆大。焙干入瓷器中收。每服四钱。水一盏半。竹叶、灯心三寸长。各七茎。
同煎七分。去滓温服。不拘时候。日三服。如病退。不必服。
沉香煎。治暴怒惊恐气逆上而不下，动伤于肝。气聚而不散。结而成形。
石斛(五两) 川椒(炒去目) 附子(炮去皮脐) 秦艽(去土) 柴胡(去苗) 沉香 木香 鳖
甲(醋煮刮去筋膜) 黄 槟榔(各二两)
上为细末。先用新枸杞十斤。洗略捶碎。法酒二斗。煮取七升。取枸杞根。别用法酒三升。
洗拍令净。与酒一处。更入蜜四两。煮成膏。和前件药末。丸如桐子大。米饮下三十丸。食
前日二服。一方加柴胡二两。杨氏方妇人患脾血病。时觉腹痛恶心。五心烦热。如劳之状。
或进或退。经候行而食惊恐所致。令服局方四物汤加吴茱萸同煎。温服病愈。
逍遥散
四物汤加柴胡 又正方 白茯苓 白术 白芍 柴胡 当归 甘草 人参
每服用煨姜一块。薄荷少许。不拘时煎服。
胶艾汤。治劳伤气血。冲任虚损。月水过多。淋沥漏下。连日不断。腹脐疼痛。及妊娠将摄
失宜。胎动不安。腹痛下坠。劳伤胞络。胎损漏血。腰痛闷乱。因损动胎上抢心。奔冲短气
。因产冲任气虚。不能约制经血。淋沥不断。延引日久。渐成羸瘦。
熟地 白芍 当归 艾叶(微炒) 阿胶(炒黄) 芎 甘草(炙各二两)
上为 咀。每服四钱。水一盏酒六分。煎八分去滓。食前热服。甚者连服内补当归丸。(见
五十三问)
答：所谓劳损，分为“役之劳”和“劳伤之劳”。“役之劳”是指体力或脑力过度使用，导致脏腑之气失去正常的节度，从而引发疾病。虚证是因为原本已有亏损，劳累则进一步造成损伤。这种积累是逐渐形成的，日积月累才成病，难道是一朝一夕就能突然导致的吗？巢元方说：“五劳、六极、七伤”，统称为虚劳。现在追溯其本源并依据《诸病源候论》的要旨来论述：
如果腹胁部有肿块，大小成形，按压不动，推之不移，久而久之使人出现寒热往来如疟疾状，咳嗽，面目浮肿，稍微活动就轻微气喘，日渐消瘦。这是由于暴怒惊恐，气机上逆而不能下行，触动肝脏，导致气机郁结不散，凝聚而成形块，久结而转变为劳损。又有每日日渐消瘦，气短乏力，腰背牵拉拘急，膝盖和小腿酸软痿弱，小便颜色发红，或者清白而浑浊，带下淋漓不止，梦中与鬼交合，身体忽冷忽热像发烧一样，骨肉烦扰疼痛。这是由于房事过度，精液耗竭，元气耗尽，病根在肾，因此形成劳损的速度尤其快。
柏子仁丸：治疗妇人经血闭阻不通，逐渐形成痨瘵（慢性消耗性疾病）。
药材：柏子仁（单独研碎）、当归（洗净）、熟地黄、白茯苓、牡丹皮、卷柏、白芍药、石斛、巴戟天（去心）、肉苁蓉（酒浸）、山药、杜仲、白薇、蒲黄、枳壳、肉桂、京三棱（煨制）、莪术（煨制）、覆盆子、枸杞子（以上各一两）、附子（炮制，去皮脐，半两）。
制法与用法：将上述药物研为细末，用炼蜜制成梧桐子大小的丸剂。每次服用五十丸，用温酒或米汤送服，空腹或在进食前服用。
人参锉散：去除热邪，解除劳损，调理顺达经水，滋养新血。药性平和中和，退热，没有大寒极冷的药剂。
药材：黄芪（三分）、黄芩、赤茯苓、白术、熟地黄、赤芍药、麦冬（以上各一两）、柴胡（半两）、人参、知母、当归、甘草（炙，以上各三钱五分）。
制法与用法：将上述药物生切如麻豆大小，焙干后放入瓷器中收藏。每次服用四钱，加水一盏半，竹叶、灯心草（三尺长）各七茎，一同煎煮至七分满，滤去药渣，温服。不拘时候，每日三次。如果病情减退，不必再服。
沉香煎：治疗因暴怒惊恐导致气机上逆不能下行，触动肝脏，气机郁结不散，凝聚而成形块。
药材：石斛（五两）、川椒（炒去目）、附子（炮制，去皮脐）、秦艽（去土）、柴胡（去苗）、沉香、木香、鳖甲（醋煮刮去筋膜）、黄芪、槟榔（以上各二两）。
制法与用法：将上述药物研为细末。先用新枸杞十斤，洗净略加捶碎，用美酒二斗，煮取七升汁液。另取枸杞根，另外用美酒三升，洗净拍碎，与前取的枸杞汁混合，再加入蜂蜜四两，熬制成膏。将前述药末与膏混合，制成梧桐子大小的丸剂。每次服用三十丸，用米汤送服，饭前服用，每日两次。另一方法加入柴胡二两。杨氏方记载：妇人患脾血病，时常感觉腹痛恶心，五心烦热，如同劳损的症状，时好时坏，月经来潮且伴有惊恐所致。令患者服用局方四物汤加吴茱萸同煎，温服，病愈。
逍遥散：
配方：四物汤加柴胡。又一方正名为：白茯苓、白术、白芍、柴胡、当归、甘草、人参。
用法：每剂服用时加煨姜一块，薄荷少许，不拘时候煎服。
胶艾汤：治疗劳伤气血，冲任脉虚损，导致月经量多，淋漓漏下，连日不断，腹脐疼痛。以及妊娠期间调摄失宜，胎动不安，腹痛下坠，劳伤胞络，胎损漏血，腰痛闷乱，因损伤触动胎儿上冲于心，奔冲感伴短气。因生产导致冲任气虚，不能约束经血，淋漓不断，拖延日久，逐渐形成消瘦。
药材：熟地黄、白芍、当归、艾叶（微炒）、阿胶（炒黄）、川芎、甘草（炙，以上各二两）。
制法与用法：将上述药物切碎。每次服用四钱，加水一盏、酒六分，煎煮至八分满，滤去药渣，食前热服。病情严重者连续服用内补当归丸。（见第五十三问）
Answer: There are two types of labor-induced injury: "labor from exertion" (Yao Lao) and "labor from damage" (Lao Shang). "Labor from exertion" refers to excessive use, causing the Qi of the Zang-Fu organs to lose their normal regulation, thereby leading to disease. Deficiency implies prior depletion, while labor causes further damage. This accumulation is gradual, forming over time; how could it occur suddenly in a single day or night? Chao Yuanfang stated that "Five Labors, Six Extremes, and Seven Injuries" are collectively referred to as Deficiency Labor (Xu Lao). Now, tracing its origin and discussing it based on the essentials of *Zhu Bing Yuan Hou Lun*:
If there are masses in the abdomen and hypochondrium, formed into shapes of various sizes, immovable upon pressing and unpushable, over time causing chills and fever resembling malaria, coughing, edema of the face and eyes, slight panting upon slight exertion, and progressive emaciation. This arises from violent anger or fright, causing Qi to ascend but not descend, disturbing the Liver. Qi gathers and does not disperse, condensing into a shape; long-standing condensation transforms into labor. Alternatively, daily progressive emaciation, shortness of breath, fatigue, pulling tension in the waist and back, soreness and weakness in the knees and shins, urine appearing red or clear and turbid, uncontrollable leukorrhea, nocturnal emissions with dreams of sexual intercourse with spirits, feeling hot and cold intermittently, and irritability with bone and muscle pain. This arises from excessive sexual activity, depleting essence and exhausting Qi, originating in the Kidney; thus, labor develops particularly rapidly.
Baizi Ren Wan (Platycladi Seed Pill): Treats women with blood obstruction and amenorrhea, gradually developing into consumptive disease (Lao Zhai).
Ingredients: Baizi Ren (Bai Zi Ren, Platycladi Semen) [separately ground], Dang Gui (Angelicae Sinensis Radix), Shu Di Huang (Rehmanniae Radix Praeparata), Bai Fu Ling (Poria), Mu Dan Pi (Moutan Cortex), Juan Bai (Selaginellae Herba), Bai Shao Yao (Paeoniae Radix Alba), Shi Hu (Dendrobii Caulis), Ba Ji Tian (Morindae Officinalis Radix) [heart removed], Rou Cong Rong (Cistanche Caulis) [soaked in wine], Shan Yao (Dioscoreae Rhizoma), Du Zhong (Eucommiae Cortex), Bai Wei (Cynanchi Atrati Radix), Pu Huang (Typhae Pollen), Zhi Qiao (Aurantii Fructus Immaturus), Rou Gui (Cinnamomi Cortex), Jing San Leng (Sparganii Rhizoma) [roasted], E Zhu (Curcumae Rhizoma) [roasted], Fu Pen Zi (Rubiae Fructus), Gou Qi Zi (Lycii Fructus) [each 1 liang], Fu Zi (Aconiti Lateralis Radix Praeparata) [processed, skin and umbilicus removed, 0.5 liang].
Preparation and Administration: Grind the above ingredients into fine powder. Mix with refined honey to form pills the size of paulownia seeds. Take 50 pills per dose, administered with warm wine or rice water, on an empty stomach or before meals.
Renshen Cuo San (Ginseng Powder): Clears heat, relieves labor, regulates menstruation, and nourishes new blood. The medicinal nature is mild and balanced, reducing fever without using excessively cold agents.
Ingredients: Huang Qi (Astragali Radix) [3 fen], Huang Qin (Scutellariae Radix), Chi Fu Ling (Poria with Red Host), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Shu Di Huang (Rehmanniae Radix Praeparata), Chi Shao Yao (Paeoniae Radix Rubra), Mai Dong (Ophiopogonis Tuber) [each 1 liang], Chai Hu (Bupleuri Radix) [0.5 liang], Ren Shen (Ginseng Radix et Rhizoma), Zhi Mu (Anemarrhenae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) [each 3 qian 5 fen].
Preparation and Administration: Cut the raw ingredients into pieces the size of hemp seeds. Dry them by baking and store in porcelain vessels. Take 4 qian per dose. Add 1.5 cups of water, 7 stalks of Zhu Ye (Phyllostachydis Folium) and Deng Xin Cao (Junci Medulla) each about 3 cun long. Decoct until reduced to 0.7 parts. Strain and take warm. No specific timing required; take three times daily. If symptoms subside, discontinue use.
Chen Xiang Jian (Agarwood Decoction): Treats conditions where violent anger or fright causes Qi to ascend and not descend, disturbing the Liver, leading to Qi gathering, failing to disperse, and condensing into masses.
Ingredients: Shi Hu (Dendrobii Caulis) [5 liang], Chuan Jiao (Sichuan Pepper) [stir-fried, eyes removed], Fu Zi (Aconiti Lateralis Radix Praeparata) [processed, skin and umbilicus removed], Qin Jiao (Gentianae Macrophyllae Radix) [cleaned of soil], Chai Hu (Bupleuri Radix) [weeds removed], Chen Xiang (Aquilariae Lignum Resinatum), Mu Xiang (Aucklandiae Radix), Bie Jia (Trionycis Carapax) [boiled in vinegar, fascia scraped off], Huang Qi (Astragali Radix), Bing Lang (Arecae Semen) [each 2 liang].
Preparation and Administration: Grind the above ingredients into fine powder. First, take 10 jin of fresh Goji berries, wash and slightly crush them. Boil in 2 dou of good wine until 7 sheng of liquid remains. Separately, take Goji roots, wash and crush them clean using 3 sheng of good wine. Combine the root liquid with the berry liquid, add 4 liang of honey, and boil into a paste. Mix this paste with the aforementioned powder to form pills the size of paulownia seeds. Take 30 pills per dose with rice water, twice daily before meals. Another formula adds 2 liang of Chai Hu. Yang’s Formula states: For women suffering from Spleen-Blood disease, experiencing occasional abdominal pain and nausea, five-palm heat, resembling labor symptoms, fluctuating in severity, caused by menstruation combined with fright. Prescribe Ju Fang Si Wu Tang (Four Substances Decoction from the Bureau Formulary) decocted with Wu Zhu Yu (Evodiae Fructus). Take warm until cured.
Xiao Yao San (Free and Easy Wanderer Powder):
Formula: Si Wu Tang (Four Substances Decoction) plus Chai Hu (Bupleuri Radix). Another correct version includes: Bai Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Bai Shao (Paeoniae Radix Alba), Chai Hu (Bupleuri Radix), Dang Gui (Angelicae Sinensis Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Ren Shen (Ginseng Radix et Rhizoma).
Administration: For each dose, add one piece of roasted ginger and a small amount of bo he (Menthae Haplocalycis Herba). Decoct and take at any time.
Jiao Ai Tang (Donkey-Hide Gelatin and Mugwort Decoction): Treats labor injuring Qi and Blood, deficiency and damage to the Chong and Ren meridians, resulting in menorrhagia, dripping leukorrhea continuing for days, and abdominal/umbilical pain. It also treats improper care during pregnancy leading to fetal restlessness, abdominal pain and bearing-down sensation, labor damaging the uterine collaterals, fetal damage with bleeding, lower back pain with mental confusion, fetal movement rushing upward to the heart causing a sensation of rushing and shortness of breath. Due to childbirth causing deficiency of Qi in the Chong and Ren meridians, inability to control menstrual blood, leading to continuous dripping, prolonged duration, and gradual emaciation.
Ingredients: Shu Di Huang (Rehmanniae Radix Praeparata), Bai Shao Yao (Paeoniae Radix Alba), Dang Gui (Angelicae Sinensis Radix), Ai Ye (Artemisiae Argyi Folium) [lightly stir-fried], E Jiao (Asini Corii Colla) [stir-fried until yellow], Xiong (Chuanxiong Rhizoma), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) [each 2 liang].
Preparation and Administration: Cut the ingredients into coarse pieces. Take 4 qian per dose. Add 1 cup of water and 0.6 cup of wine. Decoct until 0.8 parts remain. Strain and take hot before meals. For severe cases, continuously administer Nei Bu Dang Gui Wan (Internal Nourishing Angelica Pill) (see Question 53).