但较平时必然稍旺。慎勿轻用疏风散表。以风药性皆上升。嗽喘咸非所宜。亦不可妄与清肺止嗽。
转伤胃气。为害不浅。当此宜暂停补药。静以养阴。邪自退听。内本多火。腠理必疏。或啜热汤
稀饮。汗气随通。邪即解散。先哲有云。阴虚火旺人。元气伤损。虽有客邪。切忌羌、防、柴、
葛等升发散表之剂。设不知此。误用风药。则风乘火势。火助风威。以煽动其阴邪。轻则虚阳扰乱
不宁。重则气随汗脱而毙。盖邪气方张。如日之初升。虽有合剂。遏之愈逆。不获已而用药。只
宜小剂葱白、香豉以解散之。若阴火原不太盛。小建中、黄 建中。亦无妨碍。误用保肺药。必
咳嗽益甚。即于建中汤稍加葳蕤、细辛以搜散
之。俟其势衰脉虚。确遵赵以德甘寒杜风清热之例。庶无差误。如六味合生脉。去萸肉。倍地黄、
人参。加葳蕤。大剂作汤。晨夕兼进。合标本而为施治。服后咳嗽稍减。蒸热未除。此虚阳不能
敛制也。加牛膝、鳖甲以滋下源。分先后而为处裁。然鳖甲非九肋者。必不能应手也。若因饮食
过度者。亦宜暂停补药以观其势。慎勿轻与消导。戕伐其胃。以招虚虚之谤。惟枳实理中、甘草
干姜二汤。分别本元及所停多少而裁用可也。因劳役饥饱者。补中益气去升麻加煨葛。提挈脾胃
之清阳。则邪火自降。若阴虚火炎。断无升举之理。后人不审。每以升、柴治阴虚火旺。无不蒙
其害者。虚劳不足。汗出而闷。脉结心悸。行动如常。不出百日危。炙甘草汤主之。千金翼法也。
若少年禀气不足。因饮食饥饱所伤。致成虚损。日晡潮热。形体羸弱。腹胀气急。脉来弦数者。
白凤膏最当。此葛可久法也。
大约咳嗽发热。始先以泄气为主。若久嗽不止。必然气虚火旺。一切耗气之药。俱不可用。
如桔梗、杏仁、橘红、苏子。皆主疏泄。非久嗽所宜。若气耗甚者。又当以保元、生脉收敛之。
此新久虚实。不同治也。
有郁证发热喘咳。误用寒折。致心火淫肺。肺被火淫。势不得不奔迫大肠而成泄泻。慎不可
用温补脾胃药。惟逍遥散随证加减。多服乃效。思虑不遂。心神耗散。日渐发热。肌肉瘦削而成
风消。内经所谓二阳之病发心脾。以风热胜气。日益消瘦也。宜多服逍遥散。后用归脾汤调理。
妇人血既满而失合。男子精未充而思室。多成是证。妇人则经闭血溢。男子则亡血失精。并宜巽
顺丸。专调冲任。兼散瘀血。瘀血散。后更与乌骨鸡丸调补之。若误用苦寒凉血药。致脾胃滑脱者不治。
嫠妇师尼。所欲未遂。阴阳离绝。郁火亢极。不得发泄而成失合证者。较之房劳更甚。始则肝
木郁热。继则龙火上煽。
致心肺受病而喘嗽烦热。甚则迫血骤亡者有之。经闭不行而吐衄者有之。此证宜开郁降火。增损
柴胡汤、加味逍遥散选用。阴火亢极者。可用滋肾丸、玉烛散光泻郁火。后服滋养之药。如乌骨
鸡丸之类。若郁火不泄。血气不荣而发痈疽者。去生远矣。
刘默生云。虚劳多起于郁。郁则其热内蒸。内蒸则生虫。虫侵蚀脏则咳。初起早为杜绝。不
致蔓延。若迁延日久。咳嗽不止。痰如白沫。声哑喉痛。不可治矣。脾胃泄泻。六脉细数而坚急。
久卧床褥。烦躁血多者不治。如六脉平缓。重按有神。饮食不减。大肉未消。二便调适者。可用
贝母、麦冬消痰宁嗽。功多开郁。蛤蚧透骨追虫。佐以百部。杀虫独步。兼地骨皮、薄荷以清内
热。橘红、甘草调中和营为主。如寒热不止。加青蒿、鳖甲。骨蒸无汗。加牡丹皮。每夜发热不
已。加酒浸白芍。血虚有伤。加茜根。气虚少食。加人参。脾虚大便不实。加茯苓。燥结。加杏
仁。小便不利。加茯苓、泽泻。但觉脊中热痛不已。或时淫淫作痒者。皆是瘵虫为患。宜用向东
南桃头四五十个、生艾一握。雄黄豆大一块、麝香二分。捣烂烘热。擦脊骨膏肓百劳肺俞等穴。
及四肢关节间。七日一次。亦有用桃叶斤许。同艾叶一二两。分二囊盛。以陈酒三斤煮。乘热熨
背脊膏肓百劳等处。不过二三次。虫从魄门而下。下后以六味丸合生脉散调理。传尸劳瘵亦宜用
之。凡骨蒸以多汗为易治。气虚血尚未竭也。若干热无汗为难治。气血内涸。不能外通也。骨蒸
劳嗽。而见脉弦细数疾。面赤如妆。面黧色枯。目睛无神。眼眶陷下。汗出如珠。天柱不正。指
瘦如笾。声哑咽痛。嗽而加汗。嗽而上喘下泄。嗽而左不得眠。肝胀。嗽而右不得眠。肺胀。肉
脱骨痿而热甚。泄泻无度而畏寒。失血发热而脉数实。咳吐白血。及呕血声散。骨肉相失。阳事
不禁。暮热如焚。身热面色夭然白。及下血 。寒热脱形。脉坚搏者。皆不可治。如病久痞闭。忽得
气血冲和。心肾交媾。阳事必举。尤宜切戒房室。犯之必复。愈难调治也。大抵虚劳起于斫丧者。
肝肾过劳。多致亡血失精。强中阴竭而死。起于郁结者。内火烁津。多致血结干咳。嗜食发痈而死。
起于药误者。脾肺受病居多。多致饮食减少。喘嗽泄泻而死。此证多患于膏粱。不但所禀柔脆。
且性喜服药。小病必然变重。展转戕贼。不至伤残不已。试观贫居村野。有病何尝服药。所以得
尽天年。明哲保身。胡不自省。而甘委之庸术哉。
面色不衰。肌肤日瘦。外如无病。内实虚伤。俗名桃花疰。其证必蒸热咳嗽。或多汗。或无
汗。或多痰。或无痰。或经闭。或泄精。或吐血。或衄血。或善食。或泄泻。须察其所现何证。
何脏受伤而治之。然此皆为阴火煎熬之证。治多不效。室女过时不嫁。男子过时不娶。及少寡者。
多犯此证。以阴火虽乘阳位。非但不能消烁阳分之津液。阴分之津液。反竭力上供阳火之消烁。
故肢体日削。而面色愈加鲜泽也。轻者嫁娶后渐愈。重者虽暂愈一两月。向后必死。以其躯体柔
脆。精气先枯。不能胜其发泄也。惟少寡再醮者。每多自愈。以其躯体堪任也。郁火既散。津液
既通。可不药而愈矣。
传尸 热毒积久。则生恶虫。虫蚀人脏腑。故沉沉嘿嘿。不知所苦。无处不苦。经年累月。
渐就羸瘦。其证蒸热咳嗽不止。胸背痛。两目不明。四肢无力。腰膝酸疼。卧而不寐。或面色脱
白。或两颊时红。常怀忿怒。梦与鬼交。同气连枝。多遭传染。至于死亡。又传傍人。至于灭门。
又传他姓。惨毒之祸。闻者骇心。辨之之法。烧真安息香。病患吸烟嗽不止者。乃传尸也。若嗽
不甚者。非也。瘵虫最易传人。能谨戒七情。严避六气。常远房室。慎节饮食。虫不得传也。惟
纵欲恣情。精血内耗。邪祟外乘。凡觉元气稍虚。或腹饥馁。勿入劳瘵之家。或女病思男。男病
思女。一睹其面。随即染伤。不可不知。治疗之法。固本为先。祛虫次之。安息、阿魏、苏合、
沉香、冰片、麝香、犀角、龙齿、獭肝、獭爪、朱砂、雄黄。皆有祛邪伐恶之
灵。更以天灵盖助之。然各有所宜。若能食便秘面赤者。合用獭肝、獭爪。食少便滑面青者。合
用天灵盖。其夫死传妻。妻死传失。毒邪深入肾肝二脏者。用骨殖中水。以生甘草末收晒九次丸
服。服后必大泻数行。则热邪自大便而下也。其苏合香丸、芎归血余散、鳖甲生犀散、传尸丸。
皆治瘵之专方。若病入膏肓。不能起枯骨也。
慎柔师训云。尝治虚损。脉和缓而五六至。但咳嗽发热。无恶寒咽痛喉哽等证。以为可治。
服保元、四君之类十余剂。咳嗽略可。热亦微退。至二十剂外。咳嗽反盛。热复如前。而身反不
能转侧。足渐无力。至不能行而蜷。此何也。缘下焦肾气衰惫。无津液滋养百骸。阳气不能四运。
脾肺之气不能下输。故足无力而蜷。药虽有效。病虽暂减。终不可治。若初服四君、保元十余剂。
而脉细如丝。其数不改。决不可治。如细而不数者。此犹有胃气。无腹痛作泻而饮食如常。可用
保元、参、术调理。须二三年方愈。若服药后。数脉渐减。和缓有神。虽曰可治。亦得三月见功。
年半方可全愈。又须看年力之衰壮。精神脾胃之强弱断之。若服药后。脉虽和缓。而腿渐无力。
如前所述。且痰嗽不止。脉虽缓。治之无益。又或如前证。足虽无力。而热退嗽减。饮食如平人。
此脾胃尚强。犹可迁延岁月。又有如前证。六脉俱和缓。服前剂热退。而脉渐弦。反作泻下血。
此平时火热煎熬。血留经络。得补药气血流通。邪不能留而下。下后半月十日自愈。下血时能食
者不死。不能饮食。精神倦怠者。死可立待。吐血后反骤能食者。亦不可治。若见腹痛。理中汤。
恶心饮食少。六君子汤。无此二证。用四君、保元服之。盖下血者邪从下窍而出也。又有变作伤风
状者。邪从上窍而散也。当服补肺助脾之药。亦须半月而愈。凡病求汗不得汗者不治。虚损六脉
俱数。服滋阴降火之剂。不及四五十剂者。犹可治之。如服至百剂。真元耗尽。脉洪数而无神。
虽用补剂。而洪数变为细数。必渐痿困不起而毙矣。又或服寒凉未多。用保
元、四君加生姜一二十剂。求汗不出。而洪数之脉不退。亦难救治。或虽无汗而洪脉渐减。病亦
渐去。且能饮食。此为可治。如此之脉。大抵秋冬易治。春夏难疗。凡虚损脉六七至。若逢春夏火
令。津液枯槁。肾水正行死绝之乡。肺绝脾燥。无有不死者。若秋冬火令已退。金水正旺。脉虽
数可治也。设病者骨立声哑。喉痛寒热。腹疼作泻。而脉细数。亦属不治。凡病延至三四月。服
药已多。其不效者。必过用寒凉。五脏愈虚。邪火愈炽。初用补药数帖。邪火一退。反觉头眩恶
心。骨疼脚酸。神气昏懒。不思饮食。倘脉不细数而带和缓。急用保元、四君。大剂连服。便安
寝半月。睡觉精神顿爽。再服再寝。饮食渐增。则为可治。倘脉细如丝。腹痛昏愦者难治。凡久
病患脉。大小浮沉弦滑而三部不匀。或寸浮尺沉。或尺浮寸沉。但见病脉。反属可治。如久病浮
中沉但和缓。细察无神。而体倦甚者必死。再看其面色光润。此精神皆发于外。死期速矣。凡虚
损见数脉。为胃气不足。若转缓弱。为胃气生发之兆。乃少阳春升之气也。凡虚损病久。脉虽和
缓。未可决其必疗。盖久病之人。元气虚弱。脉反和缓。假气也。遇七八月间。服补剂。病得渐减。
此生机也。或延至十一月。一阳初动。阳气渐升。内气空虚。无以助生发之气。则变憎寒壮热。服
补剂十余帖。寒热渐退。犹可延挨调理。至二三月不变则生。否则不治。缘春夏木旺。脾肺久虚。
气衰不能敌时命耳。凡医新病初时有邪。脉浮数。服按病药数剂。数脉即退。病已向安。再数剂
则倦。脉反浮数。此时不可为尚有邪也。盖邪退而神气初转。故浮。只宜保元汤调养元气。浮数之脉。
得微汗而退。倘不识此。仍以祛邪之药治之。则变虚劳矣。久病服药后。六脉俱和。偶一日诊。或细
或数或虚弱。或变怪异常。即当细问起居之故。或因一夜不睡而变者。或因劳役恼怒。或因感冒
风寒。各随其感而治之。久病咳嗽气喘。若脉数者。不可用补药。如服之虚火一退。多令人痿倦不
起。须先用独参
汤。稍加陈皮以接其气。数日后。脉数渐退。方与调理。
〔诊〕石顽曰。金匮云。男子平人脉大为劳。极虚亦为劳。脉浮者。里虚也。脉虚浮弦为短气。
目瞑衄血。脉大者。春夏剧。秋冬瘥。男子脉浮弱而涩者。为无子。精气清冷。虚弱微细者。善
盗汗出。脉沉小迟者。溏泄。食不化。脉虚芤迟。及诸芤动微紧。男子失精。女子梦交。紧数之
脉。表里俱虚。紧为寒伤营。数为血不足。脉见短数。则无胃气。细数紧数。俱非吉祥。脉洪大
按之虚者。须防作泻。凡见数脉难治。病久脉数。尤非所宜。脉忽浮涩而数。忽沉弱而缓。变易
不常。虚火之故也。虚损转潮热泄泻。脉短数者不治。虚损脉浮大者。属阳虚。细数者。属阴虚。
芤为失血。若两手俱芤。而中有一部独弦者。为有瘀蓄未尽。当散瘀为先。不可骤补。若见数大
者。为火旺。必难治。若见涩脉来至者。亦不可治也。弦数为骨蒸。自上而下者。必寸口浮数。
自下而上者。必尺中弦急。若关尺俱弦细而急。如循弦缕者不治。又尺中弦强者。必因房室发热。
加之误服寒凉。故脉如是。然虚损之人。虽远房室。其尺脉之弦强。必不能便软。若更犯房室。
明日反和。此阴阳得交。故尔暂软。后日诊之。其弦强必愈甚。诊察之际。不可不辨也。石顽治
牙行陶震涵子。伤劳咳嗽失血。势如泉涌。服生地汁、墨汁不止。余及门周子。用热童便二升而
止。邀石顽诊之。脉得弦大而虚。自汗喘乏。至夜则烦扰不宁。与当归补血汤四帖而热除。时觉
左胁刺痛。按之漉漉有声。此少年喜酒负气。尝与人斗狠所致。与泽术麋衔汤。加生藕汁调服。
大便即下累累紫黑血块。数日乃尽。后与四乌 骨一芦茹为末。分四服。入黄牝鸡腹中煮啖。留
药蜜丸。尽剂而血不复来矣。
又治颜汝玉女。病虚羸寒热。腹痛里急。自汗喘嗽者三月余。屡更医药不愈。忽然吐血数口。
但（病情）较平时必然稍显旺盛。千万不要轻易使用疏风解表的药物。因为风药的药性都是上升的，咳嗽气喘都不适宜使用。也不可以胡乱给予清肺止嗽的药物，这样会转而损伤胃气，造成的危害不浅。在这种情况下，应当暂时停止服用补药，安静地以滋养阴液为主，邪气自然就会退却。体内本来多有虚火，腠理（皮肤毛孔及肌肉间隙）必定疏松。或者喝点热汤、稀粥，汗气随之通畅，邪气即刻解散。先哲有话说：阴虚火旺的人，元气已经受损，即使有外来的邪气，也切忌使用羌活、防风、柴胡、葛根等升散解表的药剂。如果不知道这一点，误用了风药，那么风邪会趁着火势，火势助长风威，从而煽动体内的阴邪。轻则导致虚阳扰乱而不安宁，重则会导致气随汗脱而死亡。大概邪气正盛的时候，就像太阳刚刚升起，虽然有合适的方剂，强行遏制反而更加违背病机。不得已而用药时，只宜用小剂量的葱白、香豉来解散邪气。如果阴火原本不太旺盛，小建中汤或黄芪建中汤也没有妨碍。误用保肺药，必然使咳嗽更加严重，此时可以在建中汤中稍微加入葳蕤、细辛来搜剔疏散邪气。等到病势衰退、脉象虚弱时，严格遵循赵以德甘寒祛风清热的法则，才没有差错。如六味地黄丸合生脉散，去掉山茱萸肉，加倍地黄、人参，加入葳蕤，大剂量煎汤，早晚同时服用，标本兼治。服药后咳嗽稍减，但蒸热未除，这是虚阳不能敛制的表现。加入牛膝、鳖甲以滋补肾阴下源，分清先后进行处方裁量。然而鳖甲如果不是九肋的，一定不能见效。如果是因饮食过度引起的，也应当暂停补药以观察病势，千万不要轻易给予消食导滞的药物，以免戕伐胃气，招致“虚虚”（使虚者更虚）的指责。只有枳实理中汤、甘草干姜汤二方，根据本元虚实及停食多少来分别裁量使用即可。如果是因劳役饥饱所伤，用补中益气汤去掉升麻，加入煨葛根，以提挈脾胃的清阳，那么邪火自然下降。如果是阴虚火炎，绝对没有升举的道理。后人如果不加审察，常用升麻、柴胡治疗阴虚火旺，无不蒙受其害的。虚劳不足，出汗且胸闷，脉结代且心悸，行动如常，不出百日就会危重。用炙甘草汤主治，出自《千金翼方》。如果是少年禀赋不足，因饮食饥饱所伤，导致成为虚损，日晡时分潮热，形体羸弱，腹胀气急，脉来弦数的，白凤膏最合适，这是葛可久的方法。
大约咳嗽发热，开始阶段以泄气为主。如果久咳不止，必然导致气虚火旺，一切耗气的药物都不可使用。如桔梗、杏仁、橘红、苏子，都主疏泄，不适合久咳使用。如果气耗损严重的，又应当用保元汤、生脉散来收敛元气。这是新病与久病、实证与虚证治疗方法不同的原因。
有郁证发热喘咳，误用寒凉药物折抑，导致心火淫溢于肺，肺被火邪淫溢，形势上不得不奔迫大肠而成泄泻。千万不可使用温补脾胃的药物，只有逍遥散随证加减，多服才能见效。思虑不顺，心神耗散，日渐发热，肌肉瘦削而成风消证，《内经》所谓“二阳之病发心脾”，是因为风热胜气，日益消瘦。宜多服逍遥散，后用归脾汤调理。妇人血满而失和合，男子精未充而思欲，多形成这种病症。妇人则经闭血溢，男子则亡血失精，都适宜用巽顺丸，专门调理冲任二脉，兼散瘀血。瘀血散去后，再给乌骨鸡丸调补。如果误用苦寒凉血药，导致脾胃滑脱的，无法医治。寡妇、尼姑，欲望未能满足，阴阳离绝，郁火亢极，不得发泄而形成失合证，比房劳伤害更严重。开始时肝木郁热，随后龙火上煽，导致心肺受病而喘嗽烦热，甚至迫血骤亡的有这种情况；经闭不行而吐衄的有这种情况。此证宜开郁降火，选用增损柴胡汤、加味逍遥散。阴火亢极的，可用滋肾丸、玉烛散光泻郁火，后服用滋养的药物，如乌骨鸡丸之类。如果郁火不泄，血气不荣而发痈疽的，离死就不远了。
刘默生说：虚劳多起于郁结，郁结则热气内蒸，内蒸则生虫，虫侵蚀脏腑则咳嗽。初起时早为杜绝，不至于蔓延。如果迁延日久，咳嗽不止，痰如白沫，声哑喉痛，就无法医治了。脾胃泄泻，六脉细数而坚急，久卧床褥，烦躁出血多的，无法医治。如果六脉平缓，重按有神，饮食不减，大肉未消，二便调适的，可以用贝母、麦冬消痰宁嗽，功效多在于开郁，蛤蚧透骨追虫，佐以百部，杀虫独步，兼用地骨皮、薄荷以清内热，橘红、甘草调和中和营卫为主。如果寒热不止，加青蒿、鳖甲。骨蒸无汗，加牡丹皮。每夜发热不已，加酒浸白芍。血虚有伤，加茜根。气虚少食，加人参。脾虚大便不实，加茯苓。燥结，加杏仁。小便不利，加茯苓、泽泻。只要觉得脊中热痛不已，或时时淫淫作痒的，都是瘵虫为患。宜用向东生长的桃头四五十个、生艾一握、雄黄黄豆大一块、麝香二分，捣烂烘热，擦拭脊骨膏肓、百劳、肺俞等穴位及四肢关节间，七日一次。也有用桃叶一斤左右，同艾叶一二两，分装两个袋子，用陈酒三斤煮，乘热熨背脊膏肓、百劳等处，不过二三次，虫从肛门而下，下后以六味地黄丸合生脉散调理，传尸劳瘵也适宜使用。凡是骨蒸以多汗为易治，因为气虚血尚未枯竭。如果是干热无汗为难治，因为气血内涸，不能外通。骨蒸劳嗽，而见脉弦细数疾，面赤如妆，面色黧黑枯槁，目睛无神，眼眶陷下，汗出如珠，天柱骨不正，手指瘦如竹签，声哑咽痛，咳嗽加重出汗，咳嗽而上喘下泄，咳嗽而左侧不得眠（肝胀），咳嗽而右侧不得眠（肺胀），肉脱骨痿而热甚，泄泻无度而畏寒，失血发热而脉数实，咳吐白血，以及呕血声散，骨肉相失，阳事不禁，暮热如焚，身热面色夭然白，以及下血，寒热脱形，脉坚搏的，都不可治。如果病久痞闭，忽然得到气血冲和，心肾交媾，阳事必举，尤其应该切戒房室，犯了必然复发，更难调治。大抵虚劳起于斫丧（纵欲过度）的，肝肾过劳，多导致亡血失精，强中阴竭而死。起于郁结的，内火烁津，多导致血结干咳，嗜食发痈而死。起于药误的，脾肺受病居多，多导致饮食减少，喘嗽泄泻而死。此证多患于富贵膏粱之人，不但禀赋柔脆，而且性情喜欢服药，小病必然变重，辗转戕贼，不到伤残不止。试看贫居村野的人，有病何尝服药，所以能得尽天年。明智的人保全自身，何不自我反省，而甘愿委身于庸医呢？
面色不衰，肌肤日渐消瘦，外表如无病，内里实则虚伤，俗名桃花疰。此证必有蒸热咳嗽，或多汗，或无汗，或多痰，或无痰，或经闭，或泄精，或吐血，或衄血，或善食，或泄泻。必须察看他呈现什么证候，哪个脏腑受伤而治疗。然而这些都是阴火煎熬的证候，治疗大多无效。少女过时不嫁，男子过时不娶，以及寡居的人，多犯此证。因为阴火虽然乘袭阳位，非但不能消烁阳分的津液，阴分的津液反而竭力上供阳火的消烁，所以肢体日渐削瘦，而面色愈加鲜泽。轻者嫁娶后渐渐痊愈，重者虽然暂时痊愈一两月，向后必然死亡，因为其躯体柔脆，精气先枯，不能承受其发泄。只有寡妇再嫁的，每多自愈，因为其躯体能承受。郁火既散，津液既通，可以不药而愈。
传尸：热毒积久，则生恶虫，虫蚀人脏腑，所以神情沉默，不知痛苦所在，无处不苦，经年累月，逐渐变得羸瘦。其证蒸热咳嗽不止，胸背痛，两目不明，四肢无力，腰膝酸疼，卧而不寐，或面色脱白，或两颊时红，常怀忿怒，梦与鬼交，同气连枝，多遭传染，至于死亡，又传给旁人，至于灭门，又传给其他姓氏，惨毒之祸，闻者骇心。辨别的方法，烧真安息香，病患吸烟后咳嗽不止的，乃是传尸。如果咳嗽不严重的，不是。瘵虫最容易传人，能谨慎戒除七情，严避六气，常远房室，慎节饮食，虫不得传播。只有纵欲恣情，精血内耗，邪祟外乘，凡觉得元气稍虚，或腹饥馁，不要进入劳瘵之家，或女病思男，男病思女，一睹其面，随即染伤，不可不知。治疗的方法，固本为先，祛虫次之。安息、阿魏、苏合、沉香、冰片、麝香、犀角、龙齿、獭肝、獭爪、朱砂、雄黄，都有祛邪伐恶的灵效，更以天灵盖辅助。然而各有所宜，如果能食便秘面赤的，合用獭肝、獭爪。食少便滑面青的，合用天灵盖。其夫死传妻，妻死传媳，毒邪深入肾肝二脏的，用骨殖中的水，以生甘草末收晒九次制成丸药服用。服后必然大泻数次，则热邪自大便而下。其苏合香丸、芎归血余散、鳖甲生犀散、传尸丸，都是治瘵的专方。如果病入膏肓，不能起枯骨也。
慎柔师训诫说：曾经治疗虚损，脉和缓而五六至，只是咳嗽发热，没有恶寒咽痛喉哽等证，认为可以医治。服用保元汤、四君子汤之类十余剂，咳嗽略微好转，热也微退。到了二十剂以外，咳嗽反而加重，热又恢复如初，而身体反而不能转侧，脚渐渐无力，以至不能行走而蜷缩。这是什么原因？因为下焦肾气衰惫，无津液滋养百骸，阳气不能四运，脾肺之气不能下输，所以脚无力而蜷缩。药虽有效，病虽暂减，终究不可治。如果初服四君子汤、保元汤十余剂，而脉细如丝，其数不变，决不可治。如果细而不数的，这还有胃气，没有腹痛作泻而饮食如常的，可以用保元汤、人参、白术调理，须二三年才能痊愈。如果服药后，数脉渐减，和缓有神，虽然说可以治，也要三个月见效，一年半方可全愈。还要看年力的衰壮，精神脾胃的强弱来判断。如果服药后，脉虽和缓，而腿渐渐无力，像前面所述，且痰嗽不止，脉虽缓，治之无益。又像前面的证，脚虽无力，而热退嗽减，饮食如平人，这是脾胃尚强，还可以迁延岁月。又有像前面的证，六脉俱和缓，服前剂热退，而脉渐渐变弦，反作泻下血，这是平时火热煎熬，血留经络，得补药气血流通，邪不能留而下，下血后半月十日自愈。下血时能食的不会死，不能饮食，精神倦怠的，死期立待。吐血后反而骤然能食的，也不可治。如果见腹痛，用理中汤。恶心饮食少，用六君子汤。没有这两证，用四君子汤、保元汤服用。大概下血是邪从下窍而出。又有变作伤风状的，邪从上窍而散，当服补肺助脾的药，也须半月而愈。凡是病求汗不得汗的，不治。虚损六脉俱数，服滋阴降火之剂，不及四五十剂的，还可治。如果服至百剂，真元耗尽，脉洪数而无神，虽用补剂，而洪数变为细数，必然渐渐痿困不起而毙。又或者服寒凉不多，用保元汤、四君子汤加生姜一二十剂，求汗不出，而洪数之脉不退，也难救治。或者虽无汗而洪脉渐减，病也渐去，且能饮食，此为可治。这样的脉，大抵秋冬易治，春夏难疗。凡是虚损脉六七至，若逢春夏火令，津液枯槁，肾水正行死绝之乡，肺绝脾燥，无不死的。如果秋冬火令已退，金水正旺，脉虽数也可治。假设病者骨立声哑，喉痛寒热，腹疼作泻，而脉细数，也属不治。凡是病延至三四月，服药已多，其不效的，必过用寒凉，五脏愈虚，邪火愈炽，初用补药数帖，邪火一退，反觉头眩恶心，骨疼脚酸，神气昏懒，不思饮食，倘若脉不细数而带和缓，急用保元汤、四君子汤，大剂连服，便安寝半月，睡觉精神顿爽，再服再寝，饮食渐增，则为可治。倘若脉细如丝，腹痛昏愦的难治。凡是久病患脉，大小浮沉弦滑而三部不匀，或寸浮尺沉，或尺浮寸沉，但见病脉，反属可治。如久病浮中沉但和缓，细察无神，而体倦甚的必死。再看其面色光润，这是精神皆发于外，死期速矣。凡是虚损见数脉，为胃气不足，若转缓弱，为胃气生发之兆，乃少阳春升之气也。凡是虚损病久，脉虽和缓，未可决其必疗，盖久病之人，元气虚弱，脉反和缓，假气也。遇七八月间，服补剂，病得渐减，此生机也。或延至十一月，一阳初动，阳气渐升，内气空虚，无以助生发之气，则变憎寒壮热，服补剂十余帖，寒热渐退，犹可延挨调理，至二三月不变则生，否则不治。缘春夏木旺，脾肺久虚，气衰不能敌时命耳。凡是医生治新病初时有邪，脉浮数，服按病药数剂，数脉即退，病已向安，再数剂则倦，脉反浮数，此时不可认为尚有邪。盖邪退而神气初转，故浮，只宜保元汤调养元气，浮数之脉，得微汗而退。倘不识此，仍以祛邪之药治之，则变虚劳矣。久病服药后，六脉俱和，偶一日诊，或细或数或虚弱，或变怪异常，即当细问起居之故，或因一夜不睡而变者，或因劳役恼怒，或因感冒风寒，各随其感而治之。久病咳嗽气喘，若脉数者，不可用补药，如服之虚火一退，多令人痿倦不起，须先用独参汤，稍加陈皮以接其气，数日后，脉数渐退，方与调理。
〔诊〕石顽说：《金匮要略》云：男子平人脉大为劳，极虚亦为劳。脉浮者，里虚也。脉虚浮弦为短气，目瞑衄血。脉大者，春夏剧，秋冬瘥。男子脉浮弱而涩者，为无子，精气清冷。虚弱微细者，善盗汗出。脉沉小迟者，溏泄，食不化。脉虚芤迟，及诸芤动微紧，男子失精，女子梦交。紧数之脉，表里俱虚，紧为寒伤营，数为血不足。脉见短数，则无胃气。细数紧数，俱非吉祥。脉洪大按之虚者，须防作泻。凡见数脉难治，病久脉数，尤非所宜。脉忽浮涩而数，忽沉弱而缓，变易不常，虚火之故也。虚损转潮热泄泻，脉短数者不治。虚损脉浮大者，属阳虚，细数者，属阴虚。芤为失血，若两手俱芤，而中有一部独弦者，为有瘀蓄未尽，当散瘀为先，不可骤补。若见数大者，为火旺，必难治。若见涩脉来至者，亦不可治也。弦数为骨蒸，自上而下者，必寸口浮数，自下而上者，必尺中弦急。若关尺俱弦细而急，如循弦缕者不治。又尺中弦强者，必因房室发热，加之误服寒凉，故脉如是。然虚损之人，虽远房室，其尺脉之弦强，必不能便软。若更犯房室，明日反和，此阴阳得交，故尔暂软，后日诊之，其弦强必愈甚，诊察之际，不可不辨也。石顽治疗牙行陶震涵之子，伤劳咳嗽失血，势如泉涌，服生地汁、墨汁不止。我的学生周子，用热童便二升而止，邀请石顽诊之。脉得弦大而虚，自汗喘乏，至夜则烦扰不宁，与当归补血汤四帖而热除。时觉左胁刺痛，按之漉漉有声，此少年喜酒负气，尝与人斗狠所致，与泽术麋衔汤，加生藕汁调服，大便即下累累紫黑血块，数日乃尽。后与四乌鲗骨一芦茹为末，分四服，入黄牝鸡腹中煮啖，留药蜜丸，尽剂而血不复来矣。
However, (the condition) will inevitably be slightly more vigorous than usual. Do not lightly use wind-dispersing and exterior-releasing drugs. Since the nature of wind drugs is ascending, they are not suitable for cough and asthma. Nor should one recklessly administer lung-clearing and cough-stopping medicines, as this will turn to damage the stomach qi, causing profound harm. At this time, it is advisable to temporarily suspend tonic medications and nourish yin quietly; the pathogenic factor will naturally recede. The interior inherently possesses excessive fire, and the cou li (skin pores and interstices) must be loose. One may drink hot soup or thin gruel; once the sweat qi flows freely, the pathogen will immediately dissipate. Ancient sages said: In individuals with yin deficiency and fire hyperactivity, where yuan qi is damaged, even if there are external pathogens, one must strictly avoid decoctions that ascend and disperse the exterior, such as Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), and Gegen (Puerariae Lobatae Radix). If this principle is ignored and wind drugs are mistakenly used, the wind will take advantage of the fire, and the fire will bolster the wind, thereby fanning the internal yin pathogen. Mildly, it causes disturbance and restlessness of deficient yang; severely, it leads to death due to qi escaping with sweat. Generally, when the pathogen is at its peak, like the sun just rising, even with appropriate formulas, forcing suppression goes against the pathology. If medication is unavoidable, only small doses of Congbai (Allii Fistulosi Bulbus) and Xiangchi (Sojae Semen Praeparatum) should be used to disperse the pathogen. If the yin fire is not originally too strong, Xiaojianzhong Tang (Minor Construct the Middle Decoction) or Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction) will cause no harm. Mistakenly using lung-protective drugs will inevitably worsen the cough. In such cases, slightly adding Weirui (Polygonati Odorati Rhizoma) and Xixin (Asari Radix et Rhizoma) to Jianzhong Tang can search out and disperse the pathogen. Wait until the pathogenic force declines and the pulse becomes weak, then strictly follow Zhao Yi-de’s example of using sweet-cold methods to dispel wind and clear heat, thus avoiding errors. For instance, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) combined with Shengmai San (Generate the Pulse Powder), removing Yurou (Corni Fructus), doubling Dihuang (Rehmanniae Radix) and Renshen (Ginseng Radix et Rhizoma), adding Weirui, prepared in a large dose as a decoction, taken morning and evening, treats both root and branch. After taking it, if the cough decreases slightly but the steaming fever remains, this indicates that deficient yang cannot be contained. Add Niuxi (Achyranthis Bidentatae Radix) and Biejia (Trionycis Carapax et Plastrum) to nourish the lower source (kidney yin), distinguishing between primary and secondary aspects in prescription. However, Biejia must be from a nine-ribbed turtle to be effective. If caused by overeating, one should also suspend tonics to observe the trend, and not lightly give digestive aids, which would injure the stomach and invite criticism for "tonifying deficiency into greater deficiency." Only Zhishi Lizhong Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction) and Gancao Ganjiang Tang (Licorice and Dried Ginger Decoction) should be used, calibrated according to the state of the original qi and the amount of food stagnation. If caused by labor and irregular meals, use Buzhong Yiqi Tang (Middle-Warming and Qi-Supplementing Decoction) without Shengma (Cimicifugae Rhizoma), adding Wei Ge (Puerariae Radix Prepared), to lift the clear yang of the spleen and stomach, so that the pathogenic fire naturally descends. In cases of yin deficiency with fire flaming upward, there is absolutely no rationale for lifting. Later generations, failing to examine this, often use Shengma and Chaihu to treat yin deficiency with fire hyperactivity, all suffering the consequences. Deficiency consumption with insufficiency, sweating with chest oppression, knotted pulse with palpitations, yet moving normally, will become critical within a hundred days. Treat with Zhigancao Tang (Prepared Licorice Decoction), from *Qianjin Yifang*. If a youth with insufficient congenital constitution suffers injury from irregular diet, resulting in deficiency consumption, with tidal fever in the afternoon, emaciated body, abdominal distension with rapid breathing, and a wiry-rapid pulse, Baifeng Gao (White Phoenix Paste) is most appropriate, following the method of Ge Kejiu.
Generally, for initial cough and fever, the focus is on draining qi. If chronic cough persists, it inevitably leads to qi deficiency and fire hyperactivity; all qi-consuming drugs must be avoided. Drugs like Jiegeng (Platycodonis Radix), Xingren (Armeniacae Semen Amarum), Juhong (Citri Reticulatae Pericarpium Rubrum), and Suzi (Perillae Fructus) all promote dispersal and are unsuitable for chronic cough. If qi exhaustion is severe, one should instead use Baoyuan Tang (Preserve the Origin Decoction) and Shengmai San to consolidate qi. This illustrates the different treatments for new versus old conditions, and excess versus deficiency.
For depression syndrome with fever, wheezing, and cough, mistaken use of cold-draining drugs causes heart fire to invade the lungs. When the lungs are invaded by fire, the situation forces the pathogen to rush to the large intestine, causing diarrhea. One must absolutely not use warm-tonifying spleen and stomach drugs; only Xiaoyao San (Free and Easy Wanderer Powder) with modifications, taken in sufficient quantity, will be effective. Unfulfilled thoughts scatter the heart spirit, leading to gradual fever, muscle wasting, and wind-consumption. As stated in the *Neijing*: "Diseases of the two yang organs originate from the heart and spleen," due to wind-heat overcoming qi, leading to daily emaciation. Take much Xiaoyao San, followed by Guipi Tang (Restore the Spleen Decoction) for regulation. Women with full blood but lack of harmony, and men with unfull semen desiring sexual release, often develop this condition. Women experience amenorrhea and blood overflow; men experience loss of blood and essence. All are suitable for Xunshun Wan (Obedience Pill), specifically regulating the Chong and Ren vessels and dispersing blood stasis. After the stasis disperses, further treat with Wuguji Wan (Black Bone Chicken Pill). If bitter-cold blood-cooling drugs are mistakenly used, causing spleen and stomach sliding collapse, it is incurable. Widows and nuns whose desires are unfulfilled suffer yin-yang separation and extreme hyperactive depression-fire, unable to vent, forming "loss-of-harmony" syndrome, which is worse than sexual fatigue. Initially, liver wood stagnates with heat; subsequently, dragon fire flares upward, damaging the heart and lungs, causing wheezing, cough, irritability, and fever. Severe cases involve sudden blood loss or amenorrhea with hematemesis/epistaxis. This syndrome requires opening depression and descending fire; select Zengsun Chaihu Tang (Modified Bupleurum Decoction) or Jiawei Xiaoyao San (Added-Ingredient Free and Easy Wanderer Powder). For extreme yin fire, use Zishen Wan (Kidney-Nourishing Pill) or Yuzhu San (Jade Candle Powder) to drain the depression-fire, followed by nourishing drugs like Wuguji Wan. If depression-fire does not vent, and blood/qi fail to nourish, leading to carbuncles and ulcers, life is far gone.
Liu Mosheng said: Deficiency consumption often originates from depression. Depression causes internal heat steaming; steaming generates worms; worms erode viscera, causing cough. Early prevention prevents spread. If prolonged, with incessant cough, white frothy sputum, hoarseness, and sore throat, it is incurable. Spleen-stomach diarrhea with fine-rapid-firm pulses, long bedridden, irritable with heavy bleeding, is incurable. If six pulses are gentle, substantial upon deep pressure, appetite unchanged, muscles not wasted, and excretions regular, use Beimu (Fritillariae Bulbus) and Maidong (Ophiopogonis Radix) to resolve phlegm and calm cough; the efficacy lies mainly in opening depression. Gejie (Geckol) penetrates bone and pursues worms; assist with Baibu (Stemonae Radix), unparalleled in killing worms. Combine Digupi (Lycii Cortex) and Bohe (Menthae Haplocalycis Herba) to clear internal heat; Juhong and Gancao harmonize the middle and nourish ying. If chills and fever persist, add Qinghao (Artemisiae Annuae Herba) and Biejia. For bone-steaming without sweat, add Mudanpi (Moutan Cortex). For nightly fever, add Jiujin Baishao (Wine-treated White Peony Root). For blood deficiency with injury, add Qiangen (Rubiae Radix). For qi deficiency with poor appetite, add Renshen. For spleen deficiency with loose stools, add Fuling (Poria). For dryness and constipation, add Xingren. For difficult urination, add Fuling and Zexie (Alismatis Rhizoma). Any sensation of continuous heat and pain in the spine, or intermittent itching, indicates zhai worms. Use 40-50 peach heads growing towards the southeast, a handful of fresh mugwort, a piece of realgar the size of a soybean, and 2 fen of musk. Pound, heat, and rub onto spinal acupoints such as Gaohuang, Bailao, and Feishu, and between limb joints, once every seven days. Alternatively, use several jin of peach leaves with 1-2 liang of mugwort, divided into two bags, boiled in three jin of aged wine, and applied hot to the back at Gaohuang and Bailao. Within two or three applications, worms exit via the anus. Afterwards, regulate with Liuwei Dihuang Wan combined with Shengmai San; this is also suitable for chuan shi lao zhai. Generally, bone-steaming with profuse sweating is easier to treat because qi deficiency has not exhausted blood. Dry heat without sweat is difficult to treat because internal qi and blood are depleted and cannot reach the exterior. Bone-steaming consumption cough with wiry-fine-rapid-turbulent pulse, face red like makeup, dark and withered complexion, spiritless eyes, sunken eye sockets, pearl-like sweat, unstable neck pillar, thin fingers like bamboo slips, hoarse voice, sore throat, cough worsening with sweat, upper asthma and lower diarrhea during cough, inability to sleep on the left side (liver distension), inability to sleep on the right side (lung distension), flesh depletion and bone atrophy with severe heat, unlimited diarrhea with aversion to cold, hematemesis with fever and rapid-solid pulse, expectoration of white blood, scattered voice with hematemesis, separation of flesh and bone, uncontrollable erections, evening heat like burning, pale sallow complexion with fever, lower bleeding, emaciation with chills and fever, and firm-pulsating pulse are all incurable. If chronic obstruction suddenly resolves with harmonious qi and heart-kidney interaction, causing erection, one must strictly abstain from sex; relapse makes treatment extremely difficult. Generally, deficiency consumption from debauchery involves liver-kidney overwork, leading to blood/essence loss and death from yin exhaustion. From depression, internal fire scorches fluids, leading to blood-stasis dry cough and death from abscesses. From medicinal error, spleen-lung disease is common, leading to death from reduced appetite, cough, and diarrhea. This condition mostly affects those rich in fatty foods; besides delicate constitution, they love taking medicine, turning minor illnesses serious, gradually destroying themselves until disabled. Observe the poor in villages; they rarely take medicine and thus live out their natural years. Wise people protect themselves; why not reflect and submit to quacks?
Face color remains undiminished while muscles waste away; externally appearing healthy, internally truly deficient, commonly known as Taohua Zhu (Peach Blossom Ticking). Symptoms include steaming fever and cough, or profuse/no sweat, profuse/no phlegm, amenorrhea, seminal emission, hematemesis, epistaxis, polyphagia, or diarrhea. One must observe the presenting symptoms and injured organ to treat accordingly. These are all conditions of yin-fire simmering, mostly refractory. Virgins marrying late, men marrying late, and widows often contract this. Because yin-fire attacks yang positions, it fails to consume yang-fluids but exhausts yin-fluids to supply the yang-fire's consumption, causing daily limb wasting while the face appears ruddy. Mild cases improve after marriage; severe cases may temporarily improve for a month or two but eventually die, as the delicate body and depleted essence cannot withstand the venting. Widows remarrying often recover spontaneously because their bodies can endure. Once depression-fire scatters and fluids flow, recovery occurs without medicine.
Chuan shi (Passing Corpse): Long accumulation of heat-toxin generates evil worms that erode viscera. The patient is silent and unaware of specific pains, suffering everywhere, becoming emaciated over months. Symptoms include incessant steaming fever and cough, chest/back pain, blurred vision, limb weakness, sore waist/knees, insomnia, pale face or malar flush, irritability, dreams of ghost intercourse. It spreads among kin, causing death, then to others, wiping out families, shocking listeners. Diagnosis: Burn real Anxi Xiang (Benzoin); if smoking induces incessant cough, it is chuan shi. If cough is mild, it is not. Zhai worms easily transmit; guarding against seven emotions, avoiding six climatic factors, avoiding sex, and moderating diet prevents transmission. Only lust and emotional indulgence deplete essence/blood internally, allowing evil spirits to attack externally. If feeling slight qi deficiency or hunger, do not enter homes of consumptive patients. Male/female patients longing for the opposite sex, upon seeing each other, immediately contract the disease. Treatment prioritizes strengthening the root, then expelling worms. Anxi, Awei, Suhexiang, Chenxiang, Bingpian, Shexiang, Xijiao, Longchi, Tagan, Zhusha, Xionghuang all have spiritual efficacy in expelling evil. Assist with Tianlinggai (Human Skull Cap). Each has specific indications: For good appetite, constipation, red face, combine Tagan and Tazhao. For poor appetite, loose stools, blue face, combine Tianlinggai. For husband-to-wife transmission, poison deep in kidney/liver, use water from bones, collected with Gancao powder, dried nine times, made into pills. Profuse diarrhea follows, expelling heat via stool. Suhexiang Wan, Xionggui Xueyu San, Biejia Shengxi San, and Chuanshi Wan are specific formulas for zhai. If the disease enters gaohuang, even raising the dead is impossible.
Master Shenrou’s teachings: I once treated deficiency consumption with gentle pulses at 5-6 beats per breath, only cough and fever, no aversion to cold/sore throat. Deemed treatable. After 10+ doses of Baoyuan or Sijunzi Tang, cough improved slightly, fever subsided. After 20 doses, cough worsened, fever returned, body immobile, legs weak, curling up. Why? Lower jiao kidney qi is exhausted, lacking fluids to nourish bones; yang qi cannot circulate; spleen/lung qi cannot descend. Legs weaken and curl. Though medicine worked temporarily, ultimately incurable. If after 10 doses, pulse is thread-thin and still rapid, definitely incurable. If fine but not rapid, stomach qi exists; no abdominal pain/diarrhea, normal diet; use Baoyuan, Renshen, Baizhu; takes 2-3 years to heal. If after medicine, rapid pulse slows to gentle/substantial, treatable but takes 3 months to show effect, 1.5 years to fully heal. Assess age, spirit, spleen/stomach strength. If pulse gentle but legs weaken, cough persists despite slow pulse, treatment is futile. If legs weak but fever/cough subside, diet normal, spleen/stomach strong, prognosis favorable. If six pulses gentle, fever subsides after medicine but pulse becomes wiry, with diarrhea and blood, this is previous heat cooking blood into collaterals; tonics move qi/blood, expelling pathogen downward. Self-heals in 10-15 days. Able to eat during bleeding = survival; unable to eat, fatigued = imminent death. Sudden appetite after hematemesis = incurable. Abdominal pain: Lizhong Tang. Nausea/poor appetite: Liujunzi Tang. Otherwise: Sijunzi Tang, Baoyuan Tang. Bleeding expels pathogen downward. Wind-like changes expel pathogen upward; use lung-spleen tonics, heals in half month. No sweat despite seeking it = incurable. Six rapid pulses in deficiency consumption; <40-50 doses of yin-nourishing/fire-descending herbs = treatable. >100 doses, yuan exhausted, surging-rapid pulse without substance, even with tonics, pulse becomes fine-rapid, leading to paralysis and death. Cold herbs few, Baoyuan/Sijunzi + Ginger 10-20 doses, no sweat, surging-rapid pulse persists = hard to save. No sweat but surging pulse slows, illness fades, appetite returns = treatable. Such pulses are easier in autumn/winter, harder in spring/summer. Deficiency consumption pulse 6-7 beats; in spring/summer fire season, fluids dry, kidney water dies, lung/spine dry = death. In autumn/winter, metal/water prosperous, rapid pulse treatable. Emaciation, hoarseness, sore throat, chills/fever, abdominal pain/diarrhea, fine-rapid pulse = incurable. Disease lasting 3-4 months, many ineffective meds, likely overused cold herbs, five viscera deficient, pathogenic fire fierce. Initial tonics reduce fire, causing dizziness, nausea, bone/joint pain, lethargy, anorexia. If pulse not fine-rapid but gentle, urgently use Baoyuan/Sijunzi large doses; sleep well for half month, spirit refreshes, appetite increases = treatable. Thread-thin pulse, abdominal pain/confusion = difficult. Chronic disease pulses varying in depth/rhythm, or cun floating/chii sinking, etc., showing pathological pulse = treatable. Chronic disease gentle pulse, subtle lack of substance, severe fatigue = death. Lustrous face = spirit projecting outward, death imminent. Rapid pulse in deficiency = insufficient stomach qi; turning gentle/weak = stomach qi generating, spring wood qi. Chronic disease gentle pulse = fake qi, not necessarily curable. August/September, tonics reduce illness = sign of life. November, yang rises, internal emptiness, chills/fever; 10+ doses tonics reduce fever = manageable. Stable by Feb/March = survival; otherwise incurable. Spring/summer wood prosperous, spleen/lung weak, qi cannot resist seasonal command. New disease with exterior pathogen, floating-rapid pulse; meds reduce rapid pulse, illness improves; subsequent doses cause fatigue, pulse floats-rapid again. Do not assume residual pathogen. Pathogen retreated, spirit recovering causes floating; use Baoyuan Tang to nourish yuan qi; micro-sweat resolves floating-rapid pulse. Ignoring this and using pathogen-expelling drugs turns it into deficiency consumption. Chronic disease, six pulses harmonious, occasional visit shows fine/rapid/weak/weird pulse; ask about lifestyle (sleep deprivation, labor, anger, cold). Treat according to cause. Chronic cough/asthma with rapid pulse: do not use tonics; reducing deficient fire causes paralysis. First use Dushen Tang (Single Ginseng Decoction) with Chenpi to connect qi; after days, pulse slows, then regulate.
[Diagnosis] Shiwan said: *Jinkui* states: Men with normal pulse appearing large are suffering from labor/extreme deficiency is also labor. Floating pulse indicates interior deficiency. Deficient-floating-wiry pulse indicates shortness of breath, closed eyes, epistaxis. Large pulse: worse in spring/summer, better in autumn/winter. Men with floating-weak-choppy pulse are infertile, clear/cold essence. Weak-fine pulse predisposes to night sweats. Deep-small-slow pulse indicates loose stools, indigestion. Deficient-kou-slow pulse, or various kou-moving-mildly-tight pulses: men lose essence, women dream of intercourse. Tight-rapid pulse: exterior-interior deficiency; tight is cold injuring ying, rapid is blood insufficiency. Short-rapid pulse indicates no stomach qi. Fine-rapid/tight-rapid are inauspicious. Surging-large pulse void on pressure: watch for diarrhea. Rapid pulse is difficult to treat; chronic rapid pulse is especially unfavorable. Fluctuating floating-choppy-rapid vs. deep-weak-gentle: changeable due to deficient fire. Deficiency consumption turning to tidal fever/diarrhea with short-rapid pulse: incurable. Floating-large pulse: yang deficiency; fine-rapid: yin deficiency. Kou indicates blood loss. Both hands kou with one segment wiry: residual blood stasis; disperse stasis first, do not tonify abruptly. Large-rapid: fire hyperactivity, difficult to treat. Choppy pulse: incurable. Wiry-rapid indicates bone-steaming. Ascending from above: cun floating-rapid. Ascending from below: chi wiry-tight. Guan-chi wiry-fine-tight like touching a string: incurable. Chi wiry-strong: due to sexual activity fever plus mistaken cold herbs. Even avoiding sex, chi wiry-strong won't soften. Relapsing sex makes pulse soft next day (yin-yang intersection), but wiry-strong returns stronger later. Differentiate carefully. Shiwan treated Tao Zhenhan’s son, labor cough/hemoptysis gushing like a spring, unremitting with Shengdi juice/Ink juice. Student Zhou Zi stopped it with 2 sheng hot child urine. Shiwan diagnosed wiry-large-void pulse, spontaneous sweat, panting fatigue, nighttime irritability. Given Danggui Buxue Tang 4 doses, fever resolved. Left hypochondriac stabbing pain, rumbling on pressure: youth loved wine, pride, fought. Given Zeshu Mixian Tang with raw lotus juice, passed purple-black blood clots. Then Si Wu Gulu Lu Ru powder, cooked in hen belly, honey pills finished, bleeding stopped.
Treated Yan Ruyu’s daughter, deficiency emaciation/chills-fever, abdominal pain/tightness, spontaneous sweat/cough for 3+ months, multiple doctors failed. Suddenly hemoptysis of several mouthfuls.