经曰。肝虚肾虚脚虚。皆令人体重烦冤。
身重多属于湿。宜用健脾行湿之剂。如除湿汤、渗湿汤、胃苓汤之类。虚人补中益气加羌、
防、茯苓、泽泻。随其攸利。仲景云。风湿脉浮身重。汗出恶风者。防己黄 汤。夏月中风湿。
身重如山。不能转侧。消暑十全散加羌活、苍术。肾着身体重。甘姜苓术汤。
石顽曰。身重无非湿证。湿证多归重于脾土。为脾病是矣。又肾为水脏。肾虚则邪水用事。
故又主肾虚。至于肝虚。亦令人体重烦冤者。何也。盖肝虚则不能胜土。土无风气。亦必郁热上
蒸而为病矣。然肝则重于烦冤。脾则重于肿重。
肾则重于痿弱。不可不辨。
解 尺脉缓涩。谓之解 。又云。肾脉太过。则令人解 。肾气郁热。精不运而解惰。烦
热气乏不欲言。此肾经虚热有余也。河间用利肾汤大谬。宜虎潜丸、清燥汤之类。肥人夏月多此。皆湿热为患也。
石顽曰。尝读内经有脱营失精之病。方家罕言。近惟陈毓仁痈疽图形。仅见失营之名。究无
方论主治。故粗工遇此。靡不妄言作名。为害不浅。夫脱营者。营气内夺。五志之火煎迫为患。
所以动辄烦冤喘促。五火交煽于内。经久始发于外。发则坚硬如石。毓仁所谓初如痰核。久则渐
大如石。破后无脓。惟流血水。乃百死一生之证。是以不立方论。良有以也。其形着也。或发膺
乳腋胁。或发肘腕胫膝。各随阴阳偏阻而瑕聚其处。久而不已。五气留连。病有所并。则上下连
属。如流注然。不可泥于毓仁之耳前后及项间。方目之为失营也。以始发之时。不赤不痛。见证
甚微。是以病者略不介意。逮至肿大硬痛。蟠根错节已极。岂待破后无脓。方为百死一生之证哉。
原夫脱营之病。靡不本之于郁。若郁于脏腑。则为噎膈等证。此不在脏腑。病从内生。与流注结
核乳岩。同源异 。推其主治。在始萌可救之际。一以和营开结为务。而开结全赖胃气有权。方
能营运药力。如益气养营之制。专心久服。庶可望其向安。设以攻坚解毒清火消痰为事。必至肿
破流水。津复外渗。至此日进参、 。徒资淋沥。其破败之状。有如榴子之裂于皮外。莲实之嵌
于房中。与翻花疮形像无异。非若流注结核之溃后。尚可图治。亦不似失精之筋脉痿 也。详脱
营失精。经虽并举。而
死生轻重悬殊。脱营由于尝贵后贱。虽不中邪。精华日脱。营既内亡。瑕复外聚。攻补皆为扼腕。
良工无以易其情志也。失精由于先富后贫。虽不伤邪。身体日减。内虽菀结。外无瑕聚。投剂略
无妨碍。医师得以施其令泽也。然二者之病。总关情志。每每交加。而有同舟敌国。两难分解之
势。故毓仁以失营二字括之。惜乎但启其端。而肯綮示人之术。则隐而不发。何怪粗工谬言为道。
妄用砭石。宁免五过四失之咎欤。
《黄帝内经》说：肝虚、肾虚、脚虚，都会导致人体沉重、心中烦闷冤屈。
身体沉重多属于湿邪为患，适宜使用健脾祛湿的方剂，如除湿汤、渗湿汤、胃苓汤之类。对于体质虚弱者，可用补中益气汤加入羌活、防风、茯苓、泽泻，根据病情灵活加减。张仲景说：风湿病见脉浮、身重、汗出、恶风者，用防己黄芪汤（Fangji Huangqi Tang）。夏季中暑兼感风湿，身体沉重如坐山中，不能翻身转动，可用消暑十全散加入羌活、苍术。肾着病（Shen Zhuo Disease, a condition characterized by cold-dampness stagnating in the lower back）身体沉重，用甘姜苓术汤（Ganjiang Lingzhu Tang）。
石顽（周学海/喻昌等医家别号，此处指代评论者）说：身体沉重无非是湿证，湿证多归属于脾土，说是脾病是可以的。另外，肾是水脏，肾虚则邪水（病理性的水湿）盛行，所以又主责于肾虚。至于肝虚，也让人身体沉重、心中烦闷冤屈，为什么呢？因为肝虚则不能克制脾土，脾土没有风气（肝木之气）疏泄，也会郁而化热上蒸而致病。然而，肝虚侧重于烦闷冤屈，脾虚侧重于肿胀沉重，肾虚侧重于痿软无力，不可不加以辨别。
【解】尺脉缓涩，称为“解㑊”（Jie Xie, a state of lethargy and weakness）。又说：肾脉太过，会让人出现解㑊。肾气郁结化热，精气运行不畅而导致懈怠懒惰，烦热气乏、不想说话，这是肾经虚热有余的表现。河间（刘完素）使用利肾汤是大错特错的，适宜用虎潜丸（Hujian Wan）、清燥汤（Qingzao Tang）之类。肥胖的人在夏季多患此病，都是湿热为患。
石顽说：曾经读《内经》，有脱营（Tuoying, depletion of nutritive qi）和失精（Shijing, loss of essence）这两种病，但医家中很少谈论。近来只有陈毓仁在《痈疽图形》中，仅见到“失营”这个名称，终究没有方剂和理论主治。所以粗劣的医生遇到这种情况，无不胡乱命名，危害不小。所谓脱营，是营气在内被剥夺，五脏的情志之火煎熬逼迫造成祸患，所以动不动就烦闷冤屈、气喘急促。五火在内交相煽动，经久之后才发于体表，发作时坚硬如石头。陈毓仁所说的初起像痰核，久后逐渐变大如石头，破溃后没有脓液，只流出血水，这是百死一生的重症。因此他不设立方论，是有道理的。这种病症显现的部位，有的发于胸膺、乳房、腋下、胁肋，有的发于肘部、腕部、胫骨、膝盖，各自随着阴阳偏阻而在瑕疵聚集的地方发生。时间久了不愈，五气留连，病势有所合并，则上下连接，如同流注（Liuzhu, flowing abscesses/nodules）一样，不能拘泥于陈毓仁所说的耳前后及颈部之间，才称之为失营。因为在刚开始发病时，不红不痛，症状很轻微，所以患者并不在意。等到肿大硬痛，盘根错节到了极点，哪里要等到破溃后没有脓液，才算是百死一生的证候呢？
推究脱营这种病，无不本源于情志抑郁。如果郁结在脏腑，就会形成噎膈等证。这不在脏腑内部，而是病从内生，与流注、结核、乳岩（Ru Yan, breast cancer）同源而异流。推求其治疗方法，在于萌芽可救之际，以调和营气、开散结聚为要务。而开散结聚全赖胃气有权力，才能营运药力，如益气养营的制剂，专心长期服用，才有望趋向安宁。假如把攻坚解毒、清热泻火、消痰作为治疗手段，必然导致肿块破溃流水，津液外渗。到了这个时候，每天进服人参、黄芪，也只是徒然资助淋漓之症。其破败的样子，就像石榴皮裂开在外面，莲子嵌在房中一样，与翻花疮（Fan Hua Chuang, fungating wounds）的形象无异，不像流注、结核溃破后还可以图谋治疗，也不像失精导致的筋脉痿弱那样。详细考察脱营和失精，《内经》虽然并列提出，但生死轻重悬殊很大。脱营是由于曾经尊贵后来卑贱，虽然没有中邪，但精华日渐脱落，营气既然在内亡失，瑕疵又在外部聚集，攻法和补法都让人扼腕叹息，高明的医生也无法改变患者的情志。失精是由于曾经富有后来贫穷，虽然没有伤邪，但身体日渐消瘦，内部虽然郁结，外部没有瑕疵聚集，投药几乎没有妨碍，医师得以施展其恩泽。然而这两种病，总归关乎情志，常常相互交织，呈现出同舟敌国、两难分解的态势。所以陈毓仁用“失营”二字概括它，可惜只是开启了端绪，而揭示关键的治疗技术却隐藏不发，难怪粗劣的医生谬误地当作道理，妄用砭石，怎能避免“五过四失”的罪过呢？
The *Classic of Difficult Issues* (or *Neijing*) states: Liver deficiency, Kidney deficiency, and Foot deficiency all cause heaviness in the body and inner vexation/depression.
Heaviness of the body mostly belongs to Dampness (Shi). It is appropriate to use formulas that strengthen the Spleen and move Dampness, such as Chushi Tang (Dampness-Removing Decoction), Shenshi Tang (Dampness-Penetrating Decoction), or Weiling Tang (Stomach-Cinnamon Decoction). For deficient individuals, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) can be used with added Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Fuling (Poria), and Zexie (Alismatis Rhizoma), adjusted according to convenience. Zhang Zhongjing said: In Wind-Dampness diseases, if the pulse is floating, the body is heavy, there is sweating, and aversion to wind, Fangji Huangqi Tang (Stephaniae Tetrandrae and Astragali Decoction) should be used. In summer, when suffering from Summerheat combined with Wind-Dampness, where the body feels heavy as if sitting in mountains and turning is impossible, Xiaoshu Shiquan San (Ten Complete Powders for Resolving Summerheat) with added Qianghuo and Cangzhu (Atractylodis Rhizoma) is indicated. For Shen Zhuo disease (a condition characterized by cold-dampness stagnating in the lower back/back region) with body heaviness, Ganjiang Lingzhu Tang (Ginger, Poria, Atractylodes, and Licorice Decoction) is used.
Shiweng stated: Heaviness of the body is nothing but a Dampness syndrome. Dampness syndromes are mostly attributed to the Earth element of the Spleen, so attributing it to Spleen disease is correct. Furthermore, the Kidney is the Water organ; when Kidney deficiency occurs, pathogenic Water dominates, thus it is also primarily attributed to Kidney deficiency. As for Liver deficiency causing body heaviness and inner vexation, why is this? Because when the Liver is deficient, it cannot control the Earth element. Without the Wind energy (Liver Wood qi) to disperse, the Earth will inevitably become stagnant and transform into Heat that steams upward, causing disease. However, Liver deficiency emphasizes vexation and depression, Spleen deficiency emphasizes swelling and heaviness, and Kidney deficiency emphasizes flaccidity and weakness. These must not fail to be distinguished.
[Explanation] A slow and choppy pulse at the Chi position is called "Jie Xie" (lethargy and physical weakness). It is also said: An excessive Kidney pulse causes Jie Xie. When Kidney Qi is stagnant and transforms into Heat, Essence fails to circulate, leading to lethargy and lassitude, accompanied by vexation, heat, fatigue, and reluctance to speak. This indicates excess of deficient Heat in the Kidney meridian. Hejian (Liu Wansu) using Lishen Tang (Kidney-Draining Decoction) is a major error. Instead, Hujian Wan (Tiger-Hiding Pill) or Qingzao Tang (Clearing Dryness Decoction) should be used. Obese people often suffer from this in summer, all caused by Damp-Heat.
Shiweng said: I once read in the *Neijing* about the diseases of Tuoying (Depletion of Nutritive Qi) and Shijing (Loss of Essence), but few physicians discuss them. Recently, only Chen Yuren, in his *Illustrated Images of Carbuncles and Ulcers*, mentions the name "Shiying" (Loss of Ying/Nutritive Qi), but ultimately provides no formula or theoretical treatment. Thus, crude practitioners encountering this condition invariably make arbitrary diagnoses, causing significant harm. What is called Tuoying involves the internal deprivation of Ying Qi (Nutritive Qi), where the Fire of the Five Emotions (Wu Zhi) scorches and pressures, causing frequent vexation, depression, panting, and shortness of breath. The Five Fires stir internally, manifesting externally only after a long duration. When it manifests, it becomes hard as stone. As Chen Yuren described, it initially resembles phlegm nodules, gradually enlarging to be hard as stone later. After rupture, there is no pus, only bloody fluid. This is a critical condition with a high mortality rate ("one life in a hundred deaths"). Therefore, he did not establish formulas or theories, which is justified. The manifestation sites vary: some appear on the chest, breasts, axillae, or hypochondrium; others on elbows, wrists, shins, or knees. They gather wherever Yin-Yang obstruction creates flaws. If prolonged without resolution, the Five Qi linger, and diseases merge, connecting up and down like Liuzhu (Flowing Abscesses). One cannot rigidly adhere to Chen Yuren’s description limiting Shiying to areas around the ears, neck, etc. At the onset, there is no redness or pain, and symptoms are minimal, so patients pay little attention. Only when it swells, becomes hard and painful, and forms complex roots does it reach an extreme state. Why wait until rupture without pus to consider it a critical condition?
Tracing the origin of Tuoying, it stems from emotional depression/stagnation. If stagnation occurs within the Zang-Fu organs, it leads to conditions like Ye Ge (Dysphagia). This pathology arises internally, sharing the same source but having different manifestations compared to Liuzhu, Jiehe (Scrofula/Tuberculous lymphadenitis), and Ru Yan (Breast Cancer). Regarding treatment, at the initial stage when it can still be saved, the priority is to harmonize Ying Qi and resolve stagnation. Resolving stagnation entirely relies on the strength of Stomach Qi to transport medicinal power. Formulas like Yiqi Yangying (Tonifying Qi and Nourishing Ying) should be taken consistently over a long period to hope for recovery. If one focuses on attacking hardness, detoxifying, clearing Heat, and resolving Phlegm, it will inevitably lead to ulceration and weeping fluids. At this stage, daily administration of Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) merely aids the continuous leakage. The appearance of the ulcer resembles a pomegranate split open externally or lotus seeds embedded in a pod, similar to Fanhua Chuang (Fungating Wounds). This differs from Liuzhu or Jiehe, which may still be treatable after ulceration, and is unlike Shijing, which presents as tendon and vessel flaccidity. Although the *Neijing* lists Tuoying and Shijing together, their severity and prognosis differ greatly. Tuoying results from a fall from nobility to baseness; although not infected by external pathogens, vital essence depletes daily. With Ying Qi lost internally and pathological masses gathering externally, both attacking and tonifying methods are frustrating, and skilled physicians cannot easily alter the patient's emotional state. Shijing results from a fall from wealth to poverty; although not injured by pathogens, the body wastes away daily. Internally there is stagnation, but externally no masses form. Medicinal administration faces little obstruction, allowing physicians to apply their therapeutic benevolence. However, both diseases are fundamentally related to emotions and often occur together, presenting a dilemma akin to allies becoming enemies, difficult to separate. Hence, Chen Yurin summarized them under "Shiying." Regrettably, he only initiated the concept but concealed the key therapeutic techniques. No wonder crude practitioners mistake errors for truth and recklessly use Bian stones (Bian Shi, lithic needles), incurring the faults of the "Five Errors and Four Losses."