河车(一具,焙干) 龙胆草 甘草(各二钱) 鳖甲(五钱) 大黄 苦参 黄柏 知母
贝母 败鼓皮 人中白(各二钱半) 桔梗 胡黄连(二钱半) 犀角 莪术 芒硝(各钱半)
为末,蜜丸梧子大,辰砂末为衣。每服捻丸至三十丸。腹热食前温酒下,膈热食后温酒
下,传尸痨瘵俱可下,其余劳怯,一月平复。
天灵盖(二指大) 槟榔(五个) 麝香 阿魏 甘遂 安息香(各三钱) 朱砂(一钱)
上为末,每服三钱。用薤白、葱白各十四茎,青蒿二把,甘草,桃枝、柳枝各五寸,桑
白皮,石榴根皮各一片,以童便四大碗,于瓷器属性武火煎,至一碗,去渣,分作三盏,调前药
末,五更初服。男患女煎,女患男煎,服药后知觉欲吐,即用白梅含之,五更尽,须下虫及
恶物黄水黑粪。如未下,良久又进一服,天明更进一服。如泻不止,
用龙骨、黄连等分为末
治卒中鬼击,心腹如刺,下血不省,及卧魇啮脚指不觉,并诸毒等症。
皂荚 藜芦 雄黄(研) 矾( 研,各等分)
每用少许,吹入鼻中,未嚏再吹,以得嚏为度。
治尸厥脉动乱而若死。
用石菖蒲末纳鼻中,仍以桂末安于舌上,苏合香丸亦可。
治尸厥不省,四肢逆冷,腹中如雷鸣,或痰气不降。
焰砂(半两) 硫黄(一两)
各为细末,每服三分,酒调灌之,良久再服即苏。
慎柔以劳损劈分两病,用意甚是,命名殊非。前人虚劳损极,只以病之深浅立名,损
上损
有国中不同,究无专攻,亦无蛮补,阴阳之际,微有偏重,兼顾之辨而已。至于痨瘵,别是
一病,内夹奇邪,前人别以杀虫毒药加补药治之,似《本草》所谓鬼注、蛊毒,西医所谓长
虫、细虫、扁虫及遗传诸证。虽其本必由正虚,究与虚损之病,由于六淫七情迥异,本是两
病,不待剖析。慎柔以损上损下为劳损之辨,是一病分二;又以瘵为损下之劳,是二病混一
。独其论治虚损,以出汗、见血为转关,实为扼要中肯,与张石顽虚损各案吻合,直接仲景
真传,迥非专主阴柔温润可比,世固有见汗、见血而速死者。仲景所谓卫气前通、阴气前通
绝证也。此系真气充周,血脉流畅,荣卫交通。
劳也者,过勤之谓也。《内经》曰∶四时阴阳生病,常起于过用,或过于劳心,或过
于劳力,或过于房室,或过于饥饱,而其机尤在过用之后重感于邪,使劳气不得休养。如劳力之
后,汗出而外扑风寒,口渴而内伤生冷,腠理外闭,经络内凝。其逼迫离位之气血为所吸摄
,不得反其故道,经络气血俱困,谓之虚劳。此时急治得法,犹可一拨即转,以其机尚灵也
。迁延误治,机钝势折,阴阳开合,举失其枢,所谓真邪相攻乱而相引也,脏腑肌肉俱减,
谓之劳损。复连、 之名,即由于此。以其困而又困,不能振新也。五脏真气不能相济
,四时更代,阴阳竭绝,骨萎髓枯,形脱色坏,穷无复之矣,谓之劳极。此时惟专由邪伤药误
,而禀赋素强,根气尚伏,肉脱未尽,尺脉尚能紧而不断者,犹可挽救,治之须知五行生化
,辗转相资之义,脏气、天气循环相应以缓待之。若大势日下,不及辗转,庸有几乎,凡体
倦困卧不能反侧,及寒热似疟而无汗,溏泄腹痛而面赤,胸痹气阻而无呕吐,皆上下内外
断绝不续之极,阴阳俱竭也。治法当气血初困之时,行气为主,行血佐之,或微加酸敛,或
微加苦坚。东垣甘温除热、升阳散火诸法,可用于此时,及肌肉已减,当用血肉之品,补血
为主,行气,行血佐之,苦酸坚敛,皆在所后。逮至劳极,法不外此,而饮食之调,起居之
慎,导引之勤,尤不可忽。人身为血肉之体,虚劳以积久而成,决非草木所能效灵,旦夕所
能奏效。此中进退消息,有不在形迹间者。当转关时,气化将通未通,往往有冲突格拒之象
,如胸痹气阻,中满食减,头眩心烦,咳嗽多痰,筋骨胀疼,肌肤 肿,鼻塞声瓮,寒热往来
等象,屡转屡变,进退无常。即至见汗、见血,机已大转,仍不免时时发动,发动愈勤,转
关愈速,全在病家、医家细心体察,以静参之。彼以血肉为腻而戒之,或用之不得其法以致
困者,是悖也。证减即喜,转变即忧,毫无真见,用药反时时错过好机会者,益悖也。天下
万病,情形之变幻,治法之微妙,未有甚于虚劳者。痨瘵一门,证虽奇险,尚无许多变化,
其治法尚无许多曲折也。读书临证,悉心揣摩,其难易当默喻之。
【追虫方】
紫河车(一具,焙干) 龙胆草 甘草(各二钱) 鳖甲(五钱) 大黄 苦参 黄柏 知母
贝母 败鼓皮 人中白(各二钱半) 桔梗 胡黄连(二钱半) 犀角 莪术 芒硝(各钱半)
研为细末,用蜂蜜制成梧桐子大小的丸药,以朱砂粉末为衣。每次服用捻成三十丸。腹部有热者,饭前用温酒送服;胸膈有热者,饭后用温酒送服。无论是传尸痨瘵还是其他劳怯病证,均可使用,其余虚劳怯弱之症,一个月即可痊愈。
天灵盖(二指大) 槟榔(五个) 麝香 阿魏 甘遂 安息香(各三钱) 朱砂(一钱)
以上药物研为细末,每次服用三钱。用薤白、葱白各十四茎,青蒿两把,甘草,桃枝、柳枝各五寸,桑白皮,石榴根皮各一片,配合童子尿四大碗,在瓷器中用猛火煎煮,至剩下一碗时,去渣,分作三份,调入前面的药末,在五更初服用。男性患病由女性煎药,女性患病由男性煎药。服药后若感觉想吐,立即含一颗白梅在口中。五更结束时,必须排出虫子及恶物、黄水、黑粪。如果未排出,过一会儿再服一次,天亮后再服一次。如果腹泻不止,用龙骨、黄连等分为末服用。
治疗卒中鬼击,心腹如针刺般疼痛,下血昏迷不醒,以及睡觉魇镇咬脚趾而不觉,以及诸毒等症状。
皂荚 藜芦 雄黄(研碎) 矾(研碎,各等分)
每次取少许,吹入鼻中,如果不打喷嚏就再吹,以打出喷嚏为度。
治疗尸厥脉象动乱看似死亡。
用石菖蒲粉末纳入鼻中,仍将桂枝粉末放在舌上,苏合香丸也可以使用。
治疗尸厥昏迷不醒,四肢逆冷,腹中如雷鸣,或痰气不降。
焰砂(半两) 硫黄(一两)
分别研为细末,每次服用三分,用酒调匀灌服,过了一会儿再服即可苏醒。
慎柔将劳损劈分为两种病证,用意是很好的,但命名却非常不当。前人对于虚劳损极,只是根据病情的深浅来命名,损伤上部、损伤中部、损伤下部虽有不同,但终究没有专门攻伐的方法,也没有蛮补的做法,只是在阴阳之间,稍微有所偏重,加以兼顾辨别罢了。至于痨瘵,是另一种病,内部夹杂奇邪,前人另外用杀虫毒药配合补药来治疗,类似于《本草》所说的鬼注、蛊毒,西医所说的长虫、细虫、扁虫及遗传诸证。虽然其根本必然由于正气虚弱,但究其与虚损之病,由于六淫七情所致截然不同,本是两种病,不需要剖析。慎柔将损上损下作为劳损的辨别,是将一种病分为两种;又将瘵视为损下的劳,是将两种病混为一谈。唯独他论述治疗虚损,以出汗、见血为转关的关键,确实扼要中肯,与张石顽虚损各案吻合,直接传承了仲景的真传,绝非专主阴柔温润可比,世上固有因见汗、见血而迅速死亡的案例。仲景所谓卫气前通、阴气前通是绝证。这是真气充周,血脉流畅,营卫交通。
劳,是指过度劳累的意思。《内经》说:四时阴阳生病,常起于过度使用,或者过于劳心,或者过于劳力,或者过于房室,或者过于饥饱,而其关键尤其在于过度使用之后再次感受外邪,使劳气不得休养。比如劳力之后,汗出而外受风寒,口渴而内伤生冷,腠理外部闭塞,经络内部凝滞。那些逼迫离位的气血被邪气吸摄,不能返回原来的道路,经络气血都困顿,称为虚劳。此时如果紧急治疗得法,还可以一拨即转,因为其机理尚且灵敏。拖延延误治疗,机理迟钝,气势折损,阴阳开合,全部失去枢纽,所谓真邪相攻乱而相互牵引,脏腑肌肉都减少,称为劳损。复连、 之名,就是由于这个原因。因为困顿而又困顿,不能振新。五脏真气不能相互济助,四时更代,阴阳竭绝,骨萎髓枯,形体脱失颜色败坏,穷尽无复,称为劳极。此时只有专门由于邪气伤害、药物误治,而禀赋素来强壮,根气尚存,肉脱未尽,尺脉尚能紧而不断者,还可以挽救,治疗时必须知晓五行生化,辗转相资的意义,脏气、天气循环相应以缓待之。如果大势日益向下,来不及辗转,平庸之人能有办法吗?凡是身体疲倦困卧不能翻身,以及寒热像疟疾而无汗,溏泄腹痛而面赤,胸痹气阻而无呕吐,都是上下内外断绝不续的极点,阴阳俱竭。治疗方法应当在气血刚刚困顿时,以行气为主,行血为辅,或者微微加酸敛,或者微微加苦坚。东垣甘温除热、升阳散火诸法,可以用于此时,等到肌肉已经减少,当用血肉之品,以补血为主,行气、行血为辅,苦酸坚敛,都在其次。到了劳极阶段,方法不外乎此,而饮食的调理,起居的谨慎,导引的勤奋,尤其不可忽视。人身是血肉之体,虚劳是由于积久而成,决非草木所能效灵,旦夕所能奏效。这其中进退消息,有不在形迹间的。当转关时,气化将要通而未通,往往有冲突格拒的现象,如胸痹气阻,中满食减,头眩心烦,咳嗽多痰,筋骨胀疼,肌肤肿胀,鼻塞声瓮,寒热往来等现象,屡转屡变,进退无常。即使到了见汗、见血,机理已经大转,仍不免时时发动,发动越勤快,转关越迅速,全在病人、医生细心体察,以静参悟。那些认为血肉之品腻而戒除它,或者使用不得法导致困顿的,是违背常理的。证候减轻就高兴,转变就忧愁,毫无真知灼见,用药反而时时错过好机会的,更是违背常理。天下万病,情形的变幻,治法的微妙,没有比虚劳更甚的了。痨瘵一门,证候虽然奇险,还没有这么多变化,其治法还没有这么多曲折。读书临证,悉心揣摩,其难易应当默喻之。
[Formula for Expelling Parasites]
Placenta (one piece, baked dry) *Gentianae Radix* (Longdan Cao), *Glycyrrhizae Radix et Rhizoma* (Gancao) (each 2 qian), *Testudinis Carapax et Plastrum* (Biejia) (5 qian), *Rhei Radix et Rhizoma* (Dahuang), *Sophorae Flavescentis Radix* (Kushen), *Phellodendri Chinensis Cortex* (Huangbai), *Anemarrhenae Rhizoma* (Zhimu), *Fritillariae Cirrhosae Bulbus* (Beimu), *Corium Equi Mortui* (Baigupi), *Natrii Sulfas Depuratus* (Renzhongbai) (each 2.5 qian), *Platycodonis Radix* (Jiegeng), *Coptidis Rhizoma* (Huhuanglian) (2.5 qian), *Rhinocerotis Cornu* (Xijiao), *Curcumae Zedoariae Rhizoma* (Ezhu), *Natrii Sulfas* (Mangxiao) (each 1.5 qian).
Grind into fine powder, make pills the size of wutong seeds using honey, and coat with *Cinnabar* (Zhusha) powder. Each dose consists of thirty pills. For heat in the abdomen, take with warm wine before meals; for heat in the chest and diaphragm, take with warm wine after meals. This formula is applicable to both *Chuan Shi Lao Zhai* (Transmitted Corpse Consumption Tuberculosis) and other consumption diseases. Other deficiency consumptions can be cured within one month.
Skull Cap (*Tianlinggai*) (size of two fingers), *Arecae Semen* (Binglang) (five pieces), *Moschus* (Shexiang), *Ferulae Resina* (Awei), *Kansui Radix* (Gansui), *Styrax* (Anshixiang) (each 3 qian), *Cinnabar* (Zhusha) (1 qian).
Grind the above into fine powder. Each dose is 3 qian. Use fourteen stalks each of *Allii Macrostemonis Bulbus* (Xiebai) and *Allii Fistulosi Bulbus* (Congbai), two handfuls of *Artemisiae Annuae Herba* (Qinghao), *Glycyrrhizae Radix et Rhizoma* (Gancao), five cun each of *Peach Twig* (Taozhi) and *Willow Twig* (Liuzhi), one slice each of *Mori Cortex* (Sangbaipi) and *Punica Granati Radicis Cortex* (Shiliugenpi), combined with four large bowls of urine from a healthy child. Decoct in a porcelain vessel over strong fire until only one bowl remains. Strain and discard the dregs. Divide into three portions. Mix with the aforementioned powder and take at the beginning of the fifth watch (around 3-5 AM). If the patient is male, the female should decoct the medicine; if female, the male should decoct it. After taking the medicine, if there is a sensation of wanting to vomit, immediately hold a white plum in the mouth. By the end of the fifth watch, worms, foul matter, yellow fluid, and black stool must be expelled. If not expelled, take another dose after a while, and a third dose at dawn. If diarrhea persists indefinitely, take an equal amount of *Dragones Sanguis* (Longgu) and *Coptidis Rhizoma* (Huanglian) ground into powder.
*Picriae Herba* (Baiwei), *Angelicae Sinensis Radix* (Danggui) (each 1 liang), *Ginseng Radix* (Renshen), *Glycyrrhizae Radix et Rhizoma* (Gancao).
Each dose is 5 qian, decocted in water.
To treat sudden attack by "ghost strike," heart and abdomen feeling like刺 (puncturing/stabbing), bleeding from below, unconsciousness, as well as sleep paralysis where one bites their toe without awareness, and various toxic conditions.
*Gleditsiae Sinensis Spina* (Zaojiao), *Veratrum Nigrum* (Lilu), *Realgar* (Xionghuang, ground), *Alumen* (Fan, ground) (equal parts).
Take a small amount each time, blow into the nose. If no sneezing occurs, blow again. Stop when sneezing occurs.
To treat *Shi Jue* (Corpse-like Fainting) where the pulse is chaotic and resembles death.
Insert *Acori Tatarinowii Rhizoma* (Shichangpu) powder into the nose. Place *Cinnamomi Ramulus* (Guizhi) powder on the tongue. *Suhe Xiang Wan* (Styrax Pill) may also be used.
To treat *Shi Jue* with unconsciousness, cold limbs, borborygmus in the abdomen, or descending failure of phlegm-qi.
Calcined Realgar (*Yan Sha*) (0.5 liang), *Sulfur* (Liuhuang) (1 liang).
Grind each into fine powder. Each dose is 3 fen, mixed with wine and administered. After a while, administer again, and the patient will revive.
Shenrou divides *Lao Sun* (Consumption Injury) into two diseases, which is very insightful, but the naming is highly inappropriate. Predecessors named extreme deficiency consumption based solely on the depth of the disease. Whether damaging the upper, middle, or lower jiao, there were differences, but ultimately there was no specific attacking method, nor reckless tonification. It merely involved slight emphasis on yin or yang, with careful consideration of balance. As for *Lao Zhai* (Tuberculosis/Consumption), it is a separate disease involving strange pathogens. Predecessors treated it separately by adding insect-killing and toxic drugs to tonifying medicines, similar to what is described in *Bencao* as *Gui Zhu* (Ghost Injection) and *Gu Du* (Gu Poison), or what Western medicine calls roundworms, pinworms, tapeworms, and hereditary conditions. Although its root must stem from righteous qi deficiency, it is fundamentally different from deficiency injuries caused by the six excesses and seven emotions. They are originally two distinct diseases, requiring no further analysis. Shenrou distinguishes *Lao Sun* by upper and lower damage, splitting one disease into two; and he considers *Zhai* as lower damage consumption, mixing two diseases into one. However, his discussion on treating deficiency consumption, identifying sweating and bleeding as critical turning points, is indeed concise and accurate. It aligns with Zhang Shiweng's cases of deficiency consumption, directly inheriting Zhongjing's true transmission, and is far superior to those who exclusively focus on yin-nourishing and gentle-warming methods. There are indeed cases in the world where patients die rapidly due to sweating and bleeding. Zhongjing stated that "Wei Qi passing through first" and "Yin Qi passing through first" are signs of terminal collapse. This refers to abundant true qi, smooth blood vessels, and communication between Ying and Wei.
"Lao" (Fatigue/Overwork) refers to excessive exertion. The *Neijing* states: Diseases arising from the yin and yang of the four seasons often begin with overuse, whether mental labor, physical labor, sexual activity, or irregular eating and drinking. The key mechanism lies especially in contracting external pathogens after overuse, preventing the recovery of fatigue qi. For example, after physical labor, sweating exposes one to wind-cold externally, or thirst leads to consuming cold/raw foods internally. The pores close externally, and meridians congeal internally. The qi and blood, forced out of their proper positions, are captured by the pathogen and cannot return to their original pathways. Meridian qi and blood become exhausted, termed *Xu Lao* (Deficiency Fatigue). At this stage, if treated urgently and correctly, recovery can be swift because the mechanism is still responsive. Delaying treatment causes the mechanism to dull and the momentum to break. Yin and yang opening and closing lose their pivot. True qi and pathogenic factors clash chaotically and attract each other. Zang-fu organs and muscles diminish, termed *Lao Sun* (Consumption Injury). The terms *Fu Lian* and [missing character] originate from this. Because exhaustion follows exhaustion, renewal is impossible. True qi of the five zang organs fails to support each other. With the changing of the four seasons, yin and yang exhaust, bones wither, marrow dries up, form degenerates, color fades, reaching a point of no return, termed *Lao Ji* (Extreme Consumption). At this stage, rescue is only possible if the constitution was originally strong, root qi remains latent, muscle wasting is not total, and the chi pulse is still tight and unbroken, despite being caused specifically by pathogenic injury or medication error. Treatment must understand the principles of the mutual generation of the Five Elements, the interdependence of organ qi and heavenly qi, waiting patiently for cyclical response. If the general trend declines daily without opportunity for rotation, what can mediocre practitioners do? Whenever the body is tired, prone to lying down, unable to turn over, accompanied by chills and fever resembling malaria but without sweat, loose stools with abdominal pain and red face, chest bi with qi obstruction but no vomiting, these are extremes of disconnection between upper/lower and internal/external, indicating exhaustion of both yin and yang. In the treatment method, when qi and blood are initially exhausted, prioritize moving qi, assisted by moving blood, or slightly add sour-astringents or slightly add bitter-hardeners. Dongyuan's methods of sweet-warm to remove heat and ascending-yang to scatter fire can be applied at this stage. Once muscles have diminished, use substances of flesh and blood, prioritizing blood tonification, assisted by moving qi and blood. Bitter, sour, hardening, and astringent methods come later. When reaching extreme consumption, the methods do not exceed this, but dietary regulation, careful living habits, and diligent guidance exercises are particularly important. The human body is a flesh-and-blood entity. Deficiency consumption accumulates over time and certainly cannot be effectively cured by herbs alone in a day or night. The nuances of advancement and retreat lie beyond mere appearances. During the turning point, when qi transformation is about to flow but has not yet done so, there are often images of conflict and rejection, such as chest bi with qi obstruction, fullness in the middle, reduced appetite, dizziness, irritability, cough with much phlegm, distension and pain in tendons and bones, swelling of skin and flesh, nasal congestion with muffled voice, alternating chills and fever, etc. These symptoms change repeatedly and unpredictably. Even when sweating and bleeding occur, indicating a major shift in the mechanism, fluctuations may still occur. The more frequent the fluctuations, the faster the turning point. It entirely depends on the patient and physician observing carefully and contemplating quietly. Those who warn against flesh-and-blood substances as being cloying, or use them improperly leading to stagnation, are acting contrary to reason. Being pleased when symptoms decrease and worried when they transform shows a lack of true insight, causing missed opportunities in medication, which is even more contrary to reason. Among all diseases under heaven, none exhibit greater variability in condition or subtlety in treatment than deficiency consumption. In the category of tuberculosis/consumption, although conditions are bizarre and dangerous, there are not so many variations, nor such complex treatments. Reading books and practicing clinically, with careful contemplation, one will silently understand the difficulties and ease.