凡因辛苦劳倦而病者，多有患头痛发热恶寒，或骨腿酸疼，或微渴，或无汗，或自汗，脉虽浮
大而无力，亦多紧数，此劳力感寒之证，即东垣云内伤证也。宜补中益气汤，或补阴益气煎，及五
福饮等剂为良，所谓温
能除大热，即此类也。若或邪盛无汗，脉见洪数，而当和解者，即当用新方散阵诸柴胡饮之类主之。
一、凡劳力感寒一证，人皆以服役辛苦之人为言，而不知凡为名利所牵，有不自揣，以致竭尽
心力而患伤寒者，皆其类也。故凡有形劳而神不劳者，劳之轻者也，若既劳其神，又劳其形，内外
俱劳，则形神俱困，斯其甚矣。今人之病伤寒者，率多此类，轻者和解，治宜如前，重者速宜救本
，当于后开培补诸方，择而用之，庶乎有济。倘不知其所致之由，而概施混治，但知攻邪，则未有
不误人者矣。此即劳倦内伤之类，诸义俱详本门。
仲景曰∶阳微则恶寒，阴弱则发热，是寒热之有虚也。曰∶其人本虚，是以发战，是战汗之皆
因虚也。曰∶耳聋无闻者，阳气虚也。曰∶面赤戴阳者，阴不足也。曰∶无阳不能作汗，必身冷而
脉迟也。曰∶客热不能杀谷，胃中虚冷也。曰∶病患脉数，数为热，当消谷引食，而反吐者，此以
发汗，令阳气微，膈气虚，脉乃数也。数为客热，不能消谷，以胃中虚冷，故吐也。曰∶虚则郑声
，以言语乱而不正也。曰∶身蜷恶寒而利，因冷气而为厥逆也。曰∶尺中脉微，此里虚，须表里实
，津液自和，便自汗出愈。曰∶脉促厥冷者宜灸，以促脉有非因热也。曰∶头疼呕吐之宜温，以头
疼之有属阴也。曰∶不利而利，发热汗出者，有阴无阳也。曰∶少阴脉沉者，汗后热不去，而厥利
恶寒者，皆宜急温也。曰∶旧有微溏者，不可与栀子汤，以里虚而寒在下也。曰∶阳明病，不能食
，攻其热必哕，所以然者，胃中虚冷故也。饮之水亦哕也。曰∶小便色白者，以下焦之虚寒也。曰
∶自利不渴者，以脏中之无火也。曰∶邪中于阴者，必生内栗，因表气虚而里气不守也。曰∶发汗
过多，其人叉手自冒心，心下悸而欲得按者，亡其阳也。曰∶发汗病不解，而反恶寒者，虚故也。
曰∶脉阴阳俱紧，反汗出者，亡其阳也。
一、诸脉有虚证，见前卷。
一、忌汗下各有虚证，见前卷。
一、表里五脏各有虚实，详一卷《传忠录·虚实辨》中，俱当互阅。
凡是因辛勤劳作、过度疲劳而患病的人，大多会出现头痛、发热、恶寒（怕冷），或者骨节和腿部酸痛，或者轻微口渴，或者无汗，或者自汗（不因活动或炎热而自然出汗），脉象虽然浮大而无力，也常兼见紧数之象。这是劳力感寒的证候，也就是李东垣所说的内伤证。适宜使用补中益气汤，或者补阴益气煎，以及五福饮等方剂治疗，这体现了“甘温能除大热”的道理，指的就是这类情况。如果邪气盛实且无汗，脉象呈现洪数，应当采用和解法治疗的，就应当使用新方散阵中的各类柴胡饮来主治。
一、凡是劳力感寒这一证候，人们通常只认为是从事体力劳动辛苦的人才会得，却不知道凡是受名利的牵绊，不能自我估量能力，以致耗尽精力心力而患上伤寒病的人，都属于这一类。所以，凡是身体劳累而精神未劳累的，属于较轻的劳损；如果既劳累精神，又劳累身体，内外都劳损，那么形体和精神都困顿，这就非常严重了。现在人患伤寒病的，大多属于这种情况。轻症用和解法，治疗如前所述；重症则应迅速救本，应当从后面列出的培补方剂中选择使用，这样或许能有疗效。倘若不知道导致疾病的原因，而一概进行混杂治疗，只知道攻伐邪气，就没有不误人的了。这属于劳倦内伤的范畴，各种义理都在本门中详细说明。
张仲景说：阳气微弱就会恶寒，阴血虚弱就会发热，这说明寒热症状有虚证的情况。他说：病人本来体质虚弱，所以出现战栗，说明战汗都是由于虚损引起的。他说：耳聋听不见声音，是阳气虚弱的表现。他说：面色赤红如戴阳（虚阳上浮），是阴精不足的表现。他说：没有阳气就不能作汗，必然身体寒冷而脉迟。他说：客热（虚热）不能消化食物，是因为胃中虚冷。他说：病人脉数，数脉主热，应当消谷善饥，反而呕吐的，这是因为发汗后导致阳气微弱，膈间气虚，脉才表现为数。数脉代表客热，不能消化食物，因为胃中虚冷，所以发生呕吐。他说：虚证会出现郑声（语言重复，声音低微），即言语错乱而不端正。他说：身体蜷缩、恶寒且下利，是因为冷气侵袭而导致四肢厥逆。他说：尺部脉微，这是里虚，需要表里充实，津液自然调和，就会自汗出而痊愈。他说：脉促且四肢厥冷的适宜灸治，因为促脉并非都由热引起。他说：头疼呕吐适宜用温法，因为头疼有属于阴证的。他说：原本不利却转为下利，伴有发热汗出的，是有阴无阳的表现。他说：少阴脉沉的，发汗后热不退，且出现四肢厥冷、下利、恶寒的，都应当紧急温补。他说：素来有大便稀溏的，不可给予栀子汤，因为里虚且寒在下焦。他说：阳明病，不能进食，若攻其热必致呃逆，之所以如此，是因为胃中虚冷。喝冷水也会引发呃逆。他说：小便颜色白的，是因为下焦虚寒。他说：自利（自行下利）且不口渴的，是因为脏腑中没有火（阳气不足）。他说：邪气侵入阴分，必然产生内心战栗，因为表气虚而里气不能固守。他说：发汗过多，病人双手交叉护住心口，心中悸动且喜欢按压的，是亡阳的表现。他说：发汗后病不解，反而更加恶寒的，是虚证所致。他说：脉象阴阳俱紧，反而汗出的，是亡阳的表现。
一、各种脉象中的虚证，见前卷。
一、忌用汗法和下法的虚证，见前卷。
一、表里五脏各有虚实，详见一卷《传忠录·虚实辨》中，都应当互相参考阅读。
For those who fall ill due to hard work and excessive fatigue, symptoms often include headache, fever, aversion to cold (Ehan), soreness and pain in the bones and legs, slight thirst, anhidrosis (no sweat), or spontaneous sweating (Zihan - sweating without exertion or heat). The pulse may be floating, large, and powerless, yet often tight and rapid. This is a syndrome of labor-induced cold invasion, which Li Dongyuan referred to as internal injury (Neishang). It is appropriate to use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Buyin Yiqi Jian (Nourish Yin and Augment Qi Decoction), or Wufu Yin (Five Blessings Drink) and similar formulas. This illustrates the principle that "sweet-warm herbs can eliminate great heat," referring specifically to such cases. If the pathogenic factor is strong with no sweat, and the pulse is surging and rapid, requiring harmonization treatment, one should use various Chaihu Yin (Bupleurum Decoction) preparations from the new formula Sanzhen series.
1. Regarding the syndrome of labor-induced cold invasion, people generally associate it only with those engaged in arduous physical labor. They fail to realize that anyone driven by fame and profit, unable to assess their own limits, exhausting their mental and physical energy to the point of contracting Shanghan (Cold Damage), belongs to this category. Therefore, when the body is fatigued but the spirit is not, it is considered mild fatigue. However, if both the spirit and the body are exhausted, leading to internal and external fatigue where both form and spirit are depleted, the condition is severe. Most contemporary cases of Shanghan belong to this type. For mild cases, harmonization is used as described above; for severe cases, urgent rescue of the root is required, selecting from the subsequent tonifying formulas listed below. Only then might there be efficacy. If the cause is unknown and indiscriminate treatment is applied, focusing solely on attacking the pathogen, errors are inevitable. This falls under the category of labor-fatigue internal injury, with detailed explanations provided in this section.
Zhang Zhongjing stated: "When Yang is deficient, there is aversion to cold; when Yin is weak, there is fever." This indicates that chills and fever can stem from deficiency. He said: "Because the person's constitution is originally deficient, they experience shivering." This shows that shaking sweats (Zhanhan) are all caused by deficiency. He said: "Deafness and inability to hear indicate deficiency of Yang Qi." He said: "A red face resembling 'floating Yang' (Daiyang) indicates insufficiency of Yin essence." He said: "Without Yang, sweat cannot be produced; thus, the body will be cold and the pulse slow." He said: "Exogenous heat (Ke Re) failing to digest food indicates deficiency-cold in the Stomach." He said: "If the patient has a rapid pulse, which typically indicates heat and should lead to good appetite, but instead vomits, it is because sweating has weakened Yang Qi and depleted Qi in the Diaphragm, resulting in a rapid pulse. This rapid pulse represents exogenous heat, which fails to digest food due to deficiency-cold in the Stomach, hence vomiting occurs." He said: "Deficiency leads to Zhengsheng (repetitive, low-volume speech), meaning speech is disordered and incoherent." He said: "Body curling up, aversion to cold, and diarrhea indicate Jue Ni (cold extremities) caused by cold Qi." He said: "A faint pulse at the Chi position indicates interior deficiency. When both exterior and interior become solid and fluids harmonize, spontaneous sweating will occur, leading to recovery." He said: "A cunited pulse (Cu Mai) with cold extremities warrants moxibustion, as a Cu pulse is not necessarily caused by heat." He said: "Headache and vomiting warrant warm methods, as some headaches are attributed to Yin syndromes." He said: "Transitioning from constipation to diarrhea with fever and sweating indicates 'Yin without Yang.'" He said: "A deep pulse at the Shaoyin position, where fever persists after sweating accompanied by cold extremities, diarrhea, and aversion to cold, requires urgent warming." He said: "Those with chronic loose stools should not receive Zhizi Tang (Gardenia Decoction), due to interior deficiency and cold in the lower Jiao." He said: "In Yangming disease, if the patient cannot eat, attacking the heat will cause hiccups; this is because the Stomach is deficient and cold. Drinking water will also induce hiccups." He said: "White urine indicates deficiency-cold in the Lower Jiao." He said: "Spontaneous diarrhea without thirst indicates the absence of Fire (Yang Qi) in the Zang organs." He said: "When pathogens invade Yin levels, internal trembling occurs because exterior Qi is deficient and interior Qi fails to secure itself." He said: "Excessive sweating causing the patient to cross their hands over the heart, experiencing palpitations and a desire for pressure, indicates loss of Yang (Wang Yang)." He said: "If the disease does not resolve after sweating, and aversion to cold worsens, it is due to deficiency." He said: "If the pulse is tight at both Yin and Yang positions but accompanied by sweating, it indicates loss of Yang."
1. Various deficiency pulses are discussed in previous volumes.
1. Deficiency syndromes contraindicating sweating and purgation methods are discussed in previous volumes.
1. Excess and deficiency patterns of the Exterior, Interior, and Five Zang organs are detailed in Volume 1, *Chuanzhong Lu · Bian Zheng* (Records of Transmission and Loyalty · Differentiation of Excess and Deficiency); these should be consulted mutually.