凡似损非损之证，惟外感寒邪者乃有之。盖以外邪初感，不为解散而误作内伤，或用清
凉，或用消导，以致寒邪郁伏，久留不散，而为寒热往来，或为潮热咳嗽，其证则全似劳损
。若用治损之法以治此证，则滋阴等剂愈以留邪，热蒸既久，非损成损矣，余尝治愈数人，
皆其证也。欲辨此者，但当详察表里，而审其致病之由。盖虚损之证，必有所因，而外感之
邪，其来则骤。若或身有疼痛，而微汗则热退，无汗则复热，或见大声咳嗽，脉虽弦紧而不
甚数，或兼和缓等证，则虽病至一两月，而邪有不解，病终不退者，本非劳损，毋误治也。
若寒热往来不止者，宜一二三四五柴胡饮酌宜用之，或正柴胡饮亦可。若兼咳嗽者，柴陈煎
。若脾肾气虚而兼咳嗽者，金水六君煎，或邪有未解而兼寒热者，仍加柴胡。
凡虚损既成，不补将何以复？而有不能服人参、熟地及诸补之药者，此为虚不受补，何
以望生。若劳损吐血失血之后，嗽不能止，而痰多甚者，此以脾肺虚极，饮食无能化血，而
随食成痰，此虽非血，而实血之类也。经曰∶白血出者，死。故凡痰之最多最浊者，不可治
。一、左右者，阴阳之道路，其有不得左右眠而认边难转者，此其阴阳之气有所偏竭而然，
多不可治。一、凡病虚损者，原无外邪，所以病虽至困，终不愦乱。其有患虚证别无邪热，
而谵妄失伦者，此心脏之败，神去之兆也，必死。一、劳嗽、喑哑声不能出，或喘急气促者
，此肺脏之败也，必死。一、劳损肌肉脱尽者，此脾脏之败也，必死。一、筋为疲极之本
，凡病虚损者，多有筋骨疼痛。若痛有至极不可忍者，乃血竭不能荣筋，此肝脏之败也，必
死。一、劳损既久，再及大便，泄泻不能禁止者，此肾脏之败也，必死。
凡是看似虚损实则并非虚损的病证，只有外感寒邪的情况才会出现。这是因为外邪刚刚侵入人体，如果不及时疏散解表，反而错误地当作内伤来治疗，或者使用清热凉药，或者使用消食导滞的药物，导致寒邪郁结潜伏在体内，长久停留不散，从而出现寒热往来，或者出现潮热咳嗽等症状，这些症状看起来完全像劳损（慢性消耗性疾病）。如果此时用治疗虚损的方法来治疗这种病证，那么滋阴等补益药物反而会留滞邪气，热气蒸腾日久，就会把非虚损的病变成真正的虚损了。我曾经治愈过几个人，都是属于这种情况。想要辨别这类病症，应当详细考察表里情况，并审察致病的原因。因为虚损的病症，必定有其原因积累，而外感之邪，发病则突然。如果有身体疼痛，微微出汗后热退，不出汗则热复起，或者出现大声咳嗽，脉象虽然弦紧但并不十分数急，或者兼见和缓等征象，那么即使患病已经一两个月，邪气没有解除，病情始终不退，这本来就不是劳损，不要误治。如果寒热往来不止的，适宜酌情选用一二三四五柴胡饮，或者正柴胡饮也可以。如果兼有咳嗽的，用柴陈煎。如果脾肾气虚而兼有咳嗽的，用金水六君煎，或者邪气尚未解除而兼有寒热的，仍然加入柴胡。
凡是虚损已经形成，不通过补益怎么能够恢复呢？但是有的人不能服用人参、熟地黄以及各种补益药物，这就是所谓的“虚不受补”，怎么能指望痊愈呢？如果是劳损吐血、失血之后，咳嗽不能停止，而且痰多严重的，这是因为脾肺极度虚弱，饮食无法转化为血液，随着食物运化而成痰，这虽然不是血液，但实际上属于血的同类。医经说：“白血出者死。”所以凡是痰最多最浑浊的，不可治愈。第一，左右是阴阳运行的道路，有的人不能向左右侧卧翻身困难，这是阴阳之气有所偏颇衰竭所致，大多不可治愈。第二，凡是患虚损病的，原本没有外邪，所以病情虽然非常困重，最终不会神志昏乱。如果有患虚证且没有其他邪热，却出现胡言乱语、失去常理的，这是心脏败坏，神气离去的征兆，必死。第三，劳嗽、声音嘶哑发不出声，或者气喘急促的，这是肺脏败坏的表现，必死。第四，劳损导致肌肉脱尽的，这是脾脏败坏的表现，必死。第五，筋是疲劳至极的根本，凡是患虚损病的，多有筋骨疼痛。如果疼痛达到极其难以忍受的程度，这是血枯竭不能濡养筋脉，肝脏败坏的表现，必死。第六，劳损日久，累及大便，泄泻不能控制的，这是肾脏败坏的表现，必死。
Regarding conditions that resemble deficiency consumption (Xu Sun, chronic wasting disease) but are not true deficiency consumption, this occurs only in cases of external contraction of cold pathogen. This is because when an external pathogen initially invades, if it is not dispersed and resolved, but mistakenly treated as an internal injury, or if cooling/clearing agents or digestive-promoting agents are used, the cold pathogen becomes depressed and latent, lingering for a long time without dissipating. This leads to alternating chills and fever, or tidal fever with coughing; these symptoms completely resemble consumption. If one uses methods for treating deficiency consumption to treat such conditions, then yin-nourishing and other tonic formulas will further retain the pathogen. After prolonged steaming heat, a non-consumption condition will turn into true consumption. I have cured several patients with these exact presentations. To distinguish this, one must carefully examine the exterior and interior, and ascertain the cause of the disease. True deficiency consumption invariably has a gradual etiology, whereas external pathogens strike suddenly. If there is body pain, where slight sweating causes the fever to recede, and lack of sweating causes the fever to return; or if there is loud coughing, and the pulse is wiry and tight but not excessively rapid, or accompanied by harmonious/sluggish qualities; even if the illness has persisted for one or two months with the pathogen unresolved and the condition unrelenting, this is fundamentally not consumption, and erroneous treatment should be avoided. For persistent alternating chills and fever, one should selectively use Chaihu Yin (Bupleurum Decoction) variants (First through Fifth), or Zheng Chaihu Yin (Correct Bupleurum Decoction) may also be used. If accompanied by coughing, use Chaichen Jian (Bupleurum and Tangerine Peel Decoction). If there is Qi deficiency of the Spleen and Kidney accompanied by coughing, use Jinshui Liujun Jian (Metal-Water Six Gentlemen Decoction); if the pathogen remains unresolved accompanied by chills and fever, add Chai Hu (Bupleuri Radix).
Once deficiency consumption has formed, how can recovery occur without tonification? However, some patients cannot tolerate Ren Shen (Ginseng Radix et Rhizoma), Shu Di Huang (Rehmanniae Radix Preparata), and other tonic medicines. This is termed "deficiency unable to accept tonification" (Xu Bu Shou Bu); how can survival be expected? Following hematemesis or hemorrhage due to consumption, if coughing persists and sputum is excessive and severe, this indicates extreme deficiency of the Spleen and Lung. Dietary intake fails to transform into blood, instead turning into phlegm with food ingestion. Although this is not blood, it belongs to the category of blood. The Classics state: "Excretion of white blood indicates death." Therefore, cases with the most abundant and turbid phlegm are incurable. First, the left and right sides are the pathways of Yin and Yang. Patients who cannot sleep on either side or find it difficult to turn over indicate a partial exhaustion of Yin and Yang Qi; these are mostly incurable. Second, patients with deficiency consumption originally lack external pathogens; thus, although the condition is severe, they do not become delirious. If a patient presents with deficiency signs but no external heat-pathogen, yet exhibits delirium and loss of rationality, this signifies the failure of the Heart and the departure of Shen (Spirit); death is inevitable. Third, chronic coughing, aphonia (loss of voice), or panting with shortness of breath indicates the failure of the Lung; death is inevitable. Fourth, complete emaciation due to consumption indicates the failure of the Spleen; death is inevitable. Fifth, sinews are the root of extreme fatigue. Patients with deficiency consumption often suffer from bone and sinew pain. If the pain reaches an unbearable intensity, it indicates blood exhaustion failing to nourish the sinews, signifying the failure of the Liver; death is inevitable. Sixth, prolonged consumption affecting the bowels, resulting in uncontrollable diarrhea, indicates the failure of the Kidney; death is inevitable.