虚损劳瘵之异 凡损伤元气者本皆虚证，而古方以虚损劳瘵各分门类，则病若有异，亦所宜辨。盖虚
损之谓，或有发见于一证，或有困惫于临时，凡在经在脏，但伤元气，则无非虚损病也。至若劳瘵之有不同者，
则或以骨蒸，或以干嗽，甚至吐血吐痰，营卫俱败， 羸日甚，此其积渐有日，本末俱竭而然。但虚损之虚，
有在阴分，有在阳分，然病在未深，多宜温补；若劳瘵之虚，深在阴中之阴分，多有不宜温补者。然凡治虚证
宜温补者，病多易治；不宜温补者，病多难治。此虚劳若乎有异，而不知劳瘵之损，即损之深而虚之甚者耳。
凡虚损不愈，则日甚成劳矣，有不可不慎也。（《景岳》）
脉候 诊其脉，甚数甚急，甚细甚弱甚微，甚涩甚滑，甚短甚长，甚浮甚沉，甚紧甚弦，甚洪甚实，
皆生于劳伤。（《中藏经》）
虚劳之脉，大抵多弦（按∶严子礼亦云然），或浮大，或数，皆虚劳之候也。大者易治，血气未衰（按∶
原文衰作定，今从《简易方》），可敛而正也。弦者难治，血气已耗，未易调补之。若带双弦，则为贼邪侵脾，
此尤难治，加
数（按∶原文此下有剂字，今从《简易方》删）则殆矣。（《直指》）
虚损之脉（按∶原文此下有《中藏经》文），然无论浮沉大小，但渐缓则渐有生意，若弦甚者病必甚，数
甚者病必危，若以弦细而再加紧数，则百无一生矣。（《景岳》）
劳脉，初起见洪大或细数，皆忌也。然投以滋补之剂尚能应手，而脉亦渐转微弱，数亦渐退，犹为可治；
若证转而脉不转，即不可治，所谓无胃气也。（《医学指要》）
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。（《医通》）
辨爪 凡劳损之病，本属阴虚，阴虚必血少，而指爪为精血之余，故凡于诊候之际，但见其指爪干黄，
觉有枯槁之色，则其发肤营气，具在吾目中矣。此于脉色之外，便可知其有虚损之候，而损之微甚，亦可因之
以辨也。（《景岳》）
五劳六极七伤 （互见前源由总说中）夫虚劳者，五劳六
极七伤是也。五劳者, 一曰志劳，二曰思劳，三曰心劳，四曰忧劳，五曰瘦劳。又肺劳者，短气而面肿，鼻不
闻香臭。肝劳者，面目干黑口苦，精神不守，恐畏不能独卧，目视不明。心劳者，忽忽喜忘，大便苦难，或时
鸭溏，口内生疮。脾劳者，舌本苦直，不得咽唾。肾劳者，背难以俯仰，小便不利，色赤黄而有余沥，茎内痛，
阴湿囊生疮，小腹满急。六极者，一曰气极，令人内虚，五脏不足，邪气多，正气少，不欲言。二曰血极，令
人无颜色，眉发堕落，忽忽喜忘。三曰筋极，令人数转筋，十指爪甲皆痛，苦倦不能久立。四曰骨极，令人酸
削，齿苦痛，手足烦疼，不可以立，不欲行动。五曰肌极（按∶《千金》作髓极），令人羸瘦无润泽，饮食不
生肌肤。六曰精极，令人少气， 然内虚，五脏气不足，发毛落，悲伤喜忘。七伤者，一曰阴寒，二曰阴萎，
三曰里急，四曰精连连，五曰精少，阴下湿，六曰精清，七曰小便苦数，临事不卒。又一曰，大饱伤脾，脾伤
善噫，欲卧面黄。二曰大怒气逆伤肝，肝伤少血目暗。三曰强力举重，久坐湿地伤肾，肾伤少精，腰背痛，厥
逆下冷。四曰形寒，寒饮伤肺，肺伤少气，咳嗽鼻鸣。五曰忧愁思虑伤心，心伤苦惊喜忘善怒。六曰风雨寒暑
伤形，形伤发肤枯夭。七曰大恐惧不节伤志，志伤恍惚不乐。（《病源论》）
证候概略 五劳者，五脏之劳也。皆因不量才力，勉强运为，忧思过度，嗜欲无节，或病失调将，积
久成劳。其病头旋眼晕，身疼脚弱，心怯气短，自汗盗汗，或发寒热，或五心常热，或往来潮热，或骨蒸作热，
夜多恶梦，昼少精神，耳内蝉鸣，口苦无味，饮食减少，此皆劳伤之证也。（《要诀》）
其证百节烦疼，腰酸脚软，或胸闷短气，心烦不安，或耳鸣目眩，咳嗽寒热，或盗汗遗精，白浊飧泄，或
食少无
味，不作肌肤，或睡中惊悸，午后发热，或怠倦无力，四肢不收，或虚火上攻，面赤喘急，此皆虚损之症，
有一症见，即当因其病而药之可也。但视其症之不大，茶饭可餐，起居可动，作为可施，自以为生，孰知其后
卧床不起，去死不远，若欲收救，不可得也。（《医林绳墨》）
咳嗽痰喘不绝声者，急则治其标也。阴虚火动而微嗽者，缓则治其本也。阴虚发热，嗽血大便结者，此虚
火盛也。咳嗽吐血，喘急不能食者，脾肺虚损也。痰嗽喘热而泄泻者，此脾惫也。痰嗽喘热而痢疾者，脾肾俱
惫也。痰嗽喘热，脾虚饱闷发肿者，难治也。（《回春》）
日晡头痛眩晕，阴血虚也。头晕头痛，或痰喘气促，肾虚不纳气也。自汗内热口干，胃气虚也。盗汗内热
口干，阴血虚也。茎痛而便不利，精内竭也。愈痛则愈欲便，愈便则愈痛，精复竭也。食少体倦，口干饮热，
小便黄短，脾肺虚热也。发热饮热，大便秘，内热也。发热饮冷，便秘，内热涩滞，肝热也。饮食少思，胃气
虚也。饮食不化，脾气虚也。劳役而小便黄，元气下陷也。体倦头痛眩晕，中气虚也。四肢逆冷，肾气虚寒也。
面目赤色，烦热作渴，脉大而虚，血脱发燥也。善思体痛，无寐盗汗，肝脾血虚也。寝寐而出汗，肾气也。平
人饮食出汗，是食反助其胃火也。平人饮食，额上蒸大汗如雨，此名蒸笼头。睡觉饱而出汗，宿食也。胸满多
痰，脾气虚也。晡热多痰，肾亏津液泛上也。忿怒胸痞，脾气滞也。倦怠胸痞，中气虚也。倦怠寒热往来，肝
脾气虚也。口苦寒热往来，肝火血虚也。内热晡热，或寒热往来，阴血虚也。畏寒，或寒热往来，肝气滞也。
妇人劳怒，夜发热，或谵语，或经适行，热在血分。怔忡惊悸，心血虚也。思虑怔忡，惊悸便勤，内有痰也。
（《医彀》）
虚损两颧红赤或唇红者，阴虚于下，逼阳于上也。仲景曰∶其面戴阳者，下虚故也。虚而多渴者，肾水不
足，引水自救也。喑唾声不出者，由肾气之竭，盖声出于喉而根于肾，经曰，内夺而厥，则为喑俳，此肾虚也。
虚而喘急者，阴虚肺格，气无所归也。喉干咽痛者，真水下亏，虚火上浮也。不眠恍惚者，血不养心，神不能
藏也。时多烦躁者，阳中无阴，柔不济刚也。易生嗔怒，或筋急酸痛者，水亏木燥，肝失所资也。饮食不甘，
肌肉渐消者，脾元失守，化机日败也。心下跳动，怔忡不宁者，气不归精也。经曰∶胃之大络，名曰虚里，出
于左乳下，其动应衣，宗气泄也。盗汗不止者，有火则阴不能守，无火则阳不能固也。虚而多痰，或如清水，
或多白沫者，此水泛为痰，脾虚不能制水也。骨痛如折者，肾主骨，真阴败竭也。腰胁痛者，肝肾虚也。膝
以下冷者、命门衰绝，火不归源也。小水黄涩淋沥者，真阴亏竭，气不化水也。足心如烙者，虚火烁阴，涌泉
涸竭也。（《景岳》）
桃花蛀 郁劳 有面色如故，肌体自充，外看如无病，内实虚损，俗呼为桃花蛀，宜看其何证，于前
药审而用之。（《要诀》）（按∶前药即建中、大补之类。）。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。（《医通》）
婺妇师尼，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、玉烛散先泻郁火，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。（同上）
各证杂说 丈夫无子者，其精清如水，冷如冰铁，皆为无子之候。又泄精精不射出，但聚于阴头，亦
无子。无此之候，皆有子。（《病源论》）
劳伤则血气虚，使阴阳不和，互有胜弱故也。阳胜则热，阴胜则寒，阴阳相乘，故发寒热。（同上）
有无故身体瘦软，绝无力气，别无他证，此平日作劳太过，血气虚而筋失养，宜劫劳散，或和气汤倍芎归
（按∶《类方》和气饮，于五积散去桂、麻、朴、芎，加干葛、大黄、升麻者，此岂其方乎）。又有言语读诵，
过耗神气，致成虚损，是为叫呼走气，宜于十全大补汤等药选用。虚人老人病中，忽一旦语言不出，扣之不应，
此不是哑风，久久药力到，补调功成，自复应矣。有于坐卧之中，似欲得人按捻，意方始安者，此亦虚证也。
外有因动作劳力，或发寒热，或身疼气短，或劳倦嗜卧，乃一时发劳，却非五劳者比，宜和气饮。有咳嗽痰多
者，名曰劳嗽，与感风寒壅热之嗽不同，此乃有本有标，本在肾而标在肺。（《要诀》）
有重阴覆其阳，火不得伸，或洒洒恶寒，或志意不乐，
或脉弦数，四肢五心烦热者，火郁汤、柴胡升麻汤，病去即已，不可过剂。（《六要》）（按∶火郁汤、柴胡
升麻汤，俱系东垣方，今不录。）
《慎柔》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。（《医通》）
似损非损 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。（《景岳》）
死证 （互见《骨蒸》中，宜参。）病劳人，脱肛，骨肉相失，声散呕血，阳事不禁，梦寐交侵，呼吸
不相从，昼凉夜热者死，吐脓血者亦死。其脉不数有根蒂者，及颊不赤者生。（《中藏》）
劳疾，久而嗽血，咽疼无声，此病自下而传上；若不嗽不疼，久而溺浊脱精，此为自上传下，皆死证也。
（《要诀》）
大抵虚劳起于 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。（《医通》）
虚劳不受补者，不治。（《丹溪》）
病患久虚，内有宿积旧痰，用参术补之，久乃吐出臭痰或绿色痰，当不治。盖积之久，而脾胃虚极不运，
故郁臭耳。（《慎柔五书》）
【虚损与劳瘵的区别】
凡是损伤元气的，原本都是虚证。但古代医方将虚损和劳瘵分别归类，说明病症虽有不同，也应当加以辨别。所谓“虚损”，有的在一时显现症状，有的在临证时感到困倦疲惫，无论病在经络还是脏腑，只要伤了元气，就都属于虚损病。至于“劳瘵”的不同，有的是骨蒸潮热，有的是干咳，甚至吐血、吐痰，营卫之气都败坏，身体日益消瘦，这是日积月累，根本和末节都枯竭所致。但是，虚损的虚，有在阴分的，有在阳分的，然而病势未深时，多适宜用温补法；若劳瘵的虚，深在阴中之阴分，大多不适宜用温补法。然而，凡是治疗虚证适宜用温补的，病多容易治愈；不适宜用温补的，病多难治。这虚劳似乎有差异，却不知道劳瘵的损耗，就是损耗得深、虚弱得严重的情况罢了。凡是虚损不能痊愈，就会日渐加重变成劳瘵，对此不可不谨慎。（出自《景岳全书》）
【脉象候诊】
诊察患者的脉象，如果极数极急，极细极弱极微，极涩极滑，极短极长，极浮极沉，极紧极弦，极洪极实，这些都是由劳伤引起的。（出自《中藏经》）
虚劳病的脉象，大抵多呈弦脉（按：严子礼也这么说），或者浮大，或者数，这都是虚劳的征候。脉大的容易治疗，因为血气尚未衰败（按：原文“衰”字作“定”字，现依据《简易方》改正），可以通过收敛使脉象恢复正常。脉弦的难治，因为血气已经耗损，不容易调补。如果脉带双弦，则是贼邪侵犯脾脏，这尤其难治，如果再加上数脉（按：原文此处有“剂”字，现依据《简易方》删除），那就危险了。（出自《直指方》）
虚损病的脉象（按：原文此处有《中藏经》的文字），然而无论脉象是浮是沉、是大是小，只要逐渐变得缓和，就逐渐有了生机；如果弦脉特别严重，病情一定很重；数脉特别严重，病情一定危急；如果是弦细而又加上紧数，那就百无一生了。（出自《景岳全书》）
劳病的脉象，初起时出现洪大或细数，都是禁忌之象。然而投以滋补的药物尚能应手见效，而且脉象也逐渐转为微弱，数脉也逐渐消退，这还是可治的；如果症状转变而脉象不转变，就不可治了，这就是所谓的“无胃气”。（出自《医学指要》）
紧数和数脉，表示表里俱虚，紧脉是因为寒邪伤及营分，数脉是因为血不足。脉见短数，就是无胃气，细数、紧数都不是吉祥之兆。脉象洪大但按之空虚的，须防发生泄泻。凡是见到数脉都难治，病程长久且脉数的，尤其不宜。脉忽而浮涩而数，忽而沉弱而缓，变化无常，这是虚火的原因。虚损转为潮热泄泻，脉短数的不治。虚损脉浮大的，属于阳虚；脉细数的，属于阴虚。芤脉主失血，如果两手脉都芤，而其中一部独现弦脉，是有瘀血蓄积未尽，应当先消散瘀血，不可急于进补。如果见到数大脉，是火旺，必定难治；如果见到涩脉来至，也不可治。弦数是骨蒸，病势自上而下发展的，寸口脉必浮数；自下而上发展的，尺中脉必弦急。如果关部和尺部都弦细而急，像摸到琴弦一样，是不治之症。另外尺中脉弦强的，必定是因为房事发热，又加上误服寒凉药物，所以脉象如此。然而虚损之人，虽然远离房事，其尺脉的弦强，必定不能立刻变软。如果再犯房事，第二天反而柔和，这是因为阴阳得以交合，所以暂时变软。过几天再诊察，其弦强必定更加严重。诊察的时候，不可不仔细辨别。（出自《医宗必读》）
【观察指甲】
凡是劳损的病，本属阴虚，阴虚必然血少，而手指指甲是精血的余气所生，所以在诊候的时候，只要看到他的指甲干枯发黄，觉得有枯槁的颜色，那么他的头发皮肤和营气，都在我的眼中了。这在脉象和面色之外，就可以知道有虚损的征候，而且损伤的轻重，也可以据此来辨别。（出自《景岳全书》）
【五劳六极七伤】
（互见于前面的源由总说中）所谓虚劳，就是五劳、六极、七伤。五劳，一是志劳，二是思劳，三是心劳，四是忧劳，五是瘦劳。又有肺劳，表现为气短且面部浮肿，鼻子闻不到香臭。肝劳，表现为面目干枯发黑、口苦，精神不能守舍，恐惧害怕不能独自睡觉，视物不明。心劳，表现为恍惚健忘，大便干结困难，有时像鸭粪一样稀溏，口中生疮。脾劳，表现为舌根僵硬，不能吞咽唾液。肾劳，表现为背部难以俯仰，小便不利，颜色赤黄且有淋漓不尽的感觉，阴茎内部疼痛，阴部潮湿且囊上生疮，小腹胀满急迫。六极，一是气极，使人内脏虚弱，五脏不足，邪气多而正气少，不想说话。二是血极，使人面色无华，眉毛头发脱落，恍惚健忘。三是筋极，使人频繁转筋，十个手指和指甲都痛，极度疲倦不能久站。四是骨极，使人肌肉酸削，牙齿痛苦，手足烦疼，不能站立，不想活动。五是肌极（按：《千金方》作髓极），使人消瘦没有润泽，饮食不能化生肌肤。六是精极，使人气少，内心虚弱，五脏气不足，毛发脱落，悲伤健忘。七伤，一是阴寒，二是阴萎，三是里急，四是精液连连流出，五是精少，阴部潮湿，六是精液清稀，七是小便频数痛苦，行房事不能完成。另一种说法：一是饱食伤脾，脾伤喜欢打嗝，想躺卧且面色黄。二是大怒气逆伤肝，肝伤则血少目暗。三是强力举重，久坐湿地伤肾，肾伤则精少，腰背痛，四肢厥冷下焦寒冷。四是形体受寒，寒饮伤肺，肺伤则气少，咳嗽鼻鸣。五是忧愁思虑伤心，心伤则惊恐健忘易怒。六是风雨寒暑伤形，形伤则发肤枯死。七是大恐惧不节制伤志，志伤则恍惚不乐。（出自《诸病源候论》）
【证候概略】
五劳，是五脏的劳损。都是因为不量力而行，勉强劳作，忧思过度，嗜欲无节制，或者生病后调养不当，积久成劳。其病症表现为头晕眼花，身体疼痛脚弱，心慌气短，自汗盗汗，或者发寒热，或者五心常热，或者往来潮热，或者骨蒸作热，夜间多恶梦，白天精神少，耳内蝉鸣，口苦无味，饮食减少，这些都是劳伤的证候。（出自《证治要诀》）
其症状包括全身关节烦疼，腰酸脚软，或者胸闷短气，心烦不安，或者耳鸣目眩，咳嗽寒热，或者盗汗遗精，白浊飧泄，或者食少无味，肌肉不长，或者睡中惊悸，午后发热，或者怠倦无力，四肢不收，或者虚火上攻，面赤喘急，这些都是虚损的症状，有一个症状出现，就应当根据病情用药。但是看那些症状不大重，茶饭能吃，起居能动，做事能做，自以为没事的人，谁知道后来卧床不起，离死不远，如果想挽救，已经来不及了。（出自《医林绳墨》）
咳嗽痰喘声不绝的，急则治其标。阴虚火动而轻微咳嗽的，缓则治其本。阴虚发热，咳嗽吐血大便结的，这是虚火盛。咳嗽吐血，喘急不能食的，是脾肺虚损。痰嗽喘热而泄泻的，这是脾惫。痰嗽喘热而痢疾的，是脾肾俱惫。痰嗽喘热，脾虚饱闷发肿的，难治。（出自《回春宝鉴》）
下午头痛眩晕，是阴血虚。头晕头痛，或者痰喘气促，是肾虚不纳气。自汗内热口干，是胃气虚。盗汗内热口干，是阴血虚。茎痛而小便不利，是精内竭。越痛越想小便，越小便越痛，是精复竭。食少体倦，口干饮热，小便黄短，是脾肺虚热。发热饮热，大便秘，是内热。发热饮冷，便秘，是内热涩滞，肝热。饮食少思，是胃气虚。饮食不化，是脾气虚。劳累而小便黄，是元气下陷。体倦头痛眩晕，是中气虚。四肢逆冷，是肾气虚寒。面目赤色，烦热作渴，脉大而虚，是血脱发燥。善思体痛，无寐盗汗，是肝脾血虚。睡觉出汗，是肾气问题。普通人吃饭出汗，是食物反助胃火。普通人吃饭，额头大汗如雨，这叫蒸笼头。睡醒吃饱后出汗，是宿食。胸满多痰，是脾气虚。下午发热多痰，是肾亏津液泛上。愤怒胸痞，是脾气滞。倦怠胸痞，是中气虚。倦怠寒热往来，是肝脾气虚。口苦寒热往来，是肝火血虚。内热下午热，或者寒热往来，是阴血虚。畏寒，或者寒热往来，是肝气滞。妇人劳怒，夜间发热，或者谵语，或者月经刚行，热在血分。怔忡惊悸，是心血虚。思虑怔忡，惊悸便勤，内有痰。（出自《医彀》）
虚损两颧红赤或唇红的，是阴虚于下，逼阳于上。张仲景说：面戴阳的，是下虚的缘故。虚而多渴的，是肾水不足，引水自救。声音嘶哑不出声的，是由肾气枯竭，声音出于喉而根于肾，经书说，内夺而厥，则为喑俳，这是肾虚。虚而喘急的，是阴虚肺格，气无所归。喉干咽痛的，是真水下亏，虚火上浮。不眠恍惚的，是血不养心，神不能藏。时常烦躁的，是阳中无阴，柔不济刚。易生嗔怒，或者筋急酸痛，是水亏木燥，肝失所资。饮食不甘，肌肉渐消，是脾元失守，化机日败。心下跳动，怔忡不宁，是气不归精。经书说：胃之大络，名叫虚里，出于左乳下，其动应衣，是宗气外泄。盗汗不止的，有火则阴不能守，无火则阳不能固。虚而多痰，或者像清水，或者多白沫，这是水泛为痰，脾虚不能制水。骨痛如折，是肾主骨，真阴败竭。腰胁痛，是肝肾虚。膝盖以下冷，是命门衰绝，火不归源。小便黄涩淋沥，是真阴亏竭，气不化水。足心如烙，是虚火烁阴，涌泉涸竭。（出自《景岳全书》）
【桃花蛀 / 郁劳】
有一种人面色如故，肌体自充，外观看起来像没病，内里其实虚损，俗称“桃花蛀”，应当看他是哪种证候，在前面的药方中仔细选择使用。（按：前药即建中汤、大补汤之类）。面色不衰，肌肤日渐消瘦，外表像没病，内里其实虚伤，俗名“桃花疰”。其症状必有蒸热咳嗽，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，必须考察他现出什么证候、哪个脏器受伤而治疗。然而这些都是阴火煎熬的证候，治疗多无效。室女过时不嫁，男子过时不娶，以及寡妇鳏夫，多患此证。因为阴火虽然乘袭阳位，不仅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，所以肢体日渐消瘦，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个月，往后必定死亡，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。（出自《医宗必读》）
寡妇师尼，欲望未遂，阴阳离绝，郁火亢极，不得发泄而成失合证的，比房劳更严重。起初是肝木郁热，继而是龙火上煽，导致心肺受病，而喘嗽烦热，甚则迫血骤亡的有之，经闭不行而吐衄的有之。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、玉烛散先泻郁火，后服滋养之药如乌鸡丸之类。如果郁火不泄，血气不荣而发痈疽的，离死就不远了。（同上）
【各证杂说】
丈夫无子的，其精清如水，冷如冰铁，都是无子的征候。还有射精时精不射出，只聚在龟头，也是无子。没有这些征候的，都有子。（出自《诸病源候论》）
劳伤则血气虚，使阴阳不和，互有胜弱，所以阳胜则热，阴胜则寒，阴阳相乘，所以发寒热。（同上）
有无故身体瘦软，绝对无力气，别无其他证候，这是平日劳作太过，血气虚而筋失养，宜用劫劳散，或者和气汤倍用川芎当归（按：《类方》中的和气饮，是在五积散去桂枝、麻黄、厚朴、川芎，加干葛、大黄、升麻，难道是这个方子吗）。还有言语读诵，过耗神气，致成虚损，这叫叫呼走气，宜在十全大补汤等药中选用。虚人老人病中，忽然有一天说不出话，叩之不答应，这不是哑风，久久药力到了，补调功成，自然能应答了。有在坐卧之中，似乎想要别人按压揉捏，心里才安适的，这也是虚证。另外还有因动作劳力，或者发寒热，或者身疼气短，或者劳倦嗜卧，这是一时发劳，却不同于五劳，宜用和气饮。有咳嗽痰多的，名叫劳嗽，与感风寒壅热之嗽不同，这是有本有标，本在肾而标在肺。（出自《证治要诀》）
有重阴覆盖其阳，火不得伸，或者洒洒恶寒，或者意志不乐，或者脉弦数，四肢五心烦热的，用火郁汤、柴胡升麻汤，病去即止，不可过量。（按：火郁汤、柴胡升麻汤，都是李东垣的方子，现在不收录。）
《慎柔书》说：曾经治疗虚损，脉象和缓而五六至，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，而且身体反而不能转侧，脚渐渐无力，以至于不能行走而蜷缩，这是什么原因？原因是下焦肾气衰惫，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，药虽有效，病虽暂减，终不可治。如果初服四君子汤、保元汤十余剂，而脉细如丝，其数脉不改，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，可用保元汤、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，虽然说可治，也得三个月见效，一年半方可全愈。又要看年力的衰壮、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，如前面所述，且痰嗽不止，脉虽缓，治之无益。又或者如前证，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。（出自《医宗必读》）
【似损非损】
凡是似损非损的证候，只有外感寒邪者才有。因为外邪初感，不为解散，而误作内伤，或者用清凉药，或者用消导药，以致寒邪郁伏，久留不散，而为寒热往来，或者为潮热咳嗽，其证则全似劳损，如果用治损的方法治疗此证，则滋阴等剂，愈以留邪，热蒸既久，非损成损矣。我曾经治愈几个人，都是这种证候。想要辨别此证，只当详细察辨表里而审察致病的原因。虚损之证，必有所因，而外感之邪，其来则骤。如果身体有疼痛，而微汗则热退，无汗则复热，或者见大声咳嗽，脉虽弦紧而不甚数，或者兼和缓等证，则虽病至一两月，而邪有不解，病终不退的，本非劳损，不要误治。（出自《景岳全书》）
【死证】
（互见于《骨蒸》中，宜参看。）患劳病的人，脱肛，骨肉相失，声散呕血，阳事不禁，梦寐交侵，呼吸不相从，昼凉夜热的死，吐脓血的也死。其脉不数有根蒂的，以及脸颊不赤的，生。（出自《中藏经》）
劳疾，久而嗽血，咽疼无声，此病自下而传上；如果不嗽不疼，久而溺浊脱精，此为自上传下，都是死证。（出自《证治要诀》）
大抵虚劳起于丧者的，肝肾过劳，多致亡血失精、强中阴竭而死。起于郁结的，内火烁津，多致血结干咳、嗜食发痈而死。起于药误的，脾肺受病居多，多致饮食减少、喘嗽泄泻而死。（出自《医宗必读》）
虚劳不受补的，不治。（出自《丹溪心法》）
病患久虚，内有宿积旧痰，用人参白术补之，久乃吐出臭痰或绿色痰，当不治。因为积之久，而脾胃虚极不运，所以郁臭耳。（出自《慎柔五书》）
[Distinction between Xu Sun (Deficiency Damage) and Lao Zhai (Consumption)]
All conditions that damage Yuan Qi (Original Qi) are fundamentally deficiency syndromes. However, ancient medical texts classified Xu Sun (Deficiency Damage) and Lao Zhai (Consumption) into separate categories, indicating that although the diseases may appear different, they should be distinguished. The term "Xu Sun" refers to conditions where symptoms may manifest at a specific time or where exhaustion is felt during clinical presentation. Regardless of whether the disease affects the meridians or the zang-fu organs, as long as Yuan Qi is damaged, it belongs to Xu Sun diseases. As for the differences in "Lao Zhai," some present with bone-steaming fever, some with dry cough, and even hemoptysis (coughing up blood) or expectoration of phlegm, with both Ying (Nutritive) and Wei (Defensive) qi deteriorating, leading to progressive emaciation. This results from gradual accumulation over time, where both the root and branches are exhausted. However, deficiency in Xu Sun can be in the Yin aspect or the Yang aspect. When the disease is not deep, warm tonification is generally suitable. In contrast, deficiency in Lao Zhai is deeply rooted in the Yin within Yin, and warm tonification is often unsuitable. Generally, deficiency syndromes suitable for warm tonification are easier to treat, while those unsuitable are harder to treat. Thus, Xu and Lao seem different, but it is unknown that the damage in Lao Zhai is simply deeper damage and more severe deficiency. If Xu Sun does not heal, it worsens daily and becomes Lao; this must be handled with caution. (From *Jingyue Quanshu*)
[Pulse Diagnosis]
When diagnosing the pulse, if it is extremely rapid and urgent, extremely fine, weak, or minute, extremely choppy or slippery, extremely short or long, extremely floating or deep, extremely tight or wiry, extremely surging or excess, these all arise from labor injury. (From *Zhongzang Jing*)
The pulse of Xu Lao (Deficiency Consumption) is generally wiry (as Yan Zili also stated), or floating and large, or rapid; these are all signs of Xu Lao. A large pulse indicates easy treatment because Blood and Qi have not yet declined (the original text says "fixed," now corrected according to *Jianyi Fang*), and can be gathered and normalized. A wiry pulse indicates difficult treatment because Blood and Qi have already been depleted and are hard to regulate and tonify. If the pulse presents as double-wiry, it indicates pathogenic factors invading the Spleen, which is particularly difficult to treat. If a rapid pulse is added (the character "ji" in the original text is deleted according to *Jianyi Fang*), it is perilous. (From *Zhizhi Fang*)
Regarding the pulse of Xu Sun (Deficiency Damage), regardless of whether it is floating, deep, large, or small, if it gradually becomes moderate, there is gradually a sign of life. If the wiry pulse is severe, the disease is severe; if the rapid pulse is severe, the disease is critical. If it is wiry and fine, further complicated by tight and rapid, there is less than one chance in a hundred of survival. (From *Jingyue Quanshu*)
For the pulse of Lao (Consumption), if it initially appears surging and large or fine and rapid, these are contraindications. However, if tonifying agents are administered and respond effectively, and the pulse gradually turns weak and the rapidness subsides, it is still treatable. If the symptoms change but the pulse does not, it is untreatable, which is referred to as "lack of Stomach Qi." (From *Yixue Zhiyao*)
A tight and rapid pulse indicates deficiency in both interior and exterior; tightness is due to Cold damaging the Ying level, and rapidness is due to Blood insufficiency. A short and rapid pulse indicates lack of Stomach Qi; fine, rapid, and tight pulses are all inauspicious. A surging and large pulse that feels empty upon pressure requires vigilance against diarrhea. Any appearance of a rapid pulse is difficult to treat; a prolonged illness with a rapid pulse is especially unfavorable. A pulse that suddenly becomes floating, choppy, and rapid, then suddenly deep, weak, and slow, changing unpredictably, is due to Deficient Fire. If Xu Sun progresses to tidal fever and diarrhea with a short and rapid pulse, it is untreatable. A floating and large pulse in Xu Sun belongs to Yang deficiency; a fine and rapid pulse belongs to Yin deficiency. A knotted (Kou) pulse indicates blood loss; if both hands show a Kou pulse, but one section alone shows a wiry pulse, it indicates residual blood stasis, which should be dispersed first before sudden tonification. If a rapid and large pulse appears, it indicates flourishing Fire and is difficult to treat; if a choppy pulse appears, it is also untreatable. Wiry and rapid pulses indicate bone-steaming; if the pathology moves from top to bottom, the Cun (inch) position must be floating and rapid; if from bottom to top, the Chi (cubit) position must be wiry and urgent. If both Guan and Chi positions are wiry, fine, and urgent, like touching a string, it is untreatable. Furthermore, a strong wiry pulse at the Chi position is likely due to heat from sexual activity compounded by the mistaken use of cold-cooling herbs. However, even if a person with Xu Sun abstains from sex, the wiry strength of the Chi pulse cannot immediately soften. If sex is resumed, the pulse may soften the next day due to the interaction of Yin and Yang, but upon re-examination later, the wiry strength will likely increase. Careful differentiation is essential during diagnosis. (From *Yitong*)
[Observation of Nails]
All Lao Sun (Consumption Damage) diseases belong to Yin deficiency, and Yin deficiency inevitably leads to Blood deficiency. Since fingernails are the surplus of Essence and Blood, during diagnosis, if the nails appear dry, yellow, and withered, one can observe the condition of the hair, skin, and Ying Qi. Beyond pulse and complexion, this allows one to identify signs of Xu Sun and assess the severity of the damage. (From *Jingyue Quanshu*)
[Wu Lao (Five Labors), Liu Ji (Six Extremes), and Qi Shang (Seven Injuries)]
(See the general explanation of origins earlier.) Xu Lao is essentially Wu Lao, Liu Ji, and Qi Shang. Wu Lao includes: 1. Zhi Lao (Mental Labor), 2. Si Lao (Overthinking), 3. Xin Lao (Heart Labor), 4. You Lao (Worry), 5. Shou Lao (Emaciation Labor). Additionally: Lung Lao presents with shortness of breath and facial edema, and inability to smell odors. Liver Lao presents with dry, dark face and eyes, bitter taste, unsettled spirit, fear preventing solitary sleep, and blurred vision. Heart Lao presents with forgetfulness, difficulty defecating or loose stools resembling duck feces, and mouth ulcers. Spleen Lao presents with a stiff tongue base and inability to swallow saliva. Kidney Lao presents with difficulty bending and extending the back, dysuria, reddish-yellow urine with dribbling, internal penile pain, dampness in the genital area with sores on the scrotum, and fullness/urgency in the lower abdomen.
Liu Ji (Six Extremes) includes: 1. Qi Ji (Qi Extreme), causing internal weakness, insufficient Zang-Fu, excess pathogens, deficient righteous Qi, and reluctance to speak. 2. Xue Ji (Blood Extreme), causing pallor, falling eyebrows/hair, forgetfulness. 3. Jin Ji (Tendon Extreme), causing frequent muscle cramps, pain in fingers/nails, extreme fatigue preventing standing. 4. Gu Ji (Bone Extreme), causing soreness/emaciation, toothache, limb pain preventing standing/movement. 5. Ji Ji (Muscle Extreme, or Sui Ji/Marrow Extreme in *Qianjin*), causing emaciation without luster, failure of diet to nourish flesh. 6. Jing Ji (Essence Extreme), causing shortness of breath, internal weakness, insufficient Zang-Fu Qi, falling hair, sadness, and forgetfulness.
Qi Shang (Seven Injuries) includes: 1. Yin Cold, 2. Impotence, 3. Internal urgency, 4. Continuous seminal emission, 5. Scanty essence, 6. Damp genitals, 7. Clear essence, 8. Painful frequent urination, 9. Inability to complete intercourse. Another view: 1. Overeating injures Spleen (belching, desire to lie down, yellow face). 2. Great anger injures Liver (less blood, dim vision). 3. Heavy lifting/sitting on wet ground injures Kidney (scanty essence, back/waist pain, cold extremities). 4. Cold form/cold drink injures Lung (shortness of breath, cough, nasal congestion). 5. Worry/thought injures Heart (fright, forgetfulness, irritability). 6. Wind/rain/cold/heat injures Form (withered skin/hair). 7. Great fear/incontinence injures Zhi (will), causing confusion and unhappiness. (From *Bingyuan Lun*)
[Overview of Symptoms]
Wu Lao refers to the labor of the five Zang organs. It results from exceeding one's capacity, forced exertion, excessive worry/thought, unregulated desires, or improper convalescence after illness, accumulating into consumption. Symptoms include dizziness, blurred vision, body ache, weak legs, palpitations, shortness of breath, spontaneous/diaphoresis, chills/fever, constant heat in the five centers, alternating tidal fever, bone-steaming heat, night terrors, daytime lethargy, tinnitus, bitter taste, anorexia. These are all signs of labor injury. (From *Yaojue*)
Symptoms include joint pain, sore waist/weak legs, chest tightness/shortness of breath, restlessness, tinnitus/blurred vision, cough/chills, night sweats/spermatorrhea, white turbidity/undigested stool, anorexia, failure to build flesh, nocturnal palpitations, afternoon fever, fatigue/limb flaccidity, Deficient Fire attacking causing red face/asthma. Any single symptom warrants treatment based on the disease. However, patients who appear functional (eating, moving, working normally) despite underlying issues may suddenly collapse and die; rescue is then impossible. (From *Yilin Shengmo*)
Unceasing cough/phlegm/wheezing requires treating the branch urgently. Mild cough due to Yin deficiency and Fire movement requires treating the root slowly. Yin deficiency with fever, hemoptysis, and constipation indicates flourishing Deficient Fire. Cough/hemoptysis with asthma/anorexia indicates Spleen-Lung deficiency. Phlegm-cough/wheezing/heat with diarrhea indicates Spleen exhaustion. Phlegm-cough/wheezing/heat with dysentery indicates Spleen-Kidney exhaustion. Phlegm-cough/wheezing/heat with Spleen deficiency, fullness, and edema is difficult to treat. (From *Huichun*)
Afternoon headache/dizziness indicates Yin Blood deficiency. Headache/dizziness with phlegm-cough/shortness of breath indicates Kidney deficiency failing to grasp Qi. Spontaneous sweat/internal heat/dry mouth indicates Stomach Qi deficiency. Night sweat/internal heat/dry mouth indicates Yin Blood deficiency. Penile pain with difficult urination indicates depletion of Essence. Increased pain/urination cycle indicates repeated Essence depletion. Low appetite/fatigue/dry mouth/thirst for hot drinks/yellow-short urine indicates Spleen-Lung Deficient Heat. Fever/thirst for hot drinks/constipation indicates internal heat. Fever/thirst for cold drinks/constipation indicates internal heat stagnation/Liver Heat. Lack of desire to eat indicates Stomach Qi deficiency. Indigestion indicates Spleen Qi deficiency. Yellow urine after labor indicates sinking of Yuan Qi. Fatigue/headache/dizziness indicates Middle Qi deficiency. Cold extremities indicate Kidney Qi deficiency/Cold. Red face/restlessness/thirst/large-empty pulse indicates Blood loss/dryness. Excessive thinking/body pain/no sleep/night sweats indicates Liver-Spleen Blood deficiency. Sweating during sleep relates to Kidney Qi. Sweating after eating in healthy people indicates food aiding Stomach Fire. Profuse sweating on the forehead after eating is called "Steaming Basket Head." Sweating after waking/full meal indicates retained food. Chest fullness/phlegm indicates Spleen Qi deficiency. Afternoon fever/phlegm indicates Kidney deficiency with fluid reflux. Anger/chest stuffiness indicates Spleen Qi stagnation. Fatigue/chest stuffiness indicates Middle Qi deficiency. Fatigue/alternating chills-fever indicates Liver-Spleen Qi deficiency. Bitter taste/alternating chills-fever indicates Liver Fire/Blood deficiency. Internal heat/afternoon fever/alternating chills-fever indicates Yin Blood deficiency. Aversion to cold/alternating chills-fever indicates Liver Qi stagnation. Female labor/anger/night fever/delirium/recent menstruation indicates heat in the Blood level. Palpitations/fright indicate Heart Blood deficiency. Thought-induced palpitations/frequent urination indicate internal phlegm. (From *Yigou*)
Red cheeks/lips in Xu Sun indicate Yin deficiency below forcing Yang upward. Zhang Zhongjing said: Facial flushing (Dai Yang) is due to lower deficiency. Excessive thirst in deficiency indicates insufficient Kidney Water seeking self-rescue. Hoarseness/loss of voice indicates Kidney Qi exhaustion (voice roots in Kidney). Asthma in deficiency indicates Yin deficiency with Lung obstruction and Qi having no return. Dry throat/sore throat indicates true water decline and floating Deficient Fire. Insomnia/confusion indicates Blood failing to nourish Heart and Shen failing to reside. Frequent irritability indicates Yang lacking Yin, rigidity lacking softness. Irritability/tendon stiffness/pain indicates Water deficiency causing Wood dryness and Liver deprivation. Poor appetite/muscle wasting indicates Spleen Yuan instability and declining transformation. Palpitations indicate Qi failing to condense. The Stomach's great collateral, Xuli, located under the left breast, pulsating visibly, indicates leakage of Zong Qi. Unstopping night sweats: Fire prevents Yin from holding; lack of Fire prevents Yang from securing. Excess phlegm (clear/white foam) in deficiency indicates Water flooding transforming into Phlegm due to Spleen failure to control Water. Bone pain like breaking indicates Kidney ruling bones and True Yin exhaustion. Waist/flank pain indicates Liver-Kidney deficiency. Cold below knees indicates Mingmen decline and Fire failing to return to source. Yellow-choppy dribbling urine indicates True Yin exhaustion and Qi failing to transform Water. Burning soles indicate Deficient Fire scorching Yin and Yongquan depletion. (From *Jingyue Quanshu*)
[Taohua Zhu / Yu Lao]
Some individuals have normal complexion and body mass, appearing healthy externally but suffering internal Xu Sun, commonly called "Taohua Zhu" (Peach Blossom Borer). Treatment depends on identifying the specific syndrome among previous formulas (e.g., Jianzhong Tang, major tonics). Others have undiminished complexion but wasting muscles, appearing healthy but internally damaged, called "Taohua Zhu" (Peach Blossom Taint). Symptoms include steaming fever/cough, hyperhidrosis/anhydrosis, excess/absence of phlegm, amenorrhea, spermatorrhea, hemoptysis, epistaxis, polyphagia, or diarrhea. One must examine the presenting syndrome and injured Zang. These are syndromes of Yin Fire simmering, often resistant to treatment. Virgins marrying late, men marrying late, widows/widowers are prone. Yin Fire attacks Yang positions, consuming Yin fluids rather than Yang fluids, causing emaciation while maintaining a ruddy complexion. Mild cases improve after marriage; severe cases may temporarily improve but eventually die due to fragile constitution and depleted Essence unable to withstand excretion. Widows remarrying often recover spontaneously due to physical resilience. Once Yu Fire disperses and fluids flow, recovery occurs without medicine. (From *Yitong*)
Widows/nuns with unfulfilled desires experience separation of Yin and Yang, extreme Yu Fire, and "Shihe Syndrome" (syndrome of mismatched union), worse than sexual labor. Initially Liver Wood stagnates with heat, then Dragon Fire flares up, affecting Heart-Lung, causing asthma/cough/fever, potentially sudden blood loss or amenorrhea with bleeding. Treat with opening depression and descending fire: Zengsun Chaihu Tang or Jiawei Xiaoyao San. For extreme Yin Fire, use Zishen Wan or Yuzhu San to drain fire first, then tonify with Wujitu Wan. If Yu Fire remains unvented, causing abscesses due to poor Blood/Qi nourishment, death is near. (Same source)
[Miscellaneous Comments on Syndromes]
Male infertility: Clear semen like water, cold like ice, or ejaculation without expulsion (semen pooling at glans) indicates infertility. Absence of these signs suggests fertility. (From *Bingyuan Lun*)
Labor injury causes Blood/Qi deficiency and Yin-Yang disharmony. Yang excess causes heat, Yin excess causes cold; mutual overcoming causes chills/fever. (Same source)
Sudden emaciation/weakness without other symptoms indicates excessive prior labor depleting Blood/Qi and starving tendons. Use Jie Lao San or Heqi Tang with increased Chuanxiong and Danggui. Verbal exertion depleting Spirit causes Xu Sun ("calling/shouting losing Qi"); use Shiquan Dabu Tang. Sudden aphonia in elderly/deficient patients is not Wind-Stroke; proper tonification restores speech. Desire for massage indicates deficiency. Acute labor from physical exertion (chills/fever/pain/shortness of breath/lethargy) differs from Wu Lao; use Heqi Tang. Chronic cough with phlegm is "Lao Sou" (Labor Cough), distinct from Wind-Cold heat cough; its root is Kidney, branch is Lung. (From *Yaojue*)
Heavy Yin covering Yang, blocking Fire, causes chills, depression, wiry-rapid pulse, and five-center heat. Use Huoyu Tang or Chaihu Shengma Tang until cured; do not overdose. (Note: Both are Li Dongyuan's formulas, omitted here.) (From *Liuyao*)
*Shenrou Shu* records: Treating Xu Sun with moderate-slow pulse (5-6 beats per breath) and cough/fever (no chills/sore throat) seemed treatable. After 10+ doses of Baoyuan Tang and Sijunzi Tang, cough/fever improved slightly. After 20+ doses, cough worsened, fever returned, and patient became immobile/leg-weakened. Reason: Lower Jiao Kidney Qi exhaustion, no fluids to nourish bones, Yang cannot circulate, Spleen-Lung Qi cannot descend. Untreatable despite temporary relief. If pulse becomes thread-like and rapid after initial doses, it is untreatable. If fine but not rapid, with normal digestion/no diarrhea, Baoyuan Tang with Renshen and Baizhu can be used for 2-3 years. If pulse slows and becomes moderate/vivid, improvement takes 3 months, full recovery 1.5 years. Prognosis depends on age/strength/Spleen-Stomach. If pulse moderates but legs weaken/cough persists, treatment is futile. If legs weaken but fever/cough subside and appetite returns, Spleen-Stomach is strong, allowing extended management. (From *Yitong*)
[Seeming Damage but Not Damage]
Syndromes resembling Xu Sun but not being so occur only with external Cold invasion. If external pathogen is not resolved and mistakenly treated as internal injury with cooling or resolving agents, Cold becomes trapped, causing alternating chills/fever or tidal fever/cough, mimicking consumption. Using tonifying/nourishing herbs traps the pathogen, turning simple heat into true consumption. I have cured several such cases. Differentiate by examining exterior/interior and etiology. Xu Sun has a cause; external pathogens strike suddenly. If body pain resolves with slight sweating and returns without sweat, or loud cough with wiry-tight but not rapid pulse, or moderate pulse, even after 1-2 months, it is not consumption. Do not mistreat. (From *Jingyue Quanshu*)
[Death Syndromes]
(See *Guzheng* for details.) Death in Lao patients: rectal prolapse, flesh/bone separation, scattered voice, hematemesis, uncontrollable erections, nocturnal emissions, irregular breathing, day-cool/night-hot, or expectoration of pus/blood. Survival: pulse not rapid with root, or non-red cheeks. (From *Zhongzang Jing*)
Lao disease with chronic hemoptysis and silent sore throat (transmitting bottom-up) or chronic turbid urine/spermatorrhea without cough/pain (transmitting top-down) are death syndromes. (From *Yaojue*)
Xu Sun from bereavement: Liver-Kidney overwork leads to blood loss/essence depletion/death. From depression: Internal Fire scorches fluids, leading to blood-stasis/dry cough/polyphagia/abscess/death. From medication error: Spleen-Lung damage leads to anorexia/asthma/diarrhea/death. (From *Yitong*)
Xu Sun intolerant to tonification is untreatable. (From *Danxi Xinfa*)
Chronic deficiency with old phlegm retention: Tonifying with Renshen/Baizhu may eventually expel foul/green phlegm; this is untreatable due to extreme Spleen-Stomach deficiency failing to transport, causing stagnation and odor. (From *Shenrou Wushu*)