骨蒸即后世所称痨瘵是也。《内经》之寒热，仲景之肺痿，及内有干血等，俱为证治之权舆。古来又有传
尸之说，所谓六代诸虫形状等，稍涉荒唐。要之，此实劳中之一证，学人宜与前门相参可也。
名义 夫骨蒸之疾而多异名，为疗皆同一体，丈夫以劳损为宗，妇人以血气为本，起于肾虚所致，故
云阴气不足，阳必凑之。血气不荣，骨髓枯竭，肾主于骨，以其先从骨热，故曰骨蒸。（《圣惠》）
古经惟有骨蒸病候，而巢氏论说，乃曰骨蒸病有五种，此说殊未当。蒸既异候，即血蒸之候必在于肝，肝
主血故也。然又谓二十三蒸者，此盖触类长之，遂至纷纷之论，其实五脏劳而生热故也。然独以骨蒸名之者，
此病热深，古人举其重者言之。（《鸡峰》）（按∶此二说似相反，宜互意而看。）
源由总说 骨蒸之候，男子因五劳七伤，或由肺壅之后，或为瘴疟之后，宿患 癖，妇人因产后虚劳，
漏汗寒热，或为月闭不通，无问男子妇人，因天行已后余热不除，或为频频劳复，小儿闪癖，其病并缘此十
候所致，因兹渐渐瘦损。（《外台》引《救急》）
骨蒸病者，亦名传尸，亦谓 ，亦称伏连，亦曰无辜。丈夫以癖气为根，妇人以血气为本，无问少长，
多染此疾，婴孺之流，传注更苦。（同上引《崔氏别录》灸骨蒸方序）（按∶又《苏游论》云∶凡患 癖之人，
多成骨蒸。）
夫传尸劳者，男子自肾传心，心而肺，肺而肝，肝而脾；女子自心传肺，肺而肝，肝而脾，脾而肾，五脏
复传六腑而死矣。或连及亲族，至于灭门。其源皆由房室饮食过度，冷热不时，忧思悲伤，有欲不遂，惊悸喜
惧，或大病后行房，或临尸哭泣，尸气所感，邪气一生，流传五脏，蠹食伤心，虽有诸候，其实不离乎心阳肾
阴也。若明阴阳用药，可以返魂夺命，起死回生。人知劳之名，未知其理。人生以血为荣，气为卫，二者运辅而
无壅滞，劳何由生。故劳者倦
也，血气倦则不运，凝滞疏漏，邪气相乘。心受之，为盗汗虚汗，忧悲恐惧，恍惚不安。肾受之，为骨蒸，为
鬼交，阳虚好色愈甚。肝受之，为瘰 ，胁满痞聚，拳挛拘急，风气乘之为疼痛。脾受之，为多思虑，慕清凉，
不食多食无味。肺受之，为气喘痰涎，睡卧不安，毛发焦枯。至于六腑亦各有证。（《永类钤方》引水丘先生
《紫庭治瘵秘方》）
夫痨者劳也，以劳伤精气血液，遂致阳盛阴亏，火炎痰聚，因其有痰有火，病名酷厉可畏者，故今人晦之
曰痰火也。然溯所因，来因非一类。有禀赋素怯，复劳伤心肾，耗夺精血而致者。有外感风寒，伤肺致久咳，
绝其生化之源而致者。有久病久疟，小愈失调，复刻真元而致者。有藜藿劳人，伤力吐血，致阴虚使然者。有
膏粱逸士，汹酒恣欲，劳伤脾肾而致者。有熏陶渐染者。种种之异，难以枚举，至于成劳则一也。然将成是证，
必有预征兆始焉，或颈项结核，或腹胁 癖，或素有梦遗，或幼多鼽衄，渐而有潮汗遗精，咳唾吐衄诸血等候
，外症必形容憔悴，肌体 羸，毛发焦枯，脉必弦涩芤虚。总之脏气偏亏，亢害无制，因而致此极也。（《痰火
点雪》）
人之一身，金水二脏，不可暂伤。盖金为生化之源，水为生生之本，真阴既亏则火自偏胜，火既偏胜则上
炎烁金，金母既伤则生化之源已息，而水子何以借其胎养乎。夫一水既亏，则五火相煽，火迫肺而为咳，痰壅
喉而为嗽，所以咳嗽一证，为亡津液之肇耶。以其伤于生化，母子俱病，真水日涸，益为致火之胎，于是阴愈
消而阳愈亢，燔烁蒸炎，迫血上行，越出诸窍而为咳唾吐衄等候。况血为有形，难成易亏，可骤补耶。血失既
多，则阴暴脱而阳亦微，阳微则恶寒，阴虚则发热，故寒热似疟者，乃阴消阳败之证谛，至于
潮热，则又为阴虚之极也。（同上）
或谓痰火之证，本于亡血夺精，而其精之与血，皆真水真阴，有形有质，难成易亏者也。夫所谓痰火者，
言末而忘本也。盖真水既亏，则相火随炽，壅迫津液为痰，故曰痰者火之标。然以痨瘵之证，谓曰阴虚火动者，
盖以一言而括尽病之标本矣。《内经》曰∶阴虚生内热。盖热者火之微，火者热之极，火迫津液而为痰，则阴
虚正谓致火致痰之本，而东垣所谓先受病为本，次受病为标者，非此谓乎。（同上）
病生于情思 张承节论∶尝观劳经言传尸瘵疾，其虫如人似鬼，形状可畏，及患者多相继而夭，愚
见考之，断无是理。以此观之，譬如俗谈不晓事人害相思病也，与一妇人情密，忽而别离，念念不舍，至于失
寐忘餐，便觉容颜瘦瘁，再偿所愿，如沉 去体，恍然而释，其劳病之说岂不类此。经云悲则气耗，思则气结，
伏郁不散，久则气血俱虚，令人发寒发热，饮食减少，相搏作痛，或因感冒，遂添咳嗽，非嗽也，缘气虚易感
风寒，在肺为嗽。久而着床，便作劳病治之，服柴胡、地骨皮、秦艽之属，凉药退热，致令真气消散，丧命之
源，古之广客蛇影仿此，不可不审，因书为后人之警。（《事证方后集》）
人之性情最喜畅快，形神最宜焕发，如此刻刻有长春之性，时时有生长之情，不惟却病，可以永年。若人
平日无事而忧思沉想，默默无言，面容黯惨，眉宇不舒，人以为老诚忠浓，不知胸中之杀机日盛，已现于形容
矣。即坐卧欢乐之场，反生暴怒；即处于富贵之境，略无喜色。所谓抑郁成痨，多气成痨，久嗽成痨，积热成痨，久疟
成痨，久病日远成痨，伤风不醒成痨，产怯成痨，传染习气成痨，小儿疳疟成痨，干嗽成痨，穷思积想成痨，酷饮成痨，
过欲成痨，悭 刻剥成痨，男女过时失配成痨。须知致痨之因不一，说不外性情之执滞习染而成，多致不治何也？药能
疗病补虚，不能移情易性故也。（《证治百问》）（按∶所谓云云数语盖有所本，《锦囊秘 》亦见之。）
感冒成痨 感冒固轻，惟人以其轻忽之，亦足以伤生，其致不醒之故，亦各有因，我将为子备言之，
以告知命者，当防微而杜渐也。今人感冒，每率己见用药，病未除而元气先伤以致困者，一也。有未冒之前，
元气先虚，既冒之后，乘虚陷里，虚邪并病，医者未及辨明而误药者，二也。有禀性怯弱，情志多郁，素有骨
蒸虚热之患，重冒风寒，而咳伤肺络，痰红痨嗽者，三也。有沉湎酒色，湿热内伤，当风露卧，复感风邪而
成痨瘵者，四也。有行房不谨，汗出当风，邪入三阴，传为虚痿，或成痨风者，五也。有童子室女，情性执滞，
素多愁郁，天癸不通，形神羸弱，偶冒风寒，内热并病而成痨者，六也。有体肥气盛，情性素暴，不耐病苦，
偶冒风寒而烦躁愈甚，酒色不戒，饮食失调，以致痰嗽咳血，音哑喉痹，朝凉暮热，大肉脱尽而死者，七也。
有劳形役心，负重疾走，因燥热而浴寒饮冷，当风露坐，以致感冒咳血而成痨者，八也。有师尼寡妇。嫁娶愆
期，忧思积忿，以致心相二火炽然日甚，偶感风邪，内外郁蒸而成痨嗽咳血者，九也。有产后气血正虚，失于
谨慎，为风所袭，邪入至阴，而为烦渴内热之恙，医者误为产虚，不知清散，补敛太早，则虚热与邪热同病而
成产痨者，十也。此十种死症，余三十年来所见，指不胜屈，而触发之因，多因感冒，岂感冒遂能杀人，实由
根本先败而然也。（《百问》）（按∶《医方考》曰∶无风不作骨蒸，其意盖与此说相发。）
传尸之由 （互见次条）传尸者，非为一门相染而成
也。人之血气衰弱，脏腑虚羸，中于鬼气，因感其邪，遂成其疾也。或因酒食而遇，或因风雨而来，或问病吊
丧而得，或朝走暮游而逢，或因气聚，或因血行，或露卧于田野，或偶会于园林，钟此病死之气，染而为疾，
故曰传尸也。（《中藏经》）
瘵虫食人骨髓。血枯精竭不救者多。人能平时爱护元气，保养精血，瘵不可得而传。惟夫纵欲多淫，若不
自觉，精血内耗，邪气外乘，是不特男子有伤，妇人亦不免矣。然而气虚腹馁，最不可入劳瘵者之门，吊丧
问疾，衣服器用中，皆能乘虚而染触。间有妇人入其房，睹其人病者，久之劳气随入，染患日久，莫不化而为
虫。（《直指》）
生虫之故 瘵疾有虫，此虫生于骨蒸劳热。（《痰火 门》）
虫因气化，气聚则生，气热则长，气衰则胜，气去则出。所以治虫之药，不能行于五脏，而五虫之症，不
能效验于今古也，哀哉！（《绳墨》）
或曰∶每见生痨者，皆属壮年无病之人、富贵安逸之人何也？痨病有多年而死者，有三年而死者，有一年
百日而死者，何也？答曰∶凡属痨病，皆在四旬之内，及童稚之年，可想见矣。彼其精神气血壮盛之时，于内
则为性情之抑郁，于外则为风寒之感冒，所以童稚壮年，鳏寡僧尼，多犯此病，难言 丧精神、气血两虚而病
也，实病于情志抑郁，积想而成。正借精血之未枯，一有内煎，壮热不透，郁而生虫，虫侵脏腑骨髓之中，有
何法可治。譬之高堂华屋，外用彩漆壮丽，内之木植滋性犹存而未枯，遂致内蒸生虫、白蚁日蛀而坏，还可脱
梁换柱而重新。人之腑脏骨髓蛀坏，即有良法神方，将安用之。（《百问》）盖因初起病痨之人，先为痨虫所
食五脏而死，既死之后，五脏皆冷，虫不能居，从鼻而出。鼻乃肺之窍，痨即肺之病，故从其窍而出。（《丹台玉案》）
脉候 诊其寸口脉数，肺痿也，甚则脉浮弱。（《病源论》）
骨蒸劳热，脉数而虚，热而涩小，必殒身躯，加汗加咳，非药可除。（《崔氏脉诀》）（按∶《医灯续焰》
曰∶脉数而虚，是其本然。盖以数为热，虚为劳耳。若蒸热而见涩小之脉，涩则精血少，小则元气衰，真阴日
损，邪火日增。不至于殒躯不已也。）
痨病之脉，与疟相似，浮弦而虚数，两寸盛而两尺无力，或弦急急数搏大者有之，不宜骤补。（《百问》）
盖脉之可补者，浮而芤濡虚大，迟缓无力，沉而迟涩弱细，结代无力，皆虚而不足，可补者也。当君参
、，佐以归、芎、芍、地，务使阳生阴长，其病乃愈。若于此不补，或恣用苦寒，则虚虚之祸，岂不旋踵而至
耶。其脉之不可补者，弦长紧实，滑数有力，此皆火郁内实，不受补者也。法当君以四物，佐以二冬、二母、
沙参、玄参等味，滋阴抑阳，务使水升火降，阴秘阳平，病或可痊。若妄施补，则实实之灾，将焉免之。
（《点雪》）
服寒凉药，症虽大减，脉反加数者，阳郁也。大忌寒凉，宜升宜补，犯之死速。（《纲目》）
男子劳热喘嗽，脉必数而无力，按之沉而稍有力者生；浮而细数无力，不能容指者死。（《普渡慈航》）
凡脉洪大者犹可治，细数急涩者难治。（《简明医彀》）
察指甲 东方先生法∶夫劳疾诸证，应丈夫妇人童男室女，如得患者，未须察脉，但看手指甲美恶，
分明是何劳候。病热甚，宜看脚甲色，与手一同也。其甲青黑者传尸之
证，红白者正色之候，黄白者酒色之候，红紫者气劳之候，细详必知其病之所在，或咳嗽，或涎塞咽中，或骨
蒸汗出，或泄利，或吐红，或惊魇，或妇人经水不调之类，先服去虫药，然后投治病汤剂。（《幼幼新书》）
证状总说 《苏游论》曰∶大都男女传尸之候，心胸满闷，背膊烦疼，两目精明，四肢无力，虽知欲卧，
睡常不着，脊膂急痛，膝胫酸疼，多卧少起，状如佯病，每至旦起，即精神尚好，欲似无病，从日午以后，即
四体微热，面好颜色，喜见人过，常怀忿怒，才不称意，即欲嗔恚，行立脚弱，夜卧盗汗，梦与鬼交通，或见
先亡，或多惊悸，有时气急，有时咳嗽，虽思想饮食而不能多餐，死在须臾而精神尚好，或两肋虚胀，或时微
利，鼻干口燥，常多粘唾，有时唇赤，有时欲睡，渐就沉羸，犹如水涸，不觉其死矣。（《外台》）（按∶
《得效方》、《治病活法秘方》水涸作涸鱼。）
初着盗汗，盗汗以后即寒热往来，寒热往来以后即渐加咳，咳后面色白，两颊见赤如胭脂色，团团如钱许
大，左卧即右出，唇口非常鲜赤，若至鲜赤即极重，十则七死三活，若此以后加吐，吐后痢，百无一生，不过
一月死。（同上引救急）
其为状也，发干而耸，或聚或分，或腹中有块，或脑后近下两边有小结，多者乃至五六，或夜卧盗汗，梦
与鬼交通，虽目视分明而四肢无力，或上气食少，渐就沉羸，纵延时日，终于溘尽。（同上引《崔氏别录》灸
骨蒸方序）
张文仲说∶荆州人王元礼，尝家患骨蒸传尸死尽，有一道士忽教灸即断，兼更教人，无有不瘥者。欲识此
病，其病先乍寒乍热，有时唇赤或颊赤，并有时痢血多唾（按∶痢盖吐讹），有时欲得食，有时不欲食，两脊
脉常急，患者多咳盗汗，以指按捻脊膂四边肉，有时心胸气满急（山胁尚德
曰∶此七字当在盗汗下），黄瘦，膂中肉尽，遂即着床。如着床，胸前自动，脊膂两边肉尽，灸疗即难。如灸，
候胸前肉动非事。（同上）
骨蒸就是后世所说的痨瘵（慢性消耗性疾病）。《黄帝内经》中记载的寒热病证、张仲景论述的肺痿，以及体内有干血等情况，都是此类疾病诊治的开端。古代又有“传尸”的说法，其中关于六代诸虫形态的描述，稍微有些荒诞不经。总之，这实际上是虚劳中的一种证候，学者应当与前门（指前文或相关章节）的内容相互参照学习。
【名义】
所谓骨蒸之疾，名称虽多异，但治疗宗旨皆归于同一根本。男子以劳损为根本，女子以血气为本，此病起于肾虚所致，所以说阴气不足，阳气就会乘虚侵袭。气血不能荣养身体，导致骨髓枯竭。肾主骨，因为热邪先从骨骼开始，所以称为骨蒸。（引自《太平圣惠方》）
古代经典仅有骨蒸病的症状记载，而巢元方在《诸病源候论》中的论述，却说骨蒸病有五种，这种说法很不恰当。既然蒸热是不同的证候，那么血蒸的证候必然与肝有关，因为肝主藏血。然而又有人说是“二十三蒸”，这大概是触类旁通、随意推演，导致了纷繁杂乱的议论，其实不过是五脏虚劳而生热罢了。之所以单独命名为骨蒸，是因为此病热势深重，古人举出其中最严重的情况来说明。（引自《鸡峰普济方》）（按语：这两种说法看似相反，应当互相参悟来理解。）
【源由总说】
骨蒸的症状表现：男子因五劳七伤，或因肺壅之后，或因瘴疟之后，或有宿患癖积；妇人因产后虚劳，漏汗寒热，或因月经闭止不通。无论男女，因天行疫病（流行性传染病）之后余热未除，或因频繁劳复（大病后过早劳作导致复发），小儿闪癖，这些病症都源于上述十种情况所致，因此逐渐消瘦受损。（引自《外台秘要》引《救急方》）
骨蒸病，又名传尸，又称鬼疰，也称伏连，还叫无辜。男子以癖气（积聚之气）为根，女子以血气为本，无论老少，大多感染此疾，婴幼儿更是传染后病情加重。（同上引《崔氏别录》灸骨蒸方序）（按语：另外《苏游论》说：凡是患有鬼疰癖积的人，多会发展为骨蒸。）
所谓传尸劳，男子从肾传心，心传肺，肺传肝，肝传脾；女子从心传肺，肺传肝，肝传脾，脾传肾，五脏再传六腑而死。或者牵连亲族，甚至灭门。其根源皆由房事饮食过度，冷热不调，忧思悲伤，欲望不得满足，惊悸喜怒，或大病后行房，或临尸哭泣，感受尸气，邪气滋生，流传五脏，蛀蚀伤心，虽然有各种症状，其实不离乎心阳和肾阴。如果明白阴阳用药，可以起死回生。人们只知道劳病的名称，却不知其道理。人生以血为荣卫，气为护卫，二者运行辅助而无壅滞，劳病从何而生？所以劳就是疲倦，血气疲倦则不运行，凝滞疏漏，邪气相乘。心受邪，表现为盗汗虚汗，忧悲恐惧，恍惚不安。肾受邪，表现为骨蒸，鬼交（梦遗性交感），阳虚好色更甚。肝受邪，表现为瘰疬，胁满痞聚，拳挛拘急，风气乘之为疼痛。脾受邪，表现为多思虑，慕清凉，不食或多食无味。肺受邪，表现为气喘痰涎，睡卧不安，毛发焦枯。至于六腑也各有证候。（引自《永类钤方》引水丘先生《紫庭治瘵秘方》）
所谓痨，就是劳的意思，因劳伤精气血液，导致阳盛阴亏，火炎痰聚，因为有痰有火，病名酷厉可畏，所以今人避讳称之为痰火。然而追溯病因，来源并非一类。有禀赋素来虚弱，又劳伤心肾，耗夺精血而致的。有外感风寒，伤肺致久咳，断绝生化之源而致的。有久病久疟，小愈失调，再次损伤真元而致的。有平民劳力之人，伤力吐血，致阴虚而然的。有富贵闲人，酗酒纵欲，劳伤脾肾而致的。有熏陶渐染者。种种差异，难以枚举，至于成为劳病则是一样的。然而在形成此证之前，必有预兆，如颈项结核，或腹胁癖积，或素有梦遗，或幼年多鼻出血，渐渐出现潮汗遗精，咳唾吐衄等血证，外症必见形容憔悴，肌体瘦弱，毛发焦枯，脉必弦涩芤虚。总之是脏气偏亏，亢害无制，因而导致这种极端的状况。（引自《痰火点雪》）
人的身体，金（肺）水（肾）二脏，不可暂时受伤。盖因金为生化之源，水为生生之本，真阴既亏则火自然偏胜，火既偏胜则上炎灼伤肺金，金母既伤则生化之源已息，而水子（肾）何以借其胎养呢？一旦水亏，则五火相煽，火迫肺而为咳，痰壅喉而为嗽，所以咳嗽一证，是亡津液的肇始。因其伤于生化，母子俱病，真水日涸，益为致火之胎，于是阴愈消而阳愈亢，燔烁蒸炎，迫血上行，越出诸窍而为咳唾吐衄等证。况且血为有形之物，难成易亏，岂能骤补？血失过多，则阴暴脱而阳亦微，阳微则恶寒，阴虚则发热，故寒热似疟者，乃是阴消阳败的确切证候，至于潮热，则是阴虚的极致。（同上）
有人说痰火之证，本于亡血夺精，而其精与血，皆真水真阴，有形有质，难成易亏。所谓痰火，是言末而忘本。盖因真水既亏，则相火随炽，壅迫津液为痰，所以说痰是火的标象。然而以痨瘵之证，称为阴虚火动，是用一句话概括了病的标本。《内经》说：阴虚生内热。热是火的轻微表现，火是热的极端，火迫津液而为痰，则阴虚正是致火致痰的根本，而东垣所谓先受病为本，次受病为标，说的不是这个吗？（同上）
【病生于情思】
张承节论述：曾经观察劳经言传尸瘵疾，说其虫像人又像鬼，形状可怕，且患者多相继夭折。我考察此事，断定绝无此理。以此观之，譬如俗谈不懂事的人害相思病，与一妇人情密，忽然别离，念念不舍，以至于失眠忘餐，便觉容颜瘦瘁，再偿所愿，如沉疴去体，恍然而释，这种劳病之说难道不与此类似吗？经云：悲则气耗，思则气结，伏郁不散，久则气血俱虚，令人发寒发热，饮食减少，相搏作痛，或因感冒，遂添咳嗽，这不是单纯的嗽，而是缘于气虚易感风寒，在肺为嗽。久而着床，便作劳病治之，服柴胡、地骨皮、秦艽等凉药退热，致使真气消散，丧命之源，古之广客蛇影（杯弓蛇影）仿此，不可不审慎，因此书写以警示后人。（引自《事证方后集》）
人的性情最喜畅快，形神最宜焕发，如此刻刻有长春之性，时时有生长之情，不仅能却病，可以永年。若人平日无事而忧思沉想，默默无言，面容黯惨，眉宇不舒，别人以为老诚忠厚，不知胸中的杀机日益旺盛，已现于形容。即坐卧欢乐之场，反生暴怒；即处于富贵之境，略无喜色。所谓抑郁成痨，多气成痨，久嗽成痨，积热成痨，久疟成痨，久病日远成痨，伤风不醒成痨，产怯成痨，传染习气成痨，小儿疳疟成痨，干嗽成痨，穷思积想成痨，酷饮成痨，过欲成痨，悭刻剥成痨，男女过时失配成痨。须知致痨之因不一，说不外性情之执滞习染而成，多致不治何也？药能疗病补虚，不能移情易性故也。（引自《证治百问》）（按语：所谓云云数语盖有所本，《锦囊秘录》亦见之。）
【感冒成痨】
感冒固然轻，惟人以其轻忽之，亦足以伤生，其致不醒之故，亦各有因，我将为子备言之，以告知命者，当防微而杜渐也。今人感冒，每率己见用药，病未除而元气先伤以致困者，一也。有未冒之前，元气先虚，既冒之后，乘虚陷里，虚邪并病，医者未及辨明而误药者，二也。有禀性怯弱，情志多郁，素有骨蒸虚热之患，重冒风寒，而咳伤肺络，痰红痨嗽者，三也。有沉湎酒色，湿热内伤，当风露卧，复感风邪而成痨瘵者，四也。有行房不谨，汗出当风，邪入三阴，传为虚痿，或成痨风者，五也。有童子室女，情性执滞，素多愁郁，天癸不通，形神羸弱，偶冒风寒，内热并病而成痨者，六也。有体肥气盛，情性素暴，不耐病苦，偶冒风寒而烦躁愈甚，酒色不戒，饮食失调，以致痰嗽咳血，音哑喉痹，朝凉暮热，大肉脱尽而死者，七也。有劳形役心，负重疾走，因燥热而浴寒饮冷，当风露坐，以致感冒咳血而成痨者，八也。有师尼寡妇，嫁娶愆期，忧思积忿，以致心相二火炽然日甚，偶感风邪，内外郁蒸而成痨嗽咳血者，九也。有产后气血正虚，失于谨慎，为风所袭，邪入至阴，而为烦渴内热之恙，医者误为产虚，不知清散，补敛太早，则虚热与邪热同病而成产痨者，十也。此十种死症，余三十年来所见，指不胜屈，而触发之因，多因感冒，岂感冒遂能杀人，实由根本先败而然也。（引自《百问》）（按语：《医方考》曰：无风不作骨蒸，其意盖与此说相发。）
【传尸之由】
（互见次条）传尸者，非为一门相染而成也。人之血气衰弱，脏腑虚羸，中于鬼气，因感其邪，遂成其疾也。或因酒食而遇，或因风雨而来，或问病吊丧而得，或朝走暮游而逢，或因气聚，或因血行，或露卧于田野，或偶会于园林，钟此病死之气，染而为疾，故曰传尸也。（引自《中藏经》）
瘵虫食人骨髓。血枯精竭不救者多。人能平时爱护元气，保养精血，瘵不可得而传。惟夫纵欲多淫，若不自觉，精血内耗，邪气外乘，是不特男子有伤，妇人亦不免矣。然而气虚腹馁，最不可入劳瘵者之门，吊丧问疾，衣服器用中，皆能乘虚而染触。间有妇人入其房，睹其人病者，久之劳气随入，染患日久，莫不化而为虫。（引自《直指方》）
虫因气化，气聚则生，气热则长，气衰则胜，气去则出。所以治虫之药，不能行于五脏，而五虫之症，不能效验于今古也，哀哉！（引自《绳墨》）
有人说：每见生痨者，皆属壮年无病之人、富贵安逸之人何也？痨病有多年而死者，有三年而死者，有一年百日而死者，何也？答曰：凡属痨病，皆在四旬之内，及童稚之年，可想见矣。彼其精神气血壮盛之时，于内则为性情之抑郁，于外则为风寒之感冒，所以童稚壮年，鳏寡僧尼，多犯此病，难言丧精神、气血两虚而病也，实病于情志抑郁，积想而成。正借精血之未枯，一有内煎，壮热不透，郁而生虫，虫侵脏腑骨髓之中，有何法可治。譬之高堂华屋，外用彩漆壮丽，内之木植滋性犹存而未枯，遂致内蒸生虫、白蚁日蛀而坏，还可脱梁换柱而重新。人之腑脏骨髓蛀坏，即有良法神方，将安用之。（引自《百问》）盖因初起病痨之人，先为痨虫所食五脏而死，既死之后，五脏皆冷，虫不能居，从鼻而出。鼻乃肺之窍，痨即肺之病，故从其窍而出。（引自《丹台玉案》）
【脉候】
诊其寸口脉数，肺痿也，甚则脉浮弱。（引自《病源论》）
骨蒸劳热，脉数而虚，热而涩小，必殒身躯，加汗加咳，非药可除。（引自《崔氏脉诀》）（按语：《医灯续焰》曰：脉数而虚，是其本然。盖以数为热，虚为劳耳。若蒸热而见涩小之脉，涩则精血少，小则元气衰，真阴日损，邪火日增。不至于殒躯不已也。）
痨病之脉，与疟相似，浮弦而虚数，两寸盛而两尺无力，或弦急急数搏大者有之，不宜骤补。（引自《百问》）
盖脉之可补者，浮而芤濡虚大，迟缓无力，沉而迟涩弱细，结代无力，皆虚而不足，可补者也。当君参、[缺字]，佐以归、芎、芍、地，务使阳生阴长，其病乃愈。若于此不补，或恣用苦寒，则虚虚之祸，岂不旋踵而至耶。其脉之不可补者，弦长紧实，滑数有力，此皆火郁内实，不受补者也。法当君以四物，佐以二冬、二母、沙参、玄参等味，滋阴抑阳，务使水升火降，阴秘阳平，病或可痊。若妄施补，则实实之灾，将焉免之。（引自《点雪》）
服寒凉药，症虽大减，脉反加数者，阳郁也。大忌寒凉，宜升宜补，犯之死速。（引自《纲目》）
男子劳热喘嗽，脉必数而无力，按之沉而稍有力者生；浮而细数无力，不能容指者死。（引自《普渡慈航》）
凡脉洪大者犹可治，细数急涩者难治。（引自《简明医彀》）
【察指甲】
东方先生法：夫劳疾诸证，应丈夫妇人童男室女，如得患者，未须察脉，但看手指甲美恶，分明是何劳候。病热甚，宜看脚甲色，与手一同也。其甲青黑者传尸之证，红白者正色之候，黄白者酒色之候，红紫者气劳之候，细详必知其病之所在，或咳嗽，或涎塞咽中，或骨蒸汗出，或泄利，或吐红，或惊魇，或妇人经水不调之类，先服去虫药，然后投治病汤剂。（引自《幼幼新书》）
【证状总说】
《苏游论》曰：大都男女传尸之候，心胸满闷，背膊烦疼，两目精明，四肢无力，虽知欲卧，睡常不着，脊膂急痛，膝胫酸疼，多卧少起，状如佯病，每至旦起，即精神尚好，欲似无病，从日午以后，即四体微热，面好颜色，喜见人过，常怀忿怒，才不称意，即欲嗔恚，行立脚弱，夜卧盗汗，梦与鬼交通，或见先亡，或多惊悸，有时气急，有时咳嗽，虽思想饮食而不能多餐，死在须臾而精神尚好，或两肋虚胀，或时微利，鼻干口燥，常多粘唾，有时唇赤，有时欲睡，渐就沉羸，犹如水涸，不觉其死矣。（引自《外台秘要》）（按语：《得效方》、《治病活法秘方》水涸作涸鱼。）
初着盗汗，盗汗以后即寒热往来，寒热往来以后即渐加咳，咳后面色白，两颊见赤如胭脂色，团团如钱许大，左卧即右出，唇口非常鲜赤，若至鲜赤即极重，十则七死三活，若此以后加吐，吐后痢，百无一生，不过一月死。（同上引救急）
其为状也，发干而耸，或聚或分，或腹中有块，或脑后近下两边有小结，多者乃至五六，或夜卧盗汗，梦与鬼交通，虽目视分明而四肢无力，或上气食少，渐就沉羸，纵延时日，终于溘尽。（同上引《崔氏别录》灸骨蒸方序）
张文仲说：荆州人王元礼，尝家患骨蒸传尸死尽，有一道士忽教灸即断，兼更教人，无有不瘥者。欲识此病，其病先乍寒乍热，有时唇赤或颊赤，并有时痢血多唾（按：痢盖吐讹），有时欲得食，有时不欲食，两脊脉常急，患者多咳盗汗，以指按捻脊膂四边肉，有时心胸气满急（山胁尚德曰：此七字当在盗汗下），黄瘦，膂中肉尽，遂即着床。如着床，胸前自动，脊膂两边肉尽，灸疗即难。如灸，候胸前肉动非事。（同上）
Gu Zheng (Bone-Steaming) is what later generations referred to as Lao Zhai (Consumptive Disease). The chills and fever recorded in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), Fei Wei (Lung Withering) discussed by Zhang Zhongjing, and conditions involving dry blood within the body are all the beginnings of the diagnosis and treatment of such diseases. In ancient times, there was also the theory of "Chuan Shi" (Transmitting Corpse), but descriptions of the shapes of various worms across six generations are somewhat absurd. In essence, this is actually a syndrome within Lao Bing (Consumptive Disease), and scholars should refer to it alongside the preceding sections.
[Nomenclature]
Although Gu Zheng has many different names, its therapeutic principle remains unified. For men, the root lies in damage from overwork; for women, it lies in blood and Qi. This disease originates from Kidney deficiency, hence it is said that when Yin Qi is insufficient, Yang Qi will invade. When Blood and Qi fail to nourish the body, the bone marrow becomes depleted. Since the Kidneys govern the bones, and heat begins in the bones, it is called Gu Zheng. (From *Taiping Shenghui Fang*)
Ancient classics only recorded symptoms of Gu Zheng, but Chao Yuanfang's discussion in *Zhu Bing Yuan Hou Lun* stated that there are five types of Gu Zheng, which is inappropriate. Since steaming heat presents differently, the syndrome of Blood Steaming must relate to the Liver, as the Liver governs Blood. However, the claim of "twenty-three steams" is likely an arbitrary extension leading to confused theories; in reality, it is merely heat generated by Five Viscera exhaustion. It is named specifically as Gu Zheng because the heat is deep-seated, and the ancients highlighted the most severe aspect. (From *Jifeng Puji Fang*) [Note: These two views seem contradictory and should be understood in conjunction.]
[Etiology Overview]
Symptoms of Gu Zheng: In men, it arises from Five Exhaustions and Seven Injuries, or after Lung congestion, or after malaria, or due to chronic accumulation masses. In women, it results from postpartum consumptive disease, leakage of sweat with chills and fever, or amenorrhea. Regardless of gender, it can follow residual heat from epidemic febrile diseases, frequent relapse due to overexertion, or pediatric accumulation masses. These illnesses stem from these ten causes, leading to gradual emaciation. (From *Waitai Miyao* citing *Jiuji Fang*)
Gu Zheng is also known as Chuan Shi, Gui Zhu, Fu Lian, or Wu Gu. For men, the root is accumulation Qi; for women, it is Blood and Qi. People of all ages are susceptible, with infants suffering more severely upon transmission. (From *Cui Shi Bie Lu* preface to Moxibustion for Gu Zheng) [Note: *Su You Lun* states that those with Gui Zhu often develop Gu Zheng.]
Regarding Chuan Shi Lao: In men, transmission goes from Kidney to Heart, then Lung, Liver, and Spleen; in women, from Heart to Lung, Liver, Spleen, and Kidney, eventually transmitting to Six Fu Organs leading to death. It may spread to relatives, even causing family extinction. The source is excessive sexual activity and diet, irregular exposure to cold and heat, sorrow and anxiety, unfulfilled desires, palpitations, or intercourse after serious illness, or weeping over corpses, absorbing corpse Qi. Evil Qi generates, spreads through Five Viscera, corrodes the Heart. Although symptoms vary, it fundamentally involves Heart Yang and Kidney Yin. Understanding Yin-Yang in medication can restore life. People know the name of Lao but not its mechanism. Life relies on Blood for nourishment and Qi for defense; if they circulate without obstruction, Lao does not arise. Thus, Lao means fatigue; when Blood and Qi are fatigued, they stagnate, allowing evil Qi to invade. If the Heart is affected, there is night sweats, fear, and restlessness. If the Kidney is affected, there is Gu Zheng and nocturnal emission dreams, worsening lust due to Yang deficiency. If the Liver is affected, there are scrofula, hypochondriac fullness, spasms, and pain from Wind. If the Spleen is affected, there is excessive thinking, craving coolness, and loss of taste. If the Lung is affected, there is wheezing, phlegm, insomnia, and dry hair. The Six Fu Organs also have their own syndromes. (From *Yonglei Qiang Fang* citing *Ziting Zhizhai Mifang*)
"Lao" implies overwork damaging Essence and Blood, leading to excess Yang and deficient Yin, with fire flaring and phlegm accumulating. Because of phlegm and fire, the disease is feared, so people euphemistically call it Tan Huo (Phlegm-Fire). However, etiologies vary: some inherit weakness and damage Heart/Kidney; some contract Wind-Cold causing chronic cough, cutting off metabolic sources; some suffer from prolonged illness/malaria disrupting recovery; some laborers vomit blood causing Yin deficiency; some indulgent individuals damage Spleen/Kidney through alcohol and sex; some are infected by environment. Though causes differ, the result is Lao. Premonitory signs include neck lumps, abdominal masses, nocturnal emissions, childhood epistaxis, tidal sweating, hemoptysis, emaciation, dry hair, and wiry/thready/empty pulses. Ultimately, it is visceral imbalance leading to extreme hyperactivity. (From *Tanhuo Dianxue*)
The Body's Metal (Lung) and Water (Kidney) organs cannot be injured temporarily. Metal is the source of metabolism; Water is the root of life. If True Yin is deficient, Fire prevails, burning Metal. If Metal is damaged, the source of metabolism ceases, and Water cannot be nourished. One water deficient leads to five fires fanning flames. Fire forces Lung causing cough; phlegm obstructs throat causing retching. Cough is the start of fluid depletion. Mother and child (Metal and Water) both suffer, True Water dries up, fueling Fire. Yin decreases, Yang increases, scorching heat forces blood upward through orifices. Blood is substantial, hard to form, easy to lose, cannot be quickly tonified. Massive blood loss causes sudden Yin collapse and weak Yang, leading to aversion to cold and fever. Chills and fever resembling malaria indicate Yin decline and Yang failure. Tidal fever indicates extreme Yin deficiency. (Same source)
Some say Phlegm-Fire stems from blood and essence loss, which are True Water/Yin, substantial and hard to replenish. Calling it Phlegm-Fire focuses on the branch and forgets the root. When True Water is deficient, Ministerial Fire flares, forcing fluids into phlegm. Thus, phlegm is the branch of fire. Calling Lao-Zhai "Yin Deficiency with Fire Movement" covers both root and branch. *Neijing* says: "Yin deficiency generates internal heat." Heat is mild fire; fire is extreme heat. Fire forces fluids into phlegm; Yin deficiency is the root of fire and phlegm. Dongyuan's concept of primary disease being root and secondary being branch applies here. (Same source)
[Disease Arising from Emotions]
Zhang Chengjie argued: Legends describe Chuan Shi worms as ghost-like, terrifying, causing sequential deaths. I find this illogical. Consider lovesickness: separation causes insomnia and weight loss; reunion cures it. Similarly, Lao disease arises from emotional depression. Classics say: Grief depletes Qi; Thinking knots Qi. Stagnation leads to Qi/Blood deficiency, chills/fever, poor appetite, and pain. Cold invasion adds cough. Chronic cases treated with cooling herbs like Chai Hu and Digupi dissipate True Qi, causing death. This is like mistaking a bow reflection for a snake. Caution is needed. (From *Shizheng Fanghou Ji*)
Human nature prefers joy and vitality. Constant growth prevents disease and prolongs life. Conversely, chronic worry, silence, and gloom hide inner destructive energy. Joy turns to anger; wealth brings no happiness. Depression, excess Qi, chronic cough, accumulated heat, prolonged malaria, lingering wind-cold, postpartum weakness, infectious habits, pediatric malnutrition, dry cough, obsessive thinking, heavy drinking, excessive desire, stinginess, and delayed marriage all cause Lao. Medicines treat disease but cannot change character. (From *Zhengzhi Baiwen*)
[Wind-Cold Becoming Lao]
Wind-cold is mild but neglected, it can be fatal. Ten reasons for failure to recover: 1. Self-medication damages Yuan Qi. 2. Pre-existing deficiency allows evil to sink inward. 3. Weak constitution with prior Gu Zheng develops lung collateral damage. 4. Alcohol/damp-heat combined with wind-cold. 5. Unsafe sex with sweat exposure leads to Three Yin invasion. 6. Youth with emotional stagnation and blocked Tian Gui. 7. Obese/aggressive individuals with poor diet and wind-cold. 8. Overwork with cold exposure. 9. Nuns/widows with repressed emotions and wind-cold. 10. Postpartum deficiency misdiagnosed and overly tonified. These ten fatal cases often start with wind-cold, but the root is prior collapse. (From *Baiwen*) [Note: *Yifang Kao* agrees: "No wind, no Gu Zheng."]
[Origin of Chuan Shi]
Chuan Shi is not just familial contagion. It occurs when Qi/Blood is weak and viscera are frail, allowing "Ghost Qi" or environmental pathogens to enter via social contact, weather, or visiting sick/dead. (From *Zhongzang Jing*)
Worms consume bone marrow; blood/essence exhaustion is often incurable. Preserving Yuan Qi prevents transmission. Indulgence consumes essence internally, allowing external evil. Avoiding consumptive patients' belongings prevents infection. Prolonged exposure transforms "Lao Qi" into worms. (From *Zhizhi Fang*)
[Origin of Worms]
Worms in Lao disease arise from Gu Zheng heat. (From *Tanhuo Men*)
Worms exist due to Qi transformation: gathering creates them, heat grows them, decline defeats them, departure expels them. Drugs cannot reach Five Viscera effectively. (From *Shengmo*)
Why do young, wealthy, idle people get Lao? Death varies in duration. Answer: Lao affects those under forty or children. In youth, internal depression and external wind-cold interact. Emotional stagnation creates heat, generating worms that invade marrow. Like termites in a beautiful house, once internal structure rots, no medicine can save it. After death, viscera cool, worms exit via nose (Lung opening). (From *Baiwen*, *Dantai Yu'an*)
[Pulse Diagnosis]
Rapid Cun Kou pulse indicates Fei Wei; severe cases show floating/weak pulse. (From *Bingyuan Lun*)
Gu Zheng shows rapid/deficient pulse. If heat accompanies thready/small pulse, death is certain despite sweating/coughing. (From *Cui Shi Maijue*) [Note: Rapid/deficient is typical; thready/small indicates severe essence/Qi loss.]
Lao pulse resembles malaria: floating/wiry/rapid/deficient, strong Cun, weak Chi. Do not tonify abruptly. (From *Baiwen*)
Tonifiable pulses: floating/empty/soggy/large, slow/weak, deep/choppy/thin, knotted/intermittent. Use Ginseng, Rehmannia, etc., to generate Yin from Yang. Avoid bitter-cold. Non-tonifiable pulses: wiry/long/tight/solid, slippery/rapid/forceful. These indicate internal fire/stagnation. Use Si Wu Tang with Anemarrhena, Ophiopogon, etc., to nourish Yin and suppress Yang. Do not tonify falsely. (From *Dianxue*)
If symptoms improve but pulse accelerates after cooling herbs, Yang is depressed. Avoid cooling; tonify and lift. Violating this causes rapid death. (From *Bencao Gangmu*)
Male Lao with wheezing/cough: rapid/weak pulse. Deep/slightly forceful is good; floating/thin/weak is fatal. (From *Pudu Cihang*)
Large/hong pulse is treatable; thin/rapid/choppy is difficult. (From *Jianming Yigou*)
[Inspecting Fingernails]
Eastern Master's method: Inspect nails before pulse. Blue-black indicates Chuan Shi; red-white is normal; yellow-white indicates alcohol/sex excess; red-purple indicates Qi Lao. Detailed observation reveals location: cough, phlegm, Gu Zheng, diarrhea, hematemesis, nightmares, menstrual issues. First administer anti-worm medicine, then treat the syndrome. (From *Youyou Xinshu*)
[Symptom Overview]
*Su You Lun*: Chest oppression, back pain, clear eyes, weak limbs, insomnia, spinal pain, leg soreness, lying down mostly. Morning: energetic. Afternoon: low-grade fever, flushed cheeks, irritability, night sweats, dream disturbances, palpitations, cough, poor appetite. Gradual wasting like drying water. (From *Waitai Miyao*) [Note: *Defang Fang* compares to dried fish.]
Initial night sweats lead to alternating chills/fever, then cough. Pale face with malar flush (red like rouge). Lips very red indicates severe case (70% mortality). Vomiting followed by dysentery is fatal within a month. (From *Jiuji*)
Dry/scaly skin, abdominal masses, occipital lumps, night sweats, dream disturbances, weak limbs, shortness of breath, gradual wasting. (From *Cui Shi Bie Lu*)
Zhang Wenzhong: Wang Yuanli's family died of Chuan Shi. A Daoist taught moxibustion, curing all. Symptoms: alternating chills/fever, red lips/cheeks, bloody stools/phlegm, appetite changes, tense spine muscles, cough, night sweats. Pressing spine muscles reveals chest tightness. Yellow/emaciated, spine muscle atrophy, bedridden. Moxibustion difficult if chest moves spontaneously. (Same source)