五劳者。五脏之劳也。皆因不量才力。勉强运为。忧思过度。嗜饮无节。或病失调理。
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
五脏虽皆有劳。心肾为多。心主血。肾主精。精竭血燥。则痨生。治劳之法。当以调心补
肾为先。不当用峻烈之剂。惟当温养滋补。以久取效。天雄附子之类。投之太多。适足以发
其虚阳。缘内无精血。不足当此猛剂。不可因有热。纯用甜冷之药。以伤肾气。独用热药者
犹釜中
无水而进火也。过用冷药者。犹釜下无火而添水也。非徒无益。又害之耳。宜十全大补汤。
或双和散、养荣汤、七珍散、药令建中汤。皆可选用。间进双补丸。若有无故身体瘦软。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。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。久欠药力到。补调功成。自复
应矣。
气虚人多不得寝。亦有痰多。胆经伏涎。欲寐不得者。不可例作虚治。妄补则痰愈盛。
有于坐卧之中。似欲得人按捻。意方始安者。此亦虚证也。诸发及有寒热者。已各见
本门
审知因虚劳得之。并宜用前药。未效用十四味建中汤。渴而不胜热药者。七珍散加木香五
味子各七分。热多。黄 鳖甲散。或人参散。独五心发热。将欲成劳者。茯苓补心汤。外虽
恶热。内自畏寒。盛夏不可单衣。大建中汤、十四味建中汤、正元饮、参附汤。
饮食减少。畏食而呕者。难独用前滞甜药。须斟酌用前快脾之剂。缩砂陈皮药却不可少
如
药令建中汤内有陈皮半夏细辛却可用。仍下鹿茸橘皮煎丸。如不呕不畏食。用前十全大补汤
双和散等药。亦当少加快脾之剂。以为之防。
有患精血不足。明知当补肾。方欲一求之归 等药。其人素减食。又恐不利于脾。方欲
理脾
气。则不免用疏刷之药。又恐愈耗肾水。全一举而两得之功。莫若鹿茸橘皮煎丸为第一。故
曰。精不足。补之以味。又曰。补肾不如补脾。以脾上交于心。下交于肾故也。道家交构心
肾。以脾为黄婆者。即此意。若肾元大段虚损。病势困笃。则肾不容少缓。又不拘于此说。
要知于滋肾之中。佐以砂仁澄茄之类。于壮脾之中。参以北五味。黄 之属。此又临时审病
用药之活法。劳疾久而嗽血。咽疼无声。此病自下而传上。若不嗽不痛。久而溺浊脱精。
此为自上传下。皆死证已。
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。
有传尸劳。骨肉相传。甚至灭门。此其五脏中皆有劳虫。古名瘵疾。难以医之。
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。详见诸痛门身体痛证。
有嗽咳痰多者。名曰劳嗽。与风寒壅热之嗽不同。此乃有本有标。本在肾而标在肺。可
与前
诸药第一段求之。选用加五味杏仁阿胶贝母款冬花之属。嗽而加以喘者。于前药更加磨沉香
仍吞灵砂丹。或三妙丹。详见嗽门。嗽而有血者。详见血门嗽血证。
五劳，是指五脏的劳损。多因不量力而行，勉强劳作；忧思过度；嗜酒无节制；或患病后失于调理，导致积久成劳。其症状表现为头晕眼花、身体疼痛、脚部软弱无力、心中胆怯、气短、自汗与盗汗，或出现寒热往来、五心（两手心、两足心及心胸）常感发热、潮热、骨蒸潮热（感觉热自骨髓深处向外透发）、夜间多恶梦、白天精神萎靡、耳内蝉鸣、口苦无味、饮食减少等。这些都是劳伤的证候。
虽然五脏皆可发生劳损，但以心和肾为多见。心主血，肾主精，若精竭血燥，则产生痨病。治疗劳病的方法，应当以调补心肾为先，不宜使用峻烈猛烈的药剂，只应采用温养滋补之法，以求长久见效。若过多投用天雄、附子之类大热之药，反而足以激发虚阳上越，因为体内缺乏精血，无法承受如此猛烈的药物。不可因为有热象，就纯用甘寒凉冷的药物，以免损伤肾气。若独用热药，犹如锅中无水而加火；若过用冷药，犹如锅下无火而加水。这不仅无益，反而有害。适宜选用十全大补汤，或双和散、养荣汤、七珍散、药令建中汤等，均可酌情选用。间歇性服用双补丸。若有无故身体消瘦软弱，完全没有力气，且无其他症状者，此乃平日劳作太过，气血虚弱，筋脉失养所致，宜用劫劳散或和气汤，并加倍使用川芎、当归。又有因言语诵读过度，耗伤神气，导致虚损者，称为“叫呼走气”，宜在十全大补汤等方剂中选用。
虚弱的老人或病中患者，忽然有一天不能说话，呼唤也不应答，这不是哑风（中风失语），而是药力未到，待补益调理之功完成，自然能恢复应答。
气虚之人往往难以入睡，也有痰多、胆经伏留涎沫，想睡却睡不着的情况，不可一概当作虚证治疗，妄用补药则痰湿更盛。有的患者在坐卧之中，似乎希望有人按压揉捏，心里才感到安宁，这也是虚证的表现。凡是发作性疾病及伴有寒热者，已在各自门类中详述。确知因虚劳所致者，均宜使用前文所述药物。若未见效，可用十四味建中汤。口渴而不能耐受热药者，用七珍散加木香、五味子各七分。热象明显者，用黄鳖甲散，或人参散。仅五心发热，即将形成劳病者，用茯苓补心汤。外虽怕热，内却畏寒，盛夏时节也不敢穿单衣者，用大建中汤、十四味建中汤、正元饮、参附汤。
饮食减少，畏惧进食且呕吐者，难以单独使用前文那些滋腻甜滞的药物，必须斟酌使用健脾快胃的药剂。缩砂仁、陈皮这类药物不可或缺。如药令建中汤内含有陈皮、半夏、细辛，却可以使用。随后服用鹿茸橘皮煎丸。如果不呕吐、不畏惧进食，则使用前十全大补汤、双和散等药物，但也应少量加入健脾快胃之剂，以防滋腻碍胃。
有患精血不足者，明知应当补肾，刚想求取当归等补血药，但此人平时食欲减退，又担心不利于脾胃，刚想调理脾气，又难免使用疏泄理气之药，恐怕更加耗伤肾水。想要一举两得，莫过于鹿茸橘皮煎丸为首选。所以说：“精不足者，补之以味。”又说：“补肾不如补脾。”因为脾土上交于心，下交于肾的缘故。道家修炼中交合心肾，以脾为“黄婆”（媒人），即为此意。若肾元严重虚损，病情危重，则肾脏不容片刻迟缓，又不拘泥于此种说法。要知道，在滋补肾阴之中，佐以砂仁、澄茄等醒脾之品；在壮补脾气之中，参入北五味子、黄芪等固摄之属，这是临证审察病情、灵活用药的方法。
劳疾日久，出现咳嗽咯血、咽痛失音，此病由下焦传至上焦；若不咳嗽不疼痛，日久出现小便浑浊、遗精滑脱，此为病由上焦传至下焦，皆属死证。
有的人面色如常，肌肉形体丰满，外表看若无病，实则内部虚损，俗称为“桃花蛀”。应观察其具体证候，在前文药物中审慎选用。
有传尸劳（一种具有传染性的慢性消耗性疾病），骨肉相传，甚至灭门，这是因为五脏中皆有劳虫，古称瘵疾，难以医治。
此外，还有因动作劳累用力，或出现寒热，或身体疼痛、气短，或疲劳倦怠、嗜睡，这是一时发生的劳损，却不同于五劳，宜用和气饮，详见诸痛门中的身体痛证。
有咳嗽痰多者，名为劳嗽，与风寒壅遏郁热所致的咳嗽不同。此病有本有标，本在肾，标在肺，可参考前文诸药第一段进行求治，选用加五味子、杏仁、阿胶、贝母、款冬花等药物。咳嗽兼见气喘者，在前药基础上再加磨沉香，同时吞服灵砂丹，或三妙丹，详见嗽门。咳嗽而有咯血者，详见血门中的嗽血证。
Wu Lao (Five Excesses/Five Labors) refers to the exhaustion of the five Zang organs. It is generally caused by overexertion beyond one's capacity, excessive worry and thinking, unregulated alcohol consumption, or failure to manage treatment properly after illness, leading to chronic accumulation and eventual labor disease. Its symptoms include dizziness and blurred vision, body pain, weakness in the legs, timidity, shortness of breath, spontaneous sweating, night sweats, alternating chills and fever, constant heat sensation in the "five centers" (both palms, both soles, and the chest), tidal fever, bone-steaming fever (heat emanating from the bone marrow), frequent nightmares, daytime lethargy, tinnitus like cicadas, bitter taste in the mouth, loss of taste, and reduced appetite. These are all signs of labor injury.
Although all five Zang organs can suffer from labor, the Heart and Kidney are most commonly affected. The Heart governs Blood, and the Kidney governs Essence. When Essence is exhausted and Blood becomes dry, tuberculosis-like conditions arise. The treatment for labor diseases should prioritize regulating and tonifying the Heart and Kidney. Harsh and potent agents should not be used; instead, warm nourishing and tonifying methods should be employed to achieve long-term effects. Overuse of hot drugs such as Tianxiong (Aconitum brachypodum root) and Fuzi (Prepared Aconite Root) may only stimulate floating deficient Yang, because the interior lacks Essence and Blood to withstand such fierce medicines. One must not use purely sweet and cold medicines just because there are heat signs, as this would damage Kidney Qi. Using only hot medicines is like adding fire to a pot without water; using too many cold medicines is like adding water to a pot without fire. This is not only ineffective but also harmful. Suitable formulas include Shiquan Dabu Tang (Ten Significant Decoction for Great Tonification), Shuanghe San (Double Harmony Powder), Yangying Tang (Nourish Ying Decoction), Qizhen San (Seven Treasures Powder), and Yaoling Jianzhong Tang (Medicine-Commanding Interior-Building Decoction). Shuangbu Wan (Double Tonifying Pill) can be taken intermittently. If a person suddenly becomes emaciated and weak without cause, lacking strength entirely, with no other symptoms, it is due to excessive daily labor causing Qi and Blood deficiency and malnourishment of sinews. Jie Lao San (Rob Labor Powder) or Heqi Tang (Harmonize Qi Decoction) with increased amounts of Xiong (Ligusticum Chuanxiong Rhizome) and Gui (Angelica Sinensis Radix) are appropriate. Furthermore, excessive speaking or reading consumes Shen (Spirit) and Qi, leading to deficiency, known as "calling out and losing Qi." In such cases, select from formulas like Shiquan Dabu Tang.
In frail elderly patients or those during illness, sudden inability to speak and lack of response to calls is not Ya Feng (Wind Aphasia/Stroke-induced muteness), but rather a delay in the efficacy of medicine. Once the tonifying and regulating treatment takes effect, speech will naturally return.
Patients with Qi deficiency often suffer from insomnia. Some have excessive phlegm and retained saliva in the Gallbladder Meridian, wanting to sleep but unable to do so. This should not be treated simply as deficiency; reckless tonification will exacerbate phlegm. Some patients feel comforted only when pressed or rubbed while sitting or lying down; this is also a sign of deficiency. For various paroxysmal diseases accompanied by chills and fever, refer to their respective sections. If confirmed to be due to deficiency-labor, the aforementioned medicines should be used. If ineffective, Shisiwei Jianzhong Tang (Fourteen Ingredients Interior-Building Decoction) may be used. For those who are thirsty but cannot tolerate hot medicines, use Qizhen San plus Muxiang (Aucklandia Root) and Wuweizi (Schisandra Fruit), each 0.7 fen. For prominent heat, use Huang Biejia San (Yellow Turtle Shell Powder) or Renshen San (Ginseng Powder). For isolated heat in the five centers, approaching labor disease, use Fuling Buxin Tang (Poria Tonifying Heart Decoction). For those who externally fear heat but internally fear cold, refusing single-layer clothing even in midsummer, use Da Jianzhong Tang (Great Interior-Building Decoction), Shisiwei Jianzhong Tang, Zhengyuan Yin (Origin-Supporting Drink), or Shenfu Tang (Ginseng and Aconite Decoction).
For reduced appetite, aversion to eating, and vomiting, one cannot solely rely on the previously mentioned cloying and sweet-stagnant medicines. One must carefully choose spleen-strengthening and stomach-promoting agents. Sha Ren (Amomum Fruit) and Chen Pi (Tangerine Peel) are indispensable. Formulas like Yaoling Jianzhong Tang containing Chen Pi, Banxia (Pinellia Tuber), and Xixin (Asarum Root) can be used. Follow with Lurong Jupi Jian Wan (Deer Antler and Tangerine Peel Decoction Pills). If there is no vomiting or aversion to eating, use Shiquan Dabu Tang, Shuanghe San, etc., but add small amounts of spleen-strengthening agents to prevent stagnation.
For patients with insufficient Essence and Blood who know they need to tonify the Kidney, one might initially seek Guib (Angelica Sinensis Radix) etc., but if the patient has poor appetite, there is concern about harming the Spleen. If one then seeks to regulate Spleen Qi, using dispersing drugs might further deplete Kidney Water. To achieve both goals simultaneously, Lurong Jupi Jian Wan is the best choice. Thus it is said: "When Essence is insufficient, tonify with flavor/substance." And again: "Tonifying the Spleen is better than tonifying the Kidney," because the Spleen connects upward to the Heart and downward to the Kidney. In Daoist practices of harmonizing Heart and Kidney, the Spleen is regarded as the "Yellow Matron" (matchmaker), which implies this meaning. However, if Kidney Yuan Qi is severely damaged and the condition is critical, the Kidney cannot wait, and one should not be bound by this theory. It is important to know that while nourishing the Kidney, add Sha Ren (Amomum Fruit) and Chengqie (Litsea Cubeba Fruit) to awaken the Spleen; while strengthening the Spleen, incorporate Bei Wuweizi (Schisandra Berry) and Huangqi (Astragalus Root) to consolidate. This represents flexible application of medicine based on clinical assessment.
If labor disease persists for a long time, leading to coughing blood, sore throat, and loss of voice, the disease transmits from the lower to the upper jiao. If there is no cough or pain, but prolonged cloudy urine and seminal emission occur, the disease transmits from the upper to the lower jiao. Both are considered fatal conditions.
Some individuals appear normal in complexion and muscle mass, showing no external signs of illness, yet internally suffer from severe deficiency, colloquially called "Peach Wood Moth Eaten." Observe their specific syndromes and carefully select from the aforementioned medicines.
Chuan Shi Lao (Transmitting Corpse Labor/Tuberculosis) spreads through bone and flesh contact, potentially wiping out families. This is due to "labor parasites" in the five Zang organs, anciently known as Zhai Ji (Consumption Disease), which is difficult to cure.
Additionally, there are cases of acute labor caused by physical exertion, presenting with chills and fever, body pain, shortness of breath, or fatigue and desire to lie down. This is temporary labor and differs from Wu Lao. Use Heqi Yin (Harmonize Qi Drink); see the Body Pain section under Various Pains.
Coughing with abundant sputum is named Lao Sou (Labor Cough), distinct from coughs caused by Wind-Cold obstructing Heat. This condition has a root (Kidney) and branch (Lung). Refer to the first part of the aforementioned medicines for treatment, selecting additions such as Wuweizi (Schisandra Fruit), Xingren (Apricot Seed), Ejiao (Donkey-Hide Gelatin), Beimu (Fritillaria Bulb), and Kuandonghua (Farfola Flower). For cough accompanied by asthma, add ground Chenxiang (Agarwood) to the previous formula and swallow Lingsha Dan (Cinnabar Pill) or Sanmiao Dan (Three Wonders Pill); see the Cough section. For cough with hemoptysis, see the Hemoptysis section under Blood Diseases.