余友洪君缉庵，病弃举业，潜心医学。不数年，得其奥，尝示所着《虚损启微》。采
，辨论明晰，非他方书所及，或以多录成方为议，不知成方者规矩也，规矩积古今而不可易
，有所变通，视夫人之善用其巧。缉庵此书，真具有与人规矩，不能使巧之微。缉庵又最孝
，其学医也，虽因已病，而实图治其母夫人之疾。始余尝见其秤药量水，心极精审，多语余
药性，故余于医道独学缉庵而得者，其所着敢易视耶？况又为人之所不能易视者耶？惜其亡后
，多致散逸，恐不久为医家覆瓿用矣，特录存之。
时乾隆辛巳小春中浣罗山张廷枚识
陆宣公见古方，必手抄录。范希文自以不为良相，当为良医。余寝瘵也久，倦于文史
方书，于虚损一症，尤加体会，自救也因以救人，肱盖三折矣。岁壬申，随侍山阳官署，暇
辄以己意条疏数语，积而成卷。或亦启微之论，发古人之所未发，而其方则仍采诸古，古即
不宜于今，斟酌之，增减之，神而明之，存其人也。
重九后三日，病夫洪炜识于淮署之饮默轩
上古天真论曰∶今时之人，以酒为浆，以妄为常，醉以入房，以欲竭其精，以耗散其
真，不知持满，不知御神，务快其心，逆于生乐，起居无节，故半百而衰也。
本神篇曰∶五脏主藏精者也，不可伤，伤则失守而阴虚，阴虚则无气，无气则死矣。
故智者
至，长生
生气通天论曰∶凡阴阳之要，阳密乃固，两者不和，若春无秋，若冬无夏。（犹四时之
缺一
，精
宣明五气论曰∶久视伤血，久卧伤气，久坐伤肉，久立伤骨，久行伤筋。
痹论曰∶阴气者，静则神藏，躁则消亡。
五癃津液别篇曰∶阴阳不和，则使液溢，而下流于阴，髓液皆减而下，下过度则虚，
背痛而胫酸。（阴阳不和，则精气俱乱，不相统摄故液溢于下，而流泄阴窍，以至真阴日损
，腰痛胫酸，此即劳瘵之渐也。）
调经论曰∶阳虚则外寒，阴虚则内热。
卫气篇曰∶下虚厥，上虚则眩。
通评虚实论曰∶所谓气虚者，言无常也。（声音不能接续。）尺虚者，行步 然。（ ，
音匡，怯弱也。尺虚则下虚。）
脉虚者，不象阴也。（气口独为五脏主藏，为阴而在里，今其脉中空不象阴矣。）如此
者，滑则生，涩则死也。
脏气法时论曰∶肝虚，则目KT KT （音荒）无所见。耳无所闻，（胆脉，从耳后入耳中。）
善恐如
而痛。（心主血，血虚不能荣养筋脉。胸腹腰胁，皆手少阴厥阴脉所及，故病见于此。）脾虚
，则腹满，肠鸣飧（音孙）泄，食不化。肺虚，则少气不能报息。（呼吸难于接续。）耳聋，（
络会耳中。）嗌干，（脉循喉咙。）肾虚，则胸中痛，大腹小腹痛。（肾脉夹脐上行，从肺出
，络心注胸中。）清厥，（精不化气。）意不乐。（心肾不交，膻中拂郁。）
口问篇曰∶上气不足，脑为之不满，耳为之苦鸣，头为之苦倾，目为之眩，中气不足
，溲便
音乐同义。）
脉要精微论曰∶言而微，终日乃复言者，此夺气也。（肺脏失守。）衣被不敛，言语善
恶，不
（脾脏失守。）水泉不止者，是膀胱不藏也。（肾脏失守。）得守者生，失守者死。夫五脏者，
身之强也。头者，精明之腑。（五脏六腑之精气，皆上升于头。）头倾视深，（目限无光，）精
神将夺矣。背者，胸中之府。（背乃脏俞所系。）背曲肩随，腑将坏矣。腰者，肾之腑。转摇
不能，肾将惫矣。膝者，筋之府。屈伸不能，行则偻（音吕）附，筋将惫矣。骨者，髓之腑。
不能久立，行则振掉，骨将惫矣。
经脉篇曰∶手太阴气绝则皮毛焦。太阴者，行气温于皮毛者也。故气不荣，则皮毛焦
焦则津液去皮节，津液去皮节者，则爪枯毛折，毛折者，则毛先死。丙笃丁死，火胜金也。
手少阴气绝则脉不通，脉不通则血不流，血不流则髦色不泽，故其面黑如漆柴者，血先死。
壬笃癸死，水胜火也。足太阴气绝者，则脉不荣肌肉。唇舌者，肌肉之本也。脉不荣则肌肉
软，肌肉软则舌萎，（枯蔫）人中满，人中满则唇反，唇反者肉先死。甲笃乙死，木胜土也。
足少阴气绝则骨枯。少阴者，冬脉也，伏行而濡骨髓者也。故骨不濡，则肉不能着也，骨肉
不相亲，则肉软却，肉软却，故齿长而垢，发无泽，发无泽者，骨先死。戊笃已死，土胜水
也。足厥阴气绝则筋绝。厥阴者，肝脉也。肝者筋之合也，筋者聚于阴器而脉络于舌本也。
故脉弗荣则筋急，筋急则引舌与卵，故唇青舌卷，卵缩则筋先死。庚笃辛死，金胜木也。五
阴气俱绝，则目系转，转则目运，（五脏之精，皆上注目。）目运者，为志先死，（志藏于肾
，阴之神也。）志先死则远一日半死矣。六阳气绝，则阴与阳相离，离则腠理发泄，绝汗乃
出，故旦占夕死，夕占旦死。
方盛衰论曰∶至阴虚天气绝，（阴虚则无以升，不升则天气亦绝而不降。）至阳盛地气
（阳亢则不能降，不降则地气不足而不升。）形弱气虚死，形气有余，脉气不足死，（脏气先
坏。）脉气有余，形气不足生。
三部九候论曰∶五脏已败，其色必夭，夭必死矣。形盛脉细，少气不足，以息者危。（
余而内不足，枝叶盛而根本伤也。）形瘦脉大，胸中多气者死。（阴气败而孤阳独留。）形肉
已脱，九候虽调犹死。（脾气脱也。）
平人气象论曰∶臂多青脉曰脱血，尺脉缓涩，谓之解亦。（音懈迹，困倦难状之名也。
）安卧脉盛，谓之脱血，（邪盛，卧必不安，今脉盛而卧安，知非气分阳邪，而为阴虚脱血也。亦
指尺脉言。）尺涩脉滑，谓之多汗，（尺肤涩则营血少，尺脉滑则阴火盛，阳盛阴虚故多汗。
）尺寒脉细，谓之后泄。（尺肤寒，脾阳衰，尺脉细肾阳衰，脾肾虚寒故后泄。）脉尺粗常热
者，谓之热中。（尺粗则真阴不足，常热则阴火有余，故为热中。）
论疾诊尺篇曰∶尺肉弱者，当病解 安卧。（尺肉弱者，肌必消瘦，瘦为阴虚，故病解
，而时欲安卧。）脱肉者，寒热不治。（若至于脱肉，则必发寒热，而真阴败绝矣。）尺炬然热
，人迎大者，当夺血。（尺肤热，火在阴，人迎大，阳气胜，故当失血。）尺坚大，脉小甚，
少气， 有加立死。（尺肤坚大而脉则小甚，真气衰少而烦 有加，真阴虚极，故当立死。
音懑。）
邪气脏腑病形篇曰∶诸小者，（诸脉细小。）阴阳形气俱不足，勿取以针，而调以甘药
大奇论曰∶脉至而搏，血衄身热者死。（搏脉弦强阴虚，最忌失血，而脉搏身热，真阴
矣。）脉来悬钩浮为常脉。（搏固大忌矣，然阴虚者，脉多浮大，若其来不高不下，如物悬空
浮钩而不失中和之气，乃其常脉无足虑也。）脉至浮合，浮合如数，一息十至以上。（如浮波
之合后以催前，泛泛无常，其状如数而实，非数热之脉。）是经气予不足也，微见九十日死
。（初见此脉，期在九十日而死，若见之已久则不必九十日矣，所以在九十日者，以时更季
易天道变而人气从之也。）脉至如火薪然，（来如焰之锐，去如灭之速。）是心精之子夺也。
草干而死。（火脏无根之脉，故曰心精予夺，草干者，阳尽时也。）脉至如散叶，（浮泛无根
零乱不整。）是肝气予虚也，木叶落而死。（金胜木败。）脉至如省客，省客者，脉塞而鼓，（
如省问之客去来无定，或无而止，或有而搏。）是肾气予不足也，悬去枣华而死。（悬华开去
华落，言于枣华开落之时，火王水败而死也。）脉至如丸泥，（泥弹之状，坚强短涩。）是胃
精予不足也，榆荚落而死。（榆钱春深而落，木王土败也。）脉至如横格，（长而且坚，如横
木格于指下。）是胆气予不足也，禾熟而死。（禾熟于秋，金令王也。）脉至如弦缕，（如弦之
急，如缕之细。）是胞精予不足也。（胞，子宫，命门元阳所聚，真元亏损也。）病善言，下霜
而死。不言，可治。（善言则阴气不藏，而虚阳外见，故至下霜时虚阳消败而死矣。不言则
肾气犹静，故尚可治。）脉至如交漆，交漆者，左右旁至也。（如写漆之交，左右旁至而缠绵
不清。）微见三十日死。（阴阳偏败，死期已促，三十日者，月建之易也。）脉至如涌泉，浮
鼓肌中，（如泉之涌，有升无降，而浮鼓于肌肉之中。）太阳（膀胱）气予不足也。少气味，韭
英而死。（外实内虚，阴精不足，故为少气味，韭英而死者，冬尽春初水渐衰也。）脉至如颓
土之状，按之不得，（虚大无力，按之即不可得。）是肌气予不足也。五色先见黑，白 发死
。（肌气即脾气，黑色者，土败极而水反乘之也。白 发于春，木王而土败矣。）脉至如悬雍
，悬雍者浮揣，切之益大，（喉间下垂肉乳，曰∶悬雍，浮短孤悬有上无下，）是十二俞（音
输）之予不足也，（俞皆在背，为十二经脏气所系。）水凝而死。（阴气盛则孤阳绝。）脉至如
偃刀，偃刀者，浮之小急，（如刀口，）按之坚大急，（如刀背，）五脏菀（郁同）热，寒热独并
于肾也。（五脏郁热而发为寒热，阳王则阴消，故独并于肾也。）如此其人不得坐，（腰为肾
之腑。）立春而死。（立春阳盛，阴日以衰，故死。）脉至如丸，（短小，）滑不直手，不直手
者，按之不可得也，是大肠气予不足也。枣叶生而死。（枣叶生初夏，火王克金，故死。）脉
至如华者，（如草木之华，轻浮柔弱。）令人善恐，不欲坐卧，行立常听，是小肠气予不足也
，（小肠与心表里，故心气怯而不能宁。）季秋而死。（丙火墓于戌。）
玉机真脏论曰∶大骨枯槁，（肩垂项倾腰重膝败，肾主骨，骨枯则肾败矣。）大肉陷下
，（尺肤细削，臂肉消瘦，脾主肉，肉陷则脾败矣。）胸中气满，喘息不便，其气动形，（肺
主气，气满喘息，以至形体振动，则气不归原，而肺脏败矣。）期六月死，（六月者，一岁阴
阳之更变。）真脏脉见，乃予之期日。（可因克贼之日以定其死期。）大骨枯槁，（肾）大肉陷
下，（脾）胸中气满，喘息不便，（肺）内痛引肩项，（病及心经）期一月死。（较前已甚，故期
一月斗建移而死。）真脏见，乃予之期日，大骨枯槁，（肾）大肉陷下，（脾）胸中气满，喘息
不便，（肺）内痛引肩项，（心）身热脱肉破 。（音郡，筋肉结聚处，盖至此而肝亦败矣。）真
藏见，十日之内死。（五脏俱伤，真脏又见，故近在十日之内死。）大骨枯槁，（肾）大肉陷下，
（脾）肩髓内消，（因于骨枯，）动作益衰，（因于肉陷，）真脏未见，期一岁死，（虽诸症未全，
然败竭已兆，仅支一年，岁易气新不能再振矣。）见其真脏，乃予之期日。大骨枯槁，（肾）大
肉陷下，（脾）胸中气满，（肺）腹内痛，心中不便，（心）肩项身热，破 脱肉，（肝）目匡陷
，真脏见，目不见人，立死。（神气已脱，故当立死。）其见人者，至其所不胜之时则死。（神气
犹存，故必待克贼之时而死。）真肝脉至，中外急如循刀刃，责责然如按琴瑟弦，色青白不泽，
毛折乃死。真心脉至，坚而搏，如循薏苡子累累然，（坚强短实）色赤黑不泽，毛折乃死。真肺
脉至，大而虚，如以毛羽中人，肤色白赤不泽，毛折乃死。真肾脉至，搏而绝，（甚也）如指弹
石辟辟然，色黑黄
率以毛折，死
我的好友洪缉庵先生，放弃了科举功名，潜心钻研医学。没过几年，他便掌握了其中的奥妙，曾向我展示他所著的《虚损启微》一书。书中内容广博，辨析论述清晰明了，这是其他医书所不及的。或许有人批评他过多收录了现成的方剂，却不知道成方是治病的基本法则（规矩），这些法则是经过古今积累而不可轻易改变的；至于如何灵活运用，则要看医者是否善于运用其技巧。缉庵的这本书，真正做到了给予人基本的法则，而不在于卖弄技巧。缉庵又极为孝顺，他学习医学，虽然是因为自己生病，但实际是为了治疗他母亲的疾病。起初我曾见他称药量水，心思极其精细审慎，多次跟我谈论药性，所以我从医道中独自向缉庵学到的东西，怎么敢轻视他的著作呢？何况这又是别人不敢轻视的东西呢？可惜他去世后，书籍大多散失，恐怕不久就要被医生用来盖酒坛底了，因此特意抄录保存下来。
时乾隆辛巳年（1761年）初冬月中旬，罗山张廷枚识
陆宣公看到古方的时候，必定亲手抄录。范希文说自己如果不能做良相，那就应当做良医。我患虚劳病很久了，对文史和医书感到厌倦，对于虚损这一病症，尤其加以体会，自救的同时也为了救人，正如“三折肱知为良医”的道理。壬申年，我在山阳官署侍奉左右，闲暇时就凭自己的意思分条列出几句心得，积累成了一卷。这也算是《启微》的论述吧，阐发了古人未曾阐发的道理，而其中的方剂仍然采自古代医书，如果古方不适合现在的情况，就斟酌它，增减它，神妙地阐明它，以保留古人的用心。
重九后第三天，患病之人洪炜写于淮署的饮默轩
《上古天真论》说：现在的人，把酒当作浆液来喝，把妄动当作常态，醉酒后行房事，用欲望耗尽精气，耗散真气，不知道保持精气充盈，不知道驾驭精神，只求满足心意，违背了生命的乐趣，起居没有节制，所以不到五十岁就衰老了。
《本神篇》说：五脏是藏精的器官，不能损伤，损伤就会失去守持而导致阴虚，阴虚就没有气，没有气就会死亡。所以明智的人……（原文此处有缺漏）……长生……
《生气通天论》说：大凡阴阳的关键，阳气致密才能固守，两者如果不协调，就像春天没有秋天，冬天没有夏天。（如同四季缺少……，精气……）
《宣明五气论》说：长时间看伤血，长时间躺卧伤气，长时间坐着伤肉，长时间站立伤骨，长时间行走伤筋。
《痹论》说：阴气，安静时神灵内藏，躁动时神灵消亡。
《五癃津液别篇》说：阴阳不和，就会导致津液外溢，向下流入阴窍，髓液都减少并向下流失，过度流失就会虚弱，导致背痛和小腿酸软。（阴阳不和，导致精气混乱，互不统摄，所以津液下溢，流泄于阴窍，致使真阴日渐亏损，出现腰痛、小腿酸软，这就是劳瘵病的开端。）
《调经论》说：阳虚则体表发冷，阴虚则体内发热。
《卫气篇》说：下部虚弱会导致厥逆，上部虚弱会导致眩晕。
《通评虚实论》说：所谓气虚，表现为说话声音断续无常。（声音不能接续。）尺脉虚弱，表现为走路……（音匡，怯弱无力。尺脉虚弱即下部虚弱。）
脉象虚弱，表现出不像阴脉的样子。（寸口脉独为五脏之主，属阴而在里，如今脉象中空，不像阴脉了。）像这样的情况，脉滑则生，脉涩则死。
《脏气法时论》说：肝虚，则眼睛……（音荒）看不见东西，耳朵听不见声音，（胆脉，从耳后进入耳中。）容易恐惧，……并且疼痛。（心主血，血虚不能滋养筋脉。胸腹腰胁，都是手少阴、厥阴经脉所到达的地方，所以病证表现在这里。）脾虚，则腹部胀满，肠鸣，完谷不化的泄泻（音孙），食物不消化。肺虚，则气短，呼吸难以接续。（呼吸难于接续。）耳聋，（络脉交会于耳中。）咽喉干燥，（经脉循行喉咙。）肾虚，则胸部疼痛，大腹和小腹疼痛。（肾脉夹脐上行，从肺出来，联络心脏注入胸中。）四肢清冷厥逆，（精气不能化为气。）心情不乐。（心肾不交，膻中气机郁结。）
《口问篇》说：上气不足，头脑就会感觉空虚，耳朵会痛苦地鸣响，头部会痛苦地倾斜，眼睛会眩晕；中气不足，小便和大便……（音乐同义，此处疑为脱字或通假，指二便失常）。
《脉要精微论》说：说话声音低微，整天才说几句话，这是夺气。（肺脏功能失守。）穿衣不能自理，言语颠倒善恶，……（脾脏功能失守。）小便失禁不止，是膀胱不能固藏。（肾脏功能失守。）能够守持的就生存，失守的就死亡。五脏，是身体强健的根本。头，是精明之府。（五脏六腑的精气，都上升汇聚于头部。）头部低垂，目光深陷，（目眶无光，）精神将要耗竭了。背，是胸中之府。（背部是脏腑俞穴所在之处。）背部弯曲，肩膀下垂，腑气将要败坏了。腰，是肾之府。转动摇晃不能自如，肾将要疲惫了。膝，是筋之府。屈伸不能自如，走路则弯腰驼背（音吕），筋将要疲惫了。骨，是髓之府。不能久立，走路则颤抖，骨将要疲惫了。
《经脉篇》说：手太阴肺经之气断绝，则皮毛焦枯。太阴经，是运行气温润皮毛的。所以气不能荣养，则皮毛焦枯；皮毛焦枯则津液离开皮节，津液离开皮节，则指甲枯槁、毛发折断，毛发折断，说明毛先死。丙日加重，丁日死亡，因为火胜金。手少阴心经之气断绝，则血脉不通，血脉不通则血液不流动，血液不流动则头发面色无光泽，所以面色黑得像漆柴一样，说明血先死。壬日加重，癸日死亡，因为水胜火。足太阴脾经之气断绝，则脉不能荣养肌肉。唇舌，是肌肉的根本。脉不能荣养则肌肉松软，肌肉松软则舌萎软（枯蔫），人中饱满，人中饱满则嘴唇翻卷，嘴唇翻卷说明肉先死。甲日加重，乙日死亡，因为木胜土。足少阴肾经之气断绝，则骨骼枯槁。少阴经，是冬脉，潜行而濡养骨髓。所以骨不能濡养，则肉不能附着，骨肉不相亲附，则肌肉软弱退缩，肌肉软弱退缩，所以牙齿显得长且垢秽，头发没有光泽，头发没有光泽，说明骨先死。戊日加重，己日死亡，因为土胜水。足厥阴肝经之气断绝，则筋脉断绝。厥阴经，是肝脉。肝合于筋，筋聚于阴器而脉络连于舌本。所以脉不能荣养则筋脉拘急，筋脉拘急则牵引舌头和睾丸，所以嘴唇青紫、舌头卷缩、睾丸上缩，说明筋先死。庚日加重，辛日死亡，因为金胜木。五脏阴气全部断绝，则目系扭转，扭转则眼球晕乱，（五脏的精气，都向上注于眼睛。）眼球晕乱，说明志先死，（志藏于肾，属于阴之神。）志先死则过一天半就会死亡。六阳经之气断绝，则阴与阳分离，分离则腠理开泄，绝汗流出，所以早晨占测晚上死，晚上占测早晨死。
《方盛衰论》说：至虚的阴气，天气就会断绝，（阴虚则无法升发，不升发则天气也断绝而不下降。）至盛的阳气，地气就会……（阳亢则无法下降，不下降则地气不足而不升发。）形体弱而气虚会死，形气有余而脉气不足会死，（脏气先坏。）脉气有余而形气不足能生。
《三部九候论》说：五脏已经败坏，其面色必然夭折，面色夭折必然死亡。形体壮盛而脉象细弱，气短不足，呼吸急促者危险。（外表看似有余而内部不足，枝叶茂盛而根本受伤。）形体消瘦而脉象盛大，胸中多气者死。（阴气败坏而孤阳独留。）形体肌肉已经脱失，即使九候脉象调和也会死。（脾气脱失。）
《平人气象论》说：手臂上青色脉显露，称为脱血，尺脉缓涩，称为解亦。（音懈迹，困倦难耐的状态名。）安静卧床而脉象盛大，称为脱血，（邪气盛，卧床必不安稳，如今脉盛而卧安，知道不是气分的阳邪，而是阴虚脱血。亦指尺脉而言。）尺脉涩而脉滑，称为多汗，（尺肤涩则营血少，尺脉滑则阴火盛，阳盛阴虚故多汗。）尺肤寒而脉细，称为后泄。（尺肤寒，脾阳衰，尺脉细肾阳衰，脾肾虚寒故后泄。）尺部脉粗常热者，称为热中。（尺部粗则真阴不足，常热则阴火有余，故为热中。）
《论疾诊尺篇》说：尺部肌肉弱者，应当病解亦而安卧。（尺部肌肉弱，肌肉必消瘦，瘦为阴虚，故病解亦，而时常想安卧。）肌肉脱失者，寒热不治。（如果到了肌肉脱失的地步，则必定发作寒热，而真阴败绝了。）尺部灼热，人迎脉大者，应当夺血。（尺肤热，火在阴分，人迎大，阳气胜，故应当失血。）尺部坚硬大，脉象小甚，气短，烦闷有加，站立不稳者立死。（尺肤坚大而脉则小甚，真气衰少而烦闷有加，真阴虚极，故应当立死。音懑。）
《邪气脏腑病形篇》说：诸脉细小，（各种脉象细小。）阴阳形气都不足，不要用针刺，而用甘药调理。
《大奇论》说：脉象来势搏击有力，伴有鼻出血、身热的死。（搏脉弦强阴虚，最忌失血，脉搏强劲身热，真阴……矣。）脉象来如悬钩浮，是正常的脉象。（搏脉固然大忌，然而阴虚者，脉多浮大，如果其来不高不下，像物体悬空，浮钩而不失中和之气，才是其常脉，无需担忧。）脉象来如浮合，浮合如数，一息十次以上。（像浮波聚合，后浪催前浪，泛泛无常，其状像数脉但实际上并非数热之脉。）这是经气给予不足，轻微见到此脉九十日死。（初见此脉，预期在九十日而死，如果见到已久则不必九十日了，之所以在九十日者，是因为时节更替，天道变化，人气随之改变。）脉象来如火薪然，（来势如火焰锐利，去势如熄灭迅速。）这是心精给予剥夺。草干而死。（火脏无根之脉，所以说心精予夺，草干者，阳气尽之时。）脉象来如散叶，（浮泛无根，零乱不整。）这是肝气给予虚弱，木叶落而死。（金胜木败。）脉象来如省客，省客者，脉塞而鼓，（像探视之客，去来无定，有时停止，有时搏动。）这是肾气给予不足，悬去枣华而死。（悬华开去，华落，言于枣花开放凋落之时，火旺水败而死也。）脉象来如丸泥，（泥弹的形状，坚强短涩。）这是胃精给予不足，榆荚落而死。（榆钱春深而落，木旺土败也。）脉象来如横格，（长而且坚，像横木格于指下。）这是胆气给予不足，禾熟而死。（禾熟于秋，金令旺也。）脉象来如弦缕，（像弦之急，像缕之细。）这是胞精给予不足。（胞，子宫，命门元阳所聚，真元亏损也。）病善言，下霜而死。不言，可治。（善言则阴气不藏，而虚阳外见，故至下霜时虚阳消败而死矣。不言则肾气犹静，故尚可治。）脉象来如交漆，交漆者，左右旁至也。（像写漆之交，左右旁至而缠绵不清。）轻微见到三十日死。（阴阳偏败，死期已促，三十日者，月建之易也。）脉象来如涌泉，浮鼓肌中，（像泉水涌出，有升无降，而浮鼓于肌肉之中。）太阳（膀胱）气给予不足。少气味，韭英而死。（外实内虚，阴精不足，故为少气味，韭英而死者，冬尽春初水渐衰也。）脉象来如颓土之状，按之不得，（虚大无力，按之即不可得。）这是肌气给予不足。五色先见黑，白……发死。（肌气即脾气，黑色者，土败极而水反乘之也。白……发于春，木旺而土败矣。）脉象来如悬雍，悬雍者浮揣，切之益大，（喉间下垂肉乳，曰：悬雍，浮短孤悬有上无下，）这是十二俞（音输）给予不足，（俞皆在背，为十二经脏气所系。）水凝而死。（阴气盛则孤阳绝。）脉象来如偃刀，偃刀者，浮之小急，（像刀口，）按之坚大急，（像刀背，）五脏菀（郁同）热，寒热独并于肾也。（五脏郁热而发为寒热，阳旺则阴消，故独并于肾也。）像这样的人不能坐，（腰为肾之府。）立春而死。（立春阳盛，阴日以衰，故死。）脉象来如丸，（短小，）滑不直手，不直手者，按之不可得也，是大肠气给予不足。枣叶生而死。（枣叶生初夏，火旺克金，故死。）脉象来如华者，（像草木之花，轻浮柔弱。）令人善恐，不欲坐卧，行立常听，是小肠气给予不足，（小肠与心表里，故心气怯而不能宁。）季秋而死。（丙火墓于戌。）
《玉机真脏论》说：大骨枯槁，（肩垂项倾腰重膝败，肾主骨，骨枯则肾败矣。）大肉陷下，（尺肤细削，臂肉消瘦，脾主肉，肉陷则脾败矣。）胸中气满，喘息不便，其气动形，（肺主气，气满喘息，以至形体振动，则气不归原，而肺脏败矣。）预期六月死，（六月者，一岁阴阳之更变。）真脏脉见，乃给予之期日。（可因克贼之日以定其死期。）大骨枯槁，（肾）大肉陷下，（脾）胸中气满，喘息不便，（肺）内痛引肩项，（病及心经）预期一月死。（较前已甚，故期一月斗建移而死。）真脏见，乃给予之期日，大骨枯槁，（肾）大肉陷下，（脾）胸中气满，喘息不便，（肺）内痛引肩项，（心）身热脱肉破……（音郡，筋肉结聚处，盖至此而肝亦败矣。）真脏见，十日之内死。（五脏俱伤，真脏又见，故近在十日之内死。）大骨枯槁，（肾）大肉陷下，（脾）肩髓内消，（因于骨枯，）动作益衰，（因于肉陷，）真脏未见，预期一岁死，（虽诸症未全，然败竭已兆，仅支一年，岁易气新不能再振矣。）见其真脏，乃给予之期日。大骨枯槁，（肾）大肉陷下，（脾）胸中气满，（肺）腹内痛，心中不便，（心）肩项身热，破……脱肉，（肝）目匡陷，真脏见，目不见人，立死。（神气已脱，故当立死。）其见人者，至其所不胜之时则死。（神气犹存，故必待克贼之时而死。）真肝脉至，中外急如循刀刃，责责然如按琴瑟弦，色青白不泽，毛折乃死。真心脉至，坚而搏，如循薏苡子累累然，（坚强短实）色赤黑不泽，毛折乃死。真肺脉至，大而虚，如以毛羽中人，肤色白赤不泽，毛折乃死。真肾脉至，搏而绝，（甚也）如指弹石辟辟然，色黑黄……率以毛折，死
My friend, Mr. Hong Ji'an (Hong Wei), abandoned his studies for the imperial examinations and devoted himself to medicine. Within a few years, he mastered its profound principles and once showed me his manuscript *Xu Sun Qi Wei* (Opening the Subtle Aspects of Deficiency Consumption). The content is extensive, and the analysis and discussion are clear and precise, surpassing other medical texts. Some might criticize him for recording too many established prescriptions (Cheng Fang), not realizing that established prescriptions are the fundamental rules (Gui Ju) of treatment; these rules have been accumulated over ancient and modern times and cannot be easily changed. As for how to apply them flexibly depends on whether the physician can skillfully utilize their ingenuity. Mr. Ji'an's book truly provides people with the fundamental rules, rather than focusing on displaying cleverness. Mr. Ji'an was also extremely filial. His study of medicine, although initiated by his own illness, was actually aimed at treating his mother's disease. Initially, I observed him weighing medicines and measuring water with extreme precision and care, and he often discussed medicinal properties with me. Therefore, how could I dare to轻视 (disregard) what I have uniquely learned from Mr. Ji'an in the way of medicine? Moreover, how could I disregard something that others would not dare to轻视? It is a pity that after his death, most of his books were lost, and they fear that soon they will only be used by physicians as lids for wine jars. Thus, I specially recorded and preserved them.
Recorded by Luo Shan Zhang Tingmei in the mid-autumn month of Xin Si year of the Qianlong era (1761)
Lu Xuan Gong (Lu Zhi) always copied ancient prescriptions by hand when he saw them. Fan Xi Wen (Fan Zhongyan) said that if he could not serve as a good Prime Minister, he should serve as a good physician. I have suffered from Xu Lao (Deficiency Consumption) for a long time and have grown weary of literary history and medical books. Regarding the syndrome of deficiency consumption, I have particularly reflected upon it, using self-rescue to help others, following the principle that "three fractures of the arm make one a good physician." In the Ren Shen year, while attending duties in the Shanyang official residence, I took advantage of my leisure to list several sentences of my own insights item by item, accumulating them into a volume. This may also be considered a discussion of *Qi Wei*, expounding upon what ancients had not yet revealed, while the prescriptions therein still draw from ancient sources. If ancient prescriptions are unsuitable for current conditions, they are deliberated, added to, or subtracted from, and divinely clarified to preserve the intent of the ancients.
Written by the sick man Hong Wei at the Yinmo Pavilion of the Huai Residence three days after the Double Ninth Festival
The *Su Wen: Shanggu Tianzhen Lun* states: People nowadays treat wine as gruel and consider reckless behavior as normal. They engage in sexual intercourse while drunk, exhaust their essence through desires, and dissipate their true Qi. They do not know how to maintain fullness, nor how to guard their spirit. They pursue only the satisfaction of their hearts, going against the joys of life, and their daily routines lack regulation. Therefore, they age prematurely, becoming decrepit before fifty.
The *Su Wen: Benshen Pian* states: The five Zang organs store essence and must not be injured. Injury leads to loss of retention and Yin deficiency. Yin deficiency results in lack of Qi, and lack of Qi leads to death. Thus, the wise... [text missing] ...prolong life...
The *Su Wen: Shengqi Tongtian Lun* states: The key to Yin and Yang is that Yang must be dense to ensure stability. If the two are not in harmony, it is like spring without autumn or winter without summer. (Similar to the four seasons lacking..., essence...)
The *Su Wen: Xuanming Wuqi Lun* states: Prolonged viewing damages Blood; prolonged lying down damages Qi; prolonged sitting damages flesh; prolonged standing damages bones; prolonged walking damages sinews.
The *Su Wen: Bilun* states: When Yin Qi is quiet, the Spirit is stored within; when agitated, the Spirit dissipates.
The *Su Wen: Wulong Jin Ye Bie Pian* states: When Yin and Yang are not in harmony, fluids overflow and flow downward into the Yin orifices. Marrow fluid decreases and flows downward; excessive loss leads to deficiency, causing back pain and soreness in the shins. (When Yin and Yang are not in harmony, Essence and Qi become chaotic and fail to control each other, leading to fluid overflow downward and leakage through the Yin orifices. This causes daily depletion of True Yin, resulting in lower back pain and shin soreness, which marks the onset of Lao Zhai [Consumption].)
The *Su Wen: Tiaojing Lun* states: Yang deficiency leads to external cold; Yin deficiency leads to internal heat.
The *Su Wen: Weiqi Pian* states: Deficiency in the lower part leads to Jue (reversal cold); deficiency in the upper part leads to dizziness.
The *Su Wen: Tongping Xushi Lun* states: What is called Qi deficiency manifests as irregular speech. (Speech cannot continue.) A weak Chi pulse indicates weakness in the lower body. (Kuang, meaning timid and weak. A weak Chi pulse indicates lower deficiency.) A deficient pulse does not resemble Yin. (The Cun Kou pulse alone governs the five Zang organs, belonging to Yin and residing internally. Now, the pulse is hollow in the middle and does not resemble Yin.) In such cases, a slippery pulse indicates survival, while a choppy pulse indicates death.
The *Su Wen: Zangqi Fashi Lun* states: Liver deficiency causes vision problems... (Huang, meaning unclear/blurred) where one cannot see, and hearing loss. (The Gallbladder meridian enters the ear from behind the ear.) There is frequent fear... and pain. (The Heart governs Blood. Blood deficiency fails to nourish sinews and vessels. The chest, abdomen, waist, and hypochondrium are areas reached by the Hand Shaoyin and Jueyin meridians, so pathology manifests here.) Spleen deficiency causes abdominal fullness, borborygmus, and undigested stool diarrhea (Sun), with food not transforming. Lung deficiency causes shortness of breath and difficulty in completing inhalation/exhalation. Deafness occurs because collaterals meet in the ear. Dry throat occurs because the meridian circulates along the throat. Kidney deficiency causes chest pain, and pain in the large and small abdomen. (The Kidney meridian ascends alongside the umbilicus, emerges from the Lung, connects with the Heart, and pours into the chest.) Cold extremities occur because Essence fails to transform into Qi. Unhappiness occurs because Heart and Kidney do not interact, leading to stagnation in the Danzhong.
The *Su Wen: Kouwen Pian* states: Insufficiency of Upper Qi leads to a feeling of emptiness in the brain, painful tinnitus, painful tilting of the head, and dizziness. Insufficiency of Middle Qi leads to urinary and fecal... (Music has the same meaning, likely a textual error or variant referring to bowel/bladder dysfunction).
The *Su Wen: Maiyao Jingwei Lun* states: Speaking in a low voice and only speaking again after a whole day indicates Loss of Qi. (Loss of Lung organ function.) Inability to dress oneself properly and confused speech indicate... (Loss of Spleen organ function.) Incontinence indicates the Bladder's failure to store. (Loss of Kidney organ function.) Those who retain function live; those who lose function die. The five Zang organs are the strength of the body. The head is the palace of clarity. (Essence and Qi of the five Zang and six Fu organs all ascend to the head.) A drooping head and deep-set eyes indicate that Spirit is about to be exhausted. The back is the mansion of the chest. (The back is where the Shu points of the organs are located.) Curvature of the back and drooping shoulders indicate that Fu Qi is about to deteriorate. The waist is the mansion of the Kidney. Inability to turn or sway indicates that the Kidney is about to fail. The knees are the mansion of sinews. Inability to flex and extend, and stooping while walking, indicate that sinews are about to fail. Bones are the mansion of marrow. Inability to stand for long periods and trembling while walking indicate that bones are about to fail.
The *Ling Shu: Jingmai Pian* states: When Qi of the Hand Taiyin (Lung) ceases, skin and hair become dry. The Taiyin meridian distributes Qi to moisten the skin and hair. Thus, if Qi fails to nourish, skin and hair become dry; if skin and hair become dry, body fluids leave the joints; if body fluids leave the joints, nails wither and hair breaks. Hair breaking indicates that hair dies first. Bing days worsen, Ding days bring death, as Fire conquers Metal. When Qi of the Hand Shaoyin (Heart) ceases, vessels are blocked. Blocked vessels mean blood does not flow. Non-flowing blood means hair and complexion lose luster. Thus, a face black as lacquered charcoal indicates that Blood dies first. Ren days worsen, Gui days bring death, as Water conquers Fire. When Qi of the Foot Taiyin (Spleen) ceases, vessels fail to nourish muscle. Lips and tongue are the root of muscle. Vessels failing to nourish lead to soft muscle; soft muscle leads to flaccid tongue, fullness in the philtrum, and everted lips. Everted lips indicate that flesh dies first. Jia days worsen, Yi days bring death, as Wood conquers Earth. When Qi of the Foot Shaoyin (Kidney) ceases, bones wither. Shaoyin is the Winter pulse, hidden and moistening the marrow. Thus, if bones are not moistened, flesh cannot adhere. If flesh and bone are not intimate, flesh becomes soft and recedes. Receding flesh makes teeth appear long and dirty, and hair loses luster. Loss of hair luster indicates that bone dies first. Wu days worsen, Ji days bring death, as Earth conquers Water. When Qi of the Foot Jueyin (Liver) ceases, sinews sever. Jueyin is the Liver pulse. The Liver harmonizes with sinews. Sinews gather at the genitalia and connect to the base of the tongue. Thus, vessels failing to nourish lead to spastic sinews. Spastic sinews pull the tongue and testicles. Cyan lips, curled tongue, and retracted testicles indicate that sinews die first. Geng days worsen, Xin days bring death, as Metal conquers Wood. When all five Yin Qi cease, the eye system twists, causing vertigo. (Essence of the five Zang organs all ascend to the eyes.) Vertigo indicates that Zhi (Will) dies first. (Zhi resides in the Kidney and is the Spirit of Yin.) Death follows Zhi death by one and a half days. When all six Yang Qi cease, Yin and Yang separate. Separation leads to sweating through the pores and exit of absolute sweat. Thus, prognosis in the morning predicts death in the evening, and vice versa.
The *Su Wen: Fang Sheng Shuai Lun* states: Extreme Yin deficiency leads to cessation of Heaven Qi. (Yin deficiency prevents ascent; lack of ascent leads to cessation of Heaven Qi and failure to descend.) Extreme Yang excess leads to... (Yang hyperactivity prevents descent; lack of descent leads to insufficiency of Earth Qi and failure to ascend.) Weak form and deficient Qi lead to death. Excess form and Qi but deficient Pulse Qi lead to death. (Zang Qi fails first.) Excess Pulse Qi but deficient form and Qi allow for survival.
The *Su Wen: Sanbu Jiuhou Lun* states: When the five Zang organs have failed, the complexion must be premature and dull. Dullness inevitably leads to death. Robust form with fine pulse, shortness of breath, and insufficient Qi indicate danger. (Apparent excess externally but internal insufficiency; branches are lush but roots are damaged.) Emaciated form with large pulse and excessive Qi in the chest indicates death. (Yin Qi has failed, leaving solitary Yang.) Emaciated flesh and bones with even regulated nine-pulse readings indicate death. (Spleen Qi has collapsed.)
The *Su Wen: Pingren Qixiang Lun* states: Prominent blue veins on the arms indicate Blood loss. Slow and choppy Chi pulse indicates Jie Yi (exhaustion/weakness). Resting with a rapid pulse indicates Blood loss. (Pathogenic excess usually causes restlessness; a rapid pulse with calm resting indicates Yin deficiency and Blood loss rather than Yang pathogen. Yi refers to the Chi pulse.) Choppy Chi pulse with slippery overall pulse indicates profuse sweating. (Choppy Chi skin indicates deficient Ying Blood; slippery Chi pulse indicates flourishing Yin Fire. Yang excess and Yin deficiency cause sweating.) Cold Chi skin with fine pulse indicates delayed diarrhea. (Cold Chi skin indicates declining Spleen Yang; fine Chi pulse indicates declining Kidney Yang. Spleen-Kidney deficiency-cold causes diarrhea.) Rough and constantly hot Chi pulse indicates Re Zhong (Internal Heat). (Rough Chi indicates insufficient True Yin; constant heat indicates surplus Yin Fire, thus Internal Heat.)
The *Su Wen: Lunji Zhouchi Pian* states: Weak flesh at the Chi position indicates Jie Yi and desire to lie down. (Weak Chi flesh implies emaciation; emaciation indicates Yin deficiency, hence Jie Yi and desire to rest.) Emaciation indicates untreatable chills and fever. (If emaciation occurs, chills and fever arise, indicating collapse of True Yin.) Burning heat at the Chi position with a large Renying pulse indicates Blood loss. (Hot Chi skin indicates Fire in Yin; large Renying indicates Yang excess, thus Blood loss.) Hard and large Chi with very small pulse, shortness of breath, and increasing irritability indicate immediate death. (Hard/large Chi with very small pulse indicates decline of True Qi and extreme Yin deficiency, leading to immediate death. Men, meaning irritability.)
The *Su Wen: Xieqi Zangfu Bingxing Pian* states: All small pulses indicate insufficiency of Yin-Yang, Form, and Qi. Do not use needles; regulate with sweet herbs.
The *Su Wen: Daqi Lun* states: A pulsating pulse with epistaxis and fever indicates death. (Pulsating pulse indicates strong Yin deficiency, worst with blood loss. Strong pulse with fever indicates... [missing text]). A hanging hook floating pulse is a normal pulse. (Pulsating is taboo, but Yin deficiency often presents with floating/large pulses. If the pulse comes neither high nor low, suspended like an object, floating and hooked without losing neutral Qi, it is normal and not worrying.) A floating combined pulse, resembling a rapid pulse with more than ten beats per breath, indicates insufficiency of Jing Qi. Mild appearance predicts death in 90 days. (First appearance predicts death in 90 days; if seen for a long time, death is sooner. The 90-day period accounts for seasonal changes affecting human Qi.) A pulse like burning firewood indicates depletion of Heart Essence. Death occurs when grass dries. (Rootless pulse of the Fire organ; grass drying signifies end of Yang.) A pulse like scattered leaves indicates insufficiency of Liver Qi. Death occurs when tree leaves fall. (Metal conquers Wood.) A pulse like a visiting scholar (Sheng Ke), obstructed yet beating, indicates insufficiency of Kidney Qi. Death occurs when jujube flowers fall. (Jujube flowers bloom and fall; Fire flourishes, Water fails, leading to death.) A pulse like a mud pellet, hard and short/choppy, indicates insufficiency of Stomach Essence. Death occurs when elm seeds fall. (Elm seeds fall in late spring; Wood flourishes, Earth fails.) A pulse like a horizontal bar, long and hard, indicates insufficiency of Gallbladder Qi. Death occurs when grain ripens. (Grain ripens in Autumn; Metal command flourishes.) A pulse like a string or thread, tight and thin, indicates insufficiency of Bao (Uterus) Essence. (Bao is the uterus, gathering Yuan Yang of Mingmen; True Yuan is depleted.) Frequent talking predicts death at frost; silence is treatable. (Talking indicates Yin fails to store and Deficient Yang floats outward, dying when frost falls. Silence indicates Kidney Qi remains quiet, thus treatable.) A pulse like intersecting lacquer, flowing sideways and entangled, indicates mild appearance predicts death in 30 days. (Yin-Yang partial failure accelerates death; 30 days corresponds to lunar cycle changes.) A pulse like a gushing spring, floating and beating in muscles, indicates insufficiency of Taiyang (Bladder) Qi. Lack of smell/presence predicts death when leek shoots appear. (Exterior excess, interior deficiency, insufficient Yin Essence. Leek shoots mark end of winter/beginning of spring when Water declines.) A pulse like collapsing earth, unpressable, indicates insufficiency of Muscle Qi. Black color appearing first predicts death when white... appears. (Muscle Qi is Spleen Qi; black indicates Earth failure extreme and Water counter-attacking. White... in Spring indicates Wood flourishes, Earth fails.) A pulse like a uvula, floating and tender, pressing makes it larger, indicates insufficiency of Twelve Shu points. (Shu points are on the back, connecting twelve meridians and Zang-Fu Qi.) Death occurs when water freezes. (Yin excess leads to isolation of solitary Yang.) A pulse like an inverted knife, superficially small/urgent, deeply hard/large/urgent, indicates Five Zang depression-heat and Chills/Fever solely combining with the Kidney. (Five Zang depression-heat causes chills/fever; Yang flourishes, Yin declines, combining with Kidney.) Such persons cannot sit. Death occurs at Lichun. (Waist is Kidney mansion. Lichun brings Yang excess, Yin declines, leading to death.) A pulse like a pill, small, slippery but not direct under hand, indicates insufficiency of Large Intestine Qi. Death occurs when jujube leaves grow. (Jujube leaves grow in early summer; Fire flourishes, conquering Metal.) A pulse like flowers, light, floating, and weak, causes fear, aversion to sitting/lying, and listening while standing/walking, indicates insufficiency of Small Intestine Qi. (Small Intestine is exterior-interior with Heart; Heart Qi is timid and unable to settle.) Death occurs in late Autumn. (Bing Fire tomb in Xu.)
The *Su Wen: Yuji Zhenzang Lun* states: Withering of large bones (shoulder drooping, neck tilting, heavy waist, failing knees; Kidney governs bones, withering bones indicate Kidney failure). Collapsing of large flesh (thin Chi skin, emaciated arm flesh; Spleen governs flesh, collapsing flesh indicates Spleen failure). Fullness in chest, difficult breathing, movement causing body vibration (Lung governs Qi; fullness/vibration indicates Qi fails to return to origin, Lung failure). Death expected in six months. (Six months represent annual Yin-Yang transition.) Appearance of Zhen Zang (True Organ) pulse allows prediction of death date based on conquering days. Withering bones, collapsing flesh, chest fullness, difficult breathing, internal pain radiating to shoulder/neck (pathology reaches Heart meridian). Death expected in one month. (More severe than before, death coincides with solar term shift.) Appearance of Zhen Zang pulse allows prediction. Withering bones, collapsing flesh, chest fullness, difficult breathing, internal pain radiating to shoulder/neck, body heat, emaciation, and broken flesh (Jun, junction of muscle/flesh, indicating Liver failure). Appearance of Zhen Zang pulse predicts death within ten days. (Five Zang injured, Zhen Zang pulse appears, death imminent.) Withering bones, collapsing flesh, internal dissipation of shoulder marrow (due to bone withering), worsening movement (due to flesh collapse), no Zhen Zang pulse yet. Death expected in one year. (Symptoms incomplete, but collapse signaled; lasts one year, new year energy cannot revive.) Appearance of Zhen Zang pulse allows prediction. Withering bones, collapsing flesh, chest fullness, abdominal pain, heart discomfort, shoulder/neck/body heat, broken flesh/emaciation, sunken eye sockets, Zhen Zang pulse appears, blindness. Immediate death. (Spirit Qi has detached.) If consciousness remains, death occurs at the time of the conquering element. (Spirit Qi remains, waiting for conquering time.) True Liver pulse: tense inside and out like touching a blade, buzzing like plucking a zither string, cyan-white dull complexion, hair breaking precedes death. True Heart pulse: hard and pulsating like rolling coix seeds, red-black dull complexion, hair breaking precedes death. True Lung pulse: large and empty, like feathers hitting a person, white-red dull complexion, hair breaking precedes death. True Kidney pulse: pounding and abrupt, like fingers snapping stones, black-yellow... generally with hair breaking, death ensues.