八味肾气九方（见妇人杂病中）
虚劳虚烦不得眠，酸枣汤主之。
【注】因虚劳而烦，是虚烦也。因虚烦而不得眠，是虚烦不得眠也。故主以酸枣仁汤，
专治虚烦，烦去则得眠也。
【集注】李 曰∶虚烦不得眠者，血虚生内热，而阴气不敛也。《内经》云∶气行于阳，
阳气满，不得入于阴，阴气虚，故目不得瞑。酸枣汤养血虚而敛阴气也。
酸枣汤方
酸枣仁（二升） 甘草（一两） 知母（二两） 茯苓（二两） 芎 （二两）
上五味，以水八升，煮酸枣仁，得六升，内诸药，煮取三升，分温三服。
五劳极虚，羸瘦腹满，不能饮食。食伤、忧伤、饮伤、房室伤、饥伤、劳伤、经络营
卫气伤，内有干血，肌肤甲错，两目黯黑，缓中补虚，大黄 虫丸主之。
【按】“缓中补虚”四字，当在“不能饮食”之下，必是传写之讹。
【注】五劳所伤，久之令人极虚羸瘦，腹中虚满，不能饮食，宜缓中补虚，如前之建
中等方也。原其所伤之道，不止过劳伤气，房室伤精也，即饮食伤胃，饥过伤脾，渴过伤
肾，忧思伤心，罢极伤肝，过言伤肺，皆令人经络营卫气伤，是以劳热煎熬，内有干血，
故肌肤不润，甲错如鳞也。两目不荣，黯黑不明也。似此干血之证，非缓中补虚之剂所
能治，故主以大黄 虫丸，攻热下血，俾瘀积去而虚劳可复也。
【集注】程林曰∶此条单指内有干血而言。夫人或因七情，或因饮食，或因房劳，皆令
正气内伤，血脉凝积，致有干血积于中，而 羸见于外也。血积则不能以濡肌肤，故肌
肤甲错；不能营于目，则两目黯黑。与大黄魔虫丸以下干血，则邪除正王矣，非大黄
虫丸能缓中补虚也。
尤怡曰∶内有干血不去，适足以留新血而渗灌不周，故去之不可不早也。此方润以
濡其干，虫以动其瘀，通以去其闭，而以地黄、芍药、甘草和养其虚，攻血而仍滋夫血
也。
大黄 虫丸方
大黄（蒸，十分） 黄芩（二两） 甘草（三两） 桃仁（一升） 杏仁（一升） 芍药（四
两） 干漆（一两） 虻虫（一升） 水蛭（百枚） 虫（半升） 蛴螬（一升） 干地黄
（十两）
上十二味，末之，炼蜜为丸，小豆大，酒饮服五丸，日三服。
虚劳诸不足，风气百疾，薯蓣丸方主之。
【注】虚劳诸不足者，谓五劳。诸虚、百损也。上条以热伤干血为言，此条以风气百
疾立论。热伤其上之血分，则病肺痈；热伤其下之血分，则病干血。风中其外之气分，则病肺痿；风中
其内之气分，则病百疾。主之以薯蓣丸，散诸风邪，补诸不足，滋诸枯槁，调诸荣卫，故其药温润共
剂，补散同方也。
【集注】徐彬曰∶虚劳不足证，多有兼风者，正不可着急治风气，故仲景以四君、四
物，养其气血；麦冬、阿胶、干姜、大枣，补其肺胃；而以桔梗、杏仁、开提肺气；桂枝
行阳；防风运牌；神曲开郁；黄卷宣肾；柴胡升少阳之气；白蔹化入营之风。虽有风气
未尝专治之，谓正气运而风气自去也。然以薯蓣名丸者，取其不寒不热，不燥不滑，脾
肾兼宜，故多用以为君，则诸药相助以为理耳。
薯蓣丸方
薯蓣（三十分） 当归 桂枝 曲 干地黄 豆黄卷（各十分） 甘草（二十八分） 人参（
七分）
芎 芍药 白术 麦门冬 杏仁（各六分） 柴胡 桔梗 茯苓（各五分） 阿胶（七分） 干姜（三
分） 白 （二分） 防风（六分） 大枣（为膏，百枚）
上二十一味，末之，炼蜜和丸，如弹子大，空腹酒服一丸，一百丸为剂。
八味肾气丸方（见妇人杂病篇中）
虚劳病出现心中空虚烦乱、无法入睡的症状，用酸枣仁汤主治。
【注】因为虚劳而导致心烦，这就是“虚烦”。因为虚烦而导致无法入睡，这就是“虚烦不得眠”。所以用酸枣仁汤为主治方剂，专门治疗虚烦，心烦去除后就能入睡了。
【集注】李氏说：所谓虚烦不得眠，是因为血虚产生内热，导致阴气不能收敛。《内经》说：阳气运行于阳分，如果阳气满盛，就不能进入阴分；阴气虚弱，所以眼睛不能闭合睡眠。酸枣仁汤能养血虚并收敛阴气。
酸枣仁汤方
酸枣仁（二升） 甘草（一两） 知母（二两） 茯苓（二两） 川芎（二两）
以上五味药，用水八升，先煮酸枣仁，煮取六升，再加入其他药物，煮取三升，分三次温服。
五种劳伤导致极度虚弱，身体消瘦、腹部胀满，不能进食。饮食所伤、忧思所伤、饮酒所伤、房事所伤、饥饿所伤、劳累所伤，以及经络营卫之气受损，体内有干结之血（瘀血），皮肤粗糙如鳞甲交错，两眼暗黑，应当缓中补虚，用大黄䗪虫丸主治。
【按语】“缓中补虚”这四个字，应当放在“不能饮食”之下，这一定是传抄过程中的错误。
【注】五劳所伤，时间久了使人极度虚弱、身体消瘦，腹中虚满，不能饮食，应当缓中补虚，像前面提到的建中等方剂一样。追溯其受伤的原因，不仅仅是过劳伤气、房事伤精，还有饮食伤胃，过度饥饿伤脾，过度口渴伤肾，忧思伤心，极度疲劳伤肝，说话过多伤肺，这些都会导致经络营卫之气受损。因此劳热煎熬，体内形成干血，所以皮肤不润泽，像鳞甲一样交错。两眼得不到血液濡养，显得暗黑不明。像这种干血的证候，不是缓中补虚的药剂所能治疗的，所以用大黄䗪虫丸，攻逐热邪、下泄瘀血，使瘀积去除而虚劳得以恢复。
【集注】程林说：这一条单指体内有干血而言。人或许因为七情，或许因为饮食，或许因为房劳，都会导致正气内伤，血脉凝滞积聚，致使干血积于体内，而消瘦表现在外。血积则不能濡润肌肤，所以皮肤粗糙如鳞甲交错；不能滋养双目，则两眼暗黑。给予大黄䗪虫丸以攻下干血，那么邪气去除正气就会旺盛，并不是大黄䗪虫丸本身能缓中补虚。
尤怡说：体内的干血如果不除去，只足以阻碍新血的生成和输布不周，所以去除它不可不早。这个方子用滋润的药物来濡养干燥，用虫类药来松动瘀血，用通利药来去除闭塞，并用地黄、芍药、甘草来调和滋养其虚损，在攻逐瘀血的同时仍然滋补血液。
大黄䗪虫丸方
大黄（蒸，十分） 黄芩（二两） 甘草（三两） 桃仁（一升） 杏仁（一升） 芍药（四两） 干漆（一两） 虻虫（一升） 水蛭（百枚） 䗪虫（半升） 蛴螬（一升） 干地黄（十两）
以上十二味药，研成粉末，用炼蜜制成丸药，大小如小豆，用酒送服五丸，每天服三次。
虚劳病各种不足，兼受风邪引发多种疾病，用薯蓣丸方主治。
【注】所谓虚劳诸不足，是指五劳、各种虚损、百种损伤。上一条论述的是热邪损伤干血，这一条论述的是风邪引发的多种疾病。热邪损伤上部的血分，则病发为肺痈；热邪损伤下部的血分，则病发为干血。风邪侵袭外部的氣分，则病发为肺痿；风邪侵袭内部的氣分，则病发为百疾。用薯蓣丸为主治方剂，疏散各种风邪，补益各种不足，滋润各种枯槁，调理各种营卫，所以该方药物温润共剂，补益与发散同方使用。
【集注】徐彬说：虚劳不足的证候，多兼有风邪，正不可以着急治疗风邪，所以张仲景用四君子汤、四物汤，来养护气血；用麦冬、阿胶、干姜、大枣，来补益肺胃；并用桔梗、杏仁，开提肺气；桂枝行阳；防风运脾；神曲开郁；黄卷宣通肾气；柴胡升发少阳之气；白蔹化解入营的风邪。虽然存在风邪却并不专门治疗它，认为正气运转起来风邪自然就会去除。然而用薯蓣命名丸药，是取其性质不寒不热、不燥不滑，适宜脾肾，所以多用它作为君药，其他药物辅助以此调理罢了。
薯蓣丸方
薯蓣（三十分） 当归 桂枝 神曲 干地黄 豆黄卷（各十分） 甘草（二十八分） 人参（七分）
川芎 芍药 白术 麦门冬 杏仁（各六分） 柴胡 桔梗 茯苓（各五分） 阿胶（七分） 干姜（三分） 白蔹（二分） 防风（六分） 大枣（制成膏状，一百枚）
以上二十一味药，研成粉末，用炼蜜调和制成丸药，大小如弹子，空腹时用酒送服一丸，一百丸为一个疗程剂量。
Ba Wei Shen Qi Wan formula (see in the chapter on miscellaneous diseases of women)
In deficiency consumption (Xu Lao), characterized by empty vexation and insomnia, Suan Zao Ren Tang (Sour Jujube Decoction) is the primary treatment.
[Annotation] Vexation caused by deficiency consumption is termed "empty vexation" (Xu Fan). Empty vexation leading to inability to sleep is termed "empty vexation with insomnia." Therefore, Suan Zao Ren Tang is used as the principal formula to specifically treat empty vexation; once the vexation subsides, sleep can be attained.
[Collected Annotations] Li stated: Regarding empty vexation with insomnia, it arises from blood deficiency generating internal heat, causing Yin qi to fail to consolidate. The *Nei Jing* (Inner Canon) states: When Qi circulates in the Yang aspect, if Yang qi is excessive, it cannot enter Yin; if Yin qi is deficient, the eyes cannot close for sleep. Suan Zao Ren Tang nourishes blood deficiency and consolidates Yin qi.
Formula for Suan Zao Ren Tang
Suan Zao Ren (Ziziphi Spinosae Semen, two sheng) Gan Cao (Glycyrrhizae Radix et Rhizoma, one liang) Zhi Mu (Anemarrhenae Rhizoma, two liang) Fu Ling (Poria, two liang) Xiong (Chuanxiong Rhizoma, two liang)
The above five herbs are boiled in eight sheng of water. First boil Suan Zao Ren until six sheng remain, then add the remaining herbs and boil until three sheng are obtained. Divide into three doses and take warm.
When the five types of labor injuries lead to extreme deficiency, emaciation, abdominal fullness, and inability to eat, due to injuries from diet, sorrow/worry, drinking, sexual activity, hunger, overwork, and damage to the meridians, Ying, and Wei qi, resulting in dry blood (stagnant blood) internally, rough skin resembling scales (jiacuo), and dark eyes, the method should be to moderate the middle and tonify deficiency. Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) is the primary treatment.
[Note] The phrase "moderate the middle and tonify deficiency" should logically follow "inability to eat"; its current position is likely a transcription error.
[Annotation] Injuries from the five labors, over time, cause extreme deficiency and emaciation, with false fullness in the abdomen and inability to eat. One should moderate the middle and tonify deficiency, similar to formulas like Jian Zhong mentioned earlier. Tracing the causes of injury, it is not merely overwork damaging Qi or sexual activity damaging Essence. Diet damages the Stomach, excessive hunger damages the Spleen, excessive thirst damages the Kidney, worry and thought damage the Heart, extreme fatigue damages the Liver, and excessive speech damages the Lung. All these damage the Qi of the meridians, Ying, and Wei. Consequently, labor-heat cauterizes, forming dry blood internally. Thus, the skin lacks moisture and becomes rough like scales. The eyes lack nourishment, appearing dark and unclear. Such conditions of dry blood cannot be treated by formulas that only moderate the middle and tonify deficiency. Therefore, Da Huang Zhe Chong Wan is used to attack heat and purge blood stasis, allowing the removal of stagnant accumulation so that deficiency consumption may recover.
[Collected Annotations] Cheng Lin said: This clause refers solely to the presence of dry blood internally. Whether due to seven emotions, diet, or sexual excess, all can damage internal righteous Qi, causing blood vessels to coagulate and accumulate, leading to dry blood stagnating inside while emaciation manifests outside. Blood stagnation fails to moisten the skin, hence the rough, scaly skin; it fails to nourish the eyes, hence the dark eyes. Administering Da Huang Zhe Chong Wan to purge the dry blood removes the pathogen and allows Zheng Qi (Righteous Qi) to flourish; it is not that Da Huang Zhe Chong Wan itself moderates the middle and tonifies deficiency.
You Yi said: If dry blood remains inside, it merely obstructs the generation of new blood and hinders proper circulation, so removing it must not be delayed. This formula uses moistening agents to hydrate dryness, insect drugs to mobilize stasis, and unblocking agents to remove obstruction, while using Di Huang, Shao Yao, and Gan Cao to harmonize and nourish the deficiency. It attacks blood stasis while simultaneously nourishing blood.
Formula for Da Huang Zhe Chong Wan
Da Huang (Rhei Radix et Rhizoma, steamed, ten fen) Huang Qin (Scutellariae Radix, two liang) Gan Cao (Glycyrrhizae Radix et Rhizoma, three liang) Tao Ren (Persicae Semen, one sheng) Xing Ren (Armeniacae Semen Amarum, one sheng) Shao Yao (Paeoniae Radix Alba, four liang) Gan Qi (Lacquer, one liang) Meng Chong (Blattidae, one sheng) Shui Zhi (Hirudo, one hundred pieces) Zhe Chong (Eupolyphaga, half sheng) Qi Luo (Silphioda Larva, one sheng) Gan Di Huang (Rehmanniae Radix Preparata, ten liang)
The above twelve herbs are powdered, mixed with refined honey to form pills the size of small beans. Take five pills with wine, three times daily.
For deficiency consumption with various deficiencies, accompanied by wind pathogens causing myriad illnesses, Shu Yu Wan (Dioscorea Pill) is the primary treatment.
[Annotation] "Various deficiencies in deficiency consumption" refers to the five labors, various deficiencies, and hundred injuries. The previous clause discussed heat injuring dry blood; this clause discusses wind pathogens causing myriad illnesses. Heat injuring the upper blood level leads to lung abscess (Fei Yong); heat injuring the lower blood level leads to dry blood. Wind invading the external Qi level leads to lung flaccidity (Fei Wei); wind invading the internal Qi level leads to myriad illnesses. Shu Yu Wan is used to disperse various wind pathogens, tonify various deficiencies, moisturize various withered states, and regulate various Ying and Wei. Thus, the herbs are warming and moistening together, combining tonification and dispersion in one formula.
[Collected Annotations] Xu Bin said: Deficiency consumption cases often accompany wind pathogens. One must not rush to treat the wind directly. Therefore, Zhang Zhongjing uses Si Jun Zi Tang and Si Wu Tang to nourish Qi and Blood; Mai Dong, E Jiao, Gan Jiang, and Da Zao to tonify Lung and Stomach; Jie Geng and Xing Ren to lift Lung Qi; Gui Zhi to move Yang; Fang Feng to transport Spleen; Shen Qu to resolve stagnation; Huang Juan to vent Kidney Qi; Chai Hu to ascend Shaoyang Qi; Bai Lian to transform wind entering Ying. Although wind pathogens exist, they are not specifically treated, under the premise that when Righteous Qi moves, wind pathogens naturally depart. However, naming the pill after Shu Yu (Dioscorea) is because it is neither cold nor hot, neither drying nor slippery, suitable for both Spleen and Kidney. Thus, it is used in large amounts as the sovereign herb, with other herbs assisting in regulation.
Formula for Shu Yu Wan
Shu Yu (Dioscoreae Rhizoma, thirty fen) Dang Gui (Angelicae Sinensis Radix) Gui Zhi (Cinnamomi Ramulus) Qu (Medicated Leaven) Gan Di Huang (Rehmanniae Radix Preparata) Dou Huang Juan (Sojae Semen Praeparatum) (each ten fen) Gan Cao (Glycyrrhizae Radix et Rhizoma, twenty-eight fen) Ren Shen (Ginseng Radix, seven fen)
Xiong (Chuanxiong Rhizoma) Shao Yao (Paeoniae Radix Alba) Bai Zhu (Atractylodis Macrocephalae Rhizoma) Mai Men Dong (Ophiopogonis Radix) Xing Ren (Armeniacae Semen Amarum) (each six fen) Chai Hu (Bupleuri Radix) Jie Geng (Platycodonis Radix) Fu Ling (Poria, each five fen) E Jiao (Colla Corii Asini, seven fen) Gan Jiang (Zingiberis Rhizoma, three fen) Bai Lian (Ibicis Folium, two fen) Fang Feng (Saposhnikoviae Radix, six fen) Da Zao (Jujubae Fructus, made into paste, one hundred pieces)
The above twenty-one herbs are powdered, mixed with refined honey to form pills the size of quail eggs. Take one pill with wine on an empty stomach. A course consists of one hundred pills.