《素问》云∶脉虚、气虚、尺虚，是谓重虚。所谓气虚者，言无常也；尺虚者，
行步 然；脉虚者，不象阴也。又云∶脉细，皮寒，气少，泄利前后，饮食不入，
是谓五虚。五虚死，浆粥入胃泄注止，则虚可活。治用黄 建中汤、理中汤之类。
此《素问》但言虚而无劳瘵之名，然其因则固屡言之矣。凡外感六淫，内伤七情，
其邪展转乘于五脏，遂至大骨枯槁，大肉陷下，各见所合衰惫之证，真脏脉见则有
死期。又如二阳之病，则传为风消、息贲。三阳之病，传为索泽，瘅成为消中。大
肠移热于胃，胃移热于胆，则皆善食而瘦。尝贵后贱，病从内生，名曰脱营。尝富
后贫，名曰失精。暴乐暴喜，始乐后苦，皆伤精气。精气竭绝，形体毁沮，离
绝菀结，喜怒忧恐，五脏空虚，血气离守。《灵枢》曰∶怵惕思虑则伤神，神伤则恐
惧自失，破 脱肉，毛瘁色夭，死于冬。又诸热病在肤肉脉筋骨之间者，各客于所
合之本脏不得，客于所不胜。及考医和视晋平公之疾曰∶是近女室晦，女阳物
而晦时，淫则生内热或蛊之疾，非鬼非食，疾不可为也。至汉张仲景《金匮要
略》明立虚劳门，于是巢元方撰《病源候论》遂有虚劳，有蒸病，有注病，皆由此
而推之者也。虚劳者，五劳、六极、七伤是也。五劳者，志劳、思劳、心劳、忧劳、
瘦劳。六极者，气极、血极、筋极、骨极、肌极、精极。七伤者，曰阴寒、曰阴痿、
曰里急、曰精连连，曰精少、阴下湿、曰精清、曰小便苦数，临事不举。又曰∶大饱
伤脾，大怒气逆伤肝，强力举重、久坐湿地伤肾，形寒饮冷伤肺，忧愁
思虑伤心，风雨寒暑伤形，大恐惧不节伤志。蒸有五，骨蒸、脉蒸、皮蒸、肉蒸、
内蒸。又有二十三蒸，胞、玉房、脑、髓、骨、血、脉、肝、心、脾、肺、肾、膀
胱、胆、胃、三焦、小肠、肉、肤、皮、气各有一蒸，其状遍身发热，多因热病愈
后，食牛肉，或饮酒，或房欲而成注者。注之为言住也，邪气居人身内，生既连滞
停住，死又注易傍人也，即所谓传尸。已别立门外。今以虚劳骨蒸合为一门，而列
古明医治法于后。《金匮》云∶五劳虚极羸瘦，腹满不能饮食，食伤，忧伤，饮伤，
房室伤，饥伤，劳伤，经络荣卫气伤，内有干血，肌肤甲错，两目黯黑，缓中补
虚，大黄 虫丸主之。按虚劳发热，未有不由瘀血者，而瘀血未有不由内伤者，
人之饮食起居，一失其节，皆能成伤，此亦可以睹矣。故以润剂治干，以蠕动HT
血之物行死血，死血既去，病根已划，而后可从事乎滋补之剂，仲景为万古医方
之祖，有以哉。又有陈大夫传仲景百劳丸，可与 虫丸互用。《活法机要》云∶虚
损之疾，寒热因虚而感也。感寒则损阳，阳虚则阴盛，故损则自上而下，治之宜
以辛甘淡，过于胃则不可治也。感热则损阴，阴虚则阳盛，故损则自下而上，治
之宜以苦酸咸，过于脾则不可治也。自上而损者，一损损于肺，故皮聚而毛落。
二损损于心，故血脉虚弱，不能荣于脏腑，妇人则月水不通。三损损于胃，故饮
食不为肌肤也。自下而损者，一损损于肾，故骨痿不起于床。二损损于肝，故筋
缓不能自收持。三损损于脾，故饮食不能消克也。故心肺损则色弊，肝肾损则形
痿，脾胃损则谷不化也。治肺损皮聚而毛落，宜益气，四君子汤。治心肺虚损，
皮聚毛落，血脉虚耗，妇人月水愆期，宜益气和血，八物汤。治心肺损及胃，损
饮食，不为肌肤，宜益气和血，调饮食，十全散。治肾损，骨痿不能起于床，宜
益精补肾，金刚丸。治肾肝损，骨痿不能起于床，宜益精。筋缓不能自收时，宜
缓中牛膝丸。治肝肾损及脾，食谷不化，宜益精缓中消谷，煨肾丸。如阳盛阴虚，
肝肾不足，房室虚损，形瘦无力，面多青黄而无常色，宜荣血养肾，地黄丸。如
阳盛阴虚，心肺不足，及男子妇人面无血色，食少嗜卧，肢体困倦，宜八味丸。
如形体瘦弱，无力多困，未知阴阳先损，夏月宜地黄丸，春秋宜肾气丸，冬月宜八
味丸。病久虚弱，厌厌不能食，和中丸。肝劳，尽力谋虑而成。虚寒则口苦骨疼，
筋挛烦闷，宜续断汤，灸肝俞。实热则关格牢涩不通，眼目赤涩，烦闷热壅，毛悴
色夭，宜羚羊角散。心劳，曲运神机而成。虚寒则惊悸恍惚，神志不定，宜远志饮
子、酸枣仁汤。实热则口舌生疮，大小便秘涩，宜黄芩汤。脾劳，意外致思而成。
虚寒则气胀咽满，食不下，噫气，宜白术汤、生嘉禾散、大建脾散。实热则四肢不
和，胀满气急不安，宜小甘露饮。肺劳，预事而忧所成。虚寒则心腹冷气，胸满背
痛，吐逆，宜温肺汤。实热则气喘，面目苦肿，宜二母汤。肾劳，矜持志节所成。
虚寒则遗精白浊，腰脊如折，宜羊肾丸。实热则小便黄赤涩痛，阴生疮，宜地黄丸。
肝伤筋极，虚则手足拘挛，腹痛，指甲痛，转筋，宜木瓜散，当归、枸杞、续断。
实则咳而胁下痛，脚心痛不可忍，手足甲青黑，宜五加皮散。心伤脉极，虚则咳而
心痛，咽肿，喉仲介介如梗，宜茯神汤，远志、酸枣仁、朱砂、龙齿。实则血焦发
落，唇舌赤，语涩肌瘦，宜麦门冬汤。脾伤肉极，虚则四肢倦，关节痛，不食，阴
引肩背皆强，宜半夏汤，豆蔻、浓朴、陈皮、益智。实则肌肉痹，腠理开，汗大泄，
四肢缓弱急痛，宜薏苡仁散。肺伤气极，虚则皮毛焦，津液枯，力乏，腹胀喘息，
宜紫菀汤，人参、黄 、白石英。实则喘息冲胸，心恚腹满，热烦呕，口燥咽干，
宜前胡汤。肾伤骨极，虚则面肿垢黑，脊痛气衰，毛发枯槁，宜鹿角丸，益智、五
味、鹿茸。实则面焦耳鸣，小便不通，手足痛，宜玄参汤。脏腑气虚，视听已卸，
精极，虚则遗精白浊，体弱，小腹急，茎弱核小，宜磁石丸，鹿茸、苁蓉、破故纸、
龙骨、人参、附子、钟乳。实则目昏毛焦，虚热烦闷，泄精，宜石斛汤。《古今录
验》五蒸汤，甘草炙一两，茯苓三两，人参二两，干地黄三两，竹叶二把，葛根三
两，知母二两，黄芩二两，粳米二合，石膏五两碎，上十味 咀。以水九升，煮小
麦一升，至六升去麦，入药煎至二升半，分三服。实热，黄连、黄芩、黄柏、大黄。
虚热，乌梅、秦艽、柴胡，气也；青蒿、鳖甲、蛤蚧、牡丹皮、小麦，血也。肺，
（鼻干）乌梅、紫菀、天门冬、麦门冬。皮，（舌白唾血）石膏、桑白皮。肤，（昏昧嗜睡）牡丹皮。
气，（遍身气热，喘促鼻干，）人参、黄芩、栀子。大肠（鼻右孔干痛）芒硝、大黄。脉，（唾白浪语，经
络溢，脉缓急不调，）当归、生地黄。心，（舌干）黄连、生地黄。血，（发焦）地黄、当归、桂心、
童子小便。小肠，下唇焦木通、赤茯苓、生地黄。脾，（唇焦）芍药、木瓜、苦参。肉，（食
无味而呕，烦躁不安，）芍药。胃，（舌下痛）石膏、粳米、大黄、芒硝、葛根。肝，（眼黑）前胡、川
芎、当归。筋，（甲焦）川芎、当归。胆，（眼白失色）柴胡、栝蒌。三焦，（乍寒乍热）石膏、竹叶。
肾，（两耳焦）石膏、知母、生地黄、寒水石。脑，（头眩闷热）羌活、地黄、防风。髓，（髓沸骨中热）
当归、地黄、天门冬。骨，（齿黑腰痛足逆冷，疳虫食藏，）鳖甲、当归、地骨皮、牡丹皮、生
地黄。肉，（肢细趺肿，脏腑俱热，）石膏、黄柏。胞，（小便黄赤）生地黄、泽泻、茯苓、沉香、滑
石。膀胱，（左耳焦）泽泻、茯苓、滑石。凡此诸蒸，皆因热病后食肉油腻，行房饮酒犯
之而成。久蒸不除，变成疳病即死矣。《珍珠囊》云∶地为阴，骨为里，皮为表，地骨
皮泻肾火，牡丹皮泻包络火，总治热在外无汗而骨蒸。知母泻肾火，治热在内有汗
而骨蒸，四物汤加二皮，治妇人骨蒸。《玄珠》云∶五行六气，水特五之一耳。一水
既亏，岂能胜五火哉，虚劳等证蜂起矣。其体虚者，最易感于邪气，当先和解，微
利微下之，从其缓而治之，次则调之。医者不知邪气加于身而未除，便行补剂，邪
气得补，遂入经络，至死不悟，如此误者，何啻千万，良可悲哉。夫凉剂能养水清
火，热剂能燥水补火，理易明也。劳为热证明矣，还可补乎。惟无邪无热无积之人，
脉举按无力而弱者，方可补之。又必察其胃中及右肾二火亏而用之。心虚则动悸恍
惚，忧烦少色，舌强，宜养荣汤、琥珀定神丸之类，以益其心血。脾虚面黄肌瘦，
吐利清冷，腹胀肠鸣，四肢无力，饮食不进，宜快胃汤、进食丸之类，以调其饮食。
肝虚目昏，筋脉拘挛，面青恐惧，如人将捕之状，宜牛膝益中汤、虎骨丹之类，以
养助其筋脉。肺虚呼吸少气喘乏，咳嗽嗌干，宜枳实汤加人参、黄 、阿胶、苏子，
以调其气。肾虚腰背脊膝厥逆而痛，神昏耳鸣，小便频数，精漏，宜八味丸加五味、
鹿茸，去附子，用山药等丸，以生其精。陈藏器诸虚用药凡例∶虚劳头痛复热，加
枸杞、萎蕤。虚而欲吐，加人参。虚而不安，亦加人参。虚而多梦纷纭，加龙骨。
虚而多热，加地黄、牡蛎、地肤子、甘草。虚而冷，加当归、川芎、干姜。虚而损，
加钟乳、棘刺、苁蓉、巴戟天。虚而大热，加黄芩、天门冬。虚而多忘，加茯苓、
远志。虚而口干，加麦门冬、知母。虚而吸吸，加胡麻、覆盆子、柏子仁。虚而多
气兼微咳，加五味子、大枣。虚而惊悸不安，加龙齿、沙参、紫石英、小草。若冷
则用紫石英、小草，若客热即用沙参、龙齿，不冷不热皆用之。虚而身强，腰中不
利，加磁石、杜仲。虚而多冷，加桂心、吴茱萸、附子、乌头。虚而劳，小便赤，
加黄芩。虚而客热，加地骨皮、白水黄 。虚而冷，加陇西黄 。虚而痰复有气，
加生姜、半夏、枳实。虚而小肠利，加桑螵蛸、龙骨、鸡 。虚而小肠不利，加
茯苓、泽泻。虚而损，溺白，加浓朴。髓竭不足，加地黄、当归。肺气不足，加天
门冬、麦门冬、五味子。心气不足，加上党人参、茯苓、菖蒲。肝气不足，加天麻、
川芎。脾气不足，加白术、白芍药、益智。肾气不足，加熟地黄、远志、牡丹皮。
胆气不足，加细辛、酸枣仁、地榆。神昏不足，加朱砂、预知子、茯神。
《证治要诀》云∶五劳皆因不量才力，勉强云为，忧思过度，嗜欲无节，或病失
调将，积久成劳。其证头旋眼晕，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，口中无味，
饮食减少，此皆劳伤之证也。五脏虽皆有劳，心肾为多。心主血，肾主精，精竭血
燥则劳生焉。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，适足以发其虚阳，缘内无精血，不足当此猛剂。然不
可因有热，纯用甜冷之药，以伤其胃气。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，而又害之。宜十全大补汤或双和散，或
养荣汤、七珍散、乐令建中汤，皆可选用，间进双补丸。诸发有杂病，如咳嗽吐血
不得卧，盗汗，寒热潮热等，已见各门。审知因虚劳得之，并宜用前药，未效用十
四味建中汤，（无热，脉不数，乃可用。）或大建中汤。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。
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、陈皮却不
可少，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，方欲一取之归 等药，其人素
减食，又恐不利于脾，方欲理脾，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。故曰精不足者，补之以味。又曰∶补肾不如
补脾，以脾上交于心，下交于肾故也。道家交媾心肾，以脾为黄婆者，即此意。若
肾元大段虚损，病势困笃，则肾又不容少缓，不必拘于此说。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。《难经》曰∶肾有两者，非皆肾也。其左为肾，右为命门。命门者诸精神之所
舍，原气之所系也。男子以脏精，女子以系胞，故知肾有二也。男子藏精者，气海也。
女子系胞者，血海也。所主者二，受病者一也。是故左肾为阴，合主地道生育之化，
故曰元气之舍也。若夫肾之藏精者、是受五脏六腑之精，输纳入精房、血海而藏之。
然精有阴有阳，阴阳平则两肾和而不偏，不平则偏，阴阳俱不足，则两肾俱虚。故
东垣治两虚者，以仲景八味丸补之。偏于左肾之阴精不足，则以地黄丸主之，以三
才封髓丹主之。右肾之阳火不足，则以八味丸、天真丸之类主之。此用方之凡例也。
《素问》说：脉象虚弱、气虚、尺部脉虚弱，这叫做“重虚”。所谓气虚，是指言语无序；尺部脉虚弱，是指行走时步履不稳；脉象虚弱，是指脉搏缺乏阴柔之象。又说：脉细、皮肤寒冷、气短、大小便泄利不止、饮食无法入口，这叫做“五虚”。出现五虚证候有死亡的危险，但如果浆粥能进入胃中，泄泻停止，那么虚损之证就可以治愈。治疗可用黄芪建中汤、理中汤之类的方剂。
这段《素问》的文字只提到了“虚”而没有提到“劳瘵”这个名称，然而导致这种病的病因却确实多次提及了。凡是外感六淫（风、寒、暑、湿、燥、火），内伤七情（喜、怒、忧、思、悲、恐、惊），邪气辗转传变侵犯五脏，最终导致大骨枯槁、大肉陷下，分别出现与其相合的脏腑衰惫的症状，如果出现真脏脉，则预示死期将至。又如阳明经的病，会传变为风消（因风热耗伤津液而消瘦）、息贲（呼吸急促胸满）。太阳经的病，会传变为索泽（肌肤干枯无光泽）、瘅成为消中（消渴病中的中消证）。大肠的热邪移注于胃，胃的热邪移注于胆，都会表现为食欲旺盛但身体消瘦。曾经尊贵后来卑贱，病从内生，名叫脱营。曾经富有后来贫穷，名叫失精。突然的快乐或暴喜，开始快乐后来痛苦，都会损伤精气。精气枯竭断绝，形体毁坏沮丧，离别隔绝、郁结不解，喜怒忧恐等情绪波动，导致五脏空虚，血气离散失守。《灵枢》说：惊恐思虑会损伤神志，神志受损则会恐惧且自我丧失能力，肌肉破败消瘦，毛发憔悴面色枯槁，死于冬季。另外，各种热病在皮肤、肌肉、血脉、筋骨之间，各客居于其所合的本脏不得其位，反而客居于所不胜的脏腑。以及考察医和诊治晋平公的疾病时说：这是接近女色所致，女子属阳物而在晦暗之时行房，淫欲过度会产生内热或蛊毒之疾，这不是鬼神作祟也不是食物致病，这种病是无法治愈的。到了汉代张仲景的《金匮要略》明确设立虚劳门，于是巢元方撰写《诸病源候论》遂有虚劳、蒸病、注病等记载，都是由此推演而来的。虚劳，就是五劳、六极、七伤。五劳，指志劳、思劳、心劳、忧劳、瘦劳。六极，指气极、血极、筋极、骨极、肌极、精极。七伤，指阴寒、阴痿、里急、精液滑出不断、精少、阴部潮湿、精液清稀、小便频数苦痛、行房事不能勃起。又说：饱食过度伤脾，大怒气逆伤肝，强力举重、久坐湿地伤肾，形体受寒、饮用冷物伤肺，忧愁思虑伤心，风雨寒暑伤形体，大惊恐惧且不知节制伤志。蒸病有五种：骨蒸、脉蒸、皮蒸、肉蒸、内蒸。又有二十三蒸，胞、玉房、脑、髓、骨、血、脉、肝、心、脾、肺、肾、膀胱、胆、胃、三焦、小肠、肉、肤、皮、气，每一类都有一种蒸病，症状是全身发热，多因热病痊愈后，吃牛肉，或饮酒，或房事不节而成。注，意思是停留，邪气居住在人体内，活着的时候连滞停住，死后又传染给旁人，即所谓的传尸。已在其他门类中单独列出。现在将虚劳骨蒸合并为一门，在后面列举古代名医的治疗方法。《金匮要略》说：五劳虚极导致身体极度消瘦，腹部胀满不能饮食，这是由于食伤、忧伤、饮伤、房室伤、饥伤、劳伤，导致经络荣卫之气受伤，体内有干血，肌肤粗糙如鳞甲，两眼暗黑，应当缓中补虚，用大黄䗪虫丸主治。按：虚劳发热，没有不是由瘀血引起的，而瘀血没有不是由内伤引起的，人的饮食起居，一旦失去节制，都能造成损伤，这也由此可见。所以用润燥药治疗干燥，用蠕动类药物推动死血，死血去除后，病根已除，然后才可以从事滋补的治疗，张仲景是万古医方的祖师，是有道理的。又有陈大夫传承的仲景百劳丸，可以与大黄䗪虫丸交替使用。《活法机要》说：虚损之疾，是因为虚而感受寒热邪气。感受寒邪则损伤阳气，阳虚则阴盛，所以损伤是从上往下发展的，治疗宜用辛甘淡味药，如果损伤超过胃就不可治了。感受热邪则损伤阴液，阴虚则阳盛，所以损伤是从下往上发展的，治疗宜用苦酸咸味药，如果损伤超过脾就不可治了。从上往下损伤的，一损损伤肺，所以皮毛聚缩而毛发脱落。二损损伤心，所以血脉虚弱，不能滋养脏腑，妇女则月经不通。三损损伤胃，所以饮食不能转化为肌肤。从下往上损伤的，一损损伤肾，所以骨痿不能起床。二损损伤肝，所以筋缓不能自主收持。三损损伤脾，所以饮食不能消化。所以心肺受损则面色败坏，肝肾受损则形体痿废，脾胃受损则谷物不能消化。治疗肺损皮毛聚缩而毛发脱落，宜益气，用四君子汤。治疗心肺虚损，皮毛聚缩，血脉虚耗，妇女月经延期，宜益气和血，用八物汤。治疗心肺损伤波及胃，影响饮食，不能化为肌肤，宜益气和血，调理饮食，用十全散。治疗肾损，骨痿不能起床，宜益精补肾，用金刚丸。治疗肝肾损伤，骨痿不能起床，宜益精。筋缓不能自主收持时，宜缓中用牛膝丸。治疗肝肾损伤波及脾，进食不化，宜益精缓中消谷，用煨肾丸。如果阳盛阴虚，肝肾不足，房事虚损，形体消瘦无力，面色青黄无常，宜养血养肾，用地黄丸。如果阳盛阴虚，心肺不足，以及男女面色无血色，食少嗜卧，肢体困倦，宜用八味丸。如果形体瘦弱，无力多困，不知道阴阳哪一方先受损，夏季宜用地黄丸，春秋宜用肾气丸，冬季宜用八味丸。病久虚弱，食欲不振，用和中丸。肝劳，因尽力谋虑而成。虚寒则口苦骨疼，筋挛烦闷，宜续断汤，灸肝俞穴。实热则关格牢涩不通，眼目赤涩，烦闷热壅，毛发憔悴面色枯槁，宜羚羊角散。心劳，因曲运神机而成。虚寒则惊悸恍惚，神志不定，宜远志饮子、酸枣仁汤。实热则口舌生疮，大小便秘涩，宜黄芩汤。脾劳，因意外致思而成。虚寒则气胀咽满，食不下，嗳气，宜白术汤、生嘉禾散、大建脾散。实热则四肢不和，胀满气急不安，宜小甘露饮。肺劳，因预事而忧所成。虚寒则心腹冷气，胸满背痛，吐逆，宜温肺汤。实热则气喘，面目苦肿，宜二母汤。肾劳，因矜持志节所成。虚寒则遗精白浊，腰脊如折，宜羊肾丸。实热则小便黄赤涩痛，阴部生疮，宜地黄丸。肝伤筋极，虚则手足拘挛，腹痛，指甲痛，转筋，宜木瓜散，当归、枸杞、续断。实则咳而胁下痛，脚心痛不可忍，手足甲青黑，宜五加皮散。心伤脉极，虚则咳而心痛，咽肿，喉间介介如有梗塞感，宜茯神汤，远志、酸枣仁、朱砂、龙齿。实则血焦发落，唇舌红赤，语涩肌瘦，宜麦门冬汤。脾伤肉极，虚则四肢倦怠，关节痛，不食，阴气牵引肩背皆强，宜半夏汤，豆蔻、浓朴、陈皮、益智。实则肌肉痹阻，腠理开泄，汗大泄，四肢缓弱急痛，宜薏苡仁散。肺伤气极，虚则皮毛焦枯，津液枯涸，乏力，腹胀喘息，宜紫菀汤，人参、黄芪、白石英。实则喘息冲胸，心中愤懑腹满，热烦呕，口燥咽干，宜前胡汤。肾伤骨极，虚则面肿垢黑，脊痛气衰，毛发枯槁，宜鹿角丸，益智、五味子、鹿茸。实则面焦耳鸣，小便不通，手足痛，宜玄参汤。脏腑气虚，视听功能衰退，精极，虚则遗精白浊，体弱，小腹急，阴茎软弱睾丸小，宜磁石丸，鹿茸、肉苁蓉、破故纸、龙骨、人参、附子、钟乳石。实则目昏毛焦，虚热烦闷，泄精，宜石斛汤。《古今录验》五蒸汤：甘草炙一两，茯苓三两，人参二两，干地黄三两，竹叶二把，葛根三两，知母二两，黄芩二两，粳米二合，石膏五两碎，以上十味捣碎。用水九升，煮小麦一升，至六升去麦，入药煎至二升半，分三次服。实热证加黄连、黄芩、黄柏、大黄。虚热证加乌梅、秦艽、柴胡，这是针对气的；青蒿、鳖甲、蛤蚧、牡丹皮、小麦，这是针对血的。肺（鼻干）用乌梅、紫菀、天门冬、麦门冬。皮（舌白唾血）用石膏、桑白皮。肤（昏昧嗜睡）用牡丹皮。气（遍身气热，喘促鼻干）用人参、黄芪、栀子。大肠（鼻右孔干痛）用芒硝、大黄。脉（唾白浪语，经络溢，脉缓急不调）用当归、生地黄。心（舌干）用黄连、生地黄。血（发焦）用地黄、当归、桂心、童子小便。小肠（下唇焦）用木通、赤茯苓、生地黄。脾（唇焦）用芍药、木瓜、苦参。肉（食无味而呕，烦躁不安）用芍药。胃（舌下痛）用石膏、粳米、大黄、芒硝、葛根。肝（眼黑）用前胡、川芎、当归。筋（甲焦）用川芎、当归。胆（眼白失色）用柴胡、栝蒌。三焦（乍寒乍热）用石膏、竹叶。肾（两耳焦）用石膏、知母、生地黄、寒水石。脑（头眩闷热）用羌活、地黄、防风。髓（髓沸骨中热）用当归、地黄、天门冬。骨（齿黑腰痛足逆冷，疳虫食藏）用鳖甲、当归、地骨皮、牡丹皮、生地黄。肉（肢细趺肿，脏腑俱热）用石膏、黄柏。胞（小便黄赤）用生地黄、泽泻、茯苓、沉香、滑石。膀胱（左耳焦）用泽泻、茯苓、滑石。凡此诸蒸，都是因为热病后吃肉油腻，行房饮酒触犯所致。久蒸不除，变成疳病就会死亡。《珍珠囊》说：地为阴，骨为里，皮为表，地骨皮泻肾火，牡丹皮泻包络火，总治热在外无汗而骨蒸。知母泻肾火，治热在内有汗而骨蒸，四物汤加地骨皮、牡丹皮，治妇人骨蒸。《玄珠》说：五行六气，水只是其中之一。一旦水亏，怎么能胜得过五火呢？虚劳等证候就蜂拥而起了。体质虚弱的人，最容易感受邪气，应当先和解，微利微下之，顺着缓和的方式治疗，其次再调理。医生不知道邪气加于身而未除，就使用补剂，邪气得到补益，遂深入经络，至死不悟，这样的误治，何止千万，实在可悲啊。凉剂能养水清火，热剂能燥水补火，道理很容易明白。劳证是热证明显，还可以补吗？只有无邪无热无积之人，脉象举按无力而弱的，才可以补。还必须察其胃中及右肾二火亏而使用。心虚则动悸恍惚，忧烦少色，舌强，宜养荣汤、琥珀定神丸之类，以益其心血。脾虚面黄肌瘦，吐利清冷，腹胀肠鸣，四肢无力，饮食不进，宜快胃汤、进食丸之类，以调其饮食。肝虚目昏，筋脉拘挛，面青恐惧，如人将捕之状，宜牛膝益中汤、虎骨丹之类，以养助其筋脉。肺虚呼吸少气喘乏，咳嗽嗌干，宜枳实汤加人参、黄芪、阿胶、苏子，以调其气。肾虚腰背脊膝厥逆而痛，神昏耳鸣，小便频数，精漏，宜八味丸加五味子、鹿茸，去附子，用山药等丸，以生其精。陈藏器诸虚用药凡例：虚劳头痛复热，加枸杞、萎蕤。虚而欲吐，加人参。虚而不安，亦加人参。虚而多梦纷纭，加龙骨。虚而多热，加地黄、牡蛎、地肤子、甘草。虚而冷，加当归、川芎、干姜。虚而损，加钟乳、棘刺、肉苁蓉、巴戟天。虚而大热，加黄芩、天门冬。虚而多忘，加茯苓、远志。虚而口干，加麦门冬、知母。虚而吸吸（呼吸浅短），加胡麻、覆盆子、柏子仁。虚而多气兼微咳，加五味子、大枣。虚而惊悸不安，加龙齿、沙参、紫石英、小草。若冷则用紫石英、小草，若客热即用沙参、龙齿，不冷不热皆用之。虚而身强，腰中不利，加磁石、杜仲。虚而多冷，加桂心、吴茱萸、附子、乌头。虚而劳，小便赤，加黄芩。虚而客热，加地骨皮、白术。虚而冷，加陇西黄芪。虚而痰复有气，加生姜、半夏、枳实。虚而小肠利，加桑螵蛸、龙骨、鸡内金。虚而小肠不利，加茯苓、泽泻。虚而损，溺白，加厚朴。髓竭不足，加地黄、当归。肺气不足，加天门冬、麦门冬、五味子。心气不足，加上党人参、茯苓、菖蒲。肝气不足，加天麻、川芎。脾气不足，加白术、白芍药、益智。肾气不足，加熟地黄、远志、牡丹皮。胆气不足，加细辛、酸枣仁、地榆。神昏不足，加朱砂、预知子、茯神。
《证治要诀》说：五劳都是因为不量力而行，勉强作为，忧思过度，嗜欲无节，或者生病后失调调养，积久成劳。其症状头晕眼花，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，口中无味，饮食减少，这都是劳伤之证。五脏虽都有劳，心肾居多。心主血，肾主精，精竭血燥则劳生焉。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，适足以发其虚阳，缘内无精血，不足当此猛剂。然而不可因为有热，纯用甜冷之药，以伤其胃气。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，而又害之。宜十全大补汤或双和散，或养荣汤、七珍散、乐令建中汤，皆可选用，间进双补丸。诸发有杂病，如咳嗽吐血不得卧，盗汗，寒热潮热等，已见各门。审知因虚劳得之，并宜用前药，未效用十四味建中汤，（无热，脉不数，乃可用。）或大建中汤。渴而不胜热药者，七珍散加木香、五味子各七分。热多黄芪鳖甲散、或人参散。独五心发热，将欲成劳者，茯苓补心汤。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、陈皮却不可少，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，方欲一取之归身等药，其人素减食，又恐不利于脾，方欲理脾，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。故曰精不足者，补之以味。又说：补肾不如补脾，以脾上交于心，下交于肾故也。道家交媾心肾，以脾为黄婆者，即此意。若肾元大段虚损，病势困笃，则肾又不容少缓，不必拘于此说。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、黄芪之属，此又临时审病用药之活法。《难经》说：肾有两个，并非都是肾。左边为肾，右边为命门。命门是诸精神之所舍，原气之所系也。男子以脏精，女子以系胞，故知肾有二也。男子藏精者，气海也。女子系胞者，血海也。所主者二，受病者一也。是故左肾为阴，合主地道生育之化，故曰元气之舍也。若夫肾之藏精者，是受五脏六腑之精，输纳入精房、血海而藏之。然精有阴有阳，阴阳平则两肾和而不偏，不平则偏，阴阳俱不足，则两肾俱虚。故东垣治两虚者，以仲景八味丸补之。偏于左肾之阴精不足，则以地黄丸主之，以三才封髓丹主之。右肾之阳火不足，则以八味丸、天真丸之类主之。此用方之凡例也。
The *Suwen* (Basic Questions) states: When the pulse is deficient, Qi is deficient, and the Chi position pulse is deficient, this is called "double deficiency" (Chong Xu). The so-called Qi deficiency refers to disordered speech; the Chi position deficiency refers to unsteady gait when walking; the pulse deficiency refers to the lack of a Yin-like quality in the pulse. It also states: A fine pulse, cold skin, shortness of breath, diarrhea or incontinence of both urine and feces, and inability to ingest food or drink constitute the "Five Deficiencies" (Wu Xu). If the Five Deficiencies appear, death is imminent; however, if gruel or porridge can enter the stomach and diarrhea stops, the deficiency condition can be cured. Treatment should employ formulas such as Huangqi Jianzhong Tang (Astragalus Decoction for Middle Jiao Construction) or Lizhong Tang (Regulate the Middle Decoction).
The *Suwen* mentions only "deficiency" without naming "Lao Zhai" (Consumption Disease), yet it frequently discusses the etiology. Whenever external pathogens (Six Evils: Wind, Cold, Summer-heat, Dampness, Dryness, Fire) invade or internal emotional injuries (Seven Emotions: Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright) occur, pathogenic factors circulate and attack the Five Viscera, eventually leading to withering of the large bones and sinking of the large muscles, presenting symptoms corresponding to the failing organs associated with each viscera. If True Zang pulses appear, death is near. Furthermore, diseases of the Yangming channel may transform into Feng Xiao (wasting due to wind-heat consuming fluids) or Xi Ben (asthma with chest fullness). Diseases of the Taiyang channel may transform into Su Ze (dry and lusterless skin) or Dan Cheng Wei Xiao Zhong (excessive hunger characteristic of Middle Xiao diabetes). Heat transferring from the Large Intestine to the Stomach, or from the Stomach to the Gallbladder, results in excessive appetite but emaciation. Former nobility reduced to low status causes illness arising internally, named Tuo Ying (Depletion of Ying). Former wealth reduced to poverty is named Shi Jing (Loss of Essence). Sudden joy or violent pleasure, followed by happiness turning to suffering, all damage Jing-Qi. When Jing-Qi is exhausted and severed, the physical form is destroyed and degraded. Separation, isolation, and stagnation, along with fluctuations of joy, anger, worry, and fear, empty the Five Viscera and cause Blood and Qi to scatter and lose their residence. The *Ling Shu* (Spiritual Pivot) states: Fright and contemplation damage Shen (Spirit); when Shen is damaged, one experiences fear and loss of self-control, muscle wasting, brittle hair, and sallow complexion, dying in winter. Additionally, various heat diseases located in the skin, flesh, vessels, sinews, and bones fail to reside in their corresponding root viscera and instead lodge in the overcoming viscera. Examining Yi He’s diagnosis of Duke Ping of Jin’s illness: he said, "This is caused by proximity to women. Women are Yang objects engaged in intercourse during dark times; excessive lust generates internal heat or Gu (poisonous worm) disease. This is neither ghost nor food pathology; it is incurable." In the Han Dynasty, Zhang Zhongjing’s *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) explicitly established the chapter on Xu Lao (Deficiency and Emaciation). Consequently, Chao Yuanfang’s *Zhu Bing Yuan Hou Lun* (General Treatise on the Causes and Symptoms of All Diseases) recorded Xu Lao, Zheng Bing (Steaming Disorder), and Zhu Bing (Transmitting Disease), all deduced from this foundation. Xu Lao refers to Wu Lao (Five Labors), Liu Ji (Six Extremes), and Qi Shang (Seven Injuries). Wu Lao includes Zhi Lao (Mental Labor), Si Lao (Pensiveness Labor), Xin Lao (Heart Labor), You Lao (Worry Labor), and Shou Lao (Emaciation Labor). Liu Ji include Qi Ji (Qi Extreme), Xue Ji (Blood Extreme), Jin Ji (Sinew Extreme), Gu Ji (Bone Extreme), Ji Ji (Flesh Extreme), and Jing Ji (Essence Extreme). Qi Shang include Yin Han (Yin Cold), Yin Wei (Impotence), Li Ji (Internal Urgency), Jing Lian Lian (Continuous Semen Leakage), Jing Shao (Scanty Essence), Yin Xia Shi (Dampness in Genitals), Jing Qing (Clear Essence), and Xiao Bian Ku Shu Lin Shi Bu Ju (Painful Frequent Urination and Failure During Intercourse). It is also stated: Overeating damages the Spleen; extreme anger with counterflow Qi damages the Liver; heavy lifting while sitting long in damp places damages the Kidney; exposure to cold and drinking cold beverages damages the Lung; sorrow and pensiveness damage the Heart; wind, rain, cold, and heat damage the Form; extreme fright and lack of moderation damage Zhi (Willpower). There are five types of steaming disorders: Gu Zheng (Bone Steaming), Mai Zheng (Vessel Steaming), Pi Zheng (Skin Steaming), Rou Zheng (Flesh Steaming), and Nei Zheng (Internal Steaming). There are also twenty-three steaming disorders: Bao (Uterus/Womb), Yu Fang (Genital Organ), Nao (Brain), Sui (Marrow), Gu (Bone), Xue (Blood), Mai (Vessel), Gan (Liver), Xin (Heart), Pi (Spleen), Fei (Lung), Shen (Kidney), Pang Guang (Bladder), Dan (Gallbladder), Wei (Stomach), San Jiao (Triple Burner), Xiao Chang (Small Intestine), Rou (Flesh), Fu (Subcutaneous Tissue), Pi (Skin), and Qi, each having one type of steaming disorder. The symptom is generalized fever, often occurring after recovery from a heat disease, triggered by eating beef, drinking alcohol, or sexual indiscretion. "Zhu" means to stay; pathogenic qi resides within the body, lingering and stagnating during life, and transmitting to others after death; this is what is called "Chuan Shi" (Transmitting Corpse). This has been listed in a separate section. Now, Xu Lao and Gu Zheng are combined into one section, with ancient physicians' treatment methods listed below. The *Jin Gui* states: "When the Five Labors lead to extreme deficiency and emaciation, abdominal fullness, and inability to eat, caused by dietary injury, emotional injury, fluid injury, sexual injury, starvation injury, and labor injury, damaging the meridians, Ying, Wei, and Qi, with dry blood retained internally, rough skin like scales, and dark eyes, one should moderate the middle and tonify deficiency using Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill)." Note: Fever in Xu Lao invariably stems from Blood stasis, which invariably stems from internal injury. Any disruption in diet or daily routine can cause injury, which illustrates this point. Therefore, use moistening agents to treat dryness, and motile substances to move dead blood. Once dead blood is removed, the root of the disease is cleared, and then tonifying agents can be employed. Zhang Zhongjing is the ancestor of medical prescriptions for eternity, and there is reason for this. Chen Dafu transmitted Zhongjing’s Bailao Wan (Hundred Labors Pill), which can be used interchangeably with Da Huang Zhe Chong Wan. *Huofa Jiyao* (Key to Active Methods) states: Diseases of deficiency and damage arise from feeling cold or heat due to deficiency. Feeling cold damages Yang; Yang deficiency leads to Yin excess, so damage proceeds from top to bottom; treatment should use Pungent, Sweet, and Bland flavors. If damage exceeds the Stomach, it is incurable. Feeling heat damages Yin; Yin deficiency leads to Yang excess, so damage proceeds from bottom to top; treatment should use Bitter, Sour, and Salty flavors. If damage exceeds the Spleen, it is incurable. Damage proceeding from top to bottom: First damage affects the Lung, causing skin contraction and hair loss. Second damage affects the Heart, causing weak blood vessels unable to nourish the viscera; in women, menstruation ceases. Third damage affects the Stomach, causing food not to transform into flesh. Damage proceeding from bottom to top: First damage affects the Kidney, causing bone flaccidity and inability to rise from bed. Second damage affects the Liver, causing sinew laxity and inability to control movement. Third damage affects the Spleen, causing inability to digest food. Thus, Lung and Heart damage result in poor complexion; Liver and Kidney damage result in physical flaccidity; Spleen and Stomach damage result in inability to digest grains. For Lung damage with skin contraction and hair loss, tonify Qi using Sijunzi Tang (Four Gentlemen Decoction). For Heart and Lung deficiency with skin/hair issues, weak vessels, and delayed menstruation in women, tonify Qi and nourish Blood using Bawu Tang (Eight Substance Decoction). For Heart/Lung damage affecting the Stomach and digestion, tonify Qi and Blood, regulate diet using Shiquan San (Ten Complete Powder). For Kidney damage with bone flaccidity, tonify Essence and strengthen Kidneys using Jingang Wan (Diamond Pill). For Liver/Kidney damage with bone flaccidity, tonify Essence. For sinew laxity, moderate the middle using Niuxi Wan (Achyranthes Pill). For Liver/Kidney damage affecting the Spleen with undigested food, tonify Essence, moderate the middle, and aid digestion using Weishen Wan (Baked Kidney Pill). If Yang is excess and Yin is deficient, with Liver/Kidney insufficiency, sexual depletion, emaciation, weakness, and variable green-yellow complexion, nourish Blood and Kidneys using Dihuang Wan (Rehmannia Pill). If Yang is excess and Yin is deficient, with Heart/Lung insufficiency, pale complexion in men and women, poor appetite, lethargy, and limb fatigue, use Bawei Wan (Eight Substances Pill). If emaciated and weak with unknown initial Yin/Yang damage: summer requires Dihuang Wan; spring/autumn requires Shenqi Wan (Kidney Qi Pill); winter requires Bawei Wan. For chronic weakness with anorexia, use Hezhong Wan (Harmonize Middle Pill). Gan Lao (Liver Labor) results from excessive planning. Deficient-Cold presents with bitter taste, bone pain, sinew cramps, and irritability; use Xuduan Tang (Dipsacus Decoction) and moxibustion on Ganshu (BL18). Excess-Heat presents with obstruction, red gritty eyes, irritability, heat oppression, brittle hair, and sallow face; use Lingyangjiao San (Antelope Horn Powder). Xin Lao (Heart Labor) results from mental exertion. Deficient-Cold presents with palpitations, trance, and unstable spirit; use Yuanzhi Yinzi (Polygala Drink) and Suanzaoren Tang (Ziziphus Decoction). Excess-Heat presents with mouth/tongue ulcers and constipation; use Huangqin Tang (Scutellaria Decoction). Pi Lao (Spleen Labor) results from unexpected thoughts. Deficient-Cold presents with Qi distension, throat fullness, anorexia, and belching; use Baizhu Tang (Atractylodes Decoction), Shengjihe San (Generate Harmony Powder), and Dajianpi San (Greatly Strengthen Spleen Powder). Excess-Heat presents with limb disharmony, distension, urgency, and restlessness; use Xiaoganlu Yin (Little Sweet Dew Drink). Fei Lao (Lung Labor) results from anticipatory worry. Deficient-Cold presents with cold Qi in heart/abdomen, chest fullness, back pain, and vomiting; use Wenfei Tang (Warm Lung Decoction). Excess-Heat presents with asthma, facial swelling; use Ermu Tang (Two Mothers Decoction). Shen Lao (Kidney Labor) results from rigid willpower. Deficient-Cold presents with spermatorrhea, white turbidity, and breaking-back sensation in waist/spine; use Yangshen Wan (Sheep Kidney Pill). Excess-Heat presents with yellow-red painful urination and genital sores; use Dihuang Wan. Gan Shang Jin Ji (Liver Injury Sinew Extreme): Deficiency causes limb spasms, abdominal pain, nail pain, and cramps; use Mugua San (Papaya Powder), Danggui (Angelica), Gouqi (Goji), Xuduan (Dipsacus). Excess causes cough with hypochondriac pain, unbearable sole pain, and black/blue nails; use Wujia Pi San (Eucommia Bark Powder). Xin Shang Mai Ji (Heart Injury Vessel Extreme): Deficiency causes cough, heart pain, throat swelling, and foreign body sensation; use Fushen Tang (Poria Decoction), Yuanzhi (Polygala), Suanzaoren (Ziziphus), Zhusha (Cinnabar), Longchi (Dragon Bone). Excess causes burnt blood, hair loss, red lips/tongue, slurred speech, and emaciation; use Maimendong Tang (Ophiopogon Decoction). Pi Shang Rou Ji (Spleen Injury Flesh Extreme): Deficiency causes limb fatigue, joint pain, anorexia, and pulling stiffness in shoulders/back; use Banxia Tang (Pinellia Decoction), Doukou (Cardamom), Houpo (Magnolia Bark), Chenpi (Tangerine Peel), Yizhi (Alpinia). Excess causes muscle bi, open pores, profuse sweating, and limb weakness/pain; use Yiyiren San (Coix Seed Powder). Fei Shang Qi Ji (Lung Injury Qi Extreme): Deficiency causes scorched skin/hair, dried fluids, fatigue, abdominal distension, and asthma; use Ziwan Tang (Aster Decoction), Renshen (Ginseng), Huangqi (Astragalus), Baishiying (White Quartz). Excess causes asthma rushing to chest, resentment, abdominal fullness, heat/vomiting, dry mouth/throat; use Qianhu Tang (Peucedanum Decoction). Shen Shang Gu Ji (Kidney Injury Bone Extreme): Deficiency causes swollen/dirty face, back pain, Qi decline, and brittle hair; use Lu Jiao Wan (Deer Horn Pill), Yizhi (Alpinia), Wuweizi (Schisandra), Lu Rong (Deer Antler Velvet). Excess causes sallow face, tinnitus, urinary retention, and limb pain; use Xuanshen Tang (Scrophularia Decoction). Zang-Fu Qi deficiency with declining vision/hearing, Jing Ji (Essence Extreme): Deficiency causes spermatorrhea, weakness, lower abdominal urgency, weak penis, and small testes; use Cishi Wan (Magnetite Pill), Lu Rong (Deer Antler), Rongrong (Cistanche), Pogostemon, Longgu (Fossil Bone), Renshen (Ginseng), Fuzi (Aconite), Zhongru (Milky Stone). Excess causes dim vision, brittle hair, deficiency-heat, irritability, and seminal emission; use Shihu Tang (Dendrobium Decoction). *Gujin Luyan* Wuzheng Tang: Zhi Gancao (Prepared Licorice) 1 liang, Fuling (Poria) 3 liang, Renshen (Ginseng) 2 liang, Gan Dihuang (Prepared Rehmannia) 3 liang, Zhuye (Bamboo Leaf) 2 bundles, Gegen (Kudzu Root) 3 liang, Zhimu (Anemarrhena) 2 liang, Huangqin (Scutellaria) 2 liang, Jingsmi (Rice) 2 he, Shigao (Gypsum) 5 liang (crushed). Ten ingredients coarsely crushed. Boil in 9 sheng water with 1 sheng Wheat until 6 sheng remain, remove wheat, add herbs, boil to 2.5 sheng, divide into three doses. For Excess-Heat: add Huanglian (Coptis), Huangqin (Scutellaria), Huangbai (Phelloderm), Dahuang (Rhubarb). For Deficiency-Heat: add Wumei (Mume Fruit), Qinjiao (Gentiana Macrophylla), Chaihu (Bupleurum) for Qi; Qinghao (Artemisia Annua), Biejia (Turtle Shell), Gejie (Gecko), Mudanpi (Moutan Cortex), Xiaomai (Wheat) for Blood. Lung (dry nose): Wumei, Ziwan, Tianmendong, Maimendong. Skin (white saliva with blood): Shigao, Sangbaipi (Mulberry Root Bark). Subcutaneous (lethargy): Mudanpi. Qi (generalized heat, panting, dry nose): Renshen, Huangqi, Zhizi (Gardenia). Large Intestine (right nostril dry/pain): Mangxiao (Mirabilite), Dahuang. Vessel (white frothy sputum, vessel overflow, irregular pulse): Danggui (Angelica), Shengdihuang (Raw Rehmannia). Heart (dry tongue): Huanglian, Shengdihuang. Blood (burnt hair): Dihuang, Danggui, Guixin (Cinnamon Twig), Tongzi Xiaoshui (Boy's Urine). Small Intestine (lower lip scorched): Mutong (Akebia), Chifuling (Red Poria), Shengdihuang. Spleen (scorched lips): Shaoyao (Peony), Mugua (Papaya), Kushen (Sophora). Flesh (loss of taste, vomiting, irritability): Shaoyao. Stomach (sublingual pain): Shigao, Jingsmi, Dahuang, Mangxiao, Gegen. Liver (dark eyes): Qianhu, Chuanxiong (Ligusticum), Danggui. Sinew (burnt nails): Chuanxiong, Danggui. Gallbladder (pale whites of eyes): Chaihu, Gualou (Trichosanthes). Triple Burner (alternating chills/fever): Shigao, Zhuye. Kidney (scorched ears): Shigao, Zhimu, Shengdihuang, Hanshuishi (Halloysite). Brain (vertigo, heat): Qianghuo (Notopterygium), Dihuang, Fangfeng (Siler). Marrow (boiling marrow heat): Danggui, Dihuang, Tianmendong. Bone (black teeth, back pain, cold feet, parasite consumption): Biejia, Danggui, Digupi (Dogwood Root Bark), Mudanpi, Shengdihuang. Flesh (thin limbs, swollen dorsum foot, visceral heat): Shigao, Huangbai. Bao (yellow-red urine): Shengdihuang, Zexie (Alisma), Fuling, Chenxiang (Agarwood), Huashi (Kaolin). Bladder (left ear scorched): Zexie, Fuling, Huashi. All these steaming disorders result from eating meat/grease, intercourse, or drinking alcohol after heat diseases. If prolonged steaming is not resolved, it transforms into Gan disease (parasitic wasting) and leads to death. *Zhenzhu Nang* states: Earth represents Yin, Bone is interior, Skin is exterior. Digupi clears Kidney fire; Mudanpi clears Pericardium fire; together they treat external heat without sweat and bone steaming. Zhimu clears Kidney fire, treating internal heat with sweat and bone steaming. Siwu Tang plus Digupi and Mudanpi treats female bone steaming. *Xuanzhu* states: Among Five Elements and Six Qi, Water is merely one part. Once Water is deficient, how can it overcome Five Fires? Thus, Xu Lao syndromes arise. Those with weak constitutions easily contract pathogens; first harmonize, gently purge or downbear, following a mild approach, then regulate. Physicians who do not realize pathogens remain and immediately use tonics allow pathogens to enter meridians upon receiving tonification, leading to death without realization. Such errors are countless and tragic. Cooling agents nourish Water and clear Fire; heating agents dry Water and tonify Fire; the principle is clear. Labor is clearly a Heat syndrome; can it be tonified? Only those without pathogens, heat, or accumulation, with weak pulses upon lifting and pressing, may be tonified. One must also check for deficiency of Stomach Fire and Right Kidney Fire before using tonics. Heart deficiency causes palpitations, trance, worry, pallor, and stiff tongue; use Yangrong Tang (Nourish Prosperity Decoction) or Hupo Ding Shen Wan (Amber Calm Spirit Pill) to tonify Heart Blood. Spleen deficiency causes yellow face, thin flesh, cold vomiting/diarrhea, abdominal distension, borborygmus, limb weakness, and anorexia; use Kuaiwei Tang (Quick Stomach Decoction) or Jinshi Wan (Advance Food Pill) to regulate diet. Liver deficiency causes dim vision, sinew spasms, blue face, and fear as if being hunted; use Niuxi Yizhong Tang (Achyranthes Benefit Middle Decoction) or Hugudan (Tiger Bone Pill) to nourish sinews. Lung deficiency causes short breath, asthma, cough, and dry throat; use Zhishi Tang (Immature Orange Decoction) plus Renshen, Huangqi, Ejiao (Donkey-hide Gelatin), Suzi (Perilla Seed) to regulate Qi. Kidney deficiency causes cold/pain in waist/back/knees, confusion, tinnitus, frequent urination, and semen leakage; use Bawei Wan plus Wuweizi and Lu Rong, remove Fuzi, use Yam pills to generate Essence. Chen Cangqi’s General Rules for Tonifying Various Deficiencies: Xu Lao headache with recurrent heat, add Gouqi, Weiru (Polygonatum). Deficiency with desire to vomit, add Renshen. Deficiency with unrest, add Renshen. Deficiency with many dreams, add Longgu. Deficiency with much heat, add Dihuang, Muli (Oyster Shell), Difuzi (Kochia), Gancao. Deficiency with cold, add Danggui, Chuanxiong, Ganjiang (Dried Ginger). Deficiency with damage, add Zhongru, Jici (Cactus Spine), Rongrong, Bajitian (Morinda). Deficiency with great heat, add Huangqin, Tianmendong. Deficiency with forgetfulness, add Fuling, Yuanzhi. Deficiency with dry mouth, add Maimendong, Zhimu. Deficiency with shallow breathing, add Huma (Sesame), Fupenzi (Rubus), Baiziren (Biota Seed). Deficiency with much Qi and slight cough, add Wuweizi, Dazao (Jujube). Deficiency with palpitations/unrest, add Longchi, Shashen (Glehnia), Zhi Shiyin (Psilocybe - likely typo for Zhi Shi or similar, context suggests calming spirit mineral, here translated as Psilocybe/Zhi Shiyin based on text, but traditionally Zhi Shi or similar calming agent might be intended, sticking to literal Shazhen/Zhi Shiyin/Cao Xiao), Cao Xiao (Herb). If cold, use Zhi Shiyin, Cao Xiao; if external heat, use Shashen, Longchi; if neither, use both. Deficiency with stiff body and stiff waist, add Cishi, Duzhong (Eucommia). Deficiency with much cold, add Guixin, Wuzhuyu (Evodia), Fuzi, Wutou (Aconite). Deficiency with labor and red urine, add Huangqin. Deficiency with external heat, add Digupi, Baishui Huangqi (White Water Astragalus). Deficiency with cold, add Longxi Huangqi (Longxi Astragalus). Deficiency with phlegm and Qi, add Shengjiang (Fresh Ginger), Banxia (Pinellia), Zhishi. Deficiency with loose Small Intestine, add Sangpiaoxiao (Mantis Egg Case), Longgu, Jineijin (Chicken Gizzard Lining). Deficiency with obstructed Small Intestine, add Fuling, Zexie. Deficiency with damage and white urine, add Houpo. Marrow exhaustion, add Dihuang, Danggui. Lung Qi deficiency, add Tianmendong, Maimendong, Wuweizi. Heart Qi deficiency, add Shangdang Renshen, Fuling, Changpu (Acorus). Liver Qi deficiency, add Tianma (Gastrodia), Chuanxiong. Spleen Qi deficiency, add Baizhu (Atractylodes), Baishaoyao (White Peony), Yizhi. Kidney Qi deficiency, add Shudihuang (Prepared Rehmannia), Yuanzhi, Mudanpi. Gallbladder Qi deficiency, add Xixin (Asarum), Suanzaoren, Diyu (Sanguisorba). Spirit confusion deficiency, add Zhusha (Cinnabar), Yuzhizi (Actinidia), Fushen (Poria with Hostwood).
*Zhengzhi Yaojue* states: The Five Labors result from overexertion beyond one's capacity, forced activity, excessive worry/pensiveness, unregulated desires, or improper convalescence after illness, accumulating into labor. Symptoms include dizziness, blurred vision, body pain, weak legs, timid heart, shortness of breath, spontaneous/diaphoresis, alternating chills/fever, constant heat in five centers, tidal fever, bone steaming, night terrors, daytime lethargy, cicada-like tinnitus, tastelessness, and reduced appetite. These are all signs of labor injury. Although all five viscera can suffer labor, Heart and Kidney are most common. Heart governs Blood; Kidney governs Essence. When Essence is exhausted and Blood is dry, labor arises. Treatment of labor should prioritize regulating Heart and tonifying Kidney, avoiding harsh agents, and using warm, nourishing, and tonifying methods for lasting effect. Using Tianxiong or Fuzi merely stirs up deficient Yang because there is no Essence/Blood to anchor them. However, one should not use purely sweet/cold medicines due to heat, as this damages Stomach 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. Both are harmful. Suitable formulas include Shiquan Dabu Tang (Ten Complete Great Tonifying Decoction), Shuanghe San (Double Harmony Powder), Yangrong Tang, Qizhen San (Seven Treasures Powder), or Leling Jianzhong Tang. Occasionally administer Shuangbu Wan (Double Tonifying Pill). For miscellaneous diseases accompanying labor, such as cough, hemoptysis, insomnia, night sweats, chills, and tidal fever, refer to respective sections. If confirmed as due to Xu Lao, use previous formulas. If ineffective, try Shisiwei Jianzhong Tang (if no heat and non-rapid pulse) or Dajianzhong Tang. For thirst intolerant to hot medicines, use Qizhen San plus Muxiang and Wuweizi. For much heat, use Huangqi Biejia San (Astragalus and Turtle Shell Powder) or Renshen San. For isolated heat in five centers approaching labor, use Fuling Buxin Tang (Poria Tonify Heart Decoction). For reduced appetite, aversion to food, and vomiting, avoid cloying sweet medicines; use Kuai Pi (Quick Spleen) agents like Shacha (Amomum) and Chenpi, followed by Lurong Jupi Jian Wan (Deer Horn and Tangerine Peel Decoction Pill). If no vomiting/aversion, use Shiquan Dabu Tang or Shuanghe San, but add mild Kuai Pi agents for prevention. For patients with insufficient Essence/Blood needing Kidney tonification, using Danggui alone may harm the Spleen if appetite is poor. Using Spleen-regulating drugs may deplete Kidney Water. To achieve both benefits simultaneously, Lurong Jupi Jian Wan is superior. Thus, "For insufficiency of Essence, tonify with flavor." Also, "Tonifying Spleen is better than tonifying Kidney" because Spleen connects Heart above and Kidney below. Daoists call Spleen the "Yellow Matron" facilitating Heart-Kidney interaction. If Kidney Yuan is severely damaged and illness is critical, Kidney cannot wait; do not rigidly adhere to this rule. Know that in tonifying Kidney, assist with Sharen (Amomum) and Chengqie (Litsea); in strengthening Spleen, add Beiwuweizi (Northern Schisandra) and Huangqi. This is flexible application. *Nanjing* states: The two kidneys are not identical. The left is Kidney; the right is Mingmen (Gate of Life). Mingmen is the residence of spirits and origin of Yuan Qi. Men store Essence; women connect to the Uterus. Thus, there are two kidneys. Men storing Essence relates to Qihai (Sea of Qi); women connecting to Uterus relates to Xuehai (Sea of Blood). Two functions, one disease source. Left Kidney is Yin, governing reproductive transformation, hence residence of Yuan Qi. The essence stored in Kidneys receives essence from all viscera, transporting it to Jingfang (Essence Chamber) and Xuehai for storage. Essence has Yin and Yang aspects. Balance harmonizes both kidneys; imbalance causes deviation. Insufficiency of both Yin and Yang leads to bilateral Kidney deficiency. Dongyuan treated bilateral deficiency with Zhongjing’s Bawei Wan. Deviation to Left Kidney Yin/Essence deficiency uses Dihuang Wan or Santian Fengsui Dan. Right Kidney Yang/Fire insufficiency uses Bawei Wan or Tianzhen Wan. These are general rules for prescription usage.