经云∶虚者补之，劳者温之。古人以阴虚、阳虚为纲领，于是以八味治阳虚，六味疗阴
虚，致温补之风满天下。又遇高谈五行者出，创立新方，百病皆从虚治，以成议药不议病之
世界矣。夫扁鹊云∶一损肺，二损心，三损脾，过于脾则不可治矣，是上损之因也；盖下损之
由，以一损肾，二损肝，三损胃，过于胃则不可治也。《金匮》云∶极虚者为劳，调以甘药，如复
脉汤、小建中汤之类是也。又云∶肌肤甲错，内有干血，以大黄 虫丸主之。由是观之，《金
匮》治虚劳，以虚、实分治，而用方以攻补兼施，当补则补，应攻则攻，不拘一格，往往有桴
鼓之应也。然而咳嗽、骨蒸、吐血、食减、咽疮等症，当审其所因，于初候之时，分虚实而药
之，亦可转危为安，几微于反掌间矣。若用近人方法，温补横于胸中，养痈为害，百难一治。
呜呼！是非虚劳之不可治，而为温补误投之不能挽也。余每治骨蒸劳极、肌肤甲错者，用大
黄虫丸法，出入加减，攻其宿瘀，廓清积血，应手取效。惟有曾服腻补者，如油入面，病根
深痼，延宕日久者，正气已伤，百难救一。况世人不知保惜其身，自恃药石为补助，乐于温补
而恶于攻逐，犹如飞蛾扑火，甘蹈灭烈，自不知其身已入于鼎沸之中。余虽具不忍之心，是
亦末焉者矣。
澜按∶虚劳一病，五脏皆有，不得专以阴虚立论，以六味滋阴、八味益阳为秘方。或用
知、柏暂平浮火，切勿多投，惟恐脾阳受侮，中土失运，每致食减、便溏之患，所以《金匮》用
复脉、建中等汤，是步步照顾脾胃为主。先生宗仲景法而扩充之，绰有余裕，又阐明虚实之
因，用药之理，经权达变，以示人卫生却病之源、理，岂不懿欤。
《黄帝内经》说：虚证用补法，劳损用温法。古人以阴虚、阳虚作为辨证的纲领，于是用八味丸治疗阳虚，用六味丸治疗阴虚，导致温补的风气遍布天下。后来又遇到高谈五行理论的人出现，创立新的方剂，认为百病都从虚证论治，形成了只议论药物而不辨析病机的局面。扁鹊说：一损（病变）在肺，二损在心的，三损在脾的，如果损伤超过脾脏就不可治愈了，这是上损的原因；至于下损的成因，是一损在肾，二损在肝，三损在胃的，如果损伤超过胃也就不可治愈了。《金匮要略》说：极度虚弱的属于劳损，用甘缓的药物调理，如复脉汤、小建中汤之类的方子。又说：皮肤粗糙如鳞甲交错，体内有干血瘀滞，用大黄䗪虫丸主治。由此看来，《金匮要略》治疗虚劳，根据虚和实分别施治，使用方剂时攻补兼施，应当补的就补，应当攻的就攻，不拘泥于一种格式，往往能像敲鼓应声那样迅速见效。然而对于咳嗽、骨蒸潮热、吐血、食欲减退、咽喉疮疡等症状，应当审察其病因，在初起阶段，分辨虚实而用药治疗，也可以转危为安，在极短的时间内恢复健康。如果使用近代人的方法，让温补药横亘在胸中，如同养痈遗患，很难治愈。唉！这不是虚劳病不可治，而是误用温补药导致病情无法挽回。我每次治疗骨蒸劳极、皮肤粗糙如鳞甲交错的患者，采用大黄䗪虫丸的方法，进行加减变化，攻逐宿存的瘀血，清除积滞的血块，往往能应手取效。只有那些曾经服用过滋腻补药的患者，就像油渗入面粉一样难以分离，病根深重顽固，拖延日久，正气已经受损，一百个人里难救一个。况且世人不知道保养自己的身体，自恃药物可以补助身体，乐于接受温补而厌恶攻逐邪气，犹如飞蛾扑火，甘愿走向毁灭，自己却不知道身体已经处于鼎沸般的危险境地。我虽然怀有不忍之心，但也只能算是无能为力的末流医者罢了。
澜按语：虚劳这一疾病，五脏都会涉及，不能专门以阴虚立论，把六味地黄丸滋阴、八味丸益阳当作秘方。有的人用知母、黄柏暂时平息浮游之火，千万不要多投用，唯恐伤害脾阳，导致中焦脾胃失去运化功能，常常引起食欲减退、大便溏泄的祸患，所以《金匮要略》使用复脉汤、小建中汤等方剂，是步步照顾脾胃为主。先生遵循张仲景的方法并加以扩充，绰绰有余，又阐明了虚实产生的原因以及用药的道理，通晓常规与权变的变化，以此向人们展示养生祛病的源头和道理，难道不美好吗？
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "For deficiency, apply tonification; for consumptive disorders, apply warmth." The ancients took Yin deficiency and Yang deficiency as the guiding principles, thereby using Ba Wei Wan (Eight-Ingredient Pill with Rehmannia) to treat Yang deficiency and Liu Wei Wan (Six-Ingredient Pill with Rehmannia) to treat Yin deficiency. This led to a prevalence of warming and tonifying practices throughout the world. Subsequently, individuals who engaged in high-minded discussions on the Five Elements emerged, creating new formulas and asserting that all diseases should be treated from the perspective of deficiency. This resulted in a medical culture that focused on discussing herbs rather than analyzing pathogenesis. Bian Que stated: "First degree damage affects the Lung, second degree affects the Heart, third degree affects the Spleen; if the damage extends beyond the Spleen, it is incurable." This explains the etiology of upper-level damage. Regarding lower-level damage: first degree affects the Kidney, second degree affects the Liver, third degree affects the Stomach; if the damage extends beyond the Stomach, it is also incurable. The *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) states: "Extreme deficiency constitutes Lao (consumptive disorder), which should be regulated with sweet medicines, such as Fumai Tang (Reinstitute the Pulse Decoction) and Xiao Jianzhong Tang (Minor Construct the Middle Decoction)." It further states: "When the skin is rough and scaly like fish scales, indicating dry blood within, Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) should be used." From this, we can see that the treatment of Lao in the *Jingui Yaolue* distinguishes between deficiency and excess, employing formulas that combine purgation and tonification. When tonification is indicated, tonify; when purgation is indicated, purge. Not bound by rigid patterns, such treatments often yield immediate results, akin to the echo following a drumbeat. However, for symptoms such as cough, bone-steaming fever, hemoptysis, anorexia, and throat ulcers, one must examine the underlying causes. During the initial stage, differentiating between deficiency and excess allows for appropriate herbal intervention, potentially turning danger into safety in a very short time. If one employs the methods of contemporary practitioners, allowing warming and tonifying herbs to stagnate in the chest, it is like nurturing a boil and inviting disaster, making cure extremely difficult. Alas! It is not that Lao is incurable, but that the misapplication of warming and tonifying therapies renders the condition irretrievable. In my practice, when treating patients with severe bone-steaming consumption and scaly skin, I utilize the method of Da Huang Zhe Chong Wan, modifying it as needed to attack residual stasis and clear accumulated blood, often achieving prompt efficacy. However, for those who have previously taken cloying tonics, the condition becomes like oil mixed into flour—difficult to separate—with deep-rooted pathology that has persisted for a long time. Their righteous Qi has been damaged, and only one in a hundred might be saved. Moreover, people generally fail to cherish their bodies, relying falsely on medicine for supplementation. They prefer warming tonification and abhor purgative approaches, much like moths flying into fire, willingly marching toward destruction, unaware that their bodies are already in a state of boiling peril. Although I possess a compassionate heart, I am merely a powerless observer in such cases.
Lan’s commentary: Lao is a disease affecting all five Zang organs; it cannot be exclusively attributed to Yin deficiency, nor can Liu Wei Wan for nourishing Yin and Ba Wei Wan for benefiting Yang be regarded as secret prescriptions. Some use Zhi Mu (Anemarrhenae Rhizoma) and Huang Bai (Phellodendri Cortex) temporarily to quell floating fire, but these should never be overused, lest they impair Spleen Yang and disrupt the transportation function of the Middle Jiao, frequently leading to complications such as anorexia and loose stools. Therefore, the *Jingui Yaolue* employs formulas like Fumai Tang and Jianzhong Tang, always prioritizing the protection of the Spleen and Stomach. The Master followed Zhang Zhongjing’s methods and expanded upon them with ample room for maneuver, elucidating the causes of deficiency and excess, as well as the rationale for medication. By demonstrating flexibility between standard procedures and adaptive measures, he revealed the sources and principles of health preservation and disease prevention to others. Is this not admirable?