大意
男子之痨。起于伤精。女子之痨。起于经闭。童儿之痨。得于母胎。（指掌）未有不因气体虚弱。劳伤心肾而得
之。以心主血。肾主精。精竭血燥。气衰火旺。蒸疰日久。则痨生焉。（心法）
内因
嗜欲无节。起居不时。七情六欲之火。时动于中。饮食劳倦之过。屡伤乎体。渐而至于真水枯竭。阴火上炎。
而发蒸蒸之躁热。（正传）
外候
睡中盗汗。午后发热。烦躁咳嗽。倦怠无力。饮食少进。痰涎带血。咯唾吐衄。肌肉削瘦。（杂着）
蒸分上下
蒸上则见喘咳痰血。唇焦面红。耳鸣目眩。肺痿肺痈。蒸中则见腹肋胀痛。四肢倦怠。多食而饥。善食而瘦。
蒸下则见遗精淋浊。泄泻燥结。腰疼脚酸。阴茎自强。（入门）
痨有阴阳
阳病口干舌疮。咽痛声哑。能嗜滋味。五心烦疼。小便黄赤。大便燥结。阴病胃逆恶心。饮食难化。痰涎白色。
四肢懈惰。小便常多。大便溏泄。又有嗽痰。仰卧不得者。必阴阳俱病也。（汇补）
五脏传变
凡阴病阳病。日久皆能传变。男子自肾传心肺肝脾。女子自心传肺肝脾肾。五脏复传六腑而死。亦有始
终只传一经者。有专着心肾不传者。大要以脉为症验。（入门）
五脏形症
如精滑胫酸。腰背拘急。邪在肾也。惊悸不寐。自汗心烦。邪在心也。嗽痰咳血。皮枯声嘶。邪在肺也。胁痛善
怒。颈项结核。邪在肝也。泄泻食少。腹胀嗜卧。邪在脾也。（丹溪）
病宜静养
经曰。静则神藏。躁则消亡。欲延生者。心神宜恬静而无躁扰。饮食宜适中而无过伤。风寒暑湿之宜避。行
立坐卧之有常。绝欲以养精。内观以养神。毋劳怒以耗气。则真阴之水自充。五内之火常熄。而痊安可期。
惟其嗜欲无节。使神散而精竭。血涸而气亡。发热不休。形骸骨立。则难为力矣。（指掌）
死候
大抵虚痨之病。两颧赤者死。喉哑失音者死。大肉脱尽者死。泄泻不食者死。一边眠者死。咳吐白血者死。
气促难眠者死。浊溺精脱者死。面目黧黑者死。下部忽发痈肿者死。病后复患痔漏者死。参 不受补者
死。喉痛不能药者死。（医统）
脉法
痨脉或弦或大。大而无力为阳虚。甚则脉细。弦而无力为阴虚。甚则脉数。又大者易治。血气未衰。可敛而
正也。弦者难治。气血已耗。滋补殊难也。尺脉洪大为阴衰火旺。左脉微细。右脉劲紧。为正虚邪盛。必死。如
脉细而数。濡而散者。皆在不治。男子久病。气口脉弱则死。强则生。女人久病。人迎脉强则生。弱则死。（汇补）
治法
万病莫难于治痨。若不究其源本。或投以大寒之药。或疗以大热之剂。殊不知大寒则愈虚其中。大热则
愈竭其内。滋阴降火。是澄其源也。消痰和血。是洁其流也。（十药神书）向后势穷力竭。莫可如何。惟壮水丸以填
阴。异功散以培脾。庶不失中和正治。（汇补）
脾肾分治
夫人之虚。不属于气。即属于血。五脏六腑。莫能外焉。以水为万化之源。无形之本。土为万物之母。有象之
基。二脏安和。一身皆治。故救肾者。必本乎阴血。血主濡之。血属阴。主下陷。虚则上升。当敛而抑。救脾者。必
本乎阳气。气主煦之。气为阳。主上升。虚则下陷。当升而举。（必读）故邵氏曰。死生之机。升降而已。（汇补）
脾肾合治
孙真人云。补脾不若补肾。许学士云。补肾不如补脾。以二脏为生人之根蒂。有相赞之功能。故脾安则土
能生金。金为水源。水安其位。不挟肝上泛而凌土。故曰。脾安则肾愈安也。设以甘寒补肾。其人减食。又恐
不利于脾。以辛温扶脾。其人阴伤。又恐愈耗其水。两者并衡。而较重于脾者。以脾土上交于心。下交于肾故也。（必读）
肺脾审治
如扶脾保肺。两不可缺。然脾喜温燥。肺喜清润。保肺则碍脾。补脾则碍肺。惟燥热而甚。能食不泻者。润肺
为先。而补脾之药亦不可缓。倘虚羸而甚。食少泻多。虽喘嗽不宁。但宜补脾。而清润之品。则宜戒矣。以脾
有生肺之能。肺无扶脾之力。故补脾之法。尤要于保肺也。（微论）
治宜甘温
虚者。必补以人参之甘温。此阳生阴长。血脱益气之义也。自好古肺热伤肺。节斋服参必死之说。印定后
人眼目。甘用苦寒。喜行清润。直至上呕下泻。犹不悔悟。不知肺脉实者。上焦伏热。非参所宜。肺脉虚者。金
气大伤。非参不保。前哲有言曰。土旺而金生。勿拘拘于保肺。水壮而火熄。毋汲汲于清心。信夫。（必读）
治禁苦寒
近世治痨。专以四物加知、柏。不知四物皆阴。行秋冬之令。非所以生万物者也。且血药常滞。非痰多食少
者所宜。血药常润。久用必致滑肠。况知柏苦寒。能泻实火。名曰滋阴。其实燥而损血。名曰降火。其实苦先
入心。久而增气。反能助火。至其败胃。所不待言。（必读）
用药
心虚。主以归脾汤。脾虚。主以补中益气汤。肺虚。主以生脉散。肝虚。主以逍遥散。肾虚。主以地黄汤。随症加
减。若肺脾兼病。主以清宁膏。肝肾俱虚。主以生熟地黄丸。心肾俱虚。主以人参养荣汤。气血俱虚。主以八
珍汤。阴阳俱虚。主以十补丸。脾肾俱虚者。滋肾之中。佐以砂仁、沉香。扶脾之中。主以五味、肉桂。随时活法可耳。
【附传尸痨】
痨瘵既久。其气必伤。伤则不能运化精微。痰瘀稽留。而变幻生虫。（医鉴）在肝为毛虫。食人筋膜。在心为羽
虫。食人血脉。在脾为 虫。食人肌肉。在肺为介虫。食人肤膏。在肾为鳞虫。食人骨髓。（正传）其症蒸热咳嗽。
胸闷背痛。两目不明。四肢无力。腰膝酸疼。卧不能寐。或面色脱白。或两颊时红。常怀怒忿。梦与鬼交。虽分
五脏见症。然皆统归于肺。所谓膏肓之内。针药所不及也。若虫蚀肺系。咯血吐痰。喉疮声哑。思食无厌。皮
枯毛落。患至于此。良可悲悯。惟补虚扶元。杀虫以绝其根。纵不获生。亦可杜其传疰耳。（汇补）
取痨虫法 用秘传黑虎丹三方。次第服之。取下恶物。以烈火烧之。藏之深坑。食葱粥将息。以复元气。
视其虫黄白者可治。青黑者不治。凡用药随脏腑见症。于滋补药中。加青蒿、百部、乌梅、朱砂之类。（汇补）
【附风痨】
风痨者。初起原因咳嗽鼻塞。久则风邪传里。耗气损血。渐变成痨。在表令人自汗。在里令人内热。在肺咳
嗽。在肝吐血。在脾体瘦。在肾泄精。此症载在灵枢。汉唐以来。俱未论及。后世医工。认为内伤积损。辄投峻
补。闭住风邪。内热愈炽。以致不治。惟罗谦甫主以秦艽鳖甲散。吴参黄集柴前梅连散。二公可谓发前人
所未发矣。（汇补）
【附郁痨】
郁痨者。童男少女。孀妇师尼。思想不得。气结于中。并留于内。阻住经脉关要之地。气血不得流通。精神无
以生长。气阻。则积阳为热而骨蒸。血阻。则积阴为寒而倦怠。初起宜逍遥散。合生地黄丸。久则旧血不去。
新血不生。气涩血枯。变为干血痨症。肌肤甲错。面目黧黑。咳嗽困倦。遍身黄肿。月事不行。宜消其瘀血。神
应丸主之。此即仲景大黄 虫丸、百痨丸二方变化而来。世人遇五痨羸瘦。用滋阴而不效。每坐以待毙。
乌足以知仲景妙用哉。但大肉已脱。大便自利者。又当禁用。（汇补）
痨瘵选方
归脾汤 补中益气汤 地黄汤 养荣汤 八珍汤（以上方俱见中风） 生脉散（方见暑症） 逍遥散（方见火症）
清宁膏 润肺不伤脾。补脾不碍肺。凡痨嗽吐血极效。
生地（十两） 麦冬（十两） 橘红（三两） 桔梗（二两） 薏苡仁（八两） 川贝母（二两）
龙眼肉（八两） 苏州薄荷叶末（五钱）
用水煎膏。将薏仁、贝母、薄荷为末。拌入膏中。噙化。缓缓咽下。
拯阴汤 治阴虚火动。皮寒骨热。食少痰多。咳嗽倦怠。焦烦短气。
生地（姜炒上） 归身（中） 麦冬（中） 白芍（中） 五味（下） 人参 炙甘草（下） 莲肉（上不去衣） 薏
仁（中） 橘红（中） 丹皮（中）
水煎。徐徐呷之。肺脉重按有力者。去人参。有血。加阿胶、童便。热盛。加地骨皮。泄泻。减归、地。加
山药、茯苓。倦甚。加人参三钱。咳者。燥痰也。加贝母、桑皮。嗽者。湿痰也。加半夏、茯苓。不寐。加枣
仁。汗多亦用。
拯阳汤 治劳伤气耗。倦怠懒言。动作喘乏。表热自汗。心烦。遍身作痛。
人参（上） 黄 （上） 肉桂（下） 当归（中酒炒） 白术（中） 甘草（下酒炒） 橘红（中） 五味（下）
姜枣水煎服。如烦热口干。加生地。气浮心乱。加丹参、枣仁。咳嗽。加麦冬。挟湿。加茯苓、苍术。
脉沉迟。加熟附。脉实数。去桂。加生地。胸闷。倍橘皮。加桔梗。痰多。加半夏、茯苓。泄泻。加升、
柴。口渴。加干葛。夏月去肉桂。冬月加干姜。
补肝散
生地 熟地 当归 白芍药 石斛 丹皮 柴胡 甘草
十补丸 即桂附八味丸。加鹿茸、五味子各三两。
秘传黑虎丹（初服） 下诸般痨虫。从大便中出。视其虫黄白者可治。青黑者不治。
真牛黄（一钱） 真阿魏（一钱） 南木香（五钱） 真雷丸（五钱） 鸡肫皮（用线鸡肫皮洗净焙干二钱）
将药研细末。用使君子去壳研末二两。加前药七钱。将飞罗白面打糊丸。如梧子大。听用。
小红丸（次服）
锦纹大黄一两。加前药末七钱。炼蜜丸。如黍米大。外用朱砂为衣。听用。
打虫化积丸（三服）
大黄（为末五两五钱） 槟榔（三两） 黑丑（头末三两五钱）
三味用面糊丸。如梧子大。听用。
初服起于四更时。用砂糖水化吞黑虎丹。若壮盛者服二钱五分。虚弱者服二钱。二次五更时。服小红
丸。白糖水化吞。如壮盛者服四十丸。虚弱者服三十五丸。三次天明。服化积丸。用片糖化水吞之。壮盛
者服三钱五分。虚弱者服三钱。虫下为验。如无虫。过二三日再服。至若收功保后。常服河车地黄丸。补
其血气而收全功。如服后泻不止者。宜服异功散。
秦艽鳖甲散 治风痨骨蒸壮热。肌肉削瘦。脉弦数者。
秦艽 知母 当归（各五钱） 鳖甲（一两） 柴胡（一两） 乌梅（一枚）
青蒿（五叶） 地骨皮（一两）
神应丸 治干血痨病。用此推陈致新。然后调理。此方惟少男室女孀妇可用。若男女交接者禁用。
大黄（四两醋炙） 鳖甲 桃仁（各一两） 当归 生地（各八钱） 黄芩 人参 甘草（各三钱）
用韭汁糊为丸。每丸六钱。朱砂为衣。经闭。红花酒下。骨蒸。地骨皮。咳嗽。桑白皮。俱用童便煎下。择除破
日。空心。面东服。少顷。饮酒一杯。至午后。当利一二行为验。啜温粥碗许。忌荤冷油腻物。此药只可一服。
病深者一月后再服除根。不可多服。
灸痨虫法 用癸亥日。灸两腰眼低陷中之穴。每穴灸艾七炷。十一炷尤妙。先隔一日点穴。方睡至半夜
子时。一交癸亥日期。便灸。其虫俱从大便中出。即用火焚之。并埋之深坑中。
大意
男子的劳损病，起因于精气损伤；女子的劳损病，起因于月经闭止；儿童的劳损病，得自母体胎元。（出自《指掌》）没有不是因为体质虚弱，劳累损伤心肾而患病的。因为心主血，肾主精，精液枯竭则血液燥热，气虚则相火旺盛，蒸灼传注日久，于是劳损病就产生了。（出自《心法》）
内因
嗜欲没有节制，起居没有规律，七情六欲之火，时常在体内萌动；饮食不节和过度劳累的过错，屡次伤害身体。逐渐导致真阴（肾水）枯竭，阴火（相火）上炎，从而引发持续的躁热症状。（出自《正传》）
外候
睡中盗汗，午后发热，烦躁咳嗽，倦怠无力，饮食减少，痰中带血，咯吐或鼻出血，肌肉消瘦。（出自《杂着》）
蒸热分上下部位
蒸热在上部，则见气喘咳嗽、痰中带血，嘴唇焦裂、面色红赤，耳鸣目眩，肺痿、肺痈；蒸热在中部，则见腹部和胁肋胀痛，四肢倦怠，虽然多吃却容易饥饿，善于进食却身体消瘦；蒸热在下部，则见遗精、淋浊，腹泻或大便干结，腰痛脚酸，阴茎异常勃起。（出自《入门》）
劳损有阴阳之分
阳证表现为口干舌疮，咽喉疼痛声音嘶哑，喜欢滋味食物，五心烦热，小便黄赤，大便干燥结硬；阴证表现为胃气上逆恶心，饮食难以消化，痰涎白色，四肢懈怠懒惰，小便经常增多，大便溏泄。又有咳嗽吐痰，仰卧不得安卧的，必定是阴阳两脏都患病了。（出自《汇补》）
五脏传变规律
凡是阴证或阳证，日久都能发生传变。男子多从肾传至心肺肝脾，女子多从心传至肺肝脾肾。五脏再传至六腑就会死亡。也有始终只传一经的，有专门涉及心肾而不传其他脏腑的。大体上以脉象作为验证病症的依据。（出自《入门》）
五脏形症表现
如精液滑泄、小腿酸痛、腰背拘急，是邪气在肾；惊悸失眠、自汗心烦，是邪气在心；咳嗽吐痰、咳血、皮肤枯槁声音嘶哑，是邪气在肺；胁痛易怒、颈项结核，是邪气在肝；腹泻食少、腹胀嗜睡，是邪气在脾。（出自朱丹溪）
疾病宜静养
《内经》说：静则神气内藏，躁则神气消亡。想要延长寿命的人，心神应当恬静而没有躁扰。饮食应当适中而不致过伤。应当避开风寒暑湿等外邪，行立坐卧要有常度。断绝房事以保养精气，内观修养以保养精神，不要劳累发怒以耗损元气，那么真阴之水自然充盈，五脏之火常灭，痊愈安康就可以期待了。只有那些嗜欲无节制，使神气涣散而精气枯竭，血液干涸而元气亡失，发热不停，形体瘦骨嶙峋的，那就很难救治了。（出自《指掌》）
死候（预后不良征象）
大致虚劳病，两颧发红的是死证，喉哑失音的是死证，大肉脱尽的是死证，腹泻不能进食的是死证，只能侧卧一侧的是死证，咳吐白沫如血的是死证，气促难以安眠的是死证，小便浑浊、精气脱失的是死证，面目黧黑的是死证，下部突然发生痈肿的是死证，病后复发痔疮瘘管的是死证，人参无法进补的是死证，咽喉疼痛无法服药的是死证。（出自《医统》）
脉法
劳损病的脉象或弦或大。脉大而无力属于阳虚，严重时脉细；脉弦而无力属于阴虚，严重时脉数。脉大者容易治疗，因为气血尚未衰败，可以收敛并纠正；脉弦者难治，因为气血已经耗损，滋补非常困难。尺脉洪大属于阴衰火旺，左脉微细、右脉劲紧，属于正气虚弱邪气盛实，必死。如果脉细而数，濡软而散，都属于不治之症。男子久病，气口脉弱则死，强则生。女子久病，人迎脉强则生，弱则死。（出自《汇补》）
治法
万病中没有比治疗劳损更难的。如果不探究其本源，或者投以大寒的药物，或者用大热的方剂治疗，殊不知大寒药会使中气更加虚寒，大热药会使内里更加枯竭。滋阴降火，是澄清源头；消痰和血，是清洁流弊。（出自《十药神书》）到了后来势穷力竭、无可奈何时，只能用壮水丸来填补真阴，用异功散来培补脾胃，这样才不失中和的正治之法。（出自《汇补》）
脾肾分治
人的虚损，不属于气虚，就属于血虚，五脏六腑都不能例外。以肾水为万物化生的源头，无形的根本；以脾土为万物的母亲，有形的基石。这两脏安宁调和，全身都能得到治理。所以救肾，必须基于阴血。血主濡润，属阴，主下行，虚则气机上逆，应当收敛而抑制它；救脾，必须基于阳气。气主温煦，属阳，主上行，虚则气机下陷，应当升提而举托它。（出自《必读》）所以邵氏说：生死的关键，在于升降而已。（出自《汇补》）
脾肾合治
孙真人说：补脾不如补肾。许学士说：补肾不如补脾。因为这两脏是人生的根基，有相互赞助的功能。所以脾安则土能生金，金为水源，水安其位，不挟带肝气上泛而克伐脾土。所以说：脾安则肾更安。如果用甘寒药补肾，其人食欲减退，又恐怕不利于脾；如果用辛温药扶脾，其人阴液受伤，又恐怕更加耗损肾水。两者权衡，比较重视脾的原因，是因为脾土上交于心，下交于肾的缘故。（出自《必读》）
肺脾审治
如扶脾保肺，两者不可缺。然而脾喜温燥，肺喜清润。保肺则会妨碍脾，补脾则会妨碍肺。只有当燥热严重，能进食且不腹泻时，才以润肺为先，但补脾的药也不可迟缓。倘若极度虚弱消瘦，食少腹泻多，即使喘嗽不安，也只宜补脾，而清润的药物则应当戒除。因为脾有生肺的功能，肺没有扶脾的力量，所以补脾的方法，尤其比保肺重要。（出自《微论》）
治宜甘温
虚证，必须用人参的甘温来补益。这是“阳生阴长”、“血脱益气”的道理。自从李东垣提出肺热伤肺，张节斋说服人参必死的说法，印定了后人的眼光，使人甘用苦寒，喜好清润，直到出现上呕下泻，仍不悔悟。不知道肺脉实者，是上焦伏热，不适合用人参；肺脉虚者，是金气大伤，非人参不能保全。前哲有话说：土旺则金生，不要拘泥于保肺；水壮则火熄，不要急切地清心。确实如此啊！（出自《必读》）
治禁苦寒
近代治疗劳损，专用四物汤加知母、黄柏。不知道四物汤全是阴药，行的是秋冬肃杀之令，不是用来生养万物的。而且血药通常滞涩，不适合痰多食少的人使用。血药通常滋润，久用必然导致滑肠。况且知母、黄柏苦寒，能泻实火，名义上是滋阴，其实是燥烈而损伤血液；名义上是降火，其实是苦味先入心，久用反而增气助火，至于败坏胃气，那是不用说的了。（出自《必读》）
用药
心虚，主治用归脾汤；脾虚，主治用补中益气汤；肺虚，主治用生脉散；肝虚，主治用逍遥散；肾虚，主治用地黄汤。随症状加减。如果肺脾兼病，主治用清宁膏；肝肾俱虚，主治用生熟地黄丸；心肾俱虚，主治用人参养荣汤；气血俱虚，主治用八珍汤；阴阳俱虚，主治用十补丸。脾肾俱虚者，在滋肾之中，佐以砂仁、沉香；扶脾之中，主以五味子、肉桂。随时灵活变通即可。
【附传尸痨】
劳损病久了，其气必然受损。受损则不能运化精微，痰瘀滞留，从而变幻生出虫邪。（出自《医鉴》）在肝为毛虫，吃人筋膜；在心为羽虫，吃人血脉；在脾为蠃虫（原文缺字，据意补），吃人肌肉；在肺为介虫，吃人肤膏；在肾为鳞虫，吃人骨髓。（出自《正传》）其症状有蒸热咳嗽，胸闷背痛，两眼不明，四肢无力，腰膝酸痛，卧床不能入睡。或者面色苍白，或者两颊时而发红，常怀愤怒怨恨，梦见与鬼性交。虽然分为五脏的症状，然而都统归于肺。所谓膏肓之内，针药所不及的地方。如果虫蚀肺系，咯血吐痰，喉疮声哑，思食无厌，皮肤枯槁毛发脱落，患病到了这种地步，实在可悲悯。只有补虚扶元，杀虫以断绝病根，纵然不能获生，也可以杜绝传染。（出自《汇补》）
取痨虫法
用秘传黑虎丹三方，依次服用。排出恶物，用烈火焚烧，藏在深坑中。吃葱粥调养，以恢复元气。看到排出的虫黄白色的可治，青黑色的不治。凡用药随脏腑见症，在滋补药中加入青蒿、百部、乌梅、朱砂之类。（出自《汇补》）
【附风痨】
风痨，初起因咳嗽鼻塞，久则风邪传入体内，耗气损血，逐渐变成劳损。在表令人自汗，在里令人内热，在肺咳嗽，在肝吐血，在脾身体消瘦，在肾泄精。此症记载在《灵枢》，汉唐以来，都没有论述。后世医生，认为是内伤积损，辄然投用峻补药物，闭住风邪，内热更加炽盛，以致不治。只有罗谦甫主张用秦艽鳖甲散，吴参黄集柴前梅连散，这两位先生可以说是发挥了前人所未发的见解。（出自《汇补》）
【附郁痨】
郁痨，童男童女、寡妇师尼，思想不得志，气结于中，并留于内，阻住经脉关要之地，气血不得流通，精神无以生长。气阻，则积阳为热而骨蒸；血阻，则积阴为寒而倦怠。初起宜用逍遥散，合生地黄丸。久则旧血不去，新血不生，气涩血枯，变为干血痨症。肌肤甲错，面目黧黑，咳嗽困倦，遍身黄肿，月事不行。宜消除瘀血，神应丸主治。这就是张仲景的大黄䗪虫丸、百痨丸二方变化而来。世人遇到五劳羸瘦，用滋阴药无效，往往坐以待毙，哪里知道张仲景的妙用呢？但是大肉已脱，大便自利的，又应当禁用。（出自《汇补》）
痨瘵选方
归脾汤 补中益气汤 地黄汤 养荣汤 八珍汤（以上方剂均见中风章节） 生脉散（方剂见暑症章节） 逍遥散（方剂见火症章节） 清宁膏 润肺不伤脾，补脾不碍肺。凡是劳嗽吐血极有效。
生地（十两） 麦冬（十两） 橘红（三两） 桔梗（二两） 薏苡仁（八两） 川贝母（二两）
龙眼肉（八两） 苏州薄荷叶末（五钱）
用水煎成膏。将薏仁、贝母、薄荷研为细末，拌入膏中。含化，缓缓咽下。
拯阴汤 治阴虚火动，皮寒骨热，食少痰多，咳嗽倦怠，焦烦短气。
生地（姜炒） 归身（中量） 麦冬（中量） 白芍（中量） 五味子（下量） 人参 炙甘草（下量） 莲肉（上量，不去衣） 薏仁（中量） 橘红（中量） 丹皮（中量）
水煎，徐徐呷服。肺脉重按有力者，去人参。有血，加阿胶、童便。热盛，加地骨皮。泄泻，减当归、生地，加山药、茯苓。倦甚，加人参三钱。咳者，燥痰也，加贝母、桑白皮。嗽者，湿痰也，加半夏、茯苓。不寐，加枣仁。汗多亦用。
拯阳汤 治劳伤气耗，倦怠懒言，动作喘乏，表热自汗，心烦，遍身作痛。
人参（上量） 黄芪（上量） 肉桂（下量） 当归（中量，酒炒） 白术（中量） 甘草（下量，酒炒） 橘红（中量） 五味子（下量）
姜枣水煎服。如烦热口干，加生地。气浮心乱，加丹参、枣仁。咳嗽，加麦冬。挟湿，加茯苓、苍术。脉沉迟，加熟附子。脉实数，去桂，加生地。胸闷，倍橘皮，加桔梗。痰多，加半夏、茯苓。泄泻，加升麻、柴胡。口渴，加干葛。夏月去肉桂，冬月加干姜。
秘传黑虎丹（初服） 下诸般痨虫，从大便中出。视其虫黄白色的可治，青黑色的不治。
真牛黄（一钱） 真阿魏（一钱） 南木香（五钱） 真雷丸（五钱） 鸡肫皮（用线鸡肫皮洗净焙干二钱）
将药研细末。用使君子去壳研末二两，加前药七钱。将飞罗白面打糊丸，如梧桐子大，听用。
小红丸（次服）
锦纹大黄一两，加前药末七钱。炼蜜丸，如黍米大。外用朱砂为衣，听用。
打虫化积丸（三服）
大黄（为末五两五钱） 槟榔（三两） 黑丑（头末三两五钱）
三味用面糊丸，如梧桐子大，听用。
初服起于四更时，用砂糖水化吞黑虎丹。若壮盛者服二钱五分，虚弱者服二钱。二次五更时，服小红丸，白糖水化吞。如壮盛者服四十丸，虚弱者服三十五丸。三次天明，服化积丸，用片糖化水吞之。壮盛者服三钱五分，虚弱者服三钱。虫下为验。如无虫，过二三日再服。至若收功保后，常服河车地黄丸，补其血气而收全功。如服后泻不止者，宜服异功散。
秦艽鳖甲散 治风痨骨蒸壮热，肌肉削瘦，脉弦数者。
秦艽 知母 当归（各五钱） 鳖甲（一两） 柴胡（一两） 乌梅（一枚）
青蒿（五叶） 地骨皮（一两）
神应丸 治干血痨病。用此推陈致新，然后调理。此方惟少男室女孀妇可用。若男女交接者禁用。
大黄（四两醋炙） 鳖甲 桃仁（各一两） 当归 生地（各八钱） 黄芩 人参 甘草（各三钱）
用韭汁糊为丸。每丸六钱，朱砂为衣。经闭，红花酒下。骨蒸，地骨皮。咳嗽，桑白皮。俱用童便煎下。择除破日。空心，面东服。少顷，饮酒一杯。至午后，当利一二行为验。啜温粥碗许。忌荤冷油腻物。此药只可一服。病深者一月后再服除根。不可多服。
灸痨虫法 用癸亥日，灸两腰眼低陷中之穴。每穴灸艾七炷。十一炷尤妙。先隔一日点穴，方睡至半夜子时，一交癸亥日期，便灸。其虫俱从大便中出。即用火焚之。并埋之深坑中。
General Principles
The lao (consumption) disease in men originates from damage to essence; in women, it originates from amenorrhea; in children, it is acquired from the maternal womb. (From *Zhi Zhang*) There is no case that does not arise due to weak constitution and labor damaging the Heart and Kidney. Since the Heart governs blood and the Kidney governs essence, when essence is exhausted, blood becomes dry; when qi is deficient, ministerial fire flares up. After prolonged steaming and transmission, lao disease arises. (From *Xin Fa*)
Internal Causes
Unrestrained desires and irregular daily routines cause the fires of the seven emotions and six desires to stir within frequently. Excessive eating, drinking, and fatigue repeatedly injure the body. Gradually, this leads to the exhaustion of true yin (Kidney water) and the flaming upward of yin fire (ministerial fire), resulting in persistent restlessness and heat. (From *Zheng Zhuan*)
External Manifestations
Night sweats during sleep, afternoon fever, irritability and cough, fatigue and weakness, reduced appetite, blood-streaked sputum, hemoptysis or epistaxis, and emaciation. (From *Za Zhuo*)
Steaming Heat by Location
Steaming heat in the upper jiao presents with panting, cough, blood in sputum, cracked lips, red face, tinnitus, dizziness, lung abscess, and lung萎 (flaccidity). Steaming heat in the middle jiao presents with abdominal and hypochondriac distension and pain, limb fatigue, polyphagia with hunger, yet thinness despite good appetite. Steaming heat in the lower jiao presents with spermatorrhea and turbid urination, diarrhea or constipation, lower back soreness and leg weakness, and spontaneous erection of the penis. (From *Ru Men*)
Yin and Yang Differentiation of Lao
Yang patterns manifest as dry mouth, tongue sores, sore throat, hoarseness, preference for rich flavors, five-palm heat, yellow-red urine, and dry hard stools. Yin patterns manifest as stomach rebellion with nausea, difficulty digesting food, white sputum, limb lethargy, frequent urination, and loose stools. Cases with coughing up sputum and inability to lie supine indicate simultaneous involvement of both yin and yang organs. (From *Hui Bu*)
Transmission among Five Zang Organs
Both yin and yang patterns can transmit over time. In men, transmission typically proceeds from Kidney to Heart, Lung, Liver, and Spleen; in women, from Heart to Lung, Liver, Spleen, and Kidney. Transmission from the five zang to the six fu organs leads to death. Some cases involve only one meridian, while others focus solely on Heart and Kidney without transmitting elsewhere. Generally, pulse diagnosis serves as the verification of symptoms. (From *Ru Men*)
Organ-Specific Symptoms
Spermatorrhea, calf soreness, and stiffness of waist and back indicate pathogen in the Kidney. Palpitations, insomnia, spontaneous sweating, and irritability indicate pathogen in the Heart. Cough with sputum, hemoptysis, dry skin, and hoarseness indicate pathogen in the Lung. Hypochondriac pain, irritability, and neck lymphadenopathy indicate pathogen in the Liver. Diarrhea, poor appetite, abdominal distension, and lethargy indicate pathogen in the Spleen. (From Zhu Danxi)
Management: Importance of Rest
The Classics state: "Stillness allows the spirit to reside; agitation causes its dissolution." Those seeking longevity should keep the mind tranquil and free from agitation. Diet should be moderate to avoid injury. One must avoid wind, cold, summer-heat, and dampness, and maintain regularity in movement and rest. Abstinence preserves essence; introspection nourishes the spirit. Avoiding labor and anger prevents qi depletion. Thus, true yin water will naturally fill, and internal fire will extinguish, leading to recovery. However, those with unrestrained desires who scatter their spirit, exhaust their essence, dry up their blood, and lose their qi, presenting with unceasing fever and skeletal emaciation, are difficult to treat. (From *Zhi Zhang*)
Prognostic Signs of Death
Generally, in deficiency lao, red malar flush indicates death; hoarseness and loss of voice indicate death; complete wasting of muscles indicates death; diarrhea with anorexia indicates death; ability to sleep only on one side indicates death; expectoration of white froth resembling blood indicates death; shortness of breath preventing sleep indicates death; turbid urine and essence loss indicate death; dark complexion indicates death; sudden onset of carbuncles in the lower body indicates death; recurrence of hemorrhoids/fistulas after illness indicates death; inability to tolerate tonification (e.g., Ginseng) indicates death; severe throat pain preventing medication intake indicates death. (From *Yi Tong*)
Pulse Diagnosis
Lao pulses may be wiry or large. A large but forceless pulse indicates yang deficiency; if severe, the pulse becomes fine. A wiry but forceless pulse indicates yin deficiency; if severe, the pulse becomes rapid. A large pulse is easier to treat as qi and blood are not yet depleted and can be gathered and corrected. A wiry pulse is difficult to treat as qi and blood are already consumed, making tonification hard. A flooding and large radial pulse at the chi position indicates yin decline and fire flourishing. A faint and fine left pulse with a firm and tight right pulse indicates deficiency of righteous qi and excess of pathogenic factors, leading to death. Fine-rapid, soggy, and scattered pulses are also untreatable. In men with chronic illness, a weak kou (cun) pulse indicates death, while strong indicates survival. In women, a strong ying (chi) pulse indicates survival, while weak indicates death. (From *Hui Bu*)
Treatment Principles
Treating lao is the most difficult among all diseases. Without investigating the root, using overly cold medicines further damages the middle jiao, while overly hot medicines further deplete the interior. Nourishing yin and descending fire clarifies the source; resolving phlegm and harmonizing blood cleanses the flow. (From *Shi Yao Shen Shu*) When strength is exhausted and no other options remain, use Zhuang Shui Wan to fill yin and Yi Gong San to cultivate the spleen, adhering to the principle of balanced, correct treatment. (From *Hui Bu*)
Differentiated Treatment of Spleen and Kidney
Deficiency involves either qi or blood, affecting all zang-fu organs. Kidney water is the source of transformation and the formless root; Spleen earth is the mother of all things and the有形 foundation. If these two organs are harmonious, the whole body is regulated. To rescue the Kidney, one must base treatment on yin-blood. Blood moistens, belongs to yin, and tends to sink; deficiency causes rising, requiring astringency and suppression. To rescue the Spleen, one must base treatment on yang-qi. Qi warms, belongs to yang, and tends to rise; deficiency causes sinking, requiring lifting and raising. (From *Bi Du*) As Shao stated: The mechanism of life and death lies in ascending and descending. (From *Hui Bu*)
Combined Treatment of Spleen and Kidney
Sun Simiao said: Tonifying the spleen is inferior to tonifying the kidney. Xu Dachun said: Tonifying the kidney is inferior to tonifying the spleen. These two organs are the roots of life and mutually support each other. When the spleen is secure, earth generates metal (lung); metal is the source of water; when water is secure, it does not carry liver qi upward to invade earth. Thus, securing the spleen secures the kidney. Using sweet-cold herbs to tonify the kidney may reduce appetite and harm the spleen; using acrid-warm herbs to support the spleen may injure yin and deplete water. Weighing both, priority is given to the spleen because spleen earth communicates with the heart above and the kidney below. (From *Bi Du*)
Careful Treatment of Lung and Spleen
Supporting the spleen and protecting the lung are both essential. However, the spleen prefers warm-dry, while the lung prefers clear-moist. Protecting the lung may hinder the spleen; tonifying the spleen may hinder the lung. Only when dry-heat is severe, appetite is good, and there is no diarrhea, should moistening the lung take precedence, though spleen-tonifying herbs should not be delayed. If emaciation is severe, with poor appetite and frequent diarrhea, even with restless coughing, only spleen tonification is appropriate, and clearing-moistening agents should be avoided. The spleen has the capacity to generate the lung, but the lung cannot support the spleen; thus, spleen tonification is more critical than lung protection. (From *Wei Lun*)
Preference for Sweet-Warm Therapies
Deficiency must be supplemented with the sweet-warm properties of Ren Shen (Ginseng). This follows the principle of "yang generating yin" and "tonifying qi in blood loss." Since Li Dongyuan's theory of lung heat injuring the lung and Zhang Jiezi's claim that taking ginseng causes death, many have been misled into preferring bitter-cold and clearing-moistening methods, leading to vomiting and diarrhea without repentance. They fail to realize that a solid lung pulse indicates latent heat in the upper jiao, unsuitable for ginseng; a deficient lung pulse indicates severe injury to metal qi, requiring ginseng for preservation. As ancients said: When earth is prosperous, metal is born; do not rigidly focus on protecting the lung. When water is strong, fire extinguishes; do not anxiously focus on clearing the heart. This is true. (From *Bi Du*)
Contraindication of Bitter-Cold Herbs
Modern treatments for lao often use Si Wu Tang plus Zhi Mu and Huang Bai. However, Si Wu Tang consists entirely of yin herbs, acting like autumn/winter energy, which does not generate life. Blood-invigorating herbs are often cloying, unsuitable for those with much phlegm and little food. They are also moistening, causing loose stools with long-term use. Moreover, Zhi Mu and Huang Bai are bitter-cold, clearing excess fire. Though called "nourishing yin," they are actually drying and damaging to blood; though called "descending fire," bitterness enters the heart first, and long-term use increases qi, potentially aiding fire. Their damaging effect on the stomach is self-evident. (From *Bi Du*)
Prescription Selection
Heart deficiency: Gui Pi Tang. Spleen deficiency: Bu Zhong Yi Qi Tang. Lung deficiency: Sheng Mai San. Liver deficiency: Xiao Yao San. Kidney deficiency: Di Huang Tang. Adjust based on symptoms. Lung-Spleen dual deficiency: Qing Ning Gao. Liver-Kidney dual deficiency: Sheng Shu Di Huang Wan. Heart-Kidney dual deficiency: Ren Shen Yang Rong Tang. Qi-Blood dual deficiency: Ba Zhen Tang. Yin-Yang dual deficiency: Shi Bu Wan. Spleen-Kidney dual deficiency: Add Sha Ren and Chen Xiang to kidney-nourishing formulas; add Wu Wei Zi and Rou Gui to spleen-supporting formulas. Adapt flexibly.
[Appendix: Infectious Consumption]
Long-standing lao injures qi, impairing the transformation of essence and micro-nutrients. Phlegm and stasis accumulate, transforming into parasites. (From *Yi Jian*) In the Liver, they are hair-parasites eating tendons; in the Heart, feather-parasites eating blood vessels; in the Spleen, flesh-parasites eating muscle; in the Lung, shell-parasites eating skin fat; in the Kidney, scale-parasites eating bone marrow. (From *Zheng Zhuan*) Symptoms include steaming fever, cough, chest/back pain, blurred vision, limb weakness, sore waist/knees, insomnia, pale complexion or malar flush, anger, and dreams of sexual intercourse with ghosts. Although symptoms vary by organ, they all converge on the Lung, specifically the Gaohuang area, beyond the reach of needles and drugs. If parasites erode the lung system, causing hemoptysis, throat sores, hoarseness, insatiable appetite, dry skin, and hair loss, the condition is pitiable. Only by tonifying deficiency, supporting yuan qi, and killing parasites to cut off the root can transmission be prevented, even if cure is unlikely. (From *Hui Bu*)
Method to Extract Parasites
Use Mi Chuan Hei Hu Dan in sequence. Expel foul matter, burn it, and bury it deep. Consume scallion porridge to restore qi. Yellow-white worms are treatable; black-green worms are not. Add Qing Hao, Bai Bu, Wu Mei, and Zhu Sha to tonifying prescriptions based on organ symptoms. (From *Hui Bu*)
[Appendix: Wind Consumption]
Wind consumption begins with cough and nasal congestion. Prolonged wind pathogen transmits inward, consuming qi and blood, gradually becoming lao. Exterior wind causes spontaneous sweating; interior wind causes internal heat. In the Lung, cough; in the Liver, hematemesis; in the Spleen, emaciation; in the Kidney, seminal emission. Recorded in *Ling Shu*, ignored until later dynasties. Later physicians mistook it for internal injury and used harsh tonics, trapping wind and exacerbating heat. Luo Qianfu proposed Qin Jiao Bie Jia San; Wu Canhuang advocated Chai Qian Mei Lian San. These pioneers offered new insights. (From *Hui Bu*)
[Appendix: Stagnation Consumption]
Stagnation consumption affects youths, widows, and nuns whose desires go unfulfilled. Qi stagnates internally, blocking meridians, hindering qi-blood flow and spirit growth. Qi blockage accumulates yang into heat (bone-steaming); blood blockage accumulates yin into cold (lethargy). Early stage: Xiao Yao San combined with Sheng Di Huang Wan. Chronic stage: old blood remains, new blood fails to generate, leading to dry blood lao. Symptoms: rough skin, dark face, cough, fatigue, generalized edema, amenorrhea. Eliminate stasis with Shen Ying Wan, derived from Zhang Zhongjing's Da Huang Zhe Chong Wan. Modern doctors fail with yin-nourishing herbs, waiting for death, unaware of Zhongjing's wisdom. Contraindicated in severe muscle wasting with spontaneous diarrhea. (From *Hui Bu*)
Selected Formulas for Lao
Gui Pi Tang, Bu Zhong Yi Qi Tang, Di Huang Tang, Yang Rong Tang, Ba Zhen Tang (see Stroke chapter); Sheng Mai San (see Summer-Heat chapter); Xiao Yao San (see Fire chapter).
Qing Ning Gao: Moistens lung without harming spleen, tonifies spleen without hindering lung. Highly effective for lao cough and hemoptysis.
Ingredients: Sheng Di (10 liang), Mai Dong (10 liang), Ju Hong (3 liang), Jie Geng (2 liang), Yi Yi Ren (8 liang), Chuan Bei Mu (2 liang), Long Yan Rou (8 liang), Bo He Ye powder (5 qian).
Preparation: Decoct in water to make paste. Mix Yi Yi Ren, Bei Mu, and Bo He powders into the paste. Hold in mouth and swallow slowly.
Zheng Yin Tang: Treats yin deficiency with fire hyperactivity, cold skin/hot bones, poor appetite, profuse phlegm, cough, fatigue, irritability, and shortness of breath.
Ingredients: Sheng Di (fried with ginger), Dang Gui, Mai Dong, Bai Shao, Wu Wei Zi, Ren Shen, Zhi Gan Cao, Lian Rou (uncleaned), Yi Yi Ren, Ju Hong, Dan Pi.
Preparation: Decoct in water, sip slowly. If lung pulse is forceful on deep pressure, remove Ren Shen. If blood is present, add E Jiao and Tong Bian. If heat is severe, add Gu Pi. If diarrhea, reduce Dang Gui/Sheng Di, add Shan Yao/Fu Ling. If extreme fatigue, add Ren Shen (3 qian). For dry cough, add Bei Mu/Sang Bai Pi. For wet cough, add Ban Xia/Fu Ling. For insomnia, add Suan Zao Ren. Also for excessive sweating.
Zheng Yang Tang: Treats lao injury with qi depletion, lethargy, reluctance to speak, panting on exertion, exterior heat, spontaneous sweating, irritability, and generalized pain.
Ingredients: Ren Shen, Huang Qi, Rou Gui, Dang Gui (wine-fried), Bai Zhu, Zhi Gan Cao (wine-fried), Ju Hong, Wu Wei Zi.
Preparation: Decoct with Ginger and Jujube. If irritability/dry mouth, add Sheng Di. If floating qi/heart chaos, add Dan Shen/Suan Zao Ren. If cough, add Mai Dong. If dampness, add Fu Ling/Cang Zhu. If deep-slow pulse, add Shu Fu Zi. If full-rapid pulse, remove Rou Gui, add Sheng Di. If chest stuffiness, double Ju Pi, add Jie Geng. If profuse phlegm, add Ban Xia/Fu Ling. If diarrhea, add Sheng Ma/Chai Hu. If thirst, add Ge Gen. Remove Rou Gui in summer, add Gan Jiang in winter.
Bu Gan San
Ingredients: Sheng Di, Shu Di, Dang Gui, Bai Shao, Shi Hu, Dan Pi, Chai Hu, Gan Cao.
Shi Bu Wan
Formula: Gui Fu Ba Wei Wan plus Lu Rong and Wu Wei Zi (3 liang each).
Mi Chuan Hei Hu Dan (First Stage)
Expels various lao parasites via stool. Yellow-white worms are treatable; black-green are not.
Ingredients: Zhen Niu Huang (1 qian), Zhen A Wei (1 qian), Nan Mu Xiang (5 qian), Zhen Lei Wan (5 qian), Ji Zhen Pi (cleaned, dried, 2 qian).
Preparation: Grind to fine powder. Mix with Shi Jun Zi powder (2 liang) and previous powder (7 qian). Use refined wheat flour paste to make pills, size of Sophora seeds.
Xiao Hong Wan (Second Stage)
Jin Wen Da Huang (1 liang) mixed with previous powder (7 qian). Honey-pill, size of millet seed. Coat with Zhu Sha.
Da Chong Hua Ji Wan (Third Stage)
Da Huang powder (5.5 liang), Bing Lang (3 liang), Hei Chou head powder (3.5 liang).
Preparation: Wheat paste pills, size of Sophora seeds.
Administration:
1. Fourth watch (approx. 1-3 AM): Dissolve Hei Hu Dan in sugar water. Strong patients: 2.5 qian; weak: 2 qian.
2. Fifth watch (approx. 3-5 AM): Take Xiao Hong Wan in white sugar water. Strong: 40 pills; weak: 35 pills.
3. Dawn: Take Hua Ji Wan in rock sugar water. Strong: 3.5 qian; weak: 3 qian.
Success is indicated by expulsion of worms. If none, repeat after 2-3 days. For recovery, regularly take He Che Di Huang Wan to tonify qi-blood. If diarrhea persists, take Yi Gong San.
Qin Jiao Bie Jia San
Treats wind-lao with bone-steaming high fever, emaciation, and wiry-rapid pulse.
Ingredients: Qin Jiao, Zhi Mu, Dang Gui (each 5 qian), Bie Jia (1 liang), Chai Hu (1 liang), Wu Mei (1 piece), Qing Hao (5 leaves), Di Gu Pi (1 liang).
Shen Ying Wan
Treats dry blood lao. Promotes elimination of old and generation of new before regulation. Suitable for unmarried youths and widows. Contraindicated for sexually active individuals.
Ingredients: Da Huang (vinegar-fried, 4 liang), Bie Jia, Tao Ren (each 1 liang), Dang Gui, Sheng Di (each 8 qian), Huang Qin, Ren Shen, Gan Cao (each 3 qian).
Preparation: Leek juice paste pills, 6 qian each. Coat with Zhu Sha. For amenorrhea, take with Red Flower wine. For bone-steaming, take with Di Gu Pi decoction. For cough, take with Sang Bai Pi decoction. All taken with child's urine. Select auspicious days. Take fasting, facing east. Drink a cup of wine shortly after. Expect 1-2 bowel movements in the afternoon. Eat warm porridge. Avoid meat, cold, and greasy foods. Only one dose allowed. For deep disease, repeat after one month. Do not overdose.
Moxibustion for Parasites
On Gui Hai day, moxa points in the depression of both lumbar regions. Seven moxa cones per point; eleven is better. Mark points one day prior. Sleep until midnight Zi hour. On Gui Hai day, perform moxibustion. Worms exit via stool. Burn and bury them deeply.