虚劳损极，统谓之劳，《内经》论之详矣。其绪旁见侧出，令人难寻，惟四乌 骨一
茹丸
一方，纯从血分攻补，实开千古治劳之妙诀。《难经》剖析损至脉证传变，补《内经》所未
；至仲景则治法大备矣。小建中汤，治劳之初起也；复脉汤，治病后之阴虚不复也；薯蓣丸
，治久病大虚，纯补之剂也；大黄 虫丸，治久病血痹，通脉生新之剂也。其义即发原于四
乌骨一 茹丸，诸方或攻或补，莫不从血分讲求手法。盖劳病乃先因气虚，久之气不能运
血，卫阳内陷，津液又为所燔灼，血行不能滑利，而因之瘀痹矣。东坦立补中益气汤，是杜
渐防微之意，非正治之法也。后世不明此义，以参、 为补虚治劳之药，往往气壅不利，遂
以为不受补矣。又或重任桂、附，而觉燥热，遂以为不受温矣。不但此也，人世真劳病少，
假劳病多。吴师朗曾着《不居集》辨之，风寒咳
嗽，饮食停滞，误治以致吐血，因吐血而即用凉润，遂逼入劳门矣。此等病治法，更宜重用
温散于攻血药中，为其风寒邪气为药所逼，固结于血分也。近医只用清凉浇灌，枉死累累，
真可悯也!读张石顽劳损门治案，悉仿乌 、 虫之义，攻令便血、吐血，使瘀尽而病除；
又有用辛温透表之法，使汗出而邪尽，真开千余年之蒙昧，而上接仲景真传者也。私尝综核
此病原委，凡由劳倦忧思内因而起者，亦必兼挟外邪，以正气内陷，外邪即相随而入也。其
脉多弦
芤，或紧涩。治宜补正而兼去邪，攻血以开结塞，生津以活脉络，疏气以鼓阳撑邪，补血以
安中润下。命门火亏者，兼用补火；脾肺气虚者，略兼补气。犹且不可重用补气、骤用补火
，更断断乎不可破气也。予每用温散发表之药，与沉锐攻血之药，以开其络而鼓其气，佐以
生津，使之脉络滑利；佐以补火，使之元气温固，即补气且少用矣，况破气之降泄乎?况寒
凉清肃之扑灭元阳乎?凡由风寒暑湿外因而渐致者，其脉多紧细，或弦滑，重用温里发表以
鼓阳撑邪，攻血理气以开结降浊。不但补血降气不可妄用，即生津补火，且不可滥施。何者
?其人阳气素弱者，至此必水饮内结；其人阳气素盛者，至此必湿热内菀。水结者，宜重宣
散
；热菀者，宜兼凉泄。故生津、补火二者，皆微有不合也。至于用药之法，甘酸者可取味，
而苦辛者必取气，气走而味守也。内因之治，宜走守并用；外因之治，宜重用走。若苦辛用
味，味浓不走，恐苦积而化燥，辛积而化热，故连、柏、姜、桂，皆慎用之。其羌活、 本
、细辛、威灵仙、防风、薄荷、三棱、莪术、姜黄、郁金、虻、 、蛴螬之属，能散邪气而
不破正气，能攻瘀血而又不坏新血，皆治劳之要品也。况近日外因劳病，多是寒湿下受，上
入少阴肾经，命门真火为邪气冲越，不得归根，渐见上热下痿，喘促泄泄，梦魇鬼交，其脉
形尺中动弱，或弦涩，诸品尤为救命仙芝矣。《脉经》曰∶沉而滑，为下重，亦为背膂痛。
即此脉、此病也。是理也，不但市医无从梦见，即高明博雅之士，一闻此说，亦不免胡卢。
医法之失传，岂一日耶!
篇中所叙要品诸药，非谓专以诸药成方也，谓此乃治病之正药，当与补虚之药并用为佐
使也
。世人于此病，只认定一虚字，全不推求所以致虚之故，无怪熟地、当归、人参、白术、龟
板、鳖甲、猪髓、羊肾，日日贪饵，至死不悟。若夫真正虚损，不挟外邪者，无论先天不足
，后天戕贼，皆以金石之精、血肉之华，为填补妙品。今人不敢用金石，而血肉不但取渣滓
，间或偶用金石，亦属锻炼太过，精气全销，只能伤人，不能益人矣。况不对证，其祸更烈
。此正调所以绝响，而沉 永无救挽之期也。予身患此，以重用石药，得延残喘，而韩飞霞
自谓饵鹿 ，以补先天缺陷，其效彰彰。此治真虚之法也，虚损病中之万一耳!此外又有
传
尸鬼注，世称劳瘵，此乃 蚀怪证，不在虚劳之列。其治法须重用杀虫攻血，亦不在虚劳治
法之中，别出可也。
虚劳损极，统称为“劳”，《内经》对此论述得非常详尽。其病情变化错综复杂，令人难以捉摸，唯有“四乌鲗骨一茹丸”这一方剂，纯粹从血分进行攻补治疗，实为开启千古以来治疗劳病的精妙秘诀。《难经》剖析了损脉的脉证及传变规律，弥补了《内经》未涉及的内容；到了张仲景，则治法已非常完备。小建中汤，用于治疗劳病初起；复脉汤，用于治疗病后阴虚不能恢复的情况；薯蓣丸，用于治疗久病大虚，是纯补的方剂；大黄䗪虫丸，用于治疗久病导致的血痹，是通脉生新的方剂。这些方剂的义理都发源于四乌鲗骨一茹丸，各个方剂或攻或补，无不从血分寻求治疗手法。大概劳病是因为先有气虚，时间久了气不能推动血液运行，卫阳内陷，津液又被灼烧，血液运行不再滑利，从而形成瘀痹。李东垣创立补中益气汤，这是防微杜渐的意思，并非正治之法。后世不明白这个道理，把人参、黄芪当作补虚治劳的药物，往往导致气机壅滞不利，于是认为病人“不受补”。或者又重用肉桂、附子，病人感到燥热，于是认为病人“不受温”。不仅如此，世间真正的劳病很少，假劳病很多。吴师朗曾著《不居集》辨析这一点，风寒咳嗽、饮食停滞，因误治导致吐血，因为吐血就立即使用凉润药物，反而将病邪逼入劳门。这类病的治疗，更应该在活血药中重用温散药物，因为风寒邪气被药物逼迫，固结在血分中。近世医生只用清凉浇灌的方法，致使许多人枉死，真是可怜！读张石顽在劳损门的医案，完全仿效乌鲗骨、䗪虫的义理，通过攻逐使便血、吐血排出，使瘀血尽去而疾病消除；又有使用辛温透表的方法，使汗出而邪气尽除，这真是开启了千余年的蒙昧，并上接张仲景的真传。我私下综合考察此病的原委，凡是因劳倦忧思等内因而起的，也必定兼挟外邪，因为正气内陷，外邪随即跟随而入。其脉象多呈弦芤，或紧涩。治疗应当扶正兼以祛邪，活血以开通结塞，生津以活化脉络，疏气以鼓动阳气支撑驱邪，补血以安中和滋润下部。命门火亏者，兼用补火；脾肺气虚者，略兼补气。仍然不可重用补气、骤用补火，更绝对不可以破气。我每次使用温散发表的药物，配合沉锐攻血的药物，以开通络脉并鼓动气机，佐以生津，使脉络滑利；佐以补火，使元气温固，此时即使补气也要少用，何况破气的降泄药呢？何况寒凉清肃之药扑灭元阳呢？凡是由风寒暑湿等外因而逐渐导致的，其脉象多紧细，或弦滑，应重用温里发表以鼓动阳气支撑驱邪，活血理气以开通结滞、降泄浊气。不但补血降气不可妄用，就连生津补火，也不可滥施。为什么呢？如果此人素来阳气虚弱，到这时必然水饮内结；如果此人素来阳气旺盛，到这时必然湿热内郁。水结者，宜重宣散；热郁者，宜兼凉泄。所以生津、补火两种方法，都有些许不合。至于用药的法度，甘酸类药物取其味，而苦辛类药物必取其气，气走窜而味守中。内因的治疗，宜走守并用；外因的治疗，宜重用走窜。如果使用苦辛类药物取其味，味道浓厚而不走窜，恐怕苦积而化燥，辛积而化热，所以黄连、黄柏、干姜、肉桂，都要慎用。像羌活、藁本、细辛、威灵仙、防风、薄荷、三棱、莪术、姜黄、郁金、虻虫、水蛭、蛴螬这类药物，能疏散邪气而不损伤正气，能攻逐瘀血而不败坏新血，都是治疗劳病的重要药物。况且近日的外因劳病，多是寒湿从下受邪，上行进入少阴肾经，命门真火被邪气冲越，不能归根，逐渐出现上热下痿、喘促泄泻、梦魇鬼交等症状，其脉象尺部动弱，或弦涩，上述诸品药物尤为救命的神草。《脉经》说：“沉而滑，主下身沉重，也主背膂疼痛。”就是这种脉象和这种病。这个医理，不但市井医生无从梦见，即使是高明博雅之士，一听到这个说法，也不免发出胡卢之声（表示不解或嘲笑）。医法的失传，难道是一天两天的事吗！
篇中所叙述的这些重要药物，并不是说专门用这些药物组成方剂，而是说这些是治疗疾病的正药，应当与补虚的药物配合，作为佐使药。世人在这个病上，只认定一个“虚”字，完全不推求导致虚的原因，难怪熟地、当归、人参、白术、龟板、鳖甲、猪髓、羊肾，日日贪吃，至死不悟。如果是真正的虚损，不兼挟外邪的，无论先天不足，还是后天戕害，都以金石之精华、血肉之华彩，作为填补的妙品。今人不敢用金石药，而血肉药不仅取用渣滓，偶尔使用金石药，也属于炼制太过，精气全消，只能伤人，不能益人。何况不对证的话，祸患更烈。这正是调元之气所以绝响，而沉疴永无救挽之时啊。我自己患有此病，因重用石药，得以延续残喘，而韩飞霞自称服用鹿茸，以补先天缺陷，效果显著。这是治疗真正虚损的方法，只是虚损病中的万分之一罢了！此外还有传尸鬼注，世人称为劳瘵，这是侵蚀怪证，不在虚劳之列。其治疗方法须重用杀虫攻血，也不在虚劳治法之中，可以单独列出。
Extreme deficiency and exhaustion are collectively referred to as "Lao" (Consumption/Deficiency Syndrome). The *Neijing* (Classic of Internal Canon) has discussed this in detail. Its manifestations are complex and divergent, making it difficult to trace; however, the formula Si Wuie Gu Yi Ru Wan (Cuttlefish Bone and Asparagus Root Pill), which purely tonifies and purges from the Blood level, truly opens a profound secret for treating Lao that has existed for millennia. The *Nanjing* (Classic of Difficult Issues) analyzes the pulse signs and transmission of the Sun (Damage) pulses, supplementing what the *Neijing* did not cover; by the time of Zhang Zhongjing, treatment methods were fully established. Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is used for the initial stage of Lao; Fumai Tang (Restore the Pulse Decoction) is used for Yin deficiency that fails to recover after an illness; Shuyu Wan (Dioscorea Pill) is used for severe deficiency due to long-standing illness, serving as a pure tonifying agent; Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) is used for blood bi (obstruction) caused by long-standing illness, serving as an agent to unblock collaterals and generate new blood. The principles of these formulas originate from Si Wuie Gu Yi Ru Wan; whether purging or tonifying, all seek therapeutic techniques from the Blood level. Generally, Lao disease begins with Qi deficiency; over time, Qi fails to move Blood, Wei Yang (Defensive Yang) sinks inward, and Body Fluids are scorched, causing Blood circulation to lose its smoothness and leading to stasis and obstruction. Li Dongyuan established Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), which reflects the intent of preventing problems before they arise, rather than being the direct treatment method. Later generations failed to understand this principle, using Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) as drugs for tonifying deficiency and treating Lao, often resulting in Qi stagnation and obstruction, leading them to believe patients "cannot tolerate tonification." Or, by heavily using Rougui (Cinnamomi Cortex) and Fuzi (Aconiti Lateralis Radix Praeparata), patients feel dryness and heat, leading them to believe patients "cannot tolerate warming." Moreover, true Lao disease in the world is rare, while false Lao disease is common. Wu Shilang wrote *Buju Ji* (Collection of Non-Abiding) to distinguish this: wind-cold cough and food stagnation, mistreated to cause hematemesis, and then immediately treated with cooling and moistening agents, forcing the pathogen into the category of Lao. For such diseases, treatment should heavily employ warming and dispersing agents within blood-invigorating prescriptions, because the wind-cold pathogens are forced by medication and consolidated in the Blood level. Recent physicians only use cooling and irrigating methods, causing numerous unnecessary deaths, which is truly pitiable! Reading Zhang Shiwan's medical cases in the Lao and Damage section, one sees them entirely imitating the principles of Wuie Gu (Cuttlefish Bone) and Zhechong (Ground Beetle), using purgation to induce hematochezia and hematemesis, eliminating stasis to cure the disease; others use acrid-warm exterior-releasing methods to induce sweating and eliminate pathogens. This truly opens up thousands of years of ignorance and connects directly to the authentic transmission of Zhang Zhongjing. I have privately synthesized the origins of this disease: those arising from internal causes like fatigue, worry, and overthinking must also be accompanied by external pathogens, because when Zheng Qi (Upright Qi) sinks inward, external pathogens follow suit. The pulse is mostly Xian-Kou (Wiry-Hollow) or Jin-Se (Tight-Choppy). Treatment should tonify Zheng Qi while dispelling pathogens, invigorate Blood to open blockages, generate fluids to activate collaterals, regulate Qi to boost Yang to support expulsion of pathogens, and nourish Blood to calm the middle and moisten the lower. If Mingmen Fire (Fire of the Gate of Life) is deficient, add fire-tonifying herbs; if Spleen and Lung Qi are deficient, slightly add Qi-tonifying herbs. However, one must not heavily tonify Qi or abruptly tonify Fire, and absolutely must not break Qi. I often use warming and dispersing exterior-releasing drugs combined with heavy and sharp blood-purging drugs to open collaterals and boost Qi, assisted by fluid-generating herbs to make collaterals smooth; assisted by fire-tonifying herbs to stabilize Yuan Qi (Original Qi). In such cases, even tonifying Qi should be used sparingly, let alone Qi-breaking descending-draining drugs, or cold-cooling clearing-astringent drugs that extinguish Yuan Yang. Those gradually caused by external causes like wind, cold, summer-heat, and dampness usually present with Jin-Xi (Tight-Fine) or Xian-Hua (Wiry-Slippery) pulses. One should heavily use interior-warming and exterior-releasing methods to boost Yang and expel pathogens, and invigorate Blood and regulate Qi to open blockages and descend turbidity. Not only should tonifying Blood and descending Qi not be used recklessly, but generating fluids and tonifying Fire should also not be applied indiscriminately. Why? If a person's Yang Qi is inherently weak, water-fluid retention will form internally at this stage; if a person's Yang Qi is inherently strong, damp-heat will accumulate internally. For water retention, heavy dispersion is suitable; for heat accumulation, mild cooling and draining are suitable. Therefore, both generating fluids and tonifying Fire are somewhat inappropriate. Regarding medication principles, sweet and sour herbs are chosen for their flavor, while bitter and acrid herbs are chosen for their Qi (aroma/volatile nature); Qi moves while Flavor stays. For internal causes, moving and staying methods should be used together; for external causes, moving methods should be heavily used. If bitter and acrid herbs are used for their flavor, the thick flavor will not move, risking bitterness accumulating to create dryness and acridity accumulating to create heat. Therefore, Lianqin (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Jiang (Zingiberis Rhizoma), and Guirui (Cinnamomi Ramulus) must be used with caution. Herbs such as Qianghuo (Notopterygii Rhizoma et Radix), Gaoben (Ligustici Rhizoma et Radix), Xixin (Asari Radix et Rhizoma), Weilingxian (Saposhnikoviae Radix), Fangfeng (Saposhnikoviae Radix), Bohe (Menthae Haplocalycis Herba), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Jianghuang (Curcumae Longae Rhizoma), Yujin (Curcumae Radix), Mengchong (Blattidae), Shuizhi (Hirudo), and Qiluo (Silphidae Larva) can disperse pathogens without damaging Zheng Qi, and attack stasis without destroying new Blood; they are essential products for treating Lao. Moreover, recent external-cause Lao diseases are mostly cold-dampness received from below, entering the Shaoyin Kidney Meridian, where the True Fire of Mingmen is rushed by pathogens and cannot return to its root, gradually showing upper heat and lower flaccidity, panting and diarrhea, nightmares and nocturnal emissions. The pulse shows movement and weakness in the Chi position, or wiriness and choppy quality; these herbs are particularly miraculous lifesavers. The *Maijing* (Pulse Classic) states: "Deep and slippery indicates heaviness in the lower body and pain in the back and spine." This refers to this specific pulse and disease. This theory is not only unknown to city physicians, but even brilliant and erudite scholars, upon hearing it, may laugh in confusion. How long has the loss of medical methods persisted!
The important herbs listed in this chapter do not mean forming prescriptions exclusively from them, but rather that these are the primary drugs for treating the disease and should be used alongside tonifying deficiency drugs as assistants and guides. People regarding this disease only fixate on the character "Xu" (Deficiency), completely failing to investigate the cause of the deficiency. No wonder they greedily consume Shudi (Rehmanniae Radix Preparata), Danggui (Angelicae Sinensis Radix), Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Guiban (Testudinis Carapax et Plastrum), Biejia (Trionycis Carapax), Zhu Sui (Porcine Marrow), and Yang Shen (Ovis/Caprae Testis) daily until death without awakening. For true deficiency damage not accompanied by external pathogens, regardless of congenital insufficiency or acquired injury, the essence of minerals and stones and the splendor of flesh and blood are considered excellent filling products. Today, people dare not use mineral and stone drugs, and for flesh and blood drugs, they only take dregs; occasionally using mineral and stone drugs involves excessive processing, destroying their essence and qi, harming rather than benefiting people. Furthermore, if not indicated correctly, the disaster is even more severe. This is why the transmission of regulating Yuan Qi has ceased, and there seems no hope for saving chronic conditions. I myself suffered from this condition and extended my life by heavily using mineral drugs; Han Feixia claimed that taking Deer Antler (Lurong) compensated for congenital defects, with evident effects. This is the method for treating true deficiency, representing only one ten-thousandth of deficiency diseases! Additionally, there is Chuan Shi Gui Zhu (Transmitting Corpse Ghost Stagnation), commonly known as Lao Zhai (Consumption Tuberculosis), which is a corrosive and strange syndrome, not belonging to the category of Xu Lao (Deficiency Consumption). Its treatment requires heavy use of insect-killing and blood-purging methods, which is distinct from Xu Lao treatment methods and should be categorized separately.