矣。故曰卫气者。所以温分肉。充皮肤。肥腠理。司开阖者也。开阖损其常度。则里
急见焉。于是为证之不足者。且不可以概述矣。主以黄 建中。正于补益中土者。兼足以托实肌表矣。
虚劳腰痛。少腹拘急。小便不利者。八味肾气丸主之。
八味肾气丸方
干地黄（八两） 薯蓣（四两） 山茱萸（四两） 泽泻（三两）
茯苓（三两） 丹皮（三两） 桂枝（一两） 附子（一两炮）
上八味。为末。炼蜜和丸。梧子大。火酒下十五丸。加至二十五丸。日再服。
〔补注〕腰者肾之府。腰痛为肾气之虚寒可知矣。惟虚寒。故少腹拘急。而膀胱之
气亦不化也。苟非益火以助真阳。以消阴翳。恐无以生土。而水得泛溢。不至上
凌君火不止矣。主以八味。固补益先天之至要者也。
虚劳诸不足。风气百疾。薯蓣丸主之。
薯蓣丸方（二钱五分为一分）
薯蓣（二十分） 当归 桂枝 干地黄 曲 豆黄卷（各十分） 甘草（二十八分）
芎 麦门冬 芍药 白术 杏仁（各六分） 人参（十分） 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（百枚为膏）
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。
〔补注〕虚劳不足之证。最易生风。倘不为调摄。必致火气日见不足。则所以善行
数变者。不益流连而不息耶。故于手足太阴少阴上下分补。不仍以中土为主。
务令三焦并益。荣卫和谐。而诸风自息矣。如桂枝、柴胡、防风。借以固表升阳。为
力颇多。非谓以此驱风。转燥津液也。
虚劳。虚烦不得眠。酸枣仁汤主之。
酸枣仁汤方
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。
〔补注〕按嘉言论此方云。素问谓阳气者。烦劳则张。精绝。辟积于夏。使人煎厥。可
见虚劳虚烦。为心肾不交之病。肾水不上交于心火。心火无制。故烦而不得眠。
不独夏月为然矣。方用枣仁为君。而兼知母之滋肾为佐。茯苓、甘草调和其间。
芎入血分而解心火之燥烦也。
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。
大黄 虫丸方
大黄（十分蒸） 黄芩（二两） 甘草（三两） 桃仁（一升）
杏仁（一升） 芍药（四两） 干地黄（十两） 干漆（一两）
虻虫（一升） 水蛭（百枚） 蛴螬（一升） 虫（一升）
上十二味。蜜丸。小豆大。酒饮服五丸。日三服。
〔补注〕嘉言云。七伤。金匮明谓食伤、忧伤、饮伤、房室伤、饥伤、劳伤、经络营卫气伤、
及房劳伤。但居其一。后人不知何见。谓七者阴寒、阴痿、里急、精速、精少、阴下湿、
精滑、小便苦数。临事不举。似乎专主肾伤为言。岂有五劳分主五脏。而七伤独
主一脏之理。虽人身恣逞伤肾者恒多。要不可为一定之名也。故虚劳证。凡本
之内伤者。有此七者之分。而虚劳发热。未有不由瘀血者。若无内伤。则营卫运
行。不失其次。瘀从何起。是必饮食起居。过时失节。营卫凝泣。先成内伤。然后随
其气所阻塞之处。血为瘀积。积之久。牢不可拔。新生之血。不得周灌。与日俱积。
其人尚有生理乎。仲景施活人手眼。以润剂润其血之干。以蠕动啖血之物。行
死血。名之曰缓中补血。岂非以行血去瘀。为安中补虚上着乎。然此特世称干
血劳之良法也。血结在内。手足脉相失者宜之。兼入琼玉膏润补之药同用尤
妙。试为细参其证。肌肤甲错。面目黯黑。及羸瘦不能饮食。全是营血瘀积胃中。
而发见于肌肤面目。所以五脏失中土之灌溉而虚极也。此与五脏之本病不
同。故可用其方而导其胃中之血。以内谷而通流营卫耳。许州陈大夫传仲景
百劳丸方云。治一切劳瘵积滞。不经药坏证者。宜服。大夫其长于谋国者欤。方
用当归、乳香、没药各一钱。虻虫十四个。人参二钱。水蛭十四个。桃仁十四个。浸
去皮尖为细末。炼蜜丸如桐子大。都作一服可百丸。五更用百劳水下。取恶物为度。服白粥十
日。百劳水即甘澜水。以杓扬百遍者也。
（接上文）因此说，卫气的作用，是温煦肌肉，充实皮肤，致密腠理，并主管汗孔的开合。如果开合功能损伤，失去了正常的节度，就会出现腹部拘急的症状。于是对于这种证候的不足表现，就不可以简单概述了。治疗以黄耆建中汤为主，这正是在补益中焦脾胃的同时，兼能固托充实肌表。
出现虚劳腰痛、少腹拘急不舒、小便不利症状的，用八味肾气丸主治。
八味肾气丸方
干地黄（八两） 薯蓣（四两） 山茱萸（四两） 泽泻（三两）
茯苓（三两） 丹皮（三两） 桂枝（一两） 附子（一两，炮制）
以上八味药，研成细末，用炼蜜调和制成丸药，大小如梧桐子。用酒送服十五丸，逐渐加量至二十五丸，每天服用两次。
〔补注〕腰部是肾脏的外府，腰痛说明是肾气的虚寒，这是显而易见的。正因为是虚寒，所以少腹拘急，而且膀胱的气化功能也不正常。如果不是通过益火（温补肾阳）来助长真阳，以消除阴寒之邪，恐怕无法生养脾土，导致水湿泛溢，直到上凌心火才停止。使用八味肾气丸，确实是补益先天之本的重要方法。
薯蓣丸方（二钱五分为一分）
薯蓣（二十分） 当归 桂枝 干地黄 神曲 豆黄卷（各十分） 甘草（二十八分）
川芎 麦门冬 芍药 白术 杏仁（各六分） 人参（十分） 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（一百枚，熬膏）
以上二十一味药研成细末，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。
〔补注〕虚劳不足的证候，最容易产生内风。如果不加以调养摄护，必然导致火气日渐不足，那么那些善于运行且变化多端的风邪，岂不是更加流连不去吗？所以在手太阴肺经、足太阴脾经、手少阴心经、足少阴肾经上下进行分补，并不仅仅以中焦脾胃为主，务必使三焦同时得到补益，营气和卫气和谐，各种风邪自然平息。像桂枝、柴胡、防风这些药，借以固护体表、升发阳气，发挥的作用很多，并不是说靠它们来驱散风邪而转燥津液。
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，取汁六升，加入其他药物，煮取三升，分三次温服。
〔补注〕按张路玉（嘉言）评论此方说，《素问》提到：“阳气者，烦劳则张，精绝，辟积于夏，使人煎厥。”由此可见，虚劳导致的虚烦，是心肾不交的病证。肾水不能上交于心火，心火失去制约，所以心烦而不得睡眠。这不仅仅发生在夏季。方中以酸枣仁为君药，配合知母的滋肾作用作为佐药，茯苓、甘草在中间调和，川芎入血分以解除心火的燥烦。
五种劳损导致极度虚弱消瘦，腹部胀满不能饮食，由饮食所伤、忧思所伤、饮酒所伤、房事所伤、饥饿所伤、劳累所伤、经络营卫气所伤引起。体内有干血（瘀血），肌肤粗糙如鳞甲交错，两眼暗黑，治疗应缓中补虚，用大黄䗪虫丸主治。
大黄䗪虫丸方
大黄（十分，蒸制） 黄芩（二两） 甘草（三两） 桃仁（一升）
杏仁（一升） 芍药（四两） 干地黄（十两） 干漆（一两）
虻虫（一升） 水蛭（一百枚） 蛴螬（一升） 䗪虫（一升）
以上十二味药，用蜂蜜制成丸药，大小如小豆。用酒送服五丸，每天三次。
〔补注〕张路玉（嘉言）说，七种损伤，《金匮要略》明确指出的食伤、忧伤、饮伤、房室伤、饥伤、劳伤、经络营卫气伤，以及房劳伤，只要具备其中一种即可。后人不知道依据什么观点，认为七伤是指阴寒、阳痿、里急、精液早泄、精液量少、阴部潮湿、遗精、小便频数痛苦、临房举不起等，这似乎专门主张是肾脏受伤的说法。难道有五劳分别主管五脏，而七伤却只主管一个脏的道理吗？虽然人体肆意纵欲损伤肾脏的情况很多，但这不能作为固定的名称。所以虚劳证，凡是本源于内伤的，都有这七种损伤的分类。而虚劳发热，没有不是由瘀血引起的。如果没有内伤，那么营卫运行就不会失去次序，瘀血从何而起？这一定是因为饮食起居，过时失节，导致营卫凝滞涩阻，先形成内伤，然后随着气机阻塞的地方，血液瘀积。积聚久了，牢固不可拔除，新生成的血液无法周身灌溉，一天天积累下去，这个人还有生机吗？张仲景施展活人的手段，用润剂滋润干燥的血液，用蠕动类吞食瘀血的虫药，推动死血，命名为“缓中补血”，这难道不是把活血化瘀作为安中补虚的关键吗？然而这只是世称干血劳的良好治法。血结在内，手足脉象不相一致的适宜使用。如果兼用琼玉膏等润补的药物同用尤其奇妙。仔细参究其证候，肌肤粗糙如鳞甲交错，面目暗黑，以及消瘦不能饮食，全是营血瘀积在胃中，而反映在肌肤和面目上，所以五脏失去了中焦脾胃的灌溉而极度虚弱。这与五脏的本病不同，所以可以用这个方子引导胃中的瘀血，通过内谷（食物营养）来通流营卫。许州陈大夫传承张仲景的百劳丸方说，治疗一切劳瘵积滞，没有被药物误治坏证的，适宜服用。这位大夫大概是擅长谋国的人吧？方中使用当归、乳香、没药各一钱，虻虫十四个，人参二钱，水蛭十四个，桃仁十四个，浸泡后去皮尖研成细末，用炼蜜制成如梧桐子大的丸药，总共做成一次服用的量约一百丸。五更天时用百劳水送服，以排出恶物为度。服药后喝十天白粥。百劳水即甘澜水，是用勺子扬了一百遍的水。
(Continuing from the previous text) Therefore, it is said that Wei Qi (Defensive Qi) functions to warm the flesh, fill the skin, consolidate the interstices, and regulate the opening and closing of pores. If the regulation of opening and closing is damaged and loses its normal degree, abdominal tension will manifest. Thus, the insufficiency patterns of such syndromes cannot be simply summarized. The treatment is primarily based on Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle), which, while tonifying the Spleen and Stomach (Middle Jiao), also sufficiently supports and consolidates the muscle and surface.
For deficiency consumption presenting with lower back pain, tension in the lower abdomen, and difficulty in urination, Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) is indicated.
Bawei Shenqi Wan Formula
Shu Di Huang (Rehmanniae Radix Praeparata, 8 liang)
Shan Yao (Dioscoreae Rhizoma, 4 liang)
Shan Zhu Yu (Corni Fructus, 4 liang)
Ze Xie (Alismatis Rhizoma, 3 liang)
Fu Ling (Poria, 3 liang)
Mu Dan Pi (Moutan Cortex, 3 liang)
Gui Zhi (Cinnamomi Ramulus, 1 liang)
Zhi Fu Zi (Aconiti Lateralis Radix Praeparata, 1 liang, processed)
The above eight herbs are ground into powder, mixed with refined honey, and formed into pills the size of wutong seeds. Take 15 pills with wine, increasing gradually to 25 pills, taken twice daily.
[Supplementary Note] The waist is the mansion of the Kidneys; thus, lower back pain indicates deficiency-cold of Kidney Qi. Because of this deficiency-cold, there is tension in the lower abdomen, and the Qi transformation of the Bladder is impaired. Unless one benefits fire to assist True Yang and dissipate yin shadows, it is feared that Earth (Spleen/Stomach) will not be generated, leading to water overflowing until it overcomes Heart Fire. Using Bawei Shenqi Wan is indeed a crucial method for tonifying the congenital foundation.
For various deficiencies of deficiency consumption, along with hundred diseases caused by wind pathogens, Shuyu Wan (Dioscorea Pill) is indicated.
Shuyu Wan Formula (2 qian 5 fen = 1 fen unit)
Shan Yao (Dioscoreae Rhizoma, 20 units)
Dang Gui (Angelicae Sinensis Radix, 10 units)
Gui Zhi (Cinnamomi Ramulus, 10 units)
Shu Di Huang (Rehmanniae Radix Praeparata, 10 units)
Qu (Medicated Leaven, 10 units)
Dou Huang Juan (Sojae Semen Preparatum, 10 units)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 28 units)
Xiong Duan (Ligustici Chuanxiong Rhizoma, 6 units)
Mai Men Dong (Ophiopogonis Tuber, 6 units)
Bai Shao (Paeoniae Radix Alba, 6 units)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 6 units)
Xing Ren (Armeniacae Semen Amarum, 6 units)
Ren Shen (Ginseng Radix, 10 units)
Chai Hu (Bupleuri Radix, 5 units)
Jie Geng (Platycodonis Radix, 5 units)
Fu Ling (Poria, 5 units)
E Jiao (Colla Corii Asini, 7 units)
Gan Jiang (Zingiberis Rhizoma, 3 units)
Bai Lian (Trollii Radix, 2 units)
Fang Feng (Saposhnikoviae Radix, 6 units)
Da Zao (Jujubae Fructus, 100 pieces, made into paste)
The above twenty-one herbs are ground into powder, mixed with refined honey, and formed into pills the size of a marble. Take one pill with wine on an empty stomach. One hundred pills constitute one course of treatment.
[Supplementary Note] Deficiency consumption patterns are prone to generating internal wind. If not properly managed, the fire Qi will gradually diminish, allowing wind pathogens, which are agile and changeable, to linger indefinitely. Therefore, tonification is distributed among the Hand-Taiyin Lung, Foot-Taiyin Spleen, Hand-Shaoyin Heart, and Foot-Shaoyin Kidney meridians, not solely focusing on the Middle Jiao. The goal is to benefit all three Jiaos simultaneously, harmonizing Ying (Nutritive) and Wei (Defensive) Qi, so that various winds subside naturally. Herbs like Gui Zhi, Chai Hu, and Fang Feng are used to secure the exterior and raise Yang, playing a significant role; they are not merely employed to dispel wind at the expense of drying fluids.
For deficiency consumption presenting with empty vexation and insomnia, Suanzaoren Tang (Sour Jujube Seed Decoction) is indicated.
Suanzaoren Tang Formula
Suan Zao Ren (Ziziphi Spinosae Semen, 2 sheng)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 liang)
Zhi Mu (Anemarrhenae Rhizoma, 2 liang)
Fu Ling (Poria, 2 liang)
Xiong Duan (Ligustici Chuanxiong Rhizoma, 2 liang)
Take the above five herbs, add 8 sheng of water, boil the Suan Zao Ren first until 6 sheng remain, then add the other herbs. Boil until 3 sheng remain. Divide into three doses and take warm.
[Supplementary Note] According to Zhang Lu Yu (Jia Yan)'s commentary: *Su Wen* states, "When Yang Qi is subjected to excessive fatigue, it expands; essence is exhausted; accumulated through summer, this leads to Jian Jue (Frying Convulsion)." This shows that empty vexation in deficiency consumption is a disorder of Heart-Kidney non-interaction. When Kidney Water fails to ascend to control Heart Fire, Heart Fire becomes unregulated, causing vexation and insomnia. This is not limited to summer. In the formula, Suan Zao Ren is the Sovereign herb, assisted by Zhi Mu to nourish the Kidney. Fu Ling and Gan Cao harmonize the middle. Xiong Duan enters the Blood level to resolve the dryness and vexation of Heart Fire.
Five types of labor lead to extreme emaciation, abdominal fullness, and inability to eat. These injuries include those from diet, sorrow/worry, drinking/alcohol, sexual activity, hunger, physical labor, and damage to the meridians, Ying, and Wei Qi. There is dried blood (stasis) inside, the skin is rough and scaly like fish scales, and the eyes are dark. The treatment should gently relieve tension and tonify deficiency using Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill).
Dahuang Zhechong Wan Formula
Da Huang (Rhei Radix et Rhizoma, 10 parts, steamed)
Huang Qin (Scutellariae Radix, 2 liang)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 3 liang)
Tao Ren (Persicae Semen, 1 sheng)
Xing Ren (Armeniacae Semen Amarum, 1 sheng)
Bai Shao (Paeoniae Radix Alba, 4 liang)
Shu Di Huang (Rehmanniae Radix Praeparata, 10 liang)
Gan Qi (Drynariae Rhizoma/Dry Lacquer, 1 liang)
Meng Chong (Blatta/Male Blowfly, 1 sheng)
Shui Zhi (Hirudo, 100 pieces)
Qicao (Otiorhynchus Larva, 1 sheng)
E Chong (Ground Beetle, 1 sheng)
The above twelve herbs are made into honeyed pills the size of adzuki beans. Take 5 pills with wine, three times daily.
[Supplementary Note] Zhang Lu Yu (Jia Yan) states that the "Seven Injuries" explicitly mentioned in *Jin Gui Yao Lue* are injuries from diet, sorrow, drinking, sexual activity, hunger, labor, and damage to meridians/Ying-Wei Qi, as well as sexual exhaustion. Having any one of these suffices. Later authors, for unknown reasons, defined seven injuries as coldness, impotence, abdominal urgency, premature ejaculation, scanty semen, dampness in the genital area, spermatorrhea, painful frequent urination, and failure to erect during intercourse. This seems to focus exclusively on Kidney injury. How can Five Labors correspond to the Five Zang organs while Seven Injuries correspond to only one? Although excessive indulgence often damages the Kidney, this cannot be a fixed definition. Therefore, in deficiency consumption originating from internal injury, these seven categories apply. Moreover, fever in deficiency consumption invariably arises from blood stasis. Without internal injury, Ying and Wei Qi would circulate normally, and stasis would not arise. It must be that irregular diet and lifestyle cause stagnation of Ying and Wei Qi, forming internal injury first. Then, where Qi is blocked, blood accumulates as stasis. Over time, it becomes firmly entrenched, preventing new blood from circulating. Day by day, this accumulation worsens; does the person still have vitality? Zhang Zhongjing employed skillful methods: using moistening agents to hydrate dry blood and using creeping creatures to consume dead blood. He named this "relieving tension and replenishing blood." Is this not emphasizing blood activation and stasis removal as the key to stabilizing the middle and tonifying deficiency? However, this is specifically the excellent method for what is known as Dry Blood Consumption. It is suitable when blood is knotted internally and the pulses of hands and feet do not match. Using it concurrently with Qiongyu Gao (Jade Elixir Paste) for moistening tonification is particularly effective. Carefully analyzing the syndrome: rough skin, dark complexion, emaciation, and anorexia indicate that Ying-Blood stasis is accumulated in the Stomach and manifests on the skin and face. Consequently, the Five Zang organs lose the irrigation of the Middle Earth and become extremely deficient. This differs from primary diseases of the Five Zang organs. Thus, this formula can guide the blood in the Stomach, allowing nutrients from food to flow freely through Ying and Wei Qi. Dr. Chen from Xuzhou transmitted Zhongjing's Bailao Wan (Hundred Labor Pill) formula, stating it treats all forms of consumption with stagnation, provided the condition has not been ruined by improper medication. Was this doctor perhaps skilled in statecraft? The formula uses Dang Gui, Ru Xiang (Olibanum), and Mo Yao (Myrrha) each 1 qian, Meng Chong 14 pieces, Ren Shen 2 qian, Shui Zhi 14 pieces, and Tao Ren 14 pieces. After soaking, remove skins and pits, grind to fine powder, and mix with refined honey into pills the size of wutong seeds. Prepare enough for one dose of about 100 pills. Take at dawn (Wu geng) with Bailao Water (Ganlan Water, water stirred vigorously 100 times with a ladle). Continue until foul matter is expelled. Follow with white rice porridge for ten days.