问曰。血痹病从何得之。师曰。夫尊荣人。骨弱肌肤盛。重因疲劳。汗出。卧不时动摇。加被微风。
遂得之。但以脉自微涩。在寸口关上小紧。宜针引阳气。令脉和。紧去则愈。
（因。赵本。作困。卧上。脉经。有起字。加作如。关上下。沈本有尺中二字。千金。但上。
有形如风状四字。紧上无小字。脉经并同。）
〔鉴〕历节。属伤气也。气伤痛。故疼痛也。血痹。属伤血也。血伤肿。故麻木也。前以明邪气聚于
气分。此以明邪气凝于血分。故以血痹名之也。尊荣人。谓膏粱之人。素食甘肥。故骨弱肌肤盛重。是以不任
疲劳。则汗出。汗出则腠理开。亦不胜久卧。卧则不时动摇。动摇即加被微风。亦遂得以干之。此言膏粱之人
。外盛内虚。虽微风小邪。易为病也。然何以知病血痹也。但以身体不仁。脉自微涩。则知邪
凝于血故也。寸口关上小紧。亦风寒微邪。应得之脉也。针
能导引经络。取诸痹。故宜针引气血。以泻其邪。令脉不涩而和。紧去邪散。血痹自通也。
医通云。血痹者。寒湿之邪。痹着于血分也。辛苦劳 之人。皮腠致密。筋骨坚强。虽有风寒湿邪。莫
之能客。惟尊荣奉养之人。肌肉丰满。筋骨柔脆。素常不胜疲劳。行卧动摇。或遇微风。则能痹着为患。不
必风寒湿之气杂至。而为病也。夫血痹者。即内经所谓在脉则血凝不流。仲景直发其所以不流之故。言血既痹。
脉自微涩。然或寸或关或尺。其脉见小急之处。即风入之处也。故其针药所施。皆引风外
出之法也。
案五脏生成篇曰。卧出而风吹之。血凝于肤者为痹。王注。痹。谓 痹也。（广韵。 音顽。巢源千金。
间有顽痹之文。知顽麻之顽。原是 字。）此即血痹也。而易通卦验曰。太阳脉虚。多病血痹。
郑玄注。痹者气不达。未当至为病。盖血痹之称。 见于此。千金云。风痹游走无定处。名曰血痹。后世呼麻
木者。即是。活人书云。痹者。闭也。闭而不仁。故曰痹也。本出于中藏经。
血痹。阴阳俱微。寸口关上微。尺中小紧。外证身体不
仁。如风痹状。黄 桂枝五物汤主之。（千金。作如风状。脉经作如风落状。并非。）
〔鉴〕此承上条。互详脉证。以明其治也。上条言六脉微涩。寸口关上小紧。此条言阴阳。寸口关上俱
微。尺中亦小紧。合而观之。可知血痹之脉。浮沉寸口关上尺中。俱微俱涩俱小紧也。微者。虚也。涩者。滞
也。小紧者。邪也。故血痹应有如是之诊也。血痹外证。亦身体顽麻。不知痛痒。故曰如风痹状。
〔沈〕血
痹。乃阴阳营卫俱微。邪入血分。而成血痹。中上二焦阳微。所以寸口关上脉。亦见微。微邪下连营血主病。
故尺中小紧。是因气虚受邪而成血痹也。用桂芍姜枣。调和营卫。而宣阳气。虽然。邪痹于血。因表阳
失护而受邪。故以黄 。补其卫外之阳。阴阳平补。俾微邪去。而痹自开矣。
〔尤〕不仁者。肌体顽痹。痛
痒不觉。如风痹状。而实非风也。以脉阴阳俱微。故不可针。而可药。经所谓阴阳形气俱不足者。勿刺以针。而
调以甘药也。
案血气形志篇王注。不仁。谓不应用则 痹矣。巢源血痹候云。血痹者。由体虚邪入于阴经故也。血为
阴。邪入于血。而痹。故为血痹也。其状形体如被微风所吹。此形容顽
痹之状也。风痹诸家不注。唯金鉴云。不似风痹历关节流走疼痛也。此以风痹。为历节。恐误也。巢源风痹候
云。痹者风寒湿三气杂至。合而成痹。其状肌肉顽浓。或疼痛。由人体虚。腠理开。故受风邪也。据此则
风痹。乃顽麻疼痛兼有。而血痹。则唯顽麻而无疼痛。历节则唯疼痛。而不顽麻。三病各异。岂可混同乎。
黄 桂枝五物汤方
黄 （三两） 芍药（三两） 桂枝（三两） 生姜（六两） 大枣（十二枚○赵本作十一枚非）
上五味。以水六升。煮取二升。温服七合。日三服。
（〔原注〕一方。有人参。○案千金。用人参三两。凡六味。故单名黄 汤。无五物二字。）
案据桂枝汤法。生姜当用三两。而多至六两者何。生
姜味辛。专行痹之津液。而和营卫药中用之。不独专于发散也。成氏尝论之。其意盖亦在于此耶。
夫男子平人。脉大为劳。极虚亦为劳。（尤本极上。有脉字。）
〔魏〕虚劳者。因劳而虚。因虚而病也。人之气通于呼吸。根于脏腑。静则生阴。动则生阳。阴阳本气之
动静所生。而动静能生气之阴阳。此二神两化之道也。故一静一动。互为其根。在天在人。俱贵和平。而无
取于偏胜。偏则在天之阳愆阴伏。而化育乖。在人则阳亢阴独。而疾病作。然则虚劳
者过于动。而阳烦。失于静而阴扰。阴日益耗。而阳日益盛也。是为因劳而虚。因虚而病之由然也。（虚劳
必起于内热。终于骨蒸。有热者十有七八。其一二虚寒者。必邪热先见。而其后日久。随正气俱衰也。）夫脉大
者。邪气盛也。极虚者。精气夺也。以二句揭虚劳之总。而未尝言其大在何脉。虚则何经。是在主治者。随五
劳七伤之故。而谛审之。岂数言可尽者乎。
〔鉴〕李 曰。平人者。形如无病之人。经云。脉病患不病者是也。劳则体疲于外。气
耗于中。脉大非气盛也。重按必空濡。乃外有余。而内不足
之象。脉极虚则精气耗矣。盖大者。劳脉之外暴者也。极虚者。劳脉之内衰者也。
男子面色薄者。主渴及亡血。卒喘悸。脉浮者。重虚也。
〔魏〕仲景再为验辨之于色于证于脉以决之。男子面色薄即不泽也。此五脏之精夺。而面色失其光润也。
然光必在面皮内蕴。润必在面皮内敷。方为至浓。若夫见呈耀。则亦非正浓色矣。今言薄。则就无光润者言
也。其人必患消渴。及诸失亡其血之疾。因而喘于胸。而悸于心。卒者。忽见忽已之谓。
〔沈〕阴血虚。而阳
气则盛。虚火上潜。津液不充则渴。气伤而不摄血。则亡血。虚阳上逆。冲肺卒喘。心营虚而真气不敛。则
悸。
〔尤〕脉浮为里虚。以劳则真阴失守。孤阳无根。气散于外。而精夺于内也。
男子脉虚沉弦。无寒热。短气里急。小便不利。面色白。时目瞑兼衄。少腹满。此为劳使之然。（
脉经。作时时目瞑。）
〔鉴〕此复申虚极为劳。以详其证之义也。脉虚沉弦。阴阳俱不足也。无寒热。是阴阳虽不足。而不相
乘也。短气面白时瞑兼衄。乃上焦虚。而血不荣也。里急小便不利少腹满。乃下焦虚而气不行也。凡此脉证。
皆因劳而病也。故曰。此为劳使之然。
〔程〕白为肺色。鼻为肺窍。气既不能下化。则上逆于头。故目为之
瞑。迫于血而鼻为之衄也。内经曰。劳则气耗。其类是欤。
案本篇。标男子二字者。凡五条。未详其意。诸家亦置
而无说。盖妇人有带下诸病。产乳众疾。其证似虚劳而否者。不能与男子无异。故殊以男子二字别之欤。
劳之为病。其脉浮大。手足烦。春夏剧。秋冬瘥。阴寒
精自出。酸削不能行。（脉经。酸上有足字。行下有少阴虚满四字。酸削。巢源
作 。外台作 削。）
〔徐〕脉大既为劳矣。而更加浮。其证则手足烦。盖阴既不足。而阳必盛也。
〔魏〕邪本阴亏阳亢。内生
之焰也。然亦随天时为衰旺。春夏者阳时也。阴虚之病必剧。秋冬者阴时也。阴虚之病稍瘥。火盛于上。则
必阳衰于下。邪火炽于上焦。邪寒凝于下焦。阴寒即内迫。阳精自外出。为白浊。为遗精。为鬼交。皆上盛下
虚之必致也。精既出夺。必益虚寒。腿脚酸软。肌肉瘦削。遂不可行立。而骨痿不能起于床矣。
案阴寒。程云。寒字作虚字看。金鉴直以为传写之讹。误甚矣。阴寒者。阴冷也。乃七伤之一。巢源云。
肾主精。髓开窍于阴。今阴虚阳弱。血气不能相荣。故使阴冷也。久不已。则阴痿弱。是也。魏为阴寒之气。
亦非。酸削。巢源作 。周礼。 首疾。注云。 。酸削也。疏云。人患头痛。则有酸嘶而痛。千金妇
人门。酸 恍惚。不能起居。刘熙释名云。酸。逊也。逊遁在后也。言脚疼力少。行遁在
后。以逊遁者也。消。弱也。如见割消。筋力弱也。即酸削。 。酸嘶。酸 。与酸削同。
朱氏格致余论云。内经冬不藏精者。春必病温。若于此时。纵嗜欲。至春升之际。必有温热病。今人多
春末夏初。患头痛脚软。食少体热。仲景谓春夏剧秋冬瘥。正俗所谓注夏病也。案本条所说。与注夏病不相
干。此恐非也。
男子。脉浮弱而涩。为无子。精气清冷。（〔原注〕一作泠○浮。脉经巢源。作微。案泠。水名。作泠为是。）
〔沈〕此以脉断无子也。男精女血。盛而成胎。然精盛脉亦当盛。若浮弱而涩者。浮乃阴虚。弱为真阳不
足。涩为精衰。阴阳精气皆为不足。故为精气清冷。则知不能成胎。谓
无子也。盖有生而不育者。亦是精气清冷所致。乏嗣者可不
知之而守养精气者乎。
〔尤〕精气交亏。而清冷不温。此得之天禀薄弱。故当无子。
巢源。虚劳无子候云。丈夫无子者。其精清如水。冷如冰铁。皆为无子之候。
夫失精家。少腹弦急。阴头寒。目眩。（〔原注〕一作目眶痛。）发落。脉极虚芤迟。清谷亡血失精。（
目眩。脉经。作目眶痛。案此条原本。连下桂枝龙蛎汤。今根据程本。分作二条。）
〔魏〕失精家。肾阳大泄。阴寒凝闭。小腹必急。小腹中之筋。必如弦之紧。而不能和缓。阴头必寒。
下真寒如是。上假热可征矣。火浮则目眩。血枯则发落。诊其脉必极虚。或浮大。或弱涩。不待言矣。更兼
芤迟。芤则中虚。胃阳不治。迟则里寒。肾阳无根。或便清谷。中焦无阳也。或吐衄
亡血。上焦浮热也。或梦交遗精。下焦无阳也。此虚劳之所以成而精失血亡。阴阳俱尽也。
巢源虚劳失精候云。肾气虚损。不能藏精。故精漏失。
其病小腹弦急。阴头寒。目眶痛。发落。令其脉数而散者。失精脉也。凡脉芤动微紧。男子失精也。
脉得诸芤动微紧。男子失精。女子梦交。桂枝龙骨牡蛎汤主之。（脉经。桂枝下。有加字。）
〔尤〕脉得诸芤动微紧者。阴阳并乖。而伤及其神与精也。故男子失精。女子梦交。沈氏所谓劳伤心气。
火浮不敛。则为心肾不交。阳泛于上。精孤于下。火不摄水不交自泄。故病失精。或精虚心相内浮。扰
精而出。则成梦交者是也。徐氏曰。桂枝汤。外证得之。能解肌去邪气。内证得之。能补
虚调阴阳。加龙骨牡蛎者。以失精梦交。为神情间病。非此不足以收敛其浮越也。
桂枝加龙骨牡蛎汤方。（〔原注〕短剧云。虚弱浮热汗出者。除桂加白薇附子各三分。故曰二加龙骨汤。）
桂枝 芍药 生姜（各三两） 甘草（二两） 大枣（十二枚） 龙骨 牡蛎（各三两）
上七味。以水七升。煮取三升。分温三服。
案短剧之文。出于外台虚劳梦泄精门云。短剧龙骨汤。疗梦失精。诸脉浮动心悸少急。隐处寒。目
眶疼。头发脱者。常七日许一剂。至良。方同。煮法后云。虚羸浮热汗出云云。
又深师桂心汤。疗虚喜梦与女邪交接。精为自出方。一名喜汤。亦与本方同。（本草。白薇。益阴清热。）
天雄散方（程氏金鉴。并删此方。）
天雄（三两炮） 白术（八两） 桂枝（六两） 龙骨（三两）
上四味。杵为散。酒服半钱匕。日三服。不知。稍增之。
〔徐〕恐失精家。有中焦阳虚。变上方。而加天雄白术。
〔尤〕案此疑亦后人所附。为补阳摄阴之用也。
案外台。载范汪疗男子虚失精。三物天雄散。即本方。无龙骨。云。张仲景方。有龙骨。文仲同。知
是非宋人所附也。
案天雄。本草大明云。助阳道暖水脏。补腰膝益精。
男子平人。脉虚弱细微者。喜盗汗也。（喜。赵本。作善。汗下。脉经。有出字。）
〔魏〕男子平人。为形若无病者言也。其形虽不病。而其脉之虚而弱。则阳已损也。细而微。则阴已
消也。阳损必驯至于失精。阴耗必驯至于亡血也。验其外证。必喜盗汗。阳
损斯表不固。阴损而热自发。皆盗汗之由。而即虚劳之由也。
巢源。虚劳盗汗候云。盗汗者。因眠睡而身体流汗也。
此由阳虚所致。久不已。令人羸瘠枯瘦。心气不足。亡津液
故也。诊其脉。男子平人。脉虚弱微细。皆为盗汗脉也。
案金鉴云。此节脉证不合。必有脱简。未知其意如何。盖虚劳盗汗。脉多虚数。故有此说乎。
人年五六十。其病脉大者。痹挟背行。若肠鸣。马刀侠瘿者。皆为劳得之。（脉下。程有浮字。若。赵作苦。）
〔尤〕人年五六十。精气衰矣。而病脉反大者。是其人当有风气也。痹侠背行。痹之侠背者。由阳气不足。
而邪气从之也。若肠鸣。马刀侠瘿者。阳气以劳而外张。火热以劳而上逆。阳外张。则寒动于中。而为肠鸣。
火上逆。则与痰相搏。而为马刀侠瘿。李氏曰。瘿生乳腋下。曰马刀。又夹生颈之两旁者为侠瘿。侠者挟也。
马刀。蛎蛤之属。疮形似之。故名马刀。瘿一作缨。发于结缨之处。二疮一在颈。一在腋
问：血痹病是如何得的？
师曰：那些养尊处优的人，骨骼柔弱而肌肤丰腴。如果再加上疲劳过度，出汗时睡觉身体不时翻动，又受到微风的侵袭，
就会得这种病。只要脉象微涩，在寸口和关部稍见紧象，适宜用针刺引导阳气，使脉象调和，紧象消失就会痊愈。
（按语：赵本将“因”作“困”。《脉经》在“卧”上有“起”字。“加”作“如”。“关上下”，沈本有“尺中”二字。《千金方》只有“上”字。《千金方》还有“有形如风状”四字。“紧”上没有“小”字。《脉经》与此相同。）
〔鉴〕历节病，属于伤气。气受伤则痛，所以表现为疼痛。血痹病，属于伤血。血受伤则肿，所以表现为麻木。前文阐明邪气聚于气分，此文阐明邪气凝滞于血分，所以称为血痹。所谓“尊荣人”，指饮食膏粱厚味之人。因为长期食用甘甜肥腻食物，所以骨骼柔弱而肌肉丰腴。因此不能耐受疲劳，一疲劳就出汗。出汗后腠理开泄，也不能久卧。躺着时身体不时翻动，翻动时就更容易受到微风的侵袭，于是邪气得以侵犯人体。这是说膏粱之人，外表丰盛而内里虚弱，即使是微风小邪，也容易导致疾病。那么怎么知道是血痹病呢？只要身体麻木不仁，脉象微涩，就知道是邪气凝滞于血分。寸口、关部脉象稍紧，也是风寒微邪应有的脉象。针刺能够导引经络之气，治疗各种痹证，所以适宜用针刺引导气血，以泻除邪气，使脉象不再涩滞而调和，紧象消失邪气散去，血痹自然通畅。
《医通》说：血痹，是寒湿之邪，痹着于血分。辛苦劳作的人，皮肤腠理致密，筋骨坚强，虽然有风寒湿邪，但不能客留体内。只有养尊处优的人，肌肉丰满，筋骨柔脆，平时就不能耐受疲劳，行走睡眠时身体动摇，或者遇到微风，就能导致痹着为患，不一定非要风寒湿三气杂至才致病。所谓血痹，就是《内经》所说的“在脉则血凝不流”。仲景直接阐发其不流的原因，说血既已痹阻，脉象自然微涩。然而无论寸、关、尺哪一部，出现脉象稍急的地方，就是风邪侵入的地方。所以其针药所施，都是引风邪外出的方法。
按：《五脏生成篇》说：“卧出而风吹之，血凝于肤者为痹。”王冰注：痹，谓顽痹也。（《广韵》：顽音同“顽”。《巢氏病源》、《千金方》间有“顽痹”的文字，可知“顽麻”的“顽”，原本就是“顽”字。）这就是血痹。《易通卦验》说：太阳脉虚，多病血痹。郑玄注：痹者气不达，未当至为病。大概“血痹”之称，见于此。《千金方》说：风痹游走无定处，名叫血痹。后世称呼麻木的，就是这个意思。《活人书》说：痹者，闭也。闭而不仁，所以叫痹。本出于《中藏经》。
血痹，阴阳脉俱微，寸口、关部脉微，尺中脉稍紧，外证身体麻木不仁，像风痹的样子。用黄芪桂枝五物汤主治。（《千金方》作“如风状”，《脉经》作“如风落状”，都不对。）
〔鉴〕此条承接上一条，互相详述脉证，以阐明治疗方法。上一条说六脉微涩，寸口、关部稍紧；这一条说阴阳脉俱微，寸口、关部都微，尺中也稍紧。合起来看，可知血痹的脉象，浮沉、寸口、关部、尺中，都呈现微、涩、稍紧的特点。微，代表虚；涩，代表滞；稍紧，代表邪。所以血痹应该有这样的诊察表现。血痹的外证，也是身体顽麻，不知痛痒，所以说像风痹的样子。
〔沈〕血痹，是阴阳营卫俱微，邪气进入血分，而成血痹。中上二焦阳微，所以寸口、关部脉也见微。微邪下连营血主病，所以尺中稍紧。这是因气虚受邪而成血痹。用桂枝、芍药、生姜、大枣，调和营卫，宣通阳气。虽然如此，邪气痹阻于血，是因为表阳失护而受邪，所以用黄芪，补益卫外之阳。阴阳平补，使微邪去除，而痹阻自开。
〔尤〕不仁，是指肌体顽痹，痛痒不觉，像风痹的样子，但实际不是风邪。因为脉象阴阳俱微，所以不可用针刺，而可用药物。经书所说“阴阳形气俱不足者，勿刺以针，而调以甘药”。
按：《血气形志篇》王冰注：不仁，谓不应用则痹矣。《巢氏病源·血痹候》说：血痹者，由体虚邪入于阴经故也。血为阴，邪入于血，而痹，所以叫血痹。其症状形体像被微风吹过一样。这是形容顽痹的状态。关于风痹，各家没有详细注释，只有《金鉴》说：不像风痹那样历节流走疼痛。这以风痹为历节，恐怕有误。《巢氏病源·风痹候》说：痹者是风寒湿三气杂至，合而成痹。其症状肌肉顽厚，或疼痛。由于人体虚弱，腠理开泄，所以受风邪。据此，风痹是顽麻疼痛兼有，而血痹，则只有顽麻而没有疼痛。历节则只有疼痛，而没有顽麻。三种病各不相同，怎么能混同呢？
黄芪桂枝五物汤方
黄芪（三两） 芍药（三两） 桂枝（三两） 生姜（六两） 大枣（十二枚○赵本作十一枚，非）
以上五味药，用水六升，煮取二升，温服七合，每日三次服用。
（〔原注〕一方有人参。○按《千金方》，用人参三两，共六味，所以单名黄芪汤，没有“五物”二字。）
按：根据桂枝汤的法度，生姜应当用三两，而这里多用至六两为什么呢？生姜味辛，专门运行痹阻的津液，而在和营卫的药中使用它，不仅仅专于发散。成无己曾经论述过，他的意思大概也在于此吧。
男子平人，脉大为劳，极虚亦为劳。（尤本在“极”上有“脉”字。）
〔魏〕虚劳病，是因劳累而虚，因虚而病。人的气通于呼吸，根于脏腑。静则生阴，动则生阳。阴阳本是气的动静所生，而动静又能产生气的阴阳。这是神与化两相变化的道理。所以一静一动，互为根本，在天在人，都贵在和平，而不偏胜。偏胜则在天的阳愆阴伏，而化育乖违；在人则阳亢阴独，而疾病发作。那么虚劳病，是过于动，而阳烦；失于静，而阴扰。阴日益耗损，而阳日益旺盛。这就是因劳而虚，因虚而病的缘由。（虚劳必起于内热，终于骨蒸。有热的占十之七八，其一二的虚寒者，必定先见邪热，而后日久，随正气一起衰败。）脉大，是邪气盛。极虚，是精气夺。用这两句揭示虚劳的总纲，而没有说大在何脉，虚在何经，这需要主治医生，随着五劳七伤的缘故，而仔细审察，难道几句话可以说尽吗？
〔鉴〕李珣说：平人，是指外形如无病之人。经书说：脉病患不病者是也。劳则体疲于外，气耗于中。脉大不是气盛，重按必然空濡，乃外有余而内不足的象。脉极虚则是精气耗损了。大，是劳脉之外暴的表现；极虚，是劳脉之内衰的表现。
〔魏〕仲景再通过观察颜色、验证证候、诊察脉象来决断。男子面色薄即不润泽。这是五脏的精气被夺，而面色失去光润。然而光必须在面皮内蕴蓄，润必须在面皮内敷布，才算是至浓。如果呈现炫耀的光泽，也不是正浓之色。现在说“薄”，就是指无光润而言。其人必定患消渴，以及诸种失血之疾，因而胸中喘促，心中悸动。卒，是忽见忽已的意思。
〔沈〕阴血虚，而阳气则盛。虚火上潜，津液不充则渴。气伤而不能摄血，则亡血。虚阳上逆，冲肺则卒然喘促。心营虚而真气不敛，则心悸。
〔尤〕脉浮为里虚。因为劳则真阴失守，孤阳无根，气散于外，而精夺于内。
男子脉虚沉弦，无寒热，短气里急，小便不利，面色白，时目瞑兼衄，少腹满，此为劳使之然。（《脉经》作“时时目瞑”。）
〔鉴〕此再次申明虚极为劳，以详述其证义。脉虚沉弦，是阴阳俱不足。无寒热，是阴阳虽不足，而不相乘侮。短气、面白、时瞑兼衄，是上焦虚，而血不荣养。里急、小便不利、少腹满，是下焦虚而气不行。凡此脉证，都是因为劳而病。所以说：此为劳使之然。
〔程〕白色为肺色，鼻为肺窍。气既不能下化，则上逆于头，所以眼睛昏花。迫于血而鼻子出血。《内经》说：劳则气耗。其类是欤。
按：本篇，标出“男子”二字的，共有五条，未详其意。各家也置之不论。大概是妇人有带下诸病，产乳众疾，其证似虚劳而非虚劳者，不能与男子无异，所以特别用“男子”二字区别开来欤。
劳之为病，其脉浮大，手足烦，春夏剧，秋冬瘥，阴寒精自出，酸削不能行。（《脉经》：酸上有“足”字。行下有“少阴虚满”四字。酸削，《巢氏病源》作“痟”，《外台秘要》作“痟削”。）
〔徐〕脉大既为劳，而更加浮，其证则手足烦。盖阴既不足，而阳必盛。
〔魏〕邪本因阴亏阳亢，内生之焰。但也随天时而有衰旺。春夏是阳时，阴虚之病必加剧。秋冬是阴时，阴虚之病稍缓解。火盛于上，则必阳衰于下。邪火炽于上焦，邪寒凝于下焦。阴寒即内迫，阳精自外出，为白浊，为遗精，为鬼交，皆上盛下虚的必然结果。精既出夺，必益虚寒。腿脚酸软，肌肉瘦削，遂不可行立，而骨痿不能起于床了。
按：阴寒，程云：寒字作虚字看。《金鉴》直以为传写之讹，误甚矣。阴寒者，阴冷也。乃七伤之一。《巢氏病源》说：肾主精，髓开窍于阴。今阴虚阳弱，血气不能相荣，故使阴冷也。久不已，则阴痿弱，是也。魏认为阴寒之气，也不对。酸削，《巢氏病源》作“痟”。《周礼》：痟首疾。注云：痟，酸削也。疏云：人患头痛，则有酸嘶而痛。《千金方·妇人门》：酸痟恍惚，不能起居。刘熙《释名》云：酸，逊也。逊遁在后也。言脚疼力少，行遁在后，以逊遁者也。消，弱也。如见割消，筋力弱也。即酸削。痟，酸嘶。酸痟，与酸削同。
朱震亨《格致余论》说：《内经》冬不藏精者，春必病温。若于此时，纵嗜欲，至春升之际，必有温热病。今人多春末夏初，患头痛脚软，食少体热，仲景谓春夏剧秋冬瘥，正俗所谓注夏病也。按本条所说，与注夏病不相干，此恐非也。
男子，脉浮弱而涩，为无子，精气清冷。（〔原注〕一作泠○浮，《脉经》、《巢氏病源》作微。按泠，水名，作泠为是。）
〔沈〕此以脉断无子。男精女血，盛而成胎。然精盛脉亦当盛。若浮弱而涩者，浮乃阴虚，弱为真阳不足，涩为精衰。阴阳精气皆为不足，故为精气清冷。则知不能成胎，谓之无子。盖有生而不育者，亦是精气清冷所致。乏嗣者可不知之而守养精气者乎？
〔尤〕精气交亏，而清冷不温。此得之天禀薄弱，故当无子。
《巢氏病源·虚劳无子候》说：丈夫无子者，其精清如水，冷如冰铁，皆为无子之候。
夫失精家，少腹弦急，阴头寒，目眩。（〔原注〕一作目眶痛。）发落。脉极虚芤迟，清谷亡血失精。（目眩，《脉经》作目眶痛。按此条原本，连下桂枝龙骨牡蛎汤，今根据程本，分作二条。）
〔魏〕失精家，肾阳大泄，阴寒凝闭。小腹必急。小腹中之筋，必如弦之紧，而不能和缓。阴头必寒。下真寒如是，上假热可征矣。火浮则目眩。血枯则发落。诊其脉必极虚。或浮大，或弱涩，不待言矣。更兼芤迟。芤则中虚，胃阳不治。迟则里寒，肾阳无根。或便清谷，中焦无阳也。或吐衄亡血，上焦浮热也。或梦交遗精，下焦无阳也。此虚劳之所以成而精失血亡，阴阳俱尽也。
其病小腹弦急，阴头寒，目眶痛，发落。令其脉数而散者，失精脉也。凡脉芤动微紧，男子失精也。
脉得诸芤动微紧，男子失精，女子梦交。桂枝龙骨牡蛎汤主之。（《脉经》：桂枝下，有加字。）
〔尤〕脉得诸芤动微紧者，阴阳并乖，而伤及其神与精也。故男子失精，女子梦交。沈氏所谓劳伤心气，火浮不敛，则为心肾不交。阳泛于上，精孤于下，火不摄水不交自泄，故病失精。或精虚心相内浮，扰精而出，则成梦交者是也。徐氏曰：桂枝汤，外证得之，能解肌去邪气。内证得之，能补虚调阴阳。加龙骨牡蛎者，以失精梦交，为神情间病，非此不足以收敛其浮越也。
桂枝加龙骨牡蛎汤方。（〔原注〕短剧云：虚弱浮热汗出者，除桂加白薇附子各三分，故曰二加龙骨汤。）
桂枝 芍药 生姜（各三两） 甘草（二两） 大枣（十二枚） 龙骨 牡蛎（各三两）
以上七味药，用水七升，煮取三升，分温三服。
按：短剧之文，出于《外台秘要·虚劳梦泄精门》云：短剧龙骨汤，疗梦失精，诸脉浮动心悸少急，隐处寒，目眶疼，头发脱者，常七日许一剂，至良。方同。煮法后云：虚羸浮热汗出云云。
又深师桂心汤，疗虚喜梦与女邪交接，精为自出方。一名喜汤，亦与本方同。（本草：白薇，益阴清热。）
天雄散方（程氏《金鉴》，并删此方。）
以上四味药，杵为散，酒服半钱匕，每日三次服用。不知，稍增之。
〔尤〕按此疑亦后人所附，为补阳摄阴之用也。
按：《外台秘要》载范汪疗男子虚失精，三物天雄散，即本方，无龙骨。云：张仲景方，有龙骨。文仲同。知是非宋人所附也。
按：天雄，《本草大明》云：助阳道暖水脏，补腰膝益精。
男子平人，脉虚弱细微者，喜盗汗也。（喜，赵本，作善。汗下，《脉经》，有出字。）
〔魏〕男子平人，为形若无病者言也。其形虽不病，而其脉之虚而弱，则阳已损也。细而微，则阴已消也。阳损必驯至于失精，阴耗必驯至于亡血也。验其外证，必喜盗汗。阳损斯表不固，阴损而热自发，皆盗汗之由，而即虚劳之由也。
此由阳虚所致。久不已，令人羸瘠枯瘦，心气不足，亡津液故也。诊其脉，男子平人，脉虚弱微细，皆为盗汗脉也。
按：《金鉴》云：此节脉证不合，必有脱简，未知其意如何。盖虚劳盗汗，脉多虚数，故有此说乎？
人年五六十，其病脉大者，痹挟背行，若肠鸣，马刀侠瘿者，皆为劳得之。（脉下，程有浮字。若，赵作苦。）
〔尤〕人年五六十，精气衰矣。而病脉反大者，是其人当有风气也。痹侠背行，痹之侠背者，由阳气不足，而邪气从之也。若肠鸣，马刀侠瘿者，阳气以劳而外张，火热以劳而上逆。阳外张，则寒动于中，而为肠鸣。火上逆，则与痰相搏，而为马刀侠瘿。李氏曰：瘿生乳腋下，曰马刀。又夹生颈之两旁者为侠瘿。侠者挟也。马刀，蛎蛤之属，疮形似之，故名马刀。瘿一作缨，发于结缨之处。二疮一在颈，一在腋。
Question: How is Blood Bi (Blood Obstruction) disease acquired?
Master said: Those who live in comfort and luxury have weak bones but abundant flesh. If they are further subjected to fatigue, sweat during sleep, and their bodies move restlessly while lying down, adding to the invasion of slight wind,
they will contract this disease. As long as the pulse is slightly choppy and fine, with a slight tightness at the Cunkou (radial artery at the wrist crease) and Guan positions, it is appropriate to use acupuncture to guide Yang Qi, harmonizing the pulse. When the tightness disappears, the patient will recover.
(Note: Zhao's edition renders "Yin" as "Kun". *Mai Jing* adds "Qi" before "Wo". "Jia" is rendered as "Ru". For "Guan Shang Xia", Shen's edition has "Chi Zhong". *Qian Jin Fang* only has "Shang". *Qian Jin Fang* also has "Xing Ru Feng Zhuang". There is no "Xiao" before "Jin". *Mai Jing* agrees.)
[Jian]: Li Jie (Joint Pain) belongs to Qi injury. Qi injury causes pain, hence the manifestation of pain. Blood Bi belongs to Blood injury. Blood injury causes swelling, hence the manifestation of numbness. The previous text elucidates pathogenic factors gathering in the Qi level; this text elucidates pathogenic factors coagulating in the Blood level, hence it is named Blood Bi. "Zun Rong Ren" refers to those who consume rich and fatty foods. Because they frequently eat sweet and greasy foods, their bones are weak and muscles are plump. Therefore, they cannot tolerate fatigue; upon fatigue, they sweat. After sweating, the interstices (Cou Li) open, and they cannot lie still for long. While lying down, if the body moves restlessly, it becomes easier to be invaded by slight wind, allowing pathogenic factors to invade. This describes people of rich diet: outwardly abundant but inwardly deficient; even slight wind or minor pathogens can easily cause disease. So how do we know it is Blood Bi? As long as there is body numbness and insensitivity, and the pulse is slightly choppy and fine, we know pathogenic factors are coagulating in the Blood. Slight tightness at Cunkou and Guan positions is also the expected pulse for slight Wind-Cold pathogens. Acupuncture can guide meridian Qi and treat various Bi syndromes, so it is appropriate to use acupuncture to guide Qi and Blood to drain the pathogen, making the pulse smooth and harmonious rather than choppy. When the tightness disappears and the pathogen scatters, Blood Bi naturally unblocks.
*Yi Tong* states: Blood Bi is Cold-Dampness pathogenic factors obstructing the Blood level. People engaged in hard labor have dense skin and interstices and strong sinews and bones; although exposed to Wind-Cold-Dampness, these pathogens cannot lodge within them. Only those in comfort have plump muscles and fragile sinews and bones, unable to tolerate fatigue normally. Movement and restlessness in walking and sleeping, or exposure to slight wind, can lead to obstruction and pathology, without necessarily requiring the mixture of Wind, Cold, and Dampness. Blood Bi is what *Nei Jing* calls "when in the vessels, blood coagulates and does not flow." Zhang Zhongjing directly expounds the reason for this non-flow, stating that once Blood is obstructed, the pulse naturally becomes slightly choppy and fine. However, wherever the pulse appears slightly urgent at the Cun, Guan, or Chi positions, that is where Wind enters. Therefore, both acupuncture and herbal therapy aim to draw Wind outwards.
Commentary: *Wu Zang Sheng Cheng Pian* says: "Going out to sleep and being blown by wind, blood coagulates in the skin, forming Bi." Wang Bing's annotation: Bi means stubborn numbness. (*Guang Yun*: Wan sounds like 'stubborn'. *Chao Shi Bing Yuan* and *Qian Jin Fang* occasionally use the term 'Wan Bi', indicating that 'Wan' in 'Wan Ma' originally was 'Wan'.) This is Blood Bi. *Yi Tong Gua Yan* states: Taiyang pulse deficiency leads to many cases of Blood Bi. Zheng Xuan's annotation: Bi means Qi does not reach, not yet manifesting as disease. It seems the term "Blood Bi" appears here. *Qian Jin Fang* says: Wind Bi wandering without fixed location is called Blood Bi. What later generations call numbness is exactly this. *Huo Ren Shu* says: Bi means closure. Closed and insensitive, hence called Bi. This originates from *Zhong Cang Jing*.
Blood Bi: Yin and Yang pulses are both slightly deficient. The Cunkou and Guan pulses are slightly deficient, and the Chi position is slightly tight. Externally, the symptom is body numbness and insensitivity, resembling Wind Bi. Huang Qi Gui Zhi Wu Wu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is the primary treatment. (*Qian Jin Fang* reads "Ru Feng Zhuang", *Mai Jing* reads "Ru Feng Luo Zhuang", neither is correct.)
[Jian]: This clause follows the previous one, detailing pulse and symptoms mutually to clarify treatment. The previous clause stated six pulses were slightly choppy and fine, with slight tightness at Cunkou and Guan; this clause states Yin and Yang pulses are both slightly deficient, with Cunkou and Guan both slightly deficient, and Chi also slightly tight. Viewing them together, we know that for Blood Bi, the pulses at floating/sinking, Cunkou, Guan, and Chi positions all present as slightly deficient, slightly choppy, and slightly tight. "Slightly deficient" indicates deficiency; "choppy" indicates stagnation; "slightly tight" indicates pathogen. Thus, Blood Bi should present such diagnostic signs. The external symptoms of Blood Bi are also body stiffness and numbness, unaware of pain or itch, hence described as resembling Wind Bi.
[Shen]: Blood Bi is when Yin-Yang, Ying, and Wei are all slightly deficient, and pathogens enter the Blood level, forming Blood Bi. Yang deficiency in the Middle and Upper Jiao causes the Cunkou and Guan pulses to appear slightly deficient. Minor pathogens connecting downward to Ying-Blood govern the disease, hence the Chi position is slightly tight. This is Blood Bi formed due to Qi deficiency receiving pathogens. Using Gui Zhi (Cinnamon Twig), Shao Yao (Peony Root), Sheng Jiang (Fresh Ginger), and Da Zao (Jujube) harmonizes Ying and Wei and promotes Yang Qi. Although the pathogen obstructs the Blood because exterior Yang failed to protect against pathogens, Huang Qi (Astragalus Root) is used to tonify exterior-protecting Yang. Balancing Yin and Yang allows minor pathogens to depart and obstructions to open.
[You]: Insensitivity refers to muscle and body stiffness and numbness, unaware of pain or itch, resembling Wind Bi, but actually not Wind. Because the Yin-Yang pulses are both slightly deficient, acupuncture is contraindicated, and herbs are preferred. As the Classics state: "When Yin-Yang, form, and Qi are all insufficient, do not prick with needles, but regulate with sweet medicines."
Commentary: Wang Bing's annotation on *Xue Qi Xing Zhi Pian*: Insensitivity means inability to use results in obstruction. *Chao Shi Bing Yuan - Blood Bi Syndrome* states: Blood Bi occurs because body deficiency allows pathogens to enter Yin meridians. Blood is Yin; pathogens entering Blood cause obstruction, hence Blood Bi. The condition feels like the body was blown by slight wind. This describes the state of stubborn numbness. Regarding Wind Bi, few provide annotations; only *Jin Jian* states it does not resemble Wind Bi moving through joints with flowing pain. Equating Wind Bi with Li Jie (Joint Pain) is likely an error. *Chao Shi Bing Yuan - Wind Bi Syndrome* states: Bi is caused by the mixture of Wind, Cold, and Dampness. Symptoms include thick, numb muscles or pain. Due to human weakness and open interstices, Wind pathogens invade. Based on this, Wind Bi involves both numbness/pain, whereas Blood Bi involves only numbness without pain. Li Jie involves only pain without numbness. These three diseases are distinct and should not be confused.
Huang Qi Gui Zhi Wu Wu Tang Formula
Huang Qi (3 liang) Shao Yao (3 liang) Gui Zhi (3 liang) Sheng Jiang (6 liang) Da Zao (12 pieces [Zhao's edition has 11 pieces, which is incorrect])
The above five ingredients are boiled in 6 sheng of water, reduced to 2 sheng. Take 7 he of warm decoction, three times daily.
([Original Note] Another formula contains Ren Shen. [Commentary] *Qian Jin Fang* uses 3 liang of Ren Shen, totaling six ingredients, hence named simply Huang Qi Tang, without the words "Five Ingredients".)
Commentary: According to the method of Gui Zhi Tang, Sheng Jiang should be 3 liang. Why is it increased to 6 liang here? Sheng Jiang is pungent and specifically circulates fluids obstructed by Bi. Used in formulas harmonizing Ying and Wei, its purpose is not solely dispersal. Cheng Wuji discussed this; his intent likely lies here.
For men who appear healthy, a large pulse indicates Lao (Consumption/Overwork); extremely deficient pulse also indicates Lao. ([You's edition adds "Mai" before "Ji"].)
[Wei]: Xu Lao (Deficiency Consumption) arises from overwork leading to deficiency, and deficiency leading to illness. Human Qi connects to respiration and roots in the Zang-Fu organs. Stillness generates Yin, movement generates Yang. Yin-Yang are generated by the stillness/movement of Qi, and stillness/movement generate Yin-Yang of Qi. This is the way of Shen and Hua transforming. Thus, stillness and movement are mutually rooted. In Heaven and in Man, harmony is prized, avoiding excess. Excess in Heaven leads to Yang error and Yin hiding, disrupting generation; in Man, Yang hyperactivity and Yin solitude cause disease. Thus, Xu Lao results from excessive movement causing Yang vexation, and lack of stillness causing Yin disturbance. Yin is increasingly consumed, while Yang increases. This is the cause of becoming deficient from overwork and ill from deficiency. ([Xu Lao must begin with internal heat and end with bone-steaming fever. Seventy to eighty percent have heat; the ten to twenty percent with deficiency-cold must first show pathogenic heat, which then declines with righteous Qi over time].) A large pulse indicates pathogenic excess. An extremely deficient pulse indicates essence depletion. These two phrases outline the general principle of Xu Lao, without specifying which pulse is large or which meridian is deficient. This requires the treating physician to examine carefully according to the causes of Five Overworks and Seven Injuries. Can this be exhausted in a few words?
[Jian]: Li Xun says: Ping Ren (healthy person) refers to someone whose appearance shows no signs of illness. The Classics say: "Pulse indicates disease, but the person appears healthy." Overwork fatigues the body externally and depletes Qi internally. A large pulse does not indicate Qi abundance; deep pressure reveals emptiness and flaccidity, showing excess outwardly and deficiency inwardly. An extremely deficient pulse indicates essence depletion. Large is the outward flare of the Lao pulse; extremely deficient is the inward decline of the Lao pulse.
Men with thin complexion primarily suffer from thirst and blood loss. Sudden panting and palpitations, with a floating pulse, indicate double deficiency.
[Wei]: Zhang Zhongjing further verifies and distinguishes by color, syndrome, and pulse. Thin complexion in men means lack of luster. This indicates depletion of the essence of the Five Zang organs, losing the luster of the face. Luster must be stored within the facial skin, and moisture must spread within the facial skin to be truly rich. If it appears dazzling, it is not the true rich color. Now saying "thin" refers to lacking luster and moisture. Such a person likely suffers from Xiao Ke (Wasting-Thirst) and various blood-loss diseases, leading to chest panting and heart palpitations. "Cu" (sudden) means appearing and disappearing suddenly.
[Shen]: Yin-Blood deficiency leads to Yang hyperactivity. Deficient Fire floats upward, failing to nourish fluids, causing thirst. Qi injury fails to control blood, causing blood loss. Deficient Yang reverses upward, rushing the Lungs causing sudden panting. Heart Ying deficiency fails to gather True Qi, causing palpitations.
[You]: Floating pulse indicates interior deficiency. Because overwork causes True Yin to lose its hold, solitary Yang has no root, Qi scatters outward, and Essence is depleted inwardly.
Men with pulses that are deficient, sinking, and wiry, without chills or fever, experiencing shortness of breath, abdominal urgency, difficult urination, white complexion, occasional dizziness/blurred vision accompanied by epistaxis, and lower abdominal fullness, this is caused by Lao. (*Mai Jing* reads "Shi Shi Mu Tong").
[Jian]: This reiterates that extreme deficiency constitutes Lao, detailing the meaning of its symptoms. Deficient, sinking, wiry pulse indicates Yin and Yang insufficiency. No chills or fever indicates that although Yin and Yang are insufficient, they do not attack each other. Shortness of breath, white complexion, occasional dizziness, and epistaxis indicate Upper Jiao deficiency and Blood failing to nourish. Abdominal urgency, difficult urination, and lower abdominal fullness indicate Lower Jiao deficiency and Qi failing to move. All these pulse and syndrome manifestations result from Lao. Hence it is said: This is caused by Lao.
[Cheng]: White is the color of the Lung; the nose is the orifice of the Lung. Since Qi cannot descend and transform, it reverses upward to the head, causing eye dizziness. Pressing on Blood causes epistaxis. *Nei Jing* says: Overwork depletes Qi. Is this not similar?
Commentary: The phrase "Man" appears in five clauses in this chapter, with unclear intent. Scholars have left it unexplained. Perhaps women have Dai Xia (Leukorrhea) diseases and postpartum illnesses, whose symptoms resemble Xu Lao but are not, and cannot be treated identically to men. Hence, the specific use of "Man" distinguishes them.
Lao disease presents with a floating and large pulse, vexation in hands and feet, worsening in Spring and Summer, improving in Autumn and Winter, spontaneous emission of cold semen, soreness and emaciation preventing walking. (*Mai Jing*: adds "Zu" before "Suan". Adds "Shao Yin Xu Man" after "Xing". *Chao Shi Bing Yuan* renders "Suan Xiao" as "Xiao"; *Wai Tai Mi Yao* as "Xiao Xiao".)
[Xu]: Pulse large indicates Lao; adding floating makes the symptom hand-foot vexation. Since Yin is insufficient, Yang must be hyperactive.
[Wei]: Pathogens originate from Yin deficiency and Yang hyperactivity, generating internal flame. However, this fluctuates with seasonal timing. Spring and Summer are Yang seasons; Yin-deficiency diseases worsen. Autumn and Winter are Yin seasons; Yin-deficiency diseases improve. Fire blazing above leads to Yang decline below. Pathogenic fire blazes in the Upper Jiao, pathogenic cold congeals in the Lower Jiao. Internal Cold forces outward, Yang Essence spontaneously exits, manifesting as white turbidity, spermatorrhea, or nocturnal emissions, all inevitable results of Upper Excess and Lower Deficiency. Once Essence is lost, deficiency and cold increase. Legs become sore and soft, muscles emaciate, making walking and standing impossible, leading to bone萎 (flaccidity) inability to rise from bed.
Commentary: Cheng interprets "Yin Han" (Cold): read "Han" as "Xu" (Deficiency). *Jin Jian* directly considers it a transcription error, which is very wrong. "Yin Han" means coldness in the Yin region, one of the Seven Injuries. *Chao Shi Bing Yuan* states: Kidney governs Essence, Marrow opens to the Yin. Now Yin is deficient and Yang is weak, Blood and Qi fail to nourish, causing Yin coldness. If prolonged, impotence results. Wei interprets it as Cold Qi, which is also incorrect. "Suan Xiao": *Chao Shi Bing Yuan* writes "Xiao". *Zhou Li*: Xiao headache. Annotation: Xiao means sourness and emaciation. Commentary: When suffering headache, there is sourness and pain. *Qian Jin Fang - Women's Section*: Sourness and confusion, unable to rise or sit. Liu Xi's *Shi Ming* states: Sour means retreating. Retreating implies falling behind. Speaking of leg pain and weakness, walking falls behind, thus retreating. Xiao means weak. Like being cut away, sinew strength is weak. That is Suan Xiao. Xiao, Suan Si, Suan Xiao are synonymous.
Zhu Danxi's *Ge Zhi Yu Lun* states: *Nei Jing* says those who do not store Essence in Winter will suffer Warmth diseases in Spring. If indulging desires at this time, arriving at Spring ascent, there must be Warmth diseases. Many people now suffer headaches, weak legs, poor appetite, and body heat in late Spring and early Summer. Zhang Zhongjing's statement "worsening in Spring/Summer, improving in Autumn/Winter" corresponds to the common "Summer Sickness" (Zhu Xia Bing). Commentary: What is described in this clause is unrelated to Summer Sickness; this interpretation is likely incorrect.
Men with floating, weak, and choppy pulses indicate infertility; Essence and Qi are clear and cold. ([Original Note] Alternatively Ling. Floating, *Mai Jing* and *Chao Shi Bing Yuan* read Wei. Commentary: Ling is a river name; reading Ling is correct.)
[Shen]: This diagnoses infertility based on pulse. Male Essence and Female Blood must be abundant to conceive. If Essence is abundant, the pulse should be abundant. If floating, weak, and choppy, floating indicates Yin deficiency, weak indicates True Yang insufficiency, choppy indicates Essence depletion. Yin-Yang and Essence-Qi are all insufficient, hence Essence-Qi is clear and cold. Knowing conception is impossible, it is called infertility. Even those born but unable to rear children are caused by clear and cold Essence-Qi. Those lacking heirs should understand this and guard/nourish Essence-Qi.
[You]: Essence and Qi mutually decline, clear and cold without warmth. This results from weak congenital constitution, hence infertility.
*Chao Shi Bing Yuan - Infertility due to Deficiency Consumption* states: Men infertile have Essence clear as water, cold as ice and iron, all signs of infertility.
Those prone to spermatorrhea experience tightness in the lower abdomen, coldness at the glans penis, dizziness/blurred vision, and hair loss. Pulse is extremely deficient, knotted, and slow, with clear stool, blood loss, and spermatorrhea. (Dizziness, *Mai Jing* reads Eye Socket Pain. Commentary: Originally this clause was linked with Gui Zhi Long Gu Mu Li Tang; now following Cheng's edition, it is split into two clauses.)
[Wei]: Those prone to spermatorrhea have massive leakage of Kidney Yang and condensation of Yin-Cold. Lower abdomen must be tight. Sinews in the lower abdomen must be tight like a string, unable to relax. Glans penis must be cold. With true cold below, false heat above can be inferred. Fire floating causes dizziness. Blood dryness causes hair loss. Palpating the pulse, it must be extremely deficient. Or floating-large, or weak-choppy, needless to say. Additionally knotted and slow. Knotted indicates middle deficiency, Stomach Yang not governing. Slow indicates interior cold, Kidney Yang having no root. Or clear stool, indicating no Yang in Middle Jiao. Or vomiting/epistaxis blood loss, indicating floating heat in Upper Jiao. Or nocturnal emission during dreams, indicating no Yang in Lower Jiao. This is how Xu Lao forms, with loss of Essence and Blood, exhaustion of Yin and Yang.
*Chao Shi Bing Yuan - Spermatorrhea due to Deficiency Consumption* states: Kidney Qi damage fails to store Essence, hence Essence leaks.
Symptoms: Tightness in lower abdomen, coldness at glans penis, eye socket pain, hair loss. If pulse is rapid and scattered, it is the pulse of spermatorrhea. Generally, knotted, moving, slightly tight pulses in men indicate spermatorrhea.
Pulse presenting with any of knotted, moving, slightly tight indicates spermatorrhea in men, and dream intercourse in women. Gui Zhi Long Gu Mu Li Tang (Cinnamon Twig plus Dragon Bone and Oyster Shell Decoction) is the primary treatment. (*Mai Jing*: adds character after Gui Zhi.)
[You]: Pulses presenting with knotted, moving, slightly tight indicate Yin-Yang discordance, damaging Shen and Essence. Hence spermatorrhea in men, dream intercourse in women. Shen's theory: Labor damages Heart Qi, Fire floats and fails to gather, leading to Heart-Kidney non-interaction. Yang floats above, Essence isolates below; Fire fails to control Water, non-interaction leads to leakage, hence spermatorrhea. Or Essence deficiency, Minister Fire floats internally, disturbing Essence causing emission, resulting in dream intercourse. Xu states: Gui Zhi Tang, when applied to exterior syndromes, releases muscle layer and expels pathogens. When applied to interior syndromes, tonifies deficiency and regulates Yin-Yang. Adding Long Gu (Dragon Bone) and Mu Li (Oyster Shell) is because spermatorrhea and dream intercourse are disorders between Spirit and Mind; only this is sufficient to gather the floating and overflowing.
Gui Zhi Jia Long Gu Mu Li Tang Formula ([Original Note]: Duan Ju states: For weakness, floating heat, and sweating, remove Gui Zhi and add Bai Wei and Fu Zi, each 3 fen, hence called Er Jia Long Gu Tang.)
Gui Zhi Shao Yao Sheng Jiang (each 3 liang) Gan Cao (2 liang) Da Zao (12 pieces) Long Gu Mu Li (each 3 liang)
The above seven ingredients are boiled in 7 sheng of water, reduced to 3 sheng. Divide into three warm doses.
Commentary: Text from Duan Ju appears in *Wai Tai Mi Yao - Dream Emission of Essence* section: Duan Ju Long Gu Tang treats dream emission, various pulses floating with palpitations and slight urgency, cold in private parts, eye socket pain, and hair loss. Usually one dose every seven days, highly effective. Formula same. After boiling method: For emaciation, floating heat, and sweating...
Also Shen Shi's Gui Xin Tang treats deficiency joy, dreaming sexual intercourse with female spirits, spontaneous emission of Essence. Also named Xi Tang, also identical to this formula. (Compendium of Materia Medica: Bai Wei benefits Yin and clears Heat.)
Tian Xiong San Formula ([Cheng's Jin Jian] deletes this formula entirely.)
Tian Xiong (3 liang, processed) Bai Zhu (8 liang) Gui Zhi (6 liang) Long Gu (3 liang)
The above four ingredients are pounded into powder. Take half a coin-bi measure with wine, three times daily. If ineffective, gradually increase dosage.
[Xu]: Fearing that among those prone to spermatorrhea, there may be Middle Jiao Yang deficiency, modifying the above formula by adding Tian Xiong and Bai Zhu.
[You]: Commentary: Suspect this was also appended by later generations, for the purpose of tonifying Yang and securing Yin.
Commentary: *Wai Tai Mi Yao* records Fan Wang's treatment for male deficiency spermatorrhea, San Wu Tian Xiong San, which is this formula without Long Gu. States: Zhang Zhongjing's formula has Long Gu. Wen Zhong agrees. Knowing it is not an appendage by Song people.
Commentary: Tian Xiong, *Ben Cao Da Ming* states: Assists Yang Dao, warms Water Organ, tonifies waist and knees, benefits Essence.
Men who appear healthy, with weak, fine, and subtle pulses, tend to suffer from night sweats. (Xi, Zhao's edition reads Shan. After Han, *Mai Jing* has Chu character.)
[Wei]: Men who appear healthy refers to those whose form shows no illness. Although their form is not diseased, their pulse being weak indicates Yang is already damaged. Fine and subtle indicates Yin is already consumed. Yang damage inevitably leads to spermatorrhea; Yin consumption inevitably leads to blood loss. Verifying external symptoms, they must tend to night sweats. Yang damage causes insecure exterior; Yin consumption causes spontaneous heat. Both are causes of night sweats, and thus causes of Xu Lao.
*Chao Shi Bing Yuan - Night Sweating due to Deficiency Consumption* states: Night sweating is sweating during sleep.
This is caused by Yang deficiency. Prolonged without cure, it causes emaciation and wasting, Heart Qi insufficiency, and loss of Body Fluids. Palpating the pulse, men who appear healthy with weak, fine, and subtle pulses are all pulses of night sweating.
Commentary: *Jin Jian* states: This clause's pulse and syndrome do not match; there must be missing text. Unclear intent. Perhaps for Xu Lao night sweating, pulses are often deficient and rapid, hence this comment?
People aged fifty or sixty, whose disease pulse is large, suffer from Bi along the back, or intestinal murmuring, or Ma Dao and Xia Ying (scrofula/lumps), all acquired from Lao. (After Mai, Cheng has Fu character. Ruo, Zhao reads Ku.)
[You]: At age fifty or sixty, Essence and Qi decline. Yet the disease pulse is unexpectedly large, indicating the person likely has Wind pathogen. Bi along the back, Bi accompanying the back, is due to Yang Qi deficiency, allowing pathogens to follow. Intestinal murmuring, Ma Dao, and Xia Ying: Yang Qi expands outward due to Lao, Fire-Heat rises upward due to Lao. Yang expanding outward causes Cold to move within, resulting in intestinal murmuring. Fire rising upward combats Phlegm, resulting in Ma Dao and Xia Ying. Li states: Ying growing near armpits is called Ma Dao. Growing on both sides of the neck is called Xia Ying. Xia means accompanying. Ma Dao resembles oysters/clams in shape, hence the name. Ying alternatively written as Ying (tassel), occurring where tassels tie. Two sores: one on neck, one on armpit.