问曰。血痹之病。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。
阳气者。卫外而为固也。乃因疲劳汗出。而阳气一伤。卧不时动摇。而阳气再伤。于是风气虽微。得
以直入血中而为痹。经云。邪入于阴则痹也。脉微为阳微。涩为血滞。紧则邪之征也。血中之邪。始
以阳气伤而得入。终必得阳气通而后出。而痹之为病。血既以风入而痹于外。阳亦以血痹而止于中。故
必针以引阳使出。阳出而邪去。邪去而脉紧乃和。血痹乃通。以是知血分受痹。不当独治其血矣。
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。
阴阳俱微。该人迎、趺阳、太溪为言。寸口关上微。尺中小紧。即阳不足而阴为痹之象。不仁者。
肌体顽痹。痛痒不觉。如风痹状。而实非风也。黄 、桂枝五物。和营之滞。助卫之行。亦针引阳气
之意。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。
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）
上五味。以水六升。煮取二升。温服七合。日三服。
夫男子平人脉大为劳。脉极虚亦为劳。
阳气者。烦劳则张。故脉大。劳则气耗。故脉极虚。李氏曰。脉大非气盛也。重按必空濡。大者。
劳脉之外暴者也。极虚者。劳脉之内衰者也。
男子面色薄。主渴及亡血。卒喘悸。脉浮者。里虚也。
渴者热伤阴气。亡血者不华于色。故面色薄者。知其渴及亡血也。李氏曰。劳者气血俱耗。气虚
则喘。血虚则悸。卒者。猝然见此病也。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。
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。男子脉浮弱而涩。为无
子。精气清冷。
脉虚沉弦者。劳而伤阳也。故为短气里急。为小便不利。少腹满。为面色白。而其极则并伤其阴
而目瞑兼衄。目瞑、目不明也。脉浮者。劳而伤阴也。故为手足烦。为酸削不能行。为春夏剧而秋冬
瘥。而其极则并伤其阳而阴寒精自出。此阴阳互根。自然之道也。若脉浮弱而涩。则精气交亏而清冷
不温。此得之天禀薄弱。故当无子。
夫失精家少腹弦急。阴头寒。目眩、发落。脉极虚芤迟。为清谷、亡血、失精。脉得诸芤动微紧。
男子失精。女子梦交。桂枝龙骨牡蛎汤主之。
脉极虚芤迟者。精失而虚及其气也。故少腹弦急。阴头寒而目眩。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
精间病。非此不足以收敛其浮越也。
桂枝龙骨牡蛎汤方
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。
天雄散方
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。
按、此疑亦后人所附。为补阳摄阴之用也。
男子平人脉虚弱细微者。喜盗汗也。人年五六十。其病脉大者。痹侠背行。若肠鸣、马刀、侠瘿
者。皆为劳得之。脉沉小迟。名脱气。其人疾行则喘喝。手足逆寒。腹满。甚则溏泄。食不消化也。
脉弦而大。弦则为减。大则为芤。减则为寒。芤则为虚。虚寒相搏。此名为革。妇人则半产、漏下。
男子则亡血、失精。
平人、不病之人也。脉虚弱细微。则阴阳俱不足矣。阳不足者不能固。阴不足者不能守。是其人
必善盗汗。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。痹之侠脊者。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
寒动于中而为腹鸣。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。一在腋下。常相联系。故俗名 串。脉沉小迟。皆阴象也。三者并见。阴盛而阳乃亡矣。故
名脱气。其人疾行则喘喝者。气脱而不固也。由是外无气而手足逆冷。胃无气而腹满。脾无气而溏泄
食不化。皆阳微气脱之证也。脉弦者阳不足。故为减为寒。脉大者阴不足。故为芤为虚。阴阳并虚。外
强中干。此名为革。又变革也。妇人半产、漏下。男子亡血、失精。是皆失其产乳生育之常矣。故名
曰革。
虚劳里急。悸衄。腹中痛。梦失精。四肢酸疼。手足烦热。咽干、口燥。小建中汤主之。
此和阴阳调营卫之法也。夫人生之道。曰阴曰阳。阴阳和平。百疾不生。若阳病不能与阴和。则
阴以其寒独行。为里急。为腹中痛。而实非阴之盛也。阴病不能与阳和。则阳以其热独行。为手足烦
热。为咽干、
口燥。而实非阳之炽也。昧者以寒攻热。以热攻寒。寒热内贼。其病益甚。惟以甘酸辛药。和合成剂。
调之使和。则阳就于阴。而寒以温。阴就于阳。而热以和。医之所以贵识其大要也。岂徒云寒可治热。
热可治寒而已哉。或问和阴阳调营卫是矣。而必以建中者何也。曰中者脾胃也。营卫生成于水谷。而
水谷转输于脾胃。故中气立。则营卫流行而不失其和。又中者四运之轴。而阴阳之机也。故中气立。则
阴阳相循。如环无端。而不极于偏。是方甘与辛合而生阳。酸得甘助而生阴。阴阳相生。中气自立。是
故求阴阳之和者。必于中气。求中气之立者。必以建中也。
小建中汤方
桂枝（三两） 甘草（二两） 芍药（六两） 大枣（十二枚） 生姜（三两） 饴糖（一升）
上六味。以水七升。煮取三升。去滓。内胶饴。更上微火消解。温服一升。日三服。
虚劳里急诸不足。黄 建中汤主之。
里急者。里虚脉急。腹中当引痛也。诸不足者。阴阳诸脉。并俱不足。而眩、悸、喘、喝。失精、
亡血等证。相因而至也。急者缓之。必以甘。不足者补之。必以温。而充虚塞空。则黄 尤有专长也。
黄 建中汤方 即小建中汤内加黄 一两半。余根据上法。气短、胸满者。加生姜。腹满者。
去枣。加茯苓一两半。及疗肺虚损不足。补气。加半夏三两。
虚劳腰痛。少腹拘急。小便不利者。八味肾气丸主之。
下焦之分。少阴主之。少阴虽为阴脏。而中有元阳。所以温经脏。行阴阳。司开阖者也。虚劳之
人。损伤少阴肾气。是以腰痛。少腹拘急。小便不利。程氏所谓肾间动气已损者是矣。八味肾气丸补
阴之虚。可以生气。助阳之弱。可以化水。乃补下治下之良剂也。
八味肾气丸方（见妇人杂病）
虚劳诸不足。风气百疾。薯蓣丸主之。
虚劳证多有挟风气者。正不可独补其虚。亦不可着意去风气。仲景以参、地、芎、归、苓、术补
其气血。胶、麦、姜、枣、甘、芍益其营卫。而以桔梗、杏仁、桂枝、防风、柴胡、白蔹、黄卷、神
曲去风行气。其用薯蓣最多者。以其不寒不热。不燥不滑。兼擅补虚去风之长。故以为君。谓必得正
气理而后风气可去耳。
薯蓣丸方
薯蓣（三十分） 人参（七分） 白术（六分） 茯苓（五分） 甘草（二十八分） 当归（十分）
干地黄（十分） 芍药（六分） 芎 （六分） 麦冬（六分） 阿胶（七分） 干姜（三分） 大
枣（百枚为膏） 桔梗（五分） 杏仁（六分） 桂枝（十分） 防风（六分） 神曲（十分） 豆
黄卷（十分） 柴胡（五分） 白蔹（二分）
上二十一味。末之。炼蜜和丸。如弹子大。空腹酒服一丸。一百丸为剂。
虚劳虚烦不得眠。酸枣仁汤主之。
人寤则魂寓于目。寐则魂藏于肝。虚劳之人。肝气不荣。则魂不得藏。魂不藏故不得眠。酸枣仁
补肝敛气。宜以为君。而魂既不归容。必有浊痰燥火乘间而袭其舍者。烦之所由作也。故以知母、甘
草。清热滋燥。茯苓、川芎。行气除痰。皆所以求肝之治。而宅其魂也。
酸枣仁汤方
酸枣仁（二升） 甘草（一两） 知母 茯苓（各二两） 芎 （一两）
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。
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。经络营卫气伤。内有
干血。肌肤甲错。两目黯黑。缓中补虚。大黄 虫丸主之。
虚劳症有挟外邪者。如上所谓风气百疾是也。有挟瘀郁者。则此所谓五劳诸伤。内有干血者是也。
夫风气不去。则足以贼正气而生长不荣。干血不去。则足以留新血而渗灌不周。故去之不可不早也。此
方润以濡其干。虫以动其瘀。通以去其闭。而仍以地黄、芍药、甘草和养其虚。攻血而不专主于血。
一如薯蓣丸之去风而不着意于风也。喻氏曰。此世俗所称干血劳之良治也。血瘀于内。手足脉相失者
宜之。兼入琼玉膏补润之剂尤妙。
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（一两烧令烟尽） 虻虫（一升去翅足熬） 水蛭（百枚熬） 蛴螬（百
枚熬） 虫（半升熬）
上十二味。末之。炼蜜和丸。小豆大。酒服五丸。日三服。
附方
千金翼炙甘草汤 治虚劳不足。汗出而闷。脉结。悸。行动如常。不出百日。危急者十一日
死。
甘草（四两炙） 桂枝 生姜（各三两） 麦冬（半升） 麻仁（半升） 人参 阿胶（各三两）
大枣（三十枚） 生地黄（一斤）
上九味。以酒七升。水八升。先煮八味。取三升。去滓。内胶消尽。温服一升。日三服。
脉结是营气不行。悸则血亏而心无所养。营滞血亏。而更出汗。岂不立槁乎。故虽行动如常。断
云不出百日。知其阴亡而阳绝也。人参、桂枝、甘草、生姜。行身之阳。胶、麦、麻、地。行身之阴。
盖欲使阳得复行阴中而脉自复也。后人只喜用胶、地等而畏姜、桂。岂知阴凝燥气。非阳不能化耶。
（徐氏）
肘后獭肝散 治冷劳。又主鬼疰一门相染。
獭肝一具。炙干末之。水服方寸匕。日三服。
问：血痹这种病，是怎么得的呢？
老师说：那些养尊处优的人，骨骼柔弱而肌肉丰盛，再加上因为疲劳而出汗，睡觉时身体不时翻动，又受到微风的侵袭，于是便得了这种病。只要脉象在寸口部位微而涩，关部稍紧，适宜用针刺来引导阳气，使脉象调和、紧象消失，病就能痊愈。
阳气的作用，是护卫体表并使其固密。如果因为疲劳出汗，阳气就受了一次损伤；睡觉时身体翻动，阳气又受了一次损伤。于是，虽然风邪很轻微，却能直接侵入血中而形成痹证。经书上说：“邪气侵入阴分就会形成痹证。”脉微表示阳气虚弱，脉涩表示血液运行滞缓，脉紧则是邪气的征象。血中的邪气，起初是因为阳气受伤才得以进入，最终必须依靠阳气的通畅才能排出。痹证这种疾病，血因为风邪侵入而在外部痹阻，阳气也因为血痹而在内部停滞。所以必须用针刺来引导阳气外出，阳气外出则邪气去除，邪气去除则脉紧变得调和，血痹得以疏通。由此可知，血分受痹，不应当只治疗血。
血痹证如果阴阳脉象都微弱，寸口和关部脉微，尺部脉稍紧，外在症状是身体麻木不仁，像风痹的样子，但用黄芪桂枝五物汤主治。
所谓“阴阳俱微”，是指人迎、趺阳、太溪三部脉都微弱。寸口和关部脉微，尺部脉稍紧，这是阳气不足而阴气痹阻的征象。“不仁”是指肌肤顽钝麻木，痛痒感觉不到，像风痹的样子，但实际上并不是风邪所致。黄芪、桂枝、芍药、生姜、大枣这五味药，能调和营血的滞涩，助长卫气的运行，这也包含了针刺引导阳气的意思。因为脉象阴阳都微弱，所以不能用针刺，而可以用药物治疗。经书所说：“阴阳形气都不足的人，不要用针刺，而要用甘味药物调理。”
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）
以上五味药，用水六升，煮取二升，温服七合，每天服三次。
阳气，因烦劳而亢张，所以脉象大；劳损导致气耗散，所以脉象极虚。李氏说：脉大并不是气盛，重按必然空软无力。大，是劳损脉象外表暴张的表现；极虚，是劳损脉象内部衰弱的表现。
男子面色淡白无华，主诉口渴及失血。突然气喘心悸，脉象浮，这是里虚的表现。
口渴是因为热伤阴气，失血是因为血液不能荣华于面色，所以面色淡白无华的人，可以知道他既有口渴又有失血。李氏说：劳损会导致气血俱耗，气虚则喘，血虚则悸。“卒”是猝然出现这些病症的意思。脉浮表示里虚，因为劳损导致真阴失守，孤阳没有根基，气散于外，精夺于内。
男子脉象虚沉弦，没有寒热症状，短气，腹部拘急，小便不利，面色白，时常眼睛昏花兼有鼻出血，小腹胀满，这是劳损导致的。
劳损这类疾病，脉象浮大，手足烦热，春夏季节加重，秋冬季节减轻。阴寒内生，精气自行滑脱，肢体酸痛消瘦不能行走。男子脉象浮弱而涩，说明无法生育，精气清冷。
脉象虚沉弦，是劳损伤了阳气，所以会出现短气、腹部拘急、小便不利、小腹胀满、面色白等症状，严重时还会伤及阴气，出现眼睛昏花兼有鼻出血。眼睛昏花，就是视物不明。脉象浮，是劳损伤了阴气，所以出现手足烦热、肢体酸痛消瘦不能行走、春夏加重秋冬减轻等症状，严重时还会伤及阳气，出现阴寒内生、精气自行滑脱。这是阴阳互根的自然规律。如果脉象浮弱而涩，则是精气交相亏损而清冷不温暖，这是因为先天禀赋薄弱，所以应当无法生育。
凡是经常失精的人，小腹弦急，阴头寒冷，头晕眼花，头发脱落。脉象极虚芤迟，主泄泻完谷不化、失血、失精。脉象出现各种芤、动、微、紧的脉象，男子失精，女子梦交，用桂枝加龙骨牡蛎汤主治。
脉象极虚芤迟，是因为精液流失，虚损波及到气，所以小腹弦急，阴头寒冷，头晕眼花。脉象出现各种芤、动、微、紧，是因为阴阳失调，损伤了神与精，所以男子失精，女子梦交。沈氏所说的劳伤心气，火浮不敛，导致心肾不交，阳气泛于上，精孤于下，火不摄水，不交自泄，所以病发失精；或者精虚心相内浮，扰动精液而出，就成为梦交。徐氏说：桂枝汤在外感病证中得到它，能解肌祛邪；在内伤病证中得到它，能补虚调阴阳。加上龙骨、牡蛎，是因为失精梦交是神精之间的病，不用这些药不足以收敛浮越的神精。
桂枝加龙骨牡蛎汤方
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，分三次温服。
天雄散方
天雄（三两，炮制） 白术（八两） 桂枝（六两） 龙骨（三两）
以上四味药，捣碎成散剂，用酒送服半钱匕，每天服三次。如果没见效，稍微增加剂量。
按：此方怀疑也是后人附入的，用于补阳摄阴。
男子平时脉象虚弱细微，容易出盗汗。人到了五六十岁，如果病脉反而大，这是痹证夹脊背而行，或者肠鸣、马刀疮、侠瘿，都是劳损导致的。脉象沉小迟，名叫脱气。这种人快走就会气喘吁喝，手脚逆冷，腹部胀满，甚至溏泄，食物不消化。
脉象弦而大，弦表示阳气减少，大表示中空如芤。减少就是寒，中空就是虚。虚寒相互搏结，这叫革脉。妇人会出现半产、漏下；男子会出现亡血、失精。
平人，就是不生病的人。脉象虚弱细微，说明阴阳都不足。阳不足就不能固摄，阴不足就不能守持，这样的人一定容易出盗汗。人到了五六十岁，精气已经衰退，如果病脉反而大，说明这个人可能有风气邪气。痹证夹脊背而行，是因为阳气不足，邪气随之而入。至于肠鸣、马刀疮、侠瘿，是因为阳气因劳损而外张，火热因劳损而上逆。阳气外张，则寒气动于中而产生腹鸣；火上逆，则与痰相搏结而形成马刀疮、侠瘿。李氏说：生在乳腋下叫马刀，又生在颈两旁叫侠瘿。“侠”通“挟”。马刀、蛎蛤之类，疮形像它们，所以叫马刀。瘿，一作缨，生在系缨带之处。这两种疮，一个在颈，一个在腋下，常相互联系，所以俗名串疮。脉象沉小迟，都是阴象。三者并见，阴盛而阳亡，所以名叫脱气。这种人快走就气喘吁喝，是气脱而不固。由此导致外无气而手脚逆冷，胃无气而腹部胀满，脾无气而溏泄食不化，这些都是阳微气脱的证候。脉弦是因为阳不足，所以为减为寒；脉大是因为阴不足，所以为芤为虚。阴阳都虚，外强中干，这叫革脉，又是变革的意思。妇人半产、漏下，男子亡血、失精，这都是失去了产乳生育的正常状态，所以名叫革脉。
虚劳，腹部拘急，心悸，鼻出血，腹中痛，梦中失精，四肢酸痛，手足烦热，咽干口燥，用小建中汤主治。
这是调和阴阳、调理营卫的方法。人生的道理，在于阴和阳。阴阳平和，百病不生。如果阳病不能与阴和，那么阴就会带着寒气独行，导致腹部拘急、腹中痛，但这实际上并不是阴气盛。如果阴病不能与阳和，那么阳就会带着热气独行，导致手足烦热、咽干口燥，但这实际上并不是阳气炽盛。愚昧的人用寒药攻热，用热药攻寒，寒热在体内互相侵害，病情会更加严重。只有用甘、酸、辛味的药物，配合制成方剂，调理使之和谐，那么阳就能依附于阴，寒气得以温煦；阴就能依附于阳，热气得以平和。医生之所以珍贵在于能识得这个大要，难道仅仅是说寒可治热、热可治寒而已吗？有人问：调和阴阳、调理营卫是对的，但一定要用“建中”是什么意思呢？回答说：中，指脾胃。营卫生成于水谷，而水谷的转输依赖于脾胃。所以中气确立，则营卫流行而不失其和谐。另外，中气是四季运转的枢纽，也是阴阳变化的关键。所以中气确立，则阴阳循环，如环无端，而不会偏颇。这个方子，甘味与辛味结合而生阳，酸味得到甘味帮助而生阴，阴阳相生，中气自然确立。因此，寻求阴阳和谐的人，必须从中气入手；寻求中气确立的人，必须通过建中来实现。
小建中汤方
桂枝（三两） 甘草（二两） 芍药（六两） 大枣（十二枚） 生姜（三两） 饴糖（一升）
以上六味药，用水七升，煮取三升，去渣，加入胶饴，再放在小火上融化，温服一升，每天服三次。
腹部拘急，是指里虚脉急，腹部牵引疼痛。各种不足，是指阴阳诸脉都不足，眩晕、心悸、气喘、呼吸困难、失精、亡血等证候相继出现。急者需要缓之，必须用甘味药；不足者需要补之，必须用温性药。而要充塞空虚，黄芪尤其有专长。
黄芪建中汤方：即在小建中汤中加入黄芪一两半，其余按照上面的方法制作。如果有气短、胸满，加生姜；如果腹部胀满，去掉大枣，加茯苓一两半。以及治疗肺虚损不足，补气，加半夏三两。
下焦的分野，由少阴主管。少阴虽然是阴脏，但其中有元阳，用来温煦经脉脏腑，运行阴阳，司管开阖。虚劳的人，损伤了少阴肾气，所以腰痛，小腹拘急，小便不利。这就是程氏所说的肾间动气已经受损。八味肾气丸补阴之虚，可以生气；助阳之弱，可以化水，是补下治下的良剂。
八味肾气丸方（见妇人杂病篇）
虚劳证多夹杂风气，正气不可单独补虚，也不可刻意去风。仲景用人参、地黄、川芎、当归、茯苓、白术补其气血，阿胶、麦冬、生姜、大枣、甘草、芍药益其营卫，而以桔梗、杏仁、桂枝、防风、柴胡、白蔹、黄卷、神曲去风行气。其中使用薯蓣最多，因为它不寒不热，不燥不滑，兼具补虚去风之长，所以作为君药。意思是必须正气理顺而后风气才可去除。
薯蓣丸方
薯蓣（三十分） 人参（七分） 白术（六分） 茯苓（五分） 甘草（二十八分） 当归（十分） 干地黄（十分） 芍药（六分） 川芎（六分） 麦冬（六分） 阿胶（七分） 干姜（三分） 大枣（百枚，熬膏） 桔梗（五分） 杏仁（六分） 桂枝（十分） 防风（六分） 神曲（十分） 豆黄卷（十分） 柴胡（五分） 白蔹（二分）
以上二十一味药，研成细末，炼蜜和丸，如弹子大小，空腹时用酒送服一丸，一百丸为一剂。
人醒着时，魂寓于目；睡觉时，魂藏于肝。虚劳的人，肝气不荣，则魂不能藏。魂不藏所以不得眠。酸枣仁补肝敛气，适宜作为君药。而既然魂不归舍，必有浊痰燥火乘虚侵袭其居所，这就是烦产生的原因。所以用知母、甘草清热滋燥，茯苓、川芎行气除痰，都是为了求得肝的治理，而使魂有所宅。
酸枣仁汤方
酸枣仁（二升） 甘草（一两） 知母 茯苓（各二两） 川芎（一两）
以上五味药，用水八升，先煮酸枣仁得六升，加入其他药，煮取三升，分三次温服。
五劳虚极羸瘦，腹部胀满不能饮食，这是食伤、忧伤、饮伤、房室伤、饥伤、劳伤，导致经络营卫气受伤，内有干血，肌肤甲错，两眼黯黑，用大黄䗪虫丸缓中补虚。
虚劳症有夹杂外邪的，如上所述的风气百疾是也；有夹杂瘀郁的，则此所谓的五劳诸伤，内有干血是也。风气不去，足以贼害正气而生长不荣；干血不去，足以留滞新血而渗灌不周。所以去除它不可不早。此方用润药濡养其干燥，用虫药动摇其瘀血，用通药去除其闭阻，而仍以地黄、芍药、甘草和养其虚。攻血而不专主于血，就像薯蓣丸去风而不执着于风一样。喻氏说：这是世俗所称干血劳的良好治疗方法。血瘀于内，手足脉象不相一致的，适宜使用。兼入琼玉膏等补润药剂尤为妙。
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，烧至烟尽） 虻虫（一升，去翅足，熬制） 水蛭（百枚，熬制） 蛴螬（百枚，熬制） 䗪虫（半升，熬制）
以上十二味药，研成细末，炼蜜和丸，如小豆大小，用酒送服五丸，每天服三次。
附方
千金翼炙甘草汤：治疗虚劳不足，汗出而胸闷，脉结代，心悸，行动如常，不出百日，危急者十一日死。
甘草（四两，炙） 桂枝 生姜（各三两） 麦冬（半升） 麻仁（半升） 人参 阿胶（各三两） 大枣（三十枚） 生地黄（一斤）
以上九味药，用酒七升，水八升，先煮前八味，取三升，去渣，加入阿胶融化，温服一升，每天服三次。
脉结代是营气不行，心悸则是血亏而心无所养。营滞血亏，而又出汗，岂不立刻枯槁吗？所以虽然行动如常，断言不出百日，这是知道阴亡而阳绝。人参、桂枝、甘草、生姜，运行身上的阳气；阿胶、麦冬、麻仁、地黄，运行身上的阴液。大概是想要使阳气能在阴中复行，而脉象自然恢复。后人只喜欢用阿胶、地黄等药而畏惧生姜、桂枝，哪里知道阴凝燥气，非阳气不能化呢？（徐氏）
Question: How is Blood Bi (Blood Obstruction) contracted?
The Master said: Those who live in luxury have weak bones but abundant flesh. If they are further subjected to fatigue and sweating, and during sleep their bodies move restlessly, exposing themselves to slight wind, this condition arises. The pulse at the cun (inch) position is fine and choppy, while the guan (bar) position is slightly tight. Acupuncture should be used to guide the Yang Qi outward. When the pulse becomes harmonious and the tightness disappears, the disease will be cured.
Yang Qi serves to defend the exterior and maintain solidity. Fatigue and sweating injure the Yang Qi once; restless movement during sleep injures it again. Thus, even slight wind pathogens can directly enter the blood and cause Bi syndrome. As the classics state: "When pathogenic factors enter the Yin, Bi results." A fine pulse indicates deficient Yang; a choppy pulse indicates stagnant blood; a tight pulse is a sign of pathogenic factors. Pathogens in the blood enter because of Yang deficiency and must exit through the unblocking of Yang Qi. In Bi syndrome, blood is obstructed externally by wind, and Yang Qi is stagnated internally due to blood obstruction. Therefore, acupuncture must be used to guide Yang Qi outward. When Yang Qi moves outward, pathogens are expelled; when pathogens are gone, the pulse tightness harmonizes, and blood obstruction resolves. From this, we know that when blood is obstructed, one should not treat only the blood.
If both Yin and Yang pulses are fine in Blood Bi, with fine pulses at the cun and guan positions and a slightly tight pulse at the chi (cubit) position, and external symptoms include numbness of the body resembling Wind-Bi, Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction) is indicated.
"Both Yin and Yang pulses are fine" refers to the renying, dizuyang, and taixi pulses being fine. Fine pulses at cun and guan with a tight chi pulse indicate insufficient Yang and obstructed Yin. "Numbness" means the skin and muscles are dull and insensitive to pain or itching, resembling Wind-Bi, but actually caused by something other than wind. The five herbs—Huangqi (Astragali Radix), Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens), and Dazao (Jujubae Fructus)—harmonize the stagnation of Ying (Nutritive) Qi and assist the movement of Wei (Defensive) Qi, reflecting the intent of acupuncture to guide Yang Qi. Since the Yin and Yang pulses are both fine, acupuncture is contraindicated, and herbal medicine is preferred. As the classics state: "When Yin-Yang and form-Qi are both deficient, do not use needles; instead, regulate with sweet medicines."
**Huangqi Guizhi Wuwu Tang Formula**
Huangqi (Astragali Radix) - 3 liang
Shaoyao (Paeoniae Radix Alba) - 3 liang
Guizhi (Cinnamomi Ramulus) - 3 liang
Shengjiang (Zingiberis Rhizoma Recens) - 6 liang
Dazao (Jujubae Fructus) - 12 pieces
Crush the above five ingredients. Boil in 6 sheng of water until 2 sheng remain. Take 7 he of the warm decoction three times daily.
In men, a large pulse in a healthy person indicates Lao (Consumption/Fatigue). An extremely deficient pulse also indicates Lao.
Yang Qi expands due to mental labor and worry, resulting in a large pulse. Labor depletes Qi, resulting in an extremely deficient pulse. Li stated: A large pulse does not indicate abundant Qi; deep pressure reveals emptiness and softness. The large quality is the superficial manifestation of Lao; extreme deficiency is the internal depletion of Lao.
A pale complexion in men indicates thirst and loss of blood. Sudden panting and palpitations with a floating pulse indicate interior deficiency.
Thirst results from heat injuring Yin Qi. Loss of blood fails to nourish the complexion, leading to a pale face. Li stated: Lao consumes both Qi and Blood. Qi deficiency causes panting; Blood deficiency causes palpitations. "Sudden" refers to the abrupt onset of these symptoms. A floating pulse indicates interior deficiency because Lao causes the loss of True Yin, leaving Lone Yang without root. Qi scatters outward, and Essence is depleted inward.
If a man’s pulse is deficient, deep, and wiry, without chills or fever, accompanied by shortness of breath, abdominal urgency, dysuria, pallor, occasional vertigo with epistaxis, and lower abdominal fullness, this is caused by Lao.
Lao diseases present with a floating and large pulse, vexation of the hands and feet, worsening in spring and summer, and improving in autumn and winter. Internal cold leads to spontaneous emission of essence, and soreness/weakness prevents walking. If a man’s pulse is floating, weak, and choppy, it indicates infertility due to cold and clear Jing (Essence).
A deficient, deep, and wiry pulse indicates Lao damaging Yang, causing shortness of breath, abdominal urgency, dysuria, lower abdominal fullness, and pallor. Severe cases damage Yin, causing vertigo and epistaxis. Vertigo implies blurred vision. A floating pulse indicates Lao damaging Yin, causing hand-foot vexation, soreness/weakness preventing walking, seasonal exacerbation, and severe cases involving internal cold and spontaneous emission. This reflects the natural mutual root of Yin and Yang. A floating, weak, and choply pulse indicates mutual deficiency of Jing and Qi, resulting in coldness and infertility due to congenital weakness.
Individuals prone to spermatorrhea often have a tense and urgent lower abdomen, coldness at the glans penis, vertigo, and hair loss. An extremely deficient, knotted, and slow pulse indicates incomplete digestion, blood loss, and spermatorrhea. Knotted, moving, fine, and tight pulses in men indicate spermatorrhea, and in women, nocturnal emissions with sexual dreams. Guizhi Jia Longgu Muli Tang (Cinnamon Twig Decoction plus Dragon Bone and Oyster Shell) is indicated.
An extremely deficient, knotted, and slow pulse indicates that Jing loss has led to Qi deficiency, causing lower abdominal tension, cold glans, and vertigo. Knotted, moving, fine, and tight pulses indicate Yin-Yang disharmony affecting Shen (Spirit) and Jing. Men suffer spermatorrhea; women suffer nocturnal emissions. Shen stated: Lao damages Heart Qi, causing Fire to float without containment, leading to Heart-Kidney non-interaction. Yang floats upward, Jing remains isolated below, Fire fails to control Water, leading to spontaneous leakage. Or, Jing deficiency allows Ministerial Fire to float internally, disturbing Jing and causing nocturnal emissions. Xu stated: Guizhi Tang resolves the exterior and expels pathogens; internally, it tonifies deficiency and regulates Yin-Yang. Adding Longgu (Fossilia Ossis Mastodi) and Muli (Concha Ostreae) is necessary because spermatorrhea and nocturnal emissions are disorders of Shen and Jing, requiring these minerals to anchor floating elements.
**Guizhi Jia Longgu Muli Tang Formula**
Guizhi (Cinnamomi Ramulus) - 3 liang
Shaoyao (Paeoniae Radix Alba) - 3 liang
Shengjiang (Zingiberis Rhizoma Recens) - 3 liang
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang
Dazao (Jujubae Fructus) - 12 pieces
Longgu (Fossilia Ossis Mastodi) - 3 liang
Muli (Concha Ostreae) - 3 liang
Boil the seven ingredients in 7 sheng of water until 3 sheng remain. Divide into three warm doses.
**Tianxiong San Formula**
Tianxiong (Aconiti Lateralis Radix Preparata) - 3 liang (prepared)
Baizhu (Atractylodis Macrocephalae Rhizoma) - 8 liang
Guizhi (Cinnamomi Ramulus) - 6 liang
Longgu (Fossilia Ossis Mastodi) - 3 liang
Grind into powder. Take half a qianbi with wine, three times daily. Increase dosage slightly if ineffective.
Note: This formula is likely an addition by later authors, used to tonify Yang and secure Yin.
Men with weak, fine, and subtle pulses tend to have night sweats. At age 50-60, a large pulse indicates Bi along the spine, intestinal borborygmi, marisco (scrofula-like lumps under the arm), or jia ying (goiter-like lumps on the neck), all caused by Lao. A deep, small, and slow pulse is called "Qi Devastation." Rapid walking causes panting; extremities are cold; abdomen is full; severe cases involve loose stools and indigestion.
A wiry and large pulse: wiry indicates reduction (deficiency); large indicates knotted (empty). Reduction implies cold; empty implies deficiency. Deficiency and cold clashing is called a Ge (Leather) pulse. In women, it causes miscarriage and bleeding; in men, blood loss and spermatorrhea.
A healthy person with weak, fine, and subtle pulses has both Yin and Yang deficiency. Yang deficiency fails to secure; Yin deficiency fails to guard, leading to night sweats. At 50-60, Jing and Qi decline; a large pulse suggests wind pathogens. Bi along the spine occurs because Yang deficiency allows pathogens to enter. Intestinal borborygmi, marisco, and jia ying occur because Yang expands outward due to Lao, and Fire rises upward. Yang expanding causes internal cold and borborygmi; Fire rising clashes with phlegm to form marisco and jia ying. Li stated: Marisco occurs under the armpit; jia ying occurs on the sides of the neck. "Jia" means clamping. These sores resemble oysters/shells, hence the name. They connect between neck and armpit, commonly called "string sores." Deep, small, and slow pulses are Yin signs. All three together indicate Yin excess and Yang extinction, named Qi Devastation. Panting upon walking indicates Qi devastation and insecurity. Cold extremities, abdominal fullness, and loose stools are all signs of Yang micro-devastation. Wiry pulse indicates Yang deficiency (cold); large pulse indicates Yin deficiency (empty). Both Yin and Yang are deficient, appearing strong outside but dry inside, called Ge pulse (also meaning transformation). Miscarriage, bleeding, blood loss, and spermatorrhea represent the loss of normal reproductive functions, hence named Ge.
For Lao with abdominal urgency, palpitations, epistaxis, abdominal pain, nocturnal spermatorrhea, limb soreness, hand-foot vexation, dry throat, and dry mouth, Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is indicated.
This method harmonizes Yin and Yang and regulates Ying and Wei. Life depends on Yin and Yang. If Yang cannot harmonize with Yin, Yin acts alone with cold, causing abdominal urgency and pain, though Yin is not actually excessive. If Yin cannot harmonize with Yang, Yang acts alone with heat, causing hand-foot vexation and dry mouth/throat, though Yang is not actually blazing. Ignorant practitioners attack heat with cold and cold with heat, worsening the condition. Using sweet, sour, and acrid herbs harmonizes the body: Yang attaches to Yin, warming cold; Yin attaches to Yang, harmonizing heat. Physicians must grasp this principle. Why "Jianzhong" (Construct the Middle)? Zhong refers to the Spleen and Stomach. Ying and Wei are generated from food and fluids, transported by the Spleen and Stomach. If Zhong Qi is established, Ying and Wei flow harmoniously. Zhong Qi is the axis of the four seasons and the mechanism of Yin-Yang. Sweet and acrid generate Yang; sour and sweet generate Yin. To harmonize Yin-Yang, one must seek Zhong Qi; to establish Zhong Qi, one must Jianzhong.
**Xiao Jianzhong Tang Formula**
Guizhi (Cinnamomi Ramulus) - 3 liang
Gancao (Glycyrrhizae Radix et Rhizoma) - 2 liang
Shaoyao (Paeoniae Radix Alba) - 6 liang
Dazao (Jujubae Fructus) - 12 pieces
Shengjiang (Zingiberis Rhizoma Recens) - 3 liang
YiTang (Maltose) - 1 sheng
Boil the six ingredients in 7 sheng of water until 3 sheng remain. Remove dregs, add YiTang, melt over low heat. Take 1 sheng warm, three times daily.
For Lao with abdominal urgency and various deficiencies, Huangqi Jianzhong Tang (Astragalus Construct the Middle Decoction) is indicated.
Abdominal urgency indicates interior deficiency and pulling pain. Various deficiencies mean all Yin-Yang pulses are deficient, leading to vertigo, palpitations, panting, spermatorrhea, and blood loss. Urgency requires sweet herbs to relax; deficiency requires warm herbs to tonify. Huangqi is particularly effective for filling voids.
**Huangqi Jianzhong Tang Formula**: Same as Xiao Jianzhong Tang plus Huangqi (Astragali Radix) 1.5 liang. For shortness of breath and chest fullness, add Shengjiang. For abdominal fullness, remove Dazao and add Fuling (Poria) 1.5 liang. For Lung deficiency and Qi tonification, add Banxia (Pinelliae Rhizoma) 3 liang.
For Lao with lower back pain, lower abdominal urgency, and dysuria, Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) is indicated.
The Lower Jiao is governed by Shaoyin. Although Shaoyin is a Yin organ, it contains Yuan Yang (Primordial Yang) to warm meridians/organs, circulate Yin-Yang, and control opening/closing. Lao damages Shaoyin Kidney Qi, causing back pain, lower abdominal urgency, and dysuria. This is what Cheng referred to as damage to the Moving Qi in the Kidney region. Bawei Shenqi Wan tonifies Yin deficiency to generate Qi and assists weak Yang to transform fluids, an excellent formula for treating the lower Jiao.
**Bawei Shenqi Wan Formula** (See Women's Diseases Chapter)
For Lao with various deficiencies and wind-pathogen diseases, Shuyu Wan (Dioscorea Pill) is indicated.
Lao often involves wind pathogens. One should not solely tonify deficiency nor solely expel wind. Zhang Zhongjing uses Renshen (Ginseng), Dihuang (Rehmannia), Xiong (Ligusticum), Danggui (Angelica), Fuling (Poria), Baizhu (Atractylodes) to tonify Qi and Blood; Ejiao (Donkey-hide Gelatin), Maidong (Ophiopogon), Shengjiang, Dazao, Gancao, Shaoyao to benefit Ying and Wei; and Jiegeng (Platycodon), Xingren (Prunus), Guizhi, Fangfeng (Saposhnikovia), Chaihu (Bupleurum), Bailian (Tinosporae Rhizoma), Huangjuan (Sojae Semen Praeparatum), Shenqu (Massa Medicata Fermentata) to move wind and Qi. Shuyu (Dioscoreae Rhizoma) is used most heavily because it is neither cold nor hot, dry nor slippery, excelling in tonifying deficiency and expelling wind, serving as the Sovereign herb. Righteous Qi must be regulated before wind can be expelled.
**Shuyu Wan Formula**
Shuyu (Dioscoreae Rhizoma) - 30 parts
Renshen (Ginseng Radix et Rhizoma) - 7 parts
Baizhu (Atractylodis Macrocephalae Rhizoma) - 6 parts
Fuling (Poria) - 5 parts
Gancao (Glycyrrhizae Radix et Rhizoma) - 28 parts
Danggui (Angelicae Sinensis Radix) - 10 parts
Shengdihuang (Rehmanniae Radix) - 10 parts
Shaoyao (Paeoniae Radix Alba) - 6 parts
Xiong (Chuanxiong Rhizoma) - 6 parts
Maidong (Ophiopogonis Radix) - 6 parts
Ejiao (Colla Corii Asini) - 7 parts
Ganjiang (Zingiberis Rhizoma) - 3 parts
Dazao (Jujubae Fructus) - 100 pieces (paste)
Jiegeng (Platycodonis Radix) - 5 parts
Xingren (Armeniacae Semen Amarum) - 6 parts
Guizhi (Cinnamomi Ramulus) - 10 parts
Fangfeng (Saposhnikoviae Radix) - 6 parts
Shenqu (Massa Medicata Fermentata) - 10 parts
Douhuangjuan (Sojae Semen Praeparatum) - 10 parts
Chaihu (Bupleuri Radix) - 5 parts
Bailian (Tinosporae Rhizoma) - 2 parts
Grind the 21 ingredients into powder. Mix with refined honey to form pills the size of quail eggs. Take one pill with wine on an empty stomach. 100 pills constitute one dose.
For Lao with empty vexation and insomnia, Suanzaoren Tang (Sour Jujube Seed Decoction) is indicated.
When awake, Hun (Ethereal Soul) resides in the eyes; when sleeping, it resides in the Liver. In Lao, Liver Qi fails to nourish, so Hun cannot reside, causing insomnia. Suanzaoren (Ziziphi Spinosae Semen) tonifies the Liver and astrings Qi, serving as the Sovereign. Since Hun does not return, turbid phlegm and dry fire invade, causing vexation. Zhimu (Anemarrhenae Rhizoma) and Gancao clear heat and moisten dryness; Fuling and Chuanxiong move Qi and resolve phlegm. These treat the Liver to house the Hun.
**Suanzaoren Tang Formula**
Suanzaoren (Ziziphi Spinosae Semen) - 2 sheng
Gancao (Glycyrrhizae Radix et Rhizoma) - 1 liang
Zhimu (Anemarrhenae Rhizoma) - 2 liang
Fuling (Poria) - 2 liang
Chuanxiong (Chuanxiong Rhizoma) - 1 liang
Boil Suanzaoren in 8 sheng of water until 6 sheng remain. Add other herbs, boil until 3 sheng remain. Divide into three warm doses.
For extreme deficiency from the Five Labors, emaciation, abdominal fullness, inability to eat, caused by dietary injury, emotional injury, fluid injury, sexual injury, hunger injury, and labor injury, damaging meridians, Ying, Wei, and Qi, with internal dried blood, rough skin like scales, and dark eyes, use Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) to gently tonify deficiency.
Lao may involve external pathogens (wind) or internal stasis (dried blood). Wind harms righteous Qi and growth; dried blood blocks new blood generation. Removal is urgent. This formula moistens dryness, uses insects to move stasis, and unblocks closure, while Rehmannia, Peony, and Licorice tonify deficiency. It attacks blood without focusing solely on blood, similar to how Shuyu Wan expels wind without focusing solely on wind. Yu stated: This is the excellent treatment for "Dried Blood Lao." It is suitable for internal blood stasis with mismatched pulses in hands and feet. Combining with Qiongyu Gao (Jade Elixir Paste) is especially good.
**Dahuang Zhechong Wan Formula**
Dahuang (Rhei Radix et Rhizoma) - 10 parts (steamed)
Huangqin (Scutellariae Radix) - 2 liang
Gancao (Glycyrrhizae Radix et Rhizoma) - 3 liang
Taoren (Persicae Semen) - 1 sheng
Xingren (Armeniacae Semen Amarum) - 1 sheng
Shaoyao (Paeoniae Radix Alba) - 4 liang
Shengdihuang (Rehmanniae Radix) - 10 liang
Ganqi (Drynariae Rhizoma / Dry Lacquer) - 1 liang (burned until smoke ceases)
Mengchong (Blattodea / Housefly larvae) - 1 sheng (wings/legs removed, roasted)
Shizhi (Hirudo / Leech) - 100 pieces (roasted)
Qicao (Silphidae Larva) - 100 pieces (roasted)
Zhechong (Eupolyphaga / Ground Beetle) - 0.5 sheng (roasted)
Grind the 12 ingredients into powder. Mix with refined honey to form pills the size of adzuki beans. Take 5 pills with wine, three times daily.
**Supplementary Formulas**
**Qianjin Yi Zhi Gancao Tang**: Treats Lao insufficiency, sweating with chest stuffiness, knotted pulse, palpitations. If the patient walks normally, death occurs within 100 days; if critical, within 11 days.
Gancao (Licorice Root, prepared) - 4 liang
Guizhi (Cinnamon Twig) - 3 liang
Shengjiang (Fresh Ginger) - 3 liang
Maidong (Ophiopogon Tuber) - 0.5 sheng
Mahuang (Ephedra Stem) - 0.5 sheng [Note: Text says Mahren/Hemp Seed usually, but context implies Mahuang or similar for pulse/knotting, however text says Ma Ren (Hemp Seed). WHO term for Ma Ren is Cannabis Seed. I will stick to text: Ma Ren] -> Correction: Text says "Ma Ren" (Hemp Seed).
Renshen (Ginseng) - 3 liang
Ejiao (Donkey-hide Gelatin) - 3 liang
Dazao (Jujube) - 30 pieces
Shengdihuang (Rehmannia Root) - 1 jin
Boil the first eight ingredients in 7 sheng of wine and 8 sheng of water until 3 sheng remain. Remove dregs, dissolve Ejiao. Take 1 sheng warm, three times daily.
Knotted pulse indicates stagnant Ying Qi; palpitations indicate Blood deficiency failing to nourish the Heart. With stagnant Ying, deficient Blood, and sweating, the body will quickly wither. Even if walking normally, death is predicted within 100 days due to Yin exhaustion and Yang severance. Ginseng, Cinnamon, Licorice, and Ginger move Yang; Gelatin, Ophiopogon, Hemp Seed, and Rehmannia move Yin. The goal is to allow Yang to re-enter Yin to restore the pulse. Later practitioners fear Ginger and Cinnamon, preferring Gelatin and Rehmannia, failing to realize that Yin coagulation and dryness require Yang to transform. (Xu)
**Zhouhou Ta Gan San**: Treats Cold Lao and infectious ghost consumption.
Beaver Liver (one piece), dried and powdered. Take one fangcunbi with water, three times daily.