问曰。血痹之病。从何得之。师曰。夫尊荣（之）人。（形乐而志苦。志苦故）
骨弱。（形乐故）肌肤盛。（然骨弱则不能耐劳。肌肤盛则气不固。若）重困疲劳（则
）汗出。（汗后愈疲而嗜）卧（卧中）不时动摇。加被微风。遂得（而干）之。（风与
血相搏。是为血痹。）但以（血痹人两手寸关尺六部）脉（本）自微涩。（一见脉微。则知其阳
之不足。一见脉涩。则知其阴之多阻。而其邪入之处。）在（于）寸口。（以左寸之心
主营。右寸之肺主卫也。今诊其）关上（之寸口）小紧。（紧为邪征。又合各部之微涩。
可知阳伤。而邪因以阻其阴。必得气通。而血方可循其度。）宜针引阳气。令脉和紧
去则愈。
此言血痹之症。由于质虚劳倦。列于虚劳之上。与他痹须当分别也。
血痹（症脉之通体）阴阳俱微。（前言微涩。今言微而不言涩。以涩即在微中也。
）寸口（脉在）关上（者亦）微。尺中小紧。（前言紧在关上之寸口。今言紧在尺中。
非前后矛盾也。邪自营卫而入。故紧止见于寸口。既入之后。邪搏于阴而不去。故紧又
见于尺中也。）外证身体不仁。（虽）如风痹（之）状。（其实非风。以）黄 桂枝五
物汤主之。（经云。阴阳形气俱不足者。勿刺以针。而调以甘药。兹方和营之滞。助卫
之行。甘药中亦寓针引阳气之意也。）
此节与上节合看。其义始备。其方即桂枝汤。妙在以 易草。倍用生姜也。
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。
（虚劳病。其机一见于脉。即当早治。）夫男子平人脉大（为七情色欲过度。内损
肾精。势将）为劳。脉极虚（为饥饱劳役过度。内损脾气。）亦为劳。（病者须当治之
于早也。）
此以大虚二脉。提出虚劳之大纲。意者肾精损则真水不能配火。故脉大。脾气损则
谷气不能内充。故脉虚。二脉俱曰为者。言其势之将成也。难经云、损其脾者。调其饮食。
适其寒温。损其肾者。益其精。未雨绸缪。其在斯乎。
（虚劳病。见于脉者。尚隐而难窥。而征之于色。则显而易见。）男子面色（无泽
而浅）薄者。主（气不布精而口）渴及（失血过多而）亡血。卒（然之顷。或气不顺而）
喘（心不宁而）悸。（更诊其脉。若）脉（之）浮（于外）者。（便知其）里（之）虚
也。（甚则为真阴失守。孤阳无根。气散于外。精夺于内之急证。可不畏哉。）
此言望色而得其虚。又当参之于脉。而定其真虚与否也。
男子（劳而伤阳。阳气不足。其）脉虚沉弦。（不关外邪。其身）无寒热。（但病
）短气里急。小便不利。面色白。（为阳伤之易见者。人可共知。而上虚则眩。当随）
时（自见其）目瞑。（阳虚阴必走。有时）兼（见为鼻）衄。（丹田气海关元等穴。俱在
少腹。元阳伤则）少腹满。此为劳（而伤阳）使之然。劳（而伤阴）之为病。（阴病而
虚。虚阳愈炽。）其脉浮大。手足烦。春夏（木火炎盛之际。气浮于外。则里愈虚而）
剧。秋冬（金水相生之候。气敛于内。则不外扰而）瘥。（阴虚而阳必荡。故）阴寒精
自出。（精枯而骨渐痿。故） 削不能行。（此为劳而伤阴使之然。）男子（精气交亏。
气亏而）脉浮弱（精亏）而（脉）涩。为（得天之禀不足。当）无子。（盖其人之）
精气（定是）清冷。
此三节首言劳而伤阳。是承第一节脉极虚为劳句来。次言劳而伤阴。是承第一节脉
大为劳句来。三言精气俱亏。本于赋禀。是承第二节脉浮里虚也二句来。然阴阳有互根
之理。天定胜人。人定亦可胜天。此中调燮补救之道。良医功同良相。若熟江湖。经走
富贵门者。恃有八仙长寿丸六八味丸左右归丸人参养荣汤补中益气汤金水六君煎百花膏
加味归脾汤加味逍遥散等之快捷方式。不必与言及此
也。
（以上各证。虽有阴阳之殊。而总不外乎一虚。于虚中求一真面目。当知有精气神
三宝。于精气神中求一真救治。则惟有桂枝龙骨牡蛎汤一方。谓为失精家之主方。而以上
阴阳互见之证。亦在其中。亦且精气神之为病。千变万化。无不总括其中。）夫（肾
主闭藏。肝主疏泄。）失精家。（过于疏泄。故）少腹弦急。（前阴为宗筋之所聚。气
随精而过泄。故）阴头（无气而自）寒。（肝开窍于目。黑水神光属肾。肝肾虚故）目
眩。（肾之华在变。肝藏血。发者血之余。肝肾虚故）发落。（以上诸症。征之于脉）
脉极虚芤迟。（迟）为清谷。（芤为）亡血。（虚为）失精。（然失精家脉复不一。苟
）脉得诸芤。动微紧。男子（为阴虚不得阳之固摄而）失精。女子（为阴虚不得阳之刚正
而）梦交。桂枝龙骨牡蛎汤主之。（是汤也。伊芳圣阐阴阳造化之微。与小建中等方相表
里。用得其法。则头头是道矣。）
此为阴虚者出其方也。其方看似失精梦交之专方。而实为以上诸证之总方也。时医
止知桂枝为表药。龙牡为涩药。妄测高深。皆不读神农本草经之过也。自夫失精家至桂
枝加龙骨牡蛎汤止。隐承第一节脉大为劳意。言虚阳盛而真阴虚者。故以脉之浮大边为
主。而间有沉弦微紧者。仍露出阳衰之象。盖以阴根于阳。阴病极则并伤其阳也。故其
方以桂枝汤调阴阳。加龙骨牡蛎。以专滋其阴。可知阴虚中又有阴阳之分也。故小注中
多以阴阳分析。又按短剧云、虚弱浮热汗出者。此方除桂枝。加白薇附子各三分。名曰
二加龙骨汤。盖以桂性升发。非阴虚火亢者所宜。况此证之汗。因虚阳鼓之而外溢。必
得白薇之苦寒泻火。即是养阴。附子之辛热导火。亦是养阴。功同肾气丸。但肾气丸金
匮中五见。皆从利小便中而治各证。不若此方之泛应曲当也。究之偏于阴虚者宜此。否
则原方及小建中等方。阴阳并理。面面周到。可谓入神。（唐王焘外台秘要。多用仲师
短剧方。）
桂枝龙骨牡蛎汤方
桂枝 芍药 生姜（各三两） 甘草（二两炙） 龙骨 牡蛎（各三两） 大枣（
十二枚）
上七味。以水七升。煮取三升。分温三服。
男（元犀）按、龙者。天地之神也。龙骨者。龙之所脱也。海者。水之所归也。牡
蛎者。海气之所结也。古圣人用此二味。绝大议论。今人以固涩止脱四字尽之。何其浅
也。
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。天雄药铺无真。当
以大附子代之。）
尤在泾云、此疑亦后人所附。为补阳摄阴之用也。男（元犀）按、尤注未确。先君
移于八味肾气丸方之后。而详注之。可谓发前人所未发。
男子平人。脉虚弱细微者。（元阳不足也。阳不足则不能卫外而为固。且阳病而阴
不能自长。阴亦不足。故不能自守。而）善盗汗也。人年五六十。（阳气就衰。脉不宜
大。而）其病脉（反）大者。（非真阳之有余。乃虚阳之上亢。）痹挟（脊）背（之左
右两）行。（为太阳之经道。太阳为诸阳主气。阳气虚则痹而不行也。）若（阳气以劳
而外张。外张则寒动于中。而为）肠鸣。（火热以劳而上逆。上逆则与痰相搏。而生于腋
下为）马刀。（生于颈旁为）侠瘿者。皆为劳得之。脉沉小迟。（三者相并。是阳气全
虚。故）名脱气。（气脱则躯乃空壳。）其人疾行。则（气竭而）喘喝。（阳虚则寒。
寒盛于外。则）手足逆寒。（寒盛于中。则为）腹满。甚则溏泄。食不消化也。脉（轻
按）弦而（重按）大。弦则为（阳微而递）减。大则为（外盛而中）芤。减则（阳不自
振）为（诸）寒。芤则（阴不守中）为（中）虚。虚寒相搏。此名为革。（革脉不易明。
以弦减芤虚二脉形容之。则不易明者明矣。
见此脉者。）妇人则（不能安胎而）半产（不能调经而）漏下。男子（不能统血。）则亡
血（不能藏精。则）失精。
自男子平人脉虚弱微细起。至亡血失精止。隐承第一节脉极虚亦为劳意。分四小节。
言虚阴盛而真阳衰者。故以脉之沉紧弦细边为主。而间有芤大者。仍现出阴虚之象。盖
以阳根于阴。阳病极则并伤其阴也。小注中以阴阳分疏。即此故也。下一节约其大要以
出方。再下一节。从前方而推进一步。再下一节。以阴阳之总根在下。举一少腹。一小便。
以示一隅之举也。
（阳虚之证。前论颇详。兹再约其大要。而出其方治。）虚劳（病如元阳之气不能内
充精血。则营枯而虚。为）里急（为）悸（为）衄。（为）腹中痛。（为）梦失精。（如
元阳之气不能外充四肢口咽。则气虚而燥。为）四肢 疼。（为）手足烦热。为咽干口
燥。（内经云。劳者温之。又云。调以甘味。以）小建中汤主之。
此为阳虚者出其方也。然小建中汤调其阴阳。和其营卫。建其中气。其用甚广。附
录尤注于后。
尤在泾云、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。惟以酸甘辛药。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。必于中气。求中气之立者。必以建中也。徐忠可云、劳字从火。未有劳
症而不发热者也。又劳字从力。以火能蚀气。未有劳症而力不疲者也。人身中不过阴阳
血气四字。气热则阳盛。血热则阴盛。然非真盛也。真盛则为气血方刚。而壮健无病矣。
惟阴不能与阳和。阳不能与阴和。故变生以上数节所列之证。阴阳中更有阴阳之分。
寒热互见。医者当如堪舆家按罗经以定子午。则各向之宜忌。以及兼针之可否。无不可
按法而行矣。至于亡血失精。阴虚阳虚皆有之者。阴极能生热也。故见脉在浮大边。即
当知阴不能维阳。肾为阴之主务。交其心肾而精血自足。见脉在细小边。即当知阳不能
胜阴。脾为阳之主。即补其中气。而三阳自泰。故仲景特拈此二大扇。以为后人治虚劳
之准。至阴虚热极而燥。此虚劳之坏证也。朱奉议创出滋阴一法。授庸医以耽延时日根据
阿附和之术。大失治虚劳正法。后人见滋阴亦有愈者。乃用参不用参。聚讼不已。岂知
仲景以行阳固阴为主。而补中安肾。分别用之。不专恃参。不专滋阴。为恢恢游刃也哉。
按阳虚阴虚。古人亦有是说。而朱紫之最混者。薛立斋倡之。张景岳和之。至于今
止知多寒者可施 术姜附等为阳虚。多热者可施地冬归芍等为阴虚。而斯道扫地尽矣。
余于前注。亦以阴虚阳虚分析。然而里急腹中痛。四肢 疼。手足烦热。脾虚也。悸。
心虚也。衄。肝虚也。（男元犀按。血从清道出为鼻衄。从浊道出为吐血。下溢为便血。
统属于冲任督之脉为病。以冲任督之脉。皆丽于肝也。）失精。肾虚也。咽干口燥。
肺虚也。五脏皆属于阴。故谓为阴虚之病。然内经云、脾为阴中之至阴。又云、阴病治
阳。故必先以温药建其脾土。而五脏皆循环而受益。谓为阳虚。盖以阴之失阳而
虚也。（男元犀按。此注又从前注深一层立论。阴虚阳虚分解。犹是为中人以下说法。）
小建中汤方
桂枝（三两） 甘草（二两） 芍药（六两） 生姜（三两） 饴糖（一升）
大枣（十二枚）
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（虚脉）急（以及眩悸喘渴失精亡血腹痛）诸（证之）不足。（相因而至。以
）黄 建中汤主之。
此一节即前节之证。前节之方。而推展言之也。
尤在泾云、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
眩悸喘渴失精亡血等症。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。补气加半夏二两。（按气短何以不加人参。胸满何以不加橘皮。
而俱加生姜乎。腹满加茯苓。以茯苓不根不苗。得气化而生。以气化者气化。犹为思议
可及。而去枣者。恐枣之甘能壅满乎。何以饴糖甘草之大甘。而不去乎。又何以疗及
问：血痹这种病，是从哪里得来的？老师回答说：那些养尊处优的人，形体安逸而精神苦闷，因为精神苦闷所以骨骼脆弱；因为形体安逸所以肌肉丰满。然而骨骼脆弱就不能耐受劳累，肌肉丰满则卫气不固，如果过度疲劳导致出汗，汗出后更加疲倦想睡觉，在睡眠中身体不时翻动，又受到微风的侵袭，于是就得病了。（风邪与血相搏结，这就叫血痹。）但是血痹病人的两手寸、关、尺六部脉象本来微涩（一见脉微，就知道阳气不足；一见脉涩，就知道阴血多有阻滞；而邪气侵入的部位）。在于寸口（左寸心主营血，右寸肺主卫气。现在诊察其关上部位的寸口脉小紧（紧脉是邪气的征象，结合各部脉的微涩，可知阳气受损，邪气因此阻碍阴血运行，必须使气机通畅，血液才能恢复正常运行）。适宜用针刺引导阳气，使脉象调和，紧脉消失就能痊愈。
这一段论述血痹的症状，是由于体质虚弱和劳倦引起的，列在虚劳篇之前，与其他痹证应当分别对待。
血痹的脉象整体阴阳俱微（前文说微涩，这里只说微而不说涩，是因为涩脉包含在微脉之中）。寸口脉在关上部位也微，尺中脉小紧（前文说紧脉出现在关上的寸口，这里说紧脉出现在尺中，并不是前后矛盾。邪气从营卫而入，所以紧脉只见于寸口；进入之后，邪气搏结于阴分而不离去，所以紧脉又见于尺中）。外在症状是身体麻木不仁（虽然像风痹的样子，其实不是风），用黄芪桂枝五物汤主治。（经文说：阴阳形气都不足的人，不要用针刺，而要用甘药调理。这个方子调和营血的滞涩，助长卫气的运行，在甘药中也蕴含了针刺引导阳气的意思。）
这一节要与上一节合起来看，意义才完备。这个方子就是桂枝汤，妙在用黄芪代替甘草，并且加倍使用生姜。
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，每天三次。
（虚劳病，其机理一表现在脉象上，就应当尽早治疗。）男子平时脉象大（这是因七情色欲过度，内损肾精，势必发展为劳损），脉象极虚（这是因饥饱劳役过度，内损脾气），也都属于劳损。（病人应当尽早治疗。）
这里以大虚和脉大两种脉象，提出虚劳的大纲。意思是肾精亏损则真水不能制约火，所以脉大；脾气亏损则谷气不能内充，所以脉虚。这两种脉象都说是“为劳”，是说病情发展的趋势即将形成。《难经》说：损伤脾脏的，要调理饮食，适应寒温；损伤肾脏的，要补益精气。未雨绸缪，大概就在这里吧。
（虚劳病，表现在脉象上，还隐蔽难以窥探，而反映在面色上，则显而易见。）男子面色浅薄无光泽的，主口渴以及失血过多导致的亡血。突然之间，或者气不顺而喘，心不宁而悸。（再诊察其脉，如果脉浮于外，就知道里虚。）（严重时则为真阴失守，孤阳无根，气散于外，精夺于内的急症，能不畏惧吗？）
这一段讲通过望面色得知虚证，又应当参合脉象，来确定是真虚还是假虚。
男子（劳倦损伤阳气，阳气不足，其）脉象虚沉弦（不关乎外邪，其身）无寒热（但病）短气里急，小便不利，面色白（这是阳气损伤容易见到的表现，人们都可以知道，而上焦虚则头晕，应当随时自行出现）目瞑（阳气虚阴必走，有时）兼见鼻衄（丹田气海关元等穴，都在少腹，元阳损伤则）少腹胀满，这是劳倦损伤阳气使之如此。劳倦损伤阴气的病症，（阴病而虚，虚阳更炽。）脉象浮大，手足烦热，春夏（木火炎盛之际，气浮于外，则里更虚而）病情加重，秋冬（金水相生之候，气敛于内，则不外扰而）病情缓解。（阴虚而阳必荡，故）阴寒精自出（精枯而骨渐痿，故）消瘦不能行走（这是劳倦损伤阴气使之如此。）男子（精气交亏，气亏而）脉浮弱（精亏）而（脉）涩，为（先天禀赋不足，当）无子（大概这个人的）精气（必定是）清冷。
这三节首先讲劳倦伤阳，是承接第一节“脉极虚亦为劳”这句话来的；其次讲劳倦伤阴，是承接第一节“脉大为劳”这句话来的；第三讲精气俱亏，本于天赋禀赋，是承接第二节“脉浮里虚”这两句话来的。然而阴阳有互根的道理，天定胜人，人定亦可胜天。其中调养补救的方法，良医的功效同于良相。如果是熟识江湖、经常出入富贵门第的人，倚仗有八仙长寿丸、六八味丸、左右归丸、人参养荣汤、补中益气汤、金水六君煎、百花膏、加味归脾汤、加味逍遥散等快捷方式，不必与他们谈论这些道理。
（以上各证，虽然有阴阳的不同，但总不外乎一个“虚”字。在虚中寻求真面目，应当知道有精气神三宝。在精气神中寻求真正的救治，就只有桂枝龙骨牡蛎汤一方，称之为失精家的主方，而以上阴阳互见的证候，也包含在其中。况且精气神的病变千变万化，无不总括其中。）夫（肾主闭藏，肝主疏泄。）失精家（过于疏泄，故）少腹弦急（前阴为宗筋所聚，气随精而过泄，故）阴头寒（肝开窍于目，黑水神光属肾，肝肾虚故）目眩（肾之华在发，肝藏血，发者血之余，肝肾虚故）发落（以上诸症，征之于脉）脉极虚芤迟（迟）为清谷（芤为）亡血（虚为）失精（然而失精家脉象又不止一种，如果）脉得诸芤、动、微、紧，男子（因阴虚不得阳之固摄而）失精，女子（因阴虚不得阳之刚正而）梦交，用桂枝龙骨牡蛎汤主治。（这个汤剂，伊芳圣阐明了阴阳造化的微妙，与小建中等方相表里，用法得当，则头头是道。）
这是为阴虚者出的方子。这个方子看似失精梦交的专方，而实为以上诸证的总方。当时的医生只知道桂枝是解表药，龙牡是收敛药，妄测高深，都是不读《神农本草经》的过错。自从“失精家”至“桂枝加龙骨牡蛎汤”止，隐含承接第一节“脉大为劳”的意思，讲虚阳盛而真阴虚者，所以以脉之浮大为主，而间有沉弦微紧者，仍露出阳衰之象。盖因阴根于阳，阴病极则并伤阳也。所以此方以桂枝汤调阴阳，加龙骨牡蛎，以专滋其阴。可知阴虚中又有阴阳之分。所以小注中多以阴阳分析。另外按《短剧》云：虚弱浮热汗出者，此方除桂枝，加白薇、附子各三分，名叫二加龙骨汤。盖因桂性升发，不适合阴虚火亢者。况且此证的汗，因虚阳鼓动而外溢，必须得白薇之苦寒泻火，即是养阴；附子之辛热导火，亦是养阴。功效同于肾气丸，但肾气丸在《金匮》中出现五次，都是从利小便中来治疗各证，不如此方泛应曲当。究其本质，偏于阴虚者宜用此方，否则原方及小建中等方，阴阳并理，面面周到，可谓入神。（唐王焘《外台秘要》，多用仲师《短剧》方。）
桂枝龙骨牡蛎汤方
桂枝 芍药 生姜（各三两） 甘草（二两炙） 龙骨 牡蛎（各三两） 大枣（十二枚）
以上七味药，用水七升，煮取三升，分三次温服。
男（元犀）按：龙，是天地之神。龙骨，是龙所脱落的。海，是水所归聚的地方。牡蛎，是海气所凝结的。古圣人用这两味药，有极大的议论，今人只用“固涩止脱”四个字来概括它，多么浅薄啊。
天雄散方
天雄（三两炮） 白术（八两） 桂枝（六两） 龙骨（三两）
以上四味药，捣成散剂，用酒送服半钱匕，每天三次。如果没效，稍微增加剂量。（按：药店没有真的天雄，应当用大附子代替。）
尤在泾说：这怀疑也是后人附会的，用于补阳摄阴。男（元犀）按：尤注不准确。先父将其移置于八味肾气丸方之后，并详细注释，可以说是发掘前人所未发的见解。
男子平时，脉象虚弱细微的（元阳不足。阳不足则不能卫外而为固，且阳病而阴也不能自长，阴也不足，故不能自守，而）容易盗汗。人到了五六十岁（阳气衰退，脉不宜大，而）其病脉（反而）大的（不是真阳有余，而是虚阳上亢。）痹痛挟（脊）背（左右两）行（这是太阳经的道，太阳为诸阳主气，阳气虚则痹而不行。）若（阳气因劳而外张，外张则寒动于中，而为）肠鸣（火热因劳而上逆，上逆则与痰相搏，而生于腋下为）马刀（生于颈旁为）侠瘿者，都是因为劳倦得的。脉沉小迟（三者相并，是阳气全虚，故）名脱气（气脱则躯壳空虚。）其人疾行，则（气竭而）喘喝（阳虚则寒，寒盛于外，则）手足逆寒（寒盛于中，则为）腹满，甚则溏泄，食物不消化。脉（轻按）弦而（重按）大，弦则为（阳微而递）减，大则为（外盛而中）芤。减则（阳不自振）为（诸）寒，芤则（阴不守中）为（中）虚。虚寒相搏，此名为革（革脉不易明白，用弦减芤虚二脉形容它，则不易明白的就明白了。
见此脉者。）妇人则（不能安胎而）半产（不能调经而）漏下，男子（不能统血。）则亡血（不能藏精，则）失精。
从“男子平人脉虚弱微细”起，至“亡血失精”止，隐含承接第一节“脉极虚亦为劳”的意思，分为四小节，讲虚阴盛而真阳衰者，所以以脉之沉紧弦细为主，而间有芤大者，仍现出阴虚之象。盖因阳根于阴，阳病极则并伤阴也。小注中以阴阳分疏，就是这个缘故。下一节约其大意而出方，再下一节，从前方推进一步，再下一节，以阴阳之总根在下，举一少腹、一小便，以示举一反三。
（阳虚之证，前论颇详，这里再约其大要，而出其方治。）虚劳（病如元阳之气不能内充精血，则营枯而虚，为）里急（为）悸（为）衄（为）腹中痛（为）梦失精（如元阳之气不能外充四肢口咽，则气虚而燥，为）四肢疼（为）手足烦热，为咽干口燥（《内经》说：劳者温之，又说：调以甘味，以）小建中汤主治。
这是为阳虚者出的方子。然而小建中汤调其阴阳，和其营卫，建其中气，其用途很广。附录尤注于后。
尤在泾说：这是和阴阳调营卫的方法。人生的道理，曰阴曰阳，阴阳和平，百病不生。如果阳病不能与阴和，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。愚昧的人以寒攻热，以热攻寒，寒热内贼，其病更重。唯有用酸甘辛药，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。医之所以珍贵在于识其大要。岂只是说寒可治热，热可治寒而已哉？有人问：和阴阳调营卫是对的，但一定要建中的原因是什么呢？回答说：中是指脾胃。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，是四运之轴，而阴阳之机也。故中气立，则阴阳相循，如环无端，而不极于偏。此方甘与辛合而生阳，酸得甘助而生阴，阴阳相生，中气自立。是故求阴阳之和，必于中气；求中气之立者，必以建中也。徐忠可说：劳字从火，未有劳症而不发热者也。又劳字从力，以火能蚀气，未有劳症而力不疲者也。人身中不过阴阳血气四字。气热则阳盛，血热则阴盛，然非真盛也。真盛则为气血方刚，而壮健无病矣。惟阴不能与阳和，阳不能与阴和，故变生以上数节所列之证。阴阳中更有阴阳之分，寒热互见，医者当如堪舆家按罗经以定子午，则各向之宜忌，以及兼针之可否，无不可按法而行矣。至于亡血失精，阴虚阳虚皆有之者，阴极能生热也。故见脉在浮大边，即当知阴不能维阳，肾为阴之主务，交其心肾而精血自足。见脉在细小边，即当知阳不能胜阴，脾为阳之主，即补其中气，而三阳自泰。故仲景特拈此二大扇，以为后人治虚劳之准。至阴虚热极而燥，此虚劳之坏证也。朱奉议创出滋阴一法，授庸医以耽延时日根据阿附和之术，大失治虚劳正法。后人见滋阴亦有愈者，乃用参不用参，聚讼不已，岂知仲景以行阳固阴为主，而补中安肾，分别用之，不专恃参，不专滋阴，为恢恢游刃也哉。
按阳虚阴虚，古人亦有是说，而朱紫之最混者，薛立斋倡之，张景岳和之。至于今止知多寒者可施术姜附等为阳虚，多热者可施地冬归芍等为阴虚，而斯道扫地尽矣。余于前注，亦以阴虚阳虚分析，然而里急腹中痛，四肢疼，手足烦热，脾虚也。悸，心虚也。衄，肝虚也（男元犀按：血从清道出为鼻衄，从浊道出为吐血，下溢为便血，统属于冲任督之脉为病，以冲任督之脉，皆丽于肝也）。失精，肾虚也。咽干口燥，肺虚也。五脏皆属于阴，故谓为阴虚之病。然《内经》云：脾为阴中之至阴，又云：阴病治阳，故必先以温药建其脾土，而五脏皆循环而受益，谓为阳虚，盖以阴之失阳而虚也（男元犀按：此注又从前注深一层立论，阴虚阳虚分解，犹是为中人以下说法）。
小建中汤方
桂枝（三两） 甘草（二两） 芍药（六两） 生姜（三两） 饴糖（一升）
大枣（十二枚）
以上六味药，用水七升，煮取三升，去滓，内胶饴，更上微火消解，温服一升，每天三次。
虚劳里（虚脉）急（以及眩悸喘渴失精亡血腹痛）诸（证之）不足（相因而至，以）黄芪建中汤主治。
这一节即前节的证、前节的方，而推展言之。
尤在泾说：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，而眩悸喘渴失精亡血等症，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，则黄芪尤有专长也。
黄芪建中汤方
即小建中汤内加黄芪一两半，其余根据上法。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，补气加半夏二两（按：气短何以不加人参，胸满何以不加橘皮，而俱加生姜乎？腹满加茯苓，以茯苓不根不苗，得气化而生，以气化者气化，犹为思议可及。而去枣者，恐枣之甘能壅满乎？何以饴糖甘草之大甘，而不去乎？又何以疗及
Question: From where does the disease of Blood Bi (Blood Obstruction) arise? The Master replied: Those who live in luxury and ease, their bodies are comfortable but their minds suffer. Because their minds suffer, their bones become weak; because their bodies are comfortable, their muscles become full. However, weak bones cannot endure fatigue, and full muscles mean that Wei Qi (Defensive Qi) is not secure. If excessive fatigue leads to sweating, and after sweating one becomes more tired and desires to lie down, moving restlessly during sleep, and is then exposed to a slight wind, the disease ensues. (Wind pathogen battles with blood, this is called Blood Bi.) However, the pulse at the Cun, Guan, and Chi positions on both wrists of patients with Blood Bi is originally fine and choppy (Seeing a fine pulse indicates deficiency of Yang Qi; seeing a choppy pulse indicates obstruction of Yin Blood; and the location where the pathogen enters). It is at the Cun Kou (The left Cun position corresponds to the Heart which governs Ying Blood, and the right Cun position corresponds to the Lung which governs Wei Qi. Now, examining the Cun Kou at the Guan position, it is slightly tight (A tight pulse is a sign of pathogen. Combined with the fine and choppy pulses in other positions, it indicates damage to Yang Qi, and the pathogen thereby obstructs Yin Blood. Qi mechanism must be unblocked for blood to flow normally). Acupuncture should be used to guide Yang Qi, harmonizing the pulse until the tightness disappears, and the patient will recover.
This section discusses that the symptoms of Blood Bi arise from constitutional weakness and overexertion, placed before the section on Consumption (Xu Lao), distinguishing it from other types of Bi syndromes.
In Blood Bi, the pulse throughout Yin and Yang is fine (Previously mentioned as fine and choppy, here only fine is mentioned because the choppy quality is contained within the fine pulse). The pulse at the Cun Kou at the Guan position is also fine, while the Chi position is slightly tight (Previously, the tightness was noted at the Cun Kou at the Guan; now it is noted at the Chi. This is not contradictory. The pathogen enters via Ying and Wei, so tightness appears only at the Cun Kou initially; after entering, the pathogen battles with Yin and remains, so tightness appears at the Chi). The external symptom is numbness and insensitivity of the body (Although it resembles Wind Bi, it is actually not Wind). It is treated with Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Twig Five-Ingredient Decoction). (The Classic states: For those deficient in Yin, Yang, Form, and Qi, do not use acupuncture, but regulate with sweet medicines. This formula harmonizes the stagnation of Ying Blood and assists the movement of Wei Qi, embodying the intent of using acupuncture to guide Yang Qi within the use of sweet medicines.)
This section should be read together with the previous one for complete understanding. This formula is essentially Guizhi Tang (Cinnamon Twig Decoction), with the brilliance lying in replacing Gancao (Licorice Root) with Huangqi (Astragalus Root) and doubling the amount of Shengjiang (Fresh Ginger).
**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).
Take the above five ingredients, add six sheng of water, decoct to obtain two sheng. Take seven he of warm decoction three times a day.
(For Xu Lao [Consumption] disease, once the pathology manifests in the pulse, early treatment is essential.) In men, a normal pulse that is large (indicates excessive emotional or sexual activity, internally damaging Kidney Essence, inevitably leading to Consumption); a pulse that is extremely empty (indicates excessive hunger, fullness, or physical labor, internally damaging Spleen Qi) also belongs to Consumption. (Patients should be treated early.)
Here, the two major pulses of extreme emptiness and largeness outline the general principles of Xu Lao. The idea is that when Kidney Essence is damaged, True Water cannot control Fire, resulting in a large pulse; when Spleen Qi is damaged, Grain Qi cannot fill the interior, resulting in an empty pulse. Both pulses are described as "indicating Consumption" to signify the trend of the condition developing. The *Nan Jing* states: For Spleen damage, regulate diet and adapt to temperature changes; for Kidney damage, replenish Essence. Preparing for a rainy day is key here.
(For Xu Lao disease, manifestations in the pulse are hidden and difficult to discern, whereas manifestations in facial color are obvious.) A man with a pale and lusterless complexion primarily suffers from thirst due to failure of Qi to distribute essence, and from loss of blood due to excessive hemorrhage. Suddenly, there may be panting due to Qi stagnation and palpitations due to Heart unrest. (Further examination of the pulse: if the pulse floats externally, it indicates interior deficiency.) (Severe cases involve loss of True Yin, rootless solitary Yang, Qi scattering externally, and Essence being depleted internally—these are critical conditions to fear.)
This section explains diagnosing deficiency through observing facial color, which must be corroborated by pulse diagnosis to determine true versus false deficiency.
Men whose Yang Qi is damaged by overexertion and thus insufficient have a pulse that is empty, deep, and wiry. There is no exterior cold or heat, but there is shortness of breath, internal urgency, dysuria, and a white complexion (These are visible signs of Yang damage known to all. Upper Jiao deficiency causes dizziness, and one may experience eye closure spontaneously. When Yang is deficient, Yin may escape, sometimes accompanied by epistaxis. The Dantian, Qihai, and Guanyuan acupoints are located in the lower abdomen; damage to Yuan Yang causes lower abdominal fullness. This is caused by overexertion damaging Yang. The disease caused by overexertion damaging Yin involves Yin deficiency with hyperactive deficient Yang. The pulse is floating and large, with vexing heat in the hands and feet. Symptoms worsen in Spring and Summer (when Wood and Fire are flourishing, Qi floats outward, making the interior more deficient) and improve in Autumn and Winter (when Metal and Water generate each other, Qi gathers inward, preventing external disturbance). Due to Yin deficiency and uncontrolled Yang, seminal emission occurs spontaneously. As Essence dries up, bones gradually atrophy, leading to emaciation and inability to walk. This is caused by overexertion damaging Yin. Men with concurrent Qi and Essence deficiency have a pulse that is floating, weak, and choppy, indicating congenital insufficiency and likely infertility. Their Essence and Qi are inherently cold and clear.)
These three sections first discuss overexertion damaging Yang, following the statement "extremely empty pulse also indicates Consumption"; secondly, they discuss overexertion damaging Yin, following "large pulse indicates Consumption"; thirdly, they discuss concurrent Qi and Essence deficiency rooted in congenital endowment, following "floating and interior-deficient pulse." However, Yin and Yang have a mutual root relationship. Heaven determines fate, but human effort can overcome Heaven. The methods of regulation and remediation are the work of good physicians, equivalent to good ministers. Those familiar with worldly ways and frequenting wealthy households rely on quick fixes like Baxian Changshou Wan, Liuba Wei Wan, Zuoyou Gui Wan, Renshen Yangrong Tang, Buzhong Yiqi Tang, Jinshui Liu Jun Jian, Baihua Gao, Jiawei Guipi Tang, and Jiawei Xiaoyao San, and need not discuss these deeper principles.
(Above syndromes, though differing in Yin and Yang, all fundamentally stem from deficiency. Seeking the true nature within deficiency requires knowing the Three Treasures: Jing, Qi, and Shen. Seeking true healing among them relies solely on Guizhi Longgu Muli Tang, the principal formula for those with chronic seminal emission. The aforementioned Yin-Yang intermingling syndromes are also included within its scope. Moreover, diseases of Jing, Qi, and Shen are myriad, all encompassed herein.) The Kidney governs storage, and the Liver governs dispersion. Those with chronic seminal emission (due to excessive dispersion) have tense and urgent lower abdomen (The anterior yin is the gathering point of sinews; Qi escapes excessively with Essence, causing coldness in the glans penis). The Liver opens into the eyes, and the black fluid/shen light belongs to the Kidney; Liver-Kidney deficiency causes dizziness. The Kidney's bloom is in the hair, the Liver stores Blood, and hair is the surplus of Blood; Liver-Kidney deficiency causes hair loss. (Corroborating these symptoms with the pulse:) The pulse is extremely empty, knotted, and slow. Slow indicates undigested food in stool; Knotted indicates loss of blood; Empty indicates loss of Essence. (However, pulses in chronic seminal emission vary. If the pulse presents as knotted, active, fine, and tight:) In men, Yin deficiency without Yang's consolidation leads to seminal emission; in women, Yin deficiency without Yang's rectitude leads to nocturnal emissions/dreams of intercourse. These are treated with Guizhi Longgu Muli Tang. (This formula elucidates the subtleties of Yin-Yang creation by Yi Fangsheng, standing in exterior-interior relation with Xiao Jianzhong Tang. Used correctly, it addresses every aspect perfectly.)
This formula is prescribed for Yin deficiency. Although it appears specific for seminal emission and dream intercourse, it is actually the general formula for the aforementioned syndromes. Contemporary physicians mistakenly believe Guizhi is only an exterior-releasing herb and Longgu/Muli are only astringents, guessing at profound meanings due to ignorance of the *Shennong Bencao Jing*. From "chronic seminal emission" to "Guizhi Jia Longgu Muli Tang," it implicitly follows the meaning of "large pulse indicates Consumption" from Section 1, discussing cases where deficient Yang is hyperactive and True Yin is deficient. Thus, the floating and large pulse is primary, while occasional deep, wiry, fine, and tight pulses reveal Yang decline. Since Yin is rooted in Yang, extreme Yin disease damages Yang. Therefore, this formula uses Guizhi Tang to harmonize Yin and Yang, adding Longgu and Muli to specifically nourish Yin. This shows that even within Yin deficiency, there are distinctions between Yin and Yang. Hence, the annotations often analyze Yin and Yang. Additionally, according to *Duanju*: For weakness, floating heat, and sweating, remove Guizhi from this formula and add Baiwei (Anemarrhenae Rhizoma) and Fuzi (Aconiti Lateralis Radix Preparata) each 3 fen, named Erjia Longgu Tang. Since Guizhi is ascending and dispersing, it is unsuitable for Yin deficiency with fire hyperactivity. The sweating in this syndrome is driven by deficient Yang overflowing outward; Baiwei's bitter cold clears fire, which is nourishing Yin; Fuzi's pungent heat guides fire, which is also nourishing Yin. Its efficacy is similar to Shenqi Wan, but Shenqi Wan appears five times in *Jinkui*, treating various syndromes via promoting urination, whereas this formula is more versatile. Ultimately, this formula is suitable for predominant Yin deficiency; otherwise, the original formula and Xiao Jianzhong Tang harmonize both Yin and Yang comprehensively, achieving divine efficacy. (Tang Wang Tao's *Waitai Miyao* frequently uses Zhongjing's *Duanju* formulas.)
**Guizhi Longgu Muli Tang Formula**
Guizhi (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix Alba), Shengjiang (Zingiberis Rhizoma Recens) (each 3 liang), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata) (2 liang), Longgu (Fossilia Ossis Mammi), Muli (Concha Ostreae) (each 3 liang), Dazao (Jujubae Fructus) (12 pieces).
Take the above seven ingredients, add seven sheng of water, decoct to obtain three sheng. Divide into three warm doses.
Male (Yuanxi) notes: Dragon represents the spirit of heaven and earth; Longgu is what dragons shed. Sea is where waters gather; Muli is where sea qi condenses. Ancient sages used these two substances with profound reasoning. Modern people reduce it to "astringing and stopping leakage," which is too shallow.
**Tianxiong San Formula**
Tianxiong (Aconiti Kusnezoffii Radix) (3 liang, processed), Baizhu (Atractylodis Macrocephalae Rhizoma) (8 liang), Guizhi (Cinnamomi Ramulus) (6 liang), Longgu (Fossilia Ossis Mammi) (3 liang).
Grind the above four ingredients into powder. Take half a qianbi dose with wine, three times a day. If ineffective, increase the dose slightly. (Note: Real Tianxiong is unavailable in pharmacies; substitute with large Fuzi.)
You Zaijing says: This is suspected to be a later addition, used for tonifying Yang and securing Yin. Male (Yuanxi) notes: You's annotation is inaccurate. My father moved it after the formula for Bawei Shenqi Wan and annotated it in detail, uncovering insights previously unexpressed.
In men at peace, a pulse that is weak, empty, and fine indicates insufficiency of Yuan Yang. Insufficient Yang cannot guard the exterior and secure the interior. Furthermore, when Yang is diseased, Yin cannot grow independently, so Yin is also insufficient and cannot maintain itself, leading to spontaneous night sweats. At age fifty or sixty, Yang Qi declines, and the pulse should not be large. If the pathological pulse is large, it is not excess of True Yang, but hyperactivity of deficient Yang. Bi pain runs along the left and right sides of the spine (the pathway of the Taiyang channel; Taiyang governs all Yang Qi; Yang deficiency causes Bi obstruction and stagnation). If Yang Qi expands outward due to exertion, cold moves internally causing borborygmus. Fire rises upward due to exertion, battling with phlegm to form Machdao (scrofula under the armpit) or Xiaying (scrofula beside the neck). All are caused by overexertion. A pulse that is deep, small, and slow indicates total Yang deficiency, named Tuo Qi (Qi collapse leaves the body an empty shell). Rapid walking causes panting and gasping due to Qi exhaustion. Yang deficiency leads to cold; severe exterior cold causes cold extremities. Severe interior cold causes abdominal fullness, potentially leading to loose stools and indigestion. A pulse that is wiry on light pressure and large on heavy pressure: wiry indicates decreasing Yang (cold), and large indicates central emptiness (deficiency). Decrease leads to cold; emptiness leads to interior deficiency. Deficiency and cold battling is named Ge Pulse (革脉). (Ge pulse is hard to understand; describing it with wiry-decreasing and empty-deficient pulses clarifies it.)
For such pulses: Women experience miscarriage and metrorrhagia; men experience loss of blood and seminal emission.
From "men at peace with weak, empty, fine pulse" to "loss of blood and seminal emission," it implicitly follows "extremely empty pulse also indicates Consumption" from Section 1, divided into four subsections discussing excess Yin and declining True Yang. Thus, the deep, tight, wiry, and fine pulse is primary, with occasional empty and large pulses revealing Yin deficiency. Since Yang is rooted in Yin, extreme Yang disease damages Yin. The annotations divide Yin and Yang accordingly. The next section summarizes the main points and provides a formula; the following section advances from the previous formula; the subsequent section highlights the lower abdomen and urination to illustrate the root of Yin and Yang below.
(Yang deficiency syndromes were discussed in detail earlier. Here, summarizing the essentials, we provide treatment.) Xu Lao (where Yuan Yang Qi cannot internally fill Essence and Blood, leading to dry Ying and deficiency) presents with internal urgency, palpitations, epistaxis, abdominal pain, and nocturnal seminal emission. (Where Yuan Yang Qi cannot externally fill limbs and mouth/throat, leading to Qi deficiency and dryness) presents with limb pain, vexing heat in hands and feet, dry throat, and dry mouth. (*Neijing* states: Tonify with warmth for exhaustion; regulate with sweet flavors. Treat with Xiao Jianzhong Tang.)
This formula is prescribed for Yang deficiency. Xiao Jianzhong Tang harmonizes Yin and Yang, regulates Ying and Wei, and establishes Middle Qi, with broad applications. You Zaijing's annotation is appended below.
You Zaijing says: This is the method of harmonizing Yin and Yang and regulating Ying and Wei. Human life depends on Yin and Yang. When Yin and Yang are balanced, diseases do not arise. If Yang disease cannot harmonize with Yin, Yin acts alone with its cold, causing internal urgency and abdominal pain, though Yin is not actually in excess. If Yin disease cannot harmonize with Yang, Yang acts alone with its heat, causing vexing heat in hands and feet and dry throat/mouth, though Yang is not actually blazing. Ignorant practitioners attack heat with cold and cold with heat, worsening the disease. Only by combining sour, sweet, and pungent herbs can harmony be achieved. Yang joins Yin, and cold becomes warm; Yin joins Yang, and heat becomes harmonized. Physicians value understanding the main principles, not just saying cold treats heat and heat treats cold. Why must one "establish the middle"? The Middle refers to the Spleen and Stomach. Ying and Wei are generated from Grain and Water, which are transported by the Spleen and Stomach. When Middle Qi stands, Ying and Wei flow harmoniously. The Middle is the axis of the Four Movements and the mechanism of Yin and Yang. When Middle Qi stands, Yin and Yang circulate endlessly without deviation. This formula combines sweet and pungent to generate Yang, and sour assisted by sweet to generate Yin. Yin and Yang generate each other, establishing Middle Qi. Thus, seeking harmony of Yin and Yang requires establishing Middle Qi. Xu Zhongke says: The character "Lao" contains "Fire"; no exhaustion syndrome lacks fever. "Lao" also contains "Strength"; since fire erodes Qi, no exhaustion syndrome lacks fatigue. The body consists only of Yin, Yang, Blood, and Qi. Heat in Qi means Yang excess; heat in Blood means Yin excess, but this is not true excess. True excess implies robust health. Disharmony between Yin and Yang generates the listed syndromes. There are divisions within Yin and Yang, and mixed cold and heat. Physicians must act like geomancers using a compass to determine directions. For loss of blood and seminal emission, both Yin and Yang deficiency exist. Extreme Yin generates heat. A floating/large pulse indicates Yin cannot sustain Yang; the Kidney governs Yin, so connecting Heart and Kidney restores Essence and Blood. A fine/small pulse indicates Yang cannot overcome Yin; the Spleen governs Yang, so tonifying Middle Qi brings peace to the Three Yang. Zhongjing highlights these two major aspects as standards for treating Xu Lao. When Yin deficiency leads to extreme heat and dryness, it is a deteriorated stage of Xu Lao. Zhu Fengyi created the method of nourishing Yin, giving quacks excuses for delay, deviating from correct treatment. Later generations saw cures with nourishing Yin and debated the use of Ginseng. Did they know Zhongjing focuses on moving Yang and securing Yin, tonifying Middle and calming Kidney separately, relying neither solely on Ginseng nor solely on nourishing Yin, allowing for flexible application?
Ancients also spoke of Yin and Yang deficiency, but confusion peaked with Xue Lizhai and Zhang Jingyue. Today, people only know that cold-predominant cases use Aconite/Ginger for Yang deficiency, and heat-predominant cases use Rehmannia/Anemarrhena for Yin deficiency, destroying this art. In my previous annotations, I analyzed Yin and Yang deficiency. Internal urgency and abdominal pain, limb pain, and vexing heat indicate Spleen deficiency. Palpitations indicate Heart deficiency. Epistaxis indicates Liver deficiency (Blood from upper orifices is epistaxis; from lower orifices is hematemesis/hematochezia, all governed by Chong, Ren, and Du meridians, which attach to the Liver). Seminal emission indicates Kidney deficiency. Dry throat and mouth indicate Lung deficiency. All Five Zang organs belong to Yin, so it is called Yin deficiency disease. However, *Neijing* states: Spleen is the ultimate Yin within Yin; treat Yang for Yin disease. Therefore, one must first use warm herbs to establish Spleen Earth, benefiting all Five Zang organs cyclically. It is called Yang deficiency because Yin becomes deficient due to loss of Yang.
**Xiao Jianzhong Tang Formula**
Guizhi (Cinnamomi Ramulus) (3 liang), Zhigancao (Glycyrrhizae Radix et Rhizoma) (2 liang), Shaoyao (Paeoniae Radix Alba) (6 liang), Shengjiang (Zingiberis Rhizoma Recens) (3 liang), Yitang (Maltose) (1 sheng), Dazao (Jujubae Fructus) (12 pieces).
Take the above six ingredients, add seven sheng of water, decoct to obtain three sheng. Remove dregs, add maltose, simmer gently until dissolved. Take one sheng warm, three times a day.
For Xu Lao with internal urgency (from weak pulse) and various insufficiencies (dizziness, palpitations, panting, thirst, seminal emission, loss of blood, abdominal pain) arising sequentially, treat with Huangqi Jianzhong Tang.
This section extends the previous section's symptoms and formula.
You Zaijing says: Internal urgency refers to internal deficiency with urgent pulse, pulling pain in the abdomen. Various insufficiencies refer to simultaneous deficiency in Yin and Yang pulses, leading to sequential symptoms like dizziness, palpitations, etc. Urgency requires soothing with sweet flavors; insufficiency requires tonifying with warm flavors. To fill voids and deficiencies, Huangqi has special expertise.
**Huangqi Jianzhong Tang Formula**
Same as Xiao Jianzhong Tang plus Huangqi (Astragali Radix) 1.5 liang, following the above method. 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 insufficiency, adding Qi, add Banxia (Pinelliae Rhizoma) 2 liang. (Note: Why add Shengjiang for shortness of breath and chest fullness instead of Renshen or Chenpi? Adding Fuling for abdominal fullness works because Fuling arises from Qi transformation. Removing Dazao fears its sweetness causing fullness, yet why keep the sweet Yitang and Gancao? And how does it treat...)