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They are all ignorant physicians. Use Jianzhong Tang (Cinnamon Twig and Licorice Decoction), remove the sugar, and add Ren Shen (Ginseng Radix).

Yin (49 years old) is in middle age but shows signs of physical decline. Movement induces wheezing and coughing. The pulse is fine and lacks spirit. Appetite has decreased by half. This indicates that the lower yuan fails to grasp qi. The body fluids are steamed and transformed into sticky phlegm. Premature aging constitutes a Lao disease (consumptive disease). (Kidney qi fails to grasp qi).
Ren Shen (Ginseng Radix), Kan Qi (Placenta), Zi Yi Hu Tao (Walnut with purple skin), Chao Tu Si Zi (Fried Cuscutae Semen), Fu Ling (Poria), Wu Wei Zi (Schisandrae Fructus), Chao Sha Ren (Fried Amomi Fructus), Shan Yao (Dioscoreae Rhizoma), made into pills with yam paste.

Jin (70 years old) experiences palpitations when awake. Walking feels like facing dangerous obstacles. After midnight (Zi hour), Chong qi (Penetrating vessel qi) rebels upward. All this is caused by deficiency of the lower jiao due to advanced age, leading to kidney qi's failure to grasp qi. Take Bawei Wan (Eight-Ingredient Pill) 3 qian. Take it for four days first.
Dan Cong Rong (Cistanche Herba, 1 liang), He Che Jiao (Human Placenta, 1 piece), Zi Shi Ying (Hematitum, 2 liang), Xiao Hui (Foeniculi Fructus, 5 qian), Qi Zi (Lycii Fructus, 3 liang), Hu Tao Rou (Juglandis Semen, 2 liang), Niu Xi (Achyranthis Bidentatae Radix, 1.5 liang), Wu Wei Zi (Schisandrae Fructus, 1 liang), Fu Ling (Poria, 2 liang), Sha Yuan (Astragali Complanati Semen, 1.5 liang), Bu Gu Zhi (Psoraleae Fructus, 1 liang), Sang Shen Zi (Mori Fructus, 2 liang), made into pills with red date flesh.

Wang: Long-term sojourn causes labor injury. Bi obstruction in the qi level leads to dysfunction of the clear orifices in the upper jiao. Initially, the disease is in the qi level; after a long time, it enters the blood level. Body pain, yellow eyes, reduced appetite, and emaciation occur because the illness affects the primordial deficiency. Neither attacking pathogens nor tonifying can eliminate the disease. Considering that the left side ascending belongs to the Liver and the right side descending belongs to the Lung, one should harmonize qi and blood to ensure proper ascending and descending. If delayed further, blood stasis will worsen daily, forming abdominal masses. (Qi and blood stagnation, obstruction of ascending and descending). Xuanfu Hua Tang (Inula Flower Decoction) plus Tao Ren (Persicae Semen), Gui Xu (Angelicae Sinensis Radix Stems), Lou Pi (Benincasae Pericarpium).

Yu (Mrs.): Hemoptysis and coughing followed by persistent evening fever. Menstruation continues. Infertility for six or seven years. This indicates damage to the Liver, Kidney, Chong Mai (Penetrating Vessel), and Ren Mai (Conception Vessel). Yin and Yang qi do not intersect, progressing into Lao Qie (consumptive weakness). Treatment focuses on securing and consolidating, containing the leakage and dispersion. (Liver, Kidney, Chong, and Ren deficiencies).
Xian He Che Jiao (Fresh Human Placenta), Huang Bo (Phellodendri Cortex), Shu Di (Rehmanniae Radix Preparata), Dan Cong Rong (Cistanche Herba), Wu Wei Zi (Schisandrae Fructus), Fu Shen (Poria with Hostwood), made into honey pills.

Tu (28 years old): Labor injury damages yang qi. Persisting for three years, the injury extends to the Middle Palace (Spleen and Stomach). Symptoms resemble regurgitation. Qi mechanisms are tilted and disordered. Intersections lose their sequence, resulting in alternating chills and fever. Overexertion injures the Spleen and Stomach. Ox belongs to Kun Earth (Spleen); use Xia Tian Gao (Beef Gelatin Paste). (Labor injury damages Spleen and Stomach).

Zhu (12 years old): Running and exertion most injure yang qi. Able to eat but unable to fatten the muscles. Limbs are often cold. This is because qi in the meridians cannot penetrate to the extremities. There is concern about Tong Sun (childhood deficiency/congenital weakness). (Labor injures meridians).
Cong Rong (Cistanche Herba, 2 liang), Dang Gui (Angelicae Sinensis Radix, 2 liang), Qi Zi (Lycii Fructus, 1 liang), Fu Ling (Poria, 2 liang), Chuan Xiong (Ligustici Chuanxiong Rhizoma, 5 qian), Sha Yuan (Astragali Complanati Semen, 5 qian), one eel, made into pills.

Xing (44 years old): Strain injury. Body pain and weakness. Guizhi Tang (Cinnamon Twig Decoction) minus Ginger, plus Wu Jia Pi (Acanthopanacis Cortex).

Regarding deficiency and damage syndromes, the *Neijing* discusses them in detail. Their names vary. Examining the *Neijing*'s discussion on damage to the five zang organs, treatments differ. Yue Ren (Bian Que) proposed treating upper damage from yang and lower damage from yin. For conditions unresponsive to acupuncture and moxibustion, sweet medicine is used to regulate. The *Jinkui Yaolue* follows this principle to establish Jianzhong Tang, urgently building middle qi so that food intake increases, generating abundant fluids and blood, thereby filling blood and generating essence to restore the insufficiency of true yuan. Only using the sweet taste inherent in grains (Jia Se), while avoiding sour, acrid, salty, and bitter tastes, is considered the only effective method. However, this can only treat damage to the yang aspect of the upper jiao, insufficient to nourish the root of true yin in the lower jiao. (Comment by Mr. Lai)
Extending to Sancai Tang (Three Powers Decoction), Guben Wan (Solidify the Root Pill), Tianzhen Wan (Heavenly Innocence Pill), Dazao Wan (Great Creation Pill), Guizhi Longgu Muli Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction), Fumai Tang (Restore Pulse Decoction), as well as various securing formulas and methods for gently tonifying the three yin meridians of the foot, these serve as auxiliary treatments for all kinds of deficiency affecting the five zang organs, greatly enlightening later generations and assisting in the treatment of damage syndromes. The *Jinkui* also states: "In men, a large pulse indicates Lao; an extremely deficient pulse also indicates Lao." A large pulse indicates qi leaking outward due to worry and depression, damaging Heart and Spleen Ying (Nutritive) qi in the upper and middle jiao, leading to languishing Ying level; this suits Guipi Tang (Restore the Spleen Decoction), Jianzhong Tang, Yangying Tang (Nourish Ying Decoction), Sijunzi Tang (Four Gentlemen Decoction), Wuweizi Tang (Schisandra Decoction), Yigong San (Extraordinary Efficacy Powder), etc. An extremely deficient pulse indicates internal loss of essence and blood, with Liver and Kidney yin failing to stand independently; this suits Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), Bawei Wan, Tianzhen Wan, Dazao Wan, Sancai Tang, Guben Wan, Fumai Tang, as well as methods for gently tonifying the three yin meridians of the foot and securing. Since Zhang Zhongjing, many heroes have emerged. Was there no one to elucidate hidden truths before him? Nor were there no high-minded scholars before Mr. Ye. Yet, abandoning Zhang Zhongjing's methods to treat Xu Lao (deficiency-lao) successfully is rarely seen. Like Li Dongyuan and Zhu Danxi, renowned ancient physicians, they primarily used Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala Rhizoma) for irrecoverable damage, sometimes using several jin. Their intent was that tangible essence and blood are hard to restore, so urgently tonifying intangible qi is key. This expands upon Zhang Zhongjing's Jianzhong decoctions. Later, Zhang Jingyue argued that insufficiency of Mingmen (Gate of Life) yin constitutes yin deficiency within yin, treated mainly with Zuogui Yin (Left Restoring Decoction) and Zuogui Wan (Left Restoring Pill); insufficiency of Mingmen yang constitutes yang deficiency within yin, treated mainly with Yougui Yin (Right Restoring Decoction) and Yougui Wan (Right Restoring Pill). These do not exceed the formulas mentioned above (Sancai, Guben, Tianzhen, Dazao) and methods for tonifying the three yin meridians and securing, offering no new insights. Thus, later generations praise Zhang Zhongjing for mastering Xu Lao treatment, having grasped its essence. (Comment by Zou Zijiu)

Long-standing deficiency without recovery is called Sun (damage); extreme damage without recovery is called Lao (lao). These three (Xu, Lao, Sun) occur sequentially. Investigating the causes of disease, they are not uniform. The symptoms presented are difficult to analyze item by item. Generally, for those injured by mental/physical fatigue damaging qi, Mr. Ye uses treatments for the upper and middle jiao, employing sweet-cool agents to tonify Lung and Stomach clear fluids, and soft agents to nourish Heart and Spleen Ying fluids, or sweet-warm agents to build the Middle Palace, preventing deviation of yin and yang, allowing Ying and Wei (Defensive) qi to circulate properly. For those injured by excessive sexual activity damaging essence, treatment should focus on the lower jiao and involve the eight extraordinary vessels. One must distinguish between replenishing essence/blood and qi/essence, and between warming fire and nourishing yin. Or utilize the subtleties of statically preserving Ren yin and warmly regulating odd yang. If caused by dysregulation of other diseases spreading, one must identify the origin and adjust according to the trend. Speculating on Mr. Ye's intent, distinguishing constitution's yin and yang is the key, considering symptoms in upper/middle/lower regions, and judging life/death based on transmission to pre-heaven/post-heaven. If analyzed step-by-step, each point has roots to verify, rather than casually combining a few tonics and speaking loosely of treatment. (Comment by Shao Xinpu)

Mr. Xu comments: This old man's method for treating Xu Lao involves nothing more than clearing the Lung, nourishing the Stomach, and tonifying the Kidney. While not causing major harm, it lacks profound meaning. Mild cases may heal; severe cases will only worsen day by day. Furthermore, his adherence to Zhang Zhongjing's methods largely misses the original intent of the sages. Zhang Zhongjing's "Xu Lao" referred to deficiency-cold syndromes, hence the pulse was floating, large, hollow, and slow, and Yi Tang (Maltose) was used in the formula for abdominal pain. Today's "Xu Lao" refers to yin exhaustion with floating fire flaming upward, with pulses being fine and rapid, which is contrary to Jianzhong Tang. Using it here is what is called "ear-food learning" (blindly following hearsay). I have personally witnessed several cases where this old man treated patients with yin deficiency and flaming fire with Jianzhong Tang, resulting in throat bi (obstruction) and hematemesis/hemoptysis. At the time, he did not realize his error. Therefore, I record this here.