Library

The syndrome of Xu Lao (Consumptive Disease) involves no external pathogens interfering; it is entirely caused by internal injury to the Zang-Fu organs. For instance, alcohol damages the Lung; damp-heat steaming and熏蒸 (fuming) consumes Lung Yin. Sexual excess damages the Kidney, depleting True Yin. Anger damages the Liver; pent-up anger causes Liver Fire to blaze internally and scorch Blood, while sudden rage causes Liver Fire to rush upward leading to hematemesis. These five factors can all exhaust Essence and Blood. The *Dao Jing* states: "Tears, saliva, essence, fluids, sweat, blood, and body fluids—these seven spiritual substances all belong to Yin." When Yin is deficient, internal heat arises, forming the syndrome of Xu Lao. Generally, Xu Lao caused by alcohol and sex is common, yet even young boys may suffer from it due to congenital insufficiency, often influenced more by the mother's Qi. Monks, nuns, widows, and unmarried women, whose desires remain unfulfilled, experience Qi and Blood stagnation, resulting in chills and fever resembling malaria, morning coolness with evening fever, loss of appetite, irregular menstruation, or amenorrhea. Many develop this disease, mostly due to steaming by stagnant fire. Medical texts on Xu Lao discuss Qi deficiency, Blood deficiency, Yang deficiency, and Yin deficiency indiscriminately, treating them together. Thus, students are left without clear guidance. One must not confuse the symptoms: Qi deficiency presents as a spiritless complexion, faint voice, weak limbs, and a faint pulse; Yang deficiency presents as cold body aversion to cold, cold extremities, clear urine and loose stools, and a deep, small, slow pulse, which can be treated with warming tonification. Therefore, if a patient with Xu Lao can tolerate Ginseng (*Ren Shen*) and Astragalus (*Huang Qi*) and responds well to tonification, it is treatable and indicates Qi/Yang deficiency. If they cannot tolerate these herbs and reject tonification, it is untreatable and indicates Blood/Yin deficiency. Although there is a method of tonifying Qi for Blood loss, this refers to acute massive hemorrhage in individuals not previously suffering from Blood deficiency, such as postpartum conditions. It does not apply to cases where Blood deficiency is caused by Fire dryness. The reason Fire becomes dry is that Water is insufficient to control it; hence the classic says, "One Water cannot overcome Five Fires." The Five Fires refer to the fires of the Five Emotions; One Water refers to the True Yin Water of the Kidney, which is Essence. The peak period of human life lasts only about twenty years! Thus, Zhu Danxi used the waxing and waning of the moon to argue that "Yang is often in excess, Yin is often deficient." Wang Jiezhai also believed that 80-90% of diseases stem from Yin deficiency, while less than 1-2% stem from Yang deficiency, largely because few restrain their desires while many indulge them. People know that indulging in sex exhausts Essence, but few realize that daily depletion of Yin Essence leads to loss of taste, increasing weakness with exertion, internal changes in the pulse, and lackluster complexion. In the Kidney, symptoms include soreness/weakness of the lower back, spine, legs, and calves, or dull pain; bone-steaming internal heat with night sweats; fever at night; generalized bone pain or pain as if broken; nocturnal emission and spermatorrhea; tinnitus; and hot soles. In the Heart, symptoms include palpitations and fright; dry heat in palms; vexatious insomnia; restless dreams; bitter taste and dry tongue; and mouth/tongue ulcers. In the Lung, symptoms include cough with profuse sputum or dry cough with little sputum; chest fullness and rebellious Qi, possibly with asthma or rapid breathing; malar flush like rouge; hot breath from nose; hemoptysis and epistaxis; spitting white foam; inability to lie on one side; sore throat and rotten gums; hoarseness. In the Liver, symptoms include chills and fever like malaria; scrofula on the neck; distension and pain in hypochondrium; dry/painful eyes; dizziness and blurred vision; irritability; and hematemesis. In the Spleen, symptoms include poor appetite, nausea, vomiting; abdominal distension and pain, indigestion; borborygmus and diarrhea; and emaciation. These are the fundamental syndromes of the Five Zang organs' Xu Lao. The Classic states: "In treating disease, seek the root." One must examine the cause of damage and which organ is injured. If caused by sexual excess, the injury is in the Kidney; even if other meridians show symptoms, treatment should focus on tonifying the Kidney while addressing others. If caused by alcohol, clearing the Lung should come first. Once the root and branch are identified, the transmission of disease must be carefully observed. For example, Kidney transmitting to Heart, Heart to Lung, etc., constitutes mutual insulting and overcoming (Zei Ke), a sign of great misfortune. The Classic says: "Diseases transmitted in sequence lead to death," meaning all Five Zang have been overcome. The *Nan Jing* says: "Seven transmissions lead to death." If disease starts in the Kidney and transmits to the Spleen, then back to the Kidney, it means the Six Channels are exhausted, and one Zang cannot be injured again. If Kidney disease transmits to Lung skipping the Heart, it is "Child disease affecting Mother." If it skips Heart/Lung to transmit to Liver, it is "Mother disease affecting Child." If it skips Heart/Liver to transmit to Spleen, it transmits to what it cannot overcome, called "light insulting." Without understanding transmission, how can one treat disease? Modern physicians often blur the lines between Qi, Blood, Yin, and Yang when treating Yin deficiency, which is erroneous. There are seven specific errors:

1. Error of Guiding Fire Back to its Source: The Dragon Fire of the Mingmen is called True Yang. If truly deficient, with Yin excess in the Kidney, Dragon Fire cannot stay in place, floats upward causing false heat in the Upper Jiao (red face, restlessness, thirst). However, though thirsty, the patient does not want to drink; tongue coating exists but tongue is slippery/soggy; urine is clear/profuse; feet are cold past knees; Right Chi pulse is deep/small/slow or floating/large/rootless. This is false heat due to Yin excess pushing Yang up, like summer where water is cold but sky is hot. Ba Wei Wan (Eight-Ingredient Pill) is appropriate to guide fire back. Conversely, in Xu Lao, true Yin deficiency causes internal heat; Water fails to control Fire, Fire flares up causing red face/lips, bleeding from mouth/nose, toothache/swelling/bleeding, etc. Though similar to Dragon Fire flaming up, it differs from floating Yang. Even with cold feet, this is due to deficient Fire rising, not True Yang failure. Urine is yellow/scanty, pulse is rapid, indicating internal heat. Using Gui Zhi Tang (Cinnamon Twig Decoction) and Fu Zi (Aconite Root) to guide fire back is like adding firewood to save a fire, worsening upper Jiao heat, cough, dryness, and throat rot.

2. Error of Lizhong Warming Tonification: If there is continuous dull abdominal pain relieved by heat/pressure, cold clear diarrhea with undigested food, and corresponding pulse/symptoms, warming is effective. However, modern doctors see distension, pain, indigestion, and diarrhea, assume Cold Deficiency, and use aromatic/dry Bai Zhu (Atractylodes Macrocephala Rhizome) and pungent/hot Gan Jiang (Dried Ginger). They fail to realize Xu Lao harms Yin; tonifying Yang further exhausts Yin, hastening death. Some cite the Classic "Clear Qi sinking causes diarrhea, Turbid Qi rising causes distension" and use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) to raise Clear and descend Turbid. Misusing Sheng Ma (Cimicifuga Rhizome) and Chai Hu (Bupleurum Root) instead promotes Yin Fire rebellion, worsening cough and bleeding, leading to danger.

3. Error of Ren Shen/Astragalus Assisting Fire: If Lung pulse is deficient but not rapid, and Lung is not hot, Ren Shen and Huang Qi are acceptable ("Earth generates Metal"). But if Fire has scorched Metal causing cough, and steamed fluids into thick phlegm, with Ministerial Fire hyperactivity causing blood to rebel upward, citing "Without Yang, Yin cannot generate" to use large doses of Ren Shen/Huang Qi in wealthy patients only increases Yang Fire and injures Metal further.

4. Error of Bitter-Cold Draining Fire: Excess Fire can be directly drained with bitter-cold herbs, but stop once heat is gone. Yin deficiency with deficient Fire cannot be cleared by Zhi Mu (Anemarrhena Rhizome) and Huang Bai (Phellodendron Bark). Not only do they fail to clear heat, they damage True Yin and harm Stomach Qi, causing poor appetite and diarrhea. If constipation occurs due to dryness, using Xiao Shi (Sodium Sulfate) and Da Huang (Rhubarb Root) is wrong because Kidney governs bowels and fluids; if Kidney fluids are exhausted, lubrication fails. Nourishing Yin moistens dryness naturally. Can deficient Yin withstand the attack of Xiao Shi/Da Huang? Shi Cai warned against bitter-cold misuse, yet people follow his warming tonification blindly.

5. Error of Er Chen Phlegm Resolution: Spleen phlegm is Damp-Phlegm, slippery/easy to expectorate, or watery; dampness requires drying, making Ban Xia (Pinellia Tuber) correct. But if Yin Water is insufficient, Yin Fire rises, insulting Lung, preventing descending/clearing action, condensing fluids into phlegm instead of generating Blood, one must use moistening agents to nourish Yin, allowing Fire to return home, clearing phlegm naturally. Er Chen Tang (Two-Aged Powder) should not be used lightly.

6. Error of Pungent Dispersal: 60-70% of fevers in Yin deficiency resemble exterior patterns. Fire rebelling upward causes head distension/pain; Fire congesting Lung causes nasal obstruction; Yin deficiency with Yang sinking inward causes shivering chills; Yin deficiency with Yang having no anchor causes floating heat on skin. However, onset is usually afternoon: first chills, then fever until dawn, sweating during sleep (night sweats) cooling the body, or just afternoon fever. Symptoms include prior Kidney deficiency signs, red lips/cheeks, thirst/restlessness, wiry/rapid or deficient/weak pulses. Large dose Yin-nourishing formulas like Bao Yin Jian (Preserve Yin Decoction) or Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) are suitable. Mistaking this for exterior pattern and using wind/herbs to disperse causes profuse sweating and multiple deficiencies. In blood-loss patients, forcing sweat yields none ("Those who lose blood cannot sweat"); forcing it causes oral/nasal bleeding, a difficult-to-treat condition of lower collapse and upper exhaustion. Modern doctors see fever and disperse, restrict diet thinking pathogen remains, starving Stomach Qi until collapse. How chilling!

7. Error of Delayed Treatment: Ancient times practiced preventive treatment: nourish Heart for mental labor, tonify Spleen for physical fatigue, nourish Liver Blood for anger, clear Lung Heat for drinking, tonify Kidney Water for lust. Remedy at萌芽 (sprouting). Moderns ignore internal heat, delay treatment until deficiency shows, relying on normal appetite, until disease deepens, too late. Treatment is hard, requiring three essentials:

First: Tonify Kidney Water. Kidney governs Water, storing Essence from all Zang-Fu. Five fluids return to Essence; Five Essences are governed by Kidney. The Kidney's essence chamber is Mingmen, where Essence stores and Qi transforms. Essence is Water within Yin; Qi is Fire/Water within Yin. Mingmen's Fire/Water are sources for Twelve Organs. Fire rarely declines, but Water often lacks. Wang Jiezhai said: Youth Kidney Water is strong, seemingly不需补 (no need to tonify), but excessive release prevents fullness. Middle age desire decreases, but youth depletion prevents recovery. Old age sees fading Tian Zhen, leaving only solitary Yang. Most diseases from youth to old age stem from True Yin insufficiency. Even weak congenital constitutions can recover if filled early. Yin-tonifying herbs are essential daily, especially for Xu Lao from excessive sex. Bao Yin Jian, Liu Wei Di Huang Wan, Zuo Gui Wan are sweet-cold agents to nourish Water/add Essence, tonifying Yin to match Yang—"Strengthen the Master of Water to control Solar Flare." Nourishing Yin lowers Fire, like adding oil to a dying lamp reducing flame size. Must take large doses long-term; Yin has no quick tonification method. For alcohol-induced cases, clear Metal/moisten Ying primarily, but keep Bao Yin Jian. Why? Drinkers without Xu Lao have intact Kidney Water. Deficiency makes Heart fearless, burning injured Lung. Tonifying North (Kidney) drains South (Heart). For thought-induced cases, clear Heart/nourish Blood primarily, keeping Bao Yin Jian ("Water strong extinguishes Fire, do not rush to drain Heart"). For fatigue-induced cases, tonify Spleen Yin primarily, assisting with Bao Yin agents. Classic: "Damage to Kidney benefits Essence." For anger injuring Liver causing bleeding, Bao Yin Liu Wei is correct; Water abundance calms Dragon/Thunder Fire, treating Liver/Kidney together.

Second: Cultivate Spleen Earth. Spleen/Stomach are Post-Heaven Root. Classic: "Abundant grain leads to prosperity." More food generates Essence/Blood. Even with pathogenic heat, medicine treats it; eventually Fire lowers, Yin recovers. If Spleen/Stomach damage, Blood/Essence fail to generate, Yin cannot match Yang. Yue Man emphasized Spleen/Stomach: First damage affects Lung (skin/hair fall); Second affects Heart (vessels fail to nourish); Third affects Spleen (food fails to form flesh); Fourth affects Liver (tendons relax); Fifth affects Kidney (bones atrophy, unable to rise). Downward transmission: beyond Stomach is untreatable; bone atrophy is death. Upward transmission: beyond Spleen is untreatable; skin/hair fall is death. Zhang Zhongjing treated Xu Lao with Sweet Medicine to establish Middle Qi, generating Blood/Essence, a good method. "Insufficient Essence is supplemented by Flavor." Flavor includes grains. Supplement with flavor and rest labor to gradually restore. Classic: "When Yin/Yang/Form/Qi are all insufficient, regulate with Sweet Medicine." Spleen/Stomach strength affects all Zang; Earth strong makes Metal strong, Metal strong fills Water. Focus on men.

Third: Careful Regulation. Xu Lao from alcohol/sex is common, but also from worry/thought/anger. Monks/widows/unmarried/disappointed people must relieve emotions, understand themselves, not rely solely on herbs. Moderns rely on medicine, ignoring desire abstinence. Some quit alcohol/sex but don't regulate labor/rest; some regulate labor/rest but struggle with Seven Emotions. Unaware that妄动 (wild movement) of Heart scatters Qi, scattered Qi fails to gather, Essence follows Qi to perish. Guangchengzi said: "Be still and clear, do not exhaust your form, do not shake your essence, thus you can live long." This is excellent regulation for Xu Lao. Many suffer, few preserve, due to late treatment by patients and poor treatment by doctors. I clarify causes of Yin-deficiency disease, critique indiscriminate text classifications, explore why True Yin easily deficiences, and detail transmission/errors, ending with treatment essentials. This is my heart-transmission, based on ancients and my experience, not to correct modern bias arbitrarily.