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The *Shengji Zonglu* states: The disease of Xu Lao (chronic weak and consumptive diseases) manifests as Wu Lao (Five Consumptions) depending on which of the Five Viscera is affected, and as Qi Shang (Seven Injuries) depending on the seven emotional factors that cause it. When the consumption and injury are severe, leading to extreme emaciation of the body, it is called Liu Ji (Six Extremes).

The so-called "Seven Injuries" are as follows: First, eating too much injures the Spleen. When the Spleen is injured, one tends to belch, desires to lie down, and the face appears yellow. (In the Five Elements, Earth corresponds to yellow; when the Spleen is injured, its true color reveals itself, hence the yellow face. Shen [Spirit] is generated by Middle Qi; when the Spleen is injured, Shen becomes fatigued, hence the desire to lie down.) Second, intense anger causes Qi to rebel and injures the Liver. When the Liver is injured, blood is deficient, and vision becomes dim. (The Liver is the official of the general, thus governing anger. It is also said: "The eyes can see only when nourished by blood." Now, since Liver injury leads to blood deficiency, vision becomes dim.) Third, excessive sexual activity combined with prolonged sitting in damp places injures the Kidney. When the Kidney is injured, there is shortness of breath, pain in the waist and legs, cold limbs, and coldness in the lower body. (Pain in the feet and coldness in the lower body indicate deficiency of Yang in Kan [Water/Kidney]. Mild cases are treated with Bawei Wan [Eight-Ingredient Pill], and severe cases with Fuzi Tang [Aconite Decoction].) Fourth, exposure to cold and consuming cold drinks injures the Lungs. When the Lungs are injured, Qi is scanty, coughing occurs, and nasal congestion/murmuring is present. (Exposure to cold refers to deficiency-cold of Xing [Form/Body]; consuming cold drinks means ingesting cold substances. Therefore, in *Jinkui Yaolue*, all five formulas for treating cough use Xiao Qinglong Tang [Minor Blue Green Dragon Decoction] with modifications.) Fifth, worry and overthinking injure the Heart. When the Heart is injured, one suffers from fright, has a tendency to forgetfulness, and becomes irritable. (The Heart houses Shen; when injured, Shen is unsettled, causing fright. The Heart governs Blood; when injured, Blood is insufficient, causing forgetfulness. The more the Heart is injured, the harder it is to dispel worry and overthinking, leading to anger. Another version omits "irritability" and includes "inability to sleep at night.") Sixth, wind, rain, cold, and heat injure the Form. When the Form is injured, hair falls out, and the skin and muscles become dry and rough. (External exposure to wind and rain inevitably brings cold-dampness. Since this comes from outside, it injures the Form and causes the skin to become rough. However, Wei Qi [Defensive Qi] resides between the skin and muscles. The *Ling Shu Jing* states: "Wei Qi warms the flesh, fills the skin, plumps the interstices, and controls the opening and closing of pores." Therefore, vigorously tonifying Wei Qi restores the Form; Guizhi Tang [Cinnamon Twig Decoction] added with Huangqi [Astragalus Root] is suitable.) Seventh, unregulated fear injures Zhi [Will]. When Zhi is injured, one feels absent-minded and unhappy. (Anger causes Qi to ascend, fear causes Qi to descend, causing Danzhong [Sea of Qi] to lose its authority, resulting in stagnation and lack of smooth flow, hence termed "injuring Zhi." Zhi is governed by the Kidneys and flows through Danzhong. Danzhong is located between the two breasts, belonging to the domain of the Heart Monarch. The Heart is the source of Shenming [Divine Illumination/Spirit], causing absent-mindedness. Danzhong is the source of joy, causing unhappiness. This is indeed an injury to Zhi, hence called the Seven Injuries.)

The so-called "Five Consumptions" are: First, Fei Lao (Lung Consumption), causing shortness of breath, facial swelling, and inability to smell odors. Second, Gan Lao (Liver Consumption), causing dry and dark complexion, bitter taste in the mouth, loss of mental stability, fear, inability to sleep alone, and blurred vision. Third, Xin Lao (Heart Consumption), causing sudden absent-mindedness and forgetfulness, difficult and dry stools, (The Heart governs Blood; moistened by Blood, stools are smooth; dried by Blood, stools are difficult.), occasional diarrhea, (due to Heart Fire failing to generate Spleen Earth), and mouth ulcers. Fourth, Pi Lao (Spleen Consumption), causing stiffness of the tongue root and difficulty swallowing saliva. Fifth, Shen Lao (Kidney Consumption), causing difficulty bending and extending the back, yellow-red urine, dribbling after urination, pain inside the penis, damp scrotum with sores, and fullness and urgency in the lower abdomen. These five conditions represent Lao Qi [Consumption Pathogen] in the Five Viscera, hence named Wu Lao.

The so-called "Six Extremes" are: First, Qi Ji (Extreme of Qi), (Qi Ji primarily relates to the Lung), causing internal emptiness, deficiency of the Five Viscera, excess of pathogenic factors, scarcity of righteous Qi, and reluctance to speak. Second, Xue Ji (Extreme of Blood), (Xue Ji or Mai Ji [Extreme of Pulse] primarily relates to the Heart), causing pallor, falling eyebrows and hair, sudden absent-mindedness, and forgetfulness. Third, Jin Ji (Extreme of Tendons), (Jin Ji primarily relates to the Liver), causing frequent muscle spasms, pain in all ten fingernails/toenails, and extreme fatigue preventing standing for long periods. Fourth, Gu Ji (Extreme of Bones), (Gu Ji primarily relates to the Kidney), causing sore and emaciated bones, painful teeth, vexing pain in hands and feet, inability to stand, and reluctance to move. Fifth, Ji Ji (Extreme of Muscle/Flesh), (Ji Ji or Rou Ji [Extreme of Flesh] primarily relates to the Spleen), causing emaciation without luster, and food/drink failing to nourish the flesh. Sixth, Jing Ji (Extreme of Essence), (Jing Ji relates to the Five Viscera, as they store Essence. Daoists regard Jing, Qi, and Shen as the Three Treasures. The Classics state: "Essence generates Qi, Qi generates Shen." If Essence cannot generate Qi, symptoms of shortness of breath and internal emptiness arise), causing shortness of breath, a sensation of internal emptiness upon inhalation, deficiency of Qi in the Five Viscera, falling hair, sadness, and forgetfulness. These six conditions represent the severity of Lao, leading to extreme emaciation, hence named Liu Ji.

Beyond Wu Lao, Qi Shang, and Liu Ji, there are various complicated manifestations. Treatment methods should generally favor tonification and nourishment. For deficiency of Form, warm it with Qi; for deficiency of Essence, tonify it with Flavor. Combining these two for administration replenishes Essence and benefits Qi; this is the key principle.

Note: Medical texts discuss the syndromes of Xu Lao most extensively. I have selected the *Shengji Zonglu*, establishing theory based on Wu Lao, Qi Shang, and Liu Ji, which grasps the essentials. Below, various formulas are collected for selection. Some distinctions are necessary, others are not. Whether one can illuminate these principles divinely depends on the individual practitioner; it cannot be taught merely by words. At the conclusion, the *Shengji Zonglu* highlights the characters "Qi Wei" [Flavor and Odor], indicating that medicine should be administered from the fundamental roots of Yin and Yang. This is what is meant by "My Way is permeated by a single thread."

Note: "Yang Deficiency" and "Yin Deficiency" are common clichés among physicians. However, this theory should not be discarded entirely but kept provisionally for reference. Ma Yuanyi from Wumen divided Yang Deficiency into two types and Yin Deficiency into three types, going deeper than contemporary views. The two types of Yang Deficiency are: Yang in the Stomach, generated postnatally; and Yang in the Kidney, the foundation of prenatals. Stomach Yang prefers ascending and floating; when deficient, it sinks downward. If further astringed and descended, the generating Qi is suppressed and cannot extend. Kidney Yang values condensing and descending; in consumption, it floats upward. If further ascended and dispersed, True Qi will perish immediately. Thus, the treatment of Yang Deficiency differs. The three types of Yin Deficiency are: Yin of the Lungs and Stomach, which is Jin Ye [Body Fluids]; Yin of the Heart and Spleen, which is Xue Mai [Blood Vessels/Blood]; and Yin of the Kidneys and Liver, which is Zhen Jing [True Essence]. Fluids are generated by Qi; only clear and moistening agents can generate them. Essence is generated by Flavor; only sticky and cloying substances can fill it. Blood is generated from water and grain; only by regulating and tonifying the Middle Jiao [Spleen/Stomach] can it be transformed. Thus, the treatment of Yin Deficiency differs.

Note: This syndrome often presents with steaming fever and coughing. Physicians use Er Pi [Two Barks, e.g., Cortex Lycii and Cortex Phellodendri] to clear the Heart and Er Dong [Two Asparas, i.e., Radix Asparagi and Rhizoma Anemarrhenae] to protect the Lung, unaware that when Earth is prosperous, Metal is generated, so there is no need to focus solely on protecting the Lung; when Water ascends, Fire descends, so there is no need to anxiously clear the Heart. Li Shicai's four sentences deeply grasp the method of treating Xu Lao.

Although there is a theory of combining Spleen and Kidney treatment in one formula, it is actually mixed and ineffective. One must examine the urgent aspect and address it accordingly. For symptoms such as poor appetite, fatigue, loose or constipated stools, and muscle emaciation, treating the Spleen is urgent. Use formulas like Liujunzi Tang [Six Gentlemen Decoction], Sijunzi Tang [Four Gentlemen Decoction], or Guipi Tang [Restore the Spleen Decoction] to tonify and nourish the Spleen and Stomach, regulate diet, which is the way to transmit Essence to the Kidneys. For symptoms such as form damage with bone flaccidity, dark complexion, bone-steaming tidal fever, low back pain, asthma, aversion to cold, vivid dreams, abdominal pain, or spermatorrhea, treating the Kidney is urgent. For Kidney Yin Deficiency, use Liuwei Wan [Six-Ingredient Pill] to tonify the True Water in Kan; for Kidney Yang Deficiency, use Bawei Wan [Eight-Ingredient Pill] to tonify the True Fire in Kan, thereby communicating with Li Fire [Heart Fire]. Examining the hexagrams of the *Zhou Yi* [Book of Changes], Kun Earth is generated by Li Fire, and Gen Earth is generated by Kan Water. Zhao Yangkui stated that tonifying Water generates Earth. Although his words seem bizarre, they contain a profound essence.

Dahuang Zhechong Wan [Rhubarb and Ground Beetle Pill] (Formula seen in *Jinkui Yaolue*)
Treats extreme deficiency from the Five Consumptions, emaciation with abdominal fullness, inability to eat, injuries from diet, sorrow, sexual excess, muscle damage, and consumption injury, leading to damage of meridians, Ying [Nutrient] Qi, and Wei [Defensive] Qi. With dry blood inside, skin resembling scales, and dark eye orbits, it moderates the middle and tonifies deficiency.

Si Wuiegu Yiluru Wan [Four Cuttlebone and One Red Sage Pill] (Formula seen in *Nuke Yaozhi*)
Treats Xu Lao with Qi exhaustion, Liver injury, blood depletion, and Essence injury.
Note: Blood-searching herbs are used for tonifying blood. Following Zhang Luyu, add cuttlefish bone and downy chicken to the ingredients of this pill.