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The syndrome of Xu Lao (Deficiency and Emaciation) refers to a condition where the spirit, Qi, and Blood are all damaged. The Kidney stores Jing (Essence), the Heart stores Shen (Spirit), the Lungs store Qi, and the Liver stores Blood. When the Kidneys are injured, Jing becomes diseased; when Jing is diseased, it leaks and fails to consolidate. When the Heart is injured, Shen becomes diseased; when Shen is diseased, it becomes fearful and uneasy. When the Lungs are injured, Qi becomes diseased; when Qi is diseased, it becomes obstructed and fails to circulate freely. When the Liver is injured, Blood becomes diseased; when Blood is diseased, it stagnates and fails to flow smoothly. However, these disorders of the four limbs/organs ultimately stem from the deficiency and collapse of Middle Jiao Qi (Spleen and Stomach Qi). Comprehending Zhang Zhongjing’s principle of establishing the Middle Jiao allows one to grasp the key essence in treating Xu Lao syndromes.

For Xu Lao presenting with abdominal tension and pain, palpitations, epistaxis, abdominal pain, nocturnal emission, soreness and pain in the four limbs, vexing heat in the hands and feet, dry throat, and dry mouth, Xiao Jian Zhong Tang (Minor Construct the Middle Decoction) should be used as the primary formula, or Dang Gui Jian Zhong Tang (Angelica Sinensis Construct the Middle Decoction). For Xu Lao presenting with abdominal tension and various deficiencies, Huang Jian Zhong Tang (Astragalus Construct the Middle Decoction) should be used. For individuals prone to seminal emission, presenting with tightness and urgency in the lower abdomen, coldness at the glans penis, dizziness, hair loss, and a pulse that is extremely deficient, cun kou (cun position), and slow, accompanied by undigested food in stool, blood loss, and seminal emission, with a pulse appearing floating and empty, rapid, fine, and slightly tight, where men suffer from seminal emission and women from dream intercourse, Gui Zhi Long Gu Mu Li Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction) should be used. For Xu Lao presenting with lower back pain, tension and urgency in the lower abdomen, and difficulty in urination, Ba Wei Shen Qi Wan (Eight-Ingredient Kidney-Qi Pill) should be used. This constitutes the general method of treatment.

For syndromes such as seminal emission, frightful spirit, Qi stagnation with Blood depletion, cough, and insomnia, one should seek specific formulas in their respective specialized sections.

Xiao Jian Zhong Tang (Minor Construct the Middle Decoction)
(See formula under "Cough")

Dang Gui Jian Zhong Tang (Angelica Sinensis Construct the Middle Decoction)
(See formula in *Jin Gui Yao Lue*)

Huang Jian Zhong Tang (Astragalus Construct the Middle Decoction)
This is Xiao Jian Zhong Tang plus Huang Qi (Astragali Radix). If there is shortness of breath and chest fullness, add Sheng Jiang (Zingiberis Rhizoma Recens); if there is abdominal fullness, remove Da Zao (Jujubae Fructus) and add Fu Ling (Poria). If there is Spleen deficiency and insufficiency requiring Qi tonification, add Ban Xia (Pinelliae Rhizoma).

Gui Zhi Long Gu Mu Li Tang (Cinnamon Twig, Dragon Bone, and Oyster Shell Decoction)
Gui Zhi (Cinnamomi Ramulus) (3 qian), Bai Shao (Paeoniae Radix Alba) (3 qian, stir-fried with wine), Sheng Jiang (Zingiberis Rhizoma Recens) (3 qian), Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) (2 qian, honey-fried), Long Gu (Fossilia Ossis Mastodi) (3 qian), Mu Li (Ostreae Concha) (3 qian), Da Zao (Jujubae Fructus) (4 pieces). Decoct in water until half a cup remains, take warm. If there is cold in the lower part, Gan Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata) may be added.

Ba Wei Wan (Eight-Ingredient Pill)
(See formula under "Hong Xiang Jiao" / Erysipelas of the legs)

Zhi Gan Cao Tang (Honey-Fried Licorice Decoction)
(See formula under "Shang Han")