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Treatment for consumptive disease (Laozai) with extreme emaciation, reduced appetite, panting and cough, body heat, and a deficient and rapid pulse. It is also used for amenorrhea due to blood exhaustion in women.

Raw Dioscoreae Rhizoma (Shanyao) (30g), Scrophulariae Radix (Xuanshen) (15g), Atractylodis Macrocephalae Rhizoma (Baizhu/Yushu) (9g), Raw Gavis Gallae Endothelium Corneum (Jineijin) (6g, crushed), Arctii Fructus (Niubangzi) (9g, stir-fried, crushed).

If the heat is severe, add Raw Rehmanniae Radix (Shengdihuang) 15-24g. The Spleen is the foundation of post-heaven acquisition and can nourish the whole body. If the Spleen and Stomach are robust, they can generally digest food and drink; thus, the whole body naturally becomes healthy. Have you ever seen someone who eats and drinks excessively yet suffers from consumptive disease? The *Neijing* (Huangdi Neijing), Chapter "Yin Yang Bie Lun" states: "Diseases of the Two Yangs originate from the Heart and Spleen... In women, this manifests as amenorrhea... it transmits to become wind-consumption (Fengxiao)... it transmits to become breath-gathering (Xiben)... These four conditions arise from internal and external factors..." Here, we first trace the reason why the Yangming Stomach cannot accept much food, thereby exploring the cause of reduced intake. Saying it originates from the Heart and Spleen traces the root cause to these organs. What does "having unspoken difficulties" (Bu de yinqu) mean? The Heart is the mansion of the Spirit (Shen). When there are hidden concerns or desires that cannot be fulfilled, the Heart Spirit becomes depressed, and Heart Blood fails to moisten the Spleen Earth, leading to illness caused by excessive thinking damaging the Spleen. Once damaged, the Spleen cannot assist the Stomach in digesting food and transforming fluids to irrigate the Five Zang organs. In men, this illness is secretly incurred without obvious signs; in women, it clearly manifests as amenorrhea. This uses female pathology to infer male pathology. As for transmission to wind-consumption (emaciation) or breath-gathering (panting/asthma), regardless of gender, when the condition reaches this stage, consumptive disease is established, and recovery is truly difficult; hence, it is said to be untreatable. However, physicians aim to save lives. Even if the danger is extreme, one must strive to recover the patient from the irrecoverable. The method of recovery should still follow the principle of "Two Yang diseases originating from Heart and Spleen." Advise the patient to live simply and reduce desires to nourish the Heart, while skillfully tonifying the Spleen and Stomach so that food intake gradually increases, and the body naturally recovers. In this formula, Baizhu strengthens Spleen Yang; robust Spleen Earth assists the Stomach. Shanyao nourishes Stomach Yin; sufficient Stomach juices allow for food acceptance (Stomach digestion relies on acidic juices). The Spleen is the organ that controls blood. The *Neijing* says "Blood is generated by the Spleen," implying the Spleen is where blood coagulates and contains much blood. Western medicine also considers the spleen rich in venous vessels, a gathering place for blood. In this condition, mental depression causes Heart Blood to flow poorly, leading to blockage in splenic vessels, resembling rotting meat or forming membranes; this is the origin of splenic disease. The Spleen and Stomach assist each other, connected by one Qi. If the Zang cannot assist the Fu, the Stomach cannot accept food. Jineijin is the gizzard lining of the chicken, which contains hard substances like porcelain, stone, copper, and iron that it can digest, showing its ability to resolve有形 (tangible) accumulations. Its nature is very mild, possessing the wonder of using the Stomach to tonify the Stomach. Thus, it aids herbs that strengthen and tonify the Spleen and Stomach, achieving remarkable results unmatched by other drugs. These three ingredients are indispensable in the formula.

Xuanshen: The *Shennong Bencao Jing* states it is slightly cold and treats residual diseases after childbirth in women. Its sweet taste outweighs its bitter taste, indicating it will not damage the Spleen and Stomach with coldness. Thus, it is used to clear floating heat from the Upper Jiao and retreat systemic fever. Being dark-colored and fluid-rich, and according to the *Shennong Bencao Jing* being able to tonify Kidney Qi, it is especially suitable for treating Yin deficiency in consumptive disease. Niubangzi is smooth and fragrant, moistening and benefiting the Lungs. Combined with Shanyao and Xuanshen, it greatly stops cough and calms panting, achieving the effect of calming the Lungs, hence added as an assistant and guide drug.

Raw Dihuangs: When used raw, its efficacy in cooling blood and retreating heat indeed surpasses Xuanshen. Westerners say it contains iron, and human blood actually contains rust. Dihuangs' ability to retreat heat lies not only in cooling blood and nourishing Yin but also in the subtlety of "tonifying iron with iron," making blood sufficient so that steaming heat naturally retreats. Furthermore, heat in consumptive disease largely stems from True Yin deficiency, allowing Ministerial Fire (Xianghuo) to fail to hide. Dihuangs guides Ministerial Fire downward to rest in its original home. Listed as a top-grade herb in the *Shennong Bencao Jing*, it is truly a good medicine. However, it is added only when heat is excessive because this formula primarily focuses on strengthening the Spleen and Stomach. Although used raw, after decoction, its juice remains sticky and muddy, which may be unsuitable for the Spleen and Stomach. When heat is severe, the Spleen and Stomach lose appetite; using Dihuangs to retreat heat allows food intake to resume, thereby assisting the Spleen and Stomach.

Raw Shanyao refers to dried Chinese yam sold in markets that has not been stir-fried. If stir-fried Shanyao is used in this formula, it will be ineffective.

Yushu (Atractylodes from Yuqian): Yellow in color and fragrant in odor, produced in Yuqian, Zhejiang. Yellow corresponds to Earth; fragrance awakens the Spleen. Its power to strengthen and tonify the Spleen and Stomach differs significantly from ordinary Baizhu. Even if not from Yuqian, as long as it is yellow and fragrant, it yields special effects. This emphasizes color and taste over geographical origin.

Western medicine states: The Stomach digests food relying entirely on acidic juices. When hungry, acidic juices naturally secrete from the Stomach. Excessive worry or anger reduces or eliminates acid secretion, causing undigested food accumulation. This aligns with the *Neijing* principles of "Two Yang diseases originating from Heart and Spleen" and "Excessive thinking damages the Spleen."

Q: The *Neijing* says the Spleen governs thought, while Westerners say thought originates in the brain. Why do you say thought originates in the Heart?
A: When the *Neijing* says the Spleen governs thought, it does not mean the Spleen thinks itself. The Spleen belongs to Earth, and Earth is quiet; only in quietness can one think deeply. Regarding Western views on the brain, the *Neijing* implies this too. The *Mai Yao Jing Wei Lun* states: "The head is the mansion of clarity and spirit." The center of the head is the brain; thus, the brain is the mansion of clarity. Since it is "clear and spiritual," how could it lack the ability to think? Yet, the brain does not think alone. Observe the ancient character for "thought" (思), composed of "cranium" (囟, meaning brain) above and "heart" (心) below. This shows that thinking requires the cooperation of Heart and Brain, aided by the stabilizing force of Spleen Earth.

Q: Your interpretation of "Two Yang diseases originating from Heart and Spleen" differs from Wang Bing's commentary. Is his annotation wrong?
A: I dare not claim so. However, interpreting the text through my explanation reveals deeper meaning and practical utility. The syntax of "Two Yang diseases originate from Heart and Spleen" differs from "Three Yang diseases manifest as chills and fever" and "One Yang disease onset...". Thus, the explanation can vary. "Two Yang diseases originate from Heart and Spleen" means the disease arises from the Heart and Spleen. "Three Yang diseases manifest as chills and fever" describes the symptoms of Three Yang diseases, hence changing "of" (Zhi) to "becomes" (Wei). The syntax of "One Yang disease" differs from "Three Yang," though the principle is similar.

Q: Why do Three Yang and One Yang describe symptoms, while Two Yang investigates the cause?
A: For Three Yang and One Yang, describing symptoms first helps identify them. For Two Yang (Stomach), everyone knows it governs diet. Everyone knows stomach illness prevents eating. But few know *why* eating is prevented. Hence, the text starts with the cause rather than symptoms.

Q: Both Stomach and Large Intestine are Two Yang. How do we know it refers specifically to the Stomach?
A: Stomach is Foot-Yangming; Large Intestine is Hand-Yangming. Foot meridians are longer and can encompass Hand meridians. Discussions on Six Meridians prioritize Foot meridians. Therefore, when the *Neijing* mentions a meridian without specifying Hand or Foot, it refers to the Foot meridian. If only Hand is mentioned, it specifies "Hand [Meridian Name]." The text supports this.

In 1913, residing in Daming, I treated a maiden with consumptive disease for over a year, amenorrhea, and extreme weakness. She consulted me, and I prescribed this decoction. After several doses, appetite increased. Body heat persisted, so I added 15g of Raw Dihuangs. After five to six doses, heat subsided, and she could get up, though leg pain prevented walking. I added Danshen and Danggui, each 9g. After ten doses, legs healed, and menstruation returned. She then mentioned severe leukorrhea, previously omitted. I removed Danshen, added Raw Oyster Shell (Muli) 18g, and doubled Yushu. After ten doses, leukorrhea cured. I mailed this formula home. A month later, my student Gao suffered from extreme fatigue, reduced appetite, and a deficient-rapid pulse. I administered Ten Doses of Zisheng Tang, resulting in full recovery. This proves Zisheng Tang is effective for consumptive disease in both men and women.

If menstruation is absent for a long time, firm blood stasis exists in the Sea of Blood. Treatments often use blood-breaking herbs, harming the patient before curing the disease. Jineijin is mild yet resolves tangible accumulations. Long-term use naturally dissolves firm stasis. Moreover, combined with Spleen-tonifying and Yin-nourishing herbs, new blood grows actively, generating new tissue that naturally transforms stasis.

Appendix:
Letter from Zhang XX, Qing County, Hebei:
Mrs. Song, nearly 40, weak. Coughed and expectorated sputum for two years, untreated. Condition worsened this spring; previous medicines failed. Pulse: Left wiry-thin, Right weak, rapid (~6 beats/cun). Cough, white foul-smelling sputum, panting, spontaneous sweating, afternoon fever (worse at night), chest oppression, reduced appetite, constipation. Diagnosis: Consumptive disease complicated by Lung pathology. Previous treatments only stopped cough, ignoring "tonifying the mother when the daughter is deficient" (Kidney-Lung relationship). Prescribed Modified Zisheng Tang: Raw Shanyao 24g, Xuanshen, Raw Dihuang, Cornus 18g each, Raw Muli, Raw Shaoyao, Raw Hematite 12g each, Yushu, Raw Jineijin, Licorice 6g each. Two doses: Sweat stopped, panting eased, fever/cough improved. Removed Muli, added Trichosanthis Semen 9g, Cortex Lycii Radicis 9g, increased Shanyao to 30g, Hematite to 18g. Ten doses: All symptoms resolved. Maintenance: Raw Shanyao powder 24g porridge with sugar, twice daily. One month later: Mrs. Song ate well and was stronger.

Another case: My clan sister, 35, initially had wind-cold cough, ignored treatment. Condition worsened; previous doctors used warm/drying dispersants, worsening heat. I diagnosed her late winter. Pulse: Deficient/weak. Emaciated, slight panting, reduced appetite, diarrhea, occasional leukorrhea, afternoon fever, malar flush. Diagnosis: Established consumptive disease. Prescribed Zisheng Tang + Stir-fried Coix Seed, Poria, Raw Dragon Bone, Raw Oyster Shell 9g each, Artemisiae Scopariae Herba, Roasted Licorice 4.5g each. Two doses: Fever/flush subsided, cough/diarrhea improved. Continued modifications for six doses: Full recovery. Maintenance: Raw Shanyao porridge with sugar.

Letter from Zhou XX, Jingnan, Sichuan:
Ms. Yang, 19, married two years, no menstruation, emaciated, reduced appetite, dry cough, five-palm heat, fine-rapid-strong pulse. Used Zisheng Tang: Raw Shanyao 30g, Yushu 6g, Niubangzi 9g, Xuanshen 15g, Raw Dihuang 12g, Raw Jineijin 3g. Five doses: Heat retreated, cough reduced, appetite increased. Removed Dihuang, doubled Yushu. Three more doses: Menstruation arrived. Total 20 doses: Cured.

Letter from Wan XX, Fakuxian, Fengtian:
Clan brother's wife, postpartum weakness, poor appetite, delayed one month. Symptoms: burning sensation, sweating, emaciation, fatigue, dry retching, dizziness. Diagnosis: Postpartum consumption (Rulao). Four doctors failed; added malar flush and diarrhea. Pulse: Six positions deficient-rapid. Previous formulas were bland. Condition critical but treatable (pulse has spirit, flush not clustered). Pathogenesis: Pre-existing Yin deficiency + postpartum blood loss -> Qi loss -> Yin fails to hold, Yang fails to secure -> sweat/fatigue. Yin/Yang disconnect -> Yin def leads to Yang float -> fever/cough/dizziness. Malar flush: Kidney area, true Yang floating upward. Emaciation/diarrhea: Two Yang (Stomach/Large Intestine) fail to nourish muscles; Spleen/Stomach Yin/Juices deficient; central pivot fails, sinking/unsecured. Prescription: Raw Huai Shanyao 60g, Yushu 9g, Xuanshen 12g, Jineijin, Niubangzi 6g each (Modified Zisheng Tang base), plus Cornus, Dragon Bone, Oyster Shell 15g each (to stop sweat/diarrhea). Five doses: Sweat/diarrhea stopped, appetite improved, cough/heat reduced slightly. Added Licorice, Asparagus Root, Raw Dihuang. Seven doses. Reduced Cornus, added Codonopsis 6g. Four doses: Appetite great, sat up. Menstruation not yet started. Returned to Zisheng Tang base + Danggui 12g. Few adjustments over several doses. One month later: Menstruation flowed.