Library

Treats consumptive disease (Xu Lao), with pulse presenting as wiry, rapid, fine, and minute; skin dry and rough like fish scales (Ji Fu Jia Cuo); body emaciated and weak; diet fails to strengthen sinews and muscles; or spontaneous sweating occurs; or cough and rebellious qi arise; or panting and shortness of breath occur; or chills and fever appear intermittently; or dreams are chaotic and numerous; and essence and qi are insecure.

Ye Tai Shen (Radix Ginseng) - 4 qian
Sheng Huang Qi (Astragali Radix) - 4 qian
Sheng Shan Yao (Dioscoreae Rhizoma) - 4 qian
Zhi Mu (Anemarrhenae Rhizoma) - 4 qian
Xuan Shen (Scrophulariae Radix) - 4 qian
Sheng Long Gu (Fossilia Ossis Mastodi) - 4 qian, crushed into fine powder
Sheng Mu Li (Concha Ostreae) - 4 qian, crushed into fine powder
Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) - 2 qian
San Leng (Sparganii Rhizoma) - 1.5 qian
E Zhu (Curcumae Rhizoma) - 1.5 qian

If the deficiency in the Qi level is severe, remove San Leng and E Zhu, and add Sheng Ji Nei Jin (Galli Gigerii Endothelium Corneum) 3 qian; for panting, double the amount of Shan Yao and add Niu Bang Zi (Arctii Fructus) 3 qian; for excessive sweating, decoct Bai Zhu (Atractylodis Macrocephalae Rhizoma), Pao Long Gu (Fossilia Ossis Mastodi), Pao Mu Li (Concha Ostreae), and Yu Rou (Corni Fructus), each 1 liang, and take orally. The sweating will stop within no more than two doses. After the sweating stops, resume taking the original formula. If there is chills first followed by fever and sweating, the pulse may be even weaker and faint, which mostly indicates sinking of the Great Qi in the chest. Carefully reading the postscript to my proposed Sheng Xian Tang (Decoction for Raising Sinking Qi) will make the treatment method clear.

Zhang Zhongjing treated Lao Zhai (chronic wasting disease) with Da Huang Zhe Chong Wan (Pill of Rhubarb and Ground Beetle) and Bai Lao Wan (Hundred Consumptives Pill), both using large amounts of blood-breaking herbs. Indeed, the meridians and collaterals of the human body are penetrated by blood, connecting internally to the Zang-Fu organs and irrigating externally the whole body. Once blood stagnates, the function of Qi transformation cannot operate vigorously, and Lao Zhai often forms because of this. Therefore, patients with Lao Zhai have skin like fish scales, and blood fails to nourish the complexion. Even if they eat delicacies daily and take Shen (Ginseng) and Ling (Poria) tonics, they cannot gain muscle strength or strengthen sinews. Or they may become increasingly emaciated and disjointed day by day, truly because blood stasis blocks the meridians and hinders Qi transformation. Wang Qingren from Yutian wrote the book *Yi Lin Gai Cuo* (Correction of Errors in Medical Forest), establishing various formulas for invigorating blood and expelling stasis. According to upper, middle, and lower locations, he separately eliminated blood stasis to treat a hundred diseases, stating that once blood stasis is removed, various diseases heal themselves. Although his statements were not without bias, his main principle was indeed well-founded, so those who used his formulas often achieved efficacy. Now, because I treat Lao Zhai, I have formulated Shi Quan Yu Zhen Tang (Ten Complete Decoction for Nourishing True Essence). In the tonic formula, I added San Leng and E Zhu to unblock and activate Qi and blood, secretly modeling the intent of Zhang Zhongjing's Da Huang Zhe Chong Wan and Bai Lao Wan. Furthermore, Zhang Zhongjing listed the chapter on Xu Lao in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), specifically using the four characters "Blood Bi and Xu Lao" as the outline. This further confirms that Xu Lao must involve Blood Bi, and severe Blood Bi inevitably leads to Xu Lao. It also shows that treating Xu Lao requires first treating Blood Bi, and treating Blood Bi is essentially treating Xu Lao.

Someone asked: Treating Lao Zhai with blood-breaking herbs is indeed an accurate theory, but using San Leng and E Zhu for breaking blood—wouldn't their force be too fierce? I replied: The blood-breaking herbs used in Zhang Zhongjing's Da Huang Zhe Chong Wan and Bai Lao Wan, such as Da Huang (Rhei Radix et Rhizoma), Gan Qi (Drynariae Rhizoma processed with honey? Note: Text says Gan Qi usually refers to Dried Lacquer or similar, but context implies strong blood breaker like Drynaria or similar ancient term, actually Gan Qi here likely refers to *Gan Qi* (Lacquer) or potentially a typo for another herb, but standard interpretation in this context often points to strong agents. However, strictly translating text: Gan Qi), and Shui Zhi (Hirudo), are all fiercer than San Leng and E Zhu. The reason they did not use San Leng and E Zhu in the formula is precisely because these two herbs were not recorded in *Shen Nong Ben Cao Jing* (Divine Farmer's Materia Medica). Later, Tao Hongjing of the Liang Dynasty wrote *Ming Yi Bie Lu* (Record of Famous Physicians' Distinct Records), adding 365 medicinal substances outside *Shen Nong Ben Cao Jing*, all medicines used by famous physicians before the Southern and Northern Dynasties, yet still did not record San Leng and E Zhu. Thus, in Zhang Zhongjing's time, San Leng and E Zhu did not exist; even if they did, it is known they had not been tested. My preference for using San Leng and E Zhu among blood-breaking herbs is truly because they are good at breaking blood and especially good at regulating Qi. Used as assistant and guide in tonic formulas, they prioritize generating grain and nourishing the stomach. Regardless of the disease, cases where appetite gradually increases after taking medicine are easy to treat, while those where appetite decreases are difficult. The combination of San Leng and E Zhu with Shen (Ginseng) and Zhu (Atractylodes) greatly opens the stomach and promotes eating, which is something I have repeatedly tested and found effective.

Someone asked: In the syndrome of Lao Zhai, half or more present with Yin deficiency and tidal fever. Therefore, Qian Zhongyang's Jian Wei Di Huang Wan (Modified Rehmannia Pill) and Zhang Jingyue's Zuo Gui Yin (Left Restoring Decoction) are excellent prescriptions for the syndrome, as they all use Shu Di Huang (Prepared Rehmanniae Radix) as the sovereign drug, greatly nourishing True Yin and retreating deficient heat. Why does your formula exclusively omit it? I replied: If discussing the use of Shu Di Huang, I am indeed someone who has experienced it. Recalling when I first read medical books, I studied Zhao Xiuke's *Yi Guan* (Medical Canon), Zhang Jingyue's *Zhang Shi Ba Zhen*, and Feng Chuzhan's *Feng Shi Jin Nang*, and thus firmly believed in their theories. In clinical practice, I most liked using Shu Di Huang. I once used Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) as a decoction, adding Su Zi (Perillae Fructus) and Bai Shao (Paeoniae Radix Alba) to treat panting and rebellious qi where inhalation fails to root; adding Chen Pi (Citri Reticulatae Pericarpium) and Bai Shao to treat phlegm-saliva due to deficiency below and excess above; adding Su Zi and Hou Po (Magnoliae Officinalis Cortex) to treat distension caused by rebellious Qi ascending due to Kidney failing to grasp Qi (at that time, patients felt a pushing sensation upon taking it; later I formulated Shen Zhe Zhen Qi Tang to treat this syndrome more effectively); I once reduced Fu Ling (Poria) and Ze Xie (Alismatis Rhizoma) by two-thirds to treat polyuria and frequent urination in women with Xiao Ke (Wasting-Thirst) (the *Jin Gui* states treating male Xiao Ke is also effective for females; see details under Yu Ye Tang); I once removed Fu Zi (Aconiti Lateralis Radix Praeparata) and added Zhi Mu and Bai Shao to treat edema resulting from failure of urine output due to Yin deficiency failing to transform Yang; I once used Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) as a decoction, adding Chuan Xiong (Ligustici Chuanxiong Rhizoma) and Zhi Mu to treat headaches feeling like bursting; adding Long Dan Cao (Gentianae Radix) and Qing Dai (Orpiment) to treat severe vertigo; adding Wu Wei Zi (Schisandrae Fructus), Gou Qi Zi (Lycii Fructus), and Bai Zi Ren (Biota Semen) to constrict dilated pupils; and I believed in the saying of decocting several bowls and drinking them generously. I used 4 liang of Shu Di Huang and 1 liang of Fu Ling to stop slippery diarrhea due to insecurity of the Lower Jiao; used 4 liang of Shu Di Huang and 1 liang of Bai Shao to promote urination in cases of Yin deficiency with difficult urination; I once used about 1 jin of Shu Di Huang in one day to treat a critical condition of sudden panting and rebellious qi with a scattered pulse nearing collapse after a severe external contraction (this condition should use the later formulated Fu Yuan Tang; at that time the formula was not yet conceived, knowing only to use Shu Di Huang was fortunate enough to succeed; this proves Feng Chuzhan's statement that Shu Di Huang can greatly tonify the Original Qi of the Kidney was indeed based on experience). Moreover, I did not just treat internal injuries; I once used Shu Di Huang and E Jiao (Asini Corii Colla) to greatly nourish True Yin for treating warm diseases where the pulse is floating on the exterior but absent on the interior, unable to produce sweat. Taking two doses in one day, it nourished Yin to respond to Yang, inducing spontaneous sweat (detailed case under Han Jie Tang). For all types of Shang Han (Cold Damage) and external contractions where pathogens sank deeply due to exhaustion of the Lower Yuan, I heavily relied on Shu Di Huang to tonify the Lower Yuan, thereby pushing pathogens out. Only when used to treat Yin deficiency with latent heat, mild cases could be effective; if the pulse was rapid reaching 7-8 beats per breath, almost no effectiveness was seen. At that time, I did not know to change methods, thinking that Di Huang Wan was the Shen Qi Wan of *Jin Gui*, praised since antiquity as a good prescription. If this failed, other prescriptions would be even less effective. I did not know that Shen Qi Wan originally used Gan Di Huang (Dry Rehmanniae Radix), i.e., Sheng Di Huang (Raw Rehmanniae Radix) in pharmacies, and the Gui used was Gui Zhi (Cinnamomi Ramulus), i.e., Mu Gui (Cinnamomum Cassia Bark) in *Shen Nong Ben Cao Jing*, which is completely different from modern Di Huang Wan. The formula appears five times in *Jin Gui*: once treating "Hong Kong foot entering the lower abdomen with numbness"; once treating "Xu Lao lumbar pain, hypogastric tension, and difficulty urinating"; once treating "Shortness of breath with slight fluid retention, should be expelled via urination"; once treating "Male Xiao Ke, urine volume increased, drinking one dou produces one dou of urine"; once treating "Female turning bladder, bladder cord twisted, inability to urinate". Viewing these five items, they originally treated diseases of the lower abdomen and Bladder mostly, not the primary medicine for Lao Zhai. Moreover, how much the subsequent preparations deviated from its original nature!

Later, I treated a woman near fifty years old. She had fever and consumptive cough, with a pulse rapid reaching nearly eight beats per breath. First, I used modified Liu Wei Di Huang Wan as a decoction, which was ineffective. Then I used modified Zuo Gui Yin, also ineffective. Suddenly, I had an insight and changed to using Sheng Huang Qi 6 qian and Zhi Mu 8 qian as the formula. After a few doses, she improved. Then I added Dan Shen and Dang Gui (Angelicae Sinensis Radix) 3 qian each. After ten doses continuously, she was fully cured. Since then, whenever encountering Yin deficiency with heat syndromes that had some foundation to recover, by heavily using Huang Qi and Zhi Mu in the formula, I achieved immediate results. Only then did I realize that He Su Po's pulse method stating that a pulse rapid to 7-8 beats per breath is untreatable is not an absolute truth. Humans are born endowing Qi from Heaven and Earth; the Qi transformation of the human body is the Qi transformation of Heaven and Earth. When Heaven and Earth are about to rain, Yang Qi must warm and rise first, then Yin clouds gather and heavy rain follows. Huang Qi warms and rises to tonify Qi, representing the rising Yang Qi before rain; Zhi Mu is cold and moist to nourish Yin, representing the gathering Yin clouds before rain. Using these two drugs together possesses the wonder of Yang rising and Yin responding, clouds moving and rain applying. Abundant moisture causes vexing heat to retreat naturally; this is treating the untreatable. Moreover, Lao Zhai patients often damage the Kidney. Huang Qi greatly tonifies Lung Qi to benefit the source of Kidney Water, making Qi vigorous to generate Water naturally. Zhi Mu greatly nourishes Lung fluids, preventing Yin and Yang from extreme imbalance, harmonizing the Lung organ, and thus the function of generating water becomes more universal (Although Huang Qi and Zhi Mu can be used together to retreat deficient heat, in cases of severe Yin deficiency with heat, one must add Sheng Di Huang 8 qian to 1 liang to be effective).

Someone else asked: Although Shen Qi Wan is not a specialized medicine for Xu Lao, the Xu Lao chapter in *Jin Gui* clearly records it treats Xu Lao lumbar pain. It seems those with deficiency can take it. You alone say it has little efficacy. Are ancient prescriptions not to be followed? I replied: If Shen Qi Wan is indeed prepared according to ancient prescriptions, using Gan Di Huang for Di Huang, Gui Zhi for Gui, and made only into pills, not decoctions, and used appropriately, it certainly has efficacy. Gan Di Huang can expel Blood Bi (*Shen Nong Ben Cao Jing*), whereas Shu Di Huang lacks this efficacy. Gui Zhi can regulate Ying and Wei, whereas Rou Gui (Cinnamomi Cortex) lacks this efficacy. Once Blood Bi is expelled, blood stasis disappears naturally; once Ying and Wei are regulated, Qi and Blood self-regulate. As for Shan Yu Rou (Corni Fructus), its sour and warm nature can also expel Bi (*Shen Nong Ben Cao Jing* Shan Zhu Yu expels cold-damp Bi). Mu Dan Pi (Moutan Cortex) is pungent and cool and can also break blood. Fu Zi is extremely pungent and warm, further warming and unblocking blood vessels, complementing the cold and cool nature of Di Huang to jointly achieve the effect of expelling Blood Bi. Thus, Shen Qi Wan is a kidney-tonifying medicine, but actually also serves as a blood-stasis-resolving medicine, hence listed in the Xu Lao chapter of *Jin Gui* as an important formula. The reason it is only made into pills and not decoctions is truly because Di Huang, after boiling and simmering, becomes thick and sticky, resembling Shu Di Huang in nature, and its power to expel Blood Bi must decrease. Hence, *Shen Nong Ben Cao Jing* states raw Di Huang is superior. The later scholar Xu Lingtai once treated a person with excess above and deficiency below, phlegm-fire obstructing the chest, panting unable to lie down. He cut Ren Shen (Ginseng) into small pieces, decocted it with clear water and phlegm-resolving medicines, and sent it down with the pill, curing the patient. Later the disease recurred. The family used the original formula themselves, decocting the Ren Shen as well, and the illness worsened. Lingtai again instructed to follow the previous method. From this, one can understand the profound meaning behind the ancients' preparation of Shen Qi Wan.

Someone else asked: Since Shen Qi Wan can be effective if prepared according to ancient prescriptions, and besides Shen Qi Wan and Da Huang Zhe Chong Wan, there are seven other formulas in the *Jin Gui* Xu Lao chapter that can be selected according to the syndrome, then your Shi Quan Yu Zhen Tang seems unnecessary to formulate? I replied: The formulas in the *Jin Gui* Xu Lao chapter, although all effective, each specializes in one syndrome of the Xu Lao chapter. My proposed Shi Quan Yu Zhen Tang, however, actually treats multiple syndromes of the Xu Lao chapter. For example, using Huang Qi to tonify Qi, and simultaneously using Ren Shen to cultivate the root of Original Qi. Using Zhi Mu to nourish Yin, and simultaneously using Shan Yao and Xuan Shen to strengthen the source of True Yin. Using San Leng and E Zhu to eliminate blood stasis, and simultaneously using Dan Shen to resolve the dregs of blood stasis. As for Long Gu and Mu Li, if utilizing their astringent nature, they can assist Huang Qi to secure Original Qi; if utilizing their cool and moist nature, they can assist Zhi Mu to nourish True Yin; if utilizing their unblocking nature (*Shen Nong Ben Cao Jing* Long Gu treats masses, later materia medica also states Mu Li resolves blood stasis), they can assist San Leng and E Zhu to dissolve stagnation. Regarding treating Lung deficiency cough and rebellious Qi, and Kidney deficiency panting, Shan Yao is best. For treating chaotic dreams and profuse sweating, Long Gu and Mu Li are superior. This is the intention of the formula. By combining ten common herbs into one prescription, it supplements the True Yin-Yang, True Qi-Blood, and True Spirit of the human body, hence called Shi Quan Yu Zhen (Ten Complete Nourishing True).

Lao Zhai patients often have concurrent blood stasis. There are originally two types of syndromes: One is blood stasis caused by Lao Zhai. The person may have improper recuperation or excessive sexual indulgence, leading to Qi and Blood depletion. Circulation throughout the body becomes sluggish, causing blood to stagnate. This stasis is mostly in the meridians. The other is Lao Zhai caused by blood stasis. The person may have suffered falls or bruises, carried heavy loads with weak strength, or had a history of hematemesis or epistaxis, with improper medication, leading to initial blood stasis that slowly develops into Lao Zhai over time. This stasis is mostly in the Zang-Fu organs. Both types can be cured by taking Shi Quan Yu Zhen Tang. For stasis in the Zang-Fu organs, one must particularly use more blood-breaking herbs. For stasis in the meridians, one can also use the previous formula Zi Sheng Tang, adding Dang Gui and Dan Shen. For severe stasis in the Zang-Fu organs, one should use my proposed Li Chong Tang or Li Chong Wan. These several formulas can be referenced, varied, and integrated, adapting to circumstances.

Secular doctors, encountering rapid pulse syndromes, generally blame Yin deficiency and blood depletion. They do not know that when Original Qi is extremely deficient and cannot support itself, the pulse can reach extreme rapidity. Suppose a person works hard or runs fast until their physical strength cannot support them; their pulse will necessarily be rapid. Comparing the inability to support due to fatigue with the inability to support due to Qi deficiency, the matters are different but the principles are the same. In my careful clinical experience, when treating Xu Lao, I dare not purely use tonic medicines. However, if Qi-regulating herbs exceed Qi-tonifying herbs, the pulse becomes faster; if Qi-tonifying herbs exceed Qi-regulating herbs, the pulse gradually slows. Thus, whether the pulse is rapid or not depends not only on the fullness or emptiness of the Blood level but also significantly on the strength of the Qi level. Therefore, in this Shi Quan Yu Zhen Tang, Tai Shen and Huang Qi are each 4 qian, while San Leng and E Zhu are each 1.5 qian. The number of Qi-tonifying herbs is originally several times that of Qi-regulating herbs. If encountering severe Qi deficiency, one must replace San Leng and E Zhu with Ji Nei Jin.

The properties of medicines—tonifying, breaking, cold, hot—are fixed, but they also shift according to the constitution of the patient. I have weighed the tonifying power of Huang Qi against the breaking power of San Leng and E Zhu; using them in equal parts originally showed no superiority. I once used 3 qian each of San Leng and E Zhu to treat all kinds of masses and accumulations in the Zang-Fu organs. Fearing injury to Qi, I assisted with 6 qian of Huang Qi. After dozens of doses, the disease went away without injuring the Qi level, and some patients felt stronger the more they took it. If encountering very severe Qi deficiency, after just a few doses, one feels Qi cannot support itself; one must add Huang Qi or reduce San Leng and E Zhu to continue long-term use. For extremely deficient people, tonic medicines are hard to attack with, and breaking medicines easily show adverse effects. If the person has strong Qi but also depression/stagnation, one must use more San Leng and E Zhu or less Huang Qi, so that taking it does not cause fullness and stuffiness. I have also weighed the heating power of Huang Qi against the cooling power of Zhi Mu; there is no superiority, and using them in equal parts allows long-term use without cold or heat sensations (This argument applies to decoctions; if made into pills, the cooling power of Zhi Mu surpasses the heating power of Huang Qi). Those who fear heat will definitely increase heat when taking it; those who fear cold will increase cold. The power of cold and heat is indefinite, just as the power of tonifying and breaking is indefinite. Therefore, clinicians adjusting prescriptions must carefully deliberate and constantly experience, ensuring every breath matches the pathogenesis, so that hundreds of uses result in no mistakes.

Appendix:
Letter from Li XX of Cang County, Zhili:
My eldest son's wife, aged twenty-four, suffered from alternating chills and fever in January of this year (Bing Yin year). She always feared taking medicine, so she endured it silently without speaking. By early April, her family came to fetch me, saying my daughter-in-law was critically ill. Upon returning home to examine her, although she was not bedridden, she was too thin and weak to bear. Her pulse was wiry, floating, and rapid. Asking carefully about the condition, she said that every afternoon she felt cold first then hot, with occasional mild cough without phlegm. She had diarrhea more than ten times a day and night. At dawn, she sweated on her head. There was continuous pain in the chest. Immediately after swallowing food, she felt unbearable distension. All signs of various deficiencies and hundred damages were obviously exposed. After long deliberation, I prescribed Xiao Yao San (Free and Easy Wanderer Powder). Two doses yielded no effect. I went back to Cang to get medicine. Fortunately, Zhang XX came from Tianjin to Cang. I detailed the entire course of my daughter-in-law's illness. Zhang XX said, "In your opinion, what formula should be used to treat this?" I replied, "I plan to combine and use Zi Sheng Tang and Shi Quan Yu Zhen Tang. Is that acceptable?" Zhang XX said, "Excellent. This is a good prescription; it will surely be effective." I then followed the meaning of the two formulas, using Sheng Huai Shan Yao 8 qian, Sheng Bai Zhu, Jing Yu Rou, Sheng Ji Nei Jin, Sheng Long Gu, Sheng Mu Li, and Xian Shi Hu (Fresh Dendrobii Caulis) each 3 qian, and Dan Shen 4 qian. After four consecutive doses, all symptoms greatly decreased. Then I added San Leng and E Zhu (The reason for using these two herbs in Shi Quan Yu Zhen Tang is that Xu Lao syndromes often involve Blood Bi) each 1 qian, Mu Dan Pi and Di Gu Pi (Lycii Cortex) each 2 qian. After eight more consecutive doses, all diseases retreated, diet increased, and now she has completely recovered.