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A woman surnamed Ning from Tianjin, nearly forty years old, had been suffering from Xu Lao (consumptive disease, a chronic weak condition characterized by deficiency of Zang-Fu organs, Qi, Blood, Yin, and Yang). Her condition worsened due to excessive physical exertion.

Etiology: Due to an unfavorable situation and mental strain from household affairs, her dietary intake decreased, gradually leading to Xu Lao. She had already fallen ill, lying in bed unwilling to get up. Additionally, due to a lawsuit, she was forced to undergo cross-examination in court for half a day. Upon returning home, her illness aggravated significantly.

Symptoms: She lay in bed with eyes closed, appearing drowsy as if asleep. When called, she opened her eyes slightly but did not speak, seeming capable of speech but extremely reluctant to do so. Her complexion showed signs of floating heat (a sensation of heat caused by the floating of deficient Yang), with a body temperature of 38.8°C. When asked if she felt heat in the heart or palpitations (Zhen Tong, anxiety with palpitations), she nodded affirmatively. Her left pulse was floating, wiry, and hard; her right pulse was floating and Kou (cork-like, hollow on pressure); neither could withstand heavy pressure. The pulse rate was six beats per breath (tachycardia). Over two days, she only drank small amounts of rice soup. She had not had a bowel movement for several days, and her urine output was very scanty.

Diagnosis: Based on the wiry left pulse and Kou right pulse, which are also floating, rapid, and rootless, it is known that this is a state of extreme deficiency of Qi and Blood, manifesting as a failure of Yin and Yang to sustain each other. Thus, Yang Qi floats upward causing facial heat, and Yang Qi escapes outward causing body heat. This is an extremely critical stage of Xu Lao. Fortunately, although her breathing is slightly hurried, it has not progressed to panting. Although there is coughing, it is not severe. It is known that the case is still treatable. At this point, one should nourish Qi and Blood, assisted by herbs that consolidate Qi and Blood, so that Yin and Yang can mutually sustain each other, ensuring safety and recovery.

Prescription: Ye Tai Shen (Wild Ginseng from Taicang, 4 qian), Sheng Huai Shan Yao (Raw Dioscorea opposita from Huai region, 8 qian), Jing Yu Rou (Cleaned Cornus officinalis fruit, 8 qian), Sheng Long Gu (Raw Dragon Bone, 8 qian, crushed), Da Gan Gou Qi (Large sweet Goji berry, 6 qian), Gan Cao (Licorice root, 2 qian), Sheng Huai Di Huang (Raw Rehmannia glutinosa from Huai region, 6 qian), Xuan Shen (Scrophularia root, 5 qian), Sha Shen (Glehnia or Adenophora root, 5 qian), Sheng Zhe Shi (Raw Hematite, 5 qian, finely ground), Sheng Hang Shao (Raw Paeonia lactiflora from Hangzhou, 4 qian).
Decoct together in a large bowl of water, divide into two doses, and take warm.

Follow-up Visit: After taking the medicine for three consecutive doses, she was able to speak and eat. The floating heat had subsided, and body temperature dropped to 37.6°C. The feeling of heat in the heart ceased. Occasionally, mild palpitations were felt. Bowel movement occurred once, and urination became smooth. Therefore, the original prescription was slightly modified for continued use.

Prescription: Ye Tai Shen (4 qian), Sheng Huai Shan Yao (1 liang), Da Gan Gou Qi (8 qian), Jing Yu Rou (6 qian), Sheng Huai Di Huang (5 qian), Gan Cao (2 qian), Xuan Shen (5 qian), Sha Shen (5 qian), Sheng Zhe Shi (4 qian, finely ground), Sheng Hang Shao (3 qian), Sheng Ji Nei Jin (Raw Chicken Gizzard Lining, 1.5 qian, yellow variety, crushed).
Decoct together in a large bowl of water, take warm.

Formula Analysis: Chicken Gizzard Lining (Ji Nei Jin) was added because patients with Xu Lao often have blood stasis in their collaterals, as described in the *Jin Gui Yao Lue* as "Blood Bi" and Xu Lao. Using Ji Nei Jin resolves Blood Bi, allowing Xu Lao to be eradicated at its root. Furthermore, when used together with Tai Shen (Ginseng), it helps transform and transport the tonifying power of Ginseng, preventing abdominal distension.

Outcome: After taking the medicine for four consecutive doses, the newly acquired acute illness was completely cured, though her chronic underlying Xu Lao was not fully resolved. She was instructed to stop taking decoctions and instead consume porridge made from fine powder of raw Huai Shan Yao daily, with a little white sugar, as a snack. Each time, a small amount of fine powder of raw Ji Nei Jin should be taken with it to consolidate the therapeutic effect.