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Huangqi (Radix Astragali) 3 liang, Shaoyao (Radix Paeoniae Rubra or Alba), Guizhi (Ramulus Cinnamomi) 3 liang, Shengjiang (Rhizoma Zingiberis Recens) 6 liang, Dazao (Fructus Jujubae) 12 pieces.
The above five herbs are boiled in 6 sheng of water to obtain 2 sheng of decoction. Take 7 ge as a dose, warm, three times a day. (Another version includes Renshen (Radix Ginseng)).
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In men who appear healthy, a large pulse indicates Lao (Consumptive Disease), and an extremely deficient pulse also indicates Lao.
[Annotation]
"Men who appear healthy" refers to those who should have the harmonious pulses of the five Zang organs corresponding to the four seasons. Now, the pulses in all six positions are both large and extremely deficient, which is not the pulse of a healthy person. However, a large pulse without strength indicates that labor has injured the Spleen Qi; an extremely deficient pulse indicates the depletion of Kidney Yin and Essence. These are all signs pointing towards the formation of Xu Lao (Deficiency Consumption), hence such diagnostic findings.
[Collected Annotations]
Li [Name obscured] said: "Healthy people" refers to those whose appearance shows no signs of illness. The Classics state: "The pulse indicates disease while the patient feels well." Labor causes physical fatigue externally and Qi consumption internally. A large pulse does not indicate abundant Qi; upon heavy pressure, it feels empty and soft, representing an image of excess on the outside and deficiency on the inside. An extremely deficient pulse indicates that Jing and Qi have been depleted. Generally, a large pulse is the external manifestation of the Lao pulse, while an extremely deficient pulse is its internal decline.
Wei Litong said: "Men who appear healthy, a large pulse indicates Lao, an extremely deficient pulse also indicates Lao." A large pulse signifies the abundance of pathogenic factors, while an extremely deficient pulse signifies the loss of essential Qi. These two sentences reveal the general principle of Xu Lao but do not specify which meridian presents the large pulse or where the deficiency lies. It is up to the treating physician to carefully examine based on the causes of the Five Labors and Seven Injuries.
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For individuals aged fifty or sixty, if they are ill and present with a large pulse, they may experience Bi Syndrome (Obstruction Syndrome) along the back. If there is borborygmus (intestinal rumbling), Madao (a type of scrofula/lymphadenitis), or Xiaying (swelling along the neck/jawline), these are all caused by Lao.
[Commentary]
The phrase "If there is borborygmus" does not fit the context and is likely due to bamboo slip dislocation. The character "Ying" (goiter) in "Xiaying" should be "Luo" (scrofula). There are cases of Lao followed by Luo, or Luo followed by Lao, but never Lao followed by Ying. This must be a transcription error.
[Annotation]
People aged twenty or thirty who frequently present with a large pulse often suffer from Lao. However, if people aged fifty or sixty have a large pulse but do not immediately develop Lao, it is because although Qi and Blood are deficient, the Ministerial Fire is naturally weak; thus, they do not suffer from Lao. Although they do not suffer from Lao, the deficiency of Qi, Blood, Ying, and Wei leads to obstruction, resulting in Madao, Shuchuang (scrofula), and Xiayiluo. This clarifies that although the pulse is large in both cases, the diseases differ.
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In Lao disease, the pulse is floating and large, the hands and feet are vexed and hot, symptoms worsen in Spring and Summer, and improve in Autumn and Winter. There is spontaneous emission of essence accompanied by a sensation of cold in the lower body, and soreness and emaciation preventing walking.
[Commentary]
The character "Han" (cold) in "spontaneous emission of essence accompanied by cold" should be "Xu" (deficiency); this is a transcription error.
[Annotation]
This states that a floating and large pulse belongs to Lao, detailing the symptoms. "Vexed and hot hands and feet" refers to the five-center heat in modern Xu Lao, caused by Yin deficiency failing to anchor Yang. Spontaneous emission of essence due to Yin deficiency refers to nocturnal emission in modern Xu Lao, caused by Yin deficiency failing to secure. Soreness and emaciation preventing walking refers to knee soreness and bone atrophy in modern Xu Lao, making it impossible to rise from bed. Spring and Summer belong to Yang; Yin deficiency cannot overcome Yang, so symptoms worsen. Autumn and Winter belong to Yin; Yin deficiency finds its place and recovers, so symptoms improve.
[Collected Annotations]
Xu Bin said: If the pulse is large indicating Lao, and additionally floating, the symptom is vexed hands and feet, because when Yin is insufficient, Yang must be excessive. Thus, Spring and Summer assisting Yang worsens the condition, while Autumn and Winter assisting Yin improves it. Yin deficiency leading to spontaneous emission of essence eventually results in soreness, emaciation, and inability to walk.
Cheng Lin said: Read "Han" (cold) as "Xu" (deficiency). Yin deficiency means Qi fails to hold, leading to spontaneous emission of essence.
Li [Name obscured] said: A floating and large pulse indicates interior deficiency with Qi bursting outward. The four limbs are the root of all Yang; labor consumes Yang, and Yin deficiency generates internal heat, causing vexed hands and feet. Most injuries from labor belong to Yin deficiency. During the peak of Wood and Fire in Spring and Summer, Qi floats outward, making the interior more deficient, so symptoms worsen. During the generation of Metal and Water in Autumn and Winter, Qi gathers inward, so the exterior is undisturbed, and symptoms improve. The Kidney stores Essence; spontaneous emission indicates the Kidney Water fails to store. The Kidney governs bones, hence soreness, emaciation, and inability to walk.
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In men, a pulse that is deficient, deep, and wiry, without aversion to cold or fever, accompanied by shortness of breath, epigastric distress, dysuria, pale complexion, occasional dizziness combined with epistaxis, and hypogastric fullness, is caused by Lao.
[Annotation]
This reiterates that extreme deficiency constitutes Lao, detailing the symptoms. A deficient, deep, and wiry pulse indicates insufficiency of both Yin and Yang. Absence of aversion to cold and fever indicates that although Yin and Yang are insufficient, they are not attacking each other. Shortness of breath, pale face, occasional dizziness, and epistaxis indicate upper Jiao deficiency and blood failing to nourish. Epigastric distress, dysuria, and hypogastric fullness indicate lower Jiao deficiency and Qi stagnation. All these pulse and symptom patterns result from injury by labor, hence stated as "caused by Lao."
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Men with a pale and thin complexion primarily suffer from thirst and blood loss. Sudden panting and palpitations with a floating pulse indicate interior deficiency.
[Commentary]
"The floating pulse indicates interior deficiency" is likely a superfluous text.
[Annotation]
This reiterates the pale complexion of Xu Lao, mutually detailing the symptoms. A pale complexion not due to epistaxis indicates blood failing to generate internally; one due to epistaxis indicates blood lost externally. "Thin complexion" refers to a pale, lusterless face, indicating insufficiency. Thus, it primarily indicates thirst due to fluid deficiency, and sudden panting due to Qi deficiency from vomiting/epistaxis blood loss, and sudden palpitations due to Blood deficiency.
[Collected Annotations]
Li [Name obscured] said: This section focuses on blood loss. The *Neijing* states: "The five colors of clarity are the brilliance of Qi." It also states: "The heart manifests in the face, and its充盈 is in the blood vessels." Labor consumes Qi and stirs Fire, forcing blood to move recklessly, inevitably leading to blood loss. Blood moistens; when blood is lost, vitality is depleted and the complexion becomes thin. When fluids are lost, vexation and thirst occur. Furthermore, in labor, both Qi and Blood are consumed. The Lung governs Qi; Qi deficiency causes panting. The Heart governs Blood; Blood deficiency causes palpitations. "Sudden" refers to the abrupt onset of these conditions.
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A man with a floating, weak, and choppy pulse will be infertile, due to clear and cold Jing and Qi.
[Annotation]
A man with a floating, large, and deficient pulse suffers from Xu Lao. A floating, weak, and choppy pulse indicates clear and cold Jing and Qi, thus leading to infertility.
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Individuals prone to seminal emission often present with tense and acute hypogastric pain, coldness at the glans penis, dizziness, hair loss, and an extremely deficient, knotted, and slow pulse. This indicates loose stools with undigested food, blood loss, and seminal emission. If the pulse presents various knotted, moving, faint, or tight qualities, and the man suffers from seminal emission or the woman from dream intercourse, Guizhi Longgu Muli Tang (Cinnamon Twig Decoction with Dragon Bone and Oyster Shell) is indicated.
[Commentary]
The phrase "blood loss and seminal emission" below this line does not connect logically with the preceding text and should be treated as a separate entry placed later.
[Annotation]
"Individuals prone to seminal emission" refers to those whose Kidney Yang fails to secure Essence. Tense and acute hypogastric pain indicates deficiency and cold. Coldness at the glans penis indicates declining Yang. Dizziness indicates depletion of Jing and Qi. Hair loss indicates exhaustion of Blood. If the pulse is extremely deficient, knotted, and slow, one should know that extreme deficiency indicates Lao, knotted indicates blood loss, and slow indicates cold, hence the symptoms of loose stools with undigested food, blood loss, and seminal emission.
[Collected Annotations]
Cheng Lin said: The Kidney governs closure and storage, while the Liver governs dispersion. Seminal emission implies excessive dispersion, hence tense and acute hypogastric pain. The glans penis is the gathering point of the Zong Jin (converging sinews); as True Yang declines daily, the glans becomes cold. Dizziness indicates Jing decline, hair loss indicates Blood exhaustion, hence the pulse is deficient, knotted, and slow. Deficient pulse indicates seminal emission, knotted pulse indicates blood loss, and slow pulse indicates diarrhea with undigested food.
Li [Name obscured] said: The Liver stores Blood, and the Kidney stores Essence. Blood loss and seminal emission mean both Liver and Kidney are deficient. The hypogastrium is the region of the Liver and Kidney. Tense and acute hypogastric pain occurs because Liver and Kidney deficiency makes the interior Qi deficient and tense, adding a wiry quality. The Liver governs sinews, and the anterior yin is the gathering of Zong Jin; Liver decline causes coldness at the glans. The Liver stores Blood and opens into the eyes; the Kidney governs bones, and the essence of bones is the pupil. The brilliance of the Kidney is in the hair, and hair is the surplus of blood. This Liver and Kidney dual deficiency causes dizziness and hair loss. The knotted pulse is felt at the surface and depth but empty in the middle, resembling a hollow reed, hence named "knotted." This is the pulse of blood loss; since the pulse is the mansion of blood, blood deficiency leads to pulse deficiency. Slow indicates involvement of the Zang organs, and slow indicates cold. Extremely deficient, knotted, and slow pulses indicate deficiency syndromes. Loose stools with undigested food indicate Xu Lao affecting the Liver and Kidney meridians.
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In men, a harmonious pulse that is weak, fine, and minute indicates a tendency to night sweats.
[Commentary]
The pulse and symptoms in this section do not match, likely due to missing bamboo slips; therefore, it is not explained.
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A pulse that is deep, small, and slow is named Tu Qi (Qi Depletion). The person pants heavily when walking quickly, experiences cold extremities, abdominal fullness, and in severe cases, loose stools and indigestion.
[Annotation]
A deep, small, and slow pulse indicates significant Yang deficiency, hence named Tu Qi. Tu Qi means the Great Qi in the chest is deficient and scant, unable to support respiration, hence panting when walking quickly. Yang deficiency leads to cold; cold prevailing externally causes the four extremities to be unwarmed, hence cold extremities. Cold prevailing internally causes abdominal fullness, loose stools, and indigestion.
[Collected Annotations]
Xu Bin said: A deep, small, and slow pulse undoubtedly indicates Yang decline. The combination of these three pulses indicates total Yang deficiency, hence named Tu Qi. The body becomes an empty shell; walking quickly exhausts Qi causing panting, lack of Yang in the limbs causes cold, lack of Yang in the abdomen causes fullness, extreme Stomach deficiency causes loose stools, and extreme Spleen deficiency causes food stagnation.
Li [Name obscured] said: This involves disease in the Spleen, Lung, and Kidney meridians. The Lung governs Qi, and Qi is Yang. Deep, small, and slow are all pulses of Yang Qi deficiency, hence Tu Qi. Panting when walking quickly occurs because the Lung governs exhalation and the Kidney governs inhalation, serving as the source of generating Qi and the gate of respiration. If Yuan Qi is depleted, Qi deficiency prevents continuous breathing; the Lung has nothing to exhale, and the Kidney has nothing to inhale, hence panting. This is Lung and Kidney disease. Furthermore, the Spleen governs the four limbs, which are the root of all Yang. Cold extremities indicate Yang deficiency failing to warm the extremities. Abdominal fullness indicates the Spleen meridian entering the abdomen and Yang deficiency causing central fullness. Loose stools and indigestion indicate Spleen deficiency failing to transport and transform water and grain, commonly presenting as watery diarrhea and undigested food stool.
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A pulse that is wiry and large: wiry indicates reduction (decrease), large indicates knotted (empty). Reduction indicates cold, knotted indicates deficiency. Deficiency and cold clashing together is named Ge Pulse (Leather Pulse). In women, it indicates miscarriage and uterine bleeding; in men, it indicates blood loss and seminal emission.
[Annotation]
See detailed explanation in *Shanghan Lun · Bian Mai Fa* (Differentiating Pulse Methods); no further explanation provided here.
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If the pulse presents various knotted, moving, faint, or tight qualities, and the man suffers from seminal emission or the woman from dream intercourse, Guizhi Longgu Muli Tang (Cinnamon Twig Decoction with Dragon Bone and Oyster Shell) is indicated.
[Annotation]
"Pulse presenting various knotted, moving, faint, or tight qualities" refers generally to the various pulses of Xu Lao, not implying that only these specific pulses indicate seminal emission in men or dream intercourse in women. By citing both male seminal emission and female dream intercourse, Guizhi Longgu Muli Tang is used to harmonize Yin and Yang and Ying and Wei, while simultaneously securing and astringing Essence.
[Collected Annotations]
Xu Bin said: Individuals prone to seminal emission have varied pulses. If various knotted, moving, faint, or tight pulses are found, it means men lose essence due to deficient Yin harboring Fire, and women experience dream intercourse due to deficient Yin harboring Fire. Using Guizhi Longgu Muli Tang treats this because Yin-deficient individuals generally need Kidney support. Thus, Guizhi and Shaoyao circulate Yang and secure Yin, Gancao, Jiang, and Dazao harmonize the Middle, and Longgu and Muli secure Essence.