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Xu (Deficiency) refers to the insufficiency of Xue (Blood) and Qi (Vital Energy); over time, the skin, muscles, and Zang-Fu organs gradually deteriorate, hence it is called Xu Sun (Deficiency Damage). Lao (Exhaustion) refers to enduring illness for a long time without rest, akin to relentless toil. Furthermore, this disease is often caused by mental exertion, physical labor, or sexual excess. Its manifestations are mostly related to Fire (Heat); the character "Lao" consists of "Li" (Power) and two "Huo" (Fire) radicals, thus named Lao. Zhai (Consumption) means decay; when the condition reaches the stage of Lao, the body has already deteriorated. Ancients divided Lao into Five Lao: Fei Lao (Lung Exhaustion), with symptoms of facial edema, shortness of breath, dry skin, brittle hair, chills, and restless cough; Xin Lao (Heart Exhaustion), with symptoms of deficient and scanty blood vessels, pallor in men, and amenorrhea in women; Pi Lao (Spleen Exhaustion), with symptoms of reduced appetite, muscle wasting, and loose stools; Gan Lao (Liver Exhaustion), with symptoms of bitter taste, eye diseases, radiating pain in the chest and hypochondrium, and tendon disorders causing difficulty walking; Shen Lao (Kidney Exhaustion), with symptoms of bone atrophy preventing prolonged standing, back stiffness, afternoon fever, night sweats, bone-steaming sensation, yellow-red urine with dribbling, urethral pain, and lower abdominal fullness and urgency. It is also divided into Six Ji (Extremes): Qi Ji (Qi Extreme), which is Lung disease at its extreme, characterized by panting rushing to the chest, frequent anger, and insufficient Qi to speak; Xue Ji (Blood Extreme), which is Heart disease at its extreme, characterized by pallor, hair loss, heart pain, and red lips and tongue; Rou Ji (Flesh Extreme), which is Spleen disease at its extreme, characterized by muscle wasting, weak limbs, and a sensation like mice crawling on the body; Jin Ji (Tendon Extreme), which is Liver disease at its extreme, characterized by frequent muscle spasms, dry and painful nails, contracture of hands and feet, and hypochondriac pain; Gu Ji (Bone Extreme), which is Kidney disease at its extreme, characterized by pain in hands and feet, spine and waist pain, inability to stand long, and loose teeth; Jing Ji (Essence Extreme), where all Zang-Fu organs are extremely deficient, characterized by lack of luster in the body, dull eyes, tinnitus, mental fatigue, spermatorrhea, white turbid discharge, and empty marrow. It is further divided into Seven Injuries: Yin Cold; Impotence; Inner Urgency (abdominal tension); Rapid Ejaculation; Scant Essence with damp genitals; Slippery Essence; Painful Frequent Urination and failure during intercourse. It is also said that excessive fullness injures the Spleen; great anger and reversed Qi injure the Liver; forceful lifting and sitting long in damp places injure the Kidneys; cold exposure and drinking cold liquids injure the Lungs; worry and overthinking injure the Heart; wind, rain, cold, and heat injure the Form; great fear and lack of moderation injure the Will (Zhi). Generally, accumulated injuries lead to Lao, and accumulated Lao leads to Ji; this does not happen overnight. Old theories state that contracting cold damages Yang (deficient Yang contracting external cold damages the Yang aspect), and contracting heat damages Yin (deficient Yin generating internal heat damages the Yin aspect). Damage to Yang proceeds from top to bottom: first damaging the Lung (skin gathers, hairs fall); second damaging the Heart (blood vessels become empty); third damaging the Spleen (food cannot transform into flesh); fourth damaging the Liver (hypochondriac pain and tendon disorders); fifth damaging the Kidney (bone atrophy preventing getting out of bed); damage reaching the Kidney leads to death, as stated: "Injuries to the five Zang organs inevitably reach the Kidney when exhausted." Damage to Yin proceeds oppositely, from bottom to top, leading to death at the Lung, as internal injury is serious when accompanied by cough (see Cough section). However, cold damaging Yang, heat damaging Yin, and the upper-lower distinction between Lung and Kidney are merely illustrative examples. Wind, cold, and dampness can all stagnate Lung Qi and generate heat; summer heat, fire, and dryness can all damage Lung Qi and cause fever. Grief can also stir Lung Fire, not just cold exposure and cold drinks injuring the Lung. Kidney Water deficiency generates heat; Mingmen Fire deficiency generates cold; forceful lifting, sexual excess, and unresolved fear can all injure the Kidney, not limited to heat syndromes. Sometimes diet first injures the Spleen, overthinking first injures the Heart, and stagnant anger first injures the Liver, then sequentially transmits to other Zang organs; why must it always be the Lung and Kidney first? The general principle requires distinguishing Qi, Blood, Yin, and Yang. For Qi deficiency, use Si Jun Zi Tang (Four Gentlemen Decoction), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Bao Yuan Tang (Protect the Origin Decoction), etc., which essentially support the Spleen and protect the Lung. For Blood deficiency, use Si Wu Tang (Four Substance Decoction), Dang Gui Bu Xue Tang (Angelica Tonify Blood Decoction), Di Gu Pi Yin (Cortex Lycii Decoction), Liu Wu Tang (Six Substance Decoction), Jia Wei Si Wu Tang (Modified Four Substance Decoction), etc., which essentially nourish the Liver and clear the Heart. For dual Qi and Blood deficiency, use Shi Quan Da Bu Tang (Comprehensive Great Tonifying Decoction), Ren Shen Yang Rong Tang (Ginseng Nourish Ying Decoction), etc. When referring to Yin and Yang here, they specifically refer to the Kidney. Yang deficiency refers to deficiency of Fire in the Kidney, with a weak pulse at the Right Chi position, treated with Ba Wei Wan (Eight-Ingredient Pill). Yin deficiency refers to deficiency of Water in the Kidney, with a fine and rapid pulse, treated with Liu Wei Wan (Six-Ingredient Pill). Differentiation methods: Yin deficiency typically presents with heat, dry constipation, red and scanty urine, burning soles, and emaciation; Yang deficiency typically presents with cold, though there may be Dai Yang (Floating Yang) or Ge Yang (Repelling Yang) syndromes with severe heat, aversion to heat rather than cold, but these are temporary, not constant. Yang deficiency usually involves intermittent loose stools, clear and copious urine, cold waist and feet, and shortness of spirit with timidity. Liver injury is treated with Bu Gan Tang (Tonify Liver Decoction) and Xiao Yao San (Free and Easy Wanderer Powder); Lung injury with Jia Wei Jiu Fei Yin (Modified Rescue Lung Decoction); Heart injury with Tian Wang Bu Xin Dan (Emperor of Heaven's Special Pill to Tonify the Heart); Spleen injury with Gui Pi Tang (Restore the Spleen Decoction). This is the general approach. Among injuries to the five Zang organs, Kidney deficiency is the most critical. Kidney deficiency causes bone-steaming tidal fever, spontaneous and night sweats, emaciation, dry mouth and throat, hoarseness, Xiao Ke (Wasting-Thirst) and Lin Zhuo (Dribbling Turbidity), spermatorrhea, hemoptysis, irritability, dry cough with sputum, insomnia, restlessness,恍惚 (fluctuation), and palpitations, all caused by Kidney Water deficiency and flaming up of Deficient Fire, primarily treated with Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill). For Lao Sou (Consumption Cough), add Wu Wei Zi (Schisandra Berry) or combine with Sheng Mai San (Generate the Pulse Powder). If heat is severe, temporarily add Zhi Mu (Anemarrhena Rhizome) and Huang Bai (Phellodendron Bark). Generally, Water deficiency accounts for 80-90% of cases; Fu Zi (Aconite) and Gui Zhi (Cinnamon Twig) should not be used lightly. Zhu Danxi emphasized Yin deficiency, so afternoon fever (afternoon belongs to Yin, so Yin deficiency causes afternoon fever), night sweats, frequent vomiting of phlegm due to rebellious Qi (ascending belongs to Yang, descending belongs to Yin; Yin deficiency with flaming fire prevents Qi descent), and a pulse that is surging and large upon superficial palpation but empty upon deep palpation, are treated with Si Wu Tang plus Zhi Mu and Huang Bai. Why do later generations follow this without effect? Because Dang Gui (Angelica Sinensis) and Chuan Xiong (Sichuan Lovage Rhizome) are acrid and aromatic, ascending in nature, not herbs that subdue fire; Zhi Mu and Huang Bai are bitter and cold, clearing Excess Fire, unsuitable for Deficient Fire, merely damaging the Stomach Qi. Instead, use Yi Yi Ren (Coix Seed), Bai He (Lily Bulb), Dong Tian/Dong Bei (Asparagus Tuber), Sang Bai Pi (Mulberry Root Bark), Di Gu Pi (Cortex Lycii), Mu Dan Pi (Moutan Cortex), Pi Pa Ye (Loquat Leaf), Wu Wei Zi, Suan Zao Ren (Ziziphus Seed), etc., assisted by Sheng Di Jiang (Rehmannia Juice), Ou Jiang (Lotus Root Juice), Ru Zhi (Human Milk), Tong Bian (Child's Urine). Add Bei Mu (Fritillaria Bulb) if there is phlegm to protect the Lung and nourish the Water source, yielding immediate results. These herbs possess cooling, descending, and astringent properties, with thin Qi, belonging to Yin within Yang. Descending from the Yang aspect, they subdue rising Fire. Their cool nature is like a sudden autumn breeze in summer heat, extinguishing inflammation, similar to using Bai Hu Tang (White Tiger Decoction) for Summerheat syndromes. However, Summerheat is an External Contraction syndrome, belonging to Excess, hence heavy cold herbs are used; this is Internal Injury, belonging to Deficiency, so cooling, descending, and astringent agents suffice. This is the balance of medication. Thus, for Qi deficiency, Sheng Mai San is used, not Bai Zhu (Atractylodes Macrocephala Rhizome). For Blood deficiency, San Cai Wan (Three Talents Pill) is used, not Si Wu Tang. Treating Water deficiency while considering both Spleen and Kidney is difficult because cooling and moistening herbs for Lung and Kidney often stagnate the Spleen; thus, overuse of cold herbs destroys the Spleen, as seen in many consumption deaths from diarrhea. One must occasionally administer sweet-warm herbs or Qi-moving herbs to support the Spleen, but avoid being too acrid-dry to prevent consuming Kidney Water. If Fire deficiency exists, both Spleen and Kidney are cold; pure warming and tonification can be used without hesitation, hence those receiving warm tonification are easier to treat. Ren Shen (Ginseng Root) is indispensable for all conditions except Lung congestion with heat and surging-rapid pulse. Wang Jiezhai's claim that taking Ginseng leads to death is greatly misleading. (Note: Raw Ginseng is cool, cooked is warm, not a hot herb; heavy substance and thin Qi suggest it is a Yin-nourishing herb. Materia Medica calls it Qi-tonifying, implying Yang roots in Yin; please verify with experts.) For chronic weakness and anorexia, use He Zhong Wan (Harmonize Middle Pill). For men with emaciation, weak Qi, and cough progressing to consumption, use Zhu Du Wan (Pig Stomach Pill), which restores flesh. If taking cold herbs reduces symptoms but the pulse accelerates, it indicates Yang depression; raising and tonifying are indicated, cold herbs are strictly contraindicated, and violation leads to death. If Heavy Yin covers Yang, trapping Fire, causing chills, depression, wiry-rapid pulse, and heat in four extremities, use Huo Yu Tang (Depressed Fire Decoction) or Chai Hu Sheng Ma Tang (Bupleurum and Cimicifuga Decoction), stopping when the disease resolves. If the complexion is normal, body is robust, appearing healthy externally but deficient internally,俗称 "Peach Wood Borer," treat according to specific symptoms. Consumption diseases involve emptiness of all vessels, requiring sticky and cloying substances to fill them; dried essence and blood require moistening substances to hydrate them. Use Ren Shen, Di Huang (Rehmannia Root), Dong Tian/Dong Bei, Gou Qi (Goji Berry), Wu Wei Zi, etc., decocted into paste. Separately, boil Qing Hao (Artemisia Annua) in child's urine into paste, mix with Sheng Di juice, fresh lotus root juice, Bo He (Mint), human milk, refine over water, adjust quantity, and add Lu Rong Jiao (Deer Antler Glue) and Xia Tian Gao (Cloud Sky Paste) to form a final paste. Take several spoons dissolved in water. To move blood stasis, add Vinegar-processed Da Huang (Rhubarb Rhizome), Xuan Ming Fen (Mirabilite), Tao Ren (Peach Kernel) paste, Jiu Zhi (Leek Juice). To stop bleeding, add Jing Mo (Beijing Ink). To resolve phlegm, add Zhu Li (Bamboo Sap). To descend fire, add Tong Bian. Most consumption syndromes involve pain radiating from the epigastrium to the hypochondrium due to stagnant Qi and unmoving new blood; pastes with Leek Juice and Peach Kernel paste are especially suitable. Chai Hu (Bupleurum Root) raises clear Qi and disperses depression, used for bone-steaming to vent heat from the muscles; Yinzhou origin is best, but not for long-term use due to its dispersing nature. For Yin deficiency with stirring Fire and persistent erections, place Xiao Ming (Mirabilite) in the palm, clasp hands until it melts, causing flaccidity. If the syndrome is fundamentally Yin deficiency but includes shortness of breath, reluctance to speak, weakness, dull eyes, and pale complexion, it involves concurrent Yang deficiency. Use Ren Shen and Mai Dong (Ophiopogon Tuber) 3 qian each, Wu Zi 21 grains, Chen Pi (Tangerine Peel), Jie Geng (Platycodon Root), Zhi Gan Cao (Prepared Licorice Root) 5 qian each, powder, make pills with oil-soaked pancakes, size of chicken eggs. Take one pill, chew with saliva and swallow. Chronic deficiency becoming consumption with accumulated heat and bone-steaming, coughing blood, rough skin like fish scales, dark and lusterless face, sleeping on one side, hoarseness, sore throat, scrofula on neck, hypochondriac pain, spasms, generalized bone/joint pain, nocturnal emissions ("dream intercourse"), irritability, five-palm heat, frizzy hair, flushed cheeks like rouge, irregular bowels, and turbid urination are caused by exhaustion of Kidney Water and Liver Blood failing to control Fire. Fire scorching and drying blood makes even Yin-nourishing formulas ineffective because dead blood remains, blocking meridians and preventing Qi-Blood circulation, so heat persists. If the patient can eat and has constipation, purgatives can be used; urgently apply Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) to move dead blood. Even without dead blood, if accumulated heat persists, downward movement is needed to curb its momentum; temporarily use Da Huang and Qing Hao decoction to guide it down (ancient formulas like Chai Hu Yin Zi, Fang Feng Dang Gui Yin Zi, Mai Jian San all use Rhubarb to curb upward flaming Qi), then regulate according to symptoms. If unable to eat and suffering diarrhea, purgatives are contraindicated, leading to death. Long-standing consumption may produce evil worms (transformed from decaying blood and damp-heat) that bore into Zang-Fu organs, gaining spiritual power and changing unpredictably, transmitting to descendants after death, even wiping out families, called Chuan Shi Lao (Transmitting Corpse Consumption). Moxibustion on both Yao Yan (Waist Eyes) points, seven moxa cones each, after midnight on Gui Hai day, followed by Chuan Shi Jiang Jun Wan (Transmitting Corpse General Pill). Gao Huang and Si Hua points can be moxibusted. One dried Wild Cat Liver, powdered, taken with water, one cun bi daily three times, effective; repeat if unsure. Generally, preserving essence and blood is paramount,驱虫 (expelling worms) secondary. An Xi (Benzoin), Su He (Styrax), A Wei (Ferula Resin), She Xiang (Musk), Xi Jiao (Rhino Horn), Dan Sha (Cinnabar), Xiong Huang (Realgar) are expelling pathogens, but Tian Ling Gai (Human Skull Cap) must be added. The worm of Chuan Shi is ghostly Qi; latent until it attaches to dry bones, then the ghostly Qi flies away, no longer attaching to humans, and can be purged. Tiger teeth and carp skull bones are also effective as they are predator items feared by ghosts. First, swallow Be Dou Fu (Big Dipper Talisman) with Xiong Gui Xue Yu San (Ligusticum, Angelica, and Blood Remainder Powder); second, use Bie Jia Sheng Xi San (Softshell Turtle and Fresh Rhino Horn Powder) to extract worms; other methods detailed in *Zhun Sheng*. Most consumption cases are Yin deficiency, leading to death only after emaciation to the bone, showing Yin governs form; only when Yin is completely exhausted is form completely destroyed. If Yang deficiency, death occurs from Qi collapse despite robust form, as Yang governs Qi; Qi collapse does not wait for form collapse. Appearance of Zhen Zang Mai (True Organ Pulse) indicates imminent death even if flesh remains. Severe bone atrophy, sunken flesh, decline in movement and spirit indicate death within a year even without True Organ Pulse. With panting and fullness moving the body, death in six months. With pain radiating to shoulders and chest, death in one month. With ulceration and persistent fever, death in ten days. Combined with True Organ Pulse, sunken eye sockets, and blindness, death is immediate. If the patient can see people, Shen (Spirit) has not yet departed; death occurs on the day of the element that overcomes the patient's element. Critical signs of consumption unresponsive to tonification include diarrhea, extreme bone/joint pain, sleeping on one side, aphonia, and wiry-rapid pulse.