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Xu Xueshi said: I recall a case where a patient suffered from Shanghan (Cold Damage), and after sweating, the illness receded. A few days later, he suddenly developed fever, spontaneous sweating, a wiry and rapid pulse, and mental restlessness. This was indeed "Lao Fu" (Relapse due to overexertion).

Upon examination, I stated: This is caused by excessive mental exertion. The Shen (Spirit) resides in the Heart. Since the Shen has not yet returned to its original state, further exertion has damaged it, leading to disharmony between Ying (Nutritive Qi) and Wei (Defensive Qi). Treatment should focus on tonifying Spleen Qi to resolve this fatigue, which may lead to recovery. I prescribed Bupi Tang (Spleen-Tonifying Decoction) combined with Xiaochaihu Tang (Minor Bupleurum Decoction). Someone questioned: "In deficiency patterns, one should tonify the Mother organ. Why are you tonifying the Child organ here?" I replied: "Do you not understand the distinction between Xu Lao (Deficiency Fatigue) and ordinary deficiency? The Nan Jing (Classic of Difficult Issues) states: 'Tonify the Mother in deficiency, drain the Child in excess.' For general deficiency, tonifying the Mother is common knowledge. However, the Qian Jin Fang (Essential Prescriptions Worth a Thousand Pieces of Gold) states: 'When Heart fatigue is severe, tonify Spleen Qi to assist it. When Spleen Qi is prosperous, it influences and nourishes the Heart.' In cases of 'Lao' (Fatigue/Overuse), one should tonify the Child organ, which is rarely known. The Mother generates me; the Child succeeds me and assists me. When treating deficiency, we tonify the one who generated us, similar to the principle in Jin Nang that 'when the root receives Qi, the branches receive shade.' When treating fatigue, we tonify the one who assists us, analogous to Xunzi's saying that 'a son cannot be wealthy while the father is poor.' This is why the treatment for deficiency differs from that for fatigue."

Hua Bren treated Pan Ziyong, who had recovered from a Ganmao (Common Cold) via sweating. A few days later, he relapsed with high fever, aversion to cold, headache, dizziness, vomiting, loss of appetite, irritability, fullness, coughing, and profuse sweating. Hua examined his pulses, finding both hands floating and tight. According to Zhang Zhongjing's methods, for Lao Fu with a floating pulse, release via sweating; with a sinking pulse, resolve via purgation. He administered Mahuang Gegen Tang (Ephedra and Pueraria Decoction) three times, inducing further sweating, followed by several days of regulation until recovery. Other physicians at the time believed the patient was weak and exhausted post-illness and intended to use warming and tonifying methods. Hua said: "The method must be as such," and thus acted against the consensus.

Wang Haizang treated the son of Li Liangzuo, who presented with Taiyang Zheng (Taiyang Syndrome). The pulses at Cun, Guan, and Chi were all floating and rapid but empty upon pressure, indicating internal Yin deficiency. He cured him with Shenzhu Jia Ganjiang Tang (Atractylodes Macrocephala Decoction with Dried Ginger). The illness recurred later. Wang observed the patient looking depressed, head down, and unwilling to speak, suspecting sexual misconduct. Upon asking if he had engaged in intercourse, the patient admitted to feeling heavy-headed and dim vision. Wang then administered Dajianzhong Wan (Great Construct Center Pills) three or four doses, causing external Yang to retreat inward, making the pulse sink and small, revealing Yin signs. He then gave pills containing Yi Han, Shaoyao, and Huixiang (Alpinia Oxyphylla) five or six doses. Within three days, approximately 600-700 pills were taken, and the pulse reappeared. He continued with Dajianzhong to consolidate, resulting in profuse sweating and recovery.

Hou Guohua suffered from Shanghan for four to five days, presenting with slight macules, thirst, and desire to drink. Wang Haizang palpated the pulse as deep, wiry, and nearly absent, characteristic of Jueyin Mai (Jueyin Pulse). After taking warming medicines for several days without improvement, he used Jiang (Ginger) and Fu (Aconite) to restore Yang and regenerate the pulse. Due to thirst, he privately drank a cup of water, causing the pulse to retreat again. He could only lift his head slightly and open his eyes. Inquiry revealed he had committed "Yin Yi" (Yin Exchange). Suspecting that Shaokui San (Burnt Underwear Powder) alone might be too cold and ineffective, Wang decocted a large bowl of Wuzhuyu Tang (Evodia Decoction), mixed in Shaokui San, and administered two doses consecutively. After two days and nights of profuse sweating, he recovered.

Zhang Luyu treated Feng Maozhi, who contracted Yin Yang Yi (Yin-Yang Exchange) in summer, presenting with lower back pain, acute tension in the lower abdomen, irritability, delirium, cyanotic-purple tongue coating, yellow thick coating in the center with swelling and cracks. Although thirsty for cold drinks, the tongue was not very dry. Pressing the epigastrium revealed hardness and pain, accompanied by belching and passing gas, indicating retained food stagnation. The concern was the empty and large pulses in all six positions, while the Chi pulses were wiry and rootless upon pressure. He prescribed Xiaoyao Tang (Free and Easy Wanderer Decoction) with added Rhubarb (Dahuang) for one dose, evacuating much black filth. After evacuation, all symptoms resolved, except for mild coldness and pain in the lower abdomen. He then gave one dose of Shaokui San, taken with Wuling San (Five-Ingredient Powder with Poria) decoction, leading to stability.

[Appendix] Fan Wang's Formula records: Former Inspector Gu Zixian fell ill, recovered but was not fully robust. He visited Hua Tuo for pulse diagnosis. Hua said: "Although recovered, you are still deficient and not fully restored. Yang Qi is insufficient. Do not engage in labor. General exertion is tolerable, but female labor (sexual intercourse) will cause death, manifesting as protruding tongue several inches long." Gu's wife heard of his recovery and traveled over a hundred li to visit him. After staying for several nights, they engaged in intercourse. One or two days later, Gu died. Chao Yuanfang's *Zhu Bing Yuan Hou Lun* (Source Book of Diseases and Syndromes) states: If a woman suffers from Shanghan and recovers within 100 days, her Qi, Blood, bones, and marrow are not yet solid. Engaging in intercourse at this time may not cause immediate discomfort, but after a few days, it leads to loose joints, weak meridians, deficient Qi and Blood, and empty marrow. Symptoms include恍惚 (mental confusion), weak breathing, dependence on others for daily activities, while eating remains normal. Men suffer similarly.

*Qian Jin Fang* states: If a woman suffers from Wenbing (Warm Disease) and recovers before full restoration, with unharmonized blood vessels and residual heat toxins, engaging in intercourse causes "Yin Yang Yi." Physician Zhang Miao reported a case where a maid, a few days after recovering from illness, was assaulted by six men; all six men died.

Yu Zhen notes: The two cases from Xu Xueshi Yingning are both Lao Fu, differing in deficiency and excess. The two cases from Wang Haizang are both Nu Lao Fu (Female Labor Relapse), but the second case's mention of "Fan Yin Yi" is erroneous. Observing Zhang Luyu's case together reveals differences in cold and heat. Yin Yang Yi and Nu Lao Fu share similar causes but different pathologies. "Yi" implies a healthy person acquiring disease from an infected person through exchange; residual pathogens enter via deficiency. Thus, Shaokui San guides pathogens out through their original route. "Fu" implies relapse when the body is still weak post-recovery. Nu Lao makes the weak even weaker, causing severe relapse and often death. If deficiency-cold signs appear, large doses of Renshen (Ginseng) and Fuzi (Prepared Aconite) can save life. If excess-heat or deficiency-heat signs appear, tonifying Yang is inappropriate, and nourishing Yin is urgent; survival is difficult. As described by Chao, this is Nu Lao Shang (Female Labor Injury), not Nu Lao Fu, with a slower progression. The maid of Zhang Miao did not die from the assaulters, but the assaulters died. This reflects Heaven's disgust for licentiousness, exceeding medical logic...