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[Background Information]
Book: *Gujin Yi An An* (Annotations on Medical Cases Ancient and Modern)
Author: Yu Zhen
Dynasty: Qing
Chapter: Lao Zhai (Consumption/Tuberculosis)
Category: Medical Discussion

[English Translation]

The *Benshi Fang* records that during the Xuanhe era of Emperor Huizong of Song, a Daoist priest at Tianqing Temple practiced the "Kaozhao" method (a Daoist exorcism ritual) with extreme rigor. At that time, a woman submitted a petition requesting treatment for her illness. The priest summoned the malevolent spirit, which said, "It is not I who cause harm, but another ghost, which also becomes a nuisance because the patient's life force is declining." It has now taken form, transforming into a worm within the patient's lung, devouring the lung system, thus causing hemoptysis (coughing up blood) and hoarseness. The priest whipped the ghost and asked, "Does this worm have any fears or taboos?" After a long silence, upon being whipped again, it replied after a while, "It only fears otter claws ground into powder, taken with wine to eliminate it." The patient's family followed his advice, and the illness was cured. This is something I witnessed with my own eyes. Otter claws share the same principle as the treatment for "Guizhu" (a contagious chronic wasting disease) in the *Zhouhou Beiji Fang*, which uses one whole liver of an otter, dried in the shade and pounded into powder, taken once per dose daily three times.

[Appendix] Shen Rou treated a young woman who presented with alternating chills and fever, night sweats, cough, dreams of sexual intercourse with ghosts, low spirits, and muteness, unaware of her own suffering. He asked her to open her mouth and observed white spots, stating, "This is worms eroding the lungs." He urgently sought otter liver for treatment, but the family did not believe him. She eventually expectorated pus and died. Later, it was heard that her three brothers all died young from this same condition. Generally, for chronic cough, one should examine the lips; if there are spots on the upper lip, the worms erode the upper part; if on the lower lip, they erode the lower part.

Li Ying, a Military Commander (Wu Jie Lang) from Yuanzhou, had three children. His eldest son purchased a house that had been vacant for a long time with no residents. Upon entering, he suddenly felt palpitations and severe coldness in his back, developing into a consumption disease (Lao Zhai), nearly dying. The illness passed to his second daughter. After the eldest son died, the daughter's condition became critical, and it then passed to the third son, presenting identical symptoms. Li Ying was terrified and offered noodles and rice daily to wandering Daoists, hoping to meet a miraculous person. One day, visiting Kaiyuan Temple, he met a man dressed in secular clothes claiming to be a poor Daoist. Addressing him by his official title "Tuanlian," the man said he heard the household suffered from contagious corpse-transmitting consumption and offered a prescription. Li Ying invited him to eat, but he declined. Li Ying offered money, which he refused. Li Ying compelled him to take medicine, resulting in severe diarrhea and the expulsion of seven worms. They were red like meat, about one cun long, and 7-8 fen wide, sharp at the front and square at the back, with a mouth near the front of the abdomen. They had feet resembling fish bones, thin as needles, sharp and curved, and already dead. Iron chopsticks could not pierce them. Li Ying burned them, and the fever subsided immediately. Another dose expelled four smaller worms, after which he recovered. The prescription used: Tianlinggai (Human Skull Cap) 3 qian, fried in butter until yellow; Tiger feces containing bone 1 qian (human bone is best, animal bone is secondary, bone from tiger intestines is also usable); fried in butter with a small amount of green snake brain until the color changes (if no green snake brain, butter frying alone is acceptable); Biejia (Turtle Shell) large pieces, fried in butter until yellow, 1 liang (nine-ribbed shells are superior); Anxi Xiang (Benzoin) half liang; Taoren (Peach Kernel) one piece, peeled and pitted. All above are powdered. Additionally, Qinghao (Artemisia Annua L.) tips, 4 cun, finely chopped, 6 liang; Chishao (Fermented Soybeans) 300 grains; Congbai (Scallion White) 21 stalks; Peach, Plum, Willow, and Mulberry branches growing eastward, 7 stalks each, thickness of chopsticks, length 7 cun, finely chopped; Fengye (Maple Leaf) 21 pieces; Tongbian (Child's Urine) 1 sheng; Water 3 sheng. Decoct to 1 sheng, strain, add the previous powders, decoct again to half a sheng, strain. Separate Binglang (Areca Seed) one piece and Shexiang (Musk) 1 qian, grind to fine powder, mix into the decoction. Take warm in the morning, cover with blankets to induce sweating. Wipe sweat with cloth and burn it immediately to prevent tiny worms from surviving. Diarrhea will follow, expelling worms. If alive, burn fiercely and discard in flowing water. The patient must not know the medication, nor later. After more than ten days, vitality returns. Take another dose, burning/discarding as before, until no worms appear. If the patient is not critical, this can bring peace; if critical, wait until near death, then let the next infected child take it to prevent future transmission.

Yu Zhen comments: "Chuanshi Lao" (Contagious Consumption) existed in ancient times by name, but is rarely seen today. Even when fathers, sons, and brothers in one family die sequentially from consumption, it is due to weak constitution and depletion of Qi and Blood, not caused by "consumption worms." Xu Shi's *Yitong* and Wang Shi's *Zhunsheng* record this in detail, drawing pictures of the worms. Shen Rou's *Wushu* exaggerates this theory, prescribing formulas like Wufeng Wan, Leigong Wan, Ziheche Wan, and Tianlinggai San, along with methods like papering the patient's room, servants smearing Anxi Xiang on their bodies, and Xionghuang (Realgar) around the mouth, ears, eyes, and nose. These are largely apocryphal and should not be strictly adhered to. This is similar to stories in *Jishen Zhi* where families bury living patients in coffins to stop contagion, only to find survivors later. Such tales led to the belief that eels cure consumption, yet efficacy is never proven. Other alchemical prescriptions include Gypsum, Peach Kernels, Sichuan Pepper (Chuanjiao) 2 jin from Shenshou San, or pig kidneys stewed with child's urine and wine. These are for reference but efficacy is uncertain. Only Zhu Danxi's case of treating Liu's brother from Linhai, who had chronic cough, hemoptysis, fever, and emaciation, mistaken for consumption and unresponsive to hundreds of remedies, stands out. Zhu diagnosed a wiry and rapid pulse, worse at night, and cured him using Daocang Fa (Meat Purging Method). He fathered a son the next year. This demonstrates true medical mastery, unlike Cui Shi's moxibustion at Sihua acupoints or at Yaoyan acupoints at 2 AM on Guihai nights.

Sun Dongsu treated the wife of Cheng Daowu, who was startled by nightmares nightly, frequently fainted, had erratic spirit, coughed, had a bluish complexion, and refused food, eating only a few slices of beef jerky daily. Previous doctors failed. Wu Bohai attributed it to Cold Phlegm causing Jue syndrome, administering Fuzi (Aconite Root) and Guizhi (Cinnamon Twig), worsening the Jue. Sun diagnosed a wiry left pulse, slippery right pulse, and slightly short both Cun pulses. Knowing two previous wives of Daowu died of consumption, he identified this as Chuanshi Zhai (Contagious Consumption), difficult to treat. He initially used tonifying and spirit-strengthening herbs to regulate diet and restore Stomach Qi before direct treatment. He used Renshen (Ginseng), Fuling (Poria), Baiziren (Biota Seed), Shichangpu (Acorus), Yuanzhi (Polygala), Danshen (Salvia), Danggui (Angelica Sinensis), Shihu (Dendrobium) to tonify spirit; added Chenpi (Tangerine Peel), Beimu (Fritillaria), Gancao (Licorice), Ziwan (Aster) to resolve phlegm and stop cough. After half a month with no progress, he formulated Taishang Hunyuan Dan: Ziheche (Placenta) one unit, Chensha (Cinnabar), Biejia (Turtle Shell), Xijiao (Rhinoceros Horn) each 1 liang; Lujiaojiao (Deer Antler Glue), Zishiying (Hematite), Shihu each 8 qian; Chenxiang (Agarwood), Rushiang (Frankincense), Anxi Xiang (Benzoin), Fuling (Poria), Ziwan (Aster), Niuxi (Achyranthes) each 5 qian; Shexiang (Musk) 5 fen. Honey-pilled size of adzuki beans. Take 36 pills morning and evening with salt water or wine. Also formulated Pili Chulai Dan: Niuhuang (Calculus Bovis), Goubao (Dog Gallstone),awei (Asafoetida), Anxi Xiang each 1 qian; Hutougu (Tiger Skull Bone) 5 qian; Woodpecker 1; Tazhao (Otter Claw) 1; Baiguxin (Old Drum Heart Skin) 3 qian; Shexiang (Musk) 5 fen; Tianlinggai (Human Skull Cap) 1, fried in butter. Honey-pilled, coated with 3 qian Xionghuang (Realgar). Take 5 fen at 5 AM on an empty stomach with Scallion White decoction, every 3-5 days, combined with Taishang Hunyuan Dan. After half a month, spirit improved significantly, no longer erratic. Slight pain in lower left abdomen required adding Baishao (White Peony Root) 1 qian to previous decoction. After one month, spirit greatly improved, fainting ceased. She gave birth to a daughter the next year, and the household's consumption contagion stopped.

Yu Zhen comments: This case and formula are more miraculous and better than the one given by the Daoist from Yuanzhou. The latter focused solely on killing worms; this one kills worms while penetrating meridians, searching for pathogens, and tonifying deficiency.

Yu Jiayan treated Yang Jideng's second daughter, who had reduced appetite, emaciation, and excessive sweating. During diagnosis, he saw muscle twitching and tremors, fatigue, and weak Qi. He stated, "This is a sign of great fright and great deficiency, requiring warming and tonification," adding Fushen (Poria with Hostwood) and Zaoren (Ziziphus Seed). However, after over ten doses, there was no effect. Yu hesitated and blamed himself: "Not external contraction, not internal injury. Sweating and trembling without rest, tolerating tonics without change. A maiden in the inner quarters with no family disaster, yet her demeanor resembles post-mourning exhaustion. Why?" Suddenly realizing, "This must be a disease of evil spirits." Asking about her complexion, she said it fluctuated between red and yellow. Regarding accompanying symptoms, she said every night when sleeping, she drooled white foam, trembled, and lost consciousness, reviving only after prolonged administration of Ginger Decoction. Lighting lamps to guard against it didn't help. Fearful of rumors from the husband's family, she hadn't disclosed this. Yu said, "Why not say so earlier? You would have healed sooner." He prescribed Xijiao (Rhinoceros Horn), Lingyangjiao (Antelope Horn), Longchi (Dragon Teeth), Huweigu (Tiger Power Bone), Muli Fen (Oyster Shell Powder), Lujiashuang (Deer Antler Frost), Renshen (Ginseng), Huangqi (Astragalus), etc., powdered. Decocted 0.5 jin of mutton to get 3 cups of thick broth, mixed with the powder, taken at once. She slept peacefully and never relapsed. It was rumored as miraculous. Evil spirits attach to the body, conflicting with human Qi, causing discomfort with no exit. Thus, spiritual relics were used, guided by the pungency of mutton, to transfer the evil to bones/horns, exiting via stool. This imitates ancient practices of transferring essence and changing Qi, fulfilling their meaning.

Yu Zhen comments: This case's annotation of formulas and explanation of syndromes reaches the hall of Xuanyuan and Qibo. The subsequent case balances ancient and modern, worthy of Bian Que's seat.

Xiong Zhongshu's young son had a strange symptom in childhood: normal diet, but fine pulse, dull spirit, depleted Qi, and premature aging appearance. Zhongshu asked Jiayan, "What disease is this?" Jiayan replied, "The disease is named 'Shihui'. As mentioned in *Zuo Zhuan*, 'approaching women leads to Shihui' refers to this. That person approached women and encountered Shihui, hence incurable. Your son encountered Shihui邪 (pathogen) but did not approach women, so it is treatable." He used the previous formula with minor addition of Niuhuang (Calculus Bovis), bringing peace.

[Appendix] Huang Shiwen treated a woman bedridden for nearly three years, resembling consumption, unresponsive to deficiency treatments. Huang diagnosed, "This is eating yin substances while being startled." Upon inquiry, she realized: "When eating rice dumplings, I was suddenly told my husband fell into water. Startled then, the illness persisted." Huang gave Qingmuxiang Wan (Magnolia Bark Pill) with purgatives. Soon, a mass was expelled, revealing a rice dumpling wrapped in phlegm. The shock kept it lodged unconsciously. She recovered healthily thereafter.

Yu Zhen comments: This case lacks pulse data, making it hard to emulate. A phlegm-wrapped dumpling in the abdomen should present as a mass, possibly painful, distended, or moving, yet none are mentioned. What is the basis? Perhaps skilled physicians diagnose beyond superficial appearances, like Bo Le judging horses beyond gender or color.

[Appendix] The son of the You family in Wuxi indulged in alcohol and lust, falling ill which worsened over time. He told his family, "I often see two women in gorgeous dress, only 3-4 cun tall, walking along my legs, disappearing at my waist." Family thought it was spirits. A doctor examined and said, "These are Kidney Spirits. When Kidney Qi is exhausted, spirits do not reside in their mansion, so the patient sees them."

Yu Zhen comments: This serves as a warning for those addicted to lust. Life originates in the Kidneys; diseases often originate in the Kidneys. The Kidneys are the root of life. How can one indulge in desires leading to death?