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Zhu Danxi said: After people reach the ages of sixty or seventy, their Jing (Essence) and Xue (Blood) are both exhausted. Even when at rest and free from illness, they often present with heat syndromes. Why is this? Symptoms include a drooping head and dizzy eyes, itchy skin, frequent urination, runny nose, falling teeth, excessive saliva, reduced sleep, weak legs, deafness, forgetfulness, dizziness, dry intestines, dirty complexion, white hair, blurred vision, sudden sleepiness after sitting for long periods, feeling cold before the wind blows, easy hunger after eating, and easy tearing when laughing. These symptoms are invariably present in old age. Some say: The *Ju Fang* (Formulas of the Bureau of Medical Relief) uses many formulas containing Wutou (Aconiti Lateralis Radix Praeparata) and Fuzi (Aconiti Radix Praeparata), which seem suitable for the elderly. Is it not because the elderly have weak Qi and deficiency-cold in the lower Jiao, making warming and tonification appropriate? Now that all these are considered heat syndromes, should Wutou and Fuzi formulas never be used on the elderly? I reply: It is not just Wutou, Fuzi, and pill preparations that should not be given recklessly; one must also be cautious with heavy drinking, fatty meats, wet noodles, meat broths, roasted, baked, and fried foods, as well as spicy and sweet, slippery foods. Others ask: Sweet and delicious foods to nourish the elderly are prescribed in the classics. If children or daughters-in-law fail in this, filial piety is compromised. Your words seem to contradict this. How can you reconcile this? I say: This is what is meant by "the Way proceeds without contradiction." Let me explain in detail. In ancient times, when the Well-Field System was implemented, local education flourished. People knew propriety and courtesy, and every household could be commended. Meat was not provided to the young or strong; only those over fifty ate meat. At that time, people had abundant and harmonious Qi and Blood, firm sinews and bones, and clear, thick stomachs and intestines. Using sweet delicacies to nourish the elderly did not cause disease. Today, however, it is different. The young eat meat, and the strong indulge gluttonously. By the time they reach fifty, diseases have already arisen. Qi is exhausted, Blood is depleted, sinews are soft, bones are brittle, stomachs and intestines are obstructed, and saliva overflows. Moreover, human Yin is hard to build but easy to lose. After sixty or seventy, Yin is insufficient to control Yang, and solitary Yang nearly flies away. Fortunately, innate Stomach Qi remains, and it relies on the Yin of food and drink to stay anchored. All the symptoms mentioned above are due to Blood deficiency. The *Neijing* states: "The Kidney dislikes dryness." Are Wutou, Fuzi, and pill preparations not drying? For those with Blood deficiency, even drying herbs like Fangfeng (Saposhnikoviae Radix), Banxia (Pinelliae Rhizoma), Cangzhu (Atractylodis Rhizoma), and Xiangfu (Cyperi Rhizoma) should not be used in large doses, let alone Wutou, Fuzi, and pills. Others ask: The entire *Ju Fang* consists of warm and hot Yang-nourishing formulas. Are your words not absurd? I say: The *Ju Fang* uses drying agents to attack Dampness; Dampness dissipates when met with dryness. It uses warming agents to tonify Deficiency; tonifying the Spleen is better than tonifying the Kidney directly, as warmth facilitates transformation and appetite, allowing temporary lower Jiao deficiency to recover somewhat. The treatment principles in the *Neijing* also permit the use of attacking methods, which is exactly this meaning. These are designed for those with dense constitutions and superficial diseases. This is akin to the Confucian concept of expedience. If treated as a constant method, would it not be a great error? The elderly, although having dense constitutions, are now approaching thinness; although diseases are superficial, their root causes are prone to flare up. Can attacking drugs be used to seek long-term effects? Those who are fat have more Blood; those who are thin have robust Qi. Occasionally, attacking methods may be suitable, but if mishandled, how can the damage be remedied? I prefer to be slightly delayed to ensure absolute safety. Is this not better? It is clear that Wutou, Fuzi, and pills should not be tried lightly. Diet requires even greater caution. The elderly have internal deficiency and weak Spleen, Yin deficiency and irritable temper. Internal deficiency leads to Stomach Heat, causing easy hunger and desire to eat; weak Spleen fails to transform food, leading to recurring hunger after eating. Yin deficiency fails to descend, causing Qi stagnation and Phlegm formation. Consequently, hearing, seeing, speaking, and moving become sluggish, dissatisfaction arises easily, and anger flares up. Even filial sons and grandsons may feel frustrated, let alone those who are not filial. Therefore, hot-natured foods, charcoal-processed foods, pungent-spicy aromas, and sweet-greasy tastes should definitely be avoided. Although those with firm stomachs and intestines and robust Spirit may tolerate indulgence, satisfying the mouth brings temporary pleasure but long-term harm. Thus, more is worse than less, less is worse than none. Palatable foods cause many diseases; rich flavors are like poison. The maxims of former sages are still heard; can we not be cautious? Someone asks: According to your words, you essentially deny these foods to the elderly. Are you comfortable with this? I say: The gentleman loves others through virtue; the petty person loves others through indulgence. How much more so for those respected! Food and drink should be used to nourish life, not to cause disease. If what nourishes becomes harmful, it is not the filial piety and respect advocated by gentlemen. So what should be done? Responding: Loving life and hating death, loving peace and hating illness, are common human emotions. Children and grandchildren must first inform them of righteousness, explain the nature of substances, use analogies, state pros and cons, speak sincerely and firmly, and act with reverence and caution. Secondly, lead by example. They will surely be moved and resist no longer. Denying food is most filial when the elder is ill. When healthy, judge carefully and administer appropriately. Substituting one food for another does not harm filial piety. However, if there is no prior guidance during idle talk, and hunger strikes, cravings arise, and delicious food is presented, how can it be resisted? The *Neijing* says: "Nourish through diet." The character "Zhong" (Middle/Center) likely aligns with this meaning; do not overlook it. I agree. The medical classic *Neijing* states: "The wonder of Yin and Yang is infinite; creation stems from this." Qin Yueran elaborated on the Eighty-One Difficulties, deriving only a fraction from the *Neijing*. Zhang Zhongjing selected the section on Cold Damage. Liu Wansu changed Zhang's methods based on Heat Theory. Li Dongyuan established theories based on Diet and Fatigue. Books preceding Zhang Zhongjing focused on Cold Damage, risking misdiagnosing Internal Injury as External Contraction. Books preceding Li Dongyuan focused on Stomach Qi, risking misdiagnosing External Contraction as Internal Injury. Books preceding Liu Wansu focused on Heat, risking misdiagnosing Cold as Heat. It is better to prioritize the *Neijing*, ensuring natural vitality. Some say: Modern doctors diagnose using only the *Mai Jue* (Pulse Instructions) and treat using various formula books, which seems simple. You teach reading the *Neijing*; although one understands diseases, there are no specific formulas. The *Mai Jing* (Pulse Classic) has thousands of threads, hard to search. I reply: Human life is precious. Without years of accumulation, how can one casually treat others' illnesses? Former scholars established theories and formulas; some aligned with the *Neijing*, some were forced, some biased, some based on patient deficiency/excess, constitution, Qi, pulse, and symptoms. Diseases vary infinitely; human forms, minds, joys, and sorrows differ; geographical suitability varies; similar symptoms require different treatments. Without reading the *Neijing*, treating based solely on formula books risks fatal errors. Though others may not know, can one's conscience be at peace? Pulse theory is subtle, understanding Yin-Yang and creation, changing endlessly. Even sages discuss its beginnings and hide its depths. A skilled pulse-taker deduces further. Can Gao Yangsheng's few sentences in the *Mai Jue* exhaust infinite diseases? This is the model for medicine. Those serving parents should know medicine, but also understand the seriousness of the profession. If the doctor is good, parental illness can be entrusted. Sima Guang said: When parents are ill, one should focus on inviting doctors, verifying formulas, and preparing medicines. Is knowing medicine not a child's duty? Cheng Yi said: Leaving a sick parent in bed to an incompetent doctor is worse than being unfilial. Those serving parents must know medicine. Entrusting to incompetent doctors shows ignorance of medicine's gravity. Alas! Medicine and pharmacy cannot be handled carelessly. These two gentlemen's words are well-founded.
Elderly people often have chronic diseases. Accumulated Qi attacks, causing mental fatigue and triggering old ailments. Having endured winter, sitting by stoves, warming quilts, eating roasted meat, and drinking hot liquids, spring accumulations erupt, causing body heat, dizziness, chest oppression, salivation, limb fatigue, and inability to bear weight on waist and legs. These are diseases arising from natural aging. One should monitor conditions; if minor illness occurs, avoid purgative or draining methods to prevent damaging Zang-Fu organs and causing other diseases. Use only drugs to resolve accumulation, harmonize Qi, cool the chest, and transform Phlegm.
In summer, the elderly should especially preserve and support themselves. Avoid cooling oneself under eaves, through cracks, or broken windows, as this is "Thief Wind," which strikes violently. Stay in airy halls, quiet rooms, near water, in tree shade, and clean places, where coolness is natural. Each morning, take a dose of warm, neutral Qi-warming decoction or powder. Eat warm, soft food, not too full, but frequently. For thirst, drink warm millet water or cardamom hot water; raw, cold, fatty, and greasy foods must be strictly avoided. Because the elderly have weak Qi, in summer, Yin is retained internally. An abdomen with weak Yin facing cold, fatty food often results in diarrhea. Once True Qi is damaged, it is hard to restore quickly. For elderly with weak Qi, after Summer Solstice, taking three to twenty doses of non-drying, kidney-tonifying, warming medicines like Congrong Wan (Cistanche Pill) or Bawei Wan (Eight-Ingredient Pill) is acceptable to assist Yuan Qi (Original Qi).
Winter is best for nursing the elderly in a sealed room. Keep bedding and clothes warm and clean, regulate diet, and adapt to temperature changes. On very cold days, occasionally drink a cup of Yam Wine or meat broth to support weakness and ward off cold. Do not travel far or expose oneself to severe winds, as elderly Qi and Blood are deficient, and True Yang Qi is scarce. Contracting cold pathogens easily causes illness, often manifesting as cough, asthma, numbness, paralysis, or dizziness.
Roasted, fried, and dry-toxic foods must be strictly avoided. Eating such hot, dry foods often causes obstruction, phlegm-cough, and throat/eye diseases. Bathing is also inadvisable. When Yang Qi is stored internally, hot baths force excessive sweating. Elderly people have diffusing Yang Qi and thin bones/flesh, making them susceptible to external injuries. Sleep early and rise late to avoid frost. In the morning, consume a little strong wine, then porridge. Before bed, take a dose of Spleen-quickening and digestive medicine.