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(Tianshi revised)

According to the *Neijing* (Classic of Internal Medicine), the discussion on Xu Lao (Deficiency and Emaciation Syndrome) involves only two aspects: Qi (Vital Energy) and Blood. It was not until the *Chao Shi Bing Yuan* (Source of Diseases by Chao Yuanfang) that the concept began to differentiate between the Five Zang Organs' deficiency, injuries from Seven Emotions, and even mentioned Liu Ji (Six Extremes) and San Shi Er Zheng (Thirty-two Steaming Syndromes). The *Benshi Fang* (Formulas of Ability) further categorized them into Chuan Shi (Transmissible Corpse Disease) and Gui Zhu (Ghost Tethering), totaling ninety-nine types. These theories are fabricated and far-fetched, repetitive and redundant, which need not be discussed. Moreover, they confuse learners with too many divergent paths; whose fault is this? Essentially, taking the *Neijing* as the standard, focusing solely on the Spleen and Kidney to govern Qi and Blood respectively is concise, comprehensive, accurate, and practicable.

Human deficiency either belongs to Qi or to Blood; the Five Zang and Six Fu organs cannot exist outside this framework. The reason for emphasizing the Spleen and Kidney alone is that Water is the origin of all things, and Earth is the mother of all things. If these two organs are harmonious and peaceful, the whole body is regulated, and a hundred diseases do not arise. The Spleen possesses the virtue of Earth; when the Spleen is at peace, Earth becomes like golden elixir (a solid foundation). Metal is substantial and Water is deep; furthermore, Earth does not encroach upon Water, allowing Water to remain in its proper position. Thus, when the Spleen is at peace, the Kidney is even more at peace. The Kidney encompasses both Water and Fire; when the Kidney is at peace, Fire does not carry Liver Qi upward to overwhelm the Spleen Earth causing dampness. Fire can benefit Spleen Earth, promoting transportation and transformation into essence and nutrients. Thus, when the Kidney is at peace, the Spleen is even more at peace. Sun Simiao said, "Tonifying the Spleen is not as good as tonifying the Kidney." Scholar Xu said, "Tonifying the Kidney is not as good as tonifying the Spleen." Both masters deeply understood that these two organs are the root of human life, and also knew that they have a mutually assisting function. Therefore, their statements seem contradictory, but their intent is actually the same.

To treat the Kidney, one must base it on Yin Blood. Blood provides nourishment; Blood belongs to Yin and tends to descend. When deficient, it may float upward, requiring consolidation and suppression; Liu Wei Wan (Six-Ingredient Pill with Rehmannia) is an example. To treat the Spleen, one must base it on Yang Qi. Qi provides warmth; Qi belongs to Yang and tends to ascend. When deficient, it may sink downward, requiring lifting and raising; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is an example.

In recent times, treating Xu Lao has focused exclusively on Si Wu Tang (Four Substance Decoction) added with Zhi Mu (Anemarrhenae Rhizoma) and Huang Bai (Phellodendri Cortex). They fail to realize that blood-tonifying herbs are often cloying and stagnating, unsuitable for those with excessive phlegm and poor appetite; blood-tonifying herbs are often moistening, and long-term use inevitably leads to loose stools. Furthermore, Zhi Mu and Huang Bai are bitter and cold, capable of draining excess fire. Although named "nourishing Yin," they are actually drying and damaging to blood. Bitterness enters the Heart first; prolonged use increases Heart Qi, potentially aiding fire. Their damage to the Stomach goes without saying. Danxi stated that excess fire can be drained, while deficient fire should be supplemented. Is the fire in Xu Lao deficiency or excess? Can it be drained? Those who overcorrect frequently use Rou Gui (Cinnamomi Cortex) and Fu Zi (Aconiti Lateralis Radix Preparata) as daily staples; this is suitable only for those with deficient fire. For individuals with dry and excess Qi and Blood, would this not aid fire and cause harm?

Generally, Xu Lao cases present many difficulties. For instance, tonifying the Spleen and Lung should ideally be done concurrently. However, the Spleen prefers warm and dry properties, while the Lung prefers clear and moist properties. Nourishing the Lung hinders the Spleen, and tonifying the Spleen hinders the Lung. Only in cases of severe heat and dryness, where the patient eats well but does not have diarrhea, is nourishing the Lung urgent, though Spleen-tonifying herbs should not be neglected. Conversely, if the patient is severely emaciated with poor appetite and frequent diarrhea, even if wheezing and coughing are restless, tonifying the Spleen should be the priority, and Lung-nourishing herbs should be avoided. It is common to see deaths from Xu Lao due to diarrhea. The cause of such diarrhea is often the use of clearing and moistening herbs. Physicians should certainly be vigilant about this. Similarly, tonifying the Kidney and Spleen should be done concurrently. However, when intending to use sweet and cold herbs to tonify the Kidney, one worries about reduced appetite harming the Spleen; when intending to use acrid and warm herbs to invigorate the Spleen, one worries about consuming Yin and Yang, further depleting Kidney Water. After careful consideration, prioritizing the Spleen is justified because Spleen Earth communicates upward with the Heart and downward with the Kidney. If the Kidney is severely deficient and the condition is critical, one must not be rigid but should adapt flexibly according to circumstances. Former sages said, "When Earth is prosperous, Metal is generated; do not rigidly focus on protecting the Lung. When Water is strong, Fire is extinguished; do not anxiously focus on clearing the Heart." This demonstrates a thorough understanding of the *Neijing*'s principles and a deep insight into fundamental treatment.