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Xu Sun (Deficiency and Damage) is a syndrome that may progress from the upper jiao to the lower jiao. For instance, when Lung Qi is deficient and Wei Qi (Defensive Qi) is weak, external pathogens easily invade, damaging Qi and injuring the Lungs. Once the Lungs are injured, they lose their ability to control Liver Wood. In such cases, using Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) or Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) will further injure the Spleen and Stomach, aggravating the disease. Instead, one should use Sijunzi Tang (Four Gentlemen Decoction) or Baoyuan Tang (Preserve Origin Decoction) with modifications. Alternatively, Xu Sun may progress from the lower jiao to the upper jiao, caused by emotional depression or excessive sexual activity, leading to Essence depletion and Kidney injury. When the Kidneys are injured, Liver Wood becomes dry and generates Fire. This downward-to-upward pathology presents with symptoms such as flaccidity of the legs, dry mouth, and alternating chills and fever. At this stage, if one hastily administers Sijunzi Tang or Baoyuan Tang to tonify the Middle Jiao, it often causes stagnation and ignites Fire, worsening the condition. One should first use Liuwei Dihuang Wan or Jin Gui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet), followed by regulation with Baoyuan Tang or Baizhu San (Atractylodes Macrocephala Powder). However, Baizhu (Atractylodes Macrocephala Rhizome) and Baifuling (Poria with Atractylodes) have diuretic properties that can drain Yin fluids, so they must be used with caution. The critical link in both upward-to-downward and downward-to-upward damage lies in the Spleen and Stomach. If the Spleen and Stomach are injured, the condition is incurable; if they remain intact, even if various mixed syndromes appear, they are merely due to Deficient Fire. Therefore, one need not worry excessively about mixed syndromes or the duration of the illness; life and death, auspiciousness and misfortune, depend solely on the meridians of the Spleen and Stomach.

Generally, Xu Sun diseases involve hyperactive Mingmen Fire (Gate of Life Fire) and insufficient Kidney Water, with the Yangming Stomach channel transforming into Dryness-Fire. Since Liver Qi connects with Stomach Qi, strong Stomach Fire leads to strong Liver Fire. With dry Wood and parched Earth, Heart Fire flares upward, leaving Metal without nourishment and Water without generation. During this time of intense interaction among the Five Fires, using Huangbai (Phellodendron Bark) and Zhimu (Anemarrhena Rhizome) to nourish Yin and descend Fire is like pouring a cup of water onto a red-hot dry wok; it will only intensify the fire and cause the wok to shatter instantly! This is terrifying. If the pulse is slow and relaxed, it indicates that Stomach Qi has not yet perished, and regulation is still possible. Use Sijunzi Tang added with Shanyao (Dioscorea Rhizome) to guide the medicine into the Spleen meridian, specifically tonifying Spleen Yin. Then, treat according to accompanying symptoms. Once Spleen Qi becomes robust, it generates Lung Metal; Lung Metal then generates Kidney Water. As Water rises, Fire naturally descends, aligning with the treatment method of "Earth generating Metal and Metal generating Water." If the pulse appears short, rapid, tight, or fine-rapid, it signifies that Yuan Qi (Original Qi) and Pathogenic factors are mutually exclusive; victory for one means defeat for the other. Yuan Qi resides in the two Kidneys; in a static state, it manifests as Water, and in motion, it transforms into Fire. The Kidney is the mother of the Liver. When Yuan Qi is sufficient, Liver Wood supports the Heart Master, allowing Spirit (Shen) to emerge, facilitating transformation and nurturing, thus sustaining endless life. For those suffering from sexual exhaustion and hard labor, damage to Yuan Qi by the Seven Emotions and Six Desires leads to malnourishment of the Heart Spirit and hyperactivity of Ministerial Fire. This excessive Fire fails to generate Earth, thereby injuring Spleen Earth. Spleen injury results in insufficient Lung Metal Qi, which cannot pacify Liver Wood; conversely, Liver Wood overacts on Earth, injuring the Acquired Foundation. Insufficient Lung Metal Qi prevents the generation of Kidney Water, injuring the Congenital Foundation. When both foundations are injured, mutual nourishment ceases, the five Zang organs lose their generative functions, and Ministerial Fire ignites spontaneously. If Kidney Water is exhausted and cannot restrain Fire, death ensues; however, some cases are salvageable. If Stomach Qi remains, use medicinal force to nourish the Spleen and Stomach: Shengmai San (Generate Pulse Powder) added with Huangqi (Astragalus Root), assisted by herbs that generate fluids, or modified Baoyuan Tang. For tidal fever, specialize in Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); for blazing Fire, use Shengyang Sanhuo Tang (Raise Yang and Scatter Fire Decoction) to disperse it. If the Spleen is not treated, the five viscera's fires will fan each other, making the condition untreatable. For deficiency without diarrhea, tonify Qi within the Blood level using Baoyuan Tang plus herbs that nourish and descend. For diarrhea with fatigue and heat, tonify Blood within the Qi level using Baoyuan Tang and Sijunzi Tang added with Baishao (White Peony Root) and fried Songhua (Pine Pollen). For spontaneous sweating indicating Yang deficiency, add Fuzi (Prepared Aconite Root). For burning pain in the chest like knife cuts, use Sisheng Wan (Four Saints Pill) until pain subsides. For chronic diarrhea injuring the Kidneys, use Baoyuan Tang combined with Sishen Wan (Four Spirits Pill); for abdominal distension, combine Hezhong San (Harmonize the Middle Powder) with Buzhong Yiqi Tang. If the pulse is peaceful but the illness persists, the medicinal force has not yet reached its target; do not change the prescription. If the pulse becomes fine-rapid or tight-rapid, these are aberrant pathogenic pulses; if accompanied by vomiting, it is an ominous sign. Furthermore, loss of taste and lack of appetite should not be mistaken for Stomach Qi extinction; rather, it indicates Deficient Fire in the Stomach, requiring the generation of Original Yin Qi. Using drying herbs would be adding fire to fire, causing the Heart to lose its nourishment, resulting in an inability to benefit the lower from above or assist the upper from below, leaving the five Zang organs empty and dry. Using more drying herbs would lead to death. All things rely on the Spleen for growth; once Spleen Qi is injured, the nine orifices become blocked, and various diseases arise. If treatment fails, one must investigate the Spleen and Stomach to avoid error.

Chronic Xu Sun diseases all injure the Spleen. Spleen injury affects the Lungs first; Lung disease impairs the control of the whole body; Spleen disease renders the limbs useless. One must nourish Stomach Qi. Nourishing the Stomach does not mean promoting appetite, but fostering a generating Qi to sustain the source of biological transformation. "Nourishing" primarily involves preserving Yuan Qi, assisted by warming methods. Hyperactive Fire indicates Blood deficiency; use Shiquan Dabu Tang (Ten Substance Great Tonification Decoction) with modifications. However, for Xu Sun originating from malaria, dysentery, vomiting, or diarrhea, even if complications arise, treat only from the perspective of the Spleen and Stomach, using Baoyuan Tang combined with herbs that warm the Spleen and Blood. Even with mixed syndromes, if Fire is hyperactive, do not treat the Fire; if Phlegm exists, do not treat the Phlegm directly. Instead, use Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) with modifications. Add Paogjiang (Processed Ginger) for vomiting; add YiZhiRen (Alpinia Oxyphylla Fruit) and Wuzhuyu (Evodia Fruit) for waist and abdominal pain, also suitable for abdominal pain and distension; add Shenqu (Medicated Leaven) for belching. Generally, chronic diseases center on Heart Fire, as Fire is the origin of life maintenance. Moreover, acute illnesses should be treated slowly; aggressive attack scatters Zheng Qi (Upright Qi). The classics state: treating with highly toxic herbs removes two or three parts of ten; with moderately toxic herbs, five parts; with non-toxic herbs, eight or nine parts. The remainder is nourished by food and grain.

Xu Sun arises from internal injury, initially due to irregular diet, physical overexertion, and sexual excess. Early stages resemble external contraction. External contraction presents with headache, fever, aversion to cold, and a floating, tight, forceful pulse, requiring diaphoresis (sweating therapy). If it moves from exterior to interior, presenting with a surging pulse and dry stool, purgation is indicated. Internal injury also causes headache, but the pain is mild; fever and aversion to cold occur with a tight, rapid, and forceless pulse. Treat with Buzhong Yiqi Tang added to Qianghuo (Notopterygium Rhizome) and Fangfeng (Saposhnikovia Root). This is "releasing the exterior without sweating." If sweating is excessive, sweat stops at the neck, occurring once daily, resembling malaria or dysentery. Treating it as malaria or dysentery will worsen the fever, mimicking Shanghan (Cold Damage). However, Shanghan has a surging, forceful pulse, whereas internal injury has a hollow, surging-like but forceless pulse. Using cooling diaphoretics or purgatives severely damages the Spleen and Stomach, inevitably depleting the Lungs, adding cough, expectoration, and hemoptysis. Treating it as Yin deficiency with hyperactive Fire further injures the Spleen and Stomach. Mixed syndromes vary; tidal fever resembling malaria is due to盛 Spleen Fire and insufficient Spleen Yin, a condition of Blood exhaustion. Nourishing Yin is inappropriate; saving Yin is key. Yin generates from Yang, and Yang grows from Yin. Use Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Lianzi (Lotus Seed), etc. Add Huangqi for excessive sweating; add Rougui (Cinnamon Bark) for aversion to cold (contraindicated in hemoptysis). If diarrhea persists despite various medicines, and the Stomach is too weak to accept medication, use three qian of aged cured meat bone ash and three qian of scorched rice crust, mixed with one qian of fried pine pollen, formed into pills with rice paste. Take 60-70 pills washed down with decoction made from Renshen, adjusted according to severity and deficiency/excess. This method is often effective.

Case Record
A woman suffered from hemoptysis and fever. Her fever was severe with panting. After using Shengmai San, her fever worsened. Her pulse varied between large, small, floating, rapid, wiry, and choppy, changing unpredictably. This indicated Spleen Yin deficiency and deceptive pulse signs. The pulse is the residence of Blood; the Spleen governs Blood. Blood exhaustion causes unpredictable pulse variations. Prescribed Baoyuan Tang added with Wuweizi (Schisandra Berry), Shanyao, Gouqi (Goji Berry), and Baifuling. Used a heavy dose of Renshen, five qian. Effective after two doses; cured after twenty doses.