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For all chronic deficiency, extreme exhaustion, accompanied by coughing with expectoration, hemoptysis, and fever.

Black-beaked white duck (one) Large jujubes (two sheng) Shenling Pingwei San (one sheng) Aged boiled wine (one bottle)

Tie the duck's feet firmly first. Measure the amount of wine the patient can drink, warm the wine according to that amount, cut open the duck's neck, let the blood drip into the wine, stir evenly, and drink it. The medicinal power enters directly into the body. Fill the duck's stomach with the powder of Shenling Pingwei San until full, tie it tightly with hemp rope, place a clay pot, put the duck inside, and slow-roast around it with fire. Add aged wine three times, boil until the wine is dry. Then eat the jujubes, dry them in the shade, and take them at will with ginseng decoction. Afterwards, take Busui Dan, which will tonify marrow, generate fluids, harmonize blood, and smooth qi.

Shenling Pingwei San one sheng, large jujubes two sheng, one bottle of wine, one black-beaked white-feathered fat duck, prepare and serve according to the prescription.

Chen Xiuyuan's commentary: Deficiency lasting for a long time, extreme weakness and exhaustion, coupled with incessant coughing, causes the Lung to be increasingly disturbed due to coughing. Incessant expectoration further damages the Lung, which is treatable by herbal medicines. Therefore, use one black-beaked white duck as the sovereign drug. White feathers indicate a clear taste entering the Lung; a black beak indicates black bones entering the Kidney, taking the meaning of Metal generating Water, and also utilizing sentient beings of different species to tonify the body. Most ingeniously, add two sheng of large jujubes, taking their sweet and warm nature to tonify the Stomach. One sheng of Pingwei San takes its function of resolving stagnation and transforming Stomach Qi. The Stomach is the root of the five Zang and six Fu organs; if the Stomach is peaceful, all organs are peaceful. This shares the same meaning as Baozhen Tang supplemented with Houpo (Magnolia Bark). Ye Tianshi also penetrated the purport of this book, but his prescriptions were added according to symptoms, leading apprentices to compile cases where only one formula using Houpo was collected in the consumptive disease section. Perhaps those of average intelligence cannot be spoken to about higher principles, valuing the way without lightly transmitting it? Chen Xiuyuan differs from this.

For chronic consumption with weakness and exhaustion, dry marrow, exhausted essence, withered blood, and scanty qi, after recovery from decoction medicine, take this medicine.

Pig spinal cord (one strip) Sheep spinal cord (one strip) Soft-shelled turtle (one) Black-bone chicken (one)

Process these four ingredients cleanly, remove bones keeping the meat, cook thoroughly in a large bowl of wine in a clay urn, then pound finely. Use the following herbs next.

Large Chinese yam (five strips) Lotus seeds (half jin) Large jujubes (one hundred pieces) Frost persimmons (ten pieces)

Process these four ingredients cleanly, cook thoroughly in a large bottle of well water in a clay urn, then pound finely. Mix with the previously cooked meat, simmer over slow fire. Then gradually add Mincollagen (four liang) Beeswax (three liang).

Mix these two with the previous eight ingredients, grind into a paste, and mix with Pingwei San powder, Sijunzi Tang powder, and Zhimu Huangbai powder, each one liang. Form pills the size of paulownia seeds. Take one hundred pills per dose, at any time, washed down with jujube decoction.

Pig and sheep spinal cords, chicken, and soft-shelled turtle; boiling and pounding requires bone removal. Ten frost persimmons, one hundred large jujubes, eight liang of Jianlian lotus seeds, five strips of yam. Simmer the cooked mixture with gentle fire, gradually adding beeswax and collagen. Mix with powders of Zhimu, Huangbai, Sijunzi, and Pingwei San, one liang each, to form pills.

Chen Xiuyuan's commentary: For chronic consumption with weakness and exhaustion, dry marrow, and exhausted essence, after recovery from decoction medicine, taking this medicine addresses the post-recovery state of consumptive disease, planning a method not tested empirically. Initial doses may show slight effect, but prolonged use inevitably worsens the condition, leaving famous doctors helpless. However, medicine treats disease, food nourishes people. Penetrating these two phrases reveals profound wisdom. Having been ill for a long time, daily immersed in medicine, the intestines and stomach become like weeds replacing grain; what the gastrointestinal tract detests is medicine. To administer more medicine would be to burden it beyond endurance. The master uses Chinese yam, lotus seeds, large jujubes, and frost persimmons, selecting daily fruits and vegetables to please the spleen and stomach's temperament. Using pig marrow, sheep marrow, soft-shelled turtle, black-bone chicken, and beef glue, daily meat products, to fill the spleen and stomach's deficiency. This aligns with Bian Que's saying: "For damage to the spleen, regulate diet." And the *Neijing* saying: "For insufficiency of essence, tonify with flavor." Only the beeswax in the formula startles ordinary physicians. *Bencao Bei Yao* states that consuming this substance adheres to the intestines and stomach, causing persistent diarrhea. Weixi Wan uses melted beeswax for pills. Wang Jinshan annotated: Beeswax has a slow and astringent nature, possessing the power to reconnect severed parts and tonify marrow, specifically regulating depleted primal yang and sorting chaotic essence, making it a divine product for primal yang deficiency, seminal emission, turbid discharge, and leukorrhea. The harm caused by popularized materia medica is often like this. Moreover, this pill consists entirely of sentient flesh and bone products, warming and nourishing our qi and blood, vastly different from insentient herbs. Ye Tianshi used human milk powder, autumn stone frost, and burnt hair ash, introducing bodily lipids as a continuation strategy, also inspired by this formula. If Ziheche (placenta) is dirty and toxic, causing fever and loss of appetite upon ingestion, is it not bewitched by the theory of supplementing humans with humans, acting against reason and harming oneself? Note: Mingjiao (collagen) is made from tender, fatty yellow cowhide using river water, or by boiling beef, removing dregs, and boiling into a paste. Adding two liang of ginger-processed Banxia powder per jin creates Xiatiang Gao, treating consumption-induced chronic cough. In the Dingwei year of Qianlong, while studying at Aofeng Academy, my teacher Meng Ping'an said that when serving as Education Commissioner in Sichuan, he suffered from cough for months. Colleagues prepared gifts, but since he did not eat beef, he accepted gratefully but dared not taste it. Zhang You, an examiner in the office suffering from phlegm disease for over twenty years, liked it and tasted it. The collagen-phlegm formed clumps, expelled in large quantities, cured completely in half a month, with immediate improvement in physical strength. I record this to spread its transmission.

Wang Jiezai said: If one indulges excessively in sexual desire, damaging essence and blood, one must develop Yin deficiency with hyperactive fire. Symptoms include night sweats during sleep, midnight fever, hacking cough, and emaciation. This is called Laozai (consumption), the most severe and difficult to treat. Mild cases require dozens of doses; severe cases may take years. However, the patient must cherish life, strengthen resolve, abstain from sex, cease delusions, avoid anger, and regulate diet to cultivate their root internally. This is internal and external combined treatment, achieving complete success.

Pan's note: The ancient concept of Xu Lao (deficiency labor) refers to pure deficiency without Yang, opposite to recent cases of Yin deficiency with fire hyperactivity presenting with hematemesis and cough. Misuse leads to harm, which is fortunate.

Zhou's General Commentary: Reading these ten formulas, they are all unexpected. Their sequence and urgency can serve as a model for thousands of generations. Even if not all ten are used together, those treating blood disorders often modify Liuwei Dihuang Wan, hoping for efficacy, starting from *Yi Guan*, without experiencing the *Shen Shu*. When Kidney Water (Foot Shaoyin) is deficient, Fire flares up as a disaster. Strengthening the Master of Water can suppress excessive Yang. Who knows that among those suffering from this disease, Yin deficiency (Kidney) is indeed common, but other causes are also numerous. If contracted from labor and hunger/fullness, the injury is in Foot Taiyin (Spleen); from worry and grief, the injury is in Hand Shaoyin (Heart); from excessive drinking, the injury is in Hand Taiyin (Lung); from anger, the injury is in Foot Jueyin (Liver). These can lead to hematemesis, hemoptysis, and spitting blood. Can merely strengthening Water suffice? In short, blood in the human body travels attached to Qi. Injury to one Zang causes Qi imbalance, leading to blood overflowing outward. Thus, rebellion causes upward exit, sinking causes downward flow, stagnation causes obstruction and pain, cold causes coagulation, heat causes dispersion. This is the natural trend. Future scholars, during diagnosis and inquiry, do they weigh and grasp the true situation? If one focuses on this, observing which Zang is injured by the disease, which pulse position is damaged, and which season corresponds to the time, one has thought through more than half. I once treated a person with hemoptysis who worked extremely hard, always spitting small purple-black clots. It was definitely more after full meals, less after eating little, and none or very little after fasting. I treated him with Chive juice, child's urine, and processed Rhubarb. Two doses brought relief, followed by Buzhong Yiqi Tang added with blood-invigorating herbs, resulting in cure. Those who know consider it strange and absurd; I say it is extremely ordinary. Truly, I studied deeply from *Shen Shu* and treated *Yi Guan* as mere talk material.