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The previous physician invited Shiwan (Zhang Lu's courtesy name) to join him for the consultation. Upon examining the patient, he found the Qi Kou pulse (pulse at the radial artery corresponding to the lungs and spleen/stomach) to be deficient, choppy, and irregular. The pulses on the left side were all wiry and faint, with the Chi position (corresponding to the kidneys) being particularly faint. He prescribed Huangqi Jianzhong Tang (Astragalus Decoction to Establish the Middle) with added Danggui (Angelica sinensis) and Xixin (Asarum). The previous physician said, "In deficiency consumption with blood loss, why not use yin-nourishing and fire-descending herbs? Why use acrid-warm and drying agents?" I replied, "Not so. The formation of deficiency consumption does not necessarily stem from fundamental deficiency. Generally, it is often caused by erroneous medication. Now that the disease is about to develop into consumption, while the root is not yet firmly established, we must urgently use acrid-warm herbs to raise the yang qi. This may hopefully rectify the previous mistakes. If we continue to use yin-nourishing (cool/cold) herbs, the yin will become even more hyperactive, and the blood will flow upward even more recklessly." Since ancient times, no method has been superior to those in *Jinkui Yaolue* (Essential Prescriptions from the Golden Cabinet) for treating consumption. For example, for deficiency consumption with abdominal tightness and various insufficiencies, using Huangqi Jianzhong Tang has its classical precedent. Even symptoms such as abdominal pain, palpitations, and epistaxis do not fall outside this scope. Furthermore, incorporating the principle of internal supplementation and middle-jiao establishment, adding Danggui harmonizes the nutritive blood, and Xixin facilitates lung qi. There is no need to worry that acrid-drying herbs will damage the blood. Consequently, after a few doses, the bleeding stopped. Subsequently, several doses of Guizhi Renshen Tang (Cinnamon Twig and Ginseng Decoction) were administered, which instantly resolved the abdominal pain and alternating chills and fever. Later, Liuwei Wan (Six-Ingredient Pill with Rehmannia) was used, replacing Yurou (Cornus officinalis fruit) with Zaoren (Semen Ziziphi Spinosae). Occasionally, decoctions such as Baoyuan Tang (Preserve the Origin Decoction), Yigong San (Extraordinary Efficacy Powder), or Danggui Buxue Tang (Danggui Blood-Nourishing Decoction) were given. The condition was managed according to the specific syndrome, leading to recovery. In my treatment of deficiency consumption, I have often discarded all conventional consumption medications to prevent the pathogenic qi from sinking into the yin aspect. This approach deeply embodies the power of *Jinkui Yaolue*.

A student asked further about the treatment of deficiency consumption, noting that contemporary practitioners often adhere to the saying "the liver is always in excess, and the kidney is always deficient," focusing primarily on clearing heat and pacifying the liver. My teacher, however, often achieves results by supporting the spleen and benefiting the liver. What is the rationale behind this? Shiwan answered, "Although cough is described as a lung disease, its root actually lies in the stomach. The *Neijing* (Classic of Internal Medicine) states in the 'Treatise on Cough': 'Its root is in the stomach, but it is closely related to the lung.' This clarifies the meaning. As for the theory of pacifying the liver, the implications are significant. The liver is the organ of growth and development, responsible for storing essence and blood. When essence and blood are abundant internally, neither symptoms nor pulse abnormalities manifest. All syndromes associated with deficiency consumption, such as abdominal tightness, loss of blood and essence, irritability, heat, and wiry pulses, are indeed due to a lack of internal vital energy (sheng qi), resulting in a loss of gentleness and the appearance of rebellious behavior. This resembles an image of excess evil heat. Therefore, sweet-warm tonification is required to support the vital energy. If it is truly yin deficiency, one should strengthen water to control yang; if it is yang deficiency, one should cultivate earth to provide thick support, allowing prosperity and stability. How could one possibly add draining and reducing methods, thereby damaging the already compromised stomach qi?"

Another question was posed: "I have heard the rationale for supporting the spleen and benefiting the liver in deficiency consumption. However, in the medical records of past sages, there are many prescriptions using Sanhuang Tang (Three-Yellow Decoction) and Siwu Tang (Four-Substance Decoction). Why is this?" The answer was, "This is due to differences in geographical environment and local customs. People in the northwest often consume food cooked with coal. Coal is the essence of soil and water; when combined with water, the fire burns intensely. Consuming this food aids the true fire. If true fire becomes excessive, it transforms into 'strong fire' (zhuang huo). Strong fire dissipates qi. Therefore, people in the northwest suffer frequently from wind-stroke (stroke) and rarely from emaciation. Even if emaciation occurs, the treatment focuses on bitter-cold herbs to clear fire. Although deficiency patterns exist, acrid-warm herbs are not needed. People in the southeast only consume food cooked with firewood. Firewood inherits the harsh nature of soil and water; it extinguishes when wet. Consuming this food specifically aids the dragon fire (ministerial fire). When dragon fire flies upward, it becomes evil fire. Thus, people in the southeast suffer less from wind-stroke but more from emaciation. Even if there is liver pathology, they most strictly avoid bitter-cold agents that damage the middle jiao. Even with wood stagnation (liver qi constraint), it is difficult to promote ascending and developing functions. However, do people in the northwest never experience severe deficiency of true yang requiring Jiang (Zingiberis Rhizoma) and Fu (Aconiti Lateralis Radix Praeparata)? Do people in the southeast never experience extreme hyperactivity of evil heat requiring Qin (Scutellariae Radix) and Lian (Phellodendri Cortex)? One must understand that although northern people have strong constitutions, their lifestyle may deplete true yang. Without strongly administering acrid-hot herbs, how can yuan qi (original qi) be supported in the realm of nothingness? Although southern people have weaker constitutions, they indulge their desires and rely on themselves, leading to violent rebellion of evil fire. Without temporarily using bitter-cold herbs, how can true yin be saved from imminent exhaustion? Mediocre physicians only know that acrid-hot herbs have the merit of assisting yang; they do not realize the hazard of damaging yin. They only fear that bitter-cold herbs damage the middle; they do not realize the power of these herbs to save yin."