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As the saying goes: Hearing a hundred times is not as good as seeing once. Indeed, there are those who fill their houses with books, yet when applied to clinical practice, they are as ineffective as playing a lute with glue (a metaphor for inappropriate methods or tools). Song Yi discussed military strategy, not without being detailed and eloquent, yet whenever he employed it, he failed. He was not even as competent as a low-ranking soldier experienced in warfare. This is because what they saw and heard were often matters not previously mentioned in strategic treatises. There is no other reason; it is due to their lack of personal practice and experience. Reflecting on this, thousands of scrolls can be summarized in a few words. More importantly, through personal practice and experience, with few words, one can uncover truths not yet revealed by predecessors and open pathways for successors. Does Shenrou have no merit to the past and present in medicine! Therefore, I list the historical examples (course of disease evolution) of deficiency consumption (Xu Lao), appended after the master's teachings.

I once treated a case of deficiency consumption. The pulse was slow (Huan) at five to six beats per respiration. The symptoms were limited to cough, fever, aversion to cold absent, sore throat, and throat obstruction. I considered it curable. After administering about ten doses of Baoyuan Tang (Preserve the Prime Decoction) and similar formulas, the cough slightly improved, and the fever subsided marginally. However, beyond twenty doses, the cough worsened, the fever returned to its previous state, and the body became unable to turn over or lie on its side. The legs gradually lost strength, eventually becoming unable to walk and curling up. Why? Because the Kidney Qi in the lower Jiao was exhausted, and there was no fluid (Jin Ye) to nourish and irrigate the bones and joints throughout the body. Furthermore, Yang Qi could not reach the four extremities, and the Qi of the Spleen and Lung could not descend and transmit downwards. (These few words actually encompass the key mechanism of deficiency consumption. However, relying solely on Baoyuan Tang, Si Jun Zi Tang (Four Gentlemen Decoction), Ba Wei Wan (Eight-Ingredient Pill), or Bu Zhong Yi Qi Tang would hardly cure such a severe condition. If occasionally cured, it must be because the Blood aspect had not yet become extremely deficient or obstructed.) Thus, the legs were weak and curled. Although the medicine had some effect, the illness was difficult to alleviate temporarily and ultimately proved incurable.

I once treated another case of deficiency consumption where all six pulses were rapid (Shu) but possessed spirit (Shen) and appeared harmonious and slow (He Huan). Even if the rate reached more than ten beats per respiration, it was still considered treatable. Initially, I used Si Jun Zi Tang added with Huang Qi (Astragalus Root) and Wu Wei Zi (Schisandra Berry). After several doses, the rapid pulse gradually decreased, retaining a sense of harmony and slowness, indicating treatability. If the pulse retreated to become fine like a thread but remained rapid, it was absolutely untreatable. In cases where the pulse retreated to be fine like a thread but was not rapid, the Stomach Qi was still present. Provided there was no abdominal pain or diarrhea (abdominal pain indicates death of blood; diarrhea indicates collapse of Qi) and dietary intake remained normal, treatment with Baoyuan Tang, Ren Shen (Ginseng Root), and Bai Zhu (Atractylodes Rhizome) could lead to recovery within two to three years. However, regarding the statement that a gradual reduction in the rapid pulse to a harmonious, spirited state indicates treatability, one must also expect results within three months and full recovery within half a year. One must also assess the patient's age and physical vigor, as well as the strength of their spirit and Spleen-Stomach function. If, after medication, the pulse becomes harmonious but the legs and feet gradually lose strength as described above, and phlegm-cough persists despite the slow pulse, treatment is futile. Conversely, if the patient presents with leg weakness but the fever has subsided, cough has reduced, and diet is normal, it indicates that Spleen Qi is still weak but the condition can be managed over time. In another scenario, if all six pulses are harmonious, and after taking the previous formula the fever subsides but the pulse becomes wiry (Xian), accompanied by diarrhea and bloody stool, this is due to stagnant blood in the meridians from previous heat-fire scorching. (This occurs when cooling medicines suppress blood flow, and latent Yang scorches and ruins it, consistent with Zhang Zhongjing's principle in the Ping Mai Pian [Chapter on Pulse Diagnosis] that excessive heat causes blood to form abscesses and pus.) It may heal spontaneously in the second half of the month or within five to ten days. If the patient can eat during bleeding, they will not die; if they cannot eat and appear spiritually fatigued, death is imminent. Treatment should focus on strengthening the Spleen and preserving Yuan Qi. For abdominal pain and wiry pulse, use Lizhong Tang (Regulate the Middle Decoction); for nausea and poor appetite, use Liu Jun Zi Tang (Six Gentlemen Decoction). Without these two symptoms, use Si Jun Zi Tang and Baoyuan Tang. Generally, bleeding represents the exit of pathogenic factors through the lower orifices; if it manifests as wind-cold symptoms, it represents the exit through the upper orifices. In such cases, warming the Lungs and assisting the Spleen with appropriate herbs can lead to recovery in half a month. In another case, if all six pulses are harmonious at eight to nine beats per respiration, and after taking the previous formula, the three right-hand pulses decrease by two to three beats while the left pulse remains rapid, this indicates that the exterior (Right) has retreated first, while the interior (Left) has not. When the rapid pulse completely retreats and the disease is nearly cured, if the left pulse is still one beat faster than the right, it shows that the exterior has retreated but the interior is not yet harmonized. Nan Zhi states: In Shang Han (Cold Damage), the Left is exterior and the Right is interior; in miscellaneous diseases, the Right is exterior and the Left is interior. This is true. (The Left pulse reflects the presence or absence of Yuan Qi; the Right pulse reflects its severity. This holds true without fail.)

Master Shenzhai once said: Any disease where sweat cannot be induced is untreatable. In deficiency consumption, if all six pulses are rapid, it is still treatable if fewer than forty to fifty doses of Yin-nourishing and fire-descending medications have been taken. If dozens or hundreds of doses have been taken, the True Yuan is exhausted. Even if the pulse appears large, surging, and slow, lacking spirit internally, using tonifying agents will cause the pulse to change from large/surging/slow to fine/rapid, leading to gradual emaciation, incapacitation, and death. Dairen stated: "Young people who do not take medicine recklessly are easier to treat." This is precisely what is meant. Alternatively, if cold-cooling medicines have not been taken excessively, using Baoyuan Tang and Si Jun Zi Tang with one or two qian of fresh ginger for ten to twenty doses might induce sweating. If sweating is not achieved and the surging-slow pulse does not recede, it is also difficult to save. However, if although no sweat is produced, the surging-slow pulse gradually decreases, the illness gradually resolves, and the patient can eat, then there is no harm. Such pulses are generally easier to treat in autumn and winter and harder in spring and summer.

In general, for deficiency consumption lasting three to four months, if the pulse is rapid but still harmonious at six to seven beats per respiration, encountering the fire season of spring and summer leads to dried-up fluids. With Kidney Water entering a realm of death and extinction, Lung exhaustion and Spleen dryness occur, resulting in inevitable death. However, in autumn and winter, when the fire season has passed and Metal and Water are prosperous, a rapid pulse is treatable. Nevertheless, if the patient exhibits emaciation, hoarseness, sore throat, alternating chills and fever, fine-rapid pulse, abdominal pain, and diarrhea, it is untreatable. If seeking treatment for such symptoms, initial use of tonics may worsen the condition. Why? Because the disease has persisted for three to four months with extensive prior medication. Ineffectiveness likely stems from the overuse of cold-cooling medicines, further weakening the Five Viscera and intensifying pathogenic fire. Initial use of tonics, whether a few or ten-plus doses, may cause the pathogenic fire to retreat, leading to dizziness, nausea, bone pain, leg soreness, mental fatigue, and loss of appetite. (There are also cases where dispersing the Lungs, soothing the Liver, strengthening the Spleen, and nourishing the Kidneys exacerbate fire; initially suppressed by cold medicines hiding the True Yang, subsequent application of methods to振奋 Yang and calm Yin leads to recovery because the root Qi is stable.) If the pulse is not fine-rapid but harmonious, urgently administer large doses of Baoyuan Tang and Si Jun Zi Tang continuously. The patient will sleep peacefully for half a day or a day, waking up with refreshed spirit. Another dose induces sleep again, dietary intake increases, and the condition becomes treatable. If the pulse is fine as a thread and the abdomen feels full and dizzy, it is difficult to treat.

For chronic deficiency consumption, even if the pulse is harmonious, one cannot definitively declare it curable. Patients with long-standing illness have weak Yuan Qi; a harmonious pulse may be a false sign. (True Qi is scattered and fails to drive the pulse, causing sluggishness.) If, after seven to eight months, intermittent tonic use gradually reduces the illness, this indicates vitality. If it extends to the eleventh month, when Yang Qi begins to move and rise, internal emptiness may fail to support this ascending mechanism, leading to aversion to cold and high fever. (Sudden appearance of chills and fever resembling a new onset in chronic illness is a critical juncture of life and death. Mild sweating with light body and vigorous Qi indicates Yang revitalization; mild sweating or no sweating with fever resolution but heavy body and weak Qi indicates Yang collapse; limb stiffness preventing turning over, or chest bi with decreasing food intake, are terminal signs of failing extraordinary vessels.) Taking ten-plus doses of tonics may gradually reduce chills and fever, allowing survival. If stable for two to three months, recovery is possible; otherwise, it is untreatable. This is because Spring Wood is prosperous, and the Spleen and Lung, weakened by long illness, cannot withstand the seasonal influence.

I once treated a new illness, either dysentery or a miscellaneous disease, where pathogenic factors were present initially, indicated by a floating-rapid pulse. After several doses of medication matching the pulse and disease, the rapid pulse receded, and the illness stabilized. However, after further doses, the patient felt fatigued, and the pulse reverted to floating-rapid. At this point, one should not assume pathogens remain. Rather, the pathogens have retreated, and the Spirit Qi is just beginning to recover, hence the floating quality. Only Baoyuan Tang should be used to nourish Yuan Qi. A floating-rapid pulse resolving with mild sweating is a method where rising Yang Qi and sufficient Yuan Spirit naturally expel pathogens. If this is misunderstood and pathogen-expelling drugs are still used, Spirit will daily diminish, muscles will waste away, and eventually, deficiency consumption will develop.

Diseases often change unpredictably or worsen with seasonal changes. Encountering specific seasons causes Heaven and Earth Qi to ascend or descend, and the body's Qi responds accordingly. If the patient's Essence and Qi are still sufficient, they can align with the seasonal timing. However, in individuals with long-term Yuan Qi deficiency, there is insufficient energy to assist this ascending/descending movement. Ascending improperly causes dizziness and vomiting; descending improperly causes hot feet and cold body. The body becomes controlled by climate rather than ruling itself. (Illness moving with solar terms indicates Qi failure; moving with lunar phases indicates Blood failure. Thus, worsening on New Moon or Full Moon in serious illness is untreatable. This text specifically refers to excessive ascent/descent. There are also cases where ascent/descent is blocked, or body Qi is discordant with Heaven and Earth, which essentially shares the same mechanism.)

For Spleen-Stomach disease, if ten parts deficient, death occurs in early spring (or looking toward spring); eight parts deficient, death in early spring (Meng Chun); five to six parts deficient, death in mid-spring. If medical treatment is inappropriate, even if originally non-fatal, the damage done makes survival until late spring impossible. Two or three days around Qingming are particularly critical for Lung-Kidney disease starting in spring. If ten parts deficient, death occurs in early summer (or looking toward summer); eight parts deficient, death in mid-summer; six parts deficient, death in late summer.

For long-standing illness, if after medication all six pulses are harmonious, but on a random day the diagnosis shows fine-rapid, weak, or abnormally changed pulses, one must carefully inquire about lifestyle. Changes may result from a single night of sleeplessness, labor, anger, or wind-cold exposure. Treat according to the specific cause. If the pulse remains unharmonious after treatment, it is difficult. For sleep deprivation or labor, use Buzhong Yiqi Tang to assist Yuan Qi; for dietary injury, use salt water to induce vomiting, followed by Er Chen Tang modifications to digest food. For sexual exhaustion, if the pulse changes but the disease does not, standard conditioning tonics can be used. If both disease and pulse change and cannot be harmonized, rescue is unlikely. Autumn and winter offer hope; spring and summer do not. For summerheat injury, keep curtains open and treat according to summerheat protocols. For wind-cold, warm the Lungs and disperse with wind-dispelling herbs; improvement in one or two doses is acceptable; if no change, it is untreatable. Generally, easier in autumn/winter, harder in spring/summer. Observe the patient's Spleen-Stomach Yuan Qi and adjust accordingly. Do not neglect this or falsely promise easy cures.

I once treated a postpartum woman with a history of consumption. She recovered a year ago with Ba Wu Tang (Eight Substance Decoction), but the condition lingered incompletely. The following year, she gave birth in a Gui-Hai year, associated with Wu-Gui transforming into Fire. The weather was extremely hot. Contemporary physicians used Ren Shen but interspersed Shan Zha (Hawthorn Fruit), believing it could counteract Ren Shen toxicity, leading to alternating chills, fever, and diarrhea. My diagnosis showed a rapid pulse at nine beats per respiration, not short. I used Baoyuan Tang added with Gan Jiang (Dried Ginger) and Shu Fu Zi (Prepared Aconite Root, 1 fen) for four doses, reducing the rapid pulse. Upon morning examination, pressing down revealed a floating-slow pulse, but removing pressure showed a fine-wiry pulse like a thread, with the rapid pulse unchanged. (This indicates a failing pulse within the floating-slow pattern. As noted in previous volumes, this "single line" refers to the spine of the pulse, not a separate vessel; the spiritual principle is entirely different.) I said, "It is incurable." She pleaded persistently. I prescribed Gui Zhi (Cinnamon Twig) processed Bai Shao (White Peony Root, 5 fen), Zhi Gan Cao (Honey-fried Licorice Root, 5 fen), Ren Shen (Ginseng, 5 fen), and Huang Qi (Astragalus, 5 fen), intending the effect of Jianzhong Tang. After eight doses, the rapid pulse retreated to nearly six beats. After four more doses, nearly five beats. She believed she was cured and stopped medication. Later, in the fourth, fifth, and sixth months, her pulse became wiry and fine, and she died. This case supports the previous discussion, so I append it.

(When diagnosing deficiency consumption, one must always pay attention to the critical junctures of life and death. Life and death depend on the pulse; the speed of death depends on the symptoms, making judgment difficult. Regarding pulses: First, short-weak Cun pulses and soft-long Chi pulses, rising and falling uniformly, appearing very healthy, yet the sides are desolate and disconnected from the flesh. Second, short-weak Right Cun, sunken Left Guan, long-thin Right Chi, soft-long Left Chi, appearing deeply rooted. Third, harmonious pulse in the morning appearing healthy, hard-large pulse in the afternoon appearing severe, with little change in symptoms. Regarding symptoms: First, heavy body unable to turn over, or distension in hypochondrium, or sweating upon movement with clear spirit and loud voice. Second, chest bi feeling like knotting, inability to expectorate phlegm, decreasing food intake, or no decrease. Third, sudden chills and fever resembling new onset, quickly subsiding, followed by increased fatigue and weak Qi, dragging speech. As for fine-rapid-kou-san-ge-lao pulses, rapid-then-slow, hard-then-soft, fine-then-large; symptoms of aphonia, belching, hiccups—none are unknown as adverse signs. Determining the exact day and hour of death based on these is ultimately difficult. I once diagnosed two people. One young man suffered foot cold injury in winter, treated with Ma Huang to induce sweating. Qi rebelled, feet moved slightly causing panting, unable to eat. Symptoms slightly reduced in January. Pulse was absent for a long time, coming like a sparrow pecking, only on the skin surface. After five to seven pecks, it circled on the skin surface without leaving, then departed like a breaking string, severed in the middle, unable to return. Both hands examined, they avoided each other, irregular arrival and departure. This indicates broken Yuan Qi, critical danger. Because diet and walking were unchanged, I predicted death at Li Xia (Start of Summer), yet it extended to Xia Zhi (Summer Solstice). Why? An elderly person with normally weak Qi and low voice suddenly developed chest bi, fatigue, walking difficulty, decreasing diet, insomnia. Pulse came like sparrow pecking, irregular, vague, weak, but did not circle, break, or avoid each other; the pause occurred after departure and failed to return, without chills or fever. It was winter. I used large doses of warming-tonifying herbs to protect Kidney and calm Liver, moving phlegm and blood, with careful dietary regulation. The pulse rotated back to normal, but I feared Kidney depletion and Liver wood drying, vulnerable to Spring growth commands. By the next winter, the pulse became knotted and intermittent. Regulating with method again, he has been healthy for four years since. Why? As Yuan Qi retreats, medicine and food advance; their forces must meet, though the mechanism is subtle and hard to explain. Ultimately, the delay or speed of death depends on Zang Qi, Heavenly Timing, and Mutual Overcoming of Five Elements. Even if not perfect, it is rarely off by more than two or three days. The Nei Jing states: 'Distinguishing Yang reveals the location of disease; distinguishing Yin reveals the period of life and death.' Yang pulses know the disease; Yin pulses know death. How can one fail to distinguish Yin and Yang pulses?)