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Males around the age of twenty, having engaged in excessive sexual activity, damage their essence and blood, inevitably developing a condition of Yin deficiency with hyperactive fire. Symptoms include night sweats during sleep, afternoon fever, harsh coughing, fatigue and weakness, reduced appetite, and in severe cases, blood-streaked phlegm, hemoptysis, hematemesis, or epistaxis. The body feels hot, the pulse is deep and rapid, muscles emaciate; this is termed Lao Zhai (Consumptive Disease). It is the most severe and difficult to treat; mild cases require dozens of doses of medicine, while severe cases may take years. However, the patient must cherish life, strengthen their will, abstain from sexual intercourse, quell delusions, avoid anger, and regulate diet to cultivate their root. Otherwise, even taking good medicine is useless. Early treatment is easy; if one waits until muscles are wasted, the patient is bedridden, and the pulse is deep, fine, and rapid, it becomes difficult to save. Furthermore, this disease strictly contraindicates the use of Ginseng Radix et Rhizoma (Renshen); if taken excessively before, it is also hard to treat. I now prescribe the following formula for conditions caused by excessive sexual desire, to be taken early when symptoms such as tidal fever, night sweats, cough, and fatigue first appear.

Sheng Di Huang (Rehmanniae Radix Praeparata, washed with wine), Gan Cao (Glycyrrhizae Radix et Rhizoma, honey-fried), Gan Jiang (Zingiberis Rhizoma, roasted) – each 5 fen; Chuan Xiong (Ligustici Chuanxiong Rhizoma), Shu Di Huang (Rehmanniae Radix Praeparata) – each 1 qian; Bai Shao Yao (Paeoniae Radix Alba, stir-fried) – 1.3 qian; Chen Pi (Citri Reticulatae Pericarpium) – 0.7 qian; Dang Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma) – each 1.3 qian; Huang Bo (Phellodendri Cortex, soaked in honey water and fried) – 0.7 qian; Zhi Mu (Anemarrhenae Rhizoma, soaked in honey water and stir-fried); Tian Men Dong (Asparagi Radix, decored and peeled) – each 1 qian; Sheng Jiang (Zingiberis Rhizoma Recens) – 3 slices. Decoct in water, take warm on an empty stomach.

My commentary: The above formula treats the method of excess fire and Yin deficiency. Generally, this syndrome belongs to the deficiency of the three Yin meridians of the foot, characterized by deficient heat without excess fire. Thus, it may manifest during the day and cease at night, or vice versa, occurring irregularly. One should primarily use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and regulate/tonify the Spleen and Stomach with Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If the Spleen and Stomach are damaged first, prioritize Bu Zhong Yi Qi Tang, and gently tonify the Liver and Kidney with Liu Wei Di Huang Wan; many recover. If mistakenly using Huang Bo and Zhi Mu, the Spleen and Stomach will be further damaged, appetite will decrease daily, the five Zang organs become more deficient, Yuan Qi sinks, leading to abdominal fullness and diarrhea, which is incurable.

Regarding epistaxis and hematemesis, these occur due to hyperactive deficient fire causing blood to flow recklessly, or due to deficient Yang failing to control blood within its vessels. The pulse is wiry and surging, indicating rootless fire floating outward. Generally, this occurs in the fourth, fifth, and sixth months when Fire and Earth qi are strong and Metal and Water qi are depleted. If one does not practice celibacy and eat bland food to nourish the Lung and Kidney, or if in the eleventh and twelfth months, when Fire qi hides, one does not avoid intimacy and damages true Yuan, then in late spring and early summer, one suffers from headache, weak legs, poor appetite, and "Summer Heat" fever, or appears aged prematurely, intolerant to cold and heat, unable to bear labor, getting sick in all seasons. This is because Qi and Blood are growing but are damaged by mental exertion, or Essence and Blood are not yet full but are squandered early. Hence, symptoms are hard to describe. If the left Chi pulse is weak or fine and rapid, it indicates insufficient True Yin of the Left Kidney; use Liu Wei Di Huang Wan. If the right Chi pulse is slow, soft, or deep, fine, and nearly absent, it indicates insufficient Ministerial Fire of the Ming Men; use Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia). If both Chi pulses are weak, it indicates dual deficiency of Yin and Yang; use Shi Bu Wan (Ten-Tonifying Pill). These all nourish the source of transformation. Refer to previous methods for fever and subsequent methods for cough.

Han Yongzhi, a Zhou Tong official, suffered from excessive sexual desire, resulting in irritability, heat, thirst, incessant drinking, dribbling urine, constipation, profuse sputum, red face and eyes, thorny tongue, cracked lips, generalized fever, sensation of needles in the skin without fixed location, burning soles, and a chaotic, surging pulse in the left three positions. This is Kidney Yin deficiency with Yang lacking attachment and floating outward. Severe heat that does not respond to cooling indicates lack of Water; one must vigorously tonify Yin. I used Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill with Rehmannia) material totaling one jin, containing 1 liang of Rou Gui (Cinnamomi Cortex), decocted rapidly in water to make six bowls. Given cold, he slept soundly after half an hour. At night, given one bowl warm, all symptoms subsided. The next day, he felt cold, feet cold to the knees, and symptoms returned; this indicated lack of Fire; one must tonify Yang. I urgently prescribed four doses of Ba Wei Di Huang Wan, and symptoms instantly receded.

Chen Lv xian, a Juren degree holder, suffered from excessive sexual desire. In early winter, he had irregular fever, incessant drinking, surging sputum, continuous spermatorrhea, and dribbling urine. Others used Si Wu Tang (Four-Substance Decoction) and Er Chen Tang (Two-Aged Decoction), leading to chest discomfort, poor appetite, and loose stools. I prescribed Si Jun Zi Tang (Four-Gentlemen Decoction) with Shu Di Huang and Dang Gui in the morning, and Jia Jian Ba Wei Wan in the evening. I also applied Fu Zi (Aconiti Lateralis Radix Praeparata) mixed with saliva to Yong Quan (KI 1) acupoint. He gradually recovered (see *Nei Ke Miao Duan*).

Wang Yidao, a Fuxiang student, had inherently weak Yuan Qi. In Bing Wu and Ding Wei years, accumulated fatigue from examinations caused illness. By December, it worsened: high fever, tears freezing upon exit, red eyes, dark face, waving hands, exposing chest, shallow breath nearly stopping, surging pulse beating strongly against fingers but empty on deep pressure, dry tongue feeling like thorns. This is internal true cold and external false heat. I first administered Shi Quan Da Bu Tang (Great Tonifying Decoction for Ten Insufficiencies). I said, "After taking this, the pulse should converge." Soon he slept deeply. Waking, he felt cold and added clothes; the pulse became minute and thread-like, revealing true deficiency-cold. I used 1 liang of Ren Shen (Ginseng Radix et Rhizoma) plus 3 qian of Shu Fu Zi (Prepared Aconite Lateral Root), decocted and taken at once, bringing peace. At night, the pulse collapsed again; I used 2 liang of Ren Shen and 5 qian of Shu Fu Zi, curing him again. Later, large doses of Ren Shen, Bai Zhu, Dang Gui, and Zhi Gan Cao regulated him to health.

The above medicines were personally tested by me. Even in coma, I knew only these could cure. Only Lizhai [Li Yan] could recognize this disease and use these medicines. Because you trusted and took them, you fully recovered. Had we mistakenly used cold-cooling agents, would we not have perished? My remaining life is gifted by Master Li. Out of gratitude, I append these words to the end of the case record to inform patients.

One man had hematemesis triggered by fatigue. I considered this Lung Qi injury from overwork, with blood not returning to its source. I gave Bu Zhong Yi Qi Tang plus Mai Men Dong, Wu Wei Zi, Shan Yao, Shu Di Huang, Fu Shen, and Yuan Zhi. He recovered.

One man had coughing with hemoptysis, heat, thirst, profuse phlegm, night sweats, and spermatorrhea. I considered this Kidney Water deficiency and used Di Huang Wan material plus Mai Men Dong and Wu Wei Zi to strengthen Water. He recovered. Later, due to fatigue and anger, purple blood clumps surged up. I first used Hua Rui Shi (Pyrite) to resolve stasis, then Du Shen Tang (Single Ginseng Decoction) to tonify Qi, and continued with previous medicines. He recovered. Subsequently, every time he fatigued, he coughed with bloody sputum; Spleen, Lung, and Kidney pulses were surging and rapid. I used Bu Zhong Yi Qi Tang plus Bei Mu, Fu Ling, Shan Zhu Yu, Shan Yao, Mai Men Dong, and Wu Wei Zi, alternating with previous medicines. He recovered.

A fortune teller talked about destiny for a long time and occasionally spat one or two mouthfuls of blood. I said this was Lung Qi injury from fatigue and gave Bu Zhong Yi Qi Tang plus Mai Men Dong, Wu Wei Zi, Shan Yao, Shu Di Huang, Fu Shen, and Yuan Zhi. He recovered.

A boy, fourteen years old, had fever and hemoptysis. I said one should tonify Middle Qi to nourish the source of transformation. He did not believe me and used cold-cooling fire-reducing herbs, worsening symptoms. Someone asked, "The boy is unmarried, how can he have Kidney deficiency? Why use Qi-tonifying Ginseng and Astragalus?" I quoted Master Danxi: "The Kidney governs storage, the Liver governs dispersion. Both contain Ministerial Fire connected to the Heart (Monarch Fire). Stimulated by objects, Ministerial Fire rises; even without intercourse, essence is secretly consumed." Also, Chu Shi's *Jing Xue Pian* states: "If a male whose essence is not full engages in sex to drain it, the five Zang organs will have unmet needs, leading to difficult-to-describe diseases later." This applies here. I used Bu Zhong Yi Qi Tang and Di Huang Wan, and he recovered.

A woman, accustomed to hard work, had cough, expectoration, and fever in early winter. Long-term, she developed hemoptysis, night sweats, irregular menstruation (every 2-3 months), and generalized pain. Others used heat-clearing and phlegm-resolving herbs, causing lockjaw and tendon spasms. I used Jia Jian Ba Wei Wan and Bu Zhong Yi Qi Tang plus Mai Men Dong, Wu Wei Zi, and Shan Yao. She recovered after more than a year.

A woman, nearly seventy, had chronic Liver-Spleen issues. Attacks involved poor appetite, chest discomfort, epigastric pain, diarrhea, or urinary difficulty. I used Xiao Yao San (Free and Easy Wanderer Powder) plus Shan Zhi, Fu Shen, Yuan Zhi, and Mu Xiang. She recovered. Later, due to worry and thought, she vomited purple blood clumps. Each attack began with fatigue followed by irritability and heat. I used previous herbs plus 3 fen of charred Huang Lian and 2 fen of Wu Zhu Yu. She recovered instantly. Then, due to anger, she vomited large amounts of bright red blood, becoming restless, thirsty, and near death. I used 1 liang of Ren Shen, 3 qian each of Bai Zhu, Bai Fu Ling, and Dang Gui, 2 qian each of Chen Pi and Pao Hei Gan Jiang, and 1 qian each of Zhi Gan Cao and Mu Xiang. One dose stopped the bleeding.

If cough is severe, add Sang Bai Pi, Ma Dou Ling, and Gua Lou Ren (each 7 qian) and 10 Wu Wei Zi.
If phlegm is profuse, add Jiang Zhi Ban Xia, Bei Mu, and Gua Lou Ren (each 1 qian).

My commentary: For the previous two cases, if Kidney Qi is weak with excess fire and dried fluids涌ing into phlegm, use Liu Wei Di Huang Wan. If Kidney Yang is exhausted, use Ba Wei Di Huang Wan. If Spleen and Lung Qi are deficient, failing to control fluids, causing profuse phlegm and cough, use Liu Jun Zi Tang plus Jie Geng; for deficiency-cold, add Pao Jiang.

If tidal fever is severe, add Sang Bai Pi, Sha Shen, and Di Gu Pi (each 7 fen).

My commentary: For the previous symptoms, if tidal fever occurs during Yin, Mao, Chen hours (Liver time), it is Liver dryness-heat; use Liu Wei Di Huang Wan to tonify Kidney Water to generate Liver Blood. If it occurs during Wu, Wei hours (Heart time), it is Heart deficient heat; use Liu Wei Di Huang Wan to strengthen the master of Water to control sunlight. If it occurs during Shen, You, Xu hours (Lung time), it is Lung deficient heat; use Bu Zhong Yi Qi Tang to cultivate Spleen Earth to generate Lung Metal. If it occurs during Hai, Zi, Chou hours (Kidney time), it is Kidney depletion deficient heat; use Liu Wei Di Huang Wan. With cold extremities, it is Kidney deficiency collapse; use Liu Wei Di Huang Wan. Generally, tidal fever, fever, and post-prandial fever indicate damage to all five Zang; use Liu Wei Di Huang Wan. For Qi and Blood deficiency, use Shi Quan Da Bu Tang.

For nocturnal emission and slippery essence, add Li Shi, Long Gu, and Shan Zhu Yu (each 7 fen).

My commentary: For the previous symptoms, if Kidney Qi is insufficient, use Yi Zhi Tang and Jin Suo Zheng Yuan Dan. If Liver-Kidney deficient heat, use Liu Wei Di Huang Wan and Jia Wei Xiao Yao San. If Spleen deficient heat, use Liu Wei Di Huang Wan and Bu Zhong Yi Qi Tang. All these belong to deficiency syndromes; use Shi Quan Da Bu Tang, or Bi Xie Fen Qing Yin to deliver Ba Wei Di Huang Wan.

For profuse night sweats, add Mu Li, Suan Zao Ren (each 7 fen), and Fu Xiao Mai (a handful).

My commentary: For the previous symptoms, if Yang Qi is weak with incessant sweating and limb fatigue, use Shen Fu Tang. If asthma, shortness of breath, dizziness, and night sweats occur, use Shen Fu Tang. If Kidney Qi is weak with night sweats and fever, use Liu Wei Di Huang Wan. If Kidney Qi is deficient with night sweats and aversion to cold, use Ba Wei Di Huang Wan. If dual Qi-Blood deficiency with night sweats, use Shi Quan Da Bu Tang. If Yang excess and Yin deficiency, use Dang Gui Liu Huang Tang. If Heart-Kidney weakness, use Ban Long Wan.

For red and white turbidity, add Bai Fu Ling (1 qian) and Huang Lian (3 fen, stir-fried).

My commentary: For the previous symptoms, if Spleen-Lung deficient heat, use Bu Zhong Yi Qi Tang to deliver Liu Wei Di Huang Wan. If Lung-Kidney deficient heat, use Huang Qin Qing Fei Yin to deliver Liu Wei Di Huang Wan. If Liver-Kidney deficient heat, use Jia Wei Xiao Yao San to deliver Liu Wei Di Huang Wan. If Labor injures Heart-Kidney, use Qing Xin Lian Zi Yin. If Depression injures Spleen, use Gui Pi Tang. If Anger injures Liver-Spleen, use Jia Wei Xiao Yao San. If Heart-Kidney weakness, use Xiao Wen Jin San. If Overthinking injures Heart-Kidney, use Fu Tu Wan. Methods for nocturnal emission, slippery essence, and red-white turbidity should be cross-referenced.

One man, over twenty, squandered himself early, suffering from nocturnal emissions, slippery essence, night sweats, bloody sputum, hot and weak legs. He took Huang Bo and Zhi Mu. I said, "This is Yang deficiency with Yin weakness; one must nourish the source of transformation." He did not believe me, persisted in taking them, and symptoms worsened. His head enlarged, fontanelle opened, vision magnified, with spitting and shouting. I regulated and tonified according to method; symptoms receded, head/fontanelle closed, and he stabilized.

If accompanied by epistaxis or hemoptysis from the Lung, add Sang Bai Pi (1 qian), Huang Qin, and Shan Zhi (each 5 fen, stir-fried).
If accompanied by coughing blood or bloody phlegm from the Spleen, add Sang Bai Pi, Bei Mu, Huang Lian, and Gua Lou Ren (each 7 fen).
If accompanied by vomiting blood from the Stomach, add Shan Zhi, Huang Lian, Gan Jiang, Pu Huang (each 1 qian), Jiuzhi (half cup), and Jiangzhi (a little).
If accompanied by spitting blood from the Kidney, add Jie Geng, Xuan Shen, and Ce Bai Ye (stir-fried) (each 1 qian).

My commentary: The above formula is suitable only for ancients with both form and disease being excess. Modern patients are mostly dual deficiency. Practitioners should seek the root cause. If depression-heat injures Lung causing epistaxis, use Huang Qi Yi Qi Tang. If Lung Qi deficient heat fails to control blood causing epistaxis, use Si Jun Zi Tang plus Chuan Xiong, Dang Gui, and Wu Wei Zi. If depression injures Spleen causing cough-hemoptysis, use Gui Pi Tang. If Stomach channel has heat causing cough-hemoptysis, use Xi Jiao Di Huang Tang. If Stomach Qi is weak causing cough-hemoptysis, use Si Jun Zi Tang plus Chuan Xiong, Dang Gui, and Sheng Ma. If Kidney channel deficient heat and Yin fire move internally causing hemoptysis, use Liu Wei Di Huang Wan and Bu Zhong Yi Qi Tang. If anger moves Liver fire causing bleeding, use Jia Wei Xiao Yao San. If Kidney depletion and Liver fire movement cause bleeding, use Liu Wei Di Huang Wan. Although blood flows recklessly due to heat, there are also cases where Defensive Qi is weak and fails to control Nutritive Blood. Do not fail to observe. All above symptoms belong to foot three-Yin deficiency with internal hyperactive deficient fire, not external causes. All should use Liu Wei Di Huang Wan and Bu Zhong Yi Qi Tang to nourish the source of transformation; this is treating the root. Causes are numerous; practitioners must adapt to symptoms to avoid error.

If blood signs appear first, or hematemesis/epistaxis is severe, treat blood first. Method: For mild cases, cool blood and stop bleeding. For severe cases, first resolve stasis, then stop bleeding and cool blood. Profuse bleeding implies stasis in the chest/diaphragm; if not resolved first, cooling and stopping will fail. Use Ge Kejiu's *Shi Yao Shen Shu* sequentially. Among formulas, Du Shen Tang is only applicable after massive hematemesis with coma, fatigue, minute pulse, and Qi deficiency. If Qi is deficient but fire remains, add Tian Men Dong (5 qian). If, as previously stated, Yin deficiency with hyperactive fire, tidal fever, night sweats, cough, and rapid pulse exist, do not use.

My commentary: Mr. Liu Zongnong said: "Ying (Nutritive) Qi is the essence of food and drink, harmonizing with the five Zang, spreading to the six Fu, entering the vessels. Coming continuously, generated by Spleen, commanded by Heart, stored by Liver, announced by Lung, excreted by Kidney, irrigating the body. Thus, entry, exit, ascent, descent, moistening, and circulation depend on this. Hence, Classics say: 'Qi commands breathing, Blood moistens.' And: 'Lung gathers Qi of all vessels, Liver commands Blood of all channels.' Qi and Blood are the bellows of the human body. Observing this, most cases result from improper diet, lifestyle, Six Evils, or Seven Emotions damaging Yuan Qi, causing meridian dysfunction and failure to control. The method is to regulate and tonify Spleen-Lung Qi, making blood return to its source, curing diseases. If tidal fever, cough, and rapid pulse occur, it is weak Yuan Qi with false heat pulse; especially appropriate to use sweet-warm Spleen-Stomach tonification."

If the disease involves Fire, stool is often dry, but one must regulate diet to avoid diarrhea. If Stomach Qi is damaged again, causing loose/watery diarrhea, cold-cooling herbs are difficult to use. Urgently regulate Spleen-Stomach using Bai Zhu, Fu Ling, Chen Pi, Ban Xia, Shen Qu, Mai Ya, and Gan Cao. Wait for Stomach Qi to recover, then use previous disease-specific medicines to conclude treatment. Afterwards, one may commonly take Bu Yin Wan and Ge Kejiu's formulas.

My commentary: *Nei Jing* says: "Kidney opens into the two yin openings, governing urination and defecation." If Kidney channel fluids are depleted, use Liu Wei Di Huang Wan. If Spleen-Lung Qi is deficient, use Bu Zhong Yi Qi Tang. If Spleen channel depression exists, use Jia Wei Gui Pi Tang. If Qi-Blood is deficient, use Ba Zhen Tang. If fever with thirst for cold drinks, use Zhu Ye Shi Gao Tang. If accumulation-heat from rich foods, use Jia Wei Qing Wei San.

A scholar had chronic constipation. After taking Sou Feng Shun Qi Wan, he had chest discomfort, good digestion, flushed face, and surging yet empty Guan and Chi pulses on the left. I said, "This is foot three-Yin deficiency." He did not believe me, took Run Chang Wan, resulting in loose stools and limb fatigue. I used Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan. After a month, results appeared; after a year, he was stable.

A scholar had emotional depression, fever, thirst, chest discomfort, poor appetite. After taking heat-clearing, phlegm-resolving, and Qi-moving agents, symptoms worsened, limbs fatigued, Heart and Spleen pulses were choppy. I used Jia Wei Gui Pi Tang. Appetite improved, symptoms receded. However, stool remained dry, malar flush present. I used Ba Zhen Tang plus Cong Rong, Mai Men Dong, and Wu Wei Zi. After thirty-plus doses, stool naturally softened.

One man had the same complaint, did not believe my words, took Da Huang etc., resulting in diarrhea and bloody stool, blackened body. He sought treatment again. I looked and said, "Both Yang and Yin collaterals are injured. Classics say: 'Injury to Yang collateral causes external bleeding; injury to Yin collateral causes internal bleeding.' Both injured externally and internally, why wait for death?" I refused treatment; he indeed died.

A scholar had dry mouth, fever, frequent turbid urine, constipation, night sweats, nocturnal emissions, leading to insomnia. I used Dang Gui Liu Huang Tang for two doses; night sweats stopped instantly. I used Liu Wei Di Huang Wan; urination and defecation harmonized. I used Shi Quan Da Bu Tang combined with previous pills. After a month, all symptoms cured.