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The pulse of deficiency and damage (Xu Sun), whether extremely rapid, extremely frequent, extremely fine, extremely weak, extremely choppy, extremely slippery, extremely short, extremely long, extremely floating, extremely deep, extremely wiry, extremely tight, extremely surging, or extremely excess, all belong to the pulse of labor injury. However, regardless of whether the pulse is floating or deep, large or small, as long as it gradually becomes relaxed and slow, it indicates that there is vitality in the condition. If the pulse is extremely wiry, the disease must be severe; if the pulse is extremely frequent, the disease must be critical; if the pulse is both wiry and fine, and additionally tight and frequent, then there is no chance of survival (it is incurable).

*Jingui Yaolue* states: A knotted pulse (Kou Mai, hollow like a scallion stalk) indicates blood deficiency; a deep, slow, and small pulse indicates qi depletion. A large but forceless pulse indicates yang deficiency; a frequent but forceless pulse indicates yin deficiency. A large and knotted pulse indicates loss of blood. In a healthy person, a large pulse is due to labor. Extreme weakness is also a sign of labor. A minute and fine pulse indicates night sweating. A weak and soft pulse at the Cun position indicates upper jiao deficiency. A weak, soft, and choppy pulse at the Chi position indicates lower jiao deficiency. A soft, slippery, and rapid pulse at the Chi position indicates blood deficiency. A deep and fine pulse at both Guan positions indicates stomach deficiency.

*Mai Jing* states: A soft pulse indicates deficiency; a slack pulse indicates deficiency. A minute and weak pulse indicates deficiency. A wiry pulse indicates middle jiao deficiency. A fine, small, and weak pulse indicates simultaneous deficiency of qi and blood.

Diseases of labor damage essentially belong to yin deficiency, and yin deficiency inevitably leads to blood insufficiency. Fingers and nails are the surplus of essence and blood; therefore, during diagnosis, if one observes dry, yellow, withered, and lifeless nails, the condition of hair, skin, and Ying Qi is evident before us. Beyond pulse and complexion, this allows us to identify signs of deficiency and damage, and to distinguish the severity of the damage.

The manifestations of deficiency diseases vary. Etiologically, there are five labors and seven injuries; clinically, they involve Ying-Wei, Zang-Fu organs. However, fundamentally, what sustains life is only Essence and Qi, and what constitutes deficiency damage is also only Essence and Qi. Qi deficiency is yang deficiency; Essence deficiency is yin deficiency. Diseases characterized by excessive fire and deficient water, presenting with dry Ying-Wei and withered body fluids, are yin deficiency syndromes. Diseases characterized by excessive water and deficient fire, presenting with cold viscera and failure of spleen and kidney, are yang deficiency syndromes. This results solely from the bias and distress of yin and yang. Treatment should focus on tonifying insufficiency and never attacking excess. Since the condition is already deficient, attacking any perceived "excess" would lead to mutual destruction of both sides, which is dangerous! The differentiation of yin and yang is difficult because within yin and yang, there is further yin and yang. Cases that appear yang but are not truly yang, or appear yin but are not truly yin, can easily confuse practitioners unless one possesses true insight. This requires careful examination. Furthermore, there are cases of simultaneous yin and yang deficiency. Yang is the root of life, so emphasis is placed solely on yang qi. Understanding this makes the treatment of deficiency damage clear as day.

1. Those with yang deficiency often feel cold. This does not refer to external cold, but rather cold generated internally due to insufficient yang qi. If one waits until cold symptoms manifest, the yang qi has already failed. One should recognize that weakness without other heat signs indicates yang deficiency, requiring warming and tonification of primordial qi to gradually restore it. Yang deficiency often arises from sorrow and worry damaging the spirit, overwork damaging physical strength, excessive sexual activity causing qi to depart with essence, or constitutional lack of primordial yang damaged by cold medicines. To tonify yang, acrid-sweet-warm-dry agents are suitable. Cool-cold-slippery substances must be avoided to prevent damaging generative qi. Substances such as Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Tian Men Dong (Asparagi Rhizoma), Mai Men Dong (Ophiopogonis Rhizoma), and Sha Shen (Glehniae Radix) are unsuitable. Shi Hu (Dendrobii Caulis), Xuan Shen (Scrophulariae Radix), Zhi Mu (Anemarrhenae Rhizoma), Huang Bo (Phellodendri Cortex), Huang Qin (Scutellariae Radix), Lian Zi (Nelumbinis Semen - *Note: Context implies Lian Qiao or similar, but text says Lian, likely Huang Lian based on context of cold herbs*), Gui Jiao (Testudinis et Chelonis Carapax et Plastrum) are absolutely contraindicated. For simultaneous qi and blood deficiency, Da Bu Yuan Jian (Great Tonify Origin Decoction), Ba Zhen Tang (Eight Treasures Decoction), or Shi Quan Da Bu Tang (Ten Significant Great Tonify Decoction) are appropriate. For simultaneous five-viscera deficiency requiring mild tonification, Wu Fu Yin (Five Blessings Drink) is used. For insufficiency of the Mingmen yin component, Zuo Gui Yin (Left Return Drink) and Zuo Gui Wan (Left Return Pill) are used. For insufficiency of the Mingmen yang component, You Gui Yin (Right Return Drink) and You Gui Wan (Right Return Pill) are used. For qi-component cold deficiency, Liu Qi Jian (Six Qi Decoction) is used. For spleen-kidney yin-component cold deficiency with varied manifestations, Li Yin Jian (Regulate Yin Decoction) is used. For significant deficiency of sanjiao yang qi, Liu Wei Hui Yang Yin (Six Ingredient Restore Yang Drink) is used. For qi deficiency and spleen cold, Yi Qi Dan (One Qi Elixir) is used. For stomach qi deficiency and cold, Wen Wei Yin (Warm Stomach Drink) and Li Zhong Tang (Regulate Middle Decoction) are used. For blood deficiency and cold stagnation, Wu Wu Jian (Five Elements Decoction) is used.

2. Those with yin deficiency often experience heat, due to water failing to assist fire, leading to yin-deficiency heat. This disease often arises from indulgence in alcohol, sex, and desires, or anger and evil thoughts causing wild exertion, stirring up fire in the five viscera, especially in those with congenital primordial yin insufficiency. Patients with deficiency damage who experience much heat and dryness, and dislike hot food, show yin deficiency signs. To nourish yin, sweet-cool-pure-still substances are suitable. For yin with internal fire, acrid-warm agents are strictly forbidden, such as Gan Jiang (Zingiberis Rhizoma), Gui Zhi (Cinnamomi Ramulus), Fu Zi (Aconiti Lateralis Radix Praeparata), Po Gu Zhi (Psoraleae Fructus), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Cang Zhu (Atractylodis Rhizoma), and Ban Xia (Pinelliae Tuber). Even Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Gou Qi Zi (Lycii Fructus), Dang Gui (Angelicae Sinensis Radix), and Du Zhong (Eucommiae Cortex), which contain yang within yin, should be used cautiously, fearing that strong yang will consume yin further and increased heat will dry up water sources. However, yin-deficient patients, due to water insufficiency, must avoid cold-bitter substances, as these are not nourishing. If fire is excessively strong and cooling is necessary, it must be combined with water-nourishing agents, used intermittently, and stopped when possible to prevent damage. This is the major principle of tonification. Treatments include:

3. For night fever or afternoon fever in deficiency damage, or preference for cold drinks and solid stools, indicating yin-deficiency heat where water fails to control fire, use Jia Jian Yi Yin Jian (Modified One Yin Decoction). If fire affects heart and kidney, causing palpitations and mental instability, use Er Yin Jian (Two Yins Decoction). If external heat persists but internal heat is slight, only tonify yin, do not clear fire; use Yi Yin Jian (One Yin Decoction) or Liu Wei Di Huang Tang (Six Ingredient Rehmannia Pill Decoction). If primordial qi is insufficient and deficiency heat persists, Da Bu Yuan Jian must be used for gradual self-recovery. Refer to the chapter on Cold and Heat for detailed treatments.

4. Deficiency damage cough involves all five viscera, but primarily focuses on lung and kidney. Lung is the metal organ, feared by fire, transformed by dryness. Dryness causes itching, which causes cough. Because kidney water fails to control fire, fire attacks metal; because yin essence fails to transform into qi, dryness occurs. Symptoms include cough, panting, sore throat, throat sores, and hoarseness. Treatment requires sweet-cool-still agents to nourish metal and water, allowing lung and kidney to generate each other without fire constraint, restoring true yin and curing cough. For strong fire, use Si Yin Jian (Four Yins Decoction) modified. For slight fire, use Yi Yin Jian, Liu Wei Di Huang Tang, or Zuo Gui Yin. For cough complicated by wind-cold, use Jin Shui Liu Jun Jian (Metal-Water Six Gentlemen Decoction). Bei Mu Wan (Fritillaria Pill) is best for cough.

5. Deficiency damage hematemesis damages yin, leading to vomiting blood or epistaxis. Treatment depends on the presence and severity of fire. For strong fire carrying blood upward, with heat signs in pulse and symptoms, treat the branch urgently using temporary clearing agents like Huang Qin, Huang Lian, Zhi Zi, Huang Bo, Zhu Ye, and Tong Bian (Child's Urine), or single prescriptions like Chou Xin Yin (Draw Firewood Drink) or Xi Xin Yin (Remove Firewood Drink). For yin deficiency with slight fire, use Bao Yin Jian (Protect Yin Decoction), Qing Hua Yin (Clear Transformation Drink), or Jia Jian Yi Yin Jian. After bleeding stops, tonify blood; avoid excessive cold. For no excess fire but pure yin injury, where yin-water deficiency causes blood movement and bleeding, use purely sweet-yin-nourishing agents to calm movement with stillness and heal injury with harmony, allowing yin qi to rest and blood to return to vessels. Use Yi Yin Jian, Liu Wei Di Huang Tang, or Xiao Ying Jian (Small Nourish Decoction). For yin deficiency involving lung with cough and blood, use Si Yin Jian modified. For labor injury without fire signs, damaging heart-spleen-kidney yin and moving blood, use Wu Yin Jian (Five Yins Decoction), Wu Fu Yin, or Liu Wei Di Huang Wan. For lower yin deficiency with floating yang above, rootless six pulses, and massive hematemesis/epistaxis, indicating fire not returning to source and loss of true yang, use You Gui Yin modified or Ba Wei Di Huang Tang (Eight Ingredient Rehmannia Pill). This occurs mostly in cases of excessive thought and fatigue. For fatigue-induced vomiting/diarrhea with spleen failing to control blood, use Liu Wei Hui Yang Yin with heavy Bai Zhu; cool medicines are forbidden. For massive bleeding, thready/dead pulses, cold limbs, and imminent death, use Zhen Yin Jian (Settle Yin Decoction) immediately to stop bleeding. For severe blood loss with qi collapse causing fainting, tonify qi to secure life using Liu Wei Hui Yang Yin or Si Wei Si Yang Yin; cool medicines will cause death. In summary, blood loss indicates major yin injury. Without protecting primordial qi and cultivating true yin, and using only cool medicines, yin will further deplete. Although bleeding may stop, the disease will deteriorate daily.

6. Deficiency damaging yin originates in the five viscera. While each viscus has its domain, treatment can be differentiated or undifferentiated. Qi damage treats lung; spirit damage treats heart; diet/muscle damage treats spleen; blood/tendon damage treats liver; essence/marrow damage treats kidney. This is differentiable. However, qi governs lung but transforms from essence; spirit governs heart but transforms from qi; muscle governs spleen but earth generates from fire; blood stores in liver but transforms from spleen/stomach; essence/marrow governs kidney but receives from five viscera. This is undifferentiable. When severe, root and branch transmit, affecting viscera, making rigid formulas inappropriate. Therefore, tonification methods must understand yin-yang ascent/descent and cold-hot-warm-cool natures, and the interplay of essence and qi. Upper jiao yang deficiency sinks to kidney, requiring stimulation of extreme yin points. Lower jiao true yin deficiency flies upward, requiring guidance back to source. Treatment must seek the root. My tonification methods are detailed in the New Formulas' Eight Strategies and Eight Arrays. For unlisted symptoms like spermatorrhea, nocturnal emission, hoarseness, night sweats, or female amenorrhea due to blood dryness, consult respective sections for corresponding treatments.