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Regarding conditions that resemble deficiency consumption (Xu Sun, chronic wasting disease) but are not true deficiency consumption, this occurs only in cases of external contraction of cold pathogen. This is because when an external pathogen initially invades, if it is not dispersed and resolved, but mistakenly treated as an internal injury, or if cooling/clearing agents or digestive-promoting agents are used, the cold pathogen becomes depressed and latent, lingering for a long time without dissipating. This leads to alternating chills and fever, or tidal fever with coughing; these symptoms completely resemble consumption. If one uses methods for treating deficiency consumption to treat such conditions, then yin-nourishing and other tonic formulas will further retain the pathogen. After prolonged steaming heat, a non-consumption condition will turn into true consumption. I have cured several patients with these exact presentations. To distinguish this, one must carefully examine the exterior and interior, and ascertain the cause of the disease. True deficiency consumption invariably has a gradual etiology, whereas external pathogens strike suddenly. If there is body pain, where slight sweating causes the fever to recede, and lack of sweating causes the fever to return; or if there is loud coughing, and the pulse is wiry and tight but not excessively rapid, or accompanied by harmonious/sluggish qualities; even if the illness has persisted for one or two months with the pathogen unresolved and the condition unrelenting, this is fundamentally not consumption, and erroneous treatment should be avoided. For persistent alternating chills and fever, one should selectively use Chaihu Yin (Bupleurum Decoction) variants (First through Fifth), or Zheng Chaihu Yin (Correct Bupleurum Decoction) may also be used. If accompanied by coughing, use Chaichen Jian (Bupleurum and Tangerine Peel Decoction). If there is Qi deficiency of the Spleen and Kidney accompanied by coughing, use Jinshui Liujun Jian (Metal-Water Six Gentlemen Decoction); if the pathogen remains unresolved accompanied by chills and fever, add Chai Hu (Bupleuri Radix).

Once deficiency consumption has formed, how can recovery occur without tonification? However, some patients cannot tolerate Ren Shen (Ginseng Radix et Rhizoma), Shu Di Huang (Rehmanniae Radix Preparata), and other tonic medicines. This is termed "deficiency unable to accept tonification" (Xu Bu Shou Bu); how can survival be expected? Following hematemesis or hemorrhage due to consumption, if coughing persists and sputum is excessive and severe, this indicates extreme deficiency of the Spleen and Lung. Dietary intake fails to transform into blood, instead turning into phlegm with food ingestion. Although this is not blood, it belongs to the category of blood. The Classics state: "Excretion of white blood indicates death." Therefore, cases with the most abundant and turbid phlegm are incurable. First, the left and right sides are the pathways of Yin and Yang. Patients who cannot sleep on either side or find it difficult to turn over indicate a partial exhaustion of Yin and Yang Qi; these are mostly incurable. Second, patients with deficiency consumption originally lack external pathogens; thus, although the condition is severe, they do not become delirious. If a patient presents with deficiency signs but no external heat-pathogen, yet exhibits delirium and loss of rationality, this signifies the failure of the Heart and the departure of Shen (Spirit); death is inevitable. Third, chronic coughing, aphonia (loss of voice), or panting with shortness of breath indicates the failure of the Lung; death is inevitable. Fourth, complete emaciation due to consumption indicates the failure of the Spleen; death is inevitable. Fifth, sinews are the root of extreme fatigue. Patients with deficiency consumption often suffer from bone and sinew pain. If the pain reaches an unbearable intensity, it indicates blood exhaustion failing to nourish the sinews, signifying the failure of the Liver; death is inevitable. Sixth, prolonged consumption affecting the bowels, resulting in uncontrollable diarrhea, indicates the failure of the Kidney; death is inevitable.