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The *Nan Jing* (Classic of Difficult Issues) states: What are the diseases caused by the Sun (Damaged) pulse? The answer is: First damage affects the skin and hair, manifesting as gathered skin and falling hair. Second damage affects the blood vessels, where the vessels are deficient and scanty, unable to nourish the five zang organs and six fu organs. Third damage affects the muscles, resulting in emaciation, where food and drink cannot transform into flesh. Fourth damage affects the sinews, causing flaccidity and inability to hold or control the limbs. Fifth damage affects the bones, leading to bone atrophy and inability to rise from bed. The reverse of this describes the disease of the Zhi (Extreme) pulse. If the disease progresses from top to bottom, death occurs when bone atrophy prevents rising from bed; if it progresses from bottom to top, death occurs when skin gathers and hair falls. The method for treating damage is: For lung damage, benefit its qi. For heart damage, regulate its Ying and Wei (nutritive and defensive qi). For spleen damage, regulate diet and adapt to cold and warmth. For liver damage, soothe its interior. For kidney damage, benefit its essence. This is the method for treating damage. If one cannot treat the deficiency, how can one discuss anything else? Thus it is said: Treating excess with reducing methods makes excess more excessive, and treating deficiency with tonifying methods makes deficiency more deficient; damaging the insufficient and benefiting the redundant—this is the harm caused by average physicians.

Zhang Jiebin adds: The above discussion on upper and lower damage has extremely refined principles, yet there are incomplete aspects that should be fully explained. Generally, conditions such as overthinking, fatigue, and external pathogens injure Yang; injuries to Yang result in disease progressing from top to bottom. Conditions such as sexual indulgence, overeating, drinking, and internal injury injure Yin; injuries to Yin result in disease progressing from bottom to top. As the Classics state: "Diseases of the Two Yang (Stomach and Large Intestine) originate in the Heart and Spleen, involving unspoken difficulties, and in women, amenorrhea." This is an example of progression from top to bottom. Again, the Classics state: "The five zang organs store essence and must not be injured; injury leads to loss of control and yin deficiency; yin deficiency leads to lack of qi; lack of qi leads to death." This is an example of progression from bottom to top. Disease progressing from top to bottom first injures Qi. Thus, first damage to the Lung manifests as disorders of voice, respiration, skin, and pores; second damage to the Heart manifests as disorders of blood vessels and complexion; third damage to the Stomach manifests as dietary irregularities; fourth damage to the Liver manifests as spasms and pain; fifth damage to the Kidney manifests as bone atrophy and incontinence of urine and feces. This is first injuring Yang, then affecting Yin; if Yang exhausts at the bottom, isolated Yin cannot survive alone, and it is incurable. Disease progressing from bottom to top first injures Essence. Thus, first damage to the Kidney manifests as dried-up sources; second damage to the Liver manifests as restless blood and withered sinews; third damage to the Spleen manifests as abundant phlegm and saliva; fourth damage to the Heart manifests as loss of spirit and mind control; fifth damage to the Lung manifests as panting and shortness of breath. This is first injuring Yin, then affecting Yang; if Yin exhausts at the top, isolated Yang cannot generate alone, and it is incurable. Therefore, it is said: Damage to the Heart and Lung leads to decline of Shen (Spirit); deficiency of the Liver and Kidney leads to deterioration of form; damage to the Spleen and Stomach leads to food and drink failing to transform into blood and qi. Wise individuals should investigate the causes and prevent the onset gradually; why worry about deficiency damage? If one waits until both source and flow are exhausted before blaming ineffective medicine or poor medical skill, this is extreme foolishness.

The *Chao Shi Bing Yuan* (Source of Diseases of Chao Yuanfang) states: Xu Lao (Deficiency Consumption) refers to Wu Lao (Five Labors), Qi Shang (Seven Injuries), and Liu Ji (Six Extremes). One is Zhi Lao (Labor of Will), two is Si Lao (Labor of Thought), three is Xin Lao (Labor of Heart), four is You Lao (Labor of Worry), five is Shou Lao (Labor of Emaciation). There is also Fei Lao (Lung Labor), characterized by shortness of breath and facial edema, and loss of smell. Gan Lao (Liver Labor) is characterized by dry, dark face and eyes, bitter taste, unsettled spirit, fearfulness preventing solitary sleeping, and blurred vision. Xin Lao (Heart Labor) is characterized by mental confusion and forgetfulness, difficult defecation or loose stools like duck dung, and mouth sores. Pi Lao (Spleen Labor) is characterized by a stiff tongue base and inability to swallow saliva. Shen Lao (Kidney Labor) is characterized by difficulty bending and extending the back, dysuria, reddish-yellow urine with dribbling, internal penile pain, damp scrotum with sores, and fullness/urgency in the lower abdomen. Regarding Liu Ji (Six Extremes): One is Qi Ji (Extremity of Qi), causing internal emptiness, deficiency of the five zang organs, excess of pathogenic factors, scarcity of healthy qi, and reluctance to speak. Two is Xue Ji (Extremity of Blood), causing lack of color, falling eyebrows and hair, mental confusion, and forgetfulness. Three is Jin Ji (Extremity of Sinews), causing frequent muscle cramps, pain in all ten fingers and nails, and debilitating fatigue preventing prolonged standing. Four is Gu Ji (Extremity of Bones), causing soreness and wasting, painful teeth, vexing pain in hands and feet, inability to stand, and reluctance to move. Five is Ji Ji (Extremity of Muscle), causing emaciation without luster, and food failing to generate muscle. Six is Jing Ji (Extremity of Essence), causing shortness of breath, shallow internal breathing, emptiness of the five zang organs, falling hair, sadness, and forgetfulness.

Regarding Qi Shang (Seven Injuries): One is excessive fullness injuring the Spleen, causing belching, desire to lie down, and yellow complexion. Two is great anger causing rebellious qi to injure the Liver, causing scanty qi and dim vision. Three is strenuous lifting or sitting long on wet ground injuring the Kidney, causing scanty essence, lower back pain, and cold extremities/jiao. Four is cold exposure and cold drinks injuring the Lung, causing scanty qi, cough, and nasal resonance. Five is sorrow and overthinking injuring the Heart, causing fright, forgetfulness, and emotional instability. Six is wind, rain, cold, and heat injuring the Form, causing withered and premature aging of skin and hair. Seven is great fear without moderation injuring Zhi (Will), causing mental vagueness and unhappiness. It is also said: Seven Injuries include: One is Yin Cold, two is Yin Impotence, three is Li Ji (Internal Urgency), four is Jing Han (Cold Essence), five is Jing Shao (Scant Essence) with damp genitals, six is Jing Qing (Clear Essence), seven is Ku Shu (Painful Frequency) of urination and failure to perform during intercourse.

Wang Jiezhai states: If one indulges excessively in sexual desires, damaging essence and blood, one will inevitably develop Bing Zheng (Pathological Conditions) of Yin Deficiency with Fire Hyperactivity. Symptoms include night sweats during sleep, afternoon fever, hacking cough, fatigue and weakness, reduced appetite, and in severe cases, blood-streaked sputum, hemoptysis, hematemesis, epistaxis, body heat with deep and rapid pulse, and muscle emaciation. This is named Lao Zhai (Consumptive Disease), which is the most difficult to treat. Mild cases require dozens of doses of medicine; severe cases take years. However, the patient must cherish life, strengthen their resolve, abstain from sexual activity, cease delusional thoughts, avoid anger, and regulate diet to cultivate their root. This is called internal and external combined treatment, which may preserve life.

Xue Lizhai states: The syndrome of Lao Zhai generally belongs to deficiency of the Foot Three Yin meridians, presenting as deficiency heat without fire, thus occurring during the day and stopping at night, or vice versa, appearing intermittently. One should primarily use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to tonify, and Bu Zhong Yi Qi Tang (Decoction for Supplementing the Middle and Augmenting the Qi) to regulate and tonify the Spleen and Stomach. If the Spleen and Stomach are damaged first, one should primarily use Bu Zhong Yi Qi Tang, supplemented by Liu Wei Di Huang Wan to gently warm the Liver and Kidney; many patients recover. If one mistakenly uses herbs like Huang Bo (Phellodendron Bark) and Zhi Mu (Anemarrhena Rhizome), it further damages the Spleen and Stomach, reduces food intake daily, increases deficiency in all organs, causes sinking of Yuan Qi (Original Qi), abdominal distension, and diarrhea, rendering it incurable. As for epistaxis and hematemesis, these occur because deficiency fire moves recklessly, carrying blood along with it to flow erratically, or because Yang Qi is deficient and cannot hold blood within the vessels, causing it to bleed randomly. The pulse is wiry and flooding, indicating rootless fire floating outward. Generally, this condition arises when Fire and Earth are too strong while Metal and Water are depleted, due to lack of maintenance, and especially during winter when fire qi hides but one does not avoid sexual intimacy, damaging true Yuan Qi. Thus, in late spring and early summer, one suffers headache, weak legs, poor appetite, and body heat, developing Zhu Xia (Summer Malady). Or, showing signs of premature aging, intolerance to cold and heat, and inability to bear labor, getting sick in every season. This is because Xin Qi (Heart Qi) was damaged by overwork while blood and qi were still growing, and Jing Xue (Essence and Blood) was squandered prematurely before full maturity, making the manifestations hard to describe. If the Left Chi (Cunian) pulse is weak, fine, or rapid, it indicates insufficiency of True Yin in the Left Kidney; use Liu Wei Di Huang Wan. If the Right Chi pulse is slow and soft, or deep, fine, and nearly imperceptible, it indicates insufficiency of Ministerial Fire in the Ming Men (Gate of Life); 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-Increment Pill). These all nourish the source of transformation, but one must still treat based on previous symptoms of fever and cough.