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In men around the age of twenty, excessive sexual activity damages essence and blood, inevitably leading to a disease pattern of Yin deficiency with hyperactive fire (Yin Xu Huo Dong). Symptoms include night sweats during sleep, afternoon fever, harsh coughing, fatigue and weakness, and reduced appetite. In severe cases, sputum may contain blood, or there may be hemoptysis, hematemesis, or epistaxis. The body feels hot while the pulse is deep and rapid (Chen Shu), and muscles emaciate. This is termed Lao Zhai (Consumption Disease), which is the most severe and difficult to treat. If treated early, it is easy to cure; however, if it progresses to muscle wasting, bedridden state, and a deep, hidden, fine, and rapid pulse, it becomes difficult to manage. (Ming Yi Za Zhu)

Lao Zhai manifests in various ways: some present with dry throat, itchy pharynx, frequent coughing without sputum; others have asthma, chest fullness, urgency, qi obstruction, and insomnia; some have blood in sputum that appears immediately upon coughing; some have a face that is often hot or experiences chills resembling cold sensations; some feel heat like fire in the chest but have cold feet; some have lower back pain, upper back pain, and weak sinews and bones. All these belong to deficiency patterns. What about nocturnal emission, "ghost intercourse" (dreams of sexual union), spontaneous sweating, night sweats, bone-steaming fever, and tidal fever? Are these not also caused by deficiency? (Dan Tai Yu An)

Five Steaming Disorders and Transmission among the Five Zang Organs. There are five types of steaming disorders:
1. Bone Steaming (Gu Zheng): Its root is in the Kidney. The body is cool in the morning but heats up in the evening. There is irritability, restless sleep, loss of taste, dark yellow urine, mental confusion, shortness of breath with weakness, lower back pain, inverted coldness in both feet, and constant heat in the palms. If the steaming becomes excessive and damaging, it internally transforms into Gan accumulation (Gan Ji), consuming the five Zang organs.
2. Pulse Steaming (Mai Zheng): Its root is in the Heart. Irritation and oppression increase daily. The patient throws hands and feet out, desires water intermittently, foams at the mouth, speaks incoherently during sleep, or experiences unsteady fear and fright. The pulse is rapid. During peak steaming, it may transform into Gan accumulation, causing sub-umbilical oppression or violent, unceasing diarrhea.
3. Skin Steaming (Pi Zheng): Its root is in the Lung. There must be severe panting, dry nose, no moisture in the mouth, white coating on the tongue, and urine as red as blood. During peak steaming, there is chest fullness, or the patient claims to have contracted "Zhu Re" (Transmitted Heat), distension under both hypochondria, severe coughing radiating to the back and scapula, restless sleep, or steaming toxins injuring the organs causing blood in saliva.
4. Flesh Steaming (Rou Zheng): Its root is in the Spleen. The body is hot like fire, irritable, anhidrotic, with abdominal distension and bloating. Vomiting occurs after eating, urine resembles blood, and stool is dry and difficult to pass. During peak steaming, the body swells, eyes become red, and sleep is restless.
5. Internal Steaming (Nei Zheng), also called Blood Steaming (Xue Zheng): It is named Internal Steaming because there is external cold but internal heat; placing the hand on the bone reveals intense internal heat. Its root lies in the five Zang and six Fu organs. This condition typically arises after an illness. Muscles and bones waste away, taste is lost, skin is dry and lusterless. During peak steaming, limbs gradually thin, and the dorsum of the feet swells. (Zhu Bing Yuan Hou Lun) [Note: The original text lists twenty-three additional steaming disorders, omitted here.]

Su You stated: The disease of Chuan Shi (Transmitting Corpse) originates from nowhere. It affects people of all ages and genders. Generally, this disease spreads through transmission. First, toxic qi transmits internally, circulating through the five Zang organs, gradually leading to emaciation and death. After death, it transfers to one family member, hence the name Chuan Shi, also known as Zhuan Zhu (Rotating Note). Because initially the patient is half-lying and half-sitting, it is called Shi Zhu (Corpse Note); with urgent breathing and coughing, it is named Fei Wei (Lung Withering); with heat in the bone marrow, it is called Gu Zheng (Bone Steaming); transmitting internally to the five Zang organs, it is named Fu Lian (Hidden Link). If not treated, it can lead to the extinction of the entire family. If a man contracts this due to deficiency, it is named Lao Ji (Extreme Exhaustion); in Wu and Chu regions, it is called Lin Li; in Ba and Shu regions, it is called Ji Lao. The source begins in the Kidney. Initially, the qi invasion causes soreness and pain in both calves, stiffness and tension in the waist and spine, weakness in walking and standing, reduced food and drink intake, buzzing sounds in both ears resembling wind, nocturnal emissions during sleep, and dampness and flaccidity in the genitalia. After the Kidney is affected, it transmits to the Heart. When the Heart first receives the qi, there is heart fright during sleep, palpitations, a feeling of emptiness and lack of qi in the chest, shallow breathing as if ending, dreams of deceased relatives, occasional night sweats, loss of taste, oral ulcers, constant mental heat, desire to lie down, symptoms lighter in the morning and heavier in the evening, bright red cheeks and lips like rouge, and sometimes heat in the five centers (palms, soles, and chest). After the Heart is affected, it transmits to the Lung. When the Lung first receives the qi, there is frequent coughing, weak strength, occasional panting, worsening when lying down, dry nose and mouth, loss of smell. If smell is perceived, only putrid odors are detected. Sometimes nausea, dizziness, and urge to vomit occur. Skin and muscles become dry, sometimes with stinging pain or a sensation like insects crawling, with fine scaling resembling bran. After the Lung is affected, it transmits to the Liver. When the Liver first receives the qi, vision is blurred, complexion lacks blood color, frequent frowning, poor distance vision, dry and gritty eyes, sometimes red and painful, or yellow sclera. Vision is unclear day and night, eyes constantly want to close, and sleep is elusive. After the Liver is affected, it transmits to the Spleen. When the Spleen first receives the qi, there is empty distension in both hypochondria, indigestion, thirst and diarrhea, undigested food in stool, abdominal pain, borborygmus, dry and cracked lips and mouth, oral ulcers or swelling, dry and erect hair lacking luster, sometimes upward rushing of qi, shoulder-lifting panting, and passage of red-black fluid. At this stage, it is a sign of impending death. (Wai Tai Mi Yao)

It is further stated: The signs of toxic qi transmitting through the five Zang organs do not exceed this example. Careful observation ensures accuracy. (Ibid.)

Signs are divided into Upper and Lower. There are two types of signs: When fire rushes to the Upper Jiao, fever is accompanied by coughing, panting, expectoration, hemoptysis, and signs of Fei Wei (Lung Withering) and Fei Yong (Lung Abscess). When fire knots in the Lower Jiao, fever is accompanied by strangury, turbid urine, constipation, seminal emission, night sweats, abdominal pain, and palpitations. (Dan Xi Xin Fa · Appendix)

Feng Lao (Wind Consumption). Feng Lao begins with coughing and nasal congestion. Over time, wind pathogen transmits inward, depleting qi and blood, gradually transforming into consumption. Later physicians mistakenly identified it as internal injury and accumulated damage, administering harsh tonics. This traps the wind pathogen, intensifying internal heat, leading to untreatable conditions. Only Luo Qianfu advocated using Qin Jiao Bie Jia San, and Wu Shen Huang Ji used Chai Qian Mei Lian San. These two masters contributed insights previously unexpressed. (Zheng Hui Hui Bu) [Note: Mei Lian San uses Chai Hu, Qian Hu, Wu Mei, and Hu Huang Lian, omitted here.]

If residual heat from Shang Han (Cold Damage) remains unfinished, or if care is neglected, leading to prolonged coughing, alternating chills and fever, hemoptysis, and epistaxis, resembling Lao Zhai, this is due to deficient Yuan Qi with lingering pathogenic factors. Standard treatment involves qi-nourishing and blood-generating herbs, combined with Xiao Chai Hu Tang, Qing Hao Bie Jia Tang, or Qian Hu, Chai Hu, Shi Gao, etc., modified according to syndrome. Recovery is assured. Pure tonics should be avoided, and it must not be mistaken for deficiency consumption where warm tonics like Du Zhong, Shu Di, and Shan Yu Rou are lightly used. (Jin Kui Yi) [Note: This view originates from Wang Zhizhong's Shang Han Gang Mu, though such signs may not necessarily be the progression of Gu Zheng.]

Chong Hui Lao (Parasitic Roundworm Consumption). Red lips, spasmodic and bi-syndrome of sinews with blue veins traversing the lower abdomen, craving for eating soil/clods. Treat with Li Zhong An Hui Tang or Shen Shou San from San Yin Fang. (Shi Bing Jie Fa) [Note: Shen Shou San consists solely of Chuan Jiao, cited from the Lao Zhai section.]

Mei Du Lao (Plague Toxin Consumption). Persistent infection with plague toxin leads to bone and joint pain, chronic ulceration, eventually becoming consumption. Treat with Xian Yi Ling Qi Liang Tang. (Ibid.) [Note: Qi Liang Tang is identical to Sou Feng Jie Du Tang.]

Accompanying Phlegm Accumulation. When Lao Zhai accompanies phlegm accumulation, symptoms include constant heat in the abdomen and hypochondria, with sudden coolness in the hands, feet, head, and face during the Yin and Mao hours (5 AM - 9 AM). If phlegm accumulation blocks the meridians, making the Tai Chong pulse and Chong Yang/Cun Kou pulses rapid but unresponsive to each other, it is extremely difficult to treat. (Ben Cao Gang Mu) [Should be considered alongside Dang Gui Long Hui Wan in formulas for removing masses.]

Women's Consumption [Attached to Similar Syndromes]. For women and maidens, if menstruation starts then suddenly stops, irregularly timed, this is the precursor to Lao Zhai. Wise practitioners should not ignore it because it seems superficial. Initially due to irregular cycles, it ultimately leads to amenorrhea. Afternoon fever, coughing with blood, dry cough, or coughing with phlegm-fluid, irritability, inability to lie flat, difficulty in urination and defecation, and fine-rapid pulses in all six positions indicate incurable syndromes. Currently, seeing maidens aged fifteen or sixteen whose Tian Gui (menstrual blood) has just started, with cycles lasting months or half-years, coming and going, then suddenly stopping, accompanied by fever, cough, and loss of appetite. Rapid regulation using blood-nourishing and spleen-harmonizing methods may achieve recovery. However, modern doctors fail to investigate, instead using blood-breaking and meridian-unblocking acrid-hot drugs. This consumes qi and blood, augments fire damaging the spleen, leaving no hope for recovery. This syndrome likely originates in the Spleen, caused by overthinking and emotional injury, leading to qi-blood imbalance, preventing timely menstruation. If it stops completely, it is due to internal fire steaming and consuming Yuan Qi, leading to death. Good physicians should first regulate the Spleen to nourish blood. Avoid acrid-dry fire-augmenting substances. For example, Xiang Fu should only be used in small amounts; Fu Xiong should not be used heavily. Drugs like Jiang, Gui, Xiang Sha, Yan Hu Suo, E Zhu, Wu Yao, and Chang Pu, which break and consume, should not be used lightly. Violating these rules often leads to fatal outcomes. Good physicians must examine this deeply. (Yi Tong)

For maidens and widows whose thoughts injure heart blood, causing fire flaming upward, spleen deficiency, lung dryness, kidney depletion, and blood closure leading to consumption, use Si Wu Tang added with Chai Hu and Huang Qin as the main treatment, or Xiao Yao San added with Zhi Zi, Huang Qin, and Huang Lian to nourish blood and descend fire. (Shi Lin Yu Ye) [Note: Yi Tong states: For maiden menstrual irregularity, resolving depression should be the primary focus.]

Zhang Shi said: For maidens with long-standing amenorrhea, Qing Hao and other cooling drugs must absolutely not be used. Many doctors assume maiden blood heat and use cooling drugs to resolve it. They do not realize that blood moves with heat and coagulates with cold, as detailed in Yang Sheng Bi Yong Fang. This theory is highly reasonable and must be understood. (Fu Ren Liang Fang)

Sore Throat. In the human body, Water ascends and Fire descends. Without obstruction or stagnation, the throat is free and the larynx smooth. If Earth declines and Water dries up, Ministerial Fire steams and flares, causing dehydration. Thus, throat dryness and pain syndromes arise. When Fire disease reaches this stage, it signifies true Yin failing to maintain control, isolated Yang having no root, floating upward to cause this condition. Which phlegm-fire syndrome is more severe than this? The so-called Dragon-Lei Fire cannot be subdued by water alone. One must nourish Yin and suppress Yang, allowing Water to ascend and Fire to descend, restoring fluids before it can stop. Using bitter-cold treatments directly will intensify Yin fire and collapse Spleen Earth, akin to drinking poison, leading to immediate death. (Tan Huo Dian Xue)

Diarrhea [See Diarrhea Section]. Diarrhea is the beginning of Yin loss and fluid exhaustion. In phlegm-fire diseases, this symptom is like frost-bitten withered leaves; few survive. Why? Because Yin deficiency generates fire, and diarrhea further depletes Yin. Clear Yang sinks further, Ministerial Fire flares higher. Below, there is urgency; above, throat pain. Various syndromes arise蜂起 (swarm). At this moment, tonifying Earth hinders the Lung, clearing Metal hinders the Spleen. Can the physician avoid being constrained? Temporarily use herbs that strengthen Earth and clear Metal, powdered into pills, taken slowly. This respects the Harmony of Heaven. Ban Gu said, "Not treating a disease yields a mediocre doctor," which is precisely the meaning. (Dian Xue) [Note: Pill formula seen in subsequent tonic formulas.]

Life and Death Decree. Su You said: If this disease causes wasting of the flesh on the spine and arms, and protrusion of chest bones, it is hard to treat. Bloody-black dysentery combined with upward rushing of qi and shoulder-lifting panting are signs of impending death, indicating organ failure. (Wai Tai Mi Yao)

Rapid, urgent, and rapid pulse indicates the extinction of Spleen Spirit; loss of voice and dry throat indicates the extinction of Heart Qi; white or black lips indicate failure of Stomach and Kidney; face like dried bone or with rouge-like flush indicates dispersion and escape of True Qi. All are untreatable. (Yong Lei)

When Zhai disease reaches bone pain and skeletal flaccidity, deep/hoarse voice, withered pulse, and sallow complexion, survival is impossible. (Zhi Zhi Fang)

Yin Deficiency Consumption has twelve treatable signs: Treatable if Yuan Qi is not exhausted; if Stomach Qi exists; if no panting, phlegm, cough, or blood; if no high fever; if muscles and bones are not wasted; if the pulse has a root upon pressing; if stool is firm; if the body can tolerate tonification; if the Spleen and Stomach can accept cooling/fire-descending herbs; if the patient observes restrictions; if heat can be resolved; if deficiency can be tonified. (Pu Du Ci Hang)

Yin Deficiency Consumption has twenty untreatable signs: Untreatable if no Stomach Qi; if phlegm-fire alternates, insomnia, coughing, hemoptysis, and bone-steaming occur; if unable to tolerate tonification; if cheeks are red, lips crimson, tidal fever without timing, and severe emaciation; if skeletal flaccidity; if unceasing diarrhea with pulse lacking Spleen quality; if hoarseness differs from usual; if pulse is wiry, urgent, and long; if medication produces no change; if it is Chuan Shi; if pulse is fine, rapid, and hurried, powerless upon pressing; if all syndromes gather; if heat is mild but Yuan Qi is exhausted first; if constitution is inherently weak and cannot endure suffering; if Yin fire rises from feet to abdomen; if fire blazes ceaselessly with dry throat and ulcers; if Spleen-Stomach deficiency-cold prevents taking fire-descending herbs; if panting is unceasing with Lung Withering and obstruction; if massive hemoptysis and unceasing epistaxis; if mind is troubled, unable to nurture, with stagnant Seven Emotions; if nocturnal emission, vaginal laxity, night sweats, and internal cold are unceasing. (Ibid.)

Once deficiency damage is established, how can recovery occur without tonification? Yet some cannot take Ren Shen, Shu Di, or other tonics. This is "deficiency unable to tolerate tonification"; how can life be expected? After consumption-related hemoptysis or blood loss, if coughing persists with copious sputum, this is due to extreme Spleen-Lung deficiency. Food cannot transform into blood but turns into phlegm with ingestion. Although not blood, it belongs to the category of blood. The Classics state: "White blood exiting means death." Therefore, the most abundant and turbid sputum is untreatable. [Note: Shou Shi Bao Yuan states: Yellow-thick sputum indicates presence of Qi and is treatable; fish-mucus-white foam indicates absence of Yuan Qi and is difficult to heal.] Left and Right are the pathways of Yin and Yang. Those who cannot sleep on either side or turn easily have biased exhaustion of Yin-Yang Qi; mostly untreatable. [Note: Yi Tong states: For consumption patients, inability to sleep on one side is also fatal. Ding Bu Ming Yi Zhi Zhang states: Lack of blood to nourish sinews prevents movement.] Patients with deficiency damage originally have no external pathogens. Thus, despite severe illness, they remain lucid. If a deficiency patient presents with delirium and disorder without external heat, this indicates Heart failure and departure of Shen; death is certain. Consumption cough with aphonia, inability to speak, or urgent panting indicates Lung failure; death is certain. Complete muscle wasting from consumption indicates Spleen failure; death is certain. Sinews are the root of exhaustion. Deficiency patients often have bone-joint pain. If pain is unbearable, it indicates blood exhaustion failing to nourish sinews, i.e., Liver failure; death is certain. Prolonged consumption followed by unceasing diarrhea indicates Kidney failure; death is certain. [Note: Dian Xue states: Phlegm-fire diarrhea with undigested food indicates Stomach Qi extinction; death is untreatable.] (Jing Yue Quan Shu)

Phlegm-fire left hypochondriac pain with inability to turn indicates dried Liver lobes, named Gan Xue Tong (Dry Blood Pain). Liver Meridian extinction; death is untreatable. Phlegm-fire with no flesh on the buttock tip indicates Spleen Meridian extinction; death is untreatable. (Tan Huo Dian Xue)

Bone Steaming with red malar eminences is untreatable. (Internal heat of Bone Steaming stems from Kidney deficiency. Kidney belongs to Water; Water nature is cold. Kidney nature is cold. Fullness brings cold; deficiency brings heat. Kidney heat causes fire to steam bones, heating marrow. Kidney governs bone marrow; malar eminences are the root of bone.)

Lao Zhai with sudden lower body carbuncles/swellings results in death. Hemorrhoids/fistulas preceding consumption result in death; consumption preceding hemorrhoids/fistulas also results in death. (Hemorrhoids/fistulas connect to Large Intestine; Large Intestine is the Interior-Exterior partner of Lung. Lung scorched by fire, transferring heat to Large Intestine.) (Ding Bu Ming Yi Zhi Zhang)

Consumption patients with chronic fistulas or sudden lower body swellings/toxoms have no hope of survival. (Deficient fire attacks纵横, flowing toxicity into intestines/stomach, directly injecting into Upper and Lower Jiao.) (Wang Shi Yi Jing)

Young males and females have fragile and tender Zang-Fu organs. Heat steaming facilitates transmission. If there is slight edema on the head, face, or limbs, the momentum is already established; even with divine elixirs, rescue is impossible. (Yi Xue Yao Ze)

General Discussion on Treatment Methods. Su You said: Someone might偶然ly obtain a prescription claiming to treat Bone Steaming, without investigating the root, and lightly use it. Since the main treatment does not match, the cure date is unknown. Such people seek no advice from experts, relying solely on their own merit. Such individuals are common. For instance, using a formula for Lung Withering/Bone Steaming to treat Shi Zhu/Pi Chuan Shi increases the disease. How could recovery occur? Formulas for Lung Withering contain many cold herbs. Cold herbs are unsuitable for Shi Zhu. Using them for Shi Zhu is counterproductive, not only failing to cure but damaging the Spleen. The Spleen prefers warmth, not cold. Injury to cold causes Spleen Qi decline. Signs of Spleen decline include empty fullness in hypochondria, indigestion, and diarrhea. Such rigid application, seeking benefit but causing harm, shows ultimate ignorance, truly pitiable. I mention one corner; others follow suit. (Wai Tai Mi Yao)

It is further stated: Treatment methods must first investigate the root, examine symptoms, diagnose the three Pulses (Cun, Guan, Chi), determine severity, assess feasibility, administer decoctions, and set a timeframe for recovery. Only then can treatment begin. Treat the root first, then the branches. Acupuncture, decoctions, and powders must correspond. Do not expect quick recovery from deep-rooted diseases with minimal dosage. Do not stop medication before improvement, then claim the medicine mismatches the disease. Such suspicion is rejected by me. Some originate post-malaria, some post-dysentery. The roots vary. Briefly outline the principles and treat by analogy. (Ibid.)

Generally, treatment prioritizes preserving essence and blood,其次 (secondarily) eliminating parasites. An Xi (Benzoin), Su He (Styrax), A Wei (Opopanax), She Xiang (Musk), Xi Jiao (Rhinoceros Horn), Dan Sha (Cinnabar), Xiong Huang (Realgar) are indeed agents to drive away evil qi. (Zhi Zhi Fang)

Modern people often use cooling drugs, damaging Stomach Qi; even Lu Bian (Lu Gu and Bian Que) would find it difficult. My discussion focuses on opening the gate and managing the Stomach. Why? In consumption diseases, blood and qi do not circulate, leading to dryness. This is a closed Guan pulse. Therefore, use opening drugs first to unblock blood vessels. Once opened, revive the Stomach. All five Zang organs possess Stomach Qi. Pathogens attaching to them weaken the Zang. Without managing the Stomach, how can other drugs act? Thus, opening the gate and managing the Stomach is the subtle method for treating consumption. However, one must understand Yin and Yang. For Yang disease drugs reviving the Stomach, do not make them too warm. For Yin disease drugs, do not make them too cool. People today say Ding Xiang, Hou Po, Rou Gui, Rong Rong can tonify the five Zang. Ignorance leads to panting and closed coughing, adding fire to heat. Some prioritize treating ghosts. One must combine method and medicine, utilizing Daoist power to support, then ghost corpses can be expelled. (Yong Lei Qian Fang, citing Mr. Shuiqiu) [Note: Yang Disease Opening Gate Powder uses Chai Hu, Jie Geng, Dang Gui, Bai Shao, Qin Jiao, Mai Men Dong, Mu Xiang, Ze Xie, Mu Tong, Sang Bai Pi, Di Gu Pi, Gan Cao. Yin Disease Closing Gate Powder uses Dang Gui, Bai Shao, Gui Zhi, Bai Zhi, Gan Cao, Mu Xiang, Zhi Ke, Nan Xing. Revive...]