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The formation of *Xu Lao* (Consumptive Disease) occurs when a person with existing deficiency is re-exposed to pathogenic factors. In cases of Yang deficiency, external cold is easily contracted, and the damage initially affects the Lung Meridian (Lung Channel). In cases of Yin deficiency, internal heat arises, and the damage originates from the Kidney. Damage caused by improper diet and overexertion stems from the Spleen.

When the Lung is damaged, symptoms include withered skin and hair, chills (feeling cold as if sprinkled with water), and cough. When the Heart is damaged, there is blood deficiency and stagnation of menstruation. When the Spleen is damaged, there is poor appetite, emaciation, and diarrhea. When the Liver is damaged, there is hypochondriac pain and reluctance to move. When the Kidney is damaged, there is bone atrophy (weakness of bones), inability to stand for long periods, afternoon fever, night sweats, and a sensation of steaming from the bones. If the disease starts from the lower part (Kidney) and progresses to withered skin and falling hair, death ensues. If it starts from the upper part (Lung) and progresses to bone atrophy such that the patient cannot rise from bed, the condition becomes terminal.

Unresolved fear injures Essence (*Jing*), apprehension and excessive thinking injure Spirit (*Shen*), unbounded joy injures Corporeal Soul (*Po*), profound sorrow injures Ethereal Soul (*Hun*), incessant worry injures Intellect (*Yi*), uncontrolled anger injures Willpower (*Zhi*), and excessive physical labor injures Qi (*Vital Energy*). This leads to the extreme depletion of Qi, Blood, Bone, Flesh, Sinew, and Essence.

[Note] "Deficiency" refers to the insufficiency of Yin-Yang, Qi-Blood, Ying-Wei (Nutritive-Defensive), Spirit-Essence, Marrow, and Body Fluids. "Damage" refers to the wasting of external tissues (skin, vessels, flesh, sinews, bones) and internal Zang organs (Lung, Heart, Spleen, Liver, Kidney). "Becoming Lao" means that prolonged deficiency fails to heal and evolves into Five Labors, Seven Injuries, and Six Extremes. "Re-exposure" means that a deficient person, if Yang-deficient and exposed to external cold, suffers damage starting from the skin/hair and Lungs; if Yin-deficient and generating internal heat, damage starts from marrow and Kidneys; if internally injured by diet and fatigue, damage starts from muscles and Spleen. These are the causes of consumptive disease. However, there are five types of syndromes: 1. Damage to skin/hair with chills and cough is Lung Labor; 2. Damage to blood vessels with pallor in men and amenorrhea in women is Heart Labor; 3. Damage with reduced intake, emaciation, and loose stools is Spleen Labor; 4. Damage with hypochondriac pain radiating to the chest and flaccid sinews preventing walking is Liver Labor; 5. Damage with bone atrophy, afternoon fever, and night sweats is Kidney Labor. If damage begins from the Kidney and reaches withered skin/falling hair, death occurs. If it begins from the Lung and reaches bone atrophy preventing rising, death occurs. If it begins from the Spleen, whether reaching withered skin or bone atrophy, death occurs.

Consumptive disease manifests as Seven Injuries: 1. Unresolved fear injures Essence; essence injury leads to sore/weak legs, impotence, and spontaneous emission. Since the Five Zang store Essence, injury leads to Yin deficiency, lack of Qi, and death. 2. Apprehension and thinking injure Shen; Shen injury leads to fear and loss of self, muscle wasting, withered hair, and sallow complexion, leading to death in Winter. 3. Unbounded joy injures Po; Po injury leads to mania, disregard for others, scorched skin/hair, and sallow complexion, leading to death in Summer. 4. Profound sorrow injures Hun; Hun injury leads to madness, impropriety, genital retraction, sinew spasm, immobility of hypochondriac bones, withered hair, and sallow complexion, leading to death in Autumn. 5. Incessant worry injures Yi; Yi injury leads to confusion, immobility of limbs, withered hair, and sallow complexion, leading to death in Spring. 6. Uncontrolled anger injures Zhi; Zhi injury leads to forgetfulness, stiffness of waist/spine, withered hair, and sallow complexion, leading to death in Late Summer. 7. Excessive labor injures Qi; Qi injury allows Fire to flourish, which consumes Qi, leading to asthenia, sweating, dispersion of Qi, and eventual death.

Consumptive disease manifests as Six Extremes: 1. Frequent cramps and nail pain are Sinew Extreme. 2. Loose teeth, limb pain, and inability to stand are Bone Extreme. 3. Pallor and hair loss are Blood Extreme. 4. Sensation of insects crawling on the body, emaciation, and dry black skin are Flesh Extreme. 5. Weak Qi, lack of luster, severe thinness, dull eyes, instability, itching, and sores from scratching are Essence Extreme. 6. Chest/hypochondriac fullness, irritability, inability to speak due to weak Qi are Qi Extreme.

[Commentary] Previous classifications of the Seven Injuries were often inconsistent. This text has been revised according to the *Neijing* (Inner Canon) to facilitate understanding for future students.