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(Wu Re Xu Lao, being Yang Deficiency Syndrome, its pathology proceeds from above downward, representing the pulse pattern of depletion. The treatment principle should be warming and tonifying. Only Mr. Dongyuan (Li Dongyuan), Yuanli (Xue Ji), and Lizhai (Xue Li) independently mastered this treatment method, which is worthy of emulation. Qi deficiency is easy to tonify; it is best to treat early, unlike Heat-type Xu Lao which is difficult to manage.)

Wu Re Xu Lao (Deficiency Consumption without Heat) belongs to Yang Deficiency Syndrome. Its pathology progresses from the upper body to the lower body, reflecting the pulse pattern of organ depletion. The therapeutic principle should employ Warming and Tonification (Wen Bu). Only Master Li Dongyuan, Xue Ji (courtesy name Yuanli), and Xue Li (courtesy name Lizhai) uniquely grasped the correct treatment for this condition, and their methods should be emulated. Qi Deficiency (Qi Xu) is relatively easy to tonify, so early intervention is ideal, unlike Heat-type Xu Lao which is more difficult to treat.

*Da Quan* states: Women's Cold Lao (Cold Consumption) belongs to Blood and Qi Insufficiency, with deficiency-cold in the Zang-Fu organs, leading to cold pain below the umbilicus, intermittent coldness in the hands and feet, irregular menstruation, indigestion, occasional vomiting, aversion to cold with fever, soreness and pain in bone joints, emaciation of the skin and muscles, and sallow complexion.

Master Xue stated: The aforementioned syndromes include those with true cold internally and externally, true heat internally and externally, true heat internally with false cold externally, and true cold internally with false heat externally. If digestion is difficult, stools are unformed, there is borborygmus and abdominal pain, food intake is feared due to cold, hands and feet are cold up to the elbows/knees, the face is yellow with vomiting, and there is aversion to wind and cold, this is a syndrome of True Cold Internally and Externally. It is appropriate to use Fuzi Lizhong Tang (Aconite Decoction for Regulating the Middle) to restore Yang, and Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia) to strengthen the Fire of the Gate of Vitality. If diet is normal, stools are firm, there is chest and abdominal fullness and distension, preference for cold drinks, hot sensations in the hands and feet, red face with vomiting, and no aversion to wind or cold, this is a syndrome of True Heat Internally and Externally. (The presence or absence of heat can indicate the deficiency or excess of Qi and Blood. The diagnostic and treatment methods of Lizhai can supplement the preceding discussion.) It is appropriate to use Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxicity) to clear Yang-Heat, and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to nourish Water. If diet is normal, stools are firm, there is chest and abdominal fullness and distension, preference for cold food, cold hands and feet, yellow face with vomiting, and aversion to wind and cold, this is a syndrome of True Heat Internally with False Cold Externally. One should also use Jiedu Tang (Decoction for Resolving Toxicity) and Liuwei Wan (Six-Ingredient Pill). If appetite is poor, stools are unformed, there is acid regurgitation and belching, chest and abdominal fullness, cold hands and feet, red face with vomiting, and aversion to wind and cold, this is a syndrome of True Cold Internally with False Heat Externally. One should also use Fuzi Lizhong Tang and Bawei Wan (Eight-Ingredient Pill), seeking the root cause (Shu) to treat it. The Classics state: "Enrich the source of Fire to dissipate Yin shadows; strengthen the master of Water to control Solar brilliance." If one does not understand the insufficiency of True Water and True Fire, and indiscriminately uses cold or hot medicines, old diseases will not leave, and new diseases will arise. The term "Shu" (Affiliation/Root) refers to "Zhu" (Master), meaning Heart and Kidney. Seeking the Shu means addressing insufficiency of Water and Fire by treating the Heart and Kidney. The Source of Fire is the root of Yang Qi, which is the Heart. The Master of Water is the root of Yin Qi, which is the Kidney. It does not mean that Fire belongs to the Heart and Source to the Liver, nor that Water belongs to the Kidney and Master to the Lung.

A woman had poor appetite and vomiting, spat out phlegm-saliva, had a yellow face, abdominal pain, irregular menstruation, and cold hands and feet. This was a syndrome of Cold both Internally and Externally. (Why were Fuzi and Lizhong not used given the internal and external cold?) She was treated with Liujun Zi Tang (Six-Gentlemen Decoction) added with Xiangfu (Cyperus Rhizome) and Muxiang (Aucklandiae Radix), and she recovered.

A woman suddenly vomited sour fluid, felt internal heat and thirst, could not eat, only desired cold water, had a bluish-red complexion, and vomited immediately after taking medicine. This was a syndrome of True Heat Internally and Externally. After more than ten days, she drank a decoction of a single herb, Huanglian (Coptidis Rhizoma), slowly adding Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuling (Poria), followed by Chenpi (Citri Reticulatae Pericarpium), Danggui (Angelicae Sinensis Radix), and Zhigancao (Prepared Licorice Root). After more than a month, she could finally consume rice water and thin porridge, and recovered through regulation. (Since it was True Heat Internally and Externally, why was Sanhuang Jiedu Tang not used, but only a single dose of Huanglian? To directly drain the source of fire. The addition of Baizhu and other herbs was to prevent bitter-cold medicines from damaging the Stomach.)

A woman had internal heat, thirst, constipation, aversion to wind and cold, and cold hands and feet. This was True Heat Internally with False Cold Externally. She first used Huanglian Jiedu Tang, then Liuwei Dihuang Wan, and recovered. (Due to symptoms of heat-thirst and constipation, even though her limbs were cold, it was false cold. However, purgatives might also be applicable in some cases. Later using Liuwei Dihuang Wan was to seek the root. One must distinguish deficiency and excess by whether the pulse is forceful or weak.)

A woman initially suffered from phlegm-wheezing, heat, and thirst. A doctor treated her with clearing-fire and dispersing-Qi methods. Her muscles wasted away daily, and her Qi declined. By the year Jiachen, Wood Qi was prosperous, Phlegm was abundant, she had body heat, oral ulcers, abdominal distension, and coma, nearly dying from starvation. This was a case of Deficient Heat without Fire (referring to the aftermath of mis-treatment leading to severe deficiency), and she was administered formulas to Strengthen Fire to Generate Earth (Zhuang Huo Sheng Tu). She responded immediately. Years later, in early summer, when sitting her head felt heavy and she could not lift it to look around; when lying down her back felt cold, as if wind penetrated her body; she experienced irritability, heat, dizziness, coughing, vomiting, profuse phlegm, and numb, cold hands and feet. This was a syndrome of True Cold Internally with False Heat Externally. She was then administered a large-dose formula containing Jiang (Zingiberis Rhizoma) and Fu Zi (Aconiti Lateralis Radix Praeparata). Within three to four doses, the major symptoms subsided. She continued with modified versions of the previous prescription and recovered. (This obtained the method of "Treating Heat with Cold" [Reversal Treatment], following the false presentation.)

Han Mao treated his sister-in-law, who was over thirty years old. (This case is repeated, but retained to preserve potential lost knowledge.) She had eighteen pregnancies, nine ended in infant death. Due to family difficulties, excessive shock and worry led to unconsciousness, sores on lips, tongue, and throat blocking the airway, lower body collapse, and leukorrhea like a gush. For over forty days, she occasionally regained consciousness, contemplated suicide, and was unbearable in grief. Doctors who administered cooling agents to resolve upper symptoms caused lower symptoms to worsen. Those who administered heating agents or steamed the lower body with herbal decoctions caused heat-induced fainting. This was a syndrome of Yang Collapse (Clearly Upper Excess and Lower Deficiency, fitting the principle of Heat due to Cold usage). Urgently, he used Yan Zhu Da Fu Zi (Salt-prepared Large Aconite) 9 qian as the sovereign herb, processed with Bohe (Menthae Haplocalycis Herba) and Fangfeng (Saposhnikoviae Radix), assisted by Xiong (Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), Jiang (Zingiberis Rhizoma), and Rougui (Cinnamomi Cortex). It was decocted in water, cooled in a well, and administered. Before the dose was finished, she slept soundly all night and woke up recognizing people. Someone asked: What is this? He replied: Medical texts state, "Treat the false with the false, the true with the true." The upper part presented False Heat, so false-cold medicines were used to follow it. The lower part presented True Cold, so true-hot medicines were used to oppose it. Thus, the upper and lower harmonized, and the disease resolved. Subsequently, Nvjin Dan (Women's Golden Pill) was used. By intricately combining two or three formulas, not only was the disease removed, but Yuan Qi (Primal Qi) was regulated. Soon after, she gave birth to two sons.

The above discussions and verified treatments address whether they apply to Xu Lao, but essentially they are the great principles of flexibly treating Cold and Heat variations. They must not fail to be examined carefully.