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The Yellow Emperor asked: There is a condition where the chest and hypochondrium feel distended and full, interfering with eating. Before the illness fully manifests, the patient first smells a fishy or foul odor, secretes clear fluid, expectorates blood, experiences cold limbs, dizziness, and bleeding from both the upper (vomiting) and lower (defecation) orifices. What is this disease called? How does it arise? Qibo replied: This disease is named "Blood Depletion" (Xueku). It arises from when the patient was young, having suffered massive blood loss, or engaging in sexual intercourse while intoxicated, leading to exhaustion of Qi and injury to the Liver. Consequently, menstruation becomes scanty or ceases entirely. The Yellow Emperor asked: How should it be treated? Qibo replied: Use four parts of Sepiae Endoconcha (Wuzhigu, cuttlefish bone) and one part of Rubia Cordifolia (Qiancao, madder root), combining these two substances. Form pills using quail eggs, sized like small beans. Take five pills before meals, washed down with Haliotidis Concha juice (Baoyujiao, abalone shell juice), to promote bowel movement and heal liver injury.

"Secretion of clear fluid" refers to frequently spitting out clear saliva, caused by Spleen deficiency failing to control saliva; "cold limbs" refers to coldness in the hands and feet; "bleeding from front and back" refers to blood in both urine/stool and vomit/blood. This is named Blood Depletion, occurring in both men and women, later generations calling it "Consumptive Disease" (Laosun). Exhaustion of Middle Qi means there is no Yang warmth to warm the limbs, resulting in coldness; Liver injury causes dizziness, hemoptysis, and hematochezia/hematuria; the Liver's failure to store blood leads to smelling a fishy odor at onset, commonly known as the smell of blood; rebellious Liver Qi causes chest and hypochondriac distension; disharmonious Stomach Qi interferes with eating.

Regarding the Sepiae Endoconcha Pill, Wang Jin San from Wu Men provided an excellent explanation in his *Gu Fang Xuan Zhu* (Selection and Annotation of Ancient Prescriptions); this should be consulted.

The *Suwen · Maijie Pian* states: When essence is depleted internally leading to厥 (Jue, reversal/collapse), it results in Yin (aphonia) and Fei (paralysis), which is due to Kidney deficiency. When the Shaoyin meridian Qi fails to arrive, it constitutes Jue.

The *Lingshu · Rebing Pian* states: In Fei disease, the body has no pain, the limbs are flaccid and unresponsive. If mental confusion is slight and speech is partially intelligible, it is treatable; if severe enough that speech is lost, it is untreatable. For diseases starting in the Yang aspect and later entering the Yin aspect, first select Yang meridians, then Yin meridians, using superficial needling.

Excess of pathogenic factors constitutes Excess patterns; depletion of essential Qi constitutes Deficiency patterns. This condition arises from internal injury depleting essence, causing Yang Qi to reverse and collapse, forming Yin and Fei. Thus, it is Kidney deficiency, and the Qi of the Shaoyin meridian cannot ascend to the base of the tongue, resulting in aphonia (Yin). Yang Qi rebelling upward leads to lower deficiency and Jue. Since it is not caused by external pathogenic factors, the body feels no pain; because primordial Yuan Qi is scattered, the limbs are flaccid and unable to hold themselves. If mental confusion is slight and speech can form sentences, allowing for some understanding, potent tonification methods can treat it; if severe enough to lose speech and Yuan Qi collapses, it is untreatable. Diseases arising from Yang are treated at Yang first, then Yin; "superficial selection" refers to shallow needle insertion to unblock meridian Qi; those arising from Yin should be treated via Yin meridians. The principles of herbal medicine can be inferred analogously. Medical texts refer to this as "Stroke-like Syndrome" (Lei Zhongfeng), because it stems from Liver and Kidney deficiency generating internal wind, rather than external wind pathogens.