血之营运。听命于气。气乃先天肾水之中。一点生阳。静而复动。化生精血。若以房劳伤其精血。则水虚而
火发。气动而血升。乌有病之不发乎。宜都气丸。加麦冬龟鹿胶治之。火盛者。大补阴丸。加鹿胶桑螵蛸治
之。或加味虎潜丸。脾肾兼治。或三才汤。加桑螵蛸秋石海粉黄柏紫梢花治之。失血之人。以养息为第一。
若不忌房劳。是自促命期。于医何咎。
世谓妇人有胎。复得咳嗽发热骨蒸。或吐血。或梦交。名为抱儿痨。其胎不能孕满十月。或七八月。或五六
月。胎便萎堕。儿不长成。其每坐产之后。不得盈月。定然废命。古书不见名论。俗医又无治法。世皆以死证
目之。而死者果相接踵。良可哀也。夫妇人怀孕。其气血既结养胞胎。又加以病。再耗其气血。一身之气血
无多。那堪两件消耗。是以其胎不能长养。而母被胎困。又受病侵。双斧伐枯树。不死何待。顾其受命之重。
诚如所云。而果得治法。何难起死回生哉。吾妻病此。亲手调治。竟得保全。始知抱儿痨之所以不起者。失
治之咎耳。夫妇人血和。然后有子。血病于是胎病。治之之法。总视其证。有时以安胎为主。胎安则母自安。
有时以治病为主。病去则胎自固。据其见证。照病用药。自无不愈者也。大旨此病。世皆谓为极虚之证。而
不知此病。多是实邪。何以言之。盖人身除肠胃中。皆不可有物塞碍。是以针砭刺穴。停住片时。即能堵塞
其气。况胎乃块然一大物。塞于下部。则气实而喘。气逆而呕。气盛而为火。皆以其壅塞故也。夫人之怀孕。
不啻藏珍。而胎之病患。有如积块。是以怀孕之脉。沉分搏指。亦与下焦积块之脉相似。第积块攻而通之。
则实邪去而人安。胎则无攻通之法。是以不便施治。然有逆实之证。亦须消息。以补兼攻。斯不至留病为
患。盖必摆脱一切拘禁。而后可救。皆不能救之死证。内经云。有故无殒也。则知不拘禁例。一意治病。为安
胎最上之法。故抱儿痨。吐血逆满。不须顾胎。直宜凉血泄瘀。丹皮桃仁。所以不忌。瘀血既去。则不壅热。去
旧生新。胎反得新血之养。若气逆火甚。非寻常杏仁枳壳枯芩等药所能治者。酒炒大黄。亦间可用。又凡
此病。皆胎气壅于下部。反而上熏肺金。直当其气。故治抱儿痨以保养肺金。为第一要法。清燥救肺汤。紫
菀散主之。痰凝气阻。咳逆不休者。豁痰丸治之。水饮冲肺。肺胀咳嗽。不得卧息者。葶苈大枣泻肺汤主之。
桔梗宁肺汤。补泻兼行。保和汤。多补少泻。皆宜酌用。此病发于胞中。其本在下。清理肺金。不过治标之法
耳。然胎在下部。既不能攻治其本。则不得不重治其标。保助肺金。以敌病气。虽病气上熏。亦无碍也。且肺
为华盖。位虽居上。而通调水道。下输膀胱。又主制节。下达大肠。肺调则大肠不滞。气得从大肠而泄。则胎
虽阻之。而上熏之势。亦稍杀矣。肺调则小水通利。气得从小水而泄。则胞中之气。亦得从小水泄下。盖膀
胱者。胞之室。膀胱畅。则胞气可借之得舒。而上熏之势。亦少杀矣。若大便燥结者。急宜用清燥救肺汤。加
火麻仁白芍肉苁蓉枳壳浓朴当归治之。若小便不利者。急宜用清燥救肺汤。加草梢生地木通防己知
母桑皮治之。且小便出膀胱。属太阳经。主皮毛。大便出大肠。属阳明经。主肌肉。二经调达。则肌肉皮毛之
气。皆清理而不滞。自不发寒蒸热矣。第皮毛肌肉之属气分者。既可以免。而腠理之热。属血分者。并不关
于二经。人身腠理之气。乃三焦所司。三焦属相火。内寄于肝胆。而下藏于胞室。今胞室既为胎所占。则相
火上壅而为呕吐。失血者往往而然。相火之气。循经外达。壅于腠理。则生寒热。甚则骨蒸。推原其故。以胞
室为胎所占。相火不得任意游行。是以壅遏。此时不能夺去其胎。只得清泄胞中之气。使相火有所泄。斯
不与大壅耳。宜四物汤。加黄柏知母赤茯苓泽泻山萸肉甘草梢肉苁蓉。此是治胞室。以滋相火之本也。
外用小柴胡汤。以和其腠理。蒸热之甚者。可用清骨散以泻之。此是治少阳。以清相火之标也。是时胞宫
不便重治。只合多清少阳。以重治其标。即不全愈。而亦杀其病气矣。如欲胞室腠理。面面兼治。则宜四物
汤。合柴胡清骨散治之。夫抱儿痨之病。根虽在胞。而其受病。则在于肺。惟其肺金津虚。无以转输于下。是
以胞中之水。皆得泛上而为病。无论咳热诸证。总宜大滋其肺。使肺津得调。肺气得降。则胞中之水火。虽
欲上逆。而亦不为害。救肺汤。紫菀散。太平丸。保和汤。人参清肺汤。阿胶泻白散。可常服之。第胞宫之水火
上逆。则病见肺。而水火之实。又实根于肾中。胞宫之相火。肾中之阳也。胞宫之阴水。天癸之水也。须极力
滋补其肾。使水化则不为痰。阴足则不动火。此为正本清源之治。肾中阴虚。而火动者。则水结为痰。为咳
为肿。为淋闭骨蒸。地黄汤。加杏仁五味子麦冬桑皮黄柏知母以清之。肾中阳虚不化水者。则水停为饮。
为咳为肿。为淋闭。清谷不化。宜地黄汤。加故纸杜仲艾叶附片台乌药沉香木通以温其阳。若肾中痰火
上逆之至。喘咳不止。胎亦上逼。照上用六味地黄汤。加龙骨牡蛎钟乳石牛膝半夏五味子麦门冬川贝
母治之。此坠降之药。各书俱云堕胎。然无病之胎。固忌此等。今既有肾气逆上之病。高者抑之。有病受坠
而下之。乃适当其胎之正位。胎反其位。而不上逼。何堕之有。至于气逆之极。发动吐血。呕咳呃哕。诸般上
逆之证。宜降气者。枳壳浓朴葶苈子槟榔。任量而施。宜降火者。酒大黄胡黄连知母黄柏龙胆草。随宜取
用。亦所不妨。况乎胎中吐血。多原素有瘀血阻滞。胎气两不兼容。是以动血。欲去瘀血。凡桃仁丹皮五灵
脂红花延胡索等。皆宜用之。若徒守拘禁。与养痈成患无异。医者果能破除俗见。而参透其所以然。于治
抱儿痨。何难起死回生哉。
又曰。用药虽不必徒守拘禁。然亦须审病。中病而止。勿毫无顾忌。而不知轻重也。慎之。
产母之所以系胎者。带脉也。带脉解则胎坠矣。若见腰痛之证。则早用当归白术熟地淮山药杜仲故纸
山萸肉龟胶黄柏黄 知母菟丝子甘枸杞续断云茯苓治之。其余带脉治法。详经血产血门。产母既病
抱儿痨。困惫之极。胎不能保。则亦无须存胎。但以安保产母为急。归芎汤。加人参糯米苎根阿胶。听其安
可也。堕亦可也。胎既下后。但照正产。按法治之。去瘀生新。自无不愈。
再按抱儿痨。产前已大虚耗。一旦产后。必见危险之证。较之寻常正产。更宜预防。一汗出不止。独参汤救
之。浮热脉大者。加附子。以引阳入阴。此虽胎前常病。火燥而至是。阳气欲脱。不得仍照火燥治法。四物汤。
加炮姜。亦是从阴引阳之法。皆可审用。一喘促为气脱之候。参附汤。加五味沉香治之。一血崩为血脱之
候。归脾汤。加血余灰棕灰海螵蛸鱼胶治之。亦有怒动肝火。而血崩者。归脾汤。加柴胡栀子治之。此三危
证。正产有之。病抱儿痨者。在所必有。医家病家。皆宜预防。
夫胎前属实热。产后属虚寒。平人大抵然也。至于病抱儿痨者。胎前之病。无一非热。至于产后。则不尽虚
寒。盖胎前已病阴虚。而产后去血过多。其阴愈虚。发热发咳。尤属痿燥之极。若徒守产后宜温补之说。鲜
不促命。宜左归饮。加阿胶天花粉百部人参麦门冬玉竹五味子治之。骨蒸咳逆者。团鱼丸治之。阴虚火
动。挟水饮而上干者。四物汤。合二陈汤。再加柴胡黄芩姜汁竹沥竺黄胆南星金箔牛黄治之。其余杂证。
均照产科治法。自无不愈。兹所论者。乃抱儿痨。产后之治法。与正产略异。然亦第举其端。尚待医士扩而充之。
一凡治抱儿痨。必先熟吾书中。经血胎血产血诸门。而于各女科。又参酌。庶克有济。
一凡抱儿痨。须在初病时。即行调治。治或未愈。而用药不错。庶几产后可以治愈。如不知治法。则产后必
亡。医家病家。两宜慎之。
以上所论抱儿痨治法。已具大略。而内中又或加外感。则虽照血家感冒之法。加减治之。或加内伤。则虽
照血证饮食诸法。加减治之。或添怒气而病增。则宜照怒复条内所用诸药治之。或加房劳而病剧。则宜
照房劳复条内所用诸药治之。法外有法。难以笔传。
The circulation of blood is entirely subject to the command of Qi. Qi originates from a spark of generating Yang within the congenital Kidney Water, moving from stillness to motion, transforming into Essence and Blood. If excessive sexual activity damages Essence and Blood, it leads to deficiency of Water and hyperactivity of Fire, chaotic movement of Qi and ascending of Blood; how could illness not occur? It is appropriate to use Duqi Wan (All-Encompassing Pill), adding Ophiopogonis Radix (Maidong, 麦冬), Tortoise Shell Glue (Guiban Jiao, 龟板胶), and Deer Antler Glue (Lujiao Jiao, 鹿角胶) for treatment. If Fire is excessive, use Dabu Yin Wan (Greatly Tonify Yin Pill), adding Deer Antler Glue and Mantis Egg Case (Sangpiaoxiao, 桑螵蛸); or use Jiawei Hujian Wan (Modified Tiger Knee Pill) to treat both Spleen and Kidney; or use Santang Tang (Three Immortals Decoction), adding Mantis Egg Case, Labiothallus (Qiushi, 秋石), Halophyte Powder (Haifen, 海粉), Phellodendron Bark (Huangbai, 黄柏), and Calycotome Flower Bud (Zishaohua, 紫梢花). For those who have lost blood, rest and recuperation are paramount. If one does not abstain from sexual activity, it is self-shortening of life span; what fault lies with the physician?
The world refers to women who, while pregnant, develop cough, fever, bone-steaming (Yin-deficiency heat), hemoptysis, or nocturnal emission as suffering from "Pregnancy Consumption" (Ba'er Lao, 抱儿痨). The fetus cannot reach full term, aborting at seven or eight months, or five or six months, failing to mature. Such patients often die within a month after delivery. Ancient texts lack specific discussions on this name, and folk physicians lack treatment methods; the world regards it as a fatal condition, and indeed deaths follow closely, which is truly lamentable. When a woman is pregnant, Qi and Blood are already gathered to nourish the fetal sac. Adding illness further depletes Qi and Blood. With limited Qi and Blood in the body, how can it withstand such dual depletion? Thus, the fetus fails to grow, the mother is constrained by the fetus, and invaded by disease—like two axes chopping a dead tree, death is inevitable. Although life is indeed at stake, if proper treatment were available, bringing back the dead would not be difficult. My wife suffered from this, and I treated her personally, ultimately saving her. Only then did I realize that the reason Pregnancy Consumption proves fatal is due to misdiagnosis or lack of treatment. Women conceive only when Qi and Blood are harmonious; blood pathology leads to fetal pathology. Treatment depends on the syndrome: sometimes prioritizing fetal stabilization, where stabilizing the fetus stabilizes the mother; sometimes prioritizing disease resolution, where resolving the disease secures the fetus. Prescribing according to observed syndromes ensures recovery. Generally, the world considers this an extreme deficiency syndrome, unaware that it is often excess pathogen. Why? Because apart from the intestines and stomach, no blockages should exist elsewhere in the body. Even needle insertion temporarily blocks Qi flow. How much more so a large solid mass like a fetus blocking the lower jiao, causing Qi stagnation leading to panting, rebellious Qi leading to vomiting, and excessive Qi transforming into Fire? All result from obstruction. Pregnancy is like storing treasure, but fetal pathology resembles abdominal masses. Hence, the pulse in pregnancy feels forceful upon deep pressure, similar to pulses of lower jiao masses. While masses can be purged to remove excess and save the person, fetuses cannot be purged, making treatment difficult. However, if excess symptoms appear, one must balance tonification with expulsion to avoid lingering illness. One must break free from all taboos to save seemingly hopeless cases. As stated in the *Neijing*: "If there is a cause [pathogen], there will be no injury." Thus, ignoring taboos to treat the disease is the highest method for fetal safety. Therefore, in Pregnancy Consumption with hemoptysis, distension, and rebellious Qi, one need not fear the fetus but should directly cool blood and resolve stasis. Cortex Moutan (Danpi, 丹皮) and Semen Persicae (Taoren, 桃仁) are permissible. Once stasis is removed, heat is no longer obstructed; removing the old generates the new, allowing the fetus to be nourished by fresh blood. If Qi rebellion and Fire are severe, ordinary herbs like Fructus Armeniacae (Xingren, 杏仁), Pericarpium Citri Reticulatae (Zhike, 枳壳), or Scorched Scutellaria Root (Kuhuangqin, 枯芩) may fail; wine-fried Rhubarb (Jiu Dahuang, 酒大黄) may occasionally be used. Furthermore, in these cases, fetal Qi obstructs the lower jiao and steams upward to attack Lung Metal. Thus, protecting Lung Metal is the primary treatment method. Qingzao Jiufei Tang (Clear Dryness Rescue Lung Decoction) and Ziwan San (Aster Powder) are main formulas. For phlegm condensation and Qi obstruction causing persistent cough, Huotan Wan (Expel Phlegm Pill) is used. For fluid retention attacking the lungs causing distension, cough, and inability to lie flat, Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs) is indicated. Jiegeng Ningfei Tang (Platycodon Lung-Calming Decoction) combines tonification and draining; Baohe Tang (Preserve Harmony Decoction) emphasizes tonification over draining; both can be used judiciously. This disease originates in the uterus, rooted below; clearing Lung Metal treats only the branch. Since the fetus is below and cannot be directly attacked, treating the branch is necessary. Protecting Lung Metal counters pathogenic Qi. Even if pathogenic Qi steams upward, it causes no harm. The Lung, as the Canopy, governs water passages downward to the Bladder and regulates the Large Intestine. Harmonized Lung Qi prevents Large Intestine stagnation, allowing Qi to exit via stool, reducing upward steam despite fetal obstruction. Harmonized Lung Qi promotes urination, allowing Qi to exit via urine, relieving uterine Qi pressure. Since the Bladder is adjacent to the uterus, Bladder patency relaxes uterine Qi, reducing upward steam. For dry constipation, urgently use Qingzao Jiufei Tang adding Hemp Seed (Huomaren, 火麻仁), White Peony Root (Baishao, 白芍), Cistanche Stem (Roucongrong, 肉苁蓉), Citrus Peel (Zhike, 枳壳), Magnolia Bark (Houpo, 厚朴), and Angelica Root (Danggui, 当归). For difficult urination, urgently use Qingzao Jiufei Tang adding Licorice Tip (Caoshao, 甘草梢), Rehmannia Root (Shengdi, 生地), Akebia Stem (Mutong, 木通), Prefecture Root (Fangji, 防己), Anemarrhena Rhizome (Zhimu, 知母), and Mulberry Root Bark (Sangpibai, 桑白皮). Urine exits via the Bladder, belonging to the Taiyang Channel governing skin/hair; stool exits via the Large Intestine, belonging to the Yangming Channel governing muscles. Harmonizing these channels clears Qi in skin/muscles, preventing chills/fever. However, interstitial heat belongs to Blood, not these channels. Interstitial Qi is governed by the Sanjiao (Triple Burner), which houses Ministerial Fire linked to Liver/Gallbladder and stored in the uterus. With the uterus occupied by the fetus, Ministerial Fire rebels causing vomiting and bleeding. Ministerial Fire reaching interstices causes chills/fever or bone-steaming. The root is uterine occupation preventing free flow of Ministerial Fire. Since the fetus cannot be removed, one must clear uterine Qi to vent Ministerial Fire. Use Siwu Tang (Four Substances Decoction) adding Phellodendron Bark, Anemarrhena Rhizome, Red Poria (Chifuling, 赤茯苓), Alisma Tuber (Zexie, 泽泻), Cornus Fruit (Shanyurou, 山萸肉), Licorice Tip, and Cistanche. This treats the uterus to nourish the root of Ministerial Fire. Externally, Xiaochaihu Tang (Minor Bupleurum Decoction) harmonizes interstices. For severe steaming heat, Qinggu San (Clear Bone Powder) drains heat, treating Shaoyang to clear the branch of Ministerial Fire. Here, heavy uterine treatment is avoided; focusing on Shaoyang reduces severity even if not fully cured. To treat both uterus and interstices, combine Siwu Tang with Chaihu Qinggu San. Pregnancy Consumption roots in the uterus but manifests in the Lung. Lung Yin deficiency fails to transmit downward, causing uterine fluids to rise. Regardless of cough/fever, heavily nourishing Lung Yin allows Lung Qi to descend, preventing uterine Water/Fire from rising harmfully. Jiufei Tang, Ziwan San, Taiping Wan, Baohe Tang, Renshen Qingfei Tang (Ginseng Lung-Clearing Decoction), and Ejiao Xiebai San (Donkey-Hide Gelatin and White Peony Powder) can be taken regularly. Uterine Water/Fire rising manifests in the Lung, but the excess stems from the Kidney. Uterine Ministerial Fire is Kidney Yang; uterine Yin Water is Tian Gui (Menstrual Fluid). Heavily tonifying the Kidney transforms water into non-phlegm and suffices Yin to quell Fire—this is treating the root. Kidney Yin deficiency with Fire hyperactivity causes phlegm, cough, edema, stranguria, bone-steaming; treat with Dihuang Tang (Rehmannia Decoction) adding Apricot Seed (Xingren, 杏仁), Schisandra Berry (Wuweizi, 五味子), Ophiopogon Root, Mulberry Root Bark, Phellodendron Bark, and Anemarrhena Rhizome. Kidney Yang deficiency failing to transform water causes fluid retention, cough, edema, stranguria, undigested food; treat with Dihuang Tang adding Psoralea Fruit (Guzhi, 故纸), Eucommia Bark (Duzhong, 杜仲), Mugwort Leaf (Aiye, 艾叶), Prepared Aconite (Fupian, 附片), Cyperus Rhizome (Taiwuyao, 台乌药), Amber (Chenxiang, 沉香), and Akebia Stem to warm Yang. If Kidney phlegm-fire rebels severely causing incessant panting/cough and fetal pressure, use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) adding Dragon Bone (Longgu, 龙骨), Oyster Shell (Muli, 牡蛎), Sperm Whale Tooth (Zhonglushi, 钟乳石), Achyranthes Root (Niuxi, 牛膝), Pinellia Tuber (Banxia, 半夏), Schisandra Berry, Ophiopogon Root, and Fritillaria Bulb (Chuanbeimu, 川贝母). These descending herbs are said to cause abortion in normal pregnancies, but here, with rebellious Kidney Qi, "high things are suppressed," and forcing downward aligns with the fetus's position, preventing upward pressure without causing abortion. For extreme Qi rebellion causing hemoptysis, vomiting, hiccupping, use descending Qi herbs like Citrus Peel, Magnolia Bark, Descurainia Seed, and Areca Seed as needed. For descending Fire, use Wine-Fried Rhubarb, Picrorhiza Root (Huhuanglian, 胡黄连), Anemarrhena Rhizome, Phellodendron Bark, and Gentian Root (Longdancao, 龙胆草). Hemoptysis during pregnancy often stems from pre-existing stasis incompatible with fetal Qi. To remove stasis, use Peach Kernel, Cortex Moutan, Trogopterus Dung (Wulingzhi, 五灵脂), Safflower (Honghua, 红花), and Corydalis Rhizome (Yanhusuo, 延胡索). Adhering strictly to taboos is like nurturing a boil until it becomes critical. Physicians breaking prejudices and understanding principles can cure Pregnancy Consumption.
Furthermore, while not blindly adhering to taboos, one must assess the disease and stop when effective, avoiding recklessness. Be cautious.
The Dai Mai (Belt Vessel) holds the fetus; if it loosens, the fetus falls. For lower back pain, early use of Danggui, Atractylodes Macrocephala Rhizome (Baizhu, 白术), Prepared Rehmannia Root (Shudi, 熟地), Chinese Yam (Huai Shanyao, 淮山药), Eucommia Bark, Psoralea Fruit, Cornus Fruit, Tortoise Shell Glue, Phellodendron Bark, Anemarrhena Rhizome, Dodder Seed (Tusizi, 菟丝子), Goji Berry (Gouqizi, 甘枸杞), Dipsacus Root (Xuduan, 续断), and Cloud Poria (Yunfuling, 云茯苓) is advised. See the Menstrual/Blood sections for other Dai Mai treatments. If Pregnancy Consumption causes extreme exhaustion, preserving the mother takes precedence over the fetus. Use Guixiong Tang (Angelica and Chuanxiong Decoction) adding Ginseng, Glutinous Rice, Ramie Root (Zhugen, 苎根), and Donkey-Hide Gelatin (Ejiao, 阿胶), allowing natural outcome. After delivery, treat as normal postpartum to remove stasis and generate new blood.
Note: Pregnancy Consumption causes severe depletion before birth; postpartum risks are higher than normal delivery. Prevent: 1. Uncontrollable sweating: Dushen Tang (Single Ginseng Decoction); add Aconite for floating heat/large pulse to guide Yang into Yin. Siwu Tang with Roasted Ginger also guides Yang from Yin. 2. Panting indicates Qi collapse: Shenfu Tang (Ginseng and Aconite Decoction) adding Schisandra Berry and Amber. 3. Metrorrhagia indicates Blood collapse: Guipi Tang (Restore the Spleen Decoction) adding Charred Hair, Charred Palm Fiber, Cuttlefish Bone, and Fish Maw. For anger-induced Liver Fire bleeding, add Bupleurum Root (Chaihu, 柴胡) and Gardenia Fruit (Zhizi, 栀子). These three crises require prevention.
Typically, prenatal conditions are excess-heat, postnatal are deficiency-cold. But Pregnancy Consumption involves heat throughout pregnancy. Postpartum, excessive blood loss worsens Yin deficiency, causing severe dryness/fever/cough. Blindly using warming tonics accelerates death. Use Zuogui Yin (Left Restoring Decoction) adding Donkey-Hide Gelatin, Trichosanthes Root (Tianhuafen, 天花粉), Stemona Root (Bubai, 百部), Ginseng, Ophiopogon Root, Polygonatum Rhizome (Yuzhu, 玉竹), and Schisandra Berry. For bone-steaming/cough, use Tuanyu Wan (Softshell Turtle Pill). For Yin deficiency with Fire and fluid retention, combine Siwu Tang with Erchen Tang (Two-Aged Decoction) adding Bupleurum Root, Scutellaria Root, Ginger Juice, Bamboo Sap (Zhulü, 竹沥), Inula Flower (Zhuhuang, 竺黄), Nardostachys Rhizome (Nanxing, 胆南星), Gold Foil (Jinpbo, 金箔), and Calculus Bovis (Niuhuang, 牛黄). Other complications follow obstetric methods. This discussion covers Pregnancy Consumption postpartum care, differing slightly from normal delivery, awaiting expansion by physicians.
1. Treat Pregnancy Consumption by mastering the book’s sections on menstrual, fetal, and postpartum blood, consulting gynecological texts.
2. Treat Pregnancy Consumption early. If initial treatment fails but is correct, postpartum cure is possible. Ignorance leads to postpartum death. Both doctors and families must be cautious.
The above outlines Pregnancy Consumption treatment. If complicated by exterior contraction, adjust blood-case cold methods; if internal injury, adjust diet/blood methods; if anger exacerbates, use anger-relapse formulas; if sexual excess worsens, use sexual-exhaustion relapse formulas. Methods beyond methods are hard to write down.