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(Nü Lao Fu - Relapse due to Sexual Exhaustion)

Pang Anshi: After a patient has just recovered, Qi, Blood, and Body Fluids are depleted. One must absolutely avoid all kinds of laborious activities. Whether it is mental exertion from speaking and thinking, physical exhaustion from combing hair or bathing, any labor generates internal heat, causing the illness to recur as it was initially. Furthermore, after recovery, the essence and marrow are withered and dry; sexual intercourse must strictly be avoided. If one engages in sexual activity leading to relapse due to sexual exhaustion (Nü Lao Fu), death is inevitable. Gu Zixian, the Inspector of Wei, after recovering from illness, Hua Tuo instructed him to carefully avoid labor. Other matters could be handled, but if he engaged in sexual exhaustion, he would die. This is called "Nü Lao Fu" (Relapse due to Sexual Exhaustion), not "Yin Yang Yi" (Transmission of Pathogen between Sexes). Additionally, the *Suwen* states: "Those who suffer from residual effects after febrile disease," referring to the fact that after recent recovery, the stomach and intestines are still weak. If one eats too much, digestion becomes difficult, and the illness recurs as before. This is called "Shi Fu" (Relapse due to Dietary Indiscretion). A recently recovered person should rest for two months if strong, or one hundred days if weak, so that no further relapse occurs.

For relapse due to labor after a major illness, Zhishi Zhizi Tang (Immature Bitter Orange and Gardenia Decoction) is the primary treatment. If there is retained food stagnation, add Rhubarb (Dahuang), sized like a chess piece, five to six pieces. (Cheng Wuji's commentary: There are two types of relapse: labor relapse and dietary relapse. In Shanghan syndrome, when blood and Qi have not yet stabilized and residual heat remains after recovery, engaging in labor early causes what is called "Labor Relapse." When fever subsides slightly but one forces eating, heat hides within, and grain qi lingers and struggles, combining two Yangs to cause illness, this is called "Dietary Relapse." Labor relapse involves floating excess heat, treated with Zhishi Zhizi Chi Tang to resolve it, without waiting for symptoms of deficiency vexation or agitation. Dietary relapse involves gastric retention, treated by purging with Rhubarb, without waiting for abdominal fullness or delirium.)

**Zhishi Zhizi Chi Tang Formula:**
Zhishi (Immature Bitter Orange) (3 pieces, roasted), Zhizi (Gardenia Fruit) (14 pieces, broken), Chi (Fermented Soybeans) (1 sheng, wrapped in silk). Take these three ingredients, boil in 7 sheng of Qing Jiang Shui (clear sour rice water) until reduced to 4 sheng. Add Zhishi and Zhizi, boil until reduced to 2 sheng. Then add Chi, boil for 5-6 more boils. Strain. Take warm, divided into two doses. Cover with blankets to induce slight sweating. (Note: Pathogens in Shanghan enter from outside, while pathogens in labor relapse arise from inside. Sweating, vomiting, and purging should be applied according to appropriateness. Zhishi Zhizi Chi Tang is essentially a vomiting agent, but here it induces slight sweating because heat gathers above (vomiting if bitter) or disperses on the surface (sweating if bitter). As the *Neijing* says: "When Fire excess prevails, use bitter to release it.")

If fever recurs after recovery from Shanghan, Xiaochaihu Tang (Minor Bupleurum Decoction) is the primary treatment. If the pulse is floating, resolve with sweating. If the pulse is deep and solid, resolve with purging. (Commentary: For recurrent fever due to residual heat after recovery, use Xiaochaihu Tang to harmonize. Floating pulse indicates heat in the exterior, hence sweating. Deep pulse indicates heat in the interior, hence purging.)

Wang Haizang: Generally, "Lao" (Exhaustion/Labor) implies movement. Movement varies, differing in interior/exterior and Blood/Qi. If it is Qi exhaustion, manifesting as weakness distinct from mental fatigue, the treatment should gently raise Qi. If it is Blood or Sinew-Bone exhaustion, tonify with formulas like Siwu Tang. If exhaustion lies in the Spleen internally (Middle Jiao), regulating the Middle can cure it. This is a tangible pathology. However, if only external signs appear, it is called "Fu Bing" (Recrudescence Disease), not "Lao." For example, re-contracting Wind-Cold.

Xu Shimwei: I recall a case where a patient suffered from Shanghan, sweated for several days, then suddenly developed body heat, spontaneous sweating, wiry-rapid pulse, and mental unrest. This was true Labor Relapse. I diagnosed it as caused by mental exhaustion. The residence of Shen (Spirit) had not returned to its original state, and further exhausting the Shen led to disharmony of Ying and Wei. One should tonify the Son organ (Spleen), benefit Spleen Qi, and relieve exhaustion to achieve healing. I prescribed Bupi Tang (Spleen-Tonifying Decoction) assisted by Xiaochaihu Tang to harmonize. Someone questioned: "Tonify the Mother when deficient, why tonify the Son?" I replied: "Do you not know the difference between Deficiency and Exhaustion? The *Nanjing* says: 'Deficient, tonify the Mother; Excess, drain the Son.' This refers to general deficiency. But the *Qianjin Fang* says: 'Severe Heart exhaustion, tonify Spleen Qi to benefit it; when Spleen is robust, it affects the Heart.' This type of exhaustion requires tonifying the Son, which is rarely heard of. The Mother generates me; the Son inherits and assists me. Treating deficiency involves tonifying the one who generated me (Mother), akin to 'The root receives Qi, the body receives shade.' Treating exhaustion involves tonifying the one who assists me (Son), akin to Xunzi's saying 'There is no case of a rich son having a poor father.' Thus, treating deficiency and exhaustion differs."

**Bupi Tang**: Treats post-Shanghan sweating recovery where the Spleen-Stomach is damaged by cold foods, causing chest/diaphragm obstruction and general Qi-Blood disharmony.
Renshen (Ginseng), Baizhu (Atractylodes Macrocephala), Gancao (Licorice), Jupi (Tangerine Peel, white part removed), Qingpi (Green Tangerine Peel, white part removed), Ganjiang (Dried Ginger) (equal parts). Grind into powder. Take 3 qian per dose, decoct in 1 sheng of water for a few boils, take hot. Adding salt is also acceptable.

Wang Haizang: **Maimendong Tang (Ophiopogon Decoction)**: Used for Labor Relapse with Qi nearly exhausted; this formula has the power to revive the dying.
Maimendong (Ophiopogon Root, heart removed, 1 liang), Gancao (Licorice, roasted, 2 liang), Jingmi (Rice, 0.5 he). Grind into fine powder. Use 2 sheng of water, cook Rice until soft, remove Rice, retain approx. 1.5 sheng of broth. Add 5 qian of medicine, 2 Jujubes (pitted), 15 fresh Bamboo Leaves. Decoct until 1 sheng remains. Strain. Take warm. For those unable to swallow, drip slowly into the mouth with cotton wool. Also treats infants unable to take oral medication via this dripping method. Do not use Shigao (Gypsum) because there is no Fire-Heat in the Sanjiao, and the patient's Yang Qi is near exhaustion. Adding Renshen is excellent.

**Waitai Mi Yao: Niurou Yin (Cow Milk Drink)**: For insufficiency after major illness, treating deficiency exhaustion. Take cow milk from a yellow cow aged 5-7 years, 1 sheng, mixed with 4 sheng of water. Boil down to 1 sheng. Drink slowly when hungry, do not drink too much at once. Ideally finish within 10 days.

**Zhouhou Beiji Fang: Shao Biejia San (Burned Turtle Shell Powder)**: For critical illness newly recovered, early labor or improper diet causing severe Labor Relapse. Burn Biejia (Turtle Shell), take 1 fang cun bi (measure).

**Li Ren Shu: Xiong Shushi Tang (Male Rat Dropping Decoction)**: Treats Labor Relapse.
Zhizi (Gardenia Fruit, 14 pieces), Xiong Shushi (Male Rat Droppings, 14 grains, pointed at both ends are best), Zhike (Bitter Orange, 3 pieces, stir-fried). Grind into fine powder. Take 4 qian per dose, with 1.5 sheng of water, 2 cun of Congbai (Scallion White), 30 Xiachi (Fragrant Fermented Beans). Decoct until 1 sheng. Divide into two doses. Do not let the patient know it contains rat droppings.

**Qiwei Congbai Tang (Seven-Ingredient Scallion White Decoction)**: Treats Shanghan relapsing due to movement/labor or slight overeating. If severe, similar to initial Shanghan, take this formula.
Congbai (Scallion White, with roots), Gegen (Kudzu Root), Xinchi (Fresh Fermented Beans, 0.5 he), Shengjiang (Fresh Ginger, sliced 1 he), Maimendong (Ophiopogon, heart removed), Shudihuang (Prepared Rehmannia Root) (each 3 qian). Flowing Water (4 sheng, stirred with ladle). Decoct the seven ingredients in clear water until reduced by two-thirds. Strain. Divide into two doses, take gradually to induce sweat.

**Qianjin Fang**: Treats Labor Relapse or Dietary Relapse with fever.
Zhiziren (Gardenia Kernel), Shigao (Gypsum) (each 3 qian), Shushi (Rat Droppings, 14 grains), Chi (Fermented Beans, 0.5 he). Decoct in 2 zhong of water until 1 zhong remains. Strain. Take orally.

**Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction)**: Treats Labor Relapse fever, high-pitched breathing with panting, body heat with irritability, lethargy of limbs.
Renshen (Ginseng, 2 qian), Baizhu (Atractylodes Macrocephala), Ruanmiao Chaihu (Bupleurum), Chenpi (Tangerine Peel), Baishao (White Peony Root) (each 1 qian), Dangguishen (Angelica Sinensis Root Body), Huangqi (Astragalus Root) (each 1.2 qian), Gancao (Licorice), Shengma (Cimicifuga) (each 0.5 qian). One dose, decoct in 2 zhong of water until 8 fen remains. Strain. Take warm. If Lower Yuan Yin Fire moves, nocturnal emission, severe deficiency exhaustion with irritability, or spontaneous/night sweating due to Yin deficiency, add Zhimu (Anemarrhena), Huangbo (Phellodendron) (each 1 qian), Wubeizi (Schisandra) (9 grains), Maimendong (Ophiopogon, 1.5 qian). If accompanied by undigested retained food and epigastric fullness, remove Shengma, add Zhishi (Immature Bitter Orange), Huanglian (Coptis) (each 1 qian). If insomnia, add Yuanzhi (Polygala), Suanzaoren (Ziziphus Seed) (each 1 qian), Fushen (Poria with Hostwood, 1.5 qian). For weak pulse/deficiency, double Renshen; for spontaneous/night sweating, double Huangqi; for poor appetite/weak Stomach, double Baizhu; for frequent external contraction, double Ruanmiao Chaihu etc.

Wu Qian: After major illness recovers, Blood and Qi are weak, residual heat remains. As ancients said: "Like a wall soaked by floodwater; when water recedes, the wall stands." Do not violate taboos. Rest quietly to nourish Qi. Rising early or labor causes Blood and Qi to boil, leading to fever. Classics say: Floating pulse, resolve with sweating; Solid pulse, resolve with purging. If neither sweating nor purging is suitable, use Xiaochaihu Tang to harmonize with modifications. It may resolve through natural sweating or shaking chills followed by sweating.

For post-recovery deficiency vexation and insomnia, use Shenhu Wendan Tang (Bupleurum and Pinellia Phlegm-Resolving Decoction) with added Suanzaoren. For deficiency emaciation, shortness of breath, rebellious Qi with nausea, use Zhuye Shigao Tang (Bamboo Leaf and Gypsum Decoction). For deficiency heat with dryness/thirst, use this same decoction removing Banxia. *Li Ren Shu* uses Xiong Shushi Tang for Labor Relapse with fever. *Qianjin Fang* uses Maimendong Tang for Labor Relapse; Li Dongyuan adds Renshen to boost Yuan Qi. For fever, poor appetite, weakness, use Shenhu Sanbai Tang or modify Buzhong Yiqi Tang. For no fever but lower deficiency with Cold, use Huangqi Jianzhong Tang; for severe deficiency, Dajianzhong Tang or Renshen Yangrong Tang. For Yin deficiency with Fire moving, add small amounts of Zhimu and Huangbo to save Kidney Water. Post-recovery, first consume thin white rice soup, then thicker, then congee, always in small amounts, keeping the stomach slightly underfilled, never overeating. Meat and other foods are forbidden. Classics say: Pulse resolved after recovery but evening mild vexation is due to early/heavy eating. Weak Stomach cannot digest; reducing grain intake heals. Classics say: Dietary relapse fever is treated with Zhishi Zhizi Chi Tang. If retained food binds stool, add Rhubarb (chess-piece size, 5-6 pieces) to purge. If dietary relapse fever persists, use modified Chaihu Tang. For poor appetite/weak Stomach/fullness, use Sizijunzi Tang as base with modifications. For exterior heat, add Chaihu; for interior/exterior heat, add small amount of Huangqin; for epigastric fullness/vexation/internal heat, add Zhishi and Huanglian; for insomnia, add Suanzaoren; for phlegm, add Juhong and Banxia; for vomiting, similarly. For undigested rice, add Shenqu and Maiya; for undigested meat, add Tangqiuzi, Zhishi, Qingpi to digest. Flexibility is key.

For men contracting illness after major recovery due to early sexual activity, it is called "Nü Lao Fu" (Female Labor Relapse). Symptoms include heavy head unable to lift, flowers/spots before eyes, back/waist pain, lower abdominal urgency/cramping, aversion to cold/fever, intermittent Yin Fire rushing to head/face causing flushing, chest/heart vexation. *Li Ren Shu* uses Xiong Shushi Tang. With heat, use Zhuyu Tang or Shao Kun San (Burned Underwear Powder). *Qianjin Fang* uses Chiyi San (Red Clothing Powder). For weakness, use Renshen Sanbai Tang to administer Chiyi San. For lower abdominal urgency/pain, deep/reversed cold pulse, use Danggui Sini Tang plus Fuzi and Wuzhuyu to deliver Chiyi San. Best to roast Wuzhuyu in wine and apply hot compress to lower abdomen. If testicles retract into abdomen and Lijing pulse appears, death is incurable.

**Zhuyu Tang**: Treats Nü Lao Fu with heavy head, visual spots, abdominal cramping with heat.
Qingzhupi (Green Bamboo Bark, scraped 0.5 sheng). Decoct in 2 zhong of water until 7 fen remains. Take warm.

**Qianjin Chiyi San**: Treats Nü Lao Fu and Yin Yang Yi.
Menstrual cloth from an unmarried girl near the private parts, burned to ash, taken with plain water, 3 times daily.

Alcohol is bitter and pungent, greatly hot and toxic. Even in extreme cold, alcohol does not freeze, proving its heat. If Shanghan febrile disease heat is unresolved and one drinks alcohol, heat intensifies and illness worsens. If pulse is wiry-large, use Xiaochaihu Tang plus Gegen, Huanglian, Wumei. If pulse is flooding-large, use Renshen Baihu Tang plus Gegen and Huanglian. Zhuye Shigao Tang or Huanglian Jiedu Tang are also usable; adding Jiju Zi (Barberry Fruit) is especially good.