Library

Extreme deficiency and exhaustion are collectively referred to as "Lao" (Consumption/Deficiency Syndrome). The *Neijing* (Classic of Internal Canon) has discussed this in detail. Its manifestations are complex and divergent, making it difficult to trace; however, the formula Si Wuie Gu Yi Ru Wan (Cuttlefish Bone and Asparagus Root Pill), which purely tonifies and purges from the Blood level, truly opens a profound secret for treating Lao that has existed for millennia. The *Nanjing* (Classic of Difficult Issues) analyzes the pulse signs and transmission of the Sun (Damage) pulses, supplementing what the *Neijing* did not cover; by the time of Zhang Zhongjing, treatment methods were fully established. Xiao Jianzhong Tang (Minor Construct the Middle Decoction) is used for the initial stage of Lao; Fumai Tang (Restore the Pulse Decoction) is used for Yin deficiency that fails to recover after an illness; Shuyu Wan (Dioscorea Pill) is used for severe deficiency due to long-standing illness, serving as a pure tonifying agent; Dahuang Zhechong Wan (Rhubarb and Ground Beetle Pill) is used for blood bi (obstruction) caused by long-standing illness, serving as an agent to unblock collaterals and generate new blood. The principles of these formulas originate from Si Wuie Gu Yi Ru Wan; whether purging or tonifying, all seek therapeutic techniques from the Blood level. Generally, Lao disease begins with Qi deficiency; over time, Qi fails to move Blood, Wei Yang (Defensive Yang) sinks inward, and Body Fluids are scorched, causing Blood circulation to lose its smoothness and leading to stasis and obstruction. Li Dongyuan established Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), which reflects the intent of preventing problems before they arise, rather than being the direct treatment method. Later generations failed to understand this principle, using Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix) as drugs for tonifying deficiency and treating Lao, often resulting in Qi stagnation and obstruction, leading them to believe patients "cannot tolerate tonification." Or, by heavily using Rougui (Cinnamomi Cortex) and Fuzi (Aconiti Lateralis Radix Praeparata), patients feel dryness and heat, leading them to believe patients "cannot tolerate warming." Moreover, true Lao disease in the world is rare, while false Lao disease is common. Wu Shilang wrote *Buju Ji* (Collection of Non-Abiding) to distinguish this: wind-cold cough and food stagnation, mistreated to cause hematemesis, and then immediately treated with cooling and moistening agents, forcing the pathogen into the category of Lao. For such diseases, treatment should heavily employ warming and dispersing agents within blood-invigorating prescriptions, because the wind-cold pathogens are forced by medication and consolidated in the Blood level. Recent physicians only use cooling and irrigating methods, causing numerous unnecessary deaths, which is truly pitiable! Reading Zhang Shiwan's medical cases in the Lao and Damage section, one sees them entirely imitating the principles of Wuie Gu (Cuttlefish Bone) and Zhechong (Ground Beetle), using purgation to induce hematochezia and hematemesis, eliminating stasis to cure the disease; others use acrid-warm exterior-releasing methods to induce sweating and eliminate pathogens. This truly opens up thousands of years of ignorance and connects directly to the authentic transmission of Zhang Zhongjing. I have privately synthesized the origins of this disease: those arising from internal causes like fatigue, worry, and overthinking must also be accompanied by external pathogens, because when Zheng Qi (Upright Qi) sinks inward, external pathogens follow suit. The pulse is mostly Xian-Kou (Wiry-Hollow) or Jin-Se (Tight-Choppy). Treatment should tonify Zheng Qi while dispelling pathogens, invigorate Blood to open blockages, generate fluids to activate collaterals, regulate Qi to boost Yang to support expulsion of pathogens, and nourish Blood to calm the middle and moisten the lower. If Mingmen Fire (Fire of the Gate of Life) is deficient, add fire-tonifying herbs; if Spleen and Lung Qi are deficient, slightly add Qi-tonifying herbs. However, one must not heavily tonify Qi or abruptly tonify Fire, and absolutely must not break Qi. I often use warming and dispersing exterior-releasing drugs combined with heavy and sharp blood-purging drugs to open collaterals and boost Qi, assisted by fluid-generating herbs to make collaterals smooth; assisted by fire-tonifying herbs to stabilize Yuan Qi (Original Qi). In such cases, even tonifying Qi should be used sparingly, let alone Qi-breaking descending-draining drugs, or cold-cooling clearing-astringent drugs that extinguish Yuan Yang. Those gradually caused by external causes like wind, cold, summer-heat, and dampness usually present with Jin-Xi (Tight-Fine) or Xian-Hua (Wiry-Slippery) pulses. One should heavily use interior-warming and exterior-releasing methods to boost Yang and expel pathogens, and invigorate Blood and regulate Qi to open blockages and descend turbidity. Not only should tonifying Blood and descending Qi not be used recklessly, but generating fluids and tonifying Fire should also not be applied indiscriminately. Why? If a person's Yang Qi is inherently weak, water-fluid retention will form internally at this stage; if a person's Yang Qi is inherently strong, damp-heat will accumulate internally. For water retention, heavy dispersion is suitable; for heat accumulation, mild cooling and draining are suitable. Therefore, both generating fluids and tonifying Fire are somewhat inappropriate. Regarding medication principles, sweet and sour herbs are chosen for their flavor, while bitter and acrid herbs are chosen for their Qi (aroma/volatile nature); Qi moves while Flavor stays. For internal causes, moving and staying methods should be used together; for external causes, moving methods should be heavily used. If bitter and acrid herbs are used for their flavor, the thick flavor will not move, risking bitterness accumulating to create dryness and acridity accumulating to create heat. Therefore, Lianqin (Coptidis Rhizoma), Huangbai (Phellodendri Cortex), Jiang (Zingiberis Rhizoma), and Guirui (Cinnamomi Ramulus) must be used with caution. Herbs such as Qianghuo (Notopterygii Rhizoma et Radix), Gaoben (Ligustici Rhizoma et Radix), Xixin (Asari Radix et Rhizoma), Weilingxian (Saposhnikoviae Radix), Fangfeng (Saposhnikoviae Radix), Bohe (Menthae Haplocalycis Herba), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Jianghuang (Curcumae Longae Rhizoma), Yujin (Curcumae Radix), Mengchong (Blattidae), Shuizhi (Hirudo), and Qiluo (Silphidae Larva) can disperse pathogens without damaging Zheng Qi, and attack stasis without destroying new Blood; they are essential products for treating Lao. Moreover, recent external-cause Lao diseases are mostly cold-dampness received from below, entering the Shaoyin Kidney Meridian, where the True Fire of Mingmen is rushed by pathogens and cannot return to its root, gradually showing upper heat and lower flaccidity, panting and diarrhea, nightmares and nocturnal emissions. The pulse shows movement and weakness in the Chi position, or wiriness and choppy quality; these herbs are particularly miraculous lifesavers. The *Maijing* (Pulse Classic) states: "Deep and slippery indicates heaviness in the lower body and pain in the back and spine." This refers to this specific pulse and disease. This theory is not only unknown to city physicians, but even brilliant and erudite scholars, upon hearing it, may laugh in confusion. How long has the loss of medical methods persisted!
The important herbs listed in this chapter do not mean forming prescriptions exclusively from them, but rather that these are the primary drugs for treating the disease and should be used alongside tonifying deficiency drugs as assistants and guides. People regarding this disease only fixate on the character "Xu" (Deficiency), completely failing to investigate the cause of the deficiency. No wonder they greedily consume Shudi (Rehmanniae Radix Preparata), Danggui (Angelicae Sinensis Radix), Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Guiban (Testudinis Carapax et Plastrum), Biejia (Trionycis Carapax), Zhu Sui (Porcine Marrow), and Yang Shen (Ovis/Caprae Testis) daily until death without awakening. For true deficiency damage not accompanied by external pathogens, regardless of congenital insufficiency or acquired injury, the essence of minerals and stones and the splendor of flesh and blood are considered excellent filling products. Today, people dare not use mineral and stone drugs, and for flesh and blood drugs, they only take dregs; occasionally using mineral and stone drugs involves excessive processing, destroying their essence and qi, harming rather than benefiting people. Furthermore, if not indicated correctly, the disaster is even more severe. This is why the transmission of regulating Yuan Qi has ceased, and there seems no hope for saving chronic conditions. I myself suffered from this condition and extended my life by heavily using mineral drugs; Han Feixia claimed that taking Deer Antler (Lurong) compensated for congenital defects, with evident effects. This is the method for treating true deficiency, representing only one ten-thousandth of deficiency diseases! Additionally, there is Chuan Shi Gui Zhu (Transmitting Corpse Ghost Stagnation), commonly known as Lao Zhai (Consumption Tuberculosis), which is a corrosive and strange syndrome, not belonging to the category of Xu Lao (Deficiency Consumption). Its treatment requires heavy use of insect-killing and blood-purging methods, which is distinct from Xu Lao treatment methods and should be categorized separately.