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Among all diseases, only *Lao Zhai* (consumptive disease) is the most severe. Recently, there are many patients, yet the treatments are increasingly erroneous. For instance, Zhu Danxi advocated using bitter-cold herbs to nourish Yin, which actually damages life. For a hundred years, those who have opposed him are numerous, so there is no need for further comment. As for Ge Kejiu's *Shi Yao Shen Shu* (Divine Book of Ten Medicines) and Wang Yutai's *Zheng Zhi Zhun Sheng* (Standard for Diagnosis and Treatment), whether wise or foolish, they are all praised as good. I alone consider them incorrect. It is like a patient having mistakenly fallen into a thicket of swords and spears, while the doctor follows behind wielding knives and arrows; how can one expect any possibility of recovery?

The term "Zhai" refers to deficiency and timidity, similar to the meaning of a bad harvest year that is incomplete and damaged. When illness reaches this stage, one is daily approaching death (Huang Quan), being even more critical than diseases in the Gao Huang (deep interior) regions. How can one not feel a chill of fear?

Diseases vary in severity and depth. Initially called "Ruo" (weakness), then "Xu" (deficiency), then "Shuai" (decline), then "Sun" (damage), and finally "Zhai". However, Zhai is worse than Sun, Sun is worse than Shuai, Shuai is worse than Xu, and Xu is worse than Ruo. If the initial cause is neglected and untreated, Ruo inevitably leads to Xu, Xu to Shuai, Shuai to Sun, and Sun to Zhai. Once it reaches Zhai, although death does not occur immediately, it is already on the path to death.

However, diseases also differ by Meridians and Zang-Fu organs. Zang organs are deeper than Fu organs, Fu organs are deeper than Jing (Main) meridians, and Jing meridians are deeper than Luo (Connecting) vessels. In the early stages, it must enter from Luo to Jing, from Jing to Fu, and from Fu to Zang. Once entering the Zang, vital energy is severed, leaving only waiting for death.

Although all five Zang organs are involved, the Kidney is the most important. The Kidneys are two, with the left Kidney being more significant. The left Kidney is the mother of Yuan Yang (Original Yang), the master of True Yin, the ancestor of Tian Yi (Heavenly One), and the source of transformation and generation. It stores Essence, controls Blood, creates life, and generates the body. If this foundation is injured, it will shake and collapse.

I have also carefully investigated the causes of disease and the errors in various treatment methods. The Classic says: "The Five Zang organs store Essence; they must not be injured. Injury leads to loss of control and Yin Deficiency. Yin Deficiency leads to lack of Qi. Lack of Qi leads to death." It also states: "The Kidney belongs to Water, receiving and storing the Essence of the Five Zang and Six Fu organs." It further says: "The Kidney governs hibernation and is the root of sealing and storing." Therefore, for men who indulge in sexual excess without restraint, or who have weak congenital constitution, fetal weakness and emaciation, insufficient Essence and Blood, and are prematurely damaged; or who are addicted to alcohol, causing toxins to rot the bone marrow—all this occurs because the Kidney belongs to Yin and governs Water. Water is Essence. When Water is exhausted, Fire becomes prosperous, which is inevitable.

Prosperous Fire scorches Metal (Lung), preventing Metal and Water from generating each other. Floating Yang loses control, erupting like a prairie fire. This is false heat, known as Prosperous Fire, Evil Fire, Dragon-Thunder Fire, or Rootless Fire, rather than Sovereign Fire. Such Fire cannot be directly suppressed by bitter-cold, heavy-Yin herbs like Huang Bo (Phellodendri Cortex) and Zhi Mu (Anemarrhenae Rhizoma).

The fever may come and go suddenly, starting and stopping intermittently; or appear during the day and hide at night, appearing at night and hiding during the day; moving irregularly. There may be coughing up phlegm and blood, incessant wheezing and coughing; itchy throat and dry thirst; spontaneous sweating and seminal emission; irregular urination and defecation; reduced appetite; and daily muscle wasting. The total reason is the exhaustion of Essence and drying of Water leading to these symptoms, which are confusing and hard to describe. All this is because Yin is insufficient to control Yang, and the disease lies in the Water within Yin.

Wang Tai said: "Feeling cold but not becoming cold is due to lack of Water." He also said: "Strengthen the master of Water to control the sunlight." Li Lizhai (Xue Ji) said: "Those lacking Water should use Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to fill True Yin." Zhang Jingyue also used purely sweet and tranquil formulas. These two sages did not deviate from the treatment of preserving the Source of Transformation, truly possessing unique insight through the ages. However, when True Yin is depleted, unless one uses the rich and greasy Shu Di Huang (Prepared Rehmanniae Radix) for moistening, and Shi Zao (Cornus Fructus, etc.) for warming and moistening to tonify emptiness, how can Essence and Blood be restored? The Classic says: "When Essence is insufficient, tonify with flavor." This refers to this principle.

But since Yin is deficient, True Yang has no attachment, and the Spleen loses its source of nourishment. Therefore, one should use sweet and neutral Shan Yao (Dioscoreae Rhizoma) and Fu Ling (Poria) to support Stomach Qi; Gou Qi Zi (Lycii Fructus), E Jiao (Asini Corii Colla), Ba Ji Tian (Morindae Officinalis Radix), and Gan Cao (Glycyrrhizae Radix et Rhizoma) are all herbs that strengthen Water and can serve as assistant ministers. But without Ren Shen (Ginseng Radix), there is no Yang, and thus Yin cannot generate. Dan Pi (Moutan Cortex) is indeed needed for bone-steaming fever, and Ze Xie (Alismatis Rhizoma) is set for promoting urination; their nature combines tonification and draining, so they must be chosen with care. When Water is abundant, bone-steaming will naturally disappear; why use blood-moving Dan Pi? When Metal is prosperous and the upper source is sufficient, why still rely on urine-promoting Ze Xie? Moreover, there is no case where Yin is deficient but the Spleen and Stomach remain independently solid. Tian Dong (Asparagi Radix) and Mai Dong (Ophiopogonis Radix), although said to treat cough, are cold and slippery, draining Yang, and should not be used lightly. Xuan Shen (Scrophulariae Radix) and Di Gu Pi (Lycii Cortex) are excellent for reducing heat but belong to sweet-cold damaging the Stomach, which must be avoided. Sang Bai Pi (Mori Cortex) drains excess Lung Fire, but one must not forget that if Fire is excessive, Water is insufficient; can one heavily drain the exterior? As for Sheng Di Huang (Rehmanniae Radix), Lotus Root Juice, Child's Urine, and Human Milk, these are also cold and slippery, hindering the Spleen. They may work for treating Excess Fire, but one must not forget that Dragon-Thunder false flames burn fiercer with water; how can they be mixed indiscriminately? Yi Yi Ren (Coicis Semen) treats Hong Kong Foot (Gout/Arthritis), removes Wind-Dampness, and eliminates Lung Abscess. Can渗利 (draining-dampness) herbs be used for this Yin-deficient cough where both Metal and Water are failing? Phlegm is Kidney Fluid that cannot distribute to four directions, carrying false fire upward; it looks like phlegm but is not true phlegm. Why rashly use Bei Mu (Fritillariae Bulbus) to vent stagnation? Even Ju Hong (Citri Reticulatae Pericarpium Rubrum) and Kuan Dong Hua (Sonchi Flos) dare to be used randomly. Pi Pa Ye (Loquat Leaf) has a light and thin quality; can it really nourish the Kidney and protect Metal?

Empty irritability and insomnia result from Fire scorching Yin; what does this have to do with Suan Zao Ren (Ziziphi Spinosae Semen) used for Gallbladder Heat insomnia? Further analysis shows that Mai Dong clears Lung Metal. Although combined with Wu Wei Zi (Schisandrae Fructus) and Ren Shen to form Sheng Mai Yin (Generate the Pulse Drink), one must not forget that Sun Simiao established this formula because Summer Heat and Fire damage Qi, not to treat coughs caused by Earth failure and Metal deficiency. Even using Bo He (Menthae Haplocalycis Herba) juice to clear heat, and Xing Ren (Armeniacae Semen) paste to treat wheezing, yet reusing these bitter-pungent Yang-draining and aromatic-dry Yin-damaging flavors makes the logic even more fragmented and inexplicable. Zhu Li (Bambusae Succus) clears stagnant Fire phlegm; what does this have to do with overflowing Kidney Fluid? Da Huang (Rhei Radix et Rhizoma) and Xuan Ming Fen (Mirabilite) treat Heat syndromes of Dryness, Fullness, Excess, and Hardness in the Stomach Fu from Cold Damage; Tao Ren (Persicae Semen) and Jiu Zhi (Allii Tuberosi Juice) are harsh agents for breaking stasis and moving blood. How can they be applied to the critical condition of Yin deficiency, Liver failure, and pain in the hypochondrium? Why is it that one does not know that Shu Di Huang is the holy medicine for rescuing Yin and restoring life? Sheng Di Huang is initially sweet-cold and cloying to the Stomach, but if subjected to nine transformations and changes in the cauldron, with subtle and profound applications, it greatly strengthens Earth to generate Essence. To say it blocks the chest and is hard to digest is due to insufficient firing power or improper processing methods. How can one recognize the true face of this herb?

Severe wheezing indicates the Xu Li (Vital Gate) pulsating against the clothes, meaning Fire does not return to its source. Why rashly administer Fu Pi (Tugeliae Pericarpium), Luobo (Raphani Fructus), Su Zi (Perillae Fructus), and Ting Li Zi (Lepidii Semen)? The disease already fears cold drinks, making the heat spread like a prairie fire; how can one bear to add Lian Qiao (Forsythiae Fructus), Zhi Zi (Gardeniae Fructus), and San Huang (Three Yellows) to severely drain True Yang? Chai Hu (Bupleuri Radix) releases Shaoyang exterior heat; treating this condition causes sweating and further damages Yuan Qi. Qing Hao (Artemisiae Annuae Herba) is bitter and primarily draining; can it truly protect the微弱 (faint) Stomach Qi? Moxibustion on Si Hua points merely connects internal Fire to rise and blaze; administering Zhong Shi (Calcitum) instead causes stasis to stagnate and create disaster. Above are the erroneous methods of Ge Kejiu, Wang Yutai, and others in treating Lao.

Do not think this is a disease of the True Zang rather than Jing/Fu; the root is already deficient, not just withered branches; True Yin is broken and incomplete, not merely a comparison of Qi and Blood weakness. Among injuries to the Five Zang, reaching the Kidney is the extreme. When True Yin fails and Yuan Yang extinguishes, there are also conditions of Water excess and Fire decline, and Yin-Yang dual deficiency, which must not be overlooked. Why do past and present physicians ignore the root for the branch, treating symptoms rather than the disease? Not only do they lack effective scraping methods, but they hasten death. Alas! Are we planting apricots (healing) or thorns (harm)? A miraculous book for governing the world has almost become a ghost tool.

Wang Yutai said: "Danxi argued that Lao Zhai is mainly Yin Deficiency. From Zi to Si hours belongs to Yang; from Wu to Hai hours belongs to Yin. Yin Deficiency leads to heat in the afternoon before Zi hour. Waking is Yang, sleeping is Yin. Yin Deficiency leads to sweating during sleep (night sweats). Ascending is Yang, descending is Yin. Yin Deficiency leads to Qi not descending; Qi not descending leads to phlegm-fluids reversing upward, resulting in continuous spitting. Pulse floating is Yang, sinking is Yin. Yin Deficiency leads to floating pulse being large and forceful, sinking pulse being empty. These are all Yin Deficiency symptoms, treated with Si Wu Tang (Four Substance Decoction) plus Huang Bo and Zhi Mu. However, why do doctors following this achieve zero success out of a hundred? Since Yin is deficient, Heart Fire flares up. Dang Gui (Angelicae Sinensis Radix) and Chuan Xiong (Chuanxiong Rhizoma) are pungent and warm in nature, not herbs for nourishing Yin and descending Fire. Furthermore, Chuan Xiong ascends, unsuitable for those with false flames and shortness of Qi. Di Huang clogs the chest, unsuitable for those with weak Stomach, poor appetite, and much phlegm. Huang Bo and Zhi Mu are bitter, pungent, and very cold. Though said to nourish Yin, they actually dry and damage Blood; though said to descend Fire, bitterness enters the Heart first, and long-term use increases Qi, actually assisting Fire. Their damaging the Stomach goes without saying. With such medication, how can it succeed?"

I often use Yi Yi Ren, Bai He (Lilii Bulbus), Tian Men Dong, Mai Men Dong, Sang Bai Pi, Di Gu Pi, Pi Pa Ye, Wu Wei Zi, Suan Zao Ren, etc., assisted by Sheng Di Huang, Lotus Root Juice, Milk, and Child's Urine. If coughing, use more Sang Pi and Pi Pa Ye; if phlegm, add Bei Mu; if blood, use more Yi Yi Ren and Bai He, adding E Jiao; if heat is severe, use more Di Gu Pi; if poor appetite, use Yi Yi Ren, up to 30-45 grams, with Mai Men Dong as the main herb to protect Lung Metal and nourish the source of transformation and generation. This works effectively. These herbs possess the Qi of dryness, descent, and gathering. The thin Qi is Yin within Yang. Thin Qi disperses; pungent, sweet, bland, neutral, cold, and cool are examples. Applying this to Yin Deficiency with Fire movement is like a cool breeze blowing away heat during humid summer. This is consistent with treating Bai Hu Tang syndrome. However, that is Exterior Excess, so heavy, cold, and storing herbs are used to correct the bias. This is Interior Deficiency, so using dry, descending, and gathering herbs achieves balance. This is the weighing of medication.

It is also said: "In Lao disease, all pulses are empty; only sticky and cloying substances can fill them. Essence and Blood are dried up; only moist and wet substances can lubricate them. Use Ren Shen, Huang Qi (Astragali Radix), Di Huang, Tian Men Dong, Mai Men Dong, Gou Qi Zi, Wu Wei Zi, etc., decocted into paste separately. Also use Qing Hao decocted with Child's Urine into paste, along with Sheng Di Juice, White Lotus Root Juice, Human Milk, and Bo He Juice, refined over water bath, mixed in appropriate amounts, combined with Lu Jiao Jiao (Cervi Cornus Colla) and Xia Tian Gao (Gelatinized Poria), formed into a pill/paste. Take several spoons dissolved in hot water. To move blood stasis, add Vinegar-processed Da Huang powder, Xuan Ming Fen, Tao Ren paste, Jiu Zhi. To stop bleeding, add Jin Mo (Gold Ink). To move phlegm, add Zhu Li. Generally, Lao symptoms involve pain radiating from below the heart to the hypochondrium, due to stagnant blood not resolving, preventing new blood from nourishing. It is especially suitable to use paste with Jiu Zhi and Tao Ren paste. Briefly, the former mention of Yi Yi Ren treats Lung Deficiency; the latter mention of Ren Shen, Huang Qi, Di Huang paste treats Kidney Deficiency. Liver and Heart belong to Yang; Lung and Kidney belong to Yin. Yin Deficiency leads to Lung and Kidney Deficiency. Thus, tonifying Lung and Kidney is tonifying Yin, not using Si Wu Tang, Huang Bo, and Zhi Mu."

It is also said: "Treating Lao should focus on the Spleen and Kidney. Why? The Kidney relates to Yuan Qi. The Spleen nourishes the physical form. The Classic says: 'For insufficiency of form, warm with Qi.' This means True Qi has the warmth of Minor Fire to generate the form. However, this Fire must not be made hot; if hot, it becomes Prosperous, and Prosperous Fire consumes True Qi. Observe the strength of this Fire between the two Kidneys. The Classic also says: 'When Essence is insufficient, tonify with flavor.' The Five Flavors enter the Stomach and return to their preferred Zang organs to generate fluids and transport to the Kidney. If the Five Flavors exceed moderation, they cause excess in the Zang, leading to destructive overcoming. Observe the cold and heat of the Five Flavors, initially in the Spleen and Stomach, then in the target Zang. Tonify deficiency, drain excess, guard Essence and Qi, regulate Yin and Yang, and keep the Spirit stored internally. Thus, Tian Shu opens, Stomach harmonizes, and pulses generate. Ying and Wei circulate inside and out, all are nourished, and the disease heals."

Li Huang Anzhai said: "The above points are Mr. Wang Yutai's methods for treating虛勞 (Deficiency Consumption), distinct from current trends. I have followed and taken them with effect, so I record them together." I secretly believe Mr. Wang Yutai's literary reputation and moral standing were outstanding in the Central Plains. His attention to medical arts and his book *Zhun Sheng* aim to benefit all living beings; his intention can be called benevolent and diligent. However, his profession was not specialized. For the symptom of Lao, treatment generally follows the branch. Moreover, Mr. Huang Anzhai appended and flattered it, forcibly calling it beautiful. I fear that future mediocre practitioners might think this method comes from famous officials, strictly follow it, and cause much harm. Regarding *Shi Yao Shen Shu*, numbered Jia, Yi, Bing, Ding... ten categories, combining acupuncture and minerals, holding prescriptions waiting for diseases, is particularly erroneous. After reviewing various medical books, mentioning 24, 36, or 99 types of Lao and Zhu (infectious/parasitic diseases), the pathology is complex, all creating strange illusions, inventing names, deceiving the world, done by busybodies. Who knows that all diseases arise from Cold and Heat, and Cold and Heat stem from Water and Fire. If Water and Fire are imbalanced and the original is deficient, it becomes ungraspable and vast as heaven and earth. Without thoroughly investigating here, where else can effort be applied? Therefore, I specifically highlight and refute this.