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Due to excessive mental or physical exertion damaging the Yang Qi, one may use Gan Wen (Sweet and Warm) herbs such as Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), and Gancao (Glycyrrhizae Radix et Rhizoma) to clear the "Great Heat" (a symptom of deficiency heat). If the pulse is slow (Chi Mai), indicating Cold Lao (Consumptive Disease due to Cold), one may use Xin Wen (Pungent and Warm) herbs such as Shengjiang (Zingiberis Rhizoma Recens), Guizhi (Cinnamomi Ramulus), Xiong Huang (Realgar), and Fuzi (Aconiti Lateralis Radix Praeparata) to invigorate the residual Yang. Ultimately, Yang-damaged Cold Lao is not common and is easy to treat, whereas Yin-damaged Fire Lao is very common and difficult to treat. Why? Damaging Yang through exertion is easy to remedy by resting, and Yang Qi recovers easily; damaging Yin through sexual desire is hard to remedy by restraining desires, and Yin fluids are difficult to replenish. Other desires are relatively easier to satisfy, but sexual desire is particularly difficult to satisfy. Humans are not sages; how can they let emotions arise naturally yet stop within the bounds of propriety? This is why there are many unmarried men and women who die young, and why Mencius praised King Tai. Once the disease has formed, mere medication offers no benefit. As parents, if one understands the situation, should one not feel compassion and arrange marriages early? Although unfulfilled desires damage Yin, excessive indulgence also damages Yin. Therefore, the Sages issued warnings regarding blood and Qi that have not yet stabilized. To follow desires while exercising restraint is indeed the way to sustain life and nurture nature!

(Note) Shen Wenpu of Renhe said: Confucius once said, "To love virtue as much as to love beauty," and again, "I have never seen anyone who loves virtue as much as he loves beauty." Frequently using virtue and beauty as metaphors cannot be without meaning. Both stem from a heart of love. The heart of benevolence, natural yet unable to bear indifference, is called the Heart of Virtue; the heart of joyous love, natural yet unable to let go, is called the Heart of Lust. These are inherent natures present from birth, so Mencius said, "Food and sex are human nature." However, lust has orthodoxy and heterodoxy. One's own wife is orthodox lust; another man's woman is heterodox lust. Confucian classics only prohibit heterodox lust, never orthodox lust. Only Buddhism and Daoism prohibit both orthodox and heterodox lust. If orthodox lust were abolished, humanity would become extinct. I believe that if humanity became extinct, heaven and earth would remain empty; would those Buddhists and Daoists then live in a flock with birds and beasts? This is why their teachings are considered heretical. The teaching of the Sages merely advocates timely marriage so that no one remains single and resentful, and establishes rituals to restrain desires so that there is no licentiousness, such as prohibiting marriage between people of the same surname, distinguishing roles between husband and wife, limiting the number of concubines for emperors and feudal lords, and stipulating that commoners should not marry before forty if they have no sons. All these contain profound meanings. Thus, a widow who does not remarry is called a chaste woman, and there is reason for this. As for unmarried men, they are indeed prone to consumptive diseases, but unmarried women are even more numerous. It is not just virgins, confined maidservants, nuns, and widows who suffer. Their unfulfilled desires, hidden and endured, are too difficult to express, perhaps beyond what pen and paper can record. Besides this, there are cases where husbands are unworthy and mothers-in-law are tyrannical. When faced with injustice, swallowing insults and submitting meekly, how can women, uneducated in learning, be expected to fully accept fate and righteousness? Depression leading to consumptive disease is everywhere. In ancient times, when a wife died and there were children, the man did not remarry, likely drawing lessons from this. I lost my wife at thirty-three and vowed not to remarry. At forty-nine, I married off my eldest son. His wife manages the household well and is extremely filial; this is a clear result. With this humble opinion, I dare to advise the world. Not only can restraining desires nourish the body, but it also makes it easier to fulfill wishes like those of Xiang Ping (Xiang Chang, a Han dynasty recluse). The *I Ching* says: "If one does not regulate [desires], there will be sighs." This refers to the sighs of family quarrels and crying children, all caused by one's own lack of self-restraint. Hence the image says: "Who else is to blame?" The meaning is subtle.

The discussion in the *Nan Jing* (Classic of Difficult Issues) regarding Upper Damage and Lower Damage has been regarded as a famous saying for millennia. Later scholars stated that damage progressing from lower to upper involves contracting heat and damaging Yin, which is correct; but stating that damage progressing from upper to lower involves contracting cold and damaging Yang is not entirely accurate. Can injuries to the Lung by Summer-heat, Dryness, and Fire be said to involve contracting cold first and then damaging Yang? Even Wind, Cold, and Dampness can all stagnate Lung Qi and transform into heat. Internally, excessive grief causes Lung Fire to arise spontaneously; excessive disturbance of Heart Yang causes the Lung to be controlled; Liver Yang acting recklessly causes Metal (Lung) to be punished. How can one stick solely to the aspect of external cold and cold drinks? Moreover, Upper Damage diseases are often unrecognized by the world because ancient texts mixed them with other syndromes. For example, Wei Syndrome (Flaccidity Syndrome) caused by Lung Heat scorching the leaves, Fei Wei (Lung Flaccidity) listed alongside Fei Yong (Lung Abscess), and Fei Xiao (Lung Wasting-Thirst) among the Three Xiao syndromes, are all forms of Upper Damage. Lung Heat scorching the leaves presents with white complexion and hair loss, which is synonymous with skin gathering and hair falling out. When Upper Damage reaches the Stomach, it becomes difficult to treat. Therefore, treating Wei Syndrome focuses exclusively on the Yangming channels, because Yangming is the Sea of the Fu and Zang organs, and Lung Metal relies heavily on Stomach Earth for nourishment. Generally, this syndrome belongs mostly to Heat, like trees and grass withering under the scorching sun. Thus, nourishing Stomach fluids is the primary task. Song Ya stated that Wind-dispelling drugs and warm-tonifying aromatic-dry agents must absolutely not be used. Occasionally, Damp-Heat in the Stomach not cleared can also ascend to scorch the Lung, causing leaf scorching and flaccidity; in such cases, clearing Yangming Damp-Heat should be prioritized. What is meant by "focusing exclusively on Yangming" is to nourish and clear it; treating Lung disease fundamentally requires treating the Stomach. However, whether Dampness exists must be carefully examined. If there is no Dampness but one arbitrarily uses Damp-draining herbs, fluids will be further depleted, Heat will increase, and sinews and vessels will become increasingly dry and contracted, making relaxation impossible. Be cautious! Be cautious!

(Note) If only the two legs are flaccid, it is indeed Jiaoxu (Lower Burner Essence Deficiency) Bone Flaccidity. However, the Spleen and Stomach govern the four limbs, and the Yangming channels bind the bones and facilitate joint movement. If central Dampness is abundant and generates Heat, causing leg flaccidity and inability to walk, one should also target Yangming to drain Damp-Heat. Penile Flaccidity is known by people as Yang Deficiency, but there are also cases of Yin Deficiency. Li Zhongzi (Li Yan) described it as: like wood standing lush when receiving dew, but withering in severe heat. Since Yangming connects with the Zongjin (General Sinews), excessive Damp-Heat in the Stomach descending to the Zongjin can also cause flaccidity; it cannot be mistaken for Deficiency.

The *Nei Jing* (Inner Canon) mentions Wei Syndrome from Lung Heat scorching the leaves. Although flaccidity appears externally, if the Lung leaves are scorched, isn't the Lung substance first flaccid internally? The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) lists Fei Wei alongside Fei Yong. The Lung is flaccid internally, but the limbs do not yet show flaccid signs. Although the syndromes differ, they are essentially the same disease as "One Damage damages the Lung" mentioned in the *Nan Jing*. The *Jin Gui Yao Lue* discusses Fei Wei in detail. It is listed alongside Fei Yong because their manifestations are similar, allowing for comparative differentiation to help later generations distinguish them; it does not mean Fei Wei is an external syndrome. Who knew later generations failed to realize it was Upper Damage? Only *Li Xu Yuan Jian* (Original Examination of Void Consumption) understood that Yin Deficiency is governed by the Lung, but did not know that Wei Syndrome is Upper Damage. Crude practitioners still denounce Qing Jin Bao Fei (Clearing Metal and Protecting Lung) methods as ineffective for consumption, so I specifically clarify this.

(Note) The Wei in Bi-Wei (Obstruction-Flaccidity) differs from Fei Wei and Jing Wei (Penile Flaccidity); all three have distinctions between Fluid Deficiency and Damp Abundance. Clinical differentiation is crucial. Generally, Fluid Deficiency presents with dry mouth but preserved taste, red tongue with no coating; Damp Abundance presents with sticky mouth and lost taste, yellow-white coating. If pulse and complexion are ambiguous, this method of examination is most essential.

Eating well but losing weight is called Xiao (Wasting-Thirst); drinking well but having dry mouth is called Ke (Thirst). *Xuan Ming Lun* classifies Xiao Ke (Wasting-Thirst Syndrome) under Dryness diseases, because this syndrome has Dryness but no Dampness. The *I Ching* says: "Fire follows Dryness. Wind arises from Fire." The *Nei Jing* says: "Its transmission is Feng Xiao (Wind Wasting)." Just as south winds in summer create barren lands for thousands of miles. This disease stems from Yin Deficiency and blazing Fire, where extreme Heat generates Wind; this is the final transmission of Lao (Consumption) syndrome, or it arises from accumulated Heat from rich foods and mineral drugs,无异于 (no different from) becoming consumption due to erroneous medication. Analyzing separately: Drinking without quenching thirst is Shang Xiao (Upper Wasting-Thirst), i.e., Ge Xiao (Diaphragm Wasting-Thirst) in the *Nei Jing*, and Shang Sun (Upper Damage) in the *Nan Jing*, because the Lung resides above the diaphragm and Metal suffers Fire punishment, thus forming Thirst disease; Eating without feeling full is Zhong Xiao (Middle Wasting-Thirst), also called Xiao Zhong, referred to as Chu Zhong (Eliminating Middle) in the *Shang Han Lun*, because the Stomach is at the center, and Earth is scorched by Fire, thus forming Wasting disease; Stomach Yang floating outward is Chu Zhong; Urine resembling paste is Xia Xiao (Lower Wasting-Thirst), i.e., Qiang Zhong Syndrome, also called Shen Xiao (Kidney Wasting-Thirst), because the Kidney is at the lowest extremity, and Essence is scorched by Fire, thus forming Withered disease. Collectively named Three Xiao because muscles waste away. All things become plump with Water and shriveled with Fire. Those who drink and eat well yet become thin—aren't this Fire roasting their fluids and Wind consuming their Jin-Ye?

(Note) Shang Xiao should be treated with small doses taken frequently to clear Fire and save the Lung, using Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng). For those who drink much but urinate little, Heat consumes the water; add Hua Fen (Trichosanthis Radix) and Mai Dong (Ophiopogonis Radix) to nourish fluids. For those who urinate much, fluids fail to permeate outward; add Ge Gen (Puerariae Lobatae Radix) to raise the Clear. For those with urine presence but difficulty urinating, fearing edema transformation, Gui Ling Gan Lu Yin (Cassia Twig, Poria, and Sweet Dew Drink) clears the Upper to open the Lower, allowing Fire to descend and Dampness to move. Treating Zhong Xiao requires directly clearing Stomach Heat; for strong constitutions, San Huang Wan (Three Yellow Pill) or Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Order Qi Decoction); for weak constitutions, Huang Lian Zhu Du Wan (Coptis Pig Stomach Pill). Treating Xia Xiao requires purging Fire and saving Yin, using Zhi Bai Ba Wei Wan (Anemarrhena, Phellodendron, and Eight Ingredient Pill) or Da Bu Yin Wan (Major Nourishing Yin Pill). Chu Zhong syndrome indicates Yin exhaustion with Stomach Yang floating outward; it is fatal.

(Correction) The *Nei Jing* also mentions Yi Han Syndrome (Transferred Cold Syndrome) with "one drink, two urinations," and the *Jin Gui Yao Lue* mentions Shen Qi Wan Syndrome with "one drink, one urination"; neither is true Xiao Ke. *Yi Bie* clarifies this in detail.

(Commentary) Drinking much and urinating much is normal and not a disease; only when muscles gradually waste away does it become Xiao Ke. I, Xiong, since childhood until now, do not drink tea unless it is extreme heat. I only eat soft porridge for breakfast every morning, yet I urinate five or six times day and night, clear and long, exceeding my daily intake by more than double. My constitution is deficient and cold, so this is natural. If one clings to the theory of Transferred Cold, how have I remained healthy until now? Repeatedly reading *Yi Bie*, I admire its outstanding insight.

Forgetfulness is also the germ of Xu Lao (Deficiency Consumption). Ancients said: Water is clear and bright, Fire is dim and turbid; this distinguishes wisdom from folly. Still water hides Spirit; restless Fire leads to extinction; this distinguishes survival from death. Thus, a calm nature makes the heart like still water; moved emotions make the heart like an escaping ape. Distractions fly outward, leaving little within. With little within, one forgets immediately after speaking, not waiting till the end of the day; even trying to recall, it feels distant as mountains and rivers. Only during the quiet time after midnight cock-crow, after the destruction of nocturnal essence, does clarity return, and daytime actions are remembered vividly. From this, although medicines have the merit of calming the mind and nourishing blood, they are certainly not as effective as self-nurturing. The Seven Emotions and Five Zang Feelings, when stirred, become Fire, all capable of disturbing my tranquil Original Spirit. Phlegm obstruction and Blood stasis are beyond mention. If spirit is short and the mind is dim, unable to remain attentive for a moment, unless it is old-age forgetfulness, how could Heaven snatch one's Soul, repeatedly destroying it, leaving insufficient Night Qi to preserve it? This is why Mencius sighed over the trees on Mount Niu. However, David Neil (Deng Yuhan) in *Ren Shen Shuo Gai* (General Description of the Human Body) states that memory is stored in the brain. When people try to recall past events and suddenly cannot, their hands unconsciously scratch the back of the head, as if seeking something to bring it out; even children do this, which is clear proof. I note that Mr. Qi Cifeng from Tiantai had extensive learning and superior memory. Later, when serving as Vice Minister of Rites, he fell from a horse and broke his skull. A Mongolian physician cut open a live cow's belly, made him lie inside, and took fresh cow brain, applying it hot to his forehead. After recovery, he completely forgot everything and could not hold a pen. Thus, the Western claim has verification. The Brain is the Sea of Marrow, also called the Mansion of the Original Spirit. When Water is sufficient and Marrow fills, the Original Spirit is clear and memory is strong. If Fire blazes and Marrow exhausts, the Original Spirit dims; premature forgetfulness will surely become consumption!

(Note) The common term "no brain oil" for forgetting things after they happen aligns well with Western theories.

(Publication) Mr. Hobson (He Xin) of the West recently published *Quan Ti Xin Lun* (New Treatise on Anatomy), stating the brain is the director of consciousness and movement, and the spirit of the body resides in the brain. His explanation is more detailed than Deng's. In his preface, he says: All things in the world have principles; if principles are not exhausted, knowledge is incomplete. If one investigates principles based on evidence, one should believe whatever anyone says. Since humans share the same heart and principle, one cannot change the principle based on the person.

Lao diseases often accompany hemorrhage; treatment methods should not be rigid. Yu Xingzhai discussed this in detail. He also criticized the drawbacks of Zhongchun's three methods, hitting the mark. He concluded that bleeding from upper orifices is due to Yang Excess and Yin Deficiency, with rising but no descending, accounting for eight or nine out of ten cases. If one claims bitter-cold drugs cause death, then Xie Xin Tang (Drain the Heart Decoction) in the *Jin Gui Yao Lue* would be the chief culprit. This elucidation is highly appropriate. Generally, consumption leads to Fire rising, and blood overflows due to Fire; this is the norm. When Qi fails to control blood, and Yang Deficiency causes Yin to escape, this is the variation. Without knowing the norm, how can one know the variation? Only those who adhere to constants can adapt to changes. If one ignores constants and speculates wildly on variations, it is chaos. The *Nei Jing* says: "When Yin is balanced and Yang is secure, Spirit thrives." This is the key principle for treating deficiency. Later generations cite the *I Ching*'s support for Yang and suppression of Yin to deceive the world, using the analogy of a walking horse lantern on a mountain. The world is confused by this. Mr. Xiangyan once refuted this: The lamp moves due to Fire, but Fire shines because of Oil. If Oil dries up, Fire extinguishes. Thus, Yang collapse occurs because Yin exhausted first, leaving Yang without foundation.

(Note) Medicine values recognizing the disease. If the disease is recognized truly, Xiao (Mirabilite), Huang (Rhubarb), Ma (Ephedra), Gui (Cinnamon) are all good medicines for the disease; if the disease is not recognized truly, Renshen (Ginseng), Kong (likely referring to a missing herb name in source, possibly Kuxingren or similar, but context implies tonics like Dangshen/Astragalus or just generic tonics represented by 'Can'), Danggui (Angelica Sinensis), Dihuang (Rehmannia) are all poisonous drugs killing patients. For instance, Danxi Master skillfully used Zhimu (Anemarrhena) and Haba (Phellodendron), and later generations criticized him. If the disease is recognized truly, and used appropriately, Zhimu and Haba have the power to revive the dying. Is there no case of Yin Deficiency with blazing Fire in the world? Most laughable is Huang Lv Su, clinging to his own constitutional bias, attempting to generalize to all bodies, writing *Zhe Gong Man Lu* to severely criticize cold-cooling herbs and exclusively advocate warm-drying ones. Confucius said: "To love benevolence but not study learning, the flaw is foolishness." This applies to this gentleman!

(Publication) Women belong to Yin, dominated by Blood; thus, when Yin is sufficient, menstruation flows, and blood is exposed externally. Men belong to Yang, dominated by Qi; thus, when Yin is sufficient, essence is complete, but blood is not exposed externally. If uninjured, one can remain unexposed for life; exposure means illness, differing only in degree.

Spermatorrhea and spontaneous leakage often lead to consumption, occurring in both sexes. Danxi said women's leukorrhea is equivalent to men's sperm leakage. Yin Deficiency with Fire stirring is Deficiency; Damp-Heat sinking downward is Excess. Regardless of Deficiency or Excess, adding Haba (Phellodendri Cortex) is advisable: Bitter strengthens Yin and secures the Kidney; Cold clears Heat and defeats Dampness. Occasionally, Yang Deficiency requiring warm-tonification occurs, one or two in a hundred.

(Note) For Damp-Heat spermatorrhea/leukorrhea, use Songshi Zhudu Wan or Yuanzhu Duban Wan; for Yin Deficiency, use Sancai Fengsui Dan or Liuwei Dihuang Wan, both effective.

Women suffer more Xu Lao than men. Paths to deficiency and consumption are numerous, not just hidden depression. Before menstruation begins, leukorrhea may appear; excessive leukorrhea gradually depletes essence. Women take this as normal, unlike men who know sperm leakage is a disease upon onset. When menstruation starts, emotional distress, careless living, or improper diet can cause illness. Untreated or mistreated, it gradually becomes consumption. Pregnancy and childbirth, if slightly careless or mistreated, easily lead to consumption. Speaking of this, is it not pitiable? Thinking of this, is it not unfilial? The most inhumane act is forcibly binding feet, insisting on small arches to please others' eyes, disregarding the daughter's body, eventually leading to death from consumption. This is especially tragic, unforeseen by Yellow Emperor and Qibo.

(Note) Foot binding originated from whom is unknown. Some say Daji, some Xi Shi; these are village fools' talk. Some say Han/Tang dynasties. Yuan dynasty Yi Fangshizhen's compilation cites *Xiuzhu Ge Nvxun* quoting Fan Sui's "binding feet prevents entering Qin" as a metaphor, implying it existed in the Warring States period. Likely, it was slight binding then, like Manchu women, not letting feet expand like men's. Thus, Han/Tang poems about beauties lack references to bound feet. Until Li Houzhu's concubine Yaoniang created the bow-moon shape, artificiality led to national ruin; this is why Jianzhai condemned her instigation. Shen Wenpu said: Later generations followed this, making it an entrenched disease. Mothers harm daughters thinking it kindness, mothers-in-law abuse wives thinking it love, creating infinite sin for billions across eons. Others say: Ancients did this not for beauty, but to restrict wandering. Alas, is this reasonable? Unmarried, parents restrict her; married, husband restricts her. Guarding the inner quarters, strict entry/exit, cultivating shame, teaching needlework—restricting wandering is easy. Why mutilate the body? Cruelty and stupidity peak here! Blinding eyes to prevent evil looks, cutting tongues to prevent evil words—is this reasonable? Moreover, chaste women historically weren't all small-footed; eloping women weren't all large-footed. Why subject tender girls to torture like wooden cangs or amputation, suffering misfortune early and torment lifelong? Seeing many suffer pain, wasting away, dying young, souls trapped in dark prisons, how sorrowful! Since our nation's peace, customs are uniform. Men shave heads and braid hair, saving morning combing trouble and enjoying cool summers—a great virtue. Why don't women share this grace? If following natural paths, satisfying bodily needs, wouldn't it be excellent!

(Correction) Foot binding is a custom; even benevolent imperial policies cannot fully eradicate it. Helpless. *Ben Cao Gang Mu* cites *Guige Shanyi*: wash feet with Xiaomiao (Mirabilite) before binding to avoid pain. Folk remedy: boil crushed Impatiens balsamina roots and wash feet frequently to soften bones, making binding painless—a good method. But absolutely do not use Monkey Bone for washing. Though bones soften, it may cause lifelong inability to walk.

Above discusses Xu Lao.

(Publication) Many paths lead to consumption, but foot-binding-induced consumption was indeed unforeseen by Xuanyuan and Qibo. Recently, regardless of gender, a new category in consumption diseases has emerged: prolonged opium smoking. Yin exhaustion and Fire flaming lead to Opium Consumption, incurable. It shortens life and ruins families. The world suffers, yet no great medicine exists. How can we wish for Xuanyuan and Qibo to rise again to treat the people's pain with needles and knives!

Zhang Dairen said: Jing (Fright) is Yang, entering from outside; Kong (Fear) is Yin, arising from inside. Jing is unawareness; Kong is awareness. Shaoyang Gallbladder Channel belongs to Wood. Gallbladder is courage. Fright injures the Gallbladder. *Nei Jing* says: "Treat Jing with Ping (Ordinariness)." Ping means ordinary. If frightened by noise, regularly strike objects to make noise, so hearing it becomes ordinary, and one is no longer frightened. Fright causes Spirit to float upward; striking objects is done below, looking down gathers the Spirit. I consider dividing Jing and Kong into external/internal entry insightful. Ancients said Heart governs Jing, not knowing emotion characters derive from Heart, except Jing which derives from Horse, because horses lack gallbladder and are easily frightened, injuring the Gallbladder. This is indeed profound insight. Human bravery/cowardliness divides by Gallbladder strength/timidity. His treatment theory seems mysterious, but explained, it is ordinary. Yet, how can ordinary people fathom it!

(Note) Since antiquity, no one treated diseases better than Hezi (Zhang Jihe), not just excelling in Sweating, Vomiting, and Purging methods.

Wei Yuheng treated Xu Dezhi's daughter, nearly twenty. She suffered flank pain, early menstruation. Recently, delayed menstruation by several days, rash on body and face, vomiting a basin of blood, sensation of obstruction below the heart...