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1. A person suddenly developed toothache in the first lunar month, which healed after more than ten days. In the fourth lunar month, due to excessive mental anxiety and fatigue, the toothache flared up severely. The physician prescribed drugs such as Gypsum Fibrosum (Shigao) and Anemarrhenae Rhizoma (Zhimu), but with no effect. Using a knife to drain purple blood from between the teeth caused unbearable pain throughout the mouth, and all teeth became loose. By the sixth and seventh lunar months, food intake increased, urine became thick like paste, and muscles wasted away completely. By the eleventh lunar month, the body could not rise. At the end of winter, using Phellodendri Cortex (Huangbai) and Rehmanniae Radix (Dihuang) allowed him to stand slightly. However, appetite remained easily hungry as before, and urine remained thick like paste. In the second and third lunar months of the following year, the condition worsened further; he took no medicine, toothache persisted, two central incisors fell out, and thirst was added, unceasing day and night. This is a case of Middle Xiao (Middle Wasting-Thirst) and Lower Xiao (Lower Wasting-Thirst). Zhongchun used Sheng Dihuang (Liu qian), Maidong (Wu liang), Tiandong (Yi liang), Wuweizi (San qian), Lugen (Wu liang), Huanglian (San qian), and Huangbai (Wu qian), decocted in ten bowls of silk-boiling water until two bowls remained, taken at any time. After a few doses, he recovered. For pills, add Wuweizi (Liu liang), Gouqi (Si liang), Niuxi (Wu liang), Huangbai (San liang), and Shashen (Liu liang) to the above prescription, made into honey pills for regular use, so it did not recur.

2. A person developed Xiao Ke (Wasting-Thirst) after taking hot-natured drugs. He was insisted upon taking Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) for a thousand doses, and it was indeed effective. This aligns with the principle of "strengthening the master of Water to control the glare of Fire."

The disease of Xu Lao (Consumptive Disease) involves no external pathogens interfering; it is caused entirely by internal injury to the Zang-Fu organs. For instance, alcohol damages the Lung; damp-heat steaming and熏蒸 (fuming) consumes Lung Yin. Sexual activity damages the Kidney; emptiness of the essence chamber leads to unrestrained Ministerial Fire. Overthinking damages the Heart; spirit injury and blood consumption lead to easy flaming-up of Fire. Fatigue damages the Spleen; it generates heat most readily, and excessive heat internally attacks True Yin. Anger damages the Liver; constrained anger causes Liver Fire to blaze internally and scorch blood, while great anger causes Liver Fire to rush upward leading to hematemesis. These five conditions can all exhaust Essence and Blood. The Daoist Canon states: Nasal mucus, saliva, essence, fluids, sweat, blood, and body fluids—the seven spiritual substances—all belong to Yin. When Yin is deficient, internal heat arises, forming the syndrome of Xu Lao. Generally, those who develop Xu Lao due to alcohol and sex are numerous, yet there are also unmarried youths suffering from this, due to congenital insufficiency, particularly influenced by the mother's constitution. If the mother has Yin deficiency, her children will likely have many weak syndromes. Monks, nuns, widows, and unmarried women with delayed menstruation, whose desires are unfulfilled, suffer from Qi and Blood stagnation, leading to chills and fever resembling malaria, morning coolness and evening heat, loss of appetite, irregular menstruation, or amenorrhea, forming this syndrome frequently, mostly due to internal steaming of constrained Fire. Medical texts discuss Xu Lao, confusingly treating Qi deficiency, Blood deficiency, Yin deficiency, and Yang deficiency together, leaving learners without direction. One must know that those with Qi deficiency present with pale, lifeless complexion, faint speech, weakness in limbs, and a faint pulse; those with Yang deficiency present with cold body and aversion to cold, cold extremities, clear urine and loose stools, and a deep, small, slow pulse; warm tonification can be administered. Thus, those Xu Lao patients who can tolerate Renshen (Ginseng Root) and Huangqi (Astragali Radix) are those capable of receiving tonification, indicating Qi or Yang deficiency syndromes. Those who cannot tolerate Renshen and Huangqi are those incapable of receiving tonification, indicating Blood or Yin deficiency syndromes. Although there is a method of tonifying Qi for Blood loss, this refers to sudden massive hemorrhage in persons not previously Blood-deficient, such as postpartum cases, and does not apply to Blood deficiency caused by Fire dryness, where the cause of Fire drying Blood is the inability of Water (Yin) to restrain it. Hence, the Classic says: "One Water cannot overcome Five Fires." The Five Fires refer to the fires of the Five Emotions; One Water refers to the True Yin Water of the Kidney. Water is Essence. Observing the Classic: "At fourteen, girls' Tian Gui arrives; at sixteen, boys' Tian Gui arrives." Does this not show that Yin forms later and is difficult to achieve? It also says, "At forty, Yin Qi is halved." Does this not show that Yin declines earlier and is easily withered? What is called Yin is my Essence, which shapes my form. The period of peak vitality lasts only about twenty years, after which the form gradually declines. Therefore, Danxi cited the waxing and waning of the moon to argue that Yang is often in excess, while Yin is often insufficient. Wang Jiezhai believed that eight or nine out of ten diseases are due to Yin deficiency, while one or two out of a hundred are due to Yang deficiency. This is because few restrain desires, while many indulge them. People only know that indulging desires exhausts Essence, but who knows that daily loss of Yin Essence leads to tasteless food, turning fatigue into deficiency, and deficiency into fatigue, with pulses changing internally and complexion losing luster. When illness occurs: in the Kidney, it manifests as soreness and weakness of the lower back, spine, legs, and calves, or dull pain; bone-steaming internal heat with night sweats; fever at night; generalized bone soreness or pain as if broken; nocturnal emission during dreams or spontaneous slipping; tinnitus; hot soles. In the Heart, it manifests as palpitations and fright; dry heat in palms; empty vexation and insomnia or restless dreaming; bitter taste and dry tongue, or oral ulcers. In the Lung, it manifests as cough with much phlegm, or dry cough with little phlegm; chest fullness and rebellious Qi, or rapid panting; red cheeks like rouge; hot breath from nose; hemoptysis; epistaxis; even vomiting white foam; inability to lie on one side; sore throat and rotten gums; hoarseness. In the Liver, it manifests as chills and fever like malaria; scrofula on the neck; distension and pain in the hypochondrium; dry or painful eyes; dizziness; blurred vision; irritability; hematemesis. In the Spleen, it manifests as poor appetite; nausea and vomiting; distension and abdominal pain; indigestion; borborygmus and diarrhea; muscle wasting. These are the fundamental symptoms of the five Zang organs in Xu Lao. The Classic says: "In treating disease, one must seek the root." One must examine what caused the damage and which organ was injured. If caused by sex, the injury is in the Kidney; even if other meridians show symptoms, tonifying the Kidney should be the root, treating other meridian symptoms concurrently. If caused by alcohol, clearing the Lung should be prioritized. Once root and branch are examined, one must observe that disease transmission is infinite. For example, Kidney transmitting to Heart, Heart to Lung, Lung to Liver, Liver to Spleen, Spleen back to Kidney—this is transmitting to the organ it overcomes, insulting and attacking, called "Thief Restriction," a sign of great misfortune. The Classic says: "Diseases transmitted sequentially die." This means the five Zang organs transmit in sequence until all are overcome. The Nan Jing says: "Seven transmissions mean death." This means if disease starts in the Kidney and transmits to the Spleen and back to the Kidney, this is six transmissions, exhausting one organ, which cannot be injured again. If Kidney disease does not transmit to the Heart but to the Lung, skipping one organ, it transmits to the Mother that generated me; since Mother and Son Qi connect, Son disease affects Mother. If Kidney disease does not transmit to the Heart or Lung, but to the Liver, skipping two organs, it transmits to the Son I generated; Mother disease affects Son. If Kidney disease does not transmit to the Heart, Lung, or Liver, but to the Spleen, skipping three organs, it transmits to the organ I cannot overcome; this is what the Classic calls "light insult." If transmission and attack are unclear, how can one treat disease? In Xu Lao, those biased toward Yin deficiency are everywhere, yet physicians often fail to deeply understand Qi, Blood, Yin, and Yang, treating vaguely, leading to premature death, which is countless! Let us explain in detail; there are seven errors. First: Error of Guiding Fire Back to its Source. The Fire of Mingmen is called Dragon Fire, also True Yang. If it is weak, Yin abundance in the Kidney prevents Dragon Fire from settling, causing it to float upward, creating false heat in the Upper Jiao: red face, vexation, thirst, and even tongue coating symptoms. But although thirsty, there is no desire to drink; although there is coating, the tongue is slippery and soft; feet are cold past the knees; urine is clear and long; the Right Chi pulse is necessarily deep, small, and slow, or floating, large, and rootless. This is false heat caused by Yin abundance below forcing Yang upward. Like the generation of Yin at Summer Solstice, cold at the bottom of water and hot in the sky; Dragon is a Yang creature, so it rises with Yang. This is precisely when one should use formulas like Bawei Wan (Eight-Ingredient Pill); drinking cold, falsely cold medicines deceives it down the throat; once the cold nature is removed, the hot nature begins, and floating fire can be guided back to its source, like the return of Yang at Winter Solstice, warming the water underground, and the Dragon returns to the sea. However, in Xu Lao, the cause is extreme deficiency of Kidney Water and True Yin; Water fails to control Fire, and Fire flares upward. This causes red face and lips, bleeding from mouth and nose, toothache and gingival bleeding, various upper Jiao deficiency heat symptoms. Although this is also Dragon Fire flaming upward, it differs from floating False Yang. Even if there is aversion to cold and cold feet below, this is caused by deficiency Fire rising, not True Yang decline. Thus, urine must be yellow-red, pulse must be rapid, with evidence of internal heat. If mistakenly using Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) to guide fire back to source, it is like adding firewood to save a fire; upper Jiao heat increases, cough, panting, dryness, and thirst worsen, and sore throat and rotten gums appear. Second: Error of Lizhong Warm Tonification. Lizhong regulates middle Jiao deficiency-cold. Deficiency-cold abdominal pain is continuous without increase or decrease, prefers hot hand pressure and hot drinks; deficiency-cold diarrhea involves undigested food, clear and cold. There must be deficiency-cold symptoms and pulse basis before using it effectively. Now, people see distension, abdominal pain, indigestion, borborygmus, and diarrhea, and immediately assume deficiency-cold, administering Xiangzao (fragrant-dry) Baizhu and Xinre (pungent-hot) Ganjiang, or even adding Guizhi and Fuzi; they do not know that Xu Lao suffers from Yin injury; tonifying Yang again makes Yang more hyperactive and Yin more exhausted, adding all heats, hastening death. Some see distension and diarrhea, cite the Classic "Clear Qi below generates sundew diarrhea, Turbid Qi above generates fullness," and use Buzhong Yiqi Tang to raise Clear and descend Turbid, mistakenly using Shengma and Chaihu, instead raising Ministerial Fire rebellion, causing frequent cough and panting, alternating hematemesis and epistaxis, leading to danger and death. Yet those whose warm tonification succeeds do so because the patient is ignorant, bringing it upon themselves. Yang-assisting drugs temporarily strengthen Stomach Qi and increase food intake; both sides claim merit, sticking stubbornly, not realizing until death, truly pitiable. Third: Error of Renshen and Huangqi assisting Fire. Those Xu Lao patients who can accept Renshen and Huangqi must have no Lung Heat, and their Lung pulse, though deficient, must not be rapid. Thus, when Earth is prosperous and generates Metal, one need not strictly adhere to protecting the Lung; ancients often used these with success. But now, Fire has scorched Metal causing cough, steamed fluids into thick phlegm, Ministerial and Sovereign Fire are extremely hyperactive, and Blood rebels upward; still citing "Without Yang, Yin cannot generate" and "Deficiency Fire can be tonified," wealthy families administer large doses of Renshen and Huangqi. Consequently, Yang Fire becomes stronger, and Metal is further injured. Hence, Haogu warned "Lung heat injures the Lung again," and Jiezhai cautioned "Taking Ginseng leads to death." Fourth: Error of Bitter-Cold Draining Fire. Real Fire disease can be directly subdued with bitter-cold, but stop when heat goes; do not overuse. Deficiency Fire disease is Yin deficiency; how can Zhimu and Huangbai, bitter-cold agents, clear it! Those taking them not only fail to clear heat but also damage Yin, vainly destroying Stomach Qi, leading to poor appetite and more diarrhea; how to treat then? Worse, seeing dry stool, they recklessly use Xiaoshi (Mirabilite) and Dahuang (Rhubarb) to purge. They do not know the Kidney governs the two openings and five fluids; since Kidney fluids are deficient, natural lubrication is lost; nourish Yin, moisten dryness, and stool will pass naturally. How can deficient Yin withstand the attack of Xiaoshi and Dahuang? Thus, Shicai's argument: the ignorant follow warm tonification, while the enlightened know to deeply warn against reckless use of bitter-cold. Fifth: Error of Erchen Phlegm Resolution. Phlegm in the Spleen Meridian is called Damp Phlegm. Slippery and easy to expectorate, or thin like water, is called Fluid Retention. Dampness requires drying; Banxia is the correct drug. If Yin Water is insufficient, Yin Fire rises, Lung suffers Fire insult, cannot descend clearly and turbidly, thus fluids condense turbidly, failing to generate Blood and generating Phlegm instead. This requires moistening agents to nourish Yin, allowing rebelling Fire to return home and rest, then Phlegm clears itself; administering Erchen leads to immediate danger. Sixth: Error of Pungent Dispersants. Six or seven out of ten cases of true Yin deficiency with fever are indistinguishable from external contraction. Fire rebellion rushing up causes head distension and slight pain; Fire rising obstructing Lung causes occasional nasal congestion; Yin deficiency with Yang sinking inward causes shivering aversion to cold; Yin deficiency with Yang having no attachment causes floating heat on the skin surface. But onset is always in the afternoon, first shivering aversion to cold, then fever shortly after; fever peaks at chicken-crow hour (3-7 AM), night sweats occur, and body cools. Or no slight cold, but only afternoon fever, necessarily presenting preceding Kidney deficiency symptoms. Or accompanied by red lips and cheekbones, thirst and vexation, string-taut and rapid pulse, or deficient and rapid/weak pulse. This requires large doses of Yin tonification, such as Baoyin or Liuwei. If mistaken for external contraction and treated with wind drugs to disperse, profuse sweating ensues, and all deficiencies arise. For those with blood loss, dispersing yields no sweat; the Classic says "Those who lose blood should not sweat"; forcing it further causes blood to flow from ears, eyes, mouth, and nose, leading to upper rebellion and lower exhaustion, a difficult-to-treat syndrome. Now, people see fever and immediately use dispersants, further believing pathogen remains, restricting diet, leading to Stomach Qi exhaustion and death; is this not chilling? Seventh: Error of Delayed Treatment. Ancient sages treated disease before it arose. For those exhausting spirit, constantly nourish Heart; for those fatigued, constantly tonify Spleen; for those angry, constantly nourish Liver Blood; for those drinking much, constantly clear Lung Heat; for those lustful, vigorously tonify Kidney Water. When disease just sprouts, remedy it. Zhang Zhongjing said: "When people have disease, treat it promptly; enduring hoping for recovery creates entrenched disease." Thus, Xu Lao rarely heals because internal heat is easily ignored; as deficiency symptoms gradually appear, treatment is still sought; relying on normal diet and sleep, unchanged complexion, one continues indulging in alcohol and sex, and hides the term Xu Lao, while physicians accommodate, letting disease deepen. Until cough, bloody phlegm, hematemesis, chills and fever, poor appetite occur, and disease is formed before medicating, it is like digging a well when thirsty or forging weapons when fighting, is it not too late! However, treating it is hardest, requiring three major essential methods. First: Tonify Kidney Water. The Classic says: "The Kidney governs Water, receiving and storing Essence of the five Zang and six Fu organs." Thus, five fluids return to Essence, and five Essences are governed by the Kidney. The Kidney has an Essence Chamber, called Mingmen; Essence is stored here, Qi transforms here; Essence is Fire within Yin. Thus, Water and Fire of Mingmen are the transformation sources of the twelve organs. Heart relies on it to clarify the Sovereign; Lung relies on it to execute regulation; Spleen and Stomach rely on it for granary richness; Liver and Gallbladder rely on it for strategic foundation; Bladder relies on it for Sanjiao Qi transformation; Large and Small Intestines rely on it for separate transmission. Thus, Water and Fire functions are indispensable. Yet Fire decline is rare, while Water deficiency is constant. Wang Jiezhai said: "In youth, Kidney Water is vigorous, seemingly no need to tonify, but excessive release cannot maintain fullness. In middle age, desire decreases, but since youth was squandered much, how can it recover? In old age, innate truth gradually ends, leaving only solitary Yang." Thus, from youth to old age, diseases arise from True Yin insufficiency. Even youths with weak constitution can recover by tonifying True Yin from childhood. Therefore, Yin-tonifying drugs are indispensable from youth to old age, especially for Xu Lao caused by excessive intercourse. Thus, Baoyin, Liuwei, Zuogui belong to sweet-cold agents that nourish Water and add Essence; tonifying Yin to match Yang, exactly as Wang Taipu said "Strengthen the master of Water to control the glare of Fire," and Danxi said "Nourish Yin then Fire descends naturally," like adding oil to a dying lamp flame, making light smaller. Must prepare large doses and take long-term. Indeed, Yin-benefiting drugs have no overnight effect, as there is no quick way to tonify Yin. For those caused by alcohol, clearing Metal and moistening dryness is primary, but Baoyin agents cannot be abandoned. Why? Drinkers who do not get Xu Lao do so because Kidney Water is deficient. Deficiency leads to lack of fear, re-scorching the long-injured Lung; how can one not get sick! Tonifying North (Water) is precisely to drain South (Fire) and save the Lung. For those caused by overthinking, clearing Heart and nourishing Blood is primary, but Baoyin agents remain indispensable, meaning "When Water is strong, Fire extinguishes; do not rush to drain Heart." For those caused by fatigue, cultivating Spleen Yin is primary, assisted by Baoyin agents. The Classic says: "Traveling far and being fatigued, encountering great heat and thirst; thirst causes Yang Qi to attack internally; internal attack causes heat to lodge in Kidney." Thus, knowing fatigue damages Spleen, internal heat inevitably reaches Kidney. If anger damages Liver and moves Blood, Baoyin and Liuwei Wan are correct treatments. Because when Water is vigorous, Dragon Water does not flare, and Thunder Fire cannot erupt; this is simultaneous treatment of Kidney and Liver. Second: Cultivate Spleen Earth. Spleen and Stomach are the root of acquired constitution. The Classic says: "Abundant grain leads to prosperity." Essence is born from grain; abundant diet naturally generates Blood and transforms Essence; as Blood and Essence gradually grow, even if evil heat exists, drugs can control and eliminate it; over time, Fire descends and Yin recovers. If Spleen and Stomach weaken, diet decreases and Blood is not generated; if Blood is not generated, Yin is insufficient to match Yang, and five Zang organs are damaged together. Thus, emphasis returns to Spleen and Stomach. It says: First damage is Lung, skin gathers and hair falls; second damage is Heart, blood vessels cannot nourish organs; third damage is Spleen, food does not become flesh; fourth damage is Liver, tendons relax and cannot hold; fifth damage is Kidney, bones wither and cannot rise from bed. From top to bottom, exceeding Stomach means untreatable; reaching bone withering and inability to rise means death. From bottom to top, exceeding Spleen means untreatable; reaching skin gathering and hair falling means death. Thus, Zhongjing treats Xu Lao only with sweet drugs, establishing Middle Qi to generate Blood and transform Essence, filling organs, a good method for recovering from Xu Lao. Following the principle: "For insufficiency of Essence, tonify with flavor." Flavor is not just drugs; flavors of five grains are also flavors. Tonifying with flavor and regulating labor leads to gradual accumulation and preservation of life. The Classic says: "When Yin, Yang, Form, and Qi are all insufficient, regulate with sweet drugs." Since drugs and food enter, they must pass through Spleen and Stomach first, then five Zang receive their Qi. Strong Spleen and Stomach mean flourishing five Zang; weak Spleen and Stomach mean declining five Zang. Thus, Middle Qi insufficiency requires sweetness. Moreover, strong Earth makes Metal prosperous; prosperous Metal fills Water. Men regard Spleen and Stomach as the root of life; women regard Heart and Spleen as the root of destiny. Thus, treating Xu Lao, regardless of which organ is damaged, one must prioritize regulating Spleen and Stomach. Third: Carefully regulate lifestyle. The cause of Xu Lao is mostly alcohol and sex; causes from sorrow, overthinking, depression, and anger are also not few. Thus, youths and unmarried women lacking laughter, and widowers, widows, monks, and nuns easily contracting this disease—if not treatable by needles and drugs, one must relieve emotions, find peace in every situation, then treat, so that disease may heal. Now, sufferers rely solely on herbs, regarding them as remedies, externally exhausting the body, internally indulging in Seven Emotions, not abstaining from alcohol and sex, not avoiding pungent-hot foods; this is walking the path to death oneself. Occasionally, some know to戒 (abstain) from alcohol and sex, regulate labor and rest, but find it hard to release Seven Emotions. Not knowing that when Heart moves妄 (wildly), Qi scatters with Heart; scattered Qi does not gather, Essence flees with Qi. Thus, Guangchengzi said: "Must be quiet and clear, no..."