(Nü Laofu - Relapse due to Sexual Exhaustion)

Pang Anshi: After a patient has just recovered, their Qi, Blood, and Body Fluids are deficient and depleted. They must absolutely avoid all forms of physical labor. Whether it is mental exertion from speaking and thinking, physical fatigue from combing hair and bathing, or heat generation from strenuous work, any of these can cause the disease to recur as it was initially. Furthermore, after recovery, when the essence and marrow are dry and depleted, sexual intercourse must strictly be avoided. Engaging in sexual activity leading to relapse due to exhaustion (Laofu) will result in death. Gu Zixian, the Inspector of Wei, after recovering from illness, was advised by Hua Tuo to carefully avoid labor; other matters could be attended to, but if he engaged in sexual exhaustion, he would die. This is called "Nü Laofu" (relapse due to female-related sexual exhaustion), not "Yin Yang Yi" (mutual transmission of disease between sexes). Additionally, the *Suwen* states: "Those who have residual symptoms after febrile disease," referring to the fact that after initial recovery, the stomach and intestines are still weak. If one eats too much, digestion becomes difficult, causing the disease to recur; this is called "Shi Fu" (relapse due to dietary indiscretion). A robust person newly recovered needs at least two months, and a weak person needs at least one hundred days, to prevent recurrence.

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 or six pieces. (Cheng Wuji: There are two types of relapse: Laofu and Shi Fu. After Shanghan recovers, if Qi and Blood are not yet balanced and residual heat remains, early labor causes relapse, termed "Laofu." If one forces eating while fever is subsiding, heat is trapped, and grain qi lingers and conflicts, combining with residual heat to cause relapse, termed "Shi Fu." Laofu involves floating heat, treated with Zhishi Zhizi Chi Tang to resolve it without waiting for vexation and restlessness. Shi Fu involves gastric retention, treated with Rhubarb to purge without waiting for abdominal fullness and delirium.)

**Zhishi Zhizi Chi Tang Formula**
Zhishi (Immature Bitter Orange, three pieces, roasted), Zhizi (Gardenia Fruit, fourteen pieces, broken), Chi (Fermented Soybeans, one sheng, wrapped in silk gauze). Take the above three ingredients, boil in seven sheng of Qing Jiang Shui (clear sour rice water) until reduced to four sheng. Add Zhishi and Zhizi, boil until reduced to two sheng. Then add Chi, boil for five or six boils. Strain. Take warm, divided into two doses. Cover the patient to induce slight sweating. (Pathogens in Shanghan enter from outside; pathogens in Laofu arise from within. Sweating, vomiting, and purging should be applied appropriately. Although Zhishi Zhizi Chi Tang is typically a vomiting agent, here it induces slight sweating because heat gathers in the upper jiao (where bitter herbs induce vomiting) or disperses to the exterior (where bitter herbs induce sweating). The *Neijing* states: "When Fire excess prevails, use bitter herbs to disperse it.")

If fever recurs after recovery from Shanghan, Xiao Chaihu Tang (Minor Bupleurum Decoction) is indicated. If the pulse is floating, treat with diaphoresis (sweating method); if the pulse is deep and solid, treat with purgation. (Recurrence of fever due to residual heat is treated with Xiao Chaihu Tang for harmonization. Floating pulse indicates heat in the exterior, hence diaphoresis. Deep pulse indicates heat in the interior, hence purgation.)

Zhang Yuansu (Haicang): Generally, "Laos" (labor/exhaustion) implies movement, which varies internally and externally, affecting Qi and Blood. For Qi exhaustion manifesting as weakness and spirit fatigue, mild lifting methods are appropriate. For Blood or sinew-bone exhaustion, formulas like Siwu Tang (Four Substance Decoction) are used for tonification. If exhaustion affects the Spleen internally (Middle Jiao), regulating the Middle Jiao cures it; this is an organic disease. However, if only external symptoms appear, it is called "Fubing" (recurrent disease), not Lao. For example, re-contracting Wind-Cold.

Xu Shumi: Recorded a case where a patient with Shanghan, after sweating for several days, suddenly developed fever, spontaneous sweating, wiry-rapid pulse, and mental unrest. This was true Laofu. I diagnosed it as caused by mental labor, damaging the Shen (Spirit) residing in the Heart. Since the original state was not restored and the Shen was further injured, Ying and Wei mechanisms were disrupted. One should tonify the Son organ (Spleen), benefit Spleen Qi, and relieve labor. I prescribed Bupi Tang (Spleen-Tonifying Decoction) assisted by Xiao Chaihu Tang. Someone questioned: "Deficiency should tonify the Mother; why tonify the Son?" I replied: Do you not know the difference between deficiency and labor? The *Nanjing* says: "Tonify the Mother in deficiency, drain the Son in excess." This applies to tonifying the Mother. But the *Qianjin Fang* says: "For severe Heart labor, tonify Spleen Qi to benefit it; when Spleen is prosperous, it influences the Heart." This type of labor requires tonifying the Son, which is rarely known. The Mother generates me; the Son inherits and assists me. Treating deficiency involves tonifying what generates me (Mother), akin to "the root receives Qi, the body benefits." Treating labor involves tonifying what assists me (Son), akin to Xunzi's saying "there is no case of a rich son having a poor father." Thus, treating deficiency and labor differs.

**Bupi Tang**: Treats post-Shanghan sweating recovery where cold foods damaged the Spleen/Stomach, causing chest/epigastric oppression and general Qi-Blood disharmony.
Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Gancao (Licorice Root), Jupi (Tangerine Peel, white part removed), Qingpi (Green Tangerine Peel, white part removed), Ganjiang (Dried Ginger) (equal parts). Powder each dose. Take 3 qian with one sheng of water, boil briefly, take hot. Adding salt is also acceptable.

Zhang Yuansu: **Maimendong Tang (Ophiopogon Decoction)**: Used for Laofu with impending Qi collapse, capable of reviving the dying.
Maimendong (Ophiopogon Radix, heart removed, 1 liang), Gancao (Licorice Root, roasted, 2 liang), Jingmi (Rice, 0.5 he). Powder finely. Boil Jingmi in two sheng of water until cooked. Remove rice. Take 1.5 sheng of the decoction, add 5 qian of powder, two dates (pitted), and fifteen fresh bamboo leaves. Boil to one sheng. Strain. Take warm. For those unable to swallow, drip slowly into the mouth with cotton. Also treats infants unable to take oral medication. Do not use Shigao (Gypsum) here because there is no Fire-Heat in the Sanjiao, and the patient's Yang Qi is nearly exhausted. Adding Renshen is excellent.

**Waitai Mi Yao**: **Niurou Yin (Cow Milk Drink)**: For post-major illness deficiency and Xu Lao (deficiency exhaustion). Use milk from a yellow cow aged 5-7 years, one sheng, boiled with four sheng of water until reduced to one sheng. Drink slightly when hungry, do not overdrink. Ideally, finish over ten days continuously.

**Zhouhou Beiji Fang**: **Shao Biejia San (Burned Turtle Shell Powder)**: For critical illness newly arising from early labor/dietary error leading to fatal Laofu. Burn Biejia (Turtle Shell), take one fangcun bi (measure).

**Huangdi Bashiyi Jing Luoyi Tongyi (Huoren Shu)**: **Xiong Shoushi Tang (Male Rat Feces Decoction)**: For Laofu.
Zhizi (Gardenia Fruit, 14 pieces), Xiong Shoushi (Male Rat Feces, 14 grains, pointed at both ends), Zhike (Bitter Orange Fruit, three pieces, stir-fried). Powder finely. Take 4 qian with 1.5 sheng of water, add 2 cun of Congbai (Scallion White) and 30 Xiachi (Fermented Soybeans). Boil to one sheng. Divide into two doses. Do not let the patient know rat feces are included.

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

**Qianjin Fang**: For Laofu or Shi Fu with fever.
Zhiziren (Gardenia Seed), Shigao (Gypsum, each 3 qian), Shoushi (Rat Feces, 14 grains), Chi (Fermented Soybeans, 0.5 he). Boil in two zhong of water until one zhong remains. Strain. Drink through.

**Buzhong Yiqi Tang (Center-Boosting Qi-Invigorating Decoction)**: For Laofu fever, high breathing/asthma, body heat with irritability, limb lethargy.
Renshen (Ginseng Root, 2 qian), Baizhu (Atractylodes Macrocephala Rhizome), Ruanmiao Chaihu (Bupleurum Root, soft shoot), Chenpi (Tangerine Peel), Baishao (White Peony Root) (each 1 qian), Dangguishen (Angelica Sinensis Root Body), Huangqi (Astragalus Root) (each 1.2 qian), Gancao (Licorice Root), Shengma (Cimicifuga Rhizome) (each 0.5 qian). One dose, boil in two zhong of water until 0.8 zhong remains. Strain. Take warm. If Lower Yuan Yin Fire moves, nocturnal emission, severe deficiency exhaustion, or spontaneous/dream sweating indicating Yin deficiency, add Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark) (each 1 qian), Wubeizi (Chinese Gooseberry), Maimendong (Ophiopogon Radix) (1.5 qian). If accompanied by retained food, epigastric fullness, remove Shengma, add Zhishi (Immature Bitter Orange), Huanglian (Coptis Rhizome) (each 1 qian). For insomnia, add Yuanzhi (Polygala Root), Suanzaoren (Ziziphus Seed), Fushen (Poria with Hostwood) (1.5 qian). Adjust dosages based on pulse/weakness: double Renshen for weak pulse/deficiency, double Huangqi for sweating, double Baizhu for poor appetite/weak stomach, double Chaihu for external factors.

Wu Shou: After major illness recovery, Qi and Blood are weak, residual heat remains. As ancients said: "Like a wall soaked by floodwater; when water recedes, the wall remains damp." Avoid triggers. Rest quietly to nourish Qi. Early rising/labor causes Qi/Blood boiling and fever. Classics state: Floating pulse -> diaphoresis; Solid pulse -> purgation. If neither applicable, use Xiao Chaihu Tang modified to harmonize. Resolution may come via steady sweating or chills then sweating.

For post-recovery vexation and insomnia, Shenhut Wendan Tang (Ginseng and Bupleurum Warm Gallbladder Decoction) plus Suanzaoren (Ziziphus Seed). For emaciation, shortness of breath, rebellious Qi with nausea, Zhuyeshigu Tang (Bamboo Leaf and Gypsum Decoction). For deficiency heat with dry thirst, use this decoction removing Banxia (Pinellia Tuber). *Huoren Shu* uses Xiong Shoushi Tang for Laofu fever. *Qianjin Fang* uses Maimendong Tang. 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-cold, use Huangqi Jianzhong Tang (Astragalus and Middle-Joint Decoction); for severe deficiency, Dajianzhong Tang or Renshen Yangrong Tang. For Yin deficiency with Fire moving, add small amounts of Zhimu and Huangbai to rescue Kidney Water. Post-recovery diet: start with thin white rice soup, then thicker, then congee. Give small amounts frequently, never overeat. Meat is forbidden. Classics say: Pulse resolved but evening vexation indicates early/excessive eating. Weak stomach cannot digest; reduce grain intake to heal. For Shi Fu fever, use Zhishi Zhizi Chi Tang. If stool impaction, add Dahuang (Rhubarb) like chess pieces. If fever persists, use Chaihu Tang modified. For weak stomach/fullness, use Sizijunzi Tang (Four Gentlemen Decoction) modified. Add Chaihu for exterior heat, Huangqin (Scutellaria Root) for internal/external heat, Zhishi/Huanglian for epigastric fullness/vexation/internal heat, Suanzaoren for insomnia, Juhong/Banxia for phlegm, Shenqu (Medicated Leaven), Maiya (Barley Sprout) for undigested rice, Tangqiuzi/Zhishi/Qingpi for undigested meat. Flexibility is key.

For men contracting disease early after recovery by violating sexual abstinence, it is called Nü Laofu. Symptoms: heavy head unable to lift, visual spots, back/waist pain, lower abdominal urgency/cramping, aversion to cold/fever, sudden flushing of Yin Fire to head/face, chest vexation. *Huoren Shu* uses Xiong Shoushi Tang. With heat, use Zhupi Tang (Bamboo Skin Decoction) or Shao Kun San (Burned Underwear Powder). *Qianjin Fang* uses Chiyi San (Red Garment Powder). For weakness, administer Chiyi San with Renshen Sanbai Tang. For lower abdominal urgency/cold pulse, use Danggui Sini Tang (Angelica and Cinnamon Twig Decoction) plus Fuzi (Aconite Root), Wuzhuyu (Evodia Fruit) to deliver Chiyi San. Apply stir-fried Wuzhuyu with wine to lower abdomen. If testicles retract into abdomen and Lijing pulse appears, death is inevitable.

**Zhupi Tang**: For Nü Laofu with heavy head, visual spots, abdominal cramping with heat.
Qingzhupi (Green Bamboo Skin, scraped half sheng). Boil in two zhong of water until 0.7 remains. Take warm.

**Qianjin Chiyi San**: For Nü Laofu and Yin Yang Yi.
Burn the menstrual cloth of a virgin girl near the genitals to ash. Take with plain water, three times daily.

Alcohol is bitter/pungent, large heat, and toxic. Even in great cold, alcohol does not freeze, proving its heat. Drinking alcohol while Shanghan heat remains unresolved increases heat and worsens disease. If pulse is wiry-large, use Xiao Chaihu Tang plus Gegen, Huanglian, Wumei (Mume Fruit). If pulse is flooding-large, use Renshen Baihu Tang (Ginseng and White Tiger Decoction) plus Gegen, Huanglian. Zhuyeshtang or Huanglian Jiedu Tang (Coptis Detoxification Decoction) are also usable. Adding Jiju Zi (Corn Silk/Stigma) is especially good.