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Xiao Ke (Wasting and Thirsting Syndrome) treatment is primarily based on nourishing the Lung, descending Fire, and generating Blood, differentiated into Upper, Middle, and Lower Xiao for specific management. Banxia (Pinelliae Rhizoma) is strictly contraindicated in all three Xiao types; it is also avoided in cases of Blood Deficiency; patients with dry mouth and sore throat, or dry intestines with difficult defecation, should not use it; nor should those with excessive sweating. If symptoms persist, Ginger must be used in processing to moderate its properties. If Xiao Ke is accompanied by diarrhea, Chao Baizhu (Stir-fried Atractylodis Macrocephalae Rhizoma) and Chao Baishao (Stir-fried Paeoniae Radix Alba) are ground into powder, taken mixed with water, followed by the previous remedies (i.e., various juice pastes). After the resolution of internal injury diseases, if dryness and thirst remain unresolved, indicating Heat in the Lung Meridian, small doses of Renshen (Ginseng Radix et Rhizoma), Huangqin (Scutellariae Radix), and Gancao (Licorice Root) can be used, mixed with Shengjiangzhi (Ginger Juice), and taken cold. Alternatively, Ginger Juice can be administered using a tea spoon. For deficient constitutions, Ren Tang (Ginseng Decoction) may be used. Huafen (Trichosanthis Radix) is a miraculous herb for treating Xiao Ke.

Upper Xiao involves the Lung, characterized by excessive drinking but reduced food intake, with normal urination and defecation; Middle Xiao involves the Stomach, characterized by excessive drinking and dark yellow urine; Lower Xiao involves the Kidney, characterized by turbid, dribbling urine resembling paste, dark complexion, and emaciation.

Prescription: Huanglian Mo (Coptidis Rhizoma Powder), Huafen Mo (Trichosanthis Radix Powder), Ren Ru Zhi (Human Milk Juice) [alternatively Niu Ru (Bovine Milk)], Ou Zhi (Lotus Root Juice), Sheng Dihuang Zhi (Rehmanniae Radix Recens Juice). The latter two juices are boiled down into a paste, mixed with the first three ingredients, assisted by Jiangzhi (Ginger Juice) and Honey to form a paste. Hold slowly on the tongue and swallow with a small amount of plain warm water. If the patient has an appetite, add Shigao (Gypsum Fibrosum) and Gualougen (Trichosanthis Radix).

[Appendix] Water envelops Heaven and Earth, as noted by predecessors. Does this mean that within humanity, Water can also envelop and moisten the Five Zang Organs? It is said: "Heaven generates One Water," and the Kidney truly governs it. The Bladder is the mansion of Body Fluids, thus disseminating Kidney Water upward to moisten the Lung; therefore, knowledgeable practitioners consider the Lung the organ of Body Fluids. From top to bottom, the San Jiao and Zang-Fu organs are contained within the True Water of Heaven One. As stated in *Su Wen*, the root of Water lies in the Kidney, and its branches in the Lung. When True Water is sufficient, there is no such thing as thirst! However, when people indulge in lust, drink alcohol and eat wheat products without restraint, and crave roasted, pickled, salty, sour, sweet, fatty, fishy, or mutton foods, while using Cinnabar and Jade to fuel their desires, flaming heat rises upward, causing Heat in the Zang-Fu organs. Dryness and Heat become rampant, drying up Body Fluids, leading to extreme thirst where one cannot control the desire to drink fluids. This rising heat affects the deficient Heart, causing Heart Fire to scatter and fail to consolidate, resulting in chest irritability, red tongue, and red lips. This condition, characterized by excessive drinking, frequent but scanty urination, belongs to the Upper Jiao and is called "Xiao Ke" (Wasting-Thirst); Heat accumulates in the Middle, affecting the deficient Spleen, with latent Yang steaming the Stomach, leading to rapid digestion and easy hunger, double the usual food intake but failure to gain muscle mass. This presents with mild thirst, preference for cold drinks, frequent sweet-smelling urine, belonging to the Middle Jiao, called "Xiao Zhong" (Middle Wasting); Heat lurks in the Lower, affecting the deficient Kidney, causing soreness of legs and knees, bone joint pain, loss of essence and empty marrow, seeking water to save itself. This presents with little water intake, immediate urination, frequent and turbid urine, belonging to the Lower Jiao, called "Xiao Shen" (Kidney Wasting). In cases of Qiangzhong Xiao Ke, death may follow immediately. The general principle of treatment is to use Baizhu San (Atractylodis Macrocephalae Powder) to nourish Spleen Qi, naturally generating Body Fluids, combined with rice porridge, and eating finely chopped cooked pork spine meat to nourish the Kidney, so that Water has its governor. Additionally, clean Huanglian (Coptidis Rhizoma) is wet-cut, placed inside a male pig stomach, tightly tied, and steamed over one dou of rice until soft. Add some steaming liquid, pound in a mortar, and form pills the size of Sophora seeds. Take 100 pills after meals with rice drink to clear the Heart and stop thirst. Li Dongyuan said: Ge Xiao (Diaphragm Wasting) is treated with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction); Xiao Zhong is treated with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) and Sanhuang Wan (Three Yellows Pill); Xiao Shen is treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).

Attached Formulas:
Futu Wan (Cuscuta Pill): Universally treats the three Xiao types and also treats white turbidity.
Tusizi (Cuscutae Semen, soaked in wine, 10 liang), Bei Wuweizi (Schisandrae Fructus, 7 liang), Baifuling (Poria, 5 liang), Shilianrou (Nelumbinis Plumula, 3 liang). Grind into powder, use 6 liang of Shanyao (Dioscoreae Rhizoma) powder made into paste to bind into pills the size of Sophora seeds. Take 50 pills with rice soup.

Maidong Yinzi (Ophiopogon Drink): Treats Ge Xiao with chest fullness, irritability, scanty Body Fluids, shortness of breath, and thirst.
Zhimu (Anemarrhenae Rhizoma), Gancao (Licorice Root, roasted), Gualou (Trichosanthis Fructus), Wuweizi (Schisandrae Fructus), Renshen (Ginseng Radix et Rhizoma), Gegen (Puerariae Lobatae Radix), Shengdihuang (Rehmanniae Radix Recens), Fushen (Poria with Hostwood), Maidong (Ophiopogonis Radix, heart removed, equal parts). Coarsely chop. Decoct in water, add 14 leaves of Zhuye (Bambusae Folium).

Jiawei Qianshi Baizhu San (Modified Qian's Atractylodis Macrocephalae Powder): Treats Xiao Ke with inability to eat.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Baifuling (Poria), Gancao (Licorice Root, roasted), Zhike (Aurantii Fructus, stir-fried, half qian each), Huoxiang (Agastaches Herba, 1 qian), Gange (Puerariae Lobatae Radix, 2 qian), Muxiang (Aucklandiae Radix), Wuweizi (Schisandrae Fructus), Chaihu (Bupleuri Radix, 3 fen). Take as one dose, decoct in water and drink.

Dihuang Yinzi (Rehmannia Drink): Treats Xiao Ke with dry throat, red face, and irritability.
Gancao (Licorice Root, roasted), Renshen (Ginseng Radix et Rhizoma), Shengdihuang (Rehmanniae Radix Recens), Shudihuang (Rehmanniae Radix Preparata), Huangqi (Astragali Radix), Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix, heart removed), Zexie (Alismatis Rhizoma), Shihu (Dendrobii Caulis), Pipaye (Loquat Leaf). Take 5 qian per dose, decoct in water and drink.

Jiajian Bawei Wan (Modified Eight-Ingredient Pill): Treats Kidney Deficiency Xiao Ke with excessive drinking.
Take the base formula, remove Fuzi (Aconiti Lateralis Radix Preparata), add Wuweizi (Schisandrae Fructus). *Jingui Yaolue* treats men with Xiao Ke having excessive urination using this same formula. See Supplementing and Tonifying section.

Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink): Treats thirst with turbid or obstructed urination.
Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix), Digupi (Lycii Cortex), Cheqianzi (Plantaginis Semen), Gancao (Licorice Root, 3 qian each), Lianzi (Nelumbinis Semen), Fuling (Poria), Huangqi (Astragali Radix), Chaihu (Bupleuri Radix), Renshen (Ginseng Radix et Rhizoma, 3 qian each). Coarsely chop. Decoct in water and drink.

Chuan Huanglian Wan (Sichuan Coptis Pill): Treats thirst.
Chuan Huanglian (Coptidis Rhizoma, 5 liang), Huafen (Trichosanthis Radix), Maidong (Ophiopogonis Radix, heart removed, 2.5 qian each). Grind into powder, mix with Shengdihuang Zhi (Rehmanniae Radix Recens Juice) and Niu Ru (Bovine Milk), knead into pills the size of Sophora seeds. Take 30 pills with Jingmi Tang (Rice Decoction).

Yuquan Wan (Jade Spring Pill): Treats irritability, thirst, and dry mouth.
Maidong (Ophiopogonis Radix, heart removed), Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Huangqi (Astragali Radix, half raw, half honey-roasted), Wumei (Mume Fructus, baked), Gancao (Licorice Root, 1 liang each), Gualougen (Trichosanthis Radix), Gange (Puerariae Lobatae Radix, 1.5 liang each). Grind into powder, make honey pills the size of quail eggs. Take one pill per dose, chew with warm water.

Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction): See Summerheat section.
Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction): See Dysentery category.
Sanhuang Wan (Three Yellows Pill): Huanglian (Coptidis Rhizoma, remove roots), Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma, roasted, equal parts). Grind into powder, make honey pills the size of Sophora seeds. Take 40 pills with cooked water.

Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill): See Supplementing and Tonifying section.