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Dian heat develops into Middle Xiao (Middle Jiao Diabetes). (The full text is found in *Zhen Jing* stating: When the five Zang organs are weak and brittle, one is prone to Xiao Dan [Diabetes with emaciation]. Wang Bing's commentary states: Dian refers to a heat-generating disease of the Xiao type.)
Feeling hungry shortly after eating is called Wei Dan (Stomach Jaundice). (Another version in *Ping Ren Qi Xiang Lun* states: Zhu Xia is equivalent to Dan Lao disease.)
Consuming large amounts of grain but having little Qi results from prior blood loss and dampness accumulating in the lower body. (The full text is found in *Zhen Sheng Si*.)

[From *Ling Shu*] Heat in the Stomach causes rapid digestion of food, leading to a sensation of emptiness in the heart and easy hunger; this corresponds to heat in the skin. (From *Shi Chuan* chapter, same below) If there is heat in the Stomach and cold in the Intestines, it leads to frequent hunger and pain/distension in the lower abdomen. Internal heat causes the Stomach to digest food rapidly. (From *Wu Long Jin Ye Pian*)

[From *Su Wen*] The binding of the Three Yang meridians is called Xiao (Wasting-Thirst). (Wang Bing’s commentary on *Yin Yang Bie Lun* states: Both the Stomach and Large Intestine have heat binding; heat promotes the consumption of water and grain.)

[Li Dongyuan] In treating Zhong Xiao (Middle Xiao) within Xiao Ke (Wasting-Thirst), ancient practitioners only treated dryness and stopped thirst, which was a mistake. One must not fail to realize that "the binding of the Three Yang is called Xiao." The Three Yang refers to the Yangming meridians. The Hand-Yangming Large Intestine governs body fluids; its pathology involves heat causing yellow eyes and dry mouth, indicating insufficient body fluids. The Foot-Yangming Stomach governs blood; its pathology involves heat causing rapid digestion and easy hunger, indicating hidden fire in the blood and insufficient blood. "Binding" means insufficient body fluids, condensation without lubrication, all caused by dryness-heat. This occurs because of frequent consumption of sweet, delicious, and fatty foods, causing Qi to overflow upward and transform into Xiao Ke. Treatment involves using Lan Cao (Plagiorhiza/Patchouli Herb) to remove stale Qi. One should not consume rich foods, aromatic herbs, or mineral drugs, as their fierce nature can assist heat and dryness. Yue Ren (Bian Que) stated: When pathogenic factors are in the Six Fu organs, the Yang pulses become discordant; discordance leads to Qi stagnation, which makes the Yang pulses vigorous. Excessive Yang pulse vigor prevents Yin Qi from nourishing, resulting in the wasting of muscles and skin.

[From *Su Wen*] The Yellow Emperor asked: There is a patient with a sweet taste in the mouth. What is this disease? How does it arise? Qibo answered: This is the overflow of the Five Qi, named Pi Dan (Spleen Dan). When the five flavors enter the mouth, they are stored in the Stomach, and the Spleen transports their essence. When fluids remain in the Spleen, it causes a sweet taste in the mouth. This arises from rich and fatty foods; such individuals must frequently eat sweet and fatty foods. Fatty foods cause internal heat, and sweet foods cause fullness in the center. Thus, Qi overflows upward, transforming into Xiao Ke. Treatment involves using Lan Cao to remove stale Qi. (From *Qi Bing Lun*)

[Zhang Jiegu] Heat in the Stomach leads to efficient digestion of water and grain; one may use sweet and acrid agents to descend fire. Use Coptis Rhizoma powder, fresh juice of Rehmanniae Radix and Nelumbinis Nucillus each one sheng, and cow's milk one sheng, boiled into an ointment. Mix with one jin of Coptis Rhizoma powder, form pills the size of paulownia seeds. Take 30–50 pills each time, swallowed with small sips of warm water, ten doses per day.

[Li Dongyuan] Zhu Du Wan treats Xiao Ke.
Pig Stomach (one) Coptidis Rhizoma (one liang) Trichosanthis Radix (four liang) Ophiopogonis Radix (decored, four liang) Anemarrhenae Rhizoma (one liang)
Grind into fine powder, place inside the pig stomach, sew with thread, steam in a steamer until extremely soft, pound while hot in a stone mortar until pillable consistency. If too hard, add a little honey to form pills. Take 30 pills each time, gradually increasing to 40–50 pills, take when thirsty. (*San Yin Fang* includes Sorghum Rice and Eucommiae Cortex. *Ben Cao* states: Pig Stomach tonifies the Center, benefits Qi, and stops thirst.)

[Li Dongyuan] Tiao Wei Cheng Qi Tang treats Xiao Zhong (Middle Wasting), characterized by thirst and excessive eating. (Formula seen in *Shang Han Lun*, suitable for early stage.) San Huang Wan (Formula seen under Fever treatment section).

[Zhang Jiegu] Shun Li San treats excess heat in the Stomach allowing for eating, with red-yellow urine and mild diarrhea. The goal is to reach a state of no desire to eat; do not cause excessive diarrhea.
Magnoliae Officinalis Cortex (one liang each) Immature Bitter Orange (one liang) Rheii Radix et Rhizoma (roasted, four liang)
Take five qian each time, decoct in water, take far from meals.

Heat transferring from the Large Intestine to the Stomach causes voracious eating yet emaciation, also known as Shi Ji (Eating without gaining flesh). (Full text in *Zhen Bing Chuan Bian*. Shi Ji means food passes through without nourishing muscles, accompanied by easy hunger. Dongyuan said: Voracious eating with emaciation occurs because latent fire pathogens in the Stomach allow for eating, while Spleen deficiency causes muscle wasting.) Heat transferring from the Stomach to the Gallbladder is also called Shi Ji. (Same source)

[Li Dongyuan] Shen Pu Wan treats Shi Ji. Symptoms include heat binding in the Stomach, rapid digestion, strong appetite, but failure to build muscle mass.
Ginseng Radix Red Poria Polyporus Acori Tatarinowii Rhizoma Polygalae Radix Cortex Lycii Radicis Achyranthis Bidentatae Radix (wine-soaked, one liang each)
Grind into powder, refine honey to make pills. Take 20 pills each time, swallow with rice drink.

In the theory of Six Qi transformations, Xiao Zhong belongs to heat. The Classics state: When Shaoyin prevails, there is heat in the epigastrium and easy hunger. It also states: When Shaoyang prevails, heat lodges in the Stomach causing easy hunger; treating with cold agents is correct.

Acupuncture and moxibustion for Xiao Zhong all select Stomach meridian points. The Classics state: When pathogens are in the Spleen and Stomach, with excess Yang and deficient Yin, one experiences Heat Zhong and easy hunger; select Zusanli and apply moxa. It also states: The Foot-Yangming Stomach Meridian, when Qi is excessive, causes heat in the anterior body; regarding the Stomach, this manifests as rapid digestion and easy hunger. (Heat requires clearing, excess requires draining.)

[From *Jia Yi Jing*] Deficiency of Yin Qi, Heat Zhong, rapid digestion with easy hunger, abdominal heat, restlessness, mania, and delirium are primarily treated by Zusanli. Abdominal distension radiating to the spine, excessive eating yet emaciation, is named Shi Ji. Upon onset, first select Shenshu, then select the costal margin.