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I composed the "Treatise on Xiao Ke (Wasting-Thirst)," aiming to synthesize the general principles of the *Nei Jing* (Inner Canon), asserting that the disease originates in the Stomach and culminates in the Lung and Kidney, thus categorizing it into Upper, Middle, and Lower Xiao. Other conditions such as Ge Xiao (Diaphragm Thirst) are also accumulations of food stagnation, essentially falling under the categories of Middle or Upper Xiao. However, lacking solid evidence from the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), my heart remained unsatisfied. Two years later, I suddenly recalled a passage from the *Nei Jing*: "If there is fatigue and overexertion, the physical form and Qi decline, the Qi from grain and water is not abundant, the Qi of the Upper Jiao fails to circulate, the Stomach Qi becomes hot, and the hot Qi steams the chest, resulting in internal heat." I suddenly realized the mechanism of pathology in the chest: it is entirely due to the fact that the Qi of grain and water in the Stomach and the Tian Zhen Qi (innate Qi/Zong Qi) circulating throughout the body maintain clarity in the body; if fatigue and overexertion injure the Da Qi (Grand Qi/Zong Qi), then the Qi in the chest declines. Consequently, the Qi from grain in the Stomach becomes insufficient. When the Qi from grain is insufficient, the injured Qi in the chest becomes even harder to recover and cannot function properly. Thus, the Qi from grain remains stagnant in the Stomach, stagnates and transforms into heat, the hot Qi steams into the chest, mixes with the declining Qi there, and transforms into internal heat. The relationship between the chest and Stomach unknowingly loses its original harmonious state. Under these circumstances, how could one avoid wasting and thirst? By penetrating this understanding, the matters in the *Jin Gui Yao Lue* that were previously unclear are now fully illuminated.

The *Jin Gui Yao Lue* states: "The pulse at Cun Kou (radial artery) is floating and slow; floating indicates deficiency, slow indicates labor/exhaustion. Deficiency means Wei Qi (Defensive Qi) is insufficient, and exhaustion means Ying Qi (Nutritive Qi) is exhausted. The pulse at Fu Yang (dorsalis pedis artery) is floating and rapid; floating indicates Qi abundance, rapid indicates consumption of food and hard stools. Qi abundance leads to frequent urination; frequent urination leads to hardness. The interaction of hardness and rapidity constitutes Xiao Ke." Here, the Cun Kou pulse is used to observe the Qi in the chest, and the Fu Yang pulse is used to observe the Qi in the Stomach. Clearly, there are pulses to follow and signs to observe, yet the subtle nuances remain difficult to explain. Generally, Yin inside serves as the guardian of Yang, and Yang outside serves as the protector of Yin. A floating pulse at Cun Kou indicates that Yin cannot guard within, so the Yang defending the exterior floats, which is termed "deficiency." A slow pulse at Cun Kou indicates that Yang cannot protect externally, so the Yin guarding internally slows down, which is termed "labor/exhaustion." Ultimately, this is because fatigue and injury to Ying and Wei cause the Cun Kou pulse to be both deficient and slow. However, Ying Qi is the essence of grain and water, while Wei Qi is the fierce Qi of grain and water. Being both deficient and slow indicates that the Qi of grain and water fails to ascend and nourish, instead stagnating internally, revealing a glimpse of Diaphragm deficiency and Stomach heat. Further considering the floating and rapid Fu Yang pulse, floating indicates Qi abundance, which is a variation of the "hot Qi steaming the chest" mentioned in the *Nei Jing*; rapidity indicates consumption of food and hard stools. In my previous discussion, I likened this to throwing water at a stone; the water flows away while the stone remains unchanged, occasionally aligning with the phenomenon of a hard Stomach that consumes food but not water. This shows that fire/heat inherently consumes water, and water entering the body should theoretically quench thirst. However, the dryness and hardness in the Stomach completely reject the infiltration of water. Instead, following the momentum of fire/heat, the water rushes urgently to the Bladder, causing frequent urination. As urine leaves, the interior becomes drier, so the interaction of hardness and rapidity constitutes Xiao Ke. This directly references the *Nei Jing* saying, "Excessive consumption of bitter flavors leads to transformation into fire over time; Spleen Qi becomes unmoistened, and Stomach Qi becomes concentrated," identifying this as the source of Xiao Ke. It is truly exquisite and subtle.

Since the Jin and Tang dynasties, there have been no lack of sages who, relying on their intelligence, speculated upon the *Nei Jing* and established their own schools. Yet none entered the inner sanctum of Zhang Zhongjing's scholarship because their understanding of the *Nei Jing* was superficial. Had they studied deeply, they could have classified symptoms according to patterns, presenting pulse, sign, formula, and treatment methods to clarify standard practices, and the *Jin Gui Yao Lue* would have been passed down from family to family and recited by every household. Take Xiao Ke for example: the prevailing view holds that "Middle Xiao is suitable for purgation." Everyone adheres to this single phrase without further discussion. Can one purge resolve the entire situation? Or should one purge gradually and slowly? If the Stomach is already extremely hard and rejects moistening agents, administering Cheng Qi Tang (Gut-Regulating Decoction) abruptly means the hard parts will not accept it, while the flawed parts will. If the Bladder cannot tolerate it, the Large Intestine will. Would this not, riding the momentum of the medicine, transmit into dysentery, loose stools, abdominal fullness, and swelling? The *Zong Lu* states that in the late stage, if the patient can eat, they will likely develop brain abscesses or back sores; if they cannot eat, they will develop abdominal fullness and distension. These are all incurable conditions. Various practitioners do not rush to treat during the initial or middle transmission stages but instead employ various treatments in the late stage, such as pills and powders containing Honeysuckle, Isatis leaf, and Shepherd's purse, or formulas like Perilla and Lepidium Powder for Abdominal Fullness. What is the purpose of this? The *Jin Gui Yao Lue*, when slight difficulty in urination is perceived, early on uses only one herb, Wen Ge (Clam Shell), to treat it. Later formularies never record this. Who knows that softening-hardness herbs either rob Yin or damage Yin; only this one is gentle and harmless, and additionally promotes diuresis. It is indeed worthy of treasure.

Jie Gu (Zhang Yuansu) stated: For those who can eat and feel thirsty, use Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng); for those who cannot eat and feel thirsty, use Qian Shi Bai Zhu San (Dr. Qian's Atractylodes Powder) plus Kudzu Root. For late-stage sores and carbuncles, Fire Evil is abundant; urgently attack the Yang aspect, do not attack the Yin aspect. If the Yuan Qi (Primal Qi) of the Lower Jiao becomes strong, life is preserved; if it loses strength, death ensues. Late-stage abdominal fullness results from excessive treatment of High Xiao (Upper Xiao) and Middle Xiao, rapidly surpassing the disease site. The heat above has not been cleared, yet cold arises in the middle. This is not the fault of the medicine, but the failure to regulate the urgency and slowness of treatment. Elder Jie Gu can be described as a rare voice in an empty valley! His statements about "not attacking the Yin," "survival if strength is gained," and "death if strength is lost" are profound warnings against the depletion of the spring (fluids), inspiring awe and respect. Following in his footsteps, I slowly propose this statement: All three Xiao types are fundamentally Fire diseases. Does one wait until late-stage sores appear to consider Fire Evil dominant? However, whether Fire is in the Yang or Yin, which Zang-Fu organs are involved, and whether it is appropriate to ascend, descend, suppress, or subdue, each case differs. Treating according to its nature, ensuring no mutual rejection, is the good method. If one does not treat the Fire but only treats the Heat, the Fire will have no abode, and how can the Heat ever cease? For instance, for Kidney Xiao (Yin disease), use Liu Wei Wan (Six-Ingredient Pill with Rehmannia); for Yang disease, use Ba Wei Wan (Eight-Ingredient Pill). This is also one method. But if one claims that Lower Xiao has only this one method, how does it compare to the theory that Middle Xiao requires purgation? They differ by more than just an inch!

The *Nei Jing · Treatise on Distinctions of Yin and Yang* says: "Binding of the Two Yangs is called Xiao." The Two Yangs refer to the Yangming channels. Hand Yangming Large Intestine governs Jin Ye (Body Fluids); in Xiao disease, yellow eyes and dry mouth occur, indicating insufficiency of fluids. Foot Yangming Stomach governs Blood; in heat disease, food consumption increases and hunger is frequent, with latent fire in the blood, indicating insufficiency of blood. Binding refers to insufficiency of Jin Ye and Blood, binding and failing to circulate, all being diseases of Dryness.

The *Nei Jing* says: "Heart transfers heat to the Lung, transmitting as Ge Xiao." Zhang Zihe claimed that Ge Xiao has not yet reached the Lung; only when Heart transfers cold to the Lung is it called Lung Xiao. Such rigidity in text harms the meaning; one who reads the *Nei Jing* thus is not truly reading it. Is there any logic that Heart transferring heat to the Lung, and Lung transmitting heat to the Diaphragm, means it hasn't reached the Lung? Must one change the text to "Heart transfers heat to the Diaphragm, transmitting as Lung Xiao" to avoid rigidity? One must recognize that Heart and Lung reside together above the Diaphragm. The Lung is a delicate organ; whether cold or heat is transferred, it easily enters. Cold pathogen entering binds externally; heat pathogen entering transmits externally. Both result in Lung Xiao, but treatments differ.

Liu Hejian discussed the disease of Three Xiao, attributing it to extreme deficiency of damp-cold Yin Qi and excess of dry-heat Yang Qi. In the Six Qi, he omitted Wind and Fire. Moreover, distinguishing Xiao Ke, Xiao Zhong, and Xiao Shen clearly as Three Xiao, does this imply Middle and Lower Xiao have no thirst? Yet when citing the Classics, he mentions thirst due to Heart-Lung Qi reversal, Liver Bi, Bi-heat, Stomach and Large Intestine binding-heat, Spleen Bi, Kidney heat, and Small Intestine Bi-heat. His reasoning became increasingly generalized. His discussion did not conform to the essence of Xiao Ke but merely cited thirst as evidence of dry-heat consuming fluids, which is truly incomprehensible. *Yu Ji Wei Yi* deeply adopted his view, criticizing the error of using warm medicines to tonify the Kidney. I do not know what specific warm medicines he referred to! How could there be a rationale for using warm medicines to treat Xiao Ke? His intent likely targeted the non-*Jin Gui* preference for Shen Qi Wan. Shen Qi Wan steams and moves Kidney Water, serving as a sacred medicine for treating Xiao Ke, known by later generations. Why did He Bozhai refute it? I fear that later students, accidentally reading the views of Zhang Zihe and others, might become confused and dizzy, so I reiterate my position.

Dan Re transforming into Xiao Zhong involves extremely deep Stomach heat and blazing Stomach fire, hence the ability to eat, easy hunger, and excessive thirst. Various practitioners claim Da Cheng Qi Tang (Major Order of the Gut Decoction) should be used for purgation. They fail to realize that gradually accumulated heat and originally stored fire do not require urgent purgation; even if purged, it will not remove them, only damaging the intestines and stomach and increasing distress. Thus, Dahuang (Rhubarb) is used only as a last resort. It should be decocted for a long time to moderate its nature. It must not be combined with Zhishi (Immature Bitter Orange) and Houpo (Magnolia Bark), as this aids its rapid downward momentum. Jie Gu used Dahuang but renamed it Shun Li San (Smooth Flowing Powder), implicitly taking "smooth flow" rather than "assault" as the intent. The prescription notes: "Treats Middle Xiao with heat in the Stomach and ability to eat, yellow urine with slight looseness; effective until appetite is lost. Do not cause excessive looseness." I worry that if slight looseness progresses to loss of appetite, Stomach Qi will be depleted. Cheng Qi Tang is not a method for slight looseness; how can it be abused? Zhang Zihe further modified the formula into Jia Jian San Huang Wan (Modified Three Yellows Pill), combining Dahuang, Huang Qin (Scutellaria), and Huang Lian (Coptis), omitting Zhishi and Houpo. The prescription notes: "Treats Dan Shi poison and heat-thirst." Speculatively, this must be used only for true Excess patterns. Did he not consider that in Xiao Ke, True Qi is consumed by fire-heat; where are there people with true Excess patterns? Then, how must one proceed to remove Stomach fire-heat? I suggest decocting Dahuang for a long time and combining it with Gancao (Licorice) to balance urgency and moderation; combining it with Renshen (Ginseng) to simultaneously attack and tonify. Like national border defense, sitting tight to困 (besiege) the enemy, one might plan for long-term healing ("three-year-old mugwort"). Currently, although there may be opportunistic quick-fix tactics, they are not advocated. How can one expect immediate results? The ancients erred.

[Five Laws]
1. Whenever treating newly acquired Xiao Ke, if one does not urgently generate fluids, replenish water, lower fire, and clear heat, and uses inappropriate medication, delaying and harming the patient, it is the doctor's fault.
2. Whenever treating established Middle Xiao, if one does not urgently rescue the Metal (Lung) and Water (Kidney) organs, letting the spring dry up without addressing the source, it is the doctor's fault.
3. Whenever treating Lung Xiao by using Di Huang Wan (Rehmannia Pill) to treat the Blood aspect, or treating Kidney Xiao by using Bai Hu Tang (White Tiger Decoction) to treat the Qi aspect, sticking rigidly to one approach without flexibility, failing to cure the disease, it is the doctor's fault.
4. Whenever Xiao Ke slightly improves, if one does not urgently restore withered moisture, allowing the Earth (Spleen/Stomach) to become dry and barren, leading to incurable sores and carbuncles, it is the doctor's fault.
5. Whenever treating Xiao Ke, if one uses cold-cooling medicines excessively, causing Water to overcome and extinguish Fire, yet fails to reverse course, gradually leading to incurable edema and fullness, it is the doctor's fault.