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Wu (aged 59) went into the mountains in early summer to buy bamboo and did not return for over a month. After enduring the summer and autumn seasons, his muscles wasted away, and his formerly obese body suddenly became emaciated. Accompanied by numbness and pain in both legs, making walking difficult, he sought medical treatment on several occasions. Some physicians considered it a deficiency syndrome, while others viewed it as dampness. After taking dozens of prescriptions, his vision became blurred, objects appearing small when they were actually large, and his condition worsened daily. A neighbor who worked as a barber claimed he could cure him, so Wu sought his help. The pulse in all six positions was surging, full, and wiry. Given that he had suddenly lost weight from a previously obese state, I suspected this might be Xiao Ke (Wasting-Thirst Syndrome). I asked about his fluid intake and urination frequency. He replied: "When I went into the mountains, the weather was initially hot, causing irritability and thirst; I liked drinking water. To this day, my throat remains dry, and I feel relief only after frequent sipping of tea. Shortly after drinking, I need to urinate." I further asked if sand-like particles appeared when his urine dripped onto dry soil. He answered: "I have not tested it, but I noticed foam rising several inches high in the excretion pit." I said: "For half a year, your muscles have been wasting away daily. If this continues, according to ancient texts, the symptom of 'drinking one part and urinating two parts' is termed Shang Xiao (Upper Wasting-Thirst). This is caused by hyperactive Yang heat; without potent cold-natured herbs, it cannot be cured."

Prescription: Shigao (Gypsum Fibrosum, 1 liang), Chuanlian (Coptidis Rhizoma, 1 qian), Huangqin (Scutellariae Radix, 1.5 qian), Huangbai (Phellodendri Cortex, 1.5 qian), Zhimu (Anemarrhenae Rhizoma, 1.5 qian), Shudihuang (Rehmanniae Radix Praeparata, 4 qian), Shengdihuang (Rehmanniae Radix, 3 qian), Tiandong (Asparagi Radix, 2 qian), Maidong (Ophiopogonis Radix, 2 qian), Guiban (Testudinis Carapax et Plastrum, 2 qian), Baishao (Paeoniae Radix Alba, 1.5 qian), Gancao (Glycyrrhizae Radix et Rhizoma, 0.4 qian).

After taking four doses, the symptoms of dryness, thirst, and urinary foam decreased slightly, and his vision cleared significantly. He asked me: "Previously, I took dozens of prescriptions, yet my condition worsened. Now, having taken only four doses, why is the effect so rapid?" I replied: "Your constitution is Yang-type, and your pulse is also Yang-type. Entering the mountains during the time of abundant Yang, combined with physical labor, and your preference for distilled liquor, caused fire in the five zang organs to flare up, resulting in dryness and thirst. When food enters the stomach, it is digested and transformed; essence circulates upward to the lungs, where fluids are distributed throughout the body and descend to the bladder. Through the regulation of water passages, urine is excreted. This process of ascending, descending, and distributing requires proper physiological function. Currently, due to fire in the zang-fu organs, it is like pouring water onto dry soil: it leaks easily and fails to nourish. Even if the dosage were increased and made into pills for long-term use, it would take nearly a year for the leg numbness and pain to heal. Wu’s survival is entirely due to the grace of the barber-doctor!"