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Commentary: Xiao Ke (Wasting and Thirsting Syndrome), investigating its onset, is caused by Kidney Deficiency. Each time it occurs, the urine is extremely sweet. Physicians mostly do not understand this disease, so ancient formula treatises lack records of it and do not discuss it. Now, I will briefly state its essentials. According to "Jia Se Zuo Gan" (Crops and Harvests produce a Sweet flavor) in the *Book of Documents* (*Hong Fan*). Inferring from physical principles, methods for making fermented syrups or vinegar-wine preserves turn sweet within moments. This clearly proves that after humans eat, flavors become sweet, flowing into the Bladder. If the Qi of the Waist and Kidneys is vigorous, it can steam Essence upward; this Qi then enters the Bone Marrow downward, subsequently transforming into Fat and Marrow, and further into Flesh and Blood. The remainder becomes Urine, hence the urine is yellow, being the surplus of Blood. The fishy odor is the Qi of the Five Viscera; the salty and moistening taste is the flavor below. Since the Waist and Kidneys are deficient and cold, they cannot steam upward, so Grain Qi all flows downward to become Urine. Thus, the sweet flavor remains unchanged, the urine is clear and cold, leading to withered skin and muscles. It is like a nursing mother, where Grain Qi flows upward and transforms into Milk. In Xiao Ke patients, Essence leaks downward as Urine; because Essence is not solidified internally, the body becomes emaciated.

Furthermore, the Lung is the canopy of the Five Viscera. If there is warm Qi steaming from below, the Lung is moistened; if the lower part is extremely cold, Yang Qi cannot ascend, causing the Lung to be dry and hot. Therefore, in the *I Ching*, there is the Pi Hexagram (Stagnation), with Qian (Heaven/Yang) above and Kun (Earth/Yin) below. Yang is blocked and cannot descend, Yin lacks Yang to ascend. Upper and Lower do not interact, resulting in Stagnation. It is like a pot with water, heated by fire. If covered with a board, warm Qi rises, moistening the board. Without heat, water vapor does not rise, and the board remains dry. Heat represents the strength of the Waist and Kidneys. One must maintain warmth and nourishment; water vapor is Food Qi. If Food Qi receives warmth, it moistens the upper part and easily digests the lower part, preventing dryness and thirst. Thus, Zhang Zhongjing said: It is suitable to take Ba Wei Shen Qi Wan (Eight-Ingredient Pill of the Kidney's Qi), avoid cold foods and drinks, and one will no longer feel thirsty. Having frequently achieved efficacy, I record the correct formulas below.

This disease and Hong Jiao (Foot Qi/Jama), although both caused by Kidney Deficiency, differ in timing. Hong Jiao begins in the second and third months, peaks in the fifth and sixth, and wanes in the seventh and eighth. Xiao Ke begins in the seventh and eighth months, peaks in the eleventh and twelfth, and wanes in the second and third. Why? Hong Jiao is an Obstructive disease; Xiao Ke is a Venting disease. In Spring and Summer, Yang Qi ascends, so Obstructive diseases flare up, and Venting diseases heal. In Autumn and Winter, Yang Qi descends, so Venting diseases flare up, and Obstructive diseases heal. Understanding these two allows the disease to be managed. Suitable foods include eating pancakes on an empty stomach every five or six days, filled with fine mutton and yellow hen meat, which provides warmth. To move Qi downward, avoiding meat and vegetables, one should boil Achyranthes Root (Niu Xi), Chinese Chives (Jiu Cai), and Turnip Greens (Man Jing); also suitable are eggs and horse meat, which have slight obstructive properties and can treat Venting diseases. Excessive obstruction leads to Hong Jiao, similar to a good ruler who balances leniency with severity, adjusting measures according to circumstances, determined in heart but unspoken.

Quack doctors sometimes advise eating Trichosanthes Powder, but often taking it yields no effect. When mulberries ripen, select soft, delicious ones, wash away floating impurities with water, and eat them until chest and heart Qi feels balanced; this is also very good. Fresh cow milk warmed to body temperature, sipped slowly when thirsty, is also beneficial.

Zhang Zhongjing said: The Foot Taiyang Meridian is the Bladder Meridian; the Bladder is the Fu Organ of the Kidney. Frequent urination indicates Excess Qi; Excess Qi consumes Grain, leading to hard stools; Deficiency results in Xiao Ke.

For men with Xiao Ke, drinking one dou of water results in excreting one dou of urine; Ba Wei Shen Qi Wan (Eight-Ingredient Pill of the Kidney's Qi) is indicated as a divine prescription. Patients with Xiao Ke should take it regularly.
Rehmanniae Radix Preparata (Ba Liang) / Dioscoreae Rhizoma (Si Liang) / Poria (San Liang) / Corni Fructus (Wu Liang) / Alisma Rhizoma (Si Liang) / Moutan Cortex (San Liang).
Crush and sieve the above herbs, mix with honey to make pills the size of Sophora seeds. Take ten pills with wine, gradually increasing dosage until effective. Avoid pork, cold water, Coriander Seed, Cilantro, vinegar products, and raw green onions.

Explanation: Those who took Wu Shi Wan San (Five-Mineral Pills/Powders) in their youth accumulate heat over years, causing deficiency and consumption. Stone heat accumulates in the Kidneys, causing Lower Jiao Deficient Heat, frequent and profuse urination, leading to Xiao Li (Wasting and Flowing). Xiao Li involves non-thirsty, spontaneous urination, also called Xiao Ke. True Xiao Ke involves thirst without difficulty in urination. Also called Ke Li, where urination follows drinking immediately. Also called Qiang Zhong (Strong Middle), characterized by persistent erection without flaccidity and spontaneous seminal emission. It can also manifest as Carbuncles and Ulcers. For such conditions, Zhu Shen Ji Tang (Pig Kidney Shepherd's Purse Decoction) is suitable to restrain stone heat in the Kidneys, followed by Ya Tong Wan (Duck Dropping Pill) for recovery.

Zhu Shen Ji Tang Formula:
Pig Kidney (One unit) / Soybean (One Sheng) / Shepherd's Purse & Gypsum (Three Liang each) / Ginseng & Polyporus (San Liang each, note: Polyporus may be Poria) / Magnetite (wrapped in silk) / Anemarrhenae Rhizoma / Kudzu Root / Scutellariae Radix / Trichosanthis Radix / Licorice Root (Two Liang each).
Chop the twelve ingredients. Boil in fifteen Sheng of water. First boil Pig Kidney and Soybean to reduce to ten Sheng. Remove dregs, add remaining herbs, boil to three Sheng. Divide into three doses. Drink only when thirsty. For Lower Jiao Heat, take one dose at night. Stop when symptoms subside.

Ya Tong Wan Formula:
White Duck Droppings (Five Sheng, poured with twenty-five Sheng boiling water, clarified to obtain twenty Sheng juice) / Ephedrae Herba (Ba Liang) / Fermented Soybean (San Sheng) / Cold Stone (Liang) / Licorice Root (Wu Liang) / Gypsum (San Liang) / Gardeniae Semen (Twenty seeds).
Chop the six ingredients. Boil in Duck Dropping Juice to reduce to six Sheng. Remove dregs, add Fermented Soybean, boil three times. Divide into doses of five He. If feeling cold and urinating freely, extend intervals. If heat persists and urine is red and urgent, dosage is not limited to five He. Engage in mild exercise, eat gradually, do not eat too little, but avoid overeating.

Qian Dan San (Lead Tetroxide Powder), treating Xiao Ke and stopping frequent urination.
Lead Tetroxide (Two Fen) / Trichosanthes (Ten Fen) / Alisma Rhizoma (Five Fen) / Gypsum (Five Fen) / Red Halloysite (Five Fen) / White Halloysite (Five Fen) / Lead Carbonate (Two Fen) / Licorice Root (Ten Fen).
Grind eight substances into powder. Take one Cun Bi with wine, three times daily. Increase slightly if ineffective. Young adults take half a Cun Bi. Disease duration of one year cures in one day of medication; two years in two days. For severe cases, take with water at night, do not use wine.

Formula for Drinking One Shi Daily with Urinary Retention: Gua Lou Wan.
Trichosanthes Root (Three Fen) / Lead Tetroxide (Three Fen) / Kudzu Root (Three Fen) / Aconiti Lateralis Radix Preparata (One Fen, processed).
Grind four substances into powder. Mix with honey to make pills size of Sophora seeds. Take ten pills with water, three times daily.

Formula for Treating Xiao Ke:
Take three Dou of live snails, raise in one Shi of river water. Collect the cool juice, drink until full. Release after a day, repeat with fresh snails.

Nei Xiao (Internal Consumption) is caused by Heat. Urine output exceeds intake, causing extreme deficiency and shortness of breath. In Nei Xiao, food digests and exits as urine without thirst. Treat with Gou Qi Tang.
Goji Branches and Leaves (One Jin, Winter Roots Three Liang) / Trichosanthis Radix (San Liang) / Gypsum (San Liang, omitted in some versions) / Coptidis Rhizoma (San Liang) / Licorice Root (Liang).
Cut five substances. Boil in ten Sheng of water to yield three Sheng. Take five He per dose, three times daily.

Formula for Frequent Urination, Dozens of Times Day and Night:
Mung Bean Sprouts (One Ba).
Crush and squeeze juice. Drink three Sheng at once for cure. Also treats pediatric diarrhea.

Patients with Xiao Ke should avoid pork.