Library

Li Dongyuan stated: For Ge Xiao (Diabetes Mellitus affecting the chest/diaphragm), treat with Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). For Zhong Xiao (Diabetes Mellitus affecting the middle jiao/stomach), symptoms include polyphagia with emaciation, spontaneous sweating, hard stools, and frequent urination. Wang Shuhe stated: Dry mouth, excessive drinking, and hunger after eating, developing into Xiao Zhong due to deficiency heat, should be treated with Tiaowei Chengqi Tang (Regulate the Stomach Purging Decoction) and Sanhuang Wan (Three Yellow Pill). For Xia Xiao (Diabetes Mellitus affecting the lower jiao/kidney), symptoms include irritability, thirst for water, dry and scorched earlobes, and urine resembling paste. Wang Shuhe stated: Scorched irritability and easy depletion of fluids indicate Kidney Xiao, which should be treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). The *Zonglu* states: In the late stage of the disease, if the patient can eat, they will inevitably develop brain carbuncles or back sores; if they cannot eat, they will inevitably develop abdominal fullness and distension. These are all considered intractable conditions.

Jiegu Laoren (Elder Jiegu, i.e., Zhang Congzheng) treated them separately: For those who can eat and feel thirsty, use Baihu Jianshen Tang (White Tiger Decoction plus Ginseng); for those who cannot eat and feel thirsty, use Baizhu San (Atractylodes Macrocephala Powder) from Qian's formula, with doubled amounts of Gegen (Kudzu Root). Once Shang Xiao (Upper Xiao) and Zhong Xiao are stabilized, Xia Xiao will no longer occur. The ancients indeed had profound intentions in their medication strategies.

Someone asked: Why do sores and carbuncles appear in the late stage? This is due to the predominance of fire pathogenic factors. These sores are extremely painful but do not ulcerate, or they discharge red pus. The Classics state: "Organic lesions without pain belong to the Yang category." One should urgently attack the Yang aspect, not the Yin aspect. If the pathology is in the Lower Jiao, survival depends on strong Yuan Qi (Original Qi), while death results from weak Yuan Qi.

Someone asked: Why does abdominal fullness occur in the late stage? Using cold medicines to treat heat is a principle that even herbalists cannot abandon or alter. However, Zang-Fu organs have distances relative to the surface. The Heart and Lung are located proximally, so small doses should be prepared; the Liver and Kidney are located distally, so large doses should be prepared. This ensures the medicinal force reaches the target precisely. Both excess and deficiency in dosage punish areas that are not at fault. For example, in Shang Xiao and Zhong Xiao, if the prescription is too rapid and intense, exceeding the pathological site, it may lead over time to abdominal fullness. This refers to the situation where upper heat has not been cleared, yet middle cold arises. This is not the fault of the medicine, but the loss of proper moderation in urgency and slowness. Therefore, great attention must be paid to prescription formulation.

Commentary: The above discussion on the transmission of the Three Xiao diseases reveals the essence of disease mechanisms. Compared with Chen Shi’s *San Yin Fang*’s discussion on Xiao Zhong, there are three additional syndromes. All involve the skin and muscles, differing only in manifestation. Generally, sores and carbuncles appearing on the surface indicate the pathogen moving outward; abdominal fullness and Qiang Zhong (priapism/excessive sexual arousal) indicate the pathogen moving inward to an extreme hyperactive state. Although *San Yin Fang* provides a formula for treating Qiang Zhong, I have not seen its key efficacy. I preserve it here for reference. Moreover, since abdominal distension resulting from transmission is considered intractable, how much more so is Qiang Zhong?

Ju Fang Qingxin Lianzi Yin (Official Bureau Clearing the Heart Lotus Seed Decoction)
Tiaowei Chengqi Tang (Regulate the Stomach Purging Decoction): Treats Xiao Zhong with heat in the Stomach, ability to eat, and dark yellow urine. (Formulas see Hot Pathogens section)

Sanyin Zhenzhu Wan (Three Causes Pearl Pill): Treats Heart deficiency with irritability and oppression, accumulated heat causing vexation and thirst, dry mouth and tongue, excessive drinking, and urination that is either free or obstructed.
Ingredients: Zhi Mu (Anemarrhenae Rhizoma, 1 liang 1 fen), Huanglian (Coptidis Rhizoma), Kushen (Sophorae Flavescentis Radix), Xuanshen (Scrophulariae Radix), Tie Fen (Ferrum), Muli (Ostreae Concha, each 1 liang), Zhusha (Cinnabar, 2 liang), Maimendong (Ophiopogonis Radix, heart removed), Tianhuafen (Trichosanthis Radix, each half liang), Jinbo (Folium Aurum), Yinbo (Folium Argenti, 200 pieces).
Preparation and Administration: Grind the above herbs into powder. Use refined honey and a little fresh Trichosanthis Radix juice to form pills the size of wutong seeds. Coat with gold and silver leaf. Take 20–30 pills per dose. First, administer with Trichosanthis Radix juice once, then follow with Ophiopogon decoction cooked with water. After symptoms subside, take twice daily.

Commentary: This is a medicine for the Heart and Stomach meridians. Among the above three formulas, there are differences in potency; select appropriately.