Library

Coptidis Rhizoma (2 qian) *Tianhuafen* (8 qian, ground into powder, mixed with milk or natural juice of lotus root or sugarcane for administration)

Xiao Ke (Wasting-Thirst Syndrome), in its fundamental principle, is one entity; however, when differentiated, it presents as three syndromes. Thirst accompanied by excessive drinking is termed Shang Xiao (Upper Wasting-Thirst); excessive appetite with rapid hunger is Zhong Xiao (Middle Wasting-Thirst); irritability, thirst with copious water intake, and urine resembling paste are termed Xia Xiao (Lower Wasting-Thirst). The *Classic of Internal Medicine* states: "Heart heat transfers to the Lung, transforming into Ge Xiao (Diaphragmatic Wasting-Thirst)." Metal (Lung) becomes dry when subjected to Fire, hence thirst. For dryness, moistening is indicated; therefore, Tianhuafen (*Fritillariae Thunbergii Bulbus*), cow's milk, lotus root juice, and sugarcane juice are used. Since Fire originates from the Heart, Huanglian (*Coptidis Rhizoma*) is employed to drain Heart fire. Regarding Zhong Xiao, the *Classic* states: "Dan Re (Intense Heat) transforms into Xiao Zhong (Wasting-Middle)." Dan refers to heat. Treatments may include Dihuang Yin Zi (*Rehmanniae Decoction*) or Zhuye Shigao Tang (*Bamboo Leaf and Gypsum Decoction*); in severe cases, Cheng Qi Tang (*Order the Qi Decoction*) is used for purging. Regarding Xia Xiao, the *Classic* states: "One meal results in two urinations, urine like paste or oil," which is considered incurable. This condition typically arises when Shang Xiao and Zhong Xiao symptoms precede; physicians, accustomed to these signs, fail to observe closely, allowing Heat pathogens to transmit downward, consuming Kidney essence. Alternatively, excessive use of bitter-cold purgatives damages True Qi, impairing the ability to control body fluids and nourish the tissues. Consequently, ingested food transforms into urine, resulting in copious discharge resembling paste and oil. Urgent treatment requires the alternating use of modified Ba Wei Wan (*Eight-Ingredient Pill*), Zuo Gui Wan (*Restore the Left Pill*) or You Gui Wan (*Restore the Right Pill*), or Bai Ling Fen Wan (*White Poria Pill*). Otherwise, emaciation, weakness, impotence, and dry teeth will occur, leading to a daily decline in vital energy.

Mr. Ding Fangzhou of our county, who studied hard and enjoyed drinking, suffered from Xiao Ke at age twenty-six. Physicians attributed it to dietary excess and prescribed only digestive aids. His thirst worsened, and his consumption of alcohol and meat increased. The following year, he developed Xia Xiao, presenting with previous symptoms plus鼓胀 (Drum-like Distension/Tympanites) and blindness. Upon my consultation, I knew the disease was likely incurable, but since the ocular manifestation was internal obstruction (Nei Zhang), there was hope for treatment. I administered Shen Qi Wan (*Kidney Qi Pill*), Ning Zhi Dan (*Calm the Spirit Pill*), and Zhu Jing Wan (*Stabilize the Scenery Pill*), followed by acupuncture on his left eye. While vision did not become very clear, he felt significant relief. A year later, after acupuncture on his right eye, his vision recovered, although the oral medications had been ineffective. Alas, this exemplifies what is termed "incurable."

Bu Zhong Yi Qi Tang (*Tonify the Middle and Augment the Qi Decoction*) combined with Sheng Mai San (*Generate the Pulse Powder*), Er Miao San (*Two Marvels Powder*), Si Ling San (*Four Poria Powder*), along with Shen Qu (*Massa Medicata Fermentata*), Huanglian, and Sheng Di Huang (*Rehmanniae Radix*).
This addresses the interaction between Dryness and Dampness. Why does a formula named Qing Zao Tang (*Clear Dryness Decoction*) focus entirely on treating Dampness? Generally, the Lungs and Stomach are inherently deficient, and during the intense autumn sun, excessive consumption of melons, tea, and water leads to internal Dampness and external Heat fermenting into pathogenic factors. When the Lung Metal is affected, celestial Qi fails to descend, and the Bladder loses its source of transformation. Symptoms include thirst, dry stool, yellow and gritty eyes. The priority must be to Clear Metal and Moisten the Lung. Therefore, Bu Zhong Yi Qi Tang combined with Sheng Mai San is used to raise Yang and generate fluids. Dryness inevitably leads to Wei Syndrome (Flaccidity Syndromes); thus, Er Miao San plus Huanglian and Sheng Di Huang is used to treat flaccidity. Dampness inevitably leads to Bi Syndrome (Obstruction Syndromes); thus, Si Ling San plus Shen Qu is used to promote diuresis and resolve dampness.

Note: This decoction is not intended, as noted by Li Dongyuan, for general treatment of blood depletion, essence exhaustion, internal烦热 (irritating heat), blocked fluid pathways, and various harms caused by dryness. Yu Jiayan advocated treating dryness via dampness resolution. Without Li Dongyuan's exceptional insight, such understanding would be impossible; otherwise, it is merely "knowing one but not the other." Furthermore, the herbal composition is杂乱 (miscellaneous) and forced. Even based on the above explanation, what is the rationale for using Sheng Ma (*Cimicifugae Rhizoma*) and Chai Hu (*Bupleuri Radix*), Huang Bo (*Phellodendri Cortex*), and Shen Qu? If treating from the perspective of dampness, Sheng Di, Mai Dong (*Ophiopogonis Tuber*), Huang Lian, and Huang Bo are absolutely unnecessary. Whether treating Summerheat or Smallpox, the approach uniformly raises Yang and regulates Qi, merely adding or subtracting from existing formulas. When the same formula treats different diseases, renaming it implies that exceptional insight lies therein?
This decoction is fundamentally useless. Because Mr. Yu praised it excessively, it was prominently recorded to awaken people from long dreams. We must establish our foundation in conduct and elevate our perspective in reading. With complete wisdom and thorough understanding, we naturally will not be deceived by predecessors.

Er Miao San (*Two Marvels Powder*): Huang Bo (*Phellodendri Cortex*) and Cang Zhu (*Atractylodis Rhizoma*) in equal parts. It is effective because Huang Bo excels at clearing heat, while Cang Zhu excels at resolving dampness, particularly for pain caused by Damp-Heat.
Dao Huan San (*Reverse Exchange Powder*): Jing Jie (*Schizonepetae Herba*) 2 liang, Da Huang (*Rhei Radix et Rhizoma*) 1 liang. It treats urinary retention directly and simply. It is considered highly relevant to Er Miao San. Additionally, Cang Zhu and Jing Jie in equal parts, formed into pills coated with Xiong Huang (*Realgar*), treat Wind-Dampness, sharing the same principle.