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(Suwen, Ping Ren Qi Xiang Lun)
When the artery in the neck pulsates visibly, accompanied by panting and rapid coughing, it is called Shui disease (Water disease). The "neck artery" refers to the pulsating artery beside the laryngeal prominence, which is the Renying point (ST9) of the Foot-Yangming Stomach Meridian. When Water Qi rebels upward and invades the Yangming meridian, the neck artery will pulsate. When Water overflows into the lungs, panting becomes urgent and rapid coughing occurs. When the eyelids are slightly swollen, resembling the shape of a lying silkworm, it is called Shui disease (Water disease). The "Mu Guo" refers to the lower eyelid, where the Stomach meridian arrives and the Spleen governs. If slight swelling resembling a lying silkworm is seen, it indicates that Water Qi has invaded the Spleen and Stomach. The Ping Re Bing Lun states: "Water is Yin, and the area under the eyes is also Yin; the abdomen is the residence of Supreme Yin. Therefore, when Water resides in the abdomen, it must cause swelling under the eyes." When urine is yellow-red and the patient desires to lie down (lethargy), it is Huang Dan disease (Jaundice). "Dan" refers to Yellow disease. The Lun Ji Zhen Chi Pian states: "Body pain with slightly yellow complexion, yellow dental calculus, and yellow nails indicate Huang Dan disease (Jaundice)." Lethargy, yellow-red urine, a pulse that is small and choppy, and lack of appetite are symptoms. The Zheng Li Lun calls this Lao Dan (Consumption Jaundice), caused by sexual exhaustion. "Dan" is pronounced "dan". Feeling hungry as if one had not eaten after finishing a meal indicates Wei Dan disease (Stomach Jaundice). Feeling hungry after eating indicates Stomach Heat. Since food is digested quickly, it is called Wei Dan (Stomach Jaundice). Furthermore, the Lun Ji Zhen Chi Pian states: "A pulse that is small and choppy indicates lack of appetite," referring to Middle Cold. Therefore, when treating Dan diseases (Jaundice), one must distinguish between Yin and Yang. Facial swelling is called Feng disease (Wind disease). Wind is a Yang pathogen; thus, facial swelling is attributed to Wind, as Yang meridians are affected by Wind Qi. Swelling of the calves and ankles is called Shui disease (Water disease). Water is a Yin pathogen; thus, swelling of the calves and ankles is attributed to Water, as Yin meridians are affected by Dampness. Yellowing of the eyes is called Huang Dan disease (Jaundice). The eyes are the gathering place of numerous meridians; heat in any meridian steams upward to the eyes, so patients with Huang Dan disease (Jaundice) will have yellow eyes.

(Suwen, Tong Ping Xu Shi Lun & Fu Zhong Lun; Appendix: Treatment of Xiao Dan)
The Yellow Emperor asked: What are the excess and deficiency patterns of Xiao Dan disease? (From Suwen, Tong Ping Xu Shi Lun)
Qibo answered: Xiao Dan (Wasting-Thirst Disease) is the general term for San Xiao (Three Thirsts), referring to internal heat, excessive hunger, and emaciation. "Dan" is pronounced "dan", or with rising and departing tones. The Guang Yun explains it as Fire Dan, or alternatively as Yellow disease.
The Yellow Emperor asked: A pulse that is substantial and large, even in long-standing disease, is treatable; a pulse that is suspended, small, and firm, even in long-standing disease, is untreatable. (Internal pathogenic heat corresponds to a substantial and large pulse, which is favorable; thus, even if the disease is long-standing, it is treatable. If the pulse is suspended and small, it indicates Excess Yang and Deficiency Yin, a contradiction between pulse and symptoms, making it untreatable. The Wu Bian Pian states: "Those whose five zang organs are inherently weak are prone to Xiao Dan." It also states: "Heat consumes muscle and flesh, forming Xiao Dan." See Section 76 of this category for details.)
The Yellow Emperor asked: You often mention that Re Zhong (Heat in the Middle) and Xiao Zhong (Wasting in the Middle) should not be treated with Gao Liang (rich/fatty foods), Fang Cao (aromatic herbs), or Shi Yao (mineral drugs). Shi Yao causes Dian (epilepsy/manic episodes), and Fang Cao causes Kuang (madness). (From Suwen, Fu Zhong Lun. Wang Bing notes: Drinking much and urinating frequently is called Re Zhong (Heat in the Middle). Eating much and urinating frequently is called Xiao Zhong (Wasting in the Middle). Excessive joy is called Dian, synonymous with epilepsy. Excessive anger is called Kuang. Dian is the same character as Dian.) These Re Zhong and Xiao Zhong conditions occur mostly in wealthy people. Prohibiting rich foods goes against their habits, and prohibiting aromatic/mineral drugs prevents cure. I wish to hear the explanation. (Gao Liang refers to strong-flavored, rich foods. Fang Cao refers to pungent and aromatic herbs. Shi Yao refers to refined minerals/metals. All three can aid heat and consume Yin; they are strictly contraindicated in heat diseases. Re Zhong and Xiao Zhong are internal heat diseases, common among the wealthy. The Tong Ping Xu Shi Lun states: "In treating Xiao Dan, fat and noble persons suffer from diseases caused by Gao Liang." Wealthy individuals consume fatty and sweet foods; fattiness generates internal heat, sweetness causes middle-jiao fullness. Accumulated qi transforms into heat, leading to Xiao Zhong and Xiao Ke diseases. Thus, Gao Liang and Fang Cao must be prohibited.)
Qibo said: The qi of Fang Cao is beautiful/aromatic, and the qi of Shi Yao is fierce/harsh. Both act rapidly and firmly. Therefore, unless the person has a calm and gentle mind, they cannot take these two types of medicine. (Aromatic substances have hot and dispersing qi; harsh substances have rigid and violent nature.)
The Yellow Emperor asked: Why can these two not be taken?
Qibo said: Pathogenic heat is fierce and harsh, and medicinal qi is similar. When the two meet, there is fear of internal injury to the Spleen. (The Spleen is the Ultimate Yin within Yin. Excess Yang damages Yin. Thus, the combination of two heats inevitably injures the Spleen. "Piao" sounds like "piao".) The Spleen belongs to Earth and dislikes Wood. Patients taking these medicines may see worsening on Jia-Yi days (Wood days), at which point further discussion is needed. (Injured Spleen fears Wood; worsening on Jia-Yi days implies severity. My commentary: Xiao Dan and Xiao Zhong correspond to the later San Xiao syndromes. Polydipsia with unquenchable thirst is Shang Xiao (Upper Xiao); excessive hunger with digestion is Zhong Xiao (Middle Xiao); frequent, turbid, uncontrollable urination is Xia Xiao (Lower Xiao). As stated in Qi Jue Lun, Fei Xiao (Lung Xiao) and Ge Xiao (Diaphragm Xiao), and in Qi Bing Lun, Xiao Ke (Wasting-Thirst), refer to Shang Xiao. Mai Yao Jing Wei Lun states "Dan transforms into Xiao Zhong"; Chuan Pian states "Stomach heat digests food causing hunger," referring to Zhong Xiao. Xie Qi Zang Fu Bing Xing Pian states "Kidney and Liver pulses being minute all indicate Xiao Dan"; Kidney and Liver are inferior, referring to Xia Xiao. Liu Hejian's San Xiao Lun states: "All five zang and six fu organs and four limbs receive Qi from the Spleen and Stomach, circulating Jin Ye (body fluids) to nourish them. However, Xiao Ke disease stems from extreme deficiency of damp-cold Yin Qi and extreme excess of dry-heat Yang Qi. Treatment should tonify the deficiency of Kidney Water/Yin-Cold, drain the excess of Heart Fire/Yang-Heat, remove severe dry-heat from intestines/stomach, and replenish depleted body fluids. This ensures pathways remain open, fluids generate without drying, and Qi/Blood harmonize without stagnation, curing the disease. If drinking leads to frequent urination, it is Xiao Ke; if eating leads to little thirst but frequent urination and emaciation, it is Xiao Zhong; if thirst persists despite drinking, with leg emaciation and lipid urine, it is Shen Xiao (Kidney Xiao). All result from excessive dry-heat obstructing the pores and collaterals of the San Jiao and intestines. Despite central intake, fluids cannot moisten the exterior or nourish the bones, causing persistent thirst and polyuria. Zhang Dairen states: "San Xiao should be judged by Fire." Fire's function: burns wood to charcoal, melts metal to liquid, turns stone to ash, boils sea to salt, dries water to powder, smelts tin to cinnabar. Marsh water evaporates in sun; pot water dries in fire. In the five zang, Heart is Monarch Fire (orthodox transformation), Kidney is Monarch Fire (counterpart transformation), San Jiao is Minister Fire (orthodox), Gallbladder is Minister Fire (counterpart). Balance cooks food and eliminates waste; imbalance scorches zang-fu and exhausts fluids. Heart Fire excessive above causes Diaphragm Xiao; in the middle causes Intestine/Stomach Xiao; below causes Essence Xiao; outside causes Muscle Xiao. Unchecked upper excess affects Lung; middle affects Spleen; lower affects Kidney/Liver; external affects sinews/bones. When four zang are exhausted, Heart burns itself to death. Thus, Suwen mentions Xiao Dan, Xiao Zhong, Xiao Ke, Feng Xiao, Ge Xiao, Fei Xiao. Though manifestations differ, they all return to Fire. These two masters explained this well. Also, Xiuzhen Fang states: "The Kidney in the body is like the root of a tree. Kidney disease first causes emaciation; nourishment cannot moisten. Thus, Xiao Ke always originates in the Kidney meridian." Due to reckless behavior, sexual excess, alcohol abuse, and consumption of dried meats/minerals during youth, Kidney Water dries up, Heart Fire blazes, San Jiao becomes fierce, five zang become dry, generating Xiao Li. This argues San Xiao originates in the Kidney. He Baizhai states: "Creation relies on Water and Fire, favoring balance over bias, union over separation. Water is damp/cold; Fire is hot/dry. Fire flares up; Water flows down. Fire should be below, Water above, to facilitate interaction. Interaction creates Hexagram Ji Ji (After Completion); non-interaction creates Wei Ji (Before Completion). Extreme non-interaction leads to separation and death. Xiao Ke is non-interaction with Fire excess; Shui Qi is non-interaction with Water excess. Controlling bias to restore interaction is the treatment. From these theories, treating Xiao requires balancing clearing Fire and strengthening Water, assessing San Jiao excess/deficiency, and using tonification or drainage appropriately. However, I have further views. Yin Yang Bie Lun states: 'Disease of Er Yang (Yang Ming) originates in Heart/Spleen, transmitting to Feng Xiao.' This is because Yang Ming is the Sea of Twelve Meridians; Spleen Earth deficiency allows Liver Wood to invade, causing muscular Feng Xiao. Qi Jue Lun states: 'Heart transferring cold to Lung causes Fei Xiao; drinking one part, urinating two parts is fatal.' This describes Yuan Yang deficiency with Metal cold/Water cold, causing Lung/Kidney Xiao. Xie Qi Zang Fu Bing Xing Pian states: 'Minute pulses of five zang indicate Xiao Dan.' This means weak Cun Kou pulse externally reflects internal depletion of Qi/Blood. Qi Jiao Bian Da Lun states: 'Excessive Year Water, approaching Tai Yang, causes people to suffer thirst and delirium.' Wu Chang Zheng Da Lun states: 'Tai Yang governing Heaven, Cold descends, Heart Fire follows, causing dry throat and thirst.' Zhi Zhen Yao Da Lun states: 'Tai Yang governing Heaven, excessive Cold, causes dry throat and thirst for drink.' These involve suppressing Yang with Yin, controlling Fire with Water, requiring warm agents to dispel Cold for spontaneous recovery. Such cases belong to Xiao Ke categories. 'Xiao' means consumption. Yang excess consumes Yin; can Yin excess consume Yang? Thus, consumption of Spirit, Blood, Qi, Muscle, Sinew, and Bone is all Xiao. I once treated a scholar over forty who fell ill due to clerical fatigue. Symptoms: mental fatigue, poor appetite, frequent fear, no upper jiao thirst, aversion to liquids, slight intake causes stagnation, yet voids 2-3 sheng nightly, half turbid. Cause unknown. He reported six months of insomnia, dreaming of dead relatives/mourning, feeling haunted. I said: No. This is due to thoughtful fatigue injuring Heart/Kidney. Yuan Yang deficiency allows Yin Evil to prevail, causing Yin dreams. Yang deficiency leads to Qi deficiency; Yang fails to guide Yin, so Water fails to transform into Qi. Hence less drinking but more turbid urine. As Yang recovers, Yin Evil retreats. This matches Suwen's 'Heart transfers cold to Lung, drink one void two.' The root was serious, but pulse was still moderate, muscles intact, Stomach Qi present. Safe. I used Gui Pi Tang minus Bai Zhu/Mu Xiang, and Ba Wei Wan minus Mu Dan Pi/Ze Xie. One tonifies Yang, one tonifies Yin, alternating. Over 300 doses, using 20+ jin of Ren Shen, he fully recovered. Is this not Spirit consumed above, Essence consumed below? Thus, Xiao has Yin/Yang distinctions, cannot all be called Fire syndromes. Recorded here as a reference for treating Xiao.)