张子和曰∶初虞世言，凡渴疾未发疮疡，便用大黄寒药，利其势使大困，火虚自胜，如发疮疡，脓血流漓
而消，此真格言也。故巴郡太守奏三黄丸，能治消渴。余尝以隔数年不愈者，减去朴硝，加黄连一斤，大作剂，
以长流千里水煎五七沸，放冷，日呷之数百次，以桂苓甘露饮、白虎汤、生藕节汁、淡竹沥、生地黄汁，相间
服之，大作剂料，以代饮水，不日而痊。故消渴一症，调之而不下，则小润小濡，固不能杀炎上之势；下之而
不调，亦旋饮旋消，终不能沃膈膜之干；下之调之而不减滋味，不戒嗜欲，不节喜怒，病已而复作。能从此三
者，消渴亦不足忧矣。
昔有消渴者，日饮数斗，刘完素以生姜自然汁一盆，置之密室中，具罂杓于其间，使其人入室，从而锁其
门，病患渴甚，不得已而饮之，饮尽渴减，得《内经》辛以润之之旨。又《内经》治渴以兰，除其陈气，亦辛
平之剂也。刘完素之汤剂，虽用此一味，亦必有旁药助之也。秦运副云∶有人消渴，引饮无度，或令食韭苗，
其渴遂止。法要日吃三五两，或炒，或作羹，无入盐，极效。但吃得十斤即佳。
苦楝根，取新白皮一握，切焙，入麝少许，水二碗，煎至一碗，空心服之，虽困倦不妨。自后下虫三四
条，状蛔虫，其色真红，而渴顿止。乃知消渴一症，有虫耗其精液者。
按∶此方神效，服之屡验。
鄂渚卒 之，患消渴九年，服药止而复作。制苏朴散，以白芍、甘草等分为末，每用一钱，水煎服，七日
顿愈。古人处方，殆不可晓，不可以平易而忽之也。（《经验方》陈日华、《本草纲目》。）
朱丹溪治徐兄，年四十岁，口干，小便数，春末得之，夏来求治。诊其两手，左涩，右略数而不强，重取
似大而稍有力，左稍沉略弱而不弦，然涩却多于右，喜两尺皆不甚起，此由饮食味浓生热，谓之痰热。禁其味
浓，宜降火以清金，抑肝以补脾，用三消丸十粒，左金、阿魏丸各五粒，以姜汤吞下，一日六次。又以四物汤
加参、术、陈皮、生甘草、五味、麦冬，煎服，一日三次，与丸药间服。一二日，自觉清快，小便减三之二，
口亦不干。止渴未除，头晕眼花，坐则腰疼，遂以摩腰膏治腰疼，仍以四物汤，用参、 ，减川芎，加牛膝、
五味、炒柏皮、麦冬，煎饮，调六一散服，反觉便多。遂去六一散，令仍服药丸而安。
薛立斋治一贵人，病疽疾未安而渴作，一日饮水数升，教服加减八味丸方。诸医大笑云∶此药能止渴，吾
辈当不复业医矣。皆用木瓜、紫苏、乌梅、人参、茯苓、山药等生津液之药，数剂，而渴愈甚。不得已用前方，
服三剂渴止。因相信久服不特渴疾不作，气血亦壮，饮食加倍，强健过于少壮之年。薛氏家藏此方，屡用有验。
窦材治一人，频饮水而渴不止。曰∶君病是消渴也。乃脾肝气虚，非内热也。其人曰∶前服凉药六剂，热
虽退而渴不止，觉胸胁气痞而喘。窦曰∶前症只伤脾肺，因凉药复损伤气海，故不能健运，而水停心下也。急
灸关元、气海各三百壮，服四神丹，六十日津液频生。方书皆作三焦猛热，下以凉药，杀人甚于刀剑，慎之。
杨贲亨，鄱阳人，博群书，精脉理，每心计造方。有患饥者，诸医以火症治。亨久思之未得，顷见堂上木
凳自仆，乃为湿气所蒸致朽，忽悟水能消物，不独属火，此湿消耳，遂投热剂而愈。（《江西通志》。）
孙文垣治一书办，年过五十，沉湎酒色，忽患下消之症，一日夜小便二十余度，清白而长，味且甜，少顷
凝结如脂，色有油光，治半年无效。腰膝以下软弱，载身不起，饮食减半，神色大瘁。脉之，六部皆无力。经
云脉至而从，按之不鼓，诸阳皆然。法当温补下焦，以熟地黄六两为君，鹿角霜、山萸肉各四两，桑螵蛸、鹿胶、
人参、白茯苓、枸杞子、远志、菟丝、山药各三两为臣；益智仁一两为佐，大附子、桂心各七钱为使，炼蜜为
丸梧桐子大。每早晚淡盐汤送下七八十丸，不终剂而愈。或曰∶凡消者皆热症也，今以温补何哉？曰∶病由
下元不足，无气升腾于上，故渴而多饮，以饮多小便亦多也。今大补下元，使阳气充盛，熏蒸于上，口自不渴。
譬之釜盖，釜虽有水，必釜底有火，盖乃润而不干也。
一人消中，日夜溺七八升，鹿角烧令焦为末，以酒调服五分，日三服，渐加至方寸匕。
一人不时发热，日饮冰水数碗，寒药二剂，热渴益甚，形体日瘦，尺脉洪大而数，时或无力。王太仆曰∶
热之不热，责其无火。又云∶倏热往来，是无火也；时作时止，是无水也。法当补肾，用加减八味丸，不月而愈。
张路玉治赵云舫，消中善食，日进膏粱数次，不能敌其饥势，丙夜必进一餐，食过即昏昏嗜卧。或时作酸
作甜，或时梦交精泄，或时经日不饮，或时引饮不辍，自言省试劳心所致。前所服皆安神补心滋阴清火之剂，
不应。察其声音，浊而多滞，其形虽肥盛，色苍而肌肉绵软。其脉六部皆洪滑而数，惟右关特甚，两尺亦洪滑，
而按之少神，此肾气不充，痰湿挟阴火泛溢于中之象。遂与加味导痰加兰、麝，数服其势大减。次以六君子
合左金枳实汤泛丸，服后，以六味丸去地黄加鳔胶、蒺藜，平调两月愈。
朔客白小楼，中消善食，脾约便难。察其形瘦而质坚，诊其脉数而有力，时喜饮冷火酒，此酒之湿热内蕴
为患。遂以调胃承气三下破其蕴热，次与滋肾丸数服，涤其余火，遂全安。粤客李之藩，上消引饮，时当三伏，
触热到吴。初时自汗发热，烦渴引饮，渐至溲便频数，饮即气喘，饮过即渴。脉之，右寸浮数动滑，知为热伤
肺气之候。因以小剂白虎加人参，三服势顿减。次与生脉散，调理数日而痊。
薛廉夫子，强中下消，饮一溲二。因新娶继室，真阴灼烁，虚阳用事，强阳不到，恣肆益甚，乃至气
急不续，精滑不收，背曲肩垂，腰膀疼软，足膝痿弱，寸步艰难，糜粥到口即厌，惟喜膏粱方物。其脉或数大少
力，或弦细数疾，此阴阳离决，中空不能主持，而随虚火辄内辄外也。与八味肾气、保元、独参，调补经年，
更与六味地黄久服而痊。
邵某仲夏与婢通，因客至，惊恐，精气大脱，即凛凛畏寒，翕翕发热，畏食饮，小便淋沥不禁。诊之，六
脉弦细如丝，责责如循刀刃，此肾中真阳大亏之候。令服生料六味，稍加桂、附，以通阳气。咸谓夏暑不宜桂、
附，另延医，峻用人参、附子，月余，饮食大进。犹谓参、附得力，恣饵不彻，遂至日食豚蹄鸡鸭七八餐，至
夜，预治熟食，饱啖二次。如此两月余，形体丰满倍常，但若时时嘈杂易饥，常见青衣群鬼围绕其侧。再诊脉，
其脉滑数有力，而右倍于左。察其形色多滞，且多言多笑，而语无伦次。此痰食壅塞于中，复加辛热，助其淫
火，始见阴虚，未传消中之患也。不急祛除，必为狂痴之患。为制涌痰之剂，迟疑不进。未几，忽大叫发狂妄
见，始信言之非谬也。
许学士云∶一卒病渴，日饮水斗许，不食者三月，心中烦闷，时已十月。予谓心经有伏热，与火府丹数服。
越二日来谢云∶当日三服渴止，又三服饮食如故。此本治淋，用以治渴，可谓通变也。方用生地二两，木通、
黄芩各一两，蜜丸桐子大，每服三十丸，木通汤下。
陆祖愚治李悦吾大便燥，年五十余，患消渴症，茶饮不能离口，小便多，大便燥，殊不欲食，及食后即饥。
病将一载，精神困怠，肌肤枯涩，自分必死。脉之，沉濡而涩，曰∶病尚可药。凡人身之津液，以火而燥，然
必以气化而生。前医纯用清凉之品，所以不效。洁古云，能食而渴者，白虎倍加人参，大作汤剂服之。今不能
食，及食即饥，当合二方加升麻，佐葛根，以升清阳之气，少合桂、附，以合从治之法。每味数两，大砂锅煎
浓汁，禁汤饮，以此代之。此病仲景谓春夏剧，秋冬瘥。今当盛暑，病虽不减，亦不剧。若根据法治之，兼绝浓
味戒嗔，闭关静养，秋冬自愈。幸其能守戒忌，交秋即瘥，至秋末全愈。
陆养愚治两广制府陈公，年近古稀，而多宠婢，且嗜酒，忽患口渴，茶饮不辍，而喜热恶凉，小便极多，
夜尤甚，大便秘结，必用蜜导，日数次，或一块，或二三块，下体软弱，食减肌削，所服不过生津润燥清凉而
已。脉之，浮按数大而虚，沉按更无力，曰∶症当温补，不当清凉。问∶消本热症，而用温补何也？曰∶经谓
脉至而从，按之不鼓，诸阳皆然。今脉数大无力，正所谓从而不鼓，无阳脉也。以症论之，口渴而喜热饮，便
秘而溺偏多，皆无阳症也。曰∶将用理中参附乎？曰∶某所言温补在下焦，而非中上二焦也。经曰∶阳所从阴
而亟起也。又曰∶肾为生气之原。今恙由于肾水衰竭，绝其生化之原，阳不生，则阴不长，津液无所蒸以出，
故上渴而多饮，下燥而不润，前无以约束而频多，后无以转输而艰秘，食减肌削，皆下元不足之过也。曰∶予
未病时痿，是肾竭之应。既痿之后，虽欲竭而无从矣。彼虽不悦，而心折其言，遂委治之。乃以八味丸料，加益
智仁，煎人参膏糊丸。每服五钱，白汤送下，日进三服，数日溺少，十日溺竟如常。大便尚燥，每日一次，不
用蜜导矣。第口渴不减，食尚无味，以升麻一钱，人参、黄 各三钱，煎汤送丸药。数服，口渴顿止，食亦有
味，又十日诸症全愈。
薛立斋曰∶一男子作渴，日饮水数碗，冬月亦然。彼用加减八味丸去肉桂服之不应。一男子患此，欲治以
前丸，彼谓肉桂性热，乃服知柏等药，渴不止，背发疽而殁。又一男子亦患此症，日渐消瘦，与前丸数服，渴
减半，一剂而痊，再剂形体复壮。夫肉桂，肾经药也。前症乃肾经虚火炎上无制为患，用肉桂导引诸药以补之，
及引虚火归原，故效。又一男子脚面发痘，愈而作渴，以前丸治之而愈。又一富商，禀赋颇浓，素作渴，日饮
水数碗，面发一毒，用消毒药溃而难愈，尺脉尚数，渴亦不止。时孟秋，谓此火旺水涸之脉也，须服加减八味
丸，以补肾水而制心火，庶免疽毒之患。彼不信，至夏果脚背发疽，脉数，按之则涩而无力，足竟黑腐而死。
一男子禀颇实，乏嗣，服附子等药，致作渴，左足大趾患疽，色紫不痛，脉亦数而涩，亦死。大抵发背脑疽，
肿痛色赤，水衰火旺之色，尚可治。若黑若紫，火极似水之象也，乃肾水已竭，精气已衰，不治。《外科精要》
云∶凡病疽疾之人，多有既安之后，忽发渴疾而不救者，十有八九。疽疾将安，而渴疾已作，宜服加减八味丸。
既安之后，而渴疾未见，宜先服之，以防其未然。薛儿闻其父云∶一士夫病渴疾，诸医皆用渴药，累载不痊。
有一名医教食加减八味丸，不半载而愈。
一老人冬月口舌生疮作渴，心脉洪大而实，尺脉大而虚，此消症也。患在肾，须加减八味丸补之，否则后
发疽难疗。不信，乃服三黄等药降火，次年夏，果发疽而殁。东垣曰∶膈消者，以白虎加人参汤治之。中消者，
善食而瘦，自汗，大便硬，小便数。《脉诀》云∶干渴饮水，多食亦饥，虚成消中者，调胃承气汤、三黄丸治
之。下消者，烦躁引饮，耳叶焦干，小便如膏脂。又云∶焦烦水易亏，此肾消也，六味地黄丸治之。《总录》所
谓未传能食者，必发脑疽背疮，不能食，必传中满鼓胀，皆谓不治之症。洁古老人分而治之，能食而渴者，白
虎加人参汤，不能食而渴者，钱氏白术散，倍加葛根治之。土中既平，不复传下消矣。前人用药，厥有旨哉。
或曰未传疮疽者何也？此火邪盛也，其疮痛甚而不溃，或赤水者是也。经云∶有形而不痛，阳之类也，急攻其
阳，无攻其阴，治在下焦。元气得强者生，失强者死。
一妇人面患毒 痛，发热作渴，脉数，按之则实。以凉膈散一剂少愈，以消毒药数剂而平。
一男子肩患疽，作渴，脉数有力。以黄连解毒汤三剂而止，更以仙方活命饮四剂而愈。
一男子溃疡后而烦渴，以圣愈汤二剂而宁。以人参、黄 、当归、地黄四剂止渴。以八珍汤二十剂而愈。
大抵溃后有此症，属气血不足，须用参、 以补气，归、地以养血。若用苦寒之剂，必致有误。
一男子患毒作渴，右关脉数。以竹叶黄 汤治之而愈，更以补中益气汤加黄芩而痊。
一男子溃后口干，遇劳益甚。以补中益气汤加五味、麦冬，治之而愈，更以黄 六一汤而敛。
缪仲淳治湖州庠友张时泰，正月间，骤发齿痛，十余日而愈。四月间，焦劳过多，齿痛大作，医用石膏、
知母等药不效。用力去齿间紫血，满口齿痛不可忍，齿俱摇动矣。至六七月间，饮水益多，小便如注，状如膏，
肌肉尽消。至十一月，身不能起。冬末，用黄 、地黄等药，稍能起立，然善食易饥如故，小便如膏亦如故。
今年二三月愈甚，亦不服药，齿痛如故，当门二齿脱落，复加口渴，昼夜不止，此中下二消症也。为立方，未
数剂而瘳。麦冬、芦根各五两，五味、地黄各三钱，黄 五钱，生地六钱，天冬一两，用缲丝汤十碗，煎二碗，
Zi Hezi stated: Chu Yushi once said that for any thirst disease before the onset of sores and ulcers, if one uses cold medicines such as Dahuang (Rhubarb) to drain the pathogen, it will weaken the body's resistance, causing severe debility. In this state, deficient fire may prevail. If sores and ulcers then erupt, with pus and blood flowing profusely until exhausted, this is indeed a profound maxim. Therefore, the Sanhuang Wan (Three-Yellow Pill) presented by the Prefect of Ba Commandery can treat Xiao Ke (Wasting-Thirst). I once treated patients who had suffered for several years without cure by removing Xiaomingjiao (Mirabilite) from the formula and adding one jin of Huanglian (Coptis Rhizome), preparing a large dose. It was decocted in running water from a thousand-li river for five to seven boils, cooled, and given to the patient to sip hundreds of times throughout the day. This was alternated with Guiling Ganlu Yin (Cassia Twig and Poria Decoction), Baihu Tang (White Tiger Decoction), juice of fresh lotus root nodes, Dan Zhuli (Bamboo Sap), and Sheng Dihuang Zhi (Fresh Rehmannia Juice). By using large doses to replace drinking water, recovery occurred within a few days. Thus, for Xiao Ke (Wasting-Thirst), if one only regulates without purging, slight moistening cannot quell the flaming-up tendency; if one only purges without regulating, the fluid is consumed as soon as it is drunk, failing to moisten the dryness of the diaphragm. Even if both purging and regulating are employed, if one does not reduce rich flavors, abstain from lustful desires, and control anger and joy, the disease will recur after remission. If these three precautions are observed, Xiao Ke (Wasting-Thirst) is nothing to worry about.
In the past, there was a patient with Xiao Ke (Wasting-Thirst) who drank several dou of water daily. Liu Wansu prepared a basin of fresh ginger juice, placed it in a sealed room along with a jar and ladle, and instructed the patient to enter. The door was locked. Thirsty beyond endurance, the patient drank the juice, and his thirst subsided. This aligns with the principle in Neijing (The Yellow Emperor's Classic of Internal Medicine): "Pungent substances moisten." Additionally, Neijing states that treating thirst with Orchid Root (Lan) removes stale qi; this is also a pungent-neutral remedy. Although Liu Wansu's decoctions used only this single herb, auxiliary herbs were certainly included. Qin Yunfu said: A person suffering from Xiao Ke (Wasting-Thirst) with uncontrolled drinking stopped their thirst by eating chive shoots. The method requires consuming three to five liang daily, either stir-fried or made into soup, without salt. It is extremely effective. Consuming ten jin yields good results.
Kelian Gen (Root of Melia Toosendan), taking a handful of new white bark, chopped and dried, mixed with a small amount of She Xiang (Musk), decocted in two bowls of water until one bowl remains, taken on an empty stomach. Even if fatigue ensues, it is acceptable. Afterwards, three or four worms resembling Ascaris lumbricoides (Roundworms), bright red in color, were passed, and the thirst ceased immediately. This reveals that in some cases of Xiao Ke (Wasting-Thirst), parasites consume the essence and fluids.
Note: This formula is miraculous and has proven effective repeatedly.
A soldier named Zhi from Ezhou suffered from Xiao Ke (Wasting-Thirst) for nine years, with symptoms recurring despite medication. Su Po San (Sophora and Mirabilite Powder) was prepared using equal parts Baishao (White Peony Root) and Gancao (Licorice Root), powdered. One qian was decocted in water and taken daily, resulting in complete recovery in seven days. Ancient prescriptions are often obscure and should not be dismissed as too simple. (From *Experience Formulas* by Chen Rihua, *Compendium of Materia Medica*.)
Zhu Danxi treated Brother Xu, aged forty, who complained of dry mouth and frequent urination, contracted in late spring and seeking treatment in summer. His pulse was choppy on the left, slightly rapid but not strong on the right. Deep pressure revealed a seemingly large and slightly forceful pulse. The left was slightly deep, weak, and non-wiry, yet more choppy than the right. Both Chi (Kidney) pulses were not prominent. This indicated heat generated by rich dietary flavors, termed Phlegm-Heat. Rich foods were prohibited. The strategy was to descend fire to clear Lung Metal and suppress Liver to tonify Spleen. Ten pills of Sanxiao Wan (Three-Wasting Pill), five pills of Zuojin Wan (Left Metal Pill), and five pills of Awei Wan (Asafoetida Pill) were swallowed with Ginger Decoction, six times daily. Simultaneously, Siwu Tang (Four Substances Decoction) plus Renshen (Ginseng), Baizhu (Atractylodes Macrocephala), Chenpi (Tangerine Peel), Sheng Gancao (Raw Licorice), Wuweizi (Schisandra), and Maidong (Ophiopogon) was decocted and taken three times daily, alternating with the pills. Within one or two days, he felt refreshed, urination decreased by two-thirds, and dry mouth resolved. However, thirst relief was incomplete; dizziness, blurred vision, and lower back pain when sitting persisted. Moyao Gao (Lower Back Rubbing Ointment) was applied for back pain. Siwu Tang (Four Substances Decoction) was modified by adding Renshen (Ginseng) [text missing], removing Chuanxiong, and adding Niuxi (Achyranthes), Wuweizi (Schisandra), fried Huangbai (Phellodendron), and Maidong (Ophiopogon), decocted and taken with Liuyi San (Six-to-One Powder). This resulted in increased bowel movements. Liuyi San (Six-to-One Powder) was discontinued, and he continued with the pills until stable.
Xue Lizhai treated a nobleman whose carbuncle disease was not yet resolved when thirst erupted, drinking several sheng of water daily. He was advised to take Jiawei Bawei Wan (Modified Eight-Ingredient Pill). Other physicians laughed, saying, "If this pill stops thirst, we might as well quit medicine." They prescribed Shengjin Ye (Fluid-Generating Herbs) such as Mugua (Chaenomeles), Zisu (Perilla), Wumei (Mume Fruit), Renshen (Ginseng), Fuling (Poria), and Shanyao (Dioscorea). After several doses, thirst worsened. Forced to use the original prescription, three doses stopped the thirst. Long-term belief in this formula not only prevented thirst recurrence but also strengthened Qi and Blood, doubled food intake, and restored vigor beyond youth. Xue's family kept this formula, which proved effective repeatedly.
Dou Cai treated a man who drank frequently but remained thirsty. He diagnosed Xiao Ke (Wasting-Thirst), attributing it to Spleen and Liver Qi deficiency rather than internal heat. The patient reported that previous cooling herbs reduced fever but not thirst, accompanied by chest/hypochondriac fullness and wheezing. Dou Cai explained that previous treatments injured Spleen and Lung, and further cooling damaged the Qi Sea, impairing transportation and causing water retention under the heart. Urgent moxibustion at Guanyuan (CV4) and Qihai (CV6), 300 moxa cones each, followed by Sishen Dan (Four-God Pill), produced frequent saliva generation within sixty days. Medical texts mistakenly treat this as fierce San Jiao (Triple Burner) heat, using cooling purgatives that kill faster than swords. Caution is essential.
Yang Benheng, from Poyang, was well-read and skilled in pulse diagnosis, often devising formulas mentally. A patient suffering from intense hunger was treated for Fire Syndrome by other doctors. Yang pondered deeply without success. Seeing a wooden stool collapse due to rot caused by dampness evaporation, he realized that water dissolves matter, not just fire; this was "Dampness Dissolving." He administered hot herbs, resulting in a cure. (From *Jiangxi General Gazetteer*.)
Sun Wen Yuan treated a clerk over fifty who indulged in alcohol and sex, suddenly developing Lower Xiao (Lower Wasting-Thirst). He urinated twenty-plus times daily, urine clear, long, sweet-tasting, and coagulating like fat with an oily sheen. Six months of treatment failed. Weakness below waist and knees, inability to support body weight, half food intake, extreme exhaustion. Pulse was powerless in all six positions. The Classic states: "When the pulse follows but lacks force upon pressure, all Yang conditions manifest thus." The method should warm and tonify the Lower Jiao (Lower Burner). Shudihuang (Prepared Rehmannia) 6 liang as Sovereign; Lujiaoshuang (Deer Antler Frost), Shanzhuyu (Cornus), Sangpiaoxiao (Mantis Egg Case), Lu Jiao Jiao (Deer Antler Glue), Renshen (Ginseng), Baifuling (White Poria), Gouqizi (Goji Berry), Yuanzhi (Polygala), Tusizi (Cuscuta), and Shanyao (Dioscorea) 4 liang each as Ministers; Yizhiren (Bitter Apricot Seed) 1 liang as Assistant; Dafuzi (Aconite) and Guixin (Cinnamon Bark) 7 qian each as Envoys. Honey-pilled, size of paulownia seeds. Taken morning and evening with light salt water, 70-80 pills per dose. Cured before finishing one batch. Some asked: "Isn't Xiao (Wasting) always Heat? Why warm tonification?" Answer: "The disease stems from Lower Yuan (Primordial) deficiency, lacking ascending Qi, causing thirst and excessive drinking/urination. Greatly tonifying the Lower Yuan fills Yang, steaming upwards, stopping thirst. Like a pot lid: water exists in the pot, but only with fire underneath does the lid become moist, not dry."
Another patient with Xiao Zhong (Middle Wasting-Thirst) urinated 7-8 sheng day and night. Burnt deer horn powder was taken with wine, 5 fen initially, three times daily, gradually increasing to a square-inch spoonful.
Another patient had intermittent fever, drank several bowls of ice water daily. Two doses of cold herbs worsened heat and thirst, leading to emaciation. Chi pulse was surging, large, rapid, sometimes powerless. Wang Taipu stated: "Failure to warm indicates lack of Fire." Also: "Sudden heat往来 implies lack of Fire; intermittent symptoms imply lack of Water." The method is to tonify Kidney using Jiawei Bawei Wan (Modified Eight-Ingredient Pill). Recovery occurred within a month.
Zhang Luyu treated Zhao Yunfang, who had Xiao Zhong (Middle Wasting-Thirst), eating rich foods multiple times daily, unable to satisfy hunger, requiring a midnight meal. Post-meal drowsiness, occasional acid/sweet taste, nocturnal emissions, periods of no drinking followed by continuous drinking. Attributed to mental strain during provincial exams. Previous calming, heart-nourishing, Yin-tonifying, fire-clearing herbs failed. Voice was turbid and stagnant. Body fat but complexion dark, muscles soft. Pulse surging, slippery, rapid in all positions, especially Right Guan (Spleen/Stomach); Chi pulses surging/slipping but lacking spirit upon pressure. This indicated insufficient Kidney Qi, with Phlegm-Damp carrying Deficient Fire flooding internally. Jiawei Daotan Tang (Modified Expectoration-Resolving Decoction) plus Lan Cao (Orchid Root) and She Xiang (Musk) reduced symptoms significantly. Next, Liujunzi Tang (Six-Gentlemen Decoction) combined with Zuojin Zhi Shi Tang (Left-Metal and Immature Tangerine Decoction) was formed into pills. Followed by Liuwei Wan (Six-Ingredient Pill) minus Dihuang, plus Biaojiao (Fish Maw) and Jili (Tribulus), balanced for two months until cured.
Shanxi merchant Bai Xiaolou had Xiao Zhong (Middle Wasting-Thirst), Spleen Constriction with difficult defecation. Thin but firm constitution, rapid forceful pulse, preference for cold spiced wine. Caused by damp-heat from wine accumulation. Tiaowei Chengqi Tang (Regulate-Stomach and Direct-Downward Decoction) was used three times to purge accumulated heat. Then Zishen Wan (Nourish-Kidney Pill) cleared residual fire, leading to full recovery. Guangdong merchant Li Zhifan had Shang Xiao (Upper Wasting-Thirst) with excessive drinking during the Dog Days of Summer. Initial spontaneous sweating, fever, irritability, thirst, progressing to frequent urination, wheezing upon drinking, immediate thirst after drinking. Right Cun pulse floating, rapid, moving, slippery. Diagnosed as Heat injuring Lung Qi. Small dose of Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) reduced symptoms after three doses. Shengmai San (Generate-Pulse Powder)调理 for several days led to recovery.
Xue Lianfu had Qiangzhong (Strong Middle) and Lower Xiao, drinking one part urine two parts. Due to marrying a new wife, True Yin was scorched, Deficient Yang acted independently, erection failed, licentiousness increased, leading to shortness of breath, seminal emission, curved back, drooping shoulders, sore waist/hips, weak legs/knees, difficulty walking, aversion to porridge, craving rich foods. Pulse varied between rapid/large/powerless or wiry/thin/rapid. This indicated separation of Yin and Yang, emptiness failing to govern, with Deficient Fire fluctuating internally/externally. Bawei Shenqi Wan (Eight-Ingredient Kidney-Qi Pill), Baoyuan Tang (Preserve-Origin Decoction), and Dushen Tang (Single-Ginseng Decoction) were used for year-long regulation, followed by long-term Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) for recovery.
Mr. Shao had intercourse with a maid in midsummer. Startled by guests, Essence/Qi depleted, leading to severe chills, mild fever, aversion to food/drink, dribbling incontinence. Pulse string-thin like silk, rough like touching a blade. Diagnosis: Severe depletion of Kidney True Yang. Raw Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) with added Guizhi (Cinnamon Twig) and Fuzi (Aconite) to unblock Yang Qi. Others argued against Cinnamon/Aconite in summer, hiring another doctor who used heavy Renshen (Ginseng) and Fuzi (Aconite). Food intake increased after a month. Believing these herbs worked, he consumed them excessively, eating 7-8 meals of pork trotters/chicken/duck daily, plus large cooked meals at night. Over two months, he became twice as plump but experienced constant hunger/gastric discomfort, seeing ghosts in blue clothes. Pulse became slippery, rapid, forceful, stronger on the right. Complexion dull, talkative, laughing excessively, incoherent speech. Diagnosis: Phlegm-Food stagnation in the middle, exacerbated by acrid-hot herbs, fueling licentious fire. Initially Yin deficiency, not yet transformed into Xiao Zhong (Middle Wasting-Thirst). Failure to expel promptly would lead to madness. An emetic-phlegm formula was prepared but delayed. Soon, he screamed, went mad, and saw hallucinations, proving the diagnosis correct.
Xu Xueshi said: A soldier drank a dou of water daily, ate nothing for three months, felt心烦 (vexation) in October. I diagnosed latent Heat in the Heart Meridian, prescribing Huofu Dan (Fire Palace Pill) several times. Two days later, he thanked me: "Thirst stopped after three doses; appetite returned after three more." Originally a Lin (Strangury) formula, adapted for thirst, showing flexibility. Formula: Dihuang (Rehmannia) 2 liang, Mutong (Akebia), Huangqin (Scutellaria) 1 liang each. Honey-pilled, paulownia seed size. 30 pills per dose, taken with Mutong Tang (Akebia Decoction).
Lu Zuyu treated Li Yuewu, constipated, over fifty, suffering from Xiao Ke (Wasting-Thirst), unable to stop drinking tea, frequent urination, dry stools, loss of appetite, yet hungry shortly after eating. Ill for a year, exhausted, dry skin, expecting death. Pulse deep, soggy, choppy. "The disease is treatable." Body fluids dry due to Fire, but must be generated by Qi transformation. Previous doctors used only cooling herbs, hence failure. Jiegu said: "Those who eat well and feel thirsty should take Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) in large decoctions." Since this patient couldn't eat and got hungry quickly, combine two formulas with Shengma (Cimicifuga) and Gegen (Pueraria) to raise Clear Yang, add small amounts of Guizhi (Cinnamon Twig) and Fuzi (Aconite) for contrary treatment. Large doses decocted in a big pot, replacing water. Zhang Zhongjing noted this disease worsens in Spring/Summer, improves in Autumn/Winter. Currently in peak summer, symptoms won't vanish but won't worsen. Following this method, avoiding rich flavors, avoiding anger, resting quietly, leads to natural recovery in Autumn. Fortunately, he adhered to restrictions, improved at autumn start, fully recovered by late autumn.
Lu Yangyu treated Governor Chen of Liangguang, nearly seventy, favored concubines, loved wine. Sudden thirst, continuous tea drinking, preferring hot over cold, extreme polyuria (worse at night), severe constipation requiring honey suppositories, lower body weakness, weight loss. Previous treatments were only fluid-generating, drying-moistening, cooling herbs. Pulse floating: rapid, large, void; deep: even more powerless. "Treatment should warm/tonify, not cool." Questioned: "Isn't Xiao Heat? Why warm?" Answer: "Classic says: Pulse follows but lacks force upon pressure. Current pulse is rapid/large/powerless, fitting 'following without force,' a Yang-deficient pulse. Symptoms: Thirst preferring hot drinks, constipation with frequent urination—all indicate Yang deficiency." Asked: "Will you use Lizhong Renshen Fuzi Tang?" Answer: "My warm tonification targets Lower Jiao, not Middle/Upper. Classic: 'Yang rises urgently from Yin.' Also: 'Kidney is the source of generating Qi.' Disease stems from Kidney Water exhaustion, cutting off the source of life. Yang doesn't generate, so Yin doesn't grow. Fluids aren't steamed out, causing upper thirst/polydipsia, lower dryness, frequent urination, difficult defecation, weight loss—all due to Lower Yuan deficiency." Patient admitted prior impotence was a sign of Kidney exhaustion. Though displeased, he accepted the treatment. Bawei Wan (Eight-Ingredient Pill) material plus Yizhiren (Bitter Apricot Seed), decocted with Renshen (Ginseng) paste into pills. 5 qian per dose, warm water, three times daily. Urine volume decreased in days, normalized in ten days. Constipation persisted, once daily, no longer needing suppositories. Thirst remained, taste bland. Added Shengma (Cimicifuga) 1 qian, Renshen (Ginseng) and Huangqi (Astragalus) 3 qian each, decocted to send pills. Several doses stopped thirst, restored taste. Ten days later, all symptoms resolved.
Xue Lizhai said: A man drank several bowls of water daily, even in winter. Using Jiawei Bawei Wan (Modified Eight-Ingredient Pill) without Rougui (Cinnamon Bark) failed. Another man wanted the same pill but refused Rougui due to its heat, taking Zhimu (Anemarrhena) and Huangbai (Phellodendron) instead. Thirst persisted, back carbuncle erupted, and he died. Another man with similar symptoms lost weight; Jiawei Bawei Wan (Modified Eight-Ingredient Pill) halved thirst in a few doses, cured in one batch, restored vigor in two. Rougui (Cinnamon Bark) enters the Kidney Meridian. The previous case involved Deficient Fire flaring up uncontrollably in the Kidney Meridian. Rougui (Cinnamon Bark) guides other herbs to tonify and draws Deficient Fire back to its origin, hence efficacy. Another man had facial acne that healed but caused thirst; cured by the same pill. A wealthy merchant with robust constitution suffered chronic thirst, drinking several bowls daily. Developed a facial toxin, difficult to heal with detox herbs. Chi pulse still rapid, thirst persisted. Early Autumn. Diagnosed as Fire excess/Water depletion pulse. Required Jiawei Bawei Wan (Modified Eight-Ingredient Pill) to tonify Kidney Water and control Heart Fire, preventing carbuncles. He refused. Summer arrived, foot carbuncle erupted, pulse rapid, deep/chop/powerless, foot blackened/rotted, he died. Another robust man, childless, took Fuzi (Aconite) etc., developed thirst, left big toe carbuncle purple/non-painful, pulse rapid/chop, also died. Generally, back/head carbuncles with swelling/pain/redness indicate Water deficiency/Fire excess, treatable. Black/Purple indicates Fire extreme resembling Water, Kidney Water exhausted, Essence depleted, untreatable. *Waike Jingyao* (Essentials of Surgery) states: Most carbuncle patients die of sudden thirst after apparent recovery. If thirst arises as carbuncle heals, take Jiawei Bawei Wan (Modified Eight-Ingredient Pill). If no thirst after recovery, take it preventively. Xue's son heard his father say: A scholar suffered chronic thirst, treated with various thirst remedies for years without cure. A famous doctor advised Jiawei Bawei Wan (Modified Eight-Ingredient Pill), cured in half a year.
An old man developed mouth/tongue sores and thirst in winter. Xin pulse surging/large/solid, Chi pulse large/void. This is Xiao (Wasting). Pathology in Kidney. Must use Jiawei Bawei Wan (Modified Eight-Ingredient Pill) to tonify. Otherwise, subsequent carbuncles will be hard to treat. He refused, took Sanhuang (Three-Yellow) herbs to descend fire. Next summer, carbuncle erupted, he died. Dongyuan said: Ge Xiao (Diaphragm Wasting) is treated with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction). Zhong Xiao (Middle Wasting) involves polyphagia, emaciation, spontaneous sweating, hard stools, frequent urination. *Maijue* (Pulse Mantra) states: Dry thirst with drinking, polyphagia with hunger,虛 (Deficiency) forming Xiao Zhong (Middle Wasting) is treated with Tiaowei Chengqi Tang (Regulate-Stomach and Direct-Downward Decoction) or Sanhuang Wan (Three-Yellow Pill). Xia Xiao (Lower Wasting) involves irritability, polydipsia, dry earlobes, urine like grease. Also: Irritability depletes water, this is Kidney Xiao, treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). *Zonglu* states: Those who haven't transmitted but eat well will develop brain/back carbuncles; those who can't eat will transmit to abdominal distension/bloating, all considered untreatable. Jiegu Elder differentiated treatment: Eat well + thirst = Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction); Can't eat + thirst = Qian Shi Baizhu San (Childhood Spleen Powder) with extra Gegen (Pueraria). Once Earth is balanced, transmission to Lower Xiao ceases. Ancients' medication principles are profound.
Some ask: Why no carbuncles in transmission? This is盛 (Excess) Fire Evil. Sores are very painful, don't ulcerate, or discharge red water. Classic: "Form present but no pain belongs to Yang. Attack Yang urgently, do not attack Yin. Treat in Lower Jiao." If Yuan Qi strengthens, survival; if weak, death.
A woman had facial toxin pain, fever, thirst. Pulse rapid, solid upon pressure. Liangge San (Cool Chest Powder) one dose improved slightly; Duoxiao Yao (Detox Herbs) several doses resolved it.
A man had shoulder carbuncle, thirst. Pulse rapid, forceful. Huanglian Jiedu Tang (Coptis Detoxification Decoction) three doses stopped it; Xianfang Huoming Yin (Immortal Life Preserving Decoction) four doses cured it.
A man had post-ulcer vexation/thirst. Shengyu Tang (Holy Salvation Decoction) two doses calmed him. Renshen (Ginseng), Huangqi (Astragalus), Danggui (Angelica), Dihuang (Rehmannia) four doses stopped thirst. Bazhen Tang (Eight-Treasure Decoction) twenty doses cured it.
Generally, post-ulcer symptoms indicate Qi/Blood deficiency. Use Renshen (Ginseng), Huangqi (Astragalus) to tonify Qi; Danggui (Angelica), Dihuang (Rehmannia) to nourish Blood. Using bitter-cold herbs causes error.
A man had toxin-induced thirst, Right Guan pulse rapid. Zhuye Huangqi Tang (Bamboo Leaf Astragalus Decoction) cured it; Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) plus Huangqin (Scutellaria) completed recovery.
A man had post-ulcer dry mouth, worsening with labor. Buzhong Yiqi Tang (Tonify Middle and Augment Qi Decoction) plus Wuweizi (Schisandra), Maidong (Ophiopogon) cured it; Huangqi Liuyi Tang (Astragalus Six-to-One Decoction) consolidated recovery.
Miu Zhongchun treated Zhang Shitai, a student from Huzhou. Sudden toothache in January, resolved in ten days. In April, overwork caused severe toothache. Doctors used Shigao (Gypsum), Zhimu (Anemarrhena) without effect. Forcefully removed purple blood from teeth, unbearable pain, teeth loosened. By June/July, increased drinking, urine pouring like water, greasy appearance, muscle wasting. By November, bedridden. Late Winter, Huangqi (Astragalus), Dihuang (Rehmannia) allowed slight standing. Polyphagia/hunger and greasy urine persisted. Feb/Mar this year worsened, no meds taken, toothache continued, two front teeth fell out, added thirst, day/night incessant. This is Middle/Lower Xiao (Wasting). Formula provided, cured in few doses. Maidong (Ophiopogon), Lugen (Reed Rhizome) 5 liang each; Wuweizi (Schisandra), Dihuang (Rehmannia) 3 qian each; Huangqi (Astragalus) 5 qian; Shengdi (Raw Rehmannia) 6 qian; Tiandong (Asparagus) 1 liang. Decocted in 10 bowls of Silk-Reeling Soup until 2 bowls remain,