不拘时服。丸方于前药中加黄柏三两，牛膝五两，沙参六两，枸杞四两，五味六两，蜜丸常服，遂不复发。
张景岳治省中周公，山左人也，年逾四旬，因案牍积劳，致成羸疾，神困食减，时多恐惧，自冬祖夏，通
夕不寐者半年有余，而上焦无渴，不嗜汤水，或有所饮，则沃而不行，然每夜必去溺二三升，莫知其所从来，
其半皆脂膏浊液， 羸至极，自分必死。诊之，脉犹带缓，肉亦未脱，知其胃气尚存，慰以无虑。乃用归脾汤
去木香，及大补元煎之属，一以养阳，一以养阴，出入间用至三百余剂，计服人参二十斤，乃得全愈。此神消
于上，精消于下之症也。可见消有阴阳，不得尽言为火。
喻嘉言曰∶友人病消渴后，渴少止，反加躁急，足膝痿弱。予主白茯苓丸方，用白茯苓、覆盆子、黄连、
栝蒌根，萆 、人参、熟地、元参各一两，石斛、蛇床子各七钱五分，鸡 三十具，微炒为末，蜜丸梧桐子
大，食前磁石汤下三十丸，内加犀角。有医曰∶肾病而以黄连、犀角治心，毋乃倒乎？予曰∶肾者，胃之关也，
胃热下传于肾，则关门大开，心之阳火，得以直降于肾，心火灼肾，燥不能濡。予用犀角、黄连，对治其下降
之阳光，宁为倒乎？服之果效。再服六味地黄丸加犀角，而肌泽病起矣。
魏玉横曰∶胡天叙年五旬，素豪饮，而多思虑。自弱冠后即善病，近则两足及臂，常时痹痛，甚则肝肾之
气上逆，或致晕厥，汗出不寐，齿痛龈露，夜卧阳事暴举，时时梦遗，面有油光，揩去复尔。脉之，两手俱豁大，
关前搏指。据症脉，乃二阳之发心脾，今已传为风消矣。询其小便，云颇清白，令以器贮，超时观之，果变稠
浆，面结腐皮，遂恐甚。告以平昔洪饮，纵欲劳神，数十年所服桂、附纯阳之药，不可胜计，未知尚能愈否？曰∶
幸未至息贲，但能断饮绝欲，多服养荣之剂，尚可为也。今病但有春夏，而无秋冬，非兼清肃之治不可。乃与
生熟地、杞子、麦冬、沙参、地骨、知母、黄柏、黄连、石膏，出入增减，十余剂，诸症渐平。惟齿痛转甚，
自制玉带膏贴之而愈。次年，因诊其媳产病，告以前方出入常服，计用石膏不下四五斤矣。此则初为寒中，后
为热中之变症也。然初之桂、附，未为痈疽，岂非天幸乎。
黄锦芳治游昼山消渴，六脉微缓而沉，肺脉尤甚，肝脉差起，小便甚多，肌肉消瘦，烦渴不止。此必初病
时过服石膏、知母、花粉、蒌仁、贝母、犀角等苦寒之药，伤其肺胃及肾，以致地气不升，天气不降。宜滋阴
补气，使漏卮不至下泄。用当归一钱，炙 四钱，升麻三分，玉竹三钱，桂元十个，桑螵蛸一钱，龙骨一钱，
菟丝二钱，龟板一钱，木瓜四分，炙草三分，使其二气交合，霖雨四布，则病自愈。嘱其日服一剂，禁服苦茶。
后病者以洋参代人参，服之甚效。
Take at any time. The pill formula adds Coptidis Rhizoma (Huangbai, 黄柏) three liang, Achyranthis Bidentatae Radix (Niuxi, 牛膝) five liang, Glehniae Radix (Shashen, 沙参) six liang, Lycii Fructus (Gouqi, 枸杞) four liang, Schisandrae Fructus (Wuweizi, 五味) six liang to the previous medicine, processed with honey into pills for regular consumption, and thus the disease did not recur.
Zhang Jingyue treated Zhou Gong, a resident of Shengzhong from Shandong, who was over forty years old. Due to fatigue accumulated from handling official documents, he developed a wasting disease characterized by mental exhaustion, reduced appetite, frequent fearfulness, and insomnia lasting more than half a year from winter to summer. There was no thirst in the upper jiao, nor desire for soups or water; even if he drank, the fluid stagnated without moving. However, he urinated two to three sheng every night, unknown to its source, half of which was turbid liquid resembling fat and paste. He became extremely emaciated and believed he would surely die. Upon examination, his pulse still showed a moderate quality, and his flesh had not wasted away, indicating that his Stomach Qi remained. He was reassured. Then, Guipi Tang (Restore the Spleen Decoction) minus Zanthoxyli Pericarpium (Muxiang, 木香), along with Dabu Yuanyuan Jian (Greatly Tonify the Origin Decoction) and similar formulas were used. One nourished Yang, the other nourished Yin, alternating between them for over three hundred doses, consuming a total of twenty jin of Ginseng Radix et Rhizoma Rubra (Renshen, 人参), until complete recovery. This is a case where Shen (Spirit) is consumed above and Jing (Essence) is consumed below. It shows that Xiao Ke (Wasting-Thirst) has Yin and Yang distinctions and cannot be entirely attributed to Fire.
Yu Jiayan said: A friend of mine suffered from Xiao Ke (Wasting-Thirst). After his thirst subsided slightly, restlessness and irritability increased, accompanied by flaccidity and weakness of the feet and knees. I prescribed Bai Fuling Wan (White Poria Pill) using Poria (Baifuling, 白茯苓), Rubi Fructus (Fupenzi, 覆盆子), Coptidis Rhizoma (Huanglian, 黄连), Trichosanthis Radix (Gualougen, 栝蒌根), Dioscoreae Hypoglaucae Rhizoma (Bixie, 萆薢), Ginseng Radix et Rhizoma (Renshen, 人参), Rehmanniae Radix Praeparata (Shudihuang, 熟地), Scrophulariae Radix (Yuan Shen, 元参) each one liang, Dendrobii Caulis (Shihu, 石斛), Cnidii Fructus (Shechuangzi, 蛇床子) each seven qian and five fen, and Gallus Gallus Domesticus Brisson Comestus (Jineijin, 鸡内金) thirty pieces, lightly fried and powdered. These were made into pills the size of paulownia seeds with honey. Thirty pills were taken before meals with a Magnetitum (Cishi, 磁石) decoction, adding Cornu Bubali (Xijiao, 犀角). A physician remarked: "Treating Kidney disease with Coptidis Rhizoma and Cornu Bubali to address the Heart—is this not inverted?" I replied: "The Kidney is the gate of the Stomach. When Stomach Heat transmits downward to the Kidney, the gate opens wide, allowing the Heart's Yang Fire to descend directly into the Kidney. The Heart Fire scorches the Kidney, causing dryness and inability to moisten. I use Cornu Bubali and Coptidis Rhizoma to counteract the descending solar fire (Heart Fire); how can this be considered inverted?" The treatment proved effective. Subsequently, taking Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Cornu Bubali resulted in lustrous skin and recovery.
Wei Yuheng said: Hu Tianxu was around fifty years old, accustomed to heavy drinking and excessive worry. Since his twenties, he was prone to illness. Recently, his legs and arms suffered from frequent bi-syndrome pain. Severe cases involved upward reversal of Liver and Kidney Qi, leading to syncope, sweating, and insomnia. He experienced toothache with receding gums, nocturnal priapism during sleep, and frequent seminal emissions. His face had an oily sheen that returned after wiping. Pulse diagnosis revealed both hands showing a large, empty quality, with strong pulsation at the cun position anterior to the guan. Based on symptoms and pulse, this was a manifestation of the Two Yang meridiments affecting the Heart and Spleen, now transmitted as Feng Xiao (Wind Wasting). Inquiry about urine revealed it appeared clear initially, but when stored, it turned into thick paste with a film on top, causing great fear. I informed him that due to decades of alcohol indulgence, sexual excess, and mental labor, coupled with countless doses of pure Yang medicines like Cinnamomi Ramulus (Guizhi, 桂枝) and Aconiti Lateralis Radix Praeparata (Fuzi, 附子), recovery might be difficult. However, since it had not progressed to Xifen (Lung Accumulation), if he could abstain from alcohol and sex, and take many blood-nourishing agents, it could be cured. The current condition exhibits only Spring/Summer (Yang) characteristics, lacking Autumn/Winter (Yin) restraint, requiring clearing and purifying treatments. Therefore, I prescribed Rehmanniae Radix (Shengdihuang/Shudihuang, 生熟地), Lycii Fructus (Qizi, 杞子), Ophiopogonis Radix (Maidong, 麦冬), Glehniae Radix (Shashen, 沙参), Cortex Lycii (Digupi, 地骨), Anemarrhenae Rhizoma (Zhimu, 知母), Phellodendri Cortex (Huangbai, 黄柏), Coptidis Rhizoma (Huanglian, 黄连), Gypsum Fibrosum (Shigao, 石膏), adjusting them over ten doses until symptoms gradually subsided. Only the toothache worsened, which healed with self-made Yudai Gao applied externally. The following year, while treating his daughter-in-law's postpartum illness, I advised her to take modified versions of the previous prescription regularly, consuming no less than four to five jin of Gypsum Fibrosum. This case transformed from initial Cold Zhong (Middle Jiao Cold) to later Heat Zhong (Middle Jiao Heat). Fortunately, the initial use of Cinnamomi Ramulus and Aconiti Lateralis Radix Praeparata did not cause carbuncles, which was sheer luck.
Huang Jinfang treated You Zhoushan for Xiao Ke (Wasting-Thirst). The six pulses were slightly moderate and deep, with the Lung pulse particularly prominent and the Liver pulse slightly rising. Urination was excessive, muscles were emaciated, and there was incessant vexatious thirst. This was likely caused by excessive intake of bitter-cold medicines such as Gypsum Fibrosum, Anemarrhenae Rhizoma, Trichosanthis Radix, Semen Trichosanthis (Louren, 蒌仁), Fritillariae Thunbergii Bulbus (Beimu, 贝母), and Cornu Bubali during the early stage of illness, damaging the Lung, Stomach, and Kidney. This prevented Earth Qi from ascending and Heaven Qi from descending. Treatment should nourish Yin and tonify Qi to prevent leakage downwards. The prescription included Angelicae Sinensis Radix (Danggui, 当归) one qian, Astragali Membranacei Radix (Zhi Huangqi, 炙黄芪) four qian, Cimicifugae Rhizoma (Shengma, 升麻) three fen, Polygonati Odorati Rhizoma (Yuzhu, 玉竹) three qian, Euphorbiae Lappae Fructus (Guiyuan, 桂圆) ten pieces, Sangxianqiao (Sangpiaoxiao, 桑螵蛸) one qian, Longgu (Longgu, 龙骨) one qian, Cuscutae Semen (Tusizi, 菟丝) two qian, Testudinis Carapax et Plastrum (Guiban, 龟板) one qian, Chaenomelis Fructus (Mu Gua, 木瓜) four fen, and Glycyrrhizae Radix et Rhizoma (Zhi Cao, 炙草) three fen. This aimed to harmonize the two Qi, spreading moisture like rain, so the disease would heal naturally. He was instructed to take one dose daily and avoid bitter tea. Later, the patient replaced Ginseng Radix et Rhizoma with Panax Quinquefolii Radix (Yangshen, 洋参), yielding excellent results.