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Therefore, Zhang Zhongjing's Shenqi Wan (Kidney Qi Pill) is used to treat the syndrome of drinking one dou of water and excreting one dou of urine. If the volume of urine exceeds the amount of water drunk, it is incurable. For Shen Xiao (Kidney Consumption/Xiao Ke affecting the Kidneys), in addition to taking nourishing pills, it is advisable to frequently decoct and drink Huangqi Tang (Astragalus Decoction). Dai Yuan Shi said: If the condition arises from excessive sexual indulgence, leading to a failure of communication between Water and Fire, with Kidney Water descending and Heart Fire flaring up, resulting in thirst and turbid urine, one should not routinely use cooling agents for the Heart. Instead, one should strengthen Kidney Water to assist Heart Fire. One should use Huangqi Yin (Astragalus Drink), adding Rongrong (Cistanche Herba) and Wuweizi (Schisandrae Fructus) half a qian each, swallowed with Bawei Wan (Eight-Ingredient Pill), as well as Xiaotusizi Wan (Small Cuscuta Pill), Xuantu Dan (Mysterious Rabbit Pellet), Lurong Wan (Deer Antler Pill), Jiajian Anshen Wan (Modified Calming Kidney Pill), or Lingsha Dan (Spirit Mercury Pellet). The disease of Shen Xiao is more severe than other types of Xiao Ke; ancient texts refer to it as "Qiangzhong" (Strong Middle) or "Neixiao" (Internal Consumption). It is often caused by unrestrained sexual desire or the ingestion of mineral drugs. Once Kidney Qi declines, the toxicity of the minerals remains alone, and essence and fluids are un-nourished. Thus, deficient Yang frequently flares up, essence leaks out uncontrollably, urination is frequent and uncontrolled, lips and mouth become dry and scorched. One should use Huangqi Yin, swallowing Xuantu Dan. Bawei Wan, Lurong Wan, Jiajian Shenqi Wan, Xiaotusizi Wan, and Lingsha Dan can all be selected. If there is no effect, add Rongrong, Wuweizi, and Shanzhuyu (Corni Fructus) each four fen to Huangqi Yin, along with Qifeng Tang (Jiaolia Decoction), Rongrong Wan, Tianwang Buxin Dan (Emperor of Heaven's Tonification of the Heart Pill), Shuangbu Wan (Double Tonification Pill), Shenli San (Kidney Drip Powder), Jinyinbo Wan (Silver and Gold Foil Pill), and Baifuling Wan (White Poria Pill).

[General Treatment] Sanxiao Wan (Three Consumptions Pill): Take high-quality Huanglian (Coptidis Rhizoma), clean it and grind it into fine powder, quantity unrestricted. Cut winter melon flesh, grind to extract natural juice, mix with the powder to form cakes, dry in the shade, then grind again into fine powder. Soak and mix with the juice, repeating this process seven times. Finally, use winter melon juice to make pills the size of paulownia seeds. Take thirty pills per dose, delivered with barley kernel soup mixed with winter melon juice. For ordinary thirst, one dose is effective. Excessive alcohol and sexual activity accumulate intense heat, steaming the five Zang organs, drying up body fluids, causing blood stasis, frequent urination, muscle wasting, and a strong craving for cold foods and drinks. Do not administer cooling agents; instead, treat primarily with Longfeng Wan (Dragon and Phoenix Pill). Dai Yun stated: Various Xiao diseases should not be treated with drying, acrid, or harsh tonifying agents; only nourishment is appropriate. Except for Pi Xiao (Spleen Consumption), Xin Xiao (Heart Consumption) and Shen Xiao should use Huangqi Liuyi Tang (Astragalus Six-to-One Decoction), or Ginseng Tang swallowed with Bawei Wan, Xuantu Dan, or Xiaotusizi Wan. Zhulong San (Bamboo Dragon Powder) is also suitable, as is Liushen Yin (Six Deities Drink), which also treats Shen Xiao. Only in Pi Xiao should Danggui (Angelicae Sinensis Radix) be added and Huangqi removed. In Sanxiao, since urination is frequent, constipation is inevitable; thus, Siwu Tang (Four Substances Decoction) should be taken regularly to moisten the large intestine. If Renshen (Ginseng Radix), Mugua (Chaenomelis Fructus), and Huafen (Trichosanthis Radix) are added, one should still consume Sihao Zhou (Four White Men Porridge). Two parts of rice water sediment can also be taken cold. If Sanxiao persists for a long time, urine loses its odor but develops a sweet smell, bubbling in the chamber pot, indicating severe illness. Furthermore, if fat-like substances float on the urine surface and splatter like candle wax on the bucket sides, this indicates loss of essence and exhaustion of true Yuan Qi. Regarding sweet urine in Xiao Ke, Xu Xueshi discussed it in detail, but the principle was not fully elucidated. Generally, water in heaven, earth, and the human body has both salty and sweet properties; sweetness represents Sheng Qi (Vital Qi), while saltiness represents Si Qi (Dead Qi). Su Dongpo's "Ode to Spring Milk" elaborates on this. Urine should naturally be salty but becomes sweet, indicating the leakage of Sheng Qi. Leakage of Sheng Qi occurs because Spleen Qi sinks into the Kidney. Spleen Qi entering the Kidney represents Earth overcoming Water. After Sanxiao persists for a long time, essence and blood are depleted; symptoms may include blindness or hemiplegia resembling wind stroke. This syndrome is mostly due to Shen Xiao. Using various tonifying medicines for Lower Xiao to generate essence and blood will lead to self-healing. After Sanxiao recedes, if dryness and thirst persist, it indicates residual heat in the Lung Meridian. A small amount of Renshen, Fuling (Poria), and Gancao (Licorice Radix), taken cold with ginger juice, can be used. For deficiency, Renshen Tang may be used. If thirst recurs after recovery, with a white, slippery, slightly swollen tongue, pain upon swallowing saliva, throat swelling, frequent desire for cold drinks, and sticky white foam that stops only with cold water, use Gancao Shigao Wan (Licorice and Gypsum Pill). After thirst resolves, one must prevent carbuncles and sores; use Huangqi Liuyi Tang to swallow Rendong Wan (Honeysuckle Pill). (For any deficiency insufficiency, chest irritability, frequent Xiao Ke, dry lips and mouth, or thirst preceding sores, or thirst following sores, frequent use of Huangqi Liuyi Tang is appropriate.) For existing sores, use Lanye San (Isatis Leaf Powder), Xuanshen San (Scrophulariae Radix Powder), or Qifeng Wan. If Xiao Ke leads to fluid retention, although medical texts mention Zisu Tang, Qumai Tang, and Tingli Wan, these are purgative and draining agents. It is better to use Wupi Yin (Five Peel Drink) to deliver Jisheng Shenqi Wan, or Li Dongyuan's Zhongman Fenxiao formulas, which are more appropriate.

[Mouth Dryness and Throat Dryness] Li Dongyuan said: Irregular diet and fatigue injury lead to Spleen and Stomach weakness. This is a disease arising from Blood, characterized by the failure of fluids to circulate in the mouth, causing dry mouth and throat. Patients feel thirsty themselves. If doctors treat this with Wuling San (Five-Ingredient Powder with Poria), thirst and dryness will worsen, further depleting fluids and leading to danger. The Classics state: "In deficiency, tonify the mother." Tonification should occur in the Heart and Small Intestine, as they are the root of the Spleen and Stomach. Use sweet-warm herbs as the principal agents, bitter-cold as guides, sour as assistants, and pungent as佐 (adjuncts). The Heart dislikes laxity; urgently use sour flavors to astringe it. If Heart Fire is hyperactive, Lung Metal suffers; when Lung Qi is deficient, tonify with sour flavors. Next, use sweet-warm and sweet-cold agents to drain excess Heart Fire within the Spleen and Stomach; this treats the root. (Buzhong Yiqi Tang, added with Wuweizi and Gegen (Puerariae Radix). Huangqi Tang from *Ben Shi Fang* is also usable.) Dai Yun said: For spontaneous thirst without disease, or thirst after convalescence, use Shenzhu Yin, Sijunzi Tang (Four Gentlemen Decoction), or Suopi Tang, all added with Gan Ge (Kudzu Root). Or Qizhen San (Seven Treasures Powder) with one qian of Mugua. Shengliao Wuling San (Raw Material Five-Ingredient Powder with Poria) with one qian of Renshen is named Chunze Tang. Wuling San combined with Sijunzi Tang is also called Chunze Tang, an especially important formula. Additionally, consume Sihao Zhou. For chronic damage from various diseases, Kidney deficiency with thirst, use Bawei Wan and Huangqi Yin. Siwu Tang with half a qian each of Renshen and Mugua, or Qizhen San, or Dabu Tang (Great Tonification Decoction) with Bai Zhu (Atractylodis Macrocephalae Rhizoma) removed and Mugua added in equal amounts, are suitable. For hemorrhage and postpartum thirst, named "Blood Thirst," seek blood-tonifying agents, as discussed in the Hematemesis chapter. For sudden intense thirst without prior illness that resolves shortly after, only honey water and Suopi Tang are appropriate. A few sips of cold rice water sediment can also be taken. For alcohol-induced thirst, use Gegen Tang to regulate Wuling San. There is also "Fruit/Tree Thirst" caused by excessive fruit consumption; Musk (Shexiang) should be included in the prescription.

[Diagnosis] A weak, thin pulse indicates a fragile Heart; a thin shoulder and back indicate a fragile Lung; weak costal bones indicate a fragile Liver; large but non-firm lips indicate a fragile Spleen; large but non-firm ears indicate a fragile Kidney. All these constitutions are prone to Xiao Dan (Xiao Ke and related disorders) and easy injury. A tiny and minute Heart pulse indicates Xiao Dan; a very slippery pulse indicates frequent thirst (Slipperiness indicates Yang excess). Tiny and minute pulses in the Lung, Liver, Spleen, and Kidney positions all indicate Xiao Dan. (All small pulses indicate insufficiency of both Yin and Yang. Do not use acupuncture; regulate with sweet medicines.) A soft and scattered Heart pulse indicates that Xiao Ke will resolve itself. A Ru (Soft) and scattered pulse indicates Qi excess and Blood deficiency. A Hong (Surging) and large pulse indicates Yang surplus and Yin deficiency. A floating and slow pulse at the Cun Kou position indicates floating means Deficiency and Wei Qi depletion; slow means Labor/Fatigue and Ying Qi exhaustion. A floating and rapid pulse at the Zu Yang position indicates floating means Wind, and rapid indicates digestion of food (hyperphagia). A solid and large pulse in a chronic disease is treatable. A suspended, small, and firm pulse in a chronic disease is untreatable. A rapid and large pulse indicates survival; a small, thin, floating, and short pulse indicates death. If a patient opens their eyes and feels thirsty, with a firm sensation below the heart, the pulse should be tight, solid, and rapid. If it is instead deep, choppy, and faint, it indicates death. If Heart transmits Cold to the Lung causing Xiao Ke, drinking one dou and urinating two dou is untreatable.