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In the winter of the Jiashen year, Lian Shen suffered from cold invasion due to overwork and fatigue. His kidney pulse alone presented as slow (Chi). I administered Wujing Tang (Warming the Meridian Decoction), adding Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex), and he recovered after three doses. I instructed him to rest quietly in a sealed room.

Three days later, due to labor and emotional stagnation related to salt administration duties, he suddenly developed Zhong Xiao (Middle Jiao Consumption Disease). He ate double the usual amount of food but still felt hungry, and if he delayed eating slightly, he experienced epigastric discomfort resembling the urge to vomit blood. I suspected that the addition of Shengjiang and Rougui in the previous prescription was too drying. I stated, "This is because the patient's constitution is deficient, leading to Liver Fire insulting the Spleen, causing only the Middle Jiao to be scorched. However, since both Chi pulses remain slow, it cannot be treated with cooling agents for Xiao disease." He did not believe me. A physician treated him by adding Maidong (Ophiopogonis Radix) and Baishao (Paeoniae Radix Alba) to the previous decoction. Although the symptoms of consumption subsided quickly and his diet returned to normal, his stool became loose and uncontrolled. He sought my treatment again. I instructed him to strictly take Guipi Tang (Restore the Spleen Decoction), added with Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Preparata), Guzhi (Dipsaci Radix), and Wuyu (Evodiae Fructus). After ten doses, the diarrhea stopped, and he began to recover significantly. This demonstrates that Xiao disease can also be caused by Cold.

I consulted various medical texts, which all stated that the three types of Xiao (Upper, Middle, Lower) belong to Fire diseases, and treatment requires cooling agents. However, the *Neijing* (Inner Canon) in the chapter on Qi Reversal states: "When Heart transfers Cold to the Lung, drinking much and urinating much indicates a fatal condition that is incurable." Thus, drinking little and urinating much, as well as excessive nocturnal urination in the elderly due to Yang deficiency, are all Cold-type Xiao diseases, representing the exhaustion of Lung and Kidney Metal and Water. Few people in the world understand this. I append a case treated by Zhang Jingyue to broaden common understanding.

Zhang Jingyue said: "I once treated a scholar-official who was over forty years old. Due to accumulated fatigue from handling documents, he fell seriously ill. He suffered from mental exhaustion, reduced appetite, and frequent fear. There was no thirst in the Upper Jiao, and he had no desire for soups or water. Even if he drank a little, he felt fullness and stagnation without relief. However, every night he would void two to three sheng of urine, without knowing its source, and half of it was turbid fluid. Finally, he invited me to examine him. He told me, 'Since falling ill, I have been sleepless throughout the night for over half a year. Even when I occasionally feel drowsy, I dream of deceased persons, funerals, and other ominous events, with ghosts and demons approaching; I fear death is inevitable.' I replied, 'Not so. This is due to accumulated worry and fatigue damaging the Yuan Yang of the Heart and Kidney. Since Yuan Yang is deficient, Yin Evil interferes, hence the frequent Yin dreams. When Yang Qi declines, Qi becomes deficient; when Yang cannot command Yin, Water fails to transform into Qi. Therefore, water intake is low, but turbid urine output is high.' As Yang Qi gradually returns, Yin Evil naturally recedes. This is precisely the symptom described in the *Neijing* as 'Heart transferring Cold to the Lung, drinking one part and urinating two parts.' The root of the disease is not light, but the pulse still shows slowness (Huan), the flesh has not wasted away, and Stomach Qi remains. There is no need to worry." I then used formulas similar to Guipi Tang (Restore the Spleen Decoction), removing Baizhu (Atractylodis Macrocephalae Rhizoma) and Muxiang (Aucklandiae Radix); and formulas similar to Bawei Wan (Eight-Ingredient Pill), removing Mudanpi (Moutan Cortex) and Zexie (Alismatis Rhizoma). One set nourished Yang, the other nourished Yin, used alternately. After more than three hundred doses, consuming over twenty jin (approx. 12 kg) of Renshen (Ginseng Radix et Rhizoma), he fully recovered. Is this not the syndrome of Spirit Consumption in the Upper and Essence Consumption in the Lower? It is evident that Xiao disease includes both Yin and Yang syndromes and cannot be entirely classified as Fire syndromes. I record this case as a reference for treating Xiao disease. Alas, Jingyue was truly miraculous in his treatment!