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The symptom of excessive thirst is naturally a heat syndrome, but how can one distinguish between deficiency and excess? If one does not realize that the massive depletion of Kidney Water (Jin Ye) and the boiling of Kidney Fire leads to Xiao Ke disease (Wasting and Thirsting Syndrome), how could it be anything other than a deficiency? It is common for patients to drink one dou of water yet excrete two dou of urine; the metabolic pathway of this water is unpredictable. Although Xiao Ke disease is categorized into upper, middle, and lower jiao types, the symptom of thirst remains consistent across them. What is this consistency? It lies in the deficiency of Kidney Water leading to hyperactivity of Kidney Fire. Therefore, in treating Xiao Ke disease, regardless of whether it involves the upper, middle, or lower jiao, tonifying the Kidney must be the primary principle. Zhang Zhongjing formulated Ba Wei Di Huang Tang (Eight-Ingredient Pill with Rehmannia), originally intended to treat the Emperor Wu of Han's Xiao Ke disease. This formula is truly miraculous. If one adheres to this prescription and administers it in large doses, why worry about the difficulty of treating deficiency-type thirst? However, medical practice often suffers from a scarcity of effective formulas and limited therapeutic methods. Today, I transmit another formula to be passed down alongside Zhang Zhongjing’s for millennia. It is remarkably effective for treating thirst, named Zhi Ke Xian Dan (Immortal Elixir to Stop Thirst). Take one bowl each morning, noon, and evening. After one day, thirst will halve; after two days, it will halve again; after three days, thirst will cease; and after four days, full recovery is expected. Do not be startled or skeptical; abide by and respectfully take this formula, and you will naturally turn adversity into safety. As for excess-type excessive thirst, besides Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction), there was originally no second formula. However, Shi Gao (Gypsum Fibrosum) is overly harsh. I have now formulated another prescription named Jie Ke Shen Dan (Divine Elixir to Relieve Thirst). After using one dose of Shi Gao, immediately follow with two doses of this decoction to mitigate the峻烈 (pungent and drastic) nature of Gypsum, which is acceptable. Generally, excess-type thirst presents with a tongue coated like thorns, red eyes, sudden onset of mania, and eruption of macules/rashes. These signs must not be overlooked.

Zhi Ke Xian Dan (Immortal Elixir to Stop Thirst)
Shu Di Huang (Prepared Rehmanniae Radix, 3 liang) Mai Dong (Ophiopogonis Tuber, 3 liang) Xuan Shen (Scrophulariae Radix, 3 liang) Tian Dong (Asparagi Tuber, 3 liang) Rou Gui (Cinnamon Cortex, 3 qian) Shan Zhu Yu (Corni Fructus, 3 liang) Bei Wu Wei Zi (Schisandrae Chinensis Fructus, 1 liang) Che Qian Zi (Plantaginis Semen, 1 liang) Niu Xi (Achyranthis Bidentatae Radix, 1 liang) Qian Shi (Euryales Semen, 1 liang). Decoct with 10 bowls of water until 3 bowls remain. Take one bowl each morning, noon, and evening.

Jie Ke Shen Dan (Divine Elixir to Relieve Thirst)
Xuan Shen (Scrophulariae Radix, 4 liang) Sheng Di Huang (Rehmanniae Radix Recens, 2 liang) Fu Ling (Poria, 1 liang) Gan Ju Hua (Chrysanthemi Flos, 1 liang). Decoct with water and take orally.

Profuse sweating leading to Yang collapse is a deficiency syndrome, so how can one distinguish between deficiency and excess? One must not fail to recognize that symptoms such as mania and macule/rash eruptions are indicative of excess. In cases where the patient exhibits excessive thirst and drinks up to half a bucket or a full bucket of water, the sweating will inevitably be torrential, like rain, unstoppable. This occurs because heat drives fluids outward. Conversely, if there is no fluid to nourish, there is typically no sweat, as extreme dryness prevents perspiration. Sweat only emerges when fluids are present to facilitate it. Such profuse sweating belongs to excess rather than deficiency. The treatment should employ Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction) in large doses to stop sweating and resolve heat. However, since profuse sweating can lead to Yang collapse, Ren Shen (Ginseng Radix) should be added in larger quantities to the Gypsum formula to prevent this disaster. This demonstrates that even excess syndromes may require tonification, let alone deficiency syndromes involving sweating. Deficiency-type sweating may manifest as sparse droplets resembling tidal fever, or beads of sweat that form but do not flow, or night sweats without daytime sweating, or sweating confined to the lower body while the upper body remains dry. Patients with deficiency sweating may not fear wind or cold, unlike those with Yang syndromes who tolerate wind and cold. If one mistakenly diagnoses this as Bai Hu Tang syndrome (Yangming Channel Heat Excess) and prescribes Zhu Ye Shi Gao Tang, death may occur instantly. How can one not be cautious? So, what medicine should be used? It is best to use Bu Xue Tang (Blood Tonifying Decoction). This formula stops sweating and brings comfort. I add Hei Jiang (Charred Ginger) and Wu Wei Zi (Schisandra) for their subtle efficacy. Dang Gui (Angelicae Sinensis Radix) generates blood and tonifies Qi; sufficient Qi ensures the skin and hair have Wei Qi protection, preventing spontaneous sweating. By generating blood, Dang Gui resolves deficiency heat, preventing further leakage of sweat. Hei Jiang (Charred Zingiberis Rhizoma) retains its action internally without dispersing, while Wu Wei Zi (Schisandrae Chinensis Fructus) is sour and astringent, naturally harmonizing Qi and Blood and preventing sweating. Thus, they complement each other to achieve success.

Bu Xue Tang (Blood Tonifying Decoction)
Dang Gui (Angelicae Sinensis Radix, 1 liang) Huang Qi (Astragali Membranacei Radix, 2 liang) Gan Jiang (Zingiberis Rhizoma, stir-fried black, 2 qian) Bei Wu Wei Zi (Schisandrae Chinensis Fructus, 1 qian). Decoct with water and take orally.