Library

I once read Mr. Liu Hejian's treatise on the "Three Xiao" (Wasting-Thirst) syndromes. Initially, he expounded on the Six Qi and Five Flavors of Heaven and Earth, using them to correspond with the Six Flavors and Five Zang Organs of the human body, thereby investigating the source of all things; finally, he cited the *Neijing* (Classic of Internal Medicine) discussions on various thirst syndromes to refute the errors of using hot-natured medicines in common prescriptions. This method of establishing images through analogy, explained repeatedly and clearly, could only be achieved by one who deeply comprehends the mechanism of Yin-Yang transformation. Let me state the essentials:

The classics mention cases where thirst is caused by the reversal of Qi in the Heart and Lungs, by Heat in the Kidney, by accumulated Heat in the Stomach and Large Intestine, by Bi syndrome (obstruction) of the Spleen, by Heat-Bi of the Small Intestine, by overeating rich and sweet foods, by sexual activity after drunkenness or full meals, by fatigue from long travel combined with hot weather, by injury leading to dryness of the Stomach, by Heat in the Kidney, and by Gout. Although the locations within the Five Zang Organs differ and the causes of disease vary, they are all fundamentally diseases of Dryness-Heat.

The Heat in the Three Xiao syndromes stems from the decline of damp-cold Yin Qi and the excessive flourishing of dry-hot Yang Qi. This is primarily due to irregular diet, causing dryness and depletion of the intestines and stomach, preventing the smooth circulation of Qi and Body Fluids. It may also result from mental exhaustion and exceeding normal limits, or from severe illness damaging Yin Qi and depleting Blood. In such cases, Yang Qi becomes fierce, and Dryness-Heat becomes severely stagnant. Alternatively, it may arise from long-term consumption of salty foods or excessive intake of fried and roasted items. Some young people take mineral-based pills and powders, which accumulate and create Excess Heat in the Lower Jiao. The deficient and warm Blood-Qi cannot control this, leading to extreme Dryness-Heat in the Kidney, causing thirst without desire to drink. If drinking water leads to increased urination, it is named **Xiao Ke** (Wasting-Thirst). If eating more does not cause significant thirst, but urination is frequent and emaciation occurs, it is named **Xiao Zhong** (Middle Wasting). If thirst is unquenchable despite continuous drinking, legs become emaciated, and urine contains fatty substances, it is named **Shen Xiao** (Kidney Wasting). These three types share the same pathogenesis of Dryness-Heat. Therefore, treatment should tonify the deficiency of Kidney Water (Yin), purge the excess of Heart Fire (Yang), eliminate severe Dryness-Heat in the intestines and stomach, and replenish the decline of whole-body Jin-Ye (Body Fluids). This ensures pathways remain open without obstruction, Jin-Ye is generated without drying up, and Qi and Blood flow smoothly without stagnation, leading to gradual recovery. Is this not precisely the use of moistening agents to nourish Yin and control Dryness, and to nourish Water to fill fluids?

Why do differing views exist? Physicians ignorant of these texts often attribute the condition to deficiency of Kidney Water in the lower part, failing to control Heart Fire in the upper Jiao. This results in Excess Heat and irritability/thirst above, and Cold Deficiency with polyuria below. They argue that administering cold medicines will further weaken Yuan Qi (Original Qi) and diminish Kidney Water, making Heart Fire harder to treat. Instead, they advocate using warm medicines to tonify Yuan Qi, believing that if Kidney Water becomes sufficient, it will overcome Heart Fire, naturally stopping thirst and normalizing urination. Alas! Such views demonstrate a lack of understanding of Yin-Yang and Deficiency-Excess principles.

Kidney Water belongs to Yin and is inherently cold; when deficient, it manifests as Heat. Heart Fire belongs to Yang and is inherently hot; when deficient, it manifests as Cold. If Kidney Water is Yin-deficient, Heart Fire becomes Yang-excessive, resulting in both Excess Yang and Deficient Yin, with heat present throughout the upper and lower body. Those proponents, seeing only wasting-thirst and frequent urination, wrongly diagnose it as lower Jiao Cold. They fail to realize that this is caused by Dryness-Heat stagnating in the intestines and stomach. Furthermore, cold-natured herbs belong to Yin, nourishing Water and purging Heart Fire; hot-natured herbs belong to Yang, nourishing Fire and consuming Water. Since Kidney Water currently fails to control Heart Fire, resulting in systemic heat, how can one use hot herbs to nourish Kidney Water in hopes of overcoming Heart Fire? This is profoundly misguided. They overlook the principle that abundant Water controls Fire, while deficient Water cannot. Thus, in Excess Yang and Deficient Yin states, Heat dries fluids, causing scanty, dribbling urination. Conversely, in Excess Yin and Deficient Yang states, inability to control Water leads to profuse, clear urination.

These physicians also misunderstand why polyuria occurs in wasting-thirst. It is because extreme Dryness-Heat causes stagnation and blockage in the pores and collaterals of the San Jiao (Triple Burner) and intestines/stomach. This dense obstruction prevents Body Fluids from permeating and moistening the exterior to nourish the limbs and tissues. Consequently, although large amounts of water enter the stomach and intestines, they cannot moisten the exterior, leading to persistent thirst and high urinary output. Since fluids fail to permeate the exterior, Yin becomes dry and exhausted, unable to self-nourish. Over time, this leads to complications such as deafness, blindness, sores, ulcers, acne, and stroke-like symptoms, endangering life. This clearly demonstrates the damage of Dryness-Heat to Yin.