刘宗浓曰∶三消之症，总由燥热伤阴所致。然因乎饮食失节，肠胃干涸，而气液不得宣平；或耗乱
精神，过违其度；或因大病，阴气损而血液衰虚，阳气悍而燥热益甚；或久嗜咸物，恣食炙爆，饮食过度。
亦有服金石丸散，积久实热结于下焦，燥甚于肾，故渴而不饮。
若饮水多而小便多者，名曰消渴。若饮食多而不甚渴，小便数而消瘦者，名曰消中。若渴而饮水不绝，
腿消瘦，而小便有脂液者，名曰肾消。此三消者，其燥热同也。
夫肾水属阴而本寒，虚则为热；心火属阳而本热。虚则为寒，若肾水阴虚，则心火阳实，水虚不能制火，
阳实热燥其液，是以燥热太甚，而三焦肠胃之腠理怫郁结滞，致密壅塞，而水液不能渗泄浸灌于外，以养乎
百骸。故肠胃之外燥热太甚，虽多饮水入于肠胃之内，终不能浸润于外，致渴不止而小便多。水液既不能
渗漉浸灌于外，则阴益燥竭，而无以自养，故久而多变为聋盲、疮疡、痤痱之类而危殆。
故治是疾者，补肾水真阴之虚，而泄心火阳热之实，除肠胃燥热之甚，济一身津液之衰，使道路散而
不结，津液生而不枯，气血利而不涩，则病日已矣。若日用苦寒，反从火
化，不危何待哉。
喻嘉言曰∶消渴之患，常始于微而成于着，始于胃而极于肺肾。始如以水沃焦，水入犹能消之；
既而以水投石，水去而石自若。至于饮一溲二，则燥火动其真阴，而势成 矣。
经谓凡治消瘅、仆击、偏估、痿、厥、气满发逆，肥贵人则膏粱之疾也。此中消所由来也。夫既瘅
成为消中，随其或上或下，火热炽盛之区，以次传入矣。
上消者，胃以其热上输于肺，而子受母累；心复以其热移之于肺，而金受火刑。金者，生水而出高源
者也。饮入胃中，游溢精气而上。则肺通调水道而下，今火热入之，高源之水为炎威所逼，合外饮之水建
瓴而下，饮一溲二，不但不能消外水，且并素酝水精竭绝而尽输于下，较大腑之暴注暴泄，尤为甚矣，故
死不治也。所谓由心之肺，谓之死阴，死阴之属，不过三日而死者，此之谓也。
至于胃以其热由关门下传于肾，又或以石药耗其真，女欲竭其精，阳强于外，阴不内守，而小溲混浊如
膏，饮一溲一，肾消之症成矣。夫惑女色以丧志，精泄无度，以致水液混浊，反从火化，亦最危候。经云∶
君火之下，阴精承之。故阴精有余，足以上承心火，则其人寿；精不足，心火直下肾中，阳精所降，其人夭。
故肾者胃之关也。关门不开，则水无输泄而为肿满；关门不闭，则水无底止而为消渴。消渴属肾一症，其曰饮
一斗溲一斗者，肾气丸主之。于以蒸动精水，上承君火，而止其下入之阳光，可谓其通天手眼。
戴人以承气治壮火，然施之消渴，又无其事。故下消之火，水中之火也，下之则愈燔；中消之火，竭
泽之火也，下之则愈伤；上消之火，燎原之火也，水从天降可灭，徒攻肠
胃，无益反损。夫地气上而为云，然后天气下为雨，是故雨出地气，地气不上，天能雨乎？故亟升地气，
以慰三农；亟升肾气，以溉三焦，皆事理之必然者乎。
《金匮》云∶寸口脉浮而迟，浮即为虚，迟即为劳。虚则卫气不足，劳则荣气竭。趺阳脉浮而数，浮
则为气，数则消谷而大坚，气盛则溲数，溲数则坚，坚数相搏，即为消渴。举寸口以候胸中之气，举趺阳以
候胃中之气。盖阴在内为阳之守，阳在外为阴之固。寸口脉浮，阴不内守，故卫外之阳浮，即为虚也；寸口
脉迟，阳不外固，故内守之阴迟，即为劳也。总因荣伤荣卫，致寸口脉虚而迟也。然荣者水谷之精，卫者
水谷之悍气，虚而且迟，水谷之气不上充而内郁，已见膈虚胃热之一斑矣。更参以趺阳脉之浮数，浮则为气，
即《内经》热气熏胸中之变文；数则谷消而大坚，是胃中坚燥不受水之润浸，转从火热之势，急奔膀胱，故溲
数，溲去其内愈燥。所以坚数相搏，即为消渴。
直引《内经》味过于苦，反从火化，脾气不濡，胃气乃浓之意，为消渴之源，精矣微矣。
洁古云∶能食而渴者，白虎加人参汤；不食而渴者，钱氏白术散加葛根。末传疮疽者，火邪盛也，急攻
其阳，无攻其阴。下焦元气，得强者生，失强者死。此皆虑泉竭之徽言。
然火之在阳在阴，分何脏腑，合何脏腑，宜升宜降，宜抑宜伏，各各不同，从其性而治之，使不相扦
格，乃为良法。若不治其火，但治其热，火无所归，热宁有止耶？如肾消，阴病用六味，阳病用八味，此亦
一法。若谓下消只此一法，其在中消宜下之说，能以寸哉？
瘅成为消中，胃热极深，胃火极炽，以故能食、易饥、多渴。诸家咸谓宜大承气下之，不知积渐之热，
素蕴之火，无
取急下。下之亦不去，徒损肠胃，转增其困耳。即当用大黄，当久蒸以和其性，更不可用枳、朴助其
疾趋之势。大黄与甘草合用，则缓急互用；与人参合用，则攻补兼施，如充国之屯田乃可耳。
张景岳曰∶消症有阴阳，不可不察。如多渴者曰消渴，善饥者曰消谷，小便淋浊如膏曰肾消，凡此者
多由于火，火盛则阴虚，是皆阳消之症也。
至于阴消之义，则未有知之者。凡阴阳血气之属，日见消败者，皆谓之消，此不可尽以火为言。如
气厥论曰∶心移寒于肺为肺消，饮一溲二，死不治。此正以元气之衰，而金寒水冷，故水不化气，而气悉
化水，讵非阳虚之症也。又如邪气脏腑病形篇曰∶五脏之脉细小者，皆为消瘅。岂以微小之脉，而为有余之阳
症也。此《内经》阴消之义显然，而人多未察也。
故古人虽以上焦属肺，中焦属胃，下焦属肾，皆从火治，而不知三焦之火，多有病本乎肾，而无不由乎
命门者。夫命门为水火之腑，已水亏而为消渴者，以水不济火，则火不归源，故有火游于肺而为上消者，
火游于胃而为中消者，火铄阴精而为下消者。是皆真阴不足，而水亏于下消症也。
若火亏而消铄者，以阳不化气，则水精不布，水不得火，则有降无升，所以直入膀胱，而饮一溲二，
以致泉源不滋，天壤枯涸，是皆真阳不足，火亏于下之消症也。阴虚之消，治宜壮水矣。若阳虚之消，
谓宜补火，人必不信，不知釜底加薪，槁禾得雨，彻顶归巅，所必然耳。
刘宗浓说：三消病症，总归是由燥热损伤阴液所致。然而，有的因为饮食不节制，导致肠胃干涸，气机和津液不能宣通平和；有的因为耗散扰乱精神，行为过度违背常度；有的因为大病之后，阴气受损而血液衰少虚弱，阳气亢悍而燥热更加严重；有的因为长期嗜好咸味食物，放纵食用烧烤油炸之物，饮食过量。也有服用金石类丸药散剂，日久积累实热结聚在下焦，肾中燥热极甚，所以口渴却不欲饮水。
如果喝水多且小便也多，名叫消渴。如果进食多但口渴不明显，小便频数且身体消瘦，名叫消中。如果口渴且饮水不止，腿部消瘦，且小便中有脂液状物质，名叫肾消。这三种消症，其燥热的病机是相同的。
肾水属于阴而本性寒，虚损时则表现为热；心火属于阳而本性热，虚损时则表现为寒。如果肾水阴虚，则心火阳实，水虚不能制约火，阳实之热燥灼津液，因此燥热太甚，导致三焦和肠胃的腠理郁结阻滞，致密壅塞，使得水液不能渗透排泄、浸润灌注于体外以滋养全身百骸。所以肠胃之外燥热太甚，虽然大量饮水进入肠胃之内，最终也不能浸润于体表，导致口渴不止且小便增多。水液既然不能渗透浸润于外，则阴液更加干燥枯竭，无法自我滋养，所以时间久了多会转变为聋、盲、疮疡、痤痱等病症而危及生命。
所以治疗这种疾病，要补肾水中真阴的虚损，清泄心火中阳热的实证，去除肠胃中过盛的燥热，救济全身津液的衰少，使经络道路疏散而不结滞，津液生成而不枯槁，气血流通而不涩滞，那么病就会日渐痊愈。如果日常只用苦寒药物，反而随火势化热，不危险还等待什么呢？
喻嘉言说：消渴的病患，常常开始于轻微而成形于显著，起始于胃而极至于肺肾。开始时就像用水浇在烧红的焦炭上，水倒进去还能被蒸发掉；后来就像用水投掷石头，水流走而石头依然如故。到了饮一斗尿两斗的地步，则是燥火动摇了真阴，病情已成危重之势了。
《内经》说：凡是治疗消瘅、仆击、偏枯、痿证、厥证、气满发逆，这些都是富贵之人膏粱厚味的疾病。这就是中消产生的由来。既然已经形成消中，随着火热炽盛的区域，或向上或向下，依次传变。
上消，是胃中的热向上输送给肺，子脏受母脏牵连；心火又将热移交给肺，金（肺）受到火（心）的刑克。金生水，肺为水之上源。水饮入胃，游溢精气而上输至肺，肺通调水道而下输。现在火热侵入，高源之水被炎威逼迫，加上外饮之水顺流而下，饮一斗尿两斗，不仅不能消化外来之水，而且连体内原本酝酿的水精也枯竭殆尽并全部下输膀胱，比大肠的暴注下泄还要严重，所以死亡且不可治愈。所谓由心传肺，叫做死阴，属于死阴的病症，不过三天就会死亡的，说的就是这种情况。
至于胃中的热通过关门下传给肾，或者因为服用石药耗伤真阴，房事过度耗尽精气，阳气强盛于外，阴精不能内守，导致小便混浊如膏脂，饮一斗尿一斗，肾消的病症就形成了。沉迷女色丧失志气，精液泄无度，导致水液混浊，反从火化，这也是最危险的征候。《内经》说：君火之下，有阴精承托。所以阴精有余，足以向上承托心火，人就能长寿；精不足，心火直下肾中，阳精下降，人就会夭折。所以说肾是胃的关口。关门不开，则水液没有输泄途径而形成肿满；关门不闭，则水液没有底止而形成消渴。消渴属于肾的一个病症，那种饮一斗溲一斗的情况，用肾气丸主治。借此蒸动精水，上承君火，制止阳光（相火）的下陷，可以说是贯通天地的手眼。
戴人用承气汤治疗壮火，然而施用于消渴，又没有这种事。所以下消之火，是水中之火，攻下则火势更旺；中消之火，是竭泽之火，攻下则伤害更重；上消之火，是燎原之火，水从天降可以扑灭，单纯攻伐肠胃，无益反而有害。地气上升成为云，然后天气下降成为雨，所以雨出自地气，地气不上升，天能下雨吗？所以亟需升发地气，以慰农事；亟需升发肾气，以灌溉三焦，都是事理必然的。
《金匮要略》说：寸口脉浮而迟，浮即为虚，迟即为劳。虚则卫气不足，劳则营气竭绝。趺阳脉浮而数，浮则为气盛，数则消谷善饥且大便坚硬，气盛则小便频数，小便频数则大便坚硬，坚与数相互搏结，即为消渴。举寸口脉以候察胸中之气，举趺阳脉以候察胃中之气。大概阴在内为阳的守卫，阳在外为阴的固护。寸口脉浮，阴不内守，所以卫外的阳浮越，即为虚；寸口脉迟，阳不外固，所以内守的阴迟滞，即为劳。总因营卫受伤，导致寸口脉虚而迟。然而营是水谷的精微，卫是水谷的悍气，既虚且迟，水谷之气不能上充而内郁，已经显露出膈虚胃热的一斑了。再参合趺阳脉的浮数，浮则为气盛，即《内经》中热气熏蒸胸中的变文；数则谷消而大便坚硬，这是胃中坚燥不受水之润浸，转而跟随火热之势，急奔膀胱，所以小便频数，小便去则内部更加干燥。所以坚与数相互搏结，即为消渴。
直接引用《内经》“味过于苦，反从火化，脾气不濡，胃气乃浓”的意思，作为消渴的源头，真是精妙入微。
洁古说：能食而口渴的，用白虎加人参汤；不能食而口渴的，用钱氏白术散加葛根。末期传变为疮疽的，是火邪旺盛，急攻其阳，不要攻其阴。下焦元气，得强健则生，失强健则死。这都是忧虑泉源枯竭的深刻言论。
然而火在阳分还是在阴分，涉及何脏腑，配合何脏腑，宜升宜降，宜抑宜伏，各不相同，顺应其性而治疗，使其不相抵触，才是良法。如果不治火，只治热，火无所归依，热怎会有停止的时候呢？比如肾消，阴病用六味地黄丸，阳病用八味丸，这也是一种方法。如果说下消只有这一种方法，那对于中消宜下的说法，又能怎么评价呢？
瘅热形成消中，胃热极深，胃火极炽，所以能食、易饥、多渴。各家都说宜用大承气汤攻下，不知道这种积渐而成的热，素来蕴蓄的火，不需要急下。攻下也不去病，徒然损伤肠胃，反而增加困顿罢了。即使当用大黄，应当久蒸以缓和其药性，更不可用枳实、厚朴助长其疾趋之势。大黄与甘草合用，则缓急互用；与人参合用，则攻补兼施，像赵充国屯田那样稳重才可。
张景岳说：消症有阴阳之分，不可不考察。比如多渴的叫消渴，善饥的叫消谷，小便淋浊如膏的叫肾消，凡这些大多由于火，火盛则阴虚，这些都是阳消的病症。
至于阴消的含义，没有人知道。凡是阴阳血气之类，日渐消败的，都叫消，这不能完全用火来解释。比如《气厥论》说：心移寒于肺为肺消，饮一溲二，死不治。这正是由于元气衰败，金寒水冷，所以水不化气，而气悉化为水，难道不是阳虚的病症吗？又如《邪气脏腑病形篇》说：五脏的脉象细小的，都为消瘅。难道微小之脉，是有余的阳症吗？这是《内经》中阴消的意义明显存在，而人们大多没有察觉。
所以古人虽然以上焦属肺，中焦属胃，下焦属肾，都从火治疗，却不知道三焦之火，多有病本源于肾，而无不由命门产生的。命门是水火之腑，已经水亏而为消渴的，是因为水不济火，则火不归源，所以有火游于肺而为上消者，火游于胃而为中消者，火铄烁阴精而为下消者。这都是真阴不足，而水亏于下的消症。
如果是火亏而消铄的，是因为阳不化气，则水精不布散，水不得火，则有降无升，所以直入膀胱，而饮一溲二，以致泉源不滋润，天地枯涸，这都是真阳不足，火亏于下的消症。阴虚的消，治疗宜壮水。如果阳虚的消，说是宜补火，人们一定不信，不知道釜底加薪，枯禾得雨，彻顶归巅，是必然的道理。
Liu Zongnong stated: The three Xiao (Wasting and Thirsting) syndromes are generally caused by dryness-heat damaging Yin fluids. However, some cases arise from irregular diet, leading to dryness of the stomach and intestines, where Qi and body fluids cannot circulate smoothly; or from mental exhaustion and overexertion violating natural limits; or following severe illness where Yin Qi is damaged and blood becomes deficient, while Yang Qi becomes hyperactive and dryness-heat intensifies; or from long-term preference for salty foods and indulgence in fried or roasted items, coupled with overeating. There are also cases resulting from long-term use of mineral pills and powders, causing accumulated excess heat to knot in the Lower Jiao, with extreme dryness in the Kidney, thus causing thirst without desire to drink.
If one drinks much water yet urinates much, it is named Xiao Ke (Wasting and Thirsting). If one eats much but is not very thirsty, urinates frequently, and emaciates, it is named Xiao Zhong (Middle Wasting). If one is thirsty and drinks incessantly, legs emaciate, and urine contains fatty substances, it is named Shen Xiao (Kidney Wasting). These three Xiao syndromes share the same pathogenesis of dryness-heat.
Kidney Water belongs to Yin and is fundamentally cold; when deficient, it manifests as heat. Heart Fire belongs to Yang and is fundamentally hot; when deficient, it manifests as cold. If Kidney Water is Yin-deficient, then Heart Fire is Yang-excess. Deficient Water cannot control Fire, and Excess Yang-heat dries up body fluids. Thus, dryness-heat becomes excessive, causing obstruction and stagnation in the collaterals of the San Jiao (Triple Burner) and stomach/intestines. This dense blockage prevents body fluids from permeating, excreting, and irrigating the exterior to nourish the hundred bones. Consequently, although large amounts of water enter the stomach and intestines, they cannot moisten the exterior, leading to unceasing thirst and polyuria. Since body fluids cannot irrigate the exterior, Yin becomes increasingly dry and exhausted, unable to self-nourish. Over time, this often transforms into deafness, blindness, sores, ulcers, acne, and miliaria, becoming critical.
Therefore, treating these diseases requires tonifying the deficiency of True Yin in Kidney Water, draining the excess Yang-heat of Heart Fire, removing excessive dryness-heat from the stomach and intestines, and assisting the decline of whole-body Jin Ye (body fluids). This ensures pathways are dispersed rather than knotted, Jin Ye is generated rather than dried up, and Qi and Blood flow freely rather than stagnate, allowing the disease to heal daily. If one merely uses bitter-cold herbs daily, the condition may transform according to fire, leading to danger.
Yu Jiayan stated: The affliction of Xiao Ke often begins subtly and becomes manifest, starting in the Stomach and reaching its extreme in the Lungs and Kidneys. Initially, it is like pouring water on red-hot charcoal; the water enters and evaporates. Later, it is like throwing water on stone; the water flows away while the stone remains unchanged. When it reaches the stage of drinking one dou and urinating two dou, dryness-fire has disturbed True Yin, and the condition becomes critical.
The Classics state: In treating Xiao Dan (Feverish Wasting), Pu Ji (Sudden Collapse), Pian Gu (Hemiplegia), Wei Zheng (Flaccidity Syndromes), Jue Zheng (Cold/Heat Extremities), and Qi Man Fa Ni (Qi Fullness and Reversal), these are diseases of rich and noble people due to rich and sweet diets. This is the origin of Middle Xiao. Once Xiao Zhong forms, depending on whether the heat moves upward or downward, it transmits sequentially to areas where fire-heat is blazing.
In Upper Xiao, heat from the Stomach transmits upward to the Lung, affecting the "child" via the "mother." Heart Fire transfers heat to the Lung, subjecting Metal (Lung) to the punishment of Fire (Heart). Metal generates Water, and the Lung is the upper source of water. Water drunk enters the Stomach, yields essence, and ascends to the Lung. The Lung regulates water passages and descends them. Now, with fire-heat invading, the water at the high source is forced down by intense heat, combined with external drinking water flowing down like a landslide. Drinking one dou and urinating two dou means not only failing to utilize external water but also exhausting internal essence, which all drains downward. This is worse than sudden diarrhea from the Large Intestine, hence fatal and untreatable. This transmission from Heart to Lung is called "Dead Yin"; conditions belonging to Dead Yin result in death within three days.
Regarding Lower Xiao, heat from the Stomach transmits downward through the "gate" to the Kidney, or mineral drugs deplete True Yin, sexual excess exhausts Jing (Essence), Yang is strong externally, and Yin fails to hold internally. Urine becomes turbid like paste. Drinking one dou and urinating one dou constitutes Shen Xiao. Indulging in lust loses willpower; excessive ejaculation causes fluid turbidity, transforming into fire. This is a critical sign. The Classics say: Below Jun Fire (Ministerial Fire), Yin Essence supports it. If Yin Essence is sufficient, it supports Heart Fire upward, ensuring longevity. If Essence is insufficient, Heart Fire descends directly into the Kidney, and Yang Essence drops, leading to premature death. Thus, the Kidney is the gate of the Stomach. If the gate does not open, water accumulates causing edema; if it does not close, water flows endlessly causing Xiao Ke. For Xiao Ke characterized by drinking one dou and urinating one dou, Sheng Di Huang Wan (Rehmannia Pill) is indicated. It steams and activates Jing Water, supporting Jun Fire upward, stopping the downward flow of sunlight (Ministerial Fire), demonstrating profound therapeutic insight.
Dai Han used Cheng Qi Tang (Order the Qi Decoction) to treat vigorous fire, but applying it to Xiao Ke is inappropriate. The fire in Lower Xiao is fire within water; purging makes it burn brighter. The fire in Middle Xiao is fire in a drained pond; purging causes more injury. The fire in Upper Xiao is prairie fire; rain from heaven can extinguish it, but attacking the intestines and stomach alone is harmful. Earth Qi rises to form clouds, then Heaven Qi falls as rain. Rain comes from Earth Qi; if Earth Qi does not rise, can Heaven rain? Therefore, urgently raising Earth Qi comforts agriculture; urgently raising Kidney Qi irrigates the San Jiao. This is logical necessity.
Jin Gui Yao Lue states: Cun Kou pulse floating and slow; floating indicates deficiency, slow indicates labor/exhaustion. Deficiency means Wei Qi (Defensive Qi) is insufficient; exhaustion means Ying Qi (Nutritive Qi) is depleted. Fu Yang pulse floating and rapid; floating indicates Qi abundance, rapid indicates digestion of food and hard stool. Abundant Qi leads to frequent urination; frequent urination leads to hard stool. Hardness and rapidity clashing constitute Xiao Ke. Cun Kou pulse examines Qi in the chest; Fu Yang pulse examines Qi in the Stomach. Yin inside guards Yang; Yang outside secures Yin. Cun Kou floating means Yin does not guard internally, so Defensive Yang floats externally, indicating deficiency. Cun Kou slow means Yang does not secure externally, so Internal Yin is sluggish, indicating exhaustion. Generally, Ying and Wei are injured, causing Cun Kou to be deficient and slow. Ying is the essence of grain and water; Wei is the fierce Qi of grain and water. Deficient and slow, grain-water Qi does not ascend but stagnates internally, revealing patterns of diaphragm deficiency and Stomach heat. Combined with Fu Yang floating and rapid: floating indicates Qi abundance (heat steaming the chest); rapid indicates food digestion and hard stool. This shows Stomach dryness resisting moisture, following fire-heat rushing to the Bladder, causing polyuria, which further dries the interior. Thus, hardness and rapidity clash, constituting Xiao Ke.
Directly quoting Nei Jing: "Taste excessively bitter, transforms into fire; Spleen Qi becomes damp-less, Stomach Qi becomes thick." This is the source of Xiao Ke, exquisite and subtle.
Jie Gu said: Those who eat well but are thirsty should use Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction); those who do not eat but are thirsty should use Qian Shi Bai Zhu San (Child Master's Atractylodes Powder) plus Ge Gen (Kudzu Root). If late-stage sores and carbuncles appear, fire-pathogens are abundant; urgently attack Yang, do not attack Yin. If Lower Jiao Yuan Qi is strong, life is preserved; if weak, death ensues. These are profound words warning against spring depletion.
However, whether fire is in Yang or Yin, which Zang-Fu organs are involved, and whether treatment should ascending, descending, suppressing, or subduing, varies greatly. Treating according to nature without conflict is the good method. If one treats heat but not fire, fire has no return, and how can heat stop? For example, in Shen Xiao, use Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) for Yin pathology and Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) for Yang pathology. This is one method. But if one claims this is the only method for Lower Xiao, how can one evaluate the theory that Middle Xiao requires purging?
Dan re transforming into Xiao Zhong involves deep Stomach heat and blazing Stomach fire, causing hunger, easy satiation, and thirst. Many experts suggest Da Cheng Qi Tang (Major Order the Qi Decoction) for purging. They do not realize that gradually accumulated heat and previously stored fire do not require urgent purging. Purging will not remove it, only damaging the intestines and stomach, increasing distress. Even if Da Huang (Rhubarb) is used, it should be steamed long to moderate its nature; Zhi Shi (Immature Bitter Orange) and Hou Po (Magnolia Bark) should be avoided to prevent accelerating movement. Da Huang combined with Gan Cao (Licorice) balances speed and slowness; combined with Ren Shen (Ginseng), it combines purging and tonifying, like Zhao Chongguo's屯田 (tuntian/military farming) strategy—steady and effective.
Zhang Jingyue stated: Xiao syndromes have Yin and Yang aspects, which must be examined. Thirst is Xiao Ke; hunger is Xiao Gu; turbid urine like paste is Shen Xiao. These mostly stem from fire; fire excess leads to Yin deficiency, constituting Yang Xiao syndromes.
As for Yin Xiao, few know its meaning. Anything involving Yin, Yang, Blood, or Qi that gradually declines is called Xiao; this cannot be entirely attributed to fire. Qi Jue Lun states: "Heart transferring cold to Lung creates Lung Xiao; drinking one dou and urinating two dou is fatal and untreatable." This is due to Yuan Qi decline, Cold Metal and Cold Water, where Water does not transform into Qi, and Qi transforms into Water. Is this not a Yang deficiency syndrome? Xie Qi Zang Fu Bing Xing Pian states: "Small and fine pulses in the five Zang organs indicate Xiao Dan." Does a minute pulse indicate an Excess Yang syndrome? This is the clear meaning of Yin Xiao in Nei Jing, yet many fail to observe it.
Thus, ancients associated Upper Jiao with Lung, Middle Jiao with Stomach, and Lower Jiao with Kidney, treating all from fire. They did not know that fire in the San Jiao often originates in the Kidney and invariably stems from Ming Men (Gate of Life). Ming Men is the palace of Water and Fire. When Water is deficient causing Xiao Ke, Water fails to balance Fire, so Fire does not return to its source. Fire wandering in the Lung causes Upper Xiao; Fire wandering in the Stomach causes Middle Xiao; Fire scorching Yin Essence causes Lower Xiao. All these are True Yin insufficiency and Water deficiency in the Lower Jiao.
If Fire is deficient and scorching occurs, it is because Yang fails to transform Qi, so Water Essence does not distribute. Without Fire, Water has descent but no ascent, entering the Bladder directly, causing drinking one dou and urinating two dou. This dries up the spring source and desiccates the earth. These are True Yang insufficiency and Fire deficiency in the Lower Jiao. For Yin deficiency Xiao, treatment should strengthen Water. For Yang deficiency Xiao, claiming treatment should tonify Fire, people will not believe it. Yet, adding fire to the bottom of the pot and rain to withered crops are inevitable truths.