计（四十） 能食善饥渴饮。日加瘪瘦。心境愁郁。内火自燃乃消症大病。（郁火）
生地 知母 石膏 麦冬 生甘草 生白芍
王（五八） 肌肉瘦减。善饥渴饮。此久久烦劳。壮盛不觉。体衰病发。皆内因之症。自心营肺卫之伤。渐
损及乎中下。按脉偏于左搏。营络虚热。故苦寒莫制其烈。甘补无济其虚。是中上消之病。（烦劳心营热）
犀角（三钱） 鲜生地（一两） 元参心（二钱） 鲜白沙参（二钱） 麦冬（二钱） 柿霜（一钱）
生甘草（四分） 鲜地骨皮（三钱）
又 固本加甜沙参。
杨（二八） 肝风厥阳。上冲眩晕。犯胃为消。（肝阳犯胃）
石膏 知母 阿胶 细生地 生甘草 生白芍
某 液涸消渴。是脏阴为病。但胃口不醒。生气曷振。阳明阳土。非甘凉不复。肝病治胃。是仲景
法。
人参 麦冬 粳米 佩兰叶 川斛 陈皮
胡（五七） 元阳变动为消。与河间甘露饮方。（阳动烁津） 河间甘露饮。
钱（十五） 阳动消烁。甘缓和阳生津。
生地 炙黑甘草 知母 麦冬 枣仁 生白芍
杨（二六） 渴饮频饥。溲溺混浊。此属肾消。阴精内耗。阳气上燔。舌碎绛赤。乃阴不上承。非客热宜此。
乃脏液无存。岂是平常小恙。（肾消）
熟地 萸肉 山药 茯神 牛膝 车前
某 脉左数。能食。（肾阴虚胃火旺） 六味加二冬龟版女贞旱莲川斛。
王（四五） 形瘦脉搏。渴饮善食。乃三消症也。古人谓入水无物不长。入火无物不消。河间每以益肾
水制心火。除肠胃激烈之燥。济身中津液之枯。是真治法。（肾阴虚心火亢） 玉女煎。
姜（五三） 经营无有不劳心。心阳过动。而肾阴暗耗。液枯。阳愈燔灼。凡入火之物。必消烁干枯。是能
食而肌肉消瘪。用景岳玉女煎。
三消一症。虽有上中下之分。其实不越阴亏阳亢。津涸热淫而已。考古治法。唯仲景之肾
气丸。助真火蒸化。上升津液。本事方之神效散。取水中咸寒之物。遂其性而治之。二者
可谓具通天手眼。万世准绳矣。他如易简之地黄引子。朱丹溪之消渴方。以及茯苓丸。黄
汤。生津甘露饮。皆错杂不一。毫无成法可遵。至先生则范于法。而不囿于法。如病在
中上者。膈膜之地。而成燎原之场。即用景岳之玉女煎。六味之加二冬龟甲旱莲。一以清
阳明之热。以滋少阴。一以救心肺之阴。而下顾真液。如元阳变动而为消烁者。即用河间
之甘露饮。生津清热。润燥养阴。甘缓和阳是也。至于壮水以制阳光。则有六味之补三阴。
而加车前牛膝。导引肝肾。斟酌变通。斯诚善矣。（邹滋九）
徐评 消渴之症有数种。案中俱未备。宜详考之。
【计姓患者，四十岁】食欲旺盛且容易饥饿，口渴多饮。身体日渐消瘦。心情愁闷抑郁，体内虚火自然燃烧，这是消症中的重症。（由情志郁结化火所致）
处方：生地黄、知母、石膏、麦冬、生甘草、生白芍
【王氏患者，五十八岁】肌肉消瘦减少，容易饥饿且口渴多饮。这是由于长久烦劳过度，在身体壮盛时未加察觉，待身体衰老时才发病，均属于内因引起的病症。病机从心营和肺卫受损，逐渐损伤到中焦和下焦。诊察脉象偏于左侧搏动有力，提示营络中有虚热。因此，苦寒药物不能遏制其火热之烈性，甘温补益药物也无法救济其虚弱之本质。这是中上消的病证。（因烦劳导致心营热盛）
处方：犀角（三钱）、鲜生地黄（一两）、元参心（二钱）、鲜南沙参（二钱）、麦冬（二钱）、柿霜（一钱）、生甘草（四分）、鲜地骨皮（三钱）
复诊：在固本方基础上加入甜沙参。
【杨某患者，二十八岁】肝风与厥阳之气上冲，引起眩晕。邪气犯胃导致消渴症状。（肝阳亢逆侵犯胃腑）
处方：石膏、知母、阿胶、细生地黄、生甘草、生白芍
【某患者】津液枯竭导致的消渴，是脏阴亏损的疾病。但是胃口不开，生机如何能振奋？阳明胃属阳土，非用甘凉滋润之法不能恢复。治疗肝病而兼顾胃，这是张仲景的治法。
处方：人参、麦冬、粳米、佩兰叶、川石斛、陈皮
【胡姓患者，五十七岁】元阳变动引发消渴，采用刘河间的甘露饮方。（阳气妄动灼伤津液）即河间甘露饮。
【钱姓患者，十五岁】阳气妄动导致消烁，用甘缓之法调和阳气并生津液。
处方：生地黄、炙黑甘草、知母、麦冬、枣仁、生白芍
【杨某患者，二十六岁】口渴多饮且频繁饥饿，小便浑浊。这属于肾消。阴精在内耗损，阳气在上焚烧。舌体破碎呈绛红色，这是阴液不能上承的表现，并非外感客热所致。这是脏腑津液枯竭，岂是平常的小病。（肾消）
处方：熟地黄、山茱萸、山药、茯神、牛膝、车前子
【某患者】脉象左侧数急，食欲旺盛。（肾阴虚兼胃火旺）
处方：六味地黄丸加天冬、麦冬、龟版、女贞子、旱莲草、川石斛。
【王某患者，四十五岁】形体消瘦，脉搏急促，口渴多饮且善于进食，这是三消症。古人说进入水中没有东西不生长，进入火中没有东西不消亡。刘河间常用益补肾水来制约心火，清除肠胃剧烈的燥热，救济身体中津液的枯涸，这才是真正的治法。（肾阴亏虚，心火亢盛）
处方：玉女煎。
【姜姓患者，五十三岁】操持经营无不劳心，心阳过度活动，导致肾阴暗耗。津液干枯，阳气更加焚烧灼热。凡是进入火中的物体，必然被消烁干枯，所以能吃但肌肉消瘦瘪陷。使用张景岳的玉女煎。
三消这一病症，虽然分为上、中、下三消，其实都不超出阴亏阳亢、津液枯竭热邪淫溢的范围。考察古代的治法，只有张仲景的肾气丸，通过助真火蒸腾气化，使津液上升；《本事方》中的神效散，取水中咸寒性质的药物，顺应其本性来治疗这两者可谓具有通达天地的高明眼光，是万世的准则。其他的如《易简方》的地黄引子，朱丹溪的消渴方，以及茯苓丸、黄汤、生津甘露饮等，都杂乱不一，毫无定法可遵循。至于这位先生（邹滋九），则遵循法则而不拘泥于法则。如果病在中上焦，膈膜之地成为燎原之火场，就使用张景岳的玉女煎，或六味地黄丸加天冬、麦冬、龟甲、旱莲草，一种方法是清阳明之热以滋养少阴，另一种方法是救心肺之阴而下顾真阴。如果是元阳变动导致消烁的，就使用刘河间的甘露饮，生津清热，润燥养阴，这就是甘缓和阳的方法。至于壮水以制阳光，则有六味地黄丸补三阴，再加车前子、牛膝，引导肝肾，斟酌变通，这确实是很好的方法。（邹滋九评注）
[Patient Ji, 40 years old] Excessive appetite with easy hunger and thirst for drinking. The body becomes emaciated day by day. The mind is sorrowful and depressed, internal fire burns spontaneously; this is a severe case of Xiao syndrome (Wasting-thirst syndrome). (Due to constrained fire from emotional stagnation)
Prescription: Sheng Di Huang (Rehmanniae Radix Praeparata), Zhi Mu (Anemarrhenae Rhizoma), Shi Gao (Gypsum Fibrosum), Mai Dong (Ophiopogonis Radix), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma), Sheng Bai Shao (Paeoniae Radix Alba).
[Patient Wang, 58 years old] Muscle mass decreases, prone to hunger and thirst. This results from long-term mental fatigue and overwork; unnoticed during robust health, it manifests when the body declines, all belonging to symptoms caused by internal factors. Injury starts from Xin Ying (Heart Nutrient Level) and Fei Wei (Lung Defensive Level), gradually damaging the Middle and Lower Jiao. Pulse examination shows a forceful beat on the left side, indicating deficient heat in the Ying collaterals. Therefore, bitter-cold herbs cannot control its fierce nature, and sweet-tonifying herbs cannot aid its deficiency. This is a disease of Middle and Upper Xiao. (Heart Ying heat due to mental fatigue)
Prescription: Xi Jiao (Rhinocerotis Cornu) [3 qian], Xian Sheng Di Huang (Fresh Rehmanniae Radix) [1 liang], Yuan Shen Xin (Scrophulariae Radix Heart) [2 qian], Xian Bai Sha Shen (Fresh Glehniae Radix) [2 qian], Mai Dong [2 qian], Shi Shuang (Diospyros Fruit Frost) [1 qian], Sheng Gan Cao [4 fen], Xian Di Gu Pi (Lycii Cortex) [3 qian].
Follow-up: Add Tian Sha Shen (Glehniae Radix) to the Gu Ben Tang (Solidify the Root Decoction).
[Patient Yang, 28 years old] Liver wind and Jue Yang (Jueyin Ascendant Yang) rush upward, causing dizziness. Invading the Stomach leads to Xiao. (Liver Yang invading the Stomach)
Prescription: Shi Gao, Zhi Mu, E Jiao (Colla Corii Asini), Xi Sheng Di Huang (Fine Fresh Rehmanniae Radix), Sheng Gan Cao, Sheng Bai Shao.
[Patient Mou] Fluid depletion leading to Xiao Ke (Wasting-thirst), is a disease of Zang Yin (Visceral Yin) deficiency. However, the stomach appetite is not awakened, how can the vital Qi be revitalized? Yang Ming Stomach is Yang Earth, which cannot recover without sweet-cool nourishment. Treating the Liver disease by addressing the Stomach is the method of Zhang Zhongjing.
Prescription: Ren Shen (Ginseng Radix), Mai Dong, Jing Mi (Oryza Sativa Grain), Pei Lan Ye (Eupatorii Herba), Chuan Hu (Dendrobii Caulis), Chen Pi (Citri Reticulatae Pericarpium).
[Patient Hu, 57 years old] Yuan Yang (Primal Yang) movement causes Xiao, treated with Liu Hejian's Gan Lu Yin (Sweet Dew Decoction). (Yang movement scorching fluids) i.e., Liu Hejian Gan Lu Yin.
[Patient Qian, 15 years old] Yang movement causes consumption/wasting; use sweet-mild methods to harmonize Yang and generate fluids.
Prescription: Sheng Di Huang, Zhi Hei Gan Cao (Honey-fried Black Licorice), Zhi Mu, Mai Dong, Zao Ren (Ziziphi Spinosae Semen), Sheng Bai Shao.
[Patient Yang, 26 years old] Frequent thirst and hunger, turbid urine. This belongs to Shen Xiao (Kidney Wasting-thirst). Internal consumption of Yin essence, Yang qi flares upward. The tongue is cracked, crimson and red, indicating Yin cannot ascend. This is not external pathogenic heat; it is the absence of Zang fluids. How can this be considered a minor ailment? (Shen Xiao)
Prescription: Shu Di Huang (Prepared Rehmanniae Radix), Yu Rou (Corni Fructus), Shan Yao (Dioscoreae Rhizoma), Fu Shen (Poria with Hostwood), Niu Xi (Achyranthis Bidentatae Radix), Che Qian (Plantaginis Semen).
[Patient Mou] Left pulse is rapid, excessive eating. (Kidney Yin deficiency with Stomach Fire hyperactivity)
Prescription: Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Dong Hua (Tian Dong and Mai Dong), Gui Ban (Testudinis Carapax et Plastrum), Nu Zhen Zi (Ligustri Lucidi Fructus), Han Lian Cao (Ecliptae Herba), Chuan Hu.
[Patient Wang, 45 years old] Emaciated form, rapid pulse, thirst, excessive eating. This is San Xiao (Three Wastings) syndrome. Ancients said: nothing does not grow in water; nothing does not consume in fire. Liu Hejian often used tonifying Kidney Water to control Heart Fire, eliminating intense dryness in the intestines and stomach, and replenishing the withered body fluids. This is the true treatment method. (Kidney Yin deficiency with Heart Fire hyperactivity)
Prescription: Yu Nu Jian (Jade Woman Decoction).
[Patient Jiang, 53 years old] Management and business inevitably involve mental labor. Overactive Heart Yang leads to hidden consumption of Kidney Yin. Fluids dry up, Yang burns more fiercely. Anything entering fire must be consumed and dried up; thus, one can eat but muscles become emaciated. Use Zhang Jingyue's Yu Nu Jian.
San Xiao (Three Wastings) is one syndrome. Although divided into Upper, Middle, and Lower, it essentially does not exceed Yin deficiency with Yang hyperactivity, fluid depletion, and heat excess. Examining ancient treatments, only Zhang Zhongjing's Shen Qi Wan (Kidney Qi Pill) assists True Fire to vaporize and ascend fluids; and Shen Xiao San (Miraculously Effective Powder) from *Ben Shi Fang* takes salty-cold substances from water to treat according to their nature. These two can be considered possessing heaven-and-earth penetrating insight, serving as eternal standards. Others such as Di Huang Yin Zi (Rehmannia Infusion) from *Yi Jian Fang*, Xiao Ke Fang (Wasting-Thirst Formula) by Zhu Danxi, as well as Fu Ling Wan, Huang Tang, and Sheng Jin Gan Lu Yin, are miscellaneous and inconsistent, lacking established methods to follow. As for Mr. Zou Zijiu, he adheres to principles without being bound by them. If the disease is in the Middle/Upper Jiao, where the diaphragm becomes a field of prairie fire, use Zhang Jingyue's Yu Nu Jian, or Liu Wei Di Huang Wan added with Dong Hua, Gui Jia (Turtle Shell), and Han Lian Cao. One clears Yang Ming heat to nourish Shao Yin; the other rescues Lung-Heart Yin while attending to True Fluids. If Yuan Yang movement causes consumption, use Liu Hejian's Gan Lu Yin to generate fluids, clear heat, moisten dryness, and nourish Yin; this is the method of sweet-mild harmony of Yang. To strengthen Water to control Solar flare, there is Liu Wei Di Huang Wan tonifying the Three Yin, plus Che Qian and Niu Xi to guide Liver and Kidney, with careful adjustment. This is truly excellent. (Commentary by Zou Zijiu)
Xu's Commentary: There are several types of Xiao Ke (Wasting-thirst) syndrome, none of which are fully covered in the cases; they should be examined in detail.