消渴，养肺、降火、生血为主，分上中下治。三消皆禁用半夏；血虚亦忌用；口
干咽痛，肠燥大便难者，亦不宜用；汗多者不可用。不已，必用姜监制。消渴，若泄泻，
用白术、白芍药炒为末，调服后，却服前药（即诸汁膏）。内伤病退后，燥渴不解，此
热在肺经，可用参、芩、甘草少许，生姜汁调，冷服。或以茶匙挑姜汁与之。虚者可用人
汤。天花粉，消渴神药也。上消者，肺也，多饮水而少食，大小便如常；中消者，胃也，
多饮水而小便赤黄；下消者，肾也，小便浊淋如膏之状，面黑而瘦。
入方
黄连末 天花粉末 人乳汁（又云牛乳） 藕汁 生地黄汁
上后二味汁为膏，入前三味搜和，佐以姜汁和蜜为膏。徐徐留舌上，以白汤少许送下。
能食者，加软石膏、栝蒌根。
〔附录〕水包天地，前辈尝有是说矣。然则中天地而为人，水亦可以包润五脏乎？曰∶天
一生水，肾实主之，膀胱为津液之府，所以宣行肾水，上润于肺，故识者肺为津液之脏。自
而下，三焦脏腑，皆囿乎天一真水之中。《素问》以水之本在肾、末在肺者，此也。真水不
有所谓渴哉！人惟淫欲恣情，酒面无节，酷嗜炙爆糟藏咸酸酢醢甘肥腥膻之属，复以丹砂玉
石济其私，于是炎火上熏，脏腑生热，燥炽盛津液干，焦渴饮水浆而不能自禁。其热气
腾，心虚受之，心火散漫，不能收敛，胸中烦躁，舌赤唇红，此渴引饮常多，小便数而少，病属上
焦，谓之“消渴”；热蓄于中，脾虚受之，伏阳蒸胃，消谷善饥，饮食倍常，不生肌肉，此
不甚烦，但欲饮冷，小便数而甜，病属中焦，谓之“消中”；热伏于下，肾虚受之，腿膝
，骨节酸疼，精走髓空，引水自救，此渴水饮不多，随即溺下，小便多而浊，病属下焦，谓
之“消肾”。又若强中消渴，其毙可立待也。治法总要，当以白术散养脾，自生津液，兼
米煮粥，以膂肉碎细煮服以养肾，则水有所司。又用净黄连湿锉，入雄猪肚中，密扎于
斗米上蒸烂，添些蒸饮，臼中杵，粘丸如桐子。服一百
，食后米饮下，可以清心止渴。东垣曰∶膈消者，以白虎加人参汤治之；中消者，以调胃
承气汤、三黄丸治之；下消者，以六味地黄丸治之。
附方
茯菟丸 治三消渴通用，亦治白浊。
菟丝子（酒浸，十两） 北五味子（七两） 白茯苓（五两） 石莲肉（三两）
上为末，用山药六两为末，作糊和丸梧子大。每服五十丸，米汤下。
麦门冬饮子 治膈消胸满烦心，津液干少，短气而渴。
知母 甘草（炙） 栝蒌 五味子 人参 葛根 生地黄 茯神 麦门冬（去心，各等分）
上 咀。水煎，入竹叶十四片。
加味钱氏白术散 治消渴不能食。
人参 白术 白茯苓 甘草（炙） 枳壳（炒，各半钱） 藿香（一钱） 干葛（二钱） 木香 五味
柴胡（三分）
上作一服，水煎服。
地黄饮子 治消渴咽干，面赤烦躁。
甘草（炙） 人参 生地黄 熟地黄 黄 天门冬 麦门冬（去心） 泽泻 石斛 枇杷
上每服五钱，水煎服。
加减八味丸 治肾虚消渴引饮。
本方内减附子，加五味子。《要略》治男子消渴，小便反多者，仍用本方。方见补损。
清心莲子饮 治渴而小便浊或涩。
黄芩 麦门冬 地骨皮 车前子 甘草（各三钱） 莲子 茯苓 黄 柴胡 人参（各三钱
上 咀。水煎服。
川黄连丸 治渴。
川黄连（五两） 天花粉 麦门冬（去心，各二钱半）
上为末，生地黄汁并牛乳夹和，捣丸梧子大。服三十丸，粳米汤送下。
玉泉丸 治烦渴口干。
麦门冬（去心） 人参 茯苓 黄 （半生半蜜炙） 乌梅（焙） 甘草（各一两） 栝蒌根 干
葛（各一两半）
上为末，蜜丸弹子大。每服一丸，温汤嚼下。
白虎加人参汤 见中暑。
调胃承气汤 见痢类。
三黄丸
黄连（去须） 黄芩 大黄（煨，各等分）
上为末，炼蜜丸梧子大。每服四十丸，熟水下。
六味地黄丸 见补损。
消渴病的治疗，以养肺、降火、生血为主，并分为上、中、下三消进行辨证治疗。三消证均禁用半夏；血虚者亦忌用；伴有口干咽痛、肠燥大便困难者，也不宜使用；汗出多者不可用。若病情未愈，必须使用生姜进行炮制制约。若消渴病患者出现泄泻，可用炒白术、炒白芍药研为细末，调服之后，再服用之前的药物（即各种汁液膏方）。内伤病消退后，若燥渴症状仍未解除，说明热邪在肺经，可用少量人参、黄芩、甘草，用生姜汁调和，冷服。或者用茶匙挑取姜汁喂服。体质虚弱者可用人参汤送服。天花粉是治疗消渴的神药。
上消，病位在肺，表现为多饮水而进食少，大小便正常；中消，病位在胃，表现为多饮水且小便颜色赤黄；下消，病位在肾，表现为小便浑浊淋漓，状如脂膏，面色黑且身体消瘦。
入方：黄连末、天花粉末、人乳汁（也有说法用牛乳）、藕汁、生地黄汁。将后两种汁液熬制成膏，加入前三味药调和，佐以姜汁和蜂蜜制成膏剂。徐徐含于舌上，用少量白开水送下。若能进食者，加软石膏、栝蒌根。
〔附录〕水包罗天地，前辈曾有过这种说法。既然这样，居于天地之间的人，水也可以包润五脏吗？回答说：天一生水，肾脏实际上主宰它，膀胱是津液的府库，所以宣行肾水，向上滋润肺部，因此有见识的人认为肺是津液之脏。从上到下，三焦脏腑，都包含在天一真水之中。《素问》说水的根本在肾，末梢在肺，就是这个道理。真水充足，就没有所谓的口渴了！人如果纵欲无度，饮酒吃面没有节制，酷嗜烧烤、糟腌、咸酸、甜肥、腥膻之类食物，又用丹砂玉石来助长私欲，于是炎火上熏，脏腑生热，燥热炽盛，津液干枯，极度口渴想喝水浆而不能自我控制。热气腾腾，心虚受之，心火散漫，不能收敛，胸中烦躁，舌头红嘴唇红，这是口渴引饮常多，小便次数多而量少，病属上焦，称为“消渴”；热蓄积在中部，脾虚受之，伏阳蒸腾胃部，消化食物快容易饥饿，饮食加倍，但不长肌肉，这并不十分烦渴，只想喝冷水，小便次数多且甜，病属中焦，称为“消中”；热潜伏在下部，肾虚受之，腿膝酸软，骨节酸痛，精气流失骨髓空虚，引水自救，这种口渴喝水不多，随即尿出，小便多而浑浊，病属下焦，称为“消肾”。如果是强中消渴，死亡可以立刻等待。治法总纲，应当用白术散滋养脾气，自然生津液，兼用米煮粥，用猪脊肉切碎煮熟服用以养肾，那么水有所主管。又用净黄连湿切，放入雄猪肚中，严密扎紧，在一斗米上蒸烂，添加一些蒸出的汤汁，在臼中捣碎，粘合作丸如梧桐子大。每次服用一百丸，饭后米饮送下，可以清心止渴。李东垣说：膈消，用白虎加人参汤治疗；中消，用调胃承气汤、三黄丸治疗；下消，用六味地黄丸治疗。
附方：
茯菟丸：治疗三消渴通用，也治疗白浊。
菟丝子（酒浸，十两）、北五味子（七两）、白茯苓（五两）、石莲肉（三两）。以上研为细末，用山药六两研末，做糊调和，制成梧子大小的丸药。每次服用五十丸，米汤送下。
麦门冬饮子：治疗膈消胸满烦心，津液干少，短气而渴。
知母、甘草（炙）、栝蒌、五味子、人参、葛根、生地黄、茯神、麦门冬（去心，各等分）。以上锉碎。加水煎煮，加入竹叶十四片。
加味钱氏白术散：治疗消渴不能食。
人参、白术、白茯苓、甘草（炙）、枳壳（炒，各半钱）、藿香（一钱）、干葛（二钱）、木香、五味子、柴胡（三分）。以上为一服量，加水煎煮服用。
地黄饮子：治疗消渴咽干，面赤烦躁。
甘草（炙）、人参、生地黄、熟地黄、黄芪、天门冬、麦门冬（去心）、泽泻、石斛、枇杷叶。每次服用五钱，加水煎煮服用。
加减八味丸：治疗肾虚消渴引饮。
本方内减去附子，加五味子。《金匮要略》治疗男子消渴，小便反多者，仍用本方。方见补损篇。
清心莲子饮：治疗口渴而小便浑浊或涩滞。
黄芩、麦门冬、地骨皮、车前子、甘草（各三钱）、莲子、茯苓、黄芪、柴胡、人参（各三钱）。以上锉碎。加水煎煮服用。
川黄连丸：治疗口渴。
川黄连（五两）、天花粉、麦门冬（去心，各二钱半）。以上研为细末，用生地黄汁和牛乳夹和，捣丸如梧子大。每次服用三十丸，粳米汤送下。
玉泉丸：治疗烦渴口干。
麦门冬（去心）、人参、茯苓、黄芪（半生半蜜炙）、乌梅（焙）、甘草（各一两）、栝蒌根、干葛（各一两半）。以上研为细末，蜂蜜炼丸如弹子大。每次服用一丸，温开水嚼服。
白虎加人参汤：见中暑篇。
调胃承气汤：见痢疾类。
三黄丸：黄连（去须）、黄芩、大黄（煨，各等分）。以上研为细末，炼蜜丸如梧子大。每次服用四十丸，熟水送下。
六味地黄丸：见补损篇。
Xiao Ke (Wasting and Thirsting Syndrome) treatment is primarily based on nourishing the Lung, descending Fire, and generating Blood, differentiated into Upper, Middle, and Lower Xiao for specific management. Banxia (Pinelliae Rhizoma) is strictly contraindicated in all three Xiao types; it is also avoided in cases of Blood Deficiency; patients with dry mouth and sore throat, or dry intestines with difficult defecation, should not use it; nor should those with excessive sweating. If symptoms persist, Ginger must be used in processing to moderate its properties. If Xiao Ke is accompanied by diarrhea, Chao Baizhu (Stir-fried Atractylodis Macrocephalae Rhizoma) and Chao Baishao (Stir-fried Paeoniae Radix Alba) are ground into powder, taken mixed with water, followed by the previous remedies (i.e., various juice pastes). After the resolution of internal injury diseases, if dryness and thirst remain unresolved, indicating Heat in the Lung Meridian, small doses of Renshen (Ginseng Radix et Rhizoma), Huangqin (Scutellariae Radix), and Gancao (Licorice Root) can be used, mixed with Shengjiangzhi (Ginger Juice), and taken cold. Alternatively, Ginger Juice can be administered using a tea spoon. For deficient constitutions, Ren Tang (Ginseng Decoction) may be used. Huafen (Trichosanthis Radix) is a miraculous herb for treating Xiao Ke.
Upper Xiao involves the Lung, characterized by excessive drinking but reduced food intake, with normal urination and defecation; Middle Xiao involves the Stomach, characterized by excessive drinking and dark yellow urine; Lower Xiao involves the Kidney, characterized by turbid, dribbling urine resembling paste, dark complexion, and emaciation.
Prescription: Huanglian Mo (Coptidis Rhizoma Powder), Huafen Mo (Trichosanthis Radix Powder), Ren Ru Zhi (Human Milk Juice) [alternatively Niu Ru (Bovine Milk)], Ou Zhi (Lotus Root Juice), Sheng Dihuang Zhi (Rehmanniae Radix Recens Juice). The latter two juices are boiled down into a paste, mixed with the first three ingredients, assisted by Jiangzhi (Ginger Juice) and Honey to form a paste. Hold slowly on the tongue and swallow with a small amount of plain warm water. If the patient has an appetite, add Shigao (Gypsum Fibrosum) and Gualougen (Trichosanthis Radix).
[Appendix] Water envelops Heaven and Earth, as noted by predecessors. Does this mean that within humanity, Water can also envelop and moisten the Five Zang Organs? It is said: "Heaven generates One Water," and the Kidney truly governs it. The Bladder is the mansion of Body Fluids, thus disseminating Kidney Water upward to moisten the Lung; therefore, knowledgeable practitioners consider the Lung the organ of Body Fluids. From top to bottom, the San Jiao and Zang-Fu organs are contained within the True Water of Heaven One. As stated in *Su Wen*, the root of Water lies in the Kidney, and its branches in the Lung. When True Water is sufficient, there is no such thing as thirst! However, when people indulge in lust, drink alcohol and eat wheat products without restraint, and crave roasted, pickled, salty, sour, sweet, fatty, fishy, or mutton foods, while using Cinnabar and Jade to fuel their desires, flaming heat rises upward, causing Heat in the Zang-Fu organs. Dryness and Heat become rampant, drying up Body Fluids, leading to extreme thirst where one cannot control the desire to drink fluids. This rising heat affects the deficient Heart, causing Heart Fire to scatter and fail to consolidate, resulting in chest irritability, red tongue, and red lips. This condition, characterized by excessive drinking, frequent but scanty urination, belongs to the Upper Jiao and is called "Xiao Ke" (Wasting-Thirst); Heat accumulates in the Middle, affecting the deficient Spleen, with latent Yang steaming the Stomach, leading to rapid digestion and easy hunger, double the usual food intake but failure to gain muscle mass. This presents with mild thirst, preference for cold drinks, frequent sweet-smelling urine, belonging to the Middle Jiao, called "Xiao Zhong" (Middle Wasting); Heat lurks in the Lower, affecting the deficient Kidney, causing soreness of legs and knees, bone joint pain, loss of essence and empty marrow, seeking water to save itself. This presents with little water intake, immediate urination, frequent and turbid urine, belonging to the Lower Jiao, called "Xiao Shen" (Kidney Wasting). In cases of Qiangzhong Xiao Ke, death may follow immediately. The general principle of treatment is to use Baizhu San (Atractylodis Macrocephalae Powder) to nourish Spleen Qi, naturally generating Body Fluids, combined with rice porridge, and eating finely chopped cooked pork spine meat to nourish the Kidney, so that Water has its governor. Additionally, clean Huanglian (Coptidis Rhizoma) is wet-cut, placed inside a male pig stomach, tightly tied, and steamed over one dou of rice until soft. Add some steaming liquid, pound in a mortar, and form pills the size of Sophora seeds. Take 100 pills after meals with rice drink to clear the Heart and stop thirst. Li Dongyuan said: Ge Xiao (Diaphragm Wasting) is treated with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction); Xiao Zhong is treated with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction) and Sanhuang Wan (Three Yellows Pill); Xiao Shen is treated with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).
Attached Formulas:
Futu Wan (Cuscuta Pill): Universally treats the three Xiao types and also treats white turbidity.
Tusizi (Cuscutae Semen, soaked in wine, 10 liang), Bei Wuweizi (Schisandrae Fructus, 7 liang), Baifuling (Poria, 5 liang), Shilianrou (Nelumbinis Plumula, 3 liang). Grind into powder, use 6 liang of Shanyao (Dioscoreae Rhizoma) powder made into paste to bind into pills the size of Sophora seeds. Take 50 pills with rice soup.
Maidong Yinzi (Ophiopogon Drink): Treats Ge Xiao with chest fullness, irritability, scanty Body Fluids, shortness of breath, and thirst.
Zhimu (Anemarrhenae Rhizoma), Gancao (Licorice Root, roasted), Gualou (Trichosanthis Fructus), Wuweizi (Schisandrae Fructus), Renshen (Ginseng Radix et Rhizoma), Gegen (Puerariae Lobatae Radix), Shengdihuang (Rehmanniae Radix Recens), Fushen (Poria with Hostwood), Maidong (Ophiopogonis Radix, heart removed, equal parts). Coarsely chop. Decoct in water, add 14 leaves of Zhuye (Bambusae Folium).
Jiawei Qianshi Baizhu San (Modified Qian's Atractylodis Macrocephalae Powder): Treats Xiao Ke with inability to eat.
Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Baifuling (Poria), Gancao (Licorice Root, roasted), Zhike (Aurantii Fructus, stir-fried, half qian each), Huoxiang (Agastaches Herba, 1 qian), Gange (Puerariae Lobatae Radix, 2 qian), Muxiang (Aucklandiae Radix), Wuweizi (Schisandrae Fructus), Chaihu (Bupleuri Radix, 3 fen). Take as one dose, decoct in water and drink.
Dihuang Yinzi (Rehmannia Drink): Treats Xiao Ke with dry throat, red face, and irritability.
Gancao (Licorice Root, roasted), Renshen (Ginseng Radix et Rhizoma), Shengdihuang (Rehmanniae Radix Recens), Shudihuang (Rehmanniae Radix Preparata), Huangqi (Astragali Radix), Tiandong (Asparagi Radix), Maidong (Ophiopogonis Radix, heart removed), Zexie (Alismatis Rhizoma), Shihu (Dendrobii Caulis), Pipaye (Loquat Leaf). Take 5 qian per dose, decoct in water and drink.
Jiajian Bawei Wan (Modified Eight-Ingredient Pill): Treats Kidney Deficiency Xiao Ke with excessive drinking.
Take the base formula, remove Fuzi (Aconiti Lateralis Radix Preparata), add Wuweizi (Schisandrae Fructus). *Jingui Yaolue* treats men with Xiao Ke having excessive urination using this same formula. See Supplementing and Tonifying section.
Qingxin Lianzi Yin (Clear Heart Lotus Seed Drink): Treats thirst with turbid or obstructed urination.
Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix), Digupi (Lycii Cortex), Cheqianzi (Plantaginis Semen), Gancao (Licorice Root, 3 qian each), Lianzi (Nelumbinis Semen), Fuling (Poria), Huangqi (Astragali Radix), Chaihu (Bupleuri Radix), Renshen (Ginseng Radix et Rhizoma, 3 qian each). Coarsely chop. Decoct in water and drink.
Chuan Huanglian Wan (Sichuan Coptis Pill): Treats thirst.
Chuan Huanglian (Coptidis Rhizoma, 5 liang), Huafen (Trichosanthis Radix), Maidong (Ophiopogonis Radix, heart removed, 2.5 qian each). Grind into powder, mix with Shengdihuang Zhi (Rehmanniae Radix Recens Juice) and Niu Ru (Bovine Milk), knead into pills the size of Sophora seeds. Take 30 pills with Jingmi Tang (Rice Decoction).
Yuquan Wan (Jade Spring Pill): Treats irritability, thirst, and dry mouth.
Maidong (Ophiopogonis Radix, heart removed), Renshen (Ginseng Radix et Rhizoma), Fuling (Poria), Huangqi (Astragali Radix, half raw, half honey-roasted), Wumei (Mume Fructus, baked), Gancao (Licorice Root, 1 liang each), Gualougen (Trichosanthis Radix), Gange (Puerariae Lobatae Radix, 1.5 liang each). Grind into powder, make honey pills the size of quail eggs. Take one pill per dose, chew with warm water.
Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction): See Summerheat section.
Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction): See Dysentery category.
Sanhuang Wan (Three Yellows Pill): Huanglian (Coptidis Rhizoma, remove roots), Huangqin (Scutellariae Radix), Dahuang (Rhei Radix et Rhizoma, roasted, equal parts). Grind into powder, make honey pills the size of Sophora seeds. Take 40 pills with cooked water.
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill): See Supplementing and Tonifying section.