八卦之中，离能 物；五行之中，惟火能焚
物；六气之中，惟火能消物。故火之为用，燔木则消而为炭；焚土则消而为伏龙肝；炼金则
消而为汁； 石则消而为灰；煮水则消而为汤；煎海则消而为盐；干汞则消而为粉；熬锡则
消而为丹。故泽中之潦，涸于炎晖；鼎中之水，干于壮火。盖五脏，心为君火正化；肾为君
火对化；三焦为相火正化；胆为相火对化，得其平，则烹炼饮食，糟粕去焉；不得其平，则
燔灼脏腑，而津液竭焉。故入水之物，无物不长；入火之物，无物不消。夫一身之心火，甚
于上为膈膜之消；甚于中，则为肠胃之消；甚于下，为膏液之消；甚于外为肌肉之消。上甚
不已，则消及于肺；中甚而不已，则消及于脾；下甚而不已，则消及于肝肾；外甚而不已，则消
及于筋骨。四脏皆消尽，则心始自焚而死矣。故《素问》有消瘅、消中、消渴、风消、膈消
、肺消之说。消
之证不同，归之火则一也。
故消瘅者，众消之总名；消中者，善饥之通称；消渴者，善饮
之同谓。惟风消、膈消、肺消，此三说，不可不分。风消者，二阳之病。二阳者，阳明也。
阳明者，胃与大肠也。心受之，则血不流，故女子不月；脾受之则味不化，故男子少精，皆不能
成隐曲之事。火伏于内，久而不已，为风所鼓，消渴肠胃，其状口干，虽饮水而不咽，此风
热格拒于贲门也。口者，病之上源，故病如是。又《经》曰∶二阳结，谓之消。此消乃肠胃之消也
。其善食而瘦者，名曰食 ，此消乃肌肉之消也。膈
消者，心移热于肺，传为膈消。王太
仆云∶心肺两间中有斜膈膜，下际内连横膈膜。故心移热于肺，久久传化，内为膈热消渴而
多饮者，此虽肺金受心火之邪，然止是膈消，未及于肺也。故饮水至斗，亦不能已。其渴也，其状
多饮而数溲，或不数溲变为水肿者，皆是也。此消乃膈膜之消也。肺消者，心移寒于肺，肺
主气，《经》曰∶“饮食入胃，游溢精气，上输于脾，脾之精气，上归于肺，通调水道，下
输膀胱，水精四布，五经并行，以为常也。《灵枢》亦曰∶上焦如雾，中焦如沤，下焦如渎。
今心为阳火，先受阳邪，阳火内郁，火郁内传，肺金受制，火与寒邪，皆来乘肺，肺外为寒所搏，阳
气得施，内为火所燥，亢极水复，故皮肤索泽而辟着，溲溺积湿而频并，上饮半升，下行
十合。故曰∶饮一溲二者，死。膈消不为寒所搏，阳气得宣散于外，故可治。肺消为寒所搏
，阳气自溃于中，故不可治。此消乃消及于肺脏者也。又若脾风传之肾，名曰疝瘕。少腹冤热而
痛，出白液，名曰蛊。王太仆云∶消灼脂肉，如虫之蚀，日渐损削，此消乃膏液之消也。故
后人论三焦，指以为肾消。此犹可治，久则变 ，不救必死。此消乃消及于肾脏者也。
夫消者必渴。渴亦有三∶有甘之渴，有石之渴，有火燥之渴。肥者令人内热，甘者令人中满，其
气上溢，转为消渴。《经》又曰∶味浓者发热。《灵枢》亦曰∶咸走血，多食之人渴。咸入
于胃中，其气上走中焦，注于肺，则血气走之，血与咸相得，则凝干而善渴。血脉者，中焦之道也。
此皆肥甘之渴。夫石药之气悍，适足滋热，与热气相遇，必内伤脾，此药石之渴也。阳明司
天，四之气，嗌干引饮，此心火为寒水所郁故然；少阳司天，三之气，炎暑至，民病渴；太
阳司天，甚则渴而欲饮，水行凌火，火气郁故然。少阴之复，渴而欲饮；少阳之复，嗌络焦
槁，渴饮水浆，色变黄赤。又伤寒五日，少阴受之，故口燥舌干而渴。肾热病者，苦渴数饮
，此皆燥热之渴也。故膏粱之人，多肥甘之渴、石药之渴；藜藿奔走之人，多燥热之渴。二
者虽殊，其实一也。故火在上者，善渴；火在中者，消谷善饥；火在上中者，善渴多饮而数
溲；火在中下者，不渴而溲白液；火偏上中下者，饮多而数溲，此其别也。后人断消渴为肾
虚，水不胜火则是也。
其药则非也，何哉？以八味丸治渴，水未能生而火反助也。此等本不
知书，妄引王太仆之注“壮火之主，以制阳光。”益火之源，以消阴翳；但益心之阳，寒
热通行，强肾之阴，热之犹可。岂知王太仆之意，以寒热而行之也！肾本恶燥，又益之以火，可
乎？今代刘河间自制神芎丸，以黄芩味苦入心，牵牛、大黄驱火气而下，以滑石引入肾经。此方
以牵牛、滑石为君，以大黄、黄芩为臣，以芎、连、薄荷为使，将离入坎，真得黄庭之秘旨
也。而又以人参白术汤、消痞丸、大人参散、碧玉鸡苏散，数法以调之。故治消渴，最为得体。
昔有消渴者，日饮数升，先生以生姜自然汁一盆，置于密室中，具罂勺于其间，使其人入室，从而锁
其门，病患渴甚，不得已而饮汁尽，渴减。《内经》“辛以润之“之旨。《内经》治渴，以
兰除其陈气，亦辛平之剂也。先生之汤剂，虽用此一味，亦必有旁药助之。初虞世曰∶凡渴疾未发疮疡，
便用大黄寒药利其势，使大困大虚自胜。如发疮疡，脓血流漓而飧，此真俗言也。故巴郡太
守奏三黄丸能治消渴。余尝
以膈数年不愈者，减去朴硝，加黄连一斤，大作剂，以长流千里水煎五、七沸，放冷，日呷
之数百次，以桂苓甘露散、白虎汤、生藕节汁、淡竹沥、生地黄汁，相间服之，大作剂料，以
代饮水，不日而痊。故消渴一证，调之而不下，则小润小濡，固不能杀炎上之势；下之而不调，亦
旋饮旋消，终不能沃膈膜之干∶下之调之，而不减滋味，不戒嗜欲，不节喜怒，病已而复作
。能从此三者，消渴亦不足忧矣！
况《灵枢》又说∶心脉滑为善渴。《经》又曰∶滑者阳气
胜。又言∶五脏脉，心脉微小为消瘅。又言∶五脏脆，为消瘅。又言∶消瘅之人，薄皮肤而
目坚固以深，长冲直扬，其心刚。刚者多怒，怒则气逆上，胸中蓄积，血气逆留，
皮充肌，血脉不行，转而为热，热则消肌肤，故为消瘅。又言∶五脏皆柔弱者
，善病消瘅。夫柔弱者，必有刚强，刚强者多怒，柔弱者易伤也。余以是遂悟气逆之人，非
徒病消渴。若寒薄其外，亦为痈肿、少气、狂、膈中、肺消。涌水者，热客其脏，则亦为惊衄、膈
消、柔 ，虚肠 死；客其腑，则为癃溺血、
口麋、伏瘕、为沉、食 、辛 鼻渊、衄 瞑目。盖
此二十一证，皆在气厥论中。《经》曰∶诸逆冲上，皆属于火。一言可了，善读书者，以是求之。
在八卦之中，离卦（象征火）能够焚烧万物；在五行之中，只有火能够烧毁物体；在六气之中，只有火能够消耗物质。所以火的作用，燃烧木头则将其消耗变成炭；焚烧泥土则将其消耗变成伏龙肝（灶心土）；熔炼金属则将其消耗变成汁液；烧石头则将其消耗变成灰；煮水则将其消耗变成汤；煎海水则将其消耗变成盐；烘干汞则将其消耗变成粉；熬锡则将其消耗变成丹砂。所以沼泽中的积水，在烈日下会干涸；锅鼎中的水，在猛火下会烧干。
五脏之中，心是君火的正化（本气）；肾是君火的对化（相火寄寓之处）；三焦是相火的正化；胆是相火的对化。如果保持平衡，就能烹煮消化饮食，排出糟粕；如果不平衡，就会燔灼脏腑，导致津液枯竭。所以进入水中的物体，没有不生长的；进入火中的物体，没有不消耗的。人体中心火过盛，在上部表现为膈膜部位的消渴症；在中部表现为肠胃部位的消渴症；在下部表现为膏脂津液部位的消渴症；在外表表现为肌肉部位的消渴症。上部症状严重不止，就会波及肺脏；中部症状严重不止，就会波及脾脏；下部症状严重不止，就会波及肝肾；外表症状严重不止，就会波及筋骨。当其他四脏的阴精都被消耗殆尽时，心脏才会因自焚而死亡。所以《素问》中有消瘅、消中、消渴、风消、膈消、肺消的说法。虽然消渴证的类型不同，但归结起来都源于火。
所谓消瘅，是所有消渴病的总称；消中，是容易饥饿的通称；消渴，是多饮的同义语。只有风消、膈消、肺消这三种说法，不可不加以区分。风消，是二阳经的病证。二阳经，就是阳明经。阳明经，包括胃和大肠。如果心经受邪，血液运行不畅，所以女子月经闭止；脾经受邪，食物五味不能运化，所以男子精气减少，都不能完成房事。火潜伏在内，时间久了不停止，被风邪鼓动，消耗肠胃津液，症状是口干，虽然喝水却咽不下去，这是风热格拒于贲门（胃的上口）所致。口是病邪上源，所以病症如此。又《内经》说：“二阳结，谓之消。”这种消，是指肠胃的消渴。那些吃得多却消瘦的人，名叫“食亦”（一种以多食消瘦为特征的病），这是肌肉的消渴。
膈消，是心将热邪移传给肺，传变为膈消。王太仆说：心肺两间中有斜行的膈膜，下端向内连接横膈膜。所以心将热移传给肺，久而久之传化，内部产生膈热导致消渴多饮，这虽然是肺金受到心火邪气的侵害，但只是膈消，尚未波及肺脏本身。所以即使喝下一斗水，也不能止渴。其口渴的症状，表现为多饮且小便频数，或者小便不频数却转变为水肿的，都是这种情况。这种消，是膈膜的消渴。
肺消，是心将寒邪移传给肺。肺主气，《内经》说：“饮食进入胃，游溢精气，向上输送给脾，脾的精气，向上归聚于肺，通调水道，向下输送到膀胱，水精散布全身，五条经脉并行，这是正常的生理状态。”《灵枢》也说：上焦如雾，中焦如沤，下焦如渎。现在心为阳火，先受阳邪，阳火内郁，火郁内传，肺金受制，火与寒邪一同侵犯肺脏，肺外部被寒邪搏击，阳气得以宣散；内部被火邪燥灼，亢极之后水气来复，所以皮肤干枯润泽消失而紧贴骨骼，小便积聚湿气而频繁，上面喝半升水，下面排出十合尿。所以说：“喝一分尿出二分，是死证。”膈消不被寒邪搏击，阳气能宣散于外，所以可治。肺消被寒邪搏击，阳气从中溃败，所以不可治。这种消，是消渴波及到肺脏。
另外，如果脾的风邪传变到肾，名叫疝瘕。小腹部冤屈发热而疼痛，流出白色液体，名叫蛊。王太仆说：消灼脂肉，像虫子侵蚀一样，日渐损耗消瘦，这种消，是膏脂津液的消渴。所以后人讨论三焦时，指认为肾消。这还可以治疗，时间久了会变成痼疾，不救治必然死亡。这种消，是消渴波及到肾脏。
凡是消渴病必定口渴。口渴也有三种：有因甘味引起的渴，有因石药引起的渴，有因火燥引起的渴。肥胖的人使人内部生热，甘甜的食物使人中焦胀满，其气上溢，转变成消渴。《内经》又说：味道浓厚的食物会产生热。《灵枢》也说：咸味入血，多吃咸的人会觉得渴。咸味进入胃中，其气向上走中焦，注入肺，使血气随之运行，血与咸味相合，就会凝涩干燥而善于引起口渴。血脉是中焦运行的通道。这些都是肥甘之渴。
石药的气性猛烈，恰好足以滋生热邪，与热气相遇，必定内伤脾胃，这是药石之渴。阳明司天，四之气时段，咽喉干燥想喝水，这是因为心火被寒水所郁遏的缘故；少阳司天，三之气时段，炎热暑气到来，百姓生病口渴；太阳司天，严重时口渴想喝水，这是水行凌犯火，火气郁遏的缘故。少阴之复，口渴想喝水；少阳之复，咽喉脉络焦枯，口渴饮水浆，颜色变为黄赤。还有伤寒五日，少阴经受邪，所以口燥舌干而渴。肾热病患者，苦于口渴多次饮水，这些都是燥热之渴。所以吃精细食物的人，多有肥甘之渴、石药之渴；吃粗劣食物奔波劳碌的人，多有燥热之渴。这两者虽然不同，其实本质是一样的。所以火在上部的，善于口渴；火在中部的，消化食物快且善于饥饿；火在上中部的，善于口渴多饮且小便频数；火在中下部的，不口渴但小便流出白液；火偏于上中下的，饮水多且小便频数，这是它们的区别。后人判断消渴为肾虚，水不胜火，这是对的。
但是用药就不对了，为什么呢？用八味丸治疗口渴，水未能生成而火反而助长。这些人本来不懂医理，胡乱引用王太仆的注解：“壮火之主，以制阳光；益火之源，以消阴翳。”只是补益心的阳气，使寒热通行，强补肾的阴气，用热药还可以。哪里知道王太仆的本意，是要用寒热之法来调理呢！肾本性厌恶燥热，又用火来补益，可以吗？
当今刘河间自制神芎丸，用黄芩味苦入心，牵牛子、大黄驱赶火气下行，用滑石引入肾经。此方以牵牛子、滑石为君药，以大黄、黄芩为臣药，以川芎、黄连、薄荷为使药，将离火引入坎水，真正得到了黄庭秘旨。又用人参白术汤、消痞丸、大人参散、碧玉鸡苏散，多种方法配合调理。所以治疗消渴，最为得体。
过去有个消渴病人，每天饮水几升，先生（张从正）拿一盆生姜自然汁，放在密室中，准备好瓶勺在其中，让病人进入房间，随即锁上门。病人极度口渴，不得已喝完了姜汁，口渴减轻。这符合《内经》“辛以润之”的宗旨。《内经》治疗口渴，用兰草去除陈腐之气，也是辛平之剂。先生的汤剂，虽然只用这一味药，也一定有旁药辅助。初虞世说：凡是渴疾未发疮疡，就用大黄等寒药利导其势，使大困大虚的状态自我战胜。如果发了疮疡，脓血流漓且腹泻，这是世俗的错误言论。所以巴郡太守奏报三黄丸能治疗消渴。我曾治疗隔食数年不愈的患者，减去朴硝，加入黄连一斤，做成大剂量，用流动的千里水煎煮五到七沸，放冷，每天呷服数百次，配合桂苓甘露散、白虎汤、生藕节汁、淡竹沥、生地黄汁，交替服用，做成大剂量的药料，代替饮水，不久就痊愈了。所以消渴一证，只调理而不攻下，那么微小的滋润濡养，固然不能扑灭炎上的火势；只攻下而不调理，也是边喝边消，终究不能浇灌膈膜的干燥；既攻下又调理，但不减损滋味，不戒除嗜欲，不节制喜怒，病好了又会复发。能做到这三点，消渴也不足为忧了！
况且《灵枢》又说：心脉滑利是善于口渴。《内经》又说：滑脉是阳气胜。又说：五脏脉象，心脉微小是消瘅。又说：五脏脆弱，是消瘅。又说：消瘅的人，皮肤薄而眼睛坚固深邃，眉毛长冲直扬，心性刚强。刚强的人多怒，怒则气逆向上，胸中蓄积，血气逆留，皮肤充塞肌肉，血脉不行，转而为热，热则消耗肌肤，所以成为消瘅。又说：五脏都柔弱的人，善于患消瘅。柔弱的人，必定有刚强的一面，刚强的人多怒，柔弱的人容易受伤。我由此领悟到气逆的人，不仅仅患消渴病。如果寒邪侵袭外部，也会成为痈肿、少气、狂躁、膈中、肺消。涌水病，热邪客居内脏，也会成为惊悸衄血、膈消、柔痉、虚肠而死；客居腑，就会成为癃闭溺血、口糜、伏瘕、沉证、食痹、鼻渊、衄血、瞑目。大概这二十一种证候，都在气厥论中。《内经》说：各种逆冲向上的病证，都属于火。一句话可以概括，善于读书的人，据此去探究。
Among the Eight Trigrams, Li (Fire) can burn all things; among the Five Elements, only Fire can incinerate objects; among the Six Qi, only Fire can consume substances. Therefore, the function of Fire is such that burning wood consumes it into charcoal; firing earth consumes it into Fulonggan (Caulis Longan, specifically cauldron heart soil); smelting metal consumes it into liquid; burning stone consumes it into ash; boiling water consumes it into soup; frying seawater consumes it into salt; drying mercury consumes it into powder; refining tin consumes it into cinnabar. Thus, puddles in marshes dry up under intense sunlight; water in cauldrons dries up under strong fire. The five Zang organs: the Heart is the primary transformation of Sovereign Fire (Jun Huo); the Kidney is the counter-transformation of Sovereign Fire; the Sanjiao (Triple Burner) is the primary transformation of Ministerial Fire (Xiang Huo); the Gallbladder is the counter-transformation of Ministerial Fire. When balanced, they cook and digest food, eliminating waste; when unbalanced, they scorch the Zang-Fu organs, exhausting Body Fluids (Jin Ye). Therefore, objects entering water grow without exception; objects entering fire are consumed without exception. If Heart Fire in the body is excessive at the upper level, it manifests as Xiao Ke (Wasting-Thirst) of the diaphragm; excessive at the middle level, as Xiao Ke of the stomach and intestines; excessive at the lower level, as Xiao Ke of essence and fluids; excessive externally, as Xiao Ke of muscles. If upper excess persists, it spreads to the Lung; if middle excess persists, it spreads to the Spleen; if lower excess persists, it spreads to the Liver and Kidney; if external excess persists, it spreads to sinews and bones. When the Yin essence of the four Zang organs is exhausted, the Heart dies from self-incineration. Thus, *Su Wen* mentions Xiao Dan (Wasting-Dryness), Xiao Zhong (Wasting-Middle), Xiao Ke (Wasting-Thirst), Feng Xiao (Wind-Wasting), Ge Xiao (Diaphragm-Wasting), and Fei Xiao (Lung-Wasting). Although the manifestations of Xiao Zheng (Wasting Syndromes) differ, they all return to Fire.
Xiao Dan is the general name for all wasting syndromes; Xiao Zhong is the common term for excessive hunger; Xiao Ke is synonymous with excessive thirst. Only Feng Xiao, Ge Xiao, and Fei Xiao require distinct differentiation. Feng Xiao is a disease of the Er Yang (Two Yang) meridians. Er Yang refers to the Yang Ming (Stomach and Large Intestine) meridians. If the Heart channel is affected, blood flow stagnates, causing amenorrhea in women; if the Spleen channel is affected, flavors are not transformed, causing seminal deficiency in men, preventing sexual intercourse. Fire lurking internally, if unchecked, is fanned by Wind, consuming Stomach and Intestine fluids, presenting as dry mouth where water cannot be swallowed due to Wind-Heat blocking the贲门 (Cardia). The mouth is the source of the disease, hence such symptoms. Also, *Jing* states: "Er Yang knotting is called Xiao." This Xiao refers to intestinal wasting. Those who eat much but lose weight are named Shi Yi (Food Wasting), which is muscle wasting.
Ge Xiao occurs when Heart transfers heat to the Lung, transforming into Ge Xiao. Wang Taipu stated: Between the Heart and Lung lies an oblique diaphragm connecting inwardly to the transverse diaphragm. Thus, Heart heat transferring to the Lung creates internal diaphragmatic heat causing thirst and polydipsia. Although Lung Metal suffers from Heart Fire pathogen, it is merely Ge Xiao, not yet involving the Lung itself. Hence, drinking a dou of water does not quench thirst. Symptoms include polydipsia and polyuria, or polyuria turning into edema. This is diaphragmatic wasting.
Fei Xiao occurs when Heart transfers cold to the Lung. The Lung governs Qi. *Jing* states: "Food enters the Stomach, its essence floats up to the Spleen, Spleen essence returns to the Lung, regulating water passages, descending to the Bladder, distributing fluids, and running through the five channels—this is normal." *Ling Shu* also says: Upper Jiao is like mist, Middle Jiao like foam, Lower Jiao like a ditch. Now, the Heart is Yang Fire, first receiving Yang pathogen. Yang Fire depresses internally, transmitting to constrain Lung Metal. Fire and Cold pathogens attack the Lung. Externally, Cold combats Qi, allowing Yang to disperse; internally, Fire dries, leading to extreme亢 (hyperactivity) and subsequent Water recovery. Skin becomes dry and adheres to bones; urine accumulates dampness and is frequent; half a sheng drunk results in ten he urinated. It is said: "One part drink, two parts urine, death." Ge Xiao is not combated by Cold, so Yang disperses externally, making it treatable. Fei Xiao is combated by Cold, so Yang collapses internally, making it untreatable. This is wasting affecting the Lung organ.
Furthermore, if Spleen Wind transmits to the Kidney, it is called Shan Jia (Hernia/Mass). Lower abdominal heat and pain with white discharge is called Gu (Gu Syndrome). Wang Taipu said: Consuming fat and flesh like insect erosion, day by day emaciating, this is Gao Ye (Essence/Fluid) wasting. Later scholars identified this as Kidney Xiao. It is treatable initially, but chronic cases become incurable and fatal. This is wasting affecting the Kidney.
Wasting always involves thirst. Thirst has three types: Gan Zhi Ke (Sweet-induced thirst), Shi Zhi Ke (Stone medicine-induced thirst), and Huo Zao Zhi Ke (Fire-dryness thirst). Obesity causes internal heat; sweetness causes middle-fullness; qi overflows upward, transforming into Xiao Ke. *Jing* states: Strong flavors generate heat. *Ling Shu* states: Salty flavor enters Blood; excessive salt causes thirst. Salt enters the Stomach, ascends to Middle Jiao, pours into the Lung, moving Qi and Blood. Blood and Salt combine, causing coagulation and dryness, leading to thirst. Blood vessels are the pathways of Middle Jiao. These are Sweet/Fatty thrists. Stone medicines have fierce Qi, generating heat, injuring the Spleen/Stomach; this is Medicine-induced thirst. When Yang Ming rules the year, fourth Qi period, throat dryness and desire to drink occur because Heart Fire is depressed by Cold Water. When Shao Yang rules, third Qi period, heat causes thirst. When Tai Yang rules, severe thirst occurs due to Water overcoming Fire and Fire depression. Shaoyin reversal causes thirst; Shaoyang reversal causes scorched throat and yellow-red urine. Taiyang cold damage on the fifth day affects Shaoyin, causing dry mouth/tongue/thirst. Kidney Heat disease causes frequent drinking. These are Dryness-Heat thrists. Refined food eaters have Sweet/Fatty/Medicine thrists; coarse food laborers have Dryness-Heat thirst. Though different, their root is one. Fire above causes thirst; Fire in middle causes hunger; Fire above/middle causes thirst/polyuria; Fire middle/lower causes white discharge without thirst; Fire unevenly distributed causes polyuria. Later scholars attribute Xiao Ke to Kidney Deficiency, stating Water fails to control Fire, which is correct.
However, the treatment is wrong. Using Ba Wei Wan (Eight-Ingredient Pill) for thirst fails to generate Water while aiding Fire. These practitioners ignorantly cite Wang Taipu’s note: "Strengthen the master of Strong Fire to control Yang brilliance; benefit the source of Fire to eliminate Yin shadows." Merely benefiting Heart Yang allows cold/heat circulation; strengthening Kidney Yin with heat is acceptable. But did they know Wang Taipu intended to use Cold/Heat regulation? The Kidney dislikes dryness; adding Fire is inappropriate. Liu Hejian created Shen Xiong Wan: Huang Qin (Scutellariae Radix) bitter enters Heart; Qian Niu Zi (Pharbitidis Semen) and Da Huang (Rhei Radix et Rhizoma) drive Fire down; Hua Shi (Talcum) guides to Kidney Channel. Qian Niu Zi and Hua Shi are Jun (Emperor) herbs; Da Huang and Huang Qin are Chen (Minister) herbs; Xiong (Chuanxiong Rhizoma), Lian (Coptidis Rhizoma), Bo He (Menthae Haplocalycis Herba) are Shi (Envoy) herbs. Transferring Li (Fire) to Kan (Water) truly grasps the secret of Huang Ting. Combined with Ren Shen Bai Zhu Tang, Xiao Pi Wan, Da Ren Shen San, Bi Yu Ji Su San, this treats Xiao Ke appropriately.
A past patient drank several sheng daily. Zhang Congzheng placed ginger juice in a sealed room with bottles. The patient, locked in, drank it all due to extreme thirst, relieving symptoms. This follows *Nei Jing*: "Pungent moistens." *Nei Jing* treats thirst with Lan (Orchid) to remove stale Qi, a pungent-neutral formula. Zhang’s decoction used this single herb, likely assisted by others. Chu Yushi said: For thirst without abscess, use Da Huang to drain pathogen, letting deficiency overcome excess. If abscesses form with pus/diarrhea, it is vulgar error. Bashu Governor reported San Huang Wan treats Xiao Ke. I treated a Ge Shi (Diaphragm Obstruction) case for years by removing Po Xiao, adding Huang Lian (Coptidis Rhizoma), decocting in flowing water, cooling, and sipping hundreds of times daily, alternating with Gui Ling Gan Lu San, Bai Hu Tang, Lotus Root Juice, Bamboo Sap, and Sheng Di Huang (Rehmanniae Radix) juice. Replacing water with large doses cured him quickly. Thus, treating Xiao Ke with regulation only provides slight moisture, failing to quell rising Fire; purging only leads to immediate consumption, failing to irrigate the diaphragm; purging/regulating without diet/lifestyle changes leads to relapse. Adhering to these three principles makes Xiao Ke manageable.
*Ling Shu* states: Slippery Heart pulse indicates propensity for thirst. *Jing* states: Slippery pulse indicates Yang excess. Heart pulse micro/small indicates Xiao Dan. Fragile Zang organs indicate Xiao Dan. Xiao Dan patients have thin skin, deep firm eyes, straight long eyebrows, and rigid hearts. Rigidity leads to anger, Qi rebellion, chest accumulation, blood stasis, heat generation, and muscle wasting. Fragile Zang organs also predispose to Xiao Dan. Fragility implies underlying rigidity; rigidity causes anger; fragility invites injury. I realized Qi rebellion causes not just Xiao Ke, but also abscesses, shortness of breath, mania, Ge Zhong, Fei Xiao if Cold attacks externally. Yong Shui (Gushing Water) with Heat in Zang causes palpitations/epistaxis, Ge Xiao, Rou Spasm, intestinal failure/death; in Fu causes stranguria/hematuria, oral ulceration, Fu Jia, Chen syndrome, Shi Bi, Bi Yuan, epistaxis, blindness. These 21 syndromes are in the Qi Jue Lun chapter. *Jing* states: All rebellious upward movements belong to Fire. One word summarizes it; wise readers seek truth here.