麻黄根，牡蛎（ 为粉），各二两，黄 （蜜炙），人参各二两、 龙骨（打碎），
地骨皮各四两，大枣七个，水六钟，煎二钟半，分六服，一日饮尽。
或治盗汗。用五偌子末，加枯矾津调，
填满脐中，以绢缚定最效。
三消病者，消渴消中消肾是也。上消主肺，中消主胃，下消主肾，故曰消渴，燥干
也。燥金又受热化而燥涩也。郁而成燥者，由风能除湿，热能耗液也。消中者，胃中蓄
热，善食而瘦，燥热郁甚、消渴多饮，小便多出，此因狂阳心火，燥其三焦，而水液不
能宣行，周身不得润泽，故瘦悴黄黑，虽消渴多饮，而水液不能浸润于肠胃之外，惟下
注而为小便多出，俗未明此，妄为下焦虚冷，误人多矣。消肾者，燥热消渴，瘦弱面
黑，小便浊淋，有脂液如膏者是也，此三者之论，与大人所犯俱同，至于小儿，则更有
大渴、热渴、疳渴三症，大渴者起于吐泻之后，盖脾胃一伤，津液虚耗，则生邪热，愈
致精华内涸，唇干舌燥而大渴也。热渴者，起于血气盛实，此是脏腑之燥热也。又有因
胃触暑毒，因热脏燥，津液不生，唇裂口干，而为热渴者，疳渴者，好餐肥腻，恣
食甘酸，骨蒸盗汗，黄瘦腹胀，口臭唇干而成疳渴，饮水最多，小便无度，然病久则发
痈疽，或变肿病，盖消渴日久，小便无度，则精气不能外输，而津液愈竭，津液竭则经
络涩，经络涩，则荣卫不行，血气凝滞，故成疳也。兼脾土虚，则肾水盛，肾水盛则反
来克土，土虚不能渗湿而生热，湿热相搏，不能传化，故发于皮肤，遍身水肿胀满也
又曰∶渴而饮不止，小便涩者，则成癖，治之之法，或补脾以生津，是补肺之母，滋肾
以壮水，是顾肺之子，治燥金之至理也。若至目胞黑肿，皮下浮青，气促如锯，喉出烟
焰，目白黄沉，唇肿白烂，肚腹膨胀而喘急，身肿满而浮紫黑斑者，并为凶候也。凡
渴家不可发汗，虽有外邪，当从轻治，以津液之源竭也。
渴而多饮为上消，肺热也。多食善饥为中消，胃热也。渴而小便数，膏浊不禁为下
消，肾热也。皆火盛而水衰也。经曰∶心移热于肺，传为膈消。又曰∶二阳结，谓之
消，（二阳者，阳明也）。手阳明大肠主津，病消则目黄口干，是津不足也。足阳明胃主
血，热则消谷善饥，是血中伏火，血不足也。未传能食者，必发脑疽痈疮，不能食
者，必传中满鼓胀，皆不治之症也。
凡血症皆不饮水，惟气症则饮水，气分渴者喜饮冷水，宜寒凉渗剂，以清其热，血
分渴者，喜饮热水，宜甘温酸剂，以滋其阴，上轻中重下危，如上中平，则不传下
矣。故肾消者，乃上消之传变，肺胃之热入肾，消烁肾脂，饮一溲二，溲如膏油，令肾
枯燥，盖肺主气，肺无病则气能管束津液精微，使之上潮咽噎，荣养筋骨血脉，其余者
为溲，肺病则津液无气管摄，而精微亦随溲下如膏油也。河间分论渴为上焦，岂中下二
消，无渴可言耶！，但明下消小便浊而有脂液，治宜养阴，以分其清浊耳，肾消小便甜
者为重，水生于甘，而死于咸，小便本咸而反甘，是生气泄，脾气下陷入肾中，为土克
水也。
上消者，舌上赤裂，大渴引饮，《逆调论》云∶心移热于肺，传为膈消者是也。以
白虎汤加人参治之，中消者，善食而瘦，自汗，大便硬，小便数。叔和云∶口干饶饮
水，多食亦饥，虚瘅成消中者是也，以调胃承气汤治之。下消者，烦燥引饮，耳叶焦
干，小便如膏，叔和云∶焦烦水易亏，此肾消也，六味丸治之。古人治三消之法如此，
然人之水火得其平，气血得其养，何消之有？其间摄养失宜，水火偏胜，津液枯槁，
以致龙雷之火上炎，熬煎既久，肠胃脂消，五脏干燥，令人四肢瘦削精神倦怠，故治消
之法，无分上下中，先治肾为急，惟六味八味，及加减八昧丸，随症而服，降其心火，
滋其肾水，则渴自止，否则燔灼脏腑，四脏皆消，心火自焚而死矣。白虎、承气，皆非
所治也。娄全善云∶肺病本于肾虚，肾虚则心寡于畏，妄行凌肺故肺病消，仲景治渴而
小便反多，用八味丸补肾救肺，后人因名肾消也。故渴者津液枯涸，干燥所使也。干燥
者，真阴亏极，虚热所致也，是以渴症下消者，名曰强中，肾水亏，心火亢也。
《经》曰∶大肠移热于胃，善食而瘦，谓之食 。东垣曰∶善食而瘦者，胃中火
伏则能食，脾虚则肌肉削矣。
《总录》谓∶不能食而渴者，未传中满，能食而渴者，必发脑疽背痈，盖不能食者，
脾之病，脾主浇灌四旁，与胃行其津液者也。脾胃既虚，则不能敷布其津液，故渴，
其间纵有能食者，亦是胃虚引谷自救，若概用寒凉泻火之药，如白虎承气之类，则内
热未除，中寒复生，能不未传鼓胀耶？惟七味白术散，人参生脉散之类，恣意多饮，复
以八味地黄丸，滋其化源，才是治法，及能食而渴发疽者，乃肥贵人膏粱之疾也。数食
甘美而肥多，故其上气转溢而为消渴，不可服膏粱芳草石药，其气剽悍，能助燥热。
《经》曰∶治之以兰，消陈积也，亦不用寒凉，其发痈疽者，何也？《经》曰∶膏粱之
变，饶生大疗，此之谓也。其肾消而亦有脑疽背痈者，盖肾主骨，脑者髓之海，背者太
阳经寒水所过之地。水涸海竭，阴火上炎，安得不发而为痈疽也。其疮甚而不溃，或赤
水者是，甚则或黑或紫，火极似水之象，乃肾水己竭不治。苦峻补其阴，能食便调神
安，无别恶症，或可救也。
消渴本乎热也，而热有内外虚实之分，若传经之热，液耗而渴，气分受病，当与寒
凉淡渗之剂，速清其热，热去而阴生矣，若胃虚亡液，阴虚而渴者，血受病也，当与甘
温酸辛之剂，滋益其阴，阴生而燥除矣。
或曰∶人有服地黄汤，而渴仍不止者何也？曰，此方土不能废其绳墨而更其道也。
盖心肺位近，宜制小其服，肾肝位远，宜制大其服，加高位中消，可以前丸缓而治之，
若下消已极，大渴大燥，须加减八味丸料一斤，内肉桂一两，水煎六七碗，恣意冰冷冻饮料
之，熟睡而渴病如失矣。处方之制，存乎人之通变耳。
或问曰∶下消无水，用六味地黄丸，可以滋少阴之肾水矣，又加附子肉桂者何？盖
因命门火衰，不能蒸腐水谷，水谷之气，不能熏蒸，上润乎肺，如釜底无薪锅盖干燥，
故渴，肺亦无所禀受，不能四布水精，并行五经而为津液矣。其所饮之水，未经火化，
直入膀胱，正谓饮一升，溺一升，饮一斗，溺一斗，试尝其味，甘而不碱可知矣，故用
附子肉桂之辛热，壮其少火，灶底加薪，枯笼蒸溽，槁禾得雨，生意维新，惟明者知
之。昔汉武帝病渴，张仲景为处此方，治下消之症，饮水一斗，小便亦一斗，用此以折
其水，使不顺趋，夫肾水下趋则消，肾水不上腾则渴，舍此安能治哉？至圣玄秘，诚良
方也。疮疽痊后，乃将痊，口渴甚者，舌黄坚硬者，及未患先渴，或心烦燥渴，小便频
数，或白浊阴痿，饮食少思，肌肤瘦消，及腿肿脚瘦，口齿生疮，服之无不效也，成无
已曰∶桂犹圭也，引导阳气，若执以使。
上消者谓心移热于肺，中消者谓内虚胃热，皆认火热为害，故或以白虎或以承气，
卒致不救。总之，是下焦命门火不归源，游于肺则为上消，游于胃即为中消，以八味肾
气丸引火归源。使火在釜底水火既济，气上熏蒸，肺受湿气而渴疾愈矣。有一等渴欲引
饮，但饮水不过一二口即厌。少顷复渴，饮亦不过如此，但不若胃渴蓄饮水无厌也，此
是中气虚寒，寒水泛上，逼其浮游之火于咽喉口舌之间，故上焦一段，欲得水救，若到
中焦，以水见水，正其所恶也，治法如面红烦燥者，理中汤送八味丸。又有一等渴欲饮
水，但饮下少顷即吐出，吐出少顷复求饮，药食毫不能下，此是阴盛格阳，肾经伤寒之
证，仲景以白通汤加人尿胆汁，热药冷探之法，一服即愈，女人多有此症。东垣又曰∶
手阳明大肠，手太阴小肠，皆属足阳明胃，大肠主津小肠主液，大肠小肠受胃之阳气，
乃能行津液于上焦，溉灌皮毛，充实腠理，若饮食不节，胃气不充，大肠小肠，无所禀
气，故津液涸竭焉。
夫君相二火得其平，则烹炼饮食，糟粕去焉，不得其平，则燔炙脏腑，津液耗焉。
盖心火甚于上。为隔膜之消，甚于中，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，中甚不已，则消及于脾，下甚不已，则消及于肾，
外甚不已，则甚及于筋骨，四脏皆消尽，则心自焚而死矣。故治消渴不减滋味，不戒嗜
欲，不节喜怒，则病难己。丹溪曰。消渴宜饮缫丝汤。能引清气上朝于口。
盖蚕与马同属午也。心也。作茧退藏之义。能抑心火而止渴也。渴家误作火
治。凉药乱投。夭人生命，必多服生脉散为佳。
《经》既云∶饮一溲二，死不治。何仲景复用肾气丸以治饮一斗溲一斗之证？盖病
尚浅，犹或可治，若瘦而过于饮，亦无及矣，方内须以五味易桂附，从四时及脉理增
减可也。此症多因酒色过度，施泄过多，以致水火不交，肾水下泄，故不宜用凉心冷剂
也，久而小便不臭，反作甜气，则生气泄矣，有浮脂溺面，此精不禁，真元竭矣，不治。
五脏六腑四肢，皆禀气于脾胃，行其津液，以濡润养之，夫消渴之病，本湿寒之阴
气极衰，燥热之阳气太盛故也，治当补肾水阴气之虚，而泻心火阳热之实，除肠胃燥热
之甚，济身中精液之衰，使道路散而不结，津液生而不枯，气血和而不涩，则病自己。
况消渴者，因饮食服饵之失宜，肠胃干涸，而气不宣平，或精神过违其度而耗乱之，或
因大病阴气损而血液衰，虚阳剽悍而燥热郁甚之所成也。若饮水多而小便，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。一皆燥热太甚，三焦肠胃之腠里，指郁结滞致密，纵复多饮于中，终
不能浸润于外，荣养百骸，故渴不止，小便多出或溲数也。时珍曰∶舌下有四窍，两窍
通心气，两窍过肾液，心气流于舌下为神水，肾液流入舌下为灵液，道家谓之金浆玉
醴，溢为醴泉，聚为华池，散为津液，降为甘露，所以灌溉脏腑，润泽肢体，是以修养
家咽津纳气，谓之清水灌灵根，人能终日不唾。则精气常留，颜色不槁。若久唾则损精
气成肺病，皮肤枯涸，故曰远唾不如近唾，近唾不如不唾。人若有病，则心肾不交，肾
水不上，故津液干而真气耗矣。《难经》曰∶肾主五液，入肝为泪，入肺为涕，入脾为
涎，入心为汗，自入为唾也。
消渴养肺降火生血为主。三消皆禁用半夏。消渴若泄泻者，用白术、白芍药之类。
内伤病后燥渴不解者，此余热在肺经也，用参芩甘草少许，生姜汁调冷服。天花粉，消
渴属热者之神药也。小儿唇红如丹，即发渴候，红甚焦黑则危。
《夷坚志》消渴杀虫方，治消渴有虫耗其精液而成者，用苦楝根取新白皮一握，切
焙入麝香少许，煎，空心服，虽困顿不妨，取下虫三四条，类蛔而色红，其渴乃止，盖
饮醇食炙，积成胃热，湿热生虫，理固有之。
麻黄根、牡蛎（制成粉末），各二两，黄耆（用蜂蜜炙烤）、人参各二两，龙骨（打碎），地骨皮各四两，大枣七枚。加水六钟，煎煮至二钟半，分六次服用，一天内饮完。
或者治疗盗汗。用五倍子研成粉末，加唾液调和，填满肚脐，用丝绸绑紧固定，效果最好。
三消病，指的是消渴、消中、消肾。上消主要责之于肺，中消主要责之于胃，下消主要责之于肾，所以称为消渴，是因为燥气干涩所致。燥金又受热化影响而变得干燥涩滞。郁结而成燥的，是因为风能除湿，热能耗伤津液。消中，是指胃中蓄积热气，食欲旺盛但身体消瘦，燥热郁结严重，口渴多饮，小便量多，这是因为心火亢盛，燥热熏灼三焦，导致水液不能正常宣发运行，周身得不到润泽，所以身体瘦弱憔悴、面色黄黑，虽然口渴多饮，但水液不能浸润肠胃之外，只能向下注泄成为小便多出，世俗之人不明白这个道理，妄断为下焦虚冷，误人很多。消肾，是指燥热导致的消渴，身体瘦弱面色黑，小便浑浊淋漓，有脂液如膏状，这三种论述，与成人所患病症相同，至于小儿，则还有大渴、热渴、疳渴三种症状。大渴，起因于吐泻之后，因为脾胃受损，津液虚耗，从而产生邪热，更加导致体内精华枯竭，嘴唇干燥舌头燥裂而大渴。热渴，起因于血气盛实，这是脏腑的燥热。又有因为胃部接触暑毒，因热脏燥热，津液不生，嘴唇开裂口干，而成为热渴的。疳渴，是因为喜好进食肥腻，恣意食用甘酸食物，出现骨蒸盗汗，面色黄瘦腹胀，口臭唇干而形成的疳渴，饮水最多，小便无节制，然而病程久了会引发痈疽，或者变成水肿病，大概因为消渴日久，小便无节制，精气不能向外输布，而津液更加枯竭，津液枯竭则经络涩滞，经络涩滞则营卫不行，血气凝滞，所以形成疳病。兼有脾土虚弱，则肾水旺盛，肾水旺盛则反过来克制脾土，土虚不能渗湿而生热，湿热相搏结，不能传化，所以发于皮肤，遍身水肿胀满。又说：口渴且饮水不止，小便涩滞的，则形成癖积，治疗的方法，或者补脾以生津，这是补肺之母（土生金），滋肾以壮水，这是顾护肺之子（金生水），是治疗燥金的至理方法。如果到了眼睑黑肿，皮下浮青，气促如拉锯声，喉出烟焰，眼白黄沉，嘴唇肿胀溃烂，肚腹膨胀而喘急，身体肿满而有浮紫黑斑的，都是凶险的征候。凡是口渴的病人不可发汗，即使有外邪，也应当从轻治疗，因为津液的源头已经枯竭了。
口渴且多饮的是上消，属于肺热。多吃且容易饥饿的是中消，属于胃热。口渴且小便频数，尿液浑浊不禁的是下消，属于肾热。这都是火盛而水衰的表现。经书说：心将热移于肺，传变为膈消。又说：二阳结聚，称为消。（二阳，指的是阳明经）。手阳明大肠主司津液，患消病则目黄口干，这是津液不足。足阳明胃主司血液，热则消化食物快且易饥，这是血中有伏火，血不足。尚未传变但能进食的，必定会发脑疽痈疮，不能进食的，必定传变为中满鼓胀，都是不治之症。
凡是血症都不饮水，只有气症才饮水。气分口渴者喜欢喝冷水，适宜用寒凉渗利之剂，以清除其热；血分口渴者喜欢喝热水，适宜用甘温酸收之剂，以滋养其阴。上轻中重下危，如果上中平调，则不会传变到下焦。所以肾消，是上消的传变，肺胃的热邪入肾，消烁肾脂，喝一杯尿排两杯，尿如膏油，使肾枯燥。大概肺主气，肺无病则气能管束津液精微，使其上潮至咽喉，荣养筋骨血脉，其余的成为小便；肺病则津液无人气管摄，而精微也随小便下泄如膏油。河间先生只讨论渴为上焦，难道中下二消没有渴可言吗？只是明确下消小便浑浊而有脂液，治疗宜养阴，以分清浊罢了。肾消小便甜的为重证，水生于甘，而死于咸，小便本应咸而反甜，这是生气泄露，脾气下陷入肾中，为土克水。
上消，舌上赤裂，大渴引饮，《逆调论》说：心移热于肺，传为膈消，就是这种情况。用白虎汤加人参治疗。中消，食欲旺盛但身体消瘦，自汗，大便干硬，小便频数。叔和说：口干饶人饮水，多吃也饿，虚劳成消中，就是用调胃承气汤治疗。下消，烦躁引饮，耳叶焦干，小便如膏，叔和说：焦烦水易亏，这是肾消，用六味丸治疗。古人治疗三消的方法如此，然而人的水火得到平衡，气血得到滋养，哪里有消渴病呢？其间调养失当，水火偏胜，津液枯槁，以致龙雷之火上炎，煎熬既久，肠胃脂消，五脏干燥，令人四肢瘦削精神倦怠，所以治疗消渴的方法，不分上下中，先治肾为急务，只有六味丸、八味丸及加减八味丸，随症状服用，降其心火，滋其肾水，则渴自然停止，否则燔灼脏腑，四脏皆消，心火自焚而死。白虎汤、承气汤，都不是适宜的治疗方剂。娄全善说：肺病本于肾虚，肾虚则心无所畏，妄行凌肺故肺病消，仲景治疗渴而小便反多，用八味丸补肾救肺，后人因此名为肾消。所以渴症是津液枯涸，由干燥所致。干燥者，是真阴亏极，虚热所致，所以渴症下消者，名为强中，是肾水亏，心火亢盛。
《内经》说：大肠移热于胃，食欲旺盛但身体消瘦，称为食消。东垣说：食欲旺盛但身体消瘦，是因为胃中火伏则能食，脾虚则肌肉削薄。
《总录》说：不能食而渴的，未传变为中满；能食而渴的，必定发脑疽背痈。大概不能食者，是脾的病，脾主浇灌四旁，与胃共同运行津液。脾胃既虚，则不能敷布其津液，所以渴。其间纵有能食的，也是胃虚引谷自救，如果一概用寒凉泻火之药，如白虎承气之类，则内热未除，中寒复生，能不传变为鼓胀吗？只有七味白术散、人参生脉散之类，恣意多饮，再服八味地黄丸，滋养其化源，才是治疗方法。以及能食而渴发疽者，是富贵人家膏粱厚味的疾病。多次食用甘美而肥腻的食物，所以上气转溢而为消渴，不可服用膏粱芳草石药，其气剽悍，能助燥热。《内经》说：治疗用兰草，消除陈积，也不用寒凉药，为什么发痈疽呢？《内经》说：膏粱之变，饶生大疔，说的就是这个道理。其肾消而也有脑疽背痈的，大概肾主骨，脑是髓海，背是太阳经寒水经过的地方。水涸海竭，阴火上炎，怎么能不发为痈疽呢。其疮很严重而不溃破，或者有赤水的，严重时或黑或紫，是火极似水的象，乃肾水已竭不治。若苦峻补其阴，能食便调神安，无其他恶症，或许可以救治。
消渴根本在于热，而热有内外虚实之分，如果是传经之热，液耗而渴，气分受病，应当给予寒凉淡渗之剂，迅速清除其热，热去而阴生。如果是胃虚亡液，阴虚而渴，是血受病，应当给予甘温酸辛之剂，滋益其阴，阴生而燥除。
有人说：有人服用地黄汤，而渴仍不止，为什么呢？回答说：这个方子不能废除规矩而改变其道。大概心肺位置近，适宜制小其剂量，肾肝位置远，适宜制大其剂量。加上高位中消，可以用前丸缓而治之，如果下消已到极点，大渴大燥，须用加减八味丸料一斤，内加肉桂一两，水煎六七碗，恣意冰冷冻饮料之，熟睡后渴病如失。处方的制作，存乎人的通变罢了。
有人问：下消无水，用六味地黄丸，可以滋少阴之肾水了，又加附子肉桂为什么呢？大概因为命门火衰，不能蒸腐水谷，水谷之气，不能熏蒸，上润于肺，如釜底无薪锅盖干燥，所以渴，肺也无所禀受，不能四布水精，并行五经而为津液。其所饮之水，未经火化，直入膀胱，正谓饮一升，溺一升，饮一斗，溺一斗，试尝其味，甘而不咸可知矣，所以用附子肉桂的辛热，壮其少火，灶底加薪，枯笼蒸溽，枯禾得雨，生意维新，只有明者知道。昔汉武帝病渴，张仲景为此处方，治疗下消之症，饮水一斗，小便亦一斗，用此以折其水，使不顺趋，夫肾水下趋则消，肾水不上腾则渴，舍此怎能治疗呢？真是圣玄秘，诚良方也。疮疽痊愈后，即将痊愈，口渴甚重的，舌黄坚硬的，以及未患病前先渴，或心烦燥渴，小便频数，或白浊阴痿，饮食少思，肌肤瘦消，以及腿肿脚瘦，口齿生疮，服之无不有效。成无己说：桂犹圭也，引导阳气，若执以使。
上消说是心移热于肺，中消说是内虚胃热，都认火热为害，所以或以白虎或以承气，最终导致不救。总之，是下焦命门火不归源，游于肺则为上消，游于胃即为中消，用八味肾气丸引火归源。使火在釜底水火既济，气上熏蒸，肺受湿气而渴疾愈矣。有一等渴欲引饮，但饮水不过一二口即厌。少顷复渴，饮亦不过如此，但不若胃渴蓄饮水无厌也，这是中气虚寒，寒水泛上，逼其浮游之火于咽喉口舌之间，所以上焦一段，欲得水救，若到中焦，以水见水，正是其所恶也，治法如面红烦躁者，理中汤送八味丸。又有一等渴欲饮水，但饮下少顷即吐出，吐出少顷复求饮，药食毫不能下，这是阴盛格阳，肾经伤寒之证，仲景用白通汤加人尿胆汁，热药冷探之法，一服即愈，女人多有此症。东垣又说：手阳明大肠，手太阴小肠，皆属足阳明胃，大肠主津小肠主液，大肠小肠受胃之阳气，乃能行津液于上焦，灌溉皮毛，充实腠理，若饮食不节，胃气不充，大肠小肠，无所禀气，故津液涸竭焉。
君相二火得其平，则烹炼饮食，糟粕去焉，不得其平，则燔炙脏腑，津液耗焉。大概心火甚于上，为隔膜之消，甚于中，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，中甚不已，则消及于脾，下甚不已，则消及于肾，外甚不已，则甚及于筋骨，四脏皆消尽，则心自焚而死矣。所以治疗消渴不减滋味，不戒嗜欲，不节喜怒，则病难已。丹溪说：消渴宜饮缫丝汤。能引清气上朝于口。大概蚕与马同属午也，心也。作茧退藏之义。能抑心火而止渴也。渴家误作火治，凉药乱投，夭人生命，必多服生脉散为佳。
《内经》既然说：饮一溲二，死不治。为何仲景复用肾气丸以治饮一斗溲一斗之证？大概病尚浅，犹或可治，如果瘦而过于饮，也无及矣，方内须以五味易桂附，从四时及脉理增减可也。此症多因酒色过度，施泄过多，以致水火不交，肾水下泄，故不宜用凉心冷剂也，久而小便不臭，反作甜气，则生气泄矣，有浮脂溺面，此精不禁，真元竭矣，不治。
五脏六腑四肢，皆禀气于脾胃，行其津液，以濡润养之，夫消渴之病，本湿寒之阴气极衰，燥热之阳气太盛故也，治当补肾水阴气之虚，而泻心火阳热之实，除肠胃燥热之甚，济身中精液之衰，使道路散而不结，津液生而不枯，气血和而不涩，则病自己。
况且消渴者，因饮食服饵之失宜，肠胃干涸，而气不宣平，或精神过违其度而耗乱之，或因大病阴气损而血液衰，虚阳剽悍而燥热郁甚之所成也。若饮水多而小便，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。一皆燥热太甚，三焦肠胃之腠理，指郁结滞致密，纵复多饮于中，终不能浸润于外，荣养百骸，故渴不止，小便多出或溲数也。时珍说：舌下有四窍，两窍通心气，两窍过肾液，心气流于舌下为神水，肾液流入舌下为灵液，道家谓之金浆玉醴，溢为醴泉，聚为华池，散为津液，降为甘露，所以灌溉脏腑，润泽肢体，是以修养家咽津纳气，谓之清水灌灵根，人能终日不唾，则精气常留，颜色不槁。若久唾则损精气成肺病，皮肤枯涸，故曰远唾不如近唾，近唾不如不唾。人若有病，则心肾不交，肾水不上，故津液干而真气耗矣。《难经》说：肾主五液，入肝为泪，入肺为涕，入脾为涎，入心为汗，自入为唾也。
消渴养肺降火生血为主。三消皆禁用半夏。消渴若泄泻者，用白术、白芍药之类。内伤病后燥渴不解者，此余热在肺经也，用参芩甘草少许，生姜汁调冷服。天花粉，消渴属热者之神药也。小儿唇红如丹，即发渴候，红甚焦黑则危。
《夷坚志》消渴杀虫方，治消渴有虫耗其精液而成者，用苦楝根取新白皮一握，切焙入麝香少许，煎，空心服，虽困顿不妨，取下虫三四条，类蛔而色红，其渴乃止，盖饮醇食炙，积成胃热，湿热生虫，理固有之。
Mahuang Gen (Radix Ephedrae), Ouli (Ostreae Concha, prepared as powder), each 2 liang; Huangqi (Radix Astragali, honey-fried), Renshen (Radix Ginseng), each 2 liang; Longgu (Draconis Os, crushed); Digupi (Cortex Lycii), each 4 liang; Dazao (Fructus Jujubae), 7 pieces. Add 6 zhong of water, decoct to obtain 2.5 zhong, divide into six doses, drink all within one day.
Alternatively, for treating night sweats (Dao Han): Use Wubeizi (Fructus Terminaliae Chebulae) powder, mix with saliva to form a paste, fill the umbilicus, and bind firmly with silk cloth; this is most effective.
The "Three Xiao" diseases refer to Xiaoke (Xiao Re), Xiaozhong (Xiao Zhong), and Xiaoshen (Xiao Shen). Upper Xiao primarily involves the Lung (Fei), Middle Xiao primarily involves the Stomach (Wei), and Lower Xiao primarily involves the Kidney (Shen); thus it is called Xiaoke, caused by dryness. Dry Metal (Zao Jin) is further affected by Heat transformation, becoming dry and astringent. Dryness formed from stagnation occurs because Wind can dry out Dampness, and Heat consumes fluids. Xiaozhong refers to heat accumulation in the Stomach, characterized by good appetite but emaciation, severe dry-heat stagnation, excessive thirst and drinking, and polyuria. This is due to hyperactive Heart Fire (Xin Huo) and dry-heat scorching the Sanjiao (Triple Burner), preventing normal distribution and movement of fluids, so the body lacks moisture, resulting in emaciation, sallow complexion, and dark skin. Although there is excessive thirst and drinking, fluids cannot moisten outside the intestines and stomach, but instead flow downward causing polyuria. Laypeople misunderstand this, falsely diagnosing it as deficiency-cold of the Lower Jiao, misleading many. Xiaoshen refers to dry-heat induced Xiaoke, characterized by emaciation, dark complexion, turbid and dribbling urine with lipid-like fluid resembling paste. These three discussions are consistent with adult conditions. However, in children, there are additionally three types: Da Ke (Great Thirst), Re Ke (Heat Thirst), and Gan Ke (Gan Thirst). Da Ke arises after vomiting and diarrhea; damage to the Spleen and Stomach leads to fluid depletion, generating pathogenic heat, further depleting essence, causing dry lips and tongue and great thirst. Re Ke arises from excess blood and qi, representing dry-heat in the Zang-Fu organs. Another type results from summer-toxicity affecting the Stomach or dry-heat in hot Zang organs, where fluids are not generated, causing cracked lips and dry mouth, leading to Re Ke. Gan Ke results from preferring fatty foods and indulging in sweet and sour tastes, accompanied by bone-steaming night sweats, sallow emaciation, abdominal distension, bad breath, and dry lips; drinking heavily with unregulated urination. Prolonged illness may lead to carbuncles and sores, or transform into edema. Generally, prolonged Xiaoke with unregulated urition prevents essence from being distributed outward, depleting fluids further. Fluid depletion causes meridian stasis, impeding Ying and Wei circulation, leading to blood and qi stagnation, forming Gan disease. Accompanied by Spleen Earth deficiency, Kidney Water becomes excessive, counter-restricting Earth. Earth deficiency fails to transform dampness, generating heat; damp-heat binds, failing to transmit and transform, manifesting as skin edema and fullness. It is said: Thirst with incessant drinking and astringent urination leads to Pi (masses). Treatment methods include tonifying the Spleen to generate fluids (tonifying the Mother of Lung/Metal), or nourishing the Kidney to strengthen Water (protecting the Child of Lung/Metal), which is the fundamental principle for treating dry Metal. If eyelids become black and swollen, subcutaneous blue floats, shortness of breath like sawing, smoke/flame from throat, yellow/sunken whites of eyes, swollen/ulcerated lips, abdominal distension with wheezing, body swelling with floating purple-black spots, these are ominous signs. Patients with thirst must not induce sweating; even if external pathogens exist, treatment should be mild because the source of fluids is exhausted.
Thirst with excessive drinking is Upper Xiao, due to Lung Heat. Excessive eating and hunger is Middle Xiao, due to Stomach Heat. Thirst with frequent urination and uncontrollable turbid urine is Lower Xiao, due to Kidney Heat. All indicate Fire excess and Water deficiency. The Classics state: Heart transfers heat to the Lung, transmitting to Ge Xiao (Diaphragm Xiao). Also: Two Yangs knot, called Xiao. (Two Yangs refers to Yangming). Hand-Yangming Large Intestine governs Jin fluids; Xiao disease presents with yellow eyes and dry mouth, indicating Jin insufficiency. Foot-Yangming Stomach governs Blood; heat causes rapid digestion and hunger, indicating latent fire in Blood and Blood insufficiency. Those who have not yet transmitted but can eat will likely develop brain abscesses and sores; those who cannot eat will likely transmit to abdominal fullness and distension, both untreatable.
Generally, Blood disorders do not involve thirst/drinking, only Qi disorders do. Qi-type thirst prefers cold water, suitable for cold-draining diuretics to clear heat. Blood-type thirst prefers hot water, suitable for sweet-warm-astringent agents to nourish Yin. Upper is light, Middle is heavy, Lower is critical; if Upper and Middle are balanced, transmission to Lower is prevented. Thus, Kidney Xiao is a progression of Upper Xiao; Lung-Stomach heat enters the Kidney, consuming Kidney fat. Drinking one part, urinating two parts; urine like paste oil, drying the Kidney. The Lung governs Qi; when healthy, Qi controls fluids and essence, directing them upward to moisten the throat and nourish sinews, bones, vessels, and blood; the remainder becomes urine. When diseased, fluids lack Qi control, and essence flows down with urine like paste oil. Hejian discussed thirst only as Upper Jiao; does Middle/Lower Xiao have no thirst? Merely clarifying that Lower Xiao has turbid urine with lipids, treatment should nourish Yin to separate clear from turbid. Sweet-tasting urine in Kidney Xiao indicates severity; Water is born from Sweet but dies from Salty. Urine should be salty but is sweet, indicating leakage of vital energy, Spleen Qi sinking into Kidney, Earth overacting on Water.
Upper Xiao: Red cracks on tongue, great thirst craving drinks. *Ni Tiao Lun* states: Heart transfers heat to Lung, transmitting to Ge Xiao. Treat with Baihu Tang (White Tiger Decoction) plus Renshen. Middle Xiao: Good appetite but emaciation, spontaneous sweating, hard stool, frequent urination. Suhe states: Dry mouth craving drinks, eating much but hungry, deficiency-dampness forms Xiaozhong. Treat with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction). Lower Xiao: Irritability, craving drinks, dry/scaly earlobes, urine like paste. Suhe states: Scorching irritability, water easily depleted, this is Kidney Xiao. Treat with Liuwei Wan (Six-Ingredient Pill with Rehmannia). Ancient methods for Three Xiao are thus. However, if Fire/Water are balanced and Qi/Blood nourished, how can Xiao occur? Improper care leads to Fire/Water imbalance, fluid exhaustion, Dragon-Lei Fire flaming upward. Long-term simmering consumes intestinal fat, dries five Zang organs, causing emaciated limbs and fatigue. Therefore, treating Xiao, regardless of upper/middle/lower, prioritizes the Kidney. Only Liuwei Wan, Bawei Wan (Eight-Ingredient Pill), and modified Bawei Wan, taken according to symptoms, lower Heart Fire and nourish Kidney Water, stopping thirst. Otherwise, organs burn, four Zang organs consume, Heart Fire self-immolates. Baihu and Chengqi are not appropriate. Lou Quanshan stated: Lung disease originates from Kidney deficiency; Kidney deficiency makes Heart fearless,妄行凌肺 (recklessly attacking Lung), causing Lung Xiao. Zhang Zhongjing treated thirst with excessive urination using Bawei Wan to tonify Kidney and save Lung, later named Kidney Xiao. Thus, thirst is due to fluid exhaustion from dryness. Dryness is extreme deficiency of True Yin causing deficient heat. Lower Xiao thirst is named Qiangzhong (Strong Middle), due to Kidney Water deficiency and Heart Fire hyperactivity.
*Jing* states: Large Intestine transfers heat to Stomach, good appetite but emaciation, called Shi Xiao (Food Xiao). Dongyuan stated: Good appetite but emaciation is due to latent fire in Stomach allowing eating, while Spleen deficiency causes muscle wasting. *Zonglu* stated: Cannot eat but thirsty indicates pre-transmission to abdominal fullness; can eat but thirsty indicates brain abscess/back carbuncle. Cannot eat is Spleen disease; Spleen irrigates surroundings and moves fluids with Stomach. Spleen/Stomach deficiency fails to distribute fluids, causing thirst. Even those who can eat are doing so due to Stomach deficiency seeking grain for self-rescue. Using cold-draining fire-clearing drugs like Baihu/Chengqi removes internal heat but generates middle cold, leading to drum-distension. Only Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder), Renshen Shengmai San (Ginseng Pulse-Sustaining Decoction), drinking freely, followed by Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) to nourish the source of transformation, is the correct method. Those who can eat, are thirsty, and develop sores suffer from rich people's diet of rich/greasy food. Frequent consumption of sweet/rich/fatty foods causes upper Qi overflow leading to Xiaoke. Do not take rich/greasy/herbal/mineral drugs; their fierce nature aids dry-heat. *Jing* states: Treat with Orchid (Lan) to eliminate stale accumulation; do not use cold drugs. Why carbuncles? *Jing* states: Changes from rich food often produce large Ding sores. For Kidney Xiao with brain/back carbuncles: Kidney governs bone, Brain is Sea of Marrow, Back is pathway of Taiyang Cold Water. Water dried, Sea exhausted, Yin Fire flares up, inevitably causing carbuncles. Severe non-ulcerating sores or red-water discharge, turning black/purple, indicate Fire extreme resembling Water, Kidney Water exhausted, untreatable. Bitterly strongly tonifying Yin might help if eating/stool/spirit are stable without other evil signs.
Xiaoke fundamentally stems from Heat, divided into internal/external and deficiency/excess. Transmission heat consuming fluids causing thirst, affecting Qi level, requires cold-draining diuretic agents to quickly clear heat; heat gone, Yin born. Stomach deficiency losing fluids, Yin deficiency causing thirst, affecting Blood level, requires sweet-warm-acrid-sour agents to nourish Yin; Yin born, dryness removed.
Question: Why does thirst persist after taking Dihuang Tang? Answer: This formula cannot abandon its rules. Heart/Lung are close, dosage should be small; Kidney/Liver are distant, dosage should be large. For high-position Middle Xiao, slow treatment with previous pills works. If Lower Xiao is extreme, great thirst/dryness, use 1 jin of modified Bawei Wan ingredients, add 1 liang Rougui (Cinnamon Bark), decoct in 6-7 bowls of water, drink ice-cold freely, sleep soundly, thirst lost. Prescription formulation depends on adaptability.
Question: Lower Xiao has no water, Liuwei Dihuang Wan nourishes Shaoyin Kidney Water, why add Fuzi (Aconite) and Rougui? Because Mingmen Fire (Gate of Life Fire) is weak, unable to steam/cook food/water. Food/water Qi cannot steam upward to moisten Lung, like a pot without fire under the lid being dry, causing thirst. Lung receives nothing, cannot distribute water essence through five meridians to form fluids. Drunk water, untransformed by fire, goes straight to Bladder: drink 1 sheng, urinate 1 sheng; drink 1 dou, urinate 1 dou. Taste is sweet, not salty. Thus, acrid-hot Fuzi/Rougui strengthens the "Lesser Fire" (Shao Huo), adding fuel to the stove, steaming the dry cage, rain on withered crops revives life. Only the wise understand. Emperor Wu of Han had thirst; Zhang Zhongjing prescribed this for Lower Xiao: drink 1 dou, urinate 1 dou. This restricts water flow, preventing downward rush. Kidney water rushing down causes Xiao; rising up causes thirst. Without this, how to treat? Truly profound, an excellent prescription. After carbuncle healing, approaching cure, severe thirst, yellow/hard tongue, pre-thirst, irritability, frequent urination, white turbidity, impotence, poor appetite, emaciation, leg swelling/foot thinning, oral ulcers—all respond well. Cheng Wuji said: Gui (Cinnamon) is like a scepter, guiding Yang Qi, acting as an executor.
Upper Xiao is Heart heat transferring to Lung; Middle Xiao is internal deficiency with Stomach heat. Both recognize Fire/Heat as harmful, using Baihu or Chengqi, ultimately fatal. Essentially, Lower Jiao Mingmen Fire fails to return to its source. Wandering to Lung is Upper Xiao; wandering to Stomach is Middle Xiao. Use Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) to guide Fire back to source. Fire in pot bottom, Water/Fire interact, Qi steams upward, Lung receives moisture, thirst cures. Some crave drinks but stop after 1-2 sips, then thirsty again shortly. Not like Stomach thirst craving endless water. This is Middle Qi deficiency-cold, Cold Water flooding upward, forcing floating Fire to throat/tongue. Upper Jiao wants water relief, but at Middle Jiao, Water meets Water, which it hates. Treatment: For red face/irritability, Lizhong Tang (Regulate the Middle Decoction) with Bawei Wan. Others crave drinks, vomit shortly after swallowing, then seek drink again, cannot keep food/medicine. This is Yin excess repelling Yang, Kidney channel Cold Damage. Zhang Zhongjing used Baitong Tang (White Passages Decoction) plus human urine and gallbladder bile, hot medicine taken cold, cured in one dose. Common in women. Dongyuan also stated: Hand-Yangming Large Intestine and Hand-Taiyin Small Intestine belong to Foot-Yangming Stomach. Large Intestine governs Jin, Small Intestine governs Ye. They receive Stomach Yang Qi to move Jin/Ye to Upper Jiao, irrigate skin/hair, fill pores. Irregular diet, insufficient Stomach Qi, Large/Small Intestines lack Qi, thus Jin/Ye exhausted.
Ruler and Minister Fires balanced cook food, waste removed. Imbalanced, they roast organs, fluids consumed. Heart Fire excessive above causes Diaphragm Xiao; excessive middle causes Intestinal/Gastric Xiao; excessive below causes Paste/Liquid Xiao; excessive outside causes Muscle Xiao. Above excessive spreads to Lung; middle to Spleen; below to Kidney; outside to sinews/bones. Four Zang consumed, Heart self-immolates. Thus, treating Xiao without reducing flavors, abandoning desires, regulating anger/joy, makes disease hard to cure. Danxi said: Xiaoke should drink Silk-Reeling Soup to draw clear Qi upward to mouth. Silkworm/Horse belong to Wu (Fire)/Heart. Cocoon-making implies retreating/storing. Suppresses Heart Fire, stops thirst. Mistaking thirst for Fire, indiscriminately using cold drugs kills. Taking Shengmai San (Pulse-Sustaining Decoction) is best.
*Jing* says: Drink 1, urinate 2, death untreatable. Why did Zhongjing use Shenqi Wan for drink 1 dou, urinate 1 dou? Disease is shallow, perhaps treatable. If emaciated and drinking excessively, too late. In formula, replace Guifu with Wuweizi, adjust per seasons/pulse. Often due to excessive alcohol/sex, excessive emission, Water/Fire not interacting, Kidney water leaking. Cold/Cool Heart agents unsuitable. Long-term urine odorless, turns sweet, vital energy leaks. Floating fat on urine surface, essence uncontrolled, True Yuan exhausted, untreatable.
Five Zang/Six Fu/limbs receive Qi from Spleen/Stomach, move fluids to nourish. Xiaoke disease stems from extreme decline of Damp-Cold Yin Qi and excess of Dry-Heat Yang Qi. Treatment should tonify Kidney Water/Yin deficiency, drain Heart Fire/Yang excess, remove intestinal dry-heat, aid body fluid decline, ensure pathways open not knotted, fluids generated not dried, Qi/Blood harmonious not stagnant, disease resolves itself.
Moreover, Xiaoke results from improper diet/medication, dry intestines/stomach, Qi not smooth, mental overexertion damaging essence/blood, or post-major illness Yin/Blood decline, deficient Yang fierce and dry-heat stagnating. Drinking much/urinating = Xiaoke; Eating much/not very thirsty/frequent urination/emaciation = Xiaozhong; Thirst/endless drinking/leg emaciation/urine with lipid = Xiaoshen. All due to extreme dry-heat, Sanjiao/intestinal pores knotted/stagnant. Despite drinking much inside, cannot moisten outside/nourish body, so thirst persists, urination increases. Shizhen said: Four openings under tongue, two connect to Heart Qi, two pass Kidney Liquid. Heart Qi flows to tongue as Divine Water; Kidney Liquid flows as Spirit Liquid. Daoists call it Golden Elixir/Jade Nectar, overflowing as Sweet Spring, gathering as Hua Chi, scattering as fluids, descending as甘露 (Sweet Dew), irrigating organs, moistening limbs. Cultivators swallow fluids/breathe, called Clear Water irrigating Spiritual Root. Not spitting all day keeps essence/color. Long spitting damages essence, causes Lung disease, dry skin. Far spitting worse than near, near worse than none. Illness disrupts Heart/Kidney interaction, Kidney Water doesn't rise, fluids dry, True Qi耗 (consumed). *Nan Jing* states: Kidney governs Five Fluids: Liver=tears, Lung=snivel, Spleen=spittle, Heart=sweat, Self=spit.
Xiaoke focuses on nourishing Lung, lowering Fire, generating Blood. Banxia (Pinellia) forbidden in Three Xiao. If Xiaoke with diarrhea, use Baizhu (Atractylodes Macrocephala), Baishaoyao (White Peony Root). Post-internal injury dry thirst unresolved: residual heat in Lung. Use small amount of Renshen, Huangqin (Scutellaria), Gancao (Licorice), mixed with fresh ginger juice, taken cold. Tianhuafen (Trichosanthes Root) is divine drug for heat-type Xiaoke. Children with red lips like cinnabar show impending thirst; very red/black dangerous.
*Yijian Zhi* Xiaoke insecticide: For Xiaoke caused by insects consuming essence. Use fresh white bark of Kulian root (Melia Radicis Cortex), handful, cut/dry, add little Muxiang (Costus Root), decoct, take empty stomach. Even if weak, ok. Expel 3-4 worms, roundworm-like, red. Thirst stops. Drinking alcohol/eating roasted food accumulates Stomach heat, damp-heat breeds insects, logically true.