伤寒太阳症消渴，小便不利，宜五苓散；厥阴症消渴，宜大承气汤之类。与杂病之消渴
，名同而病异。宜分别之。
《经》云∶心移热于肺，传为鬲消。昔医名为上消，以白虎汤加人参治之。又云∶大肠移热
于胃，善食而瘦，昔医谓为中消，以调胃承气汤下之；下消者，烦躁引饮，耳叶焦干，小便
如膏，或饮一升尿一升，饮一斗尿一斗，以肾气丸主之。
赵氏曰∶治消之法，无分上中下，先治肾为急。惟六味、八味及加减八味丸，随症而服
。降其心火，滋其肾水，则渴自止矣。白虎、承气，皆非所治也。或曰，人有服地黄汤而渴
仍不止者，何也？曰∶此方士不能废其绳墨，而更其道也。盖心肺位近，宜制小其服；肝肾
位远，宜制大其服。如上消中消，可以前丸缓而治之；若下消已极，大渴大燥，须加减大八
味丸料一斤、纳肉桂一两，水煎六七碗，恣意冰冷冻饮料之，睡熟而渴如失矣。处方之制，存乎
人之变通耳。
或问下消无水，用六味丸以滋少阴肾水矣，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。至于肺亦无所禀，不能四布水精，并行五经，其所饮之水，未经火化，直入膀胱，正谓
饮一升尿一升，饮一斗尿一斗，观其尿味甘而不咸可知矣。故用桂、附之辛热，壮其少阴之
火。灶底加薪，枯笼蒸溽，槁苗得雨，生意维新，惟明者知之，昧者鲜不以为迂也。
张隐庵（讳志聪，本朝人，着《本草崇原》并《侣山堂类辨》）曰∶有脾不能为胃行其
津液，肺不能通调水道，而为消渴者，人但知以清凉药治消，而不知脾喜燥而肺恶寒。诚观
泄泻者必渴，此因水津不能上输而惟下泄，故而以燥脾之药治之，水液上升，即不渴矣。
故以凉润治渴，人皆知之；以燥热治渴，人所不知也。
伤寒病中的太阳经证出现消渴，伴有小便不利，适宜使用五苓散；厥阴经证出现消渴，适宜使用大承气汤之类的方剂。这与杂病中的消渴，名称相同但病因病机不同，应当加以区分。
《黄帝内经》说：心将热邪转移给肺，传变发展为膈消（上消）。以前的医生称之为上消，用白虎加人参汤治疗。又说：大肠将热邪转移给胃，表现为食欲旺盛却身体消瘦，以前的医生称之为中消，用调胃承气汤攻下治疗；下消的症状是烦躁、大量饮水，耳廓焦干，小便像膏脂一样稠厚，或者喝一升尿一升，喝一斗尿一斗，用肾气丸主治。
赵氏说：治疗消渴的方法，不分上、中、下三消，首先以治疗肾脏为急务。只选用六味地黄丸、八味地黄丸以及加减八味丸，根据症状服用。降低心火，滋补肾水，口渴自然就会停止。白虎汤、承气汤都不是适用的治疗方法。有人问：有的人服用地黄汤后口渴仍然不止，为什么呢？回答说：这是医生不能遵循法度，而随意改变治法所致。大概心肺位置相近，适宜制作小剂量的药；肝肾位置较远，适宜制作大剂量的药。如上消、中消，可以用前面的丸药缓慢治疗；如果下消已经非常严重，极度口渴且燥热，必须用加减大八味丸的药材一斤，加入肉桂一两，用水煎煮成六七碗，随意地冰镇后冷饮，睡熟之后口渴就像消失了一样处方的剂量和制法，在于医生的灵活变通。
有人问：下消属于无水之证，使用六味丸来滋补肾阴（少阴肾水）就可以了，为什么还要加上附子、肉桂呢？
这是因为命门之火衰弱，不能腐熟水谷，水谷的精微之气，不能熏蒸上行滋润肺部，就像锅底没有柴火，锅盖就会干燥，所以导致口渴。至于肺也得不到滋养，不能将水液精微布散全身，并行于五脏经脉，所饮入的水，未经过肾阳的气化作用，直接流入膀胱，这就是所说的“喝一升尿一升，喝一斗尿一斗”，观察其尿液味甘而不咸就可以知道了。所以使用肉桂、附子的辛热之性，来壮旺少阴肾火。就像在灶底添加柴火，使枯干的笼屉产生蒸汽，枯萎的禾苗得到雨水，生机重新焕发，只有明智的人才能理解，愚昧的人很少不认为这是迂阔之论。
张隐庵（名志聪，本朝人，著有《本草崇原》和《侣山堂类辨》）说：有因为脾不能为胃传输津液，肺不能通调水道，而导致消渴的，人们只知道用清凉药物治疗消渴，却不知道脾喜欢燥而肺厌恶寒。确实看到泄泻的人必定会口渴，这是因为水液津液不能向上输布而只向下泄出，所以用燥湿健脾的药物来治疗，水液上升，就不会口渴了。因此，用凉润药治疗口渴，人们都知道；用燥热药治疗口渴，人们却不知道。
In Taiyang syndrome (Taiyang channel disease) caused by Cold Damage, if polydipsia (excessive thirst) occurs accompanied by difficult urination, Wuling San (Five-Ingredient Poria Decoction) is indicated; in Jueyin syndrome (Jueyin channel disease), if polydipsia occurs, Da Chengqi Tang (Major Order the Qi Decoction) or similar formulas are indicated. This differs from polydipsia in miscellaneous diseases, sharing the same name but having different pathogenesis. They should be distinguished.
The *Classic of Difficult Issues* (*Jing*) states: "Heart transfers heat to the Lung, transmitting it to become Ge Xiao (Diabetes Mellitus of the Upper Jiao)." Ancient physicians called this Shang Xiao (Upper Diabetes), treating it with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction). It also states: "Large Intestine transfers heat to the Stomach, resulting in excessive eating yet emaciation." Ancient physicians called this Zhong Xiao (Middle Diabetes), treating it with Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) to purge downward. Xia Xiao (Lower Diabetes) is characterized by irritability and excessive drinking, dry and scorched earlobes, and urine resembling paste. Or, one may drink one sheng and urinate one sheng, or drink one dou and urinate one dou; Shengqi Wan (Kidney Qi Pill) is the primary treatment.
Zhao stated: In treating diabetes, regardless of whether it is Upper, Middle, or Lower, regulating the Kidney is the urgent priority. One should use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill), or Jiajian Bawei Wan (Modified Eight-Ingredient Rehmannia Pill), administered according to symptoms. By descending Heart Fire and nourishing Kidney Water, thirst will cease naturally. Baihu Tang and Chengqi Tang are not appropriate treatments. Someone asked: "Why does thirst persist in some patients after taking Dihuang Tang?" The answer was: "This is because the physician failed to adhere to established principles and altered the method arbitrarily. Generally, the Heart and Lung are located closely, so small doses are suitable; the Liver and Kidney are located distantly, so large doses are suitable. For Upper and Middle Diabetes, the aforementioned pills can be used for slow treatment; however, if Lower Diabetes is extreme, with severe thirst and dryness, one must use one jin of the ingredients for Jiajian Da Bawei Wan, adding one liang of Rougui (Cinnamon Twig), decocted in water into six or seven bowls, and allowed to drink it cold at will. After falling asleep, the thirst disappears as if lost. The formulation and dosage depend on the physician's flexibility."
Someone asked: "For Lower Diabetes involving a lack of fluids, using Liuwei Wan to nourish Shaoyin Kidney Water should suffice. Why add Fuzi (Prepared Aconite Root) and Rougui (Cinnamon Twig)?"
The reason is that the Fire of the Gate of Life (Mingmen) is deficient, unable to rot and cook food and water. The qi of food and water cannot steam upward to moisten the Lung. It is like a pot lid drying out because there is no firewood under the pot, leading to thirst. Furthermore, the Lung receives no nourishment and cannot distribute fluid essence throughout the body and the five meridians. The ingested water, without undergoing transformation by Kidney Fire, goes directly into the Bladder. This is what is meant by 'drinking one sheng and urinating one sheng.' Observing that the urine tastes sweet rather than salty confirms this. Therefore, the acrid and hot nature of Rougui and Fuzi is used to strengthen the Shaoyin Fire. It is like adding firewood to the stove base, creating steam in a dry steamer, and giving rain to withered seedlings to restore vitality. Only the wise understand this; the ignorant rarely fail to consider it pedantic.
Zhang Yinan (courtesy name Zhi Cong, a contemporary scholar, author of *Bencao Chongyuan* and *Lushan Tang Leibian*) stated: There are cases of diabetes where the Spleen fails to transport fluids for the Stomach, and the Lung fails to regulate water passages. People only know to treat diabetes with cooling medicines, unaware that the Spleen prefers dryness and the Lung dislikes cold. Indeed, those with diarrhea inevitably feel thirsty because fluid essence cannot ascend and instead drains downward. Thus, treating with herbs that dry dampness and strengthen the Spleen allows fluids to rise, and thirst ceases. Therefore, while everyone knows to treat thirst with cooling and moistening agents, few know to treat thirst with warming and drying agents.