内经曰。二阳结谓之消。东垣曰。二阳者。阳明也。手阳明大肠主津液。若热则目黄口渴。乃津液不足也。
足阳明胃主血。若热则消谷善饥。血中伏火。乃血不足也。结谓热结也。虽有三消之分。其原皆本于胃土者。
万物所归。无所不有。凡煎炒炙爆。过饮醇酒。助其胃火。耗竭津液。传于气分。则为上消。传于血分。则为下消。
若房事撙节。阴气未损者。燥热只在胃经。但见消谷善饥而已。上消其病在肺。舌上赤裂。大渴引饮。此因胃火先
传于肺。心复继之。经云。心移热于肺。传为膈消。举其最重者而言。其实先由胃火而起也。中消其病在胃。善食而饥。
自汗时出。大便坚硬。小便频数。亦有口干饮水者。较之上消下消为少耳。今医治此。俱有甘露饮子。非不有理。但滋
阴养血。落后一层。而清热生津。尤为急着。柴胡芍药汤。良不易也。仲景治
伤寒论云。口渴者。风发也。以饮食消息止之。见得口中作渴。不但胃火所使。而肝胆风热亦复乘之。徒求药石。
不能速愈。须以饮食之中。甘蔗梨汁。频频食之。庶可免死。此亦治消渴之妙法也。（此言历练有准非虚伪浮夸之谈）下
消其病在肾。耳叶焦枯。小便如膏。其中伏有至理。人所不知。盖小便如膏。似属肾虚。凉
药治之无益。不知肾消一症。不但胃热下流。而心之阳火。亦因下趋于肾。宜用当归六黄汤。或六味地黄汤。加犀
角以治心火。其消乃愈。向使见其遗精。不敢用凉。岂不误乎。总录云。未传能食者必发脑疽背疮。为其邪火
太盛也。不能食者。必传中满臌胀。以其治之太过。上热未除。中寒复生也。岐伯曰。脉实病久可治。脉弦小病久
不可治。盖洪数之脉。邪火有余。津液犹未枯竭。若脉细无力者。津液既绝。胃气亦亡。故不可治。不得已而药之。
宜于柴芍汤中。加入人参。甚则八味地黄丸。或可起死。
柴胡芍药汤
柴胡 黄芩 花粉 甘草 白芍 麦冬 知母 黄连
上消中消。气分病也。不可骤用血药。惟此方最合。每日再用蛤蜊煎汤饮
之。大有奇效。中消大便不利。本方去黄连。加大黄以微利之（按阐发三消之蕴明若燃犀）
甘露饮
天冬 麦冬 生地 熟地 茵陈 枇杷叶 黄芩 苡仁 石斛 甘草 山栀
一方无茵陈山栀。用枳壳。
当归六黄汤
当归 黄 黄芩 黄连 黄柏 生地 熟地
《黄帝内经》说：“二阳结谓之消。”李东垣说：“二阳，指的是阳明经。手阳明大肠经主管津液，如果受热邪侵袭，就会出现目黄、口渴的症状，这是津液不足的表现。足阳明胃经主管血液，如果受热邪侵袭，就会出现消谷善饥（吃得多饿得快）的症状，这是因为血中潜伏着火邪，导致血分不足。‘结’指的是热邪郁结。虽然三消病有上、中、下的区分，但其根源都在于胃土。胃为水谷之海，万物所归，无所不有。凡是煎炒炙爆的食物，以及过量饮用美酒，都会助长胃火，耗竭津液。如果病邪传变到气分，就形成上消；如果传变到血分，就形成下消。
如果房事节制，阴气没有受损的人，燥热只停留在胃经，仅仅表现为消谷善饥。上消的病位在肺，表现为舌面红赤开裂，极度口渴想喝水。这是因为胃火先传变到肺，心火随后也参与其中。《内经》说：‘心移热于肺，传为膈消。’这是举出病情最严重的情况来说明，其实最初是由胃火引起的。中消的病位在胃，表现为食欲旺盛但容易饥饿，经常自汗，大便干硬，小便频数，也有口干想喝水的情况，但这比上消和下消的症状要轻一些。现在医生治疗这种病，都用甘露饮子，并非没有道理，但滋阴养血的方法稍显滞后，而清热生津更为急切重要。柴胡芍药汤，确实是很好的方剂。张仲景在《伤寒论》中说：‘口渴的，是风邪化热所致，通过调整饮食来缓解。’这说明口中作渴，不仅仅是胃火引起，肝胆的风热也会乘虚侵袭。如果单纯依靠药物，不能迅速痊愈，必须在饮食中，频繁食用甘蔗汁、梨汁，才可以避免死亡，这也是治疗消渴病的妙法。（这段话是经过临床历练得出的准确结论，并非虚伪浮夸之谈。）
下消的病位在肾，表现为耳廓焦枯，小便像膏脂一样稠厚，其中蕴含着深刻的医理，常人并不知晓。小便像膏脂，看似属于肾虚，用凉药治疗没有益处。殊不知肾消这一病症，不仅是胃热向下流注，而且心的阳火也因下趋于肾。适宜使用当归六黄汤，或者六味地黄汤，加入犀角以清泻心火，这样消渴才能痊愈。假如见到患者遗精，就不敢用凉药，那岂不是误人子弟吗？《古今医统大全》说：‘尚未出现多食症状的患者，必定会发脑疽或背疮，因为邪火太盛。’‘不能进食的患者，必定会传变为中满臌胀，因为治疗太过，上部的热邪未除，中焦的寒邪又生。’岐伯说：‘脉象实大，病程久者可治；脉象弦小，病程久者不可治。’这是因为洪数之脉，表示邪火有余，津液尚未枯竭；如果脉象细弱无力，说明津液已绝，胃气也已亡失，所以不可治。如果不得已而用药，适宜在柴胡芍药汤中加入人参，严重时可用八味地黄丸，或许能起死回生。
柴胡芍药汤
组成：柴胡、黄芩、天花粉、甘草、白芍、麦冬、知母、黄连。
上消和中消，属于气分病变，不可以骤然使用补血药，只有这个方剂最合适。每天再用蛤蜊煎汤饮用，大有奇效。如果是中消且大便不通畅，本方去掉黄连，加大黄以轻微通利大便。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Obstruction in the Two Yang meridians is called Xiao (Wasting and Thirsting)." Li Dongyuan said: "The Two Yang refers to the Yangming meridians. The Hand-Yangming Large Intestine meridian governs body fluids; if affected by heat, it causes yellow eyes and thirst, indicating a deficiency of body fluids. The Foot-Yangming Stomach meridian governs blood; if affected by heat, it causes excessive hunger after eating, due to latent fire in the blood leading to a deficiency of blood. 'Obstruction' refers to the accumulation of heat. Although the Three Xiao diseases are divided into Upper, Middle, and Lower, their origin lies in the Stomach Earth. As the repository of all grains, the Stomach receives everything. Foods that are fried, roasted, or grilled, as well as excessive consumption of rich wine, assist stomach fire and deplete body fluids. If the pathogen transmits to the Qi level, it becomes Upper Xiao; if it transmits to the Blood level, it becomes Lower Xiao.
If sexual activity is regulated and Yin energy is not damaged, the dryness-heat remains only in the Stomach meridian, manifesting merely as excessive hunger after eating. Upper Xiao involves the Lung, presenting with a red and cracked tongue surface and extreme thirst for drinking. This occurs because stomach fire first transmits to the Lung, followed by Heart fire. The Classics state: 'When Heart transfers heat to the Lung, it transforms into Ge Xiao (Diaphragmatic Wasting-Thirst).' This describes the most severe manifestation, but essentially, it originates from stomach fire. Middle Xiao involves the Stomach, presenting with a good appetite yet frequent hunger, spontaneous sweating, hard stools, and frequent urination, sometimes accompanied by dry mouth and desire to drink, though these symptoms are less severe than those of Upper or Lower Xiao. Currently, physicians treat this condition using Ganlu Yin (Sweet Dew Decoction). While there is some rationale, nourishing Yin and tonifying blood is somewhat secondary; clearing heat and generating fluids is more urgent. Chaihu Shaoyao Tang (Bupleurum and Peony Decoction) is indeed an excellent prescription. Zhang Zhongjing, in his *Shanghan Lun* (Treatise on Cold Damage), stated: "For thirst caused by wind-fever, resolve it through dietary management." This indicates that thirst is not solely caused by stomach fire but also by wind-heat from the Liver and Gallbladder attacking the body. Relying solely on herbs cannot bring about a rapid cure; one must frequently consume sugarcane juice and pear juice through diet to avoid death. This is also a wonderful method for treating Xiao-Kel (Wasting-Thirst Syndrome). (This statement reflects accurate clinical experience, not empty exaggeration.)
Lower Xiao involves the Kidney, presenting with withered and dry earlobes and urine resembling paste. There is profound medical logic hidden here, unknown to ordinary people. Urine resembling paste seems to indicate Kidney deficiency, and treating it with cooling herbs is ineffective. In fact, in Ren Xiao (Kidney Wasting-Thirst), not only does stomach heat flow downward, but the Yang fire of the Heart also descends toward the Kidney. It is appropriate to use Danggui Liu Huang Tang (Angelica Sinensis and Six Yellow Decoction) or Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), adding Rhinoceros Horn (Xi Jiao) to clear Heart fire, so that the wasting-thirst may heal. If one sees seminal emission and dares not use cooling herbs, would that not be a mistake? *Zonglu* states: "Those who have not yet developed polyphagia will inevitably develop brain carbuncles or back sores, due to excessive evil fire. Those who cannot eat will inevitably develop abdominal distension and bloating, because treatment was too aggressive, leaving upper heat unresolved while middle cold arises." Qibo said: "If the pulse is excess and the disease has lasted long, it is treatable; if the pulse is wiry and small and the disease has lasted long, it is untreatable." This is because a surging and rapid pulse indicates excess evil fire with still-intact body fluids. If the pulse is fine and weak, it means body fluids are exhausted and Stomach Qi is perished, hence untreatable. If medication is unavoidable, it is suitable to add Ginseng (Renshen) to Chaihu Shaoyao Tang. In severe cases, Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) might revive the dying.
Chaihu Shaoyao Tang (Bupleurum and Peony Decoction)
Ingredients: Chaihu (*Bupleuri Radix*), Huangqin (*Scutellariae Radix*), Huafen (*Trichosanthis Radix*), Gancao (*Glycyrrhizae Radix et Rhizoma*), Baishao (*Paeoniae Radix Alba*), Maidong (*Ophiopogonis Radix*), Zhimu (*Anemarrhenae Rhizoma*), Huanglian (*Coptidis Rhizoma*).
Upper Xiao and Middle Xiao are diseases of the Qi level; one should not abruptly use blood-tonifying herbs. This formula is most suitable. Additionally, drinking clam decoction daily yields great efficacy. For Middle Xiao with constipation, remove Huanglian from this formula and add Dahuang (*Rhei Radix et Rhizoma*) to gently promote bowel movement.
Ganlu Yin (Sweet Dew Decoction)
Ingredients: Tiandong (*Asparagi Radix*), Maidong (*Ophiopogonis Radix*), Shengdi (*Rehmanniae Radix*), Shudi (*Rehmanniae Radix Preparata*), Yinchend (*Artemisiae Scopariae Herba*), Pipaye (*Loquat Leaf*), Huangqin (*Scutellariae Radix*), Yiren (*Coicis Semen*, Coix Seed), Shihu (*Dendrobii Caulis*), Gancao (*Glycyrrhizae Radix et Rhizoma*), Shanzhi (*Gardeniae Fructus*).
Another version omits Yinchend and Shanzhi, using Zhike (*Aurantii Fructus Immaturus*) instead.
Danggui Liu Huang Tang (Angelica Sinensis and Six Yellow Decoction)
Ingredients: Danggui (*Angelicae Sinensis Radix*), Huangqi (*Astragali Radix*), Huangqin (*Scutellariae Radix*), Huanglian (*Coptidis Rhizoma*), Huangbai (*Phellodendri Cortex*), Shengdi (*Rehmanniae Radix*), Shudi (*Rehmanniae Radix Preparata*).