论
《内经》曰∶二阳结谓之消。又曰∶瘅成为消中。东垣曰∶二阳者阳明也，手阳明大肠主津液，若消则目黄口干，
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。结者津液不足，结而不润，皆燥热为病也。
此因数食甘美而多肥，故其气上溢，转为消渴，治当以兰，除陈气也。不可服膏粱芳草石药，其气 悍，能助燥热也。
岐伯曰∶脉实病久，可治；脉弦小病久，不可治。当分三消而治之，高消者，舌上赤裂，大渴引饮，经云心移热于肺，
传为膈消者是也，以白虎加人参汤治之。中消者，善食而瘦，自汗，大便硬，小便数，叔和云口干饮水，多食饥虚，瘅
成为消中者是也，以调胃承气汤、三黄丸治之。下消者，烦渴引饮，耳叶焦干，小便如膏，叔和云焦烦水易亏，此肾消
也，以六味地黄丸治之。总录所谓末传能食者，必发脑疽背痈；不能食者，必传中满膨胀，皆为不治之证也。张洁古分
而治之，能食而渴者，白虎加人参汤；不能食而渴者，钱氏白术散倍加葛根治之，上中既平，不复传下消矣。先哲用药，
厥有旨哉。然脏腑有远近，亦宜斟酌。如心肺位近，宜制小其服，肾肝位远，宜制大其服，皆适其至所为故，如过与不
及，皆诛罚无过之地也。如高消、中消制之太急，速过病所，久而成中满之病，正所谓上热未除，中寒复生者也，非药
之罪，失其缓急之制也，治斯疾者宜审焉。
脉法
《脉经》曰∶厥阴之为病，消渴气上冲心，心中疼热，饥而不欲食，食即吐，下之不肯止。（伤寒厥阴篇云∶食则吐
蛔，下之利不止。）寸口脉浮而迟，浮则为虚，迟则为劳，浮则卫气不足，迟则荣气竭。趺阳脉浮而数，浮则为气，数则
消谷而紧（《要略》作消谷而大坚），气盛则溲数，溲数则紧（《要略》作坚），紧数相搏，则为消渴。男子消渴，小便反
多，以饮一斗，小便一斗，肾气丸主之。心脉滑为渴（滑者阳气胜），心脉微小为消瘅。消瘅，脉实大病久可治，悬小坚
急病久不可治。脉数大者生，沉小者生；实而坚大者死，细而浮短者死。
方法
丹溪曰∶养肺降火生血为主，分上中下治。上消者肺也，多饮水而少食，大小便如常。中消者胃也，多饮食而小便
赤黄。下消者肾也，小便浊淋如膏之状。
大法，黄连、天花粉二味为末，藕汁、人乳汁、生地黄汁、佐以蜜、姜汁为膏，和二味，留舌上，徐徐以白汤少许
送下。能食者，加石膏。
猪肚丸
黄连（五两） 麦门冬（去心） 知母（去毛） 栝蒌根（各四两）
上为细末，入雄猪肚内缝之，蒸熟乘热于石臼中捣烂，如干加炼蜜，丸如梧桐子大，每服一百丸，食后米饮下，可
以清心止渴（一云治消中）。
天花粉，治消渴之圣药也。凡消渴药中，大禁半夏，及不可发汗。
三消者，琼玉膏最妙。（方见咳嗽门。）
（以上丹溪方法凡五条）
和血益气汤（东垣） 治口干舌干，小便数，舌上赤脉。此药生津液，除干燥，生肌肉。
柴胡 炙甘草 生甘草 麻黄根（各三分） 当归梢（酒洗，四分） 知母（酒洗） 汉防己（酒洗） 羌活（各
五分） 石膏（六分，另研） 生地黄（酒洗） 黄连（酒洗，各八分） 黄柏（酒洗） 升麻（各一钱） 杏仁（去
皮，另研，六分） 红花（少许） 桃仁（去皮，另研，六分）
上细切，作一服，水二盏，煎至一盏，去渣温服，忌酒醋热湿面。
当归润燥汤 治消渴，小便多，大便秘涩干燥结硬，燥渴喜好温饮，阴头退缩，舌燥口干，眼涩难开，及于黑
处见浮云。
细辛（一分） 生甘草 炙甘草 熟地黄（各三分） 柴胡（去芦，七分） 黄柏（酒洗） 知母（酒洗） 石膏 桃
仁泥 当归身 麻仁 防风 荆芥穗（各一钱） 升麻（一钱五分） 红花（少许） 杏仁（七个，另研为泥） 小椒
（三粒，炒出汗）
上细切，作一服，水二盏，煎至一盏，热服食远，忌辛热物。
生津甘露汤（一名清凉饮子，东垣） 治消中能食而瘦，口舌干，自汗，大便结燥，小便频数。
升麻（四分） 防风（去芦） 生甘草 汉防己 生地黄（各三分） 当归身（六分） 柴胡 羌活 炙甘草 黄
酒知母 酒黄芩（各一钱） 酒草龙胆 石膏 黄柏（各一钱五分） 红花（少许） 桃仁（十个，另研） 杏仁
（十个，研）
上细切，作一服，水二盏，煎至一盏，加酒一匙，稍热服。
辛润缓肌汤（一名清神补气汤，东垣） 前消渴症才愈，止有口干腹不能努，此药主之。
生地黄 细辛（各一分） 熟地黄 石膏（各四钱） 黄柏（酒洗） 黄连 生甘草 知母（各五分） 柴胡（去
芦）
当归身 荆芥穗（各一钱） 升麻（一钱五分） 桃仁泥 防风（各一钱） 红花（少许） 杏仁（六个，另研） 小
椒（二粒，炒出汗）
上细切，作一服，水二盏，煎至一盏，稍热食远服。
生津甘露饮子 治消渴，上下齿皆麻，舌根强硬肿痛，食不能下，时有腹胀，或泄黄如糜，名曰飧泄，浑身色
黄，目睛黄甚，四肢痿弱，前阴如水，尻臀腰背寒，面生黧色，胁下急痛，善嚏，喜怒不常，健忘。
藿香（二分） 柴胡 黄连 木香（各三分） 白葵花 麦门冬（去心） 当归身（酒洗） 兰香（各五分） 荜
澄茄 生甘草 山栀子 白豆仁 白芷 连翘 姜黄（各一钱） 石膏（一钱二分） 杏仁（去皮尖） 酒黄柏（各一
钱五分） 炙甘草 酒知母 升麻 人参（各二钱） 桔梗（三钱） 全蝎（五个，去毒）
上为细末，汤浸蒸饼和匀成剂，捏作片子，日中晒半干，擦碎如黍米颗大，每服一钱，津唾下，或白汤送下，食远
服。
黄 饮（东垣） 治三消。
黄 （蜜炙，六两） 炙甘草（一两）
上细切，每服二钱，水煎服。
六味地黄丸（方见虚损门。）
人参白术汤（东垣） 治胃膈瘅热烦满，饥不欲食，瘅成为消中，善食而瘦，燥热郁甚而成消渴，多饮水而小
便数。兼疗一切阴虚阳实，风热燥郁，头目昏眩，中风偏枯，酒过积毒，肠胃燥涩，并伤寒杂病产后烦渴，气液不得宣
通。
人参 白术 当归 芍药 大黄（酒浸纸裹煨） 栀子（炒） 荆芥穗 薄荷 桔梗 知母 泽泻（各五钱） 茯
苓（去皮） 连翘 栝蒌根 干葛（各一两） 甘草（三两） 藿香叶 青木香 官桂（各二钱） 石膏（四两） 寒
水石（二两） 白滑石（半斤）
上为细末，每服抄五钱，水一盏，入芒硝半两，生姜三片，煎至半盏绞汁，入蜜少许，温服，渐加至十余钱，得脏
腑流利取效。如常服，以意加减。如肠胃郁结，湿热内甚自利者，去大黄、芒硝服。
绛雪散（东垣） 治消渴、饮水无度、小便数者，大有神效。
黄芩（酒炒） 黄丹（炒飞） 汉防己 栝蒌实（各等分）
上为细末，每服二钱，温浆水调下，临卧时并进三服即止。
人参散（东垣） 治肾消善饮，而小便频数，白浊如膏。
人参（一分） 白术 泽泻 栝蒌根 桔梗 栀子 连翘（各二分） 葛根 黄芩 大黄（酒浸，纸裹煨） 薄荷 白
茯苓（各五分） 甘草（七分） 石膏（一钱） 滑石 寒水石（各一钱五分） 缩砂（少许）
上细切，作一服，为末，水一盏半，煎至一盏，入蜜少许，再煎三两沸，肾消食前服，上消食后服。
大黄甘草饮子（河间） 治男子妇人一切消渴不能止者。
大豆（五升，先煮二、三沸，出火去苦，水再煮） 大黄（一两五钱） 甘草（四两，长四指， 捶碎）
上用井水一桶，将前药同煮三五时，如稠粘更添水煮，豆软为度，盛于盆中放冷，令病患食豆，渴饮汤汁，无时候。
食尽，如燥渴止，罢药；未止，根据前再煮食之，不过三剂，其病悉愈。
麦门冬饮子（河间） 治心移热于肺，名曰膈消，心膈有热，久则引饮为消渴。
麦门冬（去心，一钱） 栝蒌根 知母 甘草 五味子 生地黄 人参 葛根 茯神（各一钱五分）
上细切，作一服，加竹叶七片，用水一盏，煎至七分，温服。
（丹溪活套）云∶三消者，多属血虚不生津液，俱宜四物汤为主治。上消者，本方加人参、五味子、麦门冬、天花
粉煎，入生藕汁、生地黄汁、人乳。饮酒人，加生葛汁。中消者，本方加知母、石膏、滑石、寒水石，以降胃火。下消
者，本方加黄柏、知母、熟地黄、五味子之类，以滋肾水，又间当饮缫丝汤为上策。
（祖传方）
原蚕茧汤 治肾消白浊，及上中二消，饥渴不生肌肉，其效如神。盖此物属火，有阴之用，大能泻膀胱中相火，
引阴水上潮于口而不渴也。
原蚕（即再养晚蚕也，其缫丝汤极效。如无缫丝汤，以茧壳、丝绵煎汤，皆可代之。）
论
《黄帝内经》说：阳明经气机郁结，称为“消”。又说：热邪炽盛发展为“消中”。李东垣说：所谓二阳，指的是阳明经。手阳明大肠经主管津液，如果津液耗伤，就会出现眼睛发黄、口干的症状，这是津液不足的表现。足阳明胃经主管血液，如果胃中有热，就会消化食物过快、容易饥饿，血中潜伏着火邪，这是血液不足的表现。郁结是因为津液不足，郁结导致无法滋润，这些都是由燥热引起的疾病。这是因为长期食用甜美肥腻的食物，导致体内气机上溢，转化为消渴病，治疗应当使用兰草类药物，以去除体内的陈腐之气。不可服用膏粱厚味、芳草及金石类药物，因为这些药性猛烈，会助长燥热。
岐伯说：脉象实大且病程长久，可以治疗；脉象弦细且病程长久，难以治疗。应当分上、中、下三消来分别治疗。上消（高消），表现为舌面红赤裂纹，极度口渴想喝水，《内经》说心将热邪转移给肺，传变为膈消，就是这种情况，用白虎加人参汤治疗。中消，表现为吃得多却消瘦，自汗出，大便干硬，小便频数，王叔和说口干想喝水，多吃但感觉虚饥，热邪炽盛发展为消中，就是这种情况，用调胃承气汤、三黄丸治疗。下消，表现为烦渴想喝水，耳廓焦枯干燥，小便像脂膏一样浑浊，王叔和说焦躁烦渴水液易亏，这就是肾消，用六味地黄丸治疗。《太平惠民和剂局方》所谓病情末期，如果能吃东西的，一定会发生脑疽或背痈；如果不能吃东西的，一定会发展为腹部胀满膨胀，这些都是不治之症。张洁古将三消分开治疗，能吃东西且口渴的，用白虎加人参汤；不能吃东西且口渴的，用钱氏白术散加倍葛根治疗，上中二消平复后，就不会再传变为下消了。先贤用药，确实大有深意啊。然而脏腑有位置远近之分，也应当斟酌处理。如心肺位置较近，宜减小服药剂量；肾肝位置较远，宜增大服药剂量，这都是为了使药力到达病所。如果过量或不足，都是在惩罚没有过错的地方（即损伤正常组织）。如上消、中消治疗过于急切，药力迅速通过病所，久而久之会导致中满的病证，正所谓上部的热邪未除，中部的寒邪又生，这不是药的罪过，而是失去了缓急适度的法度，治疗这种疾病的人应该仔细审察。
脉法
《脉经》说：厥阴经发病，症状为消渴，气向上冲撞心脏，心中疼痛且有灼热感，感到饥饿但不想吃东西，吃了就呕吐，如果用泻下法，腹泻不会停止。（《伤寒论·厥阴篇》说：吃东西吐蛔虫，用泻下法则腹泻不止。）寸口脉浮而迟，浮表示虚证，迟表示劳损，浮表示卫气不足，迟表示营气枯竭。趺阳脉浮而数，浮表示气盛，数表示消化食物快且大便坚硬（《金匮要略》作“消谷而大坚”），气盛则小便频数，小便频数则大便坚硬（《金匮要略》作“坚”），紧脉与数脉相搏结，就会形成消渴病。男子患消渴病，小便反而增多，喝一斗水，排出一斗尿，用肾气丸主治。心脉滑表示口渴（滑脉是阳气胜的表现），心脉微小表示消瘅。患消瘅，脉象实大且病程长久可治，脉象悬小坚急且病程长久不可治。脉象数大的可生，沉小的可生；脉象实而坚大的死，脉象细而浮短的死。
方法
朱丹溪说：以养肺、降火、生血为主，分上、中、下三消治疗。上消属于肺，多饮水而少食，大小便正常。中消属于胃，饮食多而小便赤黄。下消属于肾，小便浑浊淋漓像脂膏一样。
基本大法：黄连、天花粉两味药研成末，用藕汁、人乳汁、生地黄汁，佐以蜂蜜、姜汁熬制成膏，混合这两味药末，含在舌上，慢慢用少量白开水送下。能吃东西的，加石膏。
猪肚丸
黄连（五两） 麦门冬（去心） 知母（去毛） 栝蒌根（各四两）
以上药物研成细末，放入雄猪肚内缝合，蒸熟后趁热在石臼中捣烂，如果太干加入炼蜜，制成梧桐子大小的丸药，每次服用一百丸，饭后用米饮送下，可以清心止渴（另一种说法是治疗消中）。
天花粉，是治疗消渴的神药。凡是治疗消渴的药中，严禁使用半夏，也不可发汗。
三消病，琼玉膏最为巧妙。（方剂见咳嗽门。）
（以上是丹溪的方法共五条）
和血益气汤（李东垣） 治疗口干舌干，小便频数，舌上有红色脉络。此药生津液，消除干燥，促进肌肉生长。
柴胡 炙甘草 生甘草 麻黄根（各三分） 当归梢（酒洗，四分） 知母（酒洗） 汉防己（酒洗） 羌活（各五分） 石膏（六分，另研） 生地黄（酒洗） 黄连（酒洗，各八分） 黄柏（酒洗） 升麻（各一钱） 杏仁（去皮，另研，六分） 红花（少许） 桃仁（去皮，另研，六分）
以上切碎，作为一服量，加水两盏，煎至一盏，去渣温服，忌酒、醋、热性及湿面。
当归润燥汤 治疗消渴，小便多，大便秘涩干燥结硬，燥渴喜欢喝温水，阴茎退缩，舌燥口干，眼涩难睁，以及在暗处看到浮云。
细辛（一分） 生甘草 炙甘草 熟地黄（各三分） 柴胡（去芦，七分） 黄柏（酒洗） 知母（酒洗） 石膏 桃仁泥 当归身 麻仁 防风 荆芥穗（各一钱） 升麻（一钱五分） 红花（少许） 杏仁（七个，另研为泥） 小椒（三粒，炒出汗）
以上切碎，作为一服量，加水两盏，煎至一盏，热服，饭前或饭后较长时间服用，忌辛辣热物。
生津甘露汤（一名清凉饮子，李东垣） 治疗中消能吃东西却消瘦，口舌干燥，自汗，大便结燥，小便频数。
升麻（四分） 防风（去芦） 生甘草 汉防己 生地黄（各三分） 当归身（六分） 柴胡 羌活 炙甘草 黄酒知母 酒黄芩（各一钱） 酒草龙胆 石膏 黄柏（各一钱五分） 红花（少许） 桃仁（十个，另研） 杏仁（十个，研）
以上切碎，作为一服量，加水两盏，煎至一盏，加酒一匙，稍热服。
辛润缓肌汤（一名清神补气汤，李东垣） 前次消渴症刚愈，仅剩口干腹软无力努责，此药主治。
生地黄 细辛（各一分） 熟地黄 石膏（各四钱） 黄柏（酒洗） 黄连 生甘草 知母（各五分） 柴胡（去芦）
当归身 荆芥穗（各一钱） 升麻（一钱五分） 桃仁泥 防风（各一钱） 红花（少许） 杏仁（六个，另研） 小椒（二粒，炒出汗）
以上切碎，作为一服量，加水两盏，煎至一盏，稍热，饭前或饭后较长时间服用。
生津甘露饮子 治疗消渴，上下牙齿皆麻木，舌根强硬肿痛，食物咽不下去，时常腹胀，或泄泻黄色如粥状，名叫飧泄，浑身颜色发黄，眼睛黄得很厉害，四肢痿弱，前阴流水，尻臀腰背寒冷，面色黧黑，胁下急痛，爱打喷嚏，喜怒无常，健忘。
藿香（二分） 柴胡 黄连 木香（各三分） 白葵花 麦门冬（去心） 当归身（酒洗） 兰香（各五分） 荜澄茄 生甘草 山栀子 白豆仁 白芷 连翘 姜黄（各一钱） 石膏（一钱二分） 杏仁（去皮尖） 酒黄柏（各一钱五分） 炙甘草 酒知母 升麻 人参（各二钱） 桔梗（三钱） 全蝎（五个，去毒）
以上研成细末，用汤浸泡蒸饼调和均匀成剂，捏成片状，中午晒半干，擦碎如黍米大小，每次服用一钱，用津唾送下，或用白开水送下，饭前或饭后较长时间服用。
黄芪饮（李东垣） 治疗三消。
黄芪（蜜炙，六两） 炙甘草（一两）
以上切碎，每次服用二钱，水煎服。
人参白术汤（李东垣） 治疗胃膈热盛烦闷，饥饿但不想进食，热邪炽盛发展为消中，吃得多却消瘦，燥热郁结严重而成消渴，多饮水而小便频数。兼治一切阴虚阳实，风热燥郁，头目昏眩，中风偏瘫，饮酒积毒，肠胃燥涩，以及伤寒杂病产后烦渴，气液不得宣通。
人参 白术 当归 芍药 大黄（酒浸纸裹煨） 栀子（炒） 荆芥穗 薄荷 桔梗 知母 泽泻（各五钱） 茯苓（去皮） 连翘 栝蒌根 干葛（各一两） 甘草（三两） 藿香叶 青木香 官桂（各二钱） 石膏（四两） 寒水石（二两） 白滑石（半斤）
以上研成细末，每次取五钱，加水一盏，入芒硝半两，生姜三片，煎至半盏，绞取汁液，入少许蜂蜜，温服，逐渐增加至十余钱，直到脏腑通畅见效。如常服，根据情况加减。如肠胃郁结，湿热内盛自利的，去掉大黄、芒硝服用。
绛雪散（李东垣） 治疗消渴、饮水无度、小便频数的，大有神效。
黄芩（酒炒） 黄丹（炒飞） 汉防己 栝蒌实（各等分）
以上研成细末，每次服用二钱，温浆水调下，临睡前同时服用三次即止。
人参散（李东垣） 治疗肾消善饮，而小便频数，白浊像脂膏一样。
人参（一分） 白术 泽泻 栝蒌根 桔梗 栀子 连翘（各二分） 葛根 黄芩 大黄（酒浸，纸裹煨） 薄荷 白茯苓（各五分） 甘草（七分） 石膏（一钱） 滑石 寒水石（各一钱五分） 缩砂（少许）
以上切碎，作为一服量，研成末，加水一盏半，煎至一盏，入少许蜂蜜，再煎两三沸，肾消在饭前服，上消在饭后服。
大黄甘草饮子（刘河间） 治疗男子妇人一切消渴不能止的。
大豆（五升，先煮二、三沸，捞出弃去苦水，再加水煮） 大黄（一两五钱） 甘草（四两，长四指，捶碎）
以上用井水一桶，将上述药物同煮三五个时辰，如果变稠粘稠再加水煮，直到豆子软烂为止，盛在盆中放冷，让病人吃豆子，渴时喝汤汁，不限时候。吃完后，如果燥渴停止，停药；未停止，照前面方法再煮再吃，不超过三剂，其病全部痊愈。
麦门冬饮子（刘河间） 治疗心移热于肺，名叫膈消，心膈有热，久了则引水自救成为消渴。
麦门冬（去心，一钱） 栝蒌根 知母 甘草 五味子 生地黄 人参 葛根 茯神（各一钱五分）
以上切碎，作为一服量，加竹叶七片，用水一盏，煎至七分，温服。
（丹溪活套）说：三消病，多属于血虚不能生津液，都适宜以四物汤为主治。上消者，本方加人参、五味子、麦门冬、天花粉煎煮，加入生藕汁、生地黄汁、人乳。喝酒的人，加生葛汁。中消者，本方加知母、石膏、滑石、寒水石，以降胃火。下消者，本方加黄柏、知母、熟地黄、五味子之类，以滋肾水，又间或饮用缫丝汤为上策。
（祖传方）
原蚕茧汤 治疗肾消白浊，以及上中二消，饥渴不生肌肉，其效果如神。因为此物属火，具有阴的作用，大能泻膀胱中的相火，引导阴水上潮于口而不渴。
原蚕（即再养晚蚕也，其缫丝汤极效。如无缫丝汤，以茧壳、丝绵煎汤，皆可代之。）
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Obstruction in the Yangming channels is called Xiao." It also says: "Dian heat develops into Xiaozhong." Li Dongyuan stated: The so-called two Yangs refer to the Yangming channels. The Hand-Yangming Large Intestine channel governs body fluids; if these are consumed, yellowing of the eyes and dry mouth occur, indicating a deficiency of body fluids. The Foot-Yangming Stomach channel governs blood; if there is heat, it leads to rapid digestion and easy hunger, with latent fire in the blood, indicating a deficiency of blood. Obstruction arises from a deficiency of body fluids, leading to a lack of moistening; all such conditions are diseases caused by dryness-heat. This results from frequently consuming sweet and fatty foods, causing Qi to overflow upwards and transform into Xiaoke (Wasting-Thirst). Treatment should employ Orchid-type herbs to eliminate stale Qi. One must not consume rich pastes, thick meats, aromatic herbs, or mineral drugs, as their fierce nature can assist dryness-heat.
Qibo stated: 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. Treatment should be divided according to Upper, Middle, and Lower Xiao. Upper Xiao (Gao Xiao) presents with red cracks on the tongue, extreme thirst with desire to drink. The Classic states that when Heart transfers heat to the Lung, it transmits to become Ge Xiao (Diaphragm Xiao), which is this condition; treat with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction). Middle Xiao presents with polyphagia yet emaciation, spontaneous sweating, hard stools, and frequent urination. Wang Shuhe stated that dry mouth with desire to drink, eating much but feeling empty hunger, and Dian heat developing into Xiaozhong, is this condition; treat with Tiaoweichengqi Tang (Regulate the Stomach and Order the Qi Decoction) and Sanhuang Wan (Three Yellows Pill). Lower Xiao presents with irritability, thirst with desire to drink, dry and scorched earlobes, and urine turbid like paste. Wang Shuhe stated that scorched irritability and easy depletion of water indicate Shen Xiao (Kidney Xiao); treat with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). The *Taiping Huimin Heji Juzheng Fang* mentions that in the late stage, if the patient can eat, they will inevitably develop brain carbuncles or back sores; if they cannot eat, they will inevitably develop abdominal fullness and distension. These are all untreatable conditions. Zhang Jiegu treated them separately: for those who can eat and are thirsty, use Baihu Jia Renshen Tang; for those who cannot eat and are thirsty, use Qianshi Baizhu San (Childhood Baizhu Powder) with added Gegen (Kudzu Root). Once Upper and Middle Xiao are pacified, transmission to Lower Xiao ceases. The prescriptions of the sages indeed have profound meaning. However, since Zang-Fu organs are at different distances, dosage should be斟酌 (considered carefully). For organs close to the upper body like Heart and Lung, smaller doses are appropriate; for organs far away like Kidney and Liver, larger doses are appropriate. This ensures the medicinal force reaches the disease site. Overdosing or underdosing punishes the innocent tissue. If Upper or Middle Xiao are treated too hastily, the medicine passes the disease site quickly, eventually causing Zhongman (Middle Fullness) disease. This is precisely what is meant by "Upper heat not removed, Middle cold arises." This is not the fault of the medicine, but a failure to observe the proper balance of speed and slowness. Practitioners treating this disease must examine this carefully.
Pulse Diagnosis
The *Maijing* (Classic of Pulse Diagnosis) states: "Jueyin disease manifests as Xiaoke, Qi rushing up to the heart, pain and heat in the heart, hunger without desire to eat, vomiting after eating, and diarrhea that does not stop after purgation." (*Shanghan Lun Jueyin Chapter* notes: "Eating causes vomiting of roundworms; purgation causes unceasing diarrhea.") The Cun (Inch) pulse floating and slow indicates floating as deficiency and slow as labor/exhaustion; floating indicates insufficiency of Wei Qi, and slow indicates exhaustion of Ying Qi. The Yuyang (Foot Yangming) pulse floating and rapid indicates floating as Qi excess and rapid as rapid digestion with hard stools (*Jingui Yaolue* reads "rapid digestion with large hardness"); Qi excess leads to frequent urination, and frequent urination leads to hard stools (*Jingui Yaolue* reads "hardness"). The interplay of tight and rapid pulses forms Xiaoke. In men with Xiaoke, urination increases disproportionately; drinking one dou produces one dou of urine; treat with Shenqi Wan (Kidney Qi Pill). A slippery Heart pulse indicates thirst (slipperiness indicates Yang excess); a minute and small Heart pulse indicates Xiaodan (Wasting-Thirst). For Xiaodan, an excess pulse with long duration is treatable; a hanging, small, tight, and urgent pulse with long duration is untreatable. A rapid and large pulse indicates survival; a deep and small pulse indicates survival. An excess and large pulse indicates death; a fine, floating, and short pulse indicates death.
Methods
Zhu Danxi stated: The main approach is to nourish the Lung, descend Fire, and generate Blood, treating Upper, Middle, and Lower Xiao separately. Upper Xiao involves the Lung: drinking much water but eating little, with normal bowel movements and urination. Middle Xiao involves the Stomach: eating much with dark yellow urine. Lower Xiao involves the Kidney: turbid, dripping urine resembling paste.
General Method: Huanglian (Coptis Rhizome) and Tianhuafen (Trichosanthes Root) ground into powder. Mix with Lotus Root Juice, Human Milk, Shengdihuang Juice, assisted by Honey and Ginger Juice to form a paste. Combine with the two powders, hold on the tongue, and slowly swallow with a little warm water. For those who can eat, add Shigao (Gypsum).
Zhudu Wan (Pig Stomach Pill)
Huanglian (5 liang), Maidong (Ophiopogon Radix, heart removed), Zhimu (Anemarrhena Rhizome, hairs removed), Gualougen (Trichosanthes Root) (each 4 liang).
Grind into fine powder. Place inside a male pig stomach, sew shut, steam until cooked. While hot, pound in a stone mortar. If too dry, add refined honey. Form pills the size of paulownia seeds. Take 100 pills per dose after meals with rice wash. Clears Heart heat and stops thirst (another view says treats Xiaozhong).
Tianhuafen is the sacred herb for treating Xiaoke. In formulas for Xiaoke, Banxia (Pinellia Tuber) is strictly prohibited, and diaphoresis (sweating methods) should not be used.
For the Three Xiao disorders, Qiongyu Gao (Jade Nectar Paste) is most excellent. (Formula see Cough Section.)
(Above are five methods from Danxi.)
Hexue Yiqi Tang (Li Dongyuan) Treats dry mouth and tongue, frequent urination, and red vessels on the tongue. This formula generates body fluids, removes dryness, and promotes muscle growth.
Chaihu (Bupleurum Root), Zhi Gancao (Prepared Licorice Root), Sheng Gancao (Raw Licorice Root), Mahuanggen (Ephedra Root and Rhizome) (each 3 fen), Dangguishaoshao (End of Angelica Sinensis Root, wine-washed) (4 fen), Zhimu (Anemarrhena Rhizome, wine-washed), Hanfangji (Stephania Tetrandra Root, wine-washed), Qianghuo (Notopterygium Rhizome) (each 5 fen), Shigao (Gypsum Fibrosum, 6 fen, ground separately), Shengdihuang (Rehmannia Root, wine-washed), Huanglian (Coptis Rhizome, wine-washed) (each 8 fen), Huangbai (Phellodendron Bark, wine-washed), Shengma (Cimicifuga Rhizome) (each 1 qian), Xingren (Apricot Seed, skin removed, ground separately, 6 fen), Honghua (Carthamus Flower) (a little), Taoren (Peach Kernel, skin removed, ground separately, 6 fen).
Cut finely. As one dose, add 2 zhan of water, decoct to 1 zhan. Strain and take warm. Avoid alcohol, vinegar, hot foods, and damp noodles.
Danggui Runzao Tang (Angelica Moistening Dryness Decoction) Treats Xiaoke, frequent urination, constipation with dry and hard stools, dry thirst preferring warm drinks, retraction of the penis, dry tongue and mouth, dry eyes difficult to open, and seeing floating clouds in dark places.
Xixin (Asarum Root), Sheng Gancao, Zhi Gancao, Shudihuang (Prepared Rehmannia Root) (each 3 fen), Chaihu (Bupleurum Root, rhizome removed, 7 fen), Huangbai (Phellodendron Bark, wine-washed), Zhimu (Anemarrhena Rhizome, wine-washed), Shigao (Gypsum Fibrosum), Taoren Ni (Peach Kernel Paste), Dangguishen (Body of Angelica Sinensis Root), Huren (Hemp Seed), Fangfeng (Saposhnikovia Root), Jingjiesui (Schizonepeta Spike) (each 1 qian), Shengma (Cimicifuga Rhizome, 1.5 qian), Honghua (Carthamus Flower) (a little), Xingren (Apricot Seed, 7 pieces, ground into paste), Xiao Jiao (Small Pepper, 3 grains, stir-fried to release moisture).
Cut finely. As one dose, add 2 zhan of water, decoct to 1 zhan. Take hot, far from meals. Avoid spicy and hot foods.
Shengjin Ganlu Tang (Generating Fluids Sweet Dew Decoction, also known as Qingliang Yinzi, Li Dongyuan) Treats Middle Xiao with polyphagia and emaciation, dry mouth and tongue, spontaneous sweating, constipation, and frequent urination.
Shengma (Cimicifuga Rhizome, 4 fen), Fangfeng (Saposhnikovia Root, rhizome removed), Sheng Gancao (Raw Licorice Root), Hanfangji (Stephania Tetrandra Root), Shengdihuang (Rehmannia Root) (each 3 fen), Dangguishen (Body of Angelica Sinensis Root, 6 fen), Chaihu (Bupleurum Root), Qianghuo (Notopterygium Rhizome), Zhi Gancao (Prepared Licorice Root), Huangjiu Zhimu (Anemarrhena Rhizome with Yellow Wine), Jiuhuangqin (Scutellaria Root with Yellow Wine) (each 1 qian), Jiucaslongdan (Gentiana Root with Yellow Wine), Shigao (Gypsum Fibrosum), Huangbai (Phellodendron Bark) (each 1.5 qian), Honghua (Carthamus Flower) (a little), Taoren (Peach Kernel, 10 pieces, ground separately), Xingren (Apricot Seed, 10 pieces, ground).
Cut finely. As one dose, add 2 zhan of water, decoct to 1 zhan. Add 1 spoon of wine. Take slightly warm.
Xinrun Huanji Tang (Acrid-Moistening Muscle-Slowing Decoction, also known as Qingshen Buzhi Tang, Li Dongyuan) Used when previous Xiaoke symptoms have just resolved, leaving only dry mouth and inability to strain abdomen.
Shengdihuang (Rehmannia Root), Xixin (Asarum Root) (each 1 fen), Shudihuang (Prepared Rehmannia Root), Shigao (Gypsum Fibrosum) (each 4 qian), Huangbai (Phellodendron Bark, wine-washed), Huanglian (Coptis Rhizome), Sheng Gancao (Raw Licorice Root), Zhimu (Anemarrhena Rhizome) (each 5 fen), Chaihu (Bupleurum Root, rhizome removed).
Dangguishen (Body of Angelica Sinensis Root), Jingjiesui (Schizonepeta Spike) (each 1 qian), Shengma (Cimicifuga Rhizome, 1.5 qian), Taoren Ni (Peach Kernel Paste), Fangfeng (Saposhnikovia Root) (each 1 qian), Honghua (Carthamus Flower) (a little), Xingren (Apricot Seed, 6 pieces, ground separately), Xiao Jiao (Small Pepper, 2 grains, stir-fried to release moisture).
Cut finely. As one dose, add 2 zhan of water, decoct to 1 zhan. Take slightly warm, far from meals.
Shengjin Ganlu Yinzi (Generating Fluids Sweet Dew Drink) Treats Xiaoke with numbness in upper and lower teeth, stiff and swollen painful tongue root, inability to swallow food, occasional abdominal distension, or yellow loose stool like porridge named Sunxie (Undigested Food Diarrhea), whole body yellowing, severe eye yellowing, flaccid limbs, clear fluid from anterior yin, coldness in sacrum, buttocks, waist, and back, dark complexion, acute pain in hypochondrium, frequent sneezing, irregular mood, and forgetfulness.
Huoxiang (Patchouli Herb), Chaihu (Bupleurum Root), Huanglian (Coptis Rhizome), Muxiang (Aucklandia Root) (each 3 fen), Bai Kuihua (White Chrysanthemum Flower), Maidong (Ophiopogon Radix, heart removed), Dangguishen (Body of Angelica Sinensis Root, wine-washed), Lanxiang (Costus Root) (each 5 fen), Bichengqie (Long Pepper Fruit), Sheng Gancao (Raw Licorice Root), Shanzhizi (Gardenia Fruit), Bairdouren (Cardamom Seed), Baizhi (Angelica Dahurica Root), Lianqiao (Forsythia Fruit), Jianghuang (Turmeric Rhizome) (each 1 qian), Shigao (Gypsum Fibrosum, 1.2 qian), Xingren (Apricot Seed, skin and tip removed), Jiuhuangbai (Phellodendron Bark with Yellow Wine) (each 1.5 qian), Zhi Gancao (Prepared Licorice Root), Jiuzhimu (Anemarrhena Rhizome with Yellow Wine), Shengma (Cimicifuga Rhizome), Renshen (Ginseng Root) (each 2 qian), Jiegeng (Platycodon Root, 3 qian), Quanxie (Whole Scorpion, 5 pieces, detoxified).
Grind into fine powder. Soak steamed wheat dough in decoction, mix evenly into a mass. Shape into slices, sun-dry halfway through the day. Rub into pieces the size of millet seeds. Take 1 qian per dose, swallowed with saliva or warm water, far from meals.
Huangqi Yin (Astragalus Drink, Li Dongyuan) Treats the Three Xiao.
Huangqi (Astragalus Root, honey-fried, 6 liang), Zhi Gancao (Prepared Licorice Root, 1 liang).
Cut finely. Take 2 qian per dose, decoct in water.
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (Formula see Deficiency Damage Section.)
Renshen Baizhu Tang (Ginseng and Atractylodes Macrocephala Decoction, Li Dongyuan) Treats Stomach and Diaphragm heat with vexation and fullness, hunger without desire to eat, Dian heat developing into Xiaozhong, polyphagia with emaciation, severe dryness-heat stagnation transforming into Xiaoke, excessive drinking with frequent urination. Also treats all Yin deficiency with Yang excess, wind-heat dryness stagnation, dizziness and vertigo, hemiplegia from stroke, alcohol accumulation toxicity, dry and rough intestines and stomach, postpartum thirst from cold damage and miscellaneous diseases, and obstruction of Qi and fluids.
Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), Danggui (Angelica Sinensis Root), Shaoyao (Peony Root), Dahuang (Rhubarb Root, wine-soaked and wrapped in paper then baked), Zhizi (Gardenia Fruit, fried), Jingjiesui (Schizonepeta Spike), Bohe (Mint Herb), Jiegeng (Platycodon Root), Zhimu (Anemarrhena Rhizome), Zexie (Alisma Rhizome) (each 5 qian), Fuling (Poria, peeled), Lianqiao (Forsythia Fruit), Gualougen (Trichosanthes Root), Gange (Kudzu Root) (each 1 liang), Gancao (Licorice Root, 3 liang), Huoxiangye (Patchouli Leaf), Qingmuxiang (Aucklandia Root), Guanzi Gui (Cinnamon Bark) (each 2 qian), Shigao (Gypsum Fibrosum, 4 liang), Hanshuishi (Arctite, 2 liang), Bai Huashi (White Talc, half jin).
Grind into fine powder. Take 5 qian per dose, add 1 zhan of water, Mangxiao (Mirabilite, half liang), 3 slices of fresh ginger. Decoct to half a zhan, squeeze juice, add a little honey, take warm. Gradually increase to over 10 qian until bowels and viscera flow smoothly and effect is achieved. For regular use, adjust according to judgment. If intestinal stagnation with severe internal damp-heat and spontaneous diarrhea, remove Dahuang and Mangxiao.
Jiangxue San (Crimson Snow Powder, Li Dongyuan) Treats Xiaoke with unlimited drinking and frequent urination; highly effective.
Huangqin (Scutellaria Root, wine-fried), Huangdan (Lead Monoxide, fried and flown), Hanfangji (Stephania Tetrandra Root), Gualoushi (Trichosanthes Fruit) (equal parts).
Grind into fine powder. Take 2 qian per dose, mixed with warm sour plum water. Take three doses simultaneously at bedtime, then stop.
Renshen San (Ginseng Powder, Li Dongyuan) Treats Kidney Xiao with excessive drinking, frequent urination, and white turbidity like paste.
Renshen (Ginseng Root, 1 fen), Baizhu (Atractylodes Macrocephala Rhizome), Zexie (Alisma Rhizome), Gualougen (Trichosanthes Root), Jiegeng (Platycodon Root), Zhizi (Gardenia Fruit), Lianqiao (Forsythia Fruit) (each 2 fen), Gegen (Kudzu Root), Huangqin (Scutellaria Root), Dahuang (Rhubarb Root, wine-soaked and wrapped in paper then baked), Bohe (Mint Herb), Bai Fuling (Poria) (each 5 fen), Gancao (Licorice Root, 7 fen), Shigao (Gypsum Fibrosum, 1 qian), Huashi (Talcum), Hanshuishi (Arctite) (each 1.5 qian), Suosha (Amomum Fruit) (a little).
Cut finely. As one dose, grind into powder. Add 1.5 zhan of water, decoct to 1 zhan. Add a little honey, boil for two or three boils. Take before meals for Kidney Xiao, after meals for Upper Xiao.
Dahuang Gancao Yinzi (Rhubarb and Licorice Drink, Liu Hejian) Treats all cases of Xiaoke in men and women that cannot be stopped.
Daydou (Soybean, 5 sheng, boil for 2-3 boils, remove bitter water, boil again), Dahuang (Rhubarb Root, 1.5 liang), Gancao (Licorice Root, 4 liang, 4 fingers long, crushed).
Use one bucket of well water. Boil the above medicines together for 3-5 hours. If it becomes thick and sticky, add more water. Stop when beans are soft. Pour into a basin and cool. Let the patient eat the beans. When thirsty, drink the soup at any time. After finishing, if dry thirst stops, discontinue medicine. If not stopped, boil and eat again as before. Within three doses, the disease will completely heal.
Maidong Yinzi (Ophiopogon Drink, Liu Hejian) Treats Heart transferring heat to the Lung, named Ge Xiao (Diaphragm Xiao). Heat in Heart and Diaphragm, prolonged leading to excessive drinking becoming Xiaoke.
Maidong (Ophiopogon Radix, heart removed, 1 qian), Gualougen (Trichosanthes Root), Zhimu (Anemarrhena Rhizome), Gancao (Licorice Root), Wuweizi (Schisandra Berry), Shengdihuang (Rehmannia Root), Renshen (Ginseng Root), Gegen (Kudzu Root), Fushen (Poria with Hostwood) (each 1.5 qian).
Cut finely. As one dose, add 7 leaves of Zhu Ye (Bamboo Leaf). Use 1 zhan of water, decoct to 70%. Take warm.
(Danxi Flexible Methods) states: The Three Xiao disorders mostly belong to Blood deficiency failing to generate body fluids. All should primarily treat with Siwu Tang (Four Substance Decoction). For Upper Xiao, add Renshen (Ginseng Root), Wuweizi (Schisandra Berry), Maidong (Ophiopogon Radix), Tianhuafen (Trichosanthes Root) to the base formula, decoct, and add fresh Lotus Root Juice, Shengdihuang Juice, and Human Milk. For drinkers, add fresh Gegen Juice. For Middle Xiao, add Zhimu (Anemarrhena Rhizome), Shigao (Gypsum Fibrosum), Huashi (Talcum), Hanshuishi (Arctite) to the base formula to descend Stomach Fire. For Lower Xiao, add Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Shudihuang (Prepared Rehmannia Root), Wuweizi (Schisandra Berry) to the base formula to nourish Kidney Water. Occasionally, drinking Silk Reeling Soup is the best strategy.
(Ancestral Formula)
Yuancan Jian Tang (Silkworm Cocoon Decoction) Treats Kidney Xiao with white turbidity, and Upper and Middle Xiao with hunger/thirst failing to generate muscle. Effect is miraculous. This substance belongs to Fire but has Yin function; it greatly drains Ministerial Fire in the Bladder and guides Yin water upward to the mouth to stop thirst.
Yuancan (Refers to the second-generation late silkworm; its silk-reeling soup is extremely effective. If silk-reeling soup is unavailable, boiling cocoon shells and silk floss in water can substitute.)