知柏八味丸（即六味丸加知母、黄柏）
河间秘真丸 治白淫，小便不止，精气不固。或有余沥，及梦寐阴人通泄。
龙骨（一两） 大诃子皮（五枚） 缩砂仁（半两） 朱砂（一两，研细、留一分为衣）
上为末。面糊丸，绿豆大。每服一二十丸。空心温酒、热水任下。不可多服。
猪肚丸 治醉饱后遗精，神效。
牡蛎（ 、另研极细） 白术（各四两） 苦参（三两） 猪肚一具（煮极烂、去油膜、捣如泥）
上前三味，捣筛极细。同猪肚捣数百杵，令极匀。燥略增肚汁。丸如桐子大。
每服五十丸，空心米饮送下。不但治遗滑，即劳瘦者，亦能肥也。
清心莲子饮（见第四十九）
萆 厘清饮 治真元不固，不时白浊，或小便频数，凝如膏糊等证。
益智仁 川萆 石菖蒲 乌药（各等分）
上 咀。每服四钱。水一盏，入盐一捻，煎七分。食前温服。一方加茯苓、甘
草。
六味丸（见第十六）
钱氏导赤散（见第四十九）
六一散（见第四十四）
三消之脉，浮大者生。细小微涩，形脱可惊。
三消者，上中下也。渴而多饮为上消。《素问》气厥论谓之膈消。（宜金匮猪苓汤、人参
白虎汤、子和加减三黄丸、凉膈散、酒煮黄连丸、六一散之类。）消谷善饥为中消。《素问》脉
要精微论谓之消中。（宜酒煮黄连丸、大黄黄连泻心汤、山栀、黄连之类。）渴而便数有膏为下消。
《素问》气厥论谓之肺消。饮一溲二，后人又谓之肾消。（宜六味丸、固本丸、知柏八味丸之类。）
娄全善亦云∶肾消者，饮一溲二。其溲如膏油，即膈消、消中之传变。总不外火烁真阴，津液燥
竭。自古论之者多矣，惟刘河间、张戴人二论，辞义畅达，最为中綮。兹录于下。
河间曰∶五脏六腑四肢，皆禀气于脾胃。行其津液，以濡润养之。然消渴之病，本
湿寒之阴气极衰，燥热之阳气太盛故也。治当补肾水阴寒之虚，而泻心火阳热之实。
除肠胃燥热之甚，济身中津液之衰，使道路散而不结，津液生而不枯，气血和而不
涩。则病自已矣。况消渴者，因饮食服饵之失宜，肠胃干涸，而气不得宣平；或精
神过违其度而耗乱之；或因大病，阴气损而血液衰，虚阳 悍，而燥热郁甚之所成
也。若饮水多而小便多，名曰消渴。若饮食多，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。一皆以燥热太甚，三焦
肠胃之腠理，怫郁结滞，致密壅滞，复多饮于中，终不能浸润于外，荣养百骸，故
渴不止，小便多出或数溲也。戴人之论，则曰火能消物，燔木则为炭，燔金则为液，
燔石则为灰，煎海水则为盐，鼎水则干。人之心肾为君火，三焦胆为相火。得其平，
则烹炼饮食，糟粕去焉。不得其平，则燔灼脏腑，而津液耗焉。夫心火甚于上，为
膈膜之消；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，则消及于肝肾。外甚不
已，则消及于筋骨。四脏皆消尽，则心始自焚而死矣。故知消渴一证，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，则病已而复作。能从此三者，消渴
亦不足忧矣。二公此论消渴之因证，可谓既明且悉，不烦再解。但其脉浮大者，尚
属弥漫宽散。前河间云∶使道路散而不结，津液生而不枯，气血和而不涩，则病自
已矣。然非弥漫宽散之气机，不能得此不结、不枯、不涩之病机耳。故云浮大者生。
若脉细小浮涩，则气血之虚衰枯槁，不言可知。再加身体瘦悴，是谓形脱。即戴人
所云木为炭、金为液、石为灰、水为盐、鼎水干之义。形气两败，岂直可惊已哉。
河间秘真丸：治疗白淫，小便淋漓不止，精气不固。或有排尿后余沥不尽，以及在睡梦中与异性交合而泄精的症状。
药材：龙骨（一两）、大诃子皮（五枚）、缩砂仁（半两）、朱砂（一两，研成细粉，留出一分作为药衣）。
制法与用法：将上述药物研为细末，用面糊制成丸剂，大小如绿豆。每次服用一二十丸。空腹时，可用温酒或热水送服。不可过量服用。
猪肚丸：治疗醉酒后饱食导致的遗精，疗效显著。
药材：牡蛎（另研极细）、白术（各四两）、苦参（三两）、猪肚一个（煮至极烂，去除油膜，捣成泥状）。
制法与用法：将前三味药材捣碎筛成极细粉末，与猪肚泥一同捣击数百下，使其极度均匀。若过干可略增加猪肚汁。制成梧桐子大小的丸剂。每次服用五十丸，空腹时用米汤送服。此方不仅能治疗遗精滑泄，即使是因劳损消瘦的人，也能使其肥胖健壮。
清心莲子饮（见第四十九篇）
萆薢分清饮：治疗真元不固，不时出现白浊，或小便频数，尿液凝结如膏糊等症状。
药材：益智仁、川萆薢、石菖蒲、乌药（各等分）。
制法与用法：将药材切碎。每次服用四钱。加水一盏，放入少许盐，煎至七分。饭前温服。另一版本方剂中加入茯苓、甘草。
六味地黄丸（见第十六篇）
钱氏导赤散（见第四十九篇）
六一散（见第四十四篇）
三消病的脉象，若见浮大脉则预后良好（生）。若见细小微涩脉，且形体脱失，则令人惊惧（危）。
所谓三消，分为上消、中消、下消。口渴多饮的为上消。《素问·气厥论》称之为膈消。（适宜选用金匮猪苓汤、人参白虎汤、张子和加减三黄丸、凉膈散、酒煮黄连丸、六一散等方剂。）食欲亢进易饥的中消。《素问·脉要精微论》称之为消中。（适宜选用酒煮黄连丸、大黄黄连泻心汤、山栀、黄连等药物。）口渴且小便频数、尿中有脂膏样的为下消。《素问·气厥论》称之为肺消。饮水一份而小便两份，后人又称之为肾消。（适宜选用六味地黄丸、固本丸、知柏八味丸等方剂。）
娄全善也说：肾消症，饮水一份而小便两份。其尿液像膏油一样，这是膈消、消中病情的传变。总归不外乎是火邪灼伤真阴，导致津液干燥枯竭。自古以来论述此病的人很多，只有刘河间、张戴人两人的论述，文辞义理畅达，最为切中要害。现记录如下。
刘河间说：五脏六腑四肢，都禀受脾胃之气。脾胃运行津液，以滋润滋养身体。然而消渴病的发生，根本原因是湿寒之阴气极度衰弱，燥热之阳气过于旺盛。治疗应当补肾水中阴寒的不足，同时泻除心火阳热的实邪。清除肠胃中严重的燥热，补助身体中衰弱的津液，使经络道路通畅而不郁结，津液生成而不枯槁，气血调和而不涩滞。这样疾病自然痊愈。况且消渴病，是由于饮食服药不当，导致肠胃干涸，气机不能宣通平和；或者是精神过度违背常度而耗乱正气；或者是因为大病之后，阴气受损而血液衰少，虚阳悍烈，导致燥热郁结严重而形成的。如果饮水多而小便也多，称为消渴。如果饮食多，但不怎么口渴，小便次数多且身体消瘦，称为消中。如果口渴且饮水不止，腿部消瘦且小便中有脂液，称为肾消。这一切都是因为燥热太甚，导致三焦肠胃的腠理郁结阻滞，致密壅塞，虽然在中焦摄入大量水分，但最终不能浸润到体表，荣养百骸，所以口渴不止，小便多出或频数。
张戴人的论述则是：火能消耗物体，燃烧木头变成炭，燃烧金属变成液体，燃烧石头变成灰，煎煮海水变成盐，锅里的水则会干涸。人的心肾属于君火，三焦胆属于相火。保持平衡，就能烹炼饮食，排出糟粕。失去平衡，就会燔灼脏腑，导致津液耗损。心火在上部过盛，导致膈膜的消渴；在中部过盛，导致肠胃的消渴；在下部过盛，导致膏液的消渴；在外部过盛，导致肌肉的消渴。上部火热不止，则消渴波及肺部。中部火热不止，则消渴波及脾脏。下部火热不止，则消渴波及肝肾。外部火热不止，则消渴波及筋骨。四个脏器都被消尽，心脏才会自焚而死。所以知道消渴这一证候，只调理而不攻下，只能轻微滋润，确实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，如果不减少美味厚味的摄入，不戒除嗜欲，不节制喜怒情绪，那么病好了也会复发。如果能做到这三点，消渴也就不值得担忧了。这两位先生的关于消渴病因和症状的论述，可以说既明白又详尽，不需要再解释。只是他们的脉象浮大者，尚且属于弥漫宽散的脉象。前面刘河间说：使道路通畅而不郁结，津液生成而不枯槁，气血调和而不涩滞，疾病自然痊愈。然而如果不是这种弥漫宽散的气机状态，就不能得到这种不结、不枯、不涩的病机。所以说浮大脉者预后良好。如果脉象细小浮涩，那么气血的虚衰枯槁，不言而喻。再加上身体瘦弱憔悴，这叫做形脱。也就是张戴人所说的木变成炭、金变成液体、石变成灰、水变成盐、鼎中水干涸的含义。形气和元气都败坏，哪里只是令人惊惧而已呢。
Zhībǎi Bāwèi Wán (Anemarrhena and Phellodendron Eight-Ingredient Pill) (i.e., Liùwèi Wán [Six-Ingredient Rehmannia Pill] added with Zhīmǔ [Anemarrhenae Rhizoma] and Huángbò [Phellodendri Cortex])
Héjiān Mìzhēn Wán (Secret True Pill of Hejian): Treats báiyín [white turbid discharge], continuous non-stop urination, insecurity of essence and qi. Or residual dripping after urination, and nocturnal emission during dreams of sexual intercourse.
Ingredients: Lónggǔ [Dragon Bone] (1 liang), Dàhēzǐ Pí [Pericarpium Terminaliae Chebulae] (5 pieces), Suōshārén [Fructus Amomi Rotundus] (0.5 liang), Zhūshā [Cinnabar] (1 liang, ground to fine powder, reserve 1 fen for coating).
Preparation and Administration: Grind the above ingredients into fine powder. Make pills using wheat paste, size of mung beans. Take 10–20 pills per dose. On an empty stomach, take with warm wine or hot water at will. Do not overdose.
Zhūdù Wán (Pig Stomach Pill): Treats nocturnal emission caused by drunkenness and overeating; highly effective.
Ingredients: Múlì [Ostreae Concha] (separately ground to extreme fineness), Báizhú [Atractylodis Macrocephalae Rhizoma] (4 liang each), Kǔshēn [Sophorae Flavescentis Radix] (3 liang), one pig stomach (boiled until extremely soft, remove oil membrane, mash into paste).
Preparation and Administration: Pound and sieve the first three ingredients to extreme fineness. Mash together with the pig stomach paste for hundreds of strokes until extremely uniform. If too dry, slightly increase the stomach juice. Make pills the size of paulownia seeds. Take 50 pills per dose on an empty stomach, delivered with rice drink. This formula not only treats nocturnal emission and slipping, but can also fatten those who are emaciated due to consumptive disease.
Qīngxīn Liánzǐ Yǐn (Clear Heart Lotus Seed Decoction) (See Chapter 49)
Bìxiē Fēnqīng Yǐn (Dioscorea Hypoglauca Decoction for Clarifying Turbidity): Treats insecurity of primordial yuan, intermittent white turbidity in urine, or frequent urination where urine coagulates like paste.
Ingredients: Yìzhìrén [Fructus Alpiniae Oxyphyllae], Chuānbìxiē [Dioscoreae Hypoglaucae Rhizoma], Shíchāngpú [Rhizoma Acori Tatarinowii], Wùyào [Linderae Radix] (equal parts).
Preparation and Administration: Cut the herbs into small pieces. Take 4 qián per dose. Add one cup of water and a pinch of salt, decoct until reduced to 7/10. Take warm before meals. Another version adds Fúlíng [Poria] and Gāncǎo [Glycyrrhizae Radix et Rhizoma].
Liùwèi Wán (Six-Ingredient Rehmannia Pill) (See Chapter 16)
Qiánshì Dǎochì Sǎn (Child Master's Guide the Red Powder) (See Chapter 49)
Liùyī Sǎn (Six-to-One Powder) (See Chapter 44)
Regarding the pulse of Sānxiāo [Three Excesses]: Floating and large pulses indicate survival (good prognosis). Fine, small, and slightly choppy pulses, accompanied by physical depletion, are alarming (poor prognosis).
Sānxiāo refers to Upper, Middle, and Lower types. Thirst with excessive drinking is Upper Xiāo. The *Suwen* [Basic Questions] chapter "Qi Ju Lun" calls it Géxiāo [Diaphragm Consumption]. (Suitable formulas include Jīnguì Zhūlíng Tāng [Poria Decoction from the Golden Cabinet], Rénshēn Báihǔ Tāng [Ginseng White Tiger Decoction], Hézi Jiǎnjiǎn Sānhuáng Wán [Zhang Zihe's Modified Three-Yellow Pill], Liánggé Sǎn [Cooling Diaphragm Powder], Jiǔzhǔ Huánglián Wán [Wine-Boiled Coptis Pill], Liùyī Sǎn [Six-to-One Powder], etc.). Excessive hunger and rapid digestion is Middle Xiāo. The *Suwen* chapter "Mai Yao Jingwei Lun" calls it Xiāozhōng [Middle Consumption]. (Suitable treatments include Jiǔzhǔ Huánglián Wán [Wine-Boiled Coptis Pill], Dàhuáng Huánglián Xièxīn Tāng [Rhubarb and Coptis Draining Heart Decoction], Shānzhī [Gardeniae Fructus], Huánglián [Coptidis Rhizoma], etc.). Thirst with frequent urination containing lipid-like substance is Lower Xiāo. The *Suwen* chapter "Qi Ju Lun" calls it Fèixiāo [Lung Consumption]. Drinking one part while urinating two parts is later referred to as Shènxiāo [Kidney Consumption]. (Suitable formulas include Liùwèi Wán [Six-Ingredient Rehmannia Pill], Gùběn Wán [Solidify Root Pill], Zhībǎi Bāwèi Wán [Anemarrhena and Phellodendron Eight-Ingredient Pill], etc.).
Lou Quanshan also stated: In Kidney Consumption, one part drunk results in two parts urinated. The urine resembles grease or oil; this is a progression from Diaphragm Consumption and Middle Consumption. Ultimately, it does not exceed fire scorching true yin, leading to dryness and exhaustion of body fluids. Many have discussed this since ancient times, but the theories of Liu Hejian and Zhang Dairen are the most lucid and hit the nail on the head. I record them below.
Hejian said: The five zang and six fu organs, and the four limbs, all receive qi from the spleen and stomach. They circulate body fluids to moisten and nourish the body. However, the root cause of Xiao Ke [Consumption-Thirst Disease] is the extreme deficiency of damp-cold yin qi and the excessive excess of dry-heat yang qi. Treatment should tonify the deficiency of kidney water yin-cold and purge the excess of heart fire yang-heat. Remove severe dry-heat from the intestines and stomach, assist the decline of body fluids, so that pathways remain open and unblocked, body fluids generate without withering, and qi and blood harmonize without stagnation. Then the disease will resolve itself. Moreover, Xiao Ke arises from improper diet and medication, causing intestinal and gastric dryness and preventing qi from circulating smoothly; or from mental/spiritual excess violating natural limits, causing chaos; or following major illness where yin qi is damaged and blood declines, leading to fierce deficient yang and severe郁结 (stagnation) of dry-heat. If drinking is excessive and urination is excessive, it is named Xiao Ke. If food intake is excessive, thirst is mild, urination is frequent, and emaciation occurs, it is named Xiao Zhong. If thirst persists despite constant drinking, legs are emaciated, and urine contains lipid fluid, it is named Shen Xiao. All these result from excessive dry-heat causing obstruction and stagnation in the couli (pores/space between skin and muscle) of the sanjiao and intestines/stomach. Despite heavy fluid intake internally, it cannot moisten externally or nourish the bones. Thus, thirst persists, and urination is excessive or frequent.
Dairen's theory states: Fire consumes objects; burning wood turns it to charcoal, burning metal turns it to liquid, burning stone turns it to ash, boiling seawater yields salt, and water in a tripod dries up. The heart and kidney are Ministerial Fire (Jun Huo), while the sanjiao and gallbladder are Assistant Fire (Xiang Huo). When balanced, they cook food and eliminate waste. When unbalanced, they scorch the zang-fu, consuming body fluids. Excess heart fire in the upper jiao causes diaphragmatic consumption; in the middle jiao, gastrointestinal consumption; in the lower jiao, lipid consumption; on the exterior, muscular consumption. If upper excess continues, consumption spreads to the lungs. If middle excess continues, it spreads to the spleen. If lower excess continues, it spreads to the liver and kidneys. If exterior excess continues, it spreads to sinews and bones. When the four zang organs are consumed, the heart burns itself, leading to death. Therefore, knowing that for Xiao Ke, regulating without purging only provides slight moisture, failing to quell the flaming upward heat. Purging without regulating leads to immediate re-consumption of fluids, failing to irrigate the dry diaphragm. Even if purging and regulating are done, if one does not reduce rich flavors, abstain from desires, and regulate emotions, the disease will recur. If these three precautions are observed, Xiao Ke is no longer a worry. These two masters' discussions on the etiology and symptoms of Xiao Ke are clear and thorough, requiring no further explanation. However, their mention of floating and large pulses refers to a diffuse and expansive pattern. As Hejian said earlier: keeping pathways open, fluids generating, and qi/blood harmonizing leads to recovery. But only a diffuse and expansive qi mechanism can achieve this state of non-stagnation, non-withering, and non-choppy flow. Hence, floating and large pulses indicate life. If the pulse is fine, small, floating, and choppy, the deficiency and withering of qi and blood are evident. Coupled with emaciated and frail physique, this is called Xing Tuo [Physical Depletion]. This aligns with Dairen's analogy of wood turning to charcoal, metal to liquid, stone to ash, water to salt, and tripod water drying up. With both form and qi exhausted, is it merely a matter of being alarming?