（论二首 法四条 律五条）
喻昌曰∶消渴之患，常始于微而成于着，始于胃而极于肺肾。始如以水沃焦，水入犹能消之；既而以水投石，水去
而石自若。至于饮一溲一，饮一溲二，则燥火劫其真阴，操立尽之术，而势成 矣。《内经》有其论无其治，《金匮》
有论有治矣，而集书者采《伤寒论》厥阴经消渴之文凑入，后人不能抉择，斯亦不适于用也。盖伤寒传经，热邪至厥阴
而尽，热势入深，故渴而消水，及热解则不渴，且不消矣，岂杂证积渐为患之比乎？谨从《内经》拟议言之。《经》谓
凡治消瘅仆击、偏枯痿厥、气满发逆、肥贵人则膏粱之疾也，此中消所繇来也。肥而不贵，食弗给于鲜；贵而不肥，餐
弗过于饕；肥而且贵，醇酒浓味，孰为限量哉？久之食饮，酿成内热，津液干涸，求济于水，然水入尚能消之也，愈消
愈渴，其膏粱愈无已，而中消之病遂成矣。夫既瘅成为消中，随其或上或下，火热炽盛之区，以次传入矣。上消者胃以
其热上输于肺，而子受母累，心复以其热移之于肺，而金受火刑。金者生水而出高源者也，饮入胃中，游溢精气而上，
则肺通调水道而下。今火热入之，高源之水，为炎威所逼，合外饮之水，建瓴而下，饮一溲二，不但不能消外水，且并
素酝水精，竭绝而尽输于下，较大腑之暴注暴泄，尤为甚矣，故死不治也。所谓由心之肺谓之死阴，死阴之属，不过三
日而死者，此之谓也。故饮一溲二，第一危候也。至于胃以其热，由关门下传于肾，肾或以石药耗其真，女色竭其精者，
阳强于外，阴不内守，而小溲混浊如膏，饮一溲一，肾消之证成矣。《经》谓石药之性悍，又谓脾风传之肾，名曰疝瘕，
少腹冤热而痛，出白液，名曰蛊，明指肾消为言。医和有云∶女子阳物也，晦淫则生内热惑蛊之疾，此解冤热及蛊义甚
明。王太仆谓消烁肌肉，如蛊之蚀，日渐损削，乃从消字起见，浅矣浅矣。夫惑女色以丧志，精泄无度，以至水液混浊，
反从火化，亦最危候。《经》云∶君火之下，阴精承之。故阴精有余，足以上承心火，则其人寿。阴精不足，心火直下肾
中，阳精所降，其人夭矣。故肾者胃之关也，关门不开，则水无输泄而为肿满；关门不闭，则水无底止而为消渴。消渴
属肾一证，《金匮》原文未脱，其曰∶饮一斗溲一斗者，肾气丸主之。于以蒸动精水，上承君火，而止其下入之阳光，此
正通天手眼。张子和辄敢诋之，既诋仲景，复谀河间，谓其神芎丸以黄芩味苦入心，牵牛、大黄驱火气而下，以滑石引
入肾经，将离入坎，真得《黄庭》之秘。颠倒其说，阿私所好，识趣卑陋若此，又何足以入仲景之门哉？何柏斋《消渴
论》中已辨其非。昌观戴人吐下诸案中，从无有治消渴一案者，可见无其事，即无其理矣。篇首论火一段，非不有其理
也，然以承气治壮火之理，施之消渴，又无其事矣。故下消之火，水中之火也，下之则愈燔；中消之火，竭泽之火也，
下之则愈伤；上消之火，燎原之火也，水从天降可灭，徒攻肠胃，无益反损。夫地气上为云，然后天气下为雨，是故雨
出地气，地气不上，天能雨乎？故亟升地气以慰三农，与亟升肾气以溉三焦，皆事理之必然者耳。不与昔贤一为分辨，
后人亦安能行其所明哉？
（论二首 法四条 律五条）
喻昌说：消渴这种病患，通常开始于轻微症状而发展为严重病症，起始于胃，最终极至于肺和肾。起初就像用水浇灌烧焦的物体，水倒进去还能被吸收消化；后来就像用水泼向石头，水流走而石头依然如故。到了饮水一杯、排尿一杯，或饮水一杯、排尿两杯的程度时，燥火劫夺了人体的真阴，这是彻底毁灭的方法，病势已经形成。《内经》中只有对消渴的论述而没有治疗方法，《金匮要略》既有论述又有治疗方法，但编纂该书的人采集了《伤寒论》中厥阴经关于消渴的文字凑入其中，后人无法辨别选择，这也不适用于临床治疗。大概伤寒病的传经过程中，热邪传到厥阴经就终结了，因为热势深入体内，所以出现口渴并消耗水分，等到热邪解除后就不再口渴，也不再消耗水分了，这哪里是杂病逐渐积累成患可以相比的呢？我谨依据《内经》来探讨讨论这个问题。《内经》说：“凡是治疗消瘅（指以多食善饥、身体消瘦为主要特征的疾病）、仆击（突然昏倒）、偏枯（半身不遂）、痿厥（肢体痿软无力且厥冷）、气满发逆（胸腹胀满气息上逆）、肥贵人则膏粱之疾也（富贵之人因饮食肥甘厚味而得的疾病），这是中消产生的原因。”身体肥胖但不显贵，食物供应不足于新鲜美味；显贵但不肥胖，饮食不至于过于贪婪暴饮暴食；既肥胖又显贵，醇酒浓味，谁又能设定限量呢？久而久之，饮食酿成内热，津液干涸，想要通过喝水来救济，然而水喝进去尚且能被消耗掉，越消耗越口渴，那肥甘厚味的摄入就没有止境，于是中消的病就形成了。既然已经形成消中（中消），随着火热炽盛的部位，或向上或向下依次传变。上消的情况是，胃中的热向上输送给肺，子脏受母脏牵连，心又将热移交给肺，导致肺金受到火的刑罚。肺金是生水并出于高源（上焦）的器官，水进入胃中，精气游溢而上行，则肺通调水道而下输。现在火热侵入，高源之水被炎威所逼迫，加上外饮之水，像从高屋建瓴一样迅速下行，饮水一杯、排尿两杯，不仅不能消化外来的水，而且连原本酝酿的水精也枯竭殆尽，全部输注到下方，比大肠暴注暴泄还要严重得多，所以死亡且无法治疗。这就是所谓“由心传肺称为死阴，属于死阴类的病，不过三天就会死亡”所说的情况。所以饮水一杯、排尿两杯，是第一危重的征候。至于胃中的热，从关门（下焦关口）向下传给肾，肾如果因为服用石药耗损了真阴，或因女色竭尽了精血，阳气强盛于外，阴精不能固守于内，导致小便浑浊如膏脂，饮水一杯、排尿一杯，肾消的证候就形成了。《内经》说石药的性质猛烈，又说脾风传给肾，名叫疝瘕，少腹冤热而痛，排出白色液体，名叫蛊，明确指向肾消而言。医和曾说：“女子属阳物，在晦日淫乱则产生内热惑蛊的疾病”，这个解释冤热及蛊的含义非常明白。王太仆认为消烁肌肉，像蛊虫侵蚀一样，日渐损耗削瘦，是从“消”字起意，这就太浅薄了，太浅薄了。如果沉迷女色丧失志向，精液泄出无度，以至于水液浑浊，反而从火化，这也是最危险的征候。《内经》说：“君火之下，阴精承之。”所以阴精有余，足以向上承接心火，那么这个人就能长寿。阴精不足，心火直接下到肾中，阳精下降，这个人就会夭折。所以说肾是胃的关口，如果关门不开，水没有输泄通道就会发生肿胀满闷；如果关门不闭，水没有底止就会发生消渴。消渴属于肾的一个证候，《金匮要略》原文未脱漏，其中说：“饮水一斗、排尿一斗者，用肾气丸主治。”以此来蒸动精水，向上承接君火，从而制止其向下流入的阳光（相火），这正是通天的高明手段。张子和却敢诋毁它，既诋毁张仲景，又谄媚刘河间，说他的神芎丸用黄芩味苦入心，牵牛、大黄驱除火气而下，用滑石引入肾经，将离（火）入坎（水），真正得到了《黄庭经》的秘密。颠倒其说法，阿私所好，见识趣味卑陋如此，又怎么足以进入张仲景的门径呢？何柏斋在《消渴论》中已经辨明其错误。我看戴人（张子和号戴人）吐下法的各种医案中，从来没有治疗消渴的案例，可见没有这件事，也就没有这个理了。篇首关于火的一段论述，并非没有道理，然而用承气汤治疗壮火（亢盛之火）的道理，施用于消渴，又没有这回事了。所以下消的火，是水中之火，攻下则火势更旺；中消的火，是竭泽之火，攻下则伤害更重；上消的火，是燎原之火，水从天降可以扑灭，单纯攻伐肠胃，不仅无益反而有害。地气上升成为云，然后天气下降成为雨，所以雨出自地气，地气如果不上升，天能下雨吗？所以急需升腾地气以慰劳三农（泛指百姓/农业），与急需升腾肾气以灌溉三焦，都是事理必然的。不与先贤们进行一次分辨，后人又怎么能施行他们所明白的道理呢？
(Two Treatises, Four Laws, Five Rules)
Yu Chang stated: The affliction of Xiao Ke (Wasting and Thirsting Syndrome) usually begins with minor symptoms and develops into severe manifestations; it originates in the Stomach and ultimately reaches its extreme in the Lungs and Kidneys. Initially, it is like pouring water onto a scorched object; the water enters and can still be absorbed and transformed. Later, however, it is like throwing water onto a stone; the water flows away while the stone remains unchanged. When the condition progresses to drinking one unit of fluid and urinating one unit, or drinking one unit and urinating two units, dryness-fire has robbed the body's True Yin. This is a method of complete destruction, and the pathological momentum has already formed. *The Neijing* contains discussions on Xiao Ke but no treatments; *Jinkui Yaolue* contains both discussions and treatments. However, the compilers of *Jinkui Yaolue* incorporated text regarding Xiao Ke from the Jueyin Meridian chapter of *Shanghan Lun* (Treatise on Cold Damage), leading later generations to be unable to distinguish and select appropriately, rendering it unsuitable for clinical application. Generally, in the transmission of meridians in Shanghan diseases, heat pathogens reach the Jueyin meridian and terminate there. Because the heat intensity penetrates deeply, thirst occurs and water is consumed. Once the heat resolves, thirst ceases, and water consumption stops. How can this be compared to miscellaneous diseases that develop gradually over time? I shall strictly discuss this based on *The Neijing*. *The Neijing* states: "In treating all cases of Xiao Dan (Wasting-Heat syndrome characterized by polyphagia and emaciation), Pu Ji (sudden collapse), Pian Ku (hemiplegia), Wei Jue (limb flaccidity and coldness), Qi Man Fa Ni (chest fullness with rebellious qi), and Gao Liang Zhi Ji (diseases of rich people caused by rich food), these are the origins of Zhong Xiao (Middle Wasting)." Being fat but not noble means food supply lacks freshness; being noble but not fat means meals do not exceed gluttony; being both fat and noble implies excessive consumption of fine wine and rich flavors—who sets a limit? Over time, diet brews internal heat, fluids dry up, and one seeks relief through water. Yet, even when water enters, it is consumed. The more it is consumed, the thirstier one becomes. With no end to the intake of rich foods, Zhong Xiao disease eventually forms. Once Xiao Zhong (Middle Wasting) is established, depending on whether the pathogen moves upward or downward, it transmits sequentially to areas where fire-heat is blazing. In Shang Xiao (Upper Wasting), stomach heat transmits upward to the Lungs; as the 'daughter' organ suffers due to the 'mother,' Heart heat also transfers to the Lungs, causing Metal to suffer under Fire punishment. Metal (Lung) generates Water and emerges from the high source (Upper Jiao). When water enters the Stomach, essence qi floats and rises; thus, the Lung regulates water passages and directs flow downward. Now, with heat-fire invading, the water at the high source is forced by intense heat. Combined with externally ingested water, it rushes down like water poured from a high roof. Drinking one unit and urinating two units means not only failing to transform external water but also exhausting the originally brewed water essence, which is entirely discharged downward. This is even more severe than sudden violent diarrhea from the Large Intestine; therefore, death ensues without treatment. This refers to what is called "transmission from Heart to Lung is termed Dead Yin; diseases belonging to Dead Yin result in death within three days." Thus, drinking one unit and urinating two units is the first critical sign. As for stomach heat transmitting downward from the gate (Lower Jiao outlet) to the Kidney, if the Kidney has been depleted of True Essence by Stone Medicines or exhausted of Jing (Essence) by sexual indulgence, Yang may be strong externally while Yin fails to guard internally. Urine becomes turbid like paste. Drinking one unit and urinating one unit signifies the formation of Shen Xiao (Kidney Wasting). *The Neijing* states that Stone Medicines have fierce properties and that Pi Feng (Spleen Wind) transmitted to the Kidney is named Shan Jia, characterized by冤热 (oppressive heat) and pain in the lower abdomen, discharging white fluid, named Gu (Gu Disease). This clearly points to Kidney Wasting. Yi He said: "Women belong to Yang organs; licentious behavior during dark times generates internal heat and Gu disorders." This explanation of oppressive heat and Gu is very clear. Wang Tai Bu argued that wasting muscles resembles erosion by Gu worms, day by day diminishing, deriving meaning from the character 'Xiao' (waste). This is shallow, indeed shallow. Indulging in women leads to loss of will, excessive ejaculation causes turbid fluids, which transform via fire; this is also the most critical sign. *The Neijing* says: "Below Jun Huo (Monarch Fire), Yin Jing (Yin Essence) supports it." Therefore, if Yin Jing is sufficient, it can support Jun Huo upward, and the person lives long. If Yin Jing is insufficient, Jun Huo descends directly into the Kidney, Yang Jing drops, and the person dies prematurely. Thus, the Kidney is the gate of the Stomach. If the gate does not open, water has no outlet, leading to edema and fullness; if the gate does not close, water has no bottom, leading to Xiao Ke. Xiao Ke belongs to a Kidney syndrome. The original text of *Jinkui Yaolue* is preserved, stating: "For those who drink one dou and urinate one dou, Sheng Qi Wan (Kidney Qi Pill) is the primary treatment." This steams and activates Jing Water, allowing it to ascend and support Jun Huo, thereby stopping the downward flow of Sun Guang (Minister Fire). This is truly a transcendent approach. Zhang Zihe dared to denounce it, criticizing Zhang Zhongjing while flattering Liu Hejian. He claimed his Shen Xiong Wan uses Huang Qin (Scutellariae Radix) with bitter taste entering the Heart, Qian Niu (Pharbitidis Semen) and Da Huang (Rhei Radix et Rhizoma) driving fire qi downward, and Hua Shi (Talcum) guiding it into the Kidney meridian, placing Li (Fire) into Kan (Water), truly obtaining the secret of *Huang Ting Jing*. He inverted the theory, favored his own preferences, and had such low insight and taste that he could hardly enter the school of Zhang Zhongjing. He Bai Zhai already refuted this error in his *Xiao Ke Lun*. Observing Dai Ren’s (Zhang Zihe's courtesy name) various cases of vomiting and purging methods, there is never a case of treating Xiao Ke. This shows that without the event, there is no principle. The section on fire at the beginning of the chapter is not without reason, but applying the principle of using Cheng Qi Tang (Major Order the Qi Decoction) to treat Zhuang Huo (Blazing Fire) to Xiao Ke is factually incorrect. Therefore, the fire in Xia Xiao (Lower Wasting) is fire within water; purging makes it burn brighter. The fire in Zhong Xiao is fire in a drained pond; purging causes greater harm. The fire in Shang Xiao is a prairie fire; water falling from heaven can extinguish it, but merely attacking the intestines and stomach is unhelpful and damaging. Earth qi rising forms clouds, then heaven qi descends as rain; thus, rain comes from earth qi. If earth qi does not rise, can heaven rain? Therefore, urgently raising earth qi to comfort the three agricultural seasons, and urgently raising Kidney Qi to irrigate the Three Jiao, are both inevitable principles of reason. Without distinguishing these matters with past sages, how can later generations apply what they understand?