《金匮》肾气丸 本文云∶男子消渴，小便反多，以饮一斗，小便一斗，肾气丸主之。即崔氏八味丸治香港脚上
入少腹不仁之方也。 干地黄（八两） 山茱萸 山药（各四两） 泽泻 白茯苓 牡丹皮（各三两） 肉桂 附子（炮
各一两） 上八味末之，炼蜜为丸，梧子大。酒下十五丸，日再服。 按∶王太仆注《内经》云∶火自肾而起，谓龙火，
龙火当以火逐火，则火可灭。若以水治火，则火愈炽，此必然之理也。昌更谓用桂附蒸动肾水，开阖胃关，为治消渴吃
紧大法。胡乃张子和别有肺肠，前论中已详之矣。但至理难明，浅见易惑，《局方》变其名为加减八味丸，加五味子一两
半，减去附子，岂非以五味子之津润，胜于附子之燥热耶？举世咸乐宗之，大惑不解，可奈何哉！
《金匮》文蛤散 本文云∶渴欲饮水不止者，文蛤散主之。 文蛤（五两） 上一味杵为散，以沸汤五合，和
服方寸匕。 按∶《伤寒论》用此治误以水 人面，肌肤粟起之表证。今消渴里证亦用之，盖取其功擅软坚，且利水彻热
耳，前已论悉。再按∶《金匮》治消渴，止用肾气丸，五苓散，文蛤散三方，而五苓又从伤寒证中采入，白虎加人参汤亦
然，所以用方者，当会通全书，而引伸以求其当也。
《金匮》白虎加人参汤 原治太阳中 ，汗出恶寒，身热而渴。去知母之苦，加淡竹叶、麦门冬之甘，名竹叶
石膏汤，治虚烦证。 知母（六两） 石膏（一斤碎） 甘草（三两） 粳米（六合） 人参（二两） 上五味，以水
一斗，煮米熟汤成，去滓，温服一升，日三服。 按∶此治火热伤其肺胃，清热救渴之良剂也。故消渴病之在上焦者，
必取用之。东垣以治膈消，洁古以治能食而渴者，其不能食而渴者，用钱氏白术散，倍加葛根。而东垣复参《内经》膏
粱之病，不可服芳草石药，治之以兰，除其陈气之义，一变其方为兰香饮子，用石膏、知母、生熟甘草、人参，加入兰
香、防风、白豆蔻仁、连翘、桔梗、升麻、半夏。再变其方为生津甘露饮子，用石膏、人参、生熟甘草、知母、加黄柏、
杏仁、山栀、荜澄茄、白葵、白豆蔻、白芷、连翘、姜黄、麦门冬、兰香、当归身、桔梗、升麻、黄连、木香、柴胡、
藿香、全蝎，而为之辞曰∶此制之缓也。不惟不成中满，亦不传下消矣，三消皆可用。昌实不敢信其然也，乃至《三因》
之石子荠 汤，洁古之清凉饮子，俱从此方增入他药，引入他藏，全失急救肺胃之意，此后贤之所以为后贤耶。
竹叶黄 汤 治消渴证，气血虚，胃火盛而作渴。 淡竹叶 生地黄（各二钱） 黄 麦门冬 当归 川芎
黄芩（炒） 甘草 芍药 人参 半夏 石膏 （各一钱） 上水煎服。 按∶前白虎加人参汤，颛治气分燥热。此方
兼治气血燥热，后一方颛治血分燥热，宜辨证而择用之。
生地黄饮子 治消渴咽干，面赤烦躁。 人参 生干地黄 熟干地黄 黄 （蜜炙） 天门冬 麦门冬 枳壳
（麸炒） 石斛 枇杷叶 泽泻 甘草（炙各等分） 上锉散，每服三钱，水一盏，煎至六分，去滓，食远临卧顿服。 此
方生精补血，润燥止渴，佐以泽泻、枳壳，疏导二腑，使心火下降，则小腑清利；肺经润泽，则大腑流畅，宿热既除，
其渴自止，故取用之。
钱氏白术散 治虚热而渴。 人参 白术 白茯苓 甘草 藿香 木香（各一两） 干葛（二两） 上为末，
每服三钱，水煎温服。如饮水多，多与服之。 按∶仁斋用本方，加五味子、柴胡各三钱，分十剂煎服，治消渴不能食。
海藏云∶此四君子加减法，亦治湿胜气脱，泄利太过，故虚热作渴，在所必用。
《宣明》黄 汤 治心移寒于肺，为肺消，饮少溲多，当补肺平心。 黄 （三两） 五味子 人参 麦门冬 桑
白皮（各二两） 枸杞子 熟地黄（各一两半） 上为末，每服五钱，水二盏，煎至一盏，去滓，温服无时。
《宣明》麦门冬饮子 治心移热于肺，传为膈消，胸满心烦，精神短少。 人参 茯神 麦门冬 五味子 生
地黄 炙甘草 知母 葛根 栝蒌根（各等分） 上 咀，每服五钱，加竹叶十四片，煎七分，温服无时。 按∶宣明
二方，为《内经》心移寒移热两证，各出其治，一种苦心，非不可嘉。然移寒移热，其势颇锐，而生津养血，其应瘥缓，
情非的对，易老门冬饮子亦然。昌谓心之移寒，必先束肺之外郭，用参、 补肺，加散寒之药可也。而用枸杞、熟地黄、
补肾，则迂矣。用桑白皮泻肺，其如外束之寒何？至心之移热，治以咸寒，先入其心，如文蛤散之类，自无热可移。
正直走大梁，解围之上着，何不及之！所以观于海者，难为水也。
易老门冬饮子 治老弱虚人大渴。人参 枸杞子 白茯苓 甘草（各等分） 五味子 麦门冬（各两半） 上
姜水煎服。按∶易老方，即变宣明麦冬饮子，去生地、知母、葛根，加枸杞也。方下不言心移热
于肺，惟以治老弱虚人大渴，而增枸杞之润，去地黄之泥，知母之苦，葛根之发，立方于无过，治本之图，不为迂矣。
猪肚丸 治强中消渴。黄连 粟米 栝蒌根 茯神（各四两） 知母 麦门冬（各二两） 上为细末，将大猪
肚一个，洗净，入末药于内，以麻线缝合口，置甑中，炊极烂，取出药别研，以猪肚为膏，再入炼蜜，搜和前药杵匀，
丸如梧子大。每服五十丸，参汤下。又方加人参、熟地黄、干葛。又方除知母，粟米用小麦。
烂金丸 治热中消渴止后，补精血，益诸虚，解劳倦，去骨节间热，宁心强志，安神定魄，固脏腑，进饮食，
免生疮疡。大猪肚（一个） 黄连（三两） 生姜（碎） 白蜜（各二两） 先将猪肚净洗明干，夏以葱椒醋
面等同药，以水酒入银石器内煮半日，漉出黄连，洗去蜜酒令尽，锉研为细末。再用水调为膏，入猪肚内，以线缝定，
仍入银石器内煮烂，研如泥，再用人参五味子 杜仲（姜炒去丝） 山药 石斛 山茱肉 车前子 新莲肉（去皮心）
鳖甲（醋炙） 干地黄 当归（各二两） 磁石（ ） 白茯苓 槐角子（炒） 川芎（各一两） 黄 （四两） 菟
丝子（酒淘蒸研五两） 沉香（半两） 麝香（别研一线） 上为细末，用猪肚膏搜和得所，如膏少添熟蜜，捣数千杵，
丸如桐子大。每服五十丸，食前用温酒，或糯米饮送下。一方有白术二两、阳起石一两。按∶用麝香、阳起石，开窍兴
阳，浑是后人孟浪知见。其他无过之药及制肚之法，亦有可采，故合前方两存之。
洁古化水丹 治手足少阴渴饮水不止，或心痛者。《本事》治饮冷水多。川乌（脐大者四枚炮去皮） 甘草（灸
一
两） 牡蛎（生三两） 蛤粉（用浓者炮四两） 上为细末，醋浸蒸饼为丸。每服十五丸，新汲水下。心
痛者醋汤下立愈。饮水一石者，一服愈。海藏云∶此药能化停水。
按∶饮水过多，亦有能消其火热者，而火热既消，反不能消水，转成大患者，多有之。洁古有见于此，而用川乌助
火，合之牡蛎、蛤粉咸寒，共成消水之功也。又恐才退之火热，其根尚伏，所以不多用之，原有深意，但不和盘托出以
告人耳。
黄连膏 治口舌干，小便数，舌上赤，生津液，除干燥，长肌肉。 黄连（一斤碾为末） 牛乳汁 白莲藕汁
生地黄汁（各一斤） 上将汁熬膏，搓黄连末为丸，如小豆大。每服二十丸，少呷汤下，日进十服。
生地黄膏 治证同前。 生地黄（一握） 蜂蜜（一两） 人参（半两） 白茯苓（一两） 上先将地黄洗捣
烂，以新汲水调开，同蜜煎至一半，入参、苓末拌和，以瓷器密收，匙挑服。 按∶二膏一用苦寒合甘寒，一纯用甘寒，
相其所宜，择而用之，治消渴之权衡，大略可推，故两录之。
天门冬丸 治初得消中，食已如饥，手足烦热，背膊疼闷，小便白浊。 天门冬 土瓜根（干者各一两半） 栝
蒌根 熟地黄 知母（焙一两半） 肉苁蓉（酒浸一宿切焙） 鹿茸 五味子 赤石脂 泽泻（各一两半） 鸡内金（三
具微炙） 桑螵蛸（十枚炙） 牡蛎（ 二两） 苦参（一两） 上为细末，炼蜜丸，如梧子大。每服二十丸，用粟米
饮送下，食前。 按∶初得中下二消，急治其本可也。丸药本缓，且只服二十丸，未免悠悠从事矣。方中药品颇佳，但
赤石脂有可议耳，减去此物，更增三倍用之，可以必效，盖初起之易为功也。
猪肾荠 汤 治消中日夜尿八九升者。 猪肾（二具） 大豆（一斤） 荠 石膏（各三两） 人参 茯苓
（一作茯神） 知母 葛根 黄芩 磁石（绵裹） 栝蒌根 甘草（各二两） 上 咀，用水一斗五升，先煮猪肾、大
豆，取一斗，去滓，下药煮取三升。分作三服，渴急饮之，下焦热者，夜辄服一剂，渴止勿服。 按∶此方用白虎等清
凉之剂，加入猪肾、大豆、磁石，引诸清凉入肾，且急服之。凡热炽盛于上下二焦者，在所必用。后有制荠 丸，治强
中为病，茎长兴盛，不交精溢。消渴之后，多作痈疽，皆由过服丹石所致。即以本方去石膏、知母、葛根、黄芩，加鹿
茸、地骨皮、熟地黄、沉香，以其病在中下，阳气阴精两竭，故舍上焦之清凉，而事下焦之温补，为合法也。
肾沥散 治肾消，肾气虚损发渴，小便数，腰疼痛。鸡 （微炙） 远志（去心） 人参 桑螵蛸（微炒
）黄 泽泻 桂心 熟地黄 白茯苓 龙骨 当归（各一两） 麦门冬（去心） 川芎（各二两） 五味子 炙
甘草 玄参（各半两） 磁石（半两研碎淘去赤汁） 上锉碎，每服用羊肾一对切去脂膜，先以水一盏半，煮肾至一
盏，去水上浮脂及肾，次入药五钱，生姜半分，煎至五分，去滓空心服，晚食前再服。按∶肾气虚
损之证，本阴精不足，当归、川芎，虽云补阴，不能补精，且一辛一散，非所宜施。不若以山茱萸、枸杞子代之为
长，以其引用之法颇佳，故取之。
白茯苓丸 治肾消，因消中后，胃热入肾，消烁肾脂，令肾枯燥，遂致此疾，两腿渐细，腰脚无力。白茯苓 覆
盆子 黄连 栝蒌根 萆 人参 熟地黄 玄参（各一两） 石斛 蛇床子（各七钱半） 鸡 （三十具微炒） 上
为细末，炼蜜和捣三五百杵，丸如梧子大。每服三十丸，食前煎磁石汤送下。
友人朱麟生病消渴，后渴少止，反加燥急，足膝痿弱，命予亟以杂霸之药投之，不能待矣。予主是丸加犀角，坐中
一医曰∶肾病而以犀角、黄连治其心，毋乃倒乎？予曰∶肾者，胃之关也。胃之热下传于肾，则关门大开。关门大开，
则心之阳火，得以直降于肾。《经》云∶阳精所降，其人夭，非细故也。今病者心火烁肾，燥不能需，予
用犀角、黄连入肾，对治其下降之阳光，宁为倒乎？医敬服，友人服之果效，再更六味地黄丸加犀角，而肌泽病起。
忍冬丸 治渴病愈，须预防发痈疽。忍冬草（根茎花叶皆可用之） 上用米曲酒，于瓶内浸，糠火煨一宿，取
出晒干，入甘草少许为末，即以所浸酒煮糊为丸，如梧桐子大。每服五十丸至百丸，酒饮任下。按∶此方于四月间，采
鲜花十数斤，揉取其汁，煎如膏子，酒汤任用点服。养阴退阳，调和荣卫血脉，凡系火热炽盛之体，允为服食仙方。
蓝叶散 治渴利口干烦热，背生痈疽，赤 疼痛。蓝叶 升麻 玄参 麦门冬 黄 葛根 沉香 赤芍药 犀
角屑 甘草（生用各一两） 大黄（二两微炒） 每服四钱，水一盏，煎至六分，去滓，不拘时温服。
紫苏汤 治消渴后，遍身浮肿，心膈不利。 紫苏茎叶 桑白皮 赤茯苓（各一两） 郁李仁（去皮炒二两）
羚羊角 槟榔（各七钱半） 桂心 枳壳 独活 木香（各半两） 每服四钱，水一盏半，生姜半分，煎八分，温服。
乌梅木瓜汤 治饮酒过多，积为酷热里蒸，五脏津液枯燥，血泣小便并多，肌削，嗜冷物寒浆。 木瓜干 乌
梅（捶破不去仁） 麦 （炒） 甘草 草果（去皮各半两） 每服四钱，水一盏半，姜五片，煎七分，不拘时服。
杀虫方 治消渴有虫。 苦楝根 取新白皮一握切焙，入麝香少许，水二碗，煎至一碗，空心饮之。虽困顿不
妨，自后下虫三四条，类蛔虫而色红，其渴顿止。乃知消渴一证，有虫耗其精液。（出《夷坚志》） 按∶饮醇食爆，积
成胃热，湿热生虫，理固有之。不独消渴一证为然，临病宜加审谛也。
《金匮要略》中的肾气丸：原文记载：“男子患消渴病，小便反而增多，喝水一斗，排尿也一斗，用肾气丸主治。”这就是崔氏八味丸治疗脚气病邪气上冲至小腹、导致局部感觉迟钝的方子。干地黄（八两）、山茱萸、山药（各四两）、泽泻、白茯苓、牡丹皮（各三两）、肉桂、附子（炮制，各一两）。以上八味药研成细末，用炼蜜制成梧桐子大小的丸剂。每次用酒送服十五丸，每日两次服用。
按语：王太仆在注释《内经》时曾说：“火从肾脏而起，称为龙火，龙火应当以火逐火（引火归元），这样火才能熄灭。如果用水去治火，火就会更加旺盛，这是必然的道理。”我更认为，使用肉桂和附子蒸动肾水，调节胃气的开阖，是治疗消渴病的关键大法。然而张子和另有见解，在前面的论述中已经详细说明。只是其中的深奥道理难以阐明，浅薄的见识容易使人困惑，《太平惠民和剂局方》将其改名为加减八味丸，加入一两半五味子，减去附子，这难道是因为认为五味子的滋润生津作用胜过附子的燥热吗？举世的人都乐于尊崇此法，令人深感困惑不解，真是无可奈何啊！
《金匮要略》中的文蛤散：原文记载：“口渴想喝水且饮水后仍不止渴的，用文蛤散主治。”文蛤（五两）。将这一味药捣碎成散剂，用沸水五合调和，服用方寸匕大小的量。
按语：《伤寒论》用此方治疗误用水疗导致的面部及肌肤出现粟粒状突起等表证。现在治疗消渴这种里证也用此方，大概是取其具有软坚散结、利水退热的功效罢了，前面已经详细论述过。再按：《金匮要略》治疗消渴，只用了肾气丸、五苓散、文蛤散这三个方子，而五苓散是从伤寒证中采纳进来的，白虎加人参汤也是如此。所以使用方剂的人，应当融会贯通全书，引申推求以求得当。
《金匮要略》中的白虎加人参汤：原用于治疗太阳中暍（中暑），症见汗出、恶寒、身热而口渴。去掉知母的苦寒之性，加入淡竹叶、麦门冬的甘润之品，命名为竹叶石膏汤，用于治疗虚烦证。知母（六两）、石膏（一斤，打碎）、甘草（三两）、粳米（六合）、人参（二两）。以上五味药，用水一斗，煮至米熟汤成，去渣，温服一升，每日三次。
按语：这是治疗火热损伤肺胃，清热救津止渴的良好方剂。因此，消渴病病位在上焦的，必须选用此方。李东垣用它治疗膈消，张洁古用它治疗能食而渴者；对于不能食而渴者，则用钱氏白术散，并加倍加入葛根。而李东垣又参考《内经》关于膏粱厚味之病不可服用芳草石药的论述，以及用兰草去除陈腐之气的意义，对方剂进行了一次变化，制成兰香饮子，使用石膏、知母、生甘草、熟甘草、人参，加入兰香、防风、白豆蔻仁、连翘、桔梗、升麻、半夏。再次对方剂进行变化，制成生津甘露饮子，使用石膏、人参、生甘草、熟甘草、知母，加入黄柏、杏仁、山栀、荜澄茄、白葵、白豆蔻、白芷、连翘、姜黄、麦门冬、兰香、当归身、桔梗、升麻、黄连、木香、柴胡、藿香、全蝎，并解释说：“这个方剂的药力较为缓和。”不仅不会造成中满腹胀，也不会传变为下消，三消都适用。我实在不敢苟同其说法。至于《三因极一病证方论》中的石子荠汤，张洁古的清凉饮子，都是从此方增加其他药物，引入其他脏腑的治疗思路，完全失去了急救肺胃的本意，这就是后世医家之所以成为后世医家的原因吧。
竹叶黄耆汤：治疗消渴证，气血虚弱，胃火旺盛而致口渴。淡竹叶、生地黄（各二钱）、黄耆、麦门冬、当归、川芎、黄芩（炒）、甘草、芍药、人参、半夏、石膏（各一钱）。以上药物用水煎服。
按语：前面的白虎加人参汤专门治疗气分的燥热。此方兼治气血燥热，后面的方剂专门治疗血分燥热，应当辨证后选择使用。
生地黄饮子：治疗消渴咽干，面红烦躁。人参、生干地黄、熟干地黄、黄耆（蜜炙）、天门冬、麦门冬、枳壳（麸炒）、石斛、枇杷叶、泽泻、甘草（炙，各等分）。以上药物锉成散剂，每次服用三钱，用水一盏，煎至六分，去渣，在饭后临近睡觉时一次性服用。此方能生精补血，润燥止渴，佐以泽泻、枳壳疏导大小肠腑，使心火下降，则小肠清利；肺经润泽，则大肠通畅，宿热既除，口渴自然停止，所以选用此方。
钱氏白术散：治疗虚热而口渴。人参、白术、白茯苓、甘草、藿香、木香（各一两）、干葛（二两）。以上药物研成细末，每次服用三钱，用水煎温服。如果饮水多，可多次服用。
按语：仁斋用本方，加入五味子、柴胡各三钱，分为十剂煎服，治疗消渴不能进食。海藏说：这是四君子汤的加减法，也治疗湿气过重导致的气脱、泄利太过，所以对于虚热引起的口渴，是必须使用的。
《宣明论方》中的黄耆汤：治疗心移寒于肺，形成肺消，饮水少而小便多，应当补肺平心。黄耆（三两）、五味子、人参、麦门冬、桑白皮（各二两）、枸杞子、熟地黄（各一两半）。以上药物研成细末，每次服用五钱，用水二盏，煎至一盏，去渣，随时温服。
《宣明论方》中的麦门冬饮子：治疗心移热于肺，传变为膈消，胸满心烦，精神短少。人参、茯神、麦门冬、五味子、生地黄、炙甘草、知母、葛根、栝蒌根（各等分）。以上药物切碎，每次服用五钱，加入十四片竹叶，煎至七分，随时温服。
按语：《宣明论方》中的这两个方子，分别针对《内经》中心移寒和心移热两种证候提出治法，可谓煞费苦心，并非不可嘉许。然而，移寒移热的病势颇为急锐，而生津养血的药效反应却较缓慢，病情与药力不完全对应，易老的麦门冬饮子也是如此。我认为，心的寒气转移，必须先束住肺的外围，用人参、黄耆补肺，加入散寒的药物即可。而使用枸杞、熟地黄补肾，就太迂腐了。使用桑白皮泻肺，那外束的寒气怎么办呢？至于心的热气转移，治疗应用咸寒之药，先入心经，如文蛤散之类，自然没有热气可转移。正直地走大路，解围的上策，为何不采用呢！所以看过大海的人，很难被普通的水吸引。
易老麦门冬饮子：治疗年老体弱虚人大渴。人参、枸杞子、白茯苓、甘草（各等分）、五味子、麦门冬（各一两半）。以上药物用姜水煎服。
按语：易老的方子，就是变化自《宣明论方》的麦冬饮子，去掉了生地黄、知母、葛根，加入了枸杞。方剂说明中没有提到心移热于肺，只是说治疗年老体弱虚人的大渴，增加了枸杞的滋润，去掉了地黄的腻滞、知母的苦寒、葛根的升散，立方没有过失，旨在治本，也不算迂腐。
猪肚丸：治疗强中消渴。黄连、粟米、栝蒌根、茯神（各四两）、知母、麦门冬（各二两）。以上药物研成细末，取一个大猪肚，洗净，将药末放入其中，用麻线缝合口，放在甑中蒸至极烂，取出药物另研，用猪肚熬成膏，再加入炼蜜，调和前药杵匀，制成梧桐子大小的丸剂。每次服用五十丸，用人参汤送下。另一配方加入人参、熟地黄、干葛。又一配方除去知母、粟米，改用小麦。
烂金丸：治疗热中消渴停止后，补益精血，增益各种虚损，解除疲劳倦怠，去除骨节间的热邪，宁心安神定魄，巩固脏腑功能，增进饮食，避免生疮疡。大猪肚（一个）、黄连（三两）、生姜（切碎）、白蜜（各二两）。先将猪肚洗净晾干，夏季用葱、椒、醋、面等同药，加水酒放入银石器内煮半天，捞出黄连，洗去蜜酒令净，切碎研为细末。再用水调成膏，放入猪肚内，用线缝定，仍放入银石器内煮烂，研如泥状，再加入人参、五味子、杜仲（姜炒去丝）、山药、石斛、山茱萸、车前子、新莲肉（去皮心）、鳖甲（醋炙）、干地黄、当归（各二两）、磁石（煅）、白茯苓、槐角子（炒）、川芎（各一两）、黄耆（四两）、菟丝子（酒淘蒸研五两）、沉香（半两）、麝香（另研一线）。以上药物研成细末，用猪肚膏调和得宜，如果膏少添加熟蜜，捣数千杵，制成梧桐子大小的丸剂。每次服用五十丸，饭前用温酒或糯米饮送下。一方有白术二两、阳起石一两。
按语：使用麝香、阳起石，开窍兴阳，完全是后人鲁莽的认知。其他无过失的药物及制作猪肚的方法，也有可取之处，所以将此前方合并保存。
洁古化水丹：治疗手足少阴经口渴饮水不止，或心痛者。《本事方》治疗饮用冷水过多。川乌（脐大者四枚，炮制去皮）、甘草（灸一两）、牡蛎（生三两）、蛤粉（用浓者炮制四两）。以上药物研成细末，用醋浸蒸饼为丸。每次服用十五丸，用新汲水下服。心痛者用醋汤送下立即痊愈。饮水一石者，服用一次即愈。海藏说：此药能化解停聚之水。
按语：饮水过多，也有能消除其火热者，而火热既消，反而不能消化水液，转而变成大病的，有很多这种情况。洁古看到了这一点，所以用川乌助火，配合牡蛎、蛤粉的咸寒之性，共同达成消水的功效。又担心刚刚退去的火热，其根源尚潜伏，所以不多用川乌，原有深意，只是没有全盘托出来告诉人罢了。
黄连膏：治疗口舌干燥，小便频数，舌上发红，生津液，除干燥，长肌肉。黄连（一斤碾为末）、牛乳汁、白莲藕汁、生地黄汁（各一斤）。以上将汁液熬成膏，搓黄连末为丸，如小豆大小。每次服用二十丸，少量喝汤送下，每日进十服。
生地黄膏：治疗症状同上。生地黄（一握）、蜂蜜（一两）、人参（半两）、白茯苓（一两）。以上先将地黄洗净捣烂，用新汲水调开，同蜜煎至一半，加入参、苓末拌和，用瓷器密封收藏，用勺挑服。
按语：这两种膏剂，一种用苦寒合甘寒，一种纯用甘寒，根据适宜的情况选择使用，是治疗消渴的权衡之法，大致可以推测，所以两者都记录下来。
天门冬丸：治疗初得消中，食后即感饥饿，手足烦热，背膊疼痛闷胀，小便白浊。天门冬、土瓜根（干者各一两半）、栝蒌根、熟地黄、知母（焙一两半）、肉苁蓉（酒浸一夜切片焙干）、鹿茸、五味子、赤石脂、泽泻（各一两半）、鸡内金（三具微炙）、桑螵蛸（十枚炙）、牡蛎（煅二两）、苦参（一两）。以上药物研成细末，炼蜜为丸，如梧桐子大小。每次服用二十丸，用粟米饮送下，饭前服用。
按语：初得中消和下消，应当急治其根本。丸药性质本来缓和，且只服用二十丸，未免过于缓慢。方中药品颇佳，但赤石脂值得商榷，减去此物，更增三倍用量，可以确保见效，因为初起时容易奏效。
猪肾荠菜汤：治疗消中日夜排尿八九升者。猪肾（两个）、大豆（一斤）、荠菜、石膏（各三两）、人参、茯苓（一作茯神）、知母、葛根、黄芩、磁石（绵裹）、栝蒌根、甘草（各二两）。以上药物切碎，用水一斗五升，先煮猪肾、大豆，取一斗，去渣，下药煮取三升。分作三服，口渴紧急时饮服，下焦热者，夜间服一剂，渴止勿服。
按语：此方使用白虎等清凉之剂，加入猪肾、大豆、磁石，引导诸清凉药入肾，且需急服。凡热炽盛于上下二焦者，在所必用。后有制荠菜丸，治疗强中病，阴茎常勃起，不交合而精液自溢。消渴之后，多发生痈疽，都是由过服丹石所致。即用本方去掉石膏、知母、葛根、黄芩，加入鹿茸、地骨皮、熟地黄、沉香，因为病在中下焦，阳气阴精两竭，所以舍弃上焦的清凉，而从事下焦的温补，这才是合法的做法。
肾沥散：治疗肾消，肾气虚损引发口渴，小便频数，腰部疼痛。鸡（微炙）、远志（去心）、人参、桑螵蛸（微炒）、黄耆、泽泻、桂心、熟地黄、白茯苓、龙骨、当归（各一两）、麦门冬（去心）、川芎（各二两）、五味子、炙甘草、玄参（各半两）、磁石（半两研碎淘去赤汁）。以上药物锉碎，每次服用羊肾一对，切去脂膜，先用水一盏半，煮肾至一盏，去掉水上浮脂及肾，次入药五钱，生姜半分，煎至五分，去渣空腹服，晚食前再服。
按语：肾气虚损的证候，本是阴精不足，当归、川芎，虽然说是补阴，但不能补精，且一辛一散，不适合施用。不如以山茱萸、枸杞子代替为好，因为其引用配伍之法颇佳，所以选用此方。
白茯苓丸：治疗肾消，因消中之后，胃热入肾，消烁肾脂，令肾枯燥，遂致此疾，两腿逐渐变细，腰脚无力。白茯苓、覆盆子、黄连、栝蒌根、萆薢、人参、熟地黄、玄参（各一两）、石斛、蛇床子（各七钱半）、鸡（三十具微炒）。以上药物研成细末，炼蜜和捣三五百杵，制成梧桐子大小的丸剂。每次服用三十丸，饭前煎磁石汤送下。
友人朱麟生病消渴，后来口渴稍止，反而加重燥急，足膝痿弱，命令我赶快用杂霸之药投治，不能等待了。我主张用此丸加犀角，座中一位医生说：“肾病而以犀角、黄连治其心，岂不是颠倒了吗？”我说：“肾，是胃的关隘。胃的热邪下传于肾，则关门大开。关门大开，则心的阳火，得以直降于肾。《内经》说：‘阳精所降，其人夭’，这不是小事。现在病人心火灼烧肾脏，燥热不能耐受力，我用犀角、黄连入肾，对治其下降的阳光，难道是颠倒吗？”医生敬服，友人服药果然有效，再更换六味地黄丸加犀角，而肌肤润泽，病愈。
忍冬丸：治疗渴病愈后，须预防发痈疽。忍冬草（根茎花叶皆可用之）。以上用米曲酒，在瓶内浸泡，糠火煨一夜，取出晒干，加入少许甘草为末，即以所浸酒煮糊为丸，如梧桐子大小。每次服用五十丸至百丸，酒饮任下。
按语：此方在四月间，采集鲜花十余斤，揉取其汁，煎如膏子，酒汤任用点服。养阴退阳，调和营卫血脉，凡是火热炽盛的体质，确实是服食的仙方。
蓝叶散：治疗渴利口干烦热，背部生痈疽，赤痛。蓝叶、升麻、玄参、麦门冬、黄耆、葛根、沉香、赤芍药、犀角屑、甘草（生用各一两）、大黄（二两微炒）。每次服用四钱，水一盏，煎至六分，去渣，不拘时候温服。
紫苏汤：治疗消渴后，遍身浮肿，心膈不利。紫苏茎叶、桑白皮、赤茯苓（各一两）、郁李仁（去皮炒二两）、羚羊角、槟榔（各七钱半）、桂心、枳壳、独活、木香（各半两）。每次服用四钱，水一盏半，生姜半分，煎八分，温服。
乌梅木瓜汤：治疗饮酒过多，积为酷热里蒸，五脏津液枯燥，血液凝涩小便并多，肌肉消瘦，嗜冷物寒浆。木瓜干、乌梅（捶破不去仁）、麦芽（炒）、甘草、草果（去皮各半两）。每次服用四钱，水一盏半，姜五片，煎七分，不拘时候服。
杀虫方：治疗消渴有虫。苦楝根，取新白皮一握切碎焙干，加入少许麝香，水二碗，煎至一碗，空腹饮服。虽困顿不妨碍，此后下虫三四条，类似蛔虫而色红，其口渴顿时停止。乃知消渴一证，有虫耗其精液。（出自《夷坚志》）
**Shenqi Wan (Kidney Qi Pill) from *Jingui Yaolue*:** The text states: "Men suffering from Xiao Ke (Wasting and Thirsting syndrome) may experience excessive urination; if they drink one dou of water, they excrete one dou of urine, Shenqi Wan is the primary treatment." This is the same formula as Cui Shi's Bawei Wan (Eight-Ingredient Pill), used to treat Hongjiao (Gouty Arthritis) where pathogenic factors ascend to the lower abdomen causing numbness. Raw Rehmanniae Radix (Di Huang) (8 liang), Corni Fructus (Shan Zhu Yu), Dioscoreae Rhizoma (Shan Yao) (each 4 liang), Alismatis Rhizoma (Ze Xie), Poria (Fu Ling), Moutan Cortex (Mu Dan Pi) (each 3 liang), Cinnamomi Ramulus (Rou Gui), Aconiti Lateralis Radix Praeparata (Fu Zi) (prepared, each 1 liang). The above eight ingredients are ground into powder, mixed with refined honey to form pills the size of a Chinese parasol tree seed. Take 15 pills with wine, twice daily.
Commentary: Wang Tai Pu, in his commentary on the *Neijing*, stated: "Fire arising from the Kidney is called Dragon Fire. Dragon Fire should be treated by using fire to drive out fire (guiding fire back to its source), thus extinguishing it. If water is used to treat fire, the fire will burn even more fiercely; this is an inevitable principle." I further argue that using Rou Gui and Fu Zi to vaporize Kidney Water and regulate the opening and closing of the Stomach gate constitutes a crucial method for treating Xiao Ke. However, Zhang Hezi held different views, which have been detailed in previous discussions. The profound principles are difficult to elucidate, and superficial understanding easily leads to confusion. The *Ju Fang* changed its name to Ji Jian Ba Wei Wan (Modified Eight-Ingredient Pill), adding 1.5 liang of Schisandrae Fructus (Wu Wei Zi) and removing Fu Zi. Is it not because they believe the moistening and fluid-generating effect of Wu Wei Zi surpasses the drying heat of Fu Zi? The world eagerly follows this practice, leaving me deeply perplexed and helpless.
**Wen Sha San (Clam Shell Powder) from *Jingui Yaolue*:** The text states: "For those who feel thirsty and desire to drink but cannot quench their thirst, Wen Sha San is the primary treatment." Clam Shell (Wen Sha) (5 liang). Grind this single ingredient into powder. Mix with 5 he of boiling water and take a measure equivalent to a square inch spoonful.
Commentary: In the *Shanghan Lun*, this formula is used to treat exterior syndromes caused by improper water therapy, resulting in facial and skin eruptions resembling millet grains. Now, it is also used for interior Xiao Ke syndromes, likely due to its efficacy in softening hardness and promoting diuresis to clear heat, as discussed previously. Furthermore, the *Jingui Yaolue* treats Xiao Ke using only three formulas: Shenqi Wan, Wuling San, and Wen Sha San. Wuling San was adopted from Shanghan syndromes, as was Baihu Jia Renshen Tang. Therefore, practitioners must integrate knowledge across the entire text and extend reasoning to apply formulas appropriately.
**Baihu Jia Renshen Tang (White Tiger Decoction with Ginseng) from *Jingui Yaolue*:** Originally used to treat Taiyang Zhong Shu (Heatstroke), characterized by sweating, aversion to cold, fever, and thirst. By removing the bitter properties of Anemarrhenae Rhizoma (Zhi Mu) and adding the sweet properties of Lophatheri Herba (Dan Zhu Ye) and Ophiopogonis Radix (Mai Men Dong), it is renamed Zhuye Shigao Tang (Leaf and Gypsum Decoction), used to treat deficiency irritability. Anemarrhenae Rhizoma (6 liang), Gypsum Fibrosum (Shi Gao) (1 jin, crushed), Glycyrrhizae Radix et Rhizoma (Gan Cao) (3 liang), Oryza Sativa (Jing Mi) (6 he), Ginseng Radix et Rhizoma (Ren Shen) (2 liang). The above five ingredients are boiled in 1 dou of water until the rice is cooked and the decoction is ready. Strain and take 1 sheng warm, three times daily.
Commentary: This is an excellent formula for treating lung and stomach damage caused by fiery heat, clearing heat and rescuing fluids to stop thirst. Therefore, for Xiao Ke located in the Upper Jiao, this formula must be used. Li Dongyuan used it to treat Ge Xiao (Thirst between the diaphragm), and Zhang Jiegu used it for cases involving hunger with thirst. For cases involving lack of appetite with thirst, Qian Yi's Baizhu San was used with doubled Gegen (Kudzu Root). Li Dongyuan further referenced the *Neijing* principle that diseases from rich foods should not be treated with aromatic herbs or mineral drugs, but with Orchidaceous plants to remove stale qi. He modified the formula into Lanxiang Yinzi (Orchid Fragrance Decoction), using Shi Gao, Zhi Mu, raw and roasted Gan Cao, Ren Shen, plus Lan Xiang (Costi Rhizome), Fang Feng (Saposhnikovia Root), Bai Dou Kou (Cardamom), Lian Qiao (Forsythia), Jie Geng (Platycodon), Sheng Ma (Cimicifuga), Ban Xia (Pinellia). He further modified it into Shengjin Ganlu Yinzi (Generating Fluids Sweet Dew Decoction), adding Huang Bo (Phellodendron), Xing Ren (Apricot Seed), Shan Zhi (Gardenia), Bi Cheng Qie (Long Pepper Fruit), Bai Kui, Bai Dou Kou, Bai Zhi (Angelica Dahurica), Lian Qiao, Jiang Huang (Turmeric), Mai Men Dong, Lan Xiang, Dang Gui Shen (Codonopsis/Ginseng root tip), Jie Geng, Sheng Ma, Huang Lian (Coptis), Mu Xiang (Aucklandia), Chai Hu (Bupleurum), Huo Xiang (Patchouli), Quan Xie (Scorpion). He explained: "This formulation is mild." It prevents abdominal fullness and transmission to Lower Xiao, making it suitable for all three types of Xiao Ke. I sincerely disagree. Similarly, the Shizi Qi Tang from *Sanyin Fang* and Jiegu's Qingliang Yinzi derive from this formula but add other herbs targeting other organs, completely losing the intent of urgently rescuing the lungs and stomach. This illustrates why later physicians remain limited.
**Zhuye Huangqi Tang (Leaf and Astragalus Decoction):** Treats Xiao Ke with Qi and Blood deficiency, excess Stomach fire, and thirst. Lophatheri Herba (Dan Zhu Ye), Raw Rehmanniae Radix (Sheng Di Huang) (each 2 qian), Astragali Radix (Huang Qi), Ophiopogonis Radix (Mai Men Dong), Angelicae Sinensis Radix (Dang Gui), Chuanxiong Rhizoma (Chuan Xiong), Scutellariae Radix (Huang Qin, stir-fried), Glycyrrhizae Radix et Rhizoma (Gan Cao), Paeoniae Radix (Shao Yao), Ginseng Radix et Rhizoma (Ren Shen), Pinelliae Rhizoma (Ban Xia), Gypsum Fibrosum (Shi Gao) (each 1 qian). Decoct in water and take orally.
Commentary: The preceding Baihu Jia Renshen Tang specifically treats dryness-heat in the Qi level. This formula treats dryness-heat in both Qi and Blood levels, while subsequent formulas specifically target dryness-heat in the Blood level. Selection should be based on pattern differentiation.
**Shengdi Huang Yinzi (Raw Rehmannia Decoction):** Treats Xiao Ke with dry throat, red face, and irritability. Ginseng Radix et Rhizoma (Ren Shen), Raw Dried Rehmanniae Radix (Sheng Gan Di Huang), Cooked Dried Rehmanniae Radix (Shu Gan Di Huang), Astragali Radix (Huang Qi, honey-fried), Asparagi Radix (Tian Men Dong), Ophiopogonis Radix (Mai Men Dong), Aurantii Fructus (Zhi Ke, bran-fried), Dendrobii Caulis (Shi Hu), Loquat Leaf (Pi Pa Ye), Alismatis Rhizoma (Ze Xie), Glycyrrhizae Radix et Rhizoma (Gan Cao, roasted, equal parts). Grind into coarse powder. Take 3 qian per dose, decoct in 1 zhan of water until reduced to 0.6 zhan. Strain and take immediately before bed after meals. This formula generates essence and nourishes blood, moistens dryness and stops thirst. Ze Xie and Zhi Ke guide dampness through the Fu organs, descending Heart Fire so the Small Intestine clears; moistening the Lung Meridian ensures Large Intestine patency. With old heat removed, thirst ceases naturally.
**Qian Shi Baizhu San (Qian’s Atractylodes Macrocephala Powder):** Treats deficiency-heat with thirst. Ginseng Radix et Rhizoma (Ren Shen), Atractylodis Macrocephalae Rhizoma (Bai Zhu), Poria (Bai Fu Ling), Glycyrrhizae Radix et Rhizoma (Gan Cao), Agastaches Herba (Huo Xiang), Aucklandiae Radix (Mu Xiang) (each 1 liang), Puerariae Lobatae Radix (Gan Ge) (2 liang). Grind into powder. Take 3 qian per dose, decoct in water and take warm. Increase dosage if fluid intake is high.
Commentary: Renzhai used this formula adding Wu Wei Zi and Chai Hu (3 qian each), divided into ten doses, to treat Xiao Ke with inability to eat. Haizang stated: This is a modification of Sizijunzi Tang, also treating excessive dampness leading to Qi collapse and severe diarrhea; thus, it is essential for thirst caused by deficiency-heat.
**Huangqi Tang (Astragalus Decoction) from *Xuanming Lun*:** Treats Cold transferring from Heart to Lung, forming Fei Xiao (Lung Wasting-Thirst), with low fluid intake and high urine output. Tonify Lung and calm Heart. Astragali Radix (Huang Qi) (3 liang), Schisandrae Fructus (Wu Wei Zi), Ginseng Radix et Rhizoma (Ren Shen), Ophiopogonis Radix (Mai Men Dong), Morus Cortex (Sang Bai Pi) (each 2 liang), Lycii Fructus (Gou Qi Zi), Prepared Rehmanniae Radix (Shu Di Huang) (each 1.5 liang). Grind into powder. Take 5 qian per dose, decoct in 2 zhan of water until reduced to 1 zhan. Strain and take warm at any time.
**Maidong Yinzi (Ophiopogon Decoction) from *Xuanming Lun*:** Treats Heat transferring from Heart to Lung, transforming into Ge Xiao (Diaphragm Wasting-Thirst), with chest fullness, irritability, and shortness of spirit. Ginseng Radix et Rhizoma (Ren Shen), Poria cocos with Hostwood (Fu Shen), Ophiopogonis Radix (Mai Men Dong), Schisandrae Fructus (Wu Wei Zi), Raw Rehmanniae Radix (Sheng Di Huang), Roasted Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao), Anemarrhenae Rhizoma (Zhi Mu), Puerariae Lobatae Radix (Ge Gen), Trichosanthis Radix (Gua Lou Gen) (equal parts). Chop coarsely. Take 5 qian per dose, add 14 leaves of Lophatheri Herba (Dan Zhu Ye), decoct to 0.7 portion. Take warm at any time.
Commentary: These two formulas from *Xuanming Lun* address the Cold and Heat transfer syndromes from the Heart described in the *Neijing*. While the effort is commendable, the rapid progression of Cold/Heat transfer contrasts with the slow action of generating fluids and nourishing blood. The patterns do not perfectly match the remedies. Yi Lao’s Maidong Yinzi suffers from similar issues. I believe that for Heart Cold transferring to the Lung, one should first secure the Lung's exterior using Ren Shen and Huang Qi to tonify the Lung, adding dispersing-cold herbs. Using Gou Qi Zi and Shu Di Huang to tonify the Kidney is too indirect. Using Sang Bai Pi to drain the Lung does not address the exterior-constrained Cold. For Heart Heat transferring, saline-cold herbs entering the Heart first, like Wen Sha San, prevent heat transfer. Why not adopt the direct approach? Those who have seen the sea find ordinary water insufficient.
**Yi Lao Maidong Yinzi (Yi Lao’s Ophiopogon Decoction):** Treats extreme thirst in elderly and weak individuals. Ginseng Radix et Rhizoma (Ren Shen), Lycii Fructus (Gou Qi Zi), Poria (Bai Fu Ling), Glycyrrhizae Radix et Rhizoma (Gan Cao) (equal parts), Schisandrae Fructus (Wu Wei Zi), Ophiopogonis Radix (Mai Men Dong) (each 1.5 liang). Decoct with ginger water and take orally.
Commentary: Yi Lao’s formula modifies Xuanming’s Maidong Yinzi by removing Sheng Di Huang, Zhi Mu, and Ge Gen, adding Gou Qi Zi. It omits mention of Heart Heat transferring to the Lung, focusing instead on extreme thirst in the elderly and weak. Adding Gou Qi Zi for moisture removes the cloying nature of Di Huang, the bitterness of Zhi Mu, and the ascending nature of Ge Gen. The prescription avoids fault and aims at treating the root, avoiding being overly indirect.
**Zhudu Wan (Pig Stomach Pill):** Treats Qiang Zhong Xiao Ke (Excessive Yang Wasting-Thirst). Coptidis Rhizoma (Huang Lian), Setaria Italica (Su Mi), Trichosanthis Radix (Gua Lou Gen), Poria cocos with Hostwood (Fu Shen) (each 4 liang), Anemarrhenae Rhizoma (Zhi Mu), Ophiopogonis Radix (Mai Men Dong) (each 2 liang). Grind into fine powder. Clean one large pig stomach, insert powder, sew with hemp thread, steam until very tender. Remove medicine, grind separately, use pig stomach juice as paste, mix with refined honey, pound uniformly, form pills the size of Chinese parasol seeds. Take 50 pills per dose with Ren Shen decoction. Alternative: Add Ren Shen, Shu Di Huang, Gan Ge. Another variant: Remove Zhi Mu and Su Mi, use Wheat instead.
**Lanjin Wan (Rotten Gold Pill):** Treats post-Resolving Heat Middle Xiao Ke, tonifying essence and blood, benefiting various deficiencies, relieving fatigue, clearing heat in joints, calming the mind, strengthening will, stabilizing spirit, consolidating Zang-Fu, improving appetite, preventing sores. One large pig stomach, Coptidis Rhizoma (Huang Lian) (3 liang), Fresh Ginger (Sliced) (2 liang), White Honey (2 liang). Wash pig stomach clean. In summer, boil with scallion, pepper, vinegar, flour, water, and wine in silver/ceramic vessel for half a day. Remove Huang Lian, wash off honey/wine, chop and grind to fine powder. Mix with water to form paste, return to pig stomach, sew, boil again until tender, grind to mud. Add Ginseng Radix et Rhizoma (Ren Shen), Schisandrae Fructus (Wu Wei Zi), Eucommiae Cortex (Du Zhong, stir-fried with ginger to remove silk), Dioscoreae Rhizoma (Shan Yao), Dendrobii Caulis (Shi Hu), Corni Fructus (Shan Zhu Rou), Plantaginis Semen (Che Qian Zi), Fresh Lotus Seed (Qu Xin), Testudinis et Chelonis Carapax et Plastrum (Bie Jia, vinegar-fried), Dry Rehmanniae Radix (Gan Di Huang), Angelicae Sinensis Radix (Dang Gui) (each 2 liang), Magnetitum (Ci Shi, calcined), Poria (Bai Fu Ling), Sophorae Flos (Huai Jiao Zi, stir-fried), Chuanxiong Rhizoma (Chuan Xiong) (each 1 liang), Astragali Radix (Huang Qi) (4 liang), Cuscutae Semen (Tu Si Zi, wine-washed, steamed, ground) (5 liang), Aquilariae Lignum Resinatum (Chen Xiang) (0.5 liang), Moschus (She Xiang, separately ground) (1 qian). Grind to fine powder, mix with pig stomach paste. If paste is insufficient, add cooked honey. Pound thousands of times, form pills the size of sesame seeds. Take 50 pills before meals with warm wine or glutinous rice drink. Alternative: Add Bai Zhu (2 liang), Yang Qi Shi (1 liang).
Commentary: Using She Xiang and Yang Qi Shi to open orifices and stimulate yang reflects the rash cognition of later generations. Other harmless herbs and the stomach preparation method have merit, hence preserving both formulas.
**Jiegu Huashui Dan (Jiegu’s Water-Dissolving Pill):** Treats Hand-Shaoyin and Foot-Shaoyin thirst with unquenchable drinking or heart pain. *Ben Shi Fang* treats excessive cold water intake. Aconiti Radix (Chuan Wu, large umbilicus, 4 pieces, prepared, peeled), Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) (1 liang), Ostrea Concha (Mu Li, raw) (3 liang), Concha Meretricis et Cyclinae (Ge Fen, thick, prepared) (4 liang). Grind to fine powder, make pills with vinegar-soaked steamed dough. Take 15 pills with fresh well water. For heart pain, take with vinegar water for immediate relief. For drinking one dan of water, one dose cures. Haizang says: This medicine dissolves retained water.
Commentary: Excessive water intake can sometimes dissipate internal heat, but once heat is gone, the body may fail to metabolize water, leading to severe disease. Jiegu recognized this, using Chuan Wu to assist fire, combined with salty-cold Mu Li and Ge Fen to achieve water-dissolving effects. To prevent latent heat roots from remaining, he used it sparingly, showing deep insight, though not fully disclosed.
**Huanglian Gao (Coptis Paste):** Treats dry mouth/tongue, frequent urination, red tongue, generating fluids, removing dryness, promoting tissue growth. Coptidis Rhizoma (Huang Lian) (1 jin, ground), Bovis Lac (Niu Nai Zhi), Nelumbinis Nuciferae Rhizoma Juice (Bai Ou Lian Zhi), Raw Rehmanniae Radix Juice (Sheng Di Huang Zhi) (each 1 jin). Boil juices into paste, mix with Huang Lian powder to form pills the size of mung beans. Take 20 pills per dose with small sips of water, ten doses daily.
**Shengdi Huang Gao (Raw Rehmannia Paste):** Same indications. Raw Rehmanniae Radix (Sheng Di Huang) (one handful), Honey (Feng Mi) (1 liang), Ginseng Radix et Rhizoma (Ren Shen) (0.5 liang), Poria (Bai Fu Ling) (1 liang). Wash and mash Di Huang, mix with fresh water, boil with honey until half volume remains. Add Ren Shen and Fu Ling powders, mix, store in ceramic jar. Take with spoon.
Commentary: One paste uses bitter-cold combined with sweet-cold; the other uses purely sweet-cold. Choose according to suitability. These represent the balance in treating Xiao Ke, hence recorded together.
**Tianmen Dong Wan (Asparagus Pill):** Treats early-stage Xiao Zhong, feeling hungry after eating, vexing heat in hands/feet, back/shoulder pain/distension, turbid white urine. Asparagi Radix (Tian Men Dong), Trichosanthes Kirilowii Root (Tu Gua Gen, dried) (each 1.5 liang), Trichosanthis Radix (Gua Lou Gen), Prepared Rehmanniae Radix (Shu Di Huang), Anemarrhenae Rhizoma (Zhi Mu, baked) (each 1.5 liang), Cistanches Herba (Rou Cong Rong, soaked in wine overnight, sliced, baked), Cervi Cornu Pantotrichum (Lu Rong), Schisandrae Fructus (Wu Wei Zi), Halloysitum Rubrum (Chi Shi Zhi), Alismatis Rhizoma (Ze Xie) (each 1.5 liang), Gallus Gallus Domesticus Gizzard Membrane (Ji Nei Jin, 3 pieces, lightly baked), Mantispidae Oötheca (Sang Piao Xiao, 10 pieces, baked), Ostrea Concha (Mu Li, calcined) (2 liang), Sophorae Flavescentis Radix (Ku Shen) (1 liang). Grind to fine powder, refine honey into pills the size of Chinese parasol seeds. Take 20 pills before meals with Setaria Italica drink.
Commentary: Early Xiao Zhong and Xiao Xia require urgent treatment of the root. Pills act slowly, and taking only 20 pills is too leisurely. The herbs are good, but Chi Shi Zhi is questionable. Removing it and tripling the dose could ensure efficacy, as early stages respond quickly.
**Zhushen Ji Cai Tang (Pig Kidney and Shepherd’s Purse Decoction):** Treats Xiao Zhong with 8-9 sheng of urine day and night. Pig Kidneys (2 pieces), Soybeans (Da Dou) (1 jin), Shepherd’s Purse (Ji Cai), Gypsum Fibrosum (Shi Gao) (each 3 liang), Ginseng Radix et Rhizoma (Ren Shen), Poria (Fu Ling, alternatively Fu Shen), Anemarrhenae Rhizoma (Zhi Mu), Puerariae Lobatae Radix (Ge Gen), Scutellariae Radix (Huang Qin), Magnetitum (Ci Shi, wrapped in cotton), Trichosanthis Radix (Gua Lou Gen), Glycyrrhizae Radix et Rhizoma (Gan Cao) (each 2 liang). Chop coarsely. Use 1.5 dou of water. First boil pig kidneys and soybeans until 1 dou remains. Strain, add remaining herbs, boil to 3 sheng. Divide into three doses. Drink urgently when thirsty. For Lower Jiao heat, take one dose at night. Stop when thirst ceases.
Commentary: This formula uses cooling agents like Baihu Tang, adding pig kidneys, soybeans, and magnetite to guide cooling properties to the Kidney. It requires urgent administration. It is essential for intense heat in Upper and Lower Jiao. Later, Ji Cai Wan was made for Qiang Zhong (persistent erection without emission). Post-Xiao Ke often leads to abscesses due to overuse of cinnabar/mercury pills. This base formula removes Shi Gao, Zhi Mu, Ge Gen, Huang Qin, adding Lu Rong, Digentis Cortex (Di Gu Pi), Shu Di Huang, Chen Xiang. Since pathology is in Middle/Lower Jiao with exhaustion of Yang Qi and Yin Essence, abandoning Upper Jiao cooling for Lower Jiao warming is appropriate.
**Shen Li San (Kidney Drip Powder):** Treats Shen Xiao (Kidney Wasting-Thirst) with Kidney Qi deficiency causing thirst, frequent urination, and lumbar pain. Gallus Gallus Domesticus (Ji, lightly baked), Polygalae Radix (Yuan Zhi, heart removed), Ginseng Radix et Rhizoma (Ren Shen), Mantispidae Oötheca (Sang Piao Xiao, lightly fried), Astragali Radix (Huang Qi), Alismatis Rhizoma (Ze Xie), Cinnamomi Ramulus (Gui Xin), Prepared Rehmanniae Radix (Shu Di Huang), Poria (Bai Fu Ling), Os Draconis (Long Gu), Angelicae Sinensis Radix (Dang Gui) (each 1 liang), Ophiopogonis Radix (Mai Men Dong, heart removed), Chuanxiong Rhizoma (Chuan Xiong) (each 2 liang), Schisandrae Fructus (Wu Wei Zi), Roasted Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao), Scrophulariae Radix (Xuan Shen) (each 0.5 liang), Magnetitum (Ci Shi, 0.5 liang, ground, washed to remove red juice). Chop coarsely. Per dose, use one pair of sheep kidneys, remove fat membrane. Boil kidneys in 1.5 zhan water until 1 zhan remains. Remove floating fat and kidneys. Add 5 qian of herbs, 0.5 fen of ginger, decoct to 0.5 zhan. Strain and take on empty stomach. Repeat before evening meal.
Commentary: Kidney Qi deficiency stems from Yin Essence insufficiency. Dang Gui and Chuan Xiong, though said to tonify Yin, do not tonify Essence; moreover, their acrid and dispersing nature is unsuitable. Better to substitute with Corni Fructus (Shan Zhu Yu) and Lycii Fructus (Gou Qi Zi). The guiding method is excellent, hence selected.
**Baifu Ling Wan (White Poria Pill):** Treats Shen Xiao following Xiao Zhong, where Stomach Heat enters Kidney, consuming Kidney Fat, causing dryness, thinning legs, and weak waist/feet. Poria (Bai Fu Ling), Rubi Fructus (Fu Pen Zi), Coptidis Rhizoma (Huang Lian), Trichosanthis Radix (Gua Lou Gen), Dioscoreae Hexandraceae Rhizoma (Bi Xie), Ginseng Radix et Rhizoma (Ren Shen), Prepared Rehmanniae Radix (Shu Di Huang), Scrophulariae Radix (Xuan Shen) (each 1 liang), Dendrobii Caulis (Shi Hu), Cnidii Fructus (She Chuang Zi) (each 0.75 liang), Gallus Gallus Domesticus Gizzard Membrane (Ji Nei Jin, 30 pieces, lightly fried). Grind to fine powder, mix with refined honey, pound 300-500 times, form pills the size of Chinese parasol seeds. Take 30 pills before meals with Magnetitum (Ci Shi) decoction.
My friend Zhu Lin suffered from Xiao Ke. Thirst subsided slightly but was replaced by dryness and urgency, with flaccid legs/knees. He urged me to use eclectic medicines urgently. I prescribed this pill with Rhinocerotis Cornu (Xi Jiao). A physician present asked: "Treating Kidney disease with Xi Jiao and Huang Lian targeting the Heart—isn't this inverted?" I replied: "The Kidney is the gate of the Stomach. Stomach Heat transmitting to Kidney opens the gate widely. When the gate opens, Heart Yang Fire descends directly to Kidney. The *Classic* says: 'Where Yang Essence descends, life is shortened.' This is serious. Now, patient's Heart Fire scorches Kidney, unable to withstand dryness. Using Xi Jiao and Huang Lian in Kidney to counter descending Yang Sun—is this inverted?" The physician accepted my view. Friend recovered. Switched to Liuwei Dihuang Wan with Xi Jiao, resulting in lustrous skin and cure.
**Rendong Wan (Honeysuckle Pill):** Prevents carbuncles/sores after thirst illness resolves. Honeysuckle Herb (Rendong Cao, root/stem/leaf/flower usable). Soak in rice koji wine in a bottle, bake with chaff fire overnight. Dry, add little Gan Cao, grind to powder. Use soaking wine to make paste pills, size of Chinese parasol seeds. Take 50-100 pills, wine allowed.
Commentary: In April, collect fresh flowers, squeeze juice, boil to paste. Take with wine/water. Nourishes Yin, retreats Yang, harmonizes Ying/Wei and blood vessels. Suitable for fiery-heat constitutions as a health-preserving elixir.
**Lanye San (Isatis Leaf Powder):** Treats thirst-diabetes with dry mouth, vexing heat, back carbuncles, red pain. Isatidis Folium (Lanye), Cimicifugae Rhizoma (Sheng Ma), Scrophulariae Radix (Xuan Shen), Ophiopogonis Radix (Mai Men Dong), Astragali Radix (Huang Qi), Puerariae Lobatae Radix (Ge Gen), Aquilariae Lignum Resinatum (Chen Xiang), Paeoniae Radix Rubra (Chi Shao Yao), Rhinocerotis Cornu (Xi Jiao Xie), Glycyrrhizae Radix et Rhizoma (Gan Cao, raw) (each 1 liang), Rheum Palmatum (Da Huang, 2 liang, lightly fried). Take 4 qian per dose, decoct in 1 zhan water to 0.6 zhan. Strain, take warm anytime.
**Zisu Tang (Perilla Decoction):** Treats post-Xiao Ke generalized edema and chest/diaphragm discomfort. Perillae Caulis et Folium (Zisu Jing Ye), Mori Cortex (Sang Bai Pi), Red Poria (Chi Fu Ling) (each 1 liang), Pruni Semen (Yu Li Ren, peeled, fried) (2 liang), Antelopis Cornu (Ling Yang Jiao), Arecae Semen (Bing Lang) (each 0.75 liang), Cinnamomi Ramulus (Gui Xin), Aurantii Fructus (Zhi Ke), Angelicae Pubescentis Radix (Du Huo), Aucklandiae Radix (Mu Xiang) (each 0.5 liang). Take 4 qian per dose, decoct in 1.5 zhan water with 0.5 fen ginger to 0.8 zhan. Take warm.
**Wumei Mugua Tang (Dark Plum and Papaw Decoction):** Treats excessive alcohol consumption causing internal steaming heat, drying Five Zang fluids, stagnant blood, polyuria, emaciation, craving cold foods/drinks. Papaw Fructus (Mugua Gan), Dark Plum Fructus (Wu Mei, crushed, pit removed), Fried Malt (Mai Ya), Glycyrrhizae Radix et Rhizoma (Gan Cao), Tsaoko Fructus (Cao Guo, peeled) (each 0.5 liang). Take 4 qian per dose, decoct in 1.5 zhan water with 5 slices ginger to 0.7 portion. Take anytime.
**Shacha Fang (Parasite-Killing Formula):** Treats Xiao Ke with parasites. Melia Radicis Cortex (Kulian Gen), take fresh white bark, one handful, slice and bake. Add little Moschus (She Xiang). Decoct in 2 bowls water to 1 bowl. Take on empty stomach. Even if weak, no harm. Parasites (3-4, red roundworm-like) pass subsequently, thirst stops instantly. Thus, Xiao Ke involves parasites consuming essence/fluids. (From *Yijian Zhi*)
Commentary: Drinking rich wine and eating spicy food accumulates Stomach Heat; damp-heat generates parasites. This applies not only to Xiao Ke but to all diseases; careful examination is needed clinically.