夫三消者，即《内经》之所云消瘅、消中也。多饮而渴不止为上消，如气厥论云∶肺消
、膈
消，奇病论云∶消渴是也。消谷善饥为中消。如脉要精微论云∶瘅成为消中。师传篇云∶胃
中热则消谷是也。溲便频膏浊不禁为下消，如病形篇云∶肝肾脉微小为消瘅，肝肾在下是也
。何柏齐斋曰∶造化之机，水火而已，宜平不宜偏，宜交不宜分。水为寒湿，火为燥热，火
性
炎上，水性润下，憔火在下，水在上，方为既济，而坎离相交。若水偏盛不交，则为肿胀，
火
偏盛不交，则为消渴，惟制其偏而使之交。斯为善治者矣。《袖珍》云∶人生之有肾，犹水
之有根，故肾脏受病，必先形容憔悴，虽加滋养，不能光泽。凡患此证，皆肾经为病，由壮
盛之时不能保摄，恣情快欲，或饮酒无度，或嗜炙爆过多，或久服丹石之药，遂致肾水枯竭
，心火燔灼，三焦猛烈，五脏煎熬而消渴生焉。治当补肾水，泻心火，除肠胃燥热之盛，济
身中津液之衰，使道路散而不结，津液生而不枯，血气和平，其病自已。此治消渴者但察其
虚实，清火壮水，或滋泻。随所宜而用之法也。然《内经·阴阳别论》曰∶二阳之病发心脾
其传为风消。此阳明为十二经之海，土衰而木气乘之，故为肌肉消也。气厥论曰∶心移寒于
肺为肺消，饮一溲二，死不治。此言元阳之衰，而金寒水冷，则为肺肾之消也。病形篇曰∶
五脏之脉微小者，皆为肺瘅。此言寸口之脉弱见于外，以气血之衰而消于内也。又气交变大
论曰∶岁水太过，上临太阳，民病渴而妄冒。五常政大论曰∶太阳司天寒淫所胜，民病嗌干
，渴而欲饮，是皆以阴抑阳，以水制火，必以温剂散去寒邪，其病自愈也。由是观之，又乌
得概作热治哉？余尝治一缙绅，年逾四旬，因案牍积劳，致神困食减，时多恐惧，上焦无渴
，不嗜汤水，或少饮则沃而不行，每至夜必去溺三十余合，半皆津液。最后延余诊视，因相
告曰∶自病以来，通宵不寐者，已半载余，间或朦胧睡去，必梦见亡人凶丧等事，又与鬼魅
相亲。余谓之曰∶此思虑积劳，损伤心肾。元气既亏，则阴邪胜之。故多阴梦，阳衰则气虚
，阳不帅阴，则水不化气，故饮虽少而阴浊多也。此正《素问》饮一溲二之疾，幸脉犹带缓
，肉尚未脱，胃气尚行，可以无虑。必俟阳气渐回，则阴邪自渐退矣，乃用归脾去木香，八
味去丹泽，一以养阳，一以养阴。至三百余剂，人参二十余斤而后愈。此正肺消于上，精消
于下之证。可见消亦有阴阳，医断不可执滞而不通也，知我罪我，其鉴予言。
三消证，就是《内经》中所说的消瘅、消中。饮水多且口渴不止的称为上消，正如《气厥论》所说：肺消、膈消，《奇病论》所说：消渴，都是指这种情况。食物消化快且容易饥饿的称为中消，正如《脉要精微论》所说：瘅热发展为消中，《师传篇》所说：胃中有热则消谷，都是指这种情况。小便频数、尿液浑浊如膏脂且无法控制的称为下消，正如《病形篇》所说：肝肾脉象微小为消瘅，因为肝肾位于身体下部，所以这样理解。何柏齐斋说：造化的机理，不过是水和火罢了，应当平衡而不偏颇，应当交融而不分离。水代表寒湿，火代表燥热，火的性质是炎上，水的性质是润下，只有火在下而水在上，才构成“既济”（水火相交）的状态，也就是坎离相交。如果水偏盛而不能交融，就会形成肿胀；如果火偏盛而不能交融，就会形成消渴，只有制约其偏盛而使二者交融，这才是善于治疗的人。《袖珍方》说：人拥有肾脏，就像水拥有源头一样，所以肾脏患病，必然先出现形体憔悴，即使增加滋养，也不能恢复光泽。凡是患这种证候的，都是肾经发病，由于在壮盛时期不能保养摄生，放纵情欲，或者饮酒无度，或者嗜好烧烤油炸食物过多，或者长期服用丹石类药物，导致肾水枯竭，心火猛烈燃烧，三焦火热炽盛，五脏被煎熬从而产生消渴。治疗应当补肾水，泻心火，清除肠胃燥热的盛势，救济身体中津液的衰少，使经络道路散开而不郁结，津液生成而不枯涸，血气平和，疾病自然痊愈。这是治疗消渴的方法，只需考察其虚实，清火壮水，或者滋阴或利湿，根据适宜的情况使用。然而《内经·阴阳别论》说：二阳（阳明胃肠）的病发于心脾，其传变成为风消。这是因为阳明是十二经之海，土气衰弱而木气乘虚侵袭，所以导致肌肉消瘦。《气厥论》说：心将寒气移于肺称为肺消，喝一份尿两份，属于死症难以治愈。这是说元阳衰弱，金寒水冷，从而形成肺肾之消。《病形篇》说：五脏脉象微小的，都称为肺瘅。这是说寸口脉象虚弱见于外部，是因为气血衰少而在内部消耗。又《气交变大论》说：岁运水气太过，上临太阳，百姓生病口渴且神志昏乱。《五常政大论》说：太阳司天，寒邪淫胜，百姓生病咽喉干燥，口渴想喝水，这些都是以阴抑制阳，以水制约火，必须用温剂散去寒邪，疾病才能自愈。由此看来，怎么能一概当作热证来治疗呢？我曾经治疗一位官员，年龄超过四十岁，因为文书工作积劳，导致精神困倦、食欲减退，时常恐惧，上焦没有口渴感，不喜欢汤水，稍微喝一点就停滞不行，每到夜晚必定排尿三十多合，其中一半都是津液。最后请我诊视，他告诉我：自从生病以来，通宵不睡觉已经半年多了，偶尔朦胧睡去，必定梦见死去的人、凶丧等事，又像与鬼魅亲近。我对他说：这是思虑积劳，损伤心肾。元气既然亏损，那么阴邪就会胜过它。所以多做阴梦，阳气衰弱则气虚，阳气不能统帅阴液，则水不能化为气，所以虽然饮水少但排出的阴浊之物多。这正是《素问》所说的“饮一溲二”的疾病，幸好脉象还带有缓象，肌肉尚未脱失，胃气尚存，可以不必担忧。必定等到阳气逐渐回复，那么阴邪自然会逐渐消退，于是我用归脾汤去掉木香，八味丸去掉牡丹皮和泽泻，一方用来养阳，一方用来养阴。服用了三百多剂，人参用了二十多斤后才痊愈。这正是肺消在上、精消在下的证候。可见消渴也有阴阳之分，医生断不可固执拘泥而不通变，了解我的还是怪罪我的，请以我的话为鉴。
Sanxiao (Three Consumptions) refers to what is mentioned in the *Neijing* (*Classic of Internal Medicine*) as Xiaodan (Consumption and Diabetes) and Xiaozhong (Middle Consumption). Excessive drinking with unquenchable thirst is called Shangxiao (Upper Consumption), as stated in the *Qijue Lun* (*Treatise on Qi Reversal*): Feixiao (Lung Consumption) and Gexiao (Diaphragm Consumption); and in the *Qibing Lun* (*Treatise on Strange Diseases*): Xiaoke (Wasting-Thirst Syndrome). Rapid digestion of food with easy hunger is called Zhongxiao (Middle Consumption), as stated in the *Maiyao Jingwei Lun* (*Essential Essentials of Pulse Diagnosis*): Danre developing into Xiaozhong; and in the *Shichuan Pian* (*Chapter on Transmission from Master*): Heat in the Stomach leads to consumption of food. Frequent urination with turbid, paste-like urine that cannot be controlled is called Xiaxiao (Lower Consumption), as stated in the *Bingxing Pian* (*Chapter on Disease Manifestations*): Micro-pulse of Liver and Kidney indicates Xiaodan, because Liver and Kidney are located inferiorly. He Baiqizhai said: The mechanism of creation lies only in Water and Fire; they should be balanced rather than biased, and connected rather than separated. Water represents Cold-Dampness, while Fire represents Dry-Heat. The nature of Fire is to flare upwards, and the nature of Water is to moisten downwards. Only when Fire is below and Water is above does the state of "Ji Ji" (Perfect Balance/Completion of Kan and Li) occur, representing the intersection of Kan and Li. If Water is excessive and fails to connect, it results in swelling; if Fire is excessive and fails to connect, it results in Xiaoke. Only by restraining the excess and facilitating their connection can one be considered a skilled healer. The *Xiu Zhen Fang* states: The human body's Kidneys are like the source of water. Therefore, when the Kidney Meridian is diseased, emaciation appears first; even with increased nourishment, luster cannot be restored. All cases of this syndrome originate from disease in the Kidney Meridian, caused by failing to preserve vitality during youth, indulging in sexual desires, excessive alcohol consumption, overeating roasted or fried foods, or long-term use of cinnabar and stone medicines. This leads to exhaustion of Kidney Water, blazing Heart Fire, fierce heat in the Sanjiao (Triple Burner), and the simmering of the Five Zang Organs, giving rise to Xiaoke. Treatment should tonify Kidney Water, drain Heart Fire, eliminate excessive dry-heat in the Stomach and Intestines, and replenish the decline of body fluids. This ensures that pathways remain open and not obstructed, fluids are generated and not dried up, and Blood and Qi are harmonious, leading to spontaneous recovery. This is the method for treating Xiaoke: observe deficiency or excess, clear fire and strengthen water, or employ yin-nourishing or draining methods according to suitability. However, the *Yinyang Bie Lun* (*Treatise on Differentiation of Yin and Yang*) in the *Neijing* states: Diseases of Er Yang (Yangming/Stomach and Large Intestine) originating from Heart and Spleen transmit as Fengxiao (Wind Consumption). This is because Yangming is the Sea of the Twelve Meridians; when Earth Qi declines, Wood Qi overacts upon it, causing muscle wasting. The *Qijue Lun* states: When Heart transmits Cold to Lung, it is called Feixiao; drinking one part results in urinating two parts, which is incurable and fatal. This describes the decline of Primordial Yang, where Metal becomes cold and Water becomes icy, resulting in Lung-Kidney consumption. The *Bingxing Pian* states: Micro-pulses of the Five Zang Organs all indicate Feidan (Lung Fever). This means weak pulses at the Cun Kou (Radial Artery) manifest externally due to internal depletion of Qi and Blood. Furthermore, the *Jiaoliu Bian Da Lun* (*Great Treatise on Changes in Qi Interaction*) states: When the annual Water Qi is excessive and influences Taiyang, people suffer from thirst and delirium. The *Wuchang Zheng Da Lun* (*Great Treatise on Normal Conditions of the Five Constants*) states: When Taiyang governs the year and Cold pathogen prevails, people suffer from dry throat and thirst craving drink. These are all cases where Yin suppresses Yang and Water controls Fire; treatment must use warm agents to dispel Cold pathogens for spontaneous recovery. Thus, how can one generally treat this as Heat? I once treated a scholar-official over forty years old who, due to mental labor from official documents, suffered from mental fatigue, reduced appetite, and frequent fear. He had no thirst in the Upper Jiao, disliked hot drinks, and any small amount of fluid intake stagnated without moving. Every night he urinated more than thirty units, half of which were clear fluids. Finally, he consulted me and confessed: Since falling ill, he had slept through the night for over half a year; occasionally dozing off, he always dreamed of deceased persons, funerals, and felt close to ghosts/spirits. I told him: This is accumulation of worry and labor damaging Heart and Kidney. Since Yuan Qi (Primal Qi) is deficient, Yin Evil prevails. Hence, many Yin dreams. Yang decline leads to Qi deficiency; Yang fails to command Yin, so Water fails to transform into Qi. Thus, although fluid intake is small, the output of Yin turbidity is large. This is exactly the disease described in the *Suwen* as "drinking one part, urinating two." Fortunately, the pulse still shows a Huan (Moderate) quality, muscles have not wasted away, and Stomach Qi remains functional, so there is no need to worry. Once Yang Qi gradually returns, Yin Evil will naturally recede. I prescribed Guipi Tang (Restore the Spleen Decoction) removing Xiangru (Aucklandiae Radix), and Bawei Wan (Eight-Ingredient Pill) removing Mudanpi (Moutan Cortex) and Zexie (Alisma Rhizome). One formula was used to nourish Yang, the other to nourish Yin. After taking over three hundred doses and consuming more than twenty jin (approx. 12 kg) of Renshen (Ginseng Radix et Rhizoma), he recovered. This was precisely a case of Feixiao in the Upper Jiao and Jingxiao (Essence Consumption) in the Lower Jiao. It is evident that Xiao also has Yin and Yang aspects; physicians must not be rigid but must adapt. May those who understand me forgive me, and those who blame me take my words as a warning.