消渴一证，聚讼千载，阴阳错综，最见识力。昧者众而明者寡，古今一也。名 高而昧者，但执泻火，不辨阴阳，从之者众，识破者寡。自以为是，以讹传讹，相 延不断，至今不觉。遂令今世而罹此患者复受药石之害，雪上加霜，生气日绝，烂 足坏目，肉脱筋萎。不死于病而死于药，诚可悲叹者也。而名微识著见解独明者反 受侮蔑，令千古奇冤不彰于世，无数病人相继弃绝，医道至此，亦可悲矣。今将明 者之论拈出，分布一堂，粲若星列，取长补短，理法同观。谬见斯废，扫陈言于既 往。正眼重开，立确论于将来。俾从事于刘河间、朱丹溪、张子和、李东垣、王肯 堂、徐灵台、叶天士、施今墨等等诸名医谬论者，迷途知返，正偏救弊，将功补过 ，不无遵循，是所望也。
许学士《本事方》曰：人食之后，滋味皆甜，流在膀胱。若腰肾气盛，是为真 火，上蒸脾胃，变化饮食，分流水谷，从二阴出。精气入骨髓，合荣卫，行血脉， 营养一身，其次以为脂膏，其次以为血肉也。其余则为小便，故小便色黄，血之余 也。臊气者，五脏之气，咸润者则下味也。腰肾既虚冷，而不能蒸于谷气，则尽下 为小便，故味甘不变，其色清冷，则肌肤枯槁也。犹如乳母谷气上泄，皆为乳汁。 消渴病者，下泄为小便，皆精气不实于内，则小便数，瘦弱也。又肺为五脏华盖， 若下有暖气蒸则肺润，若下冷极则阳气不能升，故肺干则渴。《易》于否卦乾上坤 下，阳无阴而不降，阴无阳而不升，上下不交，故成否也。譬如釜中有水，以火暖 之，其釜若以板覆之，则暖气上腾，故板能润也，若无火力，水气则不能上，此板 则终不能润也。火力者，则是腰肾强盛也。常须暖补肾气，饮食得火力，则润上而 易消，亦免于渴也。故张仲景云：宜服肾气八味丸。
张景岳《景岳全书》曰：三消者，古人悉认为火证，然有实火者，以邪热有余 也，有虚火者，以真阴不足也。使治消证而不辨虚实，则未有不误者矣。消证有阴 阳，尤不可不察。如多渴者曰消渴，善饥者曰消谷，小便淋浊如膏者曰肾消。凡此 者多由于火，火盛则阴虚，是皆阳消之证也。至于阴消之意，则未有知之者。何以 见之？如《气厥论》曰：心移寒于肺为肺消，饮一溲二死不治。此正以元气之衰而 金寒水冷，故水不化气而气悉化水，岂非阳虚之阴证乎？……故凡治三消者，必当 察其脉气、病气、形气，但见本元亏竭，及假火等证，必当速救其本，以资化源。 若但知为火而专务清理，未有不阴阳俱败者矣。凡治消之法，最当先辨虚实，若察 其脉证果为实火致耗津液者，但去其火，则津液自生而消渴自止。若由真水不足， 则悉属阴虚，无论上中下，急宜治肾。必使阴气渐充，精血渐复，则病必自愈。若 但知清火，则阴无以生日见消败，益以困矣。……三消证，古人以上消属肺，中焦 属胃，下焦属肾，而多从火治，是故然矣。然以余论之，则三焦之火多有病本于肾 ，而无不由乎命门者，夫命门为水火之府，凡水亏证固能为消为渴，而火亏证亦能 为消渴者，何也？盖水不济火则火不归原，故有火游于肺而为上消者，有火游于胃 而为中消者，有火烁阴精而为下消者，是皆真阴不足水亏于下之消证也。又有阳不 化气则水精不布，水不得火则有降无升，所以直入膀胱而饮一溲二，以致泉源不滋 ，天壤枯槁者，是皆真阳不足，水亏于下之消证也。阴虚之消，治宜壮水，固有言 之者矣，阳虚之消，谓宜补火，则人必不信。不知釜底加薪，氤氲彻顶，槁禾得雨 ，生意归巅。此无他，皆阳气之使然也，亦生杀之微权也。余因消证多虚，难堪剥 削，若不求其斫丧之因，而再伐生气，则消者愈消，无从复矣。故再笔于此，用以 告夫明者。
张隐庵《侣山堂类辨》曰：病阳明燥热之消渴者，白虎汤主之，此外因之渴也 。胃气弱而津液不生者，人参汤主之，此内因之渴也。有脾不能为胃行其津液，肺 不能通调水道而为消渴者。人但知以凉润之药治渴，不知脾喜燥而肺恶寒。试观泄 泻者必渴，此因水津不能上输而惟下泄故尔。以燥脾之药治之，水液上升，即不渴 矣。故以凉润治渴，人皆知之，以燥热治渴，人所不知也。
赵养葵《医贯》曰：上消者，舌上赤裂，大渴饮水。《逆调论》云：此乃心移 热于肺，传于鬲消者是也。以人参白虎汤治之。中消者，善食而瘦，自汗，大便硬 ，小便数。叔和云：口干饮水，多食，肌肤瘦，成消中者是也。以调胃承气汤治之 。下消者，引饮烦躁，耳轮焦干，小便如膏。叔和云：焦烦水易亏，此肾消也，肾 气丸治之。古人治三消之法详别如此。
余又有说：人之水火得其平，气血得其养，何消之有？其间摄养失宜，水火偏胜， 津液枯槁，以致龙雷之火上炎，煎熬既久，肠胃合消，五脏干燥，令人四肢瘦削， 精神倦怠。则治消之法，无分上中下，先以治肾为急也。六味八味加减行之，随证 而服，降其心火，滋其肾水，而渴自止矣。白虎承气等方，皆非法也。《总录》谓 不能食而消者，未传中满，能食而消者，必发背痈脑疽。设不知分辨能食不能食， 概以寒凉泻火之药而施治之，则内热未除，中寒复生，能不末传鼓胀耶？惟七味白 术散、人参生脉散之类，恣意多饮，复以八味地黄丸滋其化源。如发痈疽而渴者， 或黑或紫，火极似水之象，乃肾水已竭，不治。惟峻补其阴，亦或可救也。
或问曰：人有服地黄汤而渴仍不止者何也？答曰：此方士拘于绳墨，而不能更 变其道也。盖心肺位近，宜小制其服，肝肾位远，宜大制其服。如高消中消，可以 前丸缓而治之。若下消已极，大渴大燥，须加减八味丸半料，内肉桂一两，水煎六 七碗，恣意冰冷饮之，熟睡而渴病如失矣。处方之要，在乎人之通其变，神而明之 可也。或又问曰：下消无水，用六味地黄丸可以滋少阴之肾水矣，又加肉桂附子者 何也？答曰：盖因命门火衰，不能蒸腐水谷，水谷之气不能上润于肺，譬如釜底无 薪，锅盖干燥，故渴。至于肺，亦无所禀，不能四布水精，并行五经，其所饮之水 未经火化，直入膀胱，正所谓饮一升尿一升，饮一斗尿一斗，试尝其味甘而不咸可 知矣。故用附桂之辛热以壮其少火，釜底加薪，枯笼蒸润，槁禾得雨，生意维新。 惟明者知之，昧者鲜不以为迂也。昔汉武帝病消渴，张仲景为立此方，药止八味， 故名八味地黄丸，诚良方也，可与天地同寿，至圣玄关，今犹可想。疮疽将痊，及 痊后口渴甚者，舌黄坚硬者，及未患先渴，或心烦口燥。小便频数，或白浊阴痿， 饮食少思，肌肤消瘦，及腿肿脚瘦，口舌生疮。以上诸证，均宜服之，无不神效。
治验
曾治一贵人，患疽疾未安而渴大作，一日饮水数升，愚进以加减八味地黄汤， 诸医大笑曰：此药若能止渴，我辈当不复业医矣。皆用紫苏、木瓜、乌梅、人参、 茯苓百药煎生津之药止之，而渴愈甚。数剂之后，茫无功效，不得已而用予方，连 服三日而渴止，因相信久服。不特渴疾不作，气血亦壮，饮食加倍，强健胜于壮年 。盖用此药，非予自执，鄙见实有本原，薛氏家藏书中，屡用奏捷，久服轻身，令 人皮肤光泽，耳目聪明，故详著之。使有渴疾者，能聆余言，专志服饵，取效甚神 ，庶无为庸医所惑，亦善广前人之功。方内五味子最为得力，独能补肾水降心气， 其肉桂一味不可废，若去肉桂则服之不应。
曾治一男子，患前证，余以前丸方治之，彼则谓肉桂性热，乃私易以知柏等药 ，遂口渴不止，发背疽而殂。彼盖不知肉桂为肾经药也，前证乃肾经虚火炎上无制 为患，故用肉桂导引诸药以补之，引虚火归原故效也。
有一等病渴，惟欲饮冷，但饮水不过二三口即厌弃，少顷复渴，其饮水亦如前 ，第不若消渴者之饮水无厌也。此证乃是中气虚寒，寒水泛上，逼其浮游之火于咽 喉口舌之间，故上焦一段欲得水救，若到中焦，以水见水，正其恶也。治法如面红 烦躁者，乃煎理中汤送八味丸，二三服而愈，若用他药，必无生理。又有一等病渴 ，急欲饮水，但欲下不安，少顷即吐出，片刻复欲饮水，至于药食毫不能下，此是 阴盛隔阳，肾经伤寒之证也。予反复思之，用仲景之白通汤加童便、胆汁热药冷探 之法，一服少解，二服全瘳。其在男子间有之，女子恒多有此证。陶节庵先生名回 阳反本汤。
黄疸约言
疸病多与湿热有关，《金匮》主以茵陈蒿汤、栀子大黄汤、茵陈五苓散等方， 又有小柴胡、小建中之用。可见湿热者固常见，虚劳者亦不无，不可一概而论。
胆与肝相表里，肝不升则胆不降，厥阴少阳同主疏泄也。又与胃相上下，胃不 降则胆不降，阳明少阳同主降路也。胆火内郁过久，或内结为石，或外蒸于表，皆 胆之为病也。
脏腑处处相关，牵一发动全身，实者多责肝胆，虚者多责脾胃。然肝胆脾胃本 互为体用，不可割裂，虽治则或有偏重，辨证原不可偏执也。
论治肝病
论治肝病者，多以阴柔为用，法以滋阴清热利湿，多有效验。虽然如此，亦不可一 概而论。盖肝既体阴而用阳，其病必有伤体伤用之别：伤阴者伤其体，当滋其阴； 伤阳者伤其用，当补其阳。辛以补之，酸以泻之，言其用也。其用不彰，则其体凝 滞，岂可但见其二阴之体，而忽其震下之一阳之用哉！
肿瘤治法
阳化气，阴成形。肿瘤是形，其根在气。气化行则形可散，气化滞则形必凝。 西医只见形下，不知形上；不明气化之理，不识气隧之路；对病如聋如盲，见人唯 菌唯物。开口则指鹿为马，动手即张冠李戴；病因不明，乃其常言；办法已无，为 其套话。若过于轻信，通身倚靠，诚恐欲求生路，反趋死途，财去人空，良可悲也 ！
欲化肿瘤，先扶正气。正气虚则瘤反扩散，攻之反危。正气实则瘤必退缩，拨 之可动。虚人宜守不宜攻，相安即可。实者能守复能攻，除恶务尽。要在虚实之辨 为先，切莫悔恨之言在后，千万不可不自量力，莽然汲汲于攻取之道也。
糖尿病概说
消渴这一病证，争论了千年，阴阳错综复杂，最考验医生的见识和医术。愚昧的人多而明智的人少，古今都是一样的。名声高却愚昧的医生，只执着于泻火，不辨别阴阳，跟随他们的人多，识破其谬误的人少。自以为是，以讹传讹，相沿成习不断绝，至今仍未觉悟。于是让当今患此病的人又遭受药物的伤害，雪上加霜，生机日渐断绝，导致烂足坏目，肌肉脱失，筋脉萎缩。不是死于疾病而是死于药物，实在可悲可叹啊。而那些名声微小但见识卓越、见解独特明了的医生反而受到侮辱和蔑视，使得千古奇冤不能昭示于世，无数病人相继被放弃治疗，医道到了这种地步，也可以说是悲哀了。现在我将明智者的论述摘录出来，汇集一堂，灿烂如星辰罗列，取长补短，道理和方法一同观照。谬误的见解因此废弃，扫除过去的陈腐言论。重新睁开正确的眼睛，确立确切的理论于未来。使那些从事于刘河间、朱丹溪、张子和、李东垣、王肯堂、徐灵台、叶天士、施今墨等名医谬论中的人，迷途知返，纠正偏颇补救弊端，将功补过，并非没有遵循的依据，这是我所期望的。
许学士在《本事方》中说：人进食之后，滋味都变甜，流注在膀胱。如果腰肾气盛，这就是真火，向上蒸腾脾胃，变化饮食，分离水谷，从前后二阴排出。精气进入骨髓，与营卫结合，运行于血脉，营养全身，其次形成脂膏，再次形成血肉。其余的成为小便，所以小便颜色黄，是血的余气。臊气，是五脏的气味；咸味者，是下面的味道。腰肾既然虚冷，而不能蒸化谷气，那么全部下泄成为小便，所以味道甘甜不变，颜色清冷，肌肤就会枯槁。就像乳母的谷气上泄，都变成乳汁。消渴病患者，下泄为小便，都是精气在内不实，所以小便频数，身体瘦弱。另外肺是五脏的华盖（保护伞），如果下面有暖气蒸腾则肺滋润，如果下面极冷则阳气不能上升，所以肺干则口渴。《易经》中的否卦乾上坤下，阳无阴而不降，阴无阳而不升，上下不交，所以形成否卦。譬如锅中有水，用火温暖它，如果用板子覆盖锅口，则暖气上腾，所以板子能湿润；如果没有火力，水气就不能上升，这块板子就始终不能湿润。火力，就是腰肾强盛。常常需要温补肾气，饮食得到火力，则滋润上部而易于消化，也免于口渴。所以张仲景说：适宜服用肾气八味丸。
张景岳在《景岳全书》中说：三消症，古人全都认为是火证，然而有实火，是因为邪热有余；有虚火，是因为真阴不足。如果治疗消证而不辨别虚实，就没有不失误的。消证有阴阳之分，尤其不可不考察。比如多渴的叫做消渴，容易饥饿的叫做消谷，小便浑浊如膏的叫做肾消。凡是这些大多由于火，火盛则阴虚，这都是阳消的证候。至于阴消的意思，没有人知道。怎么知道呢？如《气厥论》说：心将寒移于肺叫肺消，喝一份尿两份，死不治。这正是元气衰败而金寒水冷，所以水不化气而气全化为水，难道不是阳虚的阴证吗？……所以凡是治疗三消，必须观察其脉气、病气、形气，只要见到本元亏竭，以及假火等证候，必须迅速救其根本，以资助化源。如果只知道是火而专门致力于清理，没有不导致阴阳俱败的。凡是治疗消的方法，最应当先辨别虚实，如果察其脉证果真是实火导致耗伤津液的，只要去掉火，则津液自然产生而消渴自然停止。如果是由于真水不足，则全属阴虚，无论上中下，急宜治肾。必须使阴气逐渐充盛，精血逐渐恢复，则病必然自愈。如果只知道清火，则阴无法生长，日益消败，更加困顿。……三消证，古人认为上消属肺，中焦属胃，下焦属肾，而多从火治疗，这也是理所当然的。然而依我之见，三焦之火多有病本于肾，而没有不关乎命门的。命门是水火之府，凡是水亏证固能为消为渴，而火亏证也能为消渴，为什么呢？因为水不济火则火不归原，所以有火游于肺而为上消的，有火游于胃而为中消的，有火烁阴精而为下消的，这些都是真阴不足水亏于下的消证。又有阳不化气则水精不布散，水不得火则有降无升，所以直入膀胱而饮一溲二，以致泉源不滋润，天地枯槁的，这些都是真阳不足，水亏于下的消证。阴虚的消，治疗宜壮水，固然有人说过；阳虚的消，谓宜补火，则人们一定不信。不知道釜底加薪，热气弥漫彻顶，干枯的禾苗得雨，生机回归顶端。这没有别的，都是阳气的作用，也是生杀的微权。我因消证多虚，难以承受攻伐，如果不探究其损伤的原因，而再伐生气，则消者愈消，无从恢复了。所以再次笔述于此，用以告知明智者。
张隐庵在《侣山堂类辨》中说：患阳明燥热之消渴的，用白虎汤主治，这是外因引起的渴。胃气弱而津液不生的，用人参汤主治，这是内因引起的渴。有脾不能为胃行使其津液，肺不能通调水道而为消渴的。人们只知道用凉润的药治疗渴，不知道脾喜燥而肺恶寒。试看泄泻的人必定口渴，这是因为水津不能上输而惟独下泄的缘故。用燥脾的药治疗它，水液上升，就不渴了。所以用凉润治渴，人们都知道，用燥热治渴，人们却不知道。
赵养葵在《医贯》中说：上消，舌上赤裂，大渴饮水。《逆调论》说：这是心将热移于肺，传于鬲消的。用人参白虎汤治疗。中消，善食而瘦，自汗，大便硬，小便数。叔和说：口干饮水，多食，肌肤瘦，成消中的。用调胃承气汤治疗。下消，引饮烦躁，耳轮焦干，小便如膏。叔和说：焦烦水易亏，这是肾消，用肾气丸治疗。古人治疗三消的方法详细区别如此。
我还有话说：人的水火得其平衡，气血得其滋养，有什么消呢？其中摄养失宜，水火偏胜，津液枯槁，导致龙雷之火上炎，煎熬既久，肠胃合消，五脏干燥，令人四肢瘦削，精神倦怠。那么治疗消的方法，不分上中下，先以治肾为急。六味地黄丸、八味地黄丸加减行之，随证而服，降其心火，滋其肾水，而渴自然停止。白虎汤、承气汤等方，都不是合法之法。《总录》说不能食而消的，未传变为中满，能食而消的，必发背痈脑疽。假如不知道分辨能食不能食，一概用寒凉泻火的药来施治，则内热未除，中寒复生，能不最终传变为鼓胀吗？只有七味白术散、人参生脉散之类，恣意多饮，再用八味地黄丸滋其化源。如果发痈疽而渴的，或者黑或者紫，是火极似水的象，这是肾水已竭，不治。只有峻补其阴，或许还可以救。
有人问：有人服用地黄汤而渴仍不止，为什么呢？回答说：这是方士拘泥于规矩，而不能改变其道。心肺位置近，适宜小剂量服用，肝肾位置远，适宜大剂量服用。如上消中消，可以用前丸缓慢治疗。如果下消已到极点，大渴大燥，须用加减八味丸半料，内加肉桂一两，水煎六七碗，恣意冰冷饮用，熟睡后渴病像消失了一样。处方的关键，在于人的通晓变化，神而明之就可以了。又问：下消无水，用六味地黄丸可以滋少阴之肾水了，又加肉桂附子为什么呢？回答说：因为命门火衰，不能蒸腐水谷，水谷之气不能上润于肺，譬如釜底无薪，锅盖干燥，所以渴。至于肺，也无所禀受，不能四布水精，并行五经，其所饮之水未经火化，直入膀胱，正所谓饮一升尿一升，饮一斗尿一斗，试着尝其味甘而不咸可知了。所以用附子肉桂的辛热以壮其少火，釜底加薪，枯笼蒸润，干枯的禾苗得雨，生机维新。只有明智者知道，愚昧者很少不以为迂阔的。昔日汉武帝患消渴，张仲景为此立此方，药止八味，故名八味地黄丸，确实是良方，可与天地同寿，至圣玄关，如今犹可想见。疮疽将要痊愈，及痊愈后口渴严重的，舌黄坚硬的，以及未患病前先渴，或心烦口燥。小便频数，或白浊阴痿，饮食少思，肌肤消瘦，以及腿肿脚瘦，口舌生疮。以上诸证，均适宜服用，无不神效。
治疗验案
曾治疗一位贵人，患疽疾未安而渴大作，一天饮水数升，我进献加减八味地黄汤，众医大笑说：这药如果能止渴，我们就不再行医了。都用紫苏、木瓜、乌梅、人参、茯苓百药煎生津的药来止渴，而渴更严重。几剂之后，茫无功效，不得已而用我的方，连服三日而渴止，因此相信久服。不仅渴疾不作，气血亦壮，饮食加倍，强健胜于壮年。因为用此药，不是我自执偏见，鄙见实有本源，薛氏家藏书中，屡用奏捷，久服轻身，令人皮肤光泽，耳目聪明，所以详细著录。使有渴疾者，能听我的话，专志服用，取效甚神，庶不为庸医所惑，也是善于推广前人的功劳。方内五味子最为得力，独能补肾水降心气，其肉桂一味不可废，若去肉桂则服药无效。
曾治疗一男子，患前证，我用前丸方治疗他，他却认为肉桂性热，私自换成知母黄柏等药，遂口渴不止，发背疽而死。他大概不知道肉桂是肾经药，前证乃肾经虚火炎上无制为患，所以用肉桂导引诸药以补之，引虚火归原故有效。
有一类病渴，只欲饮冷，但饮水不过二三口即厌弃，稍后又渴，其饮水也如前，只是不像消渴者之饮水无厌。此证乃是中气虚寒，寒水泛上，逼其浮游之火于咽喉口舌之间，所以上焦一段欲得水救，若到中焦，以水见水，正是其厌恶的。治法如面红烦躁者，乃煎理中汤送服八味丸，二三服而愈，如果用其他药，必无生理。又有一类病渴，急欲饮水，但欲下不安，稍后即吐出，片刻又欲饮水，至于药食毫不能下，这是阴盛隔阳，肾经伤寒的证。我反复思考，用张仲景的白通汤加童便、胆汁热药冷探的方法，一服稍解，二服全愈。这在男子间偶有，女子恒多有此证。陶节庵先生名为回阳反本汤。
黄疸约言
疸病多与湿热有关，《金匮要略》主以茵陈蒿汤、栀子大黄汤、茵陈五苓散等方，又有小柴胡汤、小建中汤的运用。可见湿热者固常见，虚劳者也不无，不可一概而论。
胆与肝相表里，肝不升则胆不降，厥阴少阳同主疏泄。又与胃相上下，胃不降则胆不降，阳明少阳同主降路。胆火内郁过久，或内结为石，或外蒸于表，都是胆的病。
脏腑处处相关，牵一发而动全身，实证多责之于肝胆，虚证多责之于脾胃。然而肝胆脾胃本来互为体用，不可割裂，虽然治则或有偏重，辨证原不可偏执。
论治肝病
论治肝病者，多以阴柔为用，法以滋阴清热利湿，多有效验。虽然如此，也不可一概而论。盖肝既体阴而用阳，其病必有伤体伤用之别：伤阴者伤其体，当滋其阴；伤阳者伤其用，当补其阳。辛以补之，酸以泻之，说的是其用。其用不彰，则其体凝滞，岂可只见到其二阴之体，而忽略其震下之一阳之用哉！
肿瘤治法
阳化气，阴成形。肿瘤是形，其根在气。气化行则形可散，气化滞则形必凝。西医只见形下，不知形上；不明气化之理，不识气隧之路；对病如聋如盲，见人唯菌唯物。开口则指鹿为马，动手即张冠李戴；病因不明，是其常言；办法已无，是其套话。如果过于轻信，全身倚靠，诚恐欲求生路，反趋死途，财去人空，实在可悲！
欲化肿瘤，先扶正气。正气虚则瘤反扩散，攻之反危。正气实则瘤必退缩，拨之可动。虚人宜守不宜攻，相安即可。实者能守复能攻，除恶务尽。要在虚实之辨为先，切莫悔恨之言在后，千万不可不自量力，莽然汲汲于攻取之道也。
糖尿病概说
Xiaoke (Wasting and Thirst Syndrome) has been debated for a millennium; its complex interplay of Yin and Yang tests the physician's insight and skill. The ignorant are numerous, while the enlightened are few—a situation unchanged from ancient to modern times. Physicians with high reputations but lacking understanding often adhere solely to purging fire without distinguishing between Yin and Yang. Many follow them, yet few see through their errors. Self-righteous and spreading misinformation, this trend persists uncorrected to this day. Consequently, patients suffering from this condition today suffer further harm from medication, adding frost to snow. Their vital energy is gradually depleted, leading to rotting feet, blindness, muscle atrophy, and tendon flaccidity. They die not from the disease itself but from the treatment, which is truly lamentable. Conversely, physicians with humble reputations but profound insight and unique clarity are often insulted and despised. Thus, a grievance spanning millennia remains unredressed, and countless patients are abandoned. The medical profession has reached such a pitiable state. I now extract the arguments of the enlightened, gathering them together like stars in the sky, to learn from each other's strengths and weaknesses, observing both principles and methods. This will discard erroneous views and sweep away stale rhetoric. With clear eyes reopened, we can establish definitive theories for the future. It is my hope that those misled by the erroneous theories of famous physicians such as Liu Hejian, Zhu Danxi, Zhang Zihe, Li Dongyuan, Wang Kentang, Xu Lingtai, Ye Tianshi, and Shi Jinmo will return from the wrong path, correct biases, remedy faults, and make amends through proper practice.
Xu Xueshi, in *Ben Shi Fang* (Prescriptions Worth Knowing), states: After eating, all flavors become sweet and flow into the Bladder. If the Qi of the Waist and Kidney is vigorous, it constitutes True Fire, steaming upwards to the Spleen and Stomach to transform food and drink, separating fluids and grains, which exit through the two lower orifices. Essence enters the bone marrow, combines with Ying (Nutritive) and Wei (Defensive) Qi, circulates in the blood vessels, and nourishes the whole body. Next, it forms fat and flesh. The remainder becomes urine; thus, urine is yellow, being the surplus of blood. The musky odor is the Qi of the Five Zang Organs; the salty taste belongs to the lower part. If the Waist and Kidney are deficient and cold, failing to steam the Qi of grains, everything flows down as urine. Therefore, the taste remains sweet and unchanged, the color is clear and cold, and the skin and muscles become withered. Just as a nursing mother’s grain Qi ascends to become milk, so too does the Xiao Ke patient’s essence leak downward as urine. Because essence is not solid within, urination is frequent, and the body becomes emaciated and weak. Furthermore, the Lung is the canopy of the Five Zang Organs. If there is warm Qi steaming from below, the Lung is moistened; if the lower part is extremely cold, Yang Qi cannot ascend, causing dryness in the Lung and thirst. In the *I Ching* (Book of Changes), the Pi Hexagram (Obstruction) has Qian (Heaven/Yang) above and Kun (Earth/Yin) below. Without Yin, Yang cannot descend; without Yang, Yin cannot ascend. When upper and lower do not interact, Obstruction occurs. Imagine a pot of water heated by fire; if covered with a board, warm vapor rises, moistening the board. Without heat, water vapor cannot rise, and the board remains dry. This "heat" corresponds to the vigor of the Waist and Kidney. One must constantly warm and tonify Kidney Qi. When food receives this heat, it moistens the upper body and is easily digested, preventing thirst. Therefore, Zhang Zhongjing stated that one should take Shen Qi Wan (Kidney Qi Eight-Ingredient Pill).
Zhang Jingyue, in *Jing Yue Quan Shu* (Complete Works of Jingyue), says: The Three Xiaos were traditionally considered Fire syndromes. However, there is Excess Fire due to pathogenic heat abundance, and Deficient Fire due to insufficiency of True Yin. Treating Xiao without distinguishing between Excess and Deficiency inevitably leads to error. One must carefully examine whether Xiao involves Yin or Yang. For instance, excessive thirst is called Xiao Ke; excessive hunger is called Xiao Gu; turbid urine resembling paste is called Shen Xiao. These mostly stem from Fire; when Fire is excessive, Yin is deficient, constituting Yang-consuming syndromes. As for the concept of Yin Xiao, few understand it. How do we know? The *Qi Jue Lun* (Treatise on Qi Syncope) states: "When Heart transfers Cold to the Lung, it is called Lung Xiao; drinking one portion results in urinating two portions, which is incurable." This indicates that due to the decline of Yuan Qi, Metal is cold and Water is frigid. Thus, Water fails to transform into Qi, and Qi transforms entirely into Water. Is this not a Yin syndrome of Yang deficiency? ... Therefore, when treating the Three Xiaos, one must observe the pulse Qi, disease Qi, and form Qi. If the Root is exhausted or false Fire is present, one must urgently rescue the Root to support the source of transformation. If one only recognizes Fire and focuses solely on clearing it, Yin and Yang will both fail. In treating Xiao, the first priority is to distinguish Excess from Deficiency. If pulse and symptoms indicate Excess Fire consuming fluids, removing the Fire allows fluids to regenerate and thirst to cease. If caused by insufficiency of True Water, it belongs to Yin Deficiency regardless of location (Upper, Middle, Lower); urgent treatment of the Kidney is required. Yin Qi must gradually fill, and Essence and Blood must recover for the disease to heal spontaneously. If one only clears Fire, Yin cannot grow, leading to progressive depletion and worsening condition. ... Traditionally, Upper Xiao is attributed to Lung, Middle Xiao to Stomach, and Lower Xiao to Kidney, treated primarily via Fire. However, in my view, Fire in the San Jiao often originates in the Kidney and is inseparable from Ming Men (Gate of Life). Ming Men is the residence of Water and Fire. While Water deficiency causes Xiao and thirst, Fire deficiency also causes Xiao and thirst. Why? Because if Water does not balance Fire, Fire fails to return to its origin. Fire roaming in the Lung causes Upper Xiao; Fire roaming in the Stomach causes Middle Xiao; Fire scorching Yin Essence causes Lower Xiao. All these are Xiao syndromes of True Yin deficiency and Water deficiency below. Additionally, if Yang fails to transform Qi, Water Essence is not distributed. Water without Fire descends but does not ascend, entering directly into the Bladder, resulting in "drinking one, urinating two," leading to dried-up springs and withered earth. These are Xiao syndromes of True Yang deficiency and Water deficiency below. It is said that Yin-deficient Xiao should be treated by strengthening Water. But claiming that Yang-deficient Xiao should be treated by tonifying Fire is often met with disbelief. Consider adding fuel to the bottom of a pot: vapor permeates the lid, and dry crops receive rain, reviving life. This is due to the action of Yang Qi, the subtle power of generation and destruction. Since Xiao syndromes are mostly deficient and cannot withstand draining, if we do not investigate the cause of damage and instead attack Vitality again, the wasting will worsen irreversibly. I write this to inform the wise.
Zhang Yinan, in *Lv Shan Tang Lei Bian*, states: For Xiao Ke caused by Yangming Dryness-Heat, Bai Hu Tang (White Tiger Decoction) is indicated; this is thirst due to external factors. For thirst due to weak Stomach Qi and lack of fluid production, Ren Shen Tang (Ginseng Decoction) is indicated; this is thirst due to internal factors. There are cases where the Spleen cannot transport fluids for the Stomach, and the Lung cannot regulate water passages, causing Xiao Ke. People know to use cooling and moistening herbs for thirst but forget that the Spleen prefers dryness and the Lung dislikes cold. Observe that diarrhea patients often feel thirsty because fluid essence cannot ascend and leaks downward. Using herbs to dry the Spleen allows fluids to rise, stopping thirst. Thus, while everyone knows using cooling/moistening herbs for thirst, few know using warming/drying herbs for thirst.
Zhao Yangkui, in *Yi Guan*, states: Upper Xiao presents with red cracks on the tongue and extreme thirst for water. The *Ni Diao Lun* says this is Heat transferred from the Heart to the Lung, spreading to Ge Xiao. Treat with Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction). Middle Xiao presents with voracious appetite but emaciation, spontaneous sweating, hard stools, and frequent urination. He Suhe said: Dry mouth, desire for water, excessive eating, and emaciation constitute Xiao Zhong. Treat with Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction). Lower Xiao presents with craving drinks, irritability, scorched earlobes, and pasty urine. He Suhe said: Scorched irritability and easy fluid depletion indicate Shen Xiao. Treat with Shen Qi Wan (Kidney Qi Pill). Ancient methods for treating the Three Xiaos were detailed thus.
I have another perspective: When Water and Fire are balanced and Qi and Blood are nourished, how can there be Xiao? Improper lifestyle leads to imbalance of Water and Fire, depletion of fluids, and rising of Dragon-Lei Fire. Prolonged simmering consumes the intestines and stomach, drying the Five Zang Organs, leading to emaciated limbs and mental fatigue. Therefore, in treating Xiao, regardless of Upper, Middle, or Lower, treating the Kidney is urgent. Use modified Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) or Ba Wei Di Huang Wan (Eight-Ingredient Pill with Rehmannia) according to symptoms, descending Heart Fire and nourishing Kidney Water to stop thirst. Bai Hu Tang and Cheng Qi Tang are not appropriate formulas. *Zong Lu* states that inability to eat with wasting precedes abdominal fullness, while ability to eat with wasting leads to carbuncles and brain abscesses. If one cannot distinguish between ability and inability to eat, and indiscriminately uses cold/clearing herbs, internal heat remains while middle Jiao cold arises, inevitably progressing to Drum Distension (Ascites). Only formulas like Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Powder) and Ren Shen Sheng Mai San (Ginseng Generate the Pulse Powder), taken freely, followed by Ba Wei Di Huang Wan to nourish the source, are suitable. If carbuncles appear with thirst, turning black or purple, indicating Extreme Fire resembling Water, Kidney Water is exhausted, and it is incurable. Only severe tonification of Yin might save the patient.
Someone asks: Why does thirst persist after taking Di Huang Tang (Rehmannia Decoction)? Answer: This is due to practitioners sticking rigidly to rules without adapting. The Heart and Lung are close, requiring small doses; the Liver and Kidney are distant, requiring large doses. For Upper and Middle Xiao, slow treatment with pills suffices. For extreme Lower Xiao with severe thirst and dryness, use half a dose of Modified Ba Wei Wan with one liang of Rou Gui (Cinnamon Bark), decocted in six or seven bowls of water. Drink it cold while sleeping soundly, and the thirst will vanish. The key to prescription lies in adaptability and divine illumination. Another question: Lower Xiao lacks Water; Liu Wei Di Huang Wan nourishes Shaoyin Kidney Water. Why add Rou Gui (Cinnamon Bark) and Fu Zi (Aconite)? Answer: Because Ming Men Fire is weak, failing to steam and decompose food and water. The Qi of food and water cannot moisten the Lung. Like a pot without fire under it, the lid stays dry, causing thirst. The Lung receives nothing, unable to distribute fluids throughout the meridians. The drunk water, untransformed by fire, enters the Bladder directly—"drink one sheng, urinate one sheng." Tasting it reveals a sweet, not salty, flavor. Therefore, use the acrid-hot nature of Fu Zi and Rou Gui to strengthen the "Lesser Fire" (Ming Men Fire). Adding fuel to the pot steams the dry cage; dry crops get rain, and life renews. Only the wise understand this; the foolish find it absurd. When Emperor Wu of Han suffered from Xiao Ke, Zhang Zhongjing prescribed this formula with eight ingredients, hence named Ba Wei Di Huang Wan. It is indeed an excellent formula, lasting as long as heaven and earth. Regarding sores and ulcers: if thirst persists before healing or after healing, if the tongue is yellow and hard, or if there was pre-existing thirst, irritability, dry mouth, frequent urination, cloudy urine, impotence, poor appetite, emaciation, swollen legs with thin feet, or mouth/tongue sores, this formula is suitable for all, yielding miraculous effects.
Clinical Cases
I once treated a nobleman whose carbuncle was not healed but who developed severe thirst, drinking several liters daily. I prescribed Modified Ba Wei Di Huang Wan. The other physicians laughed, saying, "If this medicine stops thirst, we will quit medicine." They used Zi Su (Perilla), Mu Gua (Chaenomeles), Wu Mei (Mume Fruit), Ren Shen (Ginseng), Fu Ling (Poria), and Bai Yao Jian (Alum) to generate fluids, but the thirst worsened. After several doses with no effect, they reluctantly used my formula. After three days, thirst stopped, and they trusted me for long-term use. Not only did the thirst disappear, but his Qi and Blood strengthened, appetite doubled, and he became healthier than in his youth. I did not insist on this arbitrarily; my view has a basis. The Xue family archives record frequent successes with this formula. Long-term use lightens the body, makes skin lustrous, and sharpens hearing and vision. I detail this so those with thirst may listen to my words, take it faithfully, and achieve miraculous results, avoiding confusion by mediocre doctors. Wu Wei Zi (Schisandra Berry) in the formula is most effective, uniquely tonifying Kidney Water and descending Heart Qi. Rou Gui (Cinnamon Bark) must not be omitted; without it, the formula fails.
I once treated a man with the same condition using the previous pill formula. He believed Rou Gui was too hot and secretly replaced it with Zhi Mu (Anemarrhena) and Huang Bo (Phellodendron). Consequently, his thirst persisted, he developed a back carbuncle, and died. He did not know that Rou Gui is a herb for the Kidney Meridian. His condition was due to deficient Fire in the Kidney Meridian flaming upward unchecked. Rou Gui guides other herbs to tonify and leads deficient Fire back to its origin, hence its efficacy.
There is a type of pathological thirst where the patient desires cold drinks but rejects them after two or three sips, only to become thirsty again shortly after. Unlike typical Xiao Ke where drinking is insatiable, this case stems from deficiency-cold in the Middle Qi. Cold Water floods upward, forcing floating Fire to the throat, mouth, and tongue. The Upper Jiao desires water to quench the fire, but when water reaches the Middle Jiao, "water meets water," which repels it. Treatment: If the face is red and irritable, decoct Li Zhong Tang (Regulate the Middle Decoction) and swallow Ba Wei Wan. Two or three doses cure it. Other medicines will fail. Another type involves urgent desire to drink, but vomiting occurs immediately upon swallowing, preventing any intake of medicine or food. This is Yin Excess blocking Yang, a Cold Damage syndrome of the Kidney Meridian. After careful consideration, I used Zhang Zhongjing’s Bai Tong Tang (White Pass Decoction) added with Tong Bian (Child’s Urine) and Dan Zhu (Bile), employing the method of administering hot medicine cold. One dose provided slight relief; two doses cured it. This occurs occasionally in men but frequently in women. Mr. Tao Jie’an named this Hui Yang Fan Ben Tang (Restore Yang and Return to the Root Decoction).
Summary on Jaundice
Jaundice is mostly related to Damp-Heat. *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) primarily uses Yin Chen Hao Tang (Artemisiae Scopariae Decoction), Zhi Zi Da Huang Tang (Gardeniae and Rhubarb Decoction), and Yin Chen Wu Ling San (Artemisiae Scopariae and Poria Powder). It also mentions Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Xiao Jian Zhong Tang (Minor Construct the Middle Decoction). Thus, while Damp-Heat is common, Deficiency Consumption also exists; one cannot generalize.
The Gallbladder and Liver are exterior-interior pairs. If Liver Qi does not ascend, Gallbladder Qi does not descend; Jueyin and Shaoyang jointly govern free flow. Also, relative to the Stomach, if Stomach Qi does not descend, Gallbladder Qi does not descend; Yangming and Shaoyang jointly govern the descending pathway. Prolonged internal stagnation of Gallbladder Fire may form stones internally or steam outward, constituting Gallbladder diseases.
Organs and viscera are interconnected; moving one hair moves the whole body. Excess syndromes are often attributed to Liver and Gallbladder; deficiency syndromes to Spleen and Stomach. However, Liver/Gallbladder and Spleen/Stomach are mutually substantive and functional; they cannot be separated. Although treatment emphasis may vary, differentiation must not be biased.
On Treating Liver Diseases
Treating Liver diseases often employs Yin-nourishing methods, such as nourishing Yin, clearing Heat, and draining Dampness, which are often effective. However, generalization is inappropriate. Since the Liver is Substantially Yin but Functionally Yang, its diseases involve either injury to Substance or Function. Injury to Yin damages the Substance and requires Yin nourishment; injury to Yang damages the Function and requires Yang tonification. Acrid flavors tonify, Sour flavors drain—this refers to Function. If Function is impaired, Substance becomes stagnant. How can one focus only on the Yin Substance while ignoring the Yang Function arising from the lower震 (Thunder/Liver)?
Treatment Methods for Tumors
Yang transforms Qi; Yin forms Shape. Tumors are Shape; their root is in Qi. When Qi transforms, Shape disperses; when Qi stagnates, Shape coagulates. Western medicine sees only the material shape, ignoring the spiritual/energetic level; it misunderstands Qi transformation and ignores Qi pathways. It is deaf and blind to disease, viewing humans merely as collections of bacteria and matter. It confuses right and wrong, misidentifies causes, claims ignorance of etiology, and offers empty excuses when treatments fail. Over-reliance on this approach may lead from seeking life to pursuing death, resulting in financial ruin and loss of vitality—a true tragedy!
To resolve tumors, first support Zheng Qi (Upright Qi). If Zheng Qi is deficient, tumors may spread; attacking them is dangerous. If Zheng Qi is substantial, tumors recede and can be moved. Deficient patients should defend rather than attack; stability is sufficient. Substantial patients can defend and then attack, eliminating evil thoroughly. Differentiating Excess and Deficiency is paramount. Do not wait until regret sets in. Never overestimate oneself and rashly pursue aggressive attacks.
Overview of Diabetes Mellitus