经曰∶心移热于肺，传为膈消。又曰∶二阳结，谓之消。夫消渴者，枯燥之病也。凡渴而多饮为上消，肺热
也；多食善饥为中消，胃热也；渴而小便数，膏浊不禁为下消，肾热也。虽为火盛水衰之证，然由虚热者多，实
热者少。若作有余治之，误之甚矣。
始而心肺消渴，脾胃消中，或肾虚消浊；传染日久，即肠胃合消，五脏干燥，精神倦怠，以致消瘦四肢，将
为不起之候。初起治之得法，必不至是。
一、消渴，由心火动而消上，上消乎心，移热于肺，渴饮茶水，饮水又渴，名曰上消。小便最多，由其水
不能停，所以饮水无厌。若饮一溲一者，可治；饮一溲二者，不可治。宜莲花饮为主，次以生津四物汤滋其阴，
庶几有济。
一、消肌，脾火动而消中，中消于脾，移热于胃，喜多食，食无足时，小便色黄，各曰中消。宜人参白虎，
清胃保中。
一、消浊，乃上消之传变。肺胃之热久不清，乃致动而消肾，移热于膀胱，小便混浊，色如膏脂，名曰下
消。宜加味地黄汤，滋其真阴，久服可愈。
以上渴证，初起者，宜用前法。倘日久不愈，津液枯焦，其渴愈甚。若仍用黄连、花粉苦寒之类，未有不
致危殆者，惟七味白术散对证之药，放胆用之，非此不愈。
莲花饮 治上消口渴，饮水不休。
白莲须 粉干葛 白云苓 大生地（以上各一钱） 真雅连 天花粉 官拣参 北五味 净知母 炙甘草
淡竹叶（以上各五分）
灯心十茎，水煎，热服。
生津四物汤 治上消，已服莲花饮后，用此。
白归身 大生地 杭白芍 净知母 大麦冬 官拣参（以上各一钱） 正川芎 正雅连 天花粉 川黄柏
炙甘草（以上各五分） 肥乌梅（一粒）
灯芯十茎，水煎，热服。
人参白虎汤 治中消，消谷易饥，食无厌足。
官拣参（一钱） 熟石膏（二钱） 净知母（一钱五分） 炙甘草（一钱）
加晚粳米一两为引，水煎，以米熟为度，澄清热服。
加味地黄汤 治下消，小便混浊，色如膏脂。
大怀地（二钱） 正怀山（一钱五分） 山茱肉（一钱二分） 宣泽泻（六分） 粉丹皮（一钱） 白云
苓（一钱二分） 建莲肉（七分） 净知母（五分） 芡实米（一钱） 大麦冬（一钱） 北五味（十四粒）
净水浓煎，清晨空心服。
七味白术散 治小儿久病消渴，口干不止，惟此最神，放胆用之。方见卷三泄泻门。
《黄帝内经》说：心火移热于肺，传变成为膈消。又说：阳明经气机郁结，称为消渴。所谓消渴，是一种津液干枯的病症。凡是口渴且多饮的，称为上消，病机为肺热；食量大且容易饥饿的，称为中消，病机为胃热；口渴且小便频数，尿液浑浊如脂膏般无法控制的，称为下消，病机为肾热。虽然这属于火盛水衰的证候，但大多由虚热引起，实热较少。如果当作实证有余来治疗，错误就大了。
起初若是心肺受邪导致消渴，或脾胃受邪导致消中，或者肾虚导致消浊；若病程迁延日久，就会发展为肠胃同病导致的合消，导致五脏干燥，精神倦怠，进而四肢消瘦，这将变成难以治愈的危重征象。如果在初起时治疗方法得当，必然不会发展到这种地步。
第一、上消，是由心火妄动而消耗上部津液所致。上消主要关乎心，心火移热于肺，导致口渴想喝茶水，喝水后依然口渴，名为上消。小便量最多，是因为水液不能停留体内，所以饮水没有满足感。如果喝多少尿多少（饮一溲一），尚可治疗；如果喝一份尿两份（饮一溲二），则不可治。适宜以莲花饮为主方，其次用生津四物汤滋养阴液，或许能有疗效。
第二、中消，是脾火妄动而消耗中部津液所致。中消主要关乎脾，热邪移于胃，患者喜欢多吃，吃饭不知饱足，小便颜色黄，都称为中消。适宜用人参白虎汤，清泻胃热，保护中焦。
第三、下消，是上消的传变结果。肺胃之热长久不清除，导致热邪扰动肾脏，移热于膀胱，小便浑浊，颜色像膏脂一样，名为下消。适宜用加味地黄汤，滋养真阴，长期服用可以痊愈。
以上几种渴证，初起阶段，适宜使用前文所述方法。倘若病程日久不愈，津液枯焦，口渴更加严重。如果仍然使用黄连、天花粉等苦寒性质的药物，没有不导致病情危重的，只有七味白术散是对证的药物，可以放心大胆地使用，不用此方就不能痊愈。
莲花饮 治疗上消口渴，饮水不止。
白莲须 粉干葛 白云苓 大生地（以上各一钱） 真雅连 天花粉 官拣参 北五味 净知母 炙甘草
淡竹叶（以上各五分）
灯心草十茎，加水煎煮，热服。
生津四物汤 治疗上消，在服用莲花饮之后，使用此方。
白归身 大生地 杭白芍 净知母 大麦冬 官拣参（以上各一钱） 正川芎 正雅连 天花粉 川黄柏
炙甘草（以上各五分） 肥乌梅（一粒）
灯芯草十茎，加水煎煮，热服。
人参白虎汤 治疗中消，消化食物快且易饥，饮食不知满足。
官拣参（一钱） 熟石膏（二钱） 净知母（一钱五分） 炙甘草（一钱）
加入晚粳米一两作为药引，加水煎煮，以米煮熟为标准，澄清药液后热服。
加味地黄汤 治疗下消，小便浑浊，颜色像膏脂。
大怀地（二钱） 正怀山（一钱五分） 山茱肉（一钱二分） 宣泽泻（六分） 粉丹皮（一钱） 白云苓（一钱二分） 建莲肉（七分） 净知母（五分） 芡实米（一钱） 大麦冬（一钱） 北五味（十四粒）
加水浓煎，清晨空腹服用。
The *Yellow Emperor's Inner Classic* states: "Heart heat transfers to the Lung, transforming into Ge Xiao (Diaphragmatic Thirst)." It also says: "The binding of the Yangming [channels] is called Xiao (Thirst/Diabetes)." The condition of Xiao Ke (Thirst and Diabetes) is a disease characterized by dryness and withering. Generally, thirst accompanied by excessive drinking is termed Shang Xiao (Upper Thirst), caused by Lung Heat; excessive eating with easy hunger is termed Zhong Xiao (Middle Thirst), caused by Stomach Heat; thirst accompanied by frequent urination and uncontrollable turbid urine resembling grease is termed Xia Xiao (Lower Thirst), caused by Kidney Heat. Although this presents as a syndrome of Excessive Fire and Deficient Water, it is mostly due to Deficient Heat rather than Excess Heat. If treated as an Excess syndrome, the error would be significant.
Initially, if there is Xiao Ke affecting the Heart and Lung, or Xiao Zhong affecting the Spleen and Stomach, or Xiao Zhuo due to Kidney Deficiency; if transmitted over a long period, it leads to He Xiao (Combined Thirst) involving both intestines and stomach, causing dryness in the five Zang organs, mental fatigue, and emaciation of the limbs, resulting in a prognosis of incurability. If treated correctly at the onset, it will certainly not reach this state.
1. Shang Xiao (Upper Thirst): Caused by Heart Fire stirring and consuming upper Jiao fluids. Shang Xiao relates to the Heart; Heart heat transfers to the Lung, causing thirst for tea or water, yet drinking does not quench the thirst. This is named Shang Xiao. Urine volume is maximal because fluids cannot be retained, leading to insatiable drinking. If "one part drink yields one part urine" (Yin Yi Sou Yi), it is treatable; if "one part drink yields two parts urine" (Yin Yi Sou Er), it is untreatable. The primary formula should be Lianhua Yin (Lotus Flower Decoction), followed by Shengjin Siwu Tang (Fluid-Generating Four Substance Decoction) to nourish Yin, which may yield results.
2. Zhong Xiao (Middle Thirst): Caused by Spleen Fire stirring and consuming middle Jiao fluids. Zhong Xiao relates to the Spleen; heat transfers to the Stomach. The patient desires abundant food intake, never feeling satisfied, and urine is yellow. These are collectively termed Zhong Xiao. Ren Shen Baihu Tang (Ginseng White Tiger Decoction) is suitable to clear Stomach Heat and protect the Middle Jiao.
3. Xia Xiao (Lower Thirst): A progression of Shang Xiao. If Lung and Stomach heat remain unclarified for a long time, it agitates the Kidney, transferring heat to the Bladder. Urine becomes turbid, resembling grease in color, named Xia Xiao. Jiawei Dihuang Tang (Modified Rehmannia Decoction) is suitable to nourish True Yin; long-term use can lead to recovery.
For the above thirst syndromes, if in the early stage, the aforementioned methods are appropriate. However, if the disease persists for a long time without resolution, body fluids become scorched and dry, and thirst intensifies. If one continues to use bitter-cold herbs such as Huanglian (Coptis Rhizome) and Tianhuafen (Trichosanthes Root), danger will inevitably ensue. Only Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder) is the correct formula; use it boldly. Without this, recovery is unlikely.
Lianhua Yin (Lotus Flower Decoction): Treats Shang Xiao with persistent thirst and incessant drinking.
Bai Lian Xu (Stamen Nelumbinis), Fen Gan Ge (Powdered Puerariae Radialis), Bai Yun Ling (White Poria), Da Sheng Di (Large Rehmanniae Radix) (each 1 qian); Zhen Ya Lian (True Coptidis Rhizoma), Tian Hua Fen (Trichosanthis Radix), Guan Jian Shen (Official Panax Ginseng), Bei Wu Wei (Schisandrae Chinensis Fructus), Jing Zhi Mu (Clean Anemarrhenae Rhizoma), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) (each 0.5 qian).
Ten stems of Deng Xin Cao (Junci Medulla), decocted in water, taken hot.
Shengjin Siwu Tang (Fluid-Generating Four Substance Decoction): Treats Shang Xiao, used after taking Lianhua Yin.
Bai Gui Shen (White Angelicae Sinensis Radix), Da Sheng Di (Large Rehmanniae Radix), Hang Bai Shao (Hang Paeoniae Radix Alba), Jing Zhi Mu (Clean Anemarrhenae Rhizoma), Da Mai Dong (Large Ophiopogonis Tuber), Guan Jian Shen (Official Panax Ginseng) (each 1 qian); Zheng Chuan Xiong (Authentic Ligustici Chuanxiong Rhizoma), Zheng Ya Lian (Authentic Coptidis Rhizoma), Tian Hua Fen (Trichosanthis Radix), Chuan Huang Bo (Phellodendri Amurensis Cortex), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) (each 0.5 qian); Fei Wu Mei (Plump Mume Fructus) (1 piece).
Ten stems of Deng Xin Cao (Junci Medulla), decocted in water, taken hot.
Ren Shen Baihu Tang (Ginseng White Tiger Decoction): Treats Zhong Xiao, rapid digestion with easy hunger, insatiable appetite.
Guan Jian Shen (Official Panax Ginseng) (1 qian), Shu Shi Gao (Prepared Gypsum Fibrosum) (2 qian), Jing Zhi Mu (Clean Anemarrhenae Rhizoma) (1.5 qian), Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) (1 qian).
Add Wan Jing Mi (Late Japonica Oryzae Semen) 1 liang as a guide, decoct in water until the rice is cooked, clarify the liquid, and take hot.
Jiawei Dihuang Tang (Modified Rehmannia Decoction): Treats Xia Xiao, turbid urine resembling grease.
Da Huai Di (Large Huai Dioscoreae Rhizoma) (2 qian), Zheng Huai Shan (Authentic Huai Dioscoreae Rhizoma) (1.5 qian), Shan Zhu Rou (Corni Fructus) (1.2 qian), Xuan Ze Xie (Xuan Alismatis Rhizoma) (0.6 qian), Fen Dan Pi (Moutan Cortex) (1 qian), Bai Yun Ling (White Poria) (1.2 qian), Jian Lian Rou (Jian Nelumbinis Semen) (0.7 qian), Jing Zhi Mu (Clean Anemarrhenae Rhizoma) (0.5 qian), Qian Shi Mi (Euryales Semen) (1 qian), Da Mai Dong (Large Ophiopogonis Tuber) (1 qian), Bei Wu Wei (Schisandrae Chinensis Fructus) (14 grains).
Decoct strongly in clean water, take on an empty stomach in the morning.
Qiwei Baizhu San (Seven-Ingredient Atractylodes Macrocephala Powder): Treats pediatric chronic Xiao Ke with persistent dry mouth. This formula is most miraculous; use it boldly. See the Diarrhea section in Volume III for the prescription.