河间曰三消之疾本湿寒之阴气极衰燥热之阳气太甚皆因乎饮食服饵失节肠胃干涸而气液
不得
宣平或耗乱精神过违其度或因大病阴气损而血液衰虚阳气悍而燥热郁甚或因久嗜咸物恣食炙
爆饮食过度亦有年少服金石丸散积久实热结于下焦虚热血气不能制湿热燥甚于肾故渴而引饮
若饮水多而小便多者名曰消渴若饮食多而不甚渴小便数而消瘦者名曰消中若渴而饮水不绝腿
消瘦而小便有脂液者名曰肾消此三消者其燥热同也夫经中有言心肺气厥而渴者有言肝痹而渴
者有
言脾热而渴者有言肾热而渴者有言胃与大肠结热而渴者有言脾痹而渴者有言小肠痹热而渴者
有因病疟而渴者有因肥甘美食而渴者有因醉饱入房而渴者有因远行劳倦遇大热而渴者有因伤
害胃干而渴者有因病风而渴者虽五脏之部分不同而病之所遇各异其为燥热亡液一也
谨按先生三消之论始言天地六气五味以配养人身六位五脏而究乎万物之源终引内经论渴
诸证
以辨乎世方热药之误比物立象反复详明非深达阴阳造化之机者孰能如是哉夫治此疾者补肾水
阴寒之虚而泻心火阳热之实除肠胃燥热之甚济身津液之衰使道路散而不结津液生而不枯气血
利而不涩则病日已矣岂不以滋润之剂养阴以制燥滋水而充液哉何故世论消渴者多不知其意谓
因下部肾水虚不能制其上焦心火使上实热而多烦渴下虚冷而小便若更服寒药则元气转虚而下
部肾水转衰则上焦心火尤难治也但以暖药补养元气若下部肾水得实而胜退上焦心火则自然渴
止小便如常而病愈也吁若此未明阴阳虚实之道也夫肾水属阴而本寒虚则为热心火属阳而本热
虚则为寒若肾水阴虚则心火阳实是谓阳实阴虚而上下俱热矣以彼之言但见消渴数溲妄言为下
部寒尔岂知肠胃燥热怫郁使之然也且夫寒物属阴能养水而泻心热物属阳能养火而耗水令肾水
既不胜心火则上下俱热奈何以热药养肾水欲令胜心火岂不暗哉彼不谓水气实者必能制火虚则
不能制火故阳实阴虚而热燥其液小便淋而常少阴实阳虚不能制水小便利而常多此又不知消渴
小便多者盖燥热太甚而三焦肠胃之腠理怫郁结滞致密壅塞而水液不能渗泄浸润于外以养乎百
体故肠胃之外燥热大甚虽多饮水入于肠胃之内终不能浸润于外故渴不止而小便多水液既不能
渗泄浸润于外则阴燥竭而无以自养故久而多变于聋盲疮疡痤痱之类而危殆其为燥热伤阴也明
矣
刘河间说：三消这种疾病，本质上是湿寒的阴气极度衰弱，燥热的阳气太过旺盛。这都因为饮食和服药失去节制，导致肠胃干枯涸竭，气与津液不能宣通平和；或者耗散扰乱精神，行为超过了正常的限度；或者因为大病之后阴气受损，血液衰少虚弱，阳气刚悍而燥热郁结严重；又或者长期嗜好咸味食物，放纵食用烧烤炙烤之物，饮食过度；也有年少时服用金石类的丸药散剂，积久形成实热，结聚在下焦，虚血热气不能制约湿热，导致肾中燥热严重，所以口渴而大量饮水。
如果喝水多且小便也多，名叫“消渴”；如果饮食多但不怎么口渴，小便频数且身体消瘦，名叫“消中”；如果口渴且饮水不止，腿部消瘦且小便中有脂液状物质，名叫“肾消”。这三种消病，其燥热的病机是相同的。
经书中说：心肺之气厥逆而致口渴的；肝痹而致口渴的；脾热而致口渴的；肾热而致口渴的；胃与大肠结热而致口渴的；脾痹而致口渴的；小肠痹热而致口渴的；因病疟而致口渴的；因肥甘美食而致口渴的；因醉饱后行房事而致口渴的；因远行劳倦遇到大热而致口渴的；因伤害胃干而致口渴的；因病风而致口渴的。虽然五脏的部位不同，所遭遇的病邪各异，但导致燥热亡失津液的机理是一样的。
仔细考察先生的三消论述，起初讲述天地六气和五味来配合滋养人身六位五脏，进而探究万物的本源，最后引用《内经》中关于各种口渴证候的论述，以辨别世俗方剂中使用热药的错误。通过取象比类，反复详细阐明，如果不是深刻通达阴阳造化机理的人，谁能做到这样呢？
治疗这种疾病的办法，是补肾水阴寒之虚，泻心火阳热之实，清除肠胃严重的燥热，救济身体津液的衰竭，使经络道路通畅而不结滞，津液生成而不枯槁，气血流通而不涩滞，那么疾病就会日渐痊愈。这难道不是用滋润的药剂来养阴以制约燥热，滋补水液以充盈津液吗？
为什么世人谈论消渴病，大多不知道其中的意旨，认为是因为下部肾水虚弱，不能制约上焦的心火，使得上焦实热而多烦渴，下焦虚冷而小便异常。如果再服用寒凉药物，则元气更加虚弱，下部肾水更加衰败，那么上焦心火就更难治疗了。因此只使用温补药物来补养元气，认为如果下部肾水得到充实而胜过退却上焦心火，那么自然口渴停止，小便恢复正常，疾病也就痊愈了。唉！像这样的观点，是不明白阴阳虚实道理的表现。
肾水属于阴，本性寒，虚损时表现为热；心火属于阳，本性热，虚损时表现为寒。如果肾水阴虚，则心火阳实，这叫作阳实阴虚，上下都发热。按照那些人的说法，只是看到消渴、尿频，就胡乱说是下部寒证。哪里知道这是肠胃燥热怫郁导致的呢？况且寒性药物属阴，能滋养肾水而清泻心热；热性药物属阳，能助长心火而耗伤肾水。既然肾水已经不能胜心火，导致上下俱热，怎么能用热药来补养肾水，希望它能胜过心火呢？这岂不是太糊涂了吗？他们不明白，水气实者必然能制火，虚则不能制火，所以阳实阴虚而热燥其液，小便淋沥而量少；阴实阳虚不能制水，小便利而量多。这又是不了解消渴病小便多的原因。
这是因为燥热太甚，导致三焦肠胃的腠理怫郁结滞，致密壅塞，水液不能渗泄浸润于外以滋养百体。所以肠胃之外燥热极盛，虽然喝很多水进入肠胃之内，终究不能浸润于外，所以口渴不止而小便多。水液既然不能渗泄浸润于外，则阴分燥竭而无法自我滋养，所以时间久了会转变为聋、盲、疮疡、痤痱等病症，甚至危及生命。这清楚地表明了是燥热损伤了阴液。
Liu Hejian stated: The disease of Sanxiao (Three Wasting-Thirst syndromes) is fundamentally characterized by the extreme deficiency of the yin qi of damp-cold and the excessive abundance of the yang qi of dryness-heat. This arises from irregularities in diet and medication, leading to the drying up of the stomach and intestines, preventing the smooth circulation and harmonization of qi and body fluids. It may also result from exhausting and disrupting the spirit, exceeding normal limits; or from damage to yin qi and depletion of blood following a severe illness, where vigorous yang qi causes severe stagnation of dryness-heat; or from long-term preference for salty foods and indulgence in roasted and fried items, leading to dietary excess. Additionally, young people who take mineral-based pills and powders over a long period may accumulate excess heat that settles in the Lower Jiao (Lower Burner). The deficiency of blood and qi fails to control damp-heat, causing severe dryness-heat in the Kidney, resulting in thirst and excessive drinking.
If drinking water is abundant and urination is frequent, it is named Xiao Ke (Wasting-Thirst Syndrome). If food intake is large but thirst is not significant, with frequent urination and emaciation, it is named Xiao Zhong (Middle Wasting-Thirst Syndrome). If there is constant thirst with unceasing drinking, emaciation of the legs, and fatty substances in the urine, it is named Shen Xiao (Kidney Wasting-Thirst Syndrome). In these three wasting-thirst conditions, the pathogenesis of dryness-heat is identical.
The Classics state: Thirst caused by reversal of Qi in the Heart and Lung; thirst caused by Gan Bi (Liver Obstruction); thirst caused by Spleen Heat; thirst caused by Kidney Heat; thirst caused by accumulation of heat in the Stomach and Large Intestine; thirst caused by Pi Bi (Spleen Obstruction); thirst caused by Xiao Chang Bi Re (Small Intestine Obstruction Heat); thirst caused by malaria; thirst caused by rich and sweet foods; thirst caused by sexual activity after drunkenness and overeating; thirst caused by fatigue from long travel encountering intense heat; thirst caused by injury to the dryness of the Stomach; and thirst caused by wind diseases. Although the locations in the five Zang organs differ and the encountered pathogens vary, the mechanism of dryness-heat consuming body fluids remains the same.
Carefully examining Mr. Liu's discussion on Sanxiao, he begins by correlating the Six Qi (Six Climatic Factors) of heaven and earth and the Five Flavors with the nourishment of the six positions and five Zang organs of the human body, ultimately exploring the source of all things. He then cites the *Neijing* (Inner Canon) regarding various thirst syndromes to refute the errors of using hot medicines in common prescriptions. Through analogical reasoning and detailed explanation, only one who deeply understands the mechanisms of yin-yang transformation could achieve such clarity.
To treat this disease, one must tonify the deficiency of Yin cold in Kidney Water, drain the excess of Yang heat in Heart Fire, eliminate severe dryness-heat in the stomach and intestines, and replenish the depletion of body fluids. This ensures that pathways remain open without obstruction, body fluids are generated without becoming dry, and qi and blood flow smoothly without stagnation. Thus, the disease will gradually resolve. Is this not precisely the method of using moistening agents to nourish Yin to control dryness, and to nourish Water to fill fluids?
Why do most discussions on Xiao Ke fail to grasp this meaning? They argue that deficiency of Kidney Water in the lower part fails to control Heart Fire in the upper Jiao, resulting in upper excess heat causing irritability and thirst, while lower deficiency cold leads to urinary abnormalities. They believe that administering cold medicines further depletes Yuan Qi (Original Qi), worsening Kidney Water deficiency and making Heart Fire harder to treat. Therefore, they advocate using warm medicines to tonify Yuan Qi, believing that if Kidney Water becomes sufficient to overcome Heart Fire, thirst will cease and urination will normalize, curing the disease. Alas! Such views demonstrate a lack of understanding of the principles of yin-yang and deficiency-excess.
Kidney Water belongs to Yin and is inherently cold; when deficient, it manifests as heat. Heart Fire belongs to Yang and is inherently hot; when deficient, it manifests as cold. If Kidney Water is Yin-deficient, Heart Fire becomes Yang-excessive, termed Yang-excess and Yin-deficiency, resulting in heat throughout the upper and lower body. Those proponents merely observe symptoms of wasting-thirst and frequent urination, erroneously attributing them to lower cold. They fail to realize that this is caused by the stagnation of dryness-heat in the stomach and intestines. Cold substances belong to Yin, nourishing Water and draining Heart heat; hot substances belong to Yang, nourishing Fire and consuming Water. Since Kidney Water cannot overcome Heart Fire, resulting in heat above and below, how can hot medicines be used to tonify Kidney Water to overcome Heart Fire? This is profoundly misguided. They do not understand that when Water Qi is excess, it controls Fire; when deficient, it cannot. Thus, Yang-excess and Yin-deficiency lead to heat drying fluids, causing scanty, dribbling urination. Conversely, Yin-excess and Yang-deficiency fail to control Water, leading to profuse urination.
This again reflects ignorance of why urination is frequent in Xiao Ke. It is because severe dryness-heat causes stagnation and blockage in the pores and collaterals of the Sanjiao (Triple Burner) and stomach/intestines. Body fluids cannot seep out to nourish the hundred bodies. Consequently, despite excessive water intake entering the stomach and intestines, it cannot moisten the exterior, leading to persistent thirst and polyuria. Since body fluids cannot seep out to nourish the exterior, Yin dryness reaches exhaustion, failing to self-nourish. Over time, this transforms into deafness, blindness, sores, ulcers, acne, and miliaria, endangering life. This clearly demonstrates the damage of dryness-heat to Yin.