黄连（二钱） 天花粉（八钱为末，用乳或藕、蔗自然汁调）
消渴，一理也，分之则有三证焉。渴而多饮，为上消，善食而KT 为中消，烦渴引饮，小便如膏，为下消。经
曰∶心移热于肺，传为膈消。金得火而燥，故渴。燥者润之，故用花粉、奶乳、藕、蔗等汁。火原于心，故复泻
以黄连。中消者，经曰∶瘅成为消中。瘅者，热也。或地黄饮子，或竹叶黄 汤，甚则承气。下消者，经曰∶饭
一溲二，如膏如油
者不治。此盖先有上、中消症，医习而不察，热邪下传，销铄肾脂，或克伐太过，泄其真气，不能管束津液，以
滋众体，致同饮食之物酿而为溲，入一出二，为膏如油也。急以八味、左右合归或白茯苓丸加减互用，否则肌脱
力微，阴痿牙枯，生气日促矣。
邑人丁芳洲，苦学善饮，年二十六，病消渴。医以为酒食之过，一味消导。渴愈甚，酒肉之量愈加。明年成
下消，证如前，兼得鼓胀，目无所睹。比延余，心知病不能痊，但症系内障，有可治。遂用肾气、宁志、驻景等
药，既而针其左目。视不甚明，然病觉大减。逾年再针其右目痊。而药全不应。呜呼，此其所以为不治也欤。
补中益气合生脉、二妙、四苓三散，再有神曲、黄连、生地。
燥湿相及也。方名清燥，胡一意治湿。盖人肺胃素虚，而秋阳酷烈，瓜茶过啖，内湿外热蕴酿成邪。肺金受
之，则天气不能下降，膀胱绝其化源。口渴便燥，目睛黄涩，当以清金润肺为首务。故用补中益气合生脉以升阳
生津。燥则必痿，故用二妙加连、地以治痿。湿则必痹，故用四苓加神曲以利湿。
按此汤非如愚注，概以治血枯精涸，五内烦热，液道不通，诸燥贻害不少。喻嘉言以燥从湿治，非东垣具过
人之识，不及此，所谓知一不知二。且进而论之，药品驳杂牵强，即根据前释，升、柴、柏、曲何所取义？即从湿
治，地、麦、连、柏决用不着。又治暑、治痘，概升阳顺气，仍就是
增减。方同病异，更始厥名，过人之识其在斯乎？
此汤本不中用，以喻氏奖借过情，故大书特书，唤醒长梦。我辈立定根脚做人，高着眼力看书，智圆识达，
自不为前人欺瞒。
二妙散∶黄柏苍术等分。盖湿热作痛，黄柏妙于去热，苍术妙于去湿。
倒换散∶荆芥二两、大黄一两，治小便不通，直捷简易。谓二妙尤切。又苍术、荆芥等分为丸，雄精作衣，
治风湿，义同。
黄连（二钱） 天花粉（八钱研为细末，用乳汁或藕汁、甘蔗自然汁调服）
消渴病，其根本道理是一致的，但细分起来有三种证型。口渴且多饮的，称为上消；食欲旺盛且容易饥饿的，称为中消；心烦口渴且引水自灌，小便像膏脂一样浑浊的，称为下消。《内经》说：“心火移热于肺，传变为膈消。”肺属金，遇火则燥，所以出现口渴。燥者宜润，所以使用花粉、牛乳、藕汁、蔗汁等。火的本源在心，所以再用黄连来泻心火。中消证，《内经》说：“热盛成为消中。”瘅，就是热的意思。治疗可用地黄饮子，或者竹叶石膏汤，病情严重的用承气汤攻下。下消证，《内经》说：“吃一顿饭，排两次尿，尿液如膏如油”的属于难治之症。这大概是先有上消、中消的症状，医生习以为常而未加详察，导致热邪向下传导，销铄肾中阴精，或者是过度使用苦寒攻伐药物，损伤了人体的真气，导致不能固摄津液以滋润全身，致使饮食之物转化为尿液，入一出二，形成如膏如油的状况。此时急需使用八味丸、左右归丸或白茯苓丸加减交替使用，否则肌肉消瘦、体力微弱、阳痿、牙齿枯槁，生机日渐衰竭。
同邑人丁芳洲，刻苦学习且喜好饮酒，二十六岁时患消渴病。医生认为是酒食过度的过错，一味使用消食导滞的方法治疗。结果口渴更加严重，喝酒吃肉的数量反而增加。第二年发展为下消，症状如前所述，又兼得鼓胀病，眼睛失明。后来请我诊治，我心里知道病难以痊愈，但因为症状表现为内障，还有可治的希望。于是使用肾气丸、宁志丹、驻景丸等药物，随后针刺他的左眼。视力虽然不是很清晰，但自觉病情大大减轻。过了一年再针刺右眼后痊愈。而内服药物完全无效。唉，这就是所谓的“不治”吧。
补中益气汤合生脉散、二妙散、四苓散三散，再加上神曲、黄连、生地。
这是燥与湿相互影响的情况。方名叫做清燥，为什么一心一意去治湿呢？大概是因为人的肺胃素来虚弱，加上秋季阳光酷烈，瓜果茶水过量食用，导致内湿外热蕴酿成邪。肺金受到邪气侵袭，则天气不能下降，膀胱失去了化生的源头。出现口渴、大便干燥、眼睛黄涩，应当以清金润肺为首要任务。所以使用补中益气汤合生脉散来提升阳气、生津液。燥邪必致痿证，所以用二妙散加黄连、生地来治疗痿证。湿邪必致痹证，所以用四苓散加神曲来利湿。
按语：此汤剂不像李东垣所注的那样，一概用于治疗血枯精涸、五脏烦热、液道不通等各种燥邪带来的危害。喻嘉言主张从湿治燥，如果不是李东垣具有过人的见识，达不到这种境界，那是所谓“知一不知二”。进而讨论，药品种类驳杂牵强，即使根据前面的解释，升麻、柴胡、黄柏、神曲有什么取义呢？即使是从湿治的角度，生地、麦冬、黄连、黄柏也绝对用不着。又是治疗暑病，又是治疗痘疹，一概提升阳气、顺气，仍然是就原方增减。方剂相同而病症不同，更改变名称，过人的见识难道就在这里吗？
这个汤剂本来没有用处，因为喻氏夸奖过分，所以大书特写，唤醒长梦。我们确立根基做人，提高眼光看书，智慧圆满、见识通达，自然不会被前人欺骗。
二妙散：黄柏、苍术各等分。大概是湿热作痛，黄柏妙在清热，苍术妙在祛湿。
倒换散：荆芥二两、大黄一两，治疗小便不通，直捷简易。认为二妙散尤其贴切。另外苍术、荆芥等分为丸，以雄黄粉为衣，治疗风湿，义理相同。
Coptidis Rhizoma (2 qian) *Tianhuafen* (8 qian, ground into powder, mixed with milk or natural juice of lotus root or sugarcane for administration)
Xiao Ke (Wasting-Thirst Syndrome), in its fundamental principle, is one entity; however, when differentiated, it presents as three syndromes. Thirst accompanied by excessive drinking is termed Shang Xiao (Upper Wasting-Thirst); excessive appetite with rapid hunger is Zhong Xiao (Middle Wasting-Thirst); irritability, thirst with copious water intake, and urine resembling paste are termed Xia Xiao (Lower Wasting-Thirst). The *Classic of Internal Medicine* states: "Heart heat transfers to the Lung, transforming into Ge Xiao (Diaphragmatic Wasting-Thirst)." Metal (Lung) becomes dry when subjected to Fire, hence thirst. For dryness, moistening is indicated; therefore, Tianhuafen (*Fritillariae Thunbergii Bulbus*), cow's milk, lotus root juice, and sugarcane juice are used. Since Fire originates from the Heart, Huanglian (*Coptidis Rhizoma*) is employed to drain Heart fire. Regarding Zhong Xiao, the *Classic* states: "Dan Re (Intense Heat) transforms into Xiao Zhong (Wasting-Middle)." Dan refers to heat. Treatments may include Dihuang Yin Zi (*Rehmanniae Decoction*) or Zhuye Shigao Tang (*Bamboo Leaf and Gypsum Decoction*); in severe cases, Cheng Qi Tang (*Order the Qi Decoction*) is used for purging. Regarding Xia Xiao, the *Classic* states: "One meal results in two urinations, urine like paste or oil," which is considered incurable. This condition typically arises when Shang Xiao and Zhong Xiao symptoms precede; physicians, accustomed to these signs, fail to observe closely, allowing Heat pathogens to transmit downward, consuming Kidney essence. Alternatively, excessive use of bitter-cold purgatives damages True Qi, impairing the ability to control body fluids and nourish the tissues. Consequently, ingested food transforms into urine, resulting in copious discharge resembling paste and oil. Urgent treatment requires the alternating use of modified Ba Wei Wan (*Eight-Ingredient Pill*), Zuo Gui Wan (*Restore the Left Pill*) or You Gui Wan (*Restore the Right Pill*), or Bai Ling Fen Wan (*White Poria Pill*). Otherwise, emaciation, weakness, impotence, and dry teeth will occur, leading to a daily decline in vital energy.
Mr. Ding Fangzhou of our county, who studied hard and enjoyed drinking, suffered from Xiao Ke at age twenty-six. Physicians attributed it to dietary excess and prescribed only digestive aids. His thirst worsened, and his consumption of alcohol and meat increased. The following year, he developed Xia Xiao, presenting with previous symptoms plus鼓胀 (Drum-like Distension/Tympanites) and blindness. Upon my consultation, I knew the disease was likely incurable, but since the ocular manifestation was internal obstruction (Nei Zhang), there was hope for treatment. I administered Shen Qi Wan (*Kidney Qi Pill*), Ning Zhi Dan (*Calm the Spirit Pill*), and Zhu Jing Wan (*Stabilize the Scenery Pill*), followed by acupuncture on his left eye. While vision did not become very clear, he felt significant relief. A year later, after acupuncture on his right eye, his vision recovered, although the oral medications had been ineffective. Alas, this exemplifies what is termed "incurable."
Bu Zhong Yi Qi Tang (*Tonify the Middle and Augment the Qi Decoction*) combined with Sheng Mai San (*Generate the Pulse Powder*), Er Miao San (*Two Marvels Powder*), Si Ling San (*Four Poria Powder*), along with Shen Qu (*Massa Medicata Fermentata*), Huanglian, and Sheng Di Huang (*Rehmanniae Radix*).
This addresses the interaction between Dryness and Dampness. Why does a formula named Qing Zao Tang (*Clear Dryness Decoction*) focus entirely on treating Dampness? Generally, the Lungs and Stomach are inherently deficient, and during the intense autumn sun, excessive consumption of melons, tea, and water leads to internal Dampness and external Heat fermenting into pathogenic factors. When the Lung Metal is affected, celestial Qi fails to descend, and the Bladder loses its source of transformation. Symptoms include thirst, dry stool, yellow and gritty eyes. The priority must be to Clear Metal and Moisten the Lung. Therefore, Bu Zhong Yi Qi Tang combined with Sheng Mai San is used to raise Yang and generate fluids. Dryness inevitably leads to Wei Syndrome (Flaccidity Syndromes); thus, Er Miao San plus Huanglian and Sheng Di Huang is used to treat flaccidity. Dampness inevitably leads to Bi Syndrome (Obstruction Syndromes); thus, Si Ling San plus Shen Qu is used to promote diuresis and resolve dampness.
Note: This decoction is not intended, as noted by Li Dongyuan, for general treatment of blood depletion, essence exhaustion, internal烦热 (irritating heat), blocked fluid pathways, and various harms caused by dryness. Yu Jiayan advocated treating dryness via dampness resolution. Without Li Dongyuan's exceptional insight, such understanding would be impossible; otherwise, it is merely "knowing one but not the other." Furthermore, the herbal composition is杂乱 (miscellaneous) and forced. Even based on the above explanation, what is the rationale for using Sheng Ma (*Cimicifugae Rhizoma*) and Chai Hu (*Bupleuri Radix*), Huang Bo (*Phellodendri Cortex*), and Shen Qu? If treating from the perspective of dampness, Sheng Di, Mai Dong (*Ophiopogonis Tuber*), Huang Lian, and Huang Bo are absolutely unnecessary. Whether treating Summerheat or Smallpox, the approach uniformly raises Yang and regulates Qi, merely adding or subtracting from existing formulas. When the same formula treats different diseases, renaming it implies that exceptional insight lies therein?
This decoction is fundamentally useless. Because Mr. Yu praised it excessively, it was prominently recorded to awaken people from long dreams. We must establish our foundation in conduct and elevate our perspective in reading. With complete wisdom and thorough understanding, we naturally will not be deceived by predecessors.
Er Miao San (*Two Marvels Powder*): Huang Bo (*Phellodendri Cortex*) and Cang Zhu (*Atractylodis Rhizoma*) in equal parts. It is effective because Huang Bo excels at clearing heat, while Cang Zhu excels at resolving dampness, particularly for pain caused by Damp-Heat.
Dao Huan San (*Reverse Exchange Powder*): Jing Jie (*Schizonepetae Herba*) 2 liang, Da Huang (*Rhei Radix et Rhizoma*) 1 liang. It treats urinary retention directly and simply. It is considered highly relevant to Er Miao San. Additionally, Cang Zhu and Jing Jie in equal parts, formed into pills coated with Xiong Huang (*Realgar*), treat Wind-Dampness, sharing the same principle.