不拘时服。丸方于前药中加黄柏三两，牛膝五两，沙参六两，枸杞四两，五味六两，蜜丸常服，遂不复发。
张景岳治省中周公，山左人也，年逾四旬，因案牍积劳，致成羸疾，神困食减，时多恐惧，自冬祖夏，通
夕不寐者半年有余，而上焦无渴，不嗜汤水，或有所饮，则沃而不行，然每夜必去溺二三升，莫知其所从来，
其半皆脂膏浊液， 羸至极，自分必死。诊之，脉犹带缓，肉亦未脱，知其胃气尚存，慰以无虑。乃用归脾汤
去木香，及大补元煎之属，一以养阳，一以养阴，出入间用至三百余剂，计服人参二十斤，乃得全愈。此神消
于上，精消于下之症也。可见消有阴阳，不得尽言为火。
喻嘉言曰∶友人病消渴后，渴少止，反加躁急，足膝痿弱。予主白茯苓丸方，用白茯苓、覆盆子、黄连、
栝蒌根，萆 、人参、熟地、元参各一两，石斛、蛇床子各七钱五分，鸡 三十具，微炒为末，蜜丸梧桐子
大，食前磁石汤下三十丸，内加犀角。有医曰∶肾病而以黄连、犀角治心，毋乃倒乎？予曰∶肾者，胃之关也，
胃热下传于肾，则关门大开，心之阳火，得以直降于肾，心火灼肾，燥不能濡。予用犀角、黄连，对治其下降
之阳光，宁为倒乎？服之果效。再服六味地黄丸加犀角，而肌泽病起矣。
魏玉横曰∶胡天叙年五旬，素豪饮，而多思虑。自弱冠后即善病，近则两足及臂，常时痹痛，甚则肝肾之
气上逆，或致晕厥，汗出不寐，齿痛龈露，夜卧阳事暴举，时时梦遗，面有油光，揩去复尔。脉之，两手俱豁大，
关前搏指。据症脉，乃二阳之发心脾，今已传为风消矣。询其小便，云颇清白，令以器贮，超时观之，果变稠
浆，面结腐皮，遂恐甚。告以平昔洪饮，纵欲劳神，数十年所服桂、附纯阳之药，不可胜计，未知尚能愈否？曰∶
幸未至息贲，但能断饮绝欲，多服养荣之剂，尚可为也。今病但有春夏，而无秋冬，非兼清肃之治不可。乃与
生熟地、杞子、麦冬、沙参、地骨、知母、黄柏、黄连、石膏，出入增减，十余剂，诸症渐平。惟齿痛转甚，
自制玉带膏贴之而愈。次年，因诊其媳产病，告以前方出入常服，计用石膏不下四五斤矣。此则初为寒中，后
为热中之变症也。然初之桂、附，未为痈疽，岂非天幸乎。
黄锦芳治游昼山消渴，六脉微缓而沉，肺脉尤甚，肝脉差起，小便甚多，肌肉消瘦，烦渴不止。此必初病
时过服石膏、知母、花粉、蒌仁、贝母、犀角等苦寒之药，伤其肺胃及肾，以致地气不升，天气不降。宜滋阴
补气，使漏卮不至下泄。用当归一钱，炙 四钱，升麻三分，玉竹三钱，桂元十个，桑螵蛸一钱，龙骨一钱，
菟丝二钱，龟板一钱，木瓜四分，炙草三分，使其二气交合，霖雨四布，则病自愈。嘱其日服一剂，禁服苦茶。
后病者以洋参代人参，服之甚效。
不分时候服用。丸药方子是在前面的药方中加入黄柏三两，牛膝五两，沙参六两，枸杞四两，五味子六两，用蜂蜜制成丸药经常服用，于是疾病不再复发。
张景岳治疗省中的周公，他是山东人，年龄超过四十岁，因为处理公文积累劳累，导致形成消瘦虚弱的疾病，精神困倦，食欲减退，时常感到恐惧，从冬天到夏天，整夜不睡觉有半年多，而且上焦没有口渴感，不喜欢喝汤水，即使喝了，也感觉水液停滞不行，然而每晚必须排尿二三升，不知道尿液是从哪里来的，其中一半都是像脂膏一样的浑浊液体，身体极度消瘦虚弱，自己断定必定会死。诊察他的脉象，脉搏还带有缓和之象，肌肉也没有脱陷，知道他的胃气还存在，安慰他不要担忧。于是使用归脾汤去掉木香，以及大补元煎之类的药物，一种用来养护阳气，一种用来养护阴气，交替使用达到三百多剂，共计服用人参二十斤，才得以完全痊愈。这是神气消耗于上，精气消耗于下的病症。可见消渴病有阴阳之分，不能全部说是由火邪引起。
喻嘉言说：我的朋友患消渴病后，口渴稍微停止，反而增加了烦躁急迫，足膝痿弱无力。我主张使用白茯苓丸方，用白茯苓、覆盆子、黄连、栝蒌根（天花粉）、萆薢、人参、熟地黄、玄参各一两，石斛、蛇床子各七钱五分，鸡内金三十具，微炒后研成细末，用蜂蜜制成梧桐子大小的丸药，饭前用磁石汤送服三十丸，里面加入犀角。有位医生说：肾病却用黄连、犀角来治心，岂不是颠倒了吗？我说：肾是胃的关口，胃热下传到肾，那么关门大开，心的阳火得以直接下降到肾，心火灼烧肾脏，导致干燥而不能濡润。我用犀角、黄连，针对治疗下降的阳光（指心火），难道算是颠倒吗？服药果然有效。再服用加犀角的六味地黄丸，肌肤润泽，疾病就好了。
魏玉横说：胡天叙五十岁左右，平时豪饮，且思虑过多。从二十岁以后就容易生病，近来两脚及手臂，时常痹痛，严重时肝肾之气上逆，有时导致晕厥，出汗且不睡觉，牙齿疼痛牙龈萎缩，夜间睡觉时阴茎突然勃起，时时梦遗，面部有油光，擦去后又出现。诊脉，两手脉象都豁大，关前部位搏动有力按指。根据症状和脉象，这是二阳经病变发于心脾，现在已经传变为风消了。询问他的小便情况，他说相当清白，让他用容器储存，过一段时间观察，果然变成稠浆状，表面结成腐皮，于是非常恐惧。告诉他平素大量饮酒，纵欲劳神，几十年所服用的桂枝、附子等纯阳药物，数不胜数，不知道还能治愈否？我说：幸好还没发展到息贲病，只要能戒酒断欲，多服用养荣血的药剂，还可以治愈。现在的病只有春夏（阳盛）的表现，而没有秋冬（阴敛）的表现，不兼用清肃的治疗方法是不行的。于是给予生地黄、熟地黄、枸杞子、麦冬、沙参、地骨皮、知母、黄柏、黄连、石膏，交替增减，十多剂后，各种症状逐渐平息。只有牙齿疼痛转重，自制玉带膏贴敷而痊愈。第二年，因为诊治他的儿媳产后病，告知对方以前方的加减常服，共计使用石膏不下四五斤了。这则是起初为寒中，后来变为热中的变症。然而起初使用桂枝、附子，没有导致痈疽，难道不是天幸吗。
黄锦芳治疗游昼山的消渴病，六脉微缓而沉，肺脉尤其明显，肝脉稍起，小便非常多，肌肉消瘦，烦渴不止。这一定是初病时过量服用石膏、知母、花粉、蒌仁、贝母、犀角等苦寒药物，损伤了肺、胃及肾，导致地气不升，天气不降。应当滋阴补气，使漏卮（比喻耗散）不至于向下泄漏。使用当归一钱，炙黄芪四钱，升麻三分，玉竹三钱，桂圆十个，桑螵蛸一钱，龙骨一钱，菟丝子二钱，龟板一钱，木瓜四分，炙甘草三分，使二气交合，如霖雨四布，则病自然痊愈。嘱咐他每天服用一剂，禁止服用苦茶。后来病人用西洋参代替人参，服用后非常有效。
Take at any time. The pill formula adds Coptidis Rhizoma (Huangbai, 黄柏) three liang, Achyranthis Bidentatae Radix (Niuxi, 牛膝) five liang, Glehniae Radix (Shashen, 沙参) six liang, Lycii Fructus (Gouqi, 枸杞) four liang, Schisandrae Fructus (Wuweizi, 五味) six liang to the previous medicine, processed with honey into pills for regular consumption, and thus the disease did not recur.
Zhang Jingyue treated Zhou Gong, a resident of Shengzhong from Shandong, who was over forty years old. Due to fatigue accumulated from handling official documents, he developed a wasting disease characterized by mental exhaustion, reduced appetite, frequent fearfulness, and insomnia lasting more than half a year from winter to summer. There was no thirst in the upper jiao, nor desire for soups or water; even if he drank, the fluid stagnated without moving. However, he urinated two to three sheng every night, unknown to its source, half of which was turbid liquid resembling fat and paste. He became extremely emaciated and believed he would surely die. Upon examination, his pulse still showed a moderate quality, and his flesh had not wasted away, indicating that his Stomach Qi remained. He was reassured. Then, Guipi Tang (Restore the Spleen Decoction) minus Zanthoxyli Pericarpium (Muxiang, 木香), along with Dabu Yuanyuan Jian (Greatly Tonify the Origin Decoction) and similar formulas were used. One nourished Yang, the other nourished Yin, alternating between them for over three hundred doses, consuming a total of twenty jin of Ginseng Radix et Rhizoma Rubra (Renshen, 人参), until complete recovery. This is a case where Shen (Spirit) is consumed above and Jing (Essence) is consumed below. It shows that Xiao Ke (Wasting-Thirst) has Yin and Yang distinctions and cannot be entirely attributed to Fire.
Yu Jiayan said: A friend of mine suffered from Xiao Ke (Wasting-Thirst). After his thirst subsided slightly, restlessness and irritability increased, accompanied by flaccidity and weakness of the feet and knees. I prescribed Bai Fuling Wan (White Poria Pill) using Poria (Baifuling, 白茯苓), Rubi Fructus (Fupenzi, 覆盆子), Coptidis Rhizoma (Huanglian, 黄连), Trichosanthis Radix (Gualougen, 栝蒌根), Dioscoreae Hypoglaucae Rhizoma (Bixie, 萆薢), Ginseng Radix et Rhizoma (Renshen, 人参), Rehmanniae Radix Praeparata (Shudihuang, 熟地), Scrophulariae Radix (Yuan Shen, 元参) each one liang, Dendrobii Caulis (Shihu, 石斛), Cnidii Fructus (Shechuangzi, 蛇床子) each seven qian and five fen, and Gallus Gallus Domesticus Brisson Comestus (Jineijin, 鸡内金) thirty pieces, lightly fried and powdered. These were made into pills the size of paulownia seeds with honey. Thirty pills were taken before meals with a Magnetitum (Cishi, 磁石) decoction, adding Cornu Bubali (Xijiao, 犀角). A physician remarked: "Treating Kidney disease with Coptidis Rhizoma and Cornu Bubali to address the Heart—is this not inverted?" I replied: "The Kidney is the gate of the Stomach. When Stomach Heat transmits downward to the Kidney, the gate opens wide, allowing the Heart's Yang Fire to descend directly into the Kidney. The Heart Fire scorches the Kidney, causing dryness and inability to moisten. I use Cornu Bubali and Coptidis Rhizoma to counteract the descending solar fire (Heart Fire); how can this be considered inverted?" The treatment proved effective. Subsequently, taking Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Cornu Bubali resulted in lustrous skin and recovery.
Wei Yuheng said: Hu Tianxu was around fifty years old, accustomed to heavy drinking and excessive worry. Since his twenties, he was prone to illness. Recently, his legs and arms suffered from frequent bi-syndrome pain. Severe cases involved upward reversal of Liver and Kidney Qi, leading to syncope, sweating, and insomnia. He experienced toothache with receding gums, nocturnal priapism during sleep, and frequent seminal emissions. His face had an oily sheen that returned after wiping. Pulse diagnosis revealed both hands showing a large, empty quality, with strong pulsation at the cun position anterior to the guan. Based on symptoms and pulse, this was a manifestation of the Two Yang meridiments affecting the Heart and Spleen, now transmitted as Feng Xiao (Wind Wasting). Inquiry about urine revealed it appeared clear initially, but when stored, it turned into thick paste with a film on top, causing great fear. I informed him that due to decades of alcohol indulgence, sexual excess, and mental labor, coupled with countless doses of pure Yang medicines like Cinnamomi Ramulus (Guizhi, 桂枝) and Aconiti Lateralis Radix Praeparata (Fuzi, 附子), recovery might be difficult. However, since it had not progressed to Xifen (Lung Accumulation), if he could abstain from alcohol and sex, and take many blood-nourishing agents, it could be cured. The current condition exhibits only Spring/Summer (Yang) characteristics, lacking Autumn/Winter (Yin) restraint, requiring clearing and purifying treatments. Therefore, I prescribed Rehmanniae Radix (Shengdihuang/Shudihuang, 生熟地), Lycii Fructus (Qizi, 杞子), Ophiopogonis Radix (Maidong, 麦冬), Glehniae Radix (Shashen, 沙参), Cortex Lycii (Digupi, 地骨), Anemarrhenae Rhizoma (Zhimu, 知母), Phellodendri Cortex (Huangbai, 黄柏), Coptidis Rhizoma (Huanglian, 黄连), Gypsum Fibrosum (Shigao, 石膏), adjusting them over ten doses until symptoms gradually subsided. Only the toothache worsened, which healed with self-made Yudai Gao applied externally. The following year, while treating his daughter-in-law's postpartum illness, I advised her to take modified versions of the previous prescription regularly, consuming no less than four to five jin of Gypsum Fibrosum. This case transformed from initial Cold Zhong (Middle Jiao Cold) to later Heat Zhong (Middle Jiao Heat). Fortunately, the initial use of Cinnamomi Ramulus and Aconiti Lateralis Radix Praeparata did not cause carbuncles, which was sheer luck.
Huang Jinfang treated You Zhoushan for Xiao Ke (Wasting-Thirst). The six pulses were slightly moderate and deep, with the Lung pulse particularly prominent and the Liver pulse slightly rising. Urination was excessive, muscles were emaciated, and there was incessant vexatious thirst. This was likely caused by excessive intake of bitter-cold medicines such as Gypsum Fibrosum, Anemarrhenae Rhizoma, Trichosanthis Radix, Semen Trichosanthis (Louren, 蒌仁), Fritillariae Thunbergii Bulbus (Beimu, 贝母), and Cornu Bubali during the early stage of illness, damaging the Lung, Stomach, and Kidney. This prevented Earth Qi from ascending and Heaven Qi from descending. Treatment should nourish Yin and tonify Qi to prevent leakage downwards. The prescription included Angelicae Sinensis Radix (Danggui, 当归) one qian, Astragali Membranacei Radix (Zhi Huangqi, 炙黄芪) four qian, Cimicifugae Rhizoma (Shengma, 升麻) three fen, Polygonati Odorati Rhizoma (Yuzhu, 玉竹) three qian, Euphorbiae Lappae Fructus (Guiyuan, 桂圆) ten pieces, Sangxianqiao (Sangpiaoxiao, 桑螵蛸) one qian, Longgu (Longgu, 龙骨) one qian, Cuscutae Semen (Tusizi, 菟丝) two qian, Testudinis Carapax et Plastrum (Guiban, 龟板) one qian, Chaenomelis Fructus (Mu Gua, 木瓜) four fen, and Glycyrrhizae Radix et Rhizoma (Zhi Cao, 炙草) three fen. This aimed to harmonize the two Qi, spreading moisture like rain, so the disease would heal naturally. He was instructed to take one dose daily and avoid bitter tea. Later, the patient replaced Ginseng Radix et Rhizoma with Panax Quinquefolii Radix (Yangshen, 洋参), yielding excellent results.