【脉】 心脉滑为渴，滑者阳气胜。心脉微小为消瘅。脉软散者，气血虚。脉洪
大者，
阳余阴亏。寸口脉浮而迟，浮为虚，卫气亏；迟为劳，营气竭。趺阳脉浮而数，浮为风，数
消谷。消瘅，脉实大，病久可治；悬小坚急，病久不可治。脉数大者生，实坚大者死。细浮
短者死。
【因证】 膏粱甘肥之变，则阳脉盛矣。阳脉太甚，则阴气不得营也。津液不足
，结而不润，皆燥热为病也。
经云∶二阳结谓之消。二阳者，阳明也。手阳明主津，病消则目黄口干，是津不足也。
足阳明主血。热则消谷善饥，血中伏火，乃血不足也。此皆津血不足而热也。
夫因则火一也，病则有上、中、下三也。盖心火盛于上，为膈膜之消。病则舌上赤裂，
大渴引饮。论云∶心移热于肺，传为膈消是也，以白虎加参汤主之。
火盛于中，为肠胃之消。病则善食身瘦，自汗，大便硬，小便数。论云∶瘅成为消中者
是也。以调胃承气、三黄等治之。
火盛于下，为肾消。病则烦躁，小便浊，淋如膏油之状。论云∶焦烦水易亏者是也。六
味地黄丸主之。
【治法】 热淫所胜，治以甘苦，甘以泻之。热则伤气，气伤无润，则折热补气
，非甘寒不治。
李以补肺、降火、生血为主。
秘丹 生血为主，总治三消。
黄连 花粉 人乳 地黄汁 藕汁
上蜜为膏，徐徐留舌上，以白汤下。
参膏汤 治膈消，上焦渴，不欲多饮。
人参（五钱） 石膏（一两） 知母（六钱） 甘草（三钱五分）
水煎。或方加寒水石妙。
顺气散 治消中，能食，小便赤。
川朴（一两） 大黄（四两） 枳壳（二两） 赤芍药（一钱）
茴香散 治肾消，小便如油。
茴香 苦楝（炒） 五味
上为末，酒下二钱，食前服。
珍珠丸 治白淫滑泄，思想无穷，所愿不得之证。
黄柏（一斤，烧） 真蛤粉（一斤）
水丸，空心酒下。柏降火，蛤咸补肾。
又方 芦根 栝蒌根 麦门冬 知母 竹叶 牛乳
生津甘露饮 已下出李。
石膏 甘草（滋水之源） 黄连 山栀 黄柏 知母（泻热补水） 杏仁 麦冬 全蝎 连
翘白葵 白芷 归身 兰香（和血润燥） 升麻 柴胡（经行） 木香 藿香（反佐取之） 桔
梗（为末，舐之）
酒煮黄连丸 治中暑热渴。
太阳渴，脉浮无汗，五苓、滑石类；阳明渴，脉长有汗，白虎、凉膈等；少阳渴，脉弦
而呕，小柴胡加栝蒌；太阴渴，脉细不欲饮，不思水；少阴渴，脉沉而自利者，猪苓、三黄
汤；厥阴渴，脉微引水，少与之。
神芎丸 已下出张。
黄连（入心） 牵牛（逐火） 滑石（入肾） 大黄（逐火） 黄芩（入肺） 薄荷（散热）
三黄 治消渴。大黄，春秋二两，夏一两，冬五两；黄芩，春四两，秋夏六两，
冬三两；黄连，春四两，秋夏七两，冬三两。桂苓甘露饮调之。白虎汤调之。
生藕节汁、淡竹沥汁、生地黄汁，相兼服之、润之。
寒水石、甘草、蛤粉等分，浓煎麦门冬苗，下二钱。
神白散 治真阴虚损。
猪肚丸 治消中。
猪肚（一个） 黄连（五钱） 麦冬（去心） 知母 栝蒌
上四件末，入肚缝之，蒸烂熟，于砂盆内杵而丸之，如坚少加蜜，丸梧子大，每服五十
丸。
葛根丸 治肾消。
葛根 栝蒌（各二两） 铅丹（二两） 附子（一两，炮）
蜜丸，如梧子大，一日三服，春夏去附。
胡粉散 治大渴，又治肾消。
栝蒌根（二两五钱） 胡粉（五钱） 铅丹（五钱） 泽泻 石膏 白石脂 赤石脂（各五钱）
甘草（炙，三两五钱）
上杵为末，任意服，痛者减服。
人参白术汤 人参 白术 当归 白芍 山栀 泽泻 大黄（各五钱） 连翘 栝
蒌根 茯苓（各一两） 肉桂 藿香 木香（各一钱） 寒水石（二两） 滑石 朴硝（各半斤）
甘草（三两） 石膏（四两）
姜煎，入蜜少许。
口燥、口干、口渴、咽干，须详之。
【脉象】
心脉滑利主口渴，滑脉代表阳气偏盛。心脉微小主消瘅（一种以消瘦、烦渴为特征的疾病）。脉象软弱散漫的，是气血虚弱。脉象洪大的，是阳气有余而阴液亏损。寸口脉浮而迟，浮脉主虚，表示卫气亏虚；迟脉主劳损，表示营气枯竭。趺阳脉浮而数，浮脉主风邪，数脉主消谷善饥（食欲亢进，容易饥饿）。消瘅病，脉象实大，病程久者尚可治疗；脉象悬小坚急，病程久者不可治疗。脉象数大的预后良好，脉象实坚大的预后不良（致死）。脉象细浮短的预后不良（致死）。
【病因与证候】
食用膏粱厚味及甘甜肥腻食物导致的病变，会使阳脉盛大。阳脉过于盛大，则阴气无法正常运行滋养。津液不足，凝结而不滋润，这都是燥热致病。
经典记载说：“二阳结谓之消”。二阳指的是阳明经。手阳明大肠经主管津液，患消渴病时会出现目黄、口干，这是津液不足的表现。足阳明胃经主管血液。热盛则消谷善饥，血中有伏火，这是血不足的表现。这些都是津液和血液不足而产生的热证。
既然病因都是火，但病症分为上、中、下三消。心火旺盛于上部，称为膈消（上消）。症状表现为舌面红赤裂纹，极度口渴想喝水。医论说：“心将热移于肺，传变为膈消”，用白虎加人参汤主治。
火旺盛于中部，称为肠胃之消（中消）。症状表现为吃得多身体却消瘦，自汗出，大便干硬，小便频数。医论说：“瘅热发展为消中”，用调胃承气汤、三黄汤等治疗。
火旺盛于下部，称为肾消（下消）。症状表现为烦躁，小便浑浊，淋漓如膏油状。医论说：“焦躁烦渴，水液易亏”，用六味地黄丸主治。
【治法】
热邪过胜，治疗用甘苦味的药物，甘味药可以泻火。热邪会损伤正气，正气受损则失去滋润作用，所以要折减热邪并补益正气，非甘寒性质的药物不能治愈。
李东垣主张以补肺、降火、生血为主。
秘丹：主要功效为生血，总治上、中、下三消。
组成：黄连、天花粉、人乳、地黄汁、藕汁。
制法：以上药材炼蜜为膏，慢慢含在舌上，用白开水送服。
参膏汤：治疗膈消，上焦口渴，不想多喝水。
组成：人参（五钱）、石膏（一两）、知母（六钱）、甘草（三钱五分）。
用法：水煎服。也可以方中加入煅寒水石。
顺气散：治疗消中，能进食，小便色赤。
组成：厚朴（一两）、大黄（四两）、枳壳（二两）、赤芍药（一钱）。
茴香散：治疗肾消，小便如油状。
组成：茴香、苦楝子（炒）、五味子。
用法：以上研为末，酒送服二钱，饭前服用。
珍珠丸：治疗白淫滑泄，思虑无穷，愿望不得满足的证候。
组成：黄柏（一斤，烧制）、真蛤粉（一斤）。
制法：水泛为丸，空腹时用酒送服。黄柏降火，蛤粉咸味补肾。
生津甘露饮：此前已列出李东垣的方剂。
组成：石膏、甘草（滋水之源）、黄连、山栀、黄柏、知母（泻热补水）、杏仁、麦冬、全蝎、连翘、白葵、白芷、当归身、兰香（和血润燥）、升麻、柴胡（疏通经络）、木香、藿香（反佐取意）、桔梗（研为末，含服）。
太阳经口渴，脉浮无汗，用五苓散、滑石类药物；阳明经口渴，脉长有汗，用白虎汤、凉膈散等；少阳经口渴，脉弦且呕吐，用小柴胡汤加栝蒌；太阴经口渴，脉细不想饮水，不思喝水；少阴经口渴，脉沉且自利，用猪苓汤、三黄汤；厥阴经口渴，脉微弱需引水，少量给予。
神芎丸：此前已列出张元素的方剂。
组成：黄连（入心）、牵牛子（逐火）、滑石（入肾）、大黄（逐火）、黄芩（入肺）、薄荷（散热）。
三黄汤：治疗消渴。大黄，春秋各二两，夏一两，冬五两；黄芩，春四两，秋夏六两，冬三两；黄连，春四两，秋夏七两，冬三两。可用桂苓甘露饮或白虎汤调服。
生藕节汁、淡竹沥汁、生地黄汁，混合服用，起到滋润作用。
猪肚丸：治疗消中。
组成：猪肚（一个）、黄连（五钱）、麦冬（去心）、知母、栝蒌。
制法：以上四味研为末，填入猪肚缝中，蒸烂熟透，在砂盆内捣碎制成丸药，如果太硬可加少许蜂蜜，丸如梧桐子大，每次服用五十丸。
葛根丸：治疗肾消。
组成：葛根、栝蒌（各二两）、铅丹（二两）、附子（一两，炮制）。
制法：蜜丸，如梧桐子大，一日三次服用，春夏季节去掉附子。
胡粉散：治疗大渴，也治疗肾消。
组成：栝蒌根（二两五钱）、胡粉（五钱）、铅丹（五钱）、泽泻、石膏、白石脂、赤石脂（各五钱）、甘草（炙，三两五钱）。
用法：以上研为末，随意服用，疼痛者减少剂量。
人参白术汤：人参、白术、当归、白芍、山栀、泽泻、大黄（各五钱）、连翘、栝蒌根、茯苓（各一两）、肉桂、藿香、木香（各一钱）、寒水石（二两）、滑石、朴硝（各半斤）、甘草（三两）、石膏（四两）。
用法：生姜煎服，加入少许蜂蜜。
[Pulse]
A slippery pulse at the Heart position indicates thirst; a slippery pulse signifies an excess of Yang Qi. A minute and small pulse at the Heart position indicates Xiao Dan (a disease characterized by emaciation and vexatious thirst). A soft and scattered pulse indicates deficiency of Qi and Blood. A surging and large pulse indicates excess Yang and deficiency of Yin. At the Cun Kou (radial artery) position, a floating and slow pulse: floating indicates deficiency and depletion of Wei Qi (Defensive Qi); slow indicates劳损 (consumptive disorder) and exhaustion of Ying Qi (Nutritive Qi). At the Zu Yang (dorsalis pedis artery) position, a floating and rapid pulse: floating indicates Wind pathogen; rapid indicates excessive digestion (polyphagia). For Xiao Dan, a solid and large pulse suggests that even with long duration, the disease is treatable; a suspended, small, firm, and urgent pulse suggests that even with long duration, the disease is untreatable. A rapid and large pulse indicates survival; a solid, firm, and large pulse indicates death. A fine, floating, and short pulse indicates death.
[Etiology and Syndromes]
Diseases resulting from the consumption of rich, sweet, and fatty foods lead to an exuberance of Yang pulses. When Yang pulses are too excessive, Yin Qi cannot circulate and nourish. Insufficiency of body fluids leads to coagulation without moistening; all such conditions are caused by dryness-heat.
The Classics state: "Binding of the Two Yangs is called Xiao." The Two Yangs refer to the Yangming channels. The Hand-Yangming Large Intestine channel governs body fluids; in Xiao disease, symptoms include yellow eyes and dry mouth, indicating fluid insufficiency. The Foot-Yangming Stomach channel governs blood. Heat causes excessive digestion and hunger; latent fire in the blood indicates blood insufficiency. These are all conditions of heat arising from insufficiency of fluids and blood.
Since the etiology involves Fire, the diseases are categorized into Upper, Middle, and Lower Xiao.
Heart Fire exuberant in the Upper Jiao is called Ge Xiao (Upper Xiao). Symptoms include red cracks on the tongue and extreme thirst with desire to drink. The Treatise states: "Heart transfers heat to the Lung, transforming into Ge Xiao," treated with Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng).
Fire exuberant in the Middle Jiao is called Chang Wei Xiao (Middle Xiao/Gastrointestinal Xiao). Symptoms include polyphagia with emaciation, spontaneous sweating, hard stools, and frequent urination. The Treatise states: "Dan heat develops into Xiao Zhong," treated with Tiao Wei Cheng Qi Tang or San Huang Tang.
Fire exuberant in the Lower Jiao is called Shen Xiao (Lower Xiao/Kidney Xiao). Symptoms include irritability, turbid urine, and dribbling resembling oil. The Treatise states: "Scorched and vexed, water is easily depleted," treated with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill).
[Therapeutic Methods]
When Heat pathogen prevails excessively, treatment uses Sweet and Bitter agents; Sweet agents can purge heat. Heat damages Qi; if Qi is damaged, there is no moistening. Therefore, one must reduce heat and tonify Qi; only Sweet-Cold agents can cure this.
Li Dongyuan advocated primarily tonifying the Lung, descending Fire, and generating Blood.
Mi Dan (Secret Pill): Primarily generates blood, treating all three Xiao types.
Ingredients: Coptidis Rhizoma (Huanglian), Trichosanthis Radix (Huafen), Human Milk, Rehmanniae Radix Praeparata (Dihuang Zhi), Nelumbinis Nuciferae Rhizoma Juice (Ou Zhi).
Preparation: Honey-paste form, slowly held on the tongue, taken down with warm water.
Shen Gao Tang (Ginseng Paste Decoction): Treats Ge Xiao, thirst in the Upper Jiao, with little desire to drink.
Ingredients: Ginseng Radix et Rhizoma (Renshen, 5 qian), Gypsum Fibrosum (Shigao, 1 liang), Anemarrhenae Rhizoma (Zhimu, 6 qian), Glycyrrhizae Radix et Rhizoma (Gancao, 3.5 qian).
Usage: Decoct in water. Calcined Halloysitum (Han Shui Shi) may be added.
Shun Qi San (Smooth Qi Powder): Treats Xiao Zhong, ability to eat, red urine.
Ingredients: Magnoliae Officinalis Cortex (Chuan Pu, 1 liang), Rheii Radix et Rhizoma (Dahuang, 4 liang), Aurantii Fructus (Zhike, 2 liang), Paeoniae Radix Rubra (Chishaoyao, 1 qian).
Huixiang San (Fennel Powder): Treats Shen Xiao, urine like oil.
Ingredients: Foeniculi Fructus (Huixiang), Meliae Cortex (Kulian, stir-fried), Schisandrae Fructus (Wuweizi).
Usage: Powder form, taken with wine, 2 qian per dose, before meals.
Zhenzhu Wan (Pearl Pill): Treats Bai Yin (white discharge) and slipperiness, endless thoughts, and unfulfilled desires.
Ingredients: Phellodendri Cortex (Huangbai, 1 jin, calcined), Concha Arcae (Zhen Ga Fen, 1 jin).
Preparation: Water pills, taken with wine on an empty stomach. Huangbai descends Fire; Ga Fen (salty) tonifies Kidney.
Another Prescription: Phragmitis Rhizoma (Lugen), Trichosanthis Radix (Gualou Gen), Ophiopogonis Tuber (Maimendong), Anemarrhenae Rhizoma (Zhimu), Bambusae Folium (Zhuye), Bovis Lac (Niuniu).
Sheng Jin Gan Lu Yin (Generating Fluids and Sweet Dew Drink): Previously listed under Li.
Ingredients: Gypsum Fibrosum (Shigao), Glycyrrhizae Radix et Rhizoma (Gancao - source of water generation), Coptidis Rhizoma (Huanglian), Gardeniae Fructus (Shanzhi), Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu - purge heat and replenish water), Armeniacae Semen Amarum (Xingren), Ophiopogonis Tuber (Maidong), Scorpion (Quanxie), Forsythiae Fructus (Lianqiao), White Hibiscus Root (Bai Kui), Angelicae Dahuricae Radix (Baizhi), Angelicae Sinensis Radix (Guishen), Perilla Leaf (Lanxiang - harmonize blood and moisten dryness), Cimicifugae Rhizoma (Shengma), Bupleuri Radix (Chaihu - regulate meridians), Aucklandiae Radix (Muxiang), Costi Rhizoma (Huoxiang - counter-assistance), Platycodonis Radix (Jiegeng - powder, lick).
Jiu Zhu Huanglian Wan (Wine-Boiled Coptis Pill): Treats thirst from summer-heat.
Taiyang Thirst: Pulse floating, no sweat, use Wuling San or Talcum (Huashi) type formulas.
Yangming Thirst: Pulse long, with sweat, use Baihu Tang or Liangge San.
Shaoyang Thirst: Pulse wiry with vomiting, use Xiaochaihu Tang plus Gualou.
Taiyin Thirst: Pulse fine, no desire to drink, do not think of water.
Shaoyin Thirst: Pulse deep with spontaneous diarrhea, use Zhuling Tang or San Huang Tang.
Jueyin Thirst: Pulse faint, seeking water, give sparingly.
Shen Xiong Wan (Spiritual Xiong Pill): Previously listed under Zhang Yuansu.
Ingredients: Coptidis Rhizoma (Huanglian - enters Heart), Nephrite (Qianniu - expels fire), Talcum (Huashi - enters Kidney), Rheii Radix et Rhizoma (Dahuang - expels fire), Scutellariae Radix (Huangqin - enters Lung), Menthae Haplocalycis Herba (Bohe - dissipates heat).
San Huang (Three Yellows): Treats Xiao Ke. Dahuang: 2 liang Spring/Autumn, 1 liang Summer, 5 liang Winter. Huangqin: 4 liang Spring, 6 liang Autumn/Summer, 3 liang Winter. Huanglian: 4 liang Spring, 7 liang Autumn/Summer, 3 liang Winter. Take with Guiling Ganlu Yin or Baihu Tang.
Fresh Lotus Node Juice, Light Bamboo Sap, Fresh Rehmannia Juice: Take together for moistening.
Calcined Halloysitum (Han Shui Shi), Glycyrrhizae Radix et Rhizoma (Gancao), Concha Arcae (Ga Fen) in equal parts: Decoct Ophiopogonis Caulis (Maimendong Miao) strongly, take 2 qian.
Shen Bai San (Spirit White Powder): Treats True Yin deficiency.
Zhudu Wan (Pig Stomach Pill): Treats Xiao Zhong.
Ingredients: Pig Stomach (one), Coptidis Rhizoma (Huanglian, 5 qian), Ophiopogonis Tuber (Maidong, dehearted), Anemarrhenae Rhizoma (Zhimu), Trichosanthis Radix (Gualou).
Preparation: Powder the four ingredients, stuff into the pig stomach, steam until soft and cooked, pound in a mortar into pills. If too hard, add honey. Size of Wu Zi (walnut seed). 50 pills per dose.
Gegen Wan (Kudzu Pill): Treats Shen Xiao.
Ingredients: Puerariae Lobatae Radix (Gegen), Trichosanthis Radix (Gualou, 2 liang each), Minium (Qiandan, 2 liang), Aconiti Lateralis Radix Praeparata (Fuzi, 1 liang, processed).
Preparation: Honey pills, size of Wu Zi. Three times daily. Remove Fuzi in Spring/Summer.
Hufen San (Lead White Powder): Treats severe thirst and Shen Xiao.
Ingredients: Trichosanthis Radix (Gualou Gen, 2.5 liang), Minium (Hufen, 5 qian), Minium (Qiandan, 5 qian), Alismatis Rhizoma (Zexie), Gypsum Fibrosum (Shigao), Kaolinite (Baishizhi), Hematite (Chishizhi, 5 qian each), Glycyrrhizae Radix et Rhizoma (Gancao, roasted, 3.5 liang).
Usage: Powder, take as desired. Reduce dose if painful.
Renshen Baizhu Tang (Ginseng and Atractylodes Macrocephala Decoction): Ginseng Radix et Rhizoma (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), Angelicae Sinensis Radix (Danggui), Paeoniae Radix Alba (Baishao), Gardeniae Fructus (Shanzhi), Alismatis Rhizoma (Zexie), Rheii Radix et Rhizoma (Dahuang, 5 qian each), Forsythiae Fructus (Lianqiao), Trichosanthis Radix (Gualou Gen), Poria (Fuling, 1 liang each), Cinnamomi Cortex (Rougui), Costi Rhizoma (Huoxiang), Aucklandiae Radix (Muxiang, 1 qian each), Calcined Halloysitum (Han Shui Shi, 2 liang), Talcum (Huashi), Mirabilite (Puxiao, half jin each), Glycyrrhizae Radix et Rhizoma (Gancao, 3 liang), Gypsum Fibrosum (Shigao, 4 liang).
Usage: Decoct with ginger, add a little honey.
Dry mouth, parched mouth, thirst, and dry throat must be distinguished carefully.