脉 两寸脉滑者为上消。两关洪数者为中消。两尺浮大为下消。濡散为气实血虚。洪大为阳
盛阴虚。脉沉小有力者可治。实大浮涩者皆难治。
症 内经云∶二阳结谓之消。东垣云∶二阳者。手足阳明也。手阳明。大肠主津。病则目
黄口干。是津不足也。足阳明。胃主血。热则消谷善饥。胃中伏火。火烁而血干涸也。津血
不足。而消渴生矣。虽有三者之分。因于火则一也。上消者心移热于肺。多饮而渴。少食而
呕。中消者。脾移热于胃也。善食而瘦。大便燥。而小便黄。下消者。肾移热于膀胱也小便
淋浊。如脂膏之状。大抵渴症皆因膏粱甘肥之变。或过服金石热药。致阳盛阴虚。津液不足
。结而不润。皆责于火也。
治 宜养肺降火生血为主。或曰上消渴。是心火刑炼肺金所致。治宜降火清金。以黄连、麦
门冬、兰草、白豆蔻、仁梨、藕汁，加升麻、黄柏、之类。清气上升。而渴自止矣。中消渴者。
胃中伏火。不生津液。食已则饥。不营肌肉。宜芩、
连、石膏、治之。甚者。调胃承气汤。下消渴者。烦躁引饮。耳叶焦。小便如膏。正所谓焦
烦水易亏是也。此为肾消。宜六味地黄丸主之。圣济总录云∶未传能食者。必发痈疽背疮。不
能食者。必得中满豉胀。背为不治之症。洁古分而治之。能食而渴者。白虎加人参汤。不能
食而渴者。钱氏白术散。倍加干葛治之。上下既平。则不复传下矣。
方 五汁饮总治三消
川黄连（一钱五分） 麦门冬（一钱五分） 天花粉（一钱） 生甘草（三分） 人参（八分） 石膏
（一钱五分） 知母（一钱五分） 归身（一钱） 白芍药（八分） 黄柏（七分） 梨汁（以下临服
加入） 藕汁 生地黄汁 人乳汁（各一盏） 姜汁（二匙） 竹沥（半盏）
上作一服。加兰草叶一钱。同煎。食远服。临服时。将五汁加入。连药服之。外无加减。
脉象：两手寸部脉象滑利，属于上消。两手关部脉象洪大而数，属于中消。两手尺部脉象浮大，属于下消。脉象濡散，表示气实血虚。脉象洪大，表示阳盛阴虚。脉象沉小且有力者，病情可治。脉象实大且浮涩者，均难治愈。
症状：《内经》说：“二阳结谓之消。”李东垣说：“二阳，指的是手阳明和足阳明经。手阳明大肠经主管津液，患病则出现目黄、口干，这是津液不足的表现。足阳明胃经主管血液，有热则消化食物快、容易饥饿，这是胃中有潜伏的火邪，火邪灼烧导致血液干涸。津液和血液都不足，从而产生消渴病。虽然分为上、中、下三种类型，但起因都在于火。上消，是心火移热于肺，表现为多饮而口渴，吃得少却呕吐；中消，是脾热移于胃，表现为吃得多却身体消瘦，大便干燥，小便发黄；下消，是肾热移于膀胱，表现为小便浑浊如脂膏状。大抵来说，消渴症都是因为食用膏粱甘肥之物变化所致，或者过服金石类热性药物，导致阳盛阴虚，津液不足，郁结而不滋润，原因都归结于火。
治疗：应当以养肺、降火、生血为主。有人说上消渴，是心火克制肺金所致，治疗应当降火清金，使用黄连、麦门冬、兰草、白豆蔻、仁梨、藕汁，加入升麻、黄柏等药，使清气上升，口渴自然停止。中消渴，是胃中有潜伏火邪，不生津液，吃完就饿，不能滋养肌肉，宜用黄芩、黄连、石膏治疗。严重的，用调胃承气汤攻下。下消渴，表现为烦躁引水饮用，耳廓干枯焦黑，小便像膏脂一样，这正是“焦烦水易亏”的情况。这称为肾消，宜用六味地黄丸主治。《圣济总录》说：如果还能进食的，必定会发痈疽背疮；如果不能进食的，必定会出现中满鼓胀，背部病变是不治之症。张洁古分别进行治疗：能食而口渴的，用白虎加人参汤；不能食而口渴的，用钱氏白术散，加倍使用干葛来治疗。上下病情平稳后，就不再传变到下焦了。
方剂：五汁饮，总治三消
川黄连（一钱五分） 麦门冬（一钱五分） 天花粉（一钱） 生甘草（三分） 人参（八分） 石膏（一钱五分） 知母（一钱五分） 归身（一钱） 白芍药（八分） 黄柏（七分） 梨汁（以下临服加入） 藕汁 生地黄汁 人乳汁（各一盏） 姜汁（二匙） 竹沥（半盏）
以上药材作为一服药的量，加入兰草叶一钱，共同煎煮。在饭后服用。临服用时，将五种汁液加入，连同药液一起服用。没有其他的加减法。
Pulse: A slippery pulse at both Cun (inch) positions indicates Upper Xiao (Upper Wasting-Thirst). A surging and rapid pulse at both Guan (middle) positions indicates Middle Xiao (Middle Wasting-Thirst). A floating and large pulse at both Chi (cubit) positions indicates Lower Xiao (Lower Wasting-Thirst). A soggy and scattered pulse indicates excess Qi and deficient Blood. A surging and large pulse indicates excess Yang and deficient Yin. A deep, small, and forceful pulse is treatable. A solid, large, floating, and choppy pulse are all difficult to treat.
Symptoms: The *Neijing* states: "Binding of the Two Yangs is called Xiao." Li Dongyuan stated: "The Two Yangs refer to the Hand-Yangming and Foot-Yangming meridians. The Hand-Yangming Large Intestine governs body fluids; when diseased, it presents with yellow eyes and dry mouth, indicating insufficient fluids. The Foot-Yangming Stomach governs blood; heat causes rapid digestion and hunger, which is due to latent fire in the stomach burning and drying up the blood. When both fluids and blood are insufficient, Wasting-Thirst arises. Although divided into three types, the cause is always Fire. Upper Xiao involves Heart Fire transferring heat to the Lung, presenting with excessive drinking and thirst, little food intake but vomiting. Middle Xiao involves Spleen Heat transferring to the Stomach, presenting with excessive eating yet emaciation, dry stools, and yellow urine. Lower Xiao involves Kidney Heat transferring to the Bladder, presenting with turbid urine resembling fat or paste. Generally, Wasting-Thirst arises from changes caused by rich, sweet, and fatty foods, or from overconsumption of mineral-based hot medicines, leading to excess Yang and deficient Yin, insufficient fluids, binding without moistening, all attributed to Fire.
Treatment: The primary approach should be nourishing the Lung, descending Fire, and generating Blood. Some say Upper Xiao is caused by Heart Fire suppressing Lung Metal; treatment should descend Fire and clear Metal, using Huanglian (Coptis Rhizome), Maidong (Ophiopogon Tuber), Lanco (Houttuynia Herb), Baicoukou (Amomum Cardamomum Fruit), Pear Flesh, and Lotus Root Juice, added with Shengma (Cimicifuga Rhizome) and Huangbai (Phellodendron Bark), so that clear Qi ascends and thirst stops. Middle Xiao involves latent fire in the Stomach failing to generate fluids, hunger immediately after eating, and failure to nourish muscles; it should be treated with Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Shigao (Gypsum Fibrosum). In severe cases, use Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) to purge. Lower Xiao presents with irritability, craving water, dried and blackened earlobes, and urine like paste; this is precisely what is meant by 'irritability and scorching, water easily depleted.' This is called Kidney Xiao and should be primarily treated with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). The *Shengji Zonglu* states: If the patient can still eat, they will inevitably develop carbuncles and back sores; if they cannot eat, they will develop abdominal fullness and distension, and lesions on the back are incurable. Zhang Jiegu treated them separately: for those who can eat and have thirst, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng); for those who cannot eat and have thirst, use Qian's Baizhu San (Atractylodes Powder), adding extra Gegen (Kudzu Root). Once the upper and middle conditions are stabilized, transmission to the lower jiao ceases.
Formula: Five-Juice Drink, treating all three Xios generally
Chuan Huanglian (Coptidis Rhizoma) (1 qian 5 fen) Maidong (Ophiopogonis Tuber) (1 qian 5 fen) Tianhuafen (Trichosanthis Radix) (1 qian) Sheng Gancao (Glycyrrhizae Radix et Rhizoma) (3 fen) Renshen (Ginseng Radix) (8 fen) Shigao (Gypsum Fibrosum) (1 qian 5 fen) Zhimu (Anemarrhenae Rhizoma) (1 qian 5 fen) Guishen (Angelicae Sinensis Radix) (1 qian) Baishaoyao (Paeoniae Radix Alba) (8 fen) Huangbai (Phellodendri Cortex) (7 fen) Lizhi (Pear Juice) [add just before taking] Ou zhi (Lotus Root Juice) Sheng Dihuangzhi (Rehmanniae Radix Recens Juice) Ren Ru zhi (Human Breast Milk) (each 1 zhan) Jiang zhi (Ginger Juice) (2 chi) Zhuli (Bamboo Sap) (half zhan)
Prepare as one dose. Add Lancao Ye (Houttuyniae Herba) 1 qian, decoct together. Take well after meals. Just before taking, add the five juices, and consume together with the medicinal decoction. No other modifications.