故仲景肾气丸治饮水一斗小便亦一斗之证。若小便过于所饮者，亦无及矣。肾消服滋补丸药外，宜多
煎黄 汤饮之。戴院使云∶若因色欲过度，水火不交，肾水下泄，心火自炎，以致渴浊，不宜备用凉
心冷剂，宜坚肾水以济心火，当用黄 饮，加苁蓉、五味各半钱，吞八味丸，及小菟丝子丸、玄兔丹、
鹿茸丸、加减安肾丸、或灵砂丹。消肾为病，比诸消为重，古方谓之强中。又谓之内消。多因恣意色
欲，或饵金石，肾气既衰，石气独在，精水无所养，故常发虚阳，不交精出，小便无度，唇口干焦，
黄饮，吞玄兔丹。八味丸、鹿茸丸、加减肾气丸、小菟丝子丸、灵砂丹，皆可选用。未效，黄 饮
加苁蓉、五味、山茱萸各四分，荠茏汤、苁蓉丸、天王补心丹、双补丸、肾沥散、金银箔丸、白茯苓
丸。
【通治】三消丸，用好黄连治净为细末，不拘多少，切冬瓜肉，研取自然汁，和成饼，阴干，再
为细末，用汁浸和，加至七次，即用冬瓜汁为丸桐子大。每服三十丸，以大麦仁汤入冬瓜汁送下。寻
常渴，止一服效。酒色过度，积为酷热，熏蒸
五脏，津液枯燥，血泣，小便并多，肌肉消铄，专嗜冷物寒浆，勿投凉剂，以龙凤丸主之。戴云∶诸
消不宜用燥烈峻补之剂，惟当滋养，除消脾外，心肾二消，宜用黄 六一汤，或参 汤吞八味丸，或
玄兔丹，或小菟丝子丸。又用竹龙散皆可，又用六神饮，亦治肾消。惟脾消则加当归去黄 。三消小
便既多，大便必秘，宜常服四物汤，润其大肠，如加人参、木瓜、花粉在内，仍煮四皓粥食之，糯米
泔折二，亦可冷进。三消久而小便不臭，反作甜气，在溺桶中涌沸，其病为重。更有浮在溺面如猪脂，
溅在桶边如 烛泪，此精不禁，真元竭矣。按消渴小便甜，许学士论之甚详，其理未畅。大抵水之在
天地与人身，皆有咸有甘，甘者生气，而咸者死气也，坡仙乳泉赋备矣。小便本咸而反甘，是生气泄
也。生气泄者，脾气下陷入肾中也。脾气入肾者，土克水也。三消久之，精血既亏，或目无见，或手
足偏废如风疾，然此证消肾得之为多，但用治下消中诸补药，滋生精血自愈。三消病退后而燥渴不解，
此有余热在肺经，可用参、苓、甘草少许，生姜汁冷服。虚者可用人参汤。渴病愈后再剧，舌白滑微
肿，咽喉咽唾觉痛，嗌肿，时渴饮冷，白沫如胶，饮冷乃止，甘草石膏丸。渴疾愈，须预防发痈疽，
黄六一汤下忍冬丸。（凡诸虚不足，胸中烦躁，时常消渴
唇口干燥，或先渴而欲发疮，或病痈疽而后渴者，并宜黄 六一汤多服。）已发者，蓝叶散、玄参散、
荠丸。消渴后成水气，方书虽有紫苏汤、瞿麦汤、葶苈丸，皆克泄之剂，不若五皮饮送济生肾气丸，
及东垣中满分消诸方为妥。
【口燥咽干】东垣云∶饮食不节，劳倦所伤，以致脾胃虚弱，乃血所生病，主口中津液不行，故口干咽干，病
人自以为渴，医以五苓散治之，反加渴燥，乃重竭津液以致危亡。经云∶虚则补其母，当于心与小肠
中补之，乃脾胃之根蒂也。以甘温之药为之主，以苦寒为之使，以酸为之臣，佐以辛。心苦缓，急食
酸以收之。心火旺则肺金受邪，金虚则以酸补之，次以甘温及甘寒之剂，于脾胃中泻心火之亢盛，是
治其本也。（补中益气汤，加五味子、葛根。《本事方》黄 汤亦可。）戴云∶无病自渴，与病瘥后
渴者，参术饮、四君子汤、缩脾汤、俱加干葛。或七珍散加木瓜一钱。生料五苓散加人参一钱，名春
泽汤。以五苓散加四君子汤，亦名春泽汤，尤是要药。更兼作四皓粥食之。诸病久损，肾虚而渴，并
宜八味丸及黄 饮，四物汤加人参、木瓜各半钱，或七珍散、大补汤并去术，加木瓜如数。诸失血及
产妇蓐中渴，名曰血渴。宜求益血之剂，已于
吐血证中论之。有无病忽然大渴，少顷又定，只宜蜜汤及缩脾汤之类。折二泔冷进数口亦可。酒渴者，
干葛汤调五苓散。又有果木渴，因多食果子所致，药中宜用麝香。
【诊】 KT 弱小以薄者心脆，肩背薄者肺脆，胁骨弱者肝脆，唇大而不坚者脾脆，耳大不坚
者肾脆，皆善病消瘅易伤。心脉微小为消瘅，滑甚为善渴。（滑者阳气胜）。肺、肝、脾、肾脉微小，
皆为消瘅。（诸脉小者，阴阳俱不足也。勿取以针，而调以甘药）。心脉软而散者，当消渴自已。濡
散者，气实血虚。洪大者，阳余阴亏。寸口脉浮而迟，浮为虚，卫气亏；迟为劳，荣气竭。趺阳脉浮
而数，浮为风，数消谷。脉实大，病久可治。悬小坚，病久不可治。数大者生。细小浮短者死。病若
开目而渴，心下牢者，脉当得紧实而数，反得沉涩而微者，死也。心移寒于肺消者，饮一溲二不治。
因此，张仲景的肾气丸用于治疗饮水一斗、小便也排出一斗的症状。如果小便量超过饮水量，那就无法治愈了。对于肾消（肾脏受损引起的消渴病），除了服用滋补丸药外，适宜多煎煮黄耆汤饮用。戴院使说：如果是因房事过度，导致水火不交，肾水下泄，心火自炎，从而引起口渴且尿液浑浊，不宜常规使用凉心冷剂，而应该坚固肾水以济助心火，应当使用黄耆饮，加入肉苁蓉、五味子各半钱，送服八味丸，以及小菟丝子丸、玄兔丹、鹿茸丸、加减安肾丸，或者灵砂丹。消肾这一病症，比其他类型的消渴病更为严重，古方称之为“强中”，又称为“内消”。多因纵欲无度，或服用金石类药物所致，肾气既已衰退，石气的毒性独存，精血津液得不到滋养，所以经常发作虚阳上浮，精气不固而外泄，小便失禁，嘴唇口干焦裂，宜用黄耆饮，送服玄兔丹。八味丸、鹿茸丸、加减肾气丸、小菟丝子丸、灵砂丹，都可以选用。如果无效，在黄耆饮中加入肉苁蓉、五味子、山茱萸各四分，荠苠汤、肉苁蓉丸、天王补心丹、双补丸、肾沥散、金银箔丸、白茯苓丸。
【通用治法】三消丸：取优质黄连洗净研成细末，数量不限，切冬瓜肉，研磨取自然汁，与药末和成药饼，阴干后再研为细末，用药汁浸泡调和，重复此过程七次，最后用冬瓜汁制成梧桐子大小的丸药。每次服用三十丸，用大麦仁汤加冬瓜汁送服。一般口渴，只需服用一次即见效。因酒色过度，积聚酷热，熏蒸五脏，导致津液枯燥，血液凝涩，小便频多，肌肉消瘦，特别嗜好冷物寒浆，不可投用凉剂，应以龙凤丸为主治。戴云说：各种消渴病不宜使用燥烈峻补的药物，只应当滋养，除脾消外，心消和肾消，适宜使用黄耆六一汤，或者人参汤送服八味丸，或者玄兔丹，或小菟丝子丸。又可用竹龙散，也可用六神饮，也能治疗肾消。只有脾消则需加当归，去掉黄耆。三消病患者小便既多，大便必然秘结，适宜常服四物汤，润养大肠，如加入人参、木瓜、天花粉在内，仍煮四皓粥食用，糯米泔水沉淀后的二分之一量，也可以冷服。三消病日久，小便不臭，反而散发甜味，在尿桶中涌沸，这是病情严重的表现。更有甚者，尿液表面浮着像猪油一样的东西，溅在桶边像蜡烛泪一样，这是精气不禁，真元枯竭的表现。据考证，消渴病小便甜，许学士论述得很详细，但其原理尚未完全阐明。大抵水在天地与人体中，既有咸味也有甘味，甘味代表生气，而咸味代表死气，苏东坡的《乳泉赋》对此已有详尽描述。小便本应是咸的却反呈甘味，这是生气泄漏的表现。生气泄漏，是因为脾气下陷进入肾中。脾气入肾，是土克水的表现。三消病日久，精血既已亏损，可能出现视力丧失，或手足偏废如同风疾，但这种证候多见于消肾病，只要使用治疗下消的各种补药，滋生精血，自然痊愈。三消病退后若燥渴不解，这是有余热在肺经，可用少量人参、茯苓、甘草，加生姜汁冷服。体虚者可用人参汤。渴病痊愈后再次加重，舌苔白滑微肿，咽喉吞咽唾液觉痛，咽喉肿痛，时常想喝冷水，口吐白沫如胶状，喝冷水才停止，可用甘草石膏丸。渴疾痊愈后，必须预防发生痈疽，可用黄耆六一汤送服忍冬丸。（凡是各种虚损不足，胸中烦躁，时常消渴，唇口干燥，或先渴而后欲发疮，或患痈疽而后出现口渴的，都适宜多服黄耆六一汤。）已经发病者，可用蓝叶散、玄参散、荠苠丸。消渴后形成水气病，医书虽有紫苏汤、瞿麦汤、葶苈丸，但都是攻逐泻下的药物，不如用五皮饮送服济生肾气丸，以及李东垣的中满分消诸方更为稳妥。
【口燥咽干】李东垣说：饮食不节，劳倦所伤，导致脾胃虚弱，这是血分所生的疾病，主要症状是口中津液不行，所以口干咽干，病人自以为渴，医生如果用五苓散治疗，反而会加重口渴干燥，这是再次耗竭津液以致危及生命。经书说：虚证应当补其母脏，应当在心与小肠中进行补益，因为心小肠是脾胃的根本。以甘温的药物为主药，以苦寒的药物为使药，以酸味的药物为臣药，佐以辛味。心气易缓，急食酸味以收敛之。心火旺盛则肺金受邪，肺气虚弱则以酸味补之，其次用甘温及甘寒的药物，在脾胃中泻去心火的亢盛，这是治本的方法。（补中益气汤，加入五味子、葛根。《本事方》的黄耆汤也可以使用。）戴云说：无病自感口渴，与病愈后口渴的，可用参术饮、四君子汤、缩脾汤，均加入干葛。或者七珍散加木瓜一钱。生料五苓散加人参一钱，名为春泽汤。用五苓散加四君子汤，也叫春泽汤，尤其是要药。再配合吃四皓粥。各种疾病久损，肾虚而渴，都适宜用八味丸及黄耆饮，四物汤加人参、木瓜各半钱，或者七珍散、大补汤并去掉白术，加入木瓜适量。各种失血及产妇产褥期中口渴，名叫血渴。适宜寻求补血药剂，已在吐血证中论述过。有无病忽然大渴，片刻后又缓解的，只适宜用蜜汤及缩脾汤之类。沉淀后的糯米泔水冷服几口也可以。酒渴者，用干葛汤调服五苓散。又有果木渴，因多吃果子所致，药中适宜用麝香。
【诊法】脉象弱小且身体瘦薄的人，心脏脆弱；肩背薄的人，肺脏脆弱；胁骨弱的人，肝脏脆弱；嘴唇大而不坚实的人，脾脏脆弱；耳朵大而不坚实的人，肾脏脆弱，这些人都容易患消瘅病，容易受伤。心脉微小为消瘅病，滑而有力为善渴。（滑脉表示阳气胜）。肺、肝、脾、肾脉微小，皆为消瘅病。（诸脉小的，表示阴阳俱不足。不要用针刺治疗，而应用甘药调理）。心脉软而散的，消渴病将自愈。濡散脉，表示气实血虚。洪大脉，表示阳有余阴不足。寸口脉浮而迟，浮表示虚，卫气亏；迟表示劳损，营气竭。趺阳脉浮而数，浮表示风邪，数表示消谷善饥。脉实大，病久可治。悬小而坚，病久不可治。脉数大者生，细小浮短者死。如果病人睁眼就渴，心下痞硬，脉应当得到紧实而数的脉象，反而得到沉涩而微的脉象，主死。心将寒气移于肺导致的消渴病，饮水一斗小便二斗，属不治之症。
Therefore, Zhang Zhongjing's Shenqi Wan (Kidney Qi Pill) is used to treat the syndrome of drinking one dou of water and excreting one dou of urine. If the volume of urine exceeds the amount of water drunk, it is incurable. For Shen Xiao (Kidney Consumption/Xiao Ke affecting the Kidneys), in addition to taking nourishing pills, it is advisable to frequently decoct and drink Huangqi Tang (Astragalus Decoction). Dai Yuan Shi said: If the condition arises from excessive sexual indulgence, leading to a failure of communication between Water and Fire, with Kidney Water descending and Heart Fire flaring up, resulting in thirst and turbid urine, one should not routinely use cooling agents for the Heart. Instead, one should strengthen Kidney Water to assist Heart Fire. One should use Huangqi Yin (Astragalus Drink), adding Rongrong (Cistanche Herba) and Wuweizi (Schisandrae Fructus) half a qian each, swallowed with Bawei Wan (Eight-Ingredient Pill), as well as Xiaotusizi Wan (Small Cuscuta Pill), Xuantu Dan (Mysterious Rabbit Pellet), Lurong Wan (Deer Antler Pill), Jiajian Anshen Wan (Modified Calming Kidney Pill), or Lingsha Dan (Spirit Mercury Pellet). The disease of Shen Xiao is more severe than other types of Xiao Ke; ancient texts refer to it as "Qiangzhong" (Strong Middle) or "Neixiao" (Internal Consumption). It is often caused by unrestrained sexual desire or the ingestion of mineral drugs. Once Kidney Qi declines, the toxicity of the minerals remains alone, and essence and fluids are un-nourished. Thus, deficient Yang frequently flares up, essence leaks out uncontrollably, urination is frequent and uncontrolled, lips and mouth become dry and scorched. One should use Huangqi Yin, swallowing Xuantu Dan. Bawei Wan, Lurong Wan, Jiajian Shenqi Wan, Xiaotusizi Wan, and Lingsha Dan can all be selected. If there is no effect, add Rongrong, Wuweizi, and Shanzhuyu (Corni Fructus) each four fen to Huangqi Yin, along with Qifeng Tang (Jiaolia Decoction), Rongrong Wan, Tianwang Buxin Dan (Emperor of Heaven's Tonification of the Heart Pill), Shuangbu Wan (Double Tonification Pill), Shenli San (Kidney Drip Powder), Jinyinbo Wan (Silver and Gold Foil Pill), and Baifuling Wan (White Poria Pill).
[General Treatment] Sanxiao Wan (Three Consumptions Pill): Take high-quality Huanglian (Coptidis Rhizoma), clean it and grind it into fine powder, quantity unrestricted. Cut winter melon flesh, grind to extract natural juice, mix with the powder to form cakes, dry in the shade, then grind again into fine powder. Soak and mix with the juice, repeating this process seven times. Finally, use winter melon juice to make pills the size of paulownia seeds. Take thirty pills per dose, delivered with barley kernel soup mixed with winter melon juice. For ordinary thirst, one dose is effective. Excessive alcohol and sexual activity accumulate intense heat, steaming the five Zang organs, drying up body fluids, causing blood stasis, frequent urination, muscle wasting, and a strong craving for cold foods and drinks. Do not administer cooling agents; instead, treat primarily with Longfeng Wan (Dragon and Phoenix Pill). Dai Yun stated: Various Xiao diseases should not be treated with drying, acrid, or harsh tonifying agents; only nourishment is appropriate. Except for Pi Xiao (Spleen Consumption), Xin Xiao (Heart Consumption) and Shen Xiao should use Huangqi Liuyi Tang (Astragalus Six-to-One Decoction), or Ginseng Tang swallowed with Bawei Wan, Xuantu Dan, or Xiaotusizi Wan. Zhulong San (Bamboo Dragon Powder) is also suitable, as is Liushen Yin (Six Deities Drink), which also treats Shen Xiao. Only in Pi Xiao should Danggui (Angelicae Sinensis Radix) be added and Huangqi removed. In Sanxiao, since urination is frequent, constipation is inevitable; thus, Siwu Tang (Four Substances Decoction) should be taken regularly to moisten the large intestine. If Renshen (Ginseng Radix), Mugua (Chaenomelis Fructus), and Huafen (Trichosanthis Radix) are added, one should still consume Sihao Zhou (Four White Men Porridge). Two parts of rice water sediment can also be taken cold. If Sanxiao persists for a long time, urine loses its odor but develops a sweet smell, bubbling in the chamber pot, indicating severe illness. Furthermore, if fat-like substances float on the urine surface and splatter like candle wax on the bucket sides, this indicates loss of essence and exhaustion of true Yuan Qi. Regarding sweet urine in Xiao Ke, Xu Xueshi discussed it in detail, but the principle was not fully elucidated. Generally, water in heaven, earth, and the human body has both salty and sweet properties; sweetness represents Sheng Qi (Vital Qi), while saltiness represents Si Qi (Dead Qi). Su Dongpo's "Ode to Spring Milk" elaborates on this. Urine should naturally be salty but becomes sweet, indicating the leakage of Sheng Qi. Leakage of Sheng Qi occurs because Spleen Qi sinks into the Kidney. Spleen Qi entering the Kidney represents Earth overcoming Water. After Sanxiao persists for a long time, essence and blood are depleted; symptoms may include blindness or hemiplegia resembling wind stroke. This syndrome is mostly due to Shen Xiao. Using various tonifying medicines for Lower Xiao to generate essence and blood will lead to self-healing. After Sanxiao recedes, if dryness and thirst persist, it indicates residual heat in the Lung Meridian. A small amount of Renshen, Fuling (Poria), and Gancao (Licorice Radix), taken cold with ginger juice, can be used. For deficiency, Renshen Tang may be used. If thirst recurs after recovery, with a white, slippery, slightly swollen tongue, pain upon swallowing saliva, throat swelling, frequent desire for cold drinks, and sticky white foam that stops only with cold water, use Gancao Shigao Wan (Licorice and Gypsum Pill). After thirst resolves, one must prevent carbuncles and sores; use Huangqi Liuyi Tang to swallow Rendong Wan (Honeysuckle Pill). (For any deficiency insufficiency, chest irritability, frequent Xiao Ke, dry lips and mouth, or thirst preceding sores, or thirst following sores, frequent use of Huangqi Liuyi Tang is appropriate.) For existing sores, use Lanye San (Isatis Leaf Powder), Xuanshen San (Scrophulariae Radix Powder), or Qifeng Wan. If Xiao Ke leads to fluid retention, although medical texts mention Zisu Tang, Qumai Tang, and Tingli Wan, these are purgative and draining agents. It is better to use Wupi Yin (Five Peel Drink) to deliver Jisheng Shenqi Wan, or Li Dongyuan's Zhongman Fenxiao formulas, which are more appropriate.
[Mouth Dryness and Throat Dryness] Li Dongyuan said: Irregular diet and fatigue injury lead to Spleen and Stomach weakness. This is a disease arising from Blood, characterized by the failure of fluids to circulate in the mouth, causing dry mouth and throat. Patients feel thirsty themselves. If doctors treat this with Wuling San (Five-Ingredient Powder with Poria), thirst and dryness will worsen, further depleting fluids and leading to danger. The Classics state: "In deficiency, tonify the mother." Tonification should occur in the Heart and Small Intestine, as they are the root of the Spleen and Stomach. Use sweet-warm herbs as the principal agents, bitter-cold as guides, sour as assistants, and pungent as佐 (adjuncts). The Heart dislikes laxity; urgently use sour flavors to astringe it. If Heart Fire is hyperactive, Lung Metal suffers; when Lung Qi is deficient, tonify with sour flavors. Next, use sweet-warm and sweet-cold agents to drain excess Heart Fire within the Spleen and Stomach; this treats the root. (Buzhong Yiqi Tang, added with Wuweizi and Gegen (Puerariae Radix). Huangqi Tang from *Ben Shi Fang* is also usable.) Dai Yun said: For spontaneous thirst without disease, or thirst after convalescence, use Shenzhu Yin, Sijunzi Tang (Four Gentlemen Decoction), or Suopi Tang, all added with Gan Ge (Kudzu Root). Or Qizhen San (Seven Treasures Powder) with one qian of Mugua. Shengliao Wuling San (Raw Material Five-Ingredient Powder with Poria) with one qian of Renshen is named Chunze Tang. Wuling San combined with Sijunzi Tang is also called Chunze Tang, an especially important formula. Additionally, consume Sihao Zhou. For chronic damage from various diseases, Kidney deficiency with thirst, use Bawei Wan and Huangqi Yin. Siwu Tang with half a qian each of Renshen and Mugua, or Qizhen San, or Dabu Tang (Great Tonification Decoction) with Bai Zhu (Atractylodis Macrocephalae Rhizoma) removed and Mugua added in equal amounts, are suitable. For hemorrhage and postpartum thirst, named "Blood Thirst," seek blood-tonifying agents, as discussed in the Hematemesis chapter. For sudden intense thirst without prior illness that resolves shortly after, only honey water and Suopi Tang are appropriate. A few sips of cold rice water sediment can also be taken. For alcohol-induced thirst, use Gegen Tang to regulate Wuling San. There is also "Fruit/Tree Thirst" caused by excessive fruit consumption; Musk (Shexiang) should be included in the prescription.
[Diagnosis] A weak, thin pulse indicates a fragile Heart; a thin shoulder and back indicate a fragile Lung; weak costal bones indicate a fragile Liver; large but non-firm lips indicate a fragile Spleen; large but non-firm ears indicate a fragile Kidney. All these constitutions are prone to Xiao Dan (Xiao Ke and related disorders) and easy injury. A tiny and minute Heart pulse indicates Xiao Dan; a very slippery pulse indicates frequent thirst (Slipperiness indicates Yang excess). Tiny and minute pulses in the Lung, Liver, Spleen, and Kidney positions all indicate Xiao Dan. (All small pulses indicate insufficiency of both Yin and Yang. Do not use acupuncture; regulate with sweet medicines.) A soft and scattered Heart pulse indicates that Xiao Ke will resolve itself. A Ru (Soft) and scattered pulse indicates Qi excess and Blood deficiency. A Hong (Surging) and large pulse indicates Yang surplus and Yin deficiency. A floating and slow pulse at the Cun Kou position indicates floating means Deficiency and Wei Qi depletion; slow means Labor/Fatigue and Ying Qi exhaustion. A floating and rapid pulse at the Zu Yang position indicates floating means Wind, and rapid indicates digestion of food (hyperphagia). A solid and large pulse in a chronic disease is treatable. A suspended, small, and firm pulse in a chronic disease is untreatable. A rapid and large pulse indicates survival; a small, thin, floating, and short pulse indicates death. If a patient opens their eyes and feels thirsty, with a firm sensation below the heart, the pulse should be tight, solid, and rapid. If it is instead deep, choppy, and faint, it indicates death. If Heart transmits Cold to the Lung causing Xiao Ke, drinking one dou and urinating two dou is untreatable.