甲申冬连参天患劳力感寒肾脉独迟。余投以温经汤。加姜桂三剂得愈。令其且密室静持
。越
三日因鹾务劳郁。遽病中消。每日倍饭不饱。食少迟则嘈杂如欲呕血状。意疑前剂加姜桂太
燥。余曰此因病虚肝火侮脾故独中焦受烁但两尺仍迟非可以消剂治也不信。一医以前汤加麦
冬白芍。虽消症顿瘥。饮食如常。其大便又至滑泄。再延予治。令其恪服归脾汤。加桂附骨
脂吴萸。至十剂泄止。始大安则消亦有寒者余稽百氏方书。咸言三消悉属火病。治须凉剂。
至内经气厥论曰心移寒于肺。饮一溲二。死不治。可见少饮多溺。及老人阳虚夜溺无度。皆
寒
消肺肾金水衰竭之病。而世鲜有知之者。附张景岳治一消症于后。以广俗眼。张景岳曰予尝
治一缙绅。年逾四旬。因案牍积劳。致成大病神困食减。时多恐惧。上焦无渴不嗜汤水。或
有少饮。则沃而不行然每夜必去溺二三升。莫知其所从来。且半皆浊液。最后延余诊视。因
相告曰。自病以来。通宵不寐者已半年有余。即间有朦胧似睡之意。必梦见亡人凶丧等事。
鬼魅相亲。其不免矣。余曰不然。此以思虑积劳。损伤心肾元阳既亏。则阴邪乖之。故多
阴梦阳衰则气虚阳不帅阴则水不化气故饮水少而浊溺多也。阳气渐回则阴邪自退。此政内经
所谓心移寒于肺。饮一溲二之症耳。病本非轻。脉犹带缓。肉犹未脱。胃气尚存。可无虑也
。乃以归脾之属。去白术木香。八味之属。去丹皮泽泻一以养阳一以养阴出入间用。至三百
余剂。计人参二十余斤而后全愈此非神消于上精消于下之症乎可见消有阴阳。不得尽称为火
症姑记此一案以为治消者之鉴噫景岳其神于治乎。
甲申年冬天，连参因劳累过度又感受寒邪，导致肾脉单独呈现迟象。我给他投用温经汤，加入生姜、肉桂，服用三剂后痊愈。嘱咐他暂且在密室中静养持守。
过了三天，因为盐务工作劳累且情绪郁结，突然患上“中消”病。每天加倍吃饭仍不饱腹，如果进食稍晚，就会感到胃中嘈杂，像是要呕血的样子。我心里怀疑之前的方剂中加入生姜、肉桂过于燥热。我说：“这是因为病人身体虚弱，肝火侵犯脾土，所以只有中焦受到灼烧，但两尺脉仍然迟缓，不能用治疗消渴的寒凉药剂来治。”他不相信。一位医生用前面的汤剂加入麦冬、白芍。虽然消症症状立刻减轻，饮食恢复正常，但他的大便却变得滑泄不止。再次延请我诊治，嘱咐他严格服用归脾汤，加入肉桂、附子、骨脂、吴茱萸。服到十剂时腹泻停止，才开始大大好转。由此可见，消症也有属寒的情况。
我查阅各家医书，都说三种消症（上消、中消、下消）都属于火病，治疗必须用凉剂。直到《内经·气厥论》说：“心将寒气移于肺，喝水多而小便也多，这是死证，无法治愈。”可见饮水少而小便多，以及老人阳气虚弱夜间小便无度，都是寒性消症，是肺肾金水衰竭的疾病，世上很少有人知道这一点。附上张景岳治疗一例消症的案例，以开阔世俗的眼界。
张景岳说：“我曾经治疗一位官员，年龄超过四十岁。因为处理公文积劳成疾，导致大病缠身，精神困倦，食欲减退，时常恐惧。上焦没有口渴感，不喜欢喝汤水，即使少量饮用，也感觉停滞不行。但是每晚一定要排尿二三升，不知道尿液是从哪里来的，而且有一半是浑浊的液体。最后延请我诊视，于是互相告知说：‘自从生病以来，通宵不睡觉已经半年多了，即使偶尔有朦胧似睡的意思，必定梦见死去的人、凶丧等事，鬼魅亲近，恐怕不免一死了。’我说：‘不是这样。这是由于思虑和积劳，损伤了心肾的元阳。既然元阳亏损，阴邪就会干扰它。所以多做阴梦；阳气衰弱则气虚，阳气不能统帅阴液，则水不能化为气，所以饮水少而浑浊的小便多。’随着阳气逐渐恢复，阴邪自然消退。这正是《内经》所说的‘心移寒于肺，饮一溲二’的症状罢了。病根并不轻，但脉象还带有缓意，肌肉还没有脱形，胃气尚存，可以不必担忧。”于是用归脾汤一类药物，去掉白术、木香；用八味丸一类药物，去掉牡丹皮、泽泻。一方用来养护阳气，一方用来养护阴液，交替使用。服到三百多剂，累计用人参二十多斤，才完全痊愈。这难道不是神消于上、精消于下的病症吗？可见消症有阴证和阳证之分，不能全都称为火症。姑且记录这个案例，作为治疗消症的借鉴。唉，张景岳在治疗方面真是神奇啊！
In the winter of the Jiashen year, Lian Shen suffered from cold invasion due to overwork and fatigue. His kidney pulse alone presented as slow (Chi). I administered Wujing Tang (Warming the Meridian Decoction), adding Shengjiang (Zingiberis Rhizoma Recens) and Rougui (Cinnamomi Cortex), and he recovered after three doses. I instructed him to rest quietly in a sealed room.
Three days later, due to labor and emotional stagnation related to salt administration duties, he suddenly developed Zhong Xiao (Middle Jiao Consumption Disease). He ate double the usual amount of food but still felt hungry, and if he delayed eating slightly, he experienced epigastric discomfort resembling the urge to vomit blood. I suspected that the addition of Shengjiang and Rougui in the previous prescription was too drying. I stated, "This is because the patient's constitution is deficient, leading to Liver Fire insulting the Spleen, causing only the Middle Jiao to be scorched. However, since both Chi pulses remain slow, it cannot be treated with cooling agents for Xiao disease." He did not believe me. A physician treated him by adding Maidong (Ophiopogonis Radix) and Baishao (Paeoniae Radix Alba) to the previous decoction. Although the symptoms of consumption subsided quickly and his diet returned to normal, his stool became loose and uncontrolled. He sought my treatment again. I instructed him to strictly take Guipi Tang (Restore the Spleen Decoction), added with Rougui (Cinnamomi Cortex), Fuzi (Aconiti Lateralis Radix Preparata), Guzhi (Dipsaci Radix), and Wuyu (Evodiae Fructus). After ten doses, the diarrhea stopped, and he began to recover significantly. This demonstrates that Xiao disease can also be caused by Cold.
I consulted various medical texts, which all stated that the three types of Xiao (Upper, Middle, Lower) belong to Fire diseases, and treatment requires cooling agents. However, the *Neijing* (Inner Canon) in the chapter on Qi Reversal states: "When Heart transfers Cold to the Lung, drinking much and urinating much indicates a fatal condition that is incurable." Thus, drinking little and urinating much, as well as excessive nocturnal urination in the elderly due to Yang deficiency, are all Cold-type Xiao diseases, representing the exhaustion of Lung and Kidney Metal and Water. Few people in the world understand this. I append a case treated by Zhang Jingyue to broaden common understanding.
Zhang Jingyue said: "I once treated a scholar-official who was over forty years old. Due to accumulated fatigue from handling documents, he fell seriously ill. He suffered from mental exhaustion, reduced appetite, and frequent fear. There was no thirst in the Upper Jiao, and he had no desire for soups or water. Even if he drank a little, he felt fullness and stagnation without relief. However, every night he would void two to three sheng of urine, without knowing its source, and half of it was turbid fluid. Finally, he invited me to examine him. He told me, 'Since falling ill, I have been sleepless throughout the night for over half a year. Even when I occasionally feel drowsy, I dream of deceased persons, funerals, and other ominous events, with ghosts and demons approaching; I fear death is inevitable.' I replied, 'Not so. This is due to accumulated worry and fatigue damaging the Yuan Yang of the Heart and Kidney. Since Yuan Yang is deficient, Yin Evil interferes, hence the frequent Yin dreams. When Yang Qi declines, Qi becomes deficient; when Yang cannot command Yin, Water fails to transform into Qi. Therefore, water intake is low, but turbid urine output is high.' As Yang Qi gradually returns, Yin Evil naturally recedes. This is precisely the symptom described in the *Neijing* as 'Heart transferring Cold to the Lung, drinking one part and urinating two parts.' The root of the disease is not light, but the pulse still shows slowness (Huan), the flesh has not wasted away, and Stomach Qi remains. There is no need to worry." I then used formulas similar to Guipi Tang (Restore the Spleen Decoction), removing Baizhu (Atractylodis Macrocephalae Rhizoma) and Muxiang (Aucklandiae Radix); and formulas similar to Bawei Wan (Eight-Ingredient Pill), removing Mudanpi (Moutan Cortex) and Zexie (Alismatis Rhizoma). One set nourished Yang, the other nourished Yin, used alternately. After more than three hundred doses, consuming over twenty jin (approx. 12 kg) of Renshen (Ginseng Radix et Rhizoma), he fully recovered. Is this not the syndrome of Spirit Consumption in the Upper and Essence Consumption in the Lower? It is evident that Xiao disease includes both Yin and Yang syndromes and cannot be entirely classified as Fire syndromes. I record this case as a reference for treating Xiao disease. Alas, Jingyue was truly miraculous in his treatment!