（小便利。徐。沈。周。尤。朱。作小便不利。宜从。）
寸口脉浮而迟。
按巢源。以此条。收之虚劳候中。可以确金鉴说矣。
趺阳脉浮而数。
证治要诀曰。中消消脾。脾气热燥。饮食倍常。皆消为小便。
男子消渴。小便反多。
〔余述〕按本篇之叙真消渴。仅此二证。即消中与下消也。古今录验。虽分为三。其实亦不过脾肾二脏之病已。渴
之为候。必自胃热。而上焦之热。必止咽燥。所谓口燥不渴者。皆为膈有热。而胃无热者言。然则仲景不及上消者。其
意殆可见也。迄至宋金诸哲。以三消配之三焦。（卫生家宝。简易方。直指方。保命集等。是也。）近日和田泰纯。尝
疑其说。不能无理。但内经有肺消膈消之名。而厥阴病。既有消渴。盖为胃津竭乏。遂及胸膛者。乃不得言必无上
消证。不敢臆定。以俟识者。
渴欲饮水不止者。
〔沈〕此亦非真消渴也。
按尤氏曰。热渴饮水。水入不能消其热。而反为热所消。故渴不止。文蛤味咸性寒。寒能除热。咸能润下。用以折
炎上之势。而除热渴之疾也。此亦一说。姑存之。小便不利者。有水气。
按朱氏以为上焦有热。下焦有寒。因渴而小便不利。误矣。此证之渴。即下焦蓄水。而升腾之气液失常之所致。栝
蒌根。不啻生津液。亦能行水气。观柴胡桂枝干姜汤。（此方治饮结。说见伤寒论述义。）及牡蛎泽泻散。而可见也。此
方用治小便闭。宜用肾气丸。而其人厌泥恋者甚验。危氏得效方。附子散。治小便不通。两尺脉俱沉微。乃阴虚故也。
用绵附子。泽泻。各一两。灯心七茎。水煎服。亦此意也。
若渴欲饮水。口干舌燥者。
按此条。既出阳明篇中。则犹是。似非真消渴。然以为中消证治。亦所无妨。
猪苓汤方
猪苓（去皮） 茯苓 阿胶 滑石 泽泻（各一两）
上五味。以水四升。先煮四味。取二升。去滓。内胶烊消。温服七合。日三服。（按此方。辑义偶脱。今照原本录
补。）
（小便利。徐、沈、周、尤、朱诸家注本作“小便不利”，应当依从。）
寸口脉象浮而迟。
根据巢元方的观点，将此条归入虚劳候中，可以确证《医宗金鉴》的说法是正确的。
趺阳脉象浮而数。
《证治要诀》说：中消病在脾，脾气热燥，饮食倍增，皆化为小便排出。
男子患消渴病，小便反而增多。
〔余述〕按：本篇叙述真正的消渴病，仅有这两个证候，即中消和下消。《古今录验》虽分为三消，但其实也不过是脾、肾两脏的疾病罢了。渴的症状表现，必然源于胃热；而上焦的热邪，只会导致咽干。所谓“口干但不想喝水”的情况，都是指膈间有热而胃中没有热的情况而言。既然这样，张仲景没有提及上消，其用意大概可以理解了。直到宋、金时期的各位哲人，将三消配属于三焦。（如《卫生家宝》、《简易方》、《直指方》、《保命集》等书即是如此）。近日和田泰纯曾怀疑这种说法，认为并非没有道理。但是，《内经》中有肺消、膈消的名称，而且厥阴病中既有消渴证，这是因为胃津枯竭，进而波及胸膛所致，所以不能断言一定没有上消证。我不敢主观臆断，留待有识之士考证。
口渴想喝水且饮水不止的，
〔沈〕这也是非真正的消渴病。
按尤氏说：热盛致渴而饮水，水进入体内不能消除热邪，反而被热邪消耗，所以口渴不止。文蛤味咸性寒，寒能除热，咸能润下，用它来折抑炎上之势，从而消除热渴之疾。这也是一种说法，姑且保留在此。小便不利的，是有水气停留。
按朱氏认为上焦有热，下焦有寒，因口渴而导致小便不利，这是错误的。此证的口渴，是由于下焦蓄水，致使升腾的气液失常所致。栝蒌根不仅生津液，也能行水气。观察柴胡桂枝干姜汤（此方治疗饮邪结聚，解说见《伤寒论述义》）及牡蛎泽泻散，就可以明白了。此方用于治疗小便闭塞，宜用肾气丸，而对于那些厌恶泥土气味的人非常有效。危亦林《得效方》中的附子散，治疗小便不通，两尺脉俱沉微，这是由于阴虚的缘故。使用绵附子、泽泻各一两，灯心草七茎，水煎服，也是这个意思。
如果口渴想喝水，口干舌燥的，
按：此条既出自阳明篇中，则仍然是（阳明热盛），似乎不是真正的消渴病。然而将其作为中消证的治法，也没有妨碍。
猪苓汤方
猪苓（去皮）、茯苓、阿胶、滑石、泽泻（各一两）
以上五味药，用水四升，先煮前四味药，取汁二升，去渣，加入阿胶使其烊化溶解，温服七合，每日三次服用。（按：此方在辑义中偶然脱漏，现在依照原本记录补入。）
(Small urine volume is normal. Xu, Shen, Zhou, You, and Zhu's editions read "small urine volume is difficult," which should be adopted.)
The pulse at the cunkou position is floating and slow.
According to Chao Yuanyuan's view, classifying this clause under the syndrome of deficiency labor confirms the correctness of the statement in *Yizong Jinjian*.
The pulse at the fuyang position is floating and rapid.
*Zhengzhi Yaojue* states: Middle Xiao (Middle Wasting-Thirst) affects the spleen; spleen qi is hot and dry, food intake doubles, and all is transformed into small urine for excretion.
Men suffering from Xiao (Wasting-Thirst) have an increased volume of small urine.
[Yu's Commentary] According to this text, the description of true Xiao (Wasting-Thirst) contains only these two syndromes, namely Middle Xiao and Lower Xiao. Although *Gujin Luyan* divides it into three Xiao, it is essentially a disease of the spleen and kidney organs. The symptom of thirst must originate from stomach heat; heat in the upper jiao causes only dryness of the throat. The phrase "dry mouth but no desire to drink" refers to cases where there is heat in the diaphragm but no heat in the stomach. Given this, Zhang Zhongjing's omission of Upper Xiao reveals his intent. It was not until the philosophers of the Song and Jin dynasties that the Three Xiao were correlated with the Three Jiao (as seen in *Weisheng Jiabao*, *Jianyi Fang*, *Zhi Zhi Fang*, *Baoming Ji*, etc.). Recently, Wada Taijun questioned this theory, arguing it is not without merit. However, *Neijing* mentions Lung Xiao and Diaphragm Xiao. Furthermore, in Jueyin disease, there is already a Xiao (Wasting-Thirst) syndrome, caused by exhaustion of stomach fluids extending to the chest area. Therefore, one cannot assert that Upper Xiao syndromes do not exist. I dare not speculate arbitrarily and leave this for scholars to verify.
When there is a desire to drink water and drinking does not relieve the thirst:
[Shen] This is also not true Xiao (Wasting-Thirst).
According to You Shi: Heat-induced thirst leads to drinking, but the water entering the body fails to eliminate the heat and is instead consumed by the heat, resulting in unrelenting thirst. Wen Ge (Clam Shell) is salty and cold; cold can eliminate heat, and saltiness can moisten and direct downward. It is used to curb the upward-flaring pathogenic factor and cure heat-induced thirst. This is another interpretation, preserved here for reference. When small urine volume is difficult, it indicates the presence of fluid retention.
Zhu Shi believed that heat in the upper jiao and cold in the lower jiao cause difficulty in urination due to thirst, which is incorrect. The thirst in this syndrome is caused by fluid retention in the lower jiao, leading to abnormal ascending of qi and fluids. Gualou Gen (Trichosanthes Root) not only generates body fluids but also promotes the movement of fluid retention. This can be observed in the use of Chaihu Guizhi Ganjiang Tang (this formula treats fluid accumulation, see commentary in *Shanghan Lun Shuyi*) and Muli Zexie San. For treating urinary obstruction, Shenqi Wan (Kidney Qi Pill) should be used; it is particularly effective for patients who crave mud. In Weishi's *De Xiao Fang*, Fuzi San (Aconite Powder) treats urinary obstruction with deep and faint pulses at both chi positions, indicating yin deficiency. Using Mian Fuzi (Prepared Aconite Root), Zexie (Alisma Rhizome), each 1 liang, and Dengxin Cao (Juncus Effusus Stem) 7 stems, decocted in water and taken orally, follows this same principle.
If there is a desire to drink water accompanied by a dry mouth and tongue:
According to this clause appearing in the Yangming chapter, it still pertains to (Yangming heat excess) and seems not to be true Xiao (Wasting-Thirst). However, using it as a treatment for Middle Xiao syndrome is acceptable.
Zhuling Tang Formula
Zhuling (Poria, peeled), Fuling (Poria), Ejiao (Donkey-hide Gelatin), Huashi (Talcum), Zexie (Alisma Rhizome) (each 1 liang)
Take the above five herbs, add four sheng of water, first decoct the first four herbs to obtain two sheng of liquid, remove the dregs, add Ejiao (Donkey-hide Gelatin) and melt it. Take seven ge warm, three times a day. (Note: This formula was accidentally omitted in the collected meanings; it is now recorded and supplemented according to the original text.)