黄帝问曰∶人之善病消瘅者，何以候之？岐伯对曰∶五脏皆柔弱者，善病消瘅。夫柔弱
者必刚强，刚强多怒，柔者易伤也。此人薄皮肤而目坚固以深者，长衡直扬，其心刚，刚
则多怒，怒则气上逆，胸中蓄积，血气逆留（《太素》作留积），腹皮充胀（《太素》作髋皮
充肌），血脉不行，转而为热，热则消渴，故为消瘅，此言其刚暴而肌肉弱者也。面色微黄
，齿垢黄，爪甲上黄，黄瘅也。安卧小便黄赤，脉小而涩者，不嗜食。曰∶有病口甘者，
病名曰何，何以得之？曰∶此五气之溢也，名曰脾瘅。夫五味入口，藏于胃，脾为之行其精
气，津液在脾，故令人口甘，此肥美之所发也。此人必数食美而多食甘肥，肥令人内热，甘令
人中满，故其气上溢，转为消瘅（《素问》作渴）。治之以兰，除陈气也。凡治消瘅，治偏
枯、厥气逆满，肥贵人则膏粱之病也。鬲塞闭绝，上下不通，暴忧之病也。消瘅脉实大，
病久可治；脉悬绝小坚，病久不可治也。曰∶热中消中，不可服膏粱芳草石药，石药发
疽（《素问》作瘅），芳草发狂。夫热中消
中者，皆富贵人也。今禁膏粱。是不合其心，禁芳草石药，是病不愈，愿闻其说？曰∶夫芳
草之气美，石药之气悍，二者其气急疾坚劲，故非缓心和人，不可以服此二者。夫热气
悍，药气亦然，二者相遇，恐内伤脾，脾者土也而恶木，服此药也，至甲乙日当愈甚（
《素问》作当更论）。瘅成为消中。
黄瘅，（《千金》云∶腹满不欲食）刺脊中，黄瘅善欠，胁下满欲吐（《千金》
云∶身重不能动），脾俞主之。消渴身热，面赤（《千金》作目）黄，意舍主之。消渴嗜饮
，承浆主之。
腕骨主之。黄瘅热中善渴，太冲主之。身黄时有微热，不嗜食，膝内内踝前痛，少气，
身体重，中封主之。消瘅，善喘，气塞喉咽而不能言，手足清，溺黄，大便难，嗌中肿痛，
唾血，口中热，唾如胶，太溪主之。消渴黄瘅，足一寒一热，舌纵烦满，然谷主之。阴气不
足，热中消谷善饥，腹热身烦狂言，三里主之。
黄帝问道：人之所以容易患消瘅病，如何通过诊察来预判呢？岐伯回答说：五脏功能柔弱的人，容易患消瘅病。凡是体质柔弱的，其性格往往刚强；性格刚强的人容易发怒，而情绪波动易使身体受损。这类人皮肤薄，眼睛深邃且目光坚定，眉毛长而平直上扬，内心刚强，刚强则易怒，愤怒会导致气机上逆，气血在胸中蓄积停滞，腹部皮肤胀满，血脉运行不畅，郁久化热，热盛则耗伤津液导致口渴，因此形成消瘅病，这是指那些性情刚暴但肌肉虚弱的人。如果面色微黄，牙齿垢黄，指甲发黄，这是黄瘅病的表现。如果嗜睡、小便黄赤、脉象小而涩、食欲不振，也是相关症状。
（有人）问：有的人口中发甜，这是什么病，如何形成的？答：这是五气溢发所致，名为脾瘅。五味入口后藏于胃，由脾输布精气，津液滞留于脾，所以使人口中发甜，这是由于经常食用肥甘厚味引起的。这种人必定经常吃美味且多食甘甜油腻食物，肥腻使人内生湿热，甘甜使人中焦气机壅滞，所以脾气上溢，进而转化为消瘅病。治疗用兰草（佩兰），以清除陈久的浊气。
大凡治疗消瘅病，以及偏枯、厥气逆满等症，多见于富贵之人，属于膏粱厚味所致的疾病。膈塞不通，上下气机隔绝，是突然遭受忧思恼怒所致的疾病。消瘅病患者若脉象实大，病程虽久仍可治愈；若脉象悬绝细小坚劲，病程久则难以治愈。
（有人）问：热中和消中患者，不可服用膏粱厚味、芳草类药物及石药，因为石药会引发痈疽，芳草类药物会使人发狂。所谓热中和消中，都是富贵人的病。现在禁止他们吃膏粱厚味，这不合他们的意愿；禁止使用芳草石药，病又治不好，希望听听其中的道理。答：芳草类药物气味芳香美好，石药药性猛烈悍急，这两类药的药气都急疾坚劲，所以如果不是心境平和舒缓的人，不可以服用这两类药物。体内的热气与药气一样悍急，两者相遇，恐怕会内伤脾胃。脾属土，木克土，服用这些药物，到了甲乙日（木旺之日）病情应当加重。瘅病进一步发展可成为消中。
对于黄瘅病，（《千金方》记载：腹胀满不想吃东西），针刺脊中穴；黄瘅病喜欢打哈欠，胁下胀满想呕吐（《千金方》记载：身体沉重不能活动），由脾俞穴主治。消渴病伴有身热，面色红黄（《千金方》作目黄），由意舍穴主治。消渴病极度想喝水，由承浆穴主治。腕骨穴主治。黄瘅病伴热中善渴，由太冲穴主治。身体发黄，时有轻微发热，食欲不振，膝内侧内踝前疼痛，气短，身体沉重，由中封穴主治。消瘅病，容易气喘，气塞咽喉不能说话，手足清冷，尿黄，大便困难，咽部肿痛，咳血，口中发热，唾液如胶状，由太溪穴主治。消渴黄瘅，足部一只寒一只热，舌体松弛烦闷胀满，由然谷穴主治。阴气不足，热中消谷善饥，腹热身烦胡言乱语，由足三里穴主治。
Huangdi asked: Why are some people prone to Xiao Dan (Wasting-Thirst and Carbuncle disease), and how can it be predicted through diagnosis? Qibo replied: Those with weak Zang organs are prone to Xiao Dan. Weakness in constitution often correlates with a rigid and strong temperament; those with such temperaments are prone to anger, which makes the body susceptible to injury. These individuals have thin skin, deep-set eyes with firm gazes, long and straight eyebrows, and a rigid heart. Rigidity leads to anger; anger causes Qi to rebel upward, leading to accumulation in the chest, stagnation of Blood and Qi, abdominal distension, and obstruction of blood vessels. This stagnation transforms into Heat, which consumes fluids causing thirst, thus forming Xiao Dan. This describes those who are aggressive in temperament but weak in muscles. If the complexion is slightly yellow, teeth are coated with yellow deposit, and nails are yellow, this indicates Huang Dan (Jaundice). Lethargy, dark yellow urine, a small and choppy pulse, and lack of appetite are also symptoms.
Someone asked: Some people have a sweet taste in their mouth. What is this disease called, and how does it arise? It was answered: This is caused by the overflow of the Five Qi, named Pi Dan (Spleen Heat). When flavors enter the mouth, they are stored in the Stomach, and the Spleen distributes their essence. Fluids remain in the Spleen, causing sweetness in the mouth. This arises from rich and fatty foods. Such people must frequently eat delicious, sweet, and fatty foods. Fatty foods cause internal Heat, and sweet foods cause fullness in the Middle Jiao. Thus, Qi overflows upward and transforms into Xiao Dan. Treatment involves using Lantcao (Peilan, *Plagiorhechae Herba*) to eliminate stale turbid Qi.
Generally, treating Xiao Dan, Pian Ku (Hemiplegia), and Ju Qi Ni Man (Rebellious Qi with Fullness) addresses diseases of the wealthy, resulting from rich and refined diets. Obstruction at the diaphragm, with upper and lower Qi not communicating, is a disease caused by sudden severe worry or anger. In Xiao Dan, if the pulse is excess and large, even with long duration, it is treatable; if the pulse is suspended, extremely small, and hard, it is untreatable after a long duration.
Someone asked: Patients with Re Zhong (Internal Heat) and Xiao Zhong (Wasting Thirst) should not consume rich foods, fragrant herbs (*Fang Cao*), or mineral drugs (*Shi Yao*). Mineral drugs induce carbuncles, and fragrant herbs induce madness. Re Zhong and Xiao Zhong are diseases of the wealthy. Prohibiting rich foods goes against their desires; prohibiting fragrant herbs and mineral drugs fails to cure the illness. I wish to hear the explanation. The answer was: Fragrant herbs have beautiful aromas, and mineral drugs have fierce and potent energies. Both have rapid and forceful properties. Therefore, unless one has a calm and gentle mind, these two types of medicine should not be taken. Internal Heat is fierce, and drug energy is likewise fierce. When they meet, there is fear of internal damage to the Spleen. The Spleen belongs to Earth and fears Wood. Taking these medicines, on Jia-Yi days (Wood days), the condition will likely worsen. Dan may transform into Xiao Zhong.
For Huang Dan, (Qianjin Fang notes: abdominal fullness and loss of appetite), puncture Jizhong. For Huang Dan with frequent yawning and hypochondriac fullness with desire to vomit (Qianjin Fang notes: heavy body unable to move), Spleen Shu (BL20) governs. For Xiao Ke with body heat and red-yellow complexion (Qianjin Fang notes: yellow eyes), Yishe (BL17) governs. For Xiao Ke with excessive thirst, Chengjiang (CV24) governs. Wanggu (SI4) governs. For Huang Dan with Re Zhong and excessive thirst, Taichong (LR3) governs. For yellowing of the body with slight fever, loss of appetite, pain anterior to the medial malleolus of the knee, shortness of breath, and heavy body, Zhongfeng (LR6) governs. For Xiao Dan with frequent asthma, Qi blocking the throat preventing speech, cold hands and feet, yellow urine, difficult defecation, sore and swollen throat, hemoptysis, hot mouth, and sticky saliva, Taixi (KI3) governs. For Xiao Ke and Huang Dan with one cold and one hot foot, tongue relaxation with irritability and fullness, Rangu (KI2) governs. For insufficient Yin Qi, Re Zhong with rapid digestion and hunger, warm abdomen, restlessness, and delirious speech, Zusanli (ST36) governs.