计（四十） 能食善饥渴饮。日加瘪瘦。心境愁郁。内火自燃乃消症大病。（郁火）
生地 知母 石膏 麦冬 生甘草 生白芍
王（五八） 肌肉瘦减。善饥渴饮。此久久烦劳。壮盛不觉。体衰病发。皆内因之症。自心营肺卫之伤。渐
损及乎中下。按脉偏于左搏。营络虚热。故苦寒莫制其烈。甘补无济其虚。是中上消之病。（烦劳心营热）
犀角（三钱） 鲜生地（一两） 元参心（二钱） 鲜白沙参（二钱） 麦冬（二钱） 柿霜（一钱）
生甘草（四分） 鲜地骨皮（三钱）
又 固本加甜沙参。
杨（二八） 肝风厥阳。上冲眩晕。犯胃为消。（肝阳犯胃）
石膏 知母 阿胶 细生地 生甘草 生白芍
某 液涸消渴。是脏阴为病。但胃口不醒。生气曷振。阳明阳土。非甘凉不复。肝病治胃。是仲景
法。
人参 麦冬 粳米 佩兰叶 川斛 陈皮
胡（五七） 元阳变动为消。与河间甘露饮方。（阳动烁津） 河间甘露饮。
钱（十五） 阳动消烁。甘缓和阳生津。
生地 炙黑甘草 知母 麦冬 枣仁 生白芍
杨（二六） 渴饮频饥。溲溺混浊。此属肾消。阴精内耗。阳气上燔。舌碎绛赤。乃阴不上承。非客热宜此。
乃脏液无存。岂是平常小恙。（肾消）
熟地 萸肉 山药 茯神 牛膝 车前
某 脉左数。能食。（肾阴虚胃火旺） 六味加二冬龟版女贞旱莲川斛。
王（四五） 形瘦脉搏。渴饮善食。乃三消症也。古人谓入水无物不长。入火无物不消。河间每以益肾
水制心火。除肠胃激烈之燥。济身中津液之枯。是真治法。（肾阴虚心火亢） 玉女煎。
姜（五三） 经营无有不劳心。心阳过动。而肾阴暗耗。液枯。阳愈燔灼。凡入火之物。必消烁干枯。是能
食而肌肉消瘪。用景岳玉女煎。
三消一症。虽有上中下之分。其实不越阴亏阳亢。津涸热淫而已。考古治法。唯仲景之肾
气丸。助真火蒸化。上升津液。本事方之神效散。取水中咸寒之物。遂其性而治之。二者
可谓具通天手眼。万世准绳矣。他如易简之地黄引子。朱丹溪之消渴方。以及茯苓丸。黄
汤。生津甘露饮。皆错杂不一。毫无成法可遵。至先生则范于法。而不囿于法。如病在
中上者。膈膜之地。而成燎原之场。即用景岳之玉女煎。六味之加二冬龟甲旱莲。一以清
阳明之热。以滋少阴。一以救心肺之阴。而下顾真液。如元阳变动而为消烁者。即用河间
之甘露饮。生津清热。润燥养阴。甘缓和阳是也。至于壮水以制阳光。则有六味之补三阴。
而加车前牛膝。导引肝肾。斟酌变通。斯诚善矣。（邹滋九）
徐评 消渴之症有数种。案中俱未备。宜详考之。
[Patient Ji, 40 years old] Excessive appetite with easy hunger and thirst for drinking. The body becomes emaciated day by day. The mind is sorrowful and depressed, internal fire burns spontaneously; this is a severe case of Xiao syndrome (Wasting-thirst syndrome). (Due to constrained fire from emotional stagnation)
Prescription: Sheng Di Huang (Rehmanniae Radix Praeparata), Zhi Mu (Anemarrhenae Rhizoma), Shi Gao (Gypsum Fibrosum), Mai Dong (Ophiopogonis Radix), Sheng Gan Cao (Glycyrrhizae Radix et Rhizoma), Sheng Bai Shao (Paeoniae Radix Alba).
[Patient Wang, 58 years old] Muscle mass decreases, prone to hunger and thirst. This results from long-term mental fatigue and overwork; unnoticed during robust health, it manifests when the body declines, all belonging to symptoms caused by internal factors. Injury starts from Xin Ying (Heart Nutrient Level) and Fei Wei (Lung Defensive Level), gradually damaging the Middle and Lower Jiao. Pulse examination shows a forceful beat on the left side, indicating deficient heat in the Ying collaterals. Therefore, bitter-cold herbs cannot control its fierce nature, and sweet-tonifying herbs cannot aid its deficiency. This is a disease of Middle and Upper Xiao. (Heart Ying heat due to mental fatigue)
Prescription: Xi Jiao (Rhinocerotis Cornu) [3 qian], Xian Sheng Di Huang (Fresh Rehmanniae Radix) [1 liang], Yuan Shen Xin (Scrophulariae Radix Heart) [2 qian], Xian Bai Sha Shen (Fresh Glehniae Radix) [2 qian], Mai Dong [2 qian], Shi Shuang (Diospyros Fruit Frost) [1 qian], Sheng Gan Cao [4 fen], Xian Di Gu Pi (Lycii Cortex) [3 qian].
Follow-up: Add Tian Sha Shen (Glehniae Radix) to the Gu Ben Tang (Solidify the Root Decoction).
[Patient Yang, 28 years old] Liver wind and Jue Yang (Jueyin Ascendant Yang) rush upward, causing dizziness. Invading the Stomach leads to Xiao. (Liver Yang invading the Stomach)
Prescription: Shi Gao, Zhi Mu, E Jiao (Colla Corii Asini), Xi Sheng Di Huang (Fine Fresh Rehmanniae Radix), Sheng Gan Cao, Sheng Bai Shao.
[Patient Mou] Fluid depletion leading to Xiao Ke (Wasting-thirst), is a disease of Zang Yin (Visceral Yin) deficiency. However, the stomach appetite is not awakened, how can the vital Qi be revitalized? Yang Ming Stomach is Yang Earth, which cannot recover without sweet-cool nourishment. Treating the Liver disease by addressing the Stomach is the method of Zhang Zhongjing.
Prescription: Ren Shen (Ginseng Radix), Mai Dong, Jing Mi (Oryza Sativa Grain), Pei Lan Ye (Eupatorii Herba), Chuan Hu (Dendrobii Caulis), Chen Pi (Citri Reticulatae Pericarpium).
[Patient Hu, 57 years old] Yuan Yang (Primal Yang) movement causes Xiao, treated with Liu Hejian's Gan Lu Yin (Sweet Dew Decoction). (Yang movement scorching fluids) i.e., Liu Hejian Gan Lu Yin.
[Patient Qian, 15 years old] Yang movement causes consumption/wasting; use sweet-mild methods to harmonize Yang and generate fluids.
Prescription: Sheng Di Huang, Zhi Hei Gan Cao (Honey-fried Black Licorice), Zhi Mu, Mai Dong, Zao Ren (Ziziphi Spinosae Semen), Sheng Bai Shao.
[Patient Yang, 26 years old] Frequent thirst and hunger, turbid urine. This belongs to Shen Xiao (Kidney Wasting-thirst). Internal consumption of Yin essence, Yang qi flares upward. The tongue is cracked, crimson and red, indicating Yin cannot ascend. This is not external pathogenic heat; it is the absence of Zang fluids. How can this be considered a minor ailment? (Shen Xiao)
Prescription: Shu Di Huang (Prepared Rehmanniae Radix), Yu Rou (Corni Fructus), Shan Yao (Dioscoreae Rhizoma), Fu Shen (Poria with Hostwood), Niu Xi (Achyranthis Bidentatae Radix), Che Qian (Plantaginis Semen).
[Patient Mou] Left pulse is rapid, excessive eating. (Kidney Yin deficiency with Stomach Fire hyperactivity)
Prescription: Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) plus Dong Hua (Tian Dong and Mai Dong), Gui Ban (Testudinis Carapax et Plastrum), Nu Zhen Zi (Ligustri Lucidi Fructus), Han Lian Cao (Ecliptae Herba), Chuan Hu.
[Patient Wang, 45 years old] Emaciated form, rapid pulse, thirst, excessive eating. This is San Xiao (Three Wastings) syndrome. Ancients said: nothing does not grow in water; nothing does not consume in fire. Liu Hejian often used tonifying Kidney Water to control Heart Fire, eliminating intense dryness in the intestines and stomach, and replenishing the withered body fluids. This is the true treatment method. (Kidney Yin deficiency with Heart Fire hyperactivity)
Prescription: Yu Nu Jian (Jade Woman Decoction).
[Patient Jiang, 53 years old] Management and business inevitably involve mental labor. Overactive Heart Yang leads to hidden consumption of Kidney Yin. Fluids dry up, Yang burns more fiercely. Anything entering fire must be consumed and dried up; thus, one can eat but muscles become emaciated. Use Zhang Jingyue's Yu Nu Jian.
San Xiao (Three Wastings) is one syndrome. Although divided into Upper, Middle, and Lower, it essentially does not exceed Yin deficiency with Yang hyperactivity, fluid depletion, and heat excess. Examining ancient treatments, only Zhang Zhongjing's Shen Qi Wan (Kidney Qi Pill) assists True Fire to vaporize and ascend fluids; and Shen Xiao San (Miraculously Effective Powder) from *Ben Shi Fang* takes salty-cold substances from water to treat according to their nature. These two can be considered possessing heaven-and-earth penetrating insight, serving as eternal standards. Others such as Di Huang Yin Zi (Rehmannia Infusion) from *Yi Jian Fang*, Xiao Ke Fang (Wasting-Thirst Formula) by Zhu Danxi, as well as Fu Ling Wan, Huang Tang, and Sheng Jin Gan Lu Yin, are miscellaneous and inconsistent, lacking established methods to follow. As for Mr. Zou Zijiu, he adheres to principles without being bound by them. If the disease is in the Middle/Upper Jiao, where the diaphragm becomes a field of prairie fire, use Zhang Jingyue's Yu Nu Jian, or Liu Wei Di Huang Wan added with Dong Hua, Gui Jia (Turtle Shell), and Han Lian Cao. One clears Yang Ming heat to nourish Shao Yin; the other rescues Lung-Heart Yin while attending to True Fluids. If Yuan Yang movement causes consumption, use Liu Hejian's Gan Lu Yin to generate fluids, clear heat, moisten dryness, and nourish Yin; this is the method of sweet-mild harmony of Yang. To strengthen Water to control Solar flare, there is Liu Wei Di Huang Wan tonifying the Three Yin, plus Che Qian and Niu Xi to guide Liver and Kidney, with careful adjustment. This is truly excellent. (Commentary by Zou Zijiu)
Xu's Commentary: There are several types of Xiao Ke (Wasting-thirst) syndrome, none of which are fully covered in the cases; they should be examined in detail.