陈皮（去白，二钱） 竹茹（一团） 半夏 人参 甘草（各一钱
水煎服。
经云∶渴而多饮为上消，消谷善饥为中消，口渴、小水如膏者，为下消。三消之症，皆
燥热结聚也。大法，治上消者，宜润其肺，兼清其胃，二冬汤主之；治中消者，宜清其胃，
兼滋其肾，生地八物汤主之；治下消者，宜滋其肾，兼补其肺，地黄汤、生脉散并主之。
夫上消清胃者，使胃火不得伤肺也；中消滋肾者，使相火不得攻胃也；下消清肺者，滋上
源以生水也。三消之治，不必专执本经而滋其化源则病易痊矣。书又云∶饮一溲一，或饮一
溲二，病势危急，仲景用八味丸主之，所以安固肾气也。而河间则用黄 汤和平之剂。大抵
肺肾虚而不寒者，宜用此法。又按仲景少阴篇云∶肾经虚，必频饮热汤以自救，乃同气相求
之理，今肾经虚寒，则引水自灌，虚寒不能约制，故小便频数，似此不必与消症同论，宜
用理中汤，加益智仁主之。然予尝见伤暑发喘之症，小便极多，不啻饮一而溲二者，用六味加
知柏而效，可见此症，又由肾经阴虚而得，治宜通变，正当临证制宜，未可一途而取也。
治上消。
天冬（去心，二钱） 麦冬（去心，三钱） 花粉（一钱） 黄芩（一钱） 知母（一钱） 甘草（五分） 人参
（五分）
荷叶（一钱）
水煎服。
Chenpi (Citri Reticulatae Pericarpium, peeled of the white pith, 2 qian) Zhuru (Bambusae Caulis in Taeniam, one bundle) Banxia Pinelliae Rhizoma Ren Shen Ginseng Radix Gancao Glycyrrhizae Radix et Rhizoma (each 1 qian)
Decoct with water and take orally.
The *Neijing* states: Thirst accompanied by excessive drinking is Shangxiao (Upper Xiao); excessive hunger with rapid digestion is Zhongxiao (Middle Xiao); thirst accompanied by urine resembling paste is Xiaxiao (Lower Xiao). The manifestations of the three Xiaos are all caused by the accumulation of dryness-heat. The general treatment principle is: for Shangxiao, moisten the Lung and clear the Stomach heat simultaneously, primarily using Erdong Tang (Two Dong Decoction); for Zhongxiao, clear the Stomach heat and nourish Kidney Yin simultaneously, primarily using Shengdi Bawu Tang (Rehmannia Eight Substances Decoction); for Xiaxiao, nourish Kidney Yin and tonify Lung Qi simultaneously, primarily using Dihuang Tang (Rehmannia Decoction) and Shengmai San (Generate the Pulse Powder). Clearing the Stomach in Shangxiao prevents Stomach fire from injuring the Lung; nourishing the Kidney in Zhongxiao prevents Ministerial Fire from attacking the Stomach; clearing the Lung in Xiaxiao generates Kidney Water by nourishing the upper source. In treating the three Xiaos, one need not strictly adhere to the affected meridian alone; as long as the source of transformation is nourished, the disease will easily recover. Another medical text states: Drinking one part and urinating one part, or drinking one part and urinating two parts, indicates a critical condition. Zhang Zhongjing used Bajun Wan (Eight-Ingredient Pill with Aconite) to treat this, thereby stabilizing and securing Kidney Qi. Liu Hejian, on the other hand, used Huangqin Tang (Scutellaria Decoction) and other mild agents. Generally, for deficiency of Lung and Kidney without cold, this method is suitable. Furthermore, according to the Shaoyin chapter of Zhang Zhongjing’s *Shanghan Lun*: When the Kidney meridian is deficient, frequent drinking of hot fluids occurs as self-rescue, following the principle of seeking resonance with similar qi. However, when the Kidney meridian is deficient and cold, it draws water in freely; due to deficiency-cold failing to control and restrain, frequent urination ensues. Such cases should not be discussed identically to Xiao (Wasting-Thirst) syndrome; instead, Lizhong Tang (Regulate the Middle Decoction) with Yizhiren (Alpiniae Oxyphyllae Fructus) added is appropriate. Nevertheless, I have observed cases of asthma induced by summerheat where urination was extremely abundant, exceeding the ratio of one drink to two urinations, which responded effectively to Liujun Wan (Six-Ingredient Pill with Rehmannia) plus Zimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex). This shows that such symptoms can also arise from Yin deficiency of the Kidney meridian. Treatment requires flexibility and adaptation to clinical circumstances; one cannot rely on a single approach.
Treating Shangxiao.
Tiangong (Asparagi Radix, heart removed, 2 qian) Maidong (Ophiopogonis Radix, heart removed, 3 qian) Huafen (Trichosanthis Radix, 1 qian) Huangqin (Scutellariae Radix, 1 qian) Zimu (Anemarrhenae Rhizoma, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 5 fen) Ren Shen (Ginseng Radix, 5 fen)
Heye (Nelumbinis Folium, 1 qian)
Decoct with water and take orally.