知柏八味丸（即六味丸加知母、黄柏）
河间秘真丸 治白淫，小便不止，精气不固。或有余沥，及梦寐阴人通泄。
龙骨（一两） 大诃子皮（五枚） 缩砂仁（半两） 朱砂（一两，研细、留一分为衣）
上为末。面糊丸，绿豆大。每服一二十丸。空心温酒、热水任下。不可多服。
猪肚丸 治醉饱后遗精，神效。
牡蛎（ 、另研极细） 白术（各四两） 苦参（三两） 猪肚一具（煮极烂、去油膜、捣如泥）
上前三味，捣筛极细。同猪肚捣数百杵，令极匀。燥略增肚汁。丸如桐子大。
每服五十丸，空心米饮送下。不但治遗滑，即劳瘦者，亦能肥也。
清心莲子饮（见第四十九）
萆 厘清饮 治真元不固，不时白浊，或小便频数，凝如膏糊等证。
益智仁 川萆 石菖蒲 乌药（各等分）
上 咀。每服四钱。水一盏，入盐一捻，煎七分。食前温服。一方加茯苓、甘
草。
六味丸（见第十六）
钱氏导赤散（见第四十九）
六一散（见第四十四）
三消之脉，浮大者生。细小微涩，形脱可惊。
三消者，上中下也。渴而多饮为上消。《素问》气厥论谓之膈消。（宜金匮猪苓汤、人参
白虎汤、子和加减三黄丸、凉膈散、酒煮黄连丸、六一散之类。）消谷善饥为中消。《素问》脉
要精微论谓之消中。（宜酒煮黄连丸、大黄黄连泻心汤、山栀、黄连之类。）渴而便数有膏为下消。
《素问》气厥论谓之肺消。饮一溲二，后人又谓之肾消。（宜六味丸、固本丸、知柏八味丸之类。）
娄全善亦云∶肾消者，饮一溲二。其溲如膏油，即膈消、消中之传变。总不外火烁真阴，津液燥
竭。自古论之者多矣，惟刘河间、张戴人二论，辞义畅达，最为中綮。兹录于下。
河间曰∶五脏六腑四肢，皆禀气于脾胃。行其津液，以濡润养之。然消渴之病，本
湿寒之阴气极衰，燥热之阳气太盛故也。治当补肾水阴寒之虚，而泻心火阳热之实。
除肠胃燥热之甚，济身中津液之衰，使道路散而不结，津液生而不枯，气血和而不
涩。则病自已矣。况消渴者，因饮食服饵之失宜，肠胃干涸，而气不得宣平；或精
神过违其度而耗乱之；或因大病，阴气损而血液衰，虚阳 悍，而燥热郁甚之所成
也。若饮水多而小便多，名曰消渴。若饮食多，不甚渴，小便数而消瘦者，名曰消
中。若渴而饮水不绝，腿消瘦而小便有脂液者，名曰肾消。一皆以燥热太甚，三焦
肠胃之腠理，怫郁结滞，致密壅滞，复多饮于中，终不能浸润于外，荣养百骸，故
渴不止，小便多出或数溲也。戴人之论，则曰火能消物，燔木则为炭，燔金则为液，
燔石则为灰，煎海水则为盐，鼎水则干。人之心肾为君火，三焦胆为相火。得其平，
则烹炼饮食，糟粕去焉。不得其平，则燔灼脏腑，而津液耗焉。夫心火甚于上，为
膈膜之消；甚于中，为肠胃之消；甚于下，为膏液之消；甚于外，为肌肉之消。上
甚不已，则消及于肺。中甚不已，则消及于脾。下甚不已，则消及于肝肾。外甚不
已，则消及于筋骨。四脏皆消尽，则心始自焚而死矣。故知消渴一证，调之而不下，
则小润小濡，固不能杀炎上之势。下之而不调，亦旋饮旋消，终不能沃膈膜之干。
下之调之，而不减滋味，不戒嗜欲，不节喜怒，则病已而复作。能从此三者，消渴
亦不足忧矣。二公此论消渴之因证，可谓既明且悉，不烦再解。但其脉浮大者，尚
属弥漫宽散。前河间云∶使道路散而不结，津液生而不枯，气血和而不涩，则病自
已矣。然非弥漫宽散之气机，不能得此不结、不枯、不涩之病机耳。故云浮大者生。
若脉细小浮涩，则气血之虚衰枯槁，不言可知。再加身体瘦悴，是谓形脱。即戴人
所云木为炭、金为液、石为灰、水为盐、鼎水干之义。形气两败，岂直可惊已哉。
Zhībǎi Bāwèi Wán (Anemarrhena and Phellodendron Eight-Ingredient Pill) (i.e., Liùwèi Wán [Six-Ingredient Rehmannia Pill] added with Zhīmǔ [Anemarrhenae Rhizoma] and Huángbò [Phellodendri Cortex])
Héjiān Mìzhēn Wán (Secret True Pill of Hejian): Treats báiyín [white turbid discharge], continuous non-stop urination, insecurity of essence and qi. Or residual dripping after urination, and nocturnal emission during dreams of sexual intercourse.
Ingredients: Lónggǔ [Dragon Bone] (1 liang), Dàhēzǐ Pí [Pericarpium Terminaliae Chebulae] (5 pieces), Suōshārén [Fructus Amomi Rotundus] (0.5 liang), Zhūshā [Cinnabar] (1 liang, ground to fine powder, reserve 1 fen for coating).
Preparation and Administration: Grind the above ingredients into fine powder. Make pills using wheat paste, size of mung beans. Take 10–20 pills per dose. On an empty stomach, take with warm wine or hot water at will. Do not overdose.
Zhūdù Wán (Pig Stomach Pill): Treats nocturnal emission caused by drunkenness and overeating; highly effective.
Ingredients: Múlì [Ostreae Concha] (separately ground to extreme fineness), Báizhú [Atractylodis Macrocephalae Rhizoma] (4 liang each), Kǔshēn [Sophorae Flavescentis Radix] (3 liang), one pig stomach (boiled until extremely soft, remove oil membrane, mash into paste).
Preparation and Administration: Pound and sieve the first three ingredients to extreme fineness. Mash together with the pig stomach paste for hundreds of strokes until extremely uniform. If too dry, slightly increase the stomach juice. Make pills the size of paulownia seeds. Take 50 pills per dose on an empty stomach, delivered with rice drink. This formula not only treats nocturnal emission and slipping, but can also fatten those who are emaciated due to consumptive disease.
Qīngxīn Liánzǐ Yǐn (Clear Heart Lotus Seed Decoction) (See Chapter 49)
Bìxiē Fēnqīng Yǐn (Dioscorea Hypoglauca Decoction for Clarifying Turbidity): Treats insecurity of primordial yuan, intermittent white turbidity in urine, or frequent urination where urine coagulates like paste.
Ingredients: Yìzhìrén [Fructus Alpiniae Oxyphyllae], Chuānbìxiē [Dioscoreae Hypoglaucae Rhizoma], Shíchāngpú [Rhizoma Acori Tatarinowii], Wùyào [Linderae Radix] (equal parts).
Preparation and Administration: Cut the herbs into small pieces. Take 4 qián per dose. Add one cup of water and a pinch of salt, decoct until reduced to 7/10. Take warm before meals. Another version adds Fúlíng [Poria] and Gāncǎo [Glycyrrhizae Radix et Rhizoma].
Liùwèi Wán (Six-Ingredient Rehmannia Pill) (See Chapter 16)
Qiánshì Dǎochì Sǎn (Child Master's Guide the Red Powder) (See Chapter 49)
Liùyī Sǎn (Six-to-One Powder) (See Chapter 44)
Regarding the pulse of Sānxiāo [Three Excesses]: Floating and large pulses indicate survival (good prognosis). Fine, small, and slightly choppy pulses, accompanied by physical depletion, are alarming (poor prognosis).
Sānxiāo refers to Upper, Middle, and Lower types. Thirst with excessive drinking is Upper Xiāo. The *Suwen* [Basic Questions] chapter "Qi Ju Lun" calls it Géxiāo [Diaphragm Consumption]. (Suitable formulas include Jīnguì Zhūlíng Tāng [Poria Decoction from the Golden Cabinet], Rénshēn Báihǔ Tāng [Ginseng White Tiger Decoction], Hézi Jiǎnjiǎn Sānhuáng Wán [Zhang Zihe's Modified Three-Yellow Pill], Liánggé Sǎn [Cooling Diaphragm Powder], Jiǔzhǔ Huánglián Wán [Wine-Boiled Coptis Pill], Liùyī Sǎn [Six-to-One Powder], etc.). Excessive hunger and rapid digestion is Middle Xiāo. The *Suwen* chapter "Mai Yao Jingwei Lun" calls it Xiāozhōng [Middle Consumption]. (Suitable treatments include Jiǔzhǔ Huánglián Wán [Wine-Boiled Coptis Pill], Dàhuáng Huánglián Xièxīn Tāng [Rhubarb and Coptis Draining Heart Decoction], Shānzhī [Gardeniae Fructus], Huánglián [Coptidis Rhizoma], etc.). Thirst with frequent urination containing lipid-like substance is Lower Xiāo. The *Suwen* chapter "Qi Ju Lun" calls it Fèixiāo [Lung Consumption]. Drinking one part while urinating two parts is later referred to as Shènxiāo [Kidney Consumption]. (Suitable formulas include Liùwèi Wán [Six-Ingredient Rehmannia Pill], Gùběn Wán [Solidify Root Pill], Zhībǎi Bāwèi Wán [Anemarrhena and Phellodendron Eight-Ingredient Pill], etc.).
Lou Quanshan also stated: In Kidney Consumption, one part drunk results in two parts urinated. The urine resembles grease or oil; this is a progression from Diaphragm Consumption and Middle Consumption. Ultimately, it does not exceed fire scorching true yin, leading to dryness and exhaustion of body fluids. Many have discussed this since ancient times, but the theories of Liu Hejian and Zhang Dairen are the most lucid and hit the nail on the head. I record them below.
Hejian said: The five zang and six fu organs, and the four limbs, all receive qi from the spleen and stomach. They circulate body fluids to moisten and nourish the body. However, the root cause of Xiao Ke [Consumption-Thirst Disease] is the extreme deficiency of damp-cold yin qi and the excessive excess of dry-heat yang qi. Treatment should tonify the deficiency of kidney water yin-cold and purge the excess of heart fire yang-heat. Remove severe dry-heat from the intestines and stomach, assist the decline of body fluids, so that pathways remain open and unblocked, body fluids generate without withering, and qi and blood harmonize without stagnation. Then the disease will resolve itself. Moreover, Xiao Ke arises from improper diet and medication, causing intestinal and gastric dryness and preventing qi from circulating smoothly; or from mental/spiritual excess violating natural limits, causing chaos; or following major illness where yin qi is damaged and blood declines, leading to fierce deficient yang and severe郁结 (stagnation) of dry-heat. If drinking is excessive and urination is excessive, it is named Xiao Ke. If food intake is excessive, thirst is mild, urination is frequent, and emaciation occurs, it is named Xiao Zhong. If thirst persists despite constant drinking, legs are emaciated, and urine contains lipid fluid, it is named Shen Xiao. All these result from excessive dry-heat causing obstruction and stagnation in the couli (pores/space between skin and muscle) of the sanjiao and intestines/stomach. Despite heavy fluid intake internally, it cannot moisten externally or nourish the bones. Thus, thirst persists, and urination is excessive or frequent.
Dairen's theory states: Fire consumes objects; burning wood turns it to charcoal, burning metal turns it to liquid, burning stone turns it to ash, boiling seawater yields salt, and water in a tripod dries up. The heart and kidney are Ministerial Fire (Jun Huo), while the sanjiao and gallbladder are Assistant Fire (Xiang Huo). When balanced, they cook food and eliminate waste. When unbalanced, they scorch the zang-fu, consuming body fluids. Excess heart fire in the upper jiao causes diaphragmatic consumption; in the middle jiao, gastrointestinal consumption; in the lower jiao, lipid consumption; on the exterior, muscular consumption. If upper excess continues, consumption spreads to the lungs. If middle excess continues, it spreads to the spleen. If lower excess continues, it spreads to the liver and kidneys. If exterior excess continues, it spreads to sinews and bones. When the four zang organs are consumed, the heart burns itself, leading to death. Therefore, knowing that for Xiao Ke, regulating without purging only provides slight moisture, failing to quell the flaming upward heat. Purging without regulating leads to immediate re-consumption of fluids, failing to irrigate the dry diaphragm. Even if purging and regulating are done, if one does not reduce rich flavors, abstain from desires, and regulate emotions, the disease will recur. If these three precautions are observed, Xiao Ke is no longer a worry. These two masters' discussions on the etiology and symptoms of Xiao Ke are clear and thorough, requiring no further explanation. However, their mention of floating and large pulses refers to a diffuse and expansive pattern. As Hejian said earlier: keeping pathways open, fluids generating, and qi/blood harmonizing leads to recovery. But only a diffuse and expansive qi mechanism can achieve this state of non-stagnation, non-withering, and non-choppy flow. Hence, floating and large pulses indicate life. If the pulse is fine, small, floating, and choppy, the deficiency and withering of qi and blood are evident. Coupled with emaciated and frail physique, this is called Xing Tuo [Physical Depletion]. This aligns with Dairen's analogy of wood turning to charcoal, metal to liquid, stone to ash, water to salt, and tripod water drying up. With both form and qi exhausted, is it merely a matter of being alarming?