上消者。舌上赤裂。大渴引饮。逆调论云。心移热于肺。傅为膈消者是也。以白虎汤加人参治之。中消
者。善食而瘦。自汗大便硬。小便数。叔和云。口干饮水。多食肌肤瘦。成消中者是也。以调胃承气汤治之。
下消者。烦躁引饮。耳输焦干。小便如膏。叔和云。焦烦水易亏。此肾消也。六味丸治之。古人治三消之法。
详别如此。余又有一说焉。人之水火得其平。气血得其养。何消之有。其间摄养失宜。水火偏胜。津液枯槁。
以致龙雷之火上炎。熬煎既久。肠胃合消。五脏干燥。令人四肢瘦削。精神倦怠。故治消之法。无分上中下。先
治肾为急。惟六味八味。及加减八味丸。随证而服。降其心火。滋其肾水。则渴自止矣。白虎与承气。皆非所治也。
娄全善云。肺病本于肾虚。肾虚则必寡于畏。妄行陵肺而移寒与之。故肺病消。仲景治渴而小便反多。用
八味丸补肾救肺。后人因名之曰肾消也。
总录谓不能食而渴者。末传中满。能食而渴者。必发脑疽背痈。盖不能食者。脾之病。脾主浇灌四旁。与胃
行其津液者也。脾胃既虚。则不能敷布其津液。故渴。其间纵有能食者。亦是胃虚引谷自救。若概以寒凉泻火之
药。如白虎承气之类。则内热未除。中寒复生。能不未传鼓胀耶。惟七味白术散。人参生脉散之类。恣意多饮。
复以八味地黄丸。滋其化源。才是治法。及能食而渴发疽者。乃肥贵人膏粱之疾也。数食甘美而肥多。
故其上气转溢而为消渴。不可服膏粱芳草石药。其气 悍。能助燥热。经曰。治之以兰。消陈积也。亦不用寒
凉。及发痈疽者。何也。经曰。膏粱之变。饶生大疔。此之谓也。其肾消而亦有脑疽背痈者。盖肾主骨。脑
者髓之海。背者太阳经寒水所过之地。
水涸海竭。阴火上炎。安得不发而为痈疽。其疮甚而不溃。或赤水者是。甚则或黑或紫。火极似水之象。乃
肾水已竭不治。或峻补其阴。亦可救也。
或曰。人有服地黄汤而渴仍不止者。何也。曰此方士不能废其绳墨。而更其道也。盖心肺位近。宜制小其
服。肾肝位远。宜制大其服。如鬲消中消。可以前丸缓而治之。若下消已极。大渴大燥。须加减八味丸料一
升。内肉桂一两。水煎六七碗。恣意水冷冻饮料之。熟睡而渴病如失矣。处方之制。存乎人之通变耳。
或问曰。下消无水。用六味地黄丸。可以滋少阴之肾水矣。又加附子肉桂者何。盖因命门火衰。不能蒸腐
水谷。水谷之气。不能熏蒸。上润乎肺。如釜底无薪。锅盖干燥。故渴。至于肺亦无所禀。不能四布水精。并行
五经。其所饮之水。未经火化。直入膀胱。正谓饮一升溺一升。饮一斗溺一斗。试尝其味。甘而不咸可知矣。故
用附子肉桂之辛热。壮其少火。灶底加薪。枯笼蒸溽。稿禾得雨。生意维新。惟明者知之。昧者鲜不以为迂也。
昔汉武帝病渴。张仲景为处此方。至圣玄关。今犹可想。八味丸诚良方也。疮疽痊后。及将痊口渴甚者。舌黄
坚硬者。及未患先渴。或心烦燥渴。小便频数。或白浊阴痿。饮食少思。肌肤消瘦。及腿肿脚瘦。口齿生疮。
服之无不效。一贵人病疽。疾未安而渴作。一日饮水数升。愚遂献加减地黄方。诸医大笑云。此药若能
止渴。我辈当不复业医矣。皆用木瓜紫苏乌梅人参茯苓百药煎等。生津液之药止之。而渴愈甚。数剂之后。茫
无功效。不得已而用前方。三日渴止。因相信。久服不特渴疾不作。气血亦壮。饮食加倍。强健过于少壮之年。盖用
此药。非予敢自执鄙见。实有源流。薛氏家藏此方。屡用有验。故详着之。使有渴疾者信其言。专志服饵取效。无
为庸医所惑。庶广前人之志。久服轻身。耳目聪明。令人皮肤光泽。（方内用北五味子。最为得力。独能补肾水
降心气。其肉桂一味不可废。若去肉桂。服之不效。）
一男子患此。余欲以前丸治之。彼则谓肉桂性热。乃私易之以黄柏知母等药。遂口渴不止。发背疽而殂。
彼盖不知肉桂为肾经药也。前证乃肾经虚火炎上无制为患。用桂导引诸药以补之。引虚火归元。故效也。成无
己曰。桂犹圭也。引导阳气。若执圭以从使者然。若夫上消者。谓心移热于肺。中消者。谓内虚胃热。皆认火
热为害。故或以白虎汤。或以承气汤。卒致不救。总之是下焦命门火不归元。游于肺则为上消。游于胃即为中
消。以八味肾气丸。引火归元。使火在釜底。水火既济。气上熏蒸。俾肺受湿润之气而渴疾愈矣。
有一等病渴。惟欲饮冷。但饮水不过二三口。即厌弃。少顷复渴。其饮水亦如前。第不若消渴者之饮水无厌
也。此证乃是中气虚寒。寒水泛上。逼其浮游之火于咽喉口舌之间。故上焦一段。欲得水救。若到中焦。以水
见水。正其所恶也。治法如面红而烦躁者。煎理中汤吞八味丸。二三服而愈。若用他药。必不能济。
又有一等病。渴急欲饮水。但饮下不安。少顷即吐出。吐出片刻。复欲水饮。至于药食。毫不能下。此是
阴盛格阳。肾经伤寒之证也。予反复思之。用仲景之白通汤。加人尿胆汁。热药冷探之法。一服稍解。三
服全瘳。其在男子间有之。女子多有此证。（陶节庵名之曰回阳返本汤。）
Shangxiao (Upper Wasting-Thirst) is characterized by a red tongue with cracks, extreme thirst, and excessive drinking. The *Ni Diao Lun* states: "Heart heat transfers to the Lung, transmitting as Ge Xiao (Diaphragmatic Wasting-Thirst)," which refers to this condition. It is treated with Baihu Tang (White Tiger Decoction) plus Renshen (Ginseng).
Zhongxiao (Middle Wasting-Thirst) is characterized by voracious appetite but emaciation, spontaneous sweating, dry stools, and frequent urination. Wang Shuhe said: "Dry mouth desiring water, eating much yet muscles becoming thin, this is called Xiao Zhong," which refers to this condition. It is treated with Tiaowei Chengqi Tang (Regulate the Stomach and Direct Downward Decoction).
Xiaxiao (Lower Wasting-Thirst) is characterized by irritability, desire for water, dry and scorched ear canals, and urine resembling paste. Wang Shuhe said: "Scorched irritability, water easily depleted, this is Shen Xiao (Kidney Wasting-Thirst)," which refers to this condition. It is treated with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia).
The ancients' methods for treating the three Xiao (Wasting-Thirsts) were detailed and distinct as follows. I have another perspective: When a person's Water and Fire (Yin and Yang) are balanced, and Qi and Blood are nourished, how could there be Wasting-Thirst? Due to improper self-care, Water and Fire become unbalanced, body fluids wither, causing Longlei Zhi Huo (Dragon and Thunder Fire, i.e., Ministerial Fire) to flare upward. After prolonged simmering, the intestines and stomach combine in wasting, the five Zang organs become dry, leading to emaciated limbs and mental fatigue. Therefore, in treating Wasting-Thirst, regardless of whether it is Upper, Middle, or Lower, the priority is to treat the Kidney first. Only Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia), and Jiajian Bawei Wan (Modified Eight-Ingredient Pill) should be taken according to the syndrome, to descend Heart Fire and nourish Kidney Water, so that thirst will naturally cease. Baihu Tang (White Tiger Decoction) and Chengqi Tang (Direct Downward Decoction) are not appropriate treatments.
Lou Quanshan said: "Lung disease originates from Kidney deficiency. Kidney deficiency leads to a lack of restraint, allowing reckless Qi to invade the Lung and transfer cold to it, thus causing Lung disease and Wasting-Thirst." Zhang Zhongjing treated thirst with increased urination using Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia) to tonify the Kidney and rescue the Lung; later generations named this Shen Xiao (Kidney Wasting-Thirst).
The *Shengji Zonglu* states: Those who cannot eat but feel thirsty are in the late stage where the disease has transmitted to the Middle Jiao causing fullness; those who can eat but feel thirsty will inevitably develop Nao Ju (Brain Carbuncle) or Bei Yong (Back Abscess). This is because those who cannot eat suffer from Spleen disease. The Spleen governs irrigation to the four peripheries and works with the Stomach to transport body fluids. If the Spleen and Stomach are deficient, they cannot distribute body fluids, hence the thirst. Even among those who can eat, it is merely the deficient Stomach drawing on grain for self-rescue. If one generally uses cold and cooling drugs to purge fire, such as Baihu Tang (White Tiger Decoction) or Chengqi Tang (Direct Downward Decoction), the internal heat will not be removed, and middle Jiao cold will arise. Will it not eventually transmit to Gu Zhang (Drum Distension)? Only Qiwai Baizhu San (Seven-Ingredient Atractylodes Powder), Rensheng Maishan San (Ginseng Pulse-Nourishing Powder), etc., taken with abundant drinking, followed by Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia) to nourish the source of transformation, constitute the correct treatment. As for those who can eat, feel thirsty, and develop carbuncles, this is a disease of wealthy people consuming rich and greasy foods. Frequent consumption of sweet and fatty foods causes upper Qi to overflow and transform into Wasting-Thirst. One must not consume rich, aromatic, grassy, or mineral medicines, as their qi is fierce and can assist dryness and heat. The *Classic* says: "Treat with Orchid (Lan Cao) to eliminate stale accumulation." Cold and cooling medicines are also not used. Why do abscesses occur? The *Classic* says: "Changes from rich food give rise to large Ding (carbuncles)." This is what is meant. For those with Shen Xiao (Kidney Wasting-Thirst) who also have brain carbuncles or back abscesses, it is because the Kidney governs bones, the Brain is the Sea of Marrow, and the Back is the path of the Taiyang channel where cold water passes. When water dries up and the sea empties, Yin Fire flares upward, how can it not manifest as abscesses? If the sore is severe and does not suppurate, or if it discharges red fluid, or turns black or purple, this is the image of extreme Fire resembling Water, indicating that Kidney Water is exhausted and incurable. However, if one vigorously tonifies Yin, it might still be saved.
Someone asked: "Why does thirst persist even after taking Dihuang Tang (Rehmannia Decoction)?" I replied: "This is because the physician fails to abandon the standard rules and change the approach. The Heart and Lung are located closely, so small doses are suitable; the Liver and Kidney are located far away, so large doses are suitable. For Ge Xiao (Diaphragmatic Wasting-Thirst) and Zhong Xiao (Middle Wasting-Thirst), slow treatment with pills is acceptable. But if Xia Xiao (Lower Wasting-Thirst) is extreme, with great thirst and dryness, one must use one sheng of the ingredients for Jiajian Bawei Wan (Modified Eight-Ingredient Pill), adding one liang of Rougui (Cinnamon Twig), decocted in water until six or seven bowls remain, and drunk cold at will. After falling into a deep sleep, the thirst disease will seem to vanish. The formulation of prescriptions depends on the physician's adaptability."
Someone asked: "For Xia Xiao (Lower Wasting-Thirst) lacking water, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) can nourish the Shaoyin Kidney Water. Why add Fuzi (Aconite) and Rougui (Cinnamon Twig)?" I replied: "This is because the Fire of the Gate of Vitality (Mingmen) is deficient and cannot steam and rot food and drink. The Qi of food and drink cannot steam upward to moisten the Lung, just as the pot lid is dry without fuel at the bottom, hence the thirst. Furthermore, the Lung receives nothing and cannot distribute water essence to the four peripheries and circulate through the Five Channels. The water drunk,未经 fire transformation, goes directly into the Bladder, exactly as stated: 'Drink one sheng, urinate one sheng; drink one dou, urinate one dou.' Tasting its flavor reveals it is sweet, not salty. Therefore, the acrid-hot nature of Fuzi (Aconite) and Rougui (Cinnamon Twig) is used to strengthen the Minor Fire, like adding firewood to the stove, creating steam in the dry cage, giving life to withered crops upon rain. Only the enlightened understand this; the ignorant rarely fail to consider it pedantic."
In the past, Emperor Wu of Han suffered from Wasting-Thirst, and Zhang Zhongjing prescribed this formula. It is indeed a sacred secret gate. Bawei Dihuang Wan (Eight-Ingredient Pill with Rehmannia) is truly an excellent prescription. After the healing of carbuncles and abscesses, or when thirst is severe during recovery, or when the tongue coating is yellow and hard, or when thirst precedes illness, or when there is irritability and dry thirst, frequent urination, white turbidity, impotence, loss of appetite, emaciation, swollen legs with thin feet, or sores in the mouth and teeth, taking this medicine is invariably effective. A nobleman suffered from a carbuncle; before his illness settled, thirst arose, and he drank several sheng of water a day. I offered the Modified Dihuang Formula. All physicians laughed, saying, "If this medicine can stop thirst, we shall no longer practice medicine." They all used herbs generating fluids such as Mugua (Chaenomelis Fructus), Zisu (Perillae Folium), Wumei (Mume Fructus), Renshen (Ginseng), Fuling (Poria), and Baiyaojian (Alum), but the thirst worsened. After several doses, there was no effect whatsoever. Reluctantly, they used my previous formula. Thirst stopped in three days. Trusting it, long-term use not only prevented the return of thirst but also strengthened Qi and Blood, doubled food intake, and made him stronger than in his youth. Using this medicine is not my stubborn opinion, but has a clear lineage. The Xue family treasured this formula and found it effective repeatedly, so I record it in detail to make those with Wasting-Thirst trust these words, take the medicine with determination, and not be confused by mediocre physicians, thereby spreading the will of the predecessors. Long-term use lightens the body, brightens eyes and ears, and makes the skin lustrous. (In the formula, Bei Wuweizi (Schisandrae Chinensis Fructus) is most effective, uniquely tonifying Kidney Water and descending Heart Qi. The single herb Rougui (Cinnamon Twig) must not be omitted; if removed, the medicine is ineffective.)
A man suffered from this condition. I wanted to treat him with the previous pill, but he claimed Rougui (Cinnamon Twig) was too hot and secretly replaced it with Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma). Consequently, his thirst did not cease, he developed a back carbuncle, and died. He likely did not know that Rougui (Cinnamon Twig) enters the Kidney channel. The previous syndrome was caused by deficient Fire of the Kidney channel flaming upward without restraint. Using Gui (Cinnamon) guides the other herbs to tonify and draws the deficient Fire back to its origin, hence the efficacy. Cheng Wuji said: "Gui (Cinnamon) is like a gui (jade tablet); it guides Yang Qi, like holding a jade tablet following an envoy." If Shang Xiao (Upper Wasting-Thirst) is defined as Heart heat transferring to the Lung, and Zhong Xiao (Middle Wasting-Thirst) as internal deficiency with Stomach heat, both recognize Fire and Heat as the harm, thus using either Baihu Tang (White Tiger Decoction) or Chengqi Tang (Direct Downward Decoction), ultimately leading to death. In summary, it is the Fire of the Mingmen (Gate of Vitality) in the Lower Jiao that does not return to its root, wandering into the Lung becomes Shang Xiao (Upper Wasting-Thirst), wandering into the Stomach becomes Zhong Xiao (Middle Wasting-Thirst). Using Bawei Shenqi Wan (Eight-Ingredient Kidney Qi Pill) guides the Fire back to its root, keeping the Fire at the bottom of the pot, achieving the balance of Water and Fire, steaming upward, moistening the Lung, and curing the Wasting-Thirst.
There is a type of thirst disease where the patient only desires cold water, but drinks only two or three sips, then rejects it. After a short while, thirst returns, and drinking is the same, though not as insatiable as in typical Wasting-Thirst. This syndrome is due to deficiency-cold of the Middle Qi, with cold water flooding upward, forcing floating Fire to the throat, mouth, and tongue. Thus, the Upper Jiao segment desires water to save itself. But when the water reaches the Middle Jiao, water meets water, which is precisely what it abhors. The treatment for those with red faces and irritability is to decoct Lizhong Tang (Regulate the Middle Decoction) and swallow Bawei Wan (Eight-Ingredient Pill). Two or three doses bring cure. Using other medicines will certainly not work.
Another type of disease involves urgent thirst desiring water, but upon swallowing, discomfort arises, and vomiting occurs shortly after. After vomiting, the desire for water returns immediately. Food and medicine cannot enter at all. This is Yin excess repelling Yang, a syndrome of Cold Damage to the Kidney channel. After repeated consideration, I used Zhang Zhongjing's Baitong Tang (White Passages Decoction) added with human urine and bile, employing the method of administering hot medicine coldly. One dose provided slight relief, and three doses brought complete recovery. This occurs occasionally in men, but frequently in women. (Tao Jian'an named it Huiyang Fanben Tang (Restore Yang and Return to Base Decoction).)