脉
心脉多浮，肾脉多弱。经云∶阴不足，阳有余，则为热中。又云∶脉软散当消渴，气实血虚也。又云∶
脉数大者生，沉小者死；实而坚大者生，细而浮短者死。
病
《内经》曰∶二阳结，为之消。又曰∶瘅成为消中。东垣曰∶二阳者，阳明也。手阳明大肠主津液，病
消则目黄口干，乃津液不足也；足阳明胃主血，若热则消谷善饥，血中伏火，乃血不足也。结
者，津液不足，结而不润，皆燥热为病也，此因数食甘美而多肥，
故其气上溢，转为消渴。治当以养血滋阴，生津降火，兰除陈气也。不可服膏粱、芳草、石药，其气剽悍，
能助燥热也。歧伯曰∶实脉，病久可治；脉弦小，病久不可治。当分三消而治之。高消者，舌上赤裂，大渴
引饮，心移热于肺，传为膈消者是也，以白虎加人参汤治之。中消者，善食而瘦，自汗大便硬，小便数。叔和
云∶口干饮水，多食肌虚，瘅成为消中是也，以调胃承气汤、二黄丸治之。下消者，烦渴引饮，耳叶焦干，
小便如膏。叔和云∶焦烦水易亏，此肾消也。以六味地黄丸治之。《总录》所谓未传能食者，必发脑疽背痈；
不能食者，必传中满膨胀。皆不治之证也。洁古老人分而治之∶能食而渴者，白虎人参汤；不能食而渴者，
钱氏白术散，倍加干葛治之。上中既立，不复传下消矣，先哲用药，厥有旨哉？然脏腑有远近，亦宜斟酌，如
心肺位近，宜制小其服；肾肝位远，其制大其剂，皆适其至所为。故如过与不及，皆诛罚无过之地也，
如高消、中消制之大急，速过病所，久而无中满之病，正谓上热未除，中寒复生者也，非药之罪，
失其缓急之故也。治斯疾者，宜加意焉。
治
张洁古曰∶上消者，肺也，多饮水少食，大小便如常，此心火刑于肺金，而渴生焉。法当降
火清金，宜白虎汤加减治之。
软石膏（二钱半） 知母（一钱） 甘草（五分） 人参（七分） 升麻（一分） 黄柏（一钱）
上锉一剂，粳米一撮，水煎，食后温服。
中消者，胃也，多饮食而小便黄赤。盖足阳明胃主血，热则消
谷善饥，血中伏火，则津液消烁而渴矣。治以调胃承气汤，三黄丸主之。
黄连 黄芩 大黄 石膏（各一两）
上为末，炼蜜丸，如梧子大。每服三十丸，米汤下。
下消者，肾也，小便淋浊如膏，烦渴引饮，耳叶焦黑，小便频
数。能食者，必发痈疸背疮；不能食者，必传中满腹胀，须分治之。
若能食而消者，宜加减白虎汤主之。
石膏（二钱半） 知母（一钱） 甘草（三分） 人参（七分） 五味子（十粒） 黄柏（七分）
玄参（五分）
上锉一剂，粳米一撮，水煎，食后服。
若不食而消者，宜加减白术散主之。
人参 白术 茯苓 木香 甘草 黄柏 知母（各五分） 干葛（一钱） 五味子（十粒）
上锉一剂，水煎温服。
丹溪曰∶三消者，多属血虚不生津液，俱宜四物汤为主治。
上消者，加人参、五味、麦门冬、天花粉煎，入生藕汁、生地
黄汁、人乳，饮酒人加生葛根汁。
中消者，加知母，石膏、寒水石以降胃火。
下消者，加黄柏、知母、熟地黄、五味子以滋肾水，又当间饮缫丝汤为上策。
一人被烧酒醉伤成消渴之疾，饮水无度，余以绿豆汤频频少饮，
用生冬瓜去皮，细细嚼咽，渴则又饮豆汤，不一日而止渴也。
方
生津养血汤〔批〕（按此方治上消之剂） 治上消火盛，制金烦渴引饮。
当归（一钱） 川芎（八分） 白芍（煨，一钱） 生地黄（酒洗，一钱） 知母（五分）
黄柏（蜜水炙，五分） 麦冬门（一钱） 石莲肉（五分） 天花粉（七分） 黄连
（八分） 乌梅（五分） 薄荷（五分） 甘草（炙，五分）
上锉一剂，水煎温服。
清凉饮子〔批〕（按此方治中消之剂） 治消中能食而瘦，口舌干，自
汗，大便结燥，小便频数。
黄 （一钱） 当归身（六分） 生地黄（六分） 龙胆草（酒洗，钱半） 柴胡（一钱）
升麻（四分） 防己（五分） 羌活（一钱） 黄芩（酒洗，一钱） 防风（五分） 杏仁
（十个） 生甘草（五分） 炙甘草（一钱）
上锉一剂，水煎，加酒一匙，稍热服。
人参茯苓散〔批〕（按此方治下消之剂） 治肾消善饮而食，小便频数，白浊如膏。
人参（一分） 白术（二分） 茯苓（五分） 泽泻（二分） 滑石（一钱半） 寒水石（一
钱半） 干葛（五分） 连翘（三分） 黄芩（五分） 桔梗（二分） 栀子仁（二分） 薄荷
（五分） 大黄（五分） 天花粉（二分） 甘草（七分） 缩砂（二分）
上锉一剂，水煎，入蜜服，肾消食前，上消食后服。
缫丝汤 治三消渴如神。
如无缫丝汤，却以原蚕茧壳丝绵煎汤，皆可代之，无时饮之，大效。盖此物属火，有阴之用，大能泻
膀胱中伏火，引阴水上潮于口而消渴也。
玉泉散 治消渴之神药也。
白粉葛 天花粉 麦门冬 生地黄 五味子 甘草 糯米
上锉一剂，水煎服。
神仙减水法 治三焦虚热，三消渴疾，日夜饮水无度。
黄 人参 麦门冬 黄连 天花粉 知母 苦参 白扁豆 浮萍（照水晒干，各一两） 黄丹（二钱）
上为末，每服二钱，新汲水调下。
神白散（即益元散，方见中暑） 治真阴素被虚损，多服金石等药，
或嗜炙爆咸物，遂成消渴，用温水调服，或大渴饮冷者，新汲水尤妙。
秘方〔批〕（按此方总治三消之剂） 治三消。
用退雄鸡汤，澄清饮之，神效。
清神补气汤 消渴症才愈，止有口干腹不能拿，或者又添舌白滑，微肿，咽喉咽津觉痛嗌痛，
时时有渴，喜冷冻饮料，口中白沫如
膏。
当归身（一钱） 生地黄（一分） 黄连（酒，五分） 知母（五分） 石膏（四分） 柴
胡（七分） 升麻（一钱半） 防风（一钱） 荆芥穗（一钱） 桃仁（一钱） 杏仁（五个） 红
花（少许） 川椒（二个） 细辛（一分） 生甘草（一分）
肾气八味丸〔批〕（按此方治消渴收功之剂） 治心肾不交，消渴引饮。
Pulse
The heart pulse is often floating, and the kidney pulse is often weak. The classics state: When Yin is insufficient and Yang is in excess, it results in "Re Zhong" (Heat accumulation). It also states: A soft and scattered pulse indicates Xiao Ke (Wasting-thirst syndrome), which is due to Qi excess and Blood deficiency. Furthermore: A rapid and large pulse indicates a favorable prognosis (survival), while a deep and small pulse indicates an unfavorable prognosis (death); a solid and firm-large pulse indicates survival, whereas a thin, floating, and short pulse indicates death.
Disease
The *Nei Jing* (Inner Canon) states: Obstruction of the Two Yang meridians leads to emaciation. It also states: Dan Re (Feverish heat) develops into Xiao Zhong (Middle Wasting-thirst). Li Dongyuan stated: The Two Yang refers to the Yangming meridian. The Hand-Yangming Large Intestine meridian governs body fluids; when suffering from Xiao Ke, yellowing of the eyes and dry mouth occur, indicating fluid insufficiency. The Foot-Yangming Stomach meridian governs blood; if there is heat, food is digested quickly leading to hunger, and latent fire in the blood indicates blood insufficiency. The term "Jie" (knot/obstruction) refers to insufficient body fluids that fail to moisten, all caused by dryness-heat pathologies. This arises from long-term consumption of sweet, delicious, and fatty foods, causing Qi to overflow upward and transform into Xiao Ke. Treatment should focus on nourishing Blood and Yin, generating fluids, descending fire, and eliminating stale Qi. One must not consume rich, greasy foods, aromatic herbs, or mineral drugs, as their fierce nature can aggravate dryness-heat. Qibo stated: A solid pulse with a long-standing disease is treatable; a wiry and small pulse with a long-standing disease is difficult to treat. One must differentiate and treat the Upper, Middle, and Lower Xiao separately. Upper Xiao (Gao Xiao) presents with a red, cracked tongue, extreme thirst with excessive drinking, resulting from Heart Fire transferring heat to the Lung, transforming into Ge Xiao (Diaphragm Wasting-thirst); this is treated with Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction). Middle Xiao presents with polyphagia but emaciation, spontaneous sweating, hard stools, and frequent urination. Wang Shuhe stated: Dry mouth with desire to drink, polyphagia with muscle wasting, where feverish heat develops into Xiao Zhong; this is treated with Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) and Er Huang Wan (Two Yellow Pill). Lower Xiao presents with irritability, thirst with excessive drinking, dry and scorched earlobes, and urine resembling paste. Wang Shuhe stated: Scorched irritability with easy depletion of water indicates Kidney Xiao; this is treated with Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia). The *Zong Lu* (General Records) states: If the condition has not yet progressed but the patient can eat, they will inevitably develop brain abscesses or back carbuncles; if they cannot eat, they will inevitably progress to abdominal fullness and distension. These are incurable conditions. Zhang Jiegu treated them separately: For those who can eat and are thirsty, use Bai Hu Ren Shen Tang; for those who cannot eat and are thirsty, use Qian Shi Bai Zhu San (Child's Atractylodes Powder) with added Gan Ge (Kudzu Root). Once Upper and Middle Xiao are established, they will not transmit to Lower Xiao. The ancients' use of medicines was indeed profound. However, considering the proximity or distance of the Zang-Fu organs, dosages should be adjusted: since the Heart and Lung are close, the dosage should be small; since the Liver and Kidney are distant, the dosage should be large, ensuring the medicinal force reaches the target appropriately. Therefore, excessive or insufficient dosage punishes healthy tissue. For example, if formulas for Upper and Middle Xiao are too urgent, the medicinal force may overshoot the disease site, preventing abdominal fullness later, but this actually means upper heat remains while middle cold arises. This is not the fault of the medicine, but a failure to balance urgency and moderation. Physicians treating this disease should pay close attention.
Treatment Methods
Zhang Jiegu stated: Upper Xiao involves the Lung, presenting with increased water intake, decreased food intake, and normal bowel/bladder functions. This is Heart Fire insulting Lung Metal, causing thirst. The method should be to descend fire and clear the Lung, preferably using Bai Hu Tang (White Tiger Decoction) with modifications.
Ruan Shi Gao (Soft Gypsum) (2.5 qian) Zhi Mu (Anemarrhena Rhizome) (1 qian) Gan Cao (Licorice Root) (0.5 qian) Ren Shen (Ginseng Root) (0.7 qian) Sheng Ma (Cimicifugae Rhizoma) (0.1 qian) Huang Bo (Phellodendri Cortex) (1 qian)
Crush these ingredients for one dose, add a pinch of Jing Mi (Oryza Sativa Germ), decoct in water, and take warm after meals.
Middle Xiao involves the Stomach, presenting with increased food intake and yellow-red urine. Since the Foot-Yangming Stomach meridian governs blood, heat causes rapid digestion and hunger; latent fire in the blood consumes body fluids, leading to thirst. Treatment uses Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) and San Huang Wan (Three Yellow Pill).
Huang Lian (Coptidis Rhizoma) Huang Qin (Scutellariae Radix) Da Huang (Rhei Radix et Rhizoma) Shi Gao (Gypsum Fibrosum) (each 1 liang)
Grind into powder, refine honey to make pills the size of wu zi (wu berry seeds). Take 30 pills per dose, washed down with rice soup.
Lower Xiao involves the Kidney, presenting with turbid urine like paste, irritability and thirst with excessive drinking, blackened earlobes, and frequent urination. Those who can eat will likely develop sores and back ulcers; those who cannot eat will likely develop abdominal fullness and distension; treatment must be differentiated.
For those who can eat but waste away, use Jia Jian Bai Hu Tang (Modified White Tiger Decoction).
Shi Gao (Gypsum Fibrosum) (2.5 qian) Zhi Mu (Anemarrhena Rhizome) (1 qian) Gan Cao (Licorice Root) (0.3 qian) Ren Shen (Ginseng Root) (0.7 qian) Wu Wei Zi (Schisandrae Fructus) (10 grains) Huang Bo (Phellodendri Cortex) (0.7 qian) Xuan Shen (Scrophulariae Radix) (0.5 qian)
Crush these ingredients for one dose, add a pinch of Jing Mi (Oryza Sativa Germ), decoct in water, and take after meals.
For those who cannot eat but waste away, use Jia Jian Bai Zhu San (Modified Atractylodes Powder).
Ren Shen (Ginseng Root) Bai Zhu (Atractylodis Macrocephalae Rhizoma) Fu Ling (Poria) Mu Xiang (Aucklandiae Radix) Gan Cao (Licorice Root) Huang Bo (Phellodendri Cortex) Zhi Mu (Anemarrhena Rhizome) (each 0.5 qian) Gan Ge (Puerariae Radix) (1 qian) Wu Wei Zi (Schisandrae Fructus) (10 grains)
Crush these ingredients for one dose, decoct in water, and take warm.
Zhu Danxi stated: The Three Xiao diseases mostly belong to Blood deficiency failing to generate body fluids; all should primarily be treated with Si Wu Tang (Four Substance Decoction).
For Upper Xiao, add Ren Shen (Ginseng Root), Wu Wei Zi (Schisandrae Fructus), Mai Men Dong (Ophiopogonis Tubera), Tian Hua Fen (Trichosanthis Radix), decoct, and add fresh lotus root juice, fresh Sheng Di Huang juice (Rehmanniae Radix), and human milk. For drinkers, add fresh Ge Gen juice (Puerariae Radix).
For Middle Xiao, add Zhi Mu (Anemarrhena Rhizome), Shi Gao (Gypsum Fibrosum), and Han Shui Shi (Halloysitum Rubrum) to descend Stomach Fire.
For Lower Xiao, add Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhena Rhizome), Shu Di Huang (Prepared Rehmanniae Radix), and Wu Wei Zi (Schisandrae Fructus) to nourish Kidney Water. Additionally, intermittently drinking Sao Si Tang (Silkworm Cocoon Decoction) is the best strategy.
One person developed Xiao Ke disease due to alcohol intoxication from burning wine, drinking excessively. I used Lv Dou Tang (Mung Bean Decoction) given frequently in small amounts, and had him chew raw winter melon skin slowly. When thirsty, he drank bean soup again. Within less than a day, his thirst stopped.
Formulas
Sheng Jin Yang Xue Tang (Fluid-Generating and Blood-Nourishing Decoction) [Note: This formula treats Upper Xiao] Treats Upper Xiao with excessive fire, restraining Lung Metal, irritability, thirst, and excessive drinking.
Dang Gui (Angelicae Sinensis Radix) (1 qian) Chuan Xiong (Ligustici Chuanxiong Rhizoma) (0.8 qian) Bai Shao (Paeoniae Radix Alba) (stir-fried, 1 qian) Sheng Di Huang (Rehmanniae Radix) (wine-washed, 1 qian) Zhi Mu (Anemarrhena Rhizome) (0.5 qian) Huang Bo (Phellodendri Cortex) (honey-fried, 0.5 qian) Mai Men Dong (Ophiopogonis Tubera) (1 qian) Shi Lian Rou (Nelumbinis Plumula) (0.5 qian) Tian Hua Fen (Trichosanthis Radix) (0.7 qian) Huang Lian (Coptidis Rhizoma) (0.8 qian) Wu Mei (Mume Fructus) (0.5 qian) Bo He (Menthae Haplocalycis Herba) (0.5 qian) Gan Cao (Licorice Root) (roasted, 0.5 qian)
Crush these ingredients for one dose, decoct in water, and take warm.
Qing Liang Yin Zi (Cooling and Refreshing Drink) [Note: This formula treats Middle Xiao] Treats Middle Xiao with polyphagia and emaciation, dry mouth and tongue, spontaneous sweating, constipation, and frequent urination.
Huang Qi (Astragali Membranacei Radix) (1 qian) Dang Gui Shen (Angelicae Sinensis Radix Body) (0.6 qian) Sheng Di Huang (Rehmanniae Radix) (0.6 qian) Long Dan Cao (Gentianae Radix) (wine-washed, 1.5 qian) Chai Hu (Bupleuri Radix) (1 qian) Sheng Ma (Cimicifugae Rhizoma) (0.4 qian) Fang Ji (Stephaniae Tetrandrae Radix) (0.5 qian) Qiang Huo (Notopterygii Rhizoma et Radix) (1 qian) Huang Qin (Scutellariae Radix) (wine-washed, 1 qian) Fang Feng (Saposhnikoviae Radix) (0.5 qian) Xing Ren (Armeniacae Semen Amarum) (10 grains) Sheng Gan Cao (Licorice Root) (0.5 qian) Zhi Gan Cao (Licorice Root) (roasted, 1 qian)
Crush these ingredients for one dose, decoct in water, add one spoonful of wine, and take slightly warm.
Ren Shen Fu Ling San (Ginseng and Poria Powder) [Note: This formula treats Lower Xiao] Treats Kidney Xiao with excessive drinking and eating, frequent urination, and white turbidity like paste.
Ren Shen (Ginseng Root) (0.1 qian) Bai Zhu (Atractylodis Macrocephalae Rhizoma) (0.2 qian) Fu Ling (Poria) (0.5 qian) Ze Xie (Alismatis Rhizoma) (0.2 qian) Hua Shi (Talcum) (1.5 qian) Han Shui Shi (Halloysitum Rubrum) (1.5 qian) Gan Ge (Puerariae Radix) (0.5 qian) Lian Qiao (Forsythiae Fructus) (0.3 qian) Huang Qin (Scutellariae Radix) (0.5 qian) Jie Geng (Platycodonis Radix) (0.2 qian) Zhi Zi Ren (Gardeniae Semen) (0.2 qian) Bo He (Menthae Haplocalycis Herba) (0.5 qian) Da Huang (Rhei Radix et Rhizoma) (0.5 qian) Tian Hua Fen (Trichosanthis Radix) (0.2 qian) Gan Cao (Licorice Root) (0.7 qian) Suo Sha (Amomi Fructus Rotundus) (0.2 qian)
Crush these ingredients for one dose, decoct in water, add honey, and take. For Kidney Xiao, take before meals; for Upper Xiao, take after meals.
Sao Si Tang (Silkworm Cocoon Decoction) Treats the Three Xiao and thirst miraculously.
If Sao Si Tang is unavailable, decocting shells of original silkworm cocoons or silk floss can serve as substitutes. Drink at any time for great efficacy. This substance belongs to Fire but possesses Yin properties; it greatly drains latent fire in the Bladder and guides Yin water up to the mouth to relieve thirst.
Yu Quan San (Jade Spring Powder) A divine medicine for treating Xiao Ke.
Bai Fen Ge (Puerariae Radix) Tian Hua Fen (Trichosanthis Radix) Mai Men Dong (Ophiopogonis Tubera) Sheng Di Huang (Rehmanniae Radix) Wu Wei Zi (Schisandrae Fructus) Gan Cao (Licorice Root) Nuo Mi (Oryza Sativa Glutinosa)
Crush these ingredients for one dose, decoct in water, and take.
Shen Xian Jian Shui Fa (Immortal Water-Reducing Method) Treats deficiency-heat in the San Jiao (Triple Burner), the Three Xiao diseases, and excessive day-and-night drinking.
Huang Qi (Astragali Membranacei Radix) Ren Shen (Ginseng Root) Mai Men Dong (Ophiopogonis Tubera) Huang Lian (Coptidis Rhizoma) Tian Hua Fen (Trichosanthis Radix) Zhi Mu (Anemarrhena Rhizome) Ku Shen (Sophorae Flavescentis Radix) Bai Bian Dou (Phaseoli Lunati Semen) Fu Ping (Ulmaceae Herb) (dried in shade, each 1 liang) Huang Dan (Minium) (2 qian)
Grind into powder. Take 2 qian per dose, mixed with fresh well water.
Shen Bai San (Divine White Powder) (Also known as Yi Yuan San, see Heatstroke chapter) Treats cases where True Yin has been chronically damaged, excessive use of mineral drugs occurred, or there is a preference for roasted, fried, and salty foods, leading to Xiao Ke. Mix with warm water to take. For those extremely thirsty wanting cold drinks, fresh well water is especially excellent.
Secret Formula [Note: This formula generally treats the Three Xiao] Treats the Three Xiao.
Use broth from a castrated rooster, clarify it, and drink. Miraculous effect.
Qing Shen Bu Qi Tang (Spirit-Clearing and Qi-Nourishing Decoction) After Xiao Ke symptoms just resolve, only dry mouth and abdominal discomfort remain, or perhaps white slippery coating appears on the tongue, slight swelling, pain in the throat when swallowing saliva, occasional thirst, preference for cold drinks, and white foam in the mouth like paste.
Dang Gui Shen (Angelicae Sinensis Radix Body) (1 qian) Sheng Di Huang (Rehmanniae Radix) (0.1 qian) Huang Lian (Coptidis Rhizoma) (wine-soaked, 0.5 qian) Zhi Mu (Anemarrhena Rhizome) (0.5 qian) Shi Gao (Gypsum Fibrosum) (0.4 qian) Chai Hu (Bupleuri Radix) (0.7 qian) Sheng Ma (Cimicifugae Rhizoma) (1.5 qian) Fang Feng (Saposhnikoviae Radix) (1 qian) Jing Jie Sui (Schizonepetae Spica) (1 qian) Tao Ren (Persicae Semen) (1 qian) Xing Ren (Armeniacae Semen Amarum) (5 grains) Hong Hua (Carthami Flos) (a little) Chuan Jiao (Zanthoxyli Pericarpium) (2 grains) Xi Xin (Asari Radix et Rhizoma) (0.1 qian) Sheng Gan Cao (Licorice Root) (0.1 qian)
Shen Qi Ba Wei Wan (Kidney-Energizing Eight-Ingredient Pill) [Note: This formula is used to conclude treatment for Xiao Ke] Treats Heart-Kidney non-interaction and Xiao Ke with excessive drinking.