《内经》谓水为阴，腹者至阴之所居，是以水饮之证，先见于腹满。（《圣济》）
脾土也，土气弱则不能制水，消渴饮水过度，脾土受湿而不能有所制，则泛溢妄行于皮肤肌肉之间，聚为浮肿
胀满而成水也。（同上）
消渴后成水气，方书虽有紫苏汤、瞿麦汤、葶苈丸，皆克泄之剂，不若五皮饮送济生肾气丸，及东垣中满分
消诸方为妥。（《准绳》）
治例 凡治消之法，最当先辨虚实。若察其脉证，果为实火，致耗津液者，但去其火，则津液自生而消渴
自止。若由真火不足，则悉属阴虚，无论上中下，急宜治肾，必使阴气渐充，精血渐复，则病必自愈。若但知清
火，则阴无以生，而日见消败，益以困矣。（《景岳》）
上消善渴，中消善饥，虽曰上消属肺，中消属胃，然总之火在中上二焦者，亦无非胃火上炎而然，但当微为分
别以治之。若二焦果由实火，则皆宜白虎汤主之。若渴多饥少，病多在肺者，宜人参白虎汤主之。若水亏于下，火炎于
上，有不得不清者。宜玉女煎（用石膏、熟地、麦冬、知母、牛
膝）或加减一阴煎（用生地、芍药、麦冬、熟地、甘草、知母、地骨皮）之类主之。（同上）
下消证，小便淋浊，如膏如油，或加烦躁耳焦，此肾水亏竭之证，古法用六味地黄丸之类主之，固其宜矣。
然以余观之，则亦当辨其寒热滑涩，分而治之，庶乎尽善。若淋浊如膏，兼热病而有火者，宜补而兼清，以加减
一阴煎，或补阴丸、大补阴丸，或六味地黄丸加黄柏、知母之类主之。若下消而兼涩者，宜补宜利，以六味地黄丸
之类主之。若下焦淋浊而全无火者，乃气不摄精而然，但宜壮水养气，以左归饮（用熟地、山药、枸杞、炙甘、
茯苓、山茱）、大补元煎（方见虚劳中）之类主之。若火衰不能化气，气虚不能化液者，犹当以右归饮（此于左
归饮去茯苓，加杜仲、肉桂、制附子）、右归丸（此于上方去甘草，加鹿角胶、菟丝子、当归）、八味地黄丸之
类主之。若下焦无火而兼滑者，当以固肾补阴为主，宜秘元煎、固阴煎及苓术菟丝丸之类主之。（同上）（此三方
俱出其固阵中，兹不录。）
消渴初起，用人参白虎汤，久而生脉散。中消初发，调胃承气汤，久则参苓白术散。肾消初起，清心莲子饮，
久而六味地黄丸。（绳墨）
上消宜《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。中消宜酒煮黄
连丸（黄连一味酒煮）、大黄黄连泻心汤、山栀、黄连之类。下消宜六味丸、固本丸、知柏八味丸之类。（《续
焰》）（按∶固本丸用二地二冬。知柏八味丸即六味丸加知、柏）
三消久之精血既亏，或目无见，或手足偏废如风疾非风，然此证消肾得之为多。消心之病，往往因欲饮食过
多，及食啖辛热以致烦渴，引饮既多，小便亦多，当抑心火使之下降，自然
不渴，宜半夏泻心汤，去干姜，加栝蒌、干葛如其数，吞猪肚丸（用黄连、粟米、栝蒌根、茯神、知母、麦门、
猪肚）或酒连丸（即酒煮黄连丸），仍佐独味黄连汤，多煎候冷，遇渴恣饮，久而自愈，或用糯米煮稀粥。若因
用心过度，致心火炎上，渴而消者，宜黄 饮（即黄 六一汤）加莲肉、远志各半钱，吞玄菟丹，仍以大麦煎
汤下灵砂丹。若因色欲过度，水火不交，肾水下泄，心火自炎，以致渴浊，不宜备用凉心冷剂，宜坚肾水以济心
火，当用黄 饮加苁蓉、五味各半钱，吞八味丸及小菟丝子丸（即玄菟丹去五味子），玄菟丹、鹿茸丸、加减安
肾丸（俱系补肾大方）皆可选用，或灵砂丹。（《要诀》）
凡治初得消渴病，不急生津补水，降火彻热，用药无当，迁延误人，医之罪也。凡治中消病成，不急救金水
二藏，泉之竭矣，不云自中，医之罪也。凡治肺消病，而以地黄丸治其血分，肾消病，而以白虎汤治其气分，执一
不通，病不能除，医之罪也。凡消渴病少愈，不亟回枯泽槁，听其土燥火生，致酿疮疽无救，医之罪也。凡治消渴
病，用寒凉太过，乃至水胜火湮，犹不知反，渐成肿满不救，医之罪也。（《法律》）
治辨阴虚阳虚 三消证，古人以上焦属肺，中焦属胃，下焦属肾，而多从火冶，是固然矣。然以余论之，
则三焦之火，多有病本于肾，而无不由乎命门者。夫命门为水火之腑，凡水亏证固能为消为渴，而火亏证亦能为
消为渴者何也？盖水不济火则火不归原，故有火游于肺而为上消者，有火游于胃而为中消者，有火烁阴精而为下消
者，是皆真阴不足，水亏于下之消证也。又有阳不化气则水精不布，水不得火则有降无升，所以直入膀胱而饮一溲
二，以致泉源不滋，
天壤枯涸者，是皆真阳不足，火亏于下之消证也。阴虚之消，治宜壮水，固有言之者矣；阳虚之消，谓宜补火，
则人必不信。不知釜底加薪，氤氲彻顶，槁禾得雨，生意归巅，此无他，皆阳气之使然也，亦生杀之微权也。余
因消证多虚，难堪剥削，若不求其 丧之因而再伐生意，则消者愈消，无从复矣。故再笔于此，用以告夫明者。
（《景岳》）
治肾为要 自为儿时，闻先君言∶有一士大夫，病渴疾，诸医遍用渴药治疗，累载不安。有一名医诲之，
使服加减八味丸，不半载而疾痊。因疏其病源云。今医多用醒脾生津止渴之药误矣。其疾本起于肾水枯竭，不能
上润，是以心火上炎，不能既济，煎熬而生渴。今服八味丸，降其心火，生其肾水，则渴自止矣。复疏其药性云∶
内真北五味子最为得力，此一味独能生肾水，平补降心气，大有功效。（《外科精要》）（按∶《魏氏》竹龙散
方后曰∶渴止之后，宜服八味丸，仍以五味子代附子。沈存中载于《灵苑方》，得效者甚多。盖此方本出《肘后》。）
其治宜抑损心火，摄养肾水。（《大成》）
益火之源，以消阴翳，则便溺有节（八味丸）。壮水之主，以制阳光，则渴饮不思（六味丸）。（准绳）
（按∶便溺有节，渴饮不思，是洁古说。）
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（按∶此本
于《诸证辨疑》），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、承气皆非所治也。
总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，肺受湿气而渴疾愈矣。（《医贯》）
下消之火，水中之火也，下之则愈燔；中消之火，竭泽之火也，下之则愈伤；上消之火，燎原之火也，水从
天降可灭。徒攻肠胃，无益反损。夫地气上为云，然后天气下为雨，是故雨出地气。地气不上，天能雨乎。故亟升
地气，以慰三农，与亟升肾气，以溉三焦，皆事理之必然者耳。（《法律》）
消渴之症，虽分上中下，而肾虚以致渴，则无不同也。故治消渴之法，以治肾为主，不必问其上中下之消
也。（《石室秘 》）
治主调养 三消得之气之实、血之虚也，久久不治，气尽虚则无能为力矣。有一僧专用黄 汤，其论盖
以益血为主。诸消不宜用燥烈峻补之剂，惟当滋养。（《要诀》）
消渴属阴虚，津液不足，不能上潮者多，必多服生津补气养血药，倍加人参，阳旺则生阴也。酒客膏粱浓味
炙，先须解毒。（《六要》）
渴家误作火治，凉药乱投，促人生命，必多服主脉散为佳。（同上）
治须养脾（阳虚用归脾汤治验）消渴证候，人皆知其心火上炎，肾水下泄，小便愈多，津液愈涸，饮食
滋味皆从小便消焉，是水火不交济然尔。孰知脾土不能制肾水，而心肾二者皆取气于胃乎。治法总要，当服真料
参苓白术散，可以养脾，自生津液。（《直指》）
下消不寐新案∶省中周公者，山左人也，年逾四旬，因案牍积劳，致成羸疾，神困食减，时多恐惧，自冬春达
夏，通宵不寐者，凡半年有余，而上焦无渴，不嗜汤水，或
有少饮，则沃而不行，然每夜必去溺二三升，莫知其所从来，且半皆如膏浊液， 羸至极，自分必死。及予诊之，
喜其脉犹带缓，肉亦未脱，知其胃气尚存，慰以无虑。乃用归脾汤去木香，及大补元煎之属，一以养阳，一以养阴，
出入间用，至三百余剂，计人参二十斤，乃得全愈。此神消于上，精消于下之证也。可见消有阴阳，不得尽言为
火。姑纪此一案，以为治消治不寐者之鉴。（《景岳》）（按∶此证似非真消渴，姑存之。）
治不宜攻下 夫渴疾，饮食皆化为小便，不归大肠，大肠秘涩。世人不识，更服宣药，大肠既泻，元气败
脱，其患愈甚。切忌宣转，及毒食、腌藏、油腻之物。（《叶氏》引江谏议）
总前数者（按∶此言三消），其何以为执剂乎。吁！此虚阳炎上之热也。叔和有言，虚热不可大攻，热去则
寒起，请援此以为治法。（《直指》）
中消火证，以善饥而瘦，古法直以调胃承气汤及三黄丸之类主之。然既以善饥，其无停积可知。既无停积，
则止宜清火，岂堪攻击。非有干结不通等证，而用此二剂，恐非所宜。（《景岳》）
消渴证，真气为热火所耗，几见有大实之人耶。然则欲除胃中火热，必如之何而后可？昌谓久蒸大黄，与
甘草合用，则急缓互调；与人参合用，则攻补兼施。如充国之屯田金城，坐困先零，庶几可图三年之艾。目前纵
有乘机斗捷之着，在所不举，如之何欲取效眉睫耶。（《法律》）
诸渴杂证（宜与奇治诸方相参）诸失血及产妇蓐中渴者，名曰血渴（按∶此本出《三因》，曰非三消类，
不可不审），宜求益血之剂，已于吐血证中论之。有无病忽然大
渴，少顷又定，只宜蜜汤及缩脾汤之类，折二泔冷进数口亦可。酒渴者，干葛汤（按∶此系枳实栀子汤加干葛、
甘草）调五苓散。（《要诀》）
有一等渴欲引饮，但饮水不过一二口即厌，少顷复渴，饮亦不过若此，不若消渴者饮水无厌也。此是中气虚
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。若得至中焦，以水见水，正其所恶也。治
法如面红烦躁者，理中汤送八味丸（评曰∶予用附子理中加麦冬、五味，亦效）。又有一等口欲饮水，但饮下少
顷即吐，吐出少顷复求饮，药食毫不能下，此是阴盛格阳，肾经伤寒之症。用仲景之白通汤加人尿、胆汁，热药
冷探之法，一服即愈。女人多此症。（《医贯》）
清火生津诸方 消渴内消小便热中，六物丸。
栝蒌（六分） 麦门冬（六分） 知母（六分） 人参 土瓜根 苦参（各四分）
捣下以牛胆和为丸，服如小豆二十丸，溺下之，三日不止，稍加之。咽干加麦门冬，舌干加知母，胁下满加
人参，小便难加苦参，数者加土瓜根，随病所在倍一分加之。（《肘后》）《外台》∶《近效论》疗消渴方，于
本方去土瓜根，加黄连、牡蛎粉、黄 、干地黄，以牛乳丸。又热中虽能食多，小便多，渐消瘦方，于上方去黄
。
治胃腑实热，引饮常渴，泄热止渴，茯神汤方。
茯神（二两《外台》作茯苓） 栝蒌根 生麦门冬（各五两） 生地黄（六两） 葳蕤（四两） 小麦（二升）
淡竹叶（切三升） 大枣（二十枚） 知母（四两）
上九味 咀，以水三斗，煮小麦、竹叶取九升，去滓下药，煮取四升，分四服，服不问早晚，但渴即进，非
但正治
胃渴，通治渴患热即主之。（千金）又治渴利虚热，引饮不止，消热止渴方，于本方去小麦，加地骨皮、石膏、
生姜。
治消渴方。
栝蒌根 麦门冬 铅丹（各八分） 茯神（一作茯苓） 甘草（各六分）
上五味治下筛，以浆水服方寸匕，日三服。（《外台》无茯神）（《千金》）（按∶《外台》名栝蒌散。）
又方。
黄 茯神 栝蒌根 甘草 麦门冬（各三两） 干地黄（五两）
上六味 咀，以水八升，煮取二升半，去滓分三服，日进一剂，服十剂佳。（同上）
天花散，治消渴。
天花粉 生干地黄（洗各一两） 干葛 麦门冬（去心） 北五味子（各半两） 甘草（一分）
上粗末，每服三钱，粳米百粒，同煎服。（《直指》）
枸杞汤（主证见三消形证中）。
枸杞枝叶（一斤） 栝蒌根 石膏 黄连 甘草（各三两）
上五味 咀，以水一斗，煮取三升，分五服，日三夜二。剧者多合，渴即饮之。（《千金》）
治脾胃中热烦渴，身渐消瘦，宜服此方。
黄连 川升麻 麦门冬 黄芩 栝蒌根 知母（各一两） 茯神（半两） 栀子仁（一两） 甘草（一两）
石膏（二两）
上件药捣筛为散，每服四钱，以水一中盏，煎至六分去滓，不计时候温服。（《圣惠》）
人参散，理消中。
栝蒌根 人参 茯苓 知母 甘草（各一两） 石膏（二两）
The *Neijing* states that water is Yin, and the abdomen is the residence of the Zhiyin (Extreme Yin) organs; therefore, symptoms of fluid retention first manifest as abdominal fullness. (*Shengji Zonglu*)
Spleen belongs to Earth. When Earth Qi is weak, it cannot control Water. Excessive drinking in Xiao Ke (Wasting-Thirst) causes Spleen Earth to be dampened and lose its ability to control fluids, leading to overflowing and erratic movement between the skin and muscles, gathering into edema and distension, ultimately forming Water Disease. (Ibid.)
When Xiao Ke develops into Water Qi disease later on, although formularies mention formulas such as Zisu Tang (Perilla Decoction), Qumai Tang (Dianthus Decoction), and Tingli Wan (Descurainia Pill), which are all purgative and draining agents, it is more appropriate to use Wupi Yin (Five-Peel Drink) to deliver Jisheng Shenqi Wan (Kidney Qi Pill by Dr. Jisheng), or Li Dongyuan's Zhongman Fenxiao formulas. (*Yixue Zhunsheng*)
Treatment Principles: In treating Xiao Ke, one must first distinguish between Deficiency and Excess. If pulse and symptoms confirm Excess Fire consuming body fluids, clearing the fire will allow fluids to regenerate and Xiao Ke to cease. If caused by insufficiency of True Fire (Mingmen Fire), it falls entirely under Yin Deficiency; regardless of Upper, Middle, or Lower Xiao, urgent treatment of the Kidney is required. One must ensure Yin Qi gradually fills and Essence-Blood gradually restores, so the disease heals itself. Merely knowing to clear fire prevents Yin generation, leading to daily decline and worsening condition. (*Jingyue Quanshu*)
Upper Xiao features excessive thirst; Middle Xiao features excessive hunger. Although Upper Xiao is attributed to Lung and Middle Xiao to Stomach, essentially, fire in the Upper and Middle Jiao is nothing but Stomach Fire flaming upward, requiring slight differentiation in treatment. If both Jiaos are indeed due to Excess Fire, Baihu Tang (White Tiger Decoction) is indicated. If thirst is prominent with little hunger, indicating the pathology is mainly in the Lung, Renshen Baihu Tang (Ginseng White Tiger Decoction) is indicated. If Kidney Water is deficient below and Fire flares above, necessitating clearing, Yunu Jian (Jade Woman Decoction [composed of Shigao, Shudihuang, Maidong, Zhimu, Niuxi]) or Jiayi Yiyin Jian (Modified One-Yin Decoction [composed of Shengdihuang, Shaoyao, Maidong, Shudihuang, Gancao, Zhimu, Digupi]) are indicated. (Ibid.)
Lower Xiao presents with turbid, dripping urine resembling paste or oil, possibly accompanied by irritability and dry ears. This is a syndrome of Kidney Water exhaustion. Ancient methods appropriately used Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). However, in my observation, one must also differentiate Cold/Heat and Slippery/Astringent qualities to treat accordingly for perfection. If turbid urine resembles paste with accompanying Heat/Fire, tonification combined with clearing is suitable, using Jiayi Yiyin Jian, Buyin Wan (Tonify Yin Pill), Dabu Yin Wan (Great Tonify Yin Pill), or Liuwei Dihuang Wan added with Huangbai and Zhimu. If Lower Xiao is accompanied by astringency/difficulty, tonification combined with promoting urination is suitable, using Liuwei Dihuang Wan. If Lower Xiao turbidity has no Fire, it is due to Qi failing to secure Essence; only Zhuangshui Yangqi (Strengthen Water and Nourish Qi) is needed, using Zuogui Yin (Left Restoration Decoction [composed of Shudihuang, Shanyao, Gouqizi, Zhigancao, Fuling, Shanzhuyu], Dabu Yuanjian (Great Tonify Source Decoction [see Xu Lao chapter]). If Fire is too weak to transform Qi, and Qi is too weak to transform Fluids, Yougui Yin (Right Restoration Decoction [derived from Zuogui Yin removing Fuling, adding Duzhong, Rougui, Zhi Fuzi]), Yougui Wan (Right Restoration Pill [derived from the above formula removing Gancao, adding Lujiaojiao, Tusizi, Danggui]), or Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) are indicated. If Lower Jiao has no Fire but is slippery/slippery discharge, the focus should be securing Kidney and tonifying Yin, using Miyuan Jian (Secret Source Decoction), Guyin Jian (Secure Yin Decoction), or Lingzhu Tusizi Wan (Poria-Atractylodes-Tusizi Pill). (Ibid.) (These three formulas are from the author's "Gu Zhen" section and are not recorded here.)
At the onset of Xiao Ke, Renshen Baihu Tang is used; after a long time, Shengmai San (Generate Pulse Powder) is used. At the onset of Middle Xiao, Tiaowei Chengqi Tang (Regulate Stomach and Direct Downward Decoction) is used; after a long time, Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) is used. At the onset of Kidney Xiao, Qingxin Lianzi Yin (Clear Heart Lotus Seed Decoction) is used; after a long time, Liuwei Dihuang Wan is used. (*Shengmo*)
For Upper Xiao, Zhuling Tang (Polyporus Decoction) from *Jingui Yaolue*, Renshen Baihu Tang, Hezi's Jiayi Sanhuang Wan (Modified Three-Yellow Pill), Liangge San (Cool Chest Powder), Jiuhuang Lianwan (Wine-Fried Coptis Pill), or Liuyi San (Six-to-One Powder) are suitable. For Middle Xiao, Jiuhuang Lianwan (Coptis fried in wine), Dahuang Huanglian Xiexin Tang (Rhubarb and Coptis Drain Heart Decoction), Zhizi (Gardenia), or Huanglian (Coptis) are suitable. For Lower Xiao, Liuwei Wan (Six-Ingredient Pill), Guben Wan (Root-Securing Pill), or Zhibai Bawei Wan (Anemarrhena, Phellodendron, and Eight-Ingredient Pill) are suitable. (*Xuyan*) (Note: Guben Wan uses two parts Di and two parts Dong. Zhibai Bawei Wan is Liuwei Wan added with Zhimu and Huangbai.)
After a long duration of the Three Xiaos, Essence and Blood are depleted. Some may lose vision; others may have hemiplegia resembling wind-disease but is not wind. This syndrome occurs mostly in Kidney Xiao. Heart Xiao often arises from excessive desire, overeating, and consuming spicy/hot foods causing irritability and thirst. After drinking much, urination increases. One should suppress Heart Fire to make it descend, naturally stopping thirst. Banxia Xiexin Tang (Pinellia Drain the Epigastrium Decoction), removing Ganjiang (Dried Ginger), adding Gualou (Trichosanthes Root) and Genge (Kudzu Root) in appropriate amounts, taken with Zhudu Wan (Pig Stomach Pill [composed of Huanglian, Sorghum, Gualougen, Fushen, Zhimu, Maidong, Pig Stomach]) or Jiulian Wan (Wine-Fried Coptis Pill), assisted by single-ingredient Huanglian Tang (Coptis Decoction), boiled heavily, cooled, and drunk freely when thirsty, will heal over time. Alternatively, glutinous rice porridge can be used. If caused by excessive mental labor leading to Heart Fire flaming up, Huangqi Liuyi Tang (Astragalus Six-to-One Decoction) added with Lianrou (Lotus Seed Embryo) and Yuanzhi (Polygala Root) each half qian, taken with Xuantu Dan (Black Rabbit Pill), and sent down with Barley Decoction along with Lingsha Dan (Cinnabar Pill), is suitable. If caused by excessive sexual activity, failure of Water and Fire interaction, Kidney Water descending, and Heart Fire flaring, causing thirst and turbid urine, cool Heart cold agents should not be used. Instead, solidify Kidney Water to assist Heart Fire. Huangqi Liuyi Tang added with Rongrong (Cistanche) and Wuweizi (Schisandra) each half qian, taken with Bawei Wan (Eight-Ingredient Pill) and Xiaotusizi Wan (Small Tusizi Pill [Xuantu Dan minus Wuweizi]), Xuantu Dan, Lurong Wan (Deer Antler Pill), or Jiayi Anshen Wan (Modified Calm Kidney Pill [all major Kidney-tonifying formulas]), or Lingsha Dan, are selectable options. (*Shiyi De Xiao Fang*)
In treating newly acquired Xiao Ke, if one does not urgently generate fluids, replenish water, lower fire, and eliminate heat, and uses inappropriate medication, delaying and harming the patient is the physician's fault. In treating established Middle Xiao, if one does not urgently rescue the Metal (Lung) and Water (Kidney) organs, and the spring dries up, it will not recover from within; this is the physician's fault. Treating Lung Xiao with Liuwei Dihuang Wan for blood aspect, or Kidney Xiao with Baihu Tang for Qi aspect, being rigid and inflexible, preventing cure, is the physician's fault. If Xiao Ke slightly improves but one does not urgently restore desiccation, allowing dry earth and fire to breed carbuncles without remedy, is the physician's fault. Using cold/cooling herbs excessively in Xiao Ke, leading to Water overcoming Fire, yet not reversing course, gradually resulting in fatal edema/distension, is the physician's fault. (*Yizong Jinjian*)
Differentiating Yin and Yang Deficiency: Ancients attributed Upper Jiao to Lung, Middle Jiao to Stomach, Lower Jiao to Kidney, and treated mostly via Fire, which is true. However, I argue that Fire in the Three Jiaos often originates in the Kidney and involves the Mingmen (Gate of Life). Mingmen is the palace of Water and Fire. Water deficiency certainly causes Xiao/Ke, but why does Fire deficiency also cause Xiao/Ke? Because Water fails to nourish Fire, Fire does not return to its source. Thus, Fire wandering in Lung causes Upper Xiao; Fire wandering in Stomach causes Middle Xiao; Fire scorching Yin Essence causes Lower Xiao. These are all Xiao syndromes of True Yin insufficiency and Water deficiency below. Furthermore, Yang failing to transform Qi means Water Essence is not distributed; Water without Fire descends but does not ascend, entering directly into Bladder, causing "one drink, two urinations," depleting the source and drying the heavens and earth. These are Xiao syndromes of True Yang insufficiency and Fire deficiency below. Treatment for Yin Deficiency Xiao involves strengthening Water, which is known. Treatment for Yang Deficiency Xiao involving tonifying Fire is often disbelieved. Consider adding fuel to the bottom of the pot: vapor rises to the top; dead grain receives rain, life returns to the tip. This is due to Yang Qi, the subtle power of life and death. Since Xiao syndromes are mostly deficiency and cannot withstand depletion, if we do not seek the cause of Yang loss and further attack vitality, the wasting will worsen irrecoverably. I record this again for the wise. (*Jingyue Quanshu*)
Treating Kidney is Essential: My father told me of a scholar suffering from thirst who was treated with various thirst medicines for years without relief. A famous doctor advised him to take Jiayi Bawei Wan (Modified Eight-Ingredient Pill), and he recovered in less than half a year. The etiology was explained: Modern doctors err by using spleen-awakening, fluid-generating, thirst-quenching drugs. The disease originates from Kidney Water exhaustion failing to moisten upwards, causing Heart Fire to flare and fail to interact, boiling and creating thirst. Taking Bawei Wan lowers Heart Fire and generates Kidney Water, stopping thirst. Regarding herb properties: Northern Wuweizi is most effective; alone it generates Kidney Water and calms/reduces Heart Qi, having great efficacy. (*Waike Jingyao*) (Note: *Wei Shi* Zhu Long San post-script says: After thirst stops, take Bawei Wan, replacing Fuzi with Wuweizi. Shen Cunzhong recorded in *Lingyuan Fang* that many were effective. This formula originally comes from *Zhouhou*).
Treatment should suppress Heart Fire and nurture Kidney Water. (*Tai Ping Hui Min He Ji Ju Fang*)
Tonify the source of Fire to dissipate Yin shadows, regulating urination and defecation (Bawei Wan). Strengthen the master of Water to control Yang brilliance, eliminating thirst and desire to drink (Liuwei Wan). (*Yixue Zhunsheng*) (Note: Regulating urination/defecation and eliminating thirst desire are sayings of Jiegu.)
When Human Water and Fire are balanced, and Qi and Blood are nourished, how can there be Xiao? Improper care leads to Water/Fire imbalance, fluid exhaustion, and Dragon-Lei Fire flaming upward (based on *Zhuzheng Bianyi*). After prolonged boiling, intestines/stomach consume, five zang become dry, limbs emaciate, spirit tires. Thus, treating Xiao requires prioritizing Kidney treatment regardless of Upper/Middle/Lower. Only Liuwei, Bawei, and Jiayi Bawei Wan should be taken according to syndrome to lower Heart Fire and nourish Kidney Water, stopping thirst. Baihu and Chengqi are not treatments. It is always Mingmen Fire in Lower Jiao failing to return to origin; wandering to Lung is Upper Xiao, wandering to Stomach is Middle Xiao. Bawei Shenqi Wan guides Fire back to origin, keeping Fire at the bottom of the pot, achieving Water-Fire interaction, Qi steaming upward, moistening Lung, curing thirst. (*Yiguan*)
Fire in Lower Xiao is Fire in Water; purging makes it burn hotter. Fire in Middle Xiao is Fire in a dried pond; purging harms it more. Fire in Upper Xiao is Prairie Fire; water from heaven can extinguish it. Attacking intestines/stomach alone is harmful. Earth Qi rises to form clouds, then Heaven Qi descends as rain; thus rain comes from Earth Qi. If Earth Qi does not rise, can Heaven rain? Therefore, urgently raising Earth Qi to benefit agriculture, and urgently raising Kidney Qi to irrigate Three Jiaos, are necessary principles. (*Yizong Jinjian*)
Although Xiao Ke is divided into Upper, Middle, and Lower, Kidney Deficiency causing thirst is the same in all cases. Therefore, treating Xiao Ke focuses on the Kidney, without asking whether it is Upper, Middle, or Lower Xiao. (*Shishi Milu*)
Treatment Mainly Involves Regulation/Nourishment: The Three Xiaos arise from Qi Excess and Blood Deficiency. Untreated long-term, Qi becomes completely deficient and powerless. A monk used Huangqi Tang exclusively, arguing it primarily benefits Blood. Various Xiaos should not use drying/acrid/potent tonics, but rather nourishing agents. (*Shiyi De Xiao Fang*)
Xiao Ke belongs to Yin Deficiency, insufficient fluids failing to moisten upwards. One must take many fluids-generating, Qi-tonifying, Blood-nourishing herbs, doubling Renshen (Ginseng); when Yang is vigorous, Yin is generated. Wine drinkers and those eating rich/fatty/grilled foods must first detoxify. (*Xue Ji Yi An*)
Thirst patients mistakenly treated as Fire, randomly given cold herbs, shortening life; taking Shengmai San is best. (Ibid.)
Treatment Must Nourish Spleen (Yang Deficiency case treated with Guipi Tang): People know Xiao Ke involves Heart Fire flaming up and Kidney Water leaking, more urination means drier fluids, food essence lost through urine, due to lack of Water-Fire interaction. Few realize Spleen Earth cannot control Kidney Water, and Heart/Kidney both draw Qi from Stomach. The general method is to take Zhenliao Shenling Baizhu San (Authentic Ginseng, Poria, Atractylodes Macrocephala Powder) to nourish Spleen and naturally generate fluids. (*Zhizhi Fang*)
New Case of Lower Xiao with Insomnia: Official Zhou from Shandong, over forty, suffered emaciation from document work, with fatigue, reduced appetite, frequent fear. From winter-spring to summer, he had insomnia for over half a year, with no Upper Jiao thirst, no desire for liquids, or if drank slightly, stagnated. Yet he urinated 2-3 sheng nightly, unknown origin, half like oily turbidity. Extremely emaciated, he expected death. I found his pulse still slow, flesh not wasted, stomach Qi present, and reassured him. I used Guipi Tang removing Muxiang, and Dabu Yuanjian type formulas, one tonifying Yang, one tonifying Yin, alternating. Over 300 doses, totaling 20 jin of Renshen, he fully recovered. This is Spirit wasting above, Essence wasting below. It shows Xiao has Yin/Yang aspects, not just Fire. Recorded as reference for treating Xiao and insomnia. (*Jingyue Quanshu*) (Note: This case seems not to be true Xiao Ke, kept for record.)
Treatment Should Not Use Purging: Thirst diseases convert food/drink to urine, not returning to Large Intestine, causing constipation. Laypeople do not understand and administer purgatives. Once Large Intestine is purged, Original Qi collapses, harm increases. Avoid purgatives, toxic foods, pickled/oily items. (*Ye Shi Yi An* citing Jiang Jianyi)
Regarding the previous points (Three Xiaos), what is the controlling formula? Alas! This is Heat from Deficient Yang flaming upward. Shuhe said, Deficient Heat cannot be heavily attacked; once Heat leaves, Cold arises. Let this guide treatment. (*Zhizhi Fang*)
Middle Xiao Fire Syndrome, characterized by hunger and emaciation, ancient methods directly used Tiaowei Chengqi Tang and Sanhuang Wan. But since there is hunger, there is no food stagnation. Without stagnation, only clearing Fire is suitable, not attacking. Unless there is dry impaction, these two formulas are unsuitable. (*Jingyue Quanshu*)
In Xiao Ke, True Qi is consumed by Hot Fire; where is there a person with Great Excess? To remove Stomach Hot Fire, what to do? Chang suggests long-steamed Dahuang combined with Gancao balances speed/slowness; combined with Renshen combines attacking/tonifying. Like Chongguo garrisoning Jincheng, trapping Xianling, planning for long-term. Immediate quick fixes are rejected; how can immediate effect be expected? (*Yizong Jinjian*)
Various Thirst Syndromes (Refer to Odd Treatments Formulas): Bleeding and postpartum thirst is called Blood Thirst (from *Sanyin*, not Three Xiaos class, must examine). Seek blood-benefiting formulas (discussed in Hematemesis). Sudden thirst resolving quickly needs Honey Water or Suopi Yin. Cool fermented rice water sips help. Wine Thirst needs Gan Ge Tang (Kudzu Decoction [Zhishi Zhizi Tang plus Gan Ge, Gancao]) mixed with Wuling San. (*Shiyi De Xiao Fang*)
Some desire to drink but dislike after 1-2 sips, becoming thirsty again shortly. Unlike Xiao Ke where drinking is endless. This is Middle Qi Deficiency-Cold, Cold Water flooding up, forcing floating Fire to throat/mouth. Upper Jiao wants water. If water reaches Middle Jiao, Water meets Water, which is disliked. Treatment: If red face/irritable, Lizhong Tang delivers Bawei Wan. (Comment: I used Fuzi Lizhong plus Maidong, Wuweizi, also effective.) Another type drinks, vomits shortly after, seeks drink again, cannot keep food/medicine. This is Yin Excess repelling Yang, Kidney Channel Cold Damage. Use Zhang Zhongjing's Baitong Tang added with Human Urine and Bile, hot medicine cold probe method, cures in one dose. Women often have this. (*Yiguan*)
Formulas for Clearing Fire and Generating Fluids: Internal consumption with hot urination, use Liuwu Wan.
Gualou (6 fen), Maidong (6 fen), Zhimu (6 fen), Renshen, Tugua Gen, Kushen (4 fen each).
Pulverize, mix with Ox Gallbladder bile into pills size of small beans. Take 20 pills with water. If not stopped in 3 days, increase slightly. Add Maidong for dry throat, Zhimu for dry tongue, Renshen for hypochondriac fullness, Kushen for difficult urination, Tugua Gen for multiple symptoms. Double 1 fen based on location. (*Zhouhou Beiji Fang*) *Waitai*: *Jinxiao Lun* formula removes Tugua Gen, adds Huanglian, Muli Fen, Huangqi, Shengdihuang, pill with Milk. Formula for Heat Middle with polyphagia/polyuria/emaciation removes Huangqi from above.
Treat Stomach Organ Excess Heat, constant thirst, drain heat/quench thirst, Fushen Tang.
Fushen (2 liang, Waitai says Fuling), Gualougen, Sheng Maidong (5 liang each), Sheng Dihuang (6 liang), Weirui (4 liang), Xiaomai (2 sheng), Dan Zhuye (cut 3 sheng), Dazao (20 pieces), Zhimu (4 liang).
Nine ingredients chopped. Water 3 dou. Boil Xiaomai/Zhuye to 9 sheng, strain, add remaining herbs, boil to 4 sheng. Divide into 4 doses. Drink anytime when thirsty. Not only treats Stomach Thirst, but general Heat Thirst. (*Qianjin Fang*) Also for Thirst/Diabetes with Deficient Heat, unquenchable thirst: remove Xiaomai, add Digupi, Shigao, Shengjiang.
Formula for Xiao Ke.
Gualougen, Maidong, Qiandan (8 fen each), Fushen (or Fuling), Gancao (6 fen each).
Five ingredients powdered. Take 1 cunbi with Jiangshui (fermented grain water), 3 times daily. (*Waitai* no Fushen) (*Qianjin Fang*) (Note: *Waitai* calls it Gualou San.)
Another Formula.
Huangqi, Fushen, Gualougen, Gancao, Maidong (3 liang each), Shengdihuang (5 liang).
Six ingredients chopped. Water 8 sheng. Boil to 2.5 sheng, strain, divide 3 doses. 1 dose daily. 10 doses good. (Ibid.)
Tianhua San, treats Xiao Ke.
Tianhuafen, Sheng/Gan Dihuang (washed, 1 liang each), Gan Ge, Maidong (decored), Bei Wuweizi (0.5 liang each), Gancao (1 fen).
Coarse powder. Take 3 qian with 100 grains of Jingmi, decoct together. (*Zhizhi Fang*)
Gouqi Tang (Main signs in Three Xiaos Morphology).
Gouqi branches/leaves (1 jin), Gualougen, Shigao, Huanglian, Gancao (3 liang each).
Five ingredients chopped. Water 1 dou. Boil to 3 sheng. Divide 5 doses. 3 times day, 2 times night. Severe cases mix more, drink when thirsty. (*Qianjin Fang*)
Treats Spleen/Stomach Middle Heat Irritability/Thirst, gradual emaciation.
Huanglian, Chuan Shengma, Maidong, Huangqin, Gualougen, Zhimu (1 liang each), Fushen (0.5 liang), Zhizi Ren (1 liang), Gancao (1 liang), Shigao (2 liang).
Powdered. Take 4 qian. Water 1 zhank. Boil to 60%, strain, warm drink anytime. (*Shenghui Fang*)
Renshen San, regulates Middle Xiao.
Gualougen, Renshen, Fuling, Zhimu, Gancao (1 liang each), Shigao (2 liang).