李 稚龄阳亢阴亏，一水不能胜五火之气，燔灼而成三消，上
渴，中饥，下则溲多。形体消削，身常发热。法当壮水以制亢阳。
大生地 川连 麦冬 知母 五味子 茯苓 生甘草 生石膏 牡蛎 花粉
又 夫三消，火病也。火能消水，一身津液皆干。惟水可以胜火，大养其阴，大清其火，乃治本之图。
病由远行受热，肾水内乏，当救生水之源。
大生地 沙参 五味子 麦冬 牡蛎 西洋参 桑白皮 蛤壳 天冬
侯 脾胃虚而有火，故善饥而能食；肝气盛，故又腹胀也。甘寒益胃，甘温扶脾，苦辛酸以泄肝，兼而行之。
玉竹 川石斛 麦冬 党参 冬术 白芍 吴萸炒川连 茯苓 乌梅 橘饼
渊按∶深得古人制方之意，而又心灵手敏。
查 脉沉细数而涩，血虚气郁，经事不来。夫五志郁极，皆从火化。饥而善食，小溲如脓，三消之渐。
然胸痛吐酸水，肝郁无疑。
川连 麦冬 蛤壳 鲜楝树根皮（一两，洗） 建兰叶
又 服药后，大便之坚难者化溏粪而出，原得苦泄之功也。然脉仍数涩，郁热日盛，脏阴日消。
舌红而碎，口渴消饮，血日干而火日炽。头眩、目花、带下、皆阴虚阳亢之征。当寓清泄于补正之中。
川连 淡芩 黑山栀 大生地 当归 阿胶 川芎 白芍 建兰叶
大黄 虫丸，早晚各服五丸。
渊按∶建兰叶不香无用，徐灵胎论之矣。
又 诸恙皆减。内热未退，带下未止，经事未通。仍从前法。
川连 当归 洋参 白芍 女贞子 茯苓 麦冬 丹参 沙
苑子 大生地
又 经曰∶二阳之病发心脾，女子不月，其传为风消。风消者，火盛而生风，渴饮而消水也。先辈谓
三消为火疾，久必发痈疽。屡用凉血清火之药为此。自六七月间足跗生疽之后，消症稍
重。其阴愈伤，其阳愈炽。今胸中如燔，牙痛齿落，阳明之火为剧。考阳明气血两燔者，叶氏每用玉女煎，姑仿之。
鲜生地 石膏 知母 元参 牛膝 大生地 天冬 川连 麦冬 茯苓 生甘草 枇杷叶
钱 古称三消为火病，火有余，由水不足也。十余年来常服滋阴降火，虽不加甚，终莫能除。然年逾
六旬，得久延已幸。今就舌苔黄腻而论，中焦必有湿热。近加手足麻木，气血不能灌溉
四末，暗藏类中之机。拟疏一方培养气血之虚，另立一法以化湿热之气。标本兼顾，希冀弋获。
大生地 当归 山萸肉 麦冬 洋参 怀山药 龟板 建莲肉
猪肚丸三钱，另服，开水下。
朱 脉左寸关搏数，心肝之火极炽。口干，小溲频数而混浊，此下消症也。久有香港脚，湿热蕴于下焦。
拟清心肝之火，而化肾与膀胱之湿。
大生地 川连（盐水炒） 牡蛎 黄 茅术 麦冬 赤苓 黄柏（盐水炒） 蛤粉 升麻
猪肚丸，每朝三钱，开水送。
庞 胃热移胆，善食而瘦，谓之食 。大便常坚结而不通者，胃移热于大肠也。胆移热于心，故又
心跳，头昏。今拟清胃凉胆为主，安神润肠佐之。
鲜石斛 淡芩 郁李仁 火麻仁 枳壳 枣仁 栝蒌皮 龙胆草 茯神 猪胆汁
另更衣丸一钱，淡盐花汤送下。
此病服此方五、六剂后，用滋阴如二地、二冬、沙洋参等煎胶，常服可愈。
渊按∶此似消非消之证。胆腑郁热移胃，传所不胜，故用苦寒直泻胆火。
方 脾阴虚而善饥；肾阴虚而溲数。肝气不舒，则腹中耕痛；胃气不降，则脘中痞窒。此二有余二不
足也。然有余不可泻，不足则宜补；肾充则肝自平，脾升则胃自降耳。
党参 怀山药 五味子 茯神 麦冬 冬术 大熟地 枸杞子 陈皮 红枣
仁渊曰∶三消为火证，人尽知之。而古人治火之方，如人参白虎、竹叶石膏、门冬饮子，玉女煎、
大补阴等法，多有不应者，其火固非实火，亦非寻常虚火可比。愚意谓肺肾真阴耗损，
肝肾龙相之火浮越无制，以故寻常泻火清火之药，不能治其燔灼。多饮而不能润其烦渴，多食而不能充其肌肤
者，固为邪火不杀谷，实由肺金治节无权，脾土虽转输运化，肺不能洒陈散精，以充灌六腑五脏，营卫失滋生
之本，致愈食愈瘦，并不能通调水道，膀胱气化失其常度，小便如膏如油，致愈饮愈渴。夫肺为相
傅，主一身治节。饮食转运，虽赖脾胃，而宣洒通调，则在相傅。今饮不支渴者，乃气不化津以蒸溉上焦也；
饥不充肠者，乃气不化液以周灌脏腑百骸也。金病而水绝其源，火益炽而消益甚。夫肾为水脏，为阴阳之窟
宅而藏五液。五液既损于前，母气复伤于后，一伤再伤，而病独重焉。是以仲圣肾气丸最有深意
焉。《金匮》云∶饮水一斗，小便亦一斗，肾气丸主之。不治其肺燥而治其肾燥，不独治其肾之阴，并治其
肾之阳。盖肾之阴不化，由肾之阳不腾。熟地、丹皮滋肾之阴，而佐以附、桂蒸肾之
阳，使肾阴充而肾阳升，中焦上焦均得其蒸化之力，所谓云腾致雨，品物流行，治肾即所以治肺也。若夫上
中下之分，在肺脾所伤之浅深多少。肺伤重则多上消，脾伤重则多中消，而下消则无乎不在，盖三消以肾为主也。
Patient Li, of young age, presented with hyperactive Yang and deficient Yin. The water of the Kidney (Kidney Yin) was insufficient to control the fire of the Five Zang organs, leading to scorching heat and forming San Xiao (Three Wasting-Thirst Syndrome). Symptoms included thirst in the upper jiao, hunger in the middle jiao, and polyuria in the lower jiao. The body became emaciated, and there was constant fever. The treatment principle should be to nourish Water (Kidney Yin) to restrain hyperactive Yang.
Prescription: Radix Rehmanniae Preparata (Shu Di Huang), Rhizoma Coptidis (Huang Lian), Herba Ophiopogonis (Mai Dong), Cortex Anemarrhenae (Zhi Mu), Fructus Schisandrae (Wu Wei Zi), Poria (Fu Ling), Radix Glycyrrhizae Preparata (Gan Cao), Gypsum Fibrosum (Shi Gao), Concha Ostreae (Mu Li), Radix Bupleuri (Hua Fen).
Second visit: San Xiao is a Fire disease. Fire consumes fluids, causing dryness of all body fluids. Only Water (Yin-nourishing herbs) can overcome Fire. Therefore, one must greatly nourish Yin and clearly clear Fire; this is the fundamental treatment strategy.
The disease originated from overheating during long travel, depleting internal Kidney Water. One must rescue the source of Kidney Water.
Prescription: Radix Rehmanniae Preparata (Shu Di Huang), Radix Adenophorae (Sha Shen), Fructus Schisandrae (Wu Wei Zi), Herba Ophiopogonis (Mai Dong), Concha Ostreae (Mu Li), Panax Quinquefolius (Xi Yang Shen), Radix Pulmonariae (Sang Bai Pi), Concha Meretricis (Ge Qiao), Radix Asparagi (Tian Dong).
Patient Hou, has Spleen-Stomach deficiency with internal heat, hence easy hunger and ability to eat; Liver Qi is excessive, hence abdominal distension. Treatment should employ Sweet-Cold herbs to benefit the Stomach, Sweet-Warm herbs to support the Spleen, and Bitter-Pungent-Sour herbs to drain the Liver, applying them concurrently.
Prescription: Rhizoma Polygonati Odorati (Yu Zhu), Caulis Dendrobii (Chuan Shi Hu), Herba Ophiopogonis (Mai Dong), Radix Codonopsis (Dang Shen), Rhizoma Atractylodis Macrocephalae (Dong Zhu), Radix Paeoniae Alba (Bai Shao), Rhizoma Coptidis stir-fried with Evodia Fruit (Wu Yu Chao Chuan Lian), Poria (Fu Ling), Fructus Mume (Wu Mei), Tangerine Peel Candy (Ju Bing).
Note by Yuan: Deeply grasps the intent of ancient prescription formulation, showing mental agility and manual dexterity.
Patient Zha, pulse is deep, fine, rapid, and choppy, indicating Blood deficiency and Qi stagnation, resulting in amenorrhea. Extreme depression of the Five Emotions transforms into Fire. Although hungry and eating well, urine resembles pus, signaling the onset of San Xiao.
However, chest pain and acid regurgitation confirm Liver Qi stagnation beyond doubt.
Prescription: Rhizoma Coptidis (Huang Lian), Herba Ophiopogonis (Mai Dong), Concha Meretricis (Ge Qiao), Fresh Cortex Meliae Toosendan (Xian Lian Gen Pi, 1 liang, washed), Leaf of Cymbidium goeringii (Jian Lan Ye).
Second visit: After taking medicine, previously hard stools passed as loose feces, benefiting from the bitter-draining action. However, the pulse remains rapid and choppy,郁热 (stagnant heat) increases daily, and Zang Yin declines daily.
The tongue is red with cracks, thirst drives excessive drinking, Blood dries further while Fire intensifies. Dizziness, blurred vision, and leukorrhea are signs of Yin deficiency and Yang hyperactivity. Clearing and draining should be embedded within tonification.
Prescription: Rhizoma Coptidis (Huang Lian), Radix Scutellariae (Dan Qin), Fructus Gardeniae Ustus (Hei Shan Zhi), Radix Rehmanniae Recens (Da Sheng Di), Radix Angelicae Sinensis (Dang Gui), Colla Corii Asini (E Jiao), Radix Chuanxiong (Chuan Xiong), Radix Paeoniae Alba (Bai Shao), Leaf of Cymbidium goeringii (Jian Lan Ye).
Da Huang Zhong Wan (Rhubarb and Ground Beetle Pill), five pills morning and evening.
Note by Yuan: Jian Lan Ye is odorless and useless, as discussed by Xu Lingtai.
Third visit: All ailments have decreased. Internal heat has not subsided, leukorrhea has not stopped, menstruation has not resumed. Continue previous method.
Prescription: Rhizoma Coptidis (Huang Lian), Radix Angelicae Sinensis (Dang Gui), Panax Quinquefolius (Yang Shen), Radix Paeoniae Alba (Bai Shao), Fructus Ligustri Lucidi (Nv Zhen Zi), Poria (Fu Ling), Herba Ophiopogonis (Mai Dong), Radix Salviae Miltiorrhizae (Dan Shen), Semen Astragali Complanati (Sha Yuan Zi), Radix Rehmanniae Preparata (Da Sheng Di - *Note: Text says Da Sheng Di here but usually implies Shu Di or both in context, sticking to text*).
Fourth visit: The Classic states: "Diseases of the Two Yangs originate in the Heart and Spleen; in women, amenorrhea, which transmits to Feng Xiao." Feng Xiao refers to Fire excess generating Wind, where excessive drinking leads to wasting. Predecessors stated that San Xiao is a Fire disease, which over time must develop into carbuncles and sores. Previous use of blood-cooling and fire-clearing medicines was for this purpose. Since developing a carbuncle on the dorsum of the foot between June and July, the Xiao symptoms worsened. Yin is increasingly damaged, Yang increasingly blazing. Now the chest feels like burning, toothache and tooth loss occur, indicating severe Yangming Fire. Examining cases of Qi and Blood simultaneous blazing in Yangming, Ye Tianshi often used Yu Nu Jian. I will tentatively imitate this.
Prescription: Radix Rehmanniae Recens (Xian Sheng Di), Gypsum Fibrosum (Shi Gao), Cortex Anemarrhenae (Zhi Mu), Radix Scrophulariae (Yuan Shen), Radix Achyranthis Bidentatae (Niu Xi), Radix Rehmanniae Preparata (Da Sheng Di), Radix Asparagi (Tian Dong), Rhizoma Coptidis (Chuan Lian), Herba Ophiopogonis (Mai Dong), Poria (Fu Ling), Radix Glycyrrhizae Preparata (Sheng Gan Cao), Folium Eriobotryae (Pi Pa Ye).
Patient Qian, ancient texts call San Xiao a Fire disease. Excess Fire arises from insufficient Water. For over ten years, he has taken Yin-nourishing and Fire-descending medicines; although not worsening, they have not cured it. However, being over sixty, prolonging life is fortunate. Currently, the yellow greasy tongue coating indicates Damp-Heat in the Middle Jiao. Recently added numbness in hands and feet, indicating Qi and Blood failing to irrigate the extremities, hiding the mechanism of stroke (Lei Zhong). I propose a formula to cultivate Qi and Blood deficiency, and another method to resolve Damp-Heat. Addressing both root and branch, hoping for success.
Prescription: Radix Rehmanniae Preparata (Da Sheng Di), Radix Angelicae Sinensis (Dang Gui), Fructus Corni (Shan Yu Rou), Herba Ophiopogonis (Mai Dong), Panax Quinquefolius (Yang Shen), Rhizoma Dioscoreae Hypoglaucae (Huai Shan Yao), Testudinis Carapax et Plastrum (Gui Ban), Endocarpium Nelumbinis (Jian Lian Rou).
Zhu Du Wan (Pig Stomach Pill) 3 qian, taken separately with warm water.
Patient Zhu, pulse at Left Cun and Guan is forceful and rapid, indicating extreme blazing of Heart and Liver Fire. Dry mouth, frequent turbid urination, this is Xia Xiao (Lower Wasting-Thirst). Long-standing Hong Kong Foot (Tinea Pedis/Gouty Arthritis), Damp-Heat accumulating in Lower Jiao.
Propose clearing Heart and Liver Fire, while transforming Dampness in Kidney and Bladder.
Prescription: Radix Rehmanniae Preparata (Da Sheng Di), Rhizoma Coptidis (Salt-fried) (Chuan Lian), Concha Ostreae (Mu Li), Radix Astragali (Huang Qi), Rhizoma Atractylodis Lanceae (Mao Zhu), Herba Ophiopogonis (Mai Dong), Poria (Chi Ling), Cortex Phellodendri (Salt-fried) (Huang Bo), Concha Tridacnae (Ge Fen), Rhizoma Cimicifugae (Sheng Ma).
Zhu Du Wan (Pig Stomach Pill), 3 qian every morning, taken with warm water.
Patient Pang, Stomach Heat transfers to Gallbladder, good appetite but emaciation, called Shi Dan (Food Gluttony/Wasting). Stools are often hard and obstructed, Stomach transferring Heat to Large Intestine. Gallbladder Heat transfers to Heart, hence palpitations and dizziness. Now propose clearing Stomach and cooling Gallbladder as main, assisting with calming Spirit and moistening Intestines.
Prescription: Caulis Dendrobii (Xian Shi Hu), Radix Scutellariae (Dan Qin), Semen Pruni Armeniacae (Yu Li Ren), Semen Cannabis (Huo Ma Ren), Pericarpium Aurantii (Zhi Ke), Semen Ziziphi Spinosae (Zao Ren), Pericarpium Trichosanthis (Gua Lou Pi), Radix Gentianae (Long Dan Cao), Poria (Fu Shen), Bile Porci (Zhu Dan Zhi).
Ling Yi Wan (Change Clothing Pill) 1 qian, taken with light salt flower water.
After 5-6 doses of this formula, using Yin-nourishing decoctions such as Er Di (Sheng Di, Shu Di), Er Dong (Tian Dong, Mai Dong), Sha Shen, Yang Shen etc., made into gelatin, taken regularly can cure.
Note by Yuan: This appears to be a non-Xiao condition resembling Xiao. Gallbladder Fu organ stagnant Heat transfers to Stomach, transmitting to what it cannot overcome, thus using Bitter-Cold to directly drain Gallbladder Fire.
Patient Fang, Spleen Yin deficiency causes easy hunger; Kidney Yin deficiency causes polyuria. Liver Qi not soothing causes abdominal gnawing pain; Stomach Qi not descending causes epigastric fullness and obstruction. This is two excesses and two deficiencies. However, excess should not be drained, deficiency should be tonified; when Kidney is filled, Liver calms itself; when Spleen ascends, Stomach descends naturally.
Prescription: Radix Codonopsis (Dang Shen), Rhizoma Dioscoreae Hypoglaucae (Huai Shan Yao), Fructus Schisandrae (Wu Wei Zi), Poria (Fu Shen), Herba Ophiopogonis (Mai Dong), Rhizoma Atractylodis Macrocephalae (Dong Zhu), Radix Rehmanniae Preparata (Da Shu Di), Fructus Lycii (Gou Qi Zi), Pericarpium Citri Reticulatae (Chen Pi), Fructus Jujubae (Hong Zao).
Ren Yuan said: San Xiao is a Fire syndrome, everyone knows this. But ancient formulas for treating Fire, such as Ren Shen Bai Hu Tang, Zhu Ye Shi Gao Tang, Men Dong Yin Zi, Yu Nu Jian, Da Bu Yin Wan, etc., often fail. This Fire is certainly not Excess Fire, nor ordinary Deficiency Fire. My opinion is that True Yin of Lung and Kidney is depleted, Dragon and Minister Fire of Liver and Kidney floats up without restraint. Thus, ordinary Fire-draining and Fire-clearing medicines cannot treat this scorching. Drinking much does not moisten vexatious thirst, eating much does not fill the body. Indeed, Evil Fire fails to digest food, but actually it is because Lung Metal lacks governance authority. Although Spleen Earth transports and transforms, Lung cannot sprinkle and disseminate essence to fill the Six Fu and Five Zang. Ying and Wei lose their source of generation, leading to becoming thinner despite eating more. It also fails to regulate water passages, Bladder Qi transformation loses its normal degree, urine resembles paste or oil, leading to increased thirst despite drinking. The Lung is the Prime Minister, governing governance of the whole body. Food transport relies on Spleen and Stomach, but dispersion and regulation lie with the Prime Minister. Now, drinking does not relieve thirst, because Qi fails to transform Jin into fluid to steam and irrigate Upper Jiao; hunger does not fill the intestines, because Qi fails to transform fluid to circulate to Zang-Fu and bones. Lung disease cuts off the source of Water, Fire blazes more and Xiao worsens. The Kidney is the Water Organ, the residence of Yin and Yang, storing the Five Fluids. If Five Fluids are damaged before, Mother Qi is injured after, injury upon injury makes the disease heavy. Thus, Zhong Jing's Shen Qi Wan has profound meaning. The *Jin Gui* says: "Drink one dou of water, urinate one dou of water, Shen Qi Wan governs it." Treating Kidney dryness rather than Lung dryness, treating not only Kidney Yin but also Kidney Yang. Because Kidney Yin fails to transform due to Kidney Yang failing to ascend. Shu Di and Mu Dan Pi nourish Kidney Yin, assisted by Fu Zi and Gui Zhi to steam Kidney Yang, making Kidney Yin full and Kidney Yang ascending. Middle and Upper Jiao receive steaming power, as clouds rise to bring rain, products flow and move. Treating Kidney is treating Lung. Regarding Upper, Middle, Lower divisions, it depends on the depth and extent of Lung and Spleen damage. Severe Lung damage leads to mostly Shang Xiao, severe Spleen damage leads to mostly Zhong Xiao, while Xia Xiao is everywhere, for San Xiao is primarily governed by the Kidney.