【积热三消之症】烦渴引饮，口臭消渴，上消症也。烦热多食，食下即饥，中消症也。
小便频数，如膏如油，足心下部常热，下消症也。
【积热三消之因】膏粱浓味，时积于中，积湿成热，熏于肺则成上消，伤于胃则成中消
，流于下则成下消。
【积热三消之脉】胃脉上朝于寸口，肺消也。气口滑大，胃消也。尺脉洪大，下消也。
右脉数大，肠胃积热，左脉数大，肝胆积热。
【积热三消之治】烦渴引饮，清肺饮。口臭易饥，清胃汤，加干葛。如肺胃积热，下流
膀胱，八正散。若肝胆之热下流，龙胆泻肝丸。若肾之相火下流，而成下消，凉八味丸、文蛤散。
清肺饮
清胃汤 上二方，见前条。
八正散 见前腹胀门。
龙胆泻肝汤 见前肝火胀。
凉八味丸 即六味丸加黄柏、知母。
文蛤散
文蛤杵细，滚汤调服。
【精虚三消之症】口干消渴，饮水不多，气怯喘咳，上消症也。时食时饥，饥不欲食，
中消症也。小便频数，牵引作痛，如沥如膏，下消症也。
【精虚三消之因】或悲哀伤肺，煎熬真阴，或思虑伤脾，脾阴伤损，或房劳伤肾，精日
耗而亏损，此精虚三消之因也。
【精虚三消之脉】右寸细数，肺燥液干，右关细数，脾经阴损，两尺细数，肾肝失精。
【精虚三消之治】生脉散、人参固本丸，治上消也。地黄膏、琼玉膏，治中消也。三才
封髓丹，治下消也。先见小便过多，随乃多渴，此真阳失守，下泄无度，上不能蒸动生津，《金匮》八
生脉散
人参 拣冬 北五味
人参固本丸
人参 怀生地 怀熟地 天门冬 麦门冬
地黄膏
生地 当归 丹皮 白芍药 甘枸杞 知母 人参 甘草 地骨皮
琼玉膏
人参 白蜜 生地黄 白茯苓
三才封髓丹 见后肾痹。
八味丸 见前脏寒胀。
《内经》有风消之句，消必兼风言之也。厥阴传变二阳，则成三消，然消症多饥，仲景
云∶饥不欲食，则知消症。亦有不欲食者。故能食而渴，全重二阳，饮一溲一，全重少阴，饥不
食，气上冲心，则主厥阴矣。河间云∶消渴之症，阴精极衰，燥热太过，治宜补肾水，泻心
火，润肠胃之燥热，济身中津液，使道路不结，津液不枯，气血不涩，则病自已。
[Symptoms of Sanxiao (Three Wasting-Thirst) due to Accumulated Heat]
Vexing thirst with a desire to drink copiously, bad breath accompanied by wasting-thirst symptoms, this is the manifestation of Upper Sanxiao. Vexing heat with excessive appetite, hunger occurring shortly after eating, this is the manifestation of Middle Sanxiao. Frequent urination, urine turbid like paste or oil, constant heat in the soles of the feet and lower limbs, this is the manifestation of Lower Sanxiao.
[Etiology of Sanxiao due to Accumulated Heat]
Long-term consumption of rich, greasy, and sweet foods leads to dampness accumulating in the interior, which stagnates and transforms into heat. If damp-heat steams upward to the Lung, it forms Upper Sanxiao; if it injures the Stomach, it forms Middle Sanxiao; if it flows downward to the Lower Jiao, it forms Lower Sanxiao.
[Pulse Patterns of Sanxiao due to Accumulated Heat]
When Stomach Qi ascends to the Cun Kou (inch position), indicating Xiao of the Lung [Upper Sanxiao]; when the Qi Kou pulse is slippery and large, it indicates Xiao of the Stomach [Middle Sanxiao]; when the Chi (cubit) pulse is flooding and large, it indicates Lower Sanxiao. A rapid and large pulse on the right side indicates accumulated heat in the Intestines and Stomach; a rapid and large pulse on the left side indicates accumulated heat in the Liver and Gallbladder.
[Treatment of Sanxiao due to Accumulated Heat]
For vexing thirst with a desire to drink, use Qingfei Yin (Clear the Lung Decoction). For bad breath and easy hunger, use Qingwei Tang (Clear the Stomach Decoction), added with Gan Ge (Radix Puerariae / Kudzu Root). If there is accumulated heat in the Lung and Stomach flowing downward to the Bladder, use Bazheng San (Eight-Herb Corrective Powder). If heat from the Liver and Gallbladder flows downward, use Longdan Xiegan Wan (Gentian Liver-Draining Pill). If Ministerial Fire from the Kidney flows downward, resulting in Lower Sanxiao, use Liang Bawei Wan (Cooling Eight-Ingredient Pill) or Wen Ge San (Clam Shell Powder).
Qingfei Yin
Qingwei Tang The above two formulas are seen in previous sections.
Bazheng San See the "Abdominal Distension" section previously.
Longdan Xiegan Tang See "Liver Fire Distension" previously.
Liang Bawei Wan This is Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Huangbai (Cortex Phellodendri) and Zhimu (Rhizoma Anemarrhenae).
Wen Ge San
Grind Wen Ge (Concha Meretricis / Clam Shell) into fine powder, mix with boiling water, and take orally.
[Symptoms of Sanxiao due to Essence Deficiency]
Dry mouth and wasting-thirst, but drinking little, shortness of breath with wheezing and coughing, this is the manifestation of Upper Sanxiao. Eating intermittently, feeling hungry but having no desire to eat, this is the manifestation of Middle Sanxiao. Frequent urination, dragging pain during urination, urine thin like drips or turbid like paste, this is the manifestation of Lower Sanxiao.
[Etiology of Sanxiao due to Essence Deficiency]
Either sorrow injures the Lung, frying away True Yin; or overthinking injures the Spleen, damaging Spleen Yin; or sexual excess injures the Kidney, causing essence to be consumed and depleted day by day. These are the etiologies of Sanxiao due to Essence Deficiency.
[Pulse Patterns of Sanxiao due to Essence Deficiency]
A fine and rapid pulse at the Right Cun indicates Lung dryness and fluid depletion; a fine and rapid pulse at the Right Guan indicates damage to Spleen Yin; fine and rapid pulses at both Chi positions indicate loss of essence in the Liver and Kidney.
[Treatment of Sanxiao due to Essence Deficiency]
Use Shengmai San (Generate the Pulse Powder) and Renshen Guben Wan (Ginseng Root-Solidifying Pill) to treat Upper Sanxiao. Use Dihuang Gao (Rehmannia Paste) and Qiongyu Gao (Jade-Nourishing Paste) to treat Middle Sanxiao. Use Santai Fengsui Dan (Three Heavens Sealing Marrow Pill) to treat Lower Sanxiao. If excessive urination appears first, followed by excessive thirst, this indicates that True Yang has lost its control, leaking excessively downward, and failing to steam and transform fluids upward.
Basheng Maisan (Eight-Generating Pulse Powder) from *Jinkui Yaolue*
Renshen (Radix Ginseng) Select winter-harvested Beiwudi (Fructus Schisandrae Chinensis / Schisandra Berry)
Renshen Guben Wan
Renshen (Radix Ginseng) Huaishengdi (Radix Rehmanniae Preparata / Prepared Rehmannia Root from Huaiqing) Huaishudi (Radix Rehmanniae Recens Preparata / Steamed Rehmannia Root from Huaiqing) Tianmendong (Herba Asparagi) Maidong (Radix Ophiopogonis)
Dihuang Gao
Shengdi (Radix Rehmanniae Recens / Fresh Rehmannia Root) Danggui (Radix Angelicae Sinensis) Danpi (Cortex Moutan / Tree Peony Bark) Baishaoyao (Radix Paeoniae Alba / White Peony Root) Gouqizi (Fructus Lycii / Goji Berry) Zhimu (Rhizoma Anemarrhenae) Renshen (Radix Ginseng) Gancao (Radix Glycyrrhizae / Licorice Root) Digupi (Cortex Lycii / Wolfberry Bark)
Qiongyu Gao
Renshen (Radix Ginseng) Baimi (Mell / Honey) Shengdi (Radix Rehmanniae Recens / Fresh Rehmannia Root) Bai Fuling (Poria / Chinese Poriasclerotium)
Santai Fengsui Dan See "Kidney Bi" later.
Bawei Wan See "Viscera Cold Distension" previously.
The *Neijing* mentions "Wind Xiao," indicating that Xiao disorders often involve Wind. When disease transmits from the Jueyin channel to the Two Yang channels, it becomes Sanxiao. However, Xiao disorders mostly present with hunger and eating; Zhang Zhongjing said: "Hunger without desire to eat," thus identifying it as a Xiao disorder. There are also cases with no desire to eat. Therefore, ability to eat combined with thirst primarily concerns the Two Yang channels; drinking one dou and urinating one dou primarily concerns the Shaoyin channel; hunger without desire to eat, with Qi rushing up to the heart, primarily concerns the Jueyin channel. He Jian stated: In Xiao-Thirst disorders, Yin essence is extremely deficient, and Dry-Heat is excessive. Treatment should tonify Kidney Water, drain Heart Fire, moisten the Dry-Heat of the Intestines and Stomach, and assist the body's Jin-Ye (Body Fluids), so that pathways are not blocked, Jin-Ye is not dried up, and Qi-Blood does not become stagnant, then the disease will resolve itself.