消分上中下三症，谓消渴、消谷、消肾也。皆水火不交，燥热伤阴所致。故经云二阳结谓之消。手阳明
大肠主津，足阳明胃主液，二经燥结失润，故为消。上消主肺，肺热化燥，渴饮无度，是为消渴，经所谓心
移热于肺，传为鬲消也。中消主胃，胃热善饥，能食而瘦，是为消谷，经所谓瘅，成为消中也。下消主肾，虚阳
烁阴，引水自救溺浊如膏，精髓枯竭，是为肾消，经所谓肾热病苦渴数饮身热也。三消之症，上轻中重、
下危。然上中不甚，则不传下矣。故肾消者乃上中消之传变，肺胃之热入肾，消烁肾脂、饮一溲二，溲如膏油。
盖肺主气，肺病则不能管束津液，上朝咽嗌，而尽输于下，其精微亦随溲下也，且消之由于火盛者，
阳消症也。亦有气血消乏而为阴消症者，如经曰心移寒于肺，为肺消，饮一溲二，死不治。景岳以为元阳
大衰，金寒水冷，水不化气，而气悉化为水也。《脉经》曰∶心脉微小为消瘅，可知症多阳虚，而火多假火。
故治三消者，必察其脉气病气形气。但见本源亏竭，及假火症，当速救根本以滋化源，勿专以清火为急。故
《金匮》云∶男子消渴，小便反多，饮一斗，小便一斗，八味丸主之。所以助气化，使津液得升也。赵养葵亦
曰∶治消症无分上中下，但滋肺肾。上消小剂，中消中剂，下消大剂。概用六味丸加麦冬、五味。或命门火不
归源，游于肺为上消，游于胃为中消，惟引火归源，宜八味丸。使火归釜底，水火既济，气上熏蒸，肺受津润，
消渴自止。若过用寒凉，恐内热未除，中寒又起。古法以人参白虎汤治上消，以调胃承气汤治中消者，非也。
必右寸滑数，热伤肺气，乃可人参白虎汤。必右关数实，湿热内蕴，乃可调胃承气汤。又经云∶二阳之病发
心脾，有不得隐曲，其传为风消。谓忧伤心，思伤脾，郁结不遂，则营液暗耗，胃大肠俱失通润，而肌肉风消
也。宜归脾汤送固本丸，或生脉散。此亦阴消之类，今统论之。消症气分渴者，喜饮冷水，宜寒凉渗剂以清
热。血分渴者，喜饮热茶，宜甘温峻剂以和阴。须细诊脉之上下左右滑数沉细，以定其有余不足而审治之。如
上消气分燥渴者，黄芩汤。血分燥热者，易简地黄饮之。气血燥热者，竹叶黄 汤。肺火消渴，咽干便秘者，
生津饮。心火消渴，小水赤涩者，清心莲子饮。心火上炎，肾水不济，气血日消者，降心汤。消渴夜甚者，加
减地黄丸。消渴溺少身肿者，紫苏汤。消渴脉浮微热，小水不利者，五苓散。鬲消胃满心烦者，麦门冬饮子。
老人虚人消渴者，人参麦冬汤。通治上消，天花粉散。中消能食而瘦，渴饮便秘溺数者，兰香饮子。食已如饥，
胃热脉盛，面黄肌瘦，胸满胁胀者，七味白术散。胃火易饥，热在肌肉者，泻黄散。胃热干渴，水亏火炎者，
玉女煎。心肺热渴者，丹溪藕汁膏。脾肺津干，不思饮食者，本事黄 汤。通治中消，黄连猪肚丸。中消后，
胃热传肾，消烁脂液，腿细足痿者，白茯苓丸。下消渴饮，溺如膏油者，治宜摄固，元菟丸、秘元煎。肾消
虚涩者，通摄兼施，双补丸。肾
消淋浊有火者，补而兼泻，六味丸加知、柏，或大补地黄丸。淋浊无火者，补而兼摄，下左饮，或大补元煎。
火衰不能化气，气虚不能化液者，益火之源，加减肾气丸，或八味丸、右归饮。无火而滑，小溲无度者，益
阳固阴，鹿茸丸。肾消强中，茎长而坚，精自出者，此孤阳外张，阴不内守，难治。由好色纵淫，或饵丹石，
阳起石、钟乳粉之类。《直指》曰∶服五石者，真气既尽，石性独留，阳道兴举，不交精泄，名曰强中，
不可治。其饮食如汤沃雪，久则阳强精脱，石子荠 汤。通治下消，加减八味丸。三消久，小水不臭反甜者，
此脾气下脱，症最重。七味白术散。若溺后，溺面浮脂者，此膏液下流，肾不约制。白术散、肾气丸。外有脾
热口甜，为消瘅。经谓数食肥甘，其气上溢，转为消渴，经用兰草汤效。肥令人内热，甘令人中满，治之以兰，
除陈气也。此膏粱酿热涸津，即消中之渐，宜地黄饮子、玉泉丸。有食 ， ，易也。饮食移易而过，不生
肌肉也。经谓大肠移热于胃，善食而瘦，胃移热于胆，皆名食 ，治同中消。有酒渴，由嗜酒积热烦渴，专
嗜冷物，乌梅木瓜汤。有虫渴，脏腑生虫，耗津液而成消渴，苦楝子汤。其有渴饮一二口即厌，少顷复渴，
但不若消渴者之无厌，此中气虚寒，寒水上泛，逼其浮游之火于喉舌间，故上焦欲得水救，水到中焦，以水
遇水，即厌也。如面赤烦躁，宜理中汤送八味丸。凡渴而不能食者，末传。中满，鼓胀，能食而渴者，必发脑
疽、背痈、皆不治。此又消渴之传变，所必防者。《本事》曰∶消渴全因坎水衰少，肾阳不升。肺为华盖，
譬板覆釜，暖气上腾，则板能润。若肾气能蒸化，则饮食精液上升，自免干渴，宜八味丸。
徐忠可曰∶消因肾虚，或因二阳结，或为厥阴病。其能食而渴者，宜重二阳论治。其饥不欲食，气撞心者，
宜重厥阴论治。仲景《伤寒论》，厥阴之为病，消渴，气上撞心，饥而不欲食，皆由厥阴风郁火燔也。其饮一
溲二者，宜重肾虚论治，此临症时所宜细辨也。
缪仲淳曰∶三消渴疾，以 鱼涎，和黄连末为丸，每五七丸，乌梅汤下，日三服效。以白芍、甘草
等分为末，每一钱水煎，
日三服。有患消渴九年，服药止而复作，得是方服之，七日顿愈。不可以其平易而忽之。以栝蒌根即天花粉、
黄连各三两为末，蜜丸，每三十丸，麦冬汤下，日二服。其饮水无度，小便数者，用田螺五升，水一斗，浸
一夜，渴即饮之，每日一换水及螺，或煮食饮汁亦妙。饮水无度，小便赤涩者，用秋麻子仁一升，水三升，
煮三四沸、饮不过五升瘥。肾消饮水，溺如膏油者，用茴香、苦楝子等分炒，研末，食前酒服二钱。消渴下
元虚者，用牛膝末酒蒸五两，生地汁五升浸，日晒夜浸，汁尽为度，蜜丸，酒下三十丸。久服津液自生。
胃虚消渴者，羊肚煮烂，空腹食之。消渴烦乱者，干冬瓜瓤一两，水煎服。消渴羸瘦，小便不禁者，兔骨
和大麦苗煮汁，服极效。消中易饥者，用苁蓉、山萸、五味、蜜丸，每盐、酒下三十丸。三消骨蒸者，以冬瓜
自然汁、浸晒黄连末七次，又以冬瓜汁和丸，每三四十丸，大麦汤下，寻常口渴，一服效。
Xiao (Wasting and Thirsting) syndrome is divided into three types: upper, middle, and lower, referred to as Xiao Ke (Wasting-Thirst), Xiao Gu (Consumption of Food/Multi-eating), and Xiao Shen (Kidney Consumption). These conditions are all caused by the failure of water and fire to interact, with dryness-heat injuring Yin fluids. Thus, the Classics state: "The binding of the Two Yangs leads to Xiao." The Hand-Yangming Large Intestine channel governs Jin-Ye (Body Fluids), and the Foot-Yangming Stomach channel governs Ye (Turbid Fluids); when these two channels suffer from dryness-binding and loss of lubrication, Xiao results.
Upper Xiao primarily involves the Lung. Lung heat transforms into dryness, causing excessive thirst and drinking without limit; this is Xiao Ke. As the Classics say: "Heart transfers heat to the Lung, transmitting it as Ge Xiao (Diaphragm Consumption)." Middle Xiao primarily involves the Stomach. Stomach heat causes easy hunger; one can eat but becomes emaciated; this is Xiao Gu. As the Classics say: "Dan (Feverish Heat) becomes Xiao Zhong (Middle Consumption)." Lower Xiao primarily involves the Kidney. Deficient Yang scorches Yin essence; the patient draws water to save themselves, urine is turbid like paste, essence and marrow are depleted; this is Kidney Xiao. As the Classics say: "Kidney heat disease suffers from thirst, frequent drinking, and body heat."
Among the symptoms of the Three Xiao's, Upper is mild, Middle is severe, and Lower is critical. However, if Upper and Middle are not severe, they will not transmit to the Lower Jiao. Therefore, Kidney Xiao is often a progression from Upper and Middle Xiao; that is, heat from the Lung and Stomach enters the Kidney, consuming Kidney fat, resulting in drinking one dou and urinating two dou, with urine resembling oil paste.
Generally, the Lung governs Qi. When the Lung is diseased, it cannot control Jin-Ye, preventing them from ascending to the throat and instead transporting them entirely downward; their refined essences also follow the urine downward. Moreover, Xiao caused by excessive Fire belongs to Yang Xiao. There are also cases of Yin Xiao caused by the depletion of Qi and Blood. For example, the Classics state: "Heart transfers cold to the Lung, forming Lung Xiao; drinking one dou and urinating two dou indicates a fatal prognosis." Zhang Jingyue believed this was due to the great decline of Primordial Yang, where Metal is cold and Water is cold, so Water fails to transform into Qi, and Qi entirely transforms into Water. The *Mai Jing* states: "A minute and small Heart pulse indicates Xiao Dan," indicating that such symptoms are mostly due to Yang deficiency, and the apparent Fire is often False Fire.
Therefore, treating the Three Xiao's requires observing the patient's Mai Qi (Pulse Qi), Bing Qi (Pathogenic Qi), and Xing Qi (Constitutional Qi). Whenever the root source is exhausted or False Fire symptoms appear, one must quickly rescue the root to nourish the Source of Transformation, rather than focusing solely on clearing Fire urgently. Thus, the *Jin Gui Yao Lue* states: "In men with Xiao Ke, urine is surprisingly abundant; drinking one dou results in one dou of urine; Ba Wei Wan (Eight-Ingredient Pill) is the primary treatment." This aids Qi transformation, allowing Jin-Ye to ascend. Zhao Yangkui also stated: Treating Xiao syndrome does not distinguish between Upper, Middle, and Lower; one only needs to nourish the Lung and Kidney. Use small doses for Upper Xiao, medium doses for Middle Xiao, and large doses for Lower Xiao, generally using Liu Wei Wan (Six-Ingredient Pill) plus Mai Dong (Ophiopogon Root) and Wu Wei Zi (Schisandra Fruit). Or, if the Fire of the Gate of Vitality (Ming Men) fails to return to its source and wanders to the Lung, it becomes Upper Xiao; wandering to the Stomach, it becomes Middle Xiao. Only by guiding Fire back to its source is Ba Wei Wan suitable. This makes Fire return to the bottom of the cauldron, achieving the intersection of Water and Fire. Qi steams upward, moistening the Lung, and Xiao Ke stops naturally. If cold-cooling herbs are overused, internal heat may remain while Spleen-Stomach cold arises.
Ancient methods using Ren Shen Bai Hu Tang (Ginseng and White Tiger Decoction) for Upper Xiao and Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct Downward Decoction) for Middle Xiao are incorrect. Ren Shen Bai Hu Tang is only applicable if the Right Cun (Cun position on the radial artery) pulse is slippery and rapid, indicating heat injuring Lung Qi. Tiao Wei Cheng Qi Tang is only applicable if the Right Guan (Guan position) pulse is rapid and excess, indicating damp-heat accumulating internally. Furthermore, the Classics state: "Diseases of the Two Yangs originate in the Heart and Spleen; if there are hidden grievances, it transmits into Feng Xiao (Wind Consumption)." This means sorrow injures the Heart, worry injures the Spleen, and stagnation prevents smooth flow, causing Ying (Nutritive) fluids and Jin-Ye to be secretly consumed. The Stomach and Large Intestine lose lubrication, leading to muscle wasting as if blown away by wind. Gui Pi Tang (Restore the Spleen Decoction) administered with Gu Ben Wan (Solidify the Root Pill), or Sheng Mai San (Generate the Pulse Powder), are appropriate. This also belongs to the category of Yin Xiao and is discussed here together.
For Xiao involving Qi-fraction thirst, patients prefer cold water; cold-cooling and leaching agents should be used to clear heat. For Xiao involving Blood-fraction thirst, patients prefer hot tea; sweet-warm and vigorous tonics should be used to harmonize Yin. One must carefully diagnose the pulse's positions (upper/lower, left/right) and qualities (slippery/rapid/deep/fine) to determine excess or deficiency and treat accordingly.
- For Upper Xiao Qi-fraction dry thirst: Huang Qin Tang (Scutellaria Decoction).
- For Blood-fraction dry heat: Yi Jian Di Huang Yin (Simple Rehmannia Decoction).
- For Qi-Blood dry heat: Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction).
- For Lung Fire Xiao Ke with dry throat and constipation: Sheng Jin Yin (Generate Fluids Drink).
- For Heart Fire Xiao Ke with red, scanty, painful urination: Qing Xin Lian Zi Yin (Clear Heart Lotus Seed Decoction).
- For Heart Fire flaming upward, Kidney Water failing to assist, with daily consumption of Qi-Blood: Jiang Xin Tang (Descend Heart Decoction).
- For Xiao Ke worsening at night: Jia Jian Di Huang Wan (Modified Rehmannia Pill).
- For Xiao Ke with scanty urine and edema: Zi Su Tang (Perilla Decoction).
- For Xiao Ke with floating pulse, slight heat, and difficult urination: Wu Ling San (Five-Ingredient Powder with Poria).
- For Ge Xiao with stomach fullness and vexation: Mai Men Dong Yin Zi (Ophiopogon Decoction).
- For elderly or deficient persons with Xiao Ke: Ren Shen Mai Dong Tang (Ginseng and Ophiopogon Decoction).
- General treatment for Upper Xiao: Tian Hua Fen San (Trichosanthes Root Powder).
For Middle Xiao with ability to eat yet emaciation, thirst, constipation, and frequent urination: Lan Xiang Yin Zi (Orchid Fragrance Decoction).
For feeling hungry immediately after eating, with Stomach heat, strong pulse, sallow complexion, emaciation, chest fullness, and hypochondriac distension: Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder).
For Stomach Fire causing easy hunger and heat in the muscles: Xie Huang San (Drain Yellow Powder).
For Stomach Fire dry thirst, Yin deficiency with Fire flaring: Yu Nu Jian (Jade Woman Decoction).
For Heart-Lung heat-thirst: Dan Xi Ou Zhi Gao (Danxi Lotus Juice Paste).
For Spleen-Lung fluid dryness and lack of appetite: Ben Shi Huang Qi Tang (Essential Capacity Astragalus Decoction).
- General treatment for Middle Xiao: Huang Lian Zhu Du Wan (Coptis Pig Stomach Pill).
After Middle Xiao, if Stomach heat transmits to the Kidney, consuming fat/fluids, leading to thin legs and weak feet: Bai Fu Ling Wan (White Poria Pill).
For Lower Xiao with thirst/drinking and urine like oil paste: Treatment should focus on securing and consolidating. Yuan Tu Wan (Yuan Cuspidary Pill) or Mi Yuan Jian (Secret Origin Decoction) are used.
For Kidney Xiao with deficiency and obstruction: Combine unblocking and securing; Shuang Bu Wan (Double Tonifying Pill) is used.
For Kidney Xiao with strangury/turbidity and Fire: Tonify while draining; Liu Wei Wan plus Zhi Mu (Anemarrhena Rhizome) and Huang Bo (Phellodendron Bark), or Da Bu Di Huang Wan (Great Tonifying Rehmannia Pill).
For strangury/turbidity without Fire: Tonify while securing; Xia Zuo Yin (Lower Left Drink) or Da Bu Yuan Jian (Great Tonify Origin Decoction).
For declining Fire failing to transform Qi, and deficient Qi failing to transform fluids: Benefit the Source of Fire; Jia Jian Shen Qi Wan (Modified Kidney Qi Pill), Ba Wei Wan, or You Gui Yin (Right Restoration Decoction).
For absence of Fire with slipping/sliding and unlimited urination: Benefit Yang and secure Yin; Lu Rong Wan (Deer Antler Pill).
For Kidney Xiao Qiang Zhong (Priapism/Excessive Sexual Drive), with prolonged erection and spontaneous seminal emission: This is isolated Yang expanding outward, Yin failing to hold inward; it is difficult to treat. It arises from lust or taking cinnabar/mineral drugs like Yang Qi Shi (Stibnite) or Zhong Ru Fen (Galena Powder). The *Zhi Zhi Fang* states: Those who take Five Minerals Powder exhaust their True Qi, leaving only the mineral nature. The male organ erects, semen leaks without intercourse, named Qiang Zhong, which is incurable. Their digestion is like snow melting in boiling water; eventually, Yang remains strong while essence depletes. Shi Zi Ji Tang (Stone Seed Shepherd's Purse Decoction) is used.
- General treatment for Lower Xiao: Jia Jian Ba Wei Wan (Modified Eight-Ingredient Pill).
If Xiao persists long-term and urine loses its odor becoming sweet: This is Spleen Qi sinking; the condition is most severe. Qi Wei Bai Zhu San is used.
If lipid floats on the urine surface after urination: This is paste-fluid flowing downward, Kidney failing to constrain. Bai Zhu San and Shen Qi Wan are used.
Additionally, Spleen heat causing a sweet taste in the mouth is called Xiao Dan. The Classics state: Frequent consumption of rich/greasy foods causes Qi to overflow upward, transforming into Xiao Ke. Lan Cao Tang (Calystegia Decoction) is effective. Greasy food causes internal heat; sweet food causes central fullness. Treating with Calystegia removes stale Qi. This is heat generated by rich diet drying fluids, the initial stage of Xiao Zhong. Di Huang Yin and Yu Quan Wan are appropriate.
There is Shi Dan (Food Consumption), where food passes through easily without generating muscle. The Classics state: Large Intestine transferring heat to the Stomach causes easy eating and emaciation; Stomach transferring heat to the Gallbladder is also named Shi Dan. Treatment is the same as Middle Xiao.
There is Jiu Ke (Alcohol Thirst), caused by accumulated heat from alcohol abuse, leading to vexation/thirst and craving cold items. Wu Mei Mu Gua Tang (Medlar and Papaya Decoction) is used.
There is Chong Ke (Parasite Thirst), where parasites in the Zang-Fu consume fluids causing Xiao Ke. Ku Lian Zi Tang (Chinaberry Decoction) is used.
Some cases involve drinking only one or two sips before rejection, then thirst returns shortly after, but unlike typical Xiao Ke, it is not insatiable. This is due to Middle Qi deficiency-cold, with Cold Water surging upward, forcing Floating Fire to the throat/tongue. The Upper Jiao desires water for relief, but when water reaches the Middle Jiao, water meets water, causing rejection. If accompanied by red face and vexation, Li Zhong Tang (Regulate the Center Decoction) administered with Ba Wei Wan is suitable.
Any case of thirst with inability to eat indicates late-stage transmission. Cases with central fullness/bloating, or those who can eat yet thirst, will likely develop Brain Carbuncles or Back Abscesses; these are untreatable. This is another progression of Xiao Ke that must be prevented. The *Ben Shi Fang* states: Xiao Ke is entirely due to the decline of Kan Water (Kidney Water) and failure of Kidney Yang to ascend. The Lung is the Canopy; like a board covering a pot, if warm steam rises, the board becomes moist. If Kidney Qi can vaporize, dietary essence ascends, naturally avoiding dryness-thirst. Ba Wei Wan is suitable.
Xu Zhongke stated: Xiao is due to Kidney deficiency, or binding of the Two Yangs, or Jueyin disease. For those who can eat and thirst, treat focusing on the Two Yangs. For those who feel hungry but do not want to eat, with Qi rushing to the heart, treat focusing on Jueyin. In Zhang Zhongjing's *Shang Han Lun*, Jueyin disease presents with Xiao Ke, Qi rushing to the heart, hunger without desire to eat, all due to Jueyin Wind stagnation and Fire blazing. For those drinking one dou and urinating two dou, treat focusing on Kidney deficiency. This requires careful differentiation during clinical practice.
Miao Zhongchun stated: To treat the Three Xiao's thirst diseases, use Fish Saliva mixed with Coptis powder into pills. Take 5-7 pills with Medlar Decoction, three times daily, for efficacy. Alternatively, equal parts White Peony Root and Licorice Root powdered, decocted with water (1 qian), taken three times daily. A patient suffering from Xiao Ke for nine years, whose symptoms returned after stopping medication, was cured in seven days with this formula. Do not neglect it because it is simple. Another method: Trichosanthes Root and Coptis (3 liang each) powdered, honey-pilled, take 30 pills with Ophiopogon Decoction, twice daily. For excessive drinking and frequent urination, soak 5 sheng of river snails in 1 dou of water overnight; drink when thirsty, changing water and snails daily. Or boil and drink the juice. For excessive drinking and red/scanty urination, boil 1 sheng of Autumn Hemp Seed Kernel in 3 sheng of water for 3-4 boils; drink up to 5 sheng to recover. For Kidney Xiao drinking and urine like paste, stir-fry equal parts Fennel and Chinaberry, powder, take 2 qian with wine before meals. For Xiao Ke with lower Yuan deficiency, steam 5 liang of Achyranthes powder with wine, soak in 5 sheng of Rehmannia juice, sun-dry by day and soak by night until juice is exhausted, honey-pilled, take 30 pills with wine. Long-term use generates fluids spontaneously. For Stomach deficiency Xiao Ke, boil pig stomach until soft and eat on an empty stomach. For Xiao Ke with vexation/confusion, decoct 1 lian of dried winter melon rind in water. For Xiao Ke with emaciation and urinary incontinence, boil rabbit bone and barley seedlings; drinking the juice is extremely effective. For Xiao Zhong with easy hunger, use Cistanche, Cornus, and Schisandra honey-pilled, take 30 pills with salt/wine. For Three Xiao's bone-steaming fever, soak dried Coptis powder in natural winter melon juice seven times, then pill with winter melon juice; take 30-40 pills with barley soup. For ordinary thirst, one dose is effective.