脉 两寸脉滑者为上消。两关洪数者为中消。两尺浮大为下消。濡散为气实血虚。洪大为阳
盛阴虚。脉沉小有力者可治。实大浮涩者皆难治。
症 内经云∶二阳结谓之消。东垣云∶二阳者。手足阳明也。手阳明。大肠主津。病则目
黄口干。是津不足也。足阳明。胃主血。热则消谷善饥。胃中伏火。火烁而血干涸也。津血
不足。而消渴生矣。虽有三者之分。因于火则一也。上消者心移热于肺。多饮而渴。少食而
呕。中消者。脾移热于胃也。善食而瘦。大便燥。而小便黄。下消者。肾移热于膀胱也小便
淋浊。如脂膏之状。大抵渴症皆因膏粱甘肥之变。或过服金石热药。致阳盛阴虚。津液不足
。结而不润。皆责于火也。
治 宜养肺降火生血为主。或曰上消渴。是心火刑炼肺金所致。治宜降火清金。以黄连、麦
门冬、兰草、白豆蔻、仁梨、藕汁，加升麻、黄柏、之类。清气上升。而渴自止矣。中消渴者。
胃中伏火。不生津液。食已则饥。不营肌肉。宜芩、
连、石膏、治之。甚者。调胃承气汤。下消渴者。烦躁引饮。耳叶焦。小便如膏。正所谓焦
烦水易亏是也。此为肾消。宜六味地黄丸主之。圣济总录云∶未传能食者。必发痈疽背疮。不
能食者。必得中满豉胀。背为不治之症。洁古分而治之。能食而渴者。白虎加人参汤。不能
食而渴者。钱氏白术散。倍加干葛治之。上下既平。则不复传下矣。
方 五汁饮总治三消
川黄连（一钱五分） 麦门冬（一钱五分） 天花粉（一钱） 生甘草（三分） 人参（八分） 石膏
（一钱五分） 知母（一钱五分） 归身（一钱） 白芍药（八分） 黄柏（七分） 梨汁（以下临服
加入） 藕汁 生地黄汁 人乳汁（各一盏） 姜汁（二匙） 竹沥（半盏）
上作一服。加兰草叶一钱。同煎。食远服。临服时。将五汁加入。连药服之。外无加减。
Pulse: A slippery pulse at both Cun (inch) positions indicates Upper Xiao (Upper Wasting-Thirst). A surging and rapid pulse at both Guan (middle) positions indicates Middle Xiao (Middle Wasting-Thirst). A floating and large pulse at both Chi (cubit) positions indicates Lower Xiao (Lower Wasting-Thirst). A soggy and scattered pulse indicates excess Qi and deficient Blood. A surging and large pulse indicates excess Yang and deficient Yin. A deep, small, and forceful pulse is treatable. A solid, large, floating, and choppy pulse are all difficult to treat.
Symptoms: The *Neijing* states: "Binding of the Two Yangs is called Xiao." Li Dongyuan stated: "The Two Yangs refer to the Hand-Yangming and Foot-Yangming meridians. The Hand-Yangming Large Intestine governs body fluids; when diseased, it presents with yellow eyes and dry mouth, indicating insufficient fluids. The Foot-Yangming Stomach governs blood; heat causes rapid digestion and hunger, which is due to latent fire in the stomach burning and drying up the blood. When both fluids and blood are insufficient, Wasting-Thirst arises. Although divided into three types, the cause is always Fire. Upper Xiao involves Heart Fire transferring heat to the Lung, presenting with excessive drinking and thirst, little food intake but vomiting. Middle Xiao involves Spleen Heat transferring to the Stomach, presenting with excessive eating yet emaciation, dry stools, and yellow urine. Lower Xiao involves Kidney Heat transferring to the Bladder, presenting with turbid urine resembling fat or paste. Generally, Wasting-Thirst arises from changes caused by rich, sweet, and fatty foods, or from overconsumption of mineral-based hot medicines, leading to excess Yang and deficient Yin, insufficient fluids, binding without moistening, all attributed to Fire.
Treatment: The primary approach should be nourishing the Lung, descending Fire, and generating Blood. Some say Upper Xiao is caused by Heart Fire suppressing Lung Metal; treatment should descend Fire and clear Metal, using Huanglian (Coptis Rhizome), Maidong (Ophiopogon Tuber), Lanco (Houttuynia Herb), Baicoukou (Amomum Cardamomum Fruit), Pear Flesh, and Lotus Root Juice, added with Shengma (Cimicifuga Rhizome) and Huangbai (Phellodendron Bark), so that clear Qi ascends and thirst stops. Middle Xiao involves latent fire in the Stomach failing to generate fluids, hunger immediately after eating, and failure to nourish muscles; it should be treated with Huangqin (Scutellaria Root), Huanglian (Coptis Rhizome), and Shigao (Gypsum Fibrosum). In severe cases, use Tiaowei Chengqi Tang (Regulate the Stomach and Order the Qi Decoction) to purge. Lower Xiao presents with irritability, craving water, dried and blackened earlobes, and urine like paste; this is precisely what is meant by 'irritability and scorching, water easily depleted.' This is called Kidney Xiao and should be primarily treated with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia). The *Shengji Zonglu* states: If the patient can still eat, they will inevitably develop carbuncles and back sores; if they cannot eat, they will develop abdominal fullness and distension, and lesions on the back are incurable. Zhang Jiegu treated them separately: for those who can eat and have thirst, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng); for those who cannot eat and have thirst, use Qian's Baizhu San (Atractylodes Powder), adding extra Gegen (Kudzu Root). Once the upper and middle conditions are stabilized, transmission to the lower jiao ceases.
Formula: Five-Juice Drink, treating all three Xios generally
Chuan Huanglian (Coptidis Rhizoma) (1 qian 5 fen) Maidong (Ophiopogonis Tuber) (1 qian 5 fen) Tianhuafen (Trichosanthis Radix) (1 qian) Sheng Gancao (Glycyrrhizae Radix et Rhizoma) (3 fen) Renshen (Ginseng Radix) (8 fen) Shigao (Gypsum Fibrosum) (1 qian 5 fen) Zhimu (Anemarrhenae Rhizoma) (1 qian 5 fen) Guishen (Angelicae Sinensis Radix) (1 qian) Baishaoyao (Paeoniae Radix Alba) (8 fen) Huangbai (Phellodendri Cortex) (7 fen) Lizhi (Pear Juice) [add just before taking] Ou zhi (Lotus Root Juice) Sheng Dihuangzhi (Rehmanniae Radix Recens Juice) Ren Ru zhi (Human Breast Milk) (each 1 zhan) Jiang zhi (Ginger Juice) (2 chi) Zhuli (Bamboo Sap) (half zhan)
Prepare as one dose. Add Lancao Ye (Houttuyniae Herba) 1 qian, decoct together. Take well after meals. Just before taking, add the five juices, and consume together with the medicinal decoction. No other modifications.