渴而多饮为上消。（经谓膈消。）消谷善饥为中消。（经谓消中。）渴而便数有膏为下消。（经
谓肾消）。刘河间尝着三消论谓，五脏六腑四肢，皆禀气于脾胃，行其津液，以濡润养之。然消渴之
病，本湿寒之阴气极衰，燥热之阳气太盛故也。治当补肾水阴寒之虚，而泻心火阳热之实，除肠胃燥
热之甚，济身中津液之衰。使道路散而不结，津
液生而不枯，气血和而不涩，则病自已矣。况消渴者，因饮食服饵之失宜，肠胃干涸，而气不得宣平，
或精神过违其度而耗乱之，或因大病阴气损而血液衰，虚阳 悍而燥热郁甚之所成也。若饮水多而小
便多，曰消渴。若饮食多，不甚渴，小便数而消瘦者，名曰消中。若渴而饮水不绝，腿消瘦而小便有
脂液者，名曰肾消。一皆以燥热太甚，三焦肠胃之腠理怫郁结滞，致密壅滞，虽复多饮于中，终不能
浸润于外，荣养百骸，故渴不止，小便多出或数溲也。张戴人亦着三消之说，一从火断，谓火能消物，
燔木则为炭，燔金则为液，燔石则为灰，煎海水则为盐，鼎水则干。人之心肾为君火，三焦胆为相火，
得其平则烹炼饮食，糟粕去焉。不得其平，则燔灼脏腑而津液耗焉。夫心火甚于上为膈膜之消，甚于
中为肠胃之消，甚于下为膏液之消，甚于外为肌肉之消。上甚不已则消及于肺，中甚不已则消及于脾，
下甚不已则消及于肝肾，外甚不已则消及于筋骨，四脏皆消尽，则心始自焚而死矣。故治消渴一证，
调之而不下，则小润小濡，固不能杀炎上之势。下之而不调，亦旋饮旋消，终不能沃膈膜之干。下之
调之而不减滋味，不戒嗜欲，不节喜怒，则病已而
复作。能从此三者，消渴亦不足忧矣。然而二公备引《内经》诸条言消渴者，表白三消所由来之病源，
一皆燥热也。虽是心移寒于肺为肺消者，火与寒皆来乘肺，肺外为寒所薄，气不得施，内为火所烁故，
然太阳寒水司天，甚则渴饮者，水行凌火，火气内郁，二者固属外之寒邪，则已郁成内之燥热也。或
曰夫寒与热反，若冰炭之不同炉，而今之燥热，由外寒所郁也。将用凉以治内热，必致外寒增而愈郁；
用温以散外寒，必致内热增而愈渴。治之奈何？曰∶先治其急，处方之要，备在《本经》，谓处方而
治者，必明病之标本，达药之所能，通气之所宜，而无加害者，可以制其方也。所谓标本者，先病而
为本，后病而为标，此为病之本末也。标本相传，先当救其急也。又六气为本，三阴三阳为标。假若
胃热者，热为本，胃为标也。处方者，当除胃中之热，是治其本也。故六气乃以甚者为邪，衰者为正，
法当泻甚补衰，以平为期。养正除邪，乃天之道也，为政之理也，捕贼之义也。即此观之，处方之要，
殆尽此矣。若太阳司天，寒水之胜，心火受郁，内热已甚，即当治内热为急；内热未甚，即当散寒解
郁为急。如《宣明论》立方，着《内经》诸证条下者，其治漏风而渴，用牡蛎、白术、防风，先治漏
风为急也。若心移寒于肺为肺消者，
则以心火乘肺伤其气血为急，所移之寒，非正当其邪也。故用黄 、人参、熟地黄、五味子、桑白皮、
麦门冬、枸杞子，先救气血之衰，故不用寒药泻内热也。若心移热于肺，传为膈消者，则以肺热为急，
用麦门冬治肺中伏火、止渴为君。天花粉、知母泻热为臣。甘草、五味子、生地黄、葛根、人参，生
津益气为佐。然心火上炎于肺者，必由心有事焉，不得其正，以致其脏气血之虚，故厥阳之火上逆也。
所以用茯神安心定志养精神，竹叶以凉之，用麦门冬之属以安其宅，则火有所归息矣。因是三条消渴
之方，便见河间处方，酌量标本缓急轻重之宜，通脏腑切当之药者，如此可谓深得仲景处方之法者也。
仲景云∶男子消渴，小便反多，饮一斗而小便一斗，肾气丸主之。脉浮，小便不利，微热消渴者，与
渴欲饮水，水入即吐者，皆以五苓散利之。脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。兼口干
舌燥者，白虎汤加人参主之。即此便见表里分经，因病用药，岂非万世之准则哉。坎三，干水也，气
也，即小而井，大而海也。兑三，坤水也，形也，即微而露，大而雨也。一阳下陷于二阴为坎，坎以
气潜行乎万物之中，为受命之根本，故润万物莫如水。一阴上彻于二阳为兑，兑以形普施于万物之上，
为资生之利泽，故说万物者，莫说乎
泽。明此二水，以悟消渴、消中、消肾三消之义治之，而兼明导引之说，又有水火者焉。三焦为无形
之火，内热烁而津液枯，以五行有形之水制之者，兑泽也，权可也。吾身自有上池真水，亦气也，亦
无形也，天一之所生也。以无形之水，沃无形之火，又常而可久者，是为真水火，升降既济，而自不
渴矣。
【上消者】上焦受病。逆调论云∶心移热于肺，传为膈消是也。舌上赤裂，大渴引饮，少食，
大便如常，小便清利，知其燥在上焦，治宜流湿润燥，以白虎加人参汤主之。能食而渴为实热，人参
石膏汤，加减地骨皮散。不能食而渴为虚热，白术散，门冬饮子。有汗而渴者，以辛润之。无汗而渴
者，以苦坚之。太阳经渴，其脉浮无汗者，五苓散、滑石之类主之。（太阳无汗而渴，不宜服白虎汤，
若得汗后脉洪大而渴者，宜服之。）阳明经渴，其脉长有汗者，白虎汤、凉膈散之类主之。（阳明汗
多而渴，不宜服五苓散，若小便不利，汗少，脉浮而渴者，宜服之。）少阳经渴，其脉弦而呕者，小
柴胡汤加栝蒌之类主之。太阴经渴，其脉细不欲饮，纵饮思汤不思水者，四君子、理中汤之类主之。
少阴经渴，其脉沉细，自利者，猪苓汤、三黄丸之类主之。厥阴经渴，其脉微引饮者，宜少少与之。
小便不利而渴，知内有热也，五苓散、猪苓散泄之。小便自利而渴，知内有
燥也，甘露饮、门冬饮润之。大便自利而渴，先用白芍、白术各炒为末调服，后随证用药。大便不利
而渴，止渴润燥汤。上焦渴，小便自利，白虎汤。中焦渴，大小便俱不利，调胃承气汤。下焦渴，小
便赤涩，大便不利，大承气汤。戴院使云∶心消之病，往往因嗜欲过度，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，（半夏非所宜用。）去干姜，加栝蒌、
干葛如其数，吞猪肚丸，或酒煮黄连丸，仍佐独味黄连汤，多煎候冷，遇渴恣饮，久而自愈。若因用
心过度，致心火炎上而渴者，宜黄 六一汤，加莲肉、远志各一钱，吞玄兔丹，仍以大麦煎汤，间下
灵砂丹。渴欲饮水不止，仲景以文蛤一味捍为散，沸汤和服方寸匕。经验方用大牡蛎，于腊月或端午
日，黄泥裹 通赤，放冷，取出为末，用鲫鱼煎汤下一钱匕。盖二药性收涩，最能回津，《纲目》以
为咸软非也。《三因方》用糯谷（旋炒作爆）、桑根白皮（浓者切细，等分。）每服一两，水一碗，煮至
半碗，渴即饮之。夫水谷之气上蒸于肺而化为津，以溉一身，此金能生水之义，二药固肺药也，而又
淡渗，故取之。《保命集》用蜜煎生姜汤，大器倾注，时时呷之，法曰，心肺之病，莫厌频而少饮。
经云∶补上治上宜以缓。又云∶辛以润之。开腠理，致津液，
肺气下流，故火气降而燥衰矣。有食韭苗而渴愈者，亦辛润之意也。丹溪云∶消渴饮缲丝汤，能引清
气上朝于口。予谓蚕与马同属午也，心也，作茧成蛹，退脏之际，故能抑心火而止渴焉。饮多停积，
有化水丹，又有神仙减水法。东垣治张芸夫病消渴，舌上赤裂，饮水无度，小便数，制方名曰生津甘
露饮子。《内经》云∶热淫所胜，佐以甘苦，以甘泻之。热则伤气，气伤则无润。折热补气，非甘寒
之剂不能，故以石膏之甘寒为君。王太仆云∶壮水之主，以制阳光，故以柏、连、栀子、知母之苦寒，
泻热补水为臣。以当归、杏仁、麦门冬、全蝎、连翘、白葵花、兰香、甘草，甘寒和血润燥为佐。升
麻、柴胡苦平，行阳明、少阳二经。荜澄茄、白豆蔻、木香、藿香反佐以取之。又用桔梗为舟楫，使
浮而不下也。为末汤浸，蒸饼和成剂，晒干杵碎，如黄米大。每于掌内舐之，津液送下，不令药过病
处也。许学士治一卒病渴，日饮水三斗，不食已三月，心中烦闷，此心中有伏热。与火腑丹，每服五
十丸，温水下，日三。次日渴止，又次日食进。此方本治淋，用以治渴效，信乎，药贵变通用之。经
云∶少阳司天之政，三之气，炎暑至，民病渴。又云∶少阴之复，渴而欲饮。又云∶少阳之复，嗌络
焦槁，渴引水浆。是热助心盛而渴，治以诸寒剂，世之所知
也。经云∶太阳司天，寒气下临，心火上从，嗌干善渴。又云∶太阳司天，寒淫所胜，民病嗌干，渴
而欲饮。又云∶寒水太过，上临太阳，民病渴而妄冒。是寒攻心虚而渴，治以诸热剂，则世之所未知
也。东垣云∶消渴末传能食者，必发脑疽背疮，不能食者，必传中满鼓胀。《圣济总录》皆为必死不
治之证，洁古分而治之，能食而渴者，白虎加人参汤主之。不能食而渴者，钱氏白术散倍加葛根主之。
上下既平，不复传下消矣。或曰末传疮疽者何也？此火邪胜也，其疮痛甚而不溃，或溃赤水者是也。
经曰∶有形而不痛者，阳之类也。急攻其阳，无攻其阴，治在下焦，元气得强者生，失强者死。末传
中满者何也？以寒治热，虽方士不能废绳墨而更其道也。然脏腑有远近，心肺位近，宜制小其服，肾
肝位远，宜制大其服，皆适其所至所为。故知过与不及，皆诛罚无过之地也。如膈消、中消，制之太
急，速过病所，久而成中满之疾。正谓上热未除，中寒复生者，非药之罪，失其缓急之宜也。处方之
际，宜加审焉。（虽为三条，而分经止渴，中下亦同例，当参考焉。）
【中消者】胃也，渴而多饮，善食而瘦，自汗，大便硬，小便频数赤黄，热能消谷，知热在中
焦也。宜下之以调胃承气汤，又三黄丸主之。胃热则善消水谷，
可饮甘辛降火之剂，用黄连末、生地、白藕各自然汁，牛乳各一升，熬成膏，和黄连末一斤，丸如桐
子大。每服三五十丸，少呷白汤下，日进十服。消渴中消，自古只治燥止渴，误矣。三阳结谓之消，
三阳者，阳明也。手阳明大肠主津液所生病，热则目黄口干，是津液不足也。足阳明主血所生病，热
则消谷善饥，血中伏火，是血不足也。结者、津液不足，结而不润，皆燥热为病也。此因数食甘美而
多肥，故其气上溢转为消渴，治之以兰，除陈气也。不可服膏粱芳草石药，其气悍烈，能助热燥也。
越人云∶邪在六腑则阳脉不和，阳脉不和则气留之，气留之则阳脉盛矣，阳脉太盛则阴气不得荣也。
故肌肉皮肤消削是也。和血益气汤主之。戴云∶消脾缘脾经燥热，食物易化，皆为小便，转食转饥。
然脾消又自有三，曰消中，曰寒中，曰热中。宜用莲茗饮，加生地黄、干葛各一钱。或乌金散，或止
用莲茗饮。顺利散、参蒲丸、加味钱氏白术散、和血益气汤、清凉饮子、甘露膏、黄连猪肚丸、烂金
丸、天门冬丸、猪肾荠 汤。《内经》言大肠移热于胃，善食而瘦，谓之食 。胃移热于胆，亦曰食
。食 者，谓食移易而过，不生肌肤，亦易饥也。东垣云∶善食而瘦者，胃伏火邪于气分则能食，
脾虚则肌肉削也，即消中也。运气消中皆属热。经云∶
少阴之胜，心下热善饥。又云∶少阳之胜，热客于胃，善饥，治以寒剂是也。针灸消中，皆取于胃。
经云∶邪在脾胃，阳气有余，阴气不足，则热中善饥，取三里灸。又云∶胃足阳明之脉气盛，则身已
前皆热，于胃则消谷善饥。（热则清之，盛则泻之。）
【下消者】病在下焦，初发为膏淋，谓淋下如膏油之状，至病成，烦躁引饮，面色黧黑，形瘦
而耳焦，小便浊而有脂液，治宜养血以分其清浊而自愈矣，以六味地黄丸主之。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。《金匮》治男子消渴，小便反多，
如饮水一斗，小便亦一斗，肾气丸主之。（子和治肾消，以肾气丸本方内加山药一倍外，桂、附从四
时加减，冬一两，春秋五钱，夏二钱半。又法，肾气丸去附子，加五味子一两半。）娄全善云∶肾消
者，饮一溲二，其溲如膏油，即膈消、消中之传变。王注谓肺脏消燥，气无所持是也。盖肺脏气，肺
无病则气能管摄津液，而津液之精微者，收养筋骨血脉，余者为溲。肺病则津液无气管摄，而精微者
亦随溲下，故饮一溲二而溲如膏油也。筋骨血脉无津液以养之，故其病成，渐形瘦焦干也。然肺病本
于肾虚，肾虚则心寡于畏，妄行陵肺，而移寒与之，然后肺病消。故仲景治渴而小便反多，用肾气丸
补肾救肺，后人因名之肾消及下消也。或曰∶经既云肺消死不
治，仲景复用肾气丸治之何也？曰∶饮一溲二者，死不治。若饮一未至溲二者，病尚浅，犹或可治。
Polydipsia with excessive drinking is called Upper Xiao (Upper Wasting-Thirst). (The Classics refer to it as Ge Xiao / Diaphragm Wasting-Thirst.) Excessive hunger with rapid digestion is called Middle Xiao (Middle Wasting-Thirst). (The Classics refer to it as Xiao Zhong / Consuming-Middle.) Polydipsia with frequent urination containing fatty sediment is called Lower Xiao (Lower Wasting-Thirst). (The Classics refer to it as Shen Xiao / Kidney Wasting-Thirst). Liu Hejian once wrote the "Treatise on Three Xiao", stating that the five zang organs, six fu organs, and four limbs all receive qi from the Spleen and Stomach, which circulate body fluids to moisten and nourish them. However, the disease of Wasting-Thirst fundamentally arises from the extreme deficiency of damp-cold yin qi and the excessive excess of dry-heat yang qi. Treatment should tonify the deficiency of kidney water yin-cold, purge the excess of heart fire yang-heat, eliminate severe dry-heat in the stomach and intestines, and replenish the decline of body fluids. This ensures that pathways remain open without obstruction, body fluids are generated without drying up, and qi and blood harmonize without stagnation, so the disease will resolve itself. Moreover, Wasting-Thirst is caused by improper diet or medication, leading to dryness in the stomach and intestines and failure of qi to circulate smoothly; or by excessive mental exertion causing depletion and disorder; or by damage to yin qi and decline of blood due to severe illness, resulting in fierce deficient yang and severe郁结 (stagnation) of dry-heat. If one drinks much and urinates much, it is called Xiao Ke (Wasting-Thirst). If one eats much, has slight thirst, urinates frequently, and emaciates, it is called Xiao Zhong (Consuming-Middle). If one is thirsty and drinks incessantly, legs emaciate, and urine contains fatty liquid, it is called Shen Xiao (Kidney Wasting-Thirst). All these result from excessive dry-heat causing郁结 (stagnation) and blockage in the cou li (pores and interstices) of the San Jiao (Triple Burner), stomach, and intestines. Although much fluid is ingested, it cannot finally moisten the exterior or nourish the bones and muscles, hence thirst persists, and urination is excessive or frequent. Zhang Dairen also discussed the theory of Three Xiao, attributing them all to Fire, stating that fire consumes matter: burning wood makes charcoal, burning metal makes liquid, burning stone makes ash, boiling seawater makes salt, and water in a cauldron dries up. The Heart and Kidney belong to Ministerial Fire (Jun Huo), while the San Jiao and Gallbladder belong to Ministerial Fire (Xiang Huo). When balanced, they cook and digest food, eliminating waste. When unbalanced, they scorch the zang-fu organs and consume body fluids. Excess heart fire at the upper level causes Diaphragm Xiao; at the middle level, Gastrointestinal Xiao; at the lower level, Fluid/Grease Xiao; and at the exterior level, Muscle Xiao. If upper excess continues, it affects the Lungs; if middle excess continues, it affects the Spleen; if lower excess continues, it affects the Liver and Kidneys; if exterior excess continues, it affects sinews and bones. When the four zang organs are consumed, the Heart burns itself, leading to death. Therefore, in treating this syndrome of Wasting-Thirst, regulating without purging only provides minor moistening and cannot suppress the flaming-up tendency. Purging without regulating leads to immediate consumption of ingested fluids, failing to irrigate the dry diaphragm. If purging and regulating are done but dietary tastes are not reduced, desires not restrained, and anger/joy not moderated, the disease will recur after remission. If these three aspects are managed, Wasting-Thirst is not worth worrying about. Both gentlemen extensively cited various passages from the *Nei Jing* regarding Wasting-Thirst to clarify the origin of the Three Xiao syndromes, all pointing to Dry-Heat. Although "Heart transferring cold to the Lung" causes Lung Xiao, both fire and cold attack the Lung: externally oppressed by cold, qi cannot distribute; internally scorched by fire. In years when Taiyang Cold Water governs the climate, severe cases involve thirst and drinking due to Water overcoming Fire, causing internal stagnation of Fire Qi. These two situations originally belong to external cold pathogens but have transformed into internal dry-heat. One might ask: Cold and Heat are opposites, like ice and charcoal not sharing a furnace. Yet current dry-heat stems from external cold stagnation. Using cooling herbs for internal heat would increase external cold and stagnation; using warming herbs for external cold would increase internal heat and thirst. How to treat? Answer: Treat the acute condition first. The key to prescription lies in the *Shennong Bencao Jing*: prescribing requires understanding the root and branch of the disease, knowing the capabilities of herbs, adapting to qi dynamics, and avoiding harm. What is root and branch? The initial disease is the root; subsequent disease is the branch. This is the beginning and end of the disease. When root and branch transmit, treat the emergency first. Also, the Six Qi are root, and the Three Yin and Three Yang are branch. For example, in Stomach Heat, Heat is root, Stomach is branch. Prescribing should clear heat in the Stomach, treating the root. Thus, among the Six Qi, the excessive is pathogenic, the deficient is healthy. The method is to drain excess and tonify deficiency, aiming for balance. Nourishing righteousness and eliminating evil is the way of Heaven, the principle of governance, and the justice of catching thieves. From this, the key to prescribing is evident. If Taiyang governs, Cold Water is excessive, Heart Fire is depressed, and internal heat is severe, treat internal heat as urgent; if internal heat is not severe, dispel cold and resolve depression as urgent. As in *Xuan Ming Lun*, for leakage wind causing thirst, use Oyster Shell, Atractylodes Macrocephala, and Saposhnikovia, treating leakage wind as urgent. If Heart transfers cold to Lung causing Lung Xiao, then Heart Fire attacking Lung damaging qi and blood is urgent; the transferred cold is not the primary pathogen. Thus, use Astragalus, Ginseng, Prepared Rehmannia, Schisandra, Mulberry Root Bark, Ophiopogon, and Goji Berry to rescue qi and blood deficiency, avoiding cold herbs to purge internal heat. If Heart transfers heat to Lung transforming into Ge Xiao, then Lung Heat is urgent. Use Ophiopogon as Sovereign herb to treat latent fire in Lung and stop thirst. Trichosanthes Root and Anemarrhena Rhizome as Ministers to purge heat. Licorice, Schisandra, Rehmannia, Kudzu Root, and Ginseng as Assistants to generate fluids and boost qi. Since Heart Fire flaming upward to Lung must stem from Heart pathology, losing its proper state, leading to deficiency of organ qi and blood, thus Defiant Yang Fire reverses upward. Therefore, use Spirit Polyporus to calm Heart, stabilize will, and nourish spirit; Bamboo Leaf to cool it; and Ophiopogon-type herbs to settle its residence, so Fire has a return path and rests. From these three formulas for Wasting-Thirst, we see Hejian's prescription carefully weighing root/branch, urgency/severity, and selecting appropriate herbs for zang-fu communication, deeply mastering Zhang Zhongjing's prescription methods. Zhongjing said: Men with Wasting-Thirst, urination is excessive, drinking one dou yields one dou of urine; Kidney Qi Pill governs it. Pulse floating, urination difficult, slight fever with wasting-thirst; give Wu Ling San to promote urination. Pulse floating with fever, desire to drink water, urination difficult; Zhu Ling Tang governs it. Accompanied by dry mouth and tongue; Bai Hu Jia Ren Shen Tang governs it. This shows differentiation by interior/exterior and meridians, medicating according to disease, truly a standard for eternity. Kan trigram belongs to Water, is Qi, small as well, large as sea. Dui trigram belongs to Kun Water, is Form, small as dew, large as rain. One Yang sinking into Two Yins forms Kan; Kan moves qi secretly within all things, being the root of life, thus nothing moistens like water. One Yin rising through Two Yangs forms Dui; Dui spreads form above all things, being the benefit of generation, thus nothing delights like marsh. Understanding these two waters helps comprehend the meaning of treatment for Xiao Ke, Xiao Zhong, and Xiao Shen, along with Dao Yin (guiding and pulling) theories involving Water and Fire. San Jiao is Formless Fire; internal heat scorches and fluids dry; controlling it with Five Elements' Formless Water is Dui Marsh, permissible as a權 (adjustment). Our body possesses Zhen Shui (True Water) from Shang Chi, which is Qi, formless, born of Tian Yi (One Heaven). Using formless water to irrigate formless fire, lasting and enduring, is True Water and Fire; ascending-descending mutual completion results in no thirst.
[Upper Xiao] Disease in Upper Jiao. *Ni Tiao Lun* states: Heart transfers heat to Lung, transforming into Ge Xiao. Red cracks on tongue, severe thirst driving intake, low food intake, normal stool, clear profuse urine; know dryness is in Upper Jiao. Treatment should moisten flow and dryness, governed by Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction). Eating with thirst indicates Excess Heat; Ren Shen Shi Gao Tang (Ginseng and Gypsum Decoction) or modified Di Gu Pi San (Cortex Lycii Powder). Not eating with thirst indicates Deficient Heat; Bai Zhu San (Atractylodes Macrocephala Powder) or Dong Men Yin Zi (Ophiopogon Drink). Thirst with sweating uses Pungent-Moistening method. Thirst without sweating uses Bitter-Firming method. Taiyang Meridian thirst, pulse floating without sweat, governed by Wu Ling San (Five-Ling Powder) or Hua Shi (Talcum). (Taiyang thirst without sweat should not take Bai Hu Tang; if after sweating pulse is surging and large with thirst, take it.) Yangming Meridian thirst, pulse long with sweat, governed by Bai Hu Tang (White Tiger Decoction) or Liang Ge San (Cooling Diaphragm Powder). (Yangming thirst with much sweat should not take Wu Ling San; if urination difficult, little sweat, pulse floating with thirst, take it.) Shaoyang Meridian thirst, pulse wiry with vomiting, governed by Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Gua Lou (Trichosanthes Fruit). Taiyin Meridian thirst, pulse fine, no desire to drink, even if drinking prefers soup over water, governed by Si Jun Zi Tang (Four Gentlemen Decoction) or Li Zhong Tang (Regulate the Middle Decoction). Shaoyin Meridian thirst, pulse deep and fine with spontaneous diarrhea, governed by Zhu Ling Tang or San Huang Wan (Three Yellow Pill). Jueyin Meridian thirst, pulse faint with desire to drink, give sparingly. Urination difficult with thirst indicates internal heat; Wu Ling San or Zhu Ling San to drain. Urination free with thirst indicates internal dryness; Gan Lu Yin (Sweet Dew Drink) or Dong Men Yin to moisten. Stool free with thirst, first use fried Bai Shao (White Peony Root) and Bai Zhu (Atractylodes Macrocephala) powder mixed; then medicate according to syndrome. Stool difficult with thirst, use Zhi Ke Run Zao Tang (Stop Thirst Moisten Dryness Decoction). Upper Jiao thirst with free urination, Bai Hu Tang. Middle Jiao thirst with difficult urination and stool, Tiao Wei Cheng Qi Tang (Regulate the Stomach and Direct to the Interior Decoction). Lower Jiao thirst with dark/scanty urination and difficult stool, Da Cheng Qi Tang (Major Direct to the Interior Decoction). Dai Yuan Shi said: Xin Xiao (Heart Wasting-Thirst) often due to excessive desires and spicy/hot foods, causing vexation/thirst, drinking much, urinating much. Suppress Heart Fire to descend, naturally no thirst. Use Ban Xia Xie Xin Tang (Pinellia to Drain the Epigastrium Decoction), (Ban Xia is not suitable here.), remove Gan Jiang (Dried Ginger), add Gua Lou and Gan Ge (Kudzu Root) in equal amounts, swallow Zhu Du Wan (Pig Stomach Pill) or Jiu Zhu Huang Lian Wan (Wine-Processed Coptis Pill), aided by single-herb Huang Lian Tang (Coptis Decoction), decoct heavily, cool, drink freely when thirsty, self-heals over time. If excessive mental work causes Heart Fire flaming up with thirst, use Huang Qi Liu Yi Tang (Astragalus Six-to-One Decoction), add Lotus Seed and Yuan Zhi each 1 qian, swallow Xuan Tu Dan, aided by Barley decoction, intermittently administer Ling Sha Dan. Thirst drinking endlessly, Zhongjing uses Wen Sha (Clam Shell) alone ground to powder, mixed with boiling water, taken as a measure. Empirical formula uses large Oyster Shell, wrapped in yellow mud, fired red on Lunar Dec or Dragon Boat Day, cooled, ground, taken with Carp decoction. These two herbs are astringent, best at restoring fluids; *Ben Cao Gang Mu* calling them salty-soft is wrong. *San Yin Fang* uses Glutinous Rice (freshly popped) and Sang Gen Bai Pi (Mulberry Root Bark, thick cut, equal parts). Take 1 liang per dose, boil 1 bowl water to half bowl, drink when thirsty. Grain/fluid qi steams to Lung transforming to fluids, irrigating body; this is Metal generating Water. These two herbs are Lung herbs, yet light-draining, hence used. *Bao Ming Ji* uses Honey-fried Ginger Soup, poured in large vessel, sip frequently. Law says: Diseases of Heart/Lung, do not dislike frequent small sips. Classic says: Tonifying/Upper treatment should be slow. Also: Pungent moistens. Opens cou li, directs fluids, Lung qi flows down, so Fire Qi descends and dryness declines. Eating Leek shoots cured thirst, also pungent-moistening intent. Danxi said: Wasting-Thirst drink Silk-Reeling Soup, draws clear qi to mouth. I say Silkworm and Horse belong to Wu (Fire/Heart), spinning cocoon/pupa, retreating viscera, thus suppressing Heart Fire stopping thirst. Drinking excess retention, you have Hua Shui Dan (Water-Transforming Pill) and Shen Jian Jian Shui Fa (Immortal Water-Reduction Method). Dongyuan treated Zhang Yunfu with Wasting-Thirst, red cracked tongue, drinking limitlessly, frequent urination, formulated Sheng Jin Gan Lu Yin Zi (Generate Fluids Sweet Dew Drink). *Nei Jing* says: Excessive Heat assisted by Pungent-Bitter, use Pungent to drain. Heat damages Qi, Qi damage means no moisture. Breaking Heat boosting Qi requires Pungent-Cold agents, thus Shi Gao (Gypsum) Pungent-Cold as Sovereign. Wang Taipu said: Strengthen Master of Water to control Sunlight, thus Bo (Phellodendron), Lian (Coptis), Zhi Zi (Gardenia), Zhi Mu (Anemarrhena) Bitter-Cold, purge heat tonify water as Ministers. Dang Gui (Angelica), Xing Ren (Apricot Seed), Mai Men Dong (Ophiopogon), Quan Xie (Scorpion), Lian Qiao (Forsythia), Bai Kui Hua (White Chrysanthemum Flower), Lan Xiang (Costus Root), Gan Cao (Licorice) Pungent-Cold harmonize blood moisten dryness as Assistants. Sheng Ma (Cimicifuga), Chai Hu (Bupleurum) Bitter-Ping, move Yangming/Shaoyang meridians. Bi Cheng Qie (Long Pepper Fruit), Bai Dou Kou (Cardamom), Mu Xiang (Aucklandia), Huo Xiang (Patchouli) counter-assist to obtain effect. Use Jie Geng (Platycodon) as boat/oar, making float not sink. Grind to powder, soak in soup, mix with steamed dough pill, dry, crush, size of yellow millet. Lick on palm, swallow with saliva, do not let medicine pass disease site. Xu Xueshi treated sudden thirst, drinking 3 dou daily, no food for 3 months, vexation in heart, latent heat in heart. Given Huo Fu Dan, 50 pills each time, warm water, 3 times/day. Next day thirst stopped, next day appetite returned. This formula treats strangury, effective for thirst, proving drugs value flexible use. Classic says: Shaoyang governing climate, third period, hot summer arrives, people sick with thirst. Also: Shaoyin recurrence, thirst wanting drink. Also: Shaoyang recurrence, throat veins scorched, thirst drawing liquids. Heat assists Heart excess causing thirst, treated with cold agents, known to world. Classic says: Taiyang governing, cold qi descends, Heart Fire follows up, throat dry prone to thirst. Also: Taiyang governing, cold excess wins, people throat dry, thirst wanting drink. Also: Cold Water excessive, upper approaches Taiyang, people sick with thirst and delirium. Cold attacks Heart deficiency causing thirst, treated with hot agents, unknown to world. Dongyuan said: Wasting-Thirst late transmission, able to eat, must develop Brain Abscess/Back Ulcer; unable to eat, must transmit to Fullness/Bloating. *Sheng Ji Zong Lu* considers all fatal untreatable. Jiegu differentiated treatment: Able to eat/thirst, Bai Hu Jia Ren Shen Tang governs. Unable to eat/thirst, Qian Shi Bai Zhu San doubled with Ge Gen governs. Upper/lower balanced, no longer transmits to Lower Xiao. Question: Why late transmission to ulcers? Fire pathogen excess, ulcers painful not suppurating, or suppurating red water. Classic says: Formed but painless is Yang category. Urgently attack Yang, not Yin. Treat in Lower Jiao, Yuan Qi strong lives, weak dies. Why late transmission to fullness? Treating heat with cold, even alchemists cannot abandon rules. But zang-fu have distance, Heart/Lung near, make small dosage; Liver/Kidney far, make large dosage, all fit their destination. Know excess and insufficiency punish innocent places. Like Ge Xiao/Middle Xiao, treating too urgently passes disease site quickly, long-term becomes fullness disease. Just saying Upper Heat not removed, Middle Cold reborn, not drug fault, but loss of urgency appropriateness. Prescription time, examine carefully. (Though three categories, meridian-specific thirst stopping, Middle/Lower same example, reference accordingly.)
[Middle Xiao] Stomach. Thirst with drinking, good appetite with emaciation, spontaneous sweating, hard stool, frequent dark-yellow urine, Heat digests grain, know Heat in Middle Jiao. Should purge with Tiao Wei Cheng Qi Tang, also San Huang Wan (Three Yellow Pill) governs. Stomach Heat digests food/drink well, can drink Pungent-Sweet descending Fire agents. Use Huang Lian (Coptis) powder, Sheng Di (Rehmannia) juice, White Lotus Root juice, Cow Milk each 1 sheng, boil to paste, mix with 1 jin Huang Lian powder, pill like wisteria seed. Take 30-50 pills, sip white soup down, 10 doses/day. Wasting-Thirst Middle Xiao, ancient times only treated dryness stopping thirst, mistaken. Three Yang knotting called Xiao. Three Yang is Yangming. Hand Yangming Large Intestine governs diseases of fluids; Heat causes yellow eyes dry mouth, fluid deficiency. Foot Yangming governs diseases of blood; Heat digests grain good hunger, latent fire in blood, blood deficiency. Knotting means fluid deficiency, knotting not moistening, all dry-heat disease. Due to frequent sweet/fatty food, qi overflows transforming to Wasting-Thirst, treat with Orchid, removing stale qi. Do not take rich/greasy fragrant/grass/mineral drugs, qi fierce, aids heat-dryness. Yue Ren said: Pathogen in Six Fu, Yang pulse discordant; Yang pulse discordant, Qi stays; Qi stays, Yang pulse excess; Yang pulse too excess, Yin qi cannot nourish. Hence muscle/skin emaciation. He Xue Yi Qi Tang (Harmonize Blood Boost Qi Decoction) governs. Dai said: Xiao Pi (Spleen Wasting-Thirst) due to Spleen Meridian dry-heat, food easily digests, all become urine, turning food turning hungry. Spleen Xiao has three: Xiao Zhong, Han Zhong (Cold Middle), Re Zhong (Hot Middle). Use Lian Ming Yin (Lotus Tea Drink), add Sheng Di, Gan Ge each 1 qian. Or Wu Jin San, or only Lian Ming Yin. Shun Li San, Shen Pu Wan, Modified Qian Shi Bai Zhu San, He Xue Yi Qi Tang, Qing Liang Yin Zi, Gan Lu Gao, Huang Lian Zhu Du Wan, Lan Jin Wan, Tian Men Dong Wan, Zhu Shen Ji Tang. *Nei Jing* says: Large Intestine transfers heat to Stomach, good appetite emaciation, called Shi Xiao (Food Wasting-Thirst). Stomach transfers heat to Gallbladder, also called Shi Xiao. Shi Xiao means food passes changing, does not generate flesh, also easy hunger. Dongyuan said: Good appetite emaciation, Stomach harbors fire pathogen in Qi division can eat, Spleen deficiency muscle wastes, i.e., Xiao Zhong. Luck-based Xiao Zhong all belong to Heat. Classic says: Shaoyin victory, epigastric heat good hunger. Also: Shaoyang victory, heat guest in Stomach, good hunger, treat with cold agents. Acupuncture for Xiao Zhong, all take Stomach. Classic says: Pathogen in Spleen/Stomach, Yang qi excess, Yin qi insufficient, then Hot Middle good hunger, take San Li moxibustion. Also: Foot Yangming Stomach Meridian qi excess, front body hot, Stomach digests grain good hunger. (Heat clear it, Excess drain it.)
[Lower Xiao] Disease in Lower Jiao, initially Gao Lin (Grease Strangury), urine like grease oil. To disease formation, vexation drinking, dark face, thin body scorched ears, turbid urine with lipid. Treatment should nourish blood separate clear/turbid, self-heal. Governed by Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). Benefit Fire Source to eliminate Yin Shadow, then urination regulated. (Ba Wei Wan/Eight-Ingredient Pill.) Strengthen Water Master to control Sunlight, then thirst not desiring. Liu Wei Wan. *Jin Gui* treats men Wasting-Thirst, urination excessive, drinking one dou, urine one dou, Shen Qi Wan (Kidney Qi Pill) governs. (Zihe Zheng treats Kidney Xiao, adds double Shan Yao (Dioscorea) to Shen Qi Wan base, Gui/Fu (Cinnamon/Aconite) adjust by seasons: Winter 1 liang, Spring/Autumn 5 qian, Summer 2.5 qian. Another method: Shen Qi Wan remove Fu Zi, add Wu Wei Zi (Schisandra) 1.5 liang.) Lou Quanshan said: Kidney Xiao, drink one urinate two, urine like grease, i.e., Ge Xiao/Xiao Zhong transmission. Wang Zhu says Lung organ consumes dryness, Qi has no support. Lung Qi, Lung no disease, Qi manages fluids, fluid essence nourishes sinews/bones/blood, remainder is urine. Lung disease, fluid no Qi management, essence also follows urine down, hence drink one urinate two, urine like grease. Sinews/bones/blood no fluid nourishment, hence disease forms, gradually thin/scorched. Lung disease root in Kidney deficiency, Kidney deficiency Heart lacks fear,妄行 (recklessly acts) bullying Lung, transferring cold to it, then Lung disease Xiao. Thus Zhongjing treats thirst urination excessive, uses Shen Qi Wan tonify Kidney save Lung, later generations named Kidney Xiao and Lower Xiao. Question: Classic says Lung Xiao death untreatable, Zhongjing again uses Shen Qi Wan treat why? Answer: Drink one urinate two, death untreatable. If drink one not yet urinate two, disease shallow, still possibly treatable.