大意
一见饮食。便发畏恶。谓之恶心。
内因
恶心非心经病。由胃口有虚有热有痰也。（丹溪）
外候
恶心者。无声无物。心下欲吐不吐。兀兀不宁。如畏舟车之状。（戴氏）
恶心分辨
胃有寒气恶心者。呕清水。不渴脉迟。胃有痰火恶心者。呕酸水。烦渴脉洪。（指掌）
治法
治宜开胃理气。挟寒温散。挟热清降。挟痰开导。挟虚调补。（汇补）
用药
主以二陈汤。加黄连、山栀、竹茹、藿香等。伤食。加山楂、麦芽。挟气。加桔梗、枳壳。
胃弱主以六君子汤。胃寒主以理中汤。
恶心选方
二陈汤（方见痰症） 六君子汤（方见中风） 温胆汤（方见惊悸怔忡） 归脾汤（方见中风）
大意
二阳结。谓之消渴。（内经）二阳者。手阳明大肠。主津液。足阳明胃。主血气。津血不足。发为消渴。（入门）
内因
水之本在肾。末在肺。（内经）真水不竭。何渴之有。人惟酒色是耽。辛热太过。或以甘肥爆炙适其口。或以丹
砂玉石济其私。于是火炎上熏。津液干枯而病生焉。
外候
上消者。心也。多饮少食。大便如常。溺多而频。中消者。脾也。善渴善饥。能食而瘦。溺赤便闭。下消者。肾
也。精枯髓竭。引水自救。随即溺下。稠浊如膏。（医鉴）
三消移热
上消于心。移热于肺。中消于脾。移热于胃。下消于肾。移热于膀胱。传染既久。肠胃合消。五脏干燥。（辨
疑）故上轻中重下危。（入门）
三消传变
凡消病火炎日久。气血凝滞。能食者。末传脑疽背痈。不能食者。末传噎膈鼓胀。皆不治之症也。（总录）
死症
上消心火亢极。肺金受囚。饮一溲二者死。中消胃阳独旺。脾阴困败。下利而厥。食已善饥者死。下消肾阴
枯涸。邪火煎熬。精溺时泄。如油如脂者死。
脉法
胃脉浮数者消谷。肺脉滑数者消渴。大率数大者生。细微者死。沉小者生。牢实者死。
治法
治宜补肾水。泻心火。除肠胃燥热。济身中津液。使道路散而不结。津液生而不枯。气血利而不涩。则病自
已矣。（玉机）
血分气分
气分渴者。因外感传里。或过食香燥。热耗津液。喜饮冷水。当与寒凉渗利以清其热。热去则阴生。而渴自
止。血分渴者。因内伤劳役。精神耗散。胃气不升。或病后亡津。或余热在肺。口干作渴。喜饮热汤。当与甘温
酸剂以滋其阴。阴生则燥除而渴自止。（入门）
治宜滋补
初起宜养肺清心。久病宜滋肾养脾。盖五脏之津液。皆本乎肾。故肾缓则气上升而肺润。肾冷则气不升
而肺枯。故肾气丸为消渴良方也。又五脏之精华。悉运乎脾。脾旺则心肾相交。脾健而津液自化。故参苓
白术散为收功神药也。（汇补）
治无太峻
如上消中消。治之太急。久成中满之症。所谓上热未除。中寒复起也。
用药
上消初起。人参竹叶汤。久则麦冬饮子。中消初起。加减甘露饮。久则钱氏白术散。下消初起。生地饮子。久
则小八味丸。若心肾不交。水下火上。无以蒸气而消者。桂附八味丸。若脾胃虚衰。不能交媾水火。变化津
液而渴者。参苓白术散。夏月伏暑心胞。患消渴者。香薷散主之。其他如缲丝汤、天花粉、芦根汁、淡竹叶、麦
冬、知母、牛乳。皆消渴之神药也。不可不审。
消渴选方
人参竹叶汤 治上消属实者。
人参 淡竹叶 炙甘草 麦门冬 栀子 黄连 黄芩
麦冬饮子 治上消属虚者。
人参 麦门冬 五味子 茯神 生地 干葛 炙甘草 花粉 知母（各等分） 竹叶（十四片）
水煎服
生津甘露饮（加减） 治中消属实。
石膏（二钱半） 甘草 升麻 人参（各一钱） 知母（二钱） 桔梗 山栀（各一钱） 兰叶 麦
冬当归（各五分） 白豆蔻 白芷 连翘（各一钱） 黄连 木香 藿香（各三分） 柴胡（三分）
为末。浸饼捏作饼子。晒干。每服杵碎二钱末。随津咽下。此方制治之缓。不惟不成中满。亦不作痈疽下消矣。
钱氏白术散 治中消属虚者。
人参 白术 茯苓 藿香 甘草（各一两） 干葛（二两）
桔梗（五钱） 白蜜（十匙）
生地黄饮子 治下焦虚炎者。
人参 生地 熟地 麦冬 天冬 石斛 五味子 枇杷叶 甘草 茯苓
磁石荠 丸 治强中消渴。不交精泄者。
荠 大豆 茯苓 磁石 玄参 石斛 花粉 地骨皮 鹿茸（各一两）
沉香 人参（各五钱） 熟地（四两）
猪肾一具。煮烂。捣和蜜丸。空心盐汤下。
加味地黄丸
即六味丸加麦冬、五味。
一方 水梨取汁。和蜜熬成。不时调服。或藕汁亦妙。
一方 消渴能食。防其将生痈疽。用忍冬不拘根茎花叶。酒浸火煨晒干。入甘草、花粉为末。蜜丸服。
[General Principle]
When one sees food and immediately feels aversion, it is called "nausea" (E Xin).
[Internal Causes]
Nausea is not a disease of the Heart Meridian; it arises from deficiency, heat, or phlegm in the Stomach region. (Zhu Danxi)
[External Manifestations]
The manifestation of nausea is: there is no sound and no vomiting; there is a sensation of wanting to vomit from the epigastrium but being unable to do so, accompanied by mental restlessness and uneasiness, resembling the state of seasickness or carsickness. (Dai Shi)
[Differentiation of Nausea]
If nausea is caused by cold qi in the Stomach, clear water is vomited, there is no thirst, and the pulse is slow. If nausea is caused by phlegm-fire in the Stomach, sour water is vomited, there is mental irritability and thirst, and the pulse is surging (Hong). (Zhi Zhang)
[Therapeutic Methods]
Treatment should focus on opening the stomach and regulating Qi. For cases complicated by cold, use warming and dispersing methods; for those complicated by heat, use clearing and descending methods; for those complicated by phlegm, use guiding and resolving methods; for those complicated by deficiency, use regulating and tonifying methods. (Zheng Zhi Hui Bu)
[Medication]
The primary formula is Er Chen Tang (Two-Cured Decoction), added with Huang Lian (Coptidis Rhizoma), Shan Zhi (Gardeniae Fructus), Zhu Ru (Bambusa Textilis Caulis), and Huo Xiang (Agastaches Herba). For food stagnation, add Shan Zha (Crataegi Fructus) and Mai Ya (Hordei Fructus Germinatus). For Qi stagnation, add Jie Geng (Platycodonis Radix) and Zhi Ke (Aurantii Fructus).
For weak Stomach Qi, the primary formula is Liu Jun Zi Tang (Six-Gentlemen Decoction). For Cold in the Stomach, the primary formula is Li Zhong Tang (Regulate the Middle Decoction).
[Selected Formulas for Nausea]
Er Chen Tang (See Formula under Phlegm Syndromes) Liu Jun Zi Tang (See Formula under Wind-Stroke) Wen Dan Tang (Warm the Gallbladder Decoction) (See Formula under Palpitations) Gui Pi Tang (Restore the Spleen Decoction) (See Formula under Wind-Stroke)
[General Principle]
The binding of the Two Yang meridians is called Xiao Ke (Wasting-Thirst Syndrome). (Huang Di Nei Jing) The "Two Yang" refers to the Hand-Yangming Large Intestine Meridian, which governs Jin Ye (Body Fluids), and the Foot-Yangming Stomach Meridian, which governs Blood and Qi. Insufficiency of Jin Ye and Blood leads to Xiao Ke. (Yi Men Ru Men)
[Internal Causes]
The root of Water lies in the Kidney, and its branches in the Lung. (Huang Di Nei Jing) If the True Water (Kidney Yin) does not dry up, how can thirst occur? People indulge in alcohol and sexual activity, consume excessive spicy and hot foods, or eat sweet, fatty, fried, and roasted foods that please the palate, or take minerals like cinnabar and jade for selfish desires. Consequently, Fire flares upward and scorches, causing Jin Ye to dry up and disease to arise.
[External Manifestations]
Shang Xiao (Upper Wasting-Thirst) involves the Heart; symptoms include excessive drinking but little eating, normal stool, and frequent, abundant urination. Zhong Xiao (Middle Wasting-Thirst) involves the Spleen; symptoms include extreme thirst and hunger, ability to eat but emaciation, dark urine, and constipation. Xia Xiao (Lower Wasting-Thirst) involves the Kidney; symptoms include exhaustion of essence and marrow, drinking water to save oneself, followed by immediate urination that is thick and turbid like paste. (Yi Jian)
[Transmission of Heat in the Three Xiao]
Heat from Shang Xiao originates in the Heart and transmits to the Lung; heat from Zhong Xiao originates in the Spleen and transmits to the Stomach; heat from Xia Xiao originates in the Kidney and transmits to the Bladder. After prolonged transmission, the intestines and stomach are jointly affected, leading to dryness of the Five Zang organs. (Bian Yi) Thus, Shang Xiao is mild, Zhong Xiao is severe, and Xia Xiao is critical. (Yi Men Ru Men)
[Progression of the Three Xiao]
In all Xiao diseases, if Fire flares for a long time, causing Qi and Blood stagnation, patients who can eat may eventually develop brain abscesses or back carbuncles; those who cannot eat may eventually develop dysphagia (Ye Ge) or abdominal distension (Gu Zhang). These are all incurable conditions. (Zong Lu)
[Fatal Signs]
If Shang Xiao reaches extreme Heart Fire, imprisoning Lung Metal, and presents with "drinking one part, urinating two parts," death ensues. If Zhong Xiao features solitary excess of Stomach Yang and defeat of Spleen Yin, presenting with diarrhea, cold limbs, and hunger soon after eating, death ensues. If Xia Xiao features desiccation of Kidney Yin, boiling by pathogenic Fire, with leakage of essence and urine resembling oil or fat, death ensues.
[Pulse Diagnosis]
A floating and rapid pulse in the Stomach position indicates Xiao Gu (burning up food); a slippery and rapid pulse in the Lung position indicates Xiao Ke. Generally, a rapid and large pulse indicates survival; a fine and minute pulse indicates death. A deep and small pulse indicates survival; a firm and solid pulse indicates death.
[Therapeutic Methods]
Treatment should tonify Kidney Water, drain Heart Fire, eliminate dryness-heat in the intestines and stomach, and replenish body fluids. This ensures that pathways remain open and unblocked, Jin Ye is generated and not dried up, and Qi and Blood flow smoothly without stagnation, thus curing the disease spontaneously. (Yu Ji Wei Yi)
[Blood vs. Qi Branches]
Qi-branch thirst arises from external pathogens transmitting inward or overconsumption of aromatic and dry foods, where heat consumes Jin Ye. Patients prefer cold water. Treatment requires cold and draining herbs to clear heat; once heat is gone, Yin generates, and thirst stops. Blood-branch thirst arises from internal injury due to overwork, dissipation of spirit, failure of Stomach Qi to ascend, post-illness loss of Jin Ye, or residual heat in the Lung. Patients have a dry mouth and thirst, preferring hot drinks. Treatment requires sweet-warm and sour herbs to nourish Yin; once Yin generates, dryness is removed, and thirst stops. (Yi Men Ru Men)
[Therapy Should Include Tonification]
In the early stage, nourish the Lung and clear the Heart; in chronic stages, tonify the Kidney and nourish the Spleen. Since the Jin Ye of the Five Zang organs originate from the Kidney, sufficient Kidney Qi causes Qi to rise and moisten the Lung, whereas cold Kidney Qi fails to rise, leaving the Lung dry. Therefore, Shen Qi Wan (Kidney Qi Pill) is an excellent formula for Xiao Ke. Furthermore, the essence of the Five Zang organs depends on the Spleen's transportation. When the Spleen is robust, Heart and Kidney interact; when the Spleen is healthy, Jin Ye transforms naturally. Therefore, Shen Ling Bai Zhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) is a miraculous formula for recovery. (Zheng Zhi Hui Bu)
[Treatment Should Not Be Too Harsh]
For Shang Xiao and Zhong Xiao, if treatment is too urgent, it may lead to chronic fullness in the middle jiao. This is described as "upper heat not yet eliminated, while middle cold arises again."
[Medication]
For early Shang Xiao, use Ren Shen Zhu Ye Tang (Ginseng and Bamboo Leaf Decoction); for chronic cases, use Mai Dong Yin Zi (Ophiopogon Drink). For early Zhong Xiao, use Jia Jian Gan Lu Yin (Modified Sweet Dew Drink); for chronic cases, use Qian Shi Bai Zhu San (Child Master's Atractylodes Powder). For early Xia Xiao, use Sheng Di Yin Zi (Rehmannia Drink); for chronic cases, use Xiao Ba Wei Wan (Minor Eight-Ingredient Pill). If Heart and Kidney do not interact, with Water below and Fire above, failing to vaporize and transform, use Gui Fu Ba Wei Wan (Cinnamon and Aconite Eight-Ingredient Pill). If Spleen and Stomach are deficient and fail to interact Water and Fire to transform Jin Ye, use Shen Ling Bai Zhu San. In summer, if Xiao Ke is caused by latent summer-heat invading the Pericardium, treat with Xiang Ru San (Mosla Powder). Others such as Sao Si Tang (Silkworm Thread Decoction), Tian Hua Fen (Trichosanthis Radix), Lu Gen Zhi (Reed Rhizome Juice), Dan Zhu Ye (Lophatheri Herba), Mai Dong (Ophiopogonis Radix), Zhi Mu (Anemarrhenae Rhizoma), and cow's milk are all miraculous drugs for Xiao Ke. Careful examination is essential.
[Selected Formulas for Xiao Ke]
Ren Shen Zhu Ye Tang Treats Shang Xiao of Excess type.
Ren Shen (Ginseng Radix et Rhizoma) Dan Zhu Ye (Lophatheri Herba) Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) Mai Men Dong (Ophiopogonis Radix) Zhi Zi (Gardeniae Fructus) Huang Lian (Coptidis Rhizoma) Huang Qin (Scutellariae Radix)
Mai Dong Yin Zi Treats Shang Xiao of Deficiency type.
Ren Shen (Ginseng Radix et Rhizoma) Mai Men Dong (Ophiopogonis Radix) Wu Wei Zi (Schisandrae Chinensis Fructus) Fu Shen (Poria cum Radice) Sheng Di Huang (Rehmanniae Radix) Gan Ge (Puerariae Lobatae Radix) Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) Hua Fen (Trichosanthis Radix) Zhi Mu (Anemarrhenae Rhizoma) [Equal parts each] Zhu Ye (Bamboo Leaves) [14 leaves]
Decoct in water and take orally.
Sheng Jin Gan Lu Yin (Modified) Treats Zhong Xiao of Excess type.
Shi Gao (Gypsum Fibrosum) [2.5 qian] Gan Cao (Glycyrrhizae Radix et Rhizoma) Sheng Ma (Cimicifugae Rhizoma) Ren Shen (Ginseng Radix et Rhizoma) [1 qian each] Zhi Mu (Anemarrhenae Rhizoma) [2 qian] Jie Geng (Platycodonis Radix) Shan Zhi (Gardeniae Fructus) [1 qian each] Lan Ye (Orchid Leaf) Mai Dong (Ophiopogonis Radix) Dang Gui (Angelicae Sinensis Radix) [0.5 qian each] Bai Dou Kou (Amomi Fructus Rotundus) Bai Zhi (Angelicae Dahuricae Radix) Lian Qiao (Forsythiae Fructus) [1 qian each] Huang Lian (Coptidis Rhizoma) Mu Xiang (Aucklandiae Radix) Huo Xiang (Agastaches Herba) [0.3 qian each] Chai Hu (Bupleuri Radix) [0.3 qian]
Grind into powder, soak in dough to make pills, and sun-dry. Take 2 qian of crushed powder each time, swallowing with saliva. This formula acts gently, preventing middle jiao fullness and avoiding carbuncles or lower wasting-thirst.
Qian Shi Bai Zhu San Treats Zhong Xiao of Deficiency type.
Ren Shen (Ginseng Radix et Rhizoma) Bai Zhu (Atractylodis Macrocephalae Rhizoma) Fu Ling (Poria) Huo Xiang (Agastaches Herba) Gan Cao (Glycyrrhizae Radix et Rhizoma) [1 liang each] Gan Ge (Puerariae Lobatae Radix) [2 liang]
Jie Geng (Platycodonis Radix) [5 qian] Bai Mi (White Honey) [10 spoons]
Sheng Di Huang Yin Zi Treats deficiency-fire flaming upward in the Lower Jiao.
Ren Shen (Ginseng Radix et Rhizoma) Sheng Di Huang (Rehmanniae Radix) Shu Di Huang (Prepared Rehmanniae Radix) Mai Dong (Ophiopogonis Radix) Tian Dong (Asparagi Radix) Shi Hu (Dendrobii Caulis) Wu Wei Zi (Schisandrae Chinensis Fructus) Pi Pa Ye (Loquat Leaf) Gan Cao (Glycyrrhizae Radix et Rhizoma) Fu Ling (Poria)
Ci Shi Ni Ni Wan Treats Qiang Zhong (Strong Middle) wasting-thirst with involuntary seminal emission.
Ni Ni (Citri Reticulatae Pericarpium Viride / Citrus Unshiu Fruit) Da Dou (Sojae Semen) Fu Ling (Poria) Ci Shi (Magnetitum) Xuan Shen (Scrophulariae Radix) Shi Hu (Dendrobii Caulis) Hua Fen (Trichosanthis Radix) Di Gu Pi (Lycii Cortex) Lu Rong (Cervi Cornu Pantotrichum) [1 liang each]
Chen Xiang (Aquilariae Lignum Resinatum) Ren Shen (Ginseng Radix et Rhizoma) [5 qian each] Shu Di Huang (Prepared Rehmanniae Radix) [4 liang]
Take one pig kidney, boil until soft, mash, mix with honey, and form pills. Take on an empty stomach with salt water.
Jia Wei Di Huang Wan
This is Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) added with Mai Dong (Ophiopogonis Radix) and Wu Wei Zi (Schisandrae Chinensis Fructus).
Formula 1
Extract juice from water pears, mix with honey, and simmer into a paste. Take as needed. Lotus root juice is also excellent.
Formula 2
For Xiao Ke patients who can eat, to prevent future carbuncles, use Ren Dong Jin Yin Hua (Lonicerae Japonicae Flos), regardless of whether using roots, stems, flowers, or leaves. Soak in wine, roast over fire, sun-dry, add Gan Cao (Glycyrrhizae Radix et Rhizoma) and Hua Fen (Trichosanthis Radix), grind into powder, and form pills with honey.