三消者，凡多饮而渴不止，为上消。经云∶心移热于肺，传为鬲消。鬲消者，鬲上焦烦，饮水多而
善消也。消谷善饥为中消，验云∶胃中热，则消谷；令人悬心善饥。盖胃热则谷食易消，故令人善饥，
胃火上炎，心血燥灼，而悬悬不宁也。溲便频而膏浊不禁为下消。经云∶肾脉微小为消瘅。阴精衰少，
故肾脉微小。瘅者热也，热则消肌肤，故为消瘴。景岳又言消瘴者，三消之总称也。按张戴人云∶三消
当从火断，观《内经》论消症不同，归之于火则一也。河间论治
三消大法，当泻心火，除胃热，补肾水。又按《袖珍方》云∶消渴皆因肾水沽竭，心火燔盛，三焦猛
烈，五脏干燥，由是消渴生焉。观此诸论，则知清金、壮水二法，为治消症之大纲也。景岳引内经
心移寒于肺为肺消，饮一溲二，死不治之条，言消有阴阳，不得尽称为火症。此以示人当知病情
之变幻耳。勿执是说，而浪用热剂，则不致以火济火而杀人矣。
二冬二母散〔见小便不通。〕
泻白散〔见火。〕多饮而渴不止，甚者舌上赤裂，急合
二方，加减大剂治之。宜加五味 花粉〔生津。〕生地 玄参〔补水。〕 芦根汁〔降
火。〕 生鸡子白〔除热。〕甚者可加石膏、芩、连。
此清金、壮水、生津、除热之剂。《总录》谓不能食而渴者，末传中满，勿过用寒凉泻火之药。能
食而渴者，必发脑疽，背痈。故消渴病少愈，急宜用忍冬，少佐甘草熬膏，频饮预防，可免。
竹叶石膏汤〔见伤寒。〕治消谷善饥，饮食昼夜无度。〔经言∶善黄而瘦，火之故也。〕大便
硬少。〔戴人所谓烈火 石，则消为灰是也。〕口渴饮水，〔阳明症本渴炊。〕宜参前方加用之药。〔嘉
言云∶治中消病，当知急救金、水二脏，故须地、冬之品。〕
此方上、中、二消通可用之。昔东垣以之治鬲消，洁古以之治中消，嘉言谓人参白虎汤，治火热伤
其肺、胃，乃清
热救渴之良剂也。
六味加知柏汤〔见火。〕
八仙长寿丸〔见虚劳。〕 溲溺频数，〔水虚火旺，逼迫膀胱
下注故也。〕膏浊不禁，烦渴引饮，〔肾水虚，故引饮自救。〕甚者耳叶焦枯，〔耳为肾之外候。〕二
方通可加减用之。
此方壮水滋阴降火，为下消正治之方。宜加清金润燥之品，大剂次之。按《金匮》治男子消渴，小
便反多，以饮一斗，小便一斗，八味丸主之。沈目南注云∶男子房劳伤肾，水亏火旺，而成消渴，水亏
则相火无制，胃关大开，逼迫水饮，直从膀胱溺出而无底止，用六味滋起肾水；因相火散漫不收，借桂附
收摄元阳入肾，蒸腾肾水而治中、上二焦之火，则消渴自止。此乃兵之以奇胜者也，不善用之，反致祸
败。又按昔人每用八味丸以治消渴。云因命门火衰，不能蒸腐水谷，水谷之气，不能熏蒸上润乎肺。如釜
底无薪，锅盖干燥，故渴。至于肺亦无所禀，不能四布水精，并行五经，其所饮之水，未经火化，直入膀
胱，故饮一斗、溺一斗，试尝其味甘而不咸可知矣。桂、附壮其少火，如釜底加薪，热气蒸腾，锅盖湿
润。虽至理攸寓，然今人之病，火衰者绝少，不可轻试。
忍冬丸〔亦可作膏。〕
忍冬花〔根茎叶皆可用。 入坛内，酒浸足，泥固，糠火微煨一宿，取出晒干。入甘草少许为
末。即以所浸酒煮糊为丸，如桐子大，或汤或酒送下。〕
此养阴退阳，调和荣卫血脉，凡系火热炽盛之体，允为
服食仙方。
三消之脉，数大者生，细微者凶。
Sanxiao (Three Wasting-Thirst) refers to conditions characterized by excessive drinking and unquenchable thirst, known as Shangxiao (Upper Wasting-Thirst). The Classics state: "Heart transfers heat to the Lung, transmitting it to become Gexiao (Diaphragm Wasting-Thirst)." Gexiao is characterized by vexation and heat in the diaphragm and Upper Jiao (Triple Burner), with excessive water intake and rapid digestion of food. Zhongxiao (Middle Wasting-Thirst) is identified by excessive eating and easy hunger. Verified formulas record: "Heat in the Stomach leads to digestion of food; it causes a sensation of emptiness in the heart and easy hunger." Generally, stomach heat makes food digest easily, thus causing easy hunger. When stomach fire flares upward, it scorches Heart blood, resulting in a lingering sense of unease. Xiuxiao (Lower Wasting-Thirst) is characterized by frequent urination and uncontrollable turbid urine resembling paste. The Classics state: "A minute and small Kidney pulse indicates Xiaodan (Wasting-Thirst with Heat)." The decline of Yin essence results in a minute and small Kidney pulse. "Dan" means heat; heat consumes the flesh and skin, hence it is called Xiaozhang (Wasting-Thirst). Zhang Jingyue further states that Xiaodan is the general term for Sanxiao. According to Zhang Dairen: "Treatment of Sanxiao should be determined from the perspective of Fire." Observing the discussion on wasting-thirst in the *Neijing* (*Inner Canon*), although different, they all attribute it to Fire. Liu Hejian discusses the general principles for treating Sanxiao: one should drain Heart Fire, eliminate Stomach Heat, and tonify Kidney Water. Additionally, the *Xiuzhen Fang* (*Pocket Formulas*) states: "Xiaoke (Wasting-Thirst) arises because Kidney Water is exhausted, Heart Fire is blazing, the Triple Burner is fierce, and the Five Zang Organs are dry, thereby generating Xiaoke." From these discussions, it is known that clearing Metal (Lung) and strengthening Water (Kidney) are the main outlines for treating wasting-thirst. Zhang Jingyue cites the *Neijing* passage: "Heart transfers cold to the Lung, becoming Feixiao (Lung Wasting-Thirst); drinking one part, urinating two parts, is incurable and fatal," indicating that wasting-thirst has Yin and Yang aspects and cannot be entirely classified as a Fire syndrome. This is to show people that disease patterns change. Do not adhere rigidly to this view and recklessly use hot-acting agents, lest you kill by adding fire to fire.
Er Dong Er Mu San (Two Wintermelons and Two Mother Herbs Powder) [See section on Urinary Obstruction].
Xie Bai San (Drain White Powder) [See section on Fire]. For cases of excessive drinking and unquenchable thirst, severe enough to cause red cracks on the tongue, urgently combine these two formulas, modify them, and administer in large doses. It is suitable to add Wuweizi (Schisandra Fruit), Tianhuafen (Trichosanthes Root) [to generate fluids], Shengdihuang (Rehmannia Root) and Xuanshen (Scrophularia Root) [to nourish Yin], Lugenzhi (Reed Rhizome Juice) [to descend Fire], and raw egg white [to remove heat]. In severe cases, Shigao (Gypsum), Huangqin (Scutellaria Root), and Lianzi (Coptis Rhizome) can be added.
This is a formula for clearing Lung Metal, nourishing Kidney Water, generating fluids, and removing heat. The *Zonglu* (*General Records*) states: for those who cannot eat but feel thirsty, the disease may transmit to the Middle Jiao causing fullness; do not overuse cold and cooling herbs to drain fire. For those who can eat but feel thirsty, they will inevitably develop brain carbuncles or back sores. Therefore, when Xiaoke improves slightly, one should urgently use Rendonghua (Honeysuckle Flower), with a small amount of Gancao (Licorice Root) boiled into a paste, and drink frequently to prevent complications.
Zhuye Shaoyao Tang (Bamboo Leaf and Poria Decoction) [See section on Cold Damage]. Treats Zhongxiao (excessive eating and easy hunger), with diet day and night without limit. [The Classics say: "Easy hunger with emaciation is due to Fire."] Hard and scanty stools. [As Zhang Dairen described: "Fierce fire burns stone, turning it to ash," metaphorically describing the consumption of the body.] Thirst and desire to drink water. [Yangming syndrome inherently involves thirst.] It is appropriate to refer to the medications used in the previous formula. [Xu Jiayan said: "When treating Zhongxiao, one must know to urgently rescue the Lung and Kidney organs, thus requiring products like Dihuang and Maidong."]
This formula can be generally used for both Shangxiao and Zhongxiao. Historically, Li Dongyuan used it to treat Gexiao, Zhang Jieguy used it to treat Zhongxiao, and Xu Jiayan considered Renshen Baizhu Tang (Ginseng and White Tiger Decoction) as an excellent agent for clearing heat and saving thirst when fire damages the Lung and Stomach.
Liujia Zhibai Tang (Six-Ingredient Decoction with Anemarrhena and Phellodendron) [See section on Fire].
Baxian Changshou Wan (Eight Immortals Longevity Pill) [See section on Deficiency Consumption]. Frequent urination, [due to Yin deficiency and hyperactive Fire forcing the Bladder downward.] Turbid urine resembling paste that cannot be controlled, vexation and thirst leading to drinking, [due to Kidney Water deficiency, thus drawing water to save oneself.] In severe cases, the earlobes become dry and withered, [as the ears are the external manifestation of the Kidney.] Both formulas can be modified and used.
This formula strengthens Water, nourishes Yin, and descends Fire; it is the correct treatment formula for Xiuxiao. It is suitable to add herbs that clear Lung Metal and moisten dryness, administered in large doses subsequently. According to the *Jingui Yaolue* (*Essential Prescriptions from the Golden Cabinet*), for men with Xiaoke where urination is excessive, drinking one dou and urinating one dou, Bawei Wan (Eight-Ingredient Pill) is the primary treatment. Shen Munan annotated: "Male sexual exhaustion injures the Kidney, leading to Water deficiency and Fire hyperactivity, resulting in Xiaoke. Water deficiency means Ministerial Fire is uncontrolled, the Stomach gate opens wide, forcing water drinks directly out through the Bladder without end. Use Liuwang Wan (Six-Ingredient Pill) to replenish Kidney Water; because Ministerial Fire scatters and does not gather, borrow Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) to collect Yuan Yang (Primordial Yang) into the Kidney, steaming Kidney Water to treat Fire in the Middle and Upper Jiao, then Xiaoke stops naturally. This is winning by surprise tactics; if not used skillfully, it may lead to disaster." Additionally, ancients often used Bawei Wan to treat Xiaoke. They stated it is because Mingmen Fire (Gate of Life Fire) is weak, unable to steam and rot food and water, so the Qi of food and water cannot steam upwards to moisten the Lung. Like a pot lid being dry because there is no fire under the pot, thirst ensues. The Lung also receives nothing, unable to distribute water essence and circulate through the five meridians. The drunk water,未经 fire transformation, goes straight to the Bladder, hence drinking one dou, urinating one dou. Tasting it reveals the sweetness without saltiness. Guizhi and Fuzi strengthen the mild Fire, like adding fuel to the bottom of the pot, steaming heat and moistening the lid. Although this contains profound truth, nowadays patients rarely suffer from Fire deficiency; do not lightly try it.
Rendong Wan (Honeysuckle Pill) [Can also be made into a paste.]
Rendonghua (Honeysuckle Flower) [Roots, stems, and leaves are all usable. Place in a jar, soak sufficiently in wine, seal tightly with mud, simmer slowly with chaff fire overnight, take out and dry. Add a little Gancao (Licorice Root), grind into powder. Use the soaking wine to boil into a paste to form pills, sized like paulownia seeds, taken with decoction or wine.]
This nourishes Yin and retreats Yang, harmonizes Ying (Nutritive) and Wei (Defensive) Qi and blood vessels. For constitutions with blazing excess Fire, it is truly an immortal food prescription.
For Sanxiao, a rapid and large pulse indicates survival, while a fine and minute pulse indicates fatality.