消渴症 津液干 口渴不止为上消，治以人参白虎汤。食入即饥为中消，治以调胃承气
汤。饮一溲一小便如膏为下消，治以肾气丸。其实皆津液干之病也，赵养葵变其法。
七味饮 一服安 赵养葵云∶治消症无分上、中、下，但见大渴、大燥，须六味丸料一
斤、肉桂一两、五味子一两，水煎六七碗，恣意冷冻饮料之，睡熟而渴如失矣。白虎、承气汤皆非所治也。
金匮法 别三般 能食而渴者，重在二阳论治。以手太阳主津液，足太阳主血也。饮一
溲一者，重在少阴论治。以肾气虚不能收摄，则水直下趋，肾气虚不能蒸动，则水不能上济
也。不能食而气冲者，重在厥阴论治。以一身中唯肝火最横，燔灼无忌，耗伤津液，而为消
渴也。《金匮》论消渴，开口即揭此旨，以补《内经》之未及，不必疑其错简也。
二阳病 治多端 劳伤荣卫，渐郁而为热者，炙甘草汤可用，喻嘉言清燥汤即此汤变甘
温为甘寒之用也。热气蒸胸者，人参白虎汤可用，《金匮》麦门冬汤即此汤变甘寒而为甘平
之用也。消谷大坚者，麻仁丸加甘草、人参、当归可用，妙在滋液之中攻其坚也。盖坚则不
能消水，如以水投石，水去而石自若也。消症属火，内郁之火本足以消水，所饮之水本足以
济渴。只缘胃中坚燥，全不受水之浸润，转从火热之势，急走膀胱，故小便愈数而愈坚，愈
坚而愈消矣。此论本喻嘉言，最精。
少阴病 肾气寒 饮水多小便少名上消，食谷多而大便坚名食消、亦名中消，上中二消
属热。唯下消症饮一溲一，中无火化，可知肾气之寒也，故用肾气丸。
厥阴症 乌梅丸 方中甘、辛、苦、酸并用。甘以缓之，所以遂肝之志也。辛以散之，
所以悦肝之神也。苦以降之，则逆上之火顺而下行矣。酸以收之，以还其曲直作酸之本性，
则率性而行所无事矣。故此丸为厥阴症之总剂。治此症除此丸外，皆不用苦药，恐苦从火化也。
变通妙 燥热餐 有脾不能为胃行其津液，肺不能通调水道而为消渴者，人但知以清润
治之，而不知脾喜燥而肺恶寒。试观泄泻者必渴，此因水津不能上输而惟下泄故尔。以燥脾
之药治之，水液上升即不渴矣。余每用理中丸汤倍白术加栝蒌根，神效。
消渴症，津液枯竭。口渴不止为上消，用人参白虎汤治疗。吃下去很快就饿为中消，用调胃承气汤治疗。喝一点尿一点、小便像膏脂一样为下消，用肾气丸治疗。其实这都是津液干枯的病症。赵养葵改变了治疗方法。
七味饮，一服见效。赵养葵说：治疗消渴症不分上、中、下三消，只要见到极度口渴、极度干燥，必须用六味地黄丸的药料一斤、肉桂一两、五味子一两，加水煎煮成六七碗，随意冷冻后饮用，睡熟之后口渴就像消失了一样。人参白虎汤和调胃承气汤都不适合治疗这种情况。
《金匮要略》的方法，分为三种情况。能吃东西且口渴的，重在阳明经论治。因为手太阳小肠经主管津液，足太阳膀胱经主管血液。喝一点尿一点的，重在少阴经论治。因为肾气虚弱不能固摄，所以水液直接向下流失；肾气虚弱不能蒸腾气化，所以水液不能向上滋润。不能吃食物且气逆冲上的，重在厥阴经论治。因为全身之中只有肝火最横暴，燃烧灼烧毫无顾忌，耗伤津液，从而形成消渴症。《金匮要略》论述消渴症，开头就揭示了这个宗旨，以补充《黄帝内经》未曾涉及的内容，不必怀疑是竹简错乱。
阳明病，治疗方法多样。因劳损导致营卫之气受伤，逐渐郁结而产生热邪的，可以用炙甘草汤，喻嘉言的清燥救肺汤就是将此汤由甘温变为甘寒的用法。热气蒸腾于胸部的，可以用人参白虎汤，《金匮要略》中的麦门冬汤就是将此汤由甘寒变为甘平的用法。食物消化过快且大便干结坚硬的，可以用麻子仁丸加入甘草、人参、当归，妙处在于滋阴润燥的同时攻逐坚结。因为坚硬则不能消化水液，就像把水倒在石头上，水流走了石头依然如故。消渴症属于火证，体内的郁火本来足以消耗水液，所喝的水本来足以缓解口渴。只因为胃中干燥坚硬，完全不受水液的浸润，反而随着火热之势，急速流向膀胱，所以小便次数越多越坚硬，越坚硬就越消耗水液。这个观点本自喻嘉言，最为精辟。
少阴病，肾气虚寒。喝水多但小便少的称为上消，吃得多但大便干结的称为食消，也称为中消，上消和中消都属于热证。唯有下消症，喝一点尿一点，中间没有火的气化作用，可知是肾气虚寒，所以使用肾气丸。
厥阴症，用乌梅丸。方中甘、辛、苦、酸四种味道并用。甘味用来缓和药性，顺应肝脏的生理特性。辛味用来发散郁结，使肝脏的神志愉悦。苦味用来降泄，那么逆上的火气就会顺行而下。酸味用来收敛，恢复肝脏曲直作酸的本性，使其顺其自然地运行而无需刻意干预。所以这个丸子是治疗厥阴症的总方。治疗此症除了这个丸子外，都不用苦味药，担心苦味随火化而加重病情。
变通巧妙，针对燥热饮食。有脾脏不能为胃传输津液，肺脏不能通调水道而导致消渴的，人们只知道用清热滋润的方法治疗，却不知道脾喜欢干燥而肺厌恶寒冷。试看腹泻的人必定口渴，这是因为水津不能向上输送而只向下排泄的缘故。用燥湿健脾的药物来治疗，水液上升就不再口渴了。我每次用理中丸或理中汤加倍白术，再加入栝蒌根，效果神奇。
Xiao Ke (Wasting-Thirst Syndrome), characterized by the depletion of Jin Ye (Body Fluids). Unceasing thirst is classified as Upper Xiao Ke, treated with Renshen Baihu Tang (Ginseng White Tiger Decoction). Hunger shortly after eating is classified as Middle Xiao Ke, treated with Tiaowei Chengqi Tang (Regulate the Stomach and Purge the Yang Decoction). Drinking a small amount yet urinating frequently, with urine resembling paste, is classified as Lower Xiao Ke, treated with Shenqi Wan (Kidney Qi Pill). Fundamentally, all these are diseases caused by the dryness and depletion of Jin Ye. Zhao Yangkui altered this therapeutic approach.
Qiwei Yin (Seven-Ingredient Decoction) brings relief with a single dose. Zhao Yangkui stated: When treating Xiao Ke, one should not distinguish between Upper, Middle, or Lower types; if extreme thirst and dryness are observed, one must use one jin (approx. 500g) of Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) ingredients, one liang (approx. 30g) of Rougui (Cortex Cinnamomi), and one liang of Wuweizi (Fructus Schisandrae). Boil these in water to yield six or seven bowls, and drink them freely while cold. After falling into a deep sleep, the thirst will vanish as if it never existed. Neither Baizhu Tang nor Chengqi Tang is suitable for this condition.
The method from *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) distinguishes three categories. Those who can eat but feel thirsty focus on the treatment of the Yangming Meridians. This is because the Hand-Taiyang Small Intestine Meridian governs Jin Ye, while the Foot-Taiyang Bladder Meridian governs Blood. Those who drink a little and urinate a little focus on the treatment of the Shaoyin Meridians. This is because Kidney Qi deficiency fails to secure and retain fluids, causing water to flow directly downward; furthermore, Kidney Qi deficiency fails to vaporize and ascend fluids, preventing water from nourishing the upper body. Those who cannot eat and experience rebellious Qi rushing upward focus on the treatment of the Jueyin Meridians. Among all meridians, Liver Fire is the most rampant, burning scorchingly without restraint, consuming Jin Ye and resulting in Xiao Ke. The discussion on Xiao Ke in *Jingui Yaolue* reveals this principle right at the beginning, supplementing what was omitted in *Huangdi Neijing* (The Yellow Emperor's Classic of Internal Medicine); there is no need to suspect textual corruption.
Yangming Disease has diverse treatments. For cases where labor and damage to Ying and Wei (Nutritive and Defensive Qi) lead to gradual stagnation and heat generation, Zhigancao Tang (Licorice Decoction) can be used. Yu Jiayan’s Qingzao Jiufei Tang (Clear Dryness and Rescue the Lung Decoction) is a variation that changes this formula from sweet-warm to sweet-cool. For heat steaming in the chest, Renshen Baihu Tang can be used; Maidong Tang (Ophiopogon Decoction) in *Jingui Yaolue* is a variation that changes this formula from sweet-cool to sweet-neutral. For rapid digestion accompanied by hard, dry stools, Maren Wan (Hemp Seed Pill) added with Gancao (Radix Glycyrrhizae), Renshen (Radix Ginseng), and Danggui (Radix Angelicae Sinensis) can be used. Its brilliance lies in attacking hardness while nourishing fluids. Hardness prevents the digestion of water, just as pouring water on stone results in the water flowing away while the stone remains unchanged. Xiao Ke belongs to Fire syndrome; internal stagnant fire is sufficient to consume water, and the ingested water is sufficient to quench thirst. However, due to dryness and hardness in the Stomach, the body completely fails to absorb the moistening effect of water. Instead, following the trend of fire, the water rushes rapidly to the Bladder. Thus, frequent urination leads to greater hardness, and greater hardness leads to further consumption. This argument originates from Yu Jiayan and is extremely precise.
Shaoyin Disease involves Cold Kidney Qi. Drinking much but urinating little is named Upper Xiao Ke; eating much but having hard stools is named Food Xiao Ke, also known as Middle Xiao Ke. Both Upper and Middle Xiao Ke belong to Heat syndromes. Only Lower Xiao Ke, characterized by drinking a little and urinating a little, lacks the transformation of Fire, indicating Cold Kidney Qi; therefore, Shenqi Wan is used.
Jueyin Syndrome is treated with Wumei Wan (Mume Pill). The formula combines Sweet, Pungent, Bitter, and Sour flavors. Sweetness soothes and relaxes, thereby accommodating the nature of the Liver. Pungency disperses, thereby pleasing the spirit of the Liver. Bitterness descends, allowing rebellious fire to flow smoothly downward. Sourness astringes, restoring the Liver’s original nature of bending and straightening becoming sour, allowing it to function according to its nature without obstruction. Therefore, this pill is the general formula for Jueyin Syndrome. In treating this syndrome, aside from this pill, bitter herbs are generally avoided to prevent bitterness from transforming into Fire.
Flexible application addresses dryness and heat from diet. In cases where the Spleen fails to transport Jin Ye for the Stomach, and the Lung fails to regulate water passages, resulting in Xiao Ke, people only know to treat it with clearing and moistening methods, unaware that the Spleen prefers dryness and the Lung dislikes cold. Observe that patients with diarrhea must feel thirsty; this is because fluid essence cannot ascend and instead drains downward. Treating this with herbs that dry dampness and strengthen the Spleen causes fluid essence to ascend, and the thirst disappears. I often use Lizhong Wan (Regulate the Middle Pill) or Lizhong Tang (Regulate the Middle Decoction) with doubled Baizhu (Rhizoma Atractylodis Macrocephalae) plus Gualougen (Radix Trichosanthis), yielding miraculous effects.