陈皮（去白，二钱） 竹茹（一团） 半夏 人参 甘草（各一钱
水煎服。
经云∶渴而多饮为上消，消谷善饥为中消，口渴、小水如膏者，为下消。三消之症，皆
燥热结聚也。大法，治上消者，宜润其肺，兼清其胃，二冬汤主之；治中消者，宜清其胃，
兼滋其肾，生地八物汤主之；治下消者，宜滋其肾，兼补其肺，地黄汤、生脉散并主之。
夫上消清胃者，使胃火不得伤肺也；中消滋肾者，使相火不得攻胃也；下消清肺者，滋上
源以生水也。三消之治，不必专执本经而滋其化源则病易痊矣。书又云∶饮一溲一，或饮一
溲二，病势危急，仲景用八味丸主之，所以安固肾气也。而河间则用黄 汤和平之剂。大抵
肺肾虚而不寒者，宜用此法。又按仲景少阴篇云∶肾经虚，必频饮热汤以自救，乃同气相求
之理，今肾经虚寒，则引水自灌，虚寒不能约制，故小便频数，似此不必与消症同论，宜
用理中汤，加益智仁主之。然予尝见伤暑发喘之症，小便极多，不啻饮一而溲二者，用六味加
知柏而效，可见此症，又由肾经阴虚而得，治宜通变，正当临证制宜，未可一途而取也。
治上消。
天冬（去心，二钱） 麦冬（去心，三钱） 花粉（一钱） 黄芩（一钱） 知母（一钱） 甘草（五分） 人参
（五分）
荷叶（一钱）
水煎服。
陈皮（去除白色内层，二钱） 竹茹（一团） 半夏 人参 甘草（各一钱）
用水煎煮后服用。
《内经》说：口渴且多饮的是上消，吃得多且容易饥饿的是中消，口渴且小便像膏脂一样的，是下消。三消的症状，都是燥热结聚所致。一般治疗原则是：治疗上消，应当滋润肺脏，兼清胃火，以二冬汤为主方；治疗中消，应当清胃火，兼滋肾阴，以生地八物汤为主方；治疗下消，应当滋补肾阴，兼补肺气，以地黄汤、生脉散并为主方。所谓上消清胃，是为了使胃火不致伤害肺脏；中消滋肾，是为了使相火不致攻伐胃腑；下消清肺，是通过滋水上源来滋生肾水。治疗三消，不必专门拘泥于本经病变，只要滋其化源，病就容易痊愈了。医书又说：喝一份尿一份，或喝一份尿两份，病情危急，张仲景用八味丸主治，以此来安固肾气。而刘河间则使用黄芩汤等平和的药剂。大抵肺肾虚而不寒的，适宜用这种方法。又按张仲景《伤寒论》少阴篇所说：肾经虚弱，必定频繁饮用热汤来自救，这是同气相求的道理。如今肾经虚寒，则引水自灌，因虚寒不能制约水液，所以小便频数，像这种情况不必与消渴症同样讨论，适宜用理中汤，加益智仁主治。然而我曾见过伤暑导致发喘的症状，小便极多，不止喝一份尿两份的情况，使用六味地黄丸加知母、黄柏而见效，可见此症，又是由于肾经阴虚所致，治疗应当灵活变通，正当根据临证情况制宜，不可只拘泥于一种方法。
治疗上消。
天冬（去除心部，二钱） 麦冬（去除心部，三钱） 花粉（一钱） 黄芩（一钱） 知母（一钱） 甘草（五分） 人参（五分）
荷叶（一钱）
用水煎煮后服用。
Chenpi (Citri Reticulatae Pericarpium, peeled of the white pith, 2 qian) Zhuru (Bambusae Caulis in Taeniam, one bundle) Banxia Pinelliae Rhizoma Ren Shen Ginseng Radix Gancao Glycyrrhizae Radix et Rhizoma (each 1 qian)
Decoct with water and take orally.
The *Neijing* states: Thirst accompanied by excessive drinking is Shangxiao (Upper Xiao); excessive hunger with rapid digestion is Zhongxiao (Middle Xiao); thirst accompanied by urine resembling paste is Xiaxiao (Lower Xiao). The manifestations of the three Xiaos are all caused by the accumulation of dryness-heat. The general treatment principle is: for Shangxiao, moisten the Lung and clear the Stomach heat simultaneously, primarily using Erdong Tang (Two Dong Decoction); for Zhongxiao, clear the Stomach heat and nourish Kidney Yin simultaneously, primarily using Shengdi Bawu Tang (Rehmannia Eight Substances Decoction); for Xiaxiao, nourish Kidney Yin and tonify Lung Qi simultaneously, primarily using Dihuang Tang (Rehmannia Decoction) and Shengmai San (Generate the Pulse Powder). Clearing the Stomach in Shangxiao prevents Stomach fire from injuring the Lung; nourishing the Kidney in Zhongxiao prevents Ministerial Fire from attacking the Stomach; clearing the Lung in Xiaxiao generates Kidney Water by nourishing the upper source. In treating the three Xiaos, one need not strictly adhere to the affected meridian alone; as long as the source of transformation is nourished, the disease will easily recover. Another medical text states: Drinking one part and urinating one part, or drinking one part and urinating two parts, indicates a critical condition. Zhang Zhongjing used Bajun Wan (Eight-Ingredient Pill with Aconite) to treat this, thereby stabilizing and securing Kidney Qi. Liu Hejian, on the other hand, used Huangqin Tang (Scutellaria Decoction) and other mild agents. Generally, for deficiency of Lung and Kidney without cold, this method is suitable. Furthermore, according to the Shaoyin chapter of Zhang Zhongjing’s *Shanghan Lun*: When the Kidney meridian is deficient, frequent drinking of hot fluids occurs as self-rescue, following the principle of seeking resonance with similar qi. However, when the Kidney meridian is deficient and cold, it draws water in freely; due to deficiency-cold failing to control and restrain, frequent urination ensues. Such cases should not be discussed identically to Xiao (Wasting-Thirst) syndrome; instead, Lizhong Tang (Regulate the Middle Decoction) with Yizhiren (Alpiniae Oxyphyllae Fructus) added is appropriate. Nevertheless, I have observed cases of asthma induced by summerheat where urination was extremely abundant, exceeding the ratio of one drink to two urinations, which responded effectively to Liujun Wan (Six-Ingredient Pill with Rehmannia) plus Zimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex). This shows that such symptoms can also arise from Yin deficiency of the Kidney meridian. Treatment requires flexibility and adaptation to clinical circumstances; one cannot rely on a single approach.
Treating Shangxiao.
Tiangong (Asparagi Radix, heart removed, 2 qian) Maidong (Ophiopogonis Radix, heart removed, 3 qian) Huafen (Trichosanthis Radix, 1 qian) Huangqin (Scutellariae Radix, 1 qian) Zimu (Anemarrhenae Rhizoma, 1 qian) Gancao (Glycyrrhizae Radix et Rhizoma, 5 fen) Ren Shen (Ginseng Radix, 5 fen)
Heye (Nelumbinis Folium, 1 qian)
Decoct with water and take orally.