1.试观年老多夜溺, 休信三消尽热干, 饮多尿少浑赤热, 饮少尿多
清白寒.
【注】上消属肺, 饮水多而小便如常; 中消属胃, 饮水多而小便短赤
;下消属肾, 饮水多而小便浑浊, 三消皆燥热病也. 然试观年老好饮
茶者, 夜必多溺, 则休信三消皆热, 而亦有寒者矣. 饮水多, 小便少
而浑赤者属热, 是火盛耗水而浑也. 饮水少, 小便多而清白者属寒,
是火虚不能耗水也.
2.三消便硬若能食, 脉大实强尚可医, 不食舌白传肿泻, 热多舌紫
发痈疽.
【注】三消, 饮水多不能食. 若能食大便硬, 脉大强实者, 为胃实热
,下之尚可医也. 若不能食, 湿多舌白滑者, 病久则传变水肿泄泻.
热多舌紫干者, 病久则发痈疽而死也.
竹叶黄耆汤
3.便硬能食脉大强, 调胃金花斟酌当, 不食渴泻白术散, 竹叶黄耆
不泻方, 黄耆黄芩合四物, 竹叶石膏减粳姜, 气虚胃热参白虎, 饮一
溲二肾气汤.
【注】谓胃, 谓调胃承气汤. 金花, 谓栀子金花汤. 方俱在伤寒门,
酌其所当用可也. 不食而渴, 巳属胃虚, 兼之泄泻, 胃虚无热矣. 故
用七味白术散, 方在虚损门. 若不食而渴, 亦不泻者, 是虽虚而犹有
燥热也, 宜用竹叶黄耆汤, 即黄耆, 黄芩, 当归, 川芎, 白芍, 生地
,竹叶, 石膏, 人参, 炙草, 麦冬, 半夏也. 若气虚胃热盛者, 宜用
人参白虎汤. 若下焦虚寒, 饮一溲二者, 宜用肾气汤.
1. 试看老年人夜间多尿，不要轻信三消证（上消、中消、下消）全都是燥热伤津的病证。如果饮水多而小便少，且尿液浑浊、色红、有灼热感，这属于热证；如果饮水少而小便多，且尿液清澈、颜色淡、质地寒凉，这属于寒证。
【注】上消证病位在肺，表现为饮水多而小便量正常；中消证病位在胃，表现为饮水多而小便短少、色红；下消证病位在肾，表现为饮水多而小便浑浊。三消证本质上都是燥热为患的疾病。然而，观察那些喜欢喝茶的老年人，夜晚必然多尿，这就说明不能坚信三消证全是热证，其中也有寒证的情况。饮水多、小便少且浑浊发红的，属于热证，这是因为火邪旺盛消耗了阴液导致尿液浑浊。饮水少、小便多且清澈白色的，属于寒证，这是因为命门火虚，不能蒸化耗损水液。
2. 三消证患者若大便干硬但能进食，脉象大而实强，尚可医治；若不能进食、舌苔白滑并出现水肿泄泻，或热邪盛、舌质紫干并发痈疽，则预后不良。
【注】三消证的典型表现是饮水多但不能进食。如果能进食且大便干硬，脉象大且强实，这是胃中有实热，使用攻下法治疗尚可治愈。如果不能进食，舌苔白滑表明湿邪偏盛，病程久了会传变为水肿和泄泻。如果热邪偏盛，舌质紫干，病程久了会发作痈疽而导致死亡。
竹叶黄耆汤（Zhu Ye Huang Qi Tang, Bamboo Leaf and Astragalus Decoction）
3. 大便干硬、能进食、脉象大且强实的，应斟酌使用调胃承气汤（Tiao Wei Cheng Qi Tang, Regulate the Stomach Order the Qi Decoction）或金花汤（Jin Hua Tang, Golden Flower Decoction）；若不能进食且有口渴、泄泻症状的，使用七味白术散（Qi Wei Bai Zhu San, Seven-Ingredient Atractylodes Macrocephala Powder）；若不能进食但不泄泻的，使用竹叶黄耆汤（Zhu Ye Huang Qi Tang, Bamboo Leaf and Astragalus Decoction）。该方由黄耆（Astragali Radix）、黄芩（Scutellariae Radix）、四物汤（Si Wu Tang, Four Substances Decoction）中的当归（Angelicae Sinensis Radix）、川芎（Chuanxiong Rhizoma）、白芍（Paeoniae Radix Alba）、生地黄（Rehmanniae Radix），以及竹叶（Phyllostachidis Folium）、石膏（Gypsum Fibrosum）、人参（Ginseng Radix）、炙甘草（Glycyrrhizae Radix et Rhizoma Preparata）、麦冬（Ophiopogonis Tuber）、半夏（Pinelliae Tuber）组成。若气虚且胃热炽盛的，宜用人参白虎汤（Ren Shen Bai Hu Tang, Ginseng White Tiger Decoction）。若下焦虚寒，表现为饮水一分则排尿二分的，宜用肾气汤（Shen Qi Tang, Kidney Qi Decoction）。
【注】“谓胃”指的是调胃承气汤。“金花”指的是栀子金花汤（Zhi Zi Jin Hua Tang, Gardenia Golden Flower Decoction）。这些方剂都记载在《伤寒论》相关章节中，可根据具体情况斟酌选用。不能进食且口渴，已经属于胃气虚弱，再加上泄泻，说明胃虚无热邪。因此使用七味白术散，该方记载在虚损门中。如果不能进食且口渴，也不泄泻，这说明虽然正气虚弱但仍有燥热，适宜使用竹叶黄耆汤，即由黄耆、黄芩、当归、川芎、白芍、生地黄、竹叶、石膏、人参、炙甘草、麦冬、半夏组成。若气虚且胃热极盛的，适宜使用人参白虎汤。若下焦虚寒，饮水少而排尿多的，适宜使用肾气汤。
1. Observe that elderly people often suffer from nocturia; do not blindly believe that all cases of San Xiao (Three Burners Diabetes) are caused by dryness-heat consuming fluids. If there is excessive drinking but scanty urine that is turbid, red, and hot, this indicates a Heat syndrome; if there is little drinking but copious urine that is clear, white, and cold, this indicates a Cold syndrome.
[Note] Shang Xiao (Upper Xiao) involves the Lung, characterized by excessive drinking with normal urinary volume; Zhong Xiao (Middle Xiao) involves the Stomach, characterized by excessive drinking with scanty, red urine; Xia Xiao (Lower Xiao) involves the Kidney, characterized by excessive drinking with turbid urine. All three Xiao conditions are essentially diseases of dryness-heat. However, observing elderly individuals who prefer tea and inevitably have frequent urination at night shows that one should not firmly believe all San Xiao cases are heat syndromes; some are indeed cold syndromes. Excessive drinking with scanty, turbid, and red urine belongs to Heat, where vigorous Fire consumes Yin fluids causing turbidity. Little drinking with copious, clear, and white urine belongs to Cold, where deficient Fire fails to vaporize and consume water.
2. In San Xiao patients, if stool is hard but appetite is preserved, and the pulse is large, full, and strong, the condition is treatable; if appetite is lost, accompanied by white tongue coating progressing to edema and diarrhea, or if Heat is excessive with a purple, dry tongue leading to carbuncles and sores, the prognosis is poor.
[Note] The typical manifestation of San Xiao is excessive drinking but inability to eat. If the patient can eat, has hard stool, and presents with a large, full, and strong pulse, it indicates excess Heat in the Stomach, which can be treated with purgative methods. If the patient cannot eat and the tongue coating is white and slippery, indicating dampness predominance, prolonged illness will transform into edema and diarrhea. If Heat predominates and the tongue is purple and dry, prolonged illness will result in carbuncles and sores, leading to death.
Zhu Ye Huang Qi Tang (Bamboo Leaf and Astragalus Decoction)
3. For cases with hard stool, preserved appetite, and a large, full, and strong pulse,酌情 use Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) or Jin Hua Tang (Golden Flower Decoction); for those unable to eat with thirst and diarrhea, use Qi Wei Bai Zhu San (Seven-Ingredient Atractylodes Macrocephala Powder); for those unable to eat without diarrhea, use Zhu Ye Huang Qi Tang (Bamboo Leaf and Astragalus Decoction). This formula consists of Huang Qi (Astragali Radix), Huang Qin (Scutellariae Radix), Si Wu Tang (Four Substances Decoction) components including Dang Gui (Angelicae Sinensis Radix), Chuan Xiong (Chuanxiong Rhizoma), Bai Shao (Paeoniae Radix Alba), Sheng Di Huang (Rehmanniae Radix), Zhu Ye (Phyllostachidis Folium), Shi Gao (Gypsum Fibrosum), Ren Shen (Ginseng Radix), Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata), Mai Dong (Ophiopogonis Tuber), and Ban Xia (Pinelliae Tuber). For Qi deficiency with blazing Stomach Heat, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) is appropriate. For lower jiao deficiency-cold, characterized by drinking one part and urinating two parts, Shen Qi Tang (Kidney Qi Decoction) is appropriate.
[Note] "Wei Wei" refers to Tiao Wei Cheng Qi Tang. "Jin Hua" refers to Zhi Zi Jin Hua Tang (Gardenia Golden Flower Decoction). These formulas are recorded in the Treatise on Cold Damage sections; select them according to clinical indication. Inability to eat with thirst indicates Stomach Qi deficiency; combined with diarrhea, it signifies Stomach emptiness without Heat. Therefore, Qi Wei Bai Zhu San is used, recorded in the Deficiency and Injury section. If unable to eat and thirsty but without diarrhea, although deficient, there remains dryness-heat; thus, Zhu Ye Huang Qi Tang is suitable, composed of Huang Qi, Huang Qin, Dang Gui, Chuan Xiong, Bai Shao, Sheng Di Huang, Zhu Ye, Shi Gao, Ren Shen, Zhi Gan Cao, Mai Dong, and Ban Xia. For Qi deficiency with severe Stomach Heat, Ren Shen Bai Hu Tang is indicated. For lower jiao deficiency-cold with polydipsia and polyuria, Shen Qi Tang is indicated.