《本事方》云∶唐李祠部治消渴者，肾虚所致，每发则小便甜，医多不知其故，方书缺而不言。《
洪范》曰∶“稼穑作甘”。以物理推之，淋饧醋酒作脯法，须臾即甜，足明人之食后，滋味皆甜，流在
膀胱，若腰肾气盛，则上蒸炎，气化成精，气下入骨髓，其次为脂膏，又其次为血肉，其余则为小便；故
小便色黄，血之余气也。五脏之气咸润者，则下味也。若腰肾既虚
冷，则不能蒸化谷气，尽下为小便，故味甘，不变其色，清冷则肌肤枯稿也。犹如乳母，谷气上泄
，皆为乳汁味甘。消渴病者，下泄皆为小便，皆精气不实于内，则小便频数也。又肺为五脏华盖，
若下有暖气，蒸则气润，若下冷极，则阳不能升，故肺干而渴。譬如釜中有水，以火暖之，又以板
复之，则暖气上腾，故板能润，若无火力，则水气不能上升，此板终不得润。火力者，腰肾强盛也，
常须暖补肾气，饮食得火力，则润上而易消，亦免干渴之患。故仲景云∶宜服八味肾气丸。
余族兄双柏，五旬后病此，时师以滋阴降火之剂投之，小便愈多，色清而长，味益甘，则渴益
甚。屡更医，率认为热，尽用苦寒，轻剂如天花粉、黄连、麦冬、石膏、知母之类，重剂如汞丹之
类，不惟不效，反至遍身如癞，精神 削，脉皆细数。余后至，曰∶此东垣所云，消渴末传也。能
食者，必发脑疽背疮；不能食者，必传中满鼓胀。今脉细数，而肤皆隐疹，宁免其无疽疡乎？急宜
更药，毋用寒凉坏胃也。乃以肾气丸，加桂心、五味子、鹿角胶、益智仁，服之半月。精神霈长，
消渴痊除，小便不甜，肤疹俱脱，十年无恙。后以不如意事触之，渴疾复作，诸医又以滋阴
剂与之，遂成肿满而毙。呜呼，痛哉！设若守加味肾气丸，未必有是肿满病也。仲景、东垣，实为祖师
，千载之下，益使人崇信也。特附于斯，以告同志。
《本事方》记载：唐代李祠部治疗消渴病，认为其病因在于肾虚。每次发病时，小便味道甘甜，但医生们大多不知道其中的缘故，医书上也缺失对此的记载而未加说明。
《洪范》中说：“庄稼和收割（指土）的味道是甘甜的。”用物理道理来推究，制作淋饧、醋酒等脯腊的方法中，很快就会变甜，这充分证明人进食之后，滋味的本质都是甜的。这些甜味物质流注在膀胱，如果腰肾之气强盛，就能向上蒸腾炎上，通过气化作用转化为精；气下行进入骨髓，其次转化为脂膏，再次转化为血肉，剩下的部分则成为小便；所以小便颜色发黄，这是血液之余气。五脏之气都滋润的话，向下传导的就是甜味。如果腰肾已经虚冷，就不能蒸化谷气，导致谷气全部下泄成为小便，因此小便味甘，且不改变其清冷的颜色，导致肌肤干枯憔悴。这就好比乳母，谷气上泄，都变成了乳汁，所以乳汁味甘。消渴病患者，下泄的都成为小便，精气不能在体内充实，就会导致小便频数。
另外，肺是五脏的华盖（保护伞），如果下部有暖气蒸腾，气机就会滋润；如果下部寒冷至极，阳气就不能上升，所以肺干燥而口渴。譬如锅中有水，用火加热它，再用板子盖在上面，那么暖气就会上升，所以板子能变得湿润；如果没有火力，水气就不能上升，这块板子终究无法湿润。这里的“火力”，指的是腰肾功能的强盛。平时需要温补肾气，饮食得到火力的运化，就能滋润上部且容易消化，也能避免干渴的祸患。所以张仲景说：适宜服用八味肾气丸。
我的族兄孙双柏，五十岁后得了这个病。当时的医生用滋阴降火的药剂投治，结果小便更多，颜色清长，味道更加甘甜，口渴也越发严重。多次更换医生，都认为是热证，全部使用苦寒药物，轻剂的如天花粉、黄连、麦冬、石膏、知母之类，重剂的如汞丹之类。不仅没有效果，反而导致遍身生出如癞疮般的皮疹，精神消瘦，脉象皆细数。我后来诊治，说：这是李东垣所说的消渴病的末期传变。能吃东西的，一定会发生脑疽或背疮；不能吃东西的，一定会发展为中满鼓胀。现在脉象细数，皮肤都有隐疹，难道能避免不发生疽疡吗？应当紧急更改药方，不要用寒凉药物损伤胃气。于是我用肾气丸，加入桂心、五味子、鹿角胶、益智仁，服用半个月。精神旺盛增长，消渴病痊愈，小便不再甘甜，皮肤皮疹全部脱落，十年平安无事。后来因为不如意的事情刺激他，口渴的病又发作了，其他医生又给他用滋阴剂，最终导致全身肿胀而死。唉，真是令人痛心啊！如果当时坚守使用加味肾气丸，未必会有这种肿胀死亡的病症。张仲景、李东垣，实在是祖师爷，千年之后，更让人崇信他们。特此附记于此，以告诉志同道合的人。
The *Ben Shi Fang* records: Li Sicbu of the Tang Dynasty treated Xiao Ke (Wasting and Thirsting Syndrome), attributing it to Kidney Deficiency. Upon each onset, the urine was sweet, yet physicians largely did not understand the cause, and medical texts lacked this explanation.
The *Hong Fan* states: "Grains and harvest correspond to Earth, whose flavor is Sweet." By applying physical principles, in the method of making preserved foods from syrup, vinegar, and wine, sweetness appears quickly. This sufficiently proves that after human consumption, the essence of flavors is Sweet. These substances flow into the Bladder. If the Qi of the Waist and Kidneys is vigorous, it steams upward; through Qi transformation, it becomes Essence. The Qi descends into the Marrow, then transforms into Lipids and Fats, subsequently into Flesh and Blood, and the remainder becomes Urine. Therefore, urine is yellow, being the residual Qi of Blood. When the Qi of the Five Zang Organs is moistening, the downward transmission is Sweet. If the Waist and Kidneys are deficient and cold, they cannot steam and transform Grain Qi, causing all Grain Qi to descend as Urine. Thus, the urine tastes Sweet, remains clear and cold, and leads withered skin and muscles. This is like a nursing mother: Grain Qi ascends and leaks out, becoming breast milk, which is therefore Sweet. In patients with Xiao Ke (Wasting and Thirsting Syndrome), the descending output becomes Urine. Since Essence and Qi are not solidified internally, frequent urination occurs.
Furthermore, the Lung is the Canopy of the Five Zang Organs. If there is warm Qi steaming from below, the Qi becomes moist; if the lower part is extremely cold, Yang Qi cannot ascend, leading to a dry Lung and thirst. For example, if there is water in a pot and fire warms it, while a board covers it, warm Qi rises, making the board moist. Without fire, water vapor cannot rise, and the board remains dry. The "Fire Power" refers to the strength of the Waist and Kidneys. One must constantly warm and tonify Kidney Qi. With the aid of Fire Power, food and drink are moistened in the upper body and easily digested, avoiding the affliction of dryness and thirst. Therefore, Zhang Zhongjing stated: It is appropriate to take Ba Wei Shen Qi Wan (Eight-Ingredient Pill for the Kidney Qi).
My clan brother, Sun Shuangbai, suffered from this illness after age fifty. Contemporary physicians prescribed agents for Nourishing Yin and Descending Fire, resulting in increased urine volume, clear and long urine, sweeter taste, and exacerbated thirst. Physicians changed repeatedly, all diagnosing Heat, and using Bitter-Cold herbs. Mild agents included Tian Hua Fen (Trichosanthes Root), Huang Lian (Coptis Rhizome), Mai Dong (Ophiopogon Tuber), Shi Gao (Gypsum Fibrosum), and Zhi Mu (Anemarrhenae Rhizoma); heavy agents included Mercury Pills. Not only were they ineffective, but the patient developed widespread eczema-like rashes, emaciation, and a fine-rapid pulse. I later examined him and said: This is the terminal transmission of Xiao Ke (Wasting and Thirsting Syndrome) as described by Li Dongyuan. Those who can eat will likely develop Brain Carbuncles or Back Sores; those who cannot eat will develop abdominal fullness and distension. Currently, the pulse is fine and rapid, and the skin has hidden rashes. How can one avoid carbuncles and sores? Medication must be urgently changed; do not use Cold-Cooling herbs to damage the Stomach. I prescribed Shen Qi Wan (Kidney Qi Pill) augmented with Gui Xin (Cinnamon Twig Heart), Wu Wei Zi (Schisandra Fruit), Lu Jiao Jiao (Deer Antler Glue), and Yi Zhi Ren (Alpinia Oxyphylla Fruit). After half a month of administration, spirit and vitality recovered, Xiao Ke (Wasting and Thirsting Syndrome) was cured, urine lost its sweetness, and skin rashes resolved. He remained healthy for ten years. Later, triggered by dissatisfaction, the thirst disease recurred. Other physicians again administered Nourishing Yin agents, leading to generalized edema and death. Alas, how painful! Had he adhered to the Augmented Shen Qi Wan (Kidney Qi Pill), such edema and death might have been avoided. Zhang Zhongjing and Li Dongyuan are truly the grandmasters; a millennium later, their teachings inspire even greater reverence. I record this here to inform my colleagues.