千金论曰∶凡消渴病经百日以上者。不得灸刺。灸刺则于疮上漏脓水不歇。遂成痈疽。
羸瘦而死。亦忌有所误伤皮肉。若作针孔许大疮者。所饮之水。皆于疮中变成脓水而出。若
水出不止者必死。慎之慎之。初得消渴者。可依后方灸刺之为佳。孙氏云∶消渴病百日外既
不许针刺。所饮之水。皆化为脓水不止者皆死。特须慎之。又云∶仍不得误伤皮肉。若有小
疮。亦云致死。既今亦得消渴。且未免饮水。水入疮即损人。今初得日。岂得令其灸刺。致
此误伤之祸。辄将未顺其理。且取百日以上为能。未悟初灸之说。故不录灸刺。凡灸刺则外
脱其气。消渴皆是宣疾。灸刺特不相宜。唯香港脚宜即灸之。是以不取灸穴者耳。又有人患消
渴小便多而数。发在于春。经一夏专服栝蒌及豉汁。得其力。渴渐瘥。然小便犹数甚。昼夜
二十余行。常至三四升。极差不减二升也。转久便止。渐食肥腻。日就羸瘦。唇口干燥。吸
吸少气。不得多语。心烦热。两脚酸。食乃兼倍于常。而不为气力者。然此病皆由虚热所为
耳。疗法。栝蒌汁可长服以除热。牛乳杏酪善于补。此法最有益。（出第二十一卷中）
文仲疗消渴热中。加减六物丸方。
栝蒌根（八分） 麦门冬（六分去心） 知母（五分） 人参（四分） 苦参（四分） 土
瓜根（
四分）
右药捣筛。以牛胆和为丸。如小豆。服二十丸。日三服。麦粥汁下。未知。稍加至三十
丸。咽干者加麦门冬。舌干加知母。胁下满加人参。小便难加苦参。小便数加土瓜根。随患
加之一分。（肘后同）
又黄连丸。主消渴方。
黄连（一斤去毛） 生地黄（十斤）
上二味捣。绞地黄取汁渍黄连。出曝之燥。复纳之。令汁尽。干捣之下筛。蜜和丸如梧
子。服二十丸。日三服。亦可散。以酒服方寸匕。日三服。尽更令作。即瘥止。忌猪肉芜荑。
（
千金栝蒌粉散。疗消渴秘方。
《千金方》论述说：凡是消渴病病程超过一百天的患者，禁止使用艾灸和针刺。如果进行灸刺，疮口会持续流出脓水不止，最终演变成痈疽（严重的化脓性感染），导致身体极度消瘦而死亡。同时也忌讳误伤皮肤和肌肉。如果造成像针孔那样大小的疮口，所饮用的水都会从疮口中变成脓水排出。如果水流不止，必然导致死亡，务必谨慎再谨慎。刚患上消渴病的初期，可以按照后文的方子进行灸刺，这样较为适宜。孙思邈说：消渴病在百日之后就不允许进行针刺，所饮用的水都会化为脓水且流出不止的都会死亡，特别需要谨慎。又说：仍然不能误伤皮肉，如果有小疮，也说是致死的。既然现在我也患上了消渴病，并且难免要饮水，水进入疮口就会损害人体，如今刚患病不久，怎么能让他接受灸刺，导致这种误伤的灾祸呢？这显然是违背医理的。况且以百日以上为界限，是因为尚未领悟初起时灸刺的说法，所以不收录灸刺之法。凡是灸刺都会使体表之气外泄，消渴病属于宣散之疾（指津液耗散、虚热内盛的疾病），灸刺特别不相宜。只有香港脚（足部肿胀疼痛等症）适合立即灸治，因此不选取灸穴罢了。又有人患消渴病，小便多且频数，发病于春季，整个夏季专门服用栝蒌（瓜蒌）及豆豉汁，凭借药力，口渴逐渐缓解，然而小便仍然非常频数，昼夜二十多次，每次多达三四升，即使病情极轻也不少于两升。时间久了症状便停止，逐渐食用肥腻食物，日渐消瘦，嘴唇和口腔干燥，呼吸短促气少，不能多说话，心中烦躁发热，两脚酸软，进食量是常人的两倍，但体力却并未增加。然而此病都是由虚热引起的。治疗方法：栝蒌汁可以长期服用以清除热邪；牛乳和杏酪善于补益，这种方法最为有益。（出自第二十一卷中）
文仲治疗消渴热中证，加减六物丸方：
栝蒌根（八分） 麦门冬（六分，去心） 知母（五分） 人参（四分） 苦参（四分） 土瓜根（四分）
以上药物捣碎过筛，用牛胆汁调和制成丸剂，如小豆大小。每次服用二十丸，每日三次，用麦粥汁送服。若无效，稍加至三十丸。咽干者加麦门冬，舌干加知母，胁下胀满加人参，小便困难加苦参，小便频数加土瓜根，根据病症每样加一分。（《肘后备急方》相同）
又有黄连丸，主治消渴方：
黄连（一斤，去毛） 生地黄（十斤）
以上两味药捣碎，绞取生地黄汁浸泡黄连，取出晒干，再次放入汁液中浸泡，直到汁液被吸尽，然后干燥捣碎过筛，用蜂蜜调和制成梧桐子大小的丸剂。每次服用二十丸，每日三次。也可以做成散剂，用酒送服一方寸匕，每日三次。服完后再制作，病愈即停。忌食猪肉和芜荑。
The *Qianjin Fang* (Essential Prescriptions Worth a Thousand Gold) states: For patients with Xiao Ke (Wasting and Thirsting Syndrome) whose condition has persisted for more than one hundred days, moxibustion and acupuncture are contraindicated. If moxibustion or acupuncture is performed, the resulting sores will leak pus and fluid incessantly, eventually developing into Yong Ju (carbuncles and malignant ulcers), leading to emaciation and death. One must also avoid accidental injury to the skin and flesh. If a wound the size of a needle puncture is created, all ingested water will transform into pus and drain from the wound. If this drainage does not cease, death is inevitable; therefore, extreme caution is required. For those who have just contracted Xiao Ke, it is advisable to follow the subsequent prescriptions for moxibustion and acupuncture. Sun Simiao stated: Acupuncture is prohibited for Xiao Ke after one hundred days; if the ingested water transforms into unceasing pus, death ensues. Special caution is necessary. He further stated that one must not accidentally injure the skin and flesh; even small sores can be fatal. Since I currently suffer from Xiao Ke and inevitably consume water, allowing water to enter a wound would harm the body. Given that the illness is in its early stages, how could one subject the patient to moxibustion or acupuncture, thereby inviting such mishap? This clearly contradicts medical principles. Moreover, the restriction on the hundred-day mark exists because the rationale for early-stage moxibustion had not yet been fully understood; thus, these methods were not recorded. Generally, moxibustion and acupuncture cause the exterior Qi to dissipate. Xiao Ke is characterized by dispersion and deficiency-heat, making moxibustion and acupuncture particularly unsuitable. Only Hong Jiao Jiao (Hongjiao disease, characterized by swelling and pain in the lower limbs) is suitable for immediate moxibustion; hence, acupoints for moxibustion are not selected for Xiao Ke.
Another case involves a patient with Xiao Ke presenting with polyuria and frequency, onset in spring. Throughout the summer, the patient exclusively consumed Gualou juice (Trichosanthes fruit juice) and Douchi juice (fermented soybean juice). With the efficacy of these remedies, thirst gradually subsided, yet urinary frequency remained severe, occurring more than twenty times day and night, with volumes reaching three to four sheng per occasion, and never less than two sheng even when symptoms were mild. Over time, the urinary symptoms ceased. The patient gradually resumed a diet rich in fatty and greasy foods, becoming increasingly emaciated, with dry lips and mouth, shortness of breath, inability to speak much, irritability, heat sensation, soreness in both legs, and food intake double the normal amount without corresponding increase in strength. This condition is attributed to deficiency-heat. The treatment method involves long-term consumption of Gualou juice to clear heat; milk and apricot cheese are beneficial for tonification. This method is highly effective. (Excerpted from Volume 21)
Wen Zhong’s prescription for treating Xiao Ke with Heat in the Middle Jiao, Modified Liu Wu Wan (Six-Ingredient Pill):
Gualou Gen (Trichosanthis Radix, 8 fen)
Maimendong (Ophiopogonis Radix, 6 fen, heart removed)
Zhimu (Anemarrhenae Rhizoma, 5 fen)
Renshen (Ginseng Radix, 4 fen)
Kushen (Sophorae Flavescentis Radix, 4 fen)
Tugua Gen (Cucumeris Radix, 4 fen)
Pulverize and sieve the above herbs. Mix with ox bile to form pills the size of small beans. Take 20 pills three times daily, administered with millet porridge liquid. If ineffective, slightly increase to 30 pills. Add Maimendong for dry throat, Zhi mu for dry tongue, Renshen for fullness under the hypochondrium, Kushen for difficult urination, and Tugua Gen for frequent urination. Increase each herb by 1 fen according to specific symptoms. (Identical to *Zhou Hou Bei Ji Fang*)
Another prescription is Huanglian Wan (Coptis Pill), indicated for Xiao Ke:
Huanglian (Coptidis Rhizoma, 1 jin, hairs removed)
Sheng Dihuang (Rehmanniae Radix Recens, 10 jin)
Pulverize the two ingredients. Squeeze juice from Sheng Dihuang to soak Huanglian. Remove and dry, then re-immerse until the juice is fully absorbed. Dry, pulverize, and sieve. Mix with honey to form pills the size of wutong seeds. Take 20 pills three times daily. Alternatively, prepare as powder; take 1 cun bi (approx. 5-10 grams) with wine, three times daily. Repeat preparation until cured, then discontinue. Avoid pork and Eruyi (Coriandrum sativum).
(The Gualou Fen San (Trichosanthes Powder) from *Qianjin Fang* is a secret prescription for treating Xiao Ke.)