论曰∶消渴者，原其发动，此则肾虚所致，每发即小便至甜，医者多不知其疾，所以古
方论亦缺而不言，今略陈其要。按《洪范》稼穑作甘。以物理推之，淋饧醋酒作脯法，须臾
即皆能甜也。足明人食之后，滋味皆甜，流在膀胱，若腰肾气盛，则上蒸精气，气则下入骨
髓，其次以为脂膏，其次为血肉也。其余别为小便，故小便色黄，血之余也。臊气者，五脏
之气；咸润者，则下味也。腰肾既虚冷，则不能蒸于上，谷气则尽下为小便者也。故甘味不
变，其色清冷，则肌肤枯槁也。犹如乳母，谷气上泄，皆为乳汁。消渴疾者，下泄为小便，
此皆精气不实于内，则便羸瘦也。
又肺为五脏之华盖，若下有暖气蒸即肺润，若下冷极，即阳气不能升，故肺干则热，故
《周易》有否卦，干上坤下，阳阻阴而不降，阴无阳而不升，上下不交，故成痞也。譬如釜
中有水，以火暖之，其釜若以板盖之，则暖气上腾，故板能润也。若无火力，水气则不上，
此板终不可得润也。火力者，则为腰肾强盛也。常须暖将息，其水气即为食气，食气若得暖
气，即润上而易消下，亦免干渴也。是故张仲景云∶宜服此八味肾气丸，并不食冷物及饮冷
水，今亦不复渴，比频得效，故录正方于后耳。
凡此疾与香港脚，虽同为肾虚所致，其香港脚始发于二三月，盛于五六月，衰于七八月。凡
消渴，始发于七八月，盛于十一月、十二月，衰于二月、三月，其故何也？夫香港脚者，拥疾
也，消渴者，宣疾也，春夏阳气上，故拥疾发，即宣疾愈也。秋冬阳气下，故宣疾发，即拥
疾愈也。审此二者，疾可理也。又宜食者，每间五六日空腹一食饼，以精羊肉及黄雌鸡为
，此可温也。若取下气，不食肉，菜食者，宜煮牛膝、韭、蔓菁；又宜食鸡子、马肉，此物
微拥，亦可疗宣疾也。拥之过度，便发香港脚，犹如善为政者，宽以济猛，猛以济宽，随事制
度，使宽猛得所，定之于心，口不能言也。
又庸医或令吃栝蒌粉，往往经服之，都无一效。又每至椹熟之时，取烂美者，水淘去浮
者餐之，候心胸间气为度，此亦甚佳。生牛乳暖如人体，渴即细细呷之亦佳。
张仲景云∶足太阳者，是膀胱之经也，膀胱者是肾之腑也，而小便数，此为气盛，气盛
则消谷，大便硬；衰则为消渴也。
男子消渴，饮一斗水，小便亦得一斗，宜八味肾气丸主之，神方。消渴人宜常服之。
干地黄（八两） 薯蓣（四两） 茯苓（三两） 山茱萸（五两） 泽泻（四两） 牡
丹皮（三两）
附
上药捣筛，蜜和丸，如梧子大，酒下十丸，少少加，以知为度，忌猪肉、冷水、芜荑、
胡荽、酢物、生葱。
说曰∶少时服五石诸丸散者，积经年岁，人转虚耗，石热结于肾中，使人下焦虚热，小
便数利，则作消利。消利之病，不渴而小便自利也，亦作消渴，消渴之疾，但渴不利也。又
作渴利，渴利之病，随饮小便也。又作强中病，强中病者，茎长兴，终不痿，溺液自出。亦
作痈疽之病。凡如此等，宜服猪肾荠 汤，制其肾中石势，将饵鸭通丸便瘥也。
猪肾荠 汤
猪肾（一具） 大豆（一升） 荠 石膏（各三两） 人参 茯神（一作茯苓） 磁
石（绵
裹） 知母 葛根 黄芩 栝蒌根 甘草（各二两）
上十二味， 咀，以水一斗五升，先煮猪肾、大豆取一斗，去滓下药，煮取三升，分三
服，渴乃饮之，下焦热者，夜辄合一剂，病势渐歇即止。
鸭通汤方
白鸭通（五升，沸汤二斗半淋之，澄清取二斗汁） 麻黄（八两） 豉（三升） 冷石
（二两）
甘草（五两） 石膏（三两） 栀子仁（二十枚）
上六味， 咀，以鸭通汁煮六升，去滓，纳豉三沸，分服五合，若觉体冷小便快，阔其
间。
若热犹盛，小便赤促，服之不限五合。宜小劳之，渐进食，不可令食少，但勿便多耳。
铅丹散，治消渴，止小便方。
铅丹（二分） 栝蒌（十分） 泽泻（五分） 石膏（五分） 赤石脂（五分） 白石
脂（五分）
胡粉（二分） 甘草（十分）
凡八物，冶下筛，酒服方寸匕，日三。不知稍增，年壮服半匕。得病一年，服药一日愈，
二年二日瘥。甚者夜以水服，勿用酒。
治日饮一石许，小便不通，栝蒌丸方。
栝蒌（三分） 铅丹（三分） 葛根（三分） 附子（一分，炮）
凡四物，冶下筛，蜜丸如梧子，饮服十丸，日三。
治消渴方。
取活螺三斗，以江水一石养之，倾取冷汁，饱饮之。经日放去，更取新者渍之。
夫内消之为病，皆热中所作也，小便多于所饮，令人虚极短气。内消者，食物皆消作小
便去，而不渴也，治之枸杞汤。
枸杞枝叶（一斤，冬根三两） 栝蒌根（三两） 石膏（三两，一方无） 黄连（三两）
甘草
（二两）
凡五物，切，以水一斗，煮取三升。一服五合，日三。
治小便多，昼夜数十起方。
小豆生霍（一把）
凡一物，捣绞取汁，顿饮三升便愈。亦治小儿利。
消渴家忌食猪肉。
论说：消渴病，推究其发病原因，是由于肾虚所致。每次发作时，小便味道极甜。医生们大多不了解这种病症，所以古代方论中也缺失对此的记载而不加论述，现在简要陈述其要点。依据《尚书·洪范》中“稼穑作甘”（种植和收获的事物味道甘甜）的说法。用物理道理来推断，制作淋饧、醋酒等发酵成脯的方法，片刻之间都能变甜。这足以证明人进食之后，滋味皆甜，流注在膀胱。如果腰肾之气强盛，就能向上蒸腾精气，气则向下进入骨髓，其次化为脂膏，再次化为血肉。其余部分成为小便，所以小便颜色发黄，这是血液的剩余物。臊味，是五脏之气；咸味滋润，是下方的味道。腰肾既然虚弱寒冷，就不能向上蒸腾，谷气就全部向下变成小便。所以甘味不变，小便颜色清冷，导致肌肤枯槁。就像乳母一样，谷气上泄，都化为乳汁。消渴病患者，精气向下泄漏为小便，这是因为精气不能在体内充实，所以身体就会瘦弱。
另外，肺是五脏的华盖（保护伞），如果下部有暖气蒸腾，肺就会滋润；如果下部极度寒冷，阳气就不能上升，所以肺干燥则生热。因此《周易》中有否卦，乾在上坤在下，阳气受阻不能下降，阴气没有阳气帮助不能上升，上下不交泰，所以形成痞塞。譬如锅中有水，用火加热，如果用板子盖住锅，那么暖气上升，所以板子能湿润。如果没有火力，水气就不能上升，这块板子终究无法得到湿润。火力，就是指腰肾强盛。平时需要温暖调养，水气就是食气，食气如果得到暖气，就能滋润上部并容易消化下部，也能避免干渴。所以张仲景说：适宜服用八味肾气丸，并且不吃冷物及喝冷水，现在也不再口渴，因为频繁见效，所以记录正方的在后面。
凡是这种病与香港脚（脚气病），虽然同为肾虚所致，但香港脚病始于二三月，盛于五六月，衰于七八月。凡是消渴病，始发于七八月，盛于十一月、十二月，衰于二月、三月，这是什么缘故呢？夫香港脚者，是壅滞之疾；消渴者，是宣通之疾。春夏阳气上升，所以壅滞之疾发作，宣通之疾就痊愈了。秋冬阳气下降，所以宣通之疾发作，壅滞之疾就痊愈了。审察这两者，疾病就可以治理了。又适宜吃的食物，每隔五六天空腹吃一次饼，用精羊肉和黄雌鸡做馅，这样可以温补。如果要下气，不吃肉，只吃菜的人，适宜煮牛膝、韭菜、蔓菁；又适宜吃鸡蛋、马肉，这些食物轻微壅滞，也可以治疗宣通之疾。壅滞过度，就会引发香港脚，就像善于治国的人，以宽厚补救严厉，以严厉补救宽厚，根据事情制定制度，使宽严得当，决定于心，口不能说出来。
又有庸医让人吃栝蒌粉，往往经过服用，都没有一点效果。又到桑葚成熟的时候，选取腐烂美味的，用水淘洗去掉浮起的食用，等到心胸间气机通畅为度，这也很好。生牛乳加热到像人体温度，口渴时细细饮用也很好。
张仲景说：足太阳经，是膀胱的经脉，膀胱是肾的腑，如果小便频数，这是气盛，气盛则消谷，大便硬；气衰则为消渴病。
男子消渴，喝一杯水，小便也排出一杯，适宜用八味肾气丸主治，这是神效方。消渴病人适宜常服。
干地黄（八两） 薯蓣（四两） 茯苓（三两） 山茱萸（五两） 泽泻（四两） 牡丹皮（三两）
以上药物捣碎过筛，蜂蜜和丸，如梧桐子大小，酒送服十丸，逐渐增加，以见效为度，忌食猪肉、冷水、芜荑、胡荽、醋类食物、生葱。
解说：年轻时服用五石诸丸散的人，积累经年累月，人变得虚弱消耗，石药的热气结聚在肾中，使人下焦虚热，小便频数通利，就产生消利病。消利病，不渴而小便自利，也称作消渴，消渴病，只是渴而不通利。又称作渴利，渴利病，随饮随小便。又称作强中病，强中病，阴茎常勃起，终不萎软，尿液自行流出。也称作痈疽病。凡如此等病，适宜服用猪肾荠汤，制约肾中的石势，再服用鸭通丸就会痊愈。
猪肾荠汤方
猪肾（一个） 大豆（一升） 荠菜 石膏（各三两） 人参 茯神（一作茯苓） 磁石（绵裹） 知母 葛根 黄芩 栝蒌根 甘草（各二两）
以上十二味药，切碎，用水一斗五升，先煮猪肾、大豆取一斗，去渣下药，煮取三升，分三次服，渴时才喝，下焦热者，每晚合为一剂，病势渐歇即停。
鸭通汤方
白鸭通（五升，用沸水二斗半淋洗，澄清取二斗汁） 麻黄（八两） 豆豉（三升） 冷石（二两） 甘草（五两） 石膏（三两） 栀子仁（二十枚）
以上六味药，切碎，用鸭通汁煮取六升，去渣，纳入豆豉煮沸三次，分次服用五合，如果觉得身体冷、小便畅快，拉长服药间隔。
如果热仍然旺盛，小便赤红短促，服药不限五合。适宜轻微活动，逐渐进食，不要让吃得少，只要不要立刻吃多即可。
铅丹散，治消渴，止小便方。
铅丹（二分） 栝蒌（十分） 泽泻（五分） 石膏（五分） 赤石脂（五分） 白石脂（五分） 胡粉（二分） 甘草（十分）
共八味药，研磨过筛，酒服方寸匕，每日三次。不见效稍增加，年轻力壮者服半匕。得病一年，服药一天愈，二年两天好。严重者夜间用水送服，不要用酒。
治日饮一石许，小便不通，栝蒌丸方。
栝蒌（三分） 铅丹（三分） 葛根（三分） 附子（一分，炮制）
共四味药，研磨过筛，蜜丸如梧桐子大，饮水送服十丸，每日三次。
治消渴方。
取活螺三斗，用江水一石饲养它们，倒出冷却的汁液，饱饮。过一天放掉，再取新的浸泡。
内消这种病，都是热邪所致，小便多于所饮，令人极度虚弱短气。内消病，食物都消化成从小便排出，而不渴，治疗用枸杞汤。
枸杞枝叶（一斤，冬季用根三两） 栝蒌根（三两） 石膏（三两，一方无此药） 黄连（三两） 甘草（二两）
共五味药，切碎，用水一斗，煮取三升。一次服五合，每日三次。
治小便多，昼夜数十起方。
小豆生霍（一把）
共一味药，捣绞取汁，一次性饮用三升即愈。也治小儿腹泻。
消渴病人忌食猪肉。
Commentary: Xiao Ke (Wasting and Thirsting Syndrome), investigating its onset, is caused by Kidney Deficiency. Each time it occurs, the urine is extremely sweet. Physicians mostly do not understand this disease, so ancient formula treatises lack records of it and do not discuss it. Now, I will briefly state its essentials. According to "Jia Se Zuo Gan" (Crops and Harvests produce a Sweet flavor) in the *Book of Documents* (*Hong Fan*). Inferring from physical principles, methods for making fermented syrups or vinegar-wine preserves turn sweet within moments. This clearly proves that after humans eat, flavors become sweet, flowing into the Bladder. If the Qi of the Waist and Kidneys is vigorous, it can steam Essence upward; this Qi then enters the Bone Marrow downward, subsequently transforming into Fat and Marrow, and further into Flesh and Blood. The remainder becomes Urine, hence the urine is yellow, being the surplus of Blood. The fishy odor is the Qi of the Five Viscera; the salty and moistening taste is the flavor below. Since the Waist and Kidneys are deficient and cold, they cannot steam upward, so Grain Qi all flows downward to become Urine. Thus, the sweet flavor remains unchanged, the urine is clear and cold, leading to withered skin and muscles. It is like a nursing mother, where Grain Qi flows upward and transforms into Milk. In Xiao Ke patients, Essence leaks downward as Urine; because Essence is not solidified internally, the body becomes emaciated.
Furthermore, the Lung is the canopy of the Five Viscera. If there is warm Qi steaming from below, the Lung is moistened; if the lower part is extremely cold, Yang Qi cannot ascend, causing the Lung to be dry and hot. Therefore, in the *I Ching*, there is the Pi Hexagram (Stagnation), with Qian (Heaven/Yang) above and Kun (Earth/Yin) below. Yang is blocked and cannot descend, Yin lacks Yang to ascend. Upper and Lower do not interact, resulting in Stagnation. It is like a pot with water, heated by fire. If covered with a board, warm Qi rises, moistening the board. Without heat, water vapor does not rise, and the board remains dry. Heat represents the strength of the Waist and Kidneys. One must maintain warmth and nourishment; water vapor is Food Qi. If Food Qi receives warmth, it moistens the upper part and easily digests the lower part, preventing dryness and thirst. Thus, Zhang Zhongjing said: It is suitable to take Ba Wei Shen Qi Wan (Eight-Ingredient Pill of the Kidney's Qi), avoid cold foods and drinks, and one will no longer feel thirsty. Having frequently achieved efficacy, I record the correct formulas below.
This disease and Hong Jiao (Foot Qi/Jama), although both caused by Kidney Deficiency, differ in timing. Hong Jiao begins in the second and third months, peaks in the fifth and sixth, and wanes in the seventh and eighth. Xiao Ke begins in the seventh and eighth months, peaks in the eleventh and twelfth, and wanes in the second and third. Why? Hong Jiao is an Obstructive disease; Xiao Ke is a Venting disease. In Spring and Summer, Yang Qi ascends, so Obstructive diseases flare up, and Venting diseases heal. In Autumn and Winter, Yang Qi descends, so Venting diseases flare up, and Obstructive diseases heal. Understanding these two allows the disease to be managed. Suitable foods include eating pancakes on an empty stomach every five or six days, filled with fine mutton and yellow hen meat, which provides warmth. To move Qi downward, avoiding meat and vegetables, one should boil Achyranthes Root (Niu Xi), Chinese Chives (Jiu Cai), and Turnip Greens (Man Jing); also suitable are eggs and horse meat, which have slight obstructive properties and can treat Venting diseases. Excessive obstruction leads to Hong Jiao, similar to a good ruler who balances leniency with severity, adjusting measures according to circumstances, determined in heart but unspoken.
Quack doctors sometimes advise eating Trichosanthes Powder, but often taking it yields no effect. When mulberries ripen, select soft, delicious ones, wash away floating impurities with water, and eat them until chest and heart Qi feels balanced; this is also very good. Fresh cow milk warmed to body temperature, sipped slowly when thirsty, is also beneficial.
Zhang Zhongjing said: The Foot Taiyang Meridian is the Bladder Meridian; the Bladder is the Fu Organ of the Kidney. Frequent urination indicates Excess Qi; Excess Qi consumes Grain, leading to hard stools; Deficiency results in Xiao Ke.
For men with Xiao Ke, drinking one dou of water results in excreting one dou of urine; Ba Wei Shen Qi Wan (Eight-Ingredient Pill of the Kidney's Qi) is indicated as a divine prescription. Patients with Xiao Ke should take it regularly.
Rehmanniae Radix Preparata (Ba Liang) / Dioscoreae Rhizoma (Si Liang) / Poria (San Liang) / Corni Fructus (Wu Liang) / Alisma Rhizoma (Si Liang) / Moutan Cortex (San Liang).
Crush and sieve the above herbs, mix with honey to make pills the size of Sophora seeds. Take ten pills with wine, gradually increasing dosage until effective. Avoid pork, cold water, Coriander Seed, Cilantro, vinegar products, and raw green onions.
Explanation: Those who took Wu Shi Wan San (Five-Mineral Pills/Powders) in their youth accumulate heat over years, causing deficiency and consumption. Stone heat accumulates in the Kidneys, causing Lower Jiao Deficient Heat, frequent and profuse urination, leading to Xiao Li (Wasting and Flowing). Xiao Li involves non-thirsty, spontaneous urination, also called Xiao Ke. True Xiao Ke involves thirst without difficulty in urination. Also called Ke Li, where urination follows drinking immediately. Also called Qiang Zhong (Strong Middle), characterized by persistent erection without flaccidity and spontaneous seminal emission. It can also manifest as Carbuncles and Ulcers. For such conditions, Zhu Shen Ji Tang (Pig Kidney Shepherd's Purse Decoction) is suitable to restrain stone heat in the Kidneys, followed by Ya Tong Wan (Duck Dropping Pill) for recovery.
Zhu Shen Ji Tang Formula:
Pig Kidney (One unit) / Soybean (One Sheng) / Shepherd's Purse & Gypsum (Three Liang each) / Ginseng & Polyporus (San Liang each, note: Polyporus may be Poria) / Magnetite (wrapped in silk) / Anemarrhenae Rhizoma / Kudzu Root / Scutellariae Radix / Trichosanthis Radix / Licorice Root (Two Liang each).
Chop the twelve ingredients. Boil in fifteen Sheng of water. First boil Pig Kidney and Soybean to reduce to ten Sheng. Remove dregs, add remaining herbs, boil to three Sheng. Divide into three doses. Drink only when thirsty. For Lower Jiao Heat, take one dose at night. Stop when symptoms subside.
Ya Tong Wan Formula:
White Duck Droppings (Five Sheng, poured with twenty-five Sheng boiling water, clarified to obtain twenty Sheng juice) / Ephedrae Herba (Ba Liang) / Fermented Soybean (San Sheng) / Cold Stone (Liang) / Licorice Root (Wu Liang) / Gypsum (San Liang) / Gardeniae Semen (Twenty seeds).
Chop the six ingredients. Boil in Duck Dropping Juice to reduce to six Sheng. Remove dregs, add Fermented Soybean, boil three times. Divide into doses of five He. If feeling cold and urinating freely, extend intervals. If heat persists and urine is red and urgent, dosage is not limited to five He. Engage in mild exercise, eat gradually, do not eat too little, but avoid overeating.
Qian Dan San (Lead Tetroxide Powder), treating Xiao Ke and stopping frequent urination.
Lead Tetroxide (Two Fen) / Trichosanthes (Ten Fen) / Alisma Rhizoma (Five Fen) / Gypsum (Five Fen) / Red Halloysite (Five Fen) / White Halloysite (Five Fen) / Lead Carbonate (Two Fen) / Licorice Root (Ten Fen).
Grind eight substances into powder. Take one Cun Bi with wine, three times daily. Increase slightly if ineffective. Young adults take half a Cun Bi. Disease duration of one year cures in one day of medication; two years in two days. For severe cases, take with water at night, do not use wine.
Formula for Drinking One Shi Daily with Urinary Retention: Gua Lou Wan.
Trichosanthes Root (Three Fen) / Lead Tetroxide (Three Fen) / Kudzu Root (Three Fen) / Aconiti Lateralis Radix Preparata (One Fen, processed).
Grind four substances into powder. Mix with honey to make pills size of Sophora seeds. Take ten pills with water, three times daily.
Formula for Treating Xiao Ke:
Take three Dou of live snails, raise in one Shi of river water. Collect the cool juice, drink until full. Release after a day, repeat with fresh snails.
Nei Xiao (Internal Consumption) is caused by Heat. Urine output exceeds intake, causing extreme deficiency and shortness of breath. In Nei Xiao, food digests and exits as urine without thirst. Treat with Gou Qi Tang.
Goji Branches and Leaves (One Jin, Winter Roots Three Liang) / Trichosanthis Radix (San Liang) / Gypsum (San Liang, omitted in some versions) / Coptidis Rhizoma (San Liang) / Licorice Root (Liang).
Cut five substances. Boil in ten Sheng of water to yield three Sheng. Take five He per dose, three times daily.
Formula for Frequent Urination, Dozens of Times Day and Night:
Mung Bean Sprouts (One Ba).
Crush and squeeze juice. Drink three Sheng at once for cure. Also treats pediatric diarrhea.
Patients with Xiao Ke should avoid pork.