《巢氏病源》曰∶夫消渴者，渴不止，小便多者是也。由少年服五石诸丸散，积经年岁
，石气结于肾中，使人下焦虚热，及至年衰血气减少，不能复制于石，石势独盛，则肾为之
燥，故上为饮水，下为小便不禁也。其病变多发痈疽，此因热气留于经络，血涩不行故成痈
脓。
陈无择曰∶消渴属心，故烦心，致心火散漫，渴而引饮，诸脉软散，皆气实血虚也。消
中属脾，瘅热成则为消中。消中复有三∶有因寒中，阴胜阳郁，久必为热中。经云∶脉洪大
，阴不足，阳有余，则为热中。多食数溺为消中。阴狂兴盛，不交精泄，则为强中。病至强
中，不亦危矣。消肾属肾，壮盛之时不禁，而纵欲房劳，年长肾衰，多服金石，真气既丧，
口干精溢自泄，不饮而利。经云∶不渴而小便自利，名曰肾消，亦曰内消。
洁古老人曰∶能食能渴者，白虎加人参汤。不能食而渴者，钱氏白术散倍加干葛治之，
上中既平，不复传下消矣。前人用药，厥有旨哉。
东垣曰∶高消者，舌上赤裂，大渴引饮。《逆调论》云∶心移热于肺，传为膈消者是也
。以白虎加人参汤治之。中消者，善食而瘦，自汗，大便硬，小便数。叔和所谓口干饮水多
，食饥，虚瘅成消中是也，以调胃承气汤、三黄丸治之。下消者，烦躁引饮，耳叶焦，溺如
膏，所谓焦烦水易亏，此肾消也，以六味地黄丸治之。《总录》所谓未传能食者，必发痈疽
背疮，不能食者，必传中满鼓胀，皆谓不治之证。
丹溪曰∶消渴宜养肺降火生血为主。三消者，多属不生津液，宜四物汤为主。上消者
，本方加五味子、人参、麦门冬、天花粉，煎入生藕汁、生地黄汁、人乳。饮酒人加生葛汁
。中消者，本方加知母、石膏、滑石以降胃火。下消者，本方加黄柏、知母、熟地黄、五味
子之类，以滋肾水，当饮澡丝汤代茶。天花粉，消渴神药也。三焦皆禁用半夏，血虚亦忌用
，口干咽燥大便难者亦不宜用，汗多者不可用，不已，必用姜盐制之。
徐东皋曰∶消渴虽有数者之不同，其为病之肇端，则皆膏粱肥甘之变，酒色劳伤之过，
皆富贵人病之，而贫贱者鲜有也。凡初觉燥渴，盒饭清心寡欲，薄滋味，减思虑，则治可瘳
。若有一毫不谨，总有名医良剂，必不能有生矣。
《巢氏病源》说：所谓消渴病，就是口渴不止、小便频多的病症。这是由于年轻时服用五石散等丸药和散剂，经过多年积累，石药的燥气结聚在肾中，导致下焦虚热；等到年老体衰、气血减少时，无法再制约石气的偏盛，石气独旺，致使肾脏干燥，因此出现上身饮水不解渴、下身小便失禁的症状。这种病变容易并发痈疽，这是因为热气滞留于经络，导致血液运行涩滞不畅，从而形成痈脓。
陈无择说：消渴病归属于心，所以会出现心烦，导致心火散漫，口渴而想喝水，各种脉象软弱散乱，这都是气实血虚的表现。消中病归属于脾，因湿热内蕴而成消中。消中又分为三种：有因寒邪中阻，阴气胜而阳气郁结，日久必转化为热中。经书说：脉象洪大，阴气不足，阳气有余，就会形成热中。多吃多尿属于消中。如果房事过度而不泄精，就会导致强中病。病情发展到强中阶段，不是很危险吗？消肾病归属于肾，在身体壮盛时不禁欲，放纵房劳，年长后肾气衰退，又长期服用金石类药物，真气丧失，出现口干、精液自溢外泄，不喝水也小便频多。经书说：不口渴但小便自利，称为肾消，也叫内消。
洁古老人说：能吃饭且口渴的，用白虎加人参汤治疗。不能吃饭但口渴的，用钱乙的白术散加倍加入干葛（葛根）来治疗，上焦和中焦的病势平息后，就不会再传变为下消了。前人用药，确实很有深意啊。
李东垣说：上消症，表现为舌面红赤裂纹，极度口渴想喝水。《黄帝内经·逆调论》说：心将热邪移交给肺，传变为膈消，就是这种情况。用白虎加人参汤治疗。中消症，表现为吃得多却消瘦，自汗出，大便干硬，小便频数。这是王叔和所说的“口干饮水多，食后即饥，虚热内蕴成消中”，用调胃承气汤、三黄丸治疗。下消症，表现为烦躁想喝水，耳廓干枯焦黑，尿液像膏脂一样稠厚，这就是所谓的“焦烦水易亏”，即肾消，用六味地黄丸治疗。《济生方》等书记载：如果病未传变还能进食的，必定会发背疮痈疽；如果不能进食的，必定会传变为中满鼓胀，这些都是不治之症。
朱丹溪说：治疗消渴应以养肺、降火、生血为主。三消病，大多属于津液不生，宜以四物汤为主方。上消症，在原方基础上加五味子、人参、麦门冬、天花粉，煎煮时加入鲜藕汁、生地黄汁、人乳。饮酒者加鲜葛根汁。中消症，在原方基础上加知母、石膏、滑石以降胃火。下消症，在原方基础上加黄柏、知母、熟地黄、五味子等，以滋补肾水，应当饮用澡丝汤代替茶。天花粉是治疗消渴的神药。三焦部位都禁用半夏，血虚者也忌用，口干咽燥大便困难者也不宜用，出汗多者不可用，如果必须使用，一定要用姜盐炮制过才行。
徐东皋说：消渴病虽然有多种不同表现，但其发病的起因，都是由于饮食肥甘厚味、酒色过度及劳累损伤所致，这些病多见于富贵之人，贫贱之人很少得。凡是刚开始感到燥渴，就应当清心寡欲，饮食清淡，减少思虑，这样治疗就可以痊愈。如果有一丝毫不谨慎，即使有名医良方，也必然无法挽救生命。
According to the *Bing Yuan* (Source of Diseases) by Chao Yuanfang: Xiao Ke (Wasting and Thirsting Syndrome) is characterized by unquenchable thirst and polyuria. This condition arises from the consumption of "Five-Mineral Pills" and powders in youth, which accumulate over years. The mineral qi condenses in the Kidney, causing deficiency heat in the Lower Jiao. As one ages and Qi and Blood diminish, they can no longer restrain the mineral qi, which becomes dominant and dries out the Kidney. Consequently, there is excessive drinking above and uncontrollable urination below. Complications often include carbuncles and sores, caused by heat lingering in the meridians and obstructing blood flow, leading to pus formation.
Chen Wuzhuo stated: Xiao Ke belongs to the Heart; thus, it causes mental restlessness. The dispersal of Heart Fire leads to thirst and desire for water, with soft and scattered pulses, indicating excess Qi and deficient Blood. Xiao Zhong (Consuming Middle) belongs to the Spleen, resulting from damp-heat accumulation. Xiao Zhong has three subtypes: one due to cold invasion where Yin prevails and Yang is depressed, eventually transforming into Heat Zhong. The Classics state: a surging pulse with insufficient Yin and excess Yang results in Heat Zhong. Excessive eating and frequent urination characterize Xiao Zhong. If sexual activity is indulged without ejaculation, it leads to Qiang Zhong (Excessive Strength). Progression to Qiang Zhong is indeed perilous. Xiao Shen (Kidney Consumption) belongs to the Kidney. Indulgence in sex during prime years, followed by Kidney decline in old age and long-term use of mineral drugs, depletes True Qi. Symptoms include dry mouth, spontaneous seminal emission, and polyuria without thirst. The Classics state: non-thirsty but with spontaneous free urination is named Kidney Consumption, also called Internal Consumption.
Jiegu Laoren (Zhang Congzheng) said: For those who can eat and feel thirsty, Bai Hu Jia Ren Shen Tang (White Tiger Decoction plus Ginseng) is indicated. For those who cannot eat but feel thirsty, Qian's Bai Zhu San (Atractylodes Macrocephala Powder) with added Ge Gen (Kudzu Root) should be used. Once the Upper and Middle Jiao are balanced, transmission to Lower Xiao will not occur. The medication strategies of predecessors are indeed profound.
Li Dongyuan stated: Shang Xiao (Upper Consumption) presents with red cracks on the tongue and extreme thirst. The *Ni Tiao Lun* chapter of the *Huang Di Nei Jing* states: "Heart transferring heat to the Lung transmits as Ge Xiao (Diaphragm Consumption)." This is treated with Bai Hu Jia Ren Shen Tang. Zhong Xiao (Middle Consumption) presents with polyphagia yet emaciation, spontaneous sweating, hard stools, and frequent urination. This corresponds to Wang Shuhe's description of "dry mouth, excessive drinking, hunger after eating, and deficiency heat forming Xiao Zhong," treated with Tiao Wei Cheng Qi Tang (Regulate the Stomach Order the Qi Decoction) and San Huang Wan (Three Yellows Pill). Xia Xiao (Lower Consumption) presents with irritability, thirst, dry ears, and urine resembling paste. This is "irritability and fluid depletion," i.e., Kidney Consumption, treated with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). Texts like *Zong Lu* note that if the disease has not spread and the patient can still eat, carbuncles and back sores will likely develop; if the patient cannot eat, abdominal distension and drum-like swelling will follow. Both are considered incurable.
Zhu Danxi stated: Treatment of Xiao Ke should focus on nourishing the Lung, descending fire, and generating Blood. The Three Xiao syndromes mostly involve failure to generate fluids; Si Wu Tang (Four Substance Decoction) is the primary formula. For Shang Xiao, add Wu Wei Zi (Schisandra Berry), Ren Shen (Ginseng), Mai Men Dong (Ophiopogon Tuber), and Gua Lou Fen (Trichosanthes Root) to the base formula, decocted with fresh lotus root juice, fresh Sheng Di Huang juice (Rehmannia Root Juice), and human milk. Add fresh Ge Gen juice for drinkers. For Zhong Xiao, add Zhi Mu (Anemarrhena Rhizome), Shi Gao (Gypsum Fibrosum), and Hua Shi (Talcum) to descend Stomach Fire. For Xia Xiao, add Huang Bo (Phellodendron Bark), Zhi Mu, Shu Di Huang (Prepared Rehmannia Root), and Wu Wei Zi to nourish Kidney Water; Zao Si Tang (Morus Twig Decoction) should be drunk instead of tea. Gua Lou Fen is a divine herb for Xiao Ke. Ban Xia (Pinellia Tuber) is contraindicated in all three Jiaos, in cases of Blood deficiency, dry mouth/throat with difficult defecation, and excessive sweating. If absolutely necessary, it must be processed with ginger and salt.
Xu Donggao stated: Although Xiao Ke manifests differently, its origin lies in dietary excesses of rich and sweet foods, and harms from alcohol, sexual indulgence, and labor. It primarily affects the wealthy, rarely the poor. Upon initial signs of dryness and thirst, one should clear the mind, reduce desires, eat bland food, and minimize worry; recovery is then possible. Without strict adherence, even famous doctors and excellent remedies cannot save the patient.