（《素问·平人气象论》）
颈脉动，喘，疾咳，曰水。（颈脉，谓结喉旁动脉，足阳明之人迎也。水气上逆，反侵阳明，则颈脉动。水溢于肺，
则喘急而疾咳。）目裹微肿，如卧蚕起之状，曰水。（目裹者，目之下胞也，胃脉之所至，脾气之所主，若见微肿如卧蚕
起之状，是水气淫及脾胃也。《评热病论》曰∶水者阴也，目下亦阴也，腹者至阴之所居，故水在腹中者，必使目下肿也。）
溺黄赤，安卧者，黄胆。（疸，黄病也。《论疾诊尺篇》曰∶身痛而色微黄，齿垢黄，爪甲上黄，黄胆也。安卧，小便黄
赤，脉小而涩者，不嗜食。《正理论》谓之劳瘅，以女劳得之也。疸音旦。）已食如饥者，胃疸。（已食如饥者，是胃热也。
善消谷食，故曰胃疸。又《论疾诊尺篇》曰∶脉小而涩者，不嗜食。言中寒也。所以治疸者，当知阴阳之辨。）面肿曰风。
（风为阳邪，故面肿者曰风，阳受风气也。）足胫肿曰水。（水为阴邪，故足胫肿者曰水，阴受湿气也。）目黄者曰黄胆。
（目者宗脉之所聚也，诸经有热则上熏于目，故黄胆者其目必黄。）
（《素问·通评虚实论》《腹中论》 附∶消瘅治法）
帝曰。消瘅虚实何如？（《素问·通评虚实论》
消瘅者，三消之总称，谓内热消中而肌肤消瘦也。瘅音丹，又上、去二声，广韵曰火瘅，一曰黄病。）岐伯曰∶脉实大，
病久可治；脉悬小坚，病久不可治。（邪热在内，脉当实大者为顺，故病虽久犹可治；若脉悬小，则阳实阴虚，脉证之逆
也，故不可治。《五变篇》曰∶五脏皆柔弱者，善病消瘅。又曰∶热则消肌肤，故为消瘅。详本类后七十六。）
帝曰∶夫子数言热中消中，不可服高梁芳草石药，石药发 ，芳草发狂。（《素问·腹中论》。王氏曰∶多饮数溲，谓之热中。多食数溲，谓之消中。多喜曰 。多怒曰狂。 ，癫同。）夫热
中消中者，皆富贵人也，今禁高梁是不合其心，禁芳草石药是病不愈，愿闻其说。（高梁，浓味也。芳草，辛香之品也。
石药， 炼金石之类也。三者皆能助热，亦能销阴，凡病热者所当禁用。热中消中者，即内热病也，惟富贵之人多有之。
《通评虚实论》曰∶凡治消瘅，肥贵人则高梁之疾也。盖富贵者以肥甘为事，肥者令人内热，甘者令人中满，气积成热，
则转为消中消渴之病，故于高梁芳草之类，皆不得不禁也。）岐伯曰∶夫芳草之气美，石药之气悍，二者其气急疾坚劲，
故非缓心和人不可以服此二者。（芳美者，气热而散，悍急者，性刚而烈也。）帝曰∶不可以服此二者何以然？岐伯曰∶
夫热气 悍，药气亦然，二者相遇，恐内伤脾。（脾者阴中之至阴也，阳胜则伤阴，故二热合气，必致伤脾。 音飘。）
脾者土也而恶木，服此药者，至甲乙日更论。（脾伤者畏木，故至甲乙日更论，盖谓其必甚也。愚按∶消瘅消中者，即后
世所谓三消证也。凡多饮而渴不止者为上消，消谷善饥者为中消，溲便频而膏浊不禁者为下消。如《气厥论》之云肺消
膈消，《奇病论》之云消渴，即上消也。《脉要精微论》云瘅成为消中，《师传篇》云胃中热则消谷令人善饥，即中消也。
《邪气脏腑病形篇》云肾脉肝脉微小皆为消瘅，肝肾在下，即下消也。观刘河间《三消论》曰∶五脏六腑四肢皆禀气于
脾胃，行其津液，以濡润养之。然消渴之病，本湿寒之阴气极衰，燥热之阳气太盛故也。治当补肾水阴寒之虚，泻心火
阳热之实，除肠胃燥热之甚，济身中津液之衰，使道路散而不结，津液生而不枯，气血和而不涩，则病自已。若饮水多
而小便多，名曰消渴；若饮食多，不甚渴，小便数而消瘦者，名曰消中；若渴而饮水不绝，腿消瘦而小便有脂液者，名
曰肾消。一皆以燥热太甚，三焦肠胃之腠理脉络怫郁壅滞，虽多饮于中，终不能浸润于外，荣养百骸，故渴不止而小便
多出或数溲也。又张戴人云∶三消之说，当从火断，火之为用，燔木则消而为炭，炼金则消而为汁， 石则消而为灰，
煎海则消而为盐，干永则消而为粉，熬锡则消而为丹。故泽中之潦，消于炎辉；鼎中之水，干于壮火。盖五脏心为君火
正化，肾为君火对化，三焦为相火正化，胆为相火对化，得其平则烹炼饮食，糟粕去焉；不得其平，则燔灼脏腑，津液
竭焉。夫一身之心火，甚于上为膈膜之消，甚于中为肠胃之消，甚于下为膏液之消，甚于外为肌肉之消。上甚不已则消
及于肺，中甚不已则消及于脾，下甚不已则消及于肝肾，外甚不已则消及于筋骨，四脏皆消尽则心始自焚而死矣。故《素
问》有消瘅、消中、消渴、风消、膈消、肺消之说，消之证不同，归之火则一也。此三消从火之说，二公言之详矣。又
按《袖珍方》云∶人身之有肾，犹木之有根，故肾脏受病，必先形容憔悴，虽加以滋养，不能润泽，故患消渴者，皆是
肾经为病。由壮盛之时，不自保养，快情恣欲，饮酒无度，食脯炙丹石等药，遂使肾水枯竭，心火燔盛，三焦猛烈，五
脏渴燥，由是渴利生焉。此又言三消皆本于肾也。又何柏斋曰∶造化之机，水火而已，宜平不宜偏，宜交不宜分。水为
湿为寒，火为热为燥，火性炎上，水性润下，故火宜在下，水宜在上，则易交也。交则为既济，不交则为未济，不交之
极，则分离而死矣。消渴证，不交而火偏盛也；水气证，不交而水偏盛也。制其偏而使之交，则治之之法也。观此诸论，
则凡治消者，在清火壮水，二者之间，但察三焦虚实，或滋或泻，随所宜而用之，若乎尽矣；然以予之见，犹有说焉。
如《阴阳别论》曰∶二阳之病发心脾，其传为风消。此以阳明为十二经之海，土衰而木气乘之，故为肌肉风消也。《气厥
论》曰∶心移寒于肺为肺消，饮一溲二死不治。此言元阳之衰而金寒水冷，则为肺肾之消也。《邪气脏腑病形篇》曰五脏
之脉微小者，皆为消瘅，此言寸口之弱见于外，以血气之衰而消于内也。又如《气交变大论》曰∶岁水太过，上临太阳，
民病渴而妄冒。《五常政大论》曰∶太阳司天，寒气下临，心火上从，民病嗌干善渴。《至真要大论》曰∶太阳司天，寒
淫所胜，民病嗌干，渴而欲饮。是皆以阴抑阳，以水制火，必以温剂散去寒邪，其疾自愈。诸如此者，总皆消渴之类也。
夫消者消耗之谓，阳胜固能消阴，阴胜独不能消阳乎？故凡于精神血气肌肉筋骨之消，无非消也。予尝治一荐绅，年愈
四旬，因案牍积劳，致成大病，神困食减，时多恐惧，上焦无渴，不嗜汤水，或有少饮，则沃而不行，然每夜必去溺二
三升，莫知其所从来，且半皆浊液。最后延余诊视，因相告曰∶自病以来，通宵不寐者已半年有余，即间有蒙 似睡之
意，必梦见亡人凶丧等事，鬼魅相亲，其不免矣。余曰∶不然。此以思虑积劳，损伤心肾，元阳既亏，则阴邪胜之，故
多阴梦。阳衰则气虚，阳不帅阴，则水不化气，故饮水少而溺浊多也。阳气渐回，则阴邪自退，此正《内经》所谓心移
寒于肺，饮一溲二之证耳。病本非轻，所幸者，脉犹带缓，肉犹未脱，胃气尚存，可无虑也。乃以归脾之属去白术木香，
八味之属去丹皮泽泻，一以养阳，一以养阴，出入间用，至三百余剂，计人参二十余斤而后全愈。此非神消于上，精消
于下之证乎？可见消有阴阳，不得尽称为火证，姑纪此一按，以为治消者之鉴。）
（《素问·平人气象论》）
颈部动脉搏动明显，伴有气喘、急咳的，称为水病。（颈脉，指的是喉结旁边的动脉，即足阳明胃经的人迎穴。水气上逆，反而侵犯阳明经，就会导致颈脉搏动。水气溢于肺部，就会出现气喘急促和急咳。）眼睑微微肿胀，像卧蚕隆起的样子，称为水病。（目裹，就是眼下胞，是胃经经过的地方，由脾所主，如果见到微肿如卧蚕起的样子，这是水气淫溢波及脾胃的表现。《评热病论》说：水是阴邪，眼下也是阴位，腹部是至阴所在之处，所以水在腹中，必然会导致眼下浮肿。）小便黄赤，身体嗜睡的，是黄疸病。（疸，就是黄病。《论疾诊尺篇》说：身体疼痛且面色微黄，牙齿垢腻发黄，指甲发黄，这就是黄疸病。嗜睡，小便黄赤，脉象小而涩，食欲不振。《正理论》称之为劳瘅，是因为房劳过度而得的。疸读音为“旦”。）吃完饭却感觉像没吃饱一样饥饿的，是胃疸。（吃完饭还觉得饿，说明有胃热。容易消化谷物食物，所以叫胃疸。另外《论疾诊尺篇》说：脉象小而涩，食欲不振。说的是中寒证。所以治疗黄疸病，应当分辨阴阳的不同。）面部浮肿的叫风病。（风属于阳邪，所以面部浮肿的叫风病，因为阳经受风气侵袭。）小腿和脚踝浮肿的叫水病。（水属于阴邪，所以小腿和脚踝浮肿的叫水病，因为阴经受湿气侵袭。）眼睛发黄的叫黄疸病。（眼睛是众多经脉汇聚的地方，各条经络有热就会向上熏蒸到眼睛，所以黄疸病患者眼睛一定会发黄。）
（《素问·通评虚实论》《腹中论》 附：消瘅治法）
黄帝问：消瘅病的虚实情况是怎样的？（出自《素问·通评虚实论》）
岐伯回答：消瘅，是三消的总称，指体内热盛、消谷善饥且肌肤消瘦的病证。瘅读音为“丹”，又读上声和去声，《广韵》解释为火瘅，一说为黄病。
黄帝问：脉象实大，病程久的可以治疗；脉象悬小且坚硬的，病程久的不可治疗。（邪热在内，脉象实大为顺证，所以即使病程久仍可治；如果脉象悬小，则是阳实阴虚，脉证相反，所以不可治。《五变篇》说：五脏都柔弱的人，容易患消瘅。又说：热邪会消耗肌肤，所以形成消瘅。详见本类后第七十六节。）
黄帝问：先生多次提到热中和消中，不能服用高粱厚味、芳草和石药，石药会引起癫狂，芳草会引起发狂。（出自《素问·腹中论》。王冰注解说：多饮且频繁排尿，叫做热中。多食且频繁排尿，叫做消中。多喜笑叫做癫，与癫同义。多愤怒叫做狂。癫，与癫字相同。）那些热中和消中的病人，都是富贵人家的人，现在禁止他们吃高粱厚味是不合他们心意的，禁止服用芳草石药则病好不了，我想听听其中的道理。（高粱，指浓味的食物。芳草，指辛香类的药材。石药，指炼制金石之类的药物。这三者都能助长热邪，也能耗伤阴液，凡是患有热病的人都应当禁用。热中和消中，就是内热病，只有富贵人多见。《通评虚实论》说：凡是治疗消瘅，肥胖的贵人得的是高粱之疾。大概富贵人以肥甘厚味为日常饮食，肥腻使人产生内热，甘甜使人导致中焦痞满，气积而成热，进而转化为消中、消渴的病，所以对于高粱、芳草之类，不得不禁止服用。）
岐伯说：芳草的气味芳香美好，石药的气性刚悍猛烈，这两者的气机急疾坚劲，所以如果不是性情平和舒缓的人，不可以服用这两种药。（芳香美好的，气热而发散；刚悍急烈的，性质刚烈。）
黄帝问：不可以服用这两种药的原因是什么？
岐伯说：热气刚悍猛烈，药气也是如此，两者相遇，恐怕会内伤脾脏。（脾是阴中之至阴，阳气胜则会损伤阴，所以两种热邪之气结合，必定会导致伤脾。飘音同“飘”。）脾属土而恶木，服用这些药的人，到了甲乙日（木旺之日）病情可能会加重，届时再作讨论。（脾受伤后畏惧木气，所以到甲乙日再作讨论，意思是病情必然会加重。我按语：消瘅、消中，就是后世所说的三消证。凡是多饮且口渴不止的，称为上消；消谷善饥的，称为中消；小便频数且浑浊不禁的，称为下消。如《气厥论》说的肺消、膈消，《奇病论》说的消渴，就是上消。《脉要精微论》说瘅成为消中，《师传篇》说胃中热则消谷令人善饥，就是中消。《邪气脏腑病形篇》说肾脉肝脉微小皆为消瘅，肝肾在下，就是下消。看刘河间《三消论》说：五脏六腑四肢都禀受脾胃之气，运行津液以濡润滋养它们。然而消渴病，根本在于湿寒的阴气极衰，燥热的阳气太盛。治疗应当补肾水中阴寒之虚，泻心中阳热之实，清除肠胃燥热之甚，补充身体中津液的衰少，使道路散开而不结滞，津液生成而不枯槁，气血调和而不涩滞，那么病自然痊愈。如果饮水多而小便多，名叫消渴；如果饮食多，不太渴，小便次数多且消瘦，名叫消中；如果口渴且饮水不停，腿部消瘦且小便有脂液，名叫肾消。这一切都是因为燥热太甚，三焦肠胃的腠理脉络郁滞壅塞，虽然在中焦摄入很多水，最终不能浸润在外，荣养百骸，所以口渴不止且小便多出或频繁排尿。另外张戴人说：三消的说法，应当从火来断言。火的作用，烧木头则消而为炭，炼金则消而为汁，烧石头则消而为灰，煎海水则消而为盐，晒干水则消而为粉，熬锡则消而为丹。所以沼泽中的积水，被烈日蒸发；锅鼎中的水，被大火烧干。大概五脏中心为君火正化，肾为君火对化，三焦为相火正化，胆为相火对化，得到平衡就能烹炼饮食，糟粕得以去除；得不到平衡，就会燔灼脏腑，津液枯竭。一身的心火，极盛于上则为膈膜之消，极盛于中则为肠胃之消，极盛于下则为膏液之消，极盛于外则为肌肉之消。上部极盛不已则消及于肺，中部极盛不已则消及于脾，下部极盛不已则消及于肝肾，外部极盛不已则消及于筋骨，四脏都消尽后心才自焚而死。所以《素问》有消瘅、消中、消渴、风消、膈消、肺消的说法，消的证候不同，归结于火则是一样的。这关于三消从火的说法，这两位先生讲得很详细了。又按《袖珍方》说：人身有肾，就像树木有根，所以肾脏生病，必然先出现形体憔悴，即使加以滋养，也不能润泽，所以患消渴病的，都是肾经发病。由于在壮盛之时，不自我保养，纵情恣欲，饮酒无度，食用肉脯炙烤食品及丹石等药物，致使肾水枯竭，心火燔盛，三焦猛烈，五脏渴燥，由此产生渴利症。这又说是三消皆本源于肾。还有何柏斋说：造化的机理，不过是水火罢了，适宜平衡不适宜偏颇，适宜交济不适宜分离。水为湿为寒，火为热为燥，火性炎上，水性润下，所以火宜在下，水宜在上，这样容易交济。交济就是既济卦，不交济就是未济卦，不交济到了极点，就会分离而死。消渴证，是不交济而火偏盛；水气证，是不交济而水偏盛。制约其偏颇使之交济，就是治疗的方法。看这些论述，那么凡是治疗消证的，关键在于清火壮水二者之间，只要考察三焦的虚实，或者滋补或者泻泄，根据适宜的情况使用，似乎就穷尽了；然而依我的见解，还有话说。如《阴阳别论》说：二阳之病发于心脾，其传变为风消。这是因为阳明为十二经之海，土衰而木气乘之，所以导致肌肉风消。《气厥论》说：心移寒于肺为肺消，饮一溲二死不治。这是说元阳衰败而金寒水冷，则为肺肾之消。《邪气脏腑病形篇》说五脏之脉微小者，皆为消瘅，这是说寸口脉弱见于外，因血气衰败而在内部发生消耗。又如《气交变大论》说：岁水太过，上临太阳，百姓患病口渴且妄乱冒昧。《五常政大论》说：太阳司天，寒气下临，心火上从，百姓患病咽喉干燥且喜欢口渴。《至真要大论》说：太阳司天，寒淫所胜，百姓患病咽喉干燥，口渴想喝水。这些都是以阴抑阳，以水制火，必须用温剂散去寒邪，疾病自然痊愈。诸如此类的，总都属于消渴之类。所谓消，就是消耗的意思，阳胜固然能消阴，难道阴胜就不能消阳吗？所以凡是精神、血气、肌肉、筋骨的消耗，无非都是消证。我曾经治疗一位官员，年龄超过四十岁，因为案牍工作积劳，导致大病，精神困倦食欲减退，时常恐惧，上焦没有口渴感，不喜欢喝汤水，即使稍微喝一点，也停滞不行，但是每晚一定要排尿二三升，不知道从哪里来的，而且有一半都是浊液。最后请我诊治，于是告诉我：自从生病以来，通宵不睡觉已经半年多了，即使偶尔有朦胧似睡的意思，也一定梦见死人凶丧等事，鬼魅亲近，恐怕不免一死了。我说：不是这样的。这是因为思虑积劳，损伤心肾，元阳既然亏损，则阴邪胜之，所以多做阴梦。阳气衰则气虚，阳不能帅阴，则水不能化为气，所以饮水少而溺浊多。阳气逐渐恢复，则阴邪自然退去，这正是《内经》所谓心移寒于肺，饮一溲二的证候罢了。病根并不轻，所幸的是脉象还带缓意，肌肉还没有脱陷，胃气尚存，可以不必担忧。于是用归脾汤一类去掉白术、木香，用八味丸一类去掉牡丹皮、泽泻，一个用来养阳，一个用来养阴，交替使用，共计三百多剂，用人参二十多斤后才完全痊愈。这难道不是神消于上，精消于下的证候吗？可见消证有阴阳之分，不能全部称为火证，暂且记录这一按语，作为治疗消证的借鉴。）
(Suwen, Ping Ren Qi Xiang Lun)
When the artery in the neck pulsates visibly, accompanied by panting and rapid coughing, it is called Shui disease (Water disease). The "neck artery" refers to the pulsating artery beside the laryngeal prominence, which is the Renying point (ST9) of the Foot-Yangming Stomach Meridian. When Water Qi rebels upward and invades the Yangming meridian, the neck artery will pulsate. When Water overflows into the lungs, panting becomes urgent and rapid coughing occurs. When the eyelids are slightly swollen, resembling the shape of a lying silkworm, it is called Shui disease (Water disease). The "Mu Guo" refers to the lower eyelid, where the Stomach meridian arrives and the Spleen governs. If slight swelling resembling a lying silkworm is seen, it indicates that Water Qi has invaded the Spleen and Stomach. The Ping Re Bing Lun states: "Water is Yin, and the area under the eyes is also Yin; the abdomen is the residence of Supreme Yin. Therefore, when Water resides in the abdomen, it must cause swelling under the eyes." When urine is yellow-red and the patient desires to lie down (lethargy), it is Huang Dan disease (Jaundice). "Dan" refers to Yellow disease. The Lun Ji Zhen Chi Pian states: "Body pain with slightly yellow complexion, yellow dental calculus, and yellow nails indicate Huang Dan disease (Jaundice)." Lethargy, yellow-red urine, a pulse that is small and choppy, and lack of appetite are symptoms. The Zheng Li Lun calls this Lao Dan (Consumption Jaundice), caused by sexual exhaustion. "Dan" is pronounced "dan". Feeling hungry as if one had not eaten after finishing a meal indicates Wei Dan disease (Stomach Jaundice). Feeling hungry after eating indicates Stomach Heat. Since food is digested quickly, it is called Wei Dan (Stomach Jaundice). Furthermore, the Lun Ji Zhen Chi Pian states: "A pulse that is small and choppy indicates lack of appetite," referring to Middle Cold. Therefore, when treating Dan diseases (Jaundice), one must distinguish between Yin and Yang. Facial swelling is called Feng disease (Wind disease). Wind is a Yang pathogen; thus, facial swelling is attributed to Wind, as Yang meridians are affected by Wind Qi. Swelling of the calves and ankles is called Shui disease (Water disease). Water is a Yin pathogen; thus, swelling of the calves and ankles is attributed to Water, as Yin meridians are affected by Dampness. Yellowing of the eyes is called Huang Dan disease (Jaundice). The eyes are the gathering place of numerous meridians; heat in any meridian steams upward to the eyes, so patients with Huang Dan disease (Jaundice) will have yellow eyes.
(Suwen, Tong Ping Xu Shi Lun & Fu Zhong Lun; Appendix: Treatment of Xiao Dan)
The Yellow Emperor asked: What are the excess and deficiency patterns of Xiao Dan disease? (From Suwen, Tong Ping Xu Shi Lun)
Qibo answered: Xiao Dan (Wasting-Thirst Disease) is the general term for San Xiao (Three Thirsts), referring to internal heat, excessive hunger, and emaciation. "Dan" is pronounced "dan", or with rising and departing tones. The Guang Yun explains it as Fire Dan, or alternatively as Yellow disease.
The Yellow Emperor asked: A pulse that is substantial and large, even in long-standing disease, is treatable; a pulse that is suspended, small, and firm, even in long-standing disease, is untreatable. (Internal pathogenic heat corresponds to a substantial and large pulse, which is favorable; thus, even if the disease is long-standing, it is treatable. If the pulse is suspended and small, it indicates Excess Yang and Deficiency Yin, a contradiction between pulse and symptoms, making it untreatable. The Wu Bian Pian states: "Those whose five zang organs are inherently weak are prone to Xiao Dan." It also states: "Heat consumes muscle and flesh, forming Xiao Dan." See Section 76 of this category for details.)
The Yellow Emperor asked: You often mention that Re Zhong (Heat in the Middle) and Xiao Zhong (Wasting in the Middle) should not be treated with Gao Liang (rich/fatty foods), Fang Cao (aromatic herbs), or Shi Yao (mineral drugs). Shi Yao causes Dian (epilepsy/manic episodes), and Fang Cao causes Kuang (madness). (From Suwen, Fu Zhong Lun. Wang Bing notes: Drinking much and urinating frequently is called Re Zhong (Heat in the Middle). Eating much and urinating frequently is called Xiao Zhong (Wasting in the Middle). Excessive joy is called Dian, synonymous with epilepsy. Excessive anger is called Kuang. Dian is the same character as Dian.) These Re Zhong and Xiao Zhong conditions occur mostly in wealthy people. Prohibiting rich foods goes against their habits, and prohibiting aromatic/mineral drugs prevents cure. I wish to hear the explanation. (Gao Liang refers to strong-flavored, rich foods. Fang Cao refers to pungent and aromatic herbs. Shi Yao refers to refined minerals/metals. All three can aid heat and consume Yin; they are strictly contraindicated in heat diseases. Re Zhong and Xiao Zhong are internal heat diseases, common among the wealthy. The Tong Ping Xu Shi Lun states: "In treating Xiao Dan, fat and noble persons suffer from diseases caused by Gao Liang." Wealthy individuals consume fatty and sweet foods; fattiness generates internal heat, sweetness causes middle-jiao fullness. Accumulated qi transforms into heat, leading to Xiao Zhong and Xiao Ke diseases. Thus, Gao Liang and Fang Cao must be prohibited.)
Qibo said: The qi of Fang Cao is beautiful/aromatic, and the qi of Shi Yao is fierce/harsh. Both act rapidly and firmly. Therefore, unless the person has a calm and gentle mind, they cannot take these two types of medicine. (Aromatic substances have hot and dispersing qi; harsh substances have rigid and violent nature.)
The Yellow Emperor asked: Why can these two not be taken?
Qibo said: Pathogenic heat is fierce and harsh, and medicinal qi is similar. When the two meet, there is fear of internal injury to the Spleen. (The Spleen is the Ultimate Yin within Yin. Excess Yang damages Yin. Thus, the combination of two heats inevitably injures the Spleen. "Piao" sounds like "piao".) The Spleen belongs to Earth and dislikes Wood. Patients taking these medicines may see worsening on Jia-Yi days (Wood days), at which point further discussion is needed. (Injured Spleen fears Wood; worsening on Jia-Yi days implies severity. My commentary: Xiao Dan and Xiao Zhong correspond to the later San Xiao syndromes. Polydipsia with unquenchable thirst is Shang Xiao (Upper Xiao); excessive hunger with digestion is Zhong Xiao (Middle Xiao); frequent, turbid, uncontrollable urination is Xia Xiao (Lower Xiao). As stated in Qi Jue Lun, Fei Xiao (Lung Xiao) and Ge Xiao (Diaphragm Xiao), and in Qi Bing Lun, Xiao Ke (Wasting-Thirst), refer to Shang Xiao. Mai Yao Jing Wei Lun states "Dan transforms into Xiao Zhong"; Chuan Pian states "Stomach heat digests food causing hunger," referring to Zhong Xiao. Xie Qi Zang Fu Bing Xing Pian states "Kidney and Liver pulses being minute all indicate Xiao Dan"; Kidney and Liver are inferior, referring to Xia Xiao. Liu Hejian's San Xiao Lun states: "All five zang and six fu organs and four limbs receive Qi from the Spleen and Stomach, circulating Jin Ye (body fluids) to nourish them. However, Xiao Ke disease stems from extreme deficiency of damp-cold Yin Qi and extreme excess of dry-heat Yang Qi. Treatment should tonify the deficiency of Kidney Water/Yin-Cold, drain the excess of Heart Fire/Yang-Heat, remove severe dry-heat from intestines/stomach, and replenish depleted body fluids. This ensures pathways remain open, fluids generate without drying, and Qi/Blood harmonize without stagnation, curing the disease. If drinking leads to frequent urination, it is Xiao Ke; if eating leads to little thirst but frequent urination and emaciation, it is Xiao Zhong; if thirst persists despite drinking, with leg emaciation and lipid urine, it is Shen Xiao (Kidney Xiao). All result from excessive dry-heat obstructing the pores and collaterals of the San Jiao and intestines. Despite central intake, fluids cannot moisten the exterior or nourish the bones, causing persistent thirst and polyuria. Zhang Dairen states: "San Xiao should be judged by Fire." Fire's function: burns wood to charcoal, melts metal to liquid, turns stone to ash, boils sea to salt, dries water to powder, smelts tin to cinnabar. Marsh water evaporates in sun; pot water dries in fire. In the five zang, Heart is Monarch Fire (orthodox transformation), Kidney is Monarch Fire (counterpart transformation), San Jiao is Minister Fire (orthodox), Gallbladder is Minister Fire (counterpart). Balance cooks food and eliminates waste; imbalance scorches zang-fu and exhausts fluids. Heart Fire excessive above causes Diaphragm Xiao; in the middle causes Intestine/Stomach Xiao; below causes Essence Xiao; outside causes Muscle Xiao. Unchecked upper excess affects Lung; middle affects Spleen; lower affects Kidney/Liver; external affects sinews/bones. When four zang are exhausted, Heart burns itself to death. Thus, Suwen mentions Xiao Dan, Xiao Zhong, Xiao Ke, Feng Xiao, Ge Xiao, Fei Xiao. Though manifestations differ, they all return to Fire. These two masters explained this well. Also, Xiuzhen Fang states: "The Kidney in the body is like the root of a tree. Kidney disease first causes emaciation; nourishment cannot moisten. Thus, Xiao Ke always originates in the Kidney meridian." Due to reckless behavior, sexual excess, alcohol abuse, and consumption of dried meats/minerals during youth, Kidney Water dries up, Heart Fire blazes, San Jiao becomes fierce, five zang become dry, generating Xiao Li. This argues San Xiao originates in the Kidney. He Baizhai states: "Creation relies on Water and Fire, favoring balance over bias, union over separation. Water is damp/cold; Fire is hot/dry. Fire flares up; Water flows down. Fire should be below, Water above, to facilitate interaction. Interaction creates Hexagram Ji Ji (After Completion); non-interaction creates Wei Ji (Before Completion). Extreme non-interaction leads to separation and death. Xiao Ke is non-interaction with Fire excess; Shui Qi is non-interaction with Water excess. Controlling bias to restore interaction is the treatment. From these theories, treating Xiao requires balancing clearing Fire and strengthening Water, assessing San Jiao excess/deficiency, and using tonification or drainage appropriately. However, I have further views. Yin Yang Bie Lun states: 'Disease of Er Yang (Yang Ming) originates in Heart/Spleen, transmitting to Feng Xiao.' This is because Yang Ming is the Sea of Twelve Meridians; Spleen Earth deficiency allows Liver Wood to invade, causing muscular Feng Xiao. Qi Jue Lun states: 'Heart transferring cold to Lung causes Fei Xiao; drinking one part, urinating two parts is fatal.' This describes Yuan Yang deficiency with Metal cold/Water cold, causing Lung/Kidney Xiao. Xie Qi Zang Fu Bing Xing Pian states: 'Minute pulses of five zang indicate Xiao Dan.' This means weak Cun Kou pulse externally reflects internal depletion of Qi/Blood. Qi Jiao Bian Da Lun states: 'Excessive Year Water, approaching Tai Yang, causes people to suffer thirst and delirium.' Wu Chang Zheng Da Lun states: 'Tai Yang governing Heaven, Cold descends, Heart Fire follows, causing dry throat and thirst.' Zhi Zhen Yao Da Lun states: 'Tai Yang governing Heaven, excessive Cold, causes dry throat and thirst for drink.' These involve suppressing Yang with Yin, controlling Fire with Water, requiring warm agents to dispel Cold for spontaneous recovery. Such cases belong to Xiao Ke categories. 'Xiao' means consumption. Yang excess consumes Yin; can Yin excess consume Yang? Thus, consumption of Spirit, Blood, Qi, Muscle, Sinew, and Bone is all Xiao. I once treated a scholar over forty who fell ill due to clerical fatigue. Symptoms: mental fatigue, poor appetite, frequent fear, no upper jiao thirst, aversion to liquids, slight intake causes stagnation, yet voids 2-3 sheng nightly, half turbid. Cause unknown. He reported six months of insomnia, dreaming of dead relatives/mourning, feeling haunted. I said: No. This is due to thoughtful fatigue injuring Heart/Kidney. Yuan Yang deficiency allows Yin Evil to prevail, causing Yin dreams. Yang deficiency leads to Qi deficiency; Yang fails to guide Yin, so Water fails to transform into Qi. Hence less drinking but more turbid urine. As Yang recovers, Yin Evil retreats. This matches Suwen's 'Heart transfers cold to Lung, drink one void two.' The root was serious, but pulse was still moderate, muscles intact, Stomach Qi present. Safe. I used Gui Pi Tang minus Bai Zhu/Mu Xiang, and Ba Wei Wan minus Mu Dan Pi/Ze Xie. One tonifies Yang, one tonifies Yin, alternating. Over 300 doses, using 20+ jin of Ren Shen, he fully recovered. Is this not Spirit consumed above, Essence consumed below? Thus, Xiao has Yin/Yang distinctions, cannot all be called Fire syndromes. Recorded here as a reference for treating Xiao.)