三消者，凡多饮而渴不止，为上消。经云∶心移热于肺，传为鬲消。鬲消者，鬲上焦烦，饮水多而
善消也。消谷善饥为中消，验云∶胃中热，则消谷；令人悬心善饥。盖胃热则谷食易消，故令人善饥，
胃火上炎，心血燥灼，而悬悬不宁也。溲便频而膏浊不禁为下消。经云∶肾脉微小为消瘅。阴精衰少，
故肾脉微小。瘅者热也，热则消肌肤，故为消瘴。景岳又言消瘴者，三消之总称也。按张戴人云∶三消
当从火断，观《内经》论消症不同，归之于火则一也。河间论治
三消大法，当泻心火，除胃热，补肾水。又按《袖珍方》云∶消渴皆因肾水沽竭，心火燔盛，三焦猛
烈，五脏干燥，由是消渴生焉。观此诸论，则知清金、壮水二法，为治消症之大纲也。景岳引内经
心移寒于肺为肺消，饮一溲二，死不治之条，言消有阴阳，不得尽称为火症。此以示人当知病情
之变幻耳。勿执是说，而浪用热剂，则不致以火济火而杀人矣。
二冬二母散〔见小便不通。〕
泻白散〔见火。〕多饮而渴不止，甚者舌上赤裂，急合
二方，加减大剂治之。宜加五味 花粉〔生津。〕生地 玄参〔补水。〕 芦根汁〔降
火。〕 生鸡子白〔除热。〕甚者可加石膏、芩、连。
此清金、壮水、生津、除热之剂。《总录》谓不能食而渴者，末传中满，勿过用寒凉泻火之药。能
食而渴者，必发脑疽，背痈。故消渴病少愈，急宜用忍冬，少佐甘草熬膏，频饮预防，可免。
竹叶石膏汤〔见伤寒。〕治消谷善饥，饮食昼夜无度。〔经言∶善黄而瘦，火之故也。〕大便
硬少。〔戴人所谓烈火 石，则消为灰是也。〕口渴饮水，〔阳明症本渴炊。〕宜参前方加用之药。〔嘉
言云∶治中消病，当知急救金、水二脏，故须地、冬之品。〕
此方上、中、二消通可用之。昔东垣以之治鬲消，洁古以之治中消，嘉言谓人参白虎汤，治火热伤
其肺、胃，乃清
热救渴之良剂也。
六味加知柏汤〔见火。〕
八仙长寿丸〔见虚劳。〕 溲溺频数，〔水虚火旺，逼迫膀胱
下注故也。〕膏浊不禁，烦渴引饮，〔肾水虚，故引饮自救。〕甚者耳叶焦枯，〔耳为肾之外候。〕二
方通可加减用之。
此方壮水滋阴降火，为下消正治之方。宜加清金润燥之品，大剂次之。按《金匮》治男子消渴，小
便反多，以饮一斗，小便一斗，八味丸主之。沈目南注云∶男子房劳伤肾，水亏火旺，而成消渴，水亏
则相火无制，胃关大开，逼迫水饮，直从膀胱溺出而无底止，用六味滋起肾水；因相火散漫不收，借桂附
收摄元阳入肾，蒸腾肾水而治中、上二焦之火，则消渴自止。此乃兵之以奇胜者也，不善用之，反致祸
败。又按昔人每用八味丸以治消渴。云因命门火衰，不能蒸腐水谷，水谷之气，不能熏蒸上润乎肺。如釜
底无薪，锅盖干燥，故渴。至于肺亦无所禀，不能四布水精，并行五经，其所饮之水，未经火化，直入膀
胱，故饮一斗、溺一斗，试尝其味甘而不咸可知矣。桂、附壮其少火，如釜底加薪，热气蒸腾，锅盖湿
润。虽至理攸寓，然今人之病，火衰者绝少，不可轻试。
忍冬丸〔亦可作膏。〕
忍冬花〔根茎叶皆可用。 入坛内，酒浸足，泥固，糠火微煨一宿，取出晒干。入甘草少许为
末。即以所浸酒煮糊为丸，如桐子大，或汤或酒送下。〕
此养阴退阳，调和荣卫血脉，凡系火热炽盛之体，允为
服食仙方。
三消之脉，数大者生，细微者凶。
三消病，凡是多饮且口渴不止的，称为上消。医经说：“心将热邪移于肺，传变成为膈消。”膈消的症状是胸膈及上焦烦热，饮水多且食物容易消化。以吃得多且容易饥饿为中消，验方记载：“胃中有热，则食物易消化；使人心中悬空感且容易饥饿。”大概是因为胃热导致谷食容易消化，所以使人容易饥饿，胃火上炎，灼伤心血，从而产生心中悬空不安的感觉。小便频数且尿液浑浊如膏脂、无法控制为下消。医经说：“肾脉微小属于消瘅。”阴精衰少，所以肾脉呈现微小之象。“瘅”意为热，热邪会消耗肌肤，所以称为消瘅。张景岳又说“消瘅”是三消病的总称。据张戴人说：“治疗三消应当从‘火’论治”，观察《内经》对消症的论述虽不同，但归结于“火”是一致的。刘河间论述治疗三消的大法，应当泻心火，除胃热，补肾水。另外据《袖珍方》记载：“消渴皆因肾水枯竭，心火炽盛，三焦猛烈，五脏干燥，由此产生消渴。”看这些论述，可知清金（清肺热）、壮水（滋肾阴）二法，是治疗消症的大纲。张景岳引用《内经》中“心移寒于肺为肺消，饮一溲二，死不治”的条文，说明消症有阴阳之分，不能全部称为火症。这是为了让人知道病情的变幻莫测罢了。不要固执于这一说法而滥用热性药物，就不会因为以火助火而杀人了。
二冬二母散〔见小便不通章节〕
泻白散〔见火证章节〕。对于多饮且口渴不止，严重时舌面出现赤色裂纹者，紧急时将上述两方合用，加减后大剂量治疗。适宜加入五味子、天花粉〔生津液〕、生地黄、玄参〔补阴液〕、芦根汁〔降火〕、生鸡蛋清〔除热〕。病情严重者可以加入石膏、黄芩、黄连。
这是清肺金、滋肾水、生津液、除热的方剂。《太平惠民和剂局方》（简称《总录》）说：不能进食且口渴的，是疾病末期传入中焦导致胀满，不要用过多的寒凉泻火药。能进食且口渴的，一定会发生脑疽、背痈。所以消渴病稍微好转时，急需用忍冬（金银花），少量佐以甘草熬成膏，频繁饮用以预防，可以避免并发症。
竹叶石膏汤〔见伤寒章节〕。治疗吃得多且容易饥饿，饮食昼夜无节制。〔医经说：“善饥而消瘦，是火邪的缘故。”〕大便干硬量少。〔张戴人所说的烈火焚烧石头，最终化为灰烬，比喻身体被消耗殆尽。〕口渴想喝水，〔阳明病本应口渴。〕适宜参考前方加入使用的药物。〔徐嘉言说：“治疗中消病，应当知道急救肺、肾二脏，所以需要用地黄、麦冬这类药物。”〕
此方上消、中消均可通用。过去李东垣用它治疗膈消，张洁古用它治疗中消，徐嘉言认为人参白虎汤，治疗火热损伤肺、胃，是清热救渴的良好方剂。
六味加知柏汤〔见火证章节〕
八仙长寿丸〔见虚劳章节〕。小便频数，〔因阴虚火旺，逼迫膀胱向下注泄所致。〕尿液浑浊如膏脂无法控制，烦躁口渴引水自救，〔因肾水虚，所以引水自救。〕严重时耳廓焦枯，〔耳朵是肾脏的外在表现。〕这两方均可加减使用。
此方滋肾水、滋阴液、降虚火，是治疗下消的正治方剂。适宜加入清肺金、润燥的药物，大剂量随后跟进。据《金匮要略》治疗男子消渴，小便反而增多，喝一斗尿一斗，用八味丸主治。沈目南注解说：男子房劳伤肾，水亏火旺，而成消渴，水亏则相火失去制约，胃关大开，逼迫水饮，直接从膀胱排出而无底止，用六味丸滋补起肾水；因相火散漫不收，借桂枝、附子收摄元阳入肾，蒸腾肾水而治疗中、上二焦的火，则消渴自然停止。这是出奇制胜的方法，如果不善于使用，反而会导致祸败。另外据前人常用八味丸治疗消渴。说是因命门火衰，不能蒸腐水谷，水谷之气，不能熏蒸上润于肺。如同锅底没有柴火，锅盖干燥，所以口渴。至于肺也无所禀受，不能四布水精，并行五经，所饮之水，未经火化，直入膀胱，所以喝一斗、尿一斗，试着尝其味甘而不咸就可以知道了。桂枝、附子壮其少火，如同锅底添加柴火，热气蒸腾，锅盖湿润。虽然道理深刻，然而今人的病，火衰者极少，不可轻易尝试。
忍冬丸〔也可以做成膏剂〕
忍冬花〔根茎叶都可用。放入坛内，酒浸足量，泥封固，用糠火微煨一夜，取出晒干。加入少许甘草研末。即用所浸的酒煮糊为丸，如梧桐子大，或汤或酒送服。〕
这是养阴退阳，调和营卫血脉的方子，凡是属于火热炽盛的体质，确实是服食的仙方。
三消病的脉象，数大而有力的预后良好，细微无力的预后凶险。
Sanxiao (Three Wasting-Thirst) refers to conditions characterized by excessive drinking and unquenchable thirst, known as Shangxiao (Upper Wasting-Thirst). The Classics state: "Heart transfers heat to the Lung, transmitting it to become Gexiao (Diaphragm Wasting-Thirst)." Gexiao is characterized by vexation and heat in the diaphragm and Upper Jiao (Triple Burner), with excessive water intake and rapid digestion of food. Zhongxiao (Middle Wasting-Thirst) is identified by excessive eating and easy hunger. Verified formulas record: "Heat in the Stomach leads to digestion of food; it causes a sensation of emptiness in the heart and easy hunger." Generally, stomach heat makes food digest easily, thus causing easy hunger. When stomach fire flares upward, it scorches Heart blood, resulting in a lingering sense of unease. Xiuxiao (Lower Wasting-Thirst) is characterized by frequent urination and uncontrollable turbid urine resembling paste. The Classics state: "A minute and small Kidney pulse indicates Xiaodan (Wasting-Thirst with Heat)." The decline of Yin essence results in a minute and small Kidney pulse. "Dan" means heat; heat consumes the flesh and skin, hence it is called Xiaozhang (Wasting-Thirst). Zhang Jingyue further states that Xiaodan is the general term for Sanxiao. According to Zhang Dairen: "Treatment of Sanxiao should be determined from the perspective of Fire." Observing the discussion on wasting-thirst in the *Neijing* (*Inner Canon*), although different, they all attribute it to Fire. Liu Hejian discusses the general principles for treating Sanxiao: one should drain Heart Fire, eliminate Stomach Heat, and tonify Kidney Water. Additionally, the *Xiuzhen Fang* (*Pocket Formulas*) states: "Xiaoke (Wasting-Thirst) arises because Kidney Water is exhausted, Heart Fire is blazing, the Triple Burner is fierce, and the Five Zang Organs are dry, thereby generating Xiaoke." From these discussions, it is known that clearing Metal (Lung) and strengthening Water (Kidney) are the main outlines for treating wasting-thirst. Zhang Jingyue cites the *Neijing* passage: "Heart transfers cold to the Lung, becoming Feixiao (Lung Wasting-Thirst); drinking one part, urinating two parts, is incurable and fatal," indicating that wasting-thirst has Yin and Yang aspects and cannot be entirely classified as a Fire syndrome. This is to show people that disease patterns change. Do not adhere rigidly to this view and recklessly use hot-acting agents, lest you kill by adding fire to fire.
Er Dong Er Mu San (Two Wintermelons and Two Mother Herbs Powder) [See section on Urinary Obstruction].
Xie Bai San (Drain White Powder) [See section on Fire]. For cases of excessive drinking and unquenchable thirst, severe enough to cause red cracks on the tongue, urgently combine these two formulas, modify them, and administer in large doses. It is suitable to add Wuweizi (Schisandra Fruit), Tianhuafen (Trichosanthes Root) [to generate fluids], Shengdihuang (Rehmannia Root) and Xuanshen (Scrophularia Root) [to nourish Yin], Lugenzhi (Reed Rhizome Juice) [to descend Fire], and raw egg white [to remove heat]. In severe cases, Shigao (Gypsum), Huangqin (Scutellaria Root), and Lianzi (Coptis Rhizome) can be added.
This is a formula for clearing Lung Metal, nourishing Kidney Water, generating fluids, and removing heat. The *Zonglu* (*General Records*) states: for those who cannot eat but feel thirsty, the disease may transmit to the Middle Jiao causing fullness; do not overuse cold and cooling herbs to drain fire. For those who can eat but feel thirsty, they will inevitably develop brain carbuncles or back sores. Therefore, when Xiaoke improves slightly, one should urgently use Rendonghua (Honeysuckle Flower), with a small amount of Gancao (Licorice Root) boiled into a paste, and drink frequently to prevent complications.
Zhuye Shaoyao Tang (Bamboo Leaf and Poria Decoction) [See section on Cold Damage]. Treats Zhongxiao (excessive eating and easy hunger), with diet day and night without limit. [The Classics say: "Easy hunger with emaciation is due to Fire."] Hard and scanty stools. [As Zhang Dairen described: "Fierce fire burns stone, turning it to ash," metaphorically describing the consumption of the body.] Thirst and desire to drink water. [Yangming syndrome inherently involves thirst.] It is appropriate to refer to the medications used in the previous formula. [Xu Jiayan said: "When treating Zhongxiao, one must know to urgently rescue the Lung and Kidney organs, thus requiring products like Dihuang and Maidong."]
This formula can be generally used for both Shangxiao and Zhongxiao. Historically, Li Dongyuan used it to treat Gexiao, Zhang Jieguy used it to treat Zhongxiao, and Xu Jiayan considered Renshen Baizhu Tang (Ginseng and White Tiger Decoction) as an excellent agent for clearing heat and saving thirst when fire damages the Lung and Stomach.
Liujia Zhibai Tang (Six-Ingredient Decoction with Anemarrhena and Phellodendron) [See section on Fire].
Baxian Changshou Wan (Eight Immortals Longevity Pill) [See section on Deficiency Consumption]. Frequent urination, [due to Yin deficiency and hyperactive Fire forcing the Bladder downward.] Turbid urine resembling paste that cannot be controlled, vexation and thirst leading to drinking, [due to Kidney Water deficiency, thus drawing water to save oneself.] In severe cases, the earlobes become dry and withered, [as the ears are the external manifestation of the Kidney.] Both formulas can be modified and used.
This formula strengthens Water, nourishes Yin, and descends Fire; it is the correct treatment formula for Xiuxiao. It is suitable to add herbs that clear Lung Metal and moisten dryness, administered in large doses subsequently. According to the *Jingui Yaolue* (*Essential Prescriptions from the Golden Cabinet*), for men with Xiaoke where urination is excessive, drinking one dou and urinating one dou, Bawei Wan (Eight-Ingredient Pill) is the primary treatment. Shen Munan annotated: "Male sexual exhaustion injures the Kidney, leading to Water deficiency and Fire hyperactivity, resulting in Xiaoke. Water deficiency means Ministerial Fire is uncontrolled, the Stomach gate opens wide, forcing water drinks directly out through the Bladder without end. Use Liuwang Wan (Six-Ingredient Pill) to replenish Kidney Water; because Ministerial Fire scatters and does not gather, borrow Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) to collect Yuan Yang (Primordial Yang) into the Kidney, steaming Kidney Water to treat Fire in the Middle and Upper Jiao, then Xiaoke stops naturally. This is winning by surprise tactics; if not used skillfully, it may lead to disaster." Additionally, ancients often used Bawei Wan to treat Xiaoke. They stated it is because Mingmen Fire (Gate of Life Fire) is weak, unable to steam and rot food and water, so the Qi of food and water cannot steam upwards to moisten the Lung. Like a pot lid being dry because there is no fire under the pot, thirst ensues. The Lung also receives nothing, unable to distribute water essence and circulate through the five meridians. The drunk water,未经 fire transformation, goes straight to the Bladder, hence drinking one dou, urinating one dou. Tasting it reveals the sweetness without saltiness. Guizhi and Fuzi strengthen the mild Fire, like adding fuel to the bottom of the pot, steaming heat and moistening the lid. Although this contains profound truth, nowadays patients rarely suffer from Fire deficiency; do not lightly try it.
Rendong Wan (Honeysuckle Pill) [Can also be made into a paste.]
Rendonghua (Honeysuckle Flower) [Roots, stems, and leaves are all usable. Place in a jar, soak sufficiently in wine, seal tightly with mud, simmer slowly with chaff fire overnight, take out and dry. Add a little Gancao (Licorice Root), grind into powder. Use the soaking wine to boil into a paste to form pills, sized like paulownia seeds, taken with decoction or wine.]
This nourishes Yin and retreats Yang, harmonizes Ying (Nutritive) and Wei (Defensive) Qi and blood vessels. For constitutions with blazing excess Fire, it is truly an immortal food prescription.
For Sanxiao, a rapid and large pulse indicates survival, while a fine and minute pulse indicates fatality.