消 渴

Wasting
-thirst disease
 主要内容
• 1、概念
– 2、历史沿革
• 3、与西医联系
–4、病因病机
»5、诊断要点
–6、鉴别诊断
• 7、辨证论治
 定义 definition
• 消渴是以多饮、多食、多尿，形体消瘦乏力，或尿有
甜味为主要临床表现的一种疾病。消为消耗水谷津液气血之
意，渴即口渴引饮。本病主要临床表现为口渴多饮，消谷善
饥，小便频数量多，形体日渐消瘦，并可出现痈疽等多种并
发症。
• Wasting-thirst disease is characterized by polydipsia,
polyphagia, and polyuria with thin and weak body, or
sweet urine taste. Wasting means consume of essence,
fluid, Qi and Blood, thirst means thirsty induce drinking.
The main clinical symptom in this disease are thirst with
drinking a lot of water, metabolize food with easy hungry,
frequent urination, body becomes thinner day by day, as
well as ulcer.
 历史沿革 literature review
• 在人类医学史中，中医学对本病的认识最早，
且论述甚详细。消渴之名，首先见于《内经·奇病
论》，根据病机与症状的不同，《内经》还有消瘅、
肺消、膈消、消中等名称的记载。《金匾要略》立
专篇讨论，并最早提出治疗方药。《诸病源候论·消
渴候》明确认识到消渴病易发痈疽和水肿等并发症。
《外台秘要·消中消渴肾消》最先记载了消渴病尿甜
的发现。刘河间《三消论》是阐述三消燥热学说的
专著，提出“三消者，燥热一也”，治则是“补肾
水阴寒之虚，而泻心火阳热之实，除肠胃燥热之甚，
济人身津液之衰。”
• In the history of human medicine, Chinese Medicine
recognized this disease earliest, and had a very detailed
explanation. The name of Wasting-thirst disease were first
written in <Nei Jing.Qi Bing Lun>, according to different
pathogenesis and symptoms, <Nei Jing> also had noted
down Xiao dan , pulmonary consumption , diaphragm
elimination and middle elimination. <Jing Kui Yao Lue> has a
specific discussion corner and had mentioned about the
treatment the earliest. <Zhu Bing Yuan Hou Lun.Xiao Ke Hou>
clearly understands that Wasting-thirst disease will easily
caused ulcer or edema. <Wai Tai Me Yao.Xiao Zhong Xiao Ke
Shen Xiao> is the first book that noted down that Wasting-
thirst disease has sweet urine. Liu He Jian <San Xiao Lun>
described three waste dry heat theory, and stated that “in
three waste, there will be one dry heat”, treatment principle is
“tonify the deficiency of kidney fluid Yin cold, and clear the
sthenic of Fire Yang heat, eliminate the exuberant of Stomach
intestine dry heat and nourish the weak body fluid.”
与西医联系
Diabetes, diabetes insipidus and
Neuropathic polyuria in western medicine,
all of it can do syndrome differenciation
accroding Wasting-thirst disease
 病因病机
Cause and Pathology
• （一）病因 Cause
• 1、禀赋不足insufficiency from pre-
natal
2、情志失调 emotional imbalance
3、饮食不节 improper diet
4、劳欲过度 excessive activity
 病因病机
• （二）病机 Pathology
1、基本病机 Basic pathology
消渴的基本病机为阴津亏损，燥热偏盛，以阴虚为本，
燥热为标。
The basic pathogenesis of wasting-thirst is loss of Yin fluid,
dry heat exuberant, Yin deficiency as root cause, dry-
heat as secondary cause.
2、病位 Location
病变部位主要在肺、胃（脾）、肾，尤以肾为关键。
The location of this disease is mainly in Lung, Stomach
(spleen), Kidney, particularly Kidney has the closet
relation in this disease
 病因病机 Cause and pathology
• （二）病机 pathology
3、病理性质 pathogenesis
本虚标实，虚实夹杂为本病特点。本虚指阴虚、气虚、
甚则阳虚，其中以阴虚为主，气虚、阳虚为阴虚转化而成。
消渴病阴虚贯穿于整个病程之中涉及肺、脾胃、肾等脏，
尤以肾阴亏虚最为重要。标实是指燥热、瘀血、痰浊等，
其中又以燥热为主，痰瘀为继发因素。燥热是消渴最主要
的病理因素，燥热在上则肺燥津亏，口渴多饮；燥热在中
则胃火炽盛，消谷善饥；燥热在下则下耗肾阴，肾失封藏
固摄，则小便量多，尿甜。阴虚与燥热密切相关，相生相
伴，阴虚为本，燥热为标。
• Root cause asthenia secondary cause sthenic and mixing of
sthenic and asthenic are the feature of this disease. Root cause
asthenia means Yin deficient, Qi deficient and Yang deficient if
serious, among all Yin deficient is the main one, while Qi
deficient and Yang deficient are transform from Yin deficient. Yin
deficiency in Wasting-thirst disease pass through the whole
process of the disease and it affects Lung, Spleen and Stomach
and Kidney, Kidney Yin deficient as the most important point.
Secondary cause sthenic means dry heat, blood stasis, turbid
phlegm, among all dry heat as the main cause and phlegm stasis
as the continuous caused. Dry heat is the main pathogen in
wasting-thirst disease, in upper energizer, dry heat cause lung
dryness with fluid deficient, thirsty with polydipsia; in middle
energizer, dry heat cause stomach fire exuberant, fast
metabolism easily hungry; in lower energizer, dry heat cause the
consume of Kidney Yin, Kidney loss the function of holding,
cause polyuria, and sweet urina. Yin deficient and dry heat has a
very close relationship, it grow and partner together, Yin
deficient as root cause, dry heat as secondary cause.
病因病机 Cause and pathology
• （二）病机 pathology
4、病机转化 transformation of pathology
消渴病日久，其病机可出现多种变化，常见
的有两种：一是阴损及阳，阴阳俱虚；其中以肾
阳虚与脾阳虚较多见。二是病久入络，瘀血阻滞。
消渴病瘀血形成是一个复杂的病理过程，阴虚、
燥热、气滞、正虚是其主要因素。因阴虚血少，
粘着难行；燥热内灼，煎熬营阴，血受热灼，涩
滞不畅；情志内伤，气机郁滞，血行不畅；正气
虚弱，无力鼓动，血行迟滞。瘀血一旦形成，可
影响津液的生成与输布而使消渴加重，使本病更
加缠绵难愈而变证丛生。
• After a period of time having wasting-thirst disease, various changes
will occur in the pathology, the two mostly seen ones are: first, Yin
spoil Yang, Yin and Yang both deficient, Kidney Yang deficient and
Spleen Yang deficient as mostly seen. Secondly, after a long period of
this sickness it will move into the meridian causing the stagnation of
blood stasis. The cause of Wasting-thirst disease is a complicated
pathogenesis progress, Yin deficient, dry heat, Qi stagnant, Zheng
deficient as the mean cause. Due to Yin deficient blood less, it is sticky
and hard to move; dry heat fire the inner, tormenting the Ying Yin, blood
fire by heat becomes stagnant and unsmooth flow; emotional
imbalance, the flow of Qi stagnant, bloof flow unsmooth; healthy Qi
weak, unable to flow, the flow of blood slow and stagnant. When blood
stasis occur, it will affect the transformation and transportation of fluid
causing more serious of wasting-thirst, affecting the disease more
difficult to recover, change to a different symptoms and continue to
stay in the body.
病因病机 Cause and pathology
• （二）病机 pathology
5、预后 prognosis
消渴病的一般演变规律是，初起常以阴津亏损，燥
热为主，随着病程的进展，阴精亏损日甚，津伤则气损，
阴亏则气耗，故又渐至气阴两虚。日久则阴损及阳，而出
现阴阳两虚之证。消渴常病及多个脏腑，病变影响广泛，
可出现多种并发症，形成消渴与其他病证共见的复杂局面。
临床上，消渴病症状的轻重，“三多一少”的程度是判断
病情轻重的重要标志，而血糖值是其重要依据。是否合并
有并发症及其病变的程度，有无脏腑衰竭，特别是有无脾
肾阴阳两虚证候等，是判断预后的重要因素。症状较轻，
血糖控制较好，并发症少或不严重，脏腑衰竭之象不明显
者，病情较轻；反之则为病重。证见阴阳两虚甚至厥脱昏
迷者，是为危象。
• The usual progress of changing of Wasting-thirst disease are at
first Yin fluid insufficient, dry heat as main, as the illness
continues, Yin essence deficient gets serious, Jin injured will
cause Qi injured, Yin injured then Qi consumed, therefore
slowly progress to both Qi Yin deficient. Long period of this
caused Yin injure Yang, resulting both Yin Yang deficient
syndrome. Waste- thirst often affect on many organs, the
changes of the illness is wide, it can occurs many side
symptoms, causing wasting-thirst and other illness messed up
together in a complicated way. Clinically, the seriousness of
wasting-thirst, the level of “three many one less” are the main
pin that judge the seriousness of this disease, and blood sugar
level is the important finding. Whether there is side symptoms
messing with the level of the changes of the illness, or Zang
and Fu organ weak, most importantly whether Spleen Kidney
Yin and Yang deficient, are the points that judge the prognosis.
Light symptoms, blood sugar level under good control, less or
not serious side symptoms, Zang Fu organ have no obvious
weak, light condition; on the opposite side as serious condition,
Syndrome has serious Yin Yang deficient causing coma as
dangerous condition.
 诊断要点 Main point for
diagnosis
• 1、临床特征 characteristics
• 口渴多饮，多食易饥，尿频量多，形体
消瘦的“三多一少”或尿有甜味等为主要
临床特征。
• Thirsty with polydipsia, polyphagia with easy
hungry, polyuria and excessive volume,
emaciation as ‘three many one less’ or sweet
urine taste as the main characteristics.
诊断要点 Main point for diagnosis
• 2、病史 History
• 本病多发于中年以后，以及嗜食膏粱厚味，
醇酒炙煿。有的患者“三多”症状不明显，但中
年以后一发病，即可见并发症。本病与禀赋不足
有关，故消渴病的家族史可供诊断参考。
• This disease often occurs on people who is
over middle age, and on people who loves
oily and tasty food and pure alcohol. Some
patients do have obvious symptoms of ‘three
many’, but after middle age, the symptoms
start to appear with side symptoms. This
disease is related to insufficiency from pre-
natal, therefore, wasting-thirst disease can
refer from family history.
• 3、辅助检查 Further examination
• 查空腹、餐后2小时血糖和尿糖，尿比重，
葡萄糖耐量实验等，有助于明确诊断。病情较
重时，还要查血尿素氮、肌酐，以了解肾功能
的情况；查血酮，以了解有无酮症酸中毒；查
二氧化碳结合力及血钾、钠、钙、氯化物等，
以了解酸碱平衡及电解质情况。
• Examine the blood sugar, urine sugar ratio of the urine, and
Glucose level with empty stomach and 2 hours after meal,
is helpful to clarify the diagnosis. When the disease is very
serious, Blood urea nitrogen and creatinine is needed to
be check to understand the function of kidney; blood
ketone, to make sure no ketoacidosis, carbon diaoxide
combining power, potassium, sodium, calcium and chloride
to check acis-base balance and electrolytes conditions.
 鉴别诊断 differential diagnosis
• 1. 消渴与瘿病 wasting-thirst disease and nontoxic
goiter
• 瘿病中气郁化火，阴虚火旺的类型，以情绪激动，
多食易饥，形体日渐消瘦，心悸，眼突，颈部一侧或两
侧肿大为特征。其中的多食易饥、消瘦，类似消渴病的
中消，但眼球突出，颈前瘿肿有形则与消渴病有别，且
无消渴病的多饮、多尿、尿甜等症。
• Nontoxic goiter middle Qi stagnant transform fire, Yin asthenia with fire
excuberant type, as emotional, polyphagia easy hungry, body slowly
become emaciated, palpitation, proptosis, enlargement on oneside or
both side of the neck as the characteristic. Among all, polyphagia easy
hungry and emaciated are similar to middle waste in waste-thirst
disease, but proptosis, swollen of the neck is different with waste-thirst
disease, and it do not have the symptoms of polydipsia, polyuria and
sweet urine taste in waste-thirst disease.
鉴别诊断 differential diagnosis
• 2. 消渴与食亦 wasting-thirst and emaciated
polyphagia
• 食亦指消谷善饥，肌肉瘦削，多因胃肠、胆有燥热
而致。《素问·气论》曰：“大肠移热于胃，善食而形
体消瘦，又谓之食亦；胃移热于胆，亦曰食亦。”其中
的多食易饥、消瘦类似消渴病的中消，但无消渴病的多
饮、多尿、尿甜等症。
• Emaciated polyphagia means swift disgestion with easy hungry,
thin muscle due to stomach intestine, gallbladder and dry heat.
<Shu Wen.Qi Lun> said:‘ the heat in the large intestine move to
stomach, polyphagia but emaciated body as emaciated
polyphagia; stomach heat move to gallbladder as emaciated
polyphagia.’ the polyphagia easy hungry, emaciated body is middle
waste in waste-thin disease, but do not have the symptoms of
polydipsia, polyuria and sweet urine in wasting-thirst disease.
辨证论治 syndrome differentiation
1、辨部位 differentiate the location
消渴病的三多症状，往往同时存在，但根据表现程
度上的轻重不同，而有上中下三消的不同，即肺燥、胃
热、肾虚之别。通常把以肺燥为主，多饮症状较突出者，
称为上消；以胃热为主，多食症状较突出者，称为中
消；以肾虚为主，多尿症状较突出者，称为下消。
The three many symptoms is wasting-thirst disease usually occur
together, but according to the level of serious of the symptoms, it has
upper middle and lower difference, as Lung dryness, Stomach heat and
Kidney deficient difference. Normally as Lung dryness as the main one,
polydipsia symptom more obvious, as upper waste; as Stomach heat
as main, polyphagia symptom more obvious, as middle waste; as
Kidney deficient as main, polyuria symptom more obvious, as lower
waste.
辨证论治 syndrome differentiation
2、辨标本 differentiate root and secondary cause
• 本病以阴虚为本，燥热为标，两者互为因果，常因病
程长短及病情轻重的不同，而阴虚和燥热之表现各有侧
重。一般初病多以燥热为主，病程较长则阴虚与燥热互
见，日久则以阴虚为主，进而阴损及阳，导致气阴两虚、
阴阳俱虚之证。
• The root cause of this disease is Yin deficient while secondary
cause is dry heat, it is the cause and the circumstance, often due to
the long or short period it affects the light or serious of the disease,
and the behaviour of Yin deficient and dry heat is either more
serious. Normally acute are dry heat as main, while for chronic are
the meeting of Yin deficient and dry heat, long period then is Yin
deficient as main, Yin injured Yang, causing both Qi Yin deficient,
Yin Yang deficient syndrome.
辨证论治 syndrome differentiation
• 3. 辨本证与并发症differentiate main symptoms and side
symptoms
• 多饮、多食、多尿及消瘦之“三多一少”为消渴病本证的基
本临床特征，而易发生诸多并发症为本病的另一特点。本证与并
发症的关系，一般以本证为主，并发症为次。多数患者，先见本
证，随病情发展而出现并发症，但也有少数患者与此相反，如少
数中老年患者，“三多”及消瘦的本证症状并不明显，常因痈疽、
眼疾、心脑病症等为线索，最后确诊为本病。
• Polydipsia, polyphagia, polyuria and emaciation is ‘three many and one
less’ are the basic characteristic of waste-thirst disease, and easy
occurrence of side symptoms are the other characteristic of this disease
The relationship of main symptoms and side symptoms are main
symptoms as the main one while side symptoms as second one. Many
patient first occur main symptoms then slowly develop side symptoms
but some patient happen the opposite side, for example, in middle old
age patient ‘three many’and emaciation as the main symptoms not
obvious, often are ulcer, eyes diseases and heart symptoms as a clue,
and eventually diagnose as waste-thirst disease.
辨证论治 syndrome differentiation
（二）治疗原则 treatment principle
本病的基本病机为阴虚为本，燥热为标，故以清
热润燥、养阴生津为本病的治疗大法。《医学心悟·三消》
曰：“治上消者，宜润其肺，兼清其胃”；“治中消者，
宜清其胃，兼滋其肾”；“治下消者，宜滋其肾，兼补其
肺”。
The basic pathology of this disease is Yin deficient as root cause,
dry heat as secondary cause, therefore use clear heat and moisten
dryness, tonify Yin and promote fluid as the main treatment. <Yi
Xue Xin Wu.San Xiao> said:“ treat upper waste is to moisten the
Lung and clear the Stomach”; “treat middle waste is to clear the
Stomach and nourish the Kidney”: “treat lower waste is to
nourish the Kidney and tonify the Lung.”
辨证论治 Ø（三）分型论治
1、上消（肺热津亏）Upper waste (Lung heat fluid weak)
证候：烦渴多饮，口干舌燥，尿频量多，舌边尖红，
苔薄黄，脉洪数。
治法：清热润肺，生津止渴。
方药：消渴方加减。方中重用天花粉以生津清热；黄连清
热降火；生地黄、藕汁等养阴增液。可酌加葛根、
麦冬以加强生津止渴作用；若烦渴不止，小便频数，
脉数无力者，为肺热津伤亏，气阴两伤，可选用二
冬汤或玉泉丸；二冬汤中重用人参益气生津，天冬、
麦冬、天花粉、黄芩、知母清热生津止渴；玉泉丸
中以人参、黄芪、茯苓益气，天花粉、葛根、麦冬、
乌梅、甘草等清热生津止渴。二方同中有异，二冬
汤清热作用较强，玉泉丸益气作用较强，可根据临
床需要选择应用。
• Symptoms: anapidsia polydipsia, dry mouth and tongue, polyuria
with excess volume, tongue side and middle red, coating thin
yellow, pulse full rapid.
• Treatment: Clear heat moisten the lung, promote fluid to stop thirst
• Formula: Qing Ke Fang Jia Jien. In the formula use Tian Hua Fen
to promote fluid and clear heat; Huang Lian to clear heat and bring
down the fire; Sheng Di Huang, Ou Zhi to tonify Yin increase fluid.
Can add Ge Geng, Mai Dong to strengthen the function of
promote fluid to stop thirst; is anadipsia do not stop, polyuria,
pulse rapid without strength is Lung heat injured fluid, Qi Yin both
injured, can choose to use Er Dong Tang or Yu Quan Wan; Er
Dong Tang use Ren Sheng tonify Qi promote fluid, Tian Dong, Mai
Dong, Tian Hua Fen, Huang Qin, Zhi Mu clear heat promote fluid
stop thirst; Yu Quan Wan use Ren Sheng, Huang Qi, Fu Ling to
tonify Qi. Tian Hua Fen, Ge Geng, Mai Dong, Wu Mei, Gan Cao to
clear heat promote fluid stop thirst. There is difference in the
formula, Er Dong Tang has a stronger function of clearing heat, Yu
Quan Wan has a stronger function of tonifying Qi, can use
according to the clinical need.
 辨证论治 Ø（三）分型论治

2、中消（胃热津亏）middle waste (Stomach heat fluid injured)

证候：多食易饥，形体消瘦，大便干燥，口渴，
尿多，苔黄燥，舌干质红，脉细数。
治法：清胃泻火，养阴增液。
方药：玉女煎加减。方中生石膏、知母清肺胃之
热；生地黄、麦冬滋肺胃之阴；川牛膝引
热下行，活血化瘀；可加黄连、桅子清热
泻火。若大便燥结不行，可用增液承气汤
润燥通腑，“增水行舟”，待大便通后，
再转上方治疗。
• Symptoms: polyphagia easy hungry, emaciation, dry
stool, dry mouth, polyuria, tongue dry red, coating
yellow dry, pulse thin rapid.
• Treatment: clear Stomach and purge fire, tonify Yin
increase fluid
• Formula: Yu Nv Jian Jia Jian. In the formula Shi Gao,
Zhi Mu clear Lung Stomach heat; Sheng Di Huang,
Mai Dong nourish Lung Stomach Yin; Chuan Niu Xi
guide heat move downward, activate blood and
resolve stasis; can add Huang Lian, Zhi Zi to clear
heat and purge fire, if dry stool cannot move out,
can add Zheng Yie Chen Qi Tang to nourish dryness
and unblock Fu organ, “Zheng Shui Xing Zou”, after
smooth stoll then can switch to the formula above to
treat.
 辨证论治 Ø（三）分型论治

3.下消 ——（1）肾阴亏虚 lower waste—(1)Kidney Yin weak

证候：尿频量多，浑浊如脂膏，或尿甜，腰膝痰软，乏力，
头晕，耳鸣，唇燥，皮肤干燥，或五心烦热，骨蒸潮热，盗汗，
遗精等，舌质红，苔少，脉细数。
治法：滋阴固肾。
方药：六味地黄丸加减。方以熟地黄滋肾填精；山药滋养脾
阴，固摄精微；山茱萸滋补肝肾，而收敛精气；山药、山茱萸药
用量要大。茯苓健脾渗湿；泽泻、牡丹皮清泻肝肾火热，共奏滋
阴补肾，补而不腻之效。若阴虚火旺者，可加黄柏、知母、龙骨、
牡砺、龟板以滋阴降火；尿多而混浊者，可加益智仁、桑螵蛸、
五味子以益肾缩泉；遗精加芡实、金樱子；盗汗加糯稻根、麻黄
根。
• Symptoms: polyuria with turbid or sweet taste urine, sour and
soft knee and back, lack of strength, dizziness, tinnitus, dry
lips and skin, or feverish sensation over the five centers,
steaming bone, night sweat, and spermatorrhea, tongue red
less coating, pulse thin and rapid.
• Treatment: nourish Yin to hold Kidney
• Formula: Liu Wei Di Huang Wan Jia Jian. In the formula, Shu
Di Huang to nourish Kidney to fill in the essence; Shan Yao
nourish Spleen Yin, hold the micro essence; Shan Zhu Yu
nourish and tonify Liver and Kidney, and keep the essence
Qi; the quantity of Shan Yao and Shan Zhu are big. Fu Ling
strength spleen and clear dampness; Zhe Xie, Mu Dan Pi
clear Liver Kidney fire heat, nourishing Yin and tonify Kidney
in total, tonifying but not too over. If Yin deficient fire
exuberant, can add Huang Bo, Zhi Mu, Long Gu, Mu Li, Gui
Ban to nourish Yin and bring down the fire; polyuria with
turbid urine, can add Yi Zhi Ren, Shan Piao Xiao, Wu Wei Zi to
tonify Kidney and contractility; spermatorrhea can add Qian
Shi, Jing Ying Zhi; Night sweat can add Ru Dao Gen and Ma
 辨证论治 Ø（三）分型论治
3.下消 ——（2）阴阳两虚lower waste—(2) Yin Yang Deficent
证候：小便频数量多，浑浊如膏，甚至饮一溲一，面容憔悴，
耳轮干枯，腰膝酸软，四肢欠温，畏寒，阳疾或月经不调，舌质淡，
苔白而干，沉细无力。
治法：温阳滋阴，补肾固摄。
方药：金匾肾气丸加减。方中以六味地黄丸滋阴补肾，用附
子、肉桂温补肾阳。本方以温阳药与滋阴药并用，因为阴阳互根，
善补阳者，必于阴中求阳，则阳得阴助而生化无穷；善补阴者，必
于阳中求阴，则阴得阳升而源泉不竭。若小便混浊如膏者，加覆盆
子、桑螵蛸、金樱子固肾摄精；阳虚畏寒肢冷者，加鹿茸粉0.5g,启
动元阳，助全身阳气之气化；气虚明显者，加黄芪、人参以益气；
大便溏薄者，去熟地、牡丹皮，加补骨脂、煨肉豆蔻补肾收敛；若
阴阳俱衰而浮肿者，可选用济生肾气丸加减；若神志昏迷，四肢厥
冷，脉微细者，为阴竭阳亡的危险证候，急用生脉散合参附汤加龙
骨、牡砺益气敛阴，回阳救逆。
• Symptoms: polyuria with excess volumn and turbid urine, or would even dry
one volumn and urine one volumn, face complexion appears weak, ear
appears dry, soft and sour knee and back, lack of warmth on the four
extremeties, afraid of cold, Yang disease or imbalance on menstruation,
tongue pale with white and dry coating, pulse deep and weak
• Treatment: warm Yang and nourish Yin, tonify Kidney and holding
• Formula: Jing Kui Sheng Qi Wan Jia Jian. In the formula Liu Wei Di Huang
Wan nourish Yin and tonify Kidney, using Fu Zi, Rou Gui warm and tonify
Kidney Yang. This formula use warm Yang medicine and nourish Yin
medicine together, because Yin Yang is rooted together, if good in tonifying
Yang, then will save Yang through Yin, Yang get the help from Yin then grow
become stronger; if good in tonifying Yin, then will save Yin through Yang,
Yin get the Yang increase then will not become weak. If urine appears turbid,
add Fu Peng Zi, Sang Piao Xiao, Jing Ying Zi to holi kidney essence; Yang
deficient afraid of cold add Lu Rong Fen 0.5g, to move Yuan Yang, help the
Yang Qi in whole body gassify; Qi deficient obvious, add Huang Qi, Ren
Sheng to tonify Qi; watery stool remove Shu Di, Mu Dan Pi add Bu Gu Zhi,
Wei Rou Dou Kou to tonify kidney and holding; if Yin Yang weak and
appears swollen, can choose to use Ji Sheng Shen Qi Wan Jia Jian; if coma,
cold in four extremities, pulse thin and weak is in dangerous syndrome of Yin
weak Yang die, emergency use of sheng mai san add fu shen tang add long
gu, mu li to tonify Qi and hold Yin, hold Yang.
（四）预防与调护 prevention and nursing
本病除药物治疗外，注意饮食调摄是十分重要的。饮食
治疗是糖尿病病人的基本治疗，饮食控制的好坏，直接关系到
病情的控制和血糖的稳定。在保证机体合理需要的情况下，应
限制粮食、油脂的摄入，忌食糖类，饮食宜适量的米、麦、杂
粮、配以蔬菜、豆类、瘦肉、鸡蛋等，定时定量进食。要有耐
心，作好长期与糖尿病作斗争的准备。戒烟戒酒、浓茶及咖啡，
养成良好的生活习惯和卫生习惯。保持心情舒畅，力求做到开
朗、豁达、乐观，避免精神紧张，生气恼怒。适当参加体育锻
炼，调节劳逸，节制房事等，有利于糖尿病的控制和稳定。肥
胖者尚须控制体重的增加，减肥有利于本病的恢复。坚持定期
到医院复诊，及时调整治疗方案。
• This disease can use other than medicine, be aware of the diet
balance is very important. The treatment through diet is the basic
treatment for waste-thirst disease patient, controlling the good and
bad of diet is directly related to the stabilization of disease
controlling. In condition of proven and reasonable needs, should
control consume of food and oily food, sweet things are prohibited,
diet should have proper rice, oat mix with vegetables, bean, meat
and egg. Eating time is on time and on control. Patience is needed
as to prepare to fight with diabeter for long time. Stop smoking and
alcohol, thick tea and coffee and get the habit of healthy lifestyle
and hygiene lifestyle. Keep in good mood, should be optimistic,
cheerful and avoid tense feeling and getting angry. Should
appropriately do light sports to train the body, arrange tiredness
and control coitus, it is good for controlling and stabilizing diabetes.
Obese people should control the increasing of weigh, cut down the
fats is good for recovery. Perseverance to go clinic for check up
constantly and arrange the treatment ways.
 小 结
• 消渴是以多饮、多食、多尿及消瘦为临床特征的一
种慢性疾病。导致消渴的病因有禀赋不足，情志失调，饮
食不节，劳欲过度等。其病机主要为阴津亏损，燥热偏胜，
以阴虚为本，燥热为标。病情迁延则可导致气阴两虚或阴
阳俱虚。由于脏腑虚损，常导致变证丛生，严重者因阴液
极度虚损，虚阳上浮而出现阴竭阳亡。另外，因阴虚内热，
津液耗损，则血脉涩滞而成血瘀。其主要病位在肺、胃
（脾）、肾，尤其与肾的关系最为密切。治疗消渴，以清
热润燥、养阴生津为基本治则，对上、中、下消有侧重润
肺、养胃（脾）、益肾之别。辨证时注意对其病位、标本
及本证与并发症的辨别。由于消渴易发生血脉瘀滞，阴损
及阳的病变，及发生多种并发症，故应注意及时发现、诊
断和治疗。同时注意生活调摄，控制饮食，舒畅情志，方
能使患者早日康复。
• Wasting-thirst disease is a chronic disease characterized by polydipsia,
polyphagia, and polyuria. The causes of Wasting-thirst disease are
insufficient of endowments, Emotional imbalance, improper diet and
tiredness. The pathogenesis is loss of Yin fluid causing dry heat exuberant,
Yin deficiency as root cause, dry-heat as secondary cause. Prolonging the
disease will further cause both Qi Yin deficiency or Yin Yang deficiency.
Due to Zang and Fu organ deficient and weak, it often cause the changing
of the syndrome, in serious condition will cause Yin Fluid overly deficient,
floating of Yang asthenia resulting Yin weak Yang (die). Other than that,
due to Yin deficiency inner heat, Fluid over used, causing blood meridian
stagnant resulting blood stasis. The main location of this disease is at Lung,
Stomach (Spleen) and Kidney, particularly Kidney has the closet relation in
this disease. The basic ways to cure Wasting-thirst disease is to clear heat
moisten the dryness, tonify Yin and restore fluid, for upper, middle and
lower, is to moisten Lung, tonify Stomach (spleen) and tonify Kidney
respectively. During syndrome differentiation, the locations, root cause and
symptoms, the actual syndrome and the symptoms that happen together
should pay more attention towards it. Wasting-thirst disease occurs in
blood meridian stagnant, Yang weak due to Yin and many other symptoms
will occur, therefore, be aware of the time when find out, diagnose and cure.
At the same time, take care for a balance lifestyle, control diet and let the
emotion flow smoothly can help to recover fast in the disease.
 习 题
• 1、什么是消渴？What is wasting-thirst?
2、消渴的原因有哪些？
What is the cause of wasting-thirst?
3、如何治疗消渴 ？
How to treat wasting-thirst?
4、消渴分几型，分别采用哪些治疗方法？
How many types of wasting-thirst, and
each of them use what type of treatment?
 病例1
男，64岁。患者平喜食肥肉及糖类，嗜酒量大，口渴多饮多尿，诊断为糖尿病10余年，每
餐控制饮食。近1个月出现神倦乏力，全身肌肉消瘦，遂来诊。自诉头昏心慌，善渴易饥，
每日小便十余次，面目浮肿，全身肌肉酸痛。舌红干，苔薄微黄，脉浮数。尿糖(++++)，
空腹血糖14.2mmol/L。
Male, 64 years old. Patient likes to eat fatty meat and sweets, consume excessive
amount of alcohol, thristy with polydipsia and polyuria, diagnosed with diabetes
for 10 years, each meal is controlled. One month recently appears tired and lack of
strength, emaciated body, come for check up. Complain dizziness and nervous,
easy thirsty and hungry, urine ten times more per hour, face swollen, sour pain of
the whole body muscle. Tongue red dry with thin light yellow coating, pulse float
rapid. Urine sugar (++++), blood glucose with empty stomach 14.2mmol/L

• 中医诊断：消渴(肺胃津伤，燥热内生)；
• 治法为清热止渴；
• 方用白虎加人参汤或玉液汤。
• 处方：
白虎加人参汤(石膏、知母、人参、甘草、粳米) 或
玉液汤(黄芪、葛根、山药、天花粉、五味子、鸡内金)。
Diagnosis: wasting-thirst ( Lung stomach fluid injured, dry heat grow from inner)
Treatment: clear heat and stop thirsty
Formula: Bai Hu Jia Ren Shen Tang or Yu Ye Tang
Prescription: Bai Hu Jia Ren Shen Tang (shi gao, zhi mu, ren sheng, gan cao, jing
mi); Yu Ye Tang (huang qi, ge geng, shan yao, tian hua fen, wu wei zi, ji nei jing)
 病例2
李某，男，30岁。患者有糖尿病3年，常服消渴丸， 空腹血糖7.8mmol/L。 平素喜喝饮
料及肥甘之物。刻见：善食易饥，口干口渴，汗出，四肢乏力，形体消瘦，大便干燥。舌
红苔薄，脉细。
Lee, Male, 30 years old. Patient has diabetes for 3 years, always take Xiao Ke Wan,
empty stomach blood glucose 7.8mmol/L. usually likes to drink drinks and eat
fatty food. Symptoms: polyphagia easy hungry, dry mouth and thirsty, sweating,
lack of strength in the four extremeties, emaciation, dry stoll. Tongue red thin
coating, pulse thin.
• 中医诊断：消渴(气阴两虚) ；
• 治法为益气养阴生津；
• 方用生脉散合六味地黄丸。
• 处方：
党参、黄芪各15g，地锦草20g，生石膏30g，五味子、
麦冬、知母各10g，怀山药30g，枸杞子10g，苍术15g，
半夏10g，甘草6g，玄参、生地黄各10g
Diagnose: waste-thirst (Qi Yin deficient)
Treatment: tonify Qi nourish Yin and promote fluid
Formula: Sheng Mai San and Lui Wei Di Huang Wan
Prescription:
Dang shen, huang qi 15g, di mian cao 20g, sheng shi gao 30g, wu wei zi, mai dong,
zhi mu each 10g, huai shan yao 30g, gou ji zi 10g, chang shu 15g, ban xia 10g,
gan cao 6g, xuan shen, sheng di huang each 10g