寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

Wasting-Thirst

Sogal

한글 소갈  ·  Pinyin Xiao Ke

the Donguibogam chapter in translation — origin, signs, pulse, and the three wastings

消渴

Modern correspondence: diabetes mellitus · polydipsia–polyphagia–polyuria syndromes

This page presents the opening sections of the Donguibogam's Sogal chapter in full, each passage in three registers: the original text, an English translation, and a clinical note. Formula names link to their pages in this site's formula database. Further sections of the chapter — food wasting, transmutations, incurable signs, prohibitions, and the forty simple medicinals — will be added in order.

Origin of wasting-thirst 消渴之源

內經曰, 二陽結謂之消. 註曰, 二陽結, 謂胃及大腸俱熱結也. 腸胃藏熱, 則喜消水穀也.

The Inner Classic says: "Bind of the two yang is called wasting (消)." The annotation states: bind of the two yang means heat bind in both the stomach and the large intestine. When the intestines and stomach store heat, water and grain are readily consumed.

Naegyeong 內經 (Suwen)

手陽明大腸, 主津液. 所生病, 熱則目黃口乾, 是津液不足也. 足陽明胃, 主血. 所生病, 熱則消穀善飢, 血中伏火, 是血不足也. 結者, 津液不足, 結而不潤, 皆燥熱爲病也. 《東垣》

The hand yang brightness large intestine governs liquids (津液); among the diseases it engenders, heat causes yellowing of the eyes and dryness of the mouth — this is insufficiency of liquids. The foot yang brightness stomach governs the blood; among the diseases it engenders, heat causes swift digestion with rapid hungering (消穀善飢), with fire lying latent in the blood — this is insufficiency of blood. "Bind" means that liquid and humor are insufficient, bound and unable to moisten. All of this is disease of dryness-heat.
Clinical note The chapter opens not with the kidney but with yang brightness heat — a gastro-intestinal fire model. Swift digestion with rapid hungering is the classical description of polyphagia; the dry mouth, of polydipsia. Dongwon's dryness-heat framing underlies the whole chapter's therapeutic logic: clear heat, engender fluids, never dry the patient further.

Dongwon 東垣 — Li Dongyuan

消者, 燒也. 如火烹燒物理者也. 《入門》

"Wasting" (消) means burning (燒) — the same principle as fire boiling and scorching things.
Clinical note An etymological gloss: the disease name encodes the pathomechanism. The patient's fluids and flesh are literally cooked off — the reason for the English rendering wasting-thirst.

Immun 入門 — Introduction to Medicine

心移寒於肺爲肺消, 肺消者, 飮一溲二, 死不治. 註曰, 金受火邪, 肺藏消爍, 氣無所持, 故飮一而溲二也. 《內經》

When the heart shifts cold to the lung, this becomes lung wasting (肺消). In lung wasting, one drinks one part and urinates two; it is fatal and cannot be treated. The annotation states: metal receives the fire evil, the lung viscus is wasted and seared, and the qi has nothing by which to hold the fluids — hence one drinks one and urinates two.
Clinical note Output exceeding intake marks total failure of qi transformation. The chapter's incurable-signs section draws the line here: urine equal to intake is still treatable (the Kidney Qi Pill pattern); urine exceeding intake is beyond reach. Clinically evocative of severe osmotic diuresis and of diabetes insipidus.

Naegyeong 內經 — Suwen, Qijue lun 氣厥論

心移熱於肺, 傳爲膈消. 註曰, 心肺兩間中, 有斜膈膜, 膈膜下際, 內連於橫膈膜. 故心熱入肺, 久久傳化, 內爲膈熱, 消渴而多飮也. 《內經》

When the heart shifts heat to the lung, it is transmitted and becomes diaphragm wasting (膈消). The annotation states: between the heart and lung there lies an oblique diaphragmatic membrane, whose lower border connects internally with the transverse diaphragm. Thus heart heat enters the lung and, transforming over a long time, becomes internal diaphragm heat — wasting-thirst with copious drinking.
Clinical note Diaphragm wasting is the chapter's anatomically-argued synonym for upper wasting, used in the indications of Insamseokgo-tang 人蔘石膏湯 and Maekmundong-eumja 麥門冬飮子. The heart-to-lung heat model is why upper-wasting formulas pair heart-clearing medicinals with lung-moistening ones.

Naegyeong 內經

癉成爲消中. 註曰, 癉謂消熱病也. 多飮數溲, 謂之熱中, 多食數溲, 謂之消中. 《內經》

"Dan (癉) becomes center wasting (消中)." The annotation states: dan means a wasting heat disease. Copious drinking with frequent urination is called heat center (熱中); copious eating with frequent urination is called center wasting (消中).
Clinical note A terminological key for the whole chapter: heat center is the polydipsia-dominant form, center wasting the polyphagia-dominant form; both share polyuria.

Naegyeong 內經 — Suwen, Maiyao jingwei lun 脈要精微論

凡消癉, 肥貴人, 則膏粱之疾也. 此人因數食甘美而多肥, 故其氣上溢, 轉爲消渴. 註曰, 食肥則腠理密, 而陽氣不得外泄, 故肥令人內熱. 甘者, 性氣和緩而發散逆, 故甘令人中滿. 然內熱則陽氣炎上, 炎上則欲飮而嗌乾. 中滿則陽氣有餘, 有餘則脾氣上溢, 故轉爲消渴. 《內經》

All wasting dan in the plump and noble is a disease of rich food (膏粱之疾). Such persons habitually eat sweet, fine foods and grow fat; hence their qi spills upward and turns into wasting-thirst. The annotation states: eating fatty foods makes the interstices dense, so yang qi cannot discharge outward — hence fat makes a person hot inside. The sweet flavor is by nature harmonious and relaxing and it counters effusion and dispersion — hence sweetness makes a person full in the center. With internal heat, yang qi flames upward; flaming upward, one desires to drink and the throat is dry. With central fullness, yang qi is superabundant; being superabundant, spleen qi spills upward — hence it turns into wasting-thirst.
Clinical note The classical etiology passage most cited in modern literature on diabetes in East Asian medicine: a diet-induced disease of affluence, described four centuries before the term metabolic syndrome. The mechanism is double — fat traps yang qi inside, sweet stagnates the middle. This passage licenses dietary counseling as etiological treatment, not adjunct.

Naegyeong 內經 — Suwen, Qibing lun 奇病論

喜渴者, 由心熱也. 心主便汗, 便汗出多則腎中虛燥, 故令渴. 凡夏月渴而汗出多, 則小便少, 冬月不汗, 故小便多, 皆平人之常也. 《聖惠》

Frequent thirst arises from heart heat. The heart governs urine and sweat; when urine and sweat issue copiously, the interior of the kidney becomes vacuous and dry, and thus thirst arises. In summer, when one is thirsty and sweats much, the urine is scant; in winter one does not sweat, so the urine is copious — both are the norm in healthy people.
Clinical note A physiological control: the seasonal trade-off between sweat and urine is normal. Sogal is diagnosed only when thirst, drinking, and urination escape this homeostatic reciprocity.

Seonghye 聖惠 — Taiping shenghui fang

Signs and patterns 消渴形證

渴病有三, 曰消渴, 曰消中, 曰消腎. ○熱氣上騰, 心虛受之, 心火散漫, 不能收斂, 胸中煩燥, 舌赤脣紅. 此渴, 引飮常多, 小便數而少, 病屬上焦, 謂之消渴.

There are three thirst diseases: wasting-thirst (消渴), center wasting (消中), and kidney wasting (消腎). — When heat qi soars upward and a vacuous heart receives it, heart fire diffuses and cannot be gathered in: vexation and agitation in the chest, red tongue, red lips. The thirst draws constant, copious drinking; urination is frequent but scant. The disease belongs to the upper burner and is called wasting-thirst.

Jikji 直指 — Renzhai zhizhi fang

熱蓄於中, 脾虛受之, 伏陽蒸胃, 消穀善飢, 飮食倍常, 不生肌肉. 此渴, 亦不甚煩, 小便數而甛, 病屬中焦, 謂之消中.

When heat amasses in the center and a vacuous spleen receives it, latent yang steams the stomach: swift digestion with rapid hungering, food intake double the norm, yet no flesh is engendered. The thirst here is not severely vexing; urination is frequent and the urine sweet. The disease belongs to the middle burner and is called center wasting.
Clinical note Sweet urine (小便甛) as a pattern-defining sign — one of the clearest premodern descriptions of glycosuria, here diagnostic for the middle-burner form.

Jikji 直指

熱伏於下, 腎虛受之, 腿膝枯細, 骨節痠疼, 精走髓虛, 引水自救, 飮水不多, 隨卽尿下, 小便多而濁. 病屬下焦, 謂之消腎.

When heat lies latent below and a vacuous kidney receives it: the thighs and knees wither and grow thin, the joints ache with soreness, essence drains away and the marrow is vacuous, so the body draws in water to rescue itself. One does not drink much, yet what is drunk passes at once as urine; the urine is copious and turbid. The disease belongs to the lower burner and is called kidney wasting.
Clinical note Wasting thighs and knees, aching joints, and copious turbid urine like grease read as long-standing diabetes with sarcopenia and nephropathy — the chapter's most advanced ordinary stage.

Jikji 直指

自消腎而析之, 又有服五石過度之人, 眞氣旣盡, 石勢獨留, 陽道興强, 不交精泄, 謂之强中. 消渴輕也, 消中甚焉, 消腎又甚焉. 若强中則其斃, 可立待也. 《直指》

Analyzing further beyond kidney wasting: in those who have taken the five mineral elixirs to excess, true qi is exhausted while the mineral force alone remains; the yang member stands persistently erect, and semen discharges without intercourse — this is called rigid center (强中). Wasting-thirst is the mildest; center wasting more severe; kidney wasting more severe still. With rigid center, death may be awaited standing.
Clinical note The four-step severity ladder — sogal, sojung, sosin, gangjung — is the chapter's prognostic spine. Rigid center is a historical iatrogenic pattern from mineral-elixir toxicity; the chapter treats it with Hwangryeonjeodu-hwan 黃連猪肚丸 among others.

Jikji 直指

上消者, 肺也. 又謂之膈消, 多飮水而少食, 大便如常, 小便淸利. 中消者, 胃也. 渴而飮食多, 小便赤黃. 下消者, 腎也. 小便濁淋, 如膏油之狀, 面黑耳焦而形瘦. 《易老》 ○渴而多飮爲上消, 消穀善飢爲中消, 渴而尿數有膏油爲下消. 《綱目》

Upper wasting pertains to the lung and is also called diaphragm wasting: copious drinking with little eating; stool normal; urine clear and uninhibited. Middle wasting pertains to the stomach: thirst with copious eating and drinking; urine red-yellow. Lower wasting pertains to the kidney: urine turbid and dribbling, like grease or oil; the face blackens, the ears become scorched, and the body grows thin. — Thirst with copious drinking is upper wasting; swift digestion with rapid hungering is middle wasting; thirst with frequent urine containing grease is lower wasting.
Clinical note The one-line differential: polydipsia — upper; polyphagia — middle; polyuria with turbid or greasy urine — lower.

Yiro 易老 — Zhang Yuansu · Gangmok 綱目

五藏六府皆有津液, 熱氣在內, 則津液竭少, 故爲渴. 夫渴者數飮水, 其人必頭目眩, 背寒而嘔, 皆因裏虛故也. 《類聚》 ○飮水而安睡者, 實熱也. 飮水少傾卽吐者, 火邪假渴耳. 《入門》

The five viscera and six bowels all possess liquid and humor. When heat qi is inside, liquid and humor are exhausted and diminished, hence thirst arises. Now, one who thirsts drinks water frequently; such a person will surely have dizzy head and eyes, a cold back, and retching — all owing to interior vacuity. — One who drinks water and then sleeps peacefully has repletion heat. One who drinks water and vomits it moments later has a fire evil with false thirst.
Clinical note A bedside test for false thirst: water immediately vomited indicates rebelling fire evil, not true fluid desertion — do not treat as sogal.

Yuchwi 類聚 · Immun 入門

Pulse 脉法

消渴, 脉實大, 病久可治, 脉懸小堅, 病久不可治. 《內經》 ○消渴, 脉當得緊實而數, 反得沈濇而微者死. 《難經》 ○消渴脉數大者活, 細小浮短者死. 《脉訣》

In wasting-thirst, if the pulse is replete and large, the disease, though enduring, can be treated; if the pulse is suspended, small, and hard, an enduring disease cannot be treated. — In wasting-thirst the pulse ought to be tight, replete, and rapid; if instead it is sunken, rough, and faint, death. — A rapid, large pulse lives; fine, small, floating, and short dies.

Naegyeong 內經 · Nangyeong 難經 · Maekgyeol 脉訣

心脉滑爲渴, 滑者, 陽氣勝也. ○心脉微小爲消癉. ○脉數大者生, 沈小者死. 《脉經》 ○心脉滑甚爲喜渴. 《聖惠》

A slippery heart pulse means thirst — slipperiness is the prevailing of yang qi. A faint, small heart pulse means wasting dan. A rapid, large pulse lives; a sunken, small one dies. — An extremely slippery heart pulse means frequent thirst.

Maekgyeong 脉經 · Seonghye 聖惠

趺陽脉數, 胃中有熱. 卽消穀引飮, 大便必堅, 小便卽數. 《仲景》 ○消渴, 脉宜數大, 忌虛小. 《醫鑑》

When the instep yang (趺陽) pulse is rapid, there is heat in the stomach: swift digestion and drawing in of drink; the stool will surely be hard and the urine frequent. — In wasting-thirst the pulse should be rapid and large; a vacuous, small pulse is to be feared.
Clinical note The prognostic logic is uniform across all six sources: a pulse that matches a heat-repletion pattern (rapid, large, replete, slippery) means right qi still contends — treatable; a pulse contrary to it (sunken, faint, small, short) means right qi has deserted while the disease persists — grave. Zhongjing's instep-yang line is the pulse correlate of middle wasting and the direct license for purgation with Jowiseunggi-tang 調胃承氣湯.

Jungyeong 仲景 — Zhang Zhongjing · Uigam 醫鑑

The three kinds of wasting-thirst 消渴有三

上消者, 舌上赤裂, 大渴引飮, 膈消是也. 白虎加人參湯主之. 卽人參白虎湯也. 方見寒門. 治能食而渴. 若不能食而渴, 宜加味錢氏白朮散. 又麥門冬飮子ㆍ降心湯ㆍ人參石膏湯ㆍ淸心蓮子飮ㆍ和血益氣湯ㆍ生津養血湯ㆍ黃芩湯, 皆治上消.

Upper wasting: the tongue is red and cracked, with great thirst drawing in drink — this is diaphragm wasting. Baekhogainsam-tang 白虎加人蔘湯 governs it — i.e., Insambaekho-tang; formula in the Cold Damage chapter — treating those who can eat and thirst. If one cannot eat and thirsts, Gamijeonssibaekchul-san 加味錢氏白朮散 is appropriate. Further, Maekmundong-eumja 麥門冬飮子, Gangsim-tang 降心湯, Insamseokgo-tang 人蔘石膏湯, Cheongsimyeonja-eum 淸心蓮子飮, Hwahyeolikgi-tang 和血益氣湯, Saengjinyanghyeol-tang 生津養血湯, and Hwanggeum-tang 黃芩湯 all treat upper wasting.
Clinical note Appetite is the fork in upper wasting. Can eat and thirst — White Tiger plus Ginseng: drain blazing qi-level heat while ginseng protects fluids. Cannot eat and thirst — the augmented Baekchul-san: fortify the spleen and engender fluids, because heat-clearing alone would collapse an already-failing stomach qi. This can-eat / cannot-eat rule is the chapter's central safety principle.

Donguibogam · Sogal

中消者, 善食而瘦, 自汗, 大便硬, 小便數. 所謂癉成爲消中者, 是也. 調胃承氣湯 方見寒門ㆍ加減三黃丸 方見火門, 主之. 又蘭香飮子ㆍ生津甘露湯ㆍ順氣散ㆍ人參散ㆍ黃連猪肚丸ㆍ藕汁膏, 皆可用.

Middle wasting: eats well yet grows thin, with spontaneous sweating, hard stool, and frequent urination — this is what is meant by "dan becomes center wasting." Jowiseunggi-tang 調胃承氣湯 — formula in the Cold Damage chapter — and Gagamsamhwang-hwan 加減三黃丸 — formula in the Fire chapter — govern it. Further, Nanhyang-eumja 蘭香飮子, Saengjingamno-tang 生津甘露湯, Sungi-san 順氣散, Insam-san 人參散, Hwangryeonjeodu-hwan 黃連猪肚丸, and Ujeup-go 藕汁膏 may all be used.
Clinical note Middle wasting is the only purgation-licensed pattern of the three, and only on the Zhongjing pulse-and-stool evidence above. The chapter's transmutation section warns that over-aggressive cold purgation here creates central fullness and drum distension — short, decisive use, then step down. Ujeup-go 藕汁膏, a lotus-juice paste taken on the tongue, is recorded without quantities: white lotus-root juice and raw rehmannia juice with cow's milk, coptis and trichosanthes powder, ginger juice and honey, formed into a paste and let down with hot water three or four times a day.

Donguibogam · Sogal

下消者, 煩燥引飮, 耳輪焦乾, 小便如膏, 腿膝枯細, 所謂焦煩水易虧者, 是也. 六味地黃丸 方見虛勞 主之. 又宜人參茯苓散ㆍ加減八味元 方見五藏ㆍ加減腎氣丸ㆍ補腎地黃元ㆍ鹿茸丸. 《諸方》

Lower wasting: vexation and agitation with drawing in of drink, the ear rims scorched and dry, urine like grease, the thighs and knees withered and thin — this is what is meant by "with scorching vexation, water is easily depleted." Yukmijihwang-hwan 六味地黃丸 — formula in the Vacuity Taxation chapter — governs it. Also appropriate: Insambokryeong-san 人蔘茯苓散, Gagampalmi-won 加減八味元 — formula in the Five Viscera chapter —, Gagamsingi-hwan 加減腎氣丸, Bosinjihwang-won 補腎地黃元, and Nokyong-hwan 鹿茸丸.

Various formularies 諸方

養肺降火生血爲主, 分上中下治之. 《丹心》 ○三消多屬血虛不生津液, 宜以四物湯爲主. 治上消, 加人參ㆍ五味子ㆍ麥門冬ㆍ天花粉, 煎入牛乳汁ㆍ生地黃汁ㆍ生藕汁, 酒客生葛根汁, 調服. ○中消, 加知母ㆍ石膏ㆍ寒水石ㆍ滑石. ○下消, 加黃柏ㆍ知母ㆍ熟地黃ㆍ五味子. 《丹心》

Take nourishing the lung, downbearing fire, and engendering blood as the governing principles, treating according to the division into upper, middle, and lower. — The three wastings mostly belong to blood vacuity failing to engender liquid and humor; Samul-tang 四物湯 should serve as the base. For upper wasting, add ginseng, schisandra, ophiopogon, and trichosanthes root, decocting with cow's milk, fresh rehmannia juice, and fresh lotus-root juice; for habitual drinkers, mix in fresh kudzu-root juice. For middle wasting, add anemarrhena, gypsum, glauberite, and talcum. For lower wasting, add phellodendron, anemarrhena, prepared rehmannia, and schisandra.
Clinical note Danxi's blood-vacuity reframe: Samul-tang as chassis with burner-specific additions, plus a juice-decoction delivery — milk, raw rehmannia, lotus root, kudzu for drinkers — that is a fluid-engendering strategy in its own right. His one-line method statement summarizes the whole chapter.

Dansim 丹心 — Zhu Danxi

消渴病, 小便反多, 如飮水一斗, 小便亦一斗, 腎氣丸 方見虛勞 主之. 《仲景》

In wasting-thirst disease the urine is paradoxically copious — as when one drinks one du of water and urinates likewise one du — the Kidney Qi Pill (Palmijihwang-hwan 八味地黃丸 lineage) governs it.
Clinical note The Zhongjing exception: when polyuria is equal to intake with an otherwise cold-vacuous lower burner, warm and secure rather than clear heat — the yang-vacuity variant of lower wasting, elaborated in this chapter by Gagamsingi-hwan. Distinguish carefully from drinking one and urinating two, which the chapter classes as incurable.

Jungyeong 仲景 — Jingui yaolüe

Food wasting 食㑊證

內經曰, 大腸移熱於胃, 善食而瘦, 又謂之食㑊. ○胃移熱於膽, 亦曰食㑊. 註曰, 㑊, 易也. 飮食移易而過, 不生肌膚也. 治法與消中同. 《綱目》

The Inner Classic says: when the large intestine shifts heat to the stomach, one eats well yet grows thin — this is also called food wasting (食㑊). When the stomach shifts heat to the gallbladder, this too is called food wasting. The annotation states: yi (㑊) means to shift past — food and drink shift through and pass without engendering flesh and skin. The treatment method is the same as for center wasting.
Clinical note Polyphagia with weight loss but without the thirst — the chapter files it as a variant of the middle-burner pattern and sends it to the center-wasting formulas.

Naegyeong 內經 · Gangmok 綱目

The sweetness of the urine 消渴小便甛

消渴者, 腎虛所致, 每發則小便必甛. 以物理推之, 淋餳醋酒作脯法, 須臾卽甛, 足明人之食後, 滋味皆甛, 流在膀胱. 若腰腎氣盛, 則上蒸炎氣, 化成精氣, 下入骨髓, 其次爲脂膏, 又其次爲血肉, 其餘則爲小便. 故小便色黃, 血之餘也. 五藏之氣醎潤者, 則下味也. 若腰腎旣虛冷, 則不能蒸化穀氣, 盡下爲小便. 故味甘, 不變其色, 淸冷則肌膚枯槁也. 《本事》

Wasting-thirst arises from kidney vacuity, and whenever it flares, the urine is invariably sweet. Reason it out from the nature of things: in the method of curing meat with malt syrup, vinegar, and wine, the sweetness appears in moments — proof enough that after a person eats, the flavors all turn sweet and flow into the bladder. When the qi of the lumbus and kidney is exuberant, it steams upward as flaming qi, transforms into essential qi, and descends into the bones and marrow; what is next becomes fat and grease; next after that, blood and flesh; and only the remainder becomes urine — hence urine is yellow, being the surplus of the blood. But when the lumbus and kidney are already vacuous and cold, they cannot steam and transform the grain qi, and it all descends as urine. Hence the taste is sweet, the color unchanged, the urine clear and cold — and the flesh withers.
Clinical note The chapter's fullest account of glycosuria, complete with a proposed mechanism: sweetness in the urine is nutriment that failed to be transformed. Note the reversal — here the sweet urine argues for a cold, vacuous kidney failing to steam, not for heat; the passage is the doctrinal bridge to the warming strategy of the Kidney Qi Pill lineage.

Bonsa 本事 — Puji benshi fang

Wasting-thirst as failure of the fire below 消渴由坎火衰少

肺爲五藏華盖, 若下有煖氣蒸則肺潤, 若下冷極則陽不能升, 故肺乾而渴. 易乾上坤下, 其卦爲否, 陽無陰不降, 陰無陽不升, 故成否也. 譬如釜中有水, 以火煖之, 又以板覆, 則煖氣上騰, 故板能潤. 若無火力, 則水氣不能上升, 此板終不得潤. 火力者, 腰腎强盛, 常須煖補腎氣. 飮食得火力則潤上而易消, 亦免乾渴之患. 宜服八味腎氣丸. 卽八味元, 加五味子也. 《本事》

The lung is the flowered canopy of the five viscera. If warm qi steams from below, the lung is moistened; if the cold below is extreme, yang cannot rise, and so the lung dries and thirsts. In the Changes, Heaven above and Earth below form the hexagram Pi (否, Obstruction): yang without yin cannot descend, yin without yang cannot ascend — hence the blockage. It is like water in a cauldron: warm it with fire and cover it with a board, and the warm qi rises, so the board grows moist; but without the fire's force, the water qi cannot ascend, and the board never moistens. The fire's force is the strength of the lumbus and kidney — one must constantly warm and supplement kidney qi. When food and drink meet the fire's force, moisture rises and digestion is easy, and the affliction of dry thirst is avoided. The Eight-Ingredient Kidney Qi Pill is appropriate — i.e., Palmi-won with schisandra added.
Clinical note The cauldron-and-board analogy is the classical argument for treating a thirst disease with warming medicine: some thirst is not too much fire but too little — steam failure, not flame excess. Together with the sweet-urine passage above, it completes the yang-vacuity minority report against the chapter's dominant heat doctrine, and underwrites Palmijihwang-hwan 八味地黃丸 and Gagamsingi-hwan 加減腎氣丸.

Bonsa 本事

Wasting-thirst and leg qi as opposites 消渴與脚氣相反

消渴脚氣, 皆腎虛所致, 而爲病相反. 脚氣發於二三月, 盛於五六月, 衰於七八月. 消渴發於七八月, 盛於十一十二月, 衰於二三月. 其故何也. 脚氣, 壅疾也. 消渴, 宣疾也. 春夏陽氣上, 故壅疾發則宣疾愈, 秋冬陽氣下, 故宣疾發則壅疾愈. 審此二者, 疾可理也. 《本事》

Wasting-thirst and leg qi both arise from kidney vacuity, yet as diseases they are opposites. Leg qi arises in the second and third months, peaks in the fifth and sixth, and wanes in the seventh and eighth; wasting-thirst arises in the seventh and eighth months, peaks in the eleventh and twelfth, and wanes in the second and third. Why? Leg qi is a disease of congestion; wasting-thirst is a disease of drainage. In spring and summer yang qi rises — so the congesting disease flares while the draining disease heals; in autumn and winter yang qi descends — so the draining disease flares while the congesting one heals. Examine these two, and the illnesses can be managed.
Clinical note A seasonal epidemiology argument: one vacuous kidney, two opposite diseases, sorted by the annual rise and fall of yang. Clinically it reads as a reminder that sogal typically worsens through autumn and winter — a scheduling insight for treatment intensity.

Bonsa 本事

Formulas that treat wasting-thirst generally 消渴通治藥

宜滋陰養榮湯ㆍ活血潤燥生津飮ㆍ桑白皮湯ㆍ梅花湯ㆍ大黃甘草飮子ㆍ淸神補氣湯ㆍ黃芪湯ㆍ天花散ㆍ黃連地黃湯ㆍ生地黃飮子ㆍ門冬飮子ㆍ玉泉散ㆍ玄菟丹ㆍ三消丸ㆍ玉泉丸ㆍ五汁玉泉丸ㆍ生地黃膏ㆍ荔枝膏ㆍ衛生天花元. 《諸方》

Appropriate are Jaeumyangyeong-tang 滋陰養榮湯, Hwalhyeolyunjosaengjin-eum 活血潤燥生津飮, Sangbaekpi-tang 桑白皮湯, Maehwa-tang 梅花湯, Daehwanggamcho-eumja 大黃甘草飮子, Cheongsinbogi-tang 淸神補氣湯, Hwanggi-tang 黃芪湯, Cheonhwa-san 天花散, Hwangryeonjihwang-tang 黃連地黃湯, Saengjihwang-eumja 生地黃飮子, Mundong-eumja 門冬飮子, Okcheon-san 玉泉散, Hyeonto-dan 玄菟丹, Samso-hwan 三消丸, Okcheon-hwan 玉泉丸, Ojeupokcheon-hwan 五汁玉泉丸, Saengjihwang-go 生地黃膏, Yeoji-go 荔枝膏, and Wisaengcheonhwa-won 衛生天花元.
Clinical note The chapter's general-treatment cabinet, nineteen formulas deep — and now complete: every name opens its full page in this site's formula database, from the Jade Spring pills of the fluid-engendering tradition to the mineral maximalism of the Life-Guarding pill.

Various formularies 諸方

Drinker's thirst 酒渴

治嗜酒積熱, 津液枯燥, 煩渴引飮, 專嗜冷物. 宜龍鳳元ㆍ烏梅木瓜湯ㆍ五豆湯ㆍ酒蒸黃連丸 方見暑門ㆍ朱砂黃連元. 《得效》

Treats accumulated heat from love of wine: liquid and humor parched, vexing thirst drawing in drink, and an exclusive craving for cold things. Appropriate are Yongbong-won 龍鳳元, Omaemogwa-tang 烏梅木瓜湯, Odu-tang 五豆湯, Jujeunghwangryeon-hwan 酒蒸黃連丸 — formula in the Summerheat chapter — and Jusahwangryeon-won 朱砂黃連元.
Clinical note Alcohol as its own etiology of wasting-thirst — and now a fully navigable one: from the kidney-rebuilding Yongbong-won to the household-scale Five Beans brew, each answer to the drinker's thirst opens to its complete formula page.

Deukhyo 得效

Worm thirst 蟲渴

蟲在藏府, 耗其津液而成消渴, 宜苦練湯. 《得效》

When worms in the viscera and bowels wear away the liquid and humor, wasting-thirst forms. Goryeon-tang 苦練湯 (chinaberry-root decoction) is appropriate.
Clinical note A parasitic differential for polydipsia — thirst from fluid loss to intestinal worms, answered with an anthelmintic rather than a heat-clearing formula. The case record attached in the source describes worms expelled and the thirst resolving.

Deukhyo 得效

Rigid center 强中證

强中證, 多因耽嗜色慾, 或服丹石. 眞氣旣脫, 熱邪獨盛, 飮食如湯消雪, 肌膚日削, 小便如膏油, 陽强興盛, 不交精出, 三消之中, 最爲難治. 姑錄一二方, 以備裁擇.

Rigid center (强中證) arises mostly from indulgence in sexual desire, or from taking elixir minerals. Once true qi has deserted, the heat evil alone exuberates: food and drink vanish like snow in hot water, the flesh is pared away by the day, the urine is like grease, the yang member stands persistently erect, and essence issues without intercourse. Of the three wastings this is the hardest of all to treat; one or two formulas are recorded here merely to have something at hand.
Clinical note The terminal pattern of the severity ladder, treated with resignation even by the compilers — 'merely to have something at hand.' The paired formulas use pig's kidney and pig's stomach as vessels (the Hwangryeonjeodu-hwan 黃連猪肚丸 method), anchoring massive heat-clearing in flesh-and-broth nourishment.

Donguibogam · Sogal

Transmutations, abscess prevention, and incurable signs 傳變ㆍ癰疽ㆍ不治

消渴之疾, 末傳能食者, 必發腦疽背瘡, 不能食者, 必傳中滿鼓脹, 皆爲不治之證. 張潔古老人分而治之, 能食而渴者, 白虎加人參湯, 不能食而渴者, 錢氏白朮散 方見小兒 倍加葛根.

When wasting-thirst reaches its late transmission: those who can still eat will develop brain abscess or back sores; those who cannot eat will pass into central fullness and drum distension — both incurable signs. The elder Zhang Jie-gu divided the treatment: for those who can eat and thirst, Baekhogainsam-tang 白虎加人蔘湯; for those who cannot eat and thirst, Qian's Baekchul-san — formula in the Pediatrics chapter — with kudzu root doubled.
Clinical note The can-eat / cannot-eat fork returns as prognosis: the same divide that chose the formula now predicts the manner of death — outward to abscess if the stomach holds, inward to drum distension if it fails. The transmutation section adds the warning that over-aggressive cold purgation of upper and middle wasting causes the distension it fears.

Donguibogam · Sogal

此方有五味子, 最爲得力, 不惟止渴, 亦免生癰疽. 久服永除渴疾, 氣血加壯.

This formula's schisandra is what gives it its strength: it not only stops the thirst but averts the arising of welling- and flat-abscesses. Taken long, it removes the thirst illness forever, and qi and blood grow the stronger.
Clinical note Abscess prevention as a standing treatment goal: the chapter regards suppurative complications — read today, diabetic skin and soft-tissue infections — as the expected late course, to be pre-empted while treating the thirst.

Donguibogam · Sogal — on Gagampalmi-won 加減八味元

治飮水一斗, 小便亦一斗之證. 若小便過於所飮, 則無及矣. 《綱目》

[The Kidney Qi Pill] treats the pattern of drinking one du of water and passing likewise one du of urine. But if the urine exceeds what is drunk, nothing can reach it.
Clinical note The chapter's bright line restated at the end: output equal to intake — treatable, warm and secure; output exceeding intake — beyond medicine. The same arithmetic that opened the chapter in the lung-wasting passage closes it as the incurable sign.

Gangmok 綱目

Prohibitions 禁忌法

消渴病, 所愼者有三. 一飮酒, 二房勞, 三醎食及麪. 能愼此三者, 雖不服藥, 亦可自愈. 《千金》

In wasting-thirst disease there are three things to guard against: first, drinking wine; second, bedroom taxation; third, salty foods and wheat flour. One who can guard these three may recover even without taking medicine.
Clinical note Sun Simiao's thousand-year-old closing argument, and the chapter's: lifestyle before pharmacy. Alcohol, overexertion, and a salt- and refined-flour-heavy diet remain the first counseling targets in metabolic disease — the prescription that outranks every formula above it.

Cheongeum 千金 — Qianjin fang

Simple medicinals 單方

凡四十種. ○石膏. 主消渴. 搗末取五錢, 和粳米煮取汁飮. 《本草》

Forty kinds in all. — Gypsum (石膏): governs wasting-thirst. Pound to a powder, take 5 don, boil with non-glutinous rice, and drink the liquid.

Boncho 本草

竹葉. 止消渴. 取靑葉煮汁飮. 《本草》

Bamboo leaf (竹葉): stops wasting-thirst. Take green leaves, boil, and drink the liquid.

Boncho 本草

滑石. 治消渴. 爲末, 取三錢, 井水或蜜水調下, 卽益元散也. 一名神白散. 《醫鑑》

Talcum (滑石): treats wasting-thirst. Powder it and take 3 don mixed down in well water or honey water — this is none other than Igwon-san 益元散, also called Sinbaek-san 神白散.

Uigam 醫鑑

地漿. 治熱渴心悶. 取一盞, 飮之妙. 《本草》

Earth-water (地漿, water strained from yellow subsoil): treats heat thirst with oppression of the heart. Drink one cup — wondrous.

Boncho 本草

竹瀝. 治消渴. 不拘時恣飮之妙. 雷公云, 久渴心煩, 宜投竹瀝. 《本草》

Bamboo sap (竹瀝): treats wasting-thirst. Drink freely at any time — wondrous. Master Lei says: for long-standing thirst with a vexed heart, bamboo sap is what to give.

Boncho 本草

麥門冬. 治消渴, 及口乾燥渴. 去心煮湯飮之. 《本草》

Ophiopogon (麥門冬): treats wasting-thirst, and dry mouth with parched thirst. Remove the cores, boil, and drink the decoction.

Boncho 本草

黃柏. 主消渴. 水煎服, 或作末水丸服之. 《本草》

Phellodendron (黃柏): governs wasting-thirst. Decoct in water and take, or powder, form into water-bound pills, and take.

Boncho 本草

黃連. 治消渴要藥. 酒浸蒸曬乾爲末, 蜜丸, 白湯下五七十丸. 《綱目》

Coptis (黃連): an essential medicine for wasting-thirst. Soak in wine, steam, sun-dry, and powder; bind with honey into pills and take 50–70 with plain hot water.

Gangmok 綱目

黃芪. 治消渴. 凡消渴而欲發瘡, 或病癰疽而後渴, 宜多取黃芪煮湯服之妙. 《綱目》

Astragalus (黃芪): treats wasting-thirst. Whenever wasting-thirst is about to erupt in sores, or thirst follows a welling- or flat-abscess, boil astragalus generously and take the decoction — wondrous.
Clinical note The abscess-prevention doctrine in single-herb form: astragalus standing guard on the skin of the diabetic patient, four centuries before wound-care protocols.

Gangmok 綱目

葛根. 主消渴. 取五錢水煎飮之. 又取生者, 搗汁飮亦好. 《本草》

Kudzu root (葛根): governs wasting-thirst. Take 5 don, decoct in water, and drink; pounding the fresh root for its juice and drinking that is also good.

Boncho 本草

瓜蔞根. 卽天花粉也. 治消渴之聖藥也. 水煮取汁, 隨意飮之甚佳. 《本草》

Gualou root (瓜蔞根) — that is, trichosanthes root (天花粉): the sagely medicine for treating wasting-thirst. Boil in water and drink the liquid at will — excellent.

Boncho 本草

漬苧汁. 主消渴. 取生苧, 水漬取汁飮之. 《本草》

Ramie-steeping water (漬苧汁): governs wasting-thirst. Steep fresh ramie in water and drink the liquid.

Boncho 本草

地骨皮. 治消渴. 水煎服之. 又取葉作飮, 啜之. 《本草》

Lycium root bark (地骨皮): treats wasting-thirst. Decoct in water and take; the leaves may also be made into a drink and sipped.

Boncho 本草

蚊蛤. 卽五倍子也. 最能回津止渴. 爲末, 沸湯調下二錢, 最妙. 《入門》

Munhap (蚊蛤) — that is, Chinese gall (五倍子): supreme at returning the fluids and stopping thirst. Powder and take 2 don mixed in boiled water — most wondrous.
Clinical note A gall, not a clam, despite the name — the astringent insect gall of the sumac, here deployed as a salivary tourniquet.

Immun 入門

忍冬草. 治消渴. 水煮取汁, 四時長服. 《丹心》

Honeysuckle vine (忍冬草): treats wasting-thirst. Boil in water and take the liquid, continuously through all four seasons.

Dansim 丹心

桑枝茶. 療口乾. 如茶常服爲佳. 《本草》

Mulberry twig tea (桑枝茶): heals dry mouth. Excellent taken regularly, like tea.

Boncho 本草

桑根白皮. 主熱渴. 水煎飮之. ○黑椹, 搗濾去滓, 入石器中, 入蜜熬膏. 每取二三匙, 沸湯點服, 止渴生精神. 《本草》

Mulberry root bark (桑根白皮): governs heat thirst; decoct in water and drink. — Black mulberries (黑椹): pound, strain off the dregs, and simmer with honey in a stone vessel into a paste; take two or three spoonfuls in boiled water — it stops thirst and engenders vitality of spirit.

Boncho 本草

牡蠣肉. 治酒渴. 和薑ㆍ醋, 生食之. 俗名石花. 《本草》

Oyster flesh (牡蠣肉): treats drinker's thirst. Eat raw with ginger and vinegar. Commonly called seokhwa 石花, 'stone-flower.'

Boncho 本草

田螺. 止消渴. 煮食, 或和薑ㆍ醋, 生食幷佳. 《本草》

River snail (田螺): stops wasting-thirst. Boil and eat, or eat raw with ginger and vinegar — both are excellent.

Boncho 本草

鮎魚涎. 主三消. 取涎, 搜黃連末作丸, 烏梅湯下五十丸, 渴頓減. 《本草》

Catfish slime (鮎魚涎): governs the three wastings. Take the slime, knead it with coptis powder into pills, and take 50 with a mume decoction — the thirst abates at once.
Clinical note The chapter's strangest binder: the mucilage of a live catfish as the vehicle for coptis. Premodern pharmaceutics at its most literal — a cold, slippery, fluid-natured animal lending its very coating to a parched patient.

Boncho 本草

生藕. 取汁一盞, 入蜜一合, 分三服. 止渴最好. 《綱目》

Fresh lotus root (生藕): take one cup of its juice with 1 hop of honey, divided into three doses. Best of all for stopping thirst.

Gangmok 綱目

紅柿. 止渴, 取啖之. 《本草》

Ripe persimmon (紅柿): stops thirst; take and eat.

Boncho 本草

烏梅. 療口乾, 止消渴. 作湯和少蜜, 常啜. 《本草》

Mume plum (烏梅): heals dry mouth and stops wasting-thirst. Make a decoction with a little honey and sip constantly.

Boncho 本草

梨. 止消渴. 取消梨, 常常啖之, 最治心熱渴. 《本草》

Pear (梨): stops wasting-thirst. Eat pears constantly — best for thirst from heart heat.

Boncho 本草

獼猴桃. 止消渴. 取霜後熟者, 常啖之. 又和蜜作正果, 尤佳. 《俗方》

Hardy kiwi (獼猴桃, darae): stops wasting-thirst. Eat the fruit ripened after frost, constantly; candied in honey it is finer still.
Clinical note One of the chapter's distinctly Korean entries — the mountain darae, cited not from a Chinese classic but from the domestic folk tradition (俗方).

Sokbang 俗方 — Korean folk formulary

五味子. 止消渴最良. 作飮常啜之. 又作丸久服, 生津止渴. 《本草》

Schisandra (五味子): most excellent at stopping wasting-thirst. Make into a drink and sip constantly, or take long as pills — it engenders fluids and stops thirst.

Boncho 本草

麻仁. 止消渴. 麻仁一升, 擣碎之, 水三升煮取汁, 溫凉任服. 《本草》

Hemp seed (麻仁): stops wasting-thirst. Pound 1 doe of hemp seed, boil in 3 doe of water, and take the liquid warm or cool as one pleases.

Boncho 本草

粟米泔. 酸者, 止消渴甚良. 常取飮之. 泔久留則酸. 《本草》

Millet-washing water (粟米泔): when soured, exceedingly good at stopping wasting-thirst; drink it regularly. The washing water sours when left to stand.
Clinical note Fermented grain-washing water — a live sour beverage from the kitchen, anticipating by centuries the probiotic rice-water folk remedies still in use.

Boncho 本草

菉豆. 治消渴. 煮汁飮之, 或硏取汁服幷佳. 《本草》

Mung bean (菉豆): treats wasting-thirst. Boil and drink the liquid, or grind and take the expressed juice — both excellent.

Boncho 本草

靑粱米. 主熱中, 消渴. 煮取汁飮之, 或煮粥, 或作飯, 常食佳. 《本草》

Green millet (靑粱米): governs heat center and wasting-thirst. Boil and drink the liquid, or cook as porridge or rice and eat regularly.

Boncho 本草

糯米. 主消渴. 淘取泔飮之. 又水硏取白汁, 恣飮之, 以差爲度. ○糯稻稈灰, 淋汁飮之, 甚妙. 一人病渴殆死, 有人敎以糯稻稈斬去穗及根, 取中心, 淨器中燒作灰. 每取一合, 湯水一椀, 沃浸良久, 澄去滓, 取淸頓飮之. 卽取效如神. 《澹寮》

Glutinous rice (糯米): governs wasting-thirst. Rinse it and drink the washing water; or grind with water and drink the white liquid freely, until recovery is the measure. — Glutinous rice-straw ash: its strained liquor is exceedingly wondrous. One man, near death from thirst, was taught to cut glutinous rice straw, discard heads and roots, take the middle sections, and burn them to ash in a clean vessel; steeping 1 hop of the ash in a bowl of hot water, letting it settle, and drinking off the clear liquid at one draught, he recovered as if by a spirit's work.
Clinical note The chapter's one complete case record in the simples section — an alkaline straw-ash lixivium as a last-resort electrolyte draught. Note the dosing endpoint written into the text: drink until recovery, 以差爲度.

Damryo 澹寮 — Danliao fang

冬瓜. 主三消渴. 擣絞取汁飮之. 又作羹作虀, 常食佳. 《本草》

Winter melon (冬瓜): governs the three wasting-thirsts. Pound, wring out the juice, and drink; or make into soup or pickle and eat regularly.

Boncho 本草

蓴. 主消渴. 作羹作虀, 常食佳. 《本草》

Water shield (蓴, sun-chae): governs wasting-thirst. Make into soup or pickle and eat regularly.

Boncho 本草

菘菜. 治消渴. 常食最佳. 或取汁飮亦可. 《本草》

Napa cabbage (菘菜): treats wasting-thirst. Best eaten regularly; drinking its juice is also fine.

Boncho 本草

雄雞湯. 治三消渴疾. 退雄雞湯, 澄淸飮之神效. ○白雄雞尤佳. 《醫鑑》

Rooster broth (雄雞湯): treats the three wasting-thirst illnesses. Drink the clarified broth in which a rooster has been scalded — spirit-like in effect. A white rooster is finer still.

Uigam 醫鑑 · Boncho 本草

白鵝. 主消渴. 煮取汁飮之. 《本草》

White goose (白鵝): governs wasting-thirst. Boil and drink the broth.

Boncho 本草

黃雌雞. 主消渴. 煮熟取汁飮之, 肉亦可食. 《本草》

Yellow hen (黃雌雞): governs wasting-thirst. Boil thoroughly and drink the broth; the flesh may be eaten as well.

Boncho 本草

牛乳. 主消渴. 取生乳, 渴則飮之. 又作酪粥, 常食亦佳. 《本草》

Cow's milk (牛乳): governs wasting-thirst. Take fresh milk and drink whenever thirsty; milk porridge, eaten regularly, is also excellent.

Boncho 本草

猪肚. 止渴利. 爛蒸, 和薑ㆍ醋食之. 《本草》

Pig's stomach (猪肚): stops thirst with disinhibited urination. Steam until soft and eat with ginger and vinegar.
Clinical note The forty simples close where the formulas did — the pig's stomach that carried Hwangryeonjeodu-hwan, here served plainly at the table. The chapter's last word is a meal: by its end, the boundary between prescription and kitchen has fully dissolved.

Boncho 本草

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613), Japbyeongpyeon vol. 6, Sogal chapter, following the collated first-woodblock edition (National Library of Korea copy) established by the Korea Institute of Oriental Medicine, Mediclassics database. Original character forms (脉, 甛, 人參) are retained in the source text. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.