Library

(The *Neijing* states: If a patient does not experience aversion to cold but feels thirsty, this indicates the pathogen has transferred to the Yangming channel. It also states: If thirst occurs after taking Xiao Chai Hu Tang, it belongs to Yangming disease. Therefore, "thirst" is categorized under the Yangmen chapter.)

Cheng Wuji stated: When Shaoyang pathogens transmit inward, thirst occurs; when pathogens remain in the exterior, there is no thirst. Although San Yang channels may occasionally present with thirst, it is not as severe as in San Yin channels. Taiyin disease presents with abdominal fullness and dry throat; Shaoyin disease presents with dry mouth, dry tongue, and thirst; Jueyin disease presents with Xiao Ke (wasting-thirst syndrome). Xiao Ke refers to drinking large amounts of water yet producing little urine, because intense heat consumes fluids. In the initial stage of transmission, heat is mild, so thirst is mild; as transmission deepens, heat becomes severe, so thirst becomes severe. For patients with thirst, do not allow them to drink excessively. For mild thirst in San Yang channels, use Wuling San; for severe thirst, use Baihu Tang. For severe heat and thirst in San Yin channels, purgation should be employed. If mild thirst is forced to drink excessively, it can lead to palpitations, limb distension and binding, wheezing, hiccups, dry retching, edema, abdominal fullness, diarrhea, and dysuria, all resulting from this cause.

After sweating therapy for Taiyang disease, excessive sweating leads to dryness in the stomach, irritability, insomnia, and desire for water. Give small amounts frequently until stomach Qi harmonizes and recovery occurs. If pulse is floating, urination is difficult, there is slight fever, and Xiao Ke, use Wuling San. (Zhang Yuansu argued: For irritability and thirst, Baihu Tang is appropriate. Why use Wuling San to promote fluid metabolism? The answer is: Baihu Tang is used when exterior symptoms have resolved and pathogens have transmitted inward causing irritability and thirst. Here, the pulse is still floating, there is slight fever and thirst, indicating exterior pathogens are not fully resolved. Thus, Guizhi's acridity harmonizes the muscle layer, while Baizhu and Fuling's sweet and bland nature moistens deficiency-dryness.) Note: This explanation is not entirely clear. Taiyang channel corresponds to the Bladder organ. The Bladder is the chamber of urine. Wuling San promotes urination. The Bladder is the storehouse of body fluids. Therefore, Li Dongyuan considered thirst a primary disease of the Bladder channel. To treat thirst, one must clear Bladder heat, which is achieved by promoting urination. After sweating, if pulse is floating and rapid with irritability and thirst, use Wuling San. Originally due to incorrect purgation leading to epigastric fullness, if Xixin Tang fails to resolve the fullness, and the patient has thirst, dry mouth, irritability, and dysuria, use Wuling San. Wind-strike with fever for six or seven days unresolved, accompanied by irritability, both exterior and interior signs, thirst, and vomiting immediately after drinking water, is called Shui Ni (Water Revulsion), treated with Wuling San.

Wuling San Formula
Zhuling (Periplocae Radix Cortex, peeled, 18 zhu) Zexie (Alismatis Rhizoma, 1 liang 6 zhu half) Fuling (Poria, 18 zhu) Guizhi (Cinnamomi Ramulus, remove coarse bark, 0.5 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, 18 zhu). Grind the above five herbs into powder. Mix with rice water and administer one Fang Cun Bi three times daily. Drink plenty of warm water afterwards to induce sweating for cure. ("Ling" means command, facilitating fluid circulation and suppressing Kidney evil, which is the merit of Fuling. As the chief herb in Wuling San, it is named thus. The *Neijing* states: Bland flavors promote drainage and belong to Yang. Internal accumulation of water-dampness requires drainage, primarily using sweet-bland flavors. Hence, Fuling (sweet and neutral) is the Sovereign herb, Zhuling (sweet and neutral) is the Minister herb. Though sweet, they ultimately act as bland. Spleen dislikes dampness; internal water accumulation impairs Spleen transport. Tonifying Spleen and overcoming dampness requires sweet-warm assistance. Hence, Baizhu (sweet and warm) is the Assistant herb. The *Neijing* states: Salty flavors promote drainage and belong to Yin. Draining water and guiding urination requires salty assistance. Hence, Zexie is the Envoy herb. Stagnant water dries Kidney Qi. The *Neijing* states: Kidney dislikes dryness and urgently needs acrid flavors to moisten it. Dispersing moisture and drying dampness requires Guizhi's acrid-heat as the Envoy. Drinking warm water to induce sweating works because acrid flavors disperse, allowing water vapor to escape externally.)

After taking Guizhi Tang and experiencing excessive sweating, if severe irritability and thirst persist with a flooding pulse, use Baihu Jia Renshen Tang. Taiyang disease presenting with fever, thirst, and no aversion to cold is classified as Wenbing (Warm Disease). Xiaochaihu Tang, Baihu Tang, Guizhi Tang, and Guizhi Jia Renshen Tang (without Cinnamon Twig) are indicated for Shaoyin patterns without significant fever, dry mouth/thirst, irritability, and slight aversion to cold on the back, treated with Baihu Jia Renshen Tang. For Shaoyin disease with floating pulse, fever, no sweat, and unresolved exterior, Baihu Tang is contraindicated. For thirst with desire to drink water and no exterior signs, Baihu Jia Renshen Tang is indicated. (Thirst with desire to drink and no exterior signs indicates Taiyang pattern has ceased and transferred to Yangming. The following clause implies the same: thirst arises from Taiyang transferring to Yangming.) If Shaoyin disease persists for 7-8 days after emesis or purgation, with heat結 in the interior, exterior and interior both hot, occasional aversion to wind, severe thirst, dry tongue, irritability, and desire to drink several liters of water, use Baihu Jia Renshen Tang. (Wang Bing noted: If purely exterior, aversion to wind is intermittent. Now, with interior-exterior heat, aversion to wind is frequent.)

Baihu Jia Renshen Tang: Treats thirst with flooding pulse and free urination.
Shigao (Gypsum Fibrosum, 6 liang) Zhimu (Anemarrhenae Rhizoma, 6.5 liang) Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang) Jingmi (Oryzae Fructus Glutinosis, 6 he) Renshen (Ginseng Radix, 3 qian). Crush the herbs. Take 1 liang per dose, decoct in water, and take warm.

Xu Shimiao said: A patient initially vomited, then was incorrectly purged by a physician. After 7-8 days, internal and external fever persisted. I diagnosed it as requiring Baihu Jia Renshen Tang. Someone asked: Since vomiting and purgation have caused double deficiency, can Baihu Tang be used? I replied: Zhang Zhongjing stated that if 7-8 days pass after emesis/purgation with unresolved heat結 in the interior and exterior-interior heat, Baihu Jia Renshen Tang is appropriate. Initial vomiting indicated heat in the stomach region; now the pulse is deficient and large. Three doses cured him. Zhang Zhongjing stated that for Shaoyin disease after emesis/purgation with 7-8 days unresolved and exterior-interior heat, use Baihu Jia Renshen Tang. He also stated that for floating pulse, fever, no sweat, and unresolved exterior, Baihu Tang is contraindicated. He further stated that for floating-slippery pulse (exterior heat, interior cold), Baihu Jia Renshen Tang is used. Lin Yi corrected this, claiming Zhang Zhongjing erred in "exterior/interior." I disagree. Generally, Baihu Tang clears thirst and exterior-interior heat in Shaoyin disease. Thus, whether described as "exterior-interior heat" or "exterior heat-interior cold," it can be used. However, for floating pulse, no sweat, and unresolved exterior, Mahuang Tang or Gegen Tang are indicated, not Baihu Tang. Lin Yi's error lies in failing to consider these nuances.

Zhang Yuansu stated: Medication timing has risks of being too fast or slow. Laws prevent errors; formulas rescue where laws fail. The first clause above is Zhang Zhongjing establishing preventive laws. The second clause ("Shaoyin disease... 7-8 days unresolved... severe thirst...") establishes a formula for treatment. Baihu Tang treats severe irritability and thirst. The preventive law warns against using it prematurely if exterior signs remain. However, if back aversion to cold or frequent aversion to wind accompanies severe thirst, only Baihu Tang can suppress it. Waiting for complete exterior resolution risks being too slow. Where laws fail, formulas are needed. Abandoning formulas violates method. This synergy is essential.

Wu Kun asked: Zhang Zhongjing says Baihu Tang is contraindicated if exterior is unresolved, yet also prescribes it for "frequent aversion to wind" and "back aversion to cold," implying exterior presence. Why? Gypsum is acrid-cold, clearing Yangming channel heat. It is a holy medicine for steaming fever, tidal fever, interior-exterior heat, dry tongue, and irritability. "Frequent" means occasional, not constant. "Back aversion" is slight, not severe. For strong heat and dry thirst, its use is unquestionable. However, for constant exterior aversion to cold, back aversion without dry thirst, it is strictly contraindicated. Also, Taiyang fever with thirst and no sweat is contraindicated. But post-sweating with flooding pulse and thirst, it is allowed. For Yin Cold with red face, irritability, fever, weak pulse, poor appetite, and no significant heat, it is strictly contraindicated. Misuse leads to immediate danger.

For Taiyang disease, after heavy sweating and purgation, if constipation persists for 5-6 days, tongue is dry, thirst exists, slight tidal fever occurs at dusk, and hardness/fullness/pain extends from epigastrium to lower abdomen unapproachable to touch, use Daxiexiong Tang. For Shaoyin fever, aversion to cold, severe thirst, abdominal fullness, spontaneous sweating, and free urination, the disease resolves. This is Liver attacking Lung, called Heng. Puncture Qimen (LR14).

For Yangming disease with excessive sweating and thirst, Zhu Ling Tang is contraindicated because sweating causes stomach dryness; diuresis would worsen deficiency. (Baihu Jia Renshen Tang, Xiaochaihu Tang minus Banxia plus Gualou Gen, Zhuye. Zhang Yuansu noted: Yangming sweating indicates unresolved disease and thirst due to stomach fluid dryness. Zhu Ling Tang would further drain fluids, causing "reinforcing excess and draining deficiency.") For Yangming disease with floating-tight pulse, dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, aversion to heat rather than cold, heaviness, and thirst with dry mouth/tongue, use Baihu Jia Renshen Tang. If pulse is floating, fever, thirst, and dysuria exist, use Zhu Ling Tang.

For Shaoyin Wind-Cold with alternating chills/fever, chest/hypochondriac fullness, silent anorexia, irritability, vomiting, or thirst/cough, use Xiaochaihu Tang. If thirsty, remove Banxia, add Renshen and Gualou Gen. For Shaoyin 4-5 days with fever, aversion to wind, neck stiffness, hypochondriac fullness, warm hands/feet, and thirst, use Xiaochaihu Tang. For illness lasting 6-7 days with slow-floating-weak pulse, aversion to wind, warm hands/feet, if incorrectly purged multiple times, leading to inability to eat, hypochondriac fullness/pain, stiff neck/body, and dysuria, giving Chaihu Tang will cause tenesmus. Original thirst with drinking-induced vomiting contraindicates Chaihu Tang. (Some suggest Wuling San plus Yinchenshao Tang for tenesmus, thirst, and vomiting.)

For Shaoyin thirst with diarrhea, it belongs to Shaoyin. If accompanied by lethargy and white urine, use Sini Tang. If accompanied by cough, vomiting, insomnia, and non-white urine, use Zhu Ling Tang. If accompanied by spontaneous diarrhea with pure green watery stool, use Dachengqi Tang. If heat is present, use Baitouweng Tang (see Diarrhea chapter).

For Jueyin disease, Xiao Ke (wasting-thirst), Qi rushing up to the heart, heart pain, hunger without desire to eat, vomiting roundworms after eating, and if purged, persistent diarrhea. If thirsty, give small amounts frequently to recover. (Pathogen in Jueyin indicates deep heat. Transmission from Taiyang to Taiyin causes abdominal fullness/dry throat but not thirst. Transmission to Shaoyin causes dry mouth/tongue/thirst but not Xiao Ke. Only in Jueyin does intense heat consume fluids, causing Xiao Ke: drinking much, urinating little. Wood generates Fire; Liver Qi connects to Heart. Jueyin guest-heat rushes up, causing heart pain. On day 6-7, Jueyin receives disease, completing transmission. Stomach deficiency allows guest-heat, causing hunger without desire to eat. Roundworms move in empty stomach, emerge with food smell. This is heat in Jueyin channel. Purging damages Stomach Qi, allowing Jueyin Wood evil to attack, causing persistent vomiting/diarrhea. Note: Cheng Wuji's view of exterior-Yang transmitting inward is incorrect. Xiao Ke and heart pain are key.)

Clinical Examples for Thirst
Thirst with head sweating, dysuria, hypochondriac fullness, and alternating chills/fever: Chaihu Guizhi Jiangxin Tang. With jaundice: Yinchenshao Tang (see Head Sweating chapter).
Unresolved exterior with Phlegm-Fluid in Heart, dry retching, fever, cough, or thirst, diarrhea, choking sensation, dysuria, lower abdominal fullness, or wheezing: Xiao Qinglong Tang. Another case: Phlegm-Fluid in Heart with cough, slight wheezing, fever, no thirst. Post-medication thirst indicates cold resolving: Xiao Qinglong Tang (Remove Banxia, add Gualou Gen).
Summer heatstroke with sweating, aversion to cold, fever, cold feet, and thirst: Baihu Jia Renshen Tang and Jiuhuanglian (see Summer Heatstroke chapter; cold feet contraindicate exterior release).
Fever, aversion to cold, abdominal fullness, sweating, free urination, and thirst: Liver attacking Spleen. Puncture Qimen (see Abdominal Fullness chapter). Exterior resolved, no aversion to cold, but thirsty: Use Baihu Tang.
Thirst with hypochondriac fullness and alternating chills/fever, untreated by sweating: Xiaochaihu Tang minus Banxia plus Renshen/Gualou Gen. Post-sweat/purge: Chaihu Guizhi Jiangxin Tang (see Hypochondriac Pain chapter). Thirst with epigastric hardness/pain, tidal fever, constipation: Xiexiong (Chest Binding). Use Daxiexiong Tang. Hardness without pain: Pi (Glomus). Use Xixin Tang. Unresolved with thirst and dysuria: Wuling San (see Chest Binding/Pi chapters).
Yangming disease requiring sweating, but incorrectly cooled with cold water spray, worsening irritability, skin goosebumps, desire to drink but no actual thirst: Wenli San. If ineffective, Wuling Tang (see Chest Binding chapter).
Wenli San Formula
Wenli (Veneris Concha, 1 liang, i.e., Seashell Powder, widely used by Hejian and Danxi for phlegm). Grind one ingredient into powder. Mix with boiling water, administer one Fang Cun Bi.
Thirst with inability to drink: Heat in Dantian, Cold in Chest (see Damp-Bi chapter).
Wind-strike fever 6-7 days unresolved, irritability, exterior-interior signs, thirst, vomiting after drinking: Shui Ni. Use Wuling San.
Thirst with desire to drink: Post-Taiyang sweating with excessive sweat, irritability, insomnia; or Juevon Qi rushing, heart pain, vomiting worms: Give small amounts frequently to recover (see previous clauses and Qi Rushing chapter).
For seasonal epidemic diseases, days 5-6 with thirst but inability to drink much: Do not force water. Internal heat is insufficient to metabolize large volumes; forcing water causes pathology. By days 7-8, if severe thirst exists, give according to pattern. Allow partial intake, do not overfill. (If able to drink one dou, give five sheng. If abdominal fullness, dysuria, wheezing, or hiccups occur after drinking, stop. Spontaneous heavy sweating indicates self-recovery. *Huoren* states: Only drink if severely thirsty. For mild thirst/dry throat, sip slowly to harmonize stomach.)
Ability to drink indicates recovery. However, forcing water for mild thirst causes disaster (*Huoren*: Forced water causing chest fullness/wheezing requires Wuling San or Xiexiong Tang). Diarrhea with weak/rapid pulse and thirst indicates self-recovery (see Diarrhea chapter). Thirst with fever, floating-weak pulse (not string-tight): Sweating cures (see Delirium chapter).

Lou Quanshan stated: *Huoren* warns: Taiyang no-sweat thirst contraindicates Baihu Tang; Yangming high-sweat thirst contraindicates Zhu Ling Tang. Is Taiyang thirst never treated with Baihu Tang? Only after sweating, if pulse is flooding and thirsty, is it allowed. Is Yangming thirst never treated with Wuling San? Only if Yangming has dysuria, low sweat, floating pulse, and thirst, is it allowed.

Zhao Sizhen stated: *Huoren* strictly warns: Taiyang no-sweat thirst contraindicates Baihu Tang; Yangming high-sweat thirst contraindicates Wuling San. Examining Zhang Zhongjing, two contraindications exist: 1. Floating pulse, fever, no sweat, thirst, no exterior: Baihu Jia Renshen Tang. Unresolved exterior contraindicates it. *Huoren* cites "no sweat" instead of "unresolved exterior," which is erroneous. 2. *Neijing* states Yangming high-sweat thirst contraindicates Zhu Ling Tang. *Huoren* changed this to Wuling San. Zhu Ling drains; Wuling disperses/sweats. Change is unjustified. Why does Yangming high-sweat thirst contraindicate Zhu Ling Tang, but Taiyang sweating-thirst uses Wuling San? Taiyang is exterior, not yet causing stomach dryness from sweat volume; Wuling harmonizes exterior and drains heat. Yangming is interior, high sweat causes stomach dryness. *Neijing* also states Yangming fever/high sweat requires urgent purgation. Both are Yangming high sweat. Previous clause warns against diuresis; this warns against bowel purgation. Why? Thirst implies pathogen scattered in channels, not yet solidified in Stomach. Non-thirst implies interior solidity + exterior heat, risking fluid exhaustion, hence urgent purgation. Regarding Zhu Ling vs. Wuling: Taiyang floating pulse, dysuria, slight fever, Xiao Ke uses Wuling San. Yangming floating pulse, fever, thirst, dysuria uses Zhu Ling Tang. Symptoms match, why different formulas? Taiyang exterior unresolved after sweating: Wuling harmonizes exterior/moves fluids. Yangming interior heat in Lower Jiao: Zhu Ling drains heat. Ah! If one understands subtle mechanisms and adapts treatments, one grasps Zhang Zhongjing's essence. Regarding "Spontaneous Diarrhea with Thirst": Note says Shaoyin heat enters organs/Kidney channel; Kidney dislikes dryness, causing thirst. Uses Zhu Ling/Baitouweng Tang. Later, regarding diarrhea, it attributes thirst to Kidney deficiency seeking water, using Baitong/Sini/Zhu Ling. One views thirst as Heat, one as Deficiency. Ice and charcoal differ. How to distinguish? Separated into chapters, confusing later practitioners. Clarify: Shaoyin cough/diarrhea/vomit/thirst/irritability/insomnia, and Jueyin diarrhea/desire to drink, are transmitted heat with sinking-fine-rapid pulses. Zhang uses Shihuang/Huanglian to clear/drain. Shaoyin spontaneous diarrhea/thirst/vomit/no-vomit/irritability/lethargy is direct Yin pathogen with sinking-micro pulses. Zhang uses Fuzi/Ganjiang to warm. Why not combine these clearly? Clear differentiation prevents error. Warm or clear based on benefit.

Wu Kun stated: Classify thirst by Six Channels. Taiyang superficial heat causes no thirst; heat transmitting to Bladder base causes irritability/thirst, floating-rapid pulse, dysuria: Wuling San. Never Baihu Tang. Yangming long pulse, superficial heat, no sweat, thirst: Gegen Jiemo Tang or Liutong Shengsan (double Gegen) to sweat. Yangming heat transmitting to Stomach base, aversion to heat, sweating, thirst, floating-hyper-rapid pulse: Renshen Baihu Tang. Wuling San is inappropriate. Yangming base heat, steaming/tidal fever, dry tongue/mouth, constipation: Da Chaihu Tang or Tiaowei Chengqi Tang to purge. If interior not solid, do not purge; use modified Xiaochaihu Tang. Shaoyin string-rapid pulse, bitter taste, dry throat, fever, thirst: Xiaochaihu Tang minus Banxia plus Gualou Gen (see main clause). Taiyin spontaneous diarrhea has no thirst. Shaoyin has bitter taste, drinking, white urine (Cold below, sinking pulse): Fuzi Tang. Body cold, reversal cold, slippery pulse, thirst (Heat inside): Renshen Baihu Tang. Yin syndrome irritability/thirst, unable to swallow water, sinking pulse, cold feet: Sini Tang (drink chilled). Desire to drink in Shaoyin/epidemics indicates recovery (water harmonizes Stomach, induces sweat). Without water, dryness prevents sweat, leading to death. Observe patient strength/pathogen severity when giving water. Better insufficient than excessive. Excess water stagnates. Use fresh well water. For severe heat/constipation, add Yuanmingfen (Mirabilite) 1-2 qian to water. For summer heat irritability/thirst, add Chen Sha Tianshui San. For deficiency irritability/non-drinking, use Dengxin decoction. Mild thirst: Tea, White Plum Soup, Mung Bean Soup. Foods: Perfumed water, Pear, Lotus Root, Watermelon. Ice must be washed to remove salt.

Dai Yuanli stated: Ask about preference for cold/hot, much/little. Much/Cold = Yang Thirst. Determine channel involvement. Taiyang dysuria/thirst: Wuling San. Yangming constipation/thirst: Seek in Yangming channel. If bowels open but thirst persists: Baihu Tang. Shaoyin alternating chills/fever/thirst: Xiaochaihu Tang minus Banxia plus Gualou Gen. Yin syndromes with spontaneous diarrhea/thirst appear in respective channels. Ancient used cold agents for Yin-thirst as they often involve Yang qi. Though Yin channel, disease is Yang-like. However, some with clear stools (non-heat diarrhea), pure Yin syndrome, present with thirst due to Yin blocking Yang above and fluid loss from diarrhea. They drink little, prefer warmth. Do not use cold agents; use Lizhong Tang or Sini Tang + Renshen. Severe thirst: Lianli Tang. Yang syndrome no thirst; Yin syndrome reverse thirst. Yangming mild thirst; Taiyin severe thirst. Know this. Treating thirst: Solidify Kidney Water (Hua Tian Fen group) or promote urination (Fuling/Zhuling group). Taiyin prioritizes urination; Yangming prohibits it. Shaoyin (Half-Exterior/Interior) cannot be purged. For extreme thirst, use Xiaochaihu Tang + Hua Tian Fen to solidify Kidney Water. Water penetrates Large Intestine, softens stool, clears heat, resolves thirst. Taiyang/Bladder/Kidney channel: Must promote urination to remove heat/thirst. External cases: Irritability/thirst not Taiyang, but Yin excess blocking Yang. Do not moisten thirst; treat Yin.

Appendix
Luo Tianyi stated: Shaoyin with poor appetite and thirst: Harmonize Stomach herbs, avoid cooling agents to preserve Stomach Qi. Baizhu/Fuling are suitable.
Wang Haicang stated: Qin Ermu had Taiyin disease unresolved for 3 days, followed by vomiting/nausea, non-floating pulse. Given Banshu Wan 2-3 doses without relief. Then given Huangqi Jianzhong Tang. Pulse extremely tight, no exterior-interior signs, chest...