厥阴病。渴欲饮水者。少少与之愈。
厥阴之病。本自消渴。虽得水未必即愈。此云渴欲饮水。少少与之愈者。必厥阴热邪还返阳明
之候也。热还阳明。津液暴竭。求救于水。少少与之。胃气则和。其病乃愈。若系厥阴。则热足以
消水。而水岂能消其热哉。
下利欲饮水者。以有热故也。白头翁汤主之。
伤寒自利不渴者。为脏有寒。太阴自受寒邪也。下利欲饮水者。以里有热。传经之邪。厥阴受
之也。白头翁汤除热坚下。中有秦皮。色青味苦。气凉性涩。能入厥阴。清热去湿而止利也。
白头翁汤方
白头翁（二两） 黄连 黄柏 秦皮（各三两）
上四味。以水七升。煮取二升。去滓。温服一升。不愈。更服一升。
热利下重者。白头翁汤主之。
伤寒热邪入里。因而作利者。谓热利。下重即后重。热邪下注。虽利而不得出也。白头翁苦
辛除邪气。黄连、黄柏、秦皮。苦以坚之。寒以清之。涩以收之也。
下利后更烦。按之心下濡者。为虚烦也。宜栀子豉汤。
下利后更烦者。热邪不从下减而复上动也。按之心下濡。则中无阻滞可知。故曰虚烦。香豉、
栀子。能彻热而除烦。得吐则热从上出而愈。因其高而越之之意也。
伤寒六七日。大下后。寸脉沉而迟。手足厥逆。下部脉不至。咽喉不利。吐脓血。泄利不止者
。为难治。麻黄升麻汤主之。
伤寒六七日。寒已变热而未实也。乃大下之。阴气遂虚。阳气乃陷。阳气陷。故寸脉沉而迟。
阴气虚。故下部脉不至。阴阳并伤。不相顺接。则手足厥逆。而阳邪之内入者。方上淫而下溢。为
咽喉不利。为吐脓血。为泄利不止。是阴阳上下并受其病。而虚实冷热。亦复混淆不清矣。是以欲
治其阴。必伤其阳。欲补其虚。必碍其实。故曰此为难治。麻黄升麻汤合补泻寒热为剂。使相助而
不相悖。庶几各行其事。而并呈
其效。方用麻黄、升麻。所以引阳气发阳邪也。而得当归、知母、葳蕤、天冬之润。则肺气已滋
。而不蒙其发越之害矣。桂枝、干姜。所以通脉止厥也。而得黄芩、石膏之寒。则中气已和。而不
被其燥热之烈矣。其芍药、甘草、茯苓、白术则不特止其泄利。抑以安中益气。以为通上下和阴阳
之用耳。
麻黄升麻汤方
麻黄（二两半去节） 当归 升麻（各一两一分） 知母 黄芩 葳蕤（各十八铢） 石膏（
绵裹碎） 白术 干姜 白芍 天冬（去心） 桂枝 茯苓 甘草（炙各六铢）
上十四味。以水一斗。先煮麻黄一二沸。去上沫。纳诸药。煮取三升。去滓。分温三服。相去
如炊三斗米饭顷。令尽汗出愈。
Jueyin disease. If the patient desires to drink water, giving a small amount will lead to recovery.
The pathology of Jueyin inherently involves Xiao Ke (wasting-thirst syndrome characterized by excessive thirst and urination). Even after drinking water, immediate relief may not occur. The statement here that "desiring to drink water and receiving a small amount leads to cure" indicates that the heat pathogen of Jueyin has returned to the Yangming channel. When the heat returns to Yangming, body fluids are suddenly depleted, prompting a desperate need for water. Providing a small amount harmonizes the Stomach Qi, and the illness resolves. However, if it were purely a Jueyin condition, the internal heat would be sufficient to consume the ingested water; thus, how could water eliminate the heat?
Dysentery accompanied by a desire to drink water is due to the presence of heat within. It should be treated with Baitouweng Tang (Pulsatilla Decoction).
In Shanghan (Cold Damage), spontaneous diarrhea without thirst indicates cold in the Zang organs, specifically caused by Cold pathogens affecting the Taiyin directly. Conversely, diarrhea with a desire to drink water indicates internal heat, resulting from transmitted pathogens affecting the Jueyin. Baitouweng Tang clears heat and firms the lower intestine to stop dysentery. It contains Qinpi (Phellodendri Amurensis Cortex or Acanthopanacis Cortex, depending on interpretation, but traditionally Phellodendri Amurensis Cortex in this context or related bark), which is green in color, bitter in taste, cool in nature, and astringent in property. It enters the Jueyin channel, clears heat, removes dampness, and stops diarrhea.
Baitouweng Tang Formula
Baitouweng (Pulsatillae Radix) (2 liang)
Huanglian (Coptidis Rhizoma)
Huangbai (Phellodendri Cortex)
Qinpi (Acanthopanacis Cortex or Phellodendri Amurensis Cortex) (each 3 liang)
These four ingredients are boiled in 7 sheng of water until reduced to 2 sheng. Strain the dregs. Take 1 sheng warm. If not cured, take another 1 sheng.
Hot dysentery accompanied by tenesmus (a feeling of incomplete defecation and rectal heaviness) should be treated with Baitouweng Tang.
When Shanghan heat pathogens enter the interior and cause diarrhea, it is termed hot dysentery. "Xia zhong" refers to tenesmus. Heat pathogens sinking downward cause diarrhea that feels obstructed and difficult to expel completely. Baitouweng is bitter and pungent to dispel pathogens; Huanglian, Huangbai, and Qinpi are bitter to firm the intestines, cold to clear heat, and astringent to consolidate and stop discharge.
After dysentery, if irritability worsens and palpation of the epigastrium reveals softness, it is classified as empty irritability (Xu Fan). Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction) is appropriate.
Worsening irritability after dysentery occurs because the heat pathogen did not decrease via the lower route but instead moved upward. Softness upon palpation of the epigastrium indicates no obstruction in the middle jiao, hence the term "empty irritability." Xiangchi (Fermented Soybean) and Zhizi (Gardeniae Fructus) can penetrate and clear heat while removing irritability. If vomiting occurs, the heat exits from above, leading to recovery. This follows the principle of treating high-positioned pathogens by inducing emesis.
In Shanghan, after six or seven days, if a severe purgative was administered, and the cun pulse is deep and slow, the hands and feet are cold, the pulses at the lower extremities are imperceptible, there is throat obstruction, expectoration of pus and blood, and unceasing diarrhea, the condition is difficult to treat. Mahuang Shengma Tang (Ephedra and Cimicifugae Decoction) should be used.
At six or seven days of Shanghan, the cold has transformed into heat but has not yet solidified. If a severe purgative is mistakenly applied, Yin qi becomes deficient, and Yang qi sinks. Because Yang qi sinks, the cun pulse is deep and slow. Because Yin qi is deficient, the lower pulses are imperceptible. With both Yin and Yang injured and failing to connect smoothly, cold hands and feet result. The internalized Yang pathogen floods upward and overflows downward, causing throat obstruction, expectoration of pus and blood, and unceasing diarrhea. Here, both upper and lower aspects of Yin and Yang are diseased, and deficiency/excess and cold/heat are confused. Therefore, attempting to tonify Yin may injure Yang, and attempting to tonify deficiency may hinder excess. Thus, it is deemed difficult to treat. Mahuang Shengma Tang combines tonification and purgation, cold and heat treatments into one formula, allowing them to assist rather than contradict each other, thereby achieving their respective effects. Mahuang and Shengma are used to guide Yang qi to vent the Yang pathogen. However, combined with the moistening properties of Danggui, Zhimu, Weirui, and Tiandong, the Lung Qi is nourished, preventing harm from excessive venting. Guizhi and Ganjiang are used to unblock meridians and stop cold limbs. However, combined with the cold nature of Huangqin and Shigao, the Middle Qi is harmonized, preventing damage from excessive dryness and heat. Shaoyao, Gancao, Fuling, and Baizhu not only stop diarrhea but also stabilize the Middle and benefit Qi, serving to connect the upper and lower and harmonize Yin and Yang.
Mahuang Shengma Tang Formula
Mahuang (Ephedrae Herba) (2.5 liang, remove joints)
Danggui (Angelicae Sinensis Radix)
Shengma (Cimicifugae Rhizoma) (each 1 liang 1 fen)
Zhimu (Anemarrhenae Rhizoma)
Huangqin (Scutellariae Radix)
Weirui (Polygonati Odorati Rhizoma) (each 18 zhu)
Shigao (Gypsum Fibrosum) (wrapped in silk, crushed)
Baizhu (Atractylodis Macrocephalae Rhizoma)
Ganjiang (Zingiberis Rhizoma)
Baishao (Paeoniae Radix Alba)
Tiandong (Ophiopogonis Tuber) (remove heart)
Guizhi (Cinnamomi Ramulus)
Fuling (Poria)
Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (each 6 zhu)
These fourteen ingredients are boiled in 1 dou of water. First, boil Mahuang for one or two boils, skim off the foam, then add the remaining herbs. Boil until reduced to 3 sheng. Strain. Divide into three warm doses. Space the doses approximately equal to the time it takes to cook three dou of rice. Drink thoroughly; sweating indicates recovery.