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[Annotations] Ke Qin stated: In Yangming disease, pathogenic factors transform into heat; therefore, there is aversion to cold but aversion to heat. Heat steams and escapes outward, causing spontaneous sweating. Heat scorches the stomach, causing thirst and a desire to drink water. The pathogen is abundant and excess, resulting in a slippery pulse, yet since it remains in the channels, a floating pulse is also present. Generally, the Yangming channel belongs to the Stomach and governs the muscles externally. Although there is intense heat, if it has not formed an interior excess syndrome, bitter-cold herbs alone cannot treat it. Gypsum (Shigao) is pungent and cold. Pungency can resolve muscle-heat, while coldness can overcome stomach-fire. Cold nature is sinking and descending, while pungency moves outward; thus, it excels in both interior and exterior functions, serving as the Sovereign herb. Anemarrhena (Zhimu) is bitter and moistening. Bitterness purges fire, while moisture nourishes dryness, serving as the Minister herb. Licorice (Gancao) and Rice (Jingmi) are used to harmonize the Middle Jiao. They can drain fire from Earth, adhering to the nature of grains that produce sweetness. The cold agents become milder with them, and bitter drugs become less harsh, allowing their sinking properties to linger within the body. With these two as Assistant and Envoy herbs, there is no fear that potent cold substances will damage the Spleen and Stomach. When decocted into soup and entering the Stomach, fluids are transported to the Spleen and returned to the Lung. Fluid essence distributes throughout the four directions, relieving severe irritability and thirst. Baihu (White Tiger) is the Golden Spirit of the West. Naming the formula after it implies that when Autumn Metal takes command, summer heat naturally dissipates. Adding Ginseng (Renshen) tonifies the Middle and benefits Qi while generating fluids, coordinating with the tonifying effects of Licorice and Rice, restraining the coldness of Gypsum and Anemarrhena, draining fire without injuring Earth. This is a comprehensive strategy.

Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) treats Sun Taiyang Zhongre (Heatstroke), characterized by sweating, aversion to cold, fever, and thirst.

Gypsum (1 jin), Anemarrhena (6 liang), Licorice (2 liang), Rice (6 he), Ginseng (3 liang).

The above five ingredients are prepared according to the previous decoction and administration method.

[Annotations] Zhao Liang stated: Sweating, aversion to cold, and fever without thirst indicate Wind Strike (Zhongfeng). Sweating, aversion to cold, fever, and thirst indicate Heatstroke (Zhongyue). The symptoms are similar, distinguished solely by the presence or absence of thirst. However, both Cold Damage (Shanghan) and Wind Strike can present with slight aversion to cold at the back, intermittent aversion to wind, and thirst, which are also treated with Baihu Jia Renshen Tang. This is because fire scorches Lung Metal, and the Lung governs Qi. Lung injury leads to deficient Wei Qi; deficient Wei Qi results in exterior insufficiency, leading to sweating, fever, and aversion to cold. The *Neijing* states: "Heat transferred to the Lung transmits to become Ge Xiao (Diaphragmatic Consumption)." Ge Xiao involves thirst, all caused by Minister Fire injuring the Lung. Thus, the key lies in saving the Lung. Gypsum treats Sanjiao fire, with efficacy extending beyond clearing the Lung, specifically retreating fire from the Lung, so it serves as the Sovereign herb. Anemarrhena also clears Heart fire from the Lung, nourishing the source of Water. Ginseng generates fluids and benefits injured Qi, serving as the Minister herb. Rice and Licorice tonify Earth to support Metal, serving as Assistant herbs.

Zhuling Tang (Polyporus Decoction) treats Yangming disease with a floating pulse, fever, and thirst for water; or Shaoyin disease with diarrhea for six to seven days, accompanied by cough, vomiting, thirst, irritability, and insomnia.

Polyporus (skin removed), Poria, Donkey-hide Gelatin, Talcum, Alisma (each 1 liang).

The above five ingredients are boiled in four sheng of water. First boil the first four ingredients until two sheng remain, strain; then add Donkey-hide Gelatin and melt it. Take seven ge warm, three times daily.

[Annotations] Zhao Yuhuang stated: Zhang Zhongjing formulated Zhuling Tang to circulate water and heat in the Yangming and Shaoyin channels. However, its main intent is entirely to nourish Yin, not merely to promote urination. Generally, exterior deficiency in Cold Damage most fears loss of Yang, while interior heat fears loss of Yin. Loss of Yin refers to the depletion of Kidney Yin and Stomach fluids. Therefore, in Yin-deficient individuals, not only should the bowels not be lightly purged, but urination should also be avoided through excessive diuresis. If Yin-deficient patients undergo excessive leaching and draining, fluids will be exhausted. In this formula, Donkey-hide Gelatin is pasty in texture, nourishing Yin and moistening dryness; Talcum is slippery, clearing heat and promoting urination. Assisted by the draining actions of the two Polypori (Polyporus and Poria), it disperses turbid heat without retaining stasis and moistens True Yin without causing dryness. It is an excellent formula that promotes urination without damaging Yin. Therefore, Wuling San (Five-Ingredient Powder with Poria) is used for Yangming water-promotion because Yangming governs cold water, so Cinnamon Twig (Guizhi) is added to warm it, warming the Kidney to move water. For Yangming and Shaoyin, Zhuling Tang is used because both channels relate to fluids; specifically, Donkey-hide Gelatin and Talcum are used to moisten them. This nourishes the formless to move the formed. Although both promote urination, their cold and warm natures are vastly different, known only to the enlightened.

Wuling San (Five-Ingredient Powder with Poria) [Attached: Yinchen Wuling San] treats floating pulse, difficulty in urination, mild heat, and thirst. After sweating, if the pulse is floating and rapid with irritability and thirst. Wind Strike with fever, unresolved after six or seven days, with irritability, exterior and interior signs, thirst for water, and vomiting after drinking.

Poria (18 zhu), Polyporus (18 zhu), Atractylodes Macrocephala (18 zhu), Alisma (1 liang), Cinnamon Twig (0.5 liang).

The above five ingredients are powdered. Take one cun bi with white rice water, three times daily. Drink plenty of warm water afterwards; recovery occurs with sweating.

[Note] This formula treats Sun Taiyang pathogenic heat entering the Fu organs, where water qi fails to transform. It addresses the exterior and interior of the Bladder. One type treats Water Reversal (Shuini), where water is vomited upon ingestion; the other treats Thirst Consumption (Xiaoke), where water is consumed immediately. The Bladder is the mansion of fluid essence; it excretes urine only when Qi transformation occurs. Pathogenic heat enters; if water is abundant, it stagnates and accumulates above, Bladder Qi transformation fails, causing difficulty in urination. If heat is abundant, water is consumed by heat, Bladder fluid essence is depleted, also causing difficulty in urination. Vomiting after drinking indicates water exceeds heat; consuming after drinking indicates heat exceeds water. Both syndromes involve difficulty in urination, hence both are managed by this formula. However, it is contraindicated if urination is already normal, to avoid further injuring fluid essence. Thus, Wuling San is not exclusively for treating water-heat but is the primary formula for water-heat causing difficulty in urination. Alisma (Xie) is salty and cold as the Sovereign; saltiness enters the Water Mansion, and coldness overcomes heat pathogens. Poria and Polyporus are bland and permeating as Assistants, regulating water pathways and directing downward to the Bladder, jointly draining water-heat. Atractylodes Macrocephala dries dampness, strengthens the Spleen and assists Earth, acting as a dam to control water. Cinnamon Twig (Guizhi) is pungent and warm, disseminating Yang Qi and vaporizing the Sanjiao to move water. Alisma combined with the two Polypori descends, doubling the urination effect, allowing free urination and preventing water accumulation. Atractylodes Macrocephala combined with Cinnamon Twig ascends, rapidly enhancing Yang dissemination; Qi rises, fluids transform, and thirst stops. If fever and exterior signs persist, use Cinnamon Twig instead of Cinnamon Bark, drink warm water, and recover with sweating. This formula not only treats interior water retention causing difficulty in urination but also resolves exterior heat caused by water retention. Adding Ginseng creates Chunze Tang, focusing on assisting Qi transformation to generate fluids. Adding Artemisia Capillaris creates Yinchen Wuling San, treating damp-heat jaundice with exterior-interior deficiency and difficulty in urination, achieving complete cure.

Guizhi Qu Shaoyao Jia Fuling Baizhu Tang (Cinnamon Twig Decoction Removing Peony plus Poria and Atractylodes Macrocephala) treats cases where, after taking Guizhi Tang or undergoing purgation, there is no stiff pain in the head and neck, low-grade fever, no sweating, fullness and slight pain in the epigastrium, and difficulty in urination. This is treated with Guizhi Qu Shaoyao Jia Fuling Baizhu Tang.

Formula for Guizhi Qu Shaoyao Jia Fuling Baizhu Tang:
In the Guizhi Tang formula, remove Peony and add Poria and Atractylodes Macrocephala, each 3 liang. Prepare and administer according to the Guizhi Tang method. Recovery occurs when urination becomes normal.

[Note] After taking Guizhi Tang, sweating occurred; or after purgation, the bowels were moved. Now there is no exterior sign of stiff pain in the head/neck, low-grade fever, or no sweating. There are interior signs of fullness/slight pain in the epigastrium and difficulty in urination due to retained fluid. If there is no sweating with unresolved exterior and fluid qi in the epigastrium, Xiaolong Tan (Minor Green Dragon Decoction) should be used to induce sweating. However, now there is no sweating with unresolved exterior, fluid qi, epigastric fullness, slight pain, and difficulty in urination, yet Xiaolong Tan is not used because the patient has already undergone sweating and purgation, leaving both exterior and interior deficient. Therefore, Guizhi Tang is still used to release the exterior. Peony's sour astringency is removed to avoid worsening epigastric fullness in the absence of sweating. Poria's drying and draining properties are added because water retention causes difficulty in urination. Preparing according to Guizhi Tang method means inducing sweating via Guizhi Tang protocol. Normal urination indicates recovery as fluid pathology is resolved through water pathways. This formula is essentially Ling Gui Gan Zhu Tang with Ginger and Jujube. Its intent is primarily to release the muscle layer, with water-draining secondary. Thus, Ginger and Jujube assist Cinnamon Twig to unblock fluid essence and induce sweating. Ling Gui Gan Zhu Tang does not use Ginger and Jujube but adds Poria; its intent is primarily water-draining, with Yang-supporting secondary. Thus, Poria is doubled as Sovereign, Cinnamon Twig as Minister, supporting Yang during water-draining. Hence, the post-formula instructions do not say "according to Guizhi Tang."

Shizao Tang (Ten Jujubes Decoction) treats Sun Taiyang Wind Strike where exterior signs have resolved, with sweating but no aversion to cold. Interior water qi is present, causing difficulty in urination, vomiting, shortness of breath, and distending fullness, hardness, and pain from the epigastrium to the hypochondrium. This is an urgent formula for treating water qi.

Jujube (broken, 10 pieces), Kansui, Daphne Genkwa, Euphorbia Lathyris (stir-fried, equal parts).

The above three ingredients are separately pulverized. Boil ten large Jujubes in 1.5 sheng of water until 0.8 sheng remains, strain; add the powder. Strong individuals take 1 qian; weak individuals take 0.5 qian. Take warm on an empty stomach in the morning. If bowel movement is slight and disease persists, repeat the next day, increasing by 0.5 qian. After obtaining profuse purgation, self-nourish with millet gruel.

[Annotations] Ke Qin stated: Zhang Zhongjing's formulas for treating water qi vary greatly; this is the most峻猛 (potent/severe). Generally, water qi pathology manifests locally—coughing, palpitations, choking, vomiting, or diarrhea. Here, however, water evil lingers and knots in the middle, causing distending fullness, hardness, and pain in the heart, abdomen, and hypochondrium, blocking the ascending and descending Qi of the Sanjiao. At this time, exterior pathogens have ceased, making sweating methods inappropriate. Interior fluid retention is substantial, exceeding the capacity of bland-permeating herbs. Without selecting extremely potent water-draining herbs to subdue it, the Middle Qi will collapse, leaving one helpless awaiting death. Kansui, Genkwa, and Euphorbia are all pungent, bitter, and cold, possessing extreme toxicity. Used together, their flavors complement and enhance each other, allowing them to attack the water evil's stronghold directly, opening the waterways for massive purgation, resolving the crisis in one stroke. However, where pathogenic factors gather, Qi must be deficient. Using toxic drugs to eliminate evil inevitably damages the Spleen and Stomach. Therefore, neutral, harmonious, sweet, and緩 (gentle) substances must act as masters. Then, when evil is exhausted, life is preserved. Yet these drugs are highly toxic; Codonopsis and Atractylodes cannot serve as Sovereigns, and Licorice is incompatible. Thus, ten large, plump Jujubes are chosen as Sovereigns: one to protect the Spleen and Stomach, the other to moderate the severe toxicity. After profuse purgation, self-nourishing with millet gruel ensures internal grain Qi fills the body and prevents recurrence of evil. This is Zhang Zhongjing's method of using toxicity to attack disease, perfect in beauty and goodness. Ignorant people, confused by the saying "sweetness causes fullness," dare not use it, failing to understand the principle of restraint and control.