尝治循衣摸床者数人，皆用大补气血之剂，唯一人兼 振、脉代，遂于补剂中略加桂二分，亦振止脉和而愈。
病患不恶寒而渴者，此转属阳明也。（论见不大便。）服柴胡汤已渴者，属阳明也，以法治之。伤寒脉
浮，发热无汗，其表不解者，不可与白虎汤。渴欲饮水，无表证者，白虎人参汤主之。（渴欲饮水无表证
者，太阳症罢转属阳明也。下二条意同，皆太阳转属阳明，故渴也。）服桂枝汤，大汗出后，大烦渴不解，
脉洪大者，白虎加人参汤主之。伤寒病若吐若下后，七八日不解，热结在里，表里俱热，时时恶风，大渴，
舌上干燥而烦，欲饮水数升者，白虎加人参汤主之。（王注云∶若纯在表则恶风无时，今表里有热，故时
时恶风也。）伤寒无大热，口燥渴，心烦，脉微，恶寒者，宜白虎加人参汤。阳明病
脉浮紧，口苦腹满而喘，若下后渴欲饮水，口干舌燥者，白虎加人参汤主之。
白虎加人参汤
石膏（碎，四两） 知母（一两半） 甘草（一两） 粳米（一合） 人参（二钱）
上 咀，每服五钱，水煎温服。
上白虎加人参五条，治表渴脉洪小便利者。
〔《本》〕有人初病呕吐，俄为医者下之，已七八日，而内外发热。予诊之曰∶当用白虎加人参汤。或曰∶
既吐复下，且重虚矣，白虎可用乎？予曰∶仲景云∶若吐下后七八日不解，热结在里，表里俱热者，
白虎加人参汤正相当也。盖始吐者热在胃脘，而脉至今虚大，三投汤而愈。仲景既云∶伤寒若吐下后七八日
不解，表里俱热者，白虎加人参汤主之。又云∶伤寒脉浮，发热无汗，其表不解，不可与白虎。又云∶
脉浮滑，此以表有热，里有寒，白虎加人参汤主之。国朝林亿校正，谓张仲景于此表里自瘥矣。予谓不然，
大抵白虎能除伤寒中渴，表里发热，故前后二症或云表里俱热，或云表热里寒，皆可服之。一种脉浮无汗，
其表不解，全是麻黄与葛根症，安可行白虎也？林亿见所称表里不同，便谓之瘥，是亦不思之过也。
太阳发热，不恶寒而渴者，为温病。（论见温病。《活人》葳蕤汤主之。发热不恶寒者，以表解也，太
阳病者，必头痛身疼表未解也，此表里两症皆兼见。）
渴而下利属少阴，其病但兼欲寐，小便白者，四逆汤。兼咳呕不得眠，小便不白者，猪苓汤。兼自利
纯青色水者，大承气汤。有热者，白头翁汤。（方论见下利。）
消渴，气上冲心，心疼，饥不欲食，食则吐蛔，若下之则利不止，若欲饮水者，少少与之愈。（论见气
上冲心。）
太阳病发汗后，大汗出，胃中干，烦躁不得眠，欲得饮水者，少少与之，令胃气和则愈。若脉浮，小便不
利，微热消渴者，五苓散主之。发汗已，脉浮数，烦渴者，五苓散主之。
阳明病，脉浮紧，口苦腹满，发热汗出不恶寒，若下后脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。
五苓散方
猪苓（去皮，二两） 泽泻（一两） 白术（三两） 茯苓（去皮，二两） 桂枝（去皮，半两）
上 咀为散，每服三钱，白汤调下。（海藏云∶五苓散当服而不服之，谷消水去形亡，必就阳明燥火，戊
胃发黄，故有调胃承气症。不当服而服之，是为犯本，小便强利，津液重亡而成血症，轻则桃仁承气汤，
重则抵当汤主之。）
猪苓汤方
猪苓（去皮） 茯苓 阿胶 泽泻 滑石（各半两）
上 咀，每服五钱，水煎温服，日三。
渴而头汗，小便不利，兼胁满，往来寒热者，柴胡桂枝干姜汤。兼发黄者，茵陈蒿汤。（论见头汗。）
表不解，心下有水气，干呕发热，咳嗽而渴者，小青龙汤去半夏加栝蒌根汤。（论见咳。）
夏月汗出，恶寒身热，足冷而渴者，为中暑，白虎加人参汤及酒黄连主之。（方见中暑。恶寒身热者，
症似表也，足冷者不可表。）
发热恶寒，腹满汗出，小便利而渴者，为肝乘脾，刺期门。（论见腹满。）表解不恶寒而渴者，宜白
虎汤。（方论见前阳明。）
渴而胁满，及往来寒热，其症未经汗者，小柴胡去半夏加人参栝蒌汤。若汗下后者，柴胡桂枝干姜汤。（详
见胁痛并往来寒热。）
渴而心下硬痛，日晡潮热，不大便者，为结胸，宜大陷胸汤。若但硬不痛者，为痞，与泻心汤。不解反
渴，而小便不利者，宜五苓散。（详见结胸痞气二门。）
病在阳明应汗之，反以冷水 之灌之，其热益烦，肉上粟起，意欲饮水，反不渴者，服文蛤散。
若不瘥，与五苓汤。（论见结胸。）
文蛤散方
文蛤（一两。即海蛤粉也。河间、丹溪多用之，大能治痰）
上一味，为散，沸汤调服方寸匕。
渴欲饮水，而不能饮者，丹田有热，胸中有寒。（论见湿痹。）
中风发热，六七日不解而烦，有表里症，渴欲饮水，水入则吐者，名曰水逆，五苓散主之。
渴欲饮水，若太阳发汗后大汗出，烦躁不得眠者，及厥阴病气起冲心，心疼吐蛔者，少少与之愈。（论见前条及
气上冲。）凡得时气病至五六日，而渴欲饮水，不能多，不当与之，何者？以腹中热尚少，不能消之，更与
水作病也。至七八日，大渴欲饮水者，犹当根据症与之，与之常令不足，勿极意也，言能饮一斗，与五升。若饮而
腹满，小便不利，若喘若哕，不可与之。忽然大汗出，是为自愈也。（《活人》云∶凡病非大渴，不可饮水，
若小渴咽干者，少少咽润之，令其胃中和乃佳。）
凡得病反能饮水，此欲愈也。但闻病饮水自愈，小渴者亦强与之，饮因成其祸，不可复救。（《活人》云∶
强饮水致饮停心下满结喘者，当以五苓散或陷胸汤主之。）下痢脉弱，脉数而渴者自愈。（论见下利。）渴而发热，
其脉不弦紧而浮弱者，汗出愈。（论见谵语。）
阳明病，汗出多而渴者，不可与猪苓汤，以汗多胃中燥，与猪苓汤复利其小便故也。
上《活人》云∶切戒太阳症无汗而渴者，不可与白虎汤；阳明症汗多而渴者，不可与猪苓汤。然太阳渴
终不可与白虎耶？太阳症得汗后，脉洪大而渴者，方可与之也；阳明渴终不可与五苓散耶？阳明症小便不
利，汗少脉浮而渴者，方可与之也。
I once treated several patients presenting with *xun yi mo chuang* (involuntary grasping of clothing due to delirium), all of whom were treated with major Qi and Blood tonifying formulas. Only one patient presented with concurrent tremors and a *dai* pulse (intermittent pulse), so I added two fen of Guizhi Tang (Cinnamon Twig Decoction) ingredient, Cinnamomi Ramulus (Guizhi, 桂枝) into the tonifying formula. Consequently, the tremors ceased, the pulse harmonized, and the patient recovered.
Patients who are not aversive to cold but experience thirst indicate that the pathogen has transferred to the Yangming channel. (See discussion under "Constipation"). Those who develop thirst after taking Chaihu Tang (Bupleurum Decoction) belong to Yangming disease; treat according to the appropriate method. In Shanghan (Cold Damage) disease, if the pulse is floating, there is fever and no sweating, and the exterior syndrome remains unresolved, Baihu Tang (White Tiger Decoction) must not be administered. If there is thirst desire for water and no exterior syndrome, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated. (Thirst desire for water without exterior syndrome indicates that the Taiyang symptoms have resolved and the condition has transferred to Yangming. The following two clauses share the same meaning: both involve transfer from Taiyang to Yangming, hence the thirst.) After taking Guizhi Tang, if profuse sweating occurs followed by severe irritability and unrelenting thirst with a flooding pulse, Baihu Jia Renshen Tang is indicated. In Shanghan disease, if after emetic or purgative treatment the condition persists for seven to eight days, heat is consolidated internally, both interior and exterior present heat, there is occasional aversion to wind, extreme thirst, dryness on the tongue with irritability, and a desire to drink several sheng of water, Baihu Jia Renshen Tang is indicated. (Wang Bing's commentary states: If the pathogen is purely in the exterior, aversion to wind is constant; now that there is heat in both interior and exterior, aversion to wind occurs intermittently.) In Shanghan disease, if there is no significant fever but there is dry mouth and thirst, irritability, a faint pulse, and aversion to cold, Baihu Jia Renshen Tang is suitable. In Yangming disease, if the pulse is floating and tight, with bitter taste, abdominal fullness, and wheezing, and if after purgation there is thirst desire for water with dry mouth and tongue, Baihu Jia Renshen Tang is indicated.
Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction)
Shigao (Gypsum Fibrosum, 石膏) - crushed, four liang
Zhimu (Anemarrhenae Rhizoma, 知母) - one and a half liang
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) - one liang
Jingmi (Oryza Sativa, 粳米) - one he
Renshen (Panacis Ginseng Radix, 人参) - two qian
All ingredients are coarsely chopped. Take five qian per dose, decoct in water, and take warm.
The above five clauses regarding Baihu Jia Renshen Tang treat thirst with a flooding pulse and free urination.
[Bencao Yanyi] A patient initially suffered from vomiting, then was mistakenly treated with purgatives by another physician. After seven to eight days, internal and external heat developed. Upon diagnosis, I stated: Baihu Jia Renshen Tang should be used. Someone asked: Since vomiting and purgation have already doubly depleted the righteous Qi, can Baihu Tang still be used? I replied: Zhang Zhongjing said: If after emetic or purgative treatment the condition persists for seven to eight days, with heat consolidated internally and both interior and exterior presenting heat, Baihu Jia Renshen Tang is precisely appropriate. Initially, vomiting indicated heat in the stomach region; the pulse remaining deficient and large confirms this. Three doses cured the patient. Zhang Zhongjing stated: In Shanghan, after emetic/purgative treatment persisting seven to eight days with interior/exterior heat, use Baihu Jia Renshen Tang. He also stated: In Shanghan, if the pulse is floating, with fever and no sweating, and the exterior is unresolved, do not give Baihu Tang. He further stated: If the pulse is floating and slippery, indicating heat in the exterior and cold in the interior, use Baihu Jia Renshen Tang. Lin Yi of our dynasty, while correcting medical texts, argued that Zhang Zhongjing’s statements regarding interior/exterior here were contradictory. I disagree. Generally, Baihu Tang clears thirst and interior/exterior heat in Shanghan; thus, whether described as interior/exterior heat or exterior heat/interior cold, it may be used. However, cases with floating pulse, no sweating, and unresolved exterior are indications for Mahuang Tang (Ephedra Decoction) or Gegen Tang (Puerariae Radix Decoction); how could Baihu Tang be used? Lin Yi saw the differing descriptions of interior/exterior and deemed them contradictory, which is an error of failing to think deeply.
Taiyang disease with fever, no aversion to cold, but thirst is termed Wenbing (Warm Disease). (See discussion under Warm Disease. Huoren Shu recommends Weiyu Tang (Polygonati Odorati Rhizoma Decoction). Fever without aversion to cold suggests the exterior is resolved; however, Taiyang disease typically involves headache and body ache, suggesting the exterior is unresolved. Here, both exterior and interior symptoms are present simultaneously.)
Thirst accompanied by diarrhea belongs to Shaoyin disease. If the symptoms primarily include drowsiness and white urine, Sini Tang (Frigid Extremities Decoction) is used. If accompanied by cough, vomiting, insomnia, and non-white urine, Zhuling Tang (Polyporus Decoction) is used. If accompanied by spontaneous diarrhea of pure green watery stool, Dachengqi Tang (Major Order the Qi Decoction) is used. If there is heat, Baitouweng Tang (Pulsatillae Radix Decoction) is used. (Formula discussion under Diarrhea.)
Xiaoke (Wasting-Thirst) with sensation of Qi rushing up to the heart, heart pain, hunger without desire to eat, vomiting of roundworms upon eating; if purged, diarrhea will not stop. If thirsty for water, giving small amounts will lead to recovery. (See discussion under Qi Rushing Up to Heart.)
After inducing sweating in Taiyang disease, if profuse sweating occurs causing dryness in the stomach, irritability, and insomnia, and the patient desires water, give small amounts. Harmonizing the Stomach Qi leads to recovery. If the pulse is floating, urination is difficult, there is slight fever and thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated. After sweating, if the pulse is floating and rapid with irritability and thirst, Wuling San is indicated.
In Yangming disease, if the pulse is floating and tight, with bitter taste, abdominal fullness, fever, sweating, and no aversion to cold, and if after purgation the pulse becomes floating with fever, thirst desire for water, and difficulty urinating, Zhuling Tang is indicated.
Wuling San (Five-Ingredient Powder with Poria)
Zhuling (Polypori Umbellati, 猪苓) - peeled, two liang
Zexie (Alismatis Rhizoma, 泽泻) - one liang
Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) - three liang
Fuling (Poria, 茯苓) - peeled, two liang
Guizhi (Cinnamomi Ramulus, 桂枝) - peeled, half liang
All ingredients are coarsely chopped and made into a powder. Take three qian per dose, mixed with plain boiled water. (Li Dongyuan stated: Failure to administer Wuling San when indicated causes grain digestion to fail, water dampness to dissipate but form to perish, leading to Yangming dry-fire and yellowing of the Wei Earth/Stomach, resulting in Tiaowei Chengqi Tang syndrome. Administering it when inappropriate violates the root, causing forced diuresis and secondary loss of fluids leading to blood stasis syndromes; mild cases use Tao Ren Chengqi Tang, severe cases use Didang Tang.)
Zhuling Tang (Polyporus Decoction)
Zhuling (Polypori Umbellati, 猪苓) - peeled
Fuling (Poria, 茯苓)
Ejiao (Asini Corii Colla, 阿胶)
Zexie (Alismatis Rhizoma, 泽泻)
Huashi (Talcum, 滑石) - half liang each
All ingredients are coarsely chopped. Take five qian per dose, decoct in water, take warm, three times daily.
Thirst with head sweating, difficulty urinating, accompanied by hypochondriac fullness and alternating chills and fever, requires Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). If accompanied by jaundice, Yinchen Hao Tang (Artemisiae Scopariae Herba Decoction) is used. (See discussion under Head Sweating.)
If the exterior is unresolved, there is fluid retention in the epigastrium, dry heaving, fever, cough, and thirst, Xiao Qinglong Tang (Minor Green Dragon Decoction) with Banxia removed and Gualou Gen added is used. (See discussion under Cough.)
In summer, sweating, aversion to cold, body heat, cold feet, and thirst indicate Zhongshu (Heatstroke). Baihu Jia Renshen Tang and Jiuhuanglian (Alcohol-processed Coptidis Rhizoma) are indicated. (Formula under Heatstroke. Aversion to cold and body heat mimic exterior syndrome, but cold feet contraindicate exterior-releasing methods.)
Fever, aversion to cold, abdominal fullness, sweating, free urination, and thirst indicate Liver overacting on Spleen; puncture Qimen (LR14). (See discussion under Abdominal Fullness. If the exterior is resolved, no aversion to cold, but thirst, Baihu Tang is suitable. (Formula discussion under previous Yangming section.)
Thirst with hypochondriac fullness and alternating chills/fever, where sweating has not yet been induced, requires Xiaochaihu Tang (Minor Bupleurum Decoction) with Banxia removed and Renshen plus Gualou Gen added. If sweating or purgation has already been performed, Chaihu Guizhi Ganjiang Tang is used. (See detailed discussion under Hypochondriac Pain and Alternating Chills/Fever.)
Thirst with hard and painful epigastrium, afternoon tidal fever, and constipation indicates Jie Xiong (Chest Binding); Da Xiexiong Tang (Major Chest-Binding Decoction) is suitable. If hard but painless, it is Pi (Glomus); Xixin Tang (Heart-Piercing Decoction) is given. If unresolved, worsening thirst, and difficulty urinating, Wuling San is suitable. (See detailed discussion under Chest Binding and Glomus sections.)
When a disease in the Yangming stage should be treated with sweating, but instead is sprayed/washed with cold water, the heat increases irritability, skin develops gooseflesh, there is a desire to drink water but no actual thirst, Wen Ge San (Clam Shell Powder) is administered.
If not improved, Wuling Tang is given. (See discussion under Chest Binding.)
Wen Ge San (Clam Shell Powder)
Wenge (Venerupis Pulchella Shell / Haige Fen, 文蛤) - one liang (This is Seashell Powder. Liu Hejian and Zhu Danxi often used it; it greatly resolves phlegm.)
One ingredient, ground into powder, taken with boiling water using a square-inch measure.
Thirst desire for water but inability to drink indicates heat in the Dantian and cold in the chest. (See discussion under Damp Bi.)
Wind-stroke with fever, unresolved after six to seven days with irritability, presenting both exterior and interior symptoms, thirst desire for water, and vomiting immediately after drinking is named Shui Ni (Water Reversal); Wuling San is indicated.
Thirst desire for water: if after Taiyang sweating with profuse sweat, irritability, and insomnia occurs, or in Jueyin disease with Qi rushing to the heart, heart pain, and vomiting worms, giving small amounts of water leads to recovery. (See previous clause and Qi Rushing Up clause.) For any epidemic disease reaching day five or six, if the patient is thirsty for water but cannot drink much, do not give it. Why? Because residual heat in the abdomen is insufficient to transform the water; giving more water creates pathology. By day seven or eight, if there is extreme thirst, give water according to symptoms, but always ensure the amount is insufficient, do not let them drink to satiety. Meaning: if they can drink one dou, give only five sheng. If after drinking there is abdominal fullness, difficulty urinating, wheezing, or hiccups, do not give more. Sudden profuse sweating indicates spontaneous recovery. (Huoren Shu states: In any illness, unless extremely thirsty, do not force water intake. For mild thirst with dry throat, swallow small amounts to moisten, allowing Stomach Qi to harmonize.)
Generally, if a patient can drink water during illness, it indicates impending recovery. However, merely hearing that drinking water cures illness, and forcing water on those with mild thirst, causes water retention pathology that cannot be saved. (Huoren Shu states: Forcing water leading to retention in the epigastrium, fullness, binding, and wheezing should be treated with Wuling San or Xiexiong Tang.) In dysentery, if the pulse is weak, rapid, and accompanied by thirst, recovery is likely. (See discussion under Diarrhea.) Thirst with fever, where the pulse is not wiry/tight but floating/weak, resolves with sweating. (See discussion under Delirium.)
In Yangming disease, if sweating is profuse and there is thirst, Zhuling Tang must not be given, because profuse sweating causes Stomach dryness; administering Zhuling Tang would further drain fluids via diuresis.
Above quotes Huoren Shu: Strictly avoid giving Baihu Tang to Taiyang cases with no sweating and thirst; strictly avoid giving Zhuling Tang to Yangming cases with profuse sweating and thirst. However, is Baihu Tang never appropriate for Taiyang thirst? After Taiyang sweating, if the pulse is flooding and there is thirst, Baihu Tang may be used. Is Zhuling San never appropriate for Yangming thirst? If Yangming presents with difficulty urinating, less sweating, floating pulse, and thirst, Zhuling San may be used.