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Zhu Ling (Polypori Sclerotium, removed black skin) 18 zhu, Fu Ling (Poria, Poriae Cochlidia Sclerotium) 18 zhu, Ze Xie (Alismatis Rhizoma, Alisma orientale) 1 liang 6 zhu, Bai Zhu (Atractylodis Macrocephalae Rhizoma, Atractylodes macrocephala) 18 zhu, Gui Zhi (Cinnamomi Ramulus, Cinnamomum cassia) half liang.
The above five herbs are ground into a powder, further pounded in a mortar until uniform, mixed with rice water, and taken as one fangcun bi (a specific measuring spoon for powder) per dose, three times a day. After taking the medicine, drink plenty of warm water; recovery occurs when sweating ensues.

[Formula Analysis]
This formula targets the condition where pathogenic heat from the Taiyang meridian enters the Bladder fu-organ, leading to failure of Qi transformation and water metabolism. It is a medication for both exterior and interior aspects of the Bladder. One indication is "Water Reversal" (Shui Ni), characterized by vomiting immediately after drinking water; the other is "Xiao Ke" (Wasting-Thirst), characterized by excessive thirst and consumption of water. The Bladder is the residence of body fluids (Jin Ye); it can excrete urine only through Qi transformation. When pathogenic heat enters and combines with water to form pathology: if water predominates over heat, water stagnates and fails to transform, accumulating superiorly, thus causing vomiting upon drinking. This results from the failure of Bladder Qi transformation, leading to dysuria. If heat predominates over water, water is scorched by heat and consumed superiorly, causing immediate thirst after drinking. This results from exhaustion of Bladder fluids, leading to anuria. Both conditions present with dysuria, hence this formula governs them. However, if urination is spontaneous and normal, this formula must not be used, lest it severely damage body fluids, as such cases belong to the Yangming interior, making this formula contraindicated. Thus, Wu Ling San is not exclusively for treating water-heat complex, but is the primary formula for dysuria caused by water-heat retention. Jun herb Ze Xie (Alismatis Rhizoma) uses its salty and cold nature; saltiness directs action to the water residence, and coldness overcomes pathogenic heat. Assistant herbs Fu Ling (Poria) and Zhu Ling (Polyporus) use their bland and permeating nature to regulate water pathways, directing fluids downward to the Bladder, thereby draining both water and heat. Bai Zhu (Atractylodis Macrocephalae Rhizoma) employs its drying-dampness property to strengthen the Spleen and assist Earth, acting as a dike to control water. Gui Zhi (Cinnamomi Ramulus) utilizes its acrid and warm nature to diffuse and unblock Yang Qi, steaming and transforming the Triple Burner to promote water movement. With Ze Xie descending together with the two Polypori, the water-draining effect is doubled, resulting in free urination and no water retention. Bai Zhu ascending with Gui Zhi accelerates the effect of unblocking Yang, causing Qi to rise and fluids to transform, thereby stopping thirst. If fever persists, replace Gui Zhi with Rou Gui (Cinnamomi Cortex, though text implies modification context, strictly translating 'Gui' here as per source structure often implying branch vs trunk distinction or specific clinical adjustment, but standard Wu Ling San uses Gui Zhi; text says "replace Gui with Gui Zhi" which is contradictory to standard composition using Gui Zhi, likely meaning replace a different component or referring to a variation, but literal translation: "If fever does not resolve, replace [the current] Gui with Gui Zhi..."). *Correction based on standard TCM logic in commentary*: The text likely refers to a specific clinical nuance or variant. Literal translation: "If fever does not resolve, substitute [the ingredient] Gui with Gui Zhi..." (Note: Standard Wu Ling San contains Gui Zhi. Some commentaries suggest using Rou Gui for severe cold, but here it suggests changing TO Gui Zhi for sweating. This might be a textual variant or specific instruction for exterior release). After administration, drink more warm water to induce sweating for cure. This indicates that this formula not only treats the interior syndrome of water retention with dysuria but also resolves the exterior syndrome of fever due to water retention. Adding Ren Shen (Ginseng Radix et Rhizoma) creates Chun Ze Tang, specifically intended to assist Qi transformation to generate fluids. Adding Yin Chen (Artemisiae Scopariae Herba) creates Yin Chen Wu Ling San, effective for damp-heat jaundice with deficient exterior and interior and dysuria.

[Collection of Commentaries]
Cheng Yingmao stated: The Taiyang meridian is the Biao (exterior/superficial aspect), and the Bladder is the Ben (root/interior aspect). Wind-stroke with fever indicates the Biao is affected. If unresolved after six or seven days, the Biao pathogen transfers to the Bladder, termed "invading the Ben." Although Wu Ling San, Ma Huang Tang (Ephedra Decoction), and Gui Zhi Tang (Cinnamon Twig Decoction) are all medications for the Taiyang meridian, one releases the muscle layer to treat the exterior, while the other promotes urination to treat the interior; their indications for Biao and Ben are distinct.

[Annotation]
This clause refers to cases with both exterior and interior syndromes, distinguishing them from the Taiyang-Yangming exterior-interior syndromes characterized by fever with sweating, dry mouth, vexing thirst, consumption of water, and spontaneous normal urination. Instead, it refers to Taiyang-Bladder exterior-interior syndromes characterized by fever without sweating, moist mouth, vexing thirst, vomiting upon drinking, and dysuria. Although this disease description does not explicitly mention the symptoms of no sweating and dysuria, if there were sweating and free urination, the ingested water would escape via external diffusion or downward excretion, and Water Reversal would not occur. Zhang Zhongjing's use of Wu Ling San, instructing patients to drink warm water to induce sweating, aims at promoting urination and inducing sweating; therefore, it is inferred that symptoms of no sweating and dysuria must be present.

In Taiyang disease, if urination is free, excessive water intake will inevitably cause palpitations in the epigastrium (Xin Xia Ji); if urination is scanty, there will inevitably be distressing urgency in the lower abdomen (Li Ji).

[Note]
Initially in Taiyang disease, there is no desire for water; as it transmits to Yangming, there is desire for water. This is the norm. Now, in early Taiyang disease, there is excessive desire for water, indicating the person usually has dry Stomach. If Stomach Yang is not deficient, the ingested water can be distributed to the exterior and transformed into sweat for resolution. However, with excessive water intake and insufficient Stomach Yang, even if urination is free, water will stagnate in the Middle Jiao, causing palpitations in the epigastrium. If urination is additionally scanty, water stagnates in the Lower Jiao, causing distressing lower abdominal urgency.

[Collection of Notes]
Fang Youzhi said: Excessive water intake causing epigastric palpitations occurs because the Heart is a Fire organ; excess water suppresses it. Scanty urination leads to water stagnation, causing internal urgency.
Wang Hu said: In Taiyang disease, free urination indicates no pathogenic heat in the Bladder fu. If the person drinks excessively, this indicates heat in the Upper Jiao with hyperactive Heart Fire. Even with free urination, excessive drinking due to thirst causes water stagnation invading Fire, leading to epigastric palpitations. If the person drinks excessively but urinates little, this indicates heat in the Lower Jiao, where Taiyang pathogenic heat follows the meridian into the fu, causing water accumulation and stagnation, leading to distressing urgency in the Bladder interior.

After sweating, excessive water intake will inevitably cause wheezing/asthma; bathing/washing with water will also cause wheezing.

[Note]
The previous clause described excessive water intake before sweating, indicating Stomach heat and scanty fluids. This clause describes excessive water intake after sweating, indicating fluid loss and dry Stomach. The absence of epigastric palpitations and lower abdominal urgency indicates that water does not stagnate in the Middle or Lower Jiao, but accumulates in the Upper Jiao, attacking the Lung and causing wheezing. "Water irrigation" refers to washing the body with water. Wheezing from excessive water intake is due to consuming cold liquids, injuring the interior with cold. Wheezing from water washing is due to external chilling, injuring the exterior with cold. Both injure the Lung, hence both cause wheezing.

[Collection of Notes]
Wei Litong said: This clarifies that the wheezing in this clause is caused by water retention. Wheezing from drinking too much due to thirst and wheezing from washing with water despite no thirst have different causes but identical pathological mechanisms regarding disease induction.

After sweating, Gui Zhi Tang (Cinnamon Twig Decoction) must not be administered again. If there is sweating and wheezing without significant high fever, Ma Huang Xing Gan Shi Gao Tang (Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction) may be given.

[Note]
In Taiyang disease, if mild wheezing occurs after mistaken purgation, the exterior is unresolved; Gui Zhi Jia Hou Po Xing Zi Tang (Cinnamon Twig Decoction plus Magnolia Bark and Apricot Kernel) should be used to release the Taiyang muscle-layer exterior and treat wheezing. In Taiyang disease with Gui Zhi pattern, if mistaken purgation leads to diarrhea, rapid pulse, sweating, and wheezing with unresolved exterior, Ge Gen Huang Lian Huang Qin Tang (Kudzu, Coptis, and Scutellaria Decoction) should be used to clear Yangming muscle-heat and treat wheezing. Now, in Taiyang disease after sweating, if there is sweating and wheezing, without significant high fever and aversion to cold, it is known that the pathogen is no longer in the Taiyang exterior; since there is sweating without aversion to heat, the pathogen is also not in the Yangming interior. The presence of sweating and wheezing, despite lack of high fever and aversion to cold, indicates the pathogen resides solely in the Taiyin Lung meridian. Therefore, Gui Zhi Tang is contraindicated; instead, Ma Huang Xing Gan Shi Gao Tang should be given to disperse Lung pathogenic factors, resolving sweating and wheezing.