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Wuling San (Formula see in the chapter on Convulsions)

*Xiaofang Lun* records: In pediatric polydipsia, excessive water intake leads to abdominal distension and diarrhea. This disease originates from heat in the Heart Zang; as the Heart and Small Intestine are exterior-interiorly related, the Small Intestine also receives heat. Once the Small Intestine is heated, its Qi ascends and rushes to the stomach opening, causing the child to desire water. When this water reaches the Small Intestine, it is permeated and excreted by the intestinal heat before it can transfer to the Large Intestine. To treat this, one should first administer diuretic medicines, then administer medicines to cool the Heart Zang, and finally stop the thirst, which will be effective.

Commentary: This also falls under the indications for Wuling San.

*Xiaofang Lun* formula to treat polydipsia by first using diuretics:
Jinyu (Curcumae Radix), Huashi (Talcum), each 1 liang; Hanlianzi (Elaeocarpus decipiens Seed), 0.5 liang.
Grind the above into powder. Take half a qian each time, mixed with Scallion Decoction. Urgently take three doses of cooling Heart medicines.

*Xiaofang Lun* formula to stop thirst by subsequently cooling the Heart Zang:
Wzeiyu Gu (Sepiae Endoconcha), Haifushi (Pumex), each 1 liang; Puhuang (Typhonii Rhizoma Pollen), stir-fried, 0.5 liang.
Grind the above into powder. Take half a qian each time, taken with Loquat Leaf Decoction.

Qian Yi discussed similar jaundice symptoms saying: When the body skin and eyes are yellow, it is a Yellow Disease. Body pain, stiffness in the arms and back, difficulty in urination and defecation, full-body yellowing, yellowing of the face, eyes, and nails, urine the color of house dust, objects appearing yellow, and thirst indicate a difficult-to-treat case; this is Huangdan (Jaundice). These two conditions often occur after severe illnesses. There is another condition where the body is slightly yellow not due to post-illness weakness but due to Stomach Heat, which also applies to adults. There is also facial yellowing with abdominal distension, geophagia (eating earth), and thirst, known as Pi Gan (Spleen Malnutrition). Those born with yellow skin have Tai Dan (Fetal Jaundice). Ancient texts state that all types of jaundice are heat syndromes; deep yellow indicates this. If the yellow is pale and mixed with white, it indicates weak Stomach Qi and disharmony. *Nanzhi* states: A color like smoked yellow indicates a Dampness disease with full-body pain. A color like orange yellow indicates a Yellow Disease without body pain. Dry, yellow, and parched with free urination, heavy limbs absent, and thirst with desire to drink indicates Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction). Wet yellow belongs to the Spleen, with difficult urination, heavy limbs, apparent thirst but no desire to drink, indicating Da Yincheng Tang (Large Coptis Decoction). Free defecation with yellow stool indicates Yincheng Zhizi Huanglian Sanwu Tang (Coix Seed, Gardenia, and Coptis Three-Ingredient Decoction). Alternating chills and fever with full-body yellowing indicates Xiao Chaihu Jia Zhizi Tang (Minor Bupleurum Decoction plus Gardenia). Jiegu stated: Yang Huang involves red and difficult urination/defecation and body heat, resulting from the struggle between Spleen Earth and Heart Fire; it is a Yang syndrome. The method requires first promoting urination, then purging the bowels. Yin Huang presents with normal urination/defecation, yellowing of the face/body, and cold limbs, resulting from Spleen deficiency failing to control Kidney Water; one should use Yihuang San (Yellow-Boosting Powder) and Shi Junzi Wan (Quisqualis Pill) (Yihuang San formula see in Spleen chapter, Shi Junzi Wan formula see in Gan accumulation chapter). For treating abdominal distension in Yellow Disease, use Yinchen Hao Tang (Artemisia Capillaris Decoction) to mix with Wuling San. To promote urination, remove Dahuang (Rhei Radix et Rhizoma). To promote defecation, add Dahuang or similar herbs. Yang syndromes are suitable for those with red faces and desire to drink. Tang Shi stated: Body pain, arm/back pain, difficult urination/defecation, yellowing of skin/face/teeth/nails, and urine like house dust; if urination is free, it is easy to treat; if difficult, it is hard to treat. One should take Wuling San plus Yinchen decocted and mixed, or Daochi San (Coptis Decoction) plus Yinchen decocted. If there is body heat, take Xiao Chaihu Tang (Minor Bupleurum Decoction); if severe, take Chengqi Tang (Chengqi Decoction). [Zeng] All Yellow Disease cases cannot be treated uniformly; the root and branch differ, so diagnosis and treatment vary. This arises from Spleen and Stomach Qi deficiency, contracting Damp-Heat, which stagnates in the couli (interstices), invades the skin, accumulates to form yellow, and steams outward. Alternatively, Spleen/Stomach weakness combined with internal phlegm-stasis masses, aggravated by aggressive treatment, can cause it. However, Gan diarrhea also manifests with yellow skin, erect hair, large abdomen with visible veins, emaciation, lack luster, and inevitable body yellowing; this stems from Gan disease. Treatment: If caused by Damp-Heat, with skin yellow like smoke, use coarse-cut Wuling San plus Mahuang (Ephedrae Herba) and Shengjiang (Zingiberis Rhizoma Recens) decocted to induce sweating for cure. Alternatively, Yinchen Hao Tang mixed with Wuling San is good. If caused by Gan/phlegm-stasis, resembling loess yellow, use Xingpi San (Spleen-Awakening Powder for Slow Convulsion) and Hua Pi Wan (Stasis-Dissolving Pill for Accumulation) to awaken the Spleen and quicken the Stomach, grind away accumulation, and regulate Gan. Once Stomach Qi harmonizes, food intake doubles, essence is transformed, nourishing the body, irrigating organs, allowing the five colors to appear in their respective regions, and essence forms the complexion, the yellow will naturally disappear. [Xue] The Classics state: Central yellow corresponds to the Spleen; thus, Huangdan is the color of the Spleen. The spirit of the human body prefers concealment; if revealed externally, the interior is deficient. These syndromes result from Spleen Qi deficiency, failure of transformation and transportation, and Damp-Heat remaining in the skin and muscles, manifesting as jaundice—what Qian Zhongyang described as body pain, back stiffness, difficult urination/defecation, and full-body yellowing including face and nails. Dark brown urine indicates a difficult prognosis. Therapy should prioritize securing the Spleen. Using only harsh draining, middle-expanding, or diuretic medicines rarely avoids critical danger. For newborns up to six months old, yellowing not due to illness is Wei Re Tai Huang (Stomach Heat Fetal Jaundice). Large abdomen with geophagia is Pi Gan. With thirst and desire for cold drinks, use Xiehuang San (Draining Yellow Powder for Spleen). With difficult urination, use Yincheng Tang. Post-illness yellowing with limb edema uses Baizhu San (Atractylodes Macrocephala Powder for Thirst). Normal urination/defecation with cold limbs and lethargy uses Yihuang San (Spleen). Pale yellow-white skin uses Tiao Zhong Wan (Middle-Harmonizing Pill for Abdominal Pain) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction for Deficiency Heat) plus Yinchen. Body heat, chest fullness, and full-body yellowing uses Jiajian Xiehuang San (Modified Draining Yellow Powder). To differentiate causes: closed eyes, high fever, incessant crying, red/difficult urination/defecation, and hot breath indicate maternal consumption of rich flavors during pregnancy, leading to fetal toxin signs. Mother and infant should both take Shengdihuang Tang (Rehmannia Root Decoction for Fetal Jaundice), avoiding alcohol, wheat, pungent spices, and hot foods. Without caution, damaging Spleen Earth may lead to acute convulsions/vomiting/diarrhea or chronic limb edema, difficult urination, eye obstruction, and eventually Gan diseases. For yellowing due to Spleen deficiency, seek the cause within the Spleen and Stomach.