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In cases of diarrhea and dysentery, thirst is commonly present. Nowadays, people often attribute thirst solely to "fire" (heat pathogen), failing to realize that while excess fire can cause thirst, the absence of fire can also lead to it; this distinction must be carefully discerned. If heat is excessive within the middle jiao, it steams the spleen and scorches the stomach, consuming body fluids. Consequently, patients have an intense craving for ice water, drinking large amounts without satiety, finding greater relief with colder temperatures, and digesting it immediately upon ingestion. This type of thirst is caused by heat and should be treated with cooling methods. Conversely, if a patient feels heat in the mouth and desires water but cannot drink much, this is not true fire, and cooling treatments are inappropriate. In cases where the mouth is dry and thirsty, preferring coolness yet unable to tolerate cold, this indicates cold accumulation in the interior with rootless floating fire rising to the upper jiao; such conditions strictly contraindicate the use of cold and cool herbs.

Thirst can be categorized as true thirst or apparent thirst. True thirst involves a desire to drink tea or water; distinguishing between preference for hot or cold drinks allows differentiation between cold and heat patterns. Apparent thirst refers to dryness rather than true thirst; although the mouth is dry, there is no desire to drink, which clearly indicates a non-heat pattern. In diarrhea and dysentery, fluid loss from the lower body leads to depletion of fluids in the upper body, inevitably causing thirst. The desire to drink arises because internal fluids are insufficient and external fluids are needed to replenish them; this is not necessarily due to fire. Such cases require careful examination to determine the presence or absence of fire. If there is excess fire, clearing the fire is appropriate; if there is fluid deficiency, nourishing yin is appropriate. However, qi is the mother of water; if qi deficiency fails to generate water, tonifying the mother (qi) is necessary, otherwise water generation will fail, and thirst will persist. Earth (the Spleen) is the master of water; if spleen deficiency fails to control water retention, strengthening the master (spleen) is required, otherwise water storage will fail, and thirst will continue. By treating the root cause of thirst rather than the symptom itself, the condition of thirst can be resolved.

In cases of diarrhea and dysentery, urination is often difficult or scanty, and may appear yellow or reddish. The relationships among cold, heat, deficiency, and excess are significant and must be observed carefully. In acute violent diarrhea, due to the failure to separate clear from turbid, food and water mix and enter the large intestine, resulting in temporary difficulty in urination. However, regarding urination in dysentery, the etiology varies. Many practitioners assume that yellow and difficult urination always indicates heat, leading to frequent errors. Heat-induced cases typically present with severe redness,涩痛 (astringency and pain), or fresh blood, and crucially, heat signs must be present both above and below to confirm true heat, warranting cooling treatment. If it is not true heat, causes may include: cold in the middle jiao forcing yang downward; yin depletion from prolonged diarrhea/dysentery altering urine color; lack of warming from lower jiao yang qi preventing water transformation; or improper use of diuretics drying up body fluids. If the three jiaos show no fire, even with yellow or astringent urination, these are signs of yin and fluid exhaustion, not heat. Rapid tonification of true yin is the proper method. As stated in the *Neijing*: "Deficiency of central qi leads to abnormalities in urination and defecation." How profound this statement is! Why do modern practitioners fail to observe this? Furthermore, I often see patients with clear, white urine accompanied by abdominal pain who are still prescribed bitter-cold herbs like Huangqin (Scutellariae Radix) and Lianzi (Coptidis Rhizoma). I truly do not understand the rationale behind this. It is regrettable indeed.