Library

The disease of Jueyin manifests as excessive thirst, Qi rushing upward to the heart, pain and burning sensation in the heart region, a sensation of hunger without desire to eat, vomiting of roundworms immediately after eating, and if purgatives are misused, it leads to unceasing diarrhea.
[Note] This clause describes the primary disease of the Jueyin meridian in "Shanghan Lun" (Treatise on Cold Damage), which differs from the meaning of Xiao Ke (Wasting-Thirst) in miscellaneous diseases; this must be due to misplaced bamboo slips.

The pulse at Cun Kou is floating and slow. Floating indicates deficiency, and slow indicates exhaustion from overwork. Deficiency results in insufficient Wei Qi (Defensive Qi), and exhaustion leads to the depletion of Ying Qi (Nutritive Qi).
[Note] This clause should belong in the chapter on Xu Lao (Deficiency and Emaciation); its presence here is also due to misplaced bamboo slips.
[Commentary] Cun Kou generally refers to the three positions (Cun, Guan, Chi) on both left and right wrists. A floating pulse with strength indicates Wind pathogen, while a floating pulse without strength indicates deficiency. If it is slow upon deep palpation, it is a diagnosis of Xu Lao (Deficiency and Emaciation), thus indicating insufficiency of defensive exterior Qi and depletion of nutritive interior Qi.

The pulse at Fu Yang (dorsalis pedis artery) is floating and rapid. Floating indicates excess Qi, and rapid indicates the ability to digest food accompanied by hard stools. Excess Qi leads to frequent urination; frequent urination leads to harder stools. The interplay of hardness and frequency constitutes Xiao Ke (Wasting-Thirst).
[Note] The phrase "and hard stool" is grammatically incomplete; there should likely be the character for "stool" after "hard," omitted during transcription.
[Commentary] Fu Yang refers to the Stomach meridian pulse. A floating and full pulse that is rapid upon pressure indicates heat in Stomach Qi, hence the propensity to digest food easily. Fire excess consuming food leads to hard stools; Qi excess consuming fluids leads to frequent urination. Thus, frequent urination implies hard stools. The interplay of these factors results in the disease of excessive digestion and Wasting-Thirst.

A rapid pulse at Fu Yang indicates heat in the Stomach, leading to excessive digestion and increased appetite, hard stools, and frequent urination.
[Commentary] This reiterates the significance of hard stools and frequent urination mentioned in the previous clause. In men suffering from Xiao Ke (Wasting-Thirst), urine output is abnormally high; if drinking one dou results in urinating one dou, Shen Qi Wan (Kidney Qi Pill) is indicated.
[Commentary] When fluid intake is high but urine output is low, fluids are consumed in the upper jiao, termed Upper Xiao (Upper Wasting-Thirst). When food intake is high but stools are hard, food is consumed in the middle jiao, termed Middle Xiao (Middle Wasting-Thirst). When fluid intake is high and urine output is correspondingly high, fluids are consumed in the lower jiao, termed Lower Xiao (Lower Wasting-Thirst). Upper and Middle Xiao are heat patterns; only Lower Xiao involves both cold and heat, as the Kidney is the organ of water and fire. Drinking one dou and urinating one dou indicates no heat consumption within. Therefore, Shen Qi Wan (Kidney Qi Pill) is used to warm and nourish Yang from within Yin, allowing Kidney Yin to retain fluids rather than flowing directly downward, and enabling Kidney Qi to ascend and transform into body fluids, thereby resolving Wasting-Thirst.
[Collected Commentary] Cheng Lin stated: Frequent urination leads to Wasting-Thirst. The classic states: "Drinking one dou and urinating two dou is incurable." Since here one dou of drinking yields one dou of urination, Shen Qi Wan is used. The moving Qi in the Kidney is the Life Fire within Water. The fire in the lower jiao Kidney steams the essence of water up to the upper jiao. If Lung Metal is clear and肃 (solemn/clear), like clouds rising and rain falling, water essence distributes widely, and the five meridians function together, avoiding Wasting-Thirst. However, this patient likely suffered improper regimen, leading to Kidney Water depletion. Dragon-Lei Fire rests uneasily below, flaring upward to damage Lung Metal. Lung heat scorches leaves, causing Wasting-Thirst and craving for drinks. Water enters the Stomach, spreads out, but lacks fire transformation below, entering the Bladder directly. Hence, one dou in, one dou out. Thus, Gui Fu Shen Qi Wan (Cinnamon Twig and Aconite Kidney Qi Pill) aids True Fire to steam and transform, ascending fluids, resolving Wasting-Thirst.
Shen Mingzong stated: The term "men" refers to cases where sexual exhaustion damages the Kidney, resulting in hyperactive Fire and deficient Water, forming Wasting-Thirst.
Shen Qi Wan Formula (See Chapter on Miscellaneous Diseases of Women)

If the pulse is floating, there is difficulty in urination, slight fever, and Wasting-Thirst, promoting diuresis and sweating is appropriate; Wu Ling San (Five-Ingredient Powder with Poria) is indicated.
[Commentary] A floating pulse indicates an external origin; slight fever with a floating pulse indicates heat in the exterior. Difficulty in urination indicates water retention in the interior. Water retention prevents the transformation of fluids, causing Wasting-Thirst. Only Wu Ling San can release the exterior, promote diuresis, stop thirst, and generate fluids; hence it is indicated. From this, we infer the previous clause described a sinking pulse; stating "slight fever" implies the previous case had no fever. Furthermore, it implies that all cases of Wasting-Thirst with a sinking pulse and no fever should use Shen Qi Wan.
Wu Ling San Formula (See Chapter on Phlegm-Fluids)

If there is a floating pulse, fever, craving for water, and difficulty in urination, Zhu Ling Tang (Polyporus Decoction) is indicated.
[Commentary] This shares similar text but different meaning with the previous clause. The similarities are floating pulse, difficulty in urination, fever, slight fever, craving for water, and Wasting-Thirst. The difference lies in treatment: one uses Wu Ling San to promote diuresis and induce sweating, while the other uses Zhu Ling Tang to promote diuresis and nourish dryness. The reason for this difference lies in the presence or absence of sweating. One aims to induce sweating, implying no prior sweat; the other aims to nourish dryness, implying prior sweat. Thus, similar text but different meaning, same disease but different treatment. Zhang Zhongjing's works contain many implicit meanings; students should comprehend them through insight.
Zhu Ling Tang Formula
Zhu Ling (Polyporus, peeled), Fu Ling (Poria), E-Jiao (Donkey-Hide Gelatin), Hua Shi (Talcum), Ze Xie (Alisma) (each 1 liang)
Crush the above five herbs. Boil in 4 sheng of water, first decocting the four ingredients except E-Jiao to obtain 2 sheng. Remove dregs, dissolve E-Jiao into the liquid, and take 7 he of the warm decoction, three times daily.

Craving for water with dry mouth and tongue is treated with Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction).
[Commentary] Wasting-Thirst causes craving for water. If water is consumed immediately yet dry mouth and tongue persist, it indicates flourishing pathogenic heat. Thus, Bai Hu Jia Ren Shen Tang is used to clear heat and generate fluids.
Bai Hu Jia Ren Shen Tang Formula (See Chapter on Heat Stroke)

Craving for water with immediate vomiting after ingestion is named Shui Ni (Water Reversal); Wu Ling San (Five-Ingredient Powder with Poria) is indicated.
[Commentary] Craving for water with immediate vomiting, named Shui Ni (Water Reversal), indicates mild interior heat but strong pathogenic water. Thus, Wu Ling San is used to promote diuresis and stop vomiting.
[Collected Commentary] Li said: Accumulated water inside causes rejection and vomiting upon ingestion, named Shui Ni. Wu Ling San promotes diuresis, hence it is indicated.

Craving for water that is unceasing is treated with Wen Ge San (Clam Shell Powder).
[Commentary] Craving for water with immediate vomiting and difficulty in urination is a Wu Ling San pattern; craving for water with immediate consumption and dry mouth/tongue is a Bai Hu Jia Ren Shen Tang pattern. Craving for water without vomiting indicates pathogenic water is not strong; lack of dry mouth/tongue indicates pathogenic heat is not strong. Only unceasing craving for water warrants Wen Ge San. It is neither cold nor warm, neither clearing nor draining, but specifically focuses on generating fluids and stopping thirst. Some say Wen Ge Clam is the flower clam eaten in Wu, cold in nature and salty in taste, promoting diuresis and overcoming heat, but repeated trials failed. I researched that Wu Bei Zi (Galla Chinensis) is also called Wen Ge. Prepared according to method, it is named Bai Yao Jian (Hundred Medicines Decoction), which greatly generates fluids and stops thirst. I have used it with consistent success.
Wen Ge San Formula
Wen Ge (Clam Shell) (5 liang)
Crush the single ingredient into powder. Mix with 5 he of boiling water and take one fang cun bi (square-inch measure) per dose.

Difficulty in urination with fluid retention, where the person suffers from intense thirst, is treated with Gua Lou Qu Mai Wan (Trichosanthes Root and Epimedium Pill).
[Commentary] Difficulty in urination indicates water accumulation in the Bladder. Intense thirst indicates failure to transform fluids. Shan Yao (Dioscorea) and Gua Lou Gen (Trichosanthes Root) moisten dryness and generate fluids, stopping thirst. Fu Ling (Poria) and Qu Mai (Epimedium) drain and promote diuresis, relieving urinary difficulty. Pao Fu Zi (Prepared Aconite) disseminates and unblocks Yang Qi, steaming fluids upward and guiding water downward. This is a modification of Shen Qi Wan. However, the patient must have a sinking pulse and no fever to fit this formula.
Gua Lou Qu Mai Wan Formula
Gua Lou Gen (Trichosanthes Root, i.e., Tian Hua Fen) (2 liang), Fu Ling (Poria) (3 liang), Shan Yao (Dioscorea) (3 liang), Fu Zi (Aconite, prepared) (1 piece), Qu Mai (Epimedium) (1 liang)
Grind the five ingredients into powder, mix with refined honey, and make pills the size of bird seeds. Take 3 pills with water, three times daily. If ineffective, increase to 7-8 pills. Effectiveness is confirmed by free urination and warmth in the abdomen.
[Collected Explanation] Li said: This formula, like Wu Ling San, promotes diuresis and generates fluids. Using Shan Yao here corresponds to using Bai Zhu (Atractylodes) in Wu Ling San. However, Wu Ling San addresses exterior slight heat, using Gui Zhi (Cinnamon Twig) to reach the exterior; this formula addresses interior fluid retention, using Fu Zi (Aconite) to warm the lower jiao.
You Yi said: This is a pattern of weak Yang Qi and cold in the lower jiao, preventing water movement. Thus, Fu Zi tonifies Yang Qi, while Fu Ling and Qu Mai move water Qi. The note "warmth in the abdomen indicates effectiveness" supports this. Intense thirst suggests water Qi knots in the lower jiao while dry-fire gathers in the upper jiao. The flaming fire floating up cannot be extinguished without nourishment; the yin accumulation settling down cannot be dispersed without warming. Cold-moistening and acrid-warming agents work in harmony; this formula is an excellent method. Those seeking flexibility should reflect deeply on this.

Difficulty in urination is treated with Pu Hui San (Cat-Tail Powder). Hua Shi Bai Yu San (Talcum and White Fish Powder) and Fu Ling Rong Yan Tang (Poria and Salt Decoction) are also indicated.
[Commentary] Without exterior or interior other symptoms, difficulty in urination with thirst indicates Wasting-Thirst pathogenic water disease; difficulty in urination without thirst indicates Long Bi (Urinary Obstruction). Pu Hui San and Hua Shi Bai Yu San are indicated because Pu Hui (Cat-Tail Spadix) and Luan Fa (Burned Hair) are blood-level herbs, while Hua Shi (Talcum) and Bai Yu (White Fish, likely pterygotus or similar) are diuretics. This implies water stagnation in the blood level. Observing Dong Yuan using Tong Guan Wan (Pass Through Pill) for difficulty in urination due to heat stagnating in the blood level shows that blood-level issues often present without thirst. Fu Ling Rong Yan Tang is indicated because Fu Ling (Poria) is lightly penetrating, Bai Zhu (Atractylodes) dries dampness, and Rong Yan (Rocksalt) moistens and descends. This implies damp-water stagnation in the lower jiao. Salt is contraindicated for thirsty patients; the use of Rocksalt implies the absence of thirst.
[Collected Commentary] Wei Litong said: The causes of difficulty in urination vary, and treatments differ. Master Zhong listed three formulas side-by-side for practitioners to choose the most suitable.

Pu Hui San Formula
Pu Hui (Cat-Tail Spadix) (7 parts), Hua Shi (Talcum) (3 parts)
Crush the two ingredients into powder. Take one fang cun bi with water, three times daily.

Hua Shi Bai Yu San Formula
Hua Shi (Talcum) (2 parts), Luan Fa (Burned Hair) (3 parts), Bai Yu (White Fish) (2 parts)
Crush the three ingredients into powder. Take half a qian bi with water, three times daily.

Fu Ling Rong Yan Tang Formula
Fu Ling (Poria) (0.5 jin), Bai Zhu (Atractylodes) (2 liang), Rong Yan (Rocksalt) (size of a bullet-sized pill)
Boil the three ingredients in 5 sheng of water, reduce to 3 sheng, and divide into three warm doses.

The disease of Lin (Strangury) presents with urine resembling millet grains, tension and urgency in the lower abdomen, and pain radiating to the umbilicus.
[Commentary] Both difficulty in urination and Lin disease may present with tension/urgency in the lower abdomen and pain radiating to the umbilicus. However, in difficulty in urination, the water passage is sluggish and scanty but painless; in Lin disease, urination is frequent, the passage is sluggish and scanty, and painful. Urine resembling millet grains is what is now called Shi Lin (Stone Strangury).
Patients with Lin disease should not undergo sweating therapy; inducing sweating will inevitably lead to hematuria.
[Commentary] Lin disease is caused by damp-heat accumulating in the Bladder. If sweating is induced, dampness leaves with sweat, but heat remains alone. The water reservoir becomes depleted, and heat forces Yin blood out through the urine, resulting in Xue Lin (Blood Strangury).
[Collected Commentary] Gao Shishi said: The Bladder fluids of Lin patients are initially deficient, so sweating is contraindicated. Inducing sweating further depletes fluids, leading to Bladder Qi exhaustion and emptiness in the Bao (Uterus/Bladder). Thus, hematuria occurs. Bian Xue (blood in stool/urine) refers to hematuria.