降逆。加茯苓去其停水。盖始虽渴而终为饮。但当治饮。而不必治其渴也。
〔魏〕水停心下。阻隔正气。不
化生津液。上于胸咽。故渴也。渴必饮水。水得水而愈恣其冲逆。所以先渴而后必呕也。
此属饮家。当治其饮。不可以为渴家治其渴也。
案脉经所载三条。恐本经旧文。系于脱漏。今备录于下。
脉经云。咳而时发热。脉卒弦（千金。作在九菽。）者。非虚也。此为胸中寒实所致也。当吐之。
又云。咳家其脉弦。欲行吐药。当相人强弱。而无热乃可吐之。其脉沉者。不可发汗。
又云。病患一臂不随。时复转移在一臂。其脉沉细。非风也。必有饮在上焦。其脉虚者。为微劳。
荣卫气不周故也。
久久自瘥。
厥阴之为病。消渴气上冲心。心中疼热。饥而不欲食。食即吐蛔。下之不肯止。
〔鉴〕按此条是伤寒论厥阴经正病。与杂病消渴之义不同。必是错简。
喻氏法律云。消渴之证。内经有其论无其治。金匮有论有治矣。而集书者。采伤寒论厥阴经消渴之文
凑入。后人不能决择。斯亦不适于用也。盖伤寒热邪。至厥阴而尽。热势
入深。故渴而消水。及热解则不渴。且不消矣。岂杂证积渐为患之比乎。
寸口脉浮而迟。浮即为虚。迟即为劳。虚则卫气不足。
劳则荣气竭。（诸本。接下条为一条。今根据金鉴分出。）
〔鉴〕按此条当在虚劳篇中。错简在此。寸口通指左右三
部而言也。浮而有力为风。浮而无力为虚。按之兼迟。即为虚劳之诊。故主卫外营内虚竭也。
趺阳脉浮而数。浮即为气。数即消谷。而大坚。（一作紧。）气盛则溲数。溲数即坚。
坚数相搏。即为消渴。（脉经坚字。并作紧。金鉴云。而大坚句。不成文。大字之下。当有便字。必是传写
之讹。魏云。大坚。即大便坚也。一作紧。非。）
〔程〕趺阳。胃脉也。内经曰。三阳结谓之消。胃与大肠。谓之三阳。以其热结于中。则脉浮而数。内
经又曰。中热则胃中消谷。是数即消谷也。气盛。热气盛也。谷消热盛。
则水偏渗于膀胱。故小便数而大便硬。胃无津液。则成消渴矣。此中消脉也。
外台古今录验论云。消渴病有三。一渴而饮水多。小便数有脂。似麸片甘者。皆是消渴病也。二吃食多。
不甚渴。小便少似有油而数者。此是消中病也。三渴饮水不能多。但腿肿脚先瘦小。阴痿弱数小便者。此是肾
消病也。又东垣试效方云。高消者。舌上赤裂。大渴引饮。逆调论云。心移热于肺。传为膈消者。是也。以白
虎加人参汤治之。中消者。善食而瘦。自汗。大便硬小便数。叔和云。口干饮水。多食饥虚。 成消中者。是
也。以调胃承气三黄丸治之。下消者。烦渴引饮。耳叶焦干。小便如膏。叔和云。焦烦水易亏。此
肾消也。以八味丸治之。总录所谓末传能食者。必发脑疽背疮。不能食者。必传中满鼓胀。皆谓不治之证。○案
据此论。本节之症。即是消中之谓。
男子消渴。小便反多。以饮一斗。小便一斗。肾气丸主之。（方见妇人杂病中。）
〔程〕小便多则消渴。内经曰。饮一溲二者不治。（出气厥论。）今饮一溲一。故与肾气丸治之。肾
中之气。犹水中之火。地中之阳。蒸其精微之气。达于上焦。则云升而雨降。上焦得以如雾露之溉。肺金滋
润。得以水精四布。五经并行。斯无消渴之患。今其人也。摄养失宜。肾水衰竭。龙雷之火。不安于下。但
炎于上。而刑肺金。肺热叶焦。则消渴引饮。其饮入于胃。下无火化。直入膀胱。则饮一斗。溺亦一斗也。
此属下消。
〔尤〕盖水液属阴。非气不至。气虽属阳。中实含水。水之与气。未尝相离也。肾气丸中。有桂
附。所以斡旋肾中颓堕之气。而使上行心肺之分。故名曰肾气。不然。则滋阴润燥之品。同于饮水无济。但
益下趋之势而已。驯至阳气全消。有降无升。饮一溲二而死不治。夫岂知饮入于胃。
非得肾中真阳。焉能游溢精气。而上输脾肺耶。
〔沈〕男子二
字。是指房劳伤肾。火旺水亏。而成消渴者。
外台。近效祠部李郎中论云。消渴者。原其发动。此则肾虚所致。每发即小便至甜。按洪范。稼穑作甘。
以物理推之。淋饧醋酒作脯法。须臾即皆能甜也。足明人食之后。滋味皆甜。流在膀胱。若腰肾气盛。则上蒸
精气。气则下入骨髓。其次以为脂膏。其次为血肉也。其余别为小便。故小便色黄。血之余也。HT 气者。五脏之
气。咸润者。则下味也。腰肾既虚冷。则不能蒸于上。谷气则尽下为小便者也。故甘味不变。其色清冷。则
肌肤枯槁也。又肺为五脏之华盖。若下有暖气蒸即肺润。若下冷极。即阳气不能升。故肺干则热。
譬如釜中有水。以火暖之。其釜若以板盖之。则暖气上腾。故板能润也。若无火力。水气则不上。此板终不
可得润也。火力者。则为腰肾强盛也。常须暖将息。其水气即为食气。食气若得暖气。即润上而易消下。亦
免干渴也。是故张仲景云。宜服此八味肾气丸。又张仲景云。足太阳者。是膀胱之经也。膀胱者。是肾之腑
也。而小便数。此为气盛。气盛则消谷。大便硬。衰则为消渴也。男子消渴。饮一斗。小便亦
得一斗。宜八味肾气丸主之。神方。消渴人。宜常服之。
即本方。但用山茱萸五两桂附各三两。
吴氏方考云。是阴无阳而不升。阳无阴而不降。水下火上。不相既济耳。故用肉桂附子之辛热。壮其少
火。用六味地黄丸。益其真阴。真阴益则阳可降。少火壮则阴自升。故灶底加薪。枯笼蒸溽。槁禾得雨。生
意惟新。明者知之。昧者鲜不以为迂也。
陈氏外科精要云。一士大夫病渴。治疗累岁不安。一名医使服八味丸。不半载而疾痊。因疏其病源云。
今医多用醒脾生津止渴之药误矣。其疾本起于肾水枯竭。不能止润。是
以心火上炎。不能既济。煎熬而生渴。今服此药。降心火生其肾水。则渴自止矣。
即本方。以真北五味子。代附子。圣济直指同。朱氏集验云。治消渴。八味丸。去附子。加五味子。用
茧空。及茄空。煎汤下。
严氏济生方。加减肾气丸。治劳伤肾经。肾水不足。心
火自用。口舌焦干。多渴而引饮。精神恍惚。面赤心烦。腰痛脚弱。肢体羸瘦。不能起止。
本方。去附子。加五味子鹿角沉香。弱甚者加附子。
方勺泊宅编云。提点铸钱朝奉郎黄沔久病渴。极疲悴。予每见必劝服八味丸。初不甚信。后累医不痊。
谩服数两遂安。或问渴而以八味丸治之何也。对曰。汉武帝渴。张仲景为处此方。盖渴多是肾之真水不足致
然。若其势未至于 。但进此剂殊佳。且药性温平无害也。案汉武仲景相去数百年。
盖不过一时作此杜撰之言。取信于俗士耳。
脉浮。小便不利。微热消渴者。宜利小便发汗。五苓散主之。（方见上。）
〔徐〕脉浮微热。是表未清也。消渴小便不利。是里有热也。故以桂枝主表。白术苓泽主里。而多以
热水助其外出下达之势。此治消渴之浅而近也。按此与上条。同是消渴。上条小便多。知阴虚热结。此条小
便不利。而微热。即为客邪内入。故治法迥异。然客邪内入。非真消渴也。合论以示辨耳。
渴欲饮水。水入则吐者。名曰水逆。五苓散主之。（方见上。）
〔尤〕热渴饮水。热已消而水不行。则逆而成呕。乃消渴之变证。曰水逆者。
明非消渴。而为水逆也。故亦宜五苓散。
去其停水。
〔沈〕此亦非真消渴也。
渴欲饮水不止者。文蛤散主之。
〔鉴〕渴欲饮水。水入则吐。小便不利者。五苓散证也。渴欲饮水。水入则消。口干舌燥者。白虎加
人参汤证也。渴欲饮水。而不吐水。非水邪盛也。不口干舌燥。非热邪盛也。惟引饮不止。故以文蛤一味。不
寒不温。不清不利。专意于生津止渴也。
案金鉴云。五倍子。亦名文蛤。按法制之名百药煎。大能生津止渴。故当用之。屡试屡验也。此说本
于三因方。百药煎。于生津止渴固效矣。然其药出于后世。本条所用。即所谓花蛤也。○以上三条。详见伤
寒论辑义。
文蛤散方
文蛤（五两○俞本作四两）
上一味。杵为散。以沸汤五合。和服方寸匕。
淋之为病。小便如粟状。小腹弦急。痛引脐中。
〔徐〕淋之为病。全在下焦。故前十一篇内。言下焦有热。亦主淋闭不通。此言小便如粟状。粟者
色白。而滴沥甚。则如米屑也。然气血不同。故后人有五淋之名。小腹气不和。失其浑浓之元则弦急矣。热邪
上乘。则痛引脐中矣。
〔尤〕按巢氏云。淋之为病。由肾虚而膀胱热也。肾气通于阴。阴。水液下流之道也。
膀胱为津液之腑。肾虚则小便数。膀胱热则水下涩。数而且涩。淋沥不宣。故谓之淋。其状小便出少起多。小腹
弦急。痛引于脐。又有石淋劳淋血淋气淋膏淋之异。详见本论。其言颇为明晰。可补仲景之未备。
案如粟状。根据巢源出少起多之语。唯言滴沥短少。如米
屑耳。云色白。殆凿矣。沈程以下诸注。皆以为石淋。然以理推之。小便下砂石。不宜言如粟状。故今从徐注。
三因方云。淋。古谓之癃。名称不同也。癃者。罢也。淋者。滴也。今名虽俗。于义为得。
趺阳脉数。胃中有热。即消谷引食。大便必坚。小便即数。（程本。以此条。列于前趺阳脉浮而数
云云。即为消渴之后。是。魏本细书此条于上格云云。义与前同。故未另注。）
〔尤〕胃中有热。消谷引饮。即后世所谓消谷善饥为中消者。是也。胃热则液干。故大便坚。便坚则水液
独走前阴。故小便数亦即前条消渴胃坚之证。而列于淋病之下。疑错简也。
淋家不可发汗。发汗则必便血。
〔程〕膀胱蓄热则为淋。发汗以迫其血。血不循经。结于下焦。又为便血。（详见伤寒论辑义。）
小便不利者。有水气。其人苦渴。栝蒌瞿麦丸主之。（苦。赵本作者。）
〔尤〕此下焦阳弱气冷。而水气不行之证。故以附子益阳气。茯苓瞿麦行水气。观方后云。腹中温为知。
可以推矣。其人若渴。则是水寒偏结于下。而燥火独聚于上。故更以薯蓣栝蒌根。除热生津液也。夫上浮之
焰。非滋不熄。下积之阴。非暖不消。而寒润辛温并行。不倍此方为良法矣。欲求变通者。须于此三复焉。
〔鉴〕其人必脉沉无热。始合法也。
〔沈〕盖本经肿论。腰以下肿者。当利其小便。而不见其方。
观此方后云。小便利腹中温为知。似乎在水肿腹冷小便不利之方。想编书者误入。俟高明细详用之。
栝蒌瞿麦丸方
栝蒌根（二两） 茯苓 薯蓣（各三两） 附子（一枚炮） 瞿麦（一两）
上五味。末之。炼蜜丸梧子大。饮服三丸。日三服。不知。增至七八丸。以小便利腹中温为知。
〔程〕薯蓣栝蒌。润剂也。用以止渴生津。茯苓瞿麦。利剂也。用以渗泄水气。膀胱者州都之官。津液藏
焉。气化则能出焉。佐附子之纯阳。则水气宣行。而小便自利。亦肾气丸之变制也。
案渴而小便不利。故非消渴。小便虽不利。而未至溺如粟状。且无小腹急痛。故非淋也。即此治水病。渴
而小便不利之方。沈氏之说似是。
小便不利。蒲灰散主之。滑石白鱼散。茯苓戎盐汤。并主之。
〔鉴〕无表里他证。小便不利者。小便癃闭病也。
〔尤〕仲景不详见证。而并出三方。
以听人之随证审用。殆所谓引而不发者欤。
蒲灰散方
蒲灰（七分） 滑石（三分）
上二味。杵为散。饮服方寸匕。日三服。
〔徐〕蒲灰。即蒲席烧灰也。能去湿热利小便。滑石。能通九窍。去湿热。故主之。
案蒲灰。证类本草。甄权云。破恶血。败蒲席灰也。魏
氏家藏方。用箬灰。楼氏纲目云。蒲灰。恐即蒲黄粉。楼说难从。然千金有一方。附左备考。
千金。小便不利。茎中疼痛。小腹急痛。
蒲黄 滑石（各等分）
上二味。治下筛。酒服方寸匕。日三。（医垒元戎。治产后小便不通。密钥匙散是。）
滑石白鱼散方
滑石（二分） 乱发（二分烧） 白鱼（二分）
上三味。杵为散。饮服半钱匕。日三服。（半钱匕。俞本。作方
寸匕。）
〔尤〕别录云。白鱼。开胃下气。去水气。血余。疗转胞小便不通。合滑石。为滋阴益气。以利其小便者也。
案乱发。本经。主五淋。白鱼。恐非鱼中之白鱼。尔雅。 。白鱼。本经云。衣鱼。一名白鱼。主
妇人疝瘕。小便不利。又南齐书。明帝寝疾甚久。敕台省府署文簿。求白鱼以
为治。是也。沈云。白鱼鲞。诸注并仍之。不可从。
茯苓戎盐汤方
茯苓（半斤） 白术（二两） 戎盐（弹丸大一枚）
上三味。先将茯苓白术。煎成。入戎盐。再煎。分温三
服。（先将以下十七字。原本缺。今据宋本。及徐沈尤本补之。程本金鉴。作以水五升。
煮取三升。分温三服。卢本。五升。作六升。）
〔尤〕纲目。戎盐。即青盐。咸寒入肾。以润下之性。而就渗利之职。为驱除阴分水湿之法也。
渴欲饮水。口干舌燥者。白虎加人参汤主之。（方见中 中。）
Descend rebellious Qi. Add Poria (Fuling) to remove stagnant water. Although there was initial thirst, the pathology ultimately lies in fluid retention. Therefore, one should treat the fluid retention rather than specifically treating the thirst.
[Wei] Water stagnating below the heart (epigastrium) obstructs healthy Qi, preventing the transformation and generation of body fluids that should ascend to the chest and throat, thus causing thirst. Thirst inevitably leads to drinking water; however, once water enters, it gains momentum and exacerbates the rebellious upward movement, resulting in vomiting after the initial thirst. This belongs to the category of patients with phlegm-fluid retention (Yin Jia). Treatment should focus on resolving the fluid retention, not on treating the thirst as one would for a patient with simple thirst.
Note: The three entries recorded in *Mai Jing* (Pulse Classic) are likely original texts of this book that were misplaced due to textual loss. They are reproduced here in full.
*Mai Jing* states: Cough accompanied by intermittent fever and a sudden wiry pulse (recorded in *Qian Jin Fang* as palpable at the depth of nine grains of grain) indicates excess cold-solidification in the chest, not deficiency. Purging via emesis is indicated.
It also states: For patients with chronic cough presenting a wiry pulse, if emetic therapy is considered, one must assess the patient's strength. Emesis is only permissible if there is no heat. If the pulse is deep, sweating therapy is contraindicated.
Furthermore: A patient whose arm moves intermittently from one side to the other, with a deep and fine pulse, does not have wind-stroke. There must be fluid retention in the Upper Jiao. If the pulse is deficient, it is due to slight overexertion, causing poor circulation of Ying and Wei Qi. It will heal naturally over time.
The defining symptoms of Jueyin disease are: extreme thirst (Xiao Ke) that is not relieved by drinking, sensation of Qi rushing up to the heart, pain and burning sensation in the heart region, hunger without desire to eat, and vomiting of roundworms upon eating. If purgatives are used, diarrhea will persist.
[Jian] Note: This entry describes the primary disease of the Jueyin Meridian in *Shang Han Lun*, which differs from the concept of "Xiao Ke" (wasting-thirst) in miscellaneous diseases. This is likely a result of bamboo slip dislocation.
Yu Shi stated in his legal commentary: *Nei Jing* discusses Xiao Ke but provides no treatment, whereas *Jin Gui Yao Lue* provides both discussion and treatment. However, compilers incorporated text regarding Xiao Ke from the Jueyin chapter of *Shang Han Lun*, causing confusion for later generations and reducing clinical utility. In Shang Han diseases, when heat pathogens reach the Jueyin stage, they penetrate deeply, consuming fluids and causing thirst. Once the heat resolves, thirst ceases. This is fundamentally different from miscellaneous diseases caused by gradual accumulation.
At the Cun Kou (radial artery), a floating and slow pulse indicates deficiency and overwork, respectively. Deficiency implies insufficiency of Wei Qi, while overwork implies exhaustion of Ying Qi. (Most editions merge this with the next entry; here separated according to *Yi Zong Jin Jian*).
[Jian] Note: This entry belongs in the Xu Lao (Deficiency and Emaciation) chapter and is misplaced here. "Cun Kou" refers generally to the pulses at all three positions on both wrists. A floating pulse with force indicates Wind; floating without force indicates Deficiency. Combined with slowness upon pressure, it diagnoses Xu Lao, indicating deficiency and exhaustion of exterior-protecting and interior-nourishing Qi.
At the Fu Yang pulse (dorsal pedal artery), a floating and rapid pulse indicates Qi abundance and efficient digestion leading to hard stools (or tight pulse). Abundant Qi causes frequent urination; frequent urination leads to hard stools. The interaction between hard stools and frequent urination results in Xiao Ke. (*Mai Jing* reads "tight" instead of "hard". *Yi Zong Jin Jian* argues "Da Jian" is grammatically incorrect and likely a scribal error for "Da Bian Jian" [large stool hard]. Wei argues "Da Jian" means hard stool. "Tight" is incorrect.)
[Cheng] Fu Yang is the Stomach pulse. *Nei Jing* states: "Obstruction of the Three Yang meridians is called Xiao." Stomach and Large Intestine constitute the Three Yang. Heat obstruction in the middle causes floating and rapid pulses. *Nei Jing* also says: "Internal heat causes the stomach to digest grain quickly," meaning rapid pulse indicates efficient digestion. Abundant Qi refers to abundant heat. As grain is digested and heat abounds, fluids leak into the Bladder, causing frequent urination and hard stools. Lack of stomach fluids results in Xiao Ke. This is the pulse pattern of Middle Xiao.
*Wai Tai Mi Yao* and *Gu Jin Lu Yan* state: There are three types of Xiao Ke. 1. Thirst with excessive drinking, frequent urination with greasy, sweet urine resembling bran flakes. 2. Excessive eating with little thirst, scanty oily urine with frequency. This is Xiao Zhong. 3. Thirst with inability to drink much, leg swelling, thinning feet, impotence, and frequent urination. This is Shen Xiao. Additionally, *Dong Yuan Shi Xiao Fang* mentions Gao Xiao: red cracks on the tongue, extreme thirst. *Ni Diao Lun* states: Heart transferring heat to the Lung transforms into Ge Xiao. Treat with Bai Hu Jia Ren Shen Tang. Xiao Zhong: polyphagia with emaciation, spontaneous sweating, hard stools, frequent urination. He Shuhe states: dry mouth, thirst, polyphagia with false hunger leads to Xiao Zhong. Treat with Tiao Wei Cheng Qi Tang or San Huang Wan. Xia Xiao: irritability, thirst, dry earlobes, urine like paste. He Shuhe states: irritability and fluid depletion indicate Kidney Xiao. Treat with Ba Wei Wan. *Zong Lu* states: late-stage patients who can eat will develop brain abscesses or back sores; those who cannot eat will develop abdominal distension. These are incurable. ○ Case: Based on this discussion, the symptoms in this section correspond to Xiao Zhong.
Men suffering from Xiao Ke with increased urination, drinking one dou and urinating one dou, should be treated with Shen Qi Wan. (Formula found in the Women's Miscellaneous Diseases chapter.)
[Cheng] Frequent urination leads to Xiao Ke. *Nei Jing* states: "Drinking one dou, urinating two dou" is incurable (*Qi Jue Lun*). Here, drinking one dou yields one dou of urine, so Shen Qi Wan is administered. The Qi within the Kidneys is like fire in water or Yang in earth, steaming essence upwards to the Upper Jiao, causing clouds to rise and rain to fall, nourishing the Upper Jiao like mist and dew. Lung Metal is moistened, allowing water essence to distribute and five meridians to function, preventing Xiao Ke. Due to improper care, Kidney Water is exhausted, and Dragon-Fire rises unchecked, scorching Lung Metal, causing lung heat and leaf-browning, leading to thirst. Water entering the stomach lacks lower-fire transformation, passing directly to the Bladder, hence one dou in, one dou out. This is Lower Xiao.
[You] Fluids belong to Yin and require Qi to move. Qi belongs to Yang but contains Water. Water and Qi are inseparable. Guizhi and Fuzi in Shen Qi Wan rotate the sinking Qi in the Kidneys, enabling it to ascend to the Heart and Lungs, hence named "Kidney Qi." Otherwise, yin-nourishing and dryness-moistening herbs are like drinking water—useless and promoting downward flow, leading to total Yang collapse, descent without ascent, death from "one dou in, two dou out." Does one not know that without True Yang in the Kidneys, how can fluids transform into essence and ascend to Spleen and Lung?
[Shen] "Men" refers to Kidney injury from sexual excess, where Fire flares and Water declines, causing Xiao Ke.
*Wai Tai Mi Yao* cites Li Langzhong: Xiao Ke originates from Kidney deficiency. Urine becomes sweet upon onset. According to *Hong Fan*, crops taste sweet after harvest. Physically, syrups and wines turn sweet quickly. This proves food tastes sweet in the body, flowing to the Bladder. If Kidney Qi is strong, it steams essence upward to marrow, fat, and blood. Remaining fluid becomes urine (yellow, surplus of blood). HT Qi is the Qi of five Zang organs. Salty/moist flavors descend. If Kidneys are cold/deficient, they cannot steam upward; grain Qi descends entirely as urine, retaining sweetness and clear/cold color, leading withered skin. Lung is the canopy of Zang organs. Lower warmth moistens Lung; lower cold prevents Yang ascent, drying Lung. Like a pot of water heated under a lid: steam moistens the lid. Without fire, no steam, no moisture. Fire represents strong Kidneys. Warmth/nourishment turns water vapor into food Qi. Food Qi with warmth moistens upper and digests lower, preventing thirst. Thus Zhang Zhongjing said: Use Ba Wei Shen Qi Wan. Also, Taiyang Meridian is Bladder channel; Bladder is Kidney Fu. Frequent urination indicates Qi abundance. Abundant Qi digests grain and hardens stools; decline causes Xiao Ke. Men with Xiao Ke, one dou in, one dou out, should use Ba Wei Shen Qi Wan. Divine Formula. Patients should take regularly.
Same formula, using Cornus Fructus (Shanzhuyu) 5 liang, Cinnamon Twig (Guizhi) and Prepared Aconite Root (Fuzi) 3 liang each.
Wu Shi's *Fang Kao* states: Yin requires Yang to ascend; Yang requires Yin to descend. Water below, Fire above, failing to interact. Guizhi and Fuzi's acrid-hot nature strengthens mild Fire; Liu Wei Di Huang Wan nourishes True Yin. Nourished Yin allows Yang to descend; strengthened Fire allows Yin to ascend. Like adding fuel to a stove, reviving dead wood, or rain on dry crops. Wise understand this; fools call it pedantic.
Chen Shi's *Waike Jingyao*: A scholar suffered thirst for years. A doctor prescribed Ba Wei Wan, curing him in half a year. Analysis: Modern doctors wrongly use spleen-awakening and fluid-generating herbs. The root is Kidney Water exhaustion failing to moisten, causing Heart Fire to flare without intersection, boiling fluids. Ba Wei Wan lowers Heart Fire and generates Kidney Water, stopping thirst.
Same formula, replacing Fuzi with Schisandra Fructus (Wuweizi). *Sheng Ji Zhi Zhi* agrees. Zhu Shi's *Ji Yan*: For Xiao Ke, Ba Wei Wan removes Fuzi, adds Wuweizi, taken with decoction of silkworm cocoon shells and eggplant stems.
Yan Shi's *Jisheng Fang* Modified Kidney Qi Pill treats Kidney Meridian injury from overwork, insufficient Kidney Water, unrestrained Heart Fire, dry mouth/tongue, polydipsia, mental fog, flushed face, irritability, low back/leg weakness, emaciation, immobility.
Base formula, remove Fuzi, add Wuweizi, Deer Horn (Lujiao), Agarwood (Chenxiang). Severe weakness adds Fuzi.
Fang Shuo's *Bo Zhai Bian*: Official Huang Mian suffered chronic thirst and exhaustion. I advised Ba Wei Wan. He doubted it initially. After failed treatments, he took a few taels and recovered. Question: Why Ba Wei Wan for thirst? Answer: Zhang Zhongjing prescribed this for Emperor Wu of Han. Thirst is mostly due to insufficient True Water in Kidneys. If not severe, this formula is excellent and harmless. Note: Han Wu Di and Zhongjing lived centuries apart; this is likely a fabrication to gain credibility among commoners.
Floating pulse, difficult urination, slight fever, and Xiao Ke indicate need for diuresis and sweating. Wuling San is indicated. (Formula above.)
[Xu] Floating pulse and slight fever indicate unresolved exterior. Xiao Ke and difficult urination indicate interior heat. Guizhi addresses exterior; Baizhu, Fuling, Zexie address interior. Hot water aids expulsion. This treats superficial Xiao Ke. Compared to previous entry (polyuria indicating Yin deficiency/heat binding), this entry (oliguria with slight fever) indicates pathogenic invasion. Treatments differ. Pathogenic invasion is not true Xiao Ke. Listed together for differentiation.
Thirst with desire to drink, but vomiting immediately after ingestion, is called Water Rebellion (Shui Ni). Wuling San is indicated. (Formula above.)
[You] Heat-thirst satisfied by drinking, but water fails to transform, rebels and causes vomiting. This is a variation of Xiao Ke called Water Rebellion, indicating it is not true Xiao Ke but water rebellion. Wuling San is appropriate to remove stagnant water.
[Shen] This is not true Xiao Ke.
Thirst with continuous desire to drink, unrelieved, is treated with Wen Ge San.
[Jian] Thirst with vomiting after drinking and difficult urination is Wuling San syndrome. Thirst with immediate consumption of water, dry mouth/tongue, is Bai Hu Jia Ren Shen Tang syndrome. Thirst without vomiting indicates no excess water pathogen; no dry mouth/tongue indicates no excess heat pathogen. Continuous unrelieved thirst warrants Wen Ge, which neither clears nor promotes diuresis, but focuses solely on generating fluids and stopping thirst.
Note: *Yi Zong Jin Jian* claims Galla Chinensis (Wubeizi) is also called Wen Ge. Processed as Bai Yao Jian, it effectively generates fluids. Tested successfully. This view comes from *San Yin Fang*. While Bai Yao Jian works, it is a later invention. The original Wen Ge refers to Clam Shell (Huage). ○ These three entries are detailed in *Shang Han Lun Ji Yi*.
Wen Ge San Formula
Clam Shell (Wenge) 5 liang (Yu edition: 4 liang)
One ingredient, pounded to powder. Mix with 5 he of boiling water. Take 1 cun bi.
Lin disease presents with urine resembling millet grains, tense lower abdomen, pain radiating to the umbilicus.
[Xu] Lin disease is entirely in the Lower Jiao. Previous chapters link Lower Jiao heat to Lin obstruction. "Resembling millet" implies white, dripping particles like rice bran. Different Qi/Blood patterns led to the Five Types of Lin. Disharmony in Lower Abdomen Qi causes tension. Heat attacking upward causes pain radiating to umbilicus.
[You] Chao Shi states: Lin disease arises from Kidney deficiency and Bladder heat. Kidney Qi connects to the genitalia, the pathway for fluid drainage. Bladder stores fluids. Deficiency causes frequency; heat causes涩 (astringency/stagnation). Frequency plus stagnation causes dribbling, hence Lin. Symptoms: scanty output, frequent urges, tense lower abdomen, pain to umbilicus. Variations include Stone, Labor, Blood, Qi, and Paste Lin. See main text for details. This clarifies Zhang Zhongjing's omissions.
Note: "Resembling millet" based on Chao Shi's "scanty output" refers to short, dribbling urine like rice bran. Claiming whiteness is forced. Shen, Cheng, and others identify it as Stone Lin. Logically, passing stones shouldn't be described as "like millet." Thus, following Xu's note.
*San Yin Fang*: Lin was anciently called Long. Names differ. Long means fatigue/sinking; Lin means dripping. Modern name fits the meaning.
Rapid Fu Yang pulse, heat in Stomach, efficient digestion with appetite, hard stools, and frequent urination. (Cheng edition places this after the previous Fu Yang entry, which is correct. Wei edition notes same meaning.)
[You] Stomach heat causing polyphagia and thirst is Middle Xiao. Stomach heat dries fluids, hardening stools. Hard stools force fluids to anterior yin, causing frequent urination. This matches the previous entry's Stomach hardness/Xiao Ke but is listed under Lin disease, suggesting textual dislocation.
Patients with Lin should not undergo sweating therapy; sweating will cause hematochezia.
[Cheng] Bladder heat accumulation causes Lin. Sweating forces blood; blood leaves vessels, accumulates in Lower Jiao, causing bleeding. (See *Shang Han Lun Ji Yi*.)
Difficult urination with fluid retention, bitter thirst, treated with Gua Lou Qu Mai Wan. (Ku, Zhao edition reads "Zhe").
[You] This is Lower Jiao Yang weakness and cold, causing fluid stagnation. Fuzi tonifies Yang; Fuling and Qu Mai move fluids. Post-instruction: "Warm abdomen indicates efficacy." Thirst indicates cold-fluid binding below and dry-fire above. Shuyu and Tian Hua Gen clear heat and generate fluids. Upper flame needs nourishment to extinguish; lower yin-cold needs warmth to dissipate. Cold-moistening and acrid-warming combined is effective. Seek variation through repeated study.
[Jian] Pulse must be deep without heat to fit this method.
[Shen] *Ben Jing Swelling Chapter* states: Edema below waist requires diuresis, but no formula is given. Post-instruction "urine flows, abdomen warms" suggests this is for edema/cold/difficult urination. Compiler error. Await expert verification.
Gua Lou Qu Mai Wan Formula
Trichosanthes Root (Gualougen) 2 liang
Poria (Fuling)
Dioscorea Rhizome (Shuyu) 3 liang each
Prepared Aconite Root (Fuzi) 1 piece (prepared)
Milk Vetch Herb (Qumai) 1 liang
Five ingredients, powdered, honey-pilled size of wutong seeds. Take 3 pills with water, 3 times daily. If ineffective, increase to 7-8 pills. Efficacy marked by free urination and warm abdomen.
[Cheng] Shuyu and Gualou are moistening, stopping thirst/generating fluids. Fuling and Qumai are draining, leaching fluid retention. Bladder is official of storage; fluids stored, transformed by Qi to exit. Assisted by Fuzi's pure Yang, fluid Qi circulates, urination flows. Variation of Shen Qi Wan.
Note: Thirst with difficult urination is not Xiao Ke. Difficult urination without millet-like sediment or abdominal pain is not Lin. This formula treats water disease with thirst and difficult urination. Shen's view is plausible.
Difficult urination treated with Pu Hui San. Hua Shi Bai Yu San and Fu Ling Rong Yan Tang also treat it.
[Jian] No exterior/interior symptoms, just difficult urination, indicates Lin Bi (obstructive urinary disorder).
[You] Zhongjing lists three formulas without specifying symptoms, allowing practitioners to choose based on presentation. "Guiding without pulling the trigger."
Pu Hui San Formula
Reed Ash (Puhui) 7 parts
Talcum (Huashi) 3 parts
Two ingredients, powdered. Take 1 cun bi with water, 3 times daily.
[Xu] Puhui is ash from reed mats, clearing damp-heat and promoting urination. Huashi opens orifices, clears damp-heat.
Note: *Zheng Lei Ben Cao* Zhen Quan says: Breaks bad blood, ash from old reed mats. Wei's *Jiacang Fang* uses bamboo leaf ash. Lou's *Bencao Gangmu* suggests Puhui might be Polygonum Multiflorum powder (Puhuang). Lou's view is questionable. *Qian Jin Fang* has a formula: Difficult urination, penile pain, lower abdominal urgency. Polygonum Powder (Puhuang) and Talcum equal parts. Powdered, taken with wine, 1 cun bi, 3 times daily. (*Yi Lei Yuan Rong* postpartum retention uses Mi Mi Yao San).
Hua Shi Bai Yu San Formula
Talcum (Huashi) 2 parts
Disordered Hair (Luafa) 2 parts (burnt)
White Fish (Baiyu) 2 parts
Three ingredients, powdered. Take half qian bi with water, 3 times daily. (Yu edition: 1 cun bi).
[You] *Bie Lu*: Baiyu opens stomach, directs Qi downward, removes fluid retention. Blood residue (Luafa) treats bladder inversion/retention. Combined with Huashi, nourishes Yin/Qi, promotes urination.
Note: *Ben Jing*: Luafa treats Five Lins. Baiyu is likely not fish. *Erya*: Cantharis is Baiyu. *Ben Jing*: Clothes moth (Yiyu), alias Baiyu, treats female hernia masses and difficult urination. *Nan Qi Shu*: Emperor Ming sought Baiyu for illness. Shen says Baiyu dried fish. Annotations follow this, but it is incorrect.
Fu Ling Rong Yan Tang Formula
Poria (Fuling) 8 liang
Atractylodes Macrocephala Rhizome (Baizhu) 2 liang
Rong Salt (Rongyan) size of a bullet
Three ingredients. Decoct Fuling and Baizhu first, add Rongyan, decoct again. Divide into 3 warm doses. (First 17 characters missing in original, restored from Song edition and Xu/Shen/You editions. Cheng/Jian: Water 5 sheng, boil to 3 sheng, divide 3 doses. Lu edition: 6 sheng water.)
[You] *Gangmu*: Rongyan is Blue Salt. Salty-cold enters Kidney. Moistening-lowering nature serves diuretic function, removing Yin-damp fluid retention.
Thirst with desire to drink, dry mouth and tongue, treated with Bai Hu Jia Ren Shen Tang. (Formula see Middle Middle.)