厥阴之为病。消渴。气上冲心。心中疼热。饥而不欲食。食则吐蛔。下之利不止。
此邪热入厥阴而成消渴。成氏所谓邪愈深者热愈甚也。气上冲心。心中疼热者。火生于木。肝气
通心也。饥而不欲食者。木喜攻土。胃虚求食。而客热复不能消谷也。食即吐蛔者。蛔无食而动。闻
食臭而出也。下之利不止者。胃气重伤。而邪热下注也。夫厥阴风木之气。能生阳火而烁阴津。津虚
火实。脏燥无液。求救于水。则为消渴。消渴者。水入不足以制火。而反为火所消也。
寸口脉浮而迟。浮即为虚。迟即为劳。虚则卫气不足。劳则营气竭。趺阳脉浮而数。浮即为气。
数即消谷而大坚。气盛则溲数。溲数则坚。坚数相搏。即为消渴。
诊寸口而知营卫之并虚。诊趺阳而知胃气之独盛。合而观之。知为虚劳内热而成消渴也。夫所谓
气盛者。非胃气盛也。胃中之火盛也。火盛则水谷去而胃乃坚。如土被火烧而坚硬如石也。故曰数即
消谷而大坚。胃既坚硬。水入不能浸润。但从旁下转。而又为火气所迫而不留。故曰气盛则溲数。溲
数则坚。愈数愈坚。愈坚愈数。是以饮水多而渴不解也。
男子消渴。小便反多。以饮一斗。小便亦一斗。肾气丸主之。
男子以肾为事。肾中有气。所以主气化。行津液。而润心肺者也。此气既虚。则不能上至。气不
至。则水亦不至。而心肺失其润矣。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。
按、消渴证。有太阴、厥阴、阳明、少阴之异。系太阴者。心热移肺也。系厥阴者。风胜则干。
抑火从木出也。系阳明者。火燔而土燥也。系少阴者。水虚不能制火也。然此不言水虚不能制火。而
言火虚不能化水。则法之变而论之精也。惟火不化水。故饮一斗。水亦一斗。不然。未有不为火所消
者矣。推而言之。厥阴内热之渴。水为热所消。其小便必不多。阳明内坚之渴。水入不能内润而从旁
转。其小便虽数。而出亦必少也。
肾气丸方（见妇人杂病）
脉浮。小便不利。微热消渴者。宜利小便发汗。五苓散主之。
热渴饮水。水入不能已其热。而热亦不能消其水。于是水与热结。而热浮水外。故小便不利。而
微热消渴也。五苓散利其与热俱结之水。兼多饮暖水取汗。以去其水外浮溢之热。热除水去。渴当自
止。
五苓散方（见痰饮）
渴欲饮水。水入则吐者。名曰水逆。五苓散主之。
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。
渴欲饮水不止者。文蛤散主之。
热渴饮水。水入不能消其热。而反为热所消。故渴不止。文蛤味咸性寒。寒能除热。咸能润下。
用以折炎上之势。而除热渴之疾也。
文蛤散方
文蛤（五两）
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。
淋病有数证。云小便如粟状者。即后世所谓石淋是也。乃膀胱为火热燔灼。水液结为滓质。犹海
水煎熬而成咸碱也。小腹弦急。痛引脐中者。病在肾与膀胱也。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。膀胱为津液之府。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。
趺阳脉数。胃中有热。即消谷引饮。大便必坚。小便则数。
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。发汗则便血。
淋家热结在下。而反发其汗。热气乘心之虚而内扰其阴。则必便血。
小便不利者。有水气。其人若渴。栝蒌瞿麦丸主之。
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。并行不悖。此方为良法矣。欲求变
通者。须于此三复焉。
栝蒌瞿麦丸方
薯蓣 茯苓（各三两） 栝蒌根（二两） 附子（一枚炮） 瞿麦（一两）
上五味末之。炼蜜丸如梧子大。饮服二丸。日三服。不知。增至七八丸。以小便利。腹中温为知。
小便不利。蒲灰散主之。滑石白鱼散、茯苓戎盐汤。并主之。
蒲、香蒲也。宁原云。香蒲去湿热。利小便。合滑石为清利小便之正法也。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。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。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（半分） 滑石（三分）
上二味。杵为散。饮服方寸匕。日三服。
滑石白鱼散方
滑石 乱发（烧） 白鱼（各二分）
上三味。杵为散。饮服方寸匕。日三服。
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。
渴欲饮水。口干燥者。白虎加人参汤主之。
此肺胃热盛伤津。故以白虎清热。人参生津止渴。盖即所谓上消膈消之证。疑亦错简于此也。
白虎加人参汤方（见 病）
脉浮发热。渴欲饮水。小便不利者。猪苓汤主之。
此与前五苓散病证同。而药则异。五苓散行阳之化。热初入者宜之。猪苓汤行阴之化。热入久而
阴伤者宜之也。
按、渴欲饮水。本文共有五条。而脉浮发热。小便不利者。一用五苓。为其水与热结故也。一用
猪苓。为其水与热结。而阴气复伤也。其水入则吐者。亦用五苓。为其热消而水停也。渴不止者。则
用文蛤。为其水消而热在也。其口干燥者。则用白虎加人参。为其热甚而津伤也。此为同源而异流者。
治法亦因之各异如此。学人所当细审也。
猪苓汤方
猪苓（去皮） 茯苓 阿胶 滑石 泽泻（各一两）
上五味。以水四升。先煮四味。取二升。去滓。内胶烊消。温服七合。日三服。
The manifestation of Jueyin disease includes: excessive thirst (Xiao Ke, a condition characterized by excessive thirst and urination), sensation of Qi rushing up to the heart, pain and burning heat in the heart region, hunger without desire to eat, vomiting of roundworms if food is ingested, and unceasing diarrhea if purgatives are misused.
This is Xiao Ke formed by pathogenic heat entering the Jueyin channel. As Cheng Wuji stated, "the deeper the pathogen penetrates, the more intense the heat." The sensation of Qi rushing up to the heart and the pain/burning heat in the heart region occur because Liver Wood generates Heart Fire, and Liver Qi connects with the Heart. Hunger without desire to eat occurs because Liver Wood attacks Spleen Earth; the Stomach Qi is deficient and seeks food, but the exogenous heat cannot digest the grain. Vomiting roundworms after eating happens because roundworms move when there is no food and emerge upon smelling food odor. Unceasing diarrhea after purgation occurs because Stomach Qi is severely injured and pathogenic heat sinks downward. The Wind-Wood Qi of Jueyin can generate Yang Fire and scorch Yin fluids, leading to fluid deficiency and fire excess. The organs become dry and lack fluids, seeking relief from water, thus forming Xiao Ke. In Xiao Ke, the ingested water is insufficient to control the fire and is instead consumed by it.
The Cun Kou pulse is floating and slow. Floating indicates deficiency; slow indicates labor/exhaustion. Deficiency means Defensive Qi is insufficient; exhaustion means Nutritive Qi is depleted. The Fu Yang pulse is floating and rapid. Floating indicates Qi abundance; rapid indicates ability to digest food and hard stools. Qi abundance leads to frequent urination; frequent urination leads to hard stools. The interaction between hard stools and frequent urination constitutes Xiao Ke.
Diagnosing the Cun Kou reveals simultaneous deficiency of Nutritive and Defensive Qi; diagnosing the Fu Yang reveals isolated abundance of Stomach Qi. Observing both indicates that Xiao Ke arises from deficiency-labor and internal heat. The so-called "Qi abundance" does not refer to Stomach Qi abundance, but to the abundance of Fire in the Stomach. Abundant Fire consumes water and grain, making the Stomach rigid, like soil baked hard by fire. Thus, "rapid pulse indicates digestion of food and hard stools." Since the Stomach is rigid, ingested water cannot moisten internally but flows down the sides, forced by Fire Qi to remain neither. Thus, "Qi abundance leads to frequent urination; frequent urination leads to hard stools." The more frequent, the harder; the harder, the more frequent. Therefore, despite drinking much water, thirst remains unresolved.
In men with Xiao Ke, urination is disproportionately increased: for every one dou of water drunk, one dou of urine is passed. Shenqi Wan (Kidney Qi Pill) should be used.
Men rely on Kidney function. The Qi within the Kidney governs Qi transformation and fluid distribution, thereby moistening the Lung and Heart. When this Qi is deficient, it cannot ascend. Without ascending Qi, water cannot reach, and the Lung and Heart lose their moisture. Fluids belong to Yin and require Qi to move; although Qi belongs to Yang, it inherently contains Water. Water and Qi never separate. Shenqi Wan contains Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) to revitalize the sinking Qi in the Kidney and guide it upward to the Lung and Heart, hence the name "Kidney Qi." Otherwise, yin-nourishing and dryness-moistening herbs would be as ineffective as drinking water, merely increasing the downward trend, eventually leading to complete Yang collapse, descent without ascent, and death from drinking one dou and urinating two dou. How could one know that water entering the Stomach requires the True Yang of the Kidney to transform essence and transport it upward to the Spleen and Lung?
Note: Xiao Ke presentations vary by Taiyin, Jueyin, Yangming, and Shaoyin channels. Taiyin type involves Heart heat transferring to the Lung; Jueyin type involves Wind dominance causing dryness and Fire arising from Wood; Yangming type involves Fire blazing and Earth drying; Shaoyin type involves Yin deficiency failing to control Fire. However, this text discusses "Fire deficiency failing to transform Water" rather than "Yin deficiency failing to control Fire," representing a variation in treatment and precision in theory. Because Fire fails to transform Water, one dou of water results in one dou of urine. Otherwise, water would invariably be consumed by Fire. Extending this logic: Jueyin internal heat consumes water, so urine volume is likely low; Yangming internal rigidity causes water to bypass internally, so although urination is frequent, output is low.
Shenqi Wan Formula (see Women's Miscellaneous Diseases chapter).
When the pulse is floating, urination is difficult, accompanied by slight fever and thirst, promoting urination and sweating is appropriate. Wuling San (Five-Ingredient Powder with Poria) should be used.
Heat-thirst and drinking water fail to quench the heat or eliminate the water, leading to water-heat binding, with heat floating outside the water. This causes difficult urination, slight fever, and thirst. Wuling San promotes urination to remove water bound with heat, and combined with drinking warm water to induce sweat, it eliminates heat floating outside the water. Once heat is removed and water passes, thirst stops naturally.
Wuling San Formula (see Phlegm-Fluids chapter).
Thirst with desire to drink, but vomiting immediately after ingestion, is named Shui Ni (Water Reversal). Wuling San should be used.
Heat-thirst drinking water where heat is resolved but water stagnates leads to reversal and vomiting. This is a variant of Xiao Ke called Shui Ni, clarifying it is not typical Xiao Ke but water reversal. Thus, Wuling San is also indicated to remove stagnant water.
Thirst with desire to drink that persists incessantly is treated with Wen Ge San (Clam Shell Powder).
Heat-thirst drinking water where water fails to resolve heat but is itself consumed by heat causes persistent thirst. Wen Ge (Clam Shell) is salty and cold; cold clears heat, saltiness moistens and directs downward. It suppresses flaming-upward tendencies and resolves heat-thirst.
Wen Ge San Formula
Wen Ge (Clam Shell) (5 liang)
Grind the single ingredient into powder. Mix with 5 he of boiling water and take 1 fang cun bi.
Ling disease manifests as urination resembling millet grains, tension and urgency in the lower abdomen, and pain radiating to the umbilicus.
Ling encompasses several syndromes. "Urination resembling millet grains" refers to Shi Ling (Stone Ling) in later terminology. This occurs when Bladder Heat scorches fluids, causing them to congeal into sediment, akin to seawater boiling down to salt crust. Tension/pain in the lower abdomen radiating to the umbilicus indicates pathology in the Kidney and Bladder. According to Chao Yuanfang, Ling disease arises from Kidney Deficiency and Bladder Heat. Kidney Qi connects to the genitalia, the pathway for fluid drainage. The Bladder is the reservoir of fluids. Kidney Deficiency causes frequent urination; Bladder Heat causes sluggish flow. Frequency combined with sluggishness results in dribbling and incomplete emptying, termed Ling. Symptoms include small volume with high frequency, lower abdominal tension, and pain radiating to the umbilicus. Variants include Stone, Labor, Blood, Qi, and Paste Ling, detailed elsewhere in this treatise. His explanation is clear and supplements Zhang Zhongjing's omissions.
Fu Yang pulse rapid indicates Heat in the Stomach, leading to excessive hunger/digestion and craving for drinks, hard stools, and frequent urination.
Stomach Heat causing excessive hunger and thirst corresponds to Zhong Xiao (Middle Xiao) in later terms. Stomach Heat dries fluids, causing hard stools. Hard stools force fluids to exit via the anterior yin, causing frequent urination. This mirrors the "rigid Stomach" syndrome mentioned earlier in Xiao Ke, yet appears under Ling disease, suggesting bamboo slip dislocation.
Patients with Ling disease must not undergo diaphoresis (sweating therapy). Diaphoresis will cause hematochezia/hematuria.
Ling patients have heat binding in the lower jiao. Inducing sweat allows Heat to exploit Heart Deficiency and disturb Yin internally, inevitably causing blood in stool/urine.
Difficult urination with fluid retention, especially if accompanied by thirst, is treated with Gualou Qumai Wan (Trichosanthes Root and Purslane Pill).
This represents Cold-Weakness of Lower Jiao Yang Qi failing to move fluids. Fuzi (Prepared Aconite Root) tonifies Yang; Fuling (Poria) and Qumai (Purslane Herb) promote fluid movement. The post-formula note states "warmth in the abdomen" indicates efficacy. Thirst indicates Cold-Damp binding below and Dry-Fire aggregating above. Hence, Shanyu (Dioscorea Rhizome) and Gualougen (Trichosanthes Root) are added to clear heat and generate fluids. Flaming-upward fire requires nourishment to extinguish; accumulated Yin-Cold requires warmth to dissipate. Cold-moistening and Acrid-Warming agents work harmoniously here. This formula is an excellent method; seekers of variation must reflect deeply upon it.
Gualou Qumai Wan Formula
Shanyu (Dioscorea Rhizome) & Fuling (Poria) (3 liang each); Gualougen (Trichosanthes Root) (2 liang); Fuzi (Prepared Aconite Root) (1 piece, processed); Qumai (Purslane Herb) (1 liang).
Grind five ingredients into powder. Form pills with honey the size of mulberry seeds. Take 2 pills with water, three times daily. If ineffective, increase to 7-8 pills. Efficacy is confirmed by free urination and warmth in the abdomen.
Difficult urination is treated with Puhui San (Acorus Powder). Huashi Baiyu San (Talcum, White Fish, and Hair Powder) and Fuling Rongyan Tang (Poria, Atractylodes, and Rock Salt Decoction) also treat this condition.
Pu refers to Xiangpu (Typha Stem). Ning Yuan stated Xiangpu clears Damp-Heat and promotes urination; combined with Huashi (Talcum), it is the standard method for clearing/promoting urination. *Bielu* states Baiyu (White Fish/Paper Louse) opens the stomach, directs Qi downward, and removes fluid retention; Xuetou (Burnt Human Hair) treats bladder inversion and urinary obstruction. Combined with Huashi, they nourish Yin and boost Qi to facilitate urination. *Riben* states Rongyan (Rock Salt/Green Salt) is salty-cold, enters the Kidney, and uses its descending nature to aid permeation, removing Yin-Dampness. Zhang Zhongjing lists these three formulas without specifying distinct indications, allowing practitioners to select based on syndrome differentiation—perhaps exemplifying "guiding without forcing."
Puhui San Formula
Puhui (Typha Powder) (0.5 fen); Huashi (Talcum) (3 fen).
Grind two ingredients into powder. Take 1 fang cun bi with water, three times daily.
Huashi Baiyu San Formula
Huashi (Talcum); Lu Fa (Burnt Human Hair); Baiyu (White Fish) (2 fen each).
Grind three ingredients into powder. Take 1 fang cun bi with water, three times daily.
Fuling Rongyan Tang Formula
Fuling (Poria) (8 liang); Baizhu (Atractylodes Macrocephala Rhizome) (2 liang); Rongyan (Rock Salt) (size of a bean).
Decoct Fuling and Baizhu first. Add Rongyan and simmer further. Divide into three warm doses.
Thirst with desire to drink and dry mouth/throat is treated with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction).
This indicates Excess Heat in Lung and Stomach injuring fluids. Baihu Tang clears heat; Renshen (Ginseng) generates fluids and quenches thirst. This likely corresponds to Shang Xiao (Upper Xiao) or Ge Xiao (Diaphragmatic Xiao), possibly misplaced here due to slip dislocation.
Baihu Jia Renshen Tang Formula (see Disease chapter).
Floating pulse with fever, thirst with desire to drink, and difficult urination are treated with Zhuling Tang (Polyporus Decoction).
This presentation matches Wuling San but differs in prescription. Wuling San promotes Yang transformation, suitable for early-stage heat entry. Zhuling Tang promotes Yin transformation, suitable for prolonged heat entry injuring Yin.
Note: There are five条文 regarding thirst in this text.
1. Floating pulse, fever, difficult urination: Use Wuling San because Water and Heat bind.
2. Floating pulse, fever, difficult urination (with Yin injury): Use Zhuling Tang because Water-Heat binding injures Yin.
3. Vomiting after drinking: Use Wuling San because Heat resolves but Water stagnates.
4. Persistent thirst: Use Wen Ge San because Water resolves but Heat remains.
5. Dry mouth/thirst: Use Baihu Jia Renshen Tang because Heat is severe and fluids are injured.
These represent same-origin, different-flow pathologies requiring distinct treatments. Scholars must examine carefully.
Zhuling Tang Formula
Zhuling (Polyporus, peeled); Fuling (Poria); Ejiao (Donkey-Hide Gelatin); Huashi (Talcum); Zexie (Alisma Rhizome) (1 liang each).
Add 4 sheng of water. Decoct first four ingredients until 2 sheng remain. Strain. Dissolve Ejiao in the decoction. Take 7 he warm, three times daily.