一条 厥阴之为病消渴。气上冲心。心中疼热。饥而不欲食。食即吐蛔。下之利不止。（伤寒作气上撞心）
消渴之症。其因皆起于胸膈间。在天之阳气既虚。而其阳精又竭之所致也。阳气上虚。则下焦之虚火。因其
空而炎于上。阳精上竭。又不能供两火之燔炙。而不得不资外水以自救。故渴。然邪火在胸膈。其位最高。胃
脘虽从此下经。而其受水处。却较低于邪火。火上水下。未济之象。下水不能制上火。而上火反具吹嘘鼓逼
之势。则所饮者。一直下趋而行为小便矣。以消易而愈渴。故曰消渴也。李氏旧注。引内经心移热于肺。为膈
消。虽非仲景之所谓消渴。而与本篇之旨略同者。盖心肺上热则一。而与条中之症。发源于下焦者。为大殊
也。其又引经文二阳结。谓之消。又瘅成为消中二语。虽合仲景之旨。然是三四两条。中焦热实上炎之消渴。
而不可以概下焦之症也。读金匮者。苟不从论文方意。会其全神。而徒为零注死解。纵博引经义。无有是处
也。本篇论渴症者八条。一条言下焦之虚火上冲。而为消渴之正病。二条即言其脉。并其病因。实由上焦阳
气既虚。阳精又竭之故。三四两条。言消渴又有因于中焦坚数。而为消渴之变症者。即经所谓二阳结。及中
消者是也。五条言正病消渴之治例。六七八三条。言渴而不消之轻病。与水饮二门相通之症治。特渴家之
绪余耳。此条之文。见伤寒厥阴。与此大别。盖在伤寒。重厥阴二字。以厥阴得传经之热邪。其为病如此。是
诸症平列。而无偏重处。且肝中化热解。而诸症亦罢。又为暂病也。因其人之上焦。原无虚劳之亏空。以厥阴
之化热。下实而上撞耳。化热一解。而上焦即有以御之也。若此条。则专重在消渴二字。以消渴之人。先从肾
精下竭。不能滋养肝木。而木中之血液亦短。木气以无阴而不恋本脏。于是悉索而根据辅于其所生之心部。
譬之失所者。父母之乡。无栖止之乐。而外就其女家之义也。且心中真情。既无木液之供应。而自干自空久
矣。况肾水下虚。火又以无畏而上炽乎。夫上焦在虚而欲吸之时。下焦具穷而急投之势。肝气入心。木得火
而风生。火得木而焰起。木火合化而通明于胸膈。将逼中下二焦之津液于不尽不止。是入伤寒者。为论厥
阴之病机。而入本篇者。为论消渴之始末。故曰与此大别也。气上冲胸四句。虽言消渴者。其自下而上。一路
之兼症如此。然亦为厥阴之所必然连及者。故其义与伤寒同。下之利不止。则与伤寒亦有辨矣。盖伤寒所
言下之利不止者。下药阴寒。木性缩支柯之逆气。而下坠根株。是木从阴湿处以行根之理也。消渴所言下
之利不止者。大肠一空。火势夺前阴之飞瀑。而后奔谷道。是火从空隙处以垂焰之理故也。
二条 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。
承上文而言消渴之热。现下上焦。而谓由于下焦厥阴之气上冲者何也。盖寸口者。内为心肺之应。心统血
而肺主气。气血两充于胸膈。则阳气阳精互相根抱。故其脉体之高下得中。脉至之往来连贯者此也。今寸
口之脉浮。则是阴不足以抱阳。而使微阳。自浮之应。故浮即知为心肺之阳液虚也。浮而且迟。则是阳不胜
于健用。而致动机疲困之应。故迟即知为心肺之阳气劳也。夫以心肺中之阳液阳气。两皆亏空。则厥阴之
燥气。安得不上冲。而成干柴着灶之象乎。故曰厥阴之为病消渴者。此也。下文二句。又仲景自注上文之义。
盖谓阴阳虚劳于胸膈。而即见浮迟之脉者。以胸膈之阴阳。为荣卫之宗主。荣行脉中。卫行脉外。是荣卫又
所以载脉者也。夫阴阳相生。气血互用。阴血内虚。则脉外之卫气不足。卫气失固密之令。故脉浮。阳气外劳。
则脉中之营血耗竭。营血失生阳之气。故脉迟。是脉根于营卫。而营卫之气大会于胸中。此所以因寸口之
浮迟。而知营卫之衰竭。并内知其心肺之虚劳耳。
三条 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。
此言上焦虽无虚劳之亏空。若阳明之火太盛。亦能浮其热于胸膈。而成上中二焦消渴之变症也。趺阳即
阳明。详别见。盖指右关而言。注作足面之动脉。误。脉浮当兼实脉在内。且非浮出皮面。是从浮于关之上。将
逼寸口而言。以浮出皮面。系阳明表热之脉。惟浮于上冲。始为膈热消渴之诊故也。数为热脉。又脉之来属
阳。而其去之夹空属阴。数则至速而空窄。阳实阴虚之应也。夫阳明之脉。带实而上浮。是阳明之气自实。而
且有浮其气于膈上之势。故曰浮即为气也。数为热。热在阳明。故消谷。数为阴虚。阳明阴虚。故不能自润而
大坚也。气盛。指气浮而盛于胸膈之谓。胸膈气盛。则呵嘘之火势既大。而水易下趋。故溲数也。溲数。则水惟
一过而不能留润。故干结而即坚。于是坚则愈数。而因数愈坚。则坚数如相搏之状。坚方欲以渴胜数。而数
却以消胜坚。此消渴循环不已之道也。不出方治者。因上条有下之利不止之戒。则此条之不言戒者。其以
下为正治者可见矣。但于大承中。令芒硝长出大黄之外为合。否则。恐大黄直性下趋之力多。而芒硝软坚
破结之功少。但下其未坚者。旁流而下。而使坚者独留。则渴甚而死矣。此条当重看浮字。以浮则气浮于
上。而成热高之消渴。方与下条之但数而为中消者有别也。
四条 趺阳脉数。胃中有热。即消谷引食。大便必坚。小便即数。
承上文而言趺阳之脉。纵不浮而但数者。虽无膈热下嘘之势。而胃中有热。即消谷引食。其大便坚而小便
数者。此热在中焦。亦能逼下焦之水。而为消渴。又变症中之变也。盖小肠、膀胱。俱在胃下。胃中有热。则上吸
胸膈之津液以自救。故渴又下逼小肠之水饮于膀胱。故消。然而机势相成。渴之机动于上。而其势成于消。
消之机动于下。而其势又成于渴。故愈渴愈消。愈消愈渴矣。但言大便坚而小便数。即上条坚数相搏。即为
消渴之互词也。
五条 男子消渴。小便反多。以饮一斗。小便一斗。肾气丸主之。
此言首条厥阴消渴之治例也。首二句是水饮与消渴之辨。三四两句。是消渴与消渴之辨。其意以为渴症
颇多。不可但因一渴。而即认为消也。比如渴而小便少者。则渐积渐高。而为饮为水。另详本病。若消渴者。则
渴而小便反多者为是。以其与水饮门之小便少者相反。故曰反多也。又消症既有厥阴上冲。趺阳浮数之
异。若以趺阳热实之候。而误投厥阴上焚之剂。不又蹈实实之戒。而令消渴更甚乎。夫厥阴之候。除脉症外。
亦仍以小便为诊法。盖趺阳热实。水从燥土下经。纵使急流飞渡。终有渗泄。况从燔炙煎炼中而出乎。故其
所溲者。必不能如其所饮之数。若夫厥阴居至阴之下。阳火自微。即其精血下竭。而燥气上浮。亦无热相。惟
上入心乡。斯干柴入火。而幻生烟焰者。且火高饮下。既无伤耗。过此。则寒溪直泻。复何火干土克。而谓所饮
者或减一二耶。此饮一溲一。即知非趺阳诸症。而为厥阴上冲之消渴无疑矣。肾气丸。补下焦之精血。以补
其气源。因而上引之。以蒸填心肺之空。详虚劳本方下。消渴。为肝肾之阴既竭。因下干上空。以致木气冲之
而焰发者。则补精血以补气源。而蒸填上空之肾气丸。为的对矣。盖就上焦而论。心肺得肾气之冲和。而真
阳渐复。譬之主人返旧里。而占房者必当见还。就下焦而论。肝肾得肾气之滋息。而真阴自生。譬之故土遇
丰年。而流亡者争归复业。此真阴下滋木邪正性。真阳上治龙火消沉之本义也。至若厥阴消渴。上焦责在
无阴。而孤阳以邪热不交。故渴。下焦责在无阳。而群阴以虚寒失守。故消。重用地黄山萸。一直下补精血之
性。将辛热之桂附包藏下纳。然后从肝肾中徐徐炊动。不特下焦渐温。而以关锁者治消。并且上部津升。而
又以熏蒸者治渴矣。加燥土之薯蓣者。因上渴下消。互相注吸。故以培土者。中缓其流行之势。而使津液之
机得上升也。加渗湿之茯苓、泽泻者。中土既有堤防。恐上流缓于注受而客饮不去。则真阴将阻于湿滞而
不布也。然后以升阳走液之丹皮。双引肝肾之精神于膈上。则春晴满空。电光消灭。太清凝露。萎叶生鲜。复
何消渴之不愈哉。读仲景诸方。其神奇变幻。顷刻万状。直如蓬莱阁上。看尽蜃楼。终若不能穷其微妙也。
别以男子者。因妇人为阴柔之体。阳气尝亏。以其月有所泻也。故不轻易病消渴。凡病消渴。即属枯症。其小
便必少。大便必泻。多为死候故也。
六条 脉浮。小便不利。微热。消渴者。宜利小便。发汗。五苓散主之。
浮脉为气机上冲外鼓之应。今以其症之小便不利。及微热消渴者合诊之。则消渴为入水既多。而小便不
利。为出水又少。是知微热。因热水内积。不得下通。而衬托经表之所致。故并令脉浮也。利小便。以下通其水。
发汗。以旁散其热。谁曰不宜。然非五苓。无双解之效。故主之。方意详伤寒本方。
七条 渴欲饮水。水入则吐者。名曰水逆。五苓散主之。
此饮热胃寒之症也。盖饮久化热而烫胸。故胸病热而渴。欲饮水、饮冷伤阳而逆胃。故胃恶寒。而水入则吐
也。旧水逆停而不下行。新水逆出而不中纳。故曰水逆。五苓为辛甘渗泄之剂。故主之。以辛甘则使胃阳温
复。渗泄则使水性顺趋。而药后所云多服暖水者。亦有见耶。
八条 渴欲饮水不止者。文蛤散主之。
文蛤散方 文蛤（五两）
上一味。杵为散。以沸汤和服方寸匕。
此肾水上泛而为热饮。饮热烫胸。故渴饮不止也。文蛤。象肾而性沉。且能摄水下行。故主之。盖象肾则走少
阴。性沉而摄水下行。则热饮去而渴将自止矣。俗解谓味咸走肾。误。以其但杵为散。而不曰火 。其味安得
咸耶。文蛤、蚌属。亦名花蛤。出东海及莱州海中。背上有斑纹。故名。大者三寸。小者五六分。坊家以五倍子
混代之。非。
九条 淋之为病。小便如粟状。小腹弦急。痛引脐中。
淋者。小便不利。而其所出者。或白或赤。或膏或沙石之总名也。按其病因。大概不越三者。一则上焦以神劳
气虚。不能分运水气。中焦脾土气寒。又不能制水下化。故小便停滞。滞久则膀胱内生虚假之热。且宗气不
能提挈神髓。而阴气下陷膀胱。于是阴气得虚假之热郁。而成浊涕之状者。此所谓膏淋也。一则三焦亢热。
而真阳气化之机自疲。不管传送。而膀胱癃闭。故小便不利。且阴阳之液。两伤于邪火。则引水自救。故渴。以
渴饮之水。而久煎癃闭之膀胱。此煎水成碱。煮海成盐之象。而成砂石淋者是也。一则淫火爱慕于心君。飞
传于肾腑。而外流于阳道阴庭。又无所事。而阳火不能下泄。则横贯带脉。而沉坠腰痛。络脉胀而化机自塞。
故小便不利。邪火结而阴精下淫。故浊淋黄绿也。本条言神劳气虚。而中土不能下温其化机之淋。二条统
言治淋之戒。三条即言虚淋之治例。四条言淫火停阁之淋。故其方药俱主咸润之品。以咸走肾。而尤能泻
心火也。五六两条。言热淋之治例耳。仲景之意。以渴而小便过利者为消渴。渴而小便不利者为淋。故次
淋于消渴之后焉。淋之为病句。直贯后文诸条。小便如粟。言小便中之浊垢。颗粒而色黄白。如小米之状。膏
淋之初症也。俗解谓即砂石淋。非。盖膏淋之初症。形如粟米而软。病深。则渐大而成条。即为膏淋矣。砂石淋。
其初便时。俨如水中化碱之象。便久澄下。则坚如砂石之状故也。上中二焦之阳气虚寒。不能照临化被。而
失柔则养筋之妙。故小腹凝敛而弦急。脐中切责而引痛也。
十条 淋家不可发汗。发汗必便血。
淋家。兼前三症而言。便血。指小便尿血也。盖虚寒之淋。阳气既微。发汗以泄其气。气不应用。而动其血者势
也。血动而未及为汗。则随淋而下便矣。阳热之淋。营阴伤于亢热。汗以阴津为材料。阴不足以作汗。强责之
而动其血。故汗余之血。其见于小便者。亦与前症同也。淫火停阁之淋。阴精已在燔炙之候。夫发表不远热。
复用发汗之阳药以济之。则阴血不胜其残暴。故血亦动而下见于便矣。此总言治淋之禁也。
十一条 小便不利者。有水气。其人苦渴。栝蒌瞿麦丸主之。
栝蒌瞿麦丸方 栝蒌根（二两） 瞿麦（一两） 茯苓 薯蓣（各三两） 附子（一枚炮）
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。
此补言首条虚淋之症。而详其治例也。盖谓小便如粟。小腹弦急。痛引脐中之淋。其初症小便不利。久则水
积而有水气。水久化热。热水上烫胸膈。故其人苦渴。主本丸者。以生津之栝蒌根止渴。以泻血分之瞿麦。泻
气分之茯苓去水气。以燥土之薯蓣。温土之附子。制水以利小便。似乎单治本条诸症。不知三焦之妙。其先
Article 1 The disease of Jueyin manifests as Xiao Ke (wasting-thirst syndrome characterized by excessive thirst and fluid consumption). Qi rushes upward to strike the heart, causing pain and a burning sensation in the chest. The patient feels hungry but has no desire to eat; if they do eat, they vomit roundworms. If purgatives are incorrectly used, diarrhea will persist uncontrollably. (In *Shanghan Lun*, this is described as "Qi rushing up to strike the heart".)
The etiology of Xiao Ke originates in the chest and diaphragm region. It results from the deficiency of Yang Qi from Heaven (external/upper Yang) and the exhaustion of Yang Essence (internal essence). Due to the deficiency of Yang Qi above, the deficient fire of the Lower Jiao flares upward into the emptiness. Because Yang Essence is exhausted above, it cannot sustain the blazing fire, forcing the body to seek external water for self-rescue, thus causing thirst. However, the pathogenic fire resides in the highest position of the chest and diaphragm. Although the stomach passes below this area, its point of receiving water is lower than the pathogenic fire. This creates a state of Fire over Water and Failure of Interaction between Heart and Kidney. The water below cannot control the fire above; instead, the fire above exerts a blowing and urging force. Consequently, ingested water flows directly downward and is excreted as urine. Because fluids are consumed rapidly, thirst increases further; hence it is called Xiao Ke. Li's old commentary cites *Neijing*: "Heart transfers heat to the Lung, resulting in Ge Xiao (diaphragmatic wasting-thirst)." Although this is not Zhang Zhongjing's definition of Xiao Ke, it aligns roughly with the theme of this chapter. Generally, upper heat in the Heart and Lung is similar, but differs significantly from symptoms originating in the Lower Jiao as described in this article. He also cites: "Binding of the Two Yangs is called Xiao" and "Dan transformation leads to Xiao Zhong." While these fit Zhang Zhongjing's intent, they refer to Xiao Ke caused by excess heat in the Middle Jiao rising upward (Articles 3 and 4), which cannot generalize symptoms of the Lower Jiao. Readers of *Jingui Yaolue* who do not grasp the spirit through the text and formulas, but merely offer fragmented annotations and rigid interpretations, will find their extensive citation of classics useless. This chapter discusses eight articles on thirst. Article 1 describes the primary disease of Xiao Ke caused by deficient fire of the Lower Jiao rushing upward. Article 2 immediately follows with the pulse and etiology, confirming that the cause lies in the deficiency of Upper Jiao Yang Qi and exhaustion of Yang Essence. Articles 3 and 4 describe variant forms of Xiao Ke caused by hardness and frequency in the Middle Jiao, corresponding to the classics' "Binding of the Two Yangs" and Middle Xiao. Article 5 outlines the treatment for the primary disease. Articles 6, 7, and 8 discuss mild cases where there is thirst without wasting, conditions connected to the Water-Drink category, which are merely residual symptoms of thirst. The text here differs greatly from the Jueyin section of *Shanghan Lun*. In *Shanghan Lun*, emphasis is placed on "Jueyin," indicating transmission of heat pathogens; symptoms are listed equally without bias, and once Liver heat resolves, symptoms cease, representing an acute condition. Since the Upper Jiao lacks chronic deficiency, only Jueyin heat causes downward fullness and upward striking. Once heat resolves, the Upper Jiao can defend itself. Here, however, the focus is solely on "Xiao Ke." Patients first suffer from exhaustion of Kidney Essence below, failing to nourish Liver Wood. Consequently, Liver Blood becomes short. Without Yin to anchor it, Liver Qi scatters and attaches to its generating organ, the Heart. Like a displaced person finding no comfort in their parents' home, they seek refuge in their daughter-in-law's family. Since the Heart lacks supply from Liver fluid, it remains dry and empty for long periods. Moreover, with deficient Water below and unfeared Fire blazing above, when the Upper Jiao is deficient and seeking absorption, while the Lower Jiao is exhausted and urgently projecting, Liver Qi enters the Heart. Wood meets Fire and generates Wind; Fire meets Wood and ignites. Wood and Fire combine to illuminate the chest and diaphragm, forcing fluids of the Middle and Lower Jiao to exhaust continuously. Thus, entering *Shanghan Lun* discusses the pathogenesis of Jueyin, whereas entering this chapter discusses the beginning and end of Xiao Ke; hence the great difference. The four phrases "Qi rushes upward to the chest" describe concurrent symptoms ascending from below in Xiao Ke, which are inevitably linked to Jueyin, so the meaning is consistent with *Shanghan Lun*. However, "purging leads to persistent diarrhea" differs. In *Shanghan Lun*, purging with yin-cold medicines causes Wood's nature to contract branches and drop roots, following the principle of Wood acting in yin-dampness. In Xiao Ke, purging empties the Large Intestine; Fire seizes the waterfall of the anterior orifice and bursts into the anal canal, following the principle of Fire flaming through voids.
Article 2 The Cun Kou (radial artery at the wrist) pulse is floating and slow. Floating indicates deficiency; slow indicates labor/exhaustion. Deficiency means Wei Qi (Defensive Qi) is insufficient; exhaustion means Ying Qi (Nutritive Qi) is depleted.
Continuing from the previous text regarding the heat of Xiao Ke appearing in the Upper Jiao, why is it attributed to Qi rushing upward from the Lower Jiao Jueyin? The Cun Kou internally corresponds to the Heart and Lung. The Heart governs Blood, and the Lung governs Qi. When Qi and Blood are abundant in the chest and diaphragm, Yang Qi and Yang Essence root each other, resulting in a balanced pulse height and continuous flow. Now, the floating Cun Kou pulse indicates Yin is insufficient to embrace Yang, causing slight Yang to float outwardly. Thus, floating signifies deficiency of Yang fluids in the Heart and Lung. Floating combined with slow indicates Yang is unable to perform its vigorous functions, leading to sluggish movement. Thus, slow signifies labor/exhaustion of Yang Qi in the Heart and Lung. With both Yang fluids and Yang Qi in the Heart and Lung depleted, how can Jueyin's dry Qi not rush upward, creating an image of dry wood catching fire? Hence, "Jueyin disease manifests as Xiao Ke." The following two sentences are Zhang Zhongjing's own annotation: Yin and Yang are labored/exhausted in the chest and diaphragm, presenting as floating and slow pulses because the Yin-Yang of the chest and diaphragm are the masters of Ying and Wei. Ying moves within the vessels, Wei moves outside. Ying and Wei carry the pulse. Yin and Yang generate each other; Qi and Blood use each other. Internal deficiency of Yin-Blood leads to insufficiency of Wei Qi outside the vessels; loss of Wei Qi's securing function causes floating. External labor of Yang Qi leads to depletion of Ying-Blood within the vessels; loss of Ying-Blood's generation of Yang Qi causes slow. Since the pulse roots in Ying and Wei, and Ying and Wei gather in the chest, observing floating and slow at Cun Kou reveals the depletion of Ying and Wei and the internal deficiency-labor of the Heart and Lung.
Article 3 The Zu Yang (dorsalis pedis artery) pulse is floating and rapid. Floating indicates Qi; rapid indicates digestion of food and hard stools. Excess Qi leads to frequent urination; frequent urination leads to hardness. Hardness and rapidity contend with each other, resulting in Xiao Ke.
This states that although the Upper Jiao lacks deficiency-labor, if Mingyang (Stomach/Large Intestine) fire is too strong, it can float heat to the chest and diaphragm, forming variant Xiao Ke of the Upper and Middle Jiao. Zu Yang refers to the Stomach pulse (Right Guan position); noting it as the dorsal foot artery is incorrect. The floating should include a solid quality, not merely floating at the skin surface, but rising from the Guan toward the Cun. Skin-surface floating indicates exterior heat of the Yangming; only floating upward indicates diaphragmatic heat and Xiao Ke. Rapid is a heat pulse. Arrival belongs to Yang; departure involves emptiness belonging to Yin. Rapid arrival with narrow emptiness indicates Yang-excess and Yin-deficiency. The Yangming pulse rises with solidity, showing Yangming Qi is self-excessive and trending upward to the diaphragm; hence "floating indicates Qi." Rapid indicates heat; heat in Yangming digests food. Rapid indicates Yin-deficiency; Yangming Yin-deficiency fails to moisten, causing hard stools. "Excess Qi" refers to Qi floating and surging in the chest and diaphragm. Surging Qi increases the blowing fire, causing water to descend quickly, leading to frequent urination. Frequent urination allows water only a fleeting passage without moistening, causing dryness and hardness. Hardness increases frequency, and frequency increases hardness; they contend like opposing forces. Hardness tries to overcome frequency with thirst, while frequency overcomes hardness with consumption. This is the cycle of Xiao Ke. No formula is given because Article 1 warns against purging ("purging leads to persistent diarrhea"). The absence of such a warning here implies purging is the correct treatment. One should modify Da Cheng Qi Tang by allowing Mang Xiao (Mirabilite) to exceed Huanglian (Rhubarb) in dosage. Otherwise, Huanglian's direct downward force may dominate, leaving Mang Xiao's softening and breaking power insufficient, clearing only non-hard stool while leaving hard stool behind, leading to death from severe thirst. Emphasize "floating": floating means Qi floats upward, creating high heat Xiao Ke, distinguishing it from Article 4's pure rapidity indicating Middle Xiao.
Article 4 The Zu Yang pulse is rapid. Heat in the Stomach digests food and increases appetite. Stools must be hard, and urination frequent.
Continuing from the previous text, even if the Zu Yang pulse is not floating but merely rapid, lacking the trend of diaphragmatic heat descending, heat in the Stomach still digests food and increases appetite. Hard stools and frequent urination indicate heat in the Middle Jiao forcing water from the Lower Jiao, causing Xiao Ke—a variant among variants. The Small Intestine and Bladder lie below the Stomach. Heat in the Stomach sucks fluids from the chest and diaphragm for self-rescue, causing thirst. It also forces water from the Small Intestine into the Bladder, causing consumption. Mechanisms reinforce each other: thirst initiates above, consumptive momentum forms below; consumption initiates below, thirst momentum forms above. Thus, more thirst leads to more consumption, and more consumption leads to more thirst. "Hard stools and frequent urination" is synonymous with "hardness and rapidity contending, resulting in Xiao Ke."
Article 5 In men with Xiao Ke, urination is surprisingly profuse. For every dou of liquid drunk, a dou of urine is passed. Shen Qi Wan (Kidney Qi Pill) is prescribed.
This addresses the treatment for the primary Jueyin Xiao Ke of Article 1. The first two sentences distinguish Water-Drink from Xiao Ke; the next two distinguish Xiao Ke from other wasting syndromes. Thirst is common; one cannot assume all thirst is Xiao Ke. If thirst accompanies scanty urination, it accumulates into Water-Drink (see separate section). If Xiao Ke, thirst accompanies profuse urination, opposite to Water-Drink, hence "surprisingly profuse." Furthermore, Xiao Ke varies: Jueyin presents with upward rushing, Yangming with floating-rapid. Misapplying Jueyin-heating formulas to Yangming-excess patterns violates the rule against reinforcing excess, worsening Xiao Ke. Diagnosis relies on urination. In Yangming excess, water flows through dry earth; even if rapid, some leaks/seeps out. How could it pass unchanged? Thus, output cannot equal input. In Jueyin, residing in extreme Yin below, Yang fire is weak. Even with essence/blood exhaustion below and dry Qi floating above, there is no true heat. Only upon entering the Heart does dry wood meet fire, generating illusory flames. High fire and low drink cause no consumption beyond that point; cold streams pour directly. Why would intake decrease? "One dou drink, one dou urine" confirms this is not Yangming but Jueyin Xiao Ke. Shen Qi Tonifies Lower Jiao essence/blood to replenish Qi source, guiding it upward to steam and fill the emptiness of Heart and Lung. See detailed analysis under Xu Lao (Deficiency Labor). Xiao Ke arises from exhaustion of Liver-Kidney Yin, causing lower dryness and upper emptiness, leading to Wood Qi rushing and flame ignition. Shen Qi Wan, tonifying essence/blood to replenish Qi and steam upper emptiness, is precisely indicated. From the Upper Jiao perspective, Heart-Lung receive Kidney Qi's harmony, restoring True Yang (like a host returning home). From the Lower Jiao perspective, Liver-Kidney receive Kidney Qi's nourishment, regenerating True Yin (like homeland meeting harvest, refugees return). This is the true meaning: True Yin nourishes Wood below; True Yang controls Dragon Fire above. For Jueyin Xiao Ke, Upper Jiao lacks Yin, leaving solitary Yang with pathogenic heat unconnected, causing thirst. Lower Jiao lacks Yang, leaving group Yin with deficiency-cold losing control, causing consumption. Heavy use of Shu Di Huang (Rehmannia) and Shan Zhu Yu (Cornus) tonifies essence/blood downwards. Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite) are enclosed and guided down. Then, gently stirring from Liver-Kidney warms the Lower Jiao. Using "locking" treats consumption; rising fluids treat thirst. Adding Yu Zhu (Polygonatum) dries Earth to moderate flow between upper thirst and lower consumption, aiding fluid ascent. Adding Ze Xie (Alisma) and Fu Ling (Poria) drains dampness; with Earth embanked, fearing slowed flow retains guest drinks, blocking True Yin distribution. Finally, Dan Pi (Moutan) raises Yang and moves fluids, drawing Liver-Kidney spirit to the diaphragm. Like spring skies clearing, lightning vanishing, dew condensing, leaves refreshing—how can Xiao Ke not heal? Reading Zhang Zhongjing's formulas reveals miraculous transformations instantaneously, like viewing mirages from Penglai Pavilion, yet their subtleties remain inexhaustible. Mentioning "men" specifically: women are Yin-soft bodies with constant Yang deficiency due to menstruation, rarely suffering Xiao Ke. When women do suffer Xiao Ke, it is a withered syndrome with scanty urination and loose stools, often fatal.
Article 6 Floating pulse, difficult urination, slight fever, and Xiao Ke: promote urination and induce sweating. Wu Ling San (Five-Ingredient Powder with Poria) is prescribed.
Floating pulse indicates Qi rushing upward and expanding outward. Combined with difficult urination, slight fever, and Xiao Ke, we see excessive water intake but poor output. Slight fever arises from accumulated hot water obstructing downward flow, affecting the exterior channels, causing floating pulse. Promoting urination clears water downward; inducing sweat disperses heat laterally. Is this not appropriate? Only Wu Ling San achieves dual resolution. See *Shanghan Lun* for formula details.
Article 7 Thirst desire to drink water, but vomiting occurs after ingestion: named Shui Ni (Water Reversal). Wu Ling San (Five-Ingredient Powder with Poria) is prescribed.
This is a syndrome of warm drink and cold Stomach. Long-standing drink transforms into heat, scalding the chest, causing chest heat and thirst, desiring cold water. Cold water injures Yang and rebels against the Stomach, causing Stomach cold aversion and vomiting. Old water reverses/stagnates without descending; new water reverses/spouts without being retained. Hence "Water Reversal." Wu Ling San is acrid-sweet and draining. Acrid-sweet warms Stomach Yang; draining guides water smoothly downward. Drinking warm water post-medication aids this process.
Article 8 Thirst desiring water with incessant drinking: Wen Sha San (Clam Shell Powder) is prescribed.
Formula: Wen Sha (Clam Shell) 5 liang. Pound into powder. Mix with boiling water and take one cun-bi dose.
This is Kidney Water floating upward transforming into hot drink. Hot drink scalds the chest, causing incessant thirst-drinking. Wen Sha resembles the Kidney and is heavy/sinking, capable of directing water downward. Resembling Kidney directs it to Shao Yin; sinking/directing downward removes hot drink, stopping thirst. Popular interpretation claims salty taste enters Kidney is wrong. Since it is merely pounded into powder without roasting, how can it be salty? Wen Sha belongs to mussels/clams, also called Hua Ge, from East Sea and Laizhou. Spotted back, hence the name. Large ones 3 cun, small ones 5-6 fen. Shops substitute with Wu Bei Zi (Galla Chinensis), which is incorrect.
Article 9 The disease of Lin (strangury) presents with urine resembling millet grains, stringy tension and urgency in the lower abdomen, pain radiating to the umbilicus.
Lin is a general term for difficult urination with discharge that may be white, red, pasty, or sandy/stony. Etiologies generally fall into three types. First, Upper Jiao mental fatigue and Qi deficiency fail to distribute water/Qi; Middle Jiao Spleen Earth is cold and fails to transform water downward. Urine stagnates; long stagnation generates false heat in the Bladder. Zong Qi fails to lift essence/marrow; Yin Qi sinks into the Bladder. Yin Qi oppressed by false heat becomes turbid like mucus—this is Gao Lin (pasty strangury). Second, Three Jiao hyperthermia fatigues True Yang transformation mechanisms, ignoring transport, causing Bladder retention/inability to void. Urine is difficult. Yin-Yang fluids injured by pathogenic fire lead to water-seeking thirst. Drinking water久 boils in the retained Bladder, like boiling water to make alkali or sea water to make salt, forming Shi Lin (sand/stone strangury). Third, lustful fire loves the Heart Monarch, flies to the Kidney, flows externally to the genitalia, finds no outlet, and Yang fire cannot descend. It transversely penetrates the Dai Mai (Belt Vessel), causing sinking lumbar pain. Collaterals swell, transformation mechanisms block. Urine is difficult. Pathogenic fire binds, Yin essence淫 (flows excessively), causing Zhuo Lin (turbid strangury, yellow-green). This article describes Lin due to mental fatigue/Qi deficiency and Middle Earth failing to warm transformation. Article 2 summarizes Lin treatment prohibitions. Article 3 gives treatment for deficiency Lin. Article 4 describes Lin from stagnant lustful fire; formulas use salty-moistening herbs to enter Kidney and drain Heart Fire. Articles 5 and 6 describe heat Lin treatments. Zhang Zhongjing distinguishes Xiao Ke (thirst with excessive urination) from Lin (thirst with difficult urination), placing Lin after Xiao Ke. "Lin disease..."贯穿 subsequent articles. "Urine resembling millet" refers to turbid sediment particles, yellow-white like millet, initial stage of Gao Lin. Popular view equating it to Stone Lin is wrong. Initial Gao Lin is soft like millet; deep disease enlarges into strips. Stone Lin initially looks like alkali dissolving in water; after standing, settles hard like stones. Upper/Middle Jiao Yang Qi deficiency-cold fails to illuminate/transform, losing softness to nourish tendons. Lower abdomen contracts/tensions; umbilicus cuts/restricts, radiating pain.
Article 10 Patients with Lin should not undergo sweating therapy. Sweating will certainly cause hematuria.
"Lin patients" refers to the preceding three types. Hematuria refers to blood in urine. In deficiency-cold Lin, Yang Qi is already weak. Sweating depletes Qi; Qi fails to function, moving Blood is inevitable. Blood moves but hasn't transformed into sweat, so it exits with Lin. In Yang-heat Lin, Ying-Yin is injured by hyperthermia. Sweat requires Yin-Jin as material. Insufficient Yin cannot produce sweat; forcing it moves Blood. Residual blood appears in urine, same as above. In stagnant lustful fire Lin, Yin essence is already blazed. Exterior-releasing methods are not far from heat; using acrid-warm sweating drugs adds heat. Yin-Blood cannot withstand brutality; blood moves and exits via urine. This summarizes Lin treatment prohibitions.
Article 11 Difficult urination with Water-Fluid accumulation, bitter thirst: Gua Lou Qu Mai Wan (Trichosanthes Root and Dianthus Pill) is prescribed.
Formula: Gua Lou Gen (Trichosanthes Root) 2 liang, Qu Mai (Dianthus) 1 liang, Fu Ling (Poria) 3 liang, Yu Zhu (Polygonatum) 3 liang, Fu Zi (Aconite, processed) 1 piece. Pound five ingredients into powder. Honey pills sized like wutong seeds. Take 3 pills with water, three times daily. If ineffective, increase to 7-8 pills. Stop when urination improves and abdomen feels warm.
This supplements the deficiency Lin syndrome of Article 1, detailing treatment. Lin with urine like millet, abdominal tension/pain radiating to umbilicus starts with difficult urination. Long-term leads to water accumulation (Water-Fluid). Water ages into heat; hot water scalds chest/diaphragm, causing bitter thirst. Formula uses Gua Lou Gen to generate fluids and stop thirst; Qu Mai to drain Blood-level heat; Fu Ling to drain Qi-level water-fluid; Yu Zhu to dry Earth; Fu Zi to warm Earth and control water to promote urination. Seems to treat only these symptoms, unaware of the subtle interplay of Three Jiao...