沉香（二两） 木香（半两） 白豆蔻（一两，用仁） 甘草（一分） 脑子（一钱） 麝香（半钱） 人参（半
两）
上为细末。每服半钱，用沸汤点服。或入生姜盐少许，食后服。
当归（一两） 自然铜（金色者， 为末，醋熬，一两） 乌金石（三两，铁炭是也） 大黄（一两
童子小便浸用）
上为末。每服二钱，红花酒半盏，童子小便半盏，同调下，食前，日二服。
沉香 木香 缩砂仁 白豆蔻仁 青皮（去白） 陈皮（去白） 广术（煨） 枳实（麸炒，以上
各一两） 萝卜子（一两，另末） 黑牵牛（二两，末） 大黄（二两，炒）
上为末，生姜汁浸，蒸饼为丸，如桐子大。每服三十丸，橘皮汤下。
治气不下降，胸膈满闷。
枳实（麸炒） 白术（各半两）
上为细末，烧饭为丸，如桐子大。每服五十丸，诸饮送下。
《易》言天地，自太虚至黄泉，有六位。《内经》言人之身，自头至足，亦有六位。今余又
间，自肺至肾，又有六位。人与天地造化五行，同一炉 ，知彼则知此矣。故立天之气，曰金
与火，立地之气曰土与水，立人之气曰风与火。故金与火合，则热而清；水土合则湿而寒；
风火合则温而炎。人胸腹之间，亦犹是也。肺最在上，为金主燥；心次之，为君火主热；
肝又次之，为风木主温；胆又次之，为相火主极热；脾又次之，为湿土主凉；肾又次之，黄泉
为寒水主寒。故心肺象天，脾肾象地，肝胆象人。不知此者，不可与论人之病矣。夫土为万
物之本，水为万物之元。水土合德，以阴居阴，同处乎下，以立地为气，万物根于地，是故
水土湿寒。若燥热阳实，则地之气不立，万物之根索泽，而枝叶枯矣。
《五常政大论》曰∶
中者，命曰神机。是为动物，根本在于中也。根本者，脾、胃、肾也。食入胃，则脾为布化
气味，荣养五脏百骸。故酸入肝而养筋膜；苦入心而养血脉；甘入脾而养肌肉；辛入肺而养皮毛
；咸入肾而养骨髓。五气亦然。故清养肺，热养心，温养肝，湿养脾，寒养肾也。凡此五味
五气，太过则病，不及亦病，惟平则常安矣。故《六节藏象论》曰∶五味入口，藏于肠胃，
藏，以养五气，气和而生，津液相成，神乃自生。是其理也。又《太阴阳明论》云∶脾病而
不用者，何也？岐伯曰∶四肢皆禀气于胃，而不得至经，必因于脾乃得禀也。今脾病不能为
胃行其津液，不得禀水谷气，气日以衰，脉道不利，筋骨肌肉，皆无气以生，故不用焉。帝
曰∶脾不主时，何也？岐伯曰∶脾者，土也，治中央，常以四时长四脏，各十八日寄治，不
得独主于时也。脏藏者，常着胃土之精也。土者生万物，而法天地。故上下至头足，不得独
主于时也。
帝曰∶脾与胃，以膜相连尔，而能行其津液，何也？岐伯曰∶足太阴者，三阴也
，其脉贯胃，属脾络嗌。故太阴为之行气于三阴。足阳明者，表也，五脏六腑之海也，亦为之行
气于三阳。脏腑各因其经而受气，以益阳明，故为胃行其津液。四肢不得禀水
谷，气日以衰，阴道不利，筋骨肌肉，皆无气以生，故不用焉。不用者，谓不能为之运用
也。由是观之，则五脏六腑，四肢百骸，皆禀受于脾胃，行其津液，相与濡润滋养矣。后之
医者，欲以燥热之剂，以养脾胃，滋土之气，不亦外乎？况消渴之病者，本湿寒之阴气极衰
，燥热之阳气太甚，更服燥热之药，则脾胃之气竭矣。叔世不分五运六气之虚实，而一概言
热为实，而虚为寒，彼但知心火阳热一气之虚实，而非脏腑六气之虚实也。盖肺本清，虚则
温；心本热，虚则寒；肝本温，虚则清；脾本湿，虚则燥；肾本寒，虚则热。假若胃冷为虚
者，乃胃中阴水寒气实甚，而阳火热气衰虚也，非胃土湿气之本衰，故当温补胃中阳火之衰
，退其阴水寒气之甚。又如胃热为实者，乃胃中阳火实而阴水虚也，故当以寒药，泻胃中之
实火，而养其虚水。然此皆补泻胃中虚热，水火所乘之邪，非胃为湿者之本。其余例同法。
夫补泻脾胃湿土之水气者，润其湿者是补湿，燥其湿者是泻湿，土本湿故也。
凡脏腑诸气，不必肾水独当寒，心火独当热，要知每脏每腑，诸气和同，宣而平之可也。故余尝谓∶五常
之道，阴中有阳，阳中有阴。孤阴不长，独阳不成。但有一物皆备，五行递相济养，是谓和平。
交互克伐，是谓衰兴。变乱失常，患害由行。故水少火多，为阳实阴虚而病热也；水多火
少，为阴实阳虚而病寒也。其为治者，泻实补虚，以平为期而已矣。故治消渴者，补肾水阴寒
之虚，而泻心火阳热之实，除肠胃燥热之甚，济人身津液之衰，使道路散而不结，津液生而
不枯，气血利而不涩，则病日已矣。况消渴者，本因饮食服饵失宜，肠胃干涸，而气液不得
宣平；或耗乱精神，过违其度；或因大病，阴气损而血液衰虚，阳气悍而燥热郁甚之所成也。
故济众云∶三消渴者，皆由久嗜咸物，恣食炙爆，饮酒过度；亦有年少服金石丸
热，结于胸中，下焦虚热，血气不能制石热，燥甚于胃，故渴而引饮。若饮水多而小便多者，名
曰消渴；若饮食多而不甚饥，小便数而渐瘦者，名曰消中；若渴而饮水不绝，腿消瘦而小便
有脂液者，名曰肾消。如此三消者，其燥热一也，但有微甚耳。
余闻世之方，多一方而通治
三消渴者，以其善消水谷而喜渴也。然叔世论消渴者，多不知本。其言消渴者，上实热而下
虚冷。上热故烦渴多饮，下寒故小便多出。本因下部肾水虚，而不能制其上焦心火，故上实
热而下虚冷。又曰∶水数一，为物之本，五行之先。故肾水者，人之本，命之元，不可
使之衰弱。根本不坚，则枝叶不茂；元气不固，则形体不荣。消渴病者，下部肾水极冷，若更服
寒药，则元气转虚，而下部肾水转衰，则上焦心火亢甚而难治也。但以暖药补养元气，若
下部肾水得实而胜退上焦火，则自然渴止，小便如常而病愈也。若此之言，正与仲景相反。
所以巧言似是，于理实违者也。非徒今日之误，误已久哉！又如蒋氏《药证病原》中，论消
渴、消中、消肾病曰∶三焦五脏俱虚热，惟有膀胱冷似冰。又曰∶腰肾虚冷日增重。又曰∶膀胱肾脏冷如
泉。始言三焦五脏俱虚热，惟有膀胱冷似冰，复言五脏亦冷，且肾脏水冷言为虚，其余热者
，又皆言其虚。夫阴阳兴衰，安有此理？且其言自不相副，其失犹小，至于寒热差殊，用药
相反，过莫大焉！或又谓∶肾与膀胱属水，虚则不能制火。虚既不能制火，故小便多者
远矣。彼谓水气实者，必能制火，虚者不能制火。故阳实阴虚，而热燥其液，小便淋而常
少；阴实阳虚，不能制水，小便利而常多。岂知消渴小便多者，非谓此也。何哉？盖燥热太
甚，而三焦肠胃之腠理，怫郁结滞，致密壅塞，而水液不能渗泄浸润于外，荣养百骸。故肠
胃之外燥热太甚，虽复多饮于中，终不能浸润于外，故渴不止。小便多出者，如其多饮，不
能渗泄于肠胃之外，故数溲也。故余尽言《原病式》曰∶皮肤之汗孔者，谓泄汗之孔窍也。
一名气门者，谓泄气之门户也。一名腠理者，谓气液之隧道纹理也。一名鬼门者，谓幽冥之
门也。一名玄府者，谓玄微之府也。然玄府者，无物不有。人之脏腑皮毛，肌肉筋膜，骨髓
至于万物，悉皆有之，乃出入升降，道路门户也。故《经》曰∶出入废则神机化灭，升降
立孤危。故非出入，则无以生长壮老已；非升降，则无以生长化收藏。是知出入升降，无器不有
。故知人之眼、耳、鼻、舌、身、意、神、识，能为用者，皆有升降出入之通利也。有所闭
塞，则不能用也。若目无所见，耳无所闻，鼻不闻香，舌不知味，筋痿骨痹，爪退齿腐，毛
发堕落，皮肤不仁，肠胃不能渗泄者，悉有热气怫郁，玄府闭塞，而致津液血脉，荣卫清气
，不能升降出入故也。各随郁结微甚，而有病之大小焉。病在表则怫郁，腠理闭密，阳气不
能散越，故燥而无汗，而气液不能出矣。叔世不知其然，故见消渴数溲，妄言为下部寒尔。
岂知肠胃燥热怫郁使之然也？予之所以举此，世为消渴之证，乃肠胃之外燥热，痞闭其渗泄
之道路，水虽入肠胃之内，不能渗泄于外，故小便数出而复渴。此数句，足以尽其理也。
试
。有言心肺气厥而渴者；有言肝痹而渴者；有言脾热而渴者；有言肾热而渴者；有言胃与大
肠热结而渴者；有言脾痹而渴者；有言小肠瘅热而渴者；有因病疟而渴者；有因肥甘石药而
渴者；有因醉饱入房而渴者；有因远行劳倦遇大热而渴者；有因伤害胃干而渴者；有因肾热
而渴者；有因病风而渴者。虽五脏之部分不同，而病之所遇各异，其归燥热一也。
所谓心肺气厥而渴者，《厥论》曰∶心移热于肺，传为膈消。注曰∶心热入肺，久而传化，内为膈热
饮也。所谓肝痹而渴者，《痹论》曰∶肝痹者，夜卧则惊，多饮，数小便。如脾热而渴者，《痿论》
曰∶脾气热则胃干而渴，肌肉不仁，发为肉痿。
所谓肾热而渴者，《刺热论》曰∶肾热病者
，络于肺，系舌本，故口燥舌干而渴。叔世惟言肾虚不能制心火，为上实热而下虚冷，以热
补肾水，欲令胜退心火者，未明阴阳虚实之道也。夫肾水属阴而本寒，虚则为热；心火属阳
而本热，虚则为寒。若肾水阴虚，则心火阳实，是谓阳实阴虚，而上下俱热明矣。故《气厥
曰∶肾气衰，阳气独胜。《宣明五气论》曰∶肾恶燥，由燥肾枯水涸。《藏气法时论》曰∶
急食辛以润之。夫寒物属阴，能养水而泻心；热物属阳，能养火而耗水。今肾水既不胜心火，
则上下俱热，奈何以热药养肾水？欲令胜心火，岂不谬哉？
又如胃与大肠热结而渴者，《阴阳
别论》∶二阳结为之消。注曰∶阳结，胃及大肠俱热结也。肠胃藏热，善消水谷。又《气厥
论》曰∶大肠移热于胃，善食而瘦。《脉要精微论》曰∶瘅成为消中，善食而瘦。
如脾痹而渴者，
多者，止是三焦燥热怫郁，而气衰也明矣。岂可以燥热毒药，助其强阳，以伐衰阴乎？此真
实实虚虚之罪也！夫消渴者，多变聋、盲、疮、癣、痤、痱之类，皆肠胃燥热怫郁，水液
不能浸润于周身故也；或热甚而膀胱怫郁，不能渗泄，水液妄行而面上肿也。
如小肠瘅热而渴者，《举痛论
》曰∶热气留于小肠，肠中痛，瘅热焦渴，则便坚不得出矣。注曰∶热渗津液而小便坚矣。
如言病疟而渴者，《疟论》曰∶阳实则外热，阴虚则内热，内外皆热，则喘而渴，故欲饮冷也。然阳实
阴虚而为病热，法当用寒药养阴泻阳，是谓泻实补衰之道也。
如因肥甘石药而渴者，《奇病论》
曰∶有口甘者，病名为何？岐伯曰∶此五气之所溢也，病名脾瘅。瘅为热也，脾热则四脏不禀，
故五气上溢也。先因脾热，故曰脾瘅。又《经》曰∶五味入口，藏于胃，脾为之行其精气，
津液在脾，故令人口甘也。此肥美之所发也。此人必数食甘美而多肥也。肥者令人内热，甘者令人
中满，故其气上溢，转而为消渴。《通评虚实论》曰∶消瘅仆击，偏枯痿厥，气满发逆，肥
贵之人，膏粱之疾也。或言人惟胃气为本。脾胃合为表里，脾胃中州，当受温补以调饮食。今消
渴者，脾胃极虚，益宜温补。若服寒药，耗损脾胃，本气虚乏而难治也。此言乃不明阴阳寒
热虚实补泻之道，故妄言而无畏也。岂知《腹中论》云∶帝曰∶夫子数言热中消中，不可服芳
草石药。石药发癫，芳草发狂。注言∶多饮数溲，谓之热中；多食数溲，谓之消中。多喜曰癫，
多怒曰狂。芳，美味也。石，谓英乳。乃发热之药也。《经》又曰∶热中消中，皆富贵人也。
今禁膏粱，是不合其心；禁芳草石药，是病不愈，愿闻其说。岐伯曰∶芳草之味美，石药之气
悍，二者之气，急疾坚劲，故非缓心和人，不可服此二者。帝曰∶何以然？岐伯曰∶夫热气
悍，药气亦然。所谓饮一溲二者，当肺气从水而出也，其水谷之海竭矣。凡见消渴，便用
热药，误人多矣。故《内经》应言∶渴者皆如是。岂不昭晰欤？然而犹有惑者，诸气过极反
胜也者，是以人多误也。如阳极反似阴者是也。若不明标本，认似为是，始终乖矣。故凡见
下部觉冷，两膝如冰，此皆心火不降，状类寒水，宜加寒药，下之三、五次，则火降水升，
寒化自退。然而举世皆同执迷，至如《易》《素》二书，弃如朽坏，良可悲夫！故处其方，必明病
之标本，达药之所能，通气之所宜，而无加害者，可以制其方也已。所谓标本者，先病而为本，后病而为标
，此为病之本末也。标本相传，先当救其急也。又云∶六气为本，三阴三阳为标。盖为病，
脏病最急也。又云∶六气为胃之本。假若胃热者，胃为标，热为本也。处其方者，当除胃中之
热，是治其本也。故六气乃以甚者为邪，衰者为正，法当泻甚补衰，以平为期。养正除邪，
沉香（二两） 木香（半两） 白豆蔻（一两，取仁） 甘草（一分） 冰片（一钱） 麝香（半钱） 人参（半两）
以上药材研成细末。每次服用半钱，用沸水冲服。也可以加入少许生姜和盐，饭后服用。
当归（一两） 自然铜（选金色的，研成末，用醋熬制，一两） 乌金石（三两，即铁炭） 大黄（一两，用童子小便浸泡后使用）
以上药材研成末。每次服用二钱，用红花酒半盏、童子小便半盏，混合调匀后送服，饭前服用，每日两次。
沉香 木香 缩砂仁 白豆蔻仁 青皮（去白） 陈皮（去白） 莪术（煨） 枳实（麸炒，以上各一两） 萝卜子（一两，另研为末） 黑牵牛（二两，研末） 大黄（二两，炒）
以上药材研成末，用生姜汁浸泡，蒸饼做丸，如梧桐子大。每次服用三十丸，橘皮汤送下。
治疗气不下降，胸膈满闷。
枳实（麸炒） 白术（各半两）
以上药材研成细末，用米饭做丸，如梧桐子大。每次服用五十丸，用各种饮品送下。
《易经》讲天地，从太虚到黄泉，有六位。《黄帝内经》讲人的身体，从头到脚，也有六位。现在我又观察到，从肺到肾，又有六位。人与天地的造化五行，如同在一个炉子里冶炼，了解彼处就能了解此处。所以立天的气，叫金与火；立地的气，叫土与水；立人的气，叫风与火。所以金与火相合，则热而清；水土相合，则湿而寒；风火相合，则温而炎。人的胸腹之间，也是如此。肺在最上面，属金主燥；心次之，属君火主热；肝又次之，属风木主温；胆又次之，属相火主极热；脾又次之，属湿土主凉；肾又次之，对应黄泉，属寒水主寒。所以心肺象天，脾肾象地，肝胆象人。不懂这个道理的人，不可以跟他谈论人的疾病了。土是万物的根本，水是万物的源头。水土合德，以阴居阴，同处在下方，以此确立地为气的基础，万物根植于地，所以水土湿寒。如果燥热阳实，那么地的气就不能确立，万物的根须得不到滋润，枝叶就会枯死。
《素问·五常政大论》说：
中，叫做神机。这是动物，根本在于中。根本，是指脾、胃、肾。食物进入胃，脾就布化气味，荣养五脏百骸。所以酸入肝而养筋膜；苦入心而养血脉；甘入脾而养肌肉；辛入肺而养皮毛；咸入肾而养骨髓。五气也是这样。所以清气养肺，热气养心，温气养肝，湿气养脾，寒气养肾。这五味五气，太过则生病，不及也生病，只有平和才能常安。所以《素问·六节藏象论》说：五味入口，藏于肠胃，藏起来以养五气，气和平而生，津液相成，神气自然产生。就是这个道理。又《素问·太阴阳明论》说：脾病而不发挥作用，为什么呢？岐伯说：四肢都禀受胃气，但不能直接到达经脉，必须依靠脾才能禀受。现在脾病不能为胃运行津液，不能禀受水谷之气，气一天比一天衰弱，脉道不通利，筋骨肌肉，都没有气来生成，所以不能运动。黄帝说：脾不主时，为什么呢？岐伯说：脾属土，治理中央，常在四季中滋养四脏，每季最后十八日寄治，不能单独主一个时令。脏所藏的，常附着于胃土的精微。土能生万物，效法天地。所以上下到头足，不能单独主一个时令。
黄帝说：脾与胃，只是通过膜相连罢了，却能运行津液，为什么呢？岐伯说：足太阴脾经，是三阴经，其脉贯胃，属脾络咽。所以太阴为之在三阴经运行气。足阳明胃经，是表，是五脏六腑的海，也为之在三阳经运行气。脏腑各自顺着经脉接受气，以增益阳明，所以为胃运行津液。四肢不能禀受水谷，气一天比一天衰弱，阴道不利，筋骨肌肉，都没有气来生成，所以不能运动。所谓不用，是指不能为它们运用。由此看来，五脏六腑，四肢百骸，都禀受于脾胃，运行津液，相互濡润滋养。后来的医生，想用燥热的药剂，来养脾胃，滋土的气，不是太疏远了吗？何况消渴病的患者，本是湿寒的阴气极衰，燥热的阳气太甚，再服用燥热的药，那么脾胃之气就竭尽了。世俗之世不分五运六气的虚实，而一概说热为实，而虚为寒，他们只知心火阳热一气的虚实，而不是脏腑六气的虚实。大概肺本清，虚则温；心本热，虚则寒；肝本温，虚则清；脾本湿，虚则燥；肾本寒，虚则热。假如胃冷为虚者，乃是胃中阴水寒气实甚，而阳火热气衰虚也，不是胃土湿气之本衰，所以应当温补胃中阳火的衰，退去阴水寒气的盛。又如胃热为实者，乃是胃中阳火实而阴水虚也，所以应当用寒药，泻胃中的实火，而养其虚水。然而这都是补泻胃中虚热，水火所乘的邪气，不是胃为湿的本源。其余类推。
凡是补泻脾胃湿土的水气，润其湿的是补湿，燥其湿的是泻湿，因为土本湿的缘故。
凡是脏腑诸气，不必肾水独当寒，心火独当热，要知道每脏每腑，诸气和同，宣散而平复就可以了。所以我曾经说：五常之道，阴中有阳，阳中有阴。孤阴不长，独阳不成。只要有一物皆备，五行递相济养，这叫和平。交互克伐，这叫衰兴。变乱失常，患害由此发生。所以水少火多，为阳实阴虚而病热；水多火少，为阴实阳虚而病寒。治疗的方法，泻实补虚，以平和为限度而已。所以治疗消渴，补肾水阴寒的虚，而泻心火阳热的实，除肠胃燥热的盛，济人身津液的衰，使道路散而不结，津液生而不枯，气血利而不涩，那么病一天天好了。何况消渴病，本因饮食服饵失宜，肠胃干涸，而气液不得宣平；或者耗乱精神，过违其度；或者因病大病，阴气损而血液衰虚，阳气悍而燥热郁甚所形成的。所以《济众新编》说：三消渴，都是由久嗜咸物，恣食炙爆，饮酒过度；也有年少服金石丸热，结于胸中，下焦虚热，血气不能制石热，燥甚于胃，所以渴而引饮。如果饮水多而小便多者，名叫消渴；如果饮食多而不甚饥，小便数而渐瘦者，名叫消中；如果渴而饮水不绝，腿消瘦而小便有脂液者，名叫肾消。像这三消，它们的燥热是一样的，只是有轻微严重之分。
我听说世间的方子，多一方而通治三消渴，因为它们善消水谷而喜渴。然而世俗之世论消渴，多不知本源。他们说消渴，上实热而下虚冷。上热所以烦渴多饮，下寒所以小便多出。本因下部肾水虚，而不能制约其上焦心火，所以上实热而下虚冷。又说：水数一，为物的根本，五行的先。所以肾水，是人的根本，命的元，不可使它衰弱。根本不坚，则枝叶不茂；元气不固，则形体不荣。消渴病患者，下部肾水极冷，如果再服寒药，则元气转虚，而下部肾水转衰，则上焦心火亢盛而难治。只用暖药补养元气，如果下部肾水得实而胜退上焦火，则自然渴止，小便如常而病愈。像这样的话，正与张仲景相反。所以巧言似是，于理实际违背的。不只是今天的错误，错误已经很久了！又如蒋氏《药证病原》中，论消渴、消中、消肾病说：三焦五脏俱虚热，惟有膀胱冷似冰。又说：腰肾虚冷日增重。又说：膀胱肾脏冷如泉。始言三焦五脏俱虚热，惟有膀胱冷似冰，复言五脏亦冷，且肾脏水冷言为虚，其余热者，又皆言其虚。阴阳兴衰，哪有这个理？况且他的话自不相副，其失犹小，至于寒热差殊，用药相反，过错没有比这更大的了！有人又说：肾与膀胱属水，虚则不能制火。虚既不能制火，所以小便多的远了。他认为水气实者，必能制火，虚者不能制火。所以阳实阴虚，而热燥其液，小便淋而常少；阴实阳虚，不能制水，小便利而常多。哪里知道消渴小便多者，不是说这个。为什么呢？大概燥热太甚，而三焦肠胃的腠理，怫郁结滞，致密壅塞，而水液不能渗泄浸润于外，荣养百骸。所以肠胃之外燥热太甚，虽然反复多饮于中，最终不能浸润于外，所以渴不止。小便多出者，如其多饮，不能渗泄于肠胃之外，所以数溲。所以我详尽地说《原病式》说：皮肤之汗孔，叫做泄汗之孔窍。一名气门，叫做泄气之门户。一名腠理，叫做气液之隧道纹理。一名鬼门，叫做幽冥之门。一名玄府，叫做玄微之府。然而玄府，无物不有。人的脏腑皮毛，肌肉筋膜，骨髓至于万物，悉皆有之，乃出入升降，道路门户。所以《内经》说：出入废则神机化灭，升降立孤危。所以非出入，则无以生长壮老已；非升降，则无以生长化收藏。是知出入升降，无器不有。所以知人的眼、耳、鼻、舌、身、意、神、识，能为用者，皆有升降出入之通利也。有所闭塞，则不能用也。如果目无所见，耳无所闻，鼻不闻香，舌不知味，筋痿骨痹，爪退齿腐，毛发堕落，皮肤不仁，肠胃不能渗泄者，悉有热气怫郁，玄府闭塞，而致津液血脉，营卫清气，不能升降出入故也。各随郁结微甚，而有病之大小焉。病在表则怫郁，腠理闭密，阳气不能散越，所以燥而无汗，而气液不能出矣。世俗之世不知道这样，所以见消渴数溲，妄言为下部寒罢了。哪里知道肠胃燥热怫郁使之然呢？我之所以举此，世人认为消渴之证，乃肠胃之外燥热，痞闭其渗泄之道路，水虽入肠胃之内，不能渗泄于外，所以小便数出而复渴。这几句话，足以尽其理了。试看。有说心肺气厥而渴的；有说肝痹而渴的；有说脾热而渴的；有说肾热而渴的；有说胃与大肠热结而渴的；有说脾痹而渴的；有说小肠瘅热而渴的；有因病疟而渴的；有因肥甘石药而渴的；有因醉饱入房而渴的；有因远行劳倦遇大热而渴的；有因伤害胃干而渴的；有因肾热而渴的；有因病风而渴的。虽然五脏的部分不同，而病之所遇各异，其归燥热是一样的。
所谓心肺气厥而渴，《厥论》说：心移热于肺，传为膈消。注解说：心热入肺，久而传化，内为膈热饮也。所谓肝痹而渴，《痹论》说：肝痹者，夜卧则惊，多饮，数小便。如脾热而渴，《痿论》说：脾气热则胃干而渴，肌肉不仁，发为肉痿。
所谓肾热而渴，《刺热论》说：肾热病者，络于肺，系舌本，所以口燥舌干而渴。世俗之世只说肾虚不能制心火，为上实热而下虚冷，以热补肾水，欲令胜退心火者，未明阴阳虚实之道。夫肾水属阴而本寒，虚则为热；心火属阳而本热，虚则为寒。如果肾水阴虚，则心火阳实，这叫阳实阴虚，而上下俱热明矣。所以《气厥论》说：肾气衰，阳气独胜。《宣明五气论》说：肾恶燥，由燥肾枯水涸。《藏气法时论》说：急食辛以润之。夫寒物属阴，能养水而泻心；热物属阳，能养火而耗水。今肾水既不胜心火，则上下俱热，奈何以热药养肾水？欲令胜心火，岂不谬哉？
又如胃与大肠热结而渴，《阴阳别论》说：二阳结为之消。注解说：阳结，胃及大肠俱热结也。肠胃藏热，善消水谷。又《气厥论》说：大肠移热于胃，善食而瘦。《脉要精微论》说：瘅成为消中，善食而瘦。
如脾痹而渴，
多的，止是三焦燥热怫郁，而气衰也明矣。岂可以用燥热毒药，助其强阳，以伐衰阴乎？这真是真实实虚虚的罪过！夫消渴，多变聋、盲、疮、癣、痤、痱之类，皆肠胃燥热怫郁，水液不能浸润于周身故也；或热甚而膀胱怫郁，不能渗泄，水液妄行而面上肿也。
如小肠瘅热而渴，《举痛论》说：热气留于小肠，肠中痛，瘅热焦渴，则便坚不得出矣。注解说：热渗津液而小便坚矣。
如说病疟而渴，《疟论》说：阳实则外热，阴虚则内热，内外皆热，则喘而渴，所以欲饮冷也。然而阳实阴虚而为病热，法当用寒药养阴泻阳，这叫泻实补衰之道。
如因肥甘石药而渴，《奇病论》说：有口甘者，病名为什么？岐伯说：这是五气之所溢也，病名脾瘅。瘅为热也，脾热则四脏不禀，所以五气上溢也。先因脾热，所以说脾瘅。又《内经》说：五味入口，藏于胃，脾为之行其精气，津液在脾，所以令人口甘也。这是肥美之所发也。此人必数食甘美而多肥也。肥者令人内热，甘者令人中满，所以其气上溢，转而为消渴。《通评虚实论》说：消瘅仆击，偏枯痿厥，气满发逆，肥贵之人，膏粱之疾也。有人说人惟胃气为本。脾胃合为表里，脾胃中州，当受温补以调饮食。今消渴者，脾胃极虚，益宜温补。若服寒药，耗损脾胃，本气虚乏而难治也。这话是不明阴阳寒热虚实补泻之道，所以妄言而无畏。哪里知道《腹中论》说：黄帝说：先生多次说热中消中，不可服芳草石药。石药发癫，芳草发狂。注解说：多饮数溲，谓之热中；多食数溲，谓之消中。多喜曰癫，多怒曰狂。芳，美味也。石，谓英乳。乃发热之药也。《内经》又说：热中消中，皆富贵人也。今禁膏粱，是不合其心；禁芳草石药，是病不愈，愿闻其说。岐伯说：芳草之味美，石药之气悍，二者之气，急疾坚劲，所以非缓心和人，不可服此二者。黄帝说：为什么这样？岐伯说：夫热气悍，药气亦然。所谓饮一溲二者的，当肺气从水而出也，其水谷之海竭矣。凡见消渴，便用热药，误人多矣。所以《内经》应该说：渴者皆如是。难道不清晰吗？然而还有困惑的人，诸气过极反胜也者，是以人多误也。如阳极反似阴者是也。如果不明标本，认似为是，始终乖矣。所以凡见下部觉冷，两膝如冰，这都是心火不降，状类寒水，宜加寒药，下之三、五次，则火降水升，寒化自退。然而举世皆同执迷，至于《易》《素》二书，弃如朽坏，良可悲夫！所以处方，必明病之标本，达药之所能，通气之所宜，而无加害者，可以制其方也已。所谓标本者，先病而为本，后病而为标，此为病之本末也。标本相传，先当救其急也。又说：六气为本，三阴三阳为标。盖为病，脏病最急也。又说：六气为胃之本。假若胃热者，胃为标，热为本也。处方者，当除胃中之热，是治其本也。所以六气乃以甚者为邪，衰者为正，法当泻甚补衰，以平为期。养正除邪，
Chenxiang (Agarwood, *Aquilaria sinensis*): 2 liang. Muxiang (Costus Root, *Saussurea costus*): 0.5 liang. Baidoukou (White Cardamom Seed, *Amomum kravanh*): 1 liang, using the seed kernel. Gancao (Licorice Root, *Glycyrrhiza uralensis*): 1 fen. Naozi (Borneol, *Borneolum Syntheticum*): 1 qian. Shexiang (Musk, *Moschus*): 0.5 qian. Renshen (Ginseng Root, *Panax ginseng*): 0.5 liang.
Grind the above herbs into a fine powder. Take half a qian per dose, mixed with boiling water. Alternatively, add a small amount of fresh ginger and salt, and take after meals.
Danggui (Angelica Sinensis Root, *Angelica sinensis*): 1 liang. Ziran Tong (Natural Copper Pyrite, *Pyritum*): Select golden ones, grind into powder, simmer in vinegar, 1 liang. Wujinshi (Iron Carbon, *Ferrum Carbonicum*): 3 liang. Dahuang (Rhubarb Root, *Rhei Radix et Rhizoma*): 1 liang, soaked in urine from an uncircumcised boy before use.
Grind the above herbs into powder. Take 2 qian per dose, mixed with half a cup of Honghua (Safflower) wine and half a cup of urine from an uncircumcised boy. Take before meals, twice daily.
Chenxiang (Agarwood, *Aquilaria sinensis*). Muxiang (Costus Root, *Saussurea costus*). Suosharen (Sand Cardamom Fruit, *Amomum villosum*). Baidoukou Ren (White Cardamom Seed Kernel, *Amomum kravanh*). Qingpi (Green Tangerine Peel, *Citrus reticulata*): Remove the white pith. Chenpi (Aged Tangerine Peel, *Citrus reticulata*): Remove the white pith. Ezhu (Turmeric Tuber, *Curcuma zedoaria*): Roasted. Zhishi (Immature Bitter Orange Fruit, *Citrus aurantium*): Stir-fried with bran. (Each of the above: 1 liang). Luobozǐ (Radish Seed, *Raphani Semen*): 1 liang, ground separately into powder. Heiqianniu (Black Morning Glory Seed, *Ipomoeae turbinatae Semen*): 2 liang, ground into powder. Dahuang (Rhubarb Root, *Rhei Radix et Rhizoma*): 2 liang, stir-fried.
Grind the above herbs into powder, soak in fresh ginger juice, and make pills with steamed wheat bread dough, sized like paulownia seeds. Take 30 pills per dose, washed down with tangerine peel decoction.
Treats Qi failing to descend, causing fullness and oppression in the chest and diaphragm.
Zhishi (Immature Bitter Orange Fruit, *Citrus aurantium*): Stir-fried with bran. Baizhu (Atractylodes Macrocephala Rhizome, *Atractylodis macrocephalae Rhizoma*): Each 0.5 liang.
Grind the above herbs into a fine powder, make pills with rice paste, sized like paulownia seeds. Take 50 pills per dose, washed down with various beverages.
The *I Ching* discusses Heaven and Earth, stating that from the Great Void to the Yellow Springs, there are six positions. The *Huangdi Neijing* (Yellow Emperor’s Inner Canon) states that the human body, from head to foot, also has six positions. Now I further observe that from the Lung to the Kidney, there are again six positions. Humans and the creation of Heaven and Earth share the same Five Elements, like being smelted in one furnace; knowing one allows you to know the other. Thus, the Qi establishing Heaven is Metal and Fire; the Qi establishing Earth is Earth and Water; the Qi establishing Humanity is Wind and Fire. Therefore, when Metal and Fire combine, they are hot yet clear; when Earth and Water combine, they are damp yet cold; when Wind and Fire combine, they are warm yet blazing. The area between the chest and abdomen of humans is likewise. The Lung is at the very top, belonging to Metal and governing Dryness; the Heart follows, belonging to Sovereign Fire and governing Heat; the Liver follows, belonging to Wind-Wood and governing Warmth; the Gallbladder follows, belonging to Ministerial Fire and governing Extreme Heat; the Spleen follows, belonging to Damp-Earth and governing Coolness; the Kidney follows, corresponding to the Yellow Springs, belonging to Cold-Water and governing Cold. Thus, the Heart and Lung resemble Heaven, the Spleen and Kidney resemble Earth, and the Liver and Gallbladder resemble Humanity. Those who do not understand this cannot discuss human diseases with them. Earth is the root of all things, and Water is the origin of all things. Earth and Water unite in virtue, occupying Yin positions in Yin, dwelling together below, thereby establishing Earth as Qi. All things take root in Earth; therefore, Earth and Water are damp and cold. If Dryness-Heat and Yang-Excess prevail, the Qi of Earth cannot be established, the roots of all things will lack moisture, and branches and leaves will wither.
The *Suwen · Wu Chang Zheng Da Lun* (Great Treatise on the Five Constants and Normal Policies) says:
"Middle" is called Shenji (Spirit Mechanism). This refers to animals, whose root lies in the middle. The root refers to the Spleen, Stomach, and Kidney. When food enters the Stomach, the Spleen distributes and transforms its Qi and flavor, nourishing the five Zang organs and hundred bones. Thus, Sour enters the Liver and nourishes tendons and fascia; Bitter enters the Heart and nourishes blood vessels; Sweet enters the Spleen and nourishes muscles; Pungent enters the Lung and nourishes skin and hair; Salty enters the Kidney and nourishes bone marrow. The same applies to the Five Qi. Thus, Clear Qi nourishes the Lung, Heat nourishes the Heart, Warmth nourishes the Liver, Dampness nourishes the Spleen, and Cold nourishes the Kidney. Regarding these Five Flavors and Five Qi, excess causes disease, deficiency also causes disease; only balance ensures constant health. Thus, the *Suwen · Liu Jie Zang Xiang Lun* (Treatise on the Six Nodes and Viscera Manifestations) says: "When Five Flavors enter the mouth, they are stored in the intestines and stomach... storing them to nourish the Five Qi. When Qi is harmonious, life arises; when fluids and liquids form together, Spirit naturally generates." This is the principle. Furthermore, the *Suwen · Tai Yin Yang Ming Lun* (Treatise on Taiyin and Yangming) asks: "Why does the Spleen fail to function when diseased?" Qibo replies: "The four limbs all receive Qi from the Stomach, but cannot reach the meridians directly; they must rely on the Spleen to receive it. Now, if the Spleen is diseased and cannot transport fluids for the Stomach, it cannot receive Grain-Qi. Qi declines daily, meridians become obstructed, and tendons, bones, and muscles lack Qi to generate, hence they do not function." The Yellow Emperor asks: "Why does the Spleen not govern a specific season?" Qibo replies: "The Spleen belongs to Earth, governs the Center, and constantly nourishes the Four Zang organs throughout the four seasons, presiding for eighteen days at the end of each season; it cannot exclusively govern one season. The substances stored in the Zang organs constantly adhere to the essence of Stomach-Earth. Earth generates all things and models itself on Heaven and Earth. Therefore, from top to bottom, head to foot, it cannot exclusively govern one season."
The Yellow Emperor asks: "The Spleen and Stomach are connected only by membranes, yet they can transport fluids. Why?" Qibo replies: "The Foot-Taiyin (Spleen Meridian) is one of the Three Yin meridians; its vessel penetrates the Stomach, connects to the Spleen, and links to the throat. Thus, Taiyin transports Qi through the Three Yin meridians. The Foot-Yangming (Stomach Meridian) is exterior; it is the Sea of the Five Zang and Six Fu organs, and also transports Qi through the Three Yang meridians. The Zang and Fu organs receive Qi along their respective meridians to benefit Yangming, thus transporting fluids for the Stomach. The four limbs cannot receive Grain-Qi; Qi declines daily, Yin pathways become obstructed, tendons, bones, and muscles lack Qi to generate, hence they do not function. 'Not functioning' means being unable to utilize them. From this, we see that the Five Zang and Six Fu organs, and the four limbs and hundred bones, all receive from the Spleen and Stomach, which transport fluids, mutually moistening and nourishing. Later physicians, wishing to nourish the Spleen and Stomach and tonify Earth-Qi with drying-hot agents, are far off the mark! Moreover, patients with Xiao Ke (Wasting-Thirst) have extreme deficiency of damp-cold Yin Qi and excessive excess of dry-heat Yang Qi. Taking more drying-hot medicines would exhaust Spleen-Stomach Qi. In later ages, people fail to distinguish the excess/deficiency of the Five Movements and Six Qi, generally claiming Heat is Excess and Deficiency is Cold. They only understand the excess/deficiency of Heart-Fire Yang-Heat, not the excess/deficiency of the Six Qi of the Zang organs. Generally, the Lung is originally clear; when deficient, it becomes warm. The Heart is originally hot; when deficient, it becomes cold. The Liver is originally warm; when deficient, it becomes cool. The Spleen is originally damp; when deficient, it becomes dry. The Kidney is originally cold; when deficient, it becomes hot. If 'Stomach Cold' is considered Deficiency, it is actually because Yin-Water Cold Qi is excessive in the Stomach, while Yang-Fire Hot Qi is weak and deficient, not because the original dampness of Stomach-Earth is deficient. Therefore, one should warm and tonify the deficiency of Yang-Fire in the Stomach and reduce the excess of Yin-Water Cold Qi. Conversely, if 'Stomach Heat' is considered Excess, it is because Yang-Fire in the Stomach is excessive and Yin-Water is deficient. Thus, one should use cold medicines to purge the Excess-Fire in the Stomach and nourish the deficient Water. However, these methods address the deficiency-heat in the Stomach caused by Water and Fire invading pathogens, not the original state of Stomach-Dampness. The rest follow similar principles.
Regarding tonifying or purging the Water-Qi of Spleen-Stomach Damp-Earth: Moistening the dampness is tonifying dampness; drying the dampness is purging dampness, because Earth is originally damp.
For all Qi of the Zang and Fu organs, one need not assume Kidney-Water alone corresponds to Cold or Heart-Fire alone to Heat. One must know that for every Zang and Fu, the various Qi should be harmonized, dispersed, and balanced. Thus, I once said: In the Way of the Five Constants, Yin contains Yang, and Yang contains Yin. Solitary Yin does not grow; solitary Yang does not complete. As long as all things are present, the Five Elements mutually support and nourish each other; this is called Peace. Mutual overcoming leads to decline and rise. Disorder and loss of normalcy bring disaster. Therefore, less Water and more Fire result in Yang-Excess and Yin-Deficiency, causing Heat disease; more Water and less Fire result in Yin-Excess and Yang-Deficiency, causing Cold disease. The treatment method is to purge Excess and tonify Deficiency, aiming for balance. Thus, treating Xiao Ke involves tonifying the deficiency of Kidney-Water Yin-Cold and purging the excess of Heart-Fire Yang-Heat, removing severe dry-heat from the intestines and stomach, assisting the decline of bodily fluids, ensuring pathways remain open and unblocked, fluids generate without withering, and Qi and Blood flow smoothly without stagnation; then the disease will heal day by day. Moreover, Xiao Ke originates from improper diet and medication, leading to dry intestines and stomach, preventing the smooth distribution of Qi and fluids; or from mental exhaustion and exceeding limits; or from severe illness damaging Yin Qi and depleting Blood, resulting in fierce Yang Qi and severe stagnation of dry-heat. Thus, *Jizhong Xinbian* (New Compilation for Saving the Masses) states: San Xiao (Three Thirsts) all result from long-term craving for salty foods, indulgence in roasted/fried foods, and excessive alcohol consumption; some young people take metallic/mineral pills causing heat, which accumulates in the chest, creating lower-jiao deficiency-heat where Blood-Qi cannot control the mineral heat, causing extreme dryness in the Stomach, leading to thirst and drinking. If drinking much results in urinating much, it is named Xiao Ke (Wasting-Thirst); if eating much without intense hunger, frequent urination, and gradual emaciation occur, it is named Xiao Zhong (Consuming-Middle); if thirst persists despite continuous drinking, legs emaciate, and urine contains fatty liquid, it is named Shen Xiao (Kidney-Thirst). These three types of Xiao share the same dry-heat pathogenesis, differing only in severity.
I hear that worldly prescriptions often use one formula to treat all three types of Xiao Ke because they consume food/water quickly and crave thirst. However, modern discussions on Xiao Ke often ignore the root cause. They claim Xiao Ke involves Upper Excess-Heat and Lower Deficiency-Cold. Upper Heat causes irritability, thirst, and excessive drinking; Lower Cold causes frequent urination. The root is deficiency of Lower-Jiao Kidney-Water, failing to control Upper-Jiao Heart-Fire, resulting in Upper Excess-Heat and Lower Deficiency-Cold. They also say: Water number is one, the root of things and precursor of Five Elements. Thus, Kidney-Water is the root of humanity and origin of life; it must not be allowed to weaken. If the root is not firm, branches and leaves will not flourish; if Yuan Qi is not solid, the physique will not thrive. Patients with Xiao Ke have extremely cold Lower-Jiao Kidney-Water. If they take cold medicines, Yuan Qi becomes weaker, Lower-Jiao Kidney-Water declines further, Upper-Jiao Heart-Fire becomes hyperactive and difficult to treat. Instead, one should use warm medicines to tonify Yuan Qi. If Lower-Jiao Kidney-Water becomes substantial and overcomes Upper-Jiao Fire, thirst will naturally cease, urination will normalize, and the disease will heal. Such statements contradict Zhang Zhongjing. They sound plausible but violate logic. This error is not new; it has existed for a long time! For instance, Jiang Shi’s *Yao Zheng Bing Yuan* (Causes of Disease in Medicinal Evidence) discusses Xiao Ke, Xiao Zhong, and Kidney-Thirst, stating: "San Jiao and Five Zang are all deficiency-heat, only the Bladder is cold as ice." It also says: "Lower back and Kidney deficiency-cold increase daily." And: "Bladder and Kidneys are cold as a spring." Initially stating San Jiao and Five Zang are deficiency-heat with only the Bladder cold as ice, it later claims the Five Zang are also cold, and Kidney-Water cold is described as deficiency, while remaining heat is also called deficiency. How can Yin/Yang rise and fall work this way? His statements are self-contradictory. While the error seems small, the discrepancy in Cold/Heat and opposite medications cause grave harm! Others argue: Kidney and Bladder belong to Water; deficiency fails to control Fire. Since deficiency cannot control Fire, frequent urination occurs. They believe Excess Water-Qi controls Fire, while Deficiency cannot. Thus, Yang-Excess and Yin-Deficiency cause Heat to dry fluids, leading to scanty, painful urination; Yin-Excess and Yang-Deficiency fail to control Water, leading to profuse, frequent urination. Do they not realize that frequent urination in Xiao Ke is not due to this? Why? Because extreme dry-heat causes obstruction and stagnation in the pores of the San Jiao and intestines/stomach, making them dense and blocked. Fluids cannot渗泄 (seep and discharge) or moisten externally to nourish the body. Thus, external dry-heat is extreme; even with heavy internal drinking, it cannot moisten externally, so thirst persists. Frequent urination occurs because, despite heavy drinking, fluids cannot seep outside the intestines/stomach, leading to frequent voiding. Therefore, I elaborate in *Yuan Bing Shi*: Skin sweat pores are called Han Kong (Sweat Holes), gateways for sweating. Also called Qi Men (Qi Gates), portals for Qi release. Also called Culi (Interstices), tunnels for Qi and fluid textures. Also called Gui Men (Ghost Gates), gates to the netherworld. Also called Xuanfu (Dark Mansions), mansions of subtlety. Xuanfu exists in everything. Human Zang/Fu organs, skin/hair, muscles/fascia, bone marrow, and all things possess them; they are the pathways for entry/exit and ascent/descent. Thus, the Classics state: "If entry/exit ceases, the Spirit Mechanism perishes; if ascent/descent stands alone, it is perilous." Without entry/exit, there is no growth, strength, aging, or death; without ascent/descent, there is no growth, transformation, storage, or collection. Thus, entry/exit and ascent/descent exist in all vessels. We know that the eyes, ears, nose, tongue, body, mind, spirit, and consciousness function only because of smooth ascent/descent and entry/exit. Obstruction prevents function. If eyes cannot see, ears cannot hear, nose cannot smell, tongue cannot taste, tendons atrophy, bones bi, nails recede, teeth rot, hair falls, skin loses sensation, or intestines/stomach fail to secrete, all are caused by stagnant Heat blocking Xuanfu, preventing Jin Ye (Body Fluids), Blood Vessels, Ying-Wei (Nutritive-Defensive) Clear Qi from ascending/descending and entering/exiting. Depending on the severity of stagnation, diseases vary in magnitude. Exterior diseases involve stagnation, closed interstices, Yang Qi unable to disperse, causing dryness without sweat, preventing Qi/fluid exit. Modern physicians do not understand this; seeing frequent urination in Xiao Ke, they wrongly attribute it to Lower-Jiao Cold. Do they not know that intestinal/stomach dry-heat stagnation causes this? I cite this because worldly views on Xiao Ke attribute it to external intestinal/stomach dry-heat blocking secretion pathways. Although water enters the intestines/stomach, it cannot seep out, causing frequent urination followed by renewed thirst. These few sentences fully explain the principle. Consider cases: Some attribute thirst to Heart/Lung Qi Jue (Reversal); some to Liver Bi (Obstruction); some to Spleen Heat; some to Kidney Heat; some to Stomach/Large Intestine Heat Binding; some to Spleen Bi; some to Small Intestine Dan Heat; some to Malaria; some to rich/greasy/mineral drugs; some to drunkenness/coitus; some to travel fatigue in extreme heat; some to Stomach dryness injury; some to Kidney Heat; some to Wind disease. Although Zang locations differ and pathogenic encounters vary, the outcome is always Dry-Heat.
Regarding Heart/Lung Qi Jue causing thirst: The *Jue Lun* (Treatise on Reversal) states: "Heart transfers Heat to Lung, transmitting as Ge Xiao (Diaphragm Thirst)." Commentary: "Heart Heat enters Lung, transmits over time, internally forming Diaphragm Heat-Fluid." Regarding Liver Bi causing thirst: The *Bi Lun* (Treatise on Bi) states: "Liver Bi involves night terrors, excessive drinking, frequent urination." Regarding Spleen Heat causing thirst: The *Wei Lun* (Treatise on Flaccidity) states: "Spleen Heat causes Stomach dryness and thirst, muscle insensitivity, developing into Rou Wei (Muscle Flaccidity)."
Regarding Kidney Heat causing thirst: The *Ci Re Lun* (Treatise on Acupuncture for Heat) states: "Kidney Heat disease connects to Lung, ties to tongue root, causing dry mouth/tongue and thirst." Modern physicians only claim Kidney Deficiency fails to control Heart-Fire, resulting in Upper Excess-Heat and Lower Deficiency-Cold, using Heat to tonify Kidney-Water to overcome Heart-Fire. This misunderstands Yin/Yang Excess/Deficiency. Kidney-Water belongs to Yin and is originally Cold; deficiency leads to Heat. Heart-Fire belongs to Yang and is originally Hot; deficiency leads to Cold. If Kidney-Water is Yin-Deficient, Heart-Fire is Yang-Excessive, meaning Yang-Excess and Yin-Deficiency, clearly causing Heat above and below. Thus, *Qi Jue Lun* states: "Kidney Qi declines, Yang Qi prevails alone." *Xuan Ming Wu Qi Lun* states: "Kidney dislikes Dryness, due to dried Kidney and depleted Water." *Zang Qi Fa Shi Lun* states: "Eat pungent urgently to moisten." Cold substances belong to Yin, nourish Water, and purge Heart; Hot substances belong to Yang, nourish Fire, and deplete Water. Now, since Kidney-Water cannot overcome Heart-Fire, Heat exists above and below. How can one use Hot medicines to tonify Kidney-Water to overcome Heart-Fire? Is this not absurd?
Regarding Stomach/Large Intestine Heat Binding causing thirst: *Yin Yang Bie Lun* states: "Two Yang binding causes Xiao (Consumption)." Commentary: "Yang Binding means Stomach and Large Intestine both have Heat Binding." Intestines/Stomach storing Heat efficiently consume food/water. *Qi Jue Lun* states: "Large Intestine transfers Heat to Stomach, causing excessive eating and emaciation." *Mai Yao Jing Wei Lun* states: "Dan transforms into Xiao Zhong, causing excessive eating and emaciation."
Regarding Spleen Bi causing thirst,
the majority case is simply San Jiao dry-heat stagnation and Qi decline. How can one use drying-hot toxic drugs to assist strong Yang and attack declining Yin? This is truly committing the crime of 'tonifying Excess and purging Deficiency'! Xiao Ke often complicates into deafness, blindness, sores, tinea, acne, prickly heat, etc., all due to intestinal/stomach dry-heat stagnation preventing fluids from moistening the body; or severe Heat causing Bladder stagnation, preventing secretion, leading to erratic fluid movement and facial swelling.
Regarding Small Intestine Dan Heat causing thirst: *Ju Tong Lun* (Treatise on Pain) states: "Heat stays in Small Intestine, causing abdominal pain. Dan Heat and scorched thirst lead to hard stool inability to pass." Commentary: "Heat seeps fluids, making urine hard."
Regarding Malaria causing thirst: *Nie Lun* (Treatise on Malaria) states: "Yang Excess causes exterior Heat, Yin Deficiency causes interior Heat. Interior and exterior both Heat, causing panting and thirst, thus desiring cold drinks." However, Yang-Excess and Yin-Deficiency causing Heat disease requires cold medicines to nourish Yin and purge Yang, which is the way to purge Excess and tonify Deficiency.
Regarding Rich/Greasy/Mineral Drugs causing thirst: *Qi Bing Lun* (Treatise on Rare Diseases) asks: "One with sweet taste in mouth, what is the disease name?" Qibo replies: "This is overflow of Five Qi, named Pi Dan (Spleen Dan). Dan means Heat. Spleen Heat prevents Four Zang from receiving, so Five Qi overflow upward. Originally due to Spleen Heat, hence Pi Dan." The Classics also state: "Five Flavors enter mouth, store in Stomach, Spleen transports essence. Fluids in Spleen cause sweet taste." This originates from rich food. Such people surely eat sweet/greasy foods frequently. Grease causes internal Heat; sweetness causes central fullness. Thus Qi overflows upward, transforming into Xiao Ke. *Tong Ping Xu Shi Lun* states: "Xiao Dan, sudden collapse, hemiplegia, flaccidity, reversal Qi, belong to wealthy people, diseases of rich food." Some say Stomach Qi is the root. Spleen and Stomach are interior-exterior pairs, center of Middle Jiao, should receive warm-tonification to regulate diet. Now, Xiao Ke patients have extremely deficient Spleen/Stomach, suitable for warm-tonification. Taking cold medicines damages Spleen/Stomach, making original Qi deficient and hard to treat. This view ignores Yin/Yang/Cold/Heat/Excess/Deficiency/Tonification/Purging principles, speaking recklessly. Do they not know *Fu Zhong Lun* states: Yellow Emperor asks: "Master often says Re-Zhong and Xiao Zhong cannot take Fang Cao (Fragrant Herbs) or Shi Yao (Mineral Drugs). Mineral drugs cause Dian (Mania); Fragrant herbs cause Kuang (Rage)." Commentary: "Drinking much, urinating much is Re-Zhong; Eating much, urinating much is Xiao Zhong. Much joy is Dian; Much anger is Kuang. Fang means delicious. Shi refers to Ying Ru (Mineral preparations), heating drugs." The Classics also say: "Re-Zhong and Xiao Zhong affect wealthy people." Now forbidding rich food goes against their desires; forbidding fragrant/mineral drugs leaves the disease untreated. Wish to hear the explanation. Qibo replies: "Fragrant herbs taste good; Mineral drugs act fiercely. Their Qi is rapid, firm, and strong. Only calm-hearted people can take them." Yellow Emperor asks: "Why?" Qibo replies: "Heat Qi is fierce; Drug Qi is likewise. 'Drinking one part, urinating two parts' indicates Lung Qi exiting with Water; the Sea of Grain/Water is exhausted. Seeing Xiao Ke and immediately using Hot medicines harms many. Thus, the *Neijing* should say: 'Thirst is always like this.' Is it not clear? Yet confused people remain. When Qi extremes reverse and overcome, people err. For example, Yang Extreme resembles Yin. If one does not understand Root/Branch, mistaking similarity for truth, errors persist. Thus, seeing Lower Body Cold, knees like ice, this is Heart-Fire failing to descend, resembling Cold Water. One should add Cold medicines, administer three to five times, then Fire descends, Water rises, Cold transformation retreats. Yet the world remains deluded, discarding *I Ching* and *Suwen* like rotten wood, truly pitiable! Therefore, prescribing requires understanding Disease Root/Branch, Drug Capabilities, Qi Suitability, avoiding harm, to formulate correctly. Root/Branch: First disease is Root, subsequent is Branch, this is the beginning/end of disease. When Root/Branch transmit, save the emergency first. Also: Six Qi are Root, Three Yin/Three Yang are Branch. In disease, Zang disease is most urgent. Also: Six Qi are Root of Stomach. If Stomach Heat, Stomach is Branch, Heat is Root. Prescriber should remove Heat in Stomach, treating the Root. Thus, Six Qi consider severe as Pathogen, weak as Healthy Qi. Method: Purge severe, tonify weak, aim for balance. Nourish Healthy, remove Pathogen,"