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。
【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。
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。
【按】此条当在《虚劳篇》中，错简在此。
【注】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，故主卫外荣内虚竭也。
跗阳脉浮而数，浮即为气，数即消谷而大坚，气盛则溲数，溲数即坚，坚数相抟，即
为消渴。
【按】“而大坚”句不成文，“大”字之下当有“便”字，必是传写之遗。
【注】跗阳，胃脉也。胃脉浮盛，按之而数，为胃气热，故善消谷也。火盛消谷，则
大便必坚，气盛消水，则小便必数，故溲数即坚也，坚数相抟，即为消谷消渴之病。
跗阳脉数，胃中有热，即消谷引食，大便必坚，小便即数。
【注】此复申上条大便坚、小便数之义也。男子消渴，小便反多，以饮一斗，小便
一斗，肾气丸主之。
【注】饮水多而小便少者，水消于上，故名上消也；食谷多而大便坚者，食消于中，故
名中消也；饮水多而小便反多者，水消于下，故名下消也。上、中二消属热，惟下消寒热
兼之，以肾为水火之脏也。饮一溲一，其中无热消耗可知矣。故与肾气丸从阴中温养其
阳，使肾阴摄水则不直趋下源，肾气上蒸则能化生津液，何消渴之有耶！
【集注】程林曰∶小便多则消渴，经曰∶饮一溲二者不治。今饮一溲一，故与肾气丸
治之。肾中之动气，即水中之命火，下焦肾中之火，蒸其水之精气，达于上焦，若肺金
清肃，如云升而雨降，则水精四布，五经并行，自无消渴之患。今其人必摄养失宜，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，
游溢渗出，下无火化，直入膀胱，则饮一斗，尿亦一斗也。故用桂附肾气丸，助真火蒸化，
上升津液，何消渴之有哉！
沈明宗曰∶“男子”二字，是指房劳伤肾，火旺水亏而成消渴者。
肾气丸方（见妇人杂病中）
脉浮，小便不利，微热消渴者，宜利小便、发汗，五苓散主之。
【注】脉浮，病生于外也；脉浮微热，热在表也；小便不利，水停中也；水停则不化
津液，故消渴也。发表利水止渴生津之剂，惟五苓散能之，故以五苓散主之也。于此推之，
曰脉浮，可知上条脉沉也；曰微热，可知上条无热也。且可知凡脉沉无热之消渴，皆当
用肾气丸方也。
五苓散方（见痰饮中）
脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。
【注】此与上条文同义异。文同者，脉浮小便不利，发热、微热、渴欲饮水、消渴也。
而义异者，一以五苓散利水发汗，一以猪苓汤利水滋干也。审其所以义异之意，必在有
汗、无汗之间也。何以知之？一以发汗为主，其因无汗可知；一以滋干为主，其因有汗可
知。故文同而义异，病同而治别也。仲景之书，言外寓意处甚多，在学人以意会之自识
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。
渴欲饮水，口干舌燥者，白虎加人参汤主之。
【注】消渴则渴欲饮水，水入即消，而仍口干舌燥者，是热邪盛也，故以白虎加人参
汤，清热生津也。
白虎加人参汤方（见中喝中）
渴欲饮水，水入则吐者，名曰水逆，五苓散主之。
【注】渴欲饮水，水入即吐，名水逆者，是里热微而水邪盛也，故以五苓散利水止吐
也。
【集注】李 曰∶内有积水，故水入则拒格而上吐，名水逆也。五苓散利水，故主之。
渴欲饮水不止者，文蛤散主之。
【注】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。或云∶文蛤即今
吴人所食花蛤，性寒味咸，利水胜热，然屡试而不效。尝考五倍子亦名文蛤，按法制之
名百药煎，大能生津止渴，故尝用之，屡试屡验也。
文蛤散方
文蛤（五两）
上一味，杵为散，以沸汤五合，和服方寸匕。
小便不利者，有水气，其人苦渴，栝蒌瞿麦丸主之。
【注】小便不利，水蓄于膀胱也，其人苦渴，水不化生津液也。以薯蓣、花粉之润燥
生津，而苦渴自止；以茯苓、瞿麦之渗泄利水，而小便自利；更加炮附宣通阳气。上蒸
津液，下行水气，亦肾气丸之变制也。然其人必脉沉无热，始合法也。
栝蒌瞿麦丸方
栝蒌根（即花粉，二两） 茯苓（三两） 薯蓣（三两） 附子（炮，一枚） 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。
【集解】李 曰∶此方与五苓散同为利水津之剂。此用薯蓣即五苓用白术之义也。但
五苓兼外有微热，故用桂枝走表；此内惟水气，故用附子温下也。
尤怡曰∶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。其人苦渴，则是水气偏结于下，而燥火独聚于上。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，此方为良法也。求
变通者，于此三复焉。
小便不利，蒲灰散主之。滑石白鱼散，茯苓戎盐汤并主之。
【注】无表里他证，小便不利而渴者，消渴水邪病也；小便不利不渴者，小便癃闭病
也。主蒲灰散、滑石白鱼散者，蒲灰、乱发，血分药也。滑石、白鱼，利水药也。然必是
水郁于血分，故并主是方也。观东垣以通关丸，治热郁血分之小便不利，则可知在血分
多不渴也。主茯苓戎盐汤者，茯苓淡渗，白术燥湿，戎盐润下，亦必是水湿郁于下也。盐
为渴者之大戒，观用戎盐则不渴可知也。
【集注】魏荔彤曰∶小便不利者，所因有不同，治法亦不一，仲师并列三方，以俟主
治者择其善而从之。
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。
滑石白鱼散方
滑石（二分） 乱发（烧，三分） 白鱼（二分）
上三味，杵为散，饮服半钱匕，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，以水五升，煮取三升，分温三服。
淋之为病，小便如粟状，小腹弦急，痛引脐中。
【注】小便不利及淋病，皆或有少腹弦急，痛引脐中之证。然小便不利者，水道涩少而
不痛，淋则溲数，水道涩少而痛，有不同也。小便尿出状如粟米者，即今之所谓石淋也。
淋家不可发汗，发汗必便血。
【注】淋家，湿热蓄于膀胱之病也。若发其汗，湿从汗去，热则独留，水府告匮，热
迫阴血从小便出，即今之所谓血淋也。
【集注】高世 曰∶淋家之膀胱津液先虚，故不可发汗，若发汗更夺其津液，则膀胱气
竭，胞中并虚，故必便血。便血，尿血也。
厥阴经的病症表现为：口渴多饮，气向上冲至心脏，心中感觉疼痛且有灼热感，虽有饥饿感却不想进食，进食后随即呕吐出蛔虫，若误用泻下法治疗，会导致腹泻不止。
【按语】这一条是《伤寒论》中厥阴经的正病，与杂病中消渴病的含义不同，此处必定是竹简错乱所致。
寸口脉象浮而迟，浮脉代表虚证，迟脉代表劳损，虚则导致卫气不足，劳损则导致营气枯竭。
【按语】这一条应当位于《虚劳篇》中，此处也是竹简错乱。
【注释】寸口，泛指左右手的寸、关、尺三部脉。脉浮而有力为风邪，脉浮而无力为虚证，重按时兼见迟脉，即为虚劳的诊断，因此主治卫外之气不足、荣养之内气枯竭。
跗阳脉（足背动脉）浮而数，浮脉代表气盛，数脉代表能消化食物且大便坚硬，气盛则小便频数，小便频数则大便更加坚硬，坚与数相互搏结，即形成消渴病。
【按语】“而大坚”一句文意不通，“大”字之下应当有“便”字，必定是传抄遗漏。
【注释】跗阳，指胃脉。胃脉浮盛，重按而数，表示胃气有热，所以容易消化食物。火盛消耗食物，则大便必然坚硬；气盛消耗水分，则小便必然频数，所以小便频数意味着大便坚硬，坚与数相互搏结，即形成消谷善饥和消渴的病证。
跗阳脉数，说明胃中有热，就会消谷善饥、食欲旺盛，大便必然坚硬，小便必然频数。
【注释】这是再次阐明上一条关于大便坚硬、小便频数的意义。男子患消渴病，小便反而增多，如果喝水一斗，小便也排出一斗，应用肾气丸主治。
【注释】饮水多而小便少的，水在上焦被消耗，所以称为上消；吃饭多而大便坚硬的，食物在中焦被消耗，所以称为中消；饮水多而小便反而增多的，水在下焦被消耗，所以称为下消。上消和中消属于热证，只有下消寒热夹杂，因为肾是水脏也是火脏。喝一斗尿一斗，其中没有热邪消耗的迹象可知。所以给予肾气丸，从阴中温养阳气，使肾阴能够摄纳水分而不直接流向下方源头，肾气上蒸则能化生津液，哪里还会有消渴呢！
【集注】程林说：小便多则导致消渴，经文说：喝一斗尿两斗的无法治愈。现在喝一斗尿一斗，所以用肾气丸治疗。肾中的动气，就是水中的命门之火，下焦肾中的火，蒸腾水的精气，到达上焦，如果肺金清肃，像云上升雨下降一样，那么水精四布，五脏经脉并行，自然没有消渴的祸患。现在这个人必定是调养失当，肾水衰竭，龙雷之火不安于下，只在上面燃烧而刑克肺金，肺热叶焦，则消渴引饮，水进入胃中，游溢渗出，下面没有火来气化，直接流入膀胱，所以喝一斗，尿也一斗。所以用桂附肾气丸，帮助真火蒸化，上升津液，哪里还有消渴呢！
沈明宗说：“男子”二字，是指因房劳损伤肾脏，火旺水亏而形成的消渴病。
肾气丸方（见妇人杂病篇中）
脉浮，小便不利，微热且消渴的，适宜利小便、发汗，以五苓散主治。
【注释】脉浮，病生于体表；脉浮微热，热在表；小便不利，水停在中焦；水停则不能化生津液，所以出现消渴。发表利水、止渴生津的药剂，只有五苓散能做到，所以用五苓散主治。由此推断，前面一条说的是脉沉；这里说微热，可知前面一条无热。而且可知凡是脉沉无热的消渴，都应当使用肾气丸方。
五苓散方（见痰饮篇中）
脉浮发热，想喝水，小便不利的，以猪苓汤主治。
【注释】这与上一条条文文字相同但意义不同。文字相同的，都是脉浮、小便不利、发热、微热、想喝水、消渴。但意义不同的，一个是五苓散利水发汗，一个是猪苓汤利水滋阴润燥。审察其意义不同的原因，一定在于有汗和无汗之间。怎么知道的呢？一个以发汗为主，可知病因是无汗；一个以滋阴润燥为主，可知病因是有汗。所以文字相同但意义不同，病症相同但治法有别。仲景的书，言外之意很多，学习的人用心领会自然能识别。
猪苓汤方
猪苓（去皮） 茯苓 阿胶 滑石 泽泻（各一两）
以上五味药，用水四升，先煮前四味，取二升，去渣，加入阿胶使其溶化，温服七合，每日三次。
想喝水，口干舌燥的，以白虎加人参汤主治。
【注释】消渴则想喝水，水入即被消耗，仍然口干舌燥的，是热邪炽盛，所以用白虎加人参汤清热生津。
白虎加人参汤方（见中暍篇中）
想喝水，水入即吐的，名叫水逆，以五苓散主治。
【注释】想喝水，水入即吐，名叫水逆的，是里热轻微而水邪强盛，所以用五苓散利水止吐。
【集注】李 说：体内有积水，所以水入则拒格而上吐，名叫水逆。五苓散利水，所以主治。
想喝水且不止的，以文蛤散主治。
【注释】想喝水，水入即吐，小便不利的，是五苓散证；想喝水，水入即被消耗，口干舌燥的，是白虎加人参汤证。想喝水但不吐水，不是水邪强盛；不口干舌燥，不是热邪强盛。只是引饮不止，所以只用文蛤一味药，不寒不温，不清不利，专心于生津止渴。有人说：文蛤就是现在吴地人吃的花蛤，性寒味咸，利水胜热，然而多次尝试无效。我曾考证五倍子也叫文蛤，按照法制成名为百药煎，大能生津止渴，所以我曾经使用它，屡试屡验。
文蛤散方
文蛤（五两）
以上一味药，研成散剂，用沸水五合调和，服用一方寸匕。
小便不利，有水气，其人苦于口渴，以栝蒌瞿麦丸主治。
【注释】小便不利，是水蓄积在膀胱，其人苦于口渴，是水不能化生津液。用薯蓣、花粉的润燥生津作用，苦渴自然停止；用茯苓、瞿麦的渗泄利水作用，小便自然通利；再加炮附子宣通阳气，上蒸津液，下行水气，这也是肾气丸的变制方。然而其人必须脉沉无热，才符合此法。
栝蒌瞿麦丸方
栝蒌根（即花粉，二两） 茯苓（三两） 薯蓣（三两） 附子（炮，一枚） 瞿麦（一两）
以上五味药，研末，炼蜜制成梧桐子大小的丸药，饮水送服三丸，每日三次。不见效，增至七八丸。以小便利，腹中温暖为见效。
【集解】李 说：此方与五苓散同为利水生津之剂。此方用薯蓣即相当于五苓散用白术的意义。但五苓散兼有外在微热，所以用桂枝走表；此方内仅有水气，所以用附子温下。
尤怡说：这是下焦阳气虚弱气冷，而水气不行的证候，所以用附子益阳气，茯苓、瞿麦行水气，看方后说：腹中温暖为见效，可以推知了。其人苦于口渴，则是水气偏结于下，而燥火独聚于上。上浮的火焰，不滋润不能熄灭；下积的阴寒，不温暖不能消散；而寒润辛温，并行不悖，此方是良法。求变通的人，对此应反复思考。
小便不利，蒲灰散主治。滑石白鱼散，茯苓戎盐汤也都主治。
【注释】无表里其他证候，小便不利且口渴的，是消渴水邪病；小便不利且不口渴的，是小便癃闭病。主治蒲灰散、滑石白鱼散的，蒲灰、乱发，是血分药。滑石、白鱼，是利水药。但这一定是水郁结在血分，所以并主这些方剂。看东垣用通关丸，治疗热郁血分的小便不利，则可知在血分的多不口渴。主治茯苓戎盐汤的，茯苓淡渗，白术燥湿，戎盐润下，也一定是水湿郁结于下。盐是渴者的大忌，看用戎盐则可知不渴。
【集注】魏荔彤说：小便不利，所因有不同，治法也不一样，仲师并列三方，以待主治者选择好的而采用。
蒲灰散方
蒲灰（七分） 滑石（三分）
以上两味药，研成散剂，饮水送服一方寸匕，每日三次。
滑石白鱼散方
滑石（二分） 乱发（烧，三分） 白鱼（二分）
以上三味药，研成散剂，饮水送服半钱匕，每日三次。
茯苓戎盐汤方
茯苓（半斤） 白术（二两） 戎盐（弹丸大一枚）
以上三味药，用水五升，煮取三升，分三次温服。
淋病的症状是：小便排出如粟米状，小腹拘急紧张，疼痛牵引至脐中。
【注释】小便不利及淋病，都可能有少腹拘急紧张，疼痛牵引脐中的证候。然而小便不利的，水道涩滞量少而不痛；淋病则小便频数，水道涩滞量少而痛，有所不同。小便尿出状如粟米的，就是现在的所谓石淋。
患淋病的人不可发汗，发汗必然导致尿血。
【注释】淋家，是湿热蓄积在膀胱的病。如果发其汗，湿随汗而去，热则独自留下，水府告急匮乏，热迫阴血从小便排出，就是现在的所谓血淋。
【集注】高世栻说：淋家的膀胱津液先虚，所以不可发汗，若发汗更夺其津液，则膀胱气竭，胞中也并虚，所以必然尿血。便血，即尿血。
The disease of Jueyin manifests as excessive thirst, Qi rushing upward to the heart, pain and burning sensation in the heart region, a sensation of hunger without desire to eat, vomiting of roundworms immediately after eating, and if purgatives are misused, it leads to unceasing diarrhea.
[Note] This clause describes the primary disease of the Jueyin meridian in "Shanghan Lun" (Treatise on Cold Damage), which differs from the meaning of Xiao Ke (Wasting-Thirst) in miscellaneous diseases; this must be due to misplaced bamboo slips.
The pulse at Cun Kou is floating and slow. Floating indicates deficiency, and slow indicates exhaustion from overwork. Deficiency results in insufficient Wei Qi (Defensive Qi), and exhaustion leads to the depletion of Ying Qi (Nutritive Qi).
[Note] This clause should belong in the chapter on Xu Lao (Deficiency and Emaciation); its presence here is also due to misplaced bamboo slips.
[Commentary] Cun Kou generally refers to the three positions (Cun, Guan, Chi) on both left and right wrists. A floating pulse with strength indicates Wind pathogen, while a floating pulse without strength indicates deficiency. If it is slow upon deep palpation, it is a diagnosis of Xu Lao (Deficiency and Emaciation), thus indicating insufficiency of defensive exterior Qi and depletion of nutritive interior Qi.
The pulse at Fu Yang (dorsalis pedis artery) is floating and rapid. Floating indicates excess Qi, and rapid indicates the ability to digest food accompanied by hard stools. Excess Qi leads to frequent urination; frequent urination leads to harder stools. The interplay of hardness and frequency constitutes Xiao Ke (Wasting-Thirst).
[Note] The phrase "and hard stool" is grammatically incomplete; there should likely be the character for "stool" after "hard," omitted during transcription.
[Commentary] Fu Yang refers to the Stomach meridian pulse. A floating and full pulse that is rapid upon pressure indicates heat in Stomach Qi, hence the propensity to digest food easily. Fire excess consuming food leads to hard stools; Qi excess consuming fluids leads to frequent urination. Thus, frequent urination implies hard stools. The interplay of these factors results in the disease of excessive digestion and Wasting-Thirst.
A rapid pulse at Fu Yang indicates heat in the Stomach, leading to excessive digestion and increased appetite, hard stools, and frequent urination.
[Commentary] This reiterates the significance of hard stools and frequent urination mentioned in the previous clause. In men suffering from Xiao Ke (Wasting-Thirst), urine output is abnormally high; if drinking one dou results in urinating one dou, Shen Qi Wan (Kidney Qi Pill) is indicated.
[Commentary] When fluid intake is high but urine output is low, fluids are consumed in the upper jiao, termed Upper Xiao (Upper Wasting-Thirst). When food intake is high but stools are hard, food is consumed in the middle jiao, termed Middle Xiao (Middle Wasting-Thirst). When fluid intake is high and urine output is correspondingly high, fluids are consumed in the lower jiao, termed Lower Xiao (Lower Wasting-Thirst). Upper and Middle Xiao are heat patterns; only Lower Xiao involves both cold and heat, as the Kidney is the organ of water and fire. Drinking one dou and urinating one dou indicates no heat consumption within. Therefore, Shen Qi Wan (Kidney Qi Pill) is used to warm and nourish Yang from within Yin, allowing Kidney Yin to retain fluids rather than flowing directly downward, and enabling Kidney Qi to ascend and transform into body fluids, thereby resolving Wasting-Thirst.
[Collected Commentary] Cheng Lin stated: Frequent urination leads to Wasting-Thirst. The classic states: "Drinking one dou and urinating two dou is incurable." Since here one dou of drinking yields one dou of urination, Shen Qi Wan is used. The moving Qi in the Kidney is the Life Fire within Water. The fire in the lower jiao Kidney steams the essence of water up to the upper jiao. If Lung Metal is clear and肃 (solemn/clear), like clouds rising and rain falling, water essence distributes widely, and the five meridians function together, avoiding Wasting-Thirst. However, this patient likely suffered improper regimen, leading to Kidney Water depletion. Dragon-Lei Fire rests uneasily below, flaring upward to damage Lung Metal. Lung heat scorches leaves, causing Wasting-Thirst and craving for drinks. Water enters the Stomach, spreads out, but lacks fire transformation below, entering the Bladder directly. Hence, one dou in, one dou out. Thus, Gui Fu Shen Qi Wan (Cinnamon Twig and Aconite Kidney Qi Pill) aids True Fire to steam and transform, ascending fluids, resolving Wasting-Thirst.
Shen Mingzong stated: The term "men" refers to cases where sexual exhaustion damages the Kidney, resulting in hyperactive Fire and deficient Water, forming Wasting-Thirst.
Shen Qi Wan Formula (See Chapter on Miscellaneous Diseases of Women)
If the pulse is floating, there is difficulty in urination, slight fever, and Wasting-Thirst, promoting diuresis and sweating is appropriate; Wu Ling San (Five-Ingredient Powder with Poria) is indicated.
[Commentary] A floating pulse indicates an external origin; slight fever with a floating pulse indicates heat in the exterior. Difficulty in urination indicates water retention in the interior. Water retention prevents the transformation of fluids, causing Wasting-Thirst. Only Wu Ling San can release the exterior, promote diuresis, stop thirst, and generate fluids; hence it is indicated. From this, we infer the previous clause described a sinking pulse; stating "slight fever" implies the previous case had no fever. Furthermore, it implies that all cases of Wasting-Thirst with a sinking pulse and no fever should use Shen Qi Wan.
Wu Ling San Formula (See Chapter on Phlegm-Fluids)
If there is a floating pulse, fever, craving for water, and difficulty in urination, Zhu Ling Tang (Polyporus Decoction) is indicated.
[Commentary] This shares similar text but different meaning with the previous clause. The similarities are floating pulse, difficulty in urination, fever, slight fever, craving for water, and Wasting-Thirst. The difference lies in treatment: one uses Wu Ling San to promote diuresis and induce sweating, while the other uses Zhu Ling Tang to promote diuresis and nourish dryness. The reason for this difference lies in the presence or absence of sweating. One aims to induce sweating, implying no prior sweat; the other aims to nourish dryness, implying prior sweat. Thus, similar text but different meaning, same disease but different treatment. Zhang Zhongjing's works contain many implicit meanings; students should comprehend them through insight.
Zhu Ling Tang Formula
Zhu Ling (Polyporus, peeled), Fu Ling (Poria), E-Jiao (Donkey-Hide Gelatin), Hua Shi (Talcum), Ze Xie (Alisma) (each 1 liang)
Crush the above five herbs. Boil in 4 sheng of water, first decocting the four ingredients except E-Jiao to obtain 2 sheng. Remove dregs, dissolve E-Jiao into the liquid, and take 7 he of the warm decoction, three times daily.
Craving for water with dry mouth and tongue is treated with Bai Hu Jia Ren Shen Tang (White Tiger Plus Ginseng Decoction).
[Commentary] Wasting-Thirst causes craving for water. If water is consumed immediately yet dry mouth and tongue persist, it indicates flourishing pathogenic heat. Thus, Bai Hu Jia Ren Shen Tang is used to clear heat and generate fluids.
Bai Hu Jia Ren Shen Tang Formula (See Chapter on Heat Stroke)
Craving for water with immediate vomiting after ingestion is named Shui Ni (Water Reversal); Wu Ling San (Five-Ingredient Powder with Poria) is indicated.
[Commentary] Craving for water with immediate vomiting, named Shui Ni (Water Reversal), indicates mild interior heat but strong pathogenic water. Thus, Wu Ling San is used to promote diuresis and stop vomiting.
[Collected Commentary] Li said: Accumulated water inside causes rejection and vomiting upon ingestion, named Shui Ni. Wu Ling San promotes diuresis, hence it is indicated.
Craving for water that is unceasing is treated with Wen Ge San (Clam Shell Powder).
[Commentary] Craving for water with immediate vomiting and difficulty in urination is a Wu Ling San pattern; craving for water with immediate consumption and dry mouth/tongue is a Bai Hu Jia Ren Shen Tang pattern. Craving for water without vomiting indicates pathogenic water is not strong; lack of dry mouth/tongue indicates pathogenic heat is not strong. Only unceasing craving for water warrants Wen Ge San. It is neither cold nor warm, neither clearing nor draining, but specifically focuses on generating fluids and stopping thirst. Some say Wen Ge Clam is the flower clam eaten in Wu, cold in nature and salty in taste, promoting diuresis and overcoming heat, but repeated trials failed. I researched that Wu Bei Zi (Galla Chinensis) is also called Wen Ge. Prepared according to method, it is named Bai Yao Jian (Hundred Medicines Decoction), which greatly generates fluids and stops thirst. I have used it with consistent success.
Wen Ge San Formula
Wen Ge (Clam Shell) (5 liang)
Crush the single ingredient into powder. Mix with 5 he of boiling water and take one fang cun bi (square-inch measure) per dose.
Difficulty in urination with fluid retention, where the person suffers from intense thirst, is treated with Gua Lou Qu Mai Wan (Trichosanthes Root and Epimedium Pill).
[Commentary] Difficulty in urination indicates water accumulation in the Bladder. Intense thirst indicates failure to transform fluids. Shan Yao (Dioscorea) and Gua Lou Gen (Trichosanthes Root) moisten dryness and generate fluids, stopping thirst. Fu Ling (Poria) and Qu Mai (Epimedium) drain and promote diuresis, relieving urinary difficulty. Pao Fu Zi (Prepared Aconite) disseminates and unblocks Yang Qi, steaming fluids upward and guiding water downward. This is a modification of Shen Qi Wan. However, the patient must have a sinking pulse and no fever to fit this formula.
Gua Lou Qu Mai Wan Formula
Gua Lou Gen (Trichosanthes Root, i.e., Tian Hua Fen) (2 liang), Fu Ling (Poria) (3 liang), Shan Yao (Dioscorea) (3 liang), Fu Zi (Aconite, prepared) (1 piece), Qu Mai (Epimedium) (1 liang)
Grind the five ingredients into powder, mix with refined honey, and make pills the size of bird seeds. Take 3 pills with water, three times daily. If ineffective, increase to 7-8 pills. Effectiveness is confirmed by free urination and warmth in the abdomen.
[Collected Explanation] Li said: This formula, like Wu Ling San, promotes diuresis and generates fluids. Using Shan Yao here corresponds to using Bai Zhu (Atractylodes) in Wu Ling San. However, Wu Ling San addresses exterior slight heat, using Gui Zhi (Cinnamon Twig) to reach the exterior; this formula addresses interior fluid retention, using Fu Zi (Aconite) to warm the lower jiao.
You Yi said: This is a pattern of weak Yang Qi and cold in the lower jiao, preventing water movement. Thus, Fu Zi tonifies Yang Qi, while Fu Ling and Qu Mai move water Qi. The note "warmth in the abdomen indicates effectiveness" supports this. Intense thirst suggests water Qi knots in the lower jiao while dry-fire gathers in the upper jiao. The flaming fire floating up cannot be extinguished without nourishment; the yin accumulation settling down cannot be dispersed without warming. Cold-moistening and acrid-warming agents work in harmony; this formula is an excellent method. Those seeking flexibility should reflect deeply on this.
Difficulty in urination is treated with Pu Hui San (Cat-Tail Powder). Hua Shi Bai Yu San (Talcum and White Fish Powder) and Fu Ling Rong Yan Tang (Poria and Salt Decoction) are also indicated.
[Commentary] Without exterior or interior other symptoms, difficulty in urination with thirst indicates Wasting-Thirst pathogenic water disease; difficulty in urination without thirst indicates Long Bi (Urinary Obstruction). Pu Hui San and Hua Shi Bai Yu San are indicated because Pu Hui (Cat-Tail Spadix) and Luan Fa (Burned Hair) are blood-level herbs, while Hua Shi (Talcum) and Bai Yu (White Fish, likely pterygotus or similar) are diuretics. This implies water stagnation in the blood level. Observing Dong Yuan using Tong Guan Wan (Pass Through Pill) for difficulty in urination due to heat stagnating in the blood level shows that blood-level issues often present without thirst. Fu Ling Rong Yan Tang is indicated because Fu Ling (Poria) is lightly penetrating, Bai Zhu (Atractylodes) dries dampness, and Rong Yan (Rocksalt) moistens and descends. This implies damp-water stagnation in the lower jiao. Salt is contraindicated for thirsty patients; the use of Rocksalt implies the absence of thirst.
[Collected Commentary] Wei Litong said: The causes of difficulty in urination vary, and treatments differ. Master Zhong listed three formulas side-by-side for practitioners to choose the most suitable.
Pu Hui San Formula
Pu Hui (Cat-Tail Spadix) (7 parts), Hua Shi (Talcum) (3 parts)
Crush the two ingredients into powder. Take one fang cun bi with water, three times daily.
Hua Shi Bai Yu San Formula
Hua Shi (Talcum) (2 parts), Luan Fa (Burned Hair) (3 parts), Bai Yu (White Fish) (2 parts)
Crush the three ingredients into powder. Take half a qian bi with water, three times daily.
Fu Ling Rong Yan Tang Formula
Fu Ling (Poria) (0.5 jin), Bai Zhu (Atractylodes) (2 liang), Rong Yan (Rocksalt) (size of a bullet-sized pill)
Boil the three ingredients in 5 sheng of water, reduce to 3 sheng, and divide into three warm doses.
The disease of Lin (Strangury) presents with urine resembling millet grains, tension and urgency in the lower abdomen, and pain radiating to the umbilicus.
[Commentary] Both difficulty in urination and Lin disease may present with tension/urgency in the lower abdomen and pain radiating to the umbilicus. However, in difficulty in urination, the water passage is sluggish and scanty but painless; in Lin disease, urination is frequent, the passage is sluggish and scanty, and painful. Urine resembling millet grains is what is now called Shi Lin (Stone Strangury).
Patients with Lin disease should not undergo sweating therapy; inducing sweating will inevitably lead to hematuria.
[Commentary] Lin disease is caused by damp-heat accumulating in the Bladder. If sweating is induced, dampness leaves with sweat, but heat remains alone. The water reservoir becomes depleted, and heat forces Yin blood out through the urine, resulting in Xue Lin (Blood Strangury).
[Collected Commentary] Gao Shishi said: The Bladder fluids of Lin patients are initially deficient, so sweating is contraindicated. Inducing sweating further depletes fluids, leading to Bladder Qi exhaustion and emptiness in the Bao (Uterus/Bladder). Thus, hematuria occurs. Bian Xue (blood in stool/urine) refers to hematuria.