五苓散（方见惊）
《小方脉论》小儿渴病，吃水太多，腹胀泄泻。此病得之心藏热，心与小肠合，
小肠亦受热，小肠既热，其气上行奔胃口，致孩子吃水，其水待奔小肠，被小肠气
热渗泄，不及转入大肠，如治之，先下淋药，后下凉心藏药，然后止渴，乃效。
按∶此亦五苓散证也。
《小方脉论》治渴先下淋药方
郁金 滑石（各一两） 旱莲子（半两）
上件为末。每服半钱，煎葱汤调下。急进三服凉心药。
《小方脉论》欲止渴，次凉心藏药方
乌贼鱼骨 海浮石（各一两） 蒲黄（炒，半两）
上末。每半钱，用枇杷叶煎汤下。
钱乙论黄相似云∶身皮目皆黄者，黄病也。身疼膊背强，大小便涩，一身
尽黄，面目指爪皆黄，小便如屋尘色，看物皆黄，渴者难治，此黄胆也。二证多病
于大病后。别有一证，不因病后、身微黄者，胃热也，大人亦同。又有面黄腹大，
食土渴者，脾疳也。又有自生而身黄者，胎疸也。古书云∶诸疸皆热也，深黄者是
也，若淡黄兼白者，胃怯，胃不和也。《难知》云∶色如熏黄，乃湿病也。一身尽
痛。色如橘子黄者，黄病也，身不痛。干黄燥也，小便自利，四肢不沉重，渴而
引饮者，栀子柏皮汤。湿黄脾也，小便不利，四肢沉重，似渴不欲饮者，大茵陈
汤。大便自利而黄者，茵陈栀子黄连三物汤。往来寒热，一身尽黄者，小柴胡加
栀子汤。洁古云∶阳黄则大小便赤涩身热，是脾土与心火相搏，为阳病，法当先利
小便，后下大便。阴黄则清便自调，面目及身黄，四肢冷，是脾虚不能制肾水，当
用益黄散，下使君子丸（益黄散方见脾，使君子丸方见疳。）凡治黄病腹胀，当用茵陈蒿汤调下
五苓散，若欲利小便，去大黄。欲利大便，则加大黄之类。有阳证可服，谓面赤饮
水者是也。汤氏云∶身疼膊背疼，大小便涩，皮肤面目齿爪皆黄，小便如屋尘色，
利者易治，涩者难治，宜服五苓散加茵陈煎汤调，又宜服导赤散加茵陈煎。或身热，
宜服小柴胡汤，甚者服承气汤。〔曾〕凡黄病者，不可一概而论，标本不同，证治
亦异，乃脾胃气虚，感受湿热，郁于腠理，淫于皮肤，蕴积成黄，熏发于外，故有
此证。或脾胃虚弱，内因症癖，攻之而成。然疳泻亦主皮黄发竖，肚大青筋，肌肉
消瘦，外无色泽，身必发黄，此又本于疳病而作，致有是证。治法，若感湿热而得，
身黄如烟熏之色，以 咀五苓散加麻黄、水姜煎投，汗之即愈。或用茵陈蒿汤调下
五苓散亦好。若得于疳癖者，其形如黄土相类，以醒脾散（慢惊）、化癖丸（积）醒脾快胃，
磨积理疳，胃气既和，饮食倍进，运化精微，荣养百骸，灌溉脏腑，五色各见于本
部，精华乃形于面貌，其黄自除。〔薛〕经曰∶中央黄色，入通于脾，故黄胆者，
脾之色也，夫人身之神，贵于藏而默，用见于外，则内虚矣。其证皆因脾气有亏，
运化失职，湿热留于肌肤，发而为疸，钱仲阳所谓身痛背强，二便涩滞，遍身面目
爪甲皆黄是也，小便褐色者难治。疗法宜固脾为先，如专用克伐宽中，澹泄利水之
药，则鲜有不至危者矣。若初生及百日半年之间，不因病而身黄者，胃热胎黄也，
腹大食土为脾疳，兼作渴饮冷者，用泻黄散（脾）。小便不利者，茵陈汤。病后发黄，
肢体浮肿者用白术散（渴）。清便自调，肢冷嗜卧者益黄散（脾）。身澹黄白者调中丸（腹痛）及
补中益气汤（虚热）加茵陈。身热膈满，肌肤面目皆黄者加减泻黄散。辨其所以，若闭目
壮热，多哭不已，大小便赤涩，口中热气者，乃妊娠浓味，胎毒之候也，母子并服
生地黄汤（胎黄），仍忌酒面五辛热物。设不自慎，误伤脾土，急则变为惊风吐泻，缓则
肢体浮肿，小便不利，眼目障闭，多成疳疾矣。又有脾虚发黄者，当于脾胃中求之。
《小方脉论》记载：小儿渴病，因饮水过多，导致腹胀、泄泻。此病源于心藏热盛，心与小肠相表里，小肠亦受热邪。小肠既已受热，热气上行冲击胃口，致使孩子频繁饮水。这些水液待流入小肠时，被小肠的热气渗透排泄，来不及转入大肠。治疗此病，应先使用通淋药物，再使用清心藏热的药物，最后止渴，方能见效。
按语：这也属于五苓散的适应证。
《小方脉论》治疗渴病先使用通淋药物的方子：
郁金、滑石（各一两）、旱莲子（半两）。
以上药物研为细末。每次服用半钱，用葱汤调服。急于服用三服凉心药。
《小方脉论》欲止渴，其次使用清心藏热的方子：
乌贼鱼骨、海浮石（各一两）、蒲黄（炒制，半两）。
以上研为细末。每次半钱，用枇杷叶煎汤送服。
钱乙论述黄疸相似病症时说：身体皮肤和眼睛都发黄，称为黄病。身体疼痛，胳膊背部僵硬，大小便涩滞不畅，全身尽黄，面目及指甲皆黄，小便颜色如屋尘色，看东西都发黄，伴有口渴的难治，这是黄胆。这两种证候多在大病之后发生。另有另一种证候，不因大病后引起，身体微黄的，是胃热所致，成人也相同。又有面色黄、腹部胀大、吃泥土且口渴的，是脾疳。又有出生即身体发黄的，是胎疸。古书说：各种黄疸都是热证，深黄色的是此类；若淡黄兼白色的，是胃气怯弱，胃不和顺。《难知》说：颜色像熏过的黄色，是湿病，全身疼痛。颜色像橘子黄的，是黄病，身体不痛。干黄燥烈的，小便自利，四肢不沉重，口渴想喝水的，用栀子柏皮汤。湿黄属于脾，小便不利，四肢沉重，似渴但不想喝水的，用大茵陈汤。大便自利而黄的，用茵陈栀子黄连三物汤。往来寒热，全身尽黄的，用小柴胡加栀子汤。洁古说：阳黄则大小便赤涩身热，是脾土与心火相搏，属于阳病，法当先利小便，后通大便。阴黄则二便正常，面目及身体发黄，四肢冷，是脾虚不能制约肾水，应当用益黄散，下使君子丸（益黄散方见脾病篇，使君子丸方见疳病篇）。凡治疗黄病腹胀，应当用茵陈蒿汤调服五苓散，若想利小便，去掉大黄。若想利大便，则加大黄之类。有阳证可以服用，指面赤饮水的人是这类。汤氏说：身体疼痛，胳膊背部疼，大小便涩滞，皮肤面目牙齿指甲皆黄，小便如屋尘色，通利的易治，涩滞的难治，宜服用五苓散加茵陈煎汤调服，又宜服用导赤散加茵陈煎服。或者身热，宜服用小柴胡汤，严重的服用承气汤。〔曾〕凡是黄病患者，不可一概而论，标本不同，证治也不同，乃是脾胃气虚，感受湿热，郁结于腠理，浸淫于皮肤，蕴积而成黄，熏蒸发作于外，所以有此证。或脾胃虚弱，内因症癖，攻伐而成。然而疳泻也主皮肤黄、毛发竖起、肚子大青筋暴露、肌肉消瘦，外表无光泽，身体必发黄，这又是本于疳病而产生，导致有此证。治疗方法，若是感受湿热而得，身体黄如烟熏之色，以粗锉的五苓散加麻黄、生姜煎服，发汗即愈。或用茵陈蒿汤调服五苓散也好。若是得于疳癖者，其形如黄土相似，用醒脾散（慢惊风）、化癖丸（积滞）醒脾快胃，磨积理疳，胃气既和，饮食倍增，运化精微，荣养百骸，灌溉脏腑，五色各见于本部，精华乃形于面貌，其黄自然消除。〔薛〕经上说：中央黄色，入通于脾，所以黄胆者，是脾的颜色。人身之神，贵在藏而不露，若见于外，则内虚了。其证皆因脾气有亏，运化失职，湿热留于肌肤，发而为疸，钱仲阳所谓身体痛背强，二便涩滞，遍身面目爪甲皆黄是也，小便褐色的难治。疗法宜固护脾脏为先，如果专用克伐宽中、澹泄利水的药物，则很少有不至于危重的了。若初生及百日半年之间，不因病而身体黄的，是胃热胎黄。腹大食土为脾疳，兼作渴饮冷的，用泻黄散（脾）。小便不利的，用茵陈汤。病后发黄，肢体浮肿的用白术散（渴）。清便自调，肢冷嗜卧的用益黄散（脾）。身体淡黄白的用调中丸（腹痛）及补中益气汤（虚热）加茵陈。身热膈满，肌肤面目皆黄的用加减泻黄散。辨别其原因，若闭目壮热，多哭不已，大小便赤涩，口中热气者，是妊娠期间浓味饮食，胎毒的征候，母子并服生地黄汤（胎黄），仍忌酒面五辛热物。设不自慎，误伤脾土，急则变为惊风吐泻，缓则肢体浮肿，小便不利，眼目障闭，多成疳疾了。又有脾虚发黄者，应当在脾胃中求治。
Wuling San (Formula see in the chapter on Convulsions)
*Xiao Fang Mai Lun* records: In pediatric polydipsia, excessive water intake leads to abdominal distension and diarrhea. This disease originates from heat in the Heart Zang; as the Heart and Small Intestine are exterior-interiorly related, the Small Intestine also receives heat. Once the Small Intestine is heated, its Qi ascends and rushes to the stomach opening, causing the child to drink excessively. When this water awaits entry into the Small Intestine, it is permeated and excreted by the heat Qi of the Small Intestine, failing to transfer to the Large Intestine in time. To treat this, one should first administer diuretic/dysuria-relieving medicines, then administer medicines to cool the Heart Zang, and finally stop thirst for efficacy.
Commentary: This also falls under the indications for Wuling San.
*Xiao Fang Mai Lun* formula for treating polydipsia by first using dysuria-relieving medicines:
Jinyu (Curcuma Aromatica Rhizome), Huashi (Talcum), Hanlianzi (Ecliptae Herba).
Grind the above ingredients into powder. Take half a qian each time, mixed with Scallion Decoction. Urgently administer three doses of cooling Heart medicines.
*Xiao Fang Mai Lun* formula for stopping thirst by subsequently cooling the Heart Zang:
Wuzeiyu Gu (Sepiae Endoconcha), Haifushi (Pumex), Puhuang (Polygoni Typhonii Pollen, stir-fried).
Grind the above into powder. Take half a qian each time, taken with Loquat Leaf Decoction.
Qian Yi discussed similar jaundice conditions saying: When the body skin and eyes are yellow, it is called Huang Bing (Jaundice Disease). Body pain, stiffness in the arms and back, difficulty in urination and defecation, full-body yellowing, yellowing of the face, eyes, and nails, urine colored like house dust, objects appearing yellow, accompanied by thirst which is difficult to treat, is Huang Dan (Jaundice). These two syndromes often occur after severe illnesses. There is another syndrome, not caused by post-illness condition, with slight body yellowing, which is Stomach Heat, also applicable to adults. There is also facial yellowing, abdominal distension, geophagia (eating soil), and thirst, which is Pi Gan (Spleen Malnutrition). There is also congenital body yellowing, known as Tai Dan (Fetal Jaundice). Ancient texts state: All types of jaundice are heat syndromes; deep yellow indicates this. If pale yellow with white tones, it indicates weak Stomach Qi and disharmony. *Nan Zhi* states: Color resembling smoked yellow indicates Dampness disease, with full-body pain. Color resembling orange yellow indicates Huang Bing, without body pain. Dry, hot, and dry yellow, with spontaneous urination, non-heavy limbs, thirst, and desire to drink, indicates Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction). Wet yellow belongs to the Spleen, with difficulty in urination, heavy limbs, apparent thirst but no desire to drink, indicates Da Yincheng Tang (Large Coptis and Artemisia Capillaris Decoction). Spontaneous loose stools with yellow color indicates Yincheng Zhizi Huanglian Sanwu Tang (Coix Seed, Gardenia, and Coptis Three-Ingredient Decoction). Alternating chills and fever with full-body yellowing indicates Xiaochaihu Jia Zhizi Tang (Minor Bupleurum Decoction plus Gardenia). Jiegu states: Yang Huang presents with red, obstructed urination and defecation, and body heat; this is Earth of the Spleen clashing with Fire of the Heart, constituting a Yang disease. The method requires first promoting urination, then promoting defecation. Yin Huang presents with normal urination and defecation, yellowing of the face, eyes, and body, and cold limbs; this is Spleen deficiency failing to control Kidney Water. One should use Yihuang San (Yellow-Safeguarding Powder) and Shi Junzi Wan (Quisqualis Pill) (Yihuang San formula see in Spleen chapter, Shi Junzi Wan formula see in Gan chapter). For treating Huang Bing with abdominal distension, Yincheng Hao Tang (Artemisia Capillaris and Coix Seed Decoction) should be used to mix with Wuling San. If the goal is to promote urination, remove Dahuang. If the goal is to promote defecation, add Dahuang or similar herbs. Yang syndromes can take this, referring to those with red face and desire to drink water. Tang Shi states: Body pain, arm and back pain, obstructed urination and defecation, yellowing of skin, face, teeth, and nails, urine like house dust; if unobstructed, easy to treat; if obstructed, difficult to treat. It is suitable to take Wuling San added with Yincheng, decocted and mixed. It is also suitable to take Daochi San (Guide Out Redness Powder) added with Yincheng and decocted. Or if there is body heat, take Xiaochaihu Tang (Minor Bupleurum Decoction); if severe, take Chengqi Tang (Chengqi Decoction). [Zeng] All jaundice patients cannot be treated uniformly; the root and branch differ, so diagnosis and treatment vary. It is due to Spleen and Stomach Qi deficiency, contracting Damp-Heat, stagnating in the Cou Li (interstices), flooding the skin, accumulating to form yellow, steaming outward, thus causing this syndrome. Or due to Spleen and Stomach weakness, internal accumulation of masses, resulting from aggressive treatment. However, Gan Xie (Malnutrition Diarrhea) also manifests as yellow skin, erect hair, large abdomen with visible veins, emaciation, lack luster externally, and inevitable body yellowing; this arises from Gan disease, leading to this syndrome. Treatment method: If contracted from Damp-Heat, with body yellow like smoke-stained color, use coarse-cut Wuling San added with Mahuang and Shengjiang, decocted and administered; sweating will lead to recovery. Using Yincheng Hao Tang mixed with Wuling San is also good. If obtained from Gan Pi (Malnutrition Masses), the shape resembles yellow earth, use Xingpi San (Slow Convulsion) and Hua Pi Wan (Accumulation) to awaken the Spleen and speed up the Stomach, grind accumulations and regulate Gan, harmonize Stomach Qi, increase food intake significantly, transform essence and micro-nutrients, nourish all bones, irrigate Zang-Fu organs, let the five colors appear in their respective parts, let the essence manifest in the face, and the yellow will naturally disappear. [Xue] The Classics state: Central yellow connects to the Spleen; thus, Huang Dan is the color of the Spleen. The spirit of the human body values concealment and silence; if manifested externally, the interior is deficient. These syndromes are all due to Spleen Qi deficiency, failure of transformation and transportation, Damp-Heat remaining in the skin and muscles, erupting as Dan. As Qian Zhongyang said: body pain, back stiffness, obstructed urination and defecation, full-body, face, and nail yellowing; brown urine is difficult to treat. Therapy should prioritize securing the Spleen. If exclusively using attacking, widening the middle, and draining/diuretic medicines, few will avoid critical danger. If newborns or within 100 days to half a year, not due to illness but body yellow, it is Stomach Heat Tai Huang. Abdominal distension and eating soil indicate Pi Gan; combined with thirst and drinking cold, use Xiehuang San (Spleen). Difficulty in urination indicates Yincheng Tang. Post-illness yellowing with limb edema indicates Baizhu San (Thirst). Normal urination/defecation, cold limbs, and drowsiness indicate Yihuang San (Spleen). Pale yellow-white body indicates Tiaozhong Wan (Abdominal Pain) and Buzhong Yiqi Tang (Deficiency Heat) added with Yincheng. Body heat, chest fullness, and yellowing of skin, muscles, face, and eyes indicate Ji Jian Xiehuang San (Modified Draining Yellow Powder). Differentiate the cause: if eyes closed, high fever, incessant crying, red and obstructed urination/defecation, and hot breath in the mouth, these are signs of fetal toxin from rich flavors during pregnancy. Mother and child should both take Shengdihuang Tang (Fetal Jaundice), still avoiding alcohol, wheat, five pungent spices, and hot foods. If not cautious, mistakenly injuring Spleen Earth, urgently it transforms into Convulsion with vomiting and diarrhea; slowly it becomes limb edema, difficulty in urination, eye obstruction, mostly becoming Gan diseases. There are also cases of Spleen deficiency causing yellowing, which should be sought within the Spleen and Stomach.