（脉证九条方六首）
厥阴之为病。消渴。气上冲心。心中疼热。饥而不欲食。食即吐蝤。下之不肯止。
〔衍义〕是症伤寒传厥阴症中。但曰吐蝤。下之利不止。此曰食即吐。下不止。岂食
入便至于利下不止乎。成注曰。邪传厥阴。则热已深也。邪自太阳传至太阴。止
咽干。未成渴。传少阴。止口燥舌干而渴。未成消。传至厥阴。热甚。多饮水。乃成消
渴也。饮水多而小便少。谓之消渴。火生于木。厥阴客热。气上冲心。心中疼热。伤
寒至厥阴受病。时为传经尽当入腑。胃虚热客。饥不饮食。蝤在胃中。无食则动。
闻食臭即出。得食吐蝤。此热在厥阴经。若便下之。虚其胃气。厥阴木邪相乘。必
吐下不止。伤寒杂症病起之由虽异。至成六气之热邪则一。五脏传来之热。与
色欲劳役饮食之热。客于厥阴。其热皆无异也。
寸口脉浮而迟。浮即为虚。迟即为劳。虚则胃气不足。劳则荣气竭。趺阳脉浮而数。
浮即为气。数即消谷而大坚。（一作紧）气盛则溲数。溲数则坚。坚数相搏。即为消渴。
〔衍义〕内经云。有所劳倦。形气衰少。谷气不盛。上焦不行。胃气热。热气熏胸中。故
内热。寸口为上焦。趺阳候中焦。寸口迟为劳者。即劳役致伤也。劳即阳气退下。
谷气不得升举。以充上焦。上焦主行荣卫。谷气不充。则卫虚而脉浮。荣竭而脉
迟。盖谷气不输于上下。壅而盛于中。数则消谷者。壅盛之气。郁而为热。即消谷。
数即热也。大坚者。水谷虽入。不化津液。中焦遂燥。坚即燥也。内经所谓味过于
苦。脾气不濡。胃气乃浓。中焦热甚。火性疾速。水谷不得留停。下入膀胱而溲水
去。其内即燥而又热。即为消渴。近世谓消中也。
男子消渴。小便反多。以饮一斗。小便一斗。肾气丸主之（方见妇人杂病中）
〔衍义〕医 云。女子阴物也。晦淫则生内热惑蛊之疾。仲景独称男子。倘亦此意。
肾者主水主志。藏精以施化。若惑女色以丧志。则泄精无度。火扇不已。所主之
水所藏之精无几矣。水无几。何以敌相火。精无几。何以承君火。二火乌得不炽
而为内热惑蛊之病耶。二火炽。则肺金伤。肺金伤。则气燥液竭。内外腠理因之
干涩而思饮也。且肾乃胃之关。通调水道。肺病则水不复上归下输。肾病则不
复关键。不能调布五经。岂不饮一斗而出一斗乎。用八味补肾之精。散其本也。
不避桂附之热。为非辛不能开腠理。致五脏精输之于肾。与其施化四布以润
燥也。每恨古今论消渴者。多集其症。而不举其所自者有之。举其端而不明其
源者有之。仲景因当时失第六卷论六气之详。故只就金气而言病。不及乎火。
惟张子和论君相二火。可补仲景之未备。相火游行五脏间。火主动。动之和者。
则助本脏气生化之用。动之不和者。即为害之大也。妄动之火势盛。必挟本脏
气同起。当时脏气。有虚有实。有阴有阳。主气主血。升降浮沉。各一体用。是故治
火之中。必当先审脏气。虚则补之。实则泻之。在阳则调其气。在阴则理其血。当
升而反降者。必举之。当降而反升者。必抑之。须兼五行金木水火土之性。从而
治之。使无捍格之患。则火有所归宿而安矣。肾气丸内有桂附。治消渴恐有水
未生而火反盛之患。不思内经王注。火自肾起。为龙火。当以火逐火。则火了灭。
以水治之。则火愈炽。如是则桂附亦可从治者矣。
脉浮。小便不利。微热消渴。宜利小便发汗。五苓散主之。
〔衍义〕伤寒论太阳病。发汗后。大汗出。胃中干。烦躁不得眠。欲得饮水者。少少与
之。令胃气和则愈。若脉浮。小便不利。微热消渴者。五苓散主之。注曰。若脉浮者。
表未解也。饮水多而小便少者。谓之消渴。里热甚。实也。微热消渴者。热未成实。
上焦燥也。与是药生津液。和表里。
渴欲饮水。水入则吐者。名曰水逆。五苓散主之。（方见上）
〔衍义〕伤寒论中风发热。六七日不解而烦。有表里症。渴欲饮水。水入吐。名曰水
逆。注曰。六七日发热不解。烦者。邪在表也。渴欲饮水。邪传里也。里热甚。则能消
水。水入则不吐。里热少。则不能消水。停积不散。饮而吐也。与此药和表里。散停水。
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。以沸汤五合。和服方寸匕。
〔衍义〕文蛤散治伤寒冷水 若灌。其热不去。肉上粟起。意欲饮。反不渴者。此治
表之水寒。今不言表。而曰饮不止。属里者亦用之。何也。尝考本草。文蛤、海蛤。治
浮肿。利膀胱。下小便。则知内外之水。皆可用之。其味咸冷。咸冷本于水。则可益
水。其性润下。润下则可行水。合咸冷润下。则可退火。治热证之渴饮不止。由肾
水衰少。不能制盛火之炎燥而渴。今益水治火。一味两得之。内经曰。心移热于
肺。传为膈消者。尤宜以咸味。切于入心也。
淋之为病。小便如粟状。小腹弦急。痛引脐中。
〔衍义〕淋如粟状者。因脾胃不足。流浊下入胞中。而膀胱属水。湿浊下流。土克之
也。土克则水气不行。郁化为热。煎熬胞中。浊结如粟之水。则胞之下系。与溺窍
皆滞涩不利。且厥阴之脉。循阴器。主疏泄。胞涩不利。则厥阴之气亦不利。故攻
克于膀胱之分。作急痛引脐中。脐中者。两肾间。膀胱上口也。巢氏病源云。膀胱
有热者。水涩淋涩。小腹弦急。痛引脐中。盖本此耳。
趺阳脉数。胃中有热。即消谷引食。大便必坚。小便则数。
〔衍义〕消万物者莫甚于火。胃有热即消谷。消谷则饥。饥则引食。食虽入。以火燥
其玄府。水津不布。下入膀胱。肠胃津液不生。故大便坚。膀胱内热。则损肾阴。阴
虚则水不得固藏。故数数出之。巢氏病源云。肾虚则小便数也。
淋家不可发汗。发汗必便血。
〔衍义〕淋者。膀胱与肾病热也。肾属于阴。阴血已不足。若更发汗。则动其荣。荣动则血泄矣。
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） 茯苓（三两） 薯蓣（三两） 附子（一枚炮） 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。
〔衍义〕内经云。肺者。通调水道。下输膀胱。又谓膀胱藏津液。气化出之。益肺气通
于膀胱。上通则下行。下塞则上闭。若塞若闭。或有其一。即气不化。气不化。则水
不行而积矣。水积则津液不生而胃中燥。故苦渴。用栝蒌根生津液。薯蓣以强
肺阴。佐以茯苓治水。自上渗下。瞿麦逐膀胱癃结之水。然欲散水积之寒。通开阴道。使上下
相化。又必附子善走者为使。服之小便利。腹中温为度。若水积冷而方用之。否则不必用也。
小便不利。蒲灰散主之。滑石白鱼散。茯苓戎盐汤。并主之。
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（二分烧） 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。以水四升。煮减半。去滓。温服七合。日三服。
〔衍义〕小便不利。为膀胱气不化也。气不化。由阴阳不和。阴阳有上下。下焦之阴
阳。肝为阳。肾为阴。肾亦有阴阳。左为阳。右为阴。膀胱亦有阴阳。气为阳。血为阴。
一有不和。气即不化。自三分观之。悉为膀胱血病涩滞。致气不化而小便不利
也。蒲灰、滑石者。本草谓其利小便。消瘀血。蒲灰治瘀血为君。滑石利窍为佐。乱
发、滑石、白鱼者。发乃血之余。能消瘀血。通关便。本草治妇人小便不利。又治妇
人无故溺血。白鱼去水气。理血脉。可见皆血剂也。茯苓戎盐者。即北海盐。膀胱
乃水之海。以气相从。故咸味润下。佐茯苓利小便。然盐亦能走血。白术亦利腰
脐间血。故亦治血也。三方亦有轻重。乱发为重。蒲灰次之。戎盐又次之。
渴欲饮水。口干舌燥者。白虎加人参汤主之（方见中 中）
〔衍义〕伤寒论阳明脉浮而紧。咽燥口苦。发热汗出。不恶寒。反恶热。身重云云。若
渴欲饮水。口干舌燥者。白虎加人参汤主之。成注以苦下之。热客中焦。是谓干
燥烦渴。凡病属阴阳。热甚在表里之间者。即可用之。阳明为水谷之海。气血俱
盛。热易归之。伤寒杂病饮食之热。与夫五邪之相传。俱客之耳。
脉浮发热。渴欲饮水。小便不利者。猪苓汤主之。
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。
〔衍义〕前条有脉浮小便不利。微热消渴。用五苓散利小便取汗。利小便与此证
无异。何药之不同也。前条太阳证发汗。复大汗出。胃中干。欲得饮水。少少与之。
令胃中和即愈。脉若浮。小便不利。微热消渴者。与五苓散。此乃阳明证咽喉燥。
发热汗出身重。下后若脉浮发热。渴欲饮水。小便不利者。猪苓汤。脉浮同也。而
有太阳阳明之异。热同也。而有微甚之异。邪客入里同也。而有上焦下焦之异。
邪本太阳。入客上焦。所以宜取汗利小便。邪本阳明。虽脉浮发热。然已经下之。
其热入客下焦。津液不得下通。而小便不利矣。惟用茯苓、猪苓、泽泻。渗泄其过
饮所停之水。滑石利窍。阿胶者。成注谓其功同滑石。不思此证。既不可发汗。下
之又耗其气血。必用参 。手太阴足少阴药。补其不足。助其气化而出小便也。
须参之。
（脉证九条，方剂六首）
厥阴病的典型症状是：口渴多饮，气向上冲撞心脏，心中感觉疼痛且有灼热感，虽然感到饥饿却不想进食，一旦进食就会呕吐出蛔虫。如果误用泻下法治疗，腹泻将不会停止。
〔衍义〕这种病症在伤寒传入厥阴经时出现，但《伤寒论》中只提到“呕吐蛔虫，误下后导致利下不止”。这里说“进食即吐”，且“下利不止”，难道食物进入体内就会导致下利不止吗？成无己注释说：邪气传入厥阴，说明热邪已经深入。邪气从太阳经传到太阴经，仅表现为咽干，尚未形成口渴；传到少阴经，仅表现为口燥舌干而渴，尚未形成消渴；传到厥阴经，热势极盛，患者大量饮水，这才形成消渴病。饮水多而小便少，称为消渴。火生于木（肝属木，内寄相火），厥阴经受客热侵袭，气机上冲于心，导致心中疼痛且有灼热感。伤寒病至厥阴受邪，此时往往是传经的最后一阶段，应当转入腑证。由于胃气虚弱，热邪客居其中，患者虽觉饥饿但不想饮食。蛔虫在胃中，没有食物时它会躁动，闻到食物的气味就会出来，吃到食物则引发呕吐蛔虫。这是热邪在厥阴经的表现。如果此时直接使用泻下法，会进一步损伤胃气，导致厥阴木邪乘虚克制脾胃，必然出现呕吐和下利不止的症状。伤寒与杂病发病原因虽不同，但最终形成的六气热邪是一致的。五脏传来的热邪，以及因色欲过度、劳累、饮食不当产生的热邪，客居于厥阴经，其热邪性质并无二致。
寸口脉象浮而迟，浮脉代表虚证，迟脉代表劳损。虚证则胃气不足，劳损则营气枯竭。趺阳脉象浮而数，浮脉代表气机亢盛，数脉代表能消化食物且大便坚硬。（另一种说法认为紧脉）。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，就形成了消渴病。
〔衍义〕《内经》说：如果有劳倦过度，形体和正气都会衰弱减少，谷气也不旺盛，上焦功能不行，胃气生热，热气熏蒸胸中，所以产生内热。寸口脉候上焦，趺阳脉候中焦。寸口脉迟表示劳损，即因劳役导致的损伤。劳损会导致阳气退陷于下，谷气不能升举以充实上焦。上焦主运行营卫之气，谷气不充，则卫气虚弱而脉浮，营气枯竭而脉迟。大概是因为谷气不能输布于上下，壅滞并盛于中焦。数脉代表能消化食物，这是因为壅盛的气机郁结化为热，即所谓的“消谷”。数脉也代表热邪。大便坚硬，是因为水谷虽然进入体内，但不能化为津液，中焦因此变得干燥，坚即指燥。《内经》所说“口味过于苦，脾气不濡润，胃气就会浓烈”，中焦热势极盛，火性疾速，水谷不得停留，下行进入膀胱排出尿液，体内既干燥又炎热，这就形成了消渴病，也就是近世所说的“中消”。
男子患消渴病，小便反而增多，喝一斗水，排出一斗尿，用肾气丸主治（方剂见妇人杂病篇）。
〔衍义〕医家云：女子属阴物，若房事不节则会产生内热惑蛊之疾。张仲景唯独称述男子，或许也是这个意思。肾主水、主志，藏精并能施化。如果被女色迷惑而丧失意志，则泄精无度，相火燃烧不停。所主的水和所藏的精华就很少了。水很少，凭什么抵御相火？精很少，凭什么承接君火？两火怎能不炽盛而成为内热惑蛊的病呢？两火炽盛，则损伤肺金。肺金受伤，则气燥液竭，内外腠理因此干涩而思饮。而且肾是胃的关口，通调水道。肺病则水不再上行回归并向下输布，肾病则不再有关键作用，不能调节布散五脏经脉，岂不是喝一斗水就排出一斗尿吗？使用八味药补肾之精，是从根本上解决。不避忌桂枝、附子的热性，因为非辛味不能开泄腠理，致使五脏的精微输送到肾，与其施化四布以滋润燥热。我常常遗憾古今论述消渴病的人，大多聚集其症状，而不列举其来源的有之；列举其开端而不阐明其根源的有之。张仲景因为当时遗失了第六卷关于六气论述的详细资料，所以只从金气方面谈论疾病，不及火气。只有张子和论述君相二火，可以补充张仲景未完备之处。相火游行于五脏之间，火主动，动的和谐者，则辅助本脏气的生化之用；动的不和谐者，就是危害很大的因素。妄动的火势强盛，必定挟带本脏气一同兴起。当时的脏气，有虚有实，有阴有阳，主气主血，升降浮沉，各有一个体用关系。因此治疗火邪之中，必须先审察脏气，虚则补之，实则泻之，在阳则调其气，在阴则理其血。当升而反降的，必须提升它；当降而反升的，必须抑制它。必须兼用五行金木水火土的性质，顺从其性来治疗，使没有抵触的隐患，那么火就有归宿而安定了。肾气丸内有桂枝、附子，治疗消渴恐怕会有水未生成而火反而盛行的隐患。但不思考《内经》王冰注解说：火自肾起，为龙火，应当以火逐火，则火灭了；用水去治它，则火更炽盛。像这样，桂枝、附子也可以作为从治之法了。
〔衍义〕《伤寒论》太阳病，发汗后，大汗出，胃中干燥，烦躁不得眠，想要喝水的，少量给予他，令胃气和顺就好了。如果脉浮，小便不利，微热消渴的，用五苓散主治。注解说：如果脉浮，表证未解。饮水多而小便少，称为消渴。里热甚，属实证。微热消渴，说明热未成实，上焦干燥。给予此药生津液，调和表里。
想要喝水，水入则呕吐的，名叫水逆，用五苓散主治。（方剂见上文）
〔衍义〕《伤寒论》中风发热，六七天不解且心烦，有表里证，想要喝水，水入则吐，名叫水逆。注解说：六七天发热不解，心烦，是邪气在表。想要喝水，是邪气传入里。里热甚，则能消化水，水入则不吐。里热少，则不能消化水，停积不散，饮水则吐。给予此药调和表里，消散停积之水。
想要喝水且不止的，用文蛤散主治。
文蛤散方
文蛤（五两）
以上一味药，捣碎成散剂，用沸水五合，调和服用一方寸匕。
〔衍义〕文蛤散治疗伤寒冷水如冷水浇背般的情况，其热不去，皮肤起粟粒状，想要喝水，反而不渴的，这是治疗表部的水寒。现在不说表证，而说饮水不止，属于里证也用它，为什么呢？曾考证本草，文蛤、海蛤，治疗浮肿，利膀胱，下小便，由此可知内外的水邪都可以用它。它的味道咸冷，咸冷源于水，则可以益水；它的性质润下，润下则可以行水。结合咸冷润下的特性，则可以退火。治疗热证引起的渴饮不止，是由于肾水衰少，不能制约盛火的炎燥而口渴。现在益水以治火，一味药达到两个目的。《内经》说：心移热于肺，传变为膈消的，尤其适宜用咸味，因为咸味切于入心。
淋病的症状是：小便像粟米状，小腹拘急紧张，疼痛牵引到脐中。
〔衍义〕淋病小便如粟米状，是因为脾胃不足，流浊下行进入胞中，而膀胱属水，湿浊下行，土克水所致。土克水则水气不行，郁结化为热，煎熬胞中，浊气凝结如粟米状的水，导致胞的下系与溺窍都滞涩不利。而且厥阴经脉，循行经过阴器，主疏泄，胞涩不利，则厥阴之气也不利，所以攻冲于膀胱部位，产生急痛牵引脐中。脐中，是两肾之间，膀胱上口。巢元方《诸病源候论》说：膀胱有热的，水涩淋涩，小腹弦急，疼痛牵引脐中。大概本于此。
趺阳脉数，胃中有热，就能消化食物并引食，大便必然坚硬，小便则频数。
〔衍义〕消化万物没有比火更厉害的。胃有热就能消化食物，消化食物则饥饿，饥饿则引食。食物虽然进入，但因火热燥烈玄府，水津不布散，下行进入膀胱，肠胃津液不生，所以大便坚硬。膀胱内热，则损伤肾阴，阴虚则水不得固藏，所以频频排出。巢元方《诸病源候论》说：肾虚则小便频数。
〔衍义〕淋病，是膀胱与肾的热邪。肾属于阴，阴血已不足，如果再发汗，则会扰动营气，营气动则血液外泄。
栝蒌瞿麦丸方
栝蒌根（二两） 茯苓（三两） 薯蓣（三两） 附子（一枚，炮制） 瞿麦（一两）
以上五味药，研末，炼蜜制成梧桐子大小的丸剂，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。
〔衍义〕《内经》说：肺，通调水道，下输膀胱。又说膀胱藏津液，气化而出。补肺气通于膀胱，上通则下行，下塞则上闭。如果塞或闭，只要有一种情况，就会气不化。气不化，则水不行而积聚。水积聚则津液不生而胃中干燥，所以苦于口渴。用栝蒌根生津液，薯蓣以强肺阴，佐以茯苓治水，自上渗下。瞿麦驱逐膀胱癃结之水。然而要消散水积之寒，通开阴道，使上下相化，又必须依靠善于走窜的附子为使药。服用后小便利，腹中温暖为度。如果是水积冷而方适用它，否则不必用。
蒲灰散方
蒲灰（七分） 滑石（三分）
以上两味药，捣碎成散剂，饮水送服一方寸匕，每日三次。
滑石白鱼散方
滑石（二分） 乱发（二分，烧焦） 白鱼（二分）
以上三味药，捣碎成散剂，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，用水四升，煮取一半，去滓，温服七合，每日三次。
〔衍义〕小便不利，是膀胱气不化。气不化，由阴阳不和引起。阴阳有上下之分，下焦之阴阳，肝为阳，肾为阴。肾也有阴阳，左为阳，右为阴。膀胱也有阴阳，气为阳，血为阴。有一点不和，气就不化。从三分来看，都是膀胱血病涩滞，导致气不化而小便不利。蒲灰、滑石，本草说它们利小便，消瘀血。蒲灰治瘀血为君药，滑石利窍为佐药。乱发、滑石、白鱼，发乃血之余，能消瘀血，通关便。本草治疗妇人小便不利，又治疗妇人无故溺血。白鱼去水气，理血脉。可见这些都是血分药。茯苓戎盐，即北海盐。膀胱乃水之海，以气相从，故咸味润下，佐茯苓利小便。然而盐也能走血，白术也能利腰脐间血，所以也治血。三方也有轻重之分，乱发为重，蒲灰次之，戎盐又次之。
〔衍义〕《伤寒论》阳明脉浮而紧，咽燥口苦，发热汗出，不恶寒，反恶热，身重等等。如果渴欲饮水，口干舌燥的，用白虎加人参汤主治。成无己注释认为苦下之，热客中焦，这叫干燥烦渴。凡病属阴阳，热甚在表里之间的，就可以用此方。阳明为水谷之海，气血俱盛，热易归之。伤寒杂病饮食之热，与夫五邪之相传，都客居于此。
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，取二升去滓，加入阿胶烊化，温服七合，每日三次。
〔衍义〕前条有脉浮小便不利，微热消渴，用五苓散利小便取汗。利小便与此证无异，为何药物不同？前条太阳证发汗，复大汗出，胃中干，欲得饮水，少量给予，令胃中和即愈。脉若浮，小便不利，微热消渴的，与五苓散。此乃阳明证咽喉燥，发热汗出身重，下后若脉浮发热，渴欲饮水，小便不利的，猪苓汤。脉浮相同，而有太阳阳明之异。热相同，而有微甚之异。邪客入里相同，而有上焦下焦之异。邪本太阳，入客上焦，所以宜取汗利小便。邪本阳明，虽脉浮发热，然已经下之，其热入客下焦，津液不得下通，而小便不利矣。惟用茯苓、猪苓、泽泻，渗泄其过饮所停之水，滑石利窍。阿胶者，成注谓其功同滑石。不思此证，既不可发汗，下之又耗其气血，必用人参、地黄等手太阴足少阴药，补其不足，助其气化而出小便也。须参之。
(Nine pulse-symptom patterns, six formulas)
The typical symptoms of Jueyin disease are: excessive thirst (Xiao Ke), sensation of Qi rushing up to the heart, pain and burning sensation in the heart region, hunger without desire to eat, vomiting of roundworms upon eating. If purgatives are mistakenly used, diarrhea will not stop.
[Commentary] This syndrome appears when Shaoyang transmits to Jueyin in Shanghan diseases, but *Shanghan Lun* only mentions "vomiting roundworms, leading to persistent diarrhea if purged." Here it says "vomiting upon eating" and "persistent diarrhea," does food entering the body lead directly to persistent diarrhea? Cheng Wuji notes: When pathogenic factors transmit to Jueyin, heat has already penetrated deeply. From Taiyang to Taiyin, there is only dry throat, not yet thirst; from Taiyin to Shaoyin, there is only dry mouth and tongue with thirst, not yet Xiao Ke; reaching Jueyin, heat is severe, patients drink large amounts of water, thus forming Xiao Ke. Drinking much but urinating little is called Xiao Ke. Fire arises from Wood (Liver belongs to Wood, harboring Ministerial Fire); Jueyin is invaded by guest heat, causing Qi to rush upward to the heart, resulting in heart pain and burning sensation. In Shanghan disease, when Jueyin is affected, this is often the final stage of meridian transmission, likely transitioning to the Fu organs. Due to deficient Stomach Qi and heat lodging within, patients feel hungry but lack appetite for food. Roundworms in the stomach move when empty and emerge upon smelling food, causing vomiting upon ingestion. This indicates heat in the Jueyin meridian. Using purgatives at this stage further damages Stomach Qi, allowing Jueyin Wood pathogen to overact on Spleen/Stomach, inevitably causing persistent vomiting and diarrhea. Although Shanghan and miscellaneous diseases have different origins, the resulting Six Qi heat pathogens are identical. Heat transmitted from the Five Zang organs, as well as heat from sexual excess, fatigue, or improper diet lodging in Jueyin, shares the same nature.
Cunkou (Radial artery at wrist) pulse is floating and slow. Floating indicates deficiency; slow indicates劳损 (consumptive disorder). Deficiency implies insufficient Stomach Qi; consumptive disorder implies exhaustion of Ying (Nutritive) Qi. Duyang (Radial artery at foot) pulse is floating and rapid. Floating indicates hyperactive Qi; rapid indicates ability to digest food and hard stool. (Another version reads "tight"). Hyperactive Qi leads to frequent urination; frequent urination leads to harder stool. Hardness and rapidity interacting result in Xiao Ke.
[Commentary] *Neijing* states: With laborious fatigue, form and Zheng Qi decline, Gu (Grain) Qi becomes weak, Upper Jiao function fails, Stomach Qi generates heat, steaming the chest, causing internal heat. Cunkou reflects Upper Jiao; Duyang reflects Middle Jiao. Slow Cunkou indicates injury from labor. Labor causes Yang Qi to sink, preventing Gu Qi from ascending to nourish Upper Jiao. Upper Jiao governs Ying and Wei circulation; lack of Gu Qi leads to deficient Wei (defensive) Qi and floating pulse, exhausted Ying Qi and slow pulse. Essentially, Gu Qi fails to distribute上下 (up and down), stagnating and flourishing in the Middle Jiao. Rapid pulse indicating digestion occurs because stagnant Qi transforms into heat ("digesting food"). Rapid pulse also signifies heat. Hard stool arises because although food enters, it fails to transform into Jin Ye (Body Fluids), drying the Middle Jiao; hardness refers to dryness. As *Neijing* says: "Excessive bitter taste impairs Spleen moistening, making Stomach Qi thick/concentrated." Severe Middle Jiao heat, swift in nature due to Fire, prevents food/water retention, directing them to Bladder for excretion. Internal dryness combined with heat forms Xiao Ke, known as "Zhong Xiao" (Middle Consumption) in later eras.
Men suffering from Xiao Ke may exhibit increased urination: drinking one dou results in one dou of urine. Treat with Shenqi Wan (Kidney Qi Pill) (Formula found in Women's Miscellaneous Diseases chapter).
[Commentary] Physicians state: Women belong to Yin; immoderate sexual activity generates internal heat and蛊 (parasitic/mental confusion) disorders. Zhang Zhongjing specifically mentions men, perhaps implying this context. Kidney governs Water and Will, storing Essence for transformation. Sexual indulgence depletes Will, causing excessive seminal emission and unceasing Ministerial Fire. The governed Water and stored Essence become scarce. How can little Water resist Ministerial Fire? How can little Essence support Sovereign Fire? These two fires must blaze, causing internal heat and confusion. Blazing fires damage Lung Metal. Damaged Lung Metal leads to dry Qi and depleted fluids, causing dryness in tissues and desire to drink. Kidney is the gate of Stomomach, regulating water passages. Lung disease prevents water from ascending and descending; Kidney disease loses its gating function, failing to distribute to Five Meridians. Thus, drinking one dou yields one dou. The eight ingredients in Shenqi Wan tonify Kidney Essence, addressing the root. Not avoiding the heat of Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) is because acrid flavors open pores, allowing essence from Five Zang to reach Kidney for transformation and distribution to moisten dryness. I regret that ancient and modern discussions on Xiao Ke often list symptoms without sources, or beginnings without roots. Zhang Zhongjing, lacking the detailed Sixth Volume on Six Qi, discussed only Metal aspects, neglecting Fire. Zhang Hezi’s discussion on Sovereign and Ministerial Fires supplements this gap. Ministerial Fire moves among Five Zang; harmonious movement aids organ bio-transformation; disharmonious movement causes great harm. Excessive妄动 (reckless movement) carries organ Qi along. Organ Qi varies in deficiency/excess, Yin/Yang, Qi/Blood, ascending/descending, floating/sinking. Treating fire requires first assessing organ Qi: tonify deficiency, drain excess, regulate Qi in Yang, manage Blood in Yin. Lift what should rise but falls; suppress what should descend but rises. Incorporate Five Elements natures to treat smoothly, avoiding conflict, so Fire finds rest and peace. Shenqi Wan contains Guizhi and Fuzi; treating Xiao Ke might risk water not generating while fire flares. However, Wang Bing’s commentary on *Neijing* notes: Fire originates from Kidney as Dragon Fire; treat fire with fire to extinguish it; treating with water intensifies it. Thus, Guizhi and Fuzi serve as "following treatment" (treating like with like).
Pulse floating, dysuria (difficulty urinating), slight fever, and Xiao Ke indicate a need to promote urination and induce sweating. Treat with Wuling San (Five-Ingredient Powder with Poria).
[Commentary] *Shanghan Lun* Taiyang disease after sweating profusely leads to dry Stomach, irritability, insomnia, and desire for water. Give small amounts to harmonize Stomach Qi. If pulse is floating, dysuria exists, slight fever and Xiao Ke occur, use Wuling San. Annotation: Floating pulse means exterior unresolved. Drinking much but urinating little is Xiao Ke. Severe interior heat is excess. Slight fever and Xiao Ke mean heat is not yet solidified, Upper Jiao is dry. This formula generates fluids and harmonizes interior/exterior.
Desire to drink water, but vomiting upon ingestion, is named Shui Ni (Water Reversal). Treat with Wuling San. (Formula above).
[Commentary] *Shanghan Lun* Wind-strike fever unresolved for 6-7 days with irritability presents exterior-interior signs. Desire to drink, vomiting upon intake, is Shui Ni. Annotation: Fever unresolved with irritability indicates exterior pathogen. Desire to drink indicates transmission to interior. Severe interior heat digests water, no vomiting. Mild interior heat cannot digest water, causing stagnation and vomiting upon intake. This formula harmonizes interior/exterior and dissipates stagnant water.
Unremitting desire to drink water is treated with Wenli San (Clam Shell Powder).
Wenli San Formula
Wenli (Clam Shell) (5 liang)
One ingredient. Pound into powder. Mix with 5 he of boiling water. Take 1 fangcun bi.
[Commentary] Wenli San treats cold water injury where heat persists and skin prickles, desiring drink but not thirsty—treating exterior cold-water. Now applied to unremitting thirst indicating interior involvement. Why? Materia Medica records Wenli and Haige treat edema, benefit Bladder, and promote urination, usable for interior/exterior water. Salty and cold flavor derives from Water, benefiting Water; moist and downward nature promotes Water movement. Combined, they clear fire. Treating thirst from heat due to deficient Kidney Water failing to control blazing fire, this adds Water to control Fire, achieving dual goals. *Neijing* states: Heart transferring heat to Lung becomes Ge Xiao (Diaphragmatic Consumption); salty flavor enters Heart, making it suitable here.
Lin disease symptoms include urine resembling millet grains, tense lower abdomen, pain radiating to umbilicus.
[Commentary] Lin resembling millet grains stems from Spleen/Stomach deficiency, allowing turbid flow into Bao (Uterus/Bladder). Bladder belongs to Water; turbid dampness flows down, Earth overcoming Water. Earth overcoming Water stops Water Qi, stagnating into heat, simmering Bao. Turbid condensation like millet blocks Bao’s lower connection and urethra. Jueyin meridian circulates around genitalia and governs free flow; Bao blockage impedes Jueyin Qi, attacking Bladder area, causing acute pain radiating to umbilicus. Umbilicus is between kidneys, upper opening of Bladder. Chao Yuanfang’s *Zhubing Yuanhou Lun* states: Bladder heat causes water stagnation, Lin, tense lower abdomen, pain to umbilicus. This aligns.
Duyang pulse rapid indicates Stomach heat, leading to easy digestion and increased appetite, hard stools, and frequent urination.
[Commentary] Nothing digests faster than Fire. Stomach heat digests food, causing hunger and increased intake. Food enters, but fire dries Xuanfu (pores), preventing fluid distribution to Bladder, starving intestines of fluids, causing hard stools. Bladder heat damages Kidney Yin; Yin deficiency fails to retain water, causing frequent urination. *Zhubing Yuanhou Lun*: Kidney deficiency leads to frequent urination.
Patients with Lin disease must not be induced to sweat; sweating will cause hematuria.
[Commentary] Lin involves Bladder and Kidney heat. Kidney belongs to Yin; Yin blood is already deficient. Sweating disturbs Ying Qi, causing bleeding.
Dysuria with water accumulation and severe thirst is treated with Gualou Qumai Wan (Trichosanthes Root and Mugwort Pill).
Gualou Qumai Wan Formula
Gualou Gen (Trichosanthes Root) (2 liang)
Fuling (Poria) (3 liang)
Shuyu (Dioscorea) (3 liang)
Fuzi (Prepared Aconite Root) (1 piece, processed)
Qumai (Mugwort Herb) (1 liang)
Five ingredients. Powder. Honey pills size of mulberry seeds. Take 3 pills with water, 3 times daily. Increase to 7-8 pills if ineffective. Effective when urination improves and abdomen feels warm.
[Commentary] *Neijing*: Lung regulates water passages, sending down to Bladder. Bladder stores fluids, excreting via Qi transformation. Tonifying Lung Qi connects to Bladder; upper openness allows lower flow; lower blockage closes upper. Blockage prevents Qi transformation, stopping water flow and causing accumulation. Accumulation prevents fluid generation, drying Stomach, causing thirst. Gualou Gen generates fluids; Shuyu strengthens Lung Yin; Fuling drains water downward. Qumai expels stagnant water in Bladder. To disperse cold-water accumulation and open Yin vessels, facilitating upper-lower interaction, Fuzi (moving freely) acts as guide. Effective when urination improves and abdomen warms. Use only for cold-water accumulation.
Dysuria is treated with Puhui San (Cat-tail Ash Powder). Huashi Baiyu San (Talcum White Fish Powder) and Fuling Rongyan Tang (Poria and Rock Salt Decoction) also treat it.
Puhui San Formula
Puhui (Cat-tail Ash) (7 parts)
Huashi (Talcum) (3 parts)
Two ingredients. Powder. Take 1 fangcun bi with water, 3 times daily.
Huashi Baiyu San Formula
Huashi (Talcum) (2 parts)
Luanfa (Burnt Hair) (2 parts)
Baiyu (White Fish/Paper Moth Larva) (2 parts)
Three ingredients. Powder. Take half qian bi with water, 3 times daily.
Fuling Rongyan Tang Formula
Fuling (Poria) (0.5 jin)
Baizhu (Atractylodes Macrocephala) (2 liang)
Rongyan (Rock Salt) (1 pill-sized piece)
Three ingredients. Boil in 4 sheng water until half remains. Strain. Warm take 7 he, 3 times daily.
[Commentary] Dysuria stems from Bladder Qi failure to transform, caused by Yin-Yang disharmony. Yin-Yang has upper/lower distinctions: Lower Jiao Yin-Yang, Liver is Yang, Kidney is Yin. Kidney has left (Yang)/right (Yin). Bladder has Qi (Yang)/Blood (Yin). Disharmony stops Qi transformation. Analyzing three formulas, all address Bladder Blood stasis causing Qi failure. Puhui and Huashi promote urination and resolve blood stasis; Puhui is sovereign for stasis, Huashi assistant for orifices. Luanfa, Huashi, Baiyu: Hair is surplus of Blood, resolves stasis, opens passages. Materia Medica uses for women’s dysuria and spontaneous hematuria. Baiyu removes water qi, regulates blood vessels—all are Blood agents. Fuling and Rongyan: Rongyan is North Sea Salt. Bladder is sea of Water; salty flavor moistens downward, assisting Fuling. Salt also moves Blood; Baizhu benefits waist/navel Blood. All three formulas vary in weight: Luanfa heaviest, Puhui next, Rongyan lightest.
Desire to drink, dry mouth and tongue, is treated with Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) (Formula found in Middle Chapter).
[Commentary] *Shanghan Lun* Yangming pulse floating/tight, dry throat, bitter taste, fever, sweating, aversion to heat, heaviness. If desire to drink with dry mouth/tongue, use Baihu Jia Renshen Tang. Cheng Wuji notes bitter purgation for heat in Middle Jiao causing dryness/thirst. Applicable when heat is extreme between exterior/interior. Yangming is sea of Grain/Qi-Blood, abundant, attracting heat. Dietary heat from Shanghan/miscellaneous diseases and Five Evils lodging here.
Pulse floating, fever, desire to drink, dysuria is treated with Zhuling Tang (Polyporus Decoction).
Zhuling Tang Formula
Zhuling (Polyporus, peeled)
Fuling (Poria)
Ejiao (Donkey-hide Gelatin)
Huashi (Talcum)
Zexie (Alisma) (Each 1 liang)
Five ingredients. Boil in 4 sheng water. First boil four ingredients, reduce to 2 sheng, strain. Add Ejiao, melt. Warm take 7 he, 3 times daily.
[Commentary] Previous case had floating pulse, dysuria, slight fever, Xiao Ke, treated with Wuling San to promote urination and sweat. Similar indication, why different herbs? Previous Taiyang case post-sweating led to dry Stomach, mild water intake cured it. Floating pulse, dysuria, slight fever/Xiao Ke used Wuling San. This Yangming case features dry throat, fever, sweating, heaviness, post-purgative floating pulse/fever/thirst/dysuria uses Zhuling Tang. Floating pulse same, but Taiyang vs Yangming difference. Heat same, but severity differs. Pathogen entering interior same, but Upper vs Lower Jiao differs. Pathogen originally Taiyang, affecting Upper Jiao, hence sweating/urination promotion. Pathogen originally Yangming, post-purgative, heat entered Lower Jiao, fluids blocked, causing dysuria. Use Fuling, Zhuling, Zexie to leach stagnant water; Huashi opens orifices. Ejiao: Cheng Wuji claims similar effect to Huashi. But this case cannot sweat, purging consumed Qi/Blood. Must use Taibei (Hand-Taiyin) and Shaoyin (Foot-Shaoyin) herbs like Renshen (Ginseng) and Dihuang (Rehmannia) to tonify deficiency and assist Qi transformation for urination. Reference needed.