厥阴（为风木之脏。中见少阳相火。若风郁火燔。）之为病。（脏燥求救于水。则
为）消渴。（消渴者。水入不足以制火。而反为火所消也。又须旁参他证。方知其为真
厥阴之病。其）气上冲心。心中疼热。（火生于木。肝气通于心也。胃受木克。而求救
于食。则）饥（然既受克而致虚。虚未回。则虽饥）而（仍）不饮食。（即强）食（之。
）则（随肝气上冲而作）吐。（此
厥阴消渴证外兼见之证也。虽内经有云。二阳
结。谓之消。二阳。阳明也。阳明之消。得下则止。而此属之厥阴。）下之不肯止。
此节与伤寒论厥阴首条。末句二句三字不同。其义迥别。盖以消证后人有上消中消
下消之分。而其病源总属厥阴。夫厥阴风木。中见少阳相火。风郁火燔。则病消渴。内
经亦有风消二字。消必兼风言之。亦即此意。且上消系太阴者。心热移肺也。中消系阳
明者。火燔土燥也。下消系少阴者。水虚不能制火实。火虚不能化水也。时医俱不言及
厥阴。而不知风胜则干。火从木出。消证不外乎此。师故于开宗处。指出总纲。次节言
寸口脉。即心营肺卫之部位也。厥阴横之为病。则太阴受之。言趺阳脉。阳明之部位也。
厥阴纵之为病。则阳明受之。三节言男子消渴。男子两字。是指房劳伤肾而言。厥阴病。
乘其所生。则足太阴受之。以厥阴为主。分看合看互看。头头是道。师未出方。然无
不可于乌梅丸、及伤寒中各条悟
出对证之方。
寸口脉浮而迟。浮（不因表。）即（气不敛而）为虚。迟（不因寒。）即（营不充而）
为劳。（气既不敛而）虚则卫（行脉外之）气不足。（营既不充而）劳则营（行脉中之
）气（亦）竭。（心营肺卫。膈消之治法可悟也。然营者水谷之精气。卫者水谷之悍气。
虚而且迟。水谷之气。不上充而内郁。则胃热矣。此上消中消。可分而可合之旨。更
诊其）趺阳脉浮而数。浮即为气。（经所谓热气蒸胸中是也。）数即（为气盛。气有
余。便是火。火盛则）消谷而大坚。（坚则不能消水。如以水投石。水去而石自若也。
且夫）气（之）盛（即火之盛也。火热本足消水也。水入本足救渴也。今胃中坚燥。全
不受水之浸润。转从火热之势。急奔膀胱。）则溲数。溲数则坚。（愈数愈坚。愈坚愈
数。）坚数相搏。即为消渴。
此以寸口诊营卫。而上消之证含于其中。趺阳诊阳明。而中消之证详而不漏。然二
证实相因而起也。师未出方。今补拟其略。大抵上消证。心火亢盛。移热于肺。为膈消
者。用竹叶石膏汤去半夏加栝蒌根之类。或不去半夏。喻嘉言最得其秘。心火不足。移
寒于肺。为肺消者。用炙甘草汤。或柴胡桂姜汤加人参五味子麦门冬之类。中消证。责
在二阳。以人参白虎汤送下脾约丸颇妙。然亦须随证变通。不可胶柱也。
（饮水多而小便少者。水消于上。名上消。食谷多而大便坚者。食消于中。名中消。
饮水少而小便反多者。水消于下。名下消。上中二消属热。惟下消寒热兼之。以肾为水
火之脏也。）男子消渴。小便反多。以饮一斗。小便亦一斗。（中无火化可知。以）肾
气丸主之。（从阴中温养其阳。使肾阴摄水。则不直趋下源。肾气上蒸。则能生化津液。
何消渴之有耶。）
此提出男子两字。是指房劳伤肾。为下消立法。而以肾气丸为主治也。尤在泾谓水
液属阴。非气不至。气虽属阳。中实含水。水与气未尝相离也。肾气丸内有桂附。所
以斡旋肾中颓坠之气。而使上行心肺之分。不然则滋阴润燥之品。同于饮水无济。但益
下趋之势而已。驯至有降无升。饮一溲二。久而小便
不臭。反作甘气。此肾败而土气下泄也。更有浮在溺面如脂者。此肾败而精不禁也。
皆为不治。赵养葵谓治消之法。无分上中下。惟以六八味。专主水火津液之源而救之。
然亦在治之于早。而大剂以进。或全料。或半料。加人参两许。煮汁。一日夜服尽为妙。
此后人近理之言。亦可取以并参也。
肾气丸方（见妇人杂病）
（更有似消渴而非真消渴者。姑附之以备参考。若病发于表。为）脉浮。（水
停于中。为）小便不利。（因表邪不去。而发）微热。（因停水不能化。而为）消渴。
（此与真消渴悬殊。治者）宜利小便发汗。（以）五苓散主之。
此言外邪内水之渴。与真消渴不同也。
五苓散方（见痰饮）
（热）渴欲饮水。（饮过多。热虽消而水不行。以致）水入则吐者。名曰水逆。
（此因渴而生出呕病。更与真消渴证无涉。亦以）五苓散主之。
此言因渴而生呕。更与真消渴不同也。
（太阳病应发汗。而以水 之。外寒制其内热。以致）渴欲饮水不止者。（非味
咸质燥。不能渗散其水气。以）文蛤散主之。（此更与真消渴证相隔霄壤也。）
此言外寒制其内热而为渴。又与真消渴不同也。
文蛤散方
文蛤（五两）
上一味。杵为散。以沸汤五合。和服方寸匕。
淋之为病。小便（短而频数。尿出）如粟。（米）状。（病在下焦。及肝则）小
腹弦急。（及肾则）痛引脐中。
此言淋证之病状也。后人有石淋砂淋血淋气淋膏淋之分。此则统言之也。
（淋病为下焦之热。而下焦则大于中焦。趺阳者。胃也。）趺阳脉数。胃中有热。
即消谷引饮。大便必坚。小便则数。（数而无度。茎中不痛。是热气燔烁。消渴之渐
也。频数而短。茎中作痛。是热气下注。淋病之根也。）
此言淋病由于胃热下注。与消渴异流而同源也。师篇中凡复言叠叙之证。皆有深意。
淋家（热结在下。）不可发汗。（若）发汗则（阴液重伤。水府告匮。热逼于下。必小）
便（出）血。
此言淋家不可发汗也。
（膀胱为通身之水道。今）小便不利者。（为膀胱之气不化。便知其）有（停而不
行之）水气。（设令不渴。则病止在于膀胱也。）其人若渴。（是中焦土弱。津液不能
布散于上。而转输于下。且上焦有热而干涸。其气化不达于州都也。以）栝蒌瞿麦丸主
之。
此言小便不利。求之膀胱。然膀胱之所以能出者。气化也。气之所以化者。不在膀
胱而在肾。故清上焦之热。补中焦之虚。行下焦之水。各药中加附子一味。振作肾气。
以为诸药之先锋。方后自注腹中温三字。为大眼目。即肾气丸之变方也。
栝蒌瞿麦丸方
薯蓣（三两） 茯苓（三两） 栝蒌根（二两） 附子（一枚炮） 瞿麦（一两）
上五味。末之。炼蜜丸如梧子大。饮服二丸。日三服。不知。增至七八丸。以小便
利腹中温为知。
（若无水气而渴。止是）小便不利。（其证不杂。其方亦不必求深。审系湿热。）
蒲灰散主之。（若系血分。即用）滑石白鱼散。（若欲驱除阴分之水湿。）茯苓戎盐汤
并主之。
此为小便不利。并出三方。听人之随证择用也。
蒲灰散方
蒲灰（半分） 滑石（二分）
上二味。杵为散。饮服方寸匕。日三服。
滑石白鱼散方
滑石 乱发（烧） 白鱼（各二分）
上三味。杵为散。饮服方寸匕。日三服。
茯苓戎盐汤方
茯苓（半斤） 白术（三两） 戎盐（弹丸大一枚）
上三味。先将茯苓白术煎成。入戎盐再煎。分温三服。
（虽然。治病之道。循其所当然者。更当求其所以然。淋证小便不利。病在水也。
然金为水母。肺热则涸其源。胃为燥土。胃热则塞其流。今）渴欲饮水。口干燥者。
（肺胃热盛也。治求其本。以）白虎加人参汤主之。
此肺胃热伤之方治也。
白虎加人参汤方（见 病）
（且胃热为脉浮。为热。为渴。为小便不利。与太阳之五苓证不同。阳明之）脉
（大而）浮（肌肉上蒸蒸）发热。渴（则）欲饮（冷）水。小便（因热盛液干而）不利
者。（与太阳五苓证。发汗利水。两解其表里者迥别。故不用五苓散。而以）猪苓汤主
之。
此因脉浮发热小便不利二句。与五苓节文同。故又分别其为猪苓汤之方治。盖二证
二汤。毫厘千里。学人不可不细心研究。
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。
厥阴病（足厥阴肝经病变）的病症表现：肝脏属风木之脏，与少阳相火互为表里。若风气郁结、火势炽盛，导致脏气燥急而向水求救，则出现消渴（以多饮、多食、多尿及形体消瘦为特征的病证）。所谓消渴，是指摄入的水液不足以制约体内的火热，反而被火热消耗殆尽。此外，还需结合其他症状综合判断，才能确认这是真正的厥阴病。患者感觉有气向上冲撞心脏，心中感到疼痛且灼热（因肝木生心火，肝气通于心；胃受肝木克制而虚弱，急于寻求食物补充，故虽觉饥饿但因胃虚仍不能进食；勉强进食后，食物随上冲的肝气而上逆呕吐）。这些是厥阴消渴证之外兼见的症状。虽然《内经》提到“二阳结谓之消”（阳明胃肠气机郁结导致的消渴），阳明消渴通过攻下法可以停止，但此处的消渴属于厥阴范畴，使用攻下法并不能止住。
本节内容与《伤寒论》厥阴篇首条末尾的两句三字有所不同，其含义截然不同。大概因为后世医家将消渴分为上消、中消、下消三类，但其病源总归属于厥阴。厥阴风木之中寄寓着少阳相火，风气郁结、火势炽盛就会引发消渴，《内经》中也有“风消”的说法，即消渴必兼风邪之意，也是这个意思。况且，上消涉及太阴，是心热移于肺所致；中消涉及阳明，是火盛土燥所致；下消涉及少阴，是水虚不能制火，火虚不能化水所致。当时的医生都不提及厥阴，却不知道风胜则干，火从木出，消渴的病机不外乎此。所以张仲景在开篇处指出总纲。第二节论述寸口脉，寸口是心营和肺卫的部位。厥阴病横向传变，则太阴受累；第三节论述趺阳脉，趺阳脉是阳明的部位。厥阴病纵向传变，则阳明受累。第四节论述男子消渴，“男子”二字特指房劳损伤肾脏而言。厥阴病乘其所生之脏，则足太阴脾受累。以厥阴为主，分看、合看、互看，条理清晰。张仲景虽然没有直接开出方剂，但无不可从乌梅丸及《伤寒论》各条文中领悟出对症的方剂。
寸口脉象浮而迟。浮（不是因为表证），而是（气不收敛而）表现为虚；迟（不是因为寒证），而是（营血不充盈而）表现为劳损（虚劳）。气既不收敛而虚，则行于脉外的卫气不足；营既不充盈而劳损，则行于脉中的营气枯竭。（由此可悟出治疗膈消需调理心营肺卫的方法。）然而，营气是水谷的精微之气，卫气是水谷的悍烈之气。既虚又迟，说明水谷之气不能上充反而内郁，从而导致胃热。这揭示了上消和中消既可区分又可统一的宗旨。再诊察趺阳脉，脉象浮而数。浮即为气盛（经书中所说的热气蒸腾于胸中）；数即为气盛，气有余便是火，火盛则消化食物过快且大便坚硬（大便坚硬则不能吸收水分，如同水浇在石头上，水流走石头依然干燥）。而且，气盛即是火盛，火热本足以消耗水液，饮水本足以解渴，但现在胃中坚燥，完全不受水液的浸润，水液转而随着火热的势头，急速奔流进入膀胱。这就导致小便频数。小便频数则大便更加坚硬（越频数越坚硬，越坚硬越频数）。坚硬与频数相互搏结，就形成了消渴。
这里通过寸口脉诊断营卫，上消的症状包含在其中；通过趺阳脉诊断阳明，中消的症状详尽无遗。然而这两种证候是相继产生的。张仲景没有开出方剂，现在补充拟定其大致方案。大抵上消证，心火亢盛，移热于肺，称为膈消的，用竹叶石膏汤去掉半夏加上栝蒌根之类的药物；或者不去半夏，喻嘉言认为这样最得其精髓。若是心火不足，移寒于肺，称为肺消的，用炙甘草汤，或者柴胡桂姜汤加入人参、五味子、麦门冬之类的药物。中消证，责任在于阳明二经，用人参白虎汤送服脾约丸颇为巧妙。但也必须随证变通，不可拘泥固执。
（饮水多而小便少的，水在上部消耗，名为上消；吃得多而大便坚硬的，食物在中部消耗，名为中消；喝水少而小便反而多的，水在下部消耗，名为下消。上消和中消属于热证，只有下消寒热夹杂，因为肾是水火之脏。）男子患消渴，小便反而增多，喝一杯水，就排出一斗小便（说明中部没有火来气化水液）。用肾气丸主治。（通过温养肾中的阳气，使肾阴能够摄纳水液，水就不会直趋下焦源头；肾气上蒸，就能生化津液，哪里还会有消渴呢？）
这里提出“男子”二字，是指房劳伤肾，为下消立法，并以肾气丸为主治方。尤在泾认为水液属阴，没有气就不能到达；气虽属阳，其中实在含有水，水和气未曾分离。肾气丸内有肉桂、附子，用来斡旋肾中颓坠之气，使其上行至心肺部位。否则，滋阴润燥的药物，就如同喝水一样没有济助，只会增加下趋的趋势。久而久之，只有下降没有上升，喝一斗尿两斗，时间久了小便不臭，反而散发甜味，这是肾败坏而脾气下泄的表现。更有尿液表面浮着像油脂一样的物质，这是肾败坏而精气不禁固的表现。这些都是不治之症。赵养葵认为治疗消渴的方法，不分上中下，只用六味地黄丸或八味地黄丸，专门针对水火津液的源头进行救治。但这必须在早期治疗，并用大剂量进服，或者全料，或者半料，加入人参一两左右，煮成汁，一天一夜服完才妙。这是后人比较合理的言论，也可以参考采纳。
肾气丸方（见妇人杂病篇）
（还有类似消渴但不是真正消渴的情况，姑且附上以供参考。如果病发于体表，表现为）脉浮（体表受邪）；（水停聚在体内，表现为）小便不利（水道不通）；（因为表邪未去，而发出）微热（低烧）；（因为停水不能气化，而表现为）消渴（口渴欲饮）。这与真正的消渴相差悬殊，治疗者应当采用利小便并发汗的方法。（用）五苓散主治。
五苓散方（见痰饮篇）
（体内有）热，想喝水。（喝得过多，热虽然消除了但水液不行，导致）水入则吐，名叫水逆。（这是因为口渴而引发的呕吐病，更与真正的消渴证无关，也用）五苓散主治。
（太阳病应该发汗，却用水洗的方法，外寒遏制了内热，导致）渴欲饮水不止者。（不用味咸质燥的药物，不能渗散其水气，用）文蛤散主治。（这更与真正的消渴证相隔甚远。）
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，服用方寸匕。
淋病（以小便频数短涩、滴沥刺痛、欲出未尽、小腹拘急或痛引腰腹为特征的病证）的症状：小便（短促而频数，尿出）如粟米（米粒）状。（病位在下焦，波及肝脏则）小腹拘急弦紧；（波及肾脏则）疼痛牵引至脐中。
这里讲的是淋证的病状。后世有石淋、砂淋、血淋、气淋、膏淋之分，这里则是统称。
（淋病是由于下焦有热，而下焦的范围大于中焦，趺阳脉反映的是胃的状态。）趺阳脉数，说明胃中有热，就会消谷善饥、引水自救，大便必然坚硬，小便则频数。（频数而无节制，尿道不痛，是热气燔灼，是消渴的征兆；频数而短少，尿道作痛，是热气下注，是淋病的根源。）
这里讲的是淋病由于胃热下注引起，与消渴异流同源。张仲景的篇章中凡是重复叙述的证候，都有深意。
患有淋病的人（下焦热结），不可以发汗。（如果）发汗，则会（重伤阴液，水府告罄，热邪逼迫于下，必然导致小）便（出）血。
（膀胱是全身的水道，现在）小便不利的人。（是因为膀胱的气化功能失常，就知道有）停聚而不流动的水气。（假如不渴，那么病只停留在膀胱。）如果这个人感到口渴，（说明中焦脾土虚弱，津液不能布散于上并转输于下，且上焦有热而干涸，气化功能不能达于膀胱州都）。用栝蒌瞿麦丸主治。
这里讲的是小便不利，求之于膀胱，但膀胱之所以能排出尿液，靠的是气化。气之所以能化，不在膀胱而在肾。所以清除上焦的热，补益中焦的虚，通行下焦的水，在各药中加入附子一味，振奋肾气，作为诸药的先锋。方后自注“腹中温”三个字，是关键所在，即肾气丸的变方。
栝蒌瞿麦丸方
薯蓣（三两） 茯苓（三两） 栝蒌根（二两） 附子（一枚，炮制） 瞿麦（一两）
以上五味药，研成细末，炼蜜制成梧桐子大小的丸剂。每次饮水送服二丸，每日三次。不见效，增加到七八丸，以小便通畅、腹中温暖为见效标准。
（如果没有水气停留而口渴，仅仅是）小便不利。（其证候不复杂，方剂也不必求深奥。如果是湿热证，用）蒲灰散主治。（如果是血分证，就用）滑石白鱼散。（如果想驱除阴分的水湿，）茯苓戎盐汤也主治。
这是针对小便不利，并列出三个方剂，让人根据证候选择使用。
蒲灰散方
蒲灰（半分） 滑石（二分）
以上两味药，捣碎成散剂。每次饮水送服方寸匕，每日三次。
滑石白鱼散方
滑石 乱发（烧焦） 白鱼（各二分）
以上三味药，捣碎成散剂。每次饮水送服方寸匕，每日三次。
茯苓戎盐汤方
茯苓（半斤） 白术（三两） 戎盐（弹丸大一枚）
以上三味药，先将茯苓和白术煎煮成汁，加入戎盐再煎，分三次温服。
（虽然如此，治病之道，遵循其当然的道理，更应探求其所以然的原理。淋证和小便不利，病在水液方面。然而金生水，肺为水之母，肺热则枯竭水源；胃为燥土，胃热则堵塞水流。现在）渴欲饮水，口干燥者。（这是肺胃热盛。治疗求其根本，用）白虎加人参汤主治。
白虎加人参汤方（见百合狐惑阴阳毒病脉证治第三，此处原文可能有缺漏或泛指，依常规理解）
（而且胃热会导致脉浮、发热、口渴、小便不利，这与太阳病的五苓散证不同。阳明病的）脉（大而）浮（肌肉表面蒸蒸）发热，渴（则）欲饮（冷）水，小便（因热盛液干而）不利者。（这与太阳病五苓散证，通过发汗利水，表里双解的方法截然不同。所以不用五苓散，而用）猪苓汤主治。
这里因为脉浮、发热、小便不利这三句，与五苓散节的文字相同，所以又分别其为猪苓汤的方治。这两个证候、两个方剂，毫厘之差千里之别，学习者不可不细心研究。
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，加入阿胶烊化溶解。每次温服七合，每日三次。
Jueyin Disease (diseases of the Foot Jueyin Liver Meridian) manifests as follows: The Liver is a Zang organ of Wind and Wood, interacting with the Shaoyang Ministerial Fire. If Wind is constrained and Fire blazes, causing the Zang Qi to become dry and seek Water for relief, Xiao Ke (a disease characterized by excessive thirst, hunger, urination, and emaciation) occurs. "Xiao" implies that the ingested water is insufficient to control the internal Fire, which instead consumes the water. Furthermore, other symptoms must be considered to confirm it as a true Jueyin disease. Patients experience Qi rushing upward to the heart, accompanied by pain and heat sensation in the chest (because Liver Wood generates Heart Fire, and Liver Qi connects to the Heart; the Stomach, being overcome by Liver Wood, becomes deficient and seeks food, leading to hunger but an inability to eat due to deficiency; forced ingestion results in vomiting as the food rises with the surging Liver Qi). These are accompanying symptoms of Jueyin Xiao Ke. Although the *Neijing* states "Constriction of the Two Yangs is called Xiao" (referring to Xiao caused by Qi stagnation in the Yangming Stomach and Intestines), Yangming Xiao can be stopped by purgation, whereas this type belongs to Jueyin and does not stop with purgation.
This section differs from the last two sentences of the first verse in the Jueyin chapter of the *Shanghan Lun*, carrying a distinct meaning. Later physicians divided Xiao into Upper, Middle, and Lower types, but its root source always lies in Jueyin. Jueyin Wind-Wood contains Shaoyang Ministerial Fire; when Wind is constrained and Fire blazes, Xiao Ke arises. The *Neijing* also mentions "Wind Xiao," implying that Xiao is always associated with Wind. Specifically, Upper Xiao involves the Taiyin, resulting from Heart Heat transferring to the Lung; Middle Xiao involves Yangming, resulting from blazing Fire drying the Earth; Lower Xiao involves the Shaoyin, where Yin deficiency fails to control Fire, and Fire deficiency fails to transform Water. Contemporary physicians often ignore Jueyin, failing to realize that excess Wind causes dryness and Fire originates from Wood, encompassing the pathology of Xiao. Therefore, Zhang Zhongjing outlines the general principle at the beginning. The second verse discusses the Cun Kou pulse, the location of Heart Ying and Lung Wei. When Jueyin disease spreads horizontally, it affects Taiyin. The third verse discusses the Fu Yang pulse, the location of Yangming. When Jueyin disease spreads vertically, it affects Yangming. The fourth verse discusses Xiao in men; "men" specifically refers to kidney injury from sexual exhaustion. Jueyin disease, attacking the organ it generates, affects the Foot Taiyin Spleen. Viewing the Jueyin as the main factor, analyzing separately, jointly, and interactively provides clear logic. Although Zhang Zhongjing did not prescribe formulas directly, one can deduce appropriate prescriptions from Wumei Wan and various verses in the *Shanghan Lun*.
The Cun Kou pulse is floating and slow. Floating (not due to exterior syndrome) indicates Deficiency (Qi failing to consolidate); Slow (not due to Cold) indicates Lao (Deficiency-Disease, where Ying blood is insufficient). Since Qi is deficient and fails to consolidate, the Wei Qi (defensive Qi moving outside the vessels) is insufficient. Since Ying is deficient and diseased, the Ying Qi (nutritive Qi moving inside the vessels) is exhausted. From this, one can infer the treatment for Ge Xiao (diaphragm Xiao) involves regulating Heart Ying and Lung Wei. However, Ying Qi is the essence of grain and water, while Wei Qi is the vigorous aspect. Both deficiency and slowness indicate that the Qi of grain and water fails to ascend and instead stagnates internally, generating Stomach Heat. This reveals the principle that Upper and Middle Xiao can be distinguished yet are unified. Further examination of the Fu Yang pulse shows it floating and rapid. Floating indicates Qi abundance (heat steaming in the chest); Rapid indicates Qi excess, which transforms into Fire. Excess Fire digests food quickly and causes hard stools. Hard stools cannot absorb water, like water poured on stone. Qi abundance is Fire abundance; Fire naturally consumes water, and drinking should quench thirst. However, with dry and hard Stomach conditions, water is not absorbed but rushes rapidly to the Bladder along with the Fire, causing frequent urination. Frequent urination makes stools harder. The interaction of hardness and frequency constitutes Xiao Ke.
Here, the Cun Kou pulse diagnoses Ying and Wei, containing signs of Upper Xiao; the Fu Yang pulse diagnoses Yangming, detailing Middle Xiao without omission. These two conditions arise sequentially. Zhang Zhongjing did not provide formulas; here we supplement them. Generally, for Upper Xiao where Heart Fire is hyperactive and transfers heat to the Lung (Ge Xiao), use Zhuye Shigao Tang removing Banxia and adding Gualou Gen. Or keep Banxia, as Yu Jiyan believed this captures the secret. If Heart Fire is insufficient and cold transfers to the Lung (Fei Xiao), use Zhigancao Tang or Chaihu Guizhi Jiangtang plus Renshen, Wuweizi, and Maimendong. For Middle Xiao, focusing on the Two Yangs, sending Ren Shen Baihu Tang with Piyue Wan is excellent. However, adjustments must be made according to symptoms; one must not be rigid.
(Excessive drinking with reduced urination is water consumed above, named Upper Xiao; eating much with hard stool is food consumed in the middle, named Middle Xiao; drinking little with increased urination is water consumed below, named Lower Xiao. Upper and Middle Xiao are Heat patterns; only Lower Xiao combines Cold and Heat because the Kidney is the organ of Water and Fire.) In men with Xiao Ke, urination increases disproportionately; drinking one dou results in urinating one dou (indicating a lack of Fire transformation in the middle). Treat with Shenqi Wan. By warming and nourishing Yang within Yin, Kidney Yin can retain water, preventing it from rushing down; Kidney Qi steams upward, generating fluids, thus resolving Xiao Ke.
The mention of "men" refers to kidney injury from sexual exhaustion, establishing the treatment for Lower Xiao with Shenqi Wan as the primary prescription. You Zaijing stated that body fluids belong to Yin and require Qi to reach them; although Qi belongs to Yang, it contains Water. Water and Qi are inseparable. Shenqi Wan contains Rougui and Fuzi to rotate the sinking Qi of the Kidney, allowing it to ascend to the Heart and Lungs. Otherwise, Yin-nourishing and dryness-moistening herbs would be ineffective like drinking water, merely increasing downward flow. Eventually, there is only descent without ascent, drinking one dou and urinating two, with urine becoming odorless and sweet-smelling over time, indicating Kidney failure and Spleen Qi leakage. Urine may also have a lipid-like film, indicating Kidney failure and essence leakage. These are incurable. Zhao Yangkui stated that treating Xiao requires no distinction between upper, middle, and lower; use Liuwei Dihuang Wan or Bawei Dihuang Wan specifically targeting the source of Water, Fire, and Fluids. Early treatment with large doses, possibly full or half dosage, plus about one liang of Renshen, boiled and taken over a day and night, is effective. This is a reasonable later commentary worth referencing.
Shenqi Wan formula (see Chapter on Miscellaneous Diseases of Women).
(Some cases resemble Xiao Ke but are not true Xiao Ke. If the disease starts at the exterior, presenting as) Floating Pulse (exterior pathogen); (water retention in the interior presents as) Impaired Urination (obstruction of water passages); (due to unresolved exterior pathogen, slight Fever occurs); (due to retained water failing to transform, Thirst occurs). This differs significantly from true Xiao Ke. Treatment should promote urination and induce sweating using Wuling San.
This describes thirst caused by exterior pathogens and internal water retention, distinct from true Xiao Ke.
Wuling San formula (see Chapter on Phlegm-Fluids).
(Heat causes) Thirst and desire to drink. (If too much is drunk, Heat clears but Water fails to move, causing Vomiting upon drinking), named Shui Ni (Water Reversal). (This vomiting arises from thirst and is unrelated to true Xiao Ke). Treat with Wuling San.
This describes vomiting arising from thirst, distinct from true Xiao Ke.
(Taiyang disease should be treated with sweating, but if washed with water, Exterior Cold suppresses Internal Heat, causing) Persistent Thirst and Desire to Drink. (Only salty and dry substances can渗散 [percolate and dissipate] the Water Qi). Treat with Wenli San. (This is vastly different from true Xiao Ke).
This describes thirst caused by Exterior Cold suppressing Internal Heat, distinct from true Xiao Ke.
Wenli San Formula
Wenli (5 liang)
Grind the single ingredient into powder. Mix with 5 he of boiling water and take one fangcun bi.
Lin Disease (characterized by frequent, urgent, painful, and difficult urination) presents with Urination that is short and frequent, resembling millet grains. (The disease is in the Lower Jiao; involving the Liver causes) Urgent tension in the lower abdomen; (involving the Kidney causes) Pain radiating to the umbilicus.
This describes the symptoms of Lin disease. Later physicians distinguished Stone, Sand, Blood, Qi, and Gao Lin; here it is discussed generally.
(Lin disease is due to Heat in the Lower Jiao, which encompasses the Middle Jiao; the Fu Yang pulse reflects the Stomach.) A Rapid Fu Yang pulse indicates Heat in the Stomach, leading to excessive digestion, thirst, hard stools, and frequent urination. (Frequency without restraint and no penile pain indicates blazing Heat, a precursor to Xiao Ke; frequency with short volume and penile pain indicates Heat pouring downward, the root of Lin disease).
This explains that Lin disease stems from Stomach Heat pouring downward, sharing the same source as Xiao Ke but differing in manifestation. Repetitive descriptions in Zhang Zhongjing's chapters carry deep significance.
Patients with chronic Lin disease (Heat accumulation in the Lower Jiao) must not undergo sweating therapy. (If) Sweated, it will (severely damage Yin fluids, deplete the Water House, and force Heat downward, inevitably causing Hematuria).
This warns against sweating in Lin patients.
(The Bladder is the water pathway of the body. Now, those with) Impaired Urination (have impaired Bladder Qi transformation, indicating stagnant Water Qi). (If they are not thirsty, the disease is confined to the Bladder.) If the patient feels Thirst, (it indicates weak Middle Jiao Earth, failure of fluids to distribute upward and transport downward, Upper Jiao Heat causing dryness, and Qi transformation failing to reach the Zhou Du/Bladder). Treat with Gualou Qumi Wan.
This explains that while impaired urination relates to the Bladder, the ability to excrete depends on Qi transformation, which originates in the Kidney, not just the Bladder. Thus, clearing Upper Jiao Heat, tonifying Middle Jiao Deficiency, and promoting Lower Jiao Water flow are combined. Adding Fuzi to振奋 [stimulate] Kidney Qi serves as a vanguard for other herbs. The note "abdominal warmth" in the formula instructions is key, representing a variation of Shenqi Wan.
Gualou Qumi Wan Formula
Shuyu (3 liang), Fuling (3 liang), Gualou Gen (2 liang), Fuzi (1 piece, processed), Qumai (1 liang).
Grind the five ingredients into powder, mix with refined honey to make pills the size of wutong seeds. Take 2 pills with water, three times daily. If ineffective, increase to 7-8 pills. Efficacy is indicated by free urination and abdominal warmth.
(If there is no Water Qi retention but thirst and only) Impaired Urination exist, the syndrome is simple, and the formula need not be complex. If it is Damp-Heat, treat with Puhui San. (If it involves the Blood level, use Huashi Baiyu San). (To expel Dampness from the Yin level), Fuling Rongyan Tang is also applicable.
These three formulas are provided for Impaired Urination, allowing selection based on specific symptoms.
Puhui San Formula
Puhui (0.5 fen), Huashi (2 fen).
Grind into powder. Take one fangcun bi with water, three times daily.
Huashi Baiyu San Formula
Huashi, Luafa (burned), Baiyu (each 2 fen).
Grind into powder. Take one fangcun bi with water, three times daily.
Fuling Rongyan Tang Formula
Fuling (0.5 jin), Baizhu (3 liang), Rongyan (one pill-sized piece).
Decoct Fuling and Baizhu first, add Rongyan, and decoct again. Divide into three warm doses.
(Although treating disease follows established principles, one must also seek the underlying cause. Lin disease and impaired urination involve Water. However, Metal generates Water; Lung Heat dries the source. Stomach is Dry Earth; Stomach Heat blocks the flow. Now, with) Thirst, desire to drink, and dry mouth, (this indicates Hyperactive Heat in the Lung and Stomach). To treat the root, use Baihu Jia Renshen Tang.
This is the treatment for Lung and Stomach Heat injury.
Baihu Jia Renshen Tang formula (see Chapter on Baihe, Huxuan, and Yin-Yang Dou Diseases).
(Stomach Heat can cause Floating Pulse, Fever, Thirst, and Impaired Urination, differing from the Taiyang Wuling San pattern. In Yangming disease, the Pulse is Large and Floating, with Steaming Fever, Thirst for Cold Drinks, and Impaired Urination due to Heat consuming fluids). This is distinctly different from the Taiyang Wuling San pattern, which resolves both exterior and interior via sweating and diuresis. Therefore, do not use Wuling San; instead, use Zhu Ling Tang.
Because the phrases "Floating Pulse, Fever, Impaired Urination" resemble the Wuling San verse, this distinguishes the indication for Zhu Ling Tang. These two syndromes and two formulas differ by a hair's breadth but lead to miles of difference; students must study carefully.
Zhu Ling Tang Formula
Zhuling (decoated), Fuling, Ejiao, Huashi, Zexie (each 1 liang).
Boil the first four ingredients in 4 sheng of water until 2 sheng remains. Strain, dissolve Ejiao, and take 7 he warm, three times daily.