（经云病患不恶寒而渴者此转属阳明也又曰服脉柴胡汤已渴者属阳明也故以渴入阳明门）
成 伤寒邪传里则渴邪在表则不渴夫三阳虽或有渴不如三阴之甚也故太阴腹满嗌干少阴口燥舌干而渴厥阴则消渴消渴者
饮水多而小便少谓其热能消水也盖初传则热微而渴微传深则热甚而渴甚也凡渴与水勿令极意三阳微渴者五苓散大
渴者白虎汤三阴热甚而渴者顺下之其或渴微而强多饮之则成悸动支结喘咳KT 哕干呕肿满下利小便不利皆由此也
太阳 病发汗后大汗出胃中干烦躁不得眠欲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（张
烦渴用白虎汤宜也其用五苓散渗津液何哉曰白虎乃表证已解邪传里而烦渴者用之今脉尚浮身有微热而渴乃表邪未全解
故用桂枝之辛和肌表白术茯苓之甘淡以润虚燥也 按此说亦未莹太阳经也膀胱腑也膀胱者溺之室也五苓散者利溺药也
膀胱者津液之府故东垣以渴为膀胱经本病然则治渴者当泻膀胱之热泻膀胱之热者利小便而已矣）发汗已脉浮数烦渴者五
苓散 本以下之故心下痞与泻心汤痞不解其人渴而口燥烦小便不利者五苓散 中风发热六七日不解而烦有表里证渴欲
饮水水入即吐名曰水逆五苓散
五苓散方
猪苓（去皮十八铢） 泽泻（一两六铢半） 茯苓（十八铢） 桂（去粗皮半两） 白术（十八铢）上五味为末以
白饮和服方寸匕日三服多饮暖水汗出愈（苓者令也通行津液克伐肾邪专为号令者苓之功也五苓之中茯苓为主故曰五苓散
内经曰淡味渗泄为阳水饮内蓄须渗泄之必以甘淡为主故以茯苓甘平为君猪苓甘平为臣虽甘也终归甘淡脾恶湿水饮内蓄
则脾气不治益脾胜湿必以甘温为助故以白术甘温为佐内经曰咸味渗泄为阴泄饮导溺必以咸为助故以泽泻为使水蓄不行
则肾气燥内经曰肾恶燥急食辛以润之散湿润燥必以桂枝辛热为使多饮暖水令汗出而愈者以辛散而水气外泄故解）
服桂枝汤大汗后大烦渴不解脉洪大者白虎加人参汤 太阳病发热而渴不恶寒者为温病柴胡白虎桂枝去桂加人参伤
寒无大热口燥渴心烦背微恶寒白虎加人参汤 伤寒脉浮发热无汗其表不解者不可与白虎汤渴欲饮水无表证者白虎加人
参汤主之（渴欲饮水无表证者太阳证罢转属阳明也下条意亦同皆太阳转属阳明故渴也）伤寒病若吐若下后七八日不解热
结在里表里俱热时时恶风大渴舌上干燥而烦欲饮水数升者白虎加人参汤主之（王注云若纯在表则恶风无时今表里无热故
时时恶风也）
白虎加人参汤 治渴而脉洪小便利者
石膏（六两） 知母（六两半） 甘草（二两） 粳米（六合） 人参（三钱）上 咀每服一两水煎温服
许 有人初病呕吐俄为医者下之已七八日而内外发热予诊之曰当用白虎加人参汤或曰既吐复下且重虚矣白虎可用
乎予曰仲景云若吐下后七八日不解热结在里表里俱热者白虎加人参汤正相当也盖始吐者热在胃脘而脉至今虚大三投汤
而愈仲景既云伤寒若吐若下后七八日不解表里俱热者白虎加人参汤主之又云伤寒脉浮发热无汗其表不解不可与白虎又
云脉浮滑此以表有热里有寒白虎加人参汤○○○主之林亿校正谓张仲景于此表里目差矣予谓不然大抵白虎能除伤寒中
渴表里发热故前后二证或云表里俱热或云表热里寒皆可服之一种脉浮无汗其表不解全是麻黄与葛根证安可行白虎也林
亿见所称表里不同便谓之差是亦不思之过也
张 用药有迟速之弊故设法以关防法有关防不尽者则着方以拯治也假如上二条前条乃仲景设法以关防也后条及伤
寒病若吐若下后七八日不解结热在里表里俱热时时恶风大渴口舌干燥而烦欲水数升者以白虎加人参汤主之此二条则着
方以拯治也夫白虎汤专治大烦大渴古人设法之意惟恐表证未罢而辄用之治有太速之弊若背微恶寒及时时恶风二证其中
烦渴已甚非白虎不能遏也必候表邪俱尽未免有太迟之愆也此乃法之关防不尽者故着方以拯治也苟不着方必然违法此方
法之妙所以不可偏废也
吴 或问白虎汤仲景以表不解者不可与又时时恶风背上恶寒者此有表也又以白虎主之何也盖石膏辛寒解足阳明经
本热蒸蒸发热潮热表里皆热舌燥烦渴之圣药也且时时者时或恶风而不常也背上恶者但觉微恶而不甚也所有盛热燥渴而
用则无疑矣若夫表证恶寒常在背上恶寒而不燥渴者切不可用也又太阳经发热而渴无汗者不可与之但汗后脉洪大而渴者
则可与也如阴伤寒面赤烦躁身热与其胃虚恶心大便不实脉弱食少无大热者切不可用也如误用之则倾危可立而待矣
太阳病重发汗而复下之不大便五六日舌上燥而渴日晡小有潮热从心下至少腹硬满而痛不可近者大陷胸汤 伤寒发
热恶寒大渴欲饮水其腹必满自汗出小便利其病欲解此肝乘肺也名曰横刺期门
阳明 病汗出多而渴者不可与猪苓汤以汗多胃中燥复利其小便故也（白虎加人参汤小柴胡汤去半夏加栝蒌竹叶 张
其阳明汗多此阳明病未解而渴胃中津液干燥若与猪苓汤复利其小便是为实实虚虚之弊也）阳明病脉浮而紧咽燥口苦腹满
而喘发热汗出不恶寒反恶热身重若渴欲饮水口干舌燥者白虎加人参汤主之 若脉浮发热渴欲饮水小便不利者猪苓汤主
之
少阳 伤寒中风往来寒热胸胁满默默不欲饮食心烦喜呕或渴或咳者小柴胡汤若渴者去半夏加人参栝蒌根伤寒四五
日身热恶风项强胁下满手足温而渴者小柴胡汤 得病六七日脉迟浮弱恶风手足温医二三下之不能食而胁下满痛面目及
身颈项强小便难者与柴胡汤后必下重本渴而饮水呕者柴胡不中与也（或云下重渴欲饮水呕者五苓加茵陈蒿汤）
少阴 渴而下利属少阴其病但兼欲寐小便白者四逆汤兼咳呕不得眠小便不白者猪苓汤兼自利纯青色水者大承气汤
有热者白头翁汤（方论见下利）
厥阴 消渴气上冲心心疼饥不欲食食则吐蛔若下之则利不止若欲饮水少少与之愈（邪传厥阴则热已深也邪自太阳传
至太阴则腹满而咽干未成渴也邪至少阴者口燥舌干而渴未成消也至厥阴而消渴者热甚能消水故也饮水多而小便少者谓
之消渴木生于火肝气通心厥阴客热气上撞心心中疼热伤寒六七日厥阴受病之时为传经尽则当入腑胃虚客热饥不欲食蛔
在胃中无食则动闻食气而出得食蛔出此热在厥阴经也设使下之虚其胃气厥阴木邪相乘必吐下不止 按成氏为表阳邪传
里者非也消渴心中疼热也）
随病治例
渴而头汗小便不利兼胁满往来寒热者柴胡桂枝干姜汤兼发黄者茵陈蒿汤（论见头汗）
表不解心下有水气干呕发热咳嗽或渴或利或噎或小便不利少腹满或喘小青龙汤 又心下有水气咳而微喘发热不渴
服汤已渴者此寒去欲解也小青龙汤（俱宜去半夏加栝蒌根）
夏月汗出恶寒身热足冷而渴者为中暑白虎加人参汤及酒黄连主之（方见中暑恶寒身热者证似表也足冷者不可表）
发热恶寒腹满汗出小便利而渴者为肝乘脾刺期门（论见腹满）表解不恶寒而渴者宜白虎汤
渴而胁满及往来寒热其证未经汗者小柴胡去半夏加人参栝蒌汤若汗下后者柴胡桂枝干姜汤（详见胁满痛并往来寒
热）渴而心下硬痛日晡潮热不大便者为结胸宜大陷胸汤若但硬不痛者为痞与泻心汤不解反渴而小便不利者宜五苓散（详
见结胸痞气二门）
病在阳明应汗之反以冷水 之灌之其热益烦肉上粟起意欲饮水反不渴者服文蛤散若不瘥与五苓汤（论见结胸）
文蛤散方
文蛤（一两即海蛤粉也河间丹溪多用之大能治痰）上一味为散沸汤调服方寸匕
渴欲饮水而不能饮者丹田有热胸中有寒（论见湿痹）
中风发热六七日不解而烦有表里证渴欲饮水水入则吐者名曰水逆五苓散主之
渴欲饮水若太阳发汗后大汗出烦躁不得眠及厥阴病气起冲心心疼吐蛔者少少与之愈（论见前条及气上冲）凡得时气
病至五六日而渴欲饮水不能多不当与之何者以腹中热尚少不能消之更与水作病也至七八日大渴欲饮水者犹当根据证与之
与之常令不足勿极意也言能饮一斗与五升若饮而腹满小便不利若喘若哕不可与之忽然大汗出是为自愈也（活人云凡病非
大渴不可饮水若小渴咽干者少少呷润之令其胃中和乃佳）
凡得病反能饮水此欲愈也但闻病饮水自愈小渴者亦强与之饮因成其祸不可复救（活人云强饮水致饮停心下满结喘者
当以五苓散或陷胸汤主之）下利脉弱脉数而渴者自愈（论见下利）渴而发热其脉不弦紧而浮弱者汗出愈（论见谵语）
娄 活人云切戒太阳证无汗而渴者不可与白虎汤阳明证汗多而渴者不可与猪苓汤然太阳渴终不可与白虎耶太阳证
得汗后脉洪大而渴者方可与之也阳明渴终不可与五苓散耶阳明证小便不利汗少脉浮而渴者方可与之也
赵 活人切戒太阳证无汗而渴者不可与白虎汤阳明证汗多而渴者不可与五苓散愚详仲景论治渴药有不可与之戒有
二伤寒脉浮发热无汗渴欲饮水无表证者白虎加人参汤表不解不可与活人不云表不解但云无汗不可与则误矣经云阳明汗
多而渴不可与猪苓汤活人改作五苓散盖猪苓专渗泄五苓兼汗利安得而改之经既云汗多而渴者不可与猪苓汤而太阳伤寒
汗出而渴复用五苓散者盖渴虽同汗之多寡则异太阳属表未至汗多胃躁故用五苓渗热和表非若阳明属里汗多而胃躁也经
又云阳明发热汗多急下之均是阳明汗多前证戒利小便此证不戒利大便何也盖渴者邪气散漫在经未收敛入胃作实此证不
渴则内已作实外又发热恐热内竭津液故急下之且猪苓五苓又有可疑者太阳病脉浮小便不利微热消渴者五苓散阳明脉浮
发热渴欲饮水小便不利者猪苓汤脉证皆同何故用药之不同耶然太阳邪在表发汗不解故用五苓和表行津液阳明邪已入里
热客下焦故用猪苓渗泻其热噫白虎猪苓五苓等药若能证察于机微治明于权变则可与不可与庶得仲景之妙外有自利而渴
条下注云伤寒热入于脏流于少阴之经少阴主肾肾恶燥故渴而引饮注用猪苓汤白头翁汤又后下利问中重出自利而渴条下
却云肾虚故引水自救通用白通四逆猪苓等汤一问以渴为热一问以渴为虚冰炭不侔何凭分别又且分隶两门设使后人临病
检阅前后两不相闻疑误岂小今详定少阴病咳而下利呕渴心烦不得眠及厥阴证下利欲饮水是皆传经之邪热脉必沉细数仲
景故以滑石黄连等清利之其或少阴自利而渴欲吐不吐心烦但欲寐是直入本经之阴邪也脉必沉微仲景故以附子干姜温之
本问何不如此明示脉证合为一门而明辨之庶一见而两得焉清之温之随其攸利又何疑误之有
吴 凡渴当分六经而治太阳经标热在表则不渴若热传入膀胱之本则烦渴脉浮数小便不利也五苓散切不可与白虎汤
凡阳明病脉长标热无汗而渴者葛根解肌汤或六神通解散倍葛根以汗解之若阳明热传于胃中本热恶热 汗出而渴脉浮
洪数者人参白虎汤五苓不中与也若阳明本热或蒸蒸而热潮热燥湿舌燥口干饮水大便实者大柴胡汤或调胃承气汤下之若
内未实尚未可下宜小柴胡增损用之少阳脉弦数口苦咽干发热而渴者小柴胡去半夏加栝蒌根余见本条太阴自利则不渴惟
少阴有口苦饮水小便色白者此下有寒也脉沉者附子汤若身寒厥逆脉滑而口渴者此里有热也人参白虎汤凡阴证烦躁口渴
不能用水脉沉足冷者宜四逆汤冷冻饮料之凡伤寒时气等证欲饮水者为欲愈盖得水则能和其胃气汗出而解不与水则干燥无由
而作汗遂致闷乱而死也凡与水须察病患勇怯邪热轻重多少与之宁从不及不可太过恐水多不能渗化停蓄为害多矣其水须
用新汲井中者为良凡热病热甚大便实者以元明粉一二钱加入水中饮之最妙凡中暑烦渴者加辰砂天水散调水中饮之尤良
如虚人烦渴不饮水以灯心煎汤浸水中与之凡口渴细茶汤白梅汤绿豆汤皆可饮香水梨悉尼嫩藕西瓜皆可食凡用冰须以凉
水洗去盐味方可
戴 凡渴问其所饮欲冷欲热欲多欲少若饮多而欲冷者阳渴也更须审其有何证在经也其太阳证小便不利而渴者五苓
散其阳明证大便不利而渴者宜于前本经求之已利犹渴宜白虎汤其少阳证寒热往来而渴者小柴胡汤去半夏加栝蒌根如其
数阴亦有自利而渴各已见本经但阴有渴古人多用冷剂以其皆挟阳气耳经虽阴而病则阳也然亦有下清谷不系热利纯是阴
证而反见渴者此是阴在下隔阳于上兼因泄泻津液既去枯燥而渴其人虽引饮所饮自少而常喜温不可投冷剂宜理中汤或四
逆汤加人参一钱渴甚连理汤有阳证不渴阴证反渴者阳明不甚渴太阴乃大渴不可不知治渴一也有坚肾水而渴止者有利小
便而渴愈者坚肾水则用天花粉之属利小便则用茯苓猪苓之类盖太阴以利小便为先阳明以利小便为戒少阳以胆经半表半
里未可下之其人或大渴不止当以小柴胡汤加天花粉之属坚其肾水肾水既坚自还渗入大肠大便微通热去而渴解若病在太
阳太阳在膀胱肾经非利小便则热无从去渴何由愈外有非太阳证烦躁发渴
此乃阴盛隔阳不当润其渴维当治其阴
附
罗 伤寒食少而渴者当以和胃之药止之不可用凉药止之也恐复损胃气愈不能食白术茯苓是也
海 秦二母病太阴病三日不解后呕逆恶心而脉不浮与之半硫丸二三服不止复与黄 建中汤脉中极紧无表里病胸中
（《内经》说：病人不恶寒而口渴的，这是病邪转属阳明经。又说：服用小柴胡汤后出现口渴的，也属于阳明病。因此将“渴”这一症状归入阳明病门类。）
成无己认为：伤寒邪气传入里则口渴，邪气在表则不口渴。虽然三阳经有时也会出现口渴，但不如三阴经严重。太阴病表现为腹部胀满、咽喉干燥；少阴病表现为口燥、舌干而渴；厥阴病则表现为消渴。所谓消渴，是指饮水多而小便少，这是因为热盛能够消耗水分。刚传变时热势轻微，所以口渴轻微；传变深入后热势严重，所以口渴严重。凡是口渴的病人，给水时不要让他们喝得太饱。三阳经轻微口渴的用五苓散，严重口渴的用白虎汤。三阴经热势严重而口渴的，应当用攻下法。如果口渴轻微却强行大量饮水，就会导致心悸、四肢支撑结聚、喘咳、呃逆、干呕、肿胀、腹满、腹泻、小便不利等病症，都是由此引起的。
太阳病发汗后，大汗出，导致胃中干燥，烦躁不得安眠，想要喝水的，少量多次给予，使胃气调和即可痊愈。如果脉象浮、小便不利、微热、消渴的，用五苓散。（张元素认为：烦渴用白虎汤是适宜的，为什么使用五苓散来渗泄津液呢？回答说：白虎汤适用于表证已解、邪气传入里而出现烦渴的情况。现在脉象尚浮，身体有微热且口渴，说明表邪尚未完全解除，所以用桂枝的辛味调和肌表，用白术、茯苓的甘淡味道滋润虚燥。）按：这种说法也不够透彻。太阳经与膀胱腑的关系是：膀胱是尿液的储存室。五苓散是利小便的药物。膀胱是津液之府，所以李东垣认为口渴是膀胱经的本病。那么治疗口渴应当清泻膀胱的热，清泻膀胱热的方法就是利小便而已。）发汗后脉象浮数、烦渴的，用五苓散。本来因为误用下法导致心下痞硬，服用泻心汤后痞硬未解，其人口渴、口燥烦、小便不利的，用五苓散。中风发热六七日未解且烦躁，既有表证又有里证，口渴想喝水，水喝进去就吐出来，名叫水逆，用五苓散。
五苓散方
猪苓（去皮十八铢） 泽泻（一两六铢半） 茯苓（十八铢） 桂枝（去粗皮半两） 白术（十八铢）。以上五味药研为末，用米汤送服一方寸匕，每日三次，服药后多喝暖水，以出汗为愈。（“苓”意为号令，通行津液，克制肾邪，专门起到号令的作用，这是茯苓的功效。在五苓散中茯苓为主药，所以叫五苓散。《内经》说：淡味具有渗泄作用，属于阳。水饮内蓄，必须通过渗泄来消除，必须以甘淡为主，所以用性味甘平的茯苓为君药，性味甘平的猪苓为臣药，虽然也是甘味，但最终归于甘淡。脾恶湿，水饮内蓄则脾气不能正常运化，补益脾气、胜湿必须用甘温作为辅助，所以用性味甘温的白术为佐药。《内经》说：咸味具有渗泄作用，属于阴。泄除水饮、引导溺道必须用咸味作为辅助，所以用泽泻为使药。水蓄积不行，则肾气干燥。《内经》说：肾恶燥，急需食用辛味来滋润它。发散湿润、燥湿必须用桂枝的辛热作为使药。多喝暖水令其出汗而痊愈，是因为辛味能发散，水气向外排泄，所以病愈。）
服用桂枝汤大汗后，出现大烦渴不解，脉象洪大的，用白虎加人参汤。太阳病发热而口渴、不恶寒的，称为温病。小柴胡汤、白虎汤、桂枝汤、去桂枝加人参汤，用于伤寒无大热、口燥渴、心烦、背部微恶寒的情况，用白虎加人参汤。伤寒脉浮、发热、无汗，表证未解的，不可给予白虎汤。口渴想喝水，没有表证的，用白虎加人参汤主治。（口渴想喝水且没有表证，说明太阳证已罢，转属阳明病。下一条的意思也是如此，都是因为太阳转属阳明所以口渴。）伤寒病如果经过吐法或下法后，七八天仍未解除，热结在里，表里俱热，时时恶风，大渴，舌上干燥而烦躁，想要喝几升水的，用白虎加人参汤主治。（王冰注解说：如果纯在表，则恶风无定时。现在表里都有热，所以时时恶风。）
白虎加人参汤：治疗口渴且脉象洪大、小便通利的。
石膏（六两） 知母（六两半） 甘草（二两） 粳米（六合） 人参（三钱）。以上药物捣碎，每次服用一两，用水煎煮，温服。
许叔微说：有人初病呕吐，随即被医生误用下法，已经七八天，内外发热。我诊察后说应当用白虎加人参汤。有人说：既然已经呕吐又用下法，已经是双重虚弱了，还能用白虎汤吗？我说：仲景说：如果经过吐下后七八天仍未解除，热结在里，表里俱热的，白虎加人参汤正相当。起初呕吐是因为热在胃脘，现在脉象虚大，投服三剂汤药而痊愈。仲景既说伤寒经过吐下后七八天不解，表里俱热的，用白虎加人参汤主治；又说伤寒脉浮发热无汗，表证未解的，不可给予白虎汤；还说脉浮滑，这是表有热里有寒，用白虎加人参汤……林亿校正时说张仲景在此处“表里”二字写错了。我认为不是这样。大体上白虎汤能清除伤寒中的口渴和表里发热，所以前两条说“表里俱热”或“表热里寒”都可以服用。至于那种脉浮无汗、表证未解的，完全是麻黄汤与葛根汤的适应证，怎么可以用白虎汤呢？林亿看到所称的表里不同就说写错了，这也是不加思考的过错。
张元素说：用药有迟速的弊端，所以设立法则来防范。法则有关防不到的地方，就制定方剂来救治。假如上面两条，前一条是仲景设立法则来防范，后一条及“伤寒病若吐若下后七八日不解，热结在里，表里俱热，时时恶风，大渴，口舌干燥而烦，欲饮水数升者”，用白虎加人参汤主治。这两条则是制定方剂来救治。白虎汤专门治疗大烦大渴。古人设立法则的意图，是恐怕表证未罢就贸然使用，会有治疗过快的弊端。如果有背微恶寒或时时恶风的症状，其中烦渴已经很严重，非白虎汤不能遏制。如果一定要等到表邪全部解除，未免有治疗过迟的过失。这是法则关防不到的地方，所以制定方剂来救治。如果不制定方剂，必然违反法则。这种方法的好处，所以不可偏废。
吴崑说：有人问白虎汤，仲景说表不解者不可用，又说时时恶风、背上恶寒的，这是有表证，却又用白虎汤主治，为什么呢？大概石膏是辛寒之品，能解除足阳明经的本热，是治疗蒸蒸发热、潮热、表里皆热、舌燥烦渴的圣药。而且“时时”是指偶尔恶风而不经常，“背上恶寒”只是觉得轻微恶寒而不严重。所有盛大热势、燥渴而用的，毫无疑问。如果是表证恶寒常在，背上恶寒且不燥渴的，切不可用。还有太阳经发热而口渴无汗的，不可给予。但汗后脉洪大而渴的，则可以给予。如阴伤寒面赤烦躁身热，与其胃虚恶心大便不实脉弱食少无大热的，切不可用。如果误用，危险立刻就会到来。
太阳病重发汗又复下之，不大便五六日，舌上干燥而渴，日晡时分小有潮热，从心下至少腹硬满而痛不可触碰的，用大陷胸汤。伤寒发热恶寒，大渴想喝水，其腹部一定胀满，自汗出，小便通利，病欲解，这是肝乘肺，名叫横，刺期门穴。
阳明病汗出多而口渴的，不可与猪苓汤，因为汗多导致胃中干燥，如果再利小便，就会造成实实虚虚的弊端。（白虎加人参汤、小柴胡汤去半夏加栝蒌根、竹叶。张元素说：阳明汗多，这是阳明病未解而渴，胃中津液干燥，如果给猪苓汤再利小便，这就是实其实、虚其虚的弊端。）阳明病脉浮紧，咽燥口苦，腹满而喘，发热汗出，不恶寒反恶热，身重，如果口渴想喝水，口干舌燥的，用白虎加人参汤主治。如果脉浮发热，口渴想喝水，小便不利的，用猪苓汤主治。
少阳伤寒中风，往来寒热，胸胁满闷，默默不欲饮食，心烦喜呕，或者口渴或者咳嗽的，用小柴胡汤。如果口渴的，去掉半夏，加入人参、栝蒌根。伤寒四五日，身热恶风，项强，胁下满，手足温而渴的，用小柴胡汤。得病六七日，脉迟浮弱，恶风，手足温，医生多次误下，导致不能食，胁下满痛，面目及身颈项强，小便难，给予柴胡汤后必定出现下重感。本来口渴而饮水呕吐的，柴胡汤不宜给予。（有人说：下重、渴欲饮水、呕吐的，用五苓散加茵陈蒿汤。）
少阴病口渴而下利的，属于少阴。如果病兼有想睡觉、小便白色的，用四逆汤。如果兼有咳嗽、呕吐、不得安眠、小便不白的，用猪苓汤。如果兼有自利、纯青色稀水的，用大承气汤。有热的，用白头翁汤（方论见下利篇）。
厥阴病消渴，气上冲心，心中疼，饥不欲食，食则吐蛔，如果误用下法，则腹泻不止。如果想喝水，少量多次给予即可痊愈。（邪气传入厥阴，则热势已深。邪气从太阳传至太阴，则腹满而咽干，未形成渴；邪气到少阴，则口燥舌干而渴，未形成消渴；到了厥阴才出现消渴，是因为热甚能消耗水分。饮水多而小便少，叫做消渴。木生于火，肝气通于心，厥阴客热，气上撞心，心中疼热。伤寒六七日，厥阴受病之时，为传经尽，则当入腑。胃虚客热，饥不欲食。蛔在胃中，无食则动，闻食气而出，得食蛔出，这是热在厥阴经。如果误用下法，损伤胃气，厥阴木邪相乘，必定吐下不止。按：成无己认为是表阳邪传里，是不对的。消渴、心中疼热才是正确的。）
随病治例
口渴而头汗出、小便不利、兼有胁满、往来寒热的，用柴胡桂枝干姜汤。兼有发黄的，用茵陈蒿汤（论见头汗篇）。
表证未解，心下有停水，干呕发热咳嗽，或者口渴，或者腹泻，或者噎塞，或者小便不利，少腹满，或者喘，用小青龙汤。又有心下有停水，咳嗽微喘，发热不渴，服药后出现口渴的，这是寒去欲解的表现，用小青龙汤（都适宜去掉半夏，加入栝蒌根）。
夏季汗出恶寒、身热、足冷而口渴的，是中暑，用白虎加人参汤及酒黄连主治（方见中暑恶寒身热证，证似表证，足冷者不可发汗）。
发热恶寒、腹满、汗出、小便通利而口渴的，是肝乘脾，刺期门（论见腹满篇）。表解不恶寒而口渴的，宜用白虎汤。
口渴而胁满及往来寒热，证候未经过发汗的，用小柴胡汤去半夏加人参栝蒌汤。如果经过汗下后的，用柴胡桂枝干姜汤（详见胁满痛并往来寒热篇）。口渴而心下硬痛，日晡潮热，不大便的，是结胸，宜用大陷胸汤。如果只硬不痛的，是痞证，给予泻心汤。不解反而口渴且小便不利的，宜用五苓散（详见结胸痞气二门）。
病在阳明，应当发汗，反而用冷水喷洒浇灌，其热更烦躁，皮肤起粟粒，想喝水反而不渴的，服文蛤散。如果不愈，给予五苓汤（论见结胸篇）。
文蛤散方
文蛤（一两，即海蛤粉，河间、丹溪多用，大能治痰）。以上一味药研为散，用沸水调服一方寸匕。
口渴想喝水但不能喝的，是丹田有热，胸中有寒（论见湿痹篇）。
中风发热六七日未解且烦躁，有表里证，口渴想喝水，水入则吐的，名叫水逆，用五苓散主治。
口渴想喝水，如果是太阳病发汗后大汗出、烦躁不得安眠，以及厥阴病气上冲心、心疼、吐蛔的，少量多次给予水即可痊愈（论见前条及气上冲篇）。凡得时气病，到五六日而渴欲饮水，不能多喝，不应当给予。为什么呢？因为腹中热尚少，不能消化，再给水会致病。到七八日大渴想喝水的，还应当根据证候给予。给予时要常令不足，不要让他们喝得太饱。意思是能喝一斗就给五升。如果喝了之后腹满、小便不利、喘、呃逆的，不可给予。忽然大汗出的，是为自愈。（《活人书》说：凡病非大渴不可饮水，如果小渴咽干的，少量呷润，令其胃中和乃佳。）
凡得病反而能饮水，这是欲愈的表现。但听说病人饮水自愈，小渴者也强行给予饮水，因而造成祸患，不可挽救。（《活人书》说：强饮水导致饮停心下、满结、喘的，当用五苓散或陷胸汤主治。）下利脉弱、脉数而渴的，自愈（论见下利篇）。口渴而发热，脉不弦紧而浮弱的，汗出则愈（论见谵语篇）。
娄全善说：《活人书》告诫：太阳证无汗而渴的，不可与白虎汤；阳明证汗多而渴的，不可与猪苓汤。然而太阳渴终究不可与白虎汤吗？太阳证得汗后脉洪大而渴的，才可以给予。阳明渴终究不可与五苓散吗？阳明证小便不利、汗少、脉浮而渴的，才可以给予。
赵嗣真说：《活人书》严厉告诫：太阳证无汗而渴的，不可与白虎汤；阳明证汗多而渴的，不可与五苓散。我详细考察仲景论治渴的药，有不可给予的戒律有二：一是伤寒脉浮发热无汗，渴欲饮水，无表证的，用白虎加人参汤；表不解不可给予。《活人书》不说表不解，只说无汗不可给予，这就错了。二是《内经》说阳明汗多而渴不可与猪苓汤。《活人书》改为五苓散。大概猪苓专于渗泄，五苓兼有汗利，怎么能改呢？《内经》既说汗多而渴者不可与猪苓汤，而太阳伤寒汗出而渴复用五苓散的，大概渴虽同，但汗之多寡则异。太阳属表，未至汗多胃躁，故用五苓渗热和表，不像阳明属里，汗多而胃躁。《内经》又说阳明发热汗多急下之。均是阳明汗多，前证戒利小便，此证不戒利大便，为什么呢？大概渴者邪气散漫在经，未收敛入胃作实。此证不渴，则内已作实，外又发热，恐热内竭津液，故急下之。且猪苓、五苓又有可疑者：太阳病脉浮、小便不利、微热、消渴的，用五苓散；阳明脉浮发热、渴欲饮水、小便不利的，用猪苓汤。脉证皆同，何故用药不同？然太阳邪在表，发汗不解，故用五苓和表行津液；阳明邪已入里，热客下焦，故用猪苓渗泻其热。唉！白虎、猪苓、五苓等药，如果能证察于机微，治明于权变，则可与不可与，庶得仲景之妙。外有自利而渴条下注云：伤寒热入于脏，流于少阴之经，少阴主肾，肾恶燥，故渴而引饮，注用猪苓汤、白头翁汤。又后下利问中重出自利而渴条下，却云肾虚故引水自救，通用白通、四逆、猪苓等汤。一问以渴为热，一问以渴为虚，冰炭不侔，何凭分别？又且分隶两门，设使后人临病检阅，前后两不相闻，疑误岂小？今详定少阴病咳而下利、呕、渴、心烦、不得眠，及厥阴证下利、欲饮水，是皆传经之邪热，脉必沉细数，仲景故以滑石、黄连等清利之。其或少阴自利而渴、欲吐不吐、心烦、但欲寐，是直入本经之阴邪也，脉必沉微，仲景故以附子、干姜温之。本问何不如此明示脉证合为一门而明辨之，庶一见而两得焉，清之温之，随其攸利，又何疑误之有？
吴崑说：凡口渴应当分六经而治。太阳经标热在表则不渴，若热传入膀胱之本则烦渴，脉浮数，小便不利，用五苓散，切不可与白虎汤。凡阳明病脉长，标热无汗而渴的，用葛根解肌汤或六神通解散倍葛根以汗解之。若阳明热传于胃中本热，恶热汗出而渴，脉浮洪数的，用人参白虎汤，五苓不中与也。若阳明本热或蒸蒸而热潮热，燥湿舌燥口干饮水，大便实的，用大柴胡汤或调胃承气汤下之。若内未实尚未可下，宜小柴胡增损用之。少阳脉弦数，口苦咽干发热而渴的，用小柴胡去半夏加栝蒌根，余见本条。太阴自利则不渴，惟少阴有口苦饮水、小便色白的，此下有寒也，脉沉者用附子汤。若身寒厥逆、脉滑而口渴的，此里有热也，用人参白虎汤。凡阴证烦躁口渴，不能用水，脉沉足冷的，宜四逆汤冷冻饮料之。凡伤寒时气等证欲饮水的为欲愈，盖得水则能和其胃气，汗出而解，不与水则干燥无由而作汗，遂致闷乱而死也。凡与水须察病患勇怯、邪热轻重，多少与之，宁从不及，不可太过，恐水多不能渗化，停蓄为害多矣。其水须用新汲井中者为良。凡热病热甚大便实者，以元明粉一二钱加入水中饮之最妙。凡中暑烦渴者，加辰砂天水散调水中饮之尤良。如虚人烦渴不饮水，以灯心煎汤浸水中与之。凡口渴，细茶汤、白梅汤、绿豆汤皆可饮，香水、梨、悉尼嫩藕、西瓜皆可食。凡用冰须以凉水洗去盐味方可。
戴原礼说：凡口渴，问其所饮，欲冷欲热，欲多欲少。如果饮多而欲冷的，是阳渴。更须审其有何证在经。其太阳证小便不利而渴的，用五苓散。其阳明证大便不利而渴的，宜于前本经求之。已利犹渴，宜白虎汤。其少阳证寒热往来而渴的，用小柴胡汤去半夏加栝蒌根。如其数阴亦有自利而渴，各已见本经。但阴有渴，古人多用冷剂，以其皆挟阳气耳。经虽阴而病则阳也。然亦有下清谷不系热利，纯是阴证而反见渴者，此是阴在下隔阳于上，兼因泄泻津液既去枯燥而渴。其人虽引饮，所饮自少而常喜温，不可投冷剂，宜理中汤或四逆汤加人参一钱。渴甚，连理汤。有阳证不渴，阴证反渴者，阳明不甚渴，太阴乃大渴，不可不知。治渴一也。有坚肾水而渴止者，有利小便而渴愈者。坚肾水则用天花粉之属，利小便则用茯苓猪苓之类。盖太阴以利小便为先，阳明以利小便为戒。少阳以胆经半表半里，未可下之。其人或大渴不止，当以小柴胡汤加天花粉之属，坚其肾水。肾水既坚，自还渗入大肠，大便微通，热去而渴解。若病在太阳，太阳在膀胱肾经，非利小便则热无从去，渴何由愈？外有非太阳证烦躁发渴，此乃阴盛隔阳，不当润其渴，维当治其阴。
附
罗天益说：伤寒食少而渴的，当以和胃之药止之，不可用凉药止之。恐复损胃气，愈不能食，白术茯苓是也。
王海藏说：秦二母病太阴病三日不解，后呕逆恶心而脉不浮，与之半硫丸二三服不止，复与黄芪建中汤，脉中极紧，无表里病，胸中……
(The *Neijing* states: If a patient does not experience aversion to cold but feels thirsty, this indicates the pathogen has transferred to the Yangming channel. It also states: If thirst occurs after taking Xiao Chai Hu Tang, it belongs to Yangming disease. Therefore, "thirst" is categorized under the Yangmen chapter.)
Cheng Wuji stated: When Shaoyang pathogens transmit inward, thirst occurs; when pathogens remain in the exterior, there is no thirst. Although San Yang channels may occasionally present with thirst, it is not as severe as in San Yin channels. Taiyin disease presents with abdominal fullness and dry throat; Shaoyin disease presents with dry mouth, dry tongue, and thirst; Jueyin disease presents with Xiao Ke (wasting-thirst syndrome). Xiao Ke refers to drinking large amounts of water yet producing little urine, because intense heat consumes fluids. In the initial stage of transmission, heat is mild, so thirst is mild; as transmission deepens, heat becomes severe, so thirst becomes severe. For patients with thirst, do not allow them to drink excessively. For mild thirst in San Yang channels, use Wuling San; for severe thirst, use Baihu Tang. For severe heat and thirst in San Yin channels, purgation should be employed. If mild thirst is forced to drink excessively, it can lead to palpitations, limb distension and binding, wheezing, hiccups, dry retching, edema, abdominal fullness, diarrhea, and dysuria, all resulting from this cause.
After sweating therapy for Taiyang disease, excessive sweating leads to dryness in the stomach, irritability, insomnia, and desire for water. Give small amounts frequently until stomach Qi harmonizes and recovery occurs. If pulse is floating, urination is difficult, there is slight fever, and Xiao Ke, use Wuling San. (Zhang Yuansu argued: For irritability and thirst, Baihu Tang is appropriate. Why use Wuling San to promote fluid metabolism? The answer is: Baihu Tang is used when exterior symptoms have resolved and pathogens have transmitted inward causing irritability and thirst. Here, the pulse is still floating, there is slight fever and thirst, indicating exterior pathogens are not fully resolved. Thus, Guizhi's acridity harmonizes the muscle layer, while Baizhu and Fuling's sweet and bland nature moistens deficiency-dryness.) Note: This explanation is not entirely clear. Taiyang channel corresponds to the Bladder organ. The Bladder is the chamber of urine. Wuling San promotes urination. The Bladder is the storehouse of body fluids. Therefore, Li Dongyuan considered thirst a primary disease of the Bladder channel. To treat thirst, one must clear Bladder heat, which is achieved by promoting urination. After sweating, if pulse is floating and rapid with irritability and thirst, use Wuling San. Originally due to incorrect purgation leading to epigastric fullness, if Xixin Tang fails to resolve the fullness, and the patient has thirst, dry mouth, irritability, and dysuria, use Wuling San. Wind-strike with fever for six or seven days unresolved, accompanied by irritability, both exterior and interior signs, thirst, and vomiting immediately after drinking water, is called Shui Ni (Water Revulsion), treated with Wuling San.
Wuling San Formula
Zhuling (Periplocae Radix Cortex, peeled, 18 zhu) Zexie (Alismatis Rhizoma, 1 liang 6 zhu half) Fuling (Poria, 18 zhu) Guizhi (Cinnamomi Ramulus, remove coarse bark, 0.5 liang) Baizhu (Atractylodis Macrocephalae Rhizoma, 18 zhu). Grind the above five herbs into powder. Mix with rice water and administer one Fang Cun Bi three times daily. Drink plenty of warm water afterwards to induce sweating for cure. ("Ling" means command, facilitating fluid circulation and suppressing Kidney evil, which is the merit of Fuling. As the chief herb in Wuling San, it is named thus. The *Neijing* states: Bland flavors promote drainage and belong to Yang. Internal accumulation of water-dampness requires drainage, primarily using sweet-bland flavors. Hence, Fuling (sweet and neutral) is the Sovereign herb, Zhuling (sweet and neutral) is the Minister herb. Though sweet, they ultimately act as bland. Spleen dislikes dampness; internal water accumulation impairs Spleen transport. Tonifying Spleen and overcoming dampness requires sweet-warm assistance. Hence, Baizhu (sweet and warm) is the Assistant herb. The *Neijing* states: Salty flavors promote drainage and belong to Yin. Draining water and guiding urination requires salty assistance. Hence, Zexie is the Envoy herb. Stagnant water dries Kidney Qi. The *Neijing* states: Kidney dislikes dryness and urgently needs acrid flavors to moisten it. Dispersing moisture and drying dampness requires Guizhi's acrid-heat as the Envoy. Drinking warm water to induce sweating works because acrid flavors disperse, allowing water vapor to escape externally.)
After taking Guizhi Tang and experiencing excessive sweating, if severe irritability and thirst persist with a flooding pulse, use Baihu Jia Renshen Tang. Taiyang disease presenting with fever, thirst, and no aversion to cold is classified as Wenbing (Warm Disease). Xiaochaihu Tang, Baihu Tang, Guizhi Tang, and Guizhi Jia Renshen Tang (without Cinnamon Twig) are indicated for Shaoyin patterns without significant fever, dry mouth/thirst, irritability, and slight aversion to cold on the back, treated with Baihu Jia Renshen Tang. For Shaoyin disease with floating pulse, fever, no sweat, and unresolved exterior, Baihu Tang is contraindicated. For thirst with desire to drink water and no exterior signs, Baihu Jia Renshen Tang is indicated. (Thirst with desire to drink and no exterior signs indicates Taiyang pattern has ceased and transferred to Yangming. The following clause implies the same: thirst arises from Taiyang transferring to Yangming.) If Shaoyin disease persists for 7-8 days after emesis or purgation, with heat結 in the interior, exterior and interior both hot, occasional aversion to wind, severe thirst, dry tongue, irritability, and desire to drink several liters of water, use Baihu Jia Renshen Tang. (Wang Bing noted: If purely exterior, aversion to wind is intermittent. Now, with interior-exterior heat, aversion to wind is frequent.)
Baihu Jia Renshen Tang: Treats thirst with flooding pulse and free urination.
Shigao (Gypsum Fibrosum, 6 liang) Zhimu (Anemarrhenae Rhizoma, 6.5 liang) Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang) Jingmi (Oryzae Fructus Glutinosis, 6 he) Renshen (Ginseng Radix, 3 qian). Crush the herbs. Take 1 liang per dose, decoct in water, and take warm.
Xu Shimiao said: A patient initially vomited, then was incorrectly purged by a physician. After 7-8 days, internal and external fever persisted. I diagnosed it as requiring Baihu Jia Renshen Tang. Someone asked: Since vomiting and purgation have caused double deficiency, can Baihu Tang be used? I replied: Zhang Zhongjing stated that if 7-8 days pass after emesis/purgation with unresolved heat結 in the interior and exterior-interior heat, Baihu Jia Renshen Tang is appropriate. Initial vomiting indicated heat in the stomach region; now the pulse is deficient and large. Three doses cured him. Zhang Zhongjing stated that for Shaoyin disease after emesis/purgation with 7-8 days unresolved and exterior-interior heat, use Baihu Jia Renshen Tang. He also stated that for floating pulse, fever, no sweat, and unresolved exterior, Baihu Tang is contraindicated. He further stated that for floating-slippery pulse (exterior heat, interior cold), Baihu Jia Renshen Tang is used. Lin Yi corrected this, claiming Zhang Zhongjing erred in "exterior/interior." I disagree. Generally, Baihu Tang clears thirst and exterior-interior heat in Shaoyin disease. Thus, whether described as "exterior-interior heat" or "exterior heat-interior cold," it can be used. However, for floating pulse, no sweat, and unresolved exterior, Mahuang Tang or Gegen Tang are indicated, not Baihu Tang. Lin Yi's error lies in failing to consider these nuances.
Zhang Yuansu stated: Medication timing has risks of being too fast or slow. Laws prevent errors; formulas rescue where laws fail. The first clause above is Zhang Zhongjing establishing preventive laws. The second clause ("Shaoyin disease... 7-8 days unresolved... severe thirst...") establishes a formula for treatment. Baihu Tang treats severe irritability and thirst. The preventive law warns against using it prematurely if exterior signs remain. However, if back aversion to cold or frequent aversion to wind accompanies severe thirst, only Baihu Tang can suppress it. Waiting for complete exterior resolution risks being too slow. Where laws fail, formulas are needed. Abandoning formulas violates method. This synergy is essential.
Wu Kun asked: Zhang Zhongjing says Baihu Tang is contraindicated if exterior is unresolved, yet also prescribes it for "frequent aversion to wind" and "back aversion to cold," implying exterior presence. Why? Gypsum is acrid-cold, clearing Yangming channel heat. It is a holy medicine for steaming fever, tidal fever, interior-exterior heat, dry tongue, and irritability. "Frequent" means occasional, not constant. "Back aversion" is slight, not severe. For strong heat and dry thirst, its use is unquestionable. However, for constant exterior aversion to cold, back aversion without dry thirst, it is strictly contraindicated. Also, Taiyang fever with thirst and no sweat is contraindicated. But post-sweating with flooding pulse and thirst, it is allowed. For Yin Cold with red face, irritability, fever, weak pulse, poor appetite, and no significant heat, it is strictly contraindicated. Misuse leads to immediate danger.
For Taiyang disease, after heavy sweating and purgation, if constipation persists for 5-6 days, tongue is dry, thirst exists, slight tidal fever occurs at dusk, and hardness/fullness/pain extends from epigastrium to lower abdomen unapproachable to touch, use Daxiexiong Tang. For Shaoyin fever, aversion to cold, severe thirst, abdominal fullness, spontaneous sweating, and free urination, the disease resolves. This is Liver attacking Lung, called Heng. Puncture Qimen (LR14).
For Yangming disease with excessive sweating and thirst, Zhu Ling Tang is contraindicated because sweating causes stomach dryness; diuresis would worsen deficiency. (Baihu Jia Renshen Tang, Xiaochaihu Tang minus Banxia plus Gualou Gen, Zhuye. Zhang Yuansu noted: Yangming sweating indicates unresolved disease and thirst due to stomach fluid dryness. Zhu Ling Tang would further drain fluids, causing "reinforcing excess and draining deficiency.") For Yangming disease with floating-tight pulse, dry throat, bitter taste, abdominal fullness, wheezing, fever, sweating, aversion to heat rather than cold, heaviness, and thirst with dry mouth/tongue, use Baihu Jia Renshen Tang. If pulse is floating, fever, thirst, and dysuria exist, use Zhu Ling Tang.
For Shaoyin Wind-Cold with alternating chills/fever, chest/hypochondriac fullness, silent anorexia, irritability, vomiting, or thirst/cough, use Xiaochaihu Tang. If thirsty, remove Banxia, add Renshen and Gualou Gen. For Shaoyin 4-5 days with fever, aversion to wind, neck stiffness, hypochondriac fullness, warm hands/feet, and thirst, use Xiaochaihu Tang. For illness lasting 6-7 days with slow-floating-weak pulse, aversion to wind, warm hands/feet, if incorrectly purged multiple times, leading to inability to eat, hypochondriac fullness/pain, stiff neck/body, and dysuria, giving Chaihu Tang will cause tenesmus. Original thirst with drinking-induced vomiting contraindicates Chaihu Tang. (Some suggest Wuling San plus Yinchenshao Tang for tenesmus, thirst, and vomiting.)
For Shaoyin thirst with diarrhea, it belongs to Shaoyin. If accompanied by lethargy and white urine, use Sini Tang. If accompanied by cough, vomiting, insomnia, and non-white urine, use Zhu Ling Tang. If accompanied by spontaneous diarrhea with pure green watery stool, use Dachengqi Tang. If heat is present, use Baitouweng Tang (see Diarrhea chapter).
For Jueyin disease, Xiao Ke (wasting-thirst), Qi rushing up to the heart, heart pain, hunger without desire to eat, vomiting roundworms after eating, and if purged, persistent diarrhea. If thirsty, give small amounts frequently to recover. (Pathogen in Jueyin indicates deep heat. Transmission from Taiyang to Taiyin causes abdominal fullness/dry throat but not thirst. Transmission to Shaoyin causes dry mouth/tongue/thirst but not Xiao Ke. Only in Jueyin does intense heat consume fluids, causing Xiao Ke: drinking much, urinating little. Wood generates Fire; Liver Qi connects to Heart. Jueyin guest-heat rushes up, causing heart pain. On day 6-7, Jueyin receives disease, completing transmission. Stomach deficiency allows guest-heat, causing hunger without desire to eat. Roundworms move in empty stomach, emerge with food smell. This is heat in Jueyin channel. Purging damages Stomach Qi, allowing Jueyin Wood evil to attack, causing persistent vomiting/diarrhea. Note: Cheng Wuji's view of exterior-Yang transmitting inward is incorrect. Xiao Ke and heart pain are key.)
Clinical Examples for Thirst
Thirst with head sweating, dysuria, hypochondriac fullness, and alternating chills/fever: Chaihu Guizhi Jiangxin Tang. With jaundice: Yinchenshao Tang (see Head Sweating chapter).
Unresolved exterior with Phlegm-Fluid in Heart, dry retching, fever, cough, or thirst, diarrhea, choking sensation, dysuria, lower abdominal fullness, or wheezing: Xiao Qinglong Tang. Another case: Phlegm-Fluid in Heart with cough, slight wheezing, fever, no thirst. Post-medication thirst indicates cold resolving: Xiao Qinglong Tang (Remove Banxia, add Gualou Gen).
Summer heatstroke with sweating, aversion to cold, fever, cold feet, and thirst: Baihu Jia Renshen Tang and Jiuhuanglian (see Summer Heatstroke chapter; cold feet contraindicate exterior release).
Fever, aversion to cold, abdominal fullness, sweating, free urination, and thirst: Liver attacking Spleen. Puncture Qimen (see Abdominal Fullness chapter). Exterior resolved, no aversion to cold, but thirsty: Use Baihu Tang.
Thirst with hypochondriac fullness and alternating chills/fever, untreated by sweating: Xiaochaihu Tang minus Banxia plus Renshen/Gualou Gen. Post-sweat/purge: Chaihu Guizhi Jiangxin Tang (see Hypochondriac Pain chapter). Thirst with epigastric hardness/pain, tidal fever, constipation: Xiexiong (Chest Binding). Use Daxiexiong Tang. Hardness without pain: Pi (Glomus). Use Xixin Tang. Unresolved with thirst and dysuria: Wuling San (see Chest Binding/Pi chapters).
Yangming disease requiring sweating, but incorrectly cooled with cold water spray, worsening irritability, skin goosebumps, desire to drink but no actual thirst: Wenli San. If ineffective, Wuling Tang (see Chest Binding chapter).
Wenli San Formula
Wenli (Veneris Concha, 1 liang, i.e., Seashell Powder, widely used by Hejian and Danxi for phlegm). Grind one ingredient into powder. Mix with boiling water, administer one Fang Cun Bi.
Thirst with inability to drink: Heat in Dantian, Cold in Chest (see Damp-Bi chapter).
Wind-strike fever 6-7 days unresolved, irritability, exterior-interior signs, thirst, vomiting after drinking: Shui Ni. Use Wuling San.
Thirst with desire to drink: Post-Taiyang sweating with excessive sweat, irritability, insomnia; or Juevon Qi rushing, heart pain, vomiting worms: Give small amounts frequently to recover (see previous clauses and Qi Rushing chapter).
For seasonal epidemic diseases, days 5-6 with thirst but inability to drink much: Do not force water. Internal heat is insufficient to metabolize large volumes; forcing water causes pathology. By days 7-8, if severe thirst exists, give according to pattern. Allow partial intake, do not overfill. (If able to drink one dou, give five sheng. If abdominal fullness, dysuria, wheezing, or hiccups occur after drinking, stop. Spontaneous heavy sweating indicates self-recovery. *Huoren* states: Only drink if severely thirsty. For mild thirst/dry throat, sip slowly to harmonize stomach.)
Ability to drink indicates recovery. However, forcing water for mild thirst causes disaster (*Huoren*: Forced water causing chest fullness/wheezing requires Wuling San or Xiexiong Tang). Diarrhea with weak/rapid pulse and thirst indicates self-recovery (see Diarrhea chapter). Thirst with fever, floating-weak pulse (not string-tight): Sweating cures (see Delirium chapter).
Lou Quanshan stated: *Huoren* warns: Taiyang no-sweat thirst contraindicates Baihu Tang; Yangming high-sweat thirst contraindicates Zhu Ling Tang. Is Taiyang thirst never treated with Baihu Tang? Only after sweating, if pulse is flooding and thirsty, is it allowed. Is Yangming thirst never treated with Wuling San? Only if Yangming has dysuria, low sweat, floating pulse, and thirst, is it allowed.
Zhao Sizhen stated: *Huoren* strictly warns: Taiyang no-sweat thirst contraindicates Baihu Tang; Yangming high-sweat thirst contraindicates Wuling San. Examining Zhang Zhongjing, two contraindications exist: 1. Floating pulse, fever, no sweat, thirst, no exterior: Baihu Jia Renshen Tang. Unresolved exterior contraindicates it. *Huoren* cites "no sweat" instead of "unresolved exterior," which is erroneous. 2. *Neijing* states Yangming high-sweat thirst contraindicates Zhu Ling Tang. *Huoren* changed this to Wuling San. Zhu Ling drains; Wuling disperses/sweats. Change is unjustified. Why does Yangming high-sweat thirst contraindicate Zhu Ling Tang, but Taiyang sweating-thirst uses Wuling San? Taiyang is exterior, not yet causing stomach dryness from sweat volume; Wuling harmonizes exterior and drains heat. Yangming is interior, high sweat causes stomach dryness. *Neijing* also states Yangming fever/high sweat requires urgent purgation. Both are Yangming high sweat. Previous clause warns against diuresis; this warns against bowel purgation. Why? Thirst implies pathogen scattered in channels, not yet solidified in Stomach. Non-thirst implies interior solidity + exterior heat, risking fluid exhaustion, hence urgent purgation. Regarding Zhu Ling vs. Wuling: Taiyang floating pulse, dysuria, slight fever, Xiao Ke uses Wuling San. Yangming floating pulse, fever, thirst, dysuria uses Zhu Ling Tang. Symptoms match, why different formulas? Taiyang exterior unresolved after sweating: Wuling harmonizes exterior/moves fluids. Yangming interior heat in Lower Jiao: Zhu Ling drains heat. Ah! If one understands subtle mechanisms and adapts treatments, one grasps Zhang Zhongjing's essence. Regarding "Spontaneous Diarrhea with Thirst": Note says Shaoyin heat enters organs/Kidney channel; Kidney dislikes dryness, causing thirst. Uses Zhu Ling/Baitouweng Tang. Later, regarding diarrhea, it attributes thirst to Kidney deficiency seeking water, using Baitong/Sini/Zhu Ling. One views thirst as Heat, one as Deficiency. Ice and charcoal differ. How to distinguish? Separated into chapters, confusing later practitioners. Clarify: Shaoyin cough/diarrhea/vomit/thirst/irritability/insomnia, and Jueyin diarrhea/desire to drink, are transmitted heat with sinking-fine-rapid pulses. Zhang uses Shihuang/Huanglian to clear/drain. Shaoyin spontaneous diarrhea/thirst/vomit/no-vomit/irritability/lethargy is direct Yin pathogen with sinking-micro pulses. Zhang uses Fuzi/Ganjiang to warm. Why not combine these clearly? Clear differentiation prevents error. Warm or clear based on benefit.
Wu Kun stated: Classify thirst by Six Channels. Taiyang superficial heat causes no thirst; heat transmitting to Bladder base causes irritability/thirst, floating-rapid pulse, dysuria: Wuling San. Never Baihu Tang. Yangming long pulse, superficial heat, no sweat, thirst: Gegen Jiemo Tang or Liutong Shengsan (double Gegen) to sweat. Yangming heat transmitting to Stomach base, aversion to heat, sweating, thirst, floating-hyper-rapid pulse: Renshen Baihu Tang. Wuling San is inappropriate. Yangming base heat, steaming/tidal fever, dry tongue/mouth, constipation: Da Chaihu Tang or Tiaowei Chengqi Tang to purge. If interior not solid, do not purge; use modified Xiaochaihu Tang. Shaoyin string-rapid pulse, bitter taste, dry throat, fever, thirst: Xiaochaihu Tang minus Banxia plus Gualou Gen (see main clause). Taiyin spontaneous diarrhea has no thirst. Shaoyin has bitter taste, drinking, white urine (Cold below, sinking pulse): Fuzi Tang. Body cold, reversal cold, slippery pulse, thirst (Heat inside): Renshen Baihu Tang. Yin syndrome irritability/thirst, unable to swallow water, sinking pulse, cold feet: Sini Tang (drink chilled). Desire to drink in Shaoyin/epidemics indicates recovery (water harmonizes Stomach, induces sweat). Without water, dryness prevents sweat, leading to death. Observe patient strength/pathogen severity when giving water. Better insufficient than excessive. Excess water stagnates. Use fresh well water. For severe heat/constipation, add Yuanmingfen (Mirabilite) 1-2 qian to water. For summer heat irritability/thirst, add Chen Sha Tianshui San. For deficiency irritability/non-drinking, use Dengxin decoction. Mild thirst: Tea, White Plum Soup, Mung Bean Soup. Foods: Perfumed water, Pear, Lotus Root, Watermelon. Ice must be washed to remove salt.
Dai Yuanli stated: Ask about preference for cold/hot, much/little. Much/Cold = Yang Thirst. Determine channel involvement. Taiyang dysuria/thirst: Wuling San. Yangming constipation/thirst: Seek in Yangming channel. If bowels open but thirst persists: Baihu Tang. Shaoyin alternating chills/fever/thirst: Xiaochaihu Tang minus Banxia plus Gualou Gen. Yin syndromes with spontaneous diarrhea/thirst appear in respective channels. Ancient used cold agents for Yin-thirst as they often involve Yang qi. Though Yin channel, disease is Yang-like. However, some with clear stools (non-heat diarrhea), pure Yin syndrome, present with thirst due to Yin blocking Yang above and fluid loss from diarrhea. They drink little, prefer warmth. Do not use cold agents; use Lizhong Tang or Sini Tang + Renshen. Severe thirst: Lianli Tang. Yang syndrome no thirst; Yin syndrome reverse thirst. Yangming mild thirst; Taiyin severe thirst. Know this. Treating thirst: Solidify Kidney Water (Hua Tian Fen group) or promote urination (Fuling/Zhuling group). Taiyin prioritizes urination; Yangming prohibits it. Shaoyin (Half-Exterior/Interior) cannot be purged. For extreme thirst, use Xiaochaihu Tang + Hua Tian Fen to solidify Kidney Water. Water penetrates Large Intestine, softens stool, clears heat, resolves thirst. Taiyang/Bladder/Kidney channel: Must promote urination to remove heat/thirst. External cases: Irritability/thirst not Taiyang, but Yin excess blocking Yang. Do not moisten thirst; treat Yin.
Appendix
Luo Tianyi stated: Shaoyin with poor appetite and thirst: Harmonize Stomach herbs, avoid cooling agents to preserve Stomach Qi. Baizhu/Fuling are suitable.
Wang Haicang stated: Qin Ermu had Taiyin disease unresolved for 3 days, followed by vomiting/nausea, non-floating pulse. Given Banshu Wan 2-3 doses without relief. Then given Huangqi Jianzhong Tang. Pulse extremely tight, no exterior-interior signs, chest...