尝治循衣摸床者数人，皆用大补气血之剂，唯一人兼 振、脉代，遂于补剂中略加桂二分，亦振止脉和而愈。
病患不恶寒而渴者，此转属阳明也。（论见不大便。）服柴胡汤已渴者，属阳明也，以法治之。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，白虎人参汤主之。（渴欲饮水无表证
者，太阳症罢转属阳明也。下二条意同，皆太阳转属阳明，故渴也。）服桂枝汤，大汗出后，大烦渴不解，
脉洪大者，白虎加人参汤主之。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，今表里有热，故时
时恶风也。）伤寒无大热，口燥渴，心烦，脉微，恶寒者，宜白虎加人参汤。阳明病
脉浮紧，口苦腹满而喘，若下后渴欲饮水，口干舌燥者，白虎加人参汤主之。
白虎加人参汤
石膏（碎，四两） 知母（一两半） 甘草（一两） 粳米（一合） 人参（二钱）
上 咀，每服五钱，水煎温服。
上白虎加人参五条，治表渴脉洪小便利者。
〔《本》〕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。国朝林亿校正，谓张仲景于此表里自瘥矣。予谓不然，
大抵白虎能除伤寒中渴，表里发热，故前后二症或云表里俱热，或云表热里寒，皆可服之。一种脉浮无汗，
其表不解，全是麻黄与葛根症，安可行白虎也？林亿见所称表里不同，便谓之瘥，是亦不思之过也。
太阳发热，不恶寒而渴者，为温病。（论见温病。《活人》葳蕤汤主之。发热不恶寒者，以表解也，太
阳病者，必头痛身疼表未解也，此表里两症皆兼见。）
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。）
消渴，气上冲心，心疼，饥不欲食，食则吐蛔，若下之则利不止，若欲饮水者，少少与之愈。（论见气
上冲心。）
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。发汗已，脉浮数，烦渴者，五苓散主之。
阳明病，脉浮紧，口苦腹满，发热汗出不恶寒，若下后脉浮发热，渴欲饮水，小便不利者，猪苓汤主之。
五苓散方
猪苓（去皮，二两） 泽泻（一两） 白术（三两） 茯苓（去皮，二两） 桂枝（去皮，半两）
上 咀为散，每服三钱，白汤调下。（海藏云∶五苓散当服而不服之，谷消水去形亡，必就阳明燥火，戊
胃发黄，故有调胃承气症。不当服而服之，是为犯本，小便强利，津液重亡而成血症，轻则桃仁承气汤，
重则抵当汤主之。）
猪苓汤方
猪苓（去皮） 茯苓 阿胶 泽泻 滑石（各半两）
上 咀，每服五钱，水煎温服，日三。
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，咳嗽而渴者，小青龙汤去半夏加栝蒌根汤。（论见咳。）
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，
症似表也，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。（方论见前阳明。）
渴而胁满，及往来寒热，其症未经汗者，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，有表里症，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，烦躁不得眠者，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，犹当根据症与之，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，少少咽润之，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。）下痢脉弱，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。）
阳明病，汗出多而渴者，不可与猪苓汤，以汗多胃中燥，与猪苓汤复利其小便故也。
上《活人》云∶切戒太阳症无汗而渴者，不可与白虎汤；阳明症汗多而渴者，不可与猪苓汤。然太阳渴
终不可与白虎耶？太阳症得汗后，脉洪大而渴者，方可与之也；阳明渴终不可与五苓散耶？阳明症小便不
利，汗少脉浮而渴者，方可与之也。
我曾治疗过几位出现循衣摸床（神志不清，手无意识地抓摸衣物）症状的患者，都使用大补气血的方剂进行治疗。唯独有一位患者兼有肢体震颤、脉象间歇（代脉），于是我在补益剂中略微加入二分桂枝，结果震颤停止，脉象调和而痊愈。
患者不恶寒反而口渴的，这是病邪转入阳明经。（相关论述见“不大便”条）。服用小柴胡汤后出现口渴的，属于阳明病，应按相应法则治疗。伤寒病脉象浮，发热且无汗，表证未解的，不可给予白虎汤。若口渴想喝水，且没有表证的，以白虎加人参汤主治。（口渴想喝水且无表证的，是太阳病症候解除后转属阳明。下面两条意思相同，都是太阳转属阳明，所以出现口渴。）服用桂枝汤后，大汗出之后，出现严重烦躁、口渴不解，脉象洪大的，以白虎加人参汤主治。伤寒病如果经过吐法或下法治疗后，七八天病情未解，热邪结聚在里，表里俱热，时时感到怕风，极度口渴，舌上干燥且心烦，想要喝几升水的，以白虎加人参汤主治。（王冰注解说：如果病邪纯粹在表则怕风无时不在，现在表里有热，所以时时怕风。）伤寒病如果没有大热，但口燥渴，心烦，脉微细，伴有恶寒的，适宜用白虎加人参汤。阳明病脉象浮紧，口苦、腹胀满且气喘，如果经过下法治疗后出现口渴想喝水，口干舌燥的，以白虎加人参汤主治。
白虎加人参汤
石膏（打碎，四两） 知母（一两半） 甘草（一两） 粳米（一合） 人参（二钱）
以上药材切碎，每次服用五钱，加水煎煮，温服。
以上五条关于白虎加人参汤的论述，适用于治疗表热、脉洪大、小便通利的口渴症。
〔《本草衍义》〕有人初患呕吐，随即被医生误用下法，过了七八天，体内体外都发热。我诊察后说：应当使用白虎加人参汤。有人说：既然已经呕吐又用下法，正气已经双重虚弱，还能用白虎汤吗？我说：张仲景说：如果经过吐下法治疗后七八天未解，热邪结聚在里，表里俱热的，白虎加人参汤正合适。起初呕吐是因为热在胃脘，至今脉象虚大，服用三剂药后痊愈。张仲景既说：伤寒经过吐下法治疗后七八天未解，表里俱热的，以白虎加人参汤主治。又说：伤寒脉浮，发热无汗，表证未解的，不可给白虎汤。还说：脉浮滑，这是表有热、里有寒，以白虎加人参汤主治。本朝林亿校正医书时，认为张仲景在这里关于表里的论述自相矛盾了。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，所以前面的症状有的说表里俱热，有的说表热里寒，都可以服用。一种情况是脉浮无汗，表证未解，这完全是麻黄汤与葛根汤的适应症，怎么能用白虎汤呢？林亿看到所称的表里不同，就认为是矛盾，这也是不加思考的过错。
太阳病发热，不恶寒而口渴的，称为温病。（相关论述见温病。《活人书》主张用葳蕤汤主治。发热不恶寒，说明表已解，但太阳病患者必然头痛身疼，说明表未解，这里是表里两种症状同时存在。）
口渴并伴有腹泻的属于少阴病，如果病症只是兼有嗜睡、小便色白的，用四逆汤。如果兼有咳嗽、呕吐、不能安眠、小便颜色不白的，用猪苓汤。如果兼有自利、排出纯青色水样的，用大承气汤。如果有热的，用白头翁汤。（方剂论述见下利条。）
消渴症，感觉气向上冲撞心脏，心区疼痛，饥饿但不想吃东西，吃东西则吐出蛔虫，如果误用下法会导致腹泻不止；如果想喝水的，少量给予饮水即可痊愈。（相关论述见气上冲心条。）
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，少量给予饮水，使胃气调和即可痊愈。如果脉浮，小便不利，轻微发热且口渴的，以五苓散主治。发汗后，脉象浮数，烦躁口渴的，以五苓散主治。
阳明病，脉象浮紧，口苦、腹胀满，发热出汗且不恶寒，如果经过下法治疗后脉浮发热，口渴想喝水，小便不利的，以猪苓汤主治。
五苓散方
猪苓（去皮，二两） 泽泻（一两） 白术（三两） 茯苓（去皮，二两） 桂枝（去皮，半两）
以上药材切碎制成散剂，每次服用三钱，用白开水调服。（李东垣云：五苓散应当服用而不服用，会导致谷气消减、水湿去除但形体亡失，必然导致阳明燥火亢盛，戊土胃气受损发黄，从而出现调胃承气汤证。不应当服用却服用了，就是触犯根本，导致小便强行通利，津液再次亡失而形成血症，轻者用桃仁承气汤，重者用抵当汤主治。）
猪苓汤方
猪苓（去皮） 茯苓 阿胶 泽泻 滑石（各半两）
以上药材切碎，每次服用五钱，加水煎煮，温服，每日三次。
口渴且头部出汗，小便不利，兼有胁肋胀满、寒热往来的，用柴胡桂枝干姜汤。兼有发黄的，用茵陈蒿汤。（相关论述见头汗条。）
表证未解，心下有停饮，干呕发热，咳嗽且口渴的，用小青龙汤去掉半夏，加入栝蒌根汤。（相关论述见咳嗽条。）
夏季出汗，恶寒身热，脚冷且口渴的，是中暑，用白虎加人参汤及酒黄连主治。（方剂见中暑条。恶寒身热看似表证，但脚冷说明不可单纯解表。）
发热恶寒，腹部胀满出汗，小便通利且口渴的，这是肝木乘脾土，针刺期门穴。（相关论述见腹满条。表证已解，不恶寒而口渴的，适宜用白虎汤。（方剂论述见前文阳明篇。）
口渴且胁肋胀满，以及寒热往来，其症状未经过发汗治疗的，用小柴胡汤去掉半夏，加入人参和栝蒌根汤。如果经过发汗或下法治疗的，用柴胡桂枝干姜汤。（详见胁痛及寒热往来条。）
口渴且心下硬痛，下午定时发热（日晡潮热），大便不通的，这是结胸证，适宜用大陷胸汤。如果只是硬而不痛的，这是痞证，给予泻心汤。服药后不解反而口渴，且小便不利的，适宜用五苓散。（详见结胸和痞气两门。）
病在阳明经应当发汗的，反而用冷水喷洒浇灌它，热气更加烦闷，皮肤起粟粒状鸡皮疙瘩，心里想喝水，但实际上并不觉得渴的，服用文蛤散。
如果不好转，给予五苓散。（相关论述见结胸条。）
文蛤散方
文蛤（一两。即海蛤粉。刘河间、朱丹溪多用此药，大能治疗痰证）
以上一味药，研成散剂，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。（相关论述见湿痹条。）
中风发热，六七天未解且烦躁，有表里症状，口渴想喝水，水喝进去就吐出的，名叫水逆，以五苓散主治。
口渴想喝水，如果是太阳病发汗后大汗出，烦躁不得安眠的，以及厥阴病气上冲心，心痛吐蛔的，少量给予饮水即可痊愈。（相关论述见前条及气上冲条。）凡是得了时行病到了五六天，口渴想喝水，但不能多喝，不应当给他喝，为什么呢？因为腹中余热尚少，不能消化水分，再给水就会造成水饮为病。到了七八天，极度口渴想喝水的，仍然应当根据症状给予饮水，给予的量要常令不足，不要让他喝得太饱，意思是如果能喝一斗，只给五升。如果喝了之后腹部胀满，小便不利，或者喘息或者呃逆的，不可再给他喝。忽然然大汗出，这是自愈的表现。（《活人书》说：凡是生病如果不是极度口渴，不可随意饮水，如果是小渴咽干的，少量吞咽润喉，让胃气中和才好。）
凡是生病后反而能喝水，这是将要痊愈的迹象。但如果听说病人喝水就能自愈，对于小渴的人也强行喂水，饮水反而成为祸害，就无法挽救了。（《活人书》说：强行饮水导致水饮停滞在心下，胀满结聚、喘息的，应当用五苓散或陷胸汤主治。）下痢脉弱，脉数且口渴的，会自愈。（相关论述见下利条。）口渴且发热，脉象不弦紧而是浮弱的，出汗即可痊愈。（相关论述见谵语条。）
阳明病，出汗多且口渴的，不可给予猪苓汤，因为汗多导致胃中干燥，如果给猪苓汤再次通利小便，会更伤津液。
以上引用《活人书》的观点：切记太阳病无汗而口渴的，不可给白虎汤；阳明病汗多而口渴的，不可给猪苓汤。然而太阳病口渴终究不可给白虎汤吗？太阳病得汗后，脉象洪大而口渴的，才可以给白虎汤；阳明病口渴终究不可给五苓散吗？阳明病小便不利，汗少脉浮而口渴的，才可以给五苓散。
I once treated several patients presenting with *xun yi mo chuang* (involuntary grasping of clothing due to delirium), all of whom were treated with major Qi and Blood tonifying formulas. Only one patient presented with concurrent tremors and a *dai* pulse (intermittent pulse), so I added two fen of Guizhi Tang (Cinnamon Twig Decoction) ingredient, Cinnamomi Ramulus (Guizhi, 桂枝) into the tonifying formula. Consequently, the tremors ceased, the pulse harmonized, and the patient recovered.
Patients who are not aversive to cold but experience thirst indicate that the pathogen has transferred to the Yangming channel. (See discussion under "Constipation"). Those who develop thirst after taking Chaihu Tang (Bupleurum Decoction) belong to Yangming disease; treat according to the appropriate method. In Shanghan (Cold Damage) disease, if the pulse is floating, there is fever and no sweating, and the exterior syndrome remains unresolved, Baihu Tang (White Tiger Decoction) must not be administered. If there is thirst desire for water and no exterior syndrome, Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) is indicated. (Thirst desire for water without exterior syndrome indicates that the Taiyang symptoms have resolved and the condition has transferred to Yangming. The following two clauses share the same meaning: both involve transfer from Taiyang to Yangming, hence the thirst.) After taking Guizhi Tang, if profuse sweating occurs followed by severe irritability and unrelenting thirst with a flooding pulse, Baihu Jia Renshen Tang is indicated. In Shanghan disease, if after emetic or purgative treatment the condition persists for seven to eight days, heat is consolidated internally, both interior and exterior present heat, there is occasional aversion to wind, extreme thirst, dryness on the tongue with irritability, and a desire to drink several sheng of water, Baihu Jia Renshen Tang is indicated. (Wang Bing's commentary states: If the pathogen is purely in the exterior, aversion to wind is constant; now that there is heat in both interior and exterior, aversion to wind occurs intermittently.) In Shanghan disease, if there is no significant fever but there is dry mouth and thirst, irritability, a faint pulse, and aversion to cold, Baihu Jia Renshen Tang is suitable. In Yangming disease, if the pulse is floating and tight, with bitter taste, abdominal fullness, and wheezing, and if after purgation there is thirst desire for water with dry mouth and tongue, Baihu Jia Renshen Tang is indicated.
Baihu Jia Renshen Tang (White Tiger Plus Ginseng Decoction)
Shigao (Gypsum Fibrosum, 石膏) - crushed, four liang
Zhimu (Anemarrhenae Rhizoma, 知母) - one and a half liang
Gancao (Glycyrrhizae Radix et Rhizoma, 甘草) - one liang
Jingmi (Oryza Sativa, 粳米) - one he
Renshen (Panacis Ginseng Radix, 人参) - two qian
All ingredients are coarsely chopped. Take five qian per dose, decoct in water, and take warm.
The above five clauses regarding Baihu Jia Renshen Tang treat thirst with a flooding pulse and free urination.
[Bencao Yanyi] A patient initially suffered from vomiting, then was mistakenly treated with purgatives by another physician. After seven to eight days, internal and external heat developed. Upon diagnosis, I stated: Baihu Jia Renshen Tang should be used. Someone asked: Since vomiting and purgation have already doubly depleted the righteous Qi, can Baihu Tang still be used? I replied: Zhang Zhongjing said: If after emetic or purgative treatment the condition persists for seven to eight days, with heat consolidated internally and both interior and exterior presenting heat, Baihu Jia Renshen Tang is precisely appropriate. Initially, vomiting indicated heat in the stomach region; the pulse remaining deficient and large confirms this. Three doses cured the patient. Zhang Zhongjing stated: In Shanghan, after emetic/purgative treatment persisting seven to eight days with interior/exterior heat, use Baihu Jia Renshen Tang. He also stated: In Shanghan, if the pulse is floating, with fever and no sweating, and the exterior is unresolved, do not give Baihu Tang. He further stated: If the pulse is floating and slippery, indicating heat in the exterior and cold in the interior, use Baihu Jia Renshen Tang. Lin Yi of our dynasty, while correcting medical texts, argued that Zhang Zhongjing’s statements regarding interior/exterior here were contradictory. I disagree. Generally, Baihu Tang clears thirst and interior/exterior heat in Shanghan; thus, whether described as interior/exterior heat or exterior heat/interior cold, it may be used. However, cases with floating pulse, no sweating, and unresolved exterior are indications for Mahuang Tang (Ephedra Decoction) or Gegen Tang (Puerariae Radix Decoction); how could Baihu Tang be used? Lin Yi saw the differing descriptions of interior/exterior and deemed them contradictory, which is an error of failing to think deeply.
Taiyang disease with fever, no aversion to cold, but thirst is termed Wenbing (Warm Disease). (See discussion under Warm Disease. Huoren Shu recommends Weiyu Tang (Polygonati Odorati Rhizoma Decoction). Fever without aversion to cold suggests the exterior is resolved; however, Taiyang disease typically involves headache and body ache, suggesting the exterior is unresolved. Here, both exterior and interior symptoms are present simultaneously.)
Thirst accompanied by diarrhea belongs to Shaoyin disease. If the symptoms primarily include drowsiness and white urine, Sini Tang (Frigid Extremities Decoction) is used. If accompanied by cough, vomiting, insomnia, and non-white urine, Zhuling Tang (Polyporus Decoction) is used. If accompanied by spontaneous diarrhea of pure green watery stool, Dachengqi Tang (Major Order the Qi Decoction) is used. If there is heat, Baitouweng Tang (Pulsatillae Radix Decoction) is used. (Formula discussion under Diarrhea.)
Xiaoke (Wasting-Thirst) with sensation of Qi rushing up to the heart, heart pain, hunger without desire to eat, vomiting of roundworms upon eating; if purged, diarrhea will not stop. If thirsty for water, giving small amounts will lead to recovery. (See discussion under Qi Rushing Up to Heart.)
After inducing sweating in Taiyang disease, if profuse sweating occurs causing dryness in the stomach, irritability, and insomnia, and the patient desires water, give small amounts. Harmonizing the Stomach Qi leads to recovery. If the pulse is floating, urination is difficult, there is slight fever and thirst, Wuling San (Five-Ingredient Powder with Poria) is indicated. After sweating, if the pulse is floating and rapid with irritability and thirst, Wuling San is indicated.
In Yangming disease, if the pulse is floating and tight, with bitter taste, abdominal fullness, fever, sweating, and no aversion to cold, and if after purgation the pulse becomes floating with fever, thirst desire for water, and difficulty urinating, Zhuling Tang is indicated.
Wuling San (Five-Ingredient Powder with Poria)
Zhuling (Polypori Umbellati, 猪苓) - peeled, two liang
Zexie (Alismatis Rhizoma, 泽泻) - one liang
Baizhu (Atractylodis Macrocephalae Rhizoma, 白术) - three liang
Fuling (Poria, 茯苓) - peeled, two liang
Guizhi (Cinnamomi Ramulus, 桂枝) - peeled, half liang
All ingredients are coarsely chopped and made into a powder. Take three qian per dose, mixed with plain boiled water. (Li Dongyuan stated: Failure to administer Wuling San when indicated causes grain digestion to fail, water dampness to dissipate but form to perish, leading to Yangming dry-fire and yellowing of the Wei Earth/Stomach, resulting in Tiaowei Chengqi Tang syndrome. Administering it when inappropriate violates the root, causing forced diuresis and secondary loss of fluids leading to blood stasis syndromes; mild cases use Tao Ren Chengqi Tang, severe cases use Didang Tang.)
Zhuling Tang (Polyporus Decoction)
Zhuling (Polypori Umbellati, 猪苓) - peeled
Fuling (Poria, 茯苓)
Ejiao (Asini Corii Colla, 阿胶)
Zexie (Alismatis Rhizoma, 泽泻)
Huashi (Talcum, 滑石) - half liang each
All ingredients are coarsely chopped. Take five qian per dose, decoct in water, take warm, three times daily.
Thirst with head sweating, difficulty urinating, accompanied by hypochondriac fullness and alternating chills and fever, requires Chaihu Guizhi Ganjiang Tang (Bupleurum, Cinnamon Twig, and Dried Ginger Decoction). If accompanied by jaundice, Yinchen Hao Tang (Artemisiae Scopariae Herba Decoction) is used. (See discussion under Head Sweating.)
If the exterior is unresolved, there is fluid retention in the epigastrium, dry heaving, fever, cough, and thirst, Xiao Qinglong Tang (Minor Green Dragon Decoction) with Banxia removed and Gualou Gen added is used. (See discussion under Cough.)
In summer, sweating, aversion to cold, body heat, cold feet, and thirst indicate Zhongshu (Heatstroke). Baihu Jia Renshen Tang and Jiuhuanglian (Alcohol-processed Coptidis Rhizoma) are indicated. (Formula under Heatstroke. Aversion to cold and body heat mimic exterior syndrome, but cold feet contraindicate exterior-releasing methods.)
Fever, aversion to cold, abdominal fullness, sweating, free urination, and thirst indicate Liver overacting on Spleen; puncture Qimen (LR14). (See discussion under Abdominal Fullness. If the exterior is resolved, no aversion to cold, but thirst, Baihu Tang is suitable. (Formula discussion under previous Yangming section.)
Thirst with hypochondriac fullness and alternating chills/fever, where sweating has not yet been induced, requires Xiaochaihu Tang (Minor Bupleurum Decoction) with Banxia removed and Renshen plus Gualou Gen added. If sweating or purgation has already been performed, Chaihu Guizhi Ganjiang Tang is used. (See detailed discussion under Hypochondriac Pain and Alternating Chills/Fever.)
Thirst with hard and painful epigastrium, afternoon tidal fever, and constipation indicates Jie Xiong (Chest Binding); Da Xiexiong Tang (Major Chest-Binding Decoction) is suitable. If hard but painless, it is Pi (Glomus); Xixin Tang (Heart-Piercing Decoction) is given. If unresolved, worsening thirst, and difficulty urinating, Wuling San is suitable. (See detailed discussion under Chest Binding and Glomus sections.)
When a disease in the Yangming stage should be treated with sweating, but instead is sprayed/washed with cold water, the heat increases irritability, skin develops gooseflesh, there is a desire to drink water but no actual thirst, Wen Ge San (Clam Shell Powder) is administered.
If not improved, Wuling Tang is given. (See discussion under Chest Binding.)
Wen Ge San (Clam Shell Powder)
Wenge (Venerupis Pulchella Shell / Haige Fen, 文蛤) - one liang (This is Seashell Powder. Liu Hejian and Zhu Danxi often used it; it greatly resolves phlegm.)
One ingredient, ground into powder, taken with boiling water using a square-inch measure.
Thirst desire for water but inability to drink indicates heat in the Dantian and cold in the chest. (See discussion under Damp Bi.)
Wind-stroke with fever, unresolved after six to seven days with irritability, presenting both exterior and interior symptoms, thirst desire for water, and vomiting immediately after drinking is named Shui Ni (Water Reversal); Wuling San is indicated.
Thirst desire for water: if after Taiyang sweating with profuse sweat, irritability, and insomnia occurs, or in Jueyin disease with Qi rushing to the heart, heart pain, and vomiting worms, giving small amounts of water leads to recovery. (See previous clause and Qi Rushing Up clause.) For any epidemic disease reaching day five or six, if the patient is thirsty for water but cannot drink much, do not give it. Why? Because residual heat in the abdomen is insufficient to transform the water; giving more water creates pathology. By day seven or eight, if there is extreme thirst, give water according to symptoms, but always ensure the amount is insufficient, do not let them drink to satiety. Meaning: if they can drink one dou, give only five sheng. If after drinking there is abdominal fullness, difficulty urinating, wheezing, or hiccups, do not give more. Sudden profuse sweating indicates spontaneous recovery. (Huoren Shu states: In any illness, unless extremely thirsty, do not force water intake. For mild thirst with dry throat, swallow small amounts to moisten, allowing Stomach Qi to harmonize.)
Generally, if a patient can drink water during illness, it indicates impending recovery. However, merely hearing that drinking water cures illness, and forcing water on those with mild thirst, causes water retention pathology that cannot be saved. (Huoren Shu states: Forcing water leading to retention in the epigastrium, fullness, binding, and wheezing should be treated with Wuling San or Xiexiong Tang.) In dysentery, if the pulse is weak, rapid, and accompanied by thirst, recovery is likely. (See discussion under Diarrhea.) Thirst with fever, where the pulse is not wiry/tight but floating/weak, resolves with sweating. (See discussion under Delirium.)
In Yangming disease, if sweating is profuse and there is thirst, Zhuling Tang must not be given, because profuse sweating causes Stomach dryness; administering Zhuling Tang would further drain fluids via diuresis.
Above quotes Huoren Shu: Strictly avoid giving Baihu Tang to Taiyang cases with no sweating and thirst; strictly avoid giving Zhuling Tang to Yangming cases with profuse sweating and thirst. However, is Baihu Tang never appropriate for Taiyang thirst? After Taiyang sweating, if the pulse is flooding and there is thirst, Baihu Tang may be used. Is Zhuling San never appropriate for Yangming thirst? If Yangming presents with difficulty urinating, less sweating, floating pulse, and thirst, Zhuling San may be used.