（见中暍中）
@@@
渴欲饮水，水入则吐者，名曰水逆，五苓散主之。
【注】
渴欲饮水，水入即吐，名水逆者，是里热微而水邪盛也，故以五苓散利水止吐也。
【集注】
李□曰：内有积水，故水入则拒格而上吐，名水逆也，五苓散利水，故主之。
@@@
渴欲饮水不止者，文蛤散主之。
【注】
渴欲饮水，水入则吐，小便不利者，五苓散证也。渴欲饮水，水入则消，口干舌燥者
，白虎人参汤证也。渴欲饮水而不吐水，非水邪盛也；不口干舌燥，非热邪盛也。惟
引饮不止，故以文蛤一味，不寒不温，不清不利，专意于生津止渴也。或云：文蛤即
今吴人所食花蛤，性寒味咸，利水胜热，然屡试而不效。尝考五倍子亦名文蛤，按法
制之名百药煎，大能生津止渴，故尝用之，屡试屡验也。
文蛤五两
右一味，杵为散，以沸汤五合，和服方寸匕。
@@@
小便不利者，有水气，其人苦渴，栝蒌瞿麦圆主之。
【注】
小便不利，水蓄于膀胱也，其人苦渴，水不化生津液也。以薯蓣、花粉之润燥生津，
而苦渴自止，以茯苓、瞿麦之渗泄利水，而小便自利；更加炮附宣通阳气，上蒸津液
，下行水气。亦肾气丸之变制也。然其人必脉沉无热，始合法也。
栝蒌根（即花粉）二两 茯苓三两 薯蓣二两 附子（炮）一枚 瞿麦一两
右五味，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。
【集解】
李□曰：此方与五苓散同为利水生津之剂，此用薯蓣即五苓用白术之义也。但五苓兼
外有微热，故用桂枝走表；此内惟水气，故用附子温下也。
尤怡曰：此下焦阳弱气冷，而水气不行之证，故以附子益阳气，茯苓、瞿麦行水气，
观方后云：腹中温为知，可以推矣。其人苦渴，则是水气偏结于下，而燥火独聚于上
。夫上浮之焰，非滋不熄；下积之阴，非暖不消；而寒润辛温，并行不悖，此方为良
法也。求变通者，于此三复焉。
@@@
小便不利，蒲灰散主之，滑石白鱼散，茯苓戎盐汤并主之。
【注】
无表里他证，小便不利而渴者，消渴水邪病也；小便不利不渴者，小便癃闭病也。主
蒲灰散、滑石白鱼散者，蒲灰乱发血分药也，滑石白鱼利水药也，然必是水郁于血分
，故并主是方也。观东垣以通关丸，治热郁血分之小便不利，则可知在血分多不渴也
。主茯苓戎盐汤者，茯苓淡渗，白术燥湿，戎盐润下，亦必是水湿郁于下也。盐为渴
者之大戒，观用戎盐则不渴可知也。
【集注】
魏荔彤曰：小便不利者，所因有不同，治法亦不一，仲师并列三方，以俟主治者择其
善而从之。
（此条文见于中暑章节中）
@@@
口渴想喝水，但水喝进去就吐出来，这叫做“水逆”，用五苓散主治。
【注】
口渴想喝水，水喝下去立刻呕吐，称为“水逆”的，是因为体内热邪轻微而水湿邪气强盛，所以用五苓散来利水并停止呕吐。
【集注】
李□说：体内有积水，所以水喝进去就会被排斥而上吐，称为“水逆”，五苓散能利水，所以用它来主治。
@@@
口渴想喝水且饮水不止的，用文蛤散主治。
【注】
口渴想喝水，水喝进去就吐，小便不利的，是五苓散的适应证。口渴想喝水，水喝进去就被吸收消耗，口干舌燥的，是白虎加人参汤的适应证。口渴想喝水但不吐水，说明不是水湿邪气强盛；没有口干舌燥，说明不是热邪强盛。只是引水饮用不停止，所以只用文蛤这一味药，它性质既不寒也不温，既不清热也不利尿，专门致力于生津止渴。有人说：文蛤就是现在吴地人吃的花蛤，性寒味咸，能利水胜热，但我多次尝试使用却无效。我曾考证五倍子也名叫文蛤，按照法制成的名称叫“百药煎”，非常能够生津止渴，所以我曾经使用它，屡试屡验。
文蛤五两
以上一味药，捣碎成散剂，用沸水五合调和，服用方寸匕大小的量。
@@@
【注】
小便不利，是水蓄积在膀胱的表现；此人苦于口渴，是水不能化生为津液所致。用山药、天花粉来润燥生津，那么苦渴自然停止；用茯苓、瞿麦来渗泄利水，那么小便自然通利；再加上炮附子宣通阳气，使津液上蒸，水气下行。这也是肾气丸的变通方制。然而，病人的脉象必须是沉脉且无发热，才符合此方的用法。
栝蒌根（即天花粉）二两 茯苓三两 山药二两 附子（炮制）一枚 瞿麦一两
以上五味药，研成细末，炼蜜制成梧桐子大小的丸药，用水送服三丸，每日三次。如果效果不明显，增加到七八丸，以小便通利、腹部感到温暖作为见效的标准。
【集解】
李□说：这个方子与五苓散都是利水生津的药剂，这里用山药就相当于五苓散中使用白术的意义。但五苓散兼有体表的轻微发热，所以用桂枝走表发散；这里体内只有水气，所以用附子温补下焦。
尤怡说：这是下焦阳气虚弱、气机寒冷，导致水气不行的证候，所以用附子益助阳气，茯苓、瞿麦行散水气，看方后注说“腹部感到温暖即为见效”，就可以推知了。此人苦于口渴，则是水气偏结聚在下焦，而燥火独聚在上焦。上浮的火焰，不用滋润就不能熄灭；下积的阴寒，不用温暖就不能消散；而寒凉滋润与辛温药物并行不悖，这个方子是良法。寻求变通的人，对此应反复思考。
@@@
【注】
没有表证和里证等其他病症，小便不利且口渴的，是消渴水邪病；小便不利且不口渴的，是小便癃闭病。主治用蒲灰散、滑石白鱼散的，蒲灰和乱发属于血分药，滑石和白鱼属于利水药，但这一定是因为水郁结在血分，所以同时主治这两个方子。看东垣用通关丸治疗热郁在血分的小便不利，就可以知道在血分病变多伴有不口渴的症状。主治用茯苓戎盐汤的，茯苓淡渗利湿，白术燥湿，戎盐润下，这也一定是因为水湿郁结在下焦。盐是口渴者的禁忌，看方中使用戎盐，就知道此证是不口渴的。
【集注】
(This clause is found in the chapter on Heatstroke.)
@@@
Thirst with desire to drink water, but vomiting immediately after swallowing, is named "Water Reversal" (Shui Ni), treated primarily with Wuling San.
[Note]
Thirst with desire to drink water, vomiting immediately upon ingestion, named "Water Reversal," indicates that internal heat is slight while water-pathogen is abundant; therefore, Wuling San is used to promote urination and stop vomiting.
[Collected Notes]
Li [Name Redacted] said: There is accumulated water inside, so ingested water is rejected and vomited upward, named "Water Reversal." Wuling San promotes urination, thus it is the primary treatment.
@@@
Thirst with continuous desire to drink water without relief is treated primarily with Wenli San.
[Note]
Thirst with desire to drink water, vomiting after ingestion, and difficulty in urination constitute the syndrome for Wuling San. Thirst with desire to drink water, where water is consumed/absorbed after ingestion, accompanied by dry mouth and tongue, constitutes the syndrome for Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). Thirst with desire to drink water but no vomiting of water indicates that water-pathogen is not abundant; absence of dry mouth and tongue indicates that heat-pathogen is not abundant. Since the patient continuously draws water to drink, only Wenli (Clam Shell) is used. It is neither cold nor warm, neither clearing heat nor promoting urination, but specifically focuses on generating fluids and relieving thirst. Some say: Wenli refers to the clam (Meretrix meretrix) eaten by people in Wu today, which is cold in nature and salty in taste, capable of promoting urination and overcoming heat; however, repeated trials have been ineffective. I once researched that Wubeizi (Chinese Gallnut) is also named Wenli. Prepared according to the method, it is called Baiyao Jian (Hundred Medicines Decoction), which greatly generates fluids and relieves thirst. Therefore, I have used it, with repeated success.
Wenli (Clam Shell) five liang
The above single herb is pounded into a powder. Mix with five he of boiling water and take one fangcun bi (a measure roughly equivalent to a tablespoon) at a time.
@@@
Difficulty in urination with water-retention in the body, and the person suffers from severe thirst, is treated primarily with Gualou Qumai Wan.
[Note]
Difficulty in urination indicates water accumulation in the Bladder. Severe thirst indicates that water fails to transform into body fluids. Using Shanyao (Dioscoreae Rhizoma) and Huafen (Trichosanthis Radix) moistens dryness and generates fluids, thereby stopping severe thirst; using Fuling (Poria) and Qumai (Dianthi Herba) drains and promotes urination, thereby facilitating normal urination; additionally, Paofuzi (Prepared Aconiti Lateralis Radix) unblocks Yang Qi, causing fluids to steam upward and water qi to descend downward. This is also a modified form of Shenqi Wan. However, the patient's pulse must be deep and there must be no fever for this formula to be appropriate.
Gualou Gen (Huafen/Trichosanthis Radix) two liang, Fuling (Poria) three liang, Shuyao (Dioscoreae Rhizoma) two liang, Fuzi (Paofu/Aconiti Lateralis Radix Praeparata) one piece, Qumai (Dianthi Herba) one liang.
The above five herbs are powdered, mixed with refined honey to make pills the size of wutong seeds. Take three pills with water, three times a day. If ineffective, increase to seven or eight pills. Effectiveness is indicated by free urination and warmth in the abdomen.
[Collected Explanations]
Li [Name Redacted] said: This formula, like Wuling San, is an agent for promoting urination and generating fluids. The use of Shuyao here corresponds to the use of Baizhu in Wuling San. However, Wuling San addresses slight external heat, hence Guizhi is used to release the exterior; here, only internal water-qi exists, hence Fuzi is used to warm the lower jiao.
You Yi said: This is a syndrome of weak Yang Qi and cold qi in the Lower Jiao, leading to stagnation of water-qi. Hence, Fuzi benefits Yang Qi, while Fuling and Qumai move water-qi. The post-prescription note states "warmth in the abdomen indicates effectiveness," which allows us to deduce this. The severe thirst indicates that water-qi is concentrated in the lower part, while dry-fire gathers exclusively in the upper part. The flaming fire floating upward cannot be extinguished without nourishment/moistening; the yin-cold accumulating below cannot be dispersed without warming. Thus, cold-moistening and acrid-warming agents work together without contradiction. This formula is an excellent method. Those seeking flexibility should reflect deeply on this.
@@@
Difficulty in urination is treated primarily with Puhui San; Huashi Baiyu San and Fuling Rongyan Tang are also applicable.
[Note]
In the absence of exterior or interior other syndromes, difficulty in urination accompanied by thirst indicates Xiao Ke (Wasting-Thirst) water-pathogen disease; difficulty in urination without thirst indicates Long Bi (Urinary Obstruction). Puhui San and Huashi Baiyu San are used because Puhui (Typhae Pollen) and Luankuafa (Hair Scab) are blood-level medicines, while Huashi (Talcum) and Baiyu (Fish Maw/Scales) are diuretics; this implies that water is stagnant in the blood level, hence both formulas are applied. Observing Dong Yuan's use of Tongguan Wan to treat difficulty in urination due to heat-stagnation in the blood level, we can know that blood-level disorders often present without thirst. Fuling Rongyan Tang is used because Fuling (Poria) is lightly penetrating, Baizhu (Atractylodis Macrocephalae Rhizoma) dries dampness, and Rongyan (Halitum) moistens and descends; this also implies that water-dampness is stagnant in the lower jiao. Salt is a major taboo for those with thirst; the use of Rongyan in this formula indicates that this specific case involves no thirst.
[Collected Notes]
Wei Litong said: The causes of difficulty in urination differ, and thus the treatment methods vary. Zhongjing lists these three formulas side by side, awaiting the treating physician to select the most suitable one.