五苓散（方见惊）
《小方脉论》小儿渴病，吃水太多，腹胀泄泻。此病得之心藏热，心与小肠合，
小肠亦受热，小肠既热，其气上行奔胃口，致孩子吃水，其水待奔小肠，被小肠气
热渗泄，不及转入大肠，如治之，先下淋药，后下凉心藏药，然后止渴，乃效。
按∶此亦五苓散证也。
《小方脉论》治渴先下淋药方
郁金 滑石（各一两） 旱莲子（半两）
上件为末。每服半钱，煎葱汤调下。急进三服凉心药。
《小方脉论》欲止渴，次凉心藏药方
乌贼鱼骨 海浮石（各一两） 蒲黄（炒，半两）
上末。每半钱，用枇杷叶煎汤下。
钱乙论黄相似云∶身皮目皆黄者，黄病也。身疼膊背强，大小便涩，一身
尽黄，面目指爪皆黄，小便如屋尘色，看物皆黄，渴者难治，此黄胆也。二证多病
于大病后。别有一证，不因病后、身微黄者，胃热也，大人亦同。又有面黄腹大，
食土渴者，脾疳也。又有自生而身黄者，胎疸也。古书云∶诸疸皆热也，深黄者是
也，若淡黄兼白者，胃怯，胃不和也。《难知》云∶色如熏黄，乃湿病也。一身尽
痛。色如橘子黄者，黄病也，身不痛。干黄燥也，小便自利，四肢不沉重，渴而
引饮者，栀子柏皮汤。湿黄脾也，小便不利，四肢沉重，似渴不欲饮者，大茵陈
汤。大便自利而黄者，茵陈栀子黄连三物汤。往来寒热，一身尽黄者，小柴胡加
栀子汤。洁古云∶阳黄则大小便赤涩身热，是脾土与心火相搏，为阳病，法当先利
小便，后下大便。阴黄则清便自调，面目及身黄，四肢冷，是脾虚不能制肾水，当
用益黄散，下使君子丸（益黄散方见脾，使君子丸方见疳。）凡治黄病腹胀，当用茵陈蒿汤调下
五苓散，若欲利小便，去大黄。欲利大便，则加大黄之类。有阳证可服，谓面赤饮
水者是也。汤氏云∶身疼膊背疼，大小便涩，皮肤面目齿爪皆黄，小便如屋尘色，
利者易治，涩者难治，宜服五苓散加茵陈煎汤调，又宜服导赤散加茵陈煎。或身热，
宜服小柴胡汤，甚者服承气汤。〔曾〕凡黄病者，不可一概而论，标本不同，证治
亦异，乃脾胃气虚，感受湿热，郁于腠理，淫于皮肤，蕴积成黄，熏发于外，故有
此证。或脾胃虚弱，内因症癖，攻之而成。然疳泻亦主皮黄发竖，肚大青筋，肌肉
消瘦，外无色泽，身必发黄，此又本于疳病而作，致有是证。治法，若感湿热而得，
身黄如烟熏之色，以 咀五苓散加麻黄、水姜煎投，汗之即愈。或用茵陈蒿汤调下
五苓散亦好。若得于疳癖者，其形如黄土相类，以醒脾散（慢惊）、化癖丸（积）醒脾快胃，
磨积理疳，胃气既和，饮食倍进，运化精微，荣养百骸，灌溉脏腑，五色各见于本
部，精华乃形于面貌，其黄自除。〔薛〕经曰∶中央黄色，入通于脾，故黄胆者，
脾之色也，夫人身之神，贵于藏而默，用见于外，则内虚矣。其证皆因脾气有亏，
运化失职，湿热留于肌肤，发而为疸，钱仲阳所谓身痛背强，二便涩滞，遍身面目
爪甲皆黄是也，小便褐色者难治。疗法宜固脾为先，如专用克伐宽中，澹泄利水之
药，则鲜有不至危者矣。若初生及百日半年之间，不因病而身黄者，胃热胎黄也，
腹大食土为脾疳，兼作渴饮冷者，用泻黄散（脾）。小便不利者，茵陈汤。病后发黄，
肢体浮肿者用白术散（渴）。清便自调，肢冷嗜卧者益黄散（脾）。身澹黄白者调中丸（腹痛）及
补中益气汤（虚热）加茵陈。身热膈满，肌肤面目皆黄者加减泻黄散。辨其所以，若闭目
壮热，多哭不已，大小便赤涩，口中热气者，乃妊娠浓味，胎毒之候也，母子并服
生地黄汤（胎黄），仍忌酒面五辛热物。设不自慎，误伤脾土，急则变为惊风吐泻，缓则
肢体浮肿，小便不利，眼目障闭，多成疳疾矣。又有脾虚发黄者，当于脾胃中求之。
《小方脉论》记载：小儿渴病，因饮水过多，导致腹胀、泄泻。此病源于心藏热，心与小肠相表里，小肠亦受热邪。小肠既已受热，热气上行冲击胃口，致使孩子想喝水；当水进入小肠时，被小肠的热气渗透排泄，来不及转入大肠。治疗此病，应先使用利尿药，再使用清心藏热的药物，最后止渴，这样才有效。
按语：这也属于五苓散的适应证。
《小方脉论》治疗渴病先使用利尿药的方子：
郁金、滑石（各一两）、旱莲子（半两）。
以上药材研为细末。每次服用半钱，用葱汤调服。急于服用三服凉心药。
《小方脉论》欲止渴，其次使用清心藏热的方子：
乌贼鱼骨、海浮石（各一两）、蒲黄（炒，半两）。
以上研为细末。每次半钱，用枇杷叶煎汤送服。
钱乙论述黄疸相似病症时说：身体皮肤和眼睛都发黄，这是黄病。身体疼痛，胳膊背部僵硬，大小便涩滞不通，全身尽黄，面目指甲都黄，小便像屋尘的颜色，看东西都是黄色的，口渴的难治，这是黄疸。这两种证候多在大病之后发生。另有另一种证候，不是因病后引起，身体微黄的，是胃热，成人也相同。又有面色黄、腹部大、吃泥土且口渴的，是脾疳。又有出生即身体发黄的，是胎疸。古书说：各种黄疸都是热证，深黄色的是这种情况；如果淡黄兼带白色的，是胃气虚弱，胃不和顺。《难知》说：颜色像熏过的黄色，是湿病，全身疼痛。颜色像橘子黄的，是黄病，身体不痛。干黄干燥，小便自利，四肢不沉重，口渴想喝水的，用栀子柏皮汤。湿黄属于脾，小便不利，四肢沉重，似渴但不想喝水的，用大茵陈汤。大便自利而黄的，用茵陈栀子黄连三物汤。往来寒热，全身尽黄的，用小柴胡加栀子汤。洁古说：阳黄则大小便赤涩身热，是脾土与心火相搏，属于阳病，法度上应当先通利小便，后攻下大便。阴黄则二便正常，面目及身体发黄，四肢冷，是脾虚不能制约肾水，应当用益黄散，下使君子丸（益黄散方见脾脏章节，使君子丸方见疳积章节）。凡治疗黄病腹胀，应当用茵陈蒿汤调下五苓散，如果想要利小便，去掉大黄。如果想要利大便，则加大黄之类。有阳证可以服用，指面红饮水的人。汤氏说：身体疼痛胳膊背疼，大小便涩滞，皮肤面目牙齿指甲都黄，小便像屋尘色，小便通利的易治，涩滞的难治，宜服用五苓散加茵陈煎汤调服，又宜服用导赤散加茵陈煎服。或者身热，宜服用小柴胡汤，严重的服用承气汤。〔曾〕凡是黄病患者，不可一概而论，标本不同，证治也不同，这是脾胃气虚，感受湿热，郁结在腠理，浸淫于皮肤，蕴积而成黄，熏蒸发作于外，所以有此证。或者脾胃虚弱，内因症癖，攻伐而成。然而疳泻也主皮肤黄、毛发竖立、肚子大青筋暴露、肌肉消瘦，外表无光泽，身体必发黄，这又是基于疳病而产生，导致有此证。治疗方法，如果是感受湿热而得，身体黄如烟熏之色，以粗锉的五苓散加麻黄、生姜煎服，发汗即愈。或者用茵陈蒿汤调下五苓散也好。如果是得于疳癖者，其形如黄土相似，用醒脾散（慢惊风）、化癖丸（积滞）醒脾快胃，磨积理疳，胃气既调和，饮食加倍增加，运化精微，荣养百骸，灌溉脏腑，五色各见于本部，精华乃形成于面貌，其黄自然消除。〔薛〕经上说：中央黄色，入通于脾，所以黄疸是脾的颜色。人身的神气，贵在藏而不露，若见于外，则内虚了。这些证候都是因为脾气亏损，运化失职，湿热留于肌肤，发而为疸，钱仲阳所谓身体痛背强，二便涩滞，遍身面目爪甲皆黄，小便褐色的难治。疗法应当以固护脾土为先，如果专用克伐宽中、澹泄利水的药物，则很少有不至于危重的了。如果是初生及百日半年之间，不因病而身体黄的，是胃热胎黄。腹大食土为脾疳，兼作渴饮冷的，用泻黄散（脾）。小便不利的，用茵陈汤。病后发黄，肢体浮肿的用白术散（渴）。清便自调，肢冷嗜卧的用益黄散（脾）。身体淡黄白的用调中丸（腹痛）及补中益气汤（虚热）加茵陈。身热膈满，肌肤面目皆黄的用加减泻黄散。辨别其原因，如果闭目壮热，多哭不已，大小便赤涩，口中热气，那是妊娠期间浓味饮食，胎毒的征候，母子并服生地黄汤（胎黄），仍忌酒面五辛热物。如果不自己谨慎，误伤脾土，急则变为惊风吐泻，缓则肢体浮肿，小便不利，眼目障闭，多成为疳疾了。又有脾虚发黄的，应当在脾胃中寻求原因。
Wuling San (Formula see in the chapter on Convulsions)
*Xiaofang Lun* records: In pediatric polydipsia, excessive water intake leads to abdominal distension and diarrhea. This disease originates from heat in the Heart Zang; as the Heart and Small Intestine are exterior-interiorly related, the Small Intestine also receives heat. Once the Small Intestine is heated, its Qi ascends and rushes to the stomach opening, causing the child to desire water. When this water reaches the Small Intestine, it is permeated and excreted by the intestinal heat before it can transfer to the Large Intestine. To treat this, one should first administer diuretic medicines, then administer medicines to cool the Heart Zang, and finally stop the thirst, which will be effective.
Commentary: This also falls under the indications for Wuling San.
*Xiaofang Lun* formula to treat polydipsia by first using diuretics:
Jinyu (Curcumae Radix), Huashi (Talcum), each 1 liang; Hanlianzi (Elaeocarpus decipiens Seed), 0.5 liang.
Grind the above into powder. Take half a qian each time, mixed with Scallion Decoction. Urgently take three doses of cooling Heart medicines.
*Xiaofang Lun* formula to stop thirst by subsequently cooling the Heart Zang:
Wzeiyu Gu (Sepiae Endoconcha), Haifushi (Pumex), each 1 liang; Puhuang (Typhonii Rhizoma Pollen), stir-fried, 0.5 liang.
Grind the above into powder. Take half a qian each time, taken with Loquat Leaf Decoction.
Qian Yi discussed similar jaundice symptoms saying: When the body skin and eyes are yellow, it is a Yellow Disease. Body pain, stiffness in the arms and back, difficulty in urination and defecation, full-body yellowing, yellowing of the face, eyes, and nails, urine the color of house dust, objects appearing yellow, and thirst indicate a difficult-to-treat case; this is Huangdan (Jaundice). These two conditions often occur after severe illnesses. There is another condition where the body is slightly yellow not due to post-illness weakness but due to Stomach Heat, which also applies to adults. There is also facial yellowing with abdominal distension, geophagia (eating earth), and thirst, known as Pi Gan (Spleen Malnutrition). Those born with yellow skin have Tai Dan (Fetal Jaundice). Ancient texts state that all types of jaundice are heat syndromes; deep yellow indicates this. If the yellow is pale and mixed with white, it indicates weak Stomach Qi and disharmony. *Nanzhi* states: A color like smoked yellow indicates a Dampness disease with full-body pain. A color like orange yellow indicates a Yellow Disease without body pain. Dry, yellow, and parched with free urination, heavy limbs absent, and thirst with desire to drink indicates Zhizi Bopi Tang (Gardenia and Phellodendron Bark Decoction). Wet yellow belongs to the Spleen, with difficult urination, heavy limbs, apparent thirst but no desire to drink, indicating Da Yincheng Tang (Large Coptis Decoction). Free defecation with yellow stool indicates Yincheng Zhizi Huanglian Sanwu Tang (Coix Seed, Gardenia, and Coptis Three-Ingredient Decoction). Alternating chills and fever with full-body yellowing indicates Xiao Chaihu Jia Zhizi Tang (Minor Bupleurum Decoction plus Gardenia). Jiegu stated: Yang Huang involves red and difficult urination/defecation and body heat, resulting from the struggle between Spleen Earth and Heart Fire; it is a Yang syndrome. The method requires first promoting urination, then purging the bowels. Yin Huang presents with normal urination/defecation, yellowing of the face/body, and cold limbs, resulting from Spleen deficiency failing to control Kidney Water; one should use Yihuang San (Yellow-Boosting Powder) and Shi Junzi Wan (Quisqualis Pill) (Yihuang San formula see in Spleen chapter, Shi Junzi Wan formula see in Gan accumulation chapter). For treating abdominal distension in Yellow Disease, use Yinchen Hao Tang (Artemisia Capillaris Decoction) to mix with Wuling San. To promote urination, remove Dahuang (Rhei Radix et Rhizoma). To promote defecation, add Dahuang or similar herbs. Yang syndromes are suitable for those with red faces and desire to drink. Tang Shi stated: Body pain, arm/back pain, difficult urination/defecation, yellowing of skin/face/teeth/nails, and urine like house dust; if urination is free, it is easy to treat; if difficult, it is hard to treat. One should take Wuling San plus Yinchen decocted and mixed, or Daochi San (Coptis Decoction) plus Yinchen decocted. If there is body heat, take Xiao Chaihu Tang (Minor Bupleurum Decoction); if severe, take Chengqi Tang (Chengqi Decoction). [Zeng] All Yellow Disease cases cannot be treated uniformly; the root and branch differ, so diagnosis and treatment vary. This arises from Spleen and Stomach Qi deficiency, contracting Damp-Heat, which stagnates in the couli (interstices), invades the skin, accumulates to form yellow, and steams outward. Alternatively, Spleen/Stomach weakness combined with internal phlegm-stasis masses, aggravated by aggressive treatment, can cause it. However, Gan diarrhea also manifests with yellow skin, erect hair, large abdomen with visible veins, emaciation, lack luster, and inevitable body yellowing; this stems from Gan disease. Treatment: If caused by Damp-Heat, with skin yellow like smoke, use coarse-cut Wuling San plus Mahuang (Ephedrae Herba) and Shengjiang (Zingiberis Rhizoma Recens) decocted to induce sweating for cure. Alternatively, Yinchen Hao Tang mixed with Wuling San is good. If caused by Gan/phlegm-stasis, resembling loess yellow, use Xingpi San (Spleen-Awakening Powder for Slow Convulsion) and Hua Pi Wan (Stasis-Dissolving Pill for Accumulation) to awaken the Spleen and quicken the Stomach, grind away accumulation, and regulate Gan. Once Stomach Qi harmonizes, food intake doubles, essence is transformed, nourishing the body, irrigating organs, allowing the five colors to appear in their respective regions, and essence forms the complexion, the yellow will naturally disappear. [Xue] The Classics state: Central yellow corresponds to the Spleen; thus, Huangdan is the color of the Spleen. The spirit of the human body prefers concealment; if revealed externally, the interior is deficient. These syndromes result from Spleen Qi deficiency, failure of transformation and transportation, and Damp-Heat remaining in the skin and muscles, manifesting as jaundice—what Qian Zhongyang described as body pain, back stiffness, difficult urination/defecation, and full-body yellowing including face and nails. Dark brown urine indicates a difficult prognosis. Therapy should prioritize securing the Spleen. Using only harsh draining, middle-expanding, or diuretic medicines rarely avoids critical danger. For newborns up to six months old, yellowing not due to illness is Wei Re Tai Huang (Stomach Heat Fetal Jaundice). Large abdomen with geophagia is Pi Gan. With thirst and desire for cold drinks, use Xiehuang San (Draining Yellow Powder for Spleen). With difficult urination, use Yincheng Tang. Post-illness yellowing with limb edema uses Baizhu San (Atractylodes Macrocephala Powder for Thirst). Normal urination/defecation with cold limbs and lethargy uses Yihuang San (Spleen). Pale yellow-white skin uses Tiao Zhong Wan (Middle-Harmonizing Pill for Abdominal Pain) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction for Deficiency Heat) plus Yinchen. Body heat, chest fullness, and full-body yellowing uses Jiajian Xiehuang San (Modified Draining Yellow Powder). To differentiate causes: closed eyes, high fever, incessant crying, red/difficult urination/defecation, and hot breath indicate maternal consumption of rich flavors during pregnancy, leading to fetal toxin signs. Mother and infant should both take Shengdihuang Tang (Rehmannia Root Decoction for Fetal Jaundice), avoiding alcohol, wheat, pungent spices, and hot foods. Without caution, damaging Spleen Earth may lead to acute convulsions/vomiting/diarrhea or chronic limb edema, difficult urination, eye obstruction, and eventually Gan diseases. For yellowing due to Spleen deficiency, seek the cause within the Spleen and Stomach.