（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
（《内经》说：病人不恶寒而口渴的，这是病邪转属阳明。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篇讨论。）
成无己认为：伤寒邪气传入里则口渴，邪气在表则不渴。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，这是因为热邪能够消耗水分。一般来说，初传时热势轻微，所以口渴轻微；传变深入则热势严重，所以口渴严重。凡是口渴的病人，给水不要让他喝得太饱。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，应当采用攻下法治疗。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、满闷、腹泻、小便不利等病症，这些都是由此引起的。
太阳病发汗后，大汗出，导致胃中干燥，烦躁不得安睡，想要喝水的，少量多次给予，使胃气调和即可痊愈。如果脉浮、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，所以使用桂枝的辛味调和肌表，白术、茯苓的甘淡味道来滋润虚燥。按：这种说法也不够透彻。太阳经对应膀胱腑，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。那么治疗口渴应当泻膀胱的热，泻膀胱热的方法就是利小便而已。）发汗后脉浮数、烦渴的，用五苓散。
本来是因为误用下法，导致心下痞满，服用泻心汤后痞满未解，其人又出现口渴、口燥烦、小便不利的，用五苓散。中风发热六七日未解，出现烦躁，有表证和里证，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，出汗即愈。（“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，必须通过渗泄来治疗，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。虽然猪苓也是甘味，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，是因为辛能发散，水气随汗外泄，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。
伤寒脉浮、发热、无汗，表证未解的，不可与白虎汤。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。下一条的意思也是如此，都是因为太阳转属阳明所以口渴。）
伤寒病如果经过催吐或泻下后，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，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时，现在表里都有热，所以时时恶风。）
石膏（六两）、知母（六两半）、甘草（二两）、粳米（六合）、人参（三钱）。以上药物切碎，每次服用一两，水煎，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未解，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，到现在脉象虚大，投了三剂汤药而痊愈。仲景既说伤寒如果经过吐下后七八天未解，表里俱热的，用白虎加人参汤主治；又说伤寒脉浮发热无汗，表不解的，不可与白虎汤；还说脉浮滑，这是表有热里有寒，用白虎加人参汤主治。林亿校正说张仲景在这里把表里弄错了。我认为不是这样。大体上白虎汤能清除伤寒中的口渴、表里发热，所以前两条说表里俱热，或者说表热里寒，都可以服用。一种情况是脉浮无汗，表不解，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他弄错了，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。比如上面两条，前一条是仲景设立法则来防范，后一条及“伤寒病如果经过吐下后七八天未解，热结在里，表里俱热，时时恶风，大渴，口舌干燥而烦，想要喝几升水的”，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。古人设立法则的心意，是恐怕表证未罢而贸然使用，会有治疗过速的弊端。如果有背微恶寒或时时恶风这两个证候，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清除，未免有治疗过迟的过失。这就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。这个方法的妙处，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？因为石膏辛寒，能解除足阳明经的本热，是治疗蒸蒸发热、潮热、表里皆热、舌燥烦渴的神药。而且“时时”是指偶尔恶风而不经常，“背上恶”只是觉得微恶寒而不严重。所有盛热燥渴的情况，使用白虎汤毫无疑问。如果是表证恶寒常在背上，恶寒而不燥渴的，切不可用。还有太阳经发热而口渴无汗的，不可与之。但汗后脉洪大而渴的，则可以给予。如果是阴伤寒，面赤烦躁，身热，与其胃虚恶心，大便不实，脉弱食少，没有大热的，切不可用。如果误用，危险立刻就会到来。
太阳病重发汗后又误下，不大便五六天，舌上干燥而渴，日晡时分小有潮热，从心下直到小腹硬满疼痛，不可触碰的，用大陷胸汤。
伤寒发热恶寒，大渴想喝水，腹部一定胀满，自汗出，小便通利，病欲解除，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，因为汗多胃中燥，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，这是阳明病未解而口渴，胃中津液干燥，如果给猪苓汤再利小便，就是实实虚虚的弊端。）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。如果病兼有嗜睡、小便白色的，用四逆汤。如果兼有咳嗽、呕吐、不得眠、小便不白的，用猪苓汤。如果兼有自利、排泄纯青色稀水的，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，心中疼热，饥饿但不想吃东西，吃东西就吐蛔虫。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，未形成口渴；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，是因为热势严重能消耗水分。饮水多而小便少，叫做消渴。木生于火，肝气通于心，厥阴客热，热气上撞心，心中疼热。伤寒六七日是厥阴受病之时，因为是传经尽，则当入腑。胃虚客热，饥饿但不想吃东西。蛔虫在胃中，无食物则动，闻到食气而出，得到食物蛔虫出来，这是热在厥阴经。如果误用下法，损伤胃气，厥阴木邪相乘，必定呕吐腹泻不止。按：成无己认为是表阳邪传里，不对。消渴、心中疼热才是厥阴病的特征。）
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、少腹胀满，或者喘息的，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，这是寒邪去除、病欲解除的表现，原方用小青龙汤（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，刺期门穴（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。如果经过汗下治疗的，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。如果只是硬而不痛的，是痞证，给予泻心汤。如果未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，反而用冷水浇洗，热更烦躁，皮肤起粟粒，想喝水反而不渴的，服用文蛤散。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。
中风发热六七日未解而烦躁，有表里证，口渴想喝水，水喝进去就吐出来的，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、烦躁不得眠，以及厥阴病气上冲心、心中疼热、吐蛔的，少量多次给予水即可痊愈（论见前条及气上冲篇）。
凡是得了时气病，到了五六天而口渴想喝水，不能多喝，不应当给他喝。为什么呢？因为腹中热还少，不能消化水，再给水会造成新的病患。到了七八天，大渴想喝水的，还应当根据证候给予水。给予水要常令他不足，不要让他喝得太饱。意思是能喝一斗只给五升。如果喝了水后腹部胀满、小便不利、喘息或呃逆的，不可再给。忽然大汗出的，是自愈的表现。（《活人书》说：凡是病人大渴才可以饮水，如果小渴咽干的，少量呷润，令胃气中和才好。）
凡是生病反而能喝水，这是病欲愈的表现。但如果听到病人喝水就能自愈，小渴也强行给他喝，因而造成祸患，就不可挽救了。（《活人书》说：强行饮水导致饮停心下、满结喘息的，应当用五苓散或陷胸汤主治。）
娄全善说：《活人书》告诫：太阳证无汗而口渴的，不可与白虎汤；阳明证汗多而口渴的，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：太阳证无汗而口渴的，不可与白虎汤；阳明证汗多而口渴的，不可与五苓散。我详细考察仲景论治口渴的药物，有不可给予的戒律有二条：一是“伤寒脉浮发热无汗，渴欲饮水，无表证者，白虎加人参汤主之；表不解，不可与”。活人不说表不解，只说无汗不可与，这就错了。二是“经云：阳明汗多而渴，不可与猪苓汤”。活人改为五苓散。因为猪苓专于渗泄，五苓兼有汗利，怎么能改呢？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，是因为口渴虽然相同，但汗出的多少不同。太阳属表，未到汗多胃躁的程度，所以用五苓渗热和表，不像阳明属里，汗多而胃躁。经又说：阳明发热汗多，急下之。同样是阳明汗多，前证戒利小便，此证不戒利大便，为什么呢？因为口渴是邪气散漫在经，未收敛入胃作实；此证不渴，则内已作实，外又发热，恐怕热内竭津液，所以急下之。况且猪苓、五苓又有可疑之处：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。脉证都相同，为什么用药不同呢？然而太阳邪在表，发汗不解，所以用五苓和表行津液；阳明邪已入里，热客下焦，所以用猪苓渗泻其热。唉！白虎、猪苓、五苓等药，如果能仔细考察机微，明白权变，那么可与不可与，才符合仲景的妙处。
另外有自利而渴条下注解说：伤寒热入于脏，流于少阴之经，少阴主肾，肾恶燥，所以渴而引饮。注用猪苓汤、白头翁汤。又后下利问中重复出自利而渴条下，却说肾虚故引水自救，通用白通、四逆、猪苓等汤。一问以渴为热，一问以渴为虚，冰炭不相容，凭借什么分别？又且分隶两门，假使后人临病检阅，前后不相闻，疑误岂是小事？现在详细审定：少阴病咳而下利、呕、渴、心烦、不得眠，及厥阴证下利欲饮水，都是传经之邪热，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，五苓不与。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，用小柴胡汤去半夏加栝蒌根。其余见本条。
太阴自利则不渴，惟少阴有口苦饮水、小便色白的，这是下有寒也，脉沉者用附子汤。若身寒厥逆、脉滑而口渴的，这是里有热也，用人参白虎汤。
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。凡用冰须以凉水洗净盐味方可。
戴元礼说：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。
(The *Neijing* states: "If a patient is not aversion to cold but feels thirsty, this indicates the pathogen has transferred to the Yangming channel." It also says: "After taking Xiao Chai Hu Tang (Minor Bupleurum Decoction), if thirst occurs, it belongs to the Yangming pattern." Therefore, "thirst" is categorized under the Yangming chapter.)
Cheng Wuji stated: In Shanghan (Cold Damage), when the pathogen transmits inward, thirst occurs; when the pathogen remains in the exterior, thirst does not occur. Although the Three Yang channels may occasionally present with thirst, it is not as severe as in the Three Yin channels. Taiyin disease presents with abdominal fullness and dry throat; Shaoyin disease presents with dry mouth and tongue accompanied by thirst; Jueyin disease presents with Xiao Ke (wasting-thirst syndrome). Xiao Ke refers to drinking large amounts of water yet producing little urine, because heat consumes fluids. Generally, upon initial 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 the Three Yang channels, use Wuling San (Five-Ingredient Powder with Poria); for severe thirst, use Baihu Tang (White Tiger Decoction). For severe heat and thirst in the Three Yin channels, purgation should be employed. If a patient with mild thirst forces excessive water intake, it can lead to palpitations, chest and hypochondriac fullness, asthma and coughing, hiccups, dry retching, edema, diarrhea, and dysuria. All these conditions arise from such errors.
In Taiyang disease, after sweating therapy, profuse sweating leads to dryness in the stomach, irritability, insomnia, and desire for water. Give small amounts frequently until the Stomach Qi harmonizes and recovery ensues. If pulse is floating, urination is difficult, there is slight fever, and wasting-thirst, use Wuling San (Five-Ingredient Powder with Poria). (Zhang Yuansu argued: For irritability and thirst, Baihu Tang (White Tiger Decoction) is appropriate. Why use Wuling San (Five-Ingredient Powder with Poria) to promote fluid metabolism? The answer is: Baihu Tang (White Tiger Decoction) is used when the exterior syndrome has resolved and the pathogen has transmitted inward causing irritability and thirst. Here, the pulse is still floating, there is slight fever and thirst, indicating the exterior pathogen has not fully resolved. Thus, the acridity of Guizhi (Cinnamon Twig) harmonizes the muscle layer, while the sweet and bland nature of Baizhu (Atractylodis Rhizoma) and Fuling (Poria) moistens deficiency-dryness. Note: This explanation is not entirely clear. Taiyang corresponds to the Bladder organ; the Bladder is the reservoir of urine. Wuling San (Five-Ingredient Powder with Poria) promotes urination. The Bladder is the mansion of body fluids; thus, Li Dongyuan considered thirst a primary disease of the Bladder channel. Therefore, treating thirst requires clearing Bladder heat, which is achieved by promoting urination.) After sweating, if the pulse is floating and rapid with irritability and thirst, use Wuling San (Five-Ingredient Powder with Poria).
Originally due to erroneous purgation leading to epigastric fullness (Pi), if Pi persists despite Xixin Tang (Gastrodia and Pinellia Decoction variants), and the patient presents with thirst, dry mouth, irritability, and dysuria, use Wuling San (Five-Ingredient Powder with Poria). In Fengzhong (Wind Strike) with fever for six or seven days without resolution, accompanied by irritability, both exterior and interior signs, desire for water, and vomiting immediately after drinking (Shui Ni / Water Reversal), use Wuling San (Five-Ingredient Powder with Poria).
Wuling San (Five-Ingredient Powder with Poria) Formula: Zhu Ling (Polyporus), Zexie (Alisma), Fuling (Poria), Guizhi (Cinnamomi Ramulus), Baizhu (Atractylodis Rhizoma). Grind the five herbs into powder. Take one cunbi (measure) mixed with rice water, three times daily. Drink plenty of warm water afterwards to induce sweating for cure. ("Ling" implies command; it regulates fluids and subdues Kidney pathogens. Fuling is the chief herb, hence the name. As per the *Neijing*, bland flavors promote drainage (Yang). To drain internal fluid retention, sweet-bland herbs are essential. Fuling (sweet/neutral) is the Sovereign; Zhu Ling (sweet/neutral) is the Minister. Spleen dislikes dampness; fluid retention impairs Spleen function. Sweet-warm herbs assist the Spleen to overcome dampness; Baizhu (sweet/warm) is the Assistant. As per the *Neijing*, salty flavors promote drainage (Yin). To guide urination, salty herbs assist; Zexie (salty/cold) is the Envoy. Fluid stagnation dries Kidney Qi. The *Neijing* states the Kidney dislikes dryness and needs acrid flavors to moisten. Guizhi (acrid/hot) acts as the Envoy to disperse and moisten. Drinking warm water induces sweating, dispersing water qi via the exterior.)
After taking Guizhi Tang (Cinnamon Twig Decoction) and sweating profusely, if severe irritability and thirst persist with a flooding pulse, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng).
Taiyang disease presenting with fever, thirst, and no aversion to cold is classified as Wenbing (Warm Disease).
Xiao Chai Hu Tang (Minor Bupleurum Decoction), Baihu Tang (White Tiger Decoction), Guizhi Tang (Cinnamon Twig Decoction), and Gui Zhi Jia Ren Shen Tang (Cinnamon Twig Decoction plus Ginseng, removing Cinnamon).
Shanghan with no significant fever, dry mouth/throat, irritability, and slight aversion to cold on the back, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng).
In Shanghan, if the pulse is floating, there is fever and anhidrosis, and the exterior syndrome is unresolved, Baihu Tang (White Tiger Decoction) must not be given. If there is thirst and desire for water without exterior signs, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). (Thirst and desire for water without exterior signs indicate the Taiyang syndrome has ceased and transferred to Yangming. The following clause shares this meaning: thirst arises from Taiyang transferring to Yangming.)
If Shanghan, after emesis or purgation, remains unresolved for seven to eight days, with heat accumulated internally, simultaneous exterior and interior heat, occasional aversion to wind, severe thirst, dry tongue, irritability, and desire to drink several liters of water, use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). (Wang Bing noted: Pure exterior syndromes have constant aversion to wind; here, heat exists in both interior and exterior, causing intermittent aversion to wind.)
Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng): Treats thirst with a flooding pulse and free urination.
Shigao (Gypsum), Zhimu (Anemarrhenae Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma), Jingmi (Oryzae Fructus), Renshen (Panacis Ginseng). Cut the herbs. Boil one qian (approx. 30g) in water, take warm.
Xu Shumi stated: A patient initially vomited, then was erroneously purged by another physician. After seven to eight days, internal and external fever persisted. I diagnosed it as requiring Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng). Someone asked: "Having vomited and been purged, the patient is doubly deficient; can Baihu Tang (White Tiger Decoction) be used?" I replied: "Zhongjing states that after emesis/purgation, if unresolved for seven to eight days with internal heat accumulation and simultaneous exterior/interior heat, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is indicated. Initial vomiting indicated heat in the Stomach; now the pulse is deficient and large. Three doses cured him." Zhongjing also stated: "In Shanghan, if pulse is floating, fever, anhidrosis, and exterior is unresolved, do not give Baihu Tang." And: "Floating-slippery pulse indicates exterior heat and interior cold; use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng)." Lin Yi corrected this, claiming Zhongjing confused interior/exterior. I disagree. Broadly, Baihu Tang clears thirst and fever in Shanghan. Whether described as simultaneous exterior/interior heat or exterior heat/interior cold, it is applicable. However, floating pulse with anhidrosis and unresolved exterior is strictly Mahuang Tang (Ephedra Decoction) or Gegen Tang (Kudzu Decoction); Baihu Tang is contraindicated. Lin Yi's criticism stems from lack of deeper thought.
Zhang Yuansu stated: Medication timing has risks of being too fast or slow. Rules prevent errors; formulas rescue where rules fail. The first clause above is Zhongjing's rule to prevent misuse; the second clause ("Shanghan after emesis/purgation...") provides the formula to treat. Baihu Tang (White Tiger Decoction) treats severe irritability and thirst. Ancient rules prevented its use before exterior resolution to avoid hastening treatment. However, if back aversion to cold or intermittent wind aversion coexist with severe thirst, only Baihu Tang (White Tiger Decoction) can suppress it. Waiting for complete exterior resolution risks delay. Where rules fail, formulas are needed. Abandoning formulas violates method. Both methods are indispensable.
Wu Kun stated: Some ask why Zhongjing forbids Baihu Tang (White Tiger Decoction) in unresolved exterior cases, yet prescribes it for intermittent wind aversion or back cold. Shi Gao (Gypsum) is acrid-cold, clearing Yangming channel heat. It is a divine drug for steaming fever, tidal fever, interior/exterior heat, dry tongue, and thirst. "Intermittent" means occasional; "back cold" is slight. For intense heat and dry thirst, Baihu Tang (White Tiger Decoction) is unquestionable. However, constant back cold without dry thirst is a strict contraindication. Also, Taiyang fever with thirst and anhidrosis is contraindicated. But post-sweating, if pulse is flooding and thirsty, it is allowed. For Yin Cold Damage with red face, irritability, fever, weak Stomach, loose stools, weak pulse, and minimal heat, Baihu Tang (White Tiger Decoction) is strictly forbidden; misuse brings immediate danger.
In Taiyang disease, after heavy sweating and purgation, if constipation persists for five to six days, with dry tongue, thirst, slight tidal fever at dusk, and hardness/fullness/pain from epigastrium to lower abdomen unyielding to touch, use Daxiexiong Tang (Major Expulsion of Chest Granules Decoction).
In Shanghan with fever, aversion to cold, severe thirst, abdominal fullness, spontaneous sweating, and free urination, the disease resolves. This is Liver attacking Lung, named Heng (Horizontal). Puncture Qimen (LR14).
In Yangming disease, profuse sweating and thirst contraindicate Zhuling Tang (Polyporus Decoction), as sweating causes Stomach dryness; further diuresis worsens deficiency. (Alternatives: Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Banxia (Pinelliae Rhizoma) adding Gualougen (Trichosanthis Radix), Zhuye (Phyllostachys Folium). Zhang Yuansu noted: Yangming sweating indicates unresolved disease and Stomach fluid dryness. Zhuling Tang (Polyporus Decoction) would cause double injury.) In Yangming disease, if pulse is floating-tight, throat dry, 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 (White Tiger Decoction plus Ginseng). If pulse is floating, fever, thirst, and dysuria, use Zhuling Tang (Polyporus Decoction).
In Shaoyang Shanghan/Wind Strike, with alternating chills and fever, hypochondriac fullness, silent anorexia, irritability, frequent retching, or thirst/cough, use Xiao Chai Hu Tang (Minor Bupleurum Decoction). If thirsty, remove Banxia (Pinelliae Rhizoma), add Renshen (Panacis Ginseng) and Gualougen (Trichosanthis Radix).
In Shanghan four to five days, with fever, aversion to wind, neck stiffness, hypochondriac fullness, warm hands/feet, and thirst, use Xiao Chai Hu Tang (Minor Bupleurum Decoction).
On day six or seven, with slow-floating-weak pulse, aversion to wind, warm hands/feet, if erroneously purged multiple times leading to inability to eat, hypochondriac fullness/pain, stiff neck/body, and dysuria, giving Chai Hu Tang (Bupleurum Decoction) will cause tenesmus. If originally thirsty and vomiting after drinking, Chai Hu Tang (Bupleurum Decoction) is contraindicated. (Some suggest Wuling San (Five-Ingredient Powder with Poria) plus Yinchenshao Tang (Artemisiae Scopariae Decoction).)
In Shaoyin disease, thirst with diarrhea belongs to Shaoyin. If accompanied by somnolence and white urine, use Sini Tang (Frigid Extremities Decoction). If accompanied by cough, retching, insomnia, and non-white urine, use Zhuling Tang (Polyporus Decoction). If accompanied by spontaneous diarrhea with pure green watery stool, use Dachengqi Tang (Major Order the Qi Decoction). If heat is present, use Baitouweng Tang (Pulsatillae Decoction) (see Diarrhea chapter).
In Jueyin disease, wasting-thirst, Qi rushing upward to the heart, heart pain, hunger without desire to eat, vomiting roundworms upon eating. If purged, diarrhea becomes uncontrollable. If desiring water, give small amounts frequently for cure. (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 wasting-thirst. Only in Jueyin does severe heat consume fluids, causing wasting-thirst (drinking much, urinating little). Wood generates Fire; Liver Qi connects to Heart. Jueyin guest-heat rushes to Heart, causing heart pain. Day six/seven is Jueyin disease; transmission completes entering the Fu organs. Stomach deficiency with guest-heat causes hunger/anorexia. Roundworms move in empty stomach, emerge with food smell. This is heat in Jueyin channel. Purging damages Stomach Qi, allowing Jueyin Wood pathogen to attack, causing violent vomiting/diarrhea. Note: Cheng Wuji's view of exterior-Yang transmitting inward is incorrect. Wasting-thirst and heart pain are Jueyin characteristics.)
Case Examples:
Thirst with head sweating, dysuria, hypochondriac fullness, alternating chills/fever: Chaihu Guizhi Jiangxin Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction). With jaundice: Yinchenshao Tang (Artemisiae Scopariae Decoction) (see Head Sweating chapter).
Unresolved exterior with fluid retention in Heart, dry retching, fever, cough, or thirst, diarrhea, dysphagia, dysuria, lower abdominal fullness, or asthma: Xiaolongtan Decoction (Minor Dragon Decoction). Alternatively, fluid retention with cough, slight asthma, fever, no thirst; post-medication thirst indicates cold resolving: Xiaolongtan Decoction (Remove Banxia (Pinelliae Rhizoma), add Gualougen (Trichosanthis Radix)).
Summer sweating, aversion to cold, fever, cold feet, thirst: Summerheat stroke. Use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) and Jiuhuanglian (Alcohol-processed Coptidis Rhizoma) (see Summerheat chapter; cold feet contraindicates exterior release).
Fever, aversion to cold, abdominal fullness, sweating, free urination, thirst: Liver attacking Spleen. Puncture Qimen (LR14) (see Abdominal Fullness chapter). Exterior resolved, no aversion to cold, thirst: Baihu Tang (White Tiger Decoction).
Thirst with hypochondriac fullness and alternating chills/fever, untreated: Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Banxia (Pinelliae Rhizoma) adding Renshen (Panacis Ginseng) and Gualougen (Trichosanthis Radix). Post-sweating/purgation: Chaihu Guizhi Jiangxin Tang (Bupleurum, Cinnamon Twig, and Ginger Decoction) (see Hypochondriac Pain chapter).
Thirst with epigastric hardness/pain, tidal fever, constipation: Jie Xiong (Chest Granules). Use Daxiexiong Tang (Major Expulsion of Chest Granules Decoction). If hard but painless: Pi (Fullness). Use Xixin Tang (Gastrodia and Pinellia Decoction variants). If unresolved with thirst and dysuria: Wuling San (Five-Ingredient Powder with Poria) (see Chest Granules/Pi chapters).
Yangming disease should be sweated; erroneously washed with cold water increases irritability, skin gooseflesh, desire for water but no thirst: Wenli San (Clam Shell Powder). If ineffective, Wuling Tang (Five-Ingredient Decoction) (see Chest Granules chapter).
Wenli San (Clam Shell Powder): Wenli (Clam Shell/Sea Clam Powder). Grind to powder, mix with boiling water, take one cunbi.
Thirst wanting water but unable to drink: Heat in Dantian, Cold in Chest (see Damp Bi chapter).
Wind Strike fever six/seven days, irritability, exterior/interior signs, thirst, vomiting after drinking: Shui Ni (Water Reversal). Use Wuling San (Five-Ingredient Powder with Poria).
Thirst wanting water: Post-Taiyang sweating (profuse sweating, irritability, insomnia) or Jueyin disease (Qi rushing, heart pain, vomiting worms): Give small amounts frequently for cure (see previous clauses and Qi Rushing chapter).
For seasonal epidemic diseases, days five/six with thirst wanting water: Do not give much. Internal heat is insufficient to metabolize water; excess water creates pathology. Days seven/eight with severe thirst: Give according to syndrome. Allow partial satisfaction, do not overfill. One dou gives five sheng. If abdominal fullness, dysuria, asthma, or hiccups occur after drinking, stop. Spontaneous profuse sweating indicates self-healing. (*Huoren* states: Only give water if severely thirsty; for mild thirst/dry throat, sip to moisten and harmonize Stomach.)
Ability to drink water indicates impending recovery. Forcing water for mild thirst causes disaster. (*Huoren* states: Forced water causing chest fullness/stress requires Wuling San (Five-Ingredient Powder with Poria) or Xiexiong Tang (Expel Granules Decoction).)
Diarrhea with weak/rapid pulse and thirst: Self-healing (see Diarrhea chapter).
Thirst with fever, floating-weak pulse (not string-tight): Sweating leads to cure (see Delirium chapter).
Lou Quanshan stated: *Huoren* warns: Taiyang anhidrosis with thirst contraindicates Baihu Tang (White Tiger Decoction); Yangming profuse sweating with thirst contraindicates Zhuling Tang (Polyporus Decoction). Is Taiyang thirst never treated with Baihu Tang (White Tiger Decoction)? Post-sweating, flooding pulse with thirst allows it. Is Yangming thirst never treated with Wuling San (Five-Ingredient Powder with Poria)? Yangming dysuria, less sweating, floating pulse with thirst allows it.
Zhao Sizhen stated: *Huoren* warns: Taiyang anhidrosis with thirst contraindicates Baihu Tang (White Tiger Decoction); Yangming profuse sweating with thirst contraindicates Wuling San (Five-Ingredient Powder with Poria). Examining Zhongjing: Two prohibitions exist. 1. "Shanghan floating pulse, fever, anhidrosis, thirst, no exterior signs: Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng); unresolved exterior: contraindicated." *Huoren* said "anhidrosis" instead of "unresolved exterior," which is an error. 2. "Yangming profuse sweating with thirst: contraindicate Zhuling Tang (Polyporus Decoction)." *Huoren* changed this to Wuling San (Five-Ingredient Powder with Poria). Zhuling Tang (Polyporus Decoction) drains; Wuling San (Five-Ingredient Powder with Poria) releases exterior and drains. Why change? Profuse sweating indicates Stomach dryness; Taiyang sweating is less severe, so Wuling San (Five-Ingredient Powder with Poria) harmonizes exterior and drains heat. Yangming sweating is severe, Stomach dry. Another clause: "Yangming fever, profuse sweating: urgent purgation." Same Yangming sweating, but one prohibits diuresis, the other prohibits delaying purgation. Thirst indicates pathogen in channel, not yet solidified in Stomach. No thirst indicates internal solidity and external heat, risking fluid exhaustion, hence urgent purgation. Regarding Zhuling Tang (Polyporus Decoction) vs. Wuling San (Five-Ingredient Powder with Poria): Taiyang floating pulse, dysuria, slight fever, wasting-thirst uses Wuling San (Five-Ingredient Powder with Poria). Yangming floating pulse, fever, thirst, dysuria uses Zhuling Tang (Polyporus Decoction). Similar symptoms, different formulas? Taiyang pathogen in exterior, post-sweating failure: Wuling San (Five-Ingredient Powder with Poria) harmonizes exterior/moves fluids. Yangming pathogen in interior, heat in Lower Jiao: Zhuling Tang (Polyporus Decoction) drains heat. Mastery of nuance reveals Zhongjing's brilliance.
Note on "Spontaneous Diarrhea with Thirst": Heat enters Zang, flows to Shaoyin. Kidney dislikes dryness, causing thirst. Formulas: Zhuling Tang (Polyporus Decoction), Baitouweng Tang (Pulsatillae Decoction). Later, regarding diarrhea, it attributes thirst to Kidney deficiency seeking water, using Baitong Tang (Aconite Decoction), Sini Tang (Frigid Extremities Decoction), Zhuling Tang (Polyporus Decoction). Contradiction: Thirst as Heat vs. Thirst as Deficiency. Mixing Ice and Charcoal causes confusion. Grouping them separately misleads later practitioners. Clarification: Shaoyin cough/diarrhea/vomit/thirst/irritability/insomnia + Jueyin diarrhea/desire for water = Transmitted Heat (deep-thready-rapid pulse). Use Huanglian (Coptidis Rhizoma)/Shihua (Gypsum) to clear/drain. Shaoyin spontaneous diarrhea/thirst/vomit/no appetite/somnolence = Direct Yin Pathogen (deep-micro pulse). Use Fuzi (Aconiti Lateralis Radix Preparata)/Ganjiang (Zingiberis Rhizoma) to warm. Why not combine? Clearing and warming depend on diagnosis.
Wu Kun stated: Classify thirst by Six Channels. Taiyang exterior heat: no thirst. Heat transmitting to Bladder base: irritability, floating-rapid pulse, dysuria. Use Wuling San (Five-Ingredient Powder with Poria); strictly contraindicate Baihu Tang (White Tiger Decoction).
Yangming long pulse, exterior heat, anhidrosis, thirst: Gegen Jieji Tang (Kudzu Muscle-Releasing Decoction) or Liutong Shengsan Decoction (Six-Unity Powder) with doubled Gegen (Kudzu Root) to sweat. Yangming heat transmitting to Stomach, aversion to heat, sweating, thirst, floating-hyper-rapid pulse: Renshen Baihu Tang (Ginseng White Tiger Decoction); Wuling San (Five-Ingredient Powder with Poria) contraindicated. Yangming base heat, steaming/tidal fever, dry tongue/thirst, constipation: Dachaihu Tang (Major Bupleurum Decoction) or Tiaowei Chengqi Tang (Regulate and Nourish the Qi Decoction) to purge. If not solid yet, use modified Xiao Chai Hu Tang (Minor Bupleurum Decoction).
Shaoyang string-rapid pulse, bitter taste, dry throat, fever, thirst: Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Banxia (Pinelliae Rhizoma) adding Gualougen (Trichosanthis Radix). See main clause.
Taiyin spontaneous diarrhea: no thirst. Shaoyin bitter taste, drinking, white urine: Cold below. Deep pulse: Fuzi Tang (Aconite Decoction). Body cold, cold extremities, slippery pulse, thirst: Heat inside. Renshen Baihu Tang (Ginseng White Tiger Decoction). Yin syndrome irritability/thirst, unable to drink, deep pulse, cold feet: Sini Tang (Frigid Extremities Decoction) served cold.
Desire for water in Shanghan/epidemics indicates recovery (water harmonizes Stomach, induces sweat). Without water, dryness prevents sweating, leading to death. Observe patient strength and heat severity. Give cautiously; better insufficient than excessive. Excess water causes retention harm. Use fresh well water. For severe heat/constipation, add Yuanmingfen (Mirabilite) 1-2 qian. For summerheat irritability/thirst, add Chen Sha Tianshui San (Cinnabar Sky-Water Powder). For deficiency irritability/anorexia, Dengxin Tang (Juncus Decoction) infused in water. For general thirst: weak tea, white plum soup, mung bean soup. Edibles: Perfume pear, lotus root, watermelon. Ice must be washed to remove salt.
Dai Yuanli stated: Ask about water preference (cold/hot, amount). Much/cold indicates Yang thirst. Investigate channel involvement. Taiyang dysuria/thirst: Wuling San (Five-Ingredient Powder with Poria). Yangming constipation/thirst: Seek in Yangming channel. If bowel movement restored but thirst persists: Baihu Tang (White Tiger Decoction). Shaoyang alternating chills/fever/thirst: Xiao Chai Hu Tang (Minor Bupleurum Decoction) removing Banxia (Pinelliae Rhizoma) adding Gualougen (Trichosanthis Radix). Yin syndromes may have spontaneous diarrhea/thirst. Ancient physicians often used cold agents for Yin-thirst as they involve Yang Qi (disease is Yang despite Yin channel). However, pure Yin syndrome with clear grains, no heat, reverse thirst: Yin below blocking Yang above, fluid loss from diarrhea causes dryness. Patient drinks little, prefers warmth. Do not use cold agents; use Lizhong Tang (Middle-Warming Decoction) or Sini Tang (Frigid Extremities Decoction) plus Renshen (Panacis Ginseng). Severe thirst: Lianli Tang (Coptis and Licorice Decoction). Yang syndromes rarely thirsty; Yin syndromes often thirsty. Yangming: mild thirst; Taiyin: severe thirst. Treatments: Harden Kidney Water (Huafen/Trichosanthis Radix) or Promote Urination (Fuling/Zhuling). Taiyin prioritizes urination; Yangming prohibits it; Shaoyang (half-exterior/half-interior) prohibits purgation. For persistent thirst, Xiao Chai Hu Tang (Minor Bupleurum Decoction) plus Huafen (Trichosanthis Radix) hardens Kidney Water, which moistens Large Intestine, softens stool, clears heat, resolves thirst. Taiyang/Bladder/Kidney channel: must promote urination to clear heat/thirst. Non-Taiyang irritability/thirst: Yin excess blocking Yang; do not moisten thirst, treat Yin.
Luo Tianyi stated: Shanghan with poor appetite and thirst: Harmonize Stomach herbs; avoid cooling agents. Cooling damages Stomach Qi, worsening anorexia. Baizhu (Atractylodis Rhizoma) and Fuling (Poria) are suitable.