(见上。) 先渴后呕。为水停心下。此属饮家。此汤主之。
犀在直趋庭闻训曰。此一节与上文似不相属。而不知先生治咳。着眼在水饮二字。故于
完篇
阴
小青
有寒
而化导
能以楮
地黄丸
(见妇人杂病。) 治男子消渴。小便反多。以饮一斗。小便亦一斗。此丸主之。
尤在泾云。水液属阴。非气不至。气虽属阳。中实含水。水与气。非一亦非二也。方中
若无桂、附。何以振作肾中颓落之阳。游溢精气。上输脾肺邪。
(见痰饮。) 治脉浮小便不利。微热消渴者。宜利小便发汗。 又治渴欲饮水。水入
则吐者。名曰水逆。
尤在泾云。热渴饮水。水入不能已其热。热亦不能消其水。水与热结。热浮水外。故小
便不
已消
(歌见长沙方歌括。)治渴欲饮水不止者。此散主之。
文蛤
男元犀按。与伤寒论文蛤散症不同。伤寒论云。肉上粟起。反不渴者。水寒浸肺。涌于
外。
本
止
便
治小便不利者有水气。其人若渴者宜之。
薯蓣 茯苓(各三两。) 栝蒌根(二两。) 附子(一枚。炮。) 瞿麦(一两。)
上五味末之。炼蜜丸如梧子大。饮服二丸。日三服。不知。增至七八丸。以小便利腹中
温为
歌曰 小便不利渴斯成。水气留中液不生。(下焦火衰。中焦土弱。水气存于中。阻其
上下
男元犀按。内经云。膀胱者州都之官。津液存焉。气化则能出矣。余于气化能出之义。
而借
也。
义也。锅下虽要加薪。而其上亦要频换凉水。取凉水之气。助其清肃以下行。则源源不竭。
方中栝蒌根清上焦之热。即其义也。至于出酒之窍道。虽云末所当后。亦须去其积垢而通达。
方中瞿麦一味专通水道。清其源而并治其流也。方后自注腹。中温三字。大有深义。
(见上文。)先出现口渴,随后发生呕吐。这是因为水饮停滞在心下(胃脘部)。这属于痰饮病范畴。此汤剂主治此证。
犀在直趋庭闻训曰:这一节与上文似乎没有关联,但不知道先生治疗咳嗽,着眼点在于“水饮”二字。所以于完篇阴小青有寒而化导能以楮地黄丸
(见妇人杂病篇。)治疗男子消渴病,小便反而增多,喝水一斗,小便也排出一斗。此丸剂主治此证。
尤在泾说:水液属于阴,没有阳气就不能到达;气虽然属于阳,其中实际上含有水。水和气,既不是完全一样,也不是完全两回事。方中如果没有桂枝、附子,怎么能振奋肾中衰颓的阳气,使精气游溢上行,输送到脾肺?
(见痰饮篇。)治疗脉浮、小便不利、微热且消渴的患者,应当采用利小便并发汗的方法。又治疗想喝水,水喝进去就吐出来的情况,名叫“水逆”。
尤在泾说:因热而渴想喝水,水喝进去不能消除热,热也不能消化水。水与热结合,热浮在水外,所以小便不通畅,热也不能消除。
(歌诀见《长沙方歌括》。)治疗想喝水且喝水不止的情况。此散剂主治此证。
男元犀按:这与《伤寒论》中论述文蛤散的病症不同。《伤寒论》说:皮肤上起粟粒状疙瘩,反而不渴的,是水寒浸淫肺部,涌出于体表。本止便
薯蓣(各三两)、茯苓(各三两)、栝蒌根(二两)、附子(一枚,炮制)、瞿麦(一两)。
以上五味药研成末,用炼蜜制成梧桐子大小的丸剂。饮水送服二丸,每日三次。若无效,逐渐增加到七八丸,以小便通利、腹部温暖为度。
歌诀曰:小便不利导致口渴,水气停留中焦津液不生。(下焦火衰,中焦土弱,水气存留于中,阻碍上下气机运行)
男元犀按:《内经》说:膀胱是州都之官,津液储存于此,依靠气化作用才能排出。我对于“气化则能出”的含义,而借义也。锅下虽要加薪,而其上亦要频换凉水。取凉水之气,助其清肃以下行,则源源不竭。方中栝蒌根清除上焦的热,就是这个道理。至于排尿的窍道,虽然说是最后才考虑,但也必须去除积垢使其通达。方中瞿麦一味药专门疏通水道,清理源头并兼治支流。方后自注“腹中温”三个字,大有深意。
(See above.) First thirst followed by vomiting indicates water retention in the epigastrium (stomach area). This belongs to the category of fluid retention diseases. This decoction is indicated for this condition.
Xi Zaizhi, hearing instructions from his father Ting, said: This section seems unrelated to the preceding text, but one does not know that when Master treats cough, the focus is on the two characters "water and fluid" (Shui Yin). Therefore, regarding the completion of the chapter, Yin Xiao Qing has cold and transforms and guides, able to use Chu Di Huang Wan.
(See Women's Miscellaneous Diseases.) Treats male Xiao Ke (wasting-thirst syndrome) where urination is excessive; drinking one dou results in urinating one dou. This pill is indicated for this condition.
You Zaijing said: Water fluids belong to Yin and cannot reach without Qi. Although Qi belongs to Yang, it actually contains water within. Water and Qi are neither identical nor completely separate. Without Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite Root) in the formula, how can one rouse the declining Yang of the Kidney, allowing Jing Qi (Essence Qi) to overflow and be transported upward to the Spleen and Lung?
(See Phlegm-Fluids.) Treats patients with a floating pulse, difficulty in urination, slight fever, and wasting-thirst. One should promote diuresis and induce sweating. It also treats cases where there is an urge to drink water, but vomiting occurs immediately after swallowing, known as "Water Reversal" (Shui Ni).
You Zaijing said: When heat causes thirst and the desire to drink, water intake cannot extinguish the heat, nor can the heat dissolve the water. Water and heat bind together, with heat floating outside the water, thus causing urinary difficulty and preventing the elimination of heat.
(The rhyme is found in *Changsha Fang Ge Kuo*.) Treats cases of persistent thirst and inability to stop drinking. This powder is indicated for this condition.
Nan Yuanxi noted: This differs from the Wen Ge San (Clam Shell Powder) syndrome discussed in *Shang Han Lun*. *Shang Han Lun* states: If millet-grain-like bumps appear on the skin and there is no thirst, it is due to water-cold soaking the Lungs and surging outward. Ben stops Bian.
Treats difficulty in urination accompanied by water qi (fluid accumulation). If the patient presents with thirst, this formula is appropriate.
Dioscoreae Rhizoma (Shu Yu), Poria (Fu Ling) (each 3 liang), Puerariae Radix (Gua Lou Gen) (2 liang), Aconiti Lateralis Radix Praeparata (Fu Zi) (1 piece, prepared), Impatiens Herba (Qu Mai) (1 liang).
Grind the above five herbs into powder. Mix with refined honey to make pills the size of wu zi (cibotium seeds). Take 2 pills with water, three times a day. If ineffective, increase gradually to 7 or 8 pills. The treatment is considered effective when urination becomes smooth and the abdomen feels warm.
The rhyme states: Difficulty in urination leads to thirst; water qi stagnates in the middle, failing to generate fluids. (Lower Jiao fire declines, Middle Jiao earth weakens; water qi remains in the middle, obstructing the movement of upper and lower energies.)
Nan Yuanxi noted: *Nei Jing* states: The Bladder is the official of the capital, storing fluids; only through Qi transformation can they be excreted. Regarding the meaning of "Qi transformation enables excretion," I borrow the principle. Although coal needs to be added under the pot, cool water must frequently be replaced on top. Taking the energy of the cool water assists its clear and descending nature, ensuring a continuous supply. In the formula, Gua Lou Gen clears heat in the Upper Jiao, which illustrates this principle. As for the pathway of urine excretion, although it should be addressed last, one must remove accumulated impurities to ensure patency. Qu Mai in the formula specifically unblocks the water pathways, clearing the source and treating the branches simultaneously. The note "abdominal warmth" at the end of the formula carries profound significance.