Thirst is one of the common clinical symptoms. In the “Jin Kui Yao Lue”, there are over 50 entries discussing thirst, which not only serves as a model for treating thirst syndromes in later generations but also effectively guides clinical practice to this day. The author intends to summarize its major treatment methods into 12 aspects, described as follows.
1. Benefit Qi and Generate Fluids, Clear Heat and Stop Thirst Method
This method is suitable for thirst due to excessive heat in the lungs and stomach, with both Qi and fluids damaged. The formula used is Bai Hu Jia Ren Shen Tang (White Tiger Decoction with Ginseng).
As stated in the 26th entry of the “Jing Shi Re Bing” chapter: “When there is heat in the Tai Yang, it is called ‘re’. Sweating leads to aversion to cold, body heat, and thirst; Bai Hu Jia Ren Shen Tang is the main treatment.” ‘Re’ refers to heat stroke, and ‘Tai Yang heat’ indicates a condition caused by exposure to summer heat. Summer heat is a Yang pathogen that rises and disperses, causing the pores to open and sweat to flow; excessive sweating leads to vacuity of the pores, resulting in aversion to cold; heat from summer causes fever, thus leading to thirst.
With internal heat and damage to both Qi and fluids, Bai Hu Tang (White Tiger Decoction) is used to clear heat from the lungs and stomach, and Ren Shen (Ginseng) is added to benefit Qi and generate fluids, alleviating thirst as heat is resolved and fluids are restored. As stated in the “Shang Han Su Yuan Ji”: “Re is the evil of summer heat, its Qi is inherently hot, and does not wait to enter the interior, hence the person is thirsty… Therefore, gypsum is used to treat the seasonal summer heat evil, and Ren Shen is added to supplement the vacuity caused by sweating, increasing fluids to treat dryness and thirst.”
2. Warm and Supplement Kidney Yang, Transform Qi and Stop Thirst Method
This method is suitable for thirst due to deficiency of Kidney Yang and failure of Qi transformation. The formula used is Shen Qi Wan (Kidney Qi Pill).
The 3rd entry of the “Xiao Ke Xiao Bian Bu Li Lin Bing” chapter states: “For men with thirst, if urination is excessive, drinking one dou leads to urinating one dou, Shen Qi Wan is the main treatment.” The kidneys govern water, and the Yang of the kidneys is responsible for the entire fluid metabolism process. When Kidney Yang is deficient, it cannot vaporize fluids to moisten, nor can it transform to retain water, leading to thirst and excessive urination; thus, the treatment should focus on warming and supplementing Kidney Yang.
Shen Qi Wan contains Liu Wei Di Huang Wan (Six Flavor Rehmannia Pill) to nourish Kidney Yin; when Yin is abundant, Yang will flourish, and Yang will have support, preventing it from floating outward: it includes Gui Zhi (Cinnamon Twig) and Fu Zi (Aconite) to warm Yang and nourish the kidneys, supplementing the fire within water, invigorating Kidney Qi, allowing it to vaporize fluids to stop thirst above and transform water below. The “Yi Zong Jin Jian” states: “This formula is to warm and nourish Yang within Yin, allowing Kidney Yin to retain water without directly descending to the lower source; when Kidney Qi rises, it can generate fluids to stop thirst.”
3. Salty and Cold, Moisten and Generate Fluids to Stop Thirst Method
This method is suitable for thirst due to Yin deficiency and dryness-heat, with an unquenchable desire to drink water. The formula used is Wen Ge San (Clam Powder).
The 6th entry of the “Xiao Ke Xiao Bian Bu Li Lin Bing” chapter states: “For those who have an unquenchable thirst, Wen Ge San is the main treatment.” When Kidney Yin is weak, it cannot restrain the raging fire, and heat moves to the lungs, causing lung dryness and Yin damage, leading to an unquenchable thirst. However, water cannot eliminate the heat or control the dryness, and instead, it is consumed by the dryness and heat, resulting in continuous thirst.
Wen Ge San contains only Wen Ge (clam), which is salty and cold in nature, capable of nourishing Yin, moistening dryness, and guiding heart heat downward, thus generating fluids and alleviating thirst. As stated in the “Jin Kui Yu Han Jing”: “Its taste is salty and cold; salty and cold originates from water, thus it can benefit water; its nature is moistening and descending, which can guide water. Combining salty and cold with moistening can reduce heat, treating thirst due to heat syndrome, as Kidney water is deficient and cannot restrain the raging fire, thus thirst arises; now, benefiting water treats fire, achieving two results with one remedy.”
4. Harmonize Ying and Wei, Expel Dampness and Stop Thirst Method
This method is suitable for thirst due to water-dampness invading the meridians, obstructing the movement of Ying and Wei, and Qi failing to transform fluids. The formula used is Qi Shao Gui Jiu Tang (Astragalus, Peony, and Cinnamon Wine Decoction).
The 28th entry of the “Shui Qi Bing” chapter states: “For the disease of yellow sweat, the body swells, with fever, sweating, and thirst… Qi Shao Gui Jiu Tang is the main treatment.” This thirst arises from the mutual stagnation of damp-heat, affecting both Ying and Wei.
Therefore, Qi Shao Gui Jiu Tang is used to harmonize Ying and Wei, strengthen Wei to expel dampness, and simultaneously drain stagnant heat. This allows Wei Yang to be strengthened, Ying Yin to be nourished, damp-heat to be cleared, Qi to circulate, and fluids to be distributed, thus alleviating thirst.
5. Move Qi and Activate Blood, Open Yang and Stop Thirst Method
This method is suitable for thirst due to liver Qi stagnation and blood stasis. The formula used is Xuan Fu Hua Tang (Inula Flower Decoction).
The 7th entry of the “Wu Zang Feng Han Ji Ju Bing” chapter states: “When the liver is constrained, the person often wants to step on their chest; before the onset of pain, they only desire hot drinks; Xuan Fu Hua Tang is the main treatment.” The disease of liver constraint is caused by Qi stagnation and blood stasis, leading to the obstruction of Yang Qi. Hot drinks can help to open the Qi mechanism, allowing chest Yang to temporarily circulate, hence the thirst and desire for hot drinks before the onset of the disease. However, if the stasis is not resolved, the disease will not be eliminated; thus, Xuan Fu Hua Tang is used to move Qi, activate blood, open Yang, and disperse stasis, allowing Qi and blood to flow smoothly, and when Yang Qi is unblocked, blood stasis can be transformed, thus curing the liver constraint and alleviating thirst.
As stated in the “Jin Kui Fa Wei”: “In the case of liver constraint… the Yang Qi in the chest is not comfortable, hence before the disease, they seek heat for self-rescue. The formula of Xuan Fu Hua Tang uses 14 stalks of scallion to open Yang and harmonize the liver, 3 taels of Xuan Fu Hua to assist the lungs, and Xin Jiang to open the collaterals, thus curing the liver constraint.”
6. Benefit Qi and Supplement the Spleen, Warm the Lungs and Stop Thirst Method
This method is suitable for thirst due to cold deficiency of the lungs, with continuous coughing and spitting of phlegm, and dryness in the throat. The formula used is “Qian Jin” Sheng Jiang Gan Cao Tang (Ginger and Licorice Decoction from “Qian Jin”).
The “Lung Atrophy and Lung Abscess Coughing and Shortness of Breath Disease” chapter states: “The ‘Qian Jin’ Sheng Jiang Gan Cao Tang: treats lung atrophy, continuous coughing and spitting of phlegm, and dryness in the throat.” The spleen and stomach Qi is deficient, and water is cold and not moving, unable to transform fluids to nourish the lungs, leading to lung atrophy and dryness in the throat, thus the treatment should focus on supplementing the spleen and warming the lungs. The ingredients of ginseng, licorice, and jujube supplement spleen Qi and generate fluids; ginger is spicy and disperses warmth to warm the middle palace and distribute fluids. This allows the fluids in the stomach to irrigate the lungs, preventing dryness and heat from damaging the lung leaves, thus alleviating thirst.
7. Transform Qi, Benefit Water, and Moisten Dryness to Stop Thirst Method
This method is suitable for thirst due to cold below and dryness above. The formula used is Gua Lou Qu Mai Wan (Trichosanthes and Plantago Seed Pill).
The 10th entry of the “Xiao Ke Xiao Bian Bu Li Lin Bing” chapter states: “For those with difficulty urinating, with water Qi, and suffering from thirst, Gua Lou Qu Mai Wan is the main treatment.” This is due to insufficient Kidney Yang, which cannot transform Qi in the bladder, leading to difficulty urinating; the true Yang in the lower burner is deficient, unable to vaporize fluids upward, resulting in dryness and heat in the upper burner, thus causing thirst. The treatment should invigorate Kidney Yang and restore Qi transformation.
Thus, it can both open the water pathways and vaporize fluids upward; when fluids are vaporized and water is lowered, all symptoms will resolve.
The “Yi Zong Jin Jian” states: “This formula uses Dioscorea and pollen to moisten dryness and generate fluids, thus alleviating thirst; it uses Poria and Qu Mai to drain and benefit water, thus facilitating urination; it also adds roasted Aconite to promote Yang Qi, vaporizing fluids upward and draining water Qi downward…”
8. Promote Urination and Induce Sweating to Stop Thirst Method
This method is suitable for thirst due to Qi failing to transform fluids and water retention in the bladder. The formula used is Wu Ling San (Five-Ingredient Powder).
The 4th entry of the “Xiao Ke Xiao Bian Bu Li Lin Bing” chapter states: “When the pulse is floating, urination is difficult, and there is slight heat and thirst, it is advisable to promote urination and induce sweating; Wu Ling San is the main treatment.” The 5th entry states: “For those who desire to drink water, but water enters and is immediately vomited, this is called water reversal; Wu Ling San is the main treatment.”
Although both are caused by water retention, the symptoms are slightly different. The former is due to exterior pathogens not resolving, heat cannot be released, and bladder Qi transformation is obstructed, causing water to stagnate below, preventing fluids from being distributed, leading to thirst; the latter is due to bladder Qi transformation failing, water not being transported downward, resulting in water retention in the lower burner and also in the stomach, preventing fluids from being distributed upward, thus leading to thirst and vomiting when drinking water.
Since both conditions share a similar pathogenesis, Wu Ling San is used to transform Qi and move water, resolving both interior and exterior, allowing water to be eliminated and fluids to be distributed, thus alleviating thirst. As stated in the “Jin Kui Yao Lue Xin Dian”: “Wu Ling San resolves the water that is congealed with heat… when heat is eliminated and water is removed, thirst will naturally cease.”
9. Promote Water and Transform Phlegm to Stop Thirst Method
This method is suitable for thirst due to stagnant fluids in the stomach, with obstruction of Yang and failure of fluids to ascend. The formula used is Fu Ling Ze Xie Tang (Poria and Alisma Decoction).
The 18th entry of the “Ou Tu He Xia Li Bing” chapter states: “When the stomach is obstructed, vomiting occurs, and there is thirst with a desire to drink water, Fu Ling Ze Xie Tang is the main treatment.” This is due to stagnant fluids in the stomach, leading to disharmony and downward movement, causing vomiting, and obstructing the Qi mechanism, preventing fluids from ascending, thus leading to thirst and an increased desire to drink water, which exacerbates the drinking evil, resulting in continuous vomiting.
Therefore, Fu Ling Ze Xie Tang is used to open Yang, transform Qi, promote water, and eliminate stagnant fluids. This allows Qi to transform and water to flow, thus alleviating vomiting and thirst. As stated in the “Jin Kui Yao Lue Qian Zhu”: “If there is water retention in the stomach and vomiting occurs, if thirst arises, the water and fluids will be expelled together; if thirst arises before vomiting, it indicates that the old fluids have not been expelled, and new water increases due to thirst, leading to continuous vomiting and thirst. This is not a method of seeking transformation from the spleen; how can vomiting and thirst be resolved? Fu Ling Ze Xie Tang is the main treatment.”
10. Nourish Yin and Promote Water to Stop Thirst Method
This method is suitable for thirst due to mutual binding of water and heat, with heat damaging Yin. The formula used is Zhu Ling Tang (Polyporus Decoction).
The 13th entry of the “Xiao Ke Xiao Bian Bu Li Lin Bing” states: “When the pulse is floating and there is fever, with thirst and difficulty urinating, Zhu Ling Tang is the main treatment.”
This condition involves changes in the lungs, where lung heat damages fluids, leading to thirst and a desire to drink water. When the lungs are damaged, the upper source is not clear, and it cannot regulate the water pathways downward to the bladder, resulting in difficulty urinating. The internal water evil must bind with the heat evil, and the stagnant heat further damages Yin; thus, Zhu Ling Tang is used to promote water, eliminate heat, nourish Yin, and moisten dryness to stop thirst. As stated in the “Jin Kui Yao Lue Qian Zhu Bu”: “This Zhu Ling Tang syndrome arises from the lung meridian, where the lungs govern the skin and hair, and the initial disease is heat; thus, lung heat is present. When lung heat is not distributed, thirst arises and there is a desire to drink water.”
11. Treat Internally and Externally to Stop Thirst Method
This method is suitable for prolonged cases of lily disease, with significant internal heat due to Yin deficiency. Internally, Bai He Di Huang Tang (Lily and Rehmannia Decoction) is used, and externally, Bai He Wash is applied.
The 6th entry of the “Bai He Bing” chapter states: “If Bai He disease does not resolve after a month and turns into thirst, Bai He Wash is the main treatment.” The appearance of thirst in Bai He disease indicates significant internal heat due to Yin deficiency, with evil heat lingering in the lungs and stomach, damaging fluids.
At this time, simply taking Bai He Di Huang Tang may not be sufficient, so a combined internal and external approach is adopted. Internally, Bai He Di Huang Tang is taken, and externally, Bai He Wash is used to wash the body. Since the lungs are connected to the skin, washing the exterior can also clear the interior, achieving the effect of clearing heat, nourishing Yin, and moistening dryness, thus alleviating thirst. As stated in the “Zhang Shi Yi Tong”: “If it does not resolve after a month, the hundred vessels are blocked, and fluids are not transformed, leading to thirst; thus, using Bai He Wash can ensure that all the vessels are unblocked and fluids circulate, alleviating thirst.”
12. Dietary Regulation to Stop Thirst Method
This method is suitable for thirst due to damage to fluids in the stomach. Barley porridge or cooked pancakes can be used.
The 10th entry of the “Fu Ren Ren Cheng Bing” chapter states: “If thirst arises after vomiting, barley porridge should be consumed.” Pregnancy vomiting damages fluids, leading to thirst; thus, barley porridge is needed to generate fluids. Li Shizhen stated that barley has the function of “eliminating thirst, clearing heat, and benefiting Qi to regulate the middle”, which is precisely this.
Additionally, after using Bai He Wash, it is stated: “After washing, eat cooked pancakes…” When thirst arises after prolonged Bai He disease, not only should Bai He Di Huang Tang be taken, but Bai He Wash should also be used externally. After washing, cooked pancakes can be consumed, which are made from wheat flour, capable of benefiting Qi and nourishing Yin, helping to clear heat and stop thirst.
Source: “Henan Traditional Medicine”, please indicate the source when reprinting.
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