麻黄（去节）六两 桂枝二两 甘草（炙）二两 杏仁（去皮、尖）四十个 生姜三
两大枣十二枚 石膏如鸡子大
右七味，以水九升，先煮麻黄，减二升，去上沫，内诸药，煮取三升，去滓，温服一
升，取微似汗，汗多者，温粉扑之。
麻黄（去节）三两 芍药三两 五味子半升 干姜三两 甘草（炙）三两 细辛三两
桂枝三两 半夏（汤洗）半升
右八味，以水一斗，先煮麻黄，减二升，去上沫，内诸药，煮取三升，去滓，温服一
升。
【集解】
尤怡曰：大青龙合桂麻而去芍药加石膏，则水气不甚而挟热者宜之。倘饮多而寒伏，
则必以小青龙为当也。
@@@
肺饮不弦，但苦喘短气。
【注】
弦为诸饮之诊，然专主者肝也。水在肝部，则病悬饮，故脉沉弦也；水在肺部，则病
支饮，故脉不弦也。喘欬短气，肺饮证也；□下引痛，肝饮证也。今亦不见□下引痛
之肝证，但见苦喘短气之肺证，故曰：肺饮不弦也。
【集注】
李□曰：弦为肝脉，故肺饮不弦，苦喘短气，肺邪迫塞也，前云欬逆倚息短气为支饮
是也。
@@@
支饮亦喘而不能卧，加短气，其脉平也。
【注】
支饮水在肺之病，故亦喘而不能卧，短气也。其脉平，谓见肺之平脉，或浮、或涩、
或短，此详申上条不弦之义也。
@@@
支饮不得息，葶苈大枣汤主之。
【注】
此承上条，以明其治也。喘欬不能卧，短气不得息，皆水在肺之急证也，故以葶苈大
枣汤，直泻肺水也。
【集注】
沈明宗曰：此支饮偏溢于肺也。支饮贮于胸膈，上干于肺，气逆则呼吸难以通彻，故
不得息。然急则治标，所以佐大枣之甘以保脾，葶苈之苦以泄肺，俾肺气通调，脾得
转输，为峻攻支饮在肺之方也。
尤怡曰：不得息，肺满而气闭也，葶苈入肺，通闭泄满。用大枣者，不使伤正也。
葶苈大枣汤方（见肺痈中）
@@@
膈间支饮，其人喘满，心下痞坚，面色黧黑，其脉沉紧，得之数十日，医吐下之不愈
，木防己汤主之。虚者即愈，实者三日复发，复与不愈者，宜木防己汤去石膏加茷芩
芒硝汤主之。
【注】
支饮则喘满不得息，水在胸肺也，更兼心下痞坚，则水盘结连引膈间，故曰：膈间支
饮也。面色黧黑，水邪深结之色也。其脉沉紧，水邪深结之脉也。水邪深结，故有喘
满痞坚之证也。得之数十日，医或吐之不愈者，是水邪不单结在上，故越之而不愈也
。或下之不愈者，是水邪不单结在下，虽竭之亦不愈也。心下痞坚，饮结在中可知，
故以木防己汤开三焦水结，通上中下之气。方中用人参以吐下后伤正也。故水邪虚结
者，服之即愈。若水邪实结者，虽愈亦复发也，即复与前方亦不能愈，当以前方减石
膏之寒凝，加芒硝峻开坚结，加茯苓直输水道，未有不愈者也。
【集注】
李□曰：喘满痞坚，膈间支饮逆上也。面黑者，饮属北方水色也。脉沉为饮，紧为寒
，皆阴脉，以水饮禀阴寒之气也。吐下俱行不愈，则阴阳之气俱虚，木防己汤补虚散
饮，虚者受补即愈。实者饮邪固结不解，故复发不愈，乃寒气凝聚未解，故去石膏，
恐寒胃也。加茯苓淡以渗饮，芒硝咸以软坚。
大青龙汤方：麻黄（去除节段）六两，桂枝二两，甘草（蜜炙）二两，杏仁（去皮、尖）四十个，生姜三两，大枣十二枚，石膏如鸡蛋大小。以上七味药，用水九升，先煮麻黄，水量减少二升，撇去水面浮沫，加入其余药物，煎煮取汁三升，滤去药渣，每次温服一升，服药后以微微出汗为宜；若汗出过多，用温粉扑身止汗。
小青龙汤方：麻黄（去除节段）三两，芍药三两，五味子半升，干姜三两，甘草（蜜炙）三两，细辛三两，桂枝三两，半夏（热水洗）半升。以上八味药，用水一斗，先煮麻黄，水量减少二升，撇去水面浮沫，加入其余药物，煎煮取汁三升，滤去药渣，每次温服一升。
【集解】
尤怡说：大青龙汤是在桂枝汤和麻黄汤合方的基础上去掉芍药，加入石膏而成，适用于水气不重而兼有热邪的证候。如果饮水多且寒邪潜伏体内，则应当使用小青龙汤。
@@@
肺中有水饮停聚，脉象不呈弦象，患者只感到气喘、呼吸短促的痛苦。
【注】
弦脉是各种水饮病的常见脉象，但主要归属于肝脏。水邪在肝部，则病名为悬饮，所以脉象沉弦；水邪在肺部，则病名为支饮，所以脉象不弦。气喘咳嗽、呼吸短促，是肺中水饮的症状；胁下牵引作痛，是肝中水饮的症状。现在既没有看到胁下牵引作痛的肝经症状，只见到痛苦于气喘、呼吸短促的肺经症状，所以说：肺中水饮脉象不弦。
【集注】
李□说：弦脉是肝的脉象，所以肺中水饮脉不弦。痛苦于气喘、呼吸短促，是因为肺中邪气迫塞所致，前文所说“咳嗽逆气、倚靠呼吸、呼吸短促”即为支饮，正是此意。
@@@
支饮也会导致气喘而不能平卧，加上呼吸短促，其脉象平和（不弦）。
【注】
支饮是水邪在肺部的疾病，所以也会气喘而不能平卧，伴有呼吸短促。所谓脉象平和，是指出现肺的正常脉象，或者浮脉、涩脉、短脉，这是对上一条文中“脉不弦”含义的详细阐述。
@@@
支饮导致呼吸困难，葶苈大枣汤主治。
【注】
这是承接上一条文，来说明治疗方法。气喘咳嗽不能平卧，呼吸短促甚至无法顺畅呼吸，都是水邪在肺部的急症，所以用葶苈大枣汤，直接泻除肺中的水邪。
【集注】
沈明宗说：这是支饮偏溢于肺部。支饮贮存在胸膈，向上干扰肺部，气机逆乱则呼吸难以通畅，所以呼吸困难。然而急则治其标，所以佐以大枣的甘味来保护脾胃，用葶苈的苦味来泄降肺气，使肺气通调，脾脏得以转输，这是峻烈攻逐肺中支饮的方剂。
尤怡说：呼吸困难，是肺满而气机闭塞，葶苈入肺，能通闭泄满。使用大枣，是为了防止损伤正气。
葶苈大枣汤方（见肺痈篇中）
@@@
胸膈间有支饮，患者气喘胸闷，心下部痞硬胀满，面色黧黑，脉象沉紧，得病已数十日，医生曾用吐法或下法治疗但未痊愈，木防己汤主治。体质虚者服药即愈，体质实者三天后复发，再次服用原方仍不愈者，宜用木防己汤去石膏加茯苓芒硝汤主治。
【注】
支饮会导致气喘胸闷、呼吸困难，这是水邪在胸肺。再加上心下部痞硬胀满，说明水邪盘结并牵连膈间，所以称为膈间支饮。面色黧黑，是水邪深结的表现。脉象沉紧，也是水邪深结的脉象。因为水邪深结，所以出现气喘、胸闷、痞硬等症状。得病数十日，医生如果用吐法治疗未愈，说明水邪不单结在上焦，所以发散上焦的方法无效；如果用下法治疗未愈，说明水邪不单结在下焦，即使竭尽下法也无效。心下部痞硬胀满，可知饮邪结在中焦，所以用木防己汤开通三焦的水邪结滞，疏通上、中、下三焦的气机。方中使用人参，是因为经过吐下治疗后正气受损。所以如果是水邪虚结的情况，服用后即愈。如果是水邪实结的情况，虽然暂时痊愈也会复发，此时再给前方也不能治愈，应当以前方为基础，减去石膏的寒凝之性，加入芒硝峻烈攻破坚结，加入茯苓直通水道，没有不愈的道理。
【集注】
李□说：气喘、胸闷、痞硬胀满，是膈间支饮之气上逆所致。面色发黑，是因为水饮对应北方黑色。脉沉主饮，脉紧主寒，都是阴脉，因为水饮禀受阴寒之气。吐法和下法都用了却未痊愈，说明阴阳之气都虚弱，木防己汤能补虚散饮，虚证患者接受补益即可痊愈。实证患者因饮邪固结不解，所以复发不愈，这是因为寒气凝聚未解，所以去掉石膏，恐怕伤及胃气。加入茯苓淡渗利水以排除饮邪，加入芒硝咸味以软化坚结。
Decoction of Ma Huang (Ephedrae Herba) with Gu Zhi (Cinnamomi Ramulus) and Shi Gao (Gypsum Fibrosum), known as Da Qing Long Tang: Ma Huang (Ephedrae Herba) six liang, Gu Zhi (Cinnamomi Ramulus) two liang, Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) two liang, Xing Ren (Armeniacae Semen Amarum) forty kernels, Sheng Jiang (Zingiberis Rhizoma Recens) three liang, Da Zao (Jujubae Fructus) twelve pieces, Shi Gao (Gypsum Fibrosum) the size of a chicken egg. The above seven ingredients are decocted in nine sheng of water. First, boil Ma Huang until the volume reduces by two sheng, skim off the foam on the surface, then add the remaining herbs. Continue boiling to obtain three sheng of liquid, strain out the dregs, and take one sheng warm. Aim for a slight sweating; if sweating is excessive, apply warm powder to the body to stop it.
Decoction of Ma Huang (Ephedrae Herba) with Wu Wei Zi (Schisandrae Chinensis Fructus), known as Xiao Qing Long Tang: Ma Huang (Ephedrae Herba) three liang, Bai Shao (Paeoniae Radix Alba) three liang, Wu Wei Zi (Schisandrae Chinensis Fructus) half sheng, Gan Jiang (Zingiberis Rhizoma) three liang, Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) three liang, Xi Xin (Asari Radix et Rhizoma) three liang, Gui Zhi (Cinnamomi Ramulus) three liang, Ban Xia (Pinelliae Tuber Praeparatum cum Alumine et Zingibere) half sheng. The above eight ingredients are decocted in ten sheng of water. First, boil Ma Huang until the volume reduces by two sheng, skim off the foam on the surface, then add the remaining herbs. Continue boiling to obtain three sheng of liquid, strain out the dregs, and take one sheng warm.
[Collected Explanations]
You Yi stated: Da Qing Long Tang is derived from combining Gui Zhi Tang (Cinnamon Twig Decoction) and Ma Huang Tang (Ephedra Decoction), removing Bai Shao (Paeoniae Radix Alba) and adding Shi Gao (Gypsum Fibrosum). It is suitable for conditions where fluid retention is not severe but accompanied by heat. If there is excessive fluid intake and latent cold, Xiao Qing Long Tang (Minor Blue Dragon Decoction) should be used.
@@@
When fluid retention is in the Lung, the pulse is not wiry; the patient suffers mainly from asthma and shortness of breath.
[Annotation]
The wiry pulse is indicative of various types of fluid retention, but it primarily relates to the Liver. When water resides in the Liver region, it causes Xuan Yin (Hanging Fluid Retention), resulting in a deep and wiry pulse. When water resides in the Lung region, it causes Zhi Yin (Branching Fluid Retention), so the pulse is not wiry. Asthma, coughing, and shortness of breath are symptoms of fluid retention in the Lung; pain radiating from the hypochondrium is a symptom of fluid retention in the Liver. Since there is no pain radiating from the hypochondrium characteristic of the Liver, but only suffering from asthma and shortness of breath characteristic of the Lung, it is said that fluid retention in the Lung does not present with a wiry pulse.
[Collected Notes]
Li [Name] stated: The wiry pulse is associated with the Liver, hence fluid retention in the Lung does not show a wiry pulse. Suffering from asthma and shortness of breath is due to pathogenic factors obstructing the Lung. As mentioned previously, "coughing, reverse qi, leaning to breathe, and shortness of breath" constitute Zhi Yin (Branching Fluid Retention).
@@@
Zhi Yin (Branching Fluid Retention) also causes asthma preventing lying down, accompanied by shortness of breath, while the pulse appears normal.
[Annotation]
Zhi Yin (Branching Fluid Retention) is a disease of water in the Lung, thus causing asthma that prevents lying down and shortness of breath. A "normal" pulse here refers to the typical Lung pulses, which may be floating, choppy, or short. This elaborates on the meaning of "pulse not wiry" mentioned in the previous clause.
@@@
When Zhi Yin (Branching Fluid Retention) causes difficulty breathing, Ting Li Da Zao Tang (Descurainia Seed and Jujube Decoction) is indicated.
[Annotation]
This follows the previous clause to explain the treatment. Asthma, coughing, inability to lie down, shortness of breath, and inability to breathe smoothly are all acute syndromes of water in the Lung. Therefore, Ting Li Da Zao Tang (Descurainia Seed and Jujube Decoction) is used to directly drain the water from the Lung.
[Collected Notes]
Shen Mingzong stated: This is Zhi Yin (Branching Fluid Retention) overflowing into the Lung. Zhi Yin (Branching Fluid Retention) stores in the chest and diaphragm, interfering upward with the Lung. Qi rebellion makes breathing difficult and unsmooth, causing difficulty breathing. In emergencies, treat the branch first. Thus, the sweetness of Da Zao (Jujubae Fructus) protects the Spleen, while the bitterness of Ting Li Zi (Descurainiae Semen) drains the Lung. This allows Lung Qi to flow freely and the Spleen to transport effectively. It is a harsh formula for attacking Zhi Yin (Branching Fluid Retention) in the Lung.
You Yi stated: Difficulty breathing indicates Lung fullness and Qi closure. Ting Li Zi (Descurainiae Semen) enters the Lung to open closures and drain fullness. Da Zao (Jujubae Fructus) is used to prevent damage to healthy Qi.
Ting Li Da Zao Tang (Descurainia Seed and Jujube Decoction) formula (see in the section on Lung Abscess).
@@@
When there is Zhi Yin (Branching Fluid Retention) between the diaphragm, the patient experiences asthma and chest fullness, epigastric hardness and distension, dark facial complexion, and a deep, tight pulse. Having suffered for dozens of days, if treatments with emetics or purgatives failed to cure, Mu Fang Ji Tang (Stephania Tetrandra Decoction) is indicated. If the condition is deficient, recovery occurs immediately. If it is excess, relapse occurs after three days. If repeated administration of the same formula fails, Mu Fang Ji Tang (Stephania Tetrandra Decoction) modified by removing Shi Gao (Gypsum Fibrosum) and adding Fu Ling (Poria) and Mang Xiao (Natrii Sulfas) is indicated.
[Annotation]
Zhi Yin (Branching Fluid Retention) causes asthma, chest fullness, and difficulty breathing due to water in the chest and Lung. Combined with epigastric hardness and distension, it indicates water accumulation connecting to the diaphragm, hence called "Zhi Yin (Branching Fluid Retention) between the diaphragm." A dark facial complexion is the sign of deeply accumulated water pathogens. A deep and tight pulse is also the sign of deeply accumulated water pathogens. Due to deep accumulation, symptoms such as asthma, chest fullness, and epigastric hardness occur. After dozens of days, if emetic treatment failed, it means the water pathogen is not solely accumulated in the Upper Jiao, so dispersing methods are ineffective. If purgative treatment failed, it means the water pathogen is not solely accumulated in the Lower Jiao, so draining methods are ineffective. Epigastric hardness and distension indicate fluid accumulation in the Middle Jiao. Therefore, Mu Fang Ji Tang (Stephania Tetrandra Decoction) is used to open the water accumulation in the Three Jiao and regulate Qi in the Upper, Middle, and Lower Jiao. Ginseng is included because healthy Qi was damaged by emesis and purgation. Thus, if the water accumulation is deficient, recovery occurs upon ingestion. If the water accumulation is excess, even if temporarily cured, it will relapse. Re-administering the original formula will not work. One should modify the original formula by removing the cold nature of Shi Gao (Gypsum Fibrosum), adding Mang Xiao (Natrii Sulfas) to aggressively break hard accumulations, and adding Fu Ling (Poria) to directly channel water pathways. There will be no failure to cure.
[Collected Notes]
Li [Name] stated: Asthma, chest fullness, and epigastric hardness/distension result from the upward reversal of Zhi Yin (Branching Fluid Retention) between the diaphragm. A black face indicates that fluid retention corresponds to the Water element of the North. A deep pulse indicates fluid retention, and a tight pulse indicates cold; both are Yin pulses, as fluid retention inherits Yin-cold qi. Since neither emesis nor purgation worked, both Yin and Yang Qi are deficient. Mu Fang Ji Tang (Stephania Tetrandra Decoction) tonifies deficiency and dissipates fluid retention; deficient patients recover upon receiving tonification. In excess cases, the fluid pathogen is firmly accumulated and unresolved, leading to relapse and non-recovery. This is because cold qi has condensed and remains unresolved. Therefore, Shi Gao (Gypsum Fibrosum) is removed to avoid damaging Stomach Qi. Fu Ling (Poria) is added for its bland property to leach out fluid retention, and Mang Xiao (Natrii Sulfas) is added for its salty property to soften hard accumulations.