治心下硬如大盘, 边旋如杯, 水饮所作.
枳实七枚 白术二两, , 右二味, 以水五升, 煮取三升, 分温三服,
腹中软即散
.
【注】心下, 胃之上脘也. 上脘结硬如盘, 边旋如杯, 谓时大时小,
水气所作, 非有形食滞也. 用枳实以破结气. 白术以除水湿. 温服三
服,则腹软结开, 而硬消矣. 李杲法仲景以此方倍白术, 是以补为主
也.此方君枳实, 是以泻为主也. 然一缓一急, 一补一泻, 其用不同
,只此多寡转换之间耳.
治心下有痰饮, 胸胁支满目眩. 又曰: 短气有微
饮,当从小便去之, 桂苓甘术汤主之; 肾气丸亦主之.
茯苓四两 桂枝三两 白术三两 甘草三两, 右四味, 以水六升, 煮
取三升, 分温三服, 小便则利.
【集注】赵良曰: 『灵枢』谓心胞络之脉动则病胸胁支满者, 谓痰饮
积于心胞, 其病则必若是也. 目眩者, 痰饮阻其胸中之阳, 不能布精
于上也. 茯苓淡渗, 遂饮出下窍, 因利而去, 故用以为君. 桂枝通阳
输水走皮毛, 从汗而解, 故以为臣. 白术燥湿, 佐茯苓消痰以除支满
.甘草补中, 佐桂枝建土以制水邪也. 夫短气有微饮, 此水饮停蓄,
呼吸不利而然也. 『金匮』并出二方, 妙义益彰. 呼气之短, 用苓桂
术甘汤之轻清以通其阳, 阳化气则小便能出矣. 吸气之短, 用肾气丸
之重降以通其阴, 肾气通则关门自利矣.
【按】风水, 阳水也; 石水, 阴水也. 阳水多实, 阴水多虚. 阳水在
上,故多喘; 阴水在下, 故多满. 所以治阳水用散用攻, 治阴水用温
用补. 然阴中必有阳, 此方治阴水之在阳而上者也, 肾气丸治阴水之
在阴而下者也. 于此推之, 阳中亦必有阴, 故有小青龙阳, 五苓散之
治法也. 今举世不分阴阳虚实, 皆以金匮肾气汤治之, 服之不效, 终
不改辙, 每至吐血而死, 良可叹也.
治疗心下（胃脘部）坚硬如大盘，边缘旋转如杯状，这是由水饮邪气所致。
枳实七枚 白术二两，将这两味药，用水五升，煮取三升，分三次温服，
腹部变软后结聚即散。
【注】心下，指的是胃的上脘部位。上脘处结硬如盘，边缘旋转如杯，是指症状时大时小，
这是水气作祟，并非有形的食积停滞。使用枳实来破除结聚之气。白术用来祛除水湿。
温服三次，则腹部变软、结聚消散，坚硬也就消除了。李杲效法张仲景，将此方中的白术加倍使用，
是以补益为主的方法。此方以枳实为君药，是以泻实为主的方法。然而一缓一急，一补一泻，
其作用不同，只在这用药多寡转换之间罢了。
治疗心下有痰饮，胸胁支撑胀满且目眩。又说：短气伴有轻微饮邪，应当通过小便排出，
用桂苓甘术汤主治；肾气丸也主治。
茯苓四两 桂枝三两 白术三两 甘草三两，将这四味药，用水六升，煮取三升，分三次温服，
小便就会通畅。
【集注】赵良说：《灵枢》中提到手厥阴心包络的经脉跳动则病发胸胁支撑胀满，是说痰饮
积聚在心包，发病时必然如此。目眩，是因为痰饮阻遏了胸中的阳气，不能将精气布散于上部。
茯苓淡渗利湿，引导饮邪从下窍排出，因利尿而去除，所以用作君药。桂枝通阳，输布水液至皮毛，
从汗液而解，所以用作臣药。白术燥湿，辅助茯苓消除痰饮以除去支撑胀满感。甘草补益中气，
辅助桂枝建立土气以制约水邪。至于短气伴有轻微饮邪，这是水饮停蓄体内，导致呼吸不畅所致。
《金匮要略》同时列出这两个方剂，其中的精妙义理更加彰显。呼气短促，用苓桂术甘汤的轻清之性
以通阳，阳气化气则小便能排出。吸气短促，用肾气丸的重降之性以通阴，肾气通畅则关门自然开启。
【按语】风水，属于阳水；石水，属于阴水。阳水多实证，阴水多虚证。阳水病位在上，
所以多表现为喘促；阴水病位在下，所以多表现为胀满。因此治疗阳水用发散和攻逐的方法，
治疗阴水用温补的方法。然而阴中必含阳，此方治疗的是阴水中病位在阳且偏上的情况，
肾气丸治疗的是阴水中病位在阴且偏下的情况。由此推论，阳中也必含阴，所以有小青龙汤、
五苓散等治法。如今世人不分阴阳虚实，都用金匮肾气汤来治疗，服用无效，始终不改变方法，
往往导致吐血而死，实在令人叹息。
Treats hardness in the epigastrium (lower chest and upper abdomen) resembling a large plate, with edges rotating like a cup, caused by fluid retention (Shui Yin).
Zhi Shi (Immature Bitter Orange) seven pieces; Bai Zhu (Atractylodis Macrocephalae Rhizoma) two liang. The above two ingredients are boiled in five sheng of water to obtain three sheng, divided into three warm doses. When the abdomen becomes soft, the accumulation dissipates.
[Annotation] "Xin Xia" refers to the upper part of the stomach (Shang Wan). Hardness at Shang Wan resembling a plate, with edges rotating like a cup, indicates symptoms that vary in size from time to time. This is caused by Qi of water (Shui Qi), not by tangible food stagnation. Zhi Shi is used to break up stagnant Qi. Bai Zhu is used to eliminate dampness and water. Taking three warm doses will soften the abdomen, resolve the accumulation, and eliminate the hardness. Li Gao followed Zhang Zhongjing's method by doubling the amount of Bai Zhu in this formula, making it primarily tonifying. In this formula, Zhi Shi is the sovereign herb, making it primarily purgative. However, one is slow and the other rapid; one is tonifying and the other purging. Their applications differ only through the adjustment of dosage proportions.
Treats phlegm-fluid retention (Tan Yin) in the epigastrium, accompanied by distending fullness in the chest and hypochondrium, and vertigo (Mu Xuan). It also states: For shortness of breath (Duan Qi) with slight fluid retention, it should be eliminated via urination. Gui Ling Gan Zhu Tang is the primary prescription; Shen Qi Wan is also indicated.
Fu Ling (Poria) four liang; Gui Zhi (Cinnamomi Ramulus) three liang; Bai Zhu (Atractylodis Macrocephalae Rhizoma) three liang; Gan Cao (Glycyrrhizae Radix et Rhizoma) three liang. The above four ingredients are boiled in six sheng of water to obtain three sheng, divided into three warm doses. Urination will then become unobstructed.
[Collected Annotations] Zhao Liang stated: "Ling Shu" mentions that if the pulse of the Pericardium Meridian moves, disease manifests as distending fullness in the chest and hypochondrium. This means when phlegm-fluid accumulates in the Pericardium, the disease necessarily presents thus. Vertigo occurs because phlegm-fluid obstructs the Yang Qi of the chest, preventing the distribution of essence to the upper body. Fu Ling has a light and penetrating nature, guiding fluid out through the lower orifices and removing it via diuresis; therefore, it serves as the sovereign herb. Gui Zhi promotes Yang and transports water to the skin and hair, resolving it through sweating; therefore, it serves as the minister herb. Bai Zhu dries dampness, assisting Fu Ling in eliminating phlegm to relieve distending fullness. Gan Cao tonifies the Middle Jiao, assisting Gui Zhi in strengthening Earth to control Water pathogenic factors. Regarding shortness of breath with slight fluid retention, this results from fluid accumulation hindering respiration. "Jin Gui Yao Lue" presents both formulas together, further clarifying their subtle principles. For shortness of breath on exhalation, Qing Ling Zhu Gan Tang (Ling Gui Zhu Gan Tang) uses its light and clear properties to promote Yang; once Yang transforms Qi, urine can be excreted. For shortness of breath on inhalation, Shen Qi Wan uses its heavy and descending properties to promote Yin; once Kidney Qi flows freely, the gate naturally opens.
[Commentary] Feng Shui (Wind Edema) belongs to Yang Water; Shi Shui (Stone Edema) belongs to Yin Water. Yang Water is mostly excess syndrome; Yin Water is mostly deficiency syndrome. Yang Water locates in the upper body, hence often presenting with panting; Yin Water locates in the lower body, hence often presenting with fullness. Therefore, treating Yang Water involves dispersing and attacking methods, while treating Yin Water involves warming and tonifying methods. However, within Yin there must be Yang. This formula treats Yin Water located in Yang and superior aspects; Shen Qi Wan treats Yin Water located in Yin and inferior aspects. By inference, within Yang there must also be Yin; hence, treatment methods such as Xiao Qing Long Tang and Wu Ling San exist. Today, the world fails to distinguish between Yin/Yang and excess/deficiency, treating all cases with Jin Gui Shen Qi Tang. When ineffective, they persist in this approach, often leading to death from hematemesis, which is truly lamentable.