防己 椒目 葶苈（熬） 大黄各一两
右四味，末之，蜜丸如梧子大，先食饮服一丸，日三服，稍增。口中有津液渴者，加
芒硝半两。
【集解】
程林曰：防己、椒目导饮于前，清者从小便而出；大黄、葶苈推饮于后，浊者得从大
便而下也。此前后分消，则腹满减而水饮行，脾气转而津液生矣。若渴则甚于口舌干
燥，加芒硝佐诸药，以下腹满而救脾土。
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脉沉而弦者，悬饮内痛。
【注】
沉主里，弦主饮，悬饮之病，属饮停里，故主悬饮内痛也。
@@@
病悬饮者，十枣汤主之。
【注】
此承上条，以明其治也。主以十枣汤，亦形气实者宜之，若形气稍虚，又当临证斟酌
也。
【集注】
赵良曰：脉沉病在里也。凡弦者，为痛、为饮、为癖，悬饮结积在内作痛，故脉见沉
弦。
芫花（熬） 甘遂 大戟各等分
右三味，捣筛以水一升五合，先煮肥大枣十枚，取八合，去滓，内药末，强人服一钱
匕，羸人服半钱，平旦温服之，不下者，明日更服半钱，得快利后，糜粥自养。
【集注】
李□曰：三物皆味苦，苦以泄之，能直达水饮窠囊之处，但恐峻利泄人真元，故加大
枣甘以缓之，且枣为脾果，补土所以制水也。
@@@
病溢饮者，当发其汗，大青龙汤主之，小青龙汤亦主之。
【注】
溢饮病属经表，虽当发汗，然不无寒热之别也。热者以辛凉发其汗，大青龙汤；寒者
以辛温发其汗，小青龙汤。故曰：大青龙汤主之，小青龙汤亦主之也。
【集注】
尤怡曰：水气流行，归于四肢，当汗出而不汗出，身体重痛，谓之溢饮。夫四肢阳也
，水在阴者宜利，在阳者宜汗。
防己、椒目、葶苈（炒制）、大黄各一两。
以上四味药，研成细末，用蜂蜜制成如梧桐子大小的丸剂。饭前用温水送服一丸，每日三次，可逐渐增加剂量。若服药后口中仍有津液但感到口渴，加芒硝半两。
【集解】
程林说：防己、椒目引导水饮从前排出，清稀的部分从小便而出；大黄、葶苈推动水饮从后排出，浑浊的部分从大便而下。这样前后分消水饮，腹部胀满减轻，水饮运行通畅，脾气得以转输，津液自然生成。如果口渴严重超过口舌干燥的程度，加入芒硝辅助诸药，以消除腹部胀满并保护脾土。
@@@
脉象沉而弦的，是悬饮病，伴有内部疼痛。
【注】
沉脉主里证，弦脉主饮邪，悬饮病的病机属于水饮停聚在体内，所以表现为悬饮引起的内部疼痛。
【注】
这是承接上一条，来说明治疗方法。主治用十枣汤，也适用于形体正气充实的患者，如果形体正气稍虚，则应当根据临床具体情况斟酌使用。
【集注】
赵良说：脉沉说明病位在里。凡是弦脉，主痛、主饮、主癖积，悬饮结聚在体内引起疼痛，所以脉象呈现沉弦。
芫花（炒制）、甘遂、大戟各等分。
以上三味药，捣碎过筛，用水一升五合，先煮肥大枣十枚，取汁八合，去掉药渣，加入药末。体质强壮的人服用一钱匕的量，体质虚弱的人服用半钱匕的量，清晨温服。如果未通利，第二天再服用半钱匕，得到快速通利后，喝米粥来自我调养。
【集注】
李□说：这三味药都是苦味，苦能泄降，能直达水饮积聚的巢穴之处，但担心峻猛泻下会损伤人体的真气元气，所以加大枣，其味甘能缓和药性，且枣是脾之果，补益脾土所以能制约水邪。
@@@
患溢饮病的，应当发汗，大青龙汤主治，小青龙汤也可以主治。
【注】
溢饮病属于经络肌表，虽然应当发汗，但其中不无寒证和热证的区别。热证用辛凉药物发汗，用大青龙汤；寒证用辛温药物发汗，用小青龙汤。所以说，大青龙汤主治，小青龙汤也可以主治。
【集注】
尤怡说：水气流行，归于四肢，应当出汗却不出汗，身体沉重疼痛，这叫做溢饮。四肢属阳，水在阴分的适宜利小便，在阳分的适宜发汗。
Stephaniae Tetrandrae Radix (Fangji), Sesami Fructus (Jiumu), Lepidii Semen Tingli (Tingli), Rhizoma et Radix Rhei (Dahuang) each 1 liang.
The above four herbs are powdered, mixed with honey to form pills the size of a wutong seed. Take one pill before meals with warm water, three times a day, gradually increasing the dose. If there is saliva in the mouth but thirst persists, add Natrii Sulfas (Mangxiao) 0.5 liang.
[Ji Jie - Collected Commentary]
Cheng Lin stated: Fangji and Jiumei guide the fluid retention forward, allowing the clear portion to exit via urination; Dahuang and Tingli push the fluid retention backward, allowing the turbid portion to exit via defecation. This method of eliminating fluid from both front and back reduces abdominal fullness and promotes the movement of fluid retention, thereby restoring the function of the Spleen Qi and generating body fluids. If thirst is severe, exceeding mere dryness of the mouth and tongue, Mangxiao is added to assist the other herbs in reducing abdominal fullness and protecting the Spleen Earth.
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A pulse that is deep (Chen) and wiry (Xian) indicates Xuan Yin (Hanging Fluid Retention) with internal pain.
[Note]
A deep pulse indicates an interior syndrome; a wiry pulse indicates fluid retention. The pathology of Xuan Yin belongs to fluid retention stagnating in the interior, hence it presents as internal pain caused by Xuan Yin.
@@@
For patients suffering from Xuan Yin (Hanging Fluid Retention), Shizao Tang (Ten Date Decoction) is the primary treatment.
[Note]
This follows the previous clause to clarify the treatment method. Shizao Tang is indicated for patients with robust physical constitution and sufficient Zheng Qi (Upright Qi). If the patient's constitution is slightly deficient, the prescription should be adjusted according to clinical judgment.
[Zhu Zhu - Collected Annotations]
Zhao Liang stated: A deep pulse indicates the disease is located in the interior. Generally, a wiry pulse indicates pain, fluid retention, or phlegm-stagnation. When Xuan Yin accumulates internally causing pain, the pulse manifests as deep and wiry.
Genkwa Flos (Yuanhua), Kansui Radix (Gansui), Euphorbiae Pekinensis Radix (Daji) in equal parts.
The above three herbs are crushed and sifted. Using 1.5 sheng of water, first decoct ten large Jujubae Fructus (Dazao) until reduced to 0.8 sheng. Remove the dregs, add the herbal powder. Strong individuals take one qianbi (a spoonful measure); frail individuals take half a qianbi. Take warm on an empty stomach in the morning. If no purgation occurs, administer another half qianbi the next day. After obtaining rapid purgation, nourish oneself with millet porridge.
[Zhu Zhu - Collected Annotations]
Li [Name Missing] stated: All three herbs are bitter in flavor; bitterness drains and descends, reaching directly to the nests where fluid retention accumulates. However, fearing that such harsh purgation might damage the body's true Yuan Qi (Primordial Qi), Dazao is added. Its sweet flavor moderates the action. Since Jujube is the fruit of the Spleen, tonifying Spleen Earth helps control Water.
@@@
For patients suffering from Yi Yin (Overflowing Fluid Retention), diaphoresis (sweating) should be induced. Da Qinglong Tang (Major Blue Dragon Decoction) is the primary treatment, and Xiao Qinglong Tang (Minor Blue Dragon Decoction) may also be used.
[Note]
Yi Yin belongs to the exterior channels and muscles. Although diaphoresis is required, there is a distinction between heat and cold syndromes. For heat syndromes, induce sweating with acrid-cool herbs using Da Qinglong Tang; for cold syndromes, induce sweating with acrid-warm herbs using Xiao Qinglong Tang. Hence, it is stated that Da Qinglong Tang is primary, while Xiao Qinglong Tang is also applicable.
[Zhu Zhu - Collected Annotations]
You Yi stated: When water qi circulates and settles in the four limbs, and sweating should occur but does not, resulting in heaviness and pain in the body, this is called Yi Yin. The four limbs belong to Yang; water retained in Yin locations is suitable for promoting urination, while water in Yang locations is suitable for inducing sweating.