甘草 干地黄 白术 附子（炮） 阿胶 黄芩各三两 □中黄土半筋
右七味，以水八升，煮取三升，分温二服。
（方见狐惑）
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寸口脉弦而大，弦则为减，大则为芤，减则为寒，芤则为虚，寒虚相击，此名曰革，
妇人则半产漏下，男子则亡血失精。
【注】
详见『伤寒·辨脉篇』内，不复释。
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火邪者，桂枝去芍药，加蜀漆牡蛎龙骨，救逆汤主之。
【按】
此方是治火逆惊狂者，与首条之脉动惊病不合，必是错简。
桂枝三两 甘草（炙）二两 生姜三两 牡蛎（熬）五两 龙骨四两 大枣十二枚
蜀漆（洗去腥）三两
右为末，以水一斗三升，先煮蜀漆，减一升，内诸药，煮取三升，温服一升。
@@@
心下悸者，半夏麻黄丸主之。
【按】
此方是治寒水心下悸者，与首条之脉弱悸病不合，必是错简。
半夏 麻黄等分
右二味，末之，炼蜜和丸，小豆大，饮服三丸，日三服。
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夫病人饮水多，必暴喘满。凡食少饮多，水停心下，甚者则悸，微者短气。脉双弦者
，寒也，皆大下后，里虚，脉偏弦者，饮也。
【按】
此条微者短气之下，古本有「脉双弦者，寒也」等句，文义不属，当另分为一条在后
。
【注】
凡病人食少饮多，小便利者，为消渴病；小便不利者，为留饮病。留饮者，即今之停
水饮病也。若水停上焦胸中，则壅肺气不得降，故暴喘满也；若水停中焦心下，甚者
则凌心，故病悸动不安，微者则碍肺，故病呼吸短气；若水停下焦少腹，则不输膀胱
，故必苦里急也。仲景于此，但言上、中二焦，不及下焦者，非略之也，谓已详于『
伤寒论』中也。
【集注】
程林曰：饮水多，则水气停泛于胸膈，必暴喘满也。凡人食少饮多，则胃土不能游溢
精气，甚者必停于心下而为悸。微者则阻于胸膈而为短气也。
@@@
先渴后呕，为水停心下，此属饮家，小半夏茯苓汤主之。
【注】
水停心下，中焦部也，中焦属胃，故不止病悸、短气，而亦病呕也。病悸短气者，是
水停胃外，从膈下而上干于胸也。病呕者，是水停胃内，从胃中而上越于口也。然必
先渴饮水多而后作呕者，方属饮家呕病也。主小半夏汤者，以止呕也；加茯苓者，以
饮水多而病呕，故兼利水也。
【集注】
魏荔彤曰：水停心下，阻隔正气，不化生津液，上于胸咽故渴也；渴必饮水，水得水
而愈恣其冲逆，所以先渴而后必呕也。此属饮家，当治其饮，不可以为渴家，治其渴
也。治饮则用辛燥，治渴必用寒润，大相径庭，可不明其属于何家，而妄治之乎？
尤怡曰：先渴后呕者，本无呕病，因渴饮水，水多不下而反上逆也，故曰：此属饮家
。小半夏止呕降逆，加茯苓去其停水。
甘草、干地黄、白术、附子（炮制）、阿胶、黄芩各三两，灶心黄土半斤。
以上七味药，用水八升，煎煮至三升，分两次温服。
（此方见“狐惑病”篇）
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寸口脉象弦而大，弦脉表示阳气减损，大脉表示中空如葱管（芤脉），阳气减损则生寒，中空则主虚，寒与虚相互搏结，这种脉象称为革脉。
妇女患此脉象会出现半产（小产）及漏下（非经期阴道出血），男子患此脉象会出现亡血（失血）及失精（遗精滑精）。
【注】
详见《伤寒论·辨脉篇》中，不再赘述解释。
@@@
因火邪致病的，用桂枝去芍药加蜀漆牡蛎龙骨救逆汤主治。
【按语】
此方是治疗火逆导致惊狂的病症，与第一条所述的脉动惊病不符，必定是古籍简册错乱所致。
桂枝三两 甘草（炙）二两 生姜三两 牡蛎（煅）五两 龙骨四两 大枣十二枚
蜀漆（洗净去腥味）三两
以上为末，用水一斗三升，先煮蜀漆，减少一升水后，加入其余药物，煎煮至三升，温服一升。
@@@
心中悸动的，用半夏麻黄丸主治。
【按语】
此方是治疗寒水停聚导致的心下悸动，与第一条所述的脉弱悸病不符，必定是古籍简册错乱所致。
半夏 麻黄等量
以上两味药，研为细末，炼蜜和丸，如小豆大小，饮水送服三丸，每日三次。
@@@
病人饮水过多，必然突然发生喘促胀满。凡是进食少而饮水多，水液停聚在心下（胃脘部），严重的出现心悸，轻微的表现为短气。脉象左右手皆弦的，是寒证，多见于峻下之后，里气虚弱；脉象仅一侧弦的，是饮邪内停。
【按语】
此条文中“微者短气”之下，古本有“脉双弦者，寒也”等句，文义不连贯，应当另分为一条放在后面。
【注】
凡是病人进食少而饮水多，小便通利的，属于消渴病；小便不利的，属于留饮病。留饮病，就是现在的停水饮病。如果水停下焦胸中，就会壅滞肺气使其不得下降，所以突发喘满；如果水停在中焦心下，严重的会凌犯心脏，所以病发悸动不安，轻微的阻碍肺脏，所以病发呼吸短气；如果水停下焦少腹，就不能输注膀胱，所以必然苦于里急（腹部拘急不适）。张仲景在这里只说了上、中二焦，没有提到下焦，并不是省略了，而是因为已在《伤寒论》中详细论述过了。
【集注】
程林说：饮水多，则水气停泛于胸膈，必然突发喘满。凡人进食少饮水多，则胃土不能游溢精气，严重的必停于心下而为悸。轻微的则阻于胸膈而为短气。
@@@
先口渴后呕吐，是水停心下，这属于饮家，用小半夏茯苓汤主治。
【注】
水停心下，属于中焦部位，中焦属胃，所以不仅病发悸、短气，也会病发呕吐。病发悸、短气的，是水停在胃外，从膈下向上干犯胸廓。病发呕吐的，是水停在胃内，从胃中向上溢出到口腔。但是必须先是口渴饮水多而后才作呕的，才属于饮家之呕病。主用小半夏汤，是为了止呕；加茯苓，是因为饮水多而病呕，所以兼以利水。
【集注】
魏荔彤说：水停心下，阻隔正气，不能化生津液，上至于胸咽故口渴；口渴必然饮水，水得津液而更加恣意冲逆，所以先渴而后必呕。这属于饮家，应当治其饮，不可以当作渴家来治其渴。治饮当用辛燥，治渴必用寒润，大相径庭，能不明其属于何家而妄加治疗吗？
尤怡说：先渴后呕的，原本没有呕病，因为口渴饮水，水多不下反而上逆，所以说：这属于饮家。小半夏汤止呕降逆，加茯苓去除停水。
Gancao (Radix Glycyrrhizae), Dihuang (Radix Rehmanniae Preparata), Baizhu (Rhizoma Atractylodis Macrocephalae), Fuzi (Radix Aconiti Lateralis Preparata, processed), Ejiao (Colla Corii Asini), Huangqin (Radix Scutellariae) each 3 liang; Zaoxin Tu (Caulis Cistanches or specific soil from the stove heart) half jin.
The above seven ingredients are decocted with 8 sheng of water to obtain 3 sheng, divided into two warm doses.
(This formula is seen in the "Huoxuan Disease" chapter.)
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The pulse at the Cun Kou (radial artery at the wrist) is Xian (wiry) and Da (large). Xian indicates reduction (deficiency of Yang), Da indicates Kong (cun-kou pulse feeling hollow like a scallion stalk). Reduction leads to Cold, Kong leads to Deficiency. The interaction of Cold and Deficiency is named Ge (leather-like) pulse.
In women, this presents as Ban Chan (miscarriage) and Lou Xia (dripping bleeding); in men, it presents as Wang Xue (blood loss) and Shi Jing (loss of essence).
[Note]
See detailed explanation in 'Shanghan Lun · Bian Mai Pian' (Treatise on Differentiating Pulses), no further explanation given here.
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For cases caused by Fire Evil, Guizhi Qu Shaoyao Jia Shujie Muli Longgu Jiuni Tang (Cinnamon Twig Decoction without Peony plus Chinese Ramie Root, Oyster Shell, and Dragon Bone for Rescue from Adversity) is the primary treatment.
[Commentary]
This formula treats Fire Adversity leading to惊狂 (startled mania). It does not match the Mai Dong Jing Bing (pulse agitation causing fright disease) mentioned in the first clause, indicating likely textual corruption (cuojian).
Guizhi (Ramulus Cinnamomi) 3 liang, Gancao (Radix Glycyrrhizae, honey-fried) 2 liang, Shengjiang (Rhizoma Zingiberis Recens) 3 liang, Muli (Concha Ostreae, calcined) 5 liang, Longgu (Os Draconis) 4 liang, Dazao (Fructus Jujubae) 12 pieces.
Shujie (Herba Siegesbeckiae, washed to remove fishy odor) 3 liang.
Grind the above into powder. Use 13 sheng of water, first decoct Shujie until reduced by 1 sheng, then add other herbs. Decoct to obtain 3 sheng. Take 1 sheng warm.
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For Xin Xia Ji (palpitations in the epigastrium), Banxia Mahuang Wan (Pinellia and Ephedra Pill) is the primary treatment.
[Commentary]
This formula treats Xin Xia Ji caused by Cold Water retention. It does not match the Mai Ruo Ji Bing (weak pulse causing palpitations) mentioned in the first clause, indicating likely textual corruption.
Banxia (Rhizoma Pinelliae) and Mahuang (Herba Ephedrae) in equal parts.
Grind the above two ingredients into fine powder, mix with refined honey to form pills the size of adzuki beans. Take 3 pills with water, three times daily.
@@@
When a patient drinks excessive water, sudden Chuan Man (asthma and distension) will inevitably occur. Generally, when food intake is low but water intake is high, Water Retention occurs in Xin Xia (epigastrium). Severe cases present with Ji (palpitations); mild cases present with Duan Qi (shortness of breath). If the pulse is Shuang Xian (wiry on both hands), it indicates Han (Cold), typically occurring after severe purgation due to interior Deficiency. If the pulse is Pian Xian (wiry on one side only), it indicates Yin (fluid retention).
[Commentary]
Below "mild cases present with shortness of breath" in this clause, ancient texts contain "If the pulse is wiry on both hands, it indicates Cold." The meaning does not connect smoothly; this should be separated as a new clause placed later.
[Note]
Generally, if a patient eats little and drinks much, with free urination, it is Xiao Ke Bing (Wasting-Thirst disease); with difficult urination, it is Liu Yin Bing (Retained Fluid disease). Liu Yin Bing is what is now called Ting Shui Yin Bing (Water-Fluid Retention disease). If water stops in the Upper Jiao chest, it obstructs Lung Qi preventing descent, causing sudden asthma and distension. If water stops in the Middle Jiao epigastrium, severe cases overwhelm the Heart, causing restless palpitations; mild cases hinder the Lung, causing shortness of breath. If water stops in the Lower Jiao lower abdomen, it fails to transport to the Bladder, causing Li Ji (internal urgency/discomfort). Zhang Zhongjing mentions only the Upper and Middle Jiao here, omitting the Lower Jiao, not out of omission, but because it was detailed in 'Shanghan Lun'.
[Collected Notes]
Cheng Lin said: Excessive drinking causes Water Qi to stagnate and flood the chest and diaphragm, inevitably causing sudden asthma and distension. When people eat little and drink much, Spleen Earth cannot circulate clear Essence. Severe cases stagnate in the epigastrium causing palpitations. Mild cases block the chest/diaphragm causing shortness of breath.
@@@
First thirst followed by vomiting indicates Water Retention in Xin Xia. This belongs to Yin Jia (Fluid-Disease patients), treated primarily with Xiaobanxia Fuling Tang (Minor Pinellia and Poria Decoction).
[Note]
Water retention in Xin Xia belongs to the Middle Jiao region. The Middle Jiao belongs to the Stomach. Therefore, besides palpitations and shortness of breath, it also causes Ou (vomiting). Palpitations and shortness of breath arise when water stays outside the stomach, rising from below the diaphragm to harass the chest. Vomiting arises when water stays inside the stomach, rising from the stomach cavity to exit via the mouth. However, only when thirst leads to excessive drinking followed by vomiting does it belong to Yin Jia vomiting. Xiaobanxia Tang is used to stop vomiting; adding Fuling (Poria) addresses the vomiting caused by excessive drinking by promoting diuresis.
[Collected Notes]
Wei Litong said: Water retention in Xin Xia blocks Zheng Qi, preventing transformation into body fluids, which rise to the chest/throat causing thirst. Thirst leads to drinking; water combined with fluids increases surging rebellion, hence first thirst then vomiting. This belongs to Yin Jia; treat the fluid, do not treat it as Ke Jia (Thirst-Disease patient) treating thirst. Treating fluid requires Acrid-Warm methods; treating thirst requires Cold-Moistening methods. They are vastly different. One must not mistakenly treat without knowing the category.
You Yi said: First thirst then vomiting implies no original vomiting disease. Due to thirst and drinking, excessive water fails to descend and rebels upward. Hence, "this belongs to Yin Jia." Xiaobanxia stops vomiting and directs rebellion downward; adding Fuling removes retained water.