喻昌曰∶痰饮之证，留伏二义，最为难明。前论留饮者留而不去，伏饮者即留饮之伏于内者也。留饮有去时，伏饮
终不去，留伏之义，已见一斑。而《金匮》奥义，夫岂渺言能尽，谨吾陈之∶《金匮》论留饮者三，伏饮者一。曰心下有
留饮，其人背寒如掌大，曰留饮者。胁下痛引缺盆，曰胸中有留饮。其人短气而渴，四肢历节痛，言胸中留饮。阻抑上
焦心肺之阳，而为阴 ，则其深入于背者，有寒无热，并阻督脉上升之阳。而背寒如掌大，无非阳火内郁之象也，胁下
为手足厥阴上下之脉，而足少阳之脉，则由缺盆过季肋，故胁下引缺盆而痛，为留饮偏阻，木火不伸之象。饮留胸中，
短气而渴，四肢历节痛，为肺不行气，脾不散精之象也。合三条而观之，心、肺、肝、脾，痰饮皆可留而累之矣！其义
不更着耶？至伏饮则曰膈上病痰，满喘咳吐，发则寒热，背痛腰疼，目泣自出，其人振振身 剧，必有伏饮。言胸中乃
阳气所治，留饮阻抑其阳，则不能发动，然重阴终难蔽 ，有时阳伸，阴无可容，忽而吐发，其留饮可以出矣。若更伏
留不出，乃是三阳之气，伸而复屈，太阳不伸，作寒热，腰背痛目泣，少阳不伸，风火之化，郁而并于阳明土中，阳明
主肌肉，遂振振身 而剧也。留饮之伏而不去，其为累更大若此。然留饮、伏饮，仲景不言治法，昌自其遏抑四藏三府
之阳而求之，则所云宜用温药和之者，岂不切于此证，而急以之通其阳乎？所云苓桂术甘汤者，虽治支满目眩，岂不切
于此证，而可仿其意乎？故必深知此例，始可与言往法也。后人不明《金匮》之理，妄生五饮六证之说，即以海藏之明，
于五饮汤方下云∶一留饮在心下；二支饮在胁下；三痰饮在胃中；四溢饮在膈上；五悬饮在肠间。而统一方以治之，何
其浅耶？
再按∶痰饮总为一证，而因则有二。痰因于火，有热无寒；饮因于湿，有热有寒，即有温泉无寒火之理也。人身热
郁于内，气血凝滞，蒸其津液，结而为痰，皆火之变现也。水得于湿，留恋不侑，积而成饮。究竟饮证，热湿酿成者多，
寒湿酿成者少。盖湿无定体，春曰风湿，夏曰热湿，秋曰燥湿，冬曰寒湿。三时主热，一时主寒，热湿较寒湿三倍也。
《内经》湿土太过，痰饮为病，治以诸热剂，非指痰饮为寒。后人不解，妄用热药，借为口实，讵知凡治下淫之邪，先
从外解，故治湿淫所胜，亦不远热以散其表邪，及攻里自不远于寒矣。况于先即不可表，而积阴阻遏身中之阳，亦必借
温热以伸其阳，阴邪乃得速去。若遂指为漫用常行之法，岂不愚哉！
论苓桂术甘汤 痰饮阴象，阻抑其阳，用此阳药化气，以伸其阳，此正法也。兹所主乃在胸胁支满，目眩者何
耶？《灵枢》谓心包之脉，是动则病胸胁支满，然则痰饮积于心包，其病自必若是目眩者，痰饮阻其胸中之阳，不能布
水精于土也。茯苓治痰饮，伐肾邪，渗水道；桂枝通阳气，和荣卫，开经络；白术治风眩，燥痰水，除胀满；甘草得茯
苓，则不资满而反泄满，本草亦曰甘草能下气，除烦满，故用之也。
论苓桂术甘汤肾气丸二方 《金匮》云∶夫短气，有微饮，当从小便去之，苓桂术甘汤主之。肾气丸亦主之。
并出二方，其妙义愈益彰着，首卷辨息论中，已详仲景分别呼吸言病之旨矣。今短气亦分呼吸，各出一方，呼气之短，
用苓桂术甘汤以通其阳，阳化气则小便能出矣。吸气之短，用肾气丸以通其阴，肾气通则小便之关门利矣。一言半句之
间，莫非精蕴，其斯以为圣人乎！
论大小青龙汤 溢饮之证，水饮溢出于表，荣卫尽为之不利，必仿伤寒病荣卫两伤之法，发汗以散其水，而荣
卫通经脉行，则四肢之水亦散矣。究竟大青龙升天而行云雨，小青龙鼓浪而奔沧海，治饮证必以小青龙为第一义也。
合论十枣汤甘遂半夏汤二方 伤寒病，其胁痞满而痛，用十枣汤下其痰饮。杂病虽非伤寒之比，而悬饮内痛，
在胁则同，况脉见沉弦，非亟夺其邪，邪必不去，脉必不返。所以用十枣汤，不嫌其过峻也。凡病之在胁而当用下者，
必仿此为例也。至甘遂甘草汤之治留饮，微妙玄通，非深入圣域，莫能制之。《内经》但曰∶留者攻之耳。仲景于是析义
以尽其变，无形之气，热结于胃，则用调胃承气攻之。热结于肠，则用大小承气攻之。有形之饮，痞结于胸，则用陷胸
汤攻之。痞结于胁，则用十枣汤攻之。留结于肠胃之间，则用甘遂半夏汤攻之。法曰病者脉伏，其人欲自利，利反快，
虽利，心下续坚满，此为留饮欲去故也，甘遂半夏汤主之。脉道为留饮所膈，伏而不行，其证欲下利，利反快，似乎留
饮欲去，然虽欲去不能去也。心下续坚满，可见留饮之末，已及于肠，留饮之根，仍着于胃，不 其根，饮必不去，故
立是方。甘遂甘草大相反者，合而用之，俾其向留着之根，尽力一 ，得留者去，而药根已不存矣！正《内经》有故无
殒之义也。又加白蜜同煎，留恋其药，不致迸入无过之地。其用半夏、芍药者，入土中成其上满，半夏益土，芍药伐木，
抑何神耶？后世方书，并甘草删去，神奇化为拘腐，制本立论，皆中人以下之事矣，竟何益哉？
合论木防己汤葶苈大枣泻肺汤防己椒目葶苈大黄丸三方 三方皆治支饮，上入膈中，而有浅深次第之分。首一
方先治其肺，中一方颛治其肺，后一方兼治肺府所传之府。盖支饮上入于膈，逼近心肺，奥援肾邪。本文云∶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，
去石膏加茯苓芒硝。盖以支饮上入，阻其气则逆于肺间，而为喘消；阻其血则杂揉心下，而为痞坚，肾气上应，其色
黑，血凝之色亦黑，故黧黑见于面部。然且姑缓心肾之治，先治其肺，肺之气行，则饮不逆而俱解耳。木防己味辛温，
能散留饮结气，又主肺气喘满。石膏辛甘微寒，主心下逆气，清肺定喘。人参甘美，治喘消膈饮，补心肺不足。桂枝辛
热，通血脉，开结气，宣导诸气，在气分服之即愈。若饮在血分，深连下焦，必愈而复发，故去石膏气分之药，加芒硝
入阴分，开痞结，消血。石膏与茯苓，去心下坚，且伐肾邪也。葶苈大枣汤，大泻其肺气，亦以气停故液聚耳。防
己椒目葶苈大黄丸，治腹满口舌干燥，肠间有水气之证，乃肺气 郁于上，以致水饮不行于下，而燥热之甚，用此丸急
通水道，以救金气之 郁，不治上而治其下，故用丸剂也。
合论小半夏汤小半夏加茯苓汤外台茯苓饮三方 前一方，治支饮呕而不渴者，支饮上入膈中而至于呕，从高而
越，其势最便。但呕家本当渴，渴则可征支饮之全去，若不渴，其饮尚留，去之未尽也，不必加治。但用半夏之辛温，
生姜之辛散，再引其欲出之势，则所留之邪自尽矣。中一方，亦治卒呕吐者，但多心下痞，膈间有水，眩悸，故加茯苓
以去水，伐肾而安心也。后一方，加人参、枳实、橘皮，尤为紧要，治积饮既去，而虚气寒满其中，不能进食，此证最
多，《金匮》蚤附外台一方，启诱后人，非天民之先觉而谁？
合论泽泻汤浓朴大黄汤二方 二方之治支饮，俱从下夺，而有气血之分，前后之辨。首一方，为支饮之在心下
者，阻其阳气之升降，心气郁极，火动风生，而作冒眩。惟是不治其冒眩，但利小便以泄其支饮，则阳自升而风火自息。
仲景制方每多，若此后一方，治支饮之胸满者，夫支饮而至胸满，在仲景自用大小陷胸汤治之。此方乃承气之法，止可
施于伤寒无形，气分热结，而乃以治有质之痰饮，非仲景丝丝毕贯之法矣。其为编书者误入，更复何疑。
论五苓散一方 本文云∶假令瘦人脐下有悸，吐涎沫而癫眩，此水也，五苓散主之。此寻常一方耳。深维其义，
譬如以手指月，当下了然。盖瘦人木火之气本盛，今以水饮之故，下郁于阴中，挟其阴邪鼓动于脐，则为悸；上入于胃，
则吐涎沫；及其郁极乃发，直上头目，为癫为眩。《巢氏病源》云∶邪入之阴则癫，夫阳郁于阴，其时不为癫眩，出归
阳
位，反为癫眩者，夹带阴气而上也。故不治其癫眩，但散其在上夹带之阴邪，则立愈矣。散阴邪之法，固当从表，然不
如五苓散之表法为长，以五苓散兼利其水耳。今世之用五苓散者，但知其为分利前后水谷之方，不知其为分利表里阴阳
之方。方下所云∶多饮暖水汗出愈之文，总置不录，何其浅耶！不但此也，即如小青龙一方，世但知为发表之轻剂，全
不知其为利小水而设。夫山泽小龙，养成头角，乘雷雨而直奔沧海，其不能奋髯而升天，奚待问哉！所以《金匮》治支
饮五方，总不出小青龙一方为加减，取其开通水道，千里不留行耳。
后世治痰饮有四法∶曰实脾、燥湿、降火、行气。实脾燥湿，二陈二术，最为相宜，若阴虚则反忌之矣。降火之法，
须分虚实∶实用苦寒，虚用甘寒，庶乎可也。若夫行气之药，诸方漫然，全无着落，谨再明之。风寒之邪，从外入内，
裹其痰饮，惟用小青龙汤，则分其邪从外出，而痰饮从下出也。浊阴之气，从下入上，裹其痰饮，用茯苓浓朴汤，则分
其浊气下出，而痰饮上出也。多怒则肝气上逆，而血亦随之，气血痰饮，互结成癖，用柴胡鳖甲散以除之。多忧则脾
气内郁，而食亦不食，气食痰饮，亦互结成癖，用清痰丸以除之。多欲则肾气上逆，直透膜原，结垒万千， 胀重坠，
不可以仰，用桂苓丸引气下趋，痰饮始去也。
虚寒痰饮少壮，十中间见一二。老人小儿，十中常见四五。若果脾胃虚寒，饮食不思，阴气痞塞，呕吐涎沫者，宜
温其中。真阳虚者，更补其下，清上诸药，不可用也。
小儿慢脾风，痰饮，阻塞窍隧，星附六君汤以醒之。
老人肾虚水泛，痰饮上涌，崔氏八味丸以摄之。
痰在膈上，大满大实，非吐不除，然非定法也。使为定法，人人能用之矣，何必独推子和哉？子和必相其人可吐，
后乃吐之。一吐不彻，俟再俟三。缓以开之，据云涌痰之法，自有擒纵卷舒，其非浪用可知。谨再论《金匮》不言之意
以明之，伤寒论用汗、吐、下、和、温之法矣。至痰饮首当言吐者，仲景反不言之，何耶？其以吐发二字为言者，因喘
满而痰饮上溢，从内而自发也。其曰医吐下之不愈，亦非以吐下为咎也。其曰呕家本渴，渴者为欲解，又属望于从吐得
解也，胡竟不出可吐一语耶？仲景意中谓痰饮证内，多夹带气眩冒等证，吐之则殆。故不烦辞说，直不以吐立法，开后
世之过端，所以为立法之祖也。自子和以吐法擅名，无识者争趋快捷方式，贻误不可胜道，必会仲景意以言吐，然后吐罔不
当也。
今定吐禁一十二条 眩冒昏晕不可吐。气高气浅不可吐。积劳未息不可吐，病后新虚不可吐。水道微弱不可吐。
病势险急不可吐。阳虚多汗不可吐。素惯失血不可吐。风雨晦冥不可吐。冬气闭藏不可吐。多疑少决不可吐。吐后犯戒
不可吐。
今定药禁一十条 阴虚枯燥妄用二陈。阳虚多汗妄用青龙。心虚神怯妄用辛散。肺虚无气妄用苦泻。肝虚气刺
妄用龙荟。脾虚浮肿妄用滚痰。胃虚津竭妄用香燥。藏腑易动妄行涌泄。本非坚积妄行峻攻。血气虚羸妄行针灸。
【律三条】
凡热痰乘风火上入，目暗耳鸣，多似虚证，误行温补，转锢其痰，永无出路，医之罪也。
凡痰饮随食并出，不开幽门，徒温其胃，束手无策，迁延误人，医之罪也。
凡遇肾虚水泛，痰涌气高，喘急之证，不补其下，反清其上，必致气脱而死，医之罪也。
喻昌说：痰饮这一病证，“留”和“伏”这两个概念，是最难明白的。前文论述“留饮”，是指饮邪停留而不去；“伏饮”，就是留饮潜伏在体内的状态。留饮有时可以排出，而伏饮终究难以去除，关于“留”与“伏”的含义，从这里已可见一斑。然而《金匮要略》中的深奥义理，难道能用浅显的话完全概括吗？我谨陈述我的见解：《金匮要略》中论及留饮有三处，论及伏饮有一处。
说“心下有留饮”，患者背部寒冷如手掌大小，这叫做留饮；胁下疼痛牵引至缺盆穴，这是胸中有留饮；患者短气且口渴，四肢关节遍痛，这也是指胸中留饮。这是因为饮邪阻抑了上焦心肺的阳气，导致阴寒内盛，所以深入背部的只有寒冷而没有发热，同时阻断了督脉上升的阳气。背部寒冷如手掌大，无非是阳气内部郁结的表现。胁下是足厥阴肝经和手厥阴心包经上下运行的脉络，而足少阳胆经则从缺盆经过季肋部，所以胁下疼痛牵引缺盆，是留饮偏侧阻滞，导致肝胆木火之气不能舒展的表现。饮邪停留在胸中，导致短气和口渴，四肢关节疼痛，这是肺气不能宣发、脾气不能散精的表现。综合这三条来看，心、肺、肝、脾四个脏腑，痰饮都可以停留并累及它们！这个道理不是更明显了吗？
至于伏饮，文中说：“膈上有病痰，出现胀满、喘息、咳嗽、吐痰，发作时伴有寒热、背痛腰痛、眼泪自出，身体剧烈震颤，必定有伏饮。”这说明胸中本是阳气所主之地，留饮阻抑了阳气，使其不能发动。然而重阴终究难以永远遮蔽阳气，有时阳气伸展，阴邪无处容身，突然发作吐出，这时留饮就可以排出了。如果仍然潜伏在内无法排出，那就是三阳之气，伸展后又屈曲。太阳经阳气不伸，表现为寒热、腰背痛、流泪；少阳经阳气不伸，风火之化郁结并合并于阳明土中，阳明主肌肉，于是出现身体剧烈震颤的症状。留饮潜伏而不去，其危害竟然如此之大。
然而张仲景在书中对于留饮、伏饮没有直接说明治法，我是从它们遏抑五脏六腑阳气的角度来探究的，那么所谓“宜用温药调和”的原则，难道不是切合于此证，急需用它来通达阳气吗？所谓苓桂术甘汤（茯苓、桂枝、白术、甘草组成的方剂），虽然说是治疗支饮导致目眩的，难道不也是切合于此证，可以仿效其意使用吗？所以必须深知这个例子，才可以谈论治病的方法。
后人不明白《金匮要略》的道理，妄生“五饮六证”的说法，即使是海藏（张元素）这样高明的人，在五饮汤方下也说：“一留饮在心下；二支饮在胁下；三痰饮在胃中；四溢饮在膈上；五悬饮在肠间。”却用一个方子来统一治疗，这也太浅薄了吧！
再按：痰饮总归是一个病证，但成因有两种。痰是因为火，只有热没有寒；饮是因为湿，既有热也有寒，这就是有温泉而没有寒火的道理。人体热气郁结在内部，气血凝滞，蒸腾津液，凝结而成痰，这都是火的外在表现。水因为湿气留恋而不行，积聚而成饮。究竟而言，饮证由湿热酿成的多，由寒湿酿成的少。因为湿气没有固定的形态，春天叫风湿，夏天叫热湿，秋天叫燥湿，冬天叫寒湿。三个季节主热，一个季节主寒，热湿比寒湿多三倍。《内经》说湿土太过导致痰饮为病，治疗用各种热性药剂，并不是指痰饮本身就是寒证。后人不理解，妄用热药，借以作为口实，哪里知道凡是治疗下淫之邪，先从外部解除，所以治疗湿淫胜复，也不远离热药以发散表邪，等到攻里自然就不远离寒药了。何况如果一开始就不能解表，而积阴阻遏了身上的阳气，也必须借助温热药来伸展阳气，阴邪才能迅速去除。如果就指着这是随意使用常规方法，岂不是愚昧吗！
论苓桂术甘汤：痰饮属于阴象，阻抑阳气，使用这种阳药来化气，以伸展阳气，这是正法。这里主治的是胸胁支撑胀满、目眩的情况，为什么呢？《灵枢》说心包络的经脉，发生变动就会病见胸胁支撑胀满，既然这样，痰饮积聚在心包络，病症自然必然如此。目眩的原因，是痰饮阻抑了胸中的阳气，不能布散水精到脾胃（土）。茯苓治疗痰饮，伐除肾邪，渗利水道；桂枝通达阳气，调和营卫，开通经络；白术治疗风眩，燥化痰水，消除胀满；甘草配合茯苓，不仅不助长胀满反而能消除胀满，本草也记载甘草能降气，消除烦闷胀满，所以使用它。
论苓桂术甘汤和肾气丸两方：《金匮要略》说：“短气，有轻微饮邪，应当从小便排出，用苓桂术甘汤主治。肾气丸也主治。”并列出了两个方子，其中的妙理更加彰显。首卷辨息论中，已经详细阐述了张仲景区分呼吸言病的宗旨。现在短气也分呼吸，各出一个方子。呼气短促，用苓桂术甘汤来通阳，阳气化气则小便能排出。吸气短促，用肾气丸来通阴，肾气通畅则小便的关门就利落了。一言半句之间，无不蕴含精微深奥的道理，这大概就是圣人的境界吧！
论大青龙汤和小青龙汤：溢饮的病证，水饮溢出体表，营卫都因此不利，必须仿照伤寒病营卫两伤的方法，发汗以散水气，而营卫通畅经脉运行，那么四肢的水气也会消散。究竟而言，大青龙汤像升天而行云雨，小青龙汤像鼓浪而奔沧海，治疗饮证必须以小青龙汤为首选原则。
合论十枣汤和甘遂半夏汤两方：伤寒病，如果胁下痞满而痛，用十枣汤攻下痰饮。杂病虽然不是伤寒可比，但悬饮引起的内部疼痛，在胁下的情况是一样的，况且脉象见沉弦，如果不急切地攻夺邪气，邪气必定不去，脉象必定不恢复。所以使用十枣汤，不嫌它过于峻猛。凡是病在胁下当用攻下法的，必须仿效这个例子。至于甘遂甘草汤治疗留饮，微妙玄通，不是深入圣人境界的人，不能控制它。《内经》只说：“留滞的病邪要攻逐。”张仲景于是分析义理以穷尽其变化。无形的气，热结在胃，就用调胃承气汤攻之。热结在肠，就用大、小承气汤攻之。有形的饮邪，痞结在胸，就用陷胸汤攻之。痞结在胁，就用十枣汤攻之。留结在肠胃之间，就用甘遂半夏汤攻之。医经说：病人脉伏，其人想自行腹泻，泻后反而感觉爽快，即使腹泻，心下继续坚硬胀满，这是留饮想要排出的缘故，用甘遂半夏汤主治。脉道被留饮阻隔，伏而不行，症状是想下利，泻后反而爽快，看似留饮欲去，然而虽然想出去却不能出去。心下继续坚硬胀满，可见留饮的末梢，已经波及到肠，留饮的根本，仍然附着在胃。不铲除它的根本，饮邪必定不去，所以设立这个方子。甘遂和甘草是大相相反的，合在一起使用，让它们向着留着的根本，尽力一击，使得留下的邪气去掉，而药力本身也已经不存在了！这正是《内经》“有故无殒”的意思。又加白蜜同煎，留恋药性，不至于迸入无辜的地方。使用半夏、芍药的原因，是进入土中形成上面的胀满，半夏益土，芍药伐木，多么神奇啊！后世的方书，把甘草删去了，神奇变成了拘泥腐朽，制定本方确立理论，都是中等资质以下的人做的事了，到底有什么益处呢？
合论木防己汤、葶苈大枣泻肺汤、防己椒目葶苈大黄丸三方：这三个方子都治疗支饮，向上进入膈中，但有深浅次第的区别。第一个方子先治肺，第二个方子专门治肺，第三个方子兼治肺脏所传变的脏腑。大概支饮向上进入膈中，逼近心肺，暗中援助肾邪。原文说：“患者喘满，心下痞硬坚实，面色黧黑，脉象沉紧，得病几十天，医生用吐法、下法治疗没好，用木防己汤主治；虚证的就好了，实证三天后复发，再次用药没好的，去掉石膏加茯苓芒硝。”大概因为支饮向上进入，阻遏气机则逆乱于肺间，导致气喘消渴；阻遏血行则杂乱揉聚于心下，导致痞硬，肾气上应，其色黑，血凝的颜色也是黑，所以黧黑出现在面部。然而暂且缓治心和肾，先治肺，肺的气机运行，则饮邪不逆乱而全部解散。木防己味辛温，能散留饮结气，又主治肺气喘满。石膏辛甘微寒，主治心下逆气，清肺定喘。人参甘美，治疗喘消膈饮，补心肺不足。桂枝辛热，通血脉，开结气，宣导诸气，在气分服用即愈。如果饮在血分，深连下焦，必定好了又复发，所以去掉石膏这类气分的药，加芒硝入阴分，开痞结，消血瘀。石膏与茯苓，消除心下坚满，且伐除肾邪。葶苈大枣汤，大泻肺气，也是因为气停故液聚。防己椒目葶苈大黄丸，治疗腹满口舌干燥，肠间有水气的病证，乃是肺气郁结于上，导致水饮不行于下，而燥热严重，用这个丸剂急通水道，以救金气之郁结，不治上而治其下，所以用丸剂。
合论小半夏汤、小半夏加茯苓汤、外台茯苓饮三方：前一方，治疗支饮呕吐但不口渴的，支饮向上进入膈中以至于呕吐，从高而出，其势最便利。但呕吐的人本当口渴，口渴则可以证明支饮已全部去除，如果不渴，说明饮邪尚存，没有去尽，不必再加其他治疗。只用半夏的辛温，生姜的辛散，再引导其欲出的趋势，那么所留的邪气自然尽除。中间一方，也治疗突然呕吐的，但多了心下痞满，膈间有水，眩晕心悸，所以加茯苓以去水，伐肾邪而安心神。后一方，加人参、枳实、橘皮，尤为紧要，治疗积饮既去，而虚气寒满其中，不能进食，这个证候最多，《金匮要略》早早附上外台的方子，启发诱导后人，如果不是民众的先觉者是谁呢？
合论泽泻汤和厚朴大黄汤二方：这两个方子治疗支饮，都是从下面攻夺，但有气血之分，前后之辨。第一个方子，是为支饮在心下的，阻遏了阳气的升降，心气郁极，火动风生，而作冒眩。只是不治疗冒眩，只利小便以泄其支饮，则阳气自然上升而风火自然平息。张仲景制方每每多有……（此处原文似有脱漏或语意未完，依上下文理解为强调方义），若此后一方，治疗支饮胸满的，支饮到了胸满的程度，在张仲景那里本应用大、小陷胸汤治疗。这个方子却是承气汤的法度，只能施用于伤寒无形的气分热结，却用来治疗有质的痰饮，这不是张仲景丝丝入扣的方法了。这肯定是编书的人误入的，还有什么可疑疑的呢？
论五苓散一方：原文说：“假如瘦人脐下有悸动感，吐涎沫而且癫眩，这是水饮，五苓散主治。”这是一个寻常的方子。深思其义理，譬如用手指着月亮，当下就了然了。大概瘦人木火之气本盛，现在因为水饮的缘故，下部郁结于阴中，挟带阴邪鼓动于脐部，则为悸；向上进入胃，则吐涎沫；等到郁极乃发，直上头目，为癫为眩。《巢氏病源》说：“邪入于阴则癫。”阳气郁结于阴中，此时不为癫眩，出来回归阳位，反为癫眩的，是夹带着阴气而上。所以不治疗癫眩，只疏散在上夹带的阴邪，则立刻痊愈了。疏散阴邪的方法，固然应当从表解，然而不如五苓散的表法更好，因为五苓散兼利水气。当今世上使用五苓散的人，只知道它是分利前后水谷的方子，不知道它是分利表里阴阳的方子。方下所说的：“多饮暖水汗出愈之”的文字，全都置之不录，这也太浅薄了！不仅如此，就像小青龙一方，世人只知道它是发表的轻剂，全不知道它是为了利小水而设的。山泽中的小龙，养成头角，乘雷雨而直奔沧海，它不能奋起胡须而升天，还用得着问吗！所以《金匮要略》治疗支饮的五方，总不出小青龙一方做加减，取其开通水道，千里不留行的意思。
后世治疗痰饮有四法：曰实脾、燥湿、降火、行气。实脾燥湿，二陈汤、二术（苍术、白术），最为相宜，如果是阴虚则反而禁忌。降火的方法，须分虚实：实证用苦寒，虚证用甘寒，差不多就可以了。至于行气的药物，各方漫然，全无着落，我谨再阐明。风寒之邪，从外入内，裹挟痰饮，只用小青龙汤，则分离邪气从外出，而痰饮从下出。浊阴之气，从下入上，裹挟痰饮，用茯苓厚朴汤，则分离浊气下出，而痰饮上出。多怒则肝气上逆，而血也随之，气血痰饮，互结成为癖块，用柴胡鳖甲散来消除。多忧则脾气内郁，而食物也不消化，气食痰饮，也互结成为癖块，用清痰丸来消除。多欲则肾气上逆，直透膜原，结垒万千，腹部胀重坠，不可以仰卧，用桂苓丸引气下行，痰饮才去除。
虚寒痰饮，在少年壮年人中，十中间见到一二。老人小儿，十中常见四五。如果确实是脾胃虚寒，饮食不思，阴气痞塞，呕吐涎沫的，适宜温其中。真阳虚的，更补其下，清上的各种药物，不可使用。
痰在膈上，大满大实，非吐不能除去，但这不是定法。如果成为定法，人人都能用了，何必独推举子和（刘完素/张从正等金元四大家之一，此处指善用汗吐下法的张从正）呢？子和必须观察其人可吐，然后才吐。一次吐不彻底，等待再等三次。缓慢地开导，据说涌痰的方法，自有擒纵卷舒的变化，可知不是浪用。谨再论述《金匮要略》不言吐的意思来阐明它，《伤寒论》用了汗、吐、下、和、温的方法。至于痰饮首先应当言吐的，张仲景反而不说，为什么呢？他用“吐发”二字来说明，是因为喘满而痰饮上溢，从内而自发。他说“医生用吐下法没治好”，也不是以吐下为过错。他说“呕吐的人本来口渴，口渴的为欲解”，又是期望从吐得到解决，为什么竟然不出“可吐”一个字呢？张仲景心中认为痰饮证内，多夹带气眩冒等证，吐之则有危险。所以不烦辞说，直接不以吐立法，避免开启后世的过错端绪，所以成为立法的祖先。自从子和以吐法擅名，无识者争相趋快捷方式，贻误不可胜道，必须领会张仲景的意思来言吐，然后吐无不恰当。
现在定吐禁十二条：眩冒昏晕不可吐。气高气浅不可吐。积劳未息不可吐，病后新虚不可吐。水道微弱不可吐。病势险急不可吐。阳虚多汗不可吐。素惯失血不可吐。风雨晦冥不可吐。冬气闭藏不可吐。多疑少决不可吐。吐后犯戒不可吐。
现在定药禁十条：阴虚枯燥妄用二陈汤。阳虚多汗妄用小青龙汤。心虚神怯妄用辛散药。肺虚无气妄用苦泻药。肝虚气刺妄用龙荟丸。脾虚浮肿妄用滚痰丸。胃虚津竭妄用香燥药。脏腑易动妄行涌泄。本非坚积妄行峻攻。血气虚羸妄行针灸。
【律三条】
凡是热痰乘风火上入，目暗耳鸣，多似虚证，误行温补，转锢其痰，永无出路，是医生的罪过。
凡是痰饮随食并出，不开幽门，徒温其胃，束手无策，迁延误人，是医生的罪过。
凡是遇肾虚水泛，痰涌气高，喘急的病证，不补其下，反清其上，必致气脱而死，是医生的罪过。
Yu Chang stated: Regarding the syndrome of Phlegm-Fluid (Tan Yin), the concepts of "Retention" (Liu) and "Latency" (Fu) are the most difficult to comprehend. The previous discussion on Retained Fluid (Liu Yin) refers to fluid that remains and does not depart; Latent Fluid (Fu Yin) is simply Retained Fluid that has hidden within the interior. Retained Fluid has times when it can be expelled, whereas Latent Fluid ultimately does not depart. From this, a glimpse of the meaning of "Retention" and "Latency" can be seen. However, can the profound principles of the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) be fully exhausted by superficial words? I shall respectfully present my exposition: The *Jin Gui Yao Lue* discusses Retained Fluid in three instances and Latent Fluid in one instance.
It states: "There is Retained Fluid under the heart; the person feels cold on the back over an area the size of a palm." This is called Retained Fluid. "Pain in the hypochondrium radiating to the Quepen (LI 12) acupoint indicates Retained Fluid in the chest." "Shortness of breath with thirst, and pain throughout all joints of the four limbs, also indicates Retained Fluid in the chest." This is because the fluid obstructs and suppresses the Yang Qi of the Upper Jiao (Heart and Lung), leading to an excess of Yin-Cold. Therefore, where it penetrates deeply into the back, there is cold without heat, simultaneously blocking the ascending Yang of the Du Meridian (Governing Vessel). The coldness on the back, the size of a palm, is merely a manifestation of internal stagnation of Yang-Fire. The hypochondrium is the pathway for the upper and lower channels of the Hand and Foot Jueyin (Liver and Pericardium), while the Foot Shaoyang (Gallbladder) channel passes from Quepen through the costal margin. Thus, pain in the hypochondrium radiating to Quepen is a sign that Retained Fluid obstructs laterally, preventing the free flow of Wood and Fire (Liver and Gallbladder). Fluid retained in the chest causes shortness of breath and thirst, and pain in the four limbs and joints, which reflects the failure of Lung Qi to disseminate and Spleen Qi to distribute essence. Observing these three points together, it is evident that Phlegm-Fluid can retain and affect the Heart, Lung, Liver, and Spleen! Is not this principle even more obvious?
Regarding Latent Fluid, it states: "Phlegm-Fluid disease above the diaphragm presents with fullness, wheezing, coughing, and expectoration. Upon attack, there are alternating chills and fever, backache, waistache, spontaneous tearing, and severe tremors of the body. There must be Latent Fluid." This indicates that the chest is the domain governed by Yang Qi. When Retained Fluid obstructs this Yang, it cannot mobilize. However, heavy Yin cannot obscure Yang forever; occasionally, Yang extends, leaving no room for Yin, causing sudden eruption and vomiting, at which point the Retained Fluid can be expelled. If it continues to hide and does not exit, it means the Qi of the Three Yang meridians extends and then contracts. When Taiyang (Bladder) Yang fails to extend, it manifests as chills, fever, backache, waistache, and tearing; when Shaoyang (Gallbladder) Yang fails to extend, the transformation of Wind and Fire becomes depressed and merges into the Yangming (Stomach) Earth. Since Yangming governs the muscles, severe tremors occur. The harm of Retained Fluid hiding and not departing is thus immense.
However, Zhang Zhongjing did not explicitly state treatment methods for Retained or Latent Fluid in the text. I investigate them from the perspective of their suppression of the Yang Qi of the Zang and Fu organs. Would the principle of "using warm medicines to harmonize" not be precisely applicable here, urgently needed to unblock Yang? Although Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, Licorice Decoction) is said to treat dizziness caused by Branch Fluid (Zhi Yin), would it not also apply to this syndrome, allowing us to emulate its intent? Therefore, only by thoroughly understanding this example can one discuss treatment methods.
Later generations, failing to understand the principles of the *Jin Gui*, arbitrarily created theories of "Five Fluids and Six Syndromes." Even Zhang Yuansu (Hai Zang), despite his brilliance, stated under the Five Fluids Decoction: "1. Retained Fluid under the heart; 2. Branch Fluid in the hypochondrium; 3. Phlegm-Fluid in the stomach; 4. Overflowing Fluid above the diaphragm; 5. Hanging Fluid in the intestines." Yet he used a single formula to treat all of them. How shallow is this!
Furthermore: Phlegm-Fluid is generally one syndrome, but has two causes. Phlegm arises from Fire, presenting with Heat but no Cold; Fluid arises from Dampness, presenting with either Heat or Cold. This is the logic of having hot springs but no cold fires. When human body heat is stagnant internally, Qi and Blood coagulate, steaming body fluids until they condense into Phlegm; this is all a manifestation of Fire. Water, due to Dampness, lingers and accumulates into Fluid. Ultimately, most Fluid syndromes are brewed from Damp-Heat, while few are from Cold-Damp. Dampness has no fixed form: in Spring it is Wind-Damp, in Summer Heat-Damp, in Autumn Dry-Damp, and in Winter Cold-Damp. Three seasons govern Heat, one governs Cold; Damp-Heat is three times more prevalent than Cold-Damp. The *Nei Jing* states that excessive Wet Earth causes Phlegm-Fluid diseases, and treatment uses various hot agents; this does not imply Phlegm-Fluid itself is a Cold syndrome. Later generations, misunderstanding this, recklessly use hot medicines, using it as an excuse. Do they not know that for pathogens invading from below, one must first resolve them from the exterior? Thus, treating excessive Dampness, one does not stray far from hot medicines to disperse exterior pathogens; only when attacking the interior does one not stray from cold medicines. Moreover, if the exterior cannot be resolved initially, and accumulated Yin obstructs the body's Yang, one must rely on warm-hot medicines to extend Yang, so that Yin pathogens can be quickly removed. To call this arbitrary use of routine methods is indeed foolish!
On Ling Gui Zhu Gan Tang: Phlegm-Fluid is a Yin image that obstructs Yang. Using this Yang-promoting medicine to transform Qi and extend Yang is the correct method. Why does this case focus on fullness supporting the chest and hypochondrium, and dizziness? The *Ling Shu* states that when the Pericardium channel moves, it causes fullness supporting the chest and hypochondrium. Thus, if Phlegm-Fluid accumulates in the Pericardium, the symptoms naturally include this. As for dizziness, it is because Phlegm-Fluid obstructs the Yang in the chest, preventing the distribution of water essence to the Earth (Spleen/Stomach). Poria (Fuling) treats Phlegm-Fluid, attacks Kidney pathogens, and promotes water pathways; Cinnamon Twig (Guizhi) unblocks Yang Qi, harmonizes Ying and Wei, and opens collaterals; Atractodes (Baizhu) treats wind-induced dizziness, dries Phlegm-Fluid, and removes fullness; Licorice (Gancao) combined with Poria does not contribute to fullness but rather relieves it. Materia Medica also states Licorice descends Qi and removes irritability and fullness, hence its use.
On Ling Gui Zhu Gan Tang and Shen Qi Wan: The *Jin Gui* states: "For shortness of breath with slight Fluid retention, one should promote urination. Ling Gui Zhu Gan Tang is the primary formula. Shen Qi Wan also treats it." Listing both formulas highlights their subtle principles further. In the first volume's discussion on respiration, the intention of distinguishing respiratory disorders was detailed. Now, shortness of breath is also divided by respiration, with each formula corresponding. For shortness of breath on exhalation, Ling Gui Zhu Gan Tang is used to unblock Yang; when Yang transforms Qi, urine can be discharged. For shortness of breath on inhalation, Shen Qi Wan is used to unblock Yin; when Kidney Qi flows, the gate of urine becomes patent. Within half a sentence lies profound essence; this is why he is considered a Sage!
On Da Qing Long Tang and Xiao Qing Long Tang: In Overflowing Fluid (Yi Yin) syndrome, water fluid overflows to the exterior, making Ying and Wei entirely unfavorable. One must imitate the method for Ying and Wei injury in Cold Damage diseases: induce sweating to scatter water. When Ying and Wei circulate through meridians, water in the four limbs will also dissipate. Essentially, Da Qing Long Tang ascends like clouds and rain, while Xiao Qing Long Tang surges waves toward the ocean. For treating Fluid syndromes, Xiao Qing Long Tang must be the primary choice.
Combined Discussion on Shi Zao Tang and Gan Sui Ban Xia Tang: In Cold Damage disease, if there is hypochondriac stuffiness, fullness, and pain, Shi Zao Tang is used to purge Phlegm-Fluid. Although miscellaneous diseases are not comparable to Cold Damage, internal pain from Hanging Fluid (Xuan Yin) in the hypochondrium is the same. Moreover, with a deep and string-like pulse, if the pathogen is not urgently drained, it will not leave, and the pulse will not return. Thus, using Shi Zao Tang is acceptable despite its harshness. Any disease in the hypochondrium requiring purging should follow this example. As for Gan Sui Gan Cao Tang treating Retained Fluid, its subtlety and profundity are such that only those who have entered the realm of the Sages can master it. The *Nei Jing* only says: "Retained pathogens must be attacked." Zhang Zhongjing analyzed the principles to exhaust variations. For intangible Qi with Heat binding in the Stomach, Tiao Wei Cheng Qi Tang is used. For Heat binding in the Intestines, Da or Xiao Cheng Qi Tang is used. For tangible Fluid with stuffiness binding in the Chest, Xian Xiong Tang is used. For stuffiness binding in the Hypochondrium, Shi Zao Tang is used. For retention binding between the Stomach and Intestines, Gan Sui Ban Xia Tang is used. The classic states: "When the patient's pulse is hidden, and they desire diarrhea, which brings relief, yet after diarrhea, the epigastrium remains hard and full, this is Retained Fluid attempting to exit; Gan Sui Ban Xia Tang is indicated." The pulse vessel is blocked by Retained Fluid, hidden and non-moving. The symptom is a desire to defecate, bringing relief, seemingly indicating the Fluid is leaving, yet it cannot truly exit. The continuing hardness and fullness in the epigastrium show that the tail of the Retained Fluid has reached the intestine, but the root remains attached to the stomach. Unless the root is eradicated, the Fluid will not depart; hence this formula is established. Gan Sui and Gan Cao are strongly contrary, but used together, they drive towards the rooted retention, striking with full force, causing the retained pathogen to leave while the medicinal root itself perishes. This embodies the *Nei Jing* principle: "If there is a cause, there is no injury." Adding white honey for decoction retains the medicine, preventing it from bursting into innocent areas. The use of Ban Xia and Bai Shao is to enter the Earth element to address upper fullness; Ban Xia benefits Earth, Bai Shao subdues Wood. How miraculous! Later formularies deleted Gan Cao, turning miracle into rigidity. Establishing formulas and theories based on this is work for those of average or inferior capacity. What benefit is there?
Combined Discussion on Mu Fang Ji Tang, Ting Li Da Zao Xie Fei Tang, and Fang Ji Jiao Mu Ting Li Da Huang Wan: All three treat Branch Fluid (Zhi Yin) entering the diaphragm, with differences in depth and sequence. The first treats the Lung primarily; the second focuses exclusively on the Lung; the third treats the Lung and the Fu organ transmitted to by the Lung. Branch Fluid entering the diaphragm approaches the Heart and Lung, secretly aiding Kidney pathogens. The text states: "The patient has wheezing and fullness, hardness and firmness in the epigastrium, dark facial complexion, and a deep, tight pulse. After dozens of days, if vomiting and purging fail to cure, Mu Fang Ji Tang is indicated. If the pattern is deficiency, it cures; if excess, it recurs in three days. If recurrence is not cured by re-administration, remove Shi Gao, add Fu Ling and Mang Xiao." Generally, Branch Fluid entering upward obstructs Qi, causing rebellion in the Lung, leading to wheezing and wasting-thirst; it obstructs Blood, mixing in the epigastrium, leading to hardness. Kidney Qi responds externally with black color; blood stasis is also black, hence the dark complexion appears on the face. However, treatment of Heart and Kidney is deferred to prioritize the Lung. Once Lung Qi moves, Fluid does not rebel and resolves. Mu Fang Ji is pungent and warm, dispersing Retained Fluid and Qi stagnation, treating Lung wheezing and fullness. Shi Gao is pungent, sweet, and slightly cold, treating rebellious Qi in the epigastrium, clearing Lung, and calming wheezing. Ren Shen is sweet and pleasant, treating wheezing, wasting-thirst, and diaphragmatic Fluid, tonifying Heart and Lung deficiency. Gui Zhi is pungent and hot, unblocking vessels, opening Qi stagnation, and guiding Qi; taken in the Qi level, it cures immediately. If Fluid is in the Blood level, deeply connected to the Lower Jiao, it will recur after curing. Hence, Qi-level medicines like Shi Gao are removed, and Mang Xiao is added to enter the Yin level, opening blockage and resolving blood stasis. Shi Gao and Fu Ling remove epigastric hardness and attack Kidney pathogens. Ting Li Da Zao Tang greatly drains Lung Qi, also because Qi stagnation leads to fluid accumulation. Fang Ji Jiao Mu Ting Li Da Huang Wan treats abdominal fullness, dry mouth and tongue, and water Qi in the intestines. This is due to Lung Qi being depressed above, causing Water Fluid to fail to move below, resulting in severe dryness and heat. This pill urgently unblocks water pathways to save the depression of Metal Qi. It treats the lower rather than the upper, hence the pill form.
Combined Discussion on Xiao Ban Xia Tang, Xiao Ban Xia Jia Fu Ling Tang, and Waitai Fu Ling Yin: The first treats Branch Fluid with vomiting but no thirst. Branch Fluid entering the diaphragm causes vomiting; emerging from high places is the most convenient path. However, vomiters should normally be thirsty; thirst proves Branch Fluid is completely gone. If not thirsty, Fluid remains, not fully cleared. No additional treatment is needed. Simply using the pungent-warm nature of Ban Xia and the pungent-dispersing nature of Sheng Jiang guides the exiting trend, and the remaining pathogen will be eliminated. The second treats sudden vomiting with added epigastric stuffiness, water between the diaphragm, dizziness, and palpitations; thus, Fu Ling is added to remove water, attack Kidney, and calm the Spirit. The third adds Ren Shen, Zhi Shi, and Chen Pi, which is crucial. It treats cases where accumulated Fluid is gone, but empty Qi and Cold Fullness remain inside, preventing eating. This syndrome is common. The *Jin Gui* early appended the Waitai formula to inspire later generations. Who else but a pioneer among people could do this?
Combined Discussion on Ze Xie Tang and Hou Po Da Huang Tang: Both treat Branch Fluid by purging from below, differing in Qi/Blood and anterior/posterior aspects. The first treats Branch Fluid in the epigastrium, obstructing the ascent and descent of Yang Qi. Extreme Heart Qi depression generates Fire and Wind, causing dizziness and vertigo. Instead of treating the dizziness directly, one promotes urination to drain Branch Fluid; then Yang rises naturally, and Wind/Fire subsides. Zhang Zhongjing's formulas often... [text implies comparison] ...the latter treats Branch Fluid with chest fullness. When Branch Fluid reaches chest fullness, Zhang Zhongjing originally used Da or Xiao Xian Xiong Tang. This formula follows the Cheng Qi method, suitable only for intangible Cold Damage with Qi-level Heat binding, not for tangible Phlegm-Fluid. This is not Zhang Zhongjing's meticulous method. It is undoubtedly an error inserted by the compiler.
On Wu Ling San: The text states: "Suppose a thin person has palpitations below the umbilicus, expectorates saliva and foam, and suffers from epilepsy-like dizziness. This is Water. Wu Ling San is indicated." This is an ordinary formula. Deeply pondering its meaning, like pointing at the moon with a finger, it becomes clear. Thin people naturally have abundant Wood and Fire Qi. Due to Water Fluid, it depresses in the Yin, carrying Yin pathogens to drum at the umbilicus, causing palpitations; ascending to the Stomach, it causes expectoration of saliva and foam; when depression peaks and erupts, it goes straight to the head and eyes, causing epilepsy and dizziness. The *Chao Shi Bing Yuan* states: "Pathogens entering Yin cause epilepsy." When Yang is depressed in Yin, there is no epilepsy/dizziness; returning to Yang position, epilepsy/dizziness occurs because it carries Yin Qi upward. Thus, one does not treat epilepsy/dizziness directly, but disperses the Yin pathogen carried upward, resulting in immediate cure. The method to disperse Yin pathogen should theoretically be from the exterior, but Wu Ling San's exterior method is superior because it also promotes urination. Modern users of Wu Ling San only know it separates anterior/posterior water and grain, not realizing it separates exterior-interior and Yin-Yang. They ignore the instruction: "Drink plenty of warm water to sweat and cure." How shallow! Not only this; regarding Xiao Qing Long Tang, people know it as a mild exterior-releasing agent, unaware it is designed to promote small amounts of urine. The little dragon of mountains and marshes, growing horns, rides thunderstorms to the ocean; it cannot raise its whiskers to ascend to heaven—this needs no asking! Thus, the five formulas for Branch Fluid in the *Jin Gui* are all modifications of Xiao Qing Long Tang, taking advantage of its ability to open water pathways and travel a thousand miles without stopping.
Later generations have four methods for treating Phlegm-Fluid: Solidify Spleen, Dry Dampness, Descend Fire, Move Qi. Solidifying Spleen and drying Dampness, Er Chen Tang and Er Zhu (Cang Zhu, Bai Zhu), are most suitable, but contraindicated in Yin Deficiency. Descending Fire must distinguish deficiency/excess: Excess uses bitter-cold, Deficiency uses sweet-cold. As for Qi-moving drugs, various formulas are vague. Let me clarify. Wind-Cold pathogens entering from outside wrap Phlegm-Fluid; only Xiao Qing Long Tang separates the pathogen outward and Phlegm-Fluid downward. Turbid Yin Qi ascending from below wraps Phlegm-Fluid; Fu Ling Hou Po Tang separates turbid Qi downward and Phlegm-Fluid upward. Anger causes Liver Qi to rebel upward, carrying Blood; Qi, Blood, Phlegm, and Fluid interlock to form masses; Chai Hu Bie Jia San eliminates them. Worry causes Spleen Qi to depress internally, food stagnates; Qi, Food, Phlegm, and Fluid interlock to form masses; Qing Tan Wan eliminates them. Excessive desire causes Kidney Qi to rebel upward, penetrating the membrane source, forming countless knots, abdominal distension and heaviness, unable to lie supine; Gui Ling Wan guides Qi downward, and Phlegm-Fluid departs.
Deficient-Cold Phlegm-Fluid is rare in youth/adulthood (1-2 in 10). In elderly/children, it is common (4-5 in 10). If truly Spleen-Stomach deficient-cold, loss of appetite, Yin obstruction, vomiting saliva/foam, warm the middle. If True Yang is deficient, tonify the lower; upper-clearing medicines must not be used.
For pediatric slow spleen wind with Phlegm-Fluid blocking orifices and tunnels, Xing Fu Liu Jun Tang awakens the mind.
For elderly with Kidney deficiency causing water overflow and Phlegm-Fluid surging upward, Cui Shi Ba Wei Wan摄 (captures/secures) it.
Phlegm in the upper diaphragm with great fullness and excess requires vomiting to remove, but this is not a fixed rule. If it were fixed, everyone could use it; why praise Zi He (Zhang Congzheng)? Zi He observes if the patient can tolerate vomiting before doing so. If one vomiting is incomplete, wait for a second or third. Slowly guide it. The method of inducing phlegm has its own control and release, clearly not reckless. I re-discuss the unstated intent of the *Jin Gui* to clarify. The *Shang Han Lun* uses Sweating, Vomiting, Purging, Harmonizing, and Warming. For Phlegm-Fluid, vomiting should be mentioned first, yet Zhang Zhongjing omits it. Why? He mentions "vomiting eruption" because wheezing/fullness causes Phlegm-Fluid to overflow upward, spontaneously from within. Saying "doctors failed with vomiting/purging" does not blame vomiting/purging. Saying "vomiters should be thirsty, thirst indicates resolution" hopes for resolution via vomiting. Why not say "Vomiting is permissible"? Zhang Zhongjing likely believed Phlegm-Fluid syndromes often accompany Qi-related dizziness and vertigo; vomiting would be dangerous. Thus, he omitted verbose explanations and did not establish vomiting as a law, avoiding opening doors for future errors, thereby becoming the ancestor of legal formulation. Since Zi He gained fame with vomiting, ignorant people rushed to shortcuts, causing endless harm. One must understand Zhang Zhongjing's intent to speak of vomiting, then vomiting will be appropriate.
Now, twelve prohibitions for vomiting:
1. Dizziness, vertigo, and fainting: do not vomit.
2. High voice and shallow breathing: do not vomit.
3. Accumulated fatigue not rested: do not vomit.
4. New deficiency after illness: do not vomit.
5. Weak water pathways: do not vomit.
6. Dangerous and urgent disease progression: do not vomit.
7. Yang deficiency with profuse sweating: do not vomit.
8. History of habitual bleeding: do not vomit.
9. Stormy, dark weather: do not vomit.
10. Winter season of closure/storage: do not vomit.
11. Indecisive and suspicious constitution: do not vomit.
12. Violating precautions after vomiting: do not vomit.
Now, ten prohibitions for medicines:
1. Yin deficiency with dryness: recklessly use Er Chen Tang.
2. Yang deficiency with profuse sweating: recklessly use Xiao Qing Long Tang.
3. Heart deficiency with weak spirit: recklessly use pungent-dispersing drugs.
4. Lung deficiency with lack of Qi: recklessly use bitter-purgatives.
5. Liver deficiency with stabbing Qi: recklessly use Long Hui Wan.
6. Spleen deficiency with edema: recklessly use Gun Tan Wan.
7. Stomach deficiency with fluid exhaustion: recklessly use aromatic-dry drugs.
8. Easily disturbed Zang-Fu: recklessly induce vomiting/purging.
9. Not solid accumulation: recklessly use harsh purgatives.
10. Deficient Qi and Blood: recklessly use acupuncture/moxibustion.
[Three Laws]
1. Whenever Hot Phlegm rides Wind-Fire upward, causing dim vision and tinnitus, resembling deficiency, mistakenly using warm-tonics will bind the Phlegm permanently with no exit. This is the doctor's fault.
2. Whenever Phlegm-Fluid exits with food, if the幽门 (pylorus/opening) is not opened, merely warming the Stomach leaves one helpless, delaying and harming the patient. This is the doctor's fault.
3. Whenever encountering Kidney deficiency with water overflow, surging Phlegm, high Qi, and急促 wheezing, failing to tonify the lower and instead clearing the upper will inevitably lead to Qi collapse and death. This is the doctor's fault.