化津生，则口燥可滋。小服而频，示缓治之意。稍增者，稍稍增服之。口中有津液渴者，
乃饮渴也。加芒硝者，以峻药力耳！
【集注】李 曰∶腹满，水聚于胃也。肠间有水气，则湿渍中焦，津液不为灌溉，故
口舌干燥。前云水走肠间，沥沥有声为痰饮，此肠间有水气，即痰饮也。
防己椒目葶苈大黄丸方
防己 椒目 葶苈（熬） 大黄（各一两）
上四味，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。
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。
十枣汤方
芫花（熬） 甘遂 大干（各等分）
上三味，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。
【集解】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。
大青龙汤方
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）
上七味，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。
小青龙汤方
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）
上八味，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。喘咳短气，肺饮证也；胁下引痛，肝饮证也。今亦不见胁下引
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，前云咳逆倚息短气
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。喘咳不能卧，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茯苓
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。
木防己汤方
木防己（三两） 石膏（鸡子大，十二枚） 桂枝（二两） 人参（四两）
上四味，以水六升，煮取二升，分温再服。
木防己加茯苓芒硝汤方
木防己 桂枝（各二两） 人参 茯苓（各四两） 芒硝（三合）
上四味，以水六升，煮取二升，去滓，内芒硝，再微煎，分温再服，微利则愈。
心下有支饮，其人苦冒眩，泽泻汤主之。
【注】心下，膈下也。水在膈上则喘满，水在膈间则痞悸，水在膈下则惟苦眩晕。以
泽泻汤之平和小剂主之，治支饮之轻者可也。若阳虚水盛，又当从事乎苓桂术甘汤、五苓散矣。
【集注】尤怡曰∶水饮之邪，上乘清阳之位，则为冒眩。冒者，昏冒而神不清，如有
物冒蔽之也；眩者，目眩转而乍见眩黑也。泽
泻泄水气，白术补土气，似胜水也。
泽泻汤方
泽泻（五两） 白术（二两）
上二味，以水二升，煮取一升，分温再服。
病痰饮者，当以温药和之。
【注】稠浊为痰，阳之盛也；稀清为饮，阴之盛也。有痰无饮，当以凉药治之；有饮
无痰，当以热药温之。若痰而兼饮者，此不可纯凉，又不可纯热，故当以温药和之可也。
夫有支饮家，咳烦，胸中痛者，不卒死，至一百日或一岁，宜十枣汤。
【注】支饮，水在膈之上下也。水乘肺则咳，水乘心则烦，水结胸则痛，其人形气俱
实，以十枣汤攻之可也。然病此卒不死，或至百日，或延至一年者，以饮阴邪，阴性迟，
故不卒死也。
十枣汤方（见上）
咳家其脉弦，为有水，十枣汤主之。
【注】此承上条，以出其脉也。咳家，谓久咳之家也，咳家未可攻也。若脉弦，其咳
则为有水也，有水可攻，故以十枣汤攻之。
【集注】魏荔彤曰∶咳嗽者，有饮冷而咳嗽者，有因外感风寒而咳嗽者，所谓形寒饮
冷则伤肺也，此外感风寒之咳嗽也。有因伤倦而咳嗽者，所谓阴虚内热，火刑肺金，此
内伤虚劳之咳嗽也。于此俱无涉也。仲景命之曰∶咳家，专为痰饮在内，逆气上冲之咳
嗽言也。故其脉必弦，无外感家之浮，无内虚家之数，但见弦者，知有水饮在中为患也。
主之以十枣汤，使水邪有所制，斯下注而免于上厥也。
脉双弦者，寒也，皆大下后里虚。脉偏弦者，饮也。
【按】此条系在首条“微者短气”之下，今分在此。
【注】脉双弦者，两手左右脉皆弦也。偏弦者，或左、或右，脉单弦也。偏弦者，饮
也，故当下之；双弦者，寒也，不当下也。即偏弦当下，亦不可大下，若大下之，则虚其
里，单弦变而为双弦矣。弦为阴脉，重阴则寒，故曰∶双弦者寒也。此又示人不可以弦
脉，专主饮也。
脉弦数，有寒饮，冬夏难治。
【按】脉弦数之“数”字，当是“迟”字，始与寒饮之理合，是传写之讹。
【注】单弦主饮 ，固当下也，若单弦兼迟，而有寒饮，不可下也。寒饮之咳，冬夏难治
者，以夏阴极于内，冬阴极于外故也。此承上二条，详申弦脉饮病可下、不可下之义也。
久咳数岁，其脉弱者，可治；实大数者，死。其脉虚者，必苦冒，其人本有支饮在胸
中故也，治属饮家。
【注】久咳数岁，即今之年年举发，痰饮咳嗽水喘之病也。若其脉弱者，知邪不进则
为可治。若实大数者，知邪日进故死也。若脉虚者知正气虚，必苦冒也，审其人素本有
支饮，则不必治其咳，宜于痰饮家求治法也。
【集注】尤怡曰∶久咳数岁不己者，支饮渍肺而咳，饮久不已，则咳久不愈也，咳久
者，其气必虚，而脉反实大数者，则其邪犹盛，以犹盛之邪，而临已虚之气，其能久持
乎？故死。若脉虚者正气固虚而饮气亦衰，故可治。然饮虽衰而正不能御，亦足以上蔽清
阳之气，故其人必苦冒也。此病为支饮所致，去其饮则病自愈，故曰∶治属饮家。
咳逆倚息不得卧，小青龙汤主之。青龙汤下已，多唾，口燥，寸脉沉，尺脉微，手足厥
逆，气从少腹上冲胸咽，手足痹，其面
翕热如醉状，因复下流阴股，小便难，时复冒者，与茯苓桂枝五味甘草汤，治其气冲。冲
气即低，而反更咳、胸满者，用苓桂五味甘草汤去桂，加干姜、细辛，以治其咳满。咳
满即止，而更复渴，冲气复发者，以细辛、干姜为热药也，服之当遂渴。而渴反止者，为
支饮也。支饮者，法当冒，冒者必呕，呕者复内半夏以去其水，茯苓桂枝五味甘草汤去
甘草桂枝加细辛干姜半夏汤主之。水去呕止，其人形肿者，加杏仁主之。其证应内麻黄，以
其人遂痹故不内之；若逆而内之者必厥。所以然者，以其人血虚，麻黄发其阳故也。若
面热如醉，此为胃热上冲熏其面。加大黄以利之。
【按】小青龙汤下已之“下”字，当是“汗”字，大小青龙汤皆汗剂，必是传写之讹。
【注】咳逆，古咳嗽名也；倚息，今呼吸促也。咳嗽呼吸气促不得卧，久病多属痰饮，
新病每兼形寒，故宜以小青龙汤汗之，以散内饮外寒也。小青龙汤辛温大散，惟有余之
人宜之，若误施之于不足之人，辛热则伤阴，故多唾口燥也；大散则伤阳，故手足厥逆也；
面热如醉，阳外浮也；小便难，气上冲，阴内竭也；脉沉微，里气弱也；手足痹，表气
虚也；时复冒，虚之甚也。虽阴阳表里俱虚，然属误汗，寒热错杂之坏病，故与茯苓桂枝
五味甘草汤，先通阳和阴，俟上冲气平，再议他法也。今气冲虽下而反更咳嗽胸满者，则
知寒饮贮胸，故嫌桂枝偏于走表，加干姜、细辛独胜中之寒饮也。服之咳满即止，而更复
渴，冲气复发，则知阴火上逆，为干姜、细辛热药所动故也。若服之时遂渴，稍时而渴
反止者，则为其人素有支饮也。支饮者，法当冒，冒者是因饮逆胸中作呕而冒，非阳虚
为饮所阻不升之冒也。故仍以本方复加半夏者，以去水也，更去甘草者，恐甘助呕也。水
去呕止，其人面形肿者，加杏仁以降呕咳，上逆之余邪，若不因呕咳面肿，则为风邪所袭，
应加麻黄。今其人血虚手足痹，阳虚手足厥，且因呕咳后而肿，故不加也。若兼有面热如
醉，此为胃热上冲熏其面，更加大黄以利胃热可也。
苓桂五味甘草汤方
茯苓（四两） 桂枝（四两） 甘草（炙，三两） 五味子（半升）
上四味，以水八升，煮取三升，去滓，分温三服。
苓甘五味姜辛汤方
茯苓（四两） 甘草 干姜 细辛（各三两） 五味子（半升）
上五味，以水八升，煮取三升，去滓，温服半升，日三服。
苓桂五味甘草去甘草去桂加干姜细辛半夏汤方
茯苓（四两） 细辛 干姜（各二两） 五味子 半夏（各半升）
上五味，以水八升，煮取三升，去滓，温服半升，日三。
苓甘五味加姜辛半夏杏仁汤方
茯苓（四两） 甘草（三两） 五味子（半升） 干姜（三两） 细辛（三两） 半夏（半
升） 杏仁（去皮尖，半升）
上七味，以水一斗，煮取三升，去滓，温服半升，日三。
苓甘五味加姜辛半杏大黄汤方
茯苓（四两） 半夏（半升） 甘草（三两） 五味子（半升） 干姜（三两） 细辛（三
两） 杏仁（去皮、尖，半升） 大黄（三两）
上八味，以水一斗，煮取三升，去滓，温服半升，日三。
津液得以化生，则口燥症状可得到滋润缓解。少量多次服用，是为了显示缓治的意图。“稍增”是指稍稍增加服药剂量。口中感觉有津液且伴有口渴，这是饮邪导致口渴的表现。加入芒硝，是为了增强药力以峻下。
【集注】李氏说：腹部胀满，是因为水湿积聚在胃中。肠间有水气，就会使湿气浸渍中焦，导致津液不能正常输布灌溉，所以出现口舌干燥。前文说过“水走肠间，沥沥有声”称为痰饮，这里说的“肠间有水气”，就是痰饮。
防己椒目葶苈大黄丸方
防己、椒目、葶苈子（炒）、大黄（各一两）
以上四味药，研成细末，用蜂蜜制成梧桐子大小的丸剂。饭前用水送服一丸，每日三次，逐渐增加剂量。如果口中感觉有津液但仍觉口渴，加芒硝半两。
【集解】程林说：防己、椒目引导水饮从前阴排出，清稀的部分从小便而出；大黄、葶苈子推动水饮从后阴排出，浑浊的部分从大便而下。这就是前后分消的方法，这样腹满就会减轻，水饮得以运行，脾气得以转输，津液自然生成。如果口渴比单纯的口舌干燥更严重，加入芒硝辅助诸药，以攻下腹满并保护脾土。
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，这也适用于形体正气充实的患者，如果形体正气稍虚，应当根据临床具体情况斟酌使用。
【集注】赵良说：脉沉说明病在里。凡是弦脉，主痛、主饮、主癖积。悬饮结积在内部引起疼痛，所以脉象呈现沉弦。
十枣汤方
芫花（炒）、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，取八合药汁，去渣，加入药末。体质强壮的人服一钱匕，体弱的人服半钱，清晨温服；如果未通便，第二天再服半钱。得到顺畅腹泻后，喝米粥来自我调养。
【集解】李氏说：这三味药都味苦，苦能泄降，能直达水饮巢穴所在之处。但担心其峻利之性会损伤人的真元之气，所以加大枣，利用其甘味来缓和药性。而且大枣是脾之果，能补益脾土，从而制约水邪。
【注】溢饮病属于经络体表，虽然应当发汗，但不能没有寒热的区别。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，本该出汗却不出汗，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。
大青龙汤方
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（如鸡蛋大小）
以上七味药，用水九升，先煮麻黄，减少二升，去掉上面的浮沫，加入其他药物，煮取三升，去渣，温服一升，取微似汗。如果汗出过多，用温粉扑身止汗。
小青龙汤方
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）
以上八味药，用水一斗，先煮麻黄，减少二升，去掉上面的浮沫，加入其他药物，煮取三升，去渣，温服一升。
【集解】尤怡说：大青龙汤是在桂枝汤和麻黄汤基础上减去芍药，加入石膏而成，适用于水气不重而兼有热邪的情况。如果饮邪多而寒邪潜伏，则必须用小青龙汤才恰当。
【注】弦脉是各种饮病的诊断特征，但专门主肝的是弦脉。水在肝部，则病为悬饮，所以脉象沉弦；水在肺部，则病为支饮，所以脉象不弦。喘咳短气，是肺饮的症状；胁下牵引疼痛，是肝饮的症状。现在既不见胁下牵引疼痛的肝证，只见到苦于喘息短气的肺证，所以说：肺饮不现弦脉。
【集注】李氏说：弦脉是肝的脉象，所以肺饮不现弦脉。苦于喘息短气，是肺邪迫塞所致，前文说过“咳逆倚息短气”称为支饮，就是这个意思。
【注】支饮是水在肺的病，所以也会喘息而不能平卧，伴有短气。所谓脉平，是指见到肺的正常脉象，或浮、或涩、或短。这是对上一条“不弦”含义的详细阐述。
【注】这是承接上一条来说明治疗方法。喘咳不能平卧，短气呼吸困难，都是水在肺的急症，所以用葶苈大枣汤，直接泻除肺中的水饮。
【集注】沈明宗说：这是支饮偏溢于肺。支饮贮存在胸膈，上犯于肺，气机逆乱则呼吸难以通彻，所以呼吸困难。然而急则治标，所以佐以大枣的甘味以保脾，葶苈的苦味以泻肺，使肺气通调，脾得转输，这是峻攻肺中支饮的方剂。
尤怡说：呼吸困难，是肺满而气闭。葶苈入肺，通闭泄满。用大枣，是不使其损伤正气。
膈间有支饮，患者喘息胸闷，心下痞塞坚硬，面色黧黑，脉象沉紧，患病几十天，医生用吐法、下法治疗都没有痊愈，用木防己汤主治。如果是虚证服药后即愈，实证三天后复发，再次服用原方无效者，宜用木防己汤去石膏加茯苓芒硝汤主治。
【注】支饮会导致喘息胸闷、呼吸困难，这是水在胸肺。再加上心下痞塞坚硬，说明水盘结连及膈间，所以叫“膈间支饮”。面色黧黑，是水邪深结的颜色。脉象沉紧，是水邪深结的脉象。水邪深结，所以出现喘息、胸闷、痞塞坚硬的证候。患病几十天，医生或用吐法不愈，是因为水邪不单结在上部，所以越吐而不愈；或用下法不愈，是因为水邪不单结在下部，即使竭尽攻下也不愈。心下痞塞坚硬，可知饮邪结在中焦，所以用木防己汤开通三焦的水结，通畅上中下三焦的气机。方中使用人参，是因为经过吐下治疗后正气受损。所以水邪虚结者，服用后即愈。若水邪实结者，虽然暂时痊愈也会复发，即再次服用前方也不能愈，应当以前方减去石膏的寒凝之性，加入芒硝峻开坚结，加入茯苓直通水道，没有不愈的。
【集注】李氏说：喘息、胸闷、痞塞坚硬，是膈间支饮逆上所致。面黑，是因为饮属于北方水色。脉沉主饮，紧主寒，都是阴脉，因为水饮禀受阴寒之气。吐法和下法都用过却不愈，说明阴阳之气都虚，木防己汤补虚散饮，虚证接受补益即愈。实证则是饮邪固结不解，所以复发不愈，这是因为寒气凝聚未解，所以去掉石膏，恐怕伤胃寒，加入茯苓淡渗利饮，芒硝咸味软坚散结。
木防己汤方
木防己（三两）、石膏（如鸡蛋大，十二枚）、桂枝（二两）、人参（四两）
以上四味药，用水六升，煮取二升，分两次温服。
木防己加茯苓芒硝汤方
木防己、桂枝（各二两）、人参、茯苓（各四两）、芒硝（三合）
以上四味药，用水六升，煮取二升，去渣，加入芒硝，再稍微煎煮，分两次温服，微微通利大便即愈。
【注】心下，指膈下。水在膈上则喘息胸闷，水在膈间则痞塞悸动，水在膈下则只苦于眩晕。用泽泻汤这种平和的小方剂来主治，可以治疗轻症的支饮。如果是阳虚水盛，又应当采用苓桂术甘汤、五苓散了。
【集注】尤怡说：水饮之邪，上乘清阳之位，就会导致头昏目眩。冒，是指昏蒙不清，好像有东西遮蔽一样；眩，是指眼花旋转，突然看见黑暗。泽泻泄除水气，白术补益土气，似乎能胜水。
泽泻汤方
泽泻（五两）、白术（二两）
以上两味药，用水二升，煮取一升，分两次温服。
患痰饮病的，应当用温药调和治疗。
【注】稠浊的为痰，是阳气盛的表现；稀清的为饮，是阴气盛的表现。只有痰没有饮，应当用凉药治疗；只有饮没有痰，应当用热药温化。如果痰兼有饮，这就不可纯用凉药，也不可纯用热药，所以应当用温药调和治疗即可。
凡是患有支饮的人，咳嗽心烦，胸痛，如果没有猝死，延续到一百天或一年，宜用十枣汤。
【注】支饮，是水在膈的上下。水乘袭肺则咳，水乘袭心则烦，水结于胸则痛。如果其人形气俱实，可以用十枣汤攻逐。然而患此病没有猝死，或者延续到百日，或者拖延至一年的原因，是因为饮为阴邪，阴性迟缓，所以不会猝死。
十枣汤方（见上文）
【注】这是承接上一条，指出其脉象。咳家，指久咳的患者。对于咳家通常不可攻逐。如果脉象弦，说明他的咳嗽是由于有水饮引起的，既然有水饮就可以攻逐，所以用十枣汤攻逐。
【集注】魏荔彤说：咳嗽，有因喝冷饮而咳嗽的，有因外感风寒而咳嗽的，所谓“形寒饮冷则伤肺”，这是外感风寒引起的咳嗽。有因劳倦受伤而咳嗽的，所谓阴虚内热，火刑肺金，这是内伤虚劳引起的咳嗽。这些都与本条无关。仲景称之为“咳家”，是专门针对痰饮在内，逆气上冲引起的咳嗽而言。所以其脉必弦，没有外感病的浮脉，没有内虚病的数脉，只要见到弦脉，就知道是有水饮在中作祟。主治用十枣汤，使水邪有所制约，从而向下排泄而免于上逆厥脱。
脉象左右两手都弦的，是寒证，多见于大病下之后导致里虚。脉象单侧弦的，是饮证。
【按】这一条原本位于首条“微者短气”之下，现在分列在此。
【注】脉双弦，是指两手左右脉都呈弦象。偏弦，是指左或右单侧脉呈弦象。偏弦是饮证，所以应当攻下；双弦是寒证，不应当攻下。即使是偏弦应当攻下，也不可用猛烈攻下，如果猛烈攻下，会使里气更虚，单弦就会变成双弦。弦为阴脉，重阴则寒，所以说：双弦者是寒证。这也是提示人们不可以仅凭弦脉就专主饮病。
脉象弦而数的，如果有寒饮，冬夏两季难治。
【按】脉弦数中的“数”字，应当是“迟”字，这才符合寒饮的道理，这是传写造成的错误。
【注】单弦主饮，本来应当攻下，但如果单弦兼迟，且有寒饮，就不可以攻下。寒饮引起的咳嗽，冬夏两季难治的原因，是因为夏季阴极于内，冬季阴极于外。这是承接上两条，详细阐述弦脉饮病可下、不可下的意义。
久咳数年，如果脉象虚弱，是可以治疗的；如果脉象实大数，则是死证。如果脉象虚，必定苦于头昏，这是因为人本来就有支饮在胸中，所以治疗归属于痰饮家的范畴。
【注】久咳数年，就是如今每年发作的痰饮咳嗽水喘病。如果脉象虚弱，知道邪气没有进展，所以可治。如果脉象实大数，知道邪气日益进展，所以是死证。如果脉象虚，知道正气虚，必定苦于头昏。审察其人素来有支饮，则不必治其咳嗽，应当在痰饮的治疗法则中寻求治法。
【集注】尤怡说：久咳数年不止，是支饮浸渍于肺导致咳嗽，饮邪久留不去，所以咳嗽久不愈。咳嗽久了，人气必虚，如果脉反而实大数，说明邪气仍然强盛，以强盛的邪气面对已虚的正气，怎么能长久维持呢？所以死。如果脉虚，说明正气固然虚，饮气也衰，所以可治。然而饮邪虽衰，正气却不能抵御，也足以遮蔽清阳之气，所以其人必定苦于头昏。此病由支饮引起，去除饮邪则病自愈，所以说：治疗归属于痰饮家。
咳嗽气逆，倚靠呼吸，不能平卧，用小青龙汤主治。服用小青龙汤发汗后，如果出现多唾、口燥，寸脉沉，尺脉微，手足厥冷，气从少腹上冲胸咽，手足麻木，面部发热像醉酒的样子，随后又流注于大腿内侧，小便困难，时常头晕的，给予茯苓桂枝五味甘草汤，治疗其上冲之气。冲气平息后，反而又咳嗽、胸满的，用苓桂五味甘草汤去掉桂枝，加入干姜、细辛，以治疗其咳嗽胸满。咳嗽胸满停止后，如果再出现口渴，冲气复发的，是因为细辛、干姜是热药，服用后应当随即口渴。如果喝了药反而不渴了，是因为有支饮。支饮患者，法当头晕，头晕者必定呕吐，呕吐者再加入半夏以去除水饮，用茯苓桂枝五味甘草汤去掉甘草、桂枝，加入细辛、干姜、半夏的主治。水饮去、呕吐止后，如果患者面部浮肿，加杏仁主治。按理应当加入麻黄，但因为患者已有手足麻木，所以不加；如果逆理加入麻黄，必定导致厥逆。之所以这样，是因为患者血虚，麻黄会发散其阳气。如果面部发热像醉酒，这是胃热上冲熏蒸面部。加入大黄以通利胃热。
【按】小青龙汤下已的“下”字，应当是“汗”字，大小青龙汤都是发汗剂，必然是传写造成的错误。
【注】咳逆，是古时对咳嗽的称呼；倚息，今指呼吸急促。咳嗽呼吸气促不能平卧，久病多属痰饮，新病常兼有畏寒，所以宜用小青龙汤发汗，以散内饮外寒。小青龙汤辛温发散力强，只适合有余之人，如果误用于不足之人，辛热会伤阴，所以多唾口燥；大发汗会伤阳，所以手足厥冷；面部发热像醉酒，是阳气外浮；小便难，气上冲，是阴精内竭；脉沉微，是里气弱；手足麻木，是表气虚；时常头晕，是虚损严重。虽然阴阳表里都虚，但这属于误汗导致的寒热错杂的坏病，所以给予茯苓桂枝五味甘草汤，先通阳和阴，等待上冲之气平息，再议其他方法。现在冲气虽下，反而又咳嗽胸满，则知寒饮贮存在胸中，所以嫌桂枝偏于走表，加入干姜、细辛独胜中焦的寒饮。服用后咳嗽胸满即止，如果再出现口渴，冲气复发，则知是阴火上逆，被干姜、细辛热药所动。如果服药时随即口渴，过了一会儿口渴反而停止，则是因为其人素有支饮。支饮患者，法当头晕，头晕是因为饮邪逆于胸中作呕而导致头晕，不是阳虚被饮邪阻滞不升导致的头晕。所以仍以本方再加半夏，以去除水饮，更去掉甘草，恐怕甘味助呕。水去呕止后，如果患者面部浮肿，加杏仁以降逆止呕咳，清除上逆之余邪。如果不因呕咳而面部肿，则是风邪侵袭，应加麻黄。现在患者血虚手足麻木，阳虚手足厥冷，且因呕咳后而肿，所以不加。如果兼有面部发热像醉酒，这是胃热上冲熏蒸面部，更加大黄以通利胃热即可。
茯苓桂枝五味甘草汤方
茯苓（四两）、桂枝（四两）、甘草（炙，三两）、五味子（半升）
以上四味药，用水八升，煮取三升，去渣，分三次温服。
苓甘五味姜辛汤方
茯苓（四两）、甘草、干姜、细辛（各三两）、五味子（半升）
以上五味药，用水八升，煮取三升，去渣，温服半升，每日三次。
苓桂五味甘草去甘草去桂加干姜细辛半夏汤方
茯苓（四两）、细辛、干姜（各二两）、五味子、半夏（各半升）
以上五味药，用水八升，煮取三升，去渣，温服半升，每日三次。
苓甘五味加姜辛半夏杏仁汤方
茯苓（四两）、甘草（三两）、五味子（半升）、干姜（三两）、细辛（三两）、半夏（半升）、杏仁（去皮尖，半升）
以上七味药，用水一斗，煮取三升，去渣，温服半升，每日三次。
苓甘五味加姜辛半杏大黄汤方
茯苓（四两）、半夏（半升）、甘草（三两）、五味子（半升）、干姜（三两）、细辛（三两）、杏仁（去皮、尖，半升）、大黄（三两）
以上八味药，用水一斗，煮取三升，去渣，温服半升，每日三次。
When body fluids are generated, dryness of the mouth can be moistened. Taking small doses frequently indicates a gentle treatment approach. "Slightly increasing" refers to slightly increasing the dosage. The sensation of saliva in the mouth accompanied by thirst is due to fluid retention causing thirst. Adding Mangxiao (Natrii Sulfas) is to enhance the purgative power.
[Collected Annotations] Li said: Abdominal fullness is caused by water accumulation in the stomach. When there is water qi in the intestines, dampness infiltrates the middle jiao, preventing body fluids from being distributed and irrigated, thus causing dryness of the mouth and tongue. As mentioned earlier, "water flowing through the intestines with a gurgling sound" is called Tan-Yin (Phlegm-Fluid). What is described here as "water qi in the intestines" is indeed Tan-Yin.
Fangji Jiaomu Tingli Dahuang Wan Formula
Fangji (Stephaniae Tetrandrae Radix), Jiaomu (Levistici Fructus), Tingli (Descurainiae Semen seu Lepidii Semen, roasted), Dahuang (Rhei Radix et Rhizoma) — each 1 liang.
The above four herbs are ground into powder, mixed with honey to form pills the size of wu zi (Cibotii Spora). Take one pill before meals with water, three times a day, gradually increasing the dose. If there is a sensation of saliva but still thirst, add Ban liang of Mangxiao (Natrii Sulfas).
[Collected Explanations] Cheng Lin said: Fangji and Jiaomu guide the fluid forward, allowing the clear part to exit via urination; Dahuang and Tingli push the fluid backward, allowing the turbid part to exit via defecation. This method of draining from both front and back reduces abdominal fullness and promotes the movement of fluid, restoring spleen qi transformation and generating body fluids. If thirst is more severe than simple dryness of the mouth and tongue, adding Mangxiao assists the other herbs to purge abdominal fullness and protect the spleen earth.
A pulse that is deep (Chen) and wiry (Xian) indicates Xuan-Yin (Suspension Fluid) with internal pain.
[Annotation] A deep pulse indicates interior syndrome; a wiry pulse indicates fluid retention. Xuan-Yin disease belongs to fluid retention in the interior, hence it presents with internal pain due to Xuan-Yin.
For patients suffering from Xuan-Yin, Shizao Tang (Ten Jujube Decoction) is the primary treatment.
[Annotation] This follows the previous clause to clarify the treatment. Shizao Tang is indicated for patients with substantial constitution and qi. If the constitution is slightly deficient, clinical judgment should be exercised.
[Collected Annotations] Zhao Liang said: A deep pulse indicates the disease is in the interior. Generally, a wiry pulse indicates pain, fluid retention, or mass accumulation. Xuan-Yin accumulates internally causing pain, hence the pulse appears deep and wiry.
Shizao Tang Formula
Yuanhua (Genkwa Flos), Gansui (Kansui Radix), Daji (Euphorbiae Pekinensis Radix) — equal parts.
The above three herbs are crushed and sifted. Use 1 sheng 5 he of water, first boil ten large jujubes until 8 he remains, strain, and add the herb powder. Strong individuals take one qian bi; weak individuals take half a qian bi. Take warm in the morning. If no bowel movement occurs, take another half qian bi the next day. After obtaining smooth diarrhea, nourish oneself with millet porridge.
[Collected Explanations] Li said: All three herbs are bitter. Bitterness drains and reaches the nests of fluid retention. However, fearing their harsh purgative nature will damage true yuan qi, Da Zao (Jujubae Fructus) is added for its sweet property to moderate them. Moreover, jujube is the fruit of the spleen, tonifying earth to control water.
For patients with Yi-Yin (Overflowing Fluid), 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.
[Annotation] Yi-Yin disease involves the meridians and exterior. Although sweating is required, there is a distinction between heat and cold patterns. For heat patterns, induce sweating with acrid-cool herbs using Da Qinglong Tang; for cold patterns, induce sweating with acrid-warm herbs using Xiao Qinglong Tang. Hence, it is stated that Da Qinglong Tang is primary, but Xiao Qinglong Tang is also applicable.
[Collected Annotations] You Yi said: When water qi circulates and gathers in the limbs, and sweating should occur but does not, resulting in heavy and painful body, this is called Yi-Yin. The limbs belong to yang. Water in yin locations is suitable for promoting urination; water in yang locations is suitable for inducing sweating.
Da Qinglong Tang Formula
Mahuang (Ephedrae Herba, removed nodes, 6 liang), Guizhi (Cinnamomi Ramulus, 2 liang), Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 2 liang), Xingren (Armeniacae Semen Amarum, skin and tips removed, 40 pieces), Shengjiang (Zingiberis Rhizoma Recens, 3 liang), Dazao (Jujubae Fructus, 12 pieces), Shigao (Gypsi Fibrosus, size of a chicken egg).
The above seven herbs are boiled in 9 sheng of water. First boil Mahuang, reduce by 2 sheng, remove the foam on top, then add the remaining herbs. Boil to obtain 3 sheng, strain, and take 1 sheng warm. Aim for slight sweating. If sweating is excessive, apply warm powder to the body.
Xiao Qinglong Tang Formula
Mahuang (Ephedrae Herba, removed nodes, 3 liang), Shaoyao (Paeoniae Radix Alba, 3 liang), Wuweizi (Schisandrae Fructus, half sheng), Ganjiang (Zingiberis Rhizoma, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 3 liang), Xixin (Asari Radix et Rhizoma, 3 liang), Guizhi (Cinnamomi Ramulus, 3 liang), Banxia (Pinelliae Rhizoma, washed with hot water, half sheng).
The above eight herbs are boiled in 1 dou of water. First boil Mahuang, reduce by 2 sheng, remove the foam on top, then add the remaining herbs. Boil to obtain 3 sheng, strain, and take 1 sheng warm.
[Collected Explanations] You Yi said: Da Qinglong Tang is derived from Guizhi Tang and Mahuang Tang by removing Shaoyao and adding Shigao. It is suitable when water qi is not severe but accompanied by heat. If there is abundant fluid retention with latent cold, Xiao Qinglong Tang is appropriate.
Lung fluid retention may not present with a wiry pulse; instead, the patient suffers from wheezing and shortness of breath.
[Annotation] The wiry pulse is a diagnostic sign for various fluid diseases, but it specifically governs the liver. When water is in the liver region, it causes Xuan-Yin, hence the pulse is deep and wiry. When water is in the lung region, it causes Zhi-Yin (Supporting Fluid), hence the pulse is not wiry. Wheezing, coughing, and shortness of breath are symptoms of Lung fluid retention; pain radiating from the hypochondrium is a symptom of Liver fluid retention. Since there is no hypochondriac pain (Liver sign), only wheezing and shortness of breath (Lung signs) are seen, it is said that Lung fluid retention does not present with a wiry pulse.
[Collected Annotations] Li said: The wiry pulse is the pulse of the liver, so Lung fluid retention does not show a wiry pulse. Suffering from wheezing and shortness of breath indicates pathogenic factors obstructing the lungs. As mentioned earlier, "coughing, lying on one side to breathe, shortness of breath" is called Zhi-Yin.
Zhi-Yin also causes wheezing and inability to lie flat, accompanied by shortness of breath, while the pulse remains normal.
[Annotation] Zhi-Yin is water in the lungs, hence it causes wheezing, inability to lie flat, and shortness of breath. "Normal pulse" refers to seeing the normal lung pulse, which may be floating, choppy, or short. This elaborates on the meaning of "not wiry" from the previous clause.
For Zhi-Yin causing difficulty in breathing, Tingli Dazao Tang (Descurainia Seed and Jujube Decoction) is the primary treatment.
[Annotation] This follows the previous clause to clarify the treatment. Wheezing, coughing, inability to lie flat, shortness of breath, and difficulty breathing are all acute conditions of water in the lungs. Therefore, Tingli Dazao Tang is used to directly drain lung water.
[Collected Annotations] Shen Mingzong said: This is Zhi-Yin overflowing into the lungs. Zhi-Yin stores in the chest and diaphragm, affecting the lungs upward. Qi rebellion makes breathing difficult, hence the difficulty in breathing. In emergencies, treat the branch. Thus, Da Zao's sweetness protects the spleen, and Tingli's bitterness drains the lungs, allowing lung qi to flow freely and spleen qi to transform. This is a harsh formula for attacking Zhi-Yin in the lungs.
You Yi said: Difficulty in breathing indicates lung fullness and qi closure. Tingli enters the lungs to open closure and drain fullness. Da Zao is used to prevent damage to healthy qi.
Tingli Dazao Tang Formula (See in Lung Abscess Chapter)
When there is Zhi-Yin in the intercostal space, the patient experiences wheezing and chest fullness, epigastric stuffiness and hardness, dark facial complexion, and a deep, tight pulse. Having suffered for dozens of days, if vomiting and purging methods failed to cure, Mufangji Tang (Wood Stephania Decoction) is the primary treatment. If it is a deficiency pattern, recovery occurs immediately; if it is an excess pattern, it recurs after three days. If repeated administration fails, Mufangji Tang minus Shigao plus Fuling and Mangxiao Tang is the primary treatment.
[Annotation] Zhi-Yin causes wheezing, chest fullness, and breathing difficulty due to water in the chest and lungs. Combined with epigastric stuffiness and hardness, it indicates water knotting and connecting to the intercostal space, hence called "Zhi-Yin in the intercostal space." Dark facial complexion is the color of deeply knotted water pathogen. Deep and tight pulse is the pulse of deeply knotted water pathogen. Due to deep knotting, symptoms of wheezing, fullness, and epigastric hardness appear. After dozens of days, if vomiting fails because the water pathogen is not solely located superiorly, purging fails because it is not solely located inferiorly. Epigastric stuffiness and hardness indicate knotting in the middle. Therefore, Mufangji Tang is used to open the water knots of the San Jiao and unblock qi in the upper, middle, and lower jiao. Ren Shen is used in the formula because healthy qi was damaged by vomiting and purging. Thus, for deficiency-type water knotting, recovery occurs upon ingestion. For excess-type water knotting, even if temporarily cured, it recurs. Re-administering the original formula will fail. One should subtract the cooling nature of Shigao from the original formula, add Mangxiao to harshly open hard knots, and add Fuling to directly channel water pathways. Recovery is inevitable.
[Collected Annotations] Li said: Wheezing, chest fullness, and epigastric hardness are due to Zhi-Yin in the intercostal space rebelling upward. Black face indicates the water color of the North. Deep pulse indicates fluid, tight pulse indicates cold; both are yin pulses, as water fluid inherits yin-cold qi. Failure of both vomiting and purging indicates deficiency of yin and yang qi. Mufangji Tang tonifies deficiency and scatters fluid; deficiency patterns recover with tonification. Excess patterns involve solidified fluid pathogen that does not resolve, hence recurrence and failure to cure. This is because cold qi condensation has not resolved. Therefore, Shigao is removed to avoid damaging stomach cold. Fuling is added to leach out fluid with its bland taste, and Mangxiao is added to soften hardness with its salty taste.
Mufangji Tang Formula
Mufangji (Stephaniae Membranaceae Radix, 3 liang), Shigao (Gypsi Fibrosus, size of a chicken egg, 12 pieces), Guizhi (Cinnamomi Ramulus, 2 liang), Renshen (Ginseng Radix, 4 liang).
The above four herbs are boiled in 6 sheng of water to obtain 2 sheng. Divide into two warm doses.
Mufangji Tang minus Shigao plus Fuling and Mangxiao Tang Formula
Mufangji (Stephaniae Membranaceae Radix), Guizhi (Cinnamomi Ramulus) — each 2 liang; Renshen (Ginseng Radix), Fuling (Poria, 4 liang) — each 4 liang; Mangxiao (Natrii Sulfas, 3 he).
The above four herbs are boiled in 6 sheng of water to obtain 2 sheng. Strain, add Mangxiao, simmer slightly, divide into two warm doses. Slight diarrhea indicates recovery.
When there is Zhi-Yin in the heart region (epigastrium), the patient suffers from dizziness and vertigo. Zexie Tang (Alisma Decoction) is the primary treatment.
[Annotation] "Heart region" refers to below the diaphragm. Water above the diaphragm causes wheezing and chest fullness; water in the intercostal space causes stuffiness and palpitations; water below the diaphragm causes only dizziness and vertigo. Zexie Tang, a mild and small formula, is used to treat mild cases of Zhi-Yin. If yang deficiency and abundant water exist, Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction) or Wuling San (Five-Ingredient Powder with Poria) should be employed.
[Collected Annotations] You Yi said: When water-fluid pathogen ascends to the position of clear yang, it causes dizziness and vertigo. "Mao" refers to mental cloudiness and lack of clarity, as if covered by something; "Xuan" refers to spinning dizziness and sudden vision of darkness. Zexie drains water qi, Baizhu tonifies earth qi, seemingly overcoming water.
Zexie Tang Formula
Zexie (Alismatis Rhizoma, 5 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 2 liang).
The above two herbs are boiled in 2 sheng of water to obtain 1 sheng. Divide into two warm doses.
Patients with Tan-Yin should be treated with warm herbs to harmonize.
[Annotation] Thick and turbid substances are Tan (Phlegm), indicating excess yang; thin and clear substances are Yin (Fluid), indicating excess yin. If there is Tan without Yin, cool herbs should be used; if there is Yin without Tan, hot herbs should be used for warming. If Tan accompanies Yin, neither pure cooling nor pure heating is appropriate; thus, warm herbs should be used to harmonize.
For those with Zhi-Yin who experience coughing, irritability, and chest pain, if they do not die suddenly but survive for a hundred days or a year, Shizao Tang is appropriate.
[Annotation] Zhi-Yin is water above and below the diaphragm. Water attacking the lungs causes cough; water attacking the heart causes irritability; water knotting in the chest causes pain. If the patient's constitution and qi are substantial, Shizao Tang can be used to attack. However, the reason for not dying suddenly, or surviving for a hundred days or a year, is that Yin is a yin pathogen with slow nature, hence no sudden death.
Shizao Tang Formula (See above)
In patients with chronic cough, if the pulse is wiry, it indicates the presence of water. Shizao Tang is the primary treatment.
[Annotation] This follows the previous clause to identify the pulse. "Kejia" refers to patients with chronic cough. Chronic coughers generally should not be attacked. If the pulse is wiry, the cough is due to water. Since there is water, it can be attacked; thus, Shizao Tang is used.
[Collected Annotations] Wei Litong said: Coughing can be caused by drinking cold liquids or by external contraction of wind-cold ("cold form and cold drinks injure the lungs"), which is external wind-cold coughing. It can also be caused by fatigue injury, where yin deficiency leads to internal heat burning lung metal, which is internal injury consumptive coughing. These are irrelevant here. Zhang Zhongjing calls it "Kejia" specifically for coughing caused by internal phlegm-fluid and rebellious qi rushing upward. Therefore, the pulse must be wiry, lacking the floating pulse of external contraction or the rapid pulse of internal deficiency. Seeing only a wiry pulse indicates water-fluid pathology in the middle. Treating with Shizao Tang constrains the water pathogen, allowing it to descend and preventing upper reversal.
If the pulse is wiry on both sides (double wiry), it indicates cold, often occurring after severe purging leading to interior deficiency. If the pulse is wiry on one side (single wiry), it indicates fluid retention.
[Commentary] This clause originally followed the first clause "mild cases have shortness of breath" but is placed here separately.
[Annotation] Double wiry pulse means both left and right wrists show a wiry pulse. Single wiry pulse means only one wrist shows a wiry pulse. Single wiry indicates fluid retention, so purging is indicated; double wiry indicates cold, so purging is not indicated. Even if single wiry requires purging, severe purging should be avoided. Severe purging would further weaken the interior, turning single wiry into double wiry. Wiry is a yin pulse; double yin indicates cold, hence "double wiry indicates cold." This reminds practitioners not to attribute the wiry pulse solely to fluid retention.
If the pulse is wiry and rapid, and there is cold-fluid retention, it is difficult to treat in winter and summer.
[Commentary] The character "rapid" (Shuo) in "wiry and rapid pulse" should likely be "slow" (Chi) to align with the logic of cold-fluid retention; this is a transcription error.
[Annotation] Single wiry indicates fluid retention, which normally requires purging. However, if single wiry is accompanied by a slow pulse and cold-fluid retention, purging is contraindicated. Cough due to cold-fluid retention is difficult to treat in summer and winter because extreme yin resides internally in summer and externally in winter. This follows the previous two clauses to elaborate on whether purging is appropriate for wiry-pulse fluid diseases.
For chronic cough lasting several years, if the pulse is weak, it is treatable; if the pulse is excess, large, and rapid, it is fatal. If the pulse is deficient, the patient certainly suffers from dizziness, because they originally had Zhi-Yin in the chest. Treatment falls under the category of fluid retention management.
[Annotation] Chronic cough for several years corresponds to annually recurring phlegm-fluid cough and asthma. If the pulse is weak, it indicates the pathogen is not advancing, so it is treatable. If the pulse is excess, large, and rapid, it indicates the pathogen is advancing daily, so it is fatal. If the pulse is deficient, it indicates healthy qi deficiency, certainly causing dizziness. Examining that the person originally had Zhi-Yin, one need not treat the cough specifically but should seek treatment methods within the framework of fluid retention management.
[Collected Annotations] You Yi said: Chronic cough lasting years is caused by Zhi-Yin soaking the lungs. Long-standing fluid retention leads to long-lasting cough. Long-term cough depletes qi, making it deficient. If the pulse is paradoxically excess, large, and rapid, it indicates the pathogen remains strong. Facing strong pathogen with depleted qi, survival is impossible, hence fatal. If the pulse is deficient, it indicates both healthy qi and fluid qi are declining, so it is treatable. However, although fluid qi declines, healthy qi cannot resist it, enough to obscure clear yang qi, hence the patient suffers from dizziness. This disease is caused by Zhi-Yin; removing the fluid cures the disease, hence "treatment belongs to fluid retention management."
For coughing with rebellious qi, leaning on support to breathe, and inability to lie flat, Xiao Qinglong Tang is the primary treatment. After administering Xiao Qinglong Tang, if excessive salivation, dry mouth, deep cun pulse, shallow chi pulse, cold extremities, qi rushing from the lower abdomen to the chest and throat, numbness in extremities, facial flushing like drunkenness, subsequent flow to the inner thighs, difficult urination, and intermittent dizziness occur, give Linggui Wuzhi Gancao Tang (Poria, Cinnamon Twig, Schisandra and Licorice Decoction) to treat the qi rushing. Once the qi rushing subsides, if cough and chest fullness recur, use Linggui Wuzhi Gancao Tang minus Guizhi plus Ganjiang and Xixin to treat the cough and fullness. Once cough and fullness stop, if thirst recurs and qi rushing reappears, it is because Xixin and Ganjiang are hot herbs; taking them should cause immediate thirst. If thirst stops instead, it indicates Zhi-Yin. Zhi-Yin patients typically suffer from dizziness; dizzy patients often vomit. For vomiting, add Banxia to remove water. Use Linggui Wuzhi Gancao Tang minus Gancao and Guizhi plus Xixin, Ganjiang, and Banxia as the primary treatment. After water removal and vomiting cessation, if facial swelling occurs, add Xingren. Normally, Mahuang should be added, but due to existing numbness, it is omitted; adding it against indications would cause cold extremities. This is because the patient has blood deficiency, and Mahuang disperses yang. If facial flushing like drunkenness occurs, it indicates stomach heat rushing upward to flush the face. Add Dahuang to drain it.
[Commentary] The character "xia" (administer/purge) in "after administering Xiao Qinglong Tang" should be "han" (sweat); both Major and Minor Blue Dragon Decoctions are sweating formulas, so this is a transcription error.
[Annotation] "Keni" is the ancient term for cough; "Yixi" refers to current shortness of breath. Coughing, shortness of breath, and inability to lie down in chronic illness mostly belong to phlegm-fluid; new onset often combines with cold aversion. Thus, Xiao Qinglong Tang is used to sweat, dispersing internal fluid and external cold. Xiao Qinglong Tang is acrid-warm and strongly dispersing, suitable only for those with excess. Misusing it on deficient individuals damages yin with acrid-heat (causing salivation and dry mouth) and damages yang with strong sweating (causing cold extremities). Facial flushing like drunkenness indicates floating yang; difficult urination and qi rushing indicate depleted yin inside; deep and shallow pulse indicates weak interior qi; numbness indicates deficient exterior qi; intermittent dizziness indicates severe deficiency. Although yin, yang, interior, and exterior are all deficient, this is a mishandled disease due to mistaken sweating, characterized by mixed cold and heat. Therefore, Linggui Wuzhi Gancao Tang is given to first unblock yang and harmonize yin. Wait for the rushing qi to calm before discussing other methods. Now, although the rushing qi has subsided, cough and chest fullness recur, indicating cold-fluid stored in the chest. Guizhi is disliked for its tendency to move outward, so Ganjiang and Xixin are added to overcome central cold-fluid. After taking this, cough and fullness stop. If thirst recurs and qi rushes again, it indicates ministerial fire rebelling upward, stirred by the hot herbs Ganjiang and Xixin. If immediate thirst occurs upon taking the medicine, but thirst stops later, it indicates pre-existing Zhi-Yin. Zhi-Yin patients typically suffer from dizziness; dizziness here is caused by fluid rebellion in the chest inducing vomiting, not by yang deficiency blocking ascent. Therefore, Banxia is added to the original formula to remove water, and Gancao is removed to avoid sweet flavor aiding vomiting. After water removal and vomiting cessation, if facial swelling occurs, add Xingren to direct downward rebellious qi from residual pathogen of vomiting/cough. If not due to vomiting/cough but due to wind pathogen invasion, Mahuang should be added. Now, with blood deficiency causing numbness and yang deficiency causing cold extremities, and swelling following vomiting/cough, Mahuang is omitted. If accompanied by facial flushing like drunkenness, it is stomach heat rushing upward; add Dahuang to drain stomach heat.
Linggui Wuzhi Gancao Tang Formula
Fuling (Poria, 4 liang), Guizhi (Cinnamomi Ramulus, 4 liang), Gancao (Glycyrrhizae Radix et Rhizoma, roasted, 3 liang), Wuweizi (Schisandrae Fructus, half sheng).
The above four herbs are boiled in 8 sheng of water to obtain 3 sheng. Strain, divide into three warm doses.
Linggan Wuzhi Jiangxin Tang Formula
Fuling (Poria, 4 liang), Gancao (Glycyrrhizae Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix et Rhizoma) — each 3 liang; Wuweizi (Schisandrae Fructus, half sheng).
The above five herbs are boiled in 8 sheng of water to obtain 3 sheng. Strain, take 1/2 sheng warm, three times a day.
Linggui Wuzhi Gancao Tang minus Gancao minus Guizhi plus Ganjiang Xixin Banxia Tang Formula
Fuling (Poria, 4 liang), Xixin (Asari Radix et Rhizoma), Ganjiang (Zingiberis Rhizoma) — each 2 liang; Wuweizi (Schisandrae Fructus), Banxia (Pinelliae Rhizoma) — each half sheng.
The above five herbs are boiled in 8 sheng of water to obtain 3 sheng. Strain, take 1/2 sheng warm, three times a day.
Linggan Wuzhi Jia Jiang Xin Ban Xia Xingren Tang Formula
Fuling (Poria, 4 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang), Wuweizi (Schisandrae Fructus, half sheng), Ganjiang (Zingiberis Rhizoma, 3 liang), Xixin (Asari Radix et Rhizoma, 3 liang), Banxia (Pinelliae Rhizoma, half sheng), Xingren (Armeniacae Semen Amarum, skin and tips removed, half sheng).
The above seven herbs are boiled in 1 dou of water to obtain 3 sheng. Strain, take 1/2 sheng warm, three times a day.
Linggan Wuzhi Jia Jiang Xin Ban Xia Xingren Dahuang Tang Formula
Fuling (Poria, 4 liang), Banxia (Pinelliae Rhizoma, half sheng), Gancao (Glycyrrhizae Radix et Rhizoma, 3 liang), Wuweizi (Schisandrae Fructus, half sheng), Ganjiang (Zingiberis Rhizoma, 3 liang), Xixin (Asari Radix et Rhizoma, 3 liang), Xingren (Armeniacae Semen Amarum, skin and tips removed, half sheng), Dahuang (Rhei Radix et Rhizoma, 3 liang).
The above eight herbs are boiled in 1 dou of water to obtain 3 sheng. Strain, take 1/2 sheng warm, three times a day.