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。
倚息、倚几而息。能俯而不能仰也。肺居上焦而司呼吸。外寒内饮。壅闭肺气。则咳逆上气。甚则但
坐不得卧也。麻黄、桂枝。散外入之寒。半夏消内积之饮。细辛、干姜。治其咳满。芍药、五味。监
麻、桂之性。使入饮去邪也。
小青龙汤方（见上）
青龙汤下已。多唾口燥。寸脉沉。尺脉微。手足厥逆。气从小腹上冲胸咽。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。
服青龙汤已。设其人下实不虚。则邪解而病除。若虚则麻黄、细辛辛甘温散之品。虽能发越外邪。
亦易动人冲气。冲气、冲脉之气也。冲脉起于下焦。挟肾脉上行至喉咙。多唾口燥。气冲胸咽。面热
如醉。皆冲气上入之候也。寸沉尺微。手足厥而痹者。厥气上行。而阳气不治也。下流阴股。小便难。
时复冒者。冲气不归。而仍上逆也。茯苓、桂枝。能抑冲气使之下行。然逆气非敛不降。故以五味之
酸敛其气。土浓则阴火自伏。故以甘草之甘补其中也。
桂苓五味甘草汤方
桂枝 茯苓（各四两） 五味（半升） 甘草（三两炙）
上四味。以水八升。煮取三升。去滓。分温三服。
冲气即低。而反更咳胸满者。用桂苓五味甘草汤。去桂加干姜、细辛。以治其咳满。
服前汤已。冲气即低。而反更咳胸满者。下焦冲逆之气既伏。而肺中伏匿之寒饮续出也。故去桂
枝之辛而导气。加干姜、细辛之辛而入肺者。合茯苓、五味、甘草。消饮驱寒。以泄满止咳也。
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。
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。
冲脉之火。得表药以发之则动。得热药以逼之亦动。而辛热气味。既能劫夺胃中之阴。亦能布散
积饮之气。仲景以为渴而冲气动者。自当治其冲气。不渴而冒与呕者。则当治其水饮。故内半夏以去
其水。而所以治渴而冲气动者。惜未之及也。约而言之。冲气为麻黄所发者。治之如桂、苓、五味、
甘草。从其气而导之矣。其为姜、辛所发者。则宜甘淡咸寒。益其阴以引之。亦自然之道也。若更用
桂枝。必捍格不下。即下亦必复冲。所以然者。伤其阴故也。
苓甘五味姜辛半夏汤方
茯苓（四两） 甘草 细辛 干姜（各二两） 半夏 五味（各半升）
上六味。以水八升。煮取三升。去滓。温服半升。日三服。
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。
水在胃者。为冒、为呕。水在肺者。为喘、为肿。呕止而形肿者。胃气和而肺壅未通也。是惟麻
黄可以通之。而血虚之人。阳气无偶。发之最易厥脱。麻黄不可用矣。杏仁味辛能散。味苦能发。力
虽不及。与证适宜也。
苓甘五味加姜辛半夏杏仁汤方
茯苓（四两） 甘草 干姜 细辛（各三两） 五味 半夏 杏仁（各半升）
上七味。以水一斗。煮取三升。去滓。温服半升。日三服。
若面热如醉。此为胃热上冲熏其面。加大黄以利之。
水饮有挟阴之寒者。亦有挟阳之热者。若面热如醉。则为胃热随经上冲之证。胃之脉上行于面故
也。即于消饮药中。加大黄以下其热。与冲气上逆。其面翕热如醉者不同。冲气上行者。病属下焦阴
中之阳。故以酸温止之。此属中焦阳明之阳。故以苦寒下之。
苓甘五味加姜辛半杏大黄汤方
茯苓（四两） 甘草（二两） 干姜 细辛（各三两） 五味 半夏
杏仁（各半升） 大黄（三两）
上八味。以水一斗。煮取三升。去滓。温服半升。日三服。
先渴后呕。为水停心下。此属饮家。小半夏加茯苓汤主之。
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。盖始虽渴而终为饮。但当治饮。而不必治其渴也。
小半夏加茯苓汤方（见上）
因此可以治疗。然而，虽然水饮邪气已经衰退，但正气不足以抵御病邪，依然足以向上遮蔽清阳之气。所以患者必定感到头部昏蒙沉重。这种病症是由支饮（支撑于胸膈之间的水饮）引起的，去除水饮则疾病自然痊愈。所以说治疗属于治饮家之法。
咳嗽气逆，倚靠物体呼吸，不能平卧，用小青龙汤主治。
“倚息”是指倚靠着几案呼吸，身体只能前俯而不能后仰。肺位于上焦，主管呼吸。外感寒邪与内停水饮相互搏结，壅闭肺气，导致咳嗽气逆。严重时甚至只能坐着，无法躺下。麻黄、桂枝，发散侵入体表的寒邪；半夏，消除体内积聚的水饮；细辛、干姜，治疗咳嗽和胸满；芍药、五味子，制约麻黄、桂枝的燥烈之性，使药力能够深入水饮之中以祛除邪气。
小青龙汤方（见上文）
服用小青龙汤后，出现多唾沫、口干燥，寸脉沉，尺脉微，手足冰冷厥逆，气从小腹向上冲击胸咽，手足麻木痹痛，面部潮红发热如同醉酒状，随后热气又向下流注至大腿内侧，小便困难，时常感到头目昏眩的，给予茯苓桂枝五味甘草汤，以治疗气上冲的症状。
服用小青龙汤后，如果患者下焦实证不虚，那么邪气解除而疾病痊愈。如果是虚证，麻黄、细辛等辛甘温散的药物，虽然能发越外邪，但也容易触动冲脉之气。冲气，即冲脉之气。冲脉起始于下焦，挟肾脉上行至喉咙。多唾、口燥、气冲胸咽、面部发热如醉，都是冲气上逆的表现。寸脉沉、尺脉微，手足厥冷且麻木，是厥逆之气上行，阳气不能正常治理所致。热气下流至阴股，小便困难，时常昏眩，是冲气不能归元，仍然上逆的表现。茯苓、桂枝，能够抑制冲气使其下行。然而，逆气非收敛不能下降，所以用五味子的酸味来收敛气机。土厚则阴火自伏，所以用甘草的甘味来补益中气。
桂苓五味甘草汤方
桂枝 茯苓（各四两） 五味子（半升） 甘草（三两，炙）
以上四味药，用水八升，煮取三升，去渣，分三次温服。
冲气症状降低后，反而再次出现咳嗽、胸满的，使用桂苓五味甘草汤，去掉桂枝，加入干姜、细辛，以治疗咳嗽和胸满。
服用前面的汤药后，冲气症状降低，反而再次出现咳嗽、胸满的，是因为下焦冲逆之气既已潜伏，而肺中伏匿的寒饮继续排出。所以去掉桂枝的辛散导气作用，加入干姜、细辛的辛温入肺之品，配合茯苓、五味子、甘草，消除水饮，驱散寒邪，以泄除胸满、止咳。
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。
咳嗽和胸满停止后，如果再次出现口渴，且冲气复发的，是因为细辛、干姜是热性药物。服用后应当随即口渴，但如果口渴反而停止的，这是因为有支饮存在。支饮患者通常应当出现头目昏眩，昏眩者必定伴有呕吐。呕吐的话，再加入半夏以去除水饮。
冲脉之火，被表药发散则会发动，被热药逼迫也会发动。而辛热的气味，既能劫夺胃中的阴液，也能布散积存的水饮之气。张仲景认为，口渴且冲气动者，自然应当治疗冲气；不口渴而有昏眩和呕吐者，则应当治疗水饮。所以加入半夏以去除水饮。至于治疗口渴和冲气动的具体方法，可惜原文未及详细论述。概括而言，由麻黄引发的冲气，治疗时用桂枝、茯苓、五味子、甘草，顺从其气机而引导它；由干姜、细辛引发的冲气，则宜用甘淡咸寒的药物，滋养其阴液以引气下行，这也是自然的道理。如果再用桂枝，必然格格不入难以下达，即使下达也必然会再次引发冲气。之所以这样，是因为损伤了阴液的原因。
苓甘五味姜辛半夏汤方
茯苓（四两） 甘草 细辛 干姜（各二两） 半夏 五味子（各半升）
以上六味药，用水八升，煮取三升，去渣，温服半升，每日三次。
水饮去除了，呕吐停止了，但患者身体出现浮肿的，加杏仁为主药。此证本应加入麻黄，但因为患者已有手足麻木痹痛的症状，所以不使用麻黄。如果违背这一原则强行加入麻黄，必定会导致四肢厥逆。之所以这样，是因为患者血虚，麻黄会发散其阳气。
水在胃中，表现为昏眩、呕吐；水在肺中，表现为气喘、浮肿。呕吐停止而身体浮肿，说明胃气已和，但肺气壅塞尚未通畅。只有麻黄可以通利肺气，但对于血虚之人，阳气无所依附，使用麻黄最容易导致厥脱。因此麻黄不可用。杏仁味辛能发散，味苦能降泄，力量虽然不及麻黄，但与病情适宜。
苓甘五味加姜辛半夏杏仁汤方
茯苓（四两） 甘草 干姜 细辛（各三两） 五味子 半夏 杏仁（各半升）
以上七味药，用水一斗，煮取三升，去渣，温服半升，每日三次。
如果面部发热如同醉酒状，这是胃热上冲熏蒸面部的表现，加大黄以通利泻热。
水饮有的夹杂阴寒，有的夹杂阳热。如果面部发热如醉，则是胃热随经脉上冲的证候，因为胃的经脉上行于面部。即在消饮水的药物中，加入大黄以下行其热。这与冲气上逆导致的面部潮红如醉不同。冲气上行者，病属下焦阴中之阳，所以用酸温药止摄；此证属中焦阳明之阳，所以用苦寒药攻下。
苓甘五味加姜辛半杏大黄汤方
茯苓（四两） 甘草（二两） 干姜 细辛（各三两） 五味子 半夏 杏仁（各半升） 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。
先感到口渴，随后发生呕吐，这是因为水饮停滞在心下（胃脘），这属于饮家范畴，用小半夏加茯苓汤主治。
先渴后呕，原本没有呕吐的病，因为口渴饮水过多，水液不下行反而上逆。所以说这属于饮家。小半夏汤止呕降逆，加入茯苓以去除停聚的水饮。开始虽然口渴，但最终归结为水饮致病，只应当治疗水饮，而不必专门治疗口渴。
小半夏加茯苓汤方（见上文）
Therefore, it is treatable. However, although the pathogenic fluid retention (Yin) has diminished, the healthy Qi is insufficient to resist it, and it is still enough to obscure the clear Yang Qi upwards. Thus, the patient must suffer from a sensation of heaviness and dizziness in the head. This disease is caused by Zhi Yin (fluid retention supporting in the chest and diaphragm); once the fluid retention is removed, the disease will heal itself. Therefore, it is said that the treatment belongs to the category of treating patients with fluid retention.
Cough with rebellious Qi, leaning on objects to breathe, unable to lie flat: Xiao Qing Long Tang (Minor Blue Dragon Decoction) is the primary prescription.
"Leaning to breathe" refers to breathing while leaning on a table or stand; the body can bend forward but not lean backward. The Lung resides in the Upper Jiao and governs respiration. External cold combined with internal fluid retention obstructs and closes the Lung Qi, leading to cough and rebellious Qi. In severe cases, the patient can only sit and cannot lie down. Ma Huang (Ephedrae Herba) and Gui Zhi (Ramulus Cinnamomi) disperse the external cold invading the body; Ban Xia (Rhizoma Pinelliae) eliminates internally accumulated fluid retention; Xi Xin (Herba Asari) and Gan Jiang (Radix Zingiberis Recens) treat the cough and chest fullness; Bai Shao (Radix Paeoniae Rubra) and Wu Wei Zi (Fructus Schisandrae Chinensis) restrain the acrid and drying nature of Ma Huang and Gui Zhi, allowing the medicinal action to penetrate the fluid retention to expel pathogens.
Xiao Qing Long Tang (see above).
After taking Xiao Qing Long Tang, if symptoms such as excessive salivation, dry mouth, deep pulse at the Cun position, faint pulse at the Chi position, cold extremities (Jue Ni), Qi rushing upward from the lower abdomen to the chest and throat, numbness and bi-syndrome in the hands and feet, facial flushing resembling drunkenness, followed by heat flowing downward to the inner thighs, difficult urination, and intermittent dizziness occur, administer Fu Ling Gui Zhi Wu Wei Gan Cao Tang (Poria, Cinnamon Twig, Schisandra, and Licorice Decoction) to treat the upward rushing Qi.
After taking Xiao Qing Long Tang, if the patient has excess conditions below without deficiency, the pathogen resolves and the disease cures. If there is deficiency, the acrid, sweet, and warm-dispersing properties of Ma Huang and Xi Xin, although capable of venting external pathogens, easily disturb the Qi of the Chong Mai (Penetrating Vessel). Chong Qi refers to the Qi of the Chong Mai. The Chong Mai originates in the Lower Jiao, runs alongside the Kidney Meridian upward to the throat. Excessive salivation, dry mouth, Qi rushing to the chest and throat, and facial heat resembling drunkenness are all signs of Chong Qi ascending. A deep pulse at Cun and faint pulse at Chi, along with cold and numb extremities, indicate that Jue Qi ascends while Yang Qi fails to govern properly. Heat flowing to the inner thighs, difficult urination, and intermittent dizziness indicate that Chong Qi does not return to its origin but continues to rebel upward. Fu Ling (Poria) and Gui Zhi (Ramulus Cinnamomi) can suppress Chong Qi and guide it downward. However, rebellious Qi cannot descend without astringency; thus, the sour astringency of Wu Wei Zi is used to gather the Qi. When Earth (Spleen/Stomach) is thickened, Yin Fire naturally subdues; therefore, the sweet tonifying property of Gan Cao (Radix Glycyrrhizae Preparata) is used to supplement the Middle Jiao.
Gui Ling Wu Wei Gan Cao Tang Prescription
Gui Zhi (4 liang), Fu Ling (4 liang), Wu Wei Zi (0.5 sheng), Gan Cao (3 liang, honey-fried).
Take these four ingredients, add eight sheng of water, decoct to obtain three sheng, remove the dregs, and divide into three warm doses.
If the Chong Qi subsides but cough and chest fullness recur, use Gui Ling Wu Wei Gan Cao Tang, remove Gui Zhi, and add Gan Jiang and Xi Xin to treat the cough and fullness.
After taking the previous decoction, if the Chong Qi subsides but cough and chest fullness recur, it is because the rebellious Qi from the Lower Jiao has been subdued, but the latent cold-fluid retention in the Lung continues to emerge. Therefore, remove the acrid Qi-guiding property of Gui Zhi, and add the acrid Lung-penetrating properties of Gan Jiang and Xi Xin. Combined with Fu Ling, Wu Wei Zi, and Gan Cao, this formula eliminates fluid retention, drives out cold, relieves fullness, and stops cough.
Ling Gan Wu Wei Jiang Xin Tang Prescription
Fu Ling (4 liang), Gan Cao, Gan Jiang, Xi Xin (each 3 liang), Wu Wei Zi (0.5 sheng).
Take these five ingredients, add eight sheng of water, decoct to obtain three sheng, remove the dregs, take half a sheng warm, three times daily.
If the cough and fullness cease but thirst recurs and Chong Qi reactivates, it is because Xi Xin and Gan Jiang are hot herbs. Taking them should cause immediate thirst; if thirst instead ceases, it indicates the presence of Zhi Yin. Patients with Zhi Yin typically experience dizziness, and those who are dizzy often vomit. If vomiting occurs, add Ban Xia to eliminate the water.
The fire of the Chong Mai moves when stimulated by exterior-releasing herbs and also when pressured by hot herbs. Acrid-hot flavors can both deprive the Stomach of Yin fluids and disperse the Qi of accumulated fluid retention. Zhang Zhongjing believed that for thirst accompanied by moving Chong Qi, one should treat the Chong Qi; for non-thirst accompanied by dizziness and vomiting, one should treat the fluid retention. Hence, Ban Xia is added to remove water. Regarding the treatment for thirst and moving Chong Qi, unfortunately, it was not detailed here. Briefly speaking, Chong Qi triggered by Ma Huang is treated with Gui Zhi, Fu Ling, Wu Wei Zi, and Gan Cao, guiding the Qi according to its movement. Chong Qi triggered by Gan Jiang and Xi Xin should be treated with sweet, bland, salty, and cold herbs to nourish Yin and guide the Qi downward, which is the natural way. Using Gui Zhi again would result in rejection and failure to descend; even if it descends, Chong Qi will likely rebound. This is due to the damage of Yin.
Ling Gan Wu Wei Jiang Xin Ban Xia Tang Prescription
Fu Ling (4 liang), Gan Cao, Xi Xin, Gan Jiang (each 2 liang), Ban Xia, Wu Wei Zi (each 0.5 sheng).
Take these six ingredients, add eight sheng of water, decoct to obtain three sheng, remove the dregs, take half a sheng warm, three times daily.
If the fluid retention is gone and vomiting stops, but the patient develops edema, add Xing Ren (Armeniacae Semen Amarum) as the main herb. This condition should normally include Ma Huang, but because the patient already has numbness and bi-syndrome, Ma Huang is not used. If contrary to this principle Ma Huang is administered, it will definitely cause Jue Ni (cold extremities). This is because the patient has Blood deficiency, and Ma Huang disperses Yang Qi.
Water in the Stomach causes dizziness and vomiting; water in the Lung causes asthma and edema. When vomiting stops but edema persists, it indicates that Stomach Qi has harmonized, but Lung Qi is still obstructed. Only Ma Huang can unblock this, but for patients with Blood deficiency, where Yang Qi has no companion, using Ma Huang easily leads to collapse. Therefore, Ma Huang is contraindicated. Xing Ren is acrid and dispersing, bitter and descending; although its power is less than Ma Huang, it is suitable for this condition.
Ling Gan Wu Wei Jia Jiang Xin Ban Xia Xing Ren Tang Prescription
Fu Ling (4 liang), Gan Cao, Gan Jiang, Xi Xin (each 3 liang), Wu Wei Zi, Ban Xia, Xing Ren (each 0.5 sheng).
Take these seven ingredients, add ten dou of water, decoct to obtain three sheng, remove the dregs, take half a sheng warm, three times daily.
If the face is hot like drunkenness, this is due to Stomach Heat rushing upward to steam the face. Add Da Huang (Rhei Radix et Rhizoma) to promote drainage and clear heat.
Fluid retention may accompany Yin Cold or Yang Heat. Facial heat resembling drunkenness indicates Stomach Heat rushing upward along the meridians, as the Stomach Meridian travels up to the face. In formulas that resolve fluid retention, add Da Huang to drain the heat downwards. This differs from Chong Qi rebelling upward causing facial flushing like drunkenness. Chong Qi ascending originates from the Yang within Yin of the Lower Jiao, so it is stopped with sour-warm herbs. This case belongs to the Yang of the Middle Jiao (Yangming), so it is drained with bitter-cold herbs.
Ling Gan Wu Wei Jia Jiang Xin Ban Xia Xing Ren Da Huang Tang Prescription
Fu Ling (4 liang), Gan Cao (2 liang), Gan Jiang, Xi Xin (each 3 liang), Wu Wei Zi, Ban Xia, Xing Ren (each 0.5 sheng), Da Huang (3 liang).
Take these eight ingredients, add ten dou of water, decoct to obtain three sheng, remove the dregs, take half a sheng warm, three times daily.
Thirst followed by vomiting indicates water stagnation in the Heart-Lower area (epigastrium); this belongs to the category of fluid retention diseases. Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia plus Poria Decoction) is the primary prescription.
Thirst followed by vomiting implies no prior vomiting disorder; due to thirst, excessive water is drunk, which fails to descend and rebels upward instead. Thus, it is said to belong to fluid retention patients. Xiao Ban Xia Tang stops vomiting and directs Qi downward; adding Fu Ling removes stagnant water. Although initially thirsty, the root cause is ultimately fluid retention; therefore, one should treat the fluid retention and not necessarily the thirst.
Xiao Ban Xia Jia Fu Ling Tang (see above).