此总言用药之治例。病痰饮者。当合四饮而言。以诸饮俱由痰饮传变。故以痰饮统之耳。夫饮之由来。大概
起于肾及脾肺之脏阳衰冷。成于三焦之腑化虚寒。温药和之。则阳回气化而饮自去矣。盖指后文苓桂术
甘、肾气、及大小青龙等剂也。
十七条 心下有痰饮。胸胁支满。目眩。苓桂术甘汤主之。
苓桂术甘汤方 茯苓（四两） 桂枝 白术（各三两） 甘草（二两）
上四味。以水六升。煮取三升。分温三服。小便则利。
此言诸饮。除溢饮之外。俱以苓桂术甘汤为主方。盖痰饮是其总名。心下及胸支满。为支饮之症。胁下支满。
为悬饮之症。目眩者。饮高而水载木气以浮也。以淡渗去饮之茯苓为君。佐辛甘之桂枝以行阳。甘温之白
术以培土。然后用甘浮平缓之甘草为使。所以高托诸药。而令其徐徐下渗之意。此苓桂术甘。为诸饮之要剂也。
十八条 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。
此承上文苓桂术甘汤。而补言肾中微有伏饮。以致上干肺气者。亦主此汤也。盖肾有微饮。则其气上射于
肺。而见短气之候。故短气者即知有微饮也。微饮即伏饮。以其在肾脏。故更当利其腑而从小便去也。苓桂
术甘为利水之剂。故主之。肾气丸亦主之者。盖苓桂术甘。温上以御下。而化机下被。故小便利。肾气丸。温下
以蒸上。而化机亦下被。故小便亦利也。方论见虚劳。
十九条 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。
甘遂半夏汤方 甘遂（大者三枚） 半夏（十二枚以水一升煮取半升去渣） 芍药（五枚） 甘草（如指大一
枚）
上四味。以水二升。煮取半升。去滓。以蜜半升。和药汁。煎取八合。顿服之。
病者。病痰饮者也。饮脉多弦。留饮之脉则沉。今其脉忽然不弦不沉而伏于骨。几几有不可见之象。夫伏脉
为收束下趋之诊。以胸胁心下之饮症。忽焉收束下趋。岂非欲自利乎。反快。对利而言。利症多因利而不快。
如膨闷、疲困及疼痛、沉坠等候。此则脾肺之阳。乘日辰之官旺而偶振。故水饮不安于上而下利。利则水去
气展。故反以利为快也。然虽利而方以不坚满为快。其心下续又坚满而仍不快者。以胃脘及肠间之内水
一空。而胁下之悬饮。先从中满而由络脉以外渗者。今复因内空而还渗心下。（心下当胃脘之部。）故曰
留饮欲去。因其去机而扫荡之。其为功不较易乎。主甘遂半夏汤者。甘遂去水最速。主病之谓君。故以之名
汤。又恐性急之品。下趋甚力。而留遗胸膈之饮。故以甘草、蜂蜜、之甘浮者。托之在上而留恋之。然后以辛燥
之半夏。从上降抑。以酸敛之芍药。从下直坠。而水饮安有不去者哉。不主苓桂术甘。而主此犀利者。恐和平
之药。少延时日。而脾肺之阳仍伏。则饮将欲去而终留。其机岂不以因循坐失耶。甘遂性急。甘草性缓。相
反者、言其缓急之性也。俗解谓二药自相攻击。谬甚。
二十条 脉浮而细滑。伤饮。
此言十二条暴饮之脉也。盖饮水多而其水停心下者。皆谓之伤饮。水停故脉滑。阳微不能运水。故脉细。暴
停之水。阳气未负。故脉浮也。则脉浮而细滑者。非伤饮而何。
二十一条 脉弦数。有寒饮。冬夏难治。
先因阳虚而停饮。故其脉弦。后则积饮化虚热而复伤其阴。故其脉弦而且数也。冬夏难治者。盖治饮之例。
惟宣发渗泄二义。冬则虚阳内伏。既非大小青龙宣发之所宜。且又有碍于弦脉之阳气虚也。夏则虚阳外
应。既非苓桂术甘温燥之所宜。且亦有碍于数脉之阴液短也。谓之难治宜矣。此合溢饮、支饮而言脉症与
天时不顺。其生死相半也。
二十二条 脉沉而弦者。悬饮内痛。病悬饮者。十枣汤主之。
十枣汤方 大戟 芫花（熬） 甘遂（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。明日更加半钱。得快利后。糜粥自养。
此言悬饮之脉症治例也。脉弦为饮。又为痛。脉沉为留饮。故知为悬饮而胁下并缺盆内痛也。重言病悬饮
者。又推开内痛而广言之耳。盖谓凡属胁下有悬饮。无论内痛与否。俱以十枣汤为主治也。方论见伤寒注。
二十三条 病溢饮者。当发其汗。大青龙汤主之。小青龙汤亦主之。
大青龙汤方
麻黄（六两去节） 桂枝（二两去皮） 杏仁（四十个去皮尖） 甘草（二两炙） 生姜（三两）
大枣（十二枚） 石膏（如鸡子大碎）
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。汗多者温粉粉之。
小青龙汤方
麻黄（三两去节） 甘草（三两炙） 桂枝（三两去皮） 芍药（三两） 五味子（半升）
干姜（三两） 半夏（半升） 细辛（三两）
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。
此言溢饮之治例也。饮溢于经络四肢。非从汗解不可。故主大青龙以宣发之。小青龙汤于宣发外。尤能渗
泄。故亦主之。方论见伤寒。
二十四条 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。
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。
木防己去石膏加茯苓芒硝汤方
木防己 桂枝（各三两） 人参 茯苓（各四两） 芒硝（三合）
上五味。以水六升。煮取二升。去滓。内芒硝。再微煎。分温再服。微利则愈。
此言支饮久留之脉症治例也。夫饮症自肠间下积。逐渐上满。由胃而心下膈间。支撑鼓塞者。俱谓之支饮
故合膈间、心下而历言之也。沉。为留饮之脉。紧。即弦脉之急者。盖自其两旁之细削而言曰弦。自其两头之
绷急而言曰紧。与寒邪之紧不同。辨详腹满寒疝。虚实。就胃中之虚实而言。非指正气也。犹云饮外无干结
者为虚。饮外有干结者为实之义。长沙盖谓膈间支饮。抬气上浮而喘满。心下支饮。聚水中实而痞坚。面
则因水色外浮而黑。脉则从水性下坠而沉。且水饮鼓塞。则经脉绷急。而沉中带紧。得之数十日。则饮久而
所谓留饮者是矣。医见喘满痞坚。故吐下之。不知饮之为病。吐则膈气愈虚。而水逆更甚。且由小肠而水归
膀胱者为正道。下则直奔大肠而中气愈虚。水愈积矣。故不愈也。木防己。蔓生而中通。性寒而味辛苦。且其
形色。又外白内黄者。夫蔓生中通。则走脉络之内道。性寒则沉降。味辛则散。苦则泄。外白内黄。又上泄肺。而
下泄脾胃者可见矣。以之为主病之君。则支饮之在膈间心下。以及肠胃脉络。岂有不尽下者哉。但饮久必
化标热。故以石膏之辛凉下行者佐之。然后以人参提气。桂枝行阳。趁水饮之下落。而胸中之阳气。得参桂
助之。而下展有力。倘胃中但有水饮。而无干结之积聚。是谓胃邪未实。故水饮一去。别无余累而愈矣。然又
有水饮虽满。而曾经先结之宿垢自在者。是谓胃实。实者水去而结粪未下。则肠胃之气。滞而难行。三日之
水饮再聚。故复发。复与原汤而并不暂愈者。以水落水起。而干结者较胀。以为水饮之根据辅故也。仍主此汤
者。始终以去饮为本治也。特去石膏者。饮新复而无化热之标病也。加芒硝者。所以软坚化硬而并去其宿
垢也。更加茯苓者。恐芒硝下润之外。其味咸寒聚饮。故以淡渗之品。补救其偏弊也。长沙诊法之玄微。制方
之妙义。直有鬼神所莫测者乎。客有难余者曰。本文言医吐下之不愈。彼吐之不愈。宜矣。子言下之不愈。
以饮归膀胱为正道。下则直趋大肠而中气愈虚。水愈积之故。是医下之而不愈者。长沙以渗法愈之则得
矣。及按防己汤。并无渗水之药。独非从大肠而下者乎。何以虚者即愈也。即如去石膏加茯苓、芒硝一汤。其
汤后曰微利则愈。是亦从大肠而利下者。何以实者又愈也。夫以医下之而不愈者。长沙两下之而皆愈。此
不解者。一也。且本衣冠文物明曰医已下之矣。长沙又下之矣。安得尚有胃实者。而俟加芒硝以软坚化硬乎。此
不解者。二也。答曰。我固知子之所疑者。其以余注为未是也。夫水归膀胱为正道一语。是言去饮之常例。故
治饮者。以利小水为正法。至若水势大张。汪洋澎湃。与其从小便吹嘘渗泄之。而耽延时日。其势复不能减。
毋宁从大便扫除涤荡之之为直捷痛快乎。且小肠以上之水可渗。小肠以下之水。则水低而失膀胱之部。
非下不可。故立甘遂、半夏、十枣、葶苈以及防己等汤。俱不得已之变方变治焉而已。我故曰。水归膀胱为正
道者。此也。至于下药多寒。寒则中气愈虚。而水愈积。故不愈。不观防己二汤之重用人参桂枝乎。又何疑于
仲景下之。则中气不伤而皆愈也。若夫攻下之理。显而易见。苦寒趋下。咸寒破结。医虽以苦寒下之。而遗咸
寒之性。故结者未下耳。此长沙独用芒硝之精意也。语未及终。客唯唯而退。
二十五条 心下有支饮。其人苦眩冒。泽泻汤主之。
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。
此言支饮在心下之病症治例也。眩者。晕眩。冒者。蒸冒。皆虚气上冲外鼓之候。心下支饮离膈不远。而水饮
渐迫。以致气高气郁。故苦眩冒也。泽泻利水。而决之于沟渠。白术培土。而防之于堤岸。则水饮下注。而浮鼓
之气自平矣。故主之。
二十六条 支饮胸满者。浓朴大黄汤主之。
浓朴大黄汤方 浓朴（一尺） 大黄（六两） 枳实（四枚）
上三味。以水五升。煮取二升。分温再服。
此条支饮。另有来路。与诸条之所谓支饮之由于痰饮者不同。故其治法。亦与温药和之之例自别也。盖心
肺间之膈气虚者。不能鼓努传送而便难。便难既久。则肠胃液短而干结。渐致胃实矣。液短。则借资于外水
而饮积心下。胃实。则不能通过结硬而下渗小肠。与寒饮之上支心下者同。故亦谓之支饮也。然支饮虽同。
而其所以致饮者。因胃实胸满之故。则攻胃实之大黄。开胸满之枳朴。其可缓乎。此开壅水之地以治水之
道也。
二十七条 支饮不得息。葶苈大枣泻肺汤主之。
支饮不得息。见首条倚息下。主本汤者。泻其水饮上射之气也。方论见肺痈。
二十八条 呕家本渴。渴者为欲解。今反不渴。心下有支饮故也。小半夏汤主之。
小半夏汤方 半夏（一升） 生姜（半斤）
上二味。以水七升。煮取一升半。分温再服。
胸寒致呕。然呕能提气。呕则阳起而善渴者常也。故渴为呕家欲解之候。今虽呕而反不渴。是呕为寒饮上
逆。而不渴为内饮拒水之故。岂非心下之胃脘。有支饮乎。半夏辛燥而降逆。生姜温膈以祛寒。俾胸阳一展。
则饮去而呕将自平矣。此亦暴饮之少留者也。
二十九条 腹满。口舌干燥。此肠间有水气。己椒苈黄丸主之。
己椒苈黄丸方 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。（李氏曰。服一
丸疑有误）
此言素盛今瘦。肠间痰饮之治例也。盖瘦则液短。而其便必干。故积聚停滞而腹满。又瘦则液短。而外水必
积。故饮热而口舌干燥也。夫宿垢下瘀而腹满。积饮上烫而干燥。岂非肠间有水气乎。主本方者。大黄苦寒
逐瘀。用之治腹满者。实所以开行饮之道路也。然后以去水三将。同心合力。而共收犄角之全效矣。盖水在
肠间。防己蔓生中通。具大小肠之象。而利水性悍。以之治肠间之水。允为确当。但恐性悍之品。迫水妄行。以
致上激旁渗。故又以辛温纳下之椒目。引之顺流。苦寒利气之葶苈。押为殿后。而水饮宁复有留遗者乎。先
食而服。取其直下肠间。而不使饮食中隔也。日三服而逐渐稍增者。但徐试之。而以中病为度。不使峻药过
剂以伤正气也。口中有津液者。饮去而真气上通。得蒸被之化也。渴者以下。非指服丸以后而言。犹云若腹
满口舌干燥之外。更加渴者。于本方中加芒硝半两。夫渴与干燥有辨。干燥是内饮拒水。而饮久化热之气。
上熏廉泉。故不渴而但觉干燥也。渴则肠胃中已有结粪。而真阴短少。故求救于水而作渴。此正将作支饮
溢饮之渐。故加软坚破结之芒硝。佐大黄之逐瘀。即前二十四条木防己汤加芒硝之义也。
三十条 卒呕吐。心下痞。膈间有水。眩悸者。半夏加茯苓汤主之。
半夏加茯苓汤方 半夏（一斤） 生姜（半斤） 茯苓（六两）
上三味、以水七升。煮取一升五合。分温再服。
此支饮暴停之症治。从卒呕吐、心下痞二症。诊其有水也。卒然呕吐者。膈寒而上涌也。心下痞者。膈虚而下
这是总括论述用药的治疗原则。患有痰饮病的人，应当结合“四饮”（痰饮、悬饮、溢饮、支饮）来综合考量，因为各种饮证都是由痰饮传变而来，所以用“痰饮”来统摄它们。饮邪的由来，大抵起于肾、脾、肺脏的阳气衰弱寒冷，形成于三焦腑的气化功能虚弱寒凝。使用温药调和，则阳气回复、气化功能恢复，饮邪自然消除。这里指的是后文的苓桂术甘汤、肾气丸以及大青龙汤、小青龙汤等方剂。
第十七条 心下有痰饮，胸胁部支撑胀满，头晕目眩。用苓桂术甘汤主治。
苓桂术甘汤方：茯苓（四两）、桂枝、白术（各三两）、甘草（二两）。
以上四味药，用水六升，煮取三升药液，分三次温服。服药后小便通利。
这里论述各种饮证，除了溢饮之外，都以苓桂术甘汤为主方。因为痰饮是总称，心下及胸部支撑胀满，是支饮的症状；胁下支撑胀满，是悬饮的症状。头晕目眩，是因为饮邪位置高，水气携带肝木之气上浮所致。以淡渗利水的茯苓为君药，佐以辛甘温通的桂枝以通行阳气，甘温健脾的白术以培补中土，然后用甘缓平和的甘草为使药。这是为了高提诸药之势，让它们徐徐向下渗利。这就是为什么苓桂术甘汤是治疗各种饮证的关键方剂。
第十八条 呼吸短促，有轻微饮邪，应当通过小便排出。用苓桂术甘汤主治，肾气丸也可以主治。
这里是承接上文苓桂术甘汤，补充说明肾中有微伏的饮邪，上犯肺气，也适用此汤。肾中有微饮，其气上射于肺，出现短气的症状。所以短气就知道有微饮。微饮就是伏饮，因为它在肾脏，所以更应当利其腑气，从小便排出。苓桂术甘汤是利水之剂，所以用它主治。肾气丸也主治，是因为苓桂术甘汤温上焦以御下焦，使化生之机下达，所以小便通利；肾气丸温下焦以蒸腾上焦，使化生之机也下达，所以小便也通利。方论见《虚劳》篇。
第十九条 病人脉象沉伏，其人想要自发性腹泻，泻后反而觉得爽快，虽然腹泻，但心下继续坚硬胀满。这是留饮欲去的表现。用甘遂半夏汤主治。
甘遂半夏汤方：甘遂（大的三枚）、半夏（十二枚，用水一升煮取半升，去渣）、芍药（五枚）、甘草（如手指大一枚）。
以上四味药，用水二升，煮取半升，去渣，加入蜂蜜半升，与药汁混合，煎取八合，一次性服用。
病人，指患痰饮病的患者。饮邪的脉象多弦，留饮的脉象则沉。现在他的脉忽然不弦不沉，而是伏于骨间，几乎看不见的样子。伏脉是收敛下趋的脉象，对于胸胁心下的饮症，忽然呈现收敛下趋之象，难道不是想要自发性腹泻吗？“反快”，是相对于腹泻而言。腹泻病症多因腹泻而不舒服，如腹胀闷、疲乏困倦及疼痛、沉重下坠等症状。这里则是脾肺之阳，趁着日辰旺盛之时偶然振奋，所以水饮不安于上而向下排泄。泻后水去气展，所以反而觉得腹泻是舒服的。然而虽然腹泻，本应以心下不再坚满为快，如果心下继续坚满且仍不舒服，是因为胃脘及肠间的水液已空，而胁下的悬饮，先从中满通过络脉向外渗透，现在又因为内部空虚而回流到心下（心下对应胃脘部位）。所以说这是留饮欲去。趁它欲去之机进行扫荡，功效不是更容易发挥吗？主治甘遂半夏汤，是因为甘遂去水速度最快，针对主病所以称为君药，因此以它命名汤剂。又担心性急的药物下行力量过大，而遗留胸膈的饮邪，所以用甘草、蜂蜜这些甘缓上浮的药，托举在上而留恋之，然后用辛燥的半夏从上降抑，酸敛的芍药从下直坠，这样水饮哪有不去除的呢？不用平和的苓桂术甘汤，而用这种犀利的方剂，是担心和平的药物拖延时日，导致脾肺之阳仍然潜伏，那么饮邪将要去除却最终留下，这个契机岂不是因为因循守旧而坐失良机吗？甘遂性急，甘草性缓，相反是指它们缓急的性质不同。世俗解释认为这两药互相攻击，非常荒谬。
第二十条 脉象浮而细滑，这是伤饮。
这里说的是第十二条暴饮的脉象。大概饮水过多而水停聚在心下的，都叫作伤饮。水停所以脉滑，阳气微弱不能运化水湿，所以脉细，暴停的水，阳气尚未受损，所以脉浮。那么脉浮而细滑的，不是伤饮是什么？
第二十一条 脉象弦数，有寒饮，冬夏难治。
先因阳虚而停饮，所以脉弦，后来积饮化为虚热又损伤了阴液，所以脉弦而且数。冬夏难治，是因为治疗饮邪的原则，只有宣发和渗泄两个意义。冬天虚阳内伏，既不适合大小青龙汤宣发，况且又有碍于弦脉所代表的阳气虚。夏天虚阳外应，既不适合苓桂术甘汤温燥，况且也有碍于数脉所代表的阴液短少。称之为难治是应该的。这结合了溢饮、支饮，说明脉症与天时不顺，生死各半的情况。
第二十二条 脉象沉而弦的，是悬饮内痛。患悬饮病的，用十枣汤主治。
十枣汤方：大戟、芫花（熬制）、甘遂（各等分）。
以上三味药，捣筛成散剂。用水一升五合，先煮肥大枣十枚，取八合药液，去渣，纳入药末。体质强壮的人服一钱匕，体弱的人服半钱。清晨温服。如果不排便，明天增加半钱。得到快速通便后，喝米粥调养自己。
这里论述悬饮的脉症治疗原则。脉弦代表饮邪，也代表疼痛；脉沉代表留饮。所以知道是悬饮，并且胁下及缺盆内部疼痛。重复说“病悬饮者”，又是推开“内痛”这一症状广泛而言。意思是凡是胁下有悬饮，无论是否有内痛，都以十枣汤为主治。方论见《伤寒注》。
第二十三条 患溢饮病的人，应当发汗。用大青龙汤主治，小青龙汤也可以主治。
大青龙汤方：麻黄（六两去节）、桂枝（二两去皮）、杏仁（四十个去皮尖）、甘草（二两炙）、生姜（三两）、大枣（十二枚）、石膏（如鸡蛋大碎）。
以上七味药，用水九升，先煮麻黄减少二升，去掉上面的沫，加入其他药物，煮取三升，去渣，温服一升，取微微似有汗出。汗多的，用温粉扑身。
小青龙汤方：麻黄（三两去节）、甘草（三两炙）、桂枝（三两去皮）、芍药（三两）、五味子（半升）、干姜（三两）、半夏（半升）、细辛（三两）。
以上八味药，用水一斗，先煮麻黄减少二升，去掉上面的沫，加入其他药物，煮取三升，去渣，温服一升。
这里论述溢饮的治疗原则。饮邪溢于经络四肢，不从汗解不行。所以用大青龙汤宣发，小青龙汤在宣发的同时，更能渗泄，所以也用它主治。方论见《伤寒》。
第二十四条 膈间有支饮，其人喘满，心下痞塞坚硬，面色黧黑，脉象沉紧，得病几十天，医生用吐法或下法治疗，未愈。用木防己汤主治。如果是虚证，即痊愈；如果是实证，三天后复发，再次给予原方不愈的，宜用木防己汤去石膏加茯苓芒硝汤主治。
木防己汤方：木防己（三两）、石膏（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。
木防己去石膏加茯苓芒硝汤方：木防己、桂枝（各三两）、人参、茯苓（各四两）、芒硝（三合）。
以上五味药，用水六升，煮取二升，去渣，纳入芒硝，再微煎，分两次温服。轻微腹泻则痊愈。
这里论述支饮久留的脉症治疗原则。饮邪从肠间下积，逐渐向上充满，由胃到心下膈间，支撑鼓塞的，都叫作支饮，所以合起来说膈间、心下。沉，是留饮的脉象；紧，是弦脉之急迫者。大概从其两旁细削来说叫弦，从其两头绷急来说叫紧，这与寒邪的紧不同，辨析详见《腹满寒疝》篇。虚实，就胃中的虚实而言，不是指正气。犹言饮邪外无干结者为虚，饮邪外有干结者为实的含义。长沙（张仲景）大概认为膈间支饮，抬气上浮而喘满；心下支饮，聚水中实而痞坚。面色因水色外浮而黑；脉象从水性下坠而沉。且水饮鼓塞，经脉绷急，所以沉中带紧。得病几十天，就是饮久所谓的留饮。医生见喘满痞坚，所以用吐下法，不知道饮邪致病，吐则膈气更虚，而水逆更甚，且水从小肠归膀胱是正道，下法则直奔大肠而中气更虚，水更积聚，所以不愈。木防己蔓生而中空，性寒味辛苦，且其形色外白内黄。蔓生中空，则走脉络之内道；性寒则沉降；味辛则散，苦则泄；外白内黄，又可见其上泄肺而下泄脾胃。以之为君药治疗主病，那么支饮在膈间心下，以及肠胃脉络，哪有不尽下行的呢？但是饮久必化标热，所以用石膏辛凉下行来佐助。然后用人参提气，桂枝行阳，趁水饮下落，胸中阳气得参桂帮助，而下展有力。如果胃中只有水饮，而无干结的积聚，这叫胃邪未实，所以水饮一去，别无余累而痊愈。然而又有水饮虽满，而曾经先结的宿垢自在的，这叫胃实。实证是水去而结粪未下，则肠胃之气滞涩难行，三日之水饮再聚，所以复发。再次给原汤并不暂愈的，是因为水落水起，而干结者较胀，作为水饮的根据辅佐。仍主此汤，是以去饮为本治。特别去掉石膏，是因为饮新复而无化热的标病。加入芒硝，是为了软坚化硬并去除宿垢。再加茯苓，是恐怕芒硝下润之外，其味咸寒聚饮，所以用淡渗之品补救其偏弊。长沙诊法的玄微，制方的妙义，简直有鬼神所莫测的吗？客人责问我道：“本文说医生吐下之不愈，那吐之不愈，是应该的。你说下之不愈，是因为饮归膀胱为正道，下则直趋大肠而中气更虚，水更积聚的缘故。这是医生下之而不愈，长沙用渗法治愈也就罢了。及至看防己汤，并没有渗水之药，难道不是从大肠而下吗？为什么虚者即愈？就像去石膏加茯苓、芒硝一汤，汤后说微利则愈，这也是从大肠而利下，为什么实者又愈？以医生下之而不愈，长沙两下之而皆愈，这是不解者之一。况且本衣冠文物明曰医已下之矣，长沙又下之矣，怎么还有胃实者，而等待加芒硝以软坚化硬乎？这是不解者之二。”答道：“我固知你所疑者，是你认为我的注释不对。夫‘水归膀胱为正道’一句话，是说去饮的常例，所以治饮者，以利小水为正法。至于若水势大张，汪洋澎湃，与其从小便吹嘘渗泄，而耽延时日，其势复不能减，不如从大便扫除涤荡之更为直捷痛快。且小肠以上之水可渗，小肠以下之水，则水低而失膀胱之部，非下不可。所以立甘遂、半夏、十枣、葶苈以及防己等汤，都是不得已之变方变治罢了。我故曰：水归膀胱为正道者，此也。至于下药多寒，寒则中气更虚，而水更积，故不愈。不看防己二汤重用人参桂枝吗？又何疑于仲景下之，则中气不伤而皆愈也？若夫攻下之理，显而易见。苦寒趋下，咸寒破结。医虽以苦寒下之，而遗咸寒之性，故结者未下耳。此长沙独用芒硝之精意也。”语未及终，客唯唯而退。
第二十五条 心下有支饮，其人苦于眩晕昏冒。用泽泻汤主治。
泽泻汤方：泽泻（五两）、白术（二两）。
以上二味药，用水二升，煮取一升，分两次温服。
这里论述支饮在心下的病症治疗原则。眩，是晕眩；冒，是蒸冒。都是虚气上冲外鼓的征候。心下支饮离膈不远，而水饮渐迫，以致气高气郁，所以苦于眩晕昏冒。泽泻利水，而决之于沟渠；白术培土，而防之于堤岸。则水饮下注，而浮鼓之气自平矣。所以主治。
第二十六条 支饮胸满者，用厚朴大黄汤主治。
厚朴大黄汤方：厚朴（一尺）、大黄（六两）、枳实（四枚）。
以上三味药，用水五升，煮取二升，分两次温服。
此条支饮，另有来路，与诸条所谓支饮由于痰饮的不同，所以其治法，也与温药和之的原则自别。大概心肺间之膈气虚者，不能鼓努传送而便难。便难既久，则肠胃液短而干结，渐致胃实矣。液短，则借资于外水而饮积心下。胃实，则不能通过结硬而下渗小肠，与寒饮之上支心下者同，所以也叫作支饮。然支饮虽同，而其所以致饮者，因胃实胸满之故，则攻胃实之大黄，开胸满之枳朴，岂可迟缓？这是开壅水之地以治水之道。
第二十七条 支饮不得息，用葶苈大枣泻肺汤主治。
支饮不得息，见首条倚息下。主本汤者，泻其水饮上射之气也。方论见《肺痈》。
第二十八条 呕吐的人本来口渴，口渴的是想解，现在反而不渴，是因为心下有支饮。用小半夏汤主治。
小半夏汤方：半夏（一升）、生姜（半斤）。
以上二味药，用水七升，煮取一升半，分两次温服。
胸寒致呕，然呕能提气，呕则阳起而善渴者是常态。所以渴为呕家欲解之候。现在虽呕而反不渴，是呕为寒饮上逆，而不渴为内饮拒水之故。难道不是心下之胃脘，有支饮乎？半夏辛燥而降逆，生姜温膈以祛寒，俾胸阳一展，则饮去而呕将自平矣。这也是暴饮之少留者也。
第二十九条 腹满，口舌干燥，这是肠间有水气。用己椒苈黄丸主治。
己椒苈黄丸方：防己、椒目、葶苈（熬）、大黄（各一两）。
以上四味药，研末，蜜丸如梧子大。饭前饮服，服一丸，日三服，稍增。口中有津液，渴者加芒硝半两。（李氏曰：服一丸疑有误）
这里论述素盛今瘦，肠间痰饮的治疗原则。大概瘦则液短，而其便必干，故积聚停滞而腹满。又瘦则液短，而外水必积，故饮热而口舌干燥也。宿垢下瘀而腹满，积饮上烫而干燥，难道不是肠间有水气乎？主本方者，大黄苦寒逐瘀，用之治腹满者，实所以开行饮之道路也。然后以去水三将，同心合力，而共收犄角之全效矣。盖水在肠间，防己蔓生中通，具大小肠之象，而利水性悍，以之治肠间之水，允为确当。但恐性悍之品，迫水妄行，以致上激旁渗，故又以辛温纳下之椒目，引之顺流；苦寒利气之葶苈，押为殿后，而水饮宁复有留遗者乎？先食而服，取其直下肠间，而不使饮食中隔也。日三服而逐渐稍增者，但徐试之，而以中病为度，不使峻药过剂以伤正气也。口中有津液者，饮去而真气上通，得蒸被之化也。渴者以下，非指服丸以后而言，犹云若腹满口舌干燥之外，更加渴者，于本方中加芒硝半两。夫渴与干燥有辨，干燥是内饮拒水，而饮久化热之气，上熏廉泉，故不渴而但觉干燥也。渴则肠胃中已有结粪，而真阴短少，故求救于水而作渴。此正将作支饮溢饮之渐，故加软坚破结之芒硝，佐大黄之逐瘀，即前二十四条木防己汤加芒硝之义也。
第三十条 卒然呕吐，心下痞，膈间有水，眩悸者，用半夏加茯苓汤主治。
半夏加茯苓汤方：半夏（一斤）、生姜（半斤）、茯苓（六两）。
以上三味药，用水七升，煮取一升五合，分两次温服。
此支饮暴停之症治，从卒呕吐、心下痞二症，诊其有水也。卒然呕吐者，膈寒而上涌也。心下痞者，膈虚而下……
This section generally discusses the principles of medication treatment. For patients with Phlegm-Fluid (Tan-Yin) disease, one should consider the "Four Fluids" (Phlegm-Fluid, Suspended-Fluid, Overflowing-Fluid, and Pivotal-Fluid) comprehensively, as all types of fluid retention originate from the progression of Phlegm-Fluid; thus, "Phlegm-Fluid" is used to encompass them. The origin of Fluids generally stems from the decline and coldness of the Yang Qi in the Kidney, Spleen, and Lung Zang organs, and forms due to the deficiency-cold of transformation in the Sanjiao Fu organs. Using warming medicines to harmonize will restore Yang Qi and Qi transformation, causing the Fluids to dissipate naturally. This refers to the formulas mentioned later: Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction), Shen Qi Wan (Kidney Qi Pill), as well as Da Qing Long Tang (Major Blue-Green Dragon Decoction) and Xiao Qing Long Tang (Minor Blue-Green Dragon Decoction).
Article 17: When there is Phlegm-Fluid below the heart, accompanied by a feeling of fullness and distension in the chest and hypochondrium, and vertigo, treat with Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction).
Ling Gui Zhu Gan Tang Formula: Fu Ling (Poria, 4 liang), Gui Zhi (Cinnamon Twig), Bai Zhu (Atractodes, each 3 liang), Gan Cao (Licorice, 2 liang).
The above four ingredients are boiled in 6 sheng of water until 3 sheng remain. Divide into three warm doses. Urination will increase after administration.
This article discusses that for various fluid diseases, except for Overflowing-Fluid, Ling Gui Zhu Gan Tang is the primary formula. Since Phlegm-Fluid is the general term, fullness and distension below the heart and in the chest are symptoms of Pivotal-Fluid (Zhi-Yin); fullness and distension in the hypochondrium are symptoms of Suspended-Fluid (Xuan-Yin). Vertigo occurs because the Fluid is located high, and water carries the Wood Qi upwards. Poria (Fu Ling), with its bland and leaching properties to remove Fluid, serves as the Sovereign herb. It is assisted by Cinnamon Twig (Gui Zhi), acrid and sweet, to promote Yang Qi, and Atractodes (Bai Zhu), sweet and warm, to strengthen the Earth. Finally, Licorice (Gan Cao), sweet and mild, acts as the Envoy. This elevates the action of the other herbs, allowing them to slowly leach downwards. Thus, Ling Gui Zhu Gan Tang is the crucial formula for treating various fluids.
Article 18: Shortness of breath indicates slight Fluid retention, which should be eliminated through urination. Treat with Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction); Shen Qi Wan (Kidney Qi Pill) may also be used.
This follows up on Ling Gui Zhu Gan Tang, supplementing that slight latent Fluid in the Kidney affecting Lung Qi can also be treated with this decoction. Slight Fluid in the Kidney causes Qi to shoot upwards to the Lung, resulting in shortness of breath. Therefore, shortness of breath indicates slight Fluid. Slight Fluid is latent Fluid; since it resides in the Kidney, it is appropriate to benefit the Fu organ and eliminate it via urination. Ling Gui Zhu Gan Tang is a diuretic formula, hence it is indicated. Shen Qi Wan is also indicated because Ling Gui Zhu Gan Tang warms the Upper Jiao to control the Lower, allowing transformative Qi to descend, promoting urination; Shen Qi Wan warms the Lower Jiao to steam the Upper, also allowing transformative Qi to descend, thus promoting urination. The formula discussion is found in the "Deficiency Consumption" chapter.
Article 19: If the patient's pulse is deep and hidden, and they desire spontaneous diarrhea, which brings relief, yet despite the diarrhea, the area below the heart remains hard and full, this indicates that retained Fluid is attempting to exit. Treat with Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction).
Gan Sui Ban Xia Tang Formula: Gan Sui (Kansui Root, 3 large pieces), Ban Xia (Pinellia Tuber, 12 pieces, boiled in 1 sheng of water until 0.5 sheng remains, strain), Shao Yao (Peony Root, 5 pieces), Gan Cao (Licorice, 1 piece the size of a finger).
The above four ingredients are boiled in 2 sheng of water until 0.5 sheng remains. Strain, add 0.5 sheng of honey, mix with the decoction, and boil until 0.8 sheng remains. Take in one dose.
The "patient" refers to one suffering from Phlegm-Fluid. Pulse patterns for Fluid are often wiry; for retained Fluid, they are deep. Here, the pulse suddenly becomes neither wiry nor deep but hidden/deeply buried, almost imperceptible. A hidden pulse indicates contraction and downward movement. For fluid symptoms in the chest, hypochondrium, and below the heart, such a sudden downward trend suggests an attempt at spontaneous diarrhea. "Relief" contrasts with typical diarrhea discomfort (such as bloating, fatigue, pain, or heaviness). Here, the Yang Qi of the Spleen and Lung temporarily revitalizes during favorable time periods, causing Water-Fluid to move downward and exit via diarrhea. After evacuation, Water leaves and Qi expands, bringing relief. However, if the area below the heart remains hard and full without relief, it is because the water in the stomach and intestines has emptied, while the Suspended-Fluid in the hypochondrium, having previously seeped out through collaterals from central fullness, now re-seeps into the area below the heart (corresponding to the epigastrium) due to the internal emptiness. This is described as "retained Fluid attempting to exit." Taking advantage of this momentum to clear it makes the treatment easier. Gan Sui Ban Xia Tang is indicated because Kansui (Gan Sui) removes Water most rapidly and is the Sovereign herb targeting the main pathology, hence the name. Fearing that such potent drugs might act too forcefully downwards and leave Fluid in the chest and diaphragm, Licorice and Honey, being sweet and floating, are used to hold the action upward. Then, the acrid-drying Pinellia (Ban Xia) suppresses from above, and the sour-astringent Peony (Shao Yao) pulls down from below, ensuring the removal of Water-Fluid. Ling Gui Zhu Gan Tang is not used here because mild medicines might delay recovery, allowing Spleen and Lung Yang to remain latent, causing the Fluid to linger despite attempts to expel it. Kansui is rapid-acting, while Licorice is slow-acting; their opposition refers to these speeds, not mutual antagonism as vulgar interpretations suggest.
Article 20: A pulse that is floating, thin, and slippery indicates Injury by Fluid (Shang Yin).
This describes the pulse pattern for excessive drinking mentioned in Article 12. Drinking too much water leading to stagnation below the heart is called Injury by Fluid. Stagnant Water causes a slippery pulse; weak Yang unable to transform Water causes a thin pulse; acute accumulation where Yang is not yet compromised causes a floating pulse. Thus, a floating, thin, and slippery pulse confirms Injury by Fluid.
Article 21: A wiry and rapid pulse indicates Cold Fluid; difficult to treat in winter and summer.
Initially, Yang deficiency leads to Fluid stagnation, causing a wiry pulse. Later, accumulated Fluid transforms into deficient heat, damaging Yin, resulting in a wiry and rapid pulse. Treatment is difficult in winter and summer because the principles of treating Fluid are only dispersing/diffusing (Xuan Fa) and leaching/draining (Shen Xie). In winter, deficient Yang is hidden internally; neither Da Qing Long Tang nor Xiao Qing Long Tang is suitable for dispersing, and it further hinders the already deficient Yang indicated by the wiry pulse. In summer, deficient Yang responds externally; Ling Gui Zhu Gan Tang's warming and drying nature is unsuitable, and it hinders the Yin fluid deficiency indicated by the rapid pulse. Hence, it is deemed difficult to treat. This combines Overflowing-Fluid and Pivotal-Fluid, illustrating cases where pulse/symptoms conflict with seasonal timing, leading to a fifty-fifty prognosis.
Article 22: A pulse that is deep and wiry indicates Suspended-Fluid (Xuan Yin) with internal pain. Patients with Suspended-Fluid should be treated with Shi Zao Tang (Ten Date Pill).
Shi Zao Tang Formula: Da Ji (Euphorbia Lathyris Root), Yuan Hua (Genkwa Flower, roasted), Gan Sui (Kansui Root) in equal parts.
The above three ingredients are crushed and sifted. Boil ten large Jujubes (Da Zao) in 1.5 sheng of water until 0.8 sheng remains. Strain, add the powder. Strong individuals take 1 qian bi; weak individuals take half a qian bi. Take warm on an empty stomach in the morning. If no bowel movement occurs, increase by half a qian bi the next day. After obtaining rapid purgation, nourish oneself with millet porridge.
This discusses the pulse, symptoms, and treatment for Suspended-Fluid. A wiry pulse indicates Fluid and pain; a deep pulse indicates retained Fluid. Thus, it is identified as Suspended-Fluid with pain in the hypochondrium and clavicular region. Repeating "Patients with Suspended-Fluid" broadens the scope beyond just internal pain. It means any case of Suspended-Fluid in the hypochondrium, regardless of pain, is primarily treated with Shi Zao Tang. The formula discussion is in the "Shang Han" commentary.
Article 23: For patients with Overflowing-Fluid (Yi Yin), sweating should be induced. Treat with Da Qing Long Tang (Major Blue-Green Dragon Decoction); Xiao Qing Long Tang (Minor Blue-Green Dragon Decoction) may also be used.
Da Qing Long Tang Formula: Ma Huang (Ephedra Stem, 6 liang, tips removed), Gui Zhi (Cinnamon Twig, 2 liang, bark removed), Xing Ren (Apricot Seed, 40 pieces, skin and tips removed), Gan Cao (Licorice, 2 liang, honey-fried), Sheng Jiang (Fresh Ginger, 3 liang), Da Zao (Jujube, 12 pieces), Shi Gao (Gypsum, size of a chicken egg, crushed).
The above seven ingredients are boiled in 9 sheng of water. First, boil Ma Huang until reduced by 2 sheng, removing the foam. Add remaining herbs, boil until 3 sheng remain. Strain, take 1 sheng warm. Aim for a slight sweat. If sweating is excessive, dust with warm powder.
Xiao Qing Long Tang Formula: Ma Huang (Ephedra Stem, 3 liang, tips removed), Gan Cao (Licorice, 3 liang, honey-fried), Gui Zhi (Cinnamon Twig, 3 liang, bark removed), Shao Yao (Peony Root, 3 liang), Wu Wei Zi (Schisandra Berry, 0.5 sheng), Gan Jiang (Dried Ginger, 3 liang), Ban Xia (Pinellia Tuber, 0.5 sheng), Xi Xin (Asarum, 3 liang).
The above eight ingredients are boiled in 1 dou of water. First, boil Ma Huang until reduced by 2 sheng, removing the foam. Add remaining herbs, boil until 3 sheng remain. Strain, take 1 sheng warm.
This discusses the treatment for Overflowing-Fluid. Fluid overflowing into meridians and limbs must be resolved through sweating. Da Qing Long Tang induces diffusion/sweating; Xiao Qing Long Tang also promotes leaching/draining alongside diffusion. Hence, both are indicated. The formula discussion is in "Shang Han".
Article 24: Pivotal-Fluid (Zhi Yin) in the diaphragm causes wheezing and fullness, epigastric hardness and obstruction, dark facial complexion, and a deep, tight pulse. Onset was decades ago. Physicians attempted emesis and purgation without success. Treat with Mu Fang Ji Tang (Stephania Tetrandra Decoction). If the condition is Deficient, it resolves immediately. If Excess, it recurs in three days. If recurrence does not resolve with the original formula, use Mu Fang Ji Tang minus Shi Gao plus Fu Ling and Mang Xiao (Stephania Tetrandra Decoction minus Gypsum plus Poria and Mirabilite).
Mu Fang Ji Tang Formula: Mu Fang Ji (Stephania Tetrandra Root, 3 liang), Shi Gao (Gypsum, 12 pieces the size of a chicken egg), Gui Zhi (Cinnamon Twig, 2 liang), Ren Shen (Ginseng, 4 liang).
The above four ingredients are boiled in 6 sheng of water until 2 sheng remain. Divide into two warm doses.
Mu Fang Ji Tang minus Shi Gao plus Fu Ling and Mang Xiao Formula: Mu Fang Ji, Gui Zhi (each 3 liang), Ren Shen, Fu Ling (Poria, each 4 liang), Mang Xiao (Mirabilite, 3 he).
The above five ingredients are boiled in 6 sheng of water until 2 sheng remain. Strain, add Mang Xiao, simmer slightly. Divide into two warm doses. Mild purgation indicates cure.
This discusses the pulse, symptoms, and treatment for long-standing Pivotal-Fluid. Fluid accumulates from the intestines upward, filling the stomach, below-heart, and diaphragm, causing support and blockage, termed Pivotal-Fluid. Deep pulse indicates retained Fluid; tight pulse is a tense variant of wiry, distinct from Cold-tight. "Deficient/Excess" refers to the presence or absence of dry accumulation outside the Fluid, not Zheng Qi. Zhang Zhongjing posits that Diaphragmatic Pivotal-Fluid causes Qi to float up (wheezing/fullness); Sub-cardiac Pivotal-Fluid involves solid water accumulation (hardness/obstruction). Dark face results from Water color floating outward; deep pulse results from Water weight sinking; tightness comes from meridian tension due to Fluid blockage. Onset over decades indicates retained Fluid. Physicians used emesis/purgation mistakenly: emesis depletes Diaphragm Qi and worsens Water counterflow; purgation diverts Water to the Large Intestine rather than the Bladder (the correct path), depleting Middle Qi and accumulating more Water. Mu Fang Ji is vining and hollow, entering collateral channels; cold in nature sinks; acrid/bitter scatters/vents; white exterior/yellow interior vents Lung and Spleen/Stomach. As Sovereign, it directs Fluid downward. Shi Gao (acrid-cool) assists against secondary heat from long-standing Fluid. Ren Shen lifts Qi; Gui Zhi moves Yang, aiding the descent of Fluid. If only Fluid exists (no dry accumulation/Deficient type), cure follows. If dry feces persist (Excess type), Fluid returns in three days due to Qi stagnation. Recurrence unresponsive to the original formula requires removing Shi Gao (as secondary heat has subsided) and adding Mang Xiao (to soften hardness/clear old feces) and Fu Ling (to counteract Mang Xiao's salty-cold gathering effect with bland leaching). The guest questions why Zhang Zhongjing uses purgation when the text says purgation failed, and why adding Mang Xiao works for Excess if the physician's purgation failed. The response explains that while draining Small Water via the Bladder is the standard, massive Fluid accumulation requires direct elimination via the Large Intestine (as seen in Gan Sui Ban Xia Tang, Shi Zao Tang, etc.) when bladder drainage is insufficient for lower abdominal Water. The failure of previous purgation was due to cold medicines damaging Middle Qi; Mu Fang Ji Tang uses Ren Shen and Gui Zhi to protect Qi. The key difference is using Mang Xiao (salty-cold to break knots) alongside bitter-cold herbs, which Zhang Zhongjing uniquely employs. The guest withdraws.
Article 25: Pivotal-Fluid below the heart causes severe vertigo and dizziness. Treat with Ze Xie Tang (Alisma Decoction).
Ze Xie Tang Formula: Ze Xie (Alisma Rhizome, 5 liang), Bai Zhu (Atractodes, 2 liang).
The above two ingredients are boiled in 2 sheng of water until 1 sheng remains. Divide into two warm doses.
This discusses Pivotal-Fluid in the sub-cardiac region. Vertigo and dizziness result from deficient Qi rushing upward and expanding. Proximity to the diaphragm and increasing Water pressure cause Qi stagnation. Alisma drains Water like a canal; Atractodes strengthens Earth like a dam, allowing Water to flow down and calming floating Qi.
Article 26: Pivotal-Fluid with chest fullness is treated with Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction).
Hou Po Da Huang Tang Formula: Hou Po (Magnolia Bark, 1 chi), Da Huang (Rhubarb, 6 liang), Zhi Shi (Immature Bitter Orange, 4 pieces).
The above three ingredients are boiled in 5 sheng of water until 2 sheng remain. Divide into two warm doses.
This case of Pivotal-Fluid has a different etiology than others caused by Phlegm-Fluid. Its treatment differs from warming/harmonizing. Deficiency of Qi between Heart and Lung fails to transport stool, leading to constipation. Chronic constipation dries intestinal fluids, causing gastric excess. Fluid shortage draws external water into the sub-cardiac region. Gastric excess prevents downward seepage to the Small Intestine, mimicking Cold Fluid rising to the sub-cardiac region. Thus, it is called Pivotal-Fluid. Treatment targets gastric excess with Rhubarb and chest fullness with Magnolia Bark and Immature Bitter Orange, clearing obstructions to manage Water.
Article 27: Pivotal-Fluid causing inability to breathe is treated with Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Lung-Purging Decoction).
For Pivotal-Fluid causing breathing difficulty (see Article 1 regarding leaning to breathe), this formula purges the Qi of Water-Fluid shooting upwards. The formula discussion is in "Lung Abscess".
Article 28: Vomiting patients usually feel thirsty; thirst indicates resolution. If not thirsty now, it is due to Pivotal-Fluid below the heart. Treat with Xiao Ban Xia Tang (Minor Pinellia Decoction).
Xiao Ban Xia Tang Formula: Ban Xia (Pinellia Tuber, 1 sheng), Sheng Jiang (Fresh Ginger, 0.5 jin).
The above two ingredients are boiled in 7 sheng of water until 1.5 sheng remain. Divide into two warm doses.
Cold in the chest causes vomiting. Vomiting raises Qi, usually causing thirst (resolution sign). Lack of thirst despite vomiting indicates Cold-Fluid counterflow and internal Fluid rejecting water. This implies Pivotal-Fluid in the stomach. Pinellia is acrid-drying and descends rebellious Qi; Fresh Ginger warms the diaphragm and dispels Cold. Once Chest Yang expands, Fluid dissipates and vomiting stops. This represents minor residual Fluid from excessive drinking.
Article 29: Abdominal fullness and dry mouth/tongue indicate Water-Qi in the intestines. Treat with Ji Jiao Li Huang Wan (Stephania, Pepper Seed, Descurainia, and Rhubarb Pill).
Ji Jiao Li Huang Wan Formula: Fang Ji (Stephania Tetrandra Root), Jiao Mu (Zanthoxylum Seed), Ting Li (Descurainia Seed, roasted), Da Huang (Rhubarb) each 1 liang.
Crush into powder, make honey pills the size of wu zi seeds. Take one pill before meals with water, three times daily, gradually increasing. If thirsty, add 0.5 liang of Mang Xiao. (Li notes: taking one pill may be an error).
This discusses treatment for chronic obesity turning to emaciation with intestinal Phlegm-Fluid. Emaciation implies fluid shortage and dry stool, causing abdominal fullness. Fluid shortage also causes external water accumulation, leading to Heat-Fluid and dry mouth. Old fecal stasis causes fullness; accumulated Fluid causes dryness. Rhubarb (bitter-cold) clears stasis to open pathways for Fluid. Fang Ji (vining/hollow) targets Large/Small Intestines; Jiao Mu (acrid-warm) guides Water smoothly; Ting Li (bitter-cold) covers the rear. Taken before meals to target intestines directly. Gradual dosing avoids damaging Zheng Qi. Saliva return indicates true Qi restoration. Thirst (distinct from dryness) indicates existing dry feces and Yin deficiency seeking water, signaling impending Overflowing/Pivotal-Fluid. Adding Mang Xiao softens hardness, assisting Rhubarb, similar to Article 24.
Article 30: Sudden vomiting, epigastric obstruction, Water in the diaphragm, vertigo, and palpitations are treated with Ban Xia Jia Fu Ling Tang (Pinellia plus Poria Decoction).
Ban Xia Jia Fu Ling Tang Formula: Ban Xia (Pinellia Tuber, 1 jin), Sheng Jiang (Fresh Ginger, 0.5 jin), Fu Ling (Poria, 6 liang).
The above three ingredients are boiled in 7 sheng of water until 1.5 sheng remain. Divide into two warm doses.
This addresses acute Pivotal-Fluid diagnosed by sudden vomiting and epigastric obstruction indicating Water. Sudden vomiting is due to Cold in the Diaphragm surging upward. Epigastric obstruction is due to Diaphragm deficiency...