文蛤（五两）
上一味为散。以沸汤。和一方寸匕服。汤用五合。
病在阳不从汗散。反以冷水 之灌之。寒束其外。热被却而不得去。阳无出路。弥更益
烦。
水客皮肤。肉上粟起。阳气为水邪所格。故欲饮水。反不得饮。五苓散宣阳逐水则有余。育
阴散热则不足。独任文蛤一味。可以两收散热导湿之功。
服文蛤散不瘥。复用五苓散者。以既得文蛤咸寒之性。清热导湿。免致增逆矣。而表阳
不宣。水无出路。文蛤不堪再任。则仍取五苓宣阳逐水。此救逆之次第也。
茯苓（四两） 桂枝（三两去皮） 白术（二两） 甘草（二两炙）
上四味。以水六升。煮取三升。去滓。分温三服。
此方主治太阴湿困。而膀胱之气。不行。经云。心下逆满。气上冲胸。起则头眩。脉沉
紧。
发汗。则动经身为振振摇者。此汤主之。按心下逆满。乃伏饮搏膈。至于气冲头眩。则寒邪
上涌。助饮为逆。饮本阴邪。故脉见沉紧。脉沉不宜发汗。误汗则阳益不支。而身为振摇。
故以桂枝茯苓。扶阳化饮。而加白术甘草。伸太阴之权。以理脾而胜湿。脾乃能为胃行其津
液。而膀胱之气始化也。
再按金匮用此方以治痰饮。其一曰。心下有痰饮。胸胁支满。目眩。苓桂术甘汤主之。
又曰
。短气有微饮。当从小便去之。苓桂术甘汤主之。盖治痰饮大法。当以温药和之。温则脾阳
易于
健运。而阴寒自化。白术茯苓虽能理脾而胜湿。必合桂枝化太阳之气以伐肾邪。而通水道。
方能取效。
Wenli San (Clam Shell Powder) [Wenli: Clam Shell] (five liang)
Grind the above single herb into a powder. Mix one cun-bi (a measure of volume, approx. 2-3 grams) with boiling water for oral administration. Use five he (approx. 100 ml) of water.
When the pathogen is in the Yang aspect, it should naturally be dispersed through sweating. However, if cold water is poured over the patient, the cold binds the exterior, trapping the heat inside so it cannot escape. With no outlet for the Yang Qi, the patient becomes increasingly restless and irritable.
Water dampness lodges in the skin, causing gooseflesh on the muscles. The Yang Qi is obstructed by the water-damp pathogen; thus, there is a desire to drink, yet an inability to swallow. Using Wuling San (Five-Ingredient Powder with Poria) alone would be sufficient to circulate Yang and expel water, but insufficient to nourish Yin and clear heat. Using only Wenli (Clam Shell) can achieve both the effects of clearing heat and guiding out dampness.
If the condition does not improve after taking Wenli San, Wuling San (Five-Ingredient Powder with Poria) [Wuling San: Five-Ingredient Powder with Poria] should be administered subsequently. This is because, having utilized the salty and cold nature of Wenli (Clam Shell) to clear heat and guide out dampness, further aggravation is avoided. However, since the exterior Yang remains unventilated and water has no exit, Wenli (Clam Shell) is no longer adequate. Therefore, Wuling San (Five-Ingredient Powder with Poria) is chosen again to circulate Yang and expel water. This represents the sequential steps for correcting adverse reactions.
Fuling (Poria) [Fuling: Poria] (four liang), Guizhi (Cinnamon Twig) [Guizhi: Cinnamon Twig] (three liang, bark removed), Baizhu (Atractylodes Macrocephala Rhizome) [Baizhu: Atractylodes Macrocephala Rhizome] (two liang), Gancao (Licorice Root) [Gancao: Licorice Root] (two liang, honey-fried).
Take the above four herbs, add six sheng (approx. 1200 ml) of water, decoct to obtain three sheng (approx. 600 ml) of liquid, remove the dregs, and divide into three warm doses.
This formula primarily treats Taiyin Spleen deficiency complicated by dampness obstruction, leading to impaired Qi transformation of the Bladder. The Classics state: "Fullness and rebellious sensation below the heart, Qi rushing up to the chest, dizziness upon standing, and a deep, tight pulse."
If sweating is induced inappropriately, it disturbs the meridians, causing tremors and shaking of the body; this formula is indicated for such cases. Commentary: The fullness and rebellious sensation below the heart result from latent fluid retention binding at the diaphragm. The Qi rushing to the head and dizziness occur when cold pathogens surge upward, exacerbating the fluid retention. Since fluid retention is inherently a Yin pathogen, the pulse appears deep and tight. A deep pulse contraindicates sweating; inappropriate sweating further depletes Yang Qi, leading to bodily tremors. Therefore, Guizhi (Cinnamon Twig) and Fuling (Poria) are used to support Yang and transform fluids, while Baizhu (Atractylodes Macrocephala Rhizome) and Gancao (Licorice Root) strengthen the function of the Taiyin Spleen to resolve dampness. When the Spleen functions properly, it can transport fluids for the Stomach, allowing the Qi transformation of the Bladder to resume.
Furthermore, according to the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), this formula is used to treat Phlegm-Fluids. One indication states: "Phlegm-fluids in the epigastrium causing distension and fullness in the chest and hypochondrium, along with dizziness, are treated with Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction)." Another states: "Shortness of breath with mild fluid retention should be resolved via urination, treated with Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction)." Generally, the principle for treating Phlegm-Fluids is to harmonize with warm herbs. Warmth facilitates the vigorous movement of Spleen Yang, causing Yin-cold to transform naturally. Although Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria) regulate the Spleen and resolve dampness, they must be combined with Guizhi (Cinnamon Twig) to transform Taiyang Qi, subdue Kidney pathogens, and unblock the water passages to achieve efficacy.