Library

[Wind-stroke (Exogenous Wind Syndrome) with fever, persisting for six or seven days without resolution accompanied by irritability, presenting both exterior and interior symptoms: thirst with desire to drink water, but vomiting immediately after ingestion is termed "Water Reversal" (Shui Ni). Wuling San (Five-Ingredient Powder with Cinnamon Twig) is the primary prescription. Drinking more warm water induces sweating, leading to recovery.]

When wind-strike syndrome causes fever, and after six or seven days the condition remains unresolved with irritability, presenting both exterior and interior signs, where the patient feels thirsty and desires to drink water but vomits it immediately upon ingestion, this condition is named "Water Reversal" (Shui Ni). It should be treated primarily with Wuling San (Five-Ingredient Powder with Cinnamon Twig). By consuming a larger amount of warm water, sweating will occur, resulting in recovery.

[The exterior heat remains unresolved, and internally there is irritability and thirst due to excessive sweating. The inability to accept water indicates the presence of fluid retention below the heart. Due to insufficient true yin water in the Heart (Li), the fire function in the Chest (Dan Zhong) cannot circulate freely. Pathogenic water condenses internally, while normal fluids are rejected externally; they cannot be transported outward to the pores (Xuan Fu), upward to the mouth and tongue, or downward to the Bladder. This explains the name "Water Reversal." It is necessary to rely on the bland-tasting herbs among the Four Poria group (Si Ling) to渗泄 (osmose and drain) the water. However, even if the fluid qi descends, the irritability and thirst may not resolve, nor will the exterior heat necessarily dissipate. Therefore, one must rely on the acrid-warm nature of Guizhi (Cinnamon Twig) to enter the Heart and transform fluids; furthermore, relying on the consumption of warm water promotes renewal. Thus, water essence distributes throughout the body, resolving irritability and thirst, and essence is transported to the skin and hair, causing natural sweating. One sweat clears both exterior and interior instantly, greatly differing from methods like Mahuang Tang, Guizhi Tang, Gegen Tang, and Qinglong Decoctions. Warm water can be taken in large quantities because the vomiting is caused by cold water in the stomach; internal heat excess rejects cold. Giving Guizhi and warm water exemplifies the method of "treating heat with heat." Wuling San is established for stagnant fluid qi; it is a mild diaphoretic, not a fluid-generating formula; it expels fluid qi rather than merely promoting urination.]

If exterior heat persists and internal irritability and thirst arise, it is due to excessive sweating. The inability to tolerate drinking water indicates fluid retention below the heart. Because the true yin water within the Heart (symbolized by Li) is insufficient, the fire function in the Chest (Dan Zhong) fails to circulate smoothly. Pathogenic water and dampness condense inside, while physiological fluids are repelled outside; they cannot be transported outward to the pores (Xuan Fu), upward to the oral cavity, or downward to the Bladder. This is the origin of the term "Water Reversal." It is imperative to utilize the bland-tasting herbs of the Si Ling group (Zhu Ling, Ze Xie, Fu Ling, Bai Zhu) to osmose and drain the retained water. Nevertheless, even if the fluid qi descends, the irritability and thirst might not cease, nor will the exterior heat necessarily disperse. Hence, reliance is placed on the acrid-warm properties of Guizhi (Cinnamon Twig) to enter the Heart and facilitate fluid transformation; additionally, copious intake of warm water aids in eliminating the old and generating the new. Consequently, water essence distributes evenly, relieving irritability and thirst, and essence reaches the skin and hair, inducing spontaneous sweating. A single episode of sweating resolves both exterior and interior conditions simultaneously, marking a significant departure from the methodologies of Mahuang Tang, Guizhi Tang, Gegen Tang, and Qinglong Decoctions. Since warm water can be consumed in abundance, it implies that the vomiting stems from cold water in the stomach, which rejects cold due to internal heat hyperactivity. Administering Guizhi and warm water constitutes the therapeutic principle of "using heat to treat heat." Wuling San is formulated for stagnant fluid qi; it acts as a mild diaphoretic, not for generating fluids, nor does it solely focus on promoting urination.

[After sweating, if the pulse is floating and rapid with irritability and thirst, Wuling San is indicated.]

Following diaphoresis, if the pulse becomes floating and rapid, accompanied by irritability and thirst, Wuling San (Five-Ingredient Powder with Cinnamon Twig) is the indicated treatment.

[The preceding clause mentions exterior and interior symptoms; this clause mentions exterior and interior pulses, mutually illuminating the dual-resolving meaning of Wuling San. Although sweating has occurred, the exterior pathogen is not fully eliminated, and fluid retention is internal; thus, Wuling San is used. If there were no exterior symptoms, Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) would be appropriate. In Shanghan, if sweating resolves the exterior but irritability returns with a floating-rapid pulse, the heat remains in the exterior and has not transmitted inward, so Guizhi Tang is used. Here, with added thirst, the heat has entered the interior while the exterior pathogen persists, hence Wuling San is employed. A floating and rapid pulse suggests diaphoresis is suitable. For disease in the outer layer of the exterior, Mahuang Tang is preferred; for the inner layer of the exterior, Guizhi Tang is preferred; for the outer layer of the interior (half-exterior half-interior), Wuling San is preferred. If the disease is in the deep interior, Zhuling Tang should be used to drain water only, and Wuling San should not be used as it also induces sweating. It must be understood that Wuling San is a formula for the Taiyang half-exterior half-interior stage, with emphasis on the half-exterior.]

The previous passage describes exterior and interior symptoms, while this passage describes exterior and interior pulse patterns, together elucidating the dual-resolution mechanism of Wuling San. Although diaphoresis has been performed, the exterior syndrome is not entirely resolved, and fluid qi is constrained internally; therefore, Wuling San is administered. If there were no exterior signs, Baibu Jia Renshen Tang (White Tiger Plus Ginseng Decoction) would have been indicated. In Cold Damage, if sweating resolves the exterior but irritability recurs with a floating and rapid pulse, the heat remains in the exterior and has not yet transmitted inward, warranting Guizhi Tang. In this case, the addition of thirst indicates that heat has reached the interior while the exterior pathogen has not subsided, necessitating Wuling San. A floating and rapid pulse indicates that diaphoresis is applicable. When the pathology is at the superficial level of the exterior, Mahuang Tang is suitable; when it is at the deeper level of the exterior, Guizhi Tang is suitable; when it is at the superficial level of the interior (the half-exterior/half-interior zone), Wuling San is suitable. If the pathology lies in the deep interior, Zhuling Tang should be used to promote urination alone, and Wuling San should be avoided as it combines water-draining with diaphoresis. It is crucial to recognize that Wuling San is a formula for the Taiyang half-exterior half-interior stage, with its primary focus on the half-exterior aspect.

[Taiyang disease, after sweating, with profuse sweating, dryness in the Stomach, irritability, insomnia, and desire to drink water: give small amounts of water frequently to harmonize the Stomach Qi, leading to recovery. If the pulse is floating, urination is difficult, there is slight fever, and extreme thirst, Wuling San is indicated.]

In Taiyang disease, after diaphoresis, if profuse sweating occurs causing dryness in the Stomach, irritability, insomnia, and a desire to drink water, administer small amounts of water frequently. Harmonizing the Stomach Qi will lead to recovery. However, if the pulse is floating, urination is impaired, there is slight fever, and extreme thirst (xiaoke), Wuling San (Five-Ingredient Powder with Cinnamon Twig) is the primary prescription.

[Indiscriminate sweating causes massive loss of body fluids, leading to Stomach dryness. Sweat is the fluid of the Heart; excessive sweating depletes Yin water in the Heart (Li), failing to control Fire, causing irritability. Decline of Kidney water fails to restrain Fire, causing restlessness. Essence cannot overflow upward to nourish the Spleen; the Spleen cannot transport fluids to the Stomach; Stomach disharmony causes insomnia. Internal water deficiency requires external water supplementation, hence the desire to drink. This represents a transition to Yangming syndrome. Water controls Fire and moistens Earth (Spleen/Stomach); when Water and Earth harmonize, the Stomach does not become dry-excess, and the disease heals. However, avoid excessive drinking to prevent fluid retention causing palpitations or asthma. This is because internal heat is still minimal, so intake should be limited. If drinking several liters fails to relieve symptoms, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) should be given. If after sweating, the pulse remains floating and slight fever persists, the exterior is not fully cleared. Even without irritability, if thirst is severe and drinks are quickly consumed, but urination is poor, fluid qi has not dispersed. Shanghan results from winter cold-water qi. Weak defensive Yang of Taiyang fails to resist pathogens, allowing cold-water to invade, causing fluid retention below the heart. Insufficient chest Yang fails to disperse fluid, causing irritability, thirst, and dysuria. Urination depends on Qi transformation. Lung Qi failure means Metal does not generate Water, preventing downward transmission to the Bladder. Heart Qi failure means Heart Yin deficiency prevents connection with Kidney (Kan). Upper Jiao must open for fluids to descend. Guizhi (red, enters Bing/Fire) and Si Ling herbs (white, enter Xin/Metal) combine to form Water circulation. As a powder, it disperses in the chest. Once the Upper Jiao is like mist, the Lower Jiao flows like a ditch, avoiding irritability, thirst, and urinary obstruction. Note that Wuling San focuses on floating pulse and slight fever, not merely dysuria.]

Erroneous diaphoresis leads to massive fluid loss, resulting in Stomach dryness. Sweat is considered the fluid of the Heart; excessive sweating depletes the Yin water within the Heart (represented by the Li trigram), leaving it unable to moderate Fire, thus causing irritability. Deficiency of Kidney water fails to control Fire, leading to restlessness. Vital essence cannot flow upward to nourish the Spleen, and the Spleen fails to distribute fluids to the Stomach; Stomach disharmony results in insomnia. Internal fluid insufficiency necessitates external fluid replenishment, hence the desire to drink. This signifies a transformation into Yangming syndrome. Water controls Fire and moistens Earth (Spleen and Stomach); when Water and Earth are in harmony, the Stomach does not become dry and excess, and the disease resolves. However, one must avoid unrestricted drinking to prevent fluid retention from causing palpitations or wheezing. This is because the internal heat is still slight, so fluid intake should be moderated. If drinking several liters provides no relief, Ren Shen Bai Hu Tang (Ginseng White Tiger Decoction) should be administered. If, after sweating, the pulse remains floating and slight fever persists, the exterior pathogen has not been completely expelled. Although there is no irritability, if thirst is extreme and fluids are consumed rapidly, yet urination is inadequate, it indicates that fluid qi has not dissipated. Shanghan (Cold Damage) is contracted from the cold-water qi of winter. The defensive Yang of Taiyang is weak and insufficient to resist pathogens, allowing cold-water to invade internally, resulting in fluid retention below the heart. Furthermore, chest Yang is insufficient to disperse this fluid, leading to irritability, thirst, and difficulty in urination. Urination relies on Qi transformation. If Lung Qi fails to transform, Metal does not generate Water, preventing downward transmission to the Bladder. If Heart Qi fails to transform, Heart Yin deficiency prevents downward communication with the Kidney (Kan). The Upper Jiao must be unobstructed for fluids to descend. Guizhi (Cinnamon Twig), being red, enters the Heart (Bing Fire); the four Poria herbs, being white, enter the Lung (Xin Metal). Bing and Xin combine to facilitate Water circulation. Prepared as a powder and dispersed in the chest, it ensures the Upper Jiao becomes like mist and the Lower Jiao flows like a ditch, thereby preventing irritability, thirst, and urinary retention. It is essential to understand that Wuling San emphasizes the floating pulse and slight fever, rather than focusing solely on dysuria.

[Taiyang disease with fever, sweating, aversion to cold absent, and thirst indicates transition to Yangming. For thirst with desire to drink, give small amounts of water and treat according to principles; Wuling San is suitable.]

In Taiyang disease, if the patient presents with fever, sweating, absence of aversion to cold, and thirst, this indicates a transition to Yangming syndrome. For those with thirst and desire to drink, provide small amounts of water and treat according to proper principles; Wuling San (Five-Ingredient Powder with Cinnamon Twig) is appropriate.

[This shares the same meaning as the first half of the previous clause. The previous clause refers to post-profuse sweating; this refers to pre-sweating, constituting Taiyang Warm Disease. Taiyang Warm Disease is the direct pathway to Yangming, the most expedient route. Unlike Shanghan or Wind-stroke, which transition only after fluid depletion, drinking water is the major method for treating Warm Disease, avoiding errors of sweating, purging, or warming. Wuling San is also a method for treating excessive fluid intake. "Transition" implies pathogenic influence from other meridians. The patient may not normally have Stomach excess, so this method is preemptively established to protect against Stomach deficiency. Zhang Zhongjing, in treating Taiyang, not only preserves Stomach fluids but also anticipates complications like masses or grain jaundice. The full text appears in the Yangming chapter; this excerpt is included to illustrate Wuling San indications.]

This passage aligns with the first half of the preceding clause. The previous clause addresses the state after profuse sweating, whereas this clause addresses the state before sweating, characterizing it as Taiyang Warm Disease. It is important to note that Taiyang Warm Disease represents the most direct pathway to Yangming syndrome. This differs from Shanghan (Cold Damage) or Wind-stroke syndromes, which typically transition only after significant fluid depletion. Administering water is a fundamental method for treating Warm Disease, thereby avoiding the errors associated with inappropriate sweating, emesis, purgation, or warming therapies. Wuling San also serves as a remedy for conditions arising from excessive fluid intake. The term "transition" implies that the pathology has spread from other meridians. The patient may not inherently possess Stomach excess; thus, this method is prescribed proactively to prevent Stomach deficiency. Zhang Zhongjing, in managing Taiyang diseases, not only prioritizes preserving Stomach fluids but also anticipates potential complications such as fixed masses or grain-related jaundice. The complete context is found in the Yangming Chapter; this segment is cited here to document indications for Wuling San.

[After sweating, excessive water intake inevitably causes asthma/wheezing; washing with cold water also causes wheezing.]

After diaphoresis, excessive consumption of water will inevitably induce wheezing; similarly, bathing with cold water will also cause wheezing.

[Pre-sweating wheezing due to wind-cold is Mahuang syndrome. Post-purgation mild wheezing is Guizhi Houpo Xiren syndrome. Wheezing with sweating is Gegen Huanglian Huangqin syndrome. Post-sweat wheezing due to fluid deficiency and excessive drinking is Wuling syndrome. Cold water bathing causing wheezing indicates that external cold and internal cold drinks damage the Lungs, forcing Qi upward. Han dynasty treatments included fire and water attacks, hence mentioned by Zhongjing.]

Wheezing occurring prior to sweating due to wind-cold invasion corresponds to the Mahuang Tang syndrome. Mild wheezing following purgation corresponds to the Guizhi Houpo Xiren Tang (Guizhi Plus Magnolia Bark and Apricot Kernel Decoction) syndrome. Wheezing accompanied by sweating corresponds to the Gegen Huanglian Huangqin Tang (Pueraria, Coptis, and Scutellaria Decoction) syndrome. Wheezing after sweating due to fluid deficiency and excessive water intake corresponds to the Wuling San syndrome. Wheezing induced by washing with cold water indicates that both external cold exposure and consumption of cold beverages can injure the Lungs, forcing Qi to rush upward, resulting in wheezing. During the Han Dynasty, medical treatments included "fire attack" and "water attack" methods, which is why Zhang Zhongjing references them.

[Taiyang disease with excessive water intake: if urination is free, palpitations below the heart are certain; if urination is scanty, abdominal urgency is certain.]

In Taiyang disease, if water intake is excessive: if urination is free and abundant, palpitations below the heart are inevitable; if urination is scanty, abdominal urgency and discomfort are inevitable.

[This illustrates inspection and inquiry methods. As stated in Neijing: "One cause is dietary," examining the upper and lower aspects confirms this. Seeing the patient drink, inquire about urination. Free urination indicates water stagnation in the Upper Jiao, unable to act like mist, causing palpitations. Scanty urination indicates water accumulation in the Lower Jiao, unable to flow like a ditch, causing abdominal urgency. Fire dysfunction causes water stagnation below the heart (palpitations); Water dysfunction causes water knotting in the Bladder (abdominal urgency).]

This section illustrates the diagnostic methods of inspection and inquiry. As stated in the *Neijing* (Inner Canon): "One etiology is derived from diet," referring to assessing the consistency between upper and lower bodily functions. Upon observing the patient drinking, one should inquire about their urination status. If urination is free, it indicates water stagnation in the Upper Jiao, failing to disperse like mist, which inevitably leads to palpitations below the heart. If urination is scanty, it indicates water accumulation in the Lower Jiao, failing to drain like a ditch, which inevitably leads to abdominal urgency. Dysfunction of Fire (Heart) causes water to stagnate below the heart, resulting in palpitations; dysfunction of Water (Kidney) causes water to knot in the Bladder, resulting in abdominal urgency.

[Shanghan with sweating, palpitations below the heart, and thirst: Wuling San. Without thirst: Fuling Gancao Tang.]

In Shanghan, if sweating is accompanied by palpitations below the heart and thirst, Wuling San (Five-Ingredient Powder with Cinnamon Twig) is indicated. If there is no thirst, Fuling Gancao Tang (Poria and Licorice Decoction) is indicated.

["Palpitations below the heart" should follow "sweating"; see later clauses. Otherwise, sweating with thirst is Baibu Tang syndrome; post-sweat no thirst/no other symptoms means recovery. Both formulas address fluid below the heart. Thirst indicates fluid loss; use less Guizhi, more warm water, mild sweating. No thirst indicates fluid intact; use Guizhi modification, further sweating. Previous clause discusses symptoms; this discusses formulas; read mutually for meaning.]

The phrase "palpitations below the heart" should logically follow "sweating," as evidenced in subsequent clauses. Otherwise, sweating accompanied by thirst indicates the Baibu Tang (White Tiger Decoction) syndrome. Post-sweat absence of thirst and other symptoms implies the disease has resolved, requiring no medication. Both formulas are established for fluid retention below the heart. In cases with thirst, body fluids have been depleted; thus, a smaller dose of Guizhi is used, combined with copious warm water to induce mild sweating. In cases without thirst, fluids remain intact; thus, a modified Guizhi Tang is used to induce further sweating. The preceding clause describes symptoms without specifying treatment; this clause specifies formulas without detailed symptoms; they should be interpreted mutually to grasp the underlying intent.

[Originally treated with purgatives, causing epigastric fullness; given Xiexin Tang. Fullness persists, with thirst, dry mouth, irritability, and dysuria: Wuling San.]

Initially, improper purgation led to epigastric fullness (Pi), for which Xiexin Tang (Drain the Epigastrium Decoction) was administered. If the fullness persists, accompanied by thirst, dry mouth, irritability, and dysuria, Wuling San (Five-Ingredient Powder with Cinnamon Twig) is indicated.

[If Xiexin Tang fails to resolve fullness, it is due to fluid below the heart. Symptoms include dryness, irritability, and dysuria. Wuling San enters the Heart to expel fluid, resolving fullness.]

If Xiexin Tang (Drain the Epigastrium Decoction) fails to alleviate the epigastric fullness, it is necessarily due to fluid retention below the heart. The symptoms will necessarily include dryness, irritability, and dysuria. Administering Wuling San allows the formula to enter the Heart region and expel the fluid, thereby resolving the fullness.

[After severe purgation and subsequent sweating, dysuria results from fluid depletion. Do not treat directly; wait for natural urination recovery.]

Following severe purgation and subsequent diaphoresis, if dysuria occurs, it is due to the depletion of body fluids. Do not intervene directly; allow the body to recover naturally until urination resumes.

[For any disease, whether due to sweating, vomiting, purging, blood loss, or fluid depletion, if Yin and Yang self-harmonize, recovery is certain.]

In any disease, whether caused by diaphoresis, emesis, purgation, blood loss, or fluid depletion, if the Yin and Yang phases achieve self-harmony, spontaneous recovery is guaranteed.

[Previous Wuling usage was for fluid below the heart, expelling water, not just promoting urination. Without fluid, post-sweat dysuria is due to fluid loss; what is there to drain? "Do not treat" prohibits diuretics, not waiting for cure. But for fluid-depleted patients, how can urine flow without replenishing fluids? Treatment must focus on generating fluids. Blood/fluid loss prevents Yin-Yang harmony; harmony requires regulating the source. Blood generates Yin, fluids generate Yang; replenishing blood and fluids restores harmony. Not replenishing fluids prevents urination; not replenishing blood/fluids prevents harmony. Read Zhongjing's works to find prescriptions where none seem to exist, and treatment where none seems applied. Zhongjing has no rigid formulas or methods.]

The previous instance of using Wuling San was because fluid retention existed below the heart; the goal was to expel water, not merely to promote urination. If there is no fluid retention below the heart, then post-sweat dysuria is due to fluid depletion; in such a case, what is there to drain? The instruction "do not treat" prohibits the use of diuretic agents, rather than implying passive waiting for recovery. However, in a patient depleted of fluids, how can urination resume without replenishing fluids? To restore urination, the treatment must focus on generating fluids. If a patient has lost blood and fluids, how can Yin and Yang self-harmonize? To achieve Yin-Yang harmony, one must first regulate their sources. Blood constitutes Yin, and fluids constitute Yang; replenishing blood and generating fluids restores Yin-Yang harmony. It is crucial to understand that without replenishing fluids, urination cannot be restored; without replenishing blood and fluids, Yin-Yang cannot self-harmonize. When studying Zhang Zhongjing’s works, one should seek prescriptions in passages where none appear to be offered, and find therapeutic principles in sections that seem to advocate non-intervention. Only then will one realize that Zhang Zhongjing possesses no rigid or dead-end formulas, nor does he adhere to inflexible methods.

[Wuling San: Zhu Ling (peeled), Bai Zhu, Fu Ling (each 18 zhu), Ze Xie (1 liang 6 qian), Guizhi (0.5 liang). Pound into powder, mix with rice water, take 1 fangcun bi.]

**Wuling San (Five-Ingredient Powder with Cinnamon Twig):**
* Zhu Ling (Polyporus Umbellatus, peeled)
* Bai Zhu (Atractylodis Macrocephalae Rhizoma)
* Fu Ling (Poria, each 18 zhu)
* Ze Xie (Alismatis Rhizoma, 1 liang 6 qian)
* Guizhi (Cinnamomi Ramulus, 0.5 liang)

Pound these five ingredients into a fine powder. Mix with rice water (bai yin) and administer one *fangcun bi* (a square-inch measure) per dose.

[Zhu Ling (black, Kidney) and Ze Xie (salty, Kidney) represent water substance. Fu Ling (sweet, Spleen; white, Lung) clears the water source. Guizhi (red, Heart) unblocks channels and induces sweating, representing water function. Combined as powder, dispersed in chest, water essence distributes, nourishing Heart/Lung, overflowing to skin, unblocking water pathways, resolving via sweat. Treats post-sweat exterior-interior heat, thirst, irritability, insomnia, similar to Baibu. Difference: exterior heat unresolved, water reversal, excessive drinking. Not merely for diuresis; not for generating fluids.]"

Zhu Ling (Polyporus), being black, enters the Kidney; Ze Xie (Alisma), being salty, enters the Kidney; together they embody the substance of water. Fu Ling (Poria), being sweet and entering the Spleen, and white in color entering the Lung, serves to clarify the source of water. Guizhi (Cinnamon Twig), being red and entering the Heart, unblocks the meridians and induces sweating, representing the functional aspect of water metabolism. Combined into a powder and dispersed in the chest, the water essence distributes throughout the body, nourishing the Heart and Lungs upwards, overflowing to the skin and hair externally, and unblocking the water pathways, leading to resolution through sweating. This formula treats post-sweat conditions involving both exterior and interior heat, dryness-thirst, irritability, and insomnia, which are identical to the indications for Baibu Tang (White Tiger Decoction). The difference lies in the unresolved exterior heat and the specific variations of water reversal and excessive fluid intake. To claim this formula is designed solely for diuresis demonstrates a misunderstanding of Zhang Zhongjing’s intent. To claim it generates fluids is incorrect, as osmotic-draining herbs are not suited for this purpose.

[Shanghan with cold extremities and palpitations below the heart: treat water first with Fuling Gancao Tang, then treat cold extremities. Otherwise, water invades Stomach, causing diarrhea.]

In Shanghan, if cold extremities (Jue) are accompanied by palpitations below the heart, water retention should be treated first using Fuling Gancao Tang (Poria and Licorice Decoction), followed by treatment of the cold extremities. If this order is not followed, water will infiltrate the Stomach, inevitably causing diarrhea.

[Palpitations indicate fluid. Treating before it invades Stomach prevents connected Jue and diarrhea. This shows sequential treatment.]

Palpitations below the heart indicate the presence of fluid retention. By treating this now, before the fluid infiltrates the Stomach, one prevents the progression of cold extremities and diarrhea. This illustrates the importance of sequential treatment protocols.

[Fuling Gancao Tang: Fu Ling, Guizhi (each 1 liang), Gancao (1 liang, roasted), Sheng Jiang (3 liang). Boil 4 sheng water to 2 sheng, strain, divide into 3 warm doses.]

**Fuling Gancao Tang (Poria and Licorice Decoction):**
* Fu Ling (Poria)
* Guizhi (Cinnamomi Ramulus, each 1 liang)
* Gancao (Glycyrrhizae Radix Et Rhizoma, 1 liang, roasted)
* Sheng Jiang (Zingiberis Rhizoma Recens, 3 liang)

Boil these four ingredients in 4 sheng of water until reduced to 2 sheng. Strain the dregs and divide into three warm doses.

[Modified from Guizhi Tang. Remove Dazao for fluid/stagnation; remove Shaoyao for no irritability/cold limbs; add Fu Ling for draining; keep Jiang/Gui for sweating. Avoid Zhu/Ze to prevent water invading Stomach. Different from Wuling for thirst/irritability.]

This formula is a modification of Guizhi Tang. Da Zao (Jujube) is removed because fluid stagnation causes palpitation; Shao Yao (Peony) is removed because there is no irritability, only cold extremities; Fu Ling (Poria) is added to promote osmotic drainage; since the aim is to treat water, Sheng Jiang (Fresh Ginger) and Guizhi (Cinnamon Twig) are retained to induce sweating. Zhu Ling (Polyporus) and Ze Xie (Alisma) are omitted to prevent water from infiltrating the Stomach. This approach differs from Wuling San, which is used for treating irritability and thirst.