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Original text of *Shanghan Lun*: When an external contraction of cold pathogens has not resolved the exterior syndrome, and there is fluid retention (accumulation of pathological fluids) in the epigastrium, presenting with dry retching, fever accompanied by cough, or thirst, or diarrhea, or a sensation of choking in the throat, or difficulty in urination with fullness in the lower abdomen, or wheezing, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is the primary treatment.

Water dispersed becomes Qi, and Qi can condense back into water. The term "fluid retention" (pathological accumulation of fluids) is used instead of simply "stagnant water" to describe the condition in the epigastrium. This refers to retained fluid transformed from ingested water; although its form resembles water, it possesses a sticky and viscous nature. It adheres tightly to external pathogenic factors, thereby causing the various symptoms listed below. Dry retching occurs because the fluid retention is sticky and lodged at the stomach opening. Fever arises because the fluid retention transforms into cold-fluid retention, forcing the Yang Qi of the Heart and Lungs to float outward. Coughing happens because the fluid retention infiltrates the Lungs. Thirst results because the fluid retention fails to transform into body fluids that can ascend to moisten the mouth. Diarrhea occurs because the fluid retention flows into the Large Intestine, causing loose stools. A sensation of choking is caused by the fluid retention transforming into cold-phlegm that obstructs the throat. Difficulty in urination and lower abdominal fullness are due to the fluid retention coagulating and expanding in the Lower Jiao (Lower Burner). Wheezing occurs because the fine branching tubes within the Lungs are filled and permeated by the fluid retention.

[Original Formula for Xiao Qing Long Tang (Minor Blue Dragon Decoction)]
Mahuang (Ephedrae Herba), 3 liang, nodes removed; Guizhi (Cinnamomi Ramulus), 3 liang, bark removed; Shaoyao (Paeoniae Radix Alba), 3 liang; Wuweizi (Schisandrae Chinensis Fructus), half sheng; Ganjiang (Zingiberis Rhizoma), 3 liang, sliced; Gancao (Glycyrrhizae Radix et Rhizoma), 3 liang, honey-fried; Xixin (Asari Radix et Rhizoma), 3 liang; Banxia (Pinelliae Rhizoma), half sheng, washed with hot water.

Take the above eight ingredients. Add one dou (approx. 10 liters) of water. First decoct Mahuang, reducing the volume by two sheng (approx. 2 liters), and skim off the foam on the surface. Then add the remaining herbs. Decoct until three sheng (approx. 3 liters) remain. Strain the dregs. Take one sheng (approx. 1 liter) warm.
If there is mild diarrhea, remove Mahuang and add Yuanhua (Genkwa Flos) the size of a chicken egg, stir-fried until reddish-brown.
If there is thirst, remove Banxia and add Gualougen (Trichosanthis Radix), 3 liang.
If there is a sensation of choking, remove Mahuang and add Fuzi (Aconiti Lateralis Radix Praeparata), one piece, prepared.
If there is difficulty in urination with lower abdominal fullness, remove Mahuang and add Fuling (Poria), 4 liang.
If there is wheezing, remove Mahuang and add Xingren (Armeniacae Semen Amarum), half sheng.

Note: Yuanhua is rarely used in modern times. *Yizong Jinjian* (Golden Mirror of Medical Tradition) annotates that it belongs to the Genkwa family and has a very strong purgative effect for removing water; using just five fen can cause dozens of bowel movements. Therefore, it should be replaced with Fuling. Regarding the character "Ye" (choking/gagging), commentators often interpret it as hiccups, which is also found in dictionaries. However, observing that Mahuang is removed and Fuzi is added, it seems more appropriate to interpret this as cold-phlegm coagulation obstructing the throat, which aligns better with the properties of the added herb.

[Dosage Used by Later Generations for Xiao Qing Long Tang]
Mahuang, 2 qian; Guizhi Jian (Tip of Cinnamon Twig), 2 qian; Shaoyao, 3 qian; Wuweizi, 1.5 qian; Ganjiang, 1 qian; Gancao, 1.5 qian; Xixin, 1 qian; Banxia, 2 qian. Decoct to make one zhong (cup), taken once.

Among the various diseases treated concurrently by Xiao Qing Long Tang, wheezing is listed last. However, in later generations, Xiao Qing Long Tang became the main formula for treating external contraction-induced phlegm-wheezing. This indicates that Xiao Qing Long Tang is an agent for treating fluid retention in external contractions and essentially functions as a formula for regulating the Lung. The Lung governs respiration, and the mechanism of respiration lies in the opening and closing (expansion and contraction) of the lung lobes. If this mechanism operates naturally and flexibly, the wheezing will heal spontaneously. Therefore, Chen Xiuyuan stated: In Xiao Qing Long Tang, Wuweizi, Ganjiang, and Xixin should be the principal herbs. Wuweizi governs the closing of the Lung, Ganjiang governs the opening of the Lung, and Xixin activates the flexible mechanism of opening and closing. Thus, while other herbs in Xiao Qing Long Tang can be modified, these three must not be altered. Note: Chen’s argument is very sound. The subtle principle behind his statement that Xixin activates the flexible spirit of opening and closing is profound. Everyone knows Xixin is a herb for the Foot-Shaoyin Kidney Meridian, so it is frequently used in Shaoyin-type Shanghan syndromes. However, its nature truly facilitates the interaction between the Foot-Shaoyin and Hand-Shaoyin meridians. Therefore, it is suitable for Shaoyin Shanghan where Heart and Kidney do not interact, causing irritability. It can also guide the power of other herbs upward to the brain, making it essential for headache caused by Yin-cold. Furthermore, it contains the aroma of borneol, which penetrates and stimulates the nerves to become flexible, thereby naturally activating the flexible mechanism of lung lobe expansion and contraction.

Zou Run’an said: For any disease caused by Wind-Cold pathogens attaching themselves to essence, blood, body fluids, urine/feces, nasal discharge, or saliva, this formula can draw them out, separating them so they no longer adhere. Examining this, we understand that the use of Xixin in Xiao Qing Long Tang is also to dispel Wind-Cold from within the fluid retention.

In Zhang Zhongjing’s formulas, when Wuweizi is used, Ganjiang is always paired with it. This is because external contraction syndromes generally contraindicate Wuweizi, especially in cases complicated by phlegm-cough, due to its strong sour-astringent power which can trap external pathogens deep within the Lungs, leading to chronic consumptive cough. Only by balancing it with the pungent-spicy nature of Ganjiang is this risk mitigated. This is based on the Five Elements theory: Pungency overcomes Sourness, as explicitly stated in *Neijing*. Xu Dachun’s *Bencao Baizhong Zhu* discusses this in detail. However, my recent clinical experience yields another insight: although the skin of Wuweizi is sour, its seed contains a spicy flavor. Using the spiciness of the seed to balance the sourness of the skin prevents harm from excessive astringency. Therefore, when I treat consumptive cough, I often crush Wuweizi before decocting and add small amounts of Shegan (Belamcandae Rhizoma) and Niubangzi (Arctii Fructus), which proves effective without necessarily needing Ganjiang.

It is peculiar that physicians favor Mahuang for treating external contraction phlegm-wheezing, yet when using Xiao Qing Long Tang for external contraction wheezing, Zhang Zhongjing removes Mahuang and adds Xingren, often causing confusion among users. Recently, someone published an article in a medical journal criticizing this, arguing that if Mahuang is removed, what agent remains to treat external contraction wheezing? They fail to realize that *Shennong Bencao Jing* states Guizhi treats "shangqi" (rebellious Qi), cough, and irregular breathing, indicating Guizhi inherently descends Qi and calms wheezing. Although wheezing stems from external contraction, it is often compounded by deficiency of Yuan Qi (Primal Qi) failing to secure and hold. While Mahuang can calm wheezing, its strength lies in draining the Lungs, which may not be suitable for patients with pre-existing Yuan Qi deficiency. Therefore, Zhang Zhongjing avoids Mahuang’s lung-draining action, relying instead on Guizhi’s ability to descend Lung Qi, assisted by Xingren, which descends Lung Qi, promotes phlegm resolution, and expels pathogens. This combination ensures stable and successful treatment.

When I first began practicing medicine, I did not know to use this approach. I recall in the year Yiyu, a man named Li XX from a neighboring village, in his thirties, sought my help for external contraction phlegm-wheezing. He was obese and had a history of fluid retention. After catching a cold, he developed incessant wheezing. There was no significant heat in the interior or exterior, but he lacked mental energy, felt drowsy with eyes closed, experienced chest oppression preventing eating, had a white greasy tongue coating, and a slippery, soggy pulse with normal rate. I administered several doses of formulas for dispersing wind, clearing fire, and resolving phlegm, with no effect. Several other doctors were consulted, also without success. As days passed, the condition worsened dangerously, and he returned to me. I recommended an elderly physician, Pi XX, nearly eighty years old, living in seclusion by the Bohai Sea. After examination, Pi XX said, "This is easy to treat; it is a Xiao Qing Long Tang syndrome." He prescribed the original Xiao Qing Long Tang formula, adding Xingren 3 qian, and retaining Mahuang at 1 qian. One dose stopped the wheezing. Subsequently, Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) with Tian Dong (Asparagi Radix) and Hou Po (Magnoliae Officinalis Cortex) was given for two doses, resulting in complete recovery.

I then realized the miraculous efficacy of Xiao Qing Long Tang. Blaming my own lack of study, I extensively read commentaries on *Shanghan Lun*. Upon reading Yu Jiayan’s *Shanglun Pian*’s discussion on Xiao Qing Long Tang, I was overcome with joy, exclaiming, "Had I seen this famous treatise earlier, how could I have failed to use Xiao Qing Long Tang?" From then on, whenever I encountered external contraction wheezing suitable for this formula, I invariably used it. Through careful clinical observation, I learned that in external contraction phlegm-wheezing complicated by Heat, the Lungs are inevitably distended. One should follow the *Jingui Yaolue* method of adding Shigao (Gypsum Fibrosum) to Xiao Qing Long Tang, and heavily dose raw Shigao for efficacy. In the year Guisi, Li XX suffered another episode of external contraction phlegm-wheezing. His symptoms and pulse were similar to before but with more intense Heat. I prescribed Xiao Qing Long Tang without Mahuang, adding Xingren 3 qian, and because of the Heat, added 1 liang of raw Shigao. The wheezing stopped immediately after taking the medicine. However, once the drug effect subsided, the wheezing returned. This pattern repeated for two doses. At this time, Dr. Pi had passed away, and I had no one to consult. I struggled to modify the formula. His wife’s family sent a doctor from Cangzhou, and I withdrew. Several other doctors from distant places were consulted, and after a month of medication, the patient died.

I repeatedly studied this case. The syndrome was treatable, but the medication did not match the pathology, hence the lack of efficacy. Xu Lingtai said, "Longgu (Fossilia Ossis Mastodi) consolidates Zheng Qi (Upright Qi) but does not consolidate Pathogenic Qi." Thus, in *Shanghan Lun*, Zhang Zhongjing uses Longgu even when pathogens are not fully expelled. In cases of external contraction wheezing that recur after healing with Xiao Qing Long Tang, it is because Zheng Qi is not being consolidated. Therefore, I pre-formulated a new prescription: Longgu and Muli (Ostreae Concha), both uncalcined, 1 liang each, to consolidate Zheng Qi; Suzi (Perillae Fructus) and Qing Banxia (Prepared Pinellia), 5 qian each, to descend Qi and resolve phlegm. I named it Cong Long Tang (Following Dragon Decoction), intended for use after Xiao Qing Long Tang.

On average, the nature of Xiao Qing Long Tang is Hot. However, 80-90% of external contraction phlegm-wheezing cases involve Heat. Therefore, in my thirty-plus years of using Xiao Qing Long Tang, I have never omitted Shigao. Even if the patient shows no signs of Heat, I add 5-6 qian of raw Shigao to balance the cooling and heating properties of the formula. If the patient feels Heat or the pulse indicates Heat, I add about 1 liang or slightly more of raw Shigao. If Renshen (Ginseng Radix) is added due to a deficient pulse, even if there is no sign of Heat, I still add about 1 liang of raw Shigao to assist the body in handling the warming tonification of Renshen. If the syndrome includes irritability or severe interior/exterior Heat, I add 1.5 to 2 liang of raw Shigao to achieve efficacy. Such heavy use of Shigao not only treats external Heat but also moderates the heating nature of the other herbs in the formula. Because Shigao controls Mahuang, if the pulse is Excess-strong, I still use 1 qian of Mahuang. I cite one case to prove this.

My cousin-in-law, Chu XX, was obese and Qi-deficient, with a history of copious phlegm. A slight external contraction caused severe, unceasing wheezing, unresponsive to treatment. It took ten days for the wheezing to subside. He told me of this incident with great fear. I said, "This is easily treated; it depends on the medication. *Jingui Yaolue*’s Xiao Qing Long Tang plus Shigao is a divine formula for external contraction phlegm-wheezing. Assisted by my Cong Long Tang, the efficacy is enhanced. If wheezing recurs, take Xiao Qing Long Tang plus Shigao first. If one dose stops the wheezing, follow with one dose of Cong Long Tang to prevent recurrence. If one dose is insufficient, Xiao Qing Long Tang plus Shigao can be taken for two or three doses. If still not fully cured, follow with one dose of Cong Long Tang, which will surely cure it. If wheezing returns after stopping with Xiao Qing Long Tang plus Shigao, and further doses are ineffective, follow with one dose of Cong Long Tang, which will be effective." I copied the two formulas and gave them to him. He was delighted, as if receiving a rare treasure.

Later, when using Xiao Qing Long Tang, he feared Shigao and did not increase the dosage. Although it worked, it was not swift. Once, due to a heavier external contraction and severe wheezing, he took two doses of Xiao Qing Long Tang, adding 3 qian of raw Shigao per dose. The wheezing did not stop but worsened with irritability. I was urgently summoned. His pulse was forceful at both superficial and deep levels. I immediately added 1 liang of raw Shigao to the original formula. After decocting and taking it, the wheezing stopped instantly, and irritability resolved. He then took two doses of Cong Long Tang to conclude the treatment.

Note: Xiao Qing Long Tang focuses on expelling pathogens, while Cong Long Tang focuses on consolidating Zheng Qi. Among herbs that consolidate Zheng Qi, Longgu and Muli are used in heavy doses because they consolidate Zheng Qi without trapping Pathogenic Qi (as seen in Zhang Zhongjing’s formulas using Longgu and Muli in *Shanghan Lun*). Banxia and Niubaozi are added to resolve phlegm, Suzi to descend Qi, and Shaoyao to clear Heat and promote urination, providing an exit route for residual pathogens. Thus, after Xiao Qing Long Tang reduces the illness by 80-90%, urgently administering Cong Long Tang achieves complete recovery.

Both Cold and Warm diseases can present with phlegm-wheezing, which can be critical. Physicians attempting independent treatments often fail. Only treating with Xiao Qing Long Tang or Xiao Qing Long Tang plus Shigao yields immediate results. However, many Cold/Warm disease cases involve wheezing, varying by presence of phlegm and deficiency/excess severity, so Xiao Qing Long Tang is not always indicated. Below, I list my experienced patterns for reference in treating external contraction-induced wheezing.

(1) For rebellious Qi causing急促 wheezing, groaning, or shoulder-lifting respiration: Use Xiao Qing Long Tang, reduce Mahuang by half, add Xingren. If Heat is present, add raw Shigao.

(2) For wheezing as above, but with a weak pulse: Use Xiao Qing Long Tang, remove Mahuang, add Xingren, plus Renshen and raw Shigao. If the pulse is deficient and rapid, add Zhimu (Anemarrhenae Rhizoma).

(3) For wheezing without groaning or shoulder-lifting, characterized by difficult inhalation and easy exhalation, suffering from rebellious Qi, with a deficient, weak, or rapid pulse: Use my formulated Ziyin Qingzao Tang (Nourishing Yin and Clearing Dryness Decoction).

(4) For mild wheezing, silent breathing, with an Excess pulse but not rapid: Use original Xiao Qing Long Tang plus raw Shigao. If the pulse is rapid, reduce Mahuang by half, add raw Shigao and Zhimu.

(5) For mild wheezing, with a surging, slippery, floating pulse, thick white tongue coating, and chest烦热 (heat and irritability): Use my formulated Hanjie Tang (Dispersing Cold Decoction). Natural sweating after administration will cure the wheezing.

(6) For mild wheezing, with a slippery, Excess pulse, thick white tongue coating, or slightly yellow: Use Baihu Tang (White Tiger Decoction) with a small amount of Bohe Ye (Menthae Haplocalycis Folium).

(7) For wheezing with fever, surging, slippery, Excess pulse, white or yellow tongue coating: Use Baihu Tang plus Gualou Ren (Trichosanthis Semen).

(8) For wheezing with fever, definite Excess-Heat pulse, rapid rate, but weak upon heavy pressure: Use Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng), plus Chuanbei (Fritillariae Cirrhosae Bulbus) and Suzi. If deficiency is severe, replace Jingmi (Oryzae Fructus Glutinosus) with Shanyao (Dioscoreae Rhizoma).

(9) For wheezing with Jie Xiong (Chest Binding): Depending on severity, use one of the Xianxiong Tang/Wan formulas from *Shanghan Lun*, or my Dangxiong Tang (Scouring the Chest Decoction), to open the binding, curing the wheezing.

(10) For wheezing with irritability and chest fullness, without Jie Xiong: Use Yebiban Jia Banxia Tang (Yebiban plus Pinellia Decoction), plus Gualou Ren. During summer heat, replace Mahuang in the formula with Bohe Ye.

Regarding Mahuang Tang syndrome, mild wheezing is common. Taking the original Mahuang Tang cures it. Most practitioners know this, so I need not elaborate. However, after taking Mahuang Tang, while wheezing resolves, there is no guarantee against transmission to the Yangming stage. Adding a few qian of Zhimu to the formula ensures both wheezing and the disease are cured.

For patients with a deficient pulse, when using Xiao Qing Long Tang and Cong Long Tang, Renshen should be added, along with Tian Dong to moderate the heating nature of Renshen. However, even with Renshen and Tian Dong, there are times when this is insufficient. I once treated a man near sixty with severe phlegm-wheezing. His pulse was floating and weak, unable to withstand heavy pressure. He felt significant irritability. I prescribed Xiao Qing Long Tang without Mahuang, adding Xingren, 1 liang raw Shigao, 4 qian Yetai Shen (Wild Taihang Ginseng), and 6 qian Tian Dong, to be decocted and taken once. Fearing his weak pulse could not tolerate the medicine, I pre-purchased 3 liang of Sheng Hang Yurou (Raw Cornus Officinalis Fruit). Note: Pharmacy Yurou is often steamed with wine until black, greatly reducing its astringent property, which is unsuitable here. After taking the medicine, his breathing stabilized. Three hours later, he suddenly trembled, sweated profusely, and appeared to wheeze, but actually had no breath to speak, with severe palpitations. His pulse was like floating hemp seeds on water, indistinguishable in rate. I urgently decocted the prepared Yurou quickly and administered it. Sweating stopped, and spirit settled. I then added water, boiled thoroughly, and gave a large cup of concentrated decoction. His pulse normalized, and palpitations and wheezing ceased. Subsequently, I added 1 liang Yurou, 3 qian Yetai Shen, and 6 qian Tian Dong to Cong Long Tang, decocted and taken for two doses. Phlegm-wheezing did not recur.

Note: This case represented impending collapse of Yuan Qi, a critical situation. Heavy use of Shan Yurou (Cornus Officinalis Fruit) works instantly because the Liver governs dispersion and excretion. In impending Qi collapse, excessive Liver dispersion is often the cause. Heavy Yurou收敛 (consolidates/astringes), stopping the dispersion mechanism, thus preserving Yuan Qi. This conclusion comes from clinical practice, revealing that Shan Yurou’s power to rescue collapse is ten times that of Renshen and Fuzi. Having used it repeatedly to save lives in critical moments, I named it Huisheng Shanzhuyu Tang (Life-Returning Dogwood Decoction).

For patients with chronic Lung disease and frequent hemoptysis (coughing blood), modifications are needed when using Xiao Qing Long Tang. Remove Guizhi, retain Mahuang. In addition to adding Xingren and Shigao, add a few qian of Tian Dong. Hemoptysis and epistaxis most strictly contraindicate Guizhi, as it aggravates Heat in the Blood level, but Mahuang is less contraindicated. I recall in the year Guimao, my maternal aunt Liu, over fifty, caught Wind-Cold in early spring. I prescribed a formula containing Guizhi. One sweat cured her. Finding the formula effective, she pasted it on the wall for future use. In late spring, she contracted Wind-Warmth and self-medicated with that same formula. She subsequently vomited blood. Treatment with blood-cooling and stomach-descending herbs cured her after several doses.