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(leading to palpitations and restlessness.) Mild cases present with shortness of breath. A double-wiry pulse indicates cold, often occurring after severe purging has led to interior deficiency. A single-sided wiry pulse indicates fluid retention; if thirst precedes vomiting, (meaning the original pulse was wiry on one side; if severe purging leads to interior deficiency, deficiency and cold interact, changing the pulse to double-wiry. Qi is obstructed by water fluids, unable to transform into body fluids, hence thirst.) Xiao Banxia Fuling Tang (Minor Pinellia and Poria Decoction) is indicated for this category of "fluid patients" (those who habitually consume excessive fluids). It is also stated: Patients prone to vomiting should naturally feel thirsty, ("Vomiting patients" refers to those vomiting not due to retained water, but from other diseases. Vomiting damages body fluids, so thirst is expected.) If they feel thirsty, it indicates the disease is about to resolve. (The pathogen exits via vomiting, so even with thirst, it signifies resolution). Now, if there is no thirst, it is because there is Zhi Yin (Branching Fluid Retention) in the epigastrium. (This is a method of syndrome differentiation: when sudden vomiting occurs, one must distinguish whether it is vomiting from another disease or from Liu Yin (Stagnant Fluid). Thirst indicates vomiting from another disease; lack of thirst indicates vomiting from stagnant fluid. Before vomiting, stagnant fluid patients may also be thirsty, but after vomiting, they are no longer thirsty because some water has been expelled, Qi flows slightly better, and it can distribute and generate body fluids.) Xiao Banxia Tang (Minor Pinellia Decoction) is indicated. It is also stated: Epigastric fullness and stuffiness, use Banxia Jia Fuling Tang (Pinellia Decoction with Added Poria). Sub-umbilical palpitation, (If water stops in the epigastrium, there is epigastric palpitation and stuffiness. If it stops below the umbilicus, there is sub-umbilical palpitation.) Spitting saliva and foam, (From this, we know the vomiting mentioned earlier referred to spitting saliva and foam.) Dizziness, (Water evil forces Fire to float upward.) Wuling San (Five-Ingredient Powder with Poria) is indicated (see Shang Shi chapter). It is also stated: Shortness of breath with mild Yin (Fluid), (When water stops in the epigastrium, severe cases present with palpitations, mild cases with shortness of breath.) The treatment should promote urination to eliminate it. Guiling Zhugan Tang (Cinnamon Twig, Poria, Atractylodes Macrocephala, and Licorice Decoction) or Shenqi Wan (Kidney Qi Pill), which is the same as Bawei Wan (Eight-Ingredient Pill), are indicated.
(The *Yizong Jinjian* states: Exhalation is Yang, governed by the Heart and Lung; inhalation is Yin, governed by the Liver and Kidney. If exhalation is short of breath, it means the Yang of the Heart and Lung is obstructed by water; use Linggui Zhugan Tang to tonify upper Qi to move water. If inhalation is short of breath, it means the Yin of the Liver and Kidney is obstructed by water; use Shenqi Wan to warm Yang to move water. Note: Exhaled air rises from below, thus belonging to the Heart and Lung. Shortness of breath during exhalation means water in the Upper Jiao obstructs respiratory Qi, causing panting. Here, exhalation is used to encompass inhalation, not just exhalation alone. Inhalation is similar; do not view this rigidly.)
It is also stated: A floating, fine, and slippery pulse indicates injury by drinking fluids (a sign of early-stage disease not yet deep). A sinking pulse indicates Liu Yin (Stagnant Fluid). (*Jing* states: Sinking indicates submerged water accumulation. This is correct. It is a sign of deep-seated disease). If the patient's pulse is Fu (Hidden/Deep), (Fu is extremely deep/sinking). The person desires spontaneous diarrhea, (Water wants to exit; if not vomited out from above, it moves downward causing diarrhea.) This indicates that Liu Yin is about to exit. Although there is diarrhea, the epigastrium remains hard and full, (indicating Fu Yin (Trapped Fluid) is knotted and cannot be expelled.) Gansui Banxia Tang (Kansui and Pinellia Decoction) is indicated. (Gansui and Gancao are used together to stimulate expulsion. Since diarrhea has already occurred, Shaoyao is added to astringe, preventing loss of Yin). It is also stated: Water in the Liver causes distending fullness under the hypochondrium, pain upon sneezing. (Qi movement causes water movement, leading to impact pain.) Water in the Kidney causes epigastric palpitation. (Here, "Heart" should be understood as "Umbilicus"). It is also stated: Zhi Yin (Branching Fluid) causes abdominal fullness, (Original text says chest fullness, corrected to abdominal fullness per *Yizong Jinjian*). Nongpu Dahuang Tang (Magnolia Bark and Rhubarb Decoction) is indicated.
It is also stated: Abdominal fullness, dry mouth and tongue, water qi in the intestines (i.e., gurgling sound). Jifeng Lihuang Wan (Stephania, Lepidium, Rhubarb, and Descurainia Pill) is indicated. (Fangji and Juemu guide fluid out via urine; Dahuang and Tingli push fluid out via feces, eliminating from both front and back).
It is also stated: A sinking and wiry pulse indicates Xuan Yin (Hanging Fluid) with internal pain. Shizao Tang (Ten Jujube Decoction) is indicated (see Zhang Zhong chapter). It is also stated: Yi Yin (Overflowing Fluid) should be treated by inducing sweating. Da Qing Long Tang and Xiao Qing Long Tang are indicated. It is also stated: Fei Yin (Lung Fluid) presents with a non-wiry pulse, only suffering from panting and shortness of breath, inability to lie flat. (Fei Yin is equivalent to Zhi Yin). Tingli Dazao Tang (Descurainia and Jujube Decoction) is indicated (see Chuan Xiao chapter). It is also stated: Zhi Yin in the Diaphragm causes panting, epigastric stuffiness, hardness, and fullness. (Knotted firmly from chest to diaphragm). Dark complexion, (Color of deeply knotted water evil). Sinking-tight pulse. After dozens of days, if medical treatment with emetics and purgatives fails, (indicating knotting is severe). Mufangji Tang (Stephania Tetrandra Decoction) is the primary formula (See Chuan Xiao chapter). (Ginseng is used in the formula because Zheng Qi (Upright Qi) was damaged by emesis and purgation). Those with Xu (Deficiency) will recover immediately, (Recovering due to Ginseng tonification). Those with Shi (Excess) will relapse after three days; repeat administration. If still ineffective, remove Shigao (dislike its cold nature), add Mangxiao (to open knots), and Fuling (to drain downward). It is also stated: A wiry-numerous pulse indicates Han Yin (Cold Fluid). (External cold with internal constrained heat causes a wiry-numerous pulse). Difficult to treat in winter and summer. (In winter, using hot herbs hinders internal heat; in summer, using cold herbs hinders external cold. However, one need not be rigid about this). It is also stated: Chronic cough lasting years, (As detailed below, this is Zhi Yin infiltrating the Lung causing cough). A weak pulse is treatable, (Chronic disease should present with a weak pulse). A large-numerous pulse indicates death; a deficient pulse causes severe dizziness/giddiness. This is because the person originally had Zhi Yin in the Chest. (Qi deficiency with fluid retention prevents Clear Yang from ascending, causing dizziness as if covered by something, which is the meaning of "Head feels wrapped" in Shang Shi). Treatment belongs to the category of Fluid Patients. (Meaning it should not be treated according to the methods for Cough syndromes. Note: The Tings Yin syndromes described in *Jinkui Yaolue* should be cross-referenced with the Edema chapter).
Zhang Zihe stated: Fluid should be removed; warming and tonifying will worsen it. Because Cold Fluid is in the Middle Jiao, administering hot medicines from above is rejected by the Cold. Water-dampness is not removed, but Heart Fire increases. Since Fire does not descend, Water flows downward instead. The Upper Jiao becomes dry, and the Lower Jiao becomes cold and shivering. One should follow the *Neijing* principle: "Those that remain, attack them." Using formulas like Shizao (see Zhang Zhong chapter) or Shenyu (see Zhang Zhong chapter) is appropriate. Subsequently, use bland agents to flow away residual pathogens, and use fire-draining agents to open the stomach appetite, leading to natural recovery.