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Zhang Zhongjing said: In cases where the exterior syndrome of Shanghan (Cold Damage) is not resolved, and there is fluid retention in the epigastrium, presenting with dry retching, fever, and cough, or alternatively thirst, diarrhea, a sensation of obstruction in the throat, scanty urination with fullness in the lower abdomen, or wheezing, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is the primary treatment. (Fever, aversion to cold, headache, and body ache belong to the Taiyang exterior syndrome. In Zhang Zhongjing's writings, conditions accompanied by exterior syndromes are summarized by the phrase "exterior not resolved." Internal fluid retention causes water and cold to contend; when water stays in the stomach, it causes dry retching and throat obstruction; when water qi shoots into the lungs, it causes cough and wheezing. Fluid stagnation prevents Qi transformation and the generation of body fluids, causing thirst. Water soaking into the intestines causes diarrhea. Water accumulating in the Lower Jiao causes scanty urination and lower abdominal fullness.) He also said: In Shanghan with fluid retention in the epigastrium, presenting with cough and slight wheezing, fever but no thirst. After taking the decoction, if the patient becomes thirsty, this indicates the cold pathogen is resolving; Xiao Qing Long Tang should still be used. (Yu Jiayan stated: Wind-cold carrying fluid retention reverses upward, preventing body fluids from descending, hence no thirst. Thirst indicates the reversal has stopped, signaling that cold is departing and resolution is imminent. Using Xiao Qing Long Tang here serves as a mild agent to assist this trend toward resolution.)

Ephedrae Herba (Mahuang, 麻黄) [devoid of joints], Cinnamomi Ramulus (Guizhi, 桂枝), Paeoniae Radix Alba (Shaoyao, 芍药) [stir-fried with wine], Asari Radix et Rhizoma (Xixin, 细辛), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [roasted], Zingiberis Rhizoma (Ganjiang, 干姜) [3 liang], Pinelliae Rhizoma (Banxia, 半夏), Schisandrae Fructus (Wuweizi, 五味子) [0.5 sheng]. [Note: The original text fragment is incomplete regarding dosage and preparation instructions, typically involving boiling in water.]

Zhou Yuzai said: Individuals who habitually have phlegm-fluids, upon contracting external pathogens, suffer damage to the skin and hair pores, obstructing Lung Qi. The fluid retention stops in the epigastrium, disrupting the smooth flow of Qi above and below, leading to wheezing.

When sweating therapy is indicated, Da Qing Long Tang (Major Blue Dragon Decoction) is the primary treatment, and Xiao Qing Long Tang may also be used. Xu Zhongke annotated: In Yi Yin (Overflowing Drink), water flows into the limbs. Due to lack of sweating, the body feels painful and heavy. This is because the exterior is invaded by cold pathogen causing pain, and the muscles retain dampness causing heaviness. It is entirely an exterior condition, yet water and cold are separated. Similar to wind-cold affecting both layers with internal fluid retention, both Da Qing Long Tang and Xiao Qing Long Tang are used. However, Da Qing Long Tang combines Guizhi Tang and Mahuang Tang, removing Shaoyao and adding Shigypsum (Shi Gao, 石膏), suitable for cases with mild fluid retention and accompanying heat. If coughing is frequent and cold is latent, Xiao Qing Long Tang is appropriate. This formula removes Xingren (Apricot Seed) from Mahuang Tang and Shengjiang (Fresh Ginger) from Guizhi Tang, adding Wuweizi, Ganjiang, Banxia, and Xixin. Although it disperses the exterior, its true intent is to drain the cold-fluid downward. Regarding Zhang Zhongjing's discussion on Taiyang Zhongshu (Summerheat), stating fever, pain, heaviness, and weak pulse caused by cold water injury in summer, treated with Yi Wu Gua Di Tang (Single Melon Pedicel Decoction): although sweating is mentioned due to severe aversion to cold, here only the two Dragon decoctions are prioritized for releasing the exterior. Is it not because Yi Yin originates differently from Zhongshu, and the pores are slightly more consolidated than in summer? In summer, pores are naturally loose, and Zhongshu occurs first, so emesis is preferred. Thus, in summer, if one presents with this syndrome without fever and without Zhongshu, using these two decoctions is evident. The Jin Gui Yao Lue states: Thirst followed by vomiting indicates fluid retention in the epigastrium, treated with Xiao Qing Long Tang. By treating the fluid rather than the thirst directly, once the fluid is removed, the thirst ceases. It also states: Coughing, reverse Qi, inability to lie flat, treated with Xiao Qing Long Tang. Xu Zhongke annotated: This is the definitive presentation of Zhi Yin (Pillar Drink). Shi Zao Tang (Ten Date Decoction) is not used, but Xiao Qing Long Tang is, likely due to the presence of an exterior syndrome. However, this applies when the disease manifests before becoming critical and prevents lying down, indicating urgent severity; thus, temporarily using Guizhi to treat the exterior and Ganjiang/Banxia to treat the fluid is necessary.

Adding Shigypsum (Shi Gao, 石膏) creates Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Decoction plus Shigypsum). (From Jin Gui Yao Lue) Treating Fei Zhang (Lung Distension) with cough and rebellious Qi, irritability, wheezing, floating pulse, and fluid retention in the epigastrium. (Note: This clause parallels previous logic; adding Shigypsum clears constrained heat, assisting the action of Xiao Qing Long Tang.)