（消金燥湿） 陈皮（盐水炒，理气） 水红花子（饮停腹痛） 白蛳螺壳（痰停脘痛） 白蜜（润燥调服） 姜汁（豁
痰冲服）
又 烟体阴虚，兼夹痰饮。干咳无痰，脘痛微闷。前方咸降，
兼以温润。咳虽稍缓，痰仍内蕴。唇燥舌腻，原方加味。
苁蓉 枸杞子 旋复花 半夏 茯苓 陈皮 白蛳螺壳 海参（漂淡去砂） 姜汁（冲入） 地栗汁（冲入）
渊按∶海参入煎剂，乃叶氏之作俑也。脘痛胸闷，明系痰饮，体虽阴虚，仍不相宜。
陈 宗台先生认此症为痰饮，卓识超群，曷胜佩服。窃思痰饮久踞，中土必受其戕，而脏气互伤，
穷究必归于肾。肾为五脏之根，土为万物之本。脾土弱则清阳失旷，而气化无权；肾水亏
则真阳失藏，而源泉消涸。夫以痰饮之病，久卧不起于床，加以寒热神疲，其为水土俱败明矣。节届春分，
木旺阳升之候。木旺则土益弱，阳升则水益亏。清明节后百花齐放，将奈之何？为今之计，崇脾上而转旋清
阳，以治其中；补肾水而蛰藏真阳，以治其下。守过清明，若得病情安稳，有减无增，或者其克济乎！
苓桂术甘合二陈，上午煎服。金匮肾气丸三钱，暮服。
胡 寒饮伏留于胃脘，清阳失旷于心胸。脘中微痛，腰背牵掣觉酸，时吐清水，与苓桂术甘汤清胸中
之阳气，理中汤理脾中之阳气，阳气复则胃脘之寒饮自化矣。
照二方加陈皮、砂仁、半夏。
又 前方通胸中脾中之阳，此方兼通肾中之阳。阳气得通，三焦气机自畅，胃中寒饮自化矣。
照前方加清和丸。
萧 腹满，口舌干燥。仲景云∶肠间必有水气。渴欲饮水，水入即吐，名曰水逆。食已即吐，名曰格
塞。今兼此三者，是寒饮水气伏留于肠胃也。病已四五年，非一日可去。即宗仲景法汇集而加减之。
防己 赤苓 川椒目 泽泻 川连 大腹皮 桂木 焦白术 干姜 猪苓 半夏 白蔻仁
孙 水停心下则悸，气郁胸中则痛，痛甚则痞塞而吐白沫，得食则宽。此中虚夹痰饮为患也。
六君子汤加川朴、干姜、桂木、沉香。
杨 心胸觉冷，经事数月一来，食入则腹中胀痛，寒痰气郁凝滞不通。当以辛温宣畅，遵熟料五积意。
半夏 桂枝 茯苓 苍术 白芍 川芎 川朴 当归身 丹参 炙甘草 陈皮 枳壳 高良姜
又 苦辛温通之剂，而能调经散痞，用之而效，益信古人言不妄发，法不虚立，在用者何如耳。
前方去良姜，加茺蔚子、砂仁。
胡 阳微浊聚于胃，寒饮窃踞中宫。脘痛连胁，腹鸣漉漉。法当转运中阳，以却寒饮。
旋复花 干姜 半夏 茯苓 泽泻 陈皮 水红花子 白蛳螺壳 生姜
又 脘胁之痛虽除，脾胃之气大惫。面浮足肿，土衰水泛，脉细少神，虑其腹满。急宜温补中阳以消
水湿，又当自知节爱为上。
六君子汤去草，加炮姜、熟附子、神曲。另金匮肾气丸朝暮各服一钱五分。
某 肾中之元阳不足，胆中之火用不宣。痰饮伏留于心下，
故心胸如盆大一块，常觉板痛，背亦常寒。三四年来每交子后则
气喘，乃阳气当至而不至，痰饮阻遏，阳微阴胜故也。天明则阳气张，故喘平。至心悸咳嗽，易于惊恐，
属阴邪窃踞胸中为病。其常若伤风之状者，卫外之阳亦虚也。图治之法，当祛寒饮而逐
阴邪，斡旋阳气，如离照当空，阴邪尽扫。用仲景苓桂术甘汤，先通其胸中之阳气，再议。
茯苓（细辛一分，煎汁炒） 冬术（附子二分，炒） 党参（姜汁炒） 甘草（麻黄一
分炒） 桂木 半夏 干姜（五味子五粒，炒） 补故纸（青盐炒） 紫石英 陈皮 胡桃肉 白蛳螺壳（洗）
贾 病已两月，先呕而后咳，多吐清涎，口不渴，心胸痛而痞闷，此痰饮停于心下也。虽微有寒
热，并非外感风邪。当从胸痹痰饮门中求之。
半夏 茯苓 栝蒌皮 橘红 杏仁 生姜
渊按∶仲景治胸痹用蒌皮须同薤白，治痰饮须同桂枝，否则不效。盖胸脘之阳不化，饮痹皆不去耳。
施 背筋常冷，胸腹有块，时吐酸水。此寒痰阻于胃而太阳之气不宣，温之通之。
苏梗 桂枝 陈皮 茯苓 半夏 制附子 川椒 老生姜
仁渊曰∶《内经》无痰饮证，并无痰字。痰饮之病，始于仲景，详于《金匮》。其论痰饮有四，曰
痰饮，悬饮，支饮，溢饮。《千金》有五饮丸，治留饮，痰饮，溢饮，流饮， 饮。明·李
时珍即《金匮》四饮加伏饮为五饮。古人以胸胃肠间有水饮内积，即名曰饮。不必尽有咳嗽也。今人以
咳嗽气逆，倚息不得卧，名之曰痰饮，乃《金匮》之支饮也。其余或已更名，如脘痛
吐酸，即古之悬饮也。饮水不化，不得汗出，身体疼重浮肿，古之溢饮也。去古渐远，其名遂更。夫五饮
之生，总由肺脾阳虚，致水饮入胃不能布化通调，停蓄胃肠之间，遂生种种病情。射肺
则咳，凌心则悸，犯肝则胁痛眩冒，入肾则喘逆，侮脾则胀满痞闷，皆中上阳气不能布化之过也。然肺脾
之阳虽虚，肾中之阳尚旺，其病犹可支持，故痰饮病有积延岁月而不死者。如此篇亦以
咳嗽气逆为痰饮，然即以咳嗽气逆而论，其因多端，未必尽属痰饮也。大抵痰饮咳嗽，其痰多沫，其气多逆，
其脉多弦、多滑，其心多悸荡，其头多眩冒，其表畏寒，冬发夏愈，其口不渴，其
舌苔多白，此痰饮咳嗽之状也。治法，《金匮》要言不繁曰∶须以温药和之。盖无论何饮，化其中上焦之
阳气为先，而肾气丸一方，即开后人内饮治肾之门。故后人有外饮治肺脾，内饮治肝肾
之说。盖饮邪久延，穷而伤肾，肾阳虚而肾气上奔，非温纳补摄不效。后贤之人参蛤蚧，黑锡丹，天真丸等，
都从肾气丸得来，为温纳肾气之法。若得病之由，或冒冷雨，或卧而受凉，或过饮伤其肺脾，非一端耳。
(Xiao Jin Zao Shi - Dissolving Metal and Drying Dampness): Chen Pi (Tangerine Peel, processed with salt water to regulate Qi), Shui Hong Hua Zi (Buckwheat Vine Seed, for abdominal pain caused by fluid retention), Bai Si Luo Ke (White Snail Shell, for epigastric pain caused by phlegm retention), Bai Mi (White Honey, for moistening dryness and taken as a vehicle), Jiang Zhi (Ginger Juice, for resolving phlegm and taken by mixing).
Again: The patient has Yin deficiency constitution complicated by Phlegm-Fluids. Manifestations include dry cough without sputum, epigastric pain with slight fullness/stuffiness. The previous prescription used salty descending herbs combined with moistening and warming methods. Although the cough has slightly eased, Phlegm-Fluids remain retained internally. Signs include dry lips and greasy tongue coating; modifications are added to the original formula.
Cong Rong (Cistanche Herba), Gou Qi Zi (Lycium Fruit), Xuan Fu Hua (Inula Flower), Ban Xia (Pinellia Rhizoma), Fu Ling (Poria), Chen Pi (Tangerine Peel), Bai Si Luo Ke (White Snail Shell), Hai Shen (Sea Cucumber), Jiang Zhi (Ginger Juice, mixed in), Di Li Zhi (Dioscorea Hypoglauca Juice/Bamboo Pith Juice, mixed in).
Yu'an [Commentary]: The use of Sea Cucumber in decoctions was pioneered by Ye Tianshi. Epigastric pain and chest stuffiness clearly indicate Phlegm-Fluid pathology. Although the patient has Yin deficiency, the use of Sea Cucumber is still inappropriate.
Mr. Chen Zongtai's identification of this condition as Phlegm-Fluid demonstrates outstanding insight, which I deeply admire. I privately reflect that long-standing Phlegm-Fluid will inevitably damage the Middle Earth (Spleen/Stomach), leading to mutual injury among Zang organs. Ultimately, the root must be traced to the Kidney. The Kidney is the root of the five Zang organs, and Spleen Earth is the foundation of all things. When Spleen Earth is weak, Clear Yang fails to ascend, and Qi transformation loses its power; when Kidney Water is deficient, True Yang fails to store, and the source of life dries up. In such cases of Phlegm-Fluid disease, where the patient cannot rise from bed for a long time, accompanied by alternating chills and fever and mental fatigue, it is evident that both Earth and Water (Spleen and Kidney) are failing. Approaching the Spring Equinox, a period when Wood energy is vigorous and Yang rises. Vigorous Wood further weakens Earth, and rising Yang further depletes Water. After the Qingming Festival, when flowers bloom, what shall we do? The current strategy is: Strengthen the Spleen to rotate Clear Yang and treat the Middle; Nourish Kidney Water to store True Yang and treat the Lower. If one can pass the Qingming Festival, and if the condition stabilizes with reduction rather than increase, perhaps recovery is possible!
Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) combined with Er Chen Tang (Two-Aged Decoction), taken in the morning. Jin Kui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), 3 qian, taken in the evening.
Hu: Cold Fluids are latent and retained in the epigastrium, causing Clear Yang to fail to spread in the chest and heart region. There is mild epigastric pain, pulling soreness in the lower back and back, and frequent vomiting of clear watery saliva. Prescribe Ling Gui Zhu Gan Tang to clear Yang in the chest, and Li Zhong Tang (Regulate the Middle Decoction) to regulate Yang in the Spleen. Once Yang recovers, the cold fluids in the epigastrium will naturally transform.
To the above formula, add Chen Pi (Tangerine Peel), Sha Ren (Amomum Fruit), and Ban Xia (Pinellia Rhizoma).
Again: The previous formula unblocked Yang in the chest and Spleen; this formula additionally unblocks Yang in the Kidney. Once Yang is unblocked, the Qi mechanism of the San Jiao (Triple Burner) becomes smooth, and the cold fluids in the Stomach naturally transform.
To the previous formula, add Qing He Wan (Clear and Harmonizing Pill).
Xiao: Abdominal fullness, dry mouth and tongue. Zhang Zhongjing stated: "There must be water qi between the intestines." Thirst desire to drink water, but vomiting immediately after swallowing, named "Water Reversal" (Shui Ni). Vomiting immediately after eating, named "Ge Sai" (Obstruction/Rejection). Now presenting with all three, this indicates Cold Fluid and Water Qi are latent and retained in the intestines and stomach. The illness has persisted for four or five years and cannot be cured in a day. Following Zhang Zhongjing's method, I will combine and modify prescriptions.
Fang Ji (Stephania Root), Chi Ling (Red Poria), Chuan Jiao Mu (Zanthoxylum Seed), Ze Xie (Alisma Rhizome), Chuan Lian (Coptis Rhizoma), Da Fu Pi (Areca Peel), Gui Mu (Cinnamon Bark), Jiao Bai Zhu (Charred Atractylodes Macrocephala), Gan Jiang (Dried Ginger), Zhu Ling (Polyporus), Ban Xia (Pinellia Rhizoma), Bai Kou Ren (White Cardamom Seed).
Sun: Water stopping under the Heart causes palpitations; Qi stagnation in the chest causes pain. Severe pain leads to obstruction and vomiting of white foam, relieved by eating. This is suffering from deficiency in the Middle complicated by Phlegm-Fluids.
Liu Jun Zi Tang (Six Gentlemen Decoction) added with Chuan Pu (Magnolia Bark), Gan Jiang (Dried Ginger), Gui Mu (Cinnamon Bark), and Chen Xiang (Aquilaria Wood).
Yang: Cold sensation in the chest and heart; menstruation occurs only once every few months; abdominal distension and pain after eating; Cold Phlegm and Qi stagnation are condensed and obstructed. Treatment should employ acrid-warm dispersing and smoothing methods, following the intent of Shu Liao Wu Ji San (Cooked Five Accumulations Powder).
Ban Xia (Pinellia Rhizoma), Gui Zhi (Cinnamon Twig), Fu Ling (Poria), Cang Zhu (Atractylodes Lancea), Bai Shao (White Peony Root), Chuan Xiong (Ligusticum Rhizome), Chuan Pu (Magnolia Bark), Dang Gui Shen (Angelica Sinensis Root Body), Dan Shen (Salvia Miltiorrhiza Root), Zhi Gan Cao (Honey-fried Licorice Root), Chen Pi (Tangerine Peel), Zhi Ke (Aurantium Fruit), Gao Liang Jiang (Galangal Rhizome).
Again: The bitter-acrid-warm unblocking agent successfully regulated menstruation and dispersed obstruction. Its efficacy confirms that ancient words were not spoken lightly and methods were not established in vain; it depends on how practitioners apply them.
Remove Gao Liang Jiang from the previous formula, add Chong Wei Zi (Leonurus Fruit) and Sha Ren (Amomum Fruit).
Hu: Yang is weak, turbid Qi gathers in the Stomach, Cold Fluids occupy the Middle Palace. Epigastric pain radiates to the hypochondrium, borborygmus is audible in the abdomen. The method should be to transport Middle Yang to dispel Cold Fluids.
Xuan Fu Hua (Inula Flower), Gan Jiang (Dried Ginger), Ban Xia (Pinellia Rhizoma), Fu Ling (Poria), Ze Xie (Alisma Rhizome), Chen Pi (Tangerine Peel), Shui Hong Hua Zi (Buckwheat Vine Seed), Bai Si Luo Ke (White Snail Shell), Sheng Jiang (Fresh Ginger).
Again: Although the epigastric and hypochondriac pain has been removed, the Qi of the Spleen and Stomach is severely exhausted. Facial edema and foot swelling indicate Earth failure and Water flooding. The pulse is thin and lacks spirit; fear of abdominal fullness arises. Urgently warm and tonify Middle Yang to eliminate water-dampness. Self-restraint and care are paramount.
Liu Jun Zi Tang (Six Gentlemen Decoction) without Gan Cao (Licorice), added with Pao Jiang (Roasted Ginger), Shu Fu Zi (Prepared Aconite), and Shen Qu (Medicated Leaven). Additionally, take Jin Kui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet), 1.5 qian morning and evening.
Certain Patient: Yuan Yang (Original Yang) in the Kidney is insufficient; Fire Use (Ministerial Fire) in the Gallbladder is not disseminated. Phlegm-Fluids are latent under the Heart, so the chest feels like a large hard mass, often experiencing board-like pain, and the back is frequently cold. For the past three to four years, asthma/wheezing occurs after midnight. This is because Yang Qi should arrive but does not; Phlegm-Fluids obstruct, Yang is weak and Yin prevails. At dawn, Yang Qi expands, so wheezing subsides. Palpitations, cough, and susceptibility to fright belong to Yin Evil occupying the chest. The symptoms resembling wind-cold indicate that Defensive Yang is also deficient. The treatment strategy should dispel Cold Fluids and drive out Yin Evil, maneuver Yang Qi, like the sun shining brightly, sweeping away all Yin Evil. Use Zhang Zhongjing's Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) first to unblock Yang in the chest, then discuss further.
Fu Ling (Poria, fried with Xi Xin (Asarum) 1 fen decoction), Dong Zhu (Winter Atractylodes/Bai Zhu, fried with Fu Zi (Aconite) 2 fen), Dang Shen (Codonopsis Radix, fried with Ginger Juice), Gan Cao (Licorice Root, fried with Ma Huang (Ephedra) 1 fen), Gui Mu (Cinnamon Bark), Ban Xia (Pinellia Rhizoma), Gan Jiang (Dried Ginger, fried with Wu Wei Zi (Schisandra) 5 grains), Bu Gu Zhi (Psoralea Fructus, fried with Green Salt), Zi Shi Ying (Fluorite), Chen Pi (Tangerine Peel), Hu Tao Rou (Walnut Kernel), Bai Si Luo Ke (White Snail Shell, washed).
Jia: Ill for two months, first vomiting then coughing, frequent expectoration of clear saliva, no thirst, chest pain and oppression. This is Phlegm-Fluids stopping under the Heart. Although there is slight chills and fever, it is not external Wind-Evil. Seek treatment within the Chest Bi and Phlegm-Fluid categories.
Ban Xia (Pinellia Rhizoma), Fu Ling (Poria), Gua Lou Pi (Trichosanthes Peel), Ju Hong (Tangerine Red Peel), Xing Ren (Apricot Seed), Sheng Jiang (Fresh Ginger).
Yu'an [Commentary]: Zhang Zhongjing uses Gua Lou Pi (Trichosanthes Peel) for Chest Bi only with Xie Bai (Allium Macrostemon Bulb); for Phlegm-Fluids, only with Gui Zhi (Cinnamon Twig). Otherwise, it is ineffective. Because if Yang in the chest and epigastrium does not transform, Fluid-Bi will not be removed.
Shi: Back tendons are constantly cold, lumps in chest and abdomen, frequent vomiting of sour water. This is Cold Phlegm blocking the Stomach and Tai Yang Qi not disseminating. Warm and unblock.
Su Geng (Perilla Stem), Gui Zhi (Cinnamon Twig), Chen Pi (Tangerine Peel), Fu Ling (Poria), Ban Xia (Pinellia Rhizoma), Zhi Fu Zi (Prepared Aconite), Chuan Jiao (Sichuan Pepper), Lao Sheng Jiang (Old Fresh Ginger).
Ren Yuan said: The *Nei Jing* (Inner Canon) has no mention of Phlegm-Fluid syndromes or the character "Phlegm". Phlegm-Fluid disease began with Zhang Zhongjing and was detailed in the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet). His discussion on Phlegm-Fluids includes four types: Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Zhi Yin (Supporting Fluid), and Yi Yin (Overflowing Fluid). *Qian Jin Fang* (Thousand Gold Formulas) has Wu Yin Wan (Five Fluids Pill) treating Liu Yin (Retained Fluid), Tan Yin, Yi Yin, Liu Yin (Flowing Fluid), and Fu Yin (Latent Fluid). Ming Dynasty Li Shizhen added Fu Yin (Latent Fluid) to the four types in *Jin Gui* to make five fluids. Ancients named internal accumulation of water-fluids in the chest, stomach, and intestines as "Yin" (Fluid). It does not necessarily involve coughing. Modern people name coughing, air reversal, inability to lie flat as Phlegm-Fluid, which corresponds to Zhi Yin (Supporting Fluid) in *Jin Gui*. Others have renamed conditions: e.g., epigastric pain and sour vomiting correspond to ancient Xuan Yin (Hanging Fluid); inability to transform water intake, lack of sweating, body ache, heaviness, and edema correspond to ancient Yi Yin (Overflowing Fluid). As times move further from antiquity, names change. The origin of the five fluids generally stems from Lung and Spleen Yang deficiency, causing ingested water-fluids to fail to distribute and regulate, accumulating between the stomach and intestines, thus generating various symptoms. Invading the Lung causes cough; overwhelming the Heart causes palpitations; attacking the Liver causes hypochondriac pain and vertigo; entering the Kidney causes wheezing/reversal; insulting the Spleen causes fullness and oppression. All are due to the failure of Upper and Middle Yang to distribute. However, although Lung and Spleen Yang are deficient, if Kidney Yang remains robust, the condition can be sustained; thus, Phlegm-Fluid diseases can persist for years without death. This section also treats cough and air reversal as Phlegm-Fluid. However, regarding cough and air reversal, causes are manifold and not exclusively Phlegm-Fluid. Generally, Phlegm-Fluid cough features foamy sputum, rebellious Qi, wiry or slippery pulses, palpitations, vertigo, aversion to cold on the exterior, winter exacerbation/summer remission, no thirst, and white tongue coating. These are characteristics of Phlegm-Fluid cough. Treatment method, *Jin Gui* succinctly states: "Must harmonize with warm medicines." Regardless of the type of Fluid, transforming Yang in the Middle and Upper Jiao is primary. The Shen Qi Wan (Kidney Qi Pill) opened the door for later generations to treat internal Fluids via the Kidney. Hence, later practitioners proposed "External Fluids treated via Lung/Spleen, Internal Fluids treated via Liver/Kidney." Since Fluid pathogens linger long, eventually damaging the Kidney, Kidney Yang deficiency leads to rushing Kidney Qi. Without warm-nourishing and astringent methods, efficacy is unlikely. Later experts' Ren Shen Ge Jie San (Ginseng and Gecko Powder), Hei Xi Dan (Black Tin Pill), Tian Zhen Wan (Heavenly Truth Pill), etc., all derive from Shen Qi Wan, representing methods of warming and securing Kidney Qi. Etiology may include exposure to cold rain, sleeping while chilled, or excessive drinking damaging Lung and Spleen—reasons are not singular.