（附痰饮）
【脉】 寸口脉浮大，按之反涩，尺中亦微而涩，故有食痰。寸口脉紧如转索，
左右无常者
，有宿食。脉滑而数者，实也，有宿食，当下之。脉浮而滑者，宿食；下利不欲食者，宿食
。脉沉，病若伤寒者，宿食、留饮，宜下之。脉短疾而滑者，酒病。脉浮细而滑者，伤饮。
【因】 饮食自倍，肠胃乃伤。复加之，则胃化迟难，故宿食、留饮。饮，水
也，无形之气也。因而大饮则气逆，形寒饮冷则伤肺。病则为咳满水泄，重而为蓄积。食者
，物也，有形之血也。因而食饱，筋脉横解，肠 为重，或呕或吐或下利。
【证治】 《千金》云，胃中有癖，食冷物则痛不能食，有热物则欲食。大腹有
宿食，即寒凛发热如疟状。小腹有宿食，当暮发热，明旦复止。
《三因》云∶有饮在中脘则嘈，有宿食则吞酸。
李论 戊己火衰，不能制物，食则不消，伤其太阴，填塞闷乱，兀兀欲吐。甚则
心胃大痛，犯其血也。治宜分寒热轻重。如初得上部有脉，下部无脉，其人当吐，不吐即死
，宜瓜蒂散。轻则内消，缩砂、炒曲等是也。
重则除下，承气汤是也。寒则温之，半夏、干姜、三棱、莪术是也。热则寒之，大黄、黄连
、积实、麦芽是也。饮则下行，或大饮而气逆，或寒冷而伤肺。病则喘咳痰涎、水肿。轻则
宜取汗、利小便，使上下分消其湿，解醒汤、五苓散、半夏、术、枳壳之类是也。重则为蓄
枳、为满者，三花、神 是也。
张论 饮食不消，分贫富而治之。富者，乃膏粱太过，以致中脘停留，胀闭痞膈
，醋心，宜
木香导饮丸主之。贫者，乃动作过劳，饮食粗，酒食伤之，以致身腹满闷，时吐酸水，宜进
食丸主之。
又有重者，病证同太阴伤寒，止脉沉，可与导饮丸治之。
又论，留饮，蓄水而已，虽有四、有五之说，止一证也。夫郁愤而不伸，则肝气乘脾之
气而
不流，亦为留饮。肝主虑，久不决，则气不行。脾主思，久则脾结，亦为留饮。因饮水，脾
胃久衰，不能布散，亦为留饮。饮酒过多，胞经不及渗泄，亦为留饮。渴饮冷水，乘快过多
，逸而不动，亦为留饮。夫水者，阴物也。但积水则生湿，停酒则满，燥久而成痰，左胁同
肥气，右胁同息贲，上入肺则嗽，下入大肠则泻，入肾则涌，在太阳为支饮，皆内气逆得之
。故湿在上者，目黄面浮；在下者，股膝肿满；在中者，支饮痞膈痰逆；在阳不去，久而滞
气；在阴不去，久而成形。宜治以导水、禹功，调以五苓、葶苈、椒目，逐水为全矣。
有伤西瓜，冷水、羊乳寒湿之物，宜白术（二钱）、川乌（五分）、防风（一钱）、丁香（一
枚）、甘草（炙，一钱。）
伤羊肉面湿热之物，宜白术、黄芩、黄连（各七钱）、大黄（二钱）、甘草（炙，五分）。如
心下痞，枳实；腹痛，白芍药（一钱）；腹胀，浓朴；胸中不利，枳壳；胸中寒，陈皮；渴者
，白茯苓；腹中窄，苍术；体肢沉重，苍术。大抵伤冷物，以巴豆为君；伤热物，以大黄为
君。
槟榔丸 治伤之轻者，饮食不化，心腹鼓胀。出刘。
槟榔（二钱） 陈皮（八钱） 牵牛头末（四钱）
醋糊丸，梧子大。姜汤送下二十丸。
雄黄丸 治伤之重，胁肋虚胀者。
雄黄（一两，另研） 巴豆（五钱，生用，去油）
丸服。法同心痛。
瓜蒂散 主吐。心腹卒痛闷乱，急以治之。
瓜蒂 赤小豆（各三钱） 细末之。每服一钱，温酒下。
枳实丸 治伤食。
枳实（半两） 白术（一两） 曲丸。木香、槟榔、青皮，此三味气滞加之；大黄、黄芩、
黄连，此三味，湿热加之；萝卜子、黄连、泽泻，伏湿痞闷加之；栀子，病后食伤加之；半
夏、豆粉，湿面油腻加之；草豆蔻、棱、莪，伤冷硬加之；干姜，伤水加之；缩砂、丁香，
心胃痛加之；人参，伤胃加之。
解酲汤 治伤酒。
白豆蔻 砂仁 生姜 葛花（各半两） 白茯苓 猪苓（去皮） 陈皮（去白） 人参 白术
（各一两半） 青皮（三钱） 神曲（炒） 泽泻（各二钱五分） 木香（五分）
上为末，白汤送下。
秘方 治胃中有物，恶食。
二陈汤，加白术、山楂、川芎、苍术、神曲（炒）。
神 丸 治留饮、悬饮，脉弦。又治脉伏，其人欲自利，难利，心下续坚满。此
为留饮欲去故也。
茯苓桂术汤 治心下有痰饮，胸胁支满，目眩。
茯苓 官桂 白术 甘草
大青龙汤 治溢饮体痛，当发其汗。
麻黄（七钱） 官桂 甘草（各二钱五分） 石膏（鸡子大） 杏仁 半夏（湿加）
泽泻汤 治心下有支饮，其人苦冒眩。支饮不得息，加葶苈、枣。
朴黄汤 治支饮胸痛。
大黄 浓朴（各等分）。
二陈汤、小半夏汤 治呕家本渴，今反不渴，心下有支饮故也。治先渴却呕，水
停心下，此属饮，加茯苓。
五苓散 治瘦人，脐下有悸者，吐涎沫而颠眩，水也。亦治停痰宿水。
破饮丸 治五饮结为痈瘕，支饮胸满吐逆，心内隐痛。大能散气。
荜茇 胡椒 丁香 缩砂 青皮 乌梅 木香 蝎梢 巴豆（去油）
以青皮同巴豆，浸浆水一宿，漉出，同炒，青皮焦，去豆。将浸水淹乌梅肉，炊一熟饭
，研细为膏。姜汤送下五七丸。
控涎丹 治患胸背、手足、颈项、腰胯隐痛不忍，连筋骨牵钓痛，坐卧不安，时
走易。
甘遂 大戟（红牙） 白芥子（真）
上粉丸，梧子大，白汤送下。
痰饮证状 或咳或喘，或呕或泄，眩晕嘈烦，忪悸 ，寒热疼痛，肿满挛癖，癃
闭痞膈，如
风如癫。悬饮者，水饮在胁下，咳唾引痛。溢饮者，饮水流于四肢，当汗不汗，身体疼痛重
。支饮者，呕逆倚息，短气不得卧，其形如肿。痰饮者，其人素盛今瘦，肠间漉漉有声。留
饮者，背寒如手大，或短气而渴，四肢历节疼痛，胁下痛引缺盆。伏饮者，膈满咳喘呕吐，
发则寒热，腰背痛，目泪恶寒振振然。悬饮当下，溢饮当汗，支饮随证汗、下之，痰饮宜温
之，从小便去之。
(Attached: Phlegm-Fluid Retention)
[Pulse] The Cun Kou pulse is floating and large, but becomes choppy upon deep pressure; the Chi pulse is also faint and choppy, indicating the presence of retained food and phlegm-fluid. If the Cun Kou pulse is tight like a turning rope and irregular on both sides, it indicates retained food. A slippery and rapid pulse indicates excess syndrome with retained food, which should be treated with purgation. A floating and slippery pulse indicates retained food; diarrhea accompanied by anorexia also indicates retained food. A deep pulse in a condition resembling Taiyang cold damage indicates retained food and lingering fluid, suitable for purgation. A short, rapid, and slippery pulse indicates alcohol-induced disease. A floating, fine, and slippery pulse indicates injury from drinking fluids.
[Etiology] When food and drink intake doubles, the intestines and stomach are injured. Compounded by other factors, gastric transformation becomes slow and difficult, leading to retained food and lingering fluid. Fluid (Yin) is water, belonging to formless Qi. Excessive drinking causes Qi rebellion; exposure to cold or consumption of cold drinks injures the Lung. Manifestations include cough, chest fullness, and watery diarrhea; severe cases lead to accumulation masses. Food (Shi) is material substance, belonging to formed blood (here referring to tangible matter). Overeating causes tendons and vessels to relax, intestines to become heavy, resulting in vomiting or diarrhea.
[Syndrome Differentiation and Treatment] *Qianjin Fang* states: If there are癖 (masses) in the stomach, eating cold foods causes pain and inability to eat, while eating hot foods induces desire to eat. Large retained food in the abdomen causes chills and fever resembling malaria. Retained food in the lower abdomen causes evening fever that resolves by morning.
*San Yin Ji Yi Bing Zheng Fang Lun* states: Fluid in Zhongwan causes heartburn/epigastric discomfort; retained food causes acid regurgitation.
Li Dongyuan discusses: Deficiency of Wu-Ji Fire (Spleen-Stomach Yang) fails to control food, causing indigestion, injuring the Taiyin Spleen, leading to blockage, oppression, and nausea. Severe cases involve intense Heart-Stomach pain affecting Blood. Treatment must distinguish Cold vs. Heat severity. If initially only the Upper Jiao has a pulse and Lower Jiao lacks one, emesis is indicated; failure to vomit leads to death, suitable for Gua Di San. Mild cases resolve internally using Sha Ren (Amomum fruit) and Chao Qu (Fried Medicated Leaven). Severe cases require downward purgation using Cheng Qi Tang. For Cold, warm with Ban Xia (Pinellia tuber), Gan Jiang (Dried ginger), San Leng (Burreed rhizome), E Zhu (Curcuma rhizome). For Heat, cool with Da Huang (Rhubarb root), Huang Lian (Coptis rhizome), Zhi Shi (Immature bitter orange), Mai Ya (Malt). For Fluids, promote downward movement; if excessive drinking causes Qi rebellion or cold injures the Lung, manifesting as wheezing, cough, sputum, or edema. Mild cases benefit from diaphoresis and diuresis to drain dampness from above and below, using Jie Cheng Tang, Wu Ling San, Ban Xia, Bai Zhu, Zhi Ke. Severe cases forming accumulations or fullness use San Hua Wan, Shen You Wan.
Zhang Yuansu discusses: Indigestion treatment differs by social status. The wealthy, due to excessive rich food, suffer from Zhongwan stagnation, distension, obstruction, and acid reflux, treated with Mu Xiang Dao Yin Wan. The poor, due to overwork and coarse diet/alcohol injury, suffer from body/abdominal fullness and frequent acid regurgitation, treated with Jin Shi Wan.
Severe cases resemble Taiyin Cold Damage but with a deep pulse, treatable with Dao Yin Wan.
Regarding Lingering Fluid (Liu Yin), it is essentially water retention. Though classified into Four or Five types, it is one syndrome. Emotional depression causes Liver Qi to invade Spleen Qi, stopping flow, creating lingering fluid. Liver governs planning; prolonged indecision stops Qi. Spleen governs thought; prolonged thinking knots Spleen, creating lingering fluid. Chronic Spleen-Stomach weakness fails to distribute fluids after drinking, creating lingering fluid. Excessive alcohol intoxication overwhelms Bladder meridian excretion, creating lingering fluid. Drinking cold water excessively while active or resting creates lingering fluid. Water is Yin. Accumulated water generates dampness; stagnant wine causes fullness; dryness over time transforms into Phlegm. Left hypochondriac mass resembles Fei Qi; right hypochondriac mass resembles Xi Ben. Ascending to Lung causes cough; descending to Large Intestine causes diarrhea; entering Kidney causes surging; in Taiyang channel it is Zhi Yin. All result from internal Qi rebellion. Dampness above causes yellow eyes and facial edema; below causes thigh/knee swelling; middle causes Zhi Yin, obstruction, and phlegm. Unresolved in Yang stagnates Qi; unresolved in Yin forms masses. Treat with Dao Shui Wan, Yu Gong San to purge water; regulate with Wu Ling San, Ting Li Zi, Jiao Mu.
For injuries from cold-damp items (watermelon, cold water, mutton milk), use Bai Zhu (2 qian), Chuan Wu (0.5 qian), Fang Feng (1 qian), Ding Xiang (1 piece), Zhi Gan Cao (1 qian).
For injuries from heat-damp items (mutton, noodles), use Bai Zhu, Huang Qin, Huang Lian (7 qian each), Da Huang (2 qian), Zhi Gan Cao (0.5 qian). Add Zhi Shi for epigastric fullness; Bai Shao (1 qian) for abdominal pain; Hou Po for abdominal distension; Zhi Ke for chest discomfort; Chen Pi for chest cold; Fu Ling for thirst; Cang Zhu for narrow abdomen/heaviness. Generally, use Ba Dou as sovereign herb for cold injuries; Da Huang for heat injuries.
Bing Lang Wan treats mild food injury with indigestion and abdominal distension (from Liu Wansu).
Bing Lang (2 qian), Chen Pi (8 qian), Qian Niu Tou Mo (4 qian). Make pills with vinegar paste, size of wu zi. Take 20 pills with ginger soup.
Xiong Huang Wan treats severe food injury with flaccid distension in ribs.
Xiong Huang (1 liang, separately ground), Ba Dou (5 qian, raw, oil removed). Pill form. Method same as Xin Tong Wan.
Gua Di San primarily induces vomiting for sudden abdominal pain/oppression.
Gua Di, Chi Xiao Dou (3 qian each). Powder. Take 1 qian with warm wine.
Zhi Shi Wan treats food injury.
Zhi Shi (0.5 liang), Bai Zhu (1 liang). Pills. Additions: Mu Xiang, Bing Lang, Qing Pi for Qi stagnation; Da Huang, Huang Qin, Huang Lian for Damp-Heat; Luo Bo Zi, Huang Lian, Ze Xie for latent dampness/fullness; Zhi Zi for post-illness food injury; Ban Xia, Dou Fen for wet dough/grease; Cao Dou Kou, Leng, E Zhu for cold/hard food injury; Gan Jiang for water injury; Suo Sha, Ding Xiang for Heart/Stomach pain; Ren Shen for Stomach injury.
Jie Cheng Tang treats alcohol injury.
Bai Dou Kou, Sha Ren, Sheng Jiang, Ge Hua (0.5 liang each); Bai Fu Ling, Zhu Ling (peeled), Chen Pi (peeled), Ren Shen, Bai Zhu (1.5 liang each); Qing Pi (3 qian); Shen Qu (fried), Ze Xian (2.5 qian each); Mu Xiang (0.5 fen). Powder. Take with plain water.
Secret Recipe treats gastric foreign sensation and aversion to food.
Er Chen Tang plus Bai Zhu, Shan Zha, Chuan Xiong, Cang Zhu, Shen Qu (fried).
Shen You Wan treats Lingering Fluid and Xuan Yin with wiry pulse. Also treats hidden pulse with urge to defecate but difficulty, and persistent epigastric hardness. This indicates Lingering Fluid attempting to exit.
Fu Ling Gui Zhu Tang treats Phlegm-Fluid in Heart with hypochondriac fullness and vertigo.
Fu Ling, Guan Gui, Bai Zhu, Gan Cao.
Da Qing Long Tang treats Yi Yin with body pain, requiring diaphoresis.
Ma Huang (7 qian), Guan Gui, Gan Cao (2.5 qian each), Shi Gao (egg-sized), Xing Ren, Ban Xia (add if damp).
Ze Xie Tang treats Zhi Yin in Heart with severe vertigo. For Zhi Yin causing breathing difficulty, add Ting Li Zi, Da Zao.
Pu Huang Tang treats Zhi Yin with chest pain.
Da Huang, Hou Po (equal parts).
Er Chen Tang, Xiao Ban Xia Tang treat vomiting patients who are not thirsty (due to Zhi Yin in Heart). For initial thirst then vomiting (water retention in Heart), this is Yin, add Fu Ling.
Wu Ling San treats thin individuals with umbilical palpitations, salivation, and vertigo due to water. Also treats retained phlegm/water.
Po Yin Wan treats five fluids结成 abscess/masses, Zhi Yin with chest fullness/vomiting, and dull heart pain. Strongly disperses Qi.
Bi Bo, Hu Jiao, Ding Xiang, Suo Sha, Qing Pi, Wu Mei, Mu Xiang, Xie Shao, Ba Dou (oil removed). Soak Qing Pi and Ba Dou in fermented grain water overnight, remove, stir-fry together until Qing Pi is scorched, discard beans. Soak Wu Mei flesh in the soaking water, steam with rice, grind to paste. Take 5-7 pills with ginger soup.
Kong Xian Dan treats hidden pain in chest/back/extremities/neck/waist, radiating to bones/tendons, restlessness, migrating pain.
Gan Sui, Da Ji (red tooth variety), Bai Jie Zi (authentic). Powder pills, wu zi size. Take with plain water.
[Symptoms of Phlegm-Fluid] Cough, wheezing, vomiting, diarrhea, vertigo, heartburn, palpitations, chills/pain, edema, spasms, masses, stranguria, obstruction, resembling wind or mania.
Xuan Yin: Fluid in hypochondrium, pain on coughing/salivating.
Yi Yin: Fluid flows to limbs, lack of sweating, heavy body pain.
Zhi Yin: Vomiting, leaning to breathe, shortness of breath, inability to lie flat, swollen appearance.
Tan Yin: Previously obese now thin, gurgling sound in intestines.
Liu Yin: Back coldness palm-sized, shortness of breath/thirst, joint pain, hypochondriac pain radiating to Qimen.
Fu Yin: Chest fullness, cough/wheezing/vomiting, attacks with chills/fever, back pain, tearing, aversion to cold/shaking.
Treatment principles: Xuan Yin requires purgation; Yi Yin requires diaphoresis; Zhi Yin follows syndrome with diaphoresis/purgation; Tan Yin requires warming and diuresis.