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(Also known as Taiyang Disease with Water Retention)

【Etiology】The patient has a pre-existing condition of fluid retention (Phlegm-Fluid). They contract Wind-Cold pathogens externally. Alternatively, they may first contract Wind-Cold and then drink cold water, or indulge in drinking cold tea and cold wine, or greedily consume raw fruits and vegetables.

【Symptoms】Headache, feverish sensation in the body, aversion to cold, absence of sweating, chest and epigastric stuffiness, dry retching, coughing up thin saliva, and in severe cases, wandering pain in the chest and hypochondrium, wheezing preventing lying flat. The tongue coating is white and slippery; in severe cases, it may be black and slippery, or have one or two white strips on half the tongue, or a white patch in the center.

【Pulse】Floating, wiry, and slow. In severe cases, it is deep-wiry or slow-wiry. This corresponds to what Zhang Zhongjing described as "Taiyang disease with a floating-slow pulse, heaviness of the body, and absence of Shaoyin symptoms."

【Treatment】Initially, acrid-warm dispersing methods should be employed. For mild cases, Suqiang Dabiao Decoction (Perilla and Notopterygium Exterior-Releasing Decoction) with Pinellia Rhizome (Banxia) and Poria (Fuling) is used. For severe cases, Xiao Qinglong Tang (Minor Blue Dragon Decoction) with modifications is used. If the exterior Wind-Cold is resolved but transforms into epigastric hardness and fullness, pain radiating to the hypochondrium, dry retching, and shortness of breath, immediate purgation to remove retained fluid is required, using Juan Yin Wan Ling Tang (Ten Thousand Miracle Fluid-Removing Decoction) as the main formula. If it transforms into abdominal pain, spontaneous diarrhea, heavy and painful limbs, cough accompanied by vomiting, Yang-transmitting and diuretic methods should be applied, with Zhen Wu Tang (True Warrior Decoction) modified as the main formula. (In this formula, Fuling is heavily dosed at 8 qian, Baishao is removed, Ganjiang is added at 8 fen mixed with Wuzi at 5 fen, and Jiang Banxia is added at 4 qian.) For milder conditions, simply using Lingzhu Erchen Decoction (Poria and Atractylodes Two-Ancients Decoction) to warm the middle and promote urination is sufficient.

【Commentary by Xiu】Wind-Cold pathogens enter from the exterior and envelop the existing fluid retention. Although Xiao Qinglong Tang (Minor Blue Dragon Decoction) should be used to disperse pathogens and eliminate fluids, this is specifically indicated for Jia Yi Yin Syndrome (Clasped Overflowing Fluid Syndrome), where water flows into the limbs causing body pain and heaviness, which is most accurate. If it involves Jia Zhi Yin Syndrome (Clasped Branching Fluid Syndrome), characterized by coughing, gasping while leaning forward, shortness of inability to lie flat, edema, chest fullness, and a sound in the throat like a waterfowl, then Shegan Mahuang Tang (Belamcanda and Ephedra Decoction) should be used. (Original prescription: Shegan 1.5 qian, Mahuang 8 fen, Jiang Banxia 2 qian, Kuandonghua and Ziwan each 3 qian, Wuzi and Xixin each 3 fen, Shengjiang 2 slices, Hongzao 2 pieces. Remove Shegan, Ziwan, Kuandonghua, Shengjiang, Hongzao, Wuzi; add Chuanpo 1 qian, Shigao 4 qian, Xingren 4 qian, Ganjiang 1 qian, Huaixiaomai 3 qian. Named Nongpu Mahuang Tang, also treats cough with floating pulse and waterfowl-like throat sounds.) This formula combines four methods: releasing the exterior, directing Qi downward, moistening dryness, and opening phlegm, to resolve the simultaneous exterior-interior manifestation, thereby achieving efficacy. If Zhi Yin attacks the Lung causing Lung Distension, with cough, upward rushing of Qi, irritability, wheezing, and a floating pulse, then Xiao Qinglong Tang plus Shigao (Minor Blue Dragon Decoction plus Gypsum) should be used to release the exterior, promote urination, resolve phlegm, and clear heat to be effective. As for Juan Yin Wan Ling Tang, it combines Xiaobanxia Jia Fuling Tang (Minor Pinellia with Poria Decoction), Gansui Banxia Tang (Kansui and Pinellia Decoction), and Shizao Tang (Ten Jujube Decoction) into one compound. Regardless of whether it is Zhi Yin in the epigastrium, Liu Yin between the diaphragm, or Xuan Yin in the stomach and intestines, manifesting as wheezing, fullness, pain, distension, dizziness, palpitations, or vomiting of saliva and foam, skilled practitioners find it invariably effective. However, these treat excess-type fluid retention. Only Lingzhu Erchen Tang and modified Zhen Wu Tang, one treating exterior fluid by regulating the Spleen and the other treating interior fluid by regulating the Kidney, address deficiency-type fluid retention. With these seven formulas for fluid-clasped diseases, patterns of exterior-interior and excess-deficiency can be extrapolated.

【Commentary by Lian】When fluid enters the Stomach, if it is steamed by Fire and becomes thick and turbid, it is called Tan (Phlegm); if it remains unsteamed and clear/thin, it is called Shui (Water). Thus, Tan transforms via Fire, while Shui coagulates via Cold. Tan generates Heat, while Shui generates Cold; this is the difference in etiology between Phlegm-clasped and Water-clasped diseases. Consequently, their pulse, tongue, symptoms, and treatments differ. First, distinguish the pulse: it must be Wiry, or biased-Wiry, double-Wiry, Wiry-Slow, Slow-Wiry, Deep-Wiry, or Wiry-Tight resembling Rapid. Second, distinguish the tongue: coating is mostly white and moist, occasionally turning yellow or black, but always remaining slippery, or fully yellow/black with interspersed white strips, or yellow edges/tips with a central white patch. Long-standing cases show a smooth anterior tongue without coating and a thick white-slippery posterior coating. Third, distinguish symptoms: although the chest and epigastrium are full and painful, they are soft upon pressure; slight rubbing produces gurgling sounds. Severe cases involve intestinal cramping pain, dry retching, shortness of breath, heavy waist, swollen feet, diarrhea, and scanty urination. Fourth, distinguish treatment: For Wind-Cold clasping fluid, acrid herbs should disperse, and warm herbs harmonize. Even if Warm-Heat disease presents with water retention, despite exterior pathogens, pure acrid-cool dispersants should not be used exclusively, as this fails to resolve the exterior and leads to sinking fatigue. Interior syndromes should not be treated early with bitter-cold herbs, as this worsens confusion. This is because Water Qi restrains Heat pathogens and confines Yang Qi; therefore, acrid-light diuretic and Qi-moving herbs should be added to exterior-releasing and interior-clearing prescriptions to dispel Water Qi. Once Water Qi is gone and restraint released, attack or cooling methods can be considered effectively. In summary, early fluid-clasped disease stems from external Wind-Cold invasion and internal stagnation of rich/greasy foods, leading to Qi mechanism obstruction, often presenting with fear of wind/cold, closed sweat/urine, coughing/gasping unable to lie flat, and even skin edema. Water is a Yin pathogen, causing occasional dizziness due to Water Qi depression blocking Yang ascent, distinct from Phlegm-Fire-Damp-Heat. Generally, promote Qi movement and eliminate fluid, invigorate Stomach Yang to drive out Cold Water. Induce sweat if appropriate, promote urination if appropriate, modify with other herbs as needed, but do not tonify hastily. Even in the elderly, unblocking must precede tonifying; if tonifying, only Renshen, Baizhu, Ganjiang, Fuzi are suitable. Formulas like Linggui Zhugan Tang, Lizhong Tang, and Zhen Wu Tang by Zhang Zhongjing are correct treatments for Water-Fluid. Even with chronic cough and Lung deficiency, the root is Cold Water in the Stomach; thus, tonics should strengthen Qi to unblock Yang, not nourish Yin which aids pathology. Herbs like Yangshen, Shihu for Stomach nourishment, Sheng/Di Huang for Yin nourishment, Maidong, Ejiao for Lung protection, Doulou, Geqiao for clearing Metal, Beimu, Gualou for sliding phlegm/moistening dryness, are suitable for Phlegm-Fire-Dryness, opposite to Water-Cold of Fluid-clasped disease. Even for Hot Fluid, exterior cases use Yebing Jia Banxia Tang, interior cases use Jingpi Li Huang Wan and Kongxian Dan, modified appropriately. Contemporary physicians who do not study Shanghan Lun and Jingui Yaolue fail to understand Fluid syndromes, abandoning Zhang Zhongjing's excellent formulas, instead proposing "Yin-Deficiency Phlegm-Fluid," mistakenly identifying Yin-Excess as Yin-Deficiency, and using purely moistening/clearing methods, explaining why chronic fluid-cough is common.

【Commentary by Rongzhai】The syndrome and treatment in this section, based on Wu Kun'an's Shanghan Zhizhang by Mr. Yu Genchu and Mr. He Xiushan, incorporate empirical modifications, reaching a stage of being "simple and clear." At onset, Wu advocated Guizhi, Dan Ganjiang, Banxia, Fuling, Xingren, Zhi Cao, a method derived from Ye Tianshi with reliable efficacy. Another type, "Latent Fluid in Collaterals," also has empirical treatments by Wu: "If there is stabbing pain in chest/hypochondrium, frequent sour regurgitation, deep-wiry pulse, and no thirst, this is Latent Fluid in Collaterals; use Guizhi Wuling Tang with Jiang Zhi Cili, Banxia, Quan Fuhua." Case 2 of Vol. 2 of Quanguo Mingyi An records Yuan Guisheng treating Mrs. Ji for Wind-Cold clasping Phlegm-Fluid: cough/wheezing, gasping unable to lie flat, aversion to cold/fever, headache/body ache, chest stuffiness, back-piercing chest pain. Pulse deep-wiry-slippery, coating white-greasy. Prescription: Mahuang 4 fen, Guizhi 4 fen, Dan Ganjiang 5 fen, Bei Xixin 4 fen, Sheng Baishao 1.5 qian, Wuzi 5 fen, Gancao 5 fen, Gualou Ren 3 qian (crushed), Gan Xiebai 3 qian (washed with rice wine), Jiang Banxia 3 qian. After taking, sweat occurred, cold/fever/wheezing subsided, but body ache/cough persisted. Changed formula: Guizhi Tang plus Ganjiang, Wuzi each 5 fen, Xixin 3 fen; cured after two doses. Mr. Lian commented: "Xiao Qinglong Tang is the main formula for Wind-Cold exterior constriction and internal Phlegm-Fluid movement; skillful modification yields instant cures; combined with Gualou Xiebai acrid-sliding phlegm-resolving action, efficacy is faster. The follow-up Guizhi Tang modification uses Chen Xiuyuan's divine method of Wuzi, Ganjiang, Xixin for body ache/cough with Phlegm-Fluid. Thus, Shanghan Lun and Jingui Yaolue must be studied diligently." I consider this case a factual application of Xiao Qinglong Tang for "Fluid-Clasped Taiyang Disease," so I transcribe it here.