寒助饮。欲以热攻。则脉数必甚。夏则时热助脉。欲以寒治。则寒饮为碍。故曰难治。
案此条难解。金鉴改数作迟。肆矣。
脉沉而弦者。悬饮内痛。○病悬饮者。十枣汤主之。
〔鉴〕赵良曰。脉沉病在里也。凡弦者。为痛为饮为癖。悬饮结积。在内作痛。故脉见沉弦。
〔尤〕脉沉而弦。饮气内聚也。饮内聚。而气击之则痛。
〔徐〕主十枣汤者。甘遂性苦寒。能泻经隧水湿。而性更
迅速直达。大戟性苦辛寒。能泻脏腑之水湿。而为控涎之主。芫花性苦温。能破水饮窠囊。
故曰破癖须用芫花。合大枣用者。大戟得枣。即不损脾也。盖悬饮原为骤得之证。故攻之不嫌峻而骤。若
稍缓而为水气喘息浮肿。三因方。以十枣汤药为末。枣肉和丸以治之。可谓善于变通者矣。
十枣汤方（外台。引千金云。此本仲景伤寒论方。）
芫花（熬） 甘遂 大戟（各等分）
上三味。捣筛。以水一升五合。先煮肥大枣十枚。取八合。去滓。内药末。强人服一钱匕。羸人
服半钱。平旦温服之。不下者。明日更加半钱。得快下后。糜粥自养。（捣筛。太阳
下编。作各别为散。快下。原本。作快之。今改。）
千金云。十枣汤。治病悬饮者。若下后不可与也。凡上气汗出而咳者。此为饮也。又云。钱匕者。以大
钱上全抄之。若云半钱匕者。则是一钱抄取一边尔。并用五铢钱也。
外台。深师朱雀汤。疗久病癖饮。停痰不消。在胸膈上液液。时头眩痛苦挛。眼睛身体手足。十指甲
尽黄。亦疗胁下支满。饮辄引胁下痛。
即本方。用甘遂芫花各一分。大戟三分。大枣十二枚。
圣济总录。三圣散。治久病饮癖停痰。及胁支满。辄引胁下痛。（即本方。）
又芫花汤。治水肿。及支满 饮。
于本方。加大黄甘草五味各一两。上粗捣筛。每服三钱
匕。水二盏。枣二枚。擘破。同煎至九分。下芒硝半钱。更煎一沸。去滓温服。以利为度。
宣明论云。此汤兼下水肿腹胀。并酒食积肠垢积滞。 癖坚积蓄热。暴痛疟气久不已。或表之正气与
邪热。并甚于里。热极似阴。反寒战。表气入里。阳厥极深。脉微而绝。并风热燥甚。结于下焦。大小便
不通。实热腰痛。及小儿热结。乳癖积热。作发风潮搐。斑疹热毒。不能了绝者。
宣明论。三花神 丸。治壮实人。风痰郁热。肢体麻痹。走注疼痛。湿热肿满。气血壅滞。不得宣通。
及积痰翻胃。服三丸后。转加痛闷。此痰涎壅塞。顿攻不开。再加二丸。快利则止。
本方。去大枣。加大黄黑丑轻粉。水丸。
丹溪心法。小胃丹。治胸膈肠胃。热痰湿痰。
本方。加黄柏大黄。粥丸。
嘉定县志云。唐杲字德明。善医。太仓武指挥妻。起立
如常。卧则气绝欲死。杲言是为悬饮。饮在喉间。坐之则坠。
故无害。卧则壅塞诸窍。不得出入。而欲死也。投以十枣汤而平。
病溢饮者。当发其汗。大青龙汤主之。小青龙汤亦主之。（
脉经千金。无大青龙汤主之六字。及亦字。千金云。范汪用大青龙汤。）
〔程〕内经云。溢饮者。渴暴多饮。而易入肌肤肠胃之外也。以其病属表。故可大小青龙汤以发汗。
〔鉴〕溢饮者。饮后水流行。归于四肢。当汗出而不汗出。壅塞经表。身体疼重。即今之风水水肿病也。
〔徐〕溢饮者。水已流行。归四肢。以不汗而致身体疼重。盖表为寒气所侵而疼。肌体着湿而重。
全乎是表。但水寒相杂。犹之风寒两伤。内有水气。故以大青龙小青龙主之。然大青龙合桂麻。而去芍。加
石膏。则水气不甚。而挟热者宜之。倘咳多而寒伏。则必小青龙为当。盖麻黄去杏仁。桂枝去生姜。而加五
味干姜半夏细辛虽表散。而实欲其寒饮之下出也。
大青龙汤方（外台云。范汪溢饮者。当发其汗。大青龙汤主之。）
麻黄（六两去节） 桂枝（二两去皮） 甘草（二两炙） 杏仁（四十个去皮尖） 生
姜（三两） 大枣（十二枚） 石膏（如鸡子大碎）
上七味。以水九升。先煮麻黄。减二升。去上沫。内诸
药。煮取三升。去滓。温服一升。取微似汗。汗多者温粉粉之。（详见于伤寒辑义。下同。）
小青龙汤方
麻黄（去节三两） 芍药（三两） 五味子（半升） 干姜（三两） 甘草（三两炙）
细辛（三两） 桂枝（三两去皮） 半夏（半升汤洗）
上八味。以水一斗。先煮麻黄。减二升。去上沫。内诸药。煮取三升。去滓。温服一升。
外台云。千金溢饮者。当发其汗。宜青龙汤。
直指。桂术汤。治气分。
本方。去芍药五味子半夏。加白术枳壳。（出水饮门。）
膈间支饮。其人喘满。心下痞坚。面色黧黑。其脉紧。得之数十日。医吐下之不愈。木防己汤主之。虚
者即愈。实者三日复发。复与不愈者。宜木防己汤去石膏加茯苓芒硝汤
主之。（千金。膈间下。有有字。复发下。有发则二字。去石膏上。衍汤字。）
〔尤〕支饮上为喘满。而下为痞坚。则不特碍其肺。抑且滞其胃矣。面色黧黑者。胃中成聚。荣卫不
行也。脉浮紧者。为外寒。沉紧者。为里实。里实可下。而饮气之实。非常法可下。痰饮可吐。而饮之在心
下者。非吐可去。宜得之数十日。医吐下之。而不愈也。木防己桂枝。一苦一辛。并能行水气。而散结气。
而痞坚之处。必有伏阳。吐下之余。定无完气。书不尽言。而意可会也。故又以石膏治热。人参
益虚。于法可谓密矣。其虚者外虽痞坚。而中无结聚。即水去气行而愈。其实者。中实有物。气暂行而复聚。
故三日复发也。魏氏曰。后方去石膏。加芒硝者。以其既散复聚。则有坚定之物。留作包囊。故以坚投坚而
不破者。即以软投坚而即破也。加茯苓者。引饮下行之用耳。
〔鉴〕得之数十日。医或吐之不愈者。是水邪
不单结在上。故越之而不愈也。或下之不愈者。是水邪不单结在下。虽竭之亦不愈也。心下痞
坚。饮结在中可知。故以木防己汤。开三焦水结。通上中下之气。方中用人参。以吐下后伤正也。故水邪
虚结者。服之即愈。若水邪实结者。虽愈亦复发也。即复与前方。亦不能愈。当以前方减石膏之寒凝。加
芒硝峻开坚结。加茯苓直输水道。未有不愈者也。
木防己汤方
木防己（三两） 石膏（十二枚鸡子大○千金作鸡子大十二枚外台作鸡子大三枚案
外台似是） 桂枝（二两） 人参（四两）
上四味。以水六升。煮取二升。分温再服。
木防己加茯苓芒硝汤方
木防己 桂枝（各二两） 芒硝（三合） 人参 茯苓（各四两）
上五味。以水六升。煮取二升。去滓。内芒硝再微煎。
分温再服。微利则愈。（案千金外台。用木防己三两。为是。千金云。一方不加
茯苓。外台云。此本仲景伤寒论方。深师同。）
〔程〕防己利大小便。石膏主心下逆气。桂枝宣通水道。人参补气温中。正气旺则水饮不待散。而自散
矣。加芒硝之咸寒。可以软痞坚。茯苓之甘淡。可以渗痰饮。石膏辛寒近于解肌。不必杂于内方。故去之。
案防己。古称木防己。分汉木而为二种者。苏敬陈藏器以后之说。太平御览。载吴氏本草曰。木防己。一
名解离。一名解燕。神农辛。黄帝岐伯桐君苦无毒。李氏大寒。如葛茎蔓延如芄。白根外黄似桔梗。内
黑文如车辐解。可以证矣。又案防己。散饮泄水。石膏清肺热。止喘满。桂枝人参通阳
补气。若夫水邪结实者。非石膏之所能治。代以芒硝。峻开坚结。加茯苓利水道也。
心下有支饮。其人苦冒眩。泽泻汤主之。
〔程〕内经曰。清阳出上窍。支饮留于心膈。则上焦之气。浊而不清。清阳不能走于头目。故其人苦
眩冒也。
〔尤〕冒者。昏冒而神不清。如有物冒蔽之也。眩者。目眩转。而乍见玄黑也。
泽泻汤方（外台。引深师云。是本仲景伤寒论方。）
泽泻（五两） 白术（二两）
上二味。以水二升。煮取一升。分温再服。
〔程〕白术之甘苦。以补脾则痰不生。泽泻之甘咸。以入
肾则饮不蓄。小剂以治支饮之轻者。（外台。煮取一升下。有又以水一升。
煮取五合。此二汁十三字。）
支饮胸满者。浓朴大黄汤主之。
〔尤〕胸满。疑作腹满。支饮多胸满。此何以独用下法。浓朴大黄。与小承气同。设非腹中痛而闭者。
未可以此轻试也。
〔鉴〕胸字。当是腹字。若是胸字。无用承气汤之理。是传写之讹。支饮胸满。邪在肺也。
宜用木防己汤葶苈大枣汤。饮满腹满。邪在胃也。故用浓朴大黄汤。即小承气汤也。
千金云。浓朴大黄汤。夫酒客咳者。必致吐血。此坐久饮过度所致也。其脉虚者必冒。胸中本有支饮。
支饮胸满主之之方。
浓朴大黄汤方（外台。引千金云。此本仲景伤寒论方。）
浓朴（一尺） 大黄（六两） 枳实（四枚○千金作四两外台浓朴枳实下俱有炙字）
上三味。以水五升。煮取二升。分温再服。
张氏医通云。此即小承气。以大黄多。遂名浓朴大黄汤。
若浓朴多。则名浓朴三物汤。此支饮胸满者。必缘其人素多湿热。浊饮上逆所致。故用荡涤中焦药治之。
支饮不得息。葶苈大枣泻肺汤主之。（〔原注〕方见肺痈中○外台。引
千金云。此本仲景伤寒论方。）
〔徐〕肺因支饮。满而气闭也。一呼一吸曰息。是气既闭。而肺气之布。不能如常度也。葶苈苦寒。体
轻象阳。故能泄阳分肺中之闭。唯其泄闭。故善逐水。今气水相扰。肺为邪实。以葶苈泄之。故曰泻肺。大
枣取其甘能补胃。且以制葶苈之苦。使不伤胃也。
〔鉴〕喘咳不能卧。短气不得息。
皆水在肺之急证也。故以葶苈大枣汤。直泻肺水也。
张氏医通云。支饮留结。气塞胸中。故不得息。以其气壅则液聚。液聚则热结。所以与肺痈同治也。
呕家本渴。渴者为欲解。今反不渴。心下有支饮故也。
小半夏汤主之。（〔原注〕千金云。小半夏加茯苓汤。○案千金。用小半夏汤。外台。
引千金云。加茯苓者是也。此注当删去。）
〔沈〕此支饮上溢。而呕之方也。凡外邪上逆作呕。必伤津液。应当作渴。故谓呕家本渴。渴则病从
呕去。谓之欲解。若心下有支饮。停蓄胸膈制燥。故呕而不渴。则当治饮。
〔尤〕半夏味辛性燥。辛可散结。燥能蠲饮。生姜制半夏之悍。且以散逆止呕也。
小半夏汤方
半夏（一升） 生姜（半斤）
上二味。以水七升。煮取一升半。分温再服。
外台。虚烦门。短剧杯水汤。方后云。方有半夏。必须着生姜。不尔戟人咽。千金云。生姜呕家之圣药。
千金云。有人常积气结而死。其心上暖。以此汤少许汁。入口遂活。（出伤寒发黄门。）
千金。小半夏汤。病心腹虚冷。游痰气上。胸胁满不下食。呕逆者方。
即于本方中。加橘皮。（一方。有桂心甘草。）
杨氏家藏方。水玉汤。治眉棱骨痛不可忍者。此痰厥也。（即本方。）
严氏济生方。玉液汤。治七情伤感。气郁生涎。随气上逆。头目眩晕。心嘈忪悸。眉棱骨痛。
即本方。入沉香水一呷温服。
直指。半夏丸。治吐血下血。崩中带下。喘急痰呕。中满虚肿。亦消宿瘀。百病通用。
圆白半夏（刮净捶扁以生姜汁调和飞白面作软饼包掩半夏慢火炙令色黄去面取半
夏为末）
上末。米糊丸绿豆大。日干。每三四十丸。温熟水下。
腹满口舌干燥。此肠间有水气。己椒苈黄丸主之。
〔程〕痰饮留于中。则腹满。水谷入于胃。但为痰饮。而不为津液。故口舌干燥也。上证曰。水走肠间。
沥沥有声。故谓之痰饮。此肠间有水气。亦与痰饮不殊。故用此汤。以分消水饮。
〔尤〕水既聚于下。则
无复润于上。是以肠间有水气。而口舌反干燥也。后虽有水饮之入。只足以益下趋之势。
口燥不除。而腹满益甚矣。
防己椒目葶苈大黄丸方（千金。名椒目丸。）
防己 椒目 葶苈（熬○千金用二两余同） 大黄（各一两）
上四味。末之。蜜丸如梧子大。先食饮服一丸。日三服。稍增。口中有津液。渴者。加芒硝半两。
〔程〕此水气在小肠也。防己椒目。导饮于前。清者得从小便而出。大黄葶苈。推饮于后。浊者得从大
便而下也。此前后分消。则腹满减而水饮行。脾气转而津液生矣。若渴则甚于口舌干燥。加芒硝。佐
诸药。以下腹满。而救脾土。
卒呕吐。心下痞。膈间有水眩悸者。半夏加茯苓汤主之。（
卒。千金。作诸。据千金外台。半夏上脱小字。）
〔尤〕饮气逆于胃则呕吐。滞于气则心下痞。凌于心则悸。
蔽于阳则眩。半夏生姜。止呕降逆。加茯苓。去其水也。
〔鉴〕赵良曰。经云。以辛散之。半夏生姜。皆味辛。本草。半夏可治膈上痰。心下坚呕逆眩者。亦
上焦阳气虚。不能升发。所以半夏生姜并治之。悸则心受水凌。非半夏可独
治。必加茯苓。去水下肾逆以安神。神安则悸愈也。
小半夏加茯苓汤方
半夏（一升） 生姜（半斤） 茯苓（三两一法四两○外台引千金用四两方后云仲景
Cold aids fluid retention. If one attempts to attack with heat, the rapid pulse will become even more pronounced; in summer, the seasonal heat aids the pulse, and if one attempts to treat with cold, the cold-fluid becomes an obstacle. Therefore, it is said to be difficult to treat.
Note: This clause is difficult to understand. *Yizong Jinjian* (Medical Mirror of the Imperial Medical Academy) changed "rapid" to "slow," which is absurd.
A pulse that is deep and wiry indicates suspended fluid retention with internal pain. ○ For patients suffering from suspended fluid retention, Shizao Tang (Ten Jujube Decoction) is the primary treatment.
[Jinjian] Zhao Liang stated: A deep pulse indicates disease in the interior. Generally, a wiry pulse indicates pain, fluid retention, or phlegm-rheum accumulation. Suspended fluid retention accumulates internally causing pain, hence the pulse appears deep and wiry.
[You Yujing] A deep and wiry pulse indicates the internal gathering of fluid qi. When fluid gathers internally and qi strikes it, pain occurs.
[Xu Lingtai] The reason for using Shizao Tang is as follows: Kansui (Radix Euphorbiae Lathyri) has a bitter-cold nature and can drain water-dampness from the meridians and collaterals, with a property that acts rapidly and reaches directly; Daji (Radix Euphorbiae Pekinensis) has a bitter-pungent-cold nature and can drain water-dampness from the zang-fu organs, serving as the main drug for controlling saliva and fluid; Yuanhua (Flos Genkwa) has a bitter-warm nature and can break the nests and sacs formed by water-fluid. Thus, it is said that breaking phlegm-rheum requires the use of Yuanhua. The combination with jujubes is because Daji, when combined with jujubes, does not damage the spleen. Suspended fluid retention is originally a sudden onset condition, so aggressive and rapid purgation is not discouraged. If the condition slows down, leading to wheezing and edema due to water-qi, *San Yin Fang* (Treatise on the Specificity of Diseases) grinds the herbs of Shizao Tang into powder and forms pills with jujube paste for treatment, which can be considered a skillful adaptation.
Shizao Tang Formula (Cited in *Waitai Miyao* from *Qianjin Fang*: This was originally a formula from Zhang Zhongjing's *Shanghan Lun*.)
Yuanhua (Roasted), Kansui, Daji (Equal parts)
Grind these three herbs and sift. Use 1.5 sheng of water, first boil ten large jujubes until reduced to 0.8 sheng, remove dregs, add the herbal powder. Strong individuals take one qianbi (a measure equivalent to the amount held by a coin); weak individuals take half a qianbi. Take warm on an empty stomach in the morning. If there is no bowel movement, increase by half a qianbi the next day. After achieving brisk purgation, nourish oneself with millet porridge. (Note: In *Taiyang Xia Bian*, "grind and sift" is written as making separate powders; "kuai xia" in the original text is "kuai zhi", corrected here.)
*Qianjin Fang* states: Shizao Tang treats suspended fluid retention. It should not be administered after purgation. For cases of upper qi, sweating, and cough, this indicates fluid retention. Also, "qianbi" refers to scooping flat with a large copper coin. "Half qianbi" means taking half the amount scooped by one coin. Five-zhu coins are used.
*Waitai Miyao* records *Shenshi Fang*'s Zhuque Tang, treating chronic phlegm-rheum and retained phlegm that does not dissipate, lingering in the chest and diaphragm, feeling liquid and moving, with occasional dizziness, pain, and spasms. The eyes, body, hands, feet, and all ten fingernails turn yellow. It also treats hypochondriac fullness and distension, where drinking water triggers pain radiating to the hypochondrium.
This is the same formula: Kansui and Yuanhua each 1 fen, Daji 3 fen, Jujube 12 pieces.
*Shengji Zonglu* San Sheng San (Three Holy Powder) treats chronic phlegm-rheum and retained phlegm, as well as hypochondriac fullness and distension, often triggering pain radiating to the hypochondrium. (This is the same formula.)
There is also Yuanhua Tang, treating edema, hypochondriac fullness, and fluid retention.
Based on the above formula, add Rhubarb (Rhei Radix et Rhizoma), Licorice (Glycyrrhizae Radix et Rhizoma), and Schisandra (Schisandrae Chinensis Fructus) each 1 liang. Coarsely grind and sift. Take 3 qianbi per dose, with 2 zhan of water and 2 jujubes broken open. Decoct until 9/10 remains, add 0.5 qianbi of Mirabilite (Natrii Sulfas), boil once more, remove dregs, and take warm. Stop when bowel movement is achieved.
*Xuanming Lun* states: This decoction also drains edema and abdominal distension, as well as stagnation from alcohol and food, intestinal filth and accumulation, hard phlegm-rheum with accumulated heat, sudden pain, persistent malaria, or when healthy qi at the exterior and pathogenic heat both excess in the interior, extreme heat resembling yin causing chills, exterior qi entering the interior causing severe yang jue with a faint or absent pulse, severe wind-heat and dryness knotting in the lower jiao causing urinary and fecal obstruction, solid heat lumbar pain, pediatric heat knot, milk-phlegm with accumulated heat causing wind-tremors and convulsions, and macules/rashes with heat-toxin that cannot be cleared.
*Xuanming Lun* San Hua Shen Wan (Three Flowers Divine Pill) treats robust individuals with wind-phlegm and stagnant heat, limb numbness, migrating pain, damp-heat swelling and fullness, qi-blood congestion failing to circulate, as well as retained phlegm causing vomiting. After taking three pills, if pain and oppression worsen, it is due to phlegm-saliva blockage resisting initial attack; take two more pills, stopping when brisk purgation occurs.
This formula removes jujubes and adds Rhubarb, Black Morning Glory Seed (Pharbitidis Semen), and Calomelas (Hydrargyri Chloridum Compositum), made into pills with water.
*Danxi Xinfa* Xiao Wei Dan (Small Stomach Pill) treats hot-phlegm and damp-phlegm in the chest, diaphragm, stomach, and intestines.
This formula adds Phellodendron (Phellodendri Chinensis Cortex) and Rhubarb, made into pills with congee.
*Jiading Xianzhi* records: Tang Gao, courtesy name Deming, was skilled in medicine. The wife of the Commander of Taicang stood normally but felt breathless and near death when lying down. Tang Gao said this was suspended fluid retention; the fluid stays in the throat. Sitting allows it to fall, causing no harm; lying down blocks all orifices, preventing qi entry and exit, causing near-death sensation. He prescribed Shizao Tang, and she recovered.
For patients with overflowing fluid retention (Yi Yin), sweating should be induced. Da Qinglong Tang (Major Blue-Green Dragon Decoction) is the primary treatment. Xiao Qinglong Tang (Minor Blue-Green Dragon Decoction) may also be used. (*Maiching* and *Qianjin Fang* lack the six characters "Da Qinglong Tang zhu zhi" and the character "yi". *Qianjin Fang* states: Fan Wang used Da Qinglong Tang.)
[Cheng Zhi] *Neijing* states: Overflowing fluid retention occurs when thirst leads to sudden excessive drinking, and water easily enters outside the muscles and skin and intestines. Since the disease belongs to the exterior, Da Qinglong Tang or Xiao Qinglong Tang can be used to induce sweating.
[Jinjian] Overflowing fluid retention is when water flows after drinking, returning to the four limbs. Sweating should occur but does not, causing blockage in the meridians and surface, resulting in body ache and heaviness. This is currently known as wind-water edema.
[Xu Lingtai] Overflowing fluid retention is when water has flowed and returned to the four limbs, causing body ache and heaviness due to lack of sweating. The exterior is invaded by cold air causing ache, and the body is weighed down by dampness. It is entirely an exterior condition, but water and cold mix, similar to simultaneous wind-cold injury with internal water-qi. Hence, Da Qinglong Tang and Xiao Qinglong Tang are used. However, Da Qinglong Tang combines Guizhi and Mahuang but removes Shaoyao and adds Shigao, suitable for cases where water-qi is not severe and accompanied by heat. If there is much coughing and latent cold, Xiao Qinglong Tang is appropriate. Specifically, Mahuang removes Xingren, Guizhi removes Shengjiang, and adds Wuweizi, Ganjiang, Banxia, and Xixin. Although dispersing the exterior, the intent is actually to expel cold-fluid downward.
Da Qinglong Tang Formula (*Waitai Miyao* cites: Fan Wang believed overflowing fluid retention requires sweating, treated with Da Qinglong Tang.)
Mahuang (6 liang, remove joints), Guizhi (2 liang, remove bark), Gancao (2 liang, honey-fried), Xingren (40 pieces, remove skins and tips), Shengjiang (3 liang), Dazao (12 pieces), Shigao (crushed size of a chicken egg).
Boil these seven ingredients in 9 sheng of water. First boil Mahuang, reduce by 2 sheng, remove foam. Add other herbs, boil to obtain 3 sheng, remove dregs. Take 1 sheng warm. Aim for slight sweating. If sweating is excessive, apply warm powder to the body. (See *Shanghan Jiyi* for details, same below.)
Xiao Qinglong Tang Formula
Mahuang (3 liang, remove joints), Shaoyao (3 liang), Wuweizi (0.5 sheng), Ganjiang (3 liang), Gancao (3 liang, honey-fried), Xixin (3 liang), Guizhi (3 liang, remove bark), Banxia (0.5 sheng, washed in boiling water).
Boil these eight ingredients in 1 dou of water. First boil Mahuang, reduce by 2 sheng, remove foam. Add other herbs, boil to obtain 3 sheng, remove dregs. Take 1 sheng warm.
*Waitai Miyao* states: *Qianjin Fang* says overflowing fluid retention requires sweating, suitable for Qinglong Tang.
*Zhizhi Fang* Gui Shu Tang treats Qi Fen disease.
This formula removes Shaoyao, Wuweizi, and Banxia, adding Baizhu and Zhike. (From the Water-Fluid Retention section.)
Fluid retention (Zhi Yin) between the diaphragm causes wheezing and fullness, epigastric hardness and fullness, dark facial complexion, and a tight pulse. Having lasted for dozens of days, unsuccessful treatment by emesis or purgation, Mu Fangji Tang (Stephania Tetrandra Decoction) is the primary treatment. If the pattern is deficiency, recovery occurs immediately. If solid/excess, recurrence happens after three days. If subsequent treatment fails, Mufangji Tang minus Shigao plus Fuling and Mangxiao Tang is indicated. (*Qianjin Fang* adds "you" after "gejian" and "fa ze" after "fafa"; "tang" after "qu shigao" is an interpolation.)
[You Yujing] Zhi Yin upward causes wheezing and fullness, downward causes epigastric hardness and fullness, obstructing not only the Lung but also stagnating the Stomach. Dark facial complexion indicates accumulation in the Stomach and failure of Ying and Wei to circulate. Floating-tight pulse indicates exterior cold; deep-tight pulse indicates interior excess. Interior excess can be purged, but the excess of fluid qi is not treated by standard purgation. Phlegm-rheum can be vomited, but fluid in the epigastrium cannot be removed by vomiting. Given the duration of dozens of days and failed emesis/purgation: Mu Fangji and Guizhi, one bitter and one pungent, both move water-qi and dissipate nodulation. In areas of hardness, latent heat must exist; after emesis and purgation, vital qi is depleted. The book cannot fully express the words, but the meaning can be grasped. Thus, Shigao treats heat, and Renshen tonifies deficiency, making the method meticulous. In deficiency patterns, although externally hard/full, there is no internal knotting; water leaves, qi moves, and recovery occurs. In excess patterns, there is solid matter inside; qi temporarily moves then re-aggregates, causing recurrence after three days. Mr. Wei stated: Removing Shigao and adding Mangxiao in the subsequent formula is because re-aggregation implies a firm substance remaining as a sac; thus, using softness to break hardness works better than hardness against hardness. Adding Fuling guides fluid downward.
[Jinjian] After dozens of days, if emesis fails, it is because water-pathogen does not solely knot in the upper, so venting fails. If purgation fails, it is because water-pathogen does not solely knot in the lower, so exhausting fails. Epigastric hardness indicates fluid knotting in the middle. Thus, Mu Fangji Tang opens the three-jiao water knot and unblocks qi in upper, middle, and lower. Renshen is used because emesis/purgation damaged righteous qi. In deficiency-type water-knotting, recovery follows ingestion. In excess-type water-knotting, even if initially recovered, it recurs. Re-administering the previous formula will not work. One should modify the previous formula by removing the cold-congealing Shigao, adding Mangxiao to aggressively open hard knots, and adding Fuling to directly channel water pathways. Recovery is certain.
Mu Fangji Tang Formula
Mufangji (3 liang), Shigao (12 pieces size of chicken egg - *Qianjin* says 12 pieces, *Waitai* says 3 pieces; *Waitai* seems correct), Guizhi (2 liang), Renshen (4 liang).
Decoct these four ingredients in 6 sheng of water to obtain 2 sheng. Divide into two warm doses.
Mufangji Tang minus Shigao plus Fuling and Mangxiao Tang Formula
Mufangji, Guizhi (each 2 liang), Mangxiao (3 he), Renshen, Fuling (each 4 liang).
Decoct these five ingredients in 6 sheng of water to obtain 2 sheng, remove dregs, add Mangxiao, simmer slightly. Divide into two warm doses. Mild diarrhea indicates recovery. (Note: *Qianjin* and *Waitai* use 3 liang of Mufangji, which is correct. *Qianjin* mentions a variant without Fuling. *Waitai* states this is originally from Zhang Zhongjing's *Shanghan Lun*, consistent with *Shenshi Fang*.)
[Cheng Zhi] Fangji promotes urination and defecation; Shigao treats rebellious qi in the epigastrium; Guizhi unblocks water pathways; Renshen tonifies qi and warms the center. When righteous qi is strong, water-fluid dissipates spontaneously. Adding salty-cold Mangxiao softens hardness; sweet-bland Fuling渗泄s phlegm-fluid. Shigao is pungent-cold, close to releasing the muscle layer, and need not be mixed in internal formulas, hence removed.
Note: Fangji was anciently called Mu Fangji. The distinction between Han Fangji and Mu Fangji is a theory post-Su Jing and Chen Cangqi. *Taiping Yulan* cites Wu Shi Ben Cao: Mu Fangji, also named Jie Li or Jie Yan. Shenneng deemed it pungent; Huangdi, Qibo, Tongjun deemed it bitter, non-toxic; Li Shi deemed it greatly cold. It spreads like Ge stem and Wan grass, white root yellow outside like Jiegeng, black inside with texture like chariot spokes. This confirms it. Also, Fangji disperses fluid and drains water; Shigao clears lung heat and stops wheezing; Guizhi and Renshen unblock yang and tonify qi. If water-pathogen is solidified, Shigao cannot treat it; substitute with Mangxiao to aggressively open knots, and add Fuling to promote water pathways.
Fluid retention (Zhi Yin) in the heart region causes distressing dizziness and vertigo. Zexie Tang (Alisma Decoction) is the primary treatment.
[Cheng Zhi] *Neijing* states: Clear yang exits through the upper orifices. Zhi Yin lingering in the heart and diaphragm makes upper jiao qi turbid and unclear, preventing clear yang from reaching the head and eyes, causing distressing dizziness.
[You Yujing] "Mao" refers to mental confusion and lack of clarity, as if covered by something. "Xuan" refers to spinning vertigo and seeing darkness.
Zexie Tang Formula (*Waitai Miyao* cites *Shenshi Fang*: This is originally from Zhang Zhongjing's *Shanghan Lun*.)
Zexie (5 liang), Baizhu (2 liang).
Decoct these two ingredients in 2 sheng of water to obtain 1 sheng. Divide into two warm doses.
[Cheng Zhi] Baizhu's sweet-bitter tonifies the spleen, preventing phlegm generation; Zexie's sweet-salty enters the kidney, preventing fluid accumulation. Small doses treat mild Zhi Yin. (*Waitai Miyao* adds after "obtain 1 sheng": "add another 1 sheng of water, boil to obtain 0.5 sheng, combine these two juices," 13 characters.)
Zhi Yin with chest fullness is treated with Houpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction).
[You Yujing] "Chest fullness" is suspected to be "abdominal fullness." Zhi Yin often causes chest fullness; why use purgation here? Houpo Dahuang is identical to Xiao Chengqi Tang. Unless there is abdominal pain and constipation, this should not be tried lightly.
[Jinjian] The character "chest" should be "abdomen." If it were chest, there would be no reason to use Chengqi Tang; this is a transcription error. Zhi Yin chest fullness indicates pathogen in the Lung, suitable for Mu Fangji Tang or Tingli Dazao Tang. Fluid-fullness and abdominal-fullness indicate pathogen in the Stomach, hence Houpo Dahuang Tang (which is Xiao Chengqi Tang) is used.
*Qianjin Fang* states: Houpo Dahuang Tang. Wine drinkers who cough will likely expectorate blood, caused by long sitting and excessive drinking. Those with a deficient pulse will likely experience dizziness; there is originally Zhi Yin in the chest. Houpo Dahuang Tang treats chest fullness.
Houpo Dahuang Tang Formula (*Waitai Miyao* cites *Qianjin Fang*: This is originally from Zhang Zhongjing's *Shanghan Lun*.)
Houpo (1 chi), Dahuang (6 liang), Zhishi (4 pieces - *Qianjin* says 4 liang; *Waitai* adds "roasted" after Houpo and Zhishi).
Decoct these three ingredients in 5 sheng of water to obtain 2 sheng. Divide into two warm doses.
*Zhangshi Yitong* states: This is Xiao Chengqi Tang, named Houpo Dahuang Tang because of the larger amount of Dahuang. If Houpo is greater, it is named Houpo Sanwu Tang. This case of Zhi Yin chest fullness is likely due to inherent damp-heat and counterflow of turbid fluid, hence purgatives for the middle jiao are used.
Zhi Yin causing inability to breathe is treated with Tingli Dazao Xiefei Tang (Descurainia Seed and Jujube Lung-Draining Decoction). ([Original Note: Formula seen in Fei Yong section. *Waitai Miyao* cites *Qianjin Fang*: This is originally from Zhang Zhongjing's *Shanghan Lun*.]
[Xu Lingtai] The Lung is full and qi is closed due to Zhi Yin. Breathing is called Xi. With qi closed, Lung qi distribution cannot proceed normally. Tingli is bitter-cold and light, corresponding to Yang, thus able to drain closure in the Yang portion of the Lung. Because it drains closure, it effectively drives out water. Now qi and water disturb each other, and the Lung is excess with pathogen; draining with Tingli is called "Draining the Lung." Jujube is sweet and tonifies the Stomach, restraining Tingli's bitterness to prevent Stomach damage.
[Jinjian] Wheezing, coughing, inability to lie flat, shortness of breath, and inability to breathe are acute conditions of water in the Lung. Thus, Tingli Dazao Tang directly drains Lung water.
*Zhangshi Yitong* states: Zhi Yin lingers and knots, blocking qi in the chest, causing inability to breathe. Qi stagnation leads to fluid accumulation; fluid accumulation leads to heat knotting. Hence, it is treated similarly to Fei Yong (Lung Abscess).
Patients who vomit usually feel thirsty; thirst indicates the disease is resolving. Now, conversely, they do not feel thirsty because there is Zhi Yin in the heart region.
Xiao Banxia Tang (Minor Pinellia Decoction) is the primary treatment. ([Original Note: *Qianjin Fang* says Xiao Banxia Plus Fuling Tang. Note: *Qianjin Fang* uses Xiao Banxia Tang. *Waitai Miyao* citing *Qianjin Fang* says adding Fuling is correct. This note should be deleted.]
[Shen Mingzong] This is the formula for vomiting caused by Zhi Yin overflowing upward. Generally, external pathogens rebelling upward causing vomiting injure fluids, leading to thirst. Thus, it is said vomiting patients are usually thirsty; thirst means the disease resolves via vomiting. If there is Zhi Yin in the heart region, retaining in the chest/diaphragm and restricting dryness, vomiting occurs without thirst; thus, one must treat the fluid.
[You Yujing] Banxia is pungent and drying; pungency disperses knots, dryness eliminates fluid. Shengjiang restrains Banxia's harshness and disperses rebellion to stop vomiting.
Xiao Banxia Tang Formula
Banxia (1 sheng), Shengjiang (0.5 jin).
Decoct these two ingredients in 7 sheng of water to obtain 1.5 sheng. Divide into two warm doses.
*Waitai Miyao* Xu Fan Men, Duanju Beishui Tang, post-formula note: The formula contains Banxia, which must include Shengjiang, otherwise it irritates the throat. *Qianjin Fang* states: Shengjiang is the holy medicine for vomiting.
*Qianjin Fang* states: Someone died from chronic qi knotting, but their heart area was warm. A small amount of this decoction revived them upon entry. (From Shanghan Fa Huang Men.)
*Qianjin Fang* Xiao Banxia Tang treats cold deficiency in heart and abdomen, wandering phlegm qi rising, chest/hypochondriac fullness, loss of appetite, and vomiting/rebellion.
Add Chuanpi (Citri Reticulatae Pericarpium) to this formula. (One variant includes Guizhi and Gancao.)
*Yangshi Jiancang Fang* Shuiyu Tang treats unbearable pain in the supraorbital ridge, caused by Phlegm Jue. (This is the same formula.)
*Yanshi Jisheng Fang* Yuye Tang treats emotional injury, qi stagnation generating saliva, counterflow of qi upward, dizziness, palpitations, and supraorbital pain.
This is the same formula, added with Chenxiang (Aquilariae Lignum Resinatum), taken warm with water.
*Zhizhi Fang* Banxia Wan treats hematemesis, hematochezia, metrorrhagia/metrostaxis, wheezing/phlegm/vomiting, abdominal fullness/deficiency edema, and resolves old stasis. Universal for hundred diseases.
Round white Banxia (scrape clean, crush flat, mix with Shengjiang juice and refined wheat flour to make soft cake, wrap Banxia, slow-roast until yellow, remove flour, grind Banxia into powder).
Make pills with rice paste, size of mung beans. Dry in sun. Take 30-40 pills with warm cooked water daily.
Abdominal fullness and dry mouth/tongue indicate water-qi in the intestines. Yifeng Lihuang Wan (Stephania, Lepidium, Descurainia, and Rhubarb Pill) is the primary treatment.
[Cheng Zhi] Phlegm-rheum lingering in the middle causes abdominal fullness. Food and water entering the Stomach transform only into phlegm-rheum, not into fluids/jin-ye, hence dry mouth and tongue. The syndrome description says: water flows in the intestines, gurgling sound, hence called Tan Yin. This water-qi in the intestines is similar to Tan Yin, hence this decoction is used to separately eliminate water-fluid.
[You Yujing] Since water gathers in the lower, it cannot moisten the upper. Thus, water-qi in the intestines causes reverse dryness of mouth and tongue. Subsequent intake of water/fluid only increases the downward trend, failing to relieve dryness and worsening abdominal fullness.
Yifeng Jumotingli Dahuang Wan Formula (*Qianjin Fang* names it Jumuding Wan.)
Yifangji, Jiemu, Tingli (Roasted - *Qianjin* uses 2 liang, others same), Dahuang (each 1 liang).
Grind into powder, make pills with honey, size of walnut seeds. Take one pill before meals with water, three times daily, gradually increasing. When saliva generates in the mouth, if thirsty, add Mangxiao 0.5 liang.
[Cheng Zhi] This is water-qi in the small intestine. Yifangji and Jiemu guide fluid forward, allowing clear parts to exit via urine; Dahuang and Tingli push fluid backward, allowing turbid parts to exit via stool. This front-back separation reduces abdominal fullness and moves water-fluid, turning spleen qi and generating fluids. If thirst is worse than dry mouth, add Mangxiao to assist herbs in reducing abdominal fullness and saving spleen earth.
Sudden vomiting, epigastric fullness, water between diaphragm, dizziness, and palpitations are treated with Xiao Banxia Plus Fuling Tang. ("Cu" is "Zhu" in *Qianjin Fang*; based on *Qianjin* and *Waitai*, "Xiao" is missing before Banxia.)
[You Yujing] Fluid qi rebelling in the Stomach causes vomiting; stagnating in qi causes epigastric fullness; overwhelming the Heart causes palpitations; obscuring Yang causes dizziness. Banxia and Shengjiang stop vomiting and descend rebellion; adding Fuling removes water.
[Jinjian] Zhao Liang stated: Classic says: Disperse with pungent. Banxia and Shengjiang are both pungent. Materia Medica: Banxia treats phlegm above diaphragm and epigastric hardness/vomiting/rebellion. Dizziness is also due to deficiency of upper jiao yang qi failing to ascend, hence Banxia and Shengjiang treat both. Palpitations result from Heart overwhelmed by water, not treatable by Banxia alone; must add Fuling to drain water and subdue Kidney rebellion to calm spirit. Calmed spirit resolves palpitations.
Xiao Banxia Plus Fuling Tang Formula
Banxia (1 sheng), Shengjiang (0.5 jin), Fuling (3 liang, alternative 4 liang - *Waitai* citing *Qianjin Fang* uses 4 liang, post-formula note says Zhongjing