伤寒论茯苓三两余并同案今本千金用三两）
上三味。以水七升。煮取一升五合。分温再服。（千金注云。）
胡洽。不用茯苓。用桂心四两。三因方。名大半夏汤。
千金。茯苓汤。主胸膈痰满。
于本方中。加桂心。方后云。冷极者。加附子。气满。加槟榔。
圣济总录。半夏加茯苓汤。治三焦不顺。心下痞满。膈间有水。目眩悸动。（即本方。）
和剂局方。茯苓半夏汤。治停痰留饮。胸膈满闷。咳嗽呕吐。气短恶心。以致饮食不下。（即本方。）
易简方。消暑丸。治伤暑发热头痛。
半夏（一斤醋五升煮干） 茯苓（半斤） 甘草（半斤）
上为细末。以生姜汁作薄糊。为丸如梧桐子大。每服五十粒水下。
又二陈汤。治痰饮为患。或呕吐恶心。或头眩心悸。或
中脘不快。或发为寒热。或因食生冷。脾胃不和。
于本方。加甘草陈皮乌梅。
直指云。暑家气虚脉虚。或饮水过多。或冷药无度。伤动其中。呕吐不食。自利不渴。此则外热里寒。
无惑乎伤暑伏热之说。非理中汤不可也。又有冷药过度。胃寒停水。潮
热而呕。或身热微烦。此则阳浮外而不内。非小半夏加茯苓汤不可也。
直指。大半夏汤。治痰饮。（即本方。）
假令瘦人。脐下有悸。吐涎沫。而癫眩。此水也。五苓散主之。（癫。徐沈尤魏并作颠。金鉴云。癫
当是巅字。巅者。头也。文义相属。此传写讹。案作颠为是。此乃颠倒眩晕之谓。）
〔尤〕瘦人不应有水。而脐下悸。则水动于下矣。吐涎沫则水逆于中矣。甚而颠眩。则水且犯于上矣。形
体虽瘦。而病实为水。乃病机之变也。颠眩。即头眩。苓术猪泽。甘淡渗泄。使肠
间之水。从小便出。用桂者。下焦水气。非阳不
化也。曰多服暖水汗出者。盖欲使表里分消其水。非挟有表邪。而欲两解之谓。
〔鉴〕此条脐下有悸。是
水停脐下为病也。若欲作奔豚。则为阳虚。当以茯苓桂枝甘草大枣汤主之。
五苓散方
泽泻（一两一分） 猪苓（三分去皮） 茯苓（三分） 白术（三分） 桂枝（二分去皮）
上五味。为末。白饮服方寸匕。日三服。多饮暖水。汗
出愈。（白饮。外台。作水。医垒元戎。作白米饮。○详见于伤寒论辑义。）
朱氏集验方。治偏坠吊疝方。
即本方。煎萝卜子煎汤调下。（吉州彭履仲方。）
直指方。便毒门。五苓散。疏利小便。以泄败精。用葱二茎。煎汤调下。
得效方。小儿门。五苓散。治阴核气结。肿大钓痛。多因啼怒不止。伤动阴气。结聚不散得之。或胎妇
啼泣过伤。令儿生下。小肠气闭。加以风冷。血水相聚。水气上乘于肺。故先喘。而后疝痛。外肾不硬。脐下
痛楚不可忍。惟利二便则安。以木通葱白茴香食盐。煎汤调下。得小便利为效。
经验良方云。衡阳屈朝奉。治小儿上吐下泻。用五苓为
末。生姜自然汁为丸。麻子大。量儿大小。米饮送下。
附方
外台。茯苓饮。治心胸中有停痰宿水。自吐出水后。心胸间虚。气满不能食。消痰气令能食。（外台。
痰饮食不消。及呕逆不下食门。引延年云。仲景伤寒论同。）
茯苓 人参 白术（各三两） 枳实（二两） 橘皮（二两半） 生姜（四两）
上六味。水六升。煮取一升八合。分温三服。如人行八
九里进之。（味下外台有切以二字。合下。有去滓二字。）
〔沈〕脾虚不与胃行津液。水蓄为饮。贮于胸膈之间。满而上溢。故自吐出水。后邪去正虚。虚气上逆。
满而不能食也。所以参术。大健脾气。使新饮不聚。姜橘枳实。以驱胃家未尽之饮。日消痰气。令能食耳。
外台延年茯苓饮。主风痰气吐呕水者。（即本方。出风痰门。）
又茯苓汤。主风痰气发。即呕吐欠 。烦闷不安。或吐痰水者。
即本方。去枳实。
咳家。其脉弦为有水。十枣汤主之。（方见上○主之下。千金。有
不能卧出者。阴不受邪故也十一字。）
〔魏〕咳家专为痰饮在内。逆气上冲之咳嗽言也。故其脉必弦。无外感家之浮。无虚劳家之数。但见
弦者。知有水饮在中为患也。
〔尤〕脉弦为水。咳而脉弦。知为水饮渍入肺也。十枣汤逐水气。自大小便去。
水去则肺宁而咳愈。按许仁则论饮气咳者。由所饮之物。停澄在胸。水气上冲。肺得此气。便成咳嗽。经久
不已。渐成水病。其状不限四时昼夜。遇诸动嗽物即剧。乃至双眼突出。气如欲断。汗出大小便不
利。吐痰饮涎沫无限。上气喘急。肩息。每旦眼肿。不得平眠。此即咳家有水之证也。着有干枣三味丸亦佳。
大枣六十枚。葶苈一升。杏仁一升。合捣作丸。桑白皮饮。下七八丸。日再。稍稍加之。以大便通利为度。
案外台。更有加巴豆牵牛五味丸。当参考。
夫有支饮家。咳烦胸中痛者。不卒死。至一百日。或一岁。宜十枣汤。（方见上○赵本。无或字。）
〔徐〕夫有支饮家。乃追原之词也。谓支饮本不痛。蔓延至胸痹而痛。气上逆为咳。火上壅为烦。已有
死道矣。不卒死。甚至一百日。或经年之久。其虚可知。幸元气未竭也。
原其病支饮为本。病本不拔。终无愈期。逡巡不愈。正医家以虚故畏缩。故因宜十枣汤。以见攻病不嫌峻。不
得悠悠以待毙也。
〔魏〕不卒死。仲景之意。宜早治以十枣汤。至一百日或一岁。则难治矣。宜十枣汤者。宜于
百日一岁之前也。若谓日久饮深。宜十枣汤。恐非圣人履霜坚冰之意。总之涵泳白文自明。
案千金。本条之后。有一条云。咳而引胁下痛者。亦十枣汤主之。不知是本经之旧文否。
久咳数岁。其脉弱者可治。实大数者死。其脉虚者必苦冒。其人本有支饮在胸中故也。治属饮家。
〔沈〕久咳数载。是非虚劳咳嗽。乃脾肺素本不足。肺气滞而不利。津化为饮。上溢胸中肺叶空窍
之处。即支饮伏饮之类。内之伏饮相招。风寒袭入。内外合邪而发。世谓痰火。屡屡举发者是矣。然久咳必
是邪正两衰。其脉故弱。脉证相应。故为可治。实大数者。邪热炽盛。阴气大亏。甚者必造于亡。故主死也。
脉虚者。乃上焦膻中。宗气不布。痰饮浊阴。上溢胸中。气逆上冲。所以苦冒。冒者。瞑眩黑花昏晕
之类。因其人本有支饮。存蓄胸中。则当治其支饮。而咳自宁。故治属饮家。
咳逆倚息。不得卧。小青龙汤主之。
〔尤〕倚息。倚几而息。能俯而不能仰也。
〔沈〕此表里合邪之治也。肺主声。变动为咳。胸中素积
支饮。招邪内入。壅逆肺气。则咳逆倚息。不得卧。是形容喘逆。不能撑持。体躯难舒。呼吸之状也。故用小
青龙之麻桂甘草。开发腠理以驱外邪。从表而出。半夏细辛。温散内伏之风寒。而逐痰饮下行。干姜温肺行阳。
而散里寒。五味芍药。以收肺气之逆。使表风内饮。一齐而解。此乃寒风挟饮咳嗽之主方也。
青龙汤下已。多唾口燥。寸脉沉尺脉微。手足厥逆。气从小腹。上冲胸咽。手足痹。其面翕热如醉状。因
复下流阴股。小便难。时复冒者。与茯苓桂枝五味甘草汤。治其气冲。（程本。作若面热如醉。程云。下已。
当作汗已。金鉴从之。误。）
〔沈〕此下皆服小青龙汤。外邪解而里饮未除。扰动内阳之变也。表邪虽退。内饮未消。拒格胸间。心
火不得下达。反刑肺金。则多唾口燥。犹如肺痿之类也。但饮为阴邪。而内僻则阳气衰微。故寸脉沉。下焦
阳微。故尺脉微。而手足厥逆。因服青龙散剂。扰乱下焦。虚阳即随冲任之脉。厥而上行。故气从小腹上冲胸
咽。至于手足痹而不用。真阳以挟胃热上冲。其面翕热如醉状。冲气复反下流阴股。不归肾间
而行决渎。故小便难。冲气往返。扰动胸中留饮。则时复冒。故易桂苓。以逐冲气归源。五味收敛肺气之逆。
甘草安和脾胃。不使虚阳上浮。此乃救逆之变方也。
〔徐〕不堪发散动其气冲。以致肺燥。如痿而多唾。唾者
其痰薄如唾也。又口燥。燥者觉口干。非渴也。下流阴股。谓浮于面之阳。旋复在两股之阴。作热气也。
桂苓五味甘草汤方
茯苓（四两） 桂枝（四两去皮○千金用二两外台用一两） 甘草（炙三两○千金二
两） 五味子（半升）
上四味。以水八升。煮取三升。去滓。分温三服。（外台云。
以千金校之。亦脱此方。今于仲景方录附之。案今千金。载此方。可疑。）
冲气即低。而反更咳胸满者。用桂苓五味甘草汤。去桂加干姜细辛。以治其咳满。
〔尤〕服前汤已。冲气即低。而反更咳胸满者。下焦冲逆之气既伏。而肺中伏匿之寒饮续出也。故去
桂枝之辛而导气。加干姜细辛之辛而入肺者。合茯苓五味甘草。消饮驱寒。以
泄满止咳也。
案成无己云。桂枝泄奔豚。故桂枝加桂汤。用五两。以主奔豚气。从小腹上至心者。今冲气即低。乃
桂之功着矣。故去之。沈氏金鉴并云。枝走表。故去之。非。
苓甘五味姜辛汤方
茯苓（四两） 甘草 干姜 细辛（各三两） 五味子（半升）
上五味。以水八升。煮取三升。去滓。温服半升。日三服。（服字。根据俞本补。）
咳满即止。而更复渴。冲气复发者。以细辛干姜为热药
也。服之当遂渴。而渴反止者。为支饮也。支饮者法当冒冒者必呕。呕者复内半夏。以去其水。
〔沈〕此支饮内蓄。而复发也。咳满即止。肺之风寒已去。而更发渴。冲气复发者。饮滞外邪。留于
胸膈未除也。即以细辛干姜热药推之。若无痰饮内蓄。而服细辛干姜热药。助其燥热。应当遂渴。而渴反止
者。是内饮上溢喉间。浸润燥热。故不作渴。但阻胸中阳气。反逆上行而冒。然冒家阳气上逆。饮亦随之
而上。故冒者必呕。呕者于前去桂茯苓五味甘草汤。复内半夏。消去其水。呕即止矣。
〔尤〕所以治渴
而冲气动者。惜未之及也。约而言之。冲气为麻黄所发者。治之如桂苓五味甘草。从其气而导之矣。其为姜
辛所发者。则宜甘淡咸寒。益其阴以引之。亦自然之道也。若更用桂枝。
必捍格不下。即下亦必复冲。所以然者。伤其阴故也。
桂苓五味甘草去桂加干姜细辛半夏汤方
茯苓（四两） 甘草 细辛 干姜（各二两○千金同外台作三两） 五味子 半夏（各半升）
上六味。以水八升。煮取三升。去滓。温服半升。日三服。（服字。根据俞本补。）
案金鉴。去甘草。名苓桂五味甘草去甘草去桂加干姜细辛半夏汤。未详所据。
水去呕止。其人形肿者。加杏仁主之。其证应内麻黄。以其人遂痹。故不内之。若逆而内之者必厥。
所以然者。以其人血虚。麻黄发其阳故也。
〔徐〕形肿。谓身肿也。肺气已虚。不能遍布。则滞而肿。故以杏仁利之。气不滞则肿自消也。其证应
内麻黄者。水肿篇云。无水虚肿者。谓之气水。发其汗则已。发汗宜麻黄也。以其人遂痹。即前手足痹也。
逆而内之。谓误用麻黄。则阴阳俱虚而厥。然厥之意尚未明。故曰所以必厥者。以其人因血虚不能附气。故气
行涩而痹。更以麻黄汤药。发泄其阳气。则亡血复汗。温气去而寒气多。焉得不厥。正如新产
亡血复汗。血虚而厥也。
苓甘五味加姜辛半夏杏仁汤方
茯苓（四两） 甘草（三两） 五味子（半升） 干姜（三两） 细辛（三两） 半
夏（半升） 杏仁（半升去皮尖）
上七味。以水一斗。煮取三升。去滓。温服半升。日三服。（服字。根据俞本补。）
若面热如醉。此为胃热上冲熏其面。加大黄以利之。（外台醉下。有状字。）
〔徐〕面属阳明。胃气盛则面热如醉。是胃气之热上熏之也。既不因酒而如醉。其热势不可当。故加大
黄以利之。虽有姜辛之热。各自为功而无妨矣。
〔尤〕与冲气上逆。其面翕热如醉者不同。冲气上行者。病属
下焦。阴中之阳。故以酸温止之。此属中焦。阳明之阳。故以苦寒下之。
苓甘五味加姜辛半杏大黄汤方
茯苓（四两） 甘草（三两） 五味（半升） 干姜（三两） 细辛（三两） 半夏
（半升） 杏仁（半升） 大黄（三两）
上八味。以水一斗。煮取三升。去滓。温服半升。日三服。（服字。根据俞本补。）
千金方衍义云。赵以德曰。前四变随证加减施治。犹未离本来绳墨。至第五变。其证颇似戴阳。而能独
断阳明胃热。乃加大黄以利之。按阳明病。面合赤色。不可攻之。为其肾虚阳气不藏。故以攻为戒。而此平
昔阴亏血虚。反用大黄利之者。以其证变叠见。虽有面热如醉。而脉见寸沉尺微。洵
非表邪怫郁。而为胃中热蕴无疑。竟行涤饮攻热。不以阴虚为虑。而致扼腕也。
案以上叙证五变。应变加减。其意殆与伤寒论。证象阳且之一则同。示人以通变之法也。
先渴后呕。为水停心下。此属饮家。小半夏茯苓汤主之。
（方见上。○千金外台。以此条载上文卒呕吐心下痞云云之前。似是。后呕。作却呕。）
〔尤〕先渴后呕者。本无呕病。因渴饮水。水多不下。而反上逆也。故曰。此属饮家。小半夏。止呕
(Fu Ling [Poria] three liang, the rest are the same as before. Note: In the current edition of *Qianjin Fang*, Fu Ling is used in the amount of three liang.)
The above three herbs. Boil in seven sheng of water, reduce to one sheng and five he. Divide into two doses and take warm. (*Qianjin Fang* note says: Hu Qia's formula does not use Fu Ling, but uses Gui Xin [Cinnamon Bark] four liang. *San Yin Fang* names this Ban Xia Hou Tang [Large Pinellia Decoction]. *Qianjin Fang* calls this Fang Shen Tang [Poria Decoction], which treats phlegm-fluid retention filling the chest and diaphragm.)
Add Gui Xin [Cinnamon Bark] to this formula. The post-formula note states: If there is extreme cold, add Fu Zi [Aconite Lateralis Radix Preparata]; if there is Qi fullness, add Bing Lang [Arecae Semen].
*Shengji Zonglu*'s Ban Xia Jia Fu Ling Tang [Pinellia Plus Poria Decoction] treats malfunction of the San Jiao [Triple Burner], epigastric stuffiness and fullness, fluid retention between the diaphragm, dizziness, and palpitations. (This is the present formula.)
*He Ji Ju Fang*'s Fu Ling Ban Xia Tang [Poria and Pinellia Decoction] treats retained phlegm and lingering fluid, chest and diaphragmatic fullness and oppression, coughing and vomiting, shortness of breath, nausea, leading to inability to eat or drink. (This is the present formula.)
*Yi Jian Fang*'s Xiao Shu Wan [Heatstroke-Relieving Pills] treats fever and headache caused by heatstroke.
Herbs: Ban Xia [Pinelliae Rhizoma] (one jin, boiled dry with five sheng of vinegar), Fu Ling [Poria] (half jin), Gan Cao [Glycyrrhizae Radix et Rhizoma] (half jin).
Grind the above into a fine powder. Make thin paste with fresh Ginger Juice [Zingiberis Rhizoma Recens Sucus]. Form pills the size of Sophora seeds. Take fifty pills per dose with water.
There is also Er Chen Tang [Two-Aged Decoction], which treats disorders caused by phlegm-fluid. Symptoms include vomiting and nausea, dizziness and palpitations, discomfort in the Zhong Wan [CV12] region, alternating chills and fever, or spleen-stomach disharmony due to consumption of raw and cold foods.
To this formula, add Gan Cao [Glycyrrhizae Radix et Rhizoma], Chen Pi [Citri Reticulatae Pericarpium], and Wu Mei [Mume Fructus].
*Zhi Zhi Fang* states: Patients with summerheat have deficient Qi and pulse. Or they drink too much water, or consume excessive cold medicines, damaging the middle jiao. Symptoms include vomiting without desire to eat, spontaneous diarrhea without thirst. This is exterior heat and interior cold. There is no need to doubt the theory of summerheat and latent heat; only Li Zhong Tang [Regulate the Middle Decoction] will suffice. Furthermore, excessive consumption of cold medicines causes stomach cold and fluid retention, leading to tidal fever and vomiting, or slight body heat and vexation. This indicates Yang floating on the exterior and failing to enter the interior; only Xiao Ban Xia Jia Fu Ling Tang [Minor Pinellia Plus Poria Decoction] will suffice.
*Zhi Zhi Fang* records Da Ban Xia Tang [Large Pinellia Decoction] for treating phlegm-fluid. (This is the present formula.)
Suppose a thin person has palpitations below the umbilicus, spits saliva and foam, and experiences vertigo (dian xuan). This is a fluid disorder, treated with Wu Ling San [Five-Ingredient Powder with Poria]. ("Dian" is written as "Dian" by Xu Lingtai, Shen Mingzong, You Zaijing, and Wei Nianting. *Yi Zong Jin Jian* states that "Dian" should be "Dian" [vertex/top of head]. The context fits; this is a transcription error. Note: Writing it as "Dian" [topple/vertigo] is correct, meaning vertigo and dizziness.)
[You Zaijing] Thin people should not have fluid retention, but palpitations below the umbilicus indicate fluid moving in the lower jiao. Spitting saliva and foam indicates fluid counterflow in the middle. Severe vertigo indicates water attacking the upper jiao. Although the body is thin, the pathology is truly fluid; this is a variation in disease mechanism. "Dian xuan" refers to head dizziness. Fu Ling [Poria], Bai Zhu [Atractylodis Macrocephalae Rhizoma], Zhu Ling [Polyporus], Ze Xie [Alismatis Rhizoma] are sweet and bland, promoting diuresis and draining dampness, causing water in the intestines to exit via urination. The reason for using Gui Zhi [Cinnamomi Ramulus] is that fluid qi in the lower jiao cannot transform without Yang. "Drinking more warm water to induce sweating" aims to dissipate fluid from both the exterior and interior separately, not implying the presence of exterior pathogenic factors requiring simultaneous resolution of both layers.
[*Yi Zong Jin Jian*] The palpitation below the umbilicus in this clause indicates pathology caused by fluid stagnating below the umbilicus. If it were about to manifest as Ben Tun [Running Piglet], it would be Yang deficiency, and Fu Ling Gui Zhi Gan Cao Da Zao Tang [Poria, Cinnamon Twig, Licorice, and Jujube Decoction] should be used.
Wu Ling San [Five-Ingredient Powder with Poria] Formula
Ze Xie [Alismatis Rhizoma] (one liang and one fen) Zhu Ling [Polyporus] (three fen, peeled) Fu Ling [Poria] (three fen) Bai Zhu [Atractylodis Macrocephalae Rhizoma] (three fen) Gui Zhi [Cinnamoli Ramulus] (two fen, peeled)
Grind the above five herbs into powder. Take one cun bi (square-inch measure) with white rice drink (gruel), three times daily. Drink plenty of warm water; recovery occurs with sweating. ("White drink" is recorded as water in *Wai Tai Mi Yao* and as white rice gruel in *Yi Lei Yuan Rong*. ○ See detailed notes in *Shang Han Lun Ji Yi*.)
Zhu Shi *Ji Yan Fang* [Collected Verified Prescriptions by Mr. Zhu], a prescription for treating hernia (lateral testicular swelling).
Use this formula, decocted with Radish Seed [Raphani Semen] soup for administration. (Prescription from Peng Lvzhong of Jizhou.)
*Zhi Zhi Fang*, section on Sores and Ulcers, Wu Ling San [Five-Ingredient Powder with Poria], promotes urination to drain foul essence. Administer with scallion stalk decoction. (Two stalks.)
*De Xiao Fang* [Formulas of Effectiveness], Pediatrics section, Wu Ling San [Five-Ingredient Powder with Poria], treats qi knotting in the glans penis, swelling, and pulling pain. Often caused by prolonged crying and anger, injuring Yin qi, leading to knotting and failure to disperse. Or caused by pregnant women crying excessively, affecting the fetus. After birth, the infant suffers from closure of Small Intestine qi, compounded by wind-cold. Blood and water accumulate, and water qi ascends to attack the Lung, causing wheezing first, then hernia pain. The external genitalia are soft, and pain below the umbilicus is unbearable. Relief comes only from unblocking urination and defecation. Administer with Tong Cao [Tetrapanacis Medulla], Scallion White [Allii Fistulosi Bulbus], Fennel Seed [Foeniculi Fructus], and Salt [Halitum] decoction. Efficacy is indicated by free urination.
*Jing Yan Liang Fang* [Excellent Prescriptions of Experience] states: Qu Chaofeng of Hengyang treated pediatric vomiting and diarrhea by making Wu Ling San [Five-Ingredient Powder with Poria] into powder, forming pills with fresh Ginger Juice [Zingiberis Rhizoma Recens Sucus], sized like hemp seeds. Administer with rice drink according to the child's age.
Attached Formulas
*Wai Tai Mi Yao* [Essential Prescriptions from the Imperial Library of the Outer Palace] Fu Ling Yin [Poria Infusion] treats retained phlegm and old water in the heart and chest. After self-vomiting out the water, the chest feels empty, Qi is full, and appetite is lost. It resolves phlegm and Qi, restoring appetite. (*Wai Tai Mi Yao*, section on indigestion of phlegm-food and vomiting preventing food intake, cites *Yan Nian Fang*: identical to Zhang Zhongjing's *Shang Han Lun*.)
Fu Ling [Poria], Ren Shen [Panacis Ginseng Radix], Bai Zhu [Atractylodis Macrocephalae Rhizoma] (each three liang), Zhi Shi [Aurantii Fructus Immaturus] (two liang), Ju Pi [Citri Reticulatae Pericarpium] (two and a half liang), Sheng Jiang [Zingiberis Rhizoma Recens] (four liang)
Boil the above six herbs in six sheng of water, reduce to one sheng and eight he. Divide into three warm doses. Take after walking for eight or nine li. (In *Wai Tai Mi Yao*, "wei" has the characters "qie yi" [cut into pieces] below it; "he" has "qu zha" [strain] below it.)
[Shen Mingzong] Spleen deficiency fails to transport fluids with the Stomach; water accumulates as fluid, storing between the chest and diaphragm. Fullness overflows upward, causing self-vomiting of water. Afterwards, pathogens leave, Zheng [Upright Qi] becomes deficient, deficient Qi counterflows upward, causing fullness and inability to eat. Therefore, Ren Shen [Panacis Ginseng Radix] and Bai Zhu [Atractylodis Macrocephalae Rhizoma] strongly strengthen Spleen Qi, preventing new fluid accumulation. Ginger, Ju Pi [Citri Reticulatae Pericarpium], and Zhi Shi [Aurantii Fructus Immaturus] drive out remaining fluid in the Stomach. Day by day, phlegm and Qi are resolved, allowing eating.
*Wai Tai Mi Yao* Yan Nian Fu Ling Yin [Poria Infusion from Longevity] treats wind-phlegm, Qi counterflow, vomiting, and water expulsion. (This is the present formula, from the Wind-Phlegm section.)
Another Fu Ling Tang [Poria Decoction] treats wind-phlegm and Qi flare-up, manifesting as vomiting, yawning, vexation, uneasiness, or expectoration of phlegm-water.
This is the present formula, removing Zhi Shi [Aurantii Fructus Immaturus].
Patients with chronic cough whose pulse is wiry have water retention; treat with Shi Zao Tang [Ten-Jujube Decoction]. (Formula seen above. ○ Below "zhu zhi", *Qianjin Fang* adds eleven characters: "bu neng wo chu zhe, yin bu shou xie gu ye" [Unable to lie flat; this is because Yin does not receive pathogens].)
[Wei Nianting] "Ke jia" [patients with chronic cough] specifically refers to coughing caused by phlegm-fluid inside, with counterflowing Qi rushing upward. Thus, the pulse must be wiry, lacking the floating pulse of exterior patterns and the rapid pulse of consumptive patterns. Seeing only a wiry pulse indicates water-fluid is the cause within.
[You Zaijing] A wiry pulse indicates water. Cough with a wiry pulse indicates water-fluid has infiltrated the Lung. Shi Zao Tang [Ten-Jujube Decoction] expels water qi, eliminating it through urination and defecation. When water leaves, the Lung calms, and the cough heals. According to Xu Renze's discussion on cough due to fluid retention: ingested liquids stagnate in the chest; water qi rushes upward. The Lung receives this qi and develops cough. If prolonged, it gradually becomes a water disease. Symptoms are not limited by season or day/night. Exposure to triggers exacerbates it, even to the point of bulging eyes, sensation of suffocation, sweating, difficulty in urination and defecation, unlimited expectoration of phlegm and saliva, upper airway wheezing, shoulder breathing, morning eye swelling, and inability to sleep flat. This is the syndrome of water in chronic coughers. Dry Jujube Three-Ingredient Pills are also good. Sixty large dates, one sheng of Ting Li [Lepidii Semen], one sheng of Xing Ren [Armeniacae Semen Amarum]. Pound together into pills. Take seven or eight pills with Mulberry Root Bark [Mori Cortex] drink, twice daily. Gradually increase until bowel movement becomes loose.
Note: *Wai Tai Mi Yao* also lists pills added with Ba Dou [Crotonis Fructus], Qiu Niu [Pharbitidis Semen], and Wu Wei Zi [Schisandrae Chinensis Fructus]; these should be consulted.
For those with Zhi Yin [Supporting Fluid] who suffer from cough, vexation, and chest pain, if they do not die suddenly, after one hundred days or one year, Shi Zao Tang [Ten-Jujube Decoction] is appropriate. (Formula seen above. ○ Zhao Kaimei's edition lacks the character "huo" [or].)
[Xu Lingtai] "Fu you Zhi Yin jia" [Those who have Zhi Yin] is a retrospective term. It means Zhi Yin itself does not cause pain; it spreads to Xiong Bi [Chest Bi] causing pain. Qi counterflows upward causing cough; Fire obstructs upward causing vexation. There is already a path to death. If they do not die suddenly, lasting up to one hundred days or a year, their deficiency is evident. Fortunately, Yuan Qi [Primal Qi] is not exhausted.
Tracing the origin, Zhi Yin is the root. If the root is not removed, there is no hope of cure. Hesitation leads to non-recovery; this is precisely why doctors shrink back due to patient deficiency. Therefore, Shi Zao Tang [Ten-Jujube Decoction] should be used to show that attacking the pathogen does not shy away from harsh methods, and one must not wait idly for death.
[Wei Nianting] "Bu cu si" [not dying suddenly] implies Zhang Zhongjing's intent: treat early with Shi Zao Tang [Ten-Jujube Decoction]. By the hundredth day or one year, it becomes difficult to treat. Saying "yi Shi Zao Tang" [appropriate to use Shi Zao Tang] means it is appropriate before the hundredth day or one year. To say that long-standing duration and deep fluid retention make Shi Zao Tang appropriate contradicts the sage's principle of "treading on frost, hard ice follows." In summary, contemplating the original text clarifies this.
Note: In *Qianjin Fang*, following this clause, there is another: "Cough pulling pain in the hypochondrium is also treated with Shi Zao Tang [Ten-Jujube Decoction]." It is unknown if this is an original text from the classic.
Chronic cough for several years: if the pulse is weak, it is treatable; if solid, large, and rapid, it is fatal; if deficient, the patient will surely suffer from Mao [dizziness/blackouts]. This is because the person originally had Zhi Yin [Supporting Fluid] in the chest. Treatment belongs to managing fluid disorders.
[Shen Mingzong] Chronic cough for years is not consumptive cough, but inherent insufficiency of Spleen and Lung. Lung Qi stagnates and fails to flow freely; Jin Ye [Body Fluids] transform into fluid, overflowing into the chest and lung cavities, resembling Zhi Yin [Supporting Fluid] or Fu Yin [Latent Fluid]. Internal latent fluid attracts external Wind-Cold; internal and external pathogens combine to trigger the disease. What the world calls Phlegm-Fire, recurring frequently, is of this type. However, chronic cough inevitably involves decline of both Pathogen and Zheng [Upright Qi], hence the weak pulse. Pulse and syndrome correspond, so it is treatable. Solid, large, and rapid pulses indicate blazing pathogenic heat and severe Yin depletion; severe cases lead to exhaustion, hence fatal. Deficient pulse indicates failure of Zong Qi [Gathering Qi] in the Upper Jiao [Upper Burner] to distribute. Phlegm-fluid and turbid Yin overflow into the chest, Qi counterflows upward, causing Mao [dizziness/blackouts]. Mao refers to vertigo, black spots, and fainting. Since the person originally has Zhi Yin [Supporting Fluid] stored in the chest, one must treat the Zhi Yin, and the cough will calm. Thus, treatment belongs to fluid disorders.
Counterflowing Qi and leaning to breathe, unable to lie down, treated with Xiao Qing Long Tang [Minor Green Dragon Decoction].
[You Zaijing] "Yi xi" [leaning to breathe] means leaning on a table to breathe, able to bend forward but not backward.
[Shen Mingzong] This is the treatment for combined exterior and interior pathogens. The Lung governs sound, its change being cough. The chest inherently retains Zhi Yin [Supporting Fluid], attracting pathogens inward, obstructing and reversing Lung Qi, causing counterflowing Qi, leaning to breathe, and inability to lie down. This describes wheezing and counterflow, inability to support oneself, difficulty extending the body, and the state of respiration. Therefore, use Ma Huang [Ephedrae Herba], Gui Zhi [Cinnamomi Ramulus], and Gan Cao [Glycyrrhizae Radix et Rhizoma] from Xiao Qing Long Tang [Minor Green Dragon Decoction] to open the pores and expel exterior pathogens from the surface. Ban Xia [Pinelliae Rhizoma] and Xi Xin [Asari Radix et Rhizoma] warm and disperse internally latent Wind-Cold, driving phlegm-fluid downward. Gan Jiang [Zingiberis Rhizoma] warms the Lung and moves Yang, dispersing interior cold. Wu Wei Zi [Schisandrae Chinensis Fructus] and Shao Yao [Paeoniae Radix Alba] astringe rebellious Lung Qi, resolving exterior wind and internal fluid simultaneously. This is the main formula for cough due to Cold-Wind carrying Fluid.
After administering Xiao Qing Long Tang [Minor Green Dragon Decoction], if there is excessive salivation and dry mouth, Cun [Cun position] pulse is deep, Chi [Chi position] pulse is faint, hands and feet are cold, Qi rushes from the lower abdomen to the chest and throat, hands and feet are numb, the face appears hot like drunkenness, and subsequently flows down to the inner thighs, urination is difficult, and periodic dizziness occurs, administer Fu Ling Gui Zhi Wu Wei Gan Cao Tang [Poria, Cinnamon Twig, Schisandra, and Licorice Decoction] to treat the Qi rush. (Cheng Zhi's edition reads "ruo mian re ru zui" [if face is hot like drunkenness]. Cheng Zhi believes "xia yi" [after lowering] should be "han yi" [after sweating]. *Yi Zong Jin Jian* follows this, which is erroneous.)
[Shen Mingzong] The following describes changes after taking Xiao Qing Long Tang [Minor Green Dragon Decoction]: exterior pathogens are resolved, but interior fluid remains, disturbing internal Yang. Although exterior pathogens recede, interior fluid is not eliminated, blocking the chest. Heart Fire cannot descend, instead insulting Lung Metal, causing excessive salivation and dry mouth, resembling Fei Wei [Lung Withering]. However, fluid is a Yin pathogen; internal deviation leads to Yang deficiency and weakness, hence the deep Cun pulse. Lower Jiao Yang is weak, hence the faint Chi pulse and cold extremities. Because the Qing Long [Green Dragon] powder disturbed the Lower Jiao, deficient Yang follows the Chong and Ren vessels, rising reversely. Thus, Qi rushes from the lower abdomen to the chest and throat. Hands and feet become numb and useless. True Yang, carrying Stomach Heat, rushes upward, causing the face to appear hot like drunkenness. The Rushing Qi returns and flows down to the inner thighs, failing to return to the Kidney area to perform its function of regulating waterways, hence difficult urination. Rushing Qi往返 (goes back and forth), disturbing retained fluid in the chest, causing periodic dizziness. Therefore, replace Gui Zhi [Cinnamoli Ramulus] and Fu Ling [Poria] to guide the Rushing Qi back to its source. Wu Wei Zi [Schisandrae Chinensis Fructus] astringes rebellious Lung Qi. Gan Cao [Glycyrrhizae Radix et Rhizoma] harmonizes the Spleen and Stomach, preventing deficient Yang from floating upward. This is a modified formula for saving from adverse reactions.
[Xu Lingtai] Unbearable dispersion agitates the Qi rush, leading to Lung dryness, resembling withering with excessive saliva. Saliva here refers to thin phlegm resembling saliva. Dry mouth means feeling dry, not thirst. Flowing down to the inner thighs refers to Yang floating on the face rotating back to the Yin of the thighs, generating heat.
Fu Ling Gui Zhi Wu Wei Gan Cao Tang [Poria, Cinnamon Twig, Schisandra, and Licorice Decoction] Formula
Fu Ling [Poria] (four liang) Gui Zhi [Cinnamomi Ramulus] (four liang, peeled ○ *Qianjin Fang* uses two liang, *Wai Tai Mi Yao* uses one liang) Gan Cao [Glycyrrhizae Radix et Rhizoma] (roasted three liang ○ *Qianjin Fang* two liang) Wu Wei Zi [Schisandrae Chinensis Fructus] (half sheng)
Boil the above four herbs in eight sheng of water, reduce to three sheng. Strain. Divide into three warm doses. (*Wai Tai Mi Yao* states: Comparing with *Qianjin Fang*, this formula is also missing. Now recording it attached to Zhang Zhongjing's formulas. Note: The current *Qianjin Fang* contains this formula, which is suspicious.)
If the Qi rush subsides, but cough and chest fullness recur, use Fu Ling Gui Zhi Wu Wei Gan Cao Tang [Poria, Cinnamon Twig, Schisandra, and Licorice Decoction], remove Gui Zhi [Cinnamoli Ramulus], add Gan Jiang [Zingiberis Rhizoma] and Xi Xin [Asari Radix et Rhizoma] to treat the cough and fullness.
[You Zaijing] After taking the previous decoction, the Qi rush subsides, but cough and chest fullness recur. The counterflowing Qi from the Lower Jiao has settled, but cold-fluid hiding in the Lung continues to emerge. Therefore, remove Gui Zhi [Cinnamoli Ramulus] which acridly guides Qi, and add Gan Jiang [Zingiberis Rhizoma] and Xi Xin [Asari Radix et Rhizoma] which enter the Lung. Combined with Fu Ling [Poria], Wu Wei Zi [Schisandrae Chinensis Fructus], and Gan Cao [Glycyrrhizae Radix et Rhizoma], they resolve fluid, drive out cold, relieve fullness, and stop cough.
Note: Cheng Wuji states that Gui Zhi [Cinnamoli Ramulus] expels Ben Tun [Running Piglet], hence Gui Zhi Jia Gui Tang [Cinnamon Twig Plus Cinnamon Twig Decoction] uses five liang to treat Ben Tun Qi rising from the lower abdomen to the heart. Now that the Qi rush subsides, the efficacy of Gui Zhi [Cinnamoli Ramulus] is evident, so it is removed. Shen Mingzong and *Yi Zong Jin Jian* claim Gui Zhi [Cinnamoli Ramulus] travels to the exterior, so it is removed; this is incorrect.
Ling Gan Wu Wei Jiang Xin Tang [Poria, Licorice, Schisandra, Ginger, and Asarum Decoction] Formula
Fu Ling [Poria] (four liang) Gan Cao [Glycyrrhizae Radix et Rhizoma], Gan Jiang [Zingiberis Rhizoma], Xi Xin [Asari Radix et Rhizoma] (each three liang) Wu Wei Zi [Schisandrae Chinensis Fructus] (half sheng)
Boil the above five herbs in eight sheng of water, reduce to three sheng. Strain. Take half sheng warm, three times daily. ("Take" character supplemented according to Yu's edition.)
If cough and fullness cease, but thirst recurs, and the Qi rush reappears, it is because Xi Xin [Asari Radix et Rhizoma] and Gan Jiang [Zingiberis Rhizoma] are hot herbs. Taking them should cause immediate thirst. If thirst stops instead, it indicates Zhi Yin [Supporting Fluid]. Zhi Yin patients typically experience Mao [dizziness/blackouts]; those with Mao will vomit. For vomiting, add Ban Xia [Pinelliae Rhizoma] again to eliminate the water.
[Shen Mingzong] This is recurrence of internally stored Zhi Yin [Supporting Fluid]. Cough and fullness ceased, indicating Wind-Cold in the Lung is gone, yet thirst recurs, and Qi rush reappears; this is because fluid stagnation and exterior pathogens remain in the chest and diaphragm. Inferring from the hot herbs Xi Xin [Asari Radix et Rhizoma] and Gan Jiang [Zingiberis Rhizoma]: if there were no internal phlegm-fluid, taking these hot herbs would aid dryness and heat, causing immediate thirst. If thirst stops instead, it is because internal fluid overflows into the throat, moistening the dryness and heat, thus no thirst arises. However, it blocks Yang Qi in the chest, causing it to reverse upward and create Mao [dizziness/blackouts]. In Mao, Yang Qi counterflows upward, and fluid follows. Thus, those with Mao will vomit. For vomiting, return to the previous formula (removing Gui Zhi, Fu Ling, Wu Wei Zi, Gan Cao - *Correction based on context: actually referring to the modified formula prior to adding Ban Xia*), and add Ban Xia [Pinelliae Rhizoma] to eliminate water. Vomiting will cease.
[You Zaijing] Regarding treating thirst while the Qi rush moves, this was unfortunately not addressed. Briefly speaking, when the Qi rush is triggered by Ma Huang [Ephedrae Herba], treat it with Fu Ling Gui Zhi Wu Wei Gan Cao Tang [Poria, Cinnamon Twig, Schisandra, and Licorice Decoction], guiding the Qi along its course. When triggered by Gan Jiang [Zingiberis Rhizoma] and Xi Xin [Asari Radix et Rhizoma], one should use sweet, bland, salty, and cold herbs to nourish Yin and guide it; this is the natural way. If Gui Zhi [Cinnamoli Ramulus] is used again, it will definitely clash and fail to descend; even if it descends, the Qi rush will recur. The reason is injury to Yin.
Gui Ling Wu Wei Gan Cao Qu Gui Jia Gan Jiang Xi Xin Ban Xia Tang [Poria, Cinnamon Twig, Schisandra, Licorice, minus Cinnamon Twig, plus Ginger, Asarum, and Pinellia Decoction] Formula
Fu Ling [Poria] (four liang) Gan Cao [Glycyrrhizae Radix et Rhizoma], Xi Xin [Asari Radix et Rhizoma], Gan Jiang [Zingiberis Rhizoma] (each two liang ○ *Qianjin Fang* same, *Wai Tai Mi Yao* three liang) Wu Wei Zi [Schisandrae Chinensis Fructus], Ban Xia [Pinelliae Rhizoma] (each half sheng)
Boil the above six herbs in eight sheng of water, reduce to three sheng. Strain. Take half sheng warm, three times daily. ("Take" character supplemented according to Yu's edition.)
Note: *Yi Zong Jin Jian* removes Gan Cao [Glycyrrhizae Radix et Rhizoma], naming it Ling Gui Wu Wei Gan Cao Qu Gan Cao Qu Gui Jia Gan Jiang Xi Xin Ban Xia Tang [Poria, Cinnamon Twig, Schisandra, Licorice, minus Licorice, minus Cinnamon Twig, plus Ginger, Asarum, and Pinellia Decoction]. The basis is unclear.
When fluid is eliminated and vomiting stops, but the patient develops edema, add Xing Ren [Armeniacae Semen Amarum] as the primary treatment. The syndrome suggests adding Ma Huang [Ephedrae Herba], but because the patient has numbness, do not add it. If contrary to this and Ma Huang [Ephedrae Herba] is added, there will certainly be Jue [cold extremities/shock].
The reason is that the patient has Blood deficiency, and Ma Huang [Ephedrae Herba] disperses Yang.
[Xu Lingtai] "Xing zhong" [form swelling] refers to body edema. Lung Qi is already deficient and cannot spread throughout, causing stagnation and swelling. Therefore, use Xing Ren [Armeniacae Semen Amarum] to benefit flow. If Qi does not stagnate, swelling disappears naturally. The syndrome suggests adding Ma Huang [Ephedrae Herba] because the Edema chapter states: "Empty swelling without water is called Qi Water; inducing sweat resolves it. Inducing sweat requires Ma Huang [Ephedrae Herba]." Because the patient has numbness (the hand-foot numbness mentioned earlier), adding Ma Huang [Ephedrae Herba] contrary to this would cause both Yin and Yang to become deficient, leading to Jue [cold extremities/shock]. The meaning of Jue is not entirely clear, hence "therefore必定 Jue". Because the patient, due to Blood deficiency, cannot attach to Qi, Qi movement is sluggish and causes numbness. Further using Ma Huang Tang [Ephedra Decoction] to vent Yang Qi results in loss of Blood and repeated sweating. Warm Qi departs, and Cold increases; how can there be no Jue? This is just like postpartum blood loss followed by sweating, where Blood deficiency leads to Jue.
Ling Gan Wu Wei Jia Jiang Xin Ban Xia Xing Ren Tang [Poria, Licorice, Schisandra, plus Ginger, Asarum, Pinellia, and Apricot Seed Decoction] Formula
Fu Ling [Poria] (four liang) Gan Cao [Glycyrrhizae Radix et Rhizoma] (three liang) Wu Wei Zi [Schisandrae Chinensis Fructus] (half sheng) Gan Jiang [Zingiberis Rhizoma] (three liang) Xi Xin [Asari Radix et Rhizoma] (three liang) Ban Xia [Pinelliae Rhizoma] (half sheng) Xing Ren [Armeniacae Semen Amarum] (half sheng, skin and tip removed)
Boil the above seven herbs in one dou of water, reduce to three sheng. Strain. Take half sheng warm, three times daily. ("Take" character supplemented according to Yu's edition.)
If the face is hot like drunkenness, this is Stomach Heat rushing upward to steam the face. Add Da Huang [Rhei Radix et Rhizoma] to drain it. (*Wai Tai Mi Yao* has the character "zhuang" [state] after "zui" [drunken].)
[Xu Lingtai] The face belongs to Yangming. When Stomach Qi is abundant, the face is hot like drunkenness; this is Stomach Heat steaming upward. Since it is not like drunkenness due to alcohol, the heat intensity is unstoppable. Therefore, add Da Huang [Rhei Radix et Rhizoma] to drain it. Although there is heat from Ginger and Asarum, each performs its function without interference.
[You Zaijing] This differs from the face appearing hot like drunkenness due to counterflowing Qi. Counterflowing Qi ascending originates from the Lower Jiao, Yang within Yin, so it is stopped with sour and warm herbs. This belongs to the Middle Jiao, Yang of Yangming, so it is drained with bitter and cold herbs.
Ling Gan Wu Wei Jia Jiang Xin Ban Xia Xing Ren Da Huang Tang [Poria, Licorice, Schisandra, plus Ginger, Asarum, Pinellia, Apricot Seed, and Rhubarb Decoction] Formula
Fu Ling [Poria] (four liang) Gan Cao [Glycyrrhizae Radix et Rhizoma] (three liang) Wu Wei Zi [Schisandrae Chinensis Fructus] (half sheng) Gan Jiang [Zingiberis Rhizoma] (three liang) Xi Xin [Asari Radix et Rhizoma] (three liang) Ban Xia [Pinelliae Rhizoma] (half sheng) Xing Ren [Armeniacae Semen Amarum] (half sheng) Da Huang [Rhei Radix et Rhizoma] (three liang)
Boil the above eight herbs in one dou of water, reduce to three sheng. Strain. Take half sheng warm, three times daily. ("Take" character supplemented according to Yu's edition.)
*Qianjin Fang Yan Yi* [Explication of Qianjin Fang] states: Zhao Yi De said, "The previous four variations involved modifying treatment according to symptoms, still adhering to the original principles. In the fifth variation, the syndrome resembles Dai Yang [Floating Yang], yet one can independently diagnose Yangming Stomach Heat, thus adding Da Huang [Rhei Radix et Rhizoma] to drain it." According to Yangming disease, a face completely red should not be purged, because Kidney deficiency fails to store Yang Qi, so purging is warned against. Here, despite chronic Yin deficiency and Blood deficiency, Da Huang [Rhei Radix et Rhizoma] is used to drain. This is because the syndrome changes repeatedly; although the face is hot like drunkenness, the pulse shows deep Cun and faint Chi. Truly, this is not exterior pathogen depression, but undoubtedly Stomach Heat accumulation. Proceeding directly to purge fluid and attack heat, without worrying about Yin deficiency, causes regret.
Note: The above narrates five variations of symptoms, requiring adaptive modifications. The intent is likely similar to the clause in *Shang Han Lun* [Treatise on Cold Damage] regarding "syndrome resembling Yang Dan," demonstrating the method of adaptation to changing conditions.
Thirst first, then vomiting, indicates water stagnating in the Heart Below. This belongs to fluid disorders. Treat with Xiao Ban Xia Fu Ling Tang [Minor Pinellia and Poria Decoction].
(Formula seen above. ○ *Qianjin Fang* and *Wai Tai Mi Yao* place this clause before the preceding text "Sudden vomiting, epigastric stuffiness, etc.", which seems plausible. "Hou ou" [later vomiting] is written as "Que ou" [then vomiting].)
[You Zaijing] Thirst first, then vomiting: originally there was no vomiting disease. Due to thirst, drinking water, but excess water fails to go down, instead counterflowing upward. Hence it is said: "This belongs to fluid disorders." Xiao Ban Xia [Minor Pinellia] stops vomiting.