问曰。夫饮有四。何谓也。师曰。有痰饮。有悬饮。有溢饮。有支饮。
此分别四饮之名目也。今人于四饮外。加留饮伏饮。而不知四饮证之病因。多起于
水留而不行。甚者伏而不出。亦何必另立病名乎。
问曰。四饮何以为异。师曰。其人素盛。今瘦。（其精津化为痰饮。不复外充形体。
而第觉）水走肠间。（水顺流。则无声。有所滞碍。则）沥沥有声。谓之痰饮。（即稠
痰稀饮而俱见也。）饮后水流在胁下。（不上不下。悬结不散。）咳唾引痛。谓之悬饮。
（悬。即悬挂之义也。）饮水流行。归于四肢。当汗出而不汗出。（流壅经表。）身体
疼重。谓之溢饮。（溢。即流溢之义也。）咳逆倚息不得卧。（肺气壅而不行。）其形
如肿。谓之支饮。（如水之有派。木之有枝。附近于脏。而不正中也。）
此分别四饮之病证也。
（前言四饮。或膈间。或肠间。或胁下。或肢体。或胸中。皆不能尽饮之为病也。
凡五脏有偏虚之处。则饮乘之。可以历指其所在）水（饮）在心。心下（悸动有力。状
如）坚筑。（火为水制。而气不伸。则）短气。恶水不欲饮。水（饮）在肺。吐涎沫。（
吐过多。则渴）欲饮水。水（饮）
在脾。（中气伤。则）少气（湿气盛。则）身重。水（饮）在肝。（肝脉布胁肋。则）
胁下支满。（嚏出于肺。而肝脉上注肺。故）嚏而（牵引作）痛。水（饮）在肾。（水
盛而凌心。起于脐下。跳动甚。则为）心下悸。
此承上四饮而推及五脏。而其义始备也。言脏而不及腑。以腑为阳。在腑则行矣。
与水气篇不同。
（然以五脏言之。则为在。以病因言之。则为留。）夫心下有留饮。（背为胸之府。水留
心下。溢于胸中。而偏着于背。）其人背寒。冷如掌大。（饮留之处。阳气所不入也。
）留饮者。胁下痛引缺盆。（以饮留于肝。而应于肺也。）咳嗽则辄已。（以饮被气
击。而欲移也。） 胸中有留饮。其人（饮盛者。气不伸。则）短气（饮结者。津液不
输）而（口）渴。四肢历节痛。（以痰饮横流于肢节也。然不与历节黄汗同者。
以其）脉沉者（责其）有留饮。
此言饮之留而不去之为病也。
魏念庭云、背为太阳。在易为艮止之象。一身皆动。背独常静。静处阴邪常客之。所
以阴寒自外入。多中于背。阴寒自内生。亦多踞于背也。
（饮留而不去。谓之留饮。伏而难攻。谓之伏饮）膈上（伏饮之）病。（时见）痰
满喘咳（病根已伏其中。一值外邪暴中。其内饮与外邪相援。一时）吐（露迅）发。则
（以外邪之为）寒热背痛腰疼。（激出内饮之痰满喘咳大作。以致）目泣自出。其人振
振身 （诸）剧。（因以断之曰。）必有伏饮。
此言饮之伏而骤发也。俗谓哮喘。即是此证。当表里并治。如小青龙汤。及木防己
汤去石膏加芒硝茯苓为主治。余着有公余医录。（实时方歌括。及时方妙用。）及医学
实在易。二书中论之颇详。兹不再赘。
（饮病当求其所因。不必尽由于饮水。而即饮水可以例其余也。谓）夫病患饮水多。
（水停胸膈。）必暴喘满。（此其易见而易知也。推而言之。）凡食少（则脾虚不能制
水。）饮多。（则水邪又因而增益。）水停心下。甚者（助肾凌心。）则（为）悸。微
者（妨碍气道。而）短气。（若）脉双（手俱）弦者。寒（气周体）也。皆（因）大下
后（伤中气而）善虚。（若）脉偏（于一手。见）弦者。饮（气偏注）也。（医者求其
病因。当于虚寒二字加意焉可。）
（此言饮病之因。指其大略。以为一隅之举也。）
（上言脉弦。弦为阴象。阴则为寒。弦则为减。减则为虚。不易之理也。然有不可以
弦概之者。自当分别。）肺饮（则脉）不弦。但苦喘短气。 支饮（上附于肺。即同肺饮。故）亦喘而不能
卧。加短气。其脉（亦）平（而不弦）也。（余求其所以然之故。盖以弦者。借木之象
也。肺属金而克木。故肺之自病不弦。肺之初病亦不弦。病势之未甚则然也。二者自当别
论。）
此言饮脉之不弦者。大抵饮之未甚也。举此二者。跌出下节温药之正治。此作撇笔
看。不然与后第十四条矛盾。
（请言其治法。）病痰饮者。（偏寒偏热。皆未中綮。）当以温药和之。（此不烦
之要语也。上节言病痰饮。犹未言痰饮之见出何证也。缘其）心下有痰饮。（阴邪
冒于阳位。阳虚不运。则）胸胁支满。（阴气上干。则）目眩。（此痰饮病之的证也。上
第言以温药和之。犹未言温药之当用何方也。温能化气。甘能健脾。燥能胜湿。淡
能利水。以）苓桂术甘汤主之。（此痰饮病之的方也。）
此为痰饮病而出其方也。
苓桂术甘汤方
茯苓 桂枝 白术（各三两） 甘草（二两）
上四味。以水六升。煮取三升。分温三服。小便则利。
（和以温药。不独治痰饮然也。即微饮亦然。微者不显之谓也。饮而曰微。非气非水。
如阴霾四布。阻塞升降之路。则为短气。谓）夫短气（之由。皆由于）有微饮。（法
）当从小便（而）去之。（盖以膀胱为水腑。太阳之气通于天。以）苓桂术甘汤主之。
（令膀胱气化。则天高日晶。阴霾自散。而升降之气顺矣。若）肾气丸（是从腑而求之脏。
二方相为表里。故）亦主之。
此为短气有微饮。而出利小便二方也。喻氏谓微饮阻碍呼吸而短气。当辨之几微。
若呼之气短。是心肺之阳有碍。宜苓桂术甘汤通其阳。阳气通则膀胱之窍利矣。若吸之
气短。是肝肾之阴有碍。宜肾气丸通其阴。阴通则小便之关开矣。两方并重。与金匮原
文意未甚深透。于此说不可不姑存之。为中人以下说法。
苓桂术甘汤方（见上）
肾气丸方（见妇人杂病）
病者脉伏。（可知其有留饮矣。）其人欲自利。利（后。则所留之饮。从利而减。一
时）反（见爽）快。（然）虽利。（而病根未除。）心下续（即）坚满。（是去者自去。
续者自续。）此为留饮欲去（而不能尽去）故也。（治者。宜乘其欲去之势而导之。以）
甘遂半夏汤主之。
此言留饮有欲去之势。因出其乘势利导之方也。
甘遂半夏汤方
甘遂（大者三枚） 半夏（十二枚以水一升煮取半升去渣。） 芍药（五枚）
甘草（如指大一枚炙）
上四味。以水二升。煮取半升。去渣。以蜜半升。和药汁煎取八合。顿服之。
脉浮（本中虚也。浮中）而（见）细滑。（则为）伤饮。（谓饮水过多所伤。
乃客饮而非内饮也。弦为阴主寒。数为阳主热。前寒疝篇言数弦者。当下其寒。正可触
类而旁通。今按其）脉（则）弦数。（察其证）有寒饮。（是脉与脉相左。脉与证又相
左。相左者势必相持。至）冬（之大寒）夏（之大热。偏寒偏热之药。不能两全。故为）
难治。脉沉而弦者。（沉主里而弦主饮。其为）悬饮内痛。（无疑。）病悬饮者。十枣
汤主之。
此一节分三小节。首节言伤于客饮。以跌起内饮。次节以数弦跌起沉弦。盖悬饮原
为骤得之证。若不用此猛剂。而喘急肿胀诸证随作。恐滋蔓难图也。三因方以三味为末。
枣肉和丸。名十枣丸。颇善变通。
十枣汤方
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。纳药末。强人服
一钱匕。羸人服半钱匕。平旦温服之。不下者。明日更加半钱匕。得快利后。糜粥自养。
（上言饮水流行。归于四肢。当汗出而不汗出。身体重痛。谓之溢饮。夫四肢。阳也。
水在阴者宜利。在阳者宜汗。凡）病溢饮者。当发其汗。（然汗亦有寒热之别。热者以
辛凉发其汗。）大青龙汤主之。（寒者以辛温发其汗。）小青龙汤亦主之。
此言溢饮之治法也。小青龙汤不专发汗。而利水之功居多。二方平列。用者当知所
轻重焉。
大青龙汤方
麻黄（六两） 桂枝 甘草（各二两） 生姜（三两） 杏仁（四十个） 大枣（
十二枚） 石膏（如鸡子大一枚）
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。温粉扑之。
小青龙汤方
麻黄（去节） 芍药 干姜 甘草（炙） 细辛 桂枝（各三两） 五味子 半夏
（各半升）
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。
（膈在上。比心下稍高。）膈间（有）支饮。（迫近于肺。故）其人喘（膈间清虚。
如天之空。饮气乘之。故其人）满。（满极。则连及）心下痞坚。（胃之精华在面。阴
邪夺其正气。故不荣于）面（而）
色黧黑。其脉（因水而）沉（因寒而）紧。得之数十日。医（或疑其在上而）吐（
之。或疑其在下而）下之。（俱）不（能）愈。（宜开三焦水结。通上中下之气。以）
木防己汤主之。（方用人参。以吐下后水邪因脾）虚（而结）者（服之）即愈。（若胃
中有）实者。（虽愈而）三日复发。复与（前方。而病）不愈者。宜木防己汤去石膏（
之寒。）加茯苓（以直输水道。加）芒硝（以峻开坚结。作）汤主之。
此言支饮重证。而两出其方也。
男（元犀）按、膈间支饮喘满者。支饮充满于膈间。似有可吐之义。然既曰支饮。则偏
旁而不正中。岂一吐所能尽乎。云心下痞坚者。似有可下之义。然心下之旁。为脾之部。
以病得数十日之久。虽成坚满。而中气已虚。下之恐蹈虚虚之弊。岂常法所可下乎。
故曰医吐下之不愈也。面色黧黑者。是黑而黯黄。主脾虚胃肠实也。胃肠实则不能敷布
精华于上。此面色黧黑之所由来也。脉沉紧者。沉为病在里。紧为寒为饮。饮邪充满。
内阻三焦之气。喘满痞坚之证作矣。主以木防己汤者。以防己纹如车辐。运上焦之气。
使气行而水亦行。石膏色白体重。降天气以下行。天气降则喘满自平。得桂枝为助。化
气而蒸动水源。使决渎无壅塞之患。妙在重用人参。补五脏。益中焦。俾输转有权。以
成其攻坚破结之用。故曰虚者即愈。实者胃肠成聚。实而有物。故三日复发也。复与不
愈者。宜前方去石膏之凝寒。加茯苓以行其水气。芒硝以攻其结聚。斯支饮顺流而下出
矣。魏氏云、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。以软投坚而即破也。加茯苓者。亦引饮下行之用耳。此解亦超。
木防己汤方
木防己 桂枝（各三两） 人参（四两） 石膏（如鸡子大二枚一本十二枚）
上四味。以水六升。煮取二升。分温再服。
木防己去石膏加茯苓芒硝汤方
木防己 桂枝（各三两） 茯苓（四两） 人参（四两） 芒硝（三合）
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。
心下有支饮。（虽不正中。而迫近于心。是饮邪上乘清阳之位。故）其人苦冒眩。
泽泻汤主之。
泽泻汤方
泽泻（五两） 白术（二两）
上二味。以水二升。煮取一升。分温再服。
支饮胸满者。浓朴大黄汤主之。
上节言心下支饮。用补土镇水法。不使水气凌心。则眩冒自平。此节指支饮在胸。
进一层立论。云胸满者。胸为阳位。饮停于下。下焦不通。逆行渐高。充满于胸故也。
主以浓朴大黄汤者。是调其气分。开其下口。使上焦之饮顺流而下。浓朴性温味苦。
苦主降。温主散。枳实形圆味香。香主舒。圆主转。二味皆气分之药。能调上焦之气。
使气行而水亦行也。继以大黄之推荡。直通地道。领支饮以下行。有何胸满之足患哉。
此方药品与小承气同。其分两主治不同。学人宜潜心体认。方知古人用药之妙。
浓朴大黄汤方
浓朴（一尺） 大黄（六两） 枳实（四枚）
上三味。以水五升。煮取二升。分温再服。
支饮不得息。（肺满而气闭也。闭者宜开。以）葶苈大枣泻肺汤主之。
此为支饮气闭者而出其方治也。
葶苈大枣泻肺汤方（见肺痈）
（凡）呕家（必伤津液。）本（应口）渴。渴者（病从呕出。）为欲解。今反不渴。
（是胃中之客邪可尽。而边旁之水饮常存。饮气能制燥。）心下有支饮故也。（以）
小半夏汤主之。
此言支饮偏而不中。故不能与吐俱出也。小半夏汤。散结蠲饮。且能降逆。
小半夏汤方
半夏（一升一本五钱） 生姜（半斤一本四钱）
上二味。以水七升。煮取一升半。分温再服。
（中焦以下为腹。）腹满。（责在下焦。何以上焦为）口舌干燥。此（为）肠间有
水气。（水尽趋于下。则不能复润于上矣。以）己椒苈黄丸主之。（前后分攻水结。水
结开豁。则腹满可除。水化津生。则口燥可滋矣。）
此下三节。俱言水病。水即饮也。饮之未聚为水。水之既聚为饮。师又统言之。以
补上文所未备。此言肠间有水之治法。
己椒苈黄丸方
防己 椒目 葶苈 大黄（各一两）
Question: The disease of fluid retention (Yin) is divided into four categories. What are they specifically?
Master replied: They are Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Branch Fluid).
This distinguishes the names of the four types of Yin. Nowadays, people add Liu Yin (Retained Fluid) and Fu Yin (Latent Fluid) to the four types, not realizing that the etiology of the four types of Yin diseases mostly originates from water staying without flowing, and in severe cases, lying latent and not expelling out. Why establish new disease names?
Question: How do these four types of Yin differ?
Master replied: The patient was originally robust but now has emaciated body. (This is because the essence and fluids have transformed into phlegm-fluid, no longer filling the exterior form,) only feeling water moving in the intestines. (If water flows smoothly, there is no sound; if there is obstruction,) it makes a gurgling sound. This is called Tan Yin (Phlegm-Fluid). (It refers to the coexistence of thick phlegm and thin fluid.) After drinking water, the fluid stays under the hypochondrium. (Neither ascending nor descending, hanging and condensing without dispersing.) Coughing and spitting induce pain. This is called Xuan Yin (Hanging Fluid). ("Xuan" means hanging.) After drinking water, the fluid flows and returns to the four limbs. Sweating should occur but does not. (Fluid stagnates in the meridians and surface.) The body feels painful and heavy. This is called Yi Yin (Overflowing Fluid). ("Yi" means overflowing.) Coughing with air reflux, leaning on something to breathe, unable to lie flat. (Lung Qi is congested and cannot circulate.) The appearance resembles edema. This is called Zhi Yin (Branch Fluid). (Like water having tributaries or trees having branches, it is near the Zang organs but not in the center.)
This distinguishes the pathological manifestations of the four types of Yin.
(The previously mentioned four types of Yin may be in the diaphragm, intestines, hypochondrium, limbs, or chest, which cannot fully cover all pathologies of fluid retention. Wherever any of the Five Zang organs has a deficiency, fluid will take advantage of it. Its location can be pointed out one by one.) Fluid in the Heart: the epigastrium feels (palpitations strong like) pounding. (Fire is controlled by Water, Qi cannot extend, leading to) shortness of breath, aversion to water and unwillingness to drink. Fluid in the Lung: expectoration of saliva and foam. (Excessive expectoration leads to thirst) desire to drink water. Fluid in the Spleen: (Damage to Middle Qi leads to) lack of Qi (Dampness abundance leads to) heaviness of the body. Fluid in the Liver: (The Liver meridian spreads over the hypochondrium, leading to) fullness and distension under the hypochondrium. (Sneezing originates from the Lung, and the Liver meridian ascends to connect with the Lung, so) sneezing induces (pulling) pain. Fluid in the Kidney: (Water abundance overwhelms the Heart, originating below the umbilicus, with vigorous pulsation, becoming) palpitations in the epigastrium.
This follows up on the four types of Yin and extends to the Five Zang organs, making the theory complete. It mentions Zang but not Fu, because Fu belongs to Yang, and fluid in the Fu can circulate. This differs from the chapter on Water Qi Disease.
(However, regarding the position of the Five Zang organs, it is called "in"; regarding etiology, it is called "retained".) Retained Fluid in the epigastrium: (The back is the mansion of the chest. Fluid retained in the epigastrium overflows into the chest and focuses on the back.) The patient's back feels cold, cold as large as a palm. (Where fluid is retained, Yang Qi cannot enter.) Symptoms of Retained Fluid: pain under the hypochondrium radiating to the Qinglong point. (Because fluid is retained in the Liver, affecting the Lung.) Coughing causes the pain to cease temporarily. (Because the fluid is struck by Qi and tries to move.) Retained Fluid in the chest: the patient (if fluid is abundant, Qi cannot extend, leading to) shortness of breath (if fluid knots, fluids cannot distribute) and (oral) thirst, pain in all joints of the four limbs. (Because phlegm-fluid flows horizontally to the joints. However, it differs from Li Jie Huang Han [Joint Yellow Sweat] because) the pulse is deep (indicating) retained fluid.
This discusses the pathology of fluid remaining and not departing.
Wei Nianting said: The back belongs to Taiyang, symbolizing Gen (Mountain/Stillness) in the I Ching. The whole body moves, but the back remains still. Yin pathogens easily inhabit still places. Therefore, Yin-Cold entering from outside often attacks the back; Yin-Cold generating from inside also often occupies the back.
(Retained fluid that does not depart is called Liu Yin [Retained Fluid]; fluid that lies latent and is difficult to attack is called Fu Yin [Latent Fluid].) Disease of Latent Fluid above the diaphragm: (frequently presenting with) phlegm-fullness, wheezing, and coughing. (The root of the disease is already latent within. Once external pathogens suddenly strike, internal fluid and external pathogens support each other, causing sudden) vomiting (rapid manifestation), resulting in (due to external pathogens) chills, fever, back pain, and waist pain. (Agitating internal fluid, causing severe phlegm-fullness, wheezing, and coughing, leading to) spontaneous tearing and nasal discharge, and the patient trembling and shaking (various symptoms worsening). (Judging by this:) There must be Latent Fluid.
This discusses fluid lying latent and suddenly manifesting. The common term asthma corresponds to this syndrome. Treatment should address both exterior and interior, primarily using Xiao Qing Long Tang (Minor Blue Dragon Decoction) or Mu Fang Ji Tang (Stephania Tetrandra Decoction) with Shigao (Gypsum) removed, plus Mangxiao (Mirabilite) and Fuling (Poria). I discussed this in detail in my works *Gong Yu Yi Lu* (*Shi Fang Ge Kuo* and *Shi Fang Miao Yong*) and *Yi Xue Shi Zai Yi*. I will not repeat it here.
(Fluid diseases should seek their cause. Not all are due to drinking water, but drinking water can serve as an example for others. If) a patient drinks too much water, (water stops in the chest and diaphragm.) it must cause sudden wheezing and fullness. (This is easy to see and know. Extending this logic:) If food intake is low (then Spleen deficiency cannot control water.) and water intake is high. (Then water pathogens increase further.) Water stops in the epigastrium. In severe cases (aiding Kidney Water to overwhelm the Heart.) it causes (palpitations). In mild cases (obstructing the airway,) it causes shortness of breath. (If) the pulse is double (both hands) Xian (Wiry), it indicates Cold (Qi circulating throughout the body). All (are due to) severe purgation (damaging Middle Qi and causing) deficiency. (If) the pulse is biased (on one hand) and Xian (Wiry), it indicates Fluid (Qi biasing). (Physicians seeking the etiology should pay attention to the concepts of Deficiency and Cold.)
(This discusses the general causes of fluid diseases, pointing out the broad outline as an example.)
(Above it was stated that the pulse is Xian [Wiry]. Xian is a Yin image; Yin implies Cold; Xian implies reduction; reduction implies Deficiency. This is an unchangeable principle. However, there are cases where Xian cannot generalize. Distinctions must be made.) Lung Yin (then the pulse is) not Xian [Wiry], only suffering from wheezing and shortness of breath. Zhi Yin (Branch Fluid) (attaches to the Lung above, similar to Lung Yin, so) also wheezes and cannot lie flat, adding shortness of breath. Its pulse (also) Ping [Normal/Flat] (not Xian [Wiry]). (Seeking the reason: Xian borrows the imagery of Wood. Lung belongs to Metal and controls Wood. Thus, primary Lung disease does not present Xian [Wiry], nor does early-stage Lung disease. This is true when the disease process is not severe. These two must be discussed separately.)
This discusses fluid pulses that are not Xian [Wiry], generally indicating that fluid is not severe. By citing these two, it sets up the correct treatment with warming herbs. This section can be viewed as a rhetorical aside; otherwise, it contradicts Article 14 later.
(Please discuss the treatment method.) For patients with Phlegm-Fluid disease. (Whether偏寒偏热 [biased towards Cold or Heat], neither hits the key point.) One should harmonize with Warming Herbs. (This is a concise essential statement. The previous section mentioned Phlegm-Fluid disease but did not specify the manifestations. Because) there is Phlegm-Fluid in the epigastrium. (Yin pathogens invade Yang positions. Yang Deficiency fails to transport, leading to) fullness and distension supporting the chest and hypochondrium. (Yin Qi invades upward, leading to) vertigo/dizziness. (This is the specific syndrome of Phlegm-Fluid disease. Above, it only said to harmonize with warming herbs, without specifying which formula. Warming transforms Qi, Sweet tonifies Spleen, Dryness overcomes Dampness, Blandness promotes urination. Use Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) as the main treatment. (This is the specific formula for Phlegm-Fluid disease.)
This provides the formula for Phlegm-Fluid disease.
Formula: Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction)
Fuling (Poria cocos) Guizhi (Cinnamomi Ramulus) Baizhu (Atractylodis Macrocephalae Rhizoma) Gancacao (Glycyrrhizae Radix et Rhizoma - 2 liang)
The above four ingredients. Boil in 6 sheng of water, reduce to 3 sheng. Divide into three warm doses. Urination will promote recovery.
(Harmonizing with warming herbs is not only for treating Phlegm-Fluid but also for Wei Yin [Mild Fluid]. "Wei" means not obvious. When fluid is called "Wei", it is neither Qi nor Water, but like dark clouds spreading, blocking the pathway of ascent and descent, causing shortness of breath. It is said that) shortness of breath (results from) having Mild Fluid. (The method) should eliminate it through urination. (Since the Bladder is the Water Fu organ, and Taiyang Qi connects with Heaven, use) Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) as the main treatment. (To facilitate Bladder Qi transformation, so that Heaven is high and sun bright, dark clouds disperse, and ascending-descending Qi becomes smooth. If) Shen Qi Wan (Kidney Qi Pill) (seeks the Zang from the Fu, and the two formulas are exterior-interior partners,) it also treats it.
This provides two formulas promoting urination for shortness of breath with Mild Fluid. Yu Jia Yan (Yu Chang) stated that Mild Fluid obstructs respiration causing shortness of breath. One must distinguish subtly: if exhalation is short, it is an obstacle to Heart-Lung Yang, suitable for Ling Gui Zhu Gan Tang to unblock Yang; once Yang is unblocked, Bladder orifices open. If inhalation is short, it is an obstacle to Liver-Kidney Yin, suitable for Shen Qi Wan to unblock Yin; once Yin is unblocked, the gate of urine opens. Both formulas are equally important. This interpretation does not deeply penetrate the original meaning of *Jin Gui Yao Lue*, but should be tentatively preserved as an explanation for those of average or lower capacity.
Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction) (See above)
Shen Qi Wan (Kidney Qi Pill) (See Chapter on Miscellaneous Diseases of Women)
If the patient's pulse is Fu [Deep/Hidden]. (One can know there is Retained Fluid.) The patient desires spontaneous diarrhea. After diarrhea (the retained fluid decreases slightly, bringing temporary relief,) surprisingly (feeling refreshed). (However) although there is diarrhea, (the root of the disease remains.) The epigastrium continues to feel hard and full. (What leaves leaves itself; what remains remains.) This is because Retained Fluid wants to leave (but cannot completely exit). (The practitioner should take advantage of this momentum to guide it out, using) Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction) as the main treatment.
This discusses Retained Fluid having a tendency to leave, providing a formula to guide it along its momentum.
Formula: Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction)
Gansui (Kansui Radix - 3 large pieces) Banxia (Pinelliae Tuber - 12 pieces, boiled in 1 sheng of water to obtain 0.5 sheng, strain.) Shaoyao (Paeoniae Radix Alba - 5 pieces)
Gancao (Glycyrrhizae Radix et Rhizoma - 1 piece the size of a finger, roasted)
The above four ingredients. Boil in 2 sheng of water, reduce to 0.5 sheng. Strain. Add 0.5 sheng of honey, mix with the decoction, and boil to obtain 0.8 sheng. Take in one dose.
A floating pulse (originally indicates Middle Deficiency. Floating among) and (appearing) fine and slippery. (Indicates) Injury by Fluid. (Refers to injury from excessive drinking, which is Exogenous Fluid rather than Endogenous Fluid. Xian [Wiry] governs Yin and Cold; Shu [Rapid] governs Yang and Heat. The previous chapter on Cold Spasm stated that Rapid-Wiry pulse requires purging Cold, which can be analogized. Now, examining the) pulse (as) Xian [Wiry] and Shu [Rapid]. (Observing the syndrome) there is Cold Fluid. (The pulse contradicts itself, and the pulse contradicts the syndrome. Contradictions lead to stalemate. In the Great Cold of Winter or Great Heat of Summer, drugs biased towards Cold or Heat cannot satisfy both, thus it is) difficult to treat. A pulse that is Deep and Xian [Wiry]. (Deep governs Interior and Xian [Wiry] governs Fluid, indicating) Internal Pain of Xuan Yin (Hanging Fluid). (Undoubtedly.) For patients with Xuan Yin (Hanging Fluid), Shi Zao Tang (Ten Jujube Decoction) is the main treatment.
This section divides into three subsections. The first discusses injury by Exogenous Fluid to introduce Endogenous Fluid. The second uses Rapid-Wiry to introduce Deep-Wiry. Since Xuan Yin is an acute condition, if this potent agent is not used, symptoms such as wheezing urgency and swelling will follow, making it difficult to manage. *San Yin Fang* grinds the three ingredients into powder, mixes with jujube paste to make pills, named Shi Zao Wan (Ten Jujube Pills), which is a flexible variation.
Formula: Shi Zao Tang (Ten Jujube Decoction)
Yuanhua (Genkwa Flos - roasted) Gansui (Kansui Radix) Daji (Euphorbiae Pekinensis Radix - equal parts)
The above three ingredients. Pound and sieve. Boil 10 large jujubes in 1.5 sheng of water to obtain 0.8 sheng. Strain. Add the herbal powder. Strong individuals take 1 qian bi; weak individuals take half a qian bi. Take warm at dawn. If no evacuation occurs, increase by half a qian bi the next day. After rapid evacuation, nourish oneself with millet porridge.
(Above it was stated: drinking water flows to the limbs, sweating should occur but does not, body feels heavy and painful, called Yi Yin [Overflowing Fluid]. The four limbs belong to Yang. Water in Yin should be promoted via urination; water in Yang should be released via sweating. For) patients with Yi Yin (Overflowing Fluid), one should induce sweating. (However, sweating methods differ by Cold and Heat. For Heat, induce sweating with Acrid-Cool herbs.) Da Qing Long Tang (Major Blue Dragon Decoction) is the main treatment. (For Cold, induce sweating with Acrid-Warm herbs.) Xiao Qing Long Tang (Minor Blue Dragon Decoction) is also the main treatment.
This discusses the treatment of Yi Yin (Overflowing Fluid). Xiao Qing Long Tang (Minor Blue Dragon Decoction) is not solely for inducing sweating but has more effect in promoting water metabolism. The two formulas are listed side by side; practitioners should know how to weigh them.
Formula: Da Qing Long Tang (Major Blue Dragon Decoction)
Mahuang (Ephedrae Herba - 6 liang) Guizhi (Cinnamomi Ramulus) Gancacao (Glycyrrhizae Radix et Rhizoma - 2 liang each) Shengjiang (Zingiberis Rhizoma Recens - 3 liang) Xingren (Armeniacae Semen Amarum - 40 pieces) Dazao (Ziziphi Jujubae Fructus - 12 pieces) Shigao (Gypsi Fibrosus - 1 piece the size of a chicken egg)
The above seven ingredients. Boil in 9 sheng of water. First boil Mahuang (Ephedrae Herba) reducing by 2 sheng, remove the scum. Add other herbs. Boil to obtain 3 sheng. Strain. Take 1 sheng warm. Aim for slight sweating. If sweating is excessive, apply warm powder to the body.
Formula: Xiao Qing Long Tang (Minor Blue Dragon Decoction)
Mahuang (Ephedrae Herba - de-segmented) Shaoyao (Paeoniae Radix Alba) Ganjiang (Zingiberis Rhizoma) Gancacao (Glycyrrhizae Radix et Rhizoma - roasted) Xixin (Asari Radix et Rhizoma) Guizhi (Cinnamomi Ramulus - 3 liang each) Wuweizi (Schisandrae Chinensis Fructus) Banxia (Pinelliae Tuber - 0.5 sheng each)
The above eight ingredients. Boil in 1 dou of water. First boil Mahuang (Ephedrae Herba) reducing by 2 sheng, remove the scum. Add other herbs. Boil to obtain 3 sheng. Strain. Take 1 sheng warm.
(The diaphragm is above, slightly higher than the epigastrium.) Branch Fluid (Zhi Yin) in the diaphragm. (Pressing against the Lung, so) the patient wheezes (The diaphragm is clear and empty, like the sky. Fluid-Qi takes advantage, so the patient feels) fullness. (When fullness is extreme, it extends to) epigastric痞 hard/fullness. (The essence of the Stomach manifests in the face. Yin pathogens deprive righteous Qi, so it does not nourish the) face (leading to) dark/blackish complexion. The pulse is (due to water) Deep (and due to Cold) Tight. Having had the disease for dozens of days, physicians (suspecting it is above) vomited (it, or suspecting it is below) purged (it.) Neither (method) cured it. (One should open the water knot of the San Jiao, unblocking Qi in the Upper, Middle, and Lower. Use) Mu Fang Ji Tang (Stephania Tetrandra Decoction) as the main treatment. (Using Renshen (Ginseng) in the formula addresses cases where water pathogens knot due to Spleen) Deficiency (after vomiting and purging.) Those (who take it) recover immediately. (If there is Excess in the Stomach.) Although recovered, it recurs after three days. Re-administering (the previous formula without success,) one should use Mu Fang Ji Tang (Stephania Tetrandra Decoction) removing Shigao (Gypsum)'s Cold nature. Add Fuling (Poria) (to directly channel the water pathway) and Mangxiao (Mirabilite) (to severely open firm knots,) prepared as a decoction.
This discusses severe cases of Zhi Yin (Branch Fluid) and provides two formulas.
Commentary by Nan Yuanxi: For Zhi Yin (Branch Fluid) in the diaphragm causing wheezing and fullness, since Zhi Yin fills the diaphragm, it seems appropriate to induce vomiting. However, since it is called "Branch" Fluid, it is lateral and not central; how can one vomiting exhaust it? Epigastric痞 hard/fullness seems appropriate for purging. However, beside the epigastrium is the region of the Spleen. Having had the disease for dozens of days, although firm and full, the Middle Qi is already deficient. Purging risks compounding deficiency. How can it be treated with standard methods? Hence, it is said that physicians' vomiting and purging failed. Dark/blackish complexion indicates black mixed with dull yellow, signifying Spleen Deficiency and Intestinal-Stomach Excess. When Intestines and Stomach are Excess, they cannot distribute essence upwards, causing the dark/blackish complexion. Deep-Tight pulse: Deep indicates Interior disease; Tight indicates Cold and Fluid. Fluid pathogens fill up, internally obstructing San Jiao Qi, causing wheezing, fullness, and epigastric痞 hard/fullness. Using Mu Fang Ji Tang (Stephania Tetrandra Decoction): Fangji (Stephaniae Tetrandrae Radix) has veins like wagon spokes, moving Upper Jiao Qi, allowing Qi to move and Water to follow. Shigao (Gypsum) is white and heavy, descending Heavenly Qi downwards. When Heavenly Qi descends, wheezing and fullness calm. Assisted by Guizhi (Cinnamomi Ramulus), it transforms Qi and steams the source of Water, preventing obstruction in the waterways. The brilliance lies in heavily using Renshen (Ginseng) to tonify the Five Zang and benefit the Middle Jiao, ensuring authority in transportation to achieve the effect of attacking firm knots. Hence, those with Deficiency recover immediately. Those with Excess have accumulated matter in Intestines and Stomach, hence recurrence after three days. Re-administering without success requires removing Shigao (Gypsum)'s congealing Cold from the previous formula, adding Fuling (Poria) to move Water Qi, and Mangxiao (Mirabilite) to attack accumulations, allowing Zhi Yin (Branch Fluid) to flow down and exit. Mr. Wei stated: Removing Shigao (Gypsum) and adding Mangxiao (Mirabilite) in the latter formula is because after dispersing, it gathers again, leaving solid matter as a casing. Thus, using hardness to attack hardness fails, but using softness to attack hardness breaks it. Adding Fuling (Poria) also serves to guide fluid downward. This explanation is also excellent.
Formula: Mu Fang Ji Tang (Stephania Tetrandra Decoction)
Mufangji (Stephaniae Tetrandrae Radix) Guizhi (Cinnamomi Ramulus - 3 liang each) Renshen (Panacis Ginseng Radix - 4 liang) Shigao (Gypsi Fibrosus - 2 pieces the size of a chicken egg, one version says 12 pieces)
The above four ingredients. Boil in 6 sheng of water, reduce to 2 sheng. Divide into two warm doses.
Formula: Mu Fang Ji Tang (Stephania Tetrandra Decoction) removing Shigao (Gypsum) adding Fuling (Poria) and Mangxiao (Mirabilite)
Mufangji (Stephaniae Tetrandrae Radix) Guizhi (Cinnamomi Ramulus - 3 liang each) Fuling (Poria cocos - 4 liang) Renshen (Panacis Ginseng Radix - 4 liang) Mangxiao (Natrii Sulfas - 3 he)
The above five ingredients. Boil in 6 sheng of water, reduce to 2 sheng. Strain. Add Mangxiao (Natrii Sulfas). Simmer slightly. Divide into two warm doses. Slight evacuation indicates recovery.
There is Branch Fluid (Zhi Yin) in the epigastrium. (Although not central, it presses near the Heart. This is fluid pathogens ascending to the clear Yang position, so) the patient suffers from dizziness and vertigo.
Zexie Tang (Alisma and Atractylodes Decoction) is the main treatment.
Formula: Zexie Tang (Alisma and Atractylodes Decoction)
Zexie (Alismatis Rhizoma - 5 liang) Baizhu (Atractylodis Macrocephalae Rhizoma - 2 liang)
The above two ingredients. Boil in 2 sheng of water, reduce to 1 sheng. Divide into two warm doses.
For Zhi Yin (Branch Fluid) with chest fullness, Houpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction) is the main treatment.
The previous section discussed Branch Fluid in the epigastrium, using the method of tonifying Earth to suppress Water. If Water Qi does not overwhelm the Heart, dizziness and vertigo will naturally subside. This section points to Branch Fluid in the chest, advancing the argument. Chest fullness: The chest is a Yang position. Fluid stops below. Lower Jiao is blocked, reversing upward gradually, filling the chest. Using Houpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction) regulates the Qi level, opens the lower outlet, allowing Upper Jiao fluid to flow down. Houpo (Magnoliae Officinalis Cortex) is Warm and Bitter; Bitter directs downward, Warm disperses. Zhishi (Aurantii Fructus Immaturus) is round and fragrant; Fragrance soothes, Round rotates. Both are Qi-moving herbs, capable of regulating Upper Jiao Qi, allowing Qi to move and Water to follow. Followed by Dahuang (Rhei Radix et Rhizoma) pushing and washing, directly opening the earthy pathway, leading Branch Fluid downward. What worry is there for chest fullness? This formula contains the same herbs as Xiao Cheng Qi Tang (Minor Order the Qi Decoction), but dosages and indications differ. Students should study carefully to understand the ingenuity of ancient prescriptions.
Formula: Houpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction)
Houpo (Magnoliae Officinalis Cortex - 1 chi) Dahuang (Rhei Radix et Rhizoma - 6 liang) Zhishi (Aurantii Fructus Immaturus - 4 pieces)
The above three ingredients. Boil in 5 sheng of water, reduce to 2 sheng. Divide into two warm doses.
For Zhi Yin (Branch Fluid) causing inability to breathe. (Lungs are full and Qi is closed. Closed states require opening. Use) Tingli Dazao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs) as the main treatment.
This provides the treatment for Zhi Yin (Branch Fluid) causing Qi closure.
Formula: Tingli Dazao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lungs) (See chapter on Lung Abscess)
(Generally,) patients who vomit (must damage fluids.) Originally (should have oral) thirst. Thirst (indicates the disease is exiting via vomiting.) suggests resolution. Now conversely, there is no thirst, (meaning the guest pathogen in the Stomach can be exhausted, but peripheral fluid retention remains. Fluid-Qi can restrain dryness.) This is because there is Branch Fluid (Zhi Yin) in the epigastrium. (Use) Xiao Ban Xia Tang (Minor Pinellia Decoction) as the main treatment.
This discusses Branch Fluid (Zhi Yin) being lateral and not central, so it cannot exit entirely with vomiting. Xiao Ban Xia Tang (Minor Pinellia Decoction) dissipates knots, eliminates fluid, and descends rebellious Qi.
Formula: Xiao Ban Xia Tang (Minor Pinellia Decoction)
Banxia (Pinelliae Tuber - 1 sheng, one version says 5 qian) Shengjiang (Zingiberis Rhizoma Recens - 0.5 jin, one version says 4 qian)
The above two ingredients. Boil in 7 sheng of water, reduce to 1.5 sheng. Divide into two warm doses.
(Middle Jiao and below is the abdomen.) Abdominal fullness. (Blamed on Lower Jiao, why is there Upper Jiao) dry mouth and tongue? This (is because) there is Water Qi in the intestines. (Water sinks entirely downward, thus cannot moisten upwards anymore. Use) Jingfang Tili Huang Wan (Stephania, Sesame Fruit, Descurainia, and Rhubarb Pill) as the main treatment. (Attacking water knots from front and back separately. Once water knots are cleared, abdominal fullness is removed; as water transforms into fluids, oral dryness is nourished.)
These last three sections all discuss Water diseases. Water is Fluid. Before gathering, Fluid is Water; after gathering, Water is Fluid. The Master summarizes them to supplement what was missing above. This discusses the treatment for Water in the intestines.
Formula: Jingfang Tili Huang Wan (Stephania, Sesame Fruit, Descurainia, and Rhubarb Pill)
Fangji (Stephaniae Tetrandrae Radix) Juemu (Semen Lepidii et Descurainiae) Tingli (Descurainiae Semen) Dahuang (Rhei Radix et Rhizoma - 1 liang each)