此总言用药之治例。病痰饮者。当合四饮而言。以诸饮俱由痰饮传变。故以痰饮统之耳。夫饮之由来。大概
起于肾及脾肺之脏阳衰冷。成于三焦之腑化虚寒。温药和之。则阳回气化而饮自去矣。盖指后文苓桂术
甘、肾气、及大小青龙等剂也。
十七条 心下有痰饮。胸胁支满。目眩。苓桂术甘汤主之。
苓桂术甘汤方 茯苓（四两） 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。
此言诸饮。除溢饮之外。俱以苓桂术甘汤为主方。盖痰饮是其总名。心下及胸支满。为支饮之症。胁下支满。
为悬饮之症。目眩者。饮高而水载木气以浮也。以淡渗去饮之茯苓为君。佐辛甘之桂枝以行阳。甘温之白
术以培土。然后用甘浮平缓之甘草为使。所以高托诸药。而令其徐徐下渗之意。此苓桂术甘。为诸饮之要剂也。
十八条 夫短气。有微饮。当从小便去之。苓桂术甘汤主之。肾气丸亦主之。
此承上文苓桂术甘汤。而补言肾中微有伏饮。以致上干肺气者。亦主此汤也。盖肾有微饮。则其气上射于
肺。而见短气之候。故短气者即知有微饮也。微饮即伏饮。以其在肾脏。故更当利其腑而从小便去也。苓桂
术甘为利水之剂。故主之。肾气丸亦主之者。盖苓桂术甘。温上以御下。而化机下被。故小便利。肾气丸。温下
以蒸上。而化机亦下被。故小便亦利也。方论见虚劳。
十九条 病者脉伏。其人欲自利。利反快。虽利。心下续坚满。此为留饮欲去故也。甘遂半夏汤主之。
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）
上四味。以水二升。煮取半升。去滓。以蜜半升。和药汁。煎取八合。顿服之。
病者。病痰饮者也。饮脉多弦。留饮之脉则沉。今其脉忽然不弦不沉而伏于骨。几几有不可见之象。夫伏脉
为收束下趋之诊。以胸胁心下之饮症。忽焉收束下趋。岂非欲自利乎。反快。对利而言。利症多因利而不快。
如膨闷、疲困及疼痛、沉坠等候。此则脾肺之阳。乘日辰之官旺而偶振。故水饮不安于上而下利。利则水去
气展。故反以利为快也。然虽利而方以不坚满为快。其心下续又坚满而仍不快者。以胃脘及肠间之内水
一空。而胁下之悬饮。先从中满而由络脉以外渗者。今复因内空而还渗心下。（心下当胃脘之部。）故曰
留饮欲去。因其去机而扫荡之。其为功不较易乎。主甘遂半夏汤者。甘遂去水最速。主病之谓君。故以之名
汤。又恐性急之品。下趋甚力。而留遗胸膈之饮。故以甘草、蜂蜜、之甘浮者。托之在上而留恋之。然后以辛燥
之半夏。从上降抑。以酸敛之芍药。从下直坠。而水饮安有不去者哉。不主苓桂术甘。而主此犀利者。恐和平
之药。少延时日。而脾肺之阳仍伏。则饮将欲去而终留。其机岂不以因循坐失耶。甘遂性急。甘草性缓。相
反者、言其缓急之性也。俗解谓二药自相攻击。谬甚。
二十条 脉浮而细滑。伤饮。
此言十二条暴饮之脉也。盖饮水多而其水停心下者。皆谓之伤饮。水停故脉滑。阳微不能运水。故脉细。暴
停之水。阳气未负。故脉浮也。则脉浮而细滑者。非伤饮而何。
二十一条 脉弦数。有寒饮。冬夏难治。
先因阳虚而停饮。故其脉弦。后则积饮化虚热而复伤其阴。故其脉弦而且数也。冬夏难治者。盖治饮之例。
惟宣发渗泄二义。冬则虚阳内伏。既非大小青龙宣发之所宜。且又有碍于弦脉之阳气虚也。夏则虚阳外
应。既非苓桂术甘温燥之所宜。且亦有碍于数脉之阴液短也。谓之难治宜矣。此合溢饮、支饮而言脉症与
天时不顺。其生死相半也。
二十二条 脉沉而弦者。悬饮内痛。病悬饮者。十枣汤主之。
十枣汤方 大戟 芫花（熬） 甘遂（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。得快利后。糜粥自养。
此言悬饮之脉症治例也。脉弦为饮。又为痛。脉沉为留饮。故知为悬饮而胁下并缺盆内痛也。重言病悬饮
者。又推开内痛而广言之耳。盖谓凡属胁下有悬饮。无论内痛与否。俱以十枣汤为主治也。方论见伤寒注。
二十三条 病溢饮者。当发其汗。大青龙汤主之。小青龙汤亦主之。
大青龙汤方
麻黄（六两去节） 桂枝（二两去皮） 杏仁（四十个去皮尖） 甘草（二两炙） 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。
小青龙汤方
麻黄（三两去节） 甘草（三两炙） 桂枝（三两去皮） 芍药（三两） 五味子（半升）
干姜（三两） 半夏（半升） 细辛（三两）
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。
此言溢饮之治例也。饮溢于经络四肢。非从汗解不可。故主大青龙以宣发之。小青龙汤于宣发外。尤能渗
泄。故亦主之。方论见伤寒。
二十四条 膈间支饮。其人喘满。心下痞坚。面色黧黑。其脉沉紧。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。
木防己汤方 木防己（三两） 石膏（鸡子大十二枚） 桂枝（二两） 人参（四两）
上四味。以水六升。煮取二升。分温再服。
木防己去石膏加茯苓芒硝汤方
木防己 桂枝（各三两） 人参 茯苓（各四两） 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。
此言支饮久留之脉症治例也。夫饮症自肠间下积。逐渐上满。由胃而心下膈间。支撑鼓塞者。俱谓之支饮
故合膈间、心下而历言之也。沉。为留饮之脉。紧。即弦脉之急者。盖自其两旁之细削而言曰弦。自其两头之
绷急而言曰紧。与寒邪之紧不同。辨详腹满寒疝。虚实。就胃中之虚实而言。非指正气也。犹云饮外无干结
者为虚。饮外有干结者为实之义。长沙盖谓膈间支饮。抬气上浮而喘满。心下支饮。聚水中实而痞坚。面
则因水色外浮而黑。脉则从水性下坠而沉。且水饮鼓塞。则经脉绷急。而沉中带紧。得之数十日。则饮久而
所谓留饮者是矣。医见喘满痞坚。故吐下之。不知饮之为病。吐则膈气愈虚。而水逆更甚。且由小肠而水归
膀胱者为正道。下则直奔大肠而中气愈虚。水愈积矣。故不愈也。木防己。蔓生而中通。性寒而味辛苦。且其
形色。又外白内黄者。夫蔓生中通。则走脉络之内道。性寒则沉降。味辛则散。苦则泄。外白内黄。又上泄肺。而
下泄脾胃者可见矣。以之为主病之君。则支饮之在膈间心下。以及肠胃脉络。岂有不尽下者哉。但饮久必
化标热。故以石膏之辛凉下行者佐之。然后以人参提气。桂枝行阳。趁水饮之下落。而胸中之阳气。得参桂
助之。而下展有力。倘胃中但有水饮。而无干结之积聚。是谓胃邪未实。故水饮一去。别无余累而愈矣。然又
有水饮虽满。而曾经先结之宿垢自在者。是谓胃实。实者水去而结粪未下。则肠胃之气。滞而难行。三日之
水饮再聚。故复发。复与原汤而并不暂愈者。以水落水起。而干结者较胀。以为水饮之根据辅故也。仍主此汤
者。始终以去饮为本治也。特去石膏者。饮新复而无化热之标病也。加芒硝者。所以软坚化硬而并去其宿
垢也。更加茯苓者。恐芒硝下润之外。其味咸寒聚饮。故以淡渗之品。补救其偏弊也。长沙诊法之玄微。制方
之妙义。直有鬼神所莫测者乎。客有难余者曰。本文言医吐下之不愈。彼吐之不愈。宜矣。子言下之不愈。
以饮归膀胱为正道。下则直趋大肠而中气愈虚。水愈积之故。是医下之而不愈者。长沙以渗法愈之则得
矣。及按防己汤。并无渗水之药。独非从大肠而下者乎。何以虚者即愈也。即如去石膏加茯苓、芒硝一汤。其
汤后曰微利则愈。是亦从大肠而利下者。何以实者又愈也。夫以医下之而不愈者。长沙两下之而皆愈。此
不解者。一也。且本衣冠文物明曰医已下之矣。长沙又下之矣。安得尚有胃实者。而俟加芒硝以软坚化硬乎。此
不解者。二也。答曰。我固知子之所疑者。其以余注为未是也。夫水归膀胱为正道一语。是言去饮之常例。故
治饮者。以利小水为正法。至若水势大张。汪洋澎湃。与其从小便吹嘘渗泄之。而耽延时日。其势复不能减。
毋宁从大便扫除涤荡之之为直捷痛快乎。且小肠以上之水可渗。小肠以下之水。则水低而失膀胱之部。
非下不可。故立甘遂、半夏、十枣、葶苈以及防己等汤。俱不得已之变方变治焉而已。我故曰。水归膀胱为正
道者。此也。至于下药多寒。寒则中气愈虚。而水愈积。故不愈。不观防己二汤之重用人参桂枝乎。又何疑于
仲景下之。则中气不伤而皆愈也。若夫攻下之理。显而易见。苦寒趋下。咸寒破结。医虽以苦寒下之。而遗咸
寒之性。故结者未下耳。此长沙独用芒硝之精意也。语未及终。客唯唯而退。
二十五条 心下有支饮。其人苦眩冒。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。
此言支饮在心下之病症治例也。眩者。晕眩。冒者。蒸冒。皆虚气上冲外鼓之候。心下支饮离膈不远。而水饮
渐迫。以致气高气郁。故苦眩冒也。泽泻利水。而决之于沟渠。白术培土。而防之于堤岸。则水饮下注。而浮鼓
之气自平矣。故主之。
二十六条 支饮胸满者。浓朴大黄汤主之。
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。
此条支饮。另有来路。与诸条之所谓支饮之由于痰饮者不同。故其治法。亦与温药和之之例自别也。盖心
肺间之膈气虚者。不能鼓努传送而便难。便难既久。则肠胃液短而干结。渐致胃实矣。液短。则借资于外水
而饮积心下。胃实。则不能通过结硬而下渗小肠。与寒饮之上支心下者同。故亦谓之支饮也。然支饮虽同。
而其所以致饮者。因胃实胸满之故。则攻胃实之大黄。开胸满之枳朴。其可缓乎。此开壅水之地以治水之
道也。
二十七条 支饮不得息。葶苈大枣泻肺汤主之。
支饮不得息。见首条倚息下。主本汤者。泻其水饮上射之气也。方论见肺痈。
二十八条 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。
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。
胸寒致呕。然呕能提气。呕则阳起而善渴者常也。故渴为呕家欲解之候。今虽呕而反不渴。是呕为寒饮上
逆。而不渴为内饮拒水之故。岂非心下之胃脘。有支饮乎。半夏辛燥而降逆。生姜温膈以祛寒。俾胸阳一展。
则饮去而呕将自平矣。此亦暴饮之少留者也。
二十九条 腹满。口舌干燥。此肠间有水气。己椒苈黄丸主之。
己椒苈黄丸方 防己 椒目 葶苈（熬） 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。（李氏曰。服一
丸疑有误）
此言素盛今瘦。肠间痰饮之治例也。盖瘦则液短。而其便必干。故积聚停滞而腹满。又瘦则液短。而外水必
积。故饮热而口舌干燥也。夫宿垢下瘀而腹满。积饮上烫而干燥。岂非肠间有水气乎。主本方者。大黄苦寒
逐瘀。用之治腹满者。实所以开行饮之道路也。然后以去水三将。同心合力。而共收犄角之全效矣。盖水在
肠间。防己蔓生中通。具大小肠之象。而利水性悍。以之治肠间之水。允为确当。但恐性悍之品。迫水妄行。以
致上激旁渗。故又以辛温纳下之椒目。引之顺流。苦寒利气之葶苈。押为殿后。而水饮宁复有留遗者乎。先
食而服。取其直下肠间。而不使饮食中隔也。日三服而逐渐稍增者。但徐试之。而以中病为度。不使峻药过
剂以伤正气也。口中有津液者。饮去而真气上通。得蒸被之化也。渴者以下。非指服丸以后而言。犹云若腹
满口舌干燥之外。更加渴者。于本方中加芒硝半两。夫渴与干燥有辨。干燥是内饮拒水。而饮久化热之气。
上熏廉泉。故不渴而但觉干燥也。渴则肠胃中已有结粪。而真阴短少。故求救于水而作渴。此正将作支饮
溢饮之渐。故加软坚破结之芒硝。佐大黄之逐瘀。即前二十四条木防己汤加芒硝之义也。
三十条 卒呕吐。心下痞。膈间有水。眩悸者。半夏加茯苓汤主之。
半夏加茯苓汤方 半夏（一斤） 生姜（半斤） 茯苓（六两）
上三味、以水七升。煮取一升五合。分温再服。
此支饮暴停之症治。从卒呕吐、心下痞二症。诊其有水也。卒然呕吐者。膈寒而上涌也。心下痞者。膈虚而下
This section generally discusses the principles of medication treatment. For patients with Phlegm-Fluid (Tan-Yin) disease, one should consider the "Four Fluids" (Phlegm-Fluid, Suspended-Fluid, Overflowing-Fluid, and Pivotal-Fluid) comprehensively, as all types of fluid retention originate from the progression of Phlegm-Fluid; thus, "Phlegm-Fluid" is used to encompass them. The origin of Fluids generally stems from the decline and coldness of the Yang Qi in the Kidney, Spleen, and Lung Zang organs, and forms due to the deficiency-cold of transformation in the Sanjiao Fu organs. Using warming medicines to harmonize will restore Yang Qi and Qi transformation, causing the Fluids to dissipate naturally. This refers to the formulas mentioned later: Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction), Shen Qi Wan (Kidney Qi Pill), as well as Da Qing Long Tang (Major Blue-Green Dragon Decoction) and Xiao Qing Long Tang (Minor Blue-Green Dragon Decoction).
Article 17: When there is Phlegm-Fluid below the heart, accompanied by a feeling of fullness and distension in the chest and hypochondrium, and vertigo, treat with Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction).
Ling Gui Zhu Gan Tang Formula: Fu Ling (Poria, 4 liang), Gui Zhi (Cinnamon Twig), Bai Zhu (Atractodes, each 3 liang), Gan Cao (Licorice, 2 liang).
The above four ingredients are boiled in 6 sheng of water until 3 sheng remain. Divide into three warm doses. Urination will increase after administration.
This article discusses that for various fluid diseases, except for Overflowing-Fluid, Ling Gui Zhu Gan Tang is the primary formula. Since Phlegm-Fluid is the general term, fullness and distension below the heart and in the chest are symptoms of Pivotal-Fluid (Zhi-Yin); fullness and distension in the hypochondrium are symptoms of Suspended-Fluid (Xuan-Yin). Vertigo occurs because the Fluid is located high, and water carries the Wood Qi upwards. Poria (Fu Ling), with its bland and leaching properties to remove Fluid, serves as the Sovereign herb. It is assisted by Cinnamon Twig (Gui Zhi), acrid and sweet, to promote Yang Qi, and Atractodes (Bai Zhu), sweet and warm, to strengthen the Earth. Finally, Licorice (Gan Cao), sweet and mild, acts as the Envoy. This elevates the action of the other herbs, allowing them to slowly leach downwards. Thus, Ling Gui Zhu Gan Tang is the crucial formula for treating various fluids.
Article 18: Shortness of breath indicates slight Fluid retention, which should be eliminated through urination. Treat with Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction); Shen Qi Wan (Kidney Qi Pill) may also be used.
This follows up on Ling Gui Zhu Gan Tang, supplementing that slight latent Fluid in the Kidney affecting Lung Qi can also be treated with this decoction. Slight Fluid in the Kidney causes Qi to shoot upwards to the Lung, resulting in shortness of breath. Therefore, shortness of breath indicates slight Fluid. Slight Fluid is latent Fluid; since it resides in the Kidney, it is appropriate to benefit the Fu organ and eliminate it via urination. Ling Gui Zhu Gan Tang is a diuretic formula, hence it is indicated. Shen Qi Wan is also indicated because Ling Gui Zhu Gan Tang warms the Upper Jiao to control the Lower, allowing transformative Qi to descend, promoting urination; Shen Qi Wan warms the Lower Jiao to steam the Upper, also allowing transformative Qi to descend, thus promoting urination. The formula discussion is found in the "Deficiency Consumption" chapter.
Article 19: If the patient's pulse is deep and hidden, and they desire spontaneous diarrhea, which brings relief, yet despite the diarrhea, the area below the heart remains hard and full, this indicates that retained Fluid is attempting to exit. Treat with Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction).
Gan Sui Ban Xia Tang Formula: Gan Sui (Kansui Root, 3 large pieces), Ban Xia (Pinellia Tuber, 12 pieces, boiled in 1 sheng of water until 0.5 sheng remains, strain), Shao Yao (Peony Root, 5 pieces), Gan Cao (Licorice, 1 piece the size of a finger).
The above four ingredients are boiled in 2 sheng of water until 0.5 sheng remains. Strain, add 0.5 sheng of honey, mix with the decoction, and boil until 0.8 sheng remains. Take in one dose.
The "patient" refers to one suffering from Phlegm-Fluid. Pulse patterns for Fluid are often wiry; for retained Fluid, they are deep. Here, the pulse suddenly becomes neither wiry nor deep but hidden/deeply buried, almost imperceptible. A hidden pulse indicates contraction and downward movement. For fluid symptoms in the chest, hypochondrium, and below the heart, such a sudden downward trend suggests an attempt at spontaneous diarrhea. "Relief" contrasts with typical diarrhea discomfort (such as bloating, fatigue, pain, or heaviness). Here, the Yang Qi of the Spleen and Lung temporarily revitalizes during favorable time periods, causing Water-Fluid to move downward and exit via diarrhea. After evacuation, Water leaves and Qi expands, bringing relief. However, if the area below the heart remains hard and full without relief, it is because the water in the stomach and intestines has emptied, while the Suspended-Fluid in the hypochondrium, having previously seeped out through collaterals from central fullness, now re-seeps into the area below the heart (corresponding to the epigastrium) due to the internal emptiness. This is described as "retained Fluid attempting to exit." Taking advantage of this momentum to clear it makes the treatment easier. Gan Sui Ban Xia Tang is indicated because Kansui (Gan Sui) removes Water most rapidly and is the Sovereign herb targeting the main pathology, hence the name. Fearing that such potent drugs might act too forcefully downwards and leave Fluid in the chest and diaphragm, Licorice and Honey, being sweet and floating, are used to hold the action upward. Then, the acrid-drying Pinellia (Ban Xia) suppresses from above, and the sour-astringent Peony (Shao Yao) pulls down from below, ensuring the removal of Water-Fluid. Ling Gui Zhu Gan Tang is not used here because mild medicines might delay recovery, allowing Spleen and Lung Yang to remain latent, causing the Fluid to linger despite attempts to expel it. Kansui is rapid-acting, while Licorice is slow-acting; their opposition refers to these speeds, not mutual antagonism as vulgar interpretations suggest.
Article 20: A pulse that is floating, thin, and slippery indicates Injury by Fluid (Shang Yin).
This describes the pulse pattern for excessive drinking mentioned in Article 12. Drinking too much water leading to stagnation below the heart is called Injury by Fluid. Stagnant Water causes a slippery pulse; weak Yang unable to transform Water causes a thin pulse; acute accumulation where Yang is not yet compromised causes a floating pulse. Thus, a floating, thin, and slippery pulse confirms Injury by Fluid.
Article 21: A wiry and rapid pulse indicates Cold Fluid; difficult to treat in winter and summer.
Initially, Yang deficiency leads to Fluid stagnation, causing a wiry pulse. Later, accumulated Fluid transforms into deficient heat, damaging Yin, resulting in a wiry and rapid pulse. Treatment is difficult in winter and summer because the principles of treating Fluid are only dispersing/diffusing (Xuan Fa) and leaching/draining (Shen Xie). In winter, deficient Yang is hidden internally; neither Da Qing Long Tang nor Xiao Qing Long Tang is suitable for dispersing, and it further hinders the already deficient Yang indicated by the wiry pulse. In summer, deficient Yang responds externally; Ling Gui Zhu Gan Tang's warming and drying nature is unsuitable, and it hinders the Yin fluid deficiency indicated by the rapid pulse. Hence, it is deemed difficult to treat. This combines Overflowing-Fluid and Pivotal-Fluid, illustrating cases where pulse/symptoms conflict with seasonal timing, leading to a fifty-fifty prognosis.
Article 22: A pulse that is deep and wiry indicates Suspended-Fluid (Xuan Yin) with internal pain. Patients with Suspended-Fluid should be treated with Shi Zao Tang (Ten Date Pill).
Shi Zao Tang Formula: Da Ji (Euphorbia Lathyris Root), Yuan Hua (Genkwa Flower, roasted), Gan Sui (Kansui Root) in equal parts.
The above three ingredients are crushed and sifted. Boil ten large Jujubes (Da Zao) in 1.5 sheng of water until 0.8 sheng remains. Strain, add the powder. Strong individuals take 1 qian bi; weak individuals take half a qian bi. Take warm on an empty stomach in the morning. If no bowel movement occurs, increase by half a qian bi the next day. After obtaining rapid purgation, nourish oneself with millet porridge.
This discusses the pulse, symptoms, and treatment for Suspended-Fluid. A wiry pulse indicates Fluid and pain; a deep pulse indicates retained Fluid. Thus, it is identified as Suspended-Fluid with pain in the hypochondrium and clavicular region. Repeating "Patients with Suspended-Fluid" broadens the scope beyond just internal pain. It means any case of Suspended-Fluid in the hypochondrium, regardless of pain, is primarily treated with Shi Zao Tang. The formula discussion is in the "Shang Han" commentary.
Article 23: For patients with Overflowing-Fluid (Yi Yin), sweating should be induced. Treat with Da Qing Long Tang (Major Blue-Green Dragon Decoction); Xiao Qing Long Tang (Minor Blue-Green Dragon Decoction) may also be used.
Da Qing Long Tang Formula: Ma Huang (Ephedra Stem, 6 liang, tips removed), Gui Zhi (Cinnamon Twig, 2 liang, bark removed), Xing Ren (Apricot Seed, 40 pieces, skin and tips removed), Gan Cao (Licorice, 2 liang, honey-fried), Sheng Jiang (Fresh Ginger, 3 liang), Da Zao (Jujube, 12 pieces), Shi Gao (Gypsum, size of a chicken egg, crushed).
The above seven ingredients are boiled in 9 sheng of water. First, boil Ma Huang until reduced by 2 sheng, removing the foam. Add remaining herbs, boil until 3 sheng remain. Strain, take 1 sheng warm. Aim for a slight sweat. If sweating is excessive, dust with warm powder.
Xiao Qing Long Tang Formula: Ma Huang (Ephedra Stem, 3 liang, tips removed), Gan Cao (Licorice, 3 liang, honey-fried), Gui Zhi (Cinnamon Twig, 3 liang, bark removed), Shao Yao (Peony Root, 3 liang), Wu Wei Zi (Schisandra Berry, 0.5 sheng), Gan Jiang (Dried Ginger, 3 liang), Ban Xia (Pinellia Tuber, 0.5 sheng), Xi Xin (Asarum, 3 liang).
The above eight ingredients are boiled in 1 dou of water. First, boil Ma Huang until reduced by 2 sheng, removing the foam. Add remaining herbs, boil until 3 sheng remain. Strain, take 1 sheng warm.
This discusses the treatment for Overflowing-Fluid. Fluid overflowing into meridians and limbs must be resolved through sweating. Da Qing Long Tang induces diffusion/sweating; Xiao Qing Long Tang also promotes leaching/draining alongside diffusion. Hence, both are indicated. The formula discussion is in "Shang Han".
Article 24: Pivotal-Fluid (Zhi Yin) in the diaphragm causes wheezing and fullness, epigastric hardness and obstruction, dark facial complexion, and a deep, tight pulse. Onset was decades ago. Physicians attempted emesis and purgation without success. Treat with Mu Fang Ji Tang (Stephania Tetrandra Decoction). If the condition is Deficient, it resolves immediately. If Excess, it recurs in three days. If recurrence does not resolve with the original formula, use Mu Fang Ji Tang minus Shi Gao plus Fu Ling and Mang Xiao (Stephania Tetrandra Decoction minus Gypsum plus Poria and Mirabilite).
Mu Fang Ji Tang Formula: Mu Fang Ji (Stephania Tetrandra Root, 3 liang), Shi Gao (Gypsum, 12 pieces the size of a chicken egg), Gui Zhi (Cinnamon Twig, 2 liang), Ren Shen (Ginseng, 4 liang).
The above four ingredients are boiled in 6 sheng of water until 2 sheng remain. Divide into two warm doses.
Mu Fang Ji Tang minus Shi Gao plus Fu Ling and Mang Xiao Formula: Mu Fang Ji, Gui Zhi (each 3 liang), Ren Shen, Fu Ling (Poria, each 4 liang), Mang Xiao (Mirabilite, 3 he).
The above five ingredients are boiled in 6 sheng of water until 2 sheng remain. Strain, add Mang Xiao, simmer slightly. Divide into two warm doses. Mild purgation indicates cure.
This discusses the pulse, symptoms, and treatment for long-standing Pivotal-Fluid. Fluid accumulates from the intestines upward, filling the stomach, below-heart, and diaphragm, causing support and blockage, termed Pivotal-Fluid. Deep pulse indicates retained Fluid; tight pulse is a tense variant of wiry, distinct from Cold-tight. "Deficient/Excess" refers to the presence or absence of dry accumulation outside the Fluid, not Zheng Qi. Zhang Zhongjing posits that Diaphragmatic Pivotal-Fluid causes Qi to float up (wheezing/fullness); Sub-cardiac Pivotal-Fluid involves solid water accumulation (hardness/obstruction). Dark face results from Water color floating outward; deep pulse results from Water weight sinking; tightness comes from meridian tension due to Fluid blockage. Onset over decades indicates retained Fluid. Physicians used emesis/purgation mistakenly: emesis depletes Diaphragm Qi and worsens Water counterflow; purgation diverts Water to the Large Intestine rather than the Bladder (the correct path), depleting Middle Qi and accumulating more Water. Mu Fang Ji is vining and hollow, entering collateral channels; cold in nature sinks; acrid/bitter scatters/vents; white exterior/yellow interior vents Lung and Spleen/Stomach. As Sovereign, it directs Fluid downward. Shi Gao (acrid-cool) assists against secondary heat from long-standing Fluid. Ren Shen lifts Qi; Gui Zhi moves Yang, aiding the descent of Fluid. If only Fluid exists (no dry accumulation/Deficient type), cure follows. If dry feces persist (Excess type), Fluid returns in three days due to Qi stagnation. Recurrence unresponsive to the original formula requires removing Shi Gao (as secondary heat has subsided) and adding Mang Xiao (to soften hardness/clear old feces) and Fu Ling (to counteract Mang Xiao's salty-cold gathering effect with bland leaching). The guest questions why Zhang Zhongjing uses purgation when the text says purgation failed, and why adding Mang Xiao works for Excess if the physician's purgation failed. The response explains that while draining Small Water via the Bladder is the standard, massive Fluid accumulation requires direct elimination via the Large Intestine (as seen in Gan Sui Ban Xia Tang, Shi Zao Tang, etc.) when bladder drainage is insufficient for lower abdominal Water. The failure of previous purgation was due to cold medicines damaging Middle Qi; Mu Fang Ji Tang uses Ren Shen and Gui Zhi to protect Qi. The key difference is using Mang Xiao (salty-cold to break knots) alongside bitter-cold herbs, which Zhang Zhongjing uniquely employs. The guest withdraws.
Article 25: Pivotal-Fluid below the heart causes severe vertigo and dizziness. Treat with Ze Xie Tang (Alisma Decoction).
Ze Xie Tang Formula: Ze Xie (Alisma Rhizome, 5 liang), Bai Zhu (Atractodes, 2 liang).
The above two ingredients are boiled in 2 sheng of water until 1 sheng remains. Divide into two warm doses.
This discusses Pivotal-Fluid in the sub-cardiac region. Vertigo and dizziness result from deficient Qi rushing upward and expanding. Proximity to the diaphragm and increasing Water pressure cause Qi stagnation. Alisma drains Water like a canal; Atractodes strengthens Earth like a dam, allowing Water to flow down and calming floating Qi.
Article 26: Pivotal-Fluid with chest fullness is treated with Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction).
Hou Po Da Huang Tang Formula: Hou Po (Magnolia Bark, 1 chi), Da Huang (Rhubarb, 6 liang), Zhi Shi (Immature Bitter Orange, 4 pieces).
The above three ingredients are boiled in 5 sheng of water until 2 sheng remain. Divide into two warm doses.
This case of Pivotal-Fluid has a different etiology than others caused by Phlegm-Fluid. Its treatment differs from warming/harmonizing. Deficiency of Qi between Heart and Lung fails to transport stool, leading to constipation. Chronic constipation dries intestinal fluids, causing gastric excess. Fluid shortage draws external water into the sub-cardiac region. Gastric excess prevents downward seepage to the Small Intestine, mimicking Cold Fluid rising to the sub-cardiac region. Thus, it is called Pivotal-Fluid. Treatment targets gastric excess with Rhubarb and chest fullness with Magnolia Bark and Immature Bitter Orange, clearing obstructions to manage Water.
Article 27: Pivotal-Fluid causing inability to breathe is treated with Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Lung-Purging Decoction).
For Pivotal-Fluid causing breathing difficulty (see Article 1 regarding leaning to breathe), this formula purges the Qi of Water-Fluid shooting upwards. The formula discussion is in "Lung Abscess".
Article 28: Vomiting patients usually feel thirsty; thirst indicates resolution. If not thirsty now, it is due to Pivotal-Fluid below the heart. Treat with Xiao Ban Xia Tang (Minor Pinellia Decoction).
Xiao Ban Xia Tang Formula: Ban Xia (Pinellia Tuber, 1 sheng), Sheng Jiang (Fresh Ginger, 0.5 jin).
The above two ingredients are boiled in 7 sheng of water until 1.5 sheng remain. Divide into two warm doses.
Cold in the chest causes vomiting. Vomiting raises Qi, usually causing thirst (resolution sign). Lack of thirst despite vomiting indicates Cold-Fluid counterflow and internal Fluid rejecting water. This implies Pivotal-Fluid in the stomach. Pinellia is acrid-drying and descends rebellious Qi; Fresh Ginger warms the diaphragm and dispels Cold. Once Chest Yang expands, Fluid dissipates and vomiting stops. This represents minor residual Fluid from excessive drinking.
Article 29: Abdominal fullness and dry mouth/tongue indicate Water-Qi in the intestines. Treat with Ji Jiao Li Huang Wan (Stephania, Pepper Seed, Descurainia, and Rhubarb Pill).
Ji Jiao Li Huang Wan Formula: Fang Ji (Stephania Tetrandra Root), Jiao Mu (Zanthoxylum Seed), Ting Li (Descurainia Seed, roasted), Da Huang (Rhubarb) each 1 liang.
Crush into powder, make honey pills the size of wu zi seeds. Take one pill before meals with water, three times daily, gradually increasing. If thirsty, add 0.5 liang of Mang Xiao. (Li notes: taking one pill may be an error).
This discusses treatment for chronic obesity turning to emaciation with intestinal Phlegm-Fluid. Emaciation implies fluid shortage and dry stool, causing abdominal fullness. Fluid shortage also causes external water accumulation, leading to Heat-Fluid and dry mouth. Old fecal stasis causes fullness; accumulated Fluid causes dryness. Rhubarb (bitter-cold) clears stasis to open pathways for Fluid. Fang Ji (vining/hollow) targets Large/Small Intestines; Jiao Mu (acrid-warm) guides Water smoothly; Ting Li (bitter-cold) covers the rear. Taken before meals to target intestines directly. Gradual dosing avoids damaging Zheng Qi. Saliva return indicates true Qi restoration. Thirst (distinct from dryness) indicates existing dry feces and Yin deficiency seeking water, signaling impending Overflowing/Pivotal-Fluid. Adding Mang Xiao softens hardness, assisting Rhubarb, similar to Article 24.
Article 30: Sudden vomiting, epigastric obstruction, Water in the diaphragm, vertigo, and palpitations are treated with Ban Xia Jia Fu Ling Tang (Pinellia plus Poria Decoction).
Ban Xia Jia Fu Ling Tang Formula: Ban Xia (Pinellia Tuber, 1 jin), Sheng Jiang (Fresh Ginger, 0.5 jin), Fu Ling (Poria, 6 liang).
The above three ingredients are boiled in 7 sheng of water until 1.5 sheng remain. Divide into two warm doses.
This addresses acute Pivotal-Fluid diagnosed by sudden vomiting and epigastric obstruction indicating Water. Sudden vomiting is due to Cold in the Diaphragm surging upward. Epigastric obstruction is due to Diaphragm deficiency...