文蛤（五两）
上一味为散。以沸汤。和一方寸匕服。汤用五合。
病在阳不从汗散。反以冷水 之灌之。寒束其外。热被却而不得去。阳无出路。弥更益
烦。
水客皮肤。肉上粟起。阳气为水邪所格。故欲饮水。反不得饮。五苓散宣阳逐水则有余。育
阴散热则不足。独任文蛤一味。可以两收散热导湿之功。
服文蛤散不瘥。复用五苓散者。以既得文蛤咸寒之性。清热导湿。免致增逆矣。而表阳
不宣。水无出路。文蛤不堪再任。则仍取五苓宣阳逐水。此救逆之次第也。
茯苓（四两） 桂枝（三两去皮） 白术（二两） 甘草（二两炙）
上四味。以水六升。煮取三升。去滓。分温三服。
此方主治太阴湿困。而膀胱之气。不行。经云。心下逆满。气上冲胸。起则头眩。脉沉
紧。
发汗。则动经身为振振摇者。此汤主之。按心下逆满。乃伏饮搏膈。至于气冲头眩。则寒邪
上涌。助饮为逆。饮本阴邪。故脉见沉紧。脉沉不宜发汗。误汗则阳益不支。而身为振摇。
故以桂枝茯苓。扶阳化饮。而加白术甘草。伸太阴之权。以理脾而胜湿。脾乃能为胃行其津
液。而膀胱之气始化也。
再按金匮用此方以治痰饮。其一曰。心下有痰饮。胸胁支满。目眩。苓桂术甘汤主之。
又曰
。短气有微饮。当从小便去之。苓桂术甘汤主之。盖治痰饮大法。当以温药和之。温则脾阳
易于
健运。而阴寒自化。白术茯苓虽能理脾而胜湿。必合桂枝化太阳之气以伐肾邪。而通水道。
方能取效。
文蛤（五两）
将以上一味药研成散剂。用沸水调和一方寸匕的药粉服用，用水五合。
病邪在阳分，本应从汗而解，却反而用冷水浇灌它。寒气束缚于体表，热气被遏制而无法散去，阳气没有出路，更加烦闷不安。
水湿客居皮肤，肌肉上出现鸡皮疙瘩。阳气被水湿邪气阻隔，所以想喝水，却又喝不下去。此时若单用五苓散宣通阳气、驱逐水湿则力量有余，但滋养阴液、清除热邪则力量不足。单独使用文蛤一味药，可以同时达到散热和引导湿气排出的功效。
如果服用文蛤散后病未痊愈，再复用五苓散的原因在于：既然已经利用了文蛤咸寒的性质来清热导湿，避免了病情加重逆乱。但是表部的阳气仍未宣通，水湿没有出路，文蛤已不足以胜任后续治疗，因此仍然选用五苓散来宣通阳气、驱逐水湿。这是纠正误治的先后步骤。
茯苓（四两） 桂枝（三两，去皮） 白术（二两） 甘草（二两，炙）
以上四味药，用水六升，煮取三升药液，去掉药渣，分三次温服。
此方主治太阴脾土受湿邪困阻，导致膀胱气化功能不行。经书说：“心下逆满，气上冲胸，起立时头晕目眩，脉象沉紧。”
如果发汗，就会扰动经脉，导致身体震颤摇晃，此汤主治这种情况。按语：心下逆满，是伏留的饮邪搏结于膈部；至于气冲头眩，则是寒邪上涌，助长饮邪为逆。饮邪本属阴邪，所以脉象表现为沉紧。脉沉不宜发汗，误用发汗法会使阳气更加虚弱，导致身体震颤摇晃。因此用桂枝、茯苓扶助阳气、化除饮邪，并加入白术、甘草，增强太阴脾土的职权，以调理脾胃而胜除湿邪。脾的功能正常，才能为胃输送津液，膀胱的气化功能才得以恢复。
再按《金匮要略》用此方治疗痰饮，其中一条说：“心下有痰饮，胸胁支撑胀满，头晕目眩，用苓桂术甘汤主治。”又说：“短气伴有轻微饮邪，应当从小便排出，用苓桂术甘汤主治。”大概治疗痰饮的大法，应当用温性药物调和。温性有助于脾阳易于健运，阴寒之邪自然化解。白术、茯苓虽然能调理脾胃而胜湿，但必须配合桂枝化太阳之气以伐肾邪，从而通利水道，方能取得疗效。
Wenli San (Clam Shell Powder) [Wenli: Clam Shell] (five liang)
Grind the above single herb into a powder. Mix one cun-bi (a measure of volume, approx. 2-3 grams) with boiling water for oral administration. Use five he (approx. 100 ml) of water.
When the pathogen is in the Yang aspect, it should naturally be dispersed through sweating. However, if cold water is poured over the patient, the cold binds the exterior, trapping the heat inside so it cannot escape. With no outlet for the Yang Qi, the patient becomes increasingly restless and irritable.
Water dampness lodges in the skin, causing gooseflesh on the muscles. The Yang Qi is obstructed by the water-damp pathogen; thus, there is a desire to drink, yet an inability to swallow. Using Wuling San (Five-Ingredient Powder with Poria) alone would be sufficient to circulate Yang and expel water, but insufficient to nourish Yin and clear heat. Using only Wenli (Clam Shell) can achieve both the effects of clearing heat and guiding out dampness.
If the condition does not improve after taking Wenli San, Wuling San (Five-Ingredient Powder with Poria) [Wuling San: Five-Ingredient Powder with Poria] should be administered subsequently. This is because, having utilized the salty and cold nature of Wenli (Clam Shell) to clear heat and guide out dampness, further aggravation is avoided. However, since the exterior Yang remains unventilated and water has no exit, Wenli (Clam Shell) is no longer adequate. Therefore, Wuling San (Five-Ingredient Powder with Poria) is chosen again to circulate Yang and expel water. This represents the sequential steps for correcting adverse reactions.
Fuling (Poria) [Fuling: Poria] (four liang), Guizhi (Cinnamon Twig) [Guizhi: Cinnamon Twig] (three liang, bark removed), Baizhu (Atractylodes Macrocephala Rhizome) [Baizhu: Atractylodes Macrocephala Rhizome] (two liang), Gancao (Licorice Root) [Gancao: Licorice Root] (two liang, honey-fried).
Take the above four herbs, add six sheng (approx. 1200 ml) of water, decoct to obtain three sheng (approx. 600 ml) of liquid, remove the dregs, and divide into three warm doses.
This formula primarily treats Taiyin Spleen deficiency complicated by dampness obstruction, leading to impaired Qi transformation of the Bladder. The Classics state: "Fullness and rebellious sensation below the heart, Qi rushing up to the chest, dizziness upon standing, and a deep, tight pulse."
If sweating is induced inappropriately, it disturbs the meridians, causing tremors and shaking of the body; this formula is indicated for such cases. Commentary: The fullness and rebellious sensation below the heart result from latent fluid retention binding at the diaphragm. The Qi rushing to the head and dizziness occur when cold pathogens surge upward, exacerbating the fluid retention. Since fluid retention is inherently a Yin pathogen, the pulse appears deep and tight. A deep pulse contraindicates sweating; inappropriate sweating further depletes Yang Qi, leading to bodily tremors. Therefore, Guizhi (Cinnamon Twig) and Fuling (Poria) are used to support Yang and transform fluids, while Baizhu (Atractylodes Macrocephala Rhizome) and Gancao (Licorice Root) strengthen the function of the Taiyin Spleen to resolve dampness. When the Spleen functions properly, it can transport fluids for the Stomach, allowing the Qi transformation of the Bladder to resume.
Furthermore, according to the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), this formula is used to treat Phlegm-Fluids. One indication states: "Phlegm-fluids in the epigastrium causing distension and fullness in the chest and hypochondrium, along with dizziness, are treated with Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction)." Another states: "Shortness of breath with mild fluid retention should be resolved via urination, treated with Linggui Zhugan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction)." Generally, the principle for treating Phlegm-Fluids is to harmonize with warm herbs. Warmth facilitates the vigorous movement of Spleen Yang, causing Yin-cold to transform naturally. Although Baizhu (Atractylodes Macrocephala Rhizome) and Fuling (Poria) regulate the Spleen and resolve dampness, they must be combined with Guizhi (Cinnamon Twig) to transform Taiyang Qi, subdue Kidney pathogens, and unblock the water passages to achieve efficacy.