治因心肺阳虚，致脾湿不升，胃郁不降，饮食不能运化精微，变为饮邪。停于胃口为满闷，溢于膈上为短
气，渍满肺窍为喘促，滞腻咽喉为咳吐粘涎。甚或阴霾布满上焦，心肺之阳不能畅舒，转郁而作热。或阴气逼
阳外出为身热，迫阳气上浮为耳聋。然必诊其脉，确乎弦迟细弱者，方能投以此汤。
于术（四钱） 干姜（五钱） 桂枝尖（二钱） 炙甘草（二钱） 茯苓片（二钱） 生杭芍（二钱）
桔红（钱半） 川浓朴（钱半）
服数剂后，饮虽开通，而气分若不足者，酌加生黄 数钱。
方中用桂枝、干姜，以助心肺之阳，而宣通之。白术、茯苓、甘草，以理脾胃之湿，而淡渗之（茯苓甘草
同用最泻湿满）。用浓朴者，叶天士谓∶“浓朴多用则破气，少用则通阳”，欲借温通之性，使胃中阳通气降，
运水谷速于下行也。用桔红者，助白术、茯苓、甘草以利痰饮也。至白芍，若取其苦平之性，可防热药之上僭
（平者主降），若取其酸敛之性，可制虚火之浮游（《神农本草经》谓芍药苦平，后世谓芍药酸敛，其味实苦
而微酸）。且药之热者，宜于脾胃，恐不宜于肝胆，又取其凉润之性，善滋肝胆之阴，即预防肝胆之热也。况
其善利小便，小便利而痰饮自减乎。
一妇人，年四十许。胸中常觉满闷发热，或旬日，或浃辰之间，必大喘一两日。医者用清火理气之药，初
服稍效，久服转增剧。后愚诊视，脉沉细几不可见。病家问∶系何病因？愚曰∶此乃心肺阳虚，不能宣通脾胃，
以致多生痰饮也。人之脾胃属土，若地舆然。心肺居临其上正当太阳部位（膈上属太阳，观《伤寒论》太阳篇
自知），其阳气宣通，若日丽中天暖光下照。而胃中所纳水谷，实借其阳气宣通之力，以运化精微而生气血，
传送渣滓而为二便。清升浊降，痰饮何由而生？惟心肺阳虚，不能如离照当空，脾胃即不能借其宣通之力，以
运化传送，于是饮食停滞胃口，若大雨之后，阴雾连旬，遍地污淖，不能干渗，则痰饮生矣。痰饮既生，日积
月累，郁满上焦则作闷，渍满肺窍则作喘，阻遏心肺阳气，不能四布则作热。医者不识病源，犹用凉药清之，
勿怪其久而增剧也。遂为制此汤，服之一剂，心中热去，数剂后转觉凉甚。遂去白芍，连服二十余剂，胸次豁
然，喘不再发。
一妇人，年三十许。身形素丰。胸中痰涎郁结，若碍饮食，上焦时觉烦热。偶服礞石滚痰丸有效，遂日日
服之。初则饮食加多，继则饮食渐减，后则一日不服，即不能进饮食。又久服之。
竟分毫无效，日仅一餐，进食少许，犹不能消化。且时觉热气上腾，耳鸣欲聋，始疑药不对证。求愚延医，其
脉象浮大，按之甚软。愚曰∶此证心肺阳虚，脾胃气弱，为服苦寒攻泻之药太过，故病证脉象如斯也。拟治以
理饮汤。病家谓，从前医者，少用桂附，即不能容受，恐难再用热药。愚曰∶桂附原非正治心肺脾胃之药，况
又些些用之，病重药轻，宜其不受。若拙拟理饮汤，与此证针芥相投，服之必无他变。若畏此药，不敢轻服，
单用干姜五钱，试服亦可。病家根据愚言，煎服干姜后，耳鸣即止，须臾觉胸次开通。继投以理饮汤，服数剂，
心中亦觉凉甚。将干姜改用一两，又服二十余剂，病遂除根。
一妇人，年四十许。上焦满闷烦躁，思食凉物，而偶食之，则满闷益甚。且又黎明泄泻，日久不愈，满闷
益甚，将成臌胀。屡次延医服药，多投以半补半破之剂，或佐以清凉，或佐以收涩，皆分毫无效。后愚诊视，脉
象弦细而迟。知系寒饮结胸，阻塞气化。欲投以理饮汤，病家闻而迟疑，似不敢服。亦俾先煎干姜数钱服之，胸中
烦躁顿除。为其黎明泄泻，遂将理饮汤去浓朴、白芍，加生鸡内金钱半，补骨脂三钱，连服十余剂，诸病皆愈。
一妇人，年近五旬，常觉短气，饮食减少。屡次延医服药，或投以宣通，或投以升散，或投以健补脾胃，
兼理气之品，皆分毫无效。浸至饮食日减，羸弱不起，奄奄一息，病家亦以为不治之证矣。后闻愚在其邻村，
屡救危险之证，复延愚诊视。其脉弦细欲无，频吐稀涎。询其心中，言觉有物杜塞胃口，气不上达，知其为寒
饮凝结也。遂投以理饮汤，方中干姜改用七钱，连服三剂，胃口开通。又觉呼吸无力，遂于方中加生黄 三钱，
连服十余剂，病全愈。方书谓，饮为水之所结，痰为火之所凝，是谓饮凉而痰热也。究之饮证亦自分凉热，其
热者，多由于忧思过度，
甚则或至癫狂，虽有饮而恒不外吐。其凉者，则由于心肺阳虚，如方名下所言种种诸情状。且其证，时吐稀涎，
常觉短气，饮食廉少，是其明征也（后世谓痰之稀者为饮，稠者为痰，与《金匮》所载四饮名义不同）。
邑，韩××医学传家，年四十有四，偶得奇疾。卧则常常发搐，旋发旋止，如发寒战之状，一呼吸之间即愈。
即不发搐时，人偶以手抚之，又辄应手而发。自治不效，广求他医治疗皆不效。留连半载，病势浸增。后愚诊
视，脉甚弦细。询其饮食甚少，知系心肺脾胃阳分虚惫，不能运化精微，以生气血。血虚不能荣筋，气虚不能
充体，故发搐也。必发于卧时者，卧则气不顺也。人抚之而辄发者，气虚则畏人按也。授以理饮汤方，数剂，
饮食加多，搐亦见愈。二十剂后，病不再发。
治疗因心、肺阳气虚弱，导致脾的湿气不能上升，胃气郁滞不能下降，饮食无法运化生成精微物质，反而转化为饮邪。饮邪停滞在胃口处表现为胸脘满闷，溢于膈上表现为呼吸短促，浸渍充满肺窍表现为气喘急促，阻滞黏腻咽喉表现为咳嗽吐粘涎。严重时甚至阴霾之气布满上焦，心、肺的阳气不能舒畅舒展，转而郁结产生热象。或者阴气逼迫阳气外越表现为身体发热，迫使阳气上浮表现为耳聋。然而必须诊察其脉象，确认为弦、迟、细、弱脉，才能投用此方。
白术（四钱） 干姜（五钱） 桂枝尖（二钱） 炙甘草（二钱） 茯苓片（二钱） 生杭芍（二钱）
桔红（一钱半） 川厚朴（一钱半）
服用数剂后，若饮邪虽已开通，但气分仍然不足者，酌情加入生黄芪数钱。
方中使用桂枝、干姜，来辅助心、肺的阳气，并宣通之。使用白术、茯苓、甘草，来调理脾胃的湿气，并使其淡味渗利（茯苓与甘草同用最善于泻除湿满）。使用厚朴的原因，叶天士曾说：“厚朴多用则破气，少用则通阳”，想要借助其温通的性质，使胃中的阳气通畅、气机下降，加速水谷向下运行。使用桔红，是为了辅助白术、茯苓、甘草以利化痰饮。至于白芍，如果取其苦平的性质，可以防止热药向上僭越（平性主降）；如果取其酸敛的性质，可以制约虚火的浮游（《神农本草经》记载芍药苦平，后世认为芍药酸敛，其实其味实为苦而微酸）。况且药物中热性的部分，适宜于脾胃，恐怕不适宜于肝胆，又利用白芍凉润的性质，善于滋养肝胆之阴，即预防肝胆产生热邪。何况白芍善于通利小便，小便利则痰饮自然减少。
有一位四十岁左右的妇女。胸中常感到满闷发热，有时十天，或十二天之间，必定有大喘症状持续一两天。医生使用清火理气的药物，初服时稍有效，久服后病情反而加重。后来我诊治，脉象沉细几乎看不见。病人家属问：这是什么病因？我说：这是心、肺阳气虚弱，不能宣通脾胃，以致产生大量痰饮。人的脾胃属土，就像大地一样。心、肺居于其上，正当太阳部位（膈上属于太阳，看《伤寒论》太阳篇就知道了），其阳气宣通，就像太阳高悬中天，暖光下照。而胃中所摄入的水谷，确实借助其阳气宣通的力量，来运化精微并生成气血，传送糟粕成为大小便。清气上升，浊气下降，痰饮从何而生？只有心、肺阳气虚弱，不能像烈日当空那样，脾胃就不能借助其宣通的力量来运化传送，于是饮食停滞在胃口，就像大雨之后，阴雾连绵旬日，遍地泥泞污浊，不能干燥渗透，那么痰饮就产生了。痰饮既已产生，日积月累，郁结充满上焦则产生闷感，浸渍充满肺窍则产生气喘，阻遏心、肺阳气，不能布散全身则产生热象。医生不认识病源，还用凉药来清热，不要怪罪病情久而加重。于是我为她配制此汤，服用一剂后，心中热感去除，数剂后反而觉得非常凉快。于是去掉白芍，连续服用二十多剂，胸中豁然开朗，气喘不再发作。
有一位三十岁左右的妇女。身形向来丰腴。胸中痰涎郁结，好像阻碍饮食，上焦时常觉得烦热。偶然服用礞石滚痰丸有效，于是天天服用。起初饮食增加，接着饮食逐渐减少，后来有一天不服药，就不能进食。又长期服用。
竟然分毫无效，每天只吃一顿，吃得很少，仍然不能消化。而且时常觉得热气上腾，耳鸣欲聋，这才怀疑药不对症。求我延医诊治，其脉象浮大，重按非常软。我说：这个证候是心、肺阳气虚弱，脾胃气弱，因为服用苦寒攻泻的药物太过，所以病证和脉象如此。打算用理饮汤治疗。病人家属说，以前的医生，稍微用一点桂枝、附子，她就承受不了，恐怕难以再用热药。我说：桂枝、附子本来就不是正治心、肺、脾胃的药物，况且又用得很少，病重药轻，应该是不受补。如果我拟定的理饮汤，与此证非常契合，服用必然没有其它变故。如果畏惧此药，不敢轻易服用，单用干姜五钱，试服也可以。病人家属根据我的话，煎服干姜后，耳鸣立即停止，一会儿觉得胸中开通。继而又投以理饮汤，服用数剂，心中也觉得非常凉快。将干姜改为一两，又服用二十多剂，病根遂除。
有一位四十岁左右的妇女。上焦满闷烦躁，想吃凉物，但偶尔吃了，满闷更加严重。而且又在黎明时分泄泻，日久不愈，满闷更加严重，将要形成臌胀。屡次请医生服药，大多投以半补半破的药剂，或者佐以清凉，或者佐以收涩，都分毫无效。后来我诊治，脉象弦细而迟。知道是寒饮结聚胸中，阻塞气化。想要投以理饮汤，病人家属听到后迟疑，似乎不敢服用。也让先煎干姜数钱服用，胸中烦躁顿时消除。因为她黎明泄泻，于是将理饮汤去掉厚朴、白芍，加入生鸡内金一钱半，补骨脂三钱，连续服用十余剂，各种病都好了。
有一位近五十岁的妇女，常觉得呼吸短促，饮食减少。屡次请医生服药，有的投以宣通，有的投以升散，有的投以健补脾胃兼理气的药物，都分毫无效。渐渐到饮食日益减少，瘦弱不起，奄奄一息，病人家属也认为是治不好的病。后来听说我在邻村，屡次救治危险病症，又请我诊治。其脉象弦细几乎摸不到，频繁吐出稀薄涎沫。询问她心中感觉，她说觉得有东西堵塞胃口，气不上达，知道是寒饮凝结。于是投以理饮汤，方中干姜改为七钱，连续服用三剂，胃口开通。又觉得呼吸无力，于是在方中加入生黄芪三钱，连续服用十余剂，病全愈。医书说，饮是水所结聚，痰是火所凝，这是说饮偏凉而痰偏热。究其实际，饮证也自然分为凉热两种，其中热的，多由于忧思过度，甚至可能导致癫狂，虽然有饮但通常不外吐。其中凉的，则是由于心、肺阳气虚弱，如方名下方所述的各种情况。而且此证，时常吐稀涎，常觉短气，饮食很少，是其明显的征象（后世说痰之稀者为饮，稠者为痰，与《金匮要略》所载四饮的名义不同）。
本县韩某某，医学传家，年龄四十四岁，偶然得了奇疾。躺下时常常发生抽搐，随即发作随即停止，像发寒战的样子，一次呼吸之间就痊愈了。即使不发作时，别人偶然用手抚摸他，又立刻应手而发。自己治疗无效，广泛寻求其他医生治疗都不见效。拖延半年，病势逐渐加重。后来我诊治，脉象非常弦细。询问他饮食很少，知道是心、肺、脾胃阳气虚惫，不能运化精微，以生成气血。血虚不能濡养筋脉，气虚不能充实形体，所以发生抽搐。必定在卧时发作，是因为卧时气机不顺。别人抚摸他就发作，是因为气虚所以害怕被人按压。授以理饮汤方，服用数剂，饮食增加，抽搐也逐渐好转。二十剂后，病不再发作。
Treatment for conditions caused by deficiency of Heart and Lung Yang, leading to the failure of Spleen dampness to ascend and Stomach Qi stagnation failing to descend. Dietary intake cannot be transformed into fine nutrients (Jingwei), instead transforming into fluid retention (Yin). When fluid retention stays at the stomach opening, it manifests as fullness and oppression; when it overflows above the diaphragm, it manifests as shortness of breath; when it soaks and fills the lung orifices, it manifests as panting and rapid breathing; when it obstructs and sticks in the throat, it manifests as coughing up sticky saliva. In severe cases, yin mist may fill the Upper Jiao, preventing Heart and Lung Yang from freely expanding, which turns into stagnation and generates heat. Alternatively, Yin qi forcing Yang outward manifests as body fever, while forcing Yang Qi floating upward manifests as deafness. However, one must examine the pulse; only if it is definitively wiry (Xian), slow (Chi), thin (Xi), and weak (Ruo) should this decoction be administered.
Bai Zhu (Atractylodis Rhizoma) - 4 qian
Gan Jiang (Zingiberis Rhizoma Recens) - 5 qian
Gui Zhi Jian (Cinnamomi Ramulus Apicalis) - 2 qian
Zhi Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparata cum Melle) - 2 qian
Fu Ling Pian (Poria) - 2 qian
Sheng Hang Shao (Paeoniae Radix Alba Cruda) - 2 qian
Ju Hong (Citri Reticulatae Pericarpium Rubrum) - 1.5 qian
Chuan Hou Po (Magnoliae Officinalis Cortex) - 1.5 qian
After taking several doses, if fluid retention has been cleared but Qi deficiency remains, add Sheng Huang Qi (Astragali Radix) a few qian according to discretion.
In this formula, Gui Zhi and Gan Jiang are used to assist Heart and Lung Yang and promote their circulation. Bai Zhu, Fu Ling, and Gan Cao are used to regulate Spleen and Stomach dampness and promote its leaching out through mild diuresis (when Fu Ling and Gan Cao are used together, they are most effective in draining dampness-induced fullness). Hou Po is used because Ye Tianshi stated: "Hou Po in large doses breaks Qi, but in small doses unblocks Yang." The intention is to borrow its warm and unblocking nature to make Stomach Yang smooth and Qi descend, accelerating the downward movement of water and grain. Ju Hong is used to assist Bai Zhu, Fu Ling, and Gan Cao in benefiting the resolution of phlegm-fluid retention. As for Bai Shao, if utilizing its bitter and neutral nature, it can prevent hot herbs from flaming upward (neutral nature tends to descend); if utilizing its sour and astringent nature, it can restrain the floating of deficient fire (The *Shennong Bencao Jing* states Bai Shao is bitter and neutral, while later generations consider it sour and astringent; its actual taste is bitter with a slight sourness). Furthermore, while hot substances are suitable for the Spleen and Stomach, they may not be suitable for the Liver and Gallbladder; thus, we utilize Bai Shao's cool and moistening nature to nourish Liver and Gallbladder Yin, thereby preventing Heat in the Liver and Gallbladder. Moreover, since it promotes urination, free urination naturally reduces phlegm-fluid retention.
A woman, approximately forty years old, often felt fullness and heat in her chest. Every ten days or so, she would experience severe panting lasting one or two days. Physicians prescribed cooling and Qi-regulating medicines. Initially, there was some effect, but long-term use worsened the condition. Later, I examined her; her pulse was deep and thin, barely perceptible. The family asked about the cause. I said: This is due to deficiency of Heart and Lung Yang, failing to circulate the Spleen and Stomach, leading to excessive production of phlegm-fluid retention. The human Spleen and Stomach belong to Earth, like the land. Heart and Lung reside above them, occupying the Taiyang region (the area above the diaphragm belongs to Taiyang, as known from the Taiyang chapter of *Shanghan Lun*). Their Yang Qi circulates freely, like the sun shining brightly in the midday sky. The water and grain ingested by the Stomach rely on this Yang Qi circulation to transform fine nutrients and generate Qi and Blood, and to transport waste into urine and feces. Clear Qi ascends, turbid Qi descends; how could phlegm-fluid retention arise? Only when Heart and Lung Yang are deficient, unable to shine like the sun, can the Spleen and Stomach fail to borrow this circulating power to transform and transport. Thus, food stagnates at the stomach opening. Like muddy puddles after heavy rain that do not dry despite days of fog, phlegm-fluid retention is generated. Once generated, accumulating day by day, stagnation filling the Upper Jiao causes oppression; soaking the lung orifices causes panting; obstructing Heart and Lung Yang from spreading causes heat. Physicians who do not recognize the source still use cold medicines to clear heat; do not be surprised that the condition worsens over time. I then prepared this decoction for her. After one dose, the heat in her heart disappeared. After several doses, she felt very cool. I removed Bai Shao, and after continuing for more than twenty doses, her chest felt open and clear, and panting did not recur.
A woman, approximately thirty years old, was naturally plump. Phlegm-saliva was stagnant in her chest, hindering digestion, and she often felt irritability and heat in the Upper Jiao. She accidentally took Meng Shi Gun Tan Wan with good effect, so she took it daily. Initially, her appetite increased; subsequently, it gradually decreased; later, if she missed a dose, she could not eat at all. Long-term use yielded no effect. She ate only once a day, little by little, and still could not digest it. She also frequently felt rising heat and tinnitus almost causing deafness. She began to suspect the medicine was incorrect for her syndrome. She sought my consultation. Her pulse was floating and large, but soft upon pressure. I said: This syndrome involves deficiency of Heart and Lung Yang and weakness of Spleen and Stomach Qi, caused by excessive use of bitter-cold purgative medicines. Therefore, the symptoms and pulse present as such. I proposed treating her with Li Yin Tang. The family said previous physicians found she could not tolerate even small amounts of Gui Zhi and Fu Zi, fearing she could not handle hot medicines again. I said: Gui Zhi and Fu Zi are not the primary treatments for Heart, Lung, Spleen, and Stomach conditions. Moreover, using tiny amounts for a severe illness results in light medication for heavy disease, explaining why she could not tolerate them. If my proposed Li Yin Tang matches this syndrome perfectly, taking it will surely have no adverse changes. If you fear this medicine and dare not take it lightly, simply try taking five qian of Gan Jiang alone. Following my advice, after decocting and taking Gan Jiang, her tinnitus stopped immediately, and she felt her chest open shortly after. Subsequently, Li Yin Tang was administered. After several doses, she felt very cool in her heart. Gan Jiang was increased to one liang, and after more than twenty doses, the disease was eradicated.
A woman, approximately forty years old, suffered from fullness, oppression, and irritability in the Upper Jiao. She craved cool foods, but eating them worsened the fullness. She also had morning diarrhea that persisted for a long time without healing, worsening the fullness until it threatened to become abdominal distension (Gu Zhang). Repeated medical consultations and medications, mostly involving half-tonifying and half-purgative formulas, or adjuvants of cooling or astringent properties, were ineffective. Upon examination, her pulse was wiry, thin, and slow. I determined it was cold-fluid retention knotting in the chest, blocking Qi transformation. I intended to prescribe Li Yin Tang, but the family hesitated, seeming afraid to take it. They were instructed to first decoct and take a few qian of Gan Jiang, which instantly relieved the chest irritability. Due to her morning diarrhea, I modified Li Yin Tang by removing Hou Po and Bai Shao, adding Sheng Ji Nei Jin (Endothelium Corneum Gigeriae Galli) 1.5 qian and Gu Bu Zhi (Psoraleae Fructus) 3 qian. After more than ten doses, all illnesses were cured.
A woman near fifty years old often felt shortness of breath and reduced appetite. Repeated medical treatments, including dispersing, ascending, or tonifying Spleen and Stomach with Qi-regulating agents, were completely ineffective. Gradually, her intake decreased, she became emaciated and bedridden, gasping for life. The family considered it an incurable case. Hearing that I frequently saved critical cases in the neighboring village, they consulted me again. Her pulse was wiry, thin, and nearly imperceptible. She frequently spat thin saliva. Asking about her sensation, she reported a blockage at the stomach opening preventing Qi from reaching upward, indicating condensation of cold-fluid retention. I prescribed Li Yin Tang, changing Gan Jiang to seven qian. After three doses, the stomach opening opened. Feeling weak respiration, I added Sheng Huang Qi 3 qian to the formula. After more than ten doses, she fully recovered. Medical texts state that fluid retention (Yin) is condensed water, while phlegm (Tan) is congealed fire, implying Yin is cold and Tan is hot. However, Yin syndromes naturally divide into cold and hot types. Hot Yin often results from excessive worry and thought, potentially leading to mania, though fluid is rarely expectorated. Cold Yin results from deficiency of Heart and Lung Yang, presenting with various symptoms as described under the formula name. Moreover, frequent expectoration of thin saliva, chronic shortness of breath, and poor appetite are clear signs (Later generations define thin phlegm as Yin and thick phlegm as Tan, differing from the Four Fluid Retentions in *Jingui Yaolue*).
Han XX from the county, coming from a family of physicians, aged forty-four, contracted a strange disease. While lying down, he frequently experienced convulsions that started and stopped quickly, resembling chills, resolving within a single breath. Even when not convulsing, touching him with a hand would trigger immediate convulsions. Self-treatment failed, and other physicians were unsuccessful. The condition persisted for half a year, worsening gradually. Upon examination, his pulse was very wiry and thin. His dietary intake was scant. I identified deficiency and exhaustion of Heart, Lung, Spleen, and Stomach Yang, failing to transform fine nutrients to generate Qi and Blood. Blood deficiency fails to nourish sinews, and Qi deficiency fails to fill the body, causing convulsions. It occurs during sleep because Qi flow is obstructed when recumbent. Touch triggers it because Qi deficiency leads to aversion to pressure. I prescribed Li Yin Tang. After several doses, his appetite increased, and convulsions improved. After twenty doses, the disease did not recur.