详观来案，知此证乃寒饮结胸之甚者。拙拟理饮汤，原为治此证的方，特其药味与分量宜稍为更改耳。
今拟一方于下，以备采择。方用生箭 一两，干姜八钱，于术四钱，桂枝尖、茯苓片、炙甘草各三钱，浓朴、
陈皮各二钱，煎汤服。方中之义∶用黄 以补胸中大气，大气壮旺，自能运化水饮，仲景所谓“大气
一转，其气（指水饮之气）乃散”也，而黄 协同干姜、桂枝，又能补助心肺之阳，使心肺阳足，如日丽
中天，阴霾自开；更用白术、茯苓以理脾之湿，浓朴、陈皮以通胃之气，气顺湿消，痰饮自除；用炙甘草者，
取其至甘之味，能调干姜之辛辣，而干姜得甘草，且能逗留其热力，使之绵长，并能缓和其热力，使不猛烈也。
按∶此方即《金匮》苓桂术甘汤，加黄 、干姜、浓朴、陈皮，
亦即拙拟之理饮汤去芍药也。原方之用芍药者，因寒饮之证，有迫其真阳外越，周身作灼，或激其真阳上窜，
目眩耳聋者，芍药酸敛苦降之性，能收敛上窜外越之元阳归根也（然必与温补之药同用方有此效）。
此病原无此证，故不用白芍。至黄 在原方中，原以痰饮既开、自觉气不足者加之。兹则开始即重用黄 者，
诚以寒饮固结二十余年，非有黄 之大力者，不能斡旋诸药以成功也。
又按∶此方大能补助上焦之阳分，而人之元阳，其根柢实在于下，若更兼服生硫黄，以培下焦之阳，
则奏效更速。所言东硫黄亦可用，须择其纯黄者方无杂质，惟其热力减少，不如中硫黄耳。其用量，初次可
服细末一钱，不觉热则渐渐加多。一日之极量，可至半两，然须分四五次服下。不必与汤药同时服，或先或后均可。
【附原问】敝友患寒饮喘嗽，照方治疗未效。据其自述病因，自二十岁六月遭兵燹，困山泽中，绝饮
食五日夜，归家急汲井水一小桶饮之，至二十一岁六月，遂发大喘。一日夜后，饮二陈汤加干姜、细辛、
五味渐安。从此痰饮喘嗽，成为痼疾。所服之药，大燥大热则可，凉剂点滴不敢下咽。若误服之，即胸气急
而喘作，须咳出极多水饮方止。小便一点钟五六次，如白水。若无喘，小便亦照常。饮食无论肉味菜蔬，
俱要燥热之品。粥汤、菜汤概不敢饮。其病情喜燥热而恶冷湿者如此。其病状暑天稍安，每至霜降后朝朝发
喘，必届巳时吐出痰饮若干，始稍定。或饮极滚之汤，亦能咳出痰饮数口，胸膈略宽舒。迄今二十六七载
矣。近用黎芦散吐法及十枣汤等下法，皆出痰饮数升，证仍如故。《金匮》痰饮篇及寒水所关等剂，服过数
十次，证亦如故。想此证既能延岁月，必有疗法，乞先生赐以良方，果能祓除病根，感佩当无既也。又
《衷中参西录》载有服生硫黄法，未审日本硫黄可服否？
服药愈后谢函∶接函教，蒙授妙方，治疗敝友奇异之宿病，连服四五剂，呼吸即觉顺适。后又
照方服七八剂，寒饮消除，喘证全愈。
仔细研读来信案例，可知此证属于寒饮结聚于胸部的重症。我拟定的理饮汤，原本就是为治疗此类病症而设的，只是方中的药味和剂量需要稍作调整罢了。
现拟定一方在下，供参考选用。方用生黄芪一两，干姜八钱，白术四钱，桂枝尖、茯苓片、炙甘草各三钱，厚朴、陈皮各二钱，煎汤服用。方义解析：使用黄芪来补益胸中大气（指积聚于胸中的宗气），大气壮盛旺盛，自然能够运化水饮，正如仲景所说“大气一转，其气（指水饮之气）乃散”；同时黄芪协同干姜、桂枝，又能补助心阳和肺阳，使心肺阳气充足，如同烈日当空，阴霾自然消散；再用白术、茯苓来调理脾脏的湿气，厚朴、陈皮来疏通胃腑的气机，气机顺畅则湿气消除，痰饮自然去除；使用炙甘草，是取其味甘之性，能调和干姜的辛辣，且干姜得到甘草的配合，能使其热力停留持久，变得绵长，并能缓和其热力的猛烈程度。
按语：此方即《金匮要略》中的苓桂术甘汤，加入黄芪、干姜、厚朴、陈皮，也就是我拟定的理饮汤去掉芍药。原方中使用芍药的原因，是因为寒饮之证，有逼迫真阳外越导致周身灼热，或激发真阳上窜导致目眩耳聋的情况，芍药酸敛苦降的性质，能收敛上窜外越的元阳使其归根（但必须与温补药物同用才有效）。此病原本没有这些症状，所以不用白芍。至于黄芪在原方中，原本是用于痰饮已开、自觉气不足时加用的。这次一开始就重用黄芪，确实因为寒饮固结二十多年，若非有黄芪的大力作用，不能斡旋诸药以取得成功。
又按语：此方能大补上焦阳气，而人的元阳，其根本其实在于下焦，如果再加服生硫黄，以培补下焦阳气，则见效更快。所说的日本硫黄也可以使用，须选择纯黄色的才无杂质，只是其热力减少，不如国产硫黄。用量方面，初次可服用细末一钱，若不觉发热则逐渐增加。一日极量可达半两，但需分四五次服用。不必与汤药同时服用，先服或后服均可。
【附原问】我的朋友患有寒饮引起的喘咳，照之前的方子治疗无效。据他自述病因，二十岁六月遭遇战乱，被困在山野中，断绝饮食五天五夜，回家后急忙打了一小桶井水喝下，到二十一岁六月，突然发作严重气喘。一天一夜后，服用二陈汤加干姜、细辛、五味子逐渐安定。从此痰饮喘咳成为顽固疾病。所服用的药物，大燥大热的可以，凉性的点滴不敢咽下。如果误服凉药，就会胸中气急而喘息发作，必须咳出极多水饮才能停止。小便一小时五六次，像白水一样。如果没有喘息，小便也照常。饮食无论肉类蔬菜，都要吃燥热性质的食物。粥汤、菜汤一概不敢喝。他的病情喜欢燥热而厌恶冷湿就是这样。他的病状在暑天稍安，每到霜降后每天早晨发作喘息，必须等到巳时吐出若干痰饮，才稍微安定。或者喝极滚烫的汤，也能咳出几口痰饮，胸膈略微宽舒。至今已经二十六七年了。最近用黎芦散催吐法和十枣汤等泻下法，都排出痰饮数升，症状依然如故。《金匮要略》痰饮篇及寒水相关的方剂，服用过几十次，症状也依然如故。想这个病既然能延续这么多年，一定有治疗方法，恳请先生赐给良方，如果能祛除病根，感激之情将无法言表。另外《医学衷中参西录》记载有服用生硫黄的方法，不知日本硫黄是否可以服用？
服药痊愈后的感谢信：接到您的信件教导，承蒙传授妙方，治疗我朋友奇特的宿疾，连续服用四五剂，呼吸即刻觉得顺适。后来又照方服用七八剂，寒饮消除，喘证完全痊愈。
Carefully studying the case in your letter, it is known that this syndrome is a severe type of Cold-Fluid Accumulation in the Chest (Han Yin Jie Xiong). The Linyin Decoction (Regulate Fluids Decoction) I originally proposed was intended for treating such syndromes; only the herbal ingredients and dosages require slight modification.
Hereby, a prescription is proposed below for reference and selection. The prescription uses Raw Astragali Radix (Sheng Huangqi) 1 liang, Dried Ginger (Gan Jiang) 8 qian, Atractodis Rhizoma (Baizhu) 4 qian, Cinnamomi Ramulus Acumen (Guizhi Jian), Poria (Fuling Pian), and Prepared Licorice Root (Zhi Gancao) each 3 qian, Magnoliae Officinalis Cortex (Houpo) and Citri Reticulatae Pericarpium (Chenpi) each 2 qian. Decoct in water and take orally. The rationale of the prescription: Using Astragali Radix to tonify the Great Qi (Da Qi, referring to Zong Qi accumulating in the chest). When the Great Qi is robust and vigorous, it naturally transforms and transports fluids. As Zhongjing stated, "When the Great Qi rotates, the Qi (referring to the Qi of fluid accumulation) disperses." Furthermore, Astragali Radix, in synergy with Dried Ginger and Cinnamomi Ramulus, can assist and supplement the Yang of the Heart and Lung. When the Yang of the Heart and Lung is sufficient, like the sun shining at its zenith, the yin-cold mist dissipates naturally. Additionally, using Atractodis Rhizoma and Poria to regulate dampness in the Spleen, and Magnoliae Officinalis Cortex and Citri Reticulatae Pericarpium to unblock the Qi of the Stomach; when Qi flows smoothly and dampness disappears, Phlegm-Fluid is naturally eliminated. Using Prepared Licorice Root is to utilize its extremely sweet flavor, which can harmonize the pungency and heat of Dried Ginger. Moreover, when Dried Ginger is combined with Licorice Root, its heat energy is retained longer, becoming sustained, and its intensity is moderated so as not to be too fierce.
Note: This prescription is essentially Linggui Zhugan Decoction (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction) from *Jingui Yaolue*, added with Astragali Radix, Dried Ginger, Magnoliae Officinalis Cortex, and Citri Reticulatae Pericarpium. It is also equivalent to my proposed Linyin Decoction minus Paeoniae Radix Alba (Baishao). The reason for using Paeoniae Radix Alba in the original formula is that in cases of Cold-Fluid, there may be forcing of True Yang to escape outward, causing burning sensations throughout the body, or stimulating True Yang to rush upward, causing dizziness and deafness. The sour-astringent and bitter-descending nature of Paeoniae Radix Alba can gather the rushing and escaping Yuan Yang and return it to its root (however, this effect is achieved only when used together with warming and tonifying herbs). Since this patient's disease originally lacked these symptoms, Baishao is not used. Regarding Astragali Radix in the original formula, it was originally added when fluid accumulation had cleared and the patient felt a deficiency of Qi. In this case, heavy use of Astragali Radix from the beginning is indeed because Cold-Fluid has been solidified for over twenty years; without the powerful action of Astragali Radix, it would be difficult to maneuver the other herbs to achieve success.
Further Note: This prescription greatly supplements the Yang aspect of the Upper Jiao. However, the root of human Yuan Yang actually lies in the Lower Jiao. If one additionally takes Raw Sulfur (Sheng Liuhuang) to cultivate the Yang of the Lower Jiao, the therapeutic effect will be faster. The Japanese Sulfur mentioned can also be used, but one must select pure yellow sulfur free of impurities. Its heat energy is reduced compared to domestic sulfur. For dosage, initially, one can take 1 qian of fine powder. If no feeling of heat is perceived, gradually increase the amount. The maximum daily dose can reach half a liang, but it must be divided into four or five doses. It does not need to be taken simultaneously with the decoction; taking it before or after is acceptable.
[Attached Original Inquiry] My friend suffers from wheezing and coughing due to Cold-Fluid. Treatment according to previous prescriptions has been ineffective. According to his self-description of the etiology, in June of his twentieth year, he encountered war turmoil and was trapped in the mountains and marshes, deprived of food and drink for five days and nights. Upon returning home, he hastily drank a small bucket of well water. By June of his twenty-first year, he suddenly developed severe asthma. After one day and night, taking Erchen Decoction (Two-Cured Decoction) added with Dried Ginger, Ephedrae Herba (Xixin - *Note: Text says Xixin/Schisandra contextually often implies San Wei, but text lists Xixin/Wuweizi separately or together. Here translated as Schisandra based on Wuweizi*), and Schisandrae Fructus (Wuweizi) gradually stabilized. Since then, phlegm-fluid wheezing and coughing have become a stubborn disease. Medications taken can be strongly drying and hot; cold-natured medicines cannot be swallowed even in drops. If mistakenly taken, chest Qi becomes urgent and wheezing occurs, stopping only after coughing up a large amount of fluid. Urination occurs five to six times per hour, resembling clear water. Without wheezing, urination is normal. Diet, whether meat or vegetables, must be of drying and hot nature. Porridge soup and vegetable soup are generally avoided. His condition prefers dryness and heat while abhorring cold and dampness as follows. His symptoms are slightly relieved in summer, but every morning after Frost Descent (Shuangjiang), he develops wheezing. He must wait until the Si hour (9-11 AM) to cough up a certain amount of phlegm-fluid before feeling somewhat settled. Or, drinking extremely boiling soup can also help him cough out several mouthfuls of phlegm-fluid, slightly relaxing the chest and diaphragm. This has persisted for twenty-six or twenty-seven years. Recently, using Veratrum Nigrum Powder (Lilu San) for vomiting methods and Shizao Decoction (Ten Dates Decoction) for purging methods, several sheng of phlegm-fluid were expelled, yet the condition remained unchanged. Formulas related to the Phlegm-Fluid chapter of *Jingui Yaolue* and those dealing with Cold Water were taken dozens of times, yet the condition remained unchanged. Considering this disease has persisted for so many years, there must be a treatment method. I beg you, Sir, to bestow a good prescription. If the root cause of the disease can be eradicated, my gratitude will be boundless. Also, *Yixue Zhongzhong Canxi Lu* records the method of taking Raw Sulfur; I wonder if Japanese Sulfur is suitable for consumption?
[Letter of Thanks After Recovery from Medication] Receiving your letter and instruction, I am indebted to you for imparting the wonderful prescription. Treating my friend's strange chronic illness, after continuously taking four or five doses, breathing immediately felt smooth and comfortable. Later, following the prescription for another seven or eight doses, Cold-Fluid was eliminated, and the asthma was completely cured.