木防己三两 石膏（鸡子大）十二枚 桂枝二两 人参四两
右四味，以水六升，煮取二升，分温再服。
木防己 桂枝各二两 人参 茯苓各四两 芒硝三合
右四味，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，其人苦冒眩，泽泻汤主之。
【注】
心下，膈下也。水在膈上则喘满，水在膈间则痞悸，水在膈下则惟苦眩晕，以泽泻汤
之平和小剂主之，治支饮之轻者可也。若阳虚水盛，又当从事乎苓桂术甘汤，五苓散
矣。
【集注】
尤怡曰：水饮之邪，上乘清阳之位，则为冒眩。冒者，昏冒而神不清，如有物冒蔽之
也；眩者，目眩转而乍见眩黑也。泽泻泄水气，白术补土气，以胜水也。
泽泻五两 白术二两
右二味，以水二升，煮取一升，分温再服。
@@@
病痰饮者，当以温药和之。
【注】
稠浊为痰，阳之盛也；稀清为饮，阴之盛也。有痰无饮，当以凉药治之；有饮无痰，
当以热药温之。若痰而兼饮者，此不可纯凉，又不可纯热，故当以温药和之可也。
@@@
夫有支饮家，欬烦，胸中痛者，不卒死，至一百日或一岁，宜十枣汤。
【注】
支饮，水在膈之上下也。水乘肺则欬，水乘心则烦，水结胸则痛，其人形气俱实，以
十枣汤攻之可也。然病此卒不死，或至百日，或延至一年者，以饮阴邪，阴性迟，故
不卒死也。
十枣汤方（见上）
@@@
欬家其脉弦，为有水，十枣汤主之。
【注】
此承上条，以出其脉也。欬家，谓久欬之家也，欬家未可攻也。若脉弦，其欬则为有
水也，有水可攻，故以十枣汤攻之。
【集注】
魏荔彤曰：欬嗽者，有饮冷而欬嗽者，有因外感风寒而欬嗽者，所谓形寒饮冷则伤肺
也，此外感风寒之欬嗽也。有因伤倦而欬嗽者，所谓阴虚内热，火刑肺金，此内伤虚
劳之欬嗽也。于此俱无涉也。仲景命之曰：欬家，专为痰饮在内，逆气上冲之欬嗽言
也。故其脉必弦，无外感家之浮，无内虚家之数，但见弦者，知有水饮在中为患也，
主之以十枣汤，使水邪有所制，斯下注而免于上厥也。
@@@
脉双弦者，寒也，皆大下后里虚。脉偏弦者，饮也。
【按】
此条系在首条「微者短气」之下，今分在此。
【注】
脉双弦者，两手左右脉皆弦也，偏弦者，或左、或右、脉单弦也。偏弦者，饮也，故
当下之；双弦者，寒也，不当下也。即偏弦当下，亦不可大下，若大下之，则虚其里
，单弦变而为双弦矣。弦为阴脉，重阴则寒，故曰：双弦者寒也。此又示人不可以弦
脉，专主饮也。
@@@
脉弦数，有寒饮，冬夏难治。
【按】
脉弦数之「数」字，当是「迟」字，始与寒饮之理合，是传写之□。
【注】
单弦主饮，固当下也，若单弦兼迟，而有寒饮，不可下也。寒饮之欬，冬夏难治者，
以夏阴极于内，冬阴极于外故也。此承上二条，详申弦脉饮病可下、不可下之义也。
@@@
久欬数岁，其脉弱者，可治；实大数者，死。其脉虚者，必苦冒，其人本有支饮在胸
中故也，治属饮家。
【注】
久欬数岁，即今之年年举发，痰饮欬嗽水喘之病也。若其脉弱者，知邪不进则为可治
。若实大数者，知邪日进故死也。若脉虚者知正气虚，必苦冒也，审其人素本有支饮
，则不必治其欬，宜于痰饮家求治法也。
【集注】
尤怡曰：久欬数岁不已者，支饮渍肺而欬，饮久不已，则欬久不愈也。欬久者，其气
必虚，而脉反实大数者，则其邪犹盛，以犹盛之邪，而临已虚之气，其能久持乎？故
死。若脉虚者正气固虚而饮气亦衰，故可治。然饮虽衰而正不能御，亦足以上蔽清阳
之气，故其人必苦冒也。此病为支饮所致，去其饮则病自愈，故曰：治属饮家。
@@@
欬逆倚息不得卧，小青龙汤主之。青龙汤下已，多唾，口燥，寸脉沉，尺脉微，手足
厥逆，气从少腹上冲胸咽，手足痹，其面翕热如醉状，因复下流阴股，小便难，时复
冒者，与茯苓桂枝五味甘草汤，治其气冲。冲气即低，而反更欬，胸满者，用苓桂五
味甘草汤去桂，加干姜、细辛，以治其欬满。欬满即止，而更复渴，冲气复发者，以
细辛、干姜为热药也，服之当遂渴，而渴反止者，为支饮也；支饮者，法当冒，冒者
必呕；呕者复内半夏以去其水，茯苓桂枝五味甘草汤去甘草、桂枝，加细辛干姜半夏
汤主之。水去呕止，其人形肿者，加杏仁主之。其证应内麻黄，以其人遂痹故不内之
，若逆而内之者必厥。所以然者，以其人血虚，麻黄发其阳故也。若面热如醉，此为
胃热上冲薰其面，加大黄以利之。
【按】
小青龙汤下已之「下」字，当是「汗」字，大小青龙汤皆汗剂，必是传写之□。
【注】
欬逆，古欬嗽名也；倚息，今呼吸促也。欬嗽呼吸气促不得卧，久病多属痰饮，新病
每兼形寒，故宜以小青龙汤汗之，以散内饮外寒也。小青龙汤辛温大散，惟有余之人
宜之，若误施之于不足之人，辛热则伤阴，故多唾口燥也。大散则伤阳，故手足厥逆
也；面热如醉，阳外浮也；小便难，气上冲，阴内竭也；脉沉微，里气弱也；手足痹
，表气虚也；时复冒，虚之甚也。虽阴阳表里俱虚，然属误汗，寒热错杂之坏病，故
与茯苓桂枝五味甘草汤，先通阳和阴，俟上冲气平，再议他法也。今气冲虽下而反更
咳嗽胸满者，则知寒饮贮胸，故嫌桂枝偏于走表，加干姜、细辛独胜中之寒饮也。服
之欬满即止，而更复渴冲气复发，则知阴火上逆，为干姜、细辛热药所动故也。若服
之时遂渴，稍时而渴反止者，则为其人素有支饮也。支饮者，法当冒，冒者是因饮逆
胸中作呕而冒，非阳虚为饮所阻不升之冒也。故仍以本方复加半夏者，以去水也，更
去甘草者，恐甘助呕也。水去呕止，其人面形肿者，加杏仁以降呕欬，上逆之余邪，
若不因呕欬面肿，则为风邪所袭，应加麻黄。今其人血虚手足痹，阳虚手足厥，且因
呕欬后而肿，故不加也。若兼有面热如醉，此为胃热上冲熏其面，更加大黄以利胃热
可也。
木防己三两，石膏（如鸡蛋大小）十二枚，桂枝二两，人参四两。
以上四味药，用水六升，煎煮至二升，分两次温服。
木防己、桂枝各二两，人参、茯苓各四两，芒硝三合。
以上四味药，用水六升，煎煮至二升，去渣，加入芒硝，再微火煎煮，分两次温服，大便微通利则病愈。
@@@
心下有支饮（水饮停聚胸膈），患者感到严重的头昏目眩，用泽泻汤主治。
【注】
心下，指膈肌以下部位。水饮在膈上则导致气喘胸闷，水饮在膈间则导致痞满心悸，水饮在膈下则仅表现为苦于眩晕，用泽泻汤这种平和的小方剂来主治，适用于治疗轻症的支饮。如果是阳虚水盛，又应当采用苓桂术甘汤或五苓散。
【集注】
尤怡说：水饮之邪，上乘清阳之位，就会造成头昏目眩。冒，是指神志昏蒙不清，好像有东西遮蔽一样；眩，是指眼睛昏花旋转，突然看见黑暗。泽泻能泄除水气，白术能补益脾气，以克制水邪。
泽泻五两，白术二两。
以上两味药，用水二升，煎煮至一升，分两次温服。
@@@
患有痰饮病的患者，应当用温性药物调和治疗。
【注】
稠浊的为痰，是阳气偏盛的表现；稀清的为饮，是阴气偏盛的表现。只有痰没有饮，应当用凉药治疗；只有饮没有痰，应当用热药温化。如果既有痰又有饮，这就不能纯用凉药，也不能纯用热药，所以应当用温药来调和治疗。
@@@
凡是患有支饮的人，出现咳嗽、心烦、胸痛的症状，如果没有突然死亡，病程延续到一百天或一年，适宜用十枣汤治疗。
【注】
支饮，是指水饮停留在膈肌的上下部位。水饮侵犯肺脏则咳嗽，侵犯心脏则心烦，结聚于胸部则疼痛。如果患者形体和正气都充实，可以用十枣汤攻逐水饮。然而患病后没有立即死亡，或者延续到一百天，甚至拖延到一年的原因，是因为水饮属于阴邪，阴性迟缓，所以不会突然死亡。
十枣汤方（见上文）
@@@
咳嗽患者的脉象呈弦象，说明体内有水饮，用十枣汤主治。
【注】
这是承接上一条，进一步阐述其脉象。咳嗽家，指长期咳嗽的患者，对于此类患者不可轻易攻下。如果脉象呈弦象，说明其咳嗽是由水饮引起的，既然有水饮就可以攻逐，所以用十枣汤攻逐水饮。
【集注】
魏荔彤说：咳嗽，有的是因喝冷饮而咳嗽，有的是因外感风寒而咳嗽，所谓“形寒饮冷则伤肺”，这是外感风寒引起的咳嗽。有的是因劳累过度而咳嗽，所谓阴虚内热，火克肺金，这是内伤虚劳引起的咳嗽。这些情况都与本条无关。张仲景称之为“咳家”，专门指痰饮在内，逆气上冲引起的咳嗽。所以其脉象必定是弦脉，没有外感病的浮脉，也没有内伤虚损病的数脉，只要见到弦脉，就知道是有水饮在中焦为患，用十枣汤主治，使水邪受到制约，从而向下排泄，避免向上冲逆。
@@@
脉象双侧皆弦，是寒证，多见于峻下之后导致里气虚弱。脉象一侧弦，是水饮证。
【按语】
这一条原本位于首条“轻微者短气”之下，现在分列在此处。
【注】
脉象双侧皆弦，指左右两手脉搏都呈弦象；单侧弦，指左侧或右侧脉搏单独呈弦象。单侧弦脉，主水饮，所以应当攻下；双侧弦脉，主寒，不应当攻下。即使是单侧弦脉应当攻下，也不可用峻下法，如果峻下，会导致里气更虚，单弦脉会变为双弦脉。弦脉属阴，重阴则生寒，所以说双侧弦脉主寒。这又是提示人们，不能认为弦脉只主水饮。
@@@
脉象弦而数，伴有寒饮，冬季和夏季难以治疗。
【按语】
脉弦数中的“数”字，应当是“迟”字，才符合寒饮的道理，这是传写过程中的脱误。
【注】
单弦脉主水饮，本来应当攻下，但如果单弦兼迟，且伴有寒饮，则不可攻下。寒饮引起的咳嗽，在冬夏两季难治的原因，是因为夏季阴极于内，冬季阴极于外。这是承接上两条，详细阐明弦脉主饮病可下与不可下的道理。
@@@
长期咳嗽数年，脉象弱者，可以治疗；脉象实大数的，预后不良。脉象虚的，必然苦于头昏目眩，这是因为患者原本胸中有支饮的缘故，治疗应归属于痰饮病范畴。
【注】
长期咳嗽数年，即如今每年发作的痰饮咳嗽、水喘等疾病。如果脉象弱，说明邪气未进，则为可治。如果脉象实大数，说明邪气日益深入，故预后不良。如果脉象虚，说明正气虚弱，必然苦于头昏目眩，仔细审查患者素来有支饮，则不必单纯治疗咳嗽，应当在痰饮病患者中寻找治疗方法。
【集注】
尤怡说：长期咳嗽数年不止，是支饮浸渍肺脏所致，饮邪久留不去，所以咳嗽经久不愈。咳嗽日久，正气必然虚弱，如果脉象反而实大数，说明邪气仍然强盛，以强盛的邪气面对已虚的正气，怎么能长久维持呢？所以预后不良。如果脉象虚，说明正气固然是虚的，但饮邪之气也衰落了，所以可以治疗。然而虽然饮邪衰落，但正气不能抵御，也足以上蔽清阳之气，所以患者必然苦于头昏目眩。此病由支饮引起，去除水饮则病自愈，所以说治疗应归属于痰饮病范畴。
@@@
咳嗽气逆，倚靠呼吸，不能平卧，用小青龙汤主治。服用小青龙汤发汗后，如果出现多唾、口燥、寸脉沉、尺脉微、手足厥冷、气从少腹上冲胸咽、手足麻木、面部潮红如醉酒状，随后又下行至大腿内侧、小便困难、时常头晕的情况，给予茯苓桂枝五味甘草汤，治疗气上冲。气冲平息后，反而再次咳嗽、胸满，用苓桂五味甘草汤去掉桂枝，加入干姜、细辛，以治疗咳嗽胸满。咳嗽胸满停止后，如果再次口渴，且气冲复发，这是因为细辛、干姜是热药，服用后应当随即口渴，如果口渴反而停止，说明是支饮；支饮患者，法当头晕，头晕者必然呕吐；呕吐者，再在方中加入半夏以去除水饮，将茯苓桂枝五味甘草汤去掉甘草、桂枝，加入细辛、干姜、半夏，以此方主治。水饮去、呕吐止，如果患者身体浮肿，加杏仁主治。此证本应加入麻黄，但因为患者已有手足麻木，所以不加麻黄，如果逆理加入必致厥逆。之所以这样，是因为患者血虚，麻黄会发散阳气。如果面部发热如醉酒状，这是胃热上冲熏蒸面部，加大黄以通利胃热。
【按语】
小青龙汤下已的“下”字，应当是“汗”字，大小青龙汤都是发汗剂，必然是传写过程中的脱误。
【注】
欬逆，是古代对咳嗽的名称；倚息，即现在的呼吸急促。咳嗽呼吸急促不能平卧，久病多属于痰饮，新病往往兼有怕冷，所以适宜用小青龙汤发汗，以疏散内停的水饮和外感的风寒。小青龙汤辛温发散力强，只适合体质有余的人使用，如果误用于体质不足的人，辛热则会伤阴，所以出现多唾、口燥；大发汗则会伤阳，所以出现手足厥冷；面部发热如醉酒状，是阳气外浮；小便困难、气上冲，是阴液内竭；脉象沉微，是里气虚弱；手足麻木，是表气虚弱；时常头晕，是虚损严重。虽然阴阳表里都虚，但这属于误用汗法导致的寒热错杂的坏病，所以给予茯苓桂枝五味甘草汤，先通阳和阴，等待上冲之气平息后，再商议其他方法。现在气冲虽已下降，但反而再次咳嗽胸满，这说明寒饮贮存在胸部，所以嫌桂枝偏于走表，加入干姜、细辛专胜中焦的寒饮。服用后咳嗽胸满停止，但再次口渴且气冲复发，这说明阴火上逆，是被干姜、细辛等热药所触动。如果服用时随即口渴，过一会儿口渴反而停止，说明患者素有支饮。支饮患者，法当头晕，头晕是因为饮邪逆乱胸中作呕而导致头晕，不是阳虚被饮邪阻滞不能上升导致的头晕。所以仍以原方再加半夏，是为了去除水饮，更去掉甘草，是担心甘味助长呕吐。水饮去、呕吐止，如果患者面部浮肿，加杏仁以降逆止呕止咳，清除上逆之余邪，如果不是因为呕吐咳嗽导致面肿，而是风邪侵袭，应当加麻黄。现在患者血虚导致手足麻木，阳虚导致手足厥冷，且是在呕吐咳嗽后面肿，所以不加麻黄。如果兼有面部发热如醉酒状，这是胃热上冲熏蒸面部，更加大黄以通利胃热即可。
Mu Fang Ji (Stephaniae Tetrandrae Radix) 3 liang, Shi Gao (Gypsum Fibrosum) the size of an egg 12 pieces, Gui Zhi (Cinnamomi Ramulus) 2 liang, Ren Shen (Ginseng Radix et Rhizoma) 4 liang.
The above four herbs are decocted with 6 sheng of water until 2 sheng remain. Divide into two doses and take warm.
Mu Fang Ji (Stephaniae Tetrandrae Radix) and Gui Zhi (Cinnamomi Ramulus) each 2 liang, Ren Shen (Ginseng Radix et Rhizoma) and Fu Ling (Poria) each 4 liang, Mang Xiao (Natrii Sulfas) 3 he.
The above four herbs are decocted with 6 sheng of water until 2 sheng remain. Strain, add Mang Xiao (Natrii Sulfas), and simmer slightly. Divide into two doses and take warm. Mild loose stools indicate cure.
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When there is Zhi Yin (fluid retention in the diaphragm region) under the heart, the patient suffers from severe dizziness and vertigo. Ze Xie Tang (Alisma Decoction) is indicated.
[Annotation]
"Under the heart" refers to the area below the diaphragm. Fluid retention above the diaphragm causes panting and fullness; fluid retention between the diaphragm causes palpitations and stuffiness; fluid retention below the diaphragm causes primarily dizziness and vertigo. Ze Xie Tang (Alisma Decoction), a mild and small formula, is used to treat mild cases of Zhi Yin (fluid retention in the diaphragm region). If Yang deficiency leads to abundant water, Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala and Licorice Decoction) or Wu Ling San (Five-Ingredient Powder with Poria) should be employed.
[Collection of Annotations]
You Yi stated: When pathogenic water-fluids ascend to the position of clear Yang, they cause dizziness and vertigo. "Mao" refers to mental confusion and lack of clarity, as if obscured by something; "Xuan" refers to visual spinning and sudden darkness. Ze Xie (Alismatis Rhizoma) drains water-Qi, while Bai Zhu (Atractylodis Macrocephalae Rhizoma) tonifies Earth-Qi to overcome water.
Ze Xie (Alismatis Rhizoma) 5 liang, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 2 liang.
The above two herbs are decocted with 2 sheng of water until 1 sheng remains. Divide into two doses and take warm.
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Patients suffering from Tan Yin (phlegm-fluids) should be treated with warm herbs to harmonize.
[Annotation]
Thick and turbid substances constitute Tan (Phlegm), indicating excess Yang; thin and clear substances constitute Yin (Fluids), indicating excess Yin. If there is only Tan (Phlegm) without Yin (Fluids), cool herbs should be used; if there is only Yin (Fluids) without Tan (Phlegm), hot herbs should be used to warm. If both Tan (Phlegm) and Yin (Fluids) are present, neither pure cooling nor pure heating is appropriate; therefore, warm herbs should be used to harmonize.
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In patients with chronic Zhi Yin (fluid retention in the diaphragm region) who experience cough, irritability, and chest pain, if they do not die suddenly but survive for one hundred days or a year, Shi Zao Tang (Ten Jujube Decoction) is appropriate.
[Annotation]
Zhi Yin (fluid retention in the diaphragm region) refers to water-fluids retained above and below the diaphragm. Water invading the Lung causes cough; water invading the Heart causes irritability; water knotting in the Chest causes pain. If the patient's constitution and Qi are substantial, Shi Zao Tang (Ten Jujube Decoction) can be used to purge. However, the reason such patients do not die immediately, or survive for one hundred days or even a year, is that water-fluids are Yin pathogens, and Yin nature is slow, so sudden death does not occur.
Shi Zao Tang (Ten Jujube Decoction) formula (see above).
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For patients with chronic cough, a Xian pulse (wiry pulse) indicates the presence of water-fluids. Shi Zao Tang (Ten Jujube Decoction) is indicated.
[Annotation]
This follows the previous clause to explain the pulse. "Chronic cougher" refers to long-term cough patients; attacking/purging is generally not suitable for them initially. However, if the pulse is Xian (wiry), the cough is caused by water-fluids. Since water-fluids are present, purging is applicable, hence Shi Zao Tang (Ten Jujube Decoction) is used.
[Collection of Annotations]
Wei Litong stated: Cough may result from drinking cold liquids or external contraction of Wind-Cold, described as "cold form and cold drinks injure the Lung," which is external Wind-Cold cough. It may also result from overexertion, where Yin deficiency generates internal heat that scorches Lung Metal, constituting internal injury consumptive cough. These are unrelated here. Zhang Zhongjing terms this "cougher," specifically referring to cough due to phlegm-fluids inside with rebellious Qi rushing upward. Thus, the pulse must be Xian (wiry), lacking the floating pulse of external contraction or the rapid pulse of internal deficiency. Seeing only a Xian (wiry) pulse indicates water-fluids causing pathology in the middle. Treating with Shi Zao Tang (Ten Jujube Decoction) controls the water pathogen, allowing it to drain downward and preventing upward rebellion.
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A Shuang Xian pulse (bilateral wiry pulse) indicates Cold, often occurring after severe purgation leading to interior deficiency. A Pian Xian pulse (unilateral wiry pulse) indicates Fluid retention.
[Commentary]
This clause originally followed the first clause regarding "mild shortness of breath" but is placed here separately.
[Annotation]
Shuang Xian (bilateral wiry) means both left and right pulses are wiry; Pian Xian (unilateral wiry) means either the left or right pulse alone is wiry. Pian Xian (unilateral wiry) indicates Fluid retention, so purging is indicated; Shuang Xian (bilateral wiry) indicates Cold, so purging is not indicated. Even if Pian Xian (unilateral wiry) requires purging, severe purgation should be avoided. Severe purgation would further weaken the interior, transforming a single wiry pulse into a bilateral wiry pulse. The wiry pulse belongs to Yin; double Yin generates Cold, hence "Shuang Xian (bilateral wiry) indicates Cold." This reminds practitioners not to assume the wiry pulse exclusively indicates Fluid retention.
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A Xian Shuo pulse (wiry and rapid) with Cold Fluids is difficult to treat in winter and summer.
[Commentary]
The character "Shuo" (rapid) in "Xian Shuo" should likely be "Chi" (slow) to align with the pathology of Cold Fluids; this is a transcription error.
[Annotation]
Single Xian (wiry) indicates Fluid retention, which normally warrants purging. However, if single Xian (wiry) is accompanied by Chi (slow) and Cold Fluids, purging is contraindicated. Cough due to Cold Fluids is difficult to treat in winter and summer because extreme Yin resides internally in summer and externally in winter. This elaborates on the previous two clauses regarding when Xian (wiry) pulse-related fluid diseases can or cannot be purged.
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In chronic cough lasting years, a Ruo pulse (weak pulse) indicates treatability; a Shi Da Shuo pulse (full, large, and rapid pulse) indicates death. A Xu pulse (deficient pulse) implies suffering from dizziness, due to pre-existing Zhi Yin (fluid retention in the diaphragm region) in the chest. Treatment should focus on the Fluid disease category.
[Annotation]
Chronic cough for years corresponds to annually recurring conditions like phlegm-fluid cough and water-wheezing today. A Ruo (weak) pulse indicates the pathogen is not advancing, suggesting treatability. A Shi Da Shuo (full, large, rapid) pulse indicates daily pathogen advancement, implying a fatal prognosis. A Xu (deficient) pulse indicates righteous Qi deficiency, inevitably causing dizziness. Carefully examining that the patient has pre-existing Zhi Yin (fluid retention in the diaphragm region), treatment should not focus solely on cough but seek methods within the context of Fluid disease management.
[Collection of Annotations]
You Yi stated: Chronic cough persisting for years is caused by Zhi Yin (fluid retention in the diaphragm region) soaking the Lung; persistent fluids lead to persistent cough. Long-term cough depletes Qi; if the pulse is instead full, large, and rapid, the pathogen remains strong. Facing depleted Qi with strong pathogen cannot last long, hence death. If the pulse is deficient, both righteous Qi and pathogenic fluid Qi are weak, making it treatable. However, although fluid Qi is weak, righteous Qi cannot resist it, still obscuring Clear Yang Qi, causing dizziness. Since this disease is caused by Zhi Yin (fluid retention in the diaphragm region), removing the fluids cures the disease, hence "treatment belongs to the Fluid disease category."
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Cough with rebellious Qi, leaning to breathe, unable to lie flat, is treated with Xiao Qing Long Tang (Minor Blue Dragon Decoction). After Xiao Qing Long Tang (Minor Blue Dragon Decoction) induces sweating, if excessive salivation, dry mouth, Cun pulse (inch position) deep, Chi pulse (cubit position) faint, cold limbs, Qi rushing from the lower abdomen to the chest and throat, numbness in limbs, facial flushing resembling drunkenness, followed by downward flow to the inner thighs, difficult urination, and intermittent dizziness occur, administer Fu Ling Gui Zhi Wu Wei Gan Cao Tang (Poria, Cinnamon Twig, Schisandra and Licorice Decoction) to treat the Qi rush. Once the Qi rush subsides but cough and chest fullness recur, use Fu Ling Gui Zhi Wu Wei Gan Cao Tang (Poria, Cinnamon Twig, Schisandra and Licorice Decoction) minus Gui Zhi (Cinnamomi Ramulus), adding Gan Jiang (Zingiberis Rhizoma) and Xi Xin (Asari Radix et Rhizoma) to treat cough and fullness. Once cough and fullness cease but thirst recurs and Qi rush reappears, this is due to Xi Xin (Asari Radix et Rhizoma) and Gan Jiang (Zingiberis Rhizoma) being hot herbs; taking them should cause immediate thirst. If thirst stops instead, it indicates Zhi Yin (fluid retention in the diaphragm region); Zhi Yin (fluid retention in the diaphragm region) typically causes dizziness, and dizzy patients often vomit. For vomiting, add Ban Xia (Pinelliae Rhizoma) to remove water. Use Fu Ling Gui Zhi Wu Wei Gan Cao Tang (Poria, Cinnamon Twig, Schisandra and Licorice Decoction) minus Gan Cao (Glycyrrhizae Radix et Rhizoma) and Gui Zhi (Cinnamomi Ramulus), adding Xi Xin (Asari Radix et Rhizoma), Gan Jiang (Zingiberis Rhizoma), and Ban Xia (Pinelliae Rhizoma). If water is removed, vomiting stops, but edema appears, add Xing Ren (Armeniacae Semen Amarum). Although Ma Huang (Ephedrae Herba) should be added for edema, it is omitted because the patient already has numbness; forcing its use would cause Jue (cold reversal). This is because the patient has Blood deficiency, and Ma Huang (Ephedrae Herba) disperses Yang. If facial flushing resembles drunkenness, this is Stomach Heat rushing upward steaming the face; add Da Huang (Rhei Radix et Rhizoma) to drain it.
[Commentary]
The character "Xia" (downward/purge) in "after Xiao Qing Long Tang (Minor Blue Dragon Decoction) xia" should be "Han" (sweat); both Xiao and Da Qing Long Tang (Major Blue Dragon Decoction) are sweating formulas, so this is a transcription error.
[Annotation]
Ke Ni (rebellious cough) is an ancient term for cough; Yi Xi (leaning to breathe) refers to current shortness of breath. Cough with shortness of breath inability to lie down is often Phlegm-Fluids in chronic cases, or combined with exterior Cold in acute cases. Thus, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is used to induce sweating, dispersing interior fluids and exterior Cold. Xiao Qing Long Tang (Minor Blue Dragon Decoction) is strongly acrid and warm, suitable only for those with excess. Misusing it in deficiency damages Yin with acrid-heat (causing salivation/dry mouth) and damages Yang with heavy sweating (causing cold limbs). Facial flushing indicates Yang floating outward; difficult urination and Qi rushing indicate Yin depletion inward; deep/faint pulses indicate weak interior Qi; limb numbness indicates weak exterior Qi; intermittent dizziness indicates severe deficiency. Although Yin-Yang and Interior-Exterior are all deficient, this is a complicated disease resulting from erroneous sweating, mixing Cold and Heat. Therefore, Fu Ling Gui Zhi Wu Wei Gan Cao Tang (Poria, Cinnamon Twig, Schisandra and Licorice Decoction) is given to first unblock Yang and harmonize Yin. Wait for the rushing Qi to calm before discussing other methods. Now, although the Qi rush has subsided, cough and chest fullness recur, indicating Cold Fluids stored in the chest. Gui Zhi (Cinnamomi Ramulus) is disliked for moving outward, so Gan Jiang (Zingiberis Rhizoma) and Xi Xin (Asari Radix et Rhizoma) are added to conquer interior Cold Fluids. After taking this, cough/fullness stop, but thirst and Qi rush recur, indicating Min Fire rebelling upward, stirred by the hot herbs Gan Jiang (Zingiberis Rhizoma) and Xi Xin (Asari Radix et Rhizoma). If thirst occurs immediately upon taking but stops later, it indicates pre-existing Zhi Yin (fluid retention in the diaphragm region). Zhi Yin (fluid retention in the diaphragm region) causes dizziness; this dizziness is due to fluids rebelling in the chest causing vomiting, not Yang deficiency blocking ascent. Hence, Ban Xia (Pinelliae Rhizoma) is added to remove water, and Gan Cao (Glycyrrhizae Radix et Rhizoma) is removed to avoid sweet flavor aiding vomiting. After water removal and vomiting cessation, if facial edema appears, add Xing Ren (Armeniacae Semen Amarum) to descend rebellious Qi and stop cough/vomiting. If edema is not due to cough/vomiting but Wind invasion, Ma Huang (Ephedrae Herba) should be added. Here, Blood deficiency causes numbness, Yang deficiency causes cold limbs, and swelling follows cough/vomiting, so Ma Huang (Ephedrae Herba) is omitted. If accompanied by facial flushing like drunkenness, this is Stomach Heat rushing upward; add Da Huang (Rhei Radix et Rhizoma) to drain Stomach Heat.