而跳动不宁也。）微者短气。脉双弦者寒也，皆大下后里虚。偏弦者饮也，先渴后呕，（言
饮本偏弦，若大下里虚，虚寒相搏，变为双弦也。气被水阻，不能化生津液，故渴。）小半夏茯苓汤，此属
饮家。（言平日多饮之人也。）又谓∶呕家本渴，（呕家，谓非因停水而呕者，乃别病也。呕伤津液，故本应作
渴。）渴者为欲解。（病从呕去，故虽渴亦为欲解也）。今反不渴，心下有支饮故也，（此辨证之法，言
卒然呕吐，则未知其为别病之呕欤？抑留饮之吐欤？则以呕后渴、不渴辨之。渴者是别病之呕，不渴者乃留饮之呕
也。留饮未呕之先亦渴，而呕后反不渴者，以呕则水稍去而气稍通，能布化生津也。）小半夏汤。又谓∶心
下痞，半夏加茯苓汤。脐下悸，（水停心下，则心下悸而痞塞。若停脐下，则脐下悸也。）吐涎沫，（观
此则上文所谓呕者，为涎沫可知。）眩，（水逼火上浮也。）五苓散（见伤湿。）又谓∶短气，有微饮，（水停心
下，甚者为悸，微者短气。）当从小便去之，桂苓术甘汤、肾气丸即八味丸。
（《金鉴》云∶呼出为阳，心肺主之；吸入为阴，肝肾主之。若呼之气短，是心肺之阳为水所碍，用苓
桂术甘汤，益上气以行水。若吸之气短，是肝肾之阴为水所碍，用肾气丸，温阳以行水。按呼出气自下而上，故属
心肺。呼气短者，言水在上焦，阻
碍上焦呼吸之气，致令喘促也。乃举呼以该吸，非单言呼也。吸气仿此，勿泥看。）
又谓∶脉浮而细滑，
伤饮。（初病未深之诊。）脉沉者，有留饮。（《经》云∶沉潜水蓄。是也。病深之诊。）病者脉伏。（沉甚为
伏。）其人欲自利，（水欲去，不上出而呕，则下行而利。）此为留饮欲去也。虽利，心下续坚满，
（乃伏饮盘结不得去，可知。）甘遂半夏汤。（甘遂、甘草并用，激之使出。因已利，故
佐芍药以约敛之，不令亡
阴。）又谓∶水在肝，胁下支满，嚏而痛。（气动则水动，而冲击作痛。）水在肾，心下悸。（心，当
作脐。）又谓∶支饮腹满，（原文作胸满，从《金鉴》改之。）浓朴大黄汤。
又谓∶腹满，口舌干燥，
肠间有水气，（即水声。）己椒苈黄丸。（防己、椒目导饮从小便出，大黄、葶苈推饮从大便下，前后分消也。）
又谓∶脉沉弦者，悬饮内痛，十枣汤。（见肿胀。）又谓∶溢饮当发汗，大小青龙汤。又
谓∶肺饮脉不弦，但苦喘短气，不能卧，（肺饮即支饮。）葶苈大枣汤。（见哮喘。）又谓∶
膈间支饮，喘满心下痞坚，（自胸连膈盘结实甚。）面色黧黑，（水邪深结之色。）脉沉紧，
得之数
十日，医吐下之不愈，（盘结可知。）木防己汤（见喘）主之。（方中用参，以吐下后伤正也。）虚者即愈，
（得参补之，故愈。）实者三日复发，复与。不愈，去石膏（恶其寒）加芒硝（开结）、茯苓（下渗）。又
谓∶脉弦数，有寒饮，（外寒而内郁热，故脉弦数也。）冬夏难治。（冬用热药，则妨其内之热；夏用寒药，
则妨其外之寒也。然不必泥。）又谓∶久咳数岁，（详下乃支饮渍肺而咳也。）脉弱可治，（久病脉应弱。）脉
大数者死，脉虚必苦冒，其人本有支饮在胸中故也。（气虚停饮则清阳不升，故昏冒如有物蔽之，
即伤湿首如裹之义。）治属饮家。（言不从咳嗽门治法也。按《金匮》所言停饮证，当与水肿门参看。）
张子和谓∶饮当去水，温补转甚。盖寒饮在中，反以热药从上投之，为寒所拒，
水湿未除，反增心火，火既不降，水反下注，其上焦枯，其下寒栗，当根据《内经》
留者攻之，十枣（见肿胀）、神 （见肿胀）之属为宜，次以淡剂流其余蕴，以降火之剂开其胃
口，自愈。
（导致心跳不安。）病情轻微的表现为气短。脉象双弦的属于寒证，这通常是因为在大泻下之后导致里虚所致。脉象偏弦的属于饮邪，如果先感到口渴随后呕吐，（意思是原本脉象偏弦，若经过大泻下导致里虚，虚与寒相互搏结，脉象便变为双弦。气被水饮阻滞，不能化生津液，所以口渴。）可用小半夏茯苓汤，这属于饮家（指平时多饮水的人）的病证。又说：经常呕吐的人本来应该口渴，（“呕家”指并非因停水而呕吐的情况，而是其他疾病。呕吐损伤津液，所以本应感到口渴。）如果感到口渴，说明病将要解除。（病邪随呕吐排出，所以虽然口渴但也算是病将解除的表现）。现在反而不渴，是因为心下有支饮的缘故，（这是辨证的方法，说突然呕吐，不知道是其他疾病的呕吐呢？还是留饮导致的呕吐呢？可以通过呕吐后是否口渴来辨别。口渴的是其他疾病的呕吐，不渴的才是留饮导致的呕吐。留饮在呕吐之前也会口渴，但呕吐后反而不渴，是因为呕吐使水饮稍去、气机稍通，能够布散化生津液。）可用小半夏汤。又说：心下痞满，用半夏加茯苓汤。脐下悸动，（水饮停在心下，则心下悸动且痞塞。如果水饮停在脐下，则脐下悸动。）吐涎沫，（看这一点就知道上文所说的呕吐，是指吐涎沫。）眩晕，（水邪逼迫火气上浮。）可用五苓散（见伤湿章节）。又说：气短，有微细的水饮，（水饮停在心下，严重的表现为悸动，轻微的表现为气短。）应当通过小便排出，可用桂苓术甘汤、肾气丸即八味丸。
（《医宗金鉴》说：呼出为阳，由心肺主管；吸入为阴，由肝肾主管。如果呼气时气短，是心肺之阳被水邪阻碍，用苓桂术甘汤，补益上焦之气以行水。如果吸气时气短，是肝肾之阴被水邪阻碍，用肾气丸，温补阳气以行水。按语：呼出的气自下而上，所以属于心肺。呼气短，是说水在上焦，阻碍上焦呼吸之气，导致喘促。这里是举呼气来概括吸气，并非单指呼气。吸气同理，不要拘泥看待。）
又说：脉浮而细滑，是伤饮（初病未深入的诊候）。脉沉的，是有留饮。（《内经》说：沉潜水蓄。正是如此。这是病深入的诊候）。病人脉伏。（沉到极点是伏脉）。其人想要自利（腹泻），（水饮欲去，不从上面呕吐而出，则向下排泄而腹泻。）这是留饮即将排出的表现。虽然腹泻，但心下继续坚硬胀满，（这是伏饮盘结无法去除，可以知道。）可用甘遂半夏汤。（甘遂、甘草并用，激荡促使水饮排出。因为已经腹泻，所以佐以芍药来收敛，防止亡阴。）又说：水在肝，胁下支撑胀满，打喷嚏时疼痛。（气动则水动，冲击而作痛。）水在肾，心下悸动。（这里的“心”，应当理解为“脐”。）又说：支饮腹满，（原文作胸满，依据《医宗金鉴》改为腹满。）可用浓朴大黄汤。
又说：腹满，口舌干燥，肠间有水气，（即水声。）可用己椒苈黄丸。（防己、椒目引导水饮从小便排出，大黄、葶苈推动水饮从大便下行，前后分消。）
又说：脉沉弦的，是悬饮内痛，可用十枣汤。（见肿胀章节）。又说：溢饮应当发汗，可用大小青龙汤。又说：肺饮脉不弦，只是苦于喘促气短，不能平卧，（肺饮即支饮。）可用葶苈大枣汤。（见哮喘章节）。又说：膈间支饮，喘促且心下痞硬坚实，（从胸部连及膈肌，盘结实甚。）面色黧黑，（水邪深结的颜色。）脉沉紧，得病数十日，医生用吐法、下法治疗未愈，（可知病邪盘结。）主方用木防己汤（见喘章节）。（方中用人参，是因为吐下之后正气受损。）体质虚弱的服药后即愈，（得到人参补益，所以痊愈。）体质实实的三天后复发，再次给予原方。若不愈，去掉石膏（因其性寒）、加芒硝（开结）、茯苓（下渗）。又说：脉弦数，有寒饮，（外寒而内郁热，所以脉弦数。）冬夏难治。（冬天用热药，则会妨碍其内部的热；夏天用寒药，则会妨碍其外部的寒。然而不必拘泥。）又说：久咳数年，（详情如下乃支饮浸渍肺部而咳嗽。）脉弱可治，（久病脉应弱。）脉大数的预后不良，脉虚必然苦于头昏目眩，这是因为人本来胸中有支饮的缘故。（气虚停饮则清阳不升，所以昏冒如有物遮蔽，即伤湿首如裹的含义。）治疗归属于饮家范畴。（指不从咳嗽门的治法来看。按《金匮要略》所言停饮证，应当与水肿门参考查看。）
张子和说：饮邪应当祛除水湿，若用温补反而加重。因为寒饮在中焦，反用热药从上投服，被寒邪所拒，水湿未除，反而增加心火，火气不降，水反下注，其上焦枯槁，其下寒冷战栗，应当根据《内经》“留者攻之”的原则，使用十枣（见肿胀章节）、神祐（见肿胀章节）之类的药物为宜，其次用淡味药剂流走其余余邪，以降火药剂开通胃口，自然痊愈。
(leading to palpitations and restlessness.) Mild cases present with shortness of breath. A double-wiry pulse indicates cold, often occurring after severe purging has led to interior deficiency. A single-sided wiry pulse indicates fluid retention; if thirst precedes vomiting, (meaning the original pulse was wiry on one side; if severe purging leads to interior deficiency, deficiency and cold interact, changing the pulse to double-wiry. Qi is obstructed by water fluids, unable to transform into body fluids, hence thirst.) Xiao Banxia Fuling Tang (Minor Pinellia and Poria Decoction) is indicated for this category of "fluid patients" (those who habitually consume excessive fluids). It is also stated: Patients prone to vomiting should naturally feel thirsty, ("Vomiting patients" refers to those vomiting not due to retained water, but from other diseases. Vomiting damages body fluids, so thirst is expected.) If they feel thirsty, it indicates the disease is about to resolve. (The pathogen exits via vomiting, so even with thirst, it signifies resolution). Now, if there is no thirst, it is because there is Zhi Yin (Branching Fluid Retention) in the epigastrium. (This is a method of syndrome differentiation: when sudden vomiting occurs, one must distinguish whether it is vomiting from another disease or from Liu Yin (Stagnant Fluid). Thirst indicates vomiting from another disease; lack of thirst indicates vomiting from stagnant fluid. Before vomiting, stagnant fluid patients may also be thirsty, but after vomiting, they are no longer thirsty because some water has been expelled, Qi flows slightly better, and it can distribute and generate body fluids.) Xiao Banxia Tang (Minor Pinellia Decoction) is indicated. It is also stated: Epigastric fullness and stuffiness, use Banxia Jia Fuling Tang (Pinellia Decoction with Added Poria). Sub-umbilical palpitation, (If water stops in the epigastrium, there is epigastric palpitation and stuffiness. If it stops below the umbilicus, there is sub-umbilical palpitation.) Spitting saliva and foam, (From this, we know the vomiting mentioned earlier referred to spitting saliva and foam.) Dizziness, (Water evil forces Fire to float upward.) Wuling San (Five-Ingredient Powder with Poria) is indicated (see Shang Shi chapter). It is also stated: Shortness of breath with mild Yin (Fluid), (When water stops in the epigastrium, severe cases present with palpitations, mild cases with shortness of breath.) The treatment should promote urination to eliminate it. Guiling Zhugan Tang (Cinnamon Twig, Poria, Atractylodes Macrocephala, and Licorice Decoction) or Shenqi Wan (Kidney Qi Pill), which is the same as Bawei Wan (Eight-Ingredient Pill), are indicated.
(The *Yizong Jinjian* states: Exhalation is Yang, governed by the Heart and Lung; inhalation is Yin, governed by the Liver and Kidney. If exhalation is short of breath, it means the Yang of the Heart and Lung is obstructed by water; use Linggui Zhugan Tang to tonify upper Qi to move water. If inhalation is short of breath, it means the Yin of the Liver and Kidney is obstructed by water; use Shenqi Wan to warm Yang to move water. Note: Exhaled air rises from below, thus belonging to the Heart and Lung. Shortness of breath during exhalation means water in the Upper Jiao obstructs respiratory Qi, causing panting. Here, exhalation is used to encompass inhalation, not just exhalation alone. Inhalation is similar; do not view this rigidly.)
It is also stated: A floating, fine, and slippery pulse indicates injury by drinking fluids (a sign of early-stage disease not yet deep). A sinking pulse indicates Liu Yin (Stagnant Fluid). (*Jing* states: Sinking indicates submerged water accumulation. This is correct. It is a sign of deep-seated disease). If the patient's pulse is Fu (Hidden/Deep), (Fu is extremely deep/sinking). The person desires spontaneous diarrhea, (Water wants to exit; if not vomited out from above, it moves downward causing diarrhea.) This indicates that Liu Yin is about to exit. Although there is diarrhea, the epigastrium remains hard and full, (indicating Fu Yin (Trapped Fluid) is knotted and cannot be expelled.) Gansui Banxia Tang (Kansui and Pinellia Decoction) is indicated. (Gansui and Gancao are used together to stimulate expulsion. Since diarrhea has already occurred, Shaoyao is added to astringe, preventing loss of Yin). It is also stated: Water in the Liver causes distending fullness under the hypochondrium, pain upon sneezing. (Qi movement causes water movement, leading to impact pain.) Water in the Kidney causes epigastric palpitation. (Here, "Heart" should be understood as "Umbilicus"). It is also stated: Zhi Yin (Branching Fluid) causes abdominal fullness, (Original text says chest fullness, corrected to abdominal fullness per *Yizong Jinjian*). Nongpu Dahuang Tang (Magnolia Bark and Rhubarb Decoction) is indicated.
It is also stated: Abdominal fullness, dry mouth and tongue, water qi in the intestines (i.e., gurgling sound). Jifeng Lihuang Wan (Stephania, Lepidium, Rhubarb, and Descurainia Pill) is indicated. (Fangji and Juemu guide fluid out via urine; Dahuang and Tingli push fluid out via feces, eliminating from both front and back).
It is also stated: A sinking and wiry pulse indicates Xuan Yin (Hanging Fluid) with internal pain. Shizao Tang (Ten Jujube Decoction) is indicated (see Zhang Zhong chapter). It is also stated: Yi Yin (Overflowing Fluid) should be treated by inducing sweating. Da Qing Long Tang and Xiao Qing Long Tang are indicated. It is also stated: Fei Yin (Lung Fluid) presents with a non-wiry pulse, only suffering from panting and shortness of breath, inability to lie flat. (Fei Yin is equivalent to Zhi Yin). Tingli Dazao Tang (Descurainia and Jujube Decoction) is indicated (see Chuan Xiao chapter). It is also stated: Zhi Yin in the Diaphragm causes panting, epigastric stuffiness, hardness, and fullness. (Knotted firmly from chest to diaphragm). Dark complexion, (Color of deeply knotted water evil). Sinking-tight pulse. After dozens of days, if medical treatment with emetics and purgatives fails, (indicating knotting is severe). Mufangji Tang (Stephania Tetrandra Decoction) is the primary formula (See Chuan Xiao chapter). (Ginseng is used in the formula because Zheng Qi (Upright Qi) was damaged by emesis and purgation). Those with Xu (Deficiency) will recover immediately, (Recovering due to Ginseng tonification). Those with Shi (Excess) will relapse after three days; repeat administration. If still ineffective, remove Shigao (dislike its cold nature), add Mangxiao (to open knots), and Fuling (to drain downward). It is also stated: A wiry-numerous pulse indicates Han Yin (Cold Fluid). (External cold with internal constrained heat causes a wiry-numerous pulse). Difficult to treat in winter and summer. (In winter, using hot herbs hinders internal heat; in summer, using cold herbs hinders external cold. However, one need not be rigid about this). It is also stated: Chronic cough lasting years, (As detailed below, this is Zhi Yin infiltrating the Lung causing cough). A weak pulse is treatable, (Chronic disease should present with a weak pulse). A large-numerous pulse indicates death; a deficient pulse causes severe dizziness/giddiness. This is because the person originally had Zhi Yin in the Chest. (Qi deficiency with fluid retention prevents Clear Yang from ascending, causing dizziness as if covered by something, which is the meaning of "Head feels wrapped" in Shang Shi). Treatment belongs to the category of Fluid Patients. (Meaning it should not be treated according to the methods for Cough syndromes. Note: The Tings Yin syndromes described in *Jinkui Yaolue* should be cross-referenced with the Edema chapter).
Zhang Zihe stated: Fluid should be removed; warming and tonifying will worsen it. Because Cold Fluid is in the Middle Jiao, administering hot medicines from above is rejected by the Cold. Water-dampness is not removed, but Heart Fire increases. Since Fire does not descend, Water flows downward instead. The Upper Jiao becomes dry, and the Lower Jiao becomes cold and shivering. One should follow the *Neijing* principle: "Those that remain, attack them." Using formulas like Shizao (see Zhang Zhong chapter) or Shenyu (see Zhang Zhong chapter) is appropriate. Subsequently, use bland agents to flow away residual pathogens, and use fire-draining agents to open the stomach appetite, leading to natural recovery.