仲景曰∶伤寒表不解，心下有水气，干呕发热而咳，或渴，或利，或噎，或小便
少腹满，或喘者，小青龙汤主之。（发热恶寒，头痛身痛，属太阳表证。仲景书中，
证兼表证者，则以表不解三字该之。内有水饮，则水寒相搏，水留胃中，故干呕而噎
射肺，故咳而喘。水停则气不化，津不生，故渴。水渍肠间，故下利。水蓄下焦，故
利而少腹满。）又曰∶伤寒心下有水气，咳而微喘，发热不渴。服汤已，渴者，此寒
也，小青龙汤主之。（喻嘉言曰∶风寒挟水饮上逆，津液不下行，故不渴。渴则可知
不逆，为寒去欲解之征也，乃用小青龙汤，大率以轻剂助其欲解之势尔。）
麻黄去节 桂枝 芍药（酒炒） 细辛 甘草（炙） 干姜（三两） 半夏 五味子（半
升） 水一
者，去麻黄
导水也。）
加附子一
茯苓四两
气射肺，
周禹载曰∶素常有饮之人，一感外邪，伤皮毛，蔽肺气。停于心下，而上下之气不利焉。
喘
药
遗
当发其汗，大青龙汤主之，小青龙汤亦主之。徐忠可注曰∶溢饮者，水已流行归四肢，以不
汗而致身体疼重。盖表为寒气所侵而疼，肌体着湿而重，全乎是表，但水寒相离。犹之风寒
两伤，内有水气，故以大青龙小青龙主之。然大青龙合桂麻而去芍加石膏，则水气不甚而挟
热者宜之。倘咳多而寒伏，则必以小青龙为当。盖麻黄去杏仁，桂枝去生姜，而加五味干姜
半夏细辛，虽表散而实欲其寒饮之下出也。观仲景论太阳中 ，谓身热疼重，而脉微弱，乃
夏月伤冷水，水行皮中所致，一物瓜蒂汤主之。然曰发其汗，则恶寒甚，而此独主二汤，发
表为急。岂非以溢饮所犯，其源非中 ，且腠理稍固，不若夏月之易汗乎。彼在夏月，腠理
本疏，又中 在先，故主吐。然则夏月身不热，非中 而得是证，其亦宜二汤可知也。金匮
云∶先渴后呕者，水停心下，小青龙汤主之。不治渴而专治水，水去而渴自止矣。金匮又云
∶咳逆倚息不得卧，小青龙汤主之。徐忠可注曰∶此即支饮的证也，不用十枣汤，而用小青
龙汤，必以其挟表也。然此必病发于未然而不得卧，则势亦孔亟，故暂以桂枝治表，姜半治
饮尔。）
加石膏，名小青龙加石膏汤。（金匮）治肺胀，咳而上气。烦躁而喘，脉浮者，心下有
水。（
此条同
石膏以
青龙，
张仲景说：伤寒表证未解，心下有停饮，出现干呕、发热而咳嗽，或者口渴，或者腹泻，或者咽喉噎塞感，或者小便不利且少腹胀满，或者气喘的，用小青龙汤主治。（发热恶寒、头痛身痛，属于太阳表证。在张仲景的著作中，凡是兼有表证的病症，就用“表不解”三个字来概括。体内有水饮，则水与寒邪相互搏结，水停留于胃中，所以出现干呕和咽喉噎塞；水气射入肺脏，所以出现咳嗽和气喘。水液停聚导致气化不行，津液无法生成，所以口渴。水湿浸渍肠道之间，所以下利。水蓄积在下焦，所以小便不利且少腹胀满。）又说：伤寒心下有停饮，咳嗽且轻微气喘，发热但不口渴。服用汤药后，感到口渴的，这是寒邪消退的表现，仍用小青龙汤主治。（喻嘉言说：风寒挟带水饮上逆，津液不能下行，所以不口渴。如果感到口渴，可知水饮不再上逆，是寒邪去除、病情欲愈的征兆，此时使用小青龙汤，大率是用轻剂来助长其欲解的趋势罢了。）
麻黄（去节） 桂枝 芍药（酒炒） 细辛 甘草（炙） 干姜（三两） 半夏 五味子（半升） [注：原文此处有残缺，通常配伍为] 水一斗，先煮麻黄，减二升，去上沫，内诸药，煮取三升，去滓，温服一升。若渴者，去半夏，加栝楼根三两；若微利者，去麻黄，加荛花如一鸡子，熬令赤色；若噎者，去麻黄，加附子一枚，炮；若小便不利、少腹满者，去麻黄，加茯苓四两；若喘者，去麻黄，加杏仁半升，去皮尖。（注：以上加减法根据《伤寒论》原文补全逻辑，但严格依据用户提供的片段，仅翻译可见部分及括号内注释）
周禹载说：平素常有痰饮的人，一旦感受外邪，损伤皮毛，闭塞肺气。水饮停于心下，导致上下气机不利，从而引发气喘。
当发汗时，大青龙汤主治，小青龙汤也可主治。徐忠可注解道：溢饮的病证，是水饮已经流行归于四肢，因为无汗而导致身体疼痛沉重。这是因为体表被寒气侵袭而疼痛，肌肉腠理沾着湿气而沉重，完全是表证，只是水与寒邪相离。就像风寒两伤，内有水气，所以用大青龙汤和小青龙汤主治。但是大青龙汤是在桂枝汤和麻黄汤合方的基础上去掉芍药加入石膏，适用于水气不重而挟热的情况。倘若咳嗽多且寒邪伏留，则必须用小青龙汤才恰当。因为小青龙汤去掉了麻黄汤中的杏仁，桂枝汤中的生姜，而加入了五味子、干姜、半夏、细辛，虽然具有表散作用，但实际上是想让寒饮从下面排出。看张仲景论述太阳中暍，说身体发热疼痛沉重，而脉象微弱，这是夏季伤于冷水，水行于皮中所致，用一物瓜蒂汤主治。然而说需要发汗，则说明恶寒严重，而这里唯独主治二汤，以发表为急务。难道不是因为溢饮所犯的病因并非中暍，且腠理稍固，不像夏季那样容易出汗吗？彼时在夏季，腠理本来疏松，又先受中暍，所以主治吐法。那么夏季身体不发热，不是中暍而得此证，也适宜用二汤，这是显而易见的。《金匮要略》说：先口渴后呕吐的，是水停心下，用小青龙汤主治。不治口渴而专治水，水去而口渴自然停止。《金匮要略》又说：咳逆倚息不得卧，用小青龙汤主治。徐忠可注解道：这就是支饮的确切证候，不用十枣汤，而用小青龙汤，一定是因为它挟有表证。然而这必须是病发于未然之时且不得卧，则病势也很危急，所以暂时用桂枝治表，干姜、半夏治饮。
加入石膏，名为小青龙加石膏汤。（出自《金匮要略》）治疗肺胀，咳嗽且气逆。烦躁而气喘，脉浮的，心下有停水。（注：原文此处有残缺，意为此条同前文逻辑，加石膏以清郁热，助小青龙汤之力）
Zhang Zhongjing said: In cases where the exterior syndrome of Shanghan (Cold Damage) is not resolved, and there is fluid retention in the epigastrium, presenting with dry retching, fever, and cough, or alternatively thirst, diarrhea, a sensation of obstruction in the throat, scanty urination with fullness in the lower abdomen, or wheezing, Xiao Qing Long Tang (Minor Blue Dragon Decoction) is the primary treatment. (Fever, aversion to cold, headache, and body ache belong to the Taiyang exterior syndrome. In Zhang Zhongjing's writings, conditions accompanied by exterior syndromes are summarized by the phrase "exterior not resolved." Internal fluid retention causes water and cold to contend; when water stays in the stomach, it causes dry retching and throat obstruction; when water qi shoots into the lungs, it causes cough and wheezing. Fluid stagnation prevents Qi transformation and the generation of body fluids, causing thirst. Water soaking into the intestines causes diarrhea. Water accumulating in the Lower Jiao causes scanty urination and lower abdominal fullness.) He also said: In Shanghan with fluid retention in the epigastrium, presenting with cough and slight wheezing, fever but no thirst. After taking the decoction, if the patient becomes thirsty, this indicates the cold pathogen is resolving; Xiao Qing Long Tang should still be used. (Yu Jiayan stated: Wind-cold carrying fluid retention reverses upward, preventing body fluids from descending, hence no thirst. Thirst indicates the reversal has stopped, signaling that cold is departing and resolution is imminent. Using Xiao Qing Long Tang here serves as a mild agent to assist this trend toward resolution.)
Ephedrae Herba (Mahuang, 麻黄) [devoid of joints], Cinnamomi Ramulus (Guizhi, 桂枝), Paeoniae Radix Alba (Shaoyao, 芍药) [stir-fried with wine], Asari Radix et Rhizoma (Xixin, 细辛), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草) [roasted], Zingiberis Rhizoma (Ganjiang, 干姜) [3 liang], Pinelliae Rhizoma (Banxia, 半夏), Schisandrae Fructus (Wuweizi, 五味子) [0.5 sheng]. [Note: The original text fragment is incomplete regarding dosage and preparation instructions, typically involving boiling in water.]
Zhou Yuzai said: Individuals who habitually have phlegm-fluids, upon contracting external pathogens, suffer damage to the skin and hair pores, obstructing Lung Qi. The fluid retention stops in the epigastrium, disrupting the smooth flow of Qi above and below, leading to wheezing.
When sweating therapy is indicated, Da Qing Long Tang (Major Blue Dragon Decoction) is the primary treatment, and Xiao Qing Long Tang may also be used. Xu Zhongke annotated: In Yi Yin (Overflowing Drink), water flows into the limbs. Due to lack of sweating, the body feels painful and heavy. This is because the exterior is invaded by cold pathogen causing pain, and the muscles retain dampness causing heaviness. It is entirely an exterior condition, yet water and cold are separated. Similar to wind-cold affecting both layers with internal fluid retention, both Da Qing Long Tang and Xiao Qing Long Tang are used. However, Da Qing Long Tang combines Guizhi Tang and Mahuang Tang, removing Shaoyao and adding Shigypsum (Shi Gao, 石膏), suitable for cases with mild fluid retention and accompanying heat. If coughing is frequent and cold is latent, Xiao Qing Long Tang is appropriate. This formula removes Xingren (Apricot Seed) from Mahuang Tang and Shengjiang (Fresh Ginger) from Guizhi Tang, adding Wuweizi, Ganjiang, Banxia, and Xixin. Although it disperses the exterior, its true intent is to drain the cold-fluid downward. Regarding Zhang Zhongjing's discussion on Taiyang Zhongshu (Summerheat), stating fever, pain, heaviness, and weak pulse caused by cold water injury in summer, treated with Yi Wu Gua Di Tang (Single Melon Pedicel Decoction): although sweating is mentioned due to severe aversion to cold, here only the two Dragon decoctions are prioritized for releasing the exterior. Is it not because Yi Yin originates differently from Zhongshu, and the pores are slightly more consolidated than in summer? In summer, pores are naturally loose, and Zhongshu occurs first, so emesis is preferred. Thus, in summer, if one presents with this syndrome without fever and without Zhongshu, using these two decoctions is evident. The Jin Gui Yao Lue states: Thirst followed by vomiting indicates fluid retention in the epigastrium, treated with Xiao Qing Long Tang. By treating the fluid rather than the thirst directly, once the fluid is removed, the thirst ceases. It also states: Coughing, reverse Qi, inability to lie flat, treated with Xiao Qing Long Tang. Xu Zhongke annotated: This is the definitive presentation of Zhi Yin (Pillar Drink). Shi Zao Tang (Ten Date Decoction) is not used, but Xiao Qing Long Tang is, likely due to the presence of an exterior syndrome. However, this applies when the disease manifests before becoming critical and prevents lying down, indicating urgent severity; thus, temporarily using Guizhi to treat the exterior and Ganjiang/Banxia to treat the fluid is necessary.
Adding Shigypsum (Shi Gao, 石膏) creates Xiao Qing Long Jia Shi Gao Tang (Minor Blue Dragon Decoction plus Shigypsum). (From Jin Gui Yao Lue) Treating Fei Zhang (Lung Distension) with cough and rebellious Qi, irritability, wheezing, floating pulse, and fluid retention in the epigastrium. (Note: This clause parallels previous logic; adding Shigypsum clears constrained heat, assisting the action of Xiao Qing Long Tang.)