局方苏子降气汤治虚阳上攻气不升降上盛下虚痰涎壅盛
俞山人降气汤治同前
黑锡丹治痰气壅盛上盛下虚心火炎炽肾水枯竭灵砂丹治上盛下虚痰涎壅盛此药最能镇坠
升降阴阳(四方并见本方)
按以上诸方并系类聚温热之药而出证皆云治上盛下虚气不升降夫所谓盛者即心火之炎虚
者即
肾水之弱火炎水弱则有升无降故津液涌而为痰涎于上今以金石丹药湿热香燥之药而欲补下焦
之虚如抱薪救火尔若以为下焦阳虚而议治者亦非也夫阳火之虚则阴水必盛痰涎津液自然随气
而降又何必用此药也
金匮肾气丸治短气有微饮当从小便去之(方见补虚门)
按仲景以肾虚有饮故用此补肾逐水以其中有泽泻茯苓故也而严氏以此方治肾虚寒而不能
摄养
肾水使邪水溢上多吐痰唾夫肾既虚寒则阳火必盛未审所录摄养肾水者何物耶夫肾水乃天一所
生人之根蒂痰涎乃津液败浊而成岂可直指肾水不摄而邪水溢上耶若云肾水虚弱阴亏难降使津
液败浊而为痰水故用此药于义则明白矣
谨按痰病多生于湿故古方多用南星半夏之类然亦有所挟之邪故药有风寒暑湿之异又人身
体
有上下表里故在表者汗之在里者下之在上者涌之在下者分利之治饮之法可谓详矣或曰陈无择
以大小青龙五苓承气为外因参苓八味参苏为内因十枣葶苈大小半夏控涎破饮为不内外因今吾
子所编诸方意不侔此何也予曰大小青龙外因之表药五苓承气外因之里药也参苓八味内因之里
药参苏饮内因之表药也十枣葶苈控涎破饮不内外因之下药也大小半夏不内外因和中药也彼以
三因立论故叙药止以所因为主而不分其表里内外之异今予以表里内外分类诸方则难拘其所因
也
局方苏子降气汤，治疗虚阳上攻、气机升降失常、上盛下虚、痰涎壅盛之证。
俞山人降气汤，治疗上述相同的病证。
黑锡丹，治疗痰气壅盛、上盛下虚、心火炎炽、肾水枯竭之证。
灵砂丹，治疗上盛下虚、痰涎壅盛，此药最能镇坠（重镇降逆）。
关于“升降阴阳”（四方并见于本方）：
按语：以上各方均聚集温热性质的药物，但所述证候皆称为治疗“上盛下虚、气不升降”。所谓“盛”，即指心火炎炽；所谓“虚”，即指肾水虚弱。火炎而水弱，则气机有升无降，导致津液涌溢化为痰涎，停聚于上。如今使用金石丹药及湿热香燥的药物来补益下焦之虚，这如同抱着木柴去救火啊。如果认为是下焦阳虚而议定治法，也是不对的。若是阳火虚弱，则阴水必然旺盛，痰涎津液自然会随气机下降，又何必使用这些药物呢？
金匮肾气丸，治疗短气且有轻微饮邪者，应当通过小便排出（方剂见补虚门）。
按语：仲景认为肾虚导致有水饮，故用此方补肾逐水，因为方中含有泽泻、茯苓的缘故。而严氏用此方治疗肾虚寒而不能摄养肾水，致使邪水溢上，多吐痰唾。既然肾既虚寒，则阳火必然旺盛，不知所录文中提到的“摄养肾水”的是什么物质呢？夫肾水是天一（先天之本）所生，是人的根本；痰涎是津液败浊而成。岂能直接说肾水不摄而邪水溢上呢？如果说肾水虚弱、阴亏难降，致使津液败浊而为痰水，故用此药，这在义理上就讲得通了。
谨按：痰病多生于湿，所以古方多用南星、半夏之类的药物。然而痰病也常夹杂其他邪气，所以用药有风寒暑湿的区别。另外，人体部位有上下表里之分，所以在表的用发汗法，在里的用攻下法，在上的用涌吐法，在下的用分利法。治疗饮邪的方法可以说很详细了。有人问：陈无择以大小青龙汤、五苓散、承气汤为外因，参苓白术散、八味丸、参苏饮为内因，十枣汤、葶苈大枣泻肺汤、大小半夏汤、控涎丹破饮为不内外因。现在您编纂的这些方剂，意图与此不同，为什么呢？我回答说：大小青龙汤是治疗外因表证的药物，五苓散、承气汤是治疗外因里证的药物；参苓白术散、八味丸是治疗内因里证的药物，参苏饮是治疗内因表证的药物；十枣汤、葶苈大枣泻肺汤、控涎丹是治疗不内外因的下法药物，大小半夏汤是治疗不内外因的和法药物。陈无择以三因立论，所以叙述药物只以病因主，而不区分其表里内外的差异。现在我以表里内外分类诸方，则难以拘泥于其所分的病因类别。
Su Zi Jiang Qi Tang from the Bureau of Taiyi Prescriptions treats conditions of deficient Yang attacking upward, impaired ascending and descending of Qi, excess in the upper and deficiency in the lower, and copious phlegm-saliva.
Yu Sharen's Jiang Qi Tang treats the same conditions as above.
Hei Xi Dan (Black Lead Pill) treats conditions of copious phlegm-Qi stagnation, excess in the upper and deficiency in the lower, blazing Heart Fire, and depleted Kidney Water.
Ling Sha Dan (Cinnabar and Mercury Pill) treats excess in the upper and deficiency in the lower with copious phlegm-saliva; this medicine is most effective in suppressing and descending (heavy sedation).
Regarding "Ascending and Descending Yin and Yang" (Four prescriptions appear together in this section):
Commentary: The aforementioned prescriptions all gather warm and hot natured medicines, yet the described syndromes are all stated to treat "excess in the upper and deficiency in the lower, with impaired ascending and descending of Qi." What is meant by "excess" is the blazing of Heart Fire; what is meant by "deficiency" is the weakness of Kidney Water. When Fire blazes and Water is weak, there is ascending without descending, causing body fluids to surge and transform into phlegm-saliva, accumulating in the upper. To use mineral and metallic pills, along with damp-heat and aromatic-dry medicines, to tonify the deficiency in the Lower Jiao is like carrying firewood to put out a fire. If one considers it a deficiency of Yang in the Lower Jiao and proposes treatment accordingly, that is also incorrect. If Yang Fire were deficient, then Yin Water would necessarily be abundant, and phlegm-saliva and body fluids would naturally descend with the Qi; why would it be necessary to use such medicines?
Jinkui Shenqi Wan (Kidney Qi Pill from the Golden Cabinet) treats shortness of breath with slight fluid retention; it should be eliminated through urination (Prescription see Tonifying Deficiency Section).
Commentary: Zhang Zhongjing used this prescription to tonify the Kidney and expel water because of Kidney deficiency leading to fluid retention, due to the presence of Ze Xie (Alisma Rhizome) and Fu Ling (Poria) in the formula. Yan Zhihe used this prescription to treat Kidney deficiency-cold failing to control and nourish Kidney Water, causing pathogenic water to overflow upward, resulting in frequent spitting of phlegm-saliva. Since the Kidney is deficient and cold, Yang Fire must be abundant; I wonder what substance is referred to as "controlling and nourishing Kidney Water"? Kidney Water is generated by Tian Yi (the One from Heaven/Primordial Essence), serving as the root of human life; phlegm-saliva is formed from turbid and degenerated body fluids. How can one directly state that Kidney Water fails to control, causing pathogenic water to overflow upward? If it is said that Kidney Water is weak and Yin deficiency makes descent difficult, causing body fluids to degenerate into phlegm-water, thus using this medicine, the rationale becomes clear.
Respectfully noted: Phlegm diseases mostly arise from Dampness, so ancient prescriptions often use medicines such as Nan Xing (Arisaema Cum Bile) and Ban Xia (Pinellia Tuber). However, phlegm disease often involves accompanying pathogens, so medicines vary according to Wind-Cold, Summer-Heat, or Dampness. Furthermore, the human body has distinctions of Upper/Lower and Exterior/Interior; therefore, those in the Exterior are treated with sweating, those in the Interior with purgation, those in the Upper with emesis, and those in the Lower with separation and diuresis. Methods for treating Fluid Retention can be considered quite detailed. Someone asked: Chen Wuzhuo categorized Da Qing Long Tang and Xiao Qing Long Tang, Wu Ling San, and Cheng Qi Tangs as External Causes; Shen Ling Bai Zhu San, Ba Wei Wan, and Shen Su Yin as Internal Causes; Shi Zao Tang, Ting Li Da Zao Xie Fei Tang, Da Ban Xia Tang, Xiao Ban Xia Tang, and Kong Xian Dan as Non-External/Internal Causes. Your compilation of these prescriptions seems to differ in intent. Why? I reply: Da Qing Long Tang and Xiao Qing Long Tang are exterior medicines for External Causes; Wu Ling San and Cheng Qi Tangs are interior medicines for External Causes; Shen Ling Bai Zhu San and Ba Wei Wan are interior medicines for Internal Causes; Shen Su Yin is an exterior medicine for Internal Causes; Shi Zao Tang, Ting Li Da Zao Xie Fei Tang, and Kong Xian Dan are purgative medicines for Non-External/Internal Causes; Da Ban Xia Tang and Xiao Ban Xia Tang are harmonizing medicines for Non-External/Internal Causes. Chen Wuzhuo established his theory based on the Three Causes, so he listed medicines primarily according to etiology, without distinguishing their exterior/interior or internal/external differences. Now, I classify the prescriptions by Exterior/Interior and Internal/External, so it is difficult to strictly adhere to his etiological classification.