【支饮之症】咳逆倚息，气短不得卧，其形如肿，即《金匮》支饮症也。
【支饮之因】饮邪偏注，停留曲折之间，盖肺与大肠之脉，下膈络肠，今饮积于中，
外不得达
，喘促而不得卧矣。形如肿者，水饮之外现也。
【支饮之脉】脉多沉紧，脉弦为水，脉弱可治，数实者死。其脉虚者，必苦眩晕。
【支饮之治】《金匮》曰∶膈间支饮，其人必喘，心下痞坚，面色黎黑，其脉沉紧，
得之十数日，医吐下之不愈，木防己汤；虚者即愈，实者三日复发，复与，不愈者，以前方去石
膏，加茯苓、芒硝主之。以胃有痰饮之积热，石膏止清无形气分之热，不能去有形痰饮之
实热，故易芒硝。又云∶心下有支饮，其人苦冒眩，泽泻汤主之。又云∶支饮胸满者，浓朴
大黄汤主之。支饮不得息，葶苈大枣汤主之。呕家本渴，今反不渴，心下有支饮故也，小半
夏汤。又云∶卒呕吐，心下痞，膈间有水，眩悸者，小半夏加茯苓。咳家，其脉弦，为有水
，十枣汤主之。夫有支饮家，咳烦，胸中痛，不卒死，至一百日，或一岁，十枣汤主之。咳
逆倚息不得卧，小青龙汤主之。外另有腹满口舌干燥，此肠间有水气，己椒苈黄丸主之。假
令瘦人脐下有悸，吐涎沫而颠眩，此水也，五苓散主之。
按此二条，非指定支饮而立说，大约统言水饮家之条目。
木防己汤
木防己 石膏 桂枝 人参
上四味，煮取一升，温服，愈后复发，去石膏，加芒硝。
泽泻汤 治心下有支饮，其人苦冒眩。
泽泻 白术
上二味，水二升，煮取一升，温服。
浓朴大黄汤 治支饮胸满者。
浓朴 大黄 枳实
上三味，以水五升，煮取二升温服。
葶苈大枣汤
葶苈子 大枣肉
先以水三升，煮枣取二升，去枣，纳葶苈子。
半夏汤
半夏 生姜
上二味，以水七升，煮一升服。
小半夏加茯苓汤
半夏 生姜 白茯苓
上三味，煮一升服。
十枣汤 见前悬饮门。
小青龙汤 见前溢饮门。
己椒苈黄丸
防己 椒目 葶苈 大黄
蜜丸如梧子大，日三服。
五苓散
泽泻 猪苓 白茯苓 白术 肉桂
上五味为末，暖水调服。
【支饮的症状】咳嗽气逆，需倚靠物体呼吸，气息短促无法平卧，身体外形浮肿，这就是《金匮要略》中所述的支饮症状。
【支饮的成因】水饮邪气偏注停留于经络曲折之处。因为肺与大肠的经脉，向下穿过膈肌并联络肠道，如今水饮积聚在体内，向外不能通达，导致气喘急促且无法平卧。身体外形浮肿，是水饮外现于体表的表现。
【支饮的脉象】脉象多呈沉紧（脉位深且紧张有力），脉弦主水饮，脉弱表示病情可治，若脉数而实则预后不良（主死）。若脉象虚弱，患者必定苦于头晕目眩。
【支饮的治疗】《金匮要略》记载：膈间有支饮，患者必然气喘，胃脘部痞塞坚硬，面色黧黑，脉象沉紧，患病十几天后，经过医生催吐或攻下治疗仍未痊愈者，用木防己汤；若服药后体质虚者即愈，体质实者三天后复发，再次服用原方仍不愈者，应在前方中去掉石膏，加入茯苓、芒硝为主治之。这是因为胃中有痰饮积滞化热，石膏只能清解无形的气分热，不能去除有形的痰饮实热，所以改用芒硝。又记载：心下有支饮，患者苦于头昏目眩，用泽泻汤主治。又记载：支饮导致胸满者，用浓朴大黄汤主治。支饮导致呼吸不畅者，用葶苈大枣汤主治。呕吐的人本来应该口渴，现在反而不渴，是因为心下有支饮的缘故，用小半夏汤。又记载：突然呕吐，胃脘部痞塞，膈间有水气，出现眩晕和心悸者，用小半夏加茯苓汤。久咳之人，脉象弦，说明体内有水饮，用十枣汤主治。凡是患有支饮的人，咳嗽心烦，胸痛，如果没有突然死亡，延续到一百天或一年，仍用十枣汤主治。咳嗽气逆倚靠呼吸无法平卧者，用小青龙汤主治。此外还有腹部胀满、口舌干燥，这是肠间有水气，用己椒苈黄丸主治。假如瘦人脐下有悸动感，吐出涎沫且头晕目眩，这是水饮为患，用五苓散主治。
按语：以上两条论述，并非专门针对支饮而立论，大约是对所有水饮病患者的通用条目总结。
木防己汤
组成：木防己、石膏、桂枝、人参。
用法：以上四味药，煮取一升药液，温服。若愈后复发，去掉石膏，加入芒硝。
泽泻汤
主治：心下有支饮，患者苦于头昏目眩。
组成：泽泻、白术。
用法：以上两味药，用水二升，煮取一升药液，温服。
浓朴大黄汤
主治：支饮导致胸满者。
组成：浓朴、大黄、枳实。
用法：以上三味药，用水五升，煮取二升药液，温服。
葶苈大枣汤
组成：葶苈子、大枣肉。
用法：先用水三升，煮大枣取二升药液，去渣留汁，纳入葶苈子。
半夏汤
组成：半夏、生姜。
用法：以上两味药，用水七升，煮取一升药液服用。
小半夏加茯苓汤
组成：半夏、生姜、白茯苓。
用法：以上三味药，煮取一升药液服用。
[Symptoms of Zhi Yin (Branching Fluid Retention)] Cough with qi reversal, leaning on objects to breathe, shortness of breath unable to lie flat, and the body appearing swollen. This is the symptom of Zhi Yin as described in *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet).
[Etiology of Zhi Yin] The pathogenic factor of fluid retention deviates and stagnates in the tortuous areas of the meridians. Since the meridians of the Lung and Large Intestine pass downward through the diaphragm and connect with the intestines, when fluid accumulation occurs internally, it cannot reach the exterior, leading to panting, urgency in breathing, and inability to lie flat. The appearance of swelling is the manifestation of water-fluid retention presenting externally.
[Pulse Diagnosis of Zhi Yin] The pulse is mostly Chen Jin (Deep and Tight). A Xian (Wiry) pulse indicates water; a Ruo (Weak) pulse indicates the condition is treatable; a Shu Shi (Rapid and Excess) pulse indicates a fatal prognosis. If the pulse is Xu (Deficient), the patient must suffer from dizziness and vertigo.
[Treatment of Zhi Yin] *Jin Gui Yao Lue* states: When there is Zhi Yin between the diaphragm, the patient will inevitably pant, have epigastric fullness and hardness, a dark complexion, and a Chen Jin pulse. After ten or more days, if the condition has not been cured by physicians using emesis or purgation, Mu Fang Ji Tang (Stephania Decoction) should be used. If the patient is Deficient, they will recover; if Excess, it will relapse after three days. Upon recurrence, if the same prescription fails to cure, remove Shi Gao (Gypsum) from the previous formula and add Fu Ling (Poria) and Mang Xiao (Mirabilite) as the main treatment. This is because there is accumulated heat from phlegm-fluid in the stomach; Shi Gao only clears the heat of formless Qi-level, but cannot eliminate the excess heat of formless phlegm-fluid, hence Mang Xiao is substituted. It also states: When there is Zhi Yin in the heart region (epigastrium), the patient suffers from severe dizziness and vertigo; Ze Xie Tang (Alisma Decoction) should be used. Furthermore: For Zhi Yin causing chest fullness, Nong Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction) should be used. For Zhi Yin causing difficulty in breathing, Ting Li Da Zao Tang (Descurainia Seed and Jujube Decoction) should be used. Patients who vomit are usually thirsty; if they are not thirsty now, it is due to Zhi Yin in the heart region; Xiao Ban Xia Tang (Minor Pinellia Decoction) should be used. Additionally: Sudden vomiting, epigastric fullness, water between the diaphragm, dizziness, and palpitations are treated with Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia and Poria Decoction). For chronic coughers with a Xian pulse indicating water, Shi Zao Tang (Ten Date Decoction) should be used. For those with Zhi Yin 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 should still be used. For cough with qi reversal, leaning to breathe, and inability to lie flat, Xiao Qing Long Tang (Minor Green Dragon Decoction) should be used. Additionally, abdominal fullness with dry mouth and tongue indicates water gas in the intestines, treated with Ji Ding Li Huang Wan (Stephania, Zanthoxylum, Descurainia, and Rhubarb Pill). If a thin person experiences palpitations below the umbilicus, spitting out saliva and foam, and dizziness, this is water pathology, treated with Wu Ling San (Five-Ingredient Powder with Poria).
Note: These two passages are not specifically established for Zhi Yin alone, but generally summarize entries for all patients with fluid retention diseases.
Mu Fang Ji Tang (Stephania Decoction)
Ingredients: Mu Fang Ji (Stephaniae Tetrandrae Radix), Shi Gao (Gypsum Fibrosum), Gui Zhi (Cinnamomi Ramulus), Ren Shen (Ginseng Radix et Rhizoma).
Preparation: Boil the above four ingredients to obtain one sheng of liquid. Take warm. If it recurs after recovery, remove Shi Gao and add Mang Xiao.
Ze Xie Tang (Alisma Decoction)
Indication: Zhi Yin in the heart region, causing severe dizziness and vertigo.
Ingredients: Ze Xie (Alismatis Rhizoma), Bai Zhu (Atractylodis Macrocephalae Rhizoma).
Preparation: Boil the above two ingredients in two sheng of water to obtain one sheng. Take warm.
Nong Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction)
Indication: Zhi Yin causing chest fullness.
Ingredients: Nong Po (Magnoliae Officinalis Cortex), Da Huang (Rhei Radix et Rhizoma), Zhi Shi (Aurantii Fructus Immaturus).
Preparation: Boil the above three ingredients in five sheng of water to obtain two sheng. Take warm.
Ting Li Da Zao Tang (Descurainia Seed and Jujube Decoction)
Ingredients: Ting Li Zi (Descurainiae Semen), Da Zao Rou (Sarcocarpus Jujubae).
Preparation: First boil jujubes in three sheng of water to obtain two sheng, remove the jujubes, and add Ting Li Zi.
Ban Xia Tang (Pinellia Decoction)
Ingredients: Ban Xia (Pinelliae Tuber), Sheng Jiang (Zingiberis Recens Rhizoma).
Preparation: Boil the above two ingredients in seven sheng of water to obtain one sheng. Take orally.
Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia and Poria Decoction)
Ingredients: Ban Xia (Pinelliae Tuber), Sheng Jiang (Zingiberis Recens Rhizoma), Bai Fu Ling (Poria).
Preparation: Boil the above three ingredients to obtain one sheng. Take orally.
Shi Zao Tang (Ten Date Decoction)
Reference: See the section on Xuan Yin (Hanging Fluid) previously.
Xiao Qing Long Tang (Minor Green Dragon Decoction)
Reference: See the section on Yi Yin (Overflowing Fluid) previously.
Ji Ding Li Huang Wan (Stephania, Zanthoxylum, Descurainia, and Rhubarb Pill)
Ingredients: Fang Ji (Stephaniae Tetrandrae Radix), Jiao Mu (Zanthoxyli Fructus), Ting Li (Descurainiae Semen), Da Huang (Rhei Radix et Rhizoma).
Preparation: Honey-pill size of wu zi (wutzu seeds). Take three times daily.
Wu Ling San (Five-Ingredient Powder with Poria)
Ingredients: Ze Xie (Alismatis Rhizoma), Zhu Ling (Polyporus), Bai Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Rou Gui (Cinnamomi Cortex).
Preparation: Grind the above five ingredients into powder. Mix with warm water and take.