问曰。夫饮有四。何谓也。师曰。有痰饮。有悬饮。有溢饮。有支饮。
问曰。四饮何以为异。师曰。其人素盛今瘦。水走肠间。沥沥有声。谓之痰饮。饮后水流在胁下。
咳唾引痛。谓之悬饮。饮水流行。归于四肢。当汗出而不汗出。身体疼重。谓之溢饮。咳逆倚息不得
卧。其形如肿。谓之支
饮。
谷入而胃不能散其精。则化而为痰。水入而脾不能输其气。则凝而为饮。其平素饮食所化之精津。
凝结而不布。则为痰饮。痰饮者。痰积于中。而饮附于外也。素盛今瘦。知其精津尽为痰饮。故不复
外充形体。而反下走肠间也。饮水流溢者。水多气逆。徐氏所谓水为气吸不下者是也。其流于胁下者。
则为悬饮。其归于四肢者。则为溢饮。悬者悬于一处。溢者溢于四旁。其偏结而上附心肺者。则为支
饮。支饮者。如水之有派。木之有枝。附近于脏而不正中也。咳逆倚息不得卧者。上迫肺也。
水在心。心下坚筑。短气。恶水不欲饮。水在肺。吐涎沫。欲饮水。水在脾。少气身重。水在肝。
胁下支满。嚏而痛。水在肾。心下悸。
水即饮也。坚筑、悸动有力。筑筑然也。短气者。心属火而畏水。水气上逼。则火气不伸也。吐
涎沫者。气水相激而水从气泛也。欲饮水者。水独聚肺。而诸经失溉也。脾为水困。故少气。水淫肌
肉。故身重。土本制水。而水盛反能制土也。肝脉布胁肋。水在肝。故胁下支满。支满犹偏满也。嚏
出于肺。而肝脉上注肺。故嚏则相引而痛也。心下悸者。肾水盛而上凌心火也。
夫心下有留饮。其人背寒冷如掌大。留饮者。胁下痛引缺盆。咳嗽则辄已。胸中有留饮。其人短
气而渴。四肢历节痛。脉沉者有留饮。
留饮即痰饮之留而不去者也。背寒冷如掌大者。饮留之处。阳气所不入也。魏氏曰。背为太阳。
在易为
艮止之象。一身皆动。背独常静。静处阴邪常客之。所以风寒自外入。多中于背。而阴寒自内生。亦
多踞于背也。胁下痛引缺盆者。饮留于肝。而气连于肺也。咳嗽则辄已者。饮被气击而欲移。故辄已。
一作咳嗽则转甚。亦通。盖即水流胁下。咳唾引痛之谓。气为饮滞故短。饮结者津液不周。故渴。四
肢历节痛。为风寒湿在关节。若脉不浮而沉。而又短气而渴。则知是留饮为病。而非外入之邪矣。
膈上病痰。满喘、咳唾。发则寒热。背痛腰疼。目泣自出。其人振振身 剧。必有伏饮。
伏饮亦即痰饮之伏而不觉者。发则始见也。身热、背痛、腰疼。有似外感。而兼见喘满、咳唾。
则是活人所谓痰之为病。能令人憎寒发热。状类伤寒者也。目泣自出。振振身 动者。饮发而上逼液
道。外攻经隧也。
夫病患饮水多。必暴喘满。凡食少饮多。水停心下。甚者则悸。微者短气。脉双弦者寒也。皆大
下后善虚。脉偏弦者饮也。
饮水过多。水溢入肺者。则为喘满。水停心下者。甚则水气凌心而悸。微则气被饮抑而短也。双
弦者。两手皆弦。寒气周体也。偏弦者。一手独弦。饮气偏注也。
肺饮不弦。但苦喘、短气。支饮亦喘而不能卧。加短气。其脉平也。
肺饮、饮之在肺中者。五脏独有肺饮。以其虚而能受也。肺主气而司呼吸。苦喘短气。肺病已着。
脉虽不弦。可以知其有饮矣。支饮上附于肺。即同肺饮。故亦喘而短气。其脉亦平而不必弦也。按后
第十四
条云。咳家其脉弦。为有水。夫咳为肺病。而水即是饮。而其脉弦。此云肺饮不弦。支饮脉平。未详
何谓。
病痰饮者。当以温药和之。心下有痰饮。胸胁支满。目眩。苓桂术甘汤主之。
痰饮、阴邪也。为有形。以形碍虚则满。以阴冒阳则眩。苓、桂、术、甘。温中去湿。治痰饮之
良剂。是即所谓温药也。盖痰饮为结邪。温则易散。内属脾胃。温则能运耳。
苓桂术甘汤方
茯苓 桂枝 白术（各三两） 甘草（二两）
上四味。以水六升。煮取三升。分温三服。小便则利。
夫短气有微饮。当从小便去之。苓桂术甘汤主之。肾气丸亦主之。
气为饮抑则短。欲引其气。必蠲其饮。饮、水类也。治水必自小便去之。苓、桂、术、甘。益土
气以行水。肾气丸。养阳气以化阴。虽所主不同。而利小便则一也。
苓桂术甘汤方（见上）
肾气丸方（见妇人杂病）
病者脉伏。其人欲自利。利反快。虽利。心下续坚满。此为留饮欲去故也。甘遂半夏汤主之。
脉伏者。有留饮也。其人欲自利。利反快者。所留之饮。从利而减也。虽利、心下续坚满者。未
尽之饮。复注心下也。然虽未尽而有欲去之势。故以甘遂、半夏因其势而导之。甘草与甘遂相反。而
同用之者。盖欲
其一战而留饮尽去。因相激而相成也。芍药、白蜜。不特安中。抑缓药毒耳。
甘遂半夏汤方
甘遂（大者三枚） 半夏（十二枚以水一升煮取半升去滓） 芍药（五枚） 甘草（如指大一枚
炙）
上四味。以水二升。煮取半升。去滓。以蜜半升和药汁。煎取八合。顿服之。
脉浮而细滑。伤饮。脉弦数。有寒饮。冬夏难治。脉沉而弦者。悬饮内痛。病悬饮者。十枣汤主
之。
伤饮、饮过多也。气资于饮。而饮多反伤气。故脉浮而细滑。则饮之征也。脉弦数而有寒饮。则
病与脉相左。魏氏所谓饮自寒而挟自热是也。夫相左者。必相持。冬则时寒助饮。欲以热攻。则脉数
必甚。夏则时热助脉。欲以寒治。则寒饮为碍。故曰难治。脉沉而弦。饮气内聚也。饮内聚而气击之
则痛。十枣汤蠲饮破癖。其力颇猛。三因方以三味为末。枣肉和丸。名十枣丸。亦良。
十枣汤方
芫花（熬） 甘遂 大戟（各等分）
上三味捣筛。以水一升五合。先煮肥大枣十枚。取八合。去滓。内药末。强人服一钱匕。羸人服
半钱。平旦温服之。不下者明日更加半钱。得快利后。糜粥自养。
病溢饮者。当发其汗。大青龙汤主之。小青龙汤亦主之。
水气流行。归于四肢。当汗出而不汗出。身体重痛。谓之溢饮。夫四肢、阳也。水在阴者宜利。
在阳者宜汗。
故以大青龙发汗去水。小青龙则兼内饮而治之者耳。徐氏曰。大青龙合桂、麻而去芍药。加石膏。则
水气不甚而挟热者宜之。倘饮多而寒伏。则必小青龙为当也。
大青龙汤方
麻黄（六两） 桂枝 甘草（各二两） 生姜（三两） 杏仁（四十个） 大枣（十二枚） 石
膏（如鸡子大一枚）
上七味。以水九升。先煮麻黄。减二升。去上沫。内诸药。煮取三升。去滓。温服一升。取微似
汗。汗多者。温粉粉之。
小青龙汤方
麻黄（去节三两） 芍药（三两） 五味子（半升） 干姜（三两） 甘草（炙） 细辛 桂枝
（各三两） 半夏（半升）
上八味。以水一斗。先煮麻黄。减二升。去上沫。内诸药。煮取三升。去滓。温服一升。
膈间支饮。其人喘满。心下痞坚。面色黧黑。其脉沉紧。得之数十日。医吐下之。不愈。木防己
汤主之。虚者即愈。实者三日复发。复与不愈者。宜木防己汤去石膏。加茯苓芒硝汤主之。
支饮上为喘满。而下为痞坚。则不特碍其肺。抑且滞其胃矣。面色黧黑者。胃中成聚。营卫不行
也。脉浮紧者为外寒。沉紧者为里实。里实可下。而饮气之实。非常法可下。痰饮可吐。而饮之在心
下者。非吐可
去。宜其得之数十日。医吐下之而不愈也。木防己、桂枝。一苦一辛。并能行水气而散结气。而痞坚
之处。必有伏阳。吐下之余。定无完气。书不尽言。而意可会也。故又以石膏治热。人参益虚。于法
可谓密矣。其虚者外虽痞坚。而中无结聚。即水去气行而愈。其实者中实有物。气暂行而复聚。故三
日复发也。魏氏曰。后方去石膏加芒硝者。以其既散复聚。则有坚定之物。留作包囊。故以坚投坚而
不破者。即以软投坚而即破也。加茯苓者。亦引饮下行之用耳。
木防己汤方
木防己（三两） 石膏（如鸡子大二枚） 桂枝（二两） 人参（四两）
上四味。以水六升。煮取二升。分温再服。
木防己去石膏加茯苓芒硝汤方
木防己 桂枝（各二两） 茯苓 人参（各四两） 芒硝（三合）
上五味。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。
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
乍见玄黑也。泽泻泻水气。白术补土气以胜水也。高鼓峰云。心下有水饮。格其心火。不能下行。而
但上冲头目也。亦通。
泽泻汤方
泽泻（五两） 白术（二两）
上二味。以水二升。煮取一升。分温再服。
支饮胸满者。浓朴大黄汤主之。
胸满疑作腹满。支饮多胸满。此何以独用下法。浓朴、大黄。与小承气同。设非腹中痛而闭者。
未可以此轻试也。
浓朴大黄汤方
浓朴（一尺） 大黄（六两） 枳实（四枚）
上三味。以水五升。煮取二升。分温再服。
支饮不得息。葶苈大枣泻肺汤主之。
不得息。肺满而气闭也。葶苈入肺。通闭泄满。用大枣者。不使伤正也。
葶苈大枣泻肺汤方（见肺痈）
呕家本渴。渴者为欲解。今反不渴。心下有支饮故也。小半夏汤主之。
此为饮多而呕者言。渴者饮从呕去。故欲解。若不渴。则知其支饮仍在。而呕亦未止。半夏味辛
性燥。辛可散结。燥能蠲饮。生姜制半夏之悍。且以散逆止呕也。
小半夏汤方
半夏（一升） 生姜（半升）
上二味。以水七升。煮取一升半。分温再服。
腹满。口舌干燥。此肠间有水气。己椒苈黄丸主之。
水既聚于下。则无复润于上。是以肠间有水气而口舌反干燥也。后虽有水饮之入。只足以益下趋
之势。口燥不除而腹满益甚矣。防己疗水湿。利大小便。椒目治腹满。去十二种水气。葶苈、大黄。
泄以去其闭也。渴者知胃热甚。故加芒硝。经云。热淫于内。治以咸寒也。
己椒苈黄丸方
防己 椒目 葶苈 大黄（各一两）
上四味。末之。蜜丸如梧子大。先食饮服一丸。日三服。稍增。口中有津液。渴者。加芒硝半两。
卒呕吐。心下痞。膈间有水。眩悸者。小半夏加茯苓汤主之。
饮气逆于胃则呕吐。滞于气则心下痞。凌于心则悸。蔽于阳则眩。半夏、生姜。止呕降逆。加茯
苓去其水也。
小半夏加茯苓汤方
半夏（一升） 生姜（半斤） 茯苓（四两）
上三味。以水七升。煮取一升五合。分温再服。
假令瘦人脐下有悸。吐涎沫而颠眩。此水也。五苓散主之。
瘦人不应有水。而脐下悸。则水动于下矣。吐涎沫。则水逆于中矣。甚而颠眩。则水且犯于上矣。
形体虽瘦。而病实为水。乃病机之变也。颠眩即头眩。苓、术、猪、泽。甘淡渗泄。使肠间之水。从
小便出。用桂者。下焦水气。非阳不化也。曰多服暖水汗出者。盖欲使表里分消其水。非挟有表邪而
欲两解之谓。
五苓散方
泽泻（一两一分） 猪苓 茯苓 白术（各三分） 桂枝（二分）
上五味为末。白饮服方寸匕。日三服。多服暖水。汗出愈。
附方
外台茯苓饮 治心胸中有停痰宿水。自吐出水后。心胸间虚。气满不能食。消痰气令能食。
茯苓 人参 白术（各三两） 枳实（二两） 橘皮（二两半） 生姜（四两）
上六味。以水六升。煮取一升八合。分温三服。如人行八九里、进之。
咳家其脉弦。为有水。十枣汤主之。
脉弦为水。咳而脉弦。知为水饮渍入肺也。十枣汤逐水气自大小便去。水去则肺宁而咳愈。按许
仁则论饮气咳者。由所饮之物。停滞在胸。水气上冲。肺得此气。便成咳嗽。经久不已。渐成水病。
其状不限四
时昼夜。遇诸动嗽物即剧。乃至双眼突出。气如欲断。汗出。大小便不利。吐痰饮涎沫无限。上气喘
急肩息。每旦眼肿。不得平眠。此即咳家有水之证也。着有干枣三味丸方亦佳。大枣六十枚。葶苈一
升。杏仁一升。合捣作丸。桑白皮饮下七八丸。日再。稍稍加之。以大便通利为度。
十枣汤方（见上）
夫有支饮家。咳烦。胸中痛者。不卒死。至一百日或一岁。宜十枣汤。
胸中支饮。扰乱清道。赵氏所谓动肺则咳。动心则烦。搏击阳气则痛者是也。其甚者营卫遏绝。
神气乃亡。为卒死矣。否则延久不愈。至一百日或一岁。则犹有可治。为其邪瘥缓而正得持也。然以
经久不去之病。而仍与十枣攻击之药者。岂非以支饮不去。则其咳烦胸痛。必无止期。与其事敌以苟
安。不如悉力一决之。犹或可图耶。然亦危矣。
久咳数岁。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。
久咳数岁不已者。支饮渍肺而咳。饮久不已。则咳久不愈也。咳久者其气必虚。而脉反实大数。
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。
问：水饮病分为四种，具体是指什么？
老师回答：有痰饮、悬饮、溢饮、支饮这四种。
问：这四种饮病有什么区别？
老师回答：病人平时身体壮盛，现在消瘦，水流在肠间，发出沥沥的声音，这叫痰饮。喝水后，水流停留在胁下，咳嗽吐唾时牵引疼痛，这叫悬饮。饮水后，水液流行到四肢，本该出汗却不出汗，身体疼痛沉重，这叫溢饮。咳嗽气逆，倚靠物体呼吸，不能平卧，身形浮肿，这叫支饮。
谷物进入胃中，如果胃不能运化其精微，就会化为痰；水液进入体内，如果脾不能输布其气化功能，就会凝结为饮。那些平时饮食所化生的精津，凝结而不能布散，就形成了痰饮。所谓痰饮，是痰积聚在体内，而饮依附于体表或周围。平时壮盛现在消瘦，说明精津全部变成了痰饮，所以不再向外充盈形体，反而向下流注到肠间。饮水流溢，是因为水多气逆，正如徐氏所说“水被气吸引而下不去”。流注在胁下的，就是悬饮；流注在四肢的，就是溢饮。“悬”是指悬挂在一处，“溢”是指漫溢到四周。偏结而上附于心肺的，就是支饮。支饮就像水的支流、树木的枝杈，靠近脏腑但不居中。咳嗽气逆，倚靠呼吸不能平卧，是因为饮邪上迫于肺。
水在心，心下坚硬筑筑跳动，短气，怕水不想喝水。水在肺，吐涎沫，想喝水。水在脾，少气，身体沉重。水在肝，胁下支撑胀满，打喷嚏时牵引疼痛。水在肾，心下悸动。
水就是饮。坚筑、悸动有力，指心跳筑筑然的感觉。短气，是因为心属火而畏水，水气上逼，导致火气不能舒展。吐涎沫，是气与水相互激荡，水随气泛溢。想喝水，是因为水独聚于肺，而其他经络失去灌溉。脾被水困，所以少气；水淫浸肌肉，所以身体沉重。土本应克制水，但水盛反能克制土。肝脉分布胁肋，水在肝，所以胁下支撑胀满。“支满”即偏侧胀满。喷嚏出于肺，而肝脉上注于肺，所以打喷嚏时会相互牵引而痛。心下悸，是肾水盛而上凌心火。
心下有留饮（停留不去的水饮），病人的背部有一块手掌大小的地方感觉寒冷。留饮，是指胁下疼痛牵引至缺盆穴，咳嗽时疼痛停止（一说咳嗽时疼痛加剧，也通）。胸中有留饮，病人短气且口渴，四肢关节疼痛，脉象沉的，是有留饮。
留饮就是痰饮停留而不离去。背部寒冷如手掌大，是因为饮邪停留之处，阳气无法到达。魏氏说：背为太阳经所过，在易经中象征艮卦为止之象。全身都在活动，只有背部常静。静止的地方阴邪容易客居，所以风寒从外侵入，多伤及背部；阴寒从内生，也多盘踞于背部。胁下疼痛牵引缺盆，是因为饮邪留在肝，而气连于肺。咳嗽则疼痛停止，是因为饮邪被气冲击想要移动，所以疼痛暂止（一作咳嗽则疼痛加重，也通，即指水流胁下，咳唾引痛的情况）。气被饮邪阻滞所以短气；饮邪结聚，津液不能周流，所以口渴。四肢历节痛，是风寒湿邪在关节，如果脉不浮而沉，又伴有短气和口渴，就知道是留饮致病，而不是外来的邪气。
膈上有痰病，出现胀满、喘促、咳嗽吐痰，发作时有寒热，背痛腰疼，眼泪自出，病人身体震颤剧烈，这是必有伏饮（潜伏的水饮）。
伏饮也是痰饮潜伏而不觉察，发作时才显现。身热、背痛、腰疼，看似外感，但兼见喘满、咳唾，这就是《活人书》所说的痰之为病，能让人憎寒发热，症状类似伤寒。眼泪自出，身体震颤动摇，是因为饮邪发作上逼液道，外攻经络隧道。
病人喝水多，一定会突然喘满。凡是吃得少喝得多，水停在心下，严重的会心悸，轻微的会短气。脉象两手都弦的是寒证，这都是因为大病泻下后体质虚弱所致。脉象只有一手弦的是饮证。
饮水过多，水溢入肺，就会喘满。水停心下，严重时水气凌心而悸，轻微则气被饮邪抑制而短气。双弦脉，指两手脉皆弦，表示寒气遍布周身。偏弦脉，指一手独弦，表示饮气偏注于一侧。
肺中有饮，脉不弦，只是苦于喘、短气。支饮也会喘而不能卧，加上短气，其脉象平和。
肺饮，是饮邪在肺中。五脏中唯独肺有饮病，因为肺虚而能受邪。肺主气而司呼吸，苦于喘短气，说明肺病已明显。脉虽然不弦，也可以知道有饮邪。支饮上附于肺，同于肺饮，所以也喘而短气，其脉也平和而不必弦。按后第十四条说：“咳嗽的人脉弦，是有水。”咳嗽是肺病，水即是饮，其脉弦，这里说肺饮不弦，支饮脉平，不详其意。
患痰饮病的人，应当用温药调和。心下有痰饮，胸胁支撑胀满，头晕目眩，用苓桂术甘汤主治。
痰饮是阴邪，属于有形之物，以形阻碍正气则胀满，以阴遮蔽阳气则眩晕。茯苓、桂枝、白术、甘草，能温中祛湿，是治疗痰饮的良好方剂，这就是所谓的“温药”。因为痰饮是结聚之邪，温则易散；内属脾胃，温则能运化。
苓桂术甘汤方
茯苓、桂枝、白术（各三两） 甘草（二两）
以上四味，用水六升，煮取三升，分三次温服。小便通利则愈。
短气有轻微的水饮，应当从小便排出。用苓桂术甘汤主治，肾气丸也可主治。
气被饮邪抑制则短气，要想引导气机，必须祛除饮邪。饮属于水类，治水必须从小便去。苓桂术甘汤，益脾气以行水；肾气丸，养阳气以化阴。虽然主治不同，但利小便的作用是一致的。
病人脉伏，其人想自行腹泻，泻后反而觉得爽快，虽然腹泻，心下继续坚硬胀满，这是留饮欲去的原因。用甘遂半夏汤主治。
脉伏，是有留饮。想自行腹泻，泻后反而爽快，是因为所留的饮邪，随着腹泻而减少。虽然腹泻，心下继续坚硬胀满，是因为未尽的饮邪，又重新注于心下。然而虽然有未尽之饮，但有欲去之势，所以用甘遂、半夏顺应其势而导引它。甘草与甘遂相反，但一起使用，是想让它们相互激荡，一战而将留饮尽去，因相激而相成。芍药、白蜜，不仅安护中焦，而且缓和药毒。
甘遂半夏汤方
甘遂（大的三枚） 半夏（十二枚，用水一升煮取半升，去渣） 芍药（五枚） 甘草（如手指大一枚，炙）
以上四味，用水二升，煮取半升，去渣。用蜂蜜半升和药汁，煎取八合，一次顿服。
脉浮而细滑，是伤饮。脉弦数，有寒饮，冬夏难治。脉沉而弦，是悬饮内痛。患悬饮病的，用十枣汤主治。
伤饮，是饮水过多。气依赖于饮，但饮多反而伤气，所以脉浮而细滑，是饮邪的征象。脉弦数而有寒饮，则病与脉不相符，正如魏氏所说“饮自寒而挟带热象”。凡是不相符的，必然相互持争。冬天时令寒助长饮邪，想用热药攻伐，则脉数会更甚；夏天时令热助长脉数，想用寒药治疗，则寒饮成为障碍，所以说难治。脉沉而弦，是饮气内聚。饮内聚而气击之则痛。十枣汤能祛除饮邪、破除癖积，药力颇猛。《三因方》将三味药研末，枣肉和丸，名为十枣丸，也很好。
十枣汤方
芫花（炒熬） 甘遂 大戟（各等分）
以上三味捣筛，用水一升五合，先煮肥大枣十枚，取八合，去渣，纳入药末。强壮的人服一钱匕，体弱的人服半钱，清晨温服。如果不泻，第二天增加半钱。得快利后，吃糜粥调养。
水气流行，归于四肢，本该出汗却不出汗，身体重痛，这叫溢饮。四肢属阳，水在阴位宜利小便，在阳位宜发汗。所以用大青龙汤发汗去水，小青龙汤则是兼治内饮。徐氏说：大青龙汤合桂枝、麻黄而去芍药，加石膏，适用于水气不甚而挟热的情况。如果饮多而寒伏，则必须用小青龙汤才恰当。
大青龙汤方
麻黄（六两） 桂枝 甘草（各二两） 生姜（三两） 杏仁（四十个） 大枣（十二枚） 石膏（如鸡蛋大一枚）
以上七味，用水九升，先煮麻黄，减二升，去上浮沫，加入其他药物，煮取三升，去渣，温服一升，取微似汗。如果汗多，用温粉扑身。
小青龙汤方
麻黄（去节三两） 芍药（三两） 五味子（半升） 干姜（三两） 甘草（炙） 细辛 桂枝（各三两） 半夏（半升）
以上八味，用水一斗，先煮麻黄，减二升，去上浮沫，加入其他药物，煮取三升，去渣，温服一升。
膈间有支饮，病人喘满，心下痞硬，面色黧黑，脉沉紧，得病几十天，医生用吐法、下法治疗，未愈。用木防己汤主治。如果是虚证，服药后即愈；如果是实证，三天后复发，再次服用无效者，宜用木防己汤去石膏加茯苓芒硝汤主治。
支饮上致喘满，下致痞坚，不仅阻碍肺，而且滞塞胃。面色黧黑，是因为胃中积聚，营卫运行不畅。脉浮紧是外寒，沉紧是里实。里实可下，但饮气之实，非常法可下；痰饮可吐，但饮在心下，非吐可去。所以得病几十天，医生用吐下法治疗而未愈。木防己、桂枝，一苦一辛，都能行水气而散结气。而在痞坚之处，必有伏阳；吐下之后，正气一定受损。书中虽未尽言，但意旨可领会。所以又用石膏治热，人参益虚，法度可谓周密。如果是虚证，外虽痞坚，而中无结聚，即水去气行而愈。如果是实证，中实有物，气暂时通行后又聚集，所以三天后复发。魏氏说：后方去石膏加芒硝，是因为既然散去又复聚，则有坚定之物留存作为包囊，所以用坚投坚而不能破，即以软投坚而即破。加茯苓，也是引导饮邪下行的作用。
木防己汤方
木防己（三两） 石膏（如鸡蛋大二枚） 桂枝（二两） 人参（四两）
以上四味，用水六升，煮取二升，分两次温服。
木防己去石膏加茯苓芒硝汤方
木防己 桂枝（各二两） 茯苓 人参（各四两） 芒硝（三合）
以上五味，用水六升，煮取二升，去渣，纳入芒硝，再微煎，分两次温服。微利则愈。
水饮之邪，上乘清阳之位，则导致冒眩。冒，是昏冒而神志不清，如有物蒙蔽。眩，是目眩旋转，乍见黑色。泽泻泻水气，白术补土气以胜水。高鼓峰说：心下有 water 饮，格拒心火，不能下行，而仅上冲头目，也通。
泽泻汤方
泽泻（五两） 白术（二两）
以上二味，用水二升，煮取一升，分两次温服。
支饮胸满的，用厚朴大黄汤主治。
胸满疑作腹满。支饮多胸满，为何此处独用下法？厚朴、大黄，与小承气汤相同。如果不是腹中痛而便秘，不可以轻易尝试此方。
厚朴大黄汤方
厚朴（一尺） 大黄（六两） 枳实（四枚）
以上三味，用水五升，煮取二升，分两次温服。
不得息，是肺满而气闭。葶苈入肺，通闭泄满。用大枣，是不使伤正气。
呕吐的病人本来应该口渴，口渴说明病欲解。现在反而不渴，是因为心下有支饮。用小半夏汤主治。
这是针对饮多而呕吐而言。口渴，说明饮随呕吐而去，故欲解。如果不渴，则知支饮仍在，呕吐也未止。半夏味辛性燥，辛可散结，燥能蠲饮。生姜制约半夏的悍烈，且以散逆止呕。
小半夏汤方
半夏（一升） 生姜（半升）
以上二味，用水七升，煮取一升半，分两次温服。
水既聚于下，则无复润于上，所以肠间有水气而口舌反干燥。即使再有水饮进入，只足以增加下趋之势，口燥不除而腹满更甚。防己疗水湿，利大小便；椒目治腹满，去十二种水气；葶苈、大黄，泄以去其闭塞。如果口渴，说明胃热甚，故加芒硝。经云：热淫于内，治以咸寒。
己椒苈黄丸方
防己 椒目 葶苈 大黄（各一两）
以上四味，研末，蜜丸如梧桐子大。饭前饮服一丸，日服三次，逐渐增量。口中生津液，若口渴，加芒硝半两。
突然呕吐，心下痞，膈间有水，眩晕心悸的，用小半夏加茯苓汤主治。
饮气逆于胃则呕吐，滞于气则心下痞，凌于心则悸，蔽于阳则眩。半夏、生姜，止呕降逆，加茯苓去其水。
小半夏加茯苓汤方
半夏（一升） 生姜（半斤） 茯苓（四两）
以上三味，用水七升，煮取一升五合，分两次温服。
假如瘦人脐下有悸动感，吐涎沫且头晕，这是水饮。用五苓散主治。
瘦人不应该有水饮，但脐下悸，说明水动于下。吐涎沫，说明水逆于中。甚至头晕，说明水犯于上。形体虽瘦，但病实为水，这是病机的变化。颠眩即头眩。茯苓、白术、猪苓、泽泻，甘淡渗泄，使肠间之水从小便出。用桂枝，是因为下焦水气，非阳气不能化。说“多服暖水汗出”，是想让表里分消其水，并非挟有表邪而要两解的意思。
五苓散方
泽泻（一两一分） 猪苓 茯苓 白术（各三分） 桂枝（二分）
以上五味为末，米汤送服方寸匕，日服三次。多服暖水，汗出则愈。
附方
外台茯苓饮：治疗心胸中有停痰宿水，自吐出水后，心胸间空虚，气满不能食。消痰气令能食。
茯苓 人参 白术（各三两） 枳实（二两） 橘皮（二两半） 生姜（四两）
以上六味，用水六升，煮取一升八合，分三次温服。如人行走八九里的时间后进服。
咳嗽的人脉弦，是有水饮。用十枣汤主治。
脉弦为水，咳而脉弦，知为水饮渍入肺。十枣汤逐水气自大小便去，水去则肺宁而咳愈。按许仁则论饮气咳者，由所饮之物，停滞在胸，水气上冲，肺得此气，便成咳嗽，经久不已，渐成水病。其状不限四时昼夜，遇诸动嗽物即剧，乃至双眼突出，气如欲断，汗出，大小便不利，吐痰饮涎沫无限，上气喘急肩息，每旦眼肿，不得平眠，此即咳家有水之证也。着有干枣三味丸方亦佳。大枣六十枚，葶苈一升，杏仁一升，合捣作丸。桑白皮饮下七八丸，日再，稍稍加之，以大便通利为度。
十枣汤方（见上文）
如果有支饮病人，咳嗽心烦，胸中痛，没有猝死，延续到一百天或一年，宜用十枣汤。
胸中支饮，扰乱清道，赵氏所谓动肺则咳，动心则烦，搏击阳气则痛。其甚者营卫遏绝，神气乃亡，为猝死。否则延久不愈，至一百天或一年，则犹有可治，为其邪气稍缓而正气尚能支持。然而对于经久不去的病，仍用十枣汤攻击之药，岂不是因为支饮不去，则其咳烦胸痛，必无止期，与其事敌以苟安，不如悉力一决之，犹或可图耶？然亦危矣。
久咳数年，脉弱的可治，脉实大数的死。脉虚的必苦于头昏。这是因为其人本有支饮在胸中。治属饮家。
久咳数年不已，是支饮渍肺而咳，饮久不已，则咳久不愈。咳久者其气必虚，而脉反实大数，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。
Question: There are four types of fluid retention (Yin). What are they?
Master said: There is Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Branching Fluid).
Question: How do these four types of fluids differ?
Master said: When a person who was previously robust becomes emaciated, and water flows in the intestines making a gurgling sound, it is called Tan Yin (Phlegm-Fluid). When drinking water causes fluid to accumulate under the hypochondrium, causing pain upon coughing or spitting, it is called Xuan Yin (Hanging Fluid). When drinking water causes fluid to flow into the limbs, sweating should occur but does not, resulting in body pain and heaviness, it is called Yi Yin (Overflowing Fluid). When there is coughing with air reversal, leaning on objects to breathe, inability to lie flat, and swelling-like appearance, it is called Zhi Yin (Branching Fluid).
Grain enters the stomach; if the stomach cannot disperse its essence, it transforms into Phlegm (Tan). Water enters the body; if the spleen cannot transport its Qi, it condenses into Fluid (Yin). The essence and fluids transformed from daily diet, if condensed and not distributed, become Tan Yin (Phlegm-Fluid). "Tan" refers to phlegm accumulating internally, while "Yin" refers to fluid attaching externally. Emaciation indicates that all essence and fluids have turned into Tan Yin, thus no longer nourishing the exterior, but flowing downward into the intestines. Overflowing water implies excessive fluid and reversed Qi, as Xu described: "Water is sucked by Qi and fails to descend." Fluid accumulating under the hypochondrium is Xuan Yin (Hanging Fluid); fluid flowing to the limbs is Yi Yin (Overflowing Fluid). "Xuan" means hanging in one place; "Yi" means overflowing to all sides. Fluid clustering upward and attaching to the heart and lungs is Zhi Yin (Branching Fluid). Zhi Yin is like branches of water or trees, near the organs but not central. Coughing with air reversal and inability to lie flat is due to fluid pressing upward on the lungs.
Fluid in the Heart: hardness and palpitations below the heart, shortness of breath, aversion to water and unwillingness to drink.
Fluid in the Lungs: spitting of saliva and foam, desire to drink water.
Fluid in the Spleen: lack of Qi, heavy body.
Fluid in the Liver: distension and fullness under the hypochondrium, pain upon sneezing.
Fluid in the Kidneys: palpitations below the heart.
Water is Yin. "Jian Zhu" refers to strong palpitations. Shortness of breath occurs because the Heart belongs to Fire and fears Water; when Water Qi presses upward, Fire Qi cannot extend. Spitting saliva and foam results from Qi and Water agitating each other, with Water flooding along with Qi. Desire to drink water occurs because Water gathers exclusively in the Lungs, depriving other meridians of nourishment. The Spleen is confined by Water, leading to lack of Qi; Water invading muscles leads to heaviness. Earth normally controls Water, but excessive Water can control Earth. The Liver meridian distributes through the hypochondrium and ribs; Water in the Liver causes distension under the hypochondrium ("Zhi Man" means partial fullness). Sneezing originates from the Lungs, and the Liver meridian connects to the Lungs; thus, sneezing causes pulling pain. Palpitations below the heart result from Kidney Water overwhelming Heart Fire.
When there is Liu Yin (Stagnant Fluid) below the Heart, the patient's back feels cold over an area the size of a palm. Liu Yin refers to fluid lingering in the hypochondrium, causing pain radiating to the Clavicular Fossa (Que Pen), which stops upon coughing (or worsens, also acceptable). When there is Liu Yin in the Chest, the patient has shortness of breath and thirst, joint pain in the limbs, and a deep pulse.
Liu Yin is Tan Yin that lingers and does not depart. Back coldness indicates that Yang Qi cannot reach the site of fluid accumulation. Wei stated: The back belongs to the Taiyang meridian and symbolizes Gen (Mountain/Stillness) in the I Ching. While the whole body moves, the back remains still. Still places are prone to Yin pathogenic factors; thus, Wind-Cold from outside often attacks the back, and internal Cold also tends to reside there. Hypochondriac pain radiating to the clavicle indicates fluid in the Liver affecting Lung Qi. Pain stopping upon coughing suggests fluid is disturbed by Qi and attempts to move. Shortness of breath is due to Qi stagnation by fluid; thirst is due to fluid binding preventing fluid distribution. Limb joint pain usually indicates Wind-Cold-Dampness in joints; if the pulse is deep rather than floating, accompanied by shortness of breath and thirst, it confirms Liu Yin disease rather than external pathogens.
Phlegm disease above the Diaphragm presents with fullness, wheezing, coughing, and spitting. Upon onset, there are chills and fever, back pain, waist pain, spontaneous tearing, and severe tremors of the body. This indicates Fu Yin (Latent Fluid).
Fu Yin is latent Tan Yin that is unnoticed until it manifests. Fever, back pain, and waist pain resemble external contraction, but combined with wheezing and spitting, it matches the description in *Huoren Shu*: Phlegm disease causes aversion to cold and fever, resembling Shaoyang disease. Tearing and tremors indicate fluid attacking the fluid pathways and meridians.
Excessive water intake causes sudden wheezing and fullness. Eating little and drinking much causes water to stop below the Heart; severe cases cause palpitations, mild cases cause shortness of breath. A double-wiry pulse indicates Cold, often seen after severe purgation leading to deficiency. A single-wiry pulse indicates Fluid retention.
Excess water overflowing into the Lungs causes wheezing and fullness. Water stopping below the Heart severely causes palpitations (Water Qi凌 Heart); mildly, it suppresses Qi causing shortness of breath. Double-wiry pulse (both hands wiry) indicates pervasive Cold Qi. Single-wiry pulse (one hand wiry) indicates biased Fluid Qi.
Lung Fluid retention does not present with a wiry pulse, only wheezing and shortness of breath. Zhi Yin also causes wheezing and inability to lie down, plus shortness of breath, with a normal pulse.
Lung Fluid is retention in the Lungs. Only the Lungs are uniquely susceptible to Fluid due to their emptiness. The Lungs govern Qi and respiration; wheezing and shortness of breath indicate obvious Lung pathology. Even without a wiry pulse, Fluid can be inferred. Zhi Yin attaches to the Lungs, similar to Lung Fluid, hence similar symptoms and normal pulse. Note: Article 14 states "Coughers with a wiry pulse have Water." Since Cough is a Lung disease and Water is Fluid, why is the pulse wiry here but normal for Lung/Zhi Yin? The reason is unclear.
Patients with Tan Yin (Phlegm-Fluid) should be treated with Warm herbs to harmonize. For Tan Yin below the Heart with chest/hypochondriac fullness and dizziness, Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction) is indicated.
Tan Yin is a Yin pathogen,有形 (having form). Form obstructs emptiness causing fullness; Yin obscures Yang causing dizziness. Poria (Fuling), Cinnamon Twig (Guizhi), Atractodes (Baizhu), and Licorice (Gancao) warm the middle and remove dampness, making this a good formula for Tan Yin—the so-called "Warm Herb" method. Since Tan Yin is a binding pathogen, warmth disperses it; since it relates to the Spleen/Stomach, warmth promotes transformation.
**Ling Gui Zhu Gan Tang Formula**
Poria (Fuling), Cinnamon Twig (Guizhi), Atractodes (Baizhu) (each 3 liang), Licorice (Gancao) (2 liang).
Boil the four ingredients in 6 sheng of water to obtain 3 sheng. Divide into three warm doses. Urination will improve.
For shortness of breath due to slight Fluid retention, promote urination. Ling Gui Zhu Gan Tang is indicated; Shen Qi Wan (Kidney Qi Pill) is also indicated.
Qi suppression by Fluid causes shortness of breath; removing Fluid restores Qi. Fluid is water-like; treating water requires promoting urination. Ling Gui Zhu Gan Tang benefits Earth Qi to move Water; Shen Qi Wan nourishes Yang Qi to transform Yin. Both promote urination.
**Shen Qi Wan Formula** (See Women's Miscellaneous Diseases)
If the pulse is hidden (Fu), and the patient desires diarrhea which brings relief, yet epigastric hardness/fullness persists, this is Liu Yin (Stagnant Fluid) attempting to exit. Gan Sui Ban Xia Tang (Kansui, Pinellia, and Licorice Decoction) is indicated.
Hidden pulse indicates Liu Yin. Relief after diarrhea shows some Fluid has exited. Persistent epigastric hardness shows remaining Fluid has re-accumulated. However, since there is a tendency to exit, Kansui and Pinellia guide it. Licorice and Kansui are incompatible but used together to stimulate mutual action to expel Fluid completely. Peony and Honey protect the middle and moderate toxicity.
**Gan Sui Ban Xia Tang Formula**
Kansui (Gansui) (3 large pieces), Pinellia (Banxia) (12 pieces, boiled in 1 sheng water to 0.5 sheng, strain), Peony (Shaoyao) (5 pieces), Licorice (Gancao) (1 piece finger-sized, roasted).
Boil the four ingredients in 2 sheng of water to obtain 0.5 sheng. Strain. Mix with 0.5 sheng of honey. Decoct to 0.8 sheng. Take in one dose.
A floating and fine-slippery pulse indicates injury by Fluid. A wiry-rapid pulse with Cold Fluid is difficult to treat in winter and summer. A deep-wiry pulse indicates internal pain from Xuan Yin (Hanging Fluid). Shi Zao Tang (Ten Jujube Decoction) is indicated for Xuan Yin.
Injury by Fluid means excessive intake. Qi relies on Fluid, but excess harms Qi, causing a floating-fine-slippery pulse. A wiry-rapid pulse with Cold Fluid contradicts the pulse nature (Cold pathogen with Heat signs). In winter, seasonal Cold aids Fluid; heat therapy worsens rapidity. In summer, seasonal Heat aids Rapid pulse; cold therapy is hindered by Cold Fluid. Hence, difficult. Deep-wiry pulse indicates internal Fluid aggregation. Aggregation causes Qi strike and pain. Shi Zao Tang strongly expels Fluid and breaks accumulations. *San Yin Fang* makes pills with dates.
**Shi Zao Tang Formula**
Genkwa (Yuanhua) (roasted), Kansui (Gansui), Oldenlandia/Dandelion root equivalent (Daji) (equal parts).
Powder the three ingredients. Boil 10 large jujubes in 1.5 sheng water to obtain 0.8 sheng. Strain. Add powder. Strong adults take 1 qianbi; weak adults take half. Take warm at dawn. If no effect, increase by half qianbi next day. After effective purgation, nourish with millet porridge.
For Yi Yin (Overflowing Fluid), promote sweating. Da Qing Long Tang (Major Blue Green Dragon Decoction) is indicated; Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) is also indicated.
Yi Yin involves water flowing to limbs, lack of sweating, and body heaviness. Limbs are Yang; water in Yang positions should be sweated out. Da Qing Long Tang releases sweat to remove water; Xiao Qing Long Tang treats internal Fluid as well. Xu noted: Da Qing Long Tang (based on Guizhi/Mahuang minus Shaoyao, plus Shigao) suits mild water with Heat. If excessive Fluid with Cold, Xiao Qing Long Tang is appropriate.
**Da Qing Long Tang Formula**
Ephedra (Mahuang) (6 liang), Cinnamon Twig (Guizhi), Licorice (Gancao) (each 2 liang), Fresh Ginger (Shengjiang) (3 liang), Apricot Seed (Xingren) (40), Jujube (Dazao) (12), Gypsum (Shigao) (size of chicken egg).
Boil Mahuang in 9 sheng water, reduce by 2 sheng, remove foam. Add others, boil to 3 sheng. Strain. Take 1 sheng warm. Aim for slight sweating. If sweating too much, apply warm powder.
**Xiao Qing Long Tang Formula**
Ephedra (Mahuang) (3 liang, tips removed), Peony (Shaoyao) (3 liang), Schisandra (Wuweizi) (0.5 sheng), Dried Ginger (Ganjiang) (3 liang), Licorice (Gancao) (roasted), Asarum (Xixin), Cinnamon Twig (Guizhi) (each 3 liang), Pinellia (Banxia) (0.5 sheng).
Boil Mahuang in 1 dou water, reduce by 2 sheng, remove foam. Add others, boil to 3 sheng. Strain. Take 1 sheng warm.
Zhi Yin between Diaphragm causes wheezing/fullness, epigastric hardness, dark complexion, deep-wiry pulse. After decades of illness, failed vomiting/purging therapies. Mu Fang Ji Tang (Stephania Decoction) is indicated. If deficient, it cures; if excess, recurs in 3 days. If recurrence fails to respond, Mu Fang Ji Tang minus Shigao plus Fuling and Mangxiao is indicated.
Zhi Yin blocks Lungs (wheezing) and Stomach (hardness). Dark complexion indicates stagnation of Ying and Wei. Deep-wiry is interior excess. Interior excess usually warrants purgation, but Fluid excess requires special methods. Vomiting is for phlegm, but Fluid below Heart resists vomiting. Thus, previous treatments failed. Mu Fang Ji and Guizhi (bitter/acrid) move Water and dissipate knots. Hardness implies latent Heat; vomiting/purging damages Qi. Shigao clears Heat, Renshen tonifies Deficiency. If deficient constitution, Water leaves and Qi moves, curing the disease. If excess constitution, solid matter remains, Qi temporarily moves then re-aggregates, causing recurrence. Adding Mangxiao (soft) breaks hard accumulations; Fuling guides Fluid downward.
**Mu Fang Ji Tang Formula**
Stephania (Mufangji) (3 liang), Gypsum (Shigao) (2 pieces egg-sized), Cinnamon Twig (Guizhi) (2 liang), Ginseng (Renshen) (4 liang).
Boil in 6 sheng water to obtain 2 sheng. Divide into two warm doses.
**Mu Fang Ji Tang minus Shigao plus Fuling and Mangxiao Formula**
Stephania (Mufangji), Cinnamon Twig (Guizhi) (each 2 liang), Poria (Fuling), Ginseng (Renshen) (each 4 liang), Mirabilite (Mangxiao) (3 he).
Boil in 6 sheng water to obtain 2 sheng. Strain. Add Mangxiao. Simmer slightly. Divide into two warm doses. Mild purgation indicates cure.
Zhi Yin below Heart causes dizziness/dizziness (Mao Xuan). Ze Xie Tang (Alisma Decoction) is indicated.
Fluid attacking clear Yang causes Mao Xuan. "Mao" is mental clouding; "Xuan" is visual spinning/blackness. Alisma (Zexie) drains Water; Atractodes (Baizhu) strengthens Earth to control Water. Gao Gugeng noted: Fluid blocks Heart Fire from descending, causing upward rush to head/eyes.
**Ze Xie Tang Formula**
Alisma (Zexie) (5 liang), Atractodes (Baizhu) (2 liang).
Boil in 2 sheng water to obtain 1 sheng. Divide into two warm doses.
Zhi Yin with chest fullness uses Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction).
"Chest fullness" may be "Abdominal fullness". Why use purgation? Hou Po and Da Huang match Xiao Cheng Qi Tang. Use only if abdominal pain and constipation exist.
**Hou Po Da Huang Tang Formula**
Magnolia Bark (Houpo) (1 chi), Rhubarb (Dahuang) (6 liang), Immature Bitter Orange (Zhishi) (4 pieces).
Boil in 5 sheng water to obtain 2 sheng. Divide into two warm doses.
Zhi Yin causing breathing difficulty uses Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Lung-Purging Decoction).
Breathing difficulty indicates Lung fullness and Qi closure. Descurainia (Tingli) opens closure; Jujube protects Righteous Qi.
**Ting Li Da Zao Xie Fei Tang Formula** (See Lung Abscess)
Vomiters usually feel thirsty, indicating resolution. If not thirsty, Zhi Yin remains below Heart. Xiao Ban Xia Tang (Minor Pinellia and Ginger Decoction) is indicated.
Thirst indicates Fluid expelled via vomiting. No thirst means Fluid remains. Pinellia (Banxia) is acrid/dry to scatter knots and drain Fluid. Ginger (Shengjiang) moderates Pinellia and stops vomiting.
**Xiao Ban Xia Tang Formula**
Pinellia (Banxia) (1 sheng), Fresh Ginger (Shengjiang) (0.5 sheng).
Boil in 7 sheng water to obtain 1.5 sheng. Divide into two warm doses.
Abdominal fullness with dry mouth/tongue indicates Intestinal Fluid. Fang Ji Ting Li Huang Wan (Stephania, Descurainia, and Rhubarb Pill) is indicated.
Fluid gathering below prevents upper moistening. Intestinal Fluid causes dry mouth. Further water intake worsens downward trend and fullness. Stephania (Fangji) treats dampness/water; Pepper seed (Jiaomu) treats abdominal fullness; Descurainia (Tingli) and Rhubarb (Dahuang) purge blockage. Thirst indicates Stomach Heat; add Mangxiao (Salty-Cold).
**Fang Ji Ting Li Huang Wan Formula**
Stephania (Fangji), Pepper Seed (Jiaomu), Descurainia (Tingli), Rhubarb (Dahuang) (each 1 liang).
Powder, mix with honey, make pills like wu zi. Take 1 pill before meals with water, 3 times daily. Increase gradually. Stop when saliva returns. Add Mangxiao if thirsty.
Sudden vomiting, epigastric fullness, Diaphragmatic Fluid, dizziness, and palpitations use Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia and Ginger plus Poria Decoction).
Fluid reversing in Stomach causes vomiting; stagnating causes fullness; attacking Heart causes palpitations; obscuring Yang causes dizziness. Pinellia/Ginger stop vomiting; Poria removes Water.
**Xiao Ban Xia Jia Fu Ling Tang Formula**
Pinellia (Banxia) (1 sheng), Fresh Ginger (Shengjiang) (0.5 jin), Poria (Fuling) (4 liang).
Boil in 7 sheng water to obtain 1.5 sheng. Divide into two warm doses.
Emaciated persons with sub-umbilical palpitations, spitting foam, and dizziness have Water. Wu Ling San (Five-Ingredient Powder with Poria) is indicated.
Emaciation usually excludes Water, but sub-umbilical palpitation indicates lower Water movement. Spitting foam indicates mid-level reversal. Dizziness indicates upper invasion. Despite emaciation, the pathology is Water. Poria, Atractodes, Polyporus, Alisma promote urination. Cinnamon Twig (Guizhi) transforms lower Water via Yang. Drinking warm water induces sweating to resolve Water from both interior and exterior.
**Wu Ling San Formula**
Alisma (Zexie) (1.1 liang), Polyporus (Zhu Ling), Poria (Fuling), Atractodes (Baizhu) (each 0.3 liang), Cinnamon Twig (Guizhi) (0.2 liang).
Powder. Take with rice water. 3 times daily. Drink warm water; sweating indicates cure.
**Appendix Formula:**
**Waitai Fuling Yin**: Treats retained Phlegm/Water in Heart/Chest. After vomiting, emptiness and fullness prevent eating. Promotes digestion.
Poria (Fuling), Ginseng (Renshen), Atractodes (Baizhu) (each 3 liang), Immature Bitter Orange (Zhishi) (2 liang), Tangerine Peel (Chenpi) (2.5 liang), Fresh Ginger (Shengjiang) (4 liang).
Boil in 6 sheng water to obtain 1.8 sheng. Take warm, 3 times daily, after walking ~8 li.
Coughers with wiry pulses have Water. Shi Zao Tang is indicated.
Wiry pulse indicates Water; cough with wiry pulse means Water invades Lungs. Shi Zao Tang expels Water via urine/stool, calming Lungs and stopping cough. Xu Renze described chronic cough from stagnant Thoracic Water rising to Lungs, causing persistent cough, eye protrusion, gasping, etc. Gan Zao San Wei Wan (Three-Ingredient Pill with Jujube) is also good: Jujube (60), Descurainia (1 sheng), Apricot Seed (1 sheng). Pills taken with Mulberry Root Bark decoction.
For Zhi Yin patients with cough, irritability, and chest pain surviving 100 days or a year, Shi Zao Tang is indicated.
Thoracic Zhi Yin disturbs clear pathways, causing cough (Lung), irritability (Heart), and pain (Yang Qi). Severe cases cause death; long-term cases allow treatment as pathogen is slow and Righteous Qi holds. Using aggressive Shi Zao Tang for chronic illness risks life but aims to decisively eliminate the root cause.
Chronic cough for years: Weak pulse is treatable; Excess-Large-Rapid pulse indicates death. Empty pulse causes dizziness due to pre-existing Zhi Yin. Treatment belongs to Fluid diseases.
Long-term cough implies Lung immersion by Fluid. Chronic cough depletes Qi; if pulse is Excess-Large-Rapid, Pathogen is strong against weak Qi, leading to death. If pulse is empty, both Righteous Qi and Fluid are weak.