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Millwoods Acupuncture Center
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Edmonton AB,   Canada

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痰饮咳嗽病脉证并治第十三

Chapter 13, Water-accumulation, cough, their symptoms, pulse and treatment

夫病人饮水多,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,里虚,脉偏弦者,饮也。

If the person eats little but drink lot and the urine is smoothly, it belongs to Xiaoke disease. If the urine is not smooth, with some difficult or the urine is slow, it belongs to Liuyin disease (e.g. water accumulation disease). If the Water accumulates in the chest, it causes fullness in the chest, difficulty in the breath to asthma; if it is in the stomach, it results in palpitation, short of breath; if it is in the lower abdomen, it causes urgent feeling in the urine. If the pulse is string in both wrists, it suggests a Cold condition, which is due to a weakness condition following a heavy bowel-movement therapy. If the string pulse can be felt on only one wrist, it suggests the Water-accumulation disease.

先渴后呕,为水停心下,此属饮家,小半夏茯苓汤主之。

If the person feels thirsty first, then has nausea after drinking, this condition belongs to water-accumulation in the upper abdomen. Use Xiao Banxia Fuling Tang.

 
半夏茯苓汤方

Xiao Banxia Fuling Tang


半夏 
一升,   生姜  半斤,   茯苓 三两

Banxia 250 gram, fresh ginger 125 gram, Fuling 45 gram


右三味,以水七升,煮取一升五合,分温再服。

Add the herbs and 1250 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 300 ml herbal tea left. Drink one third of the herbal tea each time, three times a day.


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。

Normally if a person has nausea and vomiting, he should feel thirsty after vomiting. Now, he does not feel thirsty after vomiting. It indicates that he has a water-accumulation condition in the upper stomach. Use Xiao Banxia Tang.


半夏汤方

Xiao Banxia Tang


半夏 
一升,    生姜  半斤

Banxia 250 gram, fresh ginger 125 gram.


右二味,以水七升,煮取一升半,分温再服。

Add the herbs and 1250 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 300 ml herbal tea left. Drink one third of the herbal tea each time, three times a day.

卒呕吐,心下痞,膈间有水,眩悸者,半夏茯苓汤主之。

If a person has a sudden vomit, feels fullness in the upper abdomen, dizzy and palpitation, (it is also a water-accumulation condition in the upper abdomen), use Banxia jia Fuling Tang

半夏茯苓汤方

Banxia jia Fuling Tang


假令病人[1]脐下有悸,吐涎沫而癫眩,此水也,五苓散主之。

If a skinny person has palpitation feeling under the naval, spits saliva and feels dizzy, it is also a water-accumulation condition. Use Wuling San.[2]

五苓散方

Wuling San


泽泻
一两一分,猪苓(去皮)三分,茯苓三分,白术三分,桂(去皮)二分

Zexie 18 gram, Zhuling 12 gram, Fuling 12 gram, Guizhi 8 gram.

右五味,为末,白饮服方寸匕,日三服,多饮暖水,汗出愈。

Prepare the herbs into pills. Drink 1.5 gram each time, three times a day. Drink more warm water after drinking the tea. The problem should be solved after getting a sweat.


夫短气有微饮,当从小便去之,芩桂术甘汤主之。肾气丸亦主之。

If a person feels slight short of breath, it suggests a slight water-accumulation condition. Use a urine therapy with Qinguishugan Tang, or Shenqi Wan.

茯苓桂枝白术甘草汤方

Fuling Guizhi Baishu Gancao Tang


茯苓 
四两,桂枝白术  各三两,甘草  二两

Fuling 60 gram, Guizhi 45 gram, Baishu 45 gram, Gancao 30 gram


右四味,以水六升,煮取三升,分温三服,小便则利。

Add the herbs and 1500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 750 ml herbal tea left. Drink one third of the herbal tea each time, three times a day.


肾气丸方

Shenqi Wang (see the various disease for women)

(见妇人杂病中)

夫心下有留饮,其人背寒冷如掌大。留饮者,下痛引缺盆、咳嗽则转甚。胸中有留饮,其人短气而渴,四肢历节痛。脉沉者有留饮。

Cold feeling on the back as a size of palm indicates a water-accumulation condition in the upper abdomen. The person may also feel pain in the grove and upper chest open, which is worse with cough. If the water accumulated in the chest, the person feels short of breath and thirsty; if it is in the arms and legs, there will be pain there. Deep pulse suggests a water-accumulation condition.

膈上病,痰满喘咳吐,发则寒热,背痛,腰疼,目泣自出,其人振振身剧,必有伏饮。

If the water-accumulation disease is deep in the chest, the person feels fullness in the chest, asthma, cough and spit phlegm. Upon onset, he has fever and chilly, pain in the back and lower back. In severe condition, the cough causes tear from the eyes and shaking of the body.

脉浮而细滑,伤饮。

A pulse of floating and thin and smooth suggests a water-accumulation condition too. However, it indicates a early and slight extent condition.


脉沉者,有留饮。

A deep pulse suggests a more severe water-accumulation condition.


病者脉伏,其人欲自利,利反快,此为留饮欲去故也, 虽利,心下续坚满,此为留饮欲去故也,甘遂半夏汤主之。

If the pulse is deep, but the person has diarrhea, and feels good after the diarrhea, it suggests there is a water-accumulation in the body. If the person feels fullness after the diarrhea, it means the accumulated water is to deplete. In this case, use Gansui Banxia Tang

 
甘遂半夏
汤方

Gansui Banxia Tang

甘遂大者三枚,   半夏(以水一升,煮取半升,去滓)十二枚,   芍药五枚,   甘草(炙)如指大一枚

Ganshui (big one) 3 badges, Banxia (book with 250 ml water, collect 125 ml, remove residue) 12 badges, Shaoyao 5 badges, Gancao (processed, a size as a thumb) one badge.


右四味,以水二升,煮取半升,去滓,去蜜半升,和药汁煎取八合,顿服之。

Add the herbs and 500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 125 ml herbal tea left. Remove herbal residue, add honey 125 ml. Bring to dissolve. Collect the whole herbal tea as 200 ml. Drink all the tea once for all. 

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;饮后水流在下,咳吐引痛,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,气短不得卧,其形如肿,谓之支饮。

Asked: there are four kinds of the water-accumulation conditions, what are they? Master: they are Tanyin (Phlegm-water accumulation), Xuanyin (Pending-water accumulation), Yiyin (Spill-water accumulation), and Zhiyin (Branch-water accumulation). Asked: what’s the difference of them? Master: for the Phlegm-water accumulation, the person is usually strong in body shape, but now he is skinny. He feels water movement with noise in the abdomen; for Pending-water accumulation, the water is in the lower part of the chest, the person feels cough, vomit and pain in the chest; for Spill-water accumulation, the water accumulated under the skin. The person has no sweat when he supposed to have, feels heavy and pain in the body; For Brach-water accumulation, the person has couch and has hard to lie down in flatten position. The body looks as swelling.  

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,下支满,嚏而痛。水在肾,脐下悸。

If the Water is in the heart, the person feels hard and solid in the upper abdomen, short of breath, dislike drinking of water. If  the Water is in the lung, the person spits saliva, likes to drink water; if the Water is in the spleen, the person feels short of breath, heavy in the body; if it is in the liver, the person feels fullness in the sides of upper abdomen, feels pain there with sneeze; if it is in the kidney, he will feels jumping and beating feeling in the lower abdomen.

支饮腹满者,厚朴大黄汤主之。(支饮胸满,邪在肺也,宜用木防己汤、葶苈大枣汤。支饮腹满,邪在胃也,故用厚朴大黄汤,即小承气汤也。)

For Branch-water accumulation condition, use Houpo Dahuang Tang

厚朴大黄汤方

Houpo Dahuang Tang

厚朴  一尺,  大黄  六两,   枳实  四枚

Houpo 30 gram, Dahuang 90 gram, Zhishi 4 badges.


右三味,以水五升,煮取二升,分温再服。

Add the herbs and 1750 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 500 ml herbal tea left. Drink one third of the tea each time, three times a day.


心下有痰饮,胸支满,目眩,苓桂术甘汤主之。

With the Phlegm-water accumulation condition, the person feels fullness in the chest, dizzy in the eyes, sue Lingguizhugan Tang

苓桂术甘汤方

Lingguizhugan Tang

(见上)


 (
心下有痰饮), 腹满,口舌干燥,此肠间有水气,已椒苈黄圆主之。

With the Phlegm-water accumulation condition, the person feels fullness in the abdomen, dry mouth, use Jijiaolihuang Wan. 

防己椒目葶苈大黄圆方

Jijiaolihuang Wan


防己, 
椒目,  葶苈(熬),  大黄  各一两

Fangji 15 gram, Jiaomu 15 gram, Tinglizi (processed) 15 gram, Dahuang 15 gram.


右四味,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。

Prepare the herbs into pills with honey, a size as soya been. Drink one pill each time, three times a day after each meal. Increase the number of pill each time. When there is saliva in mouth, add Mangxiao 8 gram in the preparation of the pills.  

脉沉而弦者,悬饮内痛。

Deep and string pulse suggests the presence of Pending-water accumulation condition.

病悬饮者,十枣汤主之。

For the Pending-water accumulation condition, use Shi Zao Tang


十枣汤方

Shi Zao Tang


芫花
(熬), 甘遂,  大戟,  各等分

Yuanhua (processed), Ganshui, Daji, equal amount.


右三味,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,明日更服半钱,得快利后,糜粥自养。

Grind the herbs into powder. Add Chinese date 10 badges and 350 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 200 ml water left. Remove the residue, collect the herbal tea. Drink 1.8 gram of the herbal powder with the help of the date juice. For skinny person during the daytime, drink 1.5 gram each time. If there is no bowel movement, repeat the drinking 0.8 gram the herbal powder next day (not the same day!). If there is easy bowel movement, stop to take the herbs, but drink ordinary rice soup to get final recover.

病溢饮者,当发其汗,大青龙汤主之,小青龙汤亦主之。

With the Spilling-water accumulation, use sweat therapy with Da Qinglong Tang, or Xiao Qinglong Tang. 

大青龙汤方

Da Qinglong Tang


麻黄
(去节)六两,桂枝二两,甘草(炙)二两,杏仁(去皮、尖)四十个,生姜三两,大枣十二枚,石膏如鸡子大

Mahuang 90 gram, Guizhi 30 gram, Gancao (processed) 30 gram, Xinren 40 badges, fresh ginger 45 gram, Chinese date 12 badges, Shigao 30 gram.


右七味,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,温粉扑之。

Add the Mahuang and 2250 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 1750 ml herbal tea left. Remove the upper floating residue, add the remaining herbs in. Continue to boil until there is 750 ml herbal tea left. Drink one third of the tea each time to get mild sweat. If the sweat is too much, use powder on the skin to stop the sweat.


小青龙汤方

Xiao Qinglong Tang


麻黄
(去节)三两,芍药三两,五味子半升,干姜三两,甘草(炙)三两,细辛三两,桂枝三两,半夏(汤洗)半升

Mahuang 45 gram, Guizhi 45 gram, Gancao (processed) 45 gram, Wuwenzi 25 badges, Ganjiang 45 gram,  Xixin 45 gram, Banxia 124 gram, Shaoyao 45 gram.


右八味,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。

Add the Mahuang and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 2000 ml herbal tea left. Remove the upper floating residue, add the remaining herbs in. Continue to boil until there is 750 ml herbal tea left. Drink one third of the tea each time to get mild sweat.  

()饮不弦,但苦喘短气。

String pulse usually suggests the Water-accumulation condition. However, if the accumulation is in the lung (the Branch-water accumulation), the pulse is not string, and the person’s main symptom is short of breath and asthma.


支饮亦喘而不能卧,加短气,其脉平也。

With the Branch-water accumulation condition, the person can also have asthma and short of breath, hard to lie down, but the pulse can be normal, floating, harsh, or short, but not string.

支饮不得息,葶苈大枣汤主之。

For the Branch-water accumulation condition, use Tinglize Dazao Tang.


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,宜木防己汤去石膏茯苓芒硝汤主之。

With the Branch-water accumulation in between the diagram, the person fees asthma, fullness in chest, hard and solid in the upper abdomen, has dark color on face, has deep and tight pulse. After tens of days, he has been given vomiting and bowel-movement therapy but none work. In this case, use Mu Fangji Tang. If the condition belongs to the loss combination of the Water and Xiewi, e.g. a weak condition, this herbal formula will work. If the condition is due to a tight and solid combination of the Water and Xieqi, e.g. a Fullness condition, the symptoms will come back within three days. For those recurrent case and failure case, remove Shigao but add Fuling Mangxiao in the formula.  


防己汤方

Mu Fangji Tang


防己  三两,   石膏(鸡子大)十二枚,    桂枝  二两,   人参  四两

Mufangji 45 gram, Shigao 30 gram, Guizhi 30 gram, Renshen 60 gram.


右四味,以水六升,煮取二升,分温再服。


Add the herbs and 1500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 500 ml herbal tea left. Drink one third of the tea each time, three times a day.

防己茯苓芒硝汤方

Mufangji jia Fuling Mangxiao Tang


防己桂枝  各二两,人参茯苓  各四两,芒硝  三合

Mufangji 30 gram, Guizhi 30 gram, Renshen 60 gram, Fuling 60 gram, Mangxiao 75 gram.


右四味,以水六升,煮取二升,去滓,内芒硝,再微煎,分温再服,微利则愈。
       
Add the herbs and 1500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 500 ml herbal tea left. Drink one third of the tea each time, three times a day.

心下有支饮,其人苦冒眩,泽泻汤主之。

With Branch-water accumulation, if the person feels annoying dizzy, use Zexie Tang.

 泽泻汤方

Zexie Tang


泽泻 
五两 ,  白术  二两

Zexie 78 gram, Baishu 30 gram


右二味,以水二升,煮取一升,分温再服。

Add the herbs and 500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 250 ml herbal tea left. Drink one third of the tea each time, three times a day.


病痰饮者,当以温药和之。

For a Phlegm-water accumulation, the principle in the treatment is to use warm therapy.


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。

With Branch-water accumulation condition, the water attacks the lung to cause cough; attacks the heart to cause annoyed; sticks to the chest to cause fullness and pain in the chest. Use Shi Zao Tang for the treatment. The person with such condition usually can live longer as hundreds days, or one year, since the Xieqi belongs to a Yin Xie, which is slower than a Yang Xie.

咳家其脉弦,为有水,十枣汤主之。

Again, if a person has cough and his pulse is string, it indicates a Water-accumulation condition. Use Shi Zao Tang.


脉弦迟[3],有寒饮,冬夏难治。

If the pulse is string and slow, it indicates a Cold Water-accumulation condition. It is hard to solve during winter and summer.  


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。

If the cough comes every year for many years and the pulse is weak, it can be cured; if the pulse is big and strong and frequent, the one is to die. For the person with the weak pulse must have annoying cloudy mind, kinds of dizziness feeling, since he has Branch-water accumulation condition in the body.  

咳逆倚息不得卧,小青龙汤主之。青龙汤汗已[4],多唾,口燥,寸脉沉,尺脉微,手足厥逆,气从少腹上冲胸咽,手足痹,其面翕热如醉状,因复下流阴股,小便难,时复冒者,与茯苓桂枝五味甘草汤,治其气冲。冲气即低,而反更咳,胸满者,用苓桂五味甘草汤去桂,加干姜细辛,以治其咳满。咳满即止,而更复渴,冲气复发者,以细辛干姜为热药也,服之当遂渴,而渴反止者,为支饮也;支饮者,法当冒,冒者必呕;呕者复内半夏以去其水,茯苓桂枝五味甘草汤去甘草桂枝,加细辛干姜半夏汤主之。水去呕止,其人形肿者,加杏仁主之。其证应内麻黄,以其人遂痹故不内之,若逆而内之者必厥。所以然者,以其人血虚,麻黄发其阳故也。若面热如醉,此为胃热上冲熏其面,加大黄以利之。

If the person has frequent cough, asthma, so that he is hard to lie down for a sleep, use Xiao Qinglong Tang. Use Fuling Guizhi Wuwei Gancao Tang if , after drinking of the tea, the person starts to spit more saliva, feels dry in mouth, has deep pulse in the Chun position and mild in the Chin position, has reverse cold in the hands and feet, feels air pushing up from lower stomach to the throat, feels tight or pain in the hands and feet, has red face as drunk, feels kinds of liquid flowing feeling in the inguinal area, or in the inside of the thigh, has difficulty in urine, feels cloudy mind and dizzy from time to time. This herb formula works to reduce the up-pushing air feeling. After drink of the tea, the up-pushing feeling is down, but the person feels more cough, and has fullness in the chest, remove Guizhi, but add Ganjiang and Xixin to the Fuling Guizhi Wuwei Gancao Tang. If the cough and fullness stop, but the person feels more thirsty, has the up-pushing feeling again, it is due to the use of the Ganjiang and Xixin, which belongs to warm and should cause such thirsty. If the person has no thirsty however, it then indicates that the person has Branch-water accumulation. With such Branch-water accumulation condition, the person should feel cloudy mind and dizziness and has nausea. If he indeed has such nausea, add Banxia to the herb formula to remove the Water. After removal of the Water, and stop of the nausea, but the peron has swelling in the body, add Xinren to the formula. Theoretically Mahuang should be used. It is not used for the reason that he has the Bi syndrome in the hands and feet. Other wise the Mahuang may cause the Jue condition (cold hands and feet), because he has blood deficiency, the Mahuang will result in a depletion of Yangqi. If the person feels hot on the face as drunk, it is Stomach Hot pushes up to smoke the face, add Dahuang in the formula.    


苓桂五味甘草汤方

Fuling Guizhi Wuwei Gancao Tang


茯苓
 四两,桂枝 四两,甘草(炙)三两,五味子 半升

Fuling 60 gram, Guizhi 60 gram, Gancao (processed) 45 gram, Wuweizi 25 gram.


右四味,以水八升,煮取三升,去滓,分温三服。

Add the herbs and 2000 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 750 ml herbal tea left. Drink one third of the tea each time, three times a day.


苓甘五味姜辛汤方

Fuling Gancao Wuweizi Ganjiang Xixin Tang


茯苓
四两,甘草干姜细辛各三两,五味子半升

Fuling 60 gram, Gancao 45 gram, Ganjinag 45 gram, Xixin 45 gram, Wuweizi 25 gram


右五味,以水八升,煮取三升,去滓,温服半升,日三服。

Add the herbs and 2000 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 750 ml herbal tea left. Drink one third of the tea each time, three times a day.


苓桂五味甘草甘草去桂加干姜细辛半夏汤方

Fuling Guizhi Wuweizi Gancao Tang, but remove Gancao and Guizhi, but add Ganjiang, Xixin, Banxia


茯苓
四两,细辛干姜各二两,五味子半夏各半升

Fuling 60 gram, Xixin 30 gram, Ganjiang 30 gram, Wuweizi 25 gram, Banxia 124 gram


右五味,以水八升,煮取三升,去滓,温服半升,日三服。

Add the herbs and 2000 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 750 ml herbal tea left. Drink one third of the tea each time, three times a day.


苓甘五味加姜辛半夏杏仁汤方

Fuling Gancao Wuweizi jia Ganjiang, Xixin, Banxia, Xinren Tang


茯苓
四两,甘草三两,五味子半升,干姜三两,细辛三两,半夏三两,杏仁(去皮、尖)半升。

Fuling 60 gram, Gancao 45 gram, Wuweizi 25 gram, Ganjiang 45 gram, Xixin 45 gram, Banxia 45 gram, Banxia 45 gram, Xinren 125 gram


右七味,以水一斗,煮取三升,去滓,温服半升,日三服。

Add the herbs and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 750 ml herbal tea left. Drink 125 ml first, then one third of the remaining tea each time, three times a day.


苓甘五味加姜辛半杏大黄汤方

Fuling Gancao Wuweizi jia Gangjiang Xixin Banxia, Xinren, Dahuang Tang


茯苓
四两,半夏半升,甘草三两,五味子半升,干姜三两,细辛三两,杏仁(去皮、尖)半升,大黄三两

Fuling 60 gram, Banxia 125 gram, Gancao 45 gram, Wuweizi 25 gram, Ganjiang 45 gram, Xixin 45 gram, Xinren 125 gram, Dahuang 45 gram


右八味,以水一斗,煮取三升,去滓,温服半升,日三服。

Add the herbs and 2500 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 750 ml herbal tea left. Drink 125 ml first, then one third of the remaining tea each time, three times a day.



[1] In original version, it is “skinny person:

[2] If the person feels as there is an animal to run, e.g. the Bentun disease, use Fuling Guizhi Gancao Dazao Tang.

[3] In original version, it is frequent pulse.

[4] In original version, it is “after bowel-cleansing therapy”.