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Jingui Yaolue · Essentials from the Golden Cabinet
12. Phlegm, Retained Fluids and Cough · Pulses, Signs and Treatment
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Question: What are the four fluid disorders?
The Master replies: Phlegm-fluids, suspended fluids, overflowing fluids and supporting fluids.
Question: How do they differ?
The Master replies: Former fullness now thin, water moving between intestines with dripping sounds, is phlegm-fluids. Water flowing below ribs after drinking, with cough and spitting pulling painfully, is suspended fluids. Water flowing into four limbs, sweat expected but absent, body painful and heavy, is overflowing fluids. Counterflow cough with supported breathing, short qi, inability to lie and a swollen-looking form is supporting fluids.
Water in Heart gives hard pounding below Heart, short qi and aversion to water with no desire to drink.
Water in Lung gives saliva and foam, with desire to drink water.
Water in Spleen gives scant qi and heavy body.
Water in Liver gives braced fullness below ribs and pain upon sneezing.
Water in Kidney gives palpitations below Heart.
Retained fluids below Heart make a palm-sized area of the back cold.
Retained fluids give pain below ribs reaching the supraclavicular hollow, stopping upon cough. A variant instead says growing worse.
Retained fluids in the chest give short qi and thirst. Pain through limb joints with a deep pulse also means retained fluids.
Phlegm illness above the diaphragm, fullness, panting, cough and vomiting, attacks with cold and heat, back and waist pain, spontaneous tears, shaking and severe bodily twitching must mean hidden fluids.
Much water drunk by an ill person must suddenly cause panting fullness. Little food and much drink leave water below Heart. Severe cases have palpitations, mild cases short qi.
Both sides' pulses wiry mean cold, often deficiency after drastic purging. One side alone wiry means fluids.
Lung fluids do not have a wiry pulse; the suffering is panting and short qi.
Supporting fluids also cause panting and inability to lie, with short qi, yet the pulse is normal.
Phlegm-fluids should be harmonized with warming medicine.
Phlegm-fluids below Heart, braced fullness of chest and flanks, and dizziness are governed by Ling Gui Zhu Gan Tang.
Short qi with slight fluid retention should be removed through urination. Ling Gui Zhu Gan Tang governs; its formula is referred to above. Shenqi Wan also governs, with formula under foot-qi.
A hidden pulse, desire for spontaneous diarrhea, diarrhea instead passing freely, yet continued hardness and fullness below Heart, mean retained fluids wish to leave. Gansui Banxia Tang governs.
A floating, fine, slippery pulse means injury by fluids.
A wiry, rapid pulse means cold fluids, difficult to treat in winter and summer.
A deep, wiry pulse means suspended fluids with inward pain.
Suspended-fluid illness is governed by Shizao Tang.
Overflowing fluids should be treated by sweating. Da Qinglong Tang governs; Xiao Qinglong Tang also governs.
Supporting fluids between the diaphragm give panting fullness, hard focal blockage below Heart, dark face and deep, tight pulse. After several tens of days, emesis and purging have failed. Mu Fangji Tang governs. Deficient cases recover; replete cases relapse in three days. If giving it afterward does not recover the illness, Mu Fangji Tang without Shigao and with Fuling and Mangxiao is suitable.
Supporting fluids below Heart with distressing clouded dizziness are governed by Zexie Tang.
Supporting fluids with chest fullness are governed by Houpo Dahuang Tang.
Supporting fluids preventing breathing are governed by Tingli Dazao Xiefei Tang. Its formula is referred to under Lung abscess.
A vomiting patient is originally thirsty; thirst indicates impending resolution. Absence of thirst instead means supporting fluids below Heart. Xiao Banxia Tang governs. Thousand Gold instead names Xiao Banxia Jia Fuling Tang.
Abdominal fullness and dry mouth and tongue mean Water qi between intestines. Ji Jiao Li Huang Wan governs.
Sudden vomiting, focal blockage below Heart, Water between diaphragm, dizziness and palpitations are governed by Xiao Banxia Jia Fuling Tang.
A thin person with palpitations below navel, saliva and foam, and disordered dizziness has Water. Wuling San governs.
Supplement · Passage 32
Supplement: A coughing person's wiry pulse means Water. Shizao Tang governs; its formula is referred to above.
Supplement · Passage 33
Supplement: Supporting fluids with vexing cough and chest pain do not cause sudden death. At a hundred days or a year, Shizao Tang is suitable; its formula is referred to above.
Supplement · Passage 34
Supplement: Cough lasting years with a weak pulse is treatable; a replete, large, rapid pulse means death. A deficient pulse must bring distressing clouding because supporting fluids already lie in the chest. Treatment belongs to fluid disorders.
Supplement · Passage 35
Supplement: Counterflow cough with supported breathing and inability to lie is governed by Xiao Qinglong Tang; its formula is referred to above.
Supplement · Passage 36
Supplement: After Qinglong Tang has been taken, much saliva, dry mouth, deep cun and faint chi pulses, reversal of hands and feet, qi rushing from lower abdomen into chest and throat, numb extremities and a face gently hot like drunkenness may occur. Qi then flows downward to the genital region and inner thighs, urination is difficult and clouding recurs. Give Fuling Guizhi Wuwei Gancao Tang to treat the upward rush.
Supplement · Passage 37
Supplement: The rushing qi subsides, but cough and chest fullness worsen. Use Gui Ling Wuwei Gancao Tang without Gui and with Ganjiang and Xixin to treat them.
Supplement · Passage 38
Supplement: Cough and fullness stop, but thirst returns and rushing qi recurs because Xixin and Ganjiang are hot medicinals. They should cause continued thirst. If thirst instead stops, there are supporting fluids. By the method these cause clouding, clouding must cause vomiting. Add Banxia again to remove the Water.
Supplement · Passage 39
Supplement: Water gone and vomiting stopped, but form swollen: add Xingren. The presentation would call for Mahuang, but because the person consequently has impediment, do not add it. Contrary addition must cause reversal: blood is deficient and Mahuang issues the person's yang.
Supplement · Passage 40
Supplement: A face hot like drunkenness is Stomach heat rushing up to steam the face. Add Dahuang to drain it.
Supplement · Passage 41
Supplement: Thirst before vomiting means Water retained below Heart, belonging to fluid illness. Xiao Banxia Fuling Tang governs; its formula is referred to above.
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