Line 40:

“In cold damage when the exterior has not yet resolved, and there is water qì below the heart, with dry retching, heat effusion, and cough, and possibly thirst or diarrhea, or dysphagia, or inhibited urination and lesser abdominal fullness, or panting, xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) governs”.

In cold damage when the exterior has not yet been resolved and there is water qì below the heart, this will result in the contention of water and cold with cold qì counterflow in the lung manifesting with symptoms of dry retching, heat effusion, and cough. The Acupuncture classic says, “Physical cold with cold rheum damages the lungs”. What this means is that there is contraction of two kinds of cold, and both the center and exterior are damaged, which results in the upward movement of counterflow qì. By administering xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) sweat is effused and water is dissipated. With the steeping of water qì in the interior, several signs can manifest, and therefore it must be resolved and transformed.

Xiǎo Qīng Lóng Tāng (Minor Bluegreen Dragon Decoction)

má huáng (Ephedrae Herba) 3 liǎng (remove nodes), flavor is sweet and warm

sháo yào (Paeoniae Radix) 3 liǎng, flavor is sour and slightly cold

wǔ wèi zǐ (Schisandrae Fructus) ½ shēng, flavor is sour and warm

gān jiāng (Zingiberis Rhizoma) 3 liǎng, flavor is acrid and warm

zhì gān cǎo (Glycyrrhizae Radix preparata) 3 liǎng, flavor is sweet and neutral

guì zhī (Cinnamomi Ramulus) 3 liǎng (remove the bark), flavor is acrid and warm

bàn xià (Pinelliae Rhizoma preparatum) ½ shēng (washed), flavor is acrid and slightly warm

xì xǐn (Asari Herba) 3 liǎng, flavor is acrid and warm.

When cold evils are present in the exterior, without the use of acrid and sweet (medicinals), one would be unable to dissipate them.  Má huáng (Ephedrae Herba), guì zhī (Cinnamomi Ramulus), and gān cǎo (Glycyrrhizae Radix) are acrid and sweet, and can therefore effuse and dissipate cold evils. When there is stoppage of water qì below the heart that fails to move, then the kidney qì will become dry. The Nèi Jīng says, “When the kidneys suffer from dryness, swiftly eat acrid to moisten them”. Gān jiāng (Zingiberis Rhizoma), xì xǐn (Asari Herba), and bàn xià (Pinelliae Rhizoma preparatum) are acrid and can (therefore) move water qì and moisten the kidneys. Coughing counterflow and panting are (the result of) counterflow lung qì.  The Nèi Jīng says, “(When) the lungs desire to be collected (astringed), swiftly eat sour in order to collect them”.  Sháo yào (Paeoniae Radix) and wǔ wèi zǐ (Schisandrae Fructus) are both sour and can collect (astringe) counterflow qì and calm the lungs.

Use one dǒu of water for the eight ingredients above.  First boil the má huáng to reduce the water by two shēng.  Remove the foam collecting on top and add the other ingredients.  Boil until reduced to three shēng, remove the dregs, and take one shēng warm. 

Modifications:

If there is slight diarrhea remove the má huáng and add a piece of ráo huā (Wikstroemia Flos) the size of a chicken egg, and dry fry until red.

With diarrhea one cannot attack the exterior, as when sweat is issued, this will result in distention and fullness. Má huáng effuses yáng, which can lead to the steeping of water into the stomach, inevitably resulting in diarrhea. Ráo huā is able to purge water, and once water is removed, diarrhea will cease. 

If there is thirst, remove bàn xià and add three liǎng of guā lóu gēn (Trichosanthis Radix).

Acrid dries, and bitter moistens. Bàn xià is acrid and can therefore dry fluids, so without thirst it is appropriate.  (Here) there is thirst, and it is therefore eliminated. Guā lóu gēn is bitter and can generate fluids therefore it is added.  

If there is dysphagia, remove má huáng and add one piece of blast-fried fù zǐ (Aconiti Radix lateralis preparata).

The classics say, “when water obtains cold qì, there will be mutual contention amongst them and the person will experience dysphagia”.  Fù zǐ is added to warm and dissipate cold water.  When a person has cold, and sweat is repeatedly effused, this will leave the stomach cold, which will result in the vomiting of roundworms, therefore má huáng is removed out of fear of effusing sweat. 

If urination is inhibited and there is fullness in the lesser abdomen, remove má huáng and add four liǎng of fú líng (Poria).

When there is water amassment in the lower burner that fails to move resulting in inhibited urination and fullness in the lesser abdomen, má huáng is inappropriate as it effuses fluids into the exterior; fú líng discharges amassed water out through the lower, and is therefore used instead. 

Line 40:

If there is panting, remove má huáng and add ½ shēng of xìng rén (Armeniacae Semen amarum), removing the skin and tips.

The Jīn Guì Yào Lüè says, “When a person (suffers) from generalized swelling, one should not add má huáng but instead use xìng rén”.  The reason is that má huáng effuses the yáng. With panting and generalized swelling, water qì is the branch and root of the disease.

Line 41:

“In cold damage when there is water qì below the heart, cough, mild panting, and heat effusion without thirst, (but with) thirst after taking the decoction, this means cold is leaving and (the disease) is about to resolve; xiǎo qīng lóng tāng (Minor Bluegreen Dragon Decoction) governs”.

Cough and mild panting are due to cold water shooting into the lungs. Heat effusion and an absence of thirst are due to an exterior pattern, which has not yet ceased. Xiǎo qīng lóng tāng is given to effuse the exterior and dissipate water. (If) after taking the decoction there is thirst, this means that the interior has been warmed, water qì has been dissipated, and (the disease) is about to resolve.