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• 解表蠲饮小青龙
• 麻桂辛姜夏草同
• 芍药五味敛气阴
• 散寒温肺最有功

So, here we have a situation of fluids stuck in the body. And this is a formula traditionally used when there is exterior cold as well as interior fluid stagnation.

For exterior cold: 麻黄、桂枝 to induce perspiration and hence relieve the exterior

For interior fluid stagnation: 麻黄、桂枝 to induce diuresis and hence treat fluid stagnation; 细辛、干姜、五味子 get rid of fluids in the chest; 半夏 dries up fluids in the stomach (inhibit secretion of gastric juices).

What if there are no exterior signs?

It’s fine really, since, 麻黄  and  桂枝  can be used to facilitate diuresis too. But it’s important that the person’s constitution can handle 麻黄. Otherwise, I’ll think of 五苓散 as a replacement for 麻、桂.