Library

[Formula of Kansui Banxia Decoction]
Three large Kansui Radices (Kansui), twelve Bannia Rhizomes (Pinelliae Rhizoma) [boiled in one sheng of water until half a sheng remains, then filtered to remove dregs], five Shaoyao Radices (Paeoniae Radix), and one Gancao Radix (Glycyrrhizae Radix) prepared by honey-frying, approximately the size of a finger.
The above four ingredients are boiled in two sheng of water until half a sheng remains. The dregs are removed, half a sheng of honey is added, and the mixture is decocted together to obtain eight ge of liquid. It is taken in one dose.

[Collected Explanations]
Cheng Lin stated: For retained fluid-dampness, it should be purged; thus, Kansui Radix is used to drain water-dampness. For knotted phlegm-fluid, it should be dispersed; thus, Pinelliae Rhizoma is used to scatter phlegm-fluid. The nature of Kansui Radix reaches directly to the pathology, but fearing its excessive action on draining water, the sweetness of Gancao Radix and white honey is used to moderate it, and the sourness of Shaoyao Radix is used to astringe it. Although Gancao Radix and Kansui Radix are considered incompatible (mutually antagonistic) in traditional Chinese medicine theory, they actually facilitate each other's action. This is the method of using sour astringency and sweet moderation to constrain the formula. The *Ling Shu* states: Constraining a formula is like constraining a bag. This is what is meant!
You Yi stated: Gancao Radix and Kansui Radix are incompatible, yet they are used together to provoke each other, aiming for a single battle to completely eliminate retained fluid-dampness. This is achieving success through mutual stimulation. Shaoyao Radix and white honey not only soothe the middle jiao but also alleviate the toxicity of the medicinal herbs!

@@@
Question: Fluid-dampness is divided into four categories. What are they? The Master said: There is Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Branch Fluid). Question: How do these four types of fluid-dampness differ? The Master said: If a person was previously robust but is now emaciated, with fluid moving in the intestines making a gurgling sound, this is called Tan Yin (Phlegm-Fluid); if after drinking, fluid flows and stays under the hypochondrium, causing pain upon coughing or spitting, this is called Xuan Yin (Hanging Fluid); if after drinking, fluid flows into the four limbs, sweating should occur but does not, resulting in body ache and heaviness, this is called Yi Yin (Overflowing Fluid); if there is coughing with air reflux, leaning on breathing for relief, shortness of breath preventing lying flat, and a swollen appearance, this is called Zhi Yin (Branch Fluid).

[Annotation]
The hypothetical question asks: Fluid-dampness is not limited to Liu Yin (Retained Fluid) and Fu Yin (Hidden Fluid), so why does the world say there are four types of fluid-dampness? The Master said: Liu Yin and Fu Yin refer to the principles of the new/old and shallow/deep nature of fluid diseases. The four types currently referred to in the world—Tan Yin, Xuan Yin, Yi Yin, and Zhi Yin—refer to the clinical manifestations of fluid diseases. These four types of fluid-dampness are not outside the principles of Liu Yin and Fu Yin; they are simply divided into four categories based on the location where the water flows. They are named according to their symptoms, hence the four types. Tan Yin (Phlegm-Fluid) refers to water-fluid flowing in the intestines without being excreted, and water essence remaining in the diaphragm without being distributed. When subjected to Yang heat, it boils into phlegm; when subjected to Yin cold, it condenses into fluid. Wherever it exists, it makes sounds; thus, above, there is a gurgling sound in the throat, and below, a gurgling sound in the intestines. This corresponds to the modern chronic cough, sputum, and asthma that flare up in autumn and winter and subside in spring and summer. Xuan Yin (Hanging Fluid) refers to fluid staying under the hypochondrium after drinking, neither ascending nor descending, hanging and knotting without dispersing, causing pain upon coughing and spitting. This corresponds to modern pleural effusion or intercostal neuralgia due to fluid retention. Yi Yin (Overflowing Fluid) refers to fluid flowing into the four limbs after drinking, where sweating should occur but does not, blocking the meridians and exterior, causing body ache and heaviness. This corresponds to modern wind-water edema or anasarca. Zhi Yin (Branch Fluid) refers to fluid stagnating in the chest after drinking, causing coughing with air reflux, shortness of breath preventing lying flat, and a swollen appearance. This corresponds to modern fluid retention with wheezing and inability to lie flat.

[Collected Notes]
Zhao Liang said: Water flows downward, like highland water flowing into rivers and rivers into the sea. Blocking the rivers causes floods. Similarly, human water intake behaves this way. The *Nei Jing* states: When water enters the stomach, its essence floats and overflows, transferring upward to the spleen. The spleen scatters the essence, sending it upward to the lungs. The lungs regulate the water passages, transmitting it downward to the bladder. Water essence is distributed everywhere, and the five meridians function in parallel. Now, the water drunk may fail to scatter upward due to spleen qi deficiency, or fail to descend due to lung qi obstruction, leading to overflow and accumulation anywhere, causing disease.
Cheng Lin said: The *Nei Jing* states: When Earth Qi is depressed and erupts, fluid-dampness arises in the middle. Because its nature is fluid and unpredictable, treatment methods vary between inducing sweating, purging, warming, and promoting urination.
Li □ said: There are four types of fluid-dampness, yet here it is named primarily as Tan Yin (Phlegm-Fluid). In general, water accumulating in Yin becomes fluid, and fluid congealing in Yang becomes phlegm. Thus, separately speaking, there are four types of fluid; collectively speaking, they are all termed Tan Yin (Phlegm-Fluid).
You Yi said: Being previously robust and now emaciated indicates that body fluids have been transformed into phlegm-fluid, no longer nourishing the exterior, but instead flowing downward into the intestines. Overflowing fluid from drinking indicates excess water and rebellious qi. That which flows under the hypochondrium becomes Xuan Yin (Hanging Fluid); that which returns to the four limbs becomes Yi Yin (Overflowing Fluid). "Xuan" means hanging in one place; "Yi" means overflowing to the surroundings. That which knots偏 (partially) and attaches upward to the heart and lungs becomes Zhi Yin (Branch Fluid). Zhi Yin is like branches of water or trees, adjacent to the zang organs but not central. Coughing with air reflux and inability to lie flat indicates water qi pressing upward on the lungs.

@@@
Water pathogen in the Heart: hardness and palpitations in the epigastrium, shortness of breath, aversion to water and unwillingness to drink.
Water pathogen in the Lungs: vomiting of saliva and foam, desire to drink water.
Water pathogen in the Spleen: lack of qi, heavy body.
Water pathogen in the Liver: distension and fullness under the hypochondrium, pain upon sneezing.
Water pathogen in the Kidneys: palpitations in the epigastrium.

[Commentary]
The character "Heart" (Xin) in "palpitations in the epigastrium" (Xin Xia Ji) should be "Umbilicus" (Qi). This must be a transcription error.

[Annotation]
The water of the four types of fluid-dampness may remain in the diaphragm, intestines, hypochondrium, limbs, or chest, but this does not exhaust all pathological manifestations of water. Therefore, it further elucidates: Water in the Heart causes epigastric hardness and stuffiness, shortness of breath, and palpitations, with no desire to drink water; Water in the Lungs causes vomiting of saliva and foam, with thirst and desire to drink water; Water in the Spleen causes lack of qi and heavy body; Water in the Liver causes hypochondriac distension and pain upon sneezing; Water in the Kidneys causes palpitations below the umbilicus. By applying this knowledge analogously, physicians can understand the true nature of water-pathogen diseases without concealment.

@@@
For Zhi Yin (Branch Fluid) accompanied by abdominal fullness, Houpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction) is the primary treatment.

[Commentary]
The character "Chest" (Xiong) in "Zhi Yin chest fullness" should be "Abdomen" (Fu). If it were chest fullness, there would be no rationale for using Chengqi Tang formulas. This is a transcription error.

[Annotation]
Zhi Yin with chest fullness indicates the pathogen is in the Lungs; Mufangji Tang (Stephania Root and Glycyrrhiza Decoction) or Tingli Dazao Tang (Descurainia Seed and Jujube Decoction) should be used. Zhi Yin with abdominal fullness indicates the pathogen is in the Stomach; therefore, Houpo Dahuang Tang (Magnolia Bark and Rhubarb Decoction), which is equivalent to Xiao Chengqi Tang (Minor Order the Qi Decoction), is used.

[Collected Notes]
You Yi stated: Chest fullness is suspected to be a mistake for abdominal fullness. Zhi Yin often presents with chest fullness; why use purgation here alone? Houpo Dahuang Tang is identical to Xiao Chengqi Tang. Unless there is abdominal pain and constipation, this formula should not be tried lightly.