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
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。
【集解】
程林曰：留者行之，用甘遂以决水饮，结者散之，用半夏以散痰饮。甘遂之性直达，
恐其过于行水，缓以甘草白蜜之甘，收以芍药之酸，虽甘草、甘遂相反，而实有以相
使，此酸收甘缓，约之之法也。『灵枢经』曰：约方犹约囊。其斯之谓欤！
尤怡曰：甘草与甘遂相反，而同用之者，盖欲其一战而留饮尽去，因相激而相成也。
芍药、白蜜不特安中，亦缓药毒耳！
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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，
欬吐引痛，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
；欬逆倚息，气短不得卧，其形如肿，谓之支饮。
【注】
设问曰：夫饮，不止于留饮伏饮也，而世谓饮有四者何也？师曰：留饮、伏饮，言饮
病新久深浅之理也，今世所谓四者，有痰饮、悬饮、溢饮、支饮，言饮病之情状也。
四饮亦不外乎留饮、伏饮之理，但因其水流之处，特分之为四耳！由其状而命之名，
故有四也。痰饮者，水饮走肠间不泻，水精留膈间不输，得阳煎熬成痰，得阴凝聚为
饮，凡所在处有声，故在上则喉中有漉漉之声，在下则肠间有沥沥之声，即今之遇秋
冬则发，至春夏则止，久欬嗽痰喘病也。悬饮者，饮后水流在□下，不上不下，悬结
不散，欬唾引痛，即今之□下有水气，停饮□痛病也。溢饮者，饮后水流行归于四肢
，当汗出而不汗出，壅塞经表，身体疼重，即今之风水、水肿病也。支饮者，饮后水
停于胸，欬逆根据息，短气不得卧，其形如水肿状，即今之停饮，喘满不得卧之病也。
【集注】
赵良曰：水行走下，而高原之水，流入于川，川入于海，塞其川则洪水泛溢，而人之
饮水亦若是。『内经』曰：饮入于胃，游溢精气，上输于脾，脾气散精，上归于肺，
通调水道，下输膀胱，水精四布，五经并行。今所饮之水，或因脾气而不上散，或因
肺气而不下通，以致流溢，随处停积，而为病也。
程林曰『内经』云：土郁之发，饮发于中。以其性流衍不常，治法亦有汗下温利之异
。
李□曰：夫饮有四，而此独以痰饮名，总之水积阴或为饮，饮凝阳或为痰。则分而言
之，饮有四，合而言之，总为痰饮而已。
尤怡曰：素盛今瘦，知其津液尽化痰饮，故不复外充形体，而反下走肠间也。饮水流
溢者，水多气逆也，其流于□下者，则为悬饮；其归于四肢者，则为溢饮；悬者悬于
一处，溢者溢于四旁。其偏结而上附心肺者，则为支饮，支饮者，如水之有派，木之
有枝，附近于藏而不正中也。欬逆倚息不得卧者，上迫肺也。
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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，心下悸。
【按】
心下悸之「心」字，当是「脐」字，必传写之□。
【注】
四饮之水，或留膈间，或留肠间，或留□下，或留肢体，或留胸中，然不能尽水之为
病也。故又发明水之在心者，心下坚□，短气而悸，不欲饮水也；水之在肺者，吐涎
沫，渴欲饮水也；水之在脾者，少气身重也；水之在肝者，□下支满，嚏而痛也；水
之在肾者，脐下悸也。医者以此触类而通之，则水之病，自无遁情矣。
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支饮胸满者，厚朴大黄汤主之。
【按】
支饮胸满之「胸」字，当是「腹」字，若是胸字，无用承气汤之理，是传写之□。
【注】
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。
【集注】
尤怡曰：胸满疑作腹满，支饮多胸满，此何以独用下法？厚朴大黄与小承气汤同，设
非腹中痛而闭者，未可以此轻试也。
【甘遂半夏汤方】
大甘遂三枚，半夏（用水一升，煮至半升，滤去药渣）十二枚，芍药五枚，炙甘草如手指大一枚。
以上四味药，加水二升，煮取半升药液，滤去药渣，再加入蜂蜜半升，与药汁混合煎煮，取八合药液，一次性服用。
【集解】
程林说：留滞的水饮应当用攻逐法，所以用甘遂来决泄水饮；结聚的痰饮应当用消散法，所以用半夏来散除痰饮。甘遂的药性直达病所，恐怕它过于猛烈地行水，因此用甘草和白蜜的甘缓之性来制约它，用芍药的酸收之性来收敛它。虽然甘草和甘遂在中药配伍中属于“十八反”的相反药物，但实际上它们相互激发、相互成就，这就是酸收甘缓、约束药性的方法。《灵枢经》说：约束方剂就像约束口袋一样（意指要控制药力的释放）。说的就是这个道理吧！
尤怡说：甘草与甘遂性质相反，但一起使用，是想让它们相互激荡，使留滞的水饮一次性彻底清除，这是因相互激惹而相互成功。芍药和白蜜不仅安护中焦，也是用来缓和药物的毒性！
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问：水饮分为四种，是什么？老师说：有痰饮，有悬饮，有溢饮，有支饮。问：这四种饮证有什么区别？老师说：如果一个人平时身体壮盛现在却消瘦，水液流走于肠间，发出沥沥的声音，这叫痰饮；饮水后水流停留在胁下，咳嗽吐唾时牵引疼痛，这叫悬饮；饮水后水液流行归于四肢，本该出汗却不出汗，身体疼痛沉重，这叫溢饮；咳嗽气逆，倚靠呼吸，气短不能平卧，身形浮肿，这叫支饮。
【注】
设问说：水饮不止于留饮和伏饮，为什么世人说水饮有四种呢？老师说：留饮、伏饮，说的是水饮病新久深浅的道理；现在世人所说的四种，即痰饮、悬饮、溢饮、支饮，说的是水饮病的症状表现。四种饮证也不外乎留饮、伏饮的道理，只是根据水液停留的部位，特别将其分为四类罢了！根据其症状形态来命名，所以有四类。痰饮，是水饮流走肠间不泻出，水精留滞在膈间不输布，遇阳热煎熬成痰，遇阴寒凝聚为饮，凡是有水的地方就会发出声音，所以在上面则喉中有漉漉的声音，在下面则肠间有沥沥的声音，就是现在遇到秋冬季节发作，到了春夏季节停止的长期咳嗽痰喘病。悬饮，是饮水后水流停留在胁下，不上不下，悬结不散，咳嗽吐唾时牵引疼痛，就是现在胁下有水气，停饮导致胁痛病。溢饮，是饮水后水液流行归于四肢，本该出汗却不出汗，壅塞经络肌表，身体疼痛沉重，就是现在的风水、水肿病。支饮，是饮水后水液停滞在胸中，咳嗽气逆倚靠呼吸，气短不能平卧，身形像水肿状，就是现在的停饮，喘满不能平卧的病。
【集注】
赵良说：水往低处流，高原的水流入河流，河流流入大海，堵塞河流则洪水泛滥，人喝水也是如此。《内经》说：水进入胃中，游溢出精气，向上输送给脾，脾气散布精微，向上归并于肺，通调水道，向下输送到膀胱，水精四布，五脏经脉并行。现在所喝的水，可能因为脾气不能向上散布，或者因为肺气不能向下通调，导致流溢，随处停积，从而成为疾病。
程林说：《内经》讲：土气郁结发作时，水饮发于中焦。因为水饮的性质流动蔓延无常，治疗方法也有发汗、攻下、温阳、利水的不同。
李□说：水饮有四种，但这里唯独以痰饮命名，总之水积聚在阴分则为饮，饮凝滞在阳分则为痰。那么分开来说，饮有四种，合起来说，总称为痰饮而已。
尤怡说：平时壮盛现在消瘦，知道津液都化为了痰饮，所以不再向外充盈形体，反而向下流走肠间。饮水流溢的，是水多气逆，其流于胁下的，就成为悬饮；其归于四肢的，就成为溢饮；悬是悬结在一处，溢是漫溢于四周。其偏结而上附心肺的，就成为支饮，支饮就像水有支流，树有树枝，邻近脏腑而不居中。咳嗽气逆倚靠呼吸不能平卧的，是水气上迫肺脏。
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水邪在心，心下坚硬悸动，气短，厌恶水不想喝水。水邪在肺，吐涎沫，想喝水。水邪在脾，少气身体沉重。水邪在肝，胁下支撑胀满，打喷嚏时疼痛。水邪在肾，心下悸动。
【按】
心下悸中的“心”字，应该是“脐”字，必定是传抄时的错误。
【注】
四种饮证的水，或停留在膈间，或停留在肠间，或停留在胁下，或停留在肢体，或停留在胸中，但这不能完全概括水邪致病的情况。所以又阐发水邪在心者，心下坚硬痞闷，气短而悸动，不想喝水；水邪在肺者，吐涎沫，口渴想喝水；水邪在脾者，少气身体沉重；水邪在肝者，胁下支撑胀满，打喷嚏时疼痛；水邪在肾者，脐下悸动。医生以此触类旁通，那么水邪致病的真相，自然就无法隐藏了。
【按】
支饮腹部胀满中的“胸”字，应该是“腹”字，如果是胸字，就没有使用承气汤的道理，这是传抄时的错误。
【注】
支饮胸部胀满，病邪在肺，宜用木防己汤、葶苈大枣汤。支饮腹部胀满，病邪在胃，所以用厚朴大黄汤，也就是小承气汤。
【集注】
尤怡说：胸满怀疑应作腹满，支饮多见胸满，这里为何单独使用下法？厚朴大黄汤与小承气汤相同，如果不是腹中疼痛且便秘，不可以轻易尝试此方。
[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!
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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.