夫病患饮水多，必暴喘满。凡食少饮多，水停心下，甚者则悸，微者短气。脉双弦者，
寒也，皆大下后里虚。脉偏弦者，饮也。
【按】此条微者短气之下，古本有“脉双弦者，寒也”等句，文义不属，当另分为一
条在后。
【注】凡病患食少饮多，小便利者，为消渴病；小便不利者，为留饮病。留饮者，即
今之停水饮病也。若水停水焦胸中，则壅肺气不得降，故暴喘满也，若水停中焦心下，甚
者则凌心，故病悸动不安，微者则碍肺，故病呼吸短气；若水停下焦少腹，则不输膀胱，
故必苦里急也。仲景于此，但言上、中二焦，不及下焦者，非略之也，谓已详于《伤寒
论》中也。
【集注】程林曰∶饮水多，则水气停泛于胸膈，必暴喘满也。凡人食少饮多，则胃土
不能游溢精气，甚者必停于心下而为悸。微者则阻于胸膈而为短气也。
先渴后呕，为水停心下，此属饮家，小半夏茯苓汤主之。
【注】水停心下，中焦部也，中焦属胃，故不止病悸、短气，而亦病呕也。病悸、短
气者，是水停胃外，从膈下而上干于胸也。病呕者，是水停胃内，从胃中而上越于口也。然
必先渴饮水多而后作呕者，方属饮家呕病也。主小半夏汤者，以止呕也；加茯苓者，以饮
水多而病呕，故兼利水也。
【集注】魏荔彤曰∶水停心下，阻隔正气，不化生津液，上于胸咽故渴也；渴必饮水，水
得水而愈恣其冲逆，所以先渴而后必呕也。此属饮家，当治其饮，不可以为渴家治其渴也。
治饮则用辛燥，治渴必用寒润，大相径庭，可不明其属于何家，而妄治之乎？
尤怡曰∶先渴后呕者，本无呕病，因渴饮水，水多不下而反上逆也，故曰∶此属饮
家。小半夏止呕降逆，加茯苓去其停水。
小半夏加茯苓汤方
半夏（一升） 生姜（半斤） 茯苓（三两）
上三味，以水七升，煮取一升五合，分温再服。
呕家本渴，渴者为欲解，今反不渴，心下有支饮故也，小半夏汤主之。
【注】饮家渴者，是水停气不化生津液而渴也；呕家渴者，是呕吐胃干燥伤津液而渴
也，故曰呕家本应渴也。先呕后渴者，当少少与饮之，以和胃生津，为欲解也；若呕吐
后反不渴者，是必心下素有支饮故也。惟主小半夏汤止呕，而不加茯苓者，以不渴并无
新饮，且呕后己伤津液，不可再行利水，重竭津液也。
【集注】李 曰∶此专以治呕，言呕家渴者，为欲解，以胃气复而津液生也。若心下
素有支饮，则不燥自当不渴，泛溢而呕也。半夏、生姜温能和胃气，辛能散逆气，为呕家
圣药。
小半夏汤方
半夏（一升） 生姜（半斤）
上二味，以水七升，煮取一升半，分温再服。
【集解】沈明宗曰∶此支饮上溢而呕之方也。凡作呕必伤津液，应当作渴，故为呕家
本渴，渴则病从呕去，谓之欲解。若心下有支饮，停蓄胸膈致燥，故呕而不渴，则当治
饮，所以生姜散邪，半夏涤饮，呕自止矣。
卒呕吐，心下痞，膈间有水，眩悸者，半夏加茯苓汤主之。
【注】卒然呕吐，虽然不渴而心下痞塞，是膈间有水凝结也。眩者，是水阻阳气不升
也；悸者，是水气上干于心也。即不渴无新饮，而平日饮盛可知，则不必顾及津液，亦
必加茯苓以利水，斯结可开而阻可通也。
【集注】赵良曰∶心下痞，膈间有水；眩悸者，阳气必不宣散也。经云∶以辛散之。半
夏、生姜皆味辛，《本草》半夏可治膈上痰。心下坚呕逆眩者，亦上焦阳气虚不能升发，所
以半夏、生姜并治之。悸则心受水凌，非半夏可独治，必加茯苓去水，下肾逆以安神，神
安则悸愈也。
尤怡曰∶饮气逆于胃则呕吐，滞于气则心下痞，凌于心则悸，蔽于阳则眩，半夏、生
姜止呕降逆，加茯苓去其水也。
半夏加茯苓汤方（见前）
假令瘦人脐下有悸，吐涎沫而癫眩，此水也，五苓散主之。
【按】瘦人之“瘦”字，当是“病”字。癫眩之“癫”字，当是“巅”字；巅者头也。
文义相属。此传写之讹。
【注】悸者，筑筑然跳动病也。上条心下有悸，是水停心下为病也；此条脐下有悸，是
水停脐下为病也。若欲作奔豚，则为阳虚，当以茯苓桂枝甘草大枣汤主之；今吐涎沫，水
逆胃也，巅眩水阻阳也，则为水盛，故以五苓散主之也。
五苓散方
泽泻（一两一分） 猪苓（去皮，三分） 茯苓（三分） 白术（三分） 桂（去皮，二分）
上五味，为末，白饮服方寸匕，日三服，多饮暖水，汗出愈。
夫短气有微饮，当从小便去之，苓桂术甘汤主之，肾气丸亦主之。
【注】水停心下，甚者病悸，已明其治矣。微者短气，其治有二∶气虚短气，是气少不
能长息而短也；微饮短气，是水停阻碍呼吸而短也。若呼之气短，是心肺之阳有碍也，用
苓桂术甘汤以通其阳，阳气通则膀胱之窍利矣。吸之气短，是肝肾之阴有碍也，用肾气
丸以通其阴，阴气通，则小便之关开矣。故曰∶苓桂术甘汤主之，肾气丸亦主之也。
茯苓桂枝白术甘草汤方
茯苓（四两） 桂枝 白术（各三两） 甘草（二两）
上四味，以水六升，煮取三升，分温三服，小便则利。
肾气丸方（见妇人杂病中）
【集解】尤怡曰∶饮，水病也。治水必自小便去之。苓、桂、术、甘益土气以行水，肾
气丸温阳气以行水，虽所主不同，而利小便则一也。
夫心下有留饮，其人背寒冷如掌大。留饮者，胁下痛引缺盆，咳嗽则转甚。胸中有
留饮，其人短气而渴。四肢历节痛，脉沉者有留饮。
【按】此条古本内于“四肢历节痛”之下有“脉沉者有留饮”一句，当另为一条，始
合论脉之义。短气而渴之“渴”字，当是“喘”字，四肢上当有缺文。皆传写之讹。
【注】停饮初病，即以小半夏汤加茯苓、五苓散、肾气丸等药治之而愈者，微邪也。若
邪甚而不去者，留于心上则阻心阳，必背寒
冷；留于胁下则碍肝气，必胁下痛引缺盆，咳嗽转甚；留于胸中则壅肺气，必短气而喘；留
于身体则塞经络，必四肢历节痛也。由此推之，留于脾则腹肿身重，留于肾则囊足胫肿，
理必然也。
膈上病痰，满喘咳吐，发则寒热，背痛，腰疼，目泣自出，其人振振身 剧，必有伏
饮。
【注】伤饮之病，留而不去，谓之留饮；伏而难攻，谓之伏饮，伏饮者，乃饮留膈上
伏而不出，发作有时者也。即今之或值秋寒，或感春风，发则必喘满咳吐痰盛，寒热背痛
腰疼，咳剧则目泣自出，咳甚则振振身动，世俗所谓吼喘病也。
【集注】程林曰∶痰饮留于膈，则令人喘咳吐；发于外，则令人寒热，背痛、腰疼；咳
甚则肺叶举；而目泣出；喘甚则息摇肩，而振振身 。如此剧者，必有伏饮。
脉浮而细滑，伤饮。
【注】凡饮病得脉浮而细滑者，为痰饮，初病水邪未深之诊也。
【集注】李 曰∶饮脉当沉，今脉浮者，水在肺也。
脉沉者，有留饮。
【按】此条系在四肢历节痛之下，今分在此。
【注】凡饮病得脉沉者为留饮，水邪将深之诊也。
【集注】程林曰∶脉得诸沉者，当责有水，故脉沉者为水饮。
李 曰∶经云∶沉潜水蓄是也。
病者脉伏，其人欲自利，利反快，虽利，心下续坚满，此为留饮欲去故也，甘遂半夏
汤主之。
【按】“此为留饮欲去故也”句，当在利反快之下，必传写之讹。
【注】凡饮病得脉伏者，为伏饮，水邪已深之诊也。凡病饮之人，欲自下利，利后通
快，此为所留之饮，欲自去而愈故也。若虽利，利反不快，心下续有坚满，乃所留之饮
盘结不欲去也，宜攻之以甘遂半夏汤。方中反佐甘草以激之，意在所向无前，即潜伏难
攻，水结未有不破者；因自下利，故又佐芍药以约束之，防胜后穷追不止也。
甘遂半夏汤方
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）
上四味，以水二升，煮取半升，去滓，以蜜半升，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！
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；饮后水流在胁下，咳
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；咳逆
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，久咳嗽痰喘病也。悬饮者，饮后
水流在胁下，不上不下，悬结不散，咳唾引痛，即今之胁下有水气，停饮胁痛病也。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，咳逆碍息，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，其流于胁下者，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
近于脏而不正中也。咳逆倚息不得卧者，上迫肺也。
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，胁下支满，嚏而痛。水在肾，心下悸。
【按】心下悸之“心”字，当是“脐”字，必传写之讹。
【注】四饮之水，或留膈间，或留肠间，或留胁下，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，心下坚硬，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，胁下支满，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。
支饮胸满者，浓朴大黄汤主之。
【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
讹。
【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
用浓朴大黄汤，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？浓朴大黄与小承气
汤同，设非腹中痛而闭者，未可以此轻试也。
浓朴大黄汤方
浓朴（一尺） 大黄（六两） 枳实（四枚）
上三味，以水五升，煮取二升，分温再服。
心下有痰饮，胸胁支满，目眩，苓桂术甘汤主之。
【注】此承上条详出其证，以明其治也。心下有痰饮，谓痰饮之水流在膈间，故胸胁
支满，支满则阻碍阳气，不得上通于头目，故目眩也。主以苓桂术甘汤者，利水而通阳气
也。
【集注】李 曰∶胸胁支满，痰饮停滞于中也；目眩，阻遏阳气不上升也。茯苓淡渗
以利水饮，桂枝宣导以行阳气，白术去湿健脾，甘草和中益气，同为补土制水之剂。
苓桂术甘汤方（见上）
腹满，口舌干燥，此肠间有水气，己椒
苈黄丸主之。
【注】此又承上条互详其证，以别其治也。心下有痰饮，喉间有漉漉声，肠间有水气，肠
中有沥沥声者，用苓桂术甘汤，即温药和之之法也。若更腹满，则水结实矣，口舌干燥，
则水不化矣。故以防己、椒目、葶苈、大黄，前后分攻水结，水结开豁，则腹满可除。水
凡是病人饮水过多，必然会出现突然的喘息和胸满。大凡进食少而饮水多的人，水液停滞在心下（胃脘部），病情严重的会出现心悸，轻微的会出现气短。脉象双弦的，是寒证，多见于峻下之后导致里虚的情况；脉象偏弦的，是饮邪作祟。
【按语】这一条中，“微者短气”之下，古本中有“脉双弦者，寒也”等句，文义不连贯，应当另分为一条放在后面。
【注释】凡是病人进食少而饮水多，如果小便通利，属于消渴病；如果小便不利，属于留饮病。所谓留饮，就是现在的停水饮病。如果水停留在上焦胸中，就会壅塞肺气使其不能下降，所以出现突然的喘息和胸满；如果水停留在中焦心下，严重的会凌犯心脏，所以出现悸动不安，轻微的阻碍肺部，所以出现呼吸短气；如果水停留在下焦少腹，就不能输注到膀胱，所以必定苦于腹部急迫。张仲景在这里只讲了上、中二焦，没有提到下焦，并不是遗漏，而是因为已经在《伤寒论》中详细论述过了。
【集注】程林说：饮水过多，则水气停泛在胸膈，必然出现突然的喘息和胸满。凡人进食少而饮水多，则脾胃之气不能游溢精气，严重的必然停聚在心下而导致心悸。轻微的则阻滞在胸膈而导致气短。
先感到口渴想喝水，随后发生呕吐，这是水停在心下，这属于饮家，用小半夏茯苓汤主治。
【注释】水停在心下，属于中焦部位，中焦属胃，所以不仅会导致心悸、气短，也会导致呕吐。出现心悸、气短，是因为水停在胃外，从膈下向上冲犯胸廓。出现呕吐，是因为水停在胃内，从胃中向上溢出到口腔。然而，只有先口渴饮水多而后发生呕吐的，才属于饮家的呕吐病。使用小半夏汤，是为了止呕；加入茯苓，是因为因饮水多而致呕吐，所以兼用利水之法。
【集注】魏荔彤说：水停在心下，阻隔正气，不能化生津液，上达胸咽所以口渴；口渴必然饮水，水得到水后更加恣意冲逆，所以先口渴而后必然呕吐。这属于饮家，应当治疗其饮邪，不可以当作渴家来治疗其口渴。治疗饮邪要用辛燥之品，治疗口渴必用寒润之品，二者大相径庭，能不明辨其属于哪一家而妄加治疗吗？
尤怡说：先渴后呕，本来没有呕吐的病，因为口渴饮水，水多不下反而上逆，所以说：这属于饮家。小半夏汤止呕降逆，加入茯苓去除停水。
小半夏加茯苓汤方
半夏（一升） 生姜（半斤） 茯苓（三两）
以上三味药，用水七升，煮取一升五合，分两次温服。
经常呕吐的人本来应该口渴，口渴说明病将要解除，现在反而不口渴，是因为心下有支饮，用小半夏汤主治。
【注释】饮家口渴，是水停阻碍气化生发津液而导致的口渴；呕吐家口渴，是呕吐导致胃干燥损伤津液而出现的口渴，所以说呕吐家本来应该口渴。先呕吐后口渴的，应当少量给予饮水，以调和胃气、生津液，这是病欲解的表现；如果呕吐后反而不口渴，那一定是心下素有支饮所致。只用小半夏汤止呕，而不加茯苓，是因为不渴且无新饮，而且呕吐后已经损伤津液，不可再行利水，以免再次竭尽津液。
【集注】李 说：这里专门讲治疗呕吐，说呕吐家口渴，是病欲解，因为胃气恢复而津液生成。如果心下素有支饮，则不燥自然不渴，水气泛溢而呕吐。半夏、生姜温和能调和胃气，辛散能发散逆气，是治疗呕吐的圣药。
小半夏汤方
半夏（一升） 生姜（半斤）
以上两味药，用水七升，煮取一升半，分两次温服。
【集解】沈明宗说：这是治疗支饮上溢而呕吐的方子。凡是呕吐必然损伤津液，应当出现口渴，所以说呕吐家本来应该口渴，如果口渴则病从呕吐而去，称为欲解。如果心下有支饮，停蓄胸膈导致干燥，所以呕吐而不口渴，则应当治疗饮邪，所以生姜散邪，半夏涤除饮邪，呕吐自然停止。
突然呕吐，心下痞塞，膈间有水，头晕心悸的，用半夏加茯苓汤主治。
【注释】突然呕吐，虽然不渴但心下痞塞，这是膈间有水凝结。头晕，是水阻阳气不能上升；心悸，是水气上干犯心脏。即使不渴且无新饮，但从平日可知饮邪旺盛，则不必顾及津液，也必须加入茯苓以利水，这样结滞才可打开，阻滞才可疏通。
【集注】赵良说：心下痞塞，膈间有水；头晕心悸，说明阳气必然不能宣散。经书说：用辛散之。半夏、生姜皆味辛，《本草》记载半夏可治膈上痰。心下坚硬、呕吐逆气、头晕，也是上焦阳气虚不能升发，所以半夏、生姜并治。心悸则是心受水气凌犯，不是半夏能单独治疗的，必须加入茯苓去水，下肾逆以安神，神安则心悸痊愈。
尤怡说：饮气逆于胃则呕吐，滞于气机则心下痞塞，凌犯于心则心悸，遮蔽阳气则头晕，半夏、生姜止呕降逆，加入茯苓去除水邪。
半夏加茯苓汤方（见前文）
假如瘦人脐下有悸动感，吐涎沫且头顶眩晕，这是水饮为患，用五苓散主治。
【按语】瘦人之“瘦”字，当是“病”字。巅眩之“癫”字，当是“巅”字；巅者头也。文义相属。这是传写之讹误。
【注释】悸，是心跳剧烈如筑鼓般的病状。上一条说心下有悸，是水停心下为病；这一条说脐下有悸，是水停脐下为病。如果想要发作奔豚，则为阳虚，应当用茯苓桂枝甘草大枣汤主治；现在吐涎沫，是水逆于胃，头顶眩晕是水阻阳气，则为水盛，所以用五苓散主治。
五苓散方
泽泻（一两一分） 猪苓（去皮，三分） 茯苓（三分） 白术（三分） 桂枝（去皮，二分）
以上五味药，研为末，用米汤送服方寸匕，每日三次，多喝暖水，出汗即愈。
凡是气短伴有轻微水饮的，应当从小便排出，用苓桂术甘汤主治，肾气丸也可主治。
【注释】水停心下，严重的病心悸，已经明确了治法。轻微的病气短，其治法有两种：气虚导致的气短，是气少不能接续呼吸而短促；微饮导致的气短，是水停阻碍呼吸而短促。如果是呼气时气短，是心肺之阳有阻碍，用苓桂术甘汤以通其阳，阳气通则膀胱之窍利矣。如果是吸气时气短，是肝肾之阴有阻碍，用肾气丸以通其阴，阴气通，则小便之关开矣。所以说：苓桂术甘汤主治，肾气丸也可主治。
茯苓桂枝白术甘草汤方
茯苓（四两） 桂枝 白术（各三两） 甘草（二两）
以上四味药，用水六升，煮取三升，分三次温服，小便则通利。
肾气丸方（见妇人杂病篇中）
【集解】尤怡说：饮，是水病。治水必须从小便去之。苓、桂、术、甘补益土气以行水，肾气丸温助阳气以行水，虽然所主不同，而利小便则是一致的。
凡是心下有留饮，其人背部寒冷如手掌大小。留饮者，胁下疼痛牵引缺盆，咳嗽则疼痛加剧。胸中有留饮，其人气短而口渴。四肢历节痛，脉沉的，是有留饮。
【按语】这一条古本内在“四肢历节痛”之下有“脉沉者有留饮”一句，应当另为一条，才符合论述脉理的意义。“短气而渴”的“渴”字，当是“喘”字，四肢上当有缺文。都是传写之讹误。
【注释】停饮初病，即用小半夏汤加茯苓、五苓散、肾气丸等药治疗而痊愈的，是微邪。如果邪气甚重而不去的，留在心上则阻遏心阳，必然背部寒冷；留在胁下则碍肝气，必然胁下疼痛牵引缺盆，咳嗽转甚；留在胸中则壅塞肺气，必然气短而喘；留在身体则堵塞经络，必然四肢历节痛。由此推断，留在脾则腹肿身重，留在肾则囊足胫肿，道理必然是这样的。
膈上有病痰，胀满喘息咳嗽吐痰，发作时恶寒发热，背痛，腰疼，眼泪不由自主流出，其人身体震颤动摇剧烈，必有伏饮。
【注释】伤饮之病，停留不去，叫做留饮；潜伏难攻，叫做伏饮。伏饮者，乃是饮邪留于膈上潜伏而出不来，发作有定时的病。就是现在的或值秋寒，或感春风，发作时必然喘息胸满咳嗽吐痰盛，恶寒发热背痛腰疼，咳剧则眼泪自出，咳甚则身体震颤动摇，世俗所谓的吼喘病。
【集注】程林说：痰饮留于膈，则令人喘咳吐；发于外，则令人寒热，背痛、腰疼；咳甚则肺叶举而目泣出；喘甚则息摇肩，而身体震颤动摇。如此剧烈的，必有伏饮。
脉浮而细滑，是伤饮。
【注释】凡是饮病得脉浮而细滑的，为痰饮，是初病水邪未深的诊候。
【集注】李 说：饮脉应当沉，今脉浮者，水在肺也。
脉沉的，是有留饮。
【按语】这一条原本系在四肢历节痛之下，现在分列在此。
【注释】凡是饮病得脉沉的为留饮，是水邪将深的诊候。
【集注】程林说：脉得诸沉者，当责有水，故脉沉者为水饮。
李 说：经书说：沉潜水蓄是也。
病人脉伏，其人想要自下利，利后反而痛快，虽然下利，心下继续坚满，这是留饮欲去的原因，用甘遂半夏汤主治。
【按语】“此为留饮欲去故也”句，应当在“利反快”之下，必是传写之讹误。
【注释】凡是饮病得脉伏的为伏饮，是水邪已深的诊候。凡是患饮病的人，想要自下利，利后通快，这是所留之饮，想要自行离去而痊愈的缘故。如果虽然下利，利后反而不快，心下继续有坚满，乃所留之饮盘结不欲去也，宜用甘遂半夏汤攻逐。方中反佐甘草以激之，意在所向无前，即使是潜伏难攻的水结，没有不破的；因为自下利，所以又佐芍药以约束之，防止胜邪后穷追不止。
甘遂半夏汤方
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）
以上四味药，用水二升，煮取半升，去滓，用蜜半升，和药汁煎取八合，一次顿服。
【集解】程林说：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，虽然甘草、甘遂相反，而实有以相使，此酸收甘缓，约之之法也。《灵枢经》说：约方犹约囊。说的就是这个吧！
尤怡说：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！
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；饮后水流在胁下，咳吐引痛，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；咳逆倚息，气短不得卧，其形如肿，谓之支饮。
【注释】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，久咳嗽痰喘病也。悬饮者，饮后水流在胁下，不上不下，悬结不散，咳唾引痛，即今之胁下有水气，停饮胁痛病也。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，咳逆碍息，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】赵良说：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》说：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。
程林说：《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 说：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。
尤怡说：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，其流于胁下者，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，附近于脏而不正中也。咳逆倚息不得卧者，上迫肺也。
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，胁下支满，嚏而痛。水在肾，心下悸。
【按语】心下悸之“心”字，当是“脐”字，必是传写之讹误。
【注释】四饮之水，或留膈间，或留肠间，或留胁下，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，心下坚硬，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，胁下支满，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。
支饮胸满者，浓朴大黄汤主之。
【按语】支饮胸满之“胸”字，当是“腹”字，若是胸字，无用承气汤之理，是传写之讹误。
【注释】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，故用浓朴大黄汤，即小承气汤也。
【集注】尤怡说：胸满疑作腹满，支饮多胸满，此何以独用下法？浓朴大黄与小承气汤同，设非腹中痛而闭者，未可以此轻试也。
浓朴大黄汤方
浓朴（一尺） 大黄（六两） 枳实（四枚）
以上三味药，用水五升，煮取二升，分两次温服。
心下有痰饮，胸胁支满，目眩，苓桂术甘汤主之。
【注释】此承上条详出其证，以明其治也。心下有痰饮，谓痰饮之水流在膈间，故胸胁支满，支满则阻碍阳气，不得上通于头目，故目眩也。主以苓桂术甘汤者，利水而通阳气也。
【集注】李 说：胸胁支满，痰饮停滞于中也；目眩，阻遏阳气不上升也。茯苓淡渗以利水饮，桂枝宣导以行阳气，白术去湿健脾，甘草和中益气，同为补土制水之剂。
苓桂术甘汤方（见上）
腹满，口舌干燥，此肠间有水气，己椒苈黄丸主之。
【注释】此又承上条互详其证，以别其治也。心下有痰饮，喉间有漉漉声，肠间有水气，肠中有沥沥声者，用苓桂术甘汤，即温药和之之法也。若更腹满，则水结实矣，口舌干燥，则水不化矣。故以防己、椒目、葶苈、大黄，前后分攻水结，水结开豁，则腹满可除。水
Whenever a patient drinks excessive amounts of water, sudden wheezing and chest fullness will inevitably occur. Generally, when food intake is low but fluid intake is high, water stagnates in the epigastrium (region below the heart). In severe cases, palpitations occur; in mild cases, shortness of breath occurs. A double-string-like pulse indicates cold syndrome, often resulting from interior deficiency after drastic purgation. A single-string-like pulse indicates fluid retention.
[Note] In this passage, the sentences "A double-string-like pulse indicates cold..." appearing below "in mild cases, shortness of breath" do not fit the context logically and should be separated into a new paragraph at the end.
[Commentary] When a patient eats little and drinks much, if urination is free, it is Xiao Ke disease (Wasting and Thirsting Syndrome); if urination is difficult, it is Liu Yin disease (Retained Fluid Disease). Liu Yin refers to what is now called Water Retention Disease. If water stagnates in the Upper Jiao (Upper Burner) chest, it obstructs Lung Qi from descending, causing sudden wheezing and chest fullness. If water stagnates in the Middle Jiao (Middle Burner) epigastrium, severe cases invade the Heart, causing restless palpitations; mild cases hinder the Lung, causing shortness of breath. If water stagnates in the Lower Jiao (Lower Burner) lower abdomen, it fails to transport to the Bladder, causing abdominal urgency. Zhang Zhongjing mentions only the Upper and Middle Jiao here, omitting the Lower Jiao, not out of omission, but because it was detailed in the Shang Han Lun (Treatise on Cold Damage).
[Collected Annotations] Cheng Lin stated: Excessive drinking causes water qi to float and stagnate in the chest and diaphragm, leading to sudden wheezing and chest fullness. When one eats little and drinks much, the Spleen and Stomach earth cannot circulate and overflow with essence and qi. Severe cases stagnate in the epigastrium causing palpitations. Mild cases block the chest and diaphragm, causing shortness of breath.
Thirst followed by vomiting indicates water stagnating in the epigastrium; this belongs to the category of Yin Jia (Fluid-Disease Patients), treated with Xiao Ban Xia Fu Ling Tang (Minor Pinellia and Poria Decoction).
[Commentary] Water stagnating in the epigastrium belongs to the Middle Jiao, which governs the Stomach. Therefore, it causes not only palpitations and shortness of breath but also vomiting. Palpitations and shortness of breath occur because water stays outside the stomach, rising from below the diaphragm to invade the chest. Vomiting occurs because water stays inside the stomach, surging upward from the stomach to the mouth. However, only when thirst leads to excessive drinking followed by vomiting does it constitute a vomiting disease of the Yin Jia. Xiao Ban Xia Tang is used to stop vomiting; adding Poria is because the vomiting is caused by excessive water intake, so diuresis is combined.
[Collected Annotations] Wei Litong stated: Water stagnating in the epigastrium blocks righteous qi, preventing the transformation and generation of body fluids, which rise to the chest and throat, causing thirst. Thirst necessitates drinking; once water enters, it exacerbates the surging rebellion, hence thirst precedes vomiting. This belongs to the Yin Jia; one must treat the fluid retention, not the thirst as if it were a Xiao Ke case. Treating fluid retention requires acrid-drying herbs, while treating thirst requires cold-moistening herbs; they are vastly different. How can one treat blindly without distinguishing the syndrome?
You Yi stated: Thirst followed by vomiting implies no prior vomiting disease; due to thirst and excessive drinking, the water fails to descend and rebels upward. Hence, it is said: this belongs to the Yin Jia. Xiao Ban Xia Tang stops vomiting and directs rebellious qi downward; adding Poria removes retained water.
Formula for Xiao Ban Xia Jia Fu Ling Tang (Minor Pinellia and Poria Decoction):
Ban Xia (Pinelliae Rhizoma, 1 sheng)
Sheng Jiang (Zingiberis Recens Rhizoma, 0.5 jin)
Fu Ling (Poria, 3 liang)
Boil these three ingredients in 7 sheng of water to obtain 1.5 sheng. Divide into two warm doses.
Patients prone to vomiting should naturally feel thirsty; thirst indicates the condition is resolving. If there is no thirst now, it is due to Zhi Yin (Branching Fluid) in the epigastrium, treated with Xiao Ban Xia Tang.
[Commentary] For Yin Jia patients, thirst arises because water stagnation hinders qi transformation and fluid generation. For vomiting-prone patients, thirst arises because vomiting dries the stomach and damages body fluids; thus, they should naturally be thirsty. If vomiting is followed by thirst, giving small amounts of water harmonizes the stomach and generates fluids, indicating resolution. If there is no thirst after vomiting, it is because Zhi Yin has existed in the epigastrium. Only Xiao Ban Xia Tang is used to stop vomiting, without adding Poria, because there is no thirst or new fluid retention, and since body fluids are already damaged by vomiting, further diuresis would deplete them again.
[Collected Annotations] Li [Name missing] stated: This specifically addresses treating vomiting. Thirst in vomiting patients indicates resolution, as stomach qi recovers and fluids generate. If Zhi Yin exists in the epigastrium, there is no dryness and thus no thirst; vomiting occurs due to overflowing fluids. Ban Xia and Sheng Jiang warm and harmonize stomach qi and disperse rebellious qi with their acridity, making them holy medicines for vomiting.
Formula for Xiao Ban Xia Tang (Minor Pinellia Decoction):
Ban Xia (Pinelliae Rhizoma, 1 sheng)
Sheng Jiang (Zingiberis Recens Rhizoma, 0.5 jin)
Boil these two ingredients in 7 sheng of water to obtain 1.5 sheng. Divide into two warm doses.
[Collected Exegesis] Shen Mingzong stated: This is the formula for vomiting caused by Zhi Yin overflowing above the diaphragm. Vomiting always damages fluids, so thirst should occur. Thus, "vomiting patients should be thirsty"; if thirsty, the illness departs via vomiting, termed "desire for resolution." If Zhi Yin exists in the epigastrium, stagnation in the chest/diaphragm causes dryness, leading to vomiting without thirst. One must treat the fluid: Sheng Jiang disperses pathogens, Ban Xia clears fluids, and vomiting stops.
Sudden vomiting, epigastric stuffiness, water between the diaphragm, vertigo, and palpitations are treated with Ban Xia Jia Fu Ling Tang (Pinellia Decoction with Added Poria).
[Commentary] Sudden vomiting, even without thirst, accompanied by epigastric stuffiness, indicates water coagulation between the diaphragm. Vertigo results from water blocking Yang Qi from ascending; palpitations result from water Qi invading the Heart. Even without thirst or new fluid retention, the abundance of chronic fluid retention is evident. One need not worry about body fluids but must add Poria to promote urination, thereby opening obstructions and clearing blockages.
[Collected Annotations] Zhao Liang stated: Epigastric stuffiness and water between the diaphragm; vertigo and palpitations indicate Yang Qi cannot disperse freely. The Classics state: "Disperse with Acrid." Ban Xia and Sheng Jiang are acrid; Ben Cao records Ban Xia treats phlegm above the diaphragm. Epigastric hardness, vomiting, rebellious Qi, and vertigo indicate Upper Jiao Yang Qi deficiency failing to ascend, treated by both Ban Xia and Sheng Jiang. Palpitations involve the Heart being invaded by water, which Ban Xia alone cannot treat; Poria must be added to remove water, direct Kidney rebellious Qi downward, and calm the Spirit, curing palpitations.
You Yi stated: Fluid Qi rebelling in the Stomach causes vomiting; stagnating in Qi mechanisms causes epigastric stuffiness; invading the Heart causes palpitations; obscuring Yang causes vertigo. Ban Xia and Sheng Jiang stop vomiting and direct Qi downward; adding Poria removes water.
Formula for Ban Xia Jia Fu Ling Tang (See above).
If a thin person experiences palpitations below the umbilicus, spits saliva/foam, and suffers from vertigo, this is Water Pathogen, treated with Wu Ling San (Five-Ingredient Powder with Poria).
[Note] The character "thin" (shou) should likely be "diseased" (bing). The character "dian" (epileptic/crazy) in "dian xuan" should be "dian" (vertex/top of head); vertex means head. The context fits this correction. This is a transcription error.
[Commentary] "Ji" refers to a pounding heartbeat sensation. The previous passage mentioned palpitations in the epigastrium due to water stagnation there; this passage mentions palpitations below the umbilicus due to water stagnation below the umbilicus. If Ben Tun (Running Piglet) is impending, it is Yang Deficiency, treated with Fu Ling Gui Zhi Gan Cao Da Zao Tang (Poria, Cinnamon Twig, Licorice, and Jujube Decoction). Here, spitting saliva indicates Water Rebellion in the Stomach, and vertex vertigo indicates Water blocking Yang; thus, it is Excess Water, treated with Wu Ling San.
Formula for Wu Ling San (Five-Ingredient Powder with Poria):
Ze Xie (Alismatis Rhizoma, 1 liang 1 fen)
Zhu Ling (Polypori Umbellati Sclerotium, peeled, 3 fen)
Fu Ling (Poria, 3 fen)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 fen)
Gui Zhi (Cinnamomi Ramulus, peeled, 2 fen)
Grind the five ingredients into powder. Take one cun-bi (square inch measure) with rice broth, three times daily. Drink plenty of warm water until sweating occurs for cure.
For shortness of breath with slight fluid retention, elimination via urination is indicated. Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) is primary; Shen Qi Wan (Kidney Qi Pill) is also applicable.
[Commentary] Water stagnating in the epigastrium causes severe palpitations, treatment established. Mild cases cause shortness of breath, with two treatments: Qi-deficiency shortness of breath is due to insufficient Qi to sustain respiration; slight-fluid shortness of breath is due to water obstruction hindering respiration. Shortness of breath on exhalation indicates obstruction of Heart/Lung Yang; use Ling Gui Zhu Gan Tang to unblock Yang, promoting Bladder pore function. Shortness of breath on inhalation indicates obstruction of Liver/Kidney Yin; use Shen Qi Wan to unblock Yin, opening the urinary gate. Hence, Ling Gui Zhu Gan Tang is primary, and Shen Qi Wan is also applicable.
Formula for Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction):
Fu Ling (Poria, 4 liang)
Gui Zhi (Cinnamomi Ramulus, 3 liang)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 liang)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 2 liang)
Boil these four ingredients in 6 sheng of water to obtain 3 sheng. Divide into three warm doses. Urination will follow.
Formula for Shen Qi Wan (Kidney Qi Pill) (See in Women's Miscellaneous Diseases section).
[Collected Exegesis] You Yi stated: Yin is a water disease. Treating water requires eliminating it via urination. Ling, Gui, Zhu, Gan tonify Earth Qi to move water; Shen Qi Wan warms Yang Qi to move water. Though indications differ, both promote urination.
When there is retained fluid (Liu Yin) in the epigastrium, the person feels cold on the back, an area the size of a palm. In Liu Yin, pain under the hypochondrium radiates to the Clavicular Fossa (Que Pen), worsening with coughing. With retained fluid in the chest, the person has shortness of breath and thirst. Limb joint pain with a deep pulse indicates retained fluid.
[Note] In ancient texts, "Deep pulse indicates retained fluid" appears below "limb joint pain," suggesting it should be a separate line to align with pulse theory discussion. "Shortness of breath and thirst" should likely read "shortness of breath and wheezing"; there may be missing text before "limbs." These are transcription errors.
[Commentary] Early-stage retained fluid cured by Xiao Ban Xia Tang plus Poria, Wu Ling San, or Shen Qi Wan represents minor pathogenic factors. If severe and persistent: retained in the Heart blocks Heart Yang, causing back coldness; retained in the hypochondrium hinders Liver Qi, causing hypochondriac pain radiating to the clavicle, worsening with cough; retained in the chest congests Lung Qi, causing shortness of breath and wheezing; retained in the body blocks meridians, causing limb joint pain. By inference, retained in the Spleen causes abdominal swelling and heaviness; retained in the Kidneys causes scrotal, foot, and calf swelling. This is logical.
Phlegm-fluid disease above the diaphragm causes fullness, wheezing, coughing, and expectoration. Attacks feature chills and fever, back pain, waist pain, spontaneous tearing, and severe body tremors, indicating Fu Yin (Hidden Fluid).
[Commentary] Injury from fluid that remains and does not depart is Liu Yin (Retained Fluid); that which hides and is hard to attack is Fu Yin (Hidden Fluid). Fu Yin refers to fluid lingering above the diaphragm, latent and unreleased, with periodic attacks. Similar to modern asthma triggered by autumn cold or spring wind, attacks cause wheezing, chest fullness, coughing, profuse sputum, chills/fever, back/waist pain, tearing upon severe coughing, and body tremors, known colloquially as "howling asthma."
[Collected Annotations] Cheng Lin stated: Phlegm-fluid in the diaphragm causes wheezing, coughing, and expectoration; manifesting externally causes chills/fever, back/waist pain; severe coughing lifts lung lobes and causes tearing; severe wheezing shakes shoulders and causes body tremors. Such severity indicates Hidden Fluid.
A floating, fine, and slippery pulse indicates injury from fluid.
[Commentary] A fluid disease presenting with a floating, fine, and slippery pulse indicates early-stage Phlegm-Fluid where water pathogen has not yet penetrated deeply.
[Collected Annotations] Li [Name missing] stated: Fluid pulses should be deep; a floating pulse indicates water in the Lung.
A deep pulse indicates retained fluid.
[Note] This passage originally followed "limb joint pain" but is placed here.
[Commentary] A fluid disease presenting with a deep pulse indicates Liu Yin (Retained Fluid), signifying the water pathogen is penetrating deeply.
[Collected Annotations] Cheng Lin stated: Deep pulses generally indicate water; thus, a deep pulse signifies water-fluid.
Li [Name missing] stated: The Classics say: "Deep and submerged indicates water accumulation."
If the patient has a hidden (Fu) pulse, desires spontaneous diarrhea, feels relief after defecation, yet continues to have epigastric hardness/fullness despite diarrhea, this indicates the retained fluid is attempting to exit. Treat with Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction).
[Note] The sentence "this indicates the retained fluid is attempting to exit" should follow "feels relief after defecation"; this is a transcription error.
[Commentary] A fluid disease presenting with a hidden pulse indicates Fu Yin (Hidden Fluid), signifying deep water pathogen. In fluid diseases, if spontaneous diarrhea brings relief, it indicates the retained fluid is trying to exit and resolve. However, if diarrhea brings no relief and epigastric hardness persists, the retained fluid is knotted and reluctant to leave; it requires attack with Gan Sui Ban Xia Tang. Licorice is added counter-intuitively to stimulate action, ensuring breakthrough against stubborn water knots. Since spontaneous diarrhea occurs, Peony is added to restrain, preventing excessive depletion after the pathogen is overcome.
Formula for Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction):
Gan Sui (Kansui Radix, 3 large pieces)
Ban Xia (Pinelliae Rhizoma, boiled in 1 sheng water to 0.5 sheng, strained, 12 pieces)
Shao Yao (Paeoniae Radix Alba, 5 pieces)
Gan Cao (Glycyrrhizae Radix et Rhizoma, roasted, size of a finger, 1 piece)
Boil these four ingredients in 2 sheng of water to obtain 0.5 sheng. Strain. Mix with 0.5 sheng of honey and decoct to 0.8 sheng. Take all at once.
[Collected Exegesis] Cheng Lin stated: Retained pathogens are moved using Kansui to drain fluid; knotted pathogens are dispersed using Pinellia to scatter phlegm-fluid. Kansui acts directly; to prevent excessive fluid-draining, Licorice and White Honey moderate with sweetness, and Peony restrains with sourness. Although Licorice and Kansui are contrary, they assist each other. This is the method of restraint via sour-astringency and sweet-slowing. The Ling Shu states: "Regulating a formula is like tying a bag." This is what is meant!
You Yi stated: Licorice and Kansui are contrary, yet used together to ensure a single battle eliminates all retained fluid, achieving synergy through mutual stimulation. Peony and White Honey not only calm the center but also mitigate drug toxicity.
Question: There are four types of Yin (Fluid), what are they? Master said: There is Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Branching Fluid). Question: How do the four fluids differ? Master said: If a person who was formerly plump is now thin, with water moving between intestines making gurgling sounds, it is called Tan Yin; if fluid flows under the hypochondrium after drinking, causing pain upon coughing/spitting, it is called Xuan Yin; if drinking water flows to the limbs, sweat should occur but does not, causing body ache and heaviness, it is called Yi Yin; if coughing/rebellious Qi requires leaning to breathe, shortness of breath prevents lying down, and the form resembles edema, it is called Zhi Yin.
[Commentary] Question: Fluid disease includes not only Liu Yin and Fu Yin, why does the world speak of four types? Answer: Liu Yin and Fu Yin describe the new/old and shallow/deep nature of fluid disease. The current four types—Tan, Xuan, Yi, Zhi—describe the clinical manifestations. These four types essentially follow the logic of Liu/Fu Yin but are divided based on the location of water flow. Named by their characteristics, hence four types. Tan Yin: water moves through intestines without draining, essence stays in diaphragm without transporting; heated by Yang becomes phlegm, condensed by Yin becomes fluid. Sounds occur wherever present: gurgling in throat (upper) or intestines (lower). This corresponds to chronic cough/phlegm/wheezing worsening in autumn/winter and improving in spring/summer. Xuan Yin: fluid flows under hypochondrium, hanging without ascending/descending, knotted and unresolved, causing pain upon coughing/spitting. Corresponds to hypochondriac fluid accumulation/pain. Yi Yin: fluid flows to limbs, sweat should occur but doesn't, blocking exterior meridians, causing body ache/heaviness. Corresponds to Feng Shui/Water Edema. Zhi Yin: fluid stops in chest, coughing/rebellious Qi hinders breathing, shortness of breath prevents lying down, resembling edema. Corresponds to fluid retention with wheezing/fullness preventing supine position.
[Collected Annotations] Zhao Liang stated: Water flows downward; highland water flows to rivers, rivers to sea. Blocking rivers causes flooding. Human water intake is similar. Nei Jing states: Water enters Stomach, circulates essence, uploads to Spleen, Spleen scatters essence to Lung, Lung regulates water passages, downloads to Bladder, fluids distribute everywhere, Five Meridians run parallel. Current drinking water, if Spleen Qi fails to scatter upward or Lung Qi fails to conduct downward, flows and accumulates randomly, causing disease.
Cheng Lin stated: Nei Jing says: When Earth Depression manifests, fluid arises within. Due to its flowing nature, treatments vary (sweating, purging, warming, promoting urination).
Li [Name missing] stated: There are four fluids, yet this chapter names only Tan Yin. Essentially, water accumulating in Yin becomes fluid; fluid condensing in Yang becomes phlegm. Separately, there are four; collectively, all are Tan Yin.
You Yi stated: Formerly plump, now thin, indicates fluids transformed into phlegm-fluid, no longer nourishing the body externally, but flowing downward to intestines. Overflowing drinking water indicates excess water and rebellious Qi. Flowing to hypochondrium is Xuan Yin; returning to limbs is Yi Yin. "Xuan" hangs in one place; "Yi" overflows to four sides. Knotted偏 (偏) upward attaching to Heart/Lung is Zhi Yin. Zhi Yin is like river branches or tree limbs, near organs but not central. Coughing/rebellious Qi preventing supine position indicates pressure on Lung.
Water in the Heart: epigastric hardness/pounding, shortness of breath, aversion to water/no desire to drink. Water in the Lung: spitting saliva/foam, desire to drink. Water in the Spleen: lack of Qi, body heaviness. Water in the Liver: hypochondriac fullness/supporting distension, pain upon sneezing. Water in the Kidney: epigastric palpitations.
[Note] "Epigastric palpitations" should likely read "Umbilical palpitations"; this is a transcription error.
[Commentary] The four fluids may stay in diaphragm, intestines, hypochondrium, limbs, or chest, but this does not exhaust all water pathologies. Thus, it elaborates: Water in Heart causes epigastric hardness, shortness of breath, palpitations, no desire to drink. Water in Lung causes spitting saliva/foam, thirst/desire to drink. Water in Spleen causes Qi deficiency and body heaviness. Water in Liver causes hypochondriac fullness and pain upon sneezing. Water in Kidney causes umbilical palpitations. Physicians applying this analogically will understand water diseases thoroughly.
Zhi Yin with chest fullness is treated with Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction).
[Note] "Chest fullness" should likely read "Abdominal fullness"; if chest, there is no rationale for using Chengqi Decoction. This is a transcription error.
[Commentary] Zhi Yin with chest fullness involves Lung pathogen, suitable for Mu Fang Ji Tang or Ting Li Da Zao Tang. Zhi Yin with abdominal fullness involves Stomach pathogen, thus treated with Hou Po Da Huang Tang, which is Xiao Cheng Qi Tang (Minor Order the Qi Decoction).
[Collected Annotations] You Yi stated: Suspect "chest fullness" should be "abdominal fullness." Zhi Yin often causes chest fullness; why use purging here? Hou Po Da Huang is identical to Xiao Cheng Qi Tang. Unless there is abdominal pain and constipation, do not test lightly.
Formula for Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction):
Hou Po (Magnoliae Officinalis Cortex, 1 chi)
Da Huang (Rhei Radix et Rhizoma, 6 liang)
Zhi Shi (Immature Bitter Orange, 4 pieces)
Boil these three ingredients in 5 sheng of water to obtain 2 sheng. Divide into two warm doses.
Phlegm-fluid in the epigastrium, chest/hypochondriac supporting fullness, and vertigo are treated with Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction).
[Commentary] This elaborates on symptoms and treatment following the previous passage. Phlegm-fluid in epigastrium means fluid water flows in the diaphragm, causing chest/hypochondriac supporting fullness. This fullness blocks Yang Qi from ascending to head/eyes, causing vertigo. Ling Gui Zhu Gan Tang is used to promote urination and unblock Yang Qi.
[Collected Annotations] Li [Name missing] stated: Chest/hypochondriac supporting fullness indicates phlegm-fluid stagnation in the middle; vertigo indicates blocked Yang Qi failing to ascend. Poria leaches dampness to drain fluid; Cinnamon Twig guides to move Yang Qi; Atractylodes removes dampness and strengthens Spleen; Licorice harmonizes middle and boosts Qi. Together, they tonify Earth to control Water.
Formula for Ling Gui Zhu Gan Tang (See above).
Abdominal fullness, dry mouth/tongue, indicates water qi in the intestines, treated with Fang Ji Ding Jun Li Huang Wan (Stephania, Zanthoxylum, Lepidium, and Rhubarb Pill).
[Commentary] This further details symptoms to distinguish treatment. Phlegm-fluid in epigastrium with gurgling throat sounds, or water qi in intestines with gurgling intestinal sounds, uses Ling Gui Zhu Gan Tang (the method of warming and harmonizing). If abdominal fullness adds, water has become solidified; dry mouth/tongue indicates water fails to transform. Thus, Fang Ji, Jiao Mu, Ting Li, and Da Huang attack water knots from front and back. Once water knots open, abdominal fullness resolves. Water