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Liu Yin (Retention of Fluids) is a type of accumulation disorder, essentially merely the retention of water. In Wang Shuhe's *Mai Jing* (Pulse Classic), it is categorized into four types: Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Zhi Yin (Supporting Fluid), and Yi Yin (Overflowing Fluid). The *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) further subdivides them into five types of Yin disorders, naming them all based on the morphological presentation of the disease. I do not discuss these classifications here; instead, I discuss the acquisition of Yin. Its origins are fivefold: some arise from indignation and depression, some from exhaustion and fatigue, some from excessive rumination, some from binge drinking, and some from consuming cold substances during heat. Although there are many manifestations of Yin disorders, none fall outside these five categories.

When indignation and depression cannot be expressed, Liver Qi invades the Spleen, causing the Spleen to fail in transformation, thus resulting in Liu Yin. The Liver governs planning and deliberation; prolonged deliberation without resolution impedes the movement of fluid Qi. The Spleen governs thought; prolonged thought without cessation causes Spleen stagnation, also resulting in Liu Yin. When a person returns from hard labor or long travel, drinks water while exhausted, the Spleen and Stomach strength are depleted. Consequently, they become lethargic and unable to distribute fluids into the vessels, also forming Liu Yin. When one drinks too much alcohol, the intestines and stomach are already full, yet more is added. The Bladder meridians cannot excrete it in time; over a long period, this also forms Liu Yin. During the height of summer, when body fluids are scorched and dry, people prefer cold water to quench thirst. If consumed excessively for pleasure and followed by inactivity, this also forms Liu Yin. Can any person suffering from Yin disorders escape these five causes?

Water is a yin substance. Accumulated water generates dampness; retained wine generates dryness; over time, both transform into phlegm. When located in the left hypochondrium, it corresponds to Fei Qi (Liver Accumulation); when in the right hypochondrium, it corresponds to Xi Ben (Lung Accumulation); when ascending into the Lungs, it causes frequent coughing; when descending into the Large Intestine, it causes diarrhea; when entering the Kidneys, it becomes Yong Shui (Gushing Water), with a sloshing sound like liquid in a bag. Wherever it goes, if it remains in the Taiyang channel, it is called Zhi Yin, all arising from rebellious Qi. Thus, dampness above manifests as yellow eyes and facial edema; below as swelling and coldness of the thighs and knees; in the middle as chest and epigastric distension, obstruction, and rebellious phlegm. If remaining in the yang aspect without departing, it transforms into qi over time; if remaining in the yin aspect without departing, it takes form over time.

Practitioners today generally assume that Yin is a cold accumulation and use warm and hot agents to tonify and dry it. However, if cold Yin is stagnant in the middle and hot medicines are administered from above, they are rejected by the cold. The water-dampness is not removed, but heart fire increases; since the fire does not descend, water flows downward instead, leading to a dry upper jiao and a cold, shivering lower jiao. The *Nei Jing* states: "If exit and entry cease, the spirit mechanism perishes; if ascent and descent stop, the qi establishment stands alone." Do they not believe this? Moreover, there is no tonification method for Liu Yin at the lower level. When qi is just obstructed, tonification will only increase the blockage. How can they ignore the *Nei Jing*'s principle: "Those that are retained must be attacked"? Why do later generations fail so miserably in emulating the ancients! Furthermore, herbs such as Baizhu (Atractylodis Rhizoma), Renshen (Ginseng Radix), and Fuling (Poria) cause increased obstruction even when taken by patients with Yin disorders. How much worse would be the effects of burning needles and moxibustion, which would undoubtedly worsen the palpable obstruction? The ancient formula Wu Yin Wan contains over thirty ingredients, including Fanshi (Alumen), Badou (Crotonis Fructus), Fuzi (Aconiti Lateralis Radix Praeparata), and Wutou (Aconiti Radix). Although these are purgatives, they are ultimately drying and hot. Although some cooling herbs are included, their power is isolated and unsupported. Therefore, Liu Hejian of our era, basing himself on Zhang Zhongjing's Shizao Tang (Ten Jujube Decoction), formulated Sanhua Shenyou Wan (Three-Flower Divine Protection Pill) and added Dahuang (Rhei Radix et Rhizoma) and Qianniu (Pharbitidis Semen). For newly acquired diseases, administering thirty to fifty pills allows the qi flow to resume and the fluid to be expelled. Previously, I treated a patient who had suffered from this condition for decades. His pulse was minute and small in all three positions of the left hand, and slippery and large in all three positions of the right hand. Minute indicates cold; slippery and large indicate dryness. I used Gudi San (Melon Stem Powder) to induce vomiting, expelling several liters of cold phlegm, with sweat pouring like washing water. Next, using Dao Shui San (Water-Guiding Powder) and Yugong San (Yu Gong Powder), I expelled several liters of dry filth from the intestines and stomach, curing half of the patient. Then, using mild diuretic agents to clear the residual pathogen, and fire-descending agents to open the appetite, he recovered within a month. Huanglian (Coptidis Rhizoma) and Huangbai (Phellodendri Cortex) can clear upper jiao dryness and dampness; Huangqi (Astragali Radix) and Fuling (Poria) can tonify the lower jiao and leach out dampness. These two categories can be used for consolidation but not for initial expulsion. For remaining pathogens, drugs such as Tingli (Descurainiae Semen seu Lepidii Semen), Xingren (Armeniacae Semen Amarum), Sangbaipi (Mori Cortex), and Jiaomu (Zanthoxyli Pericarpium) can be used to chase water, eliminating the latent fluid.

Treating disease requires sequence and order; one must not administer drugs randomly. When the pathogen has not been expelled, tonification must strictly be avoided. Immediately after the major pathogen is expelled, one fears that tonification may inadvertently increase the pathogenic qi, making the condition worse than before treatment. Previously, a person in Henei suffered from Yin disorder. The physician diagnosed it as Spleen dampness and prescribed a powder of Muxiang (Aucklandiae Radix) and Qianniu (Pharbitidis Semen). After more than ten bowel movements, the patient was injured. The prescription was changed to a powder again, causing another ten bowel movements; then to a pill, causing another ten bowel movements. The patient became severely debilitated and slept for days and nights. Upon waking, his intestines and stomach felt loose and moist, craving only congee. Eating small amounts, he gradually recovered. Although both cases were diagnosed as dampness, the difference between tonification and purgation led to such divergent outcomes.

The *Nei Jing* states: "When Earth qi is excessive, rain and dampness prevail, damaging Kidney Water, and severe cases result in fluid retention and epigastric fullness." When Taiyang governs the year, dampness alters things, water and fluids accumulate internally, causing epigastric fullness and anorexia. The commentary notes: In this year, Taiyin is in the lower position, with dampness supervising the earth. The origin of the disease arises from earthly qi. When Shaoyin governs the year, wet-earth is the fourth qi, and the people suffer from nasal congestion, epistaxis, and fluid retention. Furthermore, when Earth depression occurs, the people suffer from fluid retention, diarrhea, dorsal edema, and heavy body. Also, when Taiyin arrives, it manifests as accumulated fluid and obstruction. When Taiyin arrives, it manifests as internal accumulation and fullness. Both Taiyang excess and Taiyang return state mention fluid retention in the middle. Based on this examination, Earth governs wet transformation, not cold transformation; Water governs cold transformation, not wet transformation. Heavy rain in heaven and accumulated puddles on earth are all considered water. In the *Nei Jing*, this belongs to Earth. Ice and frost condensation, and chilling winds, are transformations of Water. Thus, it is said: Chou and Wei years correspond to Taiyin Wet Earth; Chen and Xu years correspond to Taiyang Cold Water. These two transformations are fundamentally different, and their diseases differ. When Wet Earth is excessive, fluid retention occurs in the middle. Today, people believe that Spleen Earth is deficient. Should we follow the eternal books of Xuanyu (Yellow Emperor) and Qibo? Or should we not?