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(See "Miscellaneous Diseases of Women" chapter)

[Collected Annotations]
You Yi stated: "Yin" (Fluid Retention) refers to pathological fluid accumulation. To treat fluid retention, one must eliminate it through urination; [Ling, Gui, Zhu, Gan] (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice, representing the method of strengthening Spleen Qi to move fluids) benefits Earth Qi to circulate water, while Shenqi Wan (Kidney Qi Pill) warms Yang Qi to circulate water. Although their primary indications differ, both share the effect of promoting diuresis.

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When there is retained fluid in the epigastrium (Heart Below), the patient experiences coldness on the back over an area the size of a palm. Retained fluid, if lodged in the hypochondrium (character missing), causes pain radiating to the Clavicular Fossa (Quepen, SI15), which worsens upon coughing. If there is retained fluid in the chest, the patient suffers from shortness of breath and thirst, and pain in all joints of the four limbs. A deep pulse indicates the presence of retained fluid.

[Commentary]
In ancient editions, the phrase "A deep pulse indicates retained fluid" appears below "pain in all joints of the four limbs." This should be separated into a distinct clause to align with the principles of pulse diagnosis. The character "thirst" in "shortness of breath and thirst" should likely be "wheezing"; there may be missing text before "four limbs," which are errors due to transcription omissions.

[Annotation]
In the initial stage of fluid stagnation, if mild pathogenic factors are involved, treating with Xiaobanxia Tang (Minor Pinellia Decoction) plus Poria, or Wuling San (Five-Ingredient Powder with Poria), or Shenqi Wan (Kidney Qi Pill) can lead to recovery. However, if the pathogen is severe and persists, its location determines the symptoms: if it lodges at the Heart, it obstructs Heart Yang, causing back coldness; if it lodges in the hypochondrium (character missing), it interacts with Liver Qi, causing hypochondriac pain radiating to the Clavicular Fossa, worsening with cough; if it lodges in the chest, it congests Lung Qi, causing shortness of breath and wheezing; if it lodges in the body, it blocks the meridians, causing pain in all joints of the four limbs. By extension, if it lodges in the Spleen, it causes abdominal swelling and heaviness of the body; if it lodges in the Kidney, it causes swelling of the scrotum, feet, and shins. This reasoning is logically sound.

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Disease above the diaphragm characterized by phlegm-fullness, wheezing, coughing, and vomiting; upon attack, accompanied by aversion to cold and fever, back pain, and lower back pain; tears flowing spontaneously; and severe tremors of the body—this indicates the presence of hidden fluid retention (Fuyin).

[Annotation]
Pathogenic fluid that remains and does not disperse is called retained fluid (Liuyin); that which hides and is difficult to eradicate is called hidden fluid retention (Fuyin). Hidden fluid retention refers to fluid accumulating above the diaphragm, lying dormant, and manifesting periodically. For instance, when exposed to autumn cold or spring wind, attacks inevitably involve wheezing, fullness, coughing, vomiting profuse sputum, aversion to cold and fever, back and lower back pain. Severe coughing causes tears to flow; severe coughing induces bodily tremors. This is what laypeople call "roaring asthma."

[Collected Annotations]
Cheng Lin stated: "Phlegm-fluid lodged in the diaphragm causes wheezing, coughing, and vomiting; when manifesting externally, it causes aversion to cold and fever, back pain, and lower back pain; severe coughing lifts the lung lobes, causing tears to flow; severe wheezing involves shoulder movement during respiration, causing bodily tremors. Such severe cases must involve hidden fluid retention."

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A floating, fine, and slippery pulse indicates injury by fluid retention.

[Annotation]
In fluid diseases, a floating, fine, and slippery pulse indicates Phlegm-Fluid, representing a diagnosis where the water pathogen has just begun and has not yet penetrated deeply.

[Collected Annotations]
Li [Name Missing] stated: "The pulse for fluid retention should be deep. A floating pulse now indicates water in the Lung."

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A deep pulse indicates retained fluid.

[Commentary]
This clause originally appeared below "pain in all joints of the four limbs" but is placed here currently.

[Annotation]
In fluid diseases, a deep pulse indicates retained fluid, signifying that the water pathogen is about to penetrate deeply.

[Collected Annotations]
Cheng Lin stated: "When various types of deep pulses are obtained, one should investigate water pathology; thus, a deep pulse indicates water-fluid."
Li [Name Missing] stated: "The Classics state: 'Deep signifies submerged water accumulation.'"

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The patient presents with a hiding pulse (Fu Mai), desires spontaneous diarrhea, and feels relief after defecation; however, despite the diarrhea, the epigastrium continues to feel hard and full. This is because the retained fluid is attempting to exit. Gansui Banxia Tang (Kansui and Pinellia Decoction) is indicated.

[Commentary]
The sentence "This is because the retained fluid is attempting to exit" should follow "feels relief after defecation," indicating a textual error or omission in transmission.

[Annotation]
In fluid diseases, a hiding pulse indicates hidden fluid retention, signifying that the water pathogen has penetrated deeply. In patients with fluid disease who desire spontaneous diarrhea, feeling relief afterward suggests that the retained fluid is attempting to leave the body naturally. However, if diarrhea occurs but provides no relief, and the epigastrium remains hard and full, it means the retained fluid is knotted and reluctant to leave. In such cases, purgative treatment with Gansui Banxia Tang (Kansui and Pinellia Decoction) is appropriate. The formula uses Licorice (Gancao) as an antagonistic assistant to stimulate the action of Kansui (Gansui), aiming to break through even deeply hidden water accumulations. Since the patient is already experiencing spontaneous diarrhea, Peony (Shaoyao) is added as an assistant to constrain the healthy Qi, preventing excessive depletion after the pathogen is expelled.