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[Classical Discourse]
When the annual earth qi is excessive, fluid retention (Yin) may manifest with middle jiao fullness and reduced appetite. ○ When earth qi is stagnant and erupts, it presents as fluid retention and diarrhea. ○ When Taiyang governs the year, dampness alters things, causing water and fluids to accumulate internally, leading to middle jiao fullness and anorexia. ○ When Taiyin governs the lower region, the people suffer from fluid accumulation diseases. ○ When Taiyin qi prevails, fluid retention arises in the middle. ○ When Taiyin qi arrives, it manifests as accumulated fluid retention, epigastric distension, and obstruction. ○ During the fourth qi period when Shaoyin governs the year, the people suffer from fluid retention. ○ All pathological fluids that are clear, cold, and thin belong to Cold patterns. (From *Suwen*)

[Philosophical Discourses]
Question: There are four types of fluid retention; 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 these four types differ? Master said:
If a person was formerly robust but is now emaciated, and water flows between the intestines making a gurgling sound, this is called Tan Yin. ○ After drinking water, if the fluid stays in the hypochondrium and coughing or spitting causes pulling pain, this is called Xuan Yin. ○ If drinking water leads to fluid flowing into the four limbs, sweating should occur but does not, accompanied by body pain, this is called Yi Yin. ○ If there is coughing with air reversal, leaning on something to breathe, shortness of breath, inability to lie flat, and swelling-like appearance, this is called Zhi Yin. ○ If there is retained fluid under the heart, the patient feels cold on the back in an area the size of a palm. ○ In cases of retained fluid, there is pain in the hypochondrium radiating to the Clavicular Fossa (Qie Ren acupoint), worsening with coughing. ○ If there is retained fluid in the chest, the patient suffers from shortness of breath and thirst, with wandering joint pain in the four limbs. ○ If phlegm disease exists above the diaphragm, presenting with fullness, wheezing, coughing, and expectoration, accompanied by chills and fever upon onset, backache, lumbago, spontaneous tearing, and severe tremors of the body, there must be latent fluid retention. ○ If a patient drinks excessively, sudden wheezing and fullness will occur. Generally, if food intake is low but fluid intake is high, water stops under the heart; severely, palpitations occur; mildly, shortness of breath occurs. ○ Water in the Heart causes hardness and pounding under the heart, shortness of breath, aversion to water and unwillingness to drink; Water in the Lung causes expectoration of saliva and foam, desire to drink; Water in the Spleen causes Qi deficiency and heavy body; Water in the Liver causes hypochondriac distension and pain upon sneezing; Water in the Kidney causes palpitations under the heart. (From *Jingui Yaolue*)

Commentary: In Phlegm-Fluid diseases, Tan (Phlegm) is a pathological product of digested food, whereas Yin (Fluid) is a pathological product of undigested food. When food enters the Stomach, if Stomach Yang is vigorous and Qi is sufficient, the food transforms into righteous Qi and Blood, nourishing the Zang-Fu organs and circulating Ying and Wei. How could Tan Yin arise? Tan Yin arises because Stomach Yang is insufficient for rotting and digesting, and Spleen Qi is insufficient for rotation and transportation. Tan is essentially food; if it enters the Stomach and the Stomach is too cold to digest it, it transforms into Tan. Yin is essentially water; if it enters the Stomach and Spleen Dampness prevents its distribution, it remains as Yin. Although these two often coexist, their actual causes differ. Both should be attributed to Deficiency-Cold of the Spleen and Stomach, turning beneficial food into harmful Tan Yin. The *Neijing* discusses Yin but not Tan; discussion of Tan began with Zhang Zhongjing. Tan disease concepts appeared in *Shanghan Lun*, and later Tan and Yin were discussed together in *Jingui Yaolue*. Careful examination reveals that Yin is primary, while Tan is secondary. Thus, Tan is food; although pathogenic, it need not be eradicated completely. If digestion of grains is restored, Tan will decrease without specific treatment. Yin is Water Evil; if retained and latent, it is hardest to expel. Distinct differentiation is required, and specific treatment for Water is necessary for peace. In discussing these two diseases together, one must maintain clear distinctions and not confuse their meanings. (Wei Litong)

Yin refers to accumulated water entering from outside; Tan refers to fluids of the intestines and stomach generated from within. Initially distinct, they eventually converge. Thus, accumulated Yin that does not dissipate can transform into Tan; Yin is the gradual stage of Tan, and Tan is the transformation of Yin. If expelled externally, Yin appears clear and thin, while Tan appears thick and turbid, which is different. (*Zhengzhi Huibu*)

Water Qi reversing upward causes vomiting; stopping in the diaphragm causes epigastric fullness; affecting the head causes dizziness; harassing the Heart causes palpitations. (Wang Ang)

Tan Yin is generally one syndrome, but has two causes: Tan is caused by Fire, having Heat but no Cold; Yin is caused by Dampness, having both Heat and Cold. This explains why there are hot springs but no cold fires.
○ Tan Yin: water flows in intestines with gurgling sounds; Xuan Yin: water in hypochondrium with coughing and pulling pain; Yi Yin: water flows in four limbs, no sweat, heavy body; Zhi Yin: coughing, air reversal, shortness of breath, swelling-like form. One flows downward from Stomach to Intestines; one flows sideways from Stomach to Hypochondrium; one flows outward from Stomach to Four Limbs; one flows upward from Stomach to Chest and Diaphragm. Initially unnoticed, day by day and month by month, the essence of water turns turbid, forming Tan Yin. It first gathers where respiratory Qi cannot reach easily. Thus, from Intestines to Hypochondrium to Limbs, gradually infiltrating the Chest and Diaphragm, the condition becomes more rebellious. The trouble of Tan Yin always originates from the Stomach. ○ Areas where water accumulates are all called Retained Fluid (Liu Yin). "Retained" means staying and not leaving. Retained fluid that is not fully eliminated is called Latent Fluid (Fu Yin). "Latent" means hiding and not emerging. (Yu Jiayan)

[Supplement]
Patients with Tan Yin should be treated with Warm Medicines to harmonize. ○ If there is Tan Yin under the heart, with hypochondriac distension and dizziness, Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction) is indicated. ○ For shortness of breath due to mild fluid retention, promote urination; Ling Gui Zhu Gan Tang is indicated, and Shen Qi Wan (Kidney Qi Pill) is also indicated. ○ If the patient's pulse is deep and hidden, desiring diarrhea, which brings relief, yet epigastric hardness/fullness persists despite diarrhea, this indicates Retained Fluid attempting to exit; Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction) is indicated. ○ For Xuan Yin, Shi Zao Tang (Ten Jujube Decoction) is indicated. ○ For Yi Yin, induce sweating; Da Qing Long Tang (Major Green Dragon Decoction) is indicated, and Xiao Qing Long Tang (Minor Green Dragon Decoction) is also indicated. ○ For Zhi Yin in the diaphragm, presenting with wheezing and fullness, hard epigastric fullness, dark complexion, and deep-tight pulse, lasting dozens of days, unresponsive to emetic and purgative treatments, Mu Fang Ji Tang (Stephania Decoction) is indicated. If the constitution is deficient, recovery occurs; if solid, recurrence happens in three days; if subsequent treatment fails, Mu Fang Ji Tang minus Shigao (Gypsum) plus Fuling (Poria) and Mangxiao (Mirabilite) is indicated. ○ For Zhi Yin under the heart causing severe dizziness, Ze Xie Tang (Alisma Decoction) is indicated. ○ For Zhi Yin with chest fullness, Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction) is indicated. ○ For Zhi Yin causing breathing difficulty, Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung) is indicated. ○ Vomiting patients usually feel thirsty; thirst indicates resolution. If currently not thirsty, it is due to Zhi Yin under the heart; Xiao Ban Xia Tang (Minor Pinellia Decoction) is indicated. ○ Abdominal fullness with dry mouth and tongue indicates water Qi in the intestines; Ji Jiao Li Huang Wan (Areca Seed, Descurainia, and Rhubarb Pill) is indicated. ○ Sudden vomiting with epigastric fullness, water in the diaphragm, dizziness, and palpitations; Ban Xia Jia Fu Ling Tang (Pinellia with Added Poria Decoction) is indicated. ○ If a thin person has palpitations below the umbilicus, expectorates saliva/foam, and experiences vertigo, this is Water; Wu Ling San (Five-Ingredient Powder with Poria) is indicated. ○ *Waitai Mi Yao*'s Fuling Yin (Poria Drink) treats water, phlegm, and old fluid in the chest. After self-vomiting clear fluid, if the chest feels empty, Qi is full, and appetite is lost, this formula eliminates phlegm-Qi to restore appetite. ○ For coughing, air reversal, and inability to lie flat, Xiao Qing Long Tang is indicated. ○ Thirst followed by vomiting indicates water stopping under the heart; this belongs to Fluid Disease families; Xiao Ban Xia Fu Ling Tang (Minor Pinellia and Poria Decoction) is indicated. (From *Jingui Yaolue*)

Commentary: The phrase "this is because Retained Fluid attempts to exit" should follow "diarrhea brings relief"; it is likely a transcription error. ○ Commentary: The character "Chest" (Xiong) in "Zhi Yin Chest Fullness" should be "Abdomen" (Fu); if it were "Chest," using Chengqi Decoctions would be illogical; it should be corrected. ○ Commentary: The character "Thin" (Shou) in "Thin Person" should be "Sick" (Bing). The character "Dian" (颠) in "Dian Xuan" should be "Dian" (巅), meaning head. The text makes sense only after correction. (From *Yizong Jinjian*)

*Jingui Yaolue* states: Patients with Tan Yin should be treated with Warm Medicines to harmonize. Commentary: Tan arises from Stomach Cold; Yin arises from Spleen Dampness. Warm medicines are formulas that supplement Stomach Yang and dry Spleen Earth, excelling in both. "Harmonizing" implies not solely focusing on warming and tonifying. Even if there are moving and resolving agents, they fall under the principle of Warm Medicines. This is "harmonizing," not merely "tonifying" or "benefiting." Since Tan Yin pathogens arise from deficiency, and Tan is a tangible substance, slight guidance is needed. The method lies entirely within "Warm Medicines to Harmonize." Advocating purgation is incorrect; advocating only warming and tonifying misunderstands "harmonizing." Zhongjing's words are precious; they cannot be changed. (Wei Litong)

*Neijing* mentions Accumulated Fluid but not the name Tan Yin. Before the Han dynasties, it was called Dan Yin. Zhang Zhongjing first distinguished the meanings of Tan Yin, Xuan Yin, Yi Yin, and Zhi Yin, establishing formulas like Da/Xiao Qing Long Tang, Ban Xia variations, Ling Gui Zhu Gan Tang, and Shen Qi Wan, along with methods for internal and external fluid retention, surpassing antiquity. In summary, Tan Yin arises from Yuan Qi deficiency and Yin excess/Yang decline, causing Jin Ye (Body Fluids) to stagnate and fail to distribute, remaining in the chest. Clear water turns turbid; water accumulating in Yin becomes Yin; Yin condensing in Yang becomes Tan. If Yuan Qi is sufficient, Stomach strong, and Spleen healthy, diet is regulated, and movement is continuous; how could Tan Yin exist? Hence Zhongjing said: "Patients with Tan Yin should be treated with Warm Medicines to harmonize." Later generations, misunderstanding Tan Yin, recklessly used phlegm-resolving and Qi-breaking drugs, or cloying tonics, damaging Spleen and Stomach and aiding turbidity, greatly deviating from Zhongjing's methods. However, although Tan and Yin are similar, they have Yin-Yang differences. Yang excess and Yin deficiency cause Water Qi to condense into Tan; Yin excess and Yang deficiency cause Water Qi to overflow into Yin. Pathologies differ, so treatments vary. For Spleen/Kidney Yang deficiency and Bladder Qi transformation failure, use Ling Gui Zhu Gan Tang, Fuling Yin, Shen Qi Wan, or Zhen Wu Tang to regulate, unblock, and tonify Lower Jiao/Spleen. For external Cold triggering old Yin reversal and Bladder Qi failure with Yin rebelling against Lung Qi descending, use Xiao Qing Long Tang combined with Yue Bi Tang to open Taiyang/Bladder. For Yin lurking in collaterals or Middle Deficiency with Dampness transforming into Tan, use Chuan Wu (Aconite) and Shu Qi (Escallonia) for warming collaterals, or *Waitai* Fuling Yin minus Gancao with bitter/acrid/diuretic herbs for Dampness. For Yin rushing to Danzhong or Xuan Yin flowing into Stomach, use Ginger, Aconite, Nanxing (Arisaema), Changpu (Acorus), Xuanshu (Inula), Chuanjiao (Sichuan Pepper) to drive out Yin, open turbidity, and unblock Yang with Acrid warmth. (From *Linzheng Zhinan Yitan*)

Tan Yin, whether retained or latent, is treated accordingly. If located from Stomach up to Chest/Diaphragm/Lung/Heart, drive the retained Yin back to Stomach, exiting down via Intestines or up via vomiting. These exits are direct and effective, avoiding latency, which everyone knows. If moving from Chest/Diaphragm outward to Skin/Muscle, the clear part may exit via sweat, but the turbid part has no exit, must return to Chest/Diaphragm, then to Stomach, then to Intestines to exit down. Driving it out may fail against those latent in skin/muscle. If hiding deeply in the Back (the Fu organ of the Chest), there is no exit; it must return to Chest/Diaphragm to move toward Stomach/Intestines downwards. Not only is driving difficult, but it may carry fierce Yang/Fire from the Back, causing abscesses/toxins nodulating like orange sacs. Latent Yin is hard to discharge downward and prone to disaster; who can distinguish it? Who can expel it? ○ *Neijing* only says: "Retain, attack it." Zhongjing analyzed meanings to exhaust variations: Formless Qi, Heat binding in Stomach, use Tiao Wei Cheng Qi Tang to attack; Heat binding in Intestines, use Da/Xiao Cheng Qi Tang to attack; Tangible Yin, Epistaxis binding in Chest, use Xian Xiong Tang to attack; Epistaxis binding in Hypochondrium, use Shi Zao Tang to attack; Retention binding between Intestines/Stomach, use Gan Sui Ban Xia Tang to attack. (Yu Jiayan)

The root of Tan Yin is Water. Water enters Stomach, overflows with essence, transports upward to Spleen; this is Yang entering Yin. Spleen Qi scatters essence, returns upward to Lung; this is Earth Qi ascending. Unblocking Water pathways, transporting downward to Bladder; this is Heaven Qi descending. Water essence distributes four ways, Five Meridians run together; water enters meridians, Blood flows. If Yin-Yang disharmony, Clear/Turbid interfere, Stomach Qi chaos in Middle, Spleen Qi hard to ascend, Lung Qi滞 in descending, then Tan Yin forms. Removing Tan: Descend Qi, Clear Fire to treat Branch; Tonify Yin, Promote Urination to treat Root. Purging Yin: Descend Qi, Dry Dampness to treat Branch; Warm Kidney, Promote Urination to treat Root. (Ke Yunbo)

[Pulse Diagnosis]
Liver Pulse soft and scattered, with lustrous color, indicates Yi Yin disease. (From *Suwen*)
Lung Yin pulse is not wiry, but suffers from wheezing and shortness of breath. ○ Zhi Yin also wheezes, cannot lie flat, adds shortness of breath, pulse is normal. ○ Pulse floating, fine, and slippery indicates injury by Fluid. ○ Pulse deep indicates Retained Fluid. ○ Coughing with wiry pulse indicates Water. ○ Wiry pulse on one side indicates Fluid. ○ Wiry-rapid pulse indicates Cold Fluid, difficult to treat in Winter/Summer. ○ Deep-wiry pulse indicates Xuan Yin internal pain. ○ Chronic cough for years, weak pulse is treatable, Excess-Large-Rapid pulse indicates death. Weak pulse causes severe dizziness; originally due to Zhi Yin in Chest. (From *Jingui Yaolue*)

Commentary: The character "Rapid" (Shu) in "Wiry-Rapid Pulse" should be "Slow" (Chi) to align with Cold Fluid theory; correct it. (From *Yizong Jinjian*)

[Selected Cases]
Mildly suffered from Yin Pi (Fluid Mass) for thirty years. Initially, because sitting at night writing, leaning left on desk, food mostly fell to the left side; night drinking also sleeping on left. Young, did not notice. Three to five years later, felt wine stop with sound from lower left, hypochondriac pain, reduced appetite mixed with other symptoms. Every ten-plus days, vomited several sheng of sour water. Summer months, only right side sweated, left side absolutely no sweat. Visited many famous doctors, occasionally hit the mark, relapsed after a month. Self-reflection: must have a sac/pouch, like water needing basins; does not flow unless basin is filled. Clear parts flow, turbid parts stagnate, no outlet to drain, so accumulating 5-7 days, must vomit out. Spleen Earth dislikes Dampness, Water flows Dampness. Better to Dry Spleen to remove Dampness, Build Earth to fill basins. Thus made Cang Zhu Wan (Atractodes Pill), taken for three months, disease eliminated.
(Hu Shumi)