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Yu Chang stated: Regarding the syndrome of Phlegm-Fluid (Tan Yin), the concepts of "Retention" (Liu) and "Latency" (Fu) are the most difficult to comprehend. The previous discussion on Retained Fluid (Liu Yin) refers to fluid that remains and does not depart; Latent Fluid (Fu Yin) is simply Retained Fluid that has hidden within the interior. Retained Fluid has times when it can be expelled, whereas Latent Fluid ultimately does not depart. From this, a glimpse of the meaning of "Retention" and "Latency" can be seen. However, can the profound principles of the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) be fully exhausted by superficial words? I shall respectfully present my exposition: The *Jin Gui Yao Lue* discusses Retained Fluid in three instances and Latent Fluid in one instance.

It states: "There is Retained Fluid under the heart; the person feels cold on the back over an area the size of a palm." This is called Retained Fluid. "Pain in the hypochondrium radiating to the Quepen (LI 12) acupoint indicates Retained Fluid in the chest." "Shortness of breath with thirst, and pain throughout all joints of the four limbs, also indicates Retained Fluid in the chest." This is because the fluid obstructs and suppresses the Yang Qi of the Upper Jiao (Heart and Lung), leading to an excess of Yin-Cold. Therefore, where it penetrates deeply into the back, there is cold without heat, simultaneously blocking the ascending Yang of the Du Meridian (Governing Vessel). The coldness on the back, the size of a palm, is merely a manifestation of internal stagnation of Yang-Fire. The hypochondrium is the pathway for the upper and lower channels of the Hand and Foot Jueyin (Liver and Pericardium), while the Foot Shaoyang (Gallbladder) channel passes from Quepen through the costal margin. Thus, pain in the hypochondrium radiating to Quepen is a sign that Retained Fluid obstructs laterally, preventing the free flow of Wood and Fire (Liver and Gallbladder). Fluid retained in the chest causes shortness of breath and thirst, and pain in the four limbs and joints, which reflects the failure of Lung Qi to disseminate and Spleen Qi to distribute essence. Observing these three points together, it is evident that Phlegm-Fluid can retain and affect the Heart, Lung, Liver, and Spleen! Is not this principle even more obvious?

Regarding Latent Fluid, it states: "Phlegm-Fluid disease above the diaphragm presents with fullness, wheezing, coughing, and expectoration. Upon attack, there are alternating chills and fever, backache, waistache, spontaneous tearing, and severe tremors of the body. There must be Latent Fluid." This indicates that the chest is the domain governed by Yang Qi. When Retained Fluid obstructs this Yang, it cannot mobilize. However, heavy Yin cannot obscure Yang forever; occasionally, Yang extends, leaving no room for Yin, causing sudden eruption and vomiting, at which point the Retained Fluid can be expelled. If it continues to hide and does not exit, it means the Qi of the Three Yang meridians extends and then contracts. When Taiyang (Bladder) Yang fails to extend, it manifests as chills, fever, backache, waistache, and tearing; when Shaoyang (Gallbladder) Yang fails to extend, the transformation of Wind and Fire becomes depressed and merges into the Yangming (Stomach) Earth. Since Yangming governs the muscles, severe tremors occur. The harm of Retained Fluid hiding and not departing is thus immense.

However, Zhang Zhongjing did not explicitly state treatment methods for Retained or Latent Fluid in the text. I investigate them from the perspective of their suppression of the Yang Qi of the Zang and Fu organs. Would the principle of "using warm medicines to harmonize" not be precisely applicable here, urgently needed to unblock Yang? Although Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, Licorice Decoction) is said to treat dizziness caused by Branch Fluid (Zhi Yin), would it not also apply to this syndrome, allowing us to emulate its intent? Therefore, only by thoroughly understanding this example can one discuss treatment methods.

Later generations, failing to understand the principles of the *Jin Gui*, arbitrarily created theories of "Five Fluids and Six Syndromes." Even Zhang Yuansu (Hai Zang), despite his brilliance, stated under the Five Fluids Decoction: "1. Retained Fluid under the heart; 2. Branch Fluid in the hypochondrium; 3. Phlegm-Fluid in the stomach; 4. Overflowing Fluid above the diaphragm; 5. Hanging Fluid in the intestines." Yet he used a single formula to treat all of them. How shallow is this!

Furthermore: Phlegm-Fluid is generally one syndrome, but has two causes. Phlegm arises from Fire, presenting with Heat but no Cold; Fluid arises from Dampness, presenting with either Heat or Cold. This is the logic of having hot springs but no cold fires. When human body heat is stagnant internally, Qi and Blood coagulate, steaming body fluids until they condense into Phlegm; this is all a manifestation of Fire. Water, due to Dampness, lingers and accumulates into Fluid. Ultimately, most Fluid syndromes are brewed from Damp-Heat, while few are from Cold-Damp. Dampness has no fixed form: in Spring it is Wind-Damp, in Summer Heat-Damp, in Autumn Dry-Damp, and in Winter Cold-Damp. Three seasons govern Heat, one governs Cold; Damp-Heat is three times more prevalent than Cold-Damp. The *Nei Jing* states that excessive Wet Earth causes Phlegm-Fluid diseases, and treatment uses various hot agents; this does not imply Phlegm-Fluid itself is a Cold syndrome. Later generations, misunderstanding this, recklessly use hot medicines, using it as an excuse. Do they not know that for pathogens invading from below, one must first resolve them from the exterior? Thus, treating excessive Dampness, one does not stray far from hot medicines to disperse exterior pathogens; only when attacking the interior does one not stray from cold medicines. Moreover, if the exterior cannot be resolved initially, and accumulated Yin obstructs the body's Yang, one must rely on warm-hot medicines to extend Yang, so that Yin pathogens can be quickly removed. To call this arbitrary use of routine methods is indeed foolish!

On Ling Gui Zhu Gan Tang: Phlegm-Fluid is a Yin image that obstructs Yang. Using this Yang-promoting medicine to transform Qi and extend Yang is the correct method. Why does this case focus on fullness supporting the chest and hypochondrium, and dizziness? The *Ling Shu* states that when the Pericardium channel moves, it causes fullness supporting the chest and hypochondrium. Thus, if Phlegm-Fluid accumulates in the Pericardium, the symptoms naturally include this. As for dizziness, it is because Phlegm-Fluid obstructs the Yang in the chest, preventing the distribution of water essence to the Earth (Spleen/Stomach). Poria (Fuling) treats Phlegm-Fluid, attacks Kidney pathogens, and promotes water pathways; Cinnamon Twig (Guizhi) unblocks Yang Qi, harmonizes Ying and Wei, and opens collaterals; Atractodes (Baizhu) treats wind-induced dizziness, dries Phlegm-Fluid, and removes fullness; Licorice (Gancao) combined with Poria does not contribute to fullness but rather relieves it. Materia Medica also states Licorice descends Qi and removes irritability and fullness, hence its use.

On Ling Gui Zhu Gan Tang and Shen Qi Wan: The *Jin Gui* states: "For shortness of breath with slight Fluid retention, one should promote urination. Ling Gui Zhu Gan Tang is the primary formula. Shen Qi Wan also treats it." Listing both formulas highlights their subtle principles further. In the first volume's discussion on respiration, the intention of distinguishing respiratory disorders was detailed. Now, shortness of breath is also divided by respiration, with each formula corresponding. For shortness of breath on exhalation, Ling Gui Zhu Gan Tang is used to unblock Yang; when Yang transforms Qi, urine can be discharged. For shortness of breath on inhalation, Shen Qi Wan is used to unblock Yin; when Kidney Qi flows, the gate of urine becomes patent. Within half a sentence lies profound essence; this is why he is considered a Sage!

On Da Qing Long Tang and Xiao Qing Long Tang: In Overflowing Fluid (Yi Yin) syndrome, water fluid overflows to the exterior, making Ying and Wei entirely unfavorable. One must imitate the method for Ying and Wei injury in Cold Damage diseases: induce sweating to scatter water. When Ying and Wei circulate through meridians, water in the four limbs will also dissipate. Essentially, Da Qing Long Tang ascends like clouds and rain, while Xiao Qing Long Tang surges waves toward the ocean. For treating Fluid syndromes, Xiao Qing Long Tang must be the primary choice.

Combined Discussion on Shi Zao Tang and Gan Sui Ban Xia Tang: In Cold Damage disease, if there is hypochondriac stuffiness, fullness, and pain, Shi Zao Tang is used to purge Phlegm-Fluid. Although miscellaneous diseases are not comparable to Cold Damage, internal pain from Hanging Fluid (Xuan Yin) in the hypochondrium is the same. Moreover, with a deep and string-like pulse, if the pathogen is not urgently drained, it will not leave, and the pulse will not return. Thus, using Shi Zao Tang is acceptable despite its harshness. Any disease in the hypochondrium requiring purging should follow this example. As for Gan Sui Gan Cao Tang treating Retained Fluid, its subtlety and profundity are such that only those who have entered the realm of the Sages can master it. The *Nei Jing* only says: "Retained pathogens must be attacked." Zhang Zhongjing analyzed the principles to exhaust variations. For intangible Qi with Heat binding in the Stomach, Tiao Wei Cheng Qi Tang is used. For Heat binding in the Intestines, Da or Xiao Cheng Qi Tang is used. For tangible Fluid with stuffiness binding in the Chest, Xian Xiong Tang is used. For stuffiness binding in the Hypochondrium, Shi Zao Tang is used. For retention binding between the Stomach and Intestines, Gan Sui Ban Xia Tang is used. The classic states: "When the patient's pulse is hidden, and they desire diarrhea, which brings relief, yet after diarrhea, the epigastrium remains hard and full, this is Retained Fluid attempting to exit; Gan Sui Ban Xia Tang is indicated." The pulse vessel is blocked by Retained Fluid, hidden and non-moving. The symptom is a desire to defecate, bringing relief, seemingly indicating the Fluid is leaving, yet it cannot truly exit. The continuing hardness and fullness in the epigastrium show that the tail of the Retained Fluid has reached the intestine, but the root remains attached to the stomach. Unless the root is eradicated, the Fluid will not depart; hence this formula is established. Gan Sui and Gan Cao are strongly contrary, but used together, they drive towards the rooted retention, striking with full force, causing the retained pathogen to leave while the medicinal root itself perishes. This embodies the *Nei Jing* principle: "If there is a cause, there is no injury." Adding white honey for decoction retains the medicine, preventing it from bursting into innocent areas. The use of Ban Xia and Bai Shao is to enter the Earth element to address upper fullness; Ban Xia benefits Earth, Bai Shao subdues Wood. How miraculous! Later formularies deleted Gan Cao, turning miracle into rigidity. Establishing formulas and theories based on this is work for those of average or inferior capacity. What benefit is there?

Combined Discussion on Mu Fang Ji Tang, Ting Li Da Zao Xie Fei Tang, and Fang Ji Jiao Mu Ting Li Da Huang Wan: All three treat Branch Fluid (Zhi Yin) entering the diaphragm, with differences in depth and sequence. The first treats the Lung primarily; the second focuses exclusively on the Lung; the third treats the Lung and the Fu organ transmitted to by the Lung. Branch Fluid entering the diaphragm approaches the Heart and Lung, secretly aiding Kidney pathogens. The text states: "The patient has wheezing and fullness, hardness and firmness in the epigastrium, dark facial complexion, and a deep, tight pulse. After dozens of days, if vomiting and purging fail to cure, Mu Fang Ji Tang is indicated. If the pattern is deficiency, it cures; if excess, it recurs in three days. If recurrence is not cured by re-administration, remove Shi Gao, add Fu Ling and Mang Xiao." Generally, Branch Fluid entering upward obstructs Qi, causing rebellion in the Lung, leading to wheezing and wasting-thirst; it obstructs Blood, mixing in the epigastrium, leading to hardness. Kidney Qi responds externally with black color; blood stasis is also black, hence the dark complexion appears on the face. However, treatment of Heart and Kidney is deferred to prioritize the Lung. Once Lung Qi moves, Fluid does not rebel and resolves. Mu Fang Ji is pungent and warm, dispersing Retained Fluid and Qi stagnation, treating Lung wheezing and fullness. Shi Gao is pungent, sweet, and slightly cold, treating rebellious Qi in the epigastrium, clearing Lung, and calming wheezing. Ren Shen is sweet and pleasant, treating wheezing, wasting-thirst, and diaphragmatic Fluid, tonifying Heart and Lung deficiency. Gui Zhi is pungent and hot, unblocking vessels, opening Qi stagnation, and guiding Qi; taken in the Qi level, it cures immediately. If Fluid is in the Blood level, deeply connected to the Lower Jiao, it will recur after curing. Hence, Qi-level medicines like Shi Gao are removed, and Mang Xiao is added to enter the Yin level, opening blockage and resolving blood stasis. Shi Gao and Fu Ling remove epigastric hardness and attack Kidney pathogens. Ting Li Da Zao Tang greatly drains Lung Qi, also because Qi stagnation leads to fluid accumulation. Fang Ji Jiao Mu Ting Li Da Huang Wan treats abdominal fullness, dry mouth and tongue, and water Qi in the intestines. This is due to Lung Qi being depressed above, causing Water Fluid to fail to move below, resulting in severe dryness and heat. This pill urgently unblocks water pathways to save the depression of Metal Qi. It treats the lower rather than the upper, hence the pill form.

Combined Discussion on Xiao Ban Xia Tang, Xiao Ban Xia Jia Fu Ling Tang, and Waitai Fu Ling Yin: The first treats Branch Fluid with vomiting but no thirst. Branch Fluid entering the diaphragm causes vomiting; emerging from high places is the most convenient path. However, vomiters should normally be thirsty; thirst proves Branch Fluid is completely gone. If not thirsty, Fluid remains, not fully cleared. No additional treatment is needed. Simply using the pungent-warm nature of Ban Xia and the pungent-dispersing nature of Sheng Jiang guides the exiting trend, and the remaining pathogen will be eliminated. The second treats sudden vomiting with added epigastric stuffiness, water between the diaphragm, dizziness, and palpitations; thus, Fu Ling is added to remove water, attack Kidney, and calm the Spirit. The third adds Ren Shen, Zhi Shi, and Chen Pi, which is crucial. It treats cases where accumulated Fluid is gone, but empty Qi and Cold Fullness remain inside, preventing eating. This syndrome is common. The *Jin Gui* early appended the Waitai formula to inspire later generations. Who else but a pioneer among people could do this?

Combined Discussion on Ze Xie Tang and Hou Po Da Huang Tang: Both treat Branch Fluid by purging from below, differing in Qi/Blood and anterior/posterior aspects. The first treats Branch Fluid in the epigastrium, obstructing the ascent and descent of Yang Qi. Extreme Heart Qi depression generates Fire and Wind, causing dizziness and vertigo. Instead of treating the dizziness directly, one promotes urination to drain Branch Fluid; then Yang rises naturally, and Wind/Fire subsides. Zhang Zhongjing's formulas often... [text implies comparison] ...the latter treats Branch Fluid with chest fullness. When Branch Fluid reaches chest fullness, Zhang Zhongjing originally used Da or Xiao Xian Xiong Tang. This formula follows the Cheng Qi method, suitable only for intangible Cold Damage with Qi-level Heat binding, not for tangible Phlegm-Fluid. This is not Zhang Zhongjing's meticulous method. It is undoubtedly an error inserted by the compiler.

On Wu Ling San: The text states: "Suppose a thin person has palpitations below the umbilicus, expectorates saliva and foam, and suffers from epilepsy-like dizziness. This is Water. Wu Ling San is indicated." This is an ordinary formula. Deeply pondering its meaning, like pointing at the moon with a finger, it becomes clear. Thin people naturally have abundant Wood and Fire Qi. Due to Water Fluid, it depresses in the Yin, carrying Yin pathogens to drum at the umbilicus, causing palpitations; ascending to the Stomach, it causes expectoration of saliva and foam; when depression peaks and erupts, it goes straight to the head and eyes, causing epilepsy and dizziness. The *Chao Shi Bing Yuan* states: "Pathogens entering Yin cause epilepsy." When Yang is depressed in Yin, there is no epilepsy/dizziness; returning to Yang position, epilepsy/dizziness occurs because it carries Yin Qi upward. Thus, one does not treat epilepsy/dizziness directly, but disperses the Yin pathogen carried upward, resulting in immediate cure. The method to disperse Yin pathogen should theoretically be from the exterior, but Wu Ling San's exterior method is superior because it also promotes urination. Modern users of Wu Ling San only know it separates anterior/posterior water and grain, not realizing it separates exterior-interior and Yin-Yang. They ignore the instruction: "Drink plenty of warm water to sweat and cure." How shallow! Not only this; regarding Xiao Qing Long Tang, people know it as a mild exterior-releasing agent, unaware it is designed to promote small amounts of urine. The little dragon of mountains and marshes, growing horns, rides thunderstorms to the ocean; it cannot raise its whiskers to ascend to heaven—this needs no asking! Thus, the five formulas for Branch Fluid in the *Jin Gui* are all modifications of Xiao Qing Long Tang, taking advantage of its ability to open water pathways and travel a thousand miles without stopping.

Later generations have four methods for treating Phlegm-Fluid: Solidify Spleen, Dry Dampness, Descend Fire, Move Qi. Solidifying Spleen and drying Dampness, Er Chen Tang and Er Zhu (Cang Zhu, Bai Zhu), are most suitable, but contraindicated in Yin Deficiency. Descending Fire must distinguish deficiency/excess: Excess uses bitter-cold, Deficiency uses sweet-cold. As for Qi-moving drugs, various formulas are vague. Let me clarify. Wind-Cold pathogens entering from outside wrap Phlegm-Fluid; only Xiao Qing Long Tang separates the pathogen outward and Phlegm-Fluid downward. Turbid Yin Qi ascending from below wraps Phlegm-Fluid; Fu Ling Hou Po Tang separates turbid Qi downward and Phlegm-Fluid upward. Anger causes Liver Qi to rebel upward, carrying Blood; Qi, Blood, Phlegm, and Fluid interlock to form masses; Chai Hu Bie Jia San eliminates them. Worry causes Spleen Qi to depress internally, food stagnates; Qi, Food, Phlegm, and Fluid interlock to form masses; Qing Tan Wan eliminates them. Excessive desire causes Kidney Qi to rebel upward, penetrating the membrane source, forming countless knots, abdominal distension and heaviness, unable to lie supine; Gui Ling Wan guides Qi downward, and Phlegm-Fluid departs.

Deficient-Cold Phlegm-Fluid is rare in youth/adulthood (1-2 in 10). In elderly/children, it is common (4-5 in 10). If truly Spleen-Stomach deficient-cold, loss of appetite, Yin obstruction, vomiting saliva/foam, warm the middle. If True Yang is deficient, tonify the lower; upper-clearing medicines must not be used.

For pediatric slow spleen wind with Phlegm-Fluid blocking orifices and tunnels, Xing Fu Liu Jun Tang awakens the mind.

For elderly with Kidney deficiency causing water overflow and Phlegm-Fluid surging upward, Cui Shi Ba Wei Wan摄 (captures/secures) it.

Phlegm in the upper diaphragm with great fullness and excess requires vomiting to remove, but this is not a fixed rule. If it were fixed, everyone could use it; why praise Zi He (Zhang Congzheng)? Zi He observes if the patient can tolerate vomiting before doing so. If one vomiting is incomplete, wait for a second or third. Slowly guide it. The method of inducing phlegm has its own control and release, clearly not reckless. I re-discuss the unstated intent of the *Jin Gui* to clarify. The *Shang Han Lun* uses Sweating, Vomiting, Purging, Harmonizing, and Warming. For Phlegm-Fluid, vomiting should be mentioned first, yet Zhang Zhongjing omits it. Why? He mentions "vomiting eruption" because wheezing/fullness causes Phlegm-Fluid to overflow upward, spontaneously from within. Saying "doctors failed with vomiting/purging" does not blame vomiting/purging. Saying "vomiters should be thirsty, thirst indicates resolution" hopes for resolution via vomiting. Why not say "Vomiting is permissible"? Zhang Zhongjing likely believed Phlegm-Fluid syndromes often accompany Qi-related dizziness and vertigo; vomiting would be dangerous. Thus, he omitted verbose explanations and did not establish vomiting as a law, avoiding opening doors for future errors, thereby becoming the ancestor of legal formulation. Since Zi He gained fame with vomiting, ignorant people rushed to shortcuts, causing endless harm. One must understand Zhang Zhongjing's intent to speak of vomiting, then vomiting will be appropriate.

Now, twelve prohibitions for vomiting:
1. Dizziness, vertigo, and fainting: do not vomit.
2. High voice and shallow breathing: do not vomit.
3. Accumulated fatigue not rested: do not vomit.
4. New deficiency after illness: do not vomit.
5. Weak water pathways: do not vomit.
6. Dangerous and urgent disease progression: do not vomit.
7. Yang deficiency with profuse sweating: do not vomit.
8. History of habitual bleeding: do not vomit.
9. Stormy, dark weather: do not vomit.
10. Winter season of closure/storage: do not vomit.
11. Indecisive and suspicious constitution: do not vomit.
12. Violating precautions after vomiting: do not vomit.

Now, ten prohibitions for medicines:
1. Yin deficiency with dryness: recklessly use Er Chen Tang.
2. Yang deficiency with profuse sweating: recklessly use Xiao Qing Long Tang.
3. Heart deficiency with weak spirit: recklessly use pungent-dispersing drugs.
4. Lung deficiency with lack of Qi: recklessly use bitter-purgatives.
5. Liver deficiency with stabbing Qi: recklessly use Long Hui Wan.
6. Spleen deficiency with edema: recklessly use Gun Tan Wan.
7. Stomach deficiency with fluid exhaustion: recklessly use aromatic-dry drugs.
8. Easily disturbed Zang-Fu: recklessly induce vomiting/purging.
9. Not solid accumulation: recklessly use harsh purgatives.
10. Deficient Qi and Blood: recklessly use acupuncture/moxibustion.

[Three Laws]
1. Whenever Hot Phlegm rides Wind-Fire upward, causing dim vision and tinnitus, resembling deficiency, mistakenly using warm-tonics will bind the Phlegm permanently with no exit. This is the doctor's fault.
2. Whenever Phlegm-Fluid exits with food, if the幽门 (pylorus/opening) is not opened, merely warming the Stomach leaves one helpless, delaying and harming the patient. This is the doctor's fault.
3. Whenever encountering Kidney deficiency with water overflow, surging Phlegm, high Qi, and急促 wheezing, failing to tonify the lower and instead clearing the upper will inevitably lead to Qi collapse and death. This is the doctor's fault.