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The *Jingui Yaolue* states: Someone asked, "There are four types of fluid retention (Yin). What are they?" The Master replied, "There is Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Branch Fluid)." He was asked again, "How do these four types differ?" The Master said, "If a person who was previously robust has now become emaciated, and water flows between the intestines making a gurgling sound, this is called Tan Yin. If after drinking, water flows and accumulates under the hypochondrium, causing pain when coughing or spitting, this is called Xuan Yin. If water flows into the limbs, sweat should be produced but is not, resulting in body ache and heaviness, this is called Yi Yin. If there is coughing with air reflux, shortness of breath preventing lying flat, and the body appears swollen, this is called Zhi Yin."

Tan Yin causes harm to seven or eight out of ten people. The *Jingui Yaolue* discusses this in great detail, distinguishing them and giving each a name. Later generations, due to the multitude of names, pursued the superficial aspects while forgetting the root. They failed to consider that the laws established by the sages all originate from a single source, without many divergent paths. Generally, the Stomach is the sea of water and grain, the great source of the five zang and six fu organs. When food and drink enter the Stomach, their essence floats and overflows, transporting upwards to the Spleen. The Spleen scatters the essence, sending it upwards to the Lung. The Lung regulates the water passages, transporting downwards to the Bladder. Water essence distributes in all directions, and the five meridians run in parallel, which constitutes the state of a normal person. The *Jingui Yaolue* explains pathology from the point where water essence does not distribute in all directions and the five meridians do not run in parallel. It distinguishes depth according to symptoms, teaching people to seek meaning through names. Superficial pathology lies within the body shell but outside the zang-fu organs; there are four types of fluid: one flows down from the Stomach to the intestines, one flows sideways from the Stomach to the hypochondrium, one exits outwardly from the Stomach to the limbs, and one enters upwardly from the Stomach to the diaphragm. Initially unnoticed, day by day and month by month, the essence of water transforms into turbid matter, thus becoming Tan Yin. It must first gather in places where respiratory qi cannot easily reach. Thus, from the intestines to the hypochondrium, then to the limbs, gradually infiltrating the diaphragm, the pathological trend becomes increasingly rebellious. Therefore, the affliction of Tan Yin invariably originates from the Stomach. The five zang organs are the residence of the spirit. Accumulated water flooding to become Tan Yin, wrapping around the exterior, is surely a major affliction to the human body.

Any water-fluid that accumulates and does not dissipate is named Liú Yǐn (Retained Fluid). "Liu" means remaining and not departing. Retained fluid that is removed but not completely cleared is named Fú Yǐn (Hidden Fluid). "Fu" means hidden and not emerging. According to whether the Tan Yin is retained or hidden, appropriate treatment methods are applied; this is the profound principle. Let us discuss it now. For fluid rising from the Stomach to the chest, hypochondrium, Heart, and Lung areas, drive it back to the Stomach, or let it exit downward through the intestines, or upward through vomiting, so as not to hide. If it moves from the diaphragm outward to the skin and muscles, the clear part may exit through sweat; the turbid part has no exit. There must be some hiding in the skin and muscles that cannot be driven out. If it hides deeply in the back from the diaphragm, and since the back is the mansion of the chest, there is no other exit. Not only can it not be driven out, but it may also carry the wild yang and vigorous fire in the back, erupting as carbuncles and sores. Hidden fluid is difficult to discharge downward and prone to brewing disaster; who can distinguish it? Who can expel it?

Water in the Heart: hardness and palpitations below the heart, shortness of breath, aversion to water and unwillingness to drink. Water in the Lung: expectoration of saliva and foam, desire to drink water. Water in the Spleen: lack of qi, heavy body. Water in the Liver: fullness and distension under the hypochondrium, pain upon sneezing. Water in the Kidney: palpitations below the heart. A person with retained fluid below the heart feels cold on the back, cold as large as a palm. Retained fluid in the hypochondrium causes pain radiating to the Qinglun acupoint, stopping upon coughing (or worsening). A person with retained fluid in the chest has shortness of breath and thirst, wandering joint pain in the four limbs; those with a deep pulse have retained fluid. Phlegm disease above the diaphragm presents with fullness, wheezing, coughing, and expectoration; upon attack, there are alternating chills and fever, backache, lower back pain, spontaneous tearing, and severe tremors; this indicates hidden fluid. Patients who drink much water will suddenly experience wheezing and fullness. Those who eat little but drink much have water stopping below the heart; severely, palpitations occur; mildly, shortness of breath occurs. A double-string pulse indicates cold, often occurring after severe purgation leading to deficiency. A unilateral string-like pulse indicates fluid retention. Lung fluid retention does not present with a string-like pulse, but rather suffering from wheezing and shortness of breath. Branch fluid also causes wheezing and inability to lie down, plus shortness of breath, with a normal pulse. For phlegm-fluid diseases, warm herbs should be used to harmonize. For phlegm-fluid below the heart with hypochondrial fullness and dizziness, Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction) is the primary formula. Urination will become profuse.

The *Lingshu* states: When the Pericardium Meridian is affected, it causes chest and hypochondrial fullness. This is due to phlegm-fluid accumulating there and causing disease. With phlegm below the heart, water essence fails to ascend to nourish the eyes, causing dizziness. Poria treats phlegm-water and subdues kidney pathogenic factors. Cinnamon Twig unblocks yang qi and opens collaterals. Atractodes treats phlegm-water and removes distension. However, one should avoid sweet foods for middle-jiao fullness. Why use Licorice here? The pungency of Cinnamon Twig, combined with sweetness, aids dispersion and harmonizes heat, preventing it from flaming upward. Licorice combined with Poria prevents hypochondrial fullness and promotes seepage and drainage; sweetness can descend qi and remove fullness.

For shortness of breath caused by slight fluid retention, it should be eliminated via urination. Ling Gui Zhu Gan Tang is the primary formula. Shen Qi Wan (Kidney Qi Pill) is also indicated.

Slight fluid retention causing shortness of breath results from kidney deficiency and water pathogen accumulation, hindering the ascending and descending of sanjiao qi and respiration. These two formulas have specific indications. Ling Gui Zhu Gan Tang treats fluid in the Yang aspect, causing shortness of breath during exhalation. Shen Qi Wan treats fluid in the Yin aspect, causing shortness of breath during inhalation. Exhalation involves the Heart and Lung; inhalation involves the Kidney and Liver. Poria enters the Taiyin Lung meridian; Cinnamon Twig enters the Shaoyin Heart meridian; both are light and clear agents treating the Yang. Rehmannia enters the Shaoyin Kidney meridian; Cornus enters the Jueyin Liver meridian; both are heavy and turbid agents treating the Yin. Treatment must be based on whether the patient's constitution is biased toward Yin or Yang. One syndrome, two formulas—is there no reason?

If a patient has a hidden pulse and desires diarrhea, which brings relief, yet the epigastrium remains hard and full despite the diarrhea, this is because retained fluid is attempting to exit. Gan Sui Ban Xia Tang (Kansui, Pinellia, and Licorice Decoction) is the primary formula. Retained fluid blocks the orifices and tunnels, preventing Stomach qi from transforming and transporting, hence the hidden pulse. Once the retained fluid moves downward, the Stomach qi is injured, leading to a desire for diarrhea. Relief after diarrhea indicates temporary clearance of the middle jiao blockage. Since accumulation recurs, continued hardness and fullness persist. Further medication is needed to thoroughly purge the fluid. To reach the accumulated fluid directly, Kansui is best used as the sovereign herb for its rapid action. To harmonize the spleen and stomach and remove epigastric hardness, Pinellia serves as an assistant. However, Peony retains dampness; why is it used for retained fluid? Licorice is incompatible with Kansui; why are they used together? Licorice moderates the potency of Kansui, preventing it from acting too hastily, allowing it to linger and purge the retained fluid. Peony treats wood stagnation in the earth causing hardness and fullness, and assists Pinellia in harmonizing the stomach and dissolving hardness.

A deep and string-like pulse indicates internal pain from Xuan Yin (Hanging Fluid). For Xuan Yin, Shi Zao Tang (Ten Date Pill) is the primary formula.

Xuan Yin knotting internally causes pain, manifesting as a deep and string-like pulse. Genkwa's pungency disperses fluid; Kansui and Oldenlandia's bitterness drains water; Jujube's sweetness enters the spleen to overcome water.

For Yi Yin (Overflowing Fluid), sweating should be induced. Da Qing Long Tang (Major Green Dragon Decoction) is the primary formula, aiming for a slight sweat. If sweating is excessive, apply warm powder. Xiao Qing Long Tang (Minor Green Dragon Decoction) is also indicated.

When water-fluid overflows to the exterior, Ying and Wei are all impaired, similar to Ying and Wei injury in Cold Damage. Sweating is necessary to disperse the water so that Ying and Wei meridians can function, eliminating water from the limbs. For exterior constraint with excess heat, Da Qing Long Tang is used to release it. For interior accumulation of cold fluid, Xiao Qing Long Tang is used to release it. Although both are exterior-releasing methods, there are subtle differences that must be distinguished.

For Zhi Yin (Branch Fluid) in the diaphragm, presenting with wheezing, fullness, epigastric hardness, dark complexion, and a deep-tight pulse, lasting for decades and unresponsive to emetic and purgative treatments, Mu Fang Ji Tang (Stephania Decoction) is the primary formula. If the pattern is deficient, recovery follows; if excess, relapse occurs after three days. Re-administering the same formula without improvement requires Mu Fang Ji Tang minus Shih Gao (Gypsum) plus Fu Ling (Poria) and Mang Xiao (Mirabilite). Mild diarrhea indicates recovery.

Zhi Yin in the diaphragm obstructs the smooth flow of qi and blood. Qi obstruction causes rebellion with water into the Lung, triggering wheezing and fullness. Blood obstruction mixes with water in the epigastrium, causing hardness and fullness. Kidney qi corresponds to water; kidney water color is black, and coagulated blood is also black, hence the dark complexion. Deep pulse indicates water; tight pulse indicates cold. This cold is either external or due to water qi. Emetic and purgative treatments fail because the medicine does not match the pathology. Stephania disperses retained fluid and stagnant qi; Gypsum addresses rebellious qi in the Heart and Lung; Ginseng strengthens the Stomach to dispel water; Cinnamon Twig harmonizes Ying and opens knots. Zhi Yin moves with warmth. If the pathogen is shallow in the Qi level and predominantly deficient, recovery follows immediately. If deep in the Blood level and predominantly excess, relapse occurs. Gypsum is a Qi-level herb, so it is removed. Mang Xiao is a Blood-level herb that softens hardness and treats phlegm; Poria subdues the Kidney and promotes urination, serving as an assistant to Mang Xiao, so it is added.

For Zhi Yin below the heart causing severe dizziness and vertigo, Ze Xie Tang (Alisma Decoction) is the primary formula.

Zhi Yin obstructs the ascending and descending of Yang. Prolonged stagnation generates fire; fire stirring wind causes dizziness and vertigo. Alisma opens orifices and promotes urination to drain Zhi Yin; Atractodes harmonizes the middle and dries dampness, allowing Yang to ascend and fire to subside.

For Zhi Yin with chest fullness, Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction) is the primary formula.

This is essentially Xiao Cheng Qi Tang, named Hou Po Da Huang Tang due to the larger dose of Rhubarb. If Magnolia Bark is dominant, it is called Hou Po San Wu Tang. This case of Zhi Yin with chest fullness arises from chronic damp-heat and turbid fluid rebelling upward. Thus, herbs that purge the middle jiao are used.

For Zhi Yin causing inability to breathe, Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Lung-Purging Decoction) is the primary formula.

Zhi Yin stagnation blocks qi in the chest, causing breathing difficulty. Descurainia breaks stagnation and harmonizes fluid; Jujube benefits the Lung and harmonizes the middle. Qi congestion leads to fluid accumulation; fluid accumulation leads to heat knotting, hence treated similarly to Lung Abscess.

Those who vomit should naturally feel thirsty; thirst indicates resolution. Now, if there is no thirst, it is because of Zhi Yin below the heart. Xiao Ban Xia Tang (Pinellia and Ginger Decoction) is the primary formula. For sudden vomiting, epigastric fullness, water in the diaphragm, dizziness, and palpitations, Xiao Ban Xia Jia Fu Ling Tang (Pinellia, Ginger, and Poria Decoction) is the primary formula.

Vomiting usually involves phlegm; thirst after exhausting phlegm indicates resolution, similar to thirst after taking Xiao Qing Long Tang in Cold Damage indicating the departure of cold. Lack of thirst now indicates residual fluid retention. Pinellia resolves knots and overcomes dampness; Ginger disperses qi and stops vomiting. Adding Poria per the *Qianjin Fang* aligns with the method for sudden vomiting, epigastric fullness, diaphragmatic water, dizziness, and palpitations.

Abdominal fullness with dry mouth and tongue indicates water qi in the intestines and stomach. Ji Jiao Li Huang Wan (Stephania, Lepidium, Descurainia, and Rhubarb Pill) is the primary formula. If there is saliva in the mouth but still thirst, add half liang of Mang Xiao (Mirabilite).

Water accumulation in the intestines impairs Lung qi dissemination, leading to heat generation, abdominal fullness, and failure of fluids to ascend, causing dry mouth and tongue. Stephania, Lepidium seed, and Descurainia promote urination and dissipate stagnant qi; Descurainia specifically benefits the intestines. Since the intestines and stomach receive water and grain, excess evil causing fullness requires more than mild agents; Rhubarb must be added to purge. If there is saliva but persistent thirst, this indicates phlegm-fluid gathering in the Blood level; Mang Xiao must be added to expel it.

Thirst followed by vomiting indicates water stopping below the heart, belonging to fluid disorders. Xiao Ban Xia Fu Ling Tang (Pinellia, Ginger, and Poria Decoction) is the primary formula.

Initial thirst occurs because phlegm-fluid occupies the central palace, preventing fluids from irrigating the upper jiao, causing Lung dryness. Subsequent vomiting occurs because accumulated fluid in the Stomach rebels upward with qi. Ginger and Pinellia purge fluid; Poria leaches dampness. Removing dampness stops vomiting, unblocks fluids, and resolves thirst. This differs significantly from Cold Damage with water qi below the heart causing cough, slight wheezing, fever, and no thirst, where thirst after Xiao Qing Long Tang indicates fluid consumption. Here, thirst is due to phlegm-qii obstruction. The sequence of thirst reveals the fluctuation of fluid retention. People believe Pinellia is drying and contraindicated for thirst, ignoring its miraculous ability to resolve thirst.

If a thin person has palpitations below the umbilicus, expectorates saliva and foam, and experiences dizziness, this is water. Wu Ling San (Five-Ingredient Powder with Poria) is the primary formula.

Thin people typically lack phlegm-dampness. Dizziness and saliva expectoration clearly indicate water accumulation below the umbilicus. Wu Ling San uses the pungent-warmth of Cinnamon Twig to disperse it.

Chronic coughing for years: a weak pulse is treatable; a solid, large, and rapid pulse indicates death. A deficient pulse implies severe dizziness. This is due to pre-existing Zhi Yin in the chest. Treatment falls under fluid disorders.

The latter half specifically supplements the pulse diagnosis for dizziness caused by Zhi Yin below the heart. Dizziness belongs to wind-deficiency and cannot present with a solid pulse. Treatment falls under fluid disorders, not limited to Ze Xie Tang alone.

Zhu Danxi stated: The sources of phlegm are diverse. There is phlegm generated by heat, heat generated by phlegm, phlegm generated by qi, phlegm generated by wind, phlegm generated by fright, phlegm from accumulated fluid, phlegm from overeating, phlegm from summerheat, phlegm from cold injuries, phlegm from Spleen deficiency, and phlegm from alcoholism. Pathologically, fright-phlegm causes Pericardium pain and epilepsy; heat-phlegm causes irritability and palpitations; wind-phlegm causes paralysis and severe dizziness; fluid-phlegm causes vomiting, hypochondrial pain, and immobility of limbs; food-phlegm causes malaria, dysentery, bad breath, and masses; summerheat-phlegm causes vomiting, reversal, and dizziness; cold-phlegm causes bone bi and stabbing pain, limb immobility; wine-phlegm causes hypochondriac and arm pain, indigestion, and next-day vomiting; Spleen-deficiency phlegm causes poor appetite and reverse vomiting; damp-phlegm causes fatigue and weakness; qi-phlegm causes wandering stabbing pain. Women often suffer most from fright-phlegm, forming masses in the abdomen that swell like pregnancy, causing unbearable pain. Also, old phlegm condenses and adheres firmly; without warm herbs to guide it, rejection may occur. Pang Anchang said: "In the human body, phlegm does not flow upward against gravity; in the world, water does not flow upstream." Therefore, skilled practitioners treat qi rather than phlegm directly; when qi flows smoothly, body fluids follow. Phlegm belongs to damp-heat and is transformed from body fluids. Due to wind-cold-damp-heat or emotional/dietary injuries, qi rebels and fluids become turbid, transforming into phlegm-fluid. It may be vomited up, stagnate in the diaphragm, accumulate in the intestines/stomach, or lodge in meridians/limbs, moving with qi throughout the body. Symptoms include wheezing, coughing, nausea, vomiting, epigastric fullness, obstruction, diarrhea, dizziness, heartburn, palpitations, mania, alternating chills/fever, swelling/pain, gurgling sounds in the chest, cold spots on the back, and limb numbness—all caused by phlegm. Many diseases involve concurrent phlegm, unknown to the public. Phlegm varies by newness, duration, and severity. New/light phlegm is clear and pale with faint odor; old/heavy phlegm is yellow, turbid, sticky, difficult to expectorate, with foul odors (sour, spicy, fishy, salty, bitter), sometimes bloody. Treatment: Phlegm originates in the Spleen/Stomach; strengthen the Spleen and dry dampness. Since it rises with qi, regulate qi first, then guide it. Rising qi relates to fire; regulating qi involves clearing fire. Clear heat-phlegm, dry damp-phlegm, scatter wind-phlegm, open depressed-phlegm, soften stubborn-phlegm, digest food-phlegm. Above, induce vomiting; below, purge. For middle qi deficiency, consolidate middle qi to transport phlegm; excessive attacking damages Stomach qi and worsens phlegm.

Yu Jiayan stated: The *Neijing* says, "All qi constraints belong to the Lung." Lung constraint generates heat; excessive heat generates phlegm. Phlegm夹杂着 blood stasis forms "nest sacs" (ker nang). Chest fullness and oppression occur; even in summer, no sweat at sites of phlegm-fluid accumulation. Cold phlegm and clear fluid fill the nest sacs, causing severe vomiting and reflux. This progresses step-by-step. Often caused by rich flavors accumulating heat, drying intestines/stomach, compounded by depression. Stomach blood stagnates due to turbid phlegm, gradually leading to dysphagia and reverse vomiting over time. Drying agents worsen this. Only Bamboo Sap, Ginger Juice, and Leek Juice can treat it. Drink 3-5 cups daily until chest irritability occurs, which is auspicious. Follow with blood-nourishing, Spleen-strengthening, and moistening herbs. Methods to treat phlegm include: driving, guiding, washing, resolving, inducing vomiting, regulating Spleen, clearing fire, and moving qi. Previous methods were detailed. Nest-sac phlegm is like bees in a hive or lotus seeds in a pod; easy to grow, hard to remove. Narrow outside, wide inside, resisting driving/guiding/washing/vomiting agents, injuring healthy tissue. Qi flows from Jing to Luo vessels. Nest sacs begin with phlegm gathering at the Stomach gate. Vomiting agitates Stomach qi; half exits via throat, half enters Luo vessels connecting to the diaphragm. Rapid qi entry pierces the diaphragm, allowing phlegm to reside. Long-term phlegm blocks airways, causing incoming qi to form another sac. Phlegm-fluid in the diaphragm is imperceptible to clear qi but moves with turbid qi. Triggered by cold, heat, alcohol, food, anger, or desire, always by disturbing turbid qi rising with fire, displacing clear qi. Treating nest-sac phlegm is difficult. First, concentrate mind in qi, adjust quietly, reduce rich flavors to remove Stomach phlegm, prevent Stomach qi from rushing to Luo vessels, allow Luo qi to return to Stomach. Gradually use herbs to open sacs and wash out phlegm. Later generations use four methods for phlegm-fluid: strengthen Spleen, dry dampness, clear fire, move qi. Er Chen Tang plus Cang Zhu and Bai Zhu is suitable for strengthening Spleen and drying dampness, but contraindicated in Yin deficiency. Clearing fire must distinguish excess (bitter-cold) vs. deficiency (sweet-cold). Regulating qi herbs in various formulas are vague; let me clarify. Wind-cold invading inward trapping phlegm-fluid requires Xiao Qing Long Tang to separate pathogen outward and fluid downward. Turbid yin rising upward trapping phlegm-fluid requires Jin Gui Ban Xia Hou Po Tang (Si Qi Tang) to separate turbidity downward and fluid upward. For those with excessive desires, Kidney qi rebels piercing the membrane origin, causing massive accumulation, abdominal distension/heaviness, inability to lie supine. Gui Ling Wan guides qi downward, resolving phlegm-fluid. Deficient-cold phlegm-fluid is rare in youth but common in elderly/children. If Spleen/Stomach deficient-cold causes anorexia, yin obstruction, and saliva vomiting, warm the middle; if True Yang is deficient, tonify below; clearing upper herbs are contraindicated. Phlegm-fluid is one syndrome with two causes: Phlegm stems from fire (heat only, no cold); Fluid stems from dampness (can be heat or cold). Like hot springs exist but not cold fires. Phlegm-fluid knotting in the chest causes fullness, oppression, frequent coughing without expectoration. Total cause is Spleen failing to transport fluids for the Stomach, generating phlegm from diet, infiltrating Lung orifices, making coughing difficult. Although treating phlegm is urgent, phlegm-resolving herbs tend to consume qi and damage deficiency, risking wind invasion before phlegm exits. Only precise use of sweet-cold herbs to block wind, clear heat, moisten dryness, tonify deficiency, and resolve phlegm is correct. Fright-phlegm blocking orifices exists everywhere in Liver, Lung, Heart, and Pericardium collaterals. Three-position pulses are deficient and weak; pathogen excess, righteous qi deficient, hard to disperse. Using emetics is like a military raid on camp, risky. Guiding downward is impossible for orifice phlegm, only damaging Spleen qi. Prioritize regulating Spleen. Spleen qi is the dynamic yang of the body, like the sun in the sky. When yin condensation blocks all sides, the sun loses its place. When phlegm confounds consciousness, the Spleen loses its