水气上逆。得阳煎熬。则稠而成痰。得阴凝聚则稀而为饮。皆以脾肾二经为主。以水归
于肾而受制于脾也。金匮以痰饮悬饮溢饮支饮分四饮。后人加留饮。为五饮。不知留饮即痰
饮也。唐宋以后名色愈多。而治法愈乱。兹举数方。为扼要之法。
凡痰脉多应于滑。脉沉而弦者。主悬饮内痛。
一痰饮诸方。以二陈汤为通剂。兹加减法。仿金匮之意故取效倍于诸家。
二陈汤。（八十二）
久嗽气短。加桂枝一钱五分。白术二钱。此从水道以化气也。或与肾气丸互服。停饮胁
痛。加白芥子一钱五分。前胡二钱。
四肢肿。身体疼重。加生黄 三钱。防己二钱。
咳逆倚息。气短不得卧。加木防己三钱。桂枝人参各一钱五分。水煎好。入芒硝八分服。
心下有支饮。其人若眩冒。加泽泻四钱。白术二钱。
咳嗽不已。加干姜细辛五味子。
以上。俱仿金匮意加减。
火痰。加海粉栝蒌仁黄芩海石。○寒痰。加干姜附子。○风痰。加制南星天麻竹沥姜汁。
○
加人参白术。○实痰。加旋复花枳实。○食痰。加莱菔子。
一实热老痰。变出怪症。不可名状。宜
礞石滚痰丸。（六十三）
中脘留伏痰饮。臂痛难举。手足不得转动。宜
指迷茯苓丸。（六十四）
按痰饮之病最多。胸胁疼。呕逆。神识不清。及手足臂痛。皆是。大抵痰为阳邪。随气
所到。其症变幻无常。凡苦辛酸咸及竹沥姜汁童便皂角芒硝之类。随症可加入。亦有虚者
宜六君子汤桂苓甘术汤。肾气丸。真武汤。小半夏倍加。茯苓汤等。以扶元气。饮为阴邪。
唯停于心下胁下。为胀为咳为悸为眩冒。及溢于皮肤而为肿。必以桂苓术附。加生姜汁之类。
使离照当空。而群阴力能退避。若以地黄麦冬五味附和其阴。则阴霾冲逆肆空。饮邪滔天莫
救矣。
Water qi rebels upward. When subjected to the scorching of Yang, it becomes thick and forms phlegm (Tan Yin); when condensed by Yin, it remains thin and forms fluid retention (Yin). Both primarily involve the Spleen and Kidney meridians, as water returns to the Kidneys and is controlled by the Spleen. *Jin Gui Yao Lue* classifies Tan Yin, Xuan Yin, Yi Yin, and Zhi Yin into four categories of fluid retention. Later scholars added Liu Yin, making five types. However, it is unknown that Liu Yin is essentially Tan Yin. After the Tang and Song dynasties, names multiplied, and treatment methods became increasingly chaotic. Here, several formulas are presented as essential methods.
Generally, the pulse for phlegm manifests as slippery (Hua). A deep and wiry (Xian) pulse indicates internal pain due to Xuan Yin.
1. Among various formulas for treating phlegm and fluid retention, Er Chen Tang serves as a general base formula. The modifications here imitate the intent of *Jin Gui Yao Lue*, thus achieving effects superior to other schools.
Er Chen Tang. (Formula 82)
For chronic cough with shortness of breath, add Guizhi (Cinnamon Twig) 1.5 qian, Baizhu (Atractylodes Macrocephala Rhizome) 2 qian. This method transforms Qi through the water passages. It may be taken alternately with Shenqi Wan.
For fluid retention causing hypochondriac pain, add Baijiezi (White Mustard Seed) 1.5 qian, Qianhu (Peucedani Radix) 2 qian.
For swelling in the four limbs and heavy body pain, add Sheng Huangqi (Raw Astragalus Root) 3 qian, Fangji (Stephaniae Tetrandrae Radix) 2 qian.
For cough with rebellious Qi, leaning on support to breathe, shortness of breath, and inability to lie flat, add Mufangji (Stephaniae Membranaceae Radix) 3 qian, Guizhi (Cinnamon Twig) and Renshen (Ginseng Radix et Rhizoma) 1.5 qian each. Decoct in water, and upon completion, add Mangxiao (Natrii Sulfas) 0.8 qian to take.
For Zhi Yin located under the heart, where the patient experiences dizziness and vertigo, add Zexie (Alismatis Rhizoma) 4 qian, Baizhu (Atractylodes Macrocephala Rhizome) 2 qian.
For unceasing cough, add Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix et Rhizoma), and Wuweizi (Schisandrae Chinensis Fructus).
The above modifications all imitate the intent of *Jin Gui Yao Lue*.
For Fire Phlegm, add Haifen (Sea Powder), Gualouren (Trichosanthis Semen), Huangqin (Scutellariae Radix), and Haishi (Pumex). ○ For Cold Phlegm, add Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata). ○ For Wind Phlegm, add Zhinanxing (Arisaematis Rhizoma Preparatum), Tianma (Gastrodiae Rhizoma), Zhuli (Bamboo Sap), and Jiangzhi (Ginger Juice). ○ Add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodes Macrocephala Rhizome). ○ For Excess Phlegm, add Xuanfuhua (Inulae Flos) and Zhishi (Aurantii Fructus Immaturus). ○ For Food Stagnation Phlegm, add Laifuzi (Raphani Semen).
1. For old phlegm resulting from excess heat, which manifests as bizarre and indescribable symptoms, Mengshi Gun Tan Wan is suitable. (Formula 63)
For latent phlegm and fluid retention at the Zhongwan point, causing arm pain difficult to lift and immobility of hands and feet, Zhimi Fuling Wan is suitable. (Formula 64)
Note: Diseases of phlegm and fluid retention are numerous. Chest and hypochondriac pain, vomiting and rebellious Qi, unclear consciousness, and pain in hands, feet, and arms are all included. Generally, phlegm is a Yang pathogen; wherever Qi moves, symptoms vary unpredictably. Bitter, pungent, sour, and salty substances, as well as bamboo sap, ginger juice, child's urine, soap bean, and mangxiao, can be added according to symptoms. Deficiency cases are suitable for Liujunzi Tang, Guiling Gan Zhu Tang, Shenqi Wan, Zhenwu Tang, Xiaobanxia Tang (with doubled dosage), and Fuling Tang, to support Yuan Qi. Fluid retention is a Yin pathogen; it stops under the heart or in the hypochondrium, causing distension, cough, palpitations, and dizziness, or overflows into the skin causing edema. One must use Guizhi, Fuling, Baizhu, Fuzi, plus ginger juice, etc., so that the Sun (Li Trigram) shines brightly, forcing the Yin pathogens to retreat. If one uses Dihuang, Maidong, and Wuweizi to harmonize and nourish Yin, then Yin mist will rebel uncontrollably, and the flood of fluid retention will be incurable.