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Thin fluid is called "Yin" (fluid retention), thick fluid is called "Tan" (phlegm); this was not explicitly stated by Zhang Zhongjing. However, the distinction between thin and thick reveals its meaning. Ancient prescriptions detailed "Yin" but were brief on "Tan", whereas later works detailed "Tan" but were brief on "Yin". Among various schools of thought, only Yang Renzhai's work separated them into two categories, while others confused them indistinguishably, like mixing waters from the Zi and Ming rivers. This compilation follows Yang Renzhai's example for ease of reference; regarding the formulas, they may be used interchangeably with mutual reference.

Distinction between Tan and Yin: Tan refers to saliva and mucus condensing and accumulating in the chest and diaphragm; Yin refers to water and fluids stagnating in the bladder. (*Zhubing Yuanhou Lun*) [Note: The mention of the bladder here is questionable.]

Thick and turbid substances are Tan; clear and thin substances are Yin. One arises from fire and dryness, the other from cold and dampness. Modern physicians fail to distinguish them and treat them indiscriminately, which is why few achieve therapeutic efficacy. (*Yitong*)

Tan is the accumulation of Yin; Yin is the initial stage of Tan. Thin saliva and water constitute Yin. (*Yixue Liuyao*)

Although Tan and Yin are said to be of the same category, they are actually different. Generally, Yin belongs to the category of water fluids. Symptoms such as vomiting clear water, abdominal distension, belching with a sour and putrid odor, and gurgling sounds in the abdomen indicate that food and drink residues have stagnated and failed to circulate; this is what is termed "Yin". In contrast, unlike Yin, Tan is thick and turbid while Yin is clear. Yin stays only in the intestines and stomach, whereas Tan can reach anywhere. When undigested food and drink stagnate to form Yin, the pathology lies entirely in the Spleen and Stomach. When things reach everywhere and transform into Tan, damage to any of the Five Zang organs can cause it. Therefore, those treating these conditions must know how to differentiate and must investigate the root cause. (*Jingyue Quanshu*)

Sources of Various Yin Syndromes: Tan-Yin arises from the blockage of Qi and meridians, obstruction of Jin-Ye (body fluids) flow, and the stagnation of water-fluid Qi in the chest and fu-organs, condensing into Tan. Additionally, if a person who was previously robust becomes emaciated, and water moves through the intestines making a gurgling sound, it is called Tan-Yin. Its symptoms include distension and fullness in the chest and hypochondrium, inability to digest food and drink, accumulation in the abdomen and between the ribs, gurgling sounds when water enters the intestines, heavy body, excessive salivation, shortness of breath, propensity to sleep, chest and back pain, and in severe cases, rebellious Qi, coughing with difficulty breathing lying flat, and a swollen appearance. A pulse that is predominantly wiry indicates Tan; a floating and slippery pulse indicates Yin. (*Zhubing Yuanhou Lun*) [Note: Chao Yuanfang distinguished Tan and Yin into two categories, but this syndrome description combines texts from Branch Fluid Retention (Zhi Yin) and cannot be clearly differentiated; it is listed here tentatively. Other Tan syndromes are also vague and are not recorded.]

Hot Tan arises from the accumulation and结 (knotting) of drinking water. It implies a blockage of Yin and Yang, heat generation in the Upper Jiao, where heat Qi battles with Tan-water, gathering without dispersing, causing deficient heat in the body, hindering diet, and heat in the head and face. Hence it is called Hot Tan.

Cold Tan refers to weak Stomach Qi failing to distribute and transport food and drink, causing Tan-water to accumulate and stay in the chest and diaphragm, leading to frequent acid regurgitation, rebellious Qi, cyanosis of the four limbs, and inability to eat or drink.

Tan Solidification Syndrome: This occurs when Tan-water accumulates in the chest and fu-organs, battling with cold and heat Qi, solidifying and refusing to dissipate, causing epigastric and abdominal fullness and oppression, restless breathing, dizziness, blurred vision, and frequent nausea and rebellious Qi. Hence it is called Tan Solidification.

Flowing Yin (Liu Yin): Caused by excessive drinking of water, where water flows between the intestines and stomach making a gurgling sound. If it encounters Qi and Blood stagnation and meridian obstruction, preventing water circulation, it stagnates and overflows into the bladder, causing shortness of breath. Exposure to cold during rest can also cause deficiency-type bloating. If untreated for a long time, it consolidates into Pi (mass) disease. [Note: This is no different from Tan-Yin; retained for reference.]

Retained Yin (Liu Yin): Occurs after drinking alcohol followed by excessive water intake. Water Qi stays in the chest and diaphragm without dispersing, causing pain under the ribs, shortness of breath, and thirst. These are its manifestations.

Various Yin syndromes all result from the stagnation of Ying and Wei Qi, dysfunction of the Three Jiao, and excessive water intake leading to the accumulation of Tan-Yin. Symptoms vary: distension in both hypochondria, mental restlessness in the chest and heart, dim vision and dry mouth, nausea, rebellious Qi, and shortness of breath. Since the syndromes are diverse, they are called "Various Yins". (*Zhubing Yuanhou Lun*) [Note: The original text also includes Branch Fluid Retention (Zhi Yin) and Overflowing Fluid Retention (Yi Yin). Zhi Yin: Excessive water intake stagnates in the chest and diaphragm, supporting the Heart. Xuan Yin: Excessive water intake flows to the hypochondrium, causing hanging pain in the intercostal region.]

Etiology of Pi Disease (Alcohol Pi): If the Five Zang are harmonious, Ying and Wei Qi are regulated, and Jin-Ye flows freely; even with excessive water intake, disease does not occur. If health preservation methods are improper, causing Three Jiao blockage, the intestines and stomach cannot transport fluids. Excessive water intake leads to stagnation. Encountering cold Qi causes accumulation forming Pi. Pi refers to lateral accumulation between the two hypochondria, causing intermittent pain. (*Zhubing Yuanhou Lun*) [Note: This "Pi" is likely similar to Xuan Yin. *Jiyun* defines Pi as water in the intestines. Chao Yuanfang uses Pi to name stagnant water-fluids; is this etymologically correct? I suspect the "Pi" in Pi disease relates to "lateral/deviant" (pi), while the "Pi" in pleats/folds relates to "folding" (bi). They seem distinct. Chao Yuanfang combined them, perhaps following ancient meanings.]

Pi Consolidation Syndrome: Caused by accumulated water refusing to disperse, further compounded by dietary interactions, leading to consolidation under the hypochondria. Symptoms include cord-like protrusions, distending pain, or panting and shortness of breath. Hence it is called Pi Consolidation. A tight and solid pulse indicates Pi Consolidation.

Alcohol Pi: Occurs after heavy drinking followed by uncontrolled water intake due to thirst. Alcohol and water fail to dissipate, stagnating in the hypochondria, forming a mass that causes periodic pain, hence named Alcohol Pi. Symptoms include urgency and pain in the hypochondria.

When drinkers are extremely thirsty and consume water, water and alcohol stagnate above the chest and diaphragm, fermenting and accumulating to form Pi. This leads to vomiting old water, colored like pickled vegetables or adzuki bean juice, sour and bitter, hence called Alcohol Pi and Pickled Tan. (*Zhubing Yuanhou Lun*)

Stagnant Yin due to涩 (astringency/stagnation) of Three Jiao Qi: Human form relies on water-fluids for nourishment; the transformation of water depends on Qi and meridians for circulation. The Three Jiao is the pathway for food and fluids, the beginning and end of Qi. When the Three Jiao is balanced and Qi meridians are even, it can circulate water fluids into the meridians, transform them into blood, and irrigate the body. If Three Jiao Qi is stagnant and meridians blocked, water fluids stagnate, cannot circulate, gather into Tan-Yin, and cause various diseases. (*Shengji Zonglu*) [Note: Based on Chao Yuanfang.]

Stagnant Yin due to Disharmony of Spleen and Stomach: Water and Yin share the same origin but have different names. If the Spleen Earth is deficient, water ingested within half a day cannot be transported and transformed. It may stay below the heart, gather in the hypochondria, inject into meridians, or overflow into the bladder, often causing disease. Who would say that Blood, Qi, Tan, and Xian can generate various diseases while Water and Yin cannot? Water and Yin produce gurgling sounds, asthma, cough, vomiting, diarrhea, obstruction, distension, vertigo, palpitations, chills and fever, hard pain, edema, excessive salivation, shortness of breath, and heaviness. When Qi is blocked by Yin, causing fullness, borborygmi, bone pain, and cold bi, it is called "Qi Fen" (Qi Division). When meridians do not flow and blood transforms into water, causing red swelling of the four limbs, it is called "Xue Fen" (Blood Division). All these categories arise from Water Qi. Given the syndrome verification, one must not fail to investigate the source. (*Zhizhi Fang*)

Tan and Yin differ in origin and manifestation. Tan is thick and sticky; Yin is clear water. Their colors vary: green, yellow, green-black, or like sour浆 (fermented liquid). They may lie in the intestines and stomach, support the chest and diaphragm causing unbearable stabbing pain, or flow into meridians and limbs causing joint stiffness. Branch Fluid Retention (Zhi Yin) attacking upward causes heart pain, epigastric pain, sweating, vomiting of sour or bitter-yellow water, etc. Other symptoms include chills and fever, anorexia, and insomnia. This condition often results from drinking tea or soup excessively after alcohol, causing water fluids and damp-heat from food to condense into Yin. Or due to emotional depression and food stagnation failing to dissipate, Yin can also form. Ultimately, it must stem from Spleen-Stomach dampness or Spleen-Stomach deficiency compounded by dietary dampness, leading to stagnation. This is the general overview of Yin. (*Bencao Jing Shu*)

Tan-Yin afflictions affect seven or eight out of ten people. *Jinkui Yaolue* discusses this in detail, naming each type. Later generations, overwhelmed by the number of names, pursued details and forgot the root, failing to realize that sage legislation originates from a single source without deviation. The Stomach is the sea of food and fluids, the great source of the Five Zang and Six Fu. Drink enters the Stomach, essence floats up, transmits to the Spleen. The Spleen scatters essence, sends it up to the Lung. The Lung regulates water passages, sending it down to the Bladder. Water essence distributes in four directions, circulating through the five meridians, maintaining health. *Jinkui* discusses pathology where water essence fails to distribute and meridians fail to circulate. It classifies depth based on symptoms, teaching patients to seek meaning through names. Superficial retention is inside the shell but outside the organs. There are four types of Yin: one flows down from the Stomach to the intestines; one flows sideways from the Stomach to the hypochondria; one goes out from the Stomach to the limbs; one goes up from the Stomach to the chest and diaphragm. (*Qianjin Fang Yanyi* states: Among the four Yins, Zhi Yin is the most severe.) Initially unnoticed, day by day and month by month, the essence of water turns turbid, becoming Tan-Yin. It first gathers where respiratory Qi hardly reaches, so from intestines to hypochondria to limbs, gradually infiltrating the chest and diaphragm. The more rebellious the trend, the more Tan-Yin originates from the Stomach. The Five Zang are the residence of Shen (Spirit). Accumulated water turning into Tan-Yin wrapping around them is indeed a major affliction of the body. Any water-fluids that accumulate and do not disperse are called Liu Yin (Retained Yin). "Liu" means staying and not leaving. Liu Yin that is not fully expelled is called Fu Yin (Hidden Yin). "Fu" means not emerging. Treatment must follow whether Tan-Yin is Liu or Fu to be precise. Consider this: If it rises from the Stomach to the chest, hypochondria, Heart, and Lung, drive it back to the Stomach, or expel it down via intestines or up via vomiting, preventing hidden retention. If it moves from chest/diaphragm to skin/muscle, the clear part may exit via sweat, but the turbid part has no outlet, potentially hiding in skin/muscle resisting expulsion. If it goes from chest/diaphragm deep into the back (the mansion of the chest), there is no exit. Not only is expulsion difficult, but the fierce Yang and strong Fire in the back may trigger carbuncles and sores. Fu Yin is hard to expel downward and prone to disaster. Who can distinguish it? Who can expel it? (*Yitong*, excerpted from *Yimen Falv*)

There are five origins of Yin acquisition: anger/depression, exhaustion, overthinking, binge drinking, and cold injury during heat. Regardless of the variety of Yin syndromes, they fall within these five. Anger/depression prevents Qi extension, causing Liver Qi to invade the Spleen, Spleen Qi fails to transform, resulting in Retained Yin. The Liver governs planning; prolonged indecision stops Yin Qi. The Spleen governs thought; prolonged thinking knots the Spleen, also causing Retained Yin. Labor and travel weaken Spleen-Stomach Qi; drinking while exhausted leads to lethargy and failure to distribute fluids into meridians, causing Retained Yin. Excessive drinking fills the intestines and stomach; adding more overwhelms the Bladder's permeation and excretion, leading to Retained Yin. During hot summers, when fluids are scorched, preferring cold water to quench thirst, drinking too much while resting without movement, also causes Retained Yin. Can Yin disease arise outside these five? Water is Yin substance; accumulation generates dampness; stagnation of wine forms Tan. Left hypochondriac accumulation resembles Fei Qi; right hypochondriac resembles Xi Ben. Upward entry into Lungs causes cough; downward entry into Large Intestine causes diarrhea; entry into Kidneys causes Yong Shui (gushing water), sounding like a bag of fluid, wandering without destination. In the Taiyang channel, it becomes Zhi Yin, all caused by rebellious Qi. Dampness above causes yellow eyes and facial edema; below causes thigh/knee swelling and coldness; in the middle causes support/fullness, obstruction, and Tan rebellion. If in Yang channels and not expelled, it transforms Qi over time; if in Yin channels and not expelled, it forms shape over time. (*Rumen Shiqin*)

Pulse Methods: Cun Kou pulse tight or floating indicates Cold above the diaphragm and Water Qi below the Lungs. (*Maijing*)

The pulses are all wiry, fine, deep, and slippery. (*Sanyin Fang*) [Note: Above are cited texts on Four Yins and Retained/Hidden Yin.]

Symptoms (See above entries): Where there is water below the heart, there is palpitation ("zhuzhu"), shortness of breath, and fear. The patient experiences vertigo and fainting. Chills indicate Deficiency; fever indicates Excess. Shoulder breathing and upward pulling Qi indicate Yi Yin (Overflowing Fluid) in the chest. Long-standing cases show fullness in the supraclavicular fossa and occasional severe swelling of the "Horse Knife" (scrofula), caused by Qi-Yin. (*Qianjin Fang*)

One Arm Paralysis: A patient whose arm is paralyzed, shifting between arms, with a deep and fine pulse, does not have Wind disease but has Yin in the Upper Jiao. A deficient pulse indicates slight fatigue and uneven Ying-Wei Qi circulation, resolving spontaneously over time (or in winter). (*Maijing*)

Indigestion: Tan-Yin Indigestion Syndrome arises from Tan-water accumulation in the chest, fu-organs, and bladder, lingering and spreading to the Spleen-Stomach. The Spleen dislikes dampness; water causes distension, preventing food digestion. Symptoms include abdominal deficiency-fullness, undigested food/water, and occasional nausea/rebellious Qi. (*Zhubing Yuanhou Lun*)

Diaphragmatic Tan, Wind-Jue Headache: Diaphragmatic Tan refers to Tan-water above the diaphragm combined with severe cold, blocking Yang Qi, causing Tan-water to knot and not disperse. Yin Qi rebels upward, combining with Wind-Tan, rushing to the head, causing headache. If persistent for years, it connects to brain pain, hence Diaphragmatic Tan Wind-Jue Headache (based on *Zhouhou Beiji Fang*). If hands and feet become cold to the joints, death ensues. (*Zhubing Yuanhou Lun*) [Treatment formula appears in subsequent expectorant section. *Jifeng Fang* states: Tan-Jue syndrome arises from Tan-water accumulation, Yin Qi rebelling to head/eyes, causing headache, chest fullness, shortness of breath, and vomiting white foam. Essentially the same syndrome.]

Resembling Shanghan: Phlegm in the Middle Jiao causes aversion to cold and fever, chest/diaphragm fullness, resembling Shanghan, except for the absence of headache and stiff neck. Treat with Chaihu Banxia Tang, Jinfeicao San, or Da Banxia Tang. (*Huren Shu*) [Note: Chaihu Banxia Tang is Xiao Chaihu Tang plus Baizhu and Maidong. Jinfeicao San uses Xin Yi, Xixin, Qianhu, Jingjie, Gancao, Banxia, Shaoyao, Jiang, Zao. Da Banxia Tang is similar to Xiao Banxia Tang.]

Treatment Principles: Qi movement drives Water movement; Qi stagnation causes Water stagnation. Thus, Yin disease is common. Effective treatment prioritizes promoting Qi and meridian circulation to prevent fluid stagnation. Therefore, treating Tan-Yin requires warming herbs to harmonize, as Qi and Blood circulate better with warmth. Once it consolidates into hard masses, use herbs to resolve Tan and break Yin. (*Shengji Zonglu*)

Observing Yin treatment methods: purgation, diaphoresis, warming, or draining are fixed rules. Ignorant practitioners err in warming/draining with little harm, but errors in sweating/purging cause significant damage. It is better to regulate Qi first, then guide separation. Regulated Qi allows Jin-Ye to flow, transporting Tan-Yin downward to exit via urine. Some patients liking to spit phlegm respond to Bawei Wan, implying a deeper rationale. Wang Shuhe said: Kidney cold causes excessive salivation. The Kidney is the official of Water, controlling water retention. Warm Kidney Qi transports water down; deficient/cold Kidney Qi allows pathogenic water to rebel up. Using Shanzhuyu and Shanyao for tonification, Fuzi and Rougui for warming, Fuling and Zexie for draining is logical. Careful examination is needed at bedside. (*Jisheng Fang*)

What is the priority in treatment? Answer: Differentiate Exterior/Interior and Deficiency/Excess. Exterior Water: Fever, cough, asthma, palpitations, dry heaving, mild diarrhea. Treat with Qinglong Tang (ma Huang Tang variant) to induce sweat. Interior Water: Cool body, vomiting, cough, fullness, pulling rib pain. Treat with Shizao Tang to purge. Deficient Pulse: Full but soft abdomen. Primary: Anshen Wan, add Qingmuxiang Wan to move it. [Note: These two formulas are difficult to apply, not adopted now.] Excess Pulse: Full and hard abdomen. Primary: Qingmuxiang Wan, use Wupi San plus Zhike to guide. Common Water Qi with subcardiac palpitations: Dabanxia Tang, Xiaobanxia Fuling Tang, Wuling San are generally applicable. Malaria patients often accumulate Yellow Water, stagnating in the epigastrium or forming masses in the hypochondria. Only masses cause chills/fever, so malaria formulas often use Changshan. Water in Upper Jiao induces vomiting; if not in Upper Jiao, Changshan breaks masses and drains water. Edema syndromes belong to this category; consult parallel texts. (*Zhizhi Fang*)

I have observed Zhang Zhongjing's intent in treating Yin formulas: Exterior cases use sweating; Interior cases use purging; Dampness cases use drainage. Cold, Heat, Warmth, Coolness are applied according to their affiliation. (*Yuji Weiyi*)

Treatment should prioritize drying dampness, promoting urination, moving Qi, and strengthening the Spleen. Herbs typically use Banxia, Fuling, Renshen, and Baizhu as sovereigns, assisted by Zhuling and Zexie for drainage, Baixiandoukou and Chenpi for dispersion, Sugeng and Xuanjinhua for unblocking. Dongyuan's Wuyin Wan contains Renshen, revealing this principle. (*Bencao Jing Shu*)

Do not be distracted by secondary syndromes: When Tan-Yin generates various symptoms, do not let them distract you into creating new disease names. Prioritize treating Yin; once Yin resolves, other symptoms heal. (*Yique*: True maxim.) Sudden coma, facial paralysis, trembling limbs, feeling weightless—resembling Stroke or Deficiency but not so—are caused by Tan-Yin. Also, Kidney deficiency/cold failing to control water leads to pathogenic water rebellion and Tan-Yin; treat with Bawei Wan. (*Zabing Yuanliuxiazhu*)

Case Report: Yi Yin Treated by Sweating: Wu Jiaoshan treated a thin, weak man who developed Yi Yin syndrome after lying in damp places. Symptoms: dizziness, photophobia, alternating chills/fever (Tan indeed causes chills/fever), joint pain in limbs (damp-Tyin flowing into joints). Doctors treated it as Wind or Deficiency for nearly six months with no effect. Wu diagnosed: Cun Kou pulse deep and slippery, Chi pulses wiry. This is Yi Yin with Damp-Tan. Use sweating and vomiting. Other doctors argued against sweating/vomiting in a debilitated patient, claiming it would cause death. Wu insisted on sweating. He administered Kongxian Wan, burned a bushel of dried cotton seeds, covered the patient to retain vapor, and had him sit in the smoke. After a while, the patient vomited about one sheng of black phlegm and sweated profusely. Pain ceased, body felt light, and the disease cured. (*Lei'an*)

Formulas for Harmonizing Middle and Dispersing Cold: *Yannian Mi Lu* Fuling Yin. Mainly treats retained Tan and old water in the chest/heart. After spontaneous vomiting of water, if the chest feels empty and full of Qi, unable to eat, this formula resolves Tan Qi and restores appetite.

Fuling (3 liang), Renshen (2 liang), Baizhu (3 liang), Shengjiang (4 liang), Zhishi (2 liang, roasted), Chenpi (1.5 liang, sliced).