大意
太阴所致为积饮。因而大饮则气逆。形寒饮冷则伤肺。（内经）
内因
水者。阴物也。积水不散。留而为饮。有愤郁而停者。有困乏而停者。有思虑而停者。有痛饮而停者。有因热
而伤冷者。（子和）揆其所由。皆因气郁中州。水浆入胃。不能运化。随脏腑虚处而留着焉。（汇补）
外候
大抵停水则生湿。停酒则生热。湿则成痞。热则发躁。其变现也。或形寒饮冷而得。则类外感症。或困乏忧
思而得。则似内伤症。或流于四肢。则似风家痹症。或流于关节。则似跌扑伤症。其他五脏六腑所受。见症
各出。（汇补）
饮分各经
在心则怔忡眩晕。在肺则喘急咳嗽。在脾则短气痞闷。在肝则胁满嚏痛。在肾则脐下悸动。（金匮）在上则
面浮。在下则跗肿。在胃中则胸满口渴。而水入即吐。在经络则一臂不遂。而复移一臂。在肠间则雷鸣泄
泻。或为溺结。与癃闭相似。在阳分不去。久则化气。与黄肿相似。在阴分不去。久则成形。与积块相似。在左
胁者。形同肥气。在右胁者。形同息贲。（汇补）
饮分六症
夫饮一也。而分五饮六症。皆因形而定名也。痰饮水停肠胃。辘辘有声。令人暴肥暴瘦。悬饮水流胁下。咳
唾引痛。悬悬思水。溢饮水流四肢。身体重痛。支饮水停膈上。KT 逆倚息短气。留饮水停心下。背冷如掌大。
或短气怔忡。四肢历节疼痛。胁痛引缺盆。咳嗽转甚。伏饮水停膈满。呕吐喘咳。发热恶寒。腰背痛。身惕HT
而泪出。（仲景）
饮与痰分
饮者。蓄水之名。自外而入。痰者。肠胃之液。自内而生。其初各别。其后同归。故积饮不散。亦能变痰。是饮为
痰之渐。痰为饮之化也。若其外出。则饮形清稀。痰形稠浊。又不同也。（汇补）
停饮脉法
脉偏弦者。饮也。又脉浮而细滑者。伤饮。又沉而弦者。悬饮内痛。（要略）
停饮总治
停饮之初。挟寒挟气者俱多。故症现寒热者。汗之。在胁肋四肢者。分利之。在胸膈者。吐之。在肠胃者。下之。
（入门）若挟虚症者。补之温之。（汇补）
初宜分消
凡大饮之后。当风着寒。水气凝结不运。外有表症。内有饮症者。果当温散。然或发汗太过。阳气空虚。水饮
仍未解散。致心下悸。头眩筋惕。身 动振振欲擗地者。又当温之。不可再行分消也。（汇补）
次宜调养
若血气亏乏之人。痰饮客于中焦。以致四肢百骸胸腹。发为诸病者。宜导去痰饮。随即补元气。不可专任
汗吐渗下之法。（汇补）
虚宜温中
更有脾虚之人。每遇饮后。即觉停滞于中。肠鸣于内。甚或作泻。屡用分利不效者。法当温理中焦。（汇补）
久宜暖肾
久有肾虚不能纳气归元。则积饮于外。或泛于上焦为涎沫。或停于心下为怔忡。或留于脐腹。筑筑然动
气者。均宜益火之剂。（汇补）
饮症用药
汗以香苏饮。吐以二陈汤。分利以四苓散。下以蠲饮枳实丸。凡前五饮症。元气稍旺者。三花神佑丸、控涎
丹逐之。元气稍虚者。五饮汤。虚甚者。六君子汤。虚寒者。理中汤。下焦肾阴虚者。六味丸。肾家阳虚者。八味
丸。外感夹饮。发汗过多致虚症者。真武汤。
饮症选方
香苏饮 治外感风寒。内停水饮。用此发汗。（方见伤风）
二陈汤 治停饮胃口。恶心欲吐。怔忡口渴。服此探吐。（方见痰症）
四苓散 凡饮停肠内。或泄泻。或小便不利。以此渗利之。（方见湿症）
三花神佑丸 一切湿热。积成痰饮。变生体麻肢痹。走注疼痛。风痰涎嗽。气壅不行。
甘遂 大戟 芫花（各五钱） 黑牵牛（二两） 大黄（一两） 轻粉（一两）
滴水丸小豆大。先服三丸。后二丸。以利为度。
控涎丹 治痰饮在膈。胸背手足颈项腰胁引痛。似风症者。（方见痰症）
蠲饮枳实丸 逐痰消饮。导滞清膈。
枳实 半夏 陈皮 黑丑（各三两）
炊饼丸。姜汤下。
青木香丸 治胸膈噎塞。气滞不行。肠中水声。呕吐痰沫。不思饮食。服此宽中利膈。
黑牵牛（二十四两取头末十二两） 木香（三两） 补骨脂 荜澄茄（各四两） 槟榔（二两）
清水丸绿豆大。每服三十丸。茶汤下。气滞湿痰留饮。大效。
十枣汤（仲景） 治悬饮内痛。直达水气结聚之处。
芫花 甘遂 大戟
为末。枣子十枚。煮汤去枣。调药末。强壮者服五分。平旦服之。不下。加五分。以利为度。虚人勿服。
五饮汤（海藏） 治五饮留滞心胸胁下。
旋复花 人参 陈皮 枳实 白术 茯苓 浓朴 半夏 泽泻 猪苓 前胡 桂心 白芍药 炙甘草（各等分）
生姜。水煎服。
泽泻汤（仲景） 治饮水太过。肠胃不能传送。
泽泻（五两） 白术（二两）
水煮服。
六君子汤 治脾胃虚弱。遇饮停留。成胀满吐呕泻利者。（见前中风）
理中汤 治脾家大虚。挟寒。停饮不化者。（方见中寒）
真武汤（仲景） 外寒挟水症。发汗过多。心下悸。头眩筋惕。身 动振振欲擗地者。
茯苓（三钱） 白术（二钱） 芍药 生姜（各三钱） 附子（八分）
水煎。温服。
八味丸 治肾经阳虚。不能制水。水饮停留。或泛为痰。或浸为肿。或动为悸。（方见中风）
[General Principle]
Pathogenic factors affecting the Taiyin meridian lead to the accumulation of fluid retention (Ji Yin). Therefore, excessive drinking causes Qi rebellion; exposure to cold and consumption of cold drinks damage the Lung. (From *Neijing*)
[Internal Causes]
Water belongs to the Yin category. If accumulated water fails to dissipate, it remains in the body as fluid retention (Yin). It may stagnate due to indignation and depression, fatigue, excessive thinking, binge drinking, or heat injury followed by cold intake. (From Zhang Hezi) Investigating its origin, all cases stem from Qi stagnation in the Middle Jiao (Spleen and Stomach), causing ingested fluids to fail in transportation and transformation, subsequently lodging in areas where Zang-Fu organs are deficient. (From *Zhengzhi Huibu*)
[External Manifestations]
Generally, stagnant water generates Dampness, while stagnant wine generates Heat. Dampness leads to fullness and obstruction (Pi), while Heat causes irritability. Its manifestations may arise from cold exposure and cold drinks, resembling exterior syndrome; or from fatigue and worry, resembling interior deficiency syndrome; or flow into the four limbs, resembling wind-bi syndrome; or flow into joints, resembling trauma injuries. Other manifestations in the five Zang and six Fu organs vary. (From *Zhengzhi Huibu*)
[Fluid Retention by Meridian/Organ]
In the Heart: palpitations and dizziness. In the Lung: panting, urgency, and cough. In the Spleen: shortness of breath and chest fullness. In the Liver: hypochondriac fullness and sneezing pain. In the Kidney: pulsation below the umbilicus. (From *Jinkui Yaolue*) Above: facial edema. Below: dorsal foot edema. In the Stomach: chest fullness, thirst, but immediate vomiting upon drinking. In the meridians: unilateral arm paralysis that shifts to the other arm. In the intestines: borborygmus (rumbling sounds) with diarrhea, or urinary retention resembling long bi (difficulty urinating). If lingering in the Yang aspect for a long time, it transforms into Qi patterns resembling yellow edema. If lingering in the Yin aspect for a long time, it forms masses resembling accumulations. On the left hypochondrium: resembles Feiqi (Liver accumulation). On the right hypochondrium: resembles Xiben (Lung accumulation). (From *Zhengzhi Huibu*)
[Six Types of Fluid Retention]
Although fluid retention is one disease, it is divided into five types and six symptoms, named according to location and form. Tan Yin (Phlegm-Fluid): retained in intestines/stomach, rumbling sound, causing sudden weight gain or loss. Xuan Yin (Hanging Fluid): flows under the hypochondrium, causing pulling pain when coughing or spitting, with a sensation of hanging thirst. Yi Yin (Overflowing Fluid): flows into four limbs, causing heavy and painful body. Zhi Yin (Supporting Fluid): retained above the diaphragm, causing Qi rebellion, orthopnea, and shortness of breath. Liu Yin (Stagnant Fluid): retained in the epigastrium ("heart below"), causing a palm-sized cold patch on the back, or shortness of breath, palpitations, limb joint pain, hypochondriac pain radiating to the Clavicular Fossa (Qie Ren), and worsening cough. Fu Yin (Hidden Fluid): retained at the diaphragm causing fullness, vomiting, panting, cough, fever, aversion to cold, lower back pain, tremors, tearing. (From Zhang Zhongjing)
[Differentiation between Fluid Retention and Phlegm]
Fluid retention (Yin) is the name for accumulated water entering from outside. Phlegm (Tan) is the fluid of the intestines and stomach generated from within. Initially distinct, they eventually converge. Thus, unresolved fluid retention can transform into phlegm. Fluid retention is the precursor to phlegm; phlegm is the transformation of fluid retention. Externally, fluid retention is clear and thin, whereas phlegm is thick and turbid, which is another difference. (From *Zhengzhi Huibu*)
[Pulse Diagnosis for Fluid Retention]
A pulse that is predominantly wiry indicates fluid retention. A floating, fine, and slippery pulse indicates injured fluid retention. A deep and wiry pulse indicates hanging fluid retention with internal pain. (From *Yaolue*)
[General Treatment for Fluid Retention]
Early-stage fluid retention often involves Cold and Qi stagnation. For symptoms presenting with fever and chills, use sweating methods. For locations in the hypochondrium and limbs, use draining and separating methods. For locations in the chest and diaphragm, use emetic methods. For locations in the intestines and stomach, use purgative methods. (From *Yixue Rumen*) If accompanied by deficiency, use tonifying and warming methods. (From *Zhengzhi Huibu*)
[Initial Stage: Differentiation and Elimination]
After excessive drinking, if exposed to wind and cold, leading to congealed fluid qi that fails to circulate, presenting with both exterior syndrome and fluid retention, warming and dispersing methods are indeed appropriate. However, if excessive sweating depletes Yang Qi without resolving the fluid retention, resulting in epigastric palpitations, dizziness, muscle twitching, and body trembling as if falling to the ground, warming methods should be used instead of further differentiation and elimination. (From *Zhengzhi Huibu*)
[Secondary Stage: Nourishment and Regulation]
For individuals with depleted Qi and Blood, where phlegm-fluid lodges in the Middle Jiao causing various diseases in the limbs, bones, chest, and abdomen, one should first guide out the phlegm-fluid, then immediately tonify Yuan Qi. One should not rely solely on sweating, emesis, draining, or purging methods. (From *Zhengzhi Huibu*)
[Deficiency: Warming the Middle]
For those with Spleen deficiency who feel stagnation in the middle after drinking, with borborygmus and even diarrhea, if repeated draining methods fail, the method should be to warm and regulate the Middle Jiao. (From *Zhengzhi Huibu*)
[Chronic Stage: Warming the Kidney]
For chronic Kidney deficiency failing to grasp Qi and return it to its source, leading to external fluid accumulation, or overflow into the Upper Jiao as saliva/phlegm, or lodging in the epigastrium causing palpitations, or remaining in the umbilical/abdominal region with pulsating sensations, formulas that benefit Fire (warm Kidney Yang) are indicated. (From *Zhengzhi Huibu*)
[Medication for Fluid Retention Syndromes]
For sweating: Xiangsu Yin. For emesis: Erchen Tang. For draining/separating: Siling San. For purging: Juanyin Zhishi Wan. For the first five fluid retention syndromes: If Yuan Qi is slightly robust, use Sanhua Shenyao Wan or Kongyan Dan to purge. If Yuan Qi is slightly deficient, use Wuyin Tang. If severely deficient, use Liujunzi Tang. If deficient-cold, use Lizhong Tang. If Lower Jiao Kidney Yin deficiency, use Liuwei Wan. If Kidney Yang deficiency, use Bawei Wan. For exterior contraction with fluid retention caused by excessive sweating leading to deficiency, use Zhenwu Tang.
[Selected Formulas for Fluid Retention]
Xiangsu Yin: Treats exterior wind-cold with internal fluid retention; used for sweating. (See "Wind-Cold" chapter)
Erchen Tang: Treats fluid retention in the stomach causing nausea, vomiting urge, palpitations, and thirst; used to induce vomiting. (See "Phlegm" chapter)
Siling San: Treats fluid retention in the intestines, diarrhea, or difficult urination; used for渗利 (draining dampness). (See "Dampness" chapter)
Sanhua Shenyao Wan: Treats all damp-heat accumulating into phlegm-fluid, causing body numbness, limb bi, migrating pain, wind-phlegm cough, and Qi obstruction.
Ingredients: Kansui Radix (Gansui), Mirabilite Root (Daji), Genkwa Flower (Yuanhua) (each 5 qian), Black Morning Glory Seed (Hei Qianniu) (2 liang), Rhubarb (Dahuang) (1 liang), Calomelas (Qingfen).
Preparation: Pill with water drops, size of adzuki beans. Start with 3 pills, reduce to 2 pills later. Stop when bowels move freely.
Kongyan Dan: Treats phlegm-fluid in the diaphragm causing pulling pain in chest, back, hands, feet, neck, waist, and hypochondrium, resembling wind syndrome. (See "Phlegm" chapter)
Juanyin Zhishi Wan: Purges phlegm, eliminates fluid, guides stagnation, clears diaphragm.
Ingredients: Immature Bitter Orange (Zhishi), Pinellia Tuber (Banxia), Tangerine Peel (Chenpi), Black Morning Glory Seed (Hei Chou) (each 3 liang).
Preparation: Pill with steamed dough, taken with Ginger Decoction.
Qingmuxiang Wan: Treats chest/diaphragm blockage, Qi stagnation, intestinal water sounds, vomiting phlegm/saliva, anorexia; widens middle and benefits diaphragm.
Ingredients: Black Morning Glory Seed (Hei Qianniu) (24 liang, take head powder 12 liang), Costus Root (Muxiang) (3 liang), Psoralea Fruit (Buguzhi), Long Pepper Fruit (Bichengqie) (each 4 liang), Areca Seed (Binglang) (2 liang).
Preparation: Pill with clear water, size of mung beans. Take 30 pills per dose with tea water. Highly effective for Qi stagnation, damp-phlegm, and retained fluid.
Shizao Tang (Zhang Zhongjing): Treats hanging fluid retention with internal pain, reaching directly to the site of water qi accumulation.
Ingredients: Genkwa Flower (Yuanhua), Kansui Radix (Gansui), Mirabilite Root (Daji).
Usage: Powdered. Boil 10 Jujubes in water, remove jujubes, mix with powder. Robust persons take 0.5 fen. Take on an empty stomach in the morning. If no effect, increase by 0.5 fen. Stop when bowels move freely. Do not use for weak persons.
Wuyin Tang (Zhang Yuansu/Haizang): Treats five fluids stagnating in chest, heart, and hypochondrium.
Ingredients: Inula Flower (Xuanfuhua), Ginseng Root (Renshen), Tangerine Peel (Chenpi), Immature Bitter Orange (Zhishi), Atractylodes Macrocephala Rhizome (Baizhu), Poria (Fuling), Magnolia Bark (Nongpu), Pinellia Tuber (Banxia), Alisma Rhizome (Zexie), Polyporus (Zhuling), Peucedanum Root (Qianhu), Cinnamon Twig (Guixin), White Peony Root (Baishao), Honey-fried Licorice Root (Zhigancao) (equal parts).
Usage: Add fresh ginger, decoct in water, and drink.
Zexie Tang (Zhang Zhongjing): Treats excessive water intake causing failure of intestines/stomach to transport.
Ingredients: Alisma Rhizome (Zexie) (5 liang), Atractylodes Macrocephala Rhizome (Baizhu) (2 liang).
Usage: Decoct in water and drink.
Liujunzi Tang: Treats Spleen/Stomach weakness with fluid retention causing distension, vomiting, and diarrhea. (See "Stroke" chapter previously)
Lizhong Tang: Treats severe Spleen deficiency with Cold, causing untransformed retained fluid. (See "Interior Cold" chapter)
Zhenwu Tang (Zhang Zhongjing): Treats exterior cold with water syndrome, excessive sweating leading to epigastric palpitations, dizziness, muscle twitching, and body trembling as if falling.
Ingredients: Poria (Fuling) (3 qian), Atractylodes Macrocephala Rhizome (Baizhu) (2 qian), White Peony Root (Shaoyao), Fresh Ginger (Shengjiang) (each 3 qian), Prepared Aconite Root (Fuzi) (8 fen).
Usage: Decoct in water, take warm.
Bawei Wan: Treats Kidney channel Yang deficiency failing to control water, causing retained fluid, transforming into phlegm, soaking into edema, or moving into palpitations. (See "Stroke" chapter)