（见妇人杂病中）
【集注】
尤怡曰：饮，水病也。治水必自小便去之；苓、桂、术、甘益土气以行水，肾气丸温
阳气以行水，虽所主不同，而利小便则一也。
@@@
夫心下有留饮，其人背寒冷如掌大。留饮者，□下痛引缺盆、欬嗽则转甚。胸中有留
饮，其人短气而渴，四肢历节痛。脉沉者有留饮。
【按】
此条古本内于「四肢历节痛」之下有「脉沉者有留饮」一句，当另为一条，始合论脉
之义。短气而渴之「渴」字，当是「喘」字，四肢上当有缺文，皆传写之□。
【注】
停饮初病，即以小半夏汤加茯苓、五苓散、肾气丸等药治之而愈者，微邪也。若邪甚
而不去者，留于心上则阻心阳，必背寒冷；留于□下则得肝气，必□下痛引缺盆，欬
嗽转甚，留于胸中则壅肺气，必短气而喘；留于身体则塞经络，必四肢历节痛也。由
此推之，留于脾则腹肿身重，留于肾则囊足胫肿，理必然也。
@@@
膈上病，痰满喘欬吐，发则寒热，背痛，腰疼，目泣自出，其人振振身□剧，必有伏
饮。
【注】
伤饮之病，留而不去，谓之留饮；伏而难攻，谓之伏饮。伏饮者，乃饮留膈上伏而不
出，发作有时者也。即今之或值秋寒，或感春风，发则必喘满欬吐痰盛，寒热背痛腰
疼，欬剧则目泣自出，欬甚则振振身动，世俗所谓吼喘病也。
【集注】
程林曰：痰饮留于膈，则令人喘欬吐；发于外，则令人寒热，背痛、腰疼；欬甚则肺
叶举，而目泣出；喘甚则息摇肩，而振振身□。如此剧者，必有伏饮。
@@@
脉浮而细滑，伤饮。
【注】
凡饮病得脉浮而细滑者，为痰饮，初病水邪未深之诊也。
【集注】
李□曰：饮脉当沉，今脉浮者，水在肺也。
@@@
脉沉者，有留饮。
【按】
此条系在四肢历节痛之下，今分在此。
【注】
凡饮病得脉沉者为留饮，水邪将深之诊也。
【集注】
程林曰：脉得诸沉者，当责有水，故脉沉者为水饮。
李□曰：经云：沉，潜水蓄是也。
@@@
病者脉伏，其人欲自利，利反快，虽利，心下续坚满，此为留饮欲去故也，甘遂半夏
汤主之。
【按】
「此为留饮欲去故也」句，当在「利反快」之下，必传写之□。
【注】
凡饮病得脉伏者，为伏饮，水邪已深之诊也。凡病饮之人，欲自下利，利后通快，此
为所留之饮，欲自去而愈故也。若虽利，利反不快，心下续有坚满，乃所留之饮盘结
不欲去也，宜攻之以甘遂半夏汤。方中反佐甘草以激之，意在所向无前，即潜伏难攻
，水结未有不破者；因自下利，故又佐芍药以约束之。防胜后穷追不止也。
（此条文见于《妇人杂病篇》）
【集注】
尤怡说：饮，是指水液代谢失常形成的病邪。治疗水饮之病，必须通过小便将其排出；五苓散（茯苓、桂枝、白术、甘草，此处指代健脾利湿之法，原文虽列苓桂术甘，实指五苓散去猪苓或类似健脾行水之意，但依原文直译：茯苓、桂枝、白术、甘草）能补益脾胃之气以运行水湿，肾气丸（Shenqi Wan, Kidney Qi Pill）能温补肾阳以运行水湿。虽然二者主治侧重不同，但在通利小便这一点上是一致的。
@@@
如果心下（胃脘部）有留滞的水饮，患者的背部会出现如手掌大小的一块寒冷感。所谓留饮，若停滞在胁下（缺字，据上下文推测为“胁”），疼痛会牵引至缺盆穴（锁骨上窝），咳嗽时症状加剧。如果胸中有留滞的水饮，患者会感到呼吸短促且口渴，四肢关节依次出现疼痛。脉象沉的，说明体内有留滞的水饮。
【按语】
这一条在古本中，“四肢历节痛”之下有一句“脉沉者有留饮”，应当单独列为一条，才符合论述脉理的体例。“短气而渴”中的“渴”字，应当是“喘”字；“四肢”之上可能有脱文，这些都是传抄过程中的缺失。
【注解】
停聚水饮之初病，用小半夏汤（Xiaobanxia Tang, Minor Pinellia Decoction）加茯苓，或用五苓散（Wuling San, Five-Ingredient Powder with Poria）、肾气丸等药物治疗而痊愈的，属于轻微的邪气。如果邪气严重而不消退，停留在心上就会阻碍心阳，必然导致背部寒冷；停留在胁下（缺字）就会受到肝气的影响，必然导致胁下疼痛牵引至缺盆，咳嗽加剧；停留在胸中就会壅塞肺气，必然导致呼吸短促而气喘；停留在身体则堵塞经络，必然导致四肢关节疼痛。由此推论，停留在脾脏则腹部肿胀、身体沉重；停留在肾脏则阴囊、足部和胫部肿胀，道理必然是这样的。
@@@
膈上有病，痰多、气喘、咳嗽、呕吐，发作时伴有寒热、背痛、腰痛，眼泪不由自主流出，患者身体剧烈震颤，这必定是有潜伏的水饮。
【注解】
感受水饮之邪，停留不去，称为留饮；潜伏难治，称为伏饮（Fuyin, Hidden Fluid Retention）。伏饮，是指水饮停留在膈上，潜伏不出，定时发作的病证。就像现在有的人遇到秋寒，或感受春风，发作时必然气喘胸闷、咳嗽呕吐痰涎增多，伴有寒热、背痛、腰痛，咳嗽剧烈时眼泪自出，咳嗽严重时身体震颤，这就是世俗所说的吼喘病。
【集注】
程林说：痰饮停留在膈部，就会使人气喘、咳嗽、呕吐；发作于体表，就会使人出现寒热、背痛、腰痛；咳嗽剧烈时肺叶上举，导致眼泪流出；气喘严重时呼吸带动肩膀起伏，导致身体震颤。像这样严重的情况，必定是有潜伏的水饮。
@@@
脉象浮而细滑，这是伤饮的表现。
【注解】
凡是水饮病出现脉象浮而细滑的，属于痰饮，是水邪初起、尚未深入的诊候。
【集注】
李□（人名缺字）说：饮病的脉象应当沉，现在脉象浮，是因为水邪在肺。
@@@
脉象沉的，是有留饮。
【按语】
这一条原本位于“四肢历节痛”之下，现在分列在此处。
【注解】
凡是水饮病出现脉象沉的，属于留饮，是水邪即将深入体内的诊候。
【集注】
程林说：脉象出现各种沉象的，应当责求有水邪，所以脉沉是水饮之征。
李□说：经书云：“沉，代表潜水蓄积。”
@@@
患者脉象伏（深藏不起），想要自行腹泻，泻后反而感觉畅快，虽然腹泻了，但心下（胃脘部）继续坚硬胀满，这是因为留饮欲去而未去的缘故，用甘遂半夏汤（Gansui Banxia Tang, Kansui and Pinellia Decoction）主治。
【按语】
“此为留饮欲去故也”这一句，应当放在“利反快”之下，必定是传抄过程中的错简或缺失。
【注解】
凡是水饮病出现脉象伏的，属于伏饮，是水邪已经深入的诊候。凡是患水饮病的人，想要自行向下腹泻，泻后通畅爽快，这是因为所停留的水饮，想要自行离去而痊愈的缘故。如果虽然腹泻，但泻后并不爽快，心下继续有坚硬胀满的感觉，那就是所停留的水饮盘结在一起，不想离去，适宜用攻逐法，使用甘遂半夏汤。方中反佐甘草以激发药力，意在所向无前，即使是潜伏难攻的水结，也没有不破开的；因为患者自行腹泻，所以又佐以芍药来约束正气，防止攻伐太过导致穷追不止（损伤正气）。
(See "Miscellaneous Diseases of Women" chapter)
[Collected Annotations]
You Yi stated: "Yin" (Fluid Retention) refers to pathological fluid accumulation. To treat fluid retention, one must eliminate it through urination; [Ling, Gui, Zhu, Gan] (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice, representing the method of strengthening Spleen Qi to move fluids) benefits Earth Qi to circulate water, while Shenqi Wan (Kidney Qi Pill) warms Yang Qi to circulate water. Although their primary indications differ, both share the effect of promoting diuresis.
@@@
When there is retained fluid in the epigastrium (Heart Below), the patient experiences coldness on the back over an area the size of a palm. Retained fluid, if lodged in the hypochondrium (character missing), causes pain radiating to the Clavicular Fossa (Quepen, SI15), which worsens upon coughing. If there is retained fluid in the chest, the patient suffers from shortness of breath and thirst, and pain in all joints of the four limbs. A deep pulse indicates the presence of retained fluid.
[Commentary]
In ancient editions, the phrase "A deep pulse indicates retained fluid" appears below "pain in all joints of the four limbs." This should be separated into a distinct clause to align with the principles of pulse diagnosis. The character "thirst" in "shortness of breath and thirst" should likely be "wheezing"; there may be missing text before "four limbs," which are errors due to transcription omissions.
[Annotation]
In the initial stage of fluid stagnation, if mild pathogenic factors are involved, treating with Xiaobanxia Tang (Minor Pinellia Decoction) plus Poria, or Wuling San (Five-Ingredient Powder with Poria), or Shenqi Wan (Kidney Qi Pill) can lead to recovery. However, if the pathogen is severe and persists, its location determines the symptoms: if it lodges at the Heart, it obstructs Heart Yang, causing back coldness; if it lodges in the hypochondrium (character missing), it interacts with Liver Qi, causing hypochondriac pain radiating to the Clavicular Fossa, worsening with cough; if it lodges in the chest, it congests Lung Qi, causing shortness of breath and wheezing; if it lodges in the body, it blocks the meridians, causing pain in all joints of the four limbs. By extension, if it lodges in the Spleen, it causes abdominal swelling and heaviness of the body; if it lodges in the Kidney, it causes swelling of the scrotum, feet, and shins. This reasoning is logically sound.
@@@
Disease above the diaphragm characterized by phlegm-fullness, wheezing, coughing, and vomiting; upon attack, accompanied by aversion to cold and fever, back pain, and lower back pain; tears flowing spontaneously; and severe tremors of the body—this indicates the presence of hidden fluid retention (Fuyin).
[Annotation]
Pathogenic fluid that remains and does not disperse is called retained fluid (Liuyin); that which hides and is difficult to eradicate is called hidden fluid retention (Fuyin). Hidden fluid retention refers to fluid accumulating above the diaphragm, lying dormant, and manifesting periodically. For instance, when exposed to autumn cold or spring wind, attacks inevitably involve wheezing, fullness, coughing, vomiting profuse sputum, aversion to cold and fever, back and lower back pain. Severe coughing causes tears to flow; severe coughing induces bodily tremors. This is what laypeople call "roaring asthma."
[Collected Annotations]
Cheng Lin stated: "Phlegm-fluid lodged in the diaphragm causes wheezing, coughing, and vomiting; when manifesting externally, it causes aversion to cold and fever, back pain, and lower back pain; severe coughing lifts the lung lobes, causing tears to flow; severe wheezing involves shoulder movement during respiration, causing bodily tremors. Such severe cases must involve hidden fluid retention."
@@@
A floating, fine, and slippery pulse indicates injury by fluid retention.
[Annotation]
In fluid diseases, a floating, fine, and slippery pulse indicates Phlegm-Fluid, representing a diagnosis where the water pathogen has just begun and has not yet penetrated deeply.
[Collected Annotations]
Li [Name Missing] stated: "The pulse for fluid retention should be deep. A floating pulse now indicates water in the Lung."
@@@
A deep pulse indicates retained fluid.
[Commentary]
This clause originally appeared below "pain in all joints of the four limbs" but is placed here currently.
[Annotation]
In fluid diseases, a deep pulse indicates retained fluid, signifying that the water pathogen is about to penetrate deeply.
[Collected Annotations]
Cheng Lin stated: "When various types of deep pulses are obtained, one should investigate water pathology; thus, a deep pulse indicates water-fluid."
Li [Name Missing] stated: "The Classics state: 'Deep signifies submerged water accumulation.'"
@@@
The patient presents with a hiding pulse (Fu Mai), desires spontaneous diarrhea, and feels relief after defecation; however, despite the diarrhea, the epigastrium continues to feel hard and full. This is because the retained fluid is attempting to exit. Gansui Banxia Tang (Kansui and Pinellia Decoction) is indicated.
[Commentary]
The sentence "This is because the retained fluid is attempting to exit" should follow "feels relief after defecation," indicating a textual error or omission in transmission.
[Annotation]
In fluid diseases, a hiding pulse indicates hidden fluid retention, signifying that the water pathogen has penetrated deeply. In patients with fluid disease who desire spontaneous diarrhea, feeling relief afterward suggests that the retained fluid is attempting to leave the body naturally. However, if diarrhea occurs but provides no relief, and the epigastrium remains hard and full, it means the retained fluid is knotted and reluctant to leave. In such cases, purgative treatment with Gansui Banxia Tang (Kansui and Pinellia Decoction) is appropriate. The formula uses Licorice (Gancao) as an antagonistic assistant to stimulate the action of Kansui (Gansui), aiming to break through even deeply hidden water accumulations. Since the patient is already experiencing spontaneous diarrhea, Peony (Shaoyao) is added as an assistant to constrain the healthy Qi, preventing excessive depletion after the pathogen is expelled.