喻昌曰∶痰饮之脉，《金匮》错出不一，难于会通。以鄙见论之，亦有浅深微甚之不同，可预明也，《脉要精微》篇
曰∶肝脉软而散，色泽者，当病溢饮。溢饮者，渴暴多饮，而易入肌皮肠胃之外也。此特举暴饮水溢，饮病之最浅者为
言耳。仲景会其意，即以饮证分之为四，统言其纲曰∶痰饮、悬饮、溢饮、支饮。大都为由浅及深者商治，失此不治，
而至于积水滔天，即此四饮，自有不可同语者矣。其谓饮脉不弦，但苦喘短气者，见饮脉本弦，饮脉不弦，则水之积也
不浓，然亦害其阳气，微喘短气而已。其谓支饮亦喘而不能卧，加短气，其脉平者，见支饮上于胸膈，喘而短气，其脉
仍平，有而若无，才有停积，未至留伏，故不见于脉也。其谓脉浮而细滑者伤饮，见浮而细滑，非伤风伤寒之比，亦饮
之初郁气分而未深也。医者于此时，蚤思昏垫之灾，亟兴己溺之念，而行因势利导之法，患斯解矣。否则证成深锢，末
流愈分，伏根之所，愈不可识。经年检方问药，漫图成功，其可得乎？故凡见脉转沉弦一派，即当按法求之。其曰脉
沉者，胸中有留饮，短气而渴，四肢历节痛，言肺之治节不行，宗气不布，故短气；气不布则津亦不化，故膈燥而渴；
脾气不运，水饮流于肢节而作痛也。似此一证，肺脾交病，所称饮入于胃，游溢精气，上输于脾；脾气散精，上归于肺
之常者，且转而藉寇兵 盗粮矣。欲求其安，宁可得乎？至论弦脉，则曰咳者其脉弦。为有水，曰双弦者寒也，皆大下
后虚脉，偏弦者饮也。为喘满，曰脉弦数有寒饮，冬夏难治。曰脉沉而弦者，悬饮内痛，此即沉潜水蓄。支饮急弦而广
其说，与大下后其脉双弦者，有虚寒之别。其偏弦者，具为水饮也。冬夏难治，亦因用寒远寒，用热远热之法，不若春
秋为易施耳。悬饮内痛，谓悬饮结积于内，其甚者则痛也。更有沉紧之脉，主心下痞坚，面色黧黑之证，谓挟肾寒相杂
揉于心肺之分，则心下坚而面色黑也。有脉伏而为留饮之证，积饮把持其脉而不露，较涩脉尤甚矣。又曰脉伏便利，心
下续坚，此为留饮欲去故也。又曰久咳数岁，其脉弱者可治，实大数者死，其脉虚者必苦冒，本有支饮在胸中故也。凡
此皆病深而脉变，当一一溯其流而穷其源者，夫天枢开发，胃和则脉和，今为痰饮凝结其中，则开阖之机关不利，而脉
因之转为沉弦、急弦、偏弦、弦数、弦紧、或伏而不见，非亟去其痰饮，亦胡繇脉复其常耶。浅者浅治；深者深治；浅
深之间者，适其中而治。留者可攻；伏者可导；坚者可削；再一因循，病深无气，洒洒时惊，不可救药矣。
喻昌说：关于痰饮病的脉象，《金匮要略》中记载不一，难以融会贯通。依我个人的见解，痰饮病的脉象也有浅深、微甚的不同，这是可以预先明确的。《素问·脉要精微论》篇中说：“肝脉软而散，面色光泽的，应当患溢饮病。”所谓溢饮，是指口渴突然大量饮水，水液容易流入肌肉皮肤和肠胃之外的部位。这仅仅是列举了暴饮水液泛滥这一种情况，是饮病中最浅表的类型而言说的。张仲景领会了其意旨，便将饮证分为四类，总括其纲领称为：痰饮、悬饮、溢饮、支饮。大抵都是根据由浅入深的程度来商讨治疗，如果此时不进行治疗，以至于积水滔天，那么即使是这四种饮病，病情也就有不可同日而语的区别了。
文中说“饮脉不弦，但苦于喘促、短气”，这是指出饮脉本应呈弦象，若饮脉不弦，说明水饮积聚不浓重，然而也会损害阳气，仅表现为轻微喘促和短气罢了。文中说“支饮亦喘而不能卧，加上短气，其脉平”，这是指出支饮上犯胸膈，导致喘促和短气，但其脉象仍然平和，似有若无，因为刚刚有停积，尚未至留伏深处，所以脉象上不显现出来。文中说“脉浮而细滑者伤饮”，这是指出脉浮而细滑，并非像伤风或伤寒那样，也是饮邪初起郁结在气分，尚未深入的表现。医生在这个时候，应及早想到百姓沉沦苦难的灾难，兴起救民于水火的念头，施行顺应病势加以引导的方法，病患就能解除。否则病症形成深固难解，支流愈加分化，潜伏的病根所在，就越来越无法识别。等到过了一年再检查方剂询问药物，盲目图谋成功，这怎么可能呢？所以凡是见到脉象转为沉弦一派，就应当按照法则去探求病因。
文中说“脉沉者，胸中有留饮，短气而渴，四肢历节痛”，这是说肺的治节功能不行，宗气不能布散，所以短气；气不能布散则津液也不能化生，所以膈部干燥而口渴；脾气不运化，水饮流注于肢节因而作痛。像这样一证，肺脾两脏同时患病，原本所说的“饮入于胃，游溢精气，上输于脾；脾气散精，上归于肺”的正常生理过程，反而转变为借给敌人兵器、送给盗贼粮食（即正气受损，邪气猖獗）的局面。想要求得安宁，难道可能吗？
至于论述弦脉，则说“咳嗽的人其脉弦”，是因为有水饮；说“双弦脉主寒”，都是指大病下法之后出现的虚脉；说“偏弦者主饮”。对于喘满，说“脉弦数而有寒饮，冬夏两季难治”；说“脉沉而弦者，为悬饮内痛”，这就是水饮潜藏蓄积的表现。支饮急弦而扩展其说法，与大病下法后出现的双弦脉相比，有虚寒的区别。那些偏弦的脉象，都具备水饮的特征。冬夏两季难治，也是因为遵循“用寒远寒，用热远热”的原则，不像春秋两季那样容易施治罢了。“悬饮内痛”，是说悬饮结积在体内，严重的就会疼痛。更有沉紧的脉象，主治心下痞塞坚硬、面色黧黑的证候，这是说挟带肾寒相互混杂于心肺之间，所以心下坚硬而面色发黑。有脉伏而表现为留饮的证候，积聚的水饮把持脉道而不显露，比涩脉更为严重。又说“脉伏而大便通利，心下持续坚硬”，这是留饮欲去故也。又说“久咳数年，其脉弱者可治，实大数者死，其脉虚者必定苦于头目昏眩，这是因为本有支饮在胸中”。凡此种种，都是病情深重而脉象发生变化，应当一一追溯其流变而穷究其本源。天枢开发，胃气和顺则脉象调和，现在被痰饮凝结在其中，那么开阖的机关就不利，脉象因此转为沉弦、急弦、偏弦、弦数、弦紧，或者伏而不见，如果不急切去除痰饮，又怎么能恢复脉象的常态呢？浅表的用浅法治疗；深重的用深法治疗；介于深浅之间的，适中而治。停留的可攻逐；潜伏的可疏导；坚硬的可消磨；如果再一味拖延，病深正气衰败，时时洒洒恶寒惊悸，就不可救药了。
Yu Chang stated: Regarding the pulse of Phlegm-Fluid (Tan Yin), the *Jin Gui Yao Lue* presents inconsistent descriptions, making it difficult to harmonize. In my humble opinion, there are differences in depth and severity, which can be clarified in advance. The chapter "Mai Yao Jing Wei" states: "When the Liver pulse is soft and scattered, and the complexion is lustrous, one should suffer from Overflowing Fluid (Yi Yin). Overflowing Fluid refers to a condition where thirst suddenly drives excessive drinking, and fluids easily enter beyond the muscles, skin, and intestines/stomach." This merely cites the case of sudden water intake overflowing, representing the most superficial type of fluid disease. Zhang Zhongjing grasped its meaning and divided fluid syndromes into four categories, summarizing their general principles as: Phlegm-Fluid (Tan Yin), Hanging Fluid (Xuan Yin), Overflowing Fluid (Yi Yin), and Supporting Fluid (Zhi Yin). Generally, treatment is discussed based on progression from superficial to deep; if left untreated at this stage, leading to flooding waters, even these four types of fluid diseases will present conditions that cannot be compared.
The text mentions "If the fluid pulse is not wiry, but suffers from panting and shortness of breath," indicating that while the fluid pulse is typically wiry, a non-wiry pulse suggests the accumulation of water is not dense. However, it still damages Yang Qi, resulting only in slight panting and shortness of breath. The text states "Zhi Yin also causes panting with inability to lie down, plus shortness of breath, and its pulse is normal." This indicates that when Zhi Yin rises to the chest and diaphragm, causing panting and shortness of breath, the pulse remains calm. It appears present yet absent because the stagnation has just occurred and has not yet become entrenched or latent, hence it does not manifest in the pulse. The text says "A floating, fine, and slippery pulse indicates injury by fluid." This means a floating, fine, and slippery pulse is not comparable to wind-stroke or cold-injury; it also represents fluid pathogen initially stagnating in the Qi level without having penetrated deeply. At this time, physicians should promptly consider the disaster of submersion and harbor the intention to save those drowning, employing methods that facilitate the natural course of the disease, thus resolving the illness. Otherwise, the syndrome becomes deeply entrenched, branches multiply, and the root of the latent pathogen becomes increasingly unrecognizable. Waiting a year to review prescriptions and ask about medicines, blindly seeking success, is impossible. Therefore, whenever the pulse transforms into a sinking and wiry pattern, one must investigate according to the laws.
The text states "A sinking pulse indicates retained fluid in the chest, accompanied by shortness of breath, thirst, and pain in all joints of the limbs." This signifies that the Lung's regulatory function fails, and Zong Qi (Gathering Qi) does not disperse, causing shortness of breath; since Qi does not disperse, body fluids are not transformed, leading to dryness in the diaphragm and thirst; Spleen Qi fails to transport, allowing water-fluids to flow into the limbs and joints, causing pain. In such a case, both the Lung and Spleen are diseased. The normal physiological process described as 'fluid enters the Stomach, overflows with essence and Qi, transports upward to the Spleen; Spleen Qi scatters essence, returning it upward to the Lung' is instead turned into lending weapons to enemies and providing grain to thieves (i.e., damaging healthy Qi and aiding pathogens). How could peace be sought?
Regarding the discussion of the Wiry Pulse (Xian Mai), it states: "Those who cough have a wiry pulse, indicating the presence of water." It states: "Double wiry pulse indicates Cold, occurring after severe purgation leading to a deficient pulse." It states: "Unilateral wiry pulse indicates fluid." For panting and fullness, it states: "A wiry-numerous pulse with cold-fluid is difficult to treat in winter and summer." It states: "A sinking and wiry pulse indicates internal pain from Xuan Yin," which is the accumulation of submerged water. Zhi Yin presents an urgent wiry pulse, expanding the theory; compared to the double wiry pulse after severe purgation, there is a distinction between deficiency-cold. Unilateral wiry pulses all indicate water-fluid. Difficulty in treating during winter and summer is due to the principle of avoiding cold in cold seasons and heat in hot seasons, unlike spring and autumn which are easier to treat. "Internal pain from Xuan Yin" means Xuan Yin accumulates internally, and in severe cases, causes pain. There is also a sinking-tight pulse, governing symptoms of epigastric stuffiness and hardness, and darkened facial complexion. This implies Kidney Cold mixes with Heart-Lung regions, causing epigastric hardness and dark complexion. A hidden pulse manifests as retained fluid; accumulated fluid obstructs the pulse so it does not reveal itself, being more severe than a choppy pulse. It further states: "Hidden pulse with free bowel movement and continuous epigastric hardness indicates retained fluid attempting to exit." It also states: "Chronic cough for years, if the pulse is weak, is treatable; if solid, large, and rapid, it is fatal; if the pulse is deficient, the patient surely suffers from dizziness, because there was originally Zhi Yin in the chest." All these represent deep disease with pulse changes, requiring tracing the flow to find the source. When Tian Shu opens and Stomach Qi harmonizes, the pulse harmonizes. Now, condensed phlegm-fluid obstructs this, making opening and closing mechanisms unfavorable, causing the pulse to transform into sinking-wiry, urgent-wiry, unilateral-wiry, wiry-numerous, wiry-tight, or hidden and invisible. Unless phlegm-fluid is urgently removed, how can the pulse return to normal? Superficial cases are treated superficially; deep cases are treated deeply; intermediate cases are treated moderately. Retained fluid can be attacked; latent fluid can be guided; hardened fluid can be reduced. If one continues to delay, the disease deepens, Qi is depleted, chills and fright occur intermittently, and it becomes incurable.