金匮云。问曰。夫饮有四。何谓也。师曰。有痰饮。有悬饮。有溢饮。有支饮。问曰。四饮
何以为异。师曰。其人素盛今瘦。水走肠间。沥沥有声。谓之痰饮。饮后水流在胁下。咳唾引痛。
谓之悬饮。饮水流行。归于四肢。当汗出而不汗出。身体疼重。谓之溢饮。咳逆倚息。短气不得
卧。其形如肿。调之支饮。
痰饮为患。十人居其七八。金匮论之甚详。分别而各立其名。后世以其名之多也。徒 其未
而忘其本。曾不思圣人立法。皆从一源而出。无多歧也。盖胃为水谷之海。五脏六腑之大源。饮
入于胃。游溢精气。上输于脾。脾气散精。上归于肺。通调水道。下输膀胱。水精四布。五经并
行。以为常人。金匮即从水精不四布五经不并行之处以言其患。随证分别浅深。诲人因名以求其
义。浅者在于躯壳之内。脏腑之外。其饮有四。一由胃而下流于肠。一由胃而傍流于胁。一由胃
而外出于四肢。一由胃而上入于胸膈。始先不觉。日积月累。水之精华。转为混浊。于是遂成痰
饮。必先团聚于呼吸大气难到之处。故由肠而胁。而四肢。至渐渍于胸膈。其势愈逆。则痰饮之
患。未有不从胃起见者矣。夫五脏藏神之地也。积水泛为痰饮。包裹其外。讵非人身之大患乎。
凡水饮蓄而不散者。皆名留饮。留者
留而不去也。留饮去而不尽者。皆名伏饮。伏者伏而不出也。随其痰饮之或留或伏。而用法以治
之。始为精义。今试言之。由胃而上胸胁心肺之分者。驱其还胃。或下从肠出。或上从呕出。而
不至于伏匿。若由胸膈而外出肌肤。其清者。或从汗出。其浊者。无可出矣。必有伏匿肌肤。而
不胜驱者。若由胸膈而深藏于背。背为胸之府。更无出路。岂但驱之不胜驱。且有挟背间之狂阳
壮火。发为痈毒者。伏饮之艰于下出。易于酿祸。其谁能辨之。谁能出之耶。水在心。心下坚筑
短气。恶水不欲饮。水在肺。吐涎沫。欲饮水。水在脾。少气身重。水在肝。胁下支满。嚏而痛。
水在肾。心下悸。夫心下有留饮。其人背恶寒。冷如掌大。留饮者。胁下痛引缺盆。咳嗽则辄已。
（一作转甚。）胸中有留饮。其人短气而渴。四肢历节痛。脉沉者有留饮。膈上病痰。满喘咳吐。
发则寒热。背痛腰疼。目泣自出。其人振振身 而剧。必有伏饮。夫病患饮水多。必暴喘满。凡
食少饮多。水停心下。甚者则悸。微者短气。脉双弦者寒也。皆大下后善虚。脉偏弦者饮也。肺
饮不弦。但苦喘短气。支饮亦喘而不能卧。加短气。其脉平也。病痰饮者。当以温药和之。心下
有痰饮。胸胁支满。目眩。苓桂术甘汤主之。小便则利。
灵枢曰。包络是动。则病胸胁支满。痰饮积其处而为病也。心下有痰。水精不上注于目。故
眩。茯苓治痰水。伐肾邪。桂枝通阳气。开经络。白术治痰水。除胀满。然中满勿食甘。反用甘
草。何也。盖桂枝之辛。得甘则佐其发散。和其热。而使不僭上。甘草有茯苓。则不支满而反渗
泄。甘能下气除满也。
夫短气有微饮。当从小便去之。苓桂术甘汤主之。肾气丸亦主之。
微饮而短气。由肾虚水邪停蓄。致三焦之气升降呼吸不前也。二方各有所主。苓桂术甘汤主
饮在阳。呼气之短。
肾气丸主饮在阴。吸气之短。盖呼者出心肺。吸者入肾肝。茯苓入手太阴。桂枝入手少阴。皆轻
清之剂。治其阳也。地黄入足少阴。山萸入足厥阴。皆重浊之剂。治其阴也。必视其人形体之偏
阴偏阳而为施治。一证二方。岂无故哉。
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。
留饮堵塞窍隧。胃气不得转输。故脉伏不显。若留饮既下。胃气受伤。必欲自利。自利而反
快者。中焦所塞暂通也。通而复积。故续坚满。必更用药尽逐之。然欲直达其积饮。莫若甘遂快
利用之为君。欲和脾胃除心下坚。又必以半夏佐之。然芍药停湿。何留饮用之。甘草与甘遂相反。
何一方并用。盖甘草缓甘遂之性。使不急速。徘徊逐其所留。芍药治木郁土中而成坚满。又佐半
夏以和胃消坚也。
脉沉而弦者。悬饮内痛。病悬饮者。十枣汤主之。
悬饮结内作痛。故脉见沉弦。用芫花之辛以散饮。甘遂、大戟之苦以泄水。大枣之甘入脾而胜水也。
病溢饮者。当发其汗。大青龙汤主之。取微似汗。汗多者温粉粉之。小青龙汤亦主之。
水饮溢出于表。营卫尽为不利。犹伤寒之营卫两伤。故必发汗以散水而后营卫经脉始行。四
肢之水亦得消矣。表郁实热者。用大青龙以发之。内蓄寒饮者。用小青龙以发之。虽皆表散之法。
而微有不同。不可不辨。
膈间支饮。其人喘满。心下痞坚。面色黧黑。其脉沉紧。得之数十日。医吐下之不愈。木防
己汤主之。虚者即愈。实者三日复发。复与。不愈者。木防己汤去石膏加茯苓芒硝汤主之。微利则愈。
支饮在膈间。气血皆不通利。气不利。则与水同逆于肺而发喘满。血不利。则与水杂揉结于心下
而为痞坚。肾气上应水饮。肾水之色黑。血凝之色亦黑。故黧黑之色而见于面也。脉沉为水。紧
为寒。非别有寒邪。即水气之寒也。医虽以吐下之法治。然药不切于病。故不愈。用木防己以散
留饮结气。石膏主心肺逆气。人参以助胃祛水。桂枝以和营开结。且支饮得温则行。若邪客之浅
在气分多而虚者。服之即愈。若邪客之深在血分多而实者。则愈后必再发。以石膏为气分药。故
去之。芒硝为血分药。能治痰软坚。茯苓伐肾利水。而为芒硝之佐。故加之。
心下有支饮。其人苦冒眩。泽泻汤主之。
支饮阻其阳之升降。郁久化火。火动风生而冒眩也。故用泽泻开关利水以泄支饮。白术和中
燥湿。则阳自升而火自息矣。
支饮胸满者。浓朴大黄汤主之。
此即小承气。以大黄多。遂名浓朴大黄汤。若浓朴多。则名浓朴三物汤。此支饮胸满者。必
缘其人素多湿热。浊饮上逆所致。故用荡涤中焦药治之。
支饮不得息。葶苈大枣泻肺汤主之。
支饮留结。气塞胸中。故不得息。葶苈破结和饮。大枣通肺和中。以其气壅则液聚。液聚则
热结。所以与肺痈同治也。
呕家本渴。渴者为欲解。今反不渴。心下有支饮故也。小半夏汤主之。卒呕吐。心下痞。膈
间有水。眩悸者。小半夏加
茯苓汤主之。
呕本有痰。呕尽痰去而渴者为欲解。与伤寒服小青龙汤已渴者。寒去欲解同义。今反不渴。
是积饮尚留。去之未尽。故用半夏散结胜湿。生姜散气止呕。千金方更加茯苓佐之。即与治卒呕
吐。心下痞。膈间有水眩悸者同法也。
腹满口舌干燥。此肠胃间有水气。己椒苈黄丸主之。口中有津液渴者。加芒硝半两。
水积肠间。则肺气不宣。 郁成热。而为腹满。津液遂不上行。而口舌干燥。用防己、椒目、
葶苈利水散结气。而葶苈尤能利肠。然肠胃受水谷之气者。邪实腹满。非轻剂所能治。必加大黄
以泻之。若口中有津液而仍作渴者。此痰饮聚于血分。必加芒硝以祛逐之。
先渴后呕。为水停心下。此属饮家。小半夏茯苓汤主之。
先渴者。因痰饮占据中宫。津液不得灌注于上。肺失其润而然。后呕者。胃中所积之饮。随
气逆而上泛也。故用姜、半以涤饮。茯苓以渗湿。湿去则呕止津通而渴自已。此与伤寒心下有水
气。咳而微喘。发热不渴。服小青龙汤已而渴之义悬殊。彼以津液耗损而渴。此以痰气积阻而渴。
渴之先后变见。可以推饮之盛衰也。世以半夏性燥。渴家禁用。曷知其有主渴之妙用哉。
假令瘦人脐下有悸。吐涎沫而巅眩。此水也。五苓散主之。
瘦人本无痰湿。今巅眩吐涎。明是水积脐下而悸。故用五苓。藉桂之辛温以散之。
久咳数岁。其脉弱者可治。实大数者死。其脉虚者必苦冒。其人本有支饮在胸中故也。治属饮家。
下半条专补心下支饮冒眩之脉法。冒属风虚。必无脉实之理。治属饮家。不特泽泻汤一方也。
丹溪曰。痰之源不一。有因痰而生热者。有因热而生痰者。有因气而生者。有因风而生者。
有因惊而生者。有积饮而生者。有多食而成者。有因暑而生者。有伤冷物而成者。有脾虚而成者。
有嗜酒而成者。其为病也。惊痰则成心包痛。颠疾。热痰则成烦躁惊悸。风痰成瘫痪。大风眩晕。
饮痰成呕吐胁痛。四肢不举。食痰成疟痢口臭。痞块满闷。暑痰成呕逆眩冒。冷痰成骨痹气刺痛。
四肢不举。酒痰多成胁痛臂痛。饮酒不消。但得酒次日又吐。脾虚生痰。食不美。反胃呕吐。湿
痰多倦怠软弱。气痰攻注走刺不定。妇人于惊痰最多。结成块者为惊痰。必有一块在腹。发则如
身孕。转动跳跃。痛不可忍。又有老痰凝结胶固。非借温药引导。必有拒格之患。庞安常有言。
人身无倒上之痰。天下无逆流之水。故善治痰者。不治痰而治气。气顺则一身之津液。亦随气而
顺矣。痰属湿热。乃津液所化。因风寒湿热之感。或七情饮食所伤。以致气逆液浊。变为痰饮。
或吐咯上出。或凝滞胸膈。或留聚肠胃。或客于经络四肢。随气升降。遍身上下无处不到。其为
病也。为喘为咳。为恶心呕吐。为痞膈壅塞。关格异病。为泄为眩晕。为嘈杂怔忡惊悸。为颠狂。
为寒热。为痛肿。或胸间漉漉有声。或背心一点常如冰冷。或四肢麻痹不仁。皆痰所致。百病中
皆有兼痰者。世所不知也。痰有新久轻重之殊。新而轻者。形色清白。气味亦淡。久而重者。黄
浊稠粘。咳之难出。渐来恶味。酸辣腥臊咸苦。甚至带血而出。治法。痰生于脾胃。宜实脾燥湿。
又随气而升。宜顺气为先。分导次之。又气升属火。顺气在于降火。热痰则清之。湿痰则燥之。
风痰则散之。郁痰则开之。顽痰则软之。食痰则消之。在上者吐之。在下者下之。又中气虚者。宜
固中气以运痰。若攻之太重。则胃气虚而痰愈甚矣。
喻嘉言曰。内经云。诸气 郁。皆属于肺。盖肺郁则成热。热盛则生痰。痰挟瘀血。遂成窠
囊。膈间胀满痞闷。虽夏月。痰饮积处无汗。而冷痰清饮。积满窠囊。必大呕逆。此盈科而进也。
多由浓味积热。肠胃枯涸。又加怫郁。胃脘之血为痰浊所滞。日积月累。渐成噎膈反胃之次第。
若用燥剂。其结转甚。惟竹沥、姜汁、韭汁可以治之。日饮三五杯。必胸中烦躁不宁乃妙。后用
养血健脾润燥药。治痰之法。曰驱。曰导。曰涤。曰化。曰涌。曰理脾。曰降火。曰行气。前人
之法不为不详。至于窠囊之痰。如蜂子之穴于房中。如莲实之嵌于蓬内。生长则易。剥落则难。
其外窄中宽。任行驱导涤涌之药。徒伤他药。此实闭拒而不纳耳。夫人身之气。经盛则注于络。
络盛则注于经。窠囊之来。始于痰聚胃口。呕时数动胃气。胃气动。则半从上出于喉。半从内入
于络。胃之络贯膈者也。其气奔入之急。则冲透膈膜。而痰得以居之。痰入既久。则阻碍气道。
而气之奔入者。复结一囊也。然痰饮结聚于膈膜而成窠囊。清气入之。浑然不觉。每随浊气而动。
乃至寒之亦发。热之亦发。伤酒伤食亦发。动怒动欲亦发。总由动其浊气。浊气随火而升。转使
清气逼处不安也。故治窠囊之痰甚难。必先凝神入气。以静自调。薄滋味以去胃中之痰。使胃经
之气。不急奔于络转虚其胃。以听络中之气返还于胃。逐渐以药开导其囊。而涤去其痰。则自愈
矣。后世治痰饮有四法。曰实脾。燥湿。降火。行气。实脾燥湿。二陈汤加苍白二术。最为相宜。
若阴虚则反忌之矣。降火之法。须分虚实。实用苦寒。虚用甘寒。庶乎可也。若夫行气之药。诸
方漫然。全无着落。谨再明之。风寒之邪。从外入内。裹其痰饮。惟宜小青龙汤。分其邪从外出
而痰饮从下出也。浊阴之气。从下入上。裹其痰饮。金匮半夏浓朴汤。（即四七汤。）分其浊气
下出而痰饮从上出也。若多欲之人。则肾气上逆。直透膜原。结垒万千。 胀重坠。不可以仰。
用桂苓丸引气下趋。痰饮始豁也。又虚寒痰饮。少壮者十中间见一
二。老人小儿十中常见四五。若果脾胃虚寒。饮食不思。阴气痞塞。呕吐涎沫者。宜温其中。真
阳虚者。更补其下。清上诸药不可用也。再按痰饮总为一证。而因则有二。痰因于火。有热无寒。
饮因于湿。有热有寒。即有温泉无寒火之理也。痰饮胶结于胸中。为饱为闷。为频咳而痰不应。
总为脾失其健。不为胃行其津液。而饮食即以生痰。渐渍充满肺窍。咳不易出。虽以治痰为急。
然治痰之药。大率耗气动虚。恐痰未出而风先入也。惟是确以甘寒之药。杜风消热。润燥补虚豁
痰。乃为合法。惊痰堵塞窍隧。肝肺心胞络间无处不有。三部脉虚软无力。邪盛正衰。不易开散。
欲用涌剂。正如兵家劫营之法。安危反掌。欲导之下行。窍隧之痰。万不能导。徒伤脾气。计惟
理脾为先。脾气者人身健运之阳气。如天之有日。阴凝四塞者。日失其所。痰迷不醒者。脾失其
《金匮要略》中说：有人问，饮邪分为四种，是哪四种呢？老师回答说：有痰饮、悬饮、溢饮、支饮。又问：这四种饮邪有什么不同？老师说：如果一个人平时身体壮实，现在却消瘦了，水液在肠间流动，发出沥沥的声音，这就叫做痰饮。饮水后，水流停留在胁下，咳嗽吐唾时牵引作痛，这就叫做悬饮。饮水后，水液流行到四肢，本该出汗却没有出汗，身体疼痛且沉重，这就叫做溢饮。咳嗽气逆，需要倚靠物体呼吸，气短不能平卧，身形看起来像浮肿，这就叫做支饮。
痰饮为害，十个人中有七八个患病。《金匮要略》对此论述非常详细，分别列出并各自命名。后世因为名称太多，只追求其末节而忘记了根本。不曾思考圣人制定法则，都是从同一个源头出来的，并没有很多歧路。大概胃是水谷汇聚的海，是五脏六腑的大源头。饮食进入胃中，游溢精气，向上输送给脾。脾气散布精微物质，向上归于肺。肺通调水道，向下输送到膀胱。水精四布，五行经脉并行，这是正常人的状态。《金匮要略》就是从水精不能四布、五行经脉不能并行的地方来说明疾病的。根据证候分别深浅，教导人们通过名称来探究其含义。浅层的病位在躯壳之内，脏腑之外，饮邪有四种：一种是从胃向下流入肠道，一种是从胃向旁流注到胁下，一种是从胃向外出于四肢，一种是从胃向上进入胸膈。起初并不觉得异常，日积月累，水的精华转化为混浊之物，于是便成了痰饮。必定先团聚在呼吸大气难以到达的地方。所以从肠到胁，再到四肢，逐渐浸渍到胸膈，病势越来越逆乱，那么痰饮的祸患，没有不是从胃开始的。五脏是藏神的地方。积水泛滥成为痰饮，包裹在五脏之外，难道不是人身的大患吗？
凡是水饮蓄积而不消散的，都叫留饮。“留”就是停留不去的意思。留饮去除但不彻底的，都叫伏饮。“伏”就是潜伏不出来的意思。随着痰饮或留或伏的情况，采用相应的治法，这才是精义。现在试着谈谈它。从胃向上到胸胁心肺部位的，驱赶它回到胃，或者向下从肠道排出，或者向上从呕吐排出，从而不至于潜伏隐匿。如果从胸膈向外到肌肤，其中清稀的，或许可以从汗出排出；其中浑浊的，就没有出路了。必定有潜伏在肌肤中，无法被驱赶出去的。如果从胸膈深藏在背部，背是胸的府库，更没有出路。岂止是驱赶不动，还有挟带背部间的狂阳壮火，发作成为痈毒的。伏饮难以向下排出，容易酿成祸患，谁能辨别它？谁能排出它呢？
水在心，心下坚硬筑筑跳动，气短，厌恶水不想喝。水在肺，吐出涎沫，想喝水。水在脾，少气，身体沉重。水在肝，胁下支撑胀满，打喷嚏时疼痛。水在肾，心下悸动。心下有留饮的人，背部怕冷，冷如手掌大小。留饮在胁下，疼痛牵引缺盆穴，咳嗽时疼痛停止（另一种说法是加重）。胸中有留饮的人，气短且口渴，四肢关节游走性疼痛，脉沉的有留饮。膈上有痰病，胸闷喘咳吐痰，发作时寒热，背痛腰疼，眼泪自动流出，身体震颤动摇且病情加剧的，一定有伏饮。病人饮水多，必然突然喘满。凡是吃得少喝得多，水停在心下，严重的则心悸，轻微的则气短。脉象双弦的是寒证，都是大泻之后善于虚损的表现。脉象偏弦的是饮证。肺饮不弦，只是苦于喘和气短。支饮也喘而不能卧，加上气短，脉象平和。治疗痰饮病，应当用温药调和。心下有痰饮，胸胁支撑胀满，头晕目眩，用苓桂术甘汤主治。小便就会通畅。
《灵枢》说：手厥阴心包络发生病变，就会胸胁支撑胀满。痰饮积聚在那里而发病。心下有痰，水精不能向上注于眼睛，所以眩晕。茯苓治疗痰水，伐除肾邪。桂枝通阳气，开经络。白术治疗痰水，消除胀满。然而中焦满闷不要吃甘味药，这里反而用甘草，为什么呢？大概桂枝的辛味，得到甘味就能辅助其发散，调和其热，使不僭越上行。甘草配合茯苓，就不致胸胁支满反而能渗泄，甘味能下气除满。
气短有轻微的水饮，应当从小便排除，用苓桂术甘汤主治。肾气丸也主治。
轻微的水饮导致气短，是由于肾虚水邪停蓄，导致三焦之气升降呼吸不前。这两个方子各有所主。苓桂术甘汤主治饮邪在阳分，呼气的气短。肾气丸主治饮邪在阴分，吸气的气短。大概呼出是由心肺主导，吸入是由肾肝主导。茯苓入足太阴肺经，桂枝入手少阴心经，都是轻清的药剂，治疗阳分的问题。地黄入足少阴肾经，山茱萸入足厥阴肝经，都是重浊的药剂，治疗阴分的问题。必须看病人形体偏阴还是偏阳来施治。一个证候两个方子，难道没有缘故吗？
病人的脉伏，其人想要自利（腹泻），泻后反而感觉爽快，虽然腹泻，心下继续坚硬胀满，这是留饮想要排出的缘故。用甘遂半夏汤主治。
留饮堵塞窍道隧络，胃气不能转输，所以脉伏不显。如果留饮已经下行，胃气受伤，必然想要自利。自利而反快，是因为中焦所塞暂时通了。通了又积聚，所以继续坚满。必须再用药物彻底驱逐它。然而想要直达其积饮，不如用甘遂快速利用它作为君药。想要调和脾胃消除心下坚满，又必须以半夏作为佐药。然而芍药会停滞湿气，为什么留饮用它？甘草与甘遂相反，为什么一方并用？大概甘草缓和甘遂的药性，使其不急速，徘徊驱逐其所留存的饮邪。芍药治疗木郁土中而成的坚满，又佐助半夏和胃消坚。
悬饮结聚在内作痛，所以脉见沉弦。用芫花的辛味以散饮邪，甘遂、大戟的苦味以泄水，大枣的甘味入脾以胜水。
患溢饮病的，应当发汗，用大青龙汤主治。取微微似有汗出。汗多的用温粉扑身。小青龙汤也主治。
水饮溢出于体表，营卫都不利，如同伤寒的营卫两伤。所以必须发汗以散水，然后营卫经脉才能运行。四肢的水也能消除。表郁实热的，用大青龙汤发散它。内蓄寒饮的，用小青龙汤发散它。虽然都是表散的方法，但微妙之处不同，不可不辨别。
膈间的支饮，其人喘满，心下痞硬，面色黧黑，脉沉紧，得病几十天，医生用吐下法治不好，用木防己汤主治。虚证的即愈，实证的三天后复发，再给予原方，仍不好的，用木防己汤去石膏加茯苓芒硝汤主治。微微腹泻就痊愈。
支饮在膈间，气血都不通利。气不利，就与水一同逆于肺而发喘满。血不利，就与水杂揉结于心下而为痞硬。肾气上应水饮，肾水的颜色黑，血凝的颜色也黑，所以黧黑的颜色见于面部。脉沉为水，紧为寒，不是别有寒邪，就是水气的寒。医生虽然用吐下法治，但药不对病，所以不愈。用木防己以散留饮结气，石膏主心肺逆气，人参以助胃祛水，桂枝以和营开结。而且支饮得温则行，如果邪客之浅在气分多而虚的，服用即愈。如果邪客之深在血分多而实的，则愈后必再发。因为石膏是气分药，所以去掉它。芒硝是血分药，能治痰软坚，茯苓伐肾利水，而作为芒硝的佐药，所以加上它。
支饮阻遏阳气的升降，郁久化火，火动风生而冒眩。所以用泽泻开关利水以泄支饮，白术和中燥湿，则阳气自然上升而火自然平息。
这就是小承气汤，因为大黄多，所以名叫厚朴大黄汤。如果厚朴多，则名叫厚朴三物汤。这个支饮胸满的，一定是因为这个人平时多有湿热，浊饮上逆所致。所以用荡涤中焦的药物来治疗。
支饮留结，气塞胸中，所以不得呼吸。葶苈破结和饮，大枣通肺和中。因为气壅则液聚，液聚则热结，所以与肺痈同治。
呕吐的人本来应该口渴，口渴的是想要解除了。现在反而不渴，是因为心下有支饮的缘故。用小半夏汤主治。突然呕吐，心下痞，膈间有水，眩晕心悸的，用小半夏加茯苓汤主治。
呕吐本来有痰，呕尽痰去而渴的是想要解除。这与伤寒服小青龙汤后口渴，寒去欲解除是同义。现在反而不渴，是积饮尚留，去除未尽。所以用半夏散结胜湿，生姜散气止呕。《千金方》更加茯苓佐助它，即与治疗突然呕吐，心下痞，膈间有水眩晕心悸的方法相同。
腹满口舌干燥，这是肠胃间有水气，用己椒苈黄丸主治。口中有津液但仍觉渴的，加芒硝半两。
水积在肠间，则肺气不宣，郁而成热，而为腹满。津液遂不上行，而口舌干燥。用防己、椒目、葶苈利水散结气，而葶苈尤其能利肠。然而肠胃受水谷之气的，邪实腹满，不是轻剂所能治的，必须加大黄以泻之。如果口中有津液而仍作渴的，这是痰饮聚于血分，必须加芒硝以祛除它。
先渴，是因为痰饮占据中宫，津液不得灌注于上，肺失其润而然。后呕，是胃中所积之饮，随气逆而上泛。所以用姜、半夏以涤饮，茯苓以渗湿。湿去则呕止津通而渴自止。这与伤寒心下有水气，咳而微喘，发热不渴，服小青龙汤后口渴的意义截然不同。那是因津液耗损而渴，这是因痰气积阻而渴。渴的先后变化，可以推断饮邪的盛衰。世人认为半夏性燥，渴家禁用，哪里知道它有主渴的妙用呢？
假如瘦人脐下有悸动，吐涎沫而头顶眩晕，这是水饮，用五苓散主治。
瘦人本无痰湿，现在头顶眩晕吐涎，明显是水积脐下而悸。所以用五苓散，借桂枝的辛温以散之。
久咳数年，脉弱的可治，脉实大数的死。脉虚的必然苦于冒眩。这人本来有支饮在胸中。治疗属于饮家范畴。
下半条专门补充心下支饮冒眩的脉法。冒属风虚，必然没有脉实的道理。治疗属于饮家，不只是泽泻汤一方。
朱丹溪说：痰的来源不一，有因痰而生热的，有因热而生痰的，有因气而生的，有因风而生的，有因惊而生的，有积饮而生的，有多食而成的，有因暑而生的，有伤冷物而成的，有脾虚而成的，有嗜酒而成的。它们致病时，惊痰则成心包痛、癫疾；热痰则成烦躁惊悸；风痰成瘫痪、大风眩晕；饮痰成呕吐胁痛、四肢不举；食痰成疟痢口臭、痞块满闷；暑痰成呕逆眩冒；冷痰成骨痹气刺痛、四肢不举；酒痰多成胁痛臂痛、饮酒不消、第二天又吐；脾虚生痰，食不美、反胃呕吐；湿痰多倦怠软弱；气痰攻注走刺不定。妇人于惊痰最多，结成块者为惊痰，必有一块在腹，发作时如身孕，转动跳跃，痛不可忍。又有老痰凝结胶固，不借助温药引导，必有拒格之患。庞安常曾说：人身无倒上之痰，天下无逆流之水。所以善于治痰的人，不治痰而治气，气顺则一身之津液，也随气而顺了。痰属湿热，是津液所化，因风寒湿热之感，或七情饮食所伤，以致气逆液浊，变为痰饮。或吐咯上出，或凝滞胸膈，或留聚肠胃，或客于经络四肢，随气升降，遍身上下无处不到。它们致病时，为喘为咳，为恶心呕吐，为痞膈壅塞，关格异病，为泄为眩晕，为嘈杂怔忡惊悸，为颠狂，为寒热，为痛肿，或胸间漉漉有声，或背心一点常如冰冷，或四肢麻痹不仁，都是痰所致。百病中皆有兼痰者，世人不知道。痰有新久轻重之别，新而轻的，形色清白，气味亦淡，久而重的，黄浊稠粘，咳之难出，渐来恶味，酸辣腥臊咸苦，甚至带血而出。治法：痰生于脾胃，宜实脾燥湿，又随气而升，宜顺气为先，分导次之。又气升属火，顺气在于降火。热痰则清之，湿痰则燥之，风痰则散之，郁痰则开之，顽痰则软之，食痰则消之。在上者吐之，在下者下之。又中气虚者，宜固中气以运痰，若攻之太重，则胃气虚而痰愈甚矣。
喻嘉言说：《内经》说：诸气郁，皆属于肺。大概肺郁则成热，热盛则生痰，痰挟瘀血，遂成窠囊。膈间胀满痞闷，虽然是夏天，痰饮积聚处无汗，而冷痰清饮，积满窠囊，必然大呕逆。这是盈科而进。多由浓味积热，肠胃枯涸，又加怫郁，胃脘之血为痰浊所滞，日积月累，渐成噎膈反胃的次第。如果用燥剂，其结转更甚。只有竹沥、姜汁、韭汁可以治它。每天饮三五杯，必须胸中烦躁不宁才好。后用养血健脾润燥药。治痰的方法，曰驱，曰导，曰涤，曰化，曰涌，曰理脾，曰降火，曰行气。前人的方法不为不详。至于窠囊之痰，如蜂子之穴于房中，如莲实之嵌于蓬内，生长则易，剥落则难。其外窄中宽，任凭使用驱导涤涌之药，徒伤他药，这是实闭拒而不纳耳。人身之气，经盛则注于络，络盛则注于经。窠囊的形成，始于痰聚胃口，呕吐时数动胃气，胃气动，则半从上出于喉，半从内入于络。胃之络贯膈者也。其气奔入之急，则冲透膈膜，而痰得以居之。痰入既久，则阻碍气道，而气之奔入者，复结一囊也。然而痰饮结聚于膈膜而成窠囊，清气入之，浑然不觉。每随浊气而动，乃至寒之亦发，热之亦发，伤酒伤食亦发，动怒动欲亦发。总由动其浊气，浊气随火而升，转使清气逼处不安也。所以治窠囊之痰很难，必须先凝神入气，以静自调，薄滋味以去胃中之痰，使胃经之气，不急奔于络转虚其胃，以听络中之气返还于胃。逐渐以药开导其囊，而涤去其痰，则自愈矣。后世治痰饮有四法：曰实脾，燥湿，降火，行气。实脾燥湿，二陈汤加苍术、白术，最为相宜。若阴虚则反忌之。降火之法，须分虚实，实用苦寒，虚用甘寒，庶乎可也。若夫行气之药，诸方漫然，全无着落，谨再明之。风寒之邪，从外入内，裹其痰饮，惟宜小青龙汤，分其邪从外出而痰饮从下出也。浊阴之气，从下入上，裹其痰饮，金匮半夏厚朴汤（即四七汤），分其浊气下出而痰饮从上出也。若多欲之人，则肾气上逆，直透膜原，结垒万千，腹胀重坠，不可以仰，用桂苓丸引气下趋，痰饮始豁也。又虚寒痰饮，少壮者十中间见一二，老人小儿十中常见四五。若果脾胃虚寒，饮食不思，阴气痞塞，呕吐涎沫者，宜温其中，真阳虚者，更补其下，清上诸药不可用也。再按痰饮总为一证，而因则有二：痰因于火，有热无寒；饮因于湿，有热有寒。即有温泉无寒火之理也。痰饮胶结于胸中，为饱为闷，为频咳而痰不应，总为脾失其健，不为胃行其津液，而饮食即以生痰，渐渍充满肺窍，咳不易出。虽以治痰为急，然治痰之药，大率耗气动虚，恐痰未出而风先入也。惟是确以甘寒之药，杜风消热，润燥补虚豁痰，乃为合法。惊痰堵塞窍隧，肝肺心胞络间无处不有，三部脉虚软无力，邪盛正衰，不易开散。欲用涌剂，正如兵家劫营之法，安危反掌。欲导之下行，窍隧之痰，万不能导，徒伤脾气。计惟理脾为先。脾气者人身健运之阳气，如天之有日，阴凝四塞者，日失其所。痰迷不醒者，脾失其
The *Jingui Yaolue* states: Someone asked, "There are four types of fluid retention (Yin). What are they?" The Master replied, "There is Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Branch Fluid)." He was asked again, "How do these four types differ?" The Master said, "If a person who was previously robust has now become emaciated, and water flows between the intestines making a gurgling sound, this is called Tan Yin. If after drinking, water flows and accumulates under the hypochondrium, causing pain when coughing or spitting, this is called Xuan Yin. If water flows into the limbs, sweat should be produced but is not, resulting in body ache and heaviness, this is called Yi Yin. If there is coughing with air reflux, shortness of breath preventing lying flat, and the body appears swollen, this is called Zhi Yin."
Tan Yin causes harm to seven or eight out of ten people. The *Jingui Yaolue* discusses this in great detail, distinguishing them and giving each a name. Later generations, due to the multitude of names, pursued the superficial aspects while forgetting the root. They failed to consider that the laws established by the sages all originate from a single source, without many divergent paths. Generally, the Stomach is the sea of water and grain, the great source of the five zang and six fu organs. When food and drink enter the Stomach, their essence floats and overflows, transporting upwards to the Spleen. The Spleen scatters the essence, sending it upwards to the Lung. The Lung regulates the water passages, transporting downwards to the Bladder. Water essence distributes in all directions, and the five meridians run in parallel, which constitutes the state of a normal person. The *Jingui Yaolue* explains pathology from the point where water essence does not distribute in all directions and the five meridians do not run in parallel. It distinguishes depth according to symptoms, teaching people to seek meaning through names. Superficial pathology lies within the body shell but outside the zang-fu organs; there are four types of fluid: one flows down from the Stomach to the intestines, one flows sideways from the Stomach to the hypochondrium, one exits outwardly from the Stomach to the limbs, and one enters upwardly from the Stomach to the diaphragm. Initially unnoticed, day by day and month by month, the essence of water transforms into turbid matter, thus becoming Tan Yin. It must first gather in places where respiratory qi cannot easily reach. Thus, from the intestines to the hypochondrium, then to the limbs, gradually infiltrating the diaphragm, the pathological trend becomes increasingly rebellious. Therefore, the affliction of Tan Yin invariably originates from the Stomach. The five zang organs are the residence of the spirit. Accumulated water flooding to become Tan Yin, wrapping around the exterior, is surely a major affliction to the human body.
Any water-fluid that accumulates and does not dissipate is named Liú Yǐn (Retained Fluid). "Liu" means remaining and not departing. Retained fluid that is removed but not completely cleared is named Fú Yǐn (Hidden Fluid). "Fu" means hidden and not emerging. According to whether the Tan Yin is retained or hidden, appropriate treatment methods are applied; this is the profound principle. Let us discuss it now. For fluid rising from the Stomach to the chest, hypochondrium, Heart, and Lung areas, drive it back to the Stomach, or let it exit downward through the intestines, or upward through vomiting, so as not to hide. If it moves from the diaphragm outward to the skin and muscles, the clear part may exit through sweat; the turbid part has no exit. There must be some hiding in the skin and muscles that cannot be driven out. If it hides deeply in the back from the diaphragm, and since the back is the mansion of the chest, there is no other exit. Not only can it not be driven out, but it may also carry the wild yang and vigorous fire in the back, erupting as carbuncles and sores. Hidden fluid is difficult to discharge downward and prone to brewing disaster; who can distinguish it? Who can expel it?
Water in the Heart: hardness and palpitations below the heart, shortness of breath, aversion to water and unwillingness to drink. Water in the Lung: expectoration of saliva and foam, desire to drink water. Water in the Spleen: lack of qi, heavy body. Water in the Liver: fullness and distension under the hypochondrium, pain upon sneezing. Water in the Kidney: palpitations below the heart. A person with retained fluid below the heart feels cold on the back, cold as large as a palm. Retained fluid in the hypochondrium causes pain radiating to the Qinglun acupoint, stopping upon coughing (or worsening). A person with retained fluid in the chest has shortness of breath and thirst, wandering joint pain in the four limbs; those with a deep pulse have retained fluid. Phlegm disease above the diaphragm presents with fullness, wheezing, coughing, and expectoration; upon attack, there are alternating chills and fever, backache, lower back pain, spontaneous tearing, and severe tremors; this indicates hidden fluid. Patients who drink much water will suddenly experience wheezing and fullness. Those who eat little but drink much have water stopping below the heart; severely, palpitations occur; mildly, shortness of breath occurs. A double-string pulse indicates cold, often occurring after severe purgation leading to deficiency. A unilateral string-like pulse indicates fluid retention. Lung fluid retention does not present with a string-like pulse, but rather suffering from wheezing and shortness of breath. Branch fluid also causes wheezing and inability to lie down, plus shortness of breath, with a normal pulse. For phlegm-fluid diseases, warm herbs should be used to harmonize. For phlegm-fluid below the heart with hypochondrial fullness and dizziness, Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractodes, and Licorice Decoction) is the primary formula. Urination will become profuse.
The *Lingshu* states: When the Pericardium Meridian is affected, it causes chest and hypochondrial fullness. This is due to phlegm-fluid accumulating there and causing disease. With phlegm below the heart, water essence fails to ascend to nourish the eyes, causing dizziness. Poria treats phlegm-water and subdues kidney pathogenic factors. Cinnamon Twig unblocks yang qi and opens collaterals. Atractodes treats phlegm-water and removes distension. However, one should avoid sweet foods for middle-jiao fullness. Why use Licorice here? The pungency of Cinnamon Twig, combined with sweetness, aids dispersion and harmonizes heat, preventing it from flaming upward. Licorice combined with Poria prevents hypochondrial fullness and promotes seepage and drainage; sweetness can descend qi and remove fullness.
For shortness of breath caused by slight fluid retention, it should be eliminated via urination. Ling Gui Zhu Gan Tang is the primary formula. Shen Qi Wan (Kidney Qi Pill) is also indicated.
Slight fluid retention causing shortness of breath results from kidney deficiency and water pathogen accumulation, hindering the ascending and descending of sanjiao qi and respiration. These two formulas have specific indications. Ling Gui Zhu Gan Tang treats fluid in the Yang aspect, causing shortness of breath during exhalation. Shen Qi Wan treats fluid in the Yin aspect, causing shortness of breath during inhalation. Exhalation involves the Heart and Lung; inhalation involves the Kidney and Liver. Poria enters the Taiyin Lung meridian; Cinnamon Twig enters the Shaoyin Heart meridian; both are light and clear agents treating the Yang. Rehmannia enters the Shaoyin Kidney meridian; Cornus enters the Jueyin Liver meridian; both are heavy and turbid agents treating the Yin. Treatment must be based on whether the patient's constitution is biased toward Yin or Yang. One syndrome, two formulas—is there no reason?
If a patient has a hidden pulse and desires diarrhea, which brings relief, yet the epigastrium remains hard and full despite the diarrhea, this is because retained fluid is attempting to exit. Gan Sui Ban Xia Tang (Kansui, Pinellia, and Licorice Decoction) is the primary formula. Retained fluid blocks the orifices and tunnels, preventing Stomach qi from transforming and transporting, hence the hidden pulse. Once the retained fluid moves downward, the Stomach qi is injured, leading to a desire for diarrhea. Relief after diarrhea indicates temporary clearance of the middle jiao blockage. Since accumulation recurs, continued hardness and fullness persist. Further medication is needed to thoroughly purge the fluid. To reach the accumulated fluid directly, Kansui is best used as the sovereign herb for its rapid action. To harmonize the spleen and stomach and remove epigastric hardness, Pinellia serves as an assistant. However, Peony retains dampness; why is it used for retained fluid? Licorice is incompatible with Kansui; why are they used together? Licorice moderates the potency of Kansui, preventing it from acting too hastily, allowing it to linger and purge the retained fluid. Peony treats wood stagnation in the earth causing hardness and fullness, and assists Pinellia in harmonizing the stomach and dissolving hardness.
A deep and string-like pulse indicates internal pain from Xuan Yin (Hanging Fluid). For Xuan Yin, Shi Zao Tang (Ten Date Pill) is the primary formula.
Xuan Yin knotting internally causes pain, manifesting as a deep and string-like pulse. Genkwa's pungency disperses fluid; Kansui and Oldenlandia's bitterness drains water; Jujube's sweetness enters the spleen to overcome water.
For Yi Yin (Overflowing Fluid), sweating should be induced. Da Qing Long Tang (Major Green Dragon Decoction) is the primary formula, aiming for a slight sweat. If sweating is excessive, apply warm powder. Xiao Qing Long Tang (Minor Green Dragon Decoction) is also indicated.
When water-fluid overflows to the exterior, Ying and Wei are all impaired, similar to Ying and Wei injury in Cold Damage. Sweating is necessary to disperse the water so that Ying and Wei meridians can function, eliminating water from the limbs. For exterior constraint with excess heat, Da Qing Long Tang is used to release it. For interior accumulation of cold fluid, Xiao Qing Long Tang is used to release it. Although both are exterior-releasing methods, there are subtle differences that must be distinguished.
For Zhi Yin (Branch Fluid) in the diaphragm, presenting with wheezing, fullness, epigastric hardness, dark complexion, and a deep-tight pulse, lasting for decades and unresponsive to emetic and purgative treatments, Mu Fang Ji Tang (Stephania Decoction) is the primary formula. If the pattern is deficient, recovery follows; if excess, relapse occurs after three days. Re-administering the same formula without improvement requires Mu Fang Ji Tang minus Shih Gao (Gypsum) plus Fu Ling (Poria) and Mang Xiao (Mirabilite). Mild diarrhea indicates recovery.
Zhi Yin in the diaphragm obstructs the smooth flow of qi and blood. Qi obstruction causes rebellion with water into the Lung, triggering wheezing and fullness. Blood obstruction mixes with water in the epigastrium, causing hardness and fullness. Kidney qi corresponds to water; kidney water color is black, and coagulated blood is also black, hence the dark complexion. Deep pulse indicates water; tight pulse indicates cold. This cold is either external or due to water qi. Emetic and purgative treatments fail because the medicine does not match the pathology. Stephania disperses retained fluid and stagnant qi; Gypsum addresses rebellious qi in the Heart and Lung; Ginseng strengthens the Stomach to dispel water; Cinnamon Twig harmonizes Ying and opens knots. Zhi Yin moves with warmth. If the pathogen is shallow in the Qi level and predominantly deficient, recovery follows immediately. If deep in the Blood level and predominantly excess, relapse occurs. Gypsum is a Qi-level herb, so it is removed. Mang Xiao is a Blood-level herb that softens hardness and treats phlegm; Poria subdues the Kidney and promotes urination, serving as an assistant to Mang Xiao, so it is added.
For Zhi Yin below the heart causing severe dizziness and vertigo, Ze Xie Tang (Alisma Decoction) is the primary formula.
Zhi Yin obstructs the ascending and descending of Yang. Prolonged stagnation generates fire; fire stirring wind causes dizziness and vertigo. Alisma opens orifices and promotes urination to drain Zhi Yin; Atractodes harmonizes the middle and dries dampness, allowing Yang to ascend and fire to subside.
For Zhi Yin with chest fullness, Hou Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction) is the primary formula.
This is essentially Xiao Cheng Qi Tang, named Hou Po Da Huang Tang due to the larger dose of Rhubarb. If Magnolia Bark is dominant, it is called Hou Po San Wu Tang. This case of Zhi Yin with chest fullness arises from chronic damp-heat and turbid fluid rebelling upward. Thus, herbs that purge the middle jiao are used.
For Zhi Yin causing inability to breathe, Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Lung-Purging Decoction) is the primary formula.
Zhi Yin stagnation blocks qi in the chest, causing breathing difficulty. Descurainia breaks stagnation and harmonizes fluid; Jujube benefits the Lung and harmonizes the middle. Qi congestion leads to fluid accumulation; fluid accumulation leads to heat knotting, hence treated similarly to Lung Abscess.
Those who vomit should naturally feel thirsty; thirst indicates resolution. Now, if there is no thirst, it is because of Zhi Yin below the heart. Xiao Ban Xia Tang (Pinellia and Ginger Decoction) is the primary formula. For sudden vomiting, epigastric fullness, water in the diaphragm, dizziness, and palpitations, Xiao Ban Xia Jia Fu Ling Tang (Pinellia, Ginger, and Poria Decoction) is the primary formula.
Vomiting usually involves phlegm; thirst after exhausting phlegm indicates resolution, similar to thirst after taking Xiao Qing Long Tang in Cold Damage indicating the departure of cold. Lack of thirst now indicates residual fluid retention. Pinellia resolves knots and overcomes dampness; Ginger disperses qi and stops vomiting. Adding Poria per the *Qianjin Fang* aligns with the method for sudden vomiting, epigastric fullness, diaphragmatic water, dizziness, and palpitations.
Abdominal fullness with dry mouth and tongue indicates water qi in the intestines and stomach. Ji Jiao Li Huang Wan (Stephania, Lepidium, Descurainia, and Rhubarb Pill) is the primary formula. If there is saliva in the mouth but still thirst, add half liang of Mang Xiao (Mirabilite).
Water accumulation in the intestines impairs Lung qi dissemination, leading to heat generation, abdominal fullness, and failure of fluids to ascend, causing dry mouth and tongue. Stephania, Lepidium seed, and Descurainia promote urination and dissipate stagnant qi; Descurainia specifically benefits the intestines. Since the intestines and stomach receive water and grain, excess evil causing fullness requires more than mild agents; Rhubarb must be added to purge. If there is saliva but persistent thirst, this indicates phlegm-fluid gathering in the Blood level; Mang Xiao must be added to expel it.
Thirst followed by vomiting indicates water stopping below the heart, belonging to fluid disorders. Xiao Ban Xia Fu Ling Tang (Pinellia, Ginger, and Poria Decoction) is the primary formula.
Initial thirst occurs because phlegm-fluid occupies the central palace, preventing fluids from irrigating the upper jiao, causing Lung dryness. Subsequent vomiting occurs because accumulated fluid in the Stomach rebels upward with qi. Ginger and Pinellia purge fluid; Poria leaches dampness. Removing dampness stops vomiting, unblocks fluids, and resolves thirst. This differs significantly from Cold Damage with water qi below the heart causing cough, slight wheezing, fever, and no thirst, where thirst after Xiao Qing Long Tang indicates fluid consumption. Here, thirst is due to phlegm-qii obstruction. The sequence of thirst reveals the fluctuation of fluid retention. People believe Pinellia is drying and contraindicated for thirst, ignoring its miraculous ability to resolve thirst.
If a thin person has palpitations below the umbilicus, expectorates saliva and foam, and experiences dizziness, this is water. Wu Ling San (Five-Ingredient Powder with Poria) is the primary formula.
Thin people typically lack phlegm-dampness. Dizziness and saliva expectoration clearly indicate water accumulation below the umbilicus. Wu Ling San uses the pungent-warmth of Cinnamon Twig to disperse it.
Chronic coughing for years: a weak pulse is treatable; a solid, large, and rapid pulse indicates death. A deficient pulse implies severe dizziness. This is due to pre-existing Zhi Yin in the chest. Treatment falls under fluid disorders.
The latter half specifically supplements the pulse diagnosis for dizziness caused by Zhi Yin below the heart. Dizziness belongs to wind-deficiency and cannot present with a solid pulse. Treatment falls under fluid disorders, not limited to Ze Xie Tang alone.
Zhu Danxi stated: The sources of phlegm are diverse. There is phlegm generated by heat, heat generated by phlegm, phlegm generated by qi, phlegm generated by wind, phlegm generated by fright, phlegm from accumulated fluid, phlegm from overeating, phlegm from summerheat, phlegm from cold injuries, phlegm from Spleen deficiency, and phlegm from alcoholism. Pathologically, fright-phlegm causes Pericardium pain and epilepsy; heat-phlegm causes irritability and palpitations; wind-phlegm causes paralysis and severe dizziness; fluid-phlegm causes vomiting, hypochondrial pain, and immobility of limbs; food-phlegm causes malaria, dysentery, bad breath, and masses; summerheat-phlegm causes vomiting, reversal, and dizziness; cold-phlegm causes bone bi and stabbing pain, limb immobility; wine-phlegm causes hypochondriac and arm pain, indigestion, and next-day vomiting; Spleen-deficiency phlegm causes poor appetite and reverse vomiting; damp-phlegm causes fatigue and weakness; qi-phlegm causes wandering stabbing pain. Women often suffer most from fright-phlegm, forming masses in the abdomen that swell like pregnancy, causing unbearable pain. Also, old phlegm condenses and adheres firmly; without warm herbs to guide it, rejection may occur. Pang Anchang said: "In the human body, phlegm does not flow upward against gravity; in the world, water does not flow upstream." Therefore, skilled practitioners treat qi rather than phlegm directly; when qi flows smoothly, body fluids follow. Phlegm belongs to damp-heat and is transformed from body fluids. Due to wind-cold-damp-heat or emotional/dietary injuries, qi rebels and fluids become turbid, transforming into phlegm-fluid. It may be vomited up, stagnate in the diaphragm, accumulate in the intestines/stomach, or lodge in meridians/limbs, moving with qi throughout the body. Symptoms include wheezing, coughing, nausea, vomiting, epigastric fullness, obstruction, diarrhea, dizziness, heartburn, palpitations, mania, alternating chills/fever, swelling/pain, gurgling sounds in the chest, cold spots on the back, and limb numbness—all caused by phlegm. Many diseases involve concurrent phlegm, unknown to the public. Phlegm varies by newness, duration, and severity. New/light phlegm is clear and pale with faint odor; old/heavy phlegm is yellow, turbid, sticky, difficult to expectorate, with foul odors (sour, spicy, fishy, salty, bitter), sometimes bloody. Treatment: Phlegm originates in the Spleen/Stomach; strengthen the Spleen and dry dampness. Since it rises with qi, regulate qi first, then guide it. Rising qi relates to fire; regulating qi involves clearing fire. Clear heat-phlegm, dry damp-phlegm, scatter wind-phlegm, open depressed-phlegm, soften stubborn-phlegm, digest food-phlegm. Above, induce vomiting; below, purge. For middle qi deficiency, consolidate middle qi to transport phlegm; excessive attacking damages Stomach qi and worsens phlegm.
Yu Jiayan stated: The *Neijing* says, "All qi constraints belong to the Lung." Lung constraint generates heat; excessive heat generates phlegm. Phlegm夹杂着 blood stasis forms "nest sacs" (ker nang). Chest fullness and oppression occur; even in summer, no sweat at sites of phlegm-fluid accumulation. Cold phlegm and clear fluid fill the nest sacs, causing severe vomiting and reflux. This progresses step-by-step. Often caused by rich flavors accumulating heat, drying intestines/stomach, compounded by depression. Stomach blood stagnates due to turbid phlegm, gradually leading to dysphagia and reverse vomiting over time. Drying agents worsen this. Only Bamboo Sap, Ginger Juice, and Leek Juice can treat it. Drink 3-5 cups daily until chest irritability occurs, which is auspicious. Follow with blood-nourishing, Spleen-strengthening, and moistening herbs. Methods to treat phlegm include: driving, guiding, washing, resolving, inducing vomiting, regulating Spleen, clearing fire, and moving qi. Previous methods were detailed. Nest-sac phlegm is like bees in a hive or lotus seeds in a pod; easy to grow, hard to remove. Narrow outside, wide inside, resisting driving/guiding/washing/vomiting agents, injuring healthy tissue. Qi flows from Jing to Luo vessels. Nest sacs begin with phlegm gathering at the Stomach gate. Vomiting agitates Stomach qi; half exits via throat, half enters Luo vessels connecting to the diaphragm. Rapid qi entry pierces the diaphragm, allowing phlegm to reside. Long-term phlegm blocks airways, causing incoming qi to form another sac. Phlegm-fluid in the diaphragm is imperceptible to clear qi but moves with turbid qi. Triggered by cold, heat, alcohol, food, anger, or desire, always by disturbing turbid qi rising with fire, displacing clear qi. Treating nest-sac phlegm is difficult. First, concentrate mind in qi, adjust quietly, reduce rich flavors to remove Stomach phlegm, prevent Stomach qi from rushing to Luo vessels, allow Luo qi to return to Stomach. Gradually use herbs to open sacs and wash out phlegm. Later generations use four methods for phlegm-fluid: strengthen Spleen, dry dampness, clear fire, move qi. Er Chen Tang plus Cang Zhu and Bai Zhu is suitable for strengthening Spleen and drying dampness, but contraindicated in Yin deficiency. Clearing fire must distinguish excess (bitter-cold) vs. deficiency (sweet-cold). Regulating qi herbs in various formulas are vague; let me clarify. Wind-cold invading inward trapping phlegm-fluid requires Xiao Qing Long Tang to separate pathogen outward and fluid downward. Turbid yin rising upward trapping phlegm-fluid requires Jin Gui Ban Xia Hou Po Tang (Si Qi Tang) to separate turbidity downward and fluid upward. For those with excessive desires, Kidney qi rebels piercing the membrane origin, causing massive accumulation, abdominal distension/heaviness, inability to lie supine. Gui Ling Wan guides qi downward, resolving phlegm-fluid. Deficient-cold phlegm-fluid is rare in youth but common in elderly/children. If Spleen/Stomach deficient-cold causes anorexia, yin obstruction, and saliva vomiting, warm the middle; if True Yang is deficient, tonify below; clearing upper herbs are contraindicated. Phlegm-fluid is one syndrome with two causes: Phlegm stems from fire (heat only, no cold); Fluid stems from dampness (can be heat or cold). Like hot springs exist but not cold fires. Phlegm-fluid knotting in the chest causes fullness, oppression, frequent coughing without expectoration. Total cause is Spleen failing to transport fluids for the Stomach, generating phlegm from diet, infiltrating Lung orifices, making coughing difficult. Although treating phlegm is urgent, phlegm-resolving herbs tend to consume qi and damage deficiency, risking wind invasion before phlegm exits. Only precise use of sweet-cold herbs to block wind, clear heat, moisten dryness, tonify deficiency, and resolve phlegm is correct. Fright-phlegm blocking orifices exists everywhere in Liver, Lung, Heart, and Pericardium collaterals. Three-position pulses are deficient and weak; pathogen excess, righteous qi deficient, hard to disperse. Using emetics is like a military raid on camp, risky. Guiding downward is impossible for orifice phlegm, only damaging Spleen qi. Prioritize regulating Spleen. Spleen qi is the dynamic yang of the body, like the sun in the sky. When yin condensation blocks all sides, the sun loses its place. When phlegm confounds consciousness, the Spleen loses its