稀为饮，稠为痰，此仲景之所不言；然稀稠之分，则其意自见矣。盖古方详于饮而略于痰，后世详于痰而
略于饮。诸家唯杨仁斋书析为二门，其他则淄渑无别。此编遵仁斋之例，以易循览，至其方剂，则或宜参互通
用云。
饮痰之别 痰者，涎液结聚，在于胸膈；饮者，水浆停积，在膀胱也。（《病源论》）（按膀胱可疑）
稠浊者为痰，清稀者为饮；一为火燥，一为寒湿。今医不分，混同出治，所以鲜能取效。（《医统》）
痰为饮之积，饮为痰之渐，稀涎水是也。（《六要》）
痰之与饮，虽曰同类，而实有不同也。盖饮为水液之属，凡呕吐清水，及胸腹膨满，吞嗳酸腐，渥渥有声
等证，此皆水谷之余，停积不行，是即所谓饮也。若痰有不同于饮者，饮清澈而痰稠浊，饮惟停积肠胃，而痰
则无处不到。水谷不化而停为饮者，其病全由脾胃；无处不到而化为痰者，凡五脏之伤，皆能致之。故治此者，
当知所辨，而不可不察其本也。（《景岳》）
诸饮源条 痰饮者，由气脉闭塞，津液不通，水饮气停在胸腑，结而成痰。又其人素盛今瘦，水走肠
间，漉漉有声，谓之痰饮。其病也，胸胁胀满，水谷不消，结在腹内两肋，水入肠胃，动作有声，体重多唾，
短气好眠，胸背痛，甚则上气，咳逆倚息，短气不能卧，其形如肿是也。脉偏弦为痰，浮而滑为饮。（《病源
论》）（按∶巢氏分痰与饮为二，然此候取经文凑合支饮，不能判然为辨，仍姑列于此。又有诸痰候，亦属含
混，不录。）
热痰者，谓饮水浆结积所生也。言阴阳痞隔，上焦生热，热气与痰水相搏，聚而不散，故令身体虚热，逆
害饮食，头面 而热。故云热痰也。
冷痰者，言胃气虚弱，不能宣行水谷，故使痰水结聚，停于胸膈之间，时令人吞酸气逆，四肢变青，不能
食饮也。
痰结实候 此由痰水积聚，在于胸腑，遇冷热之气相搏，结实不消，故令人心腹痞满，气息不安，头
眩目暗，常欲呕
逆，故言痰结实。
流饮者，由饮水多，水流走于肠胃之间，漉漉有声，谓之流饮。遇血气痞涩，经络不行，水不宣通，停聚
溢于膀胱之间，即令人短气，将息遇冷，亦能虚胀，久不瘥，结聚而成癖也。（按∶此与痰饮不异，姑存之。）
留饮者，由饮酒后饮水多，水气停留于胸膈之间而不宣散，乃令人胁下痛，短气而渴，皆其候也。
诸饮者，皆由荣卫气痞涩，三焦不调，而因饮水多，停积而成痰饮。其为病也，或两胁胀满，或心胸烦闷，
或眼暗口干，或呕逆短气。诸候非一，故云诸饮。（并同上）（按∶原文更有支饮、溢饮、悬饮候。支饮曰∶
饮水过多，停积于胸膈之间，支乘于心。悬饮曰∶饮水过多，留注胁下，令胁间悬痛。）
癖病源候 （酒癖）夫五脏调和则荣卫气理，荣卫气理则津液通流，虽复多饮水浆，不能为病。若摄养
乖方，三焦痞隔，三焦痞隔则肠胃不能宣行，因饮水浆过多，便令停滞不散，更遇寒气，积聚而成癖。癖者，
谓僻侧在于两胁之间，有时而痛是也。（《病源论》）（按∶此所谓癖者，殆与悬饮相类。考《集韵》曰∶
，匹辟切，肠间水。今巢氏以癖为水饮停滞之名，岂是义乎。然窃疑 癖之癖，系侧僻之僻； 癖之癖，系襞
积之襞，似各异其解。今巢氏凑合为说，盖亦古义耳。）
癖结候 此由饮水聚停不散，复因饮食相搏，致使结积在于胁下，时有弦亘起，或胀痛，或喘息短气，
故云癖结。脉紧实者，癖结也。
夫酒癖者，因大饮酒后，渴而引饮无度，酒与饮俱不散，停滞在于胁肋下，结聚成癖，时时而痛，因即呼
为酒癖，其状胁下气急而痛。
夫饮酒人大渴，渴而饮水，水与酒停聚胸膈之上，蕴积不散而成癖也，则令呕吐宿水，色如菹汁、小豆汁
之类酸苦者，故谓之酒癖菹痰也。（并同上）
停饮由三焦气涩 人之有形，借水饮以滋养；水之所化，凭气脉以宣流。盖三焦者，水谷之道路，气
之所终始也。三焦调适，气脉平匀，则能宣通水液，行入于经，化而为血，溉灌周身。三焦气涩，脉道闭塞，
则水饮停滞，不得宣行，聚成痰饮，为病多端。（《圣济》）（按∶此本于巢氏）
停饮由脾胃不调 水之与饮，同出而异名也。人惟脾土有亏，故半日所饮水浆，不能传化，或停于心
下，或聚于胁间，或注于经络，或溢于膀胱，往往因此而致病矣，孰谓血气痰涎能生诸疾而水饮之不能为恙乎。
惟水与饮，漉漉有声，为喘为咳，为呕为泄，为痞膈，为胀满，为眩晕、为怔忪，为寒热，为坚痛，为浮肿，
为多唾，为短气，为体重。气为饮隔，痞满腹鸣，骨痛冷痹，则曰气分；经脉不行，血化为水，四肢红肿，则
曰血分。凡此等类，皆水气之所由作也。据病验证，可不究其所受之原乎。（《直指》）
痰之与饮，其由自别，其状亦殊，痰质稠粘，饮惟清水。特其色有异，或青或黄，或绿或黑，或如酸浆，
或伏于肠胃，或上支胸膈，刺痛难忍，或流于经络四肢，则关节不利。支饮上攻，为心痛，为中脘痛，甚则汗
出，为呕吐酸水、苦黄水等，种种各异，或发寒热，不思饮食及不得眠，皆其候也。此证多因酒后过饮茶汤，
则水浆与肠胃饮食湿热之气，凝而为饮。或因情抱抑郁，饮食停滞，不得以时消散，亦能成饮。总之，必由脾
胃有湿，或脾胃本虚，又感饮食之湿，则停而不消，此饮之大略也。（《本草经疏》）
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，徒徇其末而忘其
木，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，一由胃而旁流于胁，一由胃而外出四肢，一由胃而上入于胸膈。（《千金方衍
义》曰∶四饮之中，支饮为最剧。）始元不觉，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，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。若出胸膈而深藏于背，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。（《医通》）（按∶此系《医门法律》节文。）
所由有五 饮之所得，其来有五∶有愤郁而得之者，有困乏而得之者，有思虑而得之者，有痛饮而得
之者，有热时伤冷而得之者。饮证虽多，无出于此。夫愤郁而不得伸，则
肝气乘脾，脾气不化，故为留饮。肝主虑，久虑而不决，则饮气不行。脾主思，久思而不已，则脾结，故亦为
留饮。人因劳役远来。乘困饮水，脾胃力衰，因而嗜卧，不能布散于脉，亦为留饮。人饮酒过多，肠胃已满，
又复增之，脬经不及渗泄，久久如斯，亦为留饮。因隆暑津液焦涸，喜饮寒水，本欲止渴，乘快过多，逸而不
动，亦为留饮。人若病饮者，岂能出此五者之外乎。夫水者阴物也，但积水则生湿，停酒则成痰，在左胁者同
肥气，在右胁者同息贲，上入肺则多嗽，下入大肠则为泻，入肾则为涌水，濯濯如囊浆，上下无所之，故在太
阳，则为支饮，皆由气逆而得之。故湿在上者，目黄面浮；在下者，股膝肿厥∶在中者，支满痞膈痰逆。在
阳不去者，久则化气；在阴不去者，久则成形。（《儒门事亲》）
脉法 寸口脉紧或浮，膈上有寒，肺下有水气。（《脉经》）
其脉皆弦微沉滑。（《三因》）（按∶此上载有经文四饮及留饮伏饮条。）
证状 （互见上条）凡心下有水者，筑筑而悸，短气而恐，其人眩而颠，先寒即为虚，先热即为实。病
人肩息上引，此皆有溢饮在胸中，久者缺盆满，马刀肿有剧时，此为气饮所致也。（《千金》）
一臂不随 病患一臂不随，时复转移在一臂，其脉沉细，非风也，必有饮在上焦。其脉虚者，为微劳，
荣卫气不周故也，久久自瘥。（一云冬自瘥）（《脉经》）
食不消 痰饮食不消候，此由痰水结聚，在胸腑膀胱之间，久而不散，流行于脾胃，脾恶湿，得水则
胀，胀则不能消食也。或令腹里虚满，或水谷不消化，或时呕逆，皆其候也。（《病源论》）
膈痰风厥头痛 膈痰者，谓痰水在于胸膈之上，又犯大寒，使阳气不行，令痰水结聚不散，而阴气逆
上，上与风痰相结，上冲于头，即令头痛，或数岁不已，久连脑痛，故云膈痰风厥头痛（按∶此本于《肘后》）
。若手足寒冷至节，即死。（《病源论》）（治方出后吐剂中，宜参。又《鸡峰》曰∶痰厥之候，由痰水结聚
，阴气逆冲于头目，令人头痛，胸满短气，呕吐白沫。盖即此条证。）
类伤寒 中脘有痰，亦令人憎寒发热，胸膈痞满，有类伤寒，但头不疼、项不强为异，服柴胡半夏汤
、金沸草散、大半夏汤。（《活人书》）（按∶柴胡半夏汤，系小柴胡汤加白术、麦门冬。金沸草散，用旋复
花、细辛、前胡、荆芥、甘草、半夏、芍药、姜、枣，水煎。大半夏汤，犹用小半夏汤。）
治例 气行即水行，气滞即水滞，故知饮之为病，在人最多，善疗此者，要以宣通气脉为先，则水饮
无所凝滞。所以治痰饮者，当以温药和之，以人之气血，得温则宣流也。及其结而成坚癖，则兼以消痰破饮之剂
攻之。（《圣济》）
观乎治饮之法，或下或汗，或温或利，此固定法。愚者之见，温利之差，可以无害，汗下之错，为病不浅
矣。不若顺气为先，分导次之，气顺则津液流通，痰饮运下，自小便中出。有病喜吐痰唾，服八味丸而作效者，
亦有意焉。王叔和云∶肾寒多唾。盖肾为水之官，肾能摄水。肾气温和，则水液运下；肾气虚寒，则邪水溢上
。其间用山茱萸、山药辈取其补，附子、肉桂取其温，茯苓、泽泻取其利，理亦当矣。临病之际，又加详审焉
。（《济生》）
疗治之法将何先？曰∶能以表里虚实证之，斯得矣。表有水者，其身热，嗽喘怔忪，干呕微利，青龙汤汗
之而愈。
里有水者，其身凉，呕嗽痞满，引胁痛硬，十枣汤下之而安。虚者脉虚，心腹满而濡，当以安肾丸为主，加
青木香丸少许以行之。（按∶此二方俱难适用，今不取，）实者脉实，心腹满而硬，当以青木香丸为主，用五
皮散加枳壳以导之。寻常水气，心下怔忪，大半夏汤、小半夏茯苓汤、五苓散辈，通用可也。然而疟家多积
黄水，或于心下停潴，或于胁间结癖，惟癖为能生寒热，所以疟剂多用常山。盖水在上焦则吐之，水不在于上
焦，则常山亦能破其癖而下其水也。若夫水肿证候，亦此种类，请旁参而互考焉。（《直指》）
愚尝观仲景治饮诸方之意，在表者汗之，在里者下之，挟湿则分利之，寒热温凉，随其所属以治之。（《
玉机》）
治宜燥湿利水行气健脾，乃为得也。其药大都以半夏、茯苓、参、术为君，佐以猪苓、泽泻以渗泄之，白
豆蔻、橘皮以开散之，苏梗、旋复花以通畅之。东垣五饮丸中有人参，其旨概可见矣。（《本草经疏》）
治不当为诸证牵掣 病痰饮而变生诸证，不当为诸证牵掣，妄言作名，且以治饮为先，饮消则诸证自
愈。（《医碥》曰∶真格言也。）有卒然昏闷，口眼 斜，似中而实非中，四肢战曳，身如浮云，似虚而实非
虚，皆痰饮所为也。又有肾虚寒不能摄水，致邪水溢上，故作痰饮，宜八味丸。（《要诀》）
溢饮发汗治验 吴茭山治一男子瘦弱，因卧卑湿之地，遂得溢饮之证，头目眩晕，羞见光，寒热时作
（痰能作寒热信然），四肢历节疼痛（四肢历节疼痛，乃湿饮流注关节）。医作风治，或作虚治，将及半年，
俱不效。吴诊脉曰∶寸口脉沉而滑，两尺弦，此溢饮湿痰也，但汗吐之。诸医以病者虚羸，当用补法，谓汗吐
必死。吴曰∶此溢饮当发其汗。遂以控涎丸一服，却用爆干绵子一斗然之，以被围
之，勿令气泄，令患人坐熏，良久倏然吐出黑痰升许，大汗如雨，痛止身轻，其病遂愈。（《类按》）
和中散寒诸方 《延年》茯苓饮，主心胸中有停痰宿水，自吐出水后，心胸间虚气满，不能食，消痰
气，令能食方。
茯苓（三两） 人参（二两） 白术（三两） 生姜（四两） 枳实（二两炙） 橘皮（一两半切）
稀薄的称为“饮”，稠厚的称为“痰”，这是张仲景没有明确指出的；然而，关于稀与稠的区别，其含义自然显现。古代方书详细论述“饮”而简略论述“痰”，后世则详细论述“痰”而简略论述“饮”。各家学说中，只有杨仁斋的著作将二者分为两门，其他医家则混淆不清，如同淄水和渑水难以分辨。本编遵循杨仁斋的体例，以便于查阅，至于其中的方剂，则可以互相参考、通用。
痰与饮的区别：痰，是涎液凝结积聚，位于胸膈部位；饮，是水浆停积，位于膀胱。（出自《诸病源候论》）（按语：此处提到膀胱值得怀疑。）
稠浊的是痰，清稀的是饮；一个是火燥所致，一个是寒湿所致。现在的医生不加以区分，混同治疗，所以很少能取得疗效。（出自《医统正脉》）
痰是饮的积聚，饮是痰的初起阶段，稀薄的涎水就是饮。（出自《医学六要》）
痰和饮，虽然说是同类，但实际上有所不同。大概来说，饮属于水液一类，凡是呕吐清水，以及胸腹部胀满，吞酸嗳气带有腐臭味，体内漉漉有声等症状，这些都是水谷残渣，停滞积聚而不运行，这就是所谓的“饮”。如果痰不同于饮的地方在于，饮清澈而痰稠浊，饮只停留在肠胃，而痰则无处不到。水谷不消化而停滞成为饮的，其病因完全在于脾胃；无处不到而化为痰的，凡是五脏受损，都能导致它产生。所以治疗这类疾病的人，应当知道辨别，并且不可不考察其根本。（出自《景岳全书》）
各种饮证的源流条目：痰饮，是由于气脉闭塞，津液不通，水饮之气停在胸腑，凝结而成痰。另外，那人平时身体壮盛现在却消瘦，水气走窜于肠间，发出漉漉的声音，这叫做痰饮。它的病症表现是：胸胁胀满，水谷不消化，结聚在腹内两肋之间，水进入肠胃，流动时发出声音，身体沉重，多唾沫，呼吸短促喜欢睡觉，胸背疼痛，严重时出现气逆喘息，咳嗽气短不能平卧，形体看起来像浮肿一样。脉象偏弦的是痰，浮而滑的是饮。（出自《诸病源候论》）（按语：巢元方将痰与饮分为两类，但此条候证是凑合经文中的支饮，不能清晰分辨，暂且列于此。又有各种痰的候证，也属含糊，不予收录。）
热痰，是指饮水浆结积所生成的。意思是阴阳痞塞阻隔，上焦生热，热气与痰水相互搏结，聚集而不消散，所以导致身体虚热，妨碍饮食，头面部发热。所以称之为热痰。
冷痰，是说胃气虚弱，不能宣通运行水谷，所以使痰水结聚，停留在胸膈之间，时常让人吞酸气逆，四肢变青，不能进食饮水。
痰结实候证：这是由于痰水积聚，在胸腑之中，遇到冷热之气相互搏结，结实不消，所以导致人心腹痞塞胀满，气息不安，头晕眼花，经常想要呕吐气逆，所以称为痰结实。
流饮：由于饮水过多，水流走窜于肠胃之间，发出漉漉的声音，叫做流饮。如果遇到血气痞塞涩滞，经络不通，水液不能宣通，停聚溢出到膀胱之间，就会让人呼吸短促，调养时遇到寒冷，也能引起虚胀，久不痊愈，结聚而形成癖病。（按语：这与痰饮没有不同，姑且保存它。）
留饮：由于饮酒后饮水过多，水气停留在胸膈之间而不能宣散，于是让人胁下疼痛，呼吸短促且口渴，都是它的征候。
各种饮证，都是由营卫之气痞塞涩滞，三焦不调，再加上饮水过多，停积而形成的痰饮。它引起的病症，有的两胁胀满，有的心胸烦闷，有的眼睛昏暗口干，有的呕吐气逆呼吸短促。各种候证不一，所以称为诸饮。（同上）（按语：原文还有支饮、溢饮的候证。支饮说：饮水过多，停积在胸膈之间，支撑于心。悬饮说：饮水过多，留注在胁下，让胁间悬挂疼痛。）
癖病的源流候证 （酒癖）：如果五脏调和，那么营卫之气理顺，营卫之气理顺，那么津液流通，即使喝很多水浆，也不会致病。如果养生方法不当，导致三焦痞塞阻隔，三焦痞塞阻隔则肠胃不能宣通运行，因为饮水浆过多，便令停滞不散，再遇到寒气，积聚而形成癖病。癖，是说偏侧在于两胁之间，有时疼痛。（出自《诸病源候论》）（按语：这里所说的癖，大概与悬饮相似。考证《集韵》说：癖，匹辟切，指肠间的水。现在巢元方以癖为水饮停滞的名称，难道符合本义吗？但我私下怀疑，“癖病”的“癖”，关联的是“侧僻”的“僻”；“襞积”的“癖”，关联的是“衣褶”的“襞”，似乎解释各异。现在巢元方凑合在一起解说，大概是古义罢了。）
癖结候证：这是由于饮水聚停不散，又因饮食相互搏结，致使结积在于胁下，有时有弦状物挺起，或者胀痛，或者喘息短气，所以称为癖结。脉象紧实的，是癖结。
所谓酒癖，是因为大量饮酒后，口渴而引水无度，酒与水都不消散，停滞在胁肋下，结聚形成癖病，时时疼痛，因此就称为酒癖，其症状是胁下气急而痛。
喝酒的人大渴，口渴而喝水，水与酒停聚在胸膈之上，蕴积不散而形成癖病，就会导致呕吐宿水，颜色像腌菜汁、小豆汁之类酸苦的东西，所以称之为酒癖菹痰。（同上）
停饮由三焦气涩引起：人有形体，依靠水饮来滋养；水的转化，凭借气脉来宣通流动。大概三焦，是水谷的道路，气终结开始的地方。三焦调适，气脉平匀，就能宣通水液，流入经脉，转化为血，灌溉周身。三焦气涩，脉道闭塞，那么水饮停滞，不能宣通运行，聚集成痰饮，引发的病症多种多样。（出自《圣济总录》）（按语：这原本基于巢元方的观点）
停饮由脾胃不调引起：水与饮，同源而异名。人只要脾土亏损，所以半天所喝的水浆，不能传化，有的停在心下，有的聚在胁间，有的注入经络，有的溢出膀胱，往往因此而导致疾病了，谁说血气痰涎能生各种疾病而水饮不能成为祸害呢。只有水与饮，漉漉有声，表现为喘咳，表现为呕吐泄泻，表现为痞隔，表现为胀满，表现为眩晕、怔忡，表现为寒热，表现为坚痛，表现为浮肿，表现为多唾，表现为短气，表现为体重。气被饮邪阻隔，痞满腹鸣，骨痛冷痹，这就叫作“气分”；经脉不行，血化为水，四肢红肿，这就叫作“血分”。凡此等类别，都是水气产生的原因。根据病证验证，能不探究其所受的根源吗？（出自《直指方》）
痰与饮，它们的来源各自不同，症状也殊异，痰质地稠粘，饮只是清水。特别是颜色有差异，有的青有的黄，有的绿有的黑，有的像酸浆，或者潜伏在肠胃，或者上撑胸膈，刺痛难忍，或者流窜于经络四肢，那么关节不利。支饮上攻，导致心痛，导致中脘痛，严重时出汗，导致呕吐酸水、苦黄水等，种种各异，有的发作寒热，不思饮食及不能入睡，都是它的征候。此证多因酒后过量饮茶汤，那么水浆与肠胃饮食湿热之气，凝结而为饮。或者因为情志抑郁，饮食停滞，不能按时消散，也能形成饮。总之，必定是由脾胃有湿，或脾胃本虚，又感受饮食之湿，则停积不消，这是饮的大致情况。（出自《本草经疏》）
痰饮为患，十个人中有七八个，《金匮要略》论述得很详细，分别而立其名，后世因为名字太多，徒然追随末节而忘记本源，不曾思考圣人立法，都是从一源而出，没有多条歧路。大概胃是水谷之海，五脏六腑的大源头，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，以此作为常人。《金匮要略》就从水精不能四布、五经不能并行的地方，来谈论其病患，随证分别深浅，教导人们通过名称来探求其意义，浅的在于躯壳之内，脏腑之外。它的饮有四种：一种由胃而下流于肠，一种由胃而旁流于胁，一种由胃而外出四肢，一种由胃而上入于胸膈。（《千金方衍义》说：四饮之中，支饮最为严重。）起初不觉察，日积月累，水的精华，转为混浊，于是遂成痰饮，必定先团聚于呼吸大气难到达之处，所以由肠而胁而四肢，逐渐浸渍于胸膈，其势越逆，那么痰饮的病患，没有不从胃开始的。那五脏，是藏神的地方，积水泛为痰饮，包裹在外，岂不是人身的大患吗？凡是水饮蓄积而不散的，都叫作留饮。留，是留而不去的。留饮去而不尽的，都叫作伏饮。伏，是不出的。随着痰饮的或留或伏，而使用方法来治疗它，这才是精义。现在试着说说，由胃而上至胸胁心肺部位的，驱赶它们回归胃，或者下从肠排出，或者上从呕吐出，而不让它们伏匿。如果由胸膈而外出肌肤，清的或许从汗出，浊的就没有出路了，必定有伏匿在肌肤而不胜驱逐的。如果出胸膈而深藏在背部，背是胸的府邸，更没有出路，岂止是驱逐不胜驱逐，而且有挟带背间的狂阳壮火，发为痈毒的。伏饮难于从下排出，易于酿成祸患，谁能辨别它，谁能排出它呢？（出自《医宗金鉴·医通》）（按语：这是《医门法律》的节选文字。）
成因有五种：饮邪的获得，来源有五种：有因愤郁而得的，有因困乏而得的，有因思虑而得的，有因痛饮而得的，有因热时受冷而得的。饮证虽然多，没有超出这五种。人如果愤郁而不能伸展，那么肝气乘袭脾土，脾气不运化，所以成为留饮。肝主谋虑，久虑而不决断，那么饮气不行。脾主思，久思而不已，那么脾结，所以也成为留饮。人因为劳役远行，乘着困倦饮水，脾胃力量衰弱，因而嗜睡，不能布散于脉，也成为留饮。人饮酒过多，肠胃已满，又再增加，膀胱经脉来不及渗泄，久久如此，也成为留饮。因为隆暑时节津液焦涸，喜欢喝冷水，本想止渴，趁着痛快喝得过多，安逸而不活动，也成为留饮。人如果患病为饮，怎么能超出这五种之外呢。水是阴物，只要积水就生湿，停酒就成痰，在左胁的如同肥气，在右胁的如同息贲，上入肺则多咳嗽，下入大肠则为泄泻，入肾则为涌水，濯濯如囊中之浆，上下无所归依，所以在太阳经，就成为支饮，都是由气逆而得的。所以湿在上的，目黄面浮；在下的，大腿膝盖肿厥；在中的，支撑胀满痞隔痰逆。在阳分不去的，久了则化气；在阴分不去的，久了则成形。（出自《儒门事亲》）
脉法：寸口脉紧或浮，膈上有寒，肺下有 water qi（水气）。（出自《脉经》）
其脉都呈现弦微沉滑。（出自《三因极一病证方论》）（按语：上面记载有四饮及留饮伏饮的经文条目。）
证状 （互见于上条）：凡是心下有水的，心脏筑筑跳动而悸动，呼吸短促且恐惧，其人眩晕跌倒，先感到寒冷即为虚证，先感到发热即为实证。病人耸肩呼吸，气向上牵引，这都是有溢饮在胸中，久的话缺盆处饱满，马刀疮肿胀有时剧烈，这是气饮导致的。（出自《千金方》）
一臂不随：病患一只手臂不能随意运动，时常转移在另一只手臂，其脉沉细，不是风邪，必定是有饮在上焦。其脉虚的，是轻微劳累，营卫之气不周遍的缘故，久了自然会痊愈。（一说冬天自愈）（出自《脉经》）
食不消：痰饮食不消候证，这是由于痰水结聚，在胸腑膀胱之间，久而不散，流行于脾胃，脾厌恶湿气，得到水则胀，胀则不能消化食物。或者导致腹里虚满，或者水谷不消化，或者时常呕吐气逆，都是它的征候。（出自《诸病源候论》）
膈痰风厥头痛：膈痰，是说痰水在胸膈之上，又遭受大寒，使阳气不行，令痰水结聚不散，而阴气逆上，上与风痰相结，上冲于头，立即导致头痛，或者数年不愈，久连脑痛，所以称为膈痰风厥头痛（按语：这原本基于《肘后备急方》）。如果手足寒冷至关节，就会死亡。（出自《诸病源候论》）（治方出在后文吐剂中，宜参考。又《鸡峰普济方》说：痰厥的候证，由痰水结聚，阴气逆冲于头目，令人头痛，胸满短气，呕吐白沫。大概就是这个条证的症候。）
类伤寒：中脘有痰，也让人憎寒发热，胸膈痞满，有类似伤寒的症状，只是头不疼、项不强作为区别，服用柴胡半夏汤、金沸草散、大半夏汤。（出自《活人书》）（按语：柴胡半夏汤，是小柴胡汤加白术、麦门冬。金沸草散，用旋复花、细辛、前胡、荆芥、甘草、半夏、芍药、姜、枣，水煎。大半夏汤，犹用小半夏汤。）
治例：气行则水行，气滞则水滞，所以知道饮之为病，在人身上最多，善于治疗此病的人，要以宣通气脉为先，那么水饮就不会凝滞。所以治疗痰饮，应当用温药调和它，因为人的气血，得温则宣通流动。等到它结而成坚癖，则兼用消痰破饮的药剂攻伐它。（出自《圣济总录》）
观察治疗饮的方法，或用下法，或用汗法，或用温法，或用利法，这是固定的法则。愚者的见解，温法和利法的差错，可以无害，汗法和下法的错误，造成的病患就不浅了。不如顺气为先，分导次之，气顺则津液流通，痰饮运化下行，自然从小便中排出。有病喜吐痰唾，服用八味丸而见效的，也是有深意的。王叔和说：肾寒多唾。大概肾是水之官，肾能摄水。肾气温和，则水液运化下行；肾气虚寒，则邪水溢上。其间用山茱萸、山药辈取其补益，附子、肉桂取其温煦，茯苓、泽泻取其渗利，道理也是恰当的。临病之际，又要详细审察。（出自《济生方》）
疗治之法将何先？回答说：能以表里虚实来辨证，就得到了要领。表有水者，其身热，嗽喘怔忡，干呕微利，用青龙汤发汗而愈。
里有水者，其身凉，呕嗽痞满，牵引胁痛硬，用十枣汤攻下而安。虚者脉虚，心腹满而濡软，当以安肾丸为主，加少许青木香丸以推动它。（按语：这两个方子都难以适用，现在不取用。）实者脉实，心腹满而坚硬，当以青木香丸为主，用五皮散加枳壳以导引它。寻常水气，心下怔忡，大半夏汤、小半夏茯苓汤、五苓散之类，通用即可。然而疟疾患者多积黄水，有的在心下停潴，有的在胁间结癖，只有癖才能生寒热，所以疟疾药剂多用常山。大概水在上焦则用吐法，水不在于上焦，则常山也能破其癖而下其水。如果是水肿证候，也属这一种类，请旁参而互考。（出自《直指方》）
我曾观察张仲景治疗饮的各种方子的用意，在表的用汗法，在里的用下法，挟湿的用分利法，寒热温凉，随其所属来治疗。（出自《玉机微义》）
治疗宜燥湿利水行气健脾，才是得当的。其药物大都以半夏、茯苓、人参、白术为君药，佐以猪苓、泽泻以渗泄之，白豆蔻、橘皮以开散之，苏梗、旋复花以通畅之。东垣的五饮丸中有人参，其主旨概可见矣。（出自《本草经疏》）
治不当为诸证牵掣：患痰饮而变生各种证候，不应当被各种证候牵掣，妄言另立病名，且以治饮为先，饮消则各种证候自然痊愈。（《医碥》说：真是格言啊。）有突然昏闷，口眼歪斜，似中风而实非中风，四肢颤抖曳动，身如浮云，似虚而实非虚，都是痰饮所为。又有肾虚寒不能摄水，导致邪水溢上，故作痰饮，宜用八味丸。（出自《杂病源流犀烛·要诀》）
溢饮发汗治验：吴茭山治疗一个男子瘦弱，因为卧在卑湿之地，于是得了溢饮的证候，头目眩晕，羞见光，寒热时作（痰能作寒热确实如此），四肢历节疼痛（四肢历节疼痛，乃是湿饮流注关节）。医生当作风邪治疗，或当作虚证治疗，将近半年，都不见效。吴诊脉说：寸口脉沉而滑，两尺脉弦，这是溢饮湿痰，只用汗吐法。众医认为病人虚羸，应当用补法，说汗吐必死。吴说：此溢饮应当发其汗。于是用控涎丸一服，却用爆干的绵子一斗燃烧，用被子围住，不让气泄漏，让病人坐熏，良久忽然吐出黑痰约一升，大汗如雨，痛止身轻，病遂愈。（出自《类案》）
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).