典藏书目

The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states that the so-called "Four Types of Fluid Retention" (*Si Yin*) refer to Suspended Fluid Retention (*Xuan Yin*), Lingering Fluid Retention (*Liu Yin*), Branch Fluid Retention (*Zhi Yin*), and Phlegm-Fluid Retention (*Tan Yin*). If a person who was previously obese now becomes emaciated, and fluid flows in the intestines making a gurgling sound, this is called Phlegm-Fluid Retention (*Tan Yin*); if after drinking water, the fluid stays in the hypochondrium and coughing or spitting induces pain, this is called Suspended Fluid Retention (*Xuan Yin*); if fluid flows into the four limbs, sweating should occur but does not, resulting in heavy and painful body, this is called Overflowing Fluid Retention (*Yi Yin*); if there is coughing with air rushing upward, reliance on leaning objects for breathing, shortness of breath preventing lying flat, and swelling resembling edema, this is called Branch Fluid Retention (*Zhi Yin*). Additionally, there is Lingering Fluid Retention (*Liu Yin*), characterized by coldness in the back the size of a hand, or shortness of breath with thirst, pain in the four limbs and joints, pain in the hypochondrium radiating to the *Quepen* (LI 15) acupoint, and worsening symptoms upon coughing. There is also Hidden Fluid Retention (*Fu Yin*), characterized by fullness and vomiting in the diaphragm, wheezing and coughing, accompanied by alternating chills and fever, lower back pain, and tearing upon attack, with the patient trembling and experiencing aversion to cold. For Overflowing Fluid Retention (*Yi Yin*), the method should be to induce sweating; for Suspended Fluid Retention (*Xuan Yin*), according to the law, purgation should be used; for Phlegm-Fluid Retention (*Tan Yin*), warm herbs should be used to harmonize it.

Commentary: Ancient formularies state that the "Four Types of Fluid Retention" generate six syndromes, which are the Four Types plus Hidden and Lingering Fluid Retention. Or some say "Five Types," combining Lingering and Hidden Fluid Retention into one syndrome. Among the Three Causes (*San Yin*), Phlegm-Fluid Retention is treated with warm herbs to expel via urination; Branch Fluid Retention is treated with sweating or purgation depending on the syndrome, supplementing the treatment methods for the Four Types. I have observed Zhang Zhongjing's various formulas for treating fluid retention; his intent is: for pathogens in the exterior, use sweating; for those in the interior, use purgation; for those complicated with dampness, use diuresis; and treat according to cold, heat, warmth, or coolness based on their affiliation. Why must one adhere strictly to these four syndromes?

Chen Wuze stated: The reason humans have phlegm-fluid retention is due to unclear Ying and Wei (Nutritive and Defensive Qi), turbid and deteriorated blood and Qi condensing. Internally, due to the disturbance of the Seven Emotions (*Qi Qing*), Zang-Fu Qi fails to circulate, leading to stagnation and generation of saliva, which condenses into fluid retention; this is an Internal Cause (*Nei Yin*). Externally, due to invasion by the Six Evils (*Liu Yin*), the Xu Fu (pores) are blocked, preventing necessary sweating, causing accumulation into fluid retention; this is an External Cause (*Wai Yin*). Or, due to excessive dietary injury, immoderate sexual activity, or improper movement, leading to stagnant Jin Ye (Body Fluids) gathering into phlegm-fluid retention; this belongs to the Neither-Internal-Nor-External Cause (*Bu Nei Wai Yin*). As a disease manifestation, it causes wheezing, coughing, vomiting, diarrhea, dizziness, heartburn, palpitations, chills and fever, pain, swelling, fullness, spasms, masses, strangury, epigastric blockage, etc., similar to wind pathogens or mania, none of which do not originate from phlegm-fluid retention.

Commentary: Distinguishing the Three Causes from the manifestations of disease here is very appropriate. However, in his discussion, the medicines cited for the Three Causes include using interior-treating drugs for external causes, and exterior-treating drugs for internal causes; the detailed intent is found in the discussions following the formulas.

Yan Shi stated: The human Qi mechanism values smoothness; if smooth, Jin Ye circulates freely, and there will be no affliction of phlegm-fluid retention. Ancient formulas treat fluid retention using sweating, purgation, warming, and draining methods. In my opinion, it is better to prioritize regulating Qi, followed by separating and guiding stagnation. When Qi is smooth, Jin Ye circulates, and phlegm-fluid retention transforms and descends, naturally exiting through urination.

Commentary: Yan Shi's statement that "when Qi is smooth, phlegm descends" seems to imply that since the stagnation of the Seven Emotions leads to Qi stagnation generating saliva and gathering into phlegm-fluid retention, if the healer can make the Qi mechanism unobstructed, the phlegm will descend naturally. However, some patients originally have phlegm accumulation, where Qi is obstructed *because* of the phlegm. Can simply regulating Qi make the phlegm disappear on its own? One must first expel the phlegm accumulation, then the obstructed Qi will flow freely. How can one exclusively adhere to one viewpoint? Furthermore, saying "there is no upward-flowing phlegm in the human body, nor reverse-flowing water in the world" is merely nonsense from the eastern suburbs of Qi. Water nature is moistening and downward; if beaten or leaped at, it can splash over the forehead. Phlegm nature is also downward; if steamed up by fire, it can reach the vertex. Modern mediocre physicians fail to understand this meaning, yet often recite this phrase to others, which is truly pitiable.