【留饮之症】《金匮》云∶心下有饮，其人背寒冷如掌大。又云∶留饮者，胁下痛，引
缺盆，咳则辄已。又云，胸中有留饮，其人短气而渴，四肢历节痛，脉沉者，必有留饮。
【留饮之因】始因水饮停积，结成痰饮，日久不化，即曰留饮。夫留者，聚而不散之
谓也。饮留于背，妨督脉上升之阳，而为背寒，少阳肝胆之脉，由缺盆过季胁，饮留于胁，阻绝肝胆
生升之气，故胁下痛引缺盆，留饮胸中，其人短气而渴，四肢历节痛。
【留饮之脉】脉多沉者，胸有留饮；双弦者寒，偏弦者饮。
【留饮之治】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
甘遂半夏汤
甘遂 半夏 芍药 炙甘草
【伏饮之症】痰满喘咳，吐发则寒热、背痛腰疼，目泪自出，其人振振身 剧，名
【伏饮之因】水饮不散，伏于胸中，阻其肺气，则痰满喘咳；阻其中气，则吐发；伏
太阳表邪外束，则寒热背痛；伏于上焦，阻绝清升之气，则目泪自出；饮伏胃家，胃阳凝塞
，不能四布，振振 剧。夫曰吐发，则寒热背痛，可见不发即不吐，不吐即不发矣。以其
有饮内伏，故外邪触之即发也。
【伏饮之脉】左脉浮紧，寒邪束饮；寸脉沉弦，上焦阻绝；关脉沉弦，中脘凝塞；沉
脉主伏，弦脉主饮，沉弦之脉，伏饮之诊。
【伏饮之治】有寒热则病在表，腰背痛则病在太阳，此内有伏饮，外表有邪，当从表
里并治，
吐发等表症，故从表散也。
小青龙汤 见前溢饮门。
木防己汤 见前支饮门。
桢按∶以上诸条，《金匮》之论痰饮也，此以脾湿成痰，非比诸痰症，故别之曰痰饮
。夫饮者，即停蓄之水饮也；盖痰因火动而成，饮因水寒所致。
【留饮的症状】《金匮要略》说：心下有痰饮停留，患者背部感觉寒冷，范围如手掌大小。又说：所谓留饮，表现为胁下疼痛，牵引至缺盆穴，咳嗽时疼痛加剧（辄已：指咳嗽时疼痛发作或加剧）。又说，胸中有留饮，患者呼吸短促且口渴，四肢关节游走性疼痛，脉象沉的，必定有留饮。
【留饮的成因】起初是因为水饮停积，凝结成痰饮，日久不化，就称为留饮。“留”的意思，就是聚结而不消散。饮邪停留在背部，阻碍督脉上升的阳气，从而导致背部寒冷；少阳肝胆的经脉，从缺盆经过季胁部，饮邪停留在胁下，阻绝了肝胆生发升腾之气，所以胁下疼痛并牵引至缺盆；留饮停滞在胸中，导致患者呼吸短促且口渴，四肢关节疼痛。
【留饮的脉象】脉象多呈沉象，说明胸中有留饮；双侧脉弦为寒证，单侧脉弦为饮证。
【留饮的治疗】患者脉象伏匿，想要自发性腹泻，泻后反而感到舒适，虽然腹泻，但心下（胃脘部）继续坚硬胀满，这是留饮欲去而未尽的缘故。
甘遂半夏汤
甘遂、半夏、芍药、炙甘草
【伏饮的症状】痰多胸闷，气喘咳嗽，发作时伴有恶寒发热、背痛腰痛，眼泪自然流出，身体剧烈震颤动摇，这被称为伏饮。
【伏饮的成因】水饮不散，潜伏在胸中，阻碍肺气，则出现痰多胸闷、气喘咳嗽；阻碍中焦之气，则引发呕吐；若兼有太阳表邪外束，则出现恶寒发热、背痛；饮邪潜伏在上焦，阻绝清阳上升之气，则眼泪自出；饮邪潜伏在胃部，胃阳凝滞闭塞，不能布散全身，导致身体剧烈震颤动摇。之所以称为“吐发”，是因为恶寒发热、背痛等症状，可见如果不呕吐就不发病，不呕吐就不会发作。因为体内有饮邪潜伏，所以被外邪触动就会发作。
【伏饮的脉象】左脉浮紧，是寒邪束缚饮邪；寸脉沉弦，是上焦气机阻绝；关脉沉弦，是中脘部位凝滞闭塞；沉脉主伏邪，弦脉主饮邪，沉弦之脉，是诊断伏饮的依据。
【伏饮的治疗】如果有恶寒发热，说明病位在表；如果腰背疼痛，说明病位在太阳经。此时内有伏饮，外表有邪气，应当表里同治。
针对呕吐等表症，故采用从表发散的方法。
小青龙汤（见前文溢饮门）。
木防己汤（见前文支饮门）。
桢按：以上各条，《金匮要略》论述痰饮，这里认为是脾湿生痰，不同于一般的痰证，所以特别称之为“痰饮”。所谓“饮”，就是停蓄的水饮；大概痰是因火动而成，饮是因水寒所致。
[Symptoms of Retained Fluid] The *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) states: When fluid is retained under the heart, the patient experiences coldness on the back, covering an area the size of a palm. It further states: Regarding retained fluid (Liu Yin), there is pain in the hypochondrium radiating to the Quepen point (LI 18), which intensifies upon coughing. Additionally, when retained fluid exists in the chest, the patient suffers from shortness of breath and thirst, wandering pain in the four limbs and joints, and a deep pulse; this indicates the presence of retained fluid.
[Etiology of Retained Fluid] Initially, water-fluid stagnates and condenses into phlegm-fluid. After a long time without resolving, it is termed retained fluid. "Retained" implies accumulation without dispersion. When fluid remains in the back, it obstructs the ascending Yang of the Du Mai (Governing Vessel), causing back coldness. The Shaoyang Gallbladder and Liver meridians pass from Quepen (LI 18) through the lateral costal region; fluid retention in the hypochondrium obstructs the rising Qi of the Liver and Gallbladder, resulting in hypochondriac pain radiating to Quepen. Retained fluid in the chest causes shortness of breath, thirst, and pain in the limbs and joints.
[Pulse of Retained Fluid] The pulse is mostly deep, indicating retained fluid in the chest. A bilateral wiry pulse indicates Cold; a unilateral wiry pulse indicates Fluid.
[Treatment of Retained Fluid] If the patient's pulse is hidden (Fu) and they desire spontaneous diarrhea, feeling relief after defecation, yet the epigastrium remains hard and full despite the diarrhea, this signifies that the retained fluid is attempting to exit but has not fully resolved.
Gansui Banxia Tang (Kansui and Pinellia Decoction)
Gansui (Kansui Radix), Banxia (Pinelliae Rhizoma), Shaoyao (Paeoniae Radix), Zhi Gancao (Prepared Glycyrrhizae Radix et Rhizoma).
[Symptoms of Hidden Fluid] Phlegm-fullness, wheezing, and coughing. Upon attack, symptoms include aversion to cold with fever, backache, and lumbago, spontaneous tearing, and severe tremors of the body. This is named Hidden Fluid (Fu Yin).
[Etiology of Hidden Fluid] Water-fluid does not disperse but hides in the chest, obstructing Lung Qi, leading to phlegm-fullness, wheezing, and coughing. Obstruction of Middle Jiao Qi leads to vomiting. If Taiyang exterior pathogens bind externally, aversion to cold with fever and back pain occur. If fluid hides in the Upper Jiao, obstructing the ascending clear Qi, tears flow spontaneously. If fluid hides in the Stomach, Stomach Yang becomes congealed and blocked, unable to circulate, causing severe tremors. The term "attack" (Fa) implies that symptoms like aversion to cold, fever, and back pain appear only when vomiting occurs; if there is no vomiting, there is no attack. Because fluid is hidden internally, external pathogens trigger the onset.
[Pulse of Hidden Fluid] The left pulse is floating and tight, indicating Cold pathogens binding the fluid. The Cun (inch) position is deep and wiry, indicating obstruction in the Upper Jiao. The Guan (middle) position is deep and wiry, indicating congestion in the Zhongwan area. A deep pulse indicates hidden pathogens; a wiry pulse indicates fluid. A deep-wiry pulse is the diagnostic sign for Hidden Fluid.
[Treatment of Hidden Fluid] If there are aversion to cold and fever, the pathogen is in the Exterior. If there is lumbago and back pain, the pathogen is in the Taiyang channel. Here, there is hidden fluid internally and exterior pathogens externally; thus, both Interior and Exterior should be treated simultaneously.
For exterior symptoms such as vomiting, treatment focuses on dispersing from the Exterior.
Xiao Qinglong Tang (Minor Blue Dragon Decoction) (See previous section on Overflowing Fluid).
Mufangji Tang (Stephania Tetrandra Decoction) (See previous section on Pivotal Fluid).
Note by Zhen: The above paragraphs discuss phlegm-fluid according to the *Jin Gui*. This text attributes phlegm-fluid formation to Spleen dampness, distinguishing it from other phlegm syndromes, hence naming it specifically as "Phlegm-Fluid." "Fluid" refers to accumulated water-fluid. Generally, Phlegm is formed due to Fire agitation, while Fluid is caused by Water-Cold.