（此篇脉经接前肺痿肺痈咳嗽上气为一篇。痰饮。作淡饮。下并同。）
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。气短不得卧。
其形如肿。谓之支饮。（沥沥。巢源。作漉漉。气短。诸本。作短气。）
〔程〕圣济总录曰。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。灌溉周身。若三焦气塞。脉道壅闭。则水饮停滞。不得宣行。聚成痰饮。为病多端。又因脾
土不能宣达。致水饮流溢于中。布散于外。甚则五脏受病也。痰饮者何。以平人水谷之气。入于胃变化精微。
以充肌肉。则形盛。今不能变化精微。但化而为痰饮。此其人所以素盛今瘦。故水走肠间。沥沥作声也。
〔沈〕饮后水流在胁下者。乃饮积于胃。腠理不密。如汗 。横溢胃外。流于胁下。而为悬饮。悬饮者。
犹物悬挂其处之义也。胁乃阴阳之道路。悬饮阻抑往来之气。咳则气吸吊动于胁。咳唾则引痛矣。盖脾肺
之气。不能转运。饮水流行。泛于四肢皮肤肌肉之间。即当汗出而散。设不汗出。凝逆经隧。身体疼重。而
为溢饮。经谓溢饮者。渴暴多饮。而溢入肌皮肠胃之外。是也。若溢出于胃。从下注上。贮于胸膈之间。壅遏
肺气。上逆而内则咳逆倚息。短气不得卧。外应皮毛。肺气壅而不行。则如肿。故为支饮也。
〔鉴〕
痰饮悬饮溢饮支饮。言饮病之情状也。四饮亦不外乎留饮伏饮之理。但因其流水之处。特分之为四耳。由其状
而命之名。故有四也。李 曰。夫饮有四。而此独以痰饮名总之。水积阴或为饮。饮凝阳或为痰。则
分而言之饮有四。合而言之总为痰饮而已。
案痰本作淡。王羲之初月帖。淡闷干呕。宋黄伯思法帖
刊误云。淡古淡液之淡。干古干湿之干。今人以淡作痰。以干作干。非也。而肘后方。有治痰 诸方。即痰饮
也。考唐惠琳一切经音义云。淡阴。谓胸上液也。医方多作淡饮。又云。痰 。上音谈。下阴禁反。案痰
字无定体。胸膈中气病也。津液因气凝结不散。如筋胶引挽不断。名为痰 。盖痰字。始见于神农本经巴豆
条云。留饮痰癖。而饮字。则见于内经刺志论云。脉小血多者。饮中热也。王注。溜饮也。又溢饮。见于脉
要精微论。根据以上数义而考之。痰饮。即津液为病之总称。故本经以题篇目。而又以肠间沥沥有声为
痰饮者。犹伤寒外邪之统名。而又以麻黄汤一证。呼为伤寒之类。本条痰饮。又与稀则曰饮。稠则曰痰之义亦
自异。程云。痰饮。脉经千金翼。俱作淡饮。当以淡饮为是。若痰饮则稠粘。不能走肠间沥沥作声也。此说似
是而却非。不知痰乃淡从 者。沈千金翼。淡饮。五饮之一。与本条所谓颇异。云。大五饮丸。主五种饮。一
曰留饮。停水在心下。二曰 饮。水 在两胁下。三曰淡饮。水在胃中。四曰溢饮。水溢
在膈上五脏间。五曰流饮。水在肠间。动摇有声。（千金同。）所谓流饮。乃似本条之痰饮。巢源云。流饮
者。由饮水多。水流走于肠胃之间。漉漉有声。谓之流饮。亦本条之痰饮也。
巢源云。悬饮。谓饮水过多。留注胁下。令胁间悬痛。咳唾引胁痛。故云悬饮。又云。支饮。谓饮水过
多。停积于胸膈之间。支乘于心。故云支饮。案支字。徐为肺之支脉。程为支散之义。魏云。分也。尤云。
如水之有派木之有枝。并不通。今根据巢源。支。枝同。谓支撑于心膈之间。支满支
结义皆同。王注六元正纪支痛云。支。拄妨也。为是。
水在心。心下坚筑。短气。恶水不欲饮。（千金。作心下坚筑筑。）
〔尤〕水。即饮也。坚筑。悸动有力。筑筑然也。短气
者。心属火而畏水。水气上逼。则火气不伸也。
〔徐〕脏中非真能蓄有形之水。不过饮气侵之。不可泥。
水在肺。吐涎沫。欲饮水。
〔程〕联绵不断者曰涎。轻浮而白者曰沫。涎者津液所化。
沫者水饮所内。酿于肺经则吐。吐多则津液亦干。故欲饮水。
水在脾。少气身重。
〔徐〕脾主肌肉。且恶湿。得水气。则濡滞而重。脾精不运。则中气不足。而倦怠少气。
水在肝。胁下支满。嚏而痛。
〔程〕肝脉布胁肋。故胁下支满。水在肝。则条达之性为
水郁。其气上走颃颡。至蓄门而出鼻孔。因作嚏也。嚏则痛引胁肌。故嚏而痛。
水在肾。心下悸。
〔程〕水在肾。则肾气凌心。故筑筑然悸也。
夫心下有留饮。其人背寒冷如手大。（手。原本。作水。今根据诸本改订。徐沈尤。作掌。）
〔尤〕留饮。即痰饮之留而不去者也。背寒冷如掌大者。饮留之处。阳气所不入也。
〔程〕诸阳受气于
胸中。而转行于背。心下有留饮。则阳气抑遏而不行。故背寒冷如手大者。言其不尽寒也。
医学六要。仲景曰。心下有留饮。其人背恶寒。冷如冰。茯苓丸。（茯苓一两。半夏二两。枳壳五钱。
风化硝二钱半。共末。姜汁糊丸桐子大。姜汤下三十丸。）案此指迷茯苓丸也。而引仲景者何。又王隐君滚
痰丸主疗。有脊上一条如线之寒起证。亦与此同。
留饮者。胁下痛引缺盆。咳嗽则辄已。（〔原注〕一作转甚。○案脉经。千金。作转甚。程金鉴从之。）
〔程〕缺盆者。五脏六腑之道。故饮留于胁下。而痛上引
缺盆。引缺盆则咳嗽。咳嗽则痛引胁下而转甚。此属悬饮。
转甚。一本作辄已。未有咳嗽而胁下痛。引缺盆辄愈也。
胸中有留饮。其人短气而渴。四肢历节痛。脉沉者有留饮。（脉沉以下。程为另条。）
〔程〕胸中者。属上焦也。今为留饮隔碍。则气为之短。津液不能上潮。则口为之渴也。饮者湿类也。
流于关节。故四肢历节痛也。经曰。脉得诸沉者。当责有水。故脉沉者为水饮。
〔尤〕四肢历节痛。为风
寒湿在关节。若脉不浮而沉。而又短气而渴。则知是留饮为病。而非外入之邪矣。
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 剧。必有伏饮。（病痰。脉经。
千金。作之病。脉经注云。目泣自出。一作目眩。）
〔尤〕伏饮。亦即痰饮之伏而不觉者。发则始见也。身热背疼腰疼。有似外感。而兼见喘满咳唾。则是活
人所谓痰之为病。能令人憎寒发热。状类伤寒者也。目泣自出。振振身 动者。饮发而上逼液道。外攻经隧也。
案金鉴云。即今之或值秋寒。或感春风。发则必喘满咳吐。痰盛寒热。背痛腰疼。咳剧则目泣自出。咳
甚则振振身动。世俗所谓吼喘病也。今验吼喘。未见振振身 者。故欠
字不解。盖以其有所不妥者乎。况吼喘。乃前篇肺胀中之一证。与此自异。
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
喜虚。脉偏弦者饮也。（千金。外台。虚下。有耳字。脉双弦以下。程为别条。金鉴同。是。沈徐。
无喜字。程魏金鉴。作大下后里虚。）
〔程〕饮水多。则水气泛溢于胸膈。必暴喘满也。凡人食
少饮多。则胃土不能游溢精气。甚者必停于心下而为悸。微
者则填于胸膈。而为短气也。
〔鉴〕凡病患食少饮多者。为消渴病。小便不利者。为留饮。留饮者。即今
之停水饮病也。
〔尤〕水溢入肺者。则为喘满。水停心下者。甚则水气凌心而悸。微则气被饮抑而短也。双
弦者。两手皆弦。寒气周体也。偏弦者。一手独弦。饮气偏注也。
案徐云。有一手两条脉。亦曰双弦。此乃元气不壮之人。往往多见此脉。亦属虚。适愚概温补中气。兼
化痰。应手而愈。此本于吴氏脉语云双弦者。脉来如引二线也。然与经文双弦义递别。
肺饮不弦。但苦喘短气。（苦。脉经千金。作喜。）
〔尤〕肺饮。饮之在肺中者。五脏独有肺饮。以其虚而能
受也。肺主气而司呼吸。苦喘短气。肺病已着。脉虽不弦。可以知其有饮矣。
支饮亦喘而不能卧。加短气。其脉平也。（卧。千金外台。作眠。）
〔尤〕支饮上附于肺。即同肺饮。故亦喘而短气。其脉亦平。而不必弦也。按后十四条云。咳家其脉弦。
为有水。夫咳为肺病。而水即是饮。而其脉弦。此云肺饮不弦。支饮脉平。未详何谓。
案脉平。诸注纷坛。多属附会。尤为未详。可谓卓见矣。
病痰饮者。当以温药和之。
〔沈〕此言痰饮属阴。当用温药也。脾失健运。水湿酿成痰饮。其性属湿。而为阴邪。故当温药和之。
即助阳而胜脾湿。俾阳运化。湿自除矣。
〔魏〕言和之。则不专事温补。即有行消之品。亦概其义例于温药之
中。方谓之和之。而不可谓之补之益之也。盖痰饮之邪。因虚而成。而痰亦实物。必
少有开导。总不出温药和之四字。其法尽矣。
外台。引范汪。病痰者。当以温药和之。半夏汤。即千
金小半夏汤。附于后。
心下有痰饮。胸胁支满目眩。苓桂术甘汤主之。（脉经。作甘草汤。）
〔徐〕心下有痰饮。心下非即胃也。乃胃之上心之下。上焦所主。唯其气挟寒湿阴邪。冲胸及胁。而为支
满。支者。撑定不去。如痞状也。阴邪抑遏上升之阳。而目见玄色故眩。苓桂术甘汤。正所谓温药也。桂甘
之温化气。术之温健脾。苓之平而走下。以消饮气。茯苓独多。任以君也。
灵经脉篇云。包络是动。则胸胁支满。心中 大动。
茯苓桂枝白术甘草汤方（千金。名甘草汤。）
茯苓（四两） 桂枝 白术（各三两） 甘草（二两）
上四味。以水六升。煮取三升。分温三服。小便则利。
圣济总录。茯苓汤。治三焦有水气。胸胁支满目眩。（即本方。）
夫短气有微饮。当从小便去之。苓桂术甘汤主之。（方见上。）肾气丸亦主之。（方见妇人杂病中。）
〔徐〕短气有微饮。即上文微者短气也。然支饮留饮。水在心。皆短气。总是水停心下。故曰当从
小便去之。
〔尤〕气为饮抑则短。欲引其气。必蠲其饮。饮水类也。治水必自小便去之。苓桂术甘。益土气
以行水。肾气丸。养阳气以化阴。虽所主不同。而利小便则一也。
案喻氏法律云。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。此说甚凿矣。盖苓桂术甘。治肾阳不足。不能行水。而微饮停于心下以短气。肾气丸。治肾虚而
不能收摄水。水泛于心下以短气。必察其人之形体脉状。而为施治。一证二方。各有所主。其别盖在于斯耶。
严氏济生方云。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。则邪水上溢。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。
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。（脉经千金外
台。反上。有者字。）
〔魏〕病者脉伏。为水邪压溷。气血不能通。故脉反伏而不见也。其人欲自利。利反快。水流湿而就下。以
下为暂泄其势。故暂安适也。然旋利而心下续坚满。此水邪有根蒂。以维系之。不可以顺其下利之势。而为
削灭也。故曰。此为留饮欲去故也。盖阴寒之气立其基。水饮之邪成其穴。非开破导利之。不可也。
案金鉴云。此为留饮。欲去故也句。当在利反快之下。必传写之讹。盖此一句释上文。必非传写之讹。
甘遂半夏汤方（外台。引千金云。此本仲景伤寒论方。）
甘遂（大者三枚） 半夏（十二枚以水一升煮取半升去滓） 芍药（五枚○千金作二
枚外台作一两） 甘草（如指大一枚炙一本作无○千金作一枚如指大。水一升煮取半升。案一本作无四字未详）
上四味。以水二升。煮取半升。去滓。以蜜半升和药汁。
煎取八合顿服。（千金。作上四味以蜜半升内二药汁。合得一升半。煎取八合顿服之。案千金近是。）
〔程〕留者行之。用甘遂以决水饮。结者散之。用半夏以散痰饮。甘遂之性直达。恐其过于行水。缓
以甘草白蜜之甘。收以芍药之酸。虽甘草甘遂相反。而实有以相使。此（酸收甘缓。）约之之法也。灵枢经
曰。约方犹约囊。其斯之谓与。
〔尤〕甘草与甘遂相反。而同用之者。盖欲其一战。而留饮尽
去。因相激而相成也。芍药白蜜。不特安中。抑缓药毒耳。
脉浮而细滑。伤饮。
〔鉴〕凡饮病得脉浮而细滑者。为痰饮初病。水邪未深之诊也。李 曰。饮脉当沉。今脉浮者水在肺
也。
〔徐〕不曰有饮。而曰伤饮。见为外饮所骤伤。而非停积之水也。
脉弦数有寒饮。冬夏难治。
〔尤〕脉弦数而有寒饮则病与脉相左。魏氏所谓饮自寒。而挟自热是也。夫相左者。必相持冬。则时
（本篇脉经承接前文的肺痿、肺痈、咳嗽上气，合为一篇。痰饮，古作“淡饮”，下文均同。）
问：所谓“饮”有四种，是指什么？
老师答：有痰饮、悬饮、溢饮、支饮这四种。
问：这四种饮病，区别在哪里？
老师答：如果一个人平时身体壮盛，现在却消瘦了，水液流走于肠间，发出沥沥的声音，这叫痰饮。饮水后，水流停留在胁下，咳嗽吐唾时牵引胁下疼痛，这叫悬饮。饮水后，水液流行，归于四肢，本该出汗却不能出汗，身体疼痛沉重，这叫溢饮。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，这叫支饮。（“沥沥”，《诸病源候论》作“漉漉”。“气短”，各版本多作“短气”。）
〔程林〕《圣济总录》说：三焦是水谷运行的道路，也是气终结和起始的地方。三焦功能调和，气脉平稳均匀，就能宣通水液，使其进入经脉，化为血液，灌溉全身。如果三焦气机阻塞，脉道壅闭，那么水饮就会停滞，不能宣散运行，聚集成痰饮，引发多种疾病。又因为脾土不能宣达，导致水饮流溢于体内，布散于体表，严重时五脏都会受病。什么是痰饮？普通人饮食水谷之气进入胃中，化生精微物质来充实肌肉，所以形体壮盛。现在不能化生精微，只化生为痰饮，这就是这个人平时壮盛现在消瘦的原因，所以水液流走肠间，发出沥沥的声音。
〔沈明宗〕饮水后水流在胁下的，是因为饮邪积聚在胃，腠理不紧密，像汗液一样横溢到胃外，流注到胁下，形成悬饮。所谓悬饮，就像物品悬挂在某处的意思。胁部是阴阳之气往来的道路，悬饮阻碍了气的往来，咳嗽时气吸吊动于胁部，咳唾就会牵引疼痛。这是因为脾肺之气不能转运，饮水流行，泛滥于四肢皮肤肌肉之间，本应当通过出汗而消散，如果不出汗，就会凝滞逆乱于经络，导致身体疼痛沉重，形成溢饮。经文说溢饮，就是口渴突然大量饮水，水溢出进入肌皮肠胃之外，正是这种情况。如果水溢出到胃，从下向上灌注，贮存在胸膈之间，壅遏肺气，向上逆乱则内部出现咳嗽气逆、倚息、短气不能平卧；外部反映在皮毛，肺气壅塞不能宣发，所以看起来像浮肿，因此称为支饮。
〔尤怡/鉴〕痰饮、悬饮、溢饮、支饮，说的是饮病的各种情状。四种饮病也不外乎留饮、伏饮的道理，只是根据水液停留的部位不同，特别分为四类罢了。根据其形状来命名，所以有四类。李珣说：饮有四种，但这里唯独用“痰饮”来统称。水积聚在阴分可能成为饮，饮凝聚在阳分可能成为痰，分开来说饮有四种，合起来说总称为痰饮而已。
按语：“痰”字原本写作“淡”。王羲之的《初月帖》中有“淡闷干呕”。宋代黄伯思在《法帖刊误》中说：“淡”是古代“淡液”的淡，“干”是古代“干湿”的干。现在的人把“淡”写成“痰”，把“干”写成“干”，这是错误的。而《肘后备急方》中有治疗“痰”的各种方剂，指的就是痰饮。考证唐代惠琳《一切经音义》说：“淡阴”，指的是胸上的津液。医方多写作“淡饮”。又说：“痰”，上音谈，下音禁反切。案：“痰”字没有固定的形体，是胸膈中的气病。津液因为气凝结不散，像筋胶一样牵引不断，称为痰。大概“痰”字始见于《神农本草经》巴豆条，说：“留饮痰癖”。而“饮”字，则见于《内经·刺志论》，说：“脉小血多者，饮中热也。”王冰注解说：“溜饮也。”另外，“溢饮”见于《脉要精微论》。根据以上几种含义考证，“痰饮”即津液为病的总称，所以本篇以它为题名。而又把肠间沥沥有声的称为痰饮，就像《伤寒论》中外邪的统称叫伤寒，却又把麻黄汤证称为伤寒一类。本条所说的痰饮，也与“稀的叫饮，稠的叫痰”的意义有所不同。程林说，《脉经》、《千金翼方》都作“淡饮”，应当以“淡饮”为正确。如果是“痰饮”则稠粘，不能在肠间沥沥作响。这种说法似乎有理却是错的，不知道“痰”是“淡”加上“炎”（此处原文可能有误，意指字形演变或通假）。沈明宗引用《千金翼方》，将“淡饮”列为五饮之一，与本条所说的情况颇有差异。书中说：“大五饮丸”主治五种饮：一曰留饮，停水在心下；二曰饮（原文缺字，疑为悬饮），水在两胁下；三曰淡饮，水在胃中；四曰溢饮，水溢在膈上五脏间；五曰流饮，水在肠间，动摇有声。（《千金方》相同。）所谓的流饮，似乎就是本条所说的痰饮。《诸病源候论》说：流饮，是由于饮水过多，水流走动于肠胃之间，漉漉有声，叫做流饮，也就是本条所说的痰饮。
《诸病源候论》说：悬饮，谓饮水过多，留注胁下，令胁间悬挂疼痛，咳嗽吐唾牵引胁痛，所以叫悬饮。又说：支饮，谓饮水过多，停积于胸膈之间，支撑于心，所以叫支饮。案：“支”字，徐灵胎认为是肺的支脉，程林认为是支散的意思，魏荔彤认为是分的意思，尤怡认为是像水有支流、树有树枝，都不通顺。现在根据《诸病源候论》，“支”同“枝”，谓支撑于心膈之间，“支满”、“支结”的意思都相同。王冰注《六元正纪大论》“支痛”说：“支，拄妨也。”以此为准。
水在心，心下坚硬筑筑然跳动，短气，厌恶水不想喝。（《千金方》作“心下坚筑筑”。）
〔尤怡〕水，就是饮。坚筑，指悸动有力，筑筑然的样子。短气，是因为心属火而畏水，水气上逼，则火气不能舒展。
〔徐灵胎〕脏腑中并非真的蓄积有形的积水，不过是饮气侵犯罢了，不可拘泥。
水在肺，吐出涎沫，想喝水。
〔程林〕连绵不断的叫“涎”，轻浮白色的叫“沫”。涎是津液所化，沫是水饮内停，酝酿于肺经所以吐出。吐得多则津液也会干燥，所以想喝水。
水在脾，少气，身体沉重。
〔徐灵胎〕脾主肌肉，且厌恶湿气，得到水气，则濡滞而沉重。脾精不能运化，则中气不足，而倦怠少气。
水在肝，胁下支撑胀满，打喷嚏时牵引疼痛。
〔程林〕肝脉布散于胁肋，所以胁下支撑胀满。水在肝，则肝木条达的特性被水郁遏，其气上行走到颃颡（鼻咽部），到达蓄门而出鼻孔，因而作嚏。打喷嚏则疼痛牵引胁部肌肉，所以打喷嚏时疼痛。
心下有留饮的人，背部寒冷如手掌大小。（“手”，原本作“水”，今根据各本改订。徐、沈、尤作“掌”。）
〔尤怡〕留饮，就是痰饮停留不去的。背部寒冷如手掌大的地方，是饮邪停留之处，阳气所不能到达的地方。
〔程林〕诸阳之气受于胸中，而转行于背部。心下有留饮，则阳气被抑遏而不能运行，所以背部寒冷如手掌大，是说并不完全寒冷。
《医学六要》引仲景的话说：心下有留饮，其人背恶寒，冷如冰。用茯苓丸。（茯苓一两，半夏二两，枳壳五钱，风化硝二钱半，共研末，姜汁糊丸如梧桐子大，姜汤送服三十丸。）案：这就是指迷茯苓丸。为什么引用仲景的话？还有王隐君的滚痰丸主治，有脊背上有一条像线一样的寒冷起证的，也与此相同。
留饮，胁下疼痛牵引缺盆，咳嗽则暂时停止。（〔原注〕一作“转甚”。○案《脉经》、《千金》作“转甚”。程金鉴遵从这一说法。）
〔程林〕缺盆，是五脏六腑的道路，所以饮邪留在胁下，疼痛向上牵引至缺盆。牵引缺盆则引起咳嗽，咳嗽则疼痛牵引胁下而加重。这属于悬饮。
“转甚”，一本作“辄已”。没有咳嗽而胁下痛牵引缺盆就痊愈的道理。
胸中有留饮，其人短气而且口渴，四肢历节疼痛，脉沉的有留饮。（“脉沉以下”，程林视为另一条。）
〔程林〕胸中，属于上焦。现在被留饮阻隔，所以气短。津液不能上潮，所以口喝。饮是湿类，流注于关节，所以四肢历节疼痛。经文说：脉得诸沉者，应当责求有水。所以脉沉是有水饮的表现。
〔尤怡〕四肢历节疼痛，是风寒湿在关节。如果脉不浮而沉，又伴有短气和口渴，就知道是留饮为病，而不是外入的邪气。
膈上有病痰，胀满、喘咳、呕吐，发作时寒热，背痛腰疼，眼泪自动流出，其人振振动摇，身体剧烈颤动，一定有伏饮。（“病痰”，《脉经》、《千金》作“之病”。《脉经》注云：“目泣自出”，一作“目眩”。）
〔尤怡〕伏饮，也是痰饮潜伏而不觉察的，发作时才显现出来。身热背疼腰疼，有点像外感，而兼见喘满咳唾，这就是《活人书》所说的痰之为病，能令人憎寒发热，状类伤寒。眼泪自动流出，振振动摇，是饮邪发作而上逼液道，外攻经络。
案：金鉴说，就是现在的某些时候遇秋寒，或感春风，发作时必定喘满咳吐，痰盛寒热，背痛腰疼，咳剧则眼泪流出，咳甚则身体振振动摇，世俗所谓的吼喘病。现在验证吼喘病，未见振振动摇的，所以“欠”字解释不通，大概是觉得有不妥当之处吧。况且吼喘，是前篇肺胀中的一个证，与此自然不同。
凡是病人饮水多，必定突然喘满。凡是吃得少喝得多，水停在心下，严重的则心悸，轻微的则短气。脉双弦的是寒证，都是大病泻下后喜欢虚损。脉偏弦的是饮证。（《千金》、《外台》“虚”下有“耳”字。“脉双弦以下”，程林视为别条，金鉴同意，是正确的。沈、徐无“喜”字。程、魏、金鉴作“大下后里虚”。）
〔程林〕饮水多，则水气泛溢于胸膈，必定突然喘满。凡人吃得少喝得多，则胃土不能游溢精气，严重的必停于心下而为悸，轻微的则填于胸膈，而为短气。
〔金鉴〕凡是病人吃得少喝得多的，是消渴病；小便不利的，是留饮。留饮，就是现在的停水饮病。
〔尤怡〕水溢入肺，则为喘满；水停心下，重的则水气凌心而悸，轻的则气被饮抑制而短。双弦，是两手脉都弦，寒气周遍全身。偏弦，是一手独弦，饮气偏注。
案：徐灵胎说，有一手两条脉，也叫双弦。这是元气不壮的人，往往多见此脉，也属虚。恰好我概括用温补中气，兼化痰的方法，应手而愈。这基于吴氏《脉语》说双弦是脉来如引二线。然而与经文双弦的意义截然不同。
肺饮不弦，但苦喘短气。（“苦”，《脉经》、《千金》作“喜”。）
〔尤怡〕肺饮，是饮邪在肺中。五脏独有肺饮，因为它虚而能受。肺主气而司呼吸，苦于喘短气，肺病已经明显，脉虽然不弦，可以知道有饮邪。
支饮也喘而不能卧，加上短气，其脉平。（“卧”，《千金》、《外台》作“眠”。）
〔尤怡〕支饮上附于肺，即同肺饮，所以也喘而短气。其脉也平，而不必弦。按后十四条说：咳家其脉弦，为有水。咳是肺病，而水即是饮，而其脉弦，这里说肺饮不弦，支饮脉平，不明白是什么道理。
案：脉平，各家注解纷纭，大多属于附会。尤怡认为未详，可谓卓见。
患痰饮病的人，应当用温药调和。
〔沈明宗〕这是说痰饮属阴，应当用温药。脾失健运，水湿酿成痰饮，其性属湿，为阴邪，所以当用温药调和。即助阳而胜脾湿，使阳气运化，湿自除矣。
〔魏荔彤〕说“和之”，则不专门从事温补，即使有行消的药物，也概归其义例于温药之中，才叫“和之”，而不能叫“补之益之”。大概痰饮之邪，因虚而成，而痰也是实物，必须稍有开导，总不出“温药和之”四字，其方法尽在此了。
《外台秘要》引范汪的话：病痰者，当以温药和之。半夏汤，即《千金》小半夏汤，附在后面。
心下有痰饮，胸胁支撑胀满，目眩。用苓桂术甘汤主治。（《脉经》作甘草汤。）
〔徐灵胎〕心下有痰饮，心下不即胃，乃是胃之上、心之下，由上焦所主。唯其气挟寒湿阴邪，冲胸及胁，而为支满。支，是撑定不去，像痞块一样。阴邪抑遏上升之阳，而目见黑色故眩。苓桂术甘汤，正所谓温药。桂、甘之温化气，术之温健脾，苓之平而走下，以消饮气。茯苓独多，任为君药。
茯苓桂枝白术甘草汤方（《千金》名甘草汤。）
茯苓（四两） 桂枝 白术（各三两） 甘草（二两）
上四味，以水六升，煮取三升，分温三服。小便则利。
《圣济总录》茯苓汤，治三焦有水气，胸胁支满目眩。（即本方。）
凡短气有微饮，应当从小便去除。苓桂术甘汤主治。（方见上。）肾气丸也主治。（方见妇人杂病中。）
〔徐灵胎〕短气有微饮，即上文所说的“微者短气”。然而支饮、留饮、水在心，皆短气，总是水停心下，所以说应当从小便去之。
〔尤怡〕气被饮抑制则短，欲引其气，必蠲其饮。饮水类也，治水必自小便去之。苓桂术甘，益土气以行水；肾气丸，养阳气以化阴。虽然所主不同，而利小便则一。
案：喻嘉言《法律》说：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。此说很确切。盖苓桂术甘，治肾阳不足，不能行水，而微饮停于心下以短气；肾气丸，治肾虚而不能收摄水，水泛于心下以短气。必须观察病人的形体脉状，而为施治。一证两方，各有所主，其区别大概在于此吧。
严氏《济生方》说：有病喜吐痰唾，服八味丸而见效的，也是有深意的。王叔和说：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，则邪水上溢。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。道理也是对的。
病人脉伏，其人想要自利，利后反而快适，虽然利，心下继续坚满。这是留饮欲去的原因。用甘遂半夏汤主治。（《脉经》、《千金》、《外台》“反”上有“者”字。）
〔魏荔彤〕病人脉伏，为水邪压混，气血不能通，所以脉反伏而不见。其人想要自利，利后反而快适，水流湿而就下，以下行为暂泄其势，所以暂安适。然而旋即利而心下继续坚满，这是水邪有根蒂，以维系之，不可以顺其下利之势，而为削灭。所以说：此为留饮欲去故也。盖阴寒之气立其基，水饮之邪成其穴，非开破导利之，不可也。
案：金鉴说，“此为留饮欲去故也”一句，应当在“利反快”之下，必是传写之讹。盖此一句释上文，必非传写之讹。
甘遂半夏汤方（《外台》引《千金》云：此本仲景《伤寒论》方。）
甘遂（大者三枚） 半夏（十二枚，以水一升，煮取半升，去滓） 芍药（五枚○《千金》作二枚，《外台》作一两） 甘草（如指大一枚，炙，一本作无○《千金》作一枚如指大，水一升，煮取半升。案一本作无四字，未详）
上四味，以水二升，煮取半升，去滓，以蜜半升和药汁。
煎取八合顿服。（《千金》作：上四味以蜜半升内二药汁，合得一升半，煎取八合顿服之。案《千金》近是。）
〔程林〕留者行之，用甘遂以决水饮；结者散之，用半夏以散痰饮。甘遂之性直达，恐其过于行水，缓以甘草、白蜜之甘，收以芍药之酸。虽甘草、甘遂相反，而实有以相使。此（酸收甘缓），约之之法也。《灵枢经》说：约方犹约囊。说的就是这个吧。
〔尤怡〕甘草与甘遂相反，而同用之，盖欲其一战，而留饮尽去，因相激而相成也。芍药、白蜜，不特安中，抑缓药毒耳。
脉浮而细滑，伤饮。
〔金鉴〕凡饮病得脉浮而细滑者，为痰饮初病，水邪未深之诊也。李珣说：饮脉当沉，今脉浮者水在肺也。
〔徐灵胎〕不曰有饮，而曰伤饮，见为外饮所骤伤，而非停积之水也。
(This section of the Mai Jing follows the previous discussion on Lung Withered Pus (Fei Fei), Lung Abscess (Fei Yong), Cough, and Asthma (Ke Sou Shang Qi) to form a single chapter. Tan Yin [Phlegm-Fluid], originally written as "Dan Yin" [Pale Fluid], is used interchangeably below.)
Q: It is said that there are four types of Yin [Fluid Retention]. What are they?
A: There are Tan Yin [Phlegm-Fluid], Xuan Yin [Hanging Fluid], Yi Yin [Overflowing Fluid], and Zhi Yin [Piercing Fluid].
Q: How do these four types of Yin differ from one another?
A: If a person who was previously robust now appears emaciated, and water flows through the intestines making a gurgling sound (Li Li), this is called Tan Yin [Phlegm-Fluid]. If after drinking, water accumulates in the hypochondrium, and coughing or spitting induces pain in the hypochondrium, this is called Xuan Yin [Hanging Fluid]. If after drinking, water flows into the four limbs, sweating should occur but does not, resulting in body pain and heaviness, this is called Yi Yin [Overflowing Fluid]. If there is coughing with air reversal, requiring leaning forward to breathe, shortness of breath, inability to lie flat, and the appearance of edema, this is called Zhi Yin [Piercing Fluid]. ("Li Li" is written as "Lu Lu" in *Zhu Bing Yuan Hou Lun*. "Qi Duan" is often written as "Duan Qi" in various editions.)
[Cheng Lin] The *Sheng Ji Zong Lu* states: The San Jiao [Triple Burner] is the pathway for food and fluids, and the beginning and end of Qi. When the San Jiao is harmonious and Qi meridians are even, it can disseminate and circulate fluids, allowing them to enter the meridians, transform into blood, and irrigate the entire body. If the Qi of the San Jiao is blocked and meridians are congested, fluids stagnate and cannot be disseminated, gathering to form Tan Yin [Phlegm-Fluid], causing various diseases. Furthermore, if the Spleen Earth fails to distribute clearly, fluids overflow internally and spread externally, potentially affecting the Five Zang Organs. What is Tan Yin [Phlegm-Fluid]? In healthy individuals, the Qi of food and drink enters the Stomach, transforms into essence and micro-nutrients, and fills the muscles, resulting in a robust physique. Now, if it fails to transform into essence and instead becomes Tan Yin [Phlegm-Fluid], this explains why the person was previously robust but is now thin, causing water to flow through the intestines with a gurgling sound.
[Shen Mingzong] When water flows into the hypochondrium after drinking, it is because fluid accumulation in the Stomach causes the Cou Li [interstices] to be loose, allowing fluid to overflow outside the Stomach into the hypochondrium, forming Xuan Yin [Hanging Fluid]. "Xuan" means hanging, like an object suspended in place. The hypochondrium is the pathway for the ascent and descent of Yin and Yang Qi. Xuan Yin [Hanging Fluid] obstructs the free flow of Qi; when coughing, Qi is pulled upward in the hypochondrium, causing pain upon coughing and spitting. This occurs because the Qi of the Spleen and Lung fails to transport. Drinking water flows and floods between the skin, muscles, and four limbs. It should dissipate through sweating. If it does not sweat, it condenses and reverses in the meridians, causing body pain and heaviness, forming Yi Yin [Overflowing Fluid]. The classic states that Yi Yin [Overflowing Fluid] involves sudden thirst and excessive drinking, with water overflowing into the exterior of muscles, skin, and intestines. If water overflows into the Stomach and moves upward, storing in the chest and diaphragm, it obstructs Lung Qi, causing internal coughing, air reversal, reliance on support to breathe, shortness of breath, and inability to lie flat. Externally reflecting on the skin and hair, Lung Qi congestion prevents dissemination, leading to an appearance of swelling, hence called Zhi Yin [Piercing Fluid].
[You Yi/Jian] Tan Yin, Xuan Yin, Yi Yin, and Zhi Yin describe the manifestations of fluid diseases. These four types are essentially based on the principles of Liu Yin [Retained Fluid] and Fu Yin [Latent Fluid], distinguished specifically by the location where water accumulates. They are named according to their shapes, hence the four categories. Li Xun stated: Although there are four types of Yin, here "Tan Yin" is used as a general term. Water accumulating in Yin aspects may become Yin [Fluid]; Yin [Fluid] condensing in Yang aspects may become Tan [Phlegm]. Separately, there are four types of Yin; collectively, they are all termed Tan Yin [Phlegm-Fluid].
Note: The character "Tan" was originally written as "Dan". Wang Xizhi's *First Month Letter* contains "Dan Men Gan Ou" [Pale discomfort, dry vomiting]. Huang Bosi of the Song Dynasty, in *Fa Tie Kan Wu*, stated that "Dan" refers to the "Dan" in ancient "Dan Ye" [fluid], and "Gan" refers to the "Gan" in ancient "Gan Shi" [dry/wet]. Modern usage writing "Dan" as "Tan" and "Gan" as "Gan" is incorrect. However, the *Zhou Hou Bei Ji Fang* contains formulas for treating "Tan", referring to Tan Yin [Phlegm-Fluid]. Tang Dynasty Hui Lin's *Yi Qie Jing Yin Yi* states: "Dan Yin" refers to fluid above the chest. Medical texts often write "Dan Yin". It also notes: "Tan" sounds like "Tan", and the second character is reversed from "Jin". The character "Tan" has no fixed form; it is a Qi disorder in the chest and diaphragm. Body fluids凝结 due to Qi stagnation do not disperse, resembling sticky tendon glue that cannot be broken, named "Tan". The character "Tan" first appeared in the *Shennong Ben Cao Jing* under the entry for Croton Seed (Badou), stating: "Liu Yin Tan Pi" [Retained fluid and phlegm-mass]. The character "Yin" appears in the *Nei Jing · Ci Zhi Lun*: "When the pulse is small and blood is abundant, there is heat in the Yin." Wang Bing's commentary says: "Liu Yin" [Sliding Fluid]. Additionally, "Yi Yin" appears in the *Mai Yao Jing Wei Lun*. Based on these sources, Tan Yin [Phlegm-Fluid] is the general term for pathological body fluids. Hence, this chapter uses it as the title. The specific description of gurgling sounds in the intestines as Tan Yin [Phlegm-Fluid] is analogous to how external pathogens in *Shang Han Lun* are generally called Shang Han [Cold Damage], yet the Ma Huang Tang syndrome is specifically referred to as a type of Shang Han. The Tan Yin [Phlegm-Fluid] in this clause differs from the meaning that "thin fluid is Yin, thick fluid is Tan". Cheng Lin stated that both *Mai Jing* and *Qian Jin Yi Fang* write "Dan Yin", which should be correct. If it were "Tan Yin", it would be thick and sticky and could not make gurgling sounds in the intestines. This argument seems plausible but is incorrect, failing to realize that "Tan" derives from "Dan". Shen Mingzong cites *Qian Jin Yi Fang*, listing "Dan Yin" as one of the Five Yins, which differs somewhat from the Tan Yin described here. The text states: "Da Wu Yin Wan" treats five types of Yin: 1. Liu Yin [Retained Fluid], water stopped in the epigastrium; 2. [Missing Character] Yin, water in the hypochondrium; 3. Dan Yin [Pale Fluid], water in the Stomach; 4. Yi Yin [Overflowing Fluid], water overflowing above the diaphragm among the five Zang Organs; 5. Liu Yin [Flowing Fluid], water in the intestines making sounds when moved. (*Qian Jin Fang* is identical). The so-called Liu Yin [Flowing Fluid] seems to correspond to the Tan Yin [Phlegm-Fluid] in this clause. *Zhu Bing Yuan Hou Lun* states: Liu Yin [Flowing Fluid] results from excessive drinking, where water flows between the stomach and intestines with a gurgling sound, called Liu Yin [Flowing Fluid], which is also the Tan Yin [Phlegm-Fluid] of this clause.
*Zhu Bing Yuan Hou Lun* states: Xuan Yin [Hanging Fluid] refers to excessive drinking causing water to remain and accumulate in the hypochondrium, causing hanging pain in the intercostal spaces, with coughing and spitting inducing hypochondriac pain, hence called Xuan Yin [Hanging Fluid]. It also states: Zhi Yin [Piercing Fluid] refers to excessive drinking causing water to accumulate in the chest and diaphragm, supporting the Heart, hence called Zhi Yin [Piercing Fluid]. Note: Xu Lingtai considers "Zhi" to mean a branch vessel of the Lung; Cheng Lin considers it to mean spreading; Wei Litong considers it to mean division; You Yi considers it similar to water branches or tree branches, none of which are satisfactory. Following *Zhu Bing Yuan Hou Lun*, "Zhi" is synonymous with "Zhi" [Branch], meaning supporting between the heart and diaphragm. The meanings of "Zhi Man" [Supporting Fullness] and "Zhi Jie" [Supporting Knot] are the same. Wang Bing’s commentary on "Zhi Tong" [Supporting Pain] in *Liu Yuan Zheng Ji Da Lun* states: "Zhi" means obstruction or hindrance. This is considered correct.
Water in the Heart: Epigastric hardness and palpitations (Zhu Zhu), shortness of breath, aversion to water and unwillingness to drink. (*Qian Jin Fang* writes "Epigastric hardness and Zhu Zhu palpitations".)
[You Yi] Water refers to Yin [Fluid]. "Jian Zhu" refers to strong palpitations, feeling like "Zhu Zhu". Shortness of breath occurs because the Heart belongs to Fire and fears Water; when Water Qi presses upward, Fire Qi cannot extend.
[Xu Lingtai] The Zang Organs do not truly accumulate有形 (有形 - tangible/solid) water; it is merely the invasion of Yin [Fluid] Qi. One should not be rigid in interpretation.
Water in the Lung: Vomiting saliva and foam, desire to drink water.
[Cheng Lin] Continuous saliva is called "Xian"; light and white foam is called "Mo". "Xian" is transformed from body fluids; "Mo" is internalized water-fluid. Fermenting in the Lung Meridian leads to vomiting. Excessive vomiting dries up body fluids, hence the desire to drink.
Water in the Spleen: Lack of Qi, heavy body.
[Xu Lingtai] The Spleen governs muscles and dislikes dampness. Upon receiving Water Qi, it becomes damp and stagnant, leading to heaviness. If Spleen Essence fails to transport, Middle Qi becomes insufficient, resulting in fatigue and lack of Qi.
Water in the Liver: Hypochondriac fullness and support, pain upon sneezing.
[Cheng Lin] The Liver Meridian distributes along the hypochondrium and ribs, hence hypochondriac fullness and support. Water in the Liver depresses the Liver's free-flowing nature. Its Qi ascends to the Hang Sang [nasopharynx], reaches the Xu Men [accumulation gate], and exits through the nostrils, causing sneezing. Sneezing pulls pain into the hypochondriac muscles, hence pain upon sneezing.
Water in the Kidney: Epigastric palpitations.
[Cheng Lin] Water in the Kidney causes Kidney Qi to assault the Heart, resulting in "Zhu Zhu" palpitations.
When there is Liu Yin [Retained Fluid] in the epigastrium, the person experiences coldness on the back, the size of a hand. ("Hand," originally written as "Water," corrected here based on various editions. Xu, Shen, and You write "Palm.")
[You Yi] Liu Yin [Retained Fluid] is Tan Yin [Phlegm-Fluid] that remains and does not depart. The area of the back that feels cold, the size of a palm, is where the fluid resides and Yang Qi cannot reach.
[Cheng Lin] All Yang Qi receives energy in the chest and circulates to the back. Liu Yin [Retained Fluid] in the epigastrium suppresses and blocks Yang Qi, preventing its movement. Thus, the back feels cold, the size of a hand, indicating it is not completely cold.
*Yi Xue Liu Yao* quotes Zhang Zhongjing: When there is Liu Yin [Retained Fluid] in the epigastrium, the person fears cold on the back, cold as ice. Use Fu Ling Wan [Poria Pill]. (Fu Ling 1 liang, Ban Xia 2 liang, Zhi Ke 5 qian, Feng Hua Xiao 2.5 qian, ground into powder, mixed with Ginger Juice paste to make pills the size of tung seeds, taken with Ginger Decoction, 30 pills per dose.) Note: This refers to Zhi Mi Fu Ling Wan [Poria Pill for Resolving Phlegm]. Why quote Zhang Zhongjing? Also, Wang Yinjun's Gun Tan Wan [Rolling Phlegm Pill] treats a symptom of coldness rising like a line on the spine, which is similar to this.
Liu Yin [Retained Fluid]: Pain in the hypochondrium radiating to Que Pen [Collarbone Depression], coughing then temporarily stops. ([Original Note] One version reads "worsens significantly." ○ Note: *Mai Jing* and *Qian Jin* read "worsens significantly." Cheng Jin follows this.)
[Cheng Lin] Que Pen [Collarbone Depression] is the pathway for the Five Zang and Six Fu Organs. Therefore, when fluid remains in the hypochondrium, pain radiates upward to Que Pen [Collarbone Depression]. Radiating to Que Pen [Collarbone Depression] induces coughing, which then causes pain to radiate to the hypochondrium and worsen significantly. This belongs to Xuan Yin [Hanging Fluid].
"Worsens significantly" is written as "temporarily stops" in one version. There is no case where coughing relieves hypochondriac pain radiating to the collarbone.
Liu Yin [Retained Fluid] in the chest: Shortness of breath and thirst, pain in the joints of the four limbs. A sinking pulse indicates Liu Yin [Retained Fluid]. (From "Sinking Pulse" onwards, Cheng Lin treats it as a separate clause.)
[Cheng Lin] The chest belongs to the Upper Jiao [Upper Burner]. Currently obstructed by Liu Yin [Retained Fluid], Qi becomes short. Body fluids cannot ascend to moisten, causing thirst. Yin [Fluid] is a wet substance; flowing into the joints causes pain in the joints of the four limbs. The classic states: "When the pulse exhibits various sinking qualities, one should investigate water retention." Thus, a sinking pulse indicates Water-Yin [Fluid].
[You Yi] Pain in the joints of the four limbs is caused by Wind-Cold-Dampness in the joints. If the pulse is not floating but sinking, accompanied by shortness of breath and thirst, it is known to be a disease of Liu Yin [Retained Fluid], not an external pathogen.
Pathogenic Tan [Phlegm] above the diaphragm: Fullness, asthma, coughing, vomiting. Upon onset, chills and fever, back pain, waist pain, spontaneous tearing, and severe trembling/shaking of the body indicate Fu Yin [Latent Fluid]. ("Bing Tan" [Disease Phlegm] in *Mai Jing* and *Qian Jin* is written as "Zhi Bing" [Of Disease]. *Mai Jing* note: "Spontaneous tearing," one version reads "dizziness".)
[You Yi] Fu Yin [Latent Fluid] is also Tan Yin [Phlegm-Fluid] that lies latent and unnoticed, manifesting only upon onset. Fever, back pain, and waist pain resemble external contraction, but combined with asthma, fullness, coughing, and spitting, it aligns with what the *Huo Ren Shu* describes as Phlegm disease causing aversion to cold and fever, resembling Cold Damage. Spontaneous tearing and severe trembling indicate that upon onset, the fluid attacks the fluid pathways upward and the meridians outward.
Note: Jin Jian states that this corresponds to modern cases where autumn cold or spring wind triggers asthma, fullness, coughing, vomiting, profuse phlegm, chills and fever, back and waist pain, severe coughing causing tearing, and severe coughing causing body tremors—the secular "Howling Asthma." However, observing Howling Asthma, I have not seen severe trembling, so the character "Qian" [yawn/lack] is difficult to explain, likely due to some inconsistency. Moreover, Howling Asthma is one syndrome in the previous chapter on Lung Distension, distinct from this.
If a patient drinks excessively, they will inevitably suffer from sudden asthma and fullness. Generally, eating little and drinking much causes water to stop in the epigastrium. Severe cases result in palpitations; mild cases result in shortness of breath. A double-string pulse indicates Cold; this usually occurs after severe purging, leading to deficiency. A single-string pulse indicates Yin [Fluid]. (*Qian Jin* and *Wai Tai* add the character "Er" [ear/particle] after "Xu" [deficiency]. From "Double-string pulse" onwards, Cheng Lin treats it as a separate clause, which Jin Jian agrees with, considering it correct. Shen and Xu omit the character "Xi" [like/please]. Cheng, Wei, and Jin Jian read "Li Xu" [Interior Deficiency] after "Da Xia Hou" [After severe purging].)
[Cheng Lin] Excessive drinking causes Water Qi to overflow into the chest and diaphragm, inevitably causing sudden asthma and fullness. When people eat little and drink much, the Stomach Earth cannot circulate and overflow essential Qi. Severe cases stop in the epigastrium causing palpitations; mild cases fill the chest and diaphragm causing shortness of breath.
[Jin Jian] Patients who eat little and drink much suffer from Xiao Ke [Wasting-Thirst Syndrome]. Those with difficulty urinating suffer from Liu Yin [Retained Fluid]. Liu Yin [Retained Fluid] is the current condition of retained water-drink.
[You Yi] Water overflowing into the Lung causes asthma and fullness; water stopping in the epigastrium, severely, Water Qi assaults the Heart causing palpitations; mildly, Qi is suppressed by Yin [Fluid] causing shortness. Double-string pulse means both hands are string-like, indicating Cold Qi surrounding the body. Single-string pulse means only one hand is string-like, indicating Yin [Fluid] Qi focusing on one side.
Note: Xu Lingtai states that having two pulses in one hand is also called a double-string pulse. This is often seen in people with weak Yuan Qi [Primary Qi] and also belongs to deficiency. Fortunately, my method of generally warming and tonifying Middle Qi while resolving phlegm works effectively. This is based on Wu Shi's *Mai Yu* stating that a double-string pulse feels like two lines being pulled. However, this differs distinctly from the meaning of double-string pulse in the classic.
Lung Yin [Fluid] does not present a string-like pulse, but rather suffering from asthma and shortness of breath. ("Ku" [suffer] in *Mai Jing* and *Qian Jin* is written as "Xi" [like/please].)
[You Yi] Lung Yin [Fluid] is Yin [Fluid] located in the Lung. Among the Five Zang Organs, only the Lung suffers from Yin [Fluid] because it is deficient and capable of receiving it. The Lung governs Qi and respiration. Suffering from asthma and shortness of breath indicates Lung disease is established. Although the pulse is not string-like, one can know there is Yin [Fluid].
Zhi Yin [Piercing Fluid] also causes asthma and inability to lie down, plus shortness of breath. Its pulse is normal. ("Wo" [lie down] in *Qian Jin* and *Wai Tai* is written as "Mian" [sleep].)
[You Yi] Zhi Yin [Piercing Fluid] attaches to the Lung, thus being the same as Lung Yin [Fluid]. Therefore, it also causes asthma and shortness of breath. Its pulse is also normal and need not be string-like. According to Clause 14 later: "For those with chronic cough, a string-like pulse indicates water." Cough is a Lung disease, and water is Yin [Fluid], yet the pulse is string-like. Here it says Lung Yin [Fluid] is not string-like, and Zhi Yin [Piercing Fluid] has a normal pulse. The reason is unclear.
Note: Regarding "normal pulse," annotations are numerous and mostly speculative. You Yi’s statement that it is unclear can be considered a profound insight.
For patients with Tan Yin [Phlegm-Fluid], warm herbs should be used to harmonize.
[Shen Mingzong] This states that Tan Yin [Phlegm-Fluid] belongs to Yin and requires warm herbs. Spleen failure in transportation leads to water-dampness brewing into Tan Yin [Phlegm-Fluid]. Its nature is damp and constitutes a Yin Pathogen, hence warm herbs should be used to harmonize. This assists Yang to overcome Spleen dampness, allowing Yang to transform and dampness to disappear.
[Wei Litong] Saying "harmonize" implies not solely engaging in warming and tonifying. Even if there are ingredients for moving and dissolving, they fall under the principle of warm herbs to be called "harmonizing," not "tonifying" or "benefiting." Generally, Tan Yin [Phlegm-Fluid] pathogenesis arises from deficiency, and Tan [Phlegm] is also a tangible substance. Some guiding methods are necessary. The essence is contained in the four characters "Warm Herbs to Harmonize." The method is complete here.
*Wai Tai Mi Yao* quotes Fan Wang: For patients with Tan [Phlegm], warm herbs should be used to harmonize. Ban Xia Tang [Pinellia Decoction] is the same as Qian Jin Xiao Ban Xia Tang [Minor Pinellia Decoction], attached below.
When there is Tan Yin [Phlegm-Fluid] in the epigastrium, with hypochondriac fullness and support, and dizziness, use Ling Gui Zhu Gan Tang [Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction] as the primary treatment. (*Mai Jing* writes Gan Cao Tang [Licorice Decoction].)
[Xu Lingtai] Tan Yin [Phlegm-Fluid] in the epigastrium: The epigastrium is not exactly the Stomach, but above the Stomach and below the Heart, governed by the Upper Jiao [Upper Burner]. Its Qi carries Cold-Dampness Yin Pathogens, rushing to the chest and hypochondrium, causing fullness and support. "Zhi" [Support] means staying fixed and not departing, resembling a Plague [Pi] pattern. Yin Pathogens suppress ascending Yang, causing black vision and dizziness. Ling Gui Zhu Gan Tang [Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction] is precisely a warm herb formula. The warmth of Gui Zhi [Cinnamon Twig] and Gan Cao [Licorice] transforms Qi; the warmth of Bai Zhu [Atractylodes Macrocephala] strengthens the Spleen; the neutrality of Fu Ling [Poria] moves downward to eliminate Yin [Fluid] Qi. Fu Ling [Poria] is used in the largest amount and serves as the Sovereign herb.
*Ling Shu · Jing Mai Pian* states: When the Pericardium Meridian is active, there is hypochondriac fullness and support, and significant palpitations in the Heart.
Formula for Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction (Named Licorice Decoction in *Qian Jin*)
Fu Ling [Poria] (4 liang) Gui Zhi [Cinnamon Twig] Bai Zhu [Atractylodes Macrocephala] (each 3 liang) Gan Cao [Licorice] (2 liang)
The above four ingredients, with 6 sheng of water, boil to obtain 3 sheng. Divide into three warm doses. Urination will increase.
*Sheng Ji Zong Lu* Fu Ling Tang [Poria Decoction] treats Water-Qi in the San Jiao [Triple Burner], causing hypochondriac fullness and support and dizziness. (This is the same formula.)
For shortness of breath caused by slight Yin [Fluid], it should be eliminated via urination. Ling Gui Zhu Gan Tang [Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction] is the primary treatment. (Formula seen above.) Shen Qi Wan [Kidney Qi Pill] is also the primary treatment. (Formula seen in Women's Miscellaneous Diseases section.)
[Xu Lingtai] Shortness of breath with slight Yin [Fluid] refers to the "mild case of shortness of breath" mentioned earlier. However, Zhi Yin [Piercing Fluid], Liu Yin [Retained Fluid], and Water in the Heart all cause shortness of breath. It is always water stopping in the epigastrium, hence it is said to be eliminated via urination.
[You Yi] Qi is suppressed by Yin [Fluid], causing shortness. To guide the Qi, one must eliminate the Yin [Fluid]. Since Yin [Fluid] is a water-like substance, treating water requires eliminating it via urination. Ling Gui Zhu Gan Tang [Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction] benefits Earth Qi to move water; Shen Qi Wan [Kidney Qi Pill] nourishes Yang Qi to transform Yin. Although their indications differ, their effect of promoting urination is the same.
Note: Yu Jia Yan’s *Fa Lv* states: Ling Gui Zhu Gan Tang [Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction] treats Yin [Fluid] in Yang, causing shortness of exhalation; Shen Qi Wan [Kidney Qi Pill] treats Yin [Fluid] in Yin, causing shortness of inhalation. Exhalation exits via Heart and Lung; inhalation enters via Kidney and Liver. This explanation is very accurate. Ling Gui Zhu Gan Tang [Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction] treats insufficient Kidney Yang failing to move water, with slight Yin [Fluid] stopping in the epigastrium causing shortness of breath. Shen Qi Wan [Kidney Qi Pill] treats Kidney deficiency failing to secure water, with water flooding the epigastrium causing shortness of breath. One must observe the patient's physique and pulse to administer treatment. One syndrome, two formulas, each with specific indications. The distinction lies here.
Yan Shi’s *Ji Sheng Fang* states: There are cases of frequent expectoration of phlegm and saliva that respond to Ba Wei Wan [Eight-Ingredient Pill]. This has deep meaning. Wang Shuhe stated: Kidney Cold causes excessive salivation. The Kidney is the Official of Water; it controls water retention. When Kidney Qi is warm and harmonious, fluids descend; when Kidney Qi is deficient and cold, pathogenic water overflows upward. Using Cornus [Shan Zhu Yu] and Dioscorea [Shan Yao] for tonification; Aconite [Fu Zi] and Cinnamon Bark [Rou Gui] for warming; Poria [Fu Ling] and Alisma [Ze Xie] for draining. The reasoning is sound.
When the patient’s pulse is hidden (Fu), and they desire spontaneous diarrhea, which brings relief, yet despite the diarrhea, the epigastrium remains hard and full. This is because Liu Yin [Retained Fluid] is attempting to exit. Use Gan Sui Ban Xia Tang [Kansui and Pinellia Decoction] as the primary treatment. (*Mai Jing*, *Qian Jin*, *Wai Tai* add the character "Zhe" [particle] before "Fan" [instead/reversely].)
[Wei Litong] The patient’s pulse is hidden because Water Pathogen compresses and muddies the Qi and Blood, preventing circulation, hence the pulse is hidden and invisible. The desire for spontaneous diarrhea brings relief because water seeks dampness and flows downward, temporarily releasing the pathogenic pressure, hence temporary comfort. However, soon after diarrhea, the epigastrium remains hard and full. This is because the Water Pathogen has roots and connections, maintaining itself. One cannot follow the trend of diarrhea to eliminate it. Hence it is said: This is because Liu Yin [Retained Fluid] is attempting to exit. The foundation is established by Cold-Yin Qi, and the cavity is formed by Water-Yin Pathogen. Without opening, breaking, and draining, it cannot be treated.
Note: Jin Jian states that the sentence "This is because Liu Yin [Retained Fluid] is attempting to exit" should be placed after "brings relief," believing it to be a transcription error. However, this sentence explains the preceding text and is certainly not a transcription error.
Formula for Kansui and Pinellia Decoction (*Wai Tai* quotes *Qian Jin* saying: This is originally a formula from Zhang Zhongjing’s *Shang Han Lun*.)
Gan Sui [Kansui Root] (3 large pieces) Ban Xia [Pinellia Tuber] (12 pieces, boiled in 1 sheng of water to obtain 0.5 sheng, strain) Shao Yao [Peony Root] (5 pieces ○ *Qian Jin* writes 2 pieces, *Wai Tai* writes 1 liang) Gan Cao [Licorice Root] (1 piece the size of a finger, roasted, one version omits ○ *Qian Jin* writes 1 piece the size of a finger, boiled in 1 sheng of water to obtain 0.5 sheng. Note: One version omits the four characters, details unknown.)
The above four ingredients, with 2 sheng of water, boil to obtain 0.5 sheng. Strain. Mix with 0.5 sheng of honey.
Boil to obtain 0.8 sheng and take in one dose. (*Qian Jin* writes: Add 0.5 sheng of honey to the two medicinal juices, combine to get 1.5 sheng, boil to obtain 0.8 sheng and take in one dose. Note: *Qian Jin* is closer to correctness.)
[Cheng Lin] For retention, promote movement; use Gan Sui [Kansui Root] to drain Water-Yin [Fluid]. For knots, scatter them; use Ban Xia [Pinellia Tuber] to scatter Tan [Phlegm]-Yin [Fluid]. Gan Sui [Kansui Root]’s nature penetrates directly. Fearing it may overly drain water, soften it with the sweetness of Gan Cao [Licorice] and White Honey, and astringe it with the sourness of Shao Yao [Peony Root]. Although Gan Cao [Licorice] and Gan Sui [Kansui Root] are contrary, they actually assist each other. This (sour astringency and sweet moderation) is the method of contracting/restricting. *Ling Shu Jing* states: Restricting a formula is like tying a bag. This is what is meant.
[You Yi] Gan Cao [Licorice] and Gan Sui [Kansui Root] are contrary, yet used together, intending for a decisive battle to eliminate all Liu Yin [Retained Fluid], achieving mutual success through mutual stimulation. Shao Yao [Peony Root] and White Honey not only calm the Middle but also moderate the drug toxicity.
A floating, fine, and slippery pulse indicates Shang Yin [Injury by Fluid].
[Jin Jian] For any Yin [Fluid] disease presenting with a floating, fine, and slippery pulse, it is a diagnosis of early-stage Tan Yin [Phlegm-Fluid] where the Water Pathogen has not penetrated deeply. Li Xun states: Yin [Fluid] pulse should be sinking; now the pulse is floating, indicating Water in the Lung.
[Xu Lingtai] Not saying "has Yin [Fluid]" but "injured by Yin [Fluid]" indicates acute injury by external Yin [Fluid], rather than accumulated stagnant water.
A string-like and rapid pulse with Cold-Yin [Fluid] is difficult to treat in winter and summer.
[You Yi] A string-like and rapid pulse with Cold-Yin [Fluid] presents a contradiction between disease and pulse. As Wei Shi stated: The Yin [Fluid] originates from Cold, but is complicated by Heat. Contradictory conditions must contend. In Winter...