一条 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。谓之支饮。
痰为脏腑之津液所化。譬之循良之民众。因激变而为贼者也。而所以激津液之变者。大概不越寒热两因。
如肺受热而金有烊化之象。则伤其阴。阴伤。则喉嗓间如有物粘紧而不可出。微痛似喊破之状。一二日咳
出胶稠黄色之痰。不过七日。以形稀色白为渐愈者。一也。肺受微寒。则阳郁而叶紧。郁极怒发。寒邪又随阳
气之变动而化热。寒热交蒸。则自剥其液以送之。咳出成块白色。状如米粥之痰。而外裹粘涎清水者。此寒
本热标。两因并见者。二也。先从便难。渐致燥结。下气浮停。肠胃中热。衬托上蒸。肺干液竭。火熏作痒。因而致
咳。大口稠黄。朝暮不绝。此为胃中之热痰者。三也。而诸症坏痰不与焉。若夫本篇之所谓痰饮者。虽与寒因
之粘涎相似。而其实另是一种。不可不辨也。以其由于饮水所积。故曰饮。以其与痰同能致咳。故亦曰痰饮。
以痰饮渗在胃脘之外。不走小肠膀胱等腑。而悬于胁下。故曰悬饮。以痰饮久悬。而经气虚者。遂乘虚而溢
于经脉。故曰溢饮。以痰饮不旁渗两胁。而中屯心下。如有物支撑之义。故曰支饮。饮久曰留。饮深曰伏。饮以
形质入脏。则猝死。其初症。但以水气射之则病。故于五脏。则直谓之水而已矣。要皆起于肺冷气结。而不能
呵嘘。成于脾寒气滞。而不及分布者。与前所云津液所化之痰不同。故其阴冷似清水。粘滑似薄胶。药宜辛
甘温暖。治宜发汗利水。此为定例。而间或参以苦咸寒润者。特其变症变法焉尔。盛。指肉胜而言。看今瘦
自见。凡阳衰者肉胜。素盛。则阳衰可知。今瘦。则并肠胃中之阴液亦虚。故内削而瘦也。阳衰。则不能运饮。阴
虚。则借资于外水而留恋之。夫水走肠间而不下渗。故沥沥有声。而所谓痰饮者如此。四句当着眼肠间两
字。饮后。犹言痰饮之后。非指饮汤饮水也。痰饮不行。后必由肠而浸淫于胃。由胃而横鼓于胁。盖下衬则上
浮。中满则旁注。以胃络通于胁。故水流肠胃之外而在胁下。胁下为少阳、厥阴之部。肝胆善逆。故咳唾。胁络
得水而作胀。故咳唾则振而引痛也。夫胁下之水无去路。如悬阁之象。故谓之悬饮者如此。四句当着眼胁
下两字。饮水与饮后同义。言悬饮之水。久而不去。则从经络而流于四肢。夫经络之水。阳气运动。可从汗解。
今阳虚而当汗不汗。于是身体中。水热则疼。水坠则重。而谓之溢饮者如此。五句当着眼四肢两字。若夫咳
而气逆。但可坐倚而息。且水饮屯心下。抬高膈气。以致吸不能入而短气。所以不得卧倒。又水浮则气迫而
鼓于外。故其形如肿。而所谓支饮者又如此。五句当着眼在倚息短气四字。是则饮虽四名。理同一辙。先由
痰饮悬饮。终归溢饮支饮。而四者之传变。亦视其胸胁经络之虚实。以为偏全迟速耳。
二条 水在心。心下坚筑。短气。恶水不欲饮。
此合下文二条。俱是详言支饮。盖支饮屯积心下。故其水气。得以上射心肺。而成水在心肺之症也。心下者。
心之下。胃脘及脘外之总名。饮积于脘中。故坚硬如筑。吸气不能下引。故短也。但下条为水在胃脘之外。系
悬饮之所传变。饮久化热而烫于外。故欲饮水。此条为水在胃脘之中。系痰饮之所抬高。水饮内顶。故恶水
不欲饮也。
三条 水在肺。吐涎沫。欲饮水。
饮支于肺下。而水气上逼之。则肺气不得展于下而上逆。故涎沫因之上泛而见于吐也。余见上条注。
四条 水在脾。少气。身重。
此详言溢饮之症也。凡痰饮悬饮。其传变俱能病此。盖痰饮则内从胃络而外传于脾。悬饮则旁从胁络。而
下传于脾。故皆能使水气在脾也。脾土之阳衰而至水气射之。则不能运布而溢于四肢者。势也。故曰此言
溢饮之症。脾滞而精悍不升。故少气。脾湿而水土沉坠。故身重也。少气是呼气少。短气是吸气短。
五条 水在肝。胁下支满。嚏而痛。
此详言悬饮之症也。胁下为肝络之所止经。饮悬于此。则从其络而下射于肝。故水在肝也。水饮实于胁下。
如有物支鼓之状。故曰支满。即所谓支饮之义也。嚏出于肺。肝以水邪犯所不胜。肺恶湿而欲出之。故嚏。但
嚏者。下实其气而始得奋为上迸。则支满者益满。而且振痛矣。与咳唾引痛同义。
六条 水在肾。心下悸。
此四饮之外。另是一症。即后文十一条所谓伏饮之未发者。长沙于脏中列此。其为防微杜渐之意深矣。夫
肾为水脏。犹之天地之海。与水原相感召。肾阳盛而小便利。则真阴固密。而外水流行。亦何伏饮之有哉。倘
阳德虚微。则水灾祸伏。苟不见微知着而早图之。则平成无日矣。盖四饮为病。是从上而下积。有盈科后进
之渐。其症缓而较平。伏饮为病。是从下而上突。有怒潮直决之机。其症急而尤烈故也。悸是水悸。与虚悸之
跳摆嘈杂不同。水悸者。神境中戚戚然如有不测之患。又时时惕焉自警者是也。盖心肾同主手足之少阴。
而其气尝相通于窈冥。肾中伏水。而心君恍惚。譬之黄河未决。而洛城中之神机暗烛。未免形诸筋惕肉
间也。此自其初症而言。若就已成论。四饮亦低从上泛。而极于支饮。伏饮亦起从下传。而极于四脏者也。
七条 夫心下有留饮。其人背寒冷。如手大。
自此合下文八九十共四条。言除却溢饮之外。（溢饮不愈则死。无久留之候。）其余三饮。久而未去者。俱
名留饮。此条言支饮之久留者也。心系附背。心下留支饮。则水寒之气。从系而托于背。故其背当寒冷如手
大。内外形气所必应之道也。
八条 留饮者。胁下痛引缺盆。咳嗽则转甚。
此言悬饮之久留者也。缺盆。足阳明经脉第十二穴。在项下膺乳间。气舍下。气户上。左右凡两穴。痛引缺盆。
咳嗽转甚。注见首条悬饮。并五条肝水下。
九条 胸中留饮。其人短气而渴。四肢历节痛。
此亦言支饮之久留者也。但七条曰心下有留饮。则饮当胃脘之部。此曰胸中留饮。则比心下又高而逼肺
矣。逼肺。故气机艰于下引而短也。渴。详三条肺水下。四肢历节痛者。人身以历节为溪谷。痛则饮将外溢。而
其气先为郁冒之候也。
十条 脉沉者。有留饮。
此统言留饮之脉也。水性趋下。且饮留于中。则其气机重坠而不能浮。故凡脉沉者有留饮也。然诊法各从
其部。如沉脉见寸口。饮留胸中。即上文九条之症。微上关。饮留心下。即前七条之症。微下寸口。而于或左或
右单见。则饮留胁下。即前八条之症。其余脏腑。各以其部处之。而于十二篇积脉为准则也。脉沉。并于沉
处见滑细为是。
十一条 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。
此发明六条水在肾。心下悸之候也。夫伏饮者。伏而未见之谓。此其欲发而犹未全发。特比六条之但悸者
较重耳。其曰必有伏饮。此长沙之独见若神。而人犹不及觉者也。膈上病痰。言膈上素有痰病之谓。喘满
咳吐者。言因病痰。所以胸满而喘。咳嗽而吐也。二句是主。以其为上工之诊窍故也。发者。言有时而甚之谓。
发字直贯下文五症。目泣。眼泪也。振振 剧。阳虚而上奔之象。详伤寒并别注。言寒热等五症。一时发作。大
似阳虚而外中寒邪之候。但其膈上素病痰气。而为满喘咳吐者之所发。则知其非一时之暴病。而为肾中
必有伏饮所致也。盖水饮虽伏于下。而其水寒之气。必凭虚而射于上。肺性恶湿而忌寒。故膈上病寒湿之
痰。湿气上逆。故满而喘。寒气上逆。故咳而吐也。有时而发者。肺病寒湿。寒则持于丙丁。湿则持于戊己。而伏
饮惟张于壬癸故也。寒热者。寒为饮之本气。饮气上张故寒。寒起而格微阳于外。故寒而且热也。背者。胸之
府。胸满而咳。故其气彻于背而痛。腰为肾之府。肾中微阳。为饮寒所迫而外鼓。故腰疼也。目泣虽为肝液。饮
寒上擗而不能摄。故自出也。寒气上浮。而诸阳奔避。故振振自战而 剧也。十八条之苓桂术甘汤。并肾气
丸二方。其可缓乎。盖苓桂术甘汤。所以去伏饮。而肾气一丸。又所以补肾阳而不使饮之再伏耳。门人问
曰。六条注云。此四饮之外。另是一症。即此条之伏饮是也。夫自二条至六条。明似列言四饮之传五脏者。何
以知水在肾一条。独为四饮之外者。一也。又六条但曰水在肾。并无伏饮字样。此条言伏饮。并无在肾字样。
何以知肾水即伏饮者。二也。且四饮传变。各有灌注道路。自肠胃而递及胸胁经络。皆饮汤饮水。从口而入
者也。即如夫子之言。肾水便是伏饮。而谓在四饮之外。倘为亦从口入。则安得谓之四饮之外。敢问此饮是
从何道而入伏肾中者。三也。又痰饮传变。其名则有悬饮、溢饮、支饮、留饮之不同。其症则有胸中、心下、胁下、
四肢之各别。伏饮之传变。长沙并不详论。而夫子以为急而尤烈。将终伏而为病、仅如本条者。即谓之急烈
乎。抑别有所为变症者乎。四也。请得而各闻其义。答曰。此问自不可少。夫水在心肺肝脾。俱是从四饮以后。
传射入脏之重症。独水在肾家。是四饮以前之轻症。即后文十八条之微饮也。以肾为水脏。肾阳一微。即召
水而伏饮。故曰在四饮之外也。凡伏而不见者谓之伏。脏腑中不特心肺肝脾四脏。即上中二焦诸腑。俱不
能容伏饮。非无饮也。以有饮则必明见外症。而不得谓之伏故也。惟肾与膀胱。一脏一腑。有河海之象。饮伏
其中。颇能隐藏得住。而少耽时日。故知水在肾。即所谓伏饮也。四饮皆从口入。伏饮亦何曾不从口入乎。但
四饮之病。是因上中二焦。阳气不能分运。故其水气。渐积渐高。愈满愈鼓之候。伏饮之病。上中无恙。惟肾气
衰冷。而腑化寒停。膀胱之络通于脏。则水寒之气。由腑络而入伏肾中者也。痰饮之变。至溢饮、支饮。而其势
已剧。若再传肾则死。盖水源从海出。而其横流。复淹没于海。为大地失陷之象也。若夫伏饮之变。大概不越
三症。一则伏而未发。每遇羽水之运。寒水之气。及壬癸月日。间发而如本条之症。一则饮伏黄泉之下。而其
寒气每上干太虚。俾肺气缩而不能运布。则水积肠间。而即为痰饮之症。我故曰。是四饮以前之轻症。及水
源从海出者此也。一则伏饮上射。而脾肺之阳交困。以致不能传送。而小便不行。饮从上突。日肿一日。皮肉
青紫而死之症。即六条所注怒潮直决。其症急而尤烈者是矣。
十二条 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。
此暴饮也。与前悬饮支饮之留饮不同。此暴饮之在上者。与前伏饮。并十八条之微饮又不同。凡两段。前二
句为一段。言病患胸膈热而饮水多。则水不及渗而停于心下。于是水迫肺气而喘。水浮胸分而满。虽非四
饮之已成者。而其为病亦暂与支饮同也。后四句为一段。言不必病患。凡属胃虚而食少。膈热而饮多者。俱
能病此。悸及短气。详已见。其意以为虽属暴饮。倘不主猪苓五苓等汤以止渴除饮。则渐成四饮等候矣。
十三条 脉双弦者寒也。皆大下后里虚。脉偏弦者。饮也。
此及下文共三条。总言四饮之脉。而本条当是言悬饮也。夫弦为阳虚气削之诊。饮以阳气不能呵嘘下渗
所致。故饮脉必弦。但两手双弦。阳气当虚于中。又另为中寒之脉。盖因大下后里虚。而其气中馁之故。不可
误认为饮脉。唯一手偏弦。则左见为左胁之悬饮。右见为右胁之悬饮也。然以十二篇积脉之例准之。则左
右双见。饮在中央。支饮之在胸膈心下者。其脉未尝不双弦也。第以其症辨之耳。盖饮症则有喘渴短气等
候。而下后里虚者无此也。十条言留饮之脉曰沉。此条言悬饮之脉曰弦。则饮脉其沉弦兼见者乎。然愚
尝试之。大概饮之初病。其脉多弦。饮之久病。其脉多沉。长沙分别言之。岂无意耶。
十四条 肺饮不弦。但苦喘。短气。
肺饮者。支饮之上浮胸膈。而肺已受伤者是。弦为气削之脉。水饮屯胸膈。则其气不得下展。而自聚于饮上。
故气削之弦脉不见也。喘与短气。详已见。言饮脉弦。而肺饮独不可以不弦自误。但凭其外症为合。与胃
有宿食而脉见滑者同义。
十五条 支饮亦喘。不能卧。加短气。其脉平也。
支饮者。就支饮之在心下而言。盖谓同是支饮。却有高下。高者逼肺。故为肺饮。下者在心下。与肺较远。故以
支饮概之。但胃脘聚饮。气机便艰于下引。故亦喘。不能卧者。卧则胃脘横。而注饮迫肺故也。短气一症。为肺
饮之候。言饮支心下。其脉还弦。饮略高而见短气一症。则气亦高而聚于肺。气聚。故其脉平而不弦削也。
十六条 痰病者。当以温药和之。
第一条 问：饮邪分为四种，是哪四种呢？老师回答：有痰饮、悬饮、溢饮、支饮。又问：这四种饮邪的区别在哪里？老师说：如果一个人平时身体壮实，现在却消瘦了，这是因为水液流注于肠间，发出沥沥的声音，这就叫做痰饮。饮水后，水流停留在胁下，咳嗽吐唾时牵引胁肋疼痛，这就叫做悬饮。饮水后，水液流行并归于四肢，本该出汗却没有出汗，导致身体疼痛且沉重，这就叫做溢饮。咳嗽气逆，只能靠着呼吸，气息短促，不能平卧，外形看起来像浮肿，这就叫做支饮。
痰是由脏腑的津液转化而成的，好比是守法良民，因为受到激变而变成了盗贼。而导致津液发生这种变化的原因，大概离不开寒和热两种因素。比如肺受热邪，金（肺）有熔化之象，就会损伤阴液。阴液受损，咽喉嗓子里就像有东西粘连紧束而咳不出来，微微疼痛，好像喊破了嗓子一样。一两天后咳出胶稠黄色的痰，如果逐渐变得稀薄、颜色变白，就是快要痊愈的迹象，这是第一种情况。肺受轻微寒邪，阳气被郁遏而肺叶紧缩，郁极则爆发，寒邪随着阳气的变动而化热。寒热交蒸，就会剥蚀津液以排出邪气，咳出成块的白色痰，形状像米粥一样，外面包裹着粘涎和清水，这是寒为本、热为标，寒热两因同时存在的第二种情况。起初是大便困难，逐渐导致燥结，下焦之气浮停，肠胃中有热，热气上蒸，导致肺干液竭，火热熏灼引起瘙痒，因而引发咳嗽，大口咳出稠黄的痰，早晚不停，这是胃中的热痰，是第三种情况。而那些病情恶化形成的坏痰就不在此列了。至于本篇所说的“痰饮”，虽然与寒邪导致的粘涎相似，但实际上是另一种病证，不可不加以辨别。因为它是由饮水积聚而成，所以叫“饮”；因为它与痰一样能导致咳嗽，所以也叫“痰饮”。由于痰饮渗溢在胃脘之外，不走小肠、膀胱等腑，而是悬挂在胁下，所以叫“悬饮”。由于痰饮久悬，经脉之气虚弱，于是乘虚溢入经脉，所以叫“溢饮”。由于痰饮不旁渗两胁，而是中阻于心下，有像物体支撑的意思，所以叫“支饮”。饮邪停留久了叫“留饮”，饮邪深伏的叫“伏饮”。饮邪以形质进入脏，会导致猝死。其初期的症状，只是水气射入脏腑就致病，所以对于五脏，直接称为“水”罢了。这些病都起于肺气冷结，不能正常呵嘘；形成于脾寒气滞，不能及时分布运化。这与前面所说的由津液所化的“痰”不同。所以它的性质阴冷似清水，粘滑似薄胶。用药宜用辛甘温热的药物，治法宜发汗利水，这是固定的法则。偶尔参用苦咸寒润的药物，只是针对变症变法而已。“素盛”，指肌肉丰满而言，看现在的消瘦自然可见。凡是阳气衰弱的人肌肉丰满，平时壮实，说明阳气衰弱可知；现在消瘦，说明肠胃中的阴液也虚了，所以内部消耗而消瘦。阳气衰弱，就不能运化水饮；阴液虚，就依赖外来的水而留恋停滞。水走于肠间而不向下渗透，所以发出沥沥的声音，所谓的痰饮就是这样。这四句话应当着重看“肠间”两个字。“饮后”，犹言痰饮之后，不是指喝汤喝水。痰饮不行，后来必然由肠浸淫到胃，由胃横鼓到胁下。盖下衬则上浮，中满则旁注，因为胃络通于胁下，所以水流在肠胃之外而在胁下。胁下是少阳、厥阴的部位，肝胆之气善于上逆，所以咳嗽吐唾。胁下的络脉得到水液而胀满，所以咳嗽吐唾时震动并牵引疼痛。胁下的水没有出路，像悬挂在阁楼上一样，所以叫悬饮是这样。这四句话应当着重看“胁下”两个字。“饮水”与“饮后”同义，是说悬饮的水，久而不去，就从经络流到四肢。经络中的水，靠阳气运动，可以从汗解。现在阳气虚，该出汗却不出汗，于是身体中，水热则疼，水坠则重，所以叫溢饮是这样。五句话应当着重看“四肢”两个字。至于咳嗽而气逆，只能坐着倚靠来呼吸，而且水饮屯积在心下，抬高膈气，以致吸气不能深入而短气，所以不能平卧。另外水浮则气迫而鼓动于外，所以外形像浮肿，所谓的支饮就是这样。五句话应当着重看“倚息短气”四个字。这样看来，饮邪虽然有四种名称，道理却是同一辙。先由痰饮、悬饮，最终归结为溢饮、支饮。而这四者的传变，也是视胸胁经络的虚实，来决定偏全、迟速罢了。
第二条 水邪在心，心下坚硬筑筑跳动，气息短促，厌恶水不想喝。
这一条结合下面两条，都是详细阐述支饮。因为支饮屯积在心下，所以它的水气能够向上射向心肺，形成水在心肺的症状。心下，是指心的下方，是胃脘及脘外的总称。饮邪积聚在脘中，所以坚硬如筑（跳动）。吸气不能向下引，所以短气。但下一条是水在胃脘之外，属于悬饮的传变，饮邪久留化热而烫于外，所以想喝水。这一条是水在胃脘之中，属于痰饮所抬高，水饮内顶，所以厌恶水不想喝。
第三条 水在肺，吐涎沫，想喝水。
饮邪支于肺下，水气向上逼迫，肺气不能在下方舒展而上逆，所以涎沫因此上泛而吐出。其余见上一条注释。
第四条 水在脾，少气，身体沉重。
这是详细阐述溢饮的症状。凡是痰饮、悬饮，其传变都能导致此病。因为痰饮从内部通过胃络向外传于脾，悬饮从旁边通过胁络向下传于脾，所以都能使水气在脾。脾土的阳气衰弱而至水气射入，就不能运布而溢于四肢，这是必然的趋势。所以说这是阐述溢饮的症状。脾滞而精悍之气不升，所以少气；脾湿而水土沉坠，所以身体沉重。少气是指呼气少，短气是指吸气短。
第五条 水在肝，胁下支撑胀满，打喷嚏时疼痛。
这是详细阐述悬饮的症状。胁下是肝络所经过的经脉部位，饮邪悬挂于此，就顺着络脉向下射入肝脏，所以叫水在肝。水饮充实于胁下，像有物体支撑鼓胀的样子，所以叫支满，也就是所谓支饮的含义。喷嚏出于肺，肝被水邪侵犯其所不胜（金克木），肺恶湿而想要排出它，所以打喷嚏。但是打喷嚏，需要下部气实才能奋起向上迸发，那么支满的症状会更加胀满，并且震动疼痛。这与咳嗽吐唾牵引疼痛意义相同。
第六条 水在肾，心下悸动。
这是在四饮之外，另有一种病症，即后文第十一条所说的伏饮未发作时的状态。长沙（张仲景）在五脏中列出这一条，其防微杜渐的意旨很深啊。肾是水脏，犹如天地之海，与水原相互感召。肾阳盛而小便通利，真阴固密，外来的水液流行，哪里有伏饮呢？倘若阳气德行虚微，水灾祸患潜伏。如果不见微知著而早作打算，那么太平之日就没有了。因为四饮致病，是从上而下积聚，有盈科后进（泉水填满洼地再向前流）的渐进过程，症状缓和而较平稳。伏饮致病，是从下而上突发，有怒潮直决的时机，症状急迫而尤其猛烈。悸是水悸，与虚悸的跳动嘈杂不同。水悸者，心神戚戚然如有不测之患，又时时警惕自我警醒。心肾共同主宰手足少阴经，而其气常在幽深之处相通。肾中伏藏水邪，心君恍惚，好比黄河未决堤，而洛城中的神机暗中烛照，未免表现为筋惕肉瞤。这是从其初期症状而言。若就已成之症论，四饮也从上泛溢，极于支饮；伏饮也从下传变，极于四脏。
第七条 心下有留饮的人，背部寒冷，面积如手掌大小。
从此条结合下文八九十条共四条，除了溢饮之外（溢饮不愈则死，没有久留的征候），其余三种饮邪，久而未去的，都叫留饮。这一条说的是支饮久留的情况。心系附着于背，心下有留存的支饮，水寒之气从系带托于背部，所以背部对应位置寒冷如手掌大。这是内外形体与气机相应的必然道理。
第八条 留饮的人，胁下疼痛牵引至缺盆穴，咳嗽时疼痛加剧。
这是说悬饮久留的情况。缺盆，是足阳明经脉第十二穴，在项下膺乳之间，气舍穴之下，气户穴之上，左右各一穴。痛引缺盆，咳嗽转甚，注释见首条悬饮及第五条肝水下。
第九条 胸中有留饮的人，气息短促且口渴，四肢历节疼痛。
这也是说支饮久留的情况。但第七条说心下有留饮，则饮邪应当在胃脘部位；这里说胸中有留饮，则比心下位置更高而逼近肺了。逼近肺，所以气机艰难于向下引导而短气。口渴，详见第三条肺水下。四肢历节痛，人身以历节为溪谷，痛则说明饮邪将要外溢，而其气先出现郁冒的征兆。
第十条 脉象沉的，有留饮。
这是统言留饮的脉象。水性趋下，且饮邪留于中，其气机重坠而不能浮，所以凡是脉沉的都有留饮。然而诊法各从其部位，如沉脉见于寸口，饮留胸中，即上文第九条的症状；微上关部，饮留心下，即前第七条的症状；微下寸口，而在左或右单独出现，则饮留胁下，即前第八条的症状。其余脏腑，各以其部位处之，并以第十二篇积脉为准则。脉沉，并在沉处见到滑细脉才是正确的。
第十一条 膈上有痰病，胸闷、喘、咳、吐，发作时伴有寒热、背痛腰疼、眼泪自出，其人振振身瞤剧，必有伏饮。
这是阐发第六条水在肾、心下悸的证候。伏饮，是指潜伏而未显现的饮邪。这是欲发而尚未完全发作，特别比第六条仅有心悸的症状较重。说“必有伏饮”，这是长沙（张仲景）独具慧眼如神，而人们还未能察觉。膈上病痰，是说膈上素有痰病。喘满咳吐，是说因为有病痰，所以胸满而喘，咳嗽而吐。这两句是主症，因为这是高明的医生诊断的关键所在。发，是说有时加重的意思。“发”字一直贯穿下文五种症状。目泣，即眼泪。振振身瞤剧，是阳虚而上奔的征象，详见《伤寒论》及其他注释。说寒热等五种症状一时发作，大似阳虚而外感寒邪的征候。但因为膈上素来有病痰气，而为满喘咳吐等症状所引发，就知道这不是一时的暴病，而是肾中必有伏饮所致。水饮虽伏于下，但其水寒之气，必凭借空虚而上射于上。肺性恶湿而忌寒，所以膈上病寒湿之痰，湿气上逆，所以满而喘；寒气上逆，所以咳而吐。有时发作，是因为肺病寒湿，寒邪持于丙丁日（火日），湿邪持于戊己日（土日），而伏饮只在壬癸日（水日）猖獗。寒热，寒是饮的本气，饮气上张故寒；寒起而格拒微阳于外，所以既寒且热。背，是胸的府库，胸满而咳，所以气彻于背而痛。腰是肾的府库，肾中微阳，被饮寒所迫而外鼓，所以腰疼。眼泪虽为肝液，但饮寒上逼而不能摄纳，所以自出。寒气上浮，诸阳奔避，所以振振自战而身瞤剧。第十八条的苓桂术甘汤，以及肾气丸二方，可以缓解吗？苓桂术甘汤，是用来去除伏饮的；肾气丸，又是用来补肾阳而不使饮邪再次潜伏的。门人问：第六条注解说，这是在四饮之外，另有一种病症，即此条的伏饮。从第二条到第六条，明摆着是列举四饮传变至五脏的情况，为什么知道“水在肾”一条，独独是在四饮之外的呢？这是一。另外第六条只说“水在肾”，并没有“伏饮”字样，此条说“伏饮”，并没有“在肾”字样，怎么知道肾水就是伏饮呢？这是二。况且四饮传变，各有灌注道路，自肠胃而递及胸胁经络，都是饮汤饮水，从口而入的。就像先生所说，肾水便是伏饮，而又说是四饮之外，倘若也是从口入，怎么能叫四饮之外呢？敢问这饮是从何道而入并伏于肾中的呢？这是三。还有痰饮传变，其名则有悬饮、溢饮、支饮、留饮的不同，其症则有胸中、心下、胁下、四肢的各别。伏饮的传变，长沙并不详细论述，而先生认为其急而尤烈，将终伏而为病，仅仅像本条这样的，就算急烈吗？还是有别的变症呢？这是四。请让我分别听听其中的道理。回答说：这个问题自是不可少的。水在心肺肝脾，都是从四饮以后，传射入脏的重症。唯独水在肾家，是四饮以前的轻症，即后文十八条的微饮。因为肾是水脏，肾阳一微弱，就召致水而伏饮，所以说在四饮之外。凡潜伏而不见的叫做伏。脏腑中不仅心肺肝脾四脏，即上中二焦诸腑，都不能容纳伏饮，并非没有饮，而是因为如果有饮则必定明显见到外症，而不能叫做伏的缘故。只有肾与膀胱，一脏一腑，有河海之象，饮伏在其中，颇能隐藏得住，而少耽时日，所以知道水在肾，就是所谓的伏饮。四饮皆从口入，伏饮又何尝不是从口入呢？但四饮的病，是因为上中二焦阳气不能分运，所以水气渐渐积聚渐渐升高，越满越鼓的征候。伏饮的病，上中无恙，惟肾气衰冷，而腑化寒停，膀胱的络脉通于脏，则水寒之气，由腑络而入伏于肾中。痰饮的变证，到了溢饮、支饮，其势已经剧烈，如果再传肾则死。盖水源从海出，而其横流，又淹没于海，是大地的失陷之象。至于伏饮的变证，大概不超过三种症状。一是伏而未发，每逢羽水之运（冬季），寒水之气，及壬癸月日，间发而像本条的症状。二是饮伏黄泉之下，而其寒气每每上干太虚，使肺气收缩而不能运布，则水积肠间，就变成痰饮的症状，所以我说是四饮以前的轻症，及水源从海出的这种情况。三是伏饮上射，而脾肺之阳交困，以致不能传送，而小便不行，饮从上突，日肿一日，皮肉青紫而死的症状，即第六条所注的怒潮直决，其症急而尤猛的情况。
第十二条 病人饮水多，一定会突然喘满。凡是食少饮多，水停在心下，严重的则心悸，轻微的则短气。
这是暴饮。与前文的悬饮、支饮的留饮不同。这是暴饮在上部的，与前文的伏饮，以及第十八条的微饮又不同。前两句为一段，说病人胸膈热而饮水多，则水来不及渗透而停于心下，于是水迫肺气而喘，水浮胸分而满。虽然不是四饮已成的状态，但其发病也与支饮暂时相同。后四句为一段，说不必是病人，凡是属胃虚而食少，膈热而饮多的，都能得此病。悸及短气，详见已见的内容。其意以为虽然是暴饮，倘若不用猪苓汤、五苓散等汤剂来止渴除饮，则渐渐会形成四饮那样的状况了。
第十三条 脉象双弦的是寒证，都是在大泻之后里虚。脉象偏弦的是饮证。
此条及下文共三条，总言四饮的脉象，而本条应当是讲悬饮。弦脉是阳虚气削的诊断，饮邪是因为阳气不能呵嘘下渗所致，所以饮脉必弦。但两手脉双弦，阳气当虚于中，另外是中寒的脉象。这是因为大泻后里虚，而其中气馁弱的缘故，不可误认为是饮脉。只有一手脉偏弦，则左脉见弦为左胁的悬饮，右脉见弦为右胁的悬饮。然而以第十二篇积脉的例证来衡量，则左右双见，饮在中央，支饮在胸膈心下的，其脉未尝不双弦。只是根据症状来辨别罢了。因为饮症则有喘渴短气等征候，而大泻后里虚的没有这些。第十条说留饮的脉曰沉，此条说悬饮的脉曰弦，那么饮脉是沉弦兼见的吗？然而我尝试过，大概饮之初病，其脉多弦；饮之久病，其脉多沉。长沙分别言之，难道没有深意吗？
第十四条 肺饮不弦，只苦于喘、短气。
肺饮，是支饮上浮于胸膈，而肺已经受伤的情况。弦脉是气削的脉，水饮屯积胸膈，则气不得下展，而自聚于饮之上，所以气削的弦脉不见。喘与短气，详见已见的内容。说饮脉弦，而肺饮独独可以不弦，不要以此自误。只要凭其外症相合，与胃有宿食而脉见滑的意义相同。
第十五条 支饮也喘，不能卧，加上短气，其脉平。
支饮，就支饮在心下而言。意思是说同样是支饮，却有高下之分。高的逼近肺，所以叫肺饮；低的在心下，与肺较远，所以统称支饮。但胃脘聚饮，气机便艰难于向下引导，所以也喘。不能卧，是因为卧则胃脘横，而注饮迫肺的缘故。短气一症，是肺饮的征候。说饮支心下，其脉还弦；饮略高而见短气一症，则气亦高而聚于肺。气聚，所以其脉平而不弦削。
第十六条 痰饮病，应当用温药调和治疗。
Article 1 Question: The pathogenic factor of fluid retention (Yin) is divided into four types. What are they? Master replied: There is Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Yi Yin (Overflowing Fluid), and Zhi Yin (Supporting Fluid). Again asked: How do these four types of fluid retention differ from each other? Master said: If a person was previously robust but now has become emaciated, it is because water flows into the intestines, producing a gurgling sound; this is called Tan Yin. After drinking, if water flows and stays under the hypochondrium, causing pain when coughing or spitting, it is called Xuan Yin. If after drinking, water flows and accumulates in the four limbs, sweating should occur but does not, leading to body ache and heaviness, it is called Yi Yin. If there is cough with air counterflow, reliance on support for breathing, shortness of breath, inability to lie flat, and the appearance resembles edema, it is called Zhi Yin.
Tan (Phlegm) is transformed from the body fluids of the Zang-Fu organs, akin to law-abiding citizens turning into bandits due to sudden upheaval. The causes triggering this transformation of body fluids generally fall into two categories: Cold and Heat. For instance, if the Lung is affected by Heat, the Metal element (Lung) shows signs of melting, damaging Yin. When Yin is damaged, the throat feels as if something is stuck and cannot be expelled, with slight pain resembling a strained voice. After one or two days, thick yellow phlegm is coughed up. If it gradually becomes thinner and whiter, it indicates recovery; this is the first scenario. If the Lung is affected by mild Cold, Yang Qi is constrained and lung lobes tighten. Extreme constraint leads to eruption, and Cold pathogens transform into Heat along with the movement of Yang Qi. The interaction of Cold and Heat peels away fluids to expel pathogens, resulting in coughing up white, clump-shaped phlegm resembling congee, coated with sticky saliva and clear water. This represents a case where Cold is the root and Heat is the branch, with both factors present simultaneously; this is the second scenario. Initially, there is difficulty in defecation, gradually leading to dryness and constipation. Lower Qi floats and stagnates, Heat exists in the intestines and stomach, steaming upwards, drying the Lung and depleting fluids. Fire irritation causes itching, leading to cough. Large amounts of thick yellow phlegm are coughed up continuously day and night; this is Heat-Phlegm in the Stomach, the third scenario. Bad phlegm formed from deteriorating conditions is excluded here. As for "Tan Yin" mentioned in this chapter, although similar to the sticky saliva caused by Cold, it is actually a different pathology and must be distinguished. Because it is accumulated from drinking water, it is called "Yin"; because like Tan, it can cause cough, it is also called "Tan Yin". Since Tan Yin permeates outside the epigastrium and does not flow into the Small Intestine or Bladder, but hangs under the hypochondrium, it is called Xuan Yin. Because Tan Yin hangs for a long time and the Qi of the meridians becomes deficient, it overflows into the meridians taking advantage of the deficiency, hence called Yi Yin. Because Tan Yin does not permeate to both hypochondria but blocks centrally at the Heart Below (epigastrium), having the meaning of being supported by an object, it is called Zhi Yin. Fluid retained for a long time is called Liu Yin (Retained Fluid); fluid deeply hidden is called Fu Yin (Hidden Fluid). If fluid enters the Zang organs in solid form, it causes sudden death. Its initial symptoms involve only Water Qi attacking the organs, so for the five Zang organs, it is directly called "Water". All these originate from Cold Qi stagnation in the Lung, preventing normal exhalation; they form due to Cold Qi stagnation in the Spleen, failing to distribute properly. This differs from the "Tan" transformed from body fluids mentioned earlier. Therefore, its nature is cold like clear water, sticky like thin glue. Medications should be pungent, sweet, and warm; treatment methods should induce sweating and promote urination; this is the fixed rule. Occasionally, bitter, salty, cold, and moistening drugs may be used, but these are variations for changing conditions. "Su Sheng" refers to abundant flesh. The current emaciation is evident. Generally, those with deficient Yang have abundant flesh; previous robustness implies deficient Yang; current emaciation implies deficiency of Yin fluids in the intestines and stomach, leading to internal wasting. Deficient Yang cannot transport fluid; deficient Yin relies on external water, causing stagnation. Water flowing in the intestines without penetrating downward produces a gurgling sound; thus is Tan Yin defined. In these four sentences, focus on the words "intestines". "Yin Hou" means after Tan Yin formation, not referring to drinking soup or water. If Tan Yin does not move, it will later seep from the intestines to the Stomach, then expand horizontally to the hypochondrium. Because lower support leads to upper floating, central fullness leads to lateral pouring, and the Stomach meridian connects to the hypochondrium, water flows outside the intestines and stomach to the hypochondrium. The hypochondrium is the region of Shaoyang and Jueyin; Liver and Gallbladder Qi tends to rebel, causing cough and spit. The collaterals in the hypochondrium swell with water, causing vibration and pulling pain when coughing/spitting. The water under the hypochondrium has no exit, resembling hanging on a shelf; thus is Xuan Yin defined. In these four sentences, focus on "hypochondrium". "Yin Shui" and "Yin Hou" have the same meaning, stating that water from Xuan Yin, if lingering for a long time, flows from meridians to the four limbs. Water in meridians is moved by Yang Qi and can be resolved through sweat. Now, with deficient Yang, sweating fails to occur; thus, heat in water causes pain, and sinking water causes heaviness; thus is Yi Yin defined. In these five sentences, focus on "four limbs". Regarding cough with air counterflow, relying on sitting/support for breathing, and water accumulating at the Heart Below raising the Diaphragm Qi, making inhalation difficult and causing shortness of breath, leading to inability to lie flat. Additionally, floating water forces Qi to bulge outward, making the shape resemble edema; thus is Zhi Yin defined. In these five sentences, focus on "relying on support for breathing and shortness of breath". Thus, although there are four names for fluid retention, the principle is the same. It starts with Tan Yin and Xuan Yin, ultimately returning to Yi Yin and Zhi Yin. The transmission of these four depends on the deficiency or excess of the chest, hypochondrium, and meridians, determining the extent and speed.
Article 2 Water in the Heart: Hardness and palpitations below the Heart, shortness of breath, aversion to water, desire not to drink.
This article, combined with the following two, details Zhi Yin. Because Zhi Yin accumulates at the Heart Below, its Water Qi can attack upward to the Heart and Lung, forming symptoms of Water in Heart and Lung. "Heart Below" refers to the area below the Heart, collectively naming the Epigastrium and its exterior. Fluid accumulation in the Epigastrium causes hardness and pulsation ("Zhu"). Inhalation cannot descend, causing shortness of breath. However, the next article describes Water outside the Epigastrium, a progression of Xuan Yin; fluid retains for a long time, transforms into Heat, and burns externally, causing thirst for water. This article describes Water inside the Epigastrium, elevated by Tan Yin; internal pressure of fluid causes aversion to water and lack of desire to drink.
Article 3 Water in the Lung: Spitting of saliva and foam, desire to drink.
Fluid branches under the Lung, and Water Qi attacks upward, preventing Lung Qi from extending downward and causing rebellion. Thus, saliva and foam rise and are spat out. See notes on the previous article.
Article 4 Water in the Spleen: Shortness of energy (Shao Qi), heavy body.
This details the symptoms of Yi Yin. Any transmission of Tan Yin or Xuan Yin can cause this. Tan Yin transmits internally from the Stomach collateral to the Spleen; Xuan Yin transmits laterally from the hypochondrial collateral to the Spleen. Thus, both can cause Water Qi in the Spleen. When Spleen Earth Yang declines and Water Qi attacks, it cannot transport and distribute, overflowing to the four limbs; this is inevitable. Hence, this describes Yi Yin symptoms. Spleen stagnation prevents Jing-Han (essence and vigorous Qi) from ascending, causing Shao Qi. Spleen dampness and Sun-Water sinking cause body heaviness. Shao Qi refers to insufficient exhalation; Duan Qi refers to shallow inhalation.
Article 5 Water in the Liver: Fullness and support sensation under the hypochondrium, pain upon sneezing.
This details the symptoms of Xuan Yin. The hypochondrium is the pathway of the Liver collateral. Fluid hangs here, attacking the Liver via the collateral. Thus, Water in the Liver. Fluid fills the hypochondrium, feeling like support and bulging; hence "Zhi Man", which is the meaning of Zhi Yin. Sneezing originates from the Lung. The Liver is invaded by Water Evil, its unconquered element (Metal controls Wood). The Lung dislikes dampness and tries to expel it, causing sneezing. However, sneezing requires substantial Qi from below to surge upward, exacerbating the fullness and causing vibrating pain. This is synonymous with pain from coughing/spitting.
Article 6 Water in the Kidney: Palpitations below the Heart.
This is a condition separate from the Four Fluids, corresponding to the unmanifested Fu Yin mentioned in Article 11. Zhang Zhongjing listed this among the Zang organs, showing profound intent to prevent disease progression. The Kidney is the Water Organ, like the sea of heaven and earth, resonating with water sources. If Kidney Yang is strong and urination is smooth, True Yin is secure, and external water flows freely; how could there be Hidden Fluid? If Yang Virtue is weak, disaster lies in wait. Without perceiving the subtle early signs, peace is impossible. Disease from the Four Fluids accumulates from top to bottom, progressing gradually like filling basins; symptoms are slow and relatively mild. Disease from Fu Yin erupts from bottom to top, like a tidal wave bursting; symptoms are urgent and severe. "Ji" (palpitation) here is Water Ji, distinct from deficiency-induced palpitations with fluttering and noise. Water Ji involves a sense of dread as if impending disaster, with constant vigilance. Heart and Kidney jointly govern the Hand and Foot Shaoyin meridians, their Qi connecting in the profound depths. Hidden Water in the Kidney causes the Heart Monarch to be unsettled, like the Yellow River threatening to burst while the divine mechanism in Luocheng secretly illuminates, manifesting as muscle twitching. This describes initial symptoms. Regarding established conditions, the Four Fluids also flood from above, peaking at Zhi Yin; Fu Yin also transmits from below, peaking in the four Zang organs.
Article 7 When there is Retained Fluid at the Heart Below, the person experiences coldness on the back, the size of a hand.
Combining this with Articles 8, 9, and 10, excluding Yi Yin (which leads to death if unresolved, lacking signs of long-term retention), the remaining three Fluids, if lingering, are called Liu Yin. This article discusses long-term Zhi Yin. The Heart connection attaches to the back. Retained Zhi Yin at the Heart Below allows Cold-Damp Qi to transfer to the back via the connection, causing coldness on the back corresponding to the hand size. This is the necessary correspondence between internal form/energy and external manifestation.
Article 8 In cases of Retained Fluid, pain under the hypochondrium radiates to the Quepen point, worsening with cough.
This discusses long-term Xuan Yin. Quepen (ST12) is the 12th acupoint of the Foot-Yangming Meridian, located below the neck, between the chest and breast, below Qishe, above Qihu. There are two points, left and right. Pain radiating to Quepen and worsening with cough. See notes on Article 1 (Xuan Yin) and Article 5 (Water in Liver).
Article 9 In cases of Retained Fluid in the Chest, the person experiences shortness of breath and thirst, and pain in the joints of the four limbs.
This also discusses long-term Zhi Yin. Article 7 mentions Retained Fluid at the Heart Below, implying fluid in the Epigastrium. Here, Retained Fluid in the Chest is higher than the Heart Below, pressing against the Lung. Pressing the Lung makes it difficult for Qi to descend, causing shortness of breath. Thirst is detailed in Article 3 (Water in Lung). Pain in the joints of the four limbs: The body regards joints as valleys. Pain indicates fluid is about to overflow externally, preceded by Qi stagnation and dizziness.
Article 10 A deep pulse indicates Retained Fluid.
This summarizes the pulse of Retained Fluid. Water nature tends downward. Fluid retained internally causes heavy, sinking Qi that cannot float. Thus, a deep pulse indicates Retained Fluid. Diagnosis follows specific locations: Deep pulse at Cun position indicates fluid in the Chest (symptoms of Article 9); slightly above Guan position indicates fluid at the Heart Below (symptoms of Article 7); slightly below Cun position, appearing singly on left or right, indicates fluid under the hypochondrium (symptoms of Article 8). Other Zang-Fu are diagnosed by their respective positions, using the Accumulation Pulse rules from Chapter 12 as the standard. A deep pulse should also show slippery and fine qualities.
Article 11 Phlegm disease above the Diaphragm presents with fullness, wheezing, cough, and vomiting. Upon onset, chills and fever, back and waist pain, spontaneous tearing, and violent trembling occur. There must be Hidden Fluid.
This elucidates the symptoms of Water in the Kidney and palpitations below the Heart from Article 6. Fu Yin refers to latent, unmanifested fluid. It is about to manifest but not fully so, being more severe than mere palpitations in Article 6. "Must be Hidden Fluid" reflects Zhang Zhongjing's prophetic insight, often unnoticed by others. "Phlegm disease above the Diaphragm" means chronic phlegm pathology above the Diaphragm. "Wheezing, fullness, cough, vomiting" results from this pathological phlegm causing chest fullness, wheezing, coughing, and vomiting. These two phrases are the main symptoms, serving as diagnostic keys for expert physicians. "Onset" means exacerbation at certain times. The word "Onset"贯穿 (runs through) the following five symptoms. "Mu Qi" means tears. "Zhen Zhen Shen Yun Ju" indicates Yang deficiency with upward rushing. See *Shanghan Lun* and other notes. Chills, fever, etc., occurring simultaneously resemble Yang deficiency with external Cold invasion. However, since the patient has chronic phlegm-Qi above the Diaphragm triggering fullness, wheezing, cough, and vomiting, it is known not to be an acute illness but caused by Hidden Fluid in the Kidney. Although fluid hides below, its Cold-Damp Qi attacks upward through emptiness. The Lung dislikes dampness and cold. Thus, Cold-Damp Phlegm above the Diaphragm rises with Damp Qi (causing fullness/wheezing) and Cold Qi (causing cough/vomiting). Occasional exacerbation occurs because Lung Cold-Damp persists on Bing/Ding days (Fire) and Wu/Ji days (Earth), while Hidden Fluid dominates on Ren/Gui days (Water). Chills/Fever: Cold is the fundamental nature of fluid; rising fluid causes chills. Rising Cold repels slight Yang outward, causing both chills and fever. Back: The mansion of the Chest. Chest fullness and cough make Qi penetrate the back, causing pain. Waist: The mansion of the Kidney. Slight Yang in the Kidney is forced outward by Cold-Fluid, causing waist pain. Tears, though Liver fluid, are released spontaneously because Cold-Fluid presses upward and cannot control them. Cold Qi floats upward, forcing all Yang to retreat, causing trembling and shaking. Can Ling Gui Zhu Gan Tang (Article 18) and Shen Qi Wan alleviate this? Ling Gui Zhu Gan Tang removes Hidden Fluid; Shen Qi Wan tonifies Kidney Yang to prevent recurrence. Disciple asks: Article 6 note states this is a condition outside the Four Fluids, i.e., Fu Yin. Articles 2-6 clearly list the transmission of Four Fluids to the five Zang organs. Why is "Water in Kidney" considered outside the Four Fluids? One. Article 6 says "Water in Kidney" without mentioning "Fu Yin"; Article 11 mentions "Fu Yin" without "Kidney". How do we know Kidney Water is Fu Yin? Two. Four Fluids transmit via specific paths, from intestines/stomach to chest/hypochondrium/meridians, entering via mouth. If Kidney Water is Fu Yin and outside the Four Fluids, yet enters via mouth, how is it outside? From what path does this fluid enter and hide in the Kidney? Three. Tan Yin transmission has names like Xuan, Yi, Zhi, Liu, and symptoms in chest, epigastrium, hypochondrium, limbs. Zhang Zhongjing does not detail Fu Yin transmission, yet you say it is urgent and severe. Is merely hiding until becoming ill like this article considered severe, or are there other changes? Four. Please explain. Answer: This question is essential. Water in Heart, Lung, Liver, Spleen are severe conditions transmitted into Zang organs after the Four Fluids. Only Water in Kidney is a mild condition before the Four Fluids, i.e., Wei Yin (Micro Fluid) in Article 18. Since Kidney is the Water Organ, slight weakness in Kidney Yang summons Water to hide as fluid, hence "outside the Four Fluids". Anything latent and unseen is called Fu. Not only Heart, Lung, Liver, Spleen, but also Upper/Middle Jiao Fu organs cannot harbor Fu Yin. It's not that there is no fluid; if there were, external symptoms would be obvious, so it couldn't be called "hidden". Only Kidney and Bladder, one Zang one Fu, resembling rivers/seas, can hide fluid for extended periods. Thus, Water in Kidney is Fu Yin. Four Fluids enter via mouth; does Fu Yin not enter via mouth? Yes. But Four Fluid disease arises from failure of Upper/Middle Jiao Yang to distribute, causing gradual accumulation and rising. Fu Yin disease occurs when Upper/Middle are healthy, but Kidney Qi is cold and deficient, and Fu transformation stops with Cold. Bladder collaters connect to Kidney, allowing Cold-Water Qi to enter via Fu collaters and hide in Kidney. Tan Yin progression to Yi/Zhi is already severe; transmission to Kidney leads to death. Source comes from the Sea, and overflow floods the Sea, symbolizing land subsidence. Fu Yin progression generally has three outcomes: 1. Latent and unmanifested, flaring during Winter/Water periods (Ren/Gui months/days) like this article. 2. Fluid hides in the abyss, Cold Qi harasses the Upper Void, contracting Lung Qi, preventing distribution, causing water accumulation in intestines, transforming into Tan Yin. I call this the mild condition before Four Fluids, source from the Sea. 3. Fu Yin attacks upward, trapping Spleen/Lung Yang, preventing transportation, stopping urination. Fluid surges from above, daily swelling, cyanosis of skin/muscle, leading to death. This matches the "tidal wave burst" noted in Article 6, urgent and severe.
Article 12 Patients who drink excessively will suddenly experience wheezing and fullness. Generally, those with poor appetite and high fluid intake retain water at the Heart Below. Severe cases have palpitations; mild cases have shortness of breath.
This is binge drinking. Different from retained fluid in Xuan/Zhi Yin. This is upper-level binge drinking, different from Fu Yin and Wei Yin (Article 18). First two sentences: Patient has Heat in Chest/Diaphragm and drinks much. Water cannot penetrate quickly, stopping at Heart Below. Water presses Lung Qi causing wheezing; water floats in Chest causing fullness. Though not fully formed Four Fluids, the pathology is temporarily similar to Zhi Yin. Last four sentences: Regardless of being a patient, anyone with deficient Stomach/poor appetite and Heat in Diaphragm/excessive drinking can suffer this. Palpitations and shortness of breath are detailed elsewhere. The implication is that even if it is binge drinking, if not treated with Zhu Ling Tang or Wu Ling San to stop thirst and remove fluid, it will gradually develop into Four Fluid conditions.
Article 13 Bilateral wiry pulses indicate Cold, usually due to interior deficiency after severe purgation. Unilateral wiry pulse indicates Fluid.
These three articles summarize Four Fluid pulses. This article likely refers to Xuan Yin. Wiry pulse indicates Yang deficiency and Qi reduction. Fluid retention is caused by Yang Qi failing to exhale and penetrate downward, so Fluid pulse is always wiry. However, bilateral wiry pulses suggest interior Yang deficiency, indicating Middle Cold due to severe purgation causing interior deficiency and Qi collapse. Do not mistake this for Fluid pulse. Only unilateral wiry pulse indicates Xuan Yin in the left/right hypochondrium. However, according to Accumulation Pulse rules, bilateral wiry suggests fluid in the center. Zhi Yin in Chest/Epigastrium may also show bilateral wiry pulses. Differentiate by symptoms. Fluid diseases have wheezing, thirst, shortness of breath; post-purgation interior deficiency lacks these. Article 10 says Retained Fluid pulse is deep; this article says Xuan Yin pulse is wiry. Are Fluid pulses deep and wiry together? My experience suggests: Early Fluid disease often shows wiry pulse; late/chronic Fluid disease often shows deep pulse. Zhang Zhongjing distinguishes them intentionally.
Article 14 Lung Fluid is not wiry; the patient suffers mainly from wheezing and shortness of breath.
Lung Fluid refers to Zhi Yin floating to Chest/Diaphragm, injuring the Lung. Wiry pulse indicates Qi reduction. Water accumulation in Chest/Diaphragm prevents Qi from descending, gathering above the fluid. Thus, the wiry pulse of Qi reduction is absent. Wheezing and shortness of breath are detailed elsewhere. Saying Fluid pulse is wiry, but Lung Fluid specifically may not be wiry, do not be misled by this. Rely on external symptoms, similar to Stomach having retained food showing slippery pulse.
Article 15 Zhi Yin also causes wheezing, inability to lie flat, plus shortness of breath, but the pulse is level/normal.
Zhi Yin, referring to Zhi Yin at the Heart Below. Same Zhi Yin has high and low positions. High ones press the Lung, called Lung Fluid. Low ones are at Heart Below, far from Lung, called Zhi Yin generally. Fluid accumulation in Epigastrium makes Qi descent difficult, causing wheezing. Inability to lie flat is because lying horizontal causes fluid to press the Lung. Shortness of breath is a symptom of Lung Fluid. If fluid is at Heart Below, pulse is still wiry. If fluid rises slightly causing shortness of breath, Qi gathers in the Lung. Qi gathering makes the pulse level rather than wiry/reduced.
Article 16 Tan Yin disease should be treated with warm herbs to harmonize.