留饮，止证也，不过蓄水而已。王氏脉经中，派之为四∶痰饮、悬饮、支饮、溢
饮。《千金方》又派之为五饮，皆观病之形状而定名也。今予皆不论，此论饮之所得。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，停酒则生燥，久则成痰。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，支满痞隔痰逆。在阳
不去者，久则化气；在阴不去者，久则成形。
今之用方者，例言饮为寒积，皆用温热之剂，
以补之燥之。夫寒饮在中，反以热药从上投之，为寒所拒。水湿未除，反增心火；火既不降，
水反下注；其上焦枯，其下寒栗。《内经》曰∶出入废则神机化灭，升降息则气立孤危。
渠不信夫？况乎留饮下无补法，气方隔塞，补则转增。岂知《内经》所谓“留者攻之”？何后人不
师古之甚也！且以白术、参、苓，饮者服之，尚加闭塞，况燔针艾火，其痞可知。前人处五饮丸三十余味
，其间有矾石、巴豆、附子、乌头，虽是下攻，终同燥热，虽亦有寒药相参，力孤无援。
故今代刘河间根据仲景十枣汤，制三花神佑丸，而加大黄、牵牛。新得之疾，下三、五十丸，气流饮去
。昔有病此者，数十年不愈。予诊之，左手脉三部，皆微而小，右手脉三部，皆滑而大。微小
为寒，滑大为燥。余以瓜蒂散，涌其寒痰数升，汗出如沃；次以导水、禹功，去肠胃中燥垢
亦数升，其人半愈；然后以淡剂流其余蕴，以降火之剂开其胃口，不逾月而痊。夫黄连、黄柏
，可以清上燥湿；黄 、茯苓，可以补下渗湿。二者可以收后，不可以先驱。复未尽者，可以
苦葶苈、杏仁、桑白皮、椒目逐水之药，伏水皆去矣。
夫治病有先后，不可乱投。邪未去时，慎
不可补也。大邪新去，恐反增其气，转甚于未治之时也。昔河内有人病饮，医者断为脾湿，以木香
、牵牛二味散之，下十余行，因 病患；复变散为丸，又下十余行；复变丸为散，又十余行。
病者大困，睡几昼夜。既觉，肠胃宽润，惟思粥，食少许，日渐愈。虽同断为湿，但补泻
不同，其差至此。
《内经》曰∶岁土太过，雨湿流行，肾水受邪，甚则饮发中满。太阳司天，
湿气变物，水饮内蓄，中满不食。注云∶此年太阴在泉，湿监于地，病之原始，地气生焉。少阴
司天，湿土为四之气，民病鼽衄饮发。又，土郁之发，民病饮发注下，跗肿身重。又，太阴
所至，为积饮痞隔。又，太阴所至，蓄满。又，太阴之胜，与太阴之复，皆云饮发于中。以此
考之，土主湿化，不主寒；水主寒化，不主湿。天多
雨，地有积潦，皆以为水。在《内经》属土，冰霜
凝，风气凄凛，此水之化也。故曰∶丑未太阴湿土，
辰戌太阳寒水。二化本自不同，其病亦异。夫湿土太过，则饮发于中。今人以为脾土不足，则
轩岐千古之书，可从乎？不可从乎？
留饮，属于积聚类的病证，不过是水液停聚罢了。王叔和的《脉经》中，将其分为四类：痰饮、悬饮、支饮、溢饮。《千金方》又将其细分为五类饮证，都是根据病症的表现形态来命名的。现在我不讨论这些分类，这里只论述饮邪产生的原因。其来源有五种：有因愤懑郁结而得的，有因过度疲劳困乏而得的，有因思虑过度而得的，有因暴饮而得的，有在炎热时贪凉饮冷而得的。饮证的成因虽然繁多，但不出这五种范围。
凡是愤懑郁结而不能舒展，就会导致肝气侵犯脾土，脾气运化失常，从而形成留饮。肝主谋虑，长期思虑而不能决断，则饮邪之气运行不畅。脾主思，长期思虑不止，则脾气结滞，所以也形成留饮。人因为劳役远行归来，趁着困乏饮水，此时脾胃功能衰弱，因而嗜睡，不能将水液布散到经脉中，这也形成留饮。人饮酒过多，肠胃已经充满，又再增加摄入，膀胱经络来不及渗泄，久而久之如此，也形成留饮。因为在盛夏时节津液焦枯干涸，喜欢喝冷水，本意是为了止渴，但因为痛快喝得太多，且饮后安逸不动，也形成留饮。人如果患有饮证，难道能超出这五种情况之外吗？
水，属于阴性的物质。只是积水就会生湿，停积酒液就会生燥，时间久了就会变成痰。停留在左侧胁部的，与肥气（肝之积）相同；停留在右侧胁部的，与息贲（肺之积）相同；向上侵入肺脏就会多咳嗽；向下侵入大肠就会腹泻；侵入肾脏就会成为涌水，腹部有水声如囊袋中的浆液晃动。无处可去，所以在太阳经就称为支饮，这都是由气机逆乱而导致的。所以湿气在上部的，眼睛发黄、面部浮肿；在下部的，大腿膝盖肿胀厥冷；在中部的，胸脘胀满痞塞、痰气上逆。在阳分停留不去的，时间久了会化气；在阴分停留不去的，时间久了会成形。
现在使用方药的人，通常认为饮是寒性积滞，都用温热的药剂来补益和燥湿。但是寒饮停滞在中焦，反而用热药从上焦投入，会被寒邪所抗拒。水湿没有去除，反而增加了心火；心火既然不能下降，水液反而向下灌注；导致上焦干枯，下焦寒冷战栗。《内经》说：“出入废绝则神机化灭，升降停止则气立孤危。”他们难道不信吗？况且对于留饮，下面没有补法，气机刚刚隔塞，进补则会更加增加阻滞。怎么不知道《内经》所说的“留者攻之”（滞留的病邪要用攻逐的方法治疗）？为什么后人效法古人做得这么差呢！而且像白术、人参、茯苓，饮证患者服用，尚且会增加闭塞，何况是用燔针和艾火灸治，那种痞塞的情况就可以知道了。前人制定的五饮丸有三十多味药，其中含有矾石、巴豆、附子、乌头，虽然是攻下的药物，终究同于燥热，虽然也有寒药参杂其中，但力量孤单没有援助。所以现在刘河间根据张仲景的十枣汤，制作三花神佑丸，并加大黄、牵牛子。新近得的疾病，服用三五十丸，气流畅通，饮邪排出。过去有患此病的人，几十年不愈。我诊察他的脉象，左手寸关尺三部脉，都微细而小；右手寸关尺三部脉，都滑大而有力。微小为寒，滑大为燥。我用瓜蒂散，催吐出了几升寒痰，出汗如同水洗一样；接着用导水禹功散，排出了肠胃中几升干燥的垢腻，病人好了大半；然后用清淡的药剂流走其余的病邪，用降火的药剂开通胃口，不超过一个月就痊愈了。黄连、黄柏，可以清上焦的燥湿；黄芪、茯苓，可以补下焦并渗湿。这两类药物可以用于收功，不可以用于初期驱邪。还有未尽的病邪，可以用苦葶苈、杏仁、桑白皮、椒目等逐水的药物，潜伏的水邪就都排除了。
治病有先后顺序，不可乱投药物。邪气未去除时，千万不可进补。大邪气刚去除，恐怕反而增加正气（或指病气），比未治疗时更严重。过去河内有人患饮证，医生判断为脾湿，用木香、牵牛子两味药制成的散剂让他服用，腹泻了十多次，因此损伤了病患；又改为散剂，又腹泻十多次；又改为丸剂，又腹泻十多次。病人非常困顿，睡了几天几夜。醒来后，肠胃宽润，只想喝粥，吃少量食物，日渐痊愈。同样是诊断为湿，但补泻不同，差别竟然如此之大。
《内经》说：“岁土太过，雨湿流行，肾水受邪，甚则饮发中满。”太阳司天之年，湿气改变万物，水饮内蓄，中焦胀满不食。注解说：这一年太阴在泉，湿气监察于地，病的原始原因，是由地气产生的。少阴司天之年，湿土作为四之气，民众患病出现鼻塞鼻衄、饮证发作。另外，土郁发作之时，民众患病出现饮证发作、腹泻、足背肿胀身体沉重。另外，太阴所至，表现为积饮痞塞。另外，太阴所至，表现为蓄积胀满。另外，太阴胜复，都说饮证发作于中焦。以此考证，土主管湿化，不主管寒化；水主管寒化，不主管湿化。天上多雨，地上有积水，都认为是水。在《内经》中属土，冰霜凝结，风气凄厉凛冽，这是水的化生。所以说：丑未年太阴湿土，辰戌年太阳寒水。这两种化生本来不同，它们的病也不同。湿土太过，则饮证发作于中焦。现在的人却认为脾土不足，那么轩岐（黄帝与岐伯）千古之书，是可以听从呢？还是不可以听从呢？
Liu Yin (Retention of Fluids) is a type of accumulation disorder, essentially merely the retention of water. In Wang Shuhe's *Mai Jing* (Pulse Classic), it is categorized into four types: Tan Yin (Phlegm-Fluid), Xuan Yin (Hanging Fluid), Zhi Yin (Supporting Fluid), and Yi Yin (Overflowing Fluid). The *Qian Jin Fang* (Essential Prescriptions Worth a Thousand Gold) further subdivides them into five types of Yin disorders, naming them all based on the morphological presentation of the disease. I do not discuss these classifications here; instead, I discuss the acquisition of Yin. Its origins are fivefold: some arise from indignation and depression, some from exhaustion and fatigue, some from excessive rumination, some from binge drinking, and some from consuming cold substances during heat. Although there are many manifestations of Yin disorders, none fall outside these five categories.
When indignation and depression cannot be expressed, Liver Qi invades the Spleen, causing the Spleen to fail in transformation, thus resulting in Liu Yin. The Liver governs planning and deliberation; prolonged deliberation without resolution impedes the movement of fluid Qi. The Spleen governs thought; prolonged thought without cessation causes Spleen stagnation, also resulting in Liu Yin. When a person returns from hard labor or long travel, drinks water while exhausted, the Spleen and Stomach strength are depleted. Consequently, they become lethargic and unable to distribute fluids into the vessels, also forming Liu Yin. When one drinks too much alcohol, the intestines and stomach are already full, yet more is added. The Bladder meridians cannot excrete it in time; over a long period, this also forms Liu Yin. During the height of summer, when body fluids are scorched and dry, people prefer cold water to quench thirst. If consumed excessively for pleasure and followed by inactivity, this also forms Liu Yin. Can any person suffering from Yin disorders escape these five causes?
Water is a yin substance. Accumulated water generates dampness; retained wine generates dryness; over time, both transform into phlegm. When located in the left hypochondrium, it corresponds to Fei Qi (Liver Accumulation); when in the right hypochondrium, it corresponds to Xi Ben (Lung Accumulation); when ascending into the Lungs, it causes frequent coughing; when descending into the Large Intestine, it causes diarrhea; when entering the Kidneys, it becomes Yong Shui (Gushing Water), with a sloshing sound like liquid in a bag. Wherever it goes, if it remains in the Taiyang channel, it is called Zhi Yin, all arising from rebellious Qi. Thus, dampness above manifests as yellow eyes and facial edema; below as swelling and coldness of the thighs and knees; in the middle as chest and epigastric distension, obstruction, and rebellious phlegm. If remaining in the yang aspect without departing, it transforms into qi over time; if remaining in the yin aspect without departing, it takes form over time.
Practitioners today generally assume that Yin is a cold accumulation and use warm and hot agents to tonify and dry it. However, if cold Yin is stagnant in the middle and hot medicines are administered from above, they are rejected by the cold. The water-dampness is not removed, but heart fire increases; since the fire does not descend, water flows downward instead, leading to a dry upper jiao and a cold, shivering lower jiao. The *Nei Jing* states: "If exit and entry cease, the spirit mechanism perishes; if ascent and descent stop, the qi establishment stands alone." Do they not believe this? Moreover, there is no tonification method for Liu Yin at the lower level. When qi is just obstructed, tonification will only increase the blockage. How can they ignore the *Nei Jing*'s principle: "Those that are retained must be attacked"? Why do later generations fail so miserably in emulating the ancients! Furthermore, herbs such as Baizhu (Atractylodis Rhizoma), Renshen (Ginseng Radix), and Fuling (Poria) cause increased obstruction even when taken by patients with Yin disorders. How much worse would be the effects of burning needles and moxibustion, which would undoubtedly worsen the palpable obstruction? The ancient formula Wu Yin Wan contains over thirty ingredients, including Fanshi (Alumen), Badou (Crotonis Fructus), Fuzi (Aconiti Lateralis Radix Praeparata), and Wutou (Aconiti Radix). Although these are purgatives, they are ultimately drying and hot. Although some cooling herbs are included, their power is isolated and unsupported. Therefore, Liu Hejian of our era, basing himself on Zhang Zhongjing's Shizao Tang (Ten Jujube Decoction), formulated Sanhua Shenyou Wan (Three-Flower Divine Protection Pill) and added Dahuang (Rhei Radix et Rhizoma) and Qianniu (Pharbitidis Semen). For newly acquired diseases, administering thirty to fifty pills allows the qi flow to resume and the fluid to be expelled. Previously, I treated a patient who had suffered from this condition for decades. His pulse was minute and small in all three positions of the left hand, and slippery and large in all three positions of the right hand. Minute indicates cold; slippery and large indicate dryness. I used Gudi San (Melon Stem Powder) to induce vomiting, expelling several liters of cold phlegm, with sweat pouring like washing water. Next, using Dao Shui San (Water-Guiding Powder) and Yugong San (Yu Gong Powder), I expelled several liters of dry filth from the intestines and stomach, curing half of the patient. Then, using mild diuretic agents to clear the residual pathogen, and fire-descending agents to open the appetite, he recovered within a month. Huanglian (Coptidis Rhizoma) and Huangbai (Phellodendri Cortex) can clear upper jiao dryness and dampness; Huangqi (Astragali Radix) and Fuling (Poria) can tonify the lower jiao and leach out dampness. These two categories can be used for consolidation but not for initial expulsion. For remaining pathogens, drugs such as Tingli (Descurainiae Semen seu Lepidii Semen), Xingren (Armeniacae Semen Amarum), Sangbaipi (Mori Cortex), and Jiaomu (Zanthoxyli Pericarpium) can be used to chase water, eliminating the latent fluid.
Treating disease requires sequence and order; one must not administer drugs randomly. When the pathogen has not been expelled, tonification must strictly be avoided. Immediately after the major pathogen is expelled, one fears that tonification may inadvertently increase the pathogenic qi, making the condition worse than before treatment. Previously, a person in Henei suffered from Yin disorder. The physician diagnosed it as Spleen dampness and prescribed a powder of Muxiang (Aucklandiae Radix) and Qianniu (Pharbitidis Semen). After more than ten bowel movements, the patient was injured. The prescription was changed to a powder again, causing another ten bowel movements; then to a pill, causing another ten bowel movements. The patient became severely debilitated and slept for days and nights. Upon waking, his intestines and stomach felt loose and moist, craving only congee. Eating small amounts, he gradually recovered. Although both cases were diagnosed as dampness, the difference between tonification and purgation led to such divergent outcomes.
The *Nei Jing* states: "When Earth qi is excessive, rain and dampness prevail, damaging Kidney Water, and severe cases result in fluid retention and epigastric fullness." When Taiyang governs the year, dampness alters things, water and fluids accumulate internally, causing epigastric fullness and anorexia. The commentary notes: In this year, Taiyin is in the lower position, with dampness supervising the earth. The origin of the disease arises from earthly qi. When Shaoyin governs the year, wet-earth is the fourth qi, and the people suffer from nasal congestion, epistaxis, and fluid retention. Furthermore, when Earth depression occurs, the people suffer from fluid retention, diarrhea, dorsal edema, and heavy body. Also, when Taiyin arrives, it manifests as accumulated fluid and obstruction. When Taiyin arrives, it manifests as internal accumulation and fullness. Both Taiyang excess and Taiyang return state mention fluid retention in the middle. Based on this examination, Earth governs wet transformation, not cold transformation; Water governs cold transformation, not wet transformation. Heavy rain in heaven and accumulated puddles on earth are all considered water. In the *Nei Jing*, this belongs to Earth. Ice and frost condensation, and chilling winds, are transformations of Water. Thus, it is said: Chou and Wei years correspond to Taiyin Wet Earth; Chen and Xu years correspond to Taiyang Cold Water. These two transformations are fundamentally different, and their diseases differ. When Wet Earth is excessive, fluid retention occurs in the middle. Today, people believe that Spleen Earth is deficient. Should we follow the eternal books of Xuanyu (Yellow Emperor) and Qibo? Or should we not?