上古圣人视河图以明阴阳之道，五行之理，天地之所以成变化而行鬼神者，要不出此。人身一天地也，则其为生为成者，亦岂外是哉。故天一生水，地六成之，在人身则为肾。地二生火，天七成之，在人身则为心。天三生木，地八成之，在人身则为肝。地四生金，天九成之，在人身则为肺。天五生土，地十成之，在人身则为脾。故人俱阴阳五行，无异于天地，亦无异于河图也。但天地之阴阳五行，往来阖辟，尽其道之自然。人身之阴阳五行，或外为六气所感，内为七情所伤，五行戕贼而病之纷然杂出者，不可胜数矣。然概而论之，其端有二；一在富贵之子深居简出，体无劳倦，而其病即生于饱暖淫欲之中，故外感之气少而内伤之病妥。至内虚而外感亦易入矣，此犹河图之生数有亏而成数亦因之而损也。一在贫贱之人，冲风冒雨，手足勤够，而其病每生于饥寒困苦之间，故内伤之疾少而外感之气多。至外感深则内伤亦因之矣，此犹河图之成数不立而生数难独存也。病虽杂出，而斯二者之相为表里其大概也。是在司命者，因人审疾，察其内外先后，而施治得宜，则人身之阴阳和合，五行顺布，犹之天地河图也。
脾阳合中五说
今夫万物之所以托命者，土也，而五行亦无土不成。故土者后天之根本，而金木水火之枢机也。洛书一图中五称为皇极焉。盖天地太和之气，而万物之所以生长收藏者也。在人身则为脾，内而脏腑，外而肢体百骸之所资养，而气血之所从生也，且水得之而不汜，火得之而不炎，木得之而畅茂，金得之而坚凝，况饮食入胃，得脾为之健运，则清者由是而上升，浊者由是而下降。脾土一伤，则一身之枢机不灵，而百体皆困矣。经云：有胃气则生，无胃气则死。盖言土为后天资生之本，而即洛书之中五也。夫中五阳也，病则不能运，因之上有中满腹胀不食等证，病则不能化，必至下有泄泻下痢清谷等证，皆五土之失职也。故仲景有建中、理中之制，他如四君、六君子诸方，所以培中五建皇极之意也。夫或曰脾土属阴，何以为洛书之中五曰脾土体阴而用阳者也。其质虽阴，而其健运之机则阳也，非洛书之中五而何?
龙雷相火辨
《医贯》有龙火雷火之说，喻人身虚火上炎，得水则炽，不知其性而水折之，适足以光焰烛天，穹物方止。识其性而以火逐之，则炎灼自消也。后世景岳、冯氏莫不附和其议，不知其说则是而取，譬而非也。夫龙雷乃天地蒸郁之火，阴随阳发之象也。阴随阳发，而阳复为阴气所抑，郁则阴阳相争，搏而成声，辄为电矣。此龙雷之所以作也。然当炎夏之时，其阳必胜，其阴必负，阳胜阴负则其气伸散。故一时浓云骤雨，得雷奋风散而蒸郁之火豁然解矣。此犹人身外为风邪闭塞，邪热拂郁，头痛恶寒，轻则必用麻桂等汤，重则必用青龙白虎，外发其汗。内清其热，而邪由是退也。然则龙雷可以譬人身之实火，而不可以譬人身之虚火明甚。夫人身之所以虚火上炎者，皆由于真阴之不足也。真阴者，离中之一阴也，离火体阳而根阴，故离阳虽升，离阴必降。真阴亏则不能下降，而下交于坎，而坎之阴亦亏，坎根阳者也。坎阴亏则坎中之阳无所附而飞越，惟参附八味等剂热药冷饮，乃能引而归之，此犹天地九月之候，以阴剥阳，阳气外越，将为纯阴之卦，必急求一阳来复，庶可二阳三阳开泰，以复其初也。故参附八味之回阳，即大易来复之意，而岂龙雷得水则炽，得火则灭之验哉。
天根月窟说
康节诗云：天根月窟间来往三十六宫，都是春，诚以人身之真阴真阳上下相交循还不息也。盖天根者，坎中之一阳也。即复卦之初九也。有此一阳而三之木、七之火、九之金、莫不始此焉，故不曰天而曰天根，以见阳之所从生也。月窟者，离中之一阴也，姤卦之初六也，有此一阴而四之金、六之水、八之木，莫不肇此焉。故不曰月而曰月窟。以见阴之所由始也。斯二者在天地则为日月，故日往则月来，来往不息而天地始成。其为天地也，于人身为心肾，子半而肾阳上通于心，午半而心阴下交于肾，其气之一呼一吸而往来不穷者，此人之所以生也。然此往也来也，日月之往来，天地以无心而成化也，心肾之往来，至人以有心而无为也。故邵子下一间字，以见自然而然，无所矫强，故往来虽似不间，而实行所无事，俊人不识此理，心多妄动，而真阴渐耗，肾因纵欲而真阳亦亏，甚至水火不交，反泰为否，其原总由水火失职，不相往来耳。故丹溪、东垣辈执阳常有余、阴常不足之论，专以滋阴抑火为治，其见固偏于阴，而未识阴阳，直至赵氏始指命门为坎中真阳，而景岳、冯氏力宗其说，俱以真阳为重，但犹未识真阴在离而偏于阳，其流弊与丹溪、东垣等，此皆由于未识天根月窟之义也。今特以邵子诗而为之解，以明人身之阴阳互根。其往来不息者，实与天地之道吻合，不得以一人之意见妄为轻重于其间也。
论饮大纲
饮者，水气也。身中有饮，犹地中有水。地非水不能灌溉万物，人非饮不能滋润百骸。但地中之水流行则为泉为潮，长发万物，壅塞则停污，横决则泛滥，反为万物之害矣。身中之饮，运行则为津为液，滋养百骸，瘀滞则胀满，逆行则呕吐，反为百骸之病矣。然水之所流行者，土中之阳为之也，阳衰则泛滥，阳郁则停污。饮之所以运行者，脾中之阳为之也。阳衰则胀满，阳郁则呕吐。故经云：太阴所至为积饮，否隔畜满。又云：中满腹大，其发濡滞，诚以太阴所至纯是湿土用事，湿甚则阴衰，不能为胃行其津液，又不能散精上归于肺。饮与湿合，遂随经横流而病成矣。然湿性就下，虽有五脏留伏之不同，未有不本于脾者也。随脾经而下决小肠，丙火搏击于内，以至沥沥有声，谓之痰饮，犹水之畜积，沟渠郁蒸而败浊也。随脾经而旁决于少阳，阻抑左旋之道，以致咳唾引痛，谓之悬饮。犹水之壅过高原而为悬河也，随脾经而外决四肢，郁于皮毛，肌肉，当汗出而不汗出，以至身体疼痛，谓之溢饮，犹水之不归河道，汪洋四出而为洚水也。随脾经而上决于胸中，阻其宗气，致短气不得卧，以至其形如肿，谓之支饮，犹水之不趋汀海，别开一迳而为支河也。总之饮为阴体，以阳为用，阳衰则失其所用而饮愈甚。饮甚则害其所用而阳愈困。故水在心则心之阳受困，不能传化于小肠，致坚筑短气。水在肺则肺之阳受困，不能传化于大肠，致吐涎沫。水在脾则脾之阳受困，不能传化于胃，致少气身重。水在肝则肝之阳受困，不能传化于胆，致胁满嚏痛。水在肾则肾之阳受困，不能传化于膀胱，致心下悸。五脏之阳一亏，皆足以为害。而所以统摄渚经之水者，尤当专责其中州。盖阳盛则土足以制水，阳衰则水反足以侮土，使不早维昏垫之灾，急思奠安之法，始而伤于在表之阳，继而伤于在里之阳，始而伤于五脏之阳，继而伤于胸中之阳，几何不横流四决，神州陆沉者哉！
痰 饮 辨
痰与饮虽同出一源，面变现各别。痰为火化，因热而浊，饮为水积，因寒而清。余细绎《内经》，止有积饮、溢饮、悬饮等症。凡论饮证中绝无一说及痰者。惟《金匮》中有痰饮之说，然与溢饮、悬饮、支饮、留饮、伏饮数条并列，亦不过就饮证中推出有痰症耳，未尝指饮症皆属于痰也。后人以饮为痰，溷为一证，千百年来无不沿习其误，以致一切饮症认作痰治，百无一效。虽丹溪之明哲，犹有百病皆痰之论，此等大纲，可不条分而缕析之哉夫痰与饮实有阴阳之分，水火之别，断断不可混淆者。即以痰饮二字之义揣之，痰字从火从炎，皆火之为病，阳也。虽有劳瘵等证，咳嗽吐痰，病实虚寒，然根究其源，亦必阴虚火炽，相火上升所致。其余显然属火者，夫人知之，兹不赘及。凡水皆可曰饮，酒亦曰饮，饮者，其物之濡柔者也。病谓之饮，必因其脾阳困败，土衰不能生金，清肃不行，水精不能四布，因而留伏于经络，横决于四肢，非若痰之胶稠凝结可比。即伤寒中之水气，亦是饮中之一证也。如此分别，泾渭了然，而治法亦迥异矣。
留饮伏饮论
留伏二义，《金匮》论之最详。嘉言先生谓留饮者，留而不去，留饮去而不尽，则名伏饮。伏者，伏而不出也。究竟留伏二字未有分别。余按：留饮全属于水，因五脏阳衰之处而得据其间。伏饮则平素痰气内结，先已暗损胸中之阳，水饮外入，挟痰而伏匿于大气难到之所，流注于中州要害之地，随经深藏结穴，阻抑阳气上升之路，较之留饮更胜十倍矣。再以《金匮》文义细详之，其言留饮者五，伏饮者一。一曰心下有留饮，其人背恶寒，冷如掌大。夫心下者，胃脘之上也。背为胸之府，水饮留止于心下，不特胃脘之阳不振，而督脉之阳亦衰。况胃之俞穴各开一寸五分，上下各离一寸，恰如掌大，故独此处恶寒，此饮之留于心而征于背者也。一曰留饮者，心下痛引缺盆，咳嗽则转甚，言水饮留止胁下，胁下为厥阴少阳专主之地，况少阳之脉由缺盆过季胁，上出肺络，水饮偏阻，生气不达，故吊引缺盆而痛，咳则转甚，此饮之留于胁而征于经络者也。一日胸中有留饮，其人短气而渴，四肢历节痛。夫胸中者，枢机开发之所也，水饮留于胸中，开发之机不利，阳气阻遏于上，故气短而渴，阴寒凝滞于下，不能宣达四肢，故历节作痛，此饮之留于胸而征于上下四旁者也。一日脉沉者，有留饮，言水饮内郁，脉必失其阳和发越之象，此饮之留于经而征于脉者也。一日病者脉伏，其人欲自利，利反快，心下续坚满，此为留饮欲去故也。言脉伏不显，水精填塞，窍随胃气不得转输，自利则水似有去路，而仍续坚满，通而复积，有欲去而不去之势，此饮之留于胃口而征于去就无常者也。至伏饮，则曰膈上病，痰满喘咳，吐发则寒热背痛，腰疼，目泣自出，其人振振自（目闰）而剧，必有伏饮，言胸中乃阳气所治，水邪挟饮而伏匿之，阻遏手足阴阳升降之路，吐发则阴阳相乘而寒热，阳乘阴而郁于下，背痛腰疼，阴乘阴而逆于上，目泣自出，阴阳交争，内外相并，一若伤寒病之振振身（目闰）而剧，此饮之伏于膈上而征于时作时止者也。观《金匮》留饮五条，证虽不同而源则一。一因督脉之阳不伸，一因卫外之阳不伸，总由一经阳气不伸之处而留止也。若伏饮则尤甚焉。凡手足三阳皆为阻遏，故留饮尽属水而常主于动，伏饮兼有痰而有时则静，留饮尚有驱逐之法，伏饮但有温和之法。虽不立方，而轻重缓急，从可类推矣。
饮证属阳虚论
按：饮证数条，《内经》《金匮》皆责之太阴，吾故曰脾阳不足，积水停污所致也。而嘉言云：饮因于湿，有热有寒。言虽近理，实则模糊，不得不为之辨。天地江淮河汉，水行地中，振而不泄者，皆大气为之包举。人身之水注于经络，贯乎百骸，泽于皮毛，皆脾气为之摄运，苟中宫之阳一败，非泛滥则停污矣。即有湿热郁蒸，变而为败浊者，似属元阳为害，不得概指为寒然。讵知其为阳气困极，虚阳脱于外乎譬诸沟渠之水积而不流，有经寒冱而凝结者，有经烈日而秽浊者。经寒冱而凝结者，地之阳气不通于外也。经烈日而秽浊者，地之阳气尽浮乎外也。均谓之阳虚可也。然则饮症之属寒也，可知矣乎夫。
痰饮悬饮溢饮支饮论
饮之为患，《内经》独主于脾，以脾为至阴之脏而不至阳之用，且与胃相为表里。胃为水谷之海，水谷入胃，全赖脾阳为之运化，故脾有一分之阳，能消一分之水谷，脾有十分之阳，能消十分之水谷。水谷过多，则胃中之阴胜于脾中之阳，始也饮自外入而不消，继也饮自内生而益甚，不特伤脾中之阳，并伤心肺肝肾之阳。《金匮》统四纲以正其名，分五经以畅其治，无不从一源而出。一曰痰饮，有火炎之象，以其人素盛今瘦，肌肉消化为痰，心气阻遏，下迫水饮而沥沥有声，必至坚筑短气。一曰悬饮，有倒悬之象，以饮后水流胁下，附于募原隔膜之间，肝气内结，咳嗽则吊胁作痛，自必胁下支满。一日溢饮，有横散之势，以饮水流行，达于四末，肺气不宣，郁于皮毛而不汗出，自必上泛而吐涎沫。一曰支饮，有旁开之象，以其形如肿，中宫失其健运，脾气内郁而至倚息不得卧，自必少气身重。至于水在肾，心下悸，即是痰饮之一证。观伤寒门中水饮在心，心下满而悸，虽见证略有差别，而治法则一。盖以肾水最易凌心也。故仲景即于四饮之中分括五脏，非以四饮之外另有所谓五饮也。后人不察《金匮》之义，妄生五饮六证之说。海藏于五饮汤下云：一留饮在心下，二支饮在胁下，三痰饮在胃中，四溢饮在膈上，五悬饮在肠间。不必问其论症之失，即其论五饮所注之部位已背乱经旨极矣。况欲以一方而统治之，则大要论所谓谨守病极，各司其。属，有者求之，无者求之，盛者责之，虚者责之之说，将何词以解也?
治饮大法
上古时期的圣人通过观察河图来阐明阴阳的道理和五行的规律，天地之所以能形成变化并运行鬼神之力，关键就在于此。人体就是一个小天地，那么人体的生命生成过程，难道会超出这个范围吗？所以天一生水，地六成之，在人体中对应的是肾。地二生火，天七成之，在人体中对应的是心。天三生木，地八成之，在人体中对应的是肝。地四生金，天九成之，在人体中对应的是肺。天五生土，地十成之，在人体中对应的是脾。因此，人具备阴阳五行，与天地无异，也与河图的原理无异。只是天地的阴阳五行，往来开合，遵循自然之道；而人体的阴阳五行，有时被外界的六气（风、寒、暑、湿、燥、火）所感，有时被内在的七情（喜、怒、忧、思、悲、恐、惊）所伤，导致五行受损而疾病纷繁复杂地出现，数不胜数。然而概括来说，疾病的起因主要有两类：一类是富贵人家子弟，深居简出，身体没有劳累疲倦，他们的病往往产生于饱暖淫欲之中，所以外感邪气少而内伤疾病多。到了体内虚弱时，外邪也容易侵入，这就像河图中的生数有亏损，成数也因此受损一样。另一类是贫贱之人，顶着风雨，手足勤劳，他们的病往往产生于饥寒困苦之间，所以内伤疾病少而外感邪气多。到了外感深入时，内伤也会随之产生，这就像河图中的成数不确立，生数也难以单独存在一样。虽然病症繁杂，但这两者的表里关系是大致相同的。这在于掌握生命奥秘的医生，要根据每个人的具体情况审察病情，观察其内外先后的次序，从而施以适宜的治疗，这样就能使人体内的阴阳和谐、五行顺布，如同天地河图的自然秩序一样。
脾阳合中五说
大凡万物赖以生存的根本，就是土，而五行中没有土也不能成立。所以土是后天的根本，也是金、木、水、火的枢纽。洛书一图中，中央的五被称为“皇极”。这是天地太和之气，是万物生长收藏的基础。在人体中对应的是脾，内而脏腑，外而肢体骨骼都依赖它来滋养，气血也由此产生。而且水得到土的制约就不会泛滥，火得到土的制约就不会炎上，木得到土的资助就能茂盛，金得到土的承载就能坚凝。何况饮食进入胃中，依靠脾的健运功能，清轻的部分由此上升，重浊的部分由此下降。如果脾土受伤，那么全身的枢纽就不灵通，百体都会困顿。《内经》说：有胃气就能生存，无胃气就会死亡。这是说土是后天资生的根本，也就是洛书中的中五。中五是属阳的，生病时就不能运化，因此在上有中满、腹胀、不食等症状，在下有泄泻、下痢、完谷不化等症状，这都是脾土失职造成的。所以张仲景制定了建中汤、理中汤等方剂，其他如四君子汤、六君子汤等方，都是为了培补中五、建立皇极的意思。有人问：脾土属于阴，为什么说是洛书的中五呢？回答说：脾土体阴而用阳。它的质地虽然是阴，但其健运的功能则是阳，这不就是洛书的中五吗？
龙雷相火辨
《医贯》中有龙火、雷火的说法，用来比喻人身上的虚火上炎，遇到水反而燃烧更旺。如果不了解它的本性而用水去克制，只会让火势光焰烛天，直到物体烧尽才停止。如果认识它的本性而用火去驱逐它，那么炎灼自然会消退。后世的张景岳、冯氏无不附和这一观点，不知道这种说法道理是对的，但比喻却不恰当。龙雷之火是天地蒸郁之火，是阴随着阳发的现象。阴随阳发，而阳气又被阴气所抑制，郁结则阴阳相争，搏击而成声音，就形成了闪电。这就是龙雷之火产生的原因。然而在炎热的夏天，阳气必胜，阴气必负，阳胜阴负则气机伸展发散。所以一时浓云骤雨，雷电发作，风气吹散，蒸郁之火就豁然解除了。这就像人体外部被风邪闭塞，邪热拂郁，出现头痛、恶寒，轻则必须用麻黄汤、桂枝汤等方剂，重则必须用青龙汤、白虎汤，向外发汗，向内清热，邪气由此退去。既然这样，那么龙雷之火可以比喻人身上的实火，而不能比喻人身上的虚火，这是很明显的。人身上的虚火上炎，都是因为真阴不足。真阴，是离卦中的一阴，离火体阳而根于阴，所以离阳虽然上升，离阴必然下降。真阴亏虚就不能下降，而下交于坎卦，而坎卦中的阴也亏虚，坎卦根于阳。坎中之阴亏虚，则坎中之阳无所依附而飞越，只有用人参、附子、八味丸等热药冷饮的方法，才能引火归元。这就像天地九月的气候，阴气剥蚀阳气，阳气外越，将变成纯阴的坤卦，必须急求一阳来复，才可以达到二阳、三阳开泰，恢复初始状态。所以人参、附子、八味丸的回阳作用，就是《易经》中“来复”的意思，哪里是龙雷得水则炽、得火则灭的验证呢？
天根月窟说
邵雍的诗说：“天根月窟间来往三十六宫，都是春。”确实是因为人身上的真阴真阳上下相交循环不息。所谓天根，就是坎卦中的一阳，也就是复卦的初九爻。有了这一阳，三岁的木、七岁的火、九岁的金，无不始于这里，所以不叫天而叫天根，以显示阳气的来源。月窟，就是离卦中的一阴，也就是姤卦的初六爻。有了这一阴，四岁的金、六岁的水、八岁的木，无不肇始于这里。所以不叫月而叫月窟，以显示阴气的起始。这两者在天地之间就是日月，所以日往则月来，往来不息而天地始成。在人体中对应心肾，子时半夜肾阳上通于心，午时中午心阴下交于肾，气息的一呼一吸往来无穷，这就是人之所以生存的原因。然而这种往来，日月的往来，天地是以无心而成化育的；心肾的往来，至人是有心而无为的。所以邵雍用一个“间”字，以显示自然而然，没有矫揉造作，所以往来虽然看似不间断，但实际上实行的是无所事事（无为）。愚人不明白这个道理，心中多有妄动，导致真阴逐渐消耗，肾因纵欲而导致真阳也亏虚，甚至水火不交，反而由泰卦变为否卦，其根源总归是水火失职，不相往来。所以朱丹溪、李东垣等人坚持“阳常有余、阴常不足”的理论，专门以滋阴抑火为治疗方法，他们的见解固然偏重于阴，但没有认识到阴阳的整体，直到赵献可指出命门是坎中的真阳，而张景岳、冯氏极力推崇这一说法，都以真阳为重，但仍然没有认识到真阴在离卦中而偏重于阳，其流弊与朱丹溪、李东垣等人相同，这都是因为没有理解天根月窟的含义。现在特意根据邵雍的诗进行解释，以阐明人身阴阳互根的道理。它们往来不息，实际上与天地之道吻合，不能因为个人的意见而在其中妄加轻重。
论饮大纲
饮，就是水气。身体中有饮，就像地中有水。地没有水就不能灌溉万物，人没有饮就不能滋润百骸。但是地中的水流动起来就成为泉或潮，长发万物，壅塞则停滞污秽，横决则泛滥，反而成为万物的害处。身体中的饮，运行起来就成为津液，滋养百骸，瘀滞则胀满，逆行则呕吐，反而成为百骸的疾病。然而水之所以流行，是靠土中的阳气推动的，阳气衰弱则泛滥，阳气郁结则停污。饮之所以运行，是靠脾中的阳气推动的。阳气衰弱则胀满，阳气郁结则呕吐。所以《内经》说：太阴所致为积饮，痞隔蓄满。又说：中满腹大，发作时濡滞，确实是因为太阴所致全是湿土当令，湿气过重则阴衰，不能为胃行使其津液，又不能散布精气上归于肺。饮与湿结合，于是顺着经络横流而疾病形成。然而湿性趋下，虽然有五脏留伏的不同，但没有不源于脾的。顺着脾经向下决注小肠，丙火在内搏击，以至于沥沥有声，称为痰饮，就像水积聚在沟渠中，郁蒸而败浊。顺着脾经向旁决注少阳，阻碍左旋的道路，以至于咳嗽唾引痛，称为悬饮，就像水壅过高原成为悬河。顺着脾经向外决注四肢，郁结在皮毛肌肉，应当出汗而不出汗，以至于身体疼痛，称为溢饮，就像水不归河道，汪洋四出成为洪水。顺着脾经向上决注胸中，阻碍宗气，导致短气不能卧，以至于形体像肿，称为支饮，就像水不趋向汀海，另外开辟一条路径成为支流。总之，饮是阴体，以阳为用，阳气衰弱则失去其作用而饮更严重。饮严重则损害其作用而阳气更困乏。所以水在心，则心的阳气受困，不能传化于小肠，导致坚硬筑筑、短气。水在肺，则肺的阳气受困，不能传化于大肠，导致吐涎沫。水在脾，则脾的阳气受困，不能传化于胃，导致少气身重。水在肝，则肝的阳气受困，不能传化于胆，导致胁满嚏痛。水在肾，则肾的阳气受困，不能传化于膀胱，导致心下悸动。五脏的阳气一旦亏虚，都足以造成危害。而统摄诸经之水的人，尤其应当专责其中州（脾胃）。因为阳气盛则土足以制水，阳气衰则水反足以侮土，如果不早日维持以免昏垫之灾，急切思考奠安之法，开始损伤在表的阳气，继而损伤在里的阳气，开始损伤五脏的阳气，继而损伤胸中的阳气，多少会导致横流四决，神州陆沉啊！
痰 饮 辨
痰与饮虽然同出一源，但表现各异。痰是由火化生，因热而浑浊；饮是水积聚，因寒而清稀。我仔细研读《内经》，只有积饮、溢饮、悬饮等症。凡是论述饮证中绝无一说涉及痰的。只有《金匮要略》中有痰饮的说法，但它与溢饮、悬饮、支饮、留饮、伏饮数条并列，也不过是从饮证中推出有痰的症状罢了，未曾指饮证都属于痰。后人把饮当作痰，混为一谈，千百年来无不沿袭这种错误，以致一切饮证都认作痰来治，百无一效。即使是明哲的朱丹溪，也有“百病皆痰”的言论，这种大纲，能不条分缕析吗？痰与饮实在有阴阳之分，水火之别，绝对不可混淆。仅从痰饮二字的含义推测，痰字从火从炎，都是火引起的病，属阳。即使有劳瘵等证，咳嗽吐痰，病实际上是虚寒，然而追根究源，也必然是阴虚火炽，相火上冲所致。其余显然属火的，人们都知道，这里不再赘述。凡是水都可以叫饮，酒也叫饮，饮，是指物体的濡柔性质。病称为饮，一定是因为脾阳困败，土衰不能生金，清肃不行，水精不能四布，因而留伏于经络，横决于四肢，不像痰那样胶稠凝结。即使是伤寒中的水气，也是饮中的一种证候。如此分别，泾渭分明，而治疗方法也就迥然不同了。
留饮伏饮论
留和伏两个含义，《金匮要略》论述得最详细。嘉言先生认为留饮是停留不去，留饮去而不尽，就称为伏饮。伏，是潜伏而出不来。究竟留和伏二字没有分别。我认为：留饮完全属于水，是因为五脏阳气衰弱之处得以占据其间。伏饮则是平时痰气内结，先已暗中损伤胸中的阳气，水饮外入，挟带痰而潜伏在大气难到的地方，流注在中州要害之地，顺着经络深藏结穴，阻碍阳气上升的道路，比留饮更严重十倍了。再仔细详读《金匮》的文义，它说留饮有五种，伏饮有一种。第一种说心下有留饮，其人背部怕冷，冷如手掌大小。心下，就是胃脘之上。背是胸的府库，水饮留止于心下，不仅胃脘的阳气不振，而且督脉的阳气也衰。况且胃的俞穴各开一寸五分，上下各离一寸，恰如手掌大小，所以唯独此处怕冷，这是饮留于心而反映在背部的征象。第二种说留饮，心下痛牵引缺盆，咳嗽则加重，是说水饮留止胁下，胁下是厥阴、少阳专主的地方，况且少阳的经脉由缺盆经过季胁，上出肺络，水饮偏阻，生气不达，所以吊引缺盆而痛，咳则加重，这是饮留于胁而反映在经络的征象。第三种说胸中有留饮，其人短气而渴，四肢历节痛。胸中，是枢机开发的地方，水饮留于胸中，开发的机制不利，阳气阻遏于上，所以气短而渴，阴寒凝滞于下，不能宣达四肢，所以历节作痛，这是饮留于胸而反映在上下四旁的征象。第四种说脉沉者，有留饮，是说水饮内郁，脉必失去其阳和发越的征象，这是饮留于经而反映在脉的征象。第五种说病人脉伏，其人想自利，利后反而快适，心下继续坚硬胀满，这是留饮想要去除的缘故。是说脉伏不显，水精填塞，窍随胃气不得转输，自利则水似有去路，而仍然继续坚硬胀满，通而复积，有欲去而不去的趋势，这是饮留于胃口而反映在去留无常的征象。至于伏饮，则说膈上有病，痰满喘咳，吐发则寒热背痛，腰疼，眼泪鼻涕自出，其人振振目闰而加剧，必有伏饮，是说胸中是阳气所治的地方，水邪挟饮而潜伏，阻碍手足阴阳升降的道路，吐发则阴阳相乘而寒热，阳乘阴而郁于下，背痛腰疼，阴乘阴而逆于上，眼泪鼻涕自出，阴阳交争，内外相并，好像伤寒病的振振身目闰而加剧，这是饮伏于膈上而反映在时作时止的征象。看《金匮》留饮五条，证虽不同而源头则一。一是因督脉的阳气不伸，一是因卫外的阳气不伸，总归是一条经阳气不伸之处而留止。若伏饮则更严重。凡是手足三阳都被阻遏，所以留饮尽属水而常主动，伏饮兼有痰而有时则静，留饮尚有驱逐的方法，伏饮只有温和的方法。虽然不列方剂，但轻重缓急，可以类推了。
饮证属阳虚论
按：饮证数条，《内经》《金匮》都归责于太阴，所以我说是脾阳不足，积水停污所致。而嘉言说：饮因于湿，有热有寒。话虽近理，实则模糊，不得不为之辨析。天地间的江淮河汉，水行地中，振动而不泄漏的，都是大气包举。人身的水注入经络，贯穿百骸，润泽皮毛，都是脾气摄运的结果，如果中宫的阳气一败，不是泛滥就是停污。即使有湿热郁蒸，变而为败浊的，似乎属于元阳为害，不能一概指为寒。岂不知这是阳气困极，虚阳脱于外吗？譬如沟渠的水积聚而不流，有的经过寒冷冻结而凝结，有的经过烈日暴晒而秽浊。经过寒冷冻结而凝结的，是地的阳气不通于外。经过烈日暴晒而秽浊的，是地的阳气尽浮乎外。都可以称为阳虚。然而饮症属于寒的，可知了啊！
痰饮悬饮溢饮支饮论
饮为患，《内经》独主于脾，因为脾是至阴之脏而不至阳之用，且与胃相为表里。胃是水谷之海，水谷进入胃中，全赖脾阳为之运化，所以脾有一分的阳，能消一分的水谷，脾有十分的阳，能消十分的水谷。水谷过多，则胃中的阴胜于脾中的阳，开始饮自外入而不消，接着饮自内生而更甚，不仅伤脾中的阳，并伤心肺肝肾之阳。《金匮》统四纲以正其名，分五经以畅其治，无不从一源而出。第一种说痰饮，有火炎之象，因为其人素来肥胖现在消瘦，肌肉消化为痰，心气阻遏，下迫水饮而沥沥有声，必至坚硬筑筑、短气。第二种说悬饮，有倒悬之象，因为饮后水流胁下，附着于募原隔膜之间，肝气内结，咳嗽则吊胁作痛，自必胁下支满。第三种说溢饮，有横散之势，因为饮水流行，达于四末，肺气不宣，郁于皮毛而不汗出，自必上泛而吐涎沫。第四种说支饮，有旁开之象，因为形体像肿，中宫失其健运，脾气内郁而至倚息不得卧，自必少气身重。至于水在肾，心下悸，就是痰饮的一种证候。看伤寒门中水饮在心，心下满而悸，虽然见证略有差别，而治法则一。大概是因为肾水最容易凌心。所以张仲景即在四饮之中分括五脏，不是在四饮之外另有所谓五饮。后人不考察《金匮》的意义，妄生五饮六证之说。海藏在五饮汤下说：一留饮在心下，二支饮在胁下，三痰饮在胃中，四溢饮在膈上，五悬饮在肠间。不必问其论症的失误，即其论五饮所注的部位已经背离经典旨意极矣。况且想用一方来统治它们，那么《大要》所说“谨守病机，各司其属，有者求之，无者求之，盛者责之，虚者责之”的说法，将用什么话来解释呢？
治饮大法
The sages of antiquity observed the Hetu (River Chart) to elucidate the principles of Yin and Yang and the laws of the Five Phases. The reason why Heaven and Earth can undergo transformation and operate the forces of ghosts and spirits lies essentially in this. The human body is a microcosm of Heaven and Earth; therefore, the processes of its generation and completion cannot exist outside this framework. Thus, "Heaven generates Water, Earth completes it with Six"; in the human body, this corresponds to the Kidney. "Earth generates Fire, Heaven completes it with Seven"; in the human body, this corresponds to the Heart. "Heaven generates Wood, Earth completes it with Eight"; in the human body, this corresponds to the Liver. "Earth generates Metal, Heaven completes it with Nine"; in the human body, this corresponds to the Lung. "Heaven generates Earth, Earth completes it with Ten"; in the human body, this corresponds to the Spleen. Therefore, humans possess Yin and Yang and the Five Phases, identical to Heaven and Earth, and also identical to the Hetu. However, the Yin-Yang and Five Phases of Heaven and Earth follow the natural course of their coming and going, opening and closing. In contrast, the Yin-Yang and Five Phases in the human body may be affected by the external Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) or injured by internal Seven Emotions (Joy, Anger, Worry, Thought, Grief, Fear, Fright). This leads to the damage of the Five Phases and the emergence of numerous, complex diseases, which are countless. Generally speaking, there are two main origins: one is among the children of the rich and noble who live in seclusion and do not labor; their diseases arise from overindulgence in food, warmth, and lust, so they have few external contractions but many internal injuries. When the interior becomes deficient, external pathogens easily invade, similar to how a deficiency in the Generating Numbers of the Hetu causes the Completing Numbers to diminish as well. The other is among the poor and lowly who brave wind and rain and toil with their hands and feet; their diseases arise from hunger, cold, and hardship, so they have few internal injuries but many external contractions. When external contractions deepen, internal injuries follow, similar to how if the Completing Numbers of the Hetu are not established, the Generating Numbers cannot survive alone. Although diseases manifest diversely, these two categories form the general principle of their interrelated exterior and interior. It is up to the physician to examine the disease according to the individual, observe the sequence of interior and exterior, and apply appropriate treatment, thereby harmonizing the Yin and Yang and arranging the Five Phases smoothly within the body, just as in the natural order of Heaven, Earth, and the Hetu.
On the Spleen Yang Corresponding to the Central Five
All things rely on Earth for their existence, and the Five Phases cannot be complete without Earth. Thus, Earth is the root of the post-heaven period and the pivot of Metal, Wood, Water, and Fire. In the Luoshu (River Map), the central five is called the "Imperial Standard" (Huangji). It represents the supreme harmony of Heaven and Earth, the basis for the growth and storage of all things. In the human body, it corresponds to the Spleen. Internally, it nourishes the Zang-Fu organs; externally, it nourishes the limbs and bones. Qi and Blood are generated from it. Water is restrained by it and does not flood; Fire is controlled by it and does not flare upward; Wood is supported by it and flourishes; Metal is grounded by it and solidifies. Moreover, when food and drink enter the Stomach, it is the Spleen's healthy transportation that allows the clear essence to ascend and the turbid waste to descend. If the Spleen Earth is injured, the pivot of the whole body becomes unresponsive, and all parts suffer. The Classic says: "With Stomach Qi, there is life; without Stomach Qi, there is death." This means Earth is the foundation of post-heaven nourishment, corresponding to the Central Five in the Luoshu. The Central Five is Yang. When diseased, it fails to transport, leading to symptoms above such as fullness, abdominal distension, and anorexia. When it fails to transform, it leads to symptoms below such as diarrhea, dysentery, and undigested food in stool. These are all failures of the Earth element. Therefore, Zhang Zhongjing formulated Jianzhong Tang (Middle-Building Decoction) and Lizhong Tang (Regulate the Middle Decoction). Other formulas like Sijunzi Tang (Four Gentlemen Decoction) and Liujunzi Tang (Six Gentlemen Decoction) are intended to tonify the Central Five and establish the Imperial Standard. Some ask: Since Spleen Earth belongs to Yin, why is it called the Central Five? The answer is: The Spleen Earth has a Yin substance but a Yang function. Although its substance is Yin, its mechanism of healthy transportation is Yang. Is this not the Central Five of the Luoshu?
On Dragon and Thunder Ministerial Fire
The book *Yi Guan* mentions Dragon Fire and Thunder Fire, metaphorically describing deficient fire flaming upward in the human body. Such fire burns more fiercely when met with water. If one does not understand its nature and attempts to extinguish it with water, the flames will only blaze across the sky until the object is consumed. If one understands its nature and drives it out with fire, the scorching heat will naturally subside. Later physicians such as Zhang Jingyue and Feng Shi endorsed this view, unaware that while the reasoning was correct, the metaphor was inappropriate. Dragon and Thunder fires are the steaming and oppressive fires of Heaven and Earth, a phenomenon where Yin follows Yang. Yin follows Yang, but Yang is suppressed by Yin. Oppression leads to conflict between Yin and Yang, friction creates sound, and lightning results. This is the origin of Dragon and Thunder fire. However, during the hot summer, Yang prevails and Yin is defeated. When Yang prevails and Yin is defeated, the Qi expands and dissipates. Thus, sudden clouds and heavy rain occur; thunder rouses and wind scatters, and the steaming fire is suddenly resolved. This is analogous to the human body being blocked by external Wind pathogens, causing stagnation of pathogenic heat, headache, and aversion to cold. Mild cases require Mahuang Tang (Ephedra Decoction) or Guizhi Tang (Cinnamon Twig Decoction); severe cases require Qinglong Tang (Azure Dragon Decoction) or Baihu Tang (White Tiger Decoction) to induce sweating externally and clear heat internally, allowing the pathogen to retreat. Therefore, Dragon and Thunder fire can metaphorize excess fire in the body, but clearly cannot metaphorize deficient fire. Deficient fire flaming upward in the human body is due to insufficiency of True Yin. True Yin is the single Yin line in the Li trigram. Li Fire has a Yang substance but a Yin root; thus, although Li Yang ascends, Li Yin must descend. If True Yin is deficient, it cannot descend and interact with Kan. Consequently, the Yin in Kan is also deficient. Kan is rooted in Yang. If Kan Yin is deficient, the Yang within Kan has no attachment and flies away. Only hot medicines taken cold, such as Shenfu San (Ginseng and Aconite Powder) or Bawei Wan (Eight-Ingredient Pill), can guide it back. This is like the climate in the ninth month, where Yin strips Yang, and Yang escapes outward, approaching the pure Yin Kun hexagram. One must urgently seek the return of one Yang line to achieve the prosperity of two and three Yang lines, restoring the initial state. Thus, the yang-restoring effect of Shenfu and Bawei is the meaning of "return" in the I Ching, not a verification of Dragon fire burning with water and extinguishing with fire.
On Heavenly Root and Lunar Cave
Shao Yong's poem states: "Coming and going between the Heavenly Root and Lunar Cave, thirty-six palaces are all spring." This truly reflects the continuous interaction and circulation of True Yin and True Yang in the human body. The Heavenly Root is the single Yang line in the Kan trigram, corresponding to the first nine of the Fu hexagram. With this one Yang, the Wood of three, Fire of seven, and Metal of nine all begin here. Hence, it is called Heavenly Root rather than Heaven, to show the source of Yang. The Lunar Cave is the single Yin line in the Li trigram, corresponding to the first six of the Gou hexagram. With this one Yin, the Metal of four, Water of six, and Wood of eight all originate here. Hence, it is called Lunar Cave rather than Moon, to show the beginning of Yin. These two correspond to the Sun and Moon in Heaven and Earth; the Sun goes and the Moon comes, incessantly interacting, allowing Heaven and Earth to form. In the human body, they correspond to the Heart and Kidney. At midnight (Zi hour), Kidney Yang connects upward to the Heart; at noon (Wu hour), Heart Yin descends to interact with the Kidney. The endless coming and going of breath is the source of human life. However, this coming and going, whether of Sun and Moon or Heart and Kidney, operates through "non-action" (Wuwei) for Heaven and Earth, and through "actionless action" for the perfected person. Shao Yong used the character "jian" (interval/gap) to indicate naturalness without force. Although the coming and going seem uninterrupted, it is actually effortless. Ignorant people fail to understand this, acting with妄动 (reckless movement), gradually consuming True Yin. Kidney True Yang is depleted due to licentiousness, leading to a failure of Water and Fire to interact, transforming Tai (Peace) into Pi (Stagnation). The root cause is always the failure of Water and Fire to interact. Zhu Danxi and Li Donggan adhered to the theory that "Yang is often in excess, Yin is often deficient," treating specifically by nourishing Yin and suppressing fire. Their view was biased toward Yin, failing to recognize the unity of Yin and Yang. It was not until Zhao Xianke that the Mingmen (Gate of Life) was identified as the True Yang in Kan. Zhang Jingyue and Feng Shi strongly supported this, emphasizing True Yang. However, they still failed to recognize that True Yin resides in Li, becoming biased toward Yang. Their drawbacks were similar to those of Zhu Danxi and Li Donggan, all stemming from a lack of understanding of the Heavenly Root and Lunar Cave. Here, interpreting Shao Yong's poem clarifies the mutual rooting of Yin and Yang in the body. Their incessant interaction aligns with the Way of Heaven and Earth and should not be weighted arbitrarily by personal opinion.
General Principles of Fluid Retention
Fluid retention (Yin) is Water Qi. Having fluid retention in the body is like having water in the earth. Without water, the earth cannot irrigate all things; without fluids, the body cannot nourish its parts. However, water flowing in the earth becomes springs or tides, nurturing all things; if obstructed, it stagnates and pollutes; if bursting forth, it floods, becoming harmful to all things. Similarly, fluids operating in the body become Jin and Ye (thin and thick fluids), nourishing the body; if stagnant, they cause distension; if reversing, they cause vomiting, becoming diseases of the body. The flow of water is driven by the Yang within Earth; Yang deficiency leads to flooding, Yang stagnation leads to pollution. The operation of fluids is driven by the Yang within the Spleen; Yang deficiency leads to distension, Yang stagnation leads to vomiting. The Classic states: "What Taiyin brings about is accumulated fluid retention and obstruction with fullness." It also states: "Abdominal fullness and enlargement, appearing damp and sluggish." Indeed, Taiyin dominance involves excessive Wet Earth. Excessive dampness leads to Yin deficiency, preventing the Stomach from distributing its fluids and preventing the scattering of essence to the Lungs. Fluids combine with dampness, flowing horizontally along the meridians, forming disease. Dampness tends downward. Although retention varies among the five Zang organs, it always originates in the Spleen. Flowing down the Spleen meridian to the Small Intestine, Bing Fire clashes internally, producing gurgling sounds, called Tan Yin (Phlegm-Fluid). This is like water accumulating in ditches, fermenting and becoming turbid. Flowing sideways to Shaoyang, blocking the left-turning path, causing coughing pain, called Xuan Yin (Hanging Fluid). This is like water damming highlands to form a hanging river. Flowing outward to the limbs, stagnating in skin and muscle, preventing sweating despite the need to sweat, causing body pain, called Yi Yin (Overflowing Fluid). This is like water leaving its channel, spreading everywhere as floodwater. Flowing upward to the chest, blocking Zong Qi (Pectoral Qi), causing shortness of breath and inability to lie flat, resembling edema, called Zhi Yin (Supporting Fluid). This is like water diverting from the sea to form a branch river. In summary, Fluid is Yin in substance but uses Yang. Yang deficiency causes loss of function and worsens fluid retention. Severe fluid retention damages function and further traps Yang. If Water is in the Heart, Heart Yang is trapped, unable to transmit to the Small Intestine, causing palpitations and shortness of breath. If Water is in the Lungs, Lung Yang is trapped, unable to transmit to the Large Intestine, causing spitting of saliva. If Water is in the Spleen, Spleen Yang is trapped, unable to transmit to the Stomach, causing fatigue and heaviness. If Water is in the Liver, Liver Yang is trapped, unable to transmit to the Gallbladder, causing hypochondriac fullness and sneezing pain. If Water is in the Kidneys, Kidney Yang is trapped, unable to transmit to the Bladder, causing epigastric palpitations. Deficiency of any Zang Yang is sufficient to cause harm. The one who controls water in all meridians is primarily the Central State (Spleen/Stomach). When Yang is abundant, Earth controls Water; when Yang is deficient, Water insults Earth. If disaster is not prevented early, and stabilizing methods not sought, initially the exterior Yang is injured, then the interior Yang; initially the Zang Yang, then the Chest Yang. How long before horizontal flooding and the sinking of the land?
Differentiation of Phlegm and Fluid
Although Phlegm (Tan) and Fluid (Yin) share the same source, their manifestations differ. Phlegm is transformed by Fire, becoming turbid due to Heat; Fluid is accumulated Water, becoming clear due to Cold. Careful study of the *Neijing* reveals only Ji Yin, Yi Yin, and Xuan Yin. Discussions of Yin syndromes never mention Phlegm. Only the *Jingui Yaolue* mentions Tan Yin, listing it alongside Yi Yin, Xuan Yin, Zhi Yin, Liu Yin, and Fu Yin. It merely derives phlegm-like symptoms from fluid syndromes, never claiming all fluid syndromes belong to Phlegm. Later generations confused Fluid with Phlegm, merging them into one syndrome. For millennia, this error has persisted, leading to the misdiagnosis of all fluid syndromes as Phlegm, resulting in zero efficacy. Even the wise Zhu Danxi proposed that "all diseases involve Phlegm." Such major principles must be analyzed meticulously. Phlegm and Fluid have distinct Yin-Yang and Water-Fire differences and must not be confused. Etymologically, Tan (Phlegm) contains Fire/Flame radicals, indicating a Fire disease, belonging to Yang. Even in consumptive diseases with coughing and expectoration, which appear cold-deficient, the root is Yin deficiency with blazing Fire and rising Ministerial Fire. Others obviously related to Fire are known and need not be repeated. All water can be called Yin; wine is also called Yin. Yin refers to the moist and soft nature of substances. A disease is called Yin only when Spleen Yang is defeated, Earth is weak and fails to generate Metal, clearing and descending functions fail, and water essence cannot distribute, remaining in meridians and spreading to limbs. This differs from the sticky and coagulated nature of Phlegm. Even Water Qi in Shanghan is a type of Yin. With such distinction, the difference is clear, and treatments are vastly different.
Discussion on Retained and Hidden Fluid
The meanings of Retained (Liu) and Hidden (Fu) are detailed in the *Jingui*. Mr. Jiayan stated: Retained fluid stays and does not leave; if retained fluid leaves but is not completely cleared, it is called Hidden Fluid. Hidden means潜伏 (latent) and not emerging. Ultimately, there is no distinction between the two terms. I argue: Retained Fluid belongs entirely to Water, occupying spaces where Zang Yang is deficient. Hidden Fluid involves chronic internal accumulation of Phlegm-Qi, secretly damaging Chest Yang beforehand. External Water-Fluid enters, carrying Phlegm, and hides in places unreachable by Grand Qi, flowing into vital areas of the Central State. It deepens along meridians, blocking the ascent of Yang. It is ten times more severe than Retained Fluid. Reviewing the *Jingui*: there are five descriptions of Retained Fluid and one of Hidden Fluid. First: Retained Fluid in the Heart area causes back aversion to cold, cold as large as a palm. The Heart area is above the stomach. The back is the mansion of the chest. Water retention in the Heart area depresses both Stomach Yang and Du Meridian Yang. The Back-Shu points of the Stomach are 1.5 cun apart, vertically spaced one cun, exactly the size of a palm. Hence, only this area feels cold. This is Retained Fluid in the Heart manifesting on the back. Second: Retained Fluid causes pain in the Heart area radiating to the Clavicular Fossa (Quepen), worsening with cough. Water retention in the hypochondrium affects Jueyin and Shaoyang. The Shaoyang meridian passes from Quepen to the costal margin and lung collaterals. Water obstruction blocks Sheng Qi, causing pain radiating to Quepen and worsening with cough. This is Retained Fluid in the hypochondrium manifesting in meridians. Third: Retained Fluid in the chest causes shortness of breath, thirst, and joint pain in the limbs. The chest is the site of pivot opening. Water retention blocks opening mechanisms, trapping Yang above (causing shortness of breath/thirst) and Yin-Cold below (preventing limb distribution, causing joint pain). This is Retained Fluid in the chest manifesting in upper/lower/sides. Fourth: Deep pulse indicates Retained Fluid. Internal depression of Water-Fluid loses the mild and expansive quality of Yang. This is Retained Fluid in meridians manifesting in the pulse. Fifth: A patient with a hidden pulse desires spontaneous diarrhea. Diarrhea brings relief, but epigastric hardness/fullness persists. This indicates Retained Fluid attempting to exit. The hidden pulse shows water filling the orifices, preventing Stomach Qi transport. Spontaneous diarrhea offers a path, yet fullness returns. This is Retained Fluid at the stomach gate showing erratic departure. As for Hidden Fluid: Disease above the diaphragm with phlegm-fullness, wheezing, coughing. Attacks bring chills, fever, back/waist pain, tearing/nasal discharge, and tremors. This is Hidden Fluid above the diaphragm. The chest is governed by Yang. Water-Evil hides with Fluid, blocking Yin-Yang ascent/descent. Attacks cause Yin-Yang conflict (chills/fever), Yang invading Yin below (back/waist pain), Yin invading Yin above (tearing/discharge). This resembles Shanghan tremors. This is Hidden Fluid above the diaphragm manifesting intermittently. The five Retained Fluid types in *Jingui* have different symptoms but one source: either Du Meridian Yang fails to extend, or Defensive Yang fails to extend. Total blockage of Yang in one meridian causes retention. Hidden Fluid is worse, blocking all Hand and Foot Yang meridians. Retained Fluid is Water and active; Hidden Fluid includes Phlegm and can be static. Retained Fluid has expelling methods; Hidden Fluid requires warming/mild methods. Though no formulas are listed, severity and urgency can be inferred.
Fluid Syndromes Belong to Yang Deficiency
According to several fluid syndrome entries, both *Neijing* and *Jingui* attribute them to Taiyin. Thus, I say they are caused by Spleen Yang deficiency and water stagnation. Jiayan said: Fluid arises from Dampness, involving Heat or Cold. While plausible, it is vague and requires clarification. Rivers and streams flow underground, held by the Great Qi. Body water enters meridians, penetrates bones, and moistens skin, regulated by Spleen Qi. If Central Yang fails, water either floods or stagnates. Even if Damp-Heat steams and becomes turbid, seemingly harming Yuan Yang, it cannot be simply labeled Cold. Is it not Extreme Yang Deficiency causing Floating Yang to escape? Like ditch water: frozen by cold (Yang blocked externally) or fouled by sun (Yang floating externally). Both are Yang Deficiency. Thus, fluid syndromes belong to Cold, understood?
Discussion on Phlegm-Fluid, Hanging Fluid, Overflowing Fluid, and Supporting Fluid
Fluid pathology is primarily attributed to the Spleen in the *Neijing*, as the Spleen is the most Yin organ lacking Yang function, and is interior-exterior paired with the Stomach. The Stomach is the Sea of Water and Grain. Food entering the Stomach relies on Spleen Yang for transformation. One unit of Spleen Yang dissolves one unit of food; ten units dissolve ten units. Excess food makes Stomach Yin exceed Spleen Yang. Initially, external fluid is not digested; subsequently, internal fluid increases. This injures not only Spleen Yang but also Heart, Lung, Liver, and Kidney Yang. The *Jingui* standardizes four categories and treats via five meridians, all from one source. First, Phlegm-Fluid: Shows fire-flaring signs. The patient was fat, now thin, muscles dissolved into Phlegm. Heart Qi is blocked, pressing Water-Fluid downward with gurgling sounds, leading to palpitations and shortness of breath. Second, Hanging Fluid: Shows hanging signs. After drinking, water flows to the hypochondrium, attaching to the募原 (Muyuan/Diaphragm). Liver Qi knots internally; coughing pulls the hypochondrium in pain, causing hypochondriac fullness. Third, Overflowing Fluid: Shows spreading signs. Drinking water flows to the extremities. Lung Qi is not diffused, stagnating in skin/muscle without sweating, leading to spitting of saliva. Fourth, Supporting Fluid: Shows branching signs. Resembling edema, the Central State loses healthy transportation, Spleen Qi knots internally, causing orthopnea, shortness of breath, and heaviness. Water in the Kidney causing epigastric palpitation is a subtype of Phlegm-Fluid. In Shanghan, Water in the Heart causes fullness and palpitation. Symptoms vary slightly, but treatment is the same, because Kidney Water easily insults the Heart. Thus, Zhang Zhongjing categorized the five Zang within the four fluids, not creating a separate "Five Fluids" outside the four. Later scholars misunderstood *Jingui*, inventing "Five Fluids and Six Syndromes." Haizang, under Wuyin Tang, listed: 1. Retained in Heart area, 2. Supporting in Hypochondrium, 3. Phlegm in Stomach, 4. Overflowing above Diaphragm, 5. Hanging in Intestines. Regardless of symptom errors, the locations contradict classic principles. How could one formula rule them all, contrary to the *Da Yao* saying: "Strictly observe the disease mechanism, assign each to its category. Seek what exists, seek what doesn't. Blame excess, blame deficiency"? What words would explain this?