水气上逆。得阳煎熬。则稠而成痰。得阴凝聚则稀而为饮。皆以脾肾二经为主。以水归
于肾而受制于脾也。金匮以痰饮悬饮溢饮支饮分四饮。后人加留饮。为五饮。不知留饮即痰
饮也。唐宋以后名色愈多。而治法愈乱。兹举数方。为扼要之法。
凡痰脉多应于滑。脉沉而弦者。主悬饮内痛。
一痰饮诸方。以二陈汤为通剂。兹加减法。仿金匮之意故取效倍于诸家。
二陈汤。（八十二）
久嗽气短。加桂枝一钱五分。白术二钱。此从水道以化气也。或与肾气丸互服。停饮胁
痛。加白芥子一钱五分。前胡二钱。
四肢肿。身体疼重。加生黄 三钱。防己二钱。
咳逆倚息。气短不得卧。加木防己三钱。桂枝人参各一钱五分。水煎好。入芒硝八分服。
心下有支饮。其人若眩冒。加泽泻四钱。白术二钱。
咳嗽不已。加干姜细辛五味子。
以上。俱仿金匮意加减。
火痰。加海粉栝蒌仁黄芩海石。○寒痰。加干姜附子。○风痰。加制南星天麻竹沥姜汁。
○
加人参白术。○实痰。加旋复花枳实。○食痰。加莱菔子。
一实热老痰。变出怪症。不可名状。宜
礞石滚痰丸。（六十三）
中脘留伏痰饮。臂痛难举。手足不得转动。宜
指迷茯苓丸。（六十四）
按痰饮之病最多。胸胁疼。呕逆。神识不清。及手足臂痛。皆是。大抵痰为阳邪。随气
所到。其症变幻无常。凡苦辛酸咸及竹沥姜汁童便皂角芒硝之类。随症可加入。亦有虚者
宜六君子汤桂苓甘术汤。肾气丸。真武汤。小半夏倍加。茯苓汤等。以扶元气。饮为阴邪。
唯停于心下胁下。为胀为咳为悸为眩冒。及溢于皮肤而为肿。必以桂苓术附。加生姜汁之类。
使离照当空。而群阴力能退避。若以地黄麦冬五味附和其阴。则阴霾冲逆肆空。饮邪滔天莫
救矣。
水气向上逆行。受到阳气的煎熬，就会变得浓稠而成为痰；受到阴气的凝聚，就会稀薄而成为饮。这两种病理产物都以脾经和肾经为主要病变部位，因为水液归于肾脏而受脾脏的制约。《金匮要略》将痰饮、悬饮、溢饮、支饮分为四类饮证。后人增加了留饮，称为五饮。其实不知道留饮就是痰饮。唐宋以后，名称越来越多，而治疗方法也越来越混乱。现在列举几个方剂，作为扼要的治疗法则。
凡是痰证，脉象多表现为滑脉。如果脉象沉而弦，主病为悬饮引起的内部疼痛。
一、治疗痰饮的各种方剂，以二陈汤作为通用基础方。这里的加减法，模仿《金匮要略》的意思，所以疗效比各家都好。
二陈汤。（第八十二方）
久咳且气短，加桂枝一钱五分，白术二钱。这是通过水道来化生阳气的方法。或者与肾气丸交替服用。
停饮导致胁部疼痛，加白芥子一钱五分，前胡二钱。
四肢肿胀，身体沉重疼痛，加生黄芪三钱，防己二钱。
咳嗽气逆，倚靠呼吸，气短不能平卧，加木防己三钱，桂枝、人参各一钱五分。水煎好后，加入芒硝八分服用。
心下有支饮，患者出现眩晕昏冒，加泽泻四钱，白术二钱。
咳嗽不止，加干姜、细辛、五味子。
以上都是模仿《金匮要略》的意思进行加减。
火痰，加海粉、瓜蒌仁、黄芩、海浮石。○寒痰，加干姜、附子。○风痰，加制南星、天麻、竹沥、姜汁。○（此处原文可能有缺漏或排版错误，通常指虚痰或结合上文，但依原文提取）加人参、白术。○实痰，加旋覆花、枳实。○食痰，加莱菔子。
一、实证热邪形成的老痰，变出各种怪异的病症，无法用语言形容，适宜使用礞石滚痰丸。（第六十三方）
中脘穴处留有潜伏的痰饮，手臂疼痛难以举起，手足不能转动，适宜使用指迷茯苓丸。（第六十四方）
按：痰饮类的疾病最多见，胸胁疼痛、呕吐逆气、神识不清，以及手足手臂疼痛，都属于此类。大抵来说，痰属于阳邪，随着气机运行到达哪里，症状就变幻无常。凡是苦、辛、酸、咸味的药物，以及竹沥、姜汁、童便、皂角、芒硝之类，都可以随症加入。也有虚证患者适宜使用六君子汤、桂苓甘术汤、肾气丸、真武汤、小半夏汤加倍用量、茯苓汤等，来扶助元气。饮属于阴邪，只有停留在心下、胁下，会导致胀满、咳嗽、心悸、眩晕昏冒，以及溢出到皮肤而导致浮肿。必须使用桂枝、茯苓、白术、附子，加上生姜汁之类，使离卦之阳光照耀当空，那么群阴之力才能退避。如果使用地黄、麦冬、五味子来附和其阴，那么阴霾之气就会冲逆肆虐，饮邪滔天，就无法挽救了。
Water qi rebels upward. When subjected to the scorching of Yang, it becomes thick and forms phlegm (Tan Yin); when condensed by Yin, it remains thin and forms fluid retention (Yin). Both primarily involve the Spleen and Kidney meridians, as water returns to the Kidneys and is controlled by the Spleen. *Jin Gui Yao Lue* classifies Tan Yin, Xuan Yin, Yi Yin, and Zhi Yin into four categories of fluid retention. Later scholars added Liu Yin, making five types. However, it is unknown that Liu Yin is essentially Tan Yin. After the Tang and Song dynasties, names multiplied, and treatment methods became increasingly chaotic. Here, several formulas are presented as essential methods.
Generally, the pulse for phlegm manifests as slippery (Hua). A deep and wiry (Xian) pulse indicates internal pain due to Xuan Yin.
1. Among various formulas for treating phlegm and fluid retention, Er Chen Tang serves as a general base formula. The modifications here imitate the intent of *Jin Gui Yao Lue*, thus achieving effects superior to other schools.
Er Chen Tang. (Formula 82)
For chronic cough with shortness of breath, add Guizhi (Cinnamon Twig) 1.5 qian, Baizhu (Atractylodes Macrocephala Rhizome) 2 qian. This method transforms Qi through the water passages. It may be taken alternately with Shenqi Wan.
For fluid retention causing hypochondriac pain, add Baijiezi (White Mustard Seed) 1.5 qian, Qianhu (Peucedani Radix) 2 qian.
For swelling in the four limbs and heavy body pain, add Sheng Huangqi (Raw Astragalus Root) 3 qian, Fangji (Stephaniae Tetrandrae Radix) 2 qian.
For cough with rebellious Qi, leaning on support to breathe, shortness of breath, and inability to lie flat, add Mufangji (Stephaniae Membranaceae Radix) 3 qian, Guizhi (Cinnamon Twig) and Renshen (Ginseng Radix et Rhizoma) 1.5 qian each. Decoct in water, and upon completion, add Mangxiao (Natrii Sulfas) 0.8 qian to take.
For Zhi Yin located under the heart, where the patient experiences dizziness and vertigo, add Zexie (Alismatis Rhizoma) 4 qian, Baizhu (Atractylodes Macrocephala Rhizome) 2 qian.
For unceasing cough, add Ganjiang (Zingiberis Rhizoma), Xixin (Asari Radix et Rhizoma), and Wuweizi (Schisandrae Chinensis Fructus).
The above modifications all imitate the intent of *Jin Gui Yao Lue*.
For Fire Phlegm, add Haifen (Sea Powder), Gualouren (Trichosanthis Semen), Huangqin (Scutellariae Radix), and Haishi (Pumex). ○ For Cold Phlegm, add Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata). ○ For Wind Phlegm, add Zhinanxing (Arisaematis Rhizoma Preparatum), Tianma (Gastrodiae Rhizoma), Zhuli (Bamboo Sap), and Jiangzhi (Ginger Juice). ○ Add Renshen (Ginseng Radix et Rhizoma) and Baizhu (Atractylodes Macrocephala Rhizome). ○ For Excess Phlegm, add Xuanfuhua (Inulae Flos) and Zhishi (Aurantii Fructus Immaturus). ○ For Food Stagnation Phlegm, add Laifuzi (Raphani Semen).
1. For old phlegm resulting from excess heat, which manifests as bizarre and indescribable symptoms, Mengshi Gun Tan Wan is suitable. (Formula 63)
For latent phlegm and fluid retention at the Zhongwan point, causing arm pain difficult to lift and immobility of hands and feet, Zhimi Fuling Wan is suitable. (Formula 64)
Note: Diseases of phlegm and fluid retention are numerous. Chest and hypochondriac pain, vomiting and rebellious Qi, unclear consciousness, and pain in hands, feet, and arms are all included. Generally, phlegm is a Yang pathogen; wherever Qi moves, symptoms vary unpredictably. Bitter, pungent, sour, and salty substances, as well as bamboo sap, ginger juice, child's urine, soap bean, and mangxiao, can be added according to symptoms. Deficiency cases are suitable for Liujunzi Tang, Guiling Gan Zhu Tang, Shenqi Wan, Zhenwu Tang, Xiaobanxia Tang (with doubled dosage), and Fuling Tang, to support Yuan Qi. Fluid retention is a Yin pathogen; it stops under the heart or in the hypochondrium, causing distension, cough, palpitations, and dizziness, or overflows into the skin causing edema. One must use Guizhi, Fuling, Baizhu, Fuzi, plus ginger juice, etc., so that the Sun (Li Trigram) shines brightly, forcing the Yin pathogens to retreat. If one uses Dihuang, Maidong, and Wuweizi to harmonize and nourish Yin, then Yin mist will rebel uncontrollably, and the flood of fluid retention will be incurable.