Question: There are four types of fluid retention—what are they? Master replied: There is phlegm-fluid retention, pleural fluid retention, subcutaneous fluid retention, and thoracic fluid retention. Question: How are these four types of fluid retention distinguished? Master replied: When a person who was once robust becomes emaciated, and water flows through the intestines with a gurgling sound, it is called phlegm-fluid retention. When, after drinking, water lingers below the ribs, causing coughing, spitting, and referred pain, it is called pleural fluid retention. When ingested water spreads to the limbs but fails to be expelled through sweat, leading to body aches and heaviness, it is called subcutaneous fluid retention. When there is coughing, labored breathing, shortness of breath preventing lying down, and swelling-like symptoms, it is called thoracic fluid retention.

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Further question: Fluid retention is not limited to persistent fluid retention or recurrent fluid retention, yet the world speaks of four types—why is that? Master replied: Persistent fluid retention and recurrent fluid retention describe the chronicity and depth of the condition, while the four types—phlegm-fluid retention, pleural fluid retention, subcutaneous fluid retention, and thoracic fluid retention—describe its manifestations. The four types are still rooted in the principles of persistent and recurrent fluid retention but are distinguished based on where the water accumulates. Thus, they are named according to their presentations, resulting in four categories.

• Phlegm-fluid retention occurs when water stagnates in the intestines without being expelled, and fluids linger in the diaphragm without being distributed. When exposed to yang, it transforms into phlegm; when exposed to yin, it congeals into retained fluid. Wherever it lodges, there is sound—thus, in the upper body, there is a gurgling in the throat, and in the lower body, a trickling sound in the intestines. This corresponds to the wheezing syndrome with chronic cough and phlegm that flares in autumn and winter but subsides in spring and summer.
• Pleural fluid retention occurs when water lingers below the ribs after drinking, neither ascending nor descending, forming a stagnant mass that causes coughing, spitting, and referred pain. This is what is now called hypochondriac pain due to retained fluids.
• Subcutaneous fluid retention occurs when ingested water spreads to the limbs but fails to be expelled through sweat, clogging the meridians and causing body aches and heaviness. This corresponds to wind edema or disease with edema.
• Thoracic fluid retention occurs when water stagnates in the chest after drinking, causing coughing, labored breathing, shortness of breath preventing lying down, and swelling-like symptoms. This is what is now called retained fluid with panting and fullness preventing rest.

bubble_chart Collected Annotations

• Zhao Liang said: Water flows downward—just as highland water flows into rivers and rivers into the sea, blocking the rivers causes floods. Human drinking follows the same principle. The *Neijing* states: "Fluids enter the stomach, overflow as essential qi, ascend to the spleen, disperse as spleen qi, rise to the lungs, regulate water passage, and descend to the bladder, distributing water essence throughout the four limbs and five meridians." Now, ingested water may fail to disperse due to spleen qi or fail to descend due to lung qi, leading to overflow and stagnation, causing illness wherever it accumulates. Cheng Lin said: The *Neijing* states, "When earth stagnation arises, fluids accumulate internally." Because its nature is erratic, treatments include sweating, purging, warming, and draining. Li Wen said: Though there are four types of fluid retention, this passage specifically names phlegm-fluid retention. In essence, accumulated yin-water becomes retained fluid, and congealed yang-fluid becomes phlegm. Thus, divided, there are four types; combined, they are all phlegm-fluid retention. You Yi said: The change from robust to emaciated indicates that body fluids have all turned into phlegm and retained fluid, no longer nourishing the body but instead flowing downward into the intestines. Overflowing water indicates excess water and counterflow qi. If it lingers below the ribs, it is pleural fluid retention; if it spreads to the limbs, it is subcutaneous fluid retention. "Suspended" means fixed in one place, while "overflowing" means spreading outward. If it clings upward near the heart and lungs, it is thoracic fluid retention—like a tributary of water or a branch of a tree, adjacent to the organs but not centered. Coughing and labored breathing preventing rest indicate upward pressure on the lungs.