饮。即水也。伤寒停饮症最多。每见于太阳少阴。临症者都忽此。因备述之以便查阅。
如太阳中风。渴欲饮水。水入即吐者。名曰水逆。五苓散主之。此水停于胸中。故水入不能容也。
邵评∶太阳中风。表未解也。渴则风热而传里。渴欲饮水。水气不行。而反上逆。则
吐。是为水逆。必其人素有水气。邪水内结。用五苓散导水泄热。的是正法。
又评∶水逆者。其人必素有水气。中宫之阳气不宣。邪水凝结于内。水饮拒绝于
外。既不外输元府而为汗。又不上输于口舌而渴饮。亦不下输膀胱而小便不利。此水逆所由名也。
如误下之。心下痞。与泻心汤。痞不解。其人渴。而口燥烦。小便不利者。五苓散主之。
此治痞而痞不解。反渴。亦水停心下之故。非痞也。水停心下。则津液不得上升。故渴。
邵评∶下后成痞。与泻心汤而痞不解。心下有水气。饮邪内蓄。热结膀胱。气不输
化。因反上逆。故见渴而躁烦。小便不利等症。与五苓散利水泄热。使小便利。则痞与消渴俱止矣。
如脉浮。小便不利。微热消渴者。与五苓散主之。此小便不利。渴而能消水者。水蓄膀胱也。脉浮
身热。病在太阳也。故用五苓微汗以利水则愈。
邵评∶脉浮微热。表未尽除也。渴而消水。小便反不利。是水气与热邪内结膀胱
而未散也。与五苓散导水泄热。内有桂枝。兼治其表。而微汗之。盖此小便不利。
渴而能消水者。水蓄膀胱也。脉浮身热。病在太阳也。故用五苓微汗以利水。则愈。
凡服五苓。多饮暖水取汗者。欲其散达营卫。表里俱解也。
邵评∶暖水可多服。则水逆者是冷水。水能制火而润土。水土合和。则气化流通。
同五苓散解表泄热。而病自愈也。然水亦不可恣饮。少少与之。胃和则愈。如多
饮。必致水气为患。而有悸喘等病矣。
太阳中风。其人 汗出。头痛心下痞。硬满引胁下痛。干呕短气。汗出恶寒者。此
表解。内有蓄水也。十枣汤攻之。（以上诸条皆太阳热邪停水）
邵评∶此外中风邪。内有悬饮之症。其人汗出头痛。似乎表症。然不恶寒发热。心
下痞硬而满。牵引胁下而痛。干呕短气等症。是表邪已解。心下之水气湿热泛溢。上攻于脑。而头痛
汗出也。既知其表之风邪已解。而里之水气淫溢。用十枣汤攻其饮而下其气。此治悬饮内踞。水荡
三焦之正法。然必审其表邪已解。然后可攻其饮。
太阳伤寒。表不解。发热无汗。干呕而咳。或渴。或利。或喘。或小便不利者。此心下有
水气也。宜小青龙汤。外散寒邪。内散寒饮。
邵评∶发热无汗。是表不解。干呕而咳。是水气为患。饮寒相抟。逆于肺胃之间也。
饮之为病。随气升降。水气下而不上。则或渴或利。上而不下。则或喘或噎。留而
不行。则小便不利。表寒与水饮。内外合邪。用小青龙汤。以两解表里之邪。立加减法。以治或然之症也。
如咳而微喘。发热不渴。服小青龙汤已。反渴者。此寒饮去也。
邵评∶内饮外寒。相得不解。水气射肺。为咳而微喘。水气上升。是以不渴。服小青
龙已。而反渴者。水气内散。寒邪亦外散也。
解肌或下之后。仍头项强痛。发热无汗。心下满。微痛。小便不利者。此有水气在心
下也。宜桂枝去桂。加茯苓白术汤主之。小便利则愈。
邵评∶头项强痛。发热无汗。表未解也。心下满。微痛。饮在里也。此表邪与水饮凝
结不解。病根在心下。而病机在膀胱。当察其小便。若小便利。病为在表。仍当发汗。若小便不利。病为
在里。是太阳之本病。非桂枝未罢也。故去桂枝而加苓术。不欲散邪于表。故但饮逐于里。饮去。则表
邪亦解矣。因此水结中焦。只可利而不可散。病不在表。而去桂枝。加苓术者。所以利小便而燥停水也。
此症头痛发热。表症仍在。若小便利。须发汗。今小便不利。病在太阳之里。法当利
水。去桂枝者。因无汗也。不用峻药利水者。因汗下之后也。（以上皆太阳寒邪停水）
邵评∶此着眼小便不利。虽有表症。但利水而不兼散。与小青龙五苓散不同法。
但得膀胱水去。而太阳之表里症悉除。所谓治病必求其本也。
如少阴病。当欲寐。至七八日。反心烦不得眠。是少阴热邪上扰也。下利而渴。咳呕。
小便不利者。是水饮停蓄也。宜猪苓汤以利水去热。此少阴阳邪停水。
邵评∶少阴病本欲寐。至七八日心烦不得眠。是邪热耗阴。挟心火而上扰也。且
下利而热渴。是下焦虚不能制水之故。咳呕烦渴者。是肾水不升。而心火不降
也。小便不利者。水饮邪热蓄于下焦也。故用猪苓汤。利水滋阴。而升津液。斯上焦如雾而咳渴除。中
焦如呕而烦呕静。下焦如渎而利自止矣。此治少阴阳邪停水之正法。
如少阴病。至四五日。四肢沉重疼痛。腹痛。小便不利。自下利者。此为有水气也。真
武汤主之。温中以消阴水。必少阴阴邪停水。
邵评∶此少阴寒邪。阳微而气不化。水积下焦。小便不利。是病根。腹痛下利。四肢
重痛。皆水气为患。因小便不利所致。用真武汤。壮肾阳而消阴水也。
王晋三先生曰。小青龙。治动而逆上之水。五苓散治静而不行之水。十枣汤。大陷
胸丸。治中焦之水。泻之于内也。桂枝去桂加苓术汤。治下焦之水。引而竭之也。十
枣汤治弥漫之水。大陷胸治痞满之水。真武汤。治沉着之水。小青龙。入太阳治阳
水。功兼外散。真武汤入少阴治阴水。功专下渗。小青龙。治寒邪未解之水。故温以
汗之。十枣汤治阳邪未解之水。故引而竭之。
邵评∶治水之方。有寒热表里利散之不同。医者必须辨明。
Water retention (Shui Yin) refers to pathological fluid accumulation. In Shanghan (Cold Damage) diseases, syndromes of water retention are most common, frequently appearing in the Taiyang (Greater Yang) and Shaoyin (Lesser Yin) stages. Clinicians often overlook this; therefore, these conditions are detailed for reference.
In a Taiyang Wind Strike syndrome (Taiyang Zhong Feng), if the patient desires to drink water but vomits immediately upon ingestion, it is named "Water Reversal" (Shui Ni). It is primarily treated with Wuling San (Five-Ingredient Powder with Poria). This occurs because water stagnates in the chest, preventing the stomach from accommodating ingested fluids.
Commentary by Shao: Taiyang Wind Strike indicates that the exterior syndrome has not yet resolved. Thirst arises as wind-heat transmits inward. The desire to drink combined with the failure of water qi to circulate leads to counterflow vomiting, constituting Water Reversal. This condition invariably implies that the patient has a pre-existing tendency toward water retention, with pathogenic water binding internally. Using Wuling San to guide out water and drain heat is the correct method.
Further Commentary: The term "Water Reversal" applies when a patient has pre-existing water qi. The yang qi of the Middle Jiao (Spleen/Stomach) fails to diffuse. Pathogenic water condenses internally. The retained water refuses to move outward to the pores to form sweat, nor does it ascend to the mouth and tongue to quench thirst, nor does it descend to the Bladder to facilitate urination. This mechanism explains the name "Water Reversal."
If mistaken purgation is used, resulting in epigastric fullness and obstruction (Pi), and Xie Xin Tang (Drain the Epigastrium Decoction) fails to resolve the fullness, while the patient presents with thirst, dry mouth, irritability, and dysuria, Wuling San should be administered.
The persistence of fullness despite treatment for Pi, accompanied by thirst, indicates water stagnation in the epigastrium rather than simple Pi syndrome. Water stagnating in the epigastrium prevents Jin-Ye (Body Fluids) from ascending, causing thirst.
Commentary by Shao: Post-purgation Pi unresponsive to Xie Xin Tang indicates water qi in the heart/epigastrium with internal accumulation of damp-fluid and heat binding in the Bladder, impairing Qi transformation and causing counterflow. Symptoms include thirst, restlessness, and dysuria. Wuling San promotes urination and drains heat; once urination is normalized, both the Pi sensation and thirst will cease.
If the pulse is floating, there is dysuria, slight fever, and Xiao Ke (wasting-thirst or excessive drinking and urination), Wuling San is indicated. Dysuria accompanied by thirst and the ability to consume large amounts of water indicates water accumulation in the Bladder. A floating pulse and body heat indicate the disease resides in the Taiyang stage. Therefore, Wuling San induces mild sweating to promote diuresis, leading to recovery.
Commentary by Shao: Floating pulse and slight fever indicate incomplete resolution of the exterior. Thirst with high water intake but reduced urination signifies water-heat binding in the Bladder. Wuling San guides out water and drains heat; the inclusion of Guizhi (Cinnamon Twig) addresses the exterior, inducing mild sweating. As noted, dysuria with thirst and high water intake points to water accumulation in the Bladder. With the disease in Taiyang, mild sweating via Wuling San resolves the condition.
When administering Wuling San, patients should drink warm water in abundance to induce mild sweating. This aims to disperse the medicinal action through Ying and Wei (Nutritive and Defensive levels), resolving both interior and exterior aspects.
Commentary by Shao: Frequent consumption of warm water helps counteract cold water retention; water controls fire and moistens Earth (Spleen), harmonizing Water and Earth to facilitate Qi transformation. Combined with Wuling San’s exterior-resolving and heat-draining properties, the disease heals. However, water intake must be moderate. Small, frequent doses harmonize the Stomach. Excessive drinking may cause water pathology, leading to palpitations and asthma.
In Taiyang Wind Strike, if the patient sweats, has headache, epigastric fullness and stiffness radiating to the hypochondrium, dry retching, shortness of breath, sweating, and aversion to cold, the exterior is resolved, but there is internal water accumulation. Shizao Tang (Ten-Jujube Decoction) is used to attack the retention. (These cases involve Taiyang heat-pathogen stopping water.)
Commentary by Shao: This involves external Wind strike with internal Xuan Yin (Hanging Fluid). Sweating and headache mimic exterior signs, but absence of aversion-to-cold and fever, combined with epigastric fullness/stiffness radiating to the hypochondrium, dry retching, and shortness of breath, confirms the exterior pathogen has resolved. Damp-heat water qi overflows from the epigastrium, attacking the head. Knowing the exterior Wind is resolved but interior water is overflowing, Shizao Tang attacks the fluid and descends Qi. This is the correct method for treating internal Xuan Yin and sweeping water through the Three Jiao. One must confirm the exterior is resolved before attacking the fluid.
In Taiyang Cold Damage, if the exterior is unresolved, presenting with fever, anhidrosis, dry retching, cough, and optionally thirst, diarrhea, wheezing, or dysuria, this indicates water qi in the Heart/Epigastrium. Xiao Qing Long Tang (Minor Green Dragon Decoction) is appropriate to scatter exterior cold and disperse interior cold-fluid.
Commentary by Shao: Fever and anhidrosis indicate unresolved exterior. Dry retching and cough result from water qi pathology. Cold and fluid contend, rebelling between the Lung and Stomach. Pathogenic fluid moves with Qi dynamics: descending without ascending causes thirst or diarrhea; ascending without descending causes wheezing or choking; stagnation causes dysuria. Exterior cold and interior fluid combine. Xiao Qing Long Tang resolves both exterior and interior pathogens. Modification rules are established to treat variable symptoms.
If cough and slight wheezing occur with fever but no thirst, and after taking Xiao Qing Long Tang the patient becomes thirsty, this indicates the cold-fluid has been eliminated.
Commentary by Shao: Internal fluid and external cold persist, with water qi affecting the Lung, causing cough and wheezing. Ascending water qi initially suppresses thirst. Post-treatment thirst indicates the dispersion of internal water and external cold.
After muscle-relaxing or purgative treatments, if headache, neck stiffness, fever, anhidrosis, epigastric fullness, slight pain, and dysuria persist, this indicates water qi in the epigastrium. Guizhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is indicated. Recovery follows when urination normalizes.
Commentary by Shao: Headache, neck stiffness, fever, and anhidrosis indicate unresolved exterior. Epigastric fullness and slight pain indicate interior fluid. Exterior pathogen and fluid bind together; the root is in the epigastrium, but the mechanism involves the Bladder. Observe urination: if clear, the disease is exterior, requiring sweating. If dysuric, the disease is interior, representing the primary Taiyang pathology, not merely an unresolved Guizhi syndrome. Thus, Guizhi is removed, and Fu Ling and Bai Zhu added, avoiding exterior dispersal to focus on interior fluid expulsion. Once fluid is removed, the exterior pathogen resolves. Since water binds in the Middle Jiao, it should be drained, not dispersed. Removing Guizhi and adding Fu Ling/Bai Zhu promotes urination and dries stagnant water.
Although headache and fever suggest remaining exterior signs, if urination is clear, sweating is required. Here, dysuria places the disease in the interior of Taiyang, mandating diuresis. Guizhi is removed due to anhidrosis. Harsh diuretics are avoided due to prior sweating and purging. (These cases involve Taiyang cold-pathogen stopping water.)
Commentary by Shao: The key indicator is dysuria. Despite exterior signs, only diuresis is employed without exterior dispersal, differing from Xiao Qing Long Tang and Wuling San. Eliminating bladder water resolves all Taiyang exterior-interior symptoms, adhering to the principle of treating the root cause.
In Shaoyin disease, where lethargy is typical, if after seven to eight days the patient becomes irritable and unable to sleep, this indicates Shaoyin heat-pathogen disturbing upward. If accompanied by diarrhea with thirst, cough, vomiting, and dysuria, this is water retention. Zhuling Tang (Polyporus Decoction) is used to promote urination and clear heat. This represents Shaoyin Yang heat-pathogen stopping water.
Commentary by Shao: Shaoyin disease typically involves lethargy. Irritability and insomnia after several days indicate pathogenic heat consuming Yin and harassing upward with Heart Fire. Diarrhea with heat-thirst results from Lower Jiao deficiency failing to control water. Cough, vomiting, irritability, and thirst indicate Kidney Water failing to ascend and Heart Fire failing to descend. Dysuria signifies water-fluid and heat-pathogen accumulating in the Lower Jiao. Zhuling Tang promotes urination, nourishes Yin, and ascends fluids. This restores the Upper Jiao's misting function (resolving cough/thirst), regulates the Middle Jiao's fermentation (calming vomiting/irritability), and clears the Lower Jiao's channels (stopping diarrhea). This is the correct method for Shaoyin Yang heat-water retention.
In Shaoyin disease, if after four to five days the patient presents with heavy/painful limbs, abdominal pain, dysuria, and spontaneous diarrhea, this indicates water qi. Zhen Wu Tang (True Warrior Decoction) is indicated to warm the Middle and eliminate Yin-cold water. This represents Shaoyin Yin cold-pathogen stopping water.
Commentary by Shao: This involves Shaoyin cold-pathogen with deficient Yang and impaired Qi transformation, leading to water accumulation in the Lower Jiao. Dysuria is the root cause. Abdominal pain, diarrhea, and limb heaviness/pain are consequences of water qi. Zhen Yu Tang strengthens Kidney Yang to eliminate Yin-cold water.
Mr. Wang Jin-san stated: Xiao Qing Long Tang treats turbulent, counterflowing water; Wuling San treats static, stagnant water; Shizao Tang and Da Xian Xiong Wan (Major Sinking Chest Pill) treat Middle Jiao water, draining it internally; Guizhi Qu Gui Jia Fu Ling Bai Zhu Tang treats Lower Jiao water, guiding it out; Shizao Tang treats diffuse water; Da Xian Xiong treats obstructive/fullness-causing water; Zhen Yu Tang treats settled water. Xiao Qing Long Tang enters Taiyang to treat Yang-water, combining exterior dispersal. Zhen Yu Tang enters Shaoyin to treat Yin-water, specializing in downward infiltration. Xiao Qing Long Tang treats water with unresolved cold-pathogen, using warmth and sweating. Shizao Tang treats water with unresolved Yang-pathogen, using guidance and exhaustion.
Commentary by Shao: Formulas for treating water vary by cold/heat, exterior/interior, and draining/dispersing methods. Physicians must distinguish clearly.