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(See below)
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Stiffness and fullness in the epigastrium, large as a plate, resembling a rotating plate, caused by fluid retention (Shui Yin), is primarily treated with Zhishi Baizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction).
[Note]
Stiffness and fullness in the epigastrium, large as a plate, resembling a rotating plate, is caused by interior water accumulation. Although it appears suitable for purgation, it should not be purged because, despite being hard and distended, there is no pain or tightness. This indicates a deficiency-type binding of water qi, which cannot be purged. Therefore, using Baizhu (Atractylodis Macrocephalae Rhizoma) in double the amount of Zhishi (Aurantii Fructus Immaturus) tonifies the righteous qi while simultaneously breaking down the hardness; when qi moves, the binding resolves, achieving both goals. This is a harmonizing formula for treating interior water that cannot be purged.
[Collected Notes]
Zhao Liang said: The "epigastrium" refers to the upper jiao of the stomach. When stomach qi is weak, ingested fluids enter but fail to digest, leading to stagnation, binding, and hardness. It is necessary to strengthen the spleen and stomach to eliminate the stagnation. Baizhu strengthens the spleen and stomach; Zhishi is excellent at eliminating epigastric fullness, driving away retained fluids, and dispersing stagnant qi.
Cheng Lin said: This condition resembles a plate rather than a cup, indicating a diffuse state of fluid retention. Since the fluid retention is diffuse in the epigastrium like a plate, there is no need for acrid-hot agents to disperse it; simply use Zhishi and Baizhu to scatter it. Once the abdomen becomes soft, the fluids will naturally dissipate.
Shen Mingzong said: Upon observing stiffness and distension in the epigastrium like a plate, one must examine deficiency/excess and cold/heat, differentiating via pulse floating/sinking, slow/rapid, and large/small. One must not adhere rigidly to a formula and misuse it.
You Yi said: Stating "caused by fluid retention" serves to distinguish it from Qi-level disorders. Qi is formless and is dispersed with acrid-sweet agents; water has form and is drained with bitter-purgative agents.

Zhishi (Aurantii Fructus Immaturus) 7 pieces; Baizhu (Atractylodis Macrocephalae Rhizoma) 2 liang.
These two ingredients are boiled in 5 sheng of water to obtain 3 sheng. Divide into three warm doses. When the abdomen becomes soft, the condition will resolve.
[Collected Explanations]
Li [Name obscured] said: Zhishi eliminates distension through its bitter nature to drain downward; Baizhu removes dampness through its bitter nature to dry. Later, Zhang Yuansu derived Zhizhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) from this decoction for treating fullness. However, this decoction treats fluid retention, so the liquid form is used to sweep it away; the latter treats food stagnation, so the pill form is used to gradually dissolve it. One is a decoction, one is a pill, each having profound meaning, not arbitrary.
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The Fuyang pulse should normally be hidden (Fu); now it is instead tight. This indicates pre-existing cold, hernia masses (Han Jia), and abdominal pain. If the physician incorrectly uses purgation, chest fullness and shortness of breath result. The Fuyang pulse should normally be hidden; now it is instead rapid. This indicates pre-existing heat, excessive hunger, and frequent urination. Now, however, urination is difficult; this suggests impending water disease.
[Note]
This clarifies the meaning of interior water combined with cold or heat, and the consequences of incorrect purgation. Interior water pulses are hidden; this does not mean all three positions are hidden, but specifically that the Fuyang stomach pulse should be hidden. If the pulse is not hidden but tight, the person inherently possesses cold. Water and cold co-existing cause hernia masses and abdominal pain. If the physician mistakenly assumes interior water and purges, the water leaves but cold remains, further depleting the middle jiao, resulting in chest fullness and shortness of breath. If the pulse is not hidden but rapid, the person inherently possesses heat. Water and heat co-existing should cause excessive hunger and frequent urination, without water disease. Now, since urination is difficult, this indicates impending water disease.
[Collected Notes]
Zhao Liang said: The Fuyang pulse being hidden is not the normal pulse of Fuyang stomach qi, but rather due to water accumulating in the lower jiao, suppressing qi, thus the pulse is hidden. Pulse methodology states: Hidden pulses indicate water.
Wei Litong said: With water pathogen in Fuyang, the pulse should be hidden because stomach yang is sealed by clothing and damp-cold yin, preventing the Yangming pulse from emerging. Now it is instead tight, indicating not only abundant water in the interior but also abundant cold in the middle. Presumably, this person not only has water qi pathogen but also chronic accumulated cold causing hernia masses and frequent abdominal pain; the water pathogen is combined with cold. The physician fails to recognize this as yin-cold and mistakenly thinks water can be purged. Although water sinks, cold rebels upward, causing chest fullness and shortness of breath. Regarding the Fuyang pulse that should be hidden but is now rapid, it is due to pre-existing heat. Pre-existing heat should cause excessive hunger, frequent urination, and hard stool, similar to Yangming excess syndrome in Cold Damage. Now, since urination is difficult, it is known to be impending water, undoubtedly involving damp-heat pathogen.
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Liver Water disease: Abdominal distension, inability to turn over independently, hypochondriac abdominal pain, occasional slight production of saliva, and intermittent passage of urine.
[Note]
The above elucidates exterior-interior and upper-lower water; the following elucidates water related to the five zang organs and qi-blood. The Liver governs sinews, and the hypochondrium is its domain. When water pathogen invades, externally sinews relax causing inability to turn; internally abdominal distension and hypochondriac pain occur, along with dribbling urination.
[Collected Notes]
Wei Litong said: Liver Water occurs when water attaches to the Liver. Water in the Liver meridian necessarily resides in the bilateral hypochondria, causing abdominal distension and hypochondriac pain. The pathway of Shaoyang yin-yang interchange is obstructed by pathogen, hence the inability to turn independently. Liver water pathogen necessarily rushes upward to the chest and throat, causing occasional slight saliva production. As it rises and falls, if urination was blocked, it intermittently clears. This is water pathogen causing harm up and down following the ascending-descending qi of Liver Wood. Observing this indicates water in the Liver meridian; treatment should focus on the Liver organ.
You Yi said: The Liver's mansion is the hypochondrium, and its qi connects to the lower abdomen. When Liver water fails to circulate, abdominal distension and inability to turn occur, along with hypochondriac abdominal pain. Occasional slight saliva and intermittent urination occur because the Liver favors counter-flow and governs drainage; water fluids follow these movements up and down.
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Heart Water disease: Heavy body, shortness of breath, inability to lie flat, irritability and restlessness, and swelling of the external genitalia.
[Commentary]
The four characters "swelling of the external genitalia" belong in the Kidney Water section; this is a misplaced slip.
[Note]
The Heart governs vessels, and the Danzhong (Chest Center) is its domain. When water pathogen invades, externally vessel circulation throughout the body is impaired, causing heaviness; internally, shortness of breath, heart vexation, inability to lie flat, and restlessness occur.
[Collected Notes]
Cheng Lin said: *Neijing* states: The Heart governs the blood vessels of the body. *Shangjing* states: Water in the Heart causes epigastric hardness, palpitations, and shortness of breath, hence heavy body and shortness of breath. *Neijing* states: All those with water disease cannot lie flat. The Heart belongs to Fire; water in the Heart causes inability to lie flat, irritability, and restlessness.
Wei Litong said: Water pathogen is a type of accumulation. When close to a location, it lingers in that zang organ, allowing the condition to be named after the organ. Water attaching to the Heart constitutes Heart Water. Water in the Heart meridian can permeate the four limbs and hundred bones, causing heaviness; qi is obstructed by water pathogen, causing shortness of breath; water pathogen presses upon the spirit, causing inability to lie flat; divine illumination is disturbed, causing restlessness and vexation. Observing this indicates water in the Heart meridian; treatment should focus on the Heart meridian.
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Spleen Water disease: Abdominal distension, suffering from heaviness in the four limbs, failure to generate fluids, suffering from shortness of breath, and difficult urination.
[Note]
The Spleen governs the abdomen, and the four limbs are its domain. When water pathogen invades, externally the four limbs suffer heaviness; internally abdominal distension, shortness of breath, and difficult urination occur.
[Collected Notes]
Wei Litong said: Spleen Water occurs when water attaches to the Spleen. The Spleen exclusively governs the abdomen, hence abdominal distension. The Spleen governs rotation and transport, and also the four limbs; poor rotation leads to suffering from limb heaviness. Failure to generate fluids and lack of qi circulation cause obstruction up and down; thus, upper suffering from shortness of breath and lower difficult urination. Observing this indicates water in the Spleen; treatment should focus on draining water in the Spleen organ.
You Yi said: The Spleen governs the abdomen, and qi circulates to the four limbs. When the Spleen receives water qi, the abdomen distends and limbs become heavy. Fluids and qi are generated from grain; grain qi is transported by the Spleen. Spleen dampness failing to transport results in failure to generate fluids and shortness of breath; difficult urination is due to dampness failing to move.
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Lung Water disease: Body edema, difficult urination, and frequent duck-like loose stools.
[Note]
The Lung governs qi, and the skin/hair is its domain. When water pathogen invades, externally whole-body skin edema occurs; internally, fluid transmission to the bladder fails. The Large Intestine is its fu organ; water entering the Large Intestine causes duck-like loose stools.
[Collected Notes]
Zhao Liang said: The Lung governs skin/hair, circulates Ying and Wei, and combines with the Large Intestine. Now with water disease, water fills the skin. The Lung normally regulates water passages, transmitting downward to the Bladder as urine. Now, since regulation fails, water cannot exit via urine but instead follows its combination, mixing with waste to form duck-like loose stools.
Wei Litong said: Lung Water occurs when water attaches to the Lung. The Lung governs qi; qi draws water to flow, also causing whole-body edema. If the Lung fails to descend, qi transformation becomes congested, causing difficult urination. Difficult urination leads to confusion of clear and turbid, hence duck-like loose stools. Observing this indicates water in the Lung; treatment should focus on draining water in the Lung organ.
You Yi said: Duck-like loose stools refer to water and feces mixed together, resembling duck excrement.
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Kidney Water disease: Abdominal distension, umbilical swelling, lower back pain, inability to urinate, dampness under the genitals resembling sweat on an ox's nose, cold feet, and conversely thin face.
[Commentary]
Under "conversely thin face," the four characters "swelling of the external genitalia" from the previous item should be present.
[Note]
The Kidney governs the waist, and the foot/genitals are its domain. When water pathogen invades, externally genital swelling, dampness under genitals, cold feet, and thin face occur; internally abdominal distension, umbilical swelling, lower back pain, and inability to urinate occur. These five points refer to water qi distension/swelling, hence none involve wheezing or coughing.
[Collected Notes]
Cheng Lin said: The Kidney is the gate of the Stomach; if the gate is unregulated, water accumulates causing disease, hence abdominal distension and umbilical swelling. The waist is the external manifestation of the Kidney, hence lower back pain. The Bladder is the mansion of the Kidney, hence inability to urinate. Due to inability to urinate, water qi cannot escape, soaking the scrotum causing genital sweat, and flowing to the lower jiao causing cold feet. The Kidney is a water storage; attacked by water pathogen, upper jiao qi-blood follows water nature downward, hence the face conversely becomes thin, unlike the facial edema of Wind Water or Interior Water.
Wei Litong said: Kidney Water occurs when water attaches to the Kidney. The Kidney governs the lower abdomen; frozen water-dampness in the lower abdomen causes abdominal distension, umbilical swelling, and lower back pain. The lower half of the body is governed by the Kidney; water-dampness in the lower jiao blocks Bladder qi, causing not just difficult urination but complete inability to urinate. Yin-cold abundance below causes genital dampness like cold, sticky sweat on an ox's nose, and cold feet. The face is a yang region; yin abundance below and yang decline above cause the face to be thin. Observing this indicates water in the Kidney; treatment should focus on draining water in the Kidney organ.
You Yi said: Below the midpoint of the body, Kidney qi governs. Water in the Kidney causes lower back pain, umbilical swelling, and abdominal distension. Inability to urinate, genital dampness like ox-nose sweat, and cold feet occur because the Kidney is yin, water is yin; two yins combine, yang qi fails to move, and damp-cold prevails. The face conversely becomes thin because the face is yang; yin abundance below leads to yang decline above.
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The Master said: The Cun Kou pulse is deep and slow. Deep indicates water; slow indicates cold. Cold and water contend. The Fuyang pulse is hidden; food and fluids are not transformed. Spleen qi decline leads to duck-like loose stools; Stomach qi decline leads to body swelling. Shaoyang pulse is low/subdued; Shaoyin pulse is fine/thin. In men, urination is difficult; in women, menstruation is blocked. Menstruation is blood; if blood movement is unfavorable, it becomes water, named Blood Division (Xue Fen).
[Note]
Cun Kou refers to the cun positions of both wrists. Pulse deep and slow: deep indicates water, slow indicates cold. Water and cold contend in the chest, obstructing yang qi transport, causing the Fuyang bilateral guan pulses to be hidden and inactive, leading to undigested food/fluids. If Spleen qi declines, duck-like loose stools occur; if Stomach qi declines, body swelling occurs. Shaoyang right chi pulse sunken, Shaoyin left chi pulse fine/thin, are also due to excessive cold-water suppressing Mingmen fire. Thus, men have undigested water essence and difficult urination; women transform blood into water, blocking menstruation. Calling menstrual blood "Jing Shui" (Menstrual Water) is because water is the substance of blood; women prioritize blood, hence called Blood Division.
[Collected Notes]
Zhao Liang said: Why does Jingyue's pulse methodology often combine Cun Kou with Fuyang? Cun Kou belongs to the Lung, passing through Hand Taiyin. The Lung faces all vessels; the twelve meridians appear at Cun Kou at their respective times. Spleen and Stomach meridians emerge at the right Guan. The Stomach is the sea of food/fluids; all five zang receive qi from the Stomach, making the Stomach the root of the five zang. Thus, the pulse is the key to all meridians. If pathogen affects the Stomach, one must re-examine Fuyang; Fuyang is the source of Stomach pulse.
You Yi said: Combining examination of Cun Kou and Fuyang reveals excessive cold-water and failure of Stomach yang to move. Failure of Stomach yang means food/fluids are not transformed; failure to transform means both Spleen and Stomach decline. Spleen qi governs the interior, so decline causes duck-like loose stools; Stomach qi governs the exterior, so decline causes body swelling. Shaoyang is generating qi; Shaoyin is earth-pathway qi. Both receive qi from Spleen/Stomach. Spleen/Stomach decline causes Shaoyang pulse to be low (generating qi not nourished) and Shaoyin pulse to be fine (earth-pathway blocked). Men have difficult urination; women have blocked menstrual blood. The reason is all due to failure of yang qi movement and knotting of yin qi. Called Blood Division because although diseased as water, it actually originates from blood.
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The Master said: The Cun Kou pulse is slow and choppy. Slow indicates cold; choppy indicates blood deficiency. The Fuyang pulse is faint and slow. Faint indicates qi (deficiency); slow indicates cold. Cold qi and deficiency lead to cold hands and feet; cold hands and feet lead to unfavorable Ying and Wei; unfavorable Ying and Wei lead to abdominal fullness and borborygmus, with chasing qi turning toward the Bladder. Ying and Wei are both exhausted; yang qi unblocked causes body cold; yin qi unblocked causes bone pain. If yang qi moves forward first, aversion to cold occurs; if yin qi moves forward first, numbness and insensitivity occur. When yin and yang harmonize, qi flows; when the Great Qi rotates, pathogen dissipates. Excess leads to flatus; deficiency leads to enuresis. This is named Qi Division (Qi Fen).
[Commentary]
After "named Qi Division," the fifteen characters "primarily treated with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Asarum)" should be present.
[Note]
Cun Kou pulse slow indicates cold; choppy indicates little blood. Fuyang pulse faint lacks qi; slow also indicates cold. Thus, both qi and blood are deficient, invaded by cold qi. Ying and Wei are unfavorable, yin and yang unblocked, causing cold body, bone pain, cold extremities, abdominal fullness, borborygmus, aversion to cold, numbness, flatus, and enuresis. This is qi distension due to internal lodging of cold qi with dual qi-blood deficiency, hence named Qi Division. The following item explains the main treatment using Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang to warm/nourish Ying and Wei, disperse yin/yang, and expel cold pathogen.
[Collected Notes]
Cheng Lin said: Qi dispersion must exit via front or back. Pathogen excess leads to flatus posteriorly; righteous qi deficiency leads to enuresis anteriorly.
You Yi said: "Faint indicates qi" means qi deficiency. "Cold qi and deficiency" refers to the statement covering Cun Kou and Fuyang regarding cold, and additionally that qi-blood are deficient. Cold qi and deficiency cause hands/feet to lack qi and become cold; Ying and Wei lack source and are unfavorable. Consequently, within zang-fu, true qi is insufficient, and guest cold prevails alone, causing abdominal fullness and borborygmus chasing each other, with qi turning to the Bladder and descending. "Ying and Wei both exhausted" means Ying and Wei are depleted. Yang warms the exterior, so unblocking causes body cold; Ying nourishes the interior, so unblocking causes bone pain. Unblocking here means extreme deficiency unable to move, different from excess blockage. If yang moves forward first and yin does not follow, yin loses yang and aversion to cold occurs; if yin moves forward first and yang does not follow, yang stagnates alone and numbness/insensitivity occurs. Yin and yang always depend on each other; loss causes qi mechanism to cease and pathogen to attach; non-loss allows upper-lower communication and pathogen exclusion. Hence: "When yin and yang harmonize, qi flows; when Great Qi rotates, pathogen dissipates." Flatus and enuresis indicate dispersal based on excess/deficiency. Named Qi Division because cold pathogen takes advantage of yang deficiency to disease the qi.
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Qi Division: Stiffness in the epigastrium, large as a plate, edge like a rotating cup, caused by fluid retention, primarily treated with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Asarum).
[Commentary]
The sixteen characters "Qi Division, stiffness in epigastrium large as plate, edge like rotating cup, caused by fluid retention" are likely interpolations; this is evident from the original section on epigastric stiffness. The fifteen characters "primarily treated with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang" should be under the previous Qi Division item for logical coherence, representing the treatment method for Qi Division; this is certainly a misplaced slip.