脉得诸沉，责其有水。浮气与风，沉石或里。
沉数为阳，沉迟为阴。浮大出厄，虚小可惊。
据正文，水气有四∶曰气水、曰风水、曰石水、曰里水。《金匮要略》多皮水、
正水、黄汗，无气水、里水。而气水、里水，又各突见一条于后，岂以皮水即气水，
与风水之脉皆浮者，皆为表水，而以正水、石水、黄汗之脉皆沉者，皆为里水者乎？
其脉虽诸种不一，而沉则在在皆兼，即气水、风水之在表而脉应浮者，亦必有沉沉
欲下之势。盖沉下者，水之性也，以状言；浮则以位言耳。若沉而数，乃为阳水，
证必兼阳而热多。沉而迟，乃为阴水，证必兼阴而寒多。水脉浮大，水气涣散，灾
厄将出之象。水脉虚小，则正衰邪存，诚可惊也。《金匮要略》曰∶风水，其脉自浮，
外证骨节疼痛，恶风。又云∶脉浮而洪，浮则为风，洪则为气。风气相搏，风强则
为瘾疹，身体为痒。痒为泄风，久为痂癞。气强则为水，难以俯仰。风气相击，身
体洪肿，汗出乃愈。恶风则虚，此为风水。不恶风者，小便通利，上焦有寒，其口
多涎，此为黄汗。又云∶寸口脉沉滑者，中有水气，面目肿大，有热，名曰风水。
视人之目窠上微肿，如蚕新卧起状，其颈脉动，时时咳，按其手足上陷而不
起者，风水。又云∶太阳病，脉浮而紧，法当骨节疼痛。反不疼，身体反重而 。
其人不渴，汗出即愈，此为风水。恶寒者，此为极虚发汗得之。渴而不恶寒者，此
为皮水。分肿而冷，状如周痹，胸中窒，不能食，反聚痛，暮躁不得眠，此为黄汗。
痛在骨节，咳而喘，不渴者，此为脾胀。其状如厥，发汗即愈。然诸病此者，渴而
下利，小便数者，皆不可发汗。又云∶风水脉浮身重，汗出恶风者，防己黄 汤主
之。腹痛加芍药。又云∶风水恶风，一身悉肿，脉浮不渴，续自汗出，无大热，越
婢汤主之。皮水，其脉亦浮，外证 肿，按之没指，不恶风，其腹如鼓，不渴，当
发其汗。又云∶皮水为病，四肢肿，水气在皮肤中，四肢聂聂动者，防己茯苓汤主
之。又云∶厥而皮水者，蒲灰散主之。正水，其脉沉迟，外证自喘。石水，其脉自
沉，外证腹满不喘。（黄汗，其脉沉迟，身发热，胸满，四肢、头面肿久不愈，必致痈脓。）里水者，
一身面目黄肿，其脉沉，小便不利，故令病水。假如小便自利，此亡津液，故令渴也。越
婢加术汤主之，甘草麻黄汤亦主之。又云∶心水者，其身重而少气，不得卧，烦而
躁，其人阴肿。（宜防己茯苓汤、当归散之类。）肝水者，其腹大，不能自转侧，胁下腹痛，时
时津液微生，小便续通。（宜分气补心汤、当归散之类。）肺水者，其身肿，小便难，时时鸭溏。
（宜分气香苏饮，导水茯苓汤之类。）脾水者，其腹大，四肢苦重，津液不生，但苦少气，小便难。
（宜胃苓汤、调胃白术泽泻散之类。）肾水者，其腹大，脐肿腰痛，不得溺，阴下湿，如牛鼻上汗，
其足逆冷，面反瘦。（宜金匮肾气丸、济生肾气丸之类。）又云∶寸口脉沉而迟。沉则为水，迟则
为寒。寒水相搏，趺阳脉伏，水谷不化。脾气衰则 溏，胃气衰则身肿。少阳脉卑，
少阴脉细。男子则小便不利，妇人则经水不通。经为血，血不利则为水，名曰血分。
（宜调荣散、四制香附丸之类。）又云∶寸口脉迟而涩，迟则为寒，涩为血不足。趺阳脉微而迟，
微则为气，迟则为寒。寒气不足，则手足逆冷。手足逆冷，则荣卫不利。荣卫不利，
则腹满胁鸣相逐，气转膀胱，荣卫俱劳。阳气不通即身冷，阴气不通即骨疼。阳前
通则恶寒，阴气通则痹不仁。阴阳相得，其气乃行。大气一转，其气乃散。实则失
气，虚则遗尿，名曰气分。（宜防己茯苓汤、实脾饮、复元丹之类。）又云∶气分，心下坚大如盘，
边如旋杯，水饮所作，桂枝去芍药，加麻辛附子汤主之。又云∶心下坚，大如盘，
边如旋盘，水饮所作，枳术汤主之。（旋，圆也。杯高于盘，盘大于杯。此杯、盘之异，总皆水饮聚结。）
又云∶水之为病，其脉沉小，属少阴。浮者为风，无水。虚胀者为气水，发其汗即
已。脉沉者，宜麻黄附子汤。浮者，宜杏子汤。又云∶病者苦水，面目、四肢、身
体皆肿，小便不利。脉之不言水，反言胸中痛，气上冲咽，状如炙脔，当微咳喘。
审如师言，其脉何类？师曰∶寸口脉沉而紧，沉为水，紧为寒。沉紧相搏，结在关
元。始时尚微，年盛不觉。阳衰之后，荣卫相干。阳损阴盛，结寒微动。肾气上
冲，喉咽塞噎，胁下急痛。医以为留饮而大下之。气击不去，其病不除。后重吐之，
胃家虚烦，咽燥欲饮水，小便不利，水谷不化，面目手足浮肿。又与葶苈丸下水。
当时如小瘥，食饮过度，肿复如前。胸胁苦痛，象如奔 。其水扬溢，则浮咳喘
逆，当先攻击冲气令止，乃治咳。咳止，其喘自瘥。先治新病，病当在后。（总宜金匮
肾气丸。）又云∶趺阳脉当伏，今反紧。本自有寒疝 。腹中痛，医反下之，下之即胸
满短气。又云∶趺阳脉当伏，今反数。本自有热消谷，小便数，今反不利，此欲作
水。又云∶寸口脉浮而迟，浮脉则热，迟脉则潜。热潜相搏，名曰沉。趺阳脉浮而
数，浮脉即热，数脉即止。热止相搏，名曰伏。沉伏相搏，名曰水。沉则络脉虚，
伏则小便难。虚难相搏，水走皮肤，即为水矣。又云∶寸口脉弦而紧，弦则卫气不
行，紧即恶寒，水不沾流，走于肠间。又云∶少阴脉紧而沉，紧则为痛，沉则为水，
小便即难。脉得诸沉，当责有水，身体肿重。水病脉出者死。（脉出者，脉出肾少阴之部。
水源泛滥而散，欲其归源，不可得矣。）又云∶夫水病患，目下有卧蚕，面目鲜泽，脉伏。其人
消渴，病水腹大，小便不利。其脉沉绝者，有水，可下之。又云∶病下利后，渴，
饮水，小便不利，腹满因肿者何也？答曰∶此法当病水。若小便自利，及汗出者，
自当愈。又云∶诸有水者，腰以下肿，当利小便。腰以上肿，当发汗，乃愈。以上
《金匮》论水病之寒热虚实，表里阴阳，脏腑气血。虽有多种，然约而言之，总不外
肾、脾、肺三脏为之原始也。盖肾居下焦，属水，统摄阴液，为水之宗本。右为相
火，火以济寒，故水得以宣扬也。脾居中焦，属土，合肌肉，为水之堤防，主化谷
生津，津生不穷，故水得以灌溉也。肺居上焦，属金，主气，为水之化源，行荣卫
而出治节，故水得以通调也。人或房室劳倦，忧思恐惧，饮食起居，各以类伤其脏
而脏气虚。虚则各失其职，而水液之常道紊矣。在肾则不能统摄宣扬而停蓄，在脾
则不能堤防灌溉而滥行，在肺则不能生化通调而壅闭。况脾与胃合，胃又倚肾为关。
关门不利则水聚，利则必由于气化，是肺又为肾关之所倚也。故《素问·水热穴
论》曰∶其本在肾，其末在肺，皆聚水也。上仲景治水方法，皆以脉证为本，而后
量其轻重虚实，治之百无一失。世俗浅医，欲求急效，动以破气去水为正治。不知
暂宽一二，肿满续至。坐视其死者比比，可胜悼哉。后学当不厌其繁，而一惟以灵素金匮为准，斯得之矣。
《准绳》云肿病不一，或遍身肿，或四肢肿、面肿、脚肿、皆谓之水气。然有阳水，
有阴水。并可先用五皮饮，或除湿汤加木瓜，腹皮各半钱。如未效，继以四磨饮。
遍身肿，烦渴，小便赤涩，大便多闭，此属阳水。轻宜四磨饮，添磨生枳壳，兼进
保和丸。重则疏凿饮子利之，以通为度。亦有虽烦渴而大便已利者。此不可更利，
宜用五苓散，加木通、大腹皮半钱以通小便。遍身肿，不烦渴，大便自调，或溏
泄，小便虽少而不赤涩，此属阴水，宜实脾饮。小便多少如常，有时赤，有时不赤。
至晚则微赤，却无涩滞者，亦属阴也，不可遽补。木香流气饮，继进复元丹。若大
便不溏，气息胀满，宜四磨饮下黑锡丹。四肢肿，谓之肢肿，宜五皮饮加姜黄、木
瓜各一钱，或四磨饮，或用白术三两， 咀。每服半两，水一盏半，大枣三枚拍破，
同煎至九分，去滓温服，日三无时。名大枣汤。面独肿，苏子降气汤，兼气急者尤
宜。或煎熟去滓后，更磨沉香一呷。有一身之间，惟面与双脚浮肿，早则面甚，晚
则脚甚。经云∶面肿为风，脚肿为水，乃风湿所致。须问其大小肠通闭，别其阴阳
二证，前后用药。惟除湿汤，加木瓜、腹皮、白芷各半钱，可通用。或以苏子降气
汤、除湿汤各半帖煎之。罗谦甫导滞通经汤，治面目、手足浮肿。感湿而肿者，其
身虽肿，而腰下至脚尤肿。腿胀满尤甚于身。气或急，或不急。大便或溏，或不溏。
但宜通利小便为佳。煎五苓散，吞木瓜丸。（内犯牵牛，亦不可轻服。）间进除湿汤，加木瓜、
腹皮各半钱，炒莱菔子七分半。因气而肿者，其脉沉伏。或腹胀，或喘急，宜分气
香苏饮。饮食所伤而肿，或胸满，或嗳气，宜消导宽中汤。不服水土而肿者，胃苓
汤，加味五皮汤。有患生疮，用干疮药太早，致遍身肿，宜消风败毒散。若大便不
通，升麻和气散。若大便如常，或自利，当导其气自小便出，宜五皮饮，加生料五
苓散。腹若肿，只在下，宜除湿汤，和生料五苓散，加木瓜、泽泻之类。以上数条，
为有余之证。大病后浮肿，此系脾虚，宜加味六君子汤。白术三钱，人参、黄 各
一钱半，白茯苓二钱，陈皮、半夏曲、芍药、木瓜各一钱。炙甘草、大腹皮、木香
各五分，姜、枣煎服。小便不利，间入五苓散。有脾肺虚弱，不能通调水道者，宜
用补中益气汤补脾、肺、六味丸补肾。有心火克肺金，不能生肾水，以致小便不利
而成水证者，宜人参平肺散。若肾经阴亏，虚火烁肺金而小便不生者，用六味地黄
丸以补肾水，用补中益气汤以培脾土。脾、肺、肾之气交通，则水谷自然克化。二
经既虚，渐成水胀。又误用行气分利之药，以致小便不利，喘急痰盛，已成蛊证。
宜加减金匮肾气丸主之。以上数条，为不足之证。不足者，正气不足。有余者，邪
气有余。凡邪之所凑，必正气虚也。故以治不足之法治有余则可，以治有余之法治
不足则不可。洁古法，如水肿因气为肿者，加橘皮。因湿为肿者，煎防己黄 汤，
调五苓散。因热为肿者，八正散。如火热燥肺为肿者，乃绝水之源也，当清肺除燥，
水自生矣。于栀子豉汤中加黄芩。如热在下焦，阴消使气不得化者，当益阴而阳气
自化，黄柏、黄连是也。如水胀之病，当开鬼门，洁净府也，白茯苓汤主之。白茯
苓汤能变水。白茯苓、泽泻各二两，郁李仁五钱。水一碗，煎至一半，生姜自然汁
入药。常服无时，从少至多。服五七日后，觉腹下再肿，治以白术散。白术、泽泻
各半两为末，煎服三钱。或丸亦可，煎茯苓汤下三十丸。以黄 芍药建中汤之类调
养之。平复后，忌房室、猪鱼盐面等物。香茹熬膏，丸如桐子大。每服五丸，日三。
渐增，以小便利为度。冬瓜不限多少，任吃。鲤鱼一头，重一斤以上者，煮熟，取汁和冬
瓜、葱白作羹食之。青头鸭或白鸭，治如食法，细切，和米并五味煮熟作粥，食之。宜空腹时进。
昔人论水病，知经义者，固惟仲景一人。近世何柏斋、张景岳二论，亦庶几焉。故附录于下。
柏斋曰∶造化之机，水火而已，宜平不宜偏，宜交不宜分。水为湿、为寒；火
为燥，为热。火性炎上，水性润下。故火宜在下，水宜在上，则易交也。交则为既
济，不交则为未济。不交之极，则分离而死矣。消渴证，不交而火偏盛也。水气证，
不交而水偏胜也。制其偏而使之交，则治之之法也。小火不能化大水，故必先泻其
水，后补其火。开鬼门，泻在表在上之水也。洁净府，泻在里在下之水也。水势既
减，然后用暖药以补元气，使水火交，则用药之次第也。又云∶卢氏以水肿隶肝、
肾、胃而不及脾，丹溪非之似矣。然实则皆非也。盖造化生物，天地水火而已矣。
主之者天也，成之者地也。故曰干知太始，坤作成物。至于天地交合变化之用，则
水火二气也。天运水火之气于地之中，则物生矣。然水火不可偏盛。太旱物不生，
火偏盛也。太涝物亦不生，水偏盛也。水火和平，则物生矣，此自然之理也。人之
脏腑，以脾胃为主。盖饮食皆入于胃而运以脾，犹地之土也。然脾胃能化食与否，
实由于水火二气，非脾胃所能也。火盛，则脾胃燥。水盛，则脾胃湿。皆不能化物，
乃生诸病。水肿之证，盖水盛而火不能化也。火衰，则不能化水，故水之入于脾胃
者，皆渗入血脉骨肉。血亦化水，肉发肿胀，皆自然之理也。导去其水，使水少减；
复补其火，使二气平和，则病去矣。丹溪谓脾失运化，由肝木侮脾。乃欲清心经之
火，使肺金得令，以制肝木。则脾土全运化之职，水自顺道，乃不为肿。其词迂而不切，故书此辩之。
When the pulse presents various sunken characteristics, one should attribute it to the retention of water-dampness. A floating pulse indicates exterior conditions and wind pathogens, while a deep and stone-like pulse indicates interior conditions and water accumulation.
A deep and rapid pulse belongs to Yang Water; a deep and slow pulse belongs to Yin Water. A floating and large pulse suggests that the pathological factor is dispersing outward, indicating the impending resolution of disaster; a deficient and small pulse indicates that righteous Qi is weak while pathogenic factors remain, which is indeed alarming.
According to the main text, Qi-Shui (Water due to Qi) is divided into four types: Qi-Shui, Feng-Shui (Wind-Water), Shi-Shui (Stone-Water), and Li-Shui (Interior-Water). *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) mentions Pi-Shui (Skin-Water), Zheng-Shui (Regular-Water), and Huang-Han (Yellow Sweat), but does not mention Qi-Shui or Li-Shui. However, Qi-Shui and Li-Shui each appear as separate entries later in the text. Is it because Pi-Shui is equivalent to Qi-Shui, and since both Feng-Shui and Pi-Shui have floating pulses, they are considered Exterior Water? Whereas Zheng-Shui, Shi-Shui, and Huang-Han all have sunken pulses, they are considered Interior Water?
Although the pulses for water diseases vary, the sunken pulse is universally accompanied. Even for Qi-Shui and Feng-Shui located at the exterior, where the pulse should naturally be floating, there must inevitably be a tendency towards sinking. This is because sinking downwards is the nature of water, described from the perspective of morphology; floating is described from the perspective of location. If the pulse is deep and rapid, it is Yang Water, and the syndrome must involve Yang heat with predominant heat symptoms. If the pulse is deep and slow, it is Yin Water, and the syndrome must involve Yin cold with predominant cold symptoms. A water disease pulse that is floating and large indicates that water Qi is dissipating, which is a sign that disaster is about to pass. A water disease pulse that is deficient and small indicates that righteous Qi is declining while pathogens persist, which is truly worthy of concern.
*Jin Gui Yao Lue* states: For Feng-Shui (Wind-Water), the pulse is naturally floating, with external symptoms of bone and joint pain and aversion to wind. It also states: A pulse that is floating and surging (Hong); floating indicates wind, surging indicates Qi. When wind and Qi pathogens fight each other, if wind is strong, it manifests as urticaria (net-rash) and body itching. Itching is called "leaking wind"; if prolonged, it may become scabies or leprosy. If Qi is strong, it transforms into water, making it difficult to bend or straighten the body. When wind and Qi strike each other, the body becomes highly swollen, and recovery occurs through sweating. Aversion to wind characterizes Feng-Shui. Absence of aversion to wind, with free urination, cold in the Upper Jiao, and excessive salivation characterizes Huang-Han (Yellow Sweat). It also states: A Cun Kou (radial artery at the wrist) pulse that is deep and slippery indicates water Qi inside, with swelling of the face and eyes and fever, termed Feng-Shui. Observing slight swelling above the eye sockets, resembling a silkworm just waking up, pulsation of the neck vessels, frequent coughing, and pitting edema on the hands and feet that does not immediately rebound upon pressure characterizes Feng-Shui. It also states: In Tai-Yang disease, a floating and tight pulse should theoretically cause bone and joint pain. If there is no pain but the body feels heavy and numb, and the patient is not thirsty, recovery occurs after sweating; this is Feng-Shui. Aversion to cold indicates extreme deficiency caused by improper sweating. Thirst without aversion to cold characterizes Pi-Shui (Skin-Water). Generalized swelling with coldness, resembling Zhou-Bi (circumferential bi-syndrome), chest oppression, inability to eat, gathering pain, evening restlessness, and insomnia characterize Huang-Han. Pain in the joints, coughing, wheezing, and absence of thirst characterize Pi-Zhang (Spleen Distension). The condition resembles Jue-Ni (cold extremities); sweating leads to recovery. However, for those with these conditions, if they are thirsty with diarrhea and frequent urination, sweating therapy is contraindicated. It also states: For Feng-Shui with a floating pulse, heaviness, sweating, and aversion to wind, Fang-Ji Huang-Qi Tang (Stephania and Astragalus Decoction) is the primary formula. Add Bai-Shao (White Peony Root) if there is abdominal pain. It also states: For Feng-Shui with aversion to wind, generalized swelling, a floating pulse, absence of thirst, continuous spontaneous sweating, and no significant heat, Yi-Pi Tang (Ma-Xie Decoction) is the primary formula. For Pi-Shui, the pulse is also floating, with external symptoms of limb edema that pits upon pressure, absence of aversion to wind, a drum-like abdomen, and absence of thirst; sweating therapy should be employed. It also states: For Pi-Shui disease with limb swelling, water Qi in the skin, and slight tremors in the limbs, Fang-Ji Fu-Ling Tang (Stephania and Poria Decoction) is the primary formula. It also states: For Jue-Ni combined with Pi-Shui, Pu-Hui San (Cattail Pollen Powder) is the primary formula. For Zheng-Shui (Regular-Water), the pulse is deep and slow, with external symptoms of spontaneous wheezing. For Shi-Shui (Stone-Water), the pulse is naturally deep, with external symptoms of abdominal fullness but no wheezing. (For Huang-Han, the pulse is deep and slow, with body fever, chest fullness, and prolonged swelling of the limbs, head, and face, which will eventually lead to abscesses.) For Li-Shui (Interior-Water), there is generalized yellowish swelling of the body and face, a deep pulse, and difficulty in urination, leading to water disease. If urination is normal, this indicates loss of body fluids, leading to thirst. Yue-Bi Jia Zhu Tang (Ma-Xie Decoction plus Atractylodes) is the primary formula; Gan-Cao Ma-Huang Tang (Licorice and Ephedra Decoction) is also used. It also states: For Xin-Shui (Heart-Water), the body is heavy with shortness of breath, inability to lie flat, irritability, and swelling of the genitalia. (Fang-Ji Fu-Ling Tang or Dang-Gui San [Angelica Powder] may be appropriate.) For Gan-Shui (Liver-Water), the abdomen is distended, unable to turn over independently, with hypochondriac pain, occasional production of saliva, and intermittent urination. (Fen-Qi Bu-Xin Tang or Dang-Gui San may be appropriate.) For Fei-Shui (Lung-Water), the body is swollen, urination is difficult, and stools are frequently loose like duck droppings. (Fen-Qi Xiang-Su Yin or Dao-Shui Fu-Ling Tang may be appropriate.) For Pi-Shui (Spleen-Water), the abdomen is distended, limbs feel heavy, saliva generation is impaired, suffering from shortness of breath, and urination is difficult. (Wei-Ling Tang or Tiao-Wei Bai-Zhu Ze-Xie San may be appropriate.) For Shen-Shui (Kidney-Water), the abdomen is distended, the umbilicus is swollen with lower back pain, inability to urinate, dampness in the genital area resembling sweat on an ox's nose, cold extremities, and a thin face. (Jin Gui Shen Qi Wan or Ji Sheng Shen Qi Wan may be appropriate.) It also states: A Cun Kou pulse that is deep and slow. Deep indicates water; slow indicates cold. Cold and water fighting each other causes the Zu Yang pulse to vanish, leading to indigestion. Spleen Qi deficiency leads to loose stools; Stomach Qi deficiency leads to body swelling. Shao Yang pulse is low; Shao Yin pulse is fine. Men experience difficulty in urination; women experience amenorrhea. Menses constitute blood; if blood flow is obstructed, it transforms into water, termed Xue-Fen (Blood Division). (Tiao-Rong San or Si-Zhi Xiang-Fu Wan may be appropriate.) It also states: A Cun Kou pulse that is slow and choppy. Slow indicates cold; choppy indicates blood deficiency. A Zu Yang pulse that is faint and slow. Faint indicates Qi deficiency; slow indicates cold. Cold Qi and blood deficiency lead to cold extremities. Cold extremities indicate poor Ying and Wei circulation. Poor Ying and Wei circulation leads to abdominal fullness and borborygmus, with Qi shifting to the Bladder, exhausting both Ying and Wei. Obstruction of Yang Qi causes body coldness; obstruction of Yin Qi causes bone pain. Anterior unblocking of Yang Qi causes aversion to cold; posterior unblocking of Yin Qi causes numbness. When Yin and Yang harmonize, Qi flows. When the Great Qi rotates, pathogens disperse. Excess conditions manifest as flatus; deficiency conditions manifest as enuresis, termed Qi-Fen (Qi Division). (Fang-Ji Fu-Ling Tang, Shi-Pi Yin, or Fu-Yuan Dan may be appropriate.) It also states: In Qi-Fen disease, the epigastrium is hard and large like a plate, with edges like an inverted cup, caused by fluid retention; Gui-Zhi Qu Shao Yao Jia Ma-Xin Fu-Zi Tang (Cinnamon Twig Decoction minus White Peony plus Ephedra, Cinnamon Heart, and Aconite) is the primary formula. It also states: Hardness in the epigastrium, large like a plate, with edges like a rotating dish, caused by fluid retention; Zhi-Zhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction) is the primary formula. (Rotating means round. Cups are higher than plates; plates are larger than cups. This difference between cup and plate generally refers to the aggregation of fluid retention.) It also states: For water disease, a deep and small pulse belongs to Shao Yin. A floating pulse indicates wind, not water. Deficiency and distension indicate Qi-Shui; sweating resolves it. For a deep pulse, Ma-Huang Fu-Zi Tang (Ephedra and Aconite Decoction) is suitable. For a floating pulse, Xing-Zi Tang (Apricot Seed Decoction) is suitable. It also states: Patients suffering from water disease have swelling of the face, limbs, and body, with difficulty in urination. Pulse diagnosis does not mention water but rather chest pain, Qi rushing up to the throat, feeling like a lump of roasted meat, and mild coughing/wheezing. Asking carefully as the master said, what is the pulse like? The master says: A Cun Kou pulse that is deep and tight. Deep indicates water; tight indicates cold. Deep and tight fighting each other knots at Guan-Yuan. Initially subtle, unnoticed in youth. After Yang declines, Ying and Wei interfere. Yang damage and Yin excess cause slight movement of knotted cold. Kidney Qi rushes upward, causing throat blockage and hypochondriac pain. Doctors mistake it for retained fluid and use harsh purgatives. The Qi attack remains, and the disease persists. Subsequent emesis causes stomach deficiency, irritability, dry throat, desire for water, difficulty in urination, indigestion, and swelling of the face, eyes, and limbs. Then Ting-Li Wan (Descurainia Seed Pill) is given to drain water. There is temporary relief, but overeating causes recurrence of swelling. Chest and hypochondriac pain resemble Ben-Tun (Rushing Pig). Overflowing water causes floating cough and wheezing. One must first suppress the Rushing Qi, then treat the cough. Once cough stops, wheezing heals. Treat new illness first; old illness follows. (Jin Gui Shen Qi Wan is generally appropriate.) It also states: The Zu Yang pulse should be hidden but is now tight. Originally having Han-Han (Cold Colic) with abdominal pain, the doctor wrongly used purgatives, causing chest fullness and shortness of breath. It also states: The Zu Yang pulse should be hidden but is now rapid. Originally having heat that digests food quickly with frequent urination, now urination is difficult, indicating impending water disease. It also states: A Cun Kou pulse that is floating and slow. Floating indicates heat; slow indicates submergence. Heat and submergence fighting is termed Chen (Deep). A Zu Yang pulse that is floating and rapid. Floating indicates heat; rapid indicates stopping. Heat and stopping fighting is termed Fu (Hidden). Deep and Hidden fighting is termed Water. Deep indicates deficiency in collateral vessels; Hidden indicates difficulty in urination. Deficiency and difficulty fighting cause water to move into the skin, resulting in water disease. It also states: A Cun Kou pulse that is wiry and tight. Wiry indicates Wei Qi stagnation; tight indicates aversion to cold. Water fails to flow normally and moves into the intestines. It also states: A Shao Yin pulse that is tight and deep. Tight indicates pain; deep indicates water; urination becomes difficult. When the pulse presents various sunken characteristics, one should attribute it to water, with body swelling and heaviness. If the pulse in water disease emerges (floats out superficially against the root), death ensues. (Pulse emergence refers to the pulse appearing in the Shao Yin Kidney region. The water source floods and scatters, unable to return to its origin.) It also states: For water patients, there are卧蚕 (silkworm-like swellings) under the eyes, fresh luster to the face and eyes, and a hidden pulse. The patient has polydipsia, abdominal distension due to water, and difficulty in urination. If the pulse is deeply hidden, there is water, and purgation is indicated. It also states: After diarrhea, if the patient is thirsty, drinks water, has difficulty in urination, abdominal fullness, and subsequent swelling, what is the cause? Answer: This method leads to water disease. If urination is free and sweating occurs, it will heal spontaneously. It also states: For all water cases, swelling below the waist requires promoting urination; swelling above the waist requires inducing sweating, then healing. Above, *Jin Gui* discusses the cold/heat, deficiency/excess, exterior/interior, Yin/Yang, Zang-Fu, Qi, and Blood of water disease. Although varied, broadly speaking, it originates from the Kidney, Spleen, and Lung. The Kidney resides in the Lower Jiao, belongs to Water, controls Yin fluids, and is the root of water. The Minister Fire on the right warms the cold, allowing water to circulate. The Spleen resides in the Middle Jiao, belongs to Earth, combines with muscles, acts as the dike for water, transforms grain to generate fluids, and thus irrigates water. The Lung resides in the Upper Jiao, belongs to Metal, governs Qi, is the source of water transformation, circulates Ying and Wei, and regulates metabolism, thus allowing water to be distributed. If people suffer from sexual exhaustion, worry, thought, fear, improper diet, or lifestyle, they injure their Zang organs, causing Zang Qi deficiency. Deficiency leads to loss of function and disruption of normal fluid pathways. In the Kidney, failure to control and circulate leads to retention; in the Spleen, failure to dike and irrigate leads to flooding; in the Lung, failure to transform and distribute leads to congestion. Moreover, the Spleen and Stomach are paired, and the Stomach relies on the Kidney as a gate. If the gate is obstructed, water gathers; if open, it depends on Qi transformation. Thus, the Lung also relies on the Kidney gate. Therefore, *Su Wen · Shui Re Xue Lun* states: The root is in the Kidney, the branch is in the Lung; both gather water. Zhang Zhongjing’s methods for treating water are based on pulse and syndrome, assessing severity and deficiency/excess, ensuring near-perfect success. Superficial doctors seek quick results, using Qi-breaking and water-draining drugs as standard treatment. They do not know that temporary relief is followed by recurring swelling. Watching patients die is lamentable. Students should not tire of complexity but adhere strictly to *Ling Shu*, *Su Wen*, and *Jin Gui*.
*Zhun Sheng* states that swelling varies: generalized, limbs, face, or feet, all termed Qi-Shui. There is Yang Water and Yin Water. One may initially use Wu-Pi Yin (Five Peel Decoction) or Chu-Shi Tang (Dampness-Removing Decoction plus Mu-Gua and Da Fu Pi). If ineffective, follow with Si-Mo Yin (Four Grind Decoction). Generalized swelling with irritability, thirst, dark/scanty urine, and constipation belongs to Yang Water. Mild cases suit Si-Mo Yin with raw Zhi Qiao; severe cases suit Shu-Zao Yin Zi to promote urination until unblocked. Even with thirst, if stool is already loose, further purgation is contraindicated; use Wu Ling San plus Tong Cao and Da Fu Pi to promote urination. Generalized swelling without thirst, normal or loose stool, scanty but non-dark/non-astringent urine belongs to Yin Water; Shi-Pi Yin is suitable. Urination volume normal, sometimes dark, sometimes not, slightly dark at night without astringency also belongs to Yin; do not tonify hastily. Mu-Xiang Liu-Qi Yin followed by Fu-Yuan Dan. If stool is not loose but breathing is distended, Si-Mo Yin with Hei Xi Dan. Limb swelling (Zhi-Zhong) suits Wu-Pi Yin plus Jiang Huang and Mu Gua, or Si-Mo Yin, or Bai Zhu decocted with dates (Da Zao Tang). Facial swelling alone suits Su Zi Jiang Qi Tang, especially with急促 breathing. Adding Chen Xiang is beneficial. Swelling only in face and feet, worse in morning for face, evening for feet, is Wind-Water due to Wind-Damp. Ask about bowel/bladder function to distinguish Yin/Yang. Chu-Shi Tang plus Mu Gua, Da Fu Pi, and Bai Zhi is general. Or half dose of Su Zi Jiang Qi Tang and Chu-Shi Tang. Luo Qianfu’s Dao-Zhi Tong-Jing Tang treats facial and limb swelling. Dampness-induced swelling is worse below the waist; promote urination with Wu Ling San and Mu Gua Wan. Intermittently use Chu-Shi Tang plus fried Radish seeds. Qi-induced swelling has a deep-hidden pulse, abdominal distension, or wheezing; Fen-Qi Xiang-Su Yin is suitable. Diet-induced swelling with chest fullness or belching suits Xiao-Dao Kuan-Zhong Tang. Acclimatization-induced swelling suits Wei-Ling Tang or modified Wu-Pi Tang. Early use of drying medicines for sores causing generalized swelling suits Xiao-Feng Bai Du San. Constipation suits Sheng Ma He Qi San. Normal stool or spontaneous loose stool requires guiding Qi via urination; Wu-Pi Tang plus Sheng Liao Wu Ling San. Abdominal swelling below suits Chu-Shi Tang mixed with Sheng Liao Wu Ling San plus Mu Gua and Ze Xie. These are Excess syndromes. Post-illness swelling is Spleen deficiency; Jia Wei Liu Jun Zi Tang is suitable. Include Ren Shen, Huang Qi, Bai Zhu, etc. Difficulty in urination adds Wu Ling San. Spleen/Lung weakness failing to regulate waterways suits Bu Zhong Yi Qi Tang for Spleen/Lung and Liu Wei Di Huang Wan for Kidney. Heart Fire overcoming Lung Metal failing to generate Kidney Water causing water disease suits Ren Shen Ping Fei San. Kidney Yin deficiency with deficient fire scorching Lung Metal causing lack of urine suits Liu Wei Di Huang Wan and Bu Zhong Yi Qi Tang. Harmonizing Spleen, Lung, and Kidney Qi allows natural digestion. If two meridians are deficient, water distension develops. Misuse of Qi-moving and diuretic drugs leads to difficulty in urination, wheezing, phlegm, and Gu syndrome; modified Jin Gui Shen Qi Wan is suitable. These are Deficiency syndromes. Deficiency is righteous Qi deficiency; Excess is pathogenic Qi excess. Where pathogens gather, righteous Qi is always deficient. Thus, treating Excess with Deficiency methods works, but treating Deficiency with Excess methods does not. Jie Gu’s methods: Edema due to Qi adds Ju Pi; due to Dampness uses Fang-Ji Huang-Qi Tang mixed with Wu Ling San; due to Heat uses Ba Zheng San. Fire-heat drying Lung requires clearing Lung and removing dryness; add Huang Qin to Zhi Zi Chi Tang. Heat in Lower Jiao consuming Yin requires nourishing Yin; Huang Bo and Huang Lian are suitable. For water distension, open ghost gates (sweat) and clean the residence (urinate); Bai Fu Ling Tang is primary. Bai Fu Ling Tang transforms water. Bai Fu Ling, Ze Xie, Yu Li Ren, ginger juice. Take gradually. After 5-7 days, if lower abdomen swells again, treat with Bai Zhu San. Maintain with Huang Qi Shao Yao Jian Zhong Tang. After recovery, avoid sex, pork, fish, salt, and flour. Xiang Ru paste pills. Eat winter melon freely. Cook carp with winter melon and scallions. Duck congee. Take on empty stomach.
Ancient experts discussing water disease knew only Zhang Zhongjing understood the classics. Recent scholars He Bo Zhai and Zhang Jing Yue also approached this truth. Their theories are appended below.
Bo Zhai says: The mechanism of creation is Water and Fire, suitable for balance not bias, union not separation. Water is damp/cold; Fire is dry/hot. Fire rises; Water descends. Fire should be below, Water above, to facilitate interaction. Interaction is Ji Ji (Completion); non-interaction is Wei Ji (Incompletion). Extreme non-interaction leads to separation and death. Polydipsia is Fire excess due to non-interaction. Water Qi disease is Water excess due to non-interaction. Controlling bias to restore interaction is the treatment. Small Fire cannot transform Large Water; thus, drain water first, then tonify Fire. Open Ghost Gates drains exterior/superior water; Clean Residence drains interior/inferior water. After water reduces, use warm herbs to tonify Yuan Qi, allowing Water and Fire to interact. This is the sequence. Lu Shi attributed edema to Liver, Kidney, Stomach, excluding Spleen; Dan Xi criticized this, but both are incorrect. Creation involves Heaven and Earth, Water and Fire. Heaven initiates; Earth completes. Heaven transports Water/Fire Qi into Earth, generating life. Water/Fire must not be excessive. Drought (Fire excess) kills; Flood (Water excess) kills. Balance generates life. Human Zang-Fu prioritize Spleen/Stomach. Food enters Stomach, transported by Spleen, like Earth. However, digestion depends on Water/Fire Qi, not just Spleen/Stomach. Fire excess dries Spleen/Stomach; Water excess wets them; neither transforms food, causing disease. Edema is Water excess with insufficient Fire to transform it. Fire decline fails to transform Water; Water infiltrates blood/bones, transforming blood to water, causing swelling. Drain water, then tonify Fire to restore balance. Dan Xi claimed Spleen failure due to Liver Wood insulting Spleen, suggesting clearing Heart Fire to let Lung Metal control Liver, restoring Spleen function. His words were circuitous; thus, this rebuttal.