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Yu Chang stated: In differentiating the pulse of various diseases, the four pulses of Floating (Fu), Deep (Chen), Slow (Chi), and Rapid (Shu) serve as the general principles. The subtleties and profundities of water diseases (Edema) are all derived from these four characters. Those involving the Wiry (Xian), Tight (Jin), Fine (Wei), Choppy (Se), Hidden (Fu), and Concealed (Qian) pulses are merely further subdivisions resulting from deeper deduction. Wind-water (Feng Shui) presents with a Floating pulse; this is a fixed rule. However, there is wind-water associated with a Floating pulse of the Taiyang channel, wind-water with simultaneous Deep pulses of the Liver and Kidney, wind-water caused by excessive exertion and sweating, and wind-water characterized by facial swelling and congestion affecting speech. Although the treatment method for all is "opening the ghost gate" (Diaphoresis/Sweating), the distinction between the branch (Biao) and the root (Ben) varies slightly. Furthermore, in conditions where diaphoresis is indicated, if there is thirst accompanied by diarrhea, or frequent urination, sweating must not be induced. How can one violate these prohibitions without careful differentiation?

A Deep pulse indicates water; this is a fixed rule. Simultaneous Deep pulses of the Liver and Kidney are termed Stone Water (Shi Shui). When Deep and Hidden pulses interact, it is called Water Disease. A Tight and Deep pulse at the Shaoyin position indicates pain for Tightness and water for Deepness. Whenever Deep pulses are found, one should investigate the presence of water; the patient will present with bodily swelling and heaviness. If the pulse of a water disease suddenly becomes superficial and large, it is a sign of death. Deep indicates water, Tight indicates cold; when Deep and Tight interact, the pathology is located at the Guanyuan acupoint. Deep indicates interior water; water diseases with a Small Deep pulse belong to the Shaoyin channel. The *Neijing* explicitly prescribes the method of "cleansing the bladder" (Promoting Urination), yet the *Jingui Yaolue* does not mention this for treating various Deep pulses. It also states: For edema below the waist, promote urination. It also states: Spontaneous urination indicates recovery. This caution arises from the fear that if the pulse is Fine-Deep or Slow-Deep, indicating deficient Kidney Qi, the method of promoting urination might be misapplied. The aforementioned discussions on Floating and Deep pulses are clear and understandable.

Regarding the discussion on Slow and Rapid pulses: If the Cun Kou (Radial artery at wrist) pulse is Floating and Slow, Floating indicates Heat, and Slow indicates concealment. The interaction of Heat and concealment is termed Chen (Sinking/Depressed). If the Fu Yang (Radial artery at foot) pulse is Floating and Rapid, Floating indicates Heat, and Rapid indicates stagnation/stopping. The interaction of Rapid and Stagnation is termed Fu (Hidden). The interaction of Chen and Fu constitutes Water Disease. Chen implies deficiency of the collaterals, while Fu implies difficulty in urination. The interaction of deficiency and difficulty causes water to flow into the skin, resulting in edema. Such discourse on pulses cuts off superficial understanding, preventing even the wise from easily grasping it; is this not the highest level of learning?

Cun Kou is where the Lung pulse passes. Fu Yang is where the Stomach pulse passes. Combining these two pulses for diagnosis elucidates the *Neijing* principle that "binding of the three Yin channels leads to water," determining the syndrome via Cun Kou and Fu Yang. At Cun Kou, a Floating and Slow pulse: Floating represents Wei (Defensive) Qi and Yang; Slow represents Ying (Nutritive) Qi and Yin. If Wei does not harmonize with Ying, Yang resides alone outside the vessels, causing Heat. If Ying does not follow Wei and hides within the vessels, it becomes concealed. When Heat and concealed pathogens interact between Ying and Wei, the Lung Qi cannot distribute and transform, leading to self-binding and a Sinking pulse. The Spleen and Stomach are connected by membranes and form an exterior-interior relationship. At Fu Yang, a Floating and Rapid pulse: Stomach Yang does not combine with Spleen Yin. Floating and residing alone at the exterior causes Heat. Spleen Yin, unable to harmonize with Stomach Yang, is urged by Yang Qi and changes state; Rapidness indicates Yin blood becoming increasingly deficient and stagnant. The term "Fu" (Hidden) for the interaction of Rapid and Stagnation means that although the Fu Yang pulse is naturally not Hidden, it becomes Hidden due to Heat and stagnation. The Sinking at Cun Kou and Hidden at Fu Yang interacting in the middle generates water; is this not the definitive manifestation of the binding of the three Yin channels?

The Lung governs the skin and hair; the skin is where the collaterals pass. If the Lung pulse is Sinking and Qi is not充盈 (full), and Ying is concealed and Blood does not nourish, the collaterals become deficient. The Spleen transports fluids for the Stomach; if the Spleen pulse is Hidden, fluids do not enter the Bladder, causing difficult urination. Deficient collaterals and difficult urination allow accumulated water to move into the interstitial spaces of the skin, causing swelling. The *Jingui Yaolue* is profound and difficult to understand; this is precisely where its subtlety lies, and one should not let go of it easily.

A Slow and Choppy pulse at Cun Kou is explained in Volume 2 under Cold-Dampness; here, Cun Kou determines the Lung syndrome. The Lung externally connects with the skin and hair and internally with the Large Intestine. Externally connecting with skin and hair, having deduced skin deficiency and collateral deficiency, water entering causes swelling. Internally connecting with the Large Intestine, is there no pulse method to deduce it? The *Jingui Yaolue* also states: A Wiry and Tight pulse at Cun Kou. Wiry indicates Wei Qi obstruction; Tight indicates aversion to cold. Water fails to circulate freely and moves into the intestines. Using Floating, Slow, Wiry, and Tight as the main pulses for Lung-related water distinguishes the exterior and interior. Wiry indicates water, Tight indicates cold. With water-cold in the Lung, Ying and Wei fail to warm the muscle intervals, causing aversion to cold. The Lung's regulatory function fails, and it cannot regulate water passages, so water does not circulate freely but flows into the Large Intestine. "Lung water" refers interchangeably to bodily swelling, difficult urination, and frequent loose stools resembling duck droppings.

Using Fu Yang to diagnose the Stomach: Whether the Stomach is Cold or Hot is distinguished by the pulse being Tight or Rapid. Thus, it is said that the Fu Yang pulse should be Hidden; if it is now Tight, the patient originally had Cold Hernia (Han Shan) or Masses (Jia), with abdominal pain. If the physician incorrectly uses purgatives, chest fullness and shortness of breath result. It also says: The Fu Yang pulse should be Hidden; if it is now Rapid, the patient originally had Heat, consuming food quickly, and frequent urination. Now, if urination becomes difficult, water disease is about to develop. These two cases, one Cold and one Hot, arise from the pulses and syndromes governed by Fu Yang. Cold Hernia is similar to Stone Water; abdominal pain requires warming, not purging. Purging damages the Yang Qi of the chest, allowing turbid Yin to attack upward, causing chest fullness and shortness of breath. The *Neijing* states that swelling and fullness with pain around the navel is named "Wind Root" and should not be disturbed; disturbing it leads to water retention and difficult urination. Wind Root is Yang; disturbing it attacks Yin. Hernia/Masses are Yin; disturbing them attacks Yang. These are profound insights. Heat consumes food, and frequent urination characterizes Dian Cheng Xiao Zhong (Heat-induced Thirst and Wasting); now, with difficult urination, it is evident that water will invade according to the heat trend, spreading everywhere, similar to but slightly different from Yellow Sweat (Huang Han). The key to the pulse methods for water disease in the *Jingui Yaolue* lies in investigating excess and deficiency. Investigate what exists and what does not exist; clarify all primary and secondary syndromes without doubt. For excess, investigate Wind, Heat, Swelling, Pain, Strong Qi, Fever, and Restlessness, all supported by pulse evidence. For deficiency, investigate Deficiency of Righteous Qi, Wei, Ying, Channels, Collaterals, Grain and Water Qi, and the deficiency of Shaoyang and Lesser Yin, all supported by pulse evidence.

Ultimately, pulse study is a subtle science. I wish to transmit its subtlety, which emerges from simplicity; the more it is deduced, the broader it becomes, and the more it is sought, the more it is obtained. For example, "pulse emerging in water disease indicates death"; reading only the text without understanding would surely mislead others and oneself. For Wind-water and Yellow Sweat, if the pulse is Floating, Large, and Surging, does it also indicate death? Only in Shaoyin Kidney Water, where the pulse is naturally Deep, if it suddenly disappears and emerges outward, does it indicate death. Regarding deficiency of Ying and Wei, differentiation is complex: there is Ying and Wei moving upward with Wind, Fire, and Heat without circulating the body; Ying and Wei failing to secure the cou li due to excessive sweating; Ying and Wei deficiency due to insufficient grain Qi, depleting Zong Qi and causing chest pain; Ying and Wei disharmony inside and outside the vessels; Ying and Wei blockage above and below the vessels; Ying and Wei pathology affecting the Upper, Middle, and Lower Jiao with severance of the four limbs; and Ying and Wei heat toxins causing skin ulcers. Detailed analysis of each allows one to grasp the essence; those studying pulses will naturally achieve deep proficiency.

Discussion on the Fangji Huangqi Tang Formula from *Jingui Yaolue*: The text states: For Wind-water with a Floating pulse, heaviness, sweating, and aversion to wind, Fangji Huangqi Tang is the primary formula. Add Shaoyao if there is abdominal pain. A Floating pulse indicates an exterior syndrome. Sweating and aversion to wind indicate exterior deficiency. Heaviness indicates water dampness lodging in the muscle intervals. Fangji treats wind-edema and water-swelling, unblocking the cou li. Huangqi warms the muscle intervals and tonifies Wei deficiency. Baizhu treats wind in the skin and stops sweating. Gancao harmonizes the herbs and benefits the Earth (Spleen/Stomach). Shengjiang and Dazao have pungent-sweet properties to disperse. Abdominal pain involves blockage of Yin and Yang Qi, preventing ascending and descending; adding Shaoyao collects Yin.

Discussion on the Yeshibi Tang Formula from *Jingui Yaolue*: The text states: For Wind-water with aversion to wind, generalized swelling, a Floating pulse, no thirst, continuous spontaneous sweating, and no significant fever, Yeshibi Tang is the primary formula. For Interior Water, presenting with generalized yellowish swelling of the face and body, a Deep pulse, and difficult urination, thus causing water disease. If urination is spontaneous, this indicates loss of body fluids, hence thirst; Yeshibi Jia Zhuyu Tang is the primary formula. The previous case of Wind-water with continuous sweating and no significant fever justifies its use. If there were no sweating and significant fever, the exterior-releasing method would not prioritize this. The latter case of Interior Water, if urination is spontaneous, indicates fluid loss and thirst, justifying its use. Otherwise, the interior method would not prioritize this. Saying "no significant fever" implies heat is present; saying "Interior Water" refers to the interior of the body shell, not the interior of the Zang-Fu organs, hence Yeshibi Tang is applicable in both. Yeshibi Tang demonstrates mild release without aggressive sweating. As detailed in the *Shanglun* commentary on the Taiyang chapter of Shanghan Lun, it generally utilizes the property of regulating Ying and Wei gently. Its name derives from this gentle nature compared to a weak woman. Mahuang (Ephedrae Herba) is Pungent-Warm, and Shigao (Gypsum Fibrosum) is Sweet-Cold. Used together, if the Spleen leans toward Yin, it is harmonized with Pungent-Warm; if the Stomach leans toward Yang, it is harmonized with Sweet-Cold. Thus, for Yang pathogenic factors like Wind-Heat or Yin pathogenic factors like Water-Cold that disrupt the Middle Jiao, this formula is suitable. If the Middle Jiao is disharmonious, Grain and Water cannot transform their refined essence to nourish Ying and Wei. With deficient Ying and Wei, Cold or Heat pathogens obstruct the pathways, preventing communication between interior and exterior. Hence, it is used for Exterior Wind-water and for Interior Water with thirst and spontaneous urination, aiming primarily not to harm the Middle Jiao. By protecting the Middle Jiao, disasters are prevented at their inception, without waiting for the harmony of Earth and Water.

Discussion on the Fangji Fuling Tang Formula from *Jingui Yaolue*: The text states: For Pi Shui (Skin Water) disease, with swelling of the four limbs and water qi in the skin, causing slight tremors in the limbs, Fangji Fuling Tang is the primary formula. Wind-water with a Floating pulse uses Fangji Huangqi Tang, and Skin Water is treated similarly. As discussed in the pulse section, although both use "opening the ghost gate," the distinction between branch and root differs; this formula exemplifies that. Wind-water depresses the Earth Qi, so Baizhu is used to fortify Earth, and Jiang-Zao to harmonize the center. Skin Water internally connects with the Lung; Metal depression is relieved, and water soaking the skin is drained with bland leaching agents. Therefore, Fuling replaces Baizhu, and Guizhi is added to release the muscle layer and scatter water externally, avoiding Jiang-Zao to harmonize the center. Moreover, with limb tremors, wind affects Ying and Wei and disturbs the collaterals, making Guizhi indispensable.

Discussion on the Mahuang Fuzi Tang and Xingzi Tang formulas from *Jingui Yaolue*: The text states: For water disease, if the pulse is Small and Deep, it belongs to Shaoyin. If Floating, it is Wind. If bloated without water, it is Qi. For water, inducing sweat resolves it. For a Deep pulse, Mahuang Fuzi Tang is appropriate; for a Floating pulse, Xingzi Tang is appropriate. This discusses Zheng Shui (True Water) of Shaoyin, where the pulse is naturally Small and Deep, showing no tendency to emerge. If the pulse is Floating, Wind is manifesting externally. Bloated without water indicates stagnation of Hand-Taiyin (Lung) Qi. Wind diseases resolve with diaphoresis. Even if the pulse is Deep without other symptoms, following the Shaoyin pattern of Shanghan, Mahuang Fuzi Gancao Tang should be used to agitate the water and rescue the Kidney. If the pulse is Floating, external symptoms likely include wheezing; following the Taiyang pattern of Shanghan, Mahuang Xingzi Gancao Shigao Tang should be used to disperse pathogens and rescue the Lung. This is the major method for treating the Metal (Lung) and Water (Kidney) organs.

Discussion on the Huangqi Shaoyao Guizhi Kujiu Tang and Guizhi Jia Huangqi Tang formulas: The text states: Huang Han (Yellow Sweat) presents with bodily swelling, fever, sweating, and thirst, resembling Wind-water. Sweat stains clothes yellow like cypress juice, and the pulse is naturally Deep. How is it acquired? The Master said: Bathing in water while sweating allows water to enter through the pores. Huangqi Shaoyao Guizhi Kujiu Tang is the primary formula. Huang Han disease presents with cold feet; if fever occurs, it belongs to Li Jie (Joint Bi). Sweating after eating and night sweats indicate Lao Qi (Consumption Qi). If fever persists after sweating, the body will eventually become rough like fish scales. Persistent fever leads to malignant sores. If heaviness lightens after sweating, prolonged cases may develop abdominal pain. Sweating above the waist but not below, with flaccid pain in the lower back and hips, feeling like something is in the skin, severe cases involve inability to eat, body ache and heaviness, irritability, and difficult urination. This is Huang Han, treated with Guizhi Jia Huangqi Tang.

The two syndromes are largely similar. The first syndrome involves sweating due to insecure Wei Qi, allowing external water to interact with Ying, generating Heat. Severe Heat causes swelling and yellowing; it consumes fluids, causing thirst. Thus, Huangqi secures Wei, and Guizhi Tang plus Kujiu (Vinegar) guides the action into Ying to scatter Water-Cold. Since Wei deficiency causes sweating, it is not an exterior-releasing condition, so Jiang-Zao are omitted to avoid assisting Stomach Qi; reliance is placed solely on Huangqi's power to solidify Wei. The second formula uses the complete Guizhi Tang, drinking hot millet porridge to assist sweating, adding Huangqi to secure Wei. Due to fever and spontaneous/night sweats, Guizhi is used for fever, and Huangqi for excessive sweating. If fever persists after sweating, pathogens remain and must resolve from the exterior; sweating brings relief, and heaviness decreases. Prolonged abdominal/chest pain results from excessive sweating damaging exterior and chest Yang. Sweating above the waist but not below indicates Yang circulation but Yin blockage, causing upper-lower obstruction. Huangqi secures Yang, and Guizhi unblocks Yin. Huang Han and Li Jie are distinct: Yang Fire stagnating upward causes Huang Han; Yin Water accumulating downward causes cold calves. Yang Fire flourishing in muscles causes fever; Yin Cold penetrating bones and joints causes Li Jie pain. They share the same source but different manifestations. Sweating after eating occurs because food enters the growing Yang and interacts with Consumption Qi, dispersing as sweat; since the Qi Gates are not closed, fluids leak constantly, causing night sweats. "Jia Cuo" (rough skin) indicates dry, scaly skin. Persistent fever allows Heat to enter flesh and collaterals, forming abscesses. Flaccid hip pain feeling like an object in the skin corresponds to the *Neijing*'s description of Painful Bi aggravated by cold. Difficult urination results from fluids escaping through sweat. Inability to eat indicates Spleen-Stomach Qi deficiency failing to transform grain. Body heaviness indicates Wei Qi failing to warm the muscles. Irritability indicates Stomach Heat steaming upward to Heart and Lung. The methods for treating Huang Han are fully expounded here.

Discussion on the Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang and Zhizhu Tang formulas: The text states: For Qi Fen (Qi Division) disease, hardness below the heart, large as a plate, with edges like a turned cup, caused by water-fluid retention, Guizhi Qu Shaoyao Jia Mahuang Fuzi Tang is the primary formula. It also states: Hardness below the heart, large as a plate, with edges like a turned cup, caused by water-fluid retention, Zhizhu Tang is the primary formula. "Below the heart" refers to above the Stomach. If Stomach Yang Qi does not distribute, Yin of water-fluid occupies the area below the heart, becoming hard and large as a plate, blocking the smooth passage up and down, forcing circulation to the sides. This is caused by the failure of Yang Qi authority to extend. There are two Yin-Yang presentations. If Yang Qi is deficient and Yin Qi takes advantage, binding occurs below the heart. One must use Guizhi Tang removing Shaoyao (which moves inward/Yin) and add Mahuang, Fuzi, and Xixin to scatter Water-Cold in the chest. Since Shaoyin governs the interior, and Water-Cold enters from above, treatment follows the Shaoyin method of warming meridians and scattering cold. The formula notes: Recovery occurs when sweating feels like insects crawling under the skin. This shows that if Stomach Yang does not distribute, Chest Yang is also deficient. Chest Yang deficiency implies insecurity of exterior Wei Yang. Thus, during sweating, the sensation of insects crawling indicates stagnant Yang Qi. Without the powerful combination of Guizhi, Mahuang, Xixin, and Fuzi, could Water-Cold below the heart be scattered to the skin? Once Water-Cold is scattered, the heavy clouds clear, and the hardness below the heart vanishes; this is divine treatment. If Yang pathogens bind themselves in Yang positions without Yin-Cold invading above, using only Zhizhu (Zhishi and Baizhu) opens phlegm binding and strengthens Spleen-Stomach, making it easy to resolve Yang-pathogens in the Yang division.

Discussion on Haizang's Collection of Zhang Zhongjing's Water-Qi Examples: Haizang (Zhang Yuansu) was meticulous in treating edema. He posed questions on water-qis, investigating whether pulses were forceful or feeble, and distinguishing Zang (Deep) and Fu (Floating) pulses, summarizing medication principles. His intent was to elucidate the *Neijing* and Zhang Zhongjing, but his work essentially follows later conventions without substantial insight. He stated: "Height, depth, severity, exterior-interior; tonify and drain according to the meridian; carefully examine the Lung, Stomach, and Kidney meridians, and the disease will heal." This statement is concise but ultimately misses the mark. The *Neijing* clearly states that binding of the Three Yin leads to water. The Three Yin refers to Taiyin. Foot-Taiyin Spleen and Hand-Taiyin Lung, if Qi binds and fails to circulate, lead to water disease. Since the source of water comes from the Kidney, Foot-Shaoyin Kidney also governs it. Therefore, one should speak of Lung, Spleen, and Kidney, not Lung, Stomach, and Kidney. Why? The Stomach need not be singled out; it is the Sea of Grain and Water and the great source of the five Zang and six Fu organs. If the Spleen cannot scatter the water essence of the Stomach to the Lung, disease occurs in the middle. If the Lung cannot communicate the water pathways of the Stomach to the Bladder, disease occurs in the upper. If the Kidney cannot manage the Stomach's closing gate and regulate its discharge, disease occurs in the lower. Thus, water accumulates in the Stomach and spreads endlessly. Haizang mentioned Lung, Stomach, and Kidney, omitting the Spleen; he missed a crucial point in the profound principle, which need not be debated. His treatment examples still relied on Lung Deep/Large Intestine Floating and Heart Deep/Small Intestine Floating, which is a long-standing error. Did he not know that Zang and Fu organs each have their own Floating and Deep characteristics, and that the Large and Small Intestines should not be differentiated solely from the Upper Jiao? As for his collection of Zhang Zhongjing's water-q examples, he failed to penetrate the inner sanctum and instead included many heterodox views from outside. Zhang Zhongjing's discussion of miscellaneous diseases regarding water-q is extremely precise and detailed, fearing the failure of Foot-Taiyin Spleen transportation, Hand-Taiyin Lung regulation, Foot-Shaoyin Kidney gate opening, and Bladder Qi transformation. His prescribed formulas avoided the taboo of double deficiency, standing in a faultless position. Haizang took Zhang Zhongjing's Tingli Dazao Xiefei Tang for Lung Abscess as an example, intending to use lung-draining methods for draining water. He took Zhang Zhongjing's Shizao Tang for Cold Damage palpitations extending to both hypochondria and miscellaneous disease fluid retention in the hypochondria, intending to use thoracic-hypochondriac and bladder-draining methods for draining water. How dare he wield the knife under the pretext of Zhang Zhongjing? Moreover, he falsely attributed harsh post-Zhang water-draining drugs to Zhang Zhongjing, claiming Sanhua Shen Wan is Shizao Tang plus Qian Niu, Da Huang, and Qing Fen; Chushi Dan is Shen Wan plus Ruxiang and Moyao; Yuanqing Dan is Shen Wan plus Huanglian, Huangbai, and Qingdai. He collected Zhang Zhongjing's formulas to accommodate later ones, a crime unforgivable. Later practitioners imitated this, changing one or two ingredients to create new formulas, either injuring the Spleen, draining the Lung, or draining the Bladder, leading to catastrophic water accumulation and drowning, with no one regretting past medication errors, simply because this practice has existed for a long time. Among the hundreds of established formulas for water disease, none save Lung Qi depression and restore its regulation. None rescue Bladder obstruction and restore Qi transformation. Selecting a few formulas to explain for future reference, and improvising based on clinical judgment, is what is hoped for.