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Yu Jiayan said: Among the mechanisms of disease, those most relevant to human beings are water and fire. Water overflows in the exterior and interior, while fire travels through the Sanjiao (Triple Burner). Is there no theory to address this? When Qi stagnates in the Three Yang meridians, it is called "Xiao" (Wasting-Thirst); when Qi stagnates in the Three Yin meridians, it is called "Shui" (Edema). Heat stagnation in the Hand-Foot Yangming meridians leads to Wasting-Thirst; the harm of fire has already been discussed.

As for the Three Yin meridians, they refer to the Spleen and Lung organs associated with the Foot-Taiyin and Hand-Taiyin meridians. The Stomach is the sea of water and grain; water diseases essentially originate from the Stomach. Why does the classic text attribute them to the Spleen and Lung? If the Foot-Taiyin Spleen is sufficient to transport water essences upward, and the Hand-Taiyin Lung is sufficient to regulate water passages downward, the sea of water would remain calm. However, because the Qi of the Spleen and Lung stagnates and fails to move, water in the Stomach accumulates, flooding both the exterior and interior without limit. Thus, how can the authority of the Spleen and Lung fail to be exerted?

Nevertheless, their authority is particularly dependent on the Kidney. The Kidney is the gatekeeper of the Stomach. The Kidney governs opening and closing. When Kidney Qi follows Yang, it opens; if Yang is too excessive, the gate opens wide, causing water to flow down directly as Wasting-Thirst. When Kidney Qi follows Yin, it closes; if Yin is too excessive, the gate remains closed, causing water retention and edema. The classic states that the Kidney is the root and the Lung is the branch, mutually transmitting and receiving pathology. Therefore, water diseases have the Spleen, Lung, and Kidney as their three main principles. The details within these principles are particularly difficult to distinguish clearly.

The *Jingui Yaolue* lists five types of water diseases and their corresponding Zang-Fu relationships: Fengshui (Wind Edema), Zhengshui (True Edema), Pishui (Skin Edema), Shishui (Stone Edema), and Huanghan (Yellow Sweat). Although Fengshui, Pishui, and Huanghan involve the Kidney, they belong to the Yang aspect. In contrast, Zhengshui and Shishui are water of the Yin aspect; all treatments targeting the Yang aspect are ineffective here.

Zhengshui presents with a deep and slow pulse, and external symptoms include spontaneous asthma. This is because the Kidney (Water organ of North Ren-Gui) is diseased itself, hence the deep and slow pulse. The Kidney stores water, and the Lung generates water; disease in the child affects the mother, leading to external asthma. The *Neijing* states: "The Kidney is the gate of the Stomach. If the gate is not functioning properly, water accumulates and becomes pathological, overflowing up and down into the skin, causing edema of the dorsum of the foot and abdominal distension. Upward, it causes panting and inability to lie flat." The name Zhengshui in the *Jingui Yaolue* is likely derived from this.

Shishui presents with a naturally deep pulse, and external symptoms include abdominal fullness without asthma. This is because Kidney Qi merges with water and remains immobile, resulting in a deep pulse. Water accumulates in the Bladder's Bao (Uterus/Bladder region), causing only lower abdominal fullness and hardness. Since Qi does not ascend to the Lung, there is no asthma. The *Neijing* states: "Yin-Yang stagnation and deviation, with Yin exceeding Yang, is named Shishui." It also says: "When both Kidney and Liver pulses are deep, it is Shishui," because the Qi of both the Liver and Kidney penetrates into the Bao. However, since Shishui involves both the Liver and Kidney, excessive Kidney Qi leads to lower stagnation difficult to ascend, while excessive Liver Qi carries water upward to invade the Stomach boundary, which is inevitable. Later generations, failing to observe carefully, often used harsh methods to treat water diseases; can this be considered wise?

If water resides in the Heart region, it stifles the bright transformation of Heart Fire; in the Liver region, it stifles the generating transformation of Liver Wood; in the Lung region, it exhausts solitary Yang externally, leaving the Hun (Ethereal Soul) isolated; in the Spleen region, it depletes Yin internally, preventing the distribution of grain essence; in the Kidney region, not only do all Yang retreat and hide, but even the Yin that follows Yang retreats, leaving solitary Yang isolated below and cut off.

Therefore, regarding water in the Stomach, one must fear fire; if fire exists, it still belongs to Wasting-Thirst, eventually progressing to untreatable middle-fullness. Regarding water in the Kidney, one must fear the lack of fire; without fire, True Yang extinguishes, and the source of life is severed internally.

Water in the Heart suppresses Sovereign Fire; if the Spleen Earth functions vigorously, the child will save the mother. Even if water is in the Liver, Lung, or Kidney, once Spleen Earth is robust, water is controlled and dares not rampage. Thus, during times of floodwaters surging over mountains, seeking to use Earth to cultivate crops, who else but Dayu (Yu the Great) and Zhang Zhongjing should we follow?

The Stomach is the sea of water and grain, the great source of the Five Zang and Six Fu organs. If the Spleen cannot scatter the Stomach's water essences to the Lung, disease arises in the Middle Jiao; if the Lung cannot regulate the Stomach's water passages to the Bladder, disease arises in the Upper Jiao; if the Kidney cannot manage the Stomach's gate to control its transport and excretion, disease arises in the Lower Jiao. Thus, water accumulation in the Stomach floods without end.

Zhang Zhongjing's discussion of miscellaneous diseases in the category of Water Qi is extremely precise and detailed. He feared the failure of the Foot-Taiyin Spleen's transportation, the dysfunction of the Hand-Taiyin Lung's regulation, the closure of the Foot-Shaoyin Kidney's gate, and the failure of the Bladder's Qi transformation. Therefore, his prescriptions avoid the prohibition of double deficiency, standing in a position of no fault.

Later treatments either damage the Spleen or drain the Lung, or drain the Bladder. Among the hundreds of established formulas for water diseases, none can rescue Lung Qi depression and restore its regulatory function; none can rescue Bladder obstruction and restore its Qi transformation. Zhang Congzheng (Haicang)'s questions on water qi and general medication principles, upon examination, are merely clichés of later generations, let alone others.

Zhang Jingyue stated: All edema syndromes are diseases involving the mutual interaction of the Spleen, Lung, and Kidney. Lung deficiency leads to Qi failing to transform essence into water; Spleen deficiency leads to Earth failing to control Water and being counter-attacked; Kidney deficiency leads to Water having no master and acting recklessly. Water not returning to its channels rebels and overflows upward, entering the Spleen to cause muscle edema, and entering the Lung to cause rapid breathing. Separately, each of the three Zang has its specific domain; collectively, it is always due to the harm of Yin excess, with the root of the disease residing in the Kidney.

The classic states: "The Kidney is the gate of the Stomach. If the gate is not functioning properly, water accumulates according to its kind." But why is the gate not functioning? The classic states: "The Bladder is the official of the reservoir, storing body fluids; Qi transformation allows them to exit." What is meant by Qi transformation is the Qi within the Kidney, i.e., Fire within Yin. Without Yang within Yin, Qi cannot transform, so water passages are blocked, overflowing to cause edema. Therefore, treating edema requires the movement of True Qi in the Lower Jiao to enable transmission and transformation; only when True Water in the Lower Jiao is in its proper place can clarity be restored.

Seeking ancient methods, only Xue Lizhai's Modified Shenqi Tang is truly symptomatic. Although this is a formula to nourish Water, it is the direct treatment for the Spleen, Lung, and Kidney. The Kidney is the source of congenital vital energy. If congenital Yuan Qi is deficient below, postnatal Stomach Qi loses its foundation, affecting the Spleen and then the Lung, causing failure of regulation and resulting in asthma and distension. One should strongly tonify the Mingmen (Gate of Life) to restore Qi, after which the three Zang will naturally settle. The formula uses Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) to transform Yang within Yin, Shudihuang (Prepared Rehmannia Root), Shanyao (Dioscorea Rhizome), and Niuxi (Achyranthes Root) to nourish Water within Yin, and Fuling (Poria), Zexie (Alisma Rhizome), and Cheqianzi (Plantago Seed) to drain stagnation within Yin. This enables Qi to transform from Essence, thereby treating the Lung; it supplements Fire to generate Earth, thereby treating the Spleen; it strengthens Water to open orifices, thereby treating the Kidney. It tonifies without stagnation and drains without damaging; it is indeed the premier among all formulas.

If the syndrome is entirely caused by Spleen and Stomach insufficiency leading to swelling, formulas such as Sijunzi Tang (Four Gentlemen Decoction) or Guipi Tang (Restore the Spleen Decoction) are suitable, but must be combined with tonifying the Mingmen. People know that Earth controls Water, but do not know that solid Yang controls Yin; they know Qi transforms into Essence, but do not know Essence transforms into Qi. Tonifying the mother when deficient refers to this principle.

For Spleen and Kidney deficiency syndromes, using Shenqi Tang is indeed good. However, in cases of severe Spleen and Kidney deficiency, simultaneously using draining and leaching herbs inevitably reduces the tonifying power, similar to patching a sieve; the Yuan Qi ultimately cannot recover. Only by using Renshen (Ginseng Root) and Fuzi to regulate Yin, along with large doses of Baizhu (Atractylodes Macrocephala Rhizome), is it effective. For treating total deficiency, using this method yields consistent efficacy. Using obstruction to treat obstruction is the highest approach.