少阴脉紧而沉，紧则为痛，沉则为水，小便即难。脉得诸沉者，当责有水，身体肿重。
【按】脉得请沉者一条，乃始论水气病之脉，当列于篇首。但古本“脉得诸沉”之上，
有“少阴脉紧而沉……”四句，文义不属，并有脱简，不释。
【注】咳喘而不肿胀，谓之痰饮；肿重而不咳喘，谓之水气。沉脉得于诸部，身体不
肿重者，当责为气也；肿重者，当责有水也。以水蓄于里，故脉沉；水溢于表，故肿重也。
水病脉出者，死。
【注】水病肉肿，脉当不见，今脉出者，是气外散也，故死。
【集注】沈明宗曰∶脉得诸沉，沉为气郁，不行于表，则络脉虚，虚即水泛皮肤肌肉。故
身体肿重，当责有水。但沉为正水，而正水乃阴盛阳郁，脉必沉极，若陡见浮起，是真
气离根之象，故曰∶水病脉出者死。若风、皮二水脉浮洪，不在此例。
问曰∶病下利后渴饮水，小便不利，腹满阴肿者，何也？答曰∶此法当病水，若小
便自利及汗出者，自当愈。
【注】病下利则虚，其土伤其津也，土虚则水易妄行，津伤则必欲饮水？若小便自利
及汗出者，则水精输布，何水病之有？惟小便不利，则水无所从出，故必病水。病水者
脾必虚，不能制水，故腹满也；肾必虚，不能主水，故阴肿也。于此推之，凡病后伤津，
渴欲饮水，不便不利者，皆当防病水也。
【集注】程林曰∶病下利，则脾土衰而津液竭，故渴引饮；而土又不能制水，故小便
不利；脾恶湿，故腹满；肾主水，故阴肿。此为病水无疑。若小便利则水行，汗出则水散，
虽不药而亦自愈矣。
夫水病患，目下有卧蚕，而目鲜泽，脉伏，其人消渴。病水腹大，小便不利，其脉
沉绝者，有水可下之。
【按】其人消渴之下，古本有“病水腹大，小便不利，其脉沉绝者，有水可下之”四句，
与上文义不属，当另分为一条，在本门五条之次，始合里水脉证。
【注】目下窠，太阴也。目下微肿，水也。惟土不能制水，则水泛溢为病，故水始病必
先见微肿于目下也。有卧蚕状，水病证也；面目鲜泽，水病色也；沉甚脉伏，水病脉也；消
渴引饮，水病因也，此皆水病先见之征也。
【集注】赵良曰∶《内经》曰∶色泽者，病溢饮；溢饮者，渴而多饮，溢于肠胃之外。又
曰∶水阴，也，目下亦阴也，腹者至阴之所居也，故水在腹，便目下肿也。《灵枢》曰∶
水始起也，目下微肿如蚕，如新卧起之状，其人初由水谷不化津液，以成消渴，必多饮，多
饮则水积，水积则气道不宣，故脉伏矣。
沈明宗曰∶水外走则泛溢于皮肤肌肉，内
逆则浸淫于脏腑肠胃，相随胃脉上注于面，目下如卧蚕之状；水主明亮而光润，故面鲜泽，
为水病之验也，然水病因阳微阴盛，经隧不利，所以脉伏，而胃中津液水饮，外溢皮肤
肌肉，不溉喉舌，故作消渴，诚非真消渴也。
师曰∶诸有水者，腰以下肿，当利小便；腰以上肿，当发汗乃愈。
【注】诸有水者，谓诸水病也。治诸水之病，当知表里上下分消之法。腰以上肿者水
在外，当发其汗乃愈，越婢、青龙等汤证也；腰以下肿者水在下，当利小便乃愈，五苓、猪
苓等汤证也。
【集注】赵良曰∶身半以上，天之分，阳也；身半以下，地之分，阴也。而身之腠理
行天分之阳，小便通地分之阴。故水停于天者，开腠理而水从汗散；水停于地者，决其
出关而水自出矣。即《内经》开鬼门、洁净府法也。
尤怡曰∶发汗利小便，因其势而利导之也。
病水，腹大，小便不利，其脉沉绝者，有水，可下之。
【注】上条为水之在外、在下者立法也。若水在里者，非其治矣。腹者至阴脾也，故
病水必腹大也。水蓄于内，故小便不利也。其脉沉绝，即伏脉也。脉伏腹大，小便不利，里
水已成，故可下之。十枣、神 之类，酌而用之可也。
【集注】程林曰∶腹大者，为水在里，小便不利者，为水不行，是以脉必沉伏也，故
宜下之以利其水。
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。
【按】“越婢加术汤主之”七字，当在后“太阳病，脉浮而紧”条，“发汗即愈”之下，
文义始属。必是错简在此，观其里有水之文，自可知非越婢加术汤发表之药所能治矣。
【注】此承上条言里水未实，不可下、不可利之义也。里水者，谓里有水也。一身面
目黄肿，有水之证也；脉沉，有水之脉也。虽有是证脉，犹必渴而小便不利、腹大者，始
为里有水也。设不腹大满急，此里水未实，不可下也。若小便自利，此亡津液作渴，非里
有水作渴，亦不可利小便也。
【集注】尤怡曰∶里水，水从里积，与风
水不同，故其脉不浮而沉，而盛于内者，必溢于外，故一身面目悉黄肿也。水病小盒饭
不利，今反自利，则津液消亡，水病已，而渴病起矣。
越婢加术汤方（见下）
心下坚，大如盘，边如旋盘，水饮所作，枳实白术汤主之。
【注】心下坚，大如盘，边如旋盘，此里水所作也，似当下而不可下者，以坚大而不
满痛，是为水气虚结，未可下也。故以白术倍枳实，补正而兼破坚，气行则结开，两得
之矣。此里水不可下之和剂也。
【集注】赵良曰∶心下，胃上脘也。胃气弱，则所饮之水入而不消，痞结而坚，必强
其胃，乃可消痞。白术健脾强胃，枳实善消心下痞，逐停水，散滞气。
程林曰∶此证如盘而不如杯，是水饮散漫之状也。以散漫于心下如盘，不必辛热之
剂以发之。但用枳、术以散之，得腹中软而水自消矣。
沈明宗曰∶见心下坚大如盘，当审虚实寒热，脉之浮沉、迟数、大小为异，毋得执
方而误用也。
尤怡曰∶言水饮所作者，所以别于气分也。气无形以辛甘散之，水有形以苦泄之。
枳实白术汤方
枳实（七枚） 白术（二两）
上二味，以水五升，煮取三升，分温三服。腹中软即当散也。
【集解】李 曰∶枳实消胀，苦以泄之也；白术去湿，苦以燥之也。后张元素治痞用枳
术丸，亦从此汤化出。但此乃水饮所作，则用汤以荡涤之；彼属食积所伤，则用丸以消
磨之。一汤一丸，各有深意，非漫无主张也。
跗阳脉当伏，今反紧，本自有寒，疝瘕，腹中痛，医反下之，下之则胸满短气。跗阳
脉当伏，今反数，本自有热，消谷，小便数，今反不利，此欲作水。
【注】此明里有水兼寒兼热，误下之义也。里水脉伏，非谓三部脉皆当伏，乃谓跗阳胃
脉当伏也，若脉不伏反紧，其人必本自有寒也。水寒同病，则疝瘕腹中痛，医误以为里
水而下之。水去寒留，更虚其中，故胸满短气也。若脉不伏反数，其人必本自有热也。水
热同病，当消谷而小便数，不病水也，今小便反不利，此欲作水之病也。
【集注】赵良曰∶跗阳当伏者，非跗阳胃气之本脉也，为水蓄于下，其气伏，故脉亦
伏。脉法曰∶伏者为水。
魏荔彤曰∶跗阳有水邪，则当伏，以胃阳为衣，湿阴寒所固闭，故阳明之脉不出也，
今反紧，不惟水盛于里，而且寒盛于中矣。盖其人不止有水气之邪，而更兼平日有积寒疝
瘕，腹中常常作痛，水邪中又兼寒邪也。医者不识其为阴寒，乃以为水邪可下，虽水下
沉，而寒邪上逆，故胸满短气矣。此病跗阳脉当伏，今反数，为本自有热。然本自有热，
则当消谷，小便数，大便坚，如伤寒胃实之证也。今小便反不利，则知为欲作水，与湿
热之邪无疑也。
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。
【注】以上发明表里上下之水，以下发明五脏气血之水也。肝主筋，腹胁是其部也，水
邪干之，外则筋缓不能自转侧，内则腹大、胁痛，淋溲也。
【集注】魏荔彤曰∶肝水者，水附肝，则肝水也。肝经有水，必存两胁，故腹大而胁
下痛。少阳阴阳往来之道路，有邪窒碍，故不能自转侧。肝有水邪，必上冲胸咽，故时
时津液微生，及上升而下降，小便不利者又续通，此水邪随肝木往来升降之气上下为患
也。见此知肝经有水，当于肝脏治之也。
尤怡曰∶肝之府在胁，而气连少腹，肝之水不行，则腹大不能转侧，胁下腹痛也，时
时津液微生，小便续通者，肝喜冲逆而主疏泄，水液随之而上下也。
心水者，其身重，而少气不得卧，烦而躁，其人阴肿。
【按】“其人阴肿”四字，当在肾水条内，错简在此。
【注】心主脉，膻中是其部也。水邪干之，外则周身之脉不行，其身重也；内则少气心
烦，不得卧而躁也。
【集注】程林曰∶《内经》云∶心主身之血脉。《上经》曰∶水在心，心下坚筑短气，
是以身重少气也。《内经》曰∶诸有水病者，不得卧。夫心属火，水在心是以不得卧而烦
躁也。
魏荔彤曰∶夫水邪，亦积聚之类也。切近于其处，则伏留于是脏，即可以脏而名证。
水附于心，则心水也。心经有水，四肢百骸，皆可灌注，故身重；气为水邪所阻，故少气；
水邪逼处，神魂不安，故不得卧；神明扰乱，故躁而烦。见此知心经有水，当于心经治之
也。
脾水者，其腹大，四肢苦重，津液不生，但苦少气，则小便难。
【注】脾主腹，四肢是其部也。水邪干之，外则四肢苦重，内则腹大少气、小便难也。
【集注】魏荔彤曰∶脾水者，水附于脾，则脾水也。脾专主腹，故腹大，脾主旋运，又
主四肢，旋运不利，故四肢苦重。津液不生，气不行于上下，则阻碍不通，故上则苦少气，
下则小便难，见此知有水在脾，当于脾脏治水也。
尤怡曰∶脾主腹，而气行四肢，脾受水气则腹大，四肢重。津气生于谷，谷气运于
脾，脾湿不运，则津液不生而少气，小便难者，湿不行也。
肺水者，其身肿，小便难，时时鸭溏。
【注】肺主气，皮毛是其部也。水邪干之，外则周身皮肿，内则不输小便。大肠乃其府，
水走大肠，故鸭溏也。
【集注】赵良曰∶肺主皮毛，行荣卫与大，肠合，今有水病，则水充满皮肤。肺本通调
水道，下输膀胱为尿尿，今既不通，水不得自小便出，反从其合，与糟粕混成鸭溏也。
魏荔彤曰∶肺水者，水附于肺，则肺水也。肺主气，气引水行，亦能使之周身浮肿。
肺不肃则气化壅，故小便难，小便难则清浊不分，故便鸭溏，此知为有水在肺，当于肺
脏治水也。
尤怡曰∶鸭溏如鸭之后，水粪杂下也。
肾水者，其腹大脐肿，腰痛不得尿，阴下湿，如牛鼻上汗，其足逆冷，面反瘦。
【按】面反瘦之下，当有上条∶“其人阴肿”四字。
【注】肾主腰，足、阴是其部也。水邪干之，外则阴肿，阴下湿，足冷面瘦；内则腹
大脐肿，腰痛不得尿也。此五者，指水气等胀为言，故俱不喘咳也。
【集注】程林曰∶肾者，胃之关也，关门不利，故令聚水而生病，是以有腹大脐肿之
证也。腰者肾之外候，故令腰痛。膀胱者，肾之府，故冷不得尿也。以其不得尿，则水气
不得泄，浸渍于睾囊而为阴汗，流注于下焦而为足冷。夫肾为水脏，又被水邪，则上焦
之气血随水性而下趋，故其人面反瘦，非若风水里水之面目浮肿也。
魏荔彤曰∶肾水者，水附于肾，则肾水也。肾主少腹，少腹水湿固冱，故腹水脐肿
腰痛。腰以下俱肾主之也，水湿在下焦，膀胱之气反塞，故不惟小便难，而且竟不得尿。
阴寒下盛，故阴下湿如牛鼻上汗，冷而且粘，其足皆逆冷也。面乃阳之部位，下阴盛，上
阳衰，故面必瘦，见此知水在肾，当于肾脏
治水也。
尤怡曰∶身半以下，肾气主之，水在肾，则腰痛脐肿腹大也。不得尿，阴下湿如牛鼻
上汗，其足逆冷者，肾为阴，水亦为阴，两阴相得，阳气不行，而湿寒独胜也。面反瘦
者，面为阳，阴盛于下，则阳衰于上也。
师曰∶寸口脉沉而迟，沉则为水，迟则为寒，寒水相搏，跗阳脉伏，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。
【注】寸口，两寸也。脉沉而迟，沉则为水，迟则为寒，水寒相搏于胸中，则阳气不
运，故跗阳两关之脉伏而不起，水谷不化也。若脾气衰则 溏，胃气衰则身肿也。少阳右
尺脉陷下，少阴左尺脉细小，亦因寒水太甚，命火受制，故男子水精不化，小便为之不利，
女子血化为水，经水为之不通也，经血而曰经水者，以水为血之体也，女子以血为主，故
曰∶血分也。
【集注】赵良曰∶仲景脉法寸口多与跗阳合，何也？盖寸口属肺，手太阴之所过，肺
朝百脉，十二经各以其时，来见于寸口。脾、胃二经，出在右关。胃乃水谷之海，五脏皆
禀气于胃，则胃又五脏之本，所以经脉尤为诸经之要领也。邪或干于胃者，必再就跗阳
诊之。跗阳，胃脉之源也。
尤怡曰∶此合诊寸口跗阳，而知为寒水胜，而胃阳不行也。胃阳不行，则水谷不化，水
The Shao Yin pulse is tight and deep; tightness indicates pain, depth indicates water retention, and urination becomes difficult. When various pulses are found to be deep, one should attribute it to the presence of water, resulting in bodily swelling and heaviness.
[Commentary] The statement "When various pulses are found to be deep" discusses the pulse signs of Qi-Shui disease (Water-Qi Disease) at the beginning and should be placed at the start of the chapter. However, in ancient editions, above "When various pulses are found to be deep," there are four sentences: "The Shao Yin pulse is tight and deep..." which do not connect logically with the context, and there are missing bamboo slips that cannot be explained.
[Annotation] Coughing and wheezing without swelling is called Tan-Yin (Phlegm-Fluid Retention); swelling and heaviness without coughing and wheezing is called Shui-Qi (Water-Qi). If a deep pulse is found in various positions but the body is not swollen or heavy, it should be attributed to Qi stagnation; if the body is swollen and heavy, it should be attributed to Water retention. Because water accumulates internally, the pulse is deep; because water overflows externally, the body swells and feels heavy. If a patient with Water disease presents with a "pulse emerging" (sudden floating of a previously deep/hidden pulse), it is a sign of death.
[Annotation] In Water disease causing muscle swelling, the pulse should be hidden/deep. If the pulse emerges (becomes superficial/large and rootless), it indicates the dispersion of True Qi externally, hence fatal.
[Collected Annotations] Shen Mingzong said: Various deep pulses indicate Qi depression; Qi cannot circulate to the exterior, making the collaterals deficient. Deficiency leads to water flooding the skin and muscles. Thus, bodily swelling and heaviness indicate Water retention. However, Zheng-Shui (Orthodox Water, caused by Yin excess and Yang depression) has an extremely deep pulse. If it suddenly floats, it is a sign of True Qi leaving its root, hence "Water disease with emerging pulse is fatal." Feng-Shui (Wind Water) and Pi-Shui (Skin Water) have floating and full pulses, which are exceptions.
Question: After diarrhea, the patient feels thirsty and drinks water, has difficulty urinating, abdominal distension, and genital swelling. What is this? Answer: This condition should develop into Water disease. If urination becomes free and sweating occurs, it will heal spontaneously.
[Annotation] Diarrhea causes deficiency, damaging Spleen Earth and Body Fluids. When Earth is deficient, Water easily acts recklessly; when fluids are damaged, thirst for drinking arises. If urination is free and sweating occurs, Water essence can be distributed throughout the body, so no Water disease would occur. Only when urination is difficult does Water have no outlet, inevitably leading to Water disease. In Water disease, the Spleen is necessarily deficient and cannot control Water, causing abdominal distension; the Kidney is necessarily deficient and cannot govern Water, causing genital swelling. From this, we deduce that after illness, if Body Fluids are damaged, thirst arises, and urination is difficult, one must prevent Water disease.
[Collected Annotations] Cheng Lin said: Diarrhea causes Spleen Earth to decline and Body Fluids to dry up, leading to thirst and drinking. Since Earth cannot control Water, urination is difficult. Spleen dislikes dampness, so abdominal distension occurs. Kidney governs Water, so genital swelling occurs. This is undoubtedly Water disease. If urination is free, Water moves; if sweating occurs, Water disperses. Even without medicine, it will heal.
In patients with Water disease, there is a "silkworm-like" swelling under the eyes, the eyes appear bright and lustrous, the pulse is hidden (Fu), and the patient suffers from Xiao Ke (wasting-thirst). If the patient has Water disease with abdominal distension, difficulty urinating, and a deep/extinct pulse, indicating Water retention, purgatives may be used.
[Commentary] Below "the patient suffers from Xiao Ke," ancient editions have "If the patient has Water disease with abdominal distension, difficulty urinating, and a deep/extinct pulse, indicating Water retention, purgatives may be used." These four sentences do not connect logically with the preceding text and should be separated into a new clause, placed after the fifth clause of this section, to align with the pulse and symptoms of Li-Shui (Interior Water).
[Annotation] The area under the eyes belongs to the Tai Yin (Spleen). Slight swelling under the eyes indicates Water. Only when Spleen Earth cannot control Water does it overflow and cause disease; thus, early Water disease first shows slight swelling under the eyes. A silkworm-like shape is a sign of Water disease; bright and lustrous complexion is the color of Water disease; a very deep or hidden pulse is the pulse of Water disease; thirst and desire to drink are the etiology of Water disease. These are all early signs of Water disease.
[Collected Annotations] Zhao Liang said: *Nei Jing* states: Bright luster indicates Yi-Yin (Overflowing Fluid); Yi-Yin involves thirst and excessive drinking, with fluid overflowing outside the stomach and intestines. It also states: Water is Yin, and the area under the eyes is also Yin; the abdomen is the dwelling of Supreme Yin. Thus, when Water is in the abdomen, the under-eyes swell. *Ling Shu* states: When Water disease begins, the under-eyes swell slightly like a silkworm or like someone who just woke up. Initially, due to food and water failing to transform into fluids, Xiao Ke develops, leading to excessive drinking. Excessive drinking leads to water accumulation, which obstructs Qi channels, causing a hidden pulse.
Shen Mingzong said: When Water moves outward, it floods the skin and muscles; when it rebels inward, it infiltrates the Zang-Fu organs and stomach/intestines. Following the Stomach channel to the face, the under-eyes take on a silkworm-like shape. Water is bright and lustrous, so the face appears shiny, verifying Water disease. However, Water disease is caused by Yang deficiency and Yin excess, with blocked meridians, hence the hidden pulse. The fluids and water in the stomach overflow to the skin and muscles but fail to moisten the throat and tongue, causing false Xiao Ke (thirst), which is not true Xiao Ke disease.
The Master said: For all cases of Water disease, if swelling is below the waist, promote urination; if swelling is above the waist, induce sweating to achieve cure.
[Annotation] "All cases of Water disease" refers to various Water diseases. To treat them, one must know the methods of resolving Water from the exterior, interior, upper, and lower aspects. Swelling above the waist indicates Water in the exterior; inducing sweat cures it, as seen in Yuebi Tang and Qinglong Tang patterns. Swelling below the waist indicates Water in the lower jiao; promoting urination cures it, as seen in Wuling San and Zhuling Tang patterns.
[Collected Annotations] Zhao Liang said: The upper half of the body corresponds to Heaven and Yang; the lower half corresponds to Earth and Yin. The pores circulate the Yang of Heaven, while urination connects to the Yin of Earth. Thus, Water stopping in the upper part is resolved by opening pores to disperse via sweat; Water stopping in the lower part is resolved by opening outlets to discharge via urine. This is the *Nei Jing* method of "opening ghost gates (pores) and cleansing the residence (bladder)."
You Yi said: Inducing sweat and promoting urination is guiding the pathogen out according to its tendency.
In Water disease, with abdominal distension, difficulty urinating, and a deep/extinct pulse, indicating Water retention, purgatives may be used.
[Annotation] The previous clause established treatment for Water in the exterior and lower jiao. If Water is in the interior, this treatment does not apply. The abdomen is the Supreme Yin location of the Spleen, so Water disease必然 causes abdominal distension. Water accumulating internally causes difficulty urinating. A deep/extinct pulse is a Fu (hidden) pulse. With a hidden pulse, abdominal distension, and difficulty urinating, Interior Water is established, so purgatives may be used. Shizao Tang (Ten Date Pill) or Shenyuan Wan may be used with discretion.
[Collected Annotations] Cheng Lin said: Abdominal distension indicates Water in the interior; difficulty urinating indicates Water stagnation, hence the pulse must be deep and hidden. Therefore, purgatives are suitable to drain the Water.
Li-Shui (Interior Water) presents with generalized yellowish swelling of the body and face, a deep pulse, and difficulty urinating, thus causing Water disease. If urination is spontaneous and free, this indicates loss of Body Fluids, causing thirst. Yuebi Jia Zhu Tang (Yuebi Decoction plus Atractylodes Macrocephala) is the primary formula.
[Commentary] The seven characters "Yuebi Jia Zhu Tang is the primary formula" should be placed after "Induce sweating and it will heal" in the subsequent clause "Tai Yang disease, pulse floating and tight." The logic would then connect. This is likely a misplaced slip. Given the text mentions "Water in the interior," it is clear that Yuebi Jia Zhu Tang, a formula for releasing the exterior, cannot treat this condition.
[Annotation] This follows the previous clause to explain that Interior Water is not yet solid/excess, so it cannot be treated with purgatives or diuretics. Li-Shui means Water in the interior. Generalized yellowish swelling of the body and face is a sign of Water; a deep pulse is a pulse of Water. Although these signs and pulses exist, only if accompanied by thirst, difficulty urinating, and abdominal distension is it truly Interior Water. If there is no abdominal fullness or urgency, the Interior Water is not solid, and purgatives are contraindicated. If urination is free, the thirst is due to lost Body Fluids, not Water in the interior, so diuretics are contraindicated.
[Collected Annotations] You Yi said: Li-Shui is Water accumulating from the interior, different from Feng-Shui (Wind Water), so the pulse is deep rather than floating. Internal excess overflows externally, causing generalized yellowish swelling of the body and face. Water disease usually involves difficulty urinating; if it is now free, Body Fluids are consumed. The Water disease resolves, but thirst disease arises.
Yuebi Jia Zhu Tang Formula (see below)
Stiffness in the epigastrium, large as a plate, with edges like a rotating plate, caused by Water-Drink, is primarily treated with Zhishi Baizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction).
[Annotation] Stiffness in the epigastrium, large as a plate, with edges like a rotating plate, is caused by Interior Water. It seems like it should be purged, but cannot be, because although hard and large, it is not painful or full. This is a deficiency-type binding of Water-Qi, so purgatives are not applicable. Therefore, using twice as much Baizhu as Zhishi tonifies the Righteous Qi while breaking the stiffness. When Qi moves, the binding opens, achieving both goals. This is a harmonizing formula for Interior Water when purgatives are contraindicated.
[Collected Annotations] Zhao Liang said: "Epigastrium" refers to the upper part of the Stomach. Weak Stomach Qi fails to digest ingested water, leading to stagnation, hardness, and stiffness. One must strengthen the Stomach to eliminate the stagnation. Baizhu strengthens the Spleen and Stomach; Zhishi eliminates epigastric fullness, expels retained water, and dissipates stagnant Qi.
Cheng Lin said: This condition resembles a plate rather than a cup, indicating a diffuse state of Water-Drink. Since it is diffuse in the epigastrium like a plate, harsh acrid-hot formulas for release are unnecessary. Using Zhishi and Baizhu to dissipate it will result in a soft abdomen and natural resolution of Water.
Shen Mingzong said: Upon seeing epigastric stiffness large as a plate, one must examine deficiency/excess and cold/heat, distinguishing by pulse floating/sinking, slow/rapid, and large/small. Do not rigidly adhere to one formula and misuse it.
You Yi said: Specifying "caused by Water-Drink" distinguishes it from Qi-Bian (Qi Division) disease. Qi is formless and dispersed with acrid-sweet herbs; Water has form and is drained with bitter-purgative herbs.
Zhishi Baizhu Tang Formula
Zhishi (Immature Bitter Orange) (7 pieces) Baizhu (Atractylodes Macrocephala Rhizome) (2 liang)
These two ingredients are boiled in 5 sheng of water to yield 3 sheng. Divide into three warm doses. When the abdomen becomes soft, the pathogen will dissipate.
[Collected Commentary] Li Gao said: Zhishi reduces distension using bitterness to drain downward; Baizhu removes dampness using bitterness to dry. Later, Zhang Yuansu derived Zhizhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) for treating fullness from this decoction. However, this decoction treats Water-Drink, using liquid to wash away pathogens; the pill treats Food Stagnation, using solid form to grind down pathogens. One decoction, one pill, each has profound meaning, not arbitrary.
The Fuyang pulse should be hidden (Fu); now it is instead tight. The person inherently has Cold, Hernia-Jia (masses), and abdominal pain. The physician incorrectly used purgatives, resulting in chest fullness and shortness of breath. The Fuyang pulse should be hidden; now it is instead rapid. The person inherently has Heat, consumes food quickly, and urinates frequently. Now urination is instead difficult; this indicates impending Water disease.
[Annotation] This clarifies the principle of misusing purgatives in Interior Water complicated by Cold or Heat. Interior Water pulses should be hidden, not meaning all three positions are hidden, but specifically the Fuyang (Stomach) pulse should be hidden. If the pulse is not hidden but tight, the person inherently has Cold. Water and Cold combined cause Hernia-Jia and abdominal pain. The physician mistakenly purges assuming Interior Water. Water leaves, Cold remains, further weakening the Middle Jiao, causing chest fullness and shortness of breath. If the pulse is not hidden but rapid, the person inherently has Heat. Water and Heat combined should cause efficient digestion and frequent urination, not Water disease. Now urination is difficult, indicating impending Water disease.
[Collected Annotations] Zhao Liang said: The Fuyang pulse should be hidden not because it is the normal Stomach Qi pulse, but because Water accumulates below, suppressing Qi, so the pulse hides. Pulse methodology states: Hidden pulses indicate Water.
Wei Litong said: Fuyang has Water pathogen, so it should be hidden. Stomach Yang is sealed by damp-cold Yin, so the Yangming pulse does not emerge. Now it is tight, indicating not only Water abundance internally but also Cold abundance in the Middle. This person likely has chronic Cold Hernia-Jia with frequent abdominal pain, combining Water pathogen with Cold pathogen. The doctor failed to recognize Yin-Cold and assumed Water could be purged. Although Water sinks, Cold rebels upward, causing chest fullness and shortness of breath. Regarding the case where Fuyang pulse should be hidden but is now rapid: this is due to inherent Heat. Inherent Heat should cause efficient digestion, frequent urination, and hard stool, resembling Taiyang Stomach Excess syndrome. Now urination is difficult, indicating impending Water disease, undoubtedly due to Damp-Heat pathogen.
Gan-Shui (Liver Water) presents with abdominal distension, inability to turn oneself over, hypochondriac and abdominal pain, occasional slight production of saliva, and intermittent urination.
[Annotation] The above clarified Exterior/Interior and Upper/Lower Water; below clarifies Water related to the Five Zang Organs and Qi/Blood. The Liver governs sinews, and the abdomen/hypochondrium are its domains. Water pathogen invading externally causes flaccid sinews and inability to move; internally causing abdominal distension and hypochondriac pain, and urinary dribbling.
[Collected Annotations] Wei Litong said: Gan-Shui is Water attaching to the Liver. Water in the Liver meridian stays in the hypochondrium, causing abdominal distension and hypochondriac pain. The Shaoyang pathway for Yin-Yang exchange is obstructed by pathogen, causing inability to turn over. Liver Water rebels upward to the chest/throat, causing occasional saliva production. As it rises and falls, urination becomes difficult then temporarily patent. This is Water pathogen causing harm following the Liver Wood's ascending/descending Qi. Seeing this indicates Water in the Liver meridian; treat the Liver organ.
You Yi said: The Liver's mansion is in the hypochondrium, connected to the lower abdomen. When Liver Water stagnates, abdominal distension and inability to turn occur, along with hypochondriac/abdominal pain. Occasional saliva and intermittent urination occur because the Liver likes rebellion and governs free flow; Water flows up and down with it.
Xin-Shui (Heart Water) presents with heavy body, shortness of breath, inability to lie down, irritability, restlessness, and genital swelling.
[Commentary] The four characters "genital swelling" belong in the Shen-Shui (Kidney Water) clause; this is a misplaced slip.
[Annotation] The Heart governs vessels, and the Danzhong (Chest Center) is its domain. Water pathogen invading externally blocks vessels throughout the body, causing heaviness; internally causing shortness of breath, heart vexation, inability to lie down, and restlessness.
[Collected Annotations] Cheng Lin said: *Nei Jing* states: The Heart governs blood vessels in the body. *Shang Jing* states: Water in the Heart causes hardness/palpitations in the epigastrium and shortness of breath, hence heavy body and shortness of breath. *Nei Jing* states: All Water disease patients cannot lie down. The Heart belongs to Fire; Water in the Heart causes inability to lie down, irritability, and restlessness.
Wei Litong said: Water pathogen is a type of accumulation. When close to a location, it lodges in that Zang organ, named accordingly. Water attaching to the Heart is Xin-Shui. Water in the Heart meridian permeates limbs and bones, causing heaviness; Qi is blocked by Water, causing shortness of breath; Water pressure disturbs the Spirit, causing inability to lie down; confusion of Mind causes restlessness. Seeing this indicates Water in the Heart meridian; treat the Heart meridian.
Pi-Shui (Spleen Water) presents with abdominal distension, heavy limbs, lack of saliva/fluids generation, distress from shortness of breath, and difficult urination.
[Annotation] The Spleen governs the abdomen, and the limbs are its domain. Water pathogen invading externally causes heavy limbs; internally causing abdominal distension, shortness of breath, and difficult urination.
[Collected Annotations] Wei Litong said: Pi-Shui is Water attaching to the Spleen. The Spleen governs the abdomen, hence distension. The Spleen governs rotation/transformation and the limbs. Poor transformation causes heavy limbs. Lack of fluid generation and Qi failure to move up/down causes obstruction, leading to upper shortness of breath and lower difficult urination. Seeing this indicates Water in the Spleen; treat Water in the Spleen organ.
You Yi said: The Spleen governs the abdomen, and Qi moves through the limbs. Spleen affected by Water causes abdominal distension and limb heaviness. Fluids/Qi are generated from grain, transported by the Spleen. Spleen dampness fails to transport, so fluids are not generated, causing shortness of breath. Difficult urination is due to dampness stagnation.
Fei-Shui (Lung Water) presents with bodily swelling, difficult urination, and frequent duck-like loose stools.
[Annotation] The Lung governs Qi, and the skin/hair are its domain. Water pathogen invading externally causes whole-body skin swelling; internally failing to distribute fluids to urinate. The Large Intestine is its Fu organ; Water entering the Large Intestine causes duck-like loose stools.
[Collected Annotations] Zhao Liang said: The Lung governs skin/hair, circulates Ying/Wei, and combines with the Large Intestine. With Water disease, water fills the skin. The Lung normally regulates water passages, sending fluids down to the Bladder as urine. Now regulation fails; water cannot exit via urine, instead exiting through its paired Large Intestine, mixing with waste to form duck-like stools.
Wei Litong said: Fei-Shui is Water attaching to the Lung. The Lung governs Qi; Qi guides Water movement, causing generalized swelling. Lung fails to descend, causing Qi stagnation and difficult urination. Difficult urination leads to unclear/turbid separation, causing duck-like stools. Seeing this indicates Water in the Lung; treat Water in the Lung organ.
You Yi said: Duck-like stool is water and feces mixed together.
Shen-Shui (Kidney Water) presents with abdominal distension, umbilical swelling, lower back pain, inability to urinate, dampness under the genitals (like sweat on a bull's nose), cold feet, and a thin/emaciated face.
[Commentary] Below "face thin/emaciated," the four characters "genital swelling" from the previous clause should be inserted.
[Annotation] The Kidney governs the lower back, feet, and genitals, which are its domains. Water pathogen invading externally causes genital swelling, dampness under genitals, cold feet, and thin face; internally causing abdominal distension, umbilical swelling, lower back pain, and inability to urinate. These five points refer to swelling/distension from Water-Qi, hence no coughing/wheezing.
[Collected Annotations] Cheng Lin said: The Kidney is the gate of the Stomach. If the gate is unregulated, Water gathers and causes disease, leading to abdominal distension and umbilical swelling. The lower back is the external manifestation of the Kidney, hence back pain. The Bladder is the Mansion of the Kidney, hence coldness and 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 the Water Organ; invaded by Water pathogen, Upper Jiao Qi/Blood sink with the nature of Water, causing the face to become thin, unlike the facial swelling of Feng-Shui or Li-Shui.
Wei Litong said: Shen-Shui is Water attaching to the Kidney. The Kidney governs the lower abdomen; Water-dampness freezes there, causing abdominal water, umbilical swelling, and back pain. The lower 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 bull-nose sweat (cold and sticky), and cold feet. The face is a Yang region; Yin abundance below leads to Yang deficiency above, so the face becomes thin. Seeing this indicates Water in the Kidney; treat Water in the Kidney organ.
You Yi said: The lower half of the body is governed by Kidney Qi. Water in the Kidney causes back pain, umbilical swelling, and abdominal distension. Inability to urinate, genital dampness like bull-nose sweat, and cold feet occur because the Kidney is Yin, Water is Yin; two Yins combine, Yang Qi cannot move, and Damp-Cold prevails. The face becomes thin because the face is Yang; Yin abundance below leads to Yang deficiency above.
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 water are not digested, Spleen Qi decline causes undigested stool (Sun-Xie), Stomach Qi decline causes bodily swelling. The Shaoyang pulse is low/subdued, the Shao Yin pulse is fine/thin. In men, urination is difficult; in women, menstruation is blocked. Menstruation is Blood; if Blood does not flow freely, it transforms into Water, named Xue-Fen (Blood Division).
[Annotation] Cun Kou refers to the Cun position of both wrists. Deep and slow pulse: deep indicates Water, slow indicates Cold. Water and Cold contend in the Chest/Middle, Yang Qi fails to circulate, so the Fuyang pulses at both Guan positions are hidden and inactive, failing to digest food/water. If Spleen Qi declines, undigested stool occurs; if Stomach Qi declines, bodily swelling occurs. Shaoyang (Right Chi) pulse is sunken/subdued; Shao Yin (Left Chi) pulse is fine/thin, also due to excessive Cold-Water suppressing Mingmen Fire. Thus, in men, Water Essence fails to transform, causing difficult urination; in women, Blood transforms into Water, causing menstrual blockage. Calling menstruation "Jing-Shui" (Menstrual Water) is because Water is the substance of Blood; women prioritize Blood, hence named Xue-Fen (Blood Division).
[Collected Annotations] Zhao Liang said: Zhang Zhongjing's pulse diagnosis often combines Cun Kou with Fuyang. Why? Cun Kou belongs to the Lung, passing through the Hand-Taiyin. The Lung directs all vessels; the twelve meridians appear at Cun Kou at their respective times. Spleen and Stomach meridians appear at the Right Guan. The Stomach is the Sea of Food/Water; all Zang organs receive Qi from the Stomach, making it the root of the Five Zang organs. Thus, the meridians are the key to all vessels. If pathogen invades the Stomach, one must also diagnose Fuyang. Fuyang is the source of the Stomach pulse.
You Yi said: This combines diagnosing Cun Kou and Fuyang to know that Cold-Water is victorious and Stomach Yang fails to move. Stomach Yang failing to move means food/water are not digested, water...