（论七首脉证五条方九首）
师曰。病有风水。有皮水。有正水。有石水。有黄汗。风水其脉自浮。外证骨节疼痛。恶
风。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。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。
〔衍义〕风水者。肾本属水。因风而水积也。内经大奇病论曰。并浮为风水。注以浮
脉为风水。脉浮下焦。主水风搏于下。故曰风水。水热穴论曰。肾至阴。勇而劳甚。
则肾汗出。逢于风。内不入于脏腑。外不越于肌肤。客于玄府。行于皮里。传为
肿。本之于肾。名曰风水。评热病论曰。肾风。面 庞然壅害于言。不当刺而刺。后
五日。其气必至。至必少气时热。热从胸背上至头。汗出。手热。口干。小便黄。目下
肿。腹中鸣。身重。难以转侧。月事不来。烦不能正偃。正偃则咳。名曰风水。今只言
外证骨节痛恶风。不言 肿。肾外合于骨。水则病骨。肝外合于筋。风则筋束。关
节。故骨节痛。脉浮恶风者。知其风水之证在表耳。皮水者。皮肤 肿也。灵枢曰。
腹胀者。寒气客于皮肤间。 然不坚。腹大身尽肿。皮浓。按其腹。 而不起。腹
色不变。巢氏病源。则以皮水者。腹如故而不渴。与灵枢异。盖肺主气以行荣卫。
外合皮毛。皮毛病甚。则肺气 郁。荣卫停滞不行。然肺气之满。异于他邪。气虽
成水。终本轻清。故 然不坚。按之没指。腹亦 而不起。玄府闭塞而不恶风。
郁火燥其液而不渴。当发其汗。散皮毛之邪。外气通而郁解矣。此开鬼门也。正
水者肾主水。肾经之水自病也。内经曰。肾者胃之关。关不利。故聚水成病。上下
溢于皮肤。 肿胀大。上为喘呼不得卧。标本俱病也。石水者。乃水积小腹。胞内
坚满如石。内经曰。阴阳结邪。阴多阳少。名曰石水。又曰。肾肝并沉为石水。注曰。
肝脉入阴。内贯小腹。肾脉贯脊中。络膀胱。两脏并藏。气熏冲脉。自肾下入于胞。
今水不行。故坚而结。然肾主水。水冬冰。水宗于肾。肾象水而沉。名曰石水。因水
积胞内。下从足手少阴上逆于肺而为喘。巢氏病源石水者。引两胁下胀痛。或
上至胃脘则死。看来上条虽同为石水。与此条少异。此偏于肾气多。肾为阴。阴
主静。故病只在下而不动。彼则偏于肝气多。肝为阳。主动。故上行克胃脘也。黄
汗者病水。身黄汗出如柏汁。自后条诸证各有所致。其因不一。大抵黄色属土。
由阳明胃热。故色见于外。今之发热胸满。四肢头面肿者。正属足阳明经脉之
证也。热久在肌肉。故化痈脓。若巢氏云。疸水因脾胃有热。流于膀胱。小便涩而
身面大黄。腹满如水状。此亦黄汗之一也。
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。痒者为泄风。
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。
〔衍义〕风者外感之风也。气者荣卫之气也。风乃阳邪。从上受之。故脉浮。荣卫得
风而热。故脉洪。洪、大也。内经曰。脉大则病进。由邪之盛耳。荣行脉中主血。卫行
脉外主气。风强者。风得热而强也。风热入搏于卫。客于皮里。气滞郁聚而风鼓
之为瘾疹。火复助风。腠理开。毫毛摇。则身体痒。痒为泄风。内经曰。诸痛疮疡。皆
属于火。又曰。风气外在腠理。则为泄风。久之不解。风入分肉间。相搏于脉之内
外。气道涩而不利。与卫相搏。则肌肉 而疮出。风入脉中。内攻荣血。风气合
热而血 坏。遂为痂癞也。内经曰。风气与太阳俱入。行诸脉俞。散于分肉之间。
与卫气相干。其道不行。使肌肉 之而有疡。又曰。脉风成厉。厉即癞也。所谓
气强者。卫因热则怫郁。停而不行。气水同类。气停则水生。所聚之液血皆化水
也。不惟荣卫不能和。筋骨肌肉郁热之邪。且禁固。难俯仰也。至于风气复行相
击。荣卫之热与水。皆散溢于肌表。而为洪肿。及风气两解。则水散卫行。汗出乃
愈。恶风者。不敌于风。与水同为汗散而表虚。因名风水。不恶风者。卫气不从汗
散。外得固腠理。则不恶而得固上焦。则小便通利。所谓上焦有寒者。因风邪在
上焦。非真有寒冷也。如伤寒证邪客上焦。则中焦之谷气。不得上输于肺。郁为
内热。津液凝积为胃热。热则廉泉开。廉泉者。津液之道也。开则发。涎出流于唇
口。此黄汗由身倦浮肿。胃热发出土色也。
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。微拥如蚕新
卧起状。其颈脉动。时时咳。按手足上。陷而不起者。风水。
〔衍义〕内经脉沉曰水。脉滑曰风。面肿曰风。目肿如新卧起之状曰水。颈脉动喘
咳曰水。又肾风者。面 庞然。少气时热。其有 肿者。亦曰本于肾。名风水。皆出内经也。
太阳病。脉浮而紧。法当骨节疼痛。反不疼。身体反重而酸。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。身肿而冷。状如周
痹。胸中窒。不能食。反聚痛。暮躁不得眠。此为黄汗。骨节痛。咳而喘。不渴者。此为肺
胀。其状如肿。发汗则愈。然诸病此者。渴而下利。小便数者。皆不可发汗。
〔衍义〕伤寒论。脉浮而紧者。为风寒。风伤卫。寒伤荣。荣卫俱病也。荣卫者。胃之谷
气所化。从手太阳所出。循行表里。在外则荣筋骨。温皮肉。在内则贯五脏。络六
腑。故浮沉变脉。皆见于寸口。此条首言太阳病脉紧为太阳属表。荣卫所受风
水。随在诸经四属。隶于太阳之表者。分出六等。于肝脏所合。则骨节痛。若风水
挟木克土。脾合肌肉。则肌肉不利。骨节反不痛。身体重而酸。内经曰。土不及。则
体重而筋肉 酸也。因不渴则可发汗。汗则邪散乃愈。此由风胜水也。亦名风
水。其汗皆生于气。气生于精。精气若不足。辄发其汗。风水未散。而荣卫之精。先
从汗散。遂致虚极。不能温腠理。故恶寒也。若发汗辛热之味。上冲于肺。亡其津
液。则肺燥而渴。荣卫不虚。则不恶寒。风水之邪。从肺虚风入。并于所合之皮毛。
遂为皮水。皮水久不解。荣卫与邪并。外不得温分肉。至于身肿冷。状如周痹。内
窒胸膈。脾胃气郁成热。故不能食。胃热复上。与外入之水寒相击。故痛聚胸中。
暮躁不得眠也。脾土之色发于外。是为黄汗。若骨节疼痛而 肿者。是肾之候
也。咳而喘者。是肺之候也。二病俱见。由肾脉上贯肝入肺。乃标本俱病。言脾胀。
恐肺字之误。灵枢曰。肺是动病则肺胀满。膨膨而喘。咳是也。然病虽更改不动。
尽属在表。故浮紧之脉。皆得汗之但渴与下利小便数亡津液者。不可汗耳。
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。（方见中风）
〔衍义〕内经三阴结谓之水。三阴乃脾肺少阴肾也。盖胃为五脏六腑之海。十二
经皆受气焉。脾为之行津液者。脏腑经络。必因脾。乃得禀水谷气。今脾之阴不
与胃之阳和。则阴气结伏。津液凝聚不行。而关门闭矣。关闭则小便不利。不利
则水积。积则溢。面目一身。水从脾气所结。不与胃和。遂从土色发黄肿。结自三
阴。故曰里水。其脉沉也。如小便自利。则中上焦之津液。从三阴降下而亡。故渴也。是汤见后。
趺阳脉当伏。今反紧。本自有寒疝瘕。腹中痛。医反下之。下之即胸满短气。
〔衍义〕趺阳脉当伏者。非趺阳胃气之本脉也。为水蓄于下。其气伏。故脉亦伏。脉
法曰。伏者为水。急者为疝瘕。小腹痛。脉当伏而反紧。知其初有寒疝瘕痛。先病
者治其本。先当温其疝瘕。治寒救阳而后行。可也。若反下之。是重虚在上之阳。
阳气不布化。而成胸满短气也。
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。
〔衍义〕此与上条一寒一热。互举其因。此为热消谷。不能上化精微。热浊下流。致
膀胱不化。小便蓄成积水。故脉不伏而从热反数也。
寸口脉浮而迟。浮脉则热。迟脉则潜。热潜相搏。名曰沉。趺阳浮脉而数。脉浮即热。
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。
〔衍义〕寸口、趺阳合诊者何。寸口者。肺脉所过。趺阳者。胃之所过。候脾肺合病。必
是二处也。寸口脉浮而迟。浮脉即热者何。浮为卫。卫为阳。卫不与荣和。其阳独
在脉外。故浮脉即热矣。迟脉即潜者何。迟为荣。荣、阴也。荣不从卫。匿行脉中。阴
行迟。故迟脉即潜矣。热潜相搏。名曰沉者何。脉者气藏也。荣卫之出阳入阴。乃
皆肺脏主之。故百脉朝之也。今荣卫不和。热潜之邪相搏而至。则肺脏之气不
得布。故结而沉矣。趺阳脉浮而数。浮脉即热者何。脾土中焦。与胃为表里。脾、阴
也。胃、阳也。脾与胃行津液化血者也。胃经之阳。不与脾经之阴合。失阴之阳独
在表。故脉浮即热矣。数脉即止者何。脉者血之府。血阴也。血实则脉实。阴失则
脉缓。今脾经之阴血虚不足。脉被气促而数。数则阴血不得周流于脉。故脉数
即止矣。热止相搏。名曰伏者何。藏之于经。表里相资者也。脏在里。以藉经脉之
运动。今二经以热止之邪相搏。名曰水者何。脾肺。手足太阴经之脏也。夫阳为
火。阴为水。今手足两太阴持。所结沉伏之阴相搏。故化为水矣。内经曰。三阴结
为水也。沉则络脉虚者何。肺合皮毛。络脉之在皮肤者。因肺气沉。不发于外。荣
血又潜。不入于内。络脉虚矣。伏则小便难者何。小便以通行津液。今脾气复不
为胃行津液。则津液不入膀胱。故小便难矣。虚难相搏。水走皮肤。即为水者何。
小便难则水积。积则溢。溢则乘络脉之虚。而走注于皮肤。故水病矣。在内经
则曰。三阴结谓之水。仲景则举经络荣卫之变而条析之。以核病之源。察脉论
证。其可不究心而消息之乎。
寸口脉弦而紧。弦则卫气不行。紧即恶寒。水不沾流。走于肠间。
〔衍义〕脉弦为水。紧为寒。卫气喜温而恶寒。水寒则卫气无以温分肉。肥腠理。故
恶寒也。然肺者荣卫之主。通调水道。下输膀胱。气化出溺。今卫气不行。即肺之
治节不行。治节不行。则输化之职废。故不得沾流水道。反走肠间。肠、大肠也。大
肠与肺合。若上条之走皮肤。皮肤亦肺所主。二者对出。以明肺之不调。则随其所属而为病耳。
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。
〔衍义〕脉可一法取之乎。不可也。此脉沉有水。脉出为死者。是脉不可出而浮大
也。试以气强为水者观之。非脉之浮大者乎。而风水皮水脉皆浮。怀孕妇病水
亦浮。水病岂独取沉脉为例哉。此条之论。盖独为少阴病水耳。少阴者。至阴盛
水也。合四时主冬。故脉沉。水之象当然也。少阴经气当然也。当沉。故不可出。出
则少阴经气外绝。死之征矣。凡言浮沉迟数之脉。为其各有所由。故不可以一
法取之也。虽然。肾脏独病。其水则沉。兼风则不沉。所为出者。非独为浮也。为经
气离出其脏。沉之亦无有也。
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。
〔衍义〕内经色泽者。病溢饮。溢饮者。渴而多饮。易入肌皮肠胃之外。注云。是血虚
中湿。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。故脉浮矣。所积之水。溢于肠胃之郭。则腹大。三
焦之气不化。则小便难。若脉沉绝者。知其水积在内已甚。脉气不发故也。必下其水。乃可愈。
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。
〔衍义〕下利血虚液少。故渴。渴而暴饮。水停不散。故小便不利。溢于内外。以成肿
满。故小便利而汗出。则所停之水行。而肿满愈矣。
心水者。其身重而少气。不得卧。烦而躁。其人阴肿。
〔衍义〕心、君火也。其气蕃茂。遇寒水则屈伏。今水客于心。火气郁蕃。不得发于分
肉。则身重。不充盛于气海。则少气。烦热内作。则躁而不得眠也。火气不舒。其味
从郁所化而过于苦。水积于外。其味从湿所化而过于咸。咸味归阴。苦乃从咸
润下。入于胞囊。故阴肿也。如病肾水者。止以咸渗泄。但阴下湿而已。此因苦与
咸相合。苦性坚。因火与水相搏。所以咸味不得渗泄。而结为阴肿矣。
(Seven discussions, five pulse and symptom patterns, nine formulas regarding Water Qi Disease)
The Master said: Diseases include Fengshui (Wind Edema), Pishui (Skin Edema), Zhengshui (Standard Edema), Shishui (Stone Edema), and Huanghan (Yellow Sweat). The pulse of Fengshui is naturally floating; its external symptoms are joint pain and aversion to wind. The pulse of Pishui is also floating; its external symptoms are edema that leaves an indentation upon pressure, aversion to wind is absent, the abdomen is distended like a drum, there is no thirst, and sweating therapy should be employed. The pulse of Zhengshui is deep and slow; its external symptom is spontaneous wheezing. The pulse of Shishui is naturally deep; its external symptom is abdominal fullness without wheezing. The pulse of Huanghan is deep and slow, accompanied by fever, chest fullness, and edema of the limbs, head, and face. If it persists for a long time without healing, it will inevitably lead to carbuncles and pus.
[Commentary] "Fengshui" refers to water accumulation due to wind invasion, as the Kidney fundamentally belongs to Water. *Neijing* (Classic of Internal Medicine) · Daqi Binglun states: "Simultaneous floating indicates Fengshui." The commentary notes that a floating pulse indicates Fengshui; a floating pulse in the lower jiao indicates water and wind battling below, hence named Fengshui. *Suwen* · Shuire Xuelun states: "The Kidney is the organ of extreme Yin. If one exerts oneself vigorously or labors excessively, Kidney sweat emerges. If encountered by wind, it neither enters the zang-fu internally nor escapes the skin externally, but lodges in the xu fu (pores), travels within the skin, and transforms into swelling. Rooted in the Kidney, it is named Fengshui." *Ping Re Binglun* states: "Renfeng presents with facial swelling and obstruction of speech. If needling is performed inappropriately, after five days the pathogenic qi will arrive. Upon arrival, there will be shortness of qi and intermittent fever, with heat rising from the chest and back to the head, sweating, hot hands, dry mouth, yellow urine, edema under the eyes, borborygmus, heavy body, difficulty turning, amenorrhea, irritability preventing supine position, and coughing when supine. This is named Fengshui." Here, only external symptoms of joint pain and aversion to wind are mentioned, not edema. Since the Kidney corresponds to bones externally, water pathology affects the bones; the Liver corresponds to sinews externally, and wind binds the sinews involving joints, causing joint pain. A floating pulse and aversion to wind indicate that the Fengshui syndrome is at the exterior.
"Pishui" refers to skin edema. *Ling shu* states: "Abdominal distension occurs when cold qi lodges between the skin. The abdomen is soft but not firm, large, with whole-body edema and thick skin. Pressing the abdomen leaves an indentation that does not rise immediately, while the abdominal color remains unchanged." Chao Yuanfang's *Zhubing Yuanhou Lun* considers Pishui as having an unaltered abdomen and no thirst, differing from *Ling shu*. Generally, the Lung governs qi to circulate Ying and Wei, corresponding externally to the skin and hair. Severe skin disease causes Lung qi stagnation, leading to stagnation of Ying and Wei circulation. However, Lung qi fullness differs from other pathogens; although qi transforms into water, its origin is light and clear, hence the soft, non-firm texture, indentation upon pressure, and abdominal depression. Closure of xu fu prevents aversion to wind, while stagnant fire dries fluids causing no thirst. Sweating therapy should be used to disperse exterior pathogens, allowing exterior qi to flow freely and resolving stagnation. This is the method of "opening the ghost gate" (diaphoresis).
"Zhengshui" refers to the Kidney governing water, where water pathology originates in the Kidney meridian. *Neijing* states: "The Kidney is the gate of the Stomach. If the gate is obstructed, water accumulates to cause disease, overflowing up and down into the skin, causing swelling. Ascending causes wheezing and inability to lie flat, indicating both root and branch are diseased."
"Shishui" refers to water accumulation in the lower abdomen, where the bladder interior is hard and full like stone. *Neijing* states: "Yin and Yang bind evil, with Yin predominating over Yang, named Shishui." It also states: "Simultaneous deep pulses of the Kidney and Liver indicate Shishui." Commentary explains: "The Liver meridian enters the yin regions and penetrates the lower abdomen; the Kidney meridian passes through the spine and connects with the Bladder. Both organs store essence, and their qi steams the Chong mai, entering the bladder from below. When water fails to move, it becomes hard and knotted. Since the Kidney governs water, and water freezes in winter, with its source in the Kidney, the Kidney resembles water and has a deep pulse, hence named Shishui. Due to water accumulation in the bladder, it reverses upward along the Foot-Shaoyin and Hand-Shaoyin meridians to the Lung, causing wheezing." *Zhubing Yuanhou Lun* states Shishui causes distending pain in the hypochondrium, potentially ascending to the epigastrium leading to death. Comparing this with the previous paragraph, although both are Shishui, they differ slightly. This case emphasizes Kidney qi more; the Kidney is Yin, Yin is static, so the disease remains lower without moving. The other case emphasizes Liver qi more; the Liver is Yang, Yang is active, so it ascends to attack the epigastrium.
"Huanghan" is a water disease where the body turns yellow and sweat resembles paulownia juice. Subsequent paragraphs describe various causes. Generally, yellow corresponds to Earth, resulting from Yangming Stomach heat, manifesting externally. Current symptoms of fever, chest fullness, and edema of limbs, head, and face belong to the Foot-Yangming meridian. Heat lingering in muscles generates carbuncles and pus. As stated in *Zhubing Yuanhou Lun*, Dan-shui (Jaundice-Water) arises from Stomach-Spleen heat flowing to the Bladder, causing difficult urination, yellow body/face, and abdominal fullness resembling water status; this is also a type of Huanghan.
A pulse that is floating and surging indicates floating signifies wind, and surging signifies qi. Wind and qi battle each other. If wind dominates, it causes urticaria (itchy rash) and body itching; chronic itching leads to scabies-like lesions. If qi dominates, it causes water retention and difficulty bending or stretching. Mutual combat of wind and qi causes massive edema; recovery occurs through sweating. Aversion to wind indicates deficiency, termed Fengshui. Absence of aversion to wind with free urination and cold in the upper jiao causing excessive saliva indicates Huanghan.
[Commentary] Wind refers to external wind pathogens, and qi refers to Ying-Wei qi. Wind is a Yang pathogen entering from above, causing a floating pulse. Ying-Wei become heated by wind, causing a surging pulse (large). *Neijing* states: "Large pulse indicates disease progression" due to pathogenic excess. Ying circulates within vessels governing blood; Wei circulates outside governing qi. Strong wind implies wind strengthened by heat. Wind-heat battles Wei, lodging beneath the skin, causing qi stagnation and wind agitation, forming urticaria. Fire assists wind, opening pores and shaking hairs, causing itching. Itching is "Xiefeng" (leaking wind). *Neijing* states: "All painful sores and ulcers belong to fire," and "External wind in collaterals causes Xiefeng." If unresolved, wind enters muscle layers, battling inside and outside vessels, obstructing qi flow, battling Wei, causing muscle ulceration. Wind entering vessels attacks Ying blood; wind-heat damages blood, leading to scabies. *Neijing* states: "Wind and Taiyang enter together, traveling through acupoints, scattering between muscles, interfering with Wei qi, blocking pathways, causing muscle swelling and ulcers." Also: "Pulse wind becomes leprosy."
Strong qi means Wei qi is constrained by heat, stopping movement. Qi and water are similar; stopped qi generates water, transforming accumulated fluids and blood into water. Not only do Ying and Wei fail to harmonize, but heat in sinews, bones, and muscles is constrained, causing difficulty bending/stretching. When wind and qi continue to battle, Ying-Wei heat and water scatter to the surface, causing massive edema. When wind and qi resolve, water disperses, Wei moves, and sweating brings recovery. Aversion to wind indicates inability to resist wind, with water and sweat dispersing together, causing exterior deficiency, hence Fengshui. No aversion to wind means Wei qi does not disperse via sweat, securing pores and protecting the upper jiao, ensuring free urination. "Cold in upper jiao" refers to wind pathogen in the upper jiao, not actual cold. In Shanghan, if pathogen lodges in upper jiao, middle jiao grain qi cannot ascend to the Lung, becoming internal heat, condensing fluids into Stomach heat. Heat opens Lianquan (gateway of fluids), causing saliva flow. This Huanghan results from fatigue, edema, and Stomach heat emitting Earth color.
Cunkou pulse deep and slippery indicates internal water qi, swollen face and eyes, fever, named Fengshui. Observing slight swelling of the eye sockets like newly awakened sleepers, pulsating neck vessels, frequent coughing, and pitting edema on hands/feet indicates Fengshui.
[Commentary] *Inner Meridian Pulse* states deep pulse indicates water, slippery indicates wind. Facial swelling indicates wind, eye swelling like new awakening indicates water, pulsating neck with wheezing/cough indicates water. Renfeng presents with facial swelling, shortness of qi, intermittent fever; with edema, rooted in Kidney, named Fengshui, all from *Neijing*.
Taiyang disease with floating-tight pulse typically causes joint pain. If pain is absent but body feels heavy and sore, without thirst, sweating cures it; this is Fengshui. Aversion to cold indicates extreme deficiency caused by improper sweating. Thirst without aversion to cold indicates Pishui. Body edema with cold sensation resembling Zhoubi (circumferential bi), chest oppression, inability to eat, gathering pain, evening restlessness, and insomnia indicate Huanghan. Joint pain, cough, wheezing, and no thirst indicate Feizhang (Lung Distension). Appearance resembles edema; sweating cures it. However, for diseases with these signs, if accompanied by thirst, diarrhea, and frequent urination, sweating is contraindicated.
[Commentary] *Shanghan Lun* states floating-tight pulse indicates Wind-Cold. Wind injures Wei, Cold injures Ying, affecting both. Ying-Wei are transformed from Stomach grain qi, originating from Hand-Taiyang, circulating interior/exterior, nourishing sinews/bones, warming skin/flesh externally, connecting five zang/six fu internally. Thus, floating/deep pulses appear at Cunkou. This paragraph begins with Taiyang disease, tight pulse indicating exterior location. Ying-Wei affected by Fengshui distribute through meridians subordinate to Taiyang exterior. Corresponding to Liver, joint pain occurs; if Fengshui involves Wood attacking Earth, Spleen governs muscles, causing muscle dysfunction, absent joint pain, heavy/sore body. *Neijing* states: "Earth deficiency causes heavy body and sore muscles." Absence of thirst allows sweating to disperse pathogens. This is Wind overcoming Water, also named Fengshui. Sweat is generated by qi, qi by essence. If essence/qi is insufficient, sweating depletes Ying-Wei essence before Fengshui disperses, causing extreme deficiency and inability to warm pores, leading to aversion to cold. If pungent-hot herbs ascend to Lung, destroying fluids, Lung dries causing thirst; if Ying-Wei are not deficient, no aversion to cold. Fengshui pathogen enters Lung deficiency via wind, combining with skin/hair, becoming Pishui. Chronic Pishui combines Ying-Wei with pathogen, failing to warm flesh, causing cold edema resembling Zhoubi, internal chest oppression, Spleen-Stomach qi stagnation generating heat, causing anorexia. Stomach heat rises, battling external cold-water, causing chest pain, evening restlessness. Spleen Earth color emits externally as Huanghan. Joint pain with edema indicates Kidney sign; cough/wheezing indicates Lung sign. Both present due to Kidney meridian passing through Liver to Lung, affecting root and branch. "Pi Zhang" is likely a typo for "Fei Zhang." *Ling shu* states: "Lung movement disease causes Lung distension, bloating, wheezing, cough." Although conditions change, they remain exterior; thus floating-tight pulses respond to sweating, except when thirst, diarrhea, or frequent urination indicate fluid depletion.
Li Shui (Interior Water) presents with yellow edema of face/body, deep pulse, difficult urination, causing water disease. If urination is normal, fluid depletion causes thirst. Yuebi Jia Zhu Tang is indicated. (Formula see Wind Stroke section).
[Commentary] *Neijing* states binding of Three Yin causes water. Three Yin are Spleen, Lung, Shaoyin Kidney. Stomach is sea of zang-fu, receiving qi from twelve meridians. Spleen transports fluids; zang-fu/meridians rely on Spleen to receive grain qi. If Spleen Yin does not harmonize with Stomach Yang, Yin qi binds, fluids condense and stop, closing the gate. Closed gate causes difficult urination, water accumulation, overflow causing yellow edema. Binding in Three Yin is called Li Shui, with deep pulse. Normal urination drains fluids from Three Yin, causing thirst. Formula follows.
Duyang pulse should be hidden but is now tight. Originally suffering from Han Shan (Cold Hernia) and Jia (masses) with abdominal pain, the physician incorrectly used purgatives, causing chest fullness and shortness of qi.
[Commentary] Duyang pulse should be hidden because water accumulates below, hiding qi, thus pulse is hidden. Pulse methods state: hidden indicates water, rapid/tight indicates hernia/masses, lower abdominal pain. Hidden pulse turning tight indicates initial Cold Hernia/Masses pain. Treat root first: warm Hernia/Masses, treat cold, save Yang, then proceed. Incorrect purgation further deficiences upper Yang, preventing distribution, causing chest fullness/shortness of qi.
Duyang pulse should be hidden but is now rapid. Originally having heat, digesting food quickly, frequent urination, now urination is difficult, indicating impending water disease.
[Commentary] Contrasts cold and heat causes. Heat digests food but fails to transform nutrients upward; turbid heat flows down, impairing Bladder transformation, accumulating urine/water, causing rapid pulse instead of hidden.
Cunkou pulse floating and slow. Floating indicates heat, slow indicates submersion. Heat and submersion battle, named Chen (Sinking). Duyang pulse floating and rapid. Floating indicates heat, rapid indicates cessation. Heat and cessation battle, named Fu (Hidden). Sinking and Hidden battle, named Water. Sinking makes collaterals empty; Hidden makes urination difficult. Empty and difficult battle, water flows to skin, becoming water disease.
[Commentary] Combined diagnosis of Cunkou and Duyang. Cunkou is Lung pulse; Duyang is Stomach pulse. Diagnosing Spleen-Lung combined disease requires both. Cunkou floating-slow: floating indicates Wei/Yang not harmonizing with Ying, Yang alone outside vessel, hence heat. Slow indicates Ying/Yin not following Wei, hiding in vessel, Yin moves slowly, hence submersion. Heat/submersion battle causes Lung qi to bind and sink. Duyang floating-rapid: Spleen/Stomach are interior-exterior pair. Stomach Yang not harmonizing with Spleen Yin, Yang alone exterior, hence heat. Rapid indicates blood deficiency failing to circulate, hence cessation. Heat/cessation battle causes Hidden pulse. Spleen/Lung are Hand-Foot Taiyin. Yang is Fire, Yin is Water. Taiyin binding causes sinking/hidden Yin to battle, transforming into water (*Neijing*: Three Yin binding causes water). Sinking makes skin collaterals empty (Lung governs skin, Lung qi sinks, Ying blood hides, collaterals empty). Hidden makes urination difficult (Spleen fails to transport fluids to Bladder). Empty/difficult battle causes water overflow to skin, resulting in water disease. *Neijing* says Three Yin binding causes water; Zhang Zhongjing analyzes Jingluo/Ying-Wei changes to trace disease source. One must study pulse and symptoms carefully.
Cunkou pulse wiry and tight. Wiry indicates Wei qi obstruction; tight indicates aversion to cold. Water fails to flow normally, moving into intestines.
[Commentary] Wiry pulse indicates water, tight indicates cold. Wei qi prefers warmth, dislikes cold. Cold water prevents Wei qi from warming flesh and plumping pores, causing aversion to cold. Lung governs Ying-Wei and regulates water passages, transmitting to Bladder. Wei qi obstruction means Lung regulation fails, disrupting fluid transport, causing water to divert to intestines (Large Intestine, paired with Lung). Like previous text describing water in skin (also Lung governed), this shows Lung dysregulation causes disease in its associated areas.
Shaoyin pulse tight and deep. Tight indicates pain; deep indicates water, making urination difficult. Deep pulses generally indicate water, with heavy body edema. If water disease pulse emerges (becomes floating/large), it indicates death.
[Commentary] Can pulse be judged by one method? No. Deep pulse indicates water; emerging pulse indicates death (pulse should not be floating/large). Consider "Qi strong causes water"—is it not floating/large? Fengshui/Pishui pulses float; pregnant women with water disease also have floating pulses. Why restrict water disease to deep pulse? This paragraph specifically addresses Shaoyin water disease. Shaoyin is extreme Yin/Water, governing Winter, hence deep pulse is natural image and meridian qi. Should be deep; if emerging, Shaoyin meridian qi severs externally, indicating death. Floating/deep/slow/rapid pulses have specific causes; cannot use single method. Although isolated Kidney disease has deep water pulse, combined with wind it is not deep. "Emerging" means meridian qi leaving the zang, even deep pulse disappears.
Water patients present with silkworm-like swelling under eyes, bright complexion, hidden pulse, polydipsia, abdominal distension, difficult urination. Deep/absent pulse indicates significant internal water; purgation may be used.
[Commentary] *Neijing* states luster indicates Yi Yin (overflowing water). Yi Yin involves thirst, excessive drinking, water entering muscles/skin/intestines. Note: Blood deficiency with dampness. Water/Yin, under-eye/Yin, abdomen/Yin residence. Water in abdomen causes under-eye swelling. *Ling shu* states early water shows slight under-eye swelling like new awakening. Initial failure to transform fluids causes polydipsia; excessive drinking accumulates water, blocking qi, causing floating pulse. Accumulated water overflows intestines, causing abdominal distension. Sanjiao qi fails to transform, causing difficult urination. Deep/absent pulse indicates severe internal water accumulation with suppressed pulse qi. Purge water to cure.
Question: After diarrhea, patient drinks water, has difficult urination, abdominal distension, and genital edema. What is this? Answer: This should be water disease. If urination becomes free and sweating occurs, it will heal spontaneously.
[Commentary] Diarrhea causes blood/fluid deficiency, leading to thirst. Excessive drinking stops water, causing difficult urination and overflow edema. Free urination and sweating allow stopped water to move, resolving edema.
Xin Shui (Heart Water) presents with heavy body, shortness of qi, inability to lie flat, irritability, and genital edema.
[Commentary] Heart is Minister Fire, vigorous qi. Encountering cold water, it suppresses. Water invading Heart郁stagnates Fire qi, unable to emit to muscles, causing heaviness. Failing to fill Qi Sea, causing shortness of qi. Internal irritability causes restlessness and insomnia. Unsoothed Fire qi transforms bitter taste; external water accumulation transforms salty taste. Salty enters Yin; Bitter descends with Salt into bladder, causing genital edema. Kidney water disease uses salty diuretics causing only lower dampness. Here, Bitter and Salt combine; Bitter is solidifying. Fire-Water battle prevents Salt diuresis, knotting into genital edema.