热结。而阴气复伤也。其水入则吐者。亦
用五苓。为其热消而水停也。渴不止者。则用文蛤。为其水消而热在也。其口干燥者。则用白虎加人参。
为其热甚而津伤也。此为同源而异流者。治法亦因之各异如此。学人所当细审也。
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
痈肿。（ 。千金。作浮。如鼓不渴。巢源。作如故而不满又不渴。身下。脉经。千金。有体字。）
〔程〕风水与皮水相类属表。正水与石水相类属里。但风水恶风。皮水不恶风。正水自喘。石水不喘。
为异耳。自唐以来。复有五水十水之说。皆由肾不主五液。脾不能行水。致津液充郭。上下溢于皮肤。则水
病生矣。
〔鉴〕风水得之内有水气。外感风邪。风则从上肿。故面浮肿。骨节疼痛恶风。风在经表也。皮水得
之内有水气。皮受湿邪。湿则从下肿。故 肿。其腹如鼓。按之没指。水在皮里也。非风邪。故不
恶风。因水湿。故不渴也。其邪俱在外。故均脉浮。皆当从汗从散而解也。正水。水之在上病也。石水。水之
在下病也。故在上则胸满自喘。在下则腹满不喘也。其邪俱在内。故均脉沉迟。皆当从下从温解也。
〔尤〕正
水。肾脏之水自盛也。石水。水之聚而不行者也。正水。乘阳之虚。而侵及上焦。
故脉沉迟而喘。石水。因阴之盛。而结于少腹。故脉沉。腹
满而不喘也。
〔魏〕黄汗者。其脉亦沉迟。与正水石水。水邪在内无异也。然所感之湿。客于皮毛者。独盛于
他证。故身发热。热必上炎。故胸满头面肿。湿热肆行。故四肢亦肿。久久不愈。瘀窿蕴酿。致成疮痈。溃
烂成脓。必至之势也。热逼于内。汗出于外。湿瘀乎热。汗出必黄。此又就汗出之色。以明湿热之理。名之曰黄汗。
案 。程读为跗。本于喻氏。盖误矣。徐云。 者。浮
也。近是。素水热穴论云。上下溢于皮肤。故为 肿。 肿者。聚水而生病也。知是 肿。即水病之称耳。
巢源石水候云。肾主水。肾虚则水气妄行。不根据经络。停聚结在脐间。小腹肿大。 如石。故云石水。其
候引胁下胀痛。而不喘是也。脉沉者。名曰石水。尺脉微大。亦为石
水。肿起脐下。至少腹垂垂然。上至胃脘则死。不治。
张氏医通云。风水者。肾本属水。因风而水积也。经云。并浮为风水。传为 肿。又曰。肾风者。面
庞然。壅害于言。不能正偃。正偃则咳。名曰风水。其本在肾。其末在肺。皆积水也。上下溢于皮肤。故
为肿。今止言外证骨节疼痛。恶风。不言 肿。脱文也。皮水者。皮肤 肿是也。盖肺主气。以
行营卫。外合皮毛。皮毛病甚。则肺气 郁。当发其汗。散皮毛之邪。外气通。而郁解矣。正水者。肾经之
水自病也。经曰。肾者胃之关也。关门不利。故聚水成病。上下溢于皮肤。 肿腹大。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。经曰。阴阳结邪。阴多阳少。名
石水。又曰。肾肝并沉为石水。水积胞内。下从足少阴。故不发喘。
脉浮而洪。浮则为风。洪则为气。风气相搏。风强则为
隐疹。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。
〔鉴〕此为黄汗四字。当是衍文。六脉俱浮而洪。浮则为风。洪则为气。风气相搏之病。若风强于气。相
搏为病。则偏于营。故为隐疹。身体为痒。痒者肌虚。为风邪外薄故也。名曰泄风。即今之风燥疮是也。故日
久不愈。则成痂癞。痂癞。疥癣疠癞之类是也。若气强于风。相搏为病。则偏于卫。故为水气。难以俯仰。
即今之支饮喘满不得卧也。若风气两相强击为病。则为风水。故通身浮肿也。以上诸证。皆
属肌表。故当发汗。汗出乃愈也。风水无汗。当以越婢汤发汗。若汗出恶风。则为表阳虚。故加附子也。若
不恶风。小便通利。非表阳有寒。乃上焦有寒也。上焦有寒。惟兼病水者。不能约束津液。故其口多涎也。
何氏医碥云。恶风则虚一句。不恶风者。小便通利。上焦有寒。其口多涎。此为黄汗五句。当是错简
删之。案此说未知是否。金鉴改洪肿作浮肿。巢源。有身面卒洪肿候。谓肿之盛大。金鉴误耳。
寸口脉沉滑者。中有水气。面目肿大有热。名曰风水。视人之目裹上。拥如蚕新卧起状。其颈脉动。时
时咳。按其手足上。陷而不起者。风水。（脉经。千金。外台。并无蚕字。据灵论疾诊
尺及水胀篇。无蚕字为是。盖因下文目下有卧蚕之语。而错误也。裹。灵枢。作窠。潘氏
续焰云。窠者。窝也。聚精成窝。搏结之义。）
〔尤〕风水。其脉自浮。此云沉滑者。乃水脉非风脉也。至面目肿大有热。则水得风而外浮。其脉亦
必变而为浮矣。仲景不言者。以风水该之也。目窠上微肿。如蚕新卧起状者。内经所谓水为阴。而目下亦阴。
聚水者必微肿。先见于目下是也。颈脉动者。颈间人迎脉动甚。风水上凑故也。时时咳
者。水渍入肺也。按其手足上。陷而不起。与内经以手按其腹。随手而起。如裹水之状者不同。然腹中气大。
而肢间气细。气大则按之随手而起。气细则按之 而不起。而其浮肿则一也。
案水胀篇。以手按其腹。随手而起。如裹水之状者。水也。其身尽肿皮浓。按其腹。 而不起者肤胀也。
肤胀者。寒气客于皮肤之间所致。寒气在于皮肤之间。按而散之。则不能猝聚。故 而不起也。当知随手而
起。为有水无气。 而不起。为有气有水也。巢源。燥水。谓水气溢于皮肤。因令肿满。以指画肉上。则隐
隐成文本者。名曰燥水。以指画肉上。随画随散。不成文本者。名曰湿水。盖湿水。即灵枢
所谓水也。燥水。即所谓肤胀也。上条云。皮水其脉亦浮。外证 肿。按之没指。而此条云。陷而不起者
风水。则知皮水风水。即巢源所谓燥水。而亦肤胀之属也。尤注似疏。故详及之。
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。痛在骨节。咳而喘。不渴者。此为脾胀。其状如肿。发汗即愈。然诸病此者。渴而下利。
小便数者。皆不可发汗。（酸。徐沈尤作 。脾胀诸注作肺胀为解。似是。唯程魏仍旧文。本条
凡五节。根据徐注而分之。）
〔尤〕太阳有寒。则脉紧骨疼。有湿。则脉濡身重。有风。则脉浮体 。此明辨也。今得伤寒脉。而骨
节不疼。身体反重而 。即非伤寒。乃风水外胜也。风水在表而非里。故不渴。风固当汗。水在表者。亦
宜汗。故曰汗出即愈。然必气盛而实者。汗之乃愈。不然。则其表益虚。风水虽解。
而恶寒转增矣。故曰恶寒者。此为极虚。发汗得之。若其渴而不恶寒者。则非病风。而独病水。不在皮外。而
在皮中。视风水为较深矣。其证身肿而冷。状如周痹。周痹为寒湿痹其阳。皮水为水气淫于肤也。胸中窒不
能食者。寒袭于外。而气窒于中也。反聚痛。暮躁不得眠者。热为寒郁。而寒甚于暮也。寒湿外淫。必流
关节。故曰此为黄汗。痛在骨节也。其咳而喘。不渴者。水寒伤肺。气攻于表。有如肿病。而实同皮水。故曰
发汗则愈。然此诸病。若其人渴而下利。小便数者。则不可以水气当汗。而概发之也。仲景丁宁之意。岂
非虑人之津气先亡耶。或问前二条云。风水外证骨节疼。此云骨节反不疼。身体反重而 。前条云。皮水
不渴。此云渴。何也。曰。风与水合而成病。其流注关节者。则为骨节疼痛。其侵淫肌体者。则骨节不疼。
而身体 重。由所伤之处不同故也。前所云皮水不渴者。非言皮水本不渴也。谓腹如鼓。而不渴者。病方外
盛而未入里。犹可发其汗也。此所谓渴而不恶寒者。所以别于风水之不渴而恶风也。程氏曰。水气外
留于皮。内薄于肺。故令人渴。是也。
灵周痹篇云。风寒湿气。客于外分肉之间。迫切而为沫。沫得寒则聚。聚则排分肉。而分裂也。分裂
则痛。痛则神归之。神归之则热。热则痛解。痛解则厥。厥则他痹发。此内不在脏。而外未发于皮。独居分肉
之间。真气不能周。故命曰周痹。案此即历节痛风之谓。今云状如周痹者。岂谓其为走痛耶。抑与灵枢周痹
异义。而谓唯其为顽痹耶。诸注无明解者何。又案金鉴以下条越婢加术汤主之六字。移本条发汗即愈之下云。
以上四证。皆初病皮毛。状类伤寒。故均以越婢加术汤主之。发汗即愈也。此说不可从。详于下条。
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。（〔原注〕方见中风○案黄。脉经作洪。是。脉经注。
一云。皮水。其脉沉。头面浮肿。小便不利。故令病水。假令小便自利。亡津液。故令渴也。）
〔程〕里有水则脉沉。小便不利。溢于表则一身面目黄肿。故与越婢加术汤。以散其水。若小便自利。
此亡津液而渴。非里水之证。不用越婢汤也。越婢加术汤。当在故令病水之下。
案此条诸家。并以自一身面目黄肿。至故令渴也。悉属越婢汤证。殊不知此与肠痈大黄牡丹汤条。
同为倒装法。程注义独长矣。第据脉经。黄肿。乃洪肿之讹。又据外台。引古今录验。皮水越婢加术汤主之。及
脉经注文。里水亦皮水之讹。义尤明显。金鉴则不考之于古书。辄以越婢加术汤主之七字。移于前条。抑亦肆
矣。或疑脉沉用麻黄之义。考本草。麻黄为肺家之专药。李氏详辨之。皮水。水气壅遏于皮
肤之间。用麻黄而发之。则气行水利。而脉道开。沉乃为浮。此等之义。身试亲验。然后知经文之不我欺也。
趺阳脉当伏。今反紧。本自有寒疝瘕。腹中痛。医反下
之。下之胸满短气。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。
〔鉴〕赵良曰。趺阳当伏者。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。
〔魏〕趺阳有水邪则当伏。以胃阳为水湿阴寒所固闭。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。此病趺
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。
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。
〔鉴〕案此条文义不属。不释。
寸口脉弦而紧。弦则卫气不行。即恶寒。水不沾流。走于肠间。（脉经。卫气不行下。更有卫气不行四字。）
〔程〕寸口以候表。弦紧为寒。寒则表气不行。不能以卫
肌肤。故恶寒。气既不行。则水饮亦不宣。但走入肠间而为水。
案金鉴云。此条必有脱简。不释。考脉经寒疝篇云。寸口脉弦而紧。弦则卫气不行。卫气不行则恶寒。
紧则不欲食。弦紧相搏。则为寒疝。知此条亦宜有紧则云云语。金鉴为是。
少阴脉紧而沉。紧则为痛。沉则为水。小便即难。
〔沈〕少阴肾脉。紧则寒邪凝滞正气于内。曰紧则为痛。沉则卫气郁而不宣。三焦壅闭。水即泛滥。曰
沉则为水。决渎无权。小便即难。
〔鉴〕四句文义不属。并有脱简。不释。
脉得诸沉。当责有水。身体肿重。水病脉出者死。（脉经。脉得上。有师曰二字。）
〔尤〕水为阴。阴盛故令脉沉。又水行皮肤。荣卫被遏。亦令脉沉。若水病而脉出。则真气反出邪水之
上。根本脱离。而病气独胜。故死。出与浮迥异。浮者盛于上。而弱于下。出则上有而下绝无也。
〔魏〕附录
伤寒论一条以证之。少阴篇云。少阴病。下利脉微者。与白通汤。利不止。厥逆无脉。
干呕烦者。白通加猪胆汁汤主之。服汤脉暴出者死。微续者
生。
夫水病患。目下有卧蚕。面目鲜泽。脉伏。其人消渴。
〔鉴〕赵良曰。内经色泽者。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。
Heat binds, and yin qi is injured again. If drinking water leads to vomiting, Wuling San (Five-Ingredient Poria Decoction) is also used, because heat has dissipated but water retention remains. If thirst persists, Wenli San (Clam Shell Powder) is used, because water has dissipated but heat remains. If the mouth and lips are dry, Baihu Jia Renshen Tang (White Tiger Decoction plus Ginseng) is used, because heat is severe and fluids are damaged. These conditions share a common origin but differ in progression; thus, treatment methods vary accordingly. Scholars should examine this carefully.
The Master said: There are five types of edema diseases: Fengshui (Wind Edema), Pishui (Skin Edema), Zhengshui (Regular Edema), Shishui (Stone Edema), and Huanghan (Yellow Sweat). In Fengshui, the pulse is naturally floating, and external symptoms include joint pain and aversion to wind. In Pishui, the pulse is also floating, and external symptoms include generalized edema that leaves an indentation upon pressure, absence of aversion to wind, abdominal distension like a drum, and no thirst; sweating therapy should be employed. In Zhengshui, the pulse is deep and slow, and external symptoms include spontaneous panting. In Shishui, the pulse is naturally deep, and external symptoms include abdominal fullness without panting. In Huanghan, the pulse is deep and slow, with body fever, chest fullness, and swelling of the limbs, head, and face; if untreated for a long time, it will inevitably lead to carbuncles and sores. (*Qianjin Fang* reads "floating" for the pulse. *Zhubing Yuanhou Lun* reads "as before, not full, and not thirsty" for "like a drum and not thirsty." *Maijing* and *Qianjin Fang* contain the character "body".)
Cheng Lin’s commentary: Fengshui and Pishui are similar and belong to the exterior syndrome; Zhengshui and Shishui are similar and belong to the interior syndrome. The differences lie in Fengshui having aversion to wind while Pishui does not, and Zhengshui having spontaneous panting while Shishui does not. Since the Tang Dynasty, theories of five waters and ten waters have emerged, all attributing the condition to the kidney's failure to govern the five fluids and the spleen's inability to transport water, causing body fluids to fill the chest cavity and overflow into the skin, thereby generating water diseases.
You Yuyuan’s commentary: Fengshui arises from internal water qi combined with external wind pathogen. Wind moves upward, causing facial swelling, joint pain, and aversion to wind, indicating wind pathogen in the meridians and exterior. Pishui arises from internal water qi combined with damp pathogen affecting the skin. Dampness moves downward, causing lower limb swelling, abdominal distension like a drum, and indentation upon pressure, indicating water inside the skin. Without wind pathogen, there is no aversion to wind; due to water-dampness, there is no thirst. Both pathogens are external, hence both pulses are floating, and both should be resolved through sweating and dispersing. Zhengshui is water pathology in the upper jiao, and Shishui is water pathology in the lower jiao. Thus, upper involvement causes chest fullness and spontaneous panting, while lower involvement causes abdominal fullness without panting. Both pathogens are internal, hence both pulses are deep and slow, and both should be resolved through purgation or warming.
You Yuyuan’s commentary: Zhengshui is excessive water in the kidney. Shishui is water accumulation that fails to circulate. Zhengshui takes advantage of yang deficiency to invade the upper jiao, resulting in a deep, slow pulse and panting. Shishui occurs due to excess yin, binding in the lower abdomen, resulting in a deep pulse, abdominal fullness, and no panting.
Wei Nianting’s commentary: Huanghan’s pulse is also deep and slow,无异 (no difference) from Zhengshui and Shishui where water pathogen is internal. However, the dampness acquired is uniquely intense in the skin and hair pores compared to other syndromes, causing body fever. Heat flares upward, causing chest fullness and swelling of the head and face. Damp-heat spreads freely, causing swelling of the limbs. If prolonged, stagnation and fermentation occur, leading to sores and abscesses, which will eventually ulcerate and suppurate—this is an inevitable trend. Heat forces inward, sweat emerges outward, dampness obstructs heat, and sweat turns yellow. This explains the principle of damp-heat based on the color of the sweat, named Huanghan.
Note: Cheng Lin read "Fu" as "foot dorsum," following Yu Chang, which is likely incorrect. Xu Lingtai stated that "Fu" means "floating," which is closer. *Suwen: Shure Xuelun* states: "Overflowing up and down into the skin, thus forming Fu-swelling." Fu-swelling refers to disease caused by accumulated water. Knowing it is Fu-swelling confirms it is a term for water disease. *Zhubing Yuanhou Lun: Shishui Hou* states: "The kidney governs water; when kidney qi is deficient, water qi acts recklessly, not following meridians, stopping and accumulating between the umbilicus, causing lower abdominal swelling, hard as stone, hence called Shishui." Its symptoms involve pulling pain in the hypochondrium, without panting. A deep pulse indicates Shishui; a slightly large radial pulse also indicates Shishui. Swelling starting below the umbilicus, extending to the lower abdomen hanging heavily, reaching the stomach area indicates death and untreatability.
*Zhangshi Yitong* states: Fengshui occurs because the kidney belongs to water, and wind causes water accumulation. The Classics state: "Combined floating indicates Fengshui, transmitting to Fu-swelling." It also says: "Kidney wind presents with swollen face, obstruction in speech, inability to lie flat; lying flat causes cough, named Fengshui." The root is in the kidney, the branch in the lung, both involving water accumulation. Overflowing into the skin causes swelling. Here, only external symptoms of joint pain and aversion to wind are mentioned, omitting Fu-swelling, which is a textual omission. Pishui is characterized by Fu-swelling of the skin. The lung governs qi, circulating Ying and Wei, and externally connects to the skin and hair. Severe skin disease leads to lung qi stagnation; sweating should be induced to disperse exterior pathogens, allowing external qi to flow freely and resolving stagnation. Zhengshui is self-pathology of kidney meridian water. The Classics state: "The kidney is the gate of the stomach; if the gate is unregulated, water accumulates and causes disease." Overflowing into the skin causes Fu-swelling and abdominal distension; ascending causes panting and inability to lie down, affecting both root and branch. Shishui is water accumulation in the lower abdomen and bladder, hard and full as stone. The Classics state: "Yin and Yang bind evil, with more Yin than Yang, named Shishui." It also says: "Kidney and Liver pulses both deep indicate Shishui." Water accumulates in the bladder, descending via the Foot-Shaoyin meridian, hence no panting.
Pulse floating and surging: Floating indicates wind; surging indicates Qi. Wind and Qi fight each other. If wind is stronger, it causes hidden rashes (Yinzhen) and body itching; itching is called Xiefeng (Leaking Wind); if prolonged, it becomes scaly leprosy-like lesions. If Qi is stronger, it causes water retention, making flexion and extension difficult. If Wind and Qi fight strongly, the body swells massively; sweating leads to recovery. Aversion to wind indicates deficiency, constituting Fengshui. No aversion to wind, with free urination and cold in the Upper Jiao causing excessive salivation, constitutes Huanghan.
You Yuyuan’s commentary: The four characters "Huanghan" here are likely interpolations. All six pulses are floating and surging; floating indicates wind, surging indicates Qi. In diseases of Wind-Qi interaction, if wind dominates Qi, the conflict affects the Ying level, causing hidden rashes and body itching. Itching results from muscle deficiency and external wind pressure, named Xiefeng, equivalent to modern wind-dryness sores. Thus, prolonged cases become scaly lesions like tinea and leprosy. If Qi dominates Wind, the conflict affects the Wei level, causing water qi and difficulty in flexion/extension, equivalent to modern Zhiyin (branching fluid) with panting and inability to lie down. If Wind and Qi both strike strongly, it forms Fengshui, causing generalized edema. All these syndromes belong to the muscle-surface level, so sweating is indicated, and recovery follows sweating. For Fengshui without sweat, Yuespi Tang should be used to induce sweating. If sweating occurs with aversion to wind, it indicates exterior Yang deficiency, so Fuzi (Aconite) is added. If there is no aversion to wind and urination is free, it is not exterior Yang cold, but Upper Jiao cold. Upper Jiao cold, especially when complicated by water disease, fails to constrain body fluids, causing excessive salivation.
He Shi’s *Yiquan* states: The sentence "aversion to wind indicates deficiency" and the five sentences "no aversion to wind, free urination, cold in Upper Jiao, excessive salivation, this is Huanghan" are likely misplaced slips and should be deleted. Note: It is unknown if this view is correct. *Jinjian* changed "Hongzhong" (massive swelling) to "Fuzhong" (edema). *Zhubing Yuanhou Lun* has a section on "sudden massive swelling of body and face," describing swelling as grandiose; *Jinjian* erred here.
Cunkou pulse deep and slippery indicates internal water qi, with swollen face and eyes and heat, named Fengshui. Observing the area above the eyelids, swelling resembles silkworms just waking up. The neck pulse beats, there is occasional coughing, and pressing the upper parts of hands and feet leaves indentations that do not rebound immediately—this is Fengshui. (*Maijing*, *Qianjin Fang*, *Waitai Mi Yao* lack the character "silkworm"; based on *Lingshu: Lunji Zhanchi* and *Shuizhang* chapters, the absence of "silkworm" is correct. The error likely arose from the later mention of "lying silkworms under the eyes." "Guo" in *Lingshu* is written as "Ke." Pan Shi’s *Xuyan* states: "Ke" means hollow, gathering essence into a hollow, implying condensation.)
You Yuyuan’s commentary: Fengshui typically has a floating pulse. Here, deep and slippery indicates water pulse rather than wind pulse. Regarding swollen face/eyes and heat, water combined with wind floats outward, so the pulse must change to floating. Zhang Zhongjing omits mentioning this because Fengshui encompasses it. Slight swelling above the eye sockets, resembling silkworms just waking, corresponds to *Neijing*: "Water is Yin, and the area under the eyes is also Yin; those with accumulated water must have slight swelling, appearing first under the eyes." Neck pulse beating indicates vigorous movement of the Renying pulse in the neck due to Fengshui rising upward. Occasional coughing indicates water infiltrating the lungs. Pressing the upper extremities leaving non-rebounding indentions differs from *Neijing*'s description of pressing the abdomen where rebound is immediate, like holding water. However, Qi in the abdomen is large, while Qi in the limbs is fine. Large Qi rebounds immediately; fine Qi does not rebound immediately. Yet, the edema is the same.
Note: *Shuizhang* chapter states: Pressing the abdomen with immediate rebound indicates water disease. Generalized swelling with thick skin, pressing the abdomen leaving non-rebounding indentations indicates Fuzhang (Skin Distension). Fuzhang is caused by cold qi lodging between the skin layers. Cold qi between the skin cannot gather suddenly upon pressure, hence non-rebounding. One must understand: immediate rebound indicates water without Qi stagnation; non-rebounding indicates both Qi and water. *Zhubing Yuanhou Lun* describes Zaoshui (Dry Water): water qi overflows skin causing swelling; drawing a line on the flesh leaves a visible trace, named Zaoshui; if the trace disappears immediately, named Shuishui (Wet Water). Shuishui corresponds to *Lingshu*'s water; Zaoshui corresponds to Fuzhang. The previous clause states: "Pishui pulse is also floating, external symptom is Fu-swelling, indentation upon pressure." This clause states: "Non-rebounding indentation is Fengshui." Thus, Pishui and Fengshui correspond to *Chaoyuan*'s Zaoshui and belong to Fuzhang. You’s annotation seems negligent, hence this detailed explanation.
Taiyang disease, pulse floating and tight, legally should present with joint pain, but instead no pain, body feels heavy and sour, patient is not thirsty, sweating leads to cure, this is Fengshui. Aversion to cold indicates extreme deficiency, caused by improper sweating. Thirst without aversion to cold indicates Pishui. Body swelling with cold sensation, resembling Zhoubi (Circulating Bi), chest oppression, inability to eat, contrary gathering pain, evening restlessness and insomnia, this is Huanghan. Pain in joints, coughing and panting without thirst, this is Pizhang (Spleen Distension—note: commentators often interpret as Feizhang/Lung Distension, which seems plausible; Cheng and Wei retain original text). Condition resembles swelling, sweating leads to cure. However, for any disease presenting thus, if accompanied by thirst, diarrhea, and frequent urination, sweating is contraindicated. ("Sour" in Xu, Shen, You is read as "heavy." Pizhang, commentators read as Feizhang, which seems correct; Cheng and Wei keep original. This paragraph has five sections, divided according to Xu’s annotation.)
You Yuyuan’s commentary: Taiyang with cold yields tight pulse and bone pain; with dampness yields soggy pulse and heavy body; with wind yields floating pulse and heavy body. This is clear differentiation. Now, obtaining Taiyang pulse but without bone pain, yet with heavy and sour body, indicates not Taiyang cold, but external dominance of Fengshui. Fengshui is exterior, not interior, hence no thirst. Wind requires sweating; water in the exterior also requires sweating, hence "sweating leads to cure." However, this applies only when Qi is abundant and solid. Otherwise, the exterior becomes more deficient; although Fengshui resolves, aversion to cold increases. Hence, "aversion to cold indicates extreme deficiency, caused by sweating." If thirsty without aversion to cold, it is not wind disease, but solely water disease, located not outside the skin but within the skin, deeper than Fengshui. Symptoms include body swelling with cold, resembling Zhoubi. Zhoubi is cold-damp bi obstructing Yang; Pishui is water qi flooding the skin. Chest oppression and inability to eat result from external cold attacking and internal Qi stagnation. Contrary gathering pain and evening restlessness result from heat constrained by cold, with cold being severe in the evening. Cold-damp invading externally flows into joints, hence "this is Huanghan, pain in joints." Coughing, panting, and no thirst indicate cold-water injuring the lung, Qi attacking the exterior, resembling swelling disease but actually identical to Pishui, hence "sweating leads to cure." However, for these diseases, if the patient has thirst, diarrhea, and frequent urination, one cannot assume water disease requires sweating and indiscriminately induce sweat. Zhang Zhongjing’s earnest warning implies concern for premature loss of Jin-Ye (fluids) and Qi. Question: Previous clauses state Fengshui has joint pain; this says joint pain is absent, body is heavy. Previous says Pishui has no thirst; this says thirst. Why? Answer: Wind and water combine to form disease. Flowing into joints causes joint pain; invading muscles causes no joint pain but heavy body. Difference lies in the site of injury. Previous "Pishui no thirst" does not mean Pishui inherently lacks thirst, but refers to cases where abdomen is drum-like and no thirst exists, meaning disease is still exterior and has not entered interior, so sweating is still possible. Current "thirst without aversion to cold" distinguishes it from Fengshui’s "no thirst with aversion to wind." Cheng states: Water qi stays externally in skin and internally presses lung, causing thirst, which is correct.
*Lingshu: Zhoubi Pian* states: "Wind, cold, damp qi lodge between outer muscle layers, pressing tightly to form foam. Foam gathers with cold, pushing apart muscle layers, causing splitting. Splitting causes pain. Pain draws Shen (spirit/mind) back. Shen returning generates heat. Heat relieves pain. Pain relief leads to reversal (Jue). Reversal causes other Bi attacks. This is neither internal in organs nor external in skin, but alone resides between muscle layers. True Qi cannot circulate fully, hence named Zhoubi." Note: This refers to Lijie (Joint) and Tongfeng (Gout). When it says "resembling Zhoubi," does it mean wandering pain? Or does it differ from *Lingshu* Zhoubi, referring to stubborn Bi? Commentators offer no clear explanation. Also note: *Jinjian* moved the six characters "treated with Yuespi Jia Zhu Tang" from the next clause to after "sweating leads to cure" in this clause, stating: "All four syndromes initially affect skin and hair, resembling Taiyang disease, so all are treated with Yuespi Jia Zhu Tang, sweating leads to cure." This view is unacceptable; see details in the next clause.
Lishui (Interior Water) disease presents with generalized and facial yellow swelling (Note: *Maijing* reads "Hongzhong"/massive swelling, which is correct), deep pulse, and difficult urination, thus causing water disease. If urination is free, this indicates loss of Jin-Ye, thus causing thirst. Treated with Yuespi Jia Zhu Tang. ([Original Note: Formula seen in Fengzhong ○ Note: Huang in Maijing is Hong, which is correct. Maijing note: Alternatively, Pishui, pulse deep, head and face swollen, difficult urination, thus causing water disease. If urination is free, loss of Jin-Ye, thus causing thirst.])
Cheng Lin’s commentary: Interior water yields deep pulse; difficult urination; overflowing to exterior causes generalized and facial yellow swelling. Hence, Yuespi Jia Zhu Tang is given to dissipate water. If urination is free, this indicates loss of Jin-Ye and thirst, not interior water syndrome; Yuespi Tang is not used. Yuespi Jia Zhu Tang should be placed after "thus causing water disease."
Note: All commentators treat the text from "generalized and facial yellow swelling" to "thus causing thirst" as indications for Yuespi Tang. They fail to realize this, like the Dacheng Mudan Tang clause for intestinal abscess, uses inverted syntax (Daozhuang Fa). Cheng’s interpretation is superior. However, according to *Maijing*, "Huangzhong" is a corruption of "Hongzhong." According to *Waitai* citing *Gujin Luyian*, Pishui is treated with Yuespi Jia Zhu Tang, and *Maijing* notes indicate Lishui is also a corruption of Pishui, making the meaning even clearer. *Jinjian*, without consulting ancient texts, arbitrarily moved the seven characters "Yuespi Jia Zhu Tang treats it" to the previous clause, which is presumptuous. Some doubt the logic of using Mahuang (Ephedra) for a deep pulse. Examining Materia Medica, Mahuang is a specific herb for the Lung. Li Shi-zhen elaborates on this. In Pishui, water qi is blocked in the skin. Using Mahuang to induce sweating allows Qi to move, water to benefit, and pulse channels to open, changing deep to floating. Such principles can only be verified through personal experience, confirming that the Classic text does not deceive us.
Duyang pulse should be hiding (Fu), but now is tight. Originally suffering from Hanhan (Cold Spasm) and Jia (Mass), with abdominal pain. The physician incorrectly used purgation. Purging led to chest fullness and shortness of breath. Duyang pulse should be hiding, but now is rapid. Originally suffering from heat, consuming food and frequent urination, but now urination is difficult. This desires to develop water disease.
You Yuyuan’s commentary: Zhao Liang states: Duyang pulse hiding is not the normal stomach Qi pulse. It hides because water accumulates below, suppressing Qi, hence the pulse hides. Pulse methodology states: Hiding pulse indicates water.
Wei Nianting’s commentary: Duyang pulse should hide with water pathogen because Stomach Yang is sealed by water-dampness and Yin-cold, so the Yangming pulse does not emerge. Now it is tight, indicating not only water excess in interior but also cold excess in middle. The person not only has water qi pathogen but also chronic accumulated cold, Hanhan, Jia, and frequent abdominal pain; water pathogen combines with cold pathogen. The physician failed to recognize Yin-cold, mistakenly thinking water pathogen can be purged. Although water sinks, cold pathogen rebels upward, causing chest fullness and shortness of breath. This case: Duyang pulse should hide, but now is rapid. Originally having heat, which should consume food and cause frequent urination and hard stool, like Taiyang Yangming excess syndrome. Now urination is difficult, confirming desire to develop water and damp-heat pathogen.
Cunkou pulse floating and delayed: Floating pulse indicates heat; delayed pulse indicates submergence. Heat and submergence fighting is named Chen (Sinking). Duyang pulse floating and rapid: Floating pulse indicates heat; rapid pulse indicates stopping. Heat and stopping fighting is named Fu (Hidden). Chen and Fu fighting is named Water. Chen indicates collateral vessels are empty; Fu indicates difficult urination. Emptiness and difficulty fighting causes water to move to skin, thus becoming water disease.
You Yuyuan’s commentary: Note: The meaning of this clause is disjointed; not explained.
Cunkou pulse string-tight (Xian-Jin): String-tight indicates Wei Qi does not circulate, leading to aversion to cold. Water does not flow smoothly, moving into intestines. (*Maijing*: After "Wei Qi does not circulate," repeats "Wei Qi does not circulate.")
Cheng Lin’s commentary: Cunkou observes the exterior. Xian-Jin indicates cold. Cold prevents exterior Qi from circulating, failing to protect the skin, hence aversion to cold. Since Qi does not circulate, water drink also fails to distribute, moving into intestines to form water.
Note: *Jinjian* states: This clause must have missing text; not explained. Checking *Maijing: Hanhan Pian*: "Cunkou pulse Xian-Jin. Xian indicates Wei Qi does not circulate; Wei Qi not circulating causes aversion to cold. Jin indicates unwillingness to eat; Xian-Jin fighting causes Hanhan." Knowing this clause should also have "Jin indicates..." text. *Jinjian* is correct.
Shaoyin pulse tight and deep: Tight indicates pain; deep indicates water; urination becomes difficult.
Shen Mingzong’s commentary: Shaoyin Kidney pulse. Tight indicates cold pathogen stagnating Zheng Qi internally, hence "tight indicates pain." Deep indicates Wei Qi depressed and unable to circulate, Sanjiao blocked, water flooding, hence "deep indicates water." Failure of Juedu (water passages) authority leads to difficult urination.
You Yuyuan’s commentary: Four sentences are disjointed and have missing text; not explained.
Pulse presenting various deep qualities should be blamed on water. Body swelling and heaviness. In water disease, if pulse emerges (Chu), death ensues. (*Maijing*: Above "pulse," adds "Master said.")
You Yuyuan’s commentary: Water is Yin; Yin excess causes deep pulse. Also, water moving in skin suppresses Ying and Wei, also causing deep pulse. If water disease and pulse emerges, True Qi reversely emerges above evil water, root separates, and disease Qi dominates alone, hence death. "Emerging" (Chu) is vastly different from "Floating" (Fu). Floating is strong above and weak below; Emerging is strong above and completely absent below.
Wei Nianting’s commentary: Appendix: One clause from *Shanghan Lun* to verify. Shaoyin chapter states: "Shaoyin disease, diarrhea with faint pulse, give Baitong Tang. Diarrhea does not stop, cold limbs, no pulse, dry heaving and irritability, treat with Baitong Jia Zhuyedan Tang. After taking medicine, if pulse suddenly emerges, death; if slowly continues, life."
For water disease patients, lying silkworms under eyes, fresh luster of face and eyes, hiding pulse, patient has Xiaoke (wasting-thirst).
You Yuyuan’s commentary: Zhao Liang states: *Neijing* states: Luster indicates Yi Yin disease. Yi Yin means thirst and excessive drinking, overflowing outside intestines and stomach. Also: Water is Yin; area under eyes is also Yin; abdomen is residence of Supreme Yin; thus, water in abdomen causes swelling under eyes. *Lingshu* states: "When water begins, slight swelling under eyes like silkworms, like newly woken state." Initially, due to failure of food/water to transform into Jin-Ye, leading to Xiaoke, must drink excessively. Excessive drinking causes water accumulation. Water accumulation blocks Qi channels, hence hiding pulse.