病水腹大。小便不利。其脉沉绝者有水。可下之。（案此条。原本接上条。今据程本金鉴。另分为一条。）
〔鉴〕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。
〔尤〕其脉沉绝。水气瘀壅而不行。脉道被遏而不出。其势亦太甚矣。故必下其水。以通其脉。
〔徐〕水病可下。
惟此一条。沉绝二字妙。
何氏医碥云。内水腹大。小便不利。脉沉甚。可下之。
十枣汤。浚川散。神 丸。禹攻散。舟车丸之类。盖亦可从小便利。亦可从大便泄也。
问曰。病下利后。渴饮水。小便不利。腹满因肿者。何也。答曰。此法当病水。若小便自利。及汗
出者。自当愈。（因。脉经。程本。金鉴。作阴。自当愈。千金注云。一作盈月当愈。案因肿。据答语云当
病水。作阴肿。为是。）
〔鉴〕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。小便不利者。皆当防病水也。
心水者。其身重。而少气。不得卧。烦而躁。其人阴肿。（
身重。千金注云。一作身肿。阴下。脉经有大字。）
〔魏〕又为明水气附于五脏。而另成一五水之证。盖水邪亦积聚之类也。切近于其处。则伏留于是藏。
即可以藏而名证。
〔程〕内经曰。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。诸水病者。不得卧。夫心属火。水在心。则蒸郁燔烁。是以不得卧。而烦躁也。心
水不应阴肿。以肾脉出肺络心。主五液。而司闭藏。水之不行。皆本之于肾。是以其阴亦肿也。
案金鉴云。其人阴肿四字。当在肾水条内。错简在此。此说有理。然程注义亦通。姑从之。
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。
〔魏〕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。（口中有淡水之症也。）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。
〔尤〕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。
肺水者。其身肿。小便难。时时鸭溏。（身下。千金有体字。）
〔鉴〕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。为尿溺。今既不通。水不得自小便出。反从其合。与糟粕混。
成鸭溏也。
〔尤〕鸭溏。如鸭之后。水粪杂下也。
脾水者。其腹大。四肢苦重。津液不生。但苦少气小便难。
〔尤〕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。
肾水者。其腹大。脐肿。腰痛不得溺。阴下湿如牛鼻上汗。其足逆冷。
面反瘦。（反。脉经。作皮。注云。一云。大便反坚。）
〔程〕肾者胃之关也。关门不利。故令聚水而生病。是有腹大脐肿之证也。腰者肾之外候。故令腰痛。
膀胱者。肾之腑。故令不得溺也。以其不得溺。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洪肿
也。
〔魏〕是五水。又以分附于五脏而得名矣。但脏虽各附。而其实异其地者。不异其邪。治之者。
亦异其处者。不当易其法也。
师曰。诸有水者。腰以下肿。当利小便。腰以上肿。当发汗。乃愈。
〔鉴〕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。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。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。
陈氏证治大还云。凡大人小儿。通身浮肿喘急。小便不利。自下而上者。名阴水。自上而下者。名阳水。
俗名河白。用河白草。浓煎汤洗浴。此草三尖底平。叶底及梗有芒刺。阳水用无刺者。阴水用有刺者。一二
浴后。而小便便利。浮肿自消。神效神效。
师曰。寸口脉沉而迟。沉则为水。迟则为寒。寒水相搏。趺阳脉伏。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。（
沈际飞校本脉经。卑作革。脉经注。一云。水分。）
〔程〕沉为水。迟为寒。水寒相搏。则土败矣。是以胃之趺阳脉则伏。脾之水谷则不磨。脾衰则寒内
着地而为 溏。胃衰则水外溢而为身肿也。少阳者三焦也。内经曰。三焦者。决渎之官。水道出焉。今少阳
脉卑。则不能决渎矣。在男子。则小便不利。少阴者肾也。中藏经曰。肾者女子以包血。以其与冲脉并行。今
少阴脉细。则寒气宕于胞门矣。在妇人则经水不通。经虽为血。其体则水。况水病而血不行。其血亦
化为水。故名曰血分。
案沈云。卑者。即沉而弱。徐云。卑则低而弱。平脉决。荣气弱。名曰卑。王宇泰云。荣主血为阴。
如按之沉而无力。故谓之卑也。但少阳未详何部。徐云。左关胆脉也。沈云。右尺。金鉴云。左尺。然左
右配位之说。仲景所未曾言。必别有所指。史记仓公传。时少阳初代。亦同。血分。诸家无
明解。盖分。散也。血为水分散。流布肢体也。又有水分。附于左。
脉经云。问曰。病有血分。何谓也。师曰。经水前断后病水。名曰血分。此病难治。问曰。病
有水分何也。师曰。
先病水后经水断。名曰水分。此病易治。
本事续方云。治妇人经脉不通。即化黄水。水流四肢。则遍身皆肿。名曰血分。其候与水肿。相类
一等。庸医不问源流。便作水疾治之。非唯无效。又恐丧命。此乃医杀之也。宜用此方。
人参 当归 瞿麦穗 大黄 桂枝 茯苓（各半两） 苦葶苈（炒二分）
上为细末。炼蜜丸如梧桐子大。每服十五丸。空心米饮下。渐加至二十丸。止于三十丸。每无不效者。案
此方为经水不通。而发血分者设焉。若胃气衰者。宜另议方而可也。
问曰。病者苦水。面目身体。四肢皆肿。小便不利。脉之不言水。反言胸中痛。气上冲咽。状如炙肉。
当微咳喘。审如师言。其脉何类。师曰。寸口脉沉而紧。沉为水。紧为寒。沉紧相搏。结在关元。始时当微。
年盛不觉。阳衰之后。荣卫相干。阳损阴盛。结寒微动。肾气上冲。喉咽塞噎。胁下急痛。医以为留饮。而
大下之。气击不去。其病不除。后重吐之。胃家虚烦。咽燥欲饮水。小便不利。水谷不化。面目手足浮肿。
又与葶苈丸下水。当时如小瘥。食饮过度。肿复如前。胸胁苦痛。象若奔豚。其水扬溢。则浮咳喘逆。当
先攻击冲气令止。乃治咳。咳止其喘自瘥。先治新病。病当在后。（徐本。气击。作气系。无浮咳之浮字。
当微。作尚微。沈尤并同。魏本气击。作气急。）
〔沈〕此水病积寒为根。兼示误治之变也。病者面目身体。四肢皆肿。小便不利。乃水肿本有之证。但
病者竟不言此。反言胸中痛。气上冲胸。状如炙肉。当微咳喘。然水病不当有此而见之。故问其脉何类。
〔程〕寸口脉沉而紧。沉为水。紧为寒。水寒之气。结于关元。当其少壮之时。阳气正旺。
虽有结寒。亦为不觉。及至阳衰之后。营卫亦虚。其阳则损。其阴则盛。关元结寒。乘其阳虚而动。肾中阳
气。不能以胜阴寒。寒气上冲。咽喉闭塞。胁下亦相引而急痛也。医者不求其本因寒水结在关元。见其标
证面目身体。四肢皆肿。小便不利。以为水饮。而大下之。其冲气不为下止。后重吐之。非惟冲气不止。
而大吐大下。复又损其胃。而亡其津液。是以咽燥引饮也。吐下后。其阳愈虚。则不能施行便溺。其寒
愈胜。则不能消化水谷。是以小便不利。而水谷不化。面目手足。犹然浮肿。复与葶苈丸下水。而浮肿小瘥。
食饮过度。则脾胃复伤。肿复如前。其实水寒结于关元而未散。寒上冲。则胸胁苦痛。象若奔豚。水扬溢。
则为浮肿喘咳也。
〔魏〕营卫。即阴阳之气也。阴气之旺。于阳气之衰。必相干凌。阳日益损。阴日益盛。
〔沉〕葶苈丸。但下水肿之标。不能除水之本。故但小瘥。而不尽彻。稍有食饮过度。肿复如前。
〔徐〕当攻击冲气令止。如痰饮门苓桂术甘汤是也。咳止。喘虽不治。而自愈矣。此乃病根甚深。不能骤除。
故须先去异病。则原病可治。故曰先治新病。病当在后。要知冲气咳喘等。皆新病也。病当在后。病字指水
气言。然关元结寒。则又为水病之本矣。
案金鉴云。此条文义不属。不释。然今合数家之说而读之。则义略通。且世病水之人。多类此条证者。
安可措而不讲耶。浮咳二字。程注似未允。俟考。末二句。即首篇先治其卒病。后乃治其痼病之意。脉经
注云。气击不去。言邪气不去。而元气反为药所击也。
风水脉浮。身重汗出恶风者。防己黄 汤主之。腹痛者。加芍药。
〔尤〕此条义。详痉湿 篇。虽有风水风湿之异。然而水
与湿非二也。
案此条校之于痉湿 篇。唯湿作水为异耳。盖此后人误
入者。附方所载。外台证治。的是本经之旧文。脉经。与外台同。可以证矣。
防己黄 汤方（方见湿病中。）
风水恶风。一身悉肿。脉浮不渴。续自汗出。无大热。越婢汤主之。
〔沈〕此风多水少之证也。风多伤表。外应肌肉。内连及胃。故恶风一身悉肿。胃气热蒸。其机外向。不
渴而续自汗出。无大热者。则知表有微热而为实也。故以麻黄通阳气而散表。石膏入胃。能治气强壅逆。
风化之热。甘草姜枣。以和营卫。若恶风者。阳弱而为卫虚。故加附子。录验加术。并驱湿矣。
〔尤〕脉浮
不渴句。或作脉浮而渴。渴者热之内炽。汗为热逼。与表虚出汗不同。故得以石膏清热。麻黄散肿。
而无事兼固其表耶。
案大青龙汤。治伤寒烦躁。麻黄杏仁甘草石膏汤。治汗后汗出而喘。无大热。俱麻黄石膏。并用之剂。
而不言有渴。今验之。不论渴与不渴。皆可用。然此断云不渴者。义可疑也。以理推之。作而渴为是。下文
黄汗之条。汗出而渴。脉经注云。一作不渴。而渴不渴。经有误错。是其明征也。
越婢汤方（外台风水门。引古今录验云。此本仲景伤寒论方。云。里水越婢加术
汤主之。案越婢名义。详伤寒论辑义。）
麻黄（六两） 石膏（半斤） 生姜（三两） 甘草（二两） 大枣（十五枚）
上五味。以水六升。先煮麻黄。去上沫。内诸药。煮取
三升。分温三服。恶风者。加附子一枚。（炮）风水加术四两。（古今录验。）
外台风水门。煮法后云。咳肺胀。加半夏五合。洗。一
服五合。又皮水门云。古今录验。皮水。越婢汤加术主之。
煮法后云。范汪同。本出仲景伤寒论。案据外台。风水加术四两。当作皮水。
〔魏〕恶风甚者。加附子一枚。而壮阳。正所以除湿。且用其流走之烈性。以治周身之肿。凡正阳所行
之地。岂水湿之邪。可留之区乎。此亦不专治水。而水治之法也。加术治风水者。必风邪轻。而水气重。
但治其表。不足以行水。加术以助水之堤防。水由地中行而奏绩矣。（案据外台。原方只五味。盖
加味法。编书者采录于古今录验。故注此四字。）
陈氏证治大还云。越婢汤。治脉浮在表。及腰以上肿。宜此发汗。兼治勇而劳甚。肾汗出。汗出遇风。
内不得入脏腑。外不得越皮肤。客于玄府。行于皮里。传为 肿。本之于肾。名曰风水。其症恶风一身悉肿。
脉浮不渴。续自汗出。风水症。少气时热。从肩背上至头汗出。苦渴小便黄。目下
肿腹中鸣。身重难行。正卧则咳。烦而不能食。
巢源。妇人香港脚候云。若风盛者。宜作越婢汤加术四两。千金。越婢汤。治风痹脚弱方。
于本方中。加白术四两。大附子一枚。注云。胡洽方。
只五味。若恶风者。加附子一枚。多淡水者。加白术四两。
圣惠方。麻黄散。治风水。遍身肿满。骨节 疼。恶风脚弱。皮肤不仁。
于越婢加术附汤内。去甘草。加汉防己桑根白皮。
圣济总录。麻黄汤。治水气通身肿。
于本方中。加茯苓。
皮水为病。四肢肿。水气在皮肤中。四肢聂聂动者。防己茯苓汤主之。（外台。
引深师。聂聂。作集集。案聂聂。木叶动貌。十五难。厌厌聂聂。如循榆荚。）
Water disease causing abdominal distension, with difficulty in urination and a pulse that is deep and nearly imperceptible (Shen Jue), indicates the presence of water retention. Purging methods may be employed. (Note: This clause originally followed the previous one; based on the editions by Cheng Lin and Jin Jian, it is now separated into an independent clause.)
[Jin Jian] The abdomen belongs to the extreme Yin and corresponds to the Spleen. Therefore, water disease inevitably presents with abdominal distension. Water accumulation internally leads to difficulty in urination. A pulse that is deep and nearly imperceptible is known as the Hidden Pulse (Fu Mai). With a hidden pulse, abdominal distension, and difficulty in urination, internal water retention has formed; thus, purging methods are indicated. Formulas such as Shi Zao Tang (Ten Date Pill) may be used with discretion.
[You Yi] A pulse that is deep and nearly imperceptible occurs because water qi is stagnant and obstructed, preventing circulation, thereby suppressing the pulse vessels. The pathological condition is severe. Therefore, water must be purged to unblock the pulse vessels.
[Xu Lingtai] Water disease can be treated with purging methods.
The term "Shen Jue" (deep and imperceptible) in this clause is particularly apt.
He's *Yi Quan* states: Internal water retention causing abdominal distension, difficulty in urination, and a deeply suppressed pulse can be treated with purging.
Formulas such as Shi Zao Tang (Ten Date Pill), Xuan Chuan San (Abyssal River Powder), Shen You Wan (Divine Blessing Pill), Yu Gong San (Yu Gong Powder), and Zhou Che Wan (Boat Cart Pill) can be considered. Treatment may proceed by promoting diuresis or by inducing bowel evacuation.
Question: After a patient suffers from diarrhea, feels thirsty and desires to drink water, experiences difficulty in urination, abdominal fullness, and swelling of the yin organs, what is the cause? Answer: This condition will likely develop into water disease. If urination becomes free and sweating occurs, the condition will resolve spontaneously. ("Yin Zhong" [swelling of the yin], according to *Mai Jing*, Cheng Ben, and Jin Jian. *Qian Jin Fang* notes: alternatively, recovery after one lunar month. Note: Based on the answer "will likely develop into water disease," interpreting "Yin Zhong" as swelling of the yin organs is appropriate.)
[Jin Jian] Diarrhea depletes Earth (Spleen) qi and damages fluids. When Earth is deficient, water tends to act recklessly; when fluids are damaged, thirst for water arises. If urination is free and sweating occurs, water essence is distributed throughout the body, preventing water disease. However, if urination is difficult, water has no outlet, leading inevitably to water disease. In water disease, the Spleen is deficient and fails to control water, causing abdominal fullness. The Kidney is deficient and fails to govern water, causing swelling of the yin organs. From this, we infer that after any illness, if fluids are damaged, thirst arises, and urination is difficult, one should guard against developing water disease.
Heart Water Disease presents with heaviness of the body, shortness of breath, inability to lie down, irritability, restlessness, and swelling of the yin organs. (Body heaviness: *Qian Jin Fang* notes "alternatively body swelling." Yin lower: *Mai Jing* adds the character "Da".)
[Wei Lihong] This clarifies that water qi attaches to the Five Zang organs, forming a distinct category of "Five Waters." Water pathogens are similar to accumulations; they lodge near specific locations and remain within those organs, allowing the syndrome to be named after the organ.
[Cheng Lin] *Nei Jing* states: The Heart governs the blood vessels of the body. *Shang Jing* states: When water is in the Heart, there is hardness and palpitations below the heart and shortness of breath, resulting in body heaviness and shortness of breath.
*Nei Jing* also states: Patients with various water diseases cannot lie down. The Heart belongs to Fire; when water is in the Heart, it causes steaming and burning, leading to an inability to lie down and irritability. Heart Water should not present with yin swelling. The Kidney meridian emerges from the Lung and connects to the Heart, governing the five fluids and controlling closure/storage. The failure of water movement originates in the Kidney, hence the yin organs swell.
Note: Jin Jian argues that the phrase "swelling of the yin organs" belongs in the Kidney Water clause due to misplaced text. This reasoning is sound. However, Cheng's interpretation is also plausible; we tentatively follow it.
Liver Water Disease presents with abdominal distension, inability to turn over independently, pain under the ribs and in the abdomen, occasional slight production of saliva, and intermittent passage of urine.
[Wei Lihong] Water in the Liver meridian lodges in the hypochondrium, causing abdominal distension and rib pain. Shaoyang is the pathway for the interchange of Yin and Yang; obstruction by pathogens prevents independent turning. Liver water rises to the chest and throat, causing occasional slight salivation (a symptom of fresh water in the mouth). As Qi ascends and descends, intermittent urination occurs. This reflects water pathology following the ascending and descending movements of Liver Wood Qi.
[You Yi] Occasional salivation and intermittent urination occur because the Liver favors counterflow and governs dispersion and descent. Water fluids move up and down accordingly.
Lung Water Disease presents with body edema, difficult urination, and frequent passage of loose stools resembling duck feces. (Lower body: *Qian Jin Fang* includes the character "Ti" [body].)
[Jin Jian] Zhao Liang states: The Lung governs skin and hair, circulates Ying and Wei, and pairs with the Large Intestine. In water disease, water fills the skin. The Lung normally regulates water passages, directing them downward to the Bladder for excretion. Now, since regulation fails, water cannot exit via urine but follows its paired organ, mixing with waste to form duck-like loose stools.
[You Yi] Duck-like loose stools refer to the mixture of water and feces passing together, like duck droppings.
Spleen Water Disease presents with abdominal distension, heavy and burdensome limbs, lack of fluid generation, shortness of breath, and difficult urination.
[You Yi] The Spleen governs the abdomen, and Qi moves through the limbs. Spleen affected by water leads to abdominal distension and limb heaviness. Fluids are generated from grain Qi, which is transported by the Spleen. Spleen dampness failing to transport results in lack of fluids, shortness of breath, and difficult urination due to stagnant dampness.
Kidney Water Disease presents with abdominal distension, umbilical swelling, lower back pain, inability to urinate, dampness in the genital area resembling sweat on a bull's nose, cold feet, and a thin face. (Fan: *Mai Jing* reads "Pi" [skin]; note says: alternatively, stool is hard.)
[Cheng Lin] The Kidney is the gate of the Stomach. If the gate is blocked, water accumulates, causing abdominal distension and umbilical swelling. The lower back is the external indicator of the Kidney, hence back pain. The Bladder is the Fu organ of the Kidney, hence inability to urinate. Due to urinary retention, water qi soaks the scrotum, causing dampness in the yin; flowing to the Lower Jiao, it causes cold feet. The Kidney is the Water Organ; afflicted by water pathogen, Upper Jiao Qi and Blood descend with the nature of water, causing the face to appear thin, unlike the facial edema seen in Wind Water or Interior Water.
[Wei Lihong] These five water syndromes are named by attaching to the Five Zang organs. Although each attaches to a different organ, the pathogen is the same. Treatment targets different locations but does not alter the fundamental method.
The Master said: For all water diseases, if swelling is below the waist, promote urination; if swelling is above the waist, induce sweating. Then recovery occurs.
[Jin Jian] "All water diseases" refers to various water conditions. Treatment requires understanding methods to disperse water from the exterior, interior, upper, and lower aspects. Swelling above the waist indicates water in the exterior; sweating is required (e.g., Yue Bi Tang, Qing Long Tang). Swelling below the waist indicates water in the interior/lower; diuresis is required (e.g., Wu Ling San, Zhu Ling Tang). Zhao Liang states: The upper half of the body corresponds to Heaven and Yang; the lower half to Earth and Yin. Skin pores circulate Heaven's Yang; urination connects to Earth's Yin. Water stopping in the upper part is dispersed via pores/sweat; water stopping in the lower part is drained via the outlet. This aligns with *Nei Jing*'s "Open the ghost door [pores], clean the residence [bladder]."
Chen's *Zheng Zhi Da Huan* states: For adults and children with generalized edema, asthma, and difficulty urinating: swelling rising from below is called Yin Water; swelling descending from above is called Yang Water. Commonly known as He Bai Cao. Boil He Bai Cao thickly for bathing. This herb has three pointed flat bases; leaves and stems have prickles. Use non-prickled herbs for Yang Water, prickled for Yin Water. After one or two baths, urination becomes free, and edema subsides miraculously.
The Master said: Cun Kou pulse is deep and slow. Deep indicates water; slow indicates cold. Cold and water contend. Fu Yang pulse is hidden; food and water are not digested. Spleen Qi deficiency leads to loose stools; Stomach Qi deficiency leads to body swelling. Shao Yang pulse is low/weak; Shao Yin pulse is fine. In men, urination is difficult; in women, menstruation is blocked. Menstrual blood is Blood; if Blood flow is obstructed, it transforms into Water, termed Blood Partition (Xue Fen). (Shen Jifei's edition of *Mai Jing* reads "Ge" instead of "Bei". *Mai Jing* note: alternatively "Water Partition".)
[Cheng Lin] Deep indicates water, slow indicates cold. Water and cold contending lead to Earth failure. Thus, the Stomach's Fu Yang pulse is hidden, and Spleen digestion fails. Spleen deficiency causes internal cold and loose stools; Stomach deficiency causes water overflow and body swelling. Shao Yang is the San Jiao. *Nei Jing* states: San Jiao is the official of drainage, where water pathways emerge. A weak Shao Yang pulse fails to drain. In men, this causes difficulty urinating. Shao Yin is the Kidney. *Zhong Zang Jing* states: The Kidney stores blood in women, running parallel with the Chong Mai. A fine Shao Yin pulse indicates cold lodging in the Bao Men (uterus gate). In women, this blocks menstruation. Although menstruation is Blood, its substance is Water. If water disease prevents blood flow, blood transforms into water, hence "Blood Partition."
Note: Shen states: Bei means deep and weak. Xu states: Bei means low and weak. *Ping Mai Jue*: Weak Ying Qi is called Bei. Wang Yutai: Ying governs Blood as Yin; pressing deep and forceless is called Bei. The location of Shao Yang is unclear. Xu: Left Guan Gallbladder pulse. Shen: Right Chi. Jin Jian: Left Chi. Zhang Zhongjing did not specify left-right correspondence; it must refer to something else. *Shi Ji · Cang Gong Zhuan* mentions "Shao Yang Chu Dai," consistent with this. "Blood Partition" lacks clear explanation by commentators. "Fen" likely means scattering; Blood scattered by water flows through the limbs. There is also "Water Partition" attached to the left.
*Mai Jing* asks: What is Blood Partition? The Master says: If menstruation stops first, then water disease develops, it is Blood Partition. This is difficult to treat. What is Water Partition? The Master says: If water disease develops first, then menstruation stops, it is Water Partition. This is easy to treat.
*Benshi Xu Fang* states: Treating women with blocked menstruation, which transforms into yellow water flowing to limbs, causing generalized swelling, is called Blood Partition. Symptoms resemble edema. Ignorant physicians treating it as simple water disease without investigating the source are ineffective and may cause death; this is medical homicide. Use this formula: Renshen (Ginseng Radix), Danggui (Angelicae Sinensis Radix), Qumai (Dianthi Herba), Dahuang (Rhei Radix et Rhizoma), Guizhi (Cinnamomi Ramulus), Fuling (Poria), Tingli (Descurainiae Semen seu Lepidii Semen - stir-fried).
Grind to fine powder, make pills with honey the size of wu tong seeds. Take 15 pills on an empty stomach with rice decoction, gradually increasing to 20, max 30. Always effective. Note: This formula is for Blood Partition caused by menstrual blockage. If Stomach Qi is deficient, another formula should be considered.
Question: A patient suffers from water disease with edema of the face, eyes, body, and limbs, and difficulty urinating. Palpation reveals no mention of water disease, but rather chest pain, Qi rushing up to the throat feeling like a piece of roasted meat, and mild coughing/wheezing. If this matches the Master's description, what is the pulse? The Master said: Cun Kou pulse is deep and tight. Deep indicates water; tight indicates cold. Deep and tight contend, knotting at Guan Yuan. Initially mild, unnoticed in youth. After Yang declines, Ying and Wei interfere; Yang damages, Yin becomes excessive. Knotted cold moves slightly, Kidney Qi rushes up, causing throat blockage and hypochondriac pain. Physicians mistook it for retained fluid and purged heavily. Qi attack remained, disease persisted. Later, vomiting was induced, causing Stomach deficiency, irritability, dry throat, thirst, difficulty urinating, and undigested food/water. Face, hands, and feet swelled again. Tingli Wan was given to drain water; slight improvement occurred. Overeating caused swelling to return. Chest and hypochondrium painful, resembling Ben Tun (Running Piglet). Water overflowing causes floating cough and wheezing. First, attack the rushing Qi to stop it, then treat cough. Cough stops, wheezing resolves. Treat new disease first, old disease later. (Xu Ben: "Qi Ji" as "Qi Xi"; no "Fu" in "Fu Ke". "Dang Wei" as "Shang Wei". Shen/You same. Wei Ben: "Qi Ji" as "Qi Ji".)
[Shen Mingzong] This shows water disease rooted in accumulated cold, illustrating complications of mis-treatment. Generalized edema and difficulty urinating are standard signs. However, the patient complains of chest pain, Qi rushing up, sensation of roasted meat, and mild cough. Since these are atypical for water disease, the pulse is questioned.
[Cheng Lin] Deep and tight Cun Kou pulse indicates water and cold knotting at Guan Yuan. In youth, strong Yang masks this. After Yang declines, Ying/Wei weaken, Yang damages, Yin excesses. Knotted cold activates due to Yang deficiency; Kidney Yang cannot overcome cold, causing cold Qi to rush up, blocking throat and pulling hypochondrium. Physicians ignored the root (cold/water knot) and saw only symptoms (edema, difficulty urinating), mistaking it for fluid retention and purging heavily. Rushing Qi did not stop. Subsequent vomiting further damaged Stomach and fluids, causing dry throat/thirst. Post-vomit/purge, Yang is weaker, unable to manage urination; Cold is stronger, unable to digest food, causing difficulty urinating and undigested food. Tingli Wan provided slight relief, but overeating injured Spleen/Stomach, returning swelling. Root cold/water knot remains. Cold rushing up causes chest/hypochondriac pain (Ben Tun-like). Water overflowing causes edema/cough.
[Wei Lihong] Ying and Wei are Yin and Yang Qi. Yin prosperity due to Yang decline leads to interference. Yang diminishes daily, Yin increases daily.
[Shen Mingzong] Tingli Wan drains superficial edema but not the root cause, hence only slight relief. Overeating returns swelling.
[Xu Lingtai] Attack rushing Qi using formulas like Ling Gui Zhu Gan Tang from the Phlegm-Fluid chapter. Cough cessation resolves wheezing. The root is deep; acute symptoms must be removed first to treat the original disease. "New disease" refers to rushing Qi/cough; "Old disease" refers to water qi. However, knotted cold at Guan Yuan is the root of water disease.
Note: Jin Jian finds the text disjointed. However, synthesizing commentaries makes sense clinically. "Floating cough" in Cheng's note is questionable. The final sentences echo the principle: "Treat acute disease first, chronic disease later." *Mai Jing* note: "Qi Ji bu qu" means pathogens remain while healthy Qi is attacked by drugs.
Wind Water with floating pulse, heavy body, sweating, and aversion to wind is treated with Fang Ji Huang Qi Tang. Add Shaoyao if abdominal pain is present.
[You Yi] This clause's meaning is detailed in the *Jing Shi Ye Pian*. Despite differences between Wind Water and Dampness, Water and Dampness are not separate entities.
Note: Comparing with *Jing Shi Ye Pian*, only "Damp" is changed to "Water." Likely a later insertion. *Wai Tai Mi Yao* confirms this as original text. *Mai Jing* agrees.
Fang Ji Huang Qi Tang Formula (See Dampness Disease section).
Wind Water with aversion to wind, generalized edema, floating pulse, no thirst, continuous spontaneous sweating, and no significant heat is treated with Yue Bi Tang.
[Shen Mingzong] This is a case of more Wind than Water. Wind damages the exterior, affecting muscles and connecting to the Stomach, causing aversion to wind and edema. Stomach heat steams outward, causing non-thirsty spontaneous sweating and no major heat, indicating exterior mild heat/excess. Mahuang unblocks Yang and disperses exterior; Shigao enters Stomach to quell rebellious Qi and wind-transformed heat; Gancao, Shengjiang, Dazao harmonize Ying and Wei. If aversion to wind indicates weak Yang/deficient Wei, add Fuzi. *Lu Yan* adds Baizhu to expel dampness.
[You Yi] "Floating pulse, no thirst" might be "Floating pulse, thirst." Thirst indicates internal heat forcing sweat, different from exterior deficiency sweating. Thus, Shigao clears heat and Mahuang reduces swelling without needing to secure the exterior.
Note: Da Qing Long Tang treats Sun Shang restlessness; Ma Xing Shi Gan Tang treats post-sweating asthma with no major heat. Both use Mahuang and Shigao without mentioning thirst. Verification shows both cases work regardless of thirst. Asserting "no thirst" here is questionable. Logic suggests "with thirst" is correct. The subsequent Huang Han clause mentions "sweating with thirst"; *Mai Jing* note says "alternatively no thirst." This proves textual error regarding thirst/no thirst.
Yue Bi Tang Formula (*Wai Tai* Wind Water section cites *Gu Jin Lu Yan*: This is originally from Zhang Zhongjing's *Shang Lun*. Interior Water is treated with Yue Bi Jia Zhu Tang. Note: Meaning of Yue Bi see *Shang Lun Ji Yi*.)
Mahuang (6 liang), Shigao (8 liang), Shengjiang (3 liang), Gancao (2 liang), Dazao (15 pieces).
Boil five ingredients in 6 sheng water. First boil Mahuang, remove foam. Add other herbs. Boil to 3 sheng. Divide into three warm doses. If aversion to wind, add one Pao Fuzi. For Wind Water, add 4 liang Baizhu (*Gu Jin Lu Yan*).
*Wai Tai* Wind Water section post-boiling instructions: For cough and lung distension, add 5 he washed Banxia. One dose takes 5 he. Pi Shui section: *Gu Jin Lu Yan* states Pi Shui is treated with Yue Bi Jia Zhu Tang.
Post-boiling note: Fan Wang agrees. Originally from Zhang Zhongjing's *Shang Lun*. Note: According to *Wai Tai*, "Wind Water add 4 liang Baizhu" should read "Pi Shui."
[Wei Lihong] Severe aversion to wind requires adding one Fuzi to strengthen Yang and dispel dampness. Its penetrating nature treats generalized edema. Where Zheng Yang travels, water-dampness cannot linger. This is a method of treating water without directly targeting it. Adding Baizhu for Wind Water implies light Wind and heavy Water. Exterior treatment alone is insufficient; Baizhu strengthens the "dike" to guide water flow. (Note: *Wai Tai* original has five ingredients; added herbs were recorded from *Gu Jin Lu Yan*.)
Chen's *Zheng Zhi Da Huan* states: Yue Bi Tang treats exterior floating pulse and swelling above the waist, inducing sweating. It also treats exhaustion from vigorous labor, Kidney sweat encountering wind, trapped in Xuan Fu, moving under skin, transforming into foot swelling rooted in Kidney, named Wind Water. Symptoms: aversion to wind, generalized edema, floating pulse, no thirst, spontaneous sweating. Wind Water also includes shortness of breath, intermittent fever, sweating from shoulder/head, bitter thirst, yellow urine, periorbital edema, borborygmus, heavy body, cough when lying flat, irritability, and anorexia.
*Chao Yuan Fang* Female Hong Jiao section: If Wind is dominant, use Yue Bi Jia Zhu Tang (add 4 liang Baizhu). *Qian Jin Fang* Yue Bi Tang treats Wind Bi and leg weakness. Add 4 liang Baizhu and one large Fuzi. Note: Hu Qia Fang has only five ingredients. If aversion to wind, add Fuzi. If excessive fresh water, add Baizhu.
*Sheng Hui Fang* Mahuang San treats Wind Water, generalized swelling, joint pain, aversion to wind, leg weakness, and numb skin. Remove Gancao from Yue Bi Jia Zhu Fu Tang, add Han Fangji and Sangbaipi.
*Sheng Ji Zong Lu* Mahuang Tang treats Water Qi generalized swelling. Add Fuling to this formula.
Pi Shui disease presents with limb edema, water qi in the skin, and trembling/movement in the limbs. Fang Ji Fu Ling Tang is indicated. (*Wai Tai* cites *Shen Shi*: "Nie Nie" as "Ji Ji". Note: "Nie Nie" describes leaf movement. *Nan Jing 15*: "Yan Yan Nie Nie" like touching elm seeds.)