师曰。病有风水。有皮水。有正水。有石水。有黄汗。
此言肤肿病。内经概言目窠上微肿。如新卧起之状。其颈脉动。时咳。阴股间寒。
足颈肿。腹乃大。水已成矣。以手按其腹。随手而起如裹水之状。而不分别为言。然而
病因不同。则治法迥异。师故立五名以为大纲。而脉证标本变化之微。详悉于下。
风水（之脉证奈何。）其脉自浮。（浮为风。故）外证骨节疼痛。（风尚在表。故）
恶风。皮水（之脉证奈何。水行皮间。内合肺气。故）其脉亦浮。外证 肿。按之没指。
（其邪既去经而在皮间。既去经故）不恶风。（在皮间故）其腹（外实中空）如鼓。
（肿在皮外。而未及肠脏。故）不渴。当发其汗。（俾皮间之水从汗解。） 正水（之
脉证奈何。三阴结。而非风结。故）其脉沉（水属阴。故其脉）迟。（三阴结而下焦阴
气不复与胸中之阳相调。水气格阳在上。故其）外证自喘。（喘为此证之眼目。至于
目窠如蚕两胫肿腹大。与石水证相同者。不必言也。）石水（之脉证奈何。水聚于下而
不行。故）其脉自沉。（水在下而未伤中气。中未虚冷。故但沉而不迟。病专在下。而
不及于上。故其）外证（少）腹满。（而）不喘。（不喘为此证眼目。与正水所同等证。
亦不必言也。） 黄汗（之脉证奈何。水邪内郁。故）其脉沉迟。（心受邪郁。故
）身发热。（热伤在上。故）胸满。（阳部之邪从阳。故）四肢头面肿。久不愈。（
则邪气侵阴。荣气不通。）必致痈脓。
此于五条分晰其脉证也。
（试详风水之证。而别其相似之病。）脉浮而洪。浮则为风。（风者。天之气也。）
洪则为气。（气者。人之气也。是皆失其和者也。）风气相搏。（若）风强（于气。）
则（气从风而浸淫
肌肤。而）为瘾疹。身体为痒。痒者（藉瘙而稍疏浅。）为泄风。久（则生虫。）为痂
癞。（若）气强（于风。）则（风从气而鼓涌水液。而）为水。（水成则肿胀喘满。）
难以俯仰。（若）风气（并强。两）相（维）系。（而水液从之。以致）身体洪（大而）
肿。（盖风为虚邪。自汗恶风。乃其的证。今因）汗出乃愈。恶风则（邪之属）虚。（
无有疑议。故直指之曰。）此为风水。（彼夫）不恶风者。（表无风也。）小便通利。
（非风水之相搏也。）上焦有寒。其口多涎。（乃水入伤心。汗内返而为湿所致。）此
为黄汗。
此详风水之病源。且风水病最与黄汗相似。故节末又郑重以分别之。风水脉浮。黄
汗脉沉。浅而易知。师故未言之。
（风水中有变异者。不可不知也。风之脉。浮也。水之脉。滑也。今）寸口脉沉滑
者。（不见风脉。但见水脉。）中有水气。（似属正水。然高巅之上。惟风可到。故）
面目肿大。（风为阳邪。故身中）有热。（证既属风。其沉亦将变而为浮。而未变之初。
无不可先正其）名曰风水。视（其）人之目窠上微肿。如蚕新卧起状。其颈脉动。时时
咳。（此正水之征也。乃）按其手足上陷而不起者。（知非正水。而为气水矣。风气必
系。亦可正其名曰）风水。
此言风水证虽有变异。而真面目不可掩也。
太阳病。脉浮而紧。法当骨节疼痛。（此阴邪表实证也。今）反不疼。（即与阴邪迥
别。且）身体（不为疼而）反（为）重（重则便知其为正水也。不为疼）而（为） 。
（则便知其为风也。风水涣于外。未入于内。故）其人不渴。（病在外者宜汗。故
）汗出即愈。此为风水。（此外另有汗后反）恶寒者。此为极虚（之证。误因）发汗得
之。（亦另有芍药甘草附子汤之治法。不在风水之例。若前证更有）渴而不恶寒者。
（渴似风水。而于不恶寒处。得其机关。知非病风。而独病水。不在皮外。而在皮中。
视风水较深一层。）此为皮水。（其证）身肿而冷。状如周痹。（盖以周痹为寒湿痹其
阳。皮水为水气淫于肤。所以大略相似也。若前证更有）胸中（气）窒。（窒而作胀。
则）不能食。（窒而不行。）则反聚痛。（至）暮（为阴分。更）躁（而）不得眠。（明是有水伤心。寒郁其热。
其证全在于胸。）此为黄汗。（若前证之脉浮紧。而）痛在骨节。（脉证却不相反。且
）咳而喘不渴者。（乃水寒伤
肺。）此为肺胀。其状如肿。（肺主皮毛。皮毛受邪。）发汗则愈。然诸病此者。（均
宜发汗。惟）渴而下利。小便数者。（为邪已内入。恐非一汗所能愈。）皆不可发汗。
此言风水中有类太阳脉。而不出太阳证者。又有相似而实为皮水者。有相似而实为
黄汗者。有相似而并非皮水黄汗。实为肺胀者。师分别其证。未出其方。后人补以越婢
加术汤。亦未甚周到。节末以渴者。下利者。小便数者。戒其发汗。大有深意。
或问前二条云。风水外证骨节疼。此言骨节反不疼。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。其侵淫肌肤
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。
（风水皮水之外。又有湿热郁于里。为）里水者。一身面目黄肿。（其分别处在于
黄。若黄而汗出亦黄。则为黄汗。身黄而无汗出。则为里水。水在里。故）其脉（不浮而
）沉。（热久郁。故）小便不利。（积于内者溢于外。）故令病水。假令小便自利。（
不因此自利而除其黄肿。反因）此（自利而）亡（其）津液。（津液亡）故令渴。（以
）越婢加术汤主之。（方见中风）
此又从风水皮水外而言里水也。
尤在泾云、越婢加术。是治其水。非治其渴也。以其身面悉肿。故取麻黄之发表。
以其肿而且黄。知其湿
中有热。故取石膏之清热。与白术之除湿。不然。则渴而小便利者。而顾犯不可发汗之戒
耶。或云此治小便利黄肿未去者之法。越婢散肌表之水。白术止渴生津也。亦通。
（又有兼宿疾而致水。不可不知也。）趺阳（系胃脉。脉本不伏。因水蓄于下。气
伏）脉（亦）当伏。今反紧。（紧则为寒。此因其人）本自有寒。疝瘕腹中痛。医（不
温其寒。而）反下之。（阳气重伤。）即胸满短气。（而水病大作。所以然者。阳以下
而伤。则决渎无权。水不行而汛滥矣。气以下而耗。则精凝血滞。变其常而化水矣。）
趺阳脉（因水病而）当伏。今反数。（数则为热。此因其人）本自有热。（热则当）消
谷（而）小便数。今反不利。（则水液日积。）此欲作水。（所以然者。阴虚无以配阳。
则水为热蓄而不行也。）
此言水病患别有宿疾。当从趺阳脉与其旧疾见证而兼顾之。不可以见肿治肿为能事。
（水病有五。而正水之病居多。当于脉而体认其所由成。然脉之元妙。可以意会。
而不可以言传也。）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。
徐忠可云、此段论正水所成之由也。谓人身中健运不息。所以成云行雨施之用。故
人之汗。以天地之雨名之。人之气。以天地之疾风名之。故寸口脉主上。犹之天道必
下济而光明。故曰阴生于阳。趺阳脉主下。犹之地轴必上出而旋运。故曰卫气起于下
焦。今寸口脉浮而迟。浮主热。乃又见迟。迟者。元气潜于下也。既见热脉。又见潜脉。
是热为虚热。而潜为真潜。故曰热潜相搏名曰沉。言其所下济之元气。沉而不复举。
非沉脉之沉也。今趺阳脉浮而数。浮主热。乃又见数。数者。卫气止于下也。既见热脉。
又见止脉。是客气为热。而真气为止。故曰热止相搏名曰伏。言其宜上出之卫气。伏
而不能升。非伏脉之伏也。
从上而下者。不返而终沉。从下而上者。停止而久伏。则旋运之气。几乎熄矣。熄则阴
水乘之。故曰沉伏相搏名曰水。见非止客水也。恐人不明沉伏之义。故又曰络脉者。阴
精阳气。所往来也。寸口阳气沉而在下。则络脉虚。小便者。水道之所从出也。趺阳真
气。止而在下。气有余即是火。火热甚则小便难。于是上不能运其水。下不能出其水。
又焉能禁水之胡行而乱走耶。故曰虚难相搏。水走皮肤。即为水矣。水者。即身中之阴
气。合水饮而横溢也。沉伏二义。俱于浮脉见之。非真明天地升降阴阳之道者。其能道
只字耶。此仲景所以为万世师也。
次男（元犀）按、仲景此节。深文奥旨。得徐忠可此注。如暗室张灯。大有功于斯道。
但有论无方。读者每苦无下手工夫。先君从原本上下文搜讨。得其要紧。从经方中加出
一味。名消水圣愈汤。授政有先叔。屡试屡验。奉为枕秘。厥后此方刻入时方妙用中。
彼时一齐众楚。无一人能发其旨。以致无上名方。反为俗论所掩。己卯秋。先君以老归
田。重订旧着。命余读之后。颇有所悟。遂于时方妙用中一节。录此方并方论。附于本
节之后。第方中天雄难得。不妨以附子代之。菌桂绝无佳者。不妨以桂枝尖代之。方用
天雄炮一钱。牡桂去皮二钱。细辛一钱。麻黄一钱五分。甘草炙一钱。生姜二钱。大枣
二枚。知母去皮三钱。水二杯半。先煮麻黄至二杯。去上沫。次入诸药。煎八分服。日
夜三服。当汗出。如虫行皮中。即愈。水盛者。加防己二钱。天雄补上焦之阳而下行入
肾。犹天道下济而光明。而又恐下济之气潜而不返。故取细辛之一茎直上者。以举之。
牡桂暖下焦之水。而上通于心。犹地轴之上行而旋运。而又恐其上出之气
止而不上。故取麻黄之勇往直前者。以鼓之。人身小天地。惟健运不息。所以有云行雨
施之用。若潜而不返。则气不外濡。而脉络虚。故用姜枣甘草。化气生液。以补络脉。
若止而不上。则气聚为火。而小便难。故以知母滋阴化阴。以通小便。且知母治肿。出
之神农本草经。而金匮治历节风。脚肿如脱。与麻黄附子并用。可以比例而明也。此方
即仲景桂甘姜枣麻辛附子汤。加知母一味。主治迥殊。可知经方之变化如龙也。
（正水病在将成未成之际。其脉如何。）寸口脉弦而紧。（紧为寒。）弦则卫气（
为寒所结而）不行。（卫气不行。则藩篱不固。而）即恶寒。（卫气不行。则）水（液
）不（运。而不）沾流。走于肠间。（遂横流于肌肤肢体矣。）
此言水病之初成。责在卫气。以寸口主乎卫气也。意者寒从外得。阳气被抑。水之
所由成也。
（正水病在既成之际。脉又何如。）少阴脉紧而沉。紧则为痛。沉则为水。小便即
难。
此言水病之既成。责在肾阳。以少阴主肾阳也。意者寒自内生。而气化不速。水之
所由盛也。
（正水之脉。有恒有反。不可不知。盖以水阴也。阴盛则脉沉。水行皮肤。营卫被
遏。则脉亦沉。今）脉得诸沉。当责有水。（然必合之。）身体肿重。（方可断其为水。
此脉与证相符之恒也。若正）水（之）病。（其）脉（应沉而陡然暴）出者（是真气离
根。脱散于外。脉证相反。故主）死。
此言正水之常脉则沉。若陡然而出。则为反也。 尤氏云。出与浮迥异。浮者。盛
于上而弱于下。出则上有而下绝无也。
（正水之治。缓则筑以防堤。急则行其疏凿。）夫水病患。（脾胃为水气所犯。
故）目下有（形如）卧蚕。（水明亮而光润。故）面目鲜泽。（正水脉沉。沉极则）脉
伏。其人（胃中津液
水饮。俱外溢于皮肤肌肉。无以上于喉舌。则为）消渴。（此皆水病先见之征也。及其
）病水（之势既成。则）腹大。小便不利。其脉沉（甚而欲）绝者。（诊其脉则为无阳。
审其势则为）有水。可（于扶阳中疏凿其水以）下之。（俾水去则阳回。而元自复矣。）
此言正水病。腹大。小便不利。脉道被遏而不出。其势已甚。子和舟车。神佑等丸。
虽为从权救急之计。然虚人不堪姑试。余借用真武汤温补肾中之阳。坐镇北方以制水。
又加木通防己川椒目以导之。守服十余剂。气化水行。如江河之沛然莫御矣。此本论
中方外之方也。
问曰。病下利后。（阴液亡则）渴（欲）饮水。（饮水多而）小便不利。（水有入
而无出。积于腹中。而为）腹满。（固事之常也。乃）因（而为）肿者。（其故）何也。
答曰、（水必得气而行。）此（缘利后气伤。饮水过多。）法当病水。若（得）小便
自利。（则水从下通。）及汗（自）出者。（则水从外泄。水虽聚而常行。）自当愈。
（然其所以汗与利者。气内复而机自行也。而辛散渗淡之药。不足恃耳。）
此言客水成肿。易成而亦易愈。调其中气。则气复。而水自从利从汗而行矣。 有
The Master said: There are five types of water disorders: Fengshui (Wind Water), Pishui (Skin Water), Zhengshui (True Water), Shishui (Stone Water), and Huanghan (Yellow Sweat).
This discusses the disease of skin edema. The *Neijing* generally describes it as slight swelling above the eyes, resembling the appearance after just waking up; pulsation in the neck vessels; occasional coughing; coldness between the inner thighs; swelling of the ankles; and abdominal enlargement, indicating that water has formed. Pressing the abdomen with the hand causes it to rise immediately, like a bag wrapped around water. However, the *Neijing* does not distinguish them separately. Yet, because the etiologies differ, the treatment methods are vastly different. Therefore, the Master established these five names as the main outline, while the subtle details of pulse, symptoms, root and branch, and variations are elaborated below.
Fengshui (What are its pulse and symptoms?) Its pulse is naturally floating. (Floating indicates wind, therefore) the external signs include bone and joint pain. (Since wind remains at the exterior, therefore) aversion to wind.
Pishui (What are its pulse and symptoms? Water moves between the skin layers, internally connecting with Lung Qi, therefore) its pulse is also floating. The external signs show generalized edema, which leaves an indentation when pressed. (Since the pathogen is neither in the meridians but in the skin layers, and having left the meridians, therefore) there is no aversion to wind. (Because it is in the skin layers, therefore) the abdomen is like a drum. (The swelling is on the exterior of the skin and has not reached the intestines or viscera, therefore) there is no thirst. Sweating should be induced. (To allow the water in the skin layers to resolve through sweat.)
Zhengshui (What are its pulse and symptoms? The three Yin meridians are knotted, not by wind knotting, therefore) its pulse is sunken (Water belongs to Yin, therefore its pulse) slow. (The knotting of the three Yin meridians prevents lower Jiao Yin Qi from harmonizing with Yang Qi in the chest. Water Qi blocks Yang Qi upward, therefore its) external sign is spontaneous panting. (Panting is the key eye of this syndrome. As for eyelids looking like silkworms, swelling of both calves, and abdominal enlargement, which are identical to Shishui syndrome, there is no need to mention them again.)
Shishui (What are its pulse and symptoms? Water gathers in the lower part and does not move, therefore) its pulse is naturally sunken. (Water is in the lower part and has not damaged Middle Qi; the Middle is not deficient and cold, therefore it is only sunken and not slow. The disease is specifically in the lower part and does not affect the upper, therefore its) external sign is (only) fullness in the lower abdomen. (And) no panting. (No panting is the key eye of this syndrome; other syndromes identical to Zhengshui need not be mentioned either.)
Huanghan (What are its pulse and symptoms? Water pathogen is internally constrained, therefore) its pulse is sunken and slow. (The Heart is affected by pathogenic constraint, therefore) the body feels feverish. (Heat damages the upper part, therefore) chest fullness. (Pathogens in the Yang regions follow Yang, therefore) swelling of the four limbs, head, and face. If not cured for a long time, (then pathogens invade Yin, and Ying Qi does not flow smoothly,) it will inevitably lead to sores and pus.
Here, the pulses and symptoms of these five categories are analyzed separately.
(Try to detail the syndrome of Fengshui and distinguish it from similar diseases.) The pulse is floating and surging. Floating indicates wind. (Wind is the Qi of Heaven.) Surging indicates Qi. (Qi is the Qi of humans. Both represent a loss of harmony.) Wind Qi and Human Qi clash. (If) Wind is stronger (than Qi,) then (Qi follows Wind and infiltrates the muscles and skin, resulting in) urticaria, with itching of the body. Itching (relieved slightly by scratching superficially,) is called Xiefeng (Leaking Wind). Over time (worms may generate,) leading to scabies and tinea capitis. (If) Qi is stronger (than Wind,) then (Wind follows Qi and agitates fluid, leading to) edema. (Once edema forms, there is swelling, panting, and fullness.) Difficulty in bending forward or backward. (If) Wind and Qi (are both strong, mutually) interlinked, causing (fluids to follow, resulting in) massive (and large) swelling of the body. (Because Wind is a deficient pathogen, spontaneous sweating and aversion to wind are its definitive signs. Now, if healing occurs through sweating, but aversion to wind persists, it indicates the pathogen belongs to deficiency. (Without doubt, so it is pointed out directly:) This is Fengshui. (Those who have) no aversion to wind indicate (no wind at the exterior.) Urination is free. (This is not the clashing of Wind and Water.) Cold in the Upper Jiao causes excessive salivation. (This is caused by water entering and affecting the Heart, and sweat returning inward to become dampness.) This is Huanghan.
Here, the etiology of Fengshui is detailed. Since Fengshui is most easily confused with Huanghan, it is emphasized at the end of the section for differentiation. Fengshui pulse is floating; Huanghan pulse is sunken. This is shallow and easy to know, so the Master did not explicitly state it.
(Variations within Fengshui must be known. The pulse of Wind is floating; the pulse of Water is slippery. Now,) the Cun Kou pulse is sunken and slippery. (The Wind pulse is not seen, only the Water pulse.) This indicates water Qi inside. (It seems to belong to Zhengshui, however, on high peaks, only Wind can reach, therefore) facial and ocular swelling. (Wind is a Yang pathogen, therefore there is) heat in the body. (Since the syndrome belongs to Wind, the sunken pulse will eventually change to floating. But in the initial stage before change,) it is named Fengshui. Observe (the patient's) eyelids slightly swollen, resembling the shape of a newly awakened silkworm; pulsation in the neck vessels; frequent coughing. (These are signs of Zhengshui, yet upon) pressing the upper parts of hands and feet, where depression does not recover, (it is known not to be Zhengshui, but Qi-Water. Wind and Qi must be linked, so it can also be correctly named) Fengshui.
This states that although Fengshui syndromes have variations, their true nature cannot be concealed.
Taiyang disease, with a floating and tight pulse, should legally present with bone and joint pain. (This is a Yin pathogen excess exterior syndrome. Now it) instead presents without pain. (Immediately distinguishing it from Yin pathogen, and the) body (does not hurt but) instead feels heavy (heaviness indicates Zhengshui. Not hurting but) feeling . (indicates Wind. Fengshui disperses outward and has not entered inward, therefore) the patient has no thirst. (Diseases at the exterior should be treated with sweating, therefore) sweating leads to recovery. This is Fengshui. (Additionally, those who feel) aversion to cold after sweating, this is an extremely deficient syndrome. Caused by erroneous) inducing sweating. (There is also a treatment method using Shaoyao Gancao Fuzi Tang, which does not fall under the category of Fengshui. If the previous syndrome additionally presents with) thirst without aversion to cold, (thirst resembles Fengshui, but the lack of aversion to cold reveals the mechanism, knowing it is not Wind disease, but solely Water disease, not outside the skin but within the skin, one layer deeper than Fengshui.) This is Pishui. (Its syndrome involves) body swelling and coldness, resembling Zhoubi (Circulating Bi). (Generally, Zhoubi is considered Cold-Damp Bi obstructing Yang, while Pishui is Water Qi overflowing into the skin, hence they are roughly similar. If the previous syndrome additionally presents with) obstruction in the chest (Qi). (Obstruction causing distension means) inability to eat. (Obstruction preventing movement leads to) accumulated pain. (By evening, being Yin time, more) restlessness (and) insomnia. (Clearly indicating Water affecting the Heart, Cold constraining Heat. The syndrome lies entirely in the chest.) This is Huanghan. (If the previous syndrome has a floating-tight pulse, and) pain is in the bone joints. (Pulse and syndrome do not contradict, and) coughing with panting without thirst indicates (Cold-Water injuring the Lung.) This is Feizhang (Lung Distension). Its appearance resembles swelling. (The Lung governs skin and hair; skin and hair receive pathogens.) Sweating leads to recovery. However, for various diseases presenting thus, (all should use sweating, except those with) thirst accompanied by diarrhea and frequent urination. (This indicates pathogens have entered internally, fearing that a single sweating treatment will not suffice.) All such cases must not induce sweating.
This discusses how Fengshui may resemble Taiyang pulse without presenting Taiyang symptoms; there are similarities that are actually Pishui; similarities that are actually Huanghan; and similarities that are neither Pishui nor Huanghan, but actually Feizhang. The Master differentiated the syndromes but did not provide formulas. Later generations supplemented with Yuespi Jia Zhu Tang, which was not very thorough. At the end of the section, warning against sweating for those with thirst, diarrhea, or frequent urination holds profound meaning.
Someone asked: In the first two lines, it says Fengshui external signs include bone and joint pain, but here it says bones and joints instead do not hurt, and the body instead feels heavy and . In the previous line, it says Pishui has no thirst, but here it says thirst. Why? I reply: Wind and Water combine to form disease. When flowing into joints, it causes bone and joint pain. When infiltrating muscles and skin, bones and joints do not hurt, but the body feels heavy. This is due to different sites of injury. The previous statement that Pishui has no thirst does not mean Pishui inherently lacks thirst; it refers to cases where the abdomen is like a drum and there is no thirst, indicating the disease is flourishing externally and has not entered the interior, so sweating can still be used. The "thirst without aversion to cold" mentioned here is used to distinguish it from Fengshui's "no thirst with aversion to wind." Mr. Cheng said: Water Qi stays externally on the skin and presses internally on the Lung, causing thirst, which is correct.
(Besides Fengshui and Pishui, there is also Li Shui (Interior Water) caused by Damp-Heat constrained in the interior. The whole body and face are yellow and swollen. (The distinction lies in yellow. If yellow with sweating, it is also yellow, then it is Huanghan. Body yellow without sweating is Li Shui. Water is in the interior, therefore) its pulse (is not floating but) sunken. (Heat constrained for a long time, therefore) urination is difficult. (Accumulated internally overflows externally.) Thus causing water disease. Suppose urination is spontaneous and free, (not eliminating yellow swelling due to this freedom, but rather because of) this (freedom causing) loss (of) body fluids. (Loss of body fluids) thus causes thirst. (Use) Yuespi Jia Zhu Tang as the primary treatment. (Formula seen in Zhongfeng section.)
This further discusses Li Shui outside of Fengshui and Pishui.
You Zaijing said: Yuespi Jia Zhu treats the water, not the thirst. Because the face and body are all swollen, Ma Huang is taken to release the exterior. Because it is swollen and yellow, it is known that there is heat within dampness, so Shi Gao is taken to clear heat, along with Bai Zhu to remove dampness. Otherwise, for those with thirst and free urination, would one violate the warning against sweating? Some say this is the method for treating free urination with persistent yellow swelling. Yuespi dissipates water at the muscle-skin surface; Bai Zhu stops thirst and generates fluids. This is also acceptable.
(There are also cases where water is caused by concurrent chronic diseases, which must be known.) Duyang pulse (stomach meridian pulse, which normally is not hidden/fu. Due to water accumulation in the lower part, Qi is constrained,) the pulse (should also be) hidden/fu. Now it is instead tight. (Tight indicates cold. This is because the person) originally had cold, hernia masses, and abdominal pain. The doctor (did not warm the cold, but) instead used purgatives. (Yang Qi severely injured.) Immediately chest fullness and shortness of breath. (And water disease erupts. The reason is that Yang is injured downward, losing control over water passages; water does not move and floods. Qi is consumed downward, causing essence to coagulate and blood to stagnate, changing its normal state to transform into water.) Duyang pulse (due to water disease) should be hidden/fu, now it is instead rapid. (Rapid indicates heat. This is because the person) originally had heat. (Heat should) digest food (and) frequent urination. Now it is instead unfavorable/difficult. (Thus water accumulates daily.) This desires to become water. (The reason is that Yin deficiency cannot match Yang, so water is constrained by heat and does not move.)
This states that water patients with separate chronic diseases must consider the Duyang pulse and old disease manifestations simultaneously. One cannot merely treat swelling as the sole capability.
(Water disease has five types, among which Zhengshui is most common. One should recognize its origin through the pulse. However, the subtlety of the pulse can be understood intuitively but not fully conveyed in words.) Cun Kou pulse is floating and slow. Floating pulse indicates heat; slow pulse indicates submergence. Heat and submergence interacting is named Chen (Sinking). Duyang pulse is floating and rapid. Floating pulse indicates heat; rapid pulse indicates stopping. Heat and stopping interacting is named Fu (Hidden). Chen and Fu interacting is named Water. Chen implies collaterals are empty; Fu implies difficulty urinating. Emptiness and difficulty interacting cause water to move into the skin, thus becoming water.
Xu Zhongke said: This section discusses the formation of Zhengshui. It states that the continuous healthy movement in the human body creates the function of cloud formation and rain distribution. Thus, human sweat is named after heaven's rain; human Qi is named after heaven's swift wind. Therefore, Cun Kou pulse governs the upper, like Heavenly Dao must descend to illuminate, hence Yin is born from Yang. Duyang pulse governs the lower, like Earth's axis must ascend and rotate, hence Wei Qi originates from the Lower Jiao. Now, Cun Kou pulse is floating and slow. Floating governs heat, yet slow is seen. Slow means Yuan Qi submerges in the lower. Having seen the heat pulse and the submergence pulse, heat is deficient heat, and submergence is true submergence. Hence, heat and submergence interacting is named Chen. It means the Yuan Qi descending submerges and does not rise again; it is not the Chen pulse of diagnosis. Now, Duyang pulse is floating and rapid. Floating governs heat, yet rapid is seen. Rapid means Wei Qi stops in the lower. Having seen the heat pulse and the stopping pulse, the guest Qi is heat, while the True Qi is stopped. Hence, heat and stopping interacting is named Fu. It means the Wei Qi that should ascend is hidden and cannot rise; it is not the Fu pulse of diagnosis.
Descending from above,若不 returning, ultimately sinks; ascending from below, stopping and lingering hidden, then the rotating Qi almost extinguishes. Extinction allows Yin Water to take advantage. Hence, Chen and Fu interacting is named Water. It shows it is not merely external water. Fearing people do not understand Chen and Fu, it further states: Collaterals are where Yin Essence and Yang Qi interact. Cun Yang Qi sinking in the lower makes collaterals empty. Urination is the pathway of water channels. Duyang True Qi stopping in the lower means excess Qi becomes Fire. Severe Fire-Heat causes difficulty urinating. Thus, upper cannot transport water, lower cannot discharge water, how can one forbid water from wandering chaotically? Hence, emptiness and difficulty interacting cause water to move into the skin, thus becoming water. Water is the Yin Qi within the body, combining with water drink and overflowing horizontally. The meanings of Chen and Fu are both seen in the floating pulse. Only those who truly understand the ascending and descending of Heaven and Earth, and Yin and Yang, can speak even a word. This is why Zhang Zhongjing is the teacher for ten thousand generations.
Second son (Yuanxi) notes: This section of Zhongjing is profound and obscure. With Xu Zhongke's commentary, it is like lighting a lamp in a dark room, greatly benefiting this path. However, there is theory without formula, making readers suffer from lacking practical application. My father searched the original text context, found the key points, added one herb to the Jing Fang (Classic Formula), naming it Xiaoshui Shengyu Tang. Given to my uncle Zhengyou, tested repeatedly with success, treasured as a secret. Later, this formula was printed in *Shifang Miaoyong*. At that time, amidst conflicting opinions, no one could elucidate its intent, causing this supreme famous formula to be covered by vulgar theories. In autumn of Jiyi year, my father retired due to old age, revised old writings, ordered me to read them, and I gained some understanding. Thus, in the section of *Shifang Miaoyong*, I recorded this formula and its discussion, attaching it after this section. However, Tianxiong in the formula is hard to obtain; Fuzi can substitute it. Jun Gui has no good quality; Guizhi Jian (tip of Cinnamon Twig) can substitute it. Formula uses Tianxiong (prepared) 1 qian, Mogui (peeled) 2 qian, Xixin 1 qian, Mahuang 1.5 qian, Gancao (roasted) 1 qian, Shengjiang 2 qian, Dazao 2 pieces, Zhimu (peeled) 3 qian. Water 2.5 cups. First boil Mahuang to 2 cups, remove foam. Then add other herbs, decoct to 0.8 cup. Take orally, three times day and night. Should sweat, feeling like insects moving in the skin, then recovered. For severe water, add Fangji 2 qian. Tianxiong tonifies Upper Jiao Yang and descends to enter Kidney, like Heavenly Dao descending to illuminate. Fearing the descending Qi submerges and does not return, Xixin, with its single stem growing straight up, is taken to lift it. Mogui warms Lower Jiao Water and ascends to connect with Heart, like Earth's axis ascending and rotating. Fearing the ascending Qi stops and does not go up, Mahuang, brave and advancing, is taken to鼓 (rouse) it. The human body is a small universe. Only through continuous healthy movement is there the function of clouds and rain. If submerging and not returning, Qi does not moisten externally, and collaterals become empty. Thus, Jiang, Zao, and Gancao are used to transform Qi and generate fluids to supplement collaterals. If stopping and not ascending, Qi gathers into Fire, causing difficulty urinating. Thus, Zhimu is used to nourish Yin and transform Yin to unblock urination. Moreover, Zhimu treating swelling appears in *Shennong Bencao Jing*, and *Jin Gui* treats Lijie Feng (Joint Bi) with foot swelling like detachment, used together with Mahuang and Fuzi, which can be clarified by analogy. This formula is essentially Zhongjing's Guigan Jiangzao Maxing Fuzi Tang, adding one ingredient Zhimu. The main treatment is completely different, showing that Jing Fang changes like dragons.
(When Zhengshui disease is in the incipient stage, what is its pulse?) Cun Kou pulse is wiry and tight. (Tight indicates cold.) Wiry means Wei Qi (constrained by cold and) does not move. (Wei Qi not moving means the defenses are not solid, leading to) aversion to cold. (Wei Qi not moving means) water (fluids) do not (transport and) flow, moving into the intestines. (Then flowing horizontally into skin and limbs.)
This states that the initial formation of water disease blames Wei Qi, as Cun Kou governs Wei Qi. Presumably, cold comes from outside, suppressing Yang Qi, which is the cause of water formation.
(When Zhengshui disease has formed, what is the pulse?) Shaoyin pulse is tight and sunken. Tight indicates pain; sunken indicates water. Urination becomes difficult.
This states that the formed stage of water disease blames Kidney Yang, as Shaoyin governs Kidney Yang. Presumably, cold arises internally, and Qi transformation is not swift, causing water to flourish.
(The pulse of Zhengshui has constant and contrary aspects, which must be known. Since Water is Yin, Yin excess makes pulse sunken. Water moves in skin, Ying and Wei are blocked, so pulse is also sunken. Now,) obtaining various sunken pulses requires investigating water. (But must combine with symptoms.) Body swelling and heaviness. (Only then can it be diagnosed as water. This is the constant correspondence of pulse and syndrome. If Zheng) water (disease,) its pulse (should be sunken but suddenly emerges/) emerging (means True Qi leaves its root, scattering outward. Pulse and syndrome contradict, thus indicating) death.
This states the constant pulse of Zhengshui is sunken; if suddenly emerging, it is contrary. You Shi said: Emerging is vastly different from Floating. Floating is strong above and weak below; Emerging is strong above and absolutely absent below.
(Treatment of Zhengshui: slowly build dikes to prevent; urgently perform dredging.) For water patients, (Spleen and Stomach are attacked by Water Qi, therefore) there are (like) sleeping silkworms under the eyes. (Water is bright and lustrous, therefore) face and eyes are fresh and glossy. (Zhengshui pulse is sunken, extreme sunkenness makes pulse) hidden/fu. The person (Stomach fluids and water drink all overflow to skin and muscles, unable to reach throat and tongue, causing) excessive thirst. (These are all early signs of water disease. When its) water disease (force has formed, then) abdominal enlargement, urination unfavorable. Its pulse is sunken (extremely wanting to disappear/cease), (diagnosing pulse indicates no Yang, examining condition indicates) water exists. Can (while supporting Yang, dredge water to) purge it. (Letting water go returns Yang, and Original Qi recovers.)
This states Zhengshui disease, abdominal enlargement, urination unfavorable, pulse channel obstructed and not appearing, condition is severe. Hezi's Zhouche and Shenyuan pills, though emergency measures, are unsuitable for deficient persons. I borrowed Zhenwu Tang to warm Kidney Yang, stationing in the North to control Water, adding Mutong, Fangji, and Chuanjiaomu to guide it. Taking it for over ten doses, Qi transforms and water moves, like rivers surging uncontrollably. This is a formula outside the classic text.
Question: After diarrhea, (Yin fluid lost causes) thirst (desiring) drinking water, (drinking much while) urination is unfavorable, (water enters but does not exit, accumulating in abdomen, causing) abdominal fullness, (this is natural, yet) causing (swelling), why?
Answer: (Water must move with Qi.) This (is due to Qi injury after diarrhea and excessive drinking.) Legally, water disease should occur. If (getting) spontaneous urination, (water flows down.) And spontaneous sweating, (water leaks out. Although water gathers, it flows constantly.) Naturally should recover. (However, the reason for sweating and urination is internal Qi recovery and self-mechanism operation. Acrid-dispersing and leaching-diatretic drugs are unreliable.)
This states that exogenous water swelling is easy to form and easy to cure. Regulating Middle Qi restores Qi, and water naturally flows via urination and sweating.