一张姓者。疟愈后。日饮水数升。小便不利。有用四苓加木通。服之三日。溺时茎痛。
一日夜尿不及半小盏。尿盆底如朱砂。日更医。遍服利水之药。形肿日增。有一老医马
姓。主以济生肾气丸。早吞五钱。暮服六君子汤一服。许以半月必愈。服至二十余日不
效。又增出不寐气喘呕逆之逆证。病家极恼前医之失。而求治于予。予诊其色。鼻准
黄润。诊其脉。虽细小中而却有缓象。直告之曰。此证误在前医。救在后医。止守前此
丸汤并进。再十日必效。予无别法也。病家埋怨已极。誓不再服。叩头求请另方。予不
得已。以权辞告之曰。前方虽佳。但日服不改。病气与药气。习以为常。所以不效。今
且用茯苓四钱。蛤蜊粉三钱。灯草十四寸。煎水
服之。三日后再服前此之药方。必另有一番好处。病家喜而服之。是夜小便如涌。其肿
亦退去十分之七。皮肤中时见汗意。再一服。大汗如雨。肿全消。而神气亦复。喜告于
予。予令其遵马先生丸汤之法。渠弗听。从此即不服药。半月病愈体康。到寓面谢时。还
痛说前医之过。甚矣哉。医道之弗明也。详附于此。以为尤注气内返而机自行句之铁案。
亦以见医术挟时命而行。
（正水病。久则相传而概病。而其初则有五脏之分。心火脏）心火者。（水凌
于心。阳气被郁则）其身重而少气。（郁而不泄。致伤心气。则）不得卧。烦而躁。（
阳虚不能下交于阴。阴气不化。则）其人阴肿。 （肝木脏。）肝水者。（水气凌肝。必
传于脾。脾部在腹。则）其腹大。不能自转侧。（肝气横。其痛在）胁下（传则）腹痛。
（厥阴之气。冲逆水邪。随之而上下。则）时时津液微生。小便续通。（肺金脏。为
治节之官。）肺水者（肺主气。虚则失其统御之权。故）其身肿。（治节不行。则水乱。
故）小便难。时时鸭溏。（谓如鸭粪之清浊不贯也。脾土脏。主腹。而气行四肢。）脾水
者。（水气凌脾。脾气不行。则）其腹大。四肢苦重。（津气生于谷。脾不能化谷。则）
津液不生。但苦少气。（脾气不舒。则）小便难。（肾者。主水而藏精。其所赖以为锁
钥之司也。其气上通于心。领心阳之气。下达水府。）肾水者。（肾气虚。不能上领心
阳之气。而水凝矣。脐腹属少阴。
少阴病。阳虚阴甚。则）其腹大。
脐肿腰痛不得溺。阴下湿如牛鼻上汗。（阳不及下。则）其足逆冷。（面者。诸阳之会
也。肾虚不能上会。则其）面反瘦。
此分晰五脏之水。以补内经所未备。使人寻到病根。察其致病之脏而治之。不域于
脾肺肾通套成方以试病。则善矣。
师曰。诸有水者。（分其内外表里而治之。不若分其上下。尤为确切。）腰以下肿。
（阴为主用。）当利小便。腰以上肿。（阳为主用）当发汗。乃愈。
沈自南云、此以腰之上下分阴阳。即风皮正水之两大法门也。腰以下主阴。水亦属阴。
以阴从阴。故正水势必从于下部先肿。即腰以下肿。然阳衰气郁。决渎无权。水逆横
流。疏凿难缓。利小便则愈。经谓洁
净府是也。腰以上主阳。而风寒袭于皮毛。阳气被郁。风皮二水。势必起于上部先肿。
即腰以上肿。当开其腠理。取汗通阳则愈。经谓开鬼门是也。窃谓利水发汗。乃言其常。
而未及其变。当审实者施其常。虚者施其变。但治变之法。欲汗者当兼补阳。即麻黄
附子汤之类。欲利小便者。兼养其阴。即栝蒌瞿麦丸之类。然开腠通阳而利小便。必兼
变法。乃为第一义耳。
按、时医治水病。只守二方。一曰五皮饮。桑白皮橘皮生姜皮茯苓皮大腹皮各二钱。
取其以皮入皮。不伤中气之义。上肿加紫苏防风杏仁各三钱以汗之。下肿加木通防己泽
泻赤小豆各二钱以利之。且气分加白术黄 肉桂之类。血分加当归川芎桃仁五灵脂之类。
寒加附子肉桂小茴香巴戟天干姜之类。热加黄柏知母生蛤蜊之类。诸虚合四君子汤。
诸实合三子养亲汤。轻者颇效。而重病则否矣。而济生肾气丸。熟地黄四两。山萸肉山
药泽泻丹皮肉桂车前子牛膝各一两。茯苓三两。熟附子五钱。蜜丸每服三五钱。百沸汤
送下。或作汤服。此方自薛立斋极赞其妙。而张景岳李士材和之。至今奉为水肿气肿等
证之神丹。而不知一派阴药中。杂以些少桂附。亦从阴化。久服必致阴霾四布。水势滔
天。不可救援。谁制此方。大为金匮罪人。后医反以此方。名为金匮肾气丸。荒经侮圣。
大可浩叹。今因沈自南有栝蒌瞿麦丸养阴一说。余亦谓栝蒌瞿麦丸之用附子。与肾气
丸之附子同义。恐后学错认章旨。而误用之。则余亦薛立斋张景岳李士材之流辈耳。孟
夫子云、尔何曾比予于是。当知昔贤当时不得已之言也。
师曰。（上焦主气。诊之寸口。若）寸口脉沉而迟。沉则为水。迟则为寒。寒水相
搏。（则为水肿。可知水肿之必关营卫也。中焦主水谷。诊之趺阳。若）趺阳脉（不起而
）伏。（则为）水谷不化。（第不化有二。若）脾气衰。（而不化。）则（水杂于粪。
为） 溏。胃气衰（而不化。）则（水溢于外。而）身肿。（下焦主血。诊之两尺。右
尺为阴中之少阳。若）少阳（之）脉（沉弱而）卑（为相火之衰。左尺为阴中之少阴。
若）少阴（之）脉（微损而）细。（为真水之虚。北方龟蛇。非一而亦非二。均在下焦
而主血。）男子（病此。）则（水精不化。而）小便不利。妇人（病此。）则（血化为
水。而）经水不通。（而其所以然者。则皆阳气不行。阴气乃结之故。）经为血。（而
属于阴。阴）血（阻滞）不利则（渐成）为水。名曰血分。（男妇之病一体。惟妇则有
经可征也。）
此言正水之偏于下焦者为血分。而又合上中二焦而言。为寸口、趺阳、少阴、上中
下三诊之全法也。伤寒论金匮多用此笔法。
男（元犀）按、此节及下一节。字字金针。宜熟玩之。
师曰、（血分病在下焦。亦与上中二焦相关。属于虚者。上言之详矣。而属于虚中
之实者。不可不知。）寸口脉沉而数。数则为出。沉则为入。出则（肺气壅于阳。）为阳
实。入则（水气滞于阴。）为阴结。趺阳脉微而弦。微则（中土本伤。而）无胃气。弦
则（胃受木克。而气）不得息。少阴脉沉而滑。沉则为（病）在（于）里。滑则为（里邪
之）实。沉滑相搏。血结胞门。其（凝聚坚）瘕不泻。经络不通。（而肿病大作。）
名曰血分。
此承上节血分而言也。与第八节沉则脉络虚。伏则小便难等句。互相发明。又合寸
口趺阳少阴。而见气壅于阳。胃病于中。血结于阴。分之则三。合之则一也。
男（元犀）按、胞为血海。男女皆有之。此云胞门。在关元气海之间。指膀胱之位
而言也。先君口传蔡明府名本谦患水肿垂死复生验案。用泽兰之法。本于此。
尤在泾云、上条之结。为血气虚少。而行之不利也。此条之结。为阴阳壅郁。而欲
行不能也。仲景并列于此。以见血分之病。有全虚者。有虚中之实者。不同如此。
（血分为男妇兼有之病。而亦有专为妇人而言者。以妇人之病。以经为主也。或有
）问（于师）曰、病有血分水分何也。师曰、经水前断。后病水。名曰血分。此病难治。
先病水。后经水断。名曰水分。此病易治。何以故去水。其经自下。
尤在泾云、此复设问答。以明血分水分之异。血分者。因血而病为水也。水分者。
因水而病及血也。血病深而难通。故曰难治。水病浅而易行。故曰易治。
问曰。病者苦水。面目身体四肢皆肿。小便不利。（医者）脉之（病患竟）不言（
苦）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。
（水气中原不得有此证。其先）寸口脉沉而紧。沉为（微）水。紧为（积）寒。沉紧相
搏。（则微水积寒。）结在关元。始时（水与寒）尚微。年盛（邪不胜正而）不觉。（迨
至）阳衰之后。（前此所结之邪。觉）营卫（中稍稍）相干。阳（日就）损阴（日加）
盛。（而所）结（之）寒微动。（遂挟）肾气上冲。咽喉塞噎。胁下急痛。（此时若以
温肾祛寒之药治之。法当渐愈。乃）医以为留饮而大下之。（未得病源。病）气（维）
系（而）不去。其病（根）不除。复重吐之。（诛伐无过。 一则大下以伤其胃。 一则
吐伤上焦之阳。而下焦之阴火乘之。以致）胃家虚烦。咽燥欲饮水。（火乘于上。阳虚
于下。以致决渎失职。）小便不利。（釜底乏薪。）水谷不化。（水气日盛。而）面目手
足（皆见）浮肿。又与葶苈丸下（其）水。（虽非治其病根。而肿势证既盛。）当时如
小瘥。（此后或因）食欲过度。肿复如前。（又加）胸胁苦痛。象若奔豚。（且）其水
（气）扬溢。（时）则咳（而）喘逆。（治者）当先攻击。（与桂苓五味甘草汤类。）
冲气令（其即低而）止。（止后方）乃治（其）咳。（用苓甘五味姜辛汤等。令其咳止。
）咳止。其喘（不治而）自瘥。（所以然者。病根深固。不能骤除。当）先治（冲气咳
喘之）新病。（而水气之）病当在（所）后。（虽然。治病必溯其所由来。关元结寒。
水病之所由来也。）
徐忠可云、此言正水之成。有真元太虚。因误治成水。又误治而变生新病。当以治
新病为急。按第十二章。痰饮咳喘病。有小青龙汤加减五方之法。一字一珠。宜参看。
（兹试为各证补言其未及。而并出其方。）风水。（其）脉（必）浮（而其为本证之
确据者。则在）身重。（又合之）汗出恶风（及前后论列诸证。或兼或不兼）者。（一
见身重脉浮。汗出恶风。其为风水内挟湿气无疑矣。以）防己黄 汤主之。（若胃中不
和。兼见）腹痛者加芍药。（以泄之。）
按此节即太阳病。脉浮汗出恶风者。中风症也。盖以太阳为寒水之经。病则水不行。
水不行。则必化湿。而生胀满矣。故名曰风水。其证身重脉浮者。内挟湿气无疑矣。
故以防己黄 汤治之。张隐 云、防己生汉中。纹如车辐。主通气行水。 术解肌散湿。
助决渎之用。姜枣草和营卫补中央。交通上下之气。使气行而水亦行矣。腹痛者。胃
不和也。加芍药以泄之。湿气篇云、胃不和者。加芍药三分。可知耳。徐注谓为补脾之
虚。误矣。
防己黄 汤 （见湿病 尤云。水与湿。非二也。）
风水（证。身重则为湿多。而此则）恶风。一身悉肿。（则为风多。）脉浮不渴。
（病在表而不在里也。身原无汗。而）续（偶见其）自汗出。（身）无大热。（其微热不去。
为表实也。以）越婢汤主之。
徐忠可云、上节身重则湿多。此节一身悉肿则风多。风多气多热亦多。且属急风。
故欲以猛剂铲之。恶寒为卫虚。加附子。古今录验加术。并驱湿矣。
越婢汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 甘草（二两） 大枣（十二枚）
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。恶风加附
子一枚。风水加术四两。皮水为病。四肢肿。水气在皮肤中。（前论已详。不必再赘。
惟）四肢聂聂动者。（更为皮水之的证。以）防己茯苓汤主之。
此为皮水证出其方治也。
防己茯苓汤方
防己 黄 桂枝（各三两） 茯苓（六两） 甘草（二两）
上五味。以水六升。煮取二升。分温三服。
（一身面目黄肿。谓之）里水。（乃风水深入肌肉。非脏腑之表里也。腠实无汗。胃
热内向。欲迅除其热。）越婢加术汤主之。（欲迅发其汗。）甘草麻黄汤亦主之。
此为里水证出其方治也。
越婢加术汤方（见上）
甘草麻黄汤方
甘草（二两） 麻黄（四两）
上二味。以水五升。先煮麻黄。去上沫。内甘草。煮取三升。温服一升。重覆汗出。
不汗再服。慎风寒。
水之为病。其脉沉小。属少阴。（即为石水。彼夫）浮者为风。
（即是风水其内）无水。（而为）虚胀者（其病不为水。而）为气（气病不可发汗。）
水。（病）发其汗即已。（然而发汗之法。各所不同。若）脉沉者。（水在少阴。当温
其经。）宜麻黄附子汤。（脉）浮者。（水在皮毛。当通其肺。）宜杏子汤。
此为石水证出其方也。而并言及风水与气肿。从反面掉出正旨。时文有借宾定主之
法。汉文已开之。
麻黄附子汤方
麻黄（三两） 附子（一枚） 甘草（二两）
上三味。以水七升。先煮麻黄。去上沫。内诸药。煮取二升半。温服八合。日三服。
杏子汤方 （阙。恐是麻黄杏仁甘草石膏汤。）
（逆而不顺。谓之）厥而皮水（浸淫日久。腐溃而出水）者。（厥而不顺之证也。
宜用外敷之法。以）蒲灰散主之。
此言皮水溃烂谓之厥。出其外治之方也。诸家俱作水伤阳气而厥冷解。误矣。此照
钱太医定之。
蒲灰散方 （见消渴）
问曰。（汗出黄色。而身不黄。与发黄之证异。别其名曰黄汗。）黄汗之为病。身
A patient surnamed Zhang, after recovering from malaria, drank several sheng of water daily and experienced difficulty in urination. A physician prescribed Siling San (Four-Ingredient Powder for Promoting Urination) with Mutong (Caulis Akebiae), which he took for three days. Afterward, he experienced pain in the urethra during urination.
In one day and night, his urine volume was less than half a small cup, and the bottom of the urine basin appeared red like cinnabar. Physicians were changed daily, and diuretic medicines were administered indiscriminately. His body swelling increased day by day. An old physician surnamed Ma prescribed Jisheng Shenqi Wan (Kidney Qi Pill for Saving Lives). The patient took five qian of the pill in the morning and one dose of Liujunzi Tang (Six-Gentleman Decoction) in the evening. It was promised that he would be cured within half a month. After taking the medicine for more than twenty days with no effect, additional adverse symptoms emerged: insomnia, asthma, and vomiting with counterflow qi. The patient's family was extremely angry at the previous physicians' mistakes and sought treatment from me. I examined his complexion; the tip of his nose was yellow and moist. I palpated his pulse; although it was fine and small, there was a moderate and slow quality within. I told them directly: "The error in this case lies with the previous physicians, and the remedy lies with subsequent ones. If you continue to take both the pills and decoctions as before, there will definitely be an effect within ten more days. I have no other method." The family was extremely resentful, swore never to take the medicine again, and kowtowed begging for a different prescription. Reluctantly, I used a expedient excuse to tell them: "Although the previous prescription is good, taking it daily without change causes the pathogenic qi and medicinal qi to become accustomed to each other, hence the lack of effect. For now, use Fuling (Poria) 4 qian, Geli Fen (Clam Shell Powder) 3 qian, and Dengcao (Juncus Effusus) 14 cun, decocted in water for drinking. Take the previous prescription again after three days, and there will surely be a different beneficial outcome." The family happily took the medicine. That night, his urine flowed like a surge, and his swelling subsided by seven-tenths. Sweat occasionally appeared on his skin. After taking another dose, he sweated profusely like rain, all swelling disappeared, and his spirit and qi recovered. He joyfully reported this to me. I advised him to follow Master Ma's method of combining pills and decoctions, but he did not listen. From then on, he stopped taking medicine. Half a month later, he was cured and healthy. When he came to my residence to thank me in person, he still bitterly criticized the previous physicians' faults. Alas, how profound is the lack of understanding in medical principles! This is detailed here as irrefutable evidence for You's annotation regarding "qi returning inward and mechanisms moving spontaneously." It also shows that medical skill operates according to timing and fate.
(Regarding Zheng Shui [True Water Disease], if prolonged, it transmits to cause generalized disease, but initially it has distinctions among the five zang organs. Heart Fire Zang.) Heart Fire refers to: (When water evil overwhelms the heart, and yang qi is constrained,) the body feels heavy and there is shortness of breath. (If constrained and unable to vent, damaging heart qi,) one cannot lie down, feeling vexed and restless. (If yang deficiency prevents downward communication with yin, and yin qi fails to transform,) the genital area becomes swollen. (Liver Wood Zang.) Liver Water refers to: (When water qi overwhelms the liver, it must transmit to the spleen. Since the spleen is located in the abdomen,) the abdomen becomes large, and one cannot turn over independently. (With liver qi flaring horizontally, pain occurs in the hypochondrium. Upon transmission,) abdominal pain results. (As jueyin qi rebels against water evil, fluctuating up and down,) saliva is slightly produced at times, and urination flows intermittently. (Lung Metal Zang, the official of governance and regulation.) Lung Water refers to: (The lung governs qi; when deficient, it loses its commanding authority, thus) the body swells. (When governance fails, water chaos ensues, thus) urination is difficult, and loose stools resembling duck feces occur frequently. (Spleen Earth Zang, governing the abdomen, with qi circulating in the four limbs.) Spleen Water refers to: (When water qi overwhelms the spleen, spleen qi fails to move,) the abdomen becomes large, and the four limbs suffer heaviness. (Since jinye [body fluids] are generated from grain, and the spleen cannot transform grain,) jinye is not produced, leading only to shortness of breath. (If spleen qi is not free,) urination is difficult. (The kidney governs water and stores essence; it relies on being the lock and key mechanism. Its qi connects upward to the heart, receiving heart yang qi, and descends to the water mansion.) Kidney Water refers to: (When kidney qi is deficient and cannot receive heart yang qi upward, water coagulates. The umbilicus and abdomen belong to the Shaoyin channel. In Shaoyin disease, with yang deficiency and severe yin,) the abdomen becomes large, the umbilicus swells, there is lower back pain, inability to urinate, and dampness in the genital area like sweat on a bull's nose. (If yang does not reach the lower part,) the feet become cold. (The face is the gathering place of all yang meridians; if kidney deficiency prevents upward convergence,) the face appears emaciated.
This analyzes water diseases of the five zang organs to supplement what the Neijing [Inner Canon] omitted, enabling one to find the root cause, identify the affected zang organ, and treat accordingly, rather than relying on generic prescriptions for the spleen, lungs, and kidneys. This is ideal.
The Master said: "For all cases of water disease, (distinguishing treatment based on interior/exterior and surface/depth is less precise than distinguishing based on upper/lower.) If swelling is below the waist, (governed by yin,) promote urination. If swelling is above the waist, (governed by yang,) induce sweating, and recovery will follow."
Shen Zinan stated: "This divides yin and yang based on the waist, representing the two major methods for Feng Shui [Wind Water], Pi Shui [Skin Water], and Zheng Shui [True Water]. Below the waist is governed by yin; water also belongs to yin. Following yin with yin, Zheng Shui inevitably starts swelling in the lower part, i.e., below the waist. However, with yang decline and qi constraint, the triple burner lacks authority, water rebels and flows horizontally, making drainage difficult. Promoting urination leads to cure, as stated in the classics: 'Cleanse the Fu organs.' Above the waist is governed by yang; wind-cold attacks the skin and hair, constraining yang qi. Wind water and skin water inevitably start swelling in the upper part, i.e., above the waist. Opening the cou li [pores] and inducing sweating to unblock yang leads to cure, as stated in the classics: 'Open the ghost gate.' I believe promoting urination and inducing sweating refer to standard methods, not variable ones. One should apply standard methods to excess patterns and variable methods to deficiency patterns. For sweating, one should simultaneously tonify yang, such as using Mahuang Fuzi Tang (Ephedra and Prepared Aconite Decoction). For promoting urination, one should simultaneously nourish yin, such as using Gualou Qumai Wan (Trichosanthes Root and Plantago Seed Pill). However, opening pores to unblock yang while promoting urination requires variable methods, which is the primary principle."
Note: Contemporary physicians treating water disease adhere to only two formulas. One is Wupi Yin (Five-Peel Decoction): Sangbaipi (Morus Alba Bark), Jupipi (Citrus Reticulata Peel), Shengjiangpi (Zingiber Officinale Peel), Fulingpi (Poria Peel), Dafupi (Areca Seed Peel), each 2 qian. This utilizes the principle of 'peel treating peel' to avoid damaging middle jiao qi. For upper swelling, add Zisu (Perilla Leaf), Fangfeng (Saposhnikovia Root), Xingren (Apricot Seed) 3 qian each to induce sweating. For lower swelling, add Mutong (Akebia Caulis), Fangji (Stephania Root), Zexie (Alisma Rhizome), Chixiaodou (Adzuki Bean) 2 qian each to promote urination. For qi patterns, add Baizhu (Atractylodes Macrocephala Rhizome), Rougui (Cinnamon Bark), etc. For blood patterns, add Danggui (Angelica Sinensis Radix), Chuanxiong (Ligusticum Chuanxiong Rhizome), Taoren (Prunus Persica Seed), Wulingzhi (Trogopterus Dung) etc. For cold, add Fuzi (Prepared Aconite Lateral Root), Rougui, Xiaohuixiang (Fennel Fruit), Bajitian (Morinda Officinalis Root), Ganjiang (Dried Ginger) etc. For heat, add Huangbai (Phellodendron Bark), Zhimu (Anemarrhena Rhizome), Sheng Geli (Raw Clam Shell) etc. For various deficiencies, combine with Sijunzi Tang (Four-Gentleman Decoction). For various excesses, combine with Sanzi Yangqin Tang (Three-Seed Decoction for Nourishing the Elderly). Mild cases respond well, but severe cases do not. Another formula is Jisheng Shenqi Wan: Shudihuang (Rehmannia Glutinosa Preparata) 4 liang, Shanzhuyu (Cornus Officinalis Fruit), Shanyao (Dioscorea Polystachya Rhizome), Zexie, Danpi (Moutan Cortex), Rougui, Cheqianzi (Plantago Seed), Niuxi (Achyranthes Bidentata Root) each 1 liang, Fuling 3 liang, Shufuzi (Prepared Aconite Lateral Root) 5 qian. Honey-pilled, taken 3-5 qian per dose with boiling water, or decocted. Since Xue Lizhai praised its efficacy, and Zhang Jingyue and Li Shicai echoed this, it is now revered as a divine pill for edema and qi distension. However, unknown to many, mixing small amounts of Rougui and Fuzi into a mass of yin-nourishing herbs transforms them toward yin. Long-term use leads to widespread yin-cold and overwhelming water levels, irrecoverable. Who formulated this? A great sinner to the Jin Gui [Essential Prescriptions of the Golden Cabinet]. Later physicians mistakenly named it Jin Gui Shenqi Wan, offending the classics and sages, causing deep sighs. Now, because Shen Zinan proposed that Gualou Qumai Wan nourishes yin, I also consider that the use of Fuzi in Gualou Qumai Wan shares the same meaning as in Shenqi Wan. Fearful that future students misinterpret the chapter主旨 [main theme] and misuse it, I might become like Xue Lizhai, Zhang Jingyue, and Li Shicai. Mencius said, "How dare you compare me to them?" One should understand that past sages spoke out of necessity.
The Master said: "(The upper jiao governs qi, diagnosed at Cun Kou [radial artery]. If) Cun Kou pulse is deep and slow, deep indicates water, slow indicates cold. Cold and water interacting (leads to edema, showing that edema necessarily involves Ying and Wei [nutritive and defensive qi]. The middle jiao governs food and drink, diagnosed at Zu Yang [dorsalis pedis artery]. If) Zu Yang pulse (does not rise and is) hidden/fu. (This indicates) failure to transform food and drink. (There are two types of transformation failure: if) Pi Qi [spleen qi] declines (and fails to transform,) then (water mixes with feces, resulting in) loose stools. If Wei Qi [stomach qi] declines (and fails to transform,) then (water overflows outward, causing) body swelling. The lower jiao governs blood, diagnosed at both Chi positions [ulnar artery near elbow]. The right Chi represents shaoyang within yin. If) Shaoyang (pulse is) deep, weak, and low/bei (indicating decline of ministerial fire). The left Chi represents shaoyin within yin. If) Shaoyin (pulse is) slightly damaged and fine/xi (indicating deficiency of true water). The tortoise and snake of the north are neither one nor two; both reside in the lower jiao and govern blood.) Men (afflicted by this) experience (failure to transform water essence, leading to) difficulty in urination. Women (afflicted by this) experience (blood transforming into water, leading to) amenorrhea. (The reason is that yang qi fails to move, causing yin qi to knot.) Menses are blood. (Belonging to yin, if) blood (is obstructed and) fails to flow smoothly, it gradually becomes water, named Blood Fen [Blood Division]. (Men and women share the same pathology, but only women have menses as a sign.)
This discusses Zheng Shui biased toward the lower jiao as Blood Fen, integrating the upper and middle jiao, forming a complete diagnostic method using Cun Kou, Zu Yang, and Shaoyin pulses across upper, middle, and lower regions. Shang Han Lun [Treatise on Cold Damage] and Jin Gui frequently use this technique.
Nan (Yuanxi) notes: Every word in this section and the next is a golden needle; study them carefully.
The Master said: "(Blood Fen disease is in the lower jiao but relates to the upper and middle jiao. Deficiency patterns were discussed in detail above. Patterns of deficiency mixed with excess must be known.) Cun Kou pulse is deep and rapid. Rapid indicates exiting/outward, deep indicates entering/inward. Exiting means (lung qi is congested in yang,) constituting Yang Shi [Yang Excess]. Entering means (water qi stagnates in yin,) constituting Yin Jie [Yin Knot]. Zu Yang pulse is faint and wiry. Faint means (middle earth is originally injured, lacking) stomach qi. Wiry means (the stomach is overcome by wood, and qi) cannot breathe. Shaoyin pulse is deep and slippery. Deep indicates (pathogen) is in (the interior). Slippery indicates (interior pathogen) is excess. Deep and slippery interact, blood knots in the Bao Men [womb gate], its (condensed and hard) masses do not discharge, meridians and collaterals are blocked. (Edema erupts severely.) Named Blood Fen.
This continues from the previous section on Blood Fen. It elucidates mutually with Section 8 ("Deep implies collateral deficiency, Hidden implies difficulty in urination"). Integrating Cun Kou, Zu Yang, and Shaoyin reveals qi congestion in yang, stomach disease in the middle, and blood knotting in yin. Divided, there are three; united, there is one.
Nan (Yuanxi) notes: The Bao [womb] is the sea of blood, present in both men and women. Here, Bao Men refers to the position between Guanyuan and Qihai, indicating the bladder. My father orally transmitted a verified case of Cai Mingfu (surname Benqian) suffering from critical edema who revived, using Zelans [Epimedium] method, originating from this.
You Zaijing said: The knot in the first line is due to blood and qi deficiency and poor circulation. The knot in this line is due to yin-yang congestion and inability to circulate. Zhang Zhongjing placed them together to show that Blood Fen diseases include total deficiency and deficiency-mixed-with-excess patterns, differing thus.
(Blood Fen affects both men and women, but sometimes specifically refers to women, as women's diseases center on menses. There may be) questions (to the Master): "What are Blood Fen and Water Fen?" The Master said: "If menses stop first, then water disease develops, it is named Blood Fen; this is difficult to treat. If water disease develops first, then menses stop, it is named Water Fen; this is easy to treat. Why? Remove the water, and menstruation resumes naturally."
You Zaijing said: This sets up a Q&A to clarify the difference between Blood Fen and Water Fen. Blood Fen is water disease arising from blood pathology. Water Fen is blood pathology arising from water disease. Blood disease is deep and hard to unblock, hence difficult to treat. Water disease is superficial and easy to move, hence easy to treat.
Question: "A patient suffers from water disease, with swelling of the face, eyes, body, and limbs, and difficulty in urination. (The physician) takes the pulse, but the (patient) does not mention (suffering from) water, instead complaining of chest pain, qi rushing up to the throat, feeling like a roasted piece of meat, accompanied by slight cough and wheezing. Assuming the Master's words are correct, what kind of pulse would this be?" The Master said: "(Water qi originally does not present these symptoms. Initially,) Cun Kou pulse is deep and tight. Deep indicates (slight) water, tight indicates (accumulated) cold. Deep and tight interact. (Then slight water and accumulated cold) knot at Guanyuan. Initially (water and cold) are mild, and in youth (pathogen does not overcome righteous qi, so one) feels nothing. (Until) after yang declines. (The previously knotted pathogen, sensing) Ying and Wei (slightly interfering). Yang (daily) diminishes, Yin (daily) increases. (And the) knotted (cold) slightly moves. (Thus carrying) kidney qi upward rushing, causing throat obstruction and hypochondriac urgency/pain. (At this time, if treated with warming-kidney and dispelling-cold herbs, the method should gradually improve, but) physicians mistook it for retained fluid and purged heavily. (Missing the source, the pathogen) qi (remained) attached and did not leave, the disease (root) was not removed. Then repeated vomiting was induced. (Attacking non-pathogens, one heavy purge damages the stomach, one vomit damages upper jiao yang, allowing lower jiao yin-fire to exploit, leading to) stomach deficiency-vexation, dry throat desiring water. (Fire exploiting upward, yang deficient downward, leading to triple burner dysfunction.) Difficulty in urination. (Lack of fire under the cauldron.) Failure to transform food and drink. (Water qi daily increases, causing) face, hands, and feet (all showing) edema. Then Tingli Wan (Descurainia Seed Pill) was given to purge (water). (Although not treating the root, since swelling was severe.) At that time, slight improvement occurred. (Later, due to) excessive appetite, swelling returned as before. (Adding) chest and hypochondriac distress, resembling Ben Tun [Running Piglet]. (Moreover, its water (qi) overflows. (At times) coughing (and) wheezing/counterflow occur. (The healer) should first attack. (Similar to Guiling Wuwei Gancao Tang [Poria, Cinnamon Twig, Schisandra, Licorice Decoction].) Let the rushing qi (subside and) stop. (Only after stopping) then treat (the) cough. (Using Linggan Wuwei Jiangxin Tang [Poria, Cinnamon Twig, Schisandra, Ginger, Asarum Decoction] etc., to stop cough.) Cough stops, wheezing (heals without specific treatment) naturally. (The reason is the disease root is deep and solid, cannot be suddenly removed. Should) first treat (the new illness of) rushing qi, cough, and wheezing. (While water qi) disease should be addressed (later). (However, treating disease must trace its origin. Knotted cold at Guanyuan is the origin of water disease.)"
Xu Zhongke said: This states that Zheng Shui formation involves extreme primordial deficiency, becoming water due to misdiagnosis/treatment, and generating new illnesses due to further mismanagement. Treating new illnesses should be urgent. Refer to Chapter 12 on Phlegm-Fluids, Cough, and Wheezing, which details five modified formulas of Xiao Qinglong Tang [Minor Blue Dragon Decoction]. Each character is a pearl; consult them.
(I will tentatively supplement explanations for each syndrome and provide formulas.) Feng Shui [Wind Water]. (Its) pulse (must be) floating (and the definitive evidence for this primary syndrome is) body heaviness. (Combined with) sweating and aversion to wind (and various syndromes listed in previous and subsequent chapters, whether concurrent or not). (Once body heaviness, floating pulse, sweating, and aversion to wind appear, it is undoubtedly Feng Shui internal with dampness. Use) Fangji Huangqi Tang (Stephania and Astragalus Decoction) as the main formula. (If the stomach is disharmonious, accompanied by) abdominal pain, add Shaoyao (Peony Root). (To drain it.)
Note: This section corresponds to Taiyang disease with floating pulse, sweating, and aversion to wind, which is a Wind Strike syndrome. Taiyang is the meridian of cold-water; when diseased, water does not flow. When water does not flow, it must transform into dampness, generating distension and fullness. Hence named Feng Shui. Body heaviness and floating pulse indicate internal dampness. Thus treated with Fangji Huangqi Tang. Zhang Yinan said: Fangji grows in Hanzhong, veins like chariot spokes, primarily promotes qi movement and water flow. Baizhu releases muscle layer and disperses dampness, assisting the triple burner. Ginger, Jujube, and Licorice harmonize Ying and Wei, tonify the center, and facilitate communication between upper and lower qi, allowing qi to move and water to flow. Abdominal pain indicates stomach disharmony. Add Shaoyao to drain it. Dampness chapter says: If stomach is disharmonious, add Shaoyao 3 fen. Understandable. Xu's note claiming it tonifies spleen deficiency is incorrect.
Fangji Huangqi Tang (See Dampness Disease. You said: Water and dampness are not two different things.)
Feng Shui (syndrome, body heaviness indicates more dampness, but here) aversion to wind, entire body swelling. (Indicates more wind.) Pulse floating, no thirst. (Pathogen is in the exterior, not interior. Originally no sweat, but) continuously (occasionally sees) spontaneous sweating. (Body) no significant heat. (Persistent slight heat indicates exterior excess. Use) Yebing Tang (Major Yellow Decoction) as the main formula.
Xu Zhongke said: Previous section body heaviness indicates more dampness; this section entire body swelling indicates more wind. More wind means more qi and heat, and it is acute wind. Thus, a strong agent is desired to eradicate it. Aversion to cold indicates defensive deficiency; add Fuzi. Ancient Records add Baizhu, driving out dampness together.
Yebing Tang Formula
Mahuang (Ephedra Herba) (6 liang) Shigao (Gypsum Fibrosum) (0.5 jin) Shengjiang (Fresh Zingiberis Rhizoma) (3 liang) Gancao (Licorice Radix et Rhizoma) (2 liang) Dazao (Jujubae Fructus) (12 pieces)
These five ingredients. With 6 sheng of water, first boil Mahuang, remove foam, add other herbs. Boil to obtain 3 sheng. Divide into three warm doses. Aversion to wind: add one Fuzi. Wind water: add 4 liang Baizhu.
Pi Shui [Skin Water] disease presents with limb swelling, water qi in the skin. (Previous discussion is detailed, no need to repeat. Only) if four limbs tremble slightly/nienie. (This is the specific sign of Pi Shui. Use) Fangji Fuling Tang (Stephania and Poria Decoction) as the main formula.
This provides the formula and treatment for Pi Shui syndrome.
Fangji Fuling Tang Formula
Fangji (Stephaniae Tetrandrae Radix) Huangqi (Astragali Radix) Guizhi (Cinnamomi Ramulus) (each 3 liang) Fuling (Poria) (6 liang) Gancao (Licorice Radix et Rhizoma) (2 liang)
These five ingredients. With 6 sheng of water, boil to obtain 2 sheng. Divide into three warm doses.
(Swelling of entire body and face with yellow tint is called) Li Shui [Interior Water]. (This is Feng Shui penetrating deeply into muscles, not referring to zang-fu interior/exterior. Cou li are solid with no sweat, stomach heat turns inward. To rapidly eliminate heat.) Yebing Jia Zhu Tang (Major Yellow Decoction plus Atractylodes) is the main formula. (To rapidly induce sweating.) Gancao Mahuang Tang (Licorice and Ephedra Decoction) is also used.
This provides the formula and treatment for Li Shui syndrome.
Yebing Jia Zhu Tang Formula (See above)
Gancao Mahuang Tang Formula
Gancao (Licorice Radix et Rhizoma) (2 liang) Mahuang (Ephedra Herba) (4 liang)
These two ingredients. With 5 sheng of water, first boil Mahuang, remove foam, add Gancao. Boil to obtain 3 sheng. Warm dose 1 sheng. Cover heavily to induce sweat. If no sweat, take again. Avoid wind and cold.
Water disease, its pulse is deep and small, belonging to Shaoyin. (This is Shi Shui [Stone Water). Floating indicates wind.
(That is Feng Shui. Internally) no water. (But presenting as) false distension. (The disease is not water, but) qi. (Qi disease cannot be treated by sweating.) Water. (Disease) induces sweating and resolves. (However, methods of sweating differ. If) pulse is deep. (Water is in Shaoyin, should warm the channels.) Suitable for Mahuang Fuzi Tang (Ephedra and Aconite Decoction). (Pulse) floating. (Water is in skin/hair, should unblock lungs.) Suitable for Xingzi Tang (Apricot Kernel Decoction).
This provides the formula for Shi Shui syndrome. It also mentions Feng Shui and Qi Distension, bringing out the main point from the opposite side. Classical essays use the method of borrowing guests to establish the master; Han literature pioneered this.
Mahuang Fuzi Tang Formula
Mahuang (Ephedra Herba) (3 liang) Fuzi (Aconiti Lateralis Radix Preparata) (1 piece) Gancao (Licorice Radix et Rhizoma) (2 liang)
These three ingredients. With 7 sheng of water, first boil Mahuang, remove foam, add other herbs. Boil to obtain 2.5 sheng. Warm dose 8 ge, three times daily.
Xingzi Tang Formula (Missing. Likely Mahuang Xingren Gancao Shigao Tang [Ephedra, Apricot Kernel, Licorice, and Gypsum Decoction].)
(Rebellious and不顺 [not smooth] is called) Jue [Cold Extremities] with Pi Shui (oozing for a long time, rotting and discharging water). (Sign of Jue and not smooth. Should use external application method. Use) Puhui San (Reed Catkin Ash Powder) as the main formula.
This states that Pi Shui ulceration is called Jue, providing an external treatment formula. Most families interpret it as water injuring yang qi causing cold extremities, which is incorrect. This follows Physician Qian's determination.
Puhui San Formula (See Diabetes/Wasting-Thirst)
Question: (Sweat is yellow, but body is not jaundiced. Different from Fa Huang [Yellow Eruption] syndrome, named separately Huang Han [Yellow Sweat].) Huang Han disease, body