火邪实之应。而欲入者。为真阴内结之征。是胸分中亢阳剥阴。残膏投焰之象。夫五六月间。酷热在太空。逼
伤大地之生意。俾草尖苗叶垂头委顿。而失其生鲜之气。故趺阳脉微而弦。微则精悍不生。而无胃气。弦则
少气不足供呼吸。而不得息。胃既无阴阳以上行。而少阴心主。因失后天之养。而流行之气遂结。故脉沉而
滑。沉为在里之应。滑为结实之应。少阴之里。下系胞门。又少阴统血。故沉滑相搏于左寸。而知其血结胞门
矣。瘕、死血也。经络、与他处不同。言行经之血络也。盖谓死血不泻下。则经水之络不通。旧血以不去而枯。新
血遂不生而竭。于是干以召水。而成水症。亦名水在血分者。又一也。脐下同身寸之三寸。为关元穴。关元
左二寸为胞门。右二寸为子户。胞门闭塞。气不得通。恶血不泻。血以留止。状如妊娠。皆生于女子。可导而下。
少阴。俗注亦作足经。误。盖沉滑为肾部之善脉。惟心主沉滑。始为里血结聚之诊故也。
二十二条 问曰。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。水去。其经自下。
经水前断。后病水。即前二条之症。先病水。后经水断。言先病正水及脾水。则脾胃寒而营血无资始之源。即
经所谓二阳之病发心脾。女子不月者是也。名曰水分。见同一经断之病。然水分症。不得误以为血分。而责
及无辜之意。但在血分者。血行而犹当责水。且行血颇难。而血后之水为尤难。在水分者。水去而其经自通。
且去水易。而水后之血可不问。此难易之所由别也。
二十三条 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。沉则为水。紧则为寒。沉紧相搏。结在关元。始时当微。年盛不觉。
阳衰之后。营卫相干。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。气急不去。
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。饮食过度。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。
问语中之症。凡三层。水肿。一也。冲气。二也。咳喘。三也。答语中之症。亦是三层。水寒伏结关元。一也。肾
气上冲
胸分。二也。胃阳虚于误下、误吐。外病水肿。内病咳喘。三也。是则结寒结水。为积久之旧病。冲气为年衰之新
病。水肿咳喘。为误行吐下之变病。当看条端十句之问案。次看层层推测之微妙。庶可悟其诊法之例矣。
仲景设为问答而曰。今有病者。以水为苦。其面目身体四肢皆肿。是水之外症可据矣。小便不利。是水之内
症又可据矣。脉之是望闻问之大概。非持其脉之谓。乃对医者不言水肿之苦。反言胸中痛。气上冲咽。是二
症者。必更苦于水。故不言彼而言此也。当微咳喘。犹言当下且见微微咳喘二候。审如师言二句。盖承二十
及二十一两条。因脉而知其症。故此条即症以穷其脉耳。师曰。此症而欲逆推其脉。当于寸口。先见沉紧。沉
为水而紧为寒。又沉为在里。寸。主气。而气之里为关元。故沉滑相搏于寸口。而知其石水。寒气之两结于关
元。久矣。但始时病微年盛。多不自觉。四八之后。阳气渐衰。而胃中营卫之源。相干于阳气之盛衰。故阳衰者。
则精悍薄而阳愈损。阳不足以御阴。而阴以凌犯而愈盛。阳损。则关元中所结之寒微动。阴盛。则肾中之气
上冲。夫结寒与肾气之阴邪。犯咽喉。则呕不可出。咽不得下。故有塞噎炙肉之状。犯胸膈。则既似切责。复同
拘急。故反言胸中痛也。但水寒之隐邪。虽同结于关元。阳衰而寒气上冲。于理可凭。安得骤然水肿。而致咳
喘乎。是知医以数行误治所致矣。盖误以塞噎急痛为留饮。而大下之。不知气急为冲气而非饮。故气急不
去。而其痛噎之病不除也。又误以其气在上焦。下之不除。或吐之而有合于高者越之之旨乎。不知吐则胃
家虚而烦。液干而咽燥饮水。气提而小便不利。前后两行吐下。则胃阳几冷。而水谷不化。夫咽燥饮水。则入
水既多。小便不利。则出水复少。加之水谷不化。则悍气内空。而卫阳外薄。欲其面目手足之不浮肿也得乎。
然水症初起。或上或下。必由渐及。以至周身。此阳气有关隘。水性具盈科后进之道也。今上而面目。下而身
体。远而四肢皆肿。苟非误中之误。安得至此。故知医家见水治水。又曾以葶苈丸下过。虽似相近。终属倒治。
故小瘥后。必当于饮食过度。气阻而肿复如前也。且愈误则阳气愈虚。故胸胁苦痛。水势洋溢。而浑身皆肿。
于是冲气水气。两争胸分。而浮咳喘逆。如所言之症者宜矣。是此症以水寒之结于关元者。为旧病。而以冲
气为新病。当先攻击冲气。令其止伏。乃治其水邪寒邪之咳。咳止。则水寒去而喘自瘥耳。先治新病。病当在
后。言旧病当放在后治也。二语为凡属治病之要诀。故引此以实之耳。或问曰。冲气在关元结邪之后。则
冲气原为新病。若以误行吐下后之水肿咳喘较之。则冲气不又为旧病乎。既曰先治新病。而以水肿咳喘
为后治者。何也。答曰。水肿咳喘。虽成于冲后之误治。而其水病之根。实伏于早年之沉紧相搏时。故终以冲
气为新病矣。
二十四条 风水。脉浮身重。汗出恶风者。防己黄 汤主之。腹痛加芍药。（方见湿门。）
此与风湿之症尽同。故其方治亦一也。盖汗出恶风两症。并无少别。惟水与湿。略有分辨者。以湿为汗气内
留。就地所化。水为小便不利。从下所蒸。一也。且湿则有气而无水形。水则已从气而见阴象者。又一也。然皆
在经表。皆因汗出卫虚。又水湿之邪。皆为阴性。故脉症略无差别。而方治亦何容更改也。症详风水诸条下。
方论虽见湿门。其实注意在气。以防术去水。以甘草浮之在上在外。使水气趁汗而尽出也。君黄 者。先则
助防术之力以驱水。后则蜜卫表之气以扶正也。不兼治风者。因风邪以水为根据辅。且观天道之郁风化雨。
则风邪或从水化。此责水而不责风之意耶。此与下条俱言风因轻而水因重之治例也。
二十五条 风水。恶风。一身悉肿。脉浮。不渴。续自汗出。无大热。越婢汤主之。
越婢汤方 麻黄（六两） 石膏（半斤） 甘草（二两） 生姜（三两） 大枣（十五枚）
上五味。以水六升。先煮麻黄去上沫。内诸药。煮取二升。分温三服。恶风。加附子一枚炮。（方后恶风二字。
当是恶寒之讹。盖四条恶寒者。此为极虚发汗得之之候也。况本文已有恶风一症。何必于方后重提。且
何不于原方中列附子。而曰不恶风者。去附子耶。）
恶风身肿。脉浮不渴。详已见。此条当重看续自汗出。无大热二语。盖四条曰汗出即愈。是水湿二候。轻易不
得见汗。故有肿胀沉重等症。见汗。则风邪有欲散之机。故无大热也。风邪欲散。故不必责风。但以镇重之石
膏。监麻黄之发越。而托以甘浮之甘草者。令趁其自汗之机。而微助之。则阳气动而送水外出者。正使水气
载风而尽去。其兵家用贼以驱贼之义乎。
二十六条 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。
防己茯苓汤方 防己（三两） 茯苓（六两） 黄 桂枝（各三两） 甘草（二两）
上五味。以水六升。煮取二升。分温、三服。
四肢于人身。有边鄙之象。其阳气为少薄。故水先犯之而肿也。风水之水。在卫分。皮水之水。在皮里膜外。故
曰在皮肤中。聂聂。虫行之貌。水气与虚阳互相胜负故其皮中之动机有如此也。防己逐水。故尊之为主病
之君。茯苓两膺上渗下泄之任。故倍用之。以为防己之伊芳霍也。本以卫气虚而致水。故佐甘温实表之黄 。
本以四肢虚而先肿。故佐辛温外达之桂枝也。夫治风水皮水之例。利小便之功十之三。而发汗之功十之
七。以水邪在上与外故也。则甘浮之甘草。从中托之者。其可已乎。
二十七条 里水。越婢加术汤主之。甘草麻黄汤亦主之。
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。
里水。主越婢加术汤。注详五条。下水大而上注。且卫气自密。包水而不汗者。则可径情任麻黄。而不必以石
膏镇其发越。但用甘草托之、缓之。而已足矣。故亦主之也。但此条重在甘草麻黄汤一边。言病里水而卫气
少衰者。因当主彼汤。若卫气自密者。又当主此汤也。
二十八条 水之为病。其脉沉小。属少阴。浮者。为风。无水虚胀者。为气。水病发其汗即已。脉沉者。宜麻
黄附子汤。浮者。宜杏子汤。
麻黄附子汤方 麻黄（三两） 附子（一两炮） 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 麻黄（四两） 杏仁（五十个） 甘草（二两炙）
上以水七升。先煮麻黄减二升。去上沫。内诸药。煮取二升。去滓温服一升。得汗止服。（林亿谓此汤未见。
恐是麻黄杏子甘石汤。愚按汤后诸语。与仲景之方微别。或后贤之所缀补者乎。）
此总言风水、皮水、里水之治例。故不列名。而但曰水之为病也。脉沉为水。脉小为无阳。少阴属水脏。而又为
诸阳之根蒂今脉沉小。则其为水脏无阳。而聚水可知。故曰此水属少阴也。风为阳邪。其性上扬外鼓。故病
水而脉浮者为风水。若不渴而小便自利。及面无光亮者为无水。则此胀系虚胀。虚胀为气。除此症不在例
内。余则凡属病水。俱以发汗为正治。而水自已。但脉沉为发根于正石之里水。故宜同用麻黄发汗以去水
之外。配附子以壮火之源者。所以消阴翳也。脉浮为风水。风为木邪。肺气起而能胜之。故于麻黄发汗之外。
配杏仁以利肺者。是欲以金胜木。而尤欲以燥化胜水也。诸方俱佐甘草者。不特取甘浮为汗剂之助。且所
以浓土力而障狂澜之意云尔。
二十九条 厥而皮水者。蒲灰散主之。（方见消渴。）
厥、详伤寒及寒疝门。但此厥。既非四逆、白通等汤。宜温之寒厥。亦非大承气汤。宜下之热厥。虽与四逆散之
邪实阳明。治宜通散之滞厥颇同。而实异者也。盖因胃中先屯正水。水久化热。热水闭塞胃阳。不与经表之
气顺接。故厥。然厥则皮气外虚。正水乘虚蒸冒。而成皮水之症矣。故曰厥而皮水者。是正水为本病。因正水
而致厥者为标病。因厥而渐成皮水者。又标中之标病也。厥愈而皮水之后病。仍从汗例可矣。蒲草行根水
中。善泄土气。烧灰。则味咸性寒。咸则渗水。寒能清热。与甘寒而分理阴阳之滑石相配。是欲腾空胃中之正
水。行为小便。而使胃阳宽展。出与经气相接。则厥当自愈。若夫因厥致水。其皮气原非虚以吸水之比。今厥
愈而胃阳复起。则皮水亦当散于自汗。而可以不必治矣。此蒲灰散之另一方义。与淋门之用意迥别者也。
三十条 问曰。黄汗之为病。身体肿。发热。汗出而渴。状如风水。汗沾衣。色正黄。如 汁。脉自沉。从何
得之。师曰。以汗出入水中浴。水从汗孔入得之。宜黄 芍桂苦酒汤主之。
黄 芍桂苦酒汤方 黄 （五两） 芍药（三两） 桂枝（三两）
上三味。以苦酒一升。水七升。相和煮取三升。温服一升。当心烦服至六七日。乃解。若心烦不止者。以苦酒
阻故也。
此假问答。而详黄汗之所从得。并其治例也。津液外泄而为汗。且以发热烧之。故渴。肿、热、汗出、脉沉。注详
一条及四条下。但总按黄汗之症。一条曰发热。本条亦曰发热。则当身热矣。其四条、则曰身肿而冷。三十一条、
又曰两胫逆冷。假令发热。此为历节。盖谓发热。便非黄汗之义。即下文曰汗出已反发热云云。亦言不当热
而热之意也。则黄汗又似无热者矣。仲景错杂言之。几令人不能探其意旨。而黄汗之症。无确据矣。不知人
之卫气。其平日各有盛衰。卫气盛而汗出入水。水寒激伏其气元。虽与表气相脱。而其表气之受病者。犹然
自实也。故发热。卫气衰而汗出入水。水寒激伏其气元。却与表气同伏。而水寒之病表者。并能内窥也。故不
发热。而且肿冷。及两胫逆冷矣。是一条与本条。论卫气素盛之黄汗四条。及下文三十一条。论卫气原衰之
黄汗也。夫卫气与水相并。而实于外。气元为寒所激。而微于内。则补发其气元。出而与卫气相接。使大气一
转。其病乃散矣。然而鼓万物而燥万物者。莫大于风。经言在脏为肝。在天为风。故以芍药、苦酒之酸收者。敛
补气之黄 入肝脏。而以辛温畅达之桂枝。上引外引之。则内伏之气复起。而与卫阳合德。其蒸被之化。可
This is the manifestation of fire pathogen internal accumulation and struggle with righteous qi. The desire to enter interior indicates the sign of true yin internal knotting. This is the image of hyperactive yang in the chest peeling off yin, resembling residual fat thrown into a flame. In the months of May and June, intense heat fills the sky, forcing and injuring the vitality of the earth, causing grass tips and seedling leaves to droop and languish, losing their fresh and moist qi. Therefore, the Duyang pulse is fine (Wei) and wiry (Xian). Fine indicates that vigorous essence does not generate, lacking stomach qi; wiry indicates insufficient qi to supply respiration, leading to breathlessness. Since the stomach lacks yin and yang qi to ascend, and the Shaoyin Heart Master loses nourishment from post-heaven water and grain, the circulating qi becomes knotted. Thus, the pulse is deep (Chen) and slippery (Hua). Deep corresponds to disease in the interior; slippery corresponds to solidity. The Shaoyyin interior connects downward to the Baomen (uterus), and since Shaoyin governs blood, the interplay of deep and slippery pulses at the left Cun position indicates blood knotting in the Baomen. Jia refers to dead blood. Meridians here differ from other parts, referring specifically to the blood collaterals of menstruation. It means that if dead blood is not discharged downward, the menstrual blood collaterals become obstructed. Old blood remains and dries up, preventing new blood from generating, leading to depletion. Consequently, dryness invites water, forming edema syndrome, also called "water in the blood level," which is the first scenario. Three cun below the umbilicus, using body-inch measurement, is the Guanyuan acupoint. Two cun to the left of Guanyuan is Baomen; two cun to the right is Zihu. When Baomen is blocked, qi cannot circulate freely, evil blood is not discharged, and blood stagnates, presenting symptoms similar to pregnancy. These occur only in women and can be guided downward for expulsion. Shaoyin, commonly annotated as Foot Meridian by vulgar commentators, is incorrect. Because deep and slippery are auspicious pulses for the Kidney region, only when the Heart Master pulse presents deep and slippery does it indicate interior blood knotting diagnosis.
Article 22 Question: What is the difference between Blood Level (Xuefen) and Water Level (Shuifen)? Master said: If menses stop first, followed by edema, it is called Blood Level. This disease is difficult to treat. If edema occurs first, followed by menses stopping, it is called Water Level. This disease is easy to treat. Why? Because once the water is eliminated, menstruation will resume naturally.
Menses stopping first, followed by edema, refers to the symptoms in the previous two articles. Edema occurring first, followed by menses stopping, refers to initially suffering from Zhengshui (True Water) and Pishui (Spleen Water), where Spleen and Stomach cold deprives Ying and Blood of their source of generation. This corresponds to the Classic stating, "Diseases of the Yang Ming affect the Heart and Spleen, resulting in amenorrhea in women." Named Water Level, it shows that although both involve amenorrhea, Water Level syndrome must not be mistaken for Blood Level, avoiding unjust blame (misdiagnosis/treatment). For those in Blood Level, even if blood circulation improves, water still needs addressing, and moving blood is difficult, making subsequent water treatment even harder. For those in Water Level, once water is gone, menstruation naturally flows, and removing water is easy, so subsequent blood issues can be ignored. This explains the difference in difficulty.
Article 23 Question: A patient suffers from edema, with swelling of the face, eyes, body, and limbs, and dysuria. Upon pulse diagnosis, instead of mentioning water disease, the patient complains of chest pain and qi rushing up to the throat, feeling like a piece of roasted meat is stuck, accompanied by slight cough and wheezing. If this matches the Master's description, what would the pulse resemble? Master said: The Cun Kou pulse is deep and tight. Deep indicates water; tight indicates cold. The interplay of deep and tight knots at Guanyuan. Initially, it was mild and unnoticed due to youth and strength. After yang decline, Ying and Wei interfere with each other. Yang damage leads to Yin excess. The knotted cold stirs slightly, and Kidney Qi rushes upward, causing throat blockage and fullness, with urgency and pain in the hypochondrium. Physicians mistook this for retained fluid and used severe purgatives. The qi urgency remained, and the disease persisted. Later, heavy emetics were used, causing Stomach deficiency, vexation, dry throat craving water, dysuria, and indigestion of food and water, along with facial and limb edema. Then Tingli Wan was given to drain water. There was temporary slight improvement. However, overeating caused swelling to return, with severe chest and hypochondriac pain, resembling Ben Tun (running piglet). Overflowing water causes floating cough and wheezing. One should first attack the Chong Qi to stop it, then treat the cough. Once the cough stops, the wheezing resolves spontaneously. Treat new diseases first; old diseases should be treated later.
The symptoms in the question have three layers: Edema (1); Chong Qi (2); Cough and wheezing (3). The symptoms in the answer also have three layers: Cold-water knotting at Guanyuan (1); Kidney Qi rushing to the chest (2); Stomach Yang deficiency due to erroneous purging and vomiting, causing external edema and internal cough/wheezing (3). Thus, knotted cold and water are long-standing old diseases; Chong Qi is a new disease arising from aging/decline; edema and cough/wheezing are complications from erroneous emetic and purgative treatments. Observe the ten-sentence inquiry at the beginning of the article, then analyze the subtle layer-by-layer deduction to understand the diagnostic principles.
Jingze sets up a Q&A saying: Now there is a patient suffering from water disease. Swelling of face, body, and limbs confirms external water signs. Dysuria confirms internal water signs. Pulse diagnosis covers general observation, not just palpation. The patient ignores water suffering but complains of chest pain and qi rushing to the throat, implying these symptoms are more distressing than edema. "Slight cough and wheezing" implies these are present alongside. Following Articles 20 and 21, we know symptoms from pulse; here we deduce pulse from symptoms. Master said: To reverse-engineer the pulse for this condition, look at Cun Kou. First, see deep and tight. Deep is water, tight is cold. Deep is interior. Cun governs Qi, and the interior of Qi is Guanyuan. Thus, deep and tight interplay at Cun Kou indicates Shi Shui (Stone Water). Cold qi has been knotted at Guanyuan for a long time. Initially, the disease was mild and unnoticed in youth. After age forty, Yang gradually declines. The source of Ying and Wei in the Stomach is affected by Yang decline. When Yang declines, vigorous essence thins, and Yang further damages. Yang cannot control Yin, so Yin invades and increases. Yang damage causes the knotted cold at Guanyuan to stir; Yin excess causes Kidney Qi to rush upward. Knotted cold and Yin evil of Kidney Qi invade the throat, causing inability to vomit or swallow, feeling like a stuck roasted meat. Invading the chest/diaphragm causes pain and tension, hence the complaint of chest pain. Although water-cold hidden pathogens knot at Guanyuan, Yang decline causing cold qi to rush upward is logical. How could sudden edema and cough/wheezing occur? This reveals it was caused by multiple medical errors. Mistaking blockage/pain for retained fluid and purging severely failed because qi urgency is Chong Qi, not fluid. Thus, urgency persisted. Mistaking upper-jiao qi for something to be expelled upwards via vomiting might seem to follow "high things should be dispersed," but vomiting causes Stomach deficiency/vexation, fluid dryness/thirst, and qi rising/dysuria. Two rounds of vomiting and purging nearly freeze Stomach Yang, causing indigestion. Thirst leads to excessive water intake; dysuria leads to poor output. Combined with indigestion, heroic Qi empties internally, and Wei Yang thins externally. How could edema not occur? Water disease starts locally and spreads gradually due to Yang barriers and water's nature. Widespread swelling indicates severe error. Physicians treated water with water-draining methods like Tingli Wan, which is misguided. Temporary relief followed by relapse after overeating confirms this. More errors mean more Yang deficiency, worsening pain and swelling. Chong Qi and Water Qi compete in the chest, causing cough/wheezing. Here, knotted cold-water at Guanyuan is the old disease; Chong Qi is the new disease. Attack Chong Qi first to suppress it, then treat water/cold-induced cough. Cough cessation allows water/cold to leave and wheezing to resolve. "Treat new first, old later" is a key principle, illustrated here. Some ask: If Chong Qi arises after Guanyuan knotting, it is new. Compared to edema/cough from later errors, isn't Chong Qi now old? Why treat Chong Qi as new and edema/cough as old? Answer: Although edema/cough resulted from errors after Chong Qi arose, the root of the water disease lay in the early deep-tight interplay. Thus, Chong Qi remains the new disease relative to the root.
Article 24 Feng Shui (Wind Water) presents with floating pulse, heaviness, sweating, and aversion to wind. Fangji Huangqi Tang is indicated. Add Shaoyao if abdominal pain occurs. (Formula seen in Dampness chapter.)
This resembles Wind-Dampness completely, hence identical treatment. Sweating and aversion to wind are similar. The distinction lies in Water vs. Dampness: Dampness is sweat qi retained internally, transforming locally; Water is due to dysuria, steaming from below. Dampness has Qi but no visible form; Water has manifested Yin characteristics. Both affect exterior meridians due to sweating and Wei deficiency. Both are Yin pathogens, so pulse/symptoms are similar, requiring no formula change. See Feng Shui articles for details. Although listed under Dampness, the focus is on Qi. Fangji and Baizhu remove water; Gancao floats upward/outward to help expel water via sweat. Huangqi assists Fangji/Baizhu to drive water, then secures exterior Qi to support righteousness. Wind is not directly treated because wind relies on water as a base; observing nature, wind transforms into rain (water), so treating water treats wind. This and the next article illustrate treating heavy water over light wind.
Article 25 Feng Shui presents with aversion to wind, whole-body swelling, floating pulse, no thirst, continuous spontaneous sweating, and no significant heat. Yueshi Tang is indicated.
Yueshi Tang Formula: Mahuang (6 liang), Shigao (0.5 jin), Gancao (2 liang), Shengjiang (3 liang), Dazao (15 pieces).
Boil five ingredients in 6 sheng water. First boil Mahuang, remove foam. Add others. Boil to 2 sheng. Divide into 3 warm doses. If aversion to wind, add one Pao Fuzi. (Note: "Aversion to wind" in the formula note is likely a typo for "aversion to cold". Article 4 mentions aversion to cold from extreme deficiency after sweating. Since the main text already lists aversion to wind, repeating it is redundant. Also, why not list Fuzi in the main formula and say "remove if no aversion to cold"?)
Aversion to wind, swelling, floating pulse, no thirst are detailed previously. Focus on "continuous spontaneous sweating, no significant heat." Article 4 says "sweating leads to cure"; water-dampness rarely sees sweating, hence heavy swelling. Seeing sweating indicates wind pathogen wants to scatter, hence no high heat. Since wind wants to scatter, do not target wind directly. Use heavy Shigao to restrain Mahuang's dispersal, supported by floating Gancao, to leverage spontaneous sweating. Yang Qi moves to send water out, carrying wind away—like using thieves to catch thieves.
Article 26 Pi Shui (Skin Water) presents with limb swelling, water qi in the skin, and twitching/movement in the limbs. Fangji Fuling Tang is indicated.
Fangji Fuling Tang Formula: Fangji (3 liang), Fuling (6 liang), Huangqi, Guizhi (3 liang each), Gancao (2 liang).
Boil five ingredients in 6 sheng water. Boil to 2 sheng. Divide into 3 warm doses.
Limbs represent borders with thin Yang Qi, so water attacks them first. Feng Shui water is in Wei division; Pi Shui water is between skin and fascia ("in the skin"). Nie Nie describes insect-like movement. Water qi and deficient Yang contend, causing this twitching. Fangji drives water, serving as Sovereign. Fuling drains downward, doubled as Minister. Since Wei Qi deficiency causes water, add sweet-warm Huangqi to secure exterior. Since limb deficiency causes swelling, add pungent-warm Guizhi to reach exterior. Treating Feng/Pi Shui relies 30% on promoting urination and 70% on inducing sweating, as water is above/exterior. Floating Gancao supports from the center; how could it be omitted?
Article 27 Li Shui (Interior Water) is treated with Yueshi Jia Zhu Tang. Gancao Mahuang Tang is also indicated.
Gancao Mahuang Tang Formula: Gancao (2 liang), Mahuang (4 liang).
Boil two ingredients in 5 sheng water. First boil Mahuang, remove foam. Add Gancao. Boil to 3 sheng. Warm dose 1 sheng. Cover for sweating. If no sweat, repeat.
Li Shui primarily uses Yueshi Jia Zhu Tang (see Article 5). If water drains heavily upward and Wei Qi is dense, enclosing water without sweating, Mahuang can be used freely without Shigao restraint. Gancao supports and moderates. Hence it is also indicated. This article emphasizes Gancao Mahuang Tang for Li Shui with slightly declined Wei Qi. If Wei Qi is dense, use this formula.
Article 28 Water disease with deep-small pulse belongs to Shaoyin. Floating pulse indicates Wind. Empty distension without water is Qi. Inducing sweat cures water disease. Deep pulse suggests Mahuang Fuzi Tang. Floating pulse suggests Xingzi Tang.
Mahuang Fuzi Tang Formula: Mahuang (3 liang), Fuzi (1 liang, prepared), Gancao (2 liang).
Boil three ingredients in 7 sheng water. First boil Mahuang, remove foam. Add others. Boil to 2.5 sheng. Warm dose 0.8 sheng, 3 times daily.
Xingzi Tang Formula: Mahuang (4 liang), Xingren (50 pieces), Gancao (2 liang, honey-fried).
Boil in 7 sheng water. First boil Mahuang until reduced by 2 sheng, remove foam. Add others. Boil to 2 sheng. Strain. Warm dose 1 sheng. Stop if sweat occurs. (Lin Yi notes this formula is missing; likely Mahuang Xingren Gancao Shigao Tang. The instructions differ slightly from Jingze's style, possibly later additions.)
This summarizes treatment for Feng/Pi/Li Shui without naming them. Deep pulse indicates water; small pulse indicates lack of Yang. Shaoyin is the Water Organ and root of Yang. Deep-small pulse indicates Water Organ lacks Yang, accumulating water. Hence "belongs to Shaoyin." Wind is Yang pathogen, rising/extending. Floating pulse in water disease indicates Feng Shui. If no thirst, normal urination, and dull complexion, it is empty distension (Qi), excluded from this rule. Generally, sweating is correct treatment for water. Deep pulse (Li Shui) uses Mahuang to sweat out water plus Fuzi to strengthen Fire source (eliminate Yin shadow). Floating pulse (Feng Shui) uses Mahuang plus Xingren to benefit Lung (Metal controls Wood/Wind, Dryness controls Water). Gancao is added in all formulas to assist sweating via floating quality and strengthen Earth to hold back floods.
Article 29 Jue (Cold Extremities) with Pi Shui is treated with Puhui San. (Formula seen in Xiao Ke chapter.)
Jue is detailed in Shang Han and Han Shan chapters. This Jue is neither Cold Jue (treated with Si Ni/Bai Tong) nor Heat Jue (treated with Da Cheng Qi). It resembles Zhi Jue (Yang Ming stagnation) but differs. Stomach originally holds Zheng Shui (Correct Water). Long-standing water turns to heat. Hot water blocks Stomach Yang, preventing connection with exterior Qi, causing Jue. Jue makes Skin Qi weak; Zheng Shui exploits this, causing Pi Shui. Thus, Zheng Shui is Root; Jue is Branch; Pi Shui is Branch of Branch. Once Jue resolves, Pi Shui follows sweating rules. Pu Cao grows in water, draining Earth Qi. Ashed, it becomes salty-cold. Salty drains water; cold clears heat. Paired with Hua Shi (sweet-cold, regulates Yin/Yang), it empties Stomach water into urine, expanding Stomach Yang to reconnect with meridian Qi, curing Jue. If Jue causes water, Skin Qi isn't weak enough to absorb water. Once Jue resolves and Stomach Yang recovers, Pi Shui dissipates via sweat, needing no specific treatment. This second meaning of Puhui San differs from its use in Lin Men.
Article 30 Question: Huang Han (Yellow Sweat) presents with body swelling, fever, sweating with thirst, resembling Feng Shui. Sweat stains clothes yellow like Sophora juice. Pulse is self-deep. How is it acquired? Master said: Acquired by bathing in water while sweating, allowing water to enter through sweat pores. Huangqi Shaoyao Guizhi Kujiu Tang is indicated.
Huangqi Shaoyao Guizhi Kujiu Tang Formula: Huangqi (5 liang), Shaoyao (3 liang), Guizhi (3 liang).
Mix Kujiu (vinegar) 1 sheng with water 7 sheng. Boil three ingredients to 3 sheng. Warm dose 1 sheng. Vexation may occur; resolve after 6-7 days. If vexation persists, it is due to Kujiu obstruction.
This Q&A details Huang Han origin and treatment. Fluid loss as sweat, heated by fever, causes thirst. Swelling, heat, sweating, deep pulse are detailed in Articles 1 and 4. Note: Article 1 and this article mention fever (body heat). Article 4 mentions cold swelling. Article 31 mentions cold calves. If fever occurs, it is Li Jie (Joint Bi), not Huang Han. "Sweating then fever" implies inappropriate heat. Thus, Huang Han seems non-febrile. Jingze's mixed descriptions confuse readers. However, Wei Qi varies. Strong Wei Qi + water entry: Cold shocks Qi Yuan, detaching from surface but remaining solid internally, causing fever. Weak Wei Qi + water entry: Cold shocks Qi Yuan, sinking with surface, allowing cold to penetrate inward, causing no fever, cold swelling, and cold calves. Articles 1 & 30 discuss strong Wei Qi Huang Han; Articles 4 & 31 discuss weak Wei Qi Huang Han. When Wei Qi combines with water externally, Qi Yuan is shocked internally. Tonify/release Qi Yuan to connect with Wei Qi, turning Qi to disperse disease. Wind dries/gathers all things. Classic says Wind corresponds to Liver (Zang) and Heaven. Sour/astringent Shaoyao and Kujiu gather tonifying Huangqi into Liver. Pungent-warm Guizhi guides outward/upward. Internal Qi rises, combining with Wei Yang, creating transformation...