古方十种证候∶以短气不得卧,为心水;两胁疼痛,为肝水;大便鸭溏,为肺水;四肢
苦重,为脾水;腰痛足冷,为肾水;口苦咽干,为胆水;乍虚乍实,为大肠水;腹急肢瘦,
为膀胱水;小便秘涩,为胃水;小腹急满,为小肠水。各随其经络,分其内外,审其脉证,
而甄别之。然此十水谓之正水,外有风水、皮水、石水、黄汗。以义考之,风合归肝,皮合
归肺,黄汗归脾,石合归肾,虽名理不逾,奈证候少异,古方备列,不可不辨。但风水脉浮
,必恶风;皮水亦浮,按不没指,不恶风;石水脉沉,腹满不喘;黄汗,脉沉迟,发热多涎
,久而不愈,必致痈脓。正水,寸口脉浮而迟,浮则热,迟则潜,热潜相搏,名曰沉;趺阳
脉浮而数,浮则热,数则止,止热相搏,名曰伏,沉伏相搏,名曰火;沉则络脉虚,伏则小
便难,虚难相搏,水走皮肤,即为正水。此《金匮》节文。所以用寸口趺阳二脉者,盖水气
不在一经也。大抵浮脉带数,即是虚寒潜止于其间,久必沉伏,沉伏则阳虚阴实,为水必矣
。要知水脉必沉。论曰∶脉出者死。与病不相应也。诸唇黑则伤肝,缺盆平则伤心,脐出则
伤脾,足平则伤肾,背平则伤肺。凡此五伤,必不可疗也。《治法》曰∶腰以上肿,宜发汗
;腰以下肿,宜利小便。学人当知之。
古代方书中有十种证候:以呼吸短促、不能平卧,诊断为心水;两胁部疼痛,诊断为肝水;大便稀薄如鸭粪,诊断为肺水;四肢沉重困苦,诊断为脾水;腰部酸痛、足部发冷,诊断为肾水;口苦咽干,诊断为胆水;身体时而虚弱时而实盛,诊断为大肠水;腹部拘急、肢体消瘦,诊断为膀胱水;小便闭塞不通,诊断为胃水;小腹部急迫胀满,诊断为小肠水。应当根据各脏腑所属的经络,区分病位的内外,审察脉象与症状,从而进行鉴别诊断。然而这十种水气病被称为“正水”,此外还有风水、皮水、石水、黄汗四种。从医理上考证,风邪归属于肝,皮水归属于肺,黄汗归属于脾,石水归属于肾,虽然名称和理论没有超出这个范围,但症状表现略有差异,古方中详细列举了这些病症,不可不加以辨别。其中风水脉象浮,必定伴有怕风的症状;皮水脉象也浮,按压皮肤凹陷不起(按之没指),但不怕风;石水脉象沉,腹部胀满但不气喘;黄汗脉象沉迟,发热且多涎液,久治不愈,必然导致痈脓。正水的寸口脉象浮而迟,浮表示有热,迟表示阳气潜藏,热与潜相互搏结,称为“沉”;趺阳脉象浮而数,浮表示有热,数表示气机阻滞,阻滞与热相互搏结,称为“伏”,沉与伏相互搏结,称为“火”;沉则导致络脉空虚,伏则导致小便困难,虚与难相互搏结,水湿流注于皮肤,这就形成了正水。这是《金匮要略》中的节选文字。之所以使用寸口和趺阳这两处脉象来诊察,是因为水气病不仅仅局限于一条经脉。大抵而言,浮脉兼见数象,即是虚寒潜藏于其间,日久必转为沉伏,沉伏则意味着阳虚阴实,必然形成水气病。必须知道水气病的脉象必定是沉脉。医论说:“脉象浮大外露者死。”这是因为脉象与病情不相适应。凡是嘴唇发黑的,说明肝脏受损;缺盆穴部位平坦凹陷的,说明心脏受损;肚脐突出的,说明脾脏受损;足背平坦无骨的,说明肾脏受损;背部平坦无脊的,说明肺脏受损。以上这五种损伤,都是不可治愈的。《治法》中说:“腰以上浮肿,适宜用发汗法治疗;腰以下浮肿,适宜用利小便法治疗。”学习中医的人应当知晓这一点。
Ancient formularies describe ten types of water disorders: shortness of breath and inability to lie flat is diagnosed as Heart Water (Xin Shui); pain in the hypochondrium is diagnosed as Liver Water (Gan Shui); loose stools resembling duck feces is diagnosed as Lung Water (Fei Shui); heavy and burdensome limbs are diagnosed as Spleen Water (Pi Shui); lower back pain and cold feet are diagnosed as Kidney Water (Shen Shui); bitter taste in the mouth and dry throat are diagnosed as Gallbladder Water (Dan Shui); alternating deficiency and excess states are diagnosed as Large Intestine Water (Da Chang Shui); abdominal urgency with emaciated limbs is diagnosed as Bladder Water (Pang Guang Shui); difficult and obstructed urination is diagnosed as Stomach Water (Wei Shui); urgency and fullness in the lower abdomen are diagnosed as Small Intestine Water (Xiao Chang Shui). One should differentiate these conditions by examining the meridians involved, distinguishing between interior and exterior locations, and carefully assessing the pulse and symptoms. However, these ten water disorders are referred to as "True Water" (Zheng Shui). Externally, there are also Wind Water (Feng Shui), Skin Water (Pi Shui), Stone Water (Shi Shui), and Yellow Sweat (Huang Han). Based on theoretical principles, wind corresponds to the Liver, skin water to the Lungs, yellow sweat to the Spleen, and stone water to the Kidneys. Although the nomenclature and theory remain consistent, the clinical manifestations differ slightly. Since ancient formularies list these conditions in detail, they must be distinguished carefully. Wind Water presents with a floating pulse and aversion to wind; Skin Water also presents with a floating pulse, but pitting edema occurs upon pressure without aversion to wind; Stone Water presents with a deep pulse, abdominal fullness, but no dyspnea; Yellow Sweat presents with a deep and slow pulse, fever, excessive salivation, and if prolonged, will inevitably lead to carbuncles and pus. True Water is characterized by a floating and slow pulse at the Cun Kou (Radial Artery at the wrist); floating indicates heat, while slow indicates latent yang. The interaction of heat and latency is termed "Deep" (Chen). At the Fu Yang (Dorsalis Pedis Artery), the pulse is floating and rapid; floating indicates heat, while rapid indicates stagnation. The interaction of stagnation and heat is termed "Hidden" (Fu). The combination of Deep and Hidden pulses is termed "Fire" (Huo). Deepness leads to emptiness in the collateral vessels, while hiddenness leads to difficulty in urination. The interaction of emptiness and difficulty causes water to flow into the skin, resulting in True Water. This excerpt is from *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet). The reason for examining both the Cun Kou and Fu Yang pulses is that water qi does not reside in a single meridian. Generally, a floating pulse accompanied by rapidity indicates latent deficiency-cold within; over time, it will transform into a deep and hidden state. A deep and hidden state signifies yang deficiency and yin excess, inevitably leading to water retention. It must be understood that the pulse in water disorders is invariably deep. Treatises state: "A pulse that floats outwards indicates death," because the pulse does not correspond to the disease. If the lips are black, the Liver is injured; if the Supraclavicular Fossa (Que Pen) is flat, the Heart is injured; if the Umbilicus protrudes, the Spleen is injured; if the dorsum of the foot is flat, the Kidney is injured; if the back is flat, the Lungs are injured. These five types of injury are incurable. *Treatment Methods* state: "Edema above the waist should be treated with diaphoresis (sweating method); edema below the waist should be treated with promoting urination." Students of medicine should be aware of this.