仲景《卒病论》既亡，昌于卒暴中寒证，归重少阴肾藏之真阳，惟真阳衰微不振，外寒始得卒然中之，着阴病论，
畅发其义矣。透此一关，于以读仲景之书，无往非会心之妙，如《金匮》水气病证治条下，泛而观之，以为论水而已。
初不解其所指也，详而味之，乃知水虽有阴阳之分，要皆阴象，要皆少阴肾所专司。少阴之真阳蟠据，屹然不露，则水
皆内附，而与肾气同其收藏，无水患之可言也。必肾中真阳亏损，然后其水得以泛滥于周身，而心火受其湮郁，脾土受
其漂没，其势 成滔天莫返矣。故特发《金匮》奥义数则于下，以明治之一斑。
《金匮》五水之分，曰风水、曰皮水、曰正水、曰石水、曰黄汗。
其风水、皮水、黄汗，虽关于肾，属在阳分。至于正水、石水，则阴分之水，一切治阳水之法，所不得施之者矣。
正水其脉沉迟，外证自喘，北方壬癸自病，故脉见沉迟。肾藏水，肺生水，子病累母，标本俱病，故外证自喘。《内经》
曰∶肾者胃之关，关门不利，故聚水成病，上下溢于皮肤，跗肿腹大，上为喘呼，不得卧。《金匮》正水之名，盖本诸
此。石水其脉自沉，外证腹满不喘，此因肾气并于水而不动，故脉沉。水蓄膀胱之内胞，但少腹满硬，气不上干于肺，
故不喘。《内经》曰∶阴阳结斜，阴多阳少，名曰石水。又曰∶肾肝并沉为石水，以肝肾两藏之气，皆得贯入胞中故也。
而《巢氏病源》又谓∶石水者，引两胁下胀痛。或上至胃腕则死，其说果何所据耶？盖石水既关肝肾二藏，然则肾多即
下结而难上，肝多则挟木势上犯胃界，亦势有必至耳。叶永言少腹有瘕，即石水之证。偶因感发，痛楚叫喊，医不察，
误以柴胡药动其肝气，且微下之，呕血如污泥而死。巢氏所指，殆此类矣。门人问叶永言病，施何法则愈？答曰∶《经》
言
先痛而后病者，治其本。当先温其疝瘕，用附子、肉桂胜其寒，救其阳，止其痛，后治其感可也。医不知此，而用小柴
胡汤，不应。见其大便不通，用导法，不应，又微下之。讵知浊阴上逆，必用温药。阴窍乃通。设行寒下，则重阴 寒，
助其横发败浊之物，倾囊倒上，贯胃退场门，所不免矣，仲景既有动气在下，不可汗下之戒，又谓趺阳脉当伏，今反紧，
本自有疝瘕，腹中痛，医反下之，下之即胸满短气。早见及此，盖不温其疝瘕，反用寒下，虚其胸中之阳，则阳不布化，
阴得上干，乃至胸满短气，败浊一齐上涌而死也。即是推之，凡有疝瘕腹痛之证，重受外寒，其当温经救阳，允为定法
矣。本卷后采仲景治寒疝，用乌头煎方，可参阅。
《金匮》云∶少阴脉紧而沉，紧则为痛，沉则为水，小便即难。脉得诸沉，当责有水。身体肿重，水病脉出者死。
此论少阴病水之脉，出见浮大则主死。然风水、皮水，其脉皆浮。妊妇病水，其脉亦浮，不在此例也。夫少阴者，
至阴也，于时主冬。沉脉见者，水象与经气，皆所当然。故其脉反出，即是少阴经气，不得藏而外绝，必主死矣，究竟
所谓脉出主死者，非但以其浮也。惟沉之而无脉，然后浮之而主死耳。
《金匮》云∶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。
寸口脉沉为水，迟为寒，水与寒，皆非外入之邪，乃由脾胃与冲脉血海合病所致。盖胃海水谷之阳不布，则五阳虚
竭，故生寒。冲脉血海之阴不生化，则群阴内结，故生水。水寒相搏于二海，故十二经脉所禀水寒之状，应见于寸口也。
趺阳脾胃之脉，隐伏难于推寻，其人必水谷不化，脾气衰，则清浊不分于里而 溏。胃气衰，则阳气不行于表而身肿。
两有必至者，冲脉血之海。属右肾之藏，三焦是其府，男子以之藏精，女子以之系胞，同一源也。然在女则阴，血海多
主病，在男则阳，三焦多主病。其流各有不同焉，且冲脉无可诊也。男子诊其少阳脉卑，知为三焦气不化，而小便不利。
妇人诊其少阴脉细，知为血海受病，而经水不通。是则男子之水，由于气不化。女子之水，由于血不通，诚一定之理矣，
然而男子亦有病血者，女子亦有病气者，仲景方中，气病多有兼血药者，血病多有兼气药者，盖必达权通变，然后可造
精微之域耳。
《金匮》举治水寒次第之法，设为问答。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，始时尚微，年盛不觉。阳衰之后，荣卫相干，阳损阴盛，结寒微动，肾气上冲，咽喉塞噎，胁下急痛。医以为留
饮，而大下之，气系不去，其病不除。复重吐之，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。
脉沉为水，脉紧为寒为痛，水寒属于肾。足少阴之脉，自肾上贯肝膈，入肺中，循喉咙。其支者，从肺出络心，注
胸中。凡肾气上逆，必冲脉与之并行，随脉所过，与正气相冲击，遂成以上诸病。阳衰之后，结寒之邪，发而上冲。医
不治其冲气，妄吐下之，遂损其腐熟水谷传化津液之胃，于是渴而饮水，小便不利，至积水四射，冲气乘虚愈击，尚可
漫然治其水乎？故必先治冲气之本，冲气止，肾气平，则诸证自瘥。未瘥者，各随所宜，补阳泻阴，行水实胃，疏通
关元之积寒久痹可也。立一法而前后次第，了然无忒，学人可不知所宗乎？
师曰∶寸口脉迟而涩，迟则为寒，涩则为血不足。趺阳脉微而迟，微则为气，迟则为寒。寒气不足，即手足逆冷。
手足逆冷，则荣卫不利。荣卫不利，则腹满胁鸣相逐，气转膀胱，荣卫俱劳。阳气不通即身冷，阴气不通即骨疼。阳前
通则恶寒，阴前通即痹不仁。阴阳相得，其气乃行；大气一转，其气乃散。实则失气，虚则遗尿。名曰气分。（二十二）
桂枝去芍药加麻辛附子汤。（论见本方下）
寸口以候荣卫，趺阳以候脾胃。脾胃虚寒，则手足不得禀水谷气，日以益衰，故逆冷也。逆冷之气，入积于中而不
泻，则内之温气去，寒独留，故腹满也。脾之募在季肋章门，寒气入于募，正当少阳经脉之所过。少阳之府三焦也，既
不能行升发之气于上焦，必反引其在腹与入募之寒，相逐入于膀胱，留积不去，荣卫愈益不通，腹满胡由而散耶？有时
阳虽前通，然孤阳独至，卫气终不充于腠理，故恶寒，阴虽前通，然孤阴独至，终不温分肉，故痹而不仁。必阴阳二气
两相协和，荣卫通行无碍，而膻中之宗气始转。宗气一转，则离照当空。浊阴之气，自从下焦二阴之窍而散。第其散分
虚实两途，气实则从后阴喧吹而出，气虚则从前阴淋滴而出。是则寒气之聚散，总关于温气之去存，故名之曰气分也。
此等竿头进步之言，读其书者，明饮上池而不知其味，岂非腥秽汨之耶？
张仲景的《卒病论》已经失传，我在论述突发性中寒证时，着重强调少阴肾藏的真阳（肾脏中的元阳之气），认为只有真阳衰微不振，外来的寒邪才能突然侵袭人体。我撰写了关于阴病的论述，充分阐发了这一理论。一旦透彻理解这一关键点，再阅读张仲景的著作，就会处处感到心领神会的妙处。例如在《金匮要略》水气病证治条文下，泛泛地看，似乎只是在论述水液代谢的疾病。起初我不明白其真正所指，仔细品味后才知道，水虽然有阴阳之分，但本质上都属于阴象，且都由少阴肾所专门主管。如果少阴的真阳盘踞稳固，巍然不动而不显露，那么水液都会内附于肾，与肾气的收藏功能一致，就不会有水患可言。必须是肾中的真阳亏损，然后水液才得以在周身泛滥，导致心火受到淹抑郁闭，脾土受到漂没淹没，其势态如同滔天洪水无法挽回。因此，特在下文阐发《金匮要略》中关于水病的奥义数条，以展示治疗水病的一个侧面。
《金匮要略》将水病分为五类：曰风水、曰皮水、曰正水、曰石水、曰黄汗。
其中风水、皮水、黄汗，虽然与肾有关，但属于阳分病变。至于正水、石水，则是阴分的水病，所有治疗阳水的方法，都不适用于此。
正水的脉象沉迟，外在症状是气喘，这是因为北方壬癸（对应肾脏）自病，所以脉象表现为沉迟。肾主藏水，肺主生水，子病累及母脏，标本俱病，所以外在症状表现为气喘。《黄帝内经》说：“肾是胃的关口，如果关门不利，就会聚水成病，水液上下溢于皮肤，出现足背浮肿和腹部胀大，向上则引起喘息呼叫，不能平卧。”《金匮要略》中正水的名称，大概就源于此。石水的脉象自然沉伏，外在症状是腹部胀满但不气喘，这是因为肾气与水结合而静止不动，所以脉象沉。水蓄积在膀胱内的胞宫部位，只是小腹胀满坚硬，气不向上干犯肺脏，所以不喘。《黄帝内经》说：“阴阳结斜，阴多阳少，名叫石水。”又说：“肾肝脉并见沉脉为石水”，因为肝肾两脏的气，都能贯入胞中。而《诸病源候论》又说道：“石水患者，牵引两胁下胀痛。或者痛感上至胃脘部就会死亡”，这种说法究竟依据什么呢？大概石水既然关联肝肾两脏，如果肾邪多则向下结聚而难以上行，如果肝邪多则挟带木气之势向上侵犯胃界，这也是情势发展的必然结果。叶永言曾患小腹部有瘕块（腹内结块），这就是石水的证候。偶然因感受外邪诱发，疼痛剧烈叫喊，医生没有明察，误用柴胡类药物扰动肝气，并且轻微使用泻下法，导致呕出如污泥般的血液而死。巢元方所指出的情况，大概就是这类病例吧。门人询问叶永言的病，施用何种法则才能痊愈？我回答说：《内经》说“先痛而后发病的，治疗其根本”。应当先温散其疝瘕，使用附子、肉桂来战胜寒邪，救助阳气，停止疼痛，然后再治疗外感即可。医生不知道这一点，而使用小柴胡汤，无效。见其大便不通，使用导便法，无效，又轻微泻下。哪里知道浊阴之气上逆，必须使用温药，阴窍才能通畅。如果施行寒凉泻下，则会加重阴寒，助长横发的败浊之物，倾囊倒灌向上，贯穿胃部和肛门，这是难免的。张仲景既有“动气在下，不可汗下”的告诫，又说趺阳脉应当伏匿，现在反而紧，本来就有疝瘕，腹中痛，医生反而泻下，泻下后即出现胸满短气。如果早能预见这一点，大概是因为没有温散疝瘕，反而使用寒凉泻下，使胸中之阳虚弱，阳气不能布化，阴气得以上干，以至于胸满短气，败浊之气一齐上涌而死。由此推之，凡是患有疝瘕腹痛的证候，再次遭受外寒侵袭，当用温经救阳之法，这确实是确定的法则。本卷后面收录了张仲景治疗寒疝使用的乌头煎方，可以参考。
《金匮要略》说：“少阴脉紧而沉，紧则为痛，沉则为水，小便即难。脉得诸沉，当责有水。身体肿重，水病脉出者死。”
这是论述少阴病水证的脉象，如果出现浮大脉则主死。然而风水、皮水，其脉象皆浮。孕妇患病水肿，其脉也浮，不在此例。少阴属至阴，在时令上主冬。见到沉脉，是水象与经气都应有的表现。所以其脉反而浮出，就是少阴经气不能潜藏而外绝，必定主死。究竟所谓“脉出主死”，不仅仅是因为它浮。只有沉取时无脉，然后浮取时主死罢了。
《金匮要略》说：“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。”
寸口脉沉为水，迟为寒，水和寒，都不是外来的邪气，而是由脾胃与冲脉血海合病所致。因为胃作为海水谷之阳不布散，则五脏之阳虚竭，所以生寒。冲脉血海的阴不生化，则群阴内结，所以生水。水寒在二海中相搏，所以十二经脉所禀受的水寒状态，应验见于寸口脉。趺阳脉是脾胃之脉，隐伏难于推寻，其人必定水谷不化，脾气衰，则清浊不分于体内而便溏。胃气衰，则阳气不行于体表而身体浮肿。这两者是必然的结果。冲脉是血之海，隶属于右肾之藏，三焦是其腑，男子用它来藏精，女子用它来系胞，本源相同。然而在女性则阴血为主，血海多主病；在男性则阳气为主，三焦多主病。其流变各有不同。而且冲脉无法直接诊察。男子诊其少阳脉低弱，可知是三焦气化不利，而小便不利。妇人诊其少阴脉细，可知是血海受病，而月经不通。这样看来，男子的水病，由于气化不利；女子的水病，由于血行不通，这确实是确定的道理。然而男子也有病血的，女子也有病气的，张仲景的方剂中，治气病多有兼用血药的，治血病多有兼用气药的，大概必须通达权变，然后才能进入精微的境界。
《金匮要略》列举治疗水寒的次第方法，设为问答。问曰：“病人苦于水病，面目身体四肢皆肿，小便不利，切脉不说水病，反而说胸中痛，气上冲咽喉，感觉像有烤肉梗塞，应当轻微咳嗽气喘，确实像老师所说，其脉象是什么样？”老师说：“寸口脉沉而紧，沉为水，紧为寒，沉紧相搏，结聚在关元穴处。开始时症状轻微，年壮时不觉。阳气衰弱之后，营卫相互干扰，阳损阴盛，结聚的寒邪微微发动，肾气上冲，咽喉堵塞噎闷，胁下急痛。医生以为是留饮（水饮停留不去），而大力使用泻下法，气结不去，病情未除。又重复使用吐法，导致胃家虚烦，咽燥想喝水，小便不利，水谷不化，面目手足浮肿。又给予葶苈丸攻下水气，当时好像稍微好转，饮食过度，肿胀又恢复如初，胸胁苦痛，形象像奔豚气，水液扬溢，则出现浮咳、喘逆。应当先攻击冲气，令其停止后再治咳；咳止，其喘自然痊愈。先治新病，旧病当在后。”
脉沉为水，脉紧为寒为痛，水寒属于肾。足少阴经脉，从肾向上贯穿肝膈，入肺中，循喉咙。其支脉，从肺出络心，注入胸中。凡肾气上逆，必与冲脉并行，随经脉所过之处，与正气相冲击，遂形成以上诸病。阳气衰弱之后，结聚的寒邪发作而上冲。医生不治疗其冲气，妄用吐下法，于是损伤了腐熟水谷、传化津液的胃，于是口渴饮水，小便不利，直到积水四射，冲气乘虚更加冲击，还可以漫然治疗其水吗？所以必须先治冲气之本，冲气停止，肾气平和，则诸证自然痊愈。未痊愈的，各随适宜，补阳泻阴，行水实胃，疏通关元穴的积寒久痹即可。确立一个法则，前后次第，清晰无误，学习者难道不知道宗法谁吗？
老师说：“寸口脉迟而涩，迟则为寒，涩则为血不足。趺阳脉微而迟，微则为气虚，迟则为寒。寒气与不足并存，即手足逆冷。手足逆冷，则营卫不利。营卫不利，则腹满胁鸣相互追逐，气转注膀胱，营卫俱劳。阳气不通即身体冷，阴气不通即骨痛。阳气先前通则恶寒，阴气先前通即麻痹不仁。阴阳相得，其气乃行；大气一转，其气乃散。实则失气，虚则遗尿。名叫气分。（二十二）”
桂枝去芍药加麻辛附子汤。（论述见本方下）
寸口脉用来候察营卫，趺阳脉用来候察脾胃。脾胃虚寒，则手足不能禀受水谷之气，日益衰弱，所以逆冷。逆冷之气，积聚在中焦而不排泄，则体内的温气离去，寒独留，所以腹满。脾的募穴在季肋章门，寒气侵入募穴，正当少阳经脉所经过的地方。少阳的腑是三焦，既不能在上焦行升发之气，必然反过来牵引其在腹中与入募的寒，相互追逐进入膀胱，留积不去，营卫更加不通，腹满怎么能消散呢？有时阳气虽先前通，但孤阳独至，卫气终究不充于腠理，所以恶寒；阴气虽先前通，但孤阴独至，终究不温煦分肉，所以痹而不仁。必须阴阳二气两相协和，营卫通行无碍，而膻中的宗气始转。宗气一转，则离照当空（阳光普照）。浊阴之气，自从下焦二阴之窍而散。只是其散分虚实两途，气实则从后阴喧吹而出，气虚则从前阴淋滴而出。这则寒气之聚散，总关乎温气之去存，所以名叫气分。
这种竿头进步（更进一步）的话，读书的人，如果不明饮上池之水（指神医扁鹊的故事，喻指医术高明或见识超群）而不知其味，岂不是被腥秽污染了吗？
Zhang Zhongjing's *Zubing Lun* (Treatise on Acute Diseases) has been lost. In my discussions on sudden cold-stroke syndromes, I emphasize the True Yang (Yuan Qi of the Kidney) of the Shaoyin Kidney Zang. It is only when this True Yang is weak and failing that external cold pathogens can suddenly invade the body. I have written treatises on Yin diseases to fully expound this theory. Once this key point is thoroughly understood, reading Zhang Zhongjing's works will reveal profound insights everywhere. For instance, in the section on Water-Qi Disease Diagnosis and Treatment in the *Jingui Yaolue*, a superficial reading might suggest it merely discusses water metabolism disorders. Initially, I did not grasp its true meaning; upon careful reflection, I realized that although water has Yin and Yang distinctions, it essentially belongs to Yin manifestations and is specifically governed by the Shaoyin Kidney. If the True Yang of Shaoyin is firmly established and remains hidden, water fluids will adhere internally, functioning in harmony with the Kidney's storage capacity, leaving no room for water disasters. Only when the True Yang within the Kidney is depleted can water flood throughout the body, submerging and depressing Heart Fire, and drowning Spleen Earth, creating a momentum like an uncontrollable flood. Therefore, I hereby elucidate several profound principles regarding water disease from the *Jingui Yaolue* below, to illustrate a facet of its treatment.
The *Jingui Yaolue* categorizes water diseases into five types: Feng Shui (Wind Water), Pi Shui (Skin Water), Zheng Shui (Regular Water), Shi Shui (Stone Water), and Huang Han (Yellow Sweat).
Among these, Feng Shui, Pi Shui, and Huang Han, although related to the Kidney, belong to Yang-level pathologies. In contrast, Zheng Shui and Shi Shui are Yin-level water diseases; all methods used to treat Yang-water are ineffective here.
Zheng Shui presents with a deep and slow pulse (*Chen Chi*), and external symptoms include wheezing. This occurs because the North Ren-Gui (corresponding to the Kidney) is diseased itself, hence the deep and slow pulse. The Kidney stores water, and the Lung generates water; disease in the child affects the mother, involving both root and branch, thus causing external wheezing. The *Huangdi Neijing* states: "The Kidney is the gate of the Stomach. If the gate is dysfunctional, water accumulates to cause disease, overflowing up and down onto the skin, resulting in edema of the dorsum of the foot and abdominal distension. Upward, it causes wheezing and inability to lie flat." The term Zheng Shui in the *Jingui Yaolue* likely originates from this passage. Shi Shui naturally presents with a sunken pulse, and external symptoms include abdominal fullness without wheezing. This is because Kidney Qi binds with water and remains static, resulting in a sunken pulse. Water accumulates in the bladder and uterus (Bao Luo), causing only lower abdominal fullness and hardness, without Qi harassing the Lung, hence no wheezing. The *Huangdi Neijing* says: "When Yin and Yang bind obliquely, with Yin exceeding Yang, it is named Shi Shui." It also states: "Simultaneous sunken pulses of the Kidney and Liver indicate Shi Shui," as the Qi of both organs penetrates the Bao Luo. However, the *Chushi Bingyuan Fanglun* (Source Book of Pathogenesis and Prescriptions for All Diseases) claims: "In Shi Shui, pain and distension radiate from under both hypochondria. If pain extends to the epigastrium, death ensues." On what basis is this claim? Since Shi Shui involves the Liver and Kidney, if Kidney pathology predominates, it binds downward and struggles to ascend; if Liver pathology predominates, it carries Wood energy to invade the Stomach boundary. Both are inevitable outcomes. Ye Yongyan once suffered from a mass (*Jia*) in the lower abdomen, which was a case of Shi Shui. Triggered accidentally by an exogenous pathogen, he cried out in severe pain. The physician failed to observe correctly, mistakenly using Chai Hu (Bupleuri Radix) formulas to disturb Liver Qi, and additionally applied mild purgation. This resulted in vomiting blood resembling mud, leading to death. The cases described by Chao Yuanfang likely refer to such scenarios. A student asked how Ye Yongyan’s illness should be treated to recover. I replied: The *Classic* states, "If pain precedes the disease, treat the root." One must first warm and dissipate the hernia/mass, using Fuzi (Aconiti Lateralis Radix Preparata) and Rougui (Cinnamomi Cortex) to overcome cold, rescue Yang, and stop pain, before treating the exogenous factor. The physician, unaware of this, used Xiao Chai Hu Tang (Minor Bupleurum Decoction) without effect. Seeing constipation, they used enemas, without effect, then applied mild purgation. They failed to realize that when turbid Yin rises, warming herbs are required to open the Yin orifices. Had they used cold purgatives, it would have exacerbated Yin-Cold, aiding the rampant expulsion of corrupt matter upwards, potentially penetrating the stomach and anus, which is unavoidable. Zhang Zhongjing warned against sweating and purgation when there is "moving Qi in the lower abdomen" and stated that the Duyang pulse should be hidden but is now tight, indicating pre-existing hernia/mass and abdominal pain. If the physician purges, chest fullness and shortness of breath result. Had this been anticipated earlier, recognizing that failing to warm the hernia/mass but instead using cold purgation depletes Upper Jiao Yang, preventing Yang distribution and allowing Yin to harass upward, leading to chest fullness, shortness of breath, and death from surging corrupt matter, one would understand. From this, we infer that for any hernia/mass abdominal pain syndrome compounded by exogenous cold, warming meridians and rescuing Yang is indeed the definitive method. Refer to the Wutou Jian (Aconite Decoction) for cold hernia treatment recorded later in this volume.
The *Jingui Yaolue* states: "Shaoyin pulse is tight and deep; tight indicates pain, deep indicates water, urination becomes difficult. When pulses are generally deep, suspect water. With bodily swelling and heaviness, if the water disease pulse floats out, it indicates death."
This discusses the pulse of Shaoyin water disease; if it appears floating and large, it indicates death. However, in Feng Shui and Pi Shui, pulses are floating. In pregnant women with water disease, pulses are also floating, which is an exception. Shaoyin belongs to Extreme Yin and governs Winter in the seasonal cycle. A deep pulse reflects both water manifestation and meridian Qi, which is appropriate. Thus, if the pulse unexpectedly floats out, it means Shaoyin meridian Qi cannot store and is externally severed, definitely indicating death. Ultimately, "pulse floating out indicates death" does not solely mean it is floating. It specifically refers to the condition where the pulse is absent upon deep pressure but appears upon superficial pressure, indicating death.
The *Jingui Yaolue* states: "Cunkou pulse is deep and slow; deep indicates water, slow indicates cold. Cold and water contend. Duyang pulse is hidden, food and water are not transformed. Spleen Qi decline leads to loose stools; Stomach Qi decline leads to bodily swelling. Shaoyang pulse is low/subdued, Shaoyin pulse is fine/thin. In men, urination is difficult; in women, menstruation stops. Menstruation is blood; if blood circulation is impaired, it transforms into water, named Blood Partition (*Xue Fen*)."
Cunkou deep pulse indicates water, slow indicates cold. Water and cold are not external pathogens but result from combined pathology of the Spleen/Stomach and the Chong Mai (Penetrating Vessel) Blood Sea. Because the Yang of the Stomach (transforming food/water) fails to distribute, the Five Yangs become deficient and exhausted, generating cold. The Yin of the Chong Mai Blood Sea fails to generate and transform, causing internal binding of Yin pathogens, generating water. Cold and water contend in the Two Seas, so the water-cold state borne by the twelve meridians manifests at the Cunkou. The Duyang pulse, representing Spleen/Stomach, is hidden and hard to locate; the patient certainly suffers from undigested food/water. Spleen Qi decline causes failure to separate clear/turbid internally, leading to loose stools. Stomach Qi decline prevents Yang Qi from reaching the exterior, leading to bodily swelling. These are inevitable consequences. The Chong Mai is the Sea of Blood, associated with the Right Kidney Zang, with the Sanjiao as its Fu organ. In men, it stores essence; in women, it connects to the uterus; their source is identical. However, in women, Yin/Blood dominates, and the Blood Sea is often diseased; in men, Yang dominates, and the Sanjiao is often diseased. Their flows differ. Moreover, the Chong Mai cannot be directly palpated. In men, a low Shaoyang pulse indicates Sanjiao Qi transformation failure and urinary difficulty. In women, a fine Shaoyin pulse indicates Blood Sea pathology and amenorrhea. Thus, male water disease stems from Qi transformation failure; female water disease stems from blood stasis. This is a fixed principle. However, men can suffer from blood diseases, and women from Qi diseases. In Zhang Zhongjing's prescriptions, Qi-treating formulas often include blood-invigorating herbs, and blood-treating formulas often include Qi-moving herbs. One must master flexibility to reach subtle profundity.
The *Jingui Yaolue* outlines the sequence for treating water-cold through Q&A. Question: "A patient suffers from water disease, with swelling of face, body, and limbs, and urinary difficulty. Pulse diagnosis does not mention water but reports chest pain, Qi rushing up the throat feeling like stuck meat, accompanied by slight cough and wheezing. If this matches the Master's description, what is the pulse?" Master replies: "Cunkou pulse is deep and tight. Deep is water, tight is cold. Deep and tight contend, knotting at the Guanyuan acupoint. Initially, symptoms were mild, unnoticed in youth. After Yang decline, Ying and Wei interfere. Yang damage and Yin excess cause the knotted cold to stir slightly. Kidney Qi rushes upward, causing throat obstruction and hypochondriac urgency/pain. Physicians mistook this for retained fluid (*Liu Yin*) and used strong purgatives. The Qi knot remained, disease persisted. Repeated emesis caused Stomach deficiency irritability, dry throat craving water, urinary difficulty, indigestion, and facial/hand/foot edema. Then Tingli Wan (Descurainiae Fructus Pill) was given to drain water. Symptoms improved temporarily, but overeating caused swelling to return, chest/hypochondriac pain, resembling Ben Tun (Rushing Pig) Qi. Water overflowed, causing floating cough and wheezing. One must first attack the Chong Qi, stop it, then treat cough; once cough stops, wheezing resolves naturally. Treat new disease first; old disease follows later."
Pulse deep indicates water, tight indicates cold/pain; water-cold belongs to the Kidney. The Foot Shaoyin Meridian ascends from the Kidney through the Liver and Diaphragm, enters the Lung, and follows the throat. Its branch emerges from the Lung, connects to the Heart, and pours into the Chest. Whenever Kidney Qi rebels, it travels alongside the Chong Mai. Following the meridian path, it clashes with healthy Qi, causing the aforementioned symptoms. After Yang decline, knotted cold pathogens flare and rush upward. If physicians fail to treat the Chong Qi and recklessly use emesis/purgation, they damage the Stomach responsible for digesting food and transforming fluids. This leads to thirst, drinking water, urinary difficulty, and widespread water accumulation. As Chong Qi strikes due to deficiency, how can one casually treat the water? Thus, one must first treat the root of Chong Qi. Once Chong Qi stops and Kidney Qi calms, other symptoms resolve. For unresolved cases, treat according to suitability: tonify Yang, drain Yin, move water, strengthen Stomach, and unblock accumulated cold/stagnation at Guanyuan. Establishing this law clarifies the sequence without error. Should students not know whom to follow?
Master says: "Cunkou pulse is slow and choppy; slow indicates cold, choppy indicates blood deficiency. Duyang pulse is faint and slow; faint indicates Qi deficiency, slow indicates cold. Cold Qi and deficiency coexist, causing cold extremities. Cold extremities lead to poor Ying/Wei circulation. Poor Ying/Wei circulation causes abdominal fullness and borborygmus chasing each other, Qi transferring to the Bladder, exhausting Ying/Wei. Yang blockage causes body coldness; Yin blockage causes bone pain. If Yang opens first, aversion to cold occurs; if Yin opens first, numbness/paralysis occurs. When Yin and Yang harmonize, Qi flows; when Great Qi rotates, stagnation disperses. Excess leads to flatus; deficiency leads to enuresis. This is named Qi Partition (*Qi Fen*). (22)"
Guizhi Qu Shaoyao Jia Mahuang Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Ephedra and Prepared Aconite). (Discussion see under this formula.)
Cunkou monitors Ying/Wei; Duyang monitors Spleen/Stomach. Spleen/Stomach deficiency-cold means extremities cannot receive Grain Qi, declining daily, hence cold extremities. Cold Qi accumulating centrally without discharge causes internal warmth to leave, leaving only cold, hence abdominal fullness. The Spleen's Front-Mu point is Zhangmen at the costal margin. Cold invading the Mu point passes through the Shaoyang meridian. The Shaoyang Fu is the Sanjiao. Unable to ascend Qi to the Upper Jiao, it drags abdominal and Mu-point cold into the Bladder, where it stagnates. Ying/Wei become increasingly blocked; how can abdominal fullness disperse? Sometimes Yang opens first, but solitary Yang arrives, Wei Qi fails to fill the interstices, hence aversion to cold. Sometimes Yin opens first, but solitary Yin arrives, failing to warm muscles, hence numbness. Only when Yin and Yang harmonize, and Ying/Wei circulate freely, does the Zong Qi (Gathering Qi) in Danzhong rotate. Once Zong Qi rotates, it is like the sun shining brightly. Turbid Yin disperses through the two Yin orifices of the Lower Jiao. Dispersal differs by excess/deficiency: excess disperses via the posterior orifice (flatulence); deficiency disperses via the anterior orifice (urine). Thus, cold aggregation/dispersion depends on the presence/absence of Warm Qi, hence named Qi Partition.
These words of further progress... readers who do not understand them after studying the books, akin to drinking from the upper pool (referring to Bian Que) yet tasting nothing, are surely muddied by filth?