喻嘉言曰∶病机之切于人者，水火而已矣。水泛溢于表里，火游行于三焦，可无具以应之乎？三
阳结谓之消，三阴
结谓之水。手足阳明热结而病消渴，火之为害，已论之矣。
而三阴者，手足太阴脾、肺二脏也。胃为水谷之海，水病莫不本之于胃，经乃以属之脾肺昔何耶？
使足太阴脾足以转输水精于上，手太阴肺足以通调水道于下，海不扬波矣。惟脾肺二脏之气，结而不行，
乃胃中之水曰蓄，浸灌表里，无所不到也。是则脾肺之权，可不伸耶？
然其权尤重于肾，肾者胃之关也，肾司开阖，肾气从阳则开，阳太盛则关门大开，水直下而为消；
肾气从阴则阖，阴太盛则关门常阖，水不通而为肿。经文谓肾本肺标，相输俱受为言，然则水病以脾、肺
、肾为三纲矣。于中节目，尤难辨晰。
《金匮》为五水之名，及五脏表里主病，曰风水，曰正水，曰皮水，曰石水，曰黄汗。其风水、
皮水、黄汗虽关于肾，属在阳分。至于正水与石水，则阴分之水，一切治阳之法，所不得施。
正水其脉沉迟，外症自喘。北方壬癸自病，故脉见沉迟。肾藏水，肺生水，子病累母，故外症自
喘。《内经》曰∶肾者胃之关，关门不利，故聚水成病，上下泛溢于皮肤，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，外症腹满不喘。此因肾气并于水而不动。故脉沉。水蓄膀胱之内胞，但小腹满硬，
气不上于肺，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。以肝肾两脏
之气，皆得贯入于胞中故也。然石水即关于肝肾两脏，肾多即下结而难上，肝多则挟水势上犯胃界，亦势所必
至也。后世漫不加察，治水辄宗霸术，可谓智乎？
然水在心之部，则郁心火炳明之化；在肝之部，则郁肝
木发生之化；在肺之部，则孤阳竭于外，其魂独居；在脾之部，则阴竭于内，而谷精不布；在肾之部，
不但诸阳退伏，即从阳之阴亦且退伏，孤阳独居于下而隔绝也。
故胃中之水，惟恐其有火，有火仍属消渴，末传中满之不救，肾中之水，惟恐其无火，无火则真阳
灭没，而生气内绝。
其在心之水，遏抑君火，若得脾土健运，子必救母。即在肝，在肺、在肾之水，脾土一旺，水有所制，
斯不敢于横发。故当襄陵怀山之日，而欲求土宜稼穑，舍神禹、仲景之道，而谁师乎？
胃为水谷之海，五脏六腑之大源。脾不能散胃之水精于肺，而病于中；肺不能通胃之水道于膀胱，
而病于上；肾不能司胃之关门，时其输泄，而病于下。所以胃中积水浸注，无所底止耳。
仲景论杂症，于水气一门，极其精详，惟恐足太阴脾之健运失职，手太阴肺之治节不行，足少阴肾
之关门不开，并其腑膀胱之气化不行，所以方药，皆不蹈重虚之戒，立于无过之地。
后世诸治，不伤脾即泻肺，不泻肺即泻膀胱。水病门中，成方百道，求一救肺气之 郁而伸其治节
之方，无有也；求一救膀胱阻绝而伸其气化之方，无有也。海藏设水气问难、用药大凡，要其方治，浑是后
人窠臼，况其他乎？
张景岳曰∶凡水肿症，乃脾、肺、肾三脏相干之病。盖肺虚则气不化精而化水，脾虚则土不制水而反
克，肾虚则水无所主而妄行，水不归经，则逆而上泛，故传入于脾而肌肉浮肿，入于肺则气息喘急。分言之
，三脏各有所主；合言之，总由阴胜之害，而病本皆归于肾。
经曰∶肾为胃关，关门不利，故聚水而从其类。然关门何以不利也？经曰∶膀胱者，州都之官，
津液藏焉，气化则能出矣。夫所谓气化者，即肾中之气也，阴中之火也。阴中无阳，则气不能化，所以
水道不通，溢而为肿。故治肿，惟下焦之真气得行，始能传化；下焦之真水得位，始能厘清。
求古法，惟薛立斋加减肾气汤诚对症之方也。此虽壮水之剂，而即脾、肺、肾三脏之正治。盖肾为先天
生气之源，若先天元气亏于下。则后天胃气失所本，而由脾及肺，治节所以不行而喘胀。但宜峻补命门，
使气复元，则三脏自安。方中用桂、附化阴中之阳也，熟地、山药、牛膝养阴中之水也，茯苓、泽泻、车前
利阴中之滞也。此能使气化于精，即所以治肺；补火生土，即所以治脾；壮水通窍，即所以治肾。补
而不滞，利而不伐，诚诸方是第一也。
若症有全由脾胃不足而为肿胀者，宜四君，归脾之属，须兼补命门。人知土能克水，而不知阳实制
阴；知气化为精，不知精化为气。虚则补母，正此之谓也。
脾肾虚症，用肾气汤诚善，然有脾肾大虚，并以渗利，未免减去补力，正与实漏扈者同，元气终不能复
。惟参附理阴，仍加白术大剂与之。凡治全虚，悉用此法，无一不效。塞因塞用，斯其最也。
喻嘉言说：疾病机理中与人关系最密切的，不过是水和火罢了。水泛滥于体表和体内，火游行于三焦，难道没有相应的理论来应对吗？三阳经气机郁结称为“消”（消渴病），三阴经气机郁结称为“水”（水肿病）。手足阳明经热邪郁结而患消渴病，火的危害，前面已经论述过了。
至于三阴经，指的是手足太阴经所属的脾、肺两脏。胃是受纳水谷的大海，水液病变没有不根源于胃的，但《内经》却将水病归属于脾肺，这是为什么呢？如果足太阴脾的功能足够强健，能够将水谷精微转输至上；手太阴肺的功能足够通畅，能够向下通调水道，那么水海就不会掀起波澜了。只是因为脾、肺两脏的气机郁结而不能运行，导致胃中的水液蓄积，浸灌于表里各处，无处不到。这样看来，脾、肺的职权，怎能不伸张呢？
然而，脾、肺的职权尤其以肾为重。肾是胃的关口，肾主管开阖。肾气顺从阳气则开启，阳气过盛则关门大开，水液直下而下泄为消渴；肾气顺从阴气则闭合，阴气过盛则关门常闭，水液不通而发为水肿。经文说肾为本、肺为标，二者相互输注，共同受病，那么水液病变就以脾、肺、肾为三大纲领。其中的细微之处，尤其难以辨别清晰。
《金匮要略》列出了五种水的名称，以及五脏表里对应的主病，分别是：风水、正水、皮水、石水、黄汗。其中风水、皮水、黄汗虽然与肾有关，但属于阳分。至于正水和石水，则是阴分之水，所有治疗阳分的办法，都不能施用。
正水的脉象沉迟，外在症状是自发性气喘。这是因为北方壬癸水脏（肾）自病，所以脉象见沉迟。肾主藏水，肺主生水，子病累及母脏，所以外在症状表现为气喘。《内经》说：肾是胃的关口，如果关门不利，就会聚水成病，水液上下泛溢于皮肤，出现足背浮肿、腹部胀大，向上影响肺部则喘息呼叫，不能平卧。《金匮要略》中正水的名称，大概就来源于此。
石水的脉象自然沉伏，外在症状是腹部胀满但不气喘。这是因为肾气与水邪结合而凝滞不动，所以脉象沉。水蓄积在膀胱内的胞宫部位，仅小腹满硬，气不上逆于肺，所以不喘。《内经》说：阴阳结斜，阴多阳少，名叫石水。又说：肾脉和肝脉都沉，就是石水。因为肝肾两脏的气，都能贯通入于胞中。然而石水既然关系到肝肾两脏，肾气多则向下凝结而难以上升，肝气多则挟带水势向上侵犯胃界，这也是势所必然的结果。后世医生漫不经心不加考察，治疗水病往往采用霸道峻猛的方法，这能算明智吗？
如果水邪在心之部，则会郁遏心火光明温煦的化育功能；在肝之部，则会郁遏肝木生发条达的化育功能；在肺之部，则会导致孤阳耗竭于外，魂独居而无依；在脾之部，则会导致阴精枯竭于内，而水谷精微无法布散；在肾之部，不但诸阳退伏潜藏，就连顺从阳气的阴气也会退伏，导致孤阳独居于下而被隔绝。
所以，胃中的水邪，只恐怕有火，如果有火仍属于消渴范畴，最终传变为中满胀急而不治；肾中的水邪，只恐怕无火，如果没有火则真阳灭没，而生机的源头在内断绝。
水邪在心，遏抑君火，如果能得到脾土健运，子必救母（脾为心之子，实则子能令母实，此处意指通过健脾以助心）。即使水邪在肝、在肺、在肾，只要脾土旺盛，水有所制约，就不敢横行发作。所以在洪水滔天、山岳被淹的时候，想要寻求用土来种植庄稼的方法，除了遵循大禹和仲景的道路，还能向谁学习呢？
胃是水谷的大海，是五脏六腑的大源泉。脾不能将胃的水谷精微散布给肺，就会在中焦生病；肺不能将胃的水道通调给膀胱，就会在上焦生病；肾不能管理胃的关口，按时进行输注排泄，就会在下焦生病。所以胃中积水浸注，没有止境。
仲景论述杂症，在水气这一门类中，极其精详，唯恐足太阴脾的健运功能失职，手太阴肺的治节功能不行，足少阴肾的关门不开，以及其腑膀胱的气化功能不行。因此他的方药，都不蹈重虚的戒律，立于无过错之地。
后世的各种治法，不是伤脾就是泻肺，不是泻肺就是泻膀胱。水病门中的成方虽有百种，但求一个能解救肺气郁结并伸张其治节功能的方子，没有；求一个能解救膀胱阻绝并伸张其气化功能的方子，也没有。张元素（海藏）设立水气问难、用药大凡，考察其方治，完全是后人的陈词滥调，何况其他的呢？
张景岳说：凡是水肿症，都是脾、肺、肾三脏相互牵连的疾病。肺虚则气不能化精而化为水，脾虚则土不能制水反而受克，肾虚则水无所主而妄行，水不归经脉，则逆而上泛，所以传入于脾则肌肉浮肿，入于肺则气息喘急。分开来说，三脏各有所主；合起来说，总由阴胜的危害所致，而病的根本都归于肾。
经文说：肾是胃的关口，关门不利，所以聚水而从其类。然而关门为什么不利呢？经文说：膀胱是州都之官，津液藏在其中，气化后才能排出。所谓气化，就是肾中的气，即阴中之火。阴中没有阳，则气不能化，所以水道不通，溢出而为肿。所以治疗水肿，只有下焦的真气得行，才能传化；下焦的真水得位，才能厘清。
探求古法，只有薛立斋的加减肾气汤确实是对症的方子。这虽然是壮水之剂，也就是脾、肺、肾三脏的正治之法。因为肾是先天生气的源头，如果先天元气亏虚于下，则后天胃气失去根本，从而由脾波及肺，治节所以不行而出现喘胀。只应当峻补命门，使气恢复元气，则三脏自然安宁。方中使用桂枝、附子来化阴中之阳，熟地黄、山药、牛膝来养阴中之水，茯苓、泽泻、车前子来利阴中之滞。这能使气化生于精，这就是治肺；补火生土，这就是治脾；壮水通窍，这就是治肾。补而不滞，利而不伐，确实是诸方中的第一。
如果病症完全由脾胃不足而导致肿胀的，适宜用四君子汤、归脾汤之类，必须兼补命门。人们知道土能克水，却不知道阳实能制阴；知道气化为精，却不知道精化为气。虚则补母，说的就是这个道理。
脾肾虚症，使用肾气汤确实很好，但是如果有脾肾大虚，还同时使用渗利药物，未免减去了补益之力，正像对漏勺修补一样，元气终究不能恢复。只有用人参、附子理阴，仍然加大剂量加入白术。凡是治疗全虚证，全部使用这种方法，没有不有效的。塞因塞用，这是最高明的方法。
Yu Jiayan said: Among the mechanisms of disease, those most relevant to human beings are water and fire. Water overflows in the exterior and interior, while fire travels through the Sanjiao (Triple Burner). Is there no theory to address this? When Qi stagnates in the Three Yang meridians, it is called "Xiao" (Wasting-Thirst); when Qi stagnates in the Three Yin meridians, it is called "Shui" (Edema). Heat stagnation in the Hand-Foot Yangming meridians leads to Wasting-Thirst; the harm of fire has already been discussed.
As for the Three Yin meridians, they refer to the Spleen and Lung organs associated with the Foot-Taiyin and Hand-Taiyin meridians. The Stomach is the sea of water and grain; water diseases essentially originate from the Stomach. Why does the classic text attribute them to the Spleen and Lung? If the Foot-Taiyin Spleen is sufficient to transport water essences upward, and the Hand-Taiyin Lung is sufficient to regulate water passages downward, the sea of water would remain calm. However, because the Qi of the Spleen and Lung stagnates and fails to move, water in the Stomach accumulates, flooding both the exterior and interior without limit. Thus, how can the authority of the Spleen and Lung fail to be exerted?
Nevertheless, their authority is particularly dependent on the Kidney. The Kidney is the gatekeeper of the Stomach. The Kidney governs opening and closing. When Kidney Qi follows Yang, it opens; if Yang is too excessive, the gate opens wide, causing water to flow down directly as Wasting-Thirst. When Kidney Qi follows Yin, it closes; if Yin is too excessive, the gate remains closed, causing water retention and edema. The classic states that the Kidney is the root and the Lung is the branch, mutually transmitting and receiving pathology. Therefore, water diseases have the Spleen, Lung, and Kidney as their three main principles. The details within these principles are particularly difficult to distinguish clearly.
The *Jingui Yaolue* lists five types of water diseases and their corresponding Zang-Fu relationships: Fengshui (Wind Edema), Zhengshui (True Edema), Pishui (Skin Edema), Shishui (Stone Edema), and Huanghan (Yellow Sweat). Although Fengshui, Pishui, and Huanghan involve the Kidney, they belong to the Yang aspect. In contrast, Zhengshui and Shishui are water of the Yin aspect; all treatments targeting the Yang aspect are ineffective here.
Zhengshui presents with a deep and slow pulse, and external symptoms include spontaneous asthma. This is because the Kidney (Water organ of North Ren-Gui) 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, leading to external asthma. The *Neijing* states: "The Kidney is the gate of the Stomach. If the gate is not functioning properly, water accumulates and becomes pathological, overflowing up and down into the skin, causing edema of the dorsum of the foot and abdominal distension. Upward, it causes panting and inability to lie flat." The name Zhengshui in the *Jingui Yaolue* is likely derived from this.
Shishui presents with a naturally deep pulse, and external symptoms include abdominal fullness without asthma. This is because Kidney Qi merges with water and remains immobile, resulting in a deep pulse. Water accumulates in the Bladder's Bao (Uterus/Bladder region), causing only lower abdominal fullness and hardness. Since Qi does not ascend to the Lung, there is no asthma. The *Neijing* states: "Yin-Yang stagnation and deviation, with Yin exceeding Yang, is named Shishui." It also says: "When both Kidney and Liver pulses are deep, it is Shishui," because the Qi of both the Liver and Kidney penetrates into the Bao. However, since Shishui involves both the Liver and Kidney, excessive Kidney Qi leads to lower stagnation difficult to ascend, while excessive Liver Qi carries water upward to invade the Stomach boundary, which is inevitable. Later generations, failing to observe carefully, often used harsh methods to treat water diseases; can this be considered wise?
If water resides in the Heart region, it stifles the bright transformation of Heart Fire; in the Liver region, it stifles the generating transformation of Liver Wood; in the Lung region, it exhausts solitary Yang externally, leaving the Hun (Ethereal Soul) isolated; in the Spleen region, it depletes Yin internally, preventing the distribution of grain essence; in the Kidney region, not only do all Yang retreat and hide, but even the Yin that follows Yang retreats, leaving solitary Yang isolated below and cut off.
Therefore, regarding water in the Stomach, one must fear fire; if fire exists, it still belongs to Wasting-Thirst, eventually progressing to untreatable middle-fullness. Regarding water in the Kidney, one must fear the lack of fire; without fire, True Yang extinguishes, and the source of life is severed internally.
Water in the Heart suppresses Sovereign Fire; if the Spleen Earth functions vigorously, the child will save the mother. Even if water is in the Liver, Lung, or Kidney, once Spleen Earth is robust, water is controlled and dares not rampage. Thus, during times of floodwaters surging over mountains, seeking to use Earth to cultivate crops, who else but Dayu (Yu the Great) and Zhang Zhongjing should we follow?
The Stomach is the sea of water and grain, the great source of the Five Zang and Six Fu organs. If the Spleen cannot scatter the Stomach's water essences to the Lung, disease arises in the Middle Jiao; if the Lung cannot regulate the Stomach's water passages to the Bladder, disease arises in the Upper Jiao; if the Kidney cannot manage the Stomach's gate to control its transport and excretion, disease arises in the Lower Jiao. Thus, water accumulation in the Stomach floods without end.
Zhang Zhongjing's discussion of miscellaneous diseases in the category of Water Qi is extremely precise and detailed. He feared the failure of the Foot-Taiyin Spleen's transportation, the dysfunction of the Hand-Taiyin Lung's regulation, the closure of the Foot-Shaoyin Kidney's gate, and the failure of the Bladder's Qi transformation. Therefore, his prescriptions avoid the prohibition of double deficiency, standing in a position of no fault.
Later treatments either damage the Spleen or drain the Lung, or drain the Bladder. Among the hundreds of established formulas for water diseases, none can rescue Lung Qi depression and restore its regulatory function; none can rescue Bladder obstruction and restore its Qi transformation. Zhang Congzheng (Haicang)'s questions on water qi and general medication principles, upon examination, are merely clichés of later generations, let alone others.
Zhang Jingyue stated: All edema syndromes are diseases involving the mutual interaction of the Spleen, Lung, and Kidney. Lung deficiency leads to Qi failing to transform essence into water; Spleen deficiency leads to Earth failing to control Water and being counter-attacked; Kidney deficiency leads to Water having no master and acting recklessly. Water not returning to its channels rebels and overflows upward, entering the Spleen to cause muscle edema, and entering the Lung to cause rapid breathing. Separately, each of the three Zang has its specific domain; collectively, it is always due to the harm of Yin excess, with the root of the disease residing in the Kidney.
The classic states: "The Kidney is the gate of the Stomach. If the gate is not functioning properly, water accumulates according to its kind." But why is the gate not functioning? The classic states: "The Bladder is the official of the reservoir, storing body fluids; Qi transformation allows them to exit." What is meant by Qi transformation is the Qi within the Kidney, i.e., Fire within Yin. Without Yang within Yin, Qi cannot transform, so water passages are blocked, overflowing to cause edema. Therefore, treating edema requires the movement of True Qi in the Lower Jiao to enable transmission and transformation; only when True Water in the Lower Jiao is in its proper place can clarity be restored.
Seeking ancient methods, only Xue Lizhai's Modified Shenqi Tang is truly symptomatic. Although this is a formula to nourish Water, it is the direct treatment for the Spleen, Lung, and Kidney. The Kidney is the source of congenital vital energy. If congenital Yuan Qi is deficient below, postnatal Stomach Qi loses its foundation, affecting the Spleen and then the Lung, causing failure of regulation and resulting in asthma and distension. One should strongly tonify the Mingmen (Gate of Life) to restore Qi, after which the three Zang will naturally settle. The formula uses Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) to transform Yang within Yin, Shudihuang (Prepared Rehmannia Root), Shanyao (Dioscorea Rhizome), and Niuxi (Achyranthes Root) to nourish Water within Yin, and Fuling (Poria), Zexie (Alisma Rhizome), and Cheqianzi (Plantago Seed) to drain stagnation within Yin. This enables Qi to transform from Essence, thereby treating the Lung; it supplements Fire to generate Earth, thereby treating the Spleen; it strengthens Water to open orifices, thereby treating the Kidney. It tonifies without stagnation and drains without damaging; it is indeed the premier among all formulas.
If the syndrome is entirely caused by Spleen and Stomach insufficiency leading to swelling, formulas such as Sijunzi Tang (Four Gentlemen Decoction) or Guipi Tang (Restore the Spleen Decoction) are suitable, but must be combined with tonifying the Mingmen. People know that Earth controls Water, but do not know that solid Yang controls Yin; they know Qi transforms into Essence, but do not know Essence transforms into Qi. Tonifying the mother when deficient refers to this principle.
For Spleen and Kidney deficiency syndromes, using Shenqi Tang is indeed good. However, in cases of severe Spleen and Kidney deficiency, simultaneously using draining and leaching herbs inevitably reduces the tonifying power, similar to patching a sieve; the Yuan Qi ultimately cannot recover. Only by using Renshen (Ginseng Root) and Fuzi to regulate Yin, along with large doses of Baizhu (Atractylodes Macrocephala Rhizome), is it effective. For treating total deficiency, using this method yields consistent efficacy. Using obstruction to treat obstruction is the highest approach.