水气之治，古方概用泻药而不及补法，自宋南渡后，创立扶脾之剂，迄至明清诸家，无一不主于调补者。顾
古今时异，人之禀受有强弱之不同，非古人之略于补，而后人之嫌于泻也。虽然，今世虚肿固多，而实肿亦间
有之，医者随证施治，不必株守一格，庶几乎其可矣。
病起于脾肾 肾者主水，脾胃俱主土，土性克水。脾与胃合，相为表里，胃为水谷之海。今胃虚不能
传化水气，使水气渗泄经络，浸渍腑脏。脾得水湿之气加之则病，脾病则不能制水，故水气独归于肾，三焦不泻，
经脉闭塞，故水气溢于皮肤而令肿也。（《病源论》）
水病者，由肾脾俱虚故也。肾虚不能宣通水气，脾虚又不能制水，故水气盈溢，渗泄皮肤，流遍四肢，所以
通身肿也。令人上气体重，小便黄涩，按之随手而起是也。（同上）
水肿为病，皆由真阳缺少，劳伤脾胃，脾胃既寒，积寒化水。盖脾者土也，肾者水也，肾能摄水，脾能舍
水。肾水不流，脾舍堙塞，是以上为喘呼咳嗽，下为足膝 肿，面浮腹胀，小便不利，外肾或肿，甚则肌肉崩溃，
足胫流水，多致不救。（《济生》）
肾者胃之关，不惟因肾气不化而后闭，其胃之病者而关亦自闭矣。其水不待肾水而生，所饮之水亦自聚矣。
盖胃主中焦，为水谷之海，胃气和，则升降出纳之气行，水谷各从其道而输泄也。胃气不和，则出纳之关皆不利，
故水谷之津液，皆积聚而变水也。（《准绳》）
虚人气胀者，脾虚不能运气也。虚人水肿者，土虚不能制水也。水虽制于脾，实则统于肾，肾本水脏，而元阳寓
焉。命门火衰，既不能自制阴寒，又不能温养脾土，则阴不从阳，而精化为水，故水肿之证多属火衰也。（《必
读》）（按∶《医学管见》曰∶水肿之证，盖水盛而火不能化也。火衰而不能化水，故水之入于脾胃者，皆渗入
血脉骨肉，血亦化水，肉发肿胀，皆自然之理也。此李氏所本。又水肿多属阳虚，景岳有说，录在《胀满》气
证水证条，宜参。）
所因多种 （虚实之别）卒肿满，身面皆洪大。凡此满，或者虚气，或者风冷气，或者水饮气。（《肘
后》）
人中百病难疗者，莫过于水也。水者肾之制也，肾者人之本也。肾气壮则水还于海，肾气虚则水散于皮。
又三焦壅塞，荣卫闭格，血气不从，虚实交变，水随气流，故为水病。有肿于头目者（按∶目疑面讹），有肿于
腰脚者，有肿于四肢者，有肿于双目者，有因嗽而发者，有因劳而生者，有因凝滞而起者，有因虚乏而成者，有
因五脏而出者，有因六腑而来者，类目多种而状各不同。所以难治者，由此百状，人难晓达；纵晓其端，则又苦
人以骄恣，不循理法，触冒禁忌，不能备矣。（《中藏经》）
膜外气者，或谓之水病，起于他疾，不可常定。或因患疟，或因积劳，或因肾脏中风，或因肺腑伤冷，或因
隔上气，或因冲热远行，或因酒肉中所得。始于肺，终于肾。或因咳嗽，或多涕唾，或因蓄聚冷气，壅塞不散，
遂使肺脏热气攻心，五脏冷气下化为水，流入膀胱，在大肠膜外。所以切脉不能知，针灸不能及。盖人肾为命本，
不可虚也，本固即叶茂，本虚即易枯，况四时衰旺，皆乘肾脏之气，肾损即五脏皆衰，是致胃闭而脾不磨，气
结而小便涩。（《圣济》引徒都子膜外气方）（按∶徒都子大意，谓肺受寒邪，传之于肾，肾气虚弱，脾土又衰，
不能制水。然语意不确，姑举于
此。）
此病多从久患气急不瘥，或从消渴，或从黄胆，或从支饮，或从虚损大病瘥后，失于时治，或因产后，或因
香港脚肿满，或因久患癖瘕，久经利下，或因饮水不即消，三焦决漏，小便不利，变成此疾。（《鸡峰》）（按∶
或从虚损大病数语，本于《肘后》，宜参后证候总说。）
凡诸实证，或六淫外客，或饮食内伤，阳邪急速，其至必暴，每成于数日之间。若是虚证，或情志多劳，
或酒色过度，日积月累，其来有渐，每成于经月之后。然治实颇易，理虚恒难。（《必读》）
肿者肌肉之肿也，胀者腹中之胀也，盖肿属脾而胀属肝，肿轻而胀重也。如单胀而不肿，则肝邪横行，
木专克土，虫斯成矣，不易治也；惟肿胀兼有之，则阳气犹行，十可救五，但在分类而酌处之。予以肿胀之证，
治在中宫，故有痰裹食积，以致清气不升，浊气不降而成之者；有痰裹污血，以致荣卫不从，逆于肉里而成之者；
有湿热相生，隧道阻塞而成之者；有燥热冲击，秘结不行而成之者。此四者，皆有余之证也。有服寒凉太过，
饮食频伤，以致中气虚衰，郁遏不运而成之者；有痢疾之后（《医方集解》作大病后），正气衰惫，邪热不息，
以致通身浮肿肉硬而成之者；又有始则为气，终则为水，小便不利，水液游行，脾莫能制而为水肿者。此三者，
皆不足之证也。故有余者清之消之降之，不足者补之益之，毋混治也。大抵此证初起易治，以正未虚而邪未旺
也；久遂难痊，以邪已炽而正已衰也。（《苍生司命》）
脉法 水病脉洪大者可治，微细者不可治。水病胀闭，其脉浮大软者生，沉细虚小者死。水病腹大如
鼓，脉实者生，虚者死。（《脉经》）大要看尺脉，肿盛而尺脉如丝，
或洪浮按之无根者，皆不可下，此死脉也。（《朱氏》）
证候总说 水病之初，先目上肿起，如老蚕色，侠颈脉动，股里冷，胫中满，按之没指，腹内转侧有
节声，此其候也。不即治，须臾身体稍肿，肚尽胀，按之随手起，则病已成，犹可为治。此皆从虚损大病，或下
痢后，妇人产后，饮水不即消，三焦受病，小便不利，乃相结，渐渐生聚，遂流诸经络故也。（《肘后》）
轻重之候，在大小便耳。若小便不通，则气壅，攻击腹内，冲出膜外，化而为水，使人手足头面浮肿。若大
小便微涩则微肿，极涩则极肿，大小便俱不通，三日即遍身洪肿，至重则阴亦肿。夫阴肿有二∶有肿而小便自出
者，有肿而小便出涩者。又有茎头连小腹脐皆肿者，此并为死候，宜速治之。若患此疾，肿亦不常定，或先手足
面目浮肿，或先腰肋微肿，或先手足小肿。其候或消或甚，三五日稍愈，或三五日再发，亦以小便通涩为候，积
渐变成洪肿。妇人得之，与此略同。凡患此疾，令人腹胀烦闷，胸间气急。此由肺胀甚，即喘如牛吼，坐卧行立不
得，或中夜后气攻胸心，重者一年、二年方死，有一月、两月死者。若将息失度，误食毒物，一日、五日即甚也。
（《圣济》引徒都子）
项颈脉动，睡起眼浮，下如蚕卧，足胫肿，股间冷，身重倦行，行即喘急，面有时而白及光泽，准头黑，肠间
沥沥如水鸣，鼻尖常冷，小便赤涩，虽频数，绝微细，大便燥结，卧即哽气，或喉中如水鸡声，腹胁满闷，咳嗽不
止，凡此皆水证也，不可尽纪。（《鸡峰》）
阴阳 经曰∶治水之法，腰以上肿宜发汗，腰以下肿宜利小便。此至当之论，然肿满最慎于下，当辨其
阴阳。阴水为病，脉来沉迟，色多青白，不烦不渴，小便涩少而清，大腑
多泄，此阴水也，则宜用以温暖之剂，如实脾散、复元丹是也。阳水为病，脉来沉数，色多黄赤，或烦或渴，小
便赤涩，大腑多闭，此阳水也，则宜用清平之药，如疏凿饮子、鸭头丸是也。（《济生》）（鸭头丸用甜葶苈、
猪苓、汉防己，绿头鸭血为丸。）
阳水多外，因涉水冒雨，或兼风寒暑气而见阳证；阴水多内，因饮水及茶酒过多，或饥饱劳役房欲而见阴证。
阳水先肿上体，肩背手膊，手三阳经；阴水先肿下体，腰腹胫跗，足三阴经。（《入门》）
大都阳证多热，热证多实；阴证多寒，寒证多虚。先滞于内而后及于外者，多实；先肿于表而渐及于内，或
外虽胀而内不胀者，多虚。小便红赤，大便秘结者，多实；小便清白，大便稀溏者，多虚。脉滑有力者，多实；
弦浮微细者，多虚。形色红黄，气息粗长者，多实；形容憔悴，声音短促者，多虚。年青少壮，气道壅滞者，多
实；中年积劳，神疲气怯者，多虚。虚实之治，反如冰炭，若误用之，必致害矣。（《景岳》）（按∶此条原出其
《胀满》中，《必读》举之《水肿》门，今从之。）
风水 风水病者，由脾肾气虚弱所为也。肾劳则虚，虚则汗出，汗出逢风，风气内入，还客于肾，脾虚
又不能制于水，故水散溢皮肤，又与风湿相搏，故云风水也。令人身浮肿，如裹水之状，颈脉动，时咳，按肿上，
凹而不起也，骨节疼痛而恶风是也。脉浮大者，名曰风水也。（《病源论》）
有儿十五岁，病身体肿，脉浮数，大便自利，米谷不化，此成风水病，以越婢加术汤主之。五苓散亦可兼服，
然止治风水，不及此。（《鸡峰》）
凡外感毒风，邪留肤腠，则亦能忽然浮肿，如东垣所谓
八益之邪，自外而入者是也。然其来必速，其证则必有脉紧及头疼骨痛等证，方是外感之候，先宜解散其邪。（《景
岳》）
皮水 肺主于皮毛，肾主于水，肾虚则水妄行，流溢于皮肤，故令身体面目悉肿，按之没指而无汗也。
腹如故而不满，亦不渴，四肢重而不恶风是也。脉浮者，名曰皮水也。（《病源论》）
夫水之病，皆由肾虚所为，肾虚则水流散经络，始溢皮毛。今此毛水者，乃肺家停积之水，流溢于外。肺主
皮毛，故余经未伤，皮毛先伤，因名毛水也。（同上）
大腹水肿 夫水肿病者，皆由荣卫痞涩，肾脾虚弱所为。而大腹水肿者，或因大病之后，或积虚劳损，
或新热食竟，入于水。自渍及浴，令水气不散，流溢肠外，三焦闭塞，小便不通，水气结聚于内，乃腹大面肿。
故四肢小，阴下湿，手足逆冷，腰痛上气，咳嗽烦疼，故云大腹水肿。（《病源论》）（按此即正水证，仍列于斯。）
石水 肾主水，肾虚则水气妄行，不根据经络，停聚结在脐间，小腹肿大 如石，故云石水。其候引胁
下胀痛而不喘是也。脉沉者名曰石水，尺脉微大亦为石水。肿起脐下至小腹，垂垂然上至胃脘，则死不治。
（《病源论》）
若腹胀如鼓，按之坚硬，腹中时痛，始起于目下微肿，时喘，小便不利，四肢瘦削，其脉自沉，大便利则逆，
谓之石水。绕脐坚硬，腹不痛者，谓之鼓气。（《鸡峰》）
代州钱防御，命孙兆诊之，脉得沉紧数，六至以上，外证目下肿，鼻准亦肿，唇色紫，自心以下，腹大肿胀，
外阴器肿胀如升，按之如石坚，举动即喘，咳逆痰涎，口苦干渴。云得病已及两月，医者皆云下虚风气，近曾脐
下着灸，
三里亦灸之。兆告曰∶病名石水，主治不对，故不愈。仲景曰∶腰下及腹肿者，皆利其小便。又曰∶腹满口舌干
燥，此腹中有水也，方以防己葶苈椒目大黄丸主之。遂与服三丸，日三，少觉胸腹快。遂与《圣惠方》治十水葶苈
散，初服三钱，以葱浆水酒下，食顷，以葱浆稀粥投之。隔日一服，每服葶苈散之日，至日中暮，更服防己椒
目葶苈大黄丸三服，次日但进丸子三服。凡十日，觉大便快利，肿胀喘咳已减三之一，二十日，病去三之二，自
此消息加减，三十日而全愈。（《鸡峰》）
肿有四证 （妇人）水之为肿特一耳，曰风，曰气，曰血，合而有四焉。风肿者，皮粗，麻木不仁，走注
疼痛。气肿者，皮浓，四肢瘦削，腹胁胀膨。其或烦躁漱水，迷忘惊狂，呕逆烦闷，皮间有红缕赤痕者，此血肿
也。妇人经脉壅闭，败血停腐，尤多见之。然妇人怀胎，亦有气遏水道而虚肿者，此但顺气安脾，饮食无阻，既
产而肿自消。若产后发肿，则虚退而告殂矣。（《直指》）
不伏水土 不伏水土者，言人越在他境，乍离封邑，气候既殊，水土亦别，因而生病，故云不伏水土。
病之状，身体虚肿，或下利而不能食，烦满气上是也。（《病源论》）
肿喘相因 喘与胀，二证相因，必皆小便不利，喘则必生胀，胀则必生喘，但要识中标本先后。先喘而
后胀者，主于肺；先胀而后喘者，主于脾。何则？肺金司降，外主皮毛。经曰∶肺朝百脉，通调水道，下输膀胱。
又曰∶膀胱者，州都之官，津液藏焉，气化则能出矣。是小便之行，由于肺气之降下而输化也。若肺受邪而上喘，
则失降下之令，故小便渐短，以致水溢皮肤而生肿满焉。此则喘为本而肿为标，治当清金降气为主，而行水次之。
脾土恶湿，外主肌肉，土能克水。若脾土受伤，不能制水，则水湿妄行，浸渍
肌肉，水既上溢，则邪反侵肺，气不得降而生喘，此则肿为本而喘为标，治当实脾行水为主，而清金次之。苟肺
证而用燥脾之药，则金得燥而喘愈加；脾病而用清金之药，则脾得寒而胀愈甚矣。近世治喘胀者，但知实脾行
水，而不知分别肺脾二证，予故为发明之。（《杂着》）（按∶《统旨》本于此说，更曰∶先肿而后喘者，是肾
水上溢侵肺，以致气壅窒碍，不得降下而生喘。）
死证 病患荣卫竭绝，面浮肿者死。病患卒肿，其面苍黑者死。病患手掌肿无文者死。病患脐肿反出者
水气病的治法，古方大多使用泻下药物而不涉及补益方法，自从宋朝南渡之后，创立了扶助脾气的方剂，直到明清时期的各位医家，无不主张调理和补益。然而古今时代不同，人的体质禀赋有强弱之别，并非古人忽略补法，而是后人忌讳使用泻法。虽然如此，当今社会虚证水肿固然多见，但实证水肿也偶尔存在，医生应当根据证候施治，不必拘泥于一种固定模式，这样才差不多可以了。
病起于脾肾。肾主水，脾胃都主土，土的属性克制水。脾与胃相合，互为表里，胃是水谷汇聚的大海。现在胃气虚弱，不能传导化生水气，导致水气渗入泄露经络，浸渍脏腑。脾受到湿气的侵袭就会生病，脾病了就不能制约水，所以水气独自归于肾，三焦排泄不畅，经脉闭塞，因此水气溢出皮肤而导致浮肿。（《诸病源候论》）
水病，是由于肾脾两脏都虚弱造成的。肾虚不能宣通水气，脾虚又不能制约水，所以水气盈满溢散，渗漏到皮肤，流遍四肢，因此全身浮肿。让人上身感觉气息壅滞、身体沉重，小便黄且排尿涩痛，按压肿胀处随手而起（凹陷即复），就是这种情况。（同上）
水肿这种病，都是因为真阳不足，劳倦损伤脾胃，脾胃既已寒凉，积寒转化为水。脾属土，肾属水，肾能摄纳水液，脾能容纳水液。肾水不流动，脾土堵塞，所以上面出现喘呼咳嗽，下面出现足膝浮肿，面部浮肿腹胀，小便不利，外生殖器有时也会肿，严重时肌肉溃烂，足胫流水，多导致无法救治。（《济生方》）
肾是胃的关口，不仅因为肾气不化而后导致闭塞，如果胃有病，这个关口也会自动闭塞。水不是由肾水产生的，所喝的水也会自行积聚。胃主中焦，是水谷的大海，胃气调和，那么升降出入的气机就能运行，水谷各自顺着道路输泄。胃气不和，那么出纳的关口都不利，所以水谷的津液，都积聚而变成水。（《医学准绳六要》）
虚人出现气胀，是因为脾虚不能运化气机。虚人出现水肿，是因为土虚不能制约水。水虽然受脾制约，但实际上统属于肾，肾本是水脏，而元阳寓居其中。命门火衰，既不能自制阴寒，又不能温养脾土，那么阴不能从阳，精微化为水，所以水肿的证候多属于火衰。（《必读》）（按：《医学管见》说：水肿之证，大概是水盛而火不能化。火衰而不能化水，所以进入脾胃的水，都渗入血脉骨肉，血也化为水，肉发生肿胀，这都是自然之理。这是李氏学说的依据。另外水肿多属阳虚，张景岳有论述，记录在《胀满》气证水证条，宜参考。）
致病原因多种多样（虚实区别）。突然发生的肿满，身体面部都洪大。凡是这种胀满，或者是虚气，或者是风冷气，或者是水饮气。（《肘后备急方》）
人中百种难治的病，没有比水病更难的了。水是肾的制约者，肾是人的根本。肾气壮实则水回归大海，肾气虚弱则水散于皮肤。加上三焦壅塞，营卫闭阻，血气不顺，虚实交替变化，水随气流走，所以成为水病。有的头目浮肿（按：目疑为面字之误），有的腰脚浮肿，有的四肢浮肿，有的双目浮肿，有的因咳嗽引发，有的因劳累产生，有的因凝滞而起，有的因虚乏而成，有的因五脏而出，有的因六腑而来，类目多种而症状各不相同。之所以难治，是因为这百种症状，人难以知晓通达；即使知道了端绪，又苦于人傲慢放纵，不遵循理法，触犯禁忌，不能防备。（《中藏经》）
膜外气，有人称之为水病，起于其他疾病，不可常定。或者因患疟疾，或者因积劳，或者因肾脏中风，或者因肺腑受冷，或者因膈上气，或者因冲热远行，或者因酒肉中毒引起。病始于肺，终于肾。或者因咳嗽，或多涕唾，或者因蓄聚冷气，壅塞不散，致使肺脏热气攻心，五脏冷气下化为水，流入膀胱，在大肠膜外。所以切脉不能知道，针灸不能达到。大概人的肾是生命根本，不可虚弱，根本稳固则枝叶茂盛，根本虚弱则容易枯死，何况四季的衰旺，都依赖肾脏之气，肾受损则五脏都衰弱，导致胃闭而脾不磨碎食物，气结而小便涩滞。（《圣济总录》引徒都子膜外气方）（按：徒都子的主要意思，是说肺受寒邪，传之于肾，肾气虚弱，脾土又衰，不能制约水。但语意不准确，姑且列举于此。）
此病多从长期患有气喘不愈，或从消渴病，或从黄疸病，或从支饮病，或从虚损大病痊愈后，失于及时治疗，或因产后，或因香港脚肿满，或因长期患有癖瘕，久经腹泻，或因饮水不能立即消散，三焦决漏，小便不利，变成此疾。（《鸡峰总论》）（按：或从虚损大病数语，本于《肘后备急方》，宜参考后证候总说。）
凡是各种实证，或是六淫外邪客犯，或是饮食内伤，阳邪急速，其到来必然猛烈，每在数日之间形成。如果是虚证，或是情志多劳，或是酒色过度，日积月累，其来势缓慢，多在经月之后形成。然而治疗实证颇容易，调理虚证恒常困难。（《必读》）
肿是指肌肉的浮肿，胀是指腹中的胀满，大概肿属于脾而胀属于肝，肿轻而胀重。如果只有胀而不肿，则是肝邪横行，木专门克土，虫由此生成，不易治疗；只有肿胀兼有，则阳气犹行，十人可以救活五个，关键在于分类而斟酌处理。我认为肿胀之证，治疗在于中宫（脾胃），所以有痰裹食积，以致清气不升，浊气不降而形成的；有痰裹污血，以致营卫不从，逆于肉里而形成的；有湿热相生，隧道阻塞而形成的；有燥热冲击，秘结不行而形成的。这四者，都是有余的实证。有服用寒凉太过，饮食频繁受伤，以致中气虚衰，郁遏不运而形成的；有痢疾之后（《医方集解》作大病后），正气衰惫，邪热不息，以致通身浮肿肉硬而形成的；又有开始为气，终则为水，小便不利，水液游行，脾不能制约而成为水肿的。这三者，都是不足的虚证。所以有余的要清、消、降，不足的要补、益，不要混淆治疗。大抵此证初起易治，因为正气未虚而邪气未旺；久了就难痊愈，因为邪气已炽盛而正气已衰退。（《苍生司命》）
脉法。水病脉象洪大的可治，微细的不可治。水病胀闭，脉象浮大软的为生，沉细虚小的为死。水病腹部大如鼓，脉实的生，脉虚的死。（《脉经》）大要看尺脉，肿盛而尺脉如丝，或洪浮按之无根的，都不可用下法，这是死脉。（《朱氏集验方》）
证候总说。水病之初，先眼上肿起，像老蚕的颜色，挟颈部脉搏跳动，大腿内侧冷，小腿中满，按之没指，腹内转侧有节律的声音，这是它的征候。如果不立即治疗，片刻身体稍肿，肚子尽胀，按之随手而起，则病已成，还可以治疗。这都是从虚损大病，或下痢后，妇人产后，饮水不能立即消散，三焦受病，小便不利，于是相互结聚，渐渐生聚，遂流注各经络的缘故。（《肘后备急方》）
轻重的征候，在于大小便。如果小便不通，则气壅，攻击腹内，冲出膜外，化为水，使人手足头面浮肿。如果大小便微涩则微肿，极涩则极肿，大小便俱不通，三日即遍身洪肿，至重则阴部也肿。阴肿有两种：有肿而小便自出的，有肿而小便出涩的。又有阴茎头连小腹脐皆肿的，这些都为死候，宜速治。如果患此疾，肿也不常定，或先手足面目浮肿，或先腰肋微肿，或先手足小肿。其征候或消或甚，三五日稍愈，或三五日再发，也以小便通涩为征候，积渐变成洪肿。妇人得此病，与此大致相同。凡患此疾，令人腹胀烦闷，胸间气急。这是由于肺胀严重，即喘如牛吼，坐卧行立不得，或半夜后气攻胸心，重者一年、二年方死，有一月、两月死的。如果调养失度，误食毒物，一日、五日即加重。（《圣济总录》引徒都子）
项颈脉搏动，睡起眼浮，下肢如蚕卧，足胫肿，大腿间冷，身重倦行，行走即喘急，面色有时白及光泽，鼻准黑，肠间沥沥如水鸣，鼻尖常冷，小便赤涩，虽频数，绝微细，大便燥结，卧即哽气，或喉中如水鸡声，腹胁满闷，咳嗽不止，凡此都是水证，不可尽记。（《鸡峰总论》）
阴阳。经文说：治水的方法，腰以上肿宜发汗，腰以下肿宜利小便。这是最恰当的理论，然而肿满最慎用下法，应当辨别阴阳。阴水为病，脉来沉迟，颜色多青白，不烦不渴，小便涩少而清，大便多泄，这是阴水，则适宜用温暖之剂，如实脾散、复元丹等。阳水为病，脉来沉数，颜色多黄赤，或烦或渴，小便赤涩，大便多闭，这是阳水，则适宜用清平之药，如疏凿饮子、鸭头丸等。（《济生方》）（鸭头丸用甜葶苈、猪苓、汉防己，绿头鸭血为丸。）
阳水多外感，因涉水冒雨，或兼风寒暑气而见阳证；阴水多内伤，因饮水及茶酒过多，或饥饱劳役房欲而见阴证。阳水先肿上体，肩背手膊，手三阳经；阴水先肿下体，腰腹胫跗，足三阴经。（《入门》）
大都阳证多热，热证多实；阴证多寒，寒证多虚。先滞于内而后及于外的，多实；先肿于表而渐及于内，或外虽胀而内不胀的，多虚。小便红赤，大便秘结的，多实；小便清白，大便稀溏的，多虚。脉滑有力的，多实；弦浮微细的，多虚。形色红黄，气息粗长的，多实；形容憔悴，声音短促的，多虚。年青少壮，气道壅滞的，多实；中年积劳，神疲气怯的，多虚。虚实的治疗，反如冰炭，若误用之，必致害矣。（《景岳全书》）（按：此条原出其《胀满》中，《必读》举之《水肿》门，今从之。）
风水。风水病，是由于脾肾气虚弱所为。肾劳则虚，虚则汗出，汗出逢风，风气内入，还客于肾，脾虚又不能制于水，故水散溢皮肤，又与风湿相搏，故称风水。让人身浮肿，如裹水之状，颈脉动，时咳，按肿上，凹而不起，骨节疼痛而恶风。脉浮大的，名叫风水。（《诸病源候论》）
有个十五岁的男孩，病身体肿，脉浮数，大便自利，米谷不化，这是成风水病，以越婢加术汤主治。五苓散也可兼服，然而只治风水，不及此方。（《鸡峰总论》）
凡是外感毒风，邪留肤腠，也能忽然浮肿，如东垣所谓八益之邪，自外而入的是。然而其来必速，其证则必有脉紧及头疼骨痛等证，才是外感之候，先宜解散其邪。（《景岳全书》）
皮水。肺主皮毛，肾主水，肾虚则水妄行，流溢于皮肤，故令身体面目悉肿，按之没指而无汗。腹如故而不满，亦不渴，四肢重而不恶风。脉浮的，名叫皮水。（《诸病源候论》）
夫水病，皆由肾虚所为，肾虚则水流散经络，始溢皮毛。今此毛水者，乃肺家停积之水，流溢于外。肺主皮毛，故余经未伤，皮毛先伤，因名毛水也。（同上）
大腹水肿。夫水肿病，皆由荣卫痞涩，肾脾虚弱所为。而大腹水肿者，或因大病之后，或积虚劳损，或新热食竟，入于水。自渍及浴，令水气不散，流溢肠外，三焦闭塞，小便不通，水气结聚于内，乃腹大面肿。故四肢小，阴下湿，手足逆冷，腰痛上气，咳嗽烦疼，故云大腹水肿。（《诸病源候论》）（按此即正水证，仍列于斯。）
石水。肾主水，肾虚则水气妄行，不根据经络，停聚结在脐间，小腹肿大如石，故云石水。其候引胁下胀痛而不喘。脉沉的名为石水，尺脉微大也为石水。肿起脐下至小腹，垂垂然上至胃脘，则死不治。（《诸病源候论》）
若腹胀如鼓，按之坚硬，腹中时痛，始起于目下微肿，时喘，小便不利，四肢瘦削，其脉自沉，大便利则逆，谓之石水。绕脐坚硬，腹不痛者，谓之鼓气。（《鸡峰总论》）
代州钱防御，命孙兆诊之，脉得沉紧数，六至以上，外证目下肿，鼻准亦肿，唇色紫，自心以下，腹大肿胀，外阴器肿胀如升，按之如石坚，举动即喘，咳逆痰涎，口苦干渴。云得病已及两月，医者皆云下虚风气，近曾脐下着灸，三里亦灸之。兆告曰：病名石水，主治不对，故不愈。仲景曰：腰下及腹肿者，皆利其小便。又曰：腹满口舌干燥，此腹中有水也，方以防己葶苈椒目大黄丸主之。遂与服三丸，日三，少觉胸腹快。遂与《圣惠方》治十水葶苈散，初服三钱，以葱浆水酒下，食顷，以葱浆稀粥投之。隔日一服，每服葶苈散之日，至日中暮，更服防己椒目葶苈大黄丸三服，次日但进丸子三服。凡十日，觉大便快利，肿胀喘咳已减三之一，二十日，病去三之二，自此消息加减，三十日而全愈。（《鸡峰总论》）
肿有四证（妇人）。水之为肿特一耳，曰风，曰气，曰血，合而有四焉。风肿者，皮粗，麻木不仁，走注疼痛。气肿者，皮浓，四肢瘦削，腹胁胀膨。其或烦躁漱水，迷忘惊狂，呕逆烦闷，皮间有红缕赤痕者，此血肿也。妇人经脉壅闭，败血停腐，尤多见之。然妇人怀胎，亦有气遏水道而虚肿者，此但顺气安脾，饮食无阻，既产而肿自消。若产后发肿，则虚退而告殂矣。（《直指方》）
不伏水土。不伏水土者，言人越在他境，乍离封邑，气候既殊，水土亦别，因而生病，故云不伏水土。病之状，身体虚肿，或下利而不能食，烦满气上是也。（《诸病源候论》）
肿喘相因。喘与胀，二证相因，必皆小便不利，喘则必生胀，胀则必生喘，但要识中标本先后。先喘而后胀者，主于肺；先胀而后喘者，主于脾。何则？肺金司降，外主皮毛。经曰：肺朝百脉，通调水道，下输膀胱。又曰：膀胱者，州都之官，津液藏焉，气化则能出矣。是小便之行，由于肺气之降下而输化也。若肺受邪而上喘，则失降下之令，故小便渐短，以致水溢皮肤而生肿满焉。此则喘为本而肿为标，治当清金降气为主，而行水次之。脾土恶湿，外主肌肉，土能克水。若脾土受伤，不能制水，则水湿妄行，浸渍肌肉，水既上溢，则邪反侵肺，气不得降而生喘，此则肿为本而喘为标，治当实脾行水为主，而清金次之。苟肺证而用燥脾之药，则金得燥而喘愈加；脾病而用清金之药，则脾得寒而胀愈甚矣。近世治喘胀者，但知实脾行水，而不知分别肺脾二证，予故为发明之。（《杂着》）（按：《统旨》本于此说，更曰：先肿而后喘者，是肾水上溢侵肺，以致气壅窒碍，不得降下而生喘。）
Treatment of Water Qi Disease: Ancient formulas generally used purgatives and did not involve tonification. Since the Southern Song Dynasty, formulas supporting the Spleen were created, and up to the Ming and Qing dynasties, all physicians advocated regulation and tonification. However, times change between ancient and modern eras, and people's constitutional endowments vary in strength and weakness; it is not that ancients neglected tonification, but that later generations disliked purgation. Although deficiency-type edema is common today, excess-type edema also occurs occasionally. Physicians should treat according to the syndrome without rigidly adhering to a single pattern, which would be acceptable.
The disease originates in the Spleen and Kidney. The Kidney governs Water, while the Spleen and Stomach both govern Earth; Earth controls Water. The Spleen and Stomach are interior-exterior paired, with the Stomach being the Sea of Grain and Water. Currently, if the Stomach is deficient and cannot transmit and transform Water Qi, Water Qi infiltrates and leaks into the meridians, soaking the zang-fu organs. When the Spleen is affected by Dampness, it becomes diseased; when the Spleen is diseased, it cannot control Water, so Water Qi returns exclusively to the Kidney. With the San Jiao failing to drain and meridians blocked, Water Qi overflows onto the skin causing edema. (*Zhubing Yuanhou Lun*)
Water disease arises from the deficiency of both the Kidney and Spleen. Kidney deficiency fails to circulate Water Qi, and Spleen deficiency fails to control Water, causing Water Qi to overflow, seep into the skin, and spread through the limbs, resulting in generalized edema. This causes upper body qi stagnation and heaviness, yellow and difficult urination, and pitting edema that rebounds immediately upon pressure. (Same source)
Edema is caused by a lack of True Yang, labor damaging the Spleen and Stomach, leading to Cold accumulation transforming into Water. The Spleen is Earth, the Kidney is Water; the Kidney receives Water, and the Spleen stores Water. If Kidney Water does not flow and Spleen Earth is blocked, one experiences upper body wheezing and coughing, lower body leg/knee swelling, facial edema, abdominal distension, difficult urination, and sometimes external genital swelling. Severe cases involve muscle collapse and fluid leaking from calves, often leading to death. (*Jisheng Fang*)
The Kidney is the gate of the Stomach. Closure occurs not only due to Kidney Qi failing to transform, but also if the Stomach is diseased, the gate closes itself. Water is not generated by Kidney Water; ingested water accumulates on its own. The Stomach governs the Middle Jiao and is the Sea of Grain and Water. When Stomach Qi is harmonious, ascending/descending and entering/exiting Qi move, allowing grain and water to follow their paths for transport and excretion. If Stomach Qi is disharmonious, these gates are obstructed, causing fluids to accumulate and transform into Water. (*Yixue Zhunsheng*)
In deficient individuals, abdominal distension is due to Spleen deficiency failing to move Qi. Deficient edema is due to Earth deficiency failing to control Water. Although Water is controlled by the Spleen, it is ultimately governed by the Kidney. The Kidney is the Water Zang, housing the Primordial Yang. If Mingmen Fire declines, it cannot control Yin-Cold nor warm the Spleen Earth, causing Yin not to follow Yang, and essence transforming into Water. Thus, edema syndromes mostly belong to Fire decline. (Note: *Yixue Guanjian* states edema is due to Water abundance where Fire cannot transform it. Fire decline fails to transform Water, so water entering the Spleen/Stomach seeps into blood vessels and bones, turning blood to water and flesh to swelling. This is Li Shi's basis. Also, Zhang Jingyue stated edema is mostly Yang deficiency, recorded in *Zhangman*, see reference.)
Causes are varied (Distinction of Excess/Deficiency): Sudden fullness and swelling with large face/body. Such fullness may be due to deficient Qi, Wind-Cold Qi, or Fluid retention. (*Zhouhou Beiji Fang*)
Among hundred diseases, none are harder to treat than Water disease. Water is controlled by the Kidney, and the Kidney is the root of man. Strong Kidney Qi returns Water to the sea; weak Kidney Qi scatters Water to the skin. With San Jiao congestion, Ying-Wei blockage, and Blood-Qi disharmony, excess and deficiency alternate, Water flows with Qi, becoming Water disease. Swelling may occur in head/eyes, waist/legs, limbs, or both eyes. It may arise from cough, labor, stagnation, deficiency, five Zang, or six Fu organs. Causes are many, symptoms diverse, making treatment difficult as people fail to understand them. Even if understood, patient arrogance and violation of taboos hinder cure. (*Zhongzang Jing*)
"Qi outside the Membrane" is called Water disease, arising from other illnesses, variable. Causes include malaria, chronic labor, Kidney Wind strike, Lung/Spleen Cold injury, Upper Jiao Qi, heat from long travel, or alcohol/meat toxicity. It starts in the Lung and ends in the Kidney. Cough, excessive phlegm, or accumulated Cold Qi blocking can cause Lung Heat to attack the Heart, Five Zang Cold Qi to transform downward into Water, flowing to the Bladder and outside the Large Intestine membrane. Pulse diagnosis cannot detect it, acupuncture cannot reach it. The Kidney is life's root; if weak, the Five Zangs decline, causing Stomach closure and Spleen failure to grind, Qi knotting and difficult urination. (*Shengji Zonglu* citing Tu Du Zi) (Note: Tu Du Zi's main point is Lung Cold transmitting to Kidney, weakening Spleen Earth, failing to control Water. Meaning is imprecise, listed here for reference.)
This disease often follows chronic asthma, Xiao Ke (Wasting-Thirst), Jaundice, Zhi Yin (Fluid retention), post-recovery from severe deficiency illness, postpartum, Hong Kong Foot (Beriberi) swelling, chronic Pi Jia (masses), chronic diarrhea, or undigested drinking water causing San Jiao leakage and difficult urination. (*Jifeng Zonglun*) (Note: Phrases on deficiency illness originate from *Zhouhou Beiji Fang*, see reference.)
Excess syndromes: External Six Evils or internal dietary injury. Yang pathogens are rapid and violent, forming in days. Deficiency syndromes: Emotional labor or alcohol/sex excess, accumulating over months. Treating excess is easy; treating deficiency is hard. (*Bidu*)
Swelling refers to muscle edema; Distension refers to abdominal fullness. Swelling belongs to the Spleen, Distension to the Liver. Swelling is mild, Distension is severe. Isolated distension implies Liver Evil attacking Earth, generating worms, hard to treat. Combined swelling and distension imply Yang Qi still moves, 50% curable, depending on classification. Treatment focuses on the Middle Jiao. Causes include Phlegm/Food stagnation blocking Clear/Q turbid movement; Phlegm/Blood stasis blocking Ying-Wei; Damp-Heat blocking tunnels; Dry-Heat causing constipation. These four are Excess syndromes. Others include excessive cold medicine or diet injuring Middle Qi, causing deficiency and stagnation; Post-dysentery (or major illness) deficiency with lingering heat causing generalized hard edema; Qi transforming to Water with Spleen failure to control. These three are Deficiency syndromes. Excess requires clearing/reducing/descending; Deficiency requires tonifying/nourishing. Do not mix treatments. Early stage is easy (Righteous Qi strong, Pathogen weak); Late stage is hard (Pathogen strong, Righteous Qi weak). (*Cangsheng Siming*)
Pulse Methods: Water disease with洪大 (Surging-Large) pulse is treatable; 微细 (Fine-Thread) pulse is untreatable. Water disease with distension/obstruction: 浮大软 (Floating-Large-Soft) pulse indicates life; 沉细虚小 (Deep-Fine-Empty-Small) indicates death. Abdominal drum-like swelling: 实 (Solid) pulse indicates life; 虚 (Empty) pulse indicates death. (*Maijing*) Focus on the Chi pulse. If swelling is severe but Chi pulse is thread-like, or Surging-Floating without root, do not purge; this is a death pulse. (*Zhu Shi*)
General Syndrome Description: Early water disease shows eyelid swelling (color like old silkworm), neck vessel pulsation, cold inner thighs, full calves, pitting edema, and rhythmic sounds in abdomen upon turning. If untreated, body swells slightly, abdomen distends, rebounding upon pressure; still treatable. Causes include post-major illness, post-dysentery, postpartum, undigested water, San Jiao disease, difficult urination, leading to accumulation and flow into meridians. (*Zhouhou Beiji Fang*)
Severity depends on urination/stool. No urination causes Qi congestion, bursting outward, transforming to water, swelling hands/feet/face. Mild stool/urine obstruction causes mild swelling; severe obstruction causes severe swelling; complete obstruction leads to generalized swelling in three days, possibly genital swelling. Genital swelling types: with spontaneous urination or difficult urination. Swelling of glans, lower abdomen, and umbilicus is a death sign, requiring urgent treatment. Swelling patterns vary: starting in hands/feet/face, waist/flanks, or extremities. Symptoms fluctuate every 3-5 days, worsening with urine obstruction. Women present similarly. Symptoms include abdominal fullness, chest distress, shortness of breath. Severe Lung swelling causes cow-like wheezing, inability to lie/sit/walk. Death may occur in 1-2 years or 1-2 months. Improper care or toxic food worsens condition rapidly. (*Shengji Zonglu* citing Tu Du Zi)
Neck vessel pulsation, morning eye puffiness, lower body like silkworm lying, calf swelling, thigh coldness, heavy body, exertional dyspnea, pale/shiny face, black nasal tip, borborygmus, cold nose tip, red/difficult frequent urination (fine/thin), dry constipation, sighing when lying, frog-like throat sounds, abdominal/flank fullness, persistent cough—all are Water signs. (*Jifeng Zonglun*)
Yin-Yang: Scripture says: Treat above-waist swelling with sweating; below-waist swelling with promoting urination. Most cautious about purging; distinguish Yin/Yang. Yin-Water: Deep-slow pulse, blue-white complexion, no thirst, scant clear urine, loose stools. Use warming agents like Shipi San or Fuyuan Dan. Yang-Water: Deep-rapid pulse, yellow-red complexion, irritability/thirst, red/difficult urine, constipation. Use cooling agents like Shuqiao Yinzi or Yato Wan. (*Jisheng Fang*) (Yato Wan uses Tingli, Fuling, Fangji, duck blood pills.)
Yang-Water: External causes (wading rain, Wind-Cold-Heat). Starts upper body (Shoulder/Back/Arms, Hand Taiyang). Yin-Water: Internal causes (excess water/tea/alcohol, hunger/fullness/labor/sex). Starts lower body (Waist/Abdomen/Shins/Feet, Foot Taiyin). Generally, Yang=Heat=Excess; Yin=Cold=Deficiency. Internal onset then external = Excess; External onset then internal, or external distension without internal = Deficiency. Red urine/constipation = Excess; Clear urine/loose stool = Deficiency. Slippery-strong pulse = Excess; Wiry-floating-fine pulse = Deficiency. Ruddy complexion/breath = Excess; Emaciated voice = Deficiency. Youth/stagnation = Excess; Middle-age/labor/fatigue = Deficiency. Treatments for Excess/Deficiency are opposite; error causes harm. (*Jingyue Quanshu*) (Note: Originally from *Zhangman*, cited in *Bidu*).
Feng Shui (Wind Water): Caused by Spleen/Kidney Qi deficiency. Kidney labor causes deficiency, sweating, wind invasion, returning to Kidney. Spleen deficiency fails to control Water, scattering to skin, combining with Wind-Damp. Symptoms: Generalized edema like wrapped in water, neck vessel pulsation, cough, non-rebounding pitting edema, bone/joint pain, aversion to wind. Floating-large pulse names Feng Shui. (*Zhubing Yuanhou Lun*)
Case: 15-year-old boy, body swelling, floating-rapid pulse, spontaneous loose stool, undigested food. Diagnosed Feng Shui, treated with Yebijia Zhu Tang. Wuling San could be adjunct, but less effective. (*Jifeng Zonglun*)
External toxic wind lodging in skin/collaterals causes sudden swelling. Onset is fast, with tight pulse, headache, bone pain. Dispel pathogen first. (*Jingyue Quanshu*)
Pi Shui (Skin Water): Lung governs skin/hair, Kidney governs Water. Kidney deficiency causes Water to wander to skin, causing generalized swelling, pitting, no sweat. Abdomen normal, no thirst, limb heaviness, no aversion to wind. Floating pulse names Pi Shui. (*Zhubing Yuanhou Lun*)
Water disease stems from Kidney deficiency, water spreading to meridians/skin. "Mao Shui" (Hair Water) is stagnant Water in Lung overflowing externally. Lung governs skin/hair, so skin injured first. (*Same*)
Da Fu Shui Zhong (Great Abdominal Edema): Caused by Ying-Wei blockage, Spleen/Kidney deficiency. Post-major illness, chronic labor, hot food followed by bathing/water immersion. Water Qi spreads outside intestines, San Jiao blocks, no urination, Water accumulates internally causing large abdomen/face. Small limbs, wet genitals, cold extremities, back pain, upper Qi, cough/pain. (*Zhubing Yuanhou Lun*) (Note: This is Zheng Shui syndrome.)
Shi Shui (Stone Water): Kidney governs Water. Deficiency causes Water to wander, stopping at umbilicus, lower abdomen hard/swollen like stone. Symptoms: Hypochondriac pain/tightness, no wheezing. Deep pulse names Shi Shui; Chi pulse slightly large also Shi Shui. Swelling from umbilicus to stomach region is untreatable death. (*Zhubing Yuanhou Lun*)
Abdominal drum-like hardness, pain, initial eye swelling, occasional wheezing, difficult urination, emaciated limbs, deep pulse, diarrhea reversal = Shi Shui. Umbilical hardness without pain = Gu Qi (Drum Qi). (*Jifeng Zonglun*)
Case: Qian Fangyu of Daizhou, pulse deep-tight-rapid (>6 beats), eye/nose swelling, purple lips, abdominal/genital swelling hard as stone, exertional wheezing, cough/phlegm, dry mouth/thirst. Ill for 2 months. Previous doctors treated as Lower Deficiency Wind, moxa applied. Sun Zhao diagnosed Shi Shui, incorrect treatment previously. Cited Zhang Zhongjing: Lower body/abdominal swelling requires promoting urination. Fullness/dry mouth indicates Water in abdomen. Prescribed Fangji Tingli Jiaomu Dahuang Wan. Improved after 3 doses. Then Tingli San with green onion juice. Every other day Tingli San, daily pills. After 10 days, bowel movement improved, swelling/cough reduced 1/3. After 20 days, 2/3 recovered. Fully cured in 30 days. (*Jifeng Zonglun*)
Four Types of Swelling (Women): Water is one type; plus Wind, Qi, Blood. Wind Swelling: Rough skin, numbness, migrating pain. Qi Swelling: Thick skin, emaciated limbs, distended abdomen/flanks. Blood Swelling: Irritability, craving water, confusion/manic vomiting, red streaks on skin. Common in women with meridian blockage/stagnant blood. Pregnant women may have Qi-blocked Water causing deficiency swelling; resolve Qi, calm Spleen, swelling resolves postpartum. Postpartum swelling indicates deficiency death. (*Zhizhi Fang*)
Not Acclimatized (Bu Fu Shui Tu): Traveling to new regions, different climate/soil causes illness. Symptoms: Body deficiency swelling, diarrhea, anorexia, irritability, upper Qi. (*Zhubing Yuanhou Lun*)
Swelling and Wheezing Interrelated: Both involve difficult urination. Wheezing causes swelling; swelling causes wheezing. Identify root/branch. Wheezing first then swelling = Lung root. Swelling first then wheezing = Spleen root. Lung Metal descends, governs skin. Lung disease causes wheezing, loss of descending function, short urine, water overflowing to skin. Wheezing is root, swelling is branch; treat by clearing Lung/descending Qi, then moving water. Spleen Earth fears Damp, governs muscle, controls Water. Spleen injury fails to control Water, Damp soaks muscle, Water invades Lung, causing wheezing. Swelling is root, wheezing is branch; treat by strengthening Spleen/moving water, then clearing Lung. Using drying Spleen meds for Lung disease worsens wheezing; using clearing Lung meds for Spleen disease worsens distension. Modern doctors only strengthen Spleen/move water, ignoring Lung/Spleen distinction. I clarify this. (*Zazhe*) (Note: *Tongzhi* adds: Swelling then wheezing is Kidney Water overflowing to Lung.)
Death Signs: Patient with exhausted Ying-Wei, facial edema = Death. Sudden swelling, dark/black face = Death. Palm swelling without lines = Death. Umbilicus swelling protruding = [Text cuts off]