《素问》汤液醪醴论帝曰∶其有不从亳毛而生，五脏阳以竭也。津液充郭，其
魄独居，孤精于内，气耗于外，形不可与衣相保，此四极急而动中，是气拒于内而
形施于外，治之奈何？岐伯曰∶平治于权衡，去宛陈 ，微动四极，温衣，缪刺其
处，以复其形；开鬼门，洁净府，精以时服，五阳以布，疏涤五脏。故精自生，形
自盛，骨肉相保，巨气乃平。释云∶不从毫毛生者，明其邪不自腠理入，是水从内
而溢出于外者也。五脏阳以竭者，为由脾胃虚弱。夫脾胃者土也，法天地，生万物，
故水谷入胃，清阳化气，浊阴成味，五脏禀其气曰阳，禀其味曰精，即经之谓五阳
者，胃脘之阳是也。气和精生。今不得禀水谷气，则无气以生，不得禀五味，则无
精以化。肺主气而魄脏焉，无气则魄独居，肾为阳，故动之，经脉行则脾胃之水谷得
以化，四脏亦得以禀之，然后可以施治。其水在表在上者汗之，在下、在里者分
利之。夫如是，此条所治，正与评热论阴虚者对待而言也。彼为肾之阴虚，不能敌
夫所凑之阳，此为胃之阳虚，不能制夫溢水之阴也。仲景法，诸有水者，腰以下肿，
当利小便，腰以上肿，当发汗乃愈。防己黄 汤、防己茯苓汤、蒲灰散。（以上利小便。）
越婢汤、越婢加术汤、甘草麻黄汤、麻黄附子汤、杏子汤。（以上发汗。）观此可见仲景之
法，一出于《内经》。后世治水肿方，有五皮散、香苏散，中用姜、橘、紫苏、大腹
皮辛以散之，茯苓、防己、木通、桑皮淡以渗之，是开鬼门洁净府同用也。丹溪云∶
因脾虚不能制水，水渍妄行，当以参、术补脾，气得实则自能健运，自能升降，运
动其枢机，则水自行，非五苓之行水也。又云∶《内经》曰，诸气 郁，皆属于肺。
诸湿肿满，皆属于脾。诸腹胀大，皆属于热。是三者相因而为病。盖湿者土之气，
土者火之子，故湿每生于热，热气亦能自湿者，母气感子湿之变也。湿气盛，肺气不
行而 郁矣。故水肿病者，脾失运化之职，清浊混淆，因郁而为水。脾土既病，肺
为之子，而肺亦虚，荣卫不布，气停水积，凝聚浊液，渗透经络，涵流溪谷，窒碍
津液，久久灌入隧道，血亦化水矣。凡治肿，皆宜以治湿为主，所挟不同，故治
法亦异。更宜清心经之火，补养脾土，火退则肺气下降而水道通，脾土旺则运化行，
清浊分，其清者复回而为气、为血、为津液。其败浊之甚者，在上为汗，在下为溺，
以渐而分消矣。卢砥镜治水肿类例，以肺金盛而生水，水溢妄行，气息闭、枢机壅
而为肿，必欲导肾以决去之，岂理也哉。夫肺者肾之母，其气清肃，若果由肺盛生
水，则将奉行降令，通调水道，下输膀胱，水精四布，五经并行，而何病肿之有。
或问丹溪所论水病之源，在于脾土。卢氏论水，宗于水热篇，阴盛水溢，其源在肾。
所起不同，故治必异。今如丹溪之论，则《内经》非欤？曰不然，试用水热篇三章
之义绎之，则晰然矣。首章问少阴何以主肾，肾何以主水，曰肾者至阴也，至阴者
盛水也。肺者太阴也，少阴者冬脉也。故其本在肾，其末在肺，皆积水也。此以少
阴经脉在上，主肾行冬令，至阴盛水气化之常者而言也。非是为病之因也。当时
若遇邪伤，则二脏之气停而皆积水矣。今卢氏不求其为因所感之邪，而致气停水积，
乃辄以至阴盛水，谓是脏气有余而生病者，误矣。不然，何乃次章复问，肾何以能
聚水而生病，曰肾者胃之关也，关门不利，故聚水而从其类也。上下溢于皮肤，故
为肿， 肿者，聚水而生病也。此承上章积水之病，故注文以肾主下焦，膀胱为
腑，主其分注，开窍二阴，故肾气化则二阴通，二阴闭则胃填满，故云肾者胃之关
也。关闭则水积。然而气停水溢之义，尚有可言者焉，当是下焦之气也。何则？《灵
枢》本输篇曰∶少阳者属肾，上连肺，故将两脏；三焦者，决渎之腑也，水道
出焉，属膀胱，是孤腑也。宣明五气篇，下焦溢为水。注文以分注之所，气窒不泻，
则溢而为水也。又曰∶三焦病者，腹气满，小腹尤坚，不得小便，窘急，溢则水留，
即为胀。以此观之，其下焦少阳之经气，当相火之化，六气中惟相火有其经，无其
腑脏，游行于五者之间，故曰少阳为游部，其经脉之在上者，布膻中，散络心包，
在下者，出于委阳，上络膀胱。岂非上佐天道之施化，下佐地道之生发，与手厥阴为表
里，以行诸经之使者乎。是故肾经受邪，则下焦之火气郁矣。火气郁则水精不得四布，
而水聚矣。火郁之久必发，发则与冲脉之属火者，同逆而上。盖冲脉者，十二经之
海，其上者，出于项颡，渗诸阳，灌诸精；其下者，并少阳下足，渗三阴，灌诸络。
由是水从火溢，上积于肺，而为喘呼不得卧；散聚于阴络，而为 肿；随五脏之虚
者，入而聚之，为五脏之胀。夫如是之病，皆相火泛滥其水而生病者也。非相火则
水不溢，而止为积水之病。如《内经》所谓阴阳结斜，多阴少阳曰石水，少腹肿；
三阴结寒为水；肾肝并沉为石水之类是也。又尝推其肾气不化之由，多是四气相乘
害之。盖胃是肾之胜脏，或湿热盛而伤之，或胃气不足下陷而害之，或心火太过下
乘而侮之，或燥金敛涩之，或风木摇撼之，与夫劳役色欲，七情外感，皆足以致肾
气之不足也。夫胃之关，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。即《灵枢》经脉篇曰∶胃所生病，大腹水肿，膝膑肿痛。津液篇曰∶
五谷之津液，因阴阳不和，则气道不通，四海闭塞，三焦不泻，津液不化，水谷并
于肠胃之中，留于下焦，不得渗膀胱，则下焦胀，水溢则为水胀。王叔和《脉经》
曰∶脾常怀抱其子，子、肺金也。子畏火伤，下避水中，木畏金乘，下为荆棘，脾
复畏木居一隅，水遂上溢而为胀也。即此诸论观之，所谓关门不利云云者，盖以二
脏相因而然耳。第三章问诸水皆生于肾乎，曰肾者、牝脏也，地气上者，属于肾，
而生水液也。故曰至阴勇而劳甚则肾汗出，肾汗出，逢于风，内不得入于脏腑，外
不得越于皮肤，客于玄府，行于皮里，传为 肿，本之于肾，名曰风水。观是章所
谓地气上者，指人形体皆禀地之阴以生者而言也。肾居五脏之下，是至阴，主水，
以生津液，是故津液在百体，犹水在地中行，五气所化之五液，悉属于肾。今因劳
火迫于肾气之液，发出为汗，因逢风而玄府闭，其汗与风相搏，遂结于皮肤，于是五气
所化新旧之液，则皆类聚而成水矣。用是比例推之，则肾气之劳，不止房事一端而
已，如夜行劳甚，渡水跌仆，持重远行，极怒惊恐之类，岂无越出肾液于表，亦得
以逢于风者乎。此圣人之言简而意博，举一而可十者也。又按评热篇曰∶有病肾风者，
面 然壅，害于言，虚不当刺。不当刺而刺，后五日其气必至。至必少气时热，
时热从胸背上至头，汗出手热，口干苦渴，小便黄，目下肿，腹中鸣，身重难以行，
月事不来，烦而不能食，不能正偃，正偃则咳，病名曰风水。此肾虚不可妄治，治
之则阴愈虚而阳必凑之，转及五脏，有是热病状也。用此比类前后所叙，诸水溢之
病，未有不因肾虚得之。设罔顾虚，辄攻其水，是重虚其阴也。虚则诸邪可入，而
转生病矣。《内经》又谓肝肾脉并浮为风水，此尤见是阴虚之甚者也。何则？夫肾肝
二脏，同居下焦。肾为阴主静，其脉沉。肝为阳主动，其脉浮。而阴道易乏，阳道
易饶，为二脏俱有相火故也。若相火所动，不得其正，动于肾者，犹龙火之于海，
故水附而龙起。动于肝者，犹雷火之出于地，疾风暴发，故水如波涌。今水从风，
是以肝肾并浮也。王注以为风薄于下，似若水风之邪，世人莫知肝木内发之风也。
《灵枢》水胀篇，有水胀、肤胀、鼓胀、肠覃、石瘕、石水之病。治肤胀、鼓胀者，
先泻其胀之血络，后调其经，刺去其血络也。观此肤胀，与胀论篇谓荣气循脉，卫
气逆为脉胀，卫气并脉循分肉为肤胀，三里而泻，近者一下，远者三下，无问虚实，
工在疾泻。此篇之鼓胀，亦与腹中论中之鼓胀同其病状，彼则治之以鸡矢醴，一剂
知，二剂已。若饮食不节，其病虽已，当病气复聚于腹也。何与此篇治是二证，皆先
泻其胀之血络，刺去其血，而复调其经，如是之不同何哉？盖彼以气聚之病，此以气
停与血相搏，故血凝于络，气凝于经，而生水液为胀，故治不同也。仲景云∶风水，其
脉自浮，外证骨节疼痛，恶风。（《针经》论疾诊尺篇云∶视人之目窠上微肿，如新卧起
状，其颈脉动，时咳，按其手足上， 而不起者，风水肤胀也。又仲景云∶太阳病脉浮而
紧，法当骨节疼痛，反不痛，身体反重而酸，其人不渴，汗出即愈，为风水。）风水，脉浮，身
重，汗出恶风者，防己黄 汤主之。风水恶风，一身悉肿，脉浮不渴，续自汗出，无大热，
越婢汤主之。恶风者，加附子一枚炮。（续法∶风水，身体浮肿，发歇不定，肢节疼痛，上气喘
急，大腹皮散主之。风水毒瓦斯，遍身肿满，楮白皮散主之。）皮水，其脉亦浮，外证 肿，按
之没指，不恶风，其腹如鼓，不渴，当发其汗。（又云∶渴而不恶寒者，此是皮水。盖法当风水
恶寒不渴，皮水不恶寒而渴。假令皮水不渴，亦当发汗也。）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。厥而皮水者，蒲灰散主之。（续法∶皮水，身体面
目悉浮肿，木香丸主之。）正水，其脉沉迟，外证自喘。石水，其脉自沉，外证腹满不喘。（大
奇论，肾肝并沉为石水，并浮为风水。续法石水四肢细瘦，腹独肿大，海蛤丸主之。石水，病腹
光紧急如鼓，大小便涩，槟榔散主之。）黄汗，其脉沉迟，身发热，胸满，四肢头面肿，久不愈，
必致痈脓。（又云∶身肿而冷，状如周痹，胸中窒，不能食，反聚痛，暮躁不得眠，此为黄汗。
治法见黄胆门。）里水者，一身面目黄肿，其脉沉，小便不利，故令病水。假如小便自利，此亡
津液，故令渴。越婢加术汤主之。甘草麻黄汤亦主之。水之为病，其脉沉小，属少阴，浮者为风，
无水虚胀者为气。水发其汗即已，脉沉者宜麻黄附子汤，浮者宜杏子汤。心水者，其身重而
少气，不得卧，烦而躁，其人阴肿。肝水者，其腹大不能自转侧，胁下腹中痛，
时时津液微生，小便续通。肺水者，身肿，小便难，时时鸭溏。脾水者，其腹大，
四肢苦重，津液不生，但苦少气，小便难。肾水者，其腹大脐肿，腰痛不得溺，阴下
湿如牛鼻上汗，其足逆冷，面黄瘦，大便反坚。诸病水者，渴而不利，小便数者，
皆不可发汗。问曰∶病者苦水，面目四肢身体皆肿，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，始时当微；年盛不觉，阳衰之后，
荣卫相干，阳损阴盛，结寒微动，肾气上冲，喉咽塞噎，胁下急痛。医以为留
饮而大下之，气击不去，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，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。上仲景治水诸方，皆用脉病为本，然后量轻重
虚实而施治，皆守圣经之法耳。奈何今世俗之医，因病者急求一时之效，以破气去
水为功，不知过一二日，则病复至而不可救矣。呜呼！予每痛夫世人病水肿多死不
救者有二，一以病患不善调摄，二以医误投下药之过，竭其阴阳，绝其胃气，故多
死。于是详摘《素》、《灵》、《金匮》之言而稍发明之，有志者当不厌其繁也。
肿病不一，或遍身肿，或四肢肿，面肿脚肿，皆谓之水气。然有阳水，有阴水，
并可先用五皮饮，或除湿汤加木瓜、腹皮各半钱，如未效，继以四磨饮兼吞桂黄丸，
仍用赤小豆粥佐之。遍身肿，烦渴，小便赤涩，大便多闭，此属阳水。轻宜四磨饮，
添磨生枳壳，兼进保和丸；重则 凿饮子利之，以通为度。亦有虽烦渴而大便已利
者，此不可更利，宜用五苓散加木通、大腹皮半钱，以通小便。遍身肿，不烦渴，
大便自调或溏泄，小便虽少而不赤涩，此属阴水。宜实脾饮。小便多少如常，有时
赤，有时不赤，至晚则微赤，却无涩滞者，亦属阴也，不可遽补，木香流气饮，继
进复元丹。若大便不溏，气息胀满，宜四磨饮下黑锡丹。四肢肿，谓之肢肿，宜五
《素问·汤液醪醴论》中，黄帝问道：有的病不是从毫毛（皮肤毛孔）生起的，而是五脏的阳气衰竭了。津液充满胸腹，只有魄（肺神，主收敛肃降）独存于内，精气孤立于内，气耗散于外，形体消瘦到衣服都显得宽大不合身，四肢拘急且动摇不安，这是气机阻滞于内而形体衰败于外，治疗该怎么办？岐伯回答说：要平调阴阳的权衡，去除体内积久陈腐的瘀滞，轻微活动四肢，注意保暖，用缪刺法（左病取右，右病取左的针刺法）在相应部位施治，以恢复形体；开启鬼门（汗孔）发汗，洁净府（膀胱）利小便，使精气按时恢复，五脏阳气得以布散，疏通涤荡五脏。所以精气自然产生，形体自然强盛，骨肉相保，大气的运行也就平和了。
注释说：不从毫毛生起，说明邪气不是从腠理侵入的，而是水湿从体内溢出到体表。五脏阳气衰竭，是因为脾胃虚弱。脾胃属土，效法天地，化生万物，所以水谷进入胃后，清阳化为气，浊阴化为味，五脏禀受其气称为阳，禀受其味称为精，也就是经文中所说的“五阳”，即胃脘之阳。气和精才能生成。现在不能禀受水谷之气，就没有气来生成；不能禀受五味，就没有精来化生。肺主气，为魄之脏，没有气则魄独居。肾属阳，所以要动其经脉，经脉通畅则脾胃的水谷得以消化，其他四脏也能禀受，然后才可以施治。水在表、在上部的用汗法，在下、在里的用分利法。像这样，这一条所论述的治疗，正是与《评热病论》中阴虚的情况相对立的。那是肾阴虚，不能抵御聚集的阳热；这是胃阳虚，不能制约溢出的水湿阴邪。张仲景的方法说，凡是水肿，腰部以下肿的，应当利小便；腰部以上肿的，应当发汗，这样才能痊愈。防己黄芪汤、防己茯苓汤、蒲灰散。（以上都是利小便的方剂。）越婢汤、越婢加术汤、甘草麻黄汤、麻黄附子汤、杏子汤。（以上都是发汗的方剂。）看这些可以看出，张仲景的法度，完全出自《内经》。后世治疗水肿的方剂，有五皮散、香苏散，其中使用姜、橘、紫苏、大腹皮等辛味药来发散，茯苓、防己、木通、桑白皮等淡味药来渗湿，这就是开鬼门和洁净府同时使用。朱丹溪说：因为脾虚不能制水，水湿浸渍妄行，应当用人参、白术补脾，气变得充实自然能健运，自然能升降，运转枢机，水湿自然流动，这不是五苓散那种强行行水的方法。又说：《内经》说，各种气机郁结，都归属于肺；各种湿邪肿胀满闷，都归属于脾；各种腹胀大，都归属于热。这三者相互影响而致病。大概湿是土的气，土是火的儿子，所以湿往往生于热，热气也能由湿转化而来，这是母气感应子气湿的变化所致。湿气旺盛，肺气不行而郁结。所以患水肿病的人，脾失去运化的职能，清浊混淆，因郁结而变成水。脾土既已生病，肺作为它的儿子也跟着虚弱，营卫不布散，气停水积，凝聚成浊液，渗透经络，流注溪谷，阻碍津液，久而久之灌入隧道，血也化成水了。凡治疗肿病，都适宜以治湿为主，所夹杂的病邪不同，所以治法也不同。更宜清心经之火，补养脾土，火退则肺气下降而水道通利，脾土旺则运化行，清浊分开，那些清的重新回转为气、为血、为津液。那些败浊严重的，在上部化为汗，在下部化为尿，逐渐分消。卢砥镜治疗水肿的分类，认为肺金盛而生水，水溢妄行，气息闭塞、枢机壅塞而导致肿，一定要导引肾脏来决去水邪，这符合道理吗？肺是肾的母亲，其气清肃，如果真是由肺盛生水，那么肺将奉行降令，通调水道，下输膀胱，水精四布，五经并行，怎么会有肿的病呢？
有人问：丹溪论述水病的源头在于脾土。卢氏论述水病，依据《素问·水热穴论》，阴盛水溢，源头在肾。起因不同，所以治疗必然不同。现在像丹溪的论述，难道《内经》错了吗？回答说：不是这样，试着用水热穴论三章的意义来推演，就清晰了。第一章问少阴为什么主肾，肾为什么主水，回答说：肾是至阴，至阴就是盛水。肺是太阴，少阴是冬脉。所以病的根本在肾，标末在肺，都是积水。这是说少阴经脉在上，主肾行冬令，至阴盛水气化正常的情况而言。并不是说这是致病的病因。当时如果遇到邪气伤害，那么两脏之气停滞而都会积水。现在卢氏不求导致气停水积的感邪原因，却直接用至阴盛水，说是脏气有余而生病，这是错误的。不然，为什么第二章又问，肾为什么能聚水而生病，回答说：肾是胃的关隘，关门不利，所以聚水而从其同类。上下溢于皮肤，所以为肿，肿就是聚水而生病。这是承接上章积水之病，所以注文说肾主下焦，膀胱为腑，主其分注，开窍于二阴，所以肾气化则二阴通，二阴闭则胃填满，所以说肾是胃的关隘。关闭则水积。然而气停水溢的意义，还有可以说的，应该是下焦之气。为什么呢？《灵枢·本输》篇说：少阳属于肾，上连肺，所以将两脏联系起来；三焦是决渎之腑，水道由此而出，属于膀胱，是孤腑。《灵枢·宣明五气》篇说：下焦溢为水。注文说在分注的地方，气窒不泻，则溢而为水。又说：三焦病，腹部胀满，小腹尤其坚硬，不能小便，窘迫急迫，溢则水留，即为胀。以此看来，其下焦少阳的经气，应当是相火的化育，六气中只有相火有其经，无其脏腑，游行于五行之间，所以说少阳是游部，其经脉在上部的，布散膻中，散布络于心包，在下部的，出于委阳，上络膀胱。这难道不是上佐天道之施化，下佐地道之生发，与手厥阴为表里，作为运行诸经的使者吗？因此肾经受邪，则下焦的火气郁结了。火气郁结则水精不得四布，而水聚积。火郁久了必会发作，发作时与冲脉中属火的部分一起逆而上行。大概冲脉是十二经之海，其上行的，出于项颡，渗入诸阳，灌注诸精；其下行的，并少阳下行足部，渗入三阴，灌注诸络。因此水随火溢，上积于肺，而为喘呼不能卧；散聚于阴络，而为浮肿；随着五脏虚弱的地方，进入而聚积，成为五脏之胀。像这样的病，都是相火泛滥其水而生病。不是相火，水就不会溢，而只是积水之病。如《内经》所谓阴阳结斜，多阴少阳叫做石水，小腹胀肿；三阴结寒为水；肾肝脉并沉为石水之类是也。我又推究肾气不化的原因，多是四气相乘害之。胃是肾的胜脏（被克之脏），或者湿热盛而伤它，或者胃气不足下陷而害它，或者心火太过下乘而侮它，或者燥金敛涩之，或者风木摇撼之，以及劳役色欲、七情外感，都足以导致肾气不足。胃的关隘，不仅因为肾气不化而后关闭，如果是胃病，关隘也会自动关闭。那水不待肾水而生，所饮之水也自行聚积了。大概胃主中焦，是水谷之海，胃气和则升降出納之气行，水谷各从其道而输泄。胃气不和，则出纳之关皆不利，所以水谷的津液都积聚而变水。即《灵枢·经脉》篇说：胃所生的病，有大腹水肿，膝膑肿痛。《灵枢·津液》篇说：五谷的津液，因阴阳不和，则气道不通，四海闭塞，三焦不泻，津液不化，水谷并于肠胃之中，留于下焦，不得渗膀胱，则下焦胀，水溢则为水胀。王叔和《脉经》说：脾常怀抱其子，子是肺金。子畏火伤，下避水中，木畏金乘，下为荆棘，脾复畏木居一隅，水遂上溢而为胀。从这些论述来看，所谓“关门不利”云云，大概是两脏相互影响而如此。第三章问各种水都生于肾吗，回答说：肾是牝脏，地气上升的，属于肾，而生水液。所以说至阴勇而劳甚则肾汗出，肾汗出，逢于风，内不得入于脏腑，外不得越于皮肤，客于玄府，行于皮里，传为浮肿，本之于肾，名叫风水。看这一章所说的“地气上者”，指人形体都禀受地的阴气而生而言。肾居五脏之下，是至阴，主水，以生津液，所以津液在百体，犹如水在地中行，五气所化的五液，都属于肾。现在因为劳火迫于肾气之液，发出为汗，因逢风而玄府闭，其汗与风相搏，遂结于皮肤，于是五气所化的新旧之液，则皆类聚而成水了。用这个比例推演，那么肾气的劳损，不止房事一端而已，如夜行劳甚，渡水跌仆，持重远行，极怒惊恐之类，岂没有越出肾液于表，也得以逢于风的吗？这是圣人的话简而意博，举一而可十。又按《评热病论》说：有病肾风的，面部浮肿，言语困难，虚证不当刺。不当刺而刺，后五日其气必至。至必少气时热，时热从胸背上至头，汗出手热，口干苦渴，小便黄，目下肿，腹中鸣，身重难以行，月事不来，烦而不能食，不能正偃，正偃则咳，病名叫风水。这是肾虚不可妄治，治之则阴愈虚而阳必凑之，转及五脏，有这些热病症状。用此比类前后所述，各种水溢的病，无不因肾虚得之。设不顾虚，辄攻其水，是重虚其阴。虚则诸邪可入，而转生病。《内经》又说肝肾脉并浮为风水，这更是见阴虚之甚。为什么呢？夫肾肝二脏，同居下焦。肾为阴主静，其脉沉。肝为阳主动，其脉浮。而阴道易乏，阳道易饶，因为二脏都有相火。若相火所动，不得其正，动于肾者，犹龙火之于海，故水附而龙起。动于肝者，犹雷火之出于地，疾风暴发，故水如波涌。今水从风，是以肝肾并浮。王冰注以为风薄于下，似若水风之邪，世人莫知肝木内发之风。《灵枢·水胀》篇，有水胀、肤胀、鼓胀、肠覃、石瘕、石水的病。治疗肤胀、鼓胀者，先泻其胀的血络，后调其经，刺去其血络。看这个肤胀，与《胀论》篇说荣气循脉，卫气逆为脉胀，卫气并脉循分肉为肤胀，三里而泻，近者一下，远者三下，不问虚实，工在疾泻。这篇的鼓胀，也与《腹中论》中的鼓胀同其病状，彼处治疗用鸡矢醴，一剂知，二剂已。如果饮食不节，病虽已，当病气复聚于腹。为何与此篇治疗这两个证，都先泻其胀的血络，刺去其血，而复调其经，如此不同呢？大概彼处以气聚之病，此处以气停与血相搏，故血凝于络，气凝于经，而生水液为胀，所以治不同。张仲景说：风水，其脉自浮，外证骨节疼痛，恶风。（《针经·论疾诊尺》篇说：看人的目窠上微肿，像刚起床的样子，其颈脉搏动，时常咳嗽，按其手足上，凹陷不起的，是风水肤胀。又张仲景说：太阳病脉浮而紧，法当骨节疼痛，反不痛，身体反重而酸，其人不觉渴，汗出即愈，为风水。）风水，脉浮，身重，汗出恶风者，防己黄芪汤主之。风水恶风，一身悉肿，脉浮不渴，续自汗出，无大热，越婢汤主之。恶风者，加附子一枚炮。（续法：风水，身体浮肿，发歇不定，肢节疼痛，上气喘急，大腹皮散主之。风水毒瓦斯，遍身肿满，楮白皮散主之。）皮水，其脉亦浮，外证浮肿，按之没指，不恶风，其腹如鼓，不渴，当发其汗。（又说：渴而不恶寒者，这是皮水。盖法当风水恶寒不渴，皮水不恶寒而渴。假如皮水不渴，也应当发汗。）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。厥而皮水者，蒲灰散主之。（续法：皮水，身体面目悉浮肿，木香丸主之。）正水，其脉沉迟，外证自喘。石水，其脉自沉，外证腹满不喘。（《大奇论》，肾肝并沉为石水，并浮为风水。续法石水四肢细瘦，腹独肿大，海蛤丸主之。石水，病腹光紧急如鼓，大小便涩，槟榔散主之。）黄汗，其脉沉迟，身发热，胸满，四肢头面肿，久不愈，必致痈脓。（又说：身肿而冷，状如周痹，胸中窒，不能食，反聚痛，暮躁不得眠，此为黄汗。治法见黄疸门。）里水者，一身面目黄肿，其脉沉，小便不利，故令病水。假如小便自利，此亡津液，故令渴。越婢加术汤主之。甘草麻黄汤亦主之。水之为病，其脉沉小，属少阴，浮者为风，无水虚胀者为气。水发其汗即已，脉沉者宜麻黄附子汤，浮者宜杏子汤。心水者，其身重而少气，不得卧，烦而躁，其人阴肿。肝水者，其腹大不能自转侧，胁下腹中痛，时时津液微生，小便续通。肺水者，身肿，小便难，时时鸭溏。脾水者，其腹大，四肢苦重，津液不生，但苦少气，小便难。肾水者，其腹大脐肿，腰痛不得溺，阴下湿如牛鼻上汗，其足逆冷，面黄瘦，大便反坚。诸病水者，渴而不利，小便数者，皆不可发汗。问曰：病人苦水，面目四肢身体皆肿，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，始时当微；年盛不觉，阳衰之后，荣卫相干，阳损阴盛，结寒微动，肾气上冲，喉咽塞噎，胁下急痛。医以为留饮而大下之，气击不去，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，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。以上张仲景治疗水的各方，都以脉病为本，然后量轻重虚实而施治，都遵守圣经的法度。奈何当今世俗医生，因病者急求一时之效，以破气去水为功，不知过一二日，则病复至而不可救矣。呜呼！我常痛心世人患水肿多死不救的有两个原因，一是病患不善调摄，二是医生误投下药之过，竭其阴阳，绝其胃气，所以多死。于是详细摘取《素问》、《灵枢》、《金匮》之言而稍加发明，有志者应当不厌其烦。
肿病不一，或遍身肿，或四肢肿，面肿脚肿，都叫作水气。但有阳水，有阴水，并可先用五皮饮，或除湿汤加木瓜、大腹皮各半钱，如果无效，继以四磨饮兼吞桂黄丸，仍用赤小豆粥辅助。遍身肿，烦渴，小便赤涩，大便多闭，这属于阳水。轻症宜四磨饮，添磨生枳壳，兼进保和丸；重症则用凿饮子利之，以通为度。也有虽然烦渴而大便已利的，这不可再利，宜用五苓散加木通、大腹皮半钱，以通小便。遍身肿，不烦渴，大便自调或溏泄，小便虽少而不赤涩，这属于阴水。宜实脾饮。小便多少如常，有时赤，有时不赤，至晚则微赤，却没有涩滞的，也属于阴，不可遽补，木香流气饮，继进复元丹。如果大便不溏，气息胀满，宜四磨饮下黑锡丹。四肢肿，叫作肢肿，宜五
In the *Suwen* (Basic Questions), Chapter "Tangye Laoli" (Decoctions and Fermented Liquors), Emperor Huangdi asked: There are cases where disease does not originate from the hair follicles (skin pores), but rather from the exhaustion of the Yang Qi of the five Zang organs. Body fluids fill the chest and abdomen, while only the Po (Lung Spirit, governing contraction and descending) remains solitary within. Essence is isolated inside, while Qi dissipates outside. The body becomes so emaciated that clothes no longer fit properly. This presents with stiffness and tremors in the four extremities. This indicates that Qi is obstructed internally while the physical form deteriorates externally. How should this be treated? Qibo replied: One must balance the weight of Yin and Yang, remove accumulated and stale pathogenic factors, gently move the four extremities, ensure warmth in clothing, apply Miu Ci (lateral needling, treating left side for right-side symptoms and vice versa) at corresponding sites to restore the physical form; open the Guimen (sweat pores) to induce sweating, and purify the Jingfu (bladder) to promote urination. In this way, essence will recover in due time, the Yang Qi of the five organs will disperse, and the five Zang organs will be cleared and purified. Consequently, essence will generate naturally, the physical form will become robust, bones and flesh will be preserved, and the Great Qi will return to harmony.
The commentary explains: "Not originating from hair follicles" indicates that the pathogen did not enter through the Couli (interstices/skin pores), but rather that water-dampness overflowed from the interior to the exterior. "Exhaustion of the Yang Qi of the five Zang" is due to Spleen-Stomach deficiency. The Spleen and Stomach belong to Earth, modeling Heaven and Earth, and generating all things. Thus, when food and drink enter the Stomach, the Clear Yang transforms into Qi, and the Turbid Yin forms into Flavor. The Five Zang receive the Qi, which is called Yang; they receive the Flavor, which is called Jing (Essence). This refers to the "Five Yang" mentioned in the classic, which is the Yang of the Stomach cavity. When Qi and Jing are generated, health is maintained. Now, if one cannot receive the Qi of food and drink, there is no Qi to generate; if one cannot receive the five flavors, there is no Jing to transform. The Lung governs Qi and houses the Po. Without Qi, the Po remains solitary. The Kidney belongs to Yang, so its meridians must be activated. When meridians flow smoothly, the food and drink of the Spleen and Stomach can be transformed, and the other four Zang can receive nourishment, allowing treatment to proceed. For water located on the exterior or upper part, use diaphoresis (sweating); for water located on the interior or lower part, use differentiation and promotion of urination. Thus, the treatment discussed in this passage stands in contrast to the Yin deficiency described in the *Ping Re Bing Lun* (Commentary on Heat Disease). That case involves Kidney Yin deficiency unable to resist accumulating Yang heat; this case involves Stomach Yang deficiency unable to control overflowing Water-Yin. Zhang Zhongjing's method states: For edema, if swelling is below the waist, promote urination; if swelling is above the waist, induce sweating, then recovery occurs. Fangji Huangqi Tang, Fangji Fuling Tang, and Puhui San are used (all promote urination). Yueshi Tang, Yueshi Jia Zhu Tang, Gancao Mahuang Tang, Mahuang Fuzi Tang, and Xingzi Tang are used (all induce sweating). From this, we see that Zhang Zhongjing's methods derive entirely from the *Neijing*. Later generations' formulas for edema include Wupi San and Xiangsu San, using pungent herbs like Shengjiang (Rhizoma Zingiberis Recens), Ju Hong (Pericarpium Citri Reticulatae), Zijisu (Folium Perillae), and Dafupipi (Pericarpium Arecae Catechu) to disperse, and bland herbs like Fuling (Poria), Fangji (Radix Stephaniae Tetrandrae), Mutong (Caulis Akebiae Trifollatae), and Sangbaipi (Cortex Mori Radicis) to渗 (leach out dampness). This combines opening the Guimen and purifying the Jingfu. Zhu Danxi said: Because Spleen deficiency fails to control water, causing water-dampness to soak and act recklessly, one should tonify the Spleen with Renshen (Radix Ginseng) and Baizhu (Rhizoma Atractylodis Macrocephalae). When Qi becomes substantial, it naturally functions vigorously, ascending and descending, turning the pivot mechanism, so water flows naturally; this is not the forced water-draining action of Wuling San. He also stated: The *Neijing* says, "All Qi stagnation and depression belong to the Lung." "All dampness, swelling, and fullness belong to the Spleen." "All abdominal distension and enlargement belong to Heat." These three interact to cause disease. Dampness is the Qi of Earth; Earth is the child of Fire. Thus, dampness often arises from Heat, and Heat can transform from dampness, representing the mother Qi sensing the transformation of the child Qi (dampness). When dampness is excessive, Lung Qi fails to circulate and becomes stagnant. Therefore, in edema patients, the Spleen loses its function of transportation and transformation, mixing clear and turbid substances, which condense into water due to stagnation. Once Spleen Earth is diseased, its child, the Lung, also becomes deficient. Ying and Wei fail to distribute, Qi stagnates, and water accumulates, condensing into turbid fluid, penetrating meridians, flowing into valleys, obstructing Jin-Ye (body fluids), and eventually flooding the tunnels, transforming blood into water. Generally, treating edema should focus primarily on resolving dampness. Since the accompanying pathogens differ, treatments vary. It is also advisable to clear Heart Fire and tonify Spleen Earth. When Fire retreats, Lung Qi descends, and water passages open; when Spleen Earth prospers, transportation proceeds, separating clear from turbid. The clear parts revert to Qi, Blood, and Jin-Ye. The severe turbid败 (decayed) parts exit as sweat from above and urine from below, gradually dissipating. Lu Dijing classified edema, claiming that excessive Metal (Lung) generates Water, causing water to overflow recklessly, leading to closed respiration and blocked pivot mechanisms resulting in swelling. He insisted on guiding the Kidney to drain the water. Is this logical? The Lung is the mother of the Kidney, with clear and肃 (descending) Qi. If Lung excess generated water, the Lung would execute its descending command, regulate water passages, transport water downward to the Bladder, distribute water essence everywhere, and run through the five meridians. Why would swelling occur?
Someone asked: Danxi locates the source of water disease in Spleen Earth. Lu locates the source of water in the Kidney, based on the *Shui Re Pian* (Chapter on Water and Heat), where Yin excess causes water overflow. Since the origins differ, treatments must differ. Does Danxi's view contradict the *Neijing*? The answer is no. Let us deduce the meaning of the three chapters of the *Shui Re Pian*, and it will become clear. The first chapter asks why Shaoyin governs the Kidney and why the Kidney governs water. It answers: The Kidney is Supreme Yin (Zhi Yin); Supreme Yin stores water. The Lung is Taiyin; Shaoyin is the Winter pulse. Thus, the root is in the Kidney, the branch is in the Lung, and both involve water accumulation. This describes the normal state where the Shaoyin meridian is superior, governing the Kidney and executing Winter functions, with Supreme Yin storing water via Qi transformation. It does not describe the cause of disease. If pathogenic factors had injured them at that time, the Qi of both organs would have stagnated, causing water accumulation. However, Lu seeks not the pathogenic factor causing Qi stagnation and water accumulation, but instead attributes it to Supreme Yin storing water, claiming organ Qi excess causes disease. This is an error. Otherwise, why does the second chapter ask why the Kidney can gather water and cause disease? It answers: The Kidney is the gate of the Stomach. If the gate is not smooth, water gathers following its kind. Overflowing up and down onto the skin causes swelling. Swelling is disease caused by gathered water. This follows the previous chapter's discussion on water accumulation. The commentary notes that the Kidney governs the Lower Jiao, and the Bladder is the Fu organ, governing distribution. Opening the two yins, Kidney Qi transformation ensures patency of the two yins; closure of the two yins fills the Stomach. Hence, the Kidney is the gate of the Stomach. Closure leads to water accumulation. Regarding the meaning of Qi stagnation and water overflow, it refers to the Qi of the Lower Jiao. Why? The *Lingshu·Benshu* chapter states: Shaoyang belongs to the Kidney and connects upward to the Lung, thus linking the two Zang. The Sanjiao is the official of dredging, the pathway of water channels, belonging to the Bladder, and is the solitary Fu organ. The *Xuanming Wuqi* chapter states: Overflow from the Lower Jiao creates water. The commentary explains that at the site of distribution, if Qi is blocked and not discharged, it overflows into water. It also states: Sanjiao disease presents with abdominal fullness, especially hardness in the lower abdomen, inability to urinate, distress, and urgency. Overflow leads to water retention, resulting in distension. From this, the Qi of the Shaoyang meridian in the Lower Jiao relates to the transformation of Ministerial Fire. Among the Six Qi, only Ministerial Fire has a meridian but no Zang-Fu pair, wandering among the five elements. Thus, Shaoyang is called the "Wandering Department." Its meridian branches superiorly to the Danzhong, dispersing and connecting to the Pericardium; inferiorly, it emerges from Weiyang and connects upward to the Bladder. Is this not assisting the Heavenly Dao's transformation and the Earthly Dao's generation, forming a exterior-interior relationship with Hand-Jueyin to act as the messenger for all meridians? Therefore, when the Kidney meridian is invaded by pathogens, the Fire Qi of the Lower Jiao becomes stagnant. Stagnant Fire prevents the dispersion of water essence, leading to water accumulation. Long-standing Fire stagnation must eventually erupt, rising counter-flow along with the Fire-associated branches of the Chong Mai (Penetrating Vessel). The Chong Mai is the Sea of the Twelve Meridians. Its superior branch emerges from the neck and throat, seeping into Yang meridians and irrigating essence; its inferior branch runs alongside Shaoyang down the leg, seeping into Yin meridians and irrigating collaterals. Thus, water overflows with Fire, accumulating in the Lung, causing wheezing and inability to lie flat; scattering into Yin collaterals, causing swelling; entering and gathering in deficient Zang organs, causing distension of the five Zang. Such diseases are caused by Ministerial Fire flooding water. Without Ministerial Fire, water would not overflow but merely accumulate, as seen in the *Neijing*'s description of Stone Edema (Shi Shui) due to Yin-Yang knotting and skewing, with more Yin and less Yang, presenting with lower abdominal swelling; Water Edema due to knotting and cold of the Three Yin; and Stone Edema indicated by simultaneous deep pulses of the Kidney and Liver.
I further deduce that the failure of Kidney Qi transformation is often caused by the mutual harm of the Four Qi. The Stomach is the overcoming organ of the Kidney. It may be injured by excessive Damp-Heat, harmed by insufficient Stomach Qi sinking, insulted by excessive Heart Fire descending, constricted by Dry Metal, shaken by Wind-Wood, or caused by labor, sexual indulgence, seven emotions, or external pathogens, all leading to Kidney Qi deficiency. The gate of the Stomach closes not only due to Kidney Qi failure but also when the Stomach itself is diseased. Water does not wait for Kidney water to arise; ingested water also gathers. The Stomach governs the Middle Jiao and is the Sea of Food and Drink. When Stomach Qi harmonizes, ascending-descending and intake-excretion Qi moves, and food/drink follow their paths for transport and excretion. When Stomach Qi is disharmonious, the gates of intake and excretion are unsmooth, causing Jin-Ye of food and drink to accumulate and transform into water. As stated in the *Lingshu·Jingmai* chapter: Diseases produced by the Stomach include large abdominal edema and painful, swollen knees. The *Lingshu·Jinye* chapter states: When Jin-Ye of grains fails to transform due to Yin-Yang disharmony, Qi pathways block, the Four Seas close, the Sanjiao fails to discharge, and Jin-Ye does not transform, water and grain remain in the intestines and stomach, staying in the Lower Jiao without seeping into the Bladder, causing Lower Jiao distension. Water overflow results in water distension. Wang Shuhe's *Mai Jing* (Pulse Classic) states: The Spleen embraces its child, Lung Metal. The child fears Fire injury and hides in Water; Wood fears Metal oppression and becomes thorny; the Spleen fears Wood occupying a corner, so Water overflows upward causing distension. From these discussions, "gate not smooth" implies mutual influence between the two organs. The third chapter asks: Do all waters originate from the Kidney? It answers: The Kidney is a Yin organ (Pin Zang). When Earth Qi rises, it belongs to the Kidney and generates fluid liquids. Thus, when one exerts greatly, Kidney sweat appears. If Kidney sweat encounters wind, it cannot enter the Zang internally nor escape the skin externally, lodging in the Xuankou (pores), moving beneath the skin, transmitting into edema. Rooted in the Kidney, it is named Feng Shui (Wind Edema). The phrase "Earth Qi rises" here refers to the human body being formed by Earth's Yin. The Kidney resides below the five Zang, is Supreme Yin, governs water, and generates fluids. Thus, fluids in the body are like water underground. The five fluids transformed by the five Qi all belong to the Kidney. Now, due to Labor Fire forcing Kidney fluids out as sweat, and encountering wind closing the Xuankou, the sweat and wind clash, knotting in the skin. Consequently, old and new fluids transformed by the five Qi gather to form water. By analogy, Kidney Qi labor is not limited to sexual activity. Night walking, wading, falling, carrying heavy loads, extreme anger, or fright can also force Kidney fluids to the surface, where they may encounter wind. This illustrates the Sage's concise yet profound words, exemplifying how one instance applies to ten.
Furthermore, the *Ping Re Bing Lun* states: A patient with Kidney Wind presents with facial swelling, difficulty speaking, and should not be needled when deficient. If needled inappropriately, Qi will arrive after five days. Upon arrival, there will be shortness of breath and intermittent fever. Fever spreads from chest and back to the head, with sweaty, hot hands, dry mouth, bitter taste, thirst, yellow urine, periorbital edema, borborygmus, heaviness making movement difficult, amenorrhea, irritability, anorexia, inability to lie supine (supine position triggers cough). This is named Feng Shui. This indicates Kidney deficiency makes reckless treatment dangerous. Treatment worsens Yin deficiency, allowing Yang to crowd in, affecting the five Zang, producing these heat symptoms. Comparing this with previous descriptions, all water overflow diseases stem from Kidney deficiency. Ignoring deficiency and attacking water directly re-injures Yin. Deficiency allows various pathogens to enter, causing further disease. The *Neijing* also states that simultaneous floating pulses of the Liver and Kidney indicate Feng Shui, showing severe Yin deficiency. Why? The Liver and Kidney reside in the Lower Jiao. The Kidney is Yin, static, with a deep pulse. The Liver is Yang, active, with a floating pulse. Yin pathways are easily depleted; Yang pathways are abundant because both Zang contain Ministerial Fire. If Ministerial Fire moves improperly, movement in the Kidney is like Dragon Fire in the sea, so water attaches and the dragon rises. Movement in the Liver is like Thunder Fire emerging from earth, sudden and stormy, so water surges like waves. Since water follows wind, Liver and Kidney pulses float simultaneously. Wang Bing's commentary suggests wind attacks the lower, resembling Water-Wind pathogen, but people do not know of Wind generated internally by Liver Wood. The *Lingshu·Shui Zhang* chapter lists Water Distension, Skin Distension, Drum Distension, Intestinal Polyp, Stone Fibroma, and Stone Edema. To treat Skin Distension and Drum Distension, first drain the blood collaterals of distension, then regulate the meridians, removing the blood from the collaterals. This Skin Distension corresponds to the *Zhang Lun* chapter, which states that Ying Qi follows meridians, and reversed Wei Qi causes Meridian Distension; Wei Qi merging with meridians and following muscle spaces causes Skin Distension. Needling Zusanli and draining, once for near cases, thrice for distant ones, regardless of deficiency or excess, relies on rapid draining. The Drum Distension in this chapter matches the Drum Distension in the *Fuzhong Lun*, with similar symptoms. There, it was treated with Jishi Li (Chicken Excrement Ferment), effective after one dose, cured after two. If diet is irregular, even if cured, Qi may re-gather in the abdomen. Why does this chapter treat these two conditions by first draining blood collaterals and regulating meridians, differing from the other? The former addresses Qi gathering; this addresses Qi stagnation clashing with Blood, causing Blood coagulation in collaterals and Qi coagulation in meridians, generating water fluid and distension. Hence, treatments differ.
Zhang Zhongjing said: Feng Shui has a floating pulse, external signs of bone-joint pain, and aversion to wind. (*Zhenjing·Lun Ji Zhen Chi* chapter: Look for slight swelling above the eyes like after waking, pulsation of the neck artery, occasional cough, pitting edema on hands and feet—this is Feng Shui/Skin Distension.) Also, Zhang Zhongjing said: Taiyang disease with floating and tight pulses usually presents with bone-joint pain. If there is no pain, but the body feels heavy and achy, and the patient is not thirsty, sweating brings cure—this is Feng Shui. For Feng Shui with floating pulse, heaviness, sweating, and aversion to wind, Fangji Huangqi Tang governs. For Feng Shui with aversion to wind, generalized swelling, floating pulse, no thirst, continuous sweating, and no significant heat, Yueshi Tang governs. Add one prepared Fuzi (Radix Aconiti Lateralis Preparata) if aversion to wind is present. (Continued methods: For Feng Shui with intermittent swelling, joint pain, and急促 (rapid) breathing, Dafupi San governs. For Feng Shui toxin with generalized swelling, Chu Baidi San governs.) Pi Shui (Skin Water) also has a floating pulse. External signs include edema that pits on pressure, no aversion to wind, drum-like abdomen, and no thirst. Diaphoresis is indicated. (Also: Thirst without aversion to cold indicates Pi Shui. Typically, Feng Shui has aversion to cold and no thirst; Pi Shui has no aversion to cold but thirst. Even if Pi Shui has no thirst, diaphoresis is still indicated.) For Pi Shui with limb edema and water Qi in the skin causing trembling limbs, Fangji Fuling Tang governs. For Pi Shui with cold limbs, Puhui San governs. (Continued method: For Pi Shui with generalized facial and bodily swelling, Muxiang Wan governs.) Zheng Shui (Correct Water) has a deep-slow pulse and spontaneous wheezing. Shi Shui (Stone Water) has a deep pulse and abdominal fullness without wheezing. (*Da Qi Lun*: Simultaneous deep pulses of Liver and Kidney indicate Stone Water; simultaneous floating pulses indicate Feng Shui. Continued method: Stone Water presents with thin limbs and isolated abdominal swelling, treated with Haige Wan. Another Stone Water presentation: tight, drum-like abdomen with difficult urination/defecation, treated with Binglang San.) Huang Han (Yellow Sweat) has a deep-slow pulse, fever, chest fullness, and swelling of limbs, head, and face. If prolonged, it leads to abscesses/pus. (Also: Swollen, cold body resembling Zhou Bi, chest obstruction, anorexia,集聚 (gathering) pain, evening restlessness insomnia—this is Yellow Sweat. See Jaundice section for treatment.) Li Shui (Interior Water) presents with yellowish swelling of the whole body and face, deep pulse, and difficult urination, causing water disease. If urination is free, this indicates loss of Jin-Ye causing thirst. Yueshi Jia Zhu Tang governs. Gancao Mahuang Tang also governs. For water disease, deep-small pulses indicate Shaoyin; floating pulses indicate Wind. Empty distension without water indicates Qi. Sweating cures water disease. Deep pulses suit Mahuang Fuzi Tang; floating pulses suit Xingzi Tang. Xin Shui (Heart Water): Heavy body, shortness of breath, inability to lie down, irritability, agitation, and genital swelling. Gan Shui (Liver Water): Abdominal distension preventing turning over, pain in hypochondrium and abdomen, occasional slight saliva production, and continuous urination. Fei Shui (Lung Water): Generalized swelling, difficult urination, and frequent loose stools (duck droppings). Pi Shui (Spleen Water): Abdominal distension, heavy limbs, lack of saliva, shortness of breath, and difficult urination. Shen Shui (Kidney Water): Abdominal distension with umbilical swelling, lower back pain, inability to urinate, dampness under genitals like cow-nose sweat, cold feet, sallow emaciated face, and hard stool. For all water diseases, if thirsty but with difficult urination, or frequent urination, sweating is contraindicated.
Question: A patient suffers from water disease, with swelling of the face, limbs, and body, and difficult urination. Palpation reveals no mention of water, but rather chest pain, Qi rushing up the throat feeling like grilled meat, and mild cough/wheezing. If the Master speaks truly, what is the pulse pattern? Master replies: The Cun Kou pulse is deep and tight. Deep indicates water; tight indicates cold. Deep and tight interacting knot at Guan Yuan. Initially subtle; unnoticed in youth. After Yang declines, Ying and Wei interfere. Yang damages, Yin becomes excessive. Knotting cold moves slightly, Kidney Qi rushes up, causing throat blockage and hypochondriac pain. Physicians mistook this for retained fluid and purged heavily. Qi attack remained, disease persisted. Later, vomiting was induced, causing Stomach deficiency, irritability, dry throat, thirst, difficult urination, undigested food/water, and edema of face/hands/feet. Then Tingli Wan was given to drain water. Temporary relief occurred, but overeating caused recurrence of swelling, chest/hypochondriac pain, resembling Ben Tun (Running Piglet). Water overflowed, causing floating cough and wheezing. One must first attack the Rushing Qi to stop it, then treat the cough. When cough stops, wheezing resolves. Treat new disease first; old disease follows. Above are Zhang Zhongjing's formulas for water, all based on pulse and disease, assessing severity and deficiency/excess before treatment, adhering to the Classics. Why do modern physicians, seeking immediate effect for anxious patients, use Qi-breaking and water-draining methods, unaware that within one or two days, the disease returns incurably? Alas! I lament that most water edema deaths result from two causes: poor patient self-care and physician error in administering purgatives, exhausting Yin-Yang and destroying Stomach Qi. Thus, I have detailed excerpts from *Suwen*, *Lingshu*, and *Jingui Yaolue* with explanations. Those interested should not find this tedious.
Edema varies: generalized, limb, facial, or foot swelling, all termed Water Qi. There is Yang Water and Yin Water. One may initially use Wupi Yin, or Chushi Tang adding Mugua (Fructus Chaenomelis) and Fupi (Pericarpium Arecae Catechu) half qian each. If ineffective, follow with Simo Yin combined with Guihuang Wan, assisted by Red Bean Porridge. Generalized swelling with thirst, red/astringent urine, and constipation indicates Yang Water. Mild cases: Simo Yin with raw Zhike (Fructus Aurantii) ground in; combine with Baohe Wan. Severe cases: Zaoyin Zi to drain, stopping when patent. If thirsty but stool is already loose, do not purge again. Use Wuling San plus Mutong (Caulis Akebiae Trifollatae) and Dafupipi half qian to promote urination. Generalized swelling without thirst, normal or loose stool, small but non-red/non-astringent urine indicates Yin Water. Use Shipi Yin. Urine volume normal, sometimes red, sometimes not, slightly red at night without astringency, also Yin. Do not tonify hastily. Use Muxiang Liuqi Yin, followed by Fuyuan Dan. If stool is not loose but Qi is distended, use Simo Yin with Heixi Dan. Limb swelling, called Zhi Zhong, uses Wupi...