肝水者。其腹大。不能自转侧。胁下腹痛。时时津液微生。小便续通。
〔衍义〕足厥阴之脉。过阴器。抵少腹。挟胃、属肝、络胆、布胁肋。今客于经。伤其生发
之气。肝脏之阳。故病如此。然肝在下。主疏泄。虽受水郁。终有时而津可微生。则小便得以暂通也。
肺水者。其身肿。小便难。时时鸭溏。
〔衍义〕肺主皮毛。行荣卫。与大肠合。今有水病。是荣泣卫停。其魄独居。阳竭于外。
则水充满皮肤。肺本通水道。下输膀胱。为尿溺。今既不通。水不得自小便出。反
从其合。与糟粕混。成鸭溏也。
脾水者。其腹大。四肢苦重。津液不生。但苦少气。小便难。
〔衍义〕脾居中及四肢。与胃合。为其脉自足入腹。属脾络胃。为阴脏也。中主藏物。
今水在脾。而脾胃之气不行。蓄积于中。故腹大。四肢不得并水谷。故苦重。谷精
不布。故津液不生。胃之贲门不化。则宗气虚而少气。胃之幽关不通。则水积而小便难。
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。面反瘦。
〔衍义〕足少阴之脉。起足心。循内踝。贯脊属肾。络膀胱。为胃之关。今水在肾。关门
不利。故聚水。而为腹大脐肿腰痛不得溺也。夫肾为水之海。然水在海者。其味
必咸。咸必渗走囊外。湿如牛鼻上汗也。咸水之病作。则心火必退而衰微。惟孤
阴而已。故逆冷也。心火退伏。则荣卫诸阳尽退。不荣于上。而脾胃谷精亦不循
脉上于面皮。故瘦也。
师曰。诸有水者。腰以下肿。当利小便。腰以上肿。当发汗乃愈。
〔衍义〕分腰上下为便利发汗何也。盖身半以上。天之分。阳也。身半以下。地之分。
阴也。而身之腠理行天分之阳。小便通地分之阴。故水停于天者。开腠理而水
从汗散。水停于地者。决其出关而水自出矣。即内经开鬼门洁净府法也。
师曰。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（音怯）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。
〔衍义〕仲景脉法。寸口多与趺阳合。何也。盖寸口属肺。手太阴之所过。肺朝百脉。
十二经各以其时来见于寸口。脾胃二经出在右关。胃乃水谷之海。五脏皆禀
气于胃。则胃又五脏之本。所以经脉尤为诸经之要领也。邪或干于胃者。必再
就趺阳诊之。趺阳。足跗上冲阳。胃脉之源也。此条寸口沉为水迟为寒者。非外
入之邪。即脾胃冲脉二海之病。因水谷之阳不布。则五阳虚竭。虚竭则生寒。下
焦血海之阴不生化。则阴内结。内结则生水。水寒相搏。十二经脉尽从所禀。而
变见于寸口也。脾与胃为表里。脾气衰。则不能与胃行其津液。致清浊不分于
里。而为 溏。胃气衰。则不能行气于三阳。致阳道不行于表。则身体分肉皆肿。
二经既不利。则趺阳之脉伏矣。邪在血海。血海者。冲脉所主。冲脉与肾之大络。
同出肾下。男女天癸之盛衰皆系焉。内经曰。肾为作强之官。伎巧出焉。自越人
以两肾分左右。右肾为男子藏精施化。女子系胞成孕。则冲任正隶其所用之
脉也。王叔和分两肾于左右尺部。皆以足少阴经属之。其表之腑。亦并以膀胱
足太阳配之。但在左尺足太阳下注一说。与三焦为表里。尝考其由。出自灵枢。
谓足三焦下输出于委阳。太阳之别也。手少阴经也。并太阳之正入络膀胱。约
下焦。实则癃闭。又曰。三焦者。中渎之腑。水道出焉。膀胱是孤腑也。今以邪搏血
海。血海属右肾之藏。三焦是其腑。是以男女亦必从阴阳气血表里而分。在女
则是其阴。血海者病。在男则是其阳。三焦者病。冲脉非大经十二之数。附见于
足少阴脉者。是故男子少阳脉革。为三焦气不化。气不化。则小便不利。妇人少
阴脉细。则经水不通。经为血。血不利。则为水。名为血分。虽然。小便不利。因水者。
不独由于气。亦或有因血所致。如前用蒲黄散等方治血。概可见也。
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。咽喉塞噎。胁下结痛。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。
〔衍义〕此水病。脉之不言水。反言胸中痛等病。当时记其说者以为异。非异也。是
从色脉言耳。脉沉为水。紧为寒为痛。水寒属于肾。足少阴脉。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。因作
冲气。从其脉所过。随处与正气相击而为病耳。要知其病始由关元。夫五脏六
腑。在内有强弱荣悴。尽见于面部。分五官五色以辨之。关元是下纪足三阴任
脉所会。寒结关元。其肾部之色。必微枯而黑。知是久痹之证。非一日也。及阳衰
之后。荣卫失常。阴阳反作。寒结之邪。冲肾气而上。故作此证。医不治其冲气。反
吐下之。遂损其胃。致水谷不化。斯津液不行。而渴欲饮水。小便不利也。由是扬
溢于面目四肢。浮肿并至。冲气乘虚愈击。更有象若奔豚喘咳之状。必先治其冲气之本。冲
气止。肾气平。则诸证自瘥。未瘥者。当补阳泻阴。行水扶胃。疏通关元之久痹。次第施治焉耳。
风水脉浮。身重。汗出恶风者。防己黄 汤主之。腹痛者加芍药。（方见湿病）
〔衍义〕脉浮表也。汗出恶风。表之虚也。身重。水客分肉也。防己疗风肿水肿。通腠
理。黄 温分肉。补卫虚。白术治皮风止汗。甘草和药益土。生姜、大枣辛甘发散。
腹痛者。阴阳气塞。不得升降。故加芍药收阴。
风水恶风。一身悉肿。脉浮不渴。续自汗出。无大热。越婢汤主之。
越婢汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 大枣（十二枚） 甘草（二两）
上五味。以水六升。先煮麻黄。去上沫。内诸药。煮取三升。分温三服。恶风者。加附
子一枚炮。风水者。加白术四两。（古今录验）
〔衍义〕荣、阴也。水亦阴也。卫、阳也。风亦阳也。各从其类。水寒则伤荣。风热则伤卫。
脾乃荣之本。胃乃卫之源。荣伤。胃即应而病。脾病。则阴自结。不与胃和以行其津液。胃病。
则阳自壅。不与脾和以输其谷气。而荣卫不得受水谷之精悍。故气
自削。不肥腠理恶风。不充分肉皮肤。唯邪自布。故一身悉肿。其脉浮者。即首章
水风脉浮是也。续自汗出者。为风有时开其腠理也。无大热者。只因风热在卫。
而卫自不成其热也。不渴者。以内无积热。外无大汗。其津液不耗。故不渴也。用
越婢汤主之。与前条所谓里水脉沉者相反。何亦用是方治之乎。盖里水为脾
之三阴结而化水。不得升发。故用是汤发之。此证表虚恶风续自汗出者。亦欲
发中焦之谷气。以输荣卫。东垣云。上气不足。推而扬之。是二证虽有表里之分。
皆当发越脾气。以一汤治。或曰。麻黄能调血脉。开毛孔皮肤。散水寒。石膏解肌
退风热。今不言药。而云发越脾气以愈病。何也。曰仲景命方。如青龙、白虎。各有
所持。岂越婢而漫然。天人万物。气皆相贯。邪之感人。必客同类。当假物之同类
者以祛之。则用力少而成功多。非惟祛之而已。且能发越脾气。无一味相间。岂
非仲景有意于名方哉。夫五脏各一其阴阳。独脾胃居中而两属之。脾主阴而
胃主阳。自流利者言之。土固五行之一。自生成者言之。则四气皆因土而后成
故万物生于土。死亦归于土。然土不独成四气。土亦从四维而后成。不惟火生
而已。故四气有水之阴。即应于脾。风热之阳。即应于胃。饮食五味寒热。凡入于
脾胃者亦然。一有相干。则脾气不和。胃气不清。而水谷不化其精微。以荣营卫
而实阴阳也。然甘者土之本位。脾气不清。清以甘寒。要而行之。必走经脉。要而
合之。必通经隧。经隧者。脏腑相通之别脉也。是故麻黄之甘热。自阴血走手足
太阴经达于皮肤。行气于三阴。以去阴寒之邪。石膏之甘寒。自气分出走手足
阳明经。达于肌肉。行气于三阳。以去风热之邪。用其味之甘以入土。用其气之
寒热以和阴阳。用其性之善走以发越脾气。更以甘草和中。调其寒热缓急。二
药相合。协以成功。必以大枣补脾中之血。生姜之辛。益胃中之气。恶风者阳虚
故加附子以入阳。风水者。则加白术以散皮肤间风水之气。发谷精以宣荣卫。
与麻黄、石膏为使。引其入土也。越婢之名。不亦宜乎。
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。
防己茯苓汤方
防己（三两） 黄 （三两） 桂枝（三两） 茯苓（六两） 甘草（二两）
上五味。以水六升。煮取二升。分温三服。
〔衍义〕此证与风水脉浮。用防己黄 同。而有浅深之异。风水者。脉浮在表。土气
不发。用白术、姜、枣发之。此乃皮水郁其荣卫。手太阴不宣。金郁者泄之。水停者
以淡渗。故用茯苓易白术。荣卫不得宣行者。散以辛甘。故用桂枝、甘草以易姜、枣。内经云。肉蠕
动。名曰微风。以四肢聂聂动者。为风在荣卫。触于经络而动。故桂枝、甘草亦得治之也。
里水。越婢加术汤主之。甘草麻黄汤亦主之。
越婢加术汤方（方见上内加白术四两）
甘草麻黄汤方
甘草（二两） 麻黄（四两）
上二味。以水五升。先煮麻黄。去上沫。内甘草。煮取三升。温服一升。重覆汗出。不汗再服。慎风寒。
〔衍义〕此条但言里水。不叙脉证。与前条里水用汤俱同。何两出之。将亦有异乎。
前条里水证。只就身肿。小便不利。亡津液而渴者。大抵一经之病。随其气化所
变。难以一二数。其经之邪无明。其变不可详。惟在方中佐使之损益何如耳。
水之为病。其脉沉小。属少阴。浮者为风无水。虚胀者为气水。发其汗则已。脉沉者。
宜麻黄附子汤。浮者宜杏子汤。
麻黄附子汤方
麻黄（三两） 甘草（二两） 附子（一枚炮）
上三味。以水七升。先煮麻黄去沫。内诸药。煮取二升半。温服八分。日三服。
杏子汤方（缺恐即麻黄杏仁甘草石膏汤）
〔衍义〕少阴主水其性寒。此条皆少阴证也。非独脉沉小者属之。但因其从风出
于表。水不内积。故曰无水。若不因风。只是肾脉上入于肺而虚胀者。则名曰气
水。然肾水风水。已有治法。独气水分脉浮沉。发其汗。由少阳水寒之邪。其本尚
在于里。阴未变故用麻黄散水。附子治寒。脉浮者。其水已从肾上逆于肺之标。
居于阳矣。变而不寒。于是用杏子汤。就肺中下逆气。注谓未见其汤。恐即麻黄
杏子石膏甘草汤。皆发汗散水者。独附子、杏仁分表里耳。
厥而皮水者。蒲灰散主之。（方见消渴中）
〔衍义〕此病水不言病形之状。惟言止用蒲灰散。何也。大抵此证与首章同。然彼
以发汗。此得之于厥。故治法不同。厥者逆也。由少阴经肾气逆上入肺。肺与皮
毛合。故逆气溢出经络。经络之血泣。与肾气合。化而为水。充满于皮肤。故曰皮
水。用蒲黄消经络之滞。利小便为君。滑石开窍通水。通以佐之。小便利则水下
行。逆气降。与首章皮水二条。有气血虚实之不同。只此可见仲景随机应用之治矣。
问曰。黄汗之为病。身体肿。（一作重）发热。汗出。而渴。状如风水。汗沾衣。色正黄如柏汁。
脉自沉。何从得之。师曰。以汗出。入水中浴。水从汗孔入得之。宜 芍桂酒汤主之。
黄 芍药桂枝苦酒汤方
黄 （五两） 芍药（三两） 桂枝（三两）
上三味。以苦酒一升。水七升相和。煮取三升。温服一升。当心烦。服至六七日乃
解。若心烦不解者。以苦酒阻故也。（一方用美酒醯代苦酒）
〔衍义〕汗本津也。津泄则卫虚。水血同类。阴也。水入则荣寒。寒则气郁。郁则发热。
水热相搏于分肉。则身肿。荣出中焦。荣之郁热。内蓄于脾。则津液不行而渴。卫
虚。腠理不固。则汗出。脾土发热。则黄色见于面如柏汁也。所以补卫为要。黄
益气。入皮毛。肥腠理。退热止汗之功尤切。故为君。桂枝理血。入荣散寒。通血脉。
解肌肉。用之调荣以和卫。故为臣。荣气因邪所阻。不利于行。芍药能收阴气。故
佐桂枝。一阴一阳以利其荣。苦酒醋也。用之使引入血分以散滞。注一方用美
酒。美酒性热入心。可以致烦。醋但刺心而不烦。未审孰是。
肝水病，表现为腹部胀大，身体不能自行翻身转动，胁下及腹部疼痛，口中偶尔有少量津液生成，小便断续通畅。
〔衍义〕足厥阴肝经的经脉，经过外生殖器，抵达少腹部，夹行于胃旁，属于肝脏，联络胆腑，分布于胁肋部。如今邪气客居于此经，损伤了肝脏的生发之气和肝脏的阳气，所以出现上述病症。然而，肝位于下部，主司疏泄功能，虽然受到水湿郁阻，但最终有时能使津液微微化生，因此小便得以暂时通畅。
肺水病，表现为全身浮肿，小便困难，时常排出像鸭粪一样稀薄的粪便。
〔衍义〕肺主管皮毛，运行营卫之气，与大肠相表里。如今患水病，说明营血凝涩、卫气停滞，导致肺气独存（魄属肺）。阳气衰竭于体表，则水湿充满皮肤。肺本应通调水道，向下输送至膀胱形成尿液。如今水道不通，水湿不能从小便排出，反而从其相表里的大肠，与糟粕混合，形成像鸭粪一样的稀便。
脾水病，表现为腹部胀大，四肢感到沉重困苦，津液不生，只感觉气短乏力，小便困难。
〔衍义〕脾居中焦并主四肢，与胃相表里。其经脉从足进入腹部，属于脾络于胃，属于阴脏。中焦主藏纳水谷。如今水湿停留在脾，导致脾胃之气运行不畅，积聚在中焦，所以腹部胀大。四肢得不到水谷精微的滋养，所以感到沉重。谷精不能布散，所以津液不生。胃的贲门不腐熟消化，则宗气虚弱而气短。胃的下口幽关门不通，则水湿积聚而小便困难。
肾水病，表现为腹部胀大，肚脐肿胀，腰痛，无法排尿，阴部潮湿如同牛鼻上的汗水，双脚逆冷，面部反而消瘦。
〔衍义〕足少阴肾经的经脉，起于足心，沿内踝上行，贯穿脊柱，属于肾脏，联络膀胱，作为胃的关口。如今水湿在肾，关门不利，所以聚水而成腹部胀大、肚脐肿胀、腰痛、无法排尿等症状。肾为水之海，既然水在海中，其味必咸。咸味必然渗透走窜到囊外，所以湿气像牛鼻上的汗水一样。咸水之病发作时，心火必然退却而衰微，只剩下孤阴，所以双脚逆冷。心火退伏，则营卫等诸阳之气全部退却，不能荣养上部，且脾胃的水谷精微也不能循脉上达于面部皮肤，所以面部消瘦。
老师说：凡是患有水病的患者，如果腰部以下浮肿，应当采用利小便的方法治疗；如果腰部以上浮肿，应当采用发汗的方法才能痊愈。
〔衍义〕为什么要根据腰部的上下来分别决定使用利小便还是发汗呢？大概是因为身半以上是天的分野，属阳；身半以下是地的分野，属阴。而身体的腠理运行着天分的阳气，小便通应地分的阴气。所以水湿停聚在天分（上部）的，打开腠理，水湿就从汗液发散出去；水湿停聚在地分（下部）的，决开出口（尿道），水湿自然排出。这就是《内经》所说的“开鬼门（发汗）、洁净府（利小便）”的方法。
老师说：寸口脉象沉而迟，沉脉主水，迟脉主寒。寒与水相互搏结，趺阳脉象伏匿，导致水谷不能消化。脾气衰弱则大便溏薄，胃气衰弱则身体浮肿。少阳脉象低弱（音怯），少阴脉象细。男子则小便不利，女子则月经不通。经血属于血类，血行不畅，就会化为水，这叫做血分病。
〔衍义〕张仲景的脉法，寸口脉常与趺阳脉合参，为什么呢？因为寸口属于肺，是手太阴肺经所过之处，肺朝会百脉，十二经脉各自在其当令之时显现于寸口。脾胃二经的气血反映在右关部。胃是水谷之海，五脏都禀受胃气，所以胃又是五脏的根本，因此经脉尤为各经的要领。邪气如果侵犯胃，必定再诊察趺阳脉。趺阳脉位于足背上的冲阳穴，是胃脉的源头。此条文中寸口脉沉主水、迟主寒，并非外来的邪气，而是脾胃冲脉这两大海的病证。因为水谷的阳气不能布散，导致五阳虚竭，虚竭则生寒。下焦血海的阴气不能生化，则阴气在内凝结，内结则生水。水与寒相互搏结，十二经脉都禀受于胃，变化显现于寸口。脾与胃互为表里，脾气衰弱，就不能协助胃运行津液，导致清浊不分于体内，从而形成溏泄。胃气衰弱，就不能将气行于三阳经，导致阳道不行于体表，所以身体肌肉都会浮肿。这两经既不利，那么趺阳脉就伏匿了。邪气在血海，血海由冲脉所主，冲脉与肾的大络，一同出于肾下，男女天癸的盛衰都系于此。《内经》说：肾是作强之官，技巧由此而出。自从扁鹊将两肾分左右，认为右肾为男子藏精施化、女子系胞成孕之所，那么冲任二脉正隶属于其所用的经脉。王叔和将两肾分置于左右尺部，都以足少阴经归属它们，它们的表里之腑，也都以膀胱和足太阳经配合。但在左尺足太阳下注一说中，与三焦互为表里。我曾考证其由来，出自《灵枢》，说足三焦下行输出于委阳，是太阳经的别络，属于手少阴经，并与太阳经的正脉一起入络膀胱，约束下焦。实证则为癃闭。又说：三焦是中渎之腑，水道由此而出，膀胱是孤腑。如今邪气搏结于血海，血海属于右肾的藏精之处，三焦是其腑，所以男女也必须从阴阳气血表里来区分。在女性则是阴分，血海有病；在男性则是阳分，三焦有病。冲脉不属于十二正经之数，附见于足少阴脉。所以男子少阳脉革，是三焦气化不利，气化不利则小便不利。妇人少阴脉细，则月经不通。经血属于血，血行不畅，就会化为水，名为血分。虽然如此，小便不利，因水湿所致，并不仅仅由于气滞，也有因血致病的，如前面提到的蒲黄散等方剂治疗血病，概可见一斑。
问：病人苦于水病，面目身体四肢都浮肿，小便不利。诊脉时不说水病，反而说胸中痛，气上冲咽喉，感觉像有烤肉堵在那里，应当伴有轻微咳嗽气喘。果真像老师所说，他的脉象是什么样的？老师说：寸口脉沉而紧，沉脉主水，紧脉主寒。沉紧相搏，结聚在关元穴处。开始时症状轻微，年壮时不觉察。阳气衰退之后，营卫相互干扰，阳气受损阴气盛，结聚的寒气微微发动，肾气上冲，咽喉堵塞噎塞，胁下结聚疼痛。医生误以为是留饮而用峻下法治疗，气击不去，病未消除。后来又重吐之，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，但因饮食过度，浮肿又恢复如初。胸胁苦痛，形象像奔豚病。水气扬溢，则引起浮咳气喘逆乱。应当先攻击冲气使其停止，然后治疗咳嗽，咳嗽停止，气喘自然痊愈。先治新发的病，旧病应当放在后面处理。
〔衍义〕这个水病，诊脉时不说水病，反而说胸中痛等疾病，当时记录的人以为很奇怪，其实并不奇怪，这是从色脉来说的。脉沉主水，紧主寒主痛。水寒属于肾，足少阴肾经，从肾脏向上穿过肝膈，进入肺部，沿着喉咙，其支脉从肺出络于心，注入胸中。凡是肾气上逆，必定伴随冲脉并行，因而产生冲气，顺着经脉所过的地方，随处与正气相击而发病。要知道这个病起始于关元穴。五脏六腑，在内有强弱荣枯，全都表现在面部，通过分辨五官五色来辨别。关元是下纪，是足三阴经和任脉交会的地方。寒邪结聚在关元，其肾部的面色，必定微枯而黑，知道这是久痹之证，不是一天形成的。等到阳气衰退之后，营卫失常，阴阳反作，寒结之邪冲击肾气而上行，所以出现这些症状。医生不治疗冲气，反而用吐下法，于是损伤了胃，导致水谷不化，津液不行，所以口渴想喝水，小便不利。由此水气扬溢于面目四肢，浮肿并至。冲气乘虚更加冲击，更有像奔豚病一样的喘咳症状。必须先治疗冲气的根本，冲气停止，肾气平和，各种症状自然痊愈。未痊愈的，应当补阳泻阴，行水扶胃，疏通关元穴的久痹，按次序施治罢了。
风水病，脉浮，身体沉重，出汗怕风的，用防己黄芪汤主治。如果有腹痛的，加芍药。（方剂见湿病篇）
〔衍义〕脉浮表示病在表。出汗怕风，表示表虚。身体沉重，是水湿客居于分肉之间。防己治疗风肿水肿，通达腠理；黄芪温煦分肉，补益卫气之虚；白术治疗皮风止汗；甘草调和药物补益脾胃；生姜、大枣辛甘发散。腹痛，是由于阴阳之气阻塞，不能升降，所以加芍药收敛阴气。
风水病，怕风，全身都浮肿，脉浮不渴，持续自汗出，没有大热，用越婢汤主治。
越婢汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 大枣（十二枚） 甘草（二两）
以上五味药，用水六升，先煮麻黄，去掉上面的沫，加入其他药物，煮取三升，分三次温服。如果怕风的，加炮附子一枚。如果是风水病，加白术四两。（出自《古今录验》）
〔衍义〕营属阴，水也属阴；卫属阳，风也属阳。各从其类。水寒则伤营，风热则伤卫。脾是营的本源，胃是卫的源头。营受伤，胃就会相应生病；脾病，则阴气自然凝结，不与胃协调以运行津液；胃病，则阳气自然壅滞，不与脾协调以输布谷气。这样营卫就不能接受水谷的精悍之气，所以人气自削，不能肥满腠理而怕风，不能充实分肉皮肤，只有邪气散布，所以全身都浮肿。其脉浮，就是第一章说的风水脉浮。持续自汗出，是因为风有时打开腠理。没有大热，只是因为风热在卫分，而卫气自身不能形成大热。不渴，是因为内部没有积热，外部没有大汗，津液没有耗损，所以不渴。用越婢汤主治。这与前条所说的里水脉沉相反，为什么也用这个方子治疗呢？大概里水是脾之三阴凝结而化水，不得升发，所以用这个汤发越它。这个证候表虚恶风持续自汗出，也是想要发越中焦的谷气，以输布给营卫。李东垣说：上气不足，推而扬之。这两个证候虽然有表里的区别，都应当发越脾气，用一个方子治疗。有人说：麻黄能调理血脉，打开毛孔皮肤，散发水寒；石膏解肌退风热。现在不讲药理，而说发越脾气以愈病，为什么呢？回答说：张仲景命名方剂，如青龙、白虎，各有持守，难道越婢汤是漫然的吗？天人万物，气皆相通贯。邪气感人，必定客居同类，应当借用同类之物来祛除它，那么用力少而成功多。不仅仅是祛除邪气，而且能发越脾气，没有一味药是间隔的，这难道不是张仲景有意于方名吗？五脏各有一个阴阳，唯独脾胃居中而兼属阴阳。脾主阴而胃主阳。从流利方面说，土固然是五行之一；从生成方面说，四气都因土而后形成，所以万物生于土，死也归于土。然而土不仅仅成就四气，土也从四维而后形成，不仅仅是火生土而已。所以四气中有水的阴，就应于脾；风热的阳，就应于胃。饮食五味寒热，凡进入脾胃的也是这样。一有相干，则脾气不和，胃气不清，而水谷不能化其精微，以荣养营卫而充实阴阳。然而甘味是土的本位，脾气不清，用甘寒来清利它，如果要行之，必定走经脉；如果要合之，必定通经隧。经隧是脏腑相通别的脉络。所以麻黄的甘热，从阴血走向手足太阴经，到达皮肤，行气于三阴，以去除阴寒之邪。石膏的甘寒，从气分走出手足阳明经，到达肌肉，行气于三阳，以去除风热之邪。用它们的甘味入土，用它们的寒热气性来调和阴阳，用它们善于走窜的性质来发越脾气。再用甘草和中，调和寒热缓急。两药相合，协同成功。必须用大枣补脾中的血，用生姜的辛味，益胃中的气。怕风的，因为阳虚，所以加附子以入阳分；风水病，则加白术以散发皮肤间的风水之气，发谷精以宣通营卫，与麻黄、石膏为使药，引导其入土。越婢这个名字，不也很合适吗？
皮水病，表现为四肢浮肿，水气在皮肤中，四肢微微跳动的，用防己茯苓汤主治。
防己茯苓汤方
防己（三两） 黄芪（三两） 桂枝（三两） 茯苓（六两） 甘草（二两）
以上五味药，用水六升，煮取二升，分三次温服。
〔衍义〕这个证候与风水脉浮，用防己黄芪汤相同，但有浅深之别。风水病，脉浮在表，土气不发，用白术、姜、枣发越它。这是皮水郁遏了营卫，手太阴肺经不宣通，金郁者泄之，水停者用淡渗利之，所以用茯苓代替白术。营卫不得宣行的，用辛甘发散，所以用桂枝、甘草代替姜、枣。《内经》说：肌肉蠕动，名叫微风。因为四肢微微跳动，是风在营卫，触动经络而动，所以桂枝、甘草也能治疗它。
甘草麻黄汤方
甘草（二两） 麻黄（四两）
以上两味药，用水五升，先煮麻黄，去掉上面的沫，加入甘草，煮取三升，温服一升。覆盖衣被使出汗，不出汗再服。注意防风寒。
〔衍义〕这一条只说了里水，没有叙述脉证，与前条里水用的汤剂相同，为什么列出两个？难道也有不同吗？前条里水证，只针对身体浮肿，小便不利，亡失津液而口渴的情况，大体上是一个经的病，随着其气化变化而变化，难以一一列举。其经的邪气不明显，变化不可详述，只在方剂的佐使之药的增减上如何罢了。
水病，脉象沉小，属于少阴。脉浮的是风，无水。虚胀的是气水，发汗就好了。脉沉的，宜用麻黄附子汤。脉浮的，宜用杏子汤。
麻黄附子汤方
麻黄（三两） 甘草（二两） 附子（一枚炮）
以上三味药，用水七升，先煮麻黄去沫，加入其他药物，煮取二升半，温服八分，每日三次。
〔衍义〕少阴主水，其性寒。这一条都是少阴证。不仅仅是脉沉小的属于它。只是因为它从风出于表，水不内积，所以说无水。如果不因风，只是肾脉上入于肺而虚胀的，则名叫气水。然而肾水和风水，已有治法，唯独气水分脉浮沉。发汗，是由少阳水寒之邪，其根本还在里，阴未变，故用麻黄散水，附子治寒。脉浮的，其水已从肾上逆于肺的标部，居于阳分了，变得不寒了，于是用杏子汤，在肺中降逆气。注解说未见其汤，恐怕就是麻黄杏子石膏甘草汤，都是发汗散水的，唯独附子、杏仁分表里罢了。
〔衍义〕这个病讲水病，不讲病形的状况，只说只用蒲灰散，为什么呢？大体上这个证候与第一章相同，但第一章用发汗法，这个是得之于厥，所以治法不同。厥者是逆，由少阴经肾气逆上入肺，肺与皮毛相合，所以逆气溢出经络，经络的血凝涩，与肾气结合，化而为水，充满于皮肤，所以叫皮水。用蒲黄消散经络的滞涩，利小便为君药；滑石开窍通水，作为佐药。小便通利则水下行，逆气下降。与第一章皮水两条相比，有气血虚实之不同，从这里就可以看出张仲景随机应用的治法了。
问：黄汗之为病，身体肿（一作重），发热，出汗，口渴，状如风水，汗沾衣服，颜色正黄如柏树汁，脉自沉，是怎么得的？老师说：因为出汗时，进入水中洗浴，水从汗孔进入而得的。宜用黄芪芍药桂枝苦酒汤主治。
黄芪芍药桂枝苦酒汤方
黄芪（五两） 芍药（三两） 桂枝（三两）
以上三味药，用苦酒一升，水七升相和，煮取三升，温服一升。应当心烦，服至六七天乃解。如果心烦不解的，是因为苦酒阻碍的缘故。（一方用美酒醋代替苦酒）
〔衍义〕汗本是津液。津液泄出则卫气虚。水血同类，属阴。水进入则营分寒，寒则气郁，郁则发热。水热相搏于分肉之间，则身体浮肿。营气出于中焦，营的郁热内蓄于脾，则津液不行而口渴。卫气虚，腠理不固，则出汗。脾土发热，则黄色见于面部如柏树汁。所以补卫气是关键。黄芪益气，入皮毛，肥满腠理，退热止汗的功效尤其显著，所以作为君药。桂枝理血，入营分散寒，通血脉，解肌肉，用它来调营以和卫，所以作为臣药。营气因邪气阻碍，不利于运行，芍药能收阴气，所以佐助桂枝。一阴一阳以利其营。苦酒即醋，用它使药引入血分以散滞。注解说一方用美酒，美酒性热入心，可以导致心烦。醋只刺激心而不导致心烦，不知哪个正确。
Liver Water Disease presents with abdominal distension, inability to turn the body independently, pain in the hypochondrium and abdomen, occasional slight production of saliva, and intermittent patency of urination.
[Commentary] The Foot-Jueyin Liver Meridian passes through the external genitalia, reaches the lower abdomen, flanks the stomach, belongs to the Liver, connects with the Gallbladder, and spreads over the hypochondriac region. Now, pathogenic factors lodge in this meridian, damaging the generating Qi and the Yang energy of the Liver, thus causing such diseases. However, the Liver is located inferiorly and governs dispersion and drainage. Although constrained by water-dampness, there are times when fluids can be slightly generated, allowing urination to temporarily flow freely.
Lung Water Disease presents with generalized edema, difficulty in urination, and frequent passage of loose stools resembling duck feces.
[Commentary] The Lung governs the skin and hair, circulates Ying (Nutritive) and Wei (Defensive) Qi, and has a interior-exterior relationship with the Large Intestine. Now, in water disease, Ying blood is stagnant and Wei Qi is stationary, leaving only the Po (Corporeal Soul) residing alone. Yang Qi is exhausted on the exterior, so water fills the skin. The Lung normally regulates water passages, transporting fluids downward to the Bladder to form urine. Now that these passages are blocked, water cannot exit via urination but instead follows its interior-extior pair into the Large Intestine, mixing with waste to form duck-like loose stools.
Spleen Water Disease presents with abdominal distension, heavy and burdensome limbs, lack of fluid generation, shortness of breath, and difficult urination.
[Commentary] The Spleen resides in the middle jiao and governs the four limbs, having an interior-exterior relationship with the Stomach. Its meridian enters the abdomen from the foot, belongs to the Spleen, and connects with the Stomach; it is a Yin organ. The middle jiao stores substances. Now, water stagnates in the Spleen, causing Spleen and Stomach Qi to fail to move, accumulating in the middle, hence abdominal distension. The limbs do not receive grain essence, hence feeling heavy. Grain essence is not distributed, hence fluids are not generated. If the cardia of the Stomach fails to digest, Zong (Gathering) Qi becomes deficient, leading to shortness of breath. If the pylorus fails to open, water accumulates, leading to difficult urination.
Kidney Water Disease presents with abdominal distension, umbilical swelling, lower back pain, inability to urinate, dampness in the genital area resembling sweat on a cow's nose, cold feet, and a thin face.
[Commentary] The Foot-Shaoyin Kidney Meridian originates at the sole of the foot, follows the medial malleolus, penetrates the spine, belongs to the Kidney, and connects with the Bladder, serving as the gate of the Stomach. Now, water resides in the Kidney, the gate is dysfunctional, causing water accumulation, resulting in abdominal distension, umbilical swelling, lower back pain, and inability to urinate. The Kidney is the sea of water; since water is in the sea, its taste must be salty. Salty flavors tend to seep outward, causing dampness like sweat on a cow's nose. When salty-water pathology arises, Heart Fire must retreat and become weak, leaving only isolated Yin, hence cold feet. As Heart Fire retreats, Ying, Wei, and all Yang Qi retreat, failing to nourish the upper body, and Spleen-Stomach grain essence fails to ascend via meridians to the facial skin, hence emaciation.
The Master said: For all water diseases, if swelling is below the waist, promote diuresis; if swelling is above the waist, induce sweating for recovery.
[Commentary] Why distinguish between promoting diuresis and inducing sweating based on the waist? Roughly, the upper half of the body corresponds to Heaven and Yang; the lower half corresponds to Earth and Yin. The body's interstices circulate the Yang of Heaven, while urination corresponds to the Yin of Earth. Thus, water stagnating in the Heaven sector (upper body) disperses via opening the interstices (sweating); water stagnating in the Earth sector (lower body) exits via opening the gate (diuresis). This aligns with the *Neijing* method of "opening the ghost door" (sweating) and "cleansing the mansion" (diuresis).
The Master said: If the Cun Kou pulse is deep and slow, deep indicates water, slow indicates cold. Cold and water contend. The Fu Yang pulse is hidden, indicating failure to digest food and drink. Spleen Qi deficiency leads to loose stools; Stomach Qi deficiency leads to bodily swelling. The Shaoyang pulse is low/weak (sound: qie), and the Shaoyin pulse is fine. In men, this causes difficult urination; in women, menstrual obstruction. Menstrual blood belongs to Blood; if Blood does not flow smoothly, it transforms into water, named Blood Partition (Xue Fen).
[Commentary] Zhang Zhongjing's pulse diagnosis often combines Cun Kou and Fu Yang. Why? Cun Kou belongs to the Lung, passing through the Hand-Taiyin meridian. The Lung meets all vessels, and the twelve meridians manifest at Cun Kou in their respective seasons. Spleen and Stomach meridians appear at the right Guan position. The Stomach is the sea of food and drink; all five Zang organs derive Qi from it, making it the root of the five Zang and the key to all meridians. If pathogens affect the Stomach, one must re-examine Fu Yang. Fu Yang, at Chongyang on the dorsum of the foot, is the source of the Stomach meridian. Here, Cun Kou deep indicates water, slow indicates cold. This is not an external pathogen but a disease of the Stomach-Spleen and Chong (Penetrating) vessels. Because Yang Qi of food and drink is not distributed, the Five Yangs become deficient and exhausted, generating cold. The Yin of the Lower Jiao Blood Sea fails to generate and transform, condensing internally, generating water. Water and cold contend, and the twelve meridians, deriving from the Stomach, change and manifest at Cun Kou. Spleen and Stomach are interior-exterior pairs. Spleen Qi deficiency prevents assisting the Stomach in transporting fluids, causing turbid and clear to mix internally, leading to loose stools. Stomach Qi deficiency prevents moving Qi to the Three Yangs, causing Yang pathways to fail on the exterior, leading to swelling of muscles and flesh. Since both meridians are obstructed, the Fu Yang pulse hides. Pathogens in the Blood Sea, governed by the Chong vessel, which emerges with the Great Collateral of the Kidney below the Kidney, determine the decline of Tian Gui in both sexes. *Neijing* states: The Kidney is the official of strength, where skills emerge. Since Bian Que divided the two kidneys left and right, considering the Right Kidney storing essence for men and governing conception for women, the Chong and Ren vessels belong to its function. Wang Shuhe placed both kidneys in the Left and Right Chi positions, attributing them to the Foot-Shaoyin meridian, paired with the Bladder and Foot-Taiyang as their exterior-interior partners. However, the theory of Foot-Taiyang descending from the Left Chi having an interior-exterior relationship with the San Jiao derives from *Lingshu*, stating Foot San Jiao exits at Weiyang, a branch of Taiyang, belonging to Hand Shaoyin, entering the Bladder with Taiyang's main branch, constraining the Lower Jiao. Excess leads to retention. It also states: San Jiao is the middle ditch vessel, where waterways emerge; the Bladder is the solitary vessel. Now, pathogens contend with the Blood Sea, belonging to the Right Kidney's storage, with San Jiao as its vessel. Thus, men and women must be distinguished by Yin-Yang, Qi-Blood, and Interior-Exterior. In women, it is Yin; Blood Sea disease. In men, it is Yang; San Jiao disease. The Chong vessel is not one of the Twelve Major Meridians but appears attached to the Foot-Shaoyin pulse. Therefore, in men, a革 (Ge) Shaoyang pulse indicates San Jiao Qi non-transformation, leading to difficult urination. In women, a fine Shaoyin pulse indicates menstrual obstruction. Menstrual blood is Blood; if Blood does not flow smoothly, it transforms into water, named Blood Partition. Although difficult urination due to water is not solely due to Qi, it can also result from Blood issues, as seen in formulas like Puhuang San treating Blood diseases.
Question: A patient suffers from water disease, with swelling of the face, eyes, body, and limbs, and difficult urination. Pulse diagnosis does not mention water but mentions chest pain, Qi rushing up to the throat, feeling like a piece of roasted meat is stuck, accompanied by slight cough and wheezing. If true as the Master said, what kind of pulse would it be? The Master said: The Cun Kou pulse is deep and tight. Deep indicates water, tight indicates cold. Deep and tight contend, knotting at the Guanyuan point. Initially, it was slight, unnoticed in youth. After Yang declines, Ying and Wei interfere, Yang damages, Yin becomes excessive. The knotted cold moves slightly, Kidney Qi rushes up, blocking the throat, causing hypochondriac knotting pain. The physician mistook it for retained fluid and used severe purgation, but the Qi strike remained, and the disease persisted. Later, strong emesis was used, causing Stomach deficiency irritability, dry throat craving water, difficult urination, undigested food and drink, and swelling of the face, eyes, hands, and feet. Then Tingli Wan was given to drain water; symptoms improved slightly, but overeating caused swelling to return. Chest and hypochondriac distress resembled Ben Tun (running piglet) syndrome. Water overflowing caused floating cough and wheezing. One should first attack the Rushing Qi to stop it, then treat the cough. Once the cough stops, the wheezing heals naturally. Treat new diseases first; old diseases follow later.
[Commentary] This water disease, where pulse diagnosis mentions chest pain instead of water, seemed strange to recorders, but it is not strange; it is derived from color and pulse. Deep pulse indicates water, tight indicates cold and pain. Water-cold belongs to the Kidney. The Foot-Shaoyin meridian ascends from the Kidney through the Liver and Diaphragm, enters the Lung, follows the throat, and its branch exits the Lung to connect with the Heart, injecting into the chest. Whenever Kidney Qi rebels, it travels with the Chong vessel, creating Rushing Qi. Following the meridian's path, it strikes healthy Qi wherever it goes, causing disease. Know that the disease began at Guanyuan. The five Zang and six Fu organs have strength or weakness, prosperity or decline, all visible on the face, differentiated by five organs and five colors. Guanyuan is the Lower Ji, meeting the Foot-Yin meridians and Ren Mai. Cold knotting at Guanyuan means the Kidney area's color will be slightly withered and black, indicating a chronic Bi syndrome, not acute. After Yang declines, Ying and Wei become abnormal, Yin and Yang reverse, and the knotted cold attacks Kidney Qi upward, causing these symptoms. Physicians did not treat the Rushing Qi but used vomiting and purging, damaging the Stomach, causing undigested food and drink, lack of fluids, thirst, and difficult urination. Consequently, water overflowed to the face, eyes, and limbs, causing edema. Rushing Qi struck more violently due to deficiency, causing symptoms resembling Ben Tun and wheezing/coughing. One must first treat the root of the Rushing Qi. When Rushing Qi stops and Kidney Qi calms, other symptoms heal. If not healed, tonify Yang, purge Yin, move water, support the Stomach, and unblock the chronic Bi at Guanyuan in sequence.
Wind-Water disease with a floating pulse, heaviness, sweating, and aversion to wind is treated with Fangji Huangqi Tang. Add Shaoyao if there is abdominal pain. (Formula see Wetness Disease chapter)
[Commentary] Floating pulse indicates exterior. Sweating and aversion to wind indicate exterior deficiency. Heaviness indicates water lodging in the muscle intervals. Fangji treats wind-edema and water-swelling, opening interstices. Huangqi warms muscle intervals, tonifying Wei deficiency. Baizhu treats skin wind and stops sweating. Gancao harmonizes herbs and benefits Earth. Shengjiang and Dazao are pungent-sweet and dispersing. Abdominal pain is due to blockage of Yin and Yang Qi, preventing ascending and descending, so add Shaoyao to gather Yin.
Wind-Water disease with aversion to wind, generalized edema, floating pulse without thirst, continuous spontaneous sweating, and no significant heat is treated with Yuespi Tang.
Yuespi Tang Formula
Mahuang (6 liang) Shigao (0.5 jin) Shengjiang (3 liang) Dazao (12 pieces) Gancao (2 liang)
Take these five herbs, boil in 6 sheng of water. First boil Mahuang, remove foam. Add other herbs. Boil to obtain 3 sheng. Divide into three warm doses. If aversion to wind exists, add one prepared Fuzi. If Wind-Water, add 4 liang Baizhu. (From *Gujin Luyan*)
[Commentary] Ying is Yin; Water is Yin. Wei is Yang; Wind is Yang. Each follows its kind. Cold water injures Ying; hot wind injures Wei. The Spleen is the root of Ying; the Stomach is the source of Wei. If Ying is injured, the Stomach responds with disease. If the Spleen is diseased, Yin knots internally, failing to harmonize with the Stomach to transport fluids. If the Stomach is diseased, Yang knots internally, failing to harmonize with the Spleen to distribute grain Qi. Thus, Ying and Wei cannot receive the robust essence of food and drink, leading to Qi depletion, inability to fatten interstices (causing aversion to wind), and inability to fill muscles/skin, allowing pathogens to spread, causing generalized edema. The floating pulse is the Wind-Water floating pulse from Chapter 1. Continuous spontaneous sweating occurs because wind occasionally opens interstices. No significant heat exists because wind-heat is in the Wei level, and Wei itself does not generate significant heat. Lack of thirst is due to no internal accumulated heat and no massive sweating externally, so fluids are not consumed. Use Yuespi Tang. This contrasts with the previous Li Shui (Interior Water) with a deep pulse. Why use this formula? Li Shui is caused by knotting of the Spleen's Three Yin transforming into water, unable to ascend, so this decoction promotes ascent. This case has exterior deficiency, aversion to wind, and continuous sweating, aiming to promote Middle Jiao grain Qi to distribute Ying and Wei. Dong Yuan said: If Upper Qi is insufficient, push and elevate it. Although these cases differ in interior/exterior, both require promoting Spleen Qi, treated with one formula. Some say: Mahuang regulates blood vessels, opens pores/skin, dissipates cold-water; Shigao releases the muscle layer and clears wind-heat. Why speak of promoting Spleen Qi rather than pharmacology? Answer: Zhang Zhongjing names formulas like Qinglong and Baihu, each with specific intent. Is Yuespi random? Heaven, humanity, and all things are connected by Qi. Pathogens affect humans by lodging in similar categories; one must borrow similar substances to expel them, achieving much with little effort. Not only expelling pathogens, but also promoting Spleen Qi, with no herb out of place. Is this not Zhang Zhongjing's intention in naming the formula? The five Zang each have Yin and Yang, but only the Spleen and Stomach reside in the center, belonging to both. Spleen governs Yin, Stomach governs Yang. From the perspective of flow, Earth is one of the Five Elements; from the perspective of generation, the Four Qi form only after Earth, so all things are born of Earth and return to Earth. However, Earth does not just form the Four Qi; Earth forms from the Four Corners, not just Fire generating Earth. Thus, the Yin of Water in the Four Qi corresponds to the Spleen; the Yang of Wind-Heat corresponds to the Stomach. Food and drink of five flavors and hot/cold entering the Spleen and Stomach are the same. Any interference causes Spleen Qi disharmony and Stomach Qi uncleanness, preventing transformation of grain essence to nourish Ying and Wei and solidify Yin-Yang. Sweet flavor is the native position of Earth. If Spleen Qi is unclean, clear it with sweet-cold. To act upon it, it must travel meridians; to combine with it, it must connect collaterals. Collaterals are distinct vessels connecting Zang-Fu. Thus, Mahuang's sweet-hot travels from Yin-blood through Hand-Foot Taiyin meridians to the skin, moving Qi in the Three Yin to remove Yin-cold pathogens. Shigao's sweet-cold travels from Qi-level through Hand-Foot Yangming meridians to the muscle, moving Qi in the Three Yang to remove Wind-heat pathogens. Use their sweet flavor to enter Earth, their cold-hot nature to harmonize Yin-Yang, and their traveling nature to promote Spleen Qi. Use Gancao to harmonize the middle, balancing cold-hot and urgency. These two herbs cooperate for success. Use Dazao to tonify Spleen blood, and Shengjiang's pungency to benefit Stomach Qi. For aversion to wind (Yang deficiency), add Fuzi to enter Yang. For Wind-Water, add Baizhu to scatter Wind-Water Qi in the skin, releasing grain essence to disseminate Ying and Wei, acting as guides with Mahuang and Shigao to lead into Earth. Is the name Yuespi not appropriate?
Pi Shui (Skin Water) disease presents with limb swelling, water qi in the skin, and slight tremors in the limbs, treated with Fangji Fuling Tang.
Fangji Fuling Tang Formula
Fangji (3 liang) Huangqi (3 liang) Guizhi (3 liang) Fuling (6 liang) Gancao (2 liang)
Take these five herbs, boil in 6 sheng of water, obtain 2 sheng. Divide into three warm doses.
[Commentary] This condition is similar to Wind-Water with a floating pulse using Fangji Huangqi Tang, but differs in depth. Wind-Water has a floating pulse at the exterior, with Earth Qi not emerging, treated with Baizhu, Jiang, and Zao to promote it. This is Pi Shui depressing Ying and Wei, with Hand-Taiyin not diffusing. Metal depression requires draining; water stagnation requires light permeation. Thus, use Fuling instead of Baizhu. For Ying-Wei not diffusing, use pungent-sweet to scatter. Thus, use Guizhi and Gancao instead of Jiang and Zao. *Neijing* says: Muscle twitching is called mild wind. Limb tremors indicate wind in Ying-Wei, touching meridians and moving. Thus, Guizhi and Gancao can also treat it.
Li Shui (Interior Water) is treated with Yuespi Jia Zhu Tang. Gancao Mahuang Tang is also effective.
Yuespi Jia Zhu Tang Formula (See above, add 4 liang Baizhu)
Gancao Mahuang Tang Formula
Gancao (2 liang) Mahuang (4 liang)
Take these two herbs, boil in 5 sheng of water. First boil Mahuang, remove foam. Add Gancao. Boil to obtain 3 sheng. Warm dose 1 sheng. Cover to induce sweating. If no sweat, take again. Avoid wind and cold.
[Commentary] This section only mentions Li Shui, without describing pulse/symptoms, identical to the previous Li Shui treatment. Why list both? Perhaps there is a difference. The previous Li Shui case focused on body swelling, difficult urination, fluid loss, and thirst, generally a single meridian disease changing with Qi transformation, hard to enumerate. Its meridian pathogen was unclear, changes indeterminate, relying on adjustments in assistant herbs.
Water disease with a deep/small pulse belongs to Shaoyin. A floating pulse indicates Wind, no water. Deficient bloating indicates Qi-Water. Inducing sweating resolves it. Deep pulse suits Mahuang Fuzi Tang. Floating pulse suits Xingzi Tang.
Mahuang Fuzi Tang Formula
Mahuang (3 liang) Gancao (2 liang) Fuzi (1 prepared)
Take these three herbs, boil in 7 sheng of water. First boil Mahuang to remove foam. Add other herbs. Boil to obtain 2.5 sheng. Warm dose 8 fen, three times daily.
Xingzi Tang Formula (Missing, likely Mahuang Xingren Gancao Shigao Tang)
[Commentary] Shaoyin governs Water, its nature is cold. This section concerns Shaoyin syndromes. Not just deep/small pulses belong to it. Because it emerges from Wind at the exterior, water does not accumulate internally, hence "no water." If not due to Wind, but simply Kidney Qi ascending to the Lung causing deficient bloating, it is named Qi-Water. However, Kidney-Water and Wind-Water already have treatments. Only Qi-Water distinguishes by floating/deep pulses. Induce sweating. The pathogen is Shaoyang cold-water, rooted in the interior, Yin unchanged, so use Mahuang to scatter water and Fuzi to treat cold. Floating pulse indicates water has rebelled from Kidney to Lung's superficial aspect, residing in Yang, becoming non-cold. Thus, use Xingzi Tang to descend rebellious Qi in the Lung. Commentary notes the formula is missing, likely Mahuang Xingren Gancao Shigao Tang, all promoting sweating and scattering water, differing only in Fuzi and Xingren distinguishing interior/exterior.
Jue (Cold Extremities) with Pi Shui (Skin Water) is treated with Puhui San. (Formula see Xiao Ke chapter)
[Commentary] This water disease description lacks physical signs, mentioning only Puhui San. Why? Generally, this condition is similar to Chapter 1, but Chapter 1 uses sweating, whereas this results from Jue, so treatments differ. Jue means rebellion. Kidney Qi from the Shaoyin meridian rebels upward to the Lung. The Lung combines with skin/hair, so rebellious Qi overflows meridians. Meridian blood stagnates, combining with Kidney Qi, transforming into water, filling the skin, hence Pi Shui. Use Puhuang to dissipate meridian stasis and promote urination as the sovereign herb; Huashi opens orifices and unblocks water as the assistant. When urination flows, water descends, rebellious Qi lowers. Compared to the two Pi Shui sections in Chapter 1, there are differences in Qi-Blood and Deficiency-Excess, showing Zhang Zhongjing's flexible application.
Question: Huang Han (Yellow Sweat) disease presents with body swelling (or heaviness), fever, sweating, thirst, resembling Wind-Water. Sweat stains clothes yellow like cypress juice. Pulse is naturally deep. How is it contracted? The Master said: It is contracted when sweating, bathing in water, allowing water to enter through sweat pores. Treat with Huangqi Shaoyao Guizhi Kujiu Tang.
Huangqi Shaoyao Guizhi Kujiu Tang Formula
Huangqi (5 liang) Shaoyao (3 liang) Guizhi (3 liang)
Take these three herbs, mix with 1 sheng of Kujiu (vinegar/wine) and 7 sheng of water. Boil to obtain 3 sheng. Warm dose 1 sheng. Mental restlessness may occur; resolve after 6-7 days. If restlessness persists, it is due to Kujiu obstruction. (Alternative formula uses good wine/vinegar instead of Kujiu)
[Commentary] Sweat is originally Jin (fluids). Fluid loss makes Wei Qi deficient. Water and Blood are similar, belonging to Yin. Water entry makes Ying cold; cold causes Qi stagnation; stagnation causes fever. Water-heat contend in muscle intervals, causing body swelling. Ying emerges from the Middle Jiao; Ying's stagnant heat accumulates in the Spleen, preventing fluid generation, causing thirst. Wei Qi deficiency and insecure interstices cause sweating. Spleen Earth heat causes yellow color on the face like cypress juice. Tonifying Wei Qi is crucial. Huangqi benefits Qi, enters skin/hair, fattens interstices, reduces heat, and stops sweating, serving as the sovereign herb. Guizhi regulates blood, enters Ying to scatter cold, unblocks vessels, and resolves muscles, used to harmonize Ying and Wei, serving as the minister herb. Ying Qi is obstructed by pathogens, hindering flow. Shaoyao gathers Yin Qi, assisting Guizhi. One Yin, one Yang to benefit Ying. Kujiu is vinegar. Use it to guide drugs into the Blood level to dissipate stasis. Commentary notes an alternative uses good wine; good wine is hot, enters the Heart, causing restlessness. Vinegar stimulates the Heart without causing restlessness. Uncertain which is correct.