一条 师曰。病有风水。有皮水。有正水。有石水。有黄汗。风水。其脉自浮。外证骨节疼痛。恶风。皮水。
其脉亦浮。外症
肿。按之没指。不恶风。其腹如鼓。不渴。当发其汗。正水。其脉沉迟。外症自喘。石水。其脉自沉。外症腹满。不
喘。
黄汗。其脉沉迟。身发热。胸满。四肢头面肿。久不愈。必致痈脓。
本篇之水。与二篇之湿。及前十二篇之饮。似属一因。而必列为三门者。固自有所区别也。盖自其无水饮之
形。而但有其气者。曰湿。及聚湿成形。则曰饮、曰水矣。但湿、从汗气郁于毛窍所致。则湿当仅在玄府矣。不知
汗由胃腑之精悍所化。其潮热之气。自其既离脏腑。未出皮外者。俱能随地致湿。此汗剂之后。必用五苓、猪
苓等汤。以泄汗梢。而湿门之仍主葛根汤者。此也。是湿为已成之津液。却化为汗而不得出。又不能复为津
液之症也。若夫水饮二物。似属无辨矣。殊不知仲景之意。以为饮汤、饮水。滞于肠间。不能下注。因而上浮旁
鼓。凡曰痰、曰支、曰悬、曰溢、等症。是所饮者未曾变相而即为病。故曰饮。至水之所病。已由胃而小肠。及膀胱
矣。但因小便不利。膀胱为太阳之腑。太阳主经表皮肤。故其水气。由太阳之腑。而上浮外鼓。以及太阳之部
者也。是水症。虽亦由于饮。至此而已变为水相。故曰水也。然饮症中。惟伏饮与水颇同。故论饮者。亦间曰肺
水云云者。此耳。风水者。三时之风邪。客于卫分。而卫气自强。卫强则下阴之水气。上就而贴之之症也。皮
水者。经脉虚于外。小便难于下。在下之水邪既实。而见吸于外络之虚受。故水走皮肤矣。正水者。水在正路。
如肠中胃中是也。石水。言其沉坠似之也。黄汗者。后文三十条。言汗出浴水中。水入汗孔。且水寒激之。令卫
气沉伏。卫无包裹之权。故湿热之气外溢。而为色黄之汗也。五症。俱为水因。且症颇相似。故连及之耳。太阳
受风。卫气悬强。膀胱之水。不由下注。而上蒸经络。故其脉自浮。风水交搏。渐致阴气不通。而阳气鼓塞。故骨
节疼痛。恶风者。风与风相入。卫气既经受邪。而外风直侵毛窍故也。皮水。由膀胱而上蒸。与风水同义。特外
无风邪一症耳。故其脉亦浮。 。足外 骨也。 肿者。水在下焦而外泛之应。按之没指。水至外薄于皮者。
其下为尤甚也。无风因。故不恶风。其腹如鼓、水至外薄于皮者。其里为尤甚也。不渴者。既无阳邪化热之风
因。且有腹中之水内拒耳。当发其汗。总承风水、皮水、而言。以水在卫分及皮部中。俱以开玄府为便道也。从
膀胱而垫小肠及胃者。为正水。是虚寒而不能气化之候也。夫沉。为水脉。迟。为寒诊。脉之见沉迟也。宜矣。水
寒之气上射。故喘也。石水之脉单沉。是有水而不寒之应。有水。故腹满。不寒。故不喘也。但经言肝肾并沉为
石水。则石水之腹满。当在肠外肝肾之部。始与正水有别耳。黄汗为水入汗孔。水入。故脉沉。水寒激伏其卫
气。故沉而且迟矣。汗郁则身发热。水寒遏其汗气。而倒灌于胸分。则胸满矣。四肢。为阳气之充。头面。为阳气
之会。水与汗两郁之。故肿也。郁久不散。气败则痈。气败以致血败。则脓矣。
二条 脉浮而洪。浮、则为风。洪、则为气。风气相搏。风强则为隐疹。身体为痒。痒为泄风。久为痂癞。气
强、则为水。难
以俯仰。风气相击。身体洪肿。汗出乃愈。恶风则虚。此为风水。不恶风者。小便通利。上焦有寒。其口多涎。此为黄
汗。
脉、当就全部而言。以后条各部。俱有所指。故知独言脉者。为统论诸部也。风为阳邪。其性高扬。故浮、则知为
风中于卫。气属阳分。有余即火。故洪、即知为气郁在表也。风气相搏。风得气抬而益浮。气得风鼓而益洪之
义。强者。劲直也。风强。言风邪燥血。而经气干热。故皮中隐含斑疹。而身体为痒。所以然者。因内无血液以送
邪出表。而风自泄越。故痒、则名为风泄也。痒久。则变为疮痂。流为疥癞。所必至矣。气强。言阳不内抱而怒发。
则下水代营阴而上赴之。如龙水相吸之象。故气强。则为水也。难以俯仰者。以水风与气三者。争鼓于经脉
中。而身体洪肿故也。汗出。则风水及气。俱从毛孔散去。而浮洪之脉自平。故愈。若前症具而更加恶风。是卫
气虚甚之故。发汗药中。宜加滋阴养阳之品。在言外矣。此风水之正病也。不恶风五句。单顶肿字而言。非承
全症也。盖谓若身肿而不恶风。是无风因。小便通利。是无水因。且上焦有寒。其口多涎。明系水寒之气。从汗
孔而内注胸中。以致肺不能布津液之故也。是非风水。而为黄汗无疑矣。三十条言黄汗曰状如风水。故
于风水条中。辨其似是而非者。
三条 寸口脉沉滑者。中有水气。面目肿大。有热。名曰风水。视人之目窠上微拥。如蚕新卧起状。其颈脉动。
时时
咳。按其手足上。陷而不起者风水。
上条言周身之风水。故统六部而概曰脉。统上下而概曰身体洪肿。此条言上半截之风水。故言脉。则但曰
寸口。言症。则但曰面目。目窠、颈脉与咳。及手足之肿而已。寸口上应头目。内应胸中。外应卫表者也。今其脉
见沉滑。沉、为气伏之诊。滑、为水聚之应。是其上焦及卫外之气。为风所贼而下伏。因而水气乘虚而上泛外
鼓。其初机已见。故知其中有水气也。中字。非指在里在内之谓。犹云水肿之症。虽未全见。而此几微之中。便
可预识矣。盖因下文所言者。俱经表之候。而非脏腑故也。以脉合之。外症当见面目肿大。盖寸口上为面目
之应。寸口脉沉。则在上之阳气伏于下。寸口脉滑。则在下之阴气乘于上矣。此言水因也。夫沉滑之脉。不当
热而有热。岂非属阳邪。而善能化热之风因所致乎。故曰风水。下文六句。又就沉滑之脉。而更推其最初之
候也。言具此脉者。不必面目肿大。及有热二症。而始知其为风水。但如此者即是。目窠上。即上眼胞也。蚕之
渐长。凡三次脱皮者曰卧。卧起。则弯腰上扬如乙字。而光亮有水色。目窠上。为善动之地。阳气之所聚也。微
微拥起。其光亮之状。如新卧起之蚕。若非风贼阳微。而水气安能乘善动之地乎。颈脉。足阳明第九穴人迎。
所以布胃气于头面者。是也。其脉躁急跳动。又岂非风因、水因。两客于上。而阻抑其上行之气之所致乎。肺
逆。则咳。风水之邪伤卫表。而倒灌胸分。故肺逆而时时咳矣。手足。为诸阳之末。微阳搏于风而内敛。则水得
因虚而先犯之。故肿。但按之即起者。为气肿。气属无形。故一时而即能乍还。按之不起者。为水肿。水属有形。
故经时而后能渐复也。曰风水者。言见此即是。无使滋蔓难图也。门人问曰。卫阳为风所贼。水气即奔赴
之而成风水。是矣。然水之所以奔赴风邪者。是何理乎。且何道之从而上与风邪相搏耶。又二条之脉。曰浮
洪。三条之脉。曰沉滑。同一风水。而脉之所以悬殊者。抑又何说也。答曰。晴明太虚。风飙忽起。阳光渐薄。而阴
云上乘。积阴成雨。阁而未下者。风水之象也。若夫地以水气而升为云。天即以云气而悬为雨。气之升沉。即
水之变化。亦何道路之可拟哉。至于二三条之脉症。其卫气盛衰之所别也。卫气盛而被风。气就风而搏于
外。故脉浮洪。然搏于外者。卫必虚于内。而水气乘之者。水天黄亮之象也。卫气衰而被风。气畏风而伏于下。
故脉沉滑。夫伏于下者。气必空于上。而水气蒙之者。雨天沉晦之象也。法象莫大乎天地。仲景之书。直抉天
地之奥者乎。
四条 太阳病。脉浮而紧。法当骨节疼痛。反不疼。身体反重而 。其人不渴。汗出即愈。此为风水。恶寒者。
此为极
虚。发汗得之。渴而不恶寒者。此为皮水。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。
痛在骨节。咳而喘。不渴者。此为脾胀。其状如肿。发汗即愈。然诸病此者。渴而下利。小便数者。皆不可发汗。
太阳病。统言太阳诸症。如头项强痛之类。其脉浮而且紧。夫浮、为太阳脉。紧、为寒为痛。太阳为风邪所持。其
骨节之气。郁而不得外通。则必疼痛。今脉症应疼不疼。而身体反重而 者。以重、属水因。而 、属风因也。盖
脾肺恶湿气。而水滞其轻灵之用。故重。骨节喜通利。而风郁其外畅之神。故 也。是脉之所以见紧者。以水
寒之气。浮于太阳可知矣。不渴者。阳邪之风因较轻。而拒饮之水因偏重也。风水之邪。两解于汗。故汗出即
愈。此为风水。与二条之候不同。二条为风、水、俱重之症。此则水多于风。风少。故骨节不疼。水多。故反重而不
渴也。恶寒二句。是就未得风水以前而言。非指既成之候也。盖谓恶寒之故。先因他病而发其汗。汗出。则卫
气薄而毛窍疏。毛窍疏。故被风。卫气薄。故水气外凑之。而致此病云。但按一条曰恶风。二条曰恶风则虚。本
条曰恶寒者。极虚发汗得之。则风水之症。有必恶风者。以有风因。则毛孔疏泄。而畏外风之薄之者。如三条
及本条之症是矣。有不该恶风者。卫盛而与风邪搏于外。则表实。表实而恶风。是其人卫气原盛。而先曾以
发汗暴虚之之故。如二条之症是矣。其曰恶风则虚者。是不当恶而恶之义也。若此条。则不但恶风。而并恶
寒者。是其虚更甚。故二十四条之汤。君黄 以补卫气。二十五条之汤。加附子以温卫气者此也。第一条言
皮水。则曰不渴。此又曰渴而云云为皮水。非矛盾也。盖皮水。多由于肠胃之正水所外溢者。肠胃热而小便
不利。因而热蒸于外而为皮水者。则热水蒸烫而渴。肠胃寒而医反下之。因而气虚水泛。而为皮水者。则水
寒之气内拒。故不渴也。注详后文六条。至一条曰不恶风、不渴。此条曰渴而不恶寒。俱借风水之恶风、恶寒。
而细辨皮水之所以异耳。不言正水、石水者。以皮水之初候。多由正水或从石水而成。是言皮水。而正水、石
水。在其中故也。水与汗气同争表分。故身肿。水寒激伏其卫气。故身冷也。周痹者。周身之气俱卑弱。客邪外
入。故身肿。阳气内陷。故身冷。其症颇同。故取以状之耳。胸中窒。见一条胸满注。不能食。详上焦竭则善噫下。
水寒之气内逼。故聚痛。暮则微阳愈伏。而阴气出而用事。外与水寒之邪相接。则微阳有不安之象。故躁而
不得眠也。此为黄汗之下。又承身肿聚痛二症。而辨脾胀者。正所以详黄汗之症。而非添论脾胀也。盖言痛。
若不聚胸中。而在骨节。并咳喘而不渴者。此为脾气满而作胀。便不得认为黄汗矣。以脾肺相须为用。脾胀
而上侵肺。则肺气不行。故身肿。且骨节之神内郁。故痛。又肺逆则咳而喘矣。肺受脾胀之上冲。而肺中之津
液。自结而不四布。故不渴也。此为脾胀。见非黄汗之水汗交郁者比。故曰如肿也。发汗即愈。统指上文五症
而言。玩下文诸病此。并皆不可等字自见。然一切肿胀诸病。虽有渴症。但凡兼见下利。与小便数而自利者。
则其气机已经下泄。而且上焦之液自干。又皆不可发汗。以上夺其气血。而使之立尽也。伤寒、金匮之例。
但凡言小便数者。俱作不利。盖言短而数也。独本条及后文六条。曰小便数者。皆指小便利而言。其指数而
且长耶。细玩自见。
五条 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。故令渴也。
越婢加术汤主之。
越婢加术汤方 麻黄（六两） 石膏（半斤） 甘草（二两） 生姜（二两） 大枣（十五枚擘）
白术（六两）
上六味。以水六升。先煮麻黄。去上沫。内诸药。煮取三升。分温三服。
里水者。谓水从肠胃。及肝肾之正水石水发根。水势内大。而弥漫于外者。与风水、皮水之外虚而招水者不
同。故曰里水也。黄者。水泛土浮之象。肿者。水抬气鼓之象。一身面目黄肿。言一身以至面目。从下而上肿也。
沉则内应于脉。小便不利。则外应于症。故令积水于内。而浮泛于外耳。若一身面目黄肿。假令小便自利。此
必曾因汗、吐、下。以亡其津液。故令各吸其水以自润。因致渴而病水者。盖谓责在干处。吸饮而渴。故令黄肿。
不宜责在小便矣。主本汤者。卫不虚。而水邪又实其营分。故君麻黄。泄汗以泄水也。水积汗闭。必有淤热。此
发黄之根蒂。且虞麻黄发越太猛。故佐辛凉镇坠之石膏者。一举而两得也。虽曰里水。其头已经上泛外鼓。
而至一身面目。则其在上在外之标病为急。故佐守中之甘草。托之上行外出之义。然后以辛温之生姜。以
行其阳。以甘润之大枣、滋其液。则虽汗、而于气血无所损伤矣。此仲景主越婢之深意也。至于水之为性。既
去而犹有余湿者。常也。重加理脾培土之白术者。譬之荡寇之兵在前。而扫除窜匿。抚绥流亡。却收功于和
平敦浓之后军耳。但细按本方。以之主小便自利一症。允为的对。若上段之候。本文既曰里水。又曰小便不
第一条 老师说：疾病有风水、皮水、正水、石水、黄汗这五种。风水，其脉象自然浮起，外在症状是骨节疼痛，怕风。皮水，其脉象也浮起，外在症状是浮肿，按压后凹陷不起，不怕风，腹部像鼓一样胀满，口不渴，应当用发汗的方法治疗。正水，其脉象沉而迟，外在症状是自发性气喘。石水，其脉象自然沉，外在症状是腹部胀满，不喘。黄汗，其脉象沉而迟，身体发热，胸部胀满，四肢及头面部浮肿，如果久治不愈，必然导致痈脓。
本篇所说的“水”，与第二篇的“湿”，以及前十二篇的“饮”，似乎病因相同，但必须列为三个门类，自然是有区别的。大概从没有水饮的形态，而只有气的状态来说，叫做“湿”。等到湿气聚集形成有形之物，就叫做“饮”或“水”了。但是，湿是由于汗气郁结在毛孔所致，那么湿应该只在玄府（汗孔）。不知道汗是由胃腑中精悍之气所化生的，那种潮热之气，自从离开脏腑、尚未透出皮肤之外时，都能随地造成湿气。这就是为什么在使用发汗剂之后，必须用五苓散、猪苓汤等方剂来排泄残留的汗气，而湿病门类中仍然以葛根汤为主的原因。这是说，湿是已经形成的津液，却化为汗而不能排出，又不能恢复为津液的病症。至于水和饮两样东西，似乎难以区分。殊不知张仲景的本意认为，喝下的汤水，停滞在肠间，不能向下灌注，因而向上浮动并向旁鼓胀。凡是称为痰、支饮、悬饮、溢饮等病症，都是所饮之物未曾发生形态变化就直接成为疾病，所以称为“饮”。至于水所致的疾病，已经由胃传至小肠，再及膀胱。但因为小便不利，膀胱作为太阳之腑，太阳主管经脉、体表和皮肤，所以其水气从太阳之腑向上浮动向外鼓胀，波及到太阳经所属的部位。这种水症，虽然也是由于饮发展而来，但到这里已经变成了水的形态，所以称为“水”。然而，在饮症中，只有伏饮与水颇为相似，所以在论述饮的时候，也偶尔提到肺水等等，就是这个原因。
所谓风水，是三时的风邪客居于卫分，而卫气强盛，卫气强则下部的阴水之气上趋依附于它，这是一种病症。所谓皮水，是经脉在外虚弱，小便难以向下通利，在下部的水邪既已充实，而表现出对外络虚弱的吸引，所以水走窜于皮肤之间。所谓正水，是水在正常的通道里，比如肠中、胃中就是。所谓石水，是说其下沉坠的感觉像石头一样。所谓黄汗，在后文第三十条中提到，是因为出汗时洗冷水澡，水进入汗孔，且水寒刺激它，使卫气沉伏，卫气失去包裹固摄的能力，所以湿热之气外溢，形成黄色的汗液。这五种病症，都是因为水引起的，而且症状颇为相似，所以连在一起论述。
太阳经受风邪侵袭，卫气悬滞强盛，膀胱中的水气不由下注，而是向上蒸腾经络，所以其脉象自然浮起。风水相互搏结，逐渐导致阴气不通，阳气鼓塞，所以骨节疼痛。怕风，是因为风邪与风邪相入，卫气既然受到邪气侵袭，而外风直接侵犯毛窍的缘故。皮水，是由膀胱向上蒸腾，与风水意义相同，只是外在没有风邪这一症状罢了。所以其脉象也浮起。[此处原文有缺字，推测为“胕”]足外侧踝骨。浮肿，是水在下焦而向外泛溢的反应。按压后凹陷不起，说明水气到达外部紧贴皮肤的地方，其下部更为严重。因为没有风邪的原因，所以不怕风。腹部像鼓一样胀满，说明水气到达外部紧贴皮肤的地方，其内部更为严重。口不渴，是因为既没有阳邪化热的风邪原因，而且有腹中的水气在内抗拒。应当发汗，总括风水和皮水而言，因为水在卫分和皮部中，都以开通玄府作为排泄的途径。从膀胱进而垫衬小肠及胃的，就是正水，这是虚寒而不能气化的证候。沉脉，是水脉；迟脉，是寒诊。脉象出现沉迟，是适宜的。水寒之气向上射入，所以气喘。石水的脉象单纯沉，是有水而不寒的反应。因为有水，所以腹部胀满；因为不寒，所以不喘。但经文说肝肾脉并沉为石水，那么石水的腹部胀满，应当在肠外肝肾的部位，这才与正水有所区别。黄汗是因为水进入汗孔，水进入，所以脉沉；水寒激惹并潜伏卫气，所以脉沉而且迟。汗气郁结所以身体发热；水寒遏制汗气，而倒灌于胸膈部位，所以胸部胀满。四肢，是阳气充盛之处；头面，是阳气汇聚之所。水与汗两者郁结，所以浮肿。郁结久了不散，气败坏则生痈，气败坏导致血败坏，则成脓。
第二条 脉象浮而洪大。浮，代表风；洪，代表气。风邪与气相互搏结，风邪强盛则出现隐疹，身体瘙痒，瘙痒称为泄风，日久变成疮痂疥癞。气邪强盛，则导致水肿，难以俯仰。风邪与气邪相互搏击，身体高度浮肿，出汗后痊愈。如果怕风，则是正气虚弱，这属于风水。不怕风的，小便通利，上焦有寒，口中多涎，这属于黄汗。
脉象，应当就全身脉象而言，因为后面几条对各部脉象都有具体指向，所以知道单独说脉象，是对各部位的总体论述。风是阳邪，其性质高扬，所以浮脉就知道是风邪中于卫分。气属于阳分，有余即为火，所以洪脉就知道是气郁结在体表。风邪与气邪相互搏结，风得到气的抬举而更加浮起，气得到风的鼓动而更加洪大。所谓“强”，是指劲直。风邪强盛，指风邪燥伤血液，而经气干燥发热，所以皮肤中隐含斑疹，而身体瘙痒。之所以这样，是因为体内没有血液来送邪出表，而风邪自行泄越，所以瘙痒被称为风泄。瘙痒日久，则变为疮痂，流变为疥癞，这是必然的结果。气邪强盛，指阳气不能内守而怒发，则下水代替营阴而上赴，如同龙与水相互吸引的景象。所以气邪强盛，则导致水肿。难以俯仰，是因为水、风、气三者，在经脉中争着鼓动，而身体高度浮肿的缘故。出汗，则风水及气，都从毛孔散去，而浮洪的脉象自然平和，所以痊愈。如果前面的症状具备而更加怕风，这是卫气非常虚弱的缘故，在发汗药中，应当加入滋阴养阳的药物，这话在言外之意了。这是风水的正病。不怕风的五句话，单承接“肿”字而言，不是承接全部症状。大概意思是说，如果身体浮肿而不怕风，是没有风邪的原因；小便通利，是没有水邪的原因；而且上焦有寒，口中多涎，明显是水寒之气，从汗孔向内注入胸中，导致肺不能布散津液的缘故。这不是风水，而是黄汗无疑。第三十条说黄汗说“状如风水”，所以在风水条中，辨别那些似是而非的情况。
第三条 寸口脉象沉滑的，中间有水气，面目肿大，伴有发热，名叫风水。观察人的眼胞上方微微隆起，像蚕刚睡醒起来的样子，颈部脉搏跳动，时常咳嗽，按压其手足背部，凹陷不能立即弹起的，是风水。
上一条说的是周身的风水，所以统括六部脉概称为脉，统括上下概称为身体高度浮肿。这一条说的是上半截的风水，所以说脉，只说寸口；说症状，只说面目、眼胞、颈脉与咳嗽，以及手足的肿胀而已。寸口上部对应头目，内部对应胸中，外部对应卫表。现在脉象出现沉滑，沉，是气机潜伏的诊象；滑，是水气聚集的反应。这说明上焦及体外的卫气，被风邪贼害而下伏，因而水气乘虚而上泛外鼓，其初始机理已经显现，所以知道其中含有水气。“中”字，不是指在里在内的意思，犹如说水肿的病症，虽然还没有完全显现，但在这些细微征兆之中，就可以预先识别了。大概因为下文所说的，都是经表的征候，而不是脏腑的缘故。结合脉象来看，外在症状应当见面目肿大。盖因寸口上部对应面目，寸口脉沉，则在上部的阳气伏于下部；寸口脉滑，则在下部的阴气乘势于上部。这是在说水邪的原因。沉滑的脉象，本不应有热而却有热，难道不是属阳邪，而且是善于化热的风邪所致吗？所以叫风水。下文六句，又是针对沉滑的脉象，进一步推究其最初的征候。说具备这种脉象的人，不必等到面目肿大及有热这两个症状出现，才知道是风水，只要像这样就是。眼胞上方，即上眼睑。蚕逐渐长大，凡三次蜕皮的叫做“卧”。卧起，则弯腰上扬如乙字，而光亮有水色。眼胞上方，是容易活动的地方，是阳气汇聚之处。微微隆起，那光亮的样子，像新睡醒起来的蚕，如果不是风邪贼害阳气微弱，而水气怎么能乘虚占据容易活动的地方呢？颈脉，是足阳明胃经第九穴人迎穴，是用来将胃气布散到头面的。其脉躁急跳动，又岂不是风邪、水邪两者客居在上，而阻抑其上行之气所导致的吗？肺气上逆，则咳嗽。风水的邪气伤害卫表，而倒灌胸膈部位，所以肺气上逆而时常咳嗽。手足，是诸阳之末，微弱的阳气搏结于风邪而内敛，则水气得因虚而先侵犯它，所以浮肿。但如果按压后即刻弹起的，是气肿。气属于无形，所以一时就能立刻恢复。按压后不起的，是水肿。水属于有形，所以要经过一段时间后才能逐渐恢复。说风水，是说见到这种情况就是，不要让病情滋蔓难图。门人问：卫阳被风邪贼害，水气随即奔赴而形成风水，这是对的。然而水之所以奔赴风邪的，是什么道理呢？而且通过什么道路从而上与风邪相搏呢？还有第二条的脉象，说浮洪；第三条的脉象，说沉滑。同样是风水，而脉象之所以悬殊的，又有什么说法呢？回答说：晴朗太虚，风飙忽然兴起，阳光渐薄，而阴云上乘，积阴成雨，阁而未下的，就是风水的景象。至于大地以水气上升为云，天空就以云气悬挂为雨，气的升沉，就是水的变化，又有什么道路可以比拟的呢？至于二三条的脉症，其区别在于卫气的盛衰。卫气盛而被风邪侵袭，气就随风邪搏结于外，所以脉象浮洪。然而搏结于外的，卫气必定虚弱于内，而水气乘虚而入的，是水天黄亮的景象。卫气衰而被风邪侵袭，气畏惧风邪而潜伏于下，所以脉象沉滑。夫潜伏于下的，气必定空虚于上，而水气蒙蔽的，是雨天沉晦的景象。法象没有比天地更大的了，仲景的书，是直接揭示天地奥秘的吗？
第四条 太阳病，脉象浮而紧，按照常理应当骨节疼痛，反而不疼，身体反而沉重而麻木。其人不觉口渴，出汗即愈，这是风水。如果怕冷，这是极度虚弱，是因发汗不当导致的。如果口渴而不怕冷，这是皮水。身体浮肿而冷，症状像周痹，胸中窒闷，不能进食，反而聚痛，傍晚烦躁不得睡眠，这是黄汗。疼痛在骨节，咳嗽气喘，口不渴，这是脾胀。其症状像浮肿，发汗即愈。然而所有患此病的人，如果口渴且腹泻，小便频数的，都不可发汗。
太阳病，是统言太阳的各种症状，如头项强痛之类。其脉象浮而且紧。浮，是太阳脉；紧，主寒主痛。太阳被风邪所持留，其骨节之气，郁结而不能外通，则必然疼痛。现在脉症应当疼却不疼，而身体反而沉重而麻木的，因为沉重属于水邪原因，而麻木属于风邪原因。大概脾肺厌恶湿气，而水气阻滞了其轻灵的作用，所以沉重。骨节喜欢通利，而风邪郁结阻碍了其外畅的神机，所以麻木。这就是脉象之所以见紧的原因，是因为水寒之气浮于太阳可知。口不渴，是因为阳邪的风邪原因较轻，而拒饮的水邪原因偏重。风水的邪气，通过发汗得以两解，所以出汗即愈。这是风水，与第二条的证候不同。第二条是风、水俱重的病症，这里则是水多于风，风少，所以骨节不疼；水多，所以反而沉重且不渴。怕冷的两句，是针对未得风水之前而言，不是指已经形成的证候。大概意思是说，怕冷的原因，先前因为其他疾病而发汗，汗出，则卫气薄弱而毛窍疏松。毛窍疏松，所以被风邪侵袭；卫气薄弱，所以水气外凑，而导致此病。但按第一条说恶风，第二条说恶风则虚，本条说恶寒者，是极虚发汗导致的，那么风水的病症，有必然恶风的，因为有风邪原因，则毛孔疏泄，而畏外风薄侵的，如第三条及本条的症状就是这样。有不该恶风的，卫气盛而与风邪搏结于外，则表实。表实则恶风，是其人卫气原本强盛，而先前曾以发汗使其暴虚的缘故，如第二条的症状就是这样。其说“恶风则虚”，是不当恶而恶的意思。若此条，则不但恶风，而且并恶寒的，是其虚更甚，所以第二十四条的汤剂，以黄芪为君药以补卫气，第二十五条的汤剂，加附子以温卫气，就是这个原因。第一条说皮水，则说不渴，这里又说渴而云云为皮水，并不矛盾。大概皮水，多由于肠胃的正水向外溢出的。肠胃热而小便不利，因而热蒸于外而为皮水的，则热水蒸烫而口渴；肠胃寒而医生反而攻下，因而气虚水泛，而为皮水的，则水寒之气内拒，所以不渴。注释详见后文第六条。至第一条说不恶风、不渴，本条说渴而不恶寒，都是借风水之恶风、恶寒，而细致辨别皮水之所以不同的地方。不说正水、石水的，是因为皮水的初候，多由正水或从石水而成，是说皮水，而正水、石水就在其中了。水与汗气同争表分，所以身体浮肿。水寒激惹并潜伏卫气，所以身体冷。周痹，是周身之气都卑弱，客邪外入，所以身体浮肿；阳气内陷，所以身体冷。其症状颇同，所以取用来形容它。胸中窒闷，参见第一条胸满注。不能进食，详看上焦竭则善噫下。水寒之气内逼，所以聚痛。傍晚则微阳更加潜伏，而阴气出来用事，外与水寒之邪相接，则微阳有不安之象，所以烦躁而不得睡眠。这是黄汗之下，又承接身肿聚痛两个症状，而辨别脾胀的，正是为了详细阐述黄汗的症状，而不是新增讨论脾胀。大概说痛，如果不聚于胸中，而在骨节，并咳喘而不渴的，这是脾气满而作胀，便不能认为是黄汗了。因为脾肺相须为用，脾胀而上侵肺，则肺气不行，所以身体浮肿。而且骨节的神机内郁，所以痛。又肺逆则咳而喘了。肺受脾胀的上冲，而肺中的津液，自结而不能四布，所以不渴。这是脾胀，见非黄汗之水汗交郁者可比，所以说像浮肿。发汗即愈，总指上文五种症状而言。玩味下文诸病此，并皆不可等字自然明白。然而一切肿胀诸病，虽然有口渴症状，但凡兼见腹泻，与小便频数而自利的，则其气机已经下泄，而且上焦之液自干，又都不可发汗。以上夺其气血，而使之内立尽也。伤寒、金匮的体例，但凡说小便数的，都作不利解。大概说短而数。唯独本条及后文第六条，说小便数的，都指小便利而言。其指数而且长耶？细细玩味自然明白。
第五条 里水，一身面目黄肿，其脉沉，小便不利，所以令病水。假如小便自利，这是亡失津液，所以令口渴。用越婢加术汤主治。
越婢加术汤方 麻黄（六两） 石膏（半斤） 甘草（二两） 生姜（二两） 大枣（十五枚掰开） 白术（六两）
以上六味药，用水六升，先煮麻黄，去掉上面的沫，加入其余药物，煮取三升，分三次温服。
里水，是说水从肠胃，及肝肾的正水石水发根，水势内大，而弥漫于外的，与风水、皮水之外虚而招水者不同，所以叫里水。黄，是水泛土浮的景象。肿，是水抬气鼓的景象。一身面目黄肿，是说一身以至面目，从下而上肿。沉则内应于脉，小便不利，则外应于症，所以令积水于内，而浮泛于外耳。如果一身面目黄肿，假如小便自利，这必定曾因汗、吐、下法，以亡其津液，所以令各吸其水以自润，因而致渴而病水。大概说是责在干处，吸饮而渴，所以令黄肿，不宜责在小便了。主用本汤，是因为卫不虚，而水邪又实其营分，所以以麻黄为君药，泄汗以泄水。水积汗闭，必有淤热，这是发黄的根蒂，而且担心麻黄发越太猛，所以佐以辛凉镇坠的石膏，一举两得。虽曰里水，其头已经上泛外鼓，而至一身面目，则其在上在外的标病为急，所以佐以守中的甘草，托之上行外出之义，然后以辛温的生姜，以行其阳，以甘润的大枣、滋其液，则虽出汗，而对气血无所损伤了。这是仲景主用越婢的深意。至于水的性质，既去而犹有余湿的，是常态。重加理脾培土的白术，譬如荡寇之兵在前，而扫除窜匿，抚绥流亡，却收功于和平敦浓之后军耳。但细按本方，以之主小便自利一症，确为对症。若上段的证候，本文既曰里水，又曰小便不
Article 1 The Master said: There are five types of water disorders: Fengshui (Wind-water), Pishui (Skin-water), Zhengshui (Standard-water), Shishui (Stone-water), and Huanghan (Yellow sweat). In Fengshui, the pulse is naturally floating. The external manifestations include pain in the bones and joints, and aversion to wind. In Pishui, the pulse is also floating. The external manifestations include edema that leaves an indentation when pressed, aversion to wind is absent, abdominal distension like a drum, and absence of thirst. Treatment should involve inducing sweating. In Zhengshui, the pulse is deep and slow. The external manifestation is spontaneous panting. In Shishui, the pulse is naturally deep. The external manifestation is abdominal fullness without panting. In Huanghan, the pulse is deep and slow, accompanied by fever, chest fullness, and edema of the limbs, head, and face. If untreated for a long time, it will inevitably lead to sores and pus.
The "water" discussed in this chapter, along with "dampness" in the second chapter and "fluid retention" in the preceding twelve chapters, seems to share a common etiology. However, they are listed as three separate categories because there are inherent distinctions. Generally, when there is no morphological form of fluid retention but only the presence of Qi, it is called "dampness." When dampness aggregates into a tangible form, it is called "fluid retention" or "water." Dampness arises from sweat Qi stagnating in the hair follicles (Xuanfu); thus, dampness should theoretically remain only at the Xuanfu. However, sweat is transformed from the vigorous essence of the Stomach. This humid heat Qi, once leaving the Zang-Fu organs but before exiting the skin, can generate dampness anywhere. This explains why after using diaphoretic formulas, one must use formulas like Wuling San (Five-Ingredient Powder with Poria) or Zhuling Tang (Polyporus Decoction) to drain residual sweat Qi. It also explains why Gegen Tang (Kudzu Decoction) remains the primary formula for dampness disorders. This indicates that dampness is already-formed body fluids that have transformed into sweat but cannot be excreted, nor can they revert to normal body fluids. As for water and fluid retention, they seem indistinguishable. Yet, Zhang Zhongjing's intent was that ingested liquids stagnating in the intestines, unable to descend, float upward and expand laterally. Conditions such as Tan (Phlegm), Zhi Yin (Branch Fluid Retention), Xuan Yin (Hanging Fluid Retention), and Yi Yin (Overflowing Fluid Retention) represent diseases where the ingested liquid has not changed form before becoming pathological; hence, they are called "fluid retention." Water disorders, however, involve progression from the Stomach to the Small Intestine and Bladder. Due to difficult urination, and since the Bladder is the Fu organ of the Taiyang channel, which governs the meridians, exterior, and skin, the water Qi floats upward and expands outward from the Taiyang Fu organ to the Taiyang meridian regions. Although water disorders originate from fluid retention, by this stage, they have transformed into the state of "water," hence the name. Among fluid retention disorders, only Fuyin (Hidden Fluid Retention) is similar to water. Thus, when discussing fluid retention, references to Fei Shui (Lung Water) occasionally appear.
Fengshui occurs when wind pathogens of the three seasons invade the Wei (Defensive) level. The Wei Qi becomes strong; this strength causes Yin water Qi from below to ascend and adhere to it. Pishui occurs when the meridians are deficient externally, and urination is difficult downward. The water pathogen in the lower part becomes substantial, attracting the deficiency of the external collaterals, causing water to move through the skin. Zhengshui refers to water residing in its normal pathways, such as in the intestines and stomach. Shishui is named for its sinking and heavy sensation, resembling stone. Huanghan is described in Article 30: sweating while bathing in cold water allows water to enter the pores. Cold water stimulates and submerges the Wei Qi, depriving it of its enveloping power. Consequently, damp-heat Qi overflows externally, producing yellow sweat. These five conditions are all caused by water and have similar symptoms, hence they are discussed together.
When the Taiyang channel is affected by wind, the Wei Qi becomes suspended and strong. Water Qi in the Bladder does not descend but steams upward into the meridians, resulting in a floating pulse. The interaction between wind and water leads to obstruction of Yin Qi and congestion of Yang Qi, causing bone and joint pain. Aversion to wind occurs because wind pathogens penetrate each other, and external wind directly invades the hair follicles after the Wei Qi has been compromised. Pishui involves steaming upward from the Bladder, sharing the same mechanism as Fengshui, except for the absence of external wind pathogens. Hence, the pulse is also floating. [Text missing, likely referring to ankle bone]. Edema is the response of water in the lower Jiao overflowing outward. Indentation upon pressing indicates water reaching the skin, with severity increasing downwards. Absence of aversion to wind confirms the lack of wind pathogens. Abdominal distension like a drum indicates water affecting the interior more severely than the exterior. Absence of thirst suggests neither heat-transforming wind pathogens nor internal rejection by abdominal water. Inducing sweating is indicated for both Fengshui and Pishui because water in the Wei level and skin layers is best drained via opening the Xuanfu.
Zhengshui results from water moving from the Bladder to the Small Intestine and Stomach, representing a pattern of deficiency-cold and failure of Qi transformation. A deep pulse indicates water; a slow pulse indicates cold. Thus, a deep-slow pulse is appropriate. Water-cold Qi shooting upward causes panting. Shishui presents with a purely deep pulse, indicating water without cold. Abdominal fullness results from water; absence of panting results from absence of cold. However, the classic states that simultaneous deep pulses of Liver and Kidney indicate Shishui; thus, abdominal fullness in Shishui should be located outside the intestines in the Liver-Kidney region, distinguishing it from Zhengshui. In Huanghan, water entering the pores causes a deep pulse. Cold water submerging Wei Qi causes a deep and slow pulse. Stagnant sweat causes fever. Cold water obstructing sweat Qi and forcing it backward into the chest causes chest fullness. The limbs are where Yang Qi is abundant; the head and face are where Yang Qi converges. Stagnation of both water and sweat causes edema. Prolonged stagnation leads to Qi decay, generating sores; Qi decay leads to Blood decay, generating pus.
Article 2 A floating and surging pulse. Floating indicates wind; surging indicates Qi. Wind and Qi battling each other: if Wind is stronger, it causes hidden rashes and body itching. Itching is termed "Xiefeng" (Leaking Wind); prolonged cases develop crusts and scabies. If Qi is stronger, it causes water retention, making flexion and extension difficult. If Wind and Qi strike each other violently, severe body edema occurs; recovery follows sweating. Aversion to wind indicates deficiency, classifying this as Fengshui. Absence of aversion to wind, with free urination, cold in the Upper Jiao, and excessive salivation, classifies this as Huanghan.
The pulse description refers to the whole body, as subsequent articles specify parts. Wind is a Yang pathogen with ascending nature; a floating pulse indicates wind invading the Wei level. Qi belongs to the Yang division; excess manifests as fire; a surging pulse indicates Qi stagnation at the exterior. Wind and Qi battling means wind lifts Qi (making it more floating) and Qi drums Wind (making it more surging). "Strong" implies rigidity. Strong Wind dries the blood and causes dry-heat in the meridians, leading to hidden rashes and itching. Since there is insufficient blood to expel the pathogen, wind leaks out, causing itching ("Wind Leakage"). Prolonged itching leads to sores and scabies. Strong Qi implies Yang failing to hold inward and erupting; water replaces Ying-Yin and ascends, resembling dragon-water attraction, causing water retention. Difficulty in movement results from water, wind, and Qi battling in the meridians, causing severe edema. Sweating disperses wind, water, and Qi through the pores, normalizing the pulse and curing the disease. If aversion to wind is added, it indicates severe Wei Qi deficiency; nourishing Yin and tonifying Yang should be added to diaphoretics. This is the typical presentation of Fengshui. The five sentences regarding "no aversion to wind" specifically address edema, not the entire syndrome. Body edema without aversion to wind lacks wind etiology; free urination lacks water etiology. Cold in the Upper Jiao with excessive saliva indicates cold-water Qi entering the chest via pores, impairing Lung distribution of fluids. This is Huanghan, not Fengshui. Article 30 describes Huanghan as resembling Fengshui; thus, differentiation is necessary here.
Article 3 A deep and slippery pulse at the Cun Kou (Radial artery) indicates internal water Qi. Swelling of the face and eyes with fever is named Fengshui. Observing slight swelling above the eye sockets, resembling a silkworm just waking up, pulsation of the neck vessels, frequent coughing, and pitting edema on the hands and feet that does not rebound immediately confirm Fengshui.
The previous article discussed generalized Fengshui; this article focuses on the upper body. Cun Kou corresponds to the head/eyes internally and the Wei exterior externally. A deep pulse indicates submerged Qi; a slippery pulse indicates gathered water. Wind has harmed the Upper Jiao and Wei Qi, causing them to sink, allowing water Qi to rise and expand. This initial sign indicates internal water Qi. "Middle" here does not mean interior but implies that even before full edema appears, these subtle signs allow prediction. The symptoms described are exterior, not Zang-Fu related. Combining pulse and symptoms: facial swelling corresponds to Cun Kou. Deep pulse means Yang Qi sinks; slippery pulse means Yin Qi rises. This describes the water etiology. Fever with a deep-slipse pulse suggests Yang pathogenic wind transforming into heat. The following six sentences elaborate on the earliest signs based on the deep-slipse pulse. One need not wait for full facial swelling or fever; these signs suffice. Swelling above the eye socket (upper eyelid) resembles a silkworm shedding skin, bright and watery. This area is active and gathers Yang Qi. Slight swelling indicates wind harming weak Yang, allowing water to invade. Neck vessel pulsation refers to the Renying point (ST9), distributing Stomach Qi to the head. Agitated pulsation indicates wind and water pathogens obstructing ascending Qi. Lung rebellion causes coughing due to wind-water invading the Wei and flooding the chest. Hands and feet are the extremities of Yang. Weak Yang retreating inward allows water to invade first, causing edema. Non-pitting edema indicates Qi edema (formless, rebounds quickly); pitting edema indicates Water edema (tangible, rebounds slowly). Early diagnosis prevents progression. A student asked: Why does water rush to wind? What path does it take? Why do Articles 2 and 3 show different pulses (floating-surging vs. deep-slippe) for the same condition? The answer uses analogy: Wind rising, sun fading, clouds gathering, rain forming—this is Fengshui. Water evaporating to clouds, clouds condensing to rain—Qi movement mirrors water transformation. The pulse differences reflect Wei Qi strength. Strong Wei battling wind externally yields floating-surging pulse (Yang brightness); weak Wei hiding from wind internally yields deep-slippe pulse (Yin obscurity). Zhang Zhongjing’s work reveals the mysteries of Heaven and Earth.
Article 4 Taiyang disease with a floating-tight pulse typically presents with bone/joint pain. If there is no pain but instead heaviness and numbness, and no thirst, sweating cures it; this is Fengshui. Chills indicate extreme deficiency caused by improper sweating. Thirst without chills indicates Pishui. Body edema with coldness, resembling Zhoubi (generalized bi-syndrome), chest oppression, inability to eat,集聚 pain, evening restlessness, and insomnia indicate Huanghan. Pain in joints with cough/panting and no thirst indicates Pi Zhang (Spleen Distension), resembling edema, cured by sweating. However, if patients with these conditions have thirst plus diarrhea or frequent urination, sweating is contraindicated.
Taiyang disease encompasses symptoms like stiff neck. Floating-tight pulse usually means wind-cold blocking bone Qi, causing pain. Heaviness stems from water; numbness from wind. Spleen and Lungs dislike dampness; water stagnation causes heaviness. Joints prefer freedom; wind stagnation causes numbness. Tight pulse reflects floating cold-water Qi in Taiyang. No thirst indicates mild wind and strong water rejection. Sweating resolves both wind and water. This differs from Article 2 (heavy wind and water); here, water exceeds wind, explaining lack of joint pain and presence of heaviness/no thirst. Chills refer to pre-disease state: prior sweating weakened Wei Qi and opened pores, inviting wind and water. Article 1 mentions aversion to wind; Article 2 links aversion to wind with deficiency; Article 4 links chills with extreme deficiency from sweating. Some Fengshui cases have aversion to wind (wind opens pores); others do not (strong Wei battles wind externally, causing surface excess). Extreme deficiency causes both wind and cold aversion, treated with Huangqi (Astragalus) or Fuzi (Aconite) as per Articles 24-25. Article 1 says Pishui has no thirst; Article 4 says Pishui has thirst. This is not contradictory. Pishui from intestinal heat with poor urination causes thirst (heat steaming). Pishui from cold intestines due to purgative abuse causes no thirst (cold water rejecting internally). See Article 6 note. Articles 1 and 4 contrast Fengshui/Pishui symptoms to differentiate them. Zhengshui and Shishui are omitted because Pishui often originates from them. Water and sweat competing at the exterior cause edema; cold water submerging Wei Qi causes coldness. Zhoubi shares similarities with Huanghan (weak Qi, external pathogen, internal Yang depression). Chest oppression and anorexia relate to Upper Jiao dysfunction.集聚 pain in the evening results from Yin dominance meeting cold-water pathogen, disturbing weak Yang. Huanghan is differentiated from Pi Zhang: joint pain/cough/no thirst indicates Pi Zhang (Spleen distension affecting Lung), not Huanghan. Spleen-Lung interaction failure causes edema, joint pain, and cough. Lung fluid stagnation causes no thirst. Sweating cures all five conditions mentioned. However, sweating is contraindicated if thirst accompanies diarrhea or frequent urination, as Qi and fluids are already depleted downward; sweating would deplete remaining Qi and Blood. Note: "Frequent urination" in Shanghan/Jingui usually means difficult urination, but here it implies free, frequent urination.
Article 5 Li Shui (Interior Water) presents with yellow edema of the whole body and face, deep pulse, and difficult urination, causing water disease. If urination is free, it indicates loss of body fluids causing thirst. Yuebi Jia Zhu Tang (Yuebi Decoction plus Atractylodes) is indicated.
Yuebi Jia Zhu Tang Formula: Mahuang (Ephedrae Herba, 6 liang), Shigao (Gypsum Fibrosum, 0.5 jin), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 2 liang), Dazao (Jujubae Fructus, 15 pieces), Baizhu (Atractylodis Macrocephalae Rhizoma, 6 liang). Boil the six ingredients in 6 sheng of water. First boil Mahuang, remove foam. Add other herbs. Boil to 3 sheng. Divide into three warm doses.
Li Shui originates from Zhengshui/Shishui in the intestines, liver, and kidneys, with massive internal water spreading outward. Unlike Fengshui/Pishui (external deficiency attracting water), Li Shui is internal origin. Yellow color indicates water overflowing earth; edema indicates water lifting Qi. Swelling from lower body to face indicates ascending water. Deep pulse and difficult urination confirm internal accumulation and external overflow. If urination is free despite edema, it indicates prior damage to fluids (via sweating/vomiting/purging), causing thirst and compensatory water absorption. Treatment should focus on fluid restoration, not diuresis. Yuebi Jia Zhu Tang is used because Wei Qi is not deficient, but water fills the Ying level. Mahuang induces sweating to drain water. Stagnant water causes heat (root of yellowing); Shigao clears heat and calms aggression. Although Li Shui, the upper/exterior symptoms are urgent. Gancao supports upward/outward movement. Shengjiang promotes Yang; Dazao nourishes fluids. This protects Qi and Blood during sweating. Baizhu removes residual dampness, acting like rear-guard troops securing peace. The formula is precise for free urination with edema. For the upper section described as Li Shui with difficult urination...