饮。即水也。伤寒停饮症最多。每见于太阳少阴。临症者都忽此。因备述之以便查阅。
如太阳中风。渴欲饮水。水入即吐者。名曰水逆。五苓散主之。此水停于胸中。故水入不能容也。
邵评∶太阳中风。表未解也。渴则风热而传里。渴欲饮水。水气不行。而反上逆。则
吐。是为水逆。必其人素有水气。邪水内结。用五苓散导水泄热。的是正法。
又评∶水逆者。其人必素有水气。中宫之阳气不宣。邪水凝结于内。水饮拒绝于
外。既不外输元府而为汗。又不上输于口舌而渴饮。亦不下输膀胱而小便不利。此水逆所由名也。
如误下之。心下痞。与泻心汤。痞不解。其人渴。而口燥烦。小便不利者。五苓散主之。
此治痞而痞不解。反渴。亦水停心下之故。非痞也。水停心下。则津液不得上升。故渴。
邵评∶下后成痞。与泻心汤而痞不解。心下有水气。饮邪内蓄。热结膀胱。气不输
化。因反上逆。故见渴而躁烦。小便不利等症。与五苓散利水泄热。使小便利。则痞与消渴俱止矣。
如脉浮。小便不利。微热消渴者。与五苓散主之。此小便不利。渴而能消水者。水蓄膀胱也。脉浮
身热。病在太阳也。故用五苓微汗以利水则愈。
邵评∶脉浮微热。表未尽除也。渴而消水。小便反不利。是水气与热邪内结膀胱
而未散也。与五苓散导水泄热。内有桂枝。兼治其表。而微汗之。盖此小便不利。
渴而能消水者。水蓄膀胱也。脉浮身热。病在太阳也。故用五苓微汗以利水。则愈。
凡服五苓。多饮暖水取汗者。欲其散达营卫。表里俱解也。
邵评∶暖水可多服。则水逆者是冷水。水能制火而润土。水土合和。则气化流通。
同五苓散解表泄热。而病自愈也。然水亦不可恣饮。少少与之。胃和则愈。如多
饮。必致水气为患。而有悸喘等病矣。
太阳中风。其人 汗出。头痛心下痞。硬满引胁下痛。干呕短气。汗出恶寒者。此
表解。内有蓄水也。十枣汤攻之。（以上诸条皆太阳热邪停水）
邵评∶此外中风邪。内有悬饮之症。其人汗出头痛。似乎表症。然不恶寒发热。心
下痞硬而满。牵引胁下而痛。干呕短气等症。是表邪已解。心下之水气湿热泛溢。上攻于脑。而头痛
汗出也。既知其表之风邪已解。而里之水气淫溢。用十枣汤攻其饮而下其气。此治悬饮内踞。水荡
三焦之正法。然必审其表邪已解。然后可攻其饮。
太阳伤寒。表不解。发热无汗。干呕而咳。或渴。或利。或喘。或小便不利者。此心下有
水气也。宜小青龙汤。外散寒邪。内散寒饮。
邵评∶发热无汗。是表不解。干呕而咳。是水气为患。饮寒相抟。逆于肺胃之间也。
饮之为病。随气升降。水气下而不上。则或渴或利。上而不下。则或喘或噎。留而
不行。则小便不利。表寒与水饮。内外合邪。用小青龙汤。以两解表里之邪。立加减法。以治或然之症也。
如咳而微喘。发热不渴。服小青龙汤已。反渴者。此寒饮去也。
邵评∶内饮外寒。相得不解。水气射肺。为咳而微喘。水气上升。是以不渴。服小青
龙已。而反渴者。水气内散。寒邪亦外散也。
解肌或下之后。仍头项强痛。发热无汗。心下满。微痛。小便不利者。此有水气在心
下也。宜桂枝去桂。加茯苓白术汤主之。小便利则愈。
邵评∶头项强痛。发热无汗。表未解也。心下满。微痛。饮在里也。此表邪与水饮凝
结不解。病根在心下。而病机在膀胱。当察其小便。若小便利。病为在表。仍当发汗。若小便不利。病为
在里。是太阳之本病。非桂枝未罢也。故去桂枝而加苓术。不欲散邪于表。故但饮逐于里。饮去。则表
邪亦解矣。因此水结中焦。只可利而不可散。病不在表。而去桂枝。加苓术者。所以利小便而燥停水也。
此症头痛发热。表症仍在。若小便利。须发汗。今小便不利。病在太阳之里。法当利
水。去桂枝者。因无汗也。不用峻药利水者。因汗下之后也。（以上皆太阳寒邪停水）
邵评∶此着眼小便不利。虽有表症。但利水而不兼散。与小青龙五苓散不同法。
但得膀胱水去。而太阳之表里症悉除。所谓治病必求其本也。
如少阴病。当欲寐。至七八日。反心烦不得眠。是少阴热邪上扰也。下利而渴。咳呕。
小便不利者。是水饮停蓄也。宜猪苓汤以利水去热。此少阴阳邪停水。
邵评∶少阴病本欲寐。至七八日心烦不得眠。是邪热耗阴。挟心火而上扰也。且
下利而热渴。是下焦虚不能制水之故。咳呕烦渴者。是肾水不升。而心火不降
也。小便不利者。水饮邪热蓄于下焦也。故用猪苓汤。利水滋阴。而升津液。斯上焦如雾而咳渴除。中
焦如呕而烦呕静。下焦如渎而利自止矣。此治少阴阳邪停水之正法。
如少阴病。至四五日。四肢沉重疼痛。腹痛。小便不利。自下利者。此为有水气也。真
武汤主之。温中以消阴水。必少阴阴邪停水。
邵评∶此少阴寒邪。阳微而气不化。水积下焦。小便不利。是病根。腹痛下利。四肢
重痛。皆水气为患。因小便不利所致。用真武汤。壮肾阳而消阴水也。
王晋三先生曰。小青龙。治动而逆上之水。五苓散治静而不行之水。十枣汤。大陷
胸丸。治中焦之水。泻之于内也。桂枝去桂加苓术汤。治下焦之水。引而竭之也。十
枣汤治弥漫之水。大陷胸治痞满之水。真武汤。治沉着之水。小青龙。入太阳治阳
水。功兼外散。真武汤入少阴治阴水。功专下渗。小青龙。治寒邪未解之水。故温以
汗之。十枣汤治阳邪未解之水。故引而竭之。
邵评∶治水之方。有寒热表里利散之不同。医者必须辨明。
水饮，就是水液。伤寒病中停饮水邪的证候最为常见，多出现在太阳经和少阴经。临床医生往往忽视这一点，因此详细叙述这些内容以便查阅。
如果是太阳中风证，患者想喝水，但水喝下去立刻吐出来，这叫做“水逆”，用五苓散主治。这是因为水停留在胸中，所以水进入后无法容纳。
邵评：太阳中风，说明表证尚未解除。口渴是因为风热传入里部。想喝水，但水气运行不畅反而上逆，导致呕吐。这就是水逆。必定是这个人平素就有水气，邪气与水结聚在内。使用五苓散引导水气排出并泄除热邪，这是正确的治法。
又评：所谓水逆，此人必定平素就有水气，中焦脾胃的阳气不能宣通，邪水凝结在体内。水饮拒绝在外，既不能向外输布到汗孔成为汗液，也不能向上输布到口舌以解渴，更不能向下输注到膀胱使小便通畅。这就是“水逆”名称的由来。
如果误用攻下法，导致心下部痞塞胀满，给予泻心汤治疗，痞满不解除，患者感到口渴、口燥烦躁、小便不利，用五苓散主治。
这是因为治疗痞满而痞满不解除，反而出现口渴，这也是水停在心下的缘故，并非单纯的痞证。水停在心下，津液不得上升，所以口渴。
邵评：攻下后形成痞证，服用泻心汤后痞满不解除，说明心下有水气，饮邪内蓄，热邪结于膀胱，气化功能不能输布转化，因此反而上逆，出现口渴、烦躁、小便不利等症状。给予五苓散利水泄热，使小便通畅，那么痞满和消渴症状都会停止。
如果出现脉浮、小便不利、轻微发热、消渴（饮水量大且排尿也多或极度口渴），给予五苓散主治。这种小便不利，口渴且能大量饮水的情况，是水蓄积在膀胱。脉浮、身体发热，说明病在太阳经。所以用五苓散通过微发汗来利水，病就会痊愈。
邵评：脉浮、轻微发热，说明表邪未尽清除。口渴且能大量饮水，小便反而不利，这是水气与热邪内结于膀胱而未消散。给予五苓散引导水气排出并泄除热邪，方中含有桂枝，兼治表证，从而微发汗。大概这种小便不利，口渴且能大量饮水的情况，是水蓄积在膀胱。脉浮、身体发热，病在太阳经。所以用五苓散微发汗以利水，病就会痊愈。
凡是服用五苓散的，要多喝暖水以求得微汗，目的是让药力散布于营卫之间，使表里同时得到解决。
邵评：暖水可以多次服用，这样水逆证所用的冷水得以制约，水能制火并滋润脾土，水土和谐，则气化流通，配合五苓散解表泄热，病自然痊愈。然而水也不可过量饮用，应少量多次给予，胃气和顺则病愈。如果多喝，必然导致水气为患，出现心悸、气喘等疾病。
太阳中风证，患者出汗，头痛，心下部痞塞胀满，坚硬且牵引胁下疼痛，干呕，短气，出汗且恶寒，这是表证已解，内部有水液蓄积。用十枣汤攻逐水饮。（以上各条都是太阳热邪导致的水液停滞）
邵评：这是外感中风邪气，内部有悬饮的症状。患者出汗、头痛，看似表证，然而并不恶寒发热，心下部痞硬且胀满，牵引胁下疼痛，干呕、短气等症状，说明表邪已解，心下的水气湿热泛溢，上攻头部导致头痛和出汗。既然知道表部的风邪已解，而里部的水气淫溢，使用十枣汤攻逐水饮并降气，这是治疗悬饮内伏、水气荡涤三焦的正确方法。然而必须审察表邪已解，然后才可以攻逐水饮。
太阳伤寒证，表证未解，发热无汗，干呕且咳嗽，或者口渴，或者腹泻，或者气喘，或者小便不利，这是心下有 water 气。宜用小青龙汤。向外疏散寒邪，向内疏散寒性水饮。
邵评：发热无汗，说明表证未解。干呕且咳嗽，是水气为患。寒饮相互搏结，逆乱于肺胃之间。
水饮致病，随气机升降。水气下行不上行，则出现口渴或腹泻；上行不下行，则出现气喘或噎塞；停留而不运行，则小便不利。表寒与水饮，内外合邪，用小青龙汤两解表里之邪。设立加减法，以治疗各种可能的症状。
如果咳嗽且轻微气喘，发热但不口渴，服用小青龙汤后，反而出现口渴，这是寒饮已去的表现。
邵评：内饮外寒，相持不解，水气射肺，导致咳嗽和轻微气喘。水气上升，所以不口渴。服用小青龙汤后，反而出现口渴，说明水气在内消散，寒邪也在外消散。
经过解肌法或攻下法治疗后，仍然头项强痛，发热无汗，心下部胀满，轻微疼痛，小便不利，这是心下有 water 气。宜用桂枝去桂加茯苓白术汤主治。小便通畅则病愈。
邵评：头项强痛，发热无汗，说明表证未解。心下部胀满，轻微疼痛，说明饮邪在里。这是表邪与水饮凝结不解，病根在心下，而病机在膀胱。应当观察其小便情况，如果小便通畅，病在表，仍当发汗。如果小便不利，病在里，这是太阳经的本病，并非桂枝证未罢。所以去掉桂枝而加入茯苓、白术，不想在表分散邪气，所以只在里驱逐水饮。水饮去除，表邪也随之解除。因为水结在中焦，只可利水而不可发散。病不在表，而去掉桂枝，加入茯苓、白术，是为了利小便并燥湿以消除停水。
此症头痛发热，表证仍在。如果小便通畅，须发汗。现在小便不利，病在太阳之里，治法当利水。去掉桂枝，是因为无汗。不用峻烈药物利水，是因为已经经过汗法和下法之后。（以上皆属太阳寒邪导致的水液停滞）
邵评：此处着眼点在“小便不利”。虽然有表证，但只利水而不兼发散，与小青龙汤、五苓散的治法不同。只要膀胱中的水去除了，太阳经的表里症状全部消除，这就是所谓的治病必求其本。
如果是少阴病，本该嗜睡，到了七八天，反而心烦不得眠，这是少阴热邪上扰所致。如果伴有腹泻且口渴，咳嗽呕吐，小便不利，这是水饮停蓄。宜用猪苓汤利水清热。这是少阴阳热邪气导致的水液停滞。
邵评：少阴病本来应该嗜睡，到了七八天心烦不得眠，是邪热耗伤阴液，挟带心火上扰。且腹泻且热渴，是下焦虚衰不能制水的缘故。咳嗽、呕吐、烦渴，是肾水不升，心火不降。小便不利，是水饮邪热蓄积在下焦。所以用猪苓汤，利水滋阴，并升发津液。这样上焦如雾露般滋润则咳渴消除，中焦如沤腐般正常则烦呕静止，下焦如沟渠般通畅则腹泻自止。这是治疗少阴阳热邪气停水的正确方法。
如果是少阴病，到了四五天，四肢沉重疼痛，腹痛，小便不利，自发性腹泻，这是有水气。用真武汤主治。温补中焦以消除阴寒之水。必定是少阴阴寒邪气导致的水液停滞。
邵评：这是少阴寒邪，阳气微弱而气化功能失常，水积聚在下焦。小便不利是病根。腹痛、腹泻、四肢沉重疼痛，都是水气为患，因小便不利所致。使用真武汤，壮补肾阳以消除阴寒之水。
王晋三先生说：小青龙汤，治疗动荡而上逆的水饮；五苓散，治疗静止而不流动的水饮；十枣汤、大陷胸丸，治疗中焦的水饮，从内部攻逐；桂枝去桂加茯苓白术汤，治疗下焦的水饮，引导并竭尽它；十枣汤治疗弥漫的水饮，大陷胸丸治疗痞满的水饮；真武汤治疗沉着的水饮。小青龙汤入太阳经治疗阳水，功效兼有外散；真武汤入少阴经治疗阴水，功效专于下渗。小青龙汤治疗寒邪未解的水饮，所以用温法发汗；十枣汤治疗阳邪未解的水饮，所以用引导竭尽的方法。
Water retention (Shui Yin) refers to pathological fluid accumulation. In Shanghan (Cold Damage) diseases, syndromes of water retention are most common, frequently appearing in the Taiyang (Greater Yang) and Shaoyin (Lesser Yin) stages. Clinicians often overlook this; therefore, these conditions are detailed for reference.
In a Taiyang Wind Strike syndrome (Taiyang Zhong Feng), if the patient desires to drink water but vomits immediately upon ingestion, it is named "Water Reversal" (Shui Ni). It is primarily treated with Wuling San (Five-Ingredient Powder with Poria). This occurs because water stagnates in the chest, preventing the stomach from accommodating ingested fluids.
Commentary by Shao: Taiyang Wind Strike indicates that the exterior syndrome has not yet resolved. Thirst arises as wind-heat transmits inward. The desire to drink combined with the failure of water qi to circulate leads to counterflow vomiting, constituting Water Reversal. This condition invariably implies that the patient has a pre-existing tendency toward water retention, with pathogenic water binding internally. Using Wuling San to guide out water and drain heat is the correct method.
Further Commentary: The term "Water Reversal" applies when a patient has pre-existing water qi. The yang qi of the Middle Jiao (Spleen/Stomach) fails to diffuse. Pathogenic water condenses internally. The retained water refuses to move outward to the pores to form sweat, nor does it ascend to the mouth and tongue to quench thirst, nor does it descend to the Bladder to facilitate urination. This mechanism explains the name "Water Reversal."
If mistaken purgation is used, resulting in epigastric fullness and obstruction (Pi), and Xie Xin Tang (Drain the Epigastrium Decoction) fails to resolve the fullness, while the patient presents with thirst, dry mouth, irritability, and dysuria, Wuling San should be administered.
The persistence of fullness despite treatment for Pi, accompanied by thirst, indicates water stagnation in the epigastrium rather than simple Pi syndrome. Water stagnating in the epigastrium prevents Jin-Ye (Body Fluids) from ascending, causing thirst.
Commentary by Shao: Post-purgation Pi unresponsive to Xie Xin Tang indicates water qi in the heart/epigastrium with internal accumulation of damp-fluid and heat binding in the Bladder, impairing Qi transformation and causing counterflow. Symptoms include thirst, restlessness, and dysuria. Wuling San promotes urination and drains heat; once urination is normalized, both the Pi sensation and thirst will cease.
If the pulse is floating, there is dysuria, slight fever, and Xiao Ke (wasting-thirst or excessive drinking and urination), Wuling San is indicated. Dysuria accompanied by thirst and the ability to consume large amounts of water indicates water accumulation in the Bladder. A floating pulse and body heat indicate the disease resides in the Taiyang stage. Therefore, Wuling San induces mild sweating to promote diuresis, leading to recovery.
Commentary by Shao: Floating pulse and slight fever indicate incomplete resolution of the exterior. Thirst with high water intake but reduced urination signifies water-heat binding in the Bladder. Wuling San guides out water and drains heat; the inclusion of Guizhi (Cinnamon Twig) addresses the exterior, inducing mild sweating. As noted, dysuria with thirst and high water intake points to water accumulation in the Bladder. With the disease in Taiyang, mild sweating via Wuling San resolves the condition.
When administering Wuling San, patients should drink warm water in abundance to induce mild sweating. This aims to disperse the medicinal action through Ying and Wei (Nutritive and Defensive levels), resolving both interior and exterior aspects.
Commentary by Shao: Frequent consumption of warm water helps counteract cold water retention; water controls fire and moistens Earth (Spleen), harmonizing Water and Earth to facilitate Qi transformation. Combined with Wuling San’s exterior-resolving and heat-draining properties, the disease heals. However, water intake must be moderate. Small, frequent doses harmonize the Stomach. Excessive drinking may cause water pathology, leading to palpitations and asthma.
In Taiyang Wind Strike, if the patient sweats, has headache, epigastric fullness and stiffness radiating to the hypochondrium, dry retching, shortness of breath, sweating, and aversion to cold, the exterior is resolved, but there is internal water accumulation. Shizao Tang (Ten-Jujube Decoction) is used to attack the retention. (These cases involve Taiyang heat-pathogen stopping water.)
Commentary by Shao: This involves external Wind strike with internal Xuan Yin (Hanging Fluid). Sweating and headache mimic exterior signs, but absence of aversion-to-cold and fever, combined with epigastric fullness/stiffness radiating to the hypochondrium, dry retching, and shortness of breath, confirms the exterior pathogen has resolved. Damp-heat water qi overflows from the epigastrium, attacking the head. Knowing the exterior Wind is resolved but interior water is overflowing, Shizao Tang attacks the fluid and descends Qi. This is the correct method for treating internal Xuan Yin and sweeping water through the Three Jiao. One must confirm the exterior is resolved before attacking the fluid.
In Taiyang Cold Damage, if the exterior is unresolved, presenting with fever, anhidrosis, dry retching, cough, and optionally thirst, diarrhea, wheezing, or dysuria, this indicates water qi in the Heart/Epigastrium. Xiao Qing Long Tang (Minor Green Dragon Decoction) is appropriate to scatter exterior cold and disperse interior cold-fluid.
Commentary by Shao: Fever and anhidrosis indicate unresolved exterior. Dry retching and cough result from water qi pathology. Cold and fluid contend, rebelling between the Lung and Stomach. Pathogenic fluid moves with Qi dynamics: descending without ascending causes thirst or diarrhea; ascending without descending causes wheezing or choking; stagnation causes dysuria. Exterior cold and interior fluid combine. Xiao Qing Long Tang resolves both exterior and interior pathogens. Modification rules are established to treat variable symptoms.
If cough and slight wheezing occur with fever but no thirst, and after taking Xiao Qing Long Tang the patient becomes thirsty, this indicates the cold-fluid has been eliminated.
Commentary by Shao: Internal fluid and external cold persist, with water qi affecting the Lung, causing cough and wheezing. Ascending water qi initially suppresses thirst. Post-treatment thirst indicates the dispersion of internal water and external cold.
After muscle-relaxing or purgative treatments, if headache, neck stiffness, fever, anhidrosis, epigastric fullness, slight pain, and dysuria persist, this indicates water qi in the epigastrium. Guizhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction minus Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) is indicated. Recovery follows when urination normalizes.
Commentary by Shao: Headache, neck stiffness, fever, and anhidrosis indicate unresolved exterior. Epigastric fullness and slight pain indicate interior fluid. Exterior pathogen and fluid bind together; the root is in the epigastrium, but the mechanism involves the Bladder. Observe urination: if clear, the disease is exterior, requiring sweating. If dysuric, the disease is interior, representing the primary Taiyang pathology, not merely an unresolved Guizhi syndrome. Thus, Guizhi is removed, and Fu Ling and Bai Zhu added, avoiding exterior dispersal to focus on interior fluid expulsion. Once fluid is removed, the exterior pathogen resolves. Since water binds in the Middle Jiao, it should be drained, not dispersed. Removing Guizhi and adding Fu Ling/Bai Zhu promotes urination and dries stagnant water.
Although headache and fever suggest remaining exterior signs, if urination is clear, sweating is required. Here, dysuria places the disease in the interior of Taiyang, mandating diuresis. Guizhi is removed due to anhidrosis. Harsh diuretics are avoided due to prior sweating and purging. (These cases involve Taiyang cold-pathogen stopping water.)
Commentary by Shao: The key indicator is dysuria. Despite exterior signs, only diuresis is employed without exterior dispersal, differing from Xiao Qing Long Tang and Wuling San. Eliminating bladder water resolves all Taiyang exterior-interior symptoms, adhering to the principle of treating the root cause.
In Shaoyin disease, where lethargy is typical, if after seven to eight days the patient becomes irritable and unable to sleep, this indicates Shaoyin heat-pathogen disturbing upward. If accompanied by diarrhea with thirst, cough, vomiting, and dysuria, this is water retention. Zhuling Tang (Polyporus Decoction) is used to promote urination and clear heat. This represents Shaoyin Yang heat-pathogen stopping water.
Commentary by Shao: Shaoyin disease typically involves lethargy. Irritability and insomnia after several days indicate pathogenic heat consuming Yin and harassing upward with Heart Fire. Diarrhea with heat-thirst results from Lower Jiao deficiency failing to control water. Cough, vomiting, irritability, and thirst indicate Kidney Water failing to ascend and Heart Fire failing to descend. Dysuria signifies water-fluid and heat-pathogen accumulating in the Lower Jiao. Zhuling Tang promotes urination, nourishes Yin, and ascends fluids. This restores the Upper Jiao's misting function (resolving cough/thirst), regulates the Middle Jiao's fermentation (calming vomiting/irritability), and clears the Lower Jiao's channels (stopping diarrhea). This is the correct method for Shaoyin Yang heat-water retention.
In Shaoyin disease, if after four to five days the patient presents with heavy/painful limbs, abdominal pain, dysuria, and spontaneous diarrhea, this indicates water qi. Zhen Wu Tang (True Warrior Decoction) is indicated to warm the Middle and eliminate Yin-cold water. This represents Shaoyin Yin cold-pathogen stopping water.
Commentary by Shao: This involves Shaoyin cold-pathogen with deficient Yang and impaired Qi transformation, leading to water accumulation in the Lower Jiao. Dysuria is the root cause. Abdominal pain, diarrhea, and limb heaviness/pain are consequences of water qi. Zhen Yu Tang strengthens Kidney Yang to eliminate Yin-cold water.
Mr. Wang Jin-san stated: Xiao Qing Long Tang treats turbulent, counterflowing water; Wuling San treats static, stagnant water; Shizao Tang and Da Xian Xiong Wan (Major Sinking Chest Pill) treat Middle Jiao water, draining it internally; Guizhi Qu Gui Jia Fu Ling Bai Zhu Tang treats Lower Jiao water, guiding it out; Shizao Tang treats diffuse water; Da Xian Xiong treats obstructive/fullness-causing water; Zhen Yu Tang treats settled water. Xiao Qing Long Tang enters Taiyang to treat Yang-water, combining exterior dispersal. Zhen Yu Tang enters Shaoyin to treat Yin-water, specializing in downward infiltration. Xiao Qing Long Tang treats water with unresolved cold-pathogen, using warmth and sweating. Shizao Tang treats water with unresolved Yang-pathogen, using guidance and exhaustion.
Commentary by Shao: Formulas for treating water vary by cold/heat, exterior/interior, and draining/dispersing methods. Physicians must distinguish clearly.