（见下）
@@@
心下坚，大如盘边，如旋盘，水饮所作，枳实白术汤主之。
【注】
心下坚，大如盘边，如旋盘，此里水所作也。似当下而不可下者，以坚大而不满痛，
是为水气虚结，未可下也。故以白术倍枳实，补正而兼破坚，气行则结开，两得之矣
。此里水不可下之和剂也。
【集注】
赵良曰：心下，胃上脘也。胃气弱，则所饮之水入而不消，痞结而坚，必强其胃，乃
可消痞。白术健脾强胃，枳实善消心下痞，逐停水，散滞气。
程林曰：此证如盘而不如杯，是水饮散漫之状也。以散漫于心下如盘，不必辛热之剂
以发之，但用枳术以散之，得腹中耎而水自消矣。
沈明宗曰：见心下坚大如盘，当审虚实寒热，脉之浮沉、迟数、大小为异，毌得执方
而误用也。
尤怡曰：言水饮所作者，所以别于气分也。气无形以辛甘散之，水有形以苦泄之。
枳实七枚 白术二两
右二味，以水五升，煮取三升，分温三服，腹中耎即当散也。
【集解】
李□曰：枳实消胀，苦以泄之也；白术去湿，苦以燥之也。后张元素治痞用枳术丸，
亦从此汤化出。但此乃水饮所作，则用汤以荡涤之；彼属食积所伤，则用丸以消磨之
。一汤一丸，各有深意，非漫无主张也。
@@@
趺阳脉当伏，今反紧，本自有寒，疝瘕，腹中痛，医反下之，下之则胸满短气。趺阳
脉当伏，今反数，本自有热，消谷，小便数，今反不利，此欲作水。
【注】
此明里有水兼寒兼热，误下之义也。里水脉伏，非谓三部脉皆当伏，乃谓趺阳胃脉当
伏也。若脉不伏反紧，其人必本自有寒也。水寒同病，则疝瘕腹中痛，医误以为里水
而下之，水去寒留，更虚其中，故胸满短气也。若脉不伏反数，其人必本自有热也。
水热同病，当消谷而小便数，不病水也，今小便反不利，此欲作水之病也。
【集注】
赵良曰：趺阳当伏者，非趺阳胃气之本脉也，为水畜于下，其气伏，故脉亦伏，脉法
曰：伏者为水。
魏荔彤曰：趺阳有水邪，则当伏，以胃阳为衣，湿阴寒所固闭，故阳明之脉不出也。
今反紧，不惟水盛于里，而且寒盛于中矣。盖其人不止有水气之邪，而更兼平日有积
寒疝瘕，腹中常常作痛，水邪中又兼寒邪也。医者不识其为阴寒，乃以为水邪可下，
虽水下沉，而寒邪上逆，故胸满短气矣。此病趺阳脉当伏，今反数，为本自有热。然
本自有热，则当消谷，小便数，大便坚，如伤寒胃实之证也。今小便反不利，则知为
欲作水，与湿热之邪无疑也。
@@@
肝水者，其腹大，不能自转侧，□下腹痛，时时津液微生，小便续通。
【注】
以上发明表里上下之水，以下发明五藏气血之水也。肝主筋，腹□是其部也，水邪干
之，外则筋缓不能自转侧，内则腹大、□痛，淋溲也。
【集注】
魏荔彤曰：肝水者，水附肝，则肝水也。肝经有水，必存两□，故腹大而□下痛。少
阳阴阳往来之道路，有邪窒碍，故不能自转侧。肝有水邪，必上冲胸咽，故时时津液
微生，及上升而下降，小便不利者又续通，此水邪随肝木往来升降之气上下为患也。
见此知肝经有水，当于肝脏治之也。
尤怡曰：肝之府在□，而气连少腹，肝之水不行，则腹大不能转侧，□下腹痛也。时
时津液微生，小便续通者，肝喜冲逆而主□泄，水液随之而上下也。
@@@
心水者，其身重而少气，不得卧，烦而躁，其人阴肿。
【按】
「其人阴肿」四字，当在肾水条内，错简在此。
【注】
心主脉，膻中是其部也。水邪干之，外则周身之脉不行，其身重也；内则少气心烦，
不得卧而躁也。
【集注】
程林曰：『内经』云：心主身之血脉。『上经』曰：水在心，心下坚筑短气，是以身
重少气也。『内经』曰：诸有水病者，不得卧。夫心属火，水在心是以不得卧而烦躁
也。
魏荔彤曰：夫水邪，亦积聚之类也。切近于其处，则伏留于是脏，即可以脏而名证。
水附于心，则心水也，心经有水，四肢百骸，皆可灌注，故身重；气为水邪所阻，故
少气，水邪逼处，神魂不安，故不得卧；神明扰乱，故躁而烦。见此知心经有水，当
于心经治之也。
@@@
脾水者，其腹大，四肢苦重，津液不生，但苦少气，则小便难。
【注】
脾主腹，四肢是其部也，水邪干之，外则四肢苦重，内则腹大少气，小便难也。
【集注】魏荔彤曰：脾水者，水附于脾，则脾水也。脾专主腹，故腹大。脾主旋运，
又主四肢，旋运不利，故四肢苦重。津液不生，气不流行，上下则阻碍不通，故上则
苦少气，下则小便难。见此知有水在脾，当于脾脏治水也。
尤怡曰：脾主腹，而气行四肢，脾受水气则腹大，四肢重。津气生于谷，谷气运于脾
，脾湿不运，则津液不生而少气，小便难者，湿不行也。
@@@
肺水者，其身肿，小便难，时时鸭溏。
【注】
肺主气，皮毛是其部也。水邪干之，外则周身皮肿，内则不输小便，大肠乃其府，水
走大肠，故鸭溏也。
【集注】
赵良曰：肺主皮毛，行荣卫与大肠合，今有水病，则水充满皮肤。肺本通调水道，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。
魏荔彤曰：肺水者，水附于肺，则肺水也。肺主气，气引水行，亦能使之周身浮肿。
肺不肃则气化壅，故小便难，小便难则清浊不分，故便鸭溏，此知为有水在肺，当于
肺脏治水也。
尤怡曰：鸭溏如鸭之后，水粪杂下也。
@@@
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。
【按】
面反瘦之下，当有上条「其人阴肿」四字。
【注】
肾主腰，足阴是其部也。水邪干之，外则阴肿，阴下湿，足冷面瘦，内则腹大脐肿，
腰痛不得溺也。此五者，指水气等胀为言，故俱不喘咳也。
【集注】
程林曰：肾者，胃之关也，关门不利，故令聚水而生病，是以有腹大脐肿之证也。腰
者肾之外候，故令腰痛。膀胱者，肾之府，故令不得溺也。以其不得溺，则水气不得
泄，浸渍于睾囊而阴汗，流注于下焦而为足冷。夫肾为水藏，又被水邪，则上焦之气
血随水性而下趋，故其人面反瘦，非若风水里水之面目浮肿也。
魏荔彤曰：肾水者，水附于肾，则肾水也。肾主少腹，少腹水湿固冱，故腹大脐肿腰
痛。腰以下俱肾主之也，水湿在下焦，膀胱之气反塞，故不惟小便难，而且竟不得溺
。阴寒下盛，故阴下湿如牛鼻上汗，冷而且粘，其足皆逆冷也。面乃阳之部位，下阴
盛，上阳衰，故面必瘦，见此知水在肾，当于肾脏治水也。
尤怡曰：身半以下，肾气主之，水在肾，则腰痛脐肿腹大也。不得溺，阴下湿如牛鼻
上汗，其足逆冷者，肾为阴，水亦为阴，两阴相得，阳气不行，而湿寒独胜也。面反
瘦者，面为阳，阴盛于下，则阳衰于上也。
@@@
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
衰则鹜溏，胃气衰则身肿。少阳脾卑，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。
【注】
寸口，两寸也。脉沉而迟，沉则为水，迟则为寒，水寒相搏于胸中，则阳气不运，故
趺阳两关之脉伏而不起，水谷不化。若脾气衰则鹜溏，胃气衰则身肿也。少阳右尺脉
陷下，少阴左尺脉细小，亦因寒水太甚，命火受制，故男子水精不化，小便为之不利
，女子血化为水，经水为之不通也。经血而曰经水者，以水为血之体也，女子以血为
主，故曰：血分也。
【集注】
赵良曰：仲景脉法寸口多于趺阳合，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，五藏皆禀气
于胃，则胃又五藏之本，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，胃脉之源也。
尤怡曰：此合诊寸口趺阳，而知为寒水胜，而胃阳不行也。胃阳不行，则水谷不化，
水谷不化，则脾胃俱衰。脾气主里，故衰则鹜溏；胃气主表，故衰则身肿也。少阳者
生气也，少阴者地道也，而俱受气于脾胃，脾胃衰则少阳脉卑，而生气不荣，少阴脉
细，而地道不通，男子则小便不利，妇人则经血不通。而其所以然者，则皆阳气不行
，阴气乃结之故，曰血分者，谓虽病于水，而实出于血也。
@@@
师曰：寸口脉迟而涩，迟则为寒，涩为血不足；趺阳脉微而迟，微则为气，迟则为寒
。寒气不足，则手足逆冷；手足逆冷，则荣卫不利；荣卫不利，则腹满肠鸣，相逐气
转膀胱，荣卫俱劳，阳气不通，即身冷，阴气不通，即骨疼。阳气前通则恶寒，阴气
前通则痹不仁。阴阳相得，其气乃行，大气一转，其气乃散，实则失气，虚则遗溺，
名曰气分。
【按】
「名曰气分」之下，当有下条，「桂枝去芍药加麻黄附子细辛汤主之」，十五字。
【注】
寸口脉迟为寒，脉涩少血，趺阳脉微乏气，迟亦为寒。是则气血俱虚，为寒气所干，
荣卫不利，阴阳不通，故身寒骨痛，手足逆冷，腹满肠鸣，恶寒麻痹，失气遗溺也。
此气血俱虚，寒气内客之气胀，故曰气分。而下条发明主治，用桂枝去芍药加麻黄附
子细辛汤者，温养荣卫，阴阳发散，寒邪之气也。
【集注】
程林曰：气散必从前后而去，邪气实则失气于后，正气虚则遗溺于前也。
尤怡曰：微则为气者，为气不足也，寒气不足，该寸口、趺阳为言寒，而气血复不足
也。寒气不足，则手足无气而逆冷，荣卫无源而不利，由是藏府之中，真气不充，而
客寒独胜，则腹满肠鸣相逐，气转膀胱而下输也。荣卫俱劳者，荣卫俱乏竭也。阳气
温于表，故不通则身冷；阴气荣于里，故不通即骨疼；不通者，虚极而不能行，与有
余而壅者不同。阳前通则恶寒，阴前通则痹不仁者，阳先行而阴不与俱行，则阴失阳
而恶寒；阴先行而阳不与俱行，则阳独滞而痹不仁也。盖阴与阳常相须也，不可失，
失则气机不续而邪乃着，不失则上下交通而邪不容，故曰：阴阳相得，其气乃行，大
气一转，其气乃散。失气遗溺，谓分虚实而散也。曰气分者，谓寒气乘阳之虚，而病
于气也。
@@@
气分，心下坚，大如盘，边如旋杯，水饮所作，桂枝去芍药加麻黄附子细辛汤主之。
【按】
「气分，心下坚大如盘，边如旋杯，水饮所作」之十六字，当是衍文，观心下坚之本
条自知。「桂枝去芍药加麻黄附子细辛汤主之」十五字，当在上条气分之下，义始相
属，正是气分之治法，必是错简在此。
（见下文）
@@@
胃脘部痞硬，大如盘边，像旋转的盘子，这是水饮所致，用枳实白术汤主治。
【注】
胃脘部痞硬，大如盘边，像旋转的盘子，这是里水所致。看似应当攻下却不可攻下，因为虽然坚硬膨大但并不胀满疼痛，这是水气虚结，不可以攻下。所以用白术倍于枳实的比例，补益正气兼以破除坚结，气机运行则结滞解散，两全其美。这是治疗里水不可攻下的和缓之剂。
【集注】
赵良说：心下，指胃的上脘部位。胃气虚弱，则所饮入的水进入后不能消化，痞塞结聚而变硬，必须强健脾胃，才能消除痞结。白术能健脾强胃，枳实善于消除心下痞满，驱逐停积之水，疏散滞气。
程林说：此证像盘子而不像杯子，是水饮散漫的状态。水饮散漫于心下如盘状，不必用辛热之剂来发散，只用枳实、白术来消散它，得到腹中柔软则水饮自然消除。
沈明宗说：见到心下坚硬膨大如盘，应当审察虚实寒热，通过脉象的浮沉、迟数、大小来判断差异，不要固执于方剂而误用。
尤怡说：说“水饮所作”，是为了与气分病相区别。气无形，用辛甘之品发散；水有形，用苦泄之品攻下。
枳实七枚 白术二两
以上两味药，用水五升，煮取三升，分三次温服，腹中变软即当消散。
【集解】
李□说：枳实消除胀满，是用苦味来泄降；白术去除湿气，是用苦味来燥湿。后来张元素治疗痞满用枳术丸，也是从此汤化裁而来。但这方是治疗水饮所作，所以用汤剂来荡涤；彼方属于食积所伤，所以用丸剂来消磨。一汤一丸，各有深意，并非毫无主张。
@@@
趺阳脉本应当伏匿，现在反而紧，说明患者本自有寒邪，患有疝瘕，腹中疼痛，医生反而使用攻下法，攻下之后导致胸满短气。趺阳脉本应当伏匿，现在反而数，说明患者本自有热邪，表现为消谷善饥，小便频数，现在反而小便不利，这是将要发生水病的征兆。
【注】
这里阐明里有水气兼有寒邪或热邪，以及误用攻下法的含义。里水脉象伏匿，不是说三部脉都应当伏匿，而是说趺阳胃脉应当伏匿。如果脉不伏反紧，其人必定本自有寒邪。水寒同病，则出现疝瘕腹中痛，医生误以为是里水而攻下，水去寒留，更使中焦虚损，所以出现胸满短气。如果脉不伏反数，其人必定本自有热邪。水热同病，应当消谷善饥且小便频数，不患水病，现在小便反而不利，这是将要发生水病的征兆。
【集注】
赵良说：趺阳脉应当伏匿，不是趺阳胃气的本脉，而是因为水蓄积在下焦，气机被遏伏，所以脉也伏匿，脉法说：伏脉主水。
魏荔彤说：趺阳有水邪，则应当伏匿，因为胃阳被衣被、湿阴寒邪固闭，所以阳明之脉不出。现在反而紧，不仅水盛于里，而且寒盛于中。大概此人不仅有水气之邪，而且更兼平日有积寒疝瘕，腹中常常作痛，水邪之中又兼寒邪。医者不识其为阴寒，乃以为水邪可下，虽然水下沉，但寒邪上逆，所以胸满短气。此病趺阳脉当伏，现在反数，是因为本自有热。然而本自有热，则应当消谷善饥，小便频数，大便坚硬，如伤寒胃实证。现在小便反而不利，则知为欲作水，无疑是有湿热之邪。
@@@
肝水病，腹部膨大，不能自行翻身转侧，胁下腹痛，时常津液微生，小便断续通畅。
【注】
以上阐明了表里上下之水，以下阐明五脏气血之水。肝主筋，胁肋是其所属部位，水邪侵犯它，外则筋缓不能自行转侧，内则腹大、胁下痛，淋沥小便。
【集注】
魏荔彤说：肝水者，水依附于肝，就是肝水。肝经有水，必然存留于两胁，所以腹大而胁下痛。少阳阴阳往来的道路，有邪气窒碍，所以不能自行转侧。肝有水邪，必然上冲胸咽，所以时常津液微生，以及上升而下降，小便不利者又断续通畅，这是水邪随肝木往来升降之气上下为患。见此可知肝经有水，应当在肝脏治疗。
尤怡说：肝的府在胁肋，而气连少腹，肝之水不行，则腹大不能转侧，胁下腹痛。时时津液微生，小便续通者，肝喜冲逆而主疏泄，水液随之而上下流动。
@@@
心水病，身体沉重而气短，不能平卧，心烦而躁动，患者外阴肿胀。
【按】
“其人阴肿”四字，应当在肾水条内，此处为错简。
【注】
心主脉，膻中是其所属部位。水邪侵犯它，外则周身之脉运行不畅，身体沉重；内则气短心烦，不能平卧而躁动。
【集注】
程林说：《内经》说：心主身之血脉。《上经》说：水在心，心下坚筑短气，所以身体沉重气短。《内经》说：所有患水病的人，都不能平卧。心属火，水在心，所以不能平卧而烦躁。
魏荔彤说：夫水邪，也是积聚之类。切近于某处，则潜伏停留于此脏，就可以依脏命名证候。水附于心，就是心水。心经有水，四肢百骸皆可灌注，所以身体沉重；气为水邪所阻，所以气短；水邪逼迫，神魂不安，所以不能平卧；神明扰乱，所以躁动而烦。见此可知心经有水，应当于心经治疗。
@@@
脾水病，腹部膨大，四肢苦于沉重，津液不生，只苦于气短，则小便困难。
【注】
脾主腹，四肢是其所属部位，水邪侵犯它，外则四肢苦于沉重，内则腹大少气，小便困难。
【集注】
魏荔彤说：脾水者，水依附于脾，就是脾水。脾专主腹，所以腹大。脾主旋运，又主四肢，旋运不利，所以四肢苦于沉重。津液不生，气不流行，上下阻碍不通，所以上则苦于气短，下则小便困难。见此可知水在脾，应当在脾脏治水。
尤怡说：脾主腹，而气行于四肢，脾受水气则腹大，四肢重。津气生于谷，谷气运于脾，脾湿不运，则津液不生而少气，小便难者，是湿不行也。
@@@
肺水病，身体浮肿，小便困难，时常鸭溏（稀便如水粪杂下）。
【注】
肺主气，皮毛是其所属部位。水邪侵犯它，外则周身皮肤浮肿，内则不输布小便，大肠是其腑，水走大肠，所以鸭溏。
【集注】
赵良说：肺主皮毛，行营卫与大肠相合，今有水病，则水充满皮肤。肺本通调水道，下输膀胱为尿溺，现在既不通，水不得从小便出，反而从其合，与糟粕混成鸭溏。
魏荔彤说：肺水者，水依附于肺，就是肺水。肺主气，气引水行，也能使之周身浮肿。肺不肃降则气化壅滞，所以小便困难，小便难则清浊不分，所以便鸭溏，由此知为有水在肺，应当在肺脏治水。
尤怡说：鸭溏像鸭子排便后，水粪杂下。
@@@
肾水病，腹部膨大，脐部肿胀，腰痛不能排尿，外阴潮湿，像牛鼻上的汗珠，双足逆冷，面部反而消瘦。
【按】
“面反瘦”之下，应当有上一条“其人阴肿”四字。
【注】
肾主腰，足阴是其所属部位。水邪侵犯它，外则阴肿，外阴潮湿，足冷面瘦，内则腹大脐肿，腰痛不能排尿。这五种情况，是指水气等胀而言，所以都不喘咳。
【集注】
程林说：肾者，胃之关也，关门不利，所以令聚水而生病，因此有腹大脐肿的证候。腰是肾之外候，所以腰痛。膀胱是肾之府，所以不能排尿。因为不能排尿，则水气不得泄，浸渍于睾囊而阴汗，流注于下焦而为足冷。肾为水藏，又被水邪，则上焦之气血随水性而下趋，所以其人面部反而消瘦，不像风水里水的面目浮肿。
魏荔彤说：肾水者，水依附于肾，就是肾水。肾主少腹，少腹水湿固结，所以腹大脐肿腰痛。腰以下俱由肾主之，水湿在下焦，膀胱之气反塞，所以不惟小便难，而且竟不能排尿。阴寒下盛，所以阴下湿如牛鼻上汗，冷而且粘，其足皆逆冷。面部是阳的部位，下阴盛，上阳衰，所以面部必瘦，见此可知水在肾，应当在肾脏治水。
尤怡说：身半以下，肾气主之，水在肾，则腰痛脐肿腹大。不能排尿，阴下湿如牛鼻上汗，其足逆冷者，肾为阴，水亦为阴，两阴相得，阳气不行，而湿寒独胜。面部反而消瘦者，面为阳，阴盛于下，则阳衰于上。
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老师说：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，脾气衰则鹜溏（稀便），胃气衰则身肿。少阳脉卑（微弱），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，名叫血分。
【注】
寸口，指两手寸脉。脉沉而迟，沉则为水，迟则为寒，水寒相搏于胸中，则阳气不运，所以趺阳两关之脉伏而不起，水谷不化。若脾气衰则鹜溏，胃气衰则身肿。少阳右尺脉陷下，少阴左尺脉细小，也是因为寒水太甚，命门之火受制，所以男子水精不化，小便为之不利，女子血化为水，经水为之不通。经血而曰经水者，因为水为血之体，女子以血为主，所以说：血分。
【集注】
赵良说：仲景脉法寸口多于趺阳合参，为什么呢？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。邪或干于胃者，必再就趺阳诊之，趺阳，胃脉之源也。
尤怡说：此合诊寸口趺阳，而知为寒水胜，而胃阳不行也。胃阳不行，则水谷不化，水谷不化，则脾胃俱衰。脾气主里，故衰则鹜溏；胃气主表，故衰则身肿也。少阳者生气也，少阴者地道也，而俱受气于脾胃，脾胃衰则少阳脉卑，而生气不荣，少阴脉细，而地道不通，男子则小便不利，妇人则经血不通。而其所以然者，则皆阳气不行，阴气乃结之故，曰血分者，谓虽病于水，而实出于血也。
@@@
老师说：寸口脉迟而涩，迟则为寒，涩为血不足；趺阳脉微而迟，微则为气（不足），迟则为寒。寒气不足，则手足逆冷；手足逆冷，则营卫不利；营卫不利，则腹满肠鸣，相逐气转膀胱，营卫俱劳，阳气不通，即身冷，阴气不通，即骨疼。阳气前通则恶寒，阴气前通则痹不仁。阴阳相得，其气乃行，大气一转，其气乃散，实则失气，虚则遗溺，名叫气分。
【按】
“名叫气分”之下，应当有下一条，“桂枝去芍药加麻黄附子细辛汤主之”，十五字。
【注】
寸口脉迟为寒，脉涩少血，趺阳脉微乏气，迟亦为寒。是则气血俱虚，为寒气所犯，营卫不利，阴阳不通，所以身寒骨痛，手足逆冷，腹满肠鸣，恶寒麻痹，失气遗溺。此气血俱虚，寒气内客之气胀，所以叫气分。而下条发明主治，用桂枝去芍药加麻黄附子细辛汤者，温养营卫，阴阳发散，寒邪之气也。
【集注】
程林说：气散必从前后而去，邪气实则失气于后，正气虚则遗溺于前也。
尤怡说：微则为气者，为气不足也，寒气不足，该寸口、趺阳为言寒，而气血复不足也。寒气不足，则手足无气而逆冷，营卫无源而不利，由是脏腑之中，真气不充，而客寒独胜，则腹满肠鸣相逐，气转膀胱而下输也。营卫俱劳者，营卫俱乏竭也。阳气温于表，故不通则身冷；阴气荣于里，故不通即骨疼；不通者，虚极而不能行，与有余而壅者不同。阳前通则恶寒，阴前通则痹不仁者，阳先行而阴不与俱行，则阴失阳而恶寒；阴先行而阳不与俱行，则阳独滞而痹不仁也。盖阴与阳常相须也，不可失，失则气机不续而邪乃着，不失则上下交通而邪不容，所以说：阴阳相得，其气乃行，大气一转，其气乃散。失气遗溺，谓分虚实而散也。曰气分者，谓寒气乘阳之虚，而病于气也。
@@@
气分病，胃脘部痞硬，大如盘，边如旋转的杯子，水饮所致，用桂枝去芍药加麻黄附子细辛汤主治。
【按】
“气分，心下坚大如盘，边如旋杯，水饮所作”的十六字，应当是衍文，观心下坚之本条自知。“桂枝去芍药加麻黄附子细辛汤主之”十五字，应当在上一条气分之下，义始相属，正是气分之治法，必是错简在此。
(See below)
@@@
Stiffness and fullness in the epigastrium, large as a plate, resembling a rotating plate, caused by fluid retention (Shui Yin), is primarily treated with Zhishi Baizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction).
[Note]
Stiffness and fullness in the epigastrium, large as a plate, resembling a rotating plate, is caused by interior water accumulation. Although it appears suitable for purgation, it should not be purged because, despite being hard and distended, there is no pain or tightness. This indicates a deficiency-type binding of water qi, which cannot be purged. Therefore, using Baizhu (Atractylodis Macrocephalae Rhizoma) in double the amount of Zhishi (Aurantii Fructus Immaturus) tonifies the righteous qi while simultaneously breaking down the hardness; when qi moves, the binding resolves, achieving both goals. This is a harmonizing formula for treating interior water that cannot be purged.
[Collected Notes]
Zhao Liang said: The "epigastrium" refers to the upper jiao of the stomach. When stomach qi is weak, ingested fluids enter but fail to digest, leading to stagnation, binding, and hardness. It is necessary to strengthen the spleen and stomach to eliminate the stagnation. Baizhu strengthens the spleen and stomach; Zhishi is excellent at eliminating epigastric fullness, driving away retained fluids, and dispersing stagnant qi.
Cheng Lin said: This condition resembles a plate rather than a cup, indicating a diffuse state of fluid retention. Since the fluid retention is diffuse in the epigastrium like a plate, there is no need for acrid-hot agents to disperse it; simply use Zhishi and Baizhu to scatter it. Once the abdomen becomes soft, the fluids will naturally dissipate.
Shen Mingzong said: Upon observing stiffness and distension in the epigastrium like a plate, one must examine deficiency/excess and cold/heat, differentiating via pulse floating/sinking, slow/rapid, and large/small. One must not adhere rigidly to a formula and misuse it.
You Yi said: Stating "caused by fluid retention" serves to distinguish it from Qi-level disorders. Qi is formless and is dispersed with acrid-sweet agents; water has form and is drained with bitter-purgative agents.
Zhishi (Aurantii Fructus Immaturus) 7 pieces; Baizhu (Atractylodis Macrocephalae Rhizoma) 2 liang.
These two ingredients are boiled in 5 sheng of water to obtain 3 sheng. Divide into three warm doses. When the abdomen becomes soft, the condition will resolve.
[Collected Explanations]
Li [Name obscured] said: Zhishi eliminates distension through its bitter nature to drain downward; Baizhu removes dampness through its bitter nature to dry. Later, Zhang Yuansu derived Zhizhu Wan (Immature Bitter Orange and Atractylodes Macrocephala Pill) from this decoction for treating fullness. However, this decoction treats fluid retention, so the liquid form is used to sweep it away; the latter treats food stagnation, so the pill form is used to gradually dissolve it. One is a decoction, one is a pill, each having profound meaning, not arbitrary.
@@@
The Fuyang pulse should normally be hidden (Fu); now it is instead tight. This indicates pre-existing cold, hernia masses (Han Jia), and abdominal pain. If the physician incorrectly uses purgation, chest fullness and shortness of breath result. The Fuyang pulse should normally be hidden; now it is instead rapid. This indicates pre-existing heat, excessive hunger, and frequent urination. Now, however, urination is difficult; this suggests impending water disease.
[Note]
This clarifies the meaning of interior water combined with cold or heat, and the consequences of incorrect purgation. Interior water pulses are hidden; this does not mean all three positions are hidden, but specifically that the Fuyang stomach pulse should be hidden. If the pulse is not hidden but tight, the person inherently possesses cold. Water and cold co-existing cause hernia masses and abdominal pain. If the physician mistakenly assumes interior water and purges, the water leaves but cold remains, further depleting the middle jiao, resulting in chest fullness and shortness of breath. If the pulse is not hidden but rapid, the person inherently possesses heat. Water and heat co-existing should cause excessive hunger and frequent urination, without water disease. Now, since urination is difficult, this indicates impending water disease.
[Collected Notes]
Zhao Liang said: The Fuyang pulse being hidden is not the normal pulse of Fuyang stomach qi, but rather due to water accumulating in the lower jiao, suppressing qi, thus the pulse is hidden. Pulse methodology states: Hidden pulses indicate water.
Wei Litong said: With water pathogen in Fuyang, the pulse should be hidden because stomach yang is sealed by clothing and damp-cold yin, preventing the Yangming pulse from emerging. Now it is instead tight, indicating not only abundant water in the interior but also abundant cold in the middle. Presumably, this person not only has water qi pathogen but also chronic accumulated cold causing hernia masses and frequent abdominal pain; the water pathogen is combined with cold. The physician fails to recognize this as yin-cold and mistakenly thinks water can be purged. Although water sinks, cold rebels upward, causing chest fullness and shortness of breath. Regarding the Fuyang pulse that should be hidden but is now rapid, it is due to pre-existing heat. Pre-existing heat should cause excessive hunger, frequent urination, and hard stool, similar to Yangming excess syndrome in Cold Damage. Now, since urination is difficult, it is known to be impending water, undoubtedly involving damp-heat pathogen.
@@@
Liver Water disease: Abdominal distension, inability to turn over independently, hypochondriac abdominal pain, occasional slight production of saliva, and intermittent passage of urine.
[Note]
The above elucidates exterior-interior and upper-lower water; the following elucidates water related to the five zang organs and qi-blood. The Liver governs sinews, and the hypochondrium is its domain. When water pathogen invades, externally sinews relax causing inability to turn; internally abdominal distension and hypochondriac pain occur, along with dribbling urination.
[Collected Notes]
Wei Litong said: Liver Water occurs when water attaches to the Liver. Water in the Liver meridian necessarily resides in the bilateral hypochondria, causing abdominal distension and hypochondriac pain. The pathway of Shaoyang yin-yang interchange is obstructed by pathogen, hence the inability to turn independently. Liver water pathogen necessarily rushes upward to the chest and throat, causing occasional slight saliva production. As it rises and falls, if urination was blocked, it intermittently clears. This is water pathogen causing harm up and down following the ascending-descending qi of Liver Wood. Observing this indicates water in the Liver meridian; treatment should focus on the Liver organ.
You Yi said: The Liver's mansion is the hypochondrium, and its qi connects to the lower abdomen. When Liver water fails to circulate, abdominal distension and inability to turn occur, along with hypochondriac abdominal pain. Occasional slight saliva and intermittent urination occur because the Liver favors counter-flow and governs drainage; water fluids follow these movements up and down.
@@@
Heart Water disease: Heavy body, shortness of breath, inability to lie flat, irritability and restlessness, and swelling of the external genitalia.
[Commentary]
The four characters "swelling of the external genitalia" belong in the Kidney Water section; this is a misplaced slip.
[Note]
The Heart governs vessels, and the Danzhong (Chest Center) is its domain. When water pathogen invades, externally vessel circulation throughout the body is impaired, causing heaviness; internally, shortness of breath, heart vexation, inability to lie flat, and restlessness occur.
[Collected Notes]
Cheng Lin said: *Neijing* states: The Heart governs the blood vessels of the body. *Shangjing* states: Water in the Heart causes epigastric hardness, palpitations, and shortness of breath, hence heavy body and shortness of breath. *Neijing* states: All those with water disease cannot lie flat. The Heart belongs to Fire; water in the Heart causes inability to lie flat, irritability, and restlessness.
Wei Litong said: Water pathogen is a type of accumulation. When close to a location, it lingers in that zang organ, allowing the condition to be named after the organ. Water attaching to the Heart constitutes Heart Water. Water in the Heart meridian can permeate the four limbs and hundred bones, causing heaviness; qi is obstructed by water pathogen, causing shortness of breath; water pathogen presses upon the spirit, causing inability to lie flat; divine illumination is disturbed, causing restlessness and vexation. Observing this indicates water in the Heart meridian; treatment should focus on the Heart meridian.
@@@
Spleen Water disease: Abdominal distension, suffering from heaviness in the four limbs, failure to generate fluids, suffering from shortness of breath, and difficult urination.
[Note]
The Spleen governs the abdomen, and the four limbs are its domain. When water pathogen invades, externally the four limbs suffer heaviness; internally abdominal distension, shortness of breath, and difficult urination occur.
[Collected Notes]
Wei Litong said: Spleen Water occurs when water attaches to the Spleen. The Spleen exclusively governs the abdomen, hence abdominal distension. The Spleen governs rotation and transport, and also the four limbs; poor rotation leads to suffering from limb heaviness. Failure to generate fluids and lack of qi circulation cause obstruction up and down; thus, upper suffering from shortness of breath and lower difficult urination. Observing this indicates water in the Spleen; treatment should focus on draining water in the Spleen organ.
You Yi said: The Spleen governs the abdomen, and qi circulates to the four limbs. When the Spleen receives water qi, the abdomen distends and limbs become heavy. Fluids and qi are generated from grain; grain qi is transported by the Spleen. Spleen dampness failing to transport results in failure to generate fluids and shortness of breath; difficult urination is due to dampness failing to move.
@@@
Lung Water disease: Body edema, difficult urination, and frequent duck-like loose stools.
[Note]
The Lung governs qi, and the skin/hair is its domain. When water pathogen invades, externally whole-body skin edema occurs; internally, fluid transmission to the bladder fails. The Large Intestine is its fu organ; water entering the Large Intestine causes duck-like loose stools.
[Collected Notes]
Zhao Liang said: The Lung governs skin/hair, circulates Ying and Wei, and combines with the Large Intestine. Now with water disease, water fills the skin. The Lung normally regulates water passages, transmitting downward to the Bladder as urine. Now, since regulation fails, water cannot exit via urine but instead follows its combination, mixing with waste to form duck-like loose stools.
Wei Litong said: Lung Water occurs when water attaches to the Lung. The Lung governs qi; qi draws water to flow, also causing whole-body edema. If the Lung fails to descend, qi transformation becomes congested, causing difficult urination. Difficult urination leads to confusion of clear and turbid, hence duck-like loose stools. Observing this indicates water in the Lung; treatment should focus on draining water in the Lung organ.
You Yi said: Duck-like loose stools refer to water and feces mixed together, resembling duck excrement.
@@@
Kidney Water disease: Abdominal distension, umbilical swelling, lower back pain, inability to urinate, dampness under the genitals resembling sweat on an ox's nose, cold feet, and conversely thin face.
[Commentary]
Under "conversely thin face," the four characters "swelling of the external genitalia" from the previous item should be present.
[Note]
The Kidney governs the waist, and the foot/genitals are its domain. When water pathogen invades, externally genital swelling, dampness under genitals, cold feet, and thin face occur; internally abdominal distension, umbilical swelling, lower back pain, and inability to urinate occur. These five points refer to water qi distension/swelling, hence none involve wheezing or coughing.
[Collected Notes]
Cheng Lin said: The Kidney is the gate of the Stomach; if the gate is unregulated, water accumulates causing disease, hence abdominal distension and umbilical swelling. The waist is the external manifestation of the Kidney, hence lower back pain. The Bladder is the mansion of the Kidney, hence inability to urinate. Due to inability to urinate, water qi cannot escape, soaking the scrotum causing genital sweat, and flowing to the lower jiao causing cold feet. The Kidney is a water storage; attacked by water pathogen, upper jiao qi-blood follows water nature downward, hence the face conversely becomes thin, unlike the facial edema of Wind Water or Interior Water.
Wei Litong said: Kidney Water occurs when water attaches to the Kidney. The Kidney governs the lower abdomen; frozen water-dampness in the lower abdomen causes abdominal distension, umbilical swelling, and lower back pain. The lower half of the body is governed by the Kidney; water-dampness in the lower jiao blocks Bladder qi, causing not just difficult urination but complete inability to urinate. Yin-cold abundance below causes genital dampness like cold, sticky sweat on an ox's nose, and cold feet. The face is a yang region; yin abundance below and yang decline above cause the face to be thin. Observing this indicates water in the Kidney; treatment should focus on draining water in the Kidney organ.
You Yi said: Below the midpoint of the body, Kidney qi governs. Water in the Kidney causes lower back pain, umbilical swelling, and abdominal distension. Inability to urinate, genital dampness like ox-nose sweat, and cold feet occur because the Kidney is yin, water is yin; two yins combine, yang qi fails to move, and damp-cold prevails. The face conversely becomes thin because the face is yang; yin abundance below leads to yang decline above.
@@@
The Master said: The Cun Kou pulse is deep and slow. Deep indicates water; slow indicates cold. Cold and water contend. The Fuyang pulse is hidden; food and fluids are not transformed. Spleen qi decline leads to duck-like loose stools; Stomach qi decline leads to body swelling. Shaoyang pulse is low/subdued; Shaoyin pulse is fine/thin. In men, urination is difficult; in women, menstruation is blocked. Menstruation is blood; if blood movement is unfavorable, it becomes water, named Blood Division (Xue Fen).
[Note]
Cun Kou refers to the cun positions of both wrists. Pulse deep and slow: deep indicates water, slow indicates cold. Water and cold contend in the chest, obstructing yang qi transport, causing the Fuyang bilateral guan pulses to be hidden and inactive, leading to undigested food/fluids. If Spleen qi declines, duck-like loose stools occur; if Stomach qi declines, body swelling occurs. Shaoyang right chi pulse sunken, Shaoyin left chi pulse fine/thin, are also due to excessive cold-water suppressing Mingmen fire. Thus, men have undigested water essence and difficult urination; women transform blood into water, blocking menstruation. Calling menstrual blood "Jing Shui" (Menstrual Water) is because water is the substance of blood; women prioritize blood, hence called Blood Division.
[Collected Notes]
Zhao Liang said: Why does Jingyue's pulse methodology often combine Cun Kou with Fuyang? Cun Kou belongs to the Lung, passing through Hand Taiyin. The Lung faces all vessels; the twelve meridians appear at Cun Kou at their respective times. Spleen and Stomach meridians emerge at the right Guan. The Stomach is the sea of food/fluids; all five zang receive qi from the Stomach, making the Stomach the root of the five zang. Thus, the pulse is the key to all meridians. If pathogen affects the Stomach, one must re-examine Fuyang; Fuyang is the source of Stomach pulse.
You Yi said: Combining examination of Cun Kou and Fuyang reveals excessive cold-water and failure of Stomach yang to move. Failure of Stomach yang means food/fluids are not transformed; failure to transform means both Spleen and Stomach decline. Spleen qi governs the interior, so decline causes duck-like loose stools; Stomach qi governs the exterior, so decline causes body swelling. Shaoyang is generating qi; Shaoyin is earth-pathway qi. Both receive qi from Spleen/Stomach. Spleen/Stomach decline causes Shaoyang pulse to be low (generating qi not nourished) and Shaoyin pulse to be fine (earth-pathway blocked). Men have difficult urination; women have blocked menstrual blood. The reason is all due to failure of yang qi movement and knotting of yin qi. Called Blood Division because although diseased as water, it actually originates from blood.
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The Master said: The Cun Kou pulse is slow and choppy. Slow indicates cold; choppy indicates blood deficiency. The Fuyang pulse is faint and slow. Faint indicates qi (deficiency); slow indicates cold. Cold qi and deficiency lead to cold hands and feet; cold hands and feet lead to unfavorable Ying and Wei; unfavorable Ying and Wei lead to abdominal fullness and borborygmus, with chasing qi turning toward the Bladder. Ying and Wei are both exhausted; yang qi unblocked causes body cold; yin qi unblocked causes bone pain. If yang qi moves forward first, aversion to cold occurs; if yin qi moves forward first, numbness and insensitivity occur. When yin and yang harmonize, qi flows; when the Great Qi rotates, pathogen dissipates. Excess leads to flatus; deficiency leads to enuresis. This is named Qi Division (Qi Fen).
[Commentary]
After "named Qi Division," the fifteen characters "primarily treated with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Asarum)" should be present.
[Note]
Cun Kou pulse slow indicates cold; choppy indicates little blood. Fuyang pulse faint lacks qi; slow also indicates cold. Thus, both qi and blood are deficient, invaded by cold qi. Ying and Wei are unfavorable, yin and yang unblocked, causing cold body, bone pain, cold extremities, abdominal fullness, borborygmus, aversion to cold, numbness, flatus, and enuresis. This is qi distension due to internal lodging of cold qi with dual qi-blood deficiency, hence named Qi Division. The following item explains the main treatment using Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang to warm/nourish Ying and Wei, disperse yin/yang, and expel cold pathogen.
[Collected Notes]
Cheng Lin said: Qi dispersion must exit via front or back. Pathogen excess leads to flatus posteriorly; righteous qi deficiency leads to enuresis anteriorly.
You Yi said: "Faint indicates qi" means qi deficiency. "Cold qi and deficiency" refers to the statement covering Cun Kou and Fuyang regarding cold, and additionally that qi-blood are deficient. Cold qi and deficiency cause hands/feet to lack qi and become cold; Ying and Wei lack source and are unfavorable. Consequently, within zang-fu, true qi is insufficient, and guest cold prevails alone, causing abdominal fullness and borborygmus chasing each other, with qi turning to the Bladder and descending. "Ying and Wei both exhausted" means Ying and Wei are depleted. Yang warms the exterior, so unblocking causes body cold; Ying nourishes the interior, so unblocking causes bone pain. Unblocking here means extreme deficiency unable to move, different from excess blockage. If yang moves forward first and yin does not follow, yin loses yang and aversion to cold occurs; if yin moves forward first and yang does not follow, yang stagnates alone and numbness/insensitivity occurs. Yin and yang always depend on each other; loss causes qi mechanism to cease and pathogen to attach; non-loss allows upper-lower communication and pathogen exclusion. Hence: "When yin and yang harmonize, qi flows; when Great Qi rotates, pathogen dissipates." Flatus and enuresis indicate dispersal based on excess/deficiency. Named Qi Division because cold pathogen takes advantage of yang deficiency to disease the qi.
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Qi Division: Stiffness in the epigastrium, large as a plate, edge like a rotating cup, caused by fluid retention, primarily treated with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Asarum).
[Commentary]
The sixteen characters "Qi Division, stiffness in epigastrium large as plate, edge like rotating cup, caused by fluid retention" are likely interpolations; this is evident from the original section on epigastric stiffness. The fifteen characters "primarily treated with Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang" should be under the previous Qi Division item for logical coherence, representing the treatment method for Qi Division; this is certainly a misplaced slip.