参附汤 治真阳不足，上气喘急，自汗盗汗，气短头晕。 人参（半两） 附子（炮去皮脐一两） 咀，分
作三服，加生姜煎。
（论三首 合论《金匮》方六条 律七条 附论海藏法一条）
喻昌曰∶病机之切于人身者，水火而已矣。水流湿，火就燥；水柔弱，火猛烈。水泛溢于表里，火游行于三焦，拯
溺救焚，可无具以应之乎？《经》谓二阳结谓之消，三阴结谓之水，手足阳明热结而病消渴，火之为害，已论之矣。而
三阴者手足太阴脾肺二藏也，胃为水谷之海，水病莫不本之于胃。《经》乃以属之脾肺者何耶？使足太阴脾，足以转输
水精于上。手太阴肺，足以通调水道于下，海不扬波矣。惟脾肺二藏之气，结而不行，后乃胃中之水日蓄，浸灌表里，
无所不到也。是则脾肺之权，可不伸耶。然其权尤重于肾，肾者，胃之关也。肾司开阖，肾气从阳则开，阳太盛则关门
大开，水直下而为消。肾气从阴则阖，阴太盛则关门常阖，水不通而为肿。《经》又以肾本肺标，相输俱受为言，然则水
病，以脾肺肾为三纲矣。于中节目，尤难辨晰。《金匮》分五水之名，及五脏表里主病，彻底言之，后世漫不加察，其
治水辄
宗霸术，不能行所无事，可谓智乎？五水者，风水、皮水、正水、石水、黄汗也。风水其脉自浮，外证骨节疼痛，恶风，
浑是伤风本证，从表治之宜矣。皮水其脉亦浮，外证跗肿，按之没指，不恶风，其腹如鼓，不渴，当发其汗。证不同而
治同，其理安在？则以皮毛者，肺之合也。肺行荣卫，水渍皮间，荣卫之气， 郁不行，其腹如鼓，发汗以散皮毛之邪，
外气通而内郁自解耳。正水其脉沉迟，外证自喘，北方壬癸自病，阳不上通，关门闭而水日聚，上下溢于皮肤，跗肿腹
大，上为喘呼，不得卧，肾本肺标，子母俱病也。石水其脉自沉，外证腹满不喘，所主在肾，不合肺而连肝，经谓肝肾
并沉为石水，以其水积胞中，坚满如石，不上大腹，适在厥阴所部，即少腹疝瘕之类也。不知者每治他病，误动其气，
上为呕逆，多主死也。《巢氏病源》谓石水自引两胁下胀痛，或上至胃脘则死，虽不及于误治，大抵肝多肾少之证耳。
黄
汗汗如柏汁，其脉沉迟，身发热胸满，四肢头面肿，久不愈，必致痈脓。阴脉阳证，肾本胃标，其病皆胃之经脉所过，
后世名之瘅水者是也。夫水饮入胃不行，郁而为热，热则荣卫之气亦热，热之所过，末流之患，不可胜言，皆从瘅水而
浸淫不已耳。然水在心之部，则郁心火炳明之化；水在肝之部，则郁肝木发生之化；水在肺之部，则孤阳竭于外，其魄
独居；水在脾之部，则阴竭于内，而谷精不布；水在肾之部，不但诸阳退伏，即从阳之阴，亦且退伏，孤阴独居于下而
隔绝也。故胃中之水，惟恐其有火，有火仍属消渴，而传中满之不救，肾中之水，惟恐其无火，无火则真阳灭没，而生
气内绝，其在心之水，遏抑君火。若得脾土健运，子必救母，即在肝在肺在肾之水，脾土一旺，水有所制，犹不敢于横
发。第当怀山襄陵之日，求土不委颓足矣。欲土宜稼穑，岂不难哉？夫水土平成，以神禹为师，医门欲平水土，不师仲
景而谁师乎？
参附汤：治疗真阳不足，出现上气喘急、自汗盗汗、气短头晕等症状。人参（半两），附子（炮制后去皮去脐，一两）。将药材切碎，分为三服，加入生姜煎煮服用。
（共三篇论述，结合讨论《金匮要略》中的六条方剂，七条法则，并附录海藏法一条）
喻昌说：与人体关系最密切的病机，不过是水和火罢了。水趋向湿润处，火趋向干燥处；水性柔弱，火性猛烈。如果水在表里泛滥，火在三焦游走，拯救溺水和火灾，难道不需要具备相应的应对方法吗？《黄帝内经》说：“二阳结谓之消，三阴结谓之水。”手足阳明经热结导致消渴病，关于火的危害，前面已经论述过了。而所谓的“三阴”，指的是手足太阴脾脏和肺脏。胃是水谷之海，水病没有不根源于胃的。但《黄帝内经》却将其归属于脾肺，这是为什么呢？这是因为足太阴脾脏的功能足以将水液精微转输到上部；手太阴肺脏的功能足以疏通水道于下部，这样胃这个“海”就不会掀起波涛了。只有当脾肺两脏的气机郁结而不能运行时，胃中的水液才会日益蓄积，浸灌于表里之间，无处不到。由此可见，脾肺的职权怎能不伸张呢？然而，其职权中尤其以肾脏为重，肾是胃的关口。肾主管开阖，肾气从阳则开，阳气太盛则关门大开，水液直下而下表现为消渴；肾气从阴则阖，阴气太盛则关门常闭，水液不通而表现为水肿。《黄帝内经》又说肾为本、肺为标，二者相互输注共同受病。既然如此，那么水病就以脾、肺、肾为三大纲领了。其中的细目，尤其难以辨别清晰。《金匮要略》区分了五种水的名称，以及五脏表里主病的道理，说得透彻彻底。后世之人随意不加考察，治疗水病往往采用霸道手段，不能从容处理，这能算是明智吗？所谓五水，是指风水、皮水、正水、石水、黄汗。风水脉象自浮，外证见骨节疼痛、恶风，完全是伤风的本证，从表治法是适宜的。皮水脉象也浮，外证见足背浮肿，按之凹陷不起，不恶风，腹部如鼓状，口不渴，应当发汗。证候不同但治法相同，其中的道理在哪里呢？因为皮毛是肺的外合。肺运行营卫之气，水湿浸渍于皮间，导致营卫之气郁滞不行，腹部如鼓，通过发汗来疏散皮毛之邪，外气通畅则内郁自然解除。正水脉象沉迟，外证见自喘，这是北方壬癸水脏自病，阳气不能上通，关门关闭而水日益聚积，上下溢于皮肤，足背浮肿腹部大，向上表现为喘息呼叫，不能平卧，这是肾本肺标，子母同病的情况。石水脉象自沉，外证见腹胀满但不喘，所主的脏腑在肾，不合于肺而连及肝脏，《内经》说肝肾脉并沉为石水，因为水积聚在胞中，坚硬胀满如石，不向上蔓延至大腹，正好位于厥阴肝经所部，即属于少腹疝瘕之类。不懂的人往往在治疗其他疾病时，误动了其气机，向上导致呕逆，大多主死。《巢氏病源》说石水牵引两侧胁下胀痛，或者向上延伸至胃脘则死，虽然不及误治严重，但这大抵是肝多肾少的证候罢了。黄汗汗色如柏汁，脉象沉迟，身体发热胸满，四肢头面浮肿，久不愈，必然导致痈脓。这是阴脉阳证，肾本胃标，其病都在胃的经脉所经过的地方，后世称之为瘅水的是这种病。水饮进入胃中而不行，郁滞化为热，热则营卫之气也随之变热，热邪所过之处，末流的祸患不可胜数，都是从瘅水浸淫不已而来的。然而，水在心之部，则郁遏心火光明之化；水在肝之部，则郁遏肝木生发之化；水在肺之部，则孤阳竭于外，其魄独居；水在脾之部，则阴竭于内，而谷精不能布散；水在肾之部，不但诸阳退伏，就连从阳之阴，也将退伏，孤阴独居于下而隔绝。所以，胃中之水，只恐怕有火，有火仍属于消渴，进而传变为中满则不可救；肾中之水，只恐怕无火，无火则真阳灭没，而生机在内断绝；在心之水，遏抑君火。如果能得到脾土的健运，子必救母，即使是在肝、在肺、在肾的水邪，只要脾土一旺，水有所制约，还敢横行发作吗？只是在山水相迫、洪水滔天之时，寻求土德不崩塌就足够了。想要土适宜稼穑，难道不难吗？水土平成，以神禹为师，医门想要平定水土，不师法张仲景又能师法谁呢？
Shenfu Decoction: Treats deficiency of True Yang (Zhen Yang, the foundational Yang energy), manifesting as wheezing and急促 breathing (Shangchuan), spontaneous sweating (Zihan), night sweating (Daohan), shortness of breath (Qiduan), and dizziness. Ren Shen (Ginseng Radix et Rhizoma, half liang), Fu Zi (Prepared Aconiti Lateralis Radix, peeled and de-navelled after processing, one liang). Cut into pieces, divide into three doses, add fresh ginger (Sheng Jiang) and decoct.
(Three discourses combined; discussion of six prescriptions from *Jin Gui Yao Lue* [Essential Prescriptions of the Golden Cabinet], seven laws, plus an appendix on one method from Hai Zang.)
Yu Chang said: The pathogenic mechanisms most pertinent to the human body are Water and Fire. Water flows towards dampness; Fire moves towards dryness. Water is soft and weak; Fire is fierce and violent. If water overflows in the exterior and interior, and Fire wanders through the San Jiao (Triple Burner), is it not necessary to have methods to rescue from drowning and save from burning? The *Classic* (*Huang Di Nei Jing*) states: "Binding of the Two Yangs leads to Xiao [Wasting-Thirst]; binding of the Three Yin leads to Shui [Edema]." Heat binding in the Hand-Foot Yangming meridians causes Wasting-Thirst disease; the harm of Fire has already been discussed. As for the "Three Yin," these refer to the Hand-Foot Taiyin Spleen and Lung organs. The Stomach is the Sea of Water and Grain; all Water diseases fundamentally originate from the Stomach. Why does the *Classic* attribute this to the Spleen and Lung? It is because the Foot-Taiyin Spleen has the capacity to transport fluid essences upward. The Hand-Taiyin Lung has the capacity to regulate water passages downward, so that the Sea does not raise waves. Only when the Qi of the Spleen and Lung becomes bound and fails to circulate does the water in the Stomach accumulate day by day, flooding the exterior and interior, reaching everywhere. Thus, how can the authority of the Spleen and Lung fail to be extended? However, its authority is particularly heavy in the Kidney. The Kidney is the gatekeeper of the Stomach. The Kidney governs opening and closing. When Kidney Qi follows Yang, it opens; if Yang is too excessive, the gate opens wide, water flows straight down, resulting in Wasting-Thirst. When Kidney Qi follows Yin, it closes; if Yin is too excessive, the gate remains closed constantly, water cannot pass, resulting in Edema. The *Classic* also states that the Kidney is the root and the Lung is the branch, transmitting together and both receiving the disease. Therefore, regarding Water diseases, the Spleen, Lung, and Kidney form the three main principles. The details within these are especially difficult to distinguish clearly. *Jin Gui Yao Lue* distinguishes the names of the Five Waters and discusses the diseases governed by the interior-exterior relationships of the Five Zang organs thoroughly. Later generations, carelessly failing to examine this, often resort to coercive methods in treating Water diseases, unable to handle matters with ease. Can this be called wisdom? The Five Waters are: Feng Shui (Wind Edema), Pi Shui (Skin Edema), Zheng Shui (Regular Edema), Shi Shui (Stone Edema), and Huang Han (Yellow Sweat).
Feng Shui has a floating pulse. Its external symptoms include joint pain and aversion to wind. It is entirely consistent with the primary syndrome of Wind-Cold/Wind-Strike injury, so treating from the Exterior is appropriate. Pi Shui also has a floating pulse. Its external symptoms include edema of the dorsum of the foot that leaves an indentation upon pressure, no aversion to wind, abdomen like a drum, no thirst. One should induce sweating. Although the syndromes differ, the treatment is the same. What is the rationale? Because the skin and hair are the exterior correspondence of the Lung. The Lung circulates Ying (Nutritive) and Wei (Defensive) Qi. When water stagnates between the skin layers, Ying and Wei Qi become depressed and fail to circulate, causing the abdomen to resemble a drum. Inducing sweat disperses pathogens in the skin and hair; once exterior Qi flows freely, internal depression resolves naturally.
Zheng Shui has a deep and slow pulse. Its external symptom is spontaneous wheezing. This is a self-disease of the Northern Ren-Gui (Water) organ. Yang fails to ascend, the gate closes, and water accumulates daily. Overflowing up and down onto the skin, it causes edema of the dorsum of the foot and abdominal distension. Upward, it manifests as wheezing and inability to lie flat. This is the case where the Kidney is the root and the Lung is the branch, with both mother and child organs diseased.
Shi Shui has a deep pulse. Its external symptom is abdominal fullness without wheezing. The governing organ is the Kidney, which connects to the Liver rather than the Lung. The Classic states that simultaneous deep pulses of the Liver and Kidney indicate Shi Shui. This is because water accumulates in the Bao (Uterus/Lower Abdomen), becoming hard and full like stone, not extending upward to the large abdomen. It lies precisely in the region governed by the Jueyin Liver meridian, belonging to the category of Shaofu hernia masses. Those who do not understand often, while treating other diseases, inadvertently disturb their Qi, leading upward to vomiting and retching, which usually indicates death. *Chao Shi Bing Yuan* [Source Book of Diseases] states that Shi Shui draws pain and distension in the lower flanks, or if it extends upward to the epigastrium, it results in death. Although this is less severe than mis-treatment, it is generally a syndrome of excess Liver and deficient Kidney.
Huang Han (Yellow Sweat) presents with sweat resembling arbor juice (dark yellow/brown), a deep and slow pulse, fever in the body, chest fullness, and edema of the limbs, head, and face. If prolonged and unresolved, it inevitably leads to carbuncles and pus. This is a Yin pulse with Yang syndrome, where the Kidney is the root and the Stomach is the branch. The disease occurs along the pathways of the Stomach meridians; later generations call this Dan Shui [Hot Water]. When water-drink enters the Stomach but fails to move, it depresses and transforms into Heat. Heat causes Ying and Wei Qi to become hot. Wherever Heat passes, the terminal disasters are countless, all stemming from the endless infiltration of Dan Shui.
However, when water resides in the Heart's domain, it depresses the bright transformation of Heart Fire. When water resides in the Liver's domain, it depresses the generating transformation of Liver Wood. When water resides in the Lung's domain, solitary Yang exhausts itself externally, leaving only the Po (Corporeal Soul) alone. When water resides in the Spleen's domain, Yin exhausts itself internally, and grain essence fails to distribute. When water resides in the Kidney's domain, not only do all Yang energies retreat and hide, but even the Yin that follows Yang retreats and hides. Solitary Yin dwells alone below, causing isolation.
Therefore, regarding water in the Stomach, one fears Fire; if Fire exists, it still belongs to Wasting-Thirst, which transmits to Zhong Man [Fullness in the Middle] and becomes incurable. Regarding water in the Kidney, one fears the absence of Fire; without Fire, True Yang extinguishes, and vital Qi is cut off internally. Regarding water in the Heart, it suppresses Jun Fire [Monarch Fire]. If the Earth of the Spleen is strong and transporting, the Child will rescue the Mother. Even for water in the Liver, Lung, or Kidney, once the Spleen Earth prospers, water is controlled and dares not rampage. Only during times of overwhelming floods ("mountains embracing rivers") is it sufficient to seek Earth that does not collapse. To make Earth suitable for sowing and reaping, is it not difficult? For the harmony of Water and Earth, one takes Yu the Great as the model. In the medical door, to harmonize Water and Earth, who else but Zhang Zhongjing should one follow?