丹溪曰∶水肿脉多沉伏，病阳水兼阳证，脉必沉数。病阴水兼阴证，脉必沉迟。脉沉而滑
为风水。脉浮而迟，弦而紧者，皆为肿也。水病脉洪大者可治，微细者不可治。水病胀闭，
其脉浮大轻者生，沉细虚小者死。水肿腹大如鼓，脉实者生，虚者死；洪大者生，微细者死。
中恶腹大四肢满，脉大而缓者生，浮而紧者死。腹胀便血，脉大时绝剧，脉小疾者死。
肿脉紧而荣卫俱绝，面浮肿者死。
【水肿危候】大凡水肿，先起于腹而后散四肢者可治；先起于四肢而后归于腹者不治。
掌肿无纹者死。大便滑泻水肿不消者死。唇黑唇肿齿焦者死。脐肿突出者死。缺盆平者死。
阴囊及茎俱肿者死。脉绝口张足肿者死。足 肿膝如斗者死。肚上青筋见，泻后腹肿者死。
男从身下肿上女从身上肿下皆难治。
汤液醪醴论篇 帝曰∶其有不从毫毛生，而五脏阳以竭也，津液充郭，其魄独居，孤精于
内，气耗于外，形不可与衣相保。此四极亟而动中，是气拒于内，而形施于外，治之奈何？
岐伯对曰∶平治于权衡，去莞陈 ，是以微动四极，温衣，缪刺其处，以复其形。开鬼门，
洁净府。（内经要旨注明，与下参看。不从皮毛生，谓病生于内者，阴气内盛，阳气竭绝，
不得入于腹中，故言五脏阳以竭也。津液者水也，充郭皮中。阴蓄于内，水气胀满，上攻于
肺，肺气孤危。魄者，肺神。肾为水害，子不救母，故云其魄独居也。夫阴精损削于内，
阳气耗减于外，则三焦闭溢，水道不通，水满皮肤，身体浮肿，故云形不可与衣相保也。
凡此类者，皆四肢脉数急而内鼓动于肺中也。肺动者，谓气急而咳也。如是者皆水气格拒于腹
膜之内，浮肿施胀于身形之外。又穷标本，其可得乎？平治权衡，谓察脉浮沉，脉浮为
在表，脉沉为在
里。在里者泄之，在表者汗之。故云开鬼神洁净府也。去莞陈 谓去积久之水物，犹如草 之
不可久留于身中也。故耳《玉机微义》云∶鬼门者，幽玄之谓，有毛窍而不见其开阖。邪气感入，
邪与正相搏，毛窍闭塞而寒热作焉。病客于表，故宜发汗遣邪气以门也。此亦发汗之别称，
发泄诸病在表之通例也。净府者，谓膀胱，内无入孔而外有出窍，为清净津液之府。逢肾气
脏气化水谷之精而渗入脬中，气约成溺出也。夫肾主下焦，司开阖关窍二阴肺脾之气，通调
水道，下输膀胱，气化水行而自清净。否则便涩或浊或淋，为水气溢于腠理，为 肿诸病，
若莞屈陈 壅滞于身中，当泄去是物而清净，宜此二法。在表者汗之，在里者泄之，权衡
于治也。虽然，经云∶水病本之于肺肾二经，而古今方论并不以治水浊泻肾气为说者何？盖肾
阴奉行降令，为生化之源而常不足，至阴精损削于内，生气不能运化，至为 肿，其索矣，
况肺弱而母气孤危者乎？故东垣曰∶若治以甘淡渗泄阳药，独阳无阴，其欲化得乎？此深撷
以上治例之妙也。如积饮留饮伤脾，若土之于雨中则为泥矣。或因七情所致手足太阴则病身
面浮肿似水气者，用燥脾导气之剂即愈。一则若泥土之得和风暖日，水湿去而阳化，自然万物
生长；一则肺气开泄，渗导通利，水气不滞于脾矣。此正诸湿肿满，皆属脾土；诸气愤郁，
皆属于肺，而与阴阳为病水气机之不同，故亦不待开鬼门洁净府而已也。）
朱丹溪说：水肿病的脉象多表现为沉伏，如果是阳水兼有阳证，脉象必定沉而数；如果是阴水兼有阴证，脉象必定沉而迟。脉象沉而滑的，是风水病。脉象浮而迟、弦而紧的，都是肿胀病。水肿病脉象洪大的可以治疗，脉象微细的不可治疗。水肿伴腹胀闭结，脉象浮大且轻取有力的预后良好（生），脉象沉细虚小的预后不良（死）。水肿腹部胀大如鼓，脉象实的预后良好，脉象虚的预后不良；脉象洪大的预后良好，脉象微细的预后不良。中恶病出现腹部胀大、四肢满闷，脉象大而缓的预后良好，脉象浮而紧的预后不良。腹胀并伴有便血，脉象大但时有间歇或剧烈者，脉象小且急促者预后不良。肿胀病脉象紧且营卫之气俱绝，面部浮肿的预后不良。
【水肿危重征候】大凡水肿，先起于腹部而后扩散至四肢的可以治疗；先起于四肢而后回流至腹部的则无法治疗。手掌肿胀导致纹路消失的预后不良。大便滑泻且水肿不消退的预后不良。嘴唇发黑、嘴唇肿胀、牙齿焦枯的预后不良。肚脐突出肿胀的预后不良。锁骨上窝（缺盆）平坦无凹陷的预后不良。阴囊及阴茎全部肿胀的预后不良。脉搏断绝、口张不开、足部肿胀的预后不良。足部肿胀严重至膝盖像斗一样突出的预后不良。腹部青筋暴露，腹泻后腹部依然肿胀的预后不良。男性从下身向上身发展，女性从上身向下身发展的都难以治疗。
《素问·汤液醪醴论》篇中，黄帝问道：有的疾病不是从毫毛（体表）开始，而是五脏阳气衰竭，津液充满胸廓，只有肺神（魄）独存，精气孤立于内，气耗散于外，形体消瘦以至于衣服都穿不下了。这种情况是四肢极度浮肿且内部脏腑悸动，这是气机阻隔于内，而形体病变表现于外，该如何治疗？
岐伯回答说：应当平调阴阳权衡，去除体内久积的陈腐水湿，轻微活动四肢，穿着保暖衣物，用缪刺法针刺相应部位，以恢复形体正常。开启鬼门（汗孔），洁净府（膀胱）。（《内经要旨》注明，请与下文参考。所谓“不从皮毛生”，是指病生于体内，阴气内盛，阳气竭绝，不能进入腹中，所以说五脏阳气衰竭。津液就是水，充满胸廓皮中。阴气蓄积于内，水气胀满，上攻于肺，肺气孤立危险。魄是肺的神志。肾为水害，子不救母，所以说“其魄独居”。如果阴精在内部受损削减，阳气在外部耗减，那么三焦闭塞溢满，水道不通，水充满皮肤，身体浮肿，所以说形体消瘦以至于衣服都穿不下了。凡是这类情况，都是四肢脉数急且内部鼓动于肺中。肺动，是指气急而咳嗽。像这样的情况，都是水气格拒于腹膜之内，浮肿胀满施于身形之外。又穷究标本，还能得到吗？“平治权衡”，是指诊察脉象浮沉，脉浮表示病在表，脉沉表示病在里。在里的用泄法，在表的用汗法。所以说是“开鬼门，洁净府”。“去菀陈莝”是指去除积久之水物，就像草屑一样不可久留于身体中。所以《玉机微义》说：鬼门，是幽深玄妙之意，指汗毛孔看不见其开阖。邪气感入，邪与正相搏，汗毛孔闭塞而寒热发作。病客于表，所以宜发汗遣除邪气通过门户。这也是发汗的别称，发泄诸病在表的通例。净府，是指膀胱，内无入口而有出口窍道，是清净津液的府库。遇到肾气脏气化水谷之精而渗入膀胱中，气约束形成尿液排出。肾主下焦，司开阖关窍二阴，肺脾之气，通调水道，下输膀胱，气化水行而自然清净。否则小便涩滞或浑浊或淋沥，成为水气溢于腠理，成为浮肿诸病，如果像弯曲堆积的陈旧杂草壅滞于身中，应当泄去这些物质而保持清净，适宜这两种方法。在表的用汗法，在里的用泄法，在治疗中权衡。虽然如此，经文说：水病本源于肺肾二经，而古今方论并不以治水浊泻肾气为说法，为什么呢？盖因肾阴奉行降令，为生化之源而常不足，到了阴精损削于内，生气不能运化，至于发生浮肿，已经枯竭了，何况肺弱而母气孤立危险呢？所以李东垣说：如果用甘淡渗泄的阳药来治疗，独阳无阴，它能化生吗？这深刻摘取了以上治疗范例的奥妙。如积饮留饮损伤脾土，就像土在雨中变成泥一样。或者因为七情所致，手足太阴经生病，身体面浮肿似水气的，用燥脾导气的药剂即可痊愈。一则像泥土得到和风暖日，水湿去除而阳气化生，自然万物生长；一则肺气开泄，渗导通利，水气不滞留于脾。这正是“诸湿肿满，皆属脾土；诸气愤郁，皆属于肺”，而与阴阳为病的水气机理不同，所以也不等待“开鬼门，洁净府”的方法了。）
Zhu Danxi said: The pulse in edema is mostly deep and hidden. If it is Yang water accompanied by Yang syndromes, the pulse must be deep and rapid (Shu). If it is Yin water accompanied by Yin syndromes, the pulse must be deep and slow (Chi). A pulse that is deep and slippery indicates Feng Shui (Wind Edema). A pulse that is floating and slow, or wiry and tight, all indicate swelling diseases. In water diseases, a洪大 (Hong Da, surging and large) pulse is treatable, while a 微细 (Wei Xi, fine and thin) pulse is untreatable. In water disease with distension and constipation, a floating and large pulse that is light upon palpation indicates survival (favorable prognosis), whereas a deep, fine, empty, and small pulse indicates death (unfavorable prognosis). In abdominal edema where the belly is large like a drum, a solid pulse indicates survival, while a deficient pulse indicates death; a Hong Da pulse indicates survival, while a Wei Xi pulse indicates death. In Zhong E (sudden severe illness due to evil qi) with abdominal distension and fullness of the four limbs, a large and slow pulse indicates survival, while a floating and tight pulse indicates death. In abdominal distension with bloody stool, a large pulse with intermittent interruptions or extreme severity, or a small and rapid pulse, indicates death. In swelling diseases, if the pulse is tight and both Ying (Nutrient) and Wei (Defensive) Qi are exhausted, and the face is swollen, it indicates death.
[Critical Signs of Edema] Generally, if edema starts in the abdomen and then spreads to the four limbs, it is treatable; if it starts in the four limbs and then returns to the abdomen, it is untreatable. Swelling of the palms resulting in the disappearance of skin creases indicates death. Sliding diarrhea with persistent edema indicates death. Black lips, swollen lips, and scorched teeth indicate death. Protruding and swollen umbilicus indicates death. Flat supraclavicular fossae (Que Pen) indicate death. Swelling of both the scrotum and penis indicates death. Exhaustion of the pulse, open mouth, and swollen feet indicate death. Swollen feet with knees protruding like a measuring cup indicate death. Visible green veins on the abdomen with abdominal swelling persisting after diarrhea indicates death. For men, edema spreading from the lower body upward, and for women, edema spreading from the upper body downward, are both difficult to treat.
In the "Tang Ye Lao Li Lun" chapter of *Su Wen*, the Yellow Emperor asked: There are cases where the disease does not originate from the hair follicles (body surface), but rather the Yang Qi of the five Zang organs is exhausted. Fluids fill the chest cavity, only the Po (Lung Spirit) remains alone, isolated Jing (Essence) is within, and Qi is depleted outside. The form is so emaciated that it cannot even maintain its clothes. This condition involves urgent swelling in the four limbs and internal organ agitation. This is Qi blocked internally and pathology manifesting externally. How should it be treated?
Qibo replied: One should balance and regulate using weighing scales (metaphor for diagnostic assessment), remove accumulated old debris (Wan Chen), slightly move the four limbs, wear warm clothing, apply Miu Ci (diagonal needle insertion) at corresponding sites, to restore the normal form. Open the Gui Men (Ghost Gate/sweat pores), clean the Jing Fu (Clean Mansion/bladder). (Note from *Neijing Yaozhi*: "Not originating from hair follicles" means the disease arises internally. Yin Qi is abundant inside, Yang Qi is exhausted, unable to enter the abdomen, hence "Yang Qi of the five Zang organs is exhausted." Jin Ye (Fluids) refers to water, filling the chest and skin. Yin accumulates internally, water Qi causes distension, attacking the Lung upwards, leaving Lung Qi isolated and critical. Po is the spirit of the Lung. Kidney is the harm of water; as the child, it fails to save the mother, hence "its Po remains alone." If Yin Jing is damaged internally and Yang Qi is depleted externally, the San Jiao becomes closed and overflowing, water passages do not flow, water fills the skin, causing body swelling, hence "the form cannot maintain its clothes." In such cases, the pulses in the four limbs are rapid and agitated internally affecting the Lung. Lung movement refers to rapid breathing and coughing. Such conditions involve water Qi rejecting within the peritoneum and swelling manifesting on the body's exterior. Investigating root and branch, can this be resolved? "Ping Zhi Quan Heng" means examining the pulse for floating or deep. Floating pulse indicates exterior syndrome; deep pulse indicates interior syndrome. For interior, use purgation; for exterior, use sweating. Hence "Open Gui Men, Clean Jing Fu." "Qu Wan Chen Cuo" means removing long-standing water accumulation, like grass clippings that should not remain in the body. Thus, *Yu Ji Wei Yi* states: Gui Men refers to something profound and invisible, referring to sweat pores whose opening and closing are unseen. When pathogenic Qi enters, it struggles with healthy Qi, pores close, causing chills and fever. Since the pathogen resides in the exterior, one should induce sweating to expel the pathogen via the gate. This is another term for sweating, a general rule for expelling exterior pathogens. Jing Fu refers to the Bladder, which has no internal entry but an external exit, serving as the mansion for clear fluids. When Kidney Qi transforms grain essence into fluid and seeps into the bladder, Qi constrains it to form urine for excretion. The Kidney governs the Lower Jiao, controlling the opening and closing of the orifices. Lung and Spleen Qi regulates water passages, transporting downwards to the Bladder. Through Qi transformation, water flows and naturally clears. Otherwise, dysuria, turbidity, or stranguria occur, becoming water Qi overflowing into the interstices, causing various swellings. If curved, accumulated old weeds obstruct the body, these substances must be purged to achieve clarity, making these two methods appropriate. Exterior is treated by sweating, interior by purging, balancing treatment. Although the classic states: Water diseases originate from the Lung and Kidney meridians, why do ancient and modern formulas rarely discuss treating water turbidity by purging Kidney Qi? Because Kidney Yin executes descending functions, being the source of generation yet often insufficient. When Yin Jing is depleted internally, Sheng Qi (Vital Qi) cannot transform, leading to edema, which is already exhausted. How much more so when the Lung is weak and maternal Qi is isolated? Therefore, Li Dongyuan said: If treated with sweet, bland, draining, and Yang-promoting herbs, with solitary Yang and no Yin, how can transformation occur? This deeply extracts the subtleties of the above treatment examples. For instance, retained fluid damaging the Spleen Earth is like soil turning to mud in rain. Or, caused by Seven Emotions, affecting the Hand and Foot Taiyin meridians, causing body and facial swelling resembling water Qi, using formulas that dry the Spleen and guide Qi will cure it. One aspect is like mud receiving gentle wind and warm sun, where water dampness leaves and Yang transforms, allowing natural growth; the other is Lung Qi opening and venting, promoting drainage and unblocking, so water Qi does not stagnate in the Spleen. This aligns with "All dampness, swelling, and fullness belong to Spleen Earth; All Qi frustration and depression belong to Lung," differing from the mechanism of water Qi disease caused by Yin-Yang imbalance, thus not requiring the methods of "Opening Gui Men and Cleaning Jing Fu".)