脉经云水病脉洪大者可治○微细者不可治○水病胀闭其脉浮大软者生○沉细虚小者死○
水病胀大如鼓实者生虚者死
钱氏曰肾热传于膀胱热盛逆于脾胃脾虚而不能制肾水反克土脾随水行脾主四肢故流走而
身面
皆肿也若大喘者重也何以然肾水胜而克退脾土上胜心火又胜肺肺为心克故喘或问心刑肺本见
虚今何喘实曰此有二一者肺大喘此五脏逆一者肾水气上行傍侵于肺故令大喘也此皆为难治丹
溪云惟肾虚不能行水脾虚不能制水胃与脾合又胃为水谷之海因虚而不能传化焉而肾水泛滥反
得以浸渍脾土于是三焦停滞经络壅塞水渗于皮肤注于肌肉而发肿也其状目胞上下微起肢体重
者喘咳怔忡股间清冷小便涩黄皮薄而光手按成窟举手即满是也古方有十种论证。以短气不得
卧为心水。两胁紧痛为肝水。大便鸭溏为肺水。四肢苦重为脾水。腰痛足冷为肾水。口苦咽
干为胆水。下虚上实为大肠水。腹急肢瘦为膀胱水。小便闭泄为胃水。小腹急满为小肠水。
诸家只知治湿多利小便之说。执此一途。用诸去水之药。往往多死。殊不知脾极虚损。虽劫
目前。水气复来。缩手待毙矣。
按内经云。肾者至阴也。至阴者肾水也。肺者太阴也。少阴者冬脉也。故其本在肾其末
在肺
皆积水也。帝曰何以能聚水而生病。岐伯曰。肾者胃之关也。关门不利故聚水而从其类也上
下溢于皮肤故腹肿大复上为呼喘不得卧者标本俱病也故肺为喘呼肾为水肿肺为逆不得卧下焦
溢为水肺移寒于肾名曰涌水故诸有水者微肿先见于目下也
《脉经》记载：水肿病脉象洪大的可以治愈；脉象微细的难以治愈。水肿导致腹胀闭塞，若脉象浮大且柔软，预后良好（生）；若脉象沉细、虚弱且小，预后不良（死）。水肿腹部胀大如鼓，按之坚实者预后良好，按之虚软者预后不良。
钱乙（钱氏）说：肾热传移至膀胱，热势亢盛，逆犯脾胃。脾虚不能制约肾水，反而被肾水反克（五行中水克土），脾气随肾水下行。因脾主四肢，所以水湿流注，导致全身和面部都出现浮肿。如果出现严重喘息，说明病情危重。为什么这样说呢？因为肾水过胜克制脾土，导致脾土衰退；此时心火又偏胜，肺金受到心火的克制，所以出现喘息。有人问：心火刑克肺金，原本是因为肺虚，现在为何表现为喘息的实证？回答说：这有两种情况。一种是肺气极度上逆，这是五脏气机逆乱的表现；另一种是肾水之气上行，旁及侵犯肺脏，从而导致严重的喘息。这些情况都属于难治之症。
朱丹溪说：只有肾虚不能运化水液，脾虚不能制约水液。胃与脾相表里，胃又是水谷之海，因虚弱而不能传导消化。于是肾水泛滥，反过来浸渍脾土，导致三焦停滞，经络壅塞，水湿渗入皮肤，注入肌肉，从而发生浮肿。其症状表现为眼睑上下微微隆起，肢体沉重，有的伴有喘息咳嗽、心悸怔忡，大腿内侧清冷，小便涩滞且颜色黄，皮肤薄而光亮，用手按压凹陷不起，抬手后即刻恢复。古代方书有“十种水肿”的论证：以短气不能平卧为心水；两胁拘急疼痛为肝水；大便像鸭粪一样稀溏为肺水；四肢苦于沉重为脾水；腰痛足部冰冷为肾水；口苦咽干为胆水；下虚上实为大肠水；腹部急迫但四肢消瘦为膀胱水；小便闭阻或失禁为胃水；小腹急满为小肠水。
各家医家只知道治疗水肿多采用利小便的方法，执着于这一途径，使用各种去水药物，往往导致患者死亡。殊不知脾脏极度虚损，虽然暂时控制了眼前的症状，但水气很快又会复发，最终只能束手待毙。
按《内经》记载：肾属于至阴之脏，至阴即指肾水；肺属于太阴之脏；少阴对应冬季的脉象。所以水肿的根本在肾，标末在肺，都是水液积聚所致。黄帝问：为什么能聚积水液而生病？岐伯回答：肾是胃的关口，如果关门不利，就会聚积水液并同类相从，向上向下溢于皮肤，所以腹部肿大；如果进一步向上影响导致呼吸急促喘息、不能平卧，则是本（肾）标（肺）俱病。所以肺病表现为喘息呼出困难，肾病表现为水肿，肺气上逆导致不能平卧。下焦水液溢出形成水肿，肺将寒邪移于肾，称为“涌水”。因此，所有有水病的人，轻微肿胀首先出现在眼下部位。
The *Mai Jing* (Pulse Classic) states: In edema diseases, if the pulse is *hongda* (surging and large), it is treatable; if the pulse is *weixi* (faint and fine), it is untreatable. In edema with abdominal distension and obstruction, if the pulse is *fuda ruan* (floating, large, and soft), life can be preserved; if the pulse is *chenxi xuxiao* (deep, fine, deficient, and small), death ensues. In edema where the abdomen is distended like a drum, if solid upon palpation, life can be preserved; if deficient/soft, death ensues.
Qian Yi (Qianshi) stated: Kidney heat transmits to the Bladder. When heat becomes excessive, it rebels against the Spleen and Stomach. Due to Spleen deficiency, it cannot control Kidney water, which instead counter-attacks Earth (Water overacting on Earth in the Five Phases). The Spleen Qi follows the downward movement of Water. Since the Spleen governs the four limbs, water-dampness flows through, causing swelling throughout the body and face. If severe panting occurs, the condition is critical. Why is this so? Because excessive Kidney Water overacts on Spleen Earth, causing Spleen Earth to decline; at this time, Heart Fire also becomes excessive, and Lung Metal is controlled by Heart Fire, resulting in panting. One may ask: Heart Fire punishing Lung Metal usually indicates Lung deficiency; why does it now manifest as excess panting? The answer is that there are two scenarios. First, extreme upward rebellion of Lung Qi, which indicates reversal of the five Zang organs' Qi mechanisms. Second, Kidney Water Qi moves upward and invades the Lungs from the side, causing severe panting. All these conditions are difficult to treat.
Zhu Danxi stated: It is only when Kidney deficiency fails to transport water, and Spleen deficiency fails to control water, that issues arise. The Stomach and Spleen are exterior-interior related, and the Stomach is the Sea of Grain and Water. Due to deficiency, it fails to transmit and transform. Consequently, Kidney Water floods and inundates Spleen Earth, causing stagnation in the Sanjiao (Triple Burner) and obstruction in the collaterals. Water seeps into the skin and pours into the muscles, causing edema. The presentation includes slight swelling above and below the eye sockets, heaviness of the limbs, possibly accompanied by panting, coughing, palpitations (*zhengchong*), coldness in the groin area, scanty yellow urine, thin and shiny skin, pitting edema that remains after pressure is released, and immediate rebound upon lifting the hand. Ancient formulas describe ten types of edema: Shortness of breath and inability to lie flat is Heart Edema; tight pain in both hypochondriac regions is Liver Edema; stool resembling duck feces is Lung Edema; suffering from heaviness in the four limbs is Spleen Edema; lower back pain and cold feet is Kidney Edema; bitter taste in the mouth and dry throat is Gallbladder Edema; deficiency below and excess above is Large Intestine Edema; abdominal urgency with emaciated limbs is Bladder Edema; urinary retention or incontinence is Stomach Edema; urgency and fullness in the lower abdomen is Small Intestine Edema.
Various schools only know the method of treating dampness by promoting urination. Clinging to this single path and using various diuretic drugs often leads to death. They do not realize that when the Spleen is extremely deficient, although the immediate symptoms may be suppressed, the water qi will return, leaving the physician helpless and awaiting death.
According to the *Neijing* (Inner Canon): The Kidney is the organ of Supreme Yin. Supreme Yin refers to Kidney Water. The Lung is the organ of Grand Yin. Shaoyin corresponds to the winter pulse. Therefore, the root of edema lies in the Kidney, and its branch lies in the Lung; both involve water accumulation. The Yellow Emperor asked: How can water accumulate to cause disease? Qibo answered: The Kidney is the gate of the Stomach. If the gate is not functional, water accumulates and follows its kind, overflowing up and down onto the skin, causing abdominal distension and swelling. If it further affects the upper jiao causing rapid breathing, panting, and inability to lie flat, it indicates that both the root (Kidney) and the branch (Lung) are diseased. Thus, Lung disease manifests as panting and difficulty exhaling, Kidney disease manifests as edema, and Lung Qi rebellion causes inability to lie flat. Overflow of water from the Lower Jiao forms edema; when Lung transfers cold to the Kidney, it is called "Yong Shui" (Surging Water). Therefore, in all cases of water disease, slight swelling first appears under the eyes.