经云。肺移寒于肾为涌水。涌水者。按腹不坚。水气客于大肠。疾行则鸣濯濯。如囊裹浆。
水之病也。
水始起也。目窠上微肿。如新卧起之状。其颈脉动。时咳。阴股间寒。足胫肿。腹乃大。其水已成矣。以手按
其腹随手而起。如裹水之状。此其候也。
邪气内逆。则气为之闭塞而不行。不行则为水胀。
三阴结。谓之水。
平治权衡。去菀陈 。微动四极。温衣。缪刺其处。开鬼门。洁净府。精已时复。五阳已布。
故精自生。形自盛。骨肉相保。巨气乃平。
此言土虚不能制水之病。平治权衡者。使阴阳各得其平也。菀者积也。陈者久也。 者腐也。
阴阳平治。水气自去。微动四极者。运动四肢也。温则水气易行。故须温衣。不拘隧穴。名曰缪
刺。腠理谓之鬼门。膀胱谓之净府。开者发汗也。洁者渗利也。阳气既和。阴精时复。由是五阳
宣布。阴水尽涤。精血自生。形肉自盛。骨肉与衣相保。大气平矣。金匮云。师曰。病有风水。
有皮水。有正水。有石水。有黄汗。风水其脉自浮。外证骨节疼痛。恶风。皮水其脉亦浮。外证
肿。按之没指。不恶风。其腹如鼓。不渴。当发其汗。正水其脉沉迟。外证自喘。石水其脉自
沉。外证腹满不喘。黄汗其脉沉迟。身发热。胸满。四肢头面肿。久不愈。必致痈脓。
风水者。肾本属水。因风而水积也。经云。并浮为风水。传为 肿。又曰。肾风者。面
然壅。害于言。不能正偃。正偃则咳。名曰风水。其本在肾。其末在肺。皆积水也。上下溢于皮
肤。故为 肿。今止言外证骨节疼痛恶风。不言 肿。脱文也。肾外合于骨。水则病骨。肝外合
于筋。风则筋束关节。故骨节痛。脉浮恶风者。知其风水之在外也。皮水者。皮肤 肿是也。盖
肺主气以行营卫。外合皮毛。皮毛病甚则肺气 郁。当发其汗。散皮毛之邪。外气通而郁解矣。
正水者。肾经之水自病也。经曰。肾者。胃之关也。关门不利。故聚水成病。上下溢于皮肤。
肿腹大。上为喘呼。不得卧。标本俱病也。石水者。乃水积小腹胞内。坚满如石。经曰。阴阳结
邪。阴多阳少名石水。又曰。肾肝并沉为石水。水积胞内。下从足少阴。故不发喘。黄汗者。病
水身黄。汗出如柏汁。由阳明胃热。故见色于外。今之发热胸满。四肢头面肿者。正属足阳明经
脉之证也。热久在肌肉。故化痈脓。
风水脉浮。身重汗出恶风者。防己黄 汤主之。腹痛者加芍药。风水恶风。一身悉肿。脉浮
不渴。续自汗出。无大热。越婢汤主之。
水主肾病。肾脉本沉。以其肝木过盛。火热生风。水势乘风上涌。所以风水之脉反浮也。素
问云。肾肝并浮为风水。盖肾肝同处。肾为阴主静。其脉常沉。肝为阳主动。其脉常浮。二脏俱
有相火。动于肾者。犹龙火之出于海。动于肝者。犹雷火之出于泽。龙起而水随。风发而波涌。
今水从风涌。是以肾肝并浮也。水既从风而脉浮。其病在表也。骨节疼痛。表之虚也。身重。水
客分肉也。汗出恶风。卫气虚也。防己疗风肿水肿。通腠理。黄 温分肉。补卫虚。白术治风主
汗。甘草和药益土。姜、枣辛甘发散。腹痛者。肝邪气塞。不得升降。再加芍药以收阴也。若见
一身悉肿而脉浮不渴。续自汗出。无大热。此风气鼓搏其水。 向外。当与越婢汤发之。此因
势利导之法。且中有石膏化热。而无上逆喘满之虞也。
皮水为病。四肢肿。水气在皮肤中。四肢聂聂动者。防己茯苓汤主之。厥而皮水者。蒲灰散
主之。
风水脉浮。用防己黄 汤矣。而皮水即仿佛用之。前脉论中。同一开鬼门。而标中之本则微
有分。风水下郁其土
气。则用白术崇土。姜、枣和中。皮水内合于肺。肺病则气病。故又名气水。金郁泄之。水积于
皮。以淡渗之。故以茯苓易白术。加桂枝解肌以散水于外。不用姜、枣和之于中也。况四肢聂聂。
风在营卫。触动经络。桂枝安得不用耶。若皮水而见厥逆。知水渍入肾。胃病不能行阳气于四末。
故手足诸阳之本先病也。与伤寒厥而心下悸。当先治水。药虽异而理则同也。
水之为病。其脉沉小属少阴。浮者为风水。虚胀者为气水。发其汗即已。脉沉者宜麻黄附子
汤。浮者宜杏子汤。
此论少阴正水之病。其脉自见沉小。殊无外出之意。若脉见浮者。风发于外也。虚胀者。手
太阴气郁不行。而为虚胀也。风气之病。发其汗则已。即脉沉无他证者。当效伤寒少阴例。用麻
黄附子甘草。荡动其水以救肾邪。若见外证喘满。知水气之在上而不在下。即于前方除去附子。
而加杏仁以救肺邪。此治金水二脏之正法也。
里水者。一身面目黄肿。其脉沉。小便不利。故令病水。假令小便自利。此亡津液。故令渴
也。越婢加术汤主之。甘草麻黄汤主之。
里水即石水。水积膀胱内胞。而小腹硬满如石也。首条言其脉自沉。外证腹满不喘。肾肝并
沉之象。其水潜伏于里。 然不动。非借风水越婢汤之法。不能激之四汽也。此言一身面目黄肿。
脉沉小便不利。虽显阳邪内动。究竟脉沉不鼓。不能破阴邪之坚垒。必需前汤加术以发越脾气。
俾阴邪从阳。里邪从表。一发而阴霾迅扫。此内经开鬼门法也。夫小便不利而水积为患。理固宜
然。设小便自利而水道顺趋。可无病水之虑矣。何至亡津作渴耶。不知金匮设以为例。意谓此证
皆由小便不利所致。即使溲溺忽利。反加烦渴。此必阳邪内扰。迫其阴津下亡。当非
寒去欲解之比。故证虽变而治不殊。总不出越婢加术之范围也。按正水与石水似同而实异。正水
则外证自喘。其本在肾。其末在肺。石水其脉自沉。外证腹满不喘。其水之藏伏于下。积结如石
可知。求其如风水皮水之脉浮。殊不可得。非用麻黄、石膏重剂发之。永无解散之期也。甘草麻
黄汤即越婢汤之变法。病气本轻。但需开发肺气于上。则膀胱气化行矣。
问曰。黄汗之为病。身体肿。（一作重）发热汗出而渴。状如风水。汗沾衣色正黄如柏汁。
脉自沉。何从得之。师曰。以汗出入水中浴。水从汗孔入得之。宜 芍桂酒汤主之。温服一升。
当心烦。服至六七日乃解。若心烦不止者。以苦酒阻故也。黄汗之病。两胫自冷。假令发热。此
属历节。食已汗出。又身常暮卧盗汗出者。此营气也。若汗出已。反发热者。久久其身必甲错。
发热不止者。必生恶疮。若身重汗出已辄轻者。久久必身 。 即胸中痛。又从腰以上必汗出。
下无汗。腰髋弛痛。如有物在皮中状。剧者不能食。身疼重。烦躁。小便不利。此为黄汗。桂枝
加黄 汤主之。须臾。饮热粥一升余以助药力。温覆取微汗。若汗不出。更服。
黄汗皆由营气不和。水气乘虚袭入。所以有发热汗出。身体重痛。皮肤甲错。肌肉 动等证。
至于胫冷髋弛。腰下无汗。内经所谓身半以下。湿中之也。脉沉迟者。水湿之气渗于经脉。而显
迟滞不行之状。证虽多歧。观其所治。咸以桂、芍和营散邪。即兼黄 司开阖之权。杜邪气复入
之路也。按仲景于瘀热壅滞之候。每云甲错。即肌若鱼鳞之状。故发热不止则瘀热溃腐而为恶疮。
每言身 。乃经脉动惕之兆。故发汗不已。则营气内乏。而胸中痛也。
气分。心下坚大如盘。边如旋杯。水饮所作。桂枝去芍药加麻辛附子汤主之。当汗出如虫行
皮中即愈。心下坚大
如盘。边如旋盘。水饮所作。枳术汤主之。腹中软。即当散也。
肺主一身之气而治节行焉。今气分心下坚大如盘。边如旋杯。水饮所作。形容水饮久积胸中
不散。伤其氤氲之气。乃至心下坚大如盘。遮蔽大气。不得透达。只从旁边辘转。如旋杯之状。
正举空洞之位。水饮占据为言。其用桂枝去芍药加麻黄、附、辛。以通胸中阳气。阳主开。阳盛
则有开无塞。而水饮之阴可见 耳。若胸中之阳不亏。当损其有余。则用枳、术二味。开其痰结。
健其脾胃。而阳分之邪。解之自易易耳。人但知枳实太过。而用白术和之。不知痰饮所积。皆由
脾不健运之故。苟非白术豁痰利水。则徒用枳实无益耳。
夫水病患。目下有卧蚕。面目鲜泽。脉伏。其人消渴。病水腹大。小便不利。其脉沉绝者。
有水。可下之。诸有水者。腰以下肿。当利小便。腰以上肿。当发汗乃愈。
张介宾曰。水本畏土。因土虚不能制水。则寒水侮所不胜。反乘脾土。泛滥为邪。其始起也。
必从阴分。渐次而升。按肉如泥。肿有分界。夫水虽制于脾。而实主于肾。肾本水脏。而元气寓
焉。若肾中阳虚。则命门火衰。既不能自制阴寒。又不能温养脾土。阴阳不得其正。则化而为邪。
夫气即火也。精即水也。气之与水。本为同类。但在化与不化耳。故阳旺则化。而精即是气。阳
衰则不化。而水即为邪。凡火盛水亏则病燥。水盛火亏则病湿。故火不能化。则阴不从阳而精气
皆化为水。所以水肿之证。多属阳虚。
喻嘉言曰。病机之切于人者。水火而已。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。可无具以应手乎。经谓二阳结谓之消。三阴结谓之水。手足阳明热结
而病消渴。火之为害固已。而三阴者。手足太阴
脾肺二脏也。胃为水谷之海。水病莫不本之于胃。乃以属之脾肺者何耶。使脾足以转输水精于上。
肺足以通调水道而下。则胃无病水之虞矣。惟脾肺二脏之气结而不行。后乃胃中之水日蓄。渐渍
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。治气之源有三。一曰肺气。肺气清。则周身之气下行也。一曰胃气。胃气和。则胸中
之气亦易下行也。一曰膀胱之气。膀胱之气旺。则能吸引胸中之气下行也。经曰。膀胱者州都之
官。津液藏焉。气化则能出矣。又云。上焦如雾。言其气之氤氲如雾也。又云。膻中者臣使之官。
言其能分布胸中之气而下传也。夫膻中者。与上焦胸膈同位。膀胱位于腹内。膀胱之气。空洞善
容。而膻中之气得以下运。若膀胱之气不化。则腹已先胀。膻中之气安能下达耶。然欲膀胱之气
化。其权在于保肾。肾以膀胱为府也。肾气动。必先注于膀胱。屡动不已。膀胱胀满。势必逆奔
于胸膈。其窒塞之状。不可名言。治法。补肾水而致充足。则精气深藏而膀胱之胀自消。膀胱而
令气旺。则肾邪不蓄而输化之机自裕。所以然者。以肾不补则不能藏。膀胱不补则不能泻。凡治
水肿喘促。以顺肺为主。肺气顺则膀胱之气化。而水自行矣。试以格物之理论之。凡禽畜之类。
有肺者有尿。无肺者无尿。故水道不利而成胀满。以清肺为急。此义前人阐发不到。后人以五苓、
五皮等方治水者。总之未明此旨。至于车水放塘。种种劫夺膀胱之剂。则杀人之事矣。
水肿有阴阳之辨。阳水者。脉息浮数。遍身肿。烦渴。小便赤涩。大便多秘。急宜疏凿饮、禹功
散、浚川散、神芎丸、神 丸选用。小便不通。危急旦夕者。沉香琥珀丸。阴囊肿胀。二便不通
者。三白散。然骤发便剧。元气未衰者。可用上法。若病后脾虚发肿。只宜轻剂投之。如六君、
五苓、理苓之类。俱可应用。阴水者。脉沉迟。或细紧。遍身肿。不烦渴。大便自调。或溏泄。
小便虽少而不赤涩。实脾散加减。小便频数者。济生肾气丸。小便有时黄赤。有时不赤。晚则微
赤。此阴本阳标。未可据用温补。先与五苓散清理其标。次与复元丹。阴阳结邪。多阴少阳为石
水。越婢加术汤发之。肾肝并沉为石水。真武汤温之。小便涓滴不通。诸药不应。急用金液丹。
灶心赤土煎汤送半钱。误用峻利。小便不通者。理苓汤和之。经云。结阳者肿四肢。四肢为诸阳
之本。阳结则不行其阴。故留结为之肢肿。五苓散分利之。水肿暴发。脉浮喘满。咳逆烦热者。
小青龙汤。上热戴阳。下虚足冷。小青龙去麻黄换肉桂。加熟附子四五分。面目四肢浮肿属湿热。
五皮散。初起脉实气盛。五子五皮汤。面独肿而气急。苏子降气汤。煎成磨沉香调服。有一身惟
面与足肿。早则面甚。晚则足甚。苏子降气合除湿汤各半帖和服。右半边肿甚者。肺胃中有积滞
也。导气为先。大忌琥珀、郁金、苏木、五灵之类。左半边肿甚者。肝肾间有瘀血也。散血为要。
大忌胃苓。非特苍术性燥能阻滞恶血。即白术亦须生用。生则有逐湿散血之功而无壅滞之患。皮
水四肢肿而聂聂动者。防己茯苓汤。感湿而肿者。其身虽肿。而腰以下至脚尤重。防己黄 汤加
黑黄牛尿。轻者除湿汤加木瓜、大腹皮。因于气为肿者。脉必沉伏而肿满喘急。增损流气饮。大
《黄帝内经》说：肺将寒气转移给肾，称为涌水。所谓涌水，按压腹部并不坚硬，水气停留在大肠，快速行走时腹部会发出濯濯的声响，就像囊袋里包裹着浆液一样，这是水病的表现。
水病刚开始发生时，眼睑上方微微肿胀，像刚睡醒时的样子，颈部人迎脉搏动，时常咳嗽，大腿内侧感觉寒冷，小腿浮肿，随后腹部变大，这时水病已经形成了。用手按压腹部，手离开后凹陷随即弹起，像包裹着水的状态，这就是它的征候。
邪气在体内逆乱，导致气机闭塞而不能运行，气不行则形成水胀。
三阴经的气机郁结，就称为水病。
治疗时要平调权衡，去除积久的郁滞，轻微活动四肢，注意保暖，采用缪刺法针刺相应部位。通过发汗（开鬼门）和利尿（洁净府）的方法，使精气逐渐恢复，五脏阳气得以布散。
因此精气自然生成，形体自然强盛，骨肉相互保护，正气于是平和。
这段话讲的是脾土虚弱不能制约肾水的病症。“平治权衡”，是指使阴阳各得其平衡。“菀”是积聚的意思，“陈”是久远的意思，“莝”（cuò，原文缺字，据义补）是腐败的意思。
阴阳平衡调理好，水气自然消除。“微动四极”，是指运动四肢。温暖则水气容易运行，所以需要穿暖和的衣服。“缪刺”是不拘泥于常规穴位的一种刺法。“腠理”称为“鬼门”，“膀胱”称为“净府”。“开”是发汗的意思，“洁”是渗利小便的意思。阳气调和，阴精按时恢复，由此五脏阳气宣布，阴寒水气尽除，精血自然产生，肌肉形体自然强盛，骨肉与衣被相保（指身体强健），大气平和了。《金匮要略》说：老师说，疾病有风水、皮水、正水、石水、黄汗五种。风水的脉象自浮，外证见骨节疼痛，恶风。皮水的脉象也浮，外证见浮肿，按之凹陷不起，不恶风，腹部像鼓一样胀满，口不渴，应当用发汗法治疗。正水的脉象沉迟，外证见气喘。石水的脉象自沉，外证见腹部胀满但不喘。黄汗的脉象沉迟，身体发热，胸部胀满，四肢和头面浮肿，久治不愈，必然导致痈脓。
风水，肾本属水，因受风邪而致水液积聚。经文说：脉象兼见浮象为风水，传变为胕肿（足背浮肿）。又说：肾风病患者，面部浮肿壅滞，言语不利，不能仰卧，若仰卧则咳嗽，名叫风水。其根本在肾，标末在肺，都是积水所致。水气上下溢于皮肤，所以发生胕肿。现在只说外证骨节疼痛恶风，不说胕肿，是脱文（文字缺失）。肾外合于骨，水邪则病骨；肝外合于筋，风邪则束缚关节，所以骨节疼痛。脉浮恶风，可知风水之邪在表。
皮水，就是皮肤浮肿。肺主气以运行营卫，外合皮毛，皮毛病变严重则肺气郁闭，应当发汗，以疏散皮毛之邪，外气通畅则郁结解除。
正水，是肾经本身的水液自病。经文说：肾是胃的关口，关门不利，所以聚水成病。水气上下溢于皮肤，导致浮肿腹大，向上影响肺部则气喘呼叫，不能平卧，这是标本俱病。
石水，是水液积聚在小腹胞宫之内，坚硬胀满像石头一样。经文说：阴阳结聚邪气，阴多阳少叫做石水。又说：肾脉和肝脉都沉叫做石水。水积在胞内，向下归属于足少阴肾经，所以不发生气喘。
黄汗，患水病身体发黄，汗出像柏树汁一样。这是由于阳明胃热，所以颜色显现于外。现在出现的发热胸满、四肢头面肿，正是足阳明经脉的证候。热邪久留于肌肉，所以化生痈脓。
风水脉浮，身体沉重、出汗、恶风的，用防己黄芪汤主治。腹痛的加芍药。风水恶风，全身浮肿，脉浮口不渴，持续自汗出，没有大热的，用越婢汤主治。
水病主要责之于肾，肾脉本来沉。因为肝木过盛，火热生风，水势乘风上涌，所以风水的脉象反而浮。《素问》说：肾脉和肝脉都浮为风水。大概肾和肝同处下焦，肾为阴主静，其脉常沉；肝为阳主动，其脉常浮。两脏都有相火，动于肾的，犹如龙火出于海；动于肝的，犹如雷火出于泽。龙起而水随，风发而波涌。现在水从风涌，所以肾肝脉并浮。水既从风而脉浮，说明病在表。骨节疼痛，是表虚的表现。身重，是水邪客于分肉之间。汗出恶风，是卫气虚。防己治疗风肿水肿，通利腠理；黄芪温养分肉，补卫气之虚；白术治风且止汗；甘草调和药物并益脾胃之气；姜、枣辛甘发散。腹痛者，是肝邪气塞滞，不得升降，再加芍药以收敛阴气。如果见到全身浮肿而脉浮口不渴，持续自汗出，无大热，这是风气鼓动水液，向外发散，应当用越婢汤发汗。这是因势利导的方法，且方中有石膏清热，而没有气机上逆喘满的忧虑。
皮水致病，四肢浮肿，水气在皮肤中，四肢微微跳动的，用防己茯苓汤主治。出现厥逆症状的皮水，用蒲灰散主治。
风水脉浮，用防己黄芪汤。而皮水与此方相似，但在前文脉论中，虽然同样是“开鬼门”（发汗），但治标与本则有细微区别。风水下郁脾气，则用白术崇土，姜、枣和中；皮水内合于肺，肺病则气病，所以又名气水。金郁泄之，水积于皮，用淡渗利湿之法，所以用茯苓代替白术，加桂枝解肌以散水于外，不用姜、枣和中。况且四肢微微跳动，是风在营卫之间，触动经络，桂枝怎能不用呢？如果皮水出现厥逆，知道水邪浸渍入肾，胃病不能将阳气行于四肢末端，所以手足诸阳之本先病。这与伤寒中厥逆伴心下悸，应当先治水，药虽不同但道理相同。
水病，脉沉小属于少阴正水，脉浮的是风水，虚胀的是气水，发汗即可痊愈。脉沉的宜用麻黄附子汤，脉浮的宜用杏子汤。
这是论述少阴正水病。其脉自见沉小，完全没有外出的意向。如果脉见浮，是风邪发于外。虚胀，是手太阴肺气郁结不行，而形成的虚胀。风气之病，发汗即愈。即使脉沉没有其他证候，也应当效法伤寒少阴例，用麻黄附子甘草汤，荡涤水邪以救肾邪。如果见到外证喘满，知道水气在上而不在下，就在前方除去附子，加杏仁以救肺邪。这是治疗肺肾二脏的正法。
里水，全身面目黄肿，脉沉，小便不利，所以导致水病。假如小便自利，这是津液亡失，所以导致口渴。用越婢加术汤主治，或用甘草麻黄汤主治。
里水即石水，水积在膀胱胞宫内，小腹硬满像石头。首条说其脉自沉，外证腹满不喘，是肾肝脉并沉的象。其水潜伏于里，寂然不动，非借风水越婢汤的方法，不能激发四极之气。这里说全身面目黄肿，脉沉小便不利，虽然显示阳邪内动，终究脉沉不鼓动，不能破阴邪的坚垒，必需前方加白术以发越脾气，使阴邪从阳，里邪从表，一发而阴霾迅扫，这是内经“开鬼门”的方法。小便不利而水积为患，道理固然如此，假设小便自利而水道顺趋，可没有病水的忧虑了，怎么会亡津作渴呢？不知道《金匮》设立这个例子，意思是此证皆由小便不利所致，即使小便忽然通利，反而加重烦渴，这必然是阳邪内扰，逼迫阴津下亡，并非寒去欲解的情况。所以证候虽变而治法不变，总不出越婢加术汤的范围。按正水与石水看似相同实则不同。正水外证气喘，其本在肾，其末在肺；石水脉自沉，外证腹满不喘，其水藏伏于下，积结如石可知。求其像风水皮水那样脉浮，绝对得不到，非用麻黄、石膏重剂发汗，永远没有解散的时期。甘草麻黄汤即越婢汤的变法，病气本轻，只需开发肺气于上，则膀胱气化行了。
问：黄汗这种病，身体肿（一说为重），发热汗出而渴，状如风水，汗沾衣服颜色正黄像柏树汁，脉自沉，是怎么得的？老师说：因为出汗时进入水中洗澡，水从汗孔进入而得此病。宜用芍药桂酒汤主治。温服一升，当时会心烦，服到六七天才会解。如果心烦不止，是因为苦酒（醋）阻滞的缘故。黄汗病，两小腿自冷，假如发热，这属于历节病。饭后汗出，又身体常在傍晚睡觉时盗汗，这属于营气不和。如果汗出后反而发热，久久身体必然甲错（皮肤粗糙如鱼鳞），发热不止者，必生恶疮。如果身体重，汗出后随即减轻，久久必然身体消瘦（或作“身瞤”），瞤动即胸中痛。又从腰以上必汗出，腰以下无汗，腰髋弛痛，好像有东西在皮中，严重的不能食，身体疼重，烦躁，小便不利，这是黄汗，用桂枝加黄芪汤主治。片刻后，喝热粥一升多以助药力，温覆取微汗。如果汗不出，再服。
黄汗皆由营气不和，水气乘虚袭入，所以有发热汗出、身体重痛、皮肤甲错、肌肉跳动等证。至于小腿冷、髋部弛缓、腰下无汗，是内经所说的“身半以下，湿中之也”。脉沉迟，是水湿之气渗入经脉，而显迟滞不行的状态。证候虽多歧路，看其所治，都用桂枝、芍药调和营气散邪，兼用黄芪司开阖之权，杜绝邪气复入之路。按仲景对于瘀热壅滞的证候，常说甲错，即肌若鱼鳞之状，所以发热不止则瘀热溃腐而为恶疮。每言身瞤，乃经脉动惕之兆，所以发汗不已，则营气内乏，而胸中痛。
气分病，心下坚硬大如盘，边缘像旋转的杯子，是水饮所作。用桂枝去芍药加麻黄细辛附子汤主治。当汗出如虫行皮中即愈。心下坚硬大如盘，边缘像旋转的盘子，是水饮所作。用枳术汤主治。腹中软，即当消散。
肺主一身之气而治理调节它。现在气分病心下坚硬大如盘，边缘像旋转的杯子，是水饮所作，形容水饮久积胸中不散，损伤其氤氲之气，乃至心下坚硬大如盘，遮蔽大气，不得透达，只从旁边辘转，如旋杯之状。正是举空洞之位，水饮占据而言。其用桂枝去芍药加麻黄、附子、细辛，以通胸中阳气。阳主开，阳盛则有开无塞，而水饮之阴可见消散。如果胸中之阳不亏，当损其有余，则用枳实、白术二味，开其痰结，健其脾胃，而阳分之邪，解之自易。人只知道枳实太过，而用白术调和它，不知道痰饮所积，皆由脾不健运的缘故，如果不是白术豁痰利水，则徒用枳实无益。
凡水病患者，目下有卧蚕样浮肿，面目鲜泽，脉伏，其人消渴，病水腹大，小便不利，其脉沉绝的，是有水，可用攻下法。凡有水病，腰以下肿，当利小便；腰以上肿，当发汗乃愈。
张介宾说：水本畏土，因土虚不能制水，则寒水侮所不胜，反乘脾土，泛滥为邪。其始起也，必从阴分，渐次而升，按肉如泥，肿有分界。夫水虽制于脾，而实主于肾。肾本水脏，而元气寓焉。若肾中阳虚，则命门火衰，既不能自制阴寒，又不能温养脾土，阴阳不得其正，则化而为邪。夫气即火也，精即水也。气与水，本为同类，但在化与不化耳。故阳旺则化，而精即是气；阳衰则不化，而水即为邪。凡火盛水亏则病燥，水盛火亏则病湿。故火不能化，则阴不从阳而精气皆化为水，所以水肿之证，多属阳虚。
喻嘉言说：病机切近于人身的，水火而已。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，可无具以应手乎？经文谓“二阳结谓之消，三阴结谓之水”。手足阳明热结而病消渴，火之为害固已。而三阴者，手足太阴脾肺二脏也。胃为水谷之海，水病莫不本之于胃，乃以属之脾肺者何耶？使脾足以转输水精于上，肺足以通调水道而下，则胃无病水之虞矣。惟脾肺二脏之气结而不行，后乃胃中之水日蓄，渐渍表里，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？治气之源有三：一曰肺气，肺气清，则周身之气下行也；一曰胃气，胃气和，则胸中之气亦易下行也；一曰膀胱之气，膀胱之气旺，则能吸引胸中之气下行也。经曰：“膀胱者州都之官，津液藏焉，气化则能出矣。”又云：“上焦如雾”，言其气之氤氲如雾也。又云：“膻中者臣使之官”，言其能分布胸中之气而下传也。夫膻中者，与上焦胸膈同位，膀胱位于腹内，膀胱之气空洞善容，而膻中之气得以下运。若膀胱之气不化，则腹已先胀，膻中之气安能下达耶？然欲膀胱之气化，其权在于保肾。肾以膀胱为府也。肾气动，必先注于膀胱，屡动不已，膀胱胀满，势必逆奔于胸膈，其窒塞之状，不可名言。治法，补肾水而致充足，则精气深藏而膀胱之胀自消。膀胱令气旺，则肾邪不蓄而输化之机自裕。所以然者，以肾不补则不能藏，膀胱不补则不能泻。凡治水肿喘促，以顺肺为主，肺气顺则膀胱之气化，而水自行矣。试以格物之理论之，凡禽畜之类，有肺者有尿，无肺者无尿。故水道不利而成胀满，以清肺为急。此义前人阐发不到，后人以五苓、五皮等方治水者，总之未明此旨。至于车水放塘，种种劫夺膀胱之剂，则杀人之事矣。
水肿有阴阳之辨。阳水者，脉息浮数，遍身肿，烦渴，小便赤涩，大便多秘，急宜疏凿饮、禹功散、浚川散、神芎丸、神佑丸选用。小便不通，危急旦夕者，沉香琥珀丸。阴囊肿胀，二便不通者，三白散。然骤发便剧，元气未衰者，可用上法。若病后脾虚发肿，只宜轻剂投之，如六君、五苓、理苓之类，俱可应用。阴水者，脉沉迟，或细紧，遍身肿，不烦渴，大便自调，或溏泄，小便虽少而不赤涩，实脾散加减。小便频数者，济生肾气丸。小便有时黄赤，有时不赤，晚则微赤，此阴本阳标，未可据用温补，先与五苓散清理其标，次与复元丹。阴阳结邪，多阴少阳为石水，越婢加术汤发之。肾肝并沉为石水，真武汤温之。小便涓滴不通，诸药不应，急用金液丹，灶心赤土煎汤送半钱。误用峻利，小便不通者，理苓汤和之。经云：“结阳者肿四肢”，四肢为诸阳之本，阳结则不行其阴，故留结为之肢肿，五苓散分利之。水肿暴发，脉浮喘满，咳逆烦热者，小青龙汤。上热戴阳，下虚足冷，小青龙去麻黄换肉桂，加熟附子四五分。面目四肢浮肿属湿热，五皮散。初起脉实气盛，五子五皮汤。面独肿而气急，苏子降气汤，煎成磨沉香调服。有一身惟面与足肿，早则面甚，晚则足甚，苏子降气合除湿汤各半帖和服。右半边肿甚者，肺胃中有积滞也，导气为先，大忌琥珀、郁金、苏木、五灵脂之类。左半边肿甚者，肝肾间有瘀血也，散血为要，大忌胃苓汤，非特苍术性燥能阻滞恶血，即白术亦须生用，生则有逐湿散血之功而无壅滞之患。皮水四肢肿而聂聂动者，防己茯苓汤。感湿而肿者，其身虽肿，而腰以下至脚尤重，防己黄芪汤加黑黄牛尿。轻者除湿汤加木瓜、大腹皮。因于气为肿者，脉必沉伏而肿满喘急，增损流气饮。
The *Classic of Medicine* (Huangdi Neijing) states: When the Lung transfers cold to the Kidney, it is called Yong Shui (Surging Water). In Yong Shui, pressing the abdomen does not feel hard; water qi lodges in the Large Intestine, and upon rapid movement, a gurgling sound is heard, resembling a bag containing fluid. This is a manifestation of water disease.
When water disease first begins, the upper eyelids swell slightly, resembling the appearance after just waking up. The pulse at the neck (Renying point) throbs, there is occasional coughing, coldness in the groin area, and swelling of the lower legs and calves. Subsequently, the abdomen enlarges, indicating that water retention has been established. Pressing the abdomen causes an indentation that rebounds immediately upon releasing the hand, resembling a sac filled with water. These are its signs.
When pathogenic factors reverse internally, Qi becomes obstructed and fails to circulate. Failure of Qi circulation leads to water distension.
Obstruction of the Three Yin meridians is termed Water Disease.
Treatment requires balancing and weighing, removing accumulated stagnation, gently moving the four extremities, keeping warm, and applying Miu Ci (contralateral or specific point needling). By inducing sweating (opening the "Ghost Gate" / pores) and promoting urination (cleansing the "Clean House" / bladder), essence gradually recovers, and the Yang Qi of the Five Zang organs is distributed.
Thus, essence generates naturally, the physical form becomes robust, bone and flesh protect each other, and the Great Qi becomes balanced.
This passage discusses diseases where Spleen Earth is deficient and cannot control Kidney Water. "Balancing and weighing" means allowing Yin and Yang to achieve equilibrium. "Wan" refers to accumulation; "Chen" refers to longevity or duration; "Cuo" refers to decay or corruption. Once Yin and Yang are balanced and regulated, water qi dissipates naturally. "Gently moving the four extremities" refers to exercising the limbs. Warmth facilitates the movement of water qi, hence the need for warm clothing. "Miu Ci" refers to needling points without adhering strictly to standard meridian pathways. "Cou Li" (interstices/pores) is called the "Ghost Gate"; the Bladder is called the "Clean House." "Opening" refers to inducing sweating; "cleansing" refers to promoting diuresis. Once Yang Qi harmonizes and Yin essence restores, the Yang Qi of the Five Zang organs spreads, eliminating Yin-cold water qi. Essence and blood generate naturally, muscle and flesh become robust, and the body remains strong ("protecting bones and flesh like clothing protects the body"), while the Great Qi becomes peaceful.
The *Jin Gui Yao Lue* states: The Master said, there are five types of water disorders: Feng Shui (Wind Water), Pi Shui (Skin Water), Zheng Shui (Regular Water), Shi Shui (Stone Water), and Huang Han (Yellow Sweat). Feng Shui presents with a floating pulse, external symptoms of joint pain, and aversion to wind. Pi Shui also presents with a floating pulse, external symptoms of edema that pits upon pressure, no aversion to wind, abdominal distension like a drum, and no thirst; treatment should induce sweating. Zheng Shui presents with a deep and slow pulse, and external symptoms of spontaneous asthma/dyspnea. Shi Shui presents with a deep pulse, and external symptoms of abdominal fullness without asthma. Huang Han presents with a deep and slow pulse, fever, chest fullness, and edema of the limbs and face; if untreated long-term, it will inevitably lead to abscesses and pus.
Feng Shui: The Kidney belongs to Water, but due to Wind pathogen, water accumulates. The Classic states: A pulse appearing both floating indicates Feng Shui, which transmits to foot dorsum edema. It is also stated: In Kidney Wind, the face is swollen and congested, speech is impaired, and the patient cannot lie flat; lying flat induces coughing, named Feng Shui. Its root is in the Kidney, its branch in the Lung, both involving water accumulation. Water overflows上下 into the skin, causing edema. The current text mentions only external symptoms of joint pain and aversion to wind, omitting edema, which is likely a textual omission. The Kidney externally correlates with bones; water pathology affects bones. The Liver externally correlates with sinews; wind pathology binds joints, causing joint pain. A floating pulse with aversion to wind indicates the pathogen is in the exterior.
Pi Shui: This is skin edema. The Lung governs Qi to circulate Ying and Wei, and externally correlates with the skin and hair. Severe skin pathology leads to Lung Qi stagnation; treatment should induce sweating to disperse exterior pathogens, allowing external Qi to flow freely and resolving stagnation.
Zheng Shui: This is self-pathology of water in the Kidney Meridian. The Classic states: The Kidney is the gate of the Stomach. If the gate is dysfunctional, water accumulates to cause disease. Water overflows into the skin, causing edema and abdominal distension. Ascending to affect the lungs causes dyspnea and inability to lie flat; this is simultaneous disease of root and branch.
Shi Shui: Water accumulates in the lower abdomen and bladder, becoming hard and full like stone. The Classic states: Yin-Yang obstruction by pathogenic factors, with excess Yin and deficient Yang, is named Shi Shui. Also: Simultaneous deep pulses of the Kidney and Liver indicate Shi Shui. Water accumulates in the bladder, descending via the Foot Shaoyin Kidney Meridian, hence no asthma occurs.
Huang Han: The patient has water disease with yellowish complexion, and sweat resembles paulownia juice. This is due to Yangming Stomach Heat manifesting externally. Current symptoms of fever, chest fullness, and edema of limbs/face belong to the Foot Yangming Meridian. Prolonged heat in muscles transforms into abscesses and pus.
For Feng Shui with a floating pulse, heaviness, sweating, and aversion to wind, Fang Ji Huang Qi Tang (Astragalus and Stephania Decoction) is indicated. Add Shaoyao (Peony) for abdominal pain. For Feng Shui with aversion to wind, generalized edema, floating pulse, no thirst, continuous spontaneous sweating, and absence of high fever, Yue Bi Tang (Yuebi Decoction) is indicated.
Water disease primarily concerns the Kidney, whose pulse is normally deep. However, if Liver Wood is excessive, generating fire and wind, water surges with the wind, causing the Feng Shui pulse to be floating. The *Su Wen* states: Simultaneous floating pulses of Kidney and Liver indicate Feng Shui. The Kidney and Liver reside in the lower jiao; the Kidney is Yin and static (pulse usually deep); the Liver is Yang and active (pulse usually floating). Both contain Ministerial Fire. Movement in the Kidney is like dragon fire emerging from the sea; movement in the Liver is like thunder fire emerging from a marsh. When the dragon rises, water follows; when wind arises, waves surge. Thus, water surges with wind, causing simultaneous floating pulses of Kidney and Liver. Since water follows wind and the pulse is floating, the disease is in the exterior. Joint pain indicates exterior deficiency. Heaviness indicates water lodging in the intermuscular spaces. Sweating and aversion to wind indicate Wei Qi deficiency. Fang Ji treats wind and water edema, opening interstices; Huang Qi warms the intermuscular spaces and tonifies Wei Qi deficiency; Bai Zhu treats wind and stops sweating; Gan Cao harmonizes herbs and benefits Earth; Ginger and Jujube promote acrid-sweet dispersion. Abdominal pain indicates Liver pathogenic qi obstruction preventing ascending/descending; adding Shaoyao collects Yin. If generalized edema, floating pulse, no thirst, continuous sweating, and no high fever are present, this is wind鼓搏 (drumming/agitating) water outward; treat with Yue Bi Tang to induce sweating. This is a method of guiding according to the trend, using Shi Gao (Gypsum) to clear heat without risking upward reversal of asthma/fullness.
For Pi Shui causing limb edema, with water qi in the skin and slight trembling of the limbs, Fang Ji Fu Ling Tang (Stephania and Poria Decoction) is indicated. For Pi Shui presenting with Jue (cold extremities), Pu Hui San (Puhui Powder) is indicated.
Although Feng Shui with a floating pulse uses Fang Ji Huang Qi Tang, Pi Shui is similar but differs in treating the root vs. branch. Both use "opening the Ghost Gate" (sweating), but Feng Shui involves downward depression of Spleen Qi, so Bai Zhu is used to fortify Earth, along with Ginger and Jujube to harmonize the middle. Pi Shui internally combines with the Lung; Lung disease implies Qi disease, hence also called Qi Water. Metal obstruction requires unblocking; water accumulating in the skin requires mild diuresis. Thus, Fu Ling replaces Bai Zhu, and Gui Zhi (Cinnamon Twig) is added to release the muscle layer and disperse water externally, avoiding Ginger and Jujube to harmonize the middle. Furthermore, limb trembling indicates wind in Ying and Wei disturbing collaterals, necessitating Gui Zhi. If Pi Shui presents with Jue Ni (reversal/cold extremities), it indicates water infiltrating the Kidney; Stomach disease fails to transmit Yang Qi to the four extremities, affecting the roots of Yang limbs. This parallels Cold Damage cases of Jue with epigastric palpitations requiring prior water treatment; although the herbs differ, the principle is the same.
In water disease, a deep-small pulse belongs to Shaoyin (Regular Water); a floating pulse indicates Feng Shui; a vacuous distension indicates Qi Water, which resolves with sweating. A deep pulse suggests Ma Huang Fu Zi Tang (Ephedra and Aconite Decoction); a floating pulse suggests Xing Zi Tang (Apricot Seed Decoction).
This discusses Shaoyin Regular Water. The pulse is inherently deep-small, showing no tendency to exit. If the pulse is floating, Wind is emerging externally. Vacuous distension results from Hand Taiyin Lung Qi stagnation. Wind-related diseases resolve with sweating. Even if the pulse is deep without other symptoms, follow the Shaoyin protocol of Cold Damage: use Ma Huang, Fu Zi, and Gan Cao to stir water and rescue Kidney pathology. If external symptoms of asthma/fullness appear, indicating water qi above rather than below, remove Fu Zi from the previous formula and add Xing Ren (Apricot Seed) to rescue Lung pathology. This is the correct method for treating Metal and Water organs.
Li Shui (Interior Water) presents with generalized yellowish edema of the face and body, a deep pulse, and ineffective urination, leading to water disease. If urination is spontaneous, this indicates loss of Jin Ye (body fluids), causing thirst. Treat with Yue Bi Jia Zhu Tang (Yuebi Decoction plus Atractylodes) or Gan Cao Ma Huang Tang (Licorice and Ephedra Decoction).
Li Shui is equivalent to Shi Shui, with water accumulating in the bladder/uterus, causing hardness and fullness in the lower abdomen like stone. The first section describes a deep pulse and abdominal fullness without asthma, reflecting deep pulses of Kidney and Liver. The water lurks inside, remaining still. Without the method of Feng Shui/Yue Bi Tang to stimulate the four extremities, it cannot be moved. Here, generalized yellowish edema, deep pulse, and ineffective urination show internal Yang pathogen activity, yet the deep pulse lacks vigor to break Yin hardness. One must use the previous formula plus Zhu (Atractylodes) to stimulate Spleen Qi, transforming Yin pathogen to Yang and interior pathogen to exterior, sweeping away Yin turbidity in one move. This aligns with the Neijing's "open the Ghost Gate" method. While ineffective urination leading to water accumulation is logical, if urination were normal, water disease would not occur, nor would fluid loss cause thirst. The *Jin Gui* sets this example to imply these cases stem from ineffective urination; even if urination suddenly becomes free, worsening thirst indicates internal Yang pathogen disturbing and forcing Yin fluids downward, not a resolution of cold. Thus, despite symptom changes, treatment remains within the scope of Yue Bi Jia Zhu Tang. Note: Zheng Shui and Shi Shui seem similar but differ. Zheng Shui has external asthma, root in Kidney, branch in Lung. Shi Shui has a deep pulse, abdominal fullness without asthma, and water hidden low, accumulating like stone. Unlike Feng/Pi Shui with floating pulses, Shi Shui requires heavy doses of Ma Huang and Shi Gao to induce sweating, otherwise resolution is impossible. Gan Cao Ma Huang Tang is a variation of Yue Bi Tang for milder conditions, focusing on opening Lung Qi to restore Bladder Qi transformation.
Question: Huang Han disease presents with body edema (or heaviness), fever, sweating, thirst, resembling Feng Shui, with sweat staining clothes yellow like paulownia juice, and a deep pulse. How is it contracted? Master says: Bathing in water while sweating allows water to enter through the pores. Treat with Gui Zhi Jia Huang Qi Tang (Cinnamon Twig Decoction plus Astragalus). Take 1 sheng warm; initial heart vexation is expected, resolving after 6-7 days. Persistent vexation is due to Ku Jiu (vinegar) obstruction. Huang Han presents with cold lower legs; if fever occurs, it belongs to Li Jie (Joint Bi). Sweating after eating, or night sweats while sleeping, indicates Ying Qi disharmony. If fever persists after sweating, the body will eventually develop "Jia Cuo" (crisscrossed rough skin); persistent fever leads to malignant sores. If body heaviness lightens after sweating, prolonged cases may lead to emaciation or muscle twitching (Shun), causing chest pain. Sweating above the waist but none below, with flaccid pain in loins/hips, feeling like something in the skin, severe cases unable to eat, body ache/heaviness, irritability, and ineffective urination constitute Huang Han. Treat with Gui Zhi Jia Huang Qi Tang. Drink hot porridge after administration to assist medicinal power, cover warmly for slight sweating. Repeat if no sweat.
Huang Han results from Ying Qi disharmony, allowing Water Qi to invade deficiency. Symptoms include fever, sweating, body heaviness/pain, skin crisscrossing, and muscle twitching. Cold calves and flaccid hips with no sweat below the waist correspond to Neijing's "below half the body, dampness attacks." Deep-slow pulses indicate water-dampness infiltrating meridians, causing sluggishness. Although symptoms vary, treatment uses Gui Zhi and Shaoyao to harmonize Ying and dispel pathogens, combined with Huang Qi to regulate opening/closing and prevent pathogen re-entry. Zhong Jing uses "Jia Cuo" for stagnant heat causing fish-scale-like skin; persistent fever leads to ulceration. "Shun" (twitching) indicates collateral agitation; prolonged sweating depletes Ying Qi, causing chest pain.
Qi Fen (Qi Division) disease: Epigastric hardness large as a plate, edges like a rotating cup, caused by water-fluid retention. Treat with Gui Zhi Qu Shao Yao Jia Ma Huang Xi Xin Fu Zi Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Asarum, and Aconite). Recovery occurs when sweat feels like insects crawling on the skin. Alternatively, for epigastric hardness like a plate caused by water-fluid retention, use Zhi Zhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction). If the abdomen is soft, the condition will dissipate.
The Lung governs all Qi and regulates it. In Qi Fen disease, epigastric hardness like a plate indicates long-standing water-fluid retention in the chest damaging vital Qi, blocking the Great Qi. Treatment with Gui Zhi Qu Shao Yao Jia Ma Huang Xi Xin Fu Zi Tang unblocks Chest Yang. Yang promotes opening; abundant Yang prevents blockage, allowing Yin-water to dissipate. If Chest Yang is not deficient, reduce excess using Zhi Shi and Bai Zhu to open phlegm knots and strengthen Spleen/Stomach, easily resolving Yang-pathogen. People assume Zhi Shi is too harsh and balance it with Bai Zhu, not realizing phlegm-fluid retention stems from Spleen failure to transport. Without Bai Zhu's phlegm-resolving and diuretic action, Zhi Shi alone is ineffective.
In water patients,卧蚕 (silkworm-like swelling) under eyes, bright complexion, hidden pulse, thirst, abdominal distension, ineffective urination, and absent deep pulses indicate water amenable to purgation. General rule: Edema below the waist requires diuresis; edema above the waist requires sweating.
Zhang Jiebin states: Water fears Earth. Deficient Earth fails to control Water, allowing Cold Water to insult the unconquerable and attack Spleen Earth, flooding as pathogen. It starts in Yin divisions, rising gradually, feeling like mud upon pressure, with defined boundaries. Although controlled by Spleen, Water is governed by Kidney. The Kidney is the Water Organ housing Yuan Qi. Kidney Yang deficiency leads to Ming Men Fire decline, failing to control Yin cold or warm Spleen Earth. Yin-Yang imbalance transforms into pathogen. Qi is Fire; Jing is Water. They are similar but depend on transformation. Strong Yang transforms Jing to Qi; weak Yang fails to transform, making Water pathogenic. Excess Fire/Water deficiency causes Dryness; Excess Water/Fire deficiency causes Dampness. Untransformed Fire causes Yin not to follow Yang, converting essence to water. Thus, edema often belongs to Yang deficiency.
Yu Jiayan states: Pathogenesis concerning humans revolves around Water and Fire. Water flows to dampness; Fire seeks dryness. Water is soft; Fire is fierce. Water floods interior/exterior; Fire travels the San Jiao. Rescue drowning/fire requires appropriate methods. The Classic states: "Two Yang obstruction causes Xiao (wasting-thirst); Three Yin obstruction causes Shui (water)." Hand-Foot Yangming heat obstruction causes wasting-thirst, showing Fire harm. Three Yin refers to Hand-Foot Taiyin Spleen and Lung. The Stomach is the Sea of Grain and Water; water disease originates in the Stomach, yet attributed to Spleen/Lung? If Spleen transports fluids upward and Lung regulates waterways downward, Stomach faces no water disease risk. Only when Spleen/Lung Qi obstructs does Stomach water accumulate daily, soaking interior/exterior. Thus, Spleen/Lung authority must be extended, though Kidney authority is even greater. The Kidney is the Stomach's gate, controlling opening/closing. Kidney Qi following Yang opens; excessive Yang opens the gate wide, causing water to drain down as Xiao. Kidney Qi following Yin closes; excessive Yin keeps the gate shut, causing water stagnation as edema. The Classic also states Kidney is root, Lung is branch, mutually receiving. Thus, water disease has Spleen, Lung, and Kidney as three guidelines. Differentiating details is difficult. *Jin Gui* classifies five waters and organ correlations thoroughly. Later generations failed to observe, using coercive methods ineffectively. Treating Qi sources has three aspects: 1. Lung Qi clears, allowing whole-body Qi to descend. 2. Stomach Qi harmonizes, facilitating Chest Qi descent. 3. Bladder Qi prospers, attracting Chest Qi downward. The Classic states: "Bladder is the Officer of the Capital, storing fluids; Qi transformation enables excretion." Upper Jiao is like mist (vital Qi vaporizing). Dan Zhong is the Envoy, distributing Chest Qi downward. Dan Zhong shares position with Upper Jiao; Bladder is in the abdomen, hollow and accommodating, allowing Dan Zhong Qi to descend. If Bladder Qi fails to transform, abdominal bloating precedes, preventing Dan Zhong Qi descent. To transform Bladder Qi, preserve Kidney. Kidney governs Bladder. Kidney Qi moves to Bladder; repeated movement fills Bladder, potentially reversing to Chest/Diaphragm, causing severe obstruction. Treatment: Tonify Kidney Water to sufficient levels, storing essence deeply and reducing Bladder distension. Strengthen Bladder Qi to prevent Kidney pathogen accumulation and facilitate transformation. Why? Kidney tonification enables storage; Bladder tonification enables excretion. For edema/asthma, prioritize smoothing Lung Qi. Smooth Lung Qi transforms Bladder Qi, moving water. Observing animals: those with lungs urinate; those without do not. Thus, obstructed waterways causing distension require urgent Lung clearing. Predecessors missed this; later generations using Wu Ling San/Wu Pi San failed to grasp this principle. Coercive Bladder-draining agents are lethal.
Edema distinguishes Yin/Yang. Yang Water: Floating-rapid pulse, generalized edema, irritability/thirst, red/scanty urine, constipation. Urgently use Shu Zao Yin, Yu Gong San, Jun Chuan San, Shen Xiong Wan, Shen You Wan. For acute urinary retention, Chen Xiang Hu Po Wan. For scrotal swelling with bowel/bladder obstruction, San Bai San. Use these if sudden/severe with intact Yuan Qi. Post-illness Spleen deficiency edema requires mild formulas like Liu Jun, Wu Ling, or Li Ling. Yin Water: Deep-slow or fine-tight pulse, generalized edema, no thirst, normal or loose stools, scanty non-red urine. Modify Shi Pi San. For frequent urination, Ji Sheng Shen Qi Wan. For intermittent yellow/red urine, this is Yin root/Yang branch; avoid warming tonics initially. Use Wu Ling San to clear branch, then Fu Yuan Dan. Yin-Yang obstruction, excess Yin/deficient Yang is Shi Shui; treat with Yue Bi Jia Zhu Tang. Simultaneous deep Kidney/Liver pulses is Shi Shui; treat with Zhen Wu Tang. For anuria unresponsive to drugs, urgently use Jin Ye Dan delivered with Zao Xin Chi Tu (Fire Kiln Hearth Earth) decoction. If峻利 (harsh purgatives) cause anuria, harmonize with Li Ling Tang. Classic: "Yang obstruction swells limbs." Limbs are roots of Yang; Yang obstruction prevents Yin circulation, causing limb swelling. Treat with Wu Ling San. Sudden edema with floating pulse, asthma/fullness, cough/reversal, irritability/heat: Xiao Qing Long Tang. Upper heat/Dai Yang, lower deficiency/cold feet: Xiao Qing Long Tang minus Ma Huang, replace with Rou Gui, add Shu Fu Zi. Face/limb edema due to Damp-Heat: Wu Pi San. Early stage excess pulse/Qi: Wu Zi Wu Pi Tang. Facial edema only with急促 breathing: Su Zi Jiang Qi Tang (grind Chen Xiang into decoction). Generalized facial/foot edema, worse face morning/foot evening: Combine Su Zi Jiang Qi Chu Shi Tang equally. Right-sided edema indicates Phlegm-Stasis in Lung/Stomach; guide Qi first. Avoid Hu Po, Yu Jin, Su Mu, Wu Ling Zhi. Left-sided edema indicates Blood Stasis in Liver/Kidney; scatter blood. Avoid Wei Ling Tang; Cang Zhu is drying/blocking, and Bai Zhu must be raw to drain damp/scatter blood without stagnation. Pi Shui with limb trembling: Fang Ji Fu Ling Tang. Edema from Dampness, heavier below waist: Fang Ji Huang Qi Tang plus Black/Yellow Cow Urine. Mild cases: Chu Shi Tang plus Mu Gua, Da Fu Pi. Edema due to Qi: Deep-hidden pulse, distension/asthma. Use Zeng Sun Liu Qi Yin.