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腹大如鼓脉
实者生虚者死
原病式曰或云水肿者由脾虚而不能制其肾水则水气妄行而脾主四肢故水气游走四肢身面
俱肿
者似是而实非也夫治水肿腹胀以辛苦寒药为君而大利其大小便也经曰中满者治之于内然则岂
为脾土之虚也此说正与素问相反经曰诸湿肿满皆属脾土又曰太阴所主 肿又曰湿胜则濡泄甚
则水闭 肿皆所谓太阴脾土湿气之实甚也又经曰诸腹胀大皆属于热又云诸 肿疼酸皆属于火
又曰热胜则 肿皆所谓心火实热而安得言脾虚不能制肾水之实甚乎故诸水肿者湿热之相兼也
如六月湿热太甚而庶物隆盛水肿之象明可见矣故古人制以辛苦寒药治之益以辛散结而苦燥湿
以寒除热而随其利湿去结散热退气和而已所以妄
谓脾虚不能制其肾水者但谓数下致之又多水液故也岂知巴豆热毒耗损肾水阴气则心火及脾土
自
甚湿热相搏则怫郁痞膈小便不利而水肿也更宜下之者以其辛苦寒药能除湿热怫郁痞膈故也若
夫世传银粉之药以治水肿而愈者以其善开怫郁痞膈故也慎不可过度而加害尔况银粉亦能伤牙
齿者谓毒瓦斯感于肠胃而精神气血水谷能胜其毒故毒瓦斯循经上行而至齿龈嫩薄之分则为害也上
下齿缝者手足阳明之经也凡用此药先当固济尔或云阴水遍身而又恶寒止是寒者非也
丹溪曰诸气 郁皆属于肺者诸湿肿满皆属于脾诸腹胀大皆属于热盖湿者土之气土者火之
子故
湿病每生于热热气亦能自湿者子气感母湿之变也凡病肿皆以治肿为主所挟不同治法亦异卢砥
镜治水胀辨以隶于肾肝胃三经而不及脾下文继以肺金盛生水水液妄行之说岂理也哉夫脾土受
病肺为之子焉有自盛而生水者哉若为肿之水果生于肺金之清气则滋长肾阴奉行降令为生化之
源何病肿之有今渗透经络注流溪谷皆浊腐之气窒碍津液久久灌入隧道血亦化水而欲藉脾土以
制之导肾气以利之不思脾病则肝木来侮子气益衰木寡于畏脾欲不病不可得矣治法宜清心经之
火补养脾土全运化之职肺气下降渗道开通败浊之气其稍清者复回而为气为血为津液其败浊之
甚者在上为汗在下为溺以渐而分消矣卢不明言而更曰制水燥水得非白圭以邻国为壑乎
谨按河间论水气主于脾土湿甚为病盖言有余证也但脾虚受湿或湿热自甚不足所致者为甚
多故
以丹溪之论并及之观者当自审察然脉经论热甚金衰金弃土母而归水水藏火神土亡其子其气衰
微水为洋溢浸渍为池走击皮肤面目浮肿归于四肢愚医见水直往下之虚脾空胃水逐居之(云云
见本文)此实诸脏之本病也夫水为物元土为物母然物元物母为病则真气危矣故不得妄下之也
由是观之则水气之病治
非气郁饮食湿热诸证所致者禁不得妄下盖恐真脏为病也是以丹溪宣明肺肾脾之意深备此理
水病脉象洪大的可以治疗，脉象微细的不可治疗。水病出现腹胀闭塞，其脉象浮大且软的预后良好（生），脉象沉细虚小的预后不良（死）。水病患者腹部胀大如鼓，脉象实的预后良好，脉象虚的预后不良。
《原病式》中说：有人说水肿是由于脾虚不能制约肾水，导致水气妄行，而脾主四肢，所以水气游走于四肢，导致身体和面部都肿胀。这种说法似是而非。治疗水肿腹胀，应当以辛苦寒药为主，大力通利大小便。《内经》说：“中满者治之于内。”既然如此，难道是因为脾土虚弱吗？这种说法正与《素问》相反。《内经》说：“诸湿肿满，皆属脾土。”又说：“太阴所主……肿。”还说：“湿胜则濡泄，甚则水闭胕肿。”这些都是指太阴脾土湿气实盛所致。另外，《内经》说：“诸腹胀大，皆属于热。”又说：“诸痛痒疮，皆属于火。”还说：“热胜则肿。”这都是指心火实热，怎么能说是脾虚不能制约肾水呢？因此，各种水肿都是湿热相兼的结果。就像六月湿热太盛，万物茂盛隆起，水肿的现象明显可见。所以古人制定用辛苦寒药来治疗，辅以辛味散结、苦味燥湿，用寒性除热，随着湿气去除、结滞消散、热气退去，气和顺而已。所以那些荒谬地认为脾虚不能制约肾水的人，只是说因为多次攻下导致体内多水液罢了。哪里知道巴豆的热毒会耗损肾水的阴气，导致心火及脾土更加亢盛，湿热相互搏结，导致气机郁滞痞塞，小便不利而水肿。这时更应该用攻下法，因为辛苦寒药能除湿热、解除气机郁滞痞塞的缘故。至于世间流传用银粉药物治疗水肿而痊愈的，是因为它善于开通气机郁滞痞塞。但千万不可过度使用而加害身体。况且银粉也能损伤牙齿，说是毒气感应于肠胃，而精神气血水谷能够战胜其毒性，所以毒气顺着经络上行到达齿龈嫩薄的部位，从而造成危害。上下齿缝是手足阳明经循行的部位。凡是用这种药，先前应当固护脾胃。或者说阴水遍身而又恶寒，这仅仅是寒证罢了，并非如此。
丹溪说：“诸气臏郁，皆属于肺；诸湿肿满，皆属于脾；诸腹胀大，皆属于热。”盖因湿是土之气，土是火之子，所以湿病常生于热，热气也能自湿而来，这是子气感召母气，湿的变化所致。凡是患肿病，都以治疗肿为主，所夹杂的病邪不同，治疗方法也各异。卢砥镜治疗水胀，辨析其归属于肾、肝、胃三经，而没有涉及脾，下文接着论述肺金盛生水、水液妄行的说法，这合乎道理吗？脾土受病，肺为其子，哪有子气强盛而生水的道理呢？如果浮肿的水果真是由肺金的清气滋生，那么它应该滋长肾阴，奉行降令，成为生化之源，怎么会生病肿呢？如今渗透经络，注流溪谷，都是浊腐之气，窒碍津液，久久灌入隧道，血也化为水，想要借助脾土来制约它，引导肾气来利水，却不思考脾病则肝木来侮犯，子气更加衰弱，木寡于畏，脾想不生病都不可能了。治疗方法应当清心经之火，补养脾土，使其完全发挥运化之职，肺气下降，渗道开通，败浊之气，其中稍清的重新回转为气、为血、为津液，其中败浊严重的，在上表现为汗，在下表现为尿，逐渐分消。卢砥镜不明确说明这一点，反而说制水、燥水，这不是像白圭那样把邻国当作沟壑吗？
谨按河间论水气主要在于脾土，湿盛为病，这是指有余的证候。但是脾虚受湿，或湿热自盛导致的不足证候，更为多见，所以将丹溪的论点一并提及，读者应当自行审察。然而《脉经》论述热盛金衰，金弃土母而归水，水藏火神，土亡其子，其气衰微，水为洋溢，浸渍为池，走击皮肤，面目浮肿，归于四肢。愚医见水直往下攻下，导致虚脾空胃，水逐居之（详见本文）。这实际上是各脏的本病。水为物元，土为物母，然而物元气母生病，则真气危矣。所以不得妄用攻下法。由此看来，水气之病，若非气郁、饮食、湿热诸证所致者，禁止不得妄用攻下，大概是恐怕真脏为病吧。因此丹溪宣明肺、肾、脾之意，深备此理。
Edema with a洪大 (Hongda, surging and large) pulse is treatable; one with a微细 (Weixi, fine and thin) pulse is not. In edema accompanied by abdominal distension and obstruction, a浮大软 (Fudai ruan, floating, large, and soft) pulse indicates survival, while a沉细虚小 (Chenxi xuxiao, deep, fine, deficient, and small) pulse indicates death. In edema where the abdomen is enlarged like a drum, a实 (Shi, excess/full) pulse indicates survival, while a虚 (Xu, deficient/empty) pulse indicates death.
The *Yuan Bing Shi* states: Some say that edema arises from Spleen deficiency failing to control Kidney water, causing water qi to act recklessly. Since the Spleen governs the four limbs, the water qi wanders through the limbs, causing swelling of the entire body and face. This argument seems plausible but is actually incorrect. The treatment for edema and abdominal distension should prioritize bitter-pungent cold herbs to vigorously promote urination and defecation. The Classics state: "For fullness in the center, treat it internally." If this is so, how can it be attributed to Spleen Earth deficiency? This view directly contradicts the *Su Wen*. The Classics state: "All dampness, swelling, and fullness belong to Spleen Earth." It also states: "What Taiyin governs... swelling." Furthermore: "Excess dampness leads to loose stools; severely, it leads to water retention and edema." All these refer to an excess of dampness in Taiyin Spleen Earth. Additionally, the Classics state: "All abdominal distensions and enlargements belong to Heat." It also says: "All pain, itching, and sores belong to Fire." And: "Excess heat leads to swelling." These all refer to excess-heat of Heart Fire. How can one claim Spleen deficiency fails to control Kidney water? Therefore, various forms of edema are a combination of Damp-Heat. Just as in the sixth month, when Damp-Heat is excessive and all things flourish and swell, the phenomenon of edema is clearly visible. Thus, the ancients prescribed bitter-pungent cold herbs for treatment, assisting with pungent herbs to dissipate stagnation and bitter herbs to dry dampness, using cold properties to remove heat. As dampness is removed, stagnation dissipated, and heat recedes, Qi becomes harmonious. Those who absurdly claim Spleen deficiency fails to control Kidney water merely argue that frequent purgation leads to fluid accumulation. They fail to realize that the hot toxicity of Crotonis Fructus (Badou, 巴豆) depletes the Yin Qi of Kidney Water, causing Heart Fire and Spleen Earth to become excessive. Damp-Heat combats each other, leading to Qi stagnation and epigastric fullness, urinary difficulty, and edema. At this point, purgation is even more appropriate because bitter-pungent cold herbs can eliminate Damp-Heat and resolve Qi stagnation and epigastric fullness. Regarding the worldly transmission of using Calomel (Yinfen, 银粉) to cure edema, it is because it excels at opening Qi stagnation and epigastric fullness. However, one must never overuse it to cause harm. Moreover, Calomel can also damage the teeth; it is said that its toxic vapor affects the intestines and stomach, but the spirit, Qi, blood, and food essence can overcome its toxicity. Thus, the toxic vapor travels up along the meridians to the tender and thin parts of the gums, causing harm. The spaces between the upper and lower teeth are traversed by the Hand and Foot Yangming meridians. Whenever using this medicine, one must first secure and protect the Spleen and Stomach. Others say that Yin Edema involves whole-body swelling accompanied by aversion to cold; this is simply a Cold syndrome, not otherwise.
Danxi stated: "All Qi condensation and depression belong to the Lung; all dampness, swelling, and fullness belong to the Spleen; all abdominal distensions and enlargements belong to Heat." Dampness is the Qi of Earth, and Earth is the child of Fire. Therefore, Damp diseases often arise from Heat, and Heat Qi can also originate from Dampness; this is the child Qi influencing the mother Qi, a transformation of Dampness. For all swelling diseases, the primary treatment focuses on resolving the swelling, but methods vary according to accompanying pathogenic factors. Lu Dijing analyzed water distension, attributing it to the Kidney, Liver, and Stomach meridians, excluding the Spleen. He subsequently discussed the theory that Lung Metal abundance generates Water and Water fluids flow recklessly. Is this logical? When Spleen Earth is diseased, the Lung acts as its child. How can a strong child generate Water? If the water in swelling were truly generated by the clear Qi of Lung Metal, it would nourish Kidney Yin, execute descending functions, and serve as the source of bio-transformation. How could it cause swelling? Now, penetrating collaterals and flowing into valleys, it is turbid and putrid Qi obstructing Jin-Ye (Body Fluids). Over time, it pours into tunnels, and Blood transforms into Water. One might seek to use Spleen Earth to control it or guide Kidney Qi to promote diuresis. However, one fails to consider that when the Spleen is diseased, Liver Wood attacks it. The child Qi declines further; with Wood lacking fear, the Spleen cannot avoid disease. The treatment method should clear Heart Meridian Fire, tonify and nourish Spleen Earth, fully restoring its transportation and transformation duties. Lung Qi descends, the infiltration pathways open, and turbid Qi is cleared. The slightly clearer portion returns to become Qi, Blood, and Jin-Ye. The severely turbid portion manifests as sweat above and urine below, gradually dispersing. Lu did not clarify this but instead spoke of controlling and drying water, which is akin to Bai Gui treating neighboring countries as ditches.
Respectfully, Hejian's discussion on Water Qi emphasizes Spleen Earth and excessive Dampness as the pathology, referring to Excess syndromes. However, cases caused by Spleen deficiency receiving Dampness or self-generated excessive Damp-Heat resulting in Deficiency are far more common. Therefore, Danxi's arguments are included for readers to examine carefully. Nevertheless, the *Mai Jing* discusses excessive Heat causing Metal decline; Metal abandons Earth Mother and returns to Water. Water stores Fire Spirit; Earth loses its Child. Its Qi becomes weak, Water overflows, soaking like a pool, striking the skin, causing facial and ocular swelling, returning to the four limbs. Ignorant physicians see Water and blindly purge downward, causing empty Spleen and Stomach, allowing Water to reside there (see text). This is essentially the root disease of the Zang organs. Water is the origin of things; Earth is the mother of things. Yet if Origin and Mother fall ill, True Qi is endangered. Thus, blind purgation is forbidden. From this perspective, for Water Qi diseases not caused by Qi stagnation, diet, or Damp-Heat, blind purgation is strictly prohibited, lest it affect the True Zang organs. Therefore, Danxi's elucidation of Lung, Kidney, and Spleen meanings thoroughly embodies this principle.