发明曰夫香港脚之疾实水湿之所为也(云云见湿门)河间曰结阳病主四肢胫肿四肢热胜则肿
(云云)
详见湿门
谨按湿者水气之渐也故治有轻重所殊尔
内经曰经脉满则络脉溢络脉溢则缪刺之以调其络脉使形容如旧而不肿故曰缪刺其处以复
其形也
谨按缪刺谓不分隧穴而刺之也故此水热穴论无刺水穴分大法水溢于表或腹胀或四肢虽肿
而气
稍实脉浮洪者宜行此至病气孤危脉微弱而四肢水气盛实者今人往往缪刺之祸不旋踵盖不审经
言脉满络溢宜缪刺之理也
内经曰不从毫毛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
廓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痞肿故云形不可与衣相保也凡此
之类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
施张于身形之外欲穷标本其可得乎平治权衡谓察脉浮沉也脉浮为在表脉沉为在里在里者泄
之在表者汗之故云开鬼门洁净府也去宛陈 谓去积久之水物犹如草 之不可久留于身中也
谨按经论水气证治至为机密故云开鬼门洁净府然鬼门者犹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为病客于表故宜发汗遣邪气以开鬼门也此亦发汗之别称泄
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冯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肤肿诸病若宛屈陈 壅滞于身中当泄去是物而净
洁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
以治水独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 肿其气索矣况肺弱而母气孤危者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俱病身面
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
肺气开泄渗道通利水气不濡于脾矣此正诸湿肿满皆属脾土诸气 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
发明曰:所谓香港脚(足部湿痹)这一疾病,实际上是由水湿邪气引起的(相关内容详见“湿门”章节)。河间先生(刘完素)说:结阳病主要表现为四肢和小腿肿胀,如果四肢热势亢盛就会导致肿胀(相关内容详见“湿门”章节)。
谨按:湿是水气逐渐积聚的结果,因此治疗上有轻重程度的不同。
《内经》说:经脉充满则络脉溢出,络脉溢出则采用缪刺法来调理络脉,使人的容貌形体恢复如初而不肿胀,所以说缪刺其部位是为了恢复其形体。
谨按:缪刺是指不区分具体的经络穴位而进行针刺的方法。因此,《灵枢·水热穴论》中没有专门针对水病的针刺穴位分类大法。如果水热之邪溢于体表,出现腹胀或四肢肿胀,但正气稍实、脉象浮洪的,适宜采用这种方法;但如果病气孤立危重,脉象微弱而四肢水气盛实的,现在的人往往误用缪刺法,灾祸立刻就会降临。这是因为没有审察经文中关于“脉满络溢适宜缪刺”的道理。
《内经》说:如果不是从毫毛(皮肤表面)受病,而是病生于体内,是由于阴气在体内盛极,阳气竭绝无法进入腹中,所以说五脏的阳气都衰竭了。津液就是水,充斥于胸廓皮肉之间,阴寒蓄积于内,水气胀满向上攻冲于肺,导致肺气孤立危重。“魄”是肺的神志,肾属水为害,子(肾)不能救母(肺),所以说“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,水道不通,水液充满皮肤,身体痞塞肿胀,所以说形体大到衣服都穿不下了。大凡这些情况,都是由于四肢脉数急,内动于肺所致。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,浮肿扩张于身形之外,想要穷究其标本,怎么可能呢?“平治权衡”是指诊察脉象的浮沉。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。所以说要“开鬼门,洁净府”。“去宛陈莝”是指去除积久之后的水湿之物,就像草屑一样,不可久留于身体中。
谨按:经文论述水气证的治疗非常机密,所以说要“开鬼门,洁净府”。然而,“鬼门”指的是幽深玄妙之处,即汗孔,看不见它的开合。邪气感受侵入,邪气与正气相搏,导致汗孔闭塞,从而产生寒热等病症,邪气客于体表,所以适宜发汗以驱除邪气,这就是“开鬼门”。这也是发汗法的别称,是治疗诸病在体表的通例。“净府”指的是膀胱,内部没有入口,外部有出口,是清净津液的府库,依靠肾气和脏气的气化作用,将水谷的精微渗入膀胱,气约束而成尿液排出。肾主下焦,司管开阖,关窍和二阴相通;肺脾之气通调水道,向下输送到膀胱,气化则水行,自然清净。否则就会出现小便涩滞、浑浊或淋沥等症状。如果是水气溢于腠理成为肤肿等病,或者像弯曲堆积的陈旧污秽之物壅滞在身体中,应当泄去这些物质而使其洁净。适宜使用这两种方法:在表的用汗法,在里的用泄法,在治疗中进行权衡。虽然经文说水病本源在于肺肾二经,但古今方论并不单独以泻肾气的方法来治水,这是为什么呢?因为肾阴奉行降下的命令,是化生的源头,但常常不足。到了阴精在内受损削减,生气不能运化,导致严重肿胀时,其气已经索然无存了。况且肺气虚弱,母气孤立危重,所以东垣先生说:“如果用甘淡渗泄的阳药单独治疗,没有阴的配合,怎么能化生呢?”这深刻摘取了上述治疗例子的精妙之处。比如积饮、留饮损伤脾气,就像土在雨中变成泥一样;或者因为七情所致,手足太阴经同时发病,身面浮肿似水气的,使用燥脾导气的药剂就能痊愈。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;二则肺气开泄,渗道通利,水气不再濡湿脾土。这正是“诸湿肿满皆属于脾土,诸气膹郁皆属于肺”,与阴阳致病的水气机理不同,所以也不等待“开鬼门,洁净府”的方法即可治愈。
Invention states: The disease of Hongkangjiao (Hongkangjiao, a type of damp-bi in the feet) is actually caused by water-dampness pathogens (see "Dampness Section" for details). Hejian (Liu Wansu) said: Jieyang disease (Jieyang Disease, characterized by swelling of limbs due to yang qi constraint) primarily manifests as swelling of the four limbs and calves; if heat in the four limbs overcomes, it leads to swelling (see "Dampness Section" for details).
Respectfully note: Dampness is the gradual accumulation of water-qi; therefore, treatments vary in severity.
The *Neijing* says: When meridians are full, collateral vessels overflow; when collateral vessels overflow, Miao-stimulation (Miao-cijia, a specific acupuncture technique involving needle insertion at points opposite to the affected side or non-meridian points) should be used to regulate the collateral vessels, restoring the appearance and form without swelling. Thus, it is said that Miao-stimulation at specific sites restores the form.
Respectfully note: Miao-stimulation refers to needling without distinguishing specific meridian acupoints. Therefore, the *Suwen: Shuirexuelun* chapter does not outline major principles for selecting acupoints specifically for water diseases. If water-heat pathogens overflow to the exterior, causing abdominal distension or swelling of the four limbs, but with slightly robust qi and floating, surging pulses, this method is suitable. However, if the pathogenic qi is isolated and critical, with weak pulses and abundant, solid water-qi in the four limbs, modern practitioners often mistakenly use Miao-stimulation, bringing disaster immediately. This is because they fail to examine the principle in the classics that "full meridians and overflowing collaterals are suitable for Miao-stimulation."
The *Neijing* says: If the disease does not originate from the fine hairs (skin surface) but arises internally, it is because yin qi is excessively abundant internally, while yang qi is exhausted and cannot enter the abdomen. Hence, it is said that the yang qi of the five zang organs is exhausted. Jin-ye (Jin-ye, body fluids) is water; it fills the thoracic cavity and subcutaneous tissues. Yin cold accumulates internally, water-qi swells and attacks the lungs upward, making lung qi isolated and critical. "Po" (Po, the corporeal soul associated with the Lung) is the spirit of the Lung. Kidney belongs to Water and causes harm; as the child (Kidney) fails to save the mother (Lung), it is said that "Po dwells alone." If yin essence is depleted internally and yang qi is consumed externally, the Sanjiao becomes blocked, water passages do not flow, water fills the skin, and the body becomes obstructed and swollen. Hence, it is said that the form is too large to be contained by clothing. All such cases involve rapid, urgent pulses in the four limbs, moving internally within the Lungs. Lung movement refers to rapid breathing and coughing. In such instances, water-qi is rejected within the peritoneum, and edema expands outside the body. How can one exhaustively investigate the root and branch? "Pingzhi Quanheng" (Pingzhi Quanheng, balancing treatment based on pulse diagnosis) refers to observing whether the pulse is floating or sinking. A floating pulse indicates the exterior; a sinking pulse indicates the interior. For interior conditions, use purgation; for exterior conditions, use sweating. Thus, it is said to "open the ghost gate and cleanse the pure vessel." "Quwan Chencuo" (Quwan Chencuo, removing accumulated stagnation) means eliminating long-standing water-dampness products, similar to grass clippings that must not remain in the body for long.
Respectfully note: The classic discusses the treatment of water-qi diseases with great secrecy, stating one must "open the ghost gate and cleanse the pure vessel." However, the "ghost gate" refers to something profound and mysterious, namely the sweat pores, whose opening and closing are invisible. When pathogens invade, fighting with righteous qi, the sweat pores close, causing chills and fever as the pathogen resides in the exterior. Therefore, sweating is appropriate to expel the pathogen and "open the ghost gate." This is also an alternative name for diaphoresis, a general example for treating diseases in the exterior. The "pure vessel" refers to the Bladder, which has no internal inlet but an external outlet, serving as the residence of clear fluids. Relying on Kidney qi and organ transformation, the essence of food and drink seeps into the bladder, where qi constrains it to form urine for excretion. The Kidney governs the Lower Jiao, managing opening and closing, connecting with the orifices and two yins. The qi of the Lung and Spleen regulates water passages, transporting downward to the Bladder; upon transformation, water flows and naturally becomes clean. Otherwise, symptoms like dysuria, turbidity, or stranguria occur. If water-qi overflows into the interstices causing cutaneous edema, or if stagnant, old impurities accumulate in the body, these substances must be purged to achieve cleanliness. These two methods are suitable: sweating for exterior conditions, purgation for interior conditions, balancing the treatment. Although the classic states that water diseases originate from the Lung and Kidney meridians, ancient and modern formulas do not solely treat water by draining Kidney qi. Why? Because Kidney yin executes descending functions and is the source of generation, yet it is often insufficient. When yin essence is depleted internally and generating qi cannot transform, leading to severe swelling, the qi is already depleted. Moreover, Lung qi is weak, and the mother qi is isolated and critical. Therefore, Dongyuan (Li Dongyuan) said: "If treated with sweet, bland, and draining yang medicines alone, without yin, how can transformation occur?" This profoundly extracts the subtlety of the aforementioned treatment examples. For instance, retained fluid and drinking-water damaging Spleen qi is like soil turning to mud in rain. Or, caused by emotional factors, affecting both Hand and Foot Taiyin meridians, resulting in facial and bodily swelling resembling water-qi; using formulas that dry the Spleen and guide qi will lead to recovery. On one hand, like mud receiving gentle winds and warm sun, water-dampness leaves, yang transforms, and all things grow naturally. On the other hand, Lung qi opens and dissipates, channels become patent, and water-qi no longer saturates the Spleen. This aligns with "all dampness, swelling, and fullness belong to Spleen Earth, and all qi oppression and depression belong to Lung," differing from the mechanism of water-qi disease caused by yin-yang imbalance. Thus, treatment does not necessarily require "opening the ghost gate and cleansing the pure vessel."