谷不化，则脾胃俱衰。脾气主里，故衰则骛溏；胃气主表，故衰则身肿也。少阳者生气
也，少阴者地道也，而俱受气于脾胃，脾胃衰则少阳脉卑，而生气不荣，少阴脉细，而地道不
通，男子则小便不利，妇人则经血不通。而其所以然者，则皆阳气不行，阴气乃结之故。曰血分者，
谓虽病于水，而实出于血也。
师曰∶寸口脉迟而涩，迟则为寒，涩为血不足；跗阳脉微而迟，微则为气，迟则为
寒。寒气不足，则手足逆冷；手足逆冷，则荣卫不利；荣卫不利，则腹满肠鸣相逐，气
转膀胱；荣卫俱劳，阳气不通，即身冷；阴气不通，即骨疼。阳气前通则恶寒，阴气前
通则痹不仁。阴阳相得，其气乃行，大气一转，其气乃散，实则失气，虚则遗尿，名曰
气分。
【按】“名曰气分”之下，当有下条“桂枝去芍药加麻黄附子细辛汤主之”十五字。
【注】寸口脉迟为寒，脉涩少血，跗阳脉微乏气，迟亦为寒。是则气血俱虚，为寒气
所干，荣卫不利，阴阳不通，故身寒骨痛，手足逆冷，腹满肠鸣，恶寒麻痹，失气遗尿也。
此气血俱虚，寒气内客气胀，故曰气分。而下条发明主治，用桂枝去芍药加麻黄附子细
辛汤者，温养荣卫，阴阳发散，寒邪之气也。
【集注】程林曰∶气散必从前后而去，邪气实则失气于后，正气虚则遗尿于前也。
尤怡曰∶微则为气者，为气不足也。寒气不足，该寸口、跗阳为言寒，而气血复不
足也。寒气不足，则手足无气而逆冷，荣卫无源而不利，由是脏腑之中，真气不充，而
客寒独胜，则腹满肠鸣相逐，气转膀胱而下输也。荣卫俱劳者，荣卫俱乏竭也。阳气温
于表，故不通则身冷；阴气荣于里，故不通即骨疼。不通者，虚极而不能行，与有余而
壅者不同。阳前通则恶寒，阴前通则痹不仁者，阳先行而阴不与俱行，则阴失阳而恶寒；
阴先行而阳不与俱行，则阳独滞而痹不仁也。盖阴与阳常相须也，不可失，失则气机不续
而邪乃着，不失则上下交通而邪不容，故曰∶阴阳相得，其气乃行，大气一转，其气乃散。
失气遗尿，谓分虚实而散也。曰气分者，谓寒气乘阳之虚，而病于气也。
气分，心下坚，大如盘，边如旋杯，水饮所作，桂枝去芍药加麻黄附子细辛汤主之。
【按】“气分，心下坚，大如盘，边如旋
杯，水饮所作”之十六字，当是衍文，观心下坚之本条自知。“桂枝去芍药加麻黄附子细
辛汤主之”十五字，当在上条气分之下，义始相属，正是气分之治法，必是错简在此。
桂枝去芍药加麻黄附子细辛汤方
桂枝（三两） 生姜（三两） 甘草（二两） 大枣（十二枚） 麻黄 细辛（各一两）
附子（炮，一枚）
上七味，以水七升，煮麻黄，去上沫，内诸药，煮取二升，分温三服。当汗出如虫行
皮中即愈。
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，外证跗肿，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。
【注】风水得之内有水气，外感风邪。风则从上肿，故面浮肿，骨节疼痛恶风，风在
经表也。皮水得之内有水气，皮受湿邪。湿则从下肿，故跗浮肿，其腹如鼓，按之没指，
水在皮里也。非风邪，故不恶风，因水湿故不渴也。其邪俱在外，故均脉浮，皆当从汗
从散而解也。正水水之在上病也，石水水之在下病也；故在上则胸满自喘，在下则腹满
不喘也。其邪俱在内，故均脉沉迟，皆当从下从温解也。黄汗者，汗出柏汁色也。其脉
沉迟，脏内有寒饮；身发热者，经外有伏热。寒饮故胸满，四肢头面浮肿；伏热若久不愈，
故必致痈脓也。由此推之，可知黄汗是内饮外热，蒸郁于中，从土化而成也。以黄汗而
列水病之门者，亦因水之为病而肿也。
【集注】程林曰∶风水与皮水相类属表，正水与石水相类属里。但风水恶风，皮水不
恶风，正水自喘，石水不自喘为异耳！
尤怡曰∶风水，水为风搏，因风而病水也。风伤皮毛，而湿流关节，故脉浮恶风，而
骨节疼痛也。皮水，水行皮中，内合肺气，故其脉亦浮，不兼风，故不恶风也。其腹如鼓，
即《内经》 然不坚之意。以其病在皮肤，而不及肠脏，故外有胀形，而内无喘满也。水
在皮者，宜从汗解，故曰∶当发其汗。正水，肾脏之水自盛也。石水，水之聚而不行者也。
正水乘阳之虚，而浸及上焦，故脉沉迟而喘。石水因阴之盛而结于少腹，故脉沉腹满而不
喘也。黄汗，汗出沾衣如柏汁，得之湿热交病，而湿居热外，其盛于上而阳不行，则身
热胸满，四肢头面肿，久则浸及于里而荣不通，则逆于肉里而为痈脓也。
脉浮而洪，浮则为风，洪则为气。风气相搏，风强则为隐疹，身体为痒，痒为泄风，
久为痂癞；气强则为水，难以俯仰。风气相击，身体洪肿，汗出乃愈。恶风则虚，此为
风水；不恶风者，小便通利，上焦有寒，其口多涎，此为黄汗。
【按】身体洪肿之“洪”字，当是“浮”字。“此为黄汗”四字，当是衍文。
【注】六脉俱浮而洪，浮则为风，洪则为气。风气相搏之病，若风强于气，相搏为病，
则偏于营，故为隐疹，身体为痒，痒者肌虚，为风邪外薄故也。名曰泄风，即今之风燥疮
是也。故日久不愈，则成痂癞。痂癞，疥癣、 癞之类是也。若气强于风，相搏为病，则
偏于卫，故为水气，难以俯仰，即今之支饮喘满不得卧也。若风气两相强击为病，则为
风水，故通身浮肿也。以上诸证皆属肌表，故当发汗，汗出乃愈也。风水无汗，当以越婢
汤发汗，若汗出恶风则为表阳虚，故加附子也。若不恶风，小便通利，非表阳有寒，乃
上焦有寒也。上焦有寒，惟兼病水者，则其人口内必多生涎沫也。
【集注】尤怡曰∶风，天之气；气，人之气，是皆失其和者也。风湿相搏，风强则气
从风而浸淫肌体，故为瘾疹；气强则风从气而鼓涌水液，故为水；风气并强，两相搏击，
而水液从之，则为风水。汗之则风去而水行，故曰∶汗出乃愈。若恶风者表虚也，不恶风
而小便通利者，以上焦有寒不能约束津液，故其口多涎也。
寸口脉沉滑者，中有水气，面目肿大有热，名曰风水；视人之目裹上微拥，如蚕新
卧起状，其颈脉动，时时咳，按其手足上，陷而不起者，风水。
【注】此承上条详申风水之证脉也。寸口脉沉而滑，中有水气之诊也；面目肿大，中
有水气之证也。有寒者，其脉沉迟，则为石水也。有热者，其脉沉滑，名曰风水也；视
其人之目胞上微拥似蚕，如新卧起之状，人迎颈脉动甚，时咳，按其肿之手足，陷而不
起者，皆风水之证也。
【集注】赵良曰∶《内经》云∶脉沉曰水，脉滑曰风，面肿曰风，目肿如新卧起之状曰
水，颈脉动，喘咳曰水。又肾风者，面跗庞然，少气时热，其有跗肿者，亦曰本于肾，名
风水。皆出《内经》也。
程林曰∶沉者就下之性，滑者流衍之象，故沉滑者，中有水也。面肿曰风，风郁于经
则热，故面跗肿大有热，名曰风水。《内经》曰∶诸有水者微肿，先见于目下也，水者阴
也，目下亦阴也，腹者至阴之所居，故水在腹者，必使目下肿也。颈脉人迎脉也，水邪
干土，则颈脉动，水之本在肾，水之标在肺，故时时咳也。以手按其腹，随手而起，此属
水胀，如按水囊者，必随手而起。今风水搏于手足， 属肌肉之间，按而散之，猝不能
聚，故陷下而不起也。
风水脉浮，身重，汗出恶风者，防己黄 汤主之。腹痛加芍药。
【注】此承上条风水，详申其证，以明其治也。风水之病，外风内水也。脉浮恶风者
风也，身重肿者水也。汗出表虚，故用防己黄 汤，固表以散风水也。若腹痛，加芍药、
甘草以调中也。
防己黄 汤方（见湿病中）
太阳病脉浮而紧，法当骨节疼痛，反不疼，身体反重而酸，其人不渴，汗出即愈，此
为风水。恶寒者，此为极虚，发汗得之。渴而不恶寒者，此为皮水。身肿而冷，状如周
痹，胸中塞不能食，反聚痛，暮躁不得眠，此为黄汗，痛在骨节。咳而喘，不渴者，此为
脾胀，其状如肿，发汗即愈。然诸病此者，渴而下利，小便数者，皆不可发汗。
【按】脾胀之“脾”字，当是“肺”字，是传写之讹。发汗即愈之下，当有前条“越
婢加术汤主之”七字。
【注】此又详申风水、皮水、黄汗、肺胀四证之治法也。太阳病，谓头痛发热恶风也。
脉浮而紧，似伤寒也，伤寒法当骨节疼痛，反不疼，身体反重而酸，面目浮肿，其人不渴，
非伤寒也，乃风水也，发汗汗出即愈也。若愈后而恶寒者，此为过于发汗，极虚得之，当
补表阳，自可愈也，有是证渴而不恶寒，似传里也，但跗浮肿，其腹如鼓，乃皮水也。有
是证胸中窒反聚痛，不能食，暮躁不得卧，似里实也；但身肿而冷，麻木如痹，此为欲作
黄汗也。痛在骨节，似伤寒也，但其状如水肿，咳喘不渴，此为肺胀也。以上四证，皆
初病皮毛，状类伤寒，故均以越婢加术汤主之，发汗即愈也。若渴而下利，小便数者，则
津液已夺，故不可发汗也。
【集注】赵良曰∶脾胀恐是“肺”字之误。《灵枢经》云∶肺是动则病，肺胀满膨膨而喘
咳也。
魏荔彤曰∶其状如肿者，按其手足，未至陷而不起，故曰如肿，似肿而实非肿也。
尤怡曰∶太阳有寒则脉紧，骨疼有湿则脉濡，身重有风则脉浮、体酸，此明辨也。今
得伤寒脉，而骨节不疼，身体反重而酸，即非伤寒，乃风水外胜也。风水在表而非里，故
不渴，风固当汗，水在表者，亦宜汗，故曰∶汗出即愈。然必气盛而实者，汗之乃愈，不
然则其表益虚，风水虽解，而恶寒转增矣，故曰∶恶寒者，此为极虚发汗得之。若其渴而
不恶寒者，则非病风而独病水，不在皮外，而在皮中，视风水为较深矣，其证身肿而冷，状
如周痹。周痹者，寒湿痹其阳也，皮水为水气淫于肤也。胸中窒不能食者，寒袭于外，而
气窒于中也。反聚痛，暮躁不得眠者，热为寒郁，而寒甚于暮也，寒湿外淫，必流关节，
故曰∶此为黄汗，痛在骨节。其咳而喘不渴者，水寒伤肺，气攻于表，有如肿病，而实
同皮水，故曰∶发汗则愈。然而诸病若渴而下利，小便数者，则不可谓水气当汗概发之
也。仲景叮咛之意。岂非虑人之津液先亡也哉！或问∶风水外证骨节疼，此云骨节反不
痛，身体反重而酸；皮水不渴，此云渴何也？曰∶风与水合而成病，其流注关节者，则为
骨节疼痛；其浸淫肌体者，则骨节不疼，而身体酸肿，由所伤之处不同故也。皮水不渴
者，非言皮水本不渴也，谓腹如鼓而不渴者，病方外盛而未入里，犹可发其汗也，此所谓
渴而不恶寒者，所以别于风水之不渴而恶风也。
风水恶风，一身悉肿，脉浮不渴，续自汗出，无大热，越婢汤主之。恶风加附子。
【注】此又承上条风水，互详其证而变其治也。风水之邪，全在表而不在里，故恶风
一身悉肿，脉浮不渴也。初本无汗，身无大热，续自汗出而不恶风寒，表不虚也，故用
越婢汤以发之。若恶风甚者，表阳虚也，前方加附子一枚，以补其在表之阳也。
越婢汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 甘草（二两） 大枣（十五枚）
上五味，以水六升，先煮麻黄，去上沫，内诸药，煮取三升，分温三服。
恶风者，加附子一枚，炮。风水，加术四两。
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。
【注】此承皮水互详其证，以明其治也。皮水之病，是水气相搏，在皮肤之中，故四
肢聂聂 动也，以防己茯苓汤补卫通荣，祛散皮水也。
【集注】沈明宗曰∶此邪在皮肤而肿也。风入于卫，阳气虚滞，则四肢肿。经谓结阳
者肿四肢，即皮水也。皮毛受风气虚而肿，所谓水气在皮肤中，邪正相搏，风虚内鼓，故
四肢聂聂而动，是因表虚也，盖三焦之气，同入膀胱，而行决渎，今水不行，则当使小便
利而病得除。故防己、茯苓除湿而利水，以黄 补卫而实表，表实则邪不能容，甘草安
土而制水邪，桂枝以和荣卫，又行阳化气而实四末，俾风从外出，水从内泄矣。
防己茯苓汤方
防己（三两） 黄 （三两） 桂枝（三两） 茯苓（六两） 甘草（三两）
上五味，以水六升，煮取二升，分温三服。
里水，越婢加术汤主之，甘草麻黄汤亦主之。
【按】里水之“里”字，当是“皮”字，岂有里水而用麻黄之理？阅者自知，是传写
之讹。
【注】皮水表虚有汗者，防己茯苓汤固所宜也。若表实无汗有热者，则当用越婢加术
汤。无热者，则当用甘草麻黄汤发其汗，使水外从皮去也。
越婢加术汤方
于越婢汤中加术四两。
甘草麻黄汤方
水谷不能消化，说明脾胃功能都衰退了。脾气的功能主要在于固摄内脏，所以脾气虚弱时会出现大便稀薄如水；胃气的功能主要在于护卫体表，所以胃气衰弱时身体会出现浮肿。少阳之气主生发，少阴之气主滋养（地道），它们的气血都来源于脾胃，如果脾胃衰败，那么少阳脉就会沉伏不起，导致生发之气无法濡养全身；少阴脉会变得细弱，导致滋养之道不通畅。男子因此出现小便排出不畅，女子则出现月经闭止。其根本原因，都是由于阳气运行不畅，阴寒之气凝结所致。所谓“血分”病，是指虽然表现为水肿，但病因实际上源于血分病变。
老师（张仲景）说：寸口脉象迟而涩，迟脉代表有寒邪，涩脉代表血液不足；跗阳脉微而迟，微脉代表气虚，迟脉代表有寒邪。既有寒邪又有气血不足，就会导致手足逆冷；手足逆冷，会导致营卫之气运行不利；营卫运行不利，就会出现腹部胀满、肠鸣音互相追逐，气机下注膀胱；如果营卫之气极度疲惫，阳气不通畅，就会感到身体寒冷；阴气不通畅，就会感到骨骼疼痛。如果阳气先通而阴气未通，就会怕冷；如果阴气先通而阳气未通，就会出现麻木不仁。只有阴阳二气协调配合，气机才能正常运行，大气（宗气）一转，郁结之气才能消散。如果是实证，会通过放屁排出；如果是虚证，会出现遗尿。这种情况称为“气分”。
【按语】在“名曰气分”之下，应当有下一条的“桂枝去芍药加麻黄附子细辛汤主之”这十五个字。
【注释】寸口脉迟表示有寒，脉涩表示血少，跗阳脉微表示气乏，迟也表示有寒。这说明气血都虚弱，被寒气所干扰，营卫运行不利，阴阳不通畅，所以出现身寒骨痛、手足逆冷、腹部胀满肠鸣、怕冷麻痹、放屁或遗尿等症状。这是因为气血俱虚，寒气内侵客居导致气胀，所以称为气分。而下文阐述主治方法，使用桂枝去芍药加麻黄附子细辛汤，是为了温养营卫，发散阴阳及寒邪之气。
【集注】程林说：气散必然从前阴或后阴排出，邪气实盛则从后阴放屁，正气虚弱则从前阴遗尿。
尤怡说：“微则为气”，意思是气不足。寒气与不足，既指寸口和跗阳脉象显示有寒，又指气血本身也不足。寒气与气血不足，导致手足无气而逆冷，营卫失去源头而运行不利，由此脏腑中真气不充，而客寒独胜，导致腹部胀满、肠鸣音互相追逐，气机下注膀胱并向下输泄。所谓“荣卫俱劳”，是指营卫之气都衰竭了。阳气温煦体表，所以不通畅就身体寒冷；阴气濡养体内，所以不通畅就骨骼疼痛。“不通畅”是指极度虚弱而不能运行，这与邪气有余而壅滞的情况不同。阳气先行而阴气不跟随，阴气失去阳气的温煦就会怕冷；阴气先行而阳气不跟随，阳气独自停滞就会麻木不仁。大概阴与阳是相互依存的，不可分离，一旦分离，气机就会中断而邪气附着；如果不分离，上下交通而邪气无法容留，所以说：“阴阳相得，其气乃行，大气一转，其气乃散。”失气和遗尿，分别对应实证和虚证的气散情况。称为“气分”，是指寒气乘阳气虚弱之机，在气分发病。
气分病，心下坚硬，大如盘子，边缘像倒扣的杯子，这是水饮作祟，用桂枝去芍药加麻黄附子细辛汤治疗。
【按语】“气分，心下坚，大如盘，边如旋杯，水饮所作”这十六个字，应该是衍文（多余的文字），看心下坚的本条原文就知道了。“桂枝去芍药加麻黄附子细辛汤主之”这十五个字，应该放在上一条气分的下面，文义才连贯，这正是气分的治疗方法，肯定是竹简错乱导致此处有误。
桂枝去芍药加麻黄附子细辛汤方
桂枝（三两） 生姜（三两） 甘草（二两） 大枣（十二枚） 麻黄 细辛（各一两）
附子（炮制，一枚）
以上七味药，用水七升，先煮麻黄，去掉上面的浮沫，再加入其他药物，煮取二升药液，分三次温服。服药后如果感觉像虫子在皮肤里爬一样出汗，病就好了。
老师说：疾病有风水、皮水、正水、石水、黄汗五种。风水病的脉象自然浮起，外证表现为骨节疼痛、怕风；皮水病的脉象也浮起，外证表现为足背浮肿，按压凹陷不起，不怕风，腹部像鼓一样胀，口不渴，应当采用发汗法治疗；正水病的脉象沉迟，外证表现为自然气喘；石水病的脉象自然沉，外证表现为腹部胀满但不喘；黄汗病的脉象沉迟，身体发热，胸部胀满，四肢和头面部浮肿，久治不愈，必定会导致痈脓。
【注释】风水病是由于内有水气，外感风邪所致。风邪致病多从上焦肿起，所以面浮肿、骨节疼痛、怕风，这是因为风邪在经络肌表。皮水病是由于内有水气，皮肤受湿邪侵袭。湿邪致病多从下焦肿起，所以足背浮肿，腹部像鼓一样胀，按压凹陷不起，水气停留在皮肤之内。因为没有风邪，所以不怕风；因为水湿内停，所以口不渴。这两种邪气都在体表，所以脉象都浮，都应当通过发汗来解散。正水是水气在上焦的病，石水是水气在下焦的病；所以在上焦则胸满气喘，在下焦则腹满不喘。这两种邪气都在体内，所以脉象都沉迟，都应当通过利下焦和温阳来解除。黄汗，是指汗出颜色像柏树汁一样黄。其脉沉迟，说明脏内有寒饮；身体发热，说明经络外有伏热。因为有寒饮所以胸满，四肢头面浮肿；伏热如果久治不愈，必定导致痈脓。由此推断，可知黄汗是内饮外热，蒸郁于中，从土化而成。将黄汗列在水病门类中，也是因为它因水病而浮肿。
【集注】程林说：风水与皮水相似，都属于表证；正水与石水相似，都属于里证。只是风水怕风，皮水不怕风；正水自然气喘，石水不气喘，这是它们的区别！
尤怡说：风水，是水被风邪搏结，因风而导致水病。风伤皮毛，湿气流注关节，所以脉浮、怕风、骨节疼痛。皮水，水行走在皮肤之中，内合肺气，所以脉象也浮；不兼夹风邪，所以不怕风。其腹部像鼓一样胀，就是《内经》中“然不坚”的意思。因为病在皮肤，不涉及肠脏，所以外表有胀形，内部没有气喘胀满。水在皮肤，适宜从汗解，所以说：“应当发汗。”正水，是肾脏之水自盛。石水，是水聚集而不流动。正水乘阳气虚弱之机，浸淫波及上焦，所以脉沉迟且气喘。石水因阴气盛而结聚于少腹，所以脉沉、腹满而不气喘。黄汗，汗出沾衣像柏树汁，是由湿热交争致病，且湿在热之外，邪气盛于上部而阳气不行，所以身热胸满、四肢头面肿；久了浸淫入里导致营气不通，逆乱于肌肉之间而形成痈脓。
脉象浮而洪，浮脉代表风邪，洪脉代表气盛。风邪与气邪相互搏结，如果风邪强盛则出现隐疹，身体瘙痒，瘙痒称为泄风，日久会变成痂癞；如果气邪强盛则形成水气，难以俯仰。风邪与气邪相互搏击，身体严重浮肿，出汗后痊愈。如果怕风则是表虚，这是风水；如果不怕风，小便通利，上焦有寒，口中多涎，这是黄汗。
【按语】身体洪肿的“洪”字，应当是“浮”字。“此为黄汗”四字，应当是衍文。
【注释】六脉俱浮而洪，浮代表风，洪代表气。风气相搏的疾病，如果风邪强于气邪，相搏为病，则偏于营分，所以出现隐疹，身体瘙痒，瘙痒是因为肌肤虚弱，风邪外迫所致。名叫泄风，就是现在的风燥疮。所以日久不愈，就会变成痂癞。痂癞，就是疥癣、癞疮之类。如果气邪强于风邪，相搏为病，则偏于卫分，所以形成水气，难以俯仰，就是现在的支饮、喘满不得卧。如果风邪与气邪两者都强盛相互搏击为病，就形成风水，所以全身浮肿。以上各种症状都属于肌表，所以应当发汗，出汗后痊愈。风水无汗，应当用越婢汤发汗，如果汗出怕风则是表阳虚，所以要加附子。如果不怕风，小便通利，不是表阳有寒，而是上焦有寒。上焦有寒，只有兼夹水病的，人口中才会多生涎沫。
【集注】尤怡说：风，是天之气；气，是人之气，这都是失去和谐的状态。风湿相搏，风强则气随风邪浸淫肌体，所以出现瘾疹；气强则风随气邪鼓涌水液，所以形成水气；风气并强，相互搏击，水液随之流动，就形成风水。发汗则风去水行，所以说：“出汗后痊愈。”如果怕风，是表虚；不怕风而小便通利，是因为上焦有寒不能约束津液，所以口中多涎。
寸口脉沉滑的，说明中有水气，面目肿大且有热，名叫风水；观察人的眼睑上方微微隆起，像蚕刚睡醒的样子，颈部脉搏跳动，时常咳嗽，按压手足背部，凹陷不能立即弹起的，是风水。
【注释】这是承接上一条详细申述风水证的脉象。寸口脉沉而滑，是有水气的诊断；面目肿大，是有水气的症状。有寒的，脉象沉迟，就是石水。有热的，脉象沉滑，名叫风水；观察人的眼睑上方微微隆起像蚕，像刚睡醒的样子，人迎颈脉跳动厉害，时常咳嗽，按压浮肿的手足，凹陷不起的，都是风水的症状。
【集注】赵良说：《内经》说：脉沉叫水，脉滑叫风，面肿叫风，目肿像刚睡醒的样子叫水，颈脉动、喘咳叫水。还有肾风，面颊和足背肿胀，少气时时发热，如果有足肿的，也说本于肾，名叫风水。这些都出自《内经》。
程林说：沉脉具有向下的特性，滑脉具有流衍的象，所以沉滑脉，说明中有水。面肿叫风，风郁积在经络则有热，所以面颊和足背肿大且有热，名叫风水。《内经》说：所有有水病的人，轻微浮肿，首先出现在眼下。水是阴邪，眼下也是阴位，腹部是至阴所在，所以水在腹部，必然使眼下浮肿。颈脉是人迎脉，水邪干犯脾土，则颈脉跳动；水之本在肾，水之标在肺，所以时常咳嗽。用手按压腹部，随手而起，这属于水胀，像按水囊一样，必随手而起。现在风水搏结于手足，属于肌肉之间，按压后分散，猝然不能聚合，所以凹陷下去不起。
风水病，脉浮，身体沉重，汗出怕风的，用防己黄芪汤治疗。腹痛加芍药。
【注释】这是承接上一条风水病，详细申述其症状，以明确治疗方法。风水病，是外风内水。脉浮怕风是风邪，身体沉重浮肿是水邪。汗出表示表虚，所以用防己黄芪汤，固护体表以疏散风水。如果腹痛，加芍药、甘草来调和中部。
太阳病，脉浮而紧，按理应当骨节疼痛，反而不疼，身体反而沉重酸痛，病人不口渴，出汗后就痊愈，这是风水。如果怕冷的，这是极度虚弱，由发汗过度导致的。如果口渴而不怕冷的，这是皮水。身体浮肿而冷，状如周痹，胸中堵塞不能进食，反而聚痛，傍晚烦躁不得睡眠，这是黄汗，痛在骨节。咳嗽气喘，不口渴的，这是肺胀，其状像浮肿，发汗即愈。然而各种病如果有这种表现，但口渴且下利，小便频数的，都不可发汗。
【按语】肺胀的“肺”字，应当是“脾”字，是传写之误。发汗即愈之下，应当有前一条“越婢加术汤主之”这七个字。
【注释】这是又详细申述风水、皮水、黄汗、肺胀四种证候的治疗方法。太阳病，指头痛发热恶风。脉浮而紧，似伤寒。伤寒按理应当骨节疼痛，反而不疼，身体反而沉重酸痛，面目浮肿，病人不口渴，这不是伤寒，乃是风水，发汗出汗后即愈。如果愈后怕冷，这是过于发汗，极虚所致，应当补益表阳，自然可愈。如果有这种证候，口渴而不怕冷，似传入里，但足背浮肿，腹部像鼓一样，乃是皮水。如果有这种证候，胸中窒塞反而聚痛，不能进食，傍晚烦躁不得卧，似里实证；但身体浮肿而冷，麻木如痹，这是欲作黄汗。痛在骨节，似伤寒，但其状像水肿，咳喘不渴，这是肺胀。以上四证，都是初病皮毛，状类伤寒，所以都用越婢加术汤治疗，发汗即愈。如果口渴且下利，小便频数，则津液已夺，所以不可发汗。
【集注】赵良说：肺胀恐怕是“脾”字之误。《灵枢经》说：肺是动则病，肺胀满膨膨而喘咳。
魏荔彤说：其状像浮肿，按压手足，未到凹陷不起的程度，所以说像肿，似肿而实际不是肿。
尤怡说：太阳有寒则脉紧，骨疼有湿则脉濡，身重有风则脉浮、体酸，这是明确的辨别。现在得了伤寒的脉，但骨节不疼，身体反而重而酸，就不是伤寒，乃是风水外胜。风水在表而非里，所以不渴，风固然当汗，水在表的，也宜汗，所以说：“出汗即愈。”然而必须是气盛而实的，汗之乃愈，不然则表更虚，风水虽解，而怕冷反而加重，所以说：“怕冷，这是极虚发汗导致的。”如果口渴而不怕冷，则不是病风而独病水，不在皮外，而在皮中，比风水较深，其证身肿而冷，状如周痹。周痹，是寒湿痹阻阳气；皮水是水气淫溢于肤。胸中窒塞不能食，是寒袭于外，气窒于中。反而聚痛，傍晚烦躁不得眠，是热被寒郁，而寒甚于傍晚，寒湿外淫，必流注关节，所以说：“这是黄汗，痛在骨节。”其咳而喘不渴，是水寒伤肺，气攻于表，有如肿病，而实际同皮水，所以说：“发汗则愈。”然而各种病如果口渴且下利，小便频数，则不可一概认为水气当汗而发。这是仲景叮咛之意。难道不是担心人的津液先亡吗？有人问：风水外证骨节疼，这里说骨节反不痛，身体反重而酸；皮水不渴，这里说渴，为什么？回答说：风与水合而成病，其流注关节的，就为骨节疼痛；其浸淫肌体的，就骨节不疼，而身体酸肿，由受伤之处不同故也。皮水不渴，不是说皮水本来不渴，是说腹像鼓一样且不渴，是病方外盛而未入里，还可以发其汗，这就是所说的“渴而不恶寒”，用来区别于风水的不渴而恶风。
风水病，怕风，全身都肿，脉浮不渴，持续自汗出，没有大热，用越婢汤治疗。怕风加附子。
【注释】这是又承接上一条风水病，互详其症状而改变治疗方法。风水之邪，全在表而不在里，所以怕风、全身都肿、脉浮不渴。起初本无汗，身无大热，后来自汗出而不恶风寒，表不虚，所以用越婢汤发散。如果怕风严重的，是表阳虚，前方加附子一枚，以补其在表的阳气。
越婢汤方
麻黄（六两） 石膏（半斤） 生姜（三两） 甘草（二两） 大枣（十五枚）
以上五味药，用水六升，先煮麻黄，去掉上面的浮沫，加入其他药物，煮取三升，分三次温服。
皮水病，四肢浮肿，水气在皮肤中，四肢微微跳动的，用防己茯苓汤治疗。
【注释】这是承接皮水病互详其症状，以明确治疗方法。皮水病，是水气相搏，在皮肤之中，所以四肢微微跳动，用防己茯苓汤补卫通营，祛散皮水。
【集注】沈明宗说：这是邪在皮肤而肿。风入于卫分，阳气虚滞，则四肢肿。经书说结阳者肿四肢，就是皮水。皮毛受风气虚而肿，所谓水气在皮肤中，邪正相搏，风虚内鼓，所以四肢微微而动，是因表虚。大概三焦之气，同入膀胱，而行决渎，现在水不行，则应当使小便利而病得除。所以防己、茯苓除湿而利水，以黄芪补卫而实表，表实则邪不能容，甘草安土而制水邪，桂枝以和营卫，又行阳化气而充实四肢末端，使风从外出，水从内泄。
防己茯苓汤方
防己（三两） 黄芪（三两） 桂枝（三两） 茯苓（六两） 甘草（三两）
以上五味药，用水六升，煮取二升，分三次温服。
【按语】里水的“里”字，应当是“皮”字，哪有里水而用麻黄的道理？读者自知，这是传写之误。
【注释】皮水表虚有汗的，防己茯苓汤适宜。如果表实无汗有热的，则应当用越婢加术汤。无热的，则应当用甘草麻黄汤发汗，使水从皮肤排出。
If food is not digested, it indicates that both the Spleen and Stomach functions are declining. The Qi of the Spleen governs the interior; therefore, when deficient, it leads to loose stools (watery diarrhea). The Qi of the Stomach governs the exterior; therefore, when weak, it results in bodily edema. Shaoyang (Lesser Yang) represents the generating Qi, and Shaoyin (Lesser Yin) represents the pathway of nourishment (Di Dao); both receive their Qi from the Spleen and Stomach. If the Spleen and Stomach decline, the Shaoyyang pulse becomes low and deep, causing the generating Qi to fail to nourish the body; the Shaoyin pulse becomes thin, causing the nourishing pathway to be obstructed. In men, this manifests as difficult urination; in women, it manifests as amenorrhea (cessation of menstruation). The underlying reason for all these conditions is the failure of Yang Qi to circulate and the coagulation of Yin Cold. The term "Blood Division" (Xue Fen) refers to a condition where, although water retention is the manifestation, the root cause actually lies in blood pathology.
The Master said: A Chi (slow) and Se (choppy) pulse at the Cun Kou (radial artery) indicates Cold due to the slow pulse, and insufficient Blood due to the choppy pulse. A Wei (faint) and Chi (slow) pulse at the Fu Yang (dorsalis pedis artery) indicates Qi deficiency due to the faint pulse, and Cold due to the slow pulse. The combination of Cold and insufficiency of Qi and Blood leads to cold extremities (reversal coldness). Cold extremities lead to impaired circulation of Ying (Nutrient) and Wei (Defensive) Qi. Impaired Ying and Wei circulation results in abdominal fullness, borborygmus (intestinal rumbling), and Qi shifting downward to the Bladder. When Ying and Wei are exhausted, if Yang Qi is blocked, the body feels cold; if Yin Qi is blocked, bone pain occurs. If Yang Qi moves forward first while Yin lags, there is aversion to cold; if Yin Qi moves forward first while Yang lags, there is numbness and insensitivity (Bi syndrome). Only when Yin and Yang harmonize can Qi circulate properly; when the Great Qi (Zong Qi) rotates, stagnation dissipates. In excess cases, flatus is passed; in deficiency cases, urinary incontinence occurs. This condition is called "Qi Division" (Qi Fen).
[Note] Below the phrase "This is called Qi Division," the fifteen characters "Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang Zhu Zhi" (Treat with Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Asarum Decoction) should appear.
[Commentary] A Chi (slow) pulse at Cun Kou indicates Cold; a Se (choppy) pulse indicates scanty Blood; a Wei (faint) pulse at Fu Yang indicates deficient Qi; and Chi (slow) also indicates Cold. Thus, both Qi and Blood are deficient and disturbed by Cold pathogen, leading to impaired Ying and Wei circulation and unblocked Yin and Yang. Consequently, symptoms such as cold body, bone pain, cold extremities, abdominal fullness with borborygmus, aversion to cold, numbness, flatus, and urinary incontinence occur. Because Qi and Blood are both deficient and Cold pathogen invades internally causing Qi distension, it is termed "Qi Division." The following paragraph explains the treatment, using Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang to warm and nourish Ying and Wei, disperse Yin and Yang, and expel Cold pathogen.
[Collected Annotations] Cheng Lin stated: Qi disperses through the anterior or posterior orifices. In excess patterns, flatus is passed posteriorly; in deficiency patterns, urinary incontinence occurs anteriorly.
You Yi stated: "Wei implies Qi" means Qi deficiency. "Cold and insufficiency" refers to the indication of Cold in the Cun Kou and Fu Yang pulses, combined with actual deficiency of Qi and Blood. Cold and insufficiency result in lack of Qi in the extremities causing reversal coldness, and lack of source for Ying and Wei causing poor circulation. Consequently, true Qi in the zang-fu is insufficient, allowing exogenous Cold to prevail, leading to abdominal fullness, borborygmus, and Qi shifting downward to the Bladder. "Ying and Wei both labor" means exhaustion of Ying and Wei. Yang warms the exterior, so blockage causes cold body; Yin nourishes the interior, so blockage causes bone pain. "Blockage" here refers to extreme deficiency preventing movement, which differs from excess stagnation. If Yang moves forward without Yin, Yin loses Yang's warmth and feels cold; if Yin moves forward without Yang, Yang stagnates alone causing numbness. Yin and Yang must depend on each other; separation interrupts Qi mechanism and allows pathogen attachment, while union ensures communication and excludes pathogen. Hence, "When Yin and Yang harmonize, Qi flows; when Great Qi rotates, stagnation dissipates." Flatus and incontinence represent dispersion in excess and deficiency respectively. "Qi Division" means disease in the Qi level caused by Cold pathogen taking advantage of Yang deficiency.
In Qi Division disease, hardness under the heart, large as a plate, with edges like an inverted cup, caused by fluid retention, is treated with Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang.
[Note] The sixteen characters "Qi Division, hardness under the heart, large as a plate, edges like an inverted cup, caused by fluid retention" are likely interpolations. See the original text on hardness under the heart for confirmation. The fifteen characters "Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang Zhu Zhi" should belong below the previous paragraph on Qi Division to maintain logical coherence, as it is the treatment method for Qi Division; this is likely a bamboo slip error.
Formula: Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Aconite, and Asarum Decoction)
Gui Zhi (Cinnamomi Ramulus) 3 liang, Sheng Jiang (Zingiberis Rhizoma Recens) 3 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 2 liang, Da Zao (Jujubae Fructus) 12 pieces, Ma Huang (Ephedrae Herba), Xi Xin (Asari Radix et Rhizoma) 1 liang each, Fu Zi (Aconiti Lateralis Radix Praeparata) 1 piece (processed).
Take seven ingredients, add 7 sheng of water, boil Ma Huang first, remove the foam on top, then add the remaining herbs. Boil until 2 sheng remains. Divide into three doses, taken warm. Recovery occurs when sweating ensues, described as feeling like insects crawling under the skin.
The Master said: There are five types of water diseases: 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 naturally floating pulse; external signs include joint pain and aversion to wind. Pi Shui also presents with a floating pulse; external signs include edema of the dorsum of the foot where indentation persists after pressure, no aversion to wind, abdominal distension like a drum, and no thirst; treatment requires inducing sweating. Zheng Shui presents with a deep and slow pulse; external signs include spontaneous wheezing. Shi Shui presents with a naturally deep pulse; external signs include abdominal fullness without wheezing. Huang Han presents with a deep and slow pulse, fever, chest fullness, edema of the four limbs and head/face; if untreated for a long time, it inevitably leads to carbuncles and pus.
[Commentary] Feng Shui arises from internal water qi combined with external wind pathogen invasion. Wind tends to swell from above, causing facial edema, joint pain, and aversion to wind, indicating wind in the meridians and exterior. Pi Shui arises from internal water qi combined with damp pathogen invading the skin. Damp tends to swell from below, causing edema of the dorsum of the foot, abdominal distension like a drum, and persistent indentation, indicating water inside the skin. Since there is no wind pathogen, there is no aversion to wind; since there is water-damp, there is no thirst. Both pathogens are in the exterior, hence the floating pulse, and both should be resolved via sweating and dispersing. Zheng Shui is water disease in the upper jiao; Shi Shui is water disease in the lower jiao. Upper involvement causes chest fullness and spontaneous wheezing; lower involvement causes abdominal fullness without wheezing. Both pathogens are in the interior, hence the deep and slow pulse, and both should be resolved via purgation and warming. Huang Han refers to sweat colored like cypress juice. The deep and slow pulse indicates cold-fluid retention in the viscera; fever indicates latent heat in the channels. Cold-fluid causes chest fullness and edema; prolonged latent heat leads to carbuncles and pus. From this, we deduce that Huang Han is internal fluid retention and external heat steaming internally, transforming via Earth. It is classified under water diseases because it involves swelling due to water pathology.
[Collected Annotations] Cheng Lin stated: Feng Shui and Pi Shui are similar and belong to the exterior; Zheng Shui and Shi Shui are similar and belong to the interior. The differences are that Feng Shui has aversion to wind while Pi Shui does not; Zheng Shui has spontaneous wheezing while Shi Shui does not.
You Yi stated: Feng Shui is water constrained by wind, becoming diseased due to wind. Wind damages hair and skin, damp flows into joints, causing floating pulse, aversion to wind, and joint pain. Pi Shui is water moving within the skin, internally connecting with Lung Qi, hence the floating pulse; without wind, there is no aversion to wind. Abdominal distension like a drum corresponds to the meaning of "soft but not hard" in the Neijing. Since the disease is in the skin and does not affect intestines/zang-fu, there is external distension but no internal wheezing/fullness. Water in the skin should be resolved via sweating, hence "induce sweating." Zheng Shui is excessive water from the Kidney. Shi Shui is water that gathers and does not move. Zheng Shui takes advantage of Yang deficiency to invade the upper jiao, causing deep-slow pulse and wheezing. Shi Shui forms in the lower abdomen due to Yin excess, causing deep pulse, abdominal fullness, and no wheezing. Huang Han is sweat staining clothes like cypress juice, caused by damp-heat interaction where damp is outside heat. Excess in the upper jiao prevents Yang circulation, causing fever, chest fullness, and edema of limbs/head/face; prolonged involvement enters the interior, blocking Ying flow, reversing into muscle tissue to form carbuncles and pus.
A pulse that is Floating and Hong (surging) indicates Wind and Qi respectively. When Wind and Qi fight, if Wind is strong, it causes hidden rashes (urticaria) and body itching; itching is called Xie Feng (Leaking Wind), which over time becomes scaly lesions (jia lai). If Qi is strong, it causes water retention, making bending and stretching difficult. When Wind and Qi strike each other strongly, severe body edema occurs; recovery comes with sweating. Aversion to wind indicates deficiency, characterizing Feng Shui. No aversion to wind, with free urination and cold in the upper jiao causing excessive salivation, characterizes Huang Han.
[Note] The character "Hong" in "severe body edema" should be "Fu" (floating). The four characters "This is Huang Han" are likely interpolations.
[Commentary] All six pulses are floating and surging; floating indicates Wind, surging indicates Qi. In diseases of Wind-Qi fighting, if Wind dominates Qi, the conflict affects the Ying level, causing rashes and itching due to wind attacking deficient muscle tissue. This is named Xie Feng, equivalent to modern wind-dryness sores. Prolonged cases become scaly lesions (scabies, tinea, etc.). If Qi dominates Wind, the conflict affects the Wei level, causing water retention and difficulty in posture, equivalent to modern branch-fluid retention with wheezing and inability to lie flat. If both Wind and Qi are strong and strike each other, it forms Feng Shui, causing generalized edema. All these symptoms belong to the muscle-skin surface, so sweating is required for recovery. For Feng Shui without sweat, Yue Bi Tang should be used to induce sweating; if sweat occurs with aversion to wind, it indicates exterior Yang deficiency, requiring addition of Fu Zi. If no aversion to wind and urination is free, it is not exterior Yang cold, but upper jiao cold. Upper jiao cold combined with water disease causes excessive saliva production.
[Collected Annotations] You Yi stated: Wind is Heaven's Qi; Qi is Human's Qi; both represent disharmony. In damp-wind fighting, if Wind is strong, Qi follows Wind to infiltrate muscles, causing rashes; if Qi is strong, Wind follows Qi to surge fluids, causing water; if both are strong, they strike together, and fluids follow, forming Feng Shui. Sweating removes Wind and moves Water, hence "recovery with sweating." Aversion to wind indicates exterior deficiency. No aversion to wind with free urination indicates upper jiao cold failing to constrain fluids, causing salivation.
A Chen (deep) and Hua (slippery) pulse at Cun Kou indicates internal water qi, facial/ocular edema with heat, named Feng Shui. Observing slight puffiness above the eyes, resembling a silkworm just waking up, pulsation of the neck vessels, frequent coughing, and pitting edema on hands/feet that does not rebound immediately, confirms Feng Shui.
[Commentary] This elaborates on the pulse and symptoms of Feng Shui from the previous paragraph. Deep-slippery pulse at Cun Kou diagnoses internal water qi; facial/ocular edema confirms water qi symptoms. Cold patterns have deep-slow pulses, diagnosing Shi Shui. Heat patterns have deep-slippery pulses, diagnosing Feng Shui. Puffiness above eyes like a silkworm, prominent Ren Ying (neck vessel) pulsation, frequent coughing, and non-rebounding pitting edema on extremities are all signs of Feng Shui.
[Collected Annotations] Zhao Liang stated: The Neijing says: Deep pulse indicates water; slippery pulse indicates wind; facial swelling indicates wind; eye swelling like just waking indicates water; neck vessel pulsation and wheezing/coughing indicate water. Also, Kidney Wind presents with swollen face and feet, shortness of breath, and intermittent fever; if accompanied by foot edema, it is rooted in the Kidney and named Feng Shui. All cited from the Neijing.
Cheng Lin stated: Deep indicates sinking nature; slippery indicates flowing abundance, so deep-slippery indicates internal water. Facial swelling indicates wind; wind stagnating in meridians generates heat, causing facial/foot edema with heat, named Feng Shui. The Neijing states: All water diseases show slight swelling first under the eyes. Water is Yin; under-eye area is Yin; abdomen is the residence of Supreme Yin. Thus, water in the abdomen causes under-eye swelling. Neck vessel refers to Ren Ying pulse; water pathogen affecting Earth causes neck vessel pulsation. Water root is Kidney; water branch is Lung, hence frequent coughing. Pressing the abdomen and rebounding immediately indicates water distension, like pressing a water bag. Here, Feng Shui strikes muscles between extremities; pressing disperses it, preventing immediate aggregation, hence pitting without rebound.
For Feng Shui with floating pulse, heavy body, sweating, and aversion to wind, Fang Ji Huang Qi Tang is indicated. Add Shao Yao if abdominal pain is present.
[Commentary] This continues discussing Feng Shui, detailing symptoms and treatment. Feng Shui involves external Wind and internal Water. Floating pulse and aversion to wind indicate Wind; heavy body and edema indicate Water. Sweating indicates exterior deficiency, so Fang Ji Huang Qi Tang is used to secure the exterior and disperse Wind-Water. If abdominal pain occurs, add Shao Yao and Gan Cao to harmonize the middle.
Formula: Fang Ji Huang Qi Tang (See section on Dampness Diseases)
In Taiyang disease, a Floating and Tight pulse typically indicates joint pain. However, if there is no pain but rather heaviness and soreness in the body, and the patient is not thirsty, recovery follows sweating; this is Feng Shui. Aversion to cold indicates extreme deficiency, caused by improper sweating. Thirst without aversion to cold indicates Pi Shui. Body edema with cold sensation, resembling Zhou Bi (circumferential bi), chest obstruction preventing eating, alternating pain, evening restlessness, and insomnia indicate Huang Han, with pain in joints. Coughing and wheezing without thirst indicate Fei Zhang (Lung Distension), presenting like edema; recovery follows sweating. However, for any of these diseases, if accompanied by thirst, diarrhea, and frequent urination, sweating is contraindicated.
[Note] The character "Pi" (Spleen) in "Fei Zhang" should be "Fei" (Lung), a transcription error. After "recovery follows sweating," the seven characters "Yue Bi Jia Zhu Tang Zhu Zhi" (Treat with Ma Huang and Licorice Decoction plus Atractylodes Macrocephala Decoction) should appear.
[Commentary] This further details treatments for Feng Shui, Pi Shui, Huang Han, and Fei Zhang. Taiyang disease refers to headache, fever, and aversion to wind. A Floating-Tight pulse resembles Shaoyang disease, which typically causes joint pain. The absence of pain but presence of heaviness/soreness, facial edema, and lack of thirst indicate Feng Shui, not Shaoyang disease; sweating leads to recovery. Post-recovery aversion to cold indicates excessive sweating causing extreme deficiency; treating with exterior Yang tonification resolves it. Thirst without aversion to cold suggests transmission inward, but foot edema and drum-like abdomen indicate Pi Shui. Chest obstruction, pain, inability to eat, and evening restlessness suggest interior excess, but body edema with cold/numbness indicates impending Huang Han. Joint pain resembling Shaoyang disease but with edema-like appearance, coughing/wheezing without thirst indicates Fei Zhang. All four conditions begin in hair/skin, resembling Shaoyang disease, so Yue Bi Jia Zhu Tang is used to induce sweating for recovery. Thirst, diarrhea, and frequent urination indicate depleted fluids, contraindicating sweating.
[Collected Annotations] Zhao Liang stated: "Pi Zhang" is likely a typo for "Fei Zhang." The Ling Shu states: When Lung moves, disease manifests as lung distension, fullness, wheezing, and coughing.
Wei Litong stated: "Resembling edema" means pressing extremities does not cause permanent pitting, so it appears swollen but is not true edema.
You Yi stated: Taiyang Cold causes tight pulse and bone pain; Damp causes soggy pulse; Wind causes heavy body, floating pulse, and soreness. This clarifies differentiation. Having Shaoyang pulse but no bone pain, only heaviness/soreness, indicates Feng Shui exterior dominance, not Shaoyang disease. Feng Shui is exterior, not interior, hence no thirst. Wind requires sweating; water in exterior also requires sweating, hence "recovery with sweating." However, this applies only to robust patients; otherwise, sweating worsens exterior deficiency, increasing aversion to cold despite resolving Feng Shui. Hence, "aversion to cold indicates extreme deficiency from improper sweating." Thirst without aversion to cold indicates water disease alone, deeper than Feng Shui, located in the skin. Symptoms include cold body edema resembling Zhou Bi. Zhou Bi is cold-damp blocking Yang; Pi Shui is water flooding skin. Chest obstruction and inability to eat result from exterior cold blocking interior Qi. Alternating pain and evening restlessness result from heat trapped by cold, worse in evening. Cold-damp flows into joints, hence "Huang Han, pain in joints." Coughing/wheezing without thirst indicates cold-water damaging Lung, Qi attacking exterior, resembling edema but essentially Pi Shui; hence "sweating resolves it." However, if thirst, diarrhea, and frequent urination occur, do not assume all water diseases require sweating. This is Zhong Jing's caution against depleting fluids. Question: Feng Shui usually has joint pain, but here says no pain, only heaviness/soreness; Pi Shui usually has no thirst, but here says thirst. Answer: Wind-water combination flowing into joints causes pain; infiltrating muscles causes soreness/swelling without joint pain, depending on injury site. "Pi Shui no thirst" does not mean Pi Shui never causes thirst, but that drum-like abdomen without thirst indicates exterior predominance without interior invasion, allowing sweating. "Thirst without aversion to cold" distinguishes it from Feng Shui's aversion to wind and lack of thirst.
For Feng Shui with aversion to wind, generalized edema, floating pulse, no thirst, continuous spontaneous sweating, and no significant fever, Yue Bi Tang is indicated. Add Fu Zi if aversion to wind is severe.
[Commentary] This reiterates Feng Shui symptoms and modifies treatment. Feng Shui pathogen is entirely in the exterior, not interior, causing aversion to wind, generalized edema, floating pulse, and no thirst. Initially no sweat and no high fever; subsequent spontaneous sweating without aversion to wind/cold indicates exterior is not deficient, so Yue Bi Tang is used to disperse. Severe aversion to wind indicates exterior Yang deficiency, requiring addition of one Fu Zi to tonify exterior Yang.
Formula: Yue Bi Tang (Ma Huang Decoction)
Ma Huang (Ephedrae Herba) 6 liang, Shi Gao (Gypsum Fibrosum) 0.5 jin, Sheng Jiang (Zingiberis Rhizoma Recens) 3 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 2 liang, Da Zao (Jujubae Fructus) 15 pieces.
Take five ingredients, add 6 sheng of water, boil Ma Huang first, remove foam, add remaining herbs. Boil until 3 sheng remains. Divide into three doses, taken warm.
Add one processed Fu Zi if aversion to wind is present. Add 4 liang Bai Zhu (Atractylodis Macrocephalae Rhizoma) for Feng Shui.
For Pi Shui with edema of the four limbs, water qi in the skin, and subtle tremors/movements in the limbs, Fang Ji Fu Ling Tang is indicated.
[Commentary] This elaborates on Pi Shui symptoms and treatment. Pi Shui involves water-qì fighting within the skin, causing subtle limb movements. Fang Ji Fu Ling Tang is used to tonify Wei, unblock Ying, and disperse skin water.
[Collected Annotations] Shen Mingzong stated: This is swelling due to pathogen in the skin. Wind entering Wei level causes Yang deficiency/stagnation, leading to limb edema. The Classics state: Yang knotting causes limb swelling, which is Pi Shui. Skin/pores receiving wind-qi deficiency cause swelling. Water qi in skin, pathogen vs. healthy qi fighting, wind-deficiency internal bulging causes subtle limb movements due to exterior deficiency. San Jiao Qi enters Bladder to regulate water passages. Since water fails to move, promoting diuresis resolves the disease. Fang Ji and Fu Ling drain dampness and promote urination; Huang Qi tonifies Wei and secures exterior; solid exterior excludes pathogen; Gan Cao stabilizes Earth and controls water pathogen; Gui Zhi harmonizes Ying-Wei, promotes Yang transformation, and strengthens extremities, allowing Wind to exit externally and Water to exit internally.
Formula: Fang Ji Fu Ling Tang (Stephania Tetrandra and Poria Decoction)
Fang Ji (Stephaniae Tetrandrae Radix) 3 liang, Huang Qi (Astragali Radix) 3 liang, Gui Zhi (Cinnamomi Ramulus) 3 liang, Fu Ling (Poria) 6 liang, Gan Cao (Glycyrrhizae Radix et Rhizoma) 3 liang.
Take five ingredients, add 6 sheng of water, boil until 2 sheng remains. Divide into three doses, taken warm.
For Li Shui (Interior Water), Yue Bi Jia Zhu Tang is indicated; Gan Cao Ma Huang Tang is also indicated.
[Note] The character "Li" (Interior) in "Li Shui" should be "Pi" (Skin). How could Interior Water be treated with Ma Huang? Readers will understand; this is a transcription error.
[Commentary] For Pi Shui with exterior deficiency and sweating, Fang Ji Fu Ling Tang is appropriate. For exterior excess without sweat and with heat, Yue Bi Jia Zhu Tang is used. For no heat, Gan Cao Ma Huang Tang is used to induce sweating, expelling water from the skin.
Formula: Yue Bi Jia Zhu Tang (Ma Huang Decoction plus Atractylodes Macrocephala)
Add 4 liang Bai Zhu (Atractylodis Macrocephalae Rhizoma) to Yue Bi Tang.
Formula: Gan Cao Ma Huang Tang (Licorice and Ephedra Decoction)