皮饮加姜黄、木瓜各一钱，或四磨饮，或用白术三两， 咀，每服半两，水一盏半，
大枣三枚，拍破，同煎至九分，去查温服，日三无时，名大枣汤。面独肿，苏子降
气汤，兼气急者尤宜，或煎熟去滓后，更磨沉香一呷。有一身之间，唯面与双脚浮
肿，早则面甚，晚则脚甚。经云∶面肿为风，脚肿为水，乃风湿所致，须问其大小
腑通闭，别其阴阳二症。前后用药，惟除湿汤加木瓜、腹皮、白芷各半钱，可通用。
或以苏子降气汤，除湿汤各半帖煎之。罗谦甫导滞通经汤，治面目手足浮肿。感湿
而肿者，其身虽肿，而自腰下至脚尤重，腿胀满尤甚于身，气或急或不急，大便或
溏或不溏，但宜通利小便为佳。以五苓散吞木瓜丸。（内犯牵牛，亦不可轻服。）间进除湿汤，
加木瓜、腹皮各半钱，炒莱菔子七分半。因气而肿者，其脉沉伏，或腹胀，或喘急，
宜分气香苏饮。饮食所伤而肿，或胸满，或嗳气，宜消导宽中汤。不服水土而肿者，
胃苓汤，加味五皮汤。有患生疮，用干疮药太早，致遍身肿，宜消风败毒散。若大
便不通，升麻和气饮。若大便如常或自利，当导其气，自小便出，宜五皮饮和生料
五苓散。腹若肿，只在下，宜除湿汤和生料五苓散，加木瓜如泽泻之数。以上数
条为有余之证。大病后浮肿，此系脾虚，宜加味六君子汤。白术三钱，人参、黄
各一钱半，白茯苓二钱，陈皮、半夏曲、芍药、木瓜各一钱，炙甘草、大腹
皮、木瓜各五分，姜、枣煎服。小便不利，间入五苓散。有脾肺虚弱，不能通
调水道者，宜用补中益气汤补脾肺，六味丸补肾。有心火克肺金，不能生肾水，以
致小便不利，而成水证者，用人参平肺散以治肺，滋阴丸以滋小便。若肾经阴亏，
虚火烁肺金，而小便不生者，用六味地黄丸以补肾水，用补中益气汤以培脾土，肺
脾肾之气交通，则水谷自然克化。二经既虚，渐成水胀，又误用行气分利之药，以
致小便不利，喘急痰盛，已成蛊证，宜加减金匮肾气丸主之。以上数条，为不足之
证。不足者，正气不足。有余者，邪气有余。凡邪之所凑，必正气虚也。故以治不
足之法，治有余则可，以治有余之法，治不足则不可。洁古法∶如水肿，因气为
肿者，加橘皮。因湿为肿者，煎防己黄 汤，调五苓散。因热为肿者，八正散。如以
热燥于肺为肿者，乃绝水之源也。当清肺除燥，水自生矣。于栀子豉汤中加黄芩。
如热在下焦阴消，使气不得化者，当益阴而阳气自化，黄柏内加黄连是也。如水胀
之病，当开鬼门、洁净腑也，白茯苓汤主之。白茯苓汤能变水，白茯苓、泽泻各二
两，郁李仁五钱，水一碗，煎至一半，生姜自然汁入药，常服无时，从少至多，服
五七日后，觉腹下再肿，治以白术散，白术、泽泻各半两，为末，煎服三钱。或丸
亦可，煎茯苓汤下三十丸。以黄 芍药建中汤之类调养之。平复后，忌房室猪鱼盐
面等物。香薷熬膏，丸如桐子大，每服五丸，日三渐增，以小便利为度。冬瓜，不
限多少任吃。鲤鱼一头，重一斤以上者，煮熟取汁，和冬瓜、葱白作羹食之。青头
鸭或白鸭，治如食法，细切，和米并五味，煮熟作粥食之，宜空腹时进。何柏斋学
士云∶造化之机，水火而已，宜平不宜偏，宜交不宜分。水为湿为寒，火为燥为热，
火性炎上，水性润下，故火宜在下，水宜在上，则易交也。交则为既济，不交则为
未济，不交之极，则分离而死矣。消渴证不交，而火偏盛也，水气证不交，而水偏
盛也。制其偏而使之交，则治之之法也。小火不能化大水，故必先泻其水，后补其
火。开鬼门，泻在表在上之水也。洁净腑，泻在里在下之水也。水势既减，然后用
暖药以补元气使水火交，则用药之次第也。又云∶卢氏以水肿隶肝肾胃而不及脾，
丹溪非之似矣，然实则皆非也。盖造化生物，天地水火而已矣。主之者天也，成之
者地也。故曰干知太始，坤作成物，至于天地交合变化之用，则水火二气也。天运水
火之气于地之中，则物生矣。然水火不可偏盛，太旱物不生，火偏盛也。太涝物亦
不生，水偏盛也。水火和平则物生矣，此自然之理也。人之脏腑，以脾胃为主，盖
饮食皆入于胃而运以脾，犹地之土也。然脾胃能化物与否，实由于水火二气，非脾
胃所能也。火盛则脾胃燥，水盛则脾胃湿，皆不能化物，乃生诸病。水肿之证，盖
水盛而火不能化也。火衰则不能化水，故水之入于脾胃者，皆渗入血脉骨肉，血亦
化水，肉发肿胀，皆自然之理也。导去其水，使水气少减，复补其火，使二气平和
则病去矣。丹溪谓脾失运化，由肝木侮脾，乃欲清心经之火，使肺金得令以制肝木，
则脾土全运化之职，水自顺道，乃不为肿，其词迂而不切，故书此辨之。按何公虽
于医学未精，其论水火，则医书所未发，是可存也，故附着于此。
【诊】目窠微肿，如卧蚕之状，曰水。足胫肿，曰水。颈脉动，喘疾咳，曰水。
病下利后，渴饮水，小便不利，腹满因肿，此法当病水。若小便自利及汗出者，自
当愈。趺阳脉当伏，今反数，本自有热，消谷，小便数，今反不利，此欲作水。寸
口脉浮而迟，浮脉则热，迟脉则潜，热潜相搏，名曰沉。趺阳脉浮而数，浮脉则热，
数脉则止，热止相搏，名曰伏。沉伏相搏，名曰水。沉则络脉虚，伏则小便难，虚难
相搏，水走皮肤，则为水矣。脉得诸沉，当责有水，身体肿重，水病脉出者死。（《三
因》云∶大抵浮脉带数，即是虚寒潜止于其间，久必沉伏，沉伏则阳虚阴实，为水必矣。）
面然浮肿，疼痛，其色 黑，多汗恶风者，属肾风。阳水兼阳证，脉必沉数。阴水兼阴证，
脉必沉迟。沉而滑，为风水。浮而迟，弦而紧，皆为肿。水病脉洪大者可治，微细者不
可治。（又云∶浮大轻者生，沉细虚小者死。又云∶实者生，虚者死。）唇黑则伤肝。缺盆平
则伤心。脐出则伤脾。足心平则伤肾。背平则伤肺。凡此五伤，必不可治。
在皮饮的基础上，加入姜黄、木瓜各一钱；或者使用四磨饮；或者使用白术三两，切碎，每次服用半两，加水一盏半，大枣三枚，拍破，一同煎煮至九分满，滤去药渣，温服，每日三次，不限固定时间，此方名为大枣汤。如果只有面部浮肿，适用苏子降气汤，兼有气急症状者尤为适宜，或者在煎好熟药液并滤去药渣后，再研磨沉香一呷冲服。有一种情况是全身只有面部和双脚浮肿，早晨面部肿得厉害，晚上脚部肿得厉害。医经说：面部浮肿属于风邪，脚部浮肿属于水湿，这是由风湿之邪所致，必须询问其大小便的通利或闭塞情况，辨别其阴阳两种证型。前后的用药，只有除湿汤加入木瓜、大腹皮、白芷各半钱，可以通用。或者将苏子降气汤、除湿汤各取半帖一起煎煮。罗谦甫的导滞通经汤，治疗面目手足浮肿。因感受湿邪而浮肿的人，身体虽然浮肿，但从腰部以下到脚部尤其沉重，腿部胀满比身体其他部位更严重，气息有时急促有时不急促，大便有时溏薄有时正常，但适宜通过通利小便来治疗。可以用五苓散吞服木瓜丸。（其中含有牵牛子，也不可轻易服用。）间歇服用除湿汤，加入木瓜、大腹皮各半钱，炒莱菔子七分半。因气机阻滞而浮肿的人，脉象沉伏，或者腹胀，或者喘急，适宜用分气香苏饮。因饮食所伤而浮肿，或者胸中满闷，或者嗳气，适宜用消导宽中汤。不服水土（水土不服）而浮肿，用胃苓汤，加味五皮汤。有人患疮疡，因为过早使用干燥收敛的疮药，导致遍身浮肿，适宜用消风败毒散。如果大便不通，用升麻和气饮。如果大便正常或自利（腹泻），应当引导气机从小便排出，适宜用五皮饮合生料五苓散。如果腹部肿胀，且肿胀只在下腹部，适宜用除湿汤合生料五苓散，加入木瓜的量如同泽泻的量。以上几条属于有余（实证）的证候。大病之后出现浮肿，这属于脾虚，适宜用加味六君子汤。白术三钱，人参、黄芪各一钱半，白茯苓二钱，陈皮、半夏曲、芍药、木瓜各一钱，炙甘草、大腹皮、木瓜各五分，加生姜、大枣煎服。如果小便不利，间歇加入五苓散。有脾肺虚弱，不能通调水道的人，适宜用补中益气汤补益脾肺，用六味丸补肾。有心火克制肺金，不能滋生肾水，以致小便不利，形成水证的人，用人参平肺散来治肺，用滋阴丸来滋润小便。如果是肾经阴亏，虚火灼烧肺金，而小便不生的人，用六味地黄丸来补肾水，用补中益气汤来培补脾土，肺、脾、肾之气交通，则水谷自然消化。如果这两经既已虚弱，逐渐形成水胀，又误用行气分利的药物，以致小便不利，喘急痰多，已成蛊胀证，适宜用加减金匮肾气丸主治。以上几条，属于不足（虚证）的证候。不足，是指正气不足。有余，是指邪气有余。凡是邪气聚集的地方，必定是正气虚弱。所以用治疗不足的方法治疗有余是可以的，用治疗有余的方法治疗不足是不可以的。洁古法：如水肿，因气而肿的，加橘皮。因湿而肿的，煎防己黄芪汤，调服五苓散。因热而肿的，用八正散。如果因热燥于肺而肿，这是断绝了水源。应当清肺除燥，水自然会生成。可在栀子豉汤中加入黄芩。如果热在下焦阴液消耗，使气不能化生，应当益阴而阳气自然化生，如在黄柏内加黄连即是此理。如水胀病，应当开鬼门（发汗）、洁净腑（利小便），用白茯苓汤主治。白茯苓汤能化水，由白茯苓、泽泻各二两，郁李仁五钱组成，用水一碗，煎至一半，加入生姜自然汁，经常服用，不限时间，从少到多，服用五七日后，感觉小腹下再次浮肿，用白术散治疗，白术、泽泻各半两，研为末，煎服三钱。或者制成丸剂也可以，用煎好的茯苓汤送服三十丸。用黄芪芍药建中汤之类调养。病情平复后，忌食房事、猪肉、鱼类、盐、面等物。香薷熬成膏，制成梧桐子大小的丸药，每次服用五丸，每日三次逐渐增加，以小便通利为度。冬瓜，不限数量随意吃。鲤鱼一条，重一斤以上的，煮熟取汁，与冬瓜、葱白做成羹食用。青头鸭或白鸭，按食用方法处理，细切，与米及五味调料一起，煮熟做成粥食用，适宜空腹时进服。何柏斋学士说：造化的机理，不过是水火罢了，适宜平衡而不宜偏颇，适宜交合而不宜分离。水表现为湿寒，火表现为燥热，火性炎上，水性润下，所以火适宜在下，水适宜在上，这样容易交合。交合就是既济卦的状态，不交合就是未济卦的状态，不交合到了极点，就会分离而死。消渴证是不交合，而火偏盛；水气证是不交合，而水偏盛。制约其偏颇使之交合，这就是治疗的方法。小火不能化解大水，所以必须先泻其水，后补其火。开鬼门，是泻在表在上的水；洁净腑，是泻在里在下的水。水势既然减少，然后用暖药来补元气使水火交合，这就是用药的次第。又说：卢氏将水肿归属于肝肾胃而不及脾，丹溪批评他似乎有理，但实际上都不对。大概造化生物，不过是天地水火罢了。主宰的是天，成就的是地。所以说乾知太始，坤作成物，至于天地交合变化的作用，就是水火二气。天运行水火之气于地之中，万物就产生了。然而水火不可偏盛，太旱则物不生，这是火偏盛；太涝则物也不生，这是水偏盛。水火平和则物生，这是自然的道理。人的脏腑，以脾胃为主，大概饮食都进入胃而由脾运化，就像地的土一样。然而脾胃能否化物，实际上取决于水火二气，不是脾胃本身所能决定的。火盛则脾胃燥，水盛则脾胃湿，都不能化物，从而产生各种疾病。水肿之证，大概是水盛而火不能化。火衰则不能化水，所以水进入脾胃的，都渗入血脉骨肉，血也化为水，肉发生肿胀，这都是自然的道理。导去其水，使水气稍微减少，再补其火，使二气平和则病就好了。丹溪认为脾失运化，是由于肝木侮脾，于是想要清心经之火，使肺金得令以制肝木，则脾土完全行使运化之职，水自然顺道而行，就不为肿，他的言辞迂腐而不切实际，所以我写下此文辨析。按：何公虽然在医学上不够精深，但他关于水火的论述，是医书中未曾发表过的，可以保存，所以附记于此。
【诊察】眼窝微微浮肿，像卧蚕的样子，称为水病。足胫浮肿，称为水病。颈部人迎脉搏动，气喘咳嗽，称为水病。病人在下利（腹泻）之后，口渴想喝水，小便不利，腹部胀满进而浮肿，这种方法应当判断为水病。如果小便自利以及出汗的，自然应当痊愈。趺阳脉应当潜伏，现在反而数，本来体内就有热，消谷善饥，小便次数多，现在反而不利，这是将要发作水病。寸口脉浮而迟，浮脉代表热，迟脉代表潜藏，热与潜相搏结，名叫沉。趺阳脉浮而数，浮脉代表热，数脉代表止息，热与止相搏结，名叫伏。沉与伏相搏结，名叫水。沉则络脉虚，伏则小便难，虚与难相搏结，水走皮肤，就成为水病了。脉象见到各种沉脉，应当责求有水，身体肿重，水病脉象浮大无根的（脉出）者死。（《三因方》说：大抵浮脉带数，即是虚寒潜止于其间，久了必然沉伏，沉伏则阳虚阴实，必然成为水病。）面部浮肿，疼痛，面色黑，多汗恶风的，属于肾风。阳水兼阳证，脉象必沉数。阴水兼阴证，脉象必沉迟。沉而滑，为风水。浮而迟，弦而紧，都称为肿。水病脉洪大的可治，微细的不可治。（又说：浮大轻者生，沉细虚小者死。又说：实证者生，虚证者死。）嘴唇黑则伤肝。缺盆平陷则伤心。脐突则伤脾。足心平陷则伤肾。背部平陷则伤肺。凡此五种损伤，必不可治。
In addition to Pi Yin (Skin Decoction), add Jianghuang (Curcuma Longa Rhizome) and Mugua (Chaenomeles Fruit) each one qian. Alternatively, use Simo Yin (Four-Step Decoction). Or use Baizhu (Atractylodis Macrocephalae Rhizoma) three liang, cut into pieces, take half a liang per dose, add one and a half cups of water, three Jujubae Fructus (Chinese Date), crushed, decoct together until nine-tenths remain, remove the dregs, and take warm. Take three times a day without fixed time; this formula is named Dazao Tang (Jujube Decoction). If only the face is swollen, Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction) is suitable, especially for those with shortness of breath. After decocting and filtering the dregs, grind Chenxiang (Aquilaria Lignum) one xi and mix in. There is a condition where only the face and both feet are edematous throughout the body; in the morning the face swells more, and in the evening the feet swell more. The Classics state: "Facial swelling is due to Wind, foot swelling is due to Water." This is caused by Wind-Dampness. One must inquire about the patency or obstruction of urination and defecation to distinguish between Yin and Yang syndromes. For medication before and after, Chushi Tang (Dampness-Removing Decoction) added with Mugua (Chaenomeles Fruit), Fupi (Tangerine Peel), and Baizhi (Angelicae Dahuricae Radix) each half a qian can be used universally. Or decoct half a portion of Su Zi Jiang Qi Tang (Perilla Seed Descending Qi Decoction) and half a portion of Chushi Tang (Dampness-Removing Decoction) together. Luo Qianfu's Daozhi Tongjing Tang (Stagnation-Resolving and Meridian-Unblocking Decoction) treats edema of the face, eyes, hands, and feet. For those swollen due to contracting Dampness, although the whole body is swollen, the heaviness from the waist down to the feet is particularly severe, and leg distension is worse than elsewhere. Breath may be rapid or not, stool may be loose or normal, but it is best to promote diuresis. Swallow Mugua Wan (Chaenomeles Pill) with Wuling San (Five-Ingredient Powder with Poria). (Note: It contains Niuxi (Pipelinellae Rhizoma), so do not take lightly.) Intermittently take Chushi Tang (Dampness-Removing Decoction) added with Mugua (Chaenomeles Fruit) and Fupi (Tangerine Peel) each half a qian, and fried Laifuzi (Radish Seed) seven and a half fen. For swelling due to Qi stagnation, the pulse is deep and hidden, or there is abdominal distension or panting; Fenqi Xiangsu Yin (Qi-Separating Aromatic Perilla Drink) is suitable. For swelling due to dietary injury, or chest fullness or belching, Xiaodao Kuanzhong Tang (Digestion-Promoting and Middle-Widening Decoction) is suitable. For swelling due to incompatibility with local climate/water and soil, Weiling Tang (Gastrodia and Atractylodes Decoction) or Jiawei Wupi Tang (Modified Five-Peel Decoction) is used. For patients who developed sores and used drying topical medicines too early, causing generalized edema, Xiaofeng Baidu San (Wind-Expelling and Toxin-Resolving Powder) is suitable. If stool is obstructed, Shengma Heqi Yin (Cimicifuga Harmonizing Qi Drink) is used. If stool is normal or self-limiting diarrhea, guide the Qi out through urine using Wupi Yin (Five-Peel Drink) combined with Shengliao Wuling San (Unmodified Five-Ingredient Powder with Poria). If the abdomen is swollen, specifically in the lower abdomen, Chushi Tang (Dampness-Removing Decoction) combined with Shengliao Wuling San (Unmodified Five-Ingredient Powder with Poria) is suitable, adding Mugua (Chaenomeles Fruit) in the same quantity as Zexie (Alisma Rhizoma). The above items belong to Excess (Shi) syndromes. Edema after a major illness is due to Spleen Deficiency; Jiawei Liujunzi Tang (Modified Six-Gentlemen Decoction) is suitable. Baizhu (Atractylodis Macrocephalae Rhizoma) three qian, Renshen (Ginseng Radix), Huangqi (Astragali Radix) each one and a half qian, Baifuling (Poria with Hostwood) two qian, Chenpi (Tangerine Peel), Banxiaqu (Pinellia Fermented Paste), Shaoyao (Peony Root), Mugua (Chaenomeles Fruit) each one qian, Zhigancao (Honey-fried Licorice Root), Fupi (Tangerine Peel), Mugua (Chaenomeles Fruit) each five fen, decoct with Shengjiang (Fresh Ginger) and Dazao (Jujube). If urination is difficult, intermittently add Wuling San (Five-Ingredient Powder with Poria). For those with weak Spleen and Lung unable to regulate water passages, Buzhong Yiqi Tang (Middle-Warming and Qi-Supplementing Decoction) tonifies Spleen and Lung, and Liuwei Wan (Six-Ingredient Pill) tonifies Kidney. For Heart Fire suppressing Lung Metal, failing to generate Kidney Water, leading to difficult urination and Water Syndrome, Ren Shen Ping Fei San (Ginseng Calming Lung Powder) treats the Lung, and Ziyin Wan (Nourishing Yin Pill) moistens urination. For Kidney Yin deficiency with deficient fire scorching Lung Metal, resulting in no urine production, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) tonifies Kidney Water, and Buzhong Yiqi Tang (Middle-Warming and Qi-Supplementing Decoction) cultivates Spleen Earth. When Lung, Spleen, and Kidney Qi communicate, food and drink will naturally transform. If these two organs are already deficient, gradually forming Water Distension, and mistakenly using Qi-moving and diuretic drugs, leading to difficult urination, panting, and profuse phlegm, becoming Gu Distension, Jiajian Jingui Shenqi Wan (Modified Golden Cabinet Kidney Qi Pill) is the main treatment. The above items belong to Deficiency (Xu) syndromes. Deficiency refers to insufficient Righteous Qi. Excess refers to abundant Pathogenic Qi. Wherever Pathogenic Qi gathers, Righteous Qi must be deficient. Therefore, treating Excess with methods for Deficiency is acceptable, but treating Deficiency with methods for Excess is not. Jiegou's method: For edema due to Qi, add Chenpi (Tangerine Peel). For edema due to Dampness, decoct Fangji Huangqi Tang (Stephania and Astragalus Decoction) and mix with Wuling San (Five-Ingredient Powder with Poria). For edema due to Heat, Bazheng San (Eight-Righteous Powder) is used. If swelling is due to Heat-Dryness in the Lung, this cuts off the source of water. One should clear the Lung and remove dryness, and water will naturally generate. Add Huangqin (Scutellaria Root) to Zhizi Chi Tang (Gardenia and Fermented Soybean Decoction). If Heat in the Lower Jiao consumes Yin, preventing Qi transformation, one should benefit Yin so that Yang transforms naturally, such as adding Huanglian (Coptis Rhizoma) to Huangbai (Phellodendron Bark). For Water Distension, one should open the Ghost Gates (induce sweating) and purify the Fu Organs (promote urination); Bai Fuling Tang (White Poria Decoction) is the main treatment. Bai Fuling Tang (White Poria Decoction) transforms water, composed of Bai Fuling (Poria), Zexie (Alisma Rhizoma) each two liang, Yuliren (Prunus Armeniaca Seed) five qian. Decoct one bowl of water until half remains, add fresh ginger juice, take regularly without fixed time, increasing dosage gradually. After five to seven days, if lower abdomen swells again, treat with Baizhu San (Atractylodes Powder): Baizhu (Atractylodis Macrocephalae Rhizoma), Zexie (Alisma Rhizoma) each half a liang, powdered, decoct and take three qian. Pills are also acceptable, take thirty pills with decocted Fuling Tang (Poria Decoction). Maintain health with Huangqi Shaoyao Jianzhong Tang (Astragalus and Peony Middle-Warming Decoction) and similar formulas. After recovery, avoid sexual intercourse, pork, fish, salt, and flour. Xiangru (Mosla Herb) boiled into paste, formed into pills the size of paulownia seeds, take five pills each time, three times daily, gradually increasing until urination is smooth. Winter melon, eat as much as desired. One carp weighing over one jin, boil thoroughly, take the broth, and make soup with winter melon and green onion white. Green-headed duck or white duck, prepare as food, chop finely, cook with rice and five flavors into porridge, take on an empty stomach. Scholar He Bozhai said: The mechanism of creation is merely Water and Fire; they should be balanced, not biased; united, not separated. Water manifests as Damp-Cold, Fire as Dry-Heat. Fire flares upward, Water moistens downward. Thus, Fire should be below, Water above, facilitating union. Union constitutes the Hexagram Ji Ji (After Completion); non-union constitutes Wei Ji (Before Completion). Extreme non-union leads to separation and death. Xiao Ke (Wasting-Thirst) syndrome is non-union with Fire prevailing; Shui Qi (Water Qi) syndrome is non-union with Water prevailing. Restraining bias to achieve union is the treatment method. Small Fire cannot transform large Water; thus, one must first drain Water, then tonify Fire. Opening Ghost Gates drains Water in the exterior and upper parts; Purifying Fu Organs drains Water in the interior and lower parts. Once Water volume decreases, use warm medicines to tonify Original Qi to unite Water and Fire; this is the sequence of medication. Furthermore: Lu attributed Edema to Liver, Kidney, and Stomach, omitting Spleen. Danxi criticized him, seemingly rightly, but actually both were wrong. Creation produces life through Heaven and Earth, Water and Fire. Heaven dominates, Earth completes. As stated, Qian knows the beginning, Kun forms the object. The function of Heaven and Earth union and change lies in Water and Fire Qi. Heaven circulates Water and Fire Qi within Earth, generating things. However, Water and Fire cannot prevail excessively. Too much drought prevents growth (Fire prevails); too much flood prevents growth (Water prevails). Balance of Water and Fire allows growth; this is natural law. In humans, Zang-Fu organs prioritize Spleen and Stomach. Food enters Stomach and is transported by Spleen, like Earth. Whether Spleen and Stomach can transform substances depends on Water and Fire Qi, not Spleen and Stomach alone. Fire excess makes Spleen-Stomach dry; Water excess makes Spleen-Stomach damp; neither can transform substances, leading to diseases. Edema is essentially Water excess with Fire inability to transform. Fire decline means inability to transform Water; thus, Water entering Spleen-Stomach seeps into blood vessels and flesh/bone, blood transforms to water, flesh swells—this is natural. Drain the Water to reduce Water Qi, then tonify Fire to balance the two Qi, and the disease resolves. Danxi claimed Spleen failure in transport was due to Liver Wood insulting Spleen, suggesting clearing Heart Fire so Lung Metal could control Liver Wood, allowing Spleen Earth to fully transport, making Water flow smoothly without swelling. His words were circuitous and imprecise, hence this refutation. Note: Although He Gong was not deeply proficient in medicine, his discussion on Water and Fire was unprecedented in medical texts and should be preserved; thus attached here.
[Diagnosis] Slight swelling of the eye sockets, resembling a sleeping silkworm, indicates Water Disease. Swelling of the shins and calves indicates Water Disease. Pulsation in the neck vessel, panting, and rapid cough indicate Water Disease. After diarrhea, thirst with desire to drink water, difficult urination, abdominal fullness followed by swelling, this method indicates impending Water Disease. If urination is free and sweating occurs, recovery is expected. The Duyang Pulse should be hidden; now it is rapid. Originally having internal Heat, consuming food quickly, frequent urination, now urination is difficult; this suggests impending Water Disease. Cun Kou Pulse floating and slow: Floating indicates Heat, Slow indicates submergence. Heat and Submergence interacting is called Chen (Deep). Duyang Pulse floating and rapid: Floating indicates Heat, Rapid indicates stopping. Heat and Stopping interacting is called Fu (Hidden). Chen and Fu interacting is called Water. Deep implies collateral emptiness; Hidden implies difficult urination. Emptiness and Difficulty interacting causes Water to move into skin, resulting in Water Disease. Any Deep pulse warrants suspicion of Water; body swelling and heaviness confirm it. In Water Disease, if the pulse emerges (floating and forceless at the root), death ensues. (San Yin Fang states: Generally, a Floating-Rapid pulse indicates latent Cold-Due-to-Deficiency within; prolonged, it becomes Deep-Hidden. Deep-Hidden implies Yang Deficiency and Yin Excess, inevitably leading to Water Disease.) Facial edema with pain, blackish color, excessive sweating, and aversion to wind belongs to Kidney Wind. Yang Water combined with Yang Syndromes has a Deep-Rapid pulse. Yin Water combined with Yin Syndromes has a Deep-Slow pulse. Deep and Slippery indicates Feng Shui (Wind Water). Floating and Slow, Wiry and Tight all indicate swelling. In Water Disease, a洪大 (Surging-Large) pulse is treatable; Micro-Fine is untreatable. (Also: Floating-Light indicates survival; Deep-Fine-Empty-Small indicates death. Also: Excess indicates survival; Deficiency indicates death.) Black lips indicate Liver injury. Flat clavicular fossa indicates Heart injury. Protruding umbilicus indicates Spleen injury. Flat soles indicate Kidney injury. Flat back indicates Lung injury. These five injuries are incurable.