所谓水气者，非必有形之水也，或外中于风寒，或内伤于饮食，或七情所感，脏气虚实
，自
相乘侮，皆是也。夫五脏皆有中寒，而入心最急，古人论之矣。亦有脾阳不足，下焦寒盛，
自然心气下陷，肾气上凌，非关风寒外入者，此为内虚，其势较缓，而其本益深。又有饮食
寒冷及难化之物，坐卧不动，困遏中气，自损脾阳，遂致水饮泛溢膈上，心气不得上升，卒
然心大动，怔忡嘈杂，呕吐大作，阴风内起，二便频泄不禁，昏厥不省人事；或无端自觉凄
怆不乐，或忽然气闷，逼迫无赖，呼号求救，大喘大汗，脑痛如裂，皆心火不扬，为水所扑
之验也。《内经》∶逆夏气则秋为 疟，冬至重病，是心虚畏水之义也。《金匮》牡疟，徐
氏
正如此说。《脉经》三部动摇，各各不同，得病以仲夏，桃花落而死。此心气受伤，至次年
心气当旺之时，有遇缺难过之虑也。大抵风挟寒自外入者，其气猛而急；湿挟寒自下犯者，
其气沉而锐。史载之尝谓∶人之病寒水犯心者，虽治愈，亦不永年。此人世之大病，亟宜讲
明者也。若诊脉见动而应指无力，其人惨淡萎顿者，凶之兆也。兹将史氏所说，条例如下∶
水邪攻心气，用桂与姜壮心气以胜之。其病狂言，身热，骨节疼痛，面赤，眼如拔，而
脑如
脱，心脉搏坚而长，当病舌卷不能言。凡脉之搏，以有所犯，而鬼气胜之则搏，心脉之搏，
肾邪犯之也。舌卷不能言者，舌固应心，而舌本又少阴脉之所散也。治之之法，不独凉其心
，而且暖行其肾。(凉字作泻字说，泻即攻也。)
心脉大滑，而肾脉搏沉，以汗为心液，今心脉大滑，则水犯之，而动，故汗。(此心气
先为
寒水所遏，而渐透重阴者也，故脉动而有力。载之有论肾寒作喘曰∶六脉沉重而浊浑革至，
如物制之，此为肾寒太过也。如物制之四字，真为动脉传神。)
心脉搏滑急，为心疝；小急不鼓，为瘕。故曰诊得心脉而急，病名心疝，少腹当有形。
此心气不足，血为寒邪所犯也。(凡脉之滑而搏者，皆津液壅结之故也。)
元气虚弱，肾气不足，膀胱气虚，冲任脉虚，丈夫 疝，妇人癃闭。其脉六脉皆动，细
数而轻弦，肾脉小击而沉，膀胱涩而短。(此二节皆寒湿久结，心气渐为所抑者也。)
元气虚乏，肾水极寒，发为寒战，冷汗自出，六脉微细而沉。
寒邪犯心，则肾脉必击而沉，心下大动不安，甚则仆倒，宜先暖其肾，后保其心。(此
心气
虚而卒乘之者也。《内经》∶脉喘而坚，积气在中，时害于食，名曰心痹。得之外疾思虑而
心虚，故邪从之。故劳心太过者，火衰而水易乘之也。)
湿气寒气之胜，同犯于心，心气上行，不得小便。
肾水之胜，凌犯于心。经言∶心气上行，痛留眉顶间，甚则延及胸，头痛，脑户间痛，
宜暖其肾。
寒邪犯心，血气内变，伤损于中，因而下注赤白。此病世之罕有，盖伤犯人之极也。其
证发
热如火，头身俱痛，色如紫草，汁如胶涎，如茶脚，不急治之，杀人反掌。毒痢伤人不一，
惟水邪犯心最重。凡人初患痢，先发寒热、头痛，即是寒邪犯心。(此专就痢疾辨之，
即所谓下利身热者也。)
案上列诸证，有缓有急，有轻有重，其脉有微细，有弦紧，有搏大滑动。大抵邪浅，犯
于心
气营运之部，而内感于心者，其始邪在气分，则脉弦滑；日久邪入血分，则脉细紧矣。若大
邪直中心之本经，而内犯于脏，其乘心虚而侵之者，脉多细涩；其心气实而强遏之者，脉多
搏大滑动也。备胪诸证，而不及悲伤不乐者；悲伤不乐，寒燥之轻邪也。
所谓“水气”，并不一定是指有形的积水。它可能是外感风寒，也可能是内伤饮食，或者是七情（喜、怒、忧、思、悲、恐、惊）所感，导致脏腑之气虚实失衡，相互乘侮，这些情况都属于水气的范畴。五脏都有中寒的情况，但侵入心脏最为急迫，古人对此已有论述。也有因脾阳不足，下焦寒气过盛，导致心气自然下陷，肾气上凌于心，这与风寒外侵无关，属于内虚证，其发病势态较缓，但病根更深。又有因饮食寒冷及难以消化的食物，加上坐卧不动，困遏中焦之气，损伤脾阳，从而导致水饮泛溢于膈上，心气无法上升，突然发生心脏剧烈跳动，心悸怔忡，嘈杂不适，呕吐剧烈，体内阴风兴起，大小便频繁失禁，昏厥不省人事；或者无缘无故感到凄凉悲伤、心情不悦，或者突然胸闷气短，逼迫无奈，呼号求救，大汗淋漓，头痛如裂，这些都是心火不能宣扬，被水邪压制验证的表现。《黄帝内经》说：违背夏季的养生规律，秋天就会患疟疾，到了冬至病情加重，这是心气虚弱畏惧水邪的含义。《金匮要略》中的牡疟，徐氏正是这样解释的。《脉经》记载：三部脉搏动摇，各不相同，如果在仲夏得病，桃花凋谢时就会死亡。这是因为心气受伤，到了次年心气应当旺盛的时候，却遇到缺漏难以度过难关。大抵而言，风挟带寒气从外部侵入的，其气势猛烈而急促；湿挟带寒气从下部犯上的，其气势深沉而锐利。史载之曾经说：人患病，如果是寒水侵犯心脏，即使治愈了，也不能长寿。这是人世间的重大疾病，亟需讲明辨别的。如果诊脉发现脉搏跳动且按之无力，病人面色惨淡、萎靡不振的，是凶险的征兆。现将史氏所说的内容，分条列述如下：
水邪攻伐心气，使用桂枝和干姜来壮旺心气以克制它。如果病人胡言乱语，身体发热，骨节疼痛，面色发红，眼睛像要脱出，头部像要脱落，心脉搏动坚实而长，应当患有舌卷缩不能说话的症状。凡是脉搏搏动，是因为受到邪气侵犯，鬼气（指严重的邪气）胜过正气则出现搏动，心脉的搏动，是肾邪侵犯所致。舌卷缩不能说话，舌头确实对应心脏，而舌根又是少阴经脉分布的地方。治疗的方法，不仅要清泻心火，还要温通肾脏。（这里的“凉”字作“泻”字理解，泻即攻逐之意。）
心脉大而滑，肾脉沉，因为汗为心之液，现在心脉大而滑，说明水邪侵犯心脉并使其动荡，所以出汗。（这是因为心气先前被寒水遏制，逐渐透出重阴的缘故，所以脉象动而有力。史载之有关于肾寒致喘的论述说：六脉沉重浑浊，革至如物制约，这是肾寒太过的表现。“如物制约”这四个字，生动地描绘了动脉的神韵。）
心脉搏动滑急，诊断为心疝；脉象小急而不鼓动，诊断为瘕积。所以说诊得心脉紧急，病名心疝，少腹部应当有有形之邪。这是心气不足，血液被寒邪侵犯所致。（凡是脉象滑而搏动的，都是津液壅结的缘故。）
元气虚弱，肾气不足，膀胱气虚，冲任脉虚，男子患疝气，女子患小便不通。其脉象表现为六脉皆动，细数而轻弦，肾脉小击而沉，膀胱脉涩而短。（这两节内容都是寒湿久结，心气逐渐被抑制的表现。）
寒邪侵犯心脏，肾脉必然搏击而沉，心下剧烈跳动不安，甚至仆倒，应当先温补肾阳，后保护心气。（这是心气虚弱而突然被乘虚侵袭的情况。《黄帝内经》说：脉象喘促而坚，积气在中，时常影响进食，名叫心痹。得自外感疾病，思虑过度导致心虚，所以邪气随之而来。因此劳心太过的人，心火衰微，水邪就容易乘虚而入。）
肾水胜复，凌犯心脏。经文说：心气上行，疼痛停留在眉顶之间，严重时延及胸部，头痛，脑户间疼痛，应当温补肾阳。
寒邪侵犯心脏，气血内部变化，损伤中焦，因而向下注泄赤白痢疾。这种病世间罕见，可以说是伤害人体至极。其症状发作时发热如火，头身俱痛，面色像紫草，分泌物像胶涎或茶脚，如果不紧急治疗，杀人只在反掌之间。毒痢伤人方式不一，只有水邪犯心最为严重。凡人初患痢疾，先发寒热、头痛，就是寒邪侵犯心脏。（这是专门就痢疾进行辨析，即所谓的下利伴身热的情况。）
以上列举的各种证候，有的缓急不同，有的轻重各异，其脉象有的微细，有的弦紧，有的搏大滑动。大抵而言，邪气浅表，侵犯在心气运行的部位，并内感于心，起初邪在气分，脉象弦滑；日久邪入血分，脉象细紧。如果大邪直接中心之本经，内犯于脏，乘心气虚弱而侵袭的，脉象多细涩；心气实强而强力遏制的，脉象多搏大滑动。详细列举各种证候，却没有提到悲伤不乐的症状；悲伤不乐，属于寒燥的轻邪。
The so-called "Water Qi" (Shui Qi, pathogenic water energy) does not necessarily refer to visible fluid accumulation. It may result from external contraction of Wind-Cold (Feng Han), internal injury from diet, or emotional disturbances (Seven Emotions: Joy, Anger, Worry, Thought, Sorrow, Fear, Fright), leading to imbalance in the deficiency and excess of Zang-Fu Qi, causing mutual overacting or insulting among organs; all these constitute Water Qi. All five Zang organs can suffer from Cold invasion, but invasion into the Heart is the most urgent, as discussed by ancient physicians. There are also cases where Spleen Yang is insufficient, and Cold is excessive in the Lower Jiao, naturally causing Heart Qi to sink and Kidney Qi to ascend and overwhelm the Heart. This is unrelated to external Wind-Cold invasion; it belongs to Internal Deficiency patterns, with a slower onset but a deeper root. Additionally, consuming cold food and indigestible substances, combined with sedentary behavior, can obstruct Middle Jiao Qi, damaging Spleen Yang, thereby causing Water-Drink to overflow above the Diaphragm. Consequently, Heart Qi cannot ascend, leading to sudden severe palpitations, anxiety and restlessness (Zheng Chong), epigastric discomfort, violent vomiting, internal rise of Yin-Cold, frequent and involuntary urination and defecation, coma, and loss of consciousness. Or, one may inexplicably feel desolate and unhappy, or suddenly experience chest tightness and breathlessness, feeling desperate and helpless, crying out for help, accompanied by profuse sweating, headache as if splitting. These are manifestations of Heart Fire failing to flourish and being suppressed by Water pathogens. The *Nei Jing* states: "Violating the Qi of Summer leads to Malaria in Autumn, with severe illness at Winter Solstice," which implies that Heart Deficiency fears Water. Xu Shi's interpretation of *Mang Yan* (Oyster Malaria) in the *Jin Gui Yao Lue* aligns with this view. The *Mai Jing* records: "Pulses tremble in the three positions, each different; contracting disease in Mid-Summer leads to death when peach blossoms fall." This indicates Heart Qi injury; when the time comes for Heart Qi to flourish in the following year, there is a fear of inability to overcome the deficit due to lack of support. Generally, Wind carrying Cold invading from outside has fierce and rapid Qi; Dampness carrying Cold attacking from below has deep and sharp Qi. Shi Zaizhi once stated: "For diseases where Cold-Water attacks the Heart, even if cured, longevity is not guaranteed." This is a major disease in human life that urgently requires clarification. If pulse diagnosis reveals trembling pulses that are weak upon pressure, and the patient appears pale and listless, it is an ominous sign. The contents described by Shi are listed below item by item:
When Water Evil attacks Heart Qi, use Cinnamon Twig Decoction (Guizhi Tang) and Ginger (Jiang) to strengthen Heart Qi to overcome it. If the patient speaks deliriously, has fever, bone and joint pain, red face, eyes protruding as if pulled out, and head feeling as if detached, and the Heart Pulse is firm and long, they should suffer from tongue retraction and inability to speak. Whenever a pulse trembles, it is due to pathogenic invasion; when Ghost Qi (severe pathogen) overwhelms healthy Qi, trembling occurs. Trembling of the Heart Pulse is caused by Kidney Evil invading. Tongue retraction and inability to speak occur because the tongue corresponds to the Heart, and the root of the tongue is where the Shaoyin Meridian distributes. The treatment method involves not only cooling the Heart but also warming and moving the Kidney. (Here, "cooling" is interpreted as "draining"; draining means attacking.)
If the Heart Pulse is large and slippery, and the Kidney Pulse is deep, since sweat is the fluid of the Heart, a large and slippery Heart Pulse indicates Water invasion causing movement, thus resulting in sweating. (This is because Heart Qi was previously restrained by Cold-Water and gradually penetrated through heavy Yin, hence the pulse moves with strength. Shi Zaizhi had a discussion on Kidney Cold causing asthma: "Six pulses are heavy, turbid, and革 (ge-like/restrained), as if controlled by something; this indicates excessive Kidney Cold." The phrase "as if controlled by something" vividly describes the spirit of the Trembling Pulse.)
A Heart Pulse that is trembling, slippery, and rapid indicates Heart Hernia (Xin Shan); a small, rapid pulse without full beating indicates Mass Accumulation (Jia). Therefore, it is said that if the Heart Pulse is found to be urgent, the disease is named Heart Hernia, and there should be tangible signs in the lower abdomen. This is due to Heart Qi deficiency and Blood invasion by Cold Evil. (Whenever pulses are slippery and trembling, it is due to the stagnation and knotting of Body Fluids.)
If Yuan Qi is weak, Kidney Qi is insufficient, Bladder Qi is deficient, and the Chong and Ren meridians are empty, men may suffer from Hernia, and women from urinary retention. The pulse presents as all six positions trembling, fine, rapid, and lightly wiry; the Kidney pulse beats slightly and is deep; the Bladder pulse is choppy and short. (These two sections describe long-standing knotting of Cold-Dampness, gradually suppressing Heart Qi.)
If Yuan Qi is exhausted, and Kidney Water is extremely cold, chills and shaking fever may occur, with spontaneous cold sweat, and the six pulses become minute, fine, and deep.
When Cold Evil invades the Heart, the Kidney pulse must beat and be deep, with severe unrest and palpitation in the epigastrium, potentially leading to collapse. One should first warm the Kidney and then protect the Heart. (This is a case of sudden attack due to Heart Qi deficiency. The *Nei Jing* states: "Pulse is rapid and firm, accumulated Qi is in the middle, occasionally hindering eating; this is called Heart Bi (Obstruction). Acquired from external illness and mental worry leading to Heart Deficiency, so pathogens follow." Thus, those who overwork their minds have depleted Heart Fire, making them susceptible to Water invasion.)
When Dampness and Cold prevail and jointly invade the Heart, Heart Qi fails to ascend, resulting in urinary obstruction.
When Kidney Water prevails and overwhelms the Heart, the classics state: "Heart Qi fails to ascend, pain remains between the eyebrows and vertex, extending to the chest in severe cases, causing headache and pain in the Naohu region." Warm the Kidney.
When Cold Evil invades the Heart, internal changes occur in Qi and Blood, damaging the Middle Jiao, leading to downward discharge of dysentery with blood and mucus. This disease is rare in the world, representing extreme damage to the human body. Symptoms include high fever like fire, pain in the head and body, complexion resembling purple grass, secretions resembling glue or tea dregs. Without urgent treatment, death follows swiftly. While toxic dysentery harms people in various ways, Water Evil attacking the Heart is the most severe. When a person initially suffers from dysentery, starting with chills, fever, and headache, it indicates Cold Evil attacking the Heart. (This specifically analyzes dysentery, referring to the so-called 'diarrhea/dysentery with body heat'.)
The aforementioned syndromes vary in speed and severity, with pulses ranging from minute to wiry-tight or large-trembling-slippery. Generally, if the pathogen is shallow, invading the area of Heart Qi circulation and affecting the Heart internally, initially the pathogen is in the Qi level, presenting a wiry-slippery pulse; after a long time, if the pathogen enters the Blood level, the pulse becomes fine and tight. If a major pathogen directly strikes the Heart's primary meridian and invades the Zang internally, attacking due to Heart Deficiency, the pulse is often fine and choppy; if Heart Qi is strong and forcefully resists, the pulse is often large, trembling, and slippery. The detailed listing of syndromes omits "sadness and unhappiness"; sadness and unhappiness belong to mild pathogens of Cold and Dryness.