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 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。
风水。水为风激。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。而内无满喘也。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。正水乘阳之虚而侵及上焦。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。久则侵及于里而营不通。则逆于肉理而为痈脓也。
脉浮而洪。浮则为风。洪则为气。风气相搏。风强则为瘾疹。身体为痒。痒者为泄风。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。
风、天之气。气、人之气。是皆失其和者也。风气相搏。风强则气从风而侵淫肌体。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。然风水之病。其状与黄汗相似。故仲景于此复辨其证。以恶风者为风水。不恶风者为黄汗。而
风水之脉浮。黄汗之脉沉。更不必言矣。
寸口脉沉滑者。中有水气。面目肿大有热。名曰风水。视人之目窠上微肿。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。
风水其脉自浮。此云沉滑者。乃水脉。非风脉也。至面目肿大有热。则水得风而外浮。其脉亦必
变而为浮矣。仲景不言者。以风水该之也。目窠上微肿。如蚕新卧起状者。内经所谓水为阴。而目下
亦阴。聚水者必微肿先见于目下是也。颈脉动者。颈间人迎脉动甚。风水上凑故也。时时咳者。水渍
入肺也。按其手足上陷而不起。与内经以手按其腹。随手而起。如裹水之状者不同。然腹中气大。而
肢间气细。气大则按之随手而起。气细则按之 而不起。而其浮肿则一也。
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。胸中窒。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。此为肺胀。其状如肿。发汗则愈。然诸病此
者。渴而下利。小便数者。皆不可发汗。
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。周痹为寒湿痹其阳。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。痛在骨节也。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。然此诸病。若其人渴而下利。小便数者。则不可以水气当汗而概发之也。仲景丁宁之意。
岂非虑人之津气先亡耶。
或问前二条云。风水外证。骨节疼。此云骨节反不疼。身体反重而酸。前条云皮水不渴。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。其侵淫肌体者。则骨节不疼。而身体酸
重。由所伤之处不同故也。前所云皮水不渴者。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。程氏曰。水气外留于
皮。内薄于肺。故令人渴是也。
里水者。一身面目黄肿。其脉沉。小便不利。故令病水。假令小便自利。此亡津液。故令渴。越
婢加术汤主之。（方见中风）
里水。水从里积。与风水不同。故其脉不浮而沉。而盛于内者必溢于外。故一身面目悉黄肿也。
水病小
盒饭不利。今反自利。则津液消亡。水病已而渴病起矣。越婢加术。是治其水。非治其渴也。以其身
面悉肿。故取麻黄之发表。以其肿而且黄。知其湿中有热。故取石膏之清热。与白术之除湿。不然。
则渴而小便利者。而顾犯不可发汗之戒耶。或云此治小便利。黄肿未去者之法。越婢散肌表之水。白
术止渴生津也。亦通。
趺阳脉当伏。今反紧。本自有寒。疝瘕。腹中痛。医反下之。即胸满短气。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。
趺阳虽系胃脉。而出于阴部。故其脉当伏。今反紧者。以其腹中宿有寒疾故也。寒则宜温而反下
之。阳气重伤。即胸满短气。其反数者。以其胃中有热故也。热则当消谷而小便数。今反不利。则水
液日积。故欲作水。夫阴气伤者。水为热蓄而不行。阳气竭者。水与寒积而不下。仲景并举二端。以
见水病之原有如此也。
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。浮脉即热。数脉即止。
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。即为水矣。
热而潜。则热有内伏之势。而无外发之机矣。故曰沉。热而止。则热有留滞之象。而无营运之道
矣。故曰伏。热留于内而不行。则水气因之而蓄。故曰沉伏相搏。名曰水。热留于内。则气不外行。
而络脉虚。热止于中。则阳不下化。而小便难。以不化之水。而当不行之气。则惟有浸淫躯壳而已。
故曰虚难相搏。水走
皮肤。即为水矣。此亦所谓阴气伤者。水为热蓄不下者也。
寸口脉弦而紧。弦则卫气不行。即恶寒。水不沾流。走于肠间。少阴脉紧而沉。紧则为痛。沉则
为水。小便即难。
此二条并阳衰阴胜之证。而寸口则主卫气。少阴则主肾阳。主卫气者。寒从外得。而阳气被抑。
主肾阳者。寒自内生。而气化不速。亦即所谓阳气竭者。水与寒积而不行者也。
脉得诸沉。当责有水。身体肿重。水病脉出者死。
水为阴。阴盛故令脉沉。又水行皮肤。营卫被遏。亦令脉沉。若水病而脉出。则真气反出邪水之
上。根本脱离。而病气独胜。故死。出与浮迥异。浮者盛于上而弱于下。出则上有而下绝无也。
夫水病患目下有卧蚕。面目鲜泽。脉伏。其人消渴。病水腹大。小便不利。其脉沉绝者有水。可
下之。
目下有卧蚕者。目下微肿。如蚕之卧。经所谓水在腹者。必使目下肿也。水气足以润皮肤而壅营
卫。故面目鲜泽。且脉伏不起也。消渴者。阳气被郁而生热也。病水。因水而为病也。夫始因水病而
生渴。继因消渴而益病水。于是腹大。小便不利。其脉沉绝。水气瘀壅而不行。脉道被遏而不出。其
势亦太甚矣。故必下其水。以通其脉。
问曰。病下利后渴饮水。小便不利。腹满因肿者。何也。答曰。此法当病水。若小便自利。及汗
出者。自当愈。
下利后阴亡无液。故渴欲饮水。而土虚无气。不能制水。则又小便不利。腹满因肿。知其将聚水为
病矣。
若小便利。则从下通。汗出则从外泄。水虽聚而旋行。故病当愈。然其所以汗与利者。气内复而
机自行也。岂辛散淡渗。所能强责之哉。
心水者。其身重而少气。不得卧。烦而躁。其人阴肿。肝水者。其腹大。不能自转侧。胁下腹痛。
时时津液微生。小便续通。肺水者。其身肿。小便难。时时鸭溏。脾水者。其腹大。四肢苦重。津液
不生。但苦少气。小便难。肾水者。其腹大。脐肿腰痛。不得溺。阴下湿如牛鼻上汗。其足逆冷。面
反瘦。
心、阳脏也。而水困之。其阳则弱。故身重而少气也。阴肿者。水气随心气下交于肾也。肝病喜
归脾。脾受肝之水而不行。则腹大不能转侧也。肝之腑在胁。而气连少腹。故胁下腹痛也。时时津液
微生。小便续通者。肝喜冲逆而主疏泄。水液随之而上下也。肺主气化。治节一身。肺以其水行于身
则肿。无气以化其水。则小便难。鸭溏。如鸭之后。水粪杂下也。脾主腹而气行四肢。脾受水气。则
腹大四肢重。津气生于谷。谷气运于脾。脾湿不运。则津液不生而少气。小便难者。湿不行也。身半
以下。肾气主之。水在肾。则腰痛、脐肿、腹大也。不得溺。阴下湿。如牛鼻上汗。其足逆冷者。肾
为阴。水亦为阴。两阴相得。阳气不行。而湿寒独胜也。面反瘦者。面为阳。阴盛于下。则阳衰于上
也。
师曰。诸有水者。腰以下肿。当利小便。腰以上肿。当发汗乃愈。
腰以下为阴。阴难得汗而易下泄。故当利小便。腰以上为阳。阳易外泄。故当发汗。各因其势而
利导之也。
师曰。寸口脉沉而迟。沉则为水。迟则为寒。寒水相搏。趺阳脉伏。水谷不化。脾气衰则 溏。
胃气衰则身肿。少阳脉卑。少阴脉细。男子则小便不利。妇人则经水不通。经为血。血不利则为水。
名曰血分。
此合诊寸口、趺阳。而知为寒水胜而胃阳不行也。胃阳不行。则水谷不化。水谷不化。则脾胃俱
衰。脾气主里。故衰则 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。寸口脉沉而数。数则为出。沉则为入。出则为阳实。入则为阴结。趺阳脉微而弦。微则无
胃气。弦则不得息。少阴脉沉而滑。沉则为在里。滑则为实。沉滑相搏。血结胞门。其瘕不写。经络
不通。名曰血分。
此合诊寸口、趺阳、少阴。而知其气壅于阳。胃虚于中。而血结于阴也。出则为阳实者。肺被热
而治不行也。弦则不得息者。胃受制而气不利也。夫血结在阴。惟阳可以通之。而胃虚受制。肺窒不
行。更何恃而开其结。行其血耶。惟有凝聚癃闭。转成水病而已。故曰血结胞门。其瘕不写。经络不
通。名曰血分。亦如上条所云也。但上条之结。为血气虚少而行之不利也。此条之结。为阴阳壅郁而
欲行不能也。仲景并列于此。以见血分之病。虚实不同如此。
问曰。病有血分、水分。何也。师曰。经水前断、后病水。名曰血分。此病难治。先病水、后经
水断。名曰水分。此病易治。何以故。去水。其经自下。
此复设问答。以明血分、水分之异。血分者。因血而病为水也。水分者。因水而病及血也。血病
深而难通。故曰难治。水病浅而易行。故曰易治。
问曰。病者苦水。面目身体四肢皆肿。小便不利。脉之不言水。反言胸中痛。气上冲咽。状如炙
肉。当微咳喘。审如师言。其脉何类。师曰。寸口脉沉而紧。沉为水。紧为寒。沉紧相搏。结在关元。
始时尚微。年盛不觉。阳衰之后。营卫相干。阳损阴盛。结寒微动。肾气上冲。咽喉塞噎。胁下急痛。
医以为留饮而大下之。气系不去。其病不除。复重吐之。胃家虚烦。咽燥欲饮水。小便不利。水谷不
化。面目手足浮肿。又与葶苈丸下水。当时如小差。食饮过度。肿复如前。胸胁苦痛。象若奔豚。其
水扬溢。则咳喘逆。当先攻击冲气令止。乃治咳。咳止其喘自瘥。先治新病。病当在后。
此水气先得。而冲气后发之证。面目肢体俱肿。咽喉噎塞。胸胁满痛。有似留饮。而实挟冲气
也。冲气宜温降。不宜攻下。下之亦未必去。故曰气系不去。其病不除。医乃不知而复吐之。胃气重
伤。胃液因尽。故咽燥欲饮水。而小便不利。水谷不化。且聚水而成病也。是当养胃气以行水。不宜
径下其水。水虽下。终必复聚。故暂瘥而寻复如前也。水聚于中。气冲于下。其水扬溢上。及肺位。
则咳且喘逆。是不可攻其水。当先止其冲气。冲气既止。然后水气可去。水去则咳与喘逆俱去矣。先
治新病。病当在后者。谓先治其冲气。而后治其水气也。
风水。脉浮身重。汗出恶风者。防已黄 汤主之。腹痛者加芍药。
此条义详痉湿 篇。虽有风水、风湿之异。然而水与湿非二也。
防己黄 汤方（见湿病）
风水恶风。一身悉肿。脉浮不渴。续自汗出。无大热。越婢汤主之。
老师说：水气病有风水、皮水、正水、石水、黄汗五种。风水病的脉象自然浮，外在症状是骨节疼痛、怕风。皮水病的脉象也浮，外在症状是全身浮肿，按下去凹陷不起，不怕风，腹部像鼓一样胀满，口不渴，应当用发汗的方法治疗。正水病的脉象沉迟，外在症状是自觉气喘。石水病的脉象自然沉，外在症状是腹部胀满但不喘。黄汗病的脉象沉迟，身体发热，胸部胀满，四肢和头面部浮肿，如果长久不愈，必定导致痈脓。
风水，是水被风邪激荡，因风邪而引发水病。风邪损伤皮毛，湿气流注关节，所以脉浮、怕风且骨节疼痛。皮水，水行于皮肤之中，内合肺气，所以脉象也浮。因为不兼夹风邪，所以不怕风。其腹部像鼓一样胀满，就是《内经》中“胕然不坚”的意思。因为病在皮肤，没有波及肠脏，所以外表有胀形，内部没有胀满气喘的症状。水停留在皮表，适宜从汗液解出，所以说应当发汗。正水，是肾脏的水气自盛。石水，是水聚集而不流动的病。正水乘阳气虚弱而侵及上焦，所以脉沉迟且气喘。石水因阴气过盛而结聚于少腹，所以脉沉、腹部胀满而不气喘。黄汗，出汗沾衣像柏树汁一样，得病原因是湿热交争，而湿邪居于热邪之外。湿邪盛于上部而阳气不能运行，就会身体发热、胸部胀满、四肢头面浮肿。时间久了，病邪侵入体内，营气不通，逆乱于肌肉纹理之间，就会形成痈脓。
脉象浮而洪，浮表示有风，洪表示有气（指邪气盛）。风气和邪气相互搏结，风气强盛则变成瘾疹，身体瘙痒，瘙痒的是泄风，久了会变成疥癣癞疾。邪气强盛则变成水肿，身体难以俯仰。风气和邪气相互搏击，身体严重浮肿，出汗后就好了。怕风的属于虚证，这是风水。不怕风的，小便通利，上焦有寒，口中多涎，这是黄汗。
风是天之气，气是人之气，这都是失去和谐的状态。风气和邪气相互搏结，风气强盛则气跟随风邪侵淫肌体，所以发生瘾疹。邪气强盛则风跟随邪气鼓动水液，所以发生水肿。风和邪气都强盛，两者相互搏击，水液随之泛滥，就形成风水。发汗则风去而水行，所以说出汗就好了。然而风水病的症状与黄汗相似，所以仲景在这里再次辨别它们的证候：以怕风者为风水，不怕风者为黄汗。而且风水的脉浮，黄汗的脉沉，更是不必多说的了。
寸口脉沉滑的，说明体内有水气，面目肿大且有热，名叫风水。看人的眼睑上方微微肿胀，像蚕刚睡醒的样子，颈部人迎脉搏动明显，时常咳嗽，按压手足背部，凹陷不能立即弹起的，是风水。
风水脉象本应自浮，这里说沉滑，那是水脉，不是风脉。到了面目肿大且有热的时候，则是水得到风邪而外浮，脉象也必然变为浮。仲景没有明说，是因为风水已经包含这种情况了。眼睑上方微肿，像蚕刚睡醒的样子，就是《内经》所说的水是阴邪，而目下也是阴位，聚水的人一定先在目下出现微肿。颈部脉搏动明显，是颈间人迎脉跳动剧烈，因为风水之邪上凑的缘故。时常咳嗽，是水气浸渍入肺的表现。按压手足背部凹陷不起，与《内经》中用手按压腹部，随手而起，像包裹着水那样的情况不同。然而腹中气大，而肢体间气细，气大则按压随手而起，气细则按压凹陷不起，而其浮肿是一样的。
太阳病，脉浮紧，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，出汗就好了，这是风水。怕冷的，这是极度虚弱时发汗导致的。口渴但不怕冷的，这是皮水。身体浮肿而冷，症状像周痹，胸中窒塞，不能进食，反而聚痛，傍晚烦躁不得睡眠，这是黄汗。疼痛在骨节，咳嗽气喘，不口渴的，这是肺胀。症状像浮肿，发汗就好了。然而各种病如果有这种表现，但口渴且腹泻、小便频数的，都不可发汗。
太阳受寒，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。现在得了伤寒的脉象但骨节不疼，身体反而沉重酸痛，这就不是伤寒，而是风水邪气胜实于外。风水在表而不在里，所以不渴。风邪固然应当发汗，水在表者也适宜发汗，所以说出汗就好了。但是必须正气盛实的人，发汗才能好，否则表气更加虚弱，虽然风水解除了，但怕冷反而加重了。所以说怕冷的，这是极度虚弱时发汗导致的。如果口渴但不怕冷，那就不是病风，而是独病水，病位不在皮外，而在皮中，比风水病位较深。其症状身体浮肿而冷，状如周痹。周痹是寒湿痹阻阳气，皮水是水气淫溢于肤表。胸中窒塞，不能进食，是寒邪袭击于外，气机窒塞于中。反而聚痛，傍晚烦躁不得睡眠，是热被寒郁遏，而寒邪在傍晚更甚。寒湿外淫，必定流注关节，所以说这是黄汗，疼痛在骨节。咳嗽气喘不口渴的，是水寒伤肺，气攻于表，症状像肿病，但实质同于皮水，所以说发汗就好了。然而这些病，如果病人口渴且腹泻、小便频数，就不能一概用水气当汗的方法来发汗。仲景反复叮咛，难道不是担心人的津气先亡失吗？
有人问前两条说，风水的外证是骨节疼，这里说骨节反而不疼，身体反而重而酸。前条说皮水不渴，这里说渴，为什么呢？回答说：风与水结合而成病，流注到关节的，就是骨节疼痛；侵淫到肌体的，就是骨节不疼而身体酸重。这是因为受伤的部位不同所致。前条所说皮水不渴，不是说皮水本来不渴，而是说腹部像鼓一样且不渴的，是病邪方盛于外而未入里，还可以发汗。这里所说的渴而不怕冷，是用来区别风水的不渴而怕风的。程氏说：水气外留于皮，内迫于肺，所以使人渴，就是这个意思。
里水病，一身面目黄肿，脉象沉，小便不利，所以令人生水病。假如小便自利，这是亡失津液，所以令人渴。用越婢加术汤主治。（方剂见中风篇）
里水，水从体内积聚，与风水不同，所以脉不浮而沉。盛于内部的必定溢于外部，所以一身面目都黄肿。水病通常小便不利，现在反而自利，则津液消亡，水病好了而渴病起了。越婢加术汤是治其水，不是治其渴。因为身面全部浮肿，所以取麻黄发表；因为肿而且黄，知道湿中有热，所以取石膏清热，配合白术除湿。不然的话，对于渴而小便利的病人，岂不是犯了不可发汗的禁忌吗？有人说这是治疗小便利、黄肿未去的办法，越婢散肌表之水，白术止渴生津，也讲得通。
趺阳脉应当伏，现在反而紧，原本就有寒，疝瘕，腹中痛，医生反而用泻下法，就会导致胸满短气。趺阳脉应当伏，现在反而数，原本就有热，消谷善饥，小便频数，现在反而不利，这是将要发生水病。
趺阳脉虽然是胃脉，但出于阴部，所以脉应当伏。现在反而紧，是因为腹中宿有寒疾。寒应当温而反用下法，阳气重伤，就会胸满短气。脉反而数，是因为胃中有热。热应当消谷而小便数，现在反而不利，则水液日益积聚，所以将要发生水病。阴气受伤的，水被热蓄积而不行；阳气竭绝的，水与寒积聚而下不去。仲景并列这两种情况，以显示水病的原由如此。
寸口脉浮而迟，浮脉则有热，迟脉则潜藏。热与潜相搏结，名叫沉。趺阳脉浮而数，浮脉即热，数脉即止。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，就形成水病了。
热而潜，则热有内伏之势，而无外发的机理，所以叫沉。热而止，则热有留滞之象，而无营运之道，所以叫伏。热留在内部而不行，则水气因此蓄积，所以叫沉伏相搏，名叫水。热留在内部，则气不外行，而络脉虚；热止于中，则阳不下化，而小便难。以不化的水，来应对不行的气，就只有浸淫躯壳而已，所以叫虚难相搏，水走皮肤，就形成水了。这也是所谓阴气受伤，水被热蓄积而下不去的情况。
寸口脉弦而紧，弦则卫气不行，即恶寒。水不沾流，走于肠间。少阴脉紧而沉，紧则为痛，沉则为水，小便即难。
这两条都是阳衰阴盛的证候，而寸口主卫气，少阴主肾阳。主卫气的，寒从外得，阳气被抑制；主肾阳的，寒自内生，气化不迅速。也就是所谓阳气竭绝，水与寒积聚而不行的情况。
脉象见到各种沉脉，应当责求有水。身体肿重，水病脉象突然浮出的，预后不良（死）。
水是阴邪，阴盛故令脉沉。又水行于皮肤，营卫被遏制，也令脉沉。如果水病而脉象浮出，则真气反出于邪水之上，根本脱离，而病气独盛，所以死。出脉与浮脉迥然不同，浮脉是上盛下弱，出脉则是上有而下绝无。
凡是水病患者，目下有卧蚕样浮肿，面目光泽，脉伏，其人消渴，病水腹大，小便不利，脉象沉绝的，是有水，可以用攻下法。
目下有卧蚕，是目下微肿，像蚕在睡觉。经书说水在腹中，必定使目下肿。水气足以滋润皮肤而壅滞营卫，所以面目鲜泽，且脉伏不起。消渴，是阳气被郁而生热。病水，是因水而致病。开始因水病而生渴，接着因消渴而益加水病，于是腹大，小便不利，脉象沉绝，水气瘀壅而不行，脉道被遏制而不出，其势也太厉害了，所以必须攻下其水，以通其脉。
问：病人在下利之后，口渴想喝水，小便不利，腹部胀满因而浮肿，这是什么原因？答：这方法上当患水病。如果小便自利，以及出汗的，自然会痊愈。
下利后阴液亡失无液，所以口渴想喝水，而土虚无气，不能制约水，就又小便不利，腹部胀满因而浮肿，知道它将聚水为病。
如果小便利，则水从下通；出汗，则水从外泄。水虽聚但随即运行，所以病应当痊愈。然而之所以能汗出和小便利，是气机内复而自行运转的结果，难道是辛散淡渗的药物所能强行要求的吗？
心水病，身体沉重而少气，不能平卧，心烦而躁动，病人阴部肿胀。肝水病，腹部大，不能自行翻身，胁下腹痛，时常津液微生，小便断续通畅。肺水病，身体浮肿，小便难，时常大便稀溏如鸭粪。脾水病，腹部大，四肢苦于沉重，津液不生，只苦于少气，小便难。肾水病，腹部大，脐肿腰痛，不能排尿，阴部潮湿像牛鼻上的汗，双脚逆冷，面部反而消瘦。
心是阳脏，而被水困住，其阳则弱，所以身体沉重而少气。阴肿，是水气随心气下交于肾。肝病喜归于脾，脾受肝之水而不行，则腹部大不能翻身。肝的腑在胁，而气连少腹，所以胁下腹痛。时常津液微生，小便断续通畅，是肝喜冲逆而主疏泄，水液随之上下。肺主气化，治理调节一身，肺因其水行于身则肿，无气以化其水，则小便难。鸭溏，像鸭子排便，水粪杂下。脾主腹而气行四肢，脾受水气，则腹大四肢重。津液生于谷，谷气运于脾，脾湿不运，则津液不生而少气。小便难，是湿不行。身半以下，由肾气主宰。水在肾，则腰痛、脐肿、腹大。不能排尿，阴下湿，像牛鼻上汗，双脚逆冷，是因为肾为阴，水亦为阴，两阴相得，阳气不行，而湿寒独盛。面部反而消瘦，是因为面为阳，阴盛于下，则阳衰于上。
老师说：所有有水病的人，腰以下肿，应当利小便；腰以上肿，应当发汗才好。
腰以下为阴，阴难得汗而易于下泄，所以应当利小便。腰以上为阳，阳易外泄，所以应当发汗。各随其势而引导它。
老师说：寸口脉沉而迟，沉则为水，迟则为寒。寒水相搏，趺阳脉伏，水谷不化。脾气衰则便溏，胃气衰则身肿。少阳脉卑，少阴脉细。男子则小便不利，妇人则经水不通。经血属血，血不利则为水，名叫血分。
这是合诊寸口、趺阳，而知为寒水胜而胃阳不行。胃阳不行，则水谷不化。水谷不化，则脾胃俱衰。脾气主里，所以衰则便溏。胃气主表，所以衰则身肿。少阳是生气之源，少阴是地道。它们都受气于脾胃。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。而其所以然的原因，都是阳气不行，阴气乃结的缘故。叫血分，是说虽然病在水，而实则出于血。
老师说：寸口脉沉而数，数则为出，沉则为入。出则为阳实，入则为阴结。趺阳脉微而弦，微则无胃气，弦则不得息。少阴脉沉而滑，沉则为在里，滑则为实。沉滑相搏，血结胞门，其癥块不泻，经络不通，名叫血分。
这是合诊寸口、趺阳、少阴，而知其气壅于阳，胃虚于中，而血结于阴。出则为阳实，是肺被热而治节不行。弦则不得息，是胃受制而气不利。夫血结在阴，只有阳可以通之，而胃虚受制，肺窒不行，还凭借什么来开其结，行其血呢？只有凝聚癃闭，转成水病而已。所以叫血结胞门，其癥块不泻，经络不通，名叫血分。也像上一条所说的那样。只是上一条的结，是血气虚少而行之不利；这一条的结，是阴阳壅郁而欲行不能。仲景并列于此，以显示血分之病，虚实不同如此。
问：病有血分、水分，是什么？师说：月经先前停止，后来生病水，名叫血分。此病难治。先前生病水，后来月经停止，名叫水分。此病易治。为什么？去掉水，月经自然下行。
这是再次设问答，以阐明血分、水分的差异。血分，是因血而病为水。水分，是因水而病及血。血病深而难通，所以说难治。水病浅而易行，所以说易治。
问：病人苦于水病，面目身体四肢皆肿，小便不利。切脉不说水，反而说胸中痛，气上冲咽喉，感觉像炙肉堵在那里，应当微咳喘。确实像老师说的，他的脉象是什么样？师说：寸口脉沉而紧，沉为水，紧为寒。沉紧相搏，结在关元。开始时症状轻微，年壮时不觉。阳气衰弱之后，营卫相干，阳损阴盛，结寒微动，肾气上冲，咽喉塞噎，胁下急痛。医生以为是留饮而用峻下法，气结不去，病不除。又重复吐法，导致胃家虚烦，咽燥想喝水，小便不利，水谷不化，面目手足浮肿。又给葶苈丸下水，当时稍微好转，饮食过度，肿又恢复如初，胸胁苦痛，像奔豚病。水气扬溢，则咳喘逆。应当先攻击冲气令其停止，然后治咳，咳止其喘自然好。先治新病，旧病当在后。
这是水气先得，而冲气后发的证候。面目肢体俱肿，咽喉噎塞，胸胁满痛，有点像留饮，而实际挟带冲气。冲气宜温降，不宜攻下，攻下也未必能去除，所以说气结不去，病不除。医生不知道又用吐法，胃气重伤，胃液耗尽，所以咽燥想喝水，而小便不利，水谷不化，且聚水而成病。这应当养胃气以行水，不宜直接攻下其水。水虽下，终必复聚，所以暂时好转旋即又恢复如初。水聚于中，气冲于下，其水扬溢上，及于肺位，则咳且喘逆，这时不可攻其水，应当先止其冲气。冲气既止，然后水气可去，水去则咳与喘逆俱去。先治新病，病当在后，是指先治其冲气，而后治其水气。
The Master said: There are five types of water qi diseases: Fengshui (Wind-water), Pishui (Skin-water), Zhengshui (Standard Water), Shishui (Stone Water), and Huanghan (Yellow Sweat). In Fengshui, the pulse is naturally floating. The external symptoms include bone and joint pain and aversion to wind. In Pishui, the pulse is also floating. The external symptoms include generalized edema that leaves an indentation when pressed, aversion to wind is absent, the abdomen is distended like a drum, there is no thirst, and treatment should involve inducing sweating. In Zhengshui, the pulse is deep and slow. The external symptom is spontaneous panting. In Shishui, the pulse is naturally deep. The external symptoms are abdominal fullness without panting. In Huanghan, the pulse is deep and slow, accompanied by fever in the body, chest fullness, and swelling of the four limbs and head/face. If it persists for a long time without healing, it will inevitably lead to carbuncles and pus.
Fengshui occurs when water is agitated by wind, causing water disease due to wind pathogen. Wind damages the skin and hair pores, while dampness flows into the joints; thus, the pulse is floating, there is aversion to wind, and bone/joint pain. Pishui involves water circulating within the skin, internally connecting with Lung Qi, hence the pulse is also floating. Because it does not combine with wind, there is no aversion to wind. The abdominal distension like a drum corresponds to the meaning in *Neijing* ("swollen but not firm"). Since the pathology is in the skin and has not affected the intestines or viscera, there is external distension but internal fullness and panting are absent. Water retained in the skin surface should be resolved through sweat; therefore, it is stated that one should induce sweating. Zhengshui refers to the self-proliferation of Kidney water. Shishui refers to water accumulation that does not flow. Zhengshui invades the Upper Jiao due to Yang deficiency, resulting in a deep, slow pulse and panting. Shishui accumulates in the Lower Abdomen due to Yin excess, resulting in a deep pulse and abdominal fullness without panting. Huanghan is characterized by sweat staining clothes like cypress juice. It arises from the interplay of dampness and heat, where dampness resides outside heat. When dampness is excessive in the upper body and Yang cannot circulate, it causes fever, chest fullness, and swelling of the limbs and head/face. Over time, the pathogen invades the interior, blocking Ying (Nutrient) Qi, which reverses into the muscle tissue, leading to carbuncles and pus.
A pulse that is floating and surging indicates floating represents wind, and surging represents Qi (pathogenic excess). When wind Qi and pathogenic Qi struggle, if wind is strong, it becomes urticaria (wind rash), causing body itching; those who itch suffer from "Xiefeng" (Leaking Wind), which over time becomes scabies or leprosy-like conditions. If pathogenic Qi is strong, it becomes edema, making it difficult to bend or straighten the body. When wind and pathogenic Qi strike each other, causing severe body swelling, recovery occurs through sweating. Aversion to wind indicates deficiency; this is Fengshui. Absence of aversion to wind, with free urination and cold in the Upper Jiao causing excessive saliva, indicates Huanghan.
Wind is the Qi of Heaven, and Qi is the Qi of Humans; both represent a loss of harmony. When wind Qi and pathogenic Qi struggle, strong wind causes Qi to invade the muscles and skin along with the wind, resulting in urticaria. Strong pathogenic Qi causes wind to surge fluid, resulting in edema. When both wind and pathogenic Qi are strong and strike each other, fluids follow, forming Fengshui. Sweating expels wind and moves water, hence "sweating leads to recovery." However, Fengshui symptoms resemble Huanghan; thus, Zhang Zhongjing distinguishes them here: aversion to wind indicates Fengshui, while absence of aversion to wind indicates Huanghan. Furthermore, Fengshui presents with a floating pulse, whereas Huanghan presents with a deep pulse, which goes without saying.
A Cun Kou (Radial artery at wrist) pulse that is deep and slippery indicates water Qi inside. Swollen face and eyes with heat are named Fengshui. Observing slight swelling above the eye sockets, resembling a silkworm just waking up, prominent pulsation of the neck vessels (Renying), frequent coughing, and pitting edema on the hands and feet that does not rebound immediately, all indicate Fengshui.
Although Fengshui typically presents with a floating pulse, the mention of deep and slippery here refers to the water pulse, not the wind pulse. Once the face and eyes swell with heat, water combined with wind floats outward, and the pulse must change to floating. Zhang Zhongjing omits stating this explicitly because it is encompassed by the concept of Fengshui. Slight swelling above the eye sockets resembles the *Neijing* statement that water is Yin, and the area below the eyes is also Yin; accumulated water first manifests as slight swelling below the eyes. Prominent neck pulsation indicates vigorous movement of the Renying pulse due to Fengshui rising upward. Frequent coughing indicates water infiltrating the Lungs. Pitting edema on extremities differs from the *Neijing* description of abdominal water where pressing rebounds immediately; however, both present with edema.
Taiyang disease with a floating and tight pulse should present with bone/joint pain. If there is no pain but instead heavy, sore body sensations, and no thirst, sweating leads to recovery; this is Fengshui. Aversion to cold indicates extreme deficiency caused by improper sweating. Thirst without aversion to cold indicates Pishui. Body swelling with coldness, resembling Zhoubi (circulating bi-syndrome), chest oppression, inability to eat,集聚 pain, evening restlessness, and insomnia indicate Huanghan. Pain in bone/joints, coughing, panting, and no thirst indicate Feizhang (Lung Distension). The presentation resembles edema, and sweating leads to recovery. However, for any of these conditions, if the patient is thirsty with diarrhea and frequent urination, sweating is contraindicated.
Taiyang cold causes tight pulse and bone pain; dampness causes soggy pulse and heaviness; wind causes floating pulse and body soreness. This clarifies the differentiation. Now, having a Taiyang pulse but no bone pain, yet heavy/sore body, indicates not Taiyang cold but external dominance of Fengshui. Fengshui is exterior, not interior, hence no thirst. Wind requires sweating, and exterior water also requires sweating; thus, sweating leads to recovery. However, this applies only to patients with robust Qi. Otherwise, the exterior becomes more deficient, and although Fengshui resolves, aversion to cold increases. Thus, aversion to cold indicates extreme deficiency from prior sweating. Thirst without aversion to cold indicates water pathology alone, deeper than skin, unlike Fengshui. Symptoms include swollen/cold body, resembling Zhoubi. Zhoubi is cold-damp bi obstructing Yang; Pishui is water Qi flooding the skin. Chest oppression and anorexia result from external cold blocking internal Qi.集聚 pain and evening restlessness occur because heat is constrained by cold, which is worse in the evening. Cold-damp flows into joints, hence Huanghan with joint pain. Cough/panting/no thirst indicates cold-water injuring Lungs, Qi attacking the exterior, resembling edema but essentially Pishui; sweating helps. However, if thirsty with diarrhea/frequent urination, do not use sweating generally. Zhang Zhongjing’s caution warns against depleting Jin-Ye (Body Fluids) and Qi.
Question: Why does the previous text say Fengshui has bone/joint pain, while this text says no pain but heavy/sore body? Why does the previous text say Pishui has no thirst, while this text mentions thirst? Answer: Wind and water combine to form disease. If flowing into joints, it causes bone/joint pain; if invading muscles/skin, it causes no joint pain but heavy/sore body, depending on the site of injury. The previous statement "Pishui has no thirst" means that when the abdomen is drum-like and there is no thirst, the pathogen is still exterior and can be treated with sweating. The current "thirst without aversion to cold" distinguishes it from Fengshui (no thirst, aversion to wind). Cheng Shi states: Water Qi lingering on skin and pressing on Lungs causes thirst.
Li Shui (Interior Water) presents with yellow swelling of the whole body and face, deep pulse, and difficulty urinating, causing water disease. If urination is spontaneous, it indicates depletion of Jin-Ye, causing thirst. Yuebi Jia Zhu Tang (Ephedra Decoction plus Atractylodes Macrocephala) is the main formula.
Li Shui accumulates from the interior, differing from Fengshui; thus, the pulse is deep, not floating. Excess interior water overflows externally, causing yellow swelling of the body and face. Water disease usually involves difficulty urinating; spontaneous urination depletes fluids, ending water disease but starting thirst disease. Yuebi Jia Zhu Tang treats the water, not the thirst. Due to generalized swelling, Ephedra (Mahuang) is used to release the exterior. Due to yellow swelling indicating damp-heat, Gypsum (Shigao) clears heat, and Atractylodes Macrocephala (Baizhu) drains dampness. Otherwise, treating thirst with spontaneous urination via sweating would violate contraindications. Some argue this formula treats spontaneous urination with persistent yellow swelling, dispersing exterior water and generating fluids; this is also acceptable.
Duyang pulse should be hidden/deep; if tight, it indicates pre-existing cold, hernia, abdominal mass, and pain. Improper purgation by the physician leads to chest fullness and shortness of breath. If Duyang pulse is hidden but becomes rapid, it indicates pre-existing heat, excessive digestion, and frequent urination. If urination becomes difficult now, water disease is impending.
Although Duyang is the Stomach pulse, it emerges from the Yin region, so it should be hidden. Tightness indicates chronic cold in the abdomen. Purging cold injures Yang, causing chest fullness/shortness of breath. Rapidity indicates stomach heat. Heat normally aids digestion and urination; difficulty urination implies accumulating fluids, leading to water disease. Injury to Yin Qi causes water retention by heat; exhaustion of Yang Qi causes water-cold accumulation. Zhang Zhongjing lists both to show origins of water disease.
Cun Kou pulse floating and slow: Floating indicates heat; Slow indicates hiding. Heat and hiding struggle, named Chen (Deep). Duyang pulse floating and rapid: Floating indicates heat; Rapid indicates stopping. Heat and stopping struggle, named Fu (Hidden). Deep and Hidden struggling is named Water. Deep implies collateral deficiency; Hidden implies difficulty urinating. Deficiency and difficulty struggling cause water to move to the skin, forming water disease.
Heat hiding implies internal retention without external release (Chen). Heat stopping implies stagnation without circulation (Fu). Internal heat retention causes water accumulation (Deep/Hidden = Water). Internal heat prevents Qi circulation, causing collateral deficiency. Stagnant heat prevents Yang transformation, causing urinary difficulty. Untransformed water meets unmoving Qi, soaking the body (Deficiency/Difficulty = Water). This reflects Yin injury with water retained by heat.
Cun Kou pulse wiry and tight: Wiry implies Wei (Defensive) Qi obstruction, causing aversion to cold. Water fails to flow, moving into intestines. Shaoyin pulse tight and deep: Tight implies pain; Deep implies water, causing urinary difficulty.
These two lines describe Yang deficiency and Yin excess. Cun Kou governs Wei Qi; external cold suppresses Yang. Shaoyin governs Kidney Yang; internal cold slows Qi transformation (Yang exhaustion, water-cold accumulation).
Pulses showing various deep qualities indicate water. Body swelling/heaviness with a suddenly floating pulse in water disease indicates death.
Water is Yin; Yin excess causes deep pulse. Water in skin blocks Ying/Wei, also causing deep pulse. If water disease presents with a floating pulse, True Qi rises above pathogenic water, losing its root, with pathogenic Qi dominating; this is fatal. "Chu" (Emergent) differs from "Fu" (Floating); Floating is strong above/weak below; Emergent is present above but absent below.
Water patients with "silkworm" swelling under eyes, shiny complexion, hidden pulse, thirst, abdominal distension, urinary difficulty, and deep/absent pulse have water and can be treated with purgation.
Silkworm swelling under eyes indicates slight swelling. *Jing* states water in abdomen causes eye swelling. Water Qi moistens skin but blocks Ying/Wei, causing shiny complexion and hidden pulse. Thirst results from constrained Yang generating heat. Initial water disease causes thirst; subsequent thirst worsens water disease, leading to abdominal distension, urinary difficulty, and deep/absent pulse due to water stagnation blocking pulse channels. Purgation is needed to drain water and open the pulse.
Q: After diarrhea, thirst, drinking water, urinary difficulty, abdominal distension, and swelling occur. What is this? A: This will become water disease. If urination becomes free or sweating occurs, it will heal spontaneously.
Post-diarrhea Yin/fluid depletion causes thirst. Spleen deficiency fails to control water, causing urinary difficulty, abdominal distension, and swelling, indicating impending water accumulation. Free urination allows drainage downward; sweating allows release outward. Water moves and heals. This healing relies on internal Qi restoration, not merely acrid/dispersing or bland/draining herbs.
Xin Shui (Heart Water): Heavy body, shortness of breath, inability to lie flat, irritability/restlessness, genital swelling. Gan Shui (Liver Water): Abdominal distension, inability to turn over, hypochondriac/abdominal pain, occasional saliva production, intermittent urination. Fei Shui (Lung Water): Body swelling, urinary difficulty, frequent loose stools (duck-like). Pi Shui (Spleen Water): Abdominal distension, heavy limbs, lack of saliva generation, shortness of breath, urinary difficulty. Shen Shui (Kidney Water): Abdominal distension, umbilical swelling, lower back pain, inability to urinate, dampness in genitals like cow nose sweat, cold feet, thin face.
Heart is Yang organ; water confinement weakens Yang, causing heaviness/shortness of breath. Genital swelling results from water Qi interacting with Kidney via Heart Qi. Liver water affects Spleen; Spleen failure causes abdominal distension/mobility issues. Liver channel connects to hypochondrium/lower abdomen, causing pain. Intermittent urination/saliva reflects Liver’s疏泄 (free flow) function allowing fluid movement. Lung governs Qi transformation; water in body causes swelling, lack of Qi causes urinary difficulty. Duck-like stool indicates water-mixed feces. Spleen governs abdomen/limbs; water causes distension/heaviness. Spleen dampness prevents fluid/Qi generation. Kidney governs lower body; water causes back pain/umbilical swelling/abdominal distension. Urinary difficulty/genital dampness/cold feet result from Yin-Yin interaction (Kidney/Water) blocking Yang. Thin face occurs because Yang declines upwards when Yin dominates downwards.
Master said: For all water diseases, swelling below the waist requires promoting urination; swelling above the waist requires inducing sweating.
Lower body is Yin; hard to sweat, easy to drain, so promote urination. Upper body is Yang; easy to sweat, so induce sweating. Guide according to the trend.
Master said: Cun Kou pulse deep and slow: Deep is water, Slow is cold. Cold-Water struggle. Duyang pulse hidden: Food/water not transformed. Spleen Qi decline causes loose stools; Stomach Qi decline causes body swelling. Shaoyang pulse low/subdued; Shaoyin pulse fine. Men have urinary difficulty; women have amenorrhea. Blood stasis leads to water, named Xuefen (Blood Division).
Combined Cun Kou/Duyang diagnosis shows Cold-Water excess and Stomach Yang failure. Failed Stomach Yang stops food/water transformation, weakening Spleen/Stomach. Spleen governs interior (loose stools); Stomach governs exterior (swelling). Shaoyang is Source of Life; Shaoyin is Earthly Path. Both rely on Spleen/Stomach. Decline causes low Shaoyang pulse (weak vitality) and fine Shaoyin pulse (blocked path). Men: urinary difficulty; Women: amenorrhea. Cause is Yang failure and Yin knotting. "Xuefen" means although manifesting as water, it originates from blood.
Master said: Cun Kou pulse deep and rapid: Rapid is exiting, Deep is entering. Exiting is Yang excess; Entering is Yin knotting. Duyang pulse faint and wiry: Faint means no Stomach Qi; Wiry means inability to breathe. Shaoyin pulse deep and slippery: Deep is interior; Slippery is excess. Deep-Slippery struggle causes Blood Knotting at Baomen (Uterus gate). Masses do not discharge, meridians blocked, named Xuefen.
Combined Cun Kou/Duyang/Shaoyin diagnosis shows Qi congestion in Yang, Stomach deficiency in middle, Blood knotting in Yin. Exiting/Yang excess indicates Lung heat blocking regulation. Wiry/inability to breathe indicates Stomach constraint blocking Qi. Blood knotting in Yin requires Yang to open it, but Stomach deficiency and Lung blockage prevent this. Result is stagnation turning into water disease. "Xuefen" here differs from previous: previous was deficiency/stagnation; this is excess/constraint. Both illustrate Xuefen variations.
Q: Difference between Xuefen and Shuifen? A: Menstruation stops first, then water disease is Xuefen (difficult to treat). Water disease first, then menstruation stops is Shuifen (easy to treat). Why? Removing water allows menstruation to resume.
This Q&A clarifies differences. Xuefen: Blood disease leads to water (deep/hard to treat). Shuifen: Water disease leads to blood (superficial/easy to treat).
Q: Patient suffers water disease, swelling of face/body/limbs, urinary difficulty. Pulse does not indicate water but chest pain, Qi rushing to throat like roasted meat, mild cough/panting. Is this correct? What is the pulse? A: Cun Kou pulse deep and tight. Deep is water, Tight is cold. Deep-Tight struggle knots at Guan Yuan. Initially mild, unnoticed in youth. After Yang decline, Ying/Wei conflict, Yang damage/Yin excess, cold knot moves, Kidney Qi rushes up, throat obstruction, hypochondriac pain. Physician mistakes it for Phlegm-Fluid and purges heavily. Qi knot remains, disease persists. Repeated vomiting causes Stomach deficiency/irritability, dry throat/thirst, urinary difficulty, undigested food, facial/hand/foot swelling. Tingli Wan (Descurainia Seed Pill) drains water. Temporary relief occurs, but overeating causes recurrence, chest/hypochondriac pain resembling Ben Tun (Running Piglet). Water overflowing causes cough/panting. Treat Rushing Qi first to stop it, then treat cough. Cough cessation cures panting. Treat new disease first; old disease follows.
This is Water Qi followed by Rushing Qi. Swelling/throat obstruction/chest pain resembles Phlegm-Fluid but involves Rushing Qi. Rushing Qi requires warming/descending, not purging. Vomiting injures Stomach Qi/Fluids, causing thirst/urinary difficulty/undigested food/water accumulation. Nourish Stomach Qi to move water, do not purge directly. Water reaccumulates. Water in middle, Qi rushing below, overflowing to Lungs causes cough/panting. Do not purge water; stop Rushing Qi first. Once stopped, water can be removed, curing cough/panting. "Treat new first" means treat Rushing Qi before Water Qi.
Fengshui, floating pulse, heavy body, sweating, aversion to wind: Fangji Huangqi Tang (Stephania and Astragalus Decoction) is indicated. Add Shaoyao (Peony) if abdominal pain.
Meaning detailed in Jing Shi Ye Pian. Although Fengshui and Fengshi differ, water and dampness are not separate.
Fangji Huangqi Tang Formula (See Shi Bing Chapter).
Fengshui with aversion to wind, generalized swelling, floating pulse, no thirst, continuous sweating, no high heat: Yuebi Tang (Ephedra Decoction) is indicated.