利。故令病水。汤意却全是治表。全是发汗。并无利小便之品。若谓此方单主后段之症。而后文二十七条。又
明明说出专主里水。不几疑此方之或少漏耶。不知气闭于上与外。则水提于内与下。汗疏而小便自利之
理。不观水铛之气眼乎。按之。则明有水道。而咽不流。指起即下注者。是其义也。仲景真格致之入微者乎。
旧注谓此汤。当在故令病水之下。粗似近理。细按之。而自知其谬矣。
六条 趺阳脉当伏。今反紧。本自有寒。疝瘕、腹中痛。医反下之。下之。则胸满短气。趺阳脉当伏。
今反数。本自有热。消渴。小便数。今反不利。此欲作水。（趺阳、即右关脉。详已别见。他注谓足面脉。非。）
自此条。合下文七八两条。俱从脉而言水之所由来。各不相同。此条。即趺阳之脉症、而言正水也。但前后两
段。前段是言虚寒之正水。虚寒而担延日久。泛为皮水者。则不渴。后段是言热实之正水。热实而担延日久。
泛为皮水者。则渴。如四条注中之所辨者是矣。盖谓水病。脉当伏。以水性下趋故也。水病而趺阳之脉尤
当伏。以趺阳为胃土。土不足以胜水。而脉反从其化也。然又有不可以伏脉概论者。比如趺阳脉当伏不伏。
而反见紧。紧为寒。为痛。趺阳紧。则胃气自寒而且痛之诊。胃寒。则肾妖上犯。而疝症必起。肝血不舒。而瘕症
必见。且无阳气化导。而腹中切痛者。势也。医不知温之。而误以脉紧为弦。腹痛为实而下之。则愈寒而阴气
上突。故胸满。膈气亏空。故短气也。夫所以呵嘘鼓吹。而渗泄水饮者。上中之阳气也。阳不足以渗泄。而停为
正水者。此其一也。又趺阳当伏不伏。而反见数。数为热。趺阳数。是胃火有余而自热之应。胃热上炎则渴。下
逼则小便数而利者。又势也。然亦有气盛于上。则提挈而不注。气盛于下。则壅淤而不行。故但渴而小便反
不利者。夫渴。则入水既多。小便不利。则去水复少。此阳有余而停为正水者。又其一也。此欲作水。是双承上
文而言。总详正水之所以异。失治。而汪洋以为里水。泛滥而为皮水。其渴与不渴者。俱准乎此也。
七条 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。
此即寸、关、两部之脉。而言正水、变成皮水之症也。脉机之迁就。病气之从乘。不外乎虚吸实注之理。但有责
在因虚而吸取一边。有责在因实而注授一边。有彼虚此实。此虚彼实。互相吸注而宜兼责两边。此条正彼
此互相吸注之脉症也。盖谓寸口者。内应胸中。外应经络者也。寸口脉浮而迟。浮为经络之气。因营虚而有
余。故浮则知为表热也。迟为胸中之气。因肾虚而鼓缓。故迟则知为气潜也。夫迟潜虚吸。浮热下从。下从者
气沉。故名曰沉。又趺阳者。中主精悍。下主分布者也。趺阳脉浮而数。浮为胃液虚。而胃火外浮之应。胃液虚
者。不能抱阳。故浮、则知其为独往而气热也。数为精气虚、而悍气独发之应。阳无根而不能终健。故数、则知
其必去数而自止也。夫孤热外浮。乘止内息。内息者机伏。故名曰伏。寸沉、关伏。两相搏击。名曰水者。盖寸主
经络。沉则经络之气内沉。而络脉外虚。关主分布。伏则分布之机下伏。而小便难。络脉虚。则在外者有内吸
之机。小便难。则在下者有上漾之势。而水即乘虚而走皮肤。故为皮水之病矣。五句是自注沉伏相搏。名曰
水之义。
八条 寸口脉弦而紧。弦则卫气不行。（愚按此下。当有紧字。谨援各条文例补之。识者或不以为妄耶。）紧即
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。
此亦互相吸注之正水。而变为皮水之症也。但上条。系寸口与趺阳相吸注。此条。系寸口与少阴。相吸注之
异耳。又上条为热水。其症多渴。此条为寒水。其症不渴。不可不知也。盖谓寸口外主卫气。寸口脉弦而紧。弦
为气削之诊。则其卫气之削弱而不行可知。紧为寒。弦而紧。则其因卫气之虚而恶寒。又可知。夫卫气根于
胸中之宗气。卫气虚。则胸中之气不能呵嘘运布。以致水不沾沾流走于肠间。而下行为小便。遂停于胃中
而为正水矣。又少阴为水脏。若其脉紧而沉。紧为寒为痛。则其腰俞少腹。必作凝敛拘急之痛。沉为水。以其
寒而不能气化。故小便即难。而水又积于下矣。夫寸口之脉弦紧。而卫阳外虚。少阴之脉紧沉。而小便下难。
亦即上条虚难相搏。水走皮肤之互词也。
九条 脉得诸沉者。当责有水。身体肿重。
自此至后文十三条。广言水病之诊法治例也。脉得诸沉。谓寸口少阴。凡得沉脉。及沉迟、沉滑、沉紧者。皆是。
盖水性亲下。故诸脉沉者。盒饭责其有水也。肿重。详已见。补言此者。犹云脉沉。尤当以身体肿重。为有水之
确据耳。
十条 水病。脉出者死。
此紧。承上文脉沉而言。脉出。是水抬气鼓。逼其气血于在上、在外之象。真阳不得展舒以驱水。故死。犹之饮
门之脉。以实大而数者。为不治之义也。
十一条 夫水病患。目下有卧蚕。面目鲜泽。脉伏。其人消渴。
此申言六条趺阳脉当伏。今反数一症。而其诊法。注意在面目鲜泽句。盖面目为阳明胃腑之应。而鲜泽为
水热交蒸之色。故知其在下、则小便不利。在上。则消渴而病水矣。其余症脉俱别见。
十二条 病水腹大。小便不利。其脉沉绝者。有水。可下之。
腹大。是明有聚水之显征。小便不利。又明有聚水之确据。加之脉沉为水。脉沉而绝。为水势撑鼓。以致脉气
不展舒之应。故可下其水。而腹大之外症自除。沉绝之伏诊、自起矣。此条诊法之细处。在脉之沉绝处。盖脉
沉而绝。人多弃为不治之候。而不知其不可弃也。意者其主木防己汤。或加芒硝者是耶。
十三条 问曰。病下利后。渴饮水。小便不利。腹满阴肿者。何也。答曰。此法当病水。若小便自利。及汗出
者。自当愈。
此设为问答。而言阴阳乍虚者。能致正水也。盖下利后。则阴伤而借资于水。故渴饮水。又下利后。则阳虚而
不能运水。故小便不利。腹满阴肿。水积于肠胃而渗于阴器。故曰法当病水。然水病终以阳气为重。若小便
自利。及汗出者。为阳气复而水邪自去之应。故当愈。
十四条 心水者。其身重而少气。不得卧。烦而躁。其人阴肿。
心为火脏。水入脏中即猝死。此言心水者。水在心之系。系终属心。故曰心水。四脏同义。后十九条。紧承五脏
之水。而曰诸有水者。利小便、发汗、乃愈者。此也。心藏神。神为气之主。神郁于水。而气自滞。故身重而少气。不
得卧者。灵道为水所阻。而不得下伏故也。水从火脏之化而热。故烦。肾不得心阳之下交。而其气自寒。故躁
也。心肾同治少阴。而肾尤为水脏。心有水而肾更可知。故其人阴肿也。
十五条 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。
肝水者。水亦在肝之系。并肝外之部位。如少腹者是也。腹大。即下文胁下少腹大之谓。与脾水肾水之腹大
各不同。详十七八两条下。胁下腹痛。言正对胁下之少腹边旁痛也。三句一意。犹云肝偏在胁下之少腹。少
腹积水以浸肝叶。故大而内痛。内痛。故不能自转侧也。又厥阴为三阴之枢。而性复疏泄。故其气上升。则有
时而津液微生。其气下降。故有时而小便续通。与他脏之病水。口长干而小便长难者。不同。
十六条 肺水者。其身肿。小便难。时时鸭溏。
肺水者。水亦在肺之系。并当肺位之胸分。贮水而蒸肺叶者皆是。肺水身肿。有二义。肺主气。得水则气壅而
肿者。一也。又水乘气化。淫 而身肿者。二也。肺气壅而不能呵运水道。故小便难。夫温暖肺金者。胃中之阳
土也。肺病水。则胃阳可知。故其所饮食者。因中上之化寒。而泻下者。色常青黑。而水谷不融。状若鸭之溏粪矣。
十七条 脾水者。其腹大。四肢苦重。津液不生。但苦少气。小便难。
脾水。及下条肾水。俱与前三脏。同是系中水气。并其脏外之贴近处聚水也。若以为脏中之水。则脾形薄小。
肾形贴脊。纵然肿胀。安得腹大耶。但脾悬胃外。为扇动而化食者。则脾水当在胃脘之外及脐下寸许而已。
故其腹大亦当在此。与肝水之大在少腹旁。肾水之大在当脐者。各不同也。四肢为阳气之末。脾病水、而阳
气不能远充。且阳衰而水先犯之。故苦重也。津液者。脾输胃中之精汁于肺。而游溢于廉泉者也。又气者。脾
输胃中之悍气于肺。而充畅于息道者也。脾困于水。而精悍不能上行。故津液不生。但苦少气矣。脾肺合德
于上中二焦。则下焦之化机自利。此小便之所以清长也。脾阳阻于水。而上不交光于肺。下不布化于小肠。
故小便难也。
十八条 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。
肾水之腹大、在围脐。以肾位当脐故也。下文即曰脐肿者。此耳。腰为肾之府。肾系得水。而以胀急为痛也。不
得溺。与小便难不同。小便难者。并无痛楚。但因气不下化、而出自艰难之义。不得溺。谓因腰痛而欲便不得
也。盖溺者以气实少腹而送之。而实则还逼肾系。故其腰之胀痛益甚耳。阴下。通指肾囊及两腿缝而言。盖
膀胱积水。气不下通。而旁渗于外。则入于睾丸阴器中。故外湿如牛鼻上汗者。即名脬渗者。是也。肾病水。而
肾阳不下贯。故其足遂冷。以肾气下主于足。而以逆冷呈肾水之象也。面者。诸阳之位。阳为水气所浮。而上
聚于面。则水气不得上侵。故瘦。曰反瘦者。以周身之肿。有似于不瘦之意也。
十九条 师曰。诸有水者。腰以下肿。当利小便。腰以上肿。当发汗。乃愈。
此承上文而总言脏腑经络。其病水治例之大法也。诸有水。不特单指五脏。即风水。皮水、正水、石水、里水。俱
在其中。腰以下、为地之象。肿则江河沟渎之瘀塞。非决导不足以息其横流。故当利小便。腰以上。为天之象。
肿则阴云湿雾之弥漫。非风雨不足以散其郁冒。故当发汗。而皆愈也。夫脏中贮水。真气阻绝。各致暴亡。岂
俟利小便发汗。而且能复愈哉。我故曰。五脏之水。但在脏系。或在脏外之逼脏处者。此也。
二十条 师曰。寸口脉沉而迟。沉则为水。迟则为寒。水寒相搏。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。
此合下文二十一二凡三条。言妇人血分之水病也。但此条。系阳虚而经血不行。久之而败血化水。下条。为
阳实而胞血烧干。久之而血枯吸水之别耳。至按两条经旨。言脉。则从右寸。而递及趺阳。延至少阳少阴。言
症。则从胸膈。而递及脾胃。延至经水胞门。则知人身以胸膈间在天之阴阳。为有生之大宝。譬之太阳。照耀
九州。鸿铸万物。譬之甘雨。滋润大地。脉络重泉之象。苟业医者而不知此。则适以杀人。养生者而不知此。则
还以自杀而已矣。况妇人女子。得坤地之道。更以心肺为根蒂。其寸口犹所贵重云乎哉。此仲景于脉机、必
先言寸口。于病机、必先言胸膈之深意也。盖谓右手寸口。内应胸中。脉沉而迟。沉为水脉。迟为寒诊。是水
寒之气。聚于胸中。而太虚之阳光。无照临化被之用。则土性之温暖灵醒者渐自冷寂。而趺阳脉伏。于是不
能运水熟谷。而水谷不化。脾阳衰。则变化不纯而 溏。胃阳衰。则水寒薄卫而身肿。夫脾胃为后天之大仓
库。气衰。则自顾不暇。犹能生精悍以及其他脏腑乎。少阳少阴。当指手经而言。盖手少阳三焦。尝以元真司
运化之权。而手少阴心主。又以离德统营血之总。后天脾胃之气衰。则三焦之火渐寒。而少阳之脉。卑而不
起。心主之火渐熄。而少阴之脉。细而不充。三焦脉卑。则运化无神。而男子之小便不利。此症与男子同。故并
及之。非专言男子也。心主脉细。则营血失御。而妇人之经水不通。夫经者。血也。血不流利。久则败死以化黑
水。又血不流利。久则干枯以招外水。故曰则为水也。名曰血分。言水在血分中。当以治血为本。治水为标。斯
称合法耳。寸口。指右寸。趺阳。指右关。少阴。指左寸。少阳。指右尺。余诊此症多矣。其脉丝毫不爽。他注以此
条少阴。谓言肾脉。大误。以细非肾部之病诊。惟心为夏脉。宜洪而细。故为阳气瘦削之候也。
二十一条 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。其瘕不泻。经络不通。名曰血分。
其又有右手寸口。脉沉而数。数为有余。而其势欲出以外传。沉为不足。而其机欲入以内伏。盖欲出者。为阳
利。所以导致病人患水气病。此方的用意完全在于治疗表证，完全是发汗法，并没有使用利尿的药物。如果说这个方子只主治后一段的症状，而后文第二十七条又明确说出它专门主治里水，这岂不是让人怀疑此方有所遗漏吗？不知道气机闭塞于上部和外部，那么水液就会提升并停滞在内侧和下部。通过发汗疏通腠理，小便自然通利的道理，难道没有观察过煮水的锅上的气眼吗？按住它，明明看到有水道，但水汽却不流出；手指一抬起，水汽就向下倾注。其中的奥妙就在这里。张仲景真是探究事物原理达到极细微境界的人啊！
旧注认为此汤剂应当放在“故令病水”这句话的下面，表面看似乎接近事理，仔细推敲后就知道它是错误的了。
第六条 趺阳脉本应当伏匿，现在反而紧。病人本来就有寒邪，患有疝气和瘕积，腹中疼痛。医生反而使用攻下法。攻下之后，导致胸满、短气。趺阳脉本应当伏匿，现在反而数。病人本来就有热邪，表现为消渴、小便频数。现在反而小便不利。这是即将发生水气病的征兆。（趺阳脉即右手关脉，详见前文别处。其他注释说是足背部的脉，是不对的。）
从这一条结合下文第七、八两条来看，都是论述脉象来说明水气产生的来源，各不相同。这一条是根据趺阳脉的脉症，来论述正水。但前后两段，前段是论述虚寒性质的正水，虚寒拖延日久，泛溢为皮水，则不口渴；后段是论述热实性质的正水，热实拖延日久，泛溢为皮水，则口渴。就像第四条注释中所辨析的那样。大概意思是说，水气病，脉象应当伏匿，因为水性趋下的缘故。水气病，趺阳脉尤其应当伏匿，因为趺阳脉对应胃土，土气不足以克制水湿，脉象反而随水湿之气而变化。然而又有不能一概用伏脉来概括的情况。比如趺阳脉本该伏匿而不伏匿，反而出现紧脉。紧脉主寒、主痛。趺阳脉紧，则是胃气自寒且痛的诊候。胃寒，则肾寒之气上犯，疝症必然发作；肝血不畅，瘕积必然显现。而且如果没有阳气来温化导引，腹中剧烈疼痛，这是必然的趋势。医生不懂得温补，反而误将脉紧当作弦脉，腹痛当作实证而使用攻下法，这就使寒气更重，阴气上冲，所以胸满；膈间气机亏空，所以短气。所谓呵嘘鼓吹（指阳气宣通），从而渗泄水饮的，是上焦和中焦的阳气。阳气不足以渗泄水饮，而停聚成为正水，这是其中一种情况。
另外，趺阳脉本该伏匿而不伏匿，反而出现数脉。数脉主热。趺阳脉数，是胃火有余而自身发热的反映。胃热上炎则口渴，热邪下逼则小便频数而通利，这也是必然的趋势。然而也有气盛于上部，则提挈水液而不向下灌注；气盛于下部，则壅滞淤塞而不行的情况。所以虽然口渴，小便反而不利。口渴，说明摄入的水多；小便不利，说明排出的水少。这是阳气有余而停聚成为正水，又是另一种情况。“此欲作水”，是双承上文而言，详细说明了正水之所以不同的原因。如果失治，水势汪洋成为里水，泛滥成为皮水，无论口渴还是不口渴，都依据这个道理来判断。
第七条 寸口脉浮而迟。浮脉主热，迟脉主潜藏。热与潜相搏结，名叫沉。趺阳脉浮而数。浮脉即主热，数脉主止息（此处指气机郁遏）。热与止相搏结，名叫伏。沉与伏相搏结，名叫水。沉则络脉空虚，伏则小便困难。虚与难相搏结，水液走窜皮肤，就形成了水气病。
这里是通过寸、关两部脉象，来论述正水变成皮水的症状。脉机的迁就，病气的乘袭，不外乎虚能吸引、实能灌注的道理。但有责任在于因虚而吸取的一方，有责任在于因实而灌注的一方。有彼虚此实，此虚彼实，互相吸注而应该兼责两方面的。这一条正是这种彼此互相吸注的脉症。大概意思是：寸口脉，内应胸中，外应经络。寸口脉浮而迟，浮是因为经络之气因营血虚而显得有余，所以浮可知为表热；迟是因为胸中之气因肾虚而鼓动迟缓，所以迟可知为气机潜藏。夫迟、潜、虚、吸，浮、热、下从。下从者，气机下沉，所以名叫沉。又趺阳脉，中主精悍之气，下主分布之气。趺阳脉浮而数，浮是胃液虚，而胃火外浮的反映。胃液虚，不能抱持阳气，所以浮可知其为独往而气热；数是精气虚，而悍气独自发动的反映。阳气无根而不能始终强健，所以数可知其必去数而自止。夫孤热外浮，乘止内息。内息者，机枢伏匿，所以名叫伏。寸口沉、关部伏，两者相搏击，名叫水。盖寸口主经络，沉则经络之气内沉，而络脉外虚；关部主分布，伏则分布之机下伏，而小便难。络脉虚，则在外的部位有向内吸取的机制；小便难，则在下的部位有向上漾溢的趋势。于是水液便乘虚而走窜皮肤，所以形成皮水病。这五句是自注解释“沉伏相搏，名曰水”的含义。
第八条 寸口脉弦而紧。弦则卫气不行。（我按：此处下面应当有“紧”字，谨援引各条文例补充。懂行的人或许不会认为这是妄加吧。）紧即恶寒。水液不沾流，走于肠间。少阴脉紧而沉。紧则为痛，沉则为水，小便即难。
这也是互相吸注的正水，而变成皮水的症状。但上一条，是寸口与趺阳相吸注；这一条，是寸口与少阴相吸注的不同之处。又上一条为热水，其症状多口渴；这一条为寒水，其症状不口渴，不可不知道。大概意思是：寸口外主卫气。寸口脉弦而紧，弦是气机削弱的诊候，则其卫气之削弱而不行可以知道；紧是寒，弦而紧，则其因卫气之虚而恶寒也可以知道。夫卫气根源于胸中的宗气。卫气虚，则胸中之气不能呵嘘运布，以致水液不沾流而走于肠间，下行成为小便，遂停于胃中而成为正水。又少阴为水脏，若其脉紧而沉，紧为寒为痛，则其腰俞、少腹，必然产生凝敛拘急之痛；沉为水，因其寒而不能气化，所以小便即难，而水液又积聚在下部。夫寸口脉弦紧，而卫阳外虚；少阴脉紧沉，而小便下难。也就是上一条“虚难相搏，水走皮肤”的互辞说法。
第九条 脉象见到各种沉脉的，应当责问是否有水。身体浮肿沉重。
从这一条到后文第十三条，广泛论述水气病的诊法治则。脉得诸沉，谓寸口、少阴，凡是得到沉脉，以及沉迟、沉滑、沉紧的，都是如此。大概水性亲下，所以诸脉沉者，应当责其有水。肿重，详情已见前文。补充言此者，犹如说脉沉，尤其应当以身体肿重作为有水的确实证据罢了。
第十条 水气病，脉出者死。
此条紧承上文脉沉而言。脉出，是水气抬举气机，逼迫气血趋向于在上、在外的征象。真阳不得舒展以驱除水邪，所以死亡。犹如饮门之脉，以实大而数为不治之义一样。
第十一条 凡水气病患者，眼下如卧蚕，面目鲜明光泽，脉伏，其人消渴。
这是申述第六条“趺阳脉当伏，今反数”一症，而其诊法，注意点在“面目鲜泽”一句。大概面目为阳明胃腑的应验，而鲜泽为水热交蒸的颜色，所以知道在下则小便不利，在上则消渴而病水。其余症脉俱别见。
第十二条 患水气病，腹部胀大，小便不利，其脉沉绝的，是有水，可以用攻下法。
腹大，是明确有聚水的显著征象。小便不利，又明确有聚水的确实依据。加之脉沉为水，脉沉而绝，是水势撑鼓，致使脉气不能舒展的反映。所以可以攻下其水，而腹大的外症自然消除，沉绝的伏诊自然兴起。这一条诊法的细致之处，在于脉之沉绝处。大概脉沉而绝，人多弃之为不治之候，而不知道其不可放弃。我想大概是主治木防己汤，或者加芒硝的吧？
第十三条 问曰：病下利后，口渴饮水，小便不利，腹满阴肿的，是什么病？答曰：这种方法应当病水。如果小便自利，以及汗出的，自然应当痊愈。
这是设为问答，而言阴阳乍虚者，能导致正水。大概下利后，则阴伤而借资于水，所以口渴饮水；又下利后，则阳虚而不能运化水液，所以小便不利，腹满阴肿。水积于肠胃而渗于阴器，所以说方法应当病水。然而水气病终究以阳气为重，如果小便自利，以及汗出的，为阳气恢复而水邪自去的反映，所以应当痊愈。
第十四条 心水病，身体沉重而少气，不能仰卧，心烦而躁，其人阴肿。
心为火脏，水入脏中即猝死。这里说心水病，是水在心之系，系终归属于心，所以叫心水。四脏同理，后第十九条紧承五脏之水，说所有有水者，利小便、发汗，才能痊愈，就是这个意思。心藏神，神为气之主，神郁于水中，而气自然滞涩，所以身体沉重而少气。不能仰卧，是因为灵道被水所阻，而不能下伏的缘故。水从火脏之化而变热，所以烦；肾得不到心阳的下交，而其气自然寒，所以躁。心肾同治少阴，而肾尤为水脏，心有水而肾更可知道，所以其人阴肿。
第十五条 肝水病，腹部胀大，不能自行翻身转侧，胁下腹痛，时时津液微生，小便续通。
肝水病，水也在肝之系，并包括肝之外的部位，如少腹等。腹大，即下文所说的胁下少腹大。这与脾水、肾水的腹大各不相同，详见第十七、八两条之下。胁下腹痛，是说正对胁下的少腹边旁疼痛。这三句是一个意思，犹如说肝偏在胁下的少腹，少腹积水浸渍肝叶，所以大而内部疼痛。内部疼痛，所以不能自行翻身转侧。又厥阴为三阴之枢纽，而性质又主疏泄，所以其气上升，则有时津液微生；其气下降，则有时小便续通。与其他脏的病水，口常干而小便常难不同。
第十六条 肺水病，身体浮肿，小便难，时时鸭溏（稀便）。
肺水病，水也在肺之系，并包括当肺位的胸分，贮水而蒸灼肺叶的都是。肺水身肿，有两层含义：肺主气，得水则气壅而肿，这是一；又水乘气化，淫溢而身肿，这是二。肺气壅塞而不能呵嘘运化水道，所以小便难。夫温暖肺金的，是胃中的阳土。肺病水，则胃阳可知，所以其所饮食者，因中上之化寒，而泻下的，颜色常青黑，而水谷不融，状若鸭之溏粪。
第十七条 脾水病，腹部胀大，四肢苦重，津液不生，只苦少气，小便难。
脾水，及下条肾水，俱与前三脏相同，都是系中水气，并其脏外之贴近处聚水。如果认为是脏中之水，则脾形薄小，肾形贴脊，纵然肿胀，怎会有腹部胀大呢？但脾悬于胃外，为扇动而化食者，则脾水应当在胃脘之外及脐下寸许而已。所以其腹部胀大也应当在此处，与肝水之大在少腹旁、肾水之大在当脐者，各不相同。四肢为阳气之末，脾病水，而阳气不能远充，且阳衰而水先犯之，所以苦重。津液者，脾输布胃中的精汁于肺，而游溢于廉泉。又气者，脾输布胃中的悍气于肺，而充畅于息道。脾困于水，而精悍不能上行，所以津液不生，只苦少气。脾肺合德于上中二焦，则下焦之化机自利，这是小便之所以清长的原因。脾阳阻于水，而上不交光于肺，下不布化于小肠，所以小便难。
第十八条 肾水病，腹部胀大，脐肿，腰痛，不得溺（排尿困难或无法排尿），阴下湿如牛鼻上汗，其足逆冷，面反瘦。
肾水之腹大，在围脐，因为肾位当脐的缘故。下文就说脐肿，就是这个意思。腰为肾之府，肾系得水，而以胀急为痛。不得溺，与小便难不同。小便难者，并无痛苦，只因气不下化而出自艰难的意思。不得溺，是说因腰痛而想解小便却解不出来。大概溺（小便）是以气实少腹而送之，而实则还逼肾系，所以其腰之胀痛更加厉害。阴下，通指肾囊及两腿缝而言。大概膀胱积水，气不下通，而旁渗于外，则入于睾丸阴器中，所以外湿如牛鼻上汗者，就是名脬渗的，是这个意思。肾病水，而肾阳不下贯，所以其足遂冷。以肾气下主于足，而以逆冷呈肾水之象。面者，诸阳之位，阳为水气所浮，而上聚于面，则水气不得上侵，所以瘦。曰反瘦者，是因为周身之肿，有似于不瘦之意。
第十九条 老师说：所有有水气病者，腰以下肿，当利小便；腰以上肿，当发汗，才能痊愈。
这是承上文而总言脏腑经络，其病水治则的大法。所有有水，不单指五脏，即风水、皮水、正水、石水、里水，都在其中。腰以下为地之象，肿则如江河沟渎之瘀塞，非决导不足以平息其横流，所以当利小便。腰以上为天之日象，肿则如阴云湿雾之弥漫，非风雨不足以散其郁冒，所以当发汗，而皆愈。夫脏中贮水，真气阻绝，各自导致暴亡，岂等待利小便发汗，而且能复愈哉？所以我才说，五脏之水，只是在脏系，或在脏外之逼脏处的，才是这种情况。
第二十条 老师说：寸口脉沉而迟，沉则为水，迟则为寒，水寒相搏，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。经为血，血不利，则为水，名叫血分。
这合下文二十一二凡三条，论述妇人血分之水病。但此条，是阳虚而经血不行，久之而败血化水；下条，为阳实而胞血烧干，久之而血枯吸水之别耳。至于按两条经旨，言脉，则从右寸，而递及趺阳，延至少阳少阴；言症，则从胸膈，而递及脾胃，延至经水胞门。则知人身以胸膈间在天之阴阳，为有生之大宝。譬之太阳，照耀九州，鸿铸万物；譬之甘雨，滋润大地，脉络重泉之象。苟业医者而不知此，则适以杀人；养生者而不知此，则还以自杀而已矣。况妇人女子，得坤地之道，更以心肺为根蒂，其寸口犹所贵重云乎哉。此仲景于脉机，必先言寸口；于病机，必先言胸膈之深意也。
大概意思是：右手寸口，内应胸中，脉沉而迟，沉为水脉，迟为寒诊，是水寒之气，聚于胸中，而太虚之阳光，无照临化被之用，则土性之温暖灵醒者渐自冷寂，而趺阳脉伏，于是不能运水熟谷，而水谷不化。脾阳衰，则变化不纯而便溏；胃阳衰，则水寒薄卫而身肿。夫脾胃为后天之大仓廪，气衰，则自顾不暇，犹能生精悍以及其他脏腑乎？少阳少阴，当指手经而言。盖手少阳三焦，尝以元真司运化之权；而手少阴心主，又以离德统营血之总。后天脾胃之气衰，则三焦之火渐寒，而少阳之脉，卑而不起；心主之火渐熄，而少阴之脉，细而不充。三焦脉卑，则运化无神，而男子之小便不利，此症与男子同，故并及之，非专言男子也。心主脉细，则营血失御，而妇人之经水不通。夫经者，血也。血不流利，久则败死以化黑水；又血不流利，久则干枯以招外水，故曰则为水也。名曰血分，言水在血分中，当以治血为本，治水为标，斯称合法耳。寸口，指右寸；趺阳，指右关；少阴，指左寸；少阳，指右尺。余诊此症多矣，其脉丝毫不爽。他注以此条少阴，谓言肾脉，大误，以细非肾部之病诊，惟心为夏脉，宜洪而细，故为阳气瘦削之候也。
第二十一条 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，其瘕不泻，经络不通，名曰血分。
其又有右手寸口，脉沉而数，数为有余，而其势欲出以外传；沉为不足，而其机欲入以内伏。盖欲出者，为阳……
Li (purging/diuresis). Therefore, it causes the patient to suffer from water qi disease. The intention of this decoction is entirely to treat the exterior syndrome; it is entirely a sweating method, containing no herbs that promote urination. If one claims that this formula solely treats the symptoms in the latter part, yet Article 27 explicitly states it specifically treats interior water, would this not lead one to suspect omissions in this formula? One should understand that when qi closure occurs in the upper and external regions, water is lifted internally and stagnates in the lower regions. The principle that sweating unblocks the pores and allows urination to occur naturally can be observed by examining the steam holes of a boiling water pot. Pressing them reveals clear water channels, yet steam does not flow out; lifting the finger causes immediate downward pouring. This illustrates the underlying meaning. Zhang Zhongjing was truly one who investigated things to their most subtle depths!
Old annotations suggest this decoction should be placed below the phrase "therefore causing water disease." Superficially, this seems plausible, but careful analysis reveals its error.
Article 6: The Fuyang pulse should normally be deep-hidden (Fu), but now it is instead tight (Jin). The patient inherently has cold, suffering from hernia (Shan) and mass accumulation (Jia), with abdominal pain. The physician incorrectly used purgation. Purging leads to chest fullness and shortness of breath. The Fuyang pulse should normally be deep-hidden, but now it is rapid (Shu). The patient inherently has heat, manifesting as thirst and frequent urination. Now, urination is instead difficult. This indicates an impending water disease. (Note: Fuyang pulse refers to the right Guan position; see previous sections for details. Other annotations claiming it is the pulse on the dorsum of the foot are incorrect.)
From this article combined with Articles 7 and 8 below, all discuss the origin of water through pulse diagnosis, each differing. This article discusses Zheng Shui (True Water) based on the Fuyang pulse and symptoms. However, the preceding and following paragraphs differ: the former discusses deficiency-cold Zheng Shui, which, if prolonged and spreading to become Pi Shui (Skin Water), presents without thirst; the latter discusses heat-excess Zheng Shui, which, if prolonged and spreading to become Pi Shui, presents with thirst. As辨析ed in the notes for Article 4. Generally, water diseases present with a Fu pulse because water nature tends downward. In water disease, the Fuyang pulse especially should be Fu, as Fuyang corresponds to Stomach Earth; when Earth Qi is insufficient to control Water, the pulse transforms accordingly. However, not all cases can be generalized by the Fu pulse. For instance, if the Fuyang pulse should be Fu but is not, appearing instead as Jin (tight): Jin indicates cold and pain. A tight Fuyang pulse diagnoses Stomach Qi cold and painful. Stomach cold allows Kidney cold Qi to invade upward, causing hernia; Liver Blood stagnation causes masses. Without Yang Qi to warm and guide, severe abdominal pain ensues inevitably. If the physician fails to warm and mistakenly treats the tight pulse as Xuan (wiry) and abdominal pain as excess, using purgation, the cold increases, Yin Qi surges upward causing chest fullness, and Diaphragm Qi emptiness causes shortness of breath. The "breathing and blowing" (Yang Qi circulation) that permeates and drains water drinks relies on Upper and Middle Jiao Yang Qi. Insufficient Yang Qi to drain leads to Zheng Shui stagnation—this is one scenario.
Alternatively, if the Fuyang pulse should be Fu but appears Shu (rapid): Shu indicates heat. A rapid Fuyang pulse reflects excessive Stomach Fire self-heating. Stomach heat flares upward causing thirst; heat forces downward causing frequent, free urination—this is also inevitable. Yet, if Qi is abundant above, it lifts and prevents downward flow; if Qi is abundant below, it obstructs and prevents movement. Thus, despite thirst, urination may be difficult. Thirst implies high water intake; difficult urination implies low water output. This represents Yang excess leading to Zheng Shui stagnation—another scenario. "Impending water disease" doubly references the above text, detailing why Zheng Shui differs. Untreated, vast water becomes Li Shui (Interior Water), flooding as Pi Shui. Whether thirsty or not, judgment follows this principle.
Article 7: Cun Kou pulse is floating (Fu) and slow (Chi). Floating indicates heat; slow indicates submergence. Heat and submergence interacting is named Chen (Sinking). Fuyang pulse is floating and rapid (Shu). Floating indicates heat; rapid indicates stopping/retention. Heat and retention interacting is named Fu (Hidden). Sinking and Hidden interacting is named Water. Sinking implies collateral vessels are empty; Hidden implies difficulty urinating. Emptiness and difficulty interacting cause water to move into the skin, forming water disease.
This uses Cun and Guan pulses to describe Zheng Shui transforming into Pi Shui. Pulse mechanisms adapt to disease invasion via principles of deficiency attracting and excess filling. Responsibility lies with the deficient side attracting or the excess side filling. Mutual attraction/filling requires addressing both sides. This article exemplifies such mutual interaction. Cun Kou internally corresponds to the Chest/Middle and externally to collaterals. Floating Cun Kou pulse indicates Collateral Qi surplus due to Ying (Nutrient) deficiency, signifying exterior heat. Slow pulse indicates Chest Qi sluggishness due to Kidney deficiency, signifying submerged Qi. Slowness, submergence, deficiency, and attraction allow Floating Heat to descend. Descending Qi is named Chen (Sinking). Fuyang pulse governs Jing Han (Vigorous) Qi distribution. Floating Fuyang pulse reflects deficient Stomach Fluids and floating Stomach Fire. Deficient fluids cannot hold Yang, indicating solitary heat. Rapid pulse reflects deficient Essence/Qi and independent emission of Vigorous Qi. Yang lacking root cannot sustain strength, indicating rapidity leads to cessation. Solitary heat floats externally while internal mechanism rests/stops. Internal rest is named Fu (Hidden). Cun Sinking and Guan Hidden interact, named Water. Cun governs collaterals; sinking means Collateral Qi sinks internally, leaving collaterals externally empty. Guan governs distribution; hidden means distribution mechanism hides downward, causing urinary difficulty. Empty collaterals attract inward; difficult urination creates upward splashing pressure. Water exploits this void to enter skin, forming Pi Shui. These five sentences explain "Sinking and Hidden interacting, named Water."
Article 8: Cun Kou pulse is wiry (Xian) and tight (Jin). Wiry implies Wei (Defensive) Qi obstruction. (I note: "Jin" should follow here, added per textual examples. Experts may agree.) Tight implies aversion to cold. Water does not flow smoothly but moves into the intestines. Shao Yin pulse is tight and deep (Chen). Tight indicates pain; Chen indicates water. Urination becomes difficult.
This is also mutually interacting Zheng Shui transforming into Pi Shui. Unlike the previous article involving Cun Kou and Fuyang, this involves Cun Kou and Shao Yin. Previous article involved hot water with thirst; this involves cold water without thirst—note this distinction. Cun Kou externally governs Wei Qi. Wiry pulse indicates Qi depletion, showing weakened Wei Qi obstruction. Tight indicates cold; wiry and tight show aversion to cold due to Wei Qi deficiency. Wei Qi roots in Zong Qi (Gathering Qi) in the chest. Deficient Wei Qi fails to circulate, causing water to stagnate in intestines rather than flow down as urine, accumulating in Stomach as Zheng Shui. Shao Yin is the Water Organ. Tight and deep Shao Yin pulse: tight indicates cold/pain in lumbar region and lower abdomen; deep indicates water due to cold preventing Qi transformation, causing urinary difficulty and lower accumulation. Cun Kou wiry/tight with exterior Wei Yang deficiency, and Shao Yin tight/deep with lower urinary difficulty, mirrors the previous article's "emptiness and difficulty interacting, water moving to skin."
Article 9: Pulses presenting various Chen (deep) qualities indicate water presence. Body swelling and heaviness.
From here to Article 13, general diagnostic rules for water disease are discussed. "Pulses presenting various Chen" includes Cun Kou and Shao Yin Chen, Chen-Chi, Chen-Hua, Chen-Jin. Water nature is proximate to the lower; thus, deep pulses indicate water. Swelling/heaviness confirms water presence deeply.
Article 10: In water disease, a "Chu" (emerging/exiting) pulse indicates death.
Following the previous discussion on deep pulses, a Chu pulse signifies water lifting Qi, forcing blood/qi outward/upward. True Yang cannot expand to drive out water, leading to death. Similar to drinking-related pulses where solid-large-rapid indicates incurability.
Article 11: Water patients have eye bags like sleeping silkworms, bright/shiny face, deep pulse, and thirst.
Elaborating on Article 6 ("Fuyang should be hidden, now rapid"), focusing on "bright/shiny face." Face reflects Yangming Stomach; brightness/shine indicates water-heat steaming. Lower: urinary difficulty; Upper: thirst and water disease. Other symptoms/pulses noted elsewhere.
Article 12: Water disease with abdominal distension, urinary difficulty, and Chen-Jue (extremely deep/unfelt) pulse indicates water; purgation is indicated.
Abdominal distension shows obvious water accumulation; urinary difficulty confirms it. Chen-Jue pulse results from water pressure blocking Qi expansion. Purgation removes water, resolving distension and restoring pulse. The subtlety lies in Chen-Jue pulse; often deemed untreatable, it is not. Likely treated with Mug Fang Ji Tang or plus Mang Xiao.
Article 13: Q: After diarrhea, thirst, drinking water, urinary difficulty, abdominal fullness, and genital swelling—what is this? A: This will likely develop into water disease. If urination becomes free and sweating occurs, it will heal spontaneously.
Q&A illustrating how sudden Yin/Yang deficiency causes Zheng Shui. Post-diarrhea Yin injury drives thirst/water intake; Yang deficiency impairs water transport, causing urinary difficulty, abdominal fullness, genital swelling. Water accumulates in gut/intestines/genitals. Water disease prioritizes Yang Qi. Free urination/sweating indicates Yang recovery and water expulsion, leading to healing.
Article 14: Xin Shui (Heart Water): Heavy body, shortness of breath, inability to lie flat, irritability/restlessness, genital swelling.
Heart is Fire Organ; water entering causes sudden death. Xin Shui means water in Heart's system/connective tissue. Same logic applies to other four organs. Article 19 states treating all water diseases involves promoting urination and sweating. Heart houses Shen (Spirit); Shen masters Qi. Shen depressed by water causes Qi stagnation (heaviness/shortness). Inability to lie flat due to Ling Dao blockage by water. Water transforms via Fire organ becoming heat (irritability); Kidney lacks Heart Yang intersection (cold/restlessness). Heart/Kidney treat Shaoyin; Kidney is Water Organ. Heart water implies Kidney involvement, hence genital swelling.
Article 15: Gan Shui (Liver Water): Abdominal distension, inability to turn over, hypochondriac/abdominal pain, occasional slight saliva production, intermittent urination.
Gan Shui: Water in Liver system and adjacent areas (e.g., lower abdomen). Distension refers to hypochondriac/lower abdomen swelling, distinct from Pi/Shen Shui. Pain is lateral lower abdomen. Liver resides laterally; water soaking liver lobes causes internal pain and immobility. Jueyin is pivot of Three Yin, governing drainage. Qi rising produces saliva; Qi descending allows intermittent urination. Differs from other organs' constant dry mouth/difficult urination.
Article 16: Fei Shui (Lung Water): Body swelling, difficult urination, frequent loose stools (duck-like).
Fei Shui: Water in Lung system/chest, steaming lung tissue. Swelling has two meanings: 1) Lung governs Qi; water causes Qi congestion/swelling. 2) Water exploits Qi transformation, overflowing causing swelling. Lung Qi congestion impedes water pathway, causing urinary difficulty. Warmth of Lung Metal comes from Stomach Earth Yang. Lung water implies Stomach Yang deficiency. Food digestion fails due to middle-upper cold, resulting in green/black loose stools resembling duck feces.
Article 17: Pi Shui (Spleen Water): Abdominal distension, heavy limbs, lack of fluids, shortness of breath, difficult urination.
Pi/Shen Shui involve fluid accumulation in systems and adjacent tissues, not inside organs (Spleen/Kidney shapes don't support massive distension). Spleen surrounds stomach; water accumulates outside stomach/navel. Distension location differs from Gan (lateral lower) and Shen (navel). Limbs are extremities of Yang; Spleen water prevents Yang extension, causing heaviness. Spleen transports Stomach essence to Lung (fluids) and vigorous Qi (respiration). Water trapping prevents ascent, causing fluid deficiency and shortness of breath. Spleen/Lung coordinate Upper/Middle Jiao, benefiting Lower Jiao (clear urine). However, Spleen Yang blocked by water fails to connect to Lung (upper) and Small Intestine (lower), causing difficult urination.
Article 18: Shen Shui (Kidney Water): Abdominal distension around navel, umbilical swelling, lower back pain, inability to urinate, dampness under genitals like ox nose sweat, cold feet, thin face.
Shen Shui distension surrounds navel (Kidney position). Lumbar region is Kidney mansion; water causes distension/pain. "Inability to urinate" differs from difficulty; it implies pain preventing voiding. Urination relies on Lower Abdomen Qi pushing; pressure exacerbates Kidney system pain. "Under genitals" includes scrotum/thigh clefts. Bladder water pressure leaks sideways into testes/genitals, causing dampness (Paoshen). Kidney Yang fails to descend, causing cold feet (Kidney governs feet). Face is Yang position; Yang floats up due to water, preventing water invasion, causing thinness ("reverse thinness" contrasts with body edema).
Article 19: Master says: For all water diseases, swelling below waist requires promoting urination; swelling above waist requires sweating. Then heals.
Summarizes treatment principles for Zang/Fu/Collaterals. "All water" includes Feng/Pi/Zheng/Shi/Li Shui. Below waist = Earth image; swelling like blocked rivers requires draining (urination). Above waist = Heaven image; swelling like mist requires dispersing (sweating). Internal Zang water blocking True Qi causes sudden death, unresponsive to these methods. Thus, this applies only to water in Zang systems or adjacent compressions.
Article 20: Master says: Cun Kou pulse deep and slow. Deep = water; Slow = cold. Water-cold interaction, Fuyang pulse hidden, undigested food, Spleen Qi decline causes loose stools, Stomach Qi decline causes body swelling. Shaoyang pulse low/submissive, Shaoyin pulse fine. Men: urinary difficulty. Women: amenorrhea. Menses are blood; blood stasis becomes water, named Blood Branch (Xue Fen).
Combined with Articles 21-22, discussing women's Blood Branch water disease. This article: Yang deficiency stops menses, blood decays into water. Next article: Yang excess dries uterine blood, blood枯萎 absorbs water. Pulse progression: Right Cun -> Fuyang -> Shaoyang/Shao Yin. Symptom progression: Chest/Diaphragm -> Spleen/Stomach -> Menses/Uterus. Chest/Diaphragm Yin-Yang is vital for life, like Sun/Rain. Ignorance kills. Women rely on Kun Earth, Heart/Lung roots; Cun Kou is precious. Zhang Zhongjing prioritizes Cun Kou (pulse) and Chest/Diaphragm (disease).
Right Cun corresponds to Chest. Deep-slow pulse: Water-cold gathers in chest, obscuring Solar Light. Earth warmth cools; Fuyang hidden. Digestion fails. Spleen Yang decline causes loose stools; Stomach Yang decline causes swelling. Spleen/Stomach are Postnatal Granaries; weak Qi cannot nourish other organs. Shaoyang/Shao Yin refer to Hand meridians. Hand Shaoyang Sanjiao manages Yuan Zhen transformation; Hand Shaoyin Heart Master manages Ying Blood. Postnatal weakness cools Sanjiao fire (Shaoyang pulse low/submissive) and extinguishes Heart Master fire (Shaoyin pulse fine). Sanjiao weakness causes male urinary difficulty (applies to men too). Heart Master fineness causes female amenorrhea. Blood stagnation turns black/decays or dries/attracts external water. Named Blood Branch: treat blood primarily, water secondarily. Note: Cun=Right Cun; Fuyang=Right Guan; Shaoyin=Left Cun; Shaoyang=Right Chi. I diagnose this often accurately. Old notes identifying Shaoyin as Kidney pulse are wrong; fine pulse isn't typical Kidney pathology; Heart (Summer pulse) should be洪 (surging), so fine indicates Yang deficiency.
Article 21: Master says: Cun Kou pulse deep and rapid. Rapid = exiting; Deep = entering. Exiting = Yang excess; Entering = Yin knot. Fuyang pulse faint and wiry. Faint = no Stomach Qi. Wiry = breathing obstruction. Shaoyin pulse deep and slippery. Deep = interior; Slippery = excess. Deep-slippery interaction, blood knots Uterus Gate, masses persist, collaterals blocked, named Blood Branch.
Regarding Right Cun: Deep-rapid pulse. Rapid indicates surplus, tendency to exit/transmit outward; Deep indicates insufficiency, tendency to enter/internalize. Exiting...