Chapter 15, Water disease

(少阴脉紧而沉，紧则为痛，沉则为水，小便即难)，脉得诸沉者，当责有水，身体肿重。

If the pulse is deep, it suggests there is water in the body. The body is swelling and heavy. Note: is the body has cough and asthma, it belongs to Phlegm-water accumulation disease. If the body has swelling and heavy feeling but no cough or asthma, it is Shuiqi disease, though both condition is the disorder of the water distribution and metabolism in the body. If the water accumulated in the body surface, the body is swelling and heavy; if it is in side of the body, the pulse is deep.

If there is swelling, the pulse should be deep and even hard to feel. If it becomes floating, the condition suggests the floating away of the body Qi, so the person is to die. (However, there is different kinds of such Water disorders, such as Fengshui (Wind-water), Pishui (Body surface –water) and Lishui (body inside water). This condition refers to the Lishui. For the Fengshui and Pishui conditions, the pulse is not deep, but may be floating).

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。

Asked: after diarrhea, the person feels thirsty and drinks water, has hard in urine, fullness in abdomen and swelling in the penis, testis, external female genital and perineum. What is this condition? Master: This is Water disease. If the person has sweat or smooth urine, it will get recover. [1]

夫水病人，目下有卧蚕，而目鲜泽，脉伏，其人消渴。~~病水腹大，小便不利，其脉沉绝者，有水，可下之。~~

With the Water disease, the person has swelling in the lower lids of the eye[2], which is fresh color. The person has deep/hidden pulse, has Xaoke (extreme thirsty).

师曰：诸有水者，腰以下肿，当利小便 (五苓、猪苓等汤证)；腰以上肿，当发汗乃愈。(越婢、青龙等汤证也).

Master: For all kinds of Water disease, if the swelling is under the lower back of the body, use urine therapy, such as Wuling San, Zhuling Tang; if it is over the lower back of the body, use sweat therapy, such as Yuebi Tang, Qinglong Tang.

With the Water disease, if the person has fullness in the abdomen, difficult urine, deep and nearly failed pulse, a bowel-cleansing therapy can be used. (This is a condition of Lishui, e.g. the water is inside of the body. Because the urine is difficult, so the water is accumulated inside the abdomen. Use Shi Zao Tang, Shenyou Wan.)

里水者，一身面目黄肿，其脉沉，小便不利，故令病水；假如小便自利，此亡津液，故令渴也，~~越婢加术汤主之。~~(设不腹大满急，此里水未实，不可下也。若小便自利，此亡津液作渴，非里有水作渴，亦不可利小便也。)

With Lishui condition of the Water disease, the person has swelling all over the body, deep pulse, difficult urine. This is light condition for the Lishui disease, the bowel-cleansing therapy should not be used. It is diagnosed as Lishui, not the Fengshui or Pishui condition, for the fact that the pulse is deep. In the Lishui condition, if the urine is too much and the person has thirsty, the thirsty is due to the depletion of water. In this case, even the urine therapy should not be used.

心下坚，大如盘边，如旋盘，水饮所作，枳实白术汤主之。(以坚大而不满痛，是为水气虚结，未可下也。)

If the upper abdomen is hard when touched, and it is big as a big plate, it is due to the Water disease. Use Zhishi Baishu Tang. This condition also belongs to the Lishui condition, but the abdomen is hard and big in the upper abdomen, suggesting a hollow stick condition, not a fullness and pain condition, e.g. not a solid fullness condition, so the bowel-cleansing therapy should not be used, but the Zhishi Baishu Tang here to break down the hollow mass.

右二味，以水五升，煮取三升，分温三服，腹中耎即当散也。

Add the herbs and 1250 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is 750 ml herbal tea left. Drink one third of the tea each time, three times a day.

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，消谷，小便数，今反不利，此欲作水。

With the Lishui condition, the pulse on the front of the feet is deep as hidden feeling, now it is tight feeling. This is due to the presence original Cold in the body. With the Cold and Water together in the body, there will be hernia, mass enlargement, and pain in the abdomen. If the person is given bowel-cleansing therapy, it will be fullness and short of breath. If the pulse is frequent, instead of tight, it indicates the presence of Fire. The person should feel extreme hungry, has frequent urine. If now the urine becomes difficult, it suggests the development of the Water disease (Lishui disease).

水热同病，当消谷而小便数，不病水也，今小便反不利，此欲作水之病也。

As indicated above with the Fire-Water type Lishui disease, the person should has strong hungry feeling with frequent urine. If he has hard in the urine, it suggests that he will have the Lishui disease.

肝水者，其腹大，不能自转侧，下腹痛，时时津液微生，小便续通。

If the Lishui disease is due to the disorder of the Liver system, e.g. the Liver type Lishui disease, the person has big abdomen, hard to turn his body by himself. If he has pain in the lower abdomen, has water in the mouth from time to time, then the urine will be smooth again.

If the Lishui disease is due to the disorder of the Heart system, e.g. the Heart type Lishui disease, the person has heavy body and short of breath, hard to lie down for sleep, feels annoyed/impatience and has swelling in the perineum area.

脾水者，其腹大，四肢苦重，津液不生，但苦少气，则小便难。

If the Lishui disease is due to the disorder of the Spleen system, e.g. the Spleen type Lishui disease, the person feels big abdomen, annoying heavy feeling in the arms and legs. He has short of breath and difficult in urine.

If the Lishui disease is due to the disorder of the Lung system, e.g. the Lung type Lishui disease, the person feels big body swelling, difficult in urine and loss bowel movement (kind of diarrhea).

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，「其人阴肿」, 面反瘦。

If the Lishui disease is due to the disorder of the Kidney system, e.g. the Kidney type Lishui disease, the person feels big abdomen, swelling in the naval, lower back pain, very difficult in urine, wetness in the perineum area, reverse cold in the feet, swelling in the perineum area but a skinny face.

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，脾气衰则鹜溏，胃气衰则身肿。少阳脾卑，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。

Master: if the pulse in the wrist is deep and late, deep pulse suggests Water and late pulse indicates Cold. With Cold and Water combination, the pulse in the front of the feet is deep-to-hidden. The food is hardly digested, so there is diarrhea. The weakness of the stomach function causes swelling in the body. If the pulse in the right Chi position (Shaoyang pulse) is deep and it is thin and small in the left Chi position (Shaoyin pulse), there will be difficult urine in man, and difficult menstruation in woman. The period blood belongs to Blood. If the Blood is not smoothly moving, there will be the Water disease. Water disease due to such harsh movement of the Blood is then termed Blood harshness.

师曰：寸口脉迟而涩，迟则为寒，涩为血不足；趺阳脉微而迟，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，虚则遗溺，名曰气分。「桂枝去芍药加麻黄附子细辛汤主之」

If the pulse is late and harsh in the wrist, late pulse suggests Cold and harsh pulse indicates short of blood. If the pulse is mild and late, the mild is Qi and the late pulse suggests Cold. With Cold and weak in the Qi, the person feels reverse cold in the hands and feet, which again causes harsh movement of the Rongqi and Weiqi; again the fullness in abdomen and sound noise in the intestine. The Qi pushes into the urine bladder, the Rongqi and Weiqi are depleted. With the harsh movement of the Yangqi (the Rongqi and Weiqi), the body is cold; if the Yinqi is stagnated, the person has pain in the bones. If the Yangqi moves first but the Yinqi does not follows, the person feels chilly. If the Yinqi moves first but the Yangqi does not follow, the person will have tightness and stiffness and pain. When the Yangqi and Yinqi meets, the whole body Qi starts to move, then the Xieqi will deplete away, which shows as either a urine leakage or a fart. In such case, the Cold invaded in the body when the body has insufficiency in the Qi, so it is termed Qi harshness condition. Use Guizhi qui Shaoyao, jia Mahuang Fuzi Xixin Tang.

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。

With the Qi harshness disease, the person feels hard and solid in the upper abdomen, the stomach enlarged as a big plate there. This is due to Water Xieqi accumulation there. Use Guizhi qui Shaoyao, jia Mahuang Fuzi Xixin Tang

Guizhi 45 gram, fresh ginger 45 gram, Gancao 30 gram, Chinese date 12 badges, Mahuang 15 gram, Xixin 15 gram, Fuzi (processed) 30 gram.

右七味，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。

Add the Mahuang and 1750 ml water into a herbal pot. Bring to boil for 5 min. Remove the upper floating residue. Add the remaining herbs in. Continue the boiling until there is about 500 ml herbal tea left. Drink one third of the tea, three times a day. The person should have sweat and has kind of feeling as worm moving under the skin. Such feeling suggests the cure.

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，其复如，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。

Master: for the Water disease, there is also other different forms, such as Fengshui (Wind-water), Pishui (Surface Water), Zhengshui, Stone-water, and Yellow-sweat. For the Fengshui, the pulse is floating, the (small) joints feels pain, the person dislikes wind. For the Pishui form, the pulse is also floating, there is swelling on the ankles, which is deep punctum/recess upon press but returns floating when release the press. The person does not worry the wind, has no thirsty. Sweat therapy should be given. For the Zhengshui, the person has asthma. His pulse is deep and late. For Stone-water, the pulse is deep. The person has fullness in the abdomen, but no asthma. For Yellow-sweat, the pulse is deep and late. The person feels fever, fullness in the chest, swelling in the heart, arms and legs. If this condition lasts for a long time, there will be pus developing in the Yellow-sweat person.

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，身体浮肿，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~~。

If the pulse is floating and Hong (strong as wave), the floating means the Wind-invasion, and the Hong pulse suggests Qi. The combination of the Wind and the Qi in the body develops urticaria-like skin rash, if the Wind is stronger than the Qi. The person feels itch all over the body. The itch means the Wind is depleting. After a long time, the skin becomes pellagra-like skin lesion. If the Qi is stronger than the Wind, the body will have water accumulation, the body is hard to bend to front or back. In either condition, the body is swelling. Sweat therapy should work. If the person feels dislike wind, the condition belongs to the Fengshui (Wind-water form), suggesting that the body is weak. If the person has no dislike-wind feeling, has easy urine, has more saliva in the mouth (suggesting Cold in the upper Jiao Cavity), this condition is hen termed Yellow-sweat form Water-disease.

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。

If the pulse is deep and slippery, the condition suggests Shuiqi in the body. The person has swelling in the face and eyes and has fever. This condition belongs to Fengshui (the Wind-water form). The eyes are swelling as a silkworm lying there. His neck artery pumps. He has cough from time to time. If press on his hands or feet, there is recession/depression on the skin, and the recession remains after stop the press. This condition belongs to the Fengshui (the Wind-water form).

风水脉浮，身重，汗出恶风者，防己黄耆汤主之。腹痛加芍药。

With the Fengshui (the Wind-water form), the pulse is floating and the person feels heavy in the body, has sweat and has dislike-wind feeling. Use Fangji Huangqi Tang. If there is pain in abdomen, add Shaoyao in it.

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[3]，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。

With Taiyang stage of the Cold-invation Shanghan disease, the pulse is floating and tight. The person should have pain in the (small joints). If he has no such pain on the joints, but feels heavy and sour in the body, has no thirsty. This condition then belongs to the Fengshui (the Wind-water form). Sweat therapy can cure it. If the person feels chilly, it means his condition is weak due to sweat therapy. If he feels thirsty but no chilly, the condition belongs to Pishui (the Surface-water form). If the person has swelling all over the body as having a whole body Bi disease, the person feels fullness in the chest so he feels hard to eat, feels annoying in the afternoon and hard to fall into sleep, this condition belongs to Yellow-sweat form of the Water disease. If the pain is in the (small) joints, the person has cough and asthma, no thirsty, it belongs to Feizhang disease. The person looks as having swelling (on the face). In this Feizhang disease, use sweat therapy. However, if the person, no matter what kind of the Water disease he has, feels thirsty and diarrhea, has frequent urine, the sweat therapy should not be use.

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。

It may be asked: with the Fengshui condition, the person has joint pain. But now he has no joint pain but body heavy and sour. With the Pishui condition, the person supposes to have no thirsty, but now he has. Why this way? Master: The combination of the Wind and the Water in the body can have different results: either the water flows to the joint to cause pain, or to the muscles to cause heaviness and sour, depending on there it accumulates. For the Pishui condition, it is stated that the person has no thirsty. It does not mean the standard Pishui condition has no thirsty, but means the abdomen is normal, the Xieqi has not come into the inside, so that a sweat therapy can be used. Here it indicates that the person with the Pishui feels thirsty but no chilly, with the aim to distinguish from the Fengshui condition, in which there is no thirsty and has dislike-wind feeling.

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。

With Fengshui condition, if the peron feel dislike-wind feeling, has swelling all over the body, has no thirsty, but has sweat, no strong fever, and his pulse is floating, use Yuebi Tang. If he feels dislike-wind, add Fuzi in the formula.

Mahuang 90 gram, Shigao 125 gram, fresh ginger 45 gram, Gancao 30 gram, Chinese date 15 badges.

右五味，以水六升，先煮麻黄，上去沫，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。

Add the Mahuang and 1500 ml water into a herbal pot. Bring to boil for 5 min. Remove the upper floating residue. Add the remaining herbs in. Continue the boiling until there is about 500 ml herbal tea left. Drink one third of the tea, three times a day. If there is dislike-wind feeling, add Fuzi 30 gram (processed). For Fengshui condition, add Baishu 60 gram.

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。

With the Pishui condition, the person has swelling on the arms and legs, feet. The Water is in the skin, so the muscle has moving, tingling, or shaking feeling. In this case, use Fangji Fuling Tang.

Fangji 45 gram, Huangqi 45 gram, Guizhi 45 gram, Fuling 90 gram, Gancao 45 gram.

Add the herbs and 1500 ml water into a herbal pot. Bring to boil until there is about 500 ml herbal tea left. Drink one third of the tea, three times a day.

右二味，以水五升，先煮麻黄，去上沫，内甘草，煮取三升，温服一升，重复汗出，不汗再服，慎风寒。

Add the Mahuang and 1250 ml water into a herbal pot. Bring to boil for 5 min. Remove the upper floating residue. Add the Gancao in. Continue the boiling until there is about 750 ml herbal tea left. Drink one third of the tea, three times a day, until there is sweat. Be careful to avoid wind and cold.

Puhui San (see the part for Xiaoke disease)（见消渴中)
水之为病，其脉沉小，属少阴。浮者为风，无水虚胀者为风[4]水，发其汗即已。脉沉者，宜麻黄附子汤，浮者，宜杏子汤。

With the Water disease, if the pulse is deep and small, it belongs to Shaoyin (Kidney-origin ). Floating pulse suggests the Wind. If there is no water but a hollow swelling, it is a Fengshui condition. Sweat therapy will work. If the pulse is deep, use Mahuang Fuzi Tang. If the pulse is floating, use Xinzi Tang.

右三味，以水七升，先煮麻黄，去上沫，内诸药，煮取二升半，温服八合，日三服。

Add the Mahuang and 1250 ml water into a herbal pot. Bring to boil for 5 min. Remove the upper floating residue. Add the Gancao in. Continue the boiling until there is about 600 ml herbal tea left. Drink one third of the tea, three times a day.

右水七升，先煮麻黄，减二升，去上沫，内诸药煮取三升，去滓，温服一升，得汗止服。

Add the Mahuang and 1250 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is about 1250 ml left. Remove the upper floating residue. Add the Gancao in. Continue the boiling until there is about 750 ml herbal tea left. Drink one third of the tea, three times a day, until there is sweat.

问曰：黄汗之为病，身体肿，发热，汗出而渴，状如风水，汗沾衣，色正黄如蘖汁，脉自沉，何从得之？师曰：以汗出入水中浴，水从汗孔入得之，宜黄耆芍药桂枝苦酒汤主之。

Asked: with the Yellow-sweat disease, there is swelling in the body, fever, sweat and thirsty. It looks similar to the Fengshui (the Wind-water form of the Water disease). The sweat is sticky to the clothes. Its color is strong yellow, and pulse is deep. How it comes? Master: it is due to water bath after a sweat. The water comes into the body from the sweat holes. In this case, use Huangqi Shaoyao Guizhi Kujiu Tang.

右三味，以苦酒一升，水七升相和，煮取三升，温服一升，当心烦，服至六七日乃解。若心烦不止者，以苦酒阻故也。

Add the herbs, 250 ml vinegar and 1250 ml water into a herbal pot. Bring to boil and keep in mild boiling until there is 750 ml left. Drink one third of the tea each time, three times a day. The tea should make the person annoyed/impatience, which will disappear after six to seven days. The reason for this long time annoying feeling is the vinegar.

黄汗之病，两胫自冷，假令发热，此属历节。食已汗出，又身常暮卧盗汗出者，此劳气也。若汗出已，反发热者，久久其身必甲错，发热不止者，必生恶疮。若身重，汗出已辄轻者，久久必身，即胸中痛，又从腰以上，必汗出，下无汗，腰髋弛痛，如有物在皮中状，剧者不能食，身疼重，烦躁，小便不利，此为黄汗，桂枝加黄耆汤主之。

With the Yellow-sweat disease, the person feels cold in the small leg (not the calf). If the person feels fever, it belongs to Lijie disease, not the Yellow-sweat disease. If the person has sweat after eating, has sweat when lie down for sleep, it belongs to a Laoqi disease. For the Yellow-sweat disease, if the person has fever after sweat, he will have dry skin as fish scales after long time. He even has difficult-treat skin ulcer if the fever continues for a long time. If he feels initially heavy in the body, and feels light of the body after sweat, he will have pain in the chest. The person with the Yellow-sweat disease has the sweat in the upper part of the body (from the lower back as a separation), but no sweat in the lower part of the body, has loss ache in the lower back and hips as there is heavy stuff within the skin. For severe case, the person cannot eat, feels pain and heavy in the body, annoyed/impatience, difficult in the urine. For such Yellow-sweat disease, use Guizhi jia Huangqi Tang.

Guizhi 30 gram, Shaoyao 30 gram, Gancao 30 gram, fresh ginger 45 gram, Chinese date 12 badges, Huangqi 30 gram.

右六味，以水八升，煮取三升，温服一升，须臾，饮热稀粥一升余，以助药力，温覆取微汗，若不汗更服。

Add the herbs and 1500 ml water into the herbal pot. Bring to boil and keep in mild boiling until there is about 750 ml herbal tea left. Drink 250 ml of the tea. After about 30 to 40 min, eat a bowl of rice soup about 250 ml to help the herb to work. Cover the body to develop sweat. If there is no sweat, repeat the herb tea drinking again.

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。

寸口脉弦而紧，弦则卫气不行，即恶寒，水不沾流，走于肠间。

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，沉则为水，紧则为寒，沉紧相搏，结在关元，始时当微，年盛不觉，阳衰之后，荣卫相干，阳损阴盛，结寒微动，肾气上冲，咽喉塞噎，下急痛。医以为流饮，而大下之，气击不去，其病不除；后重吐之，胃家虚烦，咽燥欲饮水，小便不利，水谷不化，面目手足浮肿，又与葶苈圆下水，当时如小差，食饮过度，肿复如前，胸苦痛，状若奔豚，其水扬溢，则浮咳喘逆。当先攻击冲气，令止，乃治咳，咳止其喘自差，先治新病，病当在后。

[1] Diarrhea causes weakness in the Spleen system (the Soil). So the Soil can not control and balances the function of the Water (the Kidney system). If the urine is difficult, the water will accumulate in the body to cause swelling in the abdomen and in the external genital area. Diarrhea depletes water in the body, causing thirsty.

[2] Lower lid of the eye belongs to Taiyin, the Kidney. Swelling here suggests Water accumulation here, due to weakness of Spleen and overwhelming of Kidney water. This could be the first sign for the Water disease. Note here: swelling in the lower lid of the eyes, deep pulse and thirsty, all suggests the start of the Water disease.

[3]脾胀之「脾」字，当是「肺」字，是传写之误.In original version, it is “Spleen swelling”.

[4]为气水之「气」字，当是「风」字，若是「气」字，则无发汗之理，且通篇并无气水之病。