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Jingui Yaolue · Essentials from the Golden Cabinet
14. Water-Qi Disorders · Pulses, Signs and Treatment
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The Master says: There are wind-water, skin-water, proper-water, stone-water and yellow sweat. Wind-water naturally has a floating pulse, joint pain and aversion to wind. Skin-water also has a floating pulse, swelling that retains a finger impression, no aversion to wind, drum-like abdomen and no thirst; sweating should be induced. Proper-water has a deep, slow pulse and spontaneous panting. Stone-water a deep pulse and full abdomen without panting. Yellow sweat has deep, slow pulse, fever, chest fullness and swollen limbs, head and face; prolonged failure to recover must produce abscess pus.
Floating, surging pulse: floating means wind, surging qi. They contend. Strong wind gives hidden rash and itching, called leaking wind, eventually scabs and lai sores. Strong qi makes Water, with difficulty bending or straightening. Wind and qi striking each other cause great swelling; sweating brings recovery. Aversion to wind means deficiency: wind-water. Without aversion to wind, free urination, cold in Upper Burner and much saliva, this is yellow sweat.
Deep, slippery cunkou means Water qi within. Swollen face and eyes with heat are named wind-water. Slight puffiness above eye sockets, like the source's silkworm newly risen from lying down, throbbing neck pulse, occasional cough, and hand or foot impressions remaining depressed mean wind-water. An embedded textbook note says one version omits silkworm.
Greater Yang illness with floating, tight pulse should cause joint pain. Instead, no pain but a heavy, aching body and no thirst, recovering with sweat, is wind-water. Aversion to cold here is extreme deficiency acquired through induced sweating.
Thirst without aversion to cold is skin-water.
Swelling and cold like generalized impediment, chest blockage, inability to eat, gathering pain and evening agitation preventing sleep are yellow sweat.
Joint pain, cough, panting and no thirst are Spleen distention, resembling swelling, recovering with induced sweat.
But in all these illnesses, thirst, diarrhea and frequent urine prohibit induced sweating.
Interior-water gives yellow swelling of body, face and eyes, deep pulse and difficult urination. This causes Water illness. If urine passes freely instead, fluids are lost, hence thirst. Yuebi Jia Zhu Tang governs; its formula is referred to below.
Fuyang should be hidden but is tight instead. Preexisting cold causes shan accumulations and abdominal pain. The physician purges instead, producing chest fullness and short qi.
Fuyang should be hidden but is rapid instead. Preexisting heat consumes grain and gives frequent urine. Now urine is difficult instead: Water is about to form.
Floating, slow cunkou: floating means heat, slow concealment. Heat and concealment contending are named deep. Floating, rapid fuyang: floating means heat, rapid stopping in this wording. Heat and stopping contending are named hidden. Deep and hidden contending are Water. Deep means deficient vessels and networks; hidden difficult urine. Deficiency and difficulty contending send Water into skin: Water illness.
Wiry, tight cunkou means defensive qi not moving, aversion to cold, Water failing to moisten and flow, moving between intestines. Tight, deep Lesser Yin pulse: tightness pain, depth Water, hence difficult urine.
Deep pulse qualities should be attributed to Water, with a swollen, heavy body. In Water illness, an emerging pulse means death, according to the text.
Water illness has Sleeping Silkworms beneath eyes, fresh, lustrous face and eyes, hidden pulse and wasting-thirst. Water illness with large abdomen, difficult urine and a deep, cut-off pulse has Water that may be purged.
Question: After diarrhea, thirst and drinking, difficult urine and abdominal fullness followed by swelling—why?
Answer: By the method this should be Water illness. Free urination and sweating should bring recovery of themselves.
Heart Water gives heavy body, scant qi, inability to lie, vexation and agitation, and genital swelling.
Liver Water gives large abdomen, inability to turn unaided, pain of flank and abdomen, occasional slight production of fluids, and urination continuing to pass.
Lung Water gives bodily swelling, difficult urine and occasional duck-dropping-like diarrhea.
Spleen Water gives large abdomen, distressingly heavy limbs, no fluid production, scant qi and difficult urine.
Kidney Water gives large abdomen, swollen navel, lumbar pain, inability to urinate, dampness beneath the genitals like sweat on an ox's nose, reversely cold feet and a face instead thin.
The Master says: In all Water cases, swelling below the waist requires promotion of urine; swelling above it induced sweating for recovery.
The Master says: Deep, slow cunkou means Water and cold contending. Hidden fuyang means Water and grain not transformed. Declining Spleen qi gives duck-dropping stool, declining Stomach qi swelling. Low Lesser Yang and fine Lesser Yin pulses cause difficult urine in men, stopped menses in women. Menses are blood; obstructed blood becomes Water, named blood division.
Question: What are blood-division and Water-division illness?
The Master replies: Menses stopped before Water illness is blood division, difficult to treat. Water illness before menses stop is Water division, easy to treat: remove Water and menses descend of themselves.
Question: A patient has Water, swollen face, eyes, body and limbs, and difficult urine. On feeling the pulse, instead of naming Water, you predict chest pain, qi rushing to throat as if roasted meat were there, and slight cough and panting. It proves exactly so. What pulse indicates this?
The Master replies: Cunkou deep and tight: depth Water, tightness cold. Together they bind at Guanyuan, initially slight and unnoticed in vigorous years. After yang declines, nutritive and defensive qi interfere; yang diminishes, yin flourishes, bound cold stirs and Kidney qi rushes up. Throat blocks, sharp pain occurs beneath ribs. Mistaking it for retained fluids, the physician purges heavily; the striking qi remains and illness persists. Further emesis leaves Stomach deficient and vexed, throat dry, desire for water, difficult urine, Water and grain not transformed, face, eyes, hands and feet swollen. Tingli Wan then drains Water, giving brief slight improvement. Excess eating and drinking bring the swelling back, with chest and flank pain like running piglet. Water overflows, producing floating cough, panting and counterflow. First attack the rushing qi and stop it, then treat cough; when cough stops panting recovers. Treat the new illness first, the other afterward.
Wind-water with floating pulse, heavy body, sweat and aversion to wind is governed by Fangji Huangqi Tang. Add Shaoyao for abdominal pain; no amount is supplied.
Wind-water with aversion to wind, whole-body swelling, floating pulse, no thirst, continued spontaneous sweat and no great heat is governed by Yuebi Tang.
Skin-water with swollen limbs, Water qi within skin and faintly twitching limbs is governed by Fangji Fuling Tang.
Interior-water is governed by Yuebi Jia Zhu Tang; Gancao Mahuang Tang also governs.
Water illness with deep, small pulse belongs to Lesser Yin; floating means wind. Empty distention without Water is qi. Induced sweat ends Water. Deep pulse suits Mahuang Fuzi Tang; floating suits Xingzi Tang.
Reversal with skin-water is governed by Puhui San. Its formula is referred to under wasting-thirst.
Question: Yellow sweat gives swelling—a variant says heaviness—fever, sweat and thirst like wind-water. Sweat staining clothes is truly yellow like bai-tree juice; pulse deep. How is it acquired?
The Master replies: Bathing in water while sweating lets Water enter sweat pores. Qi Shao Gui Jiu Tang is suitable.
Yellow sweat makes both shins cold. Fever instead belongs to lijie. Sweating after food and habitual evening stolen sweat are depletion qi. Sweat followed instead by fever eventually makes skin armor-scaled; persistent fever must produce adverse sores.
A heavy body lighter after sweat eventually twitches, with chest pain. Sweat must occur above the waist but none below. Waist and hips ache loosely, as if something were in the skin. Severe cases cannot eat, have painful heaviness, agitation and difficult urine. This is yellow sweat; Guizhi Jia Huangqi Tang governs.
The Master says: Slow, rough cunkou means cold and insufficient blood. Faint, slow fuyang means qi and cold. Insufficient cold qi in the source's wording makes hands and feet reversely cold; nutritive and defensive qi fail to move, abdomen fills and flank sounds pursue each other. Qi turns to Bladder, both become exhausted. Yang not communicating makes body cold; yin not communicating bone pain. Yang communicating first gives aversion to cold, yin first numb impediment. When yin and yang join, qi moves; a turn of great qi disperses it. Repletion passes gas, deficiency leaks urine. This is named qi division.
Qi division with hardness below Heart, large as a plate and edged like a turned cup, is caused by Water and fluids. Guizhi Qu Shaoyao Jia Ma Xin Fuzi Tang governs.
Hardness below Heart, large as a plate and edged like a turned plate, from Water and fluids, is governed by Zhi Zhu Tang.
Zhi Zhu Tang Formula
Zhishi 7 fruits; Baizhu 2 liang.
Boil the two ingredients in 5 sheng water to obtain 3 sheng. Divide into three warm doses. Softening within the abdomen means it should disperse.
Fangji Huangqi Tang from Outer Terrace: for wind-water, floating pulse indicating exterior location, perhaps head sweating but no other exterior illness. The patient has heaviness only below, is harmonious above the waist, swollen below including genitals, and has difficulty bending or extending.
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