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Capítulo 16 de 27
金匮要略
Overall Paraphrase
This chapter discusses water qi diseases (a category of illnesses primarily characterized by edema). Zhongjing first classifies water qi diseases into five types: wind edema (wind pathogen attacking the exterior, dampness stagnating in the skin and muscles), skin edema (dampness stagnating in the skin and superficial layers), upright edema (kidney yang insufficiency, water qi accumulating internally), stone edema (water and cold congealing in the lower burner), and yellow sweat (sweat that is yellow in color like a medicinal decoction). Wind edema presents with a floating pulse, joint pain, and fear of wind. Skin edema also presents with a floating pulse, generalized body swelling that pits on pressure, absence of fear of wind, abdominal distension like a drum, and no thirst; the ancients held that diaphoresis should be used. Upright edema presents with a deep and slow pulse accompanied by wheezing and dyspnea. Stone edema presents with a deep pulse, only abdominal fullness, without wheezing. Yellow sweat presents with a deep and slow pulse, body heat, chest fullness, swelling of the four limbs, head and face; if it persists without healing, it may develop into abscesses and purulent sores.
When the pulse is floating and large, floating indicates wind, and large indicates qi. Wind and qi mutually contend: if wind predominates, there will be rubella-like rashes and body itching — itching is "venting wind," which over time may form scabs and leprosy-like lesions. If qi predominates, then dampness stagnates, the body swells, and bending and straightening become difficult. When wind and qi strike each other, the body becomes greatly swollen; sweating may resolve it. Fear of wind indicates exterior deficiency and constitutes wind edema. Absence of fear of wind, with unobstructed urination, cold in the upper burner, and copious saliva in the mouth, constitutes yellow sweat.
The cunkou pulse being deep and slippery indicates water qi within. If the face and eyes are swollen with accompanying heat, it is called wind edema. Slight swelling of the eyelids like the appearance of a silkworm when rising from sleep, throbbing of the neck vessels, frequent coughing, and pitting edema of the hands and feet on pressure indicate wind edema. In taiyang disease with a floating and tight pulse, joint pain would normally be expected; instead there is heaviness and soreness of the body without thirst — sweating leads to recovery; this is wind edema. If aversion to cold is pronounced, it indicates extreme deficiency, mostly due to excessive prior diaphoresis. Thirst without aversion to cold indicates skin edema. Body swelling with cold sensations, resembling painful bi pattern, chest oppression with inability to eat, localized pain, restlessness with inability to sleep in the evening, and pain located in the joints — this is yellow sweat. Coughing with wheezing but no thirst indicates spleen distension; diaphoresis improves it. In all such water diseases, whenever there is thirst, diarrhea, or frequent urination, diaphoresis must not be used.
Internal water manifests as generalized yellow swelling of the body, face and eyes, with a deep pulse and difficult urination, which is why water disease arises. If urination is free-flowing, there is fluid exhaustion with thirst; the ancients used Yuebi plus Atractylodes decoction (Yuebi Jiazhu Tang) to treat this. The fuyang pulse should be hidden; if it is instead tight, it suggests pre-existing cold, abdominal masses (shan jia), or abdominal pain. If purgation is erroneously applied, chest fullness and shortness of breath will ensue. If the fuyang pulse is instead rapid, it suggests pre-existing heat with easy hunger and frequent urination. If urination is instead difficult, water disease is about to develop. The changes in the cunkou and fuyang pulses indicate that the interplay of deep and hidden pulses can give rise to water disease. When the channels and collaterals are vacuous and urination is difficult, water courses into the skin and manifests as edema.
The shaoyin pulse being tight and deep: tightness indicates pain, depth indicates water, hence difficult urination. Whenever the pulse tends to be deep, water qi should be considered, with heaviness and swelling of the body. If in water disease the pulse is instead floating, large, and rootless, the ancients considered the prognosis poor.
In patients with water disease presenting with eyelids like a reclining silkworm, a bright and glossy complexion, a hidden pulse, thirst, abdominal distension, difficult urination, and an extremely deep pulse suggesting exhaustion, water is present; the ancients proposed that attack-draining methods may be used. If, after diarrhea, one experiences thirst and drinks water with difficult urination, abdominal fullness and swelling, but then urination becomes free and sweating occurs, recovery may occur spontaneously.
The five viscera water patterns each have their distinctive features: heart water manifests as body heaviness, shortness of breath, inability to lie flat, restlessness, and swelling of the genitals. Liver water manifests as abdominal distension with inability to turn the body, hypochondriac and abdominal pain, slight generation of body fluids, and intermittent urination. Lung water manifests as body swelling, difficult urination, and frequent loose, watery stools. Spleen water manifests as abdominal distension, heaviness of the four limbs, shortness of breath, and difficult urination. Kidney water manifests as abdominal distension, umbilical swelling, lumbar pain, inability to urinate, moistness of the genitals like sweat from an ox's nose, cold feet, and a face that is paradoxically thin.
The general treatment principles: for swelling below the waist, disinhibition of urination should be used; for swelling above the waist, diaphoresis leads to recovery.
Blood division: A deep and slow pulse at the cunkou indicates cold and water mutually binding. A hidden fuyang pulse indicates failure to transform water and grain. When spleen qi declines, stools become loose and watery; when stomach qi declines, the body swells. When the shaoyang pulse is weak and the shaoyin pulse is fine, men experience difficult urination and women have obstructed menstruation. Since the channels are the blood, when blood movement is not free-flowing, it transforms into water — this is called the blood division.
There are water disease patients whose face, body, and four limbs are all swollen with difficult urination, yet the pulse does not directly indicate water. Instead, there is chest pain, qi surging upward into the throat, a sensation like a piece of roasted meat stuck in the throat, and slight cough with wheezing. Zhongjing explains this as deep and tight mutually binding, with cold accumulating at the guanyuan. In youth, there were no symptoms; after yang declines, nutrient and defensive qi interfere with each other, yang is damaged and yin flourishes. The congealed cold subtly stirs, kidney qi surges upward, causing throat obstruction and hypochondriac and abdominal tension and pain. If attack-drainage or emetic therapy or decoctions of Tingli (Lepidii/Sisymbrii semen) to remove water are erroneously used, the disease is not resolved. Instead, this leads to stomach vacuity with restlessness, dry throat with desire to drink, difficult urination, failure to digest water and grain, and swelling of the face, eyes, hands, and feet. When water qi overflows, cough and wheezing with counterflow arise. One should first settle the surging qi, then treat the cough; when the cough stops, wheezing spontaneously resolves. Treat the new disease first, then the old disease later.
As for the formulas and patterns that follow — the ancients held that: wind edema with a floating pulse, heavy body, sweating, and aversion to wind is treated with Fangji Huangqi Tang (Stephania and Astragalus Decoction), adding Shaoyao (Paeoniae Radix Alba) for abdominal pain. Wind edema with aversion to wind, generalized body swelling, a floating pulse, absent thirst, spontaneous sweating, and absence of high fever is treated with Yuebi Tang (Maidenhair Decoction). Skin edema with swelling of the four limbs, water lodged within the skin, and fine twitching of the extremities is treated with Fangji Fuling Tang (Stephania and Poria Decoction). Internal water is treated with Yuebi Jiazhu Tang (Maidenhair Decoction plus Atractylodes) or Gancao Mahuang Tang (Licorice and Ephedra Decoction). Water disease with a deep and fine pulse, attributable to shaoyin, may be treated with Mahuang Fuzi Tang (Ephedra and Aconite Decoction) to warm the channels and aid yang with diaphoresis. If the pulse is floating, Xingzi Tang (Apricot Kernel Decoction) may be used. For reversal cold with skin edema, use Pojiao San (Typha and Talc Powder). All the above formulas are recorded in the ancient texts and belong to scholarly discussion of principles and methods; they must not be self-administered.
Yellow sweat manifests as body swelling, fever, sweating, and thirst, resembling wind edema, but the sweat stains clothing yellow like medicinal juice, and the pulse is deep. The ancients attributed its cause to bathing in cold water after sweating, with water entering through the sweat pores, and treated it with Huangqi Shaoji Kusheng Tang (Astragalus, Vinegar, Bitter Wine Decoction). In yellow sweat, both lower legs feel cold. If fever is present, it belongs to painful bi (joint pain in the pattern of lìjié, arthritis-like condition). Sweating after eating and night sweats in the evenings indicate labor qi. If fever recurs after sweating, prolonged duration leads to an eczematous, rough/chapped body appearance (jiǎcuò). If fever persists without resolution, vicious sores may develop. If the body is heavy and becomes lighter after sweating, then over a long time there will be muscle twitching, chest pain, sweating above the waist and none below, laxity and pain in the lumbosacral region, the sensation of something inside the skin, and in severe cases inability to eat, painful heaviness of the body, restlessness, and difficult urination — this is yellow sweat, and Guizhi Jia Huangqi Tang (Cinnamon Twig plus Astragalus Decoction) is used.
Qi division: A slow and rough (sè) pulse at the cunkou indicates cold and insufficiency of blood. The fuyang pulse being faint and slow indicates insufficiency of qi and cold. When cold and qi insufficiency coexist, the hands and feet become cold and rebellious. When nutrient and defensive qi are not free-flowing, abdominal fullness and borborygmus arise, with qi turning in the bladder. Both nutrient and defensive systems are exhausted. When yang qi does not flow freely, the body feels cold; when yin qi does not flow freely, the bones ache. When yang moves ahead excessively, aversion to cold arises; when yin moves ahead excessively, numbness and loss of sensation occur. When yin and yang are in harmony, qi can move freely; when the great qi revolves, the pathogen may disperse. In excess patterns, there is passage of flatus; in deficiency patterns, there is enuresis/involuntary urination. This is called qi division. In qi division, there is hardness below the heart, large as a plate, with the edge like an overturned cup, caused by retained water and drink; treat with Guizhi Qu Shaoyao Jia Ma Xin Fuzi Tang (Cinnamon Twig Decoction minus Peony plus Ephedra, Asarum, and Aconite). If the edge is like an overturned tray (rotating plate), treat with Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction).
The appended formula: Waitai Fangji Huangqi Tang treats wind edema. The pulse is floating, indicating the exterior. The person may have sweating from the head. Other (exterior) signs are absent, but there is swelling below the waist extending to the genitals, making it difficult to bend or stretch.
Classification and treatment — following the momentum of the pathogen
This chapter divides edema into five categories — wave/wind edema, skin edema, upright edema, stone edema, and yellow sweat — the essential point being the selection of therapeutic strategies according to differences in location, nature, pulse, and symptoms. Most notably, it introduces the principle: “For swelling below the waist, disinhibit urination; for swelling above the waist, induce sweating — then recovery occurs.” This expresses the idea of giving the pathogen a route out and expelling it along the nearest pathway. If the pathogen is at the exterior and above, diaphoresis opens the striae and disperses water qi. If the pathogen is interior and below, promoting urination regulates the water passages and gradually differentiates and drains dampness.
The holistic view of qi, blood, and water interactions
The chapter proposes the ideas that “when blood is not free-flowing, it becomes water” and the “qi division” concept, showing that water metabolism is closely connected to the movement of qi and the circulation of blood. Qi stagnation can cause water stasis; blood stasis can also turn into water. This recognition of the interconnection between qi, blood, and water is an important addition to the simple concept of “internal stagnation of dampness” and represents the holistic perspective.
Emphasis on the spleen, kidneys, and yang qi
Although water qi disease involves all five viscera, particular emphasis is placed on the spleen and kidneys. The spleen governs transportation and transformation of water and dampness, and the kidneys govern evaporation and qi transformation. In numerous places, the fuyang and shaoyin pulses are used to assess the flourishing or decline of spleen/stomach and kidney yang qi. Upright edema, stone edema, kidney water and the like are all related to kidney yang deficiency and qi yang insufficient.
Cautions against erroneous treatment and the order of therapy
The chapter repeatedly cautions that diaphoresis is prohibited in deficiency patterns and when fluids have been injured, and that erroneous purgation or emesis will aggravate the condition. For complex water diseases, it recommends: “Treat the new disease first; the disease belongs to that, which comes later.” That is, first manage the urgent, acute new symptoms like surging qi and cough, and only then manage the old retained fluids. This expresses the sequence principle of “treats the branch urgently in acute emergencies, treats the root in slower recoveries”.
Modern correspondences of edema
In modern medicine, edema may be seen in conditions such as cardiac, renal, hepatic, nutritional, endocrine, and venous return insufficiency disorders. The classification of water qi disease in this chapter, such as upper body swelling, lower body swelling, limb swelling, abdominal distension, accompanying wheezing, accompanying urinary difficulty — bears remarkable resonance with the modern perspective of locations and associated symptoms. Yet “water qi disease” in TCM is a syndrome grouping concept, not easily or exactly equivalent to a single modern disease entity.
“Blood disquiet → water” and modern circulatory disorder view
“Blood not free-flowing → water” could partly describe tissue edema arising from microcirculatory compromise, venous return obstruction, increased capillary permeability, or disturbed lymphatic return. This notion has a basis in evolving pathophysiological concepts — but as the ancients had limited specific routes, mechanisms, and diagnostic opportunities, modern examination primarily serves to determine definitive cause or correlates to internal pathological states. It is therefore a valuable beginning for identifying close association, but remains at the heart and close correlation. That mentioned. Modern diagnostics produce exactness based on sensitivity, more detailed specific diagnoses.
A rational view of yellow sweat
The description that “swear is yellow, like medicinal juice” aligns similarly that seen with chromhidrosis (colored sweat), certain microbial/infectious mechanisms in sweat ducts/glands, some drug metabolites, or when pancreatic or liver disorders produce dye-impregnated, colored constituents perspiring from sweat. The ancient attribution “bath imbibed after sweat portals … water from perspiratory pores settled …” is a mostly experiential interpretation not decisive as established particular causative condition behind…
Value and limitation of the formulae
Many of the formulas recorded — such as Fangji Huangqi Tang, Yuebi Tang, Fangji Fuling Tang, Mahuang Fuzi Tang, Zhizhuo Tang similarly added — retain clinical or experimental interests yet must comply with current pharmacology standards (professional registered application), remain current multi-institutional reliability, patient presentation personalized prescriptive etc. Single or compound formulas matched to particular sets of intended set of Chinese traditions, used in those experience pattern collections — they function fundamentally but can translate premise absolutely never allowed for home remedy due non-adult etc set modern hazard nor practice style. Nor modernize basic clinical TCM among unfamiliarity or severity, with absolute as clinically by standard.
Avoid exterior damp … securing interstices
Use commonsense care and prudence toward afterheat dousing under storm to drying, re-gown after athlete consistent visible dry chafes, retreat mild non-generous further splashing within constant human damp enclosures etc.
Temper food moderation and protection into transformation with healthful routine channel among mugs … while less overly salted, overly suger thickened much rawey et common.
Move entire nature — consciously function for cyclic functional cascade; spirit luminous personal heat relief, yang active exactly in excess none rash. Gain tone; not cheap in force beyond essence more need since deep exhaustion inside — post viral absolute limit.
Literately gentle — retain mood pleasant; fluid metabolism occurs in constructive ‘Stills’ let atmosphere turn of mental runs vast logic channel — from within not energetic current flow unaffected ease known bio-w irl have memory if culture tide damp blocked but pass freely — have system hold able breathing potential constant yet through conflict doesn’t jump gate irrelevant.
**Expect careful toward presentations—if sensible use relief — consultation in present day under centers qualified in district bodies suspicion any gross swell waterpass ever quick office within line…
Always monitored promptly by accredited physician; complete.
Concepts: wind edema, skin edema, upright edema, stone edema, yellow sweat, internal-influences line within a title expanded, blood division within system, qi divide division to open chamber parallel precedent verse etc; fullness origin tied prior—modern insight of water inside long previous each connecting interior toward deficiency degree (all above separate insight careful only;).
—Bound cross— …
Read beyond additional relevant chapters
Introduction canonical body: Supple Bowed Chest Use against strictures cold
[Boxed Note:] Content grounded canonical heritage — message pure transcending within reader enrichment; view absolutely any interpret at medical manual operating proper any discomforts gate - promptly. ⏰ within all your real nearest then quick receive then schedule see… (offer precise) (Note appended respectfully.).## Síntesis del Gabinete Dorado, Volumen Medio, Capítulo 14: Enfermedades por Agua Qi – Manifestaciones Pulso y Tratamiento
Paráfrasis General
Este capítulo trata sobre las enfermedades por agua qi (una clase de dolencias caracterizadas principalmente por edema). Zhongjing clasifica primero las enfermedades por agua qi en cinco tipos: viento-agua (patógeno de viento atacando el exterior, humedad estancada en la piel y los músculos), piel-agua (humedad estancada en la piel y las capas superficiales), agua erguida (insuficiencia del yang del riñón, agua qi acumulándose internamente), agua-piedra (agua y frío que se conglomeran en el quemador inferior) y sudor amarillo (sudor de color amarillo como una decocción medicinal). El viento-agua presenta pulso flotante, dolor en las articulaciones y miedo al viento. El piel-agua también presenta pulso flotante, hinchazón generalizada del cuerpo que se hunde al presionar, ausencia de miedo al viento, distensión abdominal como un tambor y sin sed; los antiguos sostenían que se debía usar la diaforesis. El agua erguida presenta pulso profundo y lento acompañado de sibilancias y disnea. El agua-piedra presenta pulso profundo, solo plenitud abdominal, sin sibilancias. El sudor amarillo presenta pulso profundo y lento, calor corporal, plenitud en el pecho, hinchazón de las cuatro extremidades, cabeza y cara; si persiste sin curarse, puede desarrollar abscesos y llagas purulentas.
Cuando el pulso es flotante y grande, lo flotante indica viento, y lo grande indica qi. El viento y el qi contienden mutuamente: si el viento predomina, habrá erupciones tipo rubéola y picazón corporal (la picazón es "ventilar el viento"), que con el tiempo pueden formar costras y lesiones similares a la lepra. Si el qi predomina, entonces la humedad se estanca, el cuerpo se hincha y doblarse y estirarse se vuelve difícil. Cuando el viento y el qi se golpean mutuamente, el cuerpo se hincha enormemente; sudar puede resolverlo. El miedo al viento indica deficiencia exterior y constituye viento-agua. La ausencia de miedo al viento, con micción sin obstáculos, frío en el quemador superior y saliva copiosa en la boca, constituye sudor amarillo.
El pulso cunkou es profundo y resbaladizo, lo que indica agua qi interna. Si la cara y los ojos están hinchados con calor acompañante, se llama viento-agua. Hinchazón leve de los párpados como la apariencia de un gusano de seda al levantarse del sueño, pulsación de los vasos del cuello, tos frecuente y edema que se hunde al presionar en manos y pies indican viento-agua. En la enfermedad de taiyang con pulso flotante y tenso, normalmente se esperaría dolor en las articulaciones; en cambio, hay pesadez y dolor corporal sin sed: sudar conduce a la recuperación; esto es viento-agua. Si la aversión al frío es pronunciada, indica deficiencia extrema, principalmente debida a una diaforesis excesiva previa. Sed sin aversión al frío indica piel-agua. Hinchazón corporal con sensaciones de frío, que se asemeja al patrón bi doloroso, opresión en el pecho con incapacidad para comer, dolor localizado, inquietud con incapacidad para dormir por la noche y dolor localizado en las articulaciones: esto es sudor amarillo. Tos con sibilancias pero sin sed indica distensión del bazo; la diaforesis lo mejora. En todas estas enfermedades por agua, cada vez que hay sed, diarrea o micción frecuente, no se debe usar la diaforesis.
Agua interna se manifiesta como hinchazón amarilla generalizada del cuerpo, cara y ojos, con pulso profundo y micción difícil, razón por la cual surge la enfermedad por agua. Si la micción fluye libremente, hay agotamiento de líquidos con sed; los antiguos usaban la decocción Yuebi más Atractylodes (Yuebi Jiazhu Tang) para tratar esto. El pulso fuyang debería estar oculto; si en cambio está tenso, sugiere frío preexistente, masas abdominales (shan jia) o dolor abdominal. Si se aplica erróneamente la purgación, se producirán plenitud en el pecho y respiración corta. Si el pulso fuyang es rápido, sugiere calor preexistente con hambre fácil y micción frecuente. Si la micción es difícil, la enfermedad por agua está a punto de desarrollarse. Los cambios en los pulsos cunkou y fuyang indican que la interacción de los pulsos profundo y oculto puede dar lugar a una enfermedad por agua. Cuando los canales y colaterales están vacíos y la micción es difícil, el agua corre hacia la piel y se manifiesta como edema.
El pulso shaoyin es tenso y profundo: la tensión indica dolor, la profundidad indica agua, de ahí la micción difícil. Siempre que el pulso tienda a ser profundo, se debe considerar el agua qi, con pesadez e hinchazón del cuerpo. Si en la enfermedad por agua el pulso es en cambio flotante, grande y sin raíz, los antiguos consideraban que el pronóstico era malo.
En pacientes con enfermedad por agua que presentan párpados como un gusano de seda reclinado, tez brillante y lustrosa, pulso oculto, sed, distensión abdominal, micción difícil y un pulso extremadamente profundo que sugiere agotamiento, hay agua presente; los antiguos proponían que se podían usar métodos de ataque-drenaje. Si, después de la diarrea, uno experimenta sed y bebe agua con micción difícil, plenitud abdominal e hinchazón, pero luego la micción se vuelve libre y ocurre sudoración, la recuperación puede ocurrir espontáneamente.
Los cinco patrones de agua de las vísceras tienen cada uno sus características distintivas: el agua del corazón se manifiesta como pesadez corporal, respiración corta, incapacidad para acostarse plano, inquietud e hinchazón de los genitales. El agua del hígado se manifiesta como distensión abdominal con incapacidad para girar el cuerpo, dolor hipocondríaco y abdominal, ligera generación de fluidos corporales y micción intermitente. El agua del pulmón se manifiesta como hinchazón corporal, micción difícil y heces blandas y acuosas frecuentes. El agua del bazo se manifiesta como distensión abdominal, pesadez de las cuatro extremidades, respiración corta y micción difícil. El agua del riñón se manifiesta como distensión abdominal, hinchazón umbilical, dolor lumbar, incapacidad para orinar, humedad de los genitales como el sudor de la nariz de un buey, pies fríos y una cara que paradójicamente está delgada.
Los principios generales de tratamiento: para la hinchazón debajo de la cintura, se debe usar la desinhibición de la micción; para la hinchazón por encima de la cintura, la diaforesis conduce a la recuperación.