治下焦受寒，小便不通。
椒目（八钱，炒捣） 小茴香（二钱，炒捣） 威灵仙（三钱）
人之水饮，由三焦而达膀胱。三焦者，身内脂膜也。曾即物类验之，其脂膜上皆有微丝血管，状若红绒毛，
即行水之处。此管热则膨涨，凉则凝滞，皆能闭塞水道。若便浊兼受凉者，更凝结稠粘杜塞溺管，滴沥不通。故
以椒目之滑而温、茴香之香而热者，散其凝寒，即以通其窍络。更佐以灵仙温窜之力，化三焦之凝滞，以达膀胱
，即化膀胱之凝滞，以达溺管也。凉甚者，肉桂、附子、干姜皆可酌加。气分虚者，更宜加人参助气分以行药力。
治水肿小便不利，其脉沉迟无力，自觉寒凉者。
于术（三钱） 桂枝尖（二钱） 茯苓片（二钱） 甘草（一钱） 干姜（三钱） 人参（三钱） 乌附子（二钱）
威灵仙（一钱五分）
肿满之证，忌用甘草，以其性近壅滞也。惟与茯苓同用，转能泻湿满，故方中未将甘草减去。若肿胀甚剧，
恐其壅滞者，去之亦可。
服药数剂后，小便微利；其脉沉迟如故者，用此汤送服生硫黄末四五厘。若不觉温暖，体验渐渐加多，以
服后移时觉微温为度。
人之水饮，非阳气不能宣通。上焦阳虚者，水饮停于膈上。中焦阳虚者，水饮停于脾胃。下焦阳虚者，水
饮停于膀胱。水饮停蓄既久，遂渐渍于周身，而头面肢体皆肿，甚或腹如抱瓮，而膨胀成矣。此方用苓桂术甘
汤，以助上焦之阳。即用甘草协同人参、干姜，以助中焦之阳。又人参同附子，名参附汤（能固下焦元阳将脱）
协同桂枝，更能助下焦之阳（桂枝上达胸膈，下通膀胱故肾气丸用桂枝不用肉桂）。三焦阳气宣通，水饮亦随
之宣通，而不复停滞为患矣。至灵仙与人参并用，治气虚小便不利甚效（此由实验而知，故前所载宣阳汤并用
之）。而其通利之性，又能运化术、草之补力，俾胀满者服之，毫无滞碍，故加之以为佐使也。若药服数剂后，
脉仍如故，病虽见愈，实无大效，此真火衰微太甚，恐非草木之品所能成功。故又用生硫黄少许，以补助相火。
诸家本草谓其能使大便润，小便长，补火之中大有行水之力，故用之因凉成水肿者尤良也。服生硫黄法，其中
有治水肿之验案宜参观。
脉沉水肿，与脉浮水肿迥异。脉浮者，多系风水，腠理闭塞，小便不利。当以《金匮》越婢汤发之，通身
得汗，小便自利。若浮而兼数者，当是阴虚火动，宜兼用凉润滋阴之药。脉沉水肿，亦未可遽以凉断。若沉而
按之有力者，系下焦蕴热未化，仍当用凉润之药，滋阴以化其阳，小便自利。惟其脉沉而且迟，微弱欲无，询
之更自觉寒凉者，方可放胆用此汤无碍。或但服生硫黄，试验渐渐加多，亦可奏效。特是肿之剧者，脉之部位皆
肿，似难辨其沉浮与有力无力，必重按移时，使按处成凹，始能细细辨认。
苓桂术甘汤，为治上焦停饮之神方。《金匮》曰∶“短气有微饮，当从小便去之，苓桂术甘汤主之，肾
气丸亦主之。”喻嘉言注云∶“呼气短，宜用苓桂术甘汤，以化太阳（膈上）之气；吸气短，宜用肾气丸，以
纳少阴（肾经）之气。”推喻氏之意，以为呼气短，则上焦阳虚，吸气短，则下焦阴虚，故二方分途施治。然
以之为学人说法，以自明其别有会心则可；以之释《金匮》，谓其文中之意本如是则不可。愚临证体验多年，
见有膈上气旺而膺胸开朗者，必能运化水饮，下达膀胱，此用苓桂术甘汤治饮之理也。见有肾气旺，而膀胱流
通者，又必能吸引水饮，下归膀胱，此用肾气丸治饮之理也。故仲景于上焦有微饮而短气者，并出两方，任人
取用其一，皆能立建功效。况桂枝为宣通水饮之妙药，茯苓为淡渗水饮之要品，又为二方之所同乎。且《金匮》
之所谓短气，乃呼气短，非吸气短也。何以言之，吸气短者，吸不归根即吐出，《神农本草经》所谓吐吸，即
喘之替言也。《金匮》之文，有单言喘者，又有短气与喘并举者。若谓短气有微饮句，当兼呼气短与吸气短
而言，而喘与短气并举者，又当作何解耶（惟论溢饮变其文曰气短似言吸气短）？
用越婢汤治风水，愚曾经验，遇药病相投，功效甚捷。其方《金匮》以治风水恶风，一身悉肿，脉浮不
渴，续自汗出，无大热者。而愚临证体验以来，即非续自汗出者，用之亦可，若一剂而汗不出者，可将石膏易
作滑石（分量须加重）。
Treatment for cold invading the Lower Jiao (Lower Burner), resulting in urinary retention.
Zhaomu (Semen Lepidii, eight qian, stir-fried and crushed) Xiaohuixiang (Fructus Foeniculi, two qian, stir-fried and crushed) Weilingxian (Radix Saposhnikoviae, three qian)
Human fluids reach the Bladder via the Sanjiao (Triple Burner). The Sanjiao refers to the fatty membranes within the body. I have verified this by observing biological structures; on these membranes exist minute blood vessels resembling red down, which are the pathways for fluid transport. These channels expand when heated and become stagnant when cooled, both conditions leading to the obstruction of fluid pathways. If turbid urine is accompanied by cold invasion, it further condenses into viscous substances that block the urethra, causing dribbling or complete retention. Therefore, the slippery and warm nature of Zhaomu and the aromatic and hot nature of Xiaohuixiang are used to disperse coagulated cold and thereby unblock the orifices and collaterals. Furthermore, the warm and penetrating power of Weilingxian is employed to resolve stagnation in the Sanjiao, allowing Qi to reach the Bladder; subsequently resolving Bladder stagnation to reach the urethra. In cases of severe cold, Rougui (Cortex Cinnamomi), Fuzi (Radix Aconiti Lateralis Preparata), and Ganjiang (Rhizoma Zingiberis Recens) may be added as appropriate. For deficiency of Qi, Renshen (Radix Ginseng) should be added to assist Qi in promoting the action of the herbs.
Treatment for edema with difficult urination, where the pulse is deep, slow, and powerless, and the patient feels cold internally.
Yushu (Rhizoma Atractylodis Macrocephalae, three qian) Guizhi Jian (Ramulus Cinnamomi, two qian) Fuling (Poria, two qian) Gancao (Radix Glycyrrhizae, one qian) Ganjiang (Rhizoma Zingiberis Recens, three qian) Renshen (Radix Ginseng, three qian) Wu Fuzi (Radix Aconiti Lateralis Preparata, two qian) Weilingxian (Radix Saposhnikoviae, one qian five fen)
For conditions of swelling and fullness, Gancao is usually contraindicated due to its cloying and obstructive nature. However, when used together with Fuling, it transforms into a agent that drains dampness and reduces fullness; thus, Gancao is not omitted from this formula. If the swelling is extremely severe and there is fear of obstruction, removing Gancao is also acceptable.
After taking several doses, if urination becomes slightly free but the pulse remains deep and slow, administer this decoction to deliver Sheng Liuhuang (Sulfur, four or five li). If warmth is not felt, gradually increase the dosage until a slight sense of warmth is experienced some time after ingestion.
Human fluids cannot be circulated without Yang Qi. When Upper Jiao Yang is deficient, fluids accumulate above the diaphragm. When Middle Jiao Yang is deficient, fluids accumulate in the Spleen and Stomach. When Lower Jiao Yang is deficient, fluids accumulate in the Bladder. Prolonged accumulation of fluids gradually permeates the entire body, causing edema of the head, face, and limbs, and even abdominal distension resembling a pot. This formula uses Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes, and Licorice Decoction) to assist Upper Jiao Yang. It simultaneously uses Gancao synergistically with Renshen and Ganjiang to assist Middle Jiao Yang. Additionally, Renshen combined with Fuzi forms Shen Fu Tang (Ginseng and Prepared Aconite Decoction) (which can secure the Yuan Yang of the Lower Jiao against collapse); combined with Guizhi, it further assists Lower Jiao Yang (Guizhi reaches the chest and diaphragm upward and connects to the Bladder downward, which is why Guizhi is used instead of Rougui in Shen Qi Wan). Once the Yang Qi of the Sanjiao is circulated, fluids are also circulated and no longer stagnate to cause pathology. Regarding the combination of Weilingxian and Renshen, it is highly effective for treating difficult urination caused by Qi deficiency (this was known through experimentation, hence its inclusion in the previously mentioned Xuan Yang Tang). Moreover, the penetrating and draining nature of Weilingxian can mobilize the tonifying power of Baizhu and Gancao, ensuring that patients with fullness suffer no obstruction; thus, it is added as an assistant envoy herb. If after several doses the pulse remains unchanged, although the disease shows improvement, there is no significant effect, indicating that the True Fire is too weak, likely beyond the capability of herbal medicines alone. Therefore, a small amount of Sheng Liuhuang is used to supplement the Ministerial Fire. Various materia medica texts state that it moistens the bowels and promotes urination, possessing great water-moving power within its fire-tonifying properties, making it particularly excellent for edema caused by cold. Methods for administering Sheng Liuhuang, including verified cases for treating edema, should be consulted.
Edema with a deep pulse is distinctly different from edema with a floating pulse. Floating pulses often indicate Wind-Edema, where pores are closed and urination is difficult. One should use Yue Bi Tang (Ma Huang, Gui Zhi, Shi Gao, Da Zao, Sheng Jiang, Gan Cao Decoction) from *Jin Gui Yao Lue* to induce sweating; once the whole body sweats, urination will naturally flow. If the pulse is floating and rapid, it indicates Yin deficiency with hyperactive fire, requiring cooling and moistening Yin-nourishing herbs. Edema with a deep pulse should not be abruptly treated with cooling herbs. If the deep pulse is forceful upon pressure, it indicates heat retained in the Lower Jiao that has not transformed; cooling and moistening herbs should still be used to nourish Yin and transform Yang, leading to natural urination. Only when the pulse is deep and slow, faint and nearly imperceptible, and the patient reports feeling cold, can this decoction be used boldly without harm. Alternatively, taking only Sheng Liuhuang and gradually increasing the dose can also be effective. However, in severe edema, the pulse sites themselves may be swollen, making it difficult to distinguish between floating/sinking or forceful/weak; one must press heavily for a period until an indentation remains to carefully identify the pulse characteristics.
Ling Gui Zhu Gan Tang is a divine formula for treating fluid retention in the Upper Jiao. *Jin Gui Yao Lue* states: "Shortness of breath with slight fluid retention should be treated by promoting urination; Ling Gui Zhu Gan Tang is the primary prescription, and Shen Qi Wan is also applicable." Yu Jiayan annotated: "Shortness of breath on exhalation suits Ling Gui Zhu Gan Tang to transform Taiyang (diaphragmatic) Qi; shortness of breath on inhalation suits Shen Qi Wan to draw Shaoyin (Kidney) Qi." Inferring Yu's intent, exhalation shortness implies Upper Jiao Yang deficiency, while inhalation shortness implies Lower Jiao Yin deficiency, hence the two formulas treat them separately. While using this as a teaching point to demonstrate unique insight is acceptable, interpreting it as the original meaning of *Jin Gui Yao Lue* is incorrect. Based on my years of clinical experience, I have seen individuals with vigorous Qi above the diaphragm and open chest cavities who can effectively transport fluids to the Bladder; this is the rationale for using Ling Gui Zhu Gan Tang to treat fluid retention. I have also seen those with vigorous Kidney Qi and patent Bladders who can attract fluids back to the Bladder; this is the rationale for using Shen Qi Wan. Thus, Zhang Zhongjing provided both formulas for upper Jiao mild fluid retention with shortness of breath, allowing either to be chosen, both yielding immediate results. Furthermore, Guizhi is a superb drug for circulating fluids, and Fuling is a key herb for leaching out dampness; both are common to these two formulas. Also, the "shortness of breath" mentioned in *Jin Gui Yao Lue* refers to exhalation shortness, not inhalation shortness. Why? Because inhalation shortness involves failing to root the breath before exhaling, which *Shennong Bencao Jing* calls "exhaling-inhaling," synonymous with panting/wheezing. *Jin Gui Yao Lue* mentions "panting" alone, and also pairs "shortness of breath" with "panting." If "shortness of breath with slight fluid retention" implied both exhalation and inhalation shortness, how would one explain the pairing of shortness of breath and panting? (Only in the discussion of Overflowing Fluids does the text vary to say "shortness of breath," seemingly referring to inhalation shortness).
I have personally experienced using Yue Bi Tang to treat Wind-Edema; when the medicine matches the disease, the efficacy is very swift. The formula in *Jin Gui Yao Lue* treats Wind-Edema with aversion to wind, generalized edema, floating pulse, no thirst, continuous spontaneous sweating, and no significant fever. However, based on my clinical experience, it can be used even without continuous spontaneous sweating. If sweating does not occur after one dose, replace Shi Gao (Gypsum Fibrosum) with Huashi (Talcum) (with increased dosage).