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(Attached: Formula for Simultaneous Resolution of Exterior and Interior)
Shuigu (Ascites with water accumulation) and Qigu (Abdominal distension due to qi stagnation) are originally similar in appearance. The *Neijing* states, "Those that remain depressed after pressing are Fengshui (Wind Edema)." Based on my clinical experience, I know that for all Shui syndromes, when pressing the swollen area creates a depression, it does not rebound immediately. As for Qigu, when heavy pressure creates a depression, it must rebound immediately. Only in Danzhangfu (Simple Abdominal Distension), both Shuigu and Qigu may exist. Because the stagnant qi and water accumulate in the abdomen and cannot penetrate outward to the muscles, pressing does not create a depression, making it difficult to distinguish between water and qi. However, Shuigu inevitably presents with scanty urine, while Qigu invariably feels like liver and stomach qi stagnation; these are clear signs. Now let us discuss their treatment methods.

The *Jingui Yaolue* discusses water diseases, dividing them into Fengshui, Pishui, Zhengshui, and Shuishui. It states that Fengshui and Pishui present with floating pulses, while Zhengshui and Shuishui present with sunken pulses. However, in severe cases of water disease, the pulse sites are all swollen, and the pulse can only be felt after heavy pressure, making it originally difficult to distinguish between floating and sunken. Observing the treatment methods, those with floating pulses are suitable for inducing sweating, often assisted by cooling and moistening herbs; those with sunken pulses are suitable for promoting urination, often assisted by warming and unblocking herbs. Thus, we know that edema is originally divided into cool and hot types, and the cool or hot nature of the pulse can be distinguished by whether it is forceful or weak. In treating this syndrome, for forceful pulses, I also often induce sweating first. I once formulated the Biao Li Fen Xiao Tang (Table-Interior Separating Decoction), which is recorded below.

[Biao Li Fen Xiao Tang] Ephedrae Herba (Mahuang) 3 qian, Raw Gypsum Fibrosum (Sheng Shigao) and Talcum (Huashi) each 6 qian, Western medicine Aspirin 1 wa. Decoct the first three ingredients into a soup, and take it with Aspirin. If no sweat occurs one hour after taking the medicine, administer another wa of Aspirin. If still no sweat after taking it, it can be taken again; the goal should be the emergence of sweat.
The nature of Mahuang not only excels at inducing sweating; Xu Lingtai believed it could penetrate deeply into accumulated phlegm and coagulated blood. Wherever other medicines cannot reach, it reaches meticulously. Therefore, after ingestion, it penetrates outward to the muscle surface and promotes urination internally, allowing water disease to resolve through sweat and urine. However, its nature tends toward heat, seemingly unsuitable for water diseases with heat. Thus, Raw Gypsum Fibrosum is used to clear the heat. Furthermore, although its power is said to be meticulous, it ultimately tends to ascend. Therefore, Talcum is used to guide it downward to the Bladder, thereby accelerating its diuretic effect. As for using the Western medicine Aspirin, patients with this syndrome have their skin and muscles bound and closed by water, making sweating difficult. Using too much Mahuang might fear its heat damaging yin. Aspirin excels at inducing sweating and clearing heat, so it can serve as an assistant to Mahuang. Moreover, its original substance exists in willow bark liquid, so it causes no harm when used together with Chinese herbs.

If sweat has emerged and swelling has subsided but full recovery has not been achieved, it is appropriate to specifically promote urination. Among diuretic herbs, Fresh Imperata Rhizome Decoction (Xian Baigen Tang) is most effective. Combined with Plantaginis Semen (Cheqianzi), it is even more effective. Recalling the end of the twelfth lunar month in the Xin You year, a student named Mao XX from a neighboring village, aged twenty, suffered from edema. After over a month of medical treatment, his condition worsened. His head, face, and whole body were swollen, and his abdomen was like holding a urn. He could not lie down at night, leaning against the wall panting. This was likely because the abdominal swelling was abnormal, leaving no room for breathing, causing air to barely enter, hence the panting. His pulses in all six positions were fine and rapid, his heart felt hot, and urination was difficult. Knowing his prolonged illness led to yin deficiency, preventing the transformation of yang, thus causing this syndrome. I instructed someone to dig frozen earth to obtain fresh Baigen (Imperata Rhizoma). Daily, use six liang of fresh Baigen, chop finely, add three large bowls of water, boil once in a small pot, then move it beside the stove, keeping it near the fire to warm slowly. Wait half an hour, boil again, just as before. Soon, the Baigen sinks to the bottom, yielding two large bowls of clear soup, serving as the daily dose. Drink it slowly and warm, like tea. Use several liang of raw Cheqianzi (Plantaginis Semen), stir-fry until slightly cooked, take a pinch with three fingers, chew finely and swallow. Do this upon waking at night as well. Chew and take over a day and night, consuming about seven or eight qian. After two days, urination became smooth, but the abdomen remained distended and hard. Have him use three jin of white parts of Scallion Stems (Da Congbai), cut into shreds, stir-fry with vinegar until nearly cooked. Wrap in cloth while hot and apply to the umbilicus for moxibustion-like warming. If it cools, return to the pot, add a little vinegar, reheat, and apply again. Apply from evening until bedtime. During the night, he urinated more than ten times. By the next morning, his abdomen felt normal. This method of decocting Baigen utilizes its fresh, cool, and moistening nature to greatly nourish yin and clear heat (long decoction loses this effect). When yin is nourished and heat cleared, urination naturally flows. For milder cases, simply using the method of slowly chewing Cheqianzi can also reduce swelling; I have used it repeatedly with success.

Although this syndrome results from yin deficiency due to prolonged illness, it is not originally inherent yin deficiency. If a person normally suffers from yin deficiency, leading to difficult urination and accumulating into edema, it is appropriate to use one and a half liang of Prepared Rehmanniae Radix (Shu Dihuang) each time, decocted together with Baigen. If worried that two boils are insufficient to extract the Dihuang, boil the Dihuang for over ten boils first, then add Baigen and cook together.
As for Cheqianzi, it is still best to chew it in small amounts, taking four or five qian per day.

For Shuigu caused by cold, the pulse must be fine, minute, slow, and weak, or there is a feeling of cold in the heart, or loose stools. It is appropriate to use six qian of Zanthoxyli Fructus Seed (Huajiaomu), stir-fried until cooked and crushed, decocted in soup to take with five fen of fine powder of native Sulfur (Sheng Liuhuang). If warmth is not felt after taking, the dosage can be increased experimentally, aiming for a slight feeling of warmth after some time. Generally, diuretic herbs tend to be cool, whereas these two herbs are warm and promote urination. If spleen and stomach are deficient and damaged, unable to transport and transform water and fluids, it is appropriate to treat with herbs that strengthen the spleen and descend stomach qi, assisted by diuretics.
In summary, Shuigu syndromes do not form without the patency of urination. Therefore, those treating this syndrome should prioritize promoting urination. For treating difficult urination, refer to my various formulas and cases for treating Longbi (Dysuria).

There are cases where the bladder ligaments are twisted (Baoxi Liaoli), causing urinary retention. Occasionally, due to vomiting, coughing, or lying on the side and stretching, a small amount may pass. This is commonly known as Zhuanbao syndrome. Pregnant women, postpartum women, and those who have fallen from heights sometimes suffer from this. I formulated Shengma Huangqi Tang (Ephedra and Astragalus Decoction - *Note: Text says 'Shengma Huang Tang', likely a typo for Huangqi*), which I have used to cure several people. This lifts the bladder ligaments to restore their correct position.

Hua Yuanhua had a formula for unblocking urinary retention. I knew of it but did not try it. Later, reading the Hangzhou newspaper, I saw Mr. XX state that using his formula plus one qian of Cimicifugae Rhizoma (Shengma) successfully cured his sister's two-day-and-night urinary retention and a Mr. Tao's one-day-and-night urinary retention, with immediate effect. The formula consists of Ginseng Radix (Renshen), Nelumbinis Plumula (Lianzixin), Plantaginis Semen (Cheqianzi), and Achyranthis Bidentatae Radix (Wangbuliuxing) each three qian, Glycyrrhizae Radix et Rhizoma (Gancao) one qian, Cinnamomi Cortex (Rougui) three fen, and Ginkgo Seed (Baiguo) twelve pieces. Note: In the formula, if Baiguo is used for cough, it can be crushed with the peel, utilizing the peel's ability to astringe the lung. If used to promote urination, it should be peeled and crushed, utilizing its slippery and descending properties.

As for Qigu, it is mostly caused by stasis in the spleen. The spleen is the master of the acquired constitution, residing in the center to transport the four directions. It originally contains many venous vessels to circulate qi transformation. If stasis obstructs this qi transformation, abdominal distension arises. Over time, it accumulates into Qigu. The *Neijing* states, "All dampness, edema, and fullness belong to the spleen." I formulated Jineijin Tang (Chicken Gizzard Lining Decoction - *Text says 'Ji Tang', context implies Jineijin Tang*), which I have used repeatedly with success. The intent of the formula: Use Chicken Gizzard Lining (Jineijin) to open spleen stasis; Atractylodis Macrocephalae Rhizoma (Baizhu) to assist spleen transportation; Bupleuri Radix (Chaihu) and Citri Reticulatae Pericarpium (Chenpi) to regulate spleen qi ascending and descending; Paeoniae Radix Alba (Baishao) to promote urination and prevent water accumulation; Zingiberis Rhizoma Recens (Shengjiang) to open orifices and harmonize Ying and Wei. Generally speaking, the herb properties are neither cool nor hot. However, if this syndrome leans toward cold, Cinnamon Twig (Guizhi), Aconiti Lateralis Radix Praeparata (Fuzi), and Zingiberis Rhizoma (Ganjiang) can be added酌情ly. If it leans toward heat, Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Gardeniae Fructus (Zhizi) can be added酌情ly. If the pulse and symptoms are all excess, and there is no improvement after a few doses of medicine, one can take one and a half qian of fine powder of the first grinding of Black Niuxi (Heiqiu - Semen Kochiae) sent down with the decocted medicine. After taking it, if bowel movements become smooth, the illness will improve slightly. However, one must continue taking the original formula for several days, using it once a day. Continuous use may damage qi. This is the general overview of the treatment methods for Shuigu and Qigu (For various schemes for treating Shuigu and Qigu, see the Medical Formulas section).