治肾虚脾弱, 腰重脚肿, 小便不利, 腹胀喘急, 痰
盛,已成鼓证, 其效如神.
熟地黄四两 白茯苓三两 牡丹皮一两 泽泻一两 干山药一两 车
前子一两 山茱萸一两 牛膝一两 肉桂一两 附子五钱, 右十味,
蜜和丸, 每服八十丸, 空心米饮下.
【集注】李中梓曰: 经云: 诸湿肿满, 皆属于脾. 又云: 其本在肾,
其末在肺, 皆聚水也. 又曰: 肾者主水, 胃之关也, 关门不利, 故聚
水而从其类也. 肿胀之病, 诸经虽有, 无不由于肺, 肾者, 盖脾主运
行,肺主气化, 肾主五液. 凡五气所化之液, 悉属于肾; 五液所行之
气,悉属于肺; 转输二脏, 以制水生金者, 悉属于脾. 故肿胀不外此
三经也. 然其治法, 有, 内, 外, 上, 下, 虚, 实, 不可不辨也. 在
外则肿, 越婢汤, 小青龙汤证也. 在内则胀, 十枣丸, 神佑丸证也.
在上则喘, 葶苈大枣汤, 防己椒目葶苈大黄丸证也. 在下则小便闭,
沉香琥珀丸, 疏凿饮子证也. 此皆治实之法, 若夫虚者, 实脾饮此方
证也. 张介宾曰: 地黄, 山药, 丹皮, 以养阴中之真水. 山萸, 桂,
附,以化阴中之真气. 茯苓, 泽泻, 车前, 牛膝, 以利阴中之滞. 能
使气化于精, 即所以治肺也; 补火生土, 即所以治脾也; 壮水利窍,
即所以治肾也. 补而不滞, 利而不伐, 治虚水方, 更无有出其, 右者
.然当因此扩充, 随证加减. 若其人因大病之后, 脾气大虚而病水胀
者, 服此虽无所碍, 终不见效, 每熟计之, 脾气大伤, 诚非肾药之
所能治. 专用理中汤一两, 加茯苓一两. 命火衰者, 加附子; 两足冷
者,加肉桂; 腹胀甚者, 加厚朴. 三大剂而足胫渐消, 十余剂而腹胀
退. 凡治中年之后脾肾虚寒者, 悉用此法. 盖气虚者, 不可复行气;
肾虚者, 不可专利水. 温补即所以化气, 塞因塞用之妙, 顾在用之者
何如耳. 古法治肿, 不用补剂, 而用去水等药, 微则分利, 甚则推逐
.如五苓散, 五淋散, 五皮散, 导水茯苓汤之类, 皆所以利水也. 如
舟车神佑丸, 浚川散, 禹功散, 十枣汤之类, 皆所以逐水也. 但察其
果系实邪, 则此等治法, 仍不可废也.
Treats Kidney deficiency and Spleen weakness, presenting with heaviness in the lower back and edema of the feet, difficult urination, abdominal distension with panting, excessive phlegm, and progression to Drum disease (Gu Zheng, a type of abdominal distension characterized by fluid accumulation). The efficacy is miraculous.
Prepared Rehmanniae Radix (Shu Dihuang) 4 liang, Poria (Fuling) 3 liang, Moutan Cortex (Mudanpi) 1 liang, Alisma Rhizoma (Zexie) 1 liang, Dioscoreae Rhizoma (Shanyao) 1 liang, Plantaginis Semen (Cheqianzi) 1 liang, Corni Fructus (Shanzhuyu) 1 liang, Achyranthis Bidentatae Radix (Niuxi) 1 liang, Cinnamomi Ramulus (Rougui) 1 liang, Aconiti Lateralis Radix Praeparata (Fuzi) 5 qian. These ten ingredients are mixed with honey to form pills. Take 80 pills per dose, swallowed with rice water on an empty stomach.
[Collected Annotations] Li Zhongzi stated: The *Classic of Internal Medicine* (*Huangdi Neijing*) states: "All dampness-induced swelling and fullness belong to the Spleen." It also states: "The root lies in the Kidney, the branch lies in the Lung; all are accumulations of water." Furthermore, it says: "The Kidney governs water and serves as the gate of the Stomach. If the gate is not functioning properly, water accumulates and follows its kind." Although swelling diseases may arise from various meridians, they invariably involve the Lung and Kidney. This is because the Spleen governs transportation and transformation, the Lung governs Qi transformation, and the Kidney governs the five fluids. All fluids transformed by the five Qi belong to the Kidney; all Qi required for the movement of the five fluids belongs to the Lung; and the transmission and regulation between these two organs, thereby controlling Water generating Metal (Kidney generating Lung), belong to the Spleen. Thus, swelling diseases do not extend beyond these three organs. However, treatment methods must be distinguished according to interior/exterior, upper/lower, and deficiency/excess patterns. Exterior manifestations present as edema, corresponding to indications for Yebiao Decoction (Yuebi Tang) and Minor Blue Dragon Decoction (Xiao Qinglong Tang). Interior manifestations present as distension, corresponding to indications for Ten Jujube Pills (Shizao Wan) and Shenyao Pills. Upper jiao manifestations present as panting, corresponding to indications for Platycodon and Large Date Decoction (Tingli Dazao Tang) and Pachysandra, Lepidium Seed, Platycodon, and Rhubarb Pill (Fangji Jiumu Tingli Dahuang Wan). Lower jiao manifestations present as urinary retention, corresponding to indications for Agarwood and Amber Pills (Chenxiang Hupo Wan) and Scouring Decoction (Shuzao Yinzi). These are all methods for treating excess patterns. As for deficiency patterns, Spleen-Strengthening Drink (Shipin Yin) and this formula (Zisheng Shenqi Wan) are indicated. Zhang Jiabin stated: Prepared Rehmanniae Radix, Dioscoreae Rhizoma, and Moutan Cortex nourish the true Yin-water within the Yin. Corni Fructus, Cinnamomi Ramulus, and Aconiti Lateralis Radix Praeparata transform the true Qi within the Yin. Poria, Alisma Rhizoma, Plantaginis Semen, and Achyranthis Bidentatae Radix promote the flow of stagnation within the Yin. This enables Qi to transform within Jing (Essence), which is effectively treating the Lung; supplementing Fire to generate Earth, which is effectively treating the Spleen; strengthening water metabolism and unblocking orifices, which is effectively treating the Kidney. It tonifies without causing stagnation and drains without damaging healthy Qi. This is a formula for treating deficiency-type edema, unsurpassed by any other. However, one should expand upon this formula and modify it according to specific symptoms. If a patient suffers from water distension due to severe Spleen Qi deficiency following a major illness, taking this formula will cause no harm but will ultimately be ineffective. One must deliberate carefully: severe damage to Spleen Qi cannot be treated solely with Kidney-tonifying herbs. Use Lizhong Decoction (Lizhong Tang) 1 liang plus Poria 1 liang. If Mingmen Fire (Gate of Life) is deficient, add Aconiti Lateralis Radix Praeparata; if both legs are cold, add Cinnamomi Ramulus; if abdominal distension is severe, add Magnoliae Officinalis Cortex (Houpo). After three doses, swelling in the calves and shins will gradually subside; after more than ten doses, abdominal distension will recede. For patients past middle age suffering from Spleen-Kidney Yang deficiency and cold, this method should be applied universally. Generally, those with Qi deficiency should not undergo further Qi-moving therapies; those with Kidney deficiency should not specialize solely in diuresis. Warming and tonifying is the way to transform Qi. The subtlety of "treating obstruction with obstruction" (using tonification to treat blockage) depends entirely on the practitioner's skill. Ancient treatments for edema avoided tonics, instead using drugs to eliminate water. Mild cases used differentiation and diuresis; severe cases used purgation to drive out water. Formulas such as Five-Ingredient Powder with Poria (Wuling San), Five-Dampness Powder (Wulin San), Five-Rind Powder (Wupi San), and Water-Guiding Poria Decoction (Daoshui Fuling Tang) are all for promoting diuresis. Formulas such as Boat-Chariot Shenyao Pills, Xunchuan Powder, Yu Gong Powder, and Ten-Jujube Decoction (Shizao Tang) are all for driving out water. However, if it is confirmed that the pathogen is truly excess, these treatment methods should not be discarded.