喻昌曰∶胀病与水病,非两病也。水气积而不行,必至于极胀,胀病亦不外水裹气结血凝,而以治水诸法施之。百
中无一愈者,失于师承无人,妄施妄投耳。今天下医脉久断,医学久荒,即欲效司马子长,担簦负笈,遍访于江、淮、
汶、泗,而师资果安有乎?昌于斯世无地可以着锥,然而皇皇斯人,不敢自外,请一比类,为后学商之。仲景谓水病,
气分心下坚大如盘,边如旋杯,水饮所作。然则胀病,岂无血分腹中坚大如盘者乎?多血少气,岂无左胁坚大如盘者乎?
多气少血,岂无右胁坚大如盘者乎?故不病之人,凡有 瘕积块痞块,即是胀病之根,日积月累,腹大如箕,腹大如瓮,
是名单腹胀。不似水气散于皮肤面目四肢也,仲景所谓石水者正指此也。胸中空旷,气食尚可从旁辘转,腹中大小肠膀
胱,逼处瘀浊占据,水不下趋,而泛溢无不至矣。《内经》明胀病之旨,而无其治。仲景微示其端,而未立法,然而比类
推之,其法不啻详也。仲景于气分心下坚大如盘者,两出其方,一方治阴气结于心下,用桂枝去芍药加麻黄附子细辛汤;
一方治阳气结于心下,用枳术汤。夫胸中阳位,尚分阴气阳气,而异其治,况腹中至阴之处,而可不从阴独治之
乎?阴气包裹阴血,阴气不散,阴血且不露,可驱其血乎?舍雄入九军单刀取胜之附子,更有何药可散其阴气,破其坚
垒乎?推之两胁皆然,但分气血阴结之微甚,而水亦必从其类矣。此等此类之法,最上一乘,非中材所几,和盘托出,
为引伸启发之助。
【律七条】
凡治水肿病,不分风水、皮水、正水、石水、黄汗五证,及脾肺肾三藏所主,恣用驱水恶劣之药,及禹功、舟车、
导水等定方者,杀人之事也。
凡治水肿病,有当发汗散邪者,不知兼实其卫,致水随汗越,浸淫皮腠,不复顺趋水道,医之罪也。
凡治水肿病,遇渴而下利之证,误利其水,致津液随竭,中土坐困,甚者脉代气促,滨于死亡,医之罪也。
凡治水肿病,遇少腹素有积块疝瘕,误行发表攻里,致其人浊气上冲胸胃,大呕大逆,痛引阴筋,卒死无救者,医
杀之也。
凡治水肿黄汗证,乃胃热酿成瘅水,误用热药,转增其热,贻患痈脓,医之罪也。
凡治水肿病,不察寸口脉之浮沉迟数,弦紧微涩,以及趺阳脉之浮数微迟紧伏,则无从辨证用药,动罹凶祸,医之
罪也。
凡治胀病,而用耗气散气,泻肺泻膀胱诸药者,杀人之事也。治病之药,贵得其宜,病有气结而不散者,当散其结;
甚有除下荡涤,而其气之结仍未遽散者,渐积使然也。今胀病乃气散而不收,更散其气,岂欲直裂其腹乎?收之不能遽
收,亦渐积使然,缓缓图成可也。若求快意一朝,如草头诸方,明明立见杀人,若辈全不悔祸,展转以售奸,吾不知其
何等肺肠,千劫不能出地狱矣。
Yu Chang said: Distension disease (Zhang Bing) and water disease (Shui Bing) are not two different diseases. When water qi accumulates and fails to circulate, it inevitably leads to extreme distension; distension disease is nothing but water enveloping, qi stagnation, and blood coagulation. If one applies only methods for treating water diseases, not one in a hundred will recover. This is due to the loss of lineage transmission, lack of guidance, and reckless treatment with inappropriate medications. Today, medical traditions have been severed for a long time, and medical studies have fallen into neglect. Even if one wishes to emulate Sima Qian (Sima Zichang), carrying books and traveling extensively through the Jianghuai, Wen, and Si regions, where can one find a true teacher? I have no place to stand in this world, yet I cannot remain indifferent to the suffering of humanity. Therefore, I propose an analogical approach for discussion with future students. Zhang Zhongjing stated that in water disease, there is a qi-level syndrome characterized by hardness and fullness below the heart as large as a plate, with edges like an inverted cup, caused by fluid retention. Then, does distension disease not also have a blood-level syndrome characterized by hardness and fullness in the abdomen as large as a plate? In cases of abundant blood and deficient qi, is there not hardness and fullness in the left hypochondrium as large as a plate? In cases of abundant qi and deficient blood, is there not hardness and fullness in the right hypochondrium as large as a plate? Thus, in individuals who appear healthy, any presence of masses or nodules constitutes the root of distension disease. Over time, the abdomen becomes distended like a winnowing basket or a jar, known as isolated abdominal distension (Dan Dan Zhang). This differs from water qi scattered across the skin, face, eyes, and limbs. The "Stone Water" (Shi Shui) mentioned by Zhang Zhongjing precisely refers to this condition. The chest remains hollow, allowing food and drink to pass by, while the small and large intestines and bladder in the abdomen are crowded and occupied by turbid stasis. Water cannot flow downward and instead overflows everywhere. The *Neijing* elucidates the principles of distension disease but provides no treatment methods. Zhang Zhongjing briefly indicated the beginning but did not establish specific laws; however, through analogy and deduction, the methods are actually quite detailed. For qi-level syndrome with hardness and fullness below the heart as large as a plate, Zhang Zhongjing presented two formulas: one treats Yin qi stagnation below the heart using Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (Cinnamon Twig Decoction Modified by Removing Peony and Adding Ephedra, Aconite Root, and Asarum); the other treats Yang qi stagnation below the heart using Zhizhu Tang (Immature Bitter Orange and Atractylodes Macrocephala Decoction). Since the chest is a Yang region and still distinguishes between Yin and Yang qi with different treatments, how much more so should the abdomen, a region of extreme Yin, be treated specifically from the perspective of Yin? Yin qi envelops Yin blood; if Yin qi does not dissipate, Yin blood cannot be exposed, and thus blood cannot be directly expelled. Besides using the potent Aconite Root (Fuzi), which penetrates deep like a single blade in nine armies, what other herb can dissipate Yin qi and break down hard accumulations? This logic extends to both hypochondriac regions, differing only in the severity of Qi and Blood Yin stagnation, while water pathogens follow their kind. Such methods represent the highest level of treatment, beyond the reach of average practitioners. I present them fully here to aid in extension and inspiration.
[Seven Laws]
1. Treating edema without distinguishing between Wind Water (Feng Shui), Skin Water (Pi Shui), Correct Water (Zheng Shui), Stone Water (Shi Shui), and Yellow Sweat (Huang Han), nor considering the governance of the Spleen, Lung, and Kidney organs, and recklessly using harsh diuretic drugs or fixed prescriptions such as Yugong San (Yugong Powder), Zhouche Wan (Boat Cart Pill), or Daoshui Wan (Water-Guiding Pill) is a murderous act.
2. Treating edema requiring sweating to disperse pathogens without simultaneously consolidating Wei Qi (Defensive Qi), leading to water escaping with sweat, infiltrating the skin and interstices, and failing to follow the normal water pathways downward, is the physician's fault.
3. Treating edema accompanied by thirst and diarrhea, and mistakenly using diuretics, causing exhaustion of body fluids and severe dysfunction of the Middle Jiao (Spleen and Stomach), potentially leading to intermittent pulse and shortness of breath approaching death, is the physician's fault.
4. Treating edema in patients with pre-existing masses or hernias in the lower abdomen, and mistakenly using exterior-releasing or interior-purging methods, causing turbid Qi to rush upward to the chest and stomach, resulting in severe vomiting, reversal, pain radiating to the genital tendons, and sudden untreatable death, is murder by the physician.
5. Treating edema with yellow sweat, which is formed by Stomach Heat brewing into Dan Water (Damp-Heat Water), and mistakenly using hot herbs, thereby increasing heat and causing carbuncles and pus, is the physician's fault.
6. Treating edema without examining the floating, sinking, slow, rapid, wiry, tight, fine, or choppy pulses at the Cun Kou (Radial artery) position, nor the floating, rapid, fine, slow, tight, or hidden pulses at the Zu Yang (Dorsalis pedis artery) position, makes differentiation and medication impossible, leading to disastrous outcomes; this is the physician's fault.
7. Treating distension disease with herbs that consume or scatter Qi, or drain the Lungs and Bladder, is a murderous act. Medicinal treatment must be appropriate. If pathology involves Qi stagnation that does not resolve, one must dissipate the stagnation; even after purging the lower jiao, if Qi stagnation persists, it is due to gradual accumulation. Current distension disease often involves Qi dispersion rather than convergence; further dispersing Qi would cause the abdomen to rupture. Convergence cannot be achieved instantly but requires gradual effort. Seeking immediate relief with folk remedies clearly leads to death. Those who do not repent and continue to sell such harmful practices possess hearts of darkness, destined for hell for countless kalpas.