论曰∶诸家方书论水病甚详，未尝有言膜外气者。唐天宝间有徒都子者，始着膜外气方
书，本末完具，自成一家，今并编之。然究其义，本于肺受寒邪，传之于肾，肾气虚弱，脾
土又衰，不能制水，使水湿散溢于肌肤之间，气攻于腹膜之外，故谓之膜外气。其病令人虚
胀，四肢肿满，按之没指是也。
徒都子论病本
膜外气者，或谓之水病起于他疾，不可常定。或因患疟，或因积劳，或因肾脏中风，或
因肺腑伤冷，或因膈上气，或因冲热远行，或因酒肉中所得，始于肺，终于肾，或因咳嗽，
或多涕唾，或因蓄聚，冷气壅塞不散，遂使肺脏热气攻心，五脏冷气下化为水，流入膀胱，
在大肠膜外，所以切脉不能知，针灸不能及。盖人肾为命本，不可虚也。本固即叶茂，本虚
即易枯。况四时衰旺，皆乘肾脏之气，肾损即五脏皆衰，是致胃闭而脾不磨，气结而小便涩。
轻重之候，在大小便耳。若小便不通则气壅，攻击腹内，冲出膜外，化而为水，使人手足头
面浮肿。若大小便微涩则微肿；极涩则极肿；大小便俱不通，三日即遍身洪肿；至重则阴亦
肿。夫阴肿有二，有肿而小便自出者，有肿而小便出涩者，又有茎头连少腹脐皆肿者，此并
为死候，宜速治之。若患此疾，肿亦不常定，或先手足面目浮肿，或先腰肋微肿，或先手足
小肿。其候或消或甚，三五日稍愈，或三五日再发，亦以小便通涩为候，积渐变成洪肿。妇
人得之，与此略同。凡患此疾，令人腹胀烦闷，胸间气急，此由肺胀甚即喘如牛吼，坐卧行
立不得，或中夜后气攻胸心，重者一年二年方死，有一月两月死者。若将息失度，误食毒物，
十日五日即甚也。愚医多以针灸出水为功，又以鲤鱼赤小豆为药，又令病患饮黄牛尿、服商
陆根，反有所损，少有瘥者。大抵此病尤忌针灸，华佗云，患水病未遇良医，第一不得针灸，
言气在膜外，已化为水，水出即引出腹中气，水尽则死。扁鹊云，水病在膜外，常针不可及，
常药不可疗，憔神针良药可也。有此疾者，宜向阳行坐，遇阴雨则愈觉壅滞，房中常须存火，
服药后夜卧觉胸间热甚，宜含红雪与好茶之类，慎勿饮酒及冷茶冷水。若渴，宜吃五灵汤方，
录在卷后。尤忌盐、生冷醋滑。
治膜外气水病，不限年月深浅，洪肿大喘，须臾不可过，朝服暮瘥。防己汤方。
防己 大戟 木香 赤茯苓（去黑皮） 海蛤 犀角（屑） 胡椒 白术 葶苈 防风
（去
叉） 木通 桑根白皮 紫苏 陈橘皮（炙） 牵牛子 诃黎勒（去核） 郁李仁 白槟榔
（各
一
上二十味等分，唯大黄一味倍用，并须新药，锉了秤为二剂，以水三升宿浸，明日五更，
用铛文火煎，减去一升，绞取饮可三盏。平旦空腹，且服一盏，如人行五里更服一盏，又如
人行五里更服一盏，至第二第三服。如药冷，用重汤暖之，不可冷服。若久病腹中虚，服至
第三盏，即微利三两行。若腹中实者，至日午即转泻，宜用盆盛验之，必有恶浊黄水，或青
里恶物出三五升，并气化为之。泻若不甚困，慎勿止之，必自住。若觉力乏，即服浆水粥补
之。后隔三五日，更服一剂，还根据此法服之。按徒都先生云，服第一剂则病减半，至第二剂
则去根本，前后历试。绝重者，朝服一剂，而暮已瘥。根本深者，服药当日肿消能起。但觉
小腹内有块结，则须后剂去之。其药滓慎勿抛弃，布囊盛，悬于风中。他日或觉微有发动，
则更煎药滓，可更治两人。徒都先生云，人家有此药滓，悬于户上，一家终不患疫气。此饮
不独治水气，凡是气病，皆治之。若患肺气，不限年月深浅，于此药二十味中，减去大黄及
诃黎勒，加贝母、人参，以童子小便煎，每日空心服之，当去病根。有患肺气困重者，因逢
患水气人服此药，偶得一盏服之，盒饭永瘥。有人一生患香港脚，时时冲心，服此饮亦除根本。
以此推之，但是气皆治，不独治水气而已。产妇有娠人服之亦无妨，小儿及老人随意如减，
瘥后宜服顺气丸。
治水气。顺气丸方。
防己（一两半） 大黄（二两半） 犀角（炙，镑） 诃黎勒皮 牵牛子 赤茯苓（去
黑
皮） 葶苈（炒） 海蛤 芎 干地黄（焙） 木通（锉） 大戟 桑根白皮（锉） 陈
橘皮（去白） 防风（
上一十七味，捣罗为末，炼蜜丸梧桐子大。每服十丸，空腹米饮下。觉壅不快，则加至
十五丸；觉通，则减至三五丸；大小便不通，即加至三十丸。此药不独治水气，其功与前饮
相类。若患水气人，服前饮后肿既消，便服此顺气丸，气顺血滑，体气轻健即止。患香港脚人，
常合此药备急。服前饮瘥，百日内即宜服五灵汤。
治水气。五灵汤方
诃黎勒皮 木通（锉） 赤茯苓（去黑皮） 防己（锉） 陈橘皮（汤浸去白，焙各一
两）
上五味，粗捣筛。每服五钱匕，水一盏半，煎至一盏。去滓，渴即饮之。觉热，即吃好
茶。
治水气。牵牛五灵煮散方。
牵牛子（炒） 槟榔（锉） 木香 赤茯苓（去黑皮） 陈橘皮（汤浸去白，焙各一两）
上五味，捣罗为散，如茶法煎三两沸，渴即饮之。此药兼治一切肺气香港脚。每觉心胸烦
闷时，服一盏即愈；奔豚气上筑心胸不可忍者，并三两盏立效。
治水气。紫苏煮散方。
紫苏叶 防风（去叉） 桑根白皮（切） 白术（锉碎等分）
上四味，捣罗为散，如茶法煎三两沸。觉热，即去白术，加甘草。功效如前方所说。又
有蛇蛊，状与水病相似，四肢如故，小便不甚涩，但腹急肿而蛊胀不下食，凡医多误作水气
治之，宜仔细详审，当服太上五蛊丸。
治百病及诸色蛊，常合随身备急。五蛊丸方。
雄黄（研） 椒目（炒） 巴豆（出油尽） 莽草 真珠末（研） 芫花（醋浸，炒焦）
鬼臼
矾石（烧令汁枯） 藜芦（去芦头） 獭肝（各一分） 蜈蚣（一寸） 附子（炮裂，去皮
脐半
两） 斑蝥（去翅、足，炒十枚）
上一十三味，捣研为末，炼蜜丸如小豆大，瓷合密收。每食后服一丸，如未效，日增一
丸，以利为度。当有虫出，形状不可具载。虫下后七日内，切宜将摄。凡服此药一剂，蛊不
能侵，百病尽除。勿食五辛。又蛇毒甚者，合五蛊丸未及，且以大豆渍酒，绞汁服半升即瘥。
又酒服桔梗、犀角末方寸匕，日三服。中毒甚不能自服，干口开与之。药下心头当烦闷，须
臾即稣。如此服七日后，宜食猪脾脏补养。今所录蛇蛊方，在卷末者，缘蛇蛊状似水病，恐
人不辨，误作水病治之，且谓水药不验。杨馨所传地仙徒都先生神方一十五首，皆治恶病。
而膜外水气，方具于首，蛇蛊次之，余方世人无有传者。杨馨云，曾有亲识患水病，洪肿满
在床，顷刻必死。旦服此药，至暮获安。不忍弃其滓，常以绢囊盛之。凡煎防己汤，须用旧
铛于火中烧令通赤，揩磨取净，免有油腻。又于药名二十味中，各取一字，合成四句之歌，
庶使年久不忘。胡牵犀苈海，汉茯戟通桑，青黄诃麝橘，白郁紫防榔。
治膜外水气，神效。牛李子丸方。
牛李子（微炒） 牵牛子（微炒） 吴茱萸（水浸一宿，炒干） 青橘皮（去白，焙各
半两）
杏仁（汤浸去皮尖、双仁，生用十五枚） 葶苈（纸上炒少许）
上六味，捣罗为末，用水浸蒸饼丸如小豆大。每服三十丸，夜后煎橘皮汤下，以转下气
为度。
治膜外水肿。泽漆丸方。
泽漆（微炒一两） 水银（炼） 葶苈（纸上炒） 大戟（微煨） 郁李仁（汤浸去皮，
炒） 枳
壳（去瓤，麸炒各一两半） 甘遂 椒目（微炒各一两）
上八味，捣罗为末，炼蜜丸如小豆大。每服十丸，空腹米饮下。未利，加至十五丸。
治膜外水气身肿。十水丸方。
本（去苗土） 泽漆（微炒） 大戟（微煨） 连翘 葶苈（纸上炒） 甘遂（微炒）
芫花（
醋浸，炒焦） 桑根白皮（炙，锉） 赤小豆（微炒各三分） 巴豆（去皮、心、膜，麸炒，
出油
尽一两）
上一十味，捣罗为末，炼蜜丸如小豆大。每服五丸，空心米饮下，不利加至十丸。
治膜外气。白牵牛散方。
白牵牛子（炒） 青橘皮（去白，焙，炒） 木通（锉各一两）
上三味，捣罗为散。每服一钱匕，煎商陆汤调下，大便下黄水为度。忌盐一百日。
治膜外水气。甘遂饼方。
甘遂 大麦面（各半两）
上二味，捣罗为末，以水和作饼子，烧熟，热服之。如不利，以熟饮投之；如利，以冷
水洗手面即止。
[Discussion]
Various medical texts discuss water diseases (Shuibing, Water Retention Disorders) in great detail, yet none mention "Qi outside the Membrane" (Mowaiqi). During the Tianbao era of the Tang Dynasty, a man named Tu Du Zi began writing treatises on Mowaiqi formulas. His works were complete and comprehensive, forming a unique school of thought, which is now compiled into this book. However, upon investigating its pathology, it originates from the Lung receiving cold pathogenic factors (Hanxie), transmitting to the Kidney. The Kidney Qi becomes weak, and Spleen Earth declines, failing to control water. This causes water-dampness to scatter and overflow between the skin and muscles, while Qi attacks outside the abdominal membrane, hence the name Mowaiqi. This disease causes false distension, swelling and fullness of the four limbs, where pressing leaves an indentation that does not immediately rise.
[Tu Du Zi on the Root of the Disease]
Mowaiqi is sometimes referred to as water disease arising from other illnesses, with unpredictable progression. It may result from malaria, chronic fatigue, Wind striking the Kidney, Cold injuring the Lung and Intestines, Qi stagnation above the diaphragm, traveling far after exposure to heat, or improper consumption of alcohol and meat. The disease begins in the Lung and ends in the Kidney. Symptoms may include coughing, excessive phlegm and saliva, or accumulation of Cold Qi obstructing circulation without dispersing. This eventually causes Heat Qi in the Lung to attack the Heart, transforming Cold Qi of the Five Zang Organs into water, flowing into the Bladder, and settling outside the membrane of the Large Intestine. Therefore, pulse diagnosis cannot detect it, and acupuncture cannot reach it. The Kidney is the root of life and must not be deficient. If the root is solid, the branches flourish; if deficient, it easily withers. Moreover, the prosperity and decline of the four seasons all depend on Kidney Qi. Damage to the Kidney leads to the decline of all Five Zang Organs, resulting in Stomach closure and Spleen failure to grind/digest, Qi knotting, and astringent urination. The severity depends on bowel and bladder movements. If urination is blocked, Qi stagnates, attacks the abdomen, breaks out through the membrane, transforms into water, causing edema of the hands, feet, head, and face. If bowel and bladder movements are slightly astringent, there is slight swelling; extremely astringent means extreme swelling; if both are completely blocked, general severe edema occurs within three days; in severe cases, the genitals also swell. There are two types of genital edema: one where urine flows freely despite swelling, and another where urination is difficult. Also, swelling of the glans penis extending to the lower abdomen and umbilicus indicates a fatal prognosis requiring urgent treatment. In this disease, edema is variable: it may start with facial and limb swelling, or mild waist/rib swelling, or slight hand/foot swelling. Symptoms fluctuate, improving slightly every three to five days or recurring, depending on urinary patency, gradually progressing to massive edema. Women suffer similarly. Generally, this disease causes abdominal distension, irritability, chest tightness, and shortness of breath. Severe Lung distension causes wheezing like a bull's bellow, making sitting, lying, walking, or standing impossible. Qi may attack the chest and heart at midnight. Severe cases may die within one to two years, or even one to two months. Improper care or ingestion of toxic substances can worsen the condition within five to ten days. Quack doctors often claim success by draining fluid via acupuncture, using Carp and Adzuki Beans as medicine, or prescribing Bull urine and Phytolaccae Radix (Shanglu), which often causes harm rather than cure. This disease strictly contraindicates acupuncture. Hua Tuo stated that for water disease, before meeting a good physician, one must absolutely avoid acupuncture because Qi outside the membrane has already transformed into water; draining water draws out abdominal Qi, leading to death when water is exhausted. Bian Que said water disease outside the membrane is beyond the reach of common needles and medicines, requiring special techniques and potent herbs. Patients should sit or walk facing the sun; rainy weather exacerbates stagnation. Keep the room warm. After taking medicine, if chest heat is felt at night, hold Red Snow (Hongxue, a cooling preparation) or good tea in the mouth. Avoid alcohol, cold tea, and cold water. For thirst, take Wuling Tang (recorded later). Strictly avoid salt, raw/cold foods, vinegar, and slippery/greasy foods.
[Treatment for Mowaiqi Water Disease]
Regardless of duration, for massive edema and sudden dyspnea, immediate treatment is required; morning administration brings evening recovery. Fangji Tang Formula.
Fangji (Stephaniae Tetrandrae Radix), Daji (Euphorbiae Pekinensis Radix), Muxiang (Aucklandiae Radix), Chifuling (Poria Cocos with Black Skin Removed), Hai Ge (Concha Meretricis et Cyclinae), Xijiao (Rhinocerotis Cornu - *Note: Use substitutes in modern practice*), Hujiao (Piperis Longi Fructus), Baizhu (Atractylodis Macrocephalae Rhizoma), Tingli (Descurainiae Semen seu Lepidii Semen), Fangfeng (Saposhnikoviae Radix), Mutong (Akebiae Caulis), Sangbaipipi (Mori Cortex), Zisu (Perillae Folium), Chenjupi (Citri Reticulatae Pericarpium), Qianniuzi (Pharbitidis Semen), Helile (Terminalia Chebulae Fructus), Yuliren (Pruni Semen), Baibinglang (Arecae Semen) [Each 1 qian].
The above twenty ingredients are equal parts, except Dahuang (Rhei Radix et Rhizoma) which is doubled. Use fresh herbs, chop, weigh, and divide into two doses. Soak in 3 sheng of water overnight. At dawn (5-7 AM), simmer gently in a pot until reduced by 1 sheng. Strain to obtain approximately 3 cups. Take 1 cup on an empty stomach in the morning. After walking about 5 li (2.5 km), take another cup. After another 5 li, take a third cup. If the medicine is cold, warm it in a double boiler; do not take cold. For chronic cases with abdominal deficiency, mild diarrhea (2-3 stools) may occur after the third cup. For excess patterns, diarrhea may occur by noon; collect stool to verify foul yellow water or green/black matter (3-5 sheng), indicating Qi transformation. Do not stop mild diarrhea; it will resolve spontaneously. If weakness ensues, replenish with Jiangshui Zhou (Fermented Rice Porridge). Repeat the dose every 3-5 days following the same method. Mr. Tu Du Zi claimed the first dose halves the disease, the second removes the root. For critical cases, one dose in the morning cures by evening. For deep-rooted cases, swelling subsides and mobility returns on the day of administration. If abdominal masses remain, subsequent doses remove them. Do not discard dregs; store in cloth bags and hang in the wind. Re-boiling dregs can treat others. Hanging these dregs at the door protects the household from epidemic Qi. This drink treats all Qi disorders, not just water. For Lung Qi disease, omit Dahuang and Helile, add Beimu (Fritillariae Bulbus) and Renshen (Ginseng Radix et Rhizoma), decoct in Urine of a Boy (Tongzi Xiaon), take on empty stomach daily to remove the root. A case of severe Lung Qi distress cured by accidental intake of this formula for water disease confirms its efficacy. Even chronic Hongjiaojiao (Hong Kong Foot/Gouty Arthritis) attacking the heart was cured. Thus, it treats all Qi disorders. Safe for pregnant/nursing women; adjust dosage for children/elderly. Post-recovery, take Shunqi Wan.
[For Water Qi. Shunqi Wan Formula]
Fangji (1.5 liang), Dahuang (2.5 liang), Xijiao (Roasted, shaved), Helile Pi (Chebulae Exocarpium), Qianniuzi, Chifuling, Tingli (Stir-fried), Hai Ge, Xiong (Ligustici Chuanxiong Rhizoma), Dihuang (Rehmanniae Radix Praeparata, baked), Mutong (Chopped), Daji, Sangbaipipi (Chopped), Chenjupi (White part removed), Fangfeng (1.5 liang).
Grind seventeen ingredients into powder, mix with refined honey to make pills the size of paulownia seeds. Take 10 pills with rice water on an empty stomach. Increase to 15 if feeling stagnant; decrease to 3-5 if unobstructed; increase to 30 if constipation/urinary retention persists. Similar efficacy to the previous drink. After edema subsides with the drink, switch to Shunqi Wan to smooth Qi and blood. Keep for emergency use in Hongjiaojiao. After recovery with the drink, take Wuling Tang within 100 days.
[For Water Qi. Wuling Tang Formula]
Helile Pi, Mutong (Chopped), Chifuling, Fangji (Chopped), Chenjupi (Soaked in soup, white part removed, baked, each 1 liang).
Coarsely crush five ingredients. Take 5 qian bi (spoonfuls), decoct in 1.5 sheng water to 1 sheng. Strain. Drink when thirsty. If feeling hot, consume good tea.
[For Water Qi. Qianni Wuling Zhusan Formula]
Qianniuzi (Stir-fried), Binglang (Betel Nut, chopped), Muxiang, Chifuling, Chenjupi (each 1 liang).
Grind into powder. Decoct like tea for 3 boils. Drink when thirsty. Treats all Lung Qi disorders and Hongjiaojiao. Relieves chest oppression instantly. For Ben Tun Qi (Running Piglet Qi) attacking the chest, 3 cups provide immediate relief.
[For Water Qi. Zisu Zhusan Formula]
Zisu Ye (Perillae Leaf), Fangfeng, Sangbaipipi, Baizhu (equal parts).
Grind into powder. Decoct like tea for 3 boils. If feeling hot, remove Baizhu and add Gancao (Licorice). Efficacy as described above. Note: Snake Gu (Poison) resembles water disease but limbs are normal, urination is not very astringent, only abdomen is tense/swollen with inability to eat. Physicians often misdiagnose as water disease. Carefully differentiate and use Taishang Wugu Wan.
[For Hundred Diseases and Various Gu Poisons. Emergency Kit. Wugu Wan Formula]
Xionghuang (Realgar), Jiaomu (Semen Piperis Longi), Badou (Crotonis Fructus, oil removed), Mangcao (Illicii Anisi Stellati Herba), Zhenzhu Mo (Margarita Pulvis), Yuanhua (Genkwa Flos, vinegar-soaked, charred), Guiji (Podophylli Peltati Rhizoma et Radix), Fanshi (Alumen, burnt dry), Lilu (Veratri Rhizoma), Talei (Leporis Hepatis), Wugong (Centipedae Corpus), Fuzi (Aconiti Lateralis Radix Praeparata, half liang), Banmao (Mylabris, wings/legs removed, fried, 10 units).
Grind thirteen ingredients into powder, mix with honey to make bean-sized pills. Store in porcelain. Take 1 pill after meals. Increase by 1 pill daily until purgation occurs. Parasites/worms will exit (shape indescribable). Care for 7 days post-purgation. One dose prevents Gu invasion and cures hundred diseases. Avoid Five Pungent Spices. For severe snake venom, if Wugu Wan is unavailable, soak Soybeans in wine, squeeze juice, take 0.5 sheng. Alternatively, take Jiegeng (Platycodonis Radix) and Xijiao powder with wine, 3 times daily. If unable to swallow, pry mouth open. Chest oppression followed by rapid recovery is expected. After 7 days, nourish with Pig Spleen. The Snake Gu formula is at the end of the volume because it mimics water disease, leading to misdiagnosis and ineffective water treatments. Yang Xin transmitted 15 divine formulas from Tu Du Zi for malignant diseases. Mowaiqi is first, Snake Gu second; others are lost. Yang Xin recounted a relative with massive edema dying instantly; morning dose brought evening peace. Dregs were saved in silk bags. When decocting Fangji Tang, use an old pot heated red-hot and cleaned to avoid grease residue. Mnemonic song for the 20 ingredients: "Hu Qian Xi Li Hai, Han Fu Ji Tong Sang, Qing Huang Ke She Ju, Bai Yu Zi Fang Lang."
[For Mowaiqi Water Qi. Niuzi Zi Wan Formula]
Niuzi Zi (Slightly fried), Qianniuzi (Slightly fried), Wuzhuyu (Soaked overnight, fried dry), Qingjupi (White part removed, baked, each 0.5 liang), Xingren (Skin/kernel removed, 15 raw kernels), Tingli (Fried on paper, small amount).
Grind six ingredients. Make pills with steamed dough soaked in water, bean-sized. Take 30 pills at night with Tangerine Peel Soup, aiming to move Qi downward.
[For Mowaiqi Edema. Zeqi Wan Formula]
Zeqi (Slightly fried, 1 liang), Shuiyin (Refined Mercury), Tingli, Daji (Slightly roasted), Yuliren, Zhike (Pulp removed, bran-fried, each 1.5 liang), Gansui, Jiaomu (Slightly fried, each 1 liang).
Grind eight ingredients. Honey pills, bean-sized. Take 10 pills with rice water on empty stomach. Increase to 15 if no purgation.
[For Mowaiqi Generalized Edema. Shishui Wan Formula]
Ben (Cnidii Rhizoma, roots/soil removed), Zeqi, Daji, Lianqiao, Tingli, Gansui, Yuanhua, Sangbaipipi, Chixiaodou (Adzuki Bean, each 3 fen), Badou (Kernel/membrane removed, bran-fried, oil removed, 1 liang).
Grind ten ingredients. Honey pills, bean-sized. Take 5 pills on empty stomach with rice water. Increase to 10 if no purgation.
[For Mowaiqi. Bai Qianniu San Formula]
Bai Qianniuzi (Fried), Qingjupi (White part removed, baked/fried), Mutong (Chopped, each 1 liang).
Grind three ingredients. Take 1 qian bi with Shanglu Tang (Phytolaccae Radix decoction). Stop when yellow water passes in stool. Avoid salt for 100 days.
[For Mowaiqi Water Qi. Gansui Bing Formula]
Gansui, Damaimian (Barley Flour, each 0.5 liang).
Grind two ingredients. Mix with water to form cakes. Bake thoroughly. Eat hot. If no purgation, take cooked beverage. If purgation occurs, wash face/hands with cold water to stop.