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[Verse]
Edema and dampness originate from the deficiency of Spleen Earth (Spleen Qi), which fails to transport fluids, causing water to soak into the skin. One must distinguish between Yang Edema and Yin Edema, as those caused by Qi, Blood, and Wind pathogens follow different pathways. Diuresis does not require harsh purgatives; when Spleen Qi is robust and transportation functions normally, comfort is naturally achieved. Use Ren Shen (Ginseng Radix) and Bai Zhu (Atractylodis Rhizoma) as main herbs, adjusting based on accompanying syndromes.

[Dissertation]
Humans rely on water and grain for life, and grain depends on Spleen Earth for digestion. If Spleen Earth is deficient, it cannot control water, leading to abnormal transmission and transformation. Kidney Water overflows and soaks Spleen Earth, causing stagnation in the San Jiao (Triple Burner) and obstruction in the meridians. Water seeps into the skin and pours into the muscles, causing edema. The manifestations include: slight swelling above and below the eyes, heaviness of the limbs, cough and palpitations, coldness between the thighs, yellow and scanty urine, shiny and swollen skin, pitting upon pressure that refills immediately upon lifting the hand. Although there are names like "Five Edemas" and "Ten Waters" with various forms, the causes of disease are essentially the same. Zhu Danxi said: Treating water disease focuses on strengthening the Spleen. When Spleen Qi is solid and Qi mechanism moves, water dissipates naturally. This is not achieved by diuretics like Wu Ling San (Poria Decoction), Shen You Wan, or Yu Gong San, but by using Ren Shen and Bai Zhu as sovereign herbs, adjusting according to accompanying symptoms, yielding effective results. If one merely seeks quick relief through harsh diuresis, it often leads to untreatable conditions, how sad! For Wind Edema, the skin is rough, numb, and painful with wandering sensations. For Qi Edema, the skin is thick, limbs are emaciated, and the abdomen and hypochondrium are distended. For Blood Edema, there are red streaks and marks under the skin. For Yang Edema, the body is swollen with thirst, red urine, irritability, constipation, and a rapid pulse. For Yin Edema, the body is cold without thirst, stools are clear, and the pulse is slow. For Feng Shui (Wind-Water), there is internal water qi, swollen face and eyes, fever with heavy and sore body, aversion to wind and spontaneous sweating, external joint pain, floating pulse without thirst. For Pi Shui (Skin-Water), there is generalized swelling, pitting upon pressure, no aversion to wind, drum-like abdomen, indicating a syndrome suitable for sweating therapy. For Li Shui (Interior-Water), the pulse is slow, and externally there is asthma. For Shi Shui (Stone-Water), the pulse is deep, and externally there is abdominal fullness without asthma. For Huang Han Feng Shui (Yellow Sweat Wind-Water), the pulse is floating, with external joint pain and aversion to wind. Generally, swelling above the waist should be treated by sweating, which opens the "Ghost Gate" (pores); swelling below the waist should be treated by promoting urination, which cleanses the "Clean Mansion" (bladder). This method of dispersing dampness from top and bottom is an excellent approach for treating edema.

Note: Edema diseases often arise from external anger and internal dietary injury. Liver Qi is often excessive; anger exacerbates distension and invades Spleen Earth. Spleen Earth is often insufficient; dietary injury impairs transportation and generates dampness. When dampness stagnates and becomes excessive, it transforms into water, rising to the head, flowing to the feet, and filling the front and back of the body. The edema is like a gourd, firm as stone, cold as ice, making sitting and walking difficult and sleep impossible. Such a condition is critical! Regarding treatment, one should primarily promote urination to relieve distension. However, if the swelling is too severe, connecting internally to the bladder and externally to the scrotum, causing tightness and obstruction, even with diuretic agents, there may be no passage. Thus, one must open the bowels to expel water. Following purgation with tonification preserves the Spleen while eliminating the disease, allowing for gradual recovery and potential survival. If the disease is extreme yet one adheres to old rules, it is like closing the city gate and expecting thieves to exit—difficult indeed! If the swelling is not severe, promoting urination is superior. In men, swelling descending from top to bottom is favorable, ascending from bottom to top is unfavorable, as men prioritize Yang then Yin. In women, swelling ascending from bottom to top is favorable, descending from top to bottom is unfavorable, as women prioritize Yin then Yang. Edema with black facial complexion is untreatable due to Yin overcoming Yang. Inability to eat indicates death due to loss of Stomach Qi. Yellow fluid oozing from calves and thighs indicates death due to Spleen exhaustion. Unstable asthma with flat supraclavicular fossae indicates death due to Lung Qi exhaustion.

[Pulse Diagnosis]
Edema syndromes have Yin and Yang aspects. Pulse observation, color inspection, and symptom inquiry must be detailed. Yin patterns present with deep-slow pulses, blue-white complexion, no thirst with diarrhea, and clear-scanty urine. If the pulse is deep-rapid, complexion is red-yellow, with dry feces, red urine, and thirst, it is a Yang pattern. Deep-thin pulses indicate death; floating-large pulses are acceptable.

Simultaneous Attack and Tonification
Modified Wei Ling Tang (Stomach Protection Decoction)
Action: Strengthens Spleen, removes dampness, relaxes the middle, and promotes urination.
Ingredients: Cang Zhu (Atractylodis Rhizoma, 1.5 qian), Chen Pi (Citri Reticulatae Pericarpium, 1 qian), Hou Po (Magnoliae Officinalis Cortex, 0.8 qian, ginger-processed), Chi Fu Ling (Poria with Red Core, peeled), Zhu Ling (Polyporus, 1 qian each), Ze Xie (Alismatis Rhizoma, 1 qian), Da Fu Pi (Arecae Pericarpium, 0.6 qian, washed, ginger-processed), Shen Qu (Medicated Leaven, stir-fried, 0.8 qian), Gan Cao (Licorice Root, honey-fried, 0.2 qian), Shan Zha (Crataegi Fructus, pitted, 0.7 qian), Xiang Fu (Cyperi Rhizoma, 0.6 qian, stir-fried with ginger juice), Mu Gua (Chaenomelis Fructus, 1 qian), Bing Lang (Areca Seed, 0.8 qian), Sha Ren (Amomi Fructus, stir-fried, ground, 0.7 qian).
Preparation: Coarsely crushed, decocted with 3 slices of fresh ginger and a bundle of Jixin (Centipeda Herba). Drink warm.
Modifications: For shortness of breath, add Zi Su Zi (Perillae Fructus), Ting Li Zi (Lepidii Semen), Sang Bai Pi (Mori Cortex), remove Bai Zhu. For fever, remove Xiang Fu, add Chao Shan Zhi (Gardeniae Fructus, stir-fried), Huang Lian (Coptidis Rhizoma). For diarrhea, add Chao Shao Yao (Paeoniae Radix Alba, stir-fried), remove Bing Lang. For aversion to cold and cold extremities with deep-thin pulse, remove Bing Lang, add Mu Xiang (Aucklandiae Radix, 0.5 qian), Guan Gui (Cinnamomi Cortex, a little). For abdominal distension, remove Bai Zhu and Gan Cao, add Luo Bo Zi (Raphani Semen).

Attack First, Then Tonify
Si Jiang Jun Tang (Four Generals Decoction)
Action: Purges bowels and expels water.
Ingredients: Gan Sui (Kansui Radix), Da Ji (Euphorbiae Pekinensis Radix), Ku Ting Li (Lepidii Semen, bitter), Da Huang (Rhei Radix et Rhizoma, 1 qian each).
Preparation: Decoct in water. After bowel movement occurs, administer tonifying medicine subsequently.

Shi Pi Tiao Qi Wan (Spleen-Strengthening and Qi-Regulating Pill)
Ingredients: Bai Zhu (Atractylodis Rhizoma, 2 liang), Ren Shen (Ginseng Radix, 1 liang), Guang Chen Pi (Citri Reticulatae Pericarpium, 5 qian), Shen Qu (Medicated Leaven, 1 liang).
Preparation: Grind into fine powder, make pills with water, swallow 2 qian with rice broth on an empty stomach.

Purely Warming and Tonifying
Note: Xue Lizhai stated: If the aforementioned symptoms include epigastric fullness, limb swelling, cold hands and feet, difficulty digesting food, diarrhea, or cold breath, this indicates failure of True Yang, deficiency-cold of Spleen, Lung, and Kidney, failing to control and resulting in water flooding. Urgently use Modified Shen Qi Wan (Kidney Qi Pill), otherwise it is untreatable. Only by regulating and tonifying Spleen Earth can there be a chance of survival.

Jin Gui Modified Shen Qi Wan (Kidney Qi Pill from Golden Cabinet)
Ingredients: Shu Di Huang (Rehmanniae Radix Praeparata, 8 liang), Shan Yao (Dioscoreae Rhizoma, 4 liang), Shan Zhu Yu (Corni Fructus, 4 liang), Bai Fu Ling (Poria, 3 liang), Ze Xie (Alismatis Rhizoma, 3 liang), Dan Pi (Moutan Cortex, 3 liang), Chuan Niu Xi (Cyathulae Radix, wine-washed, slightly stir-fried), Che Qian Zi (Plantaginis Semen, 1 liang each), Rou Gui (Cinnamomi Cortex, 1 liang), Fu Zi (Aconiti Lateralis Radix Praeparata, 1 liang).
Preparation: Grind into powder, make pills with rice paste, size of mung beans. Take 100 pills per dose, swallowed with plain warm water on an empty stomach.