死。病患阴囊茎俱肿者死。病患脉绝口张足肿，五日死。病患足趺肿，呕吐头重者死。病患足趺上肿，两膝大如
斗者，十日死。（《脉经》）（按∶此诸条中，有宜该诸病者，姑列于此。）
葛氏方云∶凡肿有五不治∶面肿仓黑（《千金翼》仓作苍），肝败不治。掌肿无理满满（《翼》无满满二字），心
败不治。脐满肿反者，脾败不治。腹满无文理，肺败不治。阴肿不起，肾败不治。（《医心方》）（《烟霞圣效
方》曰∶面生黑色者肝死，两肩凸者肺死，脐中突出脾死，两手无纹者心死，下注脚肿者肾死。此五证内显一证者，
不治也。）
水病有五不治∶第一，唇黑伤肝。第二，缺盆平伤心。第三，脐出伤脾。第四，足下平满伤肾。第五，背平
伤肺。凡此五伤，必不可治。（《病源论》）
大凡虚肿，先起于腹，而后散于四肢者，可治；先起于四肢，而后归于腹者，不治。至若蛊胀而肚上有筋，
腹满而大便滑泄，久疟而转作虚浮，与夫唇黑伤肝，缺盆平伤心，脐突伤脾，足平伤肾，背平伤肺，皆为不治之证，
当明辨之。男从脚下肿而上，女从身上肿而下，或肉硬，成手掌平，并不治。（《直指》）
水有五候∶一、因服药，泄痢不止者，死候。二、服药不泻，死候。三、体上筋脉赤，如藤大者，死候。四、
脉沉细者，死候。五、面小消瘦，死候。（《医林方》）
水肿死证，见一即危（原此举五伤）。如卵缩向上，阴囊无缝，及茎肿腐者死。大便滑泄，水肿不消者死。
加以喘满，虽暴病亦必不治。泄后腹胀而有青筋者死。鼻扇目青，耳焦面黑，破 脱肉者，死期迫矣。如肺气不
能下行，两足肿溃，而小水全无，腹中之痛不可名状，以手揉左则痛攻于右，揉右则痛攻于左，当脐揉熨则满腹
俱痛，叫喊不绝，利水敷脐之药俱不效，无可治矣。（《医通》）
治法总例 初和甫治水肿等方。经云平治权衡，谓察脉浮沉也。去宛陈 ，谓涤肠胃中腐败也。开鬼门，
谓发汗也。洁净府，利小便也。脉浮，如秤衡之在上，即发汗。鬼门，汗空也。脉沉，如秤锤之在下，即利小便。
净府，小肠也。（《鸡峰》）
治法大要，身有热者，水气在表，可汗。身无热者，水气在里，可下。其间通利小便，顺气和脾，俱不可缓耳。
（《直指》）
治疗之法，先实脾土，脾实则能舍水，土得其政，面色纯黄，江河通流，肾水行矣，肿满自消。次温肾水，
骨髓坚固，气血乃从，极阴不能化水，中焦温和，阴水泮流，然后肿自消而形自盛，骨肉相保，巨气乃平。（《济
生》）
若少壮充实患此，脉来浮大有力，当导去其水。年老虚弱得此，补中行湿为先。若气下陷者，即当提之。盖脾
者养命之本，肾者乃生气之原也，不可不究二脏之虚实。（《奇效》）
余于此证，察其实者，直清阳明，反掌收功。苟涉虚
者，温补脾肾，渐次康复。其有不大实亦不大虚者，先以清利见功，继以补中调摄。又有标实而本虚者，泻之不
可，补之无功，极为危险。（《必读》）
治水之法，行其所无事，随表里寒热上下，因其势而利导之。故宜汗宜下，宜渗宜清，宜燥宜温，六者之中，
变化莫拘。（《汇补》）
禁峻泻 此病不宜动大肠峻泻，医者多用芫花、大戟、甘遂、葶苈、猪苓、泽泻之类，故消取虽易，补
闭即难，往往致水复来而无以治之也。（《鸡峰》）
证虽可下，又当权其重轻，不可过用芫花、大戟、甘遂之剂，一发不收。吾恐峻决者易，固闭者难，水气复
来而无以治之。（《直指》）
水肿因脾虚不能制水，水渍妄行，当以参术补脾，使脾气得实，则自健运，自能升降，运动其枢机，则水自
行，非五苓、神佑之行水也，宜补中行湿利小便，切不可下。（《丹溪心法》）
诸家只知治湿当利小便之说，执此一途，用诸去水之药，往往多死。又用导水丸、舟车丸、神佑丸之类大下之，
此速死之兆。盖脾极虚而败，愈下愈虚，虽收效目前，而阴损正气，然病亦不旋踵而至。大法宜大补中宫为主，看
所挟加减，不尔则死。（《丹溪心法汇集》）
处方诸说 气虚肿满者，由脾气停滞，脾经受湿，气不流行，致头面虚浮，四肢肿满，腹肚膨胀如鼓，
上喘气急者，可与茯苓散、五苓散、三和散、分气紫苏饮、木香分气丸、俞山人降气汤、小降气汤、苏子降气汤、
曹脾散、嘉禾散。（《和剂指南》）
亦有虽烦渴而大便已利者，此不可更利，宜用五苓散加
木通、大腹皮、以通小便，或分心气饮。小便多少如常，有赤时，有不赤时，至晚则微赤，却无涩滞者，亦属阴
也，不可遽补，木香流气饮，继进复元丹。若大便不溏，气急胀满，宜四磨饮下黑锡丹。感湿而肿者，其身虽肿，
而自腰下至脚重，腿胀满尤甚于身，气或急或不急，大便或溏或不溏，但宜通利小便，多服五苓散吞木瓜丸，间
进除湿汤，加木瓜、腹皮各半钱，炒萝卜子七分半，碾碎之。有元肾气根下注而成脚肿，此当就元头上治，不可
妄以香港脚药施之。盖气入肾，则先脚肿而后肾疼；肾气注，则失肾疼而后脚肿。病后浮肿，此系脾虚，用二分平
胃散，一分五苓散，和匀汤调；或生料煎服；或用生料平胃散，加木瓜、腹皮、人参各半钱，茯苓一钱；或六君
子汤，加木香半钱。肿甚者，木香流气饮。（《要诀》）
误用峻利，小便不通者，理苓汤和之。不伏水土而肿，胃苓汤。病后腰脚浮肿，为有水气，胃苓汤加黄连。
（《医通》）
疮变为肿证治 又有年少血热生疮，变为肿满，烦渴小便少，此为热肿，《素问》所谓结阳者肿四肢是
也。（《济生》）（按严氏处有赤小豆汤，见后。）
有患生疮，用干疮药太早，致遍身肿，不可妄施他剂。若大便不通，升麻和气饮（按∶此方引《和剂》，即于
五积散中，去麻、桂、朴、芎，加干葛、大黄、升麻、灯心煎）。若大便如常，或以自利，当导其气，自小便导
之。（《要诀》）
今多有生疮，因洗浴迫毒归内而肿，此非水气，乃毒瓦斯也。有败毒散十六味，上肿加葱，下肿加灯草，甚能
泄毒去风清热。（《医宗粹言》）
通圣散，治身有恶疮，或用水洗，或用药熏，以致毒入腹而肿，本方加金银花、升麻、干葛、木通，去芒硝。
（《保命歌括》）
发表方法 若止皮肤水，腹内未有者，服诸发汗药，得汗便瘥，然慎护风寒为急。（《肘后》）
《古今录验》麻黄汤，疗风水，身体面目尽浮肿，腰背牵引髀股，不能食方。
麻黄（五两去节） 桂心（四两） 生姜（三两） 甘草（二两炙） 附子（二枚炮）
上五味切，以水一斗，先煮麻黄减二升，内药煎取三升，一服一升，日三。（《外台》）
治风水，遍身肿满，骨节酸疼，恶风脚弱，皮肤不仁，麻黄散方。
麻黄（一两去根节） 石膏（二两） 白术（二两） 附子（一两炮裂去皮脐） 汉防己（二两） 桑根
白皮（二两锉）
上件药捣筛为散，每服五钱，以水一大盏，入枣三枚，生姜半分，煎至五分去滓，不论时候温服。（《圣惠》）
治水气通身肿，麻黄汤方。
麻黄（去根节二两半） 白术（锉碎微炒二两） 甘草（炙一两） 石膏（碎三分） 赤茯苓（去黑皮一两）
上五味粗捣筛，每服五钱匕，水二盏半，枣二枚劈破，生姜一枣大拍碎，同煎至一钱，去滓温服，日三，每服盖
覆，令汗出瘥。（《圣济》）
泻水方法 论治法，本当专利小水，以宽其胀。但肿势太盛，内而膀胱，外而阴囊，相连紧急，阻塞道
路，虽加利水之剂，苦无一线之通，病何由去。必开其大便，以逐其水，随下而随补，则病已去而脾无恙，渐为调理，
庶可得生。苟病势已极，而犹守旧规，吾恐闭城门而欲其盗之出也难矣。如肿势未退，还是利水为上。（《详补指掌》）
治水肿，利小便，酒客虚热，当风饮冷水，腹肿阴胀满方。
当陆（四两） 甘遂（一两） 芒硝 吴茱萸 芫花（各二两）
上五味末之，蜜丸，服如梧子，饮服三丸，日三。一方有大黄、荛花各二两，无茱萸，加麝香、猪苓各一两。
（《千金》）（按日本前辈，于此方加大黄，名平水丸，先教谕换名浚川丸。又《外台》引《肘后》治肿入腹苦
满急，害饮食方，用葶苈、椒目、茯苓、吴茱萸。《医心方》引《新录方》治水病，腹大面肿，小便涩方。用葶苈、
芒硝、吴茱萸。并与本方同趣，当参。）
《古今录验》疗十水，大黄丸方。
大黄（一分） 硝石（一分） 大戟（一分熬） 甘遂（一分熬） 芫花（一分熬） 椒目（一分） 葶苈（一分）
上七味捣合下筛，以蜜和丸，如小豆，先食饮服一丸，日再，渐增，以知为度。范汪同。（《外台》）
治大腹水肿，气息不通，命在旦夕者方。
牛黄（二分） 昆布 海藻（各十分） 牵牛子 桂心（各八分） 葶苈子（六分） 椒目（三分）
上七味末之，别捣葶苈如膏，合和丸之，如梧子，饮服十丸，日二，稍加，小便利为度，大良。正观九年，
汉阳王患水，医所不治，余处此方，日夜尿一二斗，五六日即瘥，瘥后有他犯，因尔殂矣，计此即是神方。（崔氏
云∶蜜和为丸，蜜汤服。）（《千金》）《鸡峰》名海藻丸。《外台》∶《古今录验》疗水病，牛黄桂枝丸，
于本方去昆布、海藻、牵牛子（牛黄六铢研，桂枝十二铢。又一方云∶桂六
铢，椒目十二铢。一方云∶海藻二十四铢，不用椒目，葶苈子半升熬。一方云∶用一升），加牡蛎十二铢熬研，
蜜和丸如梧子，饮服七丸，日再。
三花神 丸，治中满腹胀，喘嗽淋 ，一切水湿肿满，湿热肠垢沉积，变生疾病。
甘遂 大戟 芫花（醋拌湿炒各半两） 牵牛（一两） 大黄（一两为细末） 轻粉（一钱）
上为末，滴水为丸，如小豆大，初服五丸，每服加五丸，温水下，每日三服，加至快利，利后却常服，病去
为度。刘庭瑞神 丸，用此药治水气，常得效。（《宣明》）
秘传八方芫花丸，消水肿。
大巴豆（二十粒去壳） 葶苈子 大黄 桂枝 芫花 杏仁（各等分）
上为末，米糊丸，每服五十丸，空心温酒吞，五更早吃，下水大效。（《得效》）（按∶《肘后》治水蛊，
用巴豆、杏仁二味。《得效》又有加味控涎丹，治热证，消浮退肿下水，于原方中，加芫花、葶苈、巴豆、黑牵
牛。）
治十水之病，百方不愈，面目四肢俱肿，气息喘急，寝卧不得，小便渐涩，腹胀气闷，水不入口，垂命欲绝，
宜服神效葶苈散方。
甜葶苈（三两隔纸炒令紫色） 牵牛子（一两半微炒） 猪苓（一两去黑皮） 泽泻（二两） 椒目（一两半）
上件药捣，细罗为散，取葱白三茎切，以浆水一大盏，煎取半盏，入清酒半盏，搅令匀，稍热空腹调下三钱，
如人行五里已来，即煮浆水粥，切入葱白，煮令极烂（《和剂》作如人行十里久，以浆水、葱白煮稀粥，至葱烂），
更入清酒五合搅匀，热吃令尽，不得吃盐及诸面食，至午后
来，或小便下三五升，或大便通利，气喘即定，肿减七分，隔日后再服，百日内切好将息。（《圣惠》）《和剂》
神助散（旧名葶苈散），治十种水气，面目四肢遍身俱肿，以手按之，随手而起，咳嗽喘急，不得安卧，腹大肿
胀，口苦舌干，小便赤涩，大便不利。既平之后，必须大将息，及断盐房室等三年。（《鸡峰》曰∶神助散，仁
宗赐名。又曰∶孙兆父子常进。又引孙兆有按，录于石水条。）《直指》神助散，于本方加木香。
神应散，治十种水气，五蛊--水蛊、血蛊、酒蛊、气蛊（按∶缺其一），四肢浮肿，腹胀，大便不通，小
便涩黄，蕴不思饮食，并皆治之。
广木香（三钱） 泽泻 槟榔 椒目（各半两） 大黄（一两半） 黑牵牛（一两） 黑附子（一只重一两
者佳半只湿纸裹炮裂）
上为细末，每服五钱，樟柳根自然汁，蜜一大匙，将前附子同擂碎，取汁放温，五更同药调服，忌盐酱蜜腥
腻房事一年。（《又用全书》）（按∶《圣惠》麻仁散，亦附子、商陆同用，然此方更多泻药，故举之于此，而
彼则录在温利中，用者宜考。）
主水气香港脚方，最急用，其法用赤小豆五合，葫一头，生姜一分，并碎破，商陆根一条切，同水煮豆烂，汤
成适寒温，去葫等，和（《政和》作细）嚼豆，空腹食之，旋旋啜汁令尽，肿立消，便止。（《本草图经》）（按∶
医心方》引《僧深方》治通身水肿，大小便不利方。商陆根三升薄切，赤小豆一斗，凡二物，水一斛，煮取一斗，
稍饮汁食豆，以小便利为度。盖是祖方。又《魏氏》有绿豆赤小豆方，即与深师同趣。《魏氏》更有通气丸，亦
赤豆、商陆并用，录在温利方中，宜参。又《朱氏》商陆、赤小豆、鲫鱼
同煮用，亦宜参。）
茅先生，小儿肿后，塌气散方（按∶后字疑）。
中庸 赤小豆 橘皮红 萝卜子 槟榔 甘草（以上各等分） 木香（一分）
[Prognosis]
If death is imminent: Patients with simultaneous swelling of the scrotum and penis die. Patients with absent pulse, open mouth, and swollen feet die in five days. Patients with swollen dorsum pedis accompanied by vomiting and heaviness of the head die. Patients with swelling on the upper dorsum pedis and knees as large as a dou (a unit of volume) die in ten days. (From *Mai Jing*) [Note: Among these entries, some apply to various diseases and are listed here for reference.]
Ge Shi Fang records: There are five types of edema that are incurable: Facial swelling with black complexion (in *Qianjin Yi Fan*, "cang" is written as "cang") indicates liver failure and is incurable. Palm swelling with disappearance of skin lines and fullness (the term "man man" is absent in *Qianjin Yi Fan*) indicates heart failure and is incurable. Umbilical protrusion or eversion indicates spleen failure and is incurable. Abdominal distension with disappearance of abdominal skin lines indicates lung failure and is incurable. Swelling of the genitalia that does not subside indicates kidney failure and is incurable. (From *Ishinpo*) (*Yanxia Shengxiao Fang* states: Black facial color indicates liver death; convex shoulders indicate lung death; protruding umbilicus indicates spleen death; hands without lines indicate heart death; lower limb flowing edema indicates kidney death. If any one of these five signs appears, it is incurable.)
There are five types of water disease that are incurable: First, black lips injure the liver. Second, flat clavicular fossae (Quepen) injure the heart. Third, protruding umbilicus injures the spleen. Fourth, flat soles injure the kidney. Fifth, flat back injures the lung. All these five injuries are untreatable. (From *Bingyuan Lun*)
Generally, deficiency-type edema starting from the abdomen and spreading to the limbs is treatable; edema starting from the limbs and returning to the abdomen is untreatable. Cases of Gu distension with visible abdominal veins, abdominal fullness with loose stools, chronic malaria transforming into deficiency-type floating edema, as well as the aforementioned signs of lip blackening injuring the liver, flat Quepen injuring the heart, protruding umbilicus injuring the spleen, flat soles injuring the kidney, and flat back injuring the lung, are all considered incurable and must be clearly distinguished. Male patients swelling upward from the feet, female patients swelling downward from the body, or cases with hard muscles and flat palms, are all untreatable. (From *Zhizhi Fang*)
There are five prognostic signs of death in water disease: 1. Incessant diarrhea and dysentery due to medication; 2. No bowel movement after taking medication; 3. Red superficial veins on the body, thick like vines; 4. Deep and fine pulse; 5. Sunken and emaciated face. (From *Yilin Fang*)
Seeing any one of the following fatal signs in edema indicates critical danger (the original text lists the five injuries mentioned above): Retraction of the testes upward, seamless scrotum, and swelling/putrefaction of the penis indicate death. Loose stools with unresolved edema indicate death. Accompanied by asthma and chest fullness, even acute cases are untreatable. Abdominal distension with blue veins after purgation indicates death. Nasal flaring, dark eye circles, scorched ears, black face, and muscle wasting indicate impending death. If Lung Qi fails to descend, leading to swollen and ulcerated feet, complete anuria, indescribable abdominal pain (pain shifting from left to right upon palpation), severe pain upon pressing the umbilicus radiating throughout the abdomen, incessant crying, and ineffectiveness of diuretic and umbilical application therapies, there is no cure. (From *Yitong*)
[General Principles of Treatment]
Chu He Fu's principles for treating edema. The Classic states "Ping Zhi Quan Heng," which means observing the floating or sinking of the pulse. "Qu Wan Chen Cuo" means cleansing the intestines and stomach of decayed matter. "Kai Gui Men" means inducing sweating. "Jie Jing Fu" means promoting urination. A floating pulse, like the beam of a scale being high, indicates the use of sweating. "Gui Men" refers to sweat pores. A deep pulse, like the weight of a scale being low, indicates the use of promoting urination. "Jing Fu" refers to the Small Intestine. (From *Jifeng*)
The main principle of treatment: If the body has heat, the water qi is in the exterior, and sweating can be used. If the body has no heat, the water qi is in the interior, and purgation can be used. In between, methods to promote urination, regulate Qi, and harmonize the Spleen should not be delayed. (From *Zhizhi Fang*)
The method of treatment: First, strengthen the Spleen Earth. When the Spleen is solid, it can contain water. When Earth functions properly, the complexion becomes purely yellow, rivers flow freely, Kidney Water moves, and swelling subsides naturally. Next, warm the Kidney Water. When the marrow is solid, Qi and Blood follow. Extreme Yin cannot transform water; when the Middle Jiao is warm, Yin water dissipates and flows. Then swelling subsides, the form recovers, bones and flesh are preserved, and Great Qi is balanced. (From *Jisheng Fang*)
For young and robust individuals suffering from this, if the pulse is floating, large, and forceful, water should be guided out. For elderly and weak individuals, tonifying the Middle and resolving dampness is paramount. If Qi sinks, it must be lifted. The Spleen is the root of life, and the Kidney is the source of vital energy; the deficiency and excess of these two Zang organs must not be neglected. (From *Qixiao Liangfang*)
Regarding this syndrome, I observe that for Excess patterns, directly clearing Yangming yields rapid results. For Deficiency patterns, warming and tonifying the Spleen and Kidney leads to gradual recovery. For those who are neither significantly excess nor deficient, clearing and draining initially shows effect, followed by tonifying the Middle and regulating. For patterns with Excess at the branch but Deficiency at the root, purging is ineffective, and tonifying is useless; this is extremely dangerous. (From *Bidu*)
The method of treating water follows non-action, adapting to the exterior/interior, cold/heat, and upper/lower conditions, guiding according to the trend. Thus, sweating, purging,渗 (seeping/diuresis), clearing, drying, and warming are all applicable, with changes不拘泥于 (not rigidly fixed) among these six methods. (From *Huibu*)
[Contraindication of Harsh Purgation]
This disease should not be treated with harsh purgation affecting the Large Intestine. Physicians often use Yuan Hua, Da Ji, Gan Sui, Ting Li Zi, Zhu Ling, Ze Xie, etc. Although water elimination is easy, subsequent consolidation and closure are difficult, often leading to the return of water with no effective treatment. (From *Jifeng*)
Even if the pattern allows for purgation, severity must be weighed. Overuse of Yuan Hua, Da Ji, Gan Sui is dangerous, as once initiated, it cannot be stopped. I fear that harsh drainage is easy, but retention is difficult; if water returns, it cannot be treated. (From *Zhizhi Fang*)
Edema caused by Spleen Deficiency failing to control water, leading to water flooding and erratic movement, should be treated with Ren Shen and Bai Zhu to tonify the Spleen. When Spleen Qi is solid, it functions naturally, ascending and descending, moving the pivot, allowing water to move on its own. This is not achieved by the water-moving properties of Wu Ling San or Shen You Wan. One should tonify the Middle, resolve dampness, and promote urination; purgation must absolutely be avoided. (From *Danxi Xinfa*)
Practitioners only know the saying that treating dampness requires promoting urination. Clinging to this path and using various water-draining drugs often leads to death. Using Da Xia agents like Dao Shui Wan, Zhou Che Wan, Shen You Wan causes rapid death. Because the Spleen is extremely deficient and failing, purging increases deficiency. Although immediate effects may be seen, Zheng Qi is damaged, and the disease recurs quickly. The major principle is to greatly tonify the Central Palace (Spleen/Stomach), adjusting for accompanying factors; otherwise, death ensues. (From *Danxi Xinfa Huibian*)
[Prescription Discussions]
For Qi Deficiency with swelling and fullness, caused by Spleen Qi stagnation, Spleen Meridian dampness, and stagnant Qi flow, resulting in facial puffiness, limb swelling, drum-like abdominal distension, and upper asthma/rapid breathing, one may use Fu Ling San, Wu Ling San, San He San, Fen Qi Zi Su Yin, Mu Xiang Fen Qi Wan, Yu Shanren Jiang Qi Tang, Xiao Jiang Qi Tang, Su Zi Jiang Qi Tang, Cao Pi San, Jia He San. (From *Heji Zhinan*)
If there is vexation and thirst but the bowels are already loose, further diuresis is contraindicated. Use Wu Ling San plus Mu Tong and Da Fu Pi to promote urination, or Fen Xin Qi Yin. If urine volume is normal, sometimes red, sometimes not, slightly red at night but without obstruction, this also belongs to Yin patterns; do not tonify hastily. Use Mu Xiang Liu Qi Yin, followed by Fu Yuan Dan. If stools are not loose, with asthma and distension, use Si Mo Yin administered with Hei Xi Dan. For edema due to dampness, where the body swells but heaviness is worse from waist to feet, with leg distension exceeding body swelling, regardless of Qi urgency or stool consistency, only promote urination. Take Wu Ling San frequently with Mu Gua Wan, intermittently take Chu Shi Tang, adding Mu Gua and Da Fu Pi (0.5 qian each), fried Luo Bo Zi (0.75 qian), crushed. For foot swelling caused by original Kidney Qi sinking, treat at the root; do not recklessly use Hong Kong Foot (Gout/Jia Ji) medicines. Qi entering the Kidney causes foot swelling first, then Kidney pain; Kidney Qi sinking causes Kidney pain first, then foot swelling. Post-illness edema due to Spleen Deficiency: mix 2 parts Ping Wei San with 1 part Wu Ling San, taken with decoction; or take raw ingredients decocted; or use raw Ping Wei San plus Mu Gua, Da Fu Pi, Ren Shen (0.5 qian each), Fu Ling (1 qian); or Liu Jun Zi Tang plus Mu Xiang (0.5 qian). For severe swelling, use Mu Xiang Liu Qi Yin. (From *Shiyi De Xiao Fang Yaojue*)
If harsh diuretics were misused causing anuria, use Li Ling Tang to harmonize. Edema due to水土不服 (unacclimatization), use Wei Ling Tang. Post-illness lumbar and foot edema due to water qi, use Wei Ling Tang plus Huang Lian. (From *Yitong*)
[Canker Sores Transforming into Edema]
Young people with blood heat developing sores that transform into swelling/fullness, with vexation/thirst and scanty urine, have Heat Edema. As stated in *Su Wen*: "Jie Yang causes swelling of the four limbs." (From *Jisheng Fang*) [Note: Yan Shi's prescription includes Chi Xiao Dou Tang, see below.]
Patients developing sores who used dry sore medications too early, resulting in whole-body swelling, should not receive other reckless prescriptions. If bowels are blocked, use Sheng Ma He Qi Yin (Note: This formula cites *Heji Ju Fang*, derived from Wu Ji San by removing Ma Huang, Gui Zhi, Hou Po, Chuan Xiong, adding Gan Ge, Da Huang, Sheng Ma, Deng Xin Cao). If bowels are normal or self-loose, guide Qi through urination. (From *Shiyi De Xiao Fang Yaojue*)
Currently, many develop swelling after bathing because washing forces toxins inward. This is not water qi but toxic vapors. Bai Du San (16 ingredients) adds Cong Bai for upper swelling and Deng Xin Cao for lower swelling, effectively draining toxins, dispelling wind, and clearing heat. (From *Yizong Cuiyan*)
Tong Sheng San treats bad sores on the body where water washing or fumigation causes toxins to enter the abdomen and swell. Add Jin Yin Hua, Sheng Ma, Gan Ge, Mu Tong to the base formula, remove Mang Xiao. (From *Baoming Ge Kuo*)
[Exterior-Releasing Methods]
If only skin water exists without internal accumulation, taking various sweating herbs leads to recovery upon sweating, but guarding against Wind-Cold is urgent. (From *Zhouhou*)
*Gu Jin Lu Yan* Ma Huang Tang treats Feng Shui (Wind Edema), with whole-body and facial swelling, back/loins pulling to thighs, inability to eat.
Ma Huang (5 liang, remove nodes) Gui Xin (4 liang) Sheng Jiang (3 liang) Gan Cao (2 liang, honey-fried) Fu Zi (2 pieces, processed)
Cut the five ingredients. Boil in 1 dou of water. First boil Ma Huang until reduced by 2 sheng. Add other herbs, boil to obtain 3 sheng. Take 1 sheng per dose, three times daily. (From *Waitai*)
Treats Feng Shui, whole-body swelling, joint soreness, aversion to wind, weak legs, insensate skin. Ma Huang San.
Ma Huang (1 liang, remove roots/nodes) Shi Gao (2 liang) Bai Zhu (2 liang) Fu Zi (1 liang, processed/cracked/skin/umbilicus removed) Han Fang Ji (2 liang) Sang Gen Bai Pi (2 liang, sliced)
Pulverize the above herbs into a powder. Take 5 qian per dose with 1 da zhen of water, 3 jujubes, 0.5 fen of ginger. Boil to 0.5 fen, strain, take warm at any time. (From *Shenghui*)
Treats general water qi swelling. Ma Huang Tang.
Ma Huang (remove roots/nodes, 2.5 liang) Bai Zhu (sliced/micro-fried, 2 liang) Gan Cao (honey-fried, 1 liang) Shi Gao (crushed, 3 fen) Chi Fu Ling (remove black skin, 1 liang)
Coarsely sieve the five ingredients. Take 5 qian bi per dose with 2.5 zhan of water, 2 split jujubes, 1 date-sized piece of smashed ginger. Boil to 1 qian, strain, take warm, three times daily. Cover after dosing to induce sweating for recovery. (From *Shengji*)
[Purging/Water-Draining Methods]
In discussing treatment, one should primarily promote urination to relieve distension. But if swelling is too severe, connecting internally to the Bladder and externally to the scrotum, blocking pathways, even with diuretics, there is no passage. How can the disease leave? One must open the bowels to drive out water, purging while tonifying simultaneously. Then the disease leaves, the Spleen remains intact, and gradual regulation may save life. If the condition is extreme yet old rules are kept, I fear it is like closing the city gate and expecting thieves to exit. If swelling persists, promoting urination is superior. (From *Xiangbu Zhizhang*)
Treats edema, promotes urination. For wine drinkers with deficiency-heat, drinking cold water in the wind, causing abdominal/scrotal swelling/fullness.
Shang Lu (4 liang) Gan Sui (1 liang) Mang Xiao Wu Zhu Yu Yuan Hua (2 liang each)
Powder the five ingredients, make honey pills the size of Wuzi seeds. Take 3 pills with water, three times daily. Another version has Da Huang and Rao Hua (2 liang each), no Zhu Yu, adds She Xiang and Zhu Ling (1 liang each). (From *Qianjin*) [Note: Japanese predecessors added Da Huang to this formula, naming it Ping Shui Wan, later renamed Jun Chuan Wan by the Prefect. Also, *Waitai* cites *Zhouhou* treating swelling entering abdomen with distress/fullness/hindering diet, using Ting Li Zi, Jiao Mu, Fu Ling, Wu Zhu Yu. *Ishinpo* cites *Xinlu Fang* treating water disease with large abdomen/facial swelling/scanty urine, using Ting Li Zi, Mang Xiao, Wu Zhu Yu. These share the same purport and should be consulted.]
*Gu Jin Lu Yan* treats Ten Waters, Da Huang Wan.
Da Huang (1 fen) Xiao Shi (1 fen) Da Ji (1 fen, roasted) Gan Sui (1 fen, roasted) Yuan Hua (1 fen, roasted) Jiao Mu (1 fen) Ting Li Zi (1 fen)
Grind and sieve the seven ingredients, mix with honey to make pills the size of small beans. Take 1 pill before meals with water, twice daily, gradually increasing until effective. Same as Fan Wang. (From *Waitai*)
Treats massive abdominal edema, blocked breath, life in danger.
Niu Huang (2 fen) Kun Bu Hai Zao (10 fen each) Qian Niu Zi Gui Xin (8 fen each) Ting Li Zi (6 fen) Jiao Mu (3 fen)
Powder the seven ingredients. Separate grind Ting Li Zi into paste. Mix and make pills the size of Wuzi seeds. Take 10 pills with water, twice daily, slightly increase until urination improves. Very good. In Zhenguan Year 9, Prince of Hanyang suffered from water disease, untreated by physicians. I prescribed this formula. Day and night he urinated 1-2 dou. Recovered in 5-6 days. Later died from another illness. This is indeed a divine formula. (Cui Shi says: Mix with honey, take with honey soup.) (From *Qianjin*) Named *Hai Zao Wan* in *Jifeng*. *Waitai*: *Gu Jin Lu Yan* treats water disease, Niu Huang Gui Zhi Wan. Remove Kun Bu, Hai Zao, Qian Niu Zi from the base formula (Niu Huang 6 zhu ground, Gui Zhi 12 zhu. Another version: Gui Zhi 6 zhu, Jiao Mu 12 zhu. Another: Hai Zao 24 zhu, no Jiao Mu, Ting Li Zi half sheng roasted. Another: use 1 sheng). Add Mu Li 12 zhu (roasted/ground), mix with honey into Wuzi-sized pills. Take 7 pills with water, twice daily.
San Hua Shen Wan treats middle-fullness/abdominal distension, asthma/cough, strangury, all water-damp swelling/fullness, damp-heat intestinal filth deposition, and generated diseases.
Gan Sui Da Ji Yuan Hua (vinegar-moistened/stir-fried, 0.5 liang each) Qian Niu Zi (1 liang) Da Huang (1 liang, fine powder) Qing Fen (1 qian)
Make powder, drop water to make pills the size of small beans. Start with 5 pills, add 5 per dose, take with warm water, three times daily. Increase until brisk purgation occurs. After purgation, continue taking regularly until disease resolves. Liu Tingrui's Shen Xiao Wan uses this drug for water qi, often effective. (From *Xuanming*)
Secret Eight-Ingredient Yuan Hua Wan, reduces edema.
Da Ba Dou (20 kernels, shell removed) Ting Li Zi Da Huang Gui Zhi Yuan Hua Xing Ren (equal parts)
Make powder, rice-paste pills. Take 50 pills on empty stomach with warm wine, early morning. Great effect in driving out water. (From *De Xiao*) [Note: *Zhouhou* treats water gu with Ba Dou and Xing Ren. *De Xiao* also has Modified Kong Yan Dan for heat patterns, reducing floating edema/driving out water, adding Yuan Hua, Ting Li Zi, Ba Dou, Hei Qian Niu to the original formula.]
Treats Ten Waters disease, unresponsive to hundreds of formulas, swelling of face/limbs, asthma, inability to sleep, scanty urine, abdominal distension/gas, inability to drink, near death. Take Shen Xiao Ting Li San.
Tian Ting Li Zi (3 liang, paper-cooked until purple) Qian Niu Zi (1.5 liang, micro-fried) Zhu Ling (1 liang, remove black skin) Ze Xie (2 liang) Jiao Mu (1.5 liang)
Grind and sieve finely. Take 3 stalks of Cong Bai, slice. Decoct in 1 da zhen of Jiang Shui (fermented grain liquid) to obtain 0.5 zhen. Add 0.5 zhen of clear wine, mix well. Take 3 qian warm on empty stomach. After walking about 5 li, cook Jiang Shui congee with sliced Cong Bai until very soft (*Heji* says walk 10 li, cook thin congee with Jiang Shui/Cong Bai until soft). Add 0.5 he of clear wine, mix, drink hot completely. Avoid salt and wheat products. By afternoon, either urinate 3-5 sheng or have loose stool. Asthma settles, swelling reduces by 70%. Take again every other day. Rest well for 100 days. (From *Shenghui*) *Heji Ju Fang* Shen Zhu San (formerly Ting Li San) treats Ten Types of Water Qi, whole-body/face/limb swelling, pitting edema, cough/asthma/inability to lie flat, massive abdominal distension, bitter taste/dry tongue, red/scanty urine, constipation. After stabilization, strict rest and abstinence from salt/sexual activity for three years are required. (*Jifeng* says: Shen Zhu San was named by Emperor Renzong. Also: Sun Zhao father and son often presented it. Also cites Sun Zhao's note, recorded under Shi Shui section.) *Zhizhi Fang* Shen Zhu San adds Mu Xiang to the base formula.
Shen Ying San treats Ten Types of Water Qi, Five Gu—Water Gu, Blood Gu, Wine Gu, Qi Gu (Note: one missing), limb swelling, abdominal distension, constipation, yellow/scanty urine, lack of appetite. Treats all.
Guang Mu Xiang (3 qian) Ze Xie Bing Lang Jiao Mu (0.5 liang each) Da Huang (1.5 liang) Hei Qian Niu Zi (1 liang) Hei Fu Zi (preferably one weighing 1 liang, half wrapped in wet paper/processed/cracked)
Make fine powder. Take 5 qian per dose with natural juice of Zhang Liu Gen, 1 large spoon of honey. Grind Fu Zi together with juice, warm, take at 5 AM with medicine. Avoid salt, soy sauce, honey, fish/meat, and sexual activity for one year. (From *You Yong Quan Shu*) [Note: *Shenghui* Ma Ren San also uses Fu Zi and Shang Lu, but this formula has more purgatives, so it is cited here, whereas that one is recorded under Warm Diuretics. Users should investigate.]
Main Water Qi Hong Kong Foot Formula, most urgent. Method: Use Chi Xiao Dou (5 he), Hu (1 head), Sheng Jiang (1 fen), all smashed. Cut Shang Lu root (1 piece). Boil together until beans are soft. When soup is warm, remove Hu etc. Chew beans finely, eat on empty stomach, sip soup slowly until finished. Swelling disappears immediately, then stop. (From *Bencao Tujing*) [Note: *Ishinpo* cites *Seng Shen Fang* treating whole-body edema with difficult urination. Shang Lu root 3 sheng thinly sliced, Chi Xiao Dou 1 dou. Two ingredients, boil in 1 hu to obtain 1 dou. Drink soup and eat beans slightly, stopping when urination improves. This is likely the ancestral formula. Also *Wei Shi* has Mung Bean/Chi Xiao Dou formula, similar to Shen Shi. *Wei Shi* also has Tong Qi Wan, using both Chi Dou and Shang Lu, recorded in Warm Diuretics, consult. Also *Zhu Shi* uses Shang Lu, Chi Xiao Dou, Crucian Carp boiled together, consult.]
Mr. Mao, post-childhood edema, Ta Qi San formula (Note: "Hou" character suspected error).
Zhong Yong Chi Xiao Dou Ju Pi Hong Luo Bo Zi Bing Lang Gan Cao (all equal parts) Mu Xiang (1 fen)