经曰∶目窠上微肿，如新卧起之状，其颈脉动，时咳，阴股间寒，足胫肿，腹乃大，其水已成
矣。以手按其腹，随手而起，如裹水之状，此其候也。盖上既目肿，下又胫肿，中则腹大，水气已
遍行周身，此必中州脾胃先败，土不胜水，日积日甚，泛滥不收。其颈脉动而时咳，乃横流溢出，
犯胃射肺。病势至此，危急之至，原非寻常之剂可以取效，但舟车、疏凿等法，又过于峻猛，诚恐
水气虽去，元气随亡，仍归于败耳。消阴利导煎主之。
消阴利导煎（自制）
当归（二钱） 茯苓（三钱） 白术（一钱五分） 广 皮（一钱） 浓朴（一钱）
肉桂（五分） 附子（八分） 木通（一钱五分） 大腹皮（一钱五分） 牛膝（一钱五分）
泽泻（一钱五分） 车前（二钱） 鲜姜皮（一钱） 苡仁（一两煎汤代水）
本方以桂、附为消阴之主药，以茯苓、姜皮、腹皮、泽泻、车前、苡仁、木通为利导之整队，
以当归、白术、广皮、浓朴顾气血而调脾胃，是速战速决，堂堂正正之师。祖怡注。
肤胀者，寒气客于皮肤之间， 然不坚，腹大，身尽肿，皮浓，按其腹， 而不起，腹色不
变，此其候也。此症
由于内则宗气失守，虚气无归；外则寒气客于皮肤，遍身流窜，故腹大身肿而皮浓。但气为无形之
邪，虽肿而不坚，按之则气散而不能骤起。当扶正去寒，理气化浊，祛寒建中汤主之。
祛寒建中汤（自制）
当归（二钱） 白芍（一钱酒炒） 茯苓（二钱） 白术（一钱） 附子（八分）
广皮（一钱） 浓朴（一钱） 枳壳（一钱麸炒） 白蔻（六分） 木香（五分）
枣（二枚） 姜（三片）
本方附、芍、茯苓同用，能除皮中水气，兼有真武汤意。术、归以顾正，姜、枣以建中。以上
是扶正祛寒。枳、朴、木香、白蔻、广皮，理气化浊。理路非常显明。姜、枣并用，胀门惟此一方
。盖以寒水去路，不外汗与小便，既有附、术、苓以通小便，而皮肤与营卫最近，不可无姜、枣以通
营卫而作汗也。祖怡注。
The *Classic of Internal Medicine* states: There is slight swelling above the eye sockets, resembling the appearance after just waking up; the carotid pulse throbs; there is occasional coughing; coldness in the inner thighs; swelling of the calves; and subsequently abdominal distension. This indicates that water retention has already formed. Pressing the abdomen with the hand causes the indentation to rise immediately upon release, resembling a state where water is wrapped inside. This is its clinical presentation. Since there is swelling above at the eyes, below at the calves, and in the middle with abdominal distension, the pathogenic water qi has circulated throughout the entire body. This must be due to the prior failure of the Spleen and Stomach (the Middle Jiao); Earth fails to control Water, accumulating day by day and becoming increasingly severe, overflowing without restraint. The throbbing of the neck pulse and occasional coughing indicate that the water qi flows horizontally and overflows, invading the Stomach and projecting into the Lungs. When the disease progresses to this stage, it is critically dangerous. It is originally not something that ordinary prescriptions can effectively treat. However, methods such as Zhou Che Wan (Boat and Cart Pill) or Shu Qiao Yin (Sieve-Draining Decoction) are too harsh and vigorous. There is genuine concern that although the water qi may be eliminated, the Yuan Qi (Original Qi) will perish along with it, ultimately leading to collapse. The primary treatment is Xiao Yin Li Dao Jian (Decoction to Eliminate Yin and Facilitate Guidance).
Xiao Yin Li Dao Jian (Self-made Prescription)
Dang Gui (Angelicae Sinensis Radix, 2 qian)
Fu Ling (Poria, 3 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1.5 qian)
Guang Pi (Citri Reticulatae Pericarpium, 1 qian)
Nong Po (Magnoliae Officinalis Cortex, 1 qian)
Rou Gui (Cinnamomi Cortex, 0.5 qian)
Fu Zi (Aconiti Lateralis Radix Praeparata, 0.8 qian)
Mu Tong (Akebiae Caulis, 1.5 qian)
Da Fu Pi (Arecae Pericarpium, 1.5 qian)
Niu Xi (Achyranthis Bidentatae Radix, 1.5 qian)
Ze Xie (Alismatis Rhizoma, 1.5 qian)
Che Qian (Plantaginis Semen, 2 qian)
Xian Jiang Pi (Zingiberis Recensis Pericarpium, 1 qian)
Yi Yi Ren (Coicis Semen, 1 liang, decocted in water to replace cooking water)
This prescription uses Rou Gui and Fu Zi as the main herbs to eliminate Yin-cold. It employs Fu Ling, Jiang Pi, Da Fu Pi, Ze Xian, Che Qian, Yi Yi Ren, and Mu Tong as the main force for promoting urination and guiding out dampness. Dang Gui, Bai Zhu, Guang Pi, and Nong Po are used to nourish Qi and Blood and regulate the Spleen and Stomach. This represents a swift, decisive, and orthodox military strategy. (Commentary by Zu Yi)
Fu Zhang (Skin Distension) occurs when Cold Qi lodges between the skin layers. The abdomen is distended but feels soft and not firm upon palpation; the whole body is swollen; the skin is thickened; pressing the abdomen leaves an indentation that does not rebound quickly; and the abdominal color remains unchanged. This is its clinical presentation. This condition arises because internally, the Zong Qi (Gathering Qi) loses its stability, leaving empty Qi without a root; externally, Cold Qi lodges in the skin and circulates throughout the body. Consequently, the abdomen becomes distended, the body swells, and the skin thickens. However, Qi is a formless pathogen; although there is swelling, it is not firm. Upon pressing, the Qi scatters and cannot rebound rapidly. The treatment should focus on supporting the Righteous Qi (Zheng Qi) and dispelling Cold, regulating Qi and transforming turbidity. The primary treatment is Qu Han Jian Zhong Tang (Decoction to Dispel Cold and Establish the Middle).
Qu Han Jian Zhong Tang (Self-made Prescription)
Dang Gui (Angelicae Sinensis Radix, 2 qian)
Bai Shao (Paeoniae Radix Alba, 1 qian, stir-fried with wine)
Fu Ling (Poria, 2 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 qian)
Fu Zi (Aconiti Lateralis Radix Praeparata, 0.8 qian)
Guang Pi (Citri Reticulatae Pericarpium, 1 qian)
Nong Po (Magnoliae Officinalis Cortex, 1 qian)
Zhi Ke (Aurantii Fructus Immaturus, 1 qian, stir-fried with bran)
Bai Kou (Amomi Fructus Rotundus, 0.6 qian)
Mu Xiang (Aucklandiae Radix, 0.5 qian)
Da Zao (Jujubae Fructus, 2 pieces)
Sheng Jiang (Zingiberis Rhizoma Recens, 3 slices)
In this prescription, the combination of Fu Zi, Bai Shao, and Fu Ling can remove water qi from the skin, incorporating the intent of Zhen Wu Tang (True Warrior Decoction). Bai Zhu and Dang Gui are used to support the Righteous Qi, while Sheng Jiang and Da Zao are used to establish the Middle Jiao. These actions constitute supporting the Righteous Qi and dispelling Cold. Zhi Ke, Nong Po, Mu Xiang, Bai Kou, and Guang Pi are used to regulate Qi and transform turbidity. The therapeutic logic is very clear. The simultaneous use of Sheng Jiang and Da Zao constitutes the unique approach for treating distension. Generally, the pathways for eliminating Cold-Water are limited to sweating and urination. Since Fu Zi, Bai Zhu, and Fu Ling are already used to promote urination, and because the skin is closest to Ying and Wei (Nutritive and Defensive Qi), it is indispensable to use Sheng Jiang and Da Zao to unblock Ying and Wei to induce sweating. (Commentary by Zu Yi)