者，除痈疽、消渴等症不常见外，至腹满一症，人人无不有之。但微则旋胀旋消，甚则胀不大消而成蛊耳。要
知人之有身，执中央以运四旁者也。今反竭四旁以奉其锢，尚有精华发现于色脉间乎？此所以脉细皮寒，少食
多汗，危羸之状，不一而足也。言当不谬，请自揆之。竟不能用，半载而逝。
按∶是症多由醉饱入房，大伤真阴，绝其带脉，水亏木燥，乘其所不胜之脾，致成胀耳。鱼盐之论，
恐未必然。
一人血蛊，服药百日后，大腹全消，左胁始露病根一条，如小枕状，以法激之，呕出黑污血斗许，余从大
便泄去始消。每思蛊胀，不论气、血、水、痰，总必自开一宇，如寇盗蟠据，必根据山傍险，方可久聚。《内经》
论五脏之积，皆有定所，何独于六腑之积久为患，如鼓胀等类者，遂谓漫无根底区界乎？（《张氏医通》载此，谓
是喻嘉言案，泛论一番。至此积果在何腑，却又说不出，此即吴圣符案之后半段也。）
杨乘六治孙氏女，年十九，病鼓症。先自头面肿起，渐次手足浮肿，又次肚腹肿胀，小水不利，医杂用枳
壳、浓朴、苍术、陈皮、三棱、莪术、半夏、黄芩等，并利水药，肿胀益甚，更加痰喘。询其起病之由，知为
寒水侮土，因治不如法，致水势冲激，而土崩防溃也。以大剂补中益气加木瓜、干姜，送《金匮》肾气丸，月
余而愈。与立斋治素性急妇人同法。）
三原民荀氏妇者，病蛊胀，诸医束手，气已绝矣。逾二鼓忽苏，家人惊喜。问之曰∶适已出门，若将远行
者，途遇一老人云，吾已延孙思邈真人医汝，速反也。乃入门，见真人已先在，年可三十许，以连环针针心窍
上，久之遂醒，不知身之已死也。视之果有上下二孔，七日始合，又十一年而终。三原医士王文之说。（《池北偶谈》。）
王损庵治嘉定沈氏子，年十八，患胸腹身面俱胀，医治半月不效。诊其脉，六部皆不出，于是用紫苏、桔
梗之类，（紫苏别名水督邮，可知其治水有殊能也。）煎服一盏，胸有微汗。再服则身尽汗，其六部和平之脉皆出，
一二日其症悉平。（又见《医说续编》谓出《赵氏或问》。）
一男子三十余，胸腹胀大，发烦躁渴面赤，不得卧而足冷。王以其人素饮酒，必酒后入内，夺于所用，精
气溢下，邪气因从之上逆，逆则阴气在上，故为 胀。其上焦之阳，因下逆之邪所迫，壅塞于上，故发烦躁，
此因邪从下而上，盛于上者也。于是用吴茱萸、附子、人参辈，以退阴逆，冰冷冻饮料之，以收上焦之浮热。入咽
觉胸中顿爽，少时腹中气转，如牛吼，泄气五七次，明日其症愈矣。（《治法汇》。同上。）
张隐庵在苕溪治一水肿者，腹大肤肿，久服八正散、五子、五皮之类，小便仍淋漓痛苦。曰∶此虽虚症，
然水不行，则肿不消，正气焉能平复？时夏月，欲用麻黄，恐阳脱而汗漏，止以苏叶、防风、杏仁三味各等分，
令煎汤温服，覆取微汗，而水即利矣。次日至病者之室，若翻水数盘，床帏被褥无不湿透。告以服药后，不待
取汗，小水如注，不及至圊，就床上坐溺。天明，不意小水复来，不及下床，是以沾濡若此，今腹胀痛楚悉
除矣。曰∶未也，此急则治其标耳。病由火土伤败以致水泛，乃久虚之症，必待脾元复故，乃保万全。与六君
子去甘草，加苍、朴、姜、附，令每日温服，后即以此方为丸。半载后来谢，已全愈矣。张曰∶如此症水虽行，
而正气不复，后仍肿胀而死者多矣。至不知发汗行水之法，徒事渗利，久之正气日消，邪气日甚，而死者亦多
矣，可不慎哉。
陆养愚治吴体原妇，患腹胀，每于鸡鸣时发，至午即宽。或与调气治之不效。后于半夜即发，至两日渐于
薄暮即发矣，夜不能卧，饮食亦减，肌体日瘦。脉之，沉微而迟，曰∶若论症，日宽夜急，血不足也，当养血；
论脉沉弱而迟，气不足也，当补气。乃以补中益气汤倍当归，加豆仁、木香，数剂而愈。
陆肖愚治陆南洋外家患痞。或以为食积痰饮，服消导、二陈之类，痞满益甚。或以为气虚中满，与补中益气
汤亦不效。寒热消补约一年，饮食大减，肌肉渐消，大便时泻时结。诊其脉，浮之弦大，沉之涩小，曰∶如
此非百剂不能全愈。用调气养荣汤加参、术各一钱五分，木香、豆仁各三分，二剂反微甚。因减参、术，增木
香、豆仁，仍不应。乃增木香、豆仁至一钱，减参、术至七分，而胀满稍愈。后增木香、豆仁至钱半，而饮食
渐加，胀满始宽大半。自后渐加参、术至二三钱，减香、豆至一二分，约六十剂全瘳。
朱丹溪治一人患趺肿，渐上膝足，不可践地，头面遍身肿胀，用苦瓠瓤实捻如豆大，以面裹煮一沸，空
心服七枚，至午当出水一斗，三日水自出不止，大瘦乃瘥。须慎口味。（苦瓠须择无靥翳细理紧净者，不尔有毒。
与徐文江妻用葫芦治法略同。）
万密斋治万邦瑞之女，年十四，病肿。寅至午上半身肿，午至戌下半身肿，亥子丑三时肿尽消，惟阴肿溺
不得出，诸医莫识其病。万曰∶此肝肾病也。肾者水脏也。亥子丑水旺之时也。肝属木，肾之子也。木生于亥，
子丑二时，肝胆气行之时也。肝经之脉环阴器，当其气行之时，故阴肿而溺不出也。水在人身随上下，午时以
前，气行于上，故上半身肿，午时以后，气行于下，故下半身肿，此病源也。五苓散，泻水之剂也。经曰∶诸
湿肿满，皆属脾土。平胃散，燥湿之剂也。以二方为主，名胃苓汤。加生姜皮之辛热，助桂枝、陈皮以散肝
经之邪；茯苓皮之甘淡，助猪苓、泽泻以渗肾经之邪；防己之通行十二经，以散流肿上下之邪也。十余剂而愈。
张子和曰∶涿郡周敬之，自京师归，鹿邑道中，渴饮水过多，渐成肿满。或用三花神 丸，惮其太峻。或
用五苓散分利水道，又太缓。淹延数月，终无一效，盖粗工之技止于此耳。后手足与肾皆肿，大小便皆秘，托
常仲明求治于张。张令仲明付药，比至，已殁矣。张曰∶病水之人，其势如长川泛溢，欲以杯杓取之难矣，必
以神禹决水之法斯愈矣。（合陈三农案以观之，则洁净府一法，当用宜速用也。）
薛立斋治一妇人，面目浮肿，月经不通，此水分也。朝用葶苈丸，夕用归脾汤，渐愈。更用人参丸兼服而
全愈。（泻补兼行法。）
一妇人素性急，先因饮酒难化，月水不调。或用理气化痰药，反吐，腹膨胀，大便泄泻。又加乌药、蓬术，
肚腹肿胀，小便不利。加猪苓、泽泻，痰喘气急，手足厥冷，头面肢体肿胀，指按成窟。脉沉细，右寸尤甚。
此脾肺虚冷，不能通调水道，下输膀胱，渗泄之令不行，生化之气不运也。东垣云∶水饮留积，若土在雨中则
为泥矣。得和气暖日，水湿去而阳化，自然万物生长。喜脉相应，遂与《金匮》加减肾气丸料服之，小便即通，
数剂肿胀消半，四肢渐温，自能转侧。又与六君加木香、肉桂、炮姜，治之全愈。后不戒七情，不调饮食，顿
作泄泻，仍用前药加附子五分而安。（误消用补法。）
孙兆治一女子心腹肿痛，色不变。经曰∶三焦胀者气满，皮肤 然石坚。遂以仲景浓朴生姜半夏人参甘
草汤，下保和丸渐愈。
丹溪治一妇血气俱虚，患单腹胀，因气馁不能运化，濒死，但手足面目俱肿，气尚行阳分犹可治。遂以参、
术、芎、归、白芍以敛胀，滑石、腹皮以敛气，苏、桔、卜子、陈皮以泄满，海金砂、木通利水，木香运气而
愈。（补泻兼行法。）
一妇人胸膈不利，饮食少思，腹胀吞酸。或用疏利之剂，反致中满不食。此脾土虚而肝木胜，用补中益气
汤加砂仁、香附、煨姜，又以六君子加芎、归、桔梗而愈。
吴江史元年母，久病之后，遇事拂意，忽胸腹胀满，面目微肿，两腿重滞，气逆上升，言语喘促。所服皆
清气之剂，不效。薛曰∶此脾肺虚寒也。先用六君子汤，一剂病势顿减。后用补中益气加茯苓、半夏、干姜，
二剂形体顿安。后以七情失调，夜间腹胀，乃以十全大补加木香而痊。
太仓陆中舍，以肾虚不能摄水，肚腹胀大，用黑丸子，（又名碑记丸。）未数服而殁于京。今之专门治蛊者，
即此方也，用之无不速亡。（病家不可不知此。）
机房蔡一素不慎起居，患症同前，更加手足逆冷，恶寒不食，用补中益气汤加附子一钱，先回其阳，至数
剂诸症渐愈。薛因他往，或用峻利之剂，下鲜血甚多，亦致不起。
绍兴术士朱 衣名甫，苦水蛊腹胀。医者只令服嘉禾散，久之不效，葛丞相授以此法即安。右取嘉禾散、
四柱散细末各等分，合和令匀，根据法煎服。（《百乙方》。）
王尚之提刑传云∶武义县方，治数人甚妙。用黄颡鱼一个，绿豆一合许，右煮淡羹顿食。绍兴张医升之云∶
以商陆根煮绿豆令熟，去商陆，取绿豆任意食之亦妙。《王氏博济方》第二卷逐气散，与此药大同小异。（同上。）
有病蛊者，梦一道人示颂云∶似犬非犬，似猫非猫，烹而食之，其病自消。偶有狐入其室，杀而烂烹食之，
腹自消。（《夷坚志》。）
（按∶白氏六帖云，青邱狐食之，令人不蛊。又本草孟诜云，狐补虚，又主五脏邪气蛊毒发寒热。原注。）
丹溪治一妇人，夜间发热，面先肿，次及肚足，渴思冷水，用麻黄、葛根、川芎、苍白术、木通、腹皮、
栀子、甘草愈。（此开鬼门法。）
一人秋冬患肿，午前上甚，午后下甚，口渴乏力，脉涩弱，食减。此气怯汗不能自出，郁而为痿。遂灸肺
、大椎、合谷、分水，用葛根、苏叶、白术、木通、海金砂、大腹皮、茯苓皮、浓朴、陈皮、黄芩、甘草，
渐愈。（同上。散利兼行法。）
陈三农治一人年甫三旬，怒后发肿，饮水过多，旦日肢体俱肿，腹胀异常。年方壮而病发于骤，脉方实而
药不厌攻，若不急于疏通，久必成大患。以胃苓散加牛膝、车前，三进而不为少动，是病深药浅也。更以舟车、
神丹进，而小便泉涌，肢体渐收。仍与胃苓汤加白术、椒仁，十五日而愈。
喻嘉言治顾鸣仲，有腹疾近三十年，朝宽暮急，每一大发，腹胀十余日方减，食湿面及房劳其应如响，（肝
肾虚，故房劳即发。脾不运，故食面即发。病情已大显著矣。）腹左隐隐微高鼓，呼吸触之， 有声。以痞
治之，内攻外贴无效。诊之曰∶人身五积六聚之症，心、肝、脾、肺、肾之邪，结于腹之上、下、左、右及脐之
当中者，皆高如覆盂者也。胆、胃、大小肠、膀胱、命门之邪，各积于本位，不甚形见者也。此症乃肾脏之阴气，
聚于膀胱之阳经，有似痞块耳。盖肾有两窍，左肾之窍从前通膀胱，右肾之窍从后通命门，邪结于左畔，即左肾
与膀胱为之主也。六腑惟胆无输泄，其五腑受五脏浊气传入，不能久留即为输泄者也。今肾邪传于膀胱，膀胱溺
其输泄之职，旧邪未行，新邪踵至，（邪字欠分晓。）势必以渐透入膜原，（膜原在膈间，去膀胱甚远，如何透入？）
如革囊裹物者然。经曰∶膀胱者，州都之官，津液藏焉，气化则能出矣。然则肾气久聚不出，岂非膀胱之失其运化
乎？夫人一团之腹，大小肠、膀胱俱居其中，（岂独此耶？）而胞又居膀胱之中，（膀胱即脬也，昔人曾有辨之者。）
惟其不久留输泄，是以宽乎若有余地。今肾之气不自收摄，悉输膀胱，膀胱之气蓄而不泄，有同胆腑之清净无为，
（据云则是其人竟无小便耶。）其能理乎！宜其胀也。经曰∶肾病者善胀，尻以代踵，脊以代头。倘膀胱能司其
输泄，何致若此之剧耶？又曰∶巨阳引精者三日，太阳膀胱经吸引精气者，其胀止于三日。（巨阳引精句，乃《内经》
言风劳之文，引入此间殊觉牵强。喻氏英雄欺人，往往如此。）此之为胀，且数十年之久，其吸引之权安在哉？治
法补肾水而致充足，则精气深藏，而膀胱之胀自消。（只此数句，是此症肯綮。）补膀胱而令气旺，则肾邪不蓄，
而输化之机自裕。所以然者，以肾不补不能藏，膀胱不补不能泻。然补肾易而补膀胱则难，以本草诸药多泻少补
也。经于膀胱之子不足者，断以死期，后人莫解其故。吾试揣之，岂非以膀胱愈不足则愈胀，胀极势必传于肾，
肾胀极势必逆传于小肠，小肠胀极势必逆传于脾，乃至通身之气
散漫而无统耶？医者于未传之先，早见而预图之，能事殚矣。
按∶是症专属肝肾二经，与膀胱毫无干涉，乃舍肝而强入膀恍，便觉支离满纸。（实肝脾肾三经之症，
未可专举肝肾。）
叶天士治一女子，年二十七岁，病肿甚异，寅后午前，上半身肿，午后丑前下半身肿，上下尽消，惟牝户
肿，小便难，诸医不能治。经云∶半身以上，天之阳也，宜发其汗，使清气出上窍也；身半以下，地之阴，宜
利小便，使浊阴出下窍也。正上下分消，以去湿之法，惟半夜阴肿不得小便，此又当从肝经求之。盖厥阴肝经
之脉，丑时起于足上，环阴器。又肝病者，则大小便难。用胃苓、五皮汤，发汗利小便也。内有茯苓，所以伐
Those causes (leading to swelling), except for conditions like carbuncles and sores (carbuncles and sores) and Xiao Ke (wasting-thirst syndrome), are not common. As for the symptom of abdominal fullness, everyone has it. But when mild, it swells and subsides immediately; when severe, the swelling does not subside and becomes Gu distension (Gu distension, a type of abdominal distension often associated with ascites or parasitic infection). One must know that the human body relies on the Central Jiao (Central Burner, primarily referring to the Spleen and Stomach) to transport and transform the Four Peripheries (the four limbs and other organs). Now, instead, the peripheries are exhausted to serve its obstructed pathology. Is there still any essence manifesting in the complexion and pulse? This is why the pulse is fine, the skin is cold, food intake is low but sweating is profuse, and various signs of critical emaciation appear one after another. These words should not be wrong; please reflect on them yourself. (The patient) ultimately did not listen and passed away half a year later.
Commentary: This condition mostly arises from sexual activity after heavy drinking, severely damaging True Yin, severing the Dai Mai (Girdle Vessel), leading to Kidney Water deficiency and Liver Wood dryness, which attacks the Earth (Spleen) it cannot overcome, resulting in distension. The theory that fish and salt cause this may not necessarily be correct.
A person suffered from Blood Gu (Blood Gu, a type of distension caused by blood stasis). After taking medicine for a hundred days, the large abdomen completely subsided, but a root of the disease emerged under the left hypochondrium, shaped like a small pillow. Using a method to stimulate it, he vomited about one dou of dark, turbid blood, and the rest was excreted through the stool before subsiding. Whenever I think of Gu distension, whether due to Qi, Blood, Water, or Phlegm, it always establishes its own territory, like bandits occupying a stronghold, relying on mountainous terrain to gather for a long time. The *Nei Jing* discusses the accumulations of the Five Zang organs, all having fixed locations. Why is it that for the accumulations of the Six Fu organs causing long-term harm, such as Drum Distension, we say they have no root or boundary? (*Zhang Shi Yi Tong* records this case, attributing it to Yu Jiayan's medical record, discussing it generally. As for which Fu organ this accumulation is in, it cannot be specified; this is actually the second half of Wu Shengfu's case.)
Yang Chengliu treated Sun's daughter, aged nineteen, suffering from Drum Distension. It started with swelling in the head and face, gradually spreading to edema in the hands and feet, then swelling in the abdomen. Urination was difficult. Doctors indiscriminately used Zhi Qiao (Bitter Orange Peel), Hou Po (Magnolia Bark), Cang Zhu (Atractylodes Lancea), Chen Pi (Tangerine Peel), San Leng (Burreed Tuber), E Zhu (Curcuma Rhizome), Ban Xia (Pinellia Tuber), Huang Qin (Scutellaria Root), and other diuretics. The swelling worsened, accompanied by phlegm and wheezing. Inquiring about the onset, it was known to be Cold Water insulting Earth (Kidney Water attacking Spleen Earth). Due to improper treatment, water pressure surged, causing Earth to collapse. A large dose of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Mu Gua (Chaenomeles Fruit) and Gan Jiang (Dried Ginger) was given, followed by Shen Qi Wan (Kidney Qi Pill) from *Jin Gui Yao Lue*. She recovered in over a month. (This method is similar to Xue Lizhai's treatment of a woman with an irritable temperament.)
The wife of a surnamed Xun from Sanyuan suffered from Gu distension. All doctors were at a loss, and her breath had ceased. Suddenly, past the second watch (3-5 AM), she revived. Her family was overjoyed. He asked her, "You just went out, as if traveling far. On the way, you met an old man who said, 'I have invited the True Person Sun Simiao to treat you. Return quickly.'" Upon entering, she saw the True Person already there, appearing about thirty years old. He used linked needles to puncture the heart cavity. After a long time, she woke up, unaware that she had died. Examination revealed two holes, upper and lower, which healed in seven days. She lived for another eleven years before passing. This was told by Wang Wenzhi, a physician from Sanyuan. (*Chi Bei Ou Tan*.)
Wang Sun'an treated the son of the Shen family from Jiading, aged eighteen, suffering from swelling in the chest, abdomen, body, and face. Medical treatment for half a month was ineffective. His pulse was imperceptible in all six positions. Therefore, Zi Su (Perilla Leaf) and Jie Geng (Platycodon Root) were decocted and taken in one cup. There was slight sweating in the chest. After a second dose, the whole body sweated, and the peaceful pulses of all six positions returned. The symptoms resolved in one or two days. (Also seen in *Yi Shuo Xu Bian*, attributed to *Zhao Shi Huo Wen*.)
A man in his thirties had a large chest and abdomen, with episodes of irritability, thirst, red face, inability to lie down, and cold feet. Wang believed that since the person usually drank alcohol, it was likely sexual activity after drinking, leading to the depletion of essence. Pathogenic factors then rose counterflow. Counterflow leads to Yin Qi being above, causing distension. The Yang Qi of the Upper Jiao, forced by the counterflowing pathogens below, became congested above, causing irritability. This is because pathogens rise from below and dominate above. Therefore, Wu Zhu Yu (Evodia Fruit), Fu Zi (Aconite Root), Ren Shen (Ginseng Root), etc., were used to retreat the counterflowing Yin. They were administered with ice-cold drinks to collect the floating heat in the Upper Jiao. After swallowing, the chest felt instantly refreshed. Soon, gas turned in the abdomen, sounding like a cow bellowing, and he passed gas five or seven times. The next day, the symptoms were cured. (*Zhi Fa Hui*. Same as above.)
Zhang Yinan treated a patient with edema in Taoxi. The abdomen was large, and the skin was swollen. Having taken Ba Zheng San (Eight-Herb Correcting Powder), Wu Zi Yan Zong Wan (Five-Seed Procreation Pill), and Wu Pi Yin (Five-Peel Decoction) for a long time, urination remained dribbling and painful. He said, "Although this is a deficiency pattern, if water does not move, swelling will not subside, and how can Zheng Qi (Upright Qi) recover?" It was summer. He wanted to use Ma Huang (Ephedra Herb) but feared Yang collapse and profuse sweating. Instead, he used equal parts of Su Ye (Perilla Leaf), Fang Feng (Saposhnikovia Root), and Xing Ren (Apricot Seed), decocted and taken warm. Covering the patient to induce slight sweating, the water flowed freely. The next day, visiting the patient's room, it seemed as if several basins of water had been spilled; bed curtains and bedding were soaked. He explained that after taking the medicine, without needing to induce sweating, urine poured out like a stream, too late to reach the toilet, so he urinated while sitting on the bed. At dawn, unexpectedly, urine came again, too late to get off the bed, hence the wetness. Now, abdominal distension and pain were completely gone. He said, "Not yet. This is only treating the branch in acute situations. The disease resulted from Fire and Earth damage leading to water flooding, a chronic deficiency pattern. Only when the Spleen Yuan recovers can safety be ensured." Liu Jun Zi Tang (Six-Gentleman Decoction) minus Gan Cao (Licorice Root), plus Cang Zhu (Atractylodes Lancea), Hou Po (Magnolia Bark), Gan Jiang (Dried Ginger), and Fu Zi (Aconite Root) were prescribed to be taken warm daily, later made into pills. Half a year later, the patient returned to express gratitude, fully recovered. Zhang said, "In cases like this, although water moves, if Zheng Qi does not recover, many die later from recurring swelling. Those who do not know the methods of inducing sweating and moving water, relying solely on渗利 (draining and promoting urination), see Zheng Qi diminish and pathogens increase over time, leading to death. How can one not be cautious?"
Lu Yangyu treated the wife of Wu Tyuan, who suffered from abdominal distension, occurring every time at cockcrow, relieving by noon. Treatment with Qi-regulating herbs was ineffective. Later, it occurred at midnight, and within two days, it occurred by dusk. She could not sleep at night, and her diet decreased. Her body grew thinner daily. Her pulse was deep, faint, and slow. He said, "Regarding symptoms, relief during the day and urgency at night indicates Blood deficiency; nourish Blood. Regarding the pulse, deep, weak, and slow indicates Qi deficiency; tonify Qi." Therefore, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Dang Gui (Angelica Sinensis Root) was given, plus Dou Ren (Cardamom Seed) and Mu Xiang (Aucklandia Root). Several doses led to recovery.
Lu Xiaoyu treated a relative of Lu Nanyang suffering from Pi (Pi Syndrome, a feeling of fullness and obstruction in the epigastrium/chest). Some considered it Food Stagnation and Phlegm-Dampness, using digestion-promoting and Er Chen Tang (Two-Cured Decoction) formulas, worsening the fullness. Others considered it Qi deficiency with middle-fullness, giving Bu Zhong Yi Qi Tang, also ineffective. For about a year, alternating between cold/heat, reducing/increasing treatments, her diet greatly decreased, muscles wasted, and bowel movements alternated between diarrhea and constipation. Her pulse was wiry and large on superficial palpation, choppy and small on deep palpation. He said, "Such a case requires a hundred doses to fully heal." Diao Qi Yang Rong Tang (Regulate Qi and Nourish Blood Decoction) was used with added Ren Shen (Ginseng Root) and Bai Zhu (Atractylodes Macrocephala Rhizome) 1.5 qian each, and Mu Xiang (Aucklandia Root) and Dou Ren (Cardamom Seed) 0.3 qian each. After two doses, symptoms slightly worsened. So, Ren Shen and Bai Zhu were reduced, and Mu Xiang and Dou Ren increased, but still no response. Then, Mu Xiang and Dou Ren were increased to 1 qian, and Ren Shen and Bai Zhu reduced to 0.7 qian, leading to slight improvement in distension. Later, Mu Xiang and Dou Ren were increased to 1.5 qian, diet gradually improved, and distension relieved by more than half. Subsequently, Ren Shen and Bai Zhu were gradually increased to 2-3 qian, and Mu Xiang and Dou Ren reduced to 1-2 fen. About sixty doses led to complete recovery.
Zhu Danxi treated a person with foot swelling, gradually ascending to the knees and feet, making walking impossible. Head and body were swollen. Ku Hu Reng Shi (Seeds of Bitter Bottle Gourd Flesh) were rolled into bean-sized balls, wrapped in flour, boiled once, and taken on an empty stomach, seven pills. By noon, one dou of fluid should be discharged. For three days, water discharge continued non-stop. The person became very thin before recovering. Diet must be restricted. (Ku Hu must be selected without spots, with fine, tight, clean texture, otherwise it is toxic. Similar to the method of using gourd to treat Mrs. Xu Wenjiang.)
Wan Muzhai treated Wan Bangrui's daughter, aged fourteen, suffering from swelling. From Yin hour to Wu hour, the upper body swelled; from Wu hour to Xu hour, the lower body swelled. During Hai, Zi, and Chou hours, swelling completely subsided, except for genital swelling and inability to urinate. Doctors could not identify the disease. Wan said, "This is a Liver-Kidney disease. The Kidney is the Water Organ. Hai, Zi, and Chou hours are when Water is prosperous. Liver belongs to Wood, child of Kidney. Wood is born in Hai. Zi and Chou hours are when Liver and Gallbladder Qi circulates. The Liver meridian circles the genitals. When its Qi circulates, thus genital swelling and urinary retention occur. Water in the body moves up and down. Before Wu hour, Qi moves upward, so upper body swells. After Wu hour, Qi moves downward, so lower body swells. This is the source of the disease. Wu Ling San (Five-Ingredient Powder with Poria) is a water-draining agent. The Classic says: All dampness, swelling, and fullness belong to Spleen Earth. Ping Wei San (Peaceful Stomach Powder) is a drying-dampness agent. Using these two formulas as the main base, named Wei Ling Tang (Stomach-Ling Decoction). Added Sheng Jiang Pi (Ginger Skin) for its pungent-warm nature to assist Gui Zhi (Cinnamon Twig) and Chen Pi (Tangerine Peel) to disperse Liver meridian pathogens; Fu Ling Pi (Poria Skin) for its sweet-bland nature to assist Zhu Ling (Polyporus) and Ze Xie (Alisma Rhizome) to drain Kidney meridian pathogens; Fang Ji (Stephania Root) travels through the twelve meridians to disperse wandering swelling pathogens. Over ten doses led to recovery."
Zhang Zihe said, "Zhou Jingzhi from Zhuojun returned from the capital. On the road in Lvyi, he drank too much water due to thirst, gradually forming swelling and fullness. Someone used San Hua Shen Wan (Three-Flower Divine Pill), fearing it was too harsh. Or used Wu Ling San (Five-Ingredient Powder with Poria) to separate and promote water channels, but it was too slow. Dragging on for months, with no effect, showing that crude physicians' skills end here. Later, hands, feet, and kidneys swelled, and both large and small bowels were blocked. He entrusted Chang Zhongming to seek treatment from Zhang. Zhang ordered Zhongming to prepare the medicine. By the time it arrived, the patient had died. Zhang said, 'For a patient with water disease, the situation is like a river overflowing. Trying to scoop it out with cups and spoons is difficult. One must use the method of Great Yu controlling the waters to cure it.' (Observing together with Chen Sansan's case, the method of purifying the bladder should be used promptly when appropriate.)"
Xue Lizhai treated a woman with facial and eye swelling and amenorrhea. This was Fluid-Water disease. Morning: Ting Li Wan (Descurainia Seed Pill); Evening: Gui Pi Tang (Restore the Spleen Decoction). Gradually improved. Further combined with Ren Shen Wan (Ginseng Pill) for full recovery. (Method of draining and tonifying simultaneously.)
A woman with an irritable temperament previously suffered from indigestion due to alcohol, leading to irregular menstruation. Someone used Qi-regulating and Phlegm-resolving herbs, causing vomiting, abdominal distension, and diarrhea. You Yao (Lindera Root) and Peng Zhu (Curcuma Zedoaria Rhizome) were added, worsening abdominal swelling and urinary difficulty. Zhu Ling (Polyporus) and Ze Xie (Alisma Rhizome) were added, causing phlegm, wheezing, shortness of breath, cold hands and feet, and swelling of the head, face, and limbs, leaving pits when pressed. Pulse was deep and fine, especially at the Right Cun position. This is Spleen and Lung deficiency-cold, unable to regulate water passages and transmit downward to the Bladder. The command of seepage and excretion does not function, and the Qi of transformation and generation does not move. Dongyuan said: Water and drink stagnating is like mud in rain-soaked earth. With harmonious Qi and warm sun, water and dampness leave, Yang transforms, and naturally all things grow. Finding a corresponding pulse, he gave Jia Jian Shen Qi Wan (Modified Kidney Qi Pill) material from *Jin Gui Yao Lue*. Urination immediately resumed. After several doses, swelling halved, limbs warmed, and she could turn herself. Then, Liu Jun Zi Tang (Six-Gentleman Decoction) with Mu Xiang (Aucklandia Root), Rou Gui (Cinnamon Bark), and Pao Jiang (Prepared Ginger) was used for full recovery. Later, failing to guard against Seven Emotions and regulate diet, sudden diarrhea occurred. The previous medicine with added 0.5 qian of Fu Zi (Aconite Root) brought peace. (Method of using tonification after mistaken reduction.)
Sun Zhao treated a young woman with heart and abdominal swelling and pain, with unchanged color. The Classic says: San Jiao distension involves Qi fullness, and the skin is hard like stone. Thus, Zhongjing's Hou Po Sheng Jiang Ban Xia Ren Shen Gan Cao Tang (Magnolia Bark, Fresh Ginger, Pinellia, Ginseng, Licorice Decoction) was given, followed by Bao He Wan (Preserve Harmony Pill), gradually improving.
Danxi treated a woman with both Blood and Qi deficiency, suffering from single abdominal distension. Due to weak Qi failing to transform and transport, she was near death, but hands, feet, and face were swollen. Since Qi still circulated in the Yang divisions, it was treatable. Thus, Ren Shen (Ginseng Root), Bai Zhu (Atractylodes Macrocephala Rhizome), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Dang Gui (Angelica Sinensis Root), and Bai Shao (White Peony Root) were used to restrain distension; Hua Shi (Talcum) and Da Fu Pi (Areca Peel) to restrain Qi; Su Ye (Perilla Leaf), Jie Geng (Platycodon Root), Bo Zi (Radish Seed), and Chen Pi (Tangerine Peel) to relieve fullness; Hai Jin Sha (Spore of Lygodium Spadix) and Mu Tong (Akebia Stem) to promote urination; Mu Xiang (Aucklandia Root) to move Qi. She recovered. (Method of tonifying and draining simultaneously.)
A woman had discomfort in the chest and diaphragm, poor appetite, abdominal distension, and acid regurgitation. Someone used draining and promoting agents, causing middle-fullness and anorexia. This is Spleen Earth deficiency and Liver Wood excess. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Sha Ren (Black Cardamom Seed), Xiang Fu (Cyperus Rhizome), and Wei Jiang (Roasted Ginger) was used. Then, Liu Jun Zi Tang (Six-Gentleman Decoction) with Chuan Xiong (Ligusticum Chuanxiong Rhizome), Dang Gui (Angelica Sinensis Root), and Jie Geng (Platycodon Root) led to recovery.
Mother of Shi Yuan Nian from Wujiang, after a long illness, encountered frustrating events, suddenly developing chest and abdominal distension, slight facial swelling, heavy legs, counterflowing Qi, and rapid speech with panting. All taken medicines were clearing-Qi agents, ineffective. Xue said, "This is Spleen and Lung deficiency-cold." First, Liu Jun Zi Tang (Six-Gentleman Decoction) was given. After one dose, the disease势头 (momentum) decreased sharply. Then, Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Fu Ling (Poria), Ban Xia (Pinellia Tuber), and Gan Jiang (Dried Ginger) was given. After two doses, the physique was instantly calm. Later, due to emotional imbalance, nighttime abdominal distension occurred. Shi Quan Da Bu Tang (Ten-Agent Great Tonifying Decoction) with Mu Xiang (Aucklandia Root) cured it.
Lu Zhongshe from Taicang, due to Kidney deficiency failing to control water, developed abdominal distension. Used Hei Wan Zi (Black Pills, also known as Bei Ji Wan). Died in the capital after a few doses. Specialists in treating Gu today use this formula, and those who use it die quickly. (Families of patients must know this.)
Cai Yisu from the Silk Workshop, careless with daily life, suffered from the same symptoms as above, plus cold hands and feet, aversion to cold, and anorexia. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with 1 qian of Fu Zi (Aconite Root) was used to first restore Yang. After several doses, symptoms gradually improved. Xue went elsewhere. Someone used harsh draining agents, causing massive hematochezia, leading to death.
Zhu Yi Mingfu, a fortune-teller from Shaoxing, suffered from Water Gu abdominal distension. Doctors only ordered Jia He San (Harmonizing Grain Powder), ineffective after a long time. Prime Minister Ge taught him this method, bringing peace. Take Jia He San and Si Zhu San (Four-Pillar Powder) fine powders in equal parts, mix well, and decoct according to method. (*Bai Bai Fang*.)
Wang Shangzhi, Inspector General, transmitted: Fang from Wuyi County treated several people excellently. Use one Yellow Catfish (Yellowhead Catfish) and about one he of Mung Bean. Decoct into light soup and eat in one meal. Physician Zhang Shengzhi from Shaoxing said: Cook Mung Beans with Shang Lu Root until soft, remove Shang Lu Root, and eat Mung Beans as desired. Also excellent. *Wang Shi Bo Ji Fang* Volume 2, Zhu Qi San (Expel Qi Powder) is largely similar to this medicine. (Same as above.)
A person with Gu distension dreamed of a Daoist priest showing a verse: "Like a dog but not a dog, like a cat but not a cat. Cook and eat it, and the disease will disappear."偶然ly, a fox entered his room. He killed it, cooked it thoroughly, and ate it. The abdomen spontaneously subsided. (*Yi Jian Zhi*.)
(Commentary: *Bai Shi Liu Tie* says eating Qingqiu Fox prevents Gu. Also, *Ben Cao Meng Shan* says Fox supplements deficiency and treats Five Zang pathogenic Qi, Gu poison, chills, and fever. Original note.)
Danxi treated a woman with night fever, face swelling first, then belly and feet, thirst for cold water. Ma Huang (Ephedra Herb), Ge Gen (Kudzu Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome), Cang Zhu (Atractylodes Lancea) and Bai Zhu (Atractylodes Macrocephala Rhizome), Mu Tong (Akebia Stem), Da Fu Pi (Areca Peel), Zhi Zi (Gardenia Fruit), Gan Cao (Licorice Root) cured her. (This is the Kai Gui Men [Open Ghost Gate] method.)
A person suffered from swelling in autumn and winter, worse in the morning upper body, worse in the afternoon lower body, thirst, fatigue, choppy and weak pulse, reduced appetite. This is Qi timidity preventing spontaneous sweating, stagnating into Wei (atrophy). Acupoints Fei Shu (Bladder 13), Da Zhui (GV 14), He Gu (LI 4), Fen Shui (CV 9) were moxa-ed. Ge Gen (Kudzu Root), Su Ye (Perilla Leaf), Bai Zhu (Atractylodes Macrocephala Rhizome), Mu Tong (Akebia Stem), Hai Jin Sha (Spore of Lygodium Spadix), Da Fu Pi (Areca Peel), Fu Ling Pi (Poria Skin), Hou Po (Magnolia Bark), Chen Pi (Tangerine Peel), Huang Qin (Scutellaria Root), Gan Cao (Licorice Root) were used. Gradually improved. (Same as above. Method of dispersing and draining simultaneously.)
Chen Sansan treated a man in his thirties. Swelling occurred after anger, excessive water drinking. Next day, limbs were swollen, abdominal distension abnormal. Young and strong, disease appeared suddenly. Pulse was solid, and medicine should not fear attack. If not urgent to dredge, long-term will become a major disaster. Wei Ling San (Stomach-Ling Powder) with Niu Xi (Achyranthes Root) and Che Qian (Plantago Seed) was given. Three doses showed little movement. This is deep disease and shallow medicine. Zhou Che Wan (Boat Cart Pill) and Shen Dan (Divine Pill) were advanced. Urine gushed like a spring, limbs gradually retracted. Still given Wei Ling Tang (Stomach-Ling Decoction) with Bai Zhu (Atractylodes Macrocephala Rhizome) and Jiao Ren (Pepper Kernel). Recovered in fifteen days.
Yu Jiayan treated Gu Mingzhong, who had abdominal disease for nearly thirty years. Relief in the morning, urgency in the evening. Each major flare-up, abdominal distension lasted over ten days before subsiding. Eating wet noodles or engaging in sexual activity triggered immediate responses. (Liver-Kidney deficiency, so sexual activity triggers it. Spleen fails to transform, so eating noodles triggers it. Disease condition is significantly apparent.) Left side of abdomen was slightly high and drum-like. Breathing touched it, making sound. Treated as Pi (obstruction), internal attack and external application ineffective. Diagnosis: The body's Five Accumulations and Six Gatherings diseases. Pathogens of Heart, Liver, Spleen, Lung, Kidney, knotting in the upper, lower, left, right of the abdomen and center of the navel, all stand high like an inverted bowl. Pathogens of Gallbladder, Stomach, Small Intestine, Large Intestine, Bladder, Ming Men (Gate of Life), each accumulate in their original position, not obviously visible. This condition is Kidney Yin Qi gathering in the Bladder Yang meridian, resembling a Pi mass. Kidney has two apertures. Left Kidney aperture connects forward to Bladder. Right Kidney aperture connects backward to Ming Men. Pathogen knots on the left side, so Left Kidney and Bladder are masters. Among Six Fu organs, only Gallbladder has no output. The other five Fu organs receive turbid Qi from Five Zang organs, cannot stay long, thus output. Now Kidney pathogen transmits to Bladder. Bladder neglects its output duty. Old pathogen not moved, new pathogen follows. (Pathogen character unclear.) Must gradually penetrate Mo Yuan (Root of Diaphragm). (Mo Yuan is between diaphragm, far from Bladder, how to penetrate?) Like a leather bag wrapping objects. Classic says: Bladder is the Official of the Prefecture, storing fluids. Qi transformation allows exit. Then, Kidney Qi gathers long-term without exiting. Is it not Bladder losing its transformation? Human abdomen contains Small Intestine, Large Intestine, Bladder. (Is it only this?) Bao (Uterus) is inside Bladder. (Bladder is Pa, ancient people辨析 this.) Because they do not stay long or output, it feels spacious as if having extra space. Now Kidney Qi does not self-restrain, all transmits to Bladder. Bladder Qi stores without exiting, similar to Gallbladder's purity and non-action. (According to this, does this person have no urine?) Can it be managed! Hence distension. Classic says: Kidney disease easily causes distension. Sitting on buttocks instead of heels, spine instead of head. If Bladder could manage output, how would it be this severe? Also says: Ju Yang drawing Essence stops distension in three days. Tai Yang Bladder Meridian attracting Essence Qi, distension stops in three days. (Ju Yang drawing Essence sentence is from *Nei Jing* discussing Wind and Lao, introduced here awkwardly. Yu's heroism deceives people, often like this.) This distension lasts decades. Where is the power of attraction? Treatment: Tonify Kidney Water to sufficiency, then Essence hides deeply, and Bladder distension disappears. (Only these sentences are the crux of this disease.) Tonify Bladder to make Qi vigorous, then Kidney pathogen does not accumulate, and output mechanism is sufficient. Why? Because Kidney not tonified cannot store, Bladder not tonified cannot drain. However, tonifying Kidney is easy, tonifying Bladder is difficult, because Materia Medica drugs mostly drain, rarely tonify. Classic regarding insufficient Son of Bladder, judges death date, later generations do not understand. I speculate: Is it not that Bladder more insufficient means more distension, extreme distension inevitably transmits to Kidney, extreme Kidney distension counter-transmits to Small Intestine, extreme Small Intestine distension counter-transmits to Spleen, until whole-body Qi scatters without unity? Physicians seeing before transmission and planning ahead, exhaust their duties.
Commentary: This disease exclusively belongs to Liver and Kidney meridians, having nothing to do with Bladder. Abandoning Liver and forcing entry into Bladder makes the text fragmented. (Actually Liver-Spleen-Kidney three meridian disease, cannot specifically mention only Liver-Kidney.)
Ye Tianshi treated a twenty-seven-year-old woman with very strange swelling. After Yin hour before Wu hour, upper body swelled. After Wu hour before Chou hour, lower body swelled. Upper and lower completely subsided, except for vulva swelling and difficult urination. Doctors could not treat. Classic says: Above half body is Heaven's Yang, should induce sweating, allowing Clear Qi to exit upper orifices. Below half body is Earth's Yin, should promote urination, allowing Turbid Yin to exit lower orifices. This is exactly upper-lower separate elimination to remove Dampness method. Only at midnight, genital swelling and inability to urinate, this should be sought from Liver meridian. Jue Yin Liver meridian starts at foot at Chou hour, circles genitals. Also, Liver disease causes difficult urination and defecation. Use Wei Ling Tang (Stomach-Ling Decoction) and Wu Pi Tang (Five-Peel Decoction) to induce sweating and promote urination. Contains Fu Ling (Poria), therefore to attack