人有两足跗上先肿，渐渐肿胀至腹，按胀上如泥之可搏，小便不利，大便反结，
此由土气之郁，非水肿也。人生脾胃之气健旺，则土能克水，而水自灌注于经络，
两不相碍也。惟脾胃气虚，则土不能转输水精于上，而胃中之水积而不流，于是浸
淫于表里、皮毛而无所不到也。然而脾胃气虚，非脾胃之故也。由于肾气之虚，则
土无升腾之气，而土乃郁而不伸，力不能制水，使水来相侮，而脾胃之气愈虚也。
夫肾司开阖，肾气从阳则开，肾气从阴则阖；阳太盛则水道大开，阴太盛则水道常
闭；阳为肾中之火，而阴为肾中之寒也。肾寒则脾胃亦寒，水畏热而不畏寒，此寒
土之所以难制水也。然则治水肿之法，乌可舍补肾之火，而他求蓄水之土哉。虽然
水势滔天，补火以生土，迂缓而难以决排；放水以全土，利便而易于蓄泄。故补肾
中之火，可治久病之水臌；泄脾胃中之水，实益初病之水胀也。下体胀而上身未胀，
正初起之病，宜急泄其水之为得。方用泄水至神汤∶
大麦须（二两） 茯苓（一两） 白术（二两） 小赤豆（三钱） 水煎服。一剂而腹必雷鸣，泻水
如注，再剂而水尽泄无遗，不必三剂也。
论理，牵牛、甘遂之方未尝不可用，但虑世人天禀日薄，而脾、胃、肾三经多
虚，恐不胜药力之过迅，故改立此方，于补中泻水，正气无伤而邪水尽出之为妙。
方中白术、茯苓健脾胃之土，又能通脾胃之气。则土之郁可解，土郁既解，力足以
制水矣。况大麦须能消无形之水，赤小豆能泄有形之湿，合而相济，自能化水，直
出于膀胱，由尾闾之间尽泻而出也。
此症用冬瓜汤亦甚效。
冬瓜一个，煎水十碗。另用白术（三两） 车前子（五钱） 肉桂（二钱） 将冬瓜水煎汤
二碗。先用一碗，少顷又用一碗。其水从大便而出，一剂而胀肿全消。
人有水肿既久，遍身手足俱胀，面目亦浮，口不渴而皮毛出水，手按其肤如泥，
此真水臌也，乃土气郁塞之甚故耳。夫土本克水，何为反致水侮？盖土虚则崩，土
崩则淤泥带水而流缓，于是日积月累，下焦阻滞，而水乃上泛。脾胃之中原能藏水，
然水过于多，则脾胃不能受，乃散布于经络皮肤矣。迨至经络皮肤不能受，势不得
不流渗于皮肤之外，泛滥于一身。不用下夺之法，何以泻滔天之水哉。方用决水汤∶
车前子（一两） 茯苓（二两） 王不留行（五钱） 肉桂（三分） 赤小豆（三钱） 水煎服。一剂而
小便如注不绝，二剂而肿胀尽消矣。
论理用鸡屎醴逐水，亦有神效。然而鸡屎醴逐水，从大便而出，而此方逐水，
从小便而出也。水从大便出者其势逆，水从小便出者其势顺。逆则效速而气伤，顺
则效缓而气固。此方利水从小便而出，利其膀胱也。凡水必从膀胱之气化，而后由
阴器以出。土气不宣，则膀胱之口闭，吾用王不留行之迅药以开其口，加入肉桂，
引车前、茯苓、赤小豆直入膀胱而利导之。茯苓、车前虽利水而不耗气，而茯苓且
是健土之药，水决而土又不崩，此夺法之善也。至于脐突、手掌无纹，用此方尚可
救也。惟是服此方泻水而愈，必须禁用食盐一月，倘不能禁，则又胀矣。胀则不可
再治也。
此症亦可用冬瓜汤更加刘寄奴一两、茯苓一两，服之亦水泻而愈。
人有气喘作胀，腹肿，小便不利，大便亦溏，渐渐一身俱肿，人以为水臌也，
不知乃肺、脾、肾三经之虚也。夫水气不能分消，大都病在胃，然胃之所以病者，
正由于三经之虚耳。胃为水谷之海，凡水入于胃为归，盖五脏六腑之大源也。但胃
能容水而不能行水，所恃脾之散水以行于肺，肺之通水以入于膀胱，肾之化水而达
于小肠也。惟脾虚则不能散胃之水精于肺，而病在中矣；肺虚则不能通胃之水道于
膀胱，而病在上矣；肾虚则不能司胃之关门，时其输泄，而病在下矣。三经既虚，
而胃中积水浸淫，遂遍走于经络皮肤，而无所底止矣。治法补其三经之气，而胃气
自旺，胃气旺而肿胀尽消。方用消胀丹∶
白术（三钱） 茯苓（一两） 麦冬（五钱） 熟地（五钱） 山药（一两） 芡实（五钱）
苏子（一钱） 水煎服。
一剂而喘少定，二剂而胀渐消，十剂而小便利，二十剂而一身之肿无不尽愈也。
方中白术、茯苓以健其脾土，麦冬、苏子以益其肺金，熟地、山药、芡实以滋
其肾水，自然脾气旺而不至健运之失职，肺气旺而不至治节之不行，肾气旺而不至
关门之不开，水自从膀胱之府而尽出于小肠矣，安得而再胀哉。
此症用百合消胀汤亦效。
白术 芡实（各一两） 茯苓 百合（各五钱） 山药（一两） 肉桂（二钱） 人参（三钱） 水煎服。
十剂少愈，三十剂全愈。
人有腰重脚肿，小便不利，或肚腹肿胀，四肢浮肿，喘急痰盛，不可以卧，此
肺、肾俱虚之病，非臌胀也。夫水症多是脾胃之虚，兹何以肺、肾之虚亦成水胀耶？
不知肺虚必盗脾胃之气，而肾虚则不能生脾胃之气。二经既虚，则脾胃之气更虚，
土难生金，而肺之气化不行，而肾之关门不开矣。于是水不能消而泛滥，一如水肿之
病也。治法似宜补肺而兼补肾，然而补肺又不若竟补肾之为得。盖肺虽生肾，然止
能生肾水，而不能生肾火也；脾胃必得肾火以相生，水气必得肾火以相化；况补肾
则肺不必来生肾水，而肺金自安矣，是补肾即所以补肺也。方用金匮肾气丸∶
茯苓（十两） 附子（一个） 牛膝（三两） 官桂（二两） 熟地（四两） 山药（六两） 丹皮（二两）
泽泻（四两） 车前子（三两） 山茱萸（二两） 各为末，蜜为丸。每日早晚白滚水各送下一
两。服三日而小便利，再服三日而腰轻，服十日而上下之肿尽消，服二十日而喘急痰盛无不尽除，
服一料完全愈。再服一料断不再发也。
此方经后人改窜分两，以致治肺肾之水胀多至不效，因世人畏茯苓、泽泻之过
于泄水耳。不知水势滔天，既不用扫荡之药以决水，乃畏利导之品，而不用之以消
水乎。故必须多用茯苓、车前为君，则水可泄之使从膀胱而下出。然而肾之关门不
开，非附子、肉桂回阳助火，蒸动肾气，则关何以开；肾关不开，而胃之积水何以
下哉。故必用桂、附以开关，关既开矣，则茯苓、车前、牛膝得尽利水而直下。又
恐水过于利，未免损伤阴气，得熟地、山药、丹皮以佐之，则利中有补，阳得阴而
生；则火无炎亢之虞，土有升腾之益。诚治水之神方，补土之妙药也。世人倘疑吾
说之偏，而妄增药味，或更改轻重，断不能收功也。
此症用温肾消水汤亦效。
人参（三钱） 熟地（五钱） 山药（一两） 山茱萸（三钱） 茯苓（一两） 肉桂（二钱）
薏仁（五钱） 水煎服。二十剂即愈。
人有手足尽胀，腹肿如臌，面目亦浮，皮肤流水，手按之不如泥，但陷下成孔，
手起而胀满如故，饮食知味，大便不溏泄，小便闭涩，气喘不能卧倒，人以为水臌
之症，而不知乃肾水之衰也。真水足而邪水不敢横行，真水衰而邪水乃致泛决。况
真水既衰，则虚火必盛，虚火既盛而真水力不能制，则火性炎上，三焦之火与冲脉
之属火者，皆同群助逆，无不逆冲而上行矣。火既上冲，而水从火泛，上走于肺，
喘嗽而不宁矣。卧主肾，肾气既逆，安得而卧耶。人至不得卧，则肺气夜不得归于
肾之中，而肾之中水空而无非火气，则肺之气不敢久留于肾，仍归于肺经。母因子
虚，则清肃之令不行于膀胱，于是，水入于膀胱之口而膀胱不受，乃散聚于阴络，
随五脏六腑之虚者入而注之，不走小肠而走手足皮肤，而毛窍出水也。此种水症，必
须补肾之水以制肾火，尤宜补肺之金以生肾水。盖肾水不能速生，惟助肺气之旺，
则皮毛闭塞，而后肾气下行，水趋膀胱而不走腠理矣。方用六味地黄汤加麦冬、五
味治之。
熟地（二两） 山茱萸（一两） 山药（一两） 茯苓（二两） 丹皮（六钱） 泽泻（一两）
麦冬（一两） 北五味（三钱） 水煎服。一剂可卧，二剂水如注，四剂而一身之肿尽消，十剂而诸
症全愈。愈后服补肾肺之药，尤须戒色至一年，禁盐至三月，否则虽愈而必发也。
盖此症原有肾火，故补水而不必补火也。肾虚以致火动，肺虚以致水流，补其水则火自静，
补其金则水自通，实有至理，而非泛然以作论也。
此症用健肾汤亦佳。
熟地 茯苓（各二两） 麦冬 莲子，连心（用各五钱） 芡实 山药（各一两） 水煎服。
二剂而胀消，十剂全消。
人有单腹胀满，四肢手足不浮肿，经数年不死者，非水臌也。盖水臌不能越两
年，未有不皮肤流水而死者。今经数年不死，皮肤又不流血，岂是水臌之症？乃虫
结于血之中，似膨而非臌也。夫此症何因而得？饮食之内或食生菜，而有恶虫之子，
入腹而生虫；或食难化之物，久变为虫。血即裹之不化，日积月累，血块渐大，虫
生遂多。所用食物止供虫食，即水谷入腹所化之血，亦为虫之外郭，而不能灌注于
各脏腑矣。此等之症，最忌小便不利与胃口不健者，难以医疗。倘小便利而胃口开，
均可治之。盖小便利者，肾气能通于膀胱也；胃口开者，心气能行于脾胃也。二脏
之气有根，可用杀虫下血之药而无恐，以其本实未拨也。方用逐秽消胀汤∶
白术（一两） 雷丸（三钱） 白薇（三钱） 甘草（一钱） 人参（三钱） 大黄（一两）
当归（一两） 丹皮（五钱） 萝卜子（一两） 红花（三钱） 水煎服。一剂腹内必作雷鸣，少顷
下恶物满桶，如血如脓，或有头无足之虫，或色紫色黑之状。又服一剂，大泻大下，
而恶物无留矣。然后以人参一钱、茯苓五钱、薏仁一两、山药二两、白芥子一钱、陈皮五
分、白术二钱，调理而安。
前方用攻于补之中，虽不至大伤脏腑，然大泻大下，毕竟元气少损。故秽尽之
后，即以参、苓、薏、药之类继之，则脾气坚固，不愁亡阴之祸也。或问此等之病，
既非水臌，初起之时，何以知其是虫臌与血臌也？吾辨之于面焉，凡面色澹黄之中，
而有红点或红纹者是也；更验之于腹焉，凡未饮食而作疼，既饮食而不痛者是也。
苟面有红点、红纹与既饮食而不痛，即可用逐秽消胀汤减半治之，亦一剂而即愈也。
但下后毋论新久，必须忌盐者一月。苟若不忌，必至再病，则难治矣。
此症用雷逐丹亦神效。
雷丸（三钱） 当归 白芍（各五钱） 红花（一两） 雄黄 浓朴 槟榔（各二钱） 枳实 甘草（各一钱）
水煎服。一剂下恶秽一桶愈。
人有上身先肿，因而下体亦肿，久之一身尽肿，气喘嗽不得卧，小腹如光亮之色，人以为水臌
已成，谁知是水臌之假症乎。夫湿从下受，未闻湿从上受者也。凡人脾土健旺，必能散精于肺，
通调水道，下输膀胱，水精四布，五经并行，何致水气之上侵。惟脾土既虚，饮食不化精而化水，
乃邪水而非真水也。真水既无所生，则肾中干涸无非火气，于是同任、冲之属火者俱逆而上出。是
水从火溢，上积于肺而嗽、奔越于肺而喘，既喘且嗽，身自难卧；散聚于阴络而成跗肿，故先上肿而后
下肿也。似乎治法亟宜治肾矣，然而火盛由于水衰，而水衰实先由于土衰也，补土其可缓乎。惟是
既补脾以健土，必至燥肾以旺火，故补脾又必须补肾，而补肾又必须补脾，所贵二者之兼治也。方
用二天同补丹∶
山药（一两） 芡实（一两） 茯苓（五钱） 白术（二两） 肉桂（三分） 诃子（一钱） 百合（五钱）
水煎服。二剂而喘嗽轻，又二剂而喘嗽止，十剂而肿胀消，再十剂全愈。
此方无一味非治脾之药，即无一味非补肾之药也。健其土而不亏夫肾，滋其水
而不损于脾，两相分消而又两相资益，得利之功而无利之失，治水臌之假症，实有
鬼神不测之妙也。
此症用芡术汤亦效。
白术 芡实（各二两） 茯苓（一两） 肉桂（一钱） 车前子（五钱） 水煎服。二剂轻，四剂又
轻，十剂愈。
[Original] A person presents with swelling starting on the dorsum of both feet, gradually spreading to the abdomen. Pressing the swollen area yields an impression like mud. Urination is difficult, while defecation is constipated. This is caused by the stagnation of Earth Qi (Spleen/Stomach energy), not edema.
[Translation] When a person’s Spleen and Stomach Qi are robust, Earth can control Water, allowing Water to flow naturally into the meridians without obstruction. However, when Spleen and Stomach Qi are deficient, Earth cannot transport fluid essences upward. Consequently, water accumulates in the Stomach, stagnates, and infiltrates the interior and exterior, skin, and hair, reaching everywhere. Yet, this Spleen-Stomach deficiency stems not from the organs themselves but from Kidney Qi deficiency. The Kidney governs opening and closing; when Kidney Qi follows Yang, it opens; when it follows Yin, it closes. Excessive Yang opens the water pathways widely, while excessive Yin keeps them closed. Yang represents Fire within the Kidney, and Yin represents Cold. Kidney Cold induces Spleen-Stomach Cold. Since Water fears Heat but not Cold, cold Earth struggles to control Water. Therefore, treating edema requires nourishing Kidney Fire rather than seeking other means to strengthen Earth. Although replenishing Fire to generate Earth is slow for massive water accumulation, draining water directly preserves Earth function. Nourishing Kidney Fire treats chronic water distension, while draining Spleen-Stomach water benefits early-stage water swelling. For lower-body swelling without upper-body involvement (early stage), urgent drainage is indicated. Formula: Xie Shui Zhi Shen Tang (Divine Water-Draining Decoction) consisting of Barley Stigma (Liang), Poria (Qian), Atractylodes Macrocephala Rhizome (Liang), and Adzuki Bean (Qian). One dose causes rumbling and profuse watery diarrhea; two doses clear all water. While drastic purgatives like Morning Glory Seed and Kansui could be used, modern constitutions are often weak, risking damage from harsh drugs. Thus, this formula balances tonification and drainage. Atractylodes and Poria strengthen Earth and move Qi, resolving stagnation. Barley stigma resolves formless dampness; Adzuki beans drain formed dampness. Together, they facilitate water excretion via the Bladder and Weilu point. Winter Melon Soup is also effective: one winter melon boiled in ten bowls of water, then decocted with Atractylodes, Plantago Seed, and Cinnamon Bark to yield two bowls. Drink sequentially; water exits via stool, resolving swelling in one dose.
[Original] Long-standing edema with whole-body swelling, pitting upon pressure, and oozing skin indicates true water distension due to severe Earth stagnation. Earth normally controls Water, but when Earth collapses from deficiency, it fails to contain Water, leading to lower jiao blockage and upward flooding. When the Spleen-Stomach cannot hold excess water, it spreads to meridians and skin. If these fail, water leaks externally. Drastic downward purging is necessary. Formula: Jue Shui Tang (Water-Deciding Decoction) with Plantago Seed, Poria, Galium Verum Herb, Cinnamon Bark, and Adzuki Bean. One dose ensures continuous urination; two doses resolve swelling. Unlike Chicken Dropping Wine which drains via stool (reverse path, fast but damaging), this formula drains via urine (smooth path, slower but stabilizing). It uses Galium to open the Bladder orifice, guided by Cinnamon. Poria and Plantago drain without depleting Qi; Poria also strengthens Earth. Even with protruding umbilicus or absent palm lines, this formula saves lives. Post-cure, salt must be avoided for one month to prevent relapse. Winter Melon Soup with Liu Ji Nu and Poria is also effective.
[Original] Asthma with abdominal swelling, difficult urination, loose stools, and progressive whole-body swelling is often mistaken for water distension but is actually deficiency of Lung, Spleen, and Kidney meridians. The Stomach is the sea of water and grain, but relies on the Spleen to scatter fluids to the Lung, the Lung to direct fluids to the Bladder, and the Kidney to transform fluids to the Small Intestine. Deficiency in any meridian disrupts this process. Treatment tonifies the three meridians to restore Stomach Qi and resolve swelling. Formula: Xiao Zhang Dan (Swelling-Resolving Pill) with Atractylodes, Poria, Ophiopogon, Prepared Rehmannia, Chinese Yam, Euryale Seed, and Perilla Seed. One dose calms asthma; two reduce swelling; ten normalize urination; twenty cure all swelling. Ophiopogon and Perilla benefit Lung Metal; Rehmannia, Yam, and Euryale nourish Kidney Water. This restores Spleen transport, Lung regulation, and Kidney gate function, ensuring water exits via the Bladder. Baihe Xiao Zhang Tang (Lily Swelling-Resolving Decoction) with Atractylodes, Euryale, Poria, Lily Bulb, Yam, Cinnamon, and Ginseng is also effective (30 doses for full cure).
[Original] Heavy waist, swollen legs, difficult urination, abdominal distension, limb edema, asthma, phlegm, and inability to lie down indicate Lung-Kidney deficiency, not distension. Lung deficiency steals Spleen-Stomach Qi; Kidney deficiency fails to generate it. This leads to failed Lung transformation and blocked Kidney gate, causing water flooding. While treating both Lung and Kidney seems logical, tonifying the Kidney is superior because it generates Kidney Fire, essential for Spleen-Stomach interaction and water transformation. Tonifying the Kidney also pacifies the Lung. Formula: Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) with Poria, Aconite, Achyranthes, Cinnamon, Prepared Rehmannia, Yam, Moutan, Alisma, Plantago, and Cornus. Taken as honey pills, it resolves urination issues in three days, back heaviness in six, swelling in ten, and asthma/phlegm in twenty. Modern dosage alterations often render it ineffective due to fear of Alisma and Poria’s draining nature. However, massive water requires strong diuretics (Poria, Plantago) guided by Aconite and Cinnamon to open the Kidney gate. Rehmannia, Yam, and Moutan prevent Yin depletion during drainage. Warming Kidney Decoction (Ginseng, Rehmannia, Yam, Cornus, Poria, Cinnamon, Coix Seed) is also effective.
[Original] Whole-body swelling, drum-like abdomen, facial puffiness, oozing skin, non-pitting indentation, normal appetite, normal stool, obstructed urination, and orthopnea suggest Kidney Water decline, not water distension. True Water deficiency allows Empty Fire to flare, rising through the San Jiao and Chong Mai, forcing Water upward into the Lung (causing cough/asthma). Inability to lie down reflects rebellious Kidney Qi. Lung Qi cannot descend to the Kidney at night, leaving the Kidney dry and fiery. Lung Qi returns to itself, failing to send clear fluids to the Bladder. Water accumulates in yin collaterals and leaks through skin pores. Treatment must tonify Kidney Water to suppress Fire and Lung Metal to generate Water. Formula: Liu Wei Di Huang Tang (Six-Ingredient Pill with Rehmannia) plus Ophiopogon and Schisandra. One dose allows lying down; two cause profuse urination; four resolve swelling; ten cure symptoms. Post-cure, avoid sexual activity for one year and salt for three months. Jian Shen Tang (Kidney-Strengthening Decoction) is also beneficial.
[Original] Abdominal distension without limb edema persisting for years is not water distension (which is fatal within two years due to skin leakage). It is likely "Insect Distension" or "Blood Distension," where parasites or blood stasis accumulate in the blood vessels, consuming nutrients. If urination is clear and appetite is good, treatment is possible using insecticidal and blood-invigorating herbs. Formula: Zhu Hui Xiao Zhang Tang (Filth-Expelling Swelling-Resolving Decoction) with Atractylodes, Omphalia, Gentian Root, Licorice, Ginseng, Rhubarb, Angelica, Moutan, Radish Seed, and Safflower. One dose expels foul matter (blood, pus, worms); a second dose clears everything. Follow with Ginseng, Poria, Coix Seed, Yam, White Mustard Seed, Tangerine Peel, and Atractylodes to stabilize Spleen Qi. Diagnosis involves yellow complexion with red spots/lines and abdominal pain before eating but not after. Lei Zhu Dan (Thunder Expelling Pill) with Omphalia, Angelica, White Peony, Safflower, Realgar, Magnolia Bark, Areca Nut, Immature Bitter Orange, and Licorice is also effective.
[Original] Upper-body swelling spreading downward, asthma, cough, inability to lie down, and shiny lower abdomen mimic water distension but are false signs. Dampness usually enters from below; if Spleen Earth is strong, it disperses essence to the Lung and directs water to the Bladder. Spleen deficiency causes food to transform into pathological water instead of essence. Lack of True Water leads to Kidney Dryness and Fire rebellion, carrying water upward to the Lung (cough/asthma) and causing foot swelling. Treating the Kidney alone is insufficient; since Fire excess stems from Water deficiency, which stems from Earth deficiency, tonifying Earth is crucial. However, tonifying Earth may dry the Kidney, so simultaneous tonification of Spleen and Kidney is required. Formula: Er Tian Tong Bu Dan (Two Heavens Simultaneous Tonification Pill) with Yam, Euryale, Poria, Atractylodes, Cinnamon, Chebula, and Lily Bulb. Two doses relieve asthma; ten reduce swelling; twenty cure. Qiu Shu Tang (Euryale-Atractylodes Decoction) is also effective.