遗风庞 暑热内着，口腹不慎，化胀，脉濡左弦，舌白罩灰，呛咳脘闷，最重之症。宜
分消，候正。（八月十一号丁未二十九日。）
金沸花（三钱包煎） 赤小豆（四钱） 大腹皮（三钱） 冬瓜皮（三钱） 赤苓（四钱） 光杏
仁（三钱） 炒枳壳（钱半） 鸡内金（三钱） 前胡（钱半） 蔻壳（钱半） 通草（钱半）
清煎三帖。
复诊 浮肿消减，脉浮濡，舌滑白，呛咳音嘶，脘中略和。仍宜分消为稳。（八月十四
号戊申初二日。）
金沸花（三钱，包煎） 桑白皮（三钱） 冬瓜皮（三钱） 莱菔子（三钱） 赤苓（四钱） 光
杏仁
（三钱） 原滑石（四钱） 川萆 （三钱） 大腹皮（三钱） 杜赤小豆（三钱） 鸡内金（三钱）
（引）路路通（七个）
三帖。
三诊 浮肿已退，脉弦劲，呛咳音嘶，舌滑。宜清肺利湿为妥。（八月二十号戊申初八
日。）
霜桑叶（三钱） 生米仁（四钱） 射干（钱半） 白前（钱半） 石决明（四钱） 川贝（钱半）
茯
苓（四钱） 粉丹皮（二钱） 光杏仁（三钱） 冬瓜子（四钱） 通草（钱半） （引）鲜枇杷叶（五
片）
四帖。
介按∶暑热外受，湿自内起，无形夹有形之邪，阻遏肺气下降之司而为咳嗽，乘入脾脏
而为
肿胀。治法仿徐之才轻可去实之意，而以苦降肃肺，辛淡渗湿，故能奏效。最后一诊，浮肿
已退，而亦以清肺渗湿为治，方法井井有条。
柯桥李 高年痰湿胶固，腹满，跗浮，溺少，脉濡细，舌浓腻，微灰两边白，呛咳。最
重之症。（八月九号丁未二十七日。）
仙半夏（钱半） 炒苏子（二钱） 鸡内金（三钱） 麦芽（三钱） 川朴（钱半） 原滑石（四
钱） 炒莱菔子（三钱） 橘红（一钱） 赤苓（四钱） 光杏仁（三钱） 大腹皮（三钱） （引）路路通（
七个）
三帖。
介按∶湿壅三焦，肺气不降，而脾阳不运，则跗肿腹满，呛咳嗽痰，喘胀要旨，开鬼门
以取
汗，洁净腑以利水，无非宣通表里，务在治病源头。故以清肃肺气，渗湿导滞为治。但高年
患此，是属重险之候。
盛陵徐 腹中仍属胀闷，食入尤甚，脉涩滞，舌滑尖红，大便溏，跗浮，究属重极之症
。（六月初五日。）
乌药（二钱） 鸡内金（三钱） 冬瓜皮（三钱） 炒谷芽（四钱） 左金丸（八分） 新会皮（
钱半） 赤苓（四钱） 佛手花（八分） 通草（钱半） 浓朴（一钱） 枳壳（钱半）
清煎四帖。
介按∶湿热阻滞，肝阳横逆，致脾胃失于健运，而便溏跗浮。治以清肝扶脾兼渗湿，庶
免腹满之虞矣。
安昌沈（浓记） 湿久化肿，脉涩滞，舌滑，溲数，脾阳受伤，非轻藐之症。（八月二十九
日。）
带皮苓（四钱） 猪苓（钱半） 大豆卷（三钱） 光杏仁（三钱） 桂枝（五分） 车前（三钱）
原滑石（四钱） 杜赤小豆（三钱） 泽泻（三钱） 冬瓜皮（三钱） 莱菔子（三钱）
清煎三帖。
又 浮肿稍减，脉尚涩滞，舌滑，溲数，脾阳伤残，究非轻藐之症。（九月初四日。）
商陆（一钱） 赤苓（三钱） 炒菔子（三钱） 海金砂（四钱） 桂枝（五分） 车前（三钱）
滑石（四钱） 新会皮（钱半） 泽泻（三钱） 冬瓜皮（三钱） 大腹皮（三钱）
清煎三帖。
介按∶湿漫三焦，郁伤脾阳，故治以通阳祛湿为主。方从河间桂苓甘露饮脱胎，恰是对
症良剂。
后马金 室女食积化肿，脉濡右大，舌滑，便溺涩。宜消食消肿。
焦六曲（四钱） 大腹皮（三钱） 通草（钱半） 冬瓜皮（三钱） 炒莱菔子（二钱） 赤苓（
四钱） 枳壳（钱半） 炒麦芽（三钱） 陈皮（一钱） 车前（三钱） 杜赤小豆（四钱）
清煎三帖。
介按∶食积伤脾，脾失运化之权，更兼湿热壅滞，溢于皮肤而化肿。治以消积逐水，则
浮肿自退。
后马金 闺女舌微黄，脉弦濡，便利稀水，浮肿已退。宜分消为稳。（八月二十九日。）
广藿梗（二钱） 炒川连（八分） 泽泻（三钱） 鸡内金（三钱） 滑石（四钱） 猪苓（钱半）
炒菔子（三钱） 通草（钱半） 省头草（三钱） 浓朴（一钱） 新会皮（钱半）
清煎三帖。
介按∶湿热久蕴，脾气未复化泻，再以清热渗湿，理气消积，俾气行湿退，则肿泻均瘥
。
遗风包 痢后浮肿腹大，脉涩滞，舌滑白，溺少。宜和中分消。（七分十四日。）
大腹皮（三钱） 焦六曲（四钱） 生香附（钱半） 炒枳壳（二钱） 泽泻（三钱） 炒车前（
三钱） 赤苓（四钱） 炒莱菔子（二钱） 冬瓜皮（三钱） 防己（三钱） 通草（钱半）
清煎二帖。
介按∶痢后脾虚湿滞，故治法仍以扶脾渗湿。
渔庄王 伏暑湿热，脉濡，舌滑微黄，跗肿溲赤，尤宜防胀。（八月二十九日。）
棉茵陈（三钱） 赤苓（四钱） 通草（钱半） 蔻壳（钱半） 杜赤小豆（四钱） 广皮（钱半）
省头草（三钱） 藿香梗（二钱） 仙半夏（钱半） 扁豆衣（三钱） 焦六曲（三钱）
清煎三帖。
介按∶湿为粘腻之邪，暑为熏蒸之气，两相胶锢，病势最为淹缠。今以跗肿溲赤，治以
芳香理气，辛淡渗湿，方法俱佳。若日久而湿浊凝滞，伤残脾阳，即防化胀之虑。
遗风金 痰湿化肿，左脉濡细，右寸关弦滑，呛咳气急，胸满溺少。症非轻藐，宜治防
变。
金沸花（三钱，包煎） 炒车前（三钱） 通草（钱半） 川贝（钱半） 沉香曲（钱半） 广橘
红（一钱） 海石（三钱） 光杏仁（三钱） 杜赤小豆（三钱） 白前（钱半） 地骷髅（三钱）
清煎三帖。
介按∶余阅叶香岩《指南医案》，内有朱姓一症，适与此案证治相同，爰节录之，以资
质证
。其述病源曰∶初因面肿，邪干阳位，气壅不通，二便皆少，桂附不应，即与导滞。滞属有
质，湿热无形，入肺为喘，乘脾为胀，六腑开合皆废，便不通爽，溺短混浊，时或点滴，视
其舌绛口渴，腑病背胀，脏病腹满，更兼倚倒左右，肿胀随着处为甚，湿热布散三焦，阴眼
难以决胜矣。经云∶从上之下者治其上。又云∶从上之下而甚于下者，必先治其上，而后治
其下。此病逆乱纷更，全无头绪，皆不辨有形无形之误。姑以清肃上焦为先（方用飞滑石三
钱，大杏仁十位，生苡仁三钱，白通草一钱，鲜枇杷叶去毛三钱，茯苓皮三钱，淡豆豉钱半
，黑山栀壳一钱，急火煎，五分服）。叶氏发明
病源与误治之由，以及应当治法，分辨明晰，深堪则效。今此案与叶氏所述，适相符合，而
疗法亦意旨相同。惟药味则大同小异。前哲后贤，如出一辙，正如先哲所谓活法法∶中多活
法，奇方方外有奇方，今以此案征之，益信。
渔庄沈（霖记） 木克土化胀，两跗皆肿，脉沉弦，便泻不爽，气逆溺少，非轻藐之症
。（七月初三日）
大腹皮（三钱） 鸡内金（三钱） 新会皮（钱半） 川朴（一钱） 车前（三钱） 沉香（五分
，冲） 枳壳（钱半） 炒米仁（四钱） 通草（钱半） 省头草（三钱） 杜赤豆（四钱）
清煎三帖。
又 浮肿已退，脉虚细，腰痛，胃纳尚和。宜《金匮》肾气丸加减治之。
生地（四钱） 陈萸肉（钱半） 淮牛膝（三钱） 草（三钱） 茯苓（四钱） 丹皮（一钱）
炒车前（三钱） 炒杜仲（三钱） 怀药（三钱） 泽泻（三钱） 五加皮（三钱）
清煎五帖。
又 诸款悉减，脉虚，夜不安寐，临晚跗浮，嘈杂已瘥，仍遵前法加减为妥。（九月二十
二日。）
当归（钱半） 夜交藤（三钱） 仙半夏（钱半） 谷芽（四钱） 炒川连（六分） 茯神（四钱）
新会皮（钱半） 海桐皮（三钱） 柏子仁（三钱） 枣仁（三钱） 草（三钱）
清煎四帖。
又 诸款悉瘥，脉虚细，临晚跗浮酸楚。宜分消为妥。（九月二十七日。）
生牡蛎（四钱） 杜赤豆（三钱） 海桐皮（三钱） 大腹皮（三钱） 泽泻（三钱） 茯苓（四
钱） 冬瓜子（三钱） 通草（钱半） 防己（钱半） 草（三钱） 柏子仁（三钱）
清煎四帖。
又 两跗犹肿，脉涩滞，面浮。宜分消，防化胀。（十月初三日。）
生牡蛎（四钱） 冬瓜子（三钱） 新会皮（钱半） 草（三钱） 泽泻（三钱） 赤苓（四
钱） 猪苓（钱半） 五加皮（三钱） 防己（钱半） 商陆（钱半切忌甜） 大腹皮（三钱）
清煎四帖。
介按∶李中梓曰∶肿胀之病，诸经虽有，无不由于脾肺肾者。盖脾主营运，肺主气化，
肾主
五液，凡五气所化之液，悉属于肾，五液所行之气，悉属于肺。转输二脏以制水生金者，悉
属于脾。故肿胀不外此三经也。然其治法，有内外上下虚实，不可不辨也。在外则肿，越脾
汤、小青龙汤证也。在内则胀，十枣汤、神佑丸证也。在上则喘，葶苈大枣汤、防己、椒目
葶苈大黄丸证也。在下则小便闭，沉香琥珀丸、疏凿饮子证也。此皆治实之法。若夫虚者，
实脾饮、肾气丸证也。李氏此言，发明尽致，但此症初起，系是情怀少畅，以致清气不转，
肝木侮脾，而湿热停滞化胀，第一方宗鸡金散加减，以运气消积，参用渗湿之品。次则因其
利久伤阴，宗肾气汤意以养阴渗湿，补而不滞，利而不伐，洵治虚胀之良方。故至三诊而诸
款悉减。然此时肾液未充，心神未安，则宗安神丸以补心而渗湿，四五两方，皆以牡蛎泽泻
散加减，以分消下焦未净之湿热，步骤井然，故多奏效。但三诊方中，有仍遵前法加减之言
，而且浮肿已退，则此诊以前，似乎遗失一方，深怀未窥全豹之感。
[Background Information]
Book: Shao Lansun's Medical Cases; Author: Shao Lansun; Dynasty: Qing; Chapter: Swelling and Distension; Category: Medical Discussion
Patient Yi Feng Pang. Summer-heat pathogen has settled internally due to careless diet, leading to Qi stagnation and resulting in swelling (Zhong Zhang). The pulse is soggy (Ru) with the left side wiry (Xian); the tongue coating is white covered with gray. Accompanied by hacking cough and epigastric stuffiness, this is a severe condition. Treatment should employ the method of separating and draining (Fen Xiao), waiting for the healthy Qi to recover before further regulation. (August 11th, Lunar Calendar: Ding Wei Year, 29th day.)
Jin Fei Hua (Golden Flower, San Bu Bao Jian) [3 qian, wrapped and decocted]; Chi Xiao Dou (Adzuki Bean) [4 qian]; Da Fu Pi (Areca Peel) [3 qian]; Dong Gua Pi (Winter Melon Peel) [3 qian]; Chi Ling (Red Poria) [4 qian]; Guang Xing Ren (Apricot Seed) [3 qian]; Chao Zhi Qiao (Stir-fried Bitter Orange) [1.5 qian]; Ji Nei Jin (Chicken Gizzard Lining) [3 qian]; Qian Hu (Peucedanum Root) [1.5 qian]; Kou Ke (Cardamom Shell) [1.5 qian]; Tong Cao (Tetrapanax Pith) [1.5 qian].
Decoct in clear water, three doses.
Second Visit: Edema has subsided. Pulse is floating and soggy (Fu Ru); tongue coating is slippery and white. Hacking cough with hoarse voice; epigastrium is slightly relieved. Still appropriate to use separation and drainage for stability. (August 14th, Lunar Calendar: Wu Shen Year, 2nd day.)
Jin Fei Hua [3 qian, wrapped and decocted]; Sang Bai Pi (Mulberry Root Bark) [3 qian]; Dong Gua Pi [3 qian]; Lai Fu Zi (Radish Seed) [3 qian]; Chi Ling [4 qian]; Guang Xing Ren [3 qian]; Yuan Shi (Raw Talcum) [4 qian]; Chuan Bi Xie (Dioscorea Hypoglauca Rhizome) [3 qian]; Da Fu Pi [3 qian]; Du Chi Xiao Dou (Red Adzuki Bean) [3 qian]; Ji Nei Jin [3 qian].
(Leading herb) Lu Lu Tong (Liquidambar Fruit) [7 pieces].
Three doses.
Third Visit: Edema has receded. Pulse is wiry and vigorous. Hacking cough with hoarse voice; tongue coating is slippery. Treatment should appropriately focus on clearing the Lung and promoting diuresis to remove dampness. (August 20th, Lunar Calendar: Wu Shen Year, 8th day.)
Shuang Sang Ye (Frost Mulberry Leaf) [3 qian]; Sheng Yi Yi Ren (Raw Coix Seed) [4 qian]; She Gan (Belamcanda Rhizome) [1.5 qian]; Bai Qian (Cynanchum Stellatum Rootstock) [1.5 qian]; Shi Jue Ming (Abalone Shell) [4 qian]; Chuan Bei Mu (Sichuan Fritillary Bulb) [1.5 qian]; Fu Ling (Poria) [4 qian]; Fen Dan Pi (Moutan Cortex) [2 qian]; Guang Xing Ren [3 qian]; Dong Gua Zi (Winter Melon Seed) [4 qian]; Tong Cao [1.5 qian].
(Leading herb) Xian Pi Pa Ye (Fresh Loquat Leaf) [5 leaves].
Four doses.
Commentary: Summer-heat pathogen is received externally, while dampness arises internally. Formless pathogens combine with formless dampness, obstructing the Lung Qi's descending function, causing cough; invading the Spleen causes swelling. The treatment imitates Xu Zhicai's principle that "light substances can eliminate excess," using bitter substances to descend Qi and purify the Lung, and acrid-light substances to渗湿 (percolate dampness), thus achieving efficacy. In the final visit, although edema had receded, treatment still focused on clearing the Lung and percolating dampness, with methods arranged systematically.
Li from Keqiao. Elderly patient with phlegm-dampness firmly consolidated, abdominal fullness, dorsal foot edema, scanty urination. Pulse is soggy and fine (Ru Xi); tongue coating is thick and greasy, slightly gray with white edges, accompanied by hacking cough. This is a severe condition. (August 9th, Lunar Calendar: Ding Wei Year, 27th day.)
Xian Ban Xia (Pinellia Ternata) [1.5 qian]; Chao Su Zi (Perilla Seed) [2 qian]; Ji Nei Jin [3 qian]; Mai Ya (Barley Sprout) [3 qian]; Chuan Hou Po (Magnolia Bark) [1.5 qian]; Yuan Shi [4 qian]; Chao Lai Fu Zi [3 qian]; Ju Hong (Citrus Reticulata Pericarpium Rubrum) [1 qian]; Chi Ling [4 qian]; Guang Xing Ren [3 qian]; Da Fu Pi [3 qian].
(Leading herb) Lu Lu Tong [7 pieces].
Three doses.
Commentary: Dampness obstructs the Triple Burner, Lung Qi fails to descend, and Spleen Yang fails to transport, resulting in dorsal foot edema, abdominal fullness, hacking cough with phlegm, wheezing, and distension. The key lies in opening the "Ghost Door" (sweating pores) to induce sweating, and cleansing the Bowels (bladder/intestines) to promote urination, aiming to unblock the exterior and interior, addressing the root cause. Thus, purification of Lung Qi and percolation of dampness with guiding out stagnation are employed. However, for an elderly person, this is a critical and dangerous condition.
Xu from Shengling. Abdominal distension and stuffiness persist, worsening after eating. Pulse is choppy and stagnant (Se Zhi); tongue coating is slippery with a red tip; stool is loose; dorsal foot edema. This is ultimately a very severe condition. (June 5th.)
Wu Yao (Lindera Root) [2 qian]; Ji Nei Jin [3 qian]; Dong Gua Pi [3 qian]; Chao Gu Ya (Stir-fried Rice Sprout) [4 qian]; Zuo Jin Wan (Left Metal Pill) [0.8 fen]; Xin Hui Pi (Xinhui Tangerine Peel) [1.5 qian]; Chi Ling [4 qian]; Fo Shou Hua (Buddha's Hand Flower) [0.8 fen]; Tong Cao [1.5 qian]; Nong Hou Po (Thick Magnolia Bark) [1 qian]; Zhi Qiao (Bitter Orange) [1.5 qian].
Decoct in clear water, four doses.
Commentary: Damp-heat obstruction and Liver Yang flaring horizontally cause the Spleen and Stomach to lose their robust transportation function, leading to loose stools and dorsal foot edema. Treatment focuses on clearing the Liver and supporting the Spleen while percolating dampness, thereby avoiding the risk of abdominal fullness.
Shen (Nong Ji) from Anchang. Dampness lingering for a long time transforms into swelling. Pulse is choppy and stagnant; tongue coating is slippery; frequent urination; Spleen Yang is injured. This is not a minor condition. (August 29th.)
Dai Pi Ling (Poria with Skin) [4 qian]; Zhu Ling (Polyporus) [1.5 qian]; Da Dou Juan (Soybean Sprout) [3 qian]; Guang Xing Ren [3 qian]; Gui Zhi (Cinnamon Twig) [0.5 fen]; Che Qian (Plantago Seed) [3 qian]; Yuan Shi [4 qian]; Du Chi Xiao Dou [3 qian]; Ze Xie (Alisma Rhizome) [3 qian]; Dong Gua Pi [3 qian]; Lai Fu Zi [3 qian].
Decoct in clear water, three doses.
Second Prescription: Edema slightly reduced; pulse remains choppy and stagnant; tongue coating slippery; frequent urination; Spleen Yang severely damaged. Ultimately, this is not a minor condition. (September 4th.)
Shang Lu (Phytolacca Root) [1 qian]; Chi Ling [3 qian]; Chao Fu Zi (Stir-fried Radish Seed) [3 qian]; Hai Jin Sha (Lygodium Spore) [4 qian]; Gui Zhi [0.5 fen]; Che Qian [3 qian]; Shi (Talcum) [4 qian]; Xin Hui Pi [1.5 qian]; Ze Xian [3 qian]; Dong Gua Pi [3 qian]; Da Fu Pi [3 qian].
Decoct in clear water, three doses.
Commentary: Dampness permeates the Triple Burner, depressing and injuring Spleen Yang. Therefore, treatment primarily focuses on unblocking Yang and dispelling dampness. The formula is derived from Liu Hejian's Gui Ling Gan Lu Yin (Cinnamon Twig, Poria, and Dew-Drop Decoction), which is precisely a good remedy for this syndrome.
Jin from Houma Jin. Unmarried female with swelling transformed from food stagnation. Pulse is soggy and large on the right; tongue coating slippery; urination and defecation are difficult and涩滞 (stagnant). Treatment should focus on resolving food stagnation and reducing swelling.
Jiao Liu Qu (Charred Medicated Leaven) [4 qian]; Da Fu Pi [3 qian]; Tong Cao [1.5 qian]; Dong Gua Pi [3 qian]; Chao Lai Fu Zi [2 qian]; Chi Ling [4 qian]; Zhi Qiao [1.5 qian]; Chao Mai Ya (Stir-fried Barley Sprout) [3 qian]; Chen Pi (Aged Tangerine Peel) [1 qian]; Che Qian [3 qian]; Du Chi Xiao Dou [4 qian].
Decoct in clear water, three doses.
Commentary: Food stagnation injures the Spleen, causing loss of transportation and transformation. Combined with damp-heat congestion overflowing into the skin, it transforms into swelling. Treatment with resolving accumulation and driving out water will naturally make edema recede.
Jin from Houma Jin. Daughter with slightly yellow tongue coating, pulse wiry and soggy, frequent passage of watery stool, edema has receded. Treatment should focus on separation and drainage for stability. (August 29th.)
Guang Huo Geng (Patchouli Stem) [2 qian]; Chuan Lian (Stir-fried Coptis Rhizome) [0.8 fen]; Ze Xian [3 qian]; Ji Nei Jin [3 qian]; Shi [4 qian]; Zhu Ling [1.5 qian]; Chao Fu Zi [3 qian]; Tong Cao [1.5 qian]; Sheng Tou Cao (Eupatorium Fortunei / Peilan) [3 qian]; Nong Hou Po [1 qian]; Xin Hui Pi [1.5 qian].
Decoct in clear water, three doses.
Commentary: Damp-heat has accumulated for a long time, and Spleen Qi has not recovered to transform diarrhea. Further treatment involves clearing heat and percolating dampness, regulating Qi and resolving stagnation. When Qi moves, dampness retreats, and both swelling and diarrhea will heal.
Bao from Yifeng. Post-dysentery edema and abdominal distension. Pulse is choppy and stagnant; tongue coating is slippery and white; scanty urination. Treatment should focus on harmonizing the Middle and separating/draining. (July 14th.)
Da Fu Pi [3 qian]; Jiao Liu Qu [4 qian]; Sheng Xiang Fu (Cyperi Rhizoma) [1.5 qian]; Chao Zhi Qiao [2 qian]; Ze Xian [3 qian]; Chao Che Qian [3 qian]; Chi Ling [4 qian]; Chao Lai Fu Zi [2 qian]; Dong Gua Pi [3 qian]; Fang Ji (Stephania Tetrandra Root) [3 qian]; Tong Cao [1.5 qian].
Decoct in clear water, two doses.
Commentary: Post-dysentery Spleen deficiency with dampness stagnation dictates that treatment still focuses on supporting the Spleen and percolating dampness.
Wang from Yuzhuang. Hidden summer-heat and damp-heat. Pulse is soggy; tongue coating slippery and slightly yellow; dorsal foot edema and red urine. Particularly important to prevent progression to abdominal distension. (August 29th.)
Mian Yin Chen (Artemisia Capillaris) [3 qian]; Chi Ling [4 qian]; Tong Cao [1.5 qian]; Kou Ke [1.5 qian]; Du Chi Xiao Dou [4 qian]; Guang Pi (Broad-leaved Citrus Peel) [1.5 qian]; Sheng Tou Cao [3 qian]; Huo Xiang Geng (Agastache Stem) [2 qian]; Xian Ban Xia [1.5 qian]; Bian Dou Yi (Lablab Bean Coat) [3 qian]; Jiao Liu Qu [3 qian].
Decoct in clear water, three doses.
Commentary: Dampness is a sticky pathogen, and summer-heat is a steaming qi. The two bind together, making the disease course most lingering. Now presenting with dorsal foot edema and red urine, treatment uses aromatic Qi-regulating and acrid-light damp-percolating methods, which are excellent. If damp-turbidity condenses and stagnates over time, injuring Spleen Yang, one must guard against the fear of transforming into abdominal distension.
Jin from Yifeng. Phlegm-dampness transforming into swelling. Left pulse is soggy and fine; right Cun and Guan pulses are wiry and slippery. Hacking cough, rapid breathing, chest fullness, scanty urination. Condition is not minor; treat to prevent changes.
Jin Fei Hua [3 qian, wrapped and decocted]; Chao Che Qian [3 qian]; Tong Cao [1.5 qian]; Chuan Bei Mu [1.5 qian]; Chen Xiang Qu (Aquilaria Fermented Mass) [1.5 qian]; Guang Ju Hong (Broad Orange Red Pericarp) [1 qian]; Hai Shi (Floating Limestone) [3 qian]; Guang Xing Ren [3 qian]; Du Chi Xiao Dou [3 qian]; Bai Qian [1.5 qian]; Di Ku Lou (Old Radix Raphani Indici) [3 qian].
Decoct in clear water, three doses.
Commentary: I have read Ye Tianshi's *Zhinan Yian* (Medical Cases Guiding the Way), where a case of a patient surnamed Zhu matches this case in syndrome and treatment. I excerpt it here for reference. It states regarding the disease origin: Initially due to facial swelling, pathogen affects Yang positions, Qi congestion blocks flow, urination and defecation are both scarce. Guizhi and Fuzi were ineffective, so stagnation-resolving methods were used. Stagnation belongs to form, damp-heat to formless. Entering the Lung causes wheezing, attacking the Spleen causes distension. The opening and closing of the Six Bowels fail; stool is not smooth, urine is short and turbid, sometimes dropping drop by drop. Observing the crimson tongue and thirst, bowels disease presents as back distension, organs disease as abdominal fullness, plus leaning left or right, swelling worsening at specific sites. Damp-heat spreads through the Triple Burner; Yin eyes struggle to win. The Classics say: "For those coming from above and affecting below, treat the upper." And: "For those coming from above and worsening below, first treat the upper, then treat the lower." This disease is chaotic and disordered, lacking order, all due to errors in distinguishing form from formless. Tentatively, clear and purify the Upper Jiao first (Formula: Fei Shi [Talcum] 3 qian, Da Xing Ren [Almond] 10 pieces, Sheng Yi Yi Ren [Coix Seed] 3 qian, Bai Tong Cao [White Tetrapanax Pith] 1 qian, Xian Pi Pa Ye [Fresh Loquat Leaf] 3 qian, Fu Ling Pi [Poria Skin] 3 qian, Dan Dou Chi [Fermented Soybean] 1.5 qian, Hei Shan Zhi Qiao [Gardenia Husk] 1 qian. Decoct rapidly, take 0.5 fen). Ye Tianshi elucidated the disease origin and reasons for misdiagnosis/mistreatment, as well as appropriate treatments, with clear distinctions, worthy of emulation. This case coincides with Ye's description, and the therapeutic intent is identical, though the herbs differ slightly. Former sages and later worthies follow the same track, just as the former sage said: "Living methods within methods, many living methods; miraculous formulas beyond formulas, miraculous formulas outside." Verifying this case confirms this belief.
Shen (Lin Ji) from Yuzhuang. Wood overacting on Earth transforms into distension. Both dorsal feet swollen. Pulse deep and wiry. Stool is loose but unsatisfactory. Qi rebels, urination is scanty. Not a minor condition. (July 3rd.)
Da Fu Pi [3 qian]; Ji Nei Jin [3 qian]; Xin Hui Pi [1.5 qian]; Chuan Hou Po [1 qian]; Che Qian [3 qian]; Chen Xiang (Aquilaria Wood) [0.5 fen, taken with liquid]; Zhi Qiao [1.5 qian]; Chao Yi Yi Ren (Stir-fried Coix Seed) [4 qian]; Tong Cao [1.5 qian]; Sheng Tou Cao [3 qian]; Du Chi Dou (Red Kidney Bean) [4 qian].
Decoct in clear water, three doses.
Second Prescription: Edema has receded. Pulse is deficient and fine. Lower back pain. Stomach appetite is still harmonious. Treatment should modify *Jingui Yaolue* Shen Qi Wan (Kidney Qi Pill).
Sheng Di (Rehmannia Root) [4 qian]; Chen Yu Rou (Cornus Fruit) [1.5 qian]; Huai Niu Xi (Achyranthes Root) [3 qian]; Bi Xie (Dioscorea Hypoglauca Rhizome) [3 qian]; Fu Ling [4 qian]; Dan Pi (Moutan Cortex) [1 qian]; Chao Che Qian [3 qian]; Chao Du Zhong (Eucommia Bark) [3 qian]; Huai Yao (Dioscorea Opposita Rhizome) [3 qian]; Ze Xian [3 qian]; Wu Jia Pi (Acanthopanax Bark) [3 qian].
Decoct in clear water, five doses.
Third Prescription: All symptoms significantly reduced. Pulse is deficient. Sleep is restless at night. Dorsal foot edema in the evening. Clammy sensation has healed. Still appropriate to follow previous methods with modifications. (September 22nd.)
Dang Gui (Angelica Sinensis) [1.5 qian]; Ye Jiao Teng (Polygonum Multiflorum Vine) [3 qian]; Xian Ban Xia [1.5 qian]; Gu Ya (Rice Sprout) [4 qian]; Chuan Lian [0.6 fen]; Fu Shen (Poria with Hostwood) [4 qian]; Xin Hui Pi [1.5 qian]; Hai Tong Pi (Sarcandra Glabra Stem) [3 qian]; Bai Zi Ren (Biota Seed) [3 qian]; Zao Ren (Ziziphus Seed) [3 qian]; Bi Xie [3 qian].
Decoct in clear water, four doses.
Fourth Prescription: All symptoms healed. Pulse is deficient and fine. Dorsal foot edema and soreness in the evening. Treatment should focus on separation and drainage. (September 27th.)
Sheng Mu Li (Oyster Shell) [4 qian]; Du Chi Dou [3 qian]; Hai Tong Pi [3 qian]; Da Fu Pi [3 qian]; Ze Xian [3 qian]; Fu Ling [4 qian]; Dong Gua Zi [3 qian]; Tong Cao [1.5 qian]; Fang Ji [1.5 qian]; Bi Xie [3 qian]; Bai Zi Ren [3 qian].
Decoct in clear water, four doses.
Fifth Prescription: Both dorsal feet still swollen. Pulse is choppy and stagnant. Facial edema. Treatment should focus on separation and drainage, preventing transformation into abdominal distension. (October 3rd.)
Sheng Mu Li [4 qian]; Dong Gua Zi [3 qian]; Xin Hui Pi [1.5 qian]; Bi Xie [3 qian]; Ze Xian [3 qian]; Chi Ling [4 qian]; Zhu Ling [1.5 qian]; Wu Jia Pi [3 qian]; Fang Ji [1.5 qian]; Shang Lu (Phytolacca Root) [1.5 qian, avoid sweet variety]; Da Fu Pi [3 qian].
Decoct in clear water, four doses.
Commentary: Li Zhongzi stated: Regarding swelling and distension diseases, although they may involve various meridians, none do not stem from the Spleen, Lung, and Kidney. The Spleen manages nutrient transportation; the Lung governs Qi transformation; the Kidney manages the Five Fluids. All fluids transformed by the Five Qi belong to the Kidney; all Qi moving the Five Fluids belongs to the Lung. The transfer between these two organs to control Water generating Metal belongs to the Spleen. Thus, swelling and distension do not go beyond these three meridians. However, their treatments vary by exterior/interior, upper/lower, and deficiency/excess, which must be distinguished. Exterior swelling corresponds to Yue Pi Tang and Xiao Qing Long Tang syndromes. Interior distension corresponds to Shi Zao Tang and Shen You Wan syndromes. Upper wheezing corresponds to Ting Li Da Zao Tang and Fang Ji Jiao Mu Ting Li Da Huang Wan syndromes. Lower urinary retention corresponds to Chen Xiang Hu Po Wan and Shu Zao Yin Zi syndromes. These are all methods for treating Excess. For Deficiency, there are Shi Pi Yin and Shen Qi Wan. Li's words explain this thoroughly. However, this case initially arose from constrained emotions, causing Clear Qi to fail to circulate, Liver Wood insulting the Spleen, and damp-heat stagnating to transform into distension. The first formula modified Ji Jin San to move Qi and resolve accumulation, incorporating damp-percolating items. Secondly, because prolonged diuresis injured Yin, the intent of Shen Qi Tang was used to nourish Yin and percolate dampness, tonifying without stagnation and draining without damaging, truly a good formula for treating deficient distension. Thus, by the third visit, all symptoms reduced. However, at this time, Kidney fluids were not filled, and Heart Spirit was not calm, so An Shen Wan was used to tonify the Heart and percolate dampness. The fourth and fifth formulas modified Mu Li Ze Xie San to separate and drain residual damp-heat in the Lower Jiao. The steps were orderly, hence effective. But the third prescription mentions following previous methods with modifications, and since edema had receded, it seems a prescription between visits was lost, leaving a feeling of not seeing the whole picture.