脉∶水肿之病，有阴有阳。阴脉沉迟，其色青白，不渴而泻，小便清涩；脉或沉数，色赤而黄，燥粪赤溺，兼渴为
阳。沉细必死，浮大无妨。
水肿者，通身浮肿，皮薄而光，手按成窟，举手即满者，是水肿也。初起眼胞上下微肿如裹水。上则喘咳
气急，下则足膝浮肿，大小便短涩不利，或大便溏泄，皆因脾虚不能运化水谷，停于三焦，注于肌肉，渗于皮肤
而发肿也。治用健脾利水以为上策。久则肌肉溃烂，阴囊足胫水出，唇黑，缺盆平，脐口肉硬，足背手掌俱平
者，是脾气惫也。
水肿气急而小便涩，血肿气满而四肢寒。朝宽暮急是血虚，暮宽朝急是气虚，朝暮急气血俱虚，大凡水肿
者，宜健脾去湿利水也。
实脾饮 治水肿。
苍术（米泔制） 白术（土炒） 浓朴（姜汁炒） 茯苓（连皮用） 猪苓 泽泻 香附 砂仁 枳壳
（麸炒） 陈皮 大腹皮 木香（各等分）
上锉一剂，灯芯一团，水煎，磨木香调服。气急加苏子、葶苈、桑白皮，去白术，发热加炒山栀、黄连，去
香附；泻加炒芍药，去枳壳，小水不通加木通、滑石，去白术；饮食停滞加山楂、神曲，去白术；恶寒手足厥冷
、脉沉细，加官桂少许；腰上肿加藿香，腰以下加牛膝、黄柏，去香附；胸腹肿胀饱闷加萝卜子，去白术。
加减胃苓汤 治水肿。
苍术（米泔制，一钱半） 陈皮（去白，一钱） 浓朴（姜制，八分） 猪芩（去皮） 赤茯苓（去皮）
泽泻 白术（去芦。各一钱） 大腹皮（六分） 神曲（炒，八分） 甘草（炙，三分） 山楂（去核，七分）
香附（姜炒，六分） 木瓜（一钱） 槟榔（八分） 砂仁（七分）
上锉一剂，水二钟、生姜三片、灯芯一团，煎至一钟，食远温服，渣再煎服。
水肿腹有积块者，宜半消而半补也。
木香流气饮 调顺荣卫、流通血脉、快利三焦、安和五脏，治诸气痞滞不通，胸膈膨闷、口苦咽干、
呕吐食少、肩背腰胁走注则痛、喘急痰嗽、面目虚浮、四肢肿胀、大便闭结、小便赤涩；又治忧思太过，怔忡郁
积、香港脚风湿、结聚肿痛、胀满喘急、水肿等症，并皆治之。
陈皮（一钱四分） 青皮（去瓤） 香附 紫苏（各一钱二分） 赤茯苓 木瓜 白术（去芦） 麦门冬
大黄（各二钱五分） 白芷 枳壳（麸炒。各三分） 草果 人参（去芦。各一钱半） 官桂 蓬术 大腹皮
丁皮 槟榔 木香 沉香（各四分半） 木通（六分） 甘草 半夏（姜汁炒） 浓朴（姜汁炒。各一钱二分）
上锉一剂，生姜三片、枣一枚，水煎，不拘时热服。
消肿调脾顺气汤 治水肿，消胀满，顺气和脾，除湿利水。
苍术（米泔浸） 陈皮 浓朴（去皮姜炒） 草果 砂仁 猪苓 泽泻 木香 槟榔（男雌女雄） 香附
枳壳（麸炒） 桔梗 三棱 莪术 官桂 大茴香 木通 人参 木瓜 桑白皮 牵牛（男用白，女用黑） 大腹皮
大黄 甘草
上锉剂，生姜煎服。
水肿因气恼者，宜顺气也，分心气饮。（方见气症。）根据本方加猪苓、泽泻、车前、葶苈、木瓜、麦门冬。
湿热作肿胀滑泄者，宜清热除湿利水也。
葶苈木香散 治湿热内外甚，水肿腹胀、小便赤涩、大便滑泄，此药下水湿、消肿胀、止泻、利小便之
圣药也。
猪苓（一钱半） 泽泻（五分） 白术（二钱半） 茯苓（二钱半） 官桂（二钱半） 葶苈（二钱半）
木通（五钱） 木香（五钱） 滑石（三两） 甘草（五钱）
上为细末，每服三钱，白汤调下，食前服。若小便不得通利而反泄看，此乃湿热痞闷深而攻之不开是反为注
泄，乃
正气已衰，多难救也。
水肿元气壮盛者，宜消导也。
三消丸 治肿胀。
甘遂 木香 巴豆（去壳。各一钱）
上共研为末，寒粟米饭为丸，如梧桐子大，量人虚实用之。实者每服二分，虚者每服分半。先服五芩散加
瞿麦、车前、木通、滑石煎服，后服此三消丸。消上用陈皮汤下，消下用葱白汤下。隔一日进一服，三服止。若
动三五次，以冷粥补之。消完后用白术（三两）、陈皮（三两）、甘草（炙，三两），浓朴（姜炒，二两）
皂矾（三两），用面炒尽烟，或用醋炒皂矾三五次，同前药研为末，醋糊丸，梧桐子大。每服五十丸，米汤送下
。每日进三服，忌恼怒、戒煎炒及无鳞鱼诸般发物，连服四十九日而安。
脉象：水肿这一疾病，有阴证和阳证之分。阴证的脉象沉而迟缓，面色青白，口不渴且伴有腹泻，小便清长或涩滞；若脉象沉数，面色红黄，大便干燥、小便赤涩，兼有口渴症状的，属于阳证。脉象沉细者预后不良，多主死亡；脉象浮大者尚可应对，无妨。
所谓水肿，是指全身浮肿，皮肤薄而光亮，用手按压出现凹陷（成窟），抬手后凹陷随即恢复饱满的，就是水肿病。初起时眼睑上下微微肿胀，如同包裹着水一样。向上发展则出现气喘咳嗽、呼吸急促，向下发展则足膝浮肿，大小便短少涩滞不利，或者大便溏泄。这都是因为脾虚不能运化水谷，导致水湿停滞在三焦，灌注于肌肉，渗透于皮肤而引发肿胀。治疗应当以健脾利水为上策。如果病程长久，导致肌肉溃烂，阴囊及小腿流出水液，嘴唇发黑，锁骨上窝（缺盆）平满消失，肚脐周围肌肉坚硬，足背和手掌平坦无纹路的，这是脾气衰竭的表现。
水肿伴有气急且小便涩滞的，是血肿伴有气满且四肢寒冷。早晨症状减轻、傍晚加重的是血虚，傍晚症状减轻、早晨加重的是气虚，早晚都加重的是气血俱虚。大凡水肿病患者，适宜采用健脾祛湿利水的方法治疗。
实脾饮：治疗水肿。
苍术（用米泔水制）、白术（用土炒）、厚朴（用姜汁炒）、茯苓（连皮使用）、猪苓、泽泻、香附、砂仁、枳壳（用麦麸炒）、陈皮、大腹皮、木香（以上各等分）。
将上述药材锉碎为一剂，加灯芯草一团，用水煎煮，磨取木香汁调服。若气急，加苏子、葶苈子、桑白皮，去掉白术；若发热，加炒山栀、黄连，去掉香附；若腹泻，加炒芍药，去掉枳壳；若小便不通，加木通、滑石，去掉白术；若饮食停滞，加山楂、神曲，去掉白术；若恶寒手足厥冷、脉象沉细，加少许官桂；若腰部以上肿胀，加藿香；腰部以下肿胀，加牛膝、黄柏，去掉香附；若胸腹胀满饱闷，加萝卜子，去掉白术。
加减胃苓汤：治疗水肿。
苍术（米泔制，一钱半）、陈皮（去白，一钱）、厚朴（姜制，八分）、猪苓（去皮）、赤茯苓（去皮）、泽泻、白术（去芦，各一钱）、大腹皮（六分）、神曲（炒，八分）、甘草（炙，三分）、山楂（去核，七分）、香附（姜炒，六分）、木瓜（一钱）、槟榔（八分）、砂仁（七分）。
将上述药材锉碎为一剂，加水两钟、生姜三片、灯芯草一团，煎至一钟，饭后温服，药渣再煎服用。
木香流气饮：调理顺达荣卫、流通血脉、快利三焦、安和五脏，治疗各种气机痞塞阻滞不通引起的胸膈膨闷、口苦咽干、呕吐食少、肩背腰胁游走性疼痛、喘急痰嗽、面目虚浮、四肢肿胀、大便闭结、小便赤涩等症状；又治疗忧思过度导致的怔忡郁积、脚气风湿、结聚肿痛、胀满喘急、水肿等症，均能治疗。
陈皮（一钱四分）、青皮（去瓤）、香附、紫苏（各一钱二分）、赤茯苓、木瓜、白术（去芦）、麦门冬、大黄（各二钱五分）、白芷、枳壳（麸炒，各三分）、草果、人参（去芦，各一钱半）、官桂、蓬术、大腹皮、丁皮、槟榔、木香、沉香（各四分半）、木通（六分）、甘草、半夏（姜汁炒）、厚朴（姜汁炒，各一钱二分）。
将上述药材锉碎为一剂，加生姜三片、大枣一枚，用水煎煮，不拘时间热服。
消肿调脾顺气汤：治疗水肿，消除胀满，顺气和脾，除湿利水。
苍术（米泔浸）、陈皮、厚朴（去皮姜炒）、草果、砂仁、猪苓、泽泻、木香、槟榔（男用雌株，女用雄株）、香附、枳壳（麸炒）、桔梗、三棱、莪术、官桂、大茴香、木通、人参、木瓜、桑白皮、牵牛子（男用白色，女用黑色）、大腹皮、大黄、甘草。
将上述药材锉碎，加生姜煎服。
因气恼引起的水肿，适宜顺气治疗，可用分心气饮。（方剂见气症章节。）根据本方加入猪苓、泽泻、车前子、葶苈子、木瓜、麦门冬。
葶苈木香散：治疗湿热内外皆盛，出现水肿腹胀、小便赤涩、大便滑泄，此药是下水湿、消肿胀、止泻、利小便的圣药。
猪苓（一钱半）、泽泻（五分）、白术（二钱半）、茯苓（二钱半）、官桂（二钱半）、葶苈子（二钱半）、木通（五钱）、木香（五钱）、滑石（三两）、甘草（五钱）。
将上述药材研为细末，每次服用三钱，用白开水调下，饭前服用。如果小便不得通利反而出现泄泻，这是因为湿热痞闷深重，攻伐不开反而导致泄泻，此时正气已衰，大多难以救治。
三消丸：治疗肿胀。
甘遂、木香、巴豆（去壳，各一钱）。
将上述药材共研为末，用寒粟米饭做丸，如梧桐子大小，根据病人虚实情况用量。实证每次服用二分，虚证每次服用一分半。先服用五苓散加瞿麦、车前子、木通、滑石煎服，随后服用此三消丸。消上部肿胀用陈皮汤送服，消下部肿胀用葱白汤送服。隔一日进服一次，服三次停止。若排便三五次，用冷粥补养。消肿完成后，用白术（三两）、陈皮（三两）、甘草（炙，三两）、厚朴（姜炒，二两）、皂矾（三两），用面炒尽烟，或用醋炒皂矾三五次，同前药研为末，醋糊为丸，梧桐子大小。每次服用五十丸，米汤送下。每日进服三次，忌恼怒，戒食煎炒及无鳞鱼等各种发物，连续服用四十九日即可安宁。
Pulse: Edema is a disease that can be classified into Yin and Yang patterns. A Yin pattern presents with a deep and slow pulse, bluish-white complexion, absence of thirst accompanied by diarrhea, and clear or scanty/difficult urination; if the pulse is deep and rapid, the complexion is reddish-yellow, there is dry stool and red urine, along with thirst, it belongs to the Yang pattern. A deep and fine pulse indicates a fatal prognosis, whereas a floating and large pulse is manageable.
Edema refers to generalized swelling where the skin is thin and shiny, leaving an indentation when pressed that fills back up immediately upon lifting the hand. Initially, there is slight swelling around the eyelids, resembling water retention. Upward progression leads to wheezing, coughing, and shortness of breath; downward progression results in swelling of the feet and knees, with short, scanty, and difficult urination, or loose stools. This is caused by Spleen deficiency failing to transform and transport food and fluids, leading to fluid retention in the San Jiao (Triple Burner), infiltrating muscles, and permeating the skin, resulting in swelling. The superior treatment strategy is to strengthen the Spleen and promote diuresis. If the condition persists for a long time, causing muscle ulceration, fluid exudation from the scrotum and calves, black lips, flattening of the supraclavicular fossa (Quepen), hardness around the umbilicus, and flattening of the dorsum of the feet and palms, this indicates exhaustion of Spleen Qi.
Edema accompanied by shortness of breath and scanty/difficult urination, or blood-related swelling with abdominal distension and cold limbs, varies by time of day: symptoms easing in the morning and worsening in the evening indicate Blood deficiency; easing in the evening and worsening in the morning indicate Qi deficiency; worsening at both times indicates combined Qi and Blood deficiency. Generally, for edema, strengthening the Spleen, removing dampness, and promoting diuresis are appropriate.
Shi Pi Yin (Solidify the Spleen Decoction): Treats edema.
Cang Zhu (Atractylodis Rhizoma processed with rice bran water), Bai Zhu (Atractylodis Macrocephalae Rhizoma stir-fried with soil), Hou Po (Magnoliae Officinalis Cortex stir-fried with ginger juice), Fu Ling (Poria with peel), Zhu Ling (Polyporus), Ze Xie (Alismatis Rhizoma), Xiang Fu (Cyperi Rhizoma), Sha Ren (Amomi Fructus), Zhi Ke (Aurantii Fructus stir-fried with bran), Chen Pi (Citri Reticulatae Pericarpium), Da Fu Pi (Arecae Pericarpium), Mu Xiang (Aucklandiae Radix) [all in equal parts].
Crush one dose, add a bundle of Centella asiatica herb (Deng Xin Cao), decoct with water, and take mixed with ground Mu Xiang juice. For shortness of breath, add Zi Su Zi (Perillae Fructus), Ting Li Zi (Lepidii Semen), and Sang Bai Pi (Mori Cortex); remove Bai Zhu. For fever, add Chao Shan Zhi (Gardeniae Fructus stir-fried) and Huang Lian (Coptidis Rhizoma); remove Xiang Fu. For diarrhea, add Chao Shao Yao (Paeoniae Radix Alba stir-fried); remove Zhi Ke. For urinary obstruction, add Mu Tong (Akebiae Caulis) and Hua Shi (Talcum); remove Bai Zhu. For food stagnation, add Shan Zha (Crataegi Fructus) and Shen Qu (Massa Medicata Fermentata); remove Bai Zhu. For aversion to cold, cold extremities, and deep/fine pulse, add a small amount of Guan Gui (Cinnamomi Ramulus). For swelling above the waist, add Huo Xiang (Agastaches Herba); for swelling below the waist, add Niu Xi (Achyranthis Bidentatae Radix) and Huang Bo (Phellodendri Cortex); remove Xiang Fu. For chest/abdominal fullness and oppression, add Luo Bo Zi (Raphani Semen); remove Bai Zhu.
Jia Jian Wei Ling Tang (Modified Stomach-Ling Decoction): Treats edema.
Cang Zhu (processed with rice bran water, 1.5 qian), Chen Pi (peeled, 1 qian), Hou Po (processed with ginger, 0.8 fen), Zhu Ling (peeled), Chi Fu Ling (Poria with red interior, peeled), Ze Xie, Bai Zhu (de-gorged, each 1 qian), Da Fu Pi (0.6 fen), Shen Qu (stir-fried, 0.8 fen), Gan Cao (honey-fried, 0.3 fen), Shan Zha (pitted, 0.7 fen), Xiang Fu (stir-fried with ginger, 0.6 fen), Mu Gua (Chaenomelis Fructus, 1 qian), Bing Lang (Arecae Semen, 0.8 fen), Sha Ren (0.7 fen).
Crush one dose, add two zhong of water, three slices of Sheng Jiang (Zingiberis Rhizoma Recens), and a bundle of Deng Xin Cao, decoct until one zhong remains. Take warm after meals; decoct the dregs again for a second dose.
For edema with abdominal masses, a combination of half resolving and half tonifying is suitable.
Mu Xiang Liu Qi Yin (Wood Fragrance Flowing Qi Decoction): Regulates and smooths Ying and Wei (Nutritive and Defensive Qi), unblocks blood vessels, benefits the San Jiao, and harmonizes the Five Zang organs. It treats various conditions caused by Qi stagnation and blockage, such as chest/diaphragmatic distension, bitter taste in the mouth, dry throat, vomiting, poor appetite, wandering pain in shoulders/back/waist/flanks, wheezing, phlegm-cough, puffy face/eyes, swollen limbs, constipation, and red/scanty urination. It also treats palpitations and depression due to excessive worry/thinking, Hong Kong foot (podagra/gout) with wind-dampness, nodular swelling/pain, distension, wheezing, and edema.
Chen Pi (1.4 qian), Qing Pi (Citri Reticulatae Pericarpium Immaturum, de-pithed), Xiang Fu, Zi Su Ye/Hua (Perillae Folium/Fructus) [each 1.2 qian], Chi Fu Ling, Mu Gua, Bai Zhu (de-gorged), Mai Men Dong (Ophiopogonis Tuber), Da Huang (Rhei Radix et Rhizoma) [each 2.5 qian], Bai Zhi (Angelicae Dahuricae Radix), Zhi Ke (stir-fried with bran, each 0.3 fen), Cao Guo (Tsaoko Fructus), Ren Shen (Ginseng Radix et Rhizoma, de-gorged) [each 1.5 qian], Guan Gui, Peng Ze (Curcumae Longae Rhizoma), Da Fu Pi, Ding Pi (Syzygii Aromatisati Fructus Pericarpium), Bing Lang, Mu Xiang, Chen Xiang (Aquilariae Lignum Resinatum) [each 0.45 fen], Mu Tong (0.6 fen), Gan Cao, Ban Xia (Pinelliae Rhizoma stir-fried with ginger juice), Hou Po (stir-fried with ginger juice, each 1.2 qian).
Crush one dose, add three slices of Sheng Jiang and one Jujube (Ziziphi Jujubae Fructus), decoct with water, and take hot at any time.
Xiao Zhong Tiao Pi Shun Qi Tang (Reduce Swelling, Regulate Spleen, Smooth Qi Decoction): Treats edema, reduces distension, smooths Qi and regulates the Spleen, removes dampness and promotes diuresis.
Cang Zhu (soaked in rice bran water), Chen Pi, Hou Po (peeled, stir-fried with ginger), Cao Guo, Sha Ren, Zhu Ling, Ze Xie, Mu Xiang, Bing Lang (male uses female plant, female uses male plant), Xiang Fu, Zhi Ke (stir-fried with bran), Jie Geng (Platycodonis Radix), San Leng (Sparganii Rhizoma), E Zhu (Curcumae Rhizoma), Guan Gui, Da Hui Xiang (Foeniculi Fructus), Mu Tong, Ren Shen, Mu Gua, Sang Bai Pi, Qian Niu Zi (Pharbitidis Semen - males use white, females use black), Da Fu Pi, Da Huang, Gan Cao.
Crush the dose, decoct with Sheng Jiang, and take.
For edema caused by anger/stress, smoothing Qi is appropriate, using Fen Xin Qi Yin (see Qi Syndrome chapter). Modify this formula by adding Zhu Ling, Ze Xie, Che Qian Zi (Plantaginis Semen), Ting Li Zi, Mu Gua, and Mai Men Dong.
For swelling and loose stools caused by Damp-Heat, clearing heat, removing dampness, and promoting diuresis is appropriate.
Ting Li Mu Xiang San (Lepidium and Aucklandia Powder): Treats severe internal and external Damp-Heat, presenting with edema, abdominal distension, red/scanty urination, and loose stools. This medicine is a sacred remedy for draining damp-fluids, reducing swelling, stopping diarrhea, and promoting urination.
Zhu Ling (1.5 qian), Ze Xie (0.5 fen), Bai Zhu (2.5 qian), Fu Ling (2.5 qian), Guan Gui (2.5 qian), Ting Li Zi (2.5 qian), Mu Tong (5 qian), Mu Xiang (5 qian), Hua Shi (3 liang), Gan Cao (5 qian).
Grind into a fine powder. Take 3 qian per dose, mixed with warm water, before meals. If urination does not improve but diarrhea worsens, it indicates deep-seated Damp-Heat blockage that cannot be cleared, leading to diarrhea; this signifies depletion of Healthy Qi and is often incurable.
For edema patients with robust Yuan Qi (Original Qi), resolution and guiding out is appropriate.
San Xiao Wan (Three Eliminations Pill): Treats swelling.
Gan Suan (Kansui Radix), Mu Xiang, Ba Dou (Crotonis Fructus, de-shelled) [each 1 qian].
Grind together into powder, form pills with cold millet rice, size of Sophora japonica seeds. Dosage depends on deficiency/excess: Excess cases take 0.2 qian; Deficiency cases take 0.15 qian. First, take Wu Ling San (Five-Ling Powder) added with Qu Mai (Polygoni Avicularis Herba), Che Qian Zi, Mu Tong, and Hua Shi, decocted and taken. Then take this San Xiao Wan. For upper body swelling, take with Chen Pi decoction; for lower body swelling, take with Cong Bai (Allii Fistulosi Bulbus) decoction. Take every other day, stop after three doses. If bowel movements occur 3-5 times, replenish with cold congee. After swelling resolves, use Bai Zhu (3 liang), Chen Pi (3 liang), Gan Cao (honey-fried, 3 liang), Hou Po (ginger-fried, 2 liang), and Zao Fan (Vitriol). Stir-fry with flour until smoke ceases, or stir-fry Zao Fan with vinegar 3-5 times. Grind with previous herbs into powder, bind with vinegar paste, form pills size of Sophora japonica seeds. Take 50 pills per dose with rice gruel. Take three times daily. Avoid anger, fried foods, scaleless fish, and other triggering foods. Continue for 49 days for recovery.