牡蛎（熬） 泽泻 栝蒌根 蜀漆（洗去腥） 葶苈（熬） 商陆根（熬） 海藻（洗去咸以上各等分）
上七味。异捣。下筛为散。更入臼中治之。白饮和服方寸匕。小便利。止后服。日三。
成注云。咸味涌泄。牡蛎泽泻海藻之咸。以泄水气。内经曰。湿淫于内平以苦。佐以酸辛以苦泄之。蜀漆葶苈栝
蒌商陆之酸辛与苦以导肿湿。
琥按上成注。犹混杂不明。牡蛎泽泻海藻三味之咸。固能入肾而导水。若蜀漆葶苈商陆根之苦辛。乃苦以泄其水。
辛以散其邪也。又商陆兼酸。酸与苦皆能涌泄。至于栝蒌根。非泄水之物。条辩云。苦能彻热。乃蜀漆之使。大都上方。
用以治下焦水热病最宜。或问大病瘥后。成注既云脾胃气虚。何不竟用补脾之剂。使脾胃气壮。肾水不将有以制约邪余
曰然。尚论篇亦云。脾土告困。不能摄水。疑者以为罔顾其虚。而反用牡蛎泽泻散峻攻。殊不知此正因水势未犯身半以
上。急驱其水。所全甚大。设用轻剂则阴水必袭入阳界。驱之恐无及矣。愚以言虽如此。使脾土果虚。如仲景五苓散方
亦可借用。但方中药宜去桂。加牡蛎海藻。投之甚稳。盖此条系下焦水热证。故不宜加桂也。
大病瘥后。喜唾。久不了了者胃上有寒当以丸药温之宜理中丸。（大病瘥后。何为而胃上有寒。此必是病热之时。过
用凉药所致条辩云唾者。口中液也。寒以饮言。胸中有寒饮。故喜唾也。不了了。言病了而不了。无已时也。与理中丸
以温脾胃之气。其不用汤而用丸者。以病瘥之后。不可骤补故也。）
牡蛎（煅制） 泽泻 栝蒌根 蜀漆（水洗以去除腥味） 葶苈子（煅制） 商陆根（煅制） 海藻（水洗以去除咸味，以上各药分量相等）
以上七味药。分别捣碎，过筛制成散剂。再放入臼中进一步研磨均匀。用米汤调和，每次服用一方寸匕的量。若小便通畅，则停止服药。每日服用三次。
成无己注解说：咸味具有涌吐和泄下的作用。牡蛎、泽泻、海藻的咸味，用来泄除水气。《内经》说：“湿气内盛，用苦味平抑它，佐以酸味和辛味，用苦味来泄除湿邪。”蜀漆、葶苈子、栝蒌、商陆的酸、辛与苦味，用来引导消除肿胀和水湿。
琥按语：上述成无己的注解，仍然混杂不清。牡蛎、泽泻、海藻这三味药的咸味，固然能入肾经而引导水液下行；至于蜀漆、葶苈子、商陆根的苦辛味，则是苦味以泄下水邪，辛味以发散病邪。另外商陆兼有酸味，酸味与苦味都能起到涌泄的作用。至于栝蒌根，并不是泄水的药物。条辩云：苦味能彻除热邪，这是蜀漆的功效。大抵上方，用于治疗下焦水热病证最为适宜。有人问：大病初愈后，成无己既然说是脾胃气虚，为何不直接用补脾的药物，使脾胃之气强壮，这样肾水就不会有制约邪气的余地吗？回答说：是的，《尚论篇》也说：“脾土困乏，不能摄纳水液。”疑惑的人认为这是不顾患者体虚，反而使用牡蛎泽泻散这种峻猛的攻伐方剂。殊不知这是因为水势尚未侵犯身体上半部，急需驱除水邪，保全大局非常重要。如果用药轻缓，阴寒之水必定会侵袭阳分，届时再想驱除恐怕就来不及了。我认为话虽如此，如果脾土确实虚弱，如张仲景的五苓散方也可以借用。但方中的药物应当去掉桂枝，加入牡蛎和海藻，投药非常稳妥。因为这一条属于下焦水热证，所以不宜加桂枝。
大病初愈后，喜欢流口水，长期不好，这是胃上有寒，应当用丸药温补，宜用理中丸。（大病初愈后，为什么会有胃上有寒？这一定是生病发热时，过度使用凉药所致。条辩云：唾是口中的津液。寒是指寒饮，胸中有寒饮，所以喜欢流口水。“不了了”是说病好了但未完全好，没有尽头的时候。给予理中丸以温补脾胃之气。之所以不用汤剂而用丸剂，是因为大病初愈之后，不可骤然进补的缘故。）
Oyster Shell (Calcined), Alisma Rhizome, Trichosanthes Root, Lysimachia Herba (Washed to remove fishy odor), Lepidium Seed (Calcined), Phytolacca Radix (Calcined), Sargassum Thallus (Washed to remove saltiness; all ingredients in equal parts).
The above seven herbs. Process separately by pounding, pass through a sieve to make a powder. Further grind in a mortar. Mix with rice water and administer one "Fangcun Bi" (a measure equivalent to a teaspoonful) per dose. If urination becomes smooth, discontinue administration. Take three times daily.
Cheng Wuji commented: The salty flavor has the effect of inducing vomiting and purging. The salinity of Oyster Shell, Alisma Rhizome, and Sargassum Thallus is used to drain dampness and water retention. The *Neijing* states: "When dampness overflows internally, level it with bitter flavors, assist with sour and pungent flavors, using bitter to drain it." The sour, pungent, and bitter flavors of Lysimachia Herba, Lepidium Seed, Trichanthes Root, and Phytolacca Radix are used to guide out swelling and dampness.
Hu's commentary: Cheng Wuji's annotation above remains mixed and unclear. The salinity of Oyster Shell, Alisma Rhizome, and Sargassum Thallus can indeed enter the Kidney channel to guide water downward. As for the bitter and pungent flavors of Lysimachia Herba, Lepidium Seed, and Phytolacca Radix, the bitter flavor drains water, while the pungent flavor disperses pathogenic factors. Additionally, Phytolacca Radix possesses a sour flavor; both sour and bitter flavors can induce drainage. Regarding Trichosanthes Root, it is not a herb that drains water. *Tiaobian* states: "Bitter flavors can penetrate heat," which refers to the function of Lysimachia Herba. Generally, the above formula is most suitable for treating lower jiao water-heat syndromes. One might ask: After a major illness subsides, since Cheng Wuji attributes this to deficiency of Spleen-Stomach Qi, why not simply use formulas that tonify the Spleen to strengthen Spleen-Stomach Qi, thereby ensuring that Kidney Water does not have room to constrain residual pathogens? The answer is: Yes, *Shanglun Pian* also states: "Spleen Earth is exhausted and cannot control water." Those who doubt believe this disregards the patient's deficiency and instead uses the harsh attacking formula Muli Zexie San. They fail to realize that because the water accumulation has not yet invaded the upper half of the body, it is urgent to drive out the water to preserve the greater good. If mild agents were used, Yin Water would inevitably invade the Yang realm, and it might be too late to drive it out later. I believe that although this reasoning holds, if Spleen Earth is truly deficient, Zhang Zhongjing's Wuling San could also be borrowed. However, Cinnamon Twig should be removed from the formula, and Oyster Shell and Sargassum Thallus added; this approach is very stable. This clause pertains to a lower jiao water-heat syndrome, so adding Cinnamon Twig is inappropriate.
After a major illness subsides, if there is a preference for spitting saliva that persists for a long time without resolution, this indicates Cold in the Stomach. It should be treated with pills to warm the interior, preferably Lizhong Wan. (Why is there Cold in the Stomach after a major illness subsides? This is likely caused by the excessive use of cooling medicines during the febrile stage of the disease. *Tiaobian* states: Saliva is the fluid in the mouth. 'Cold' here refers to cold fluids; there is cold-fluid retention in the chest, hence the tendency to spit. 'Bu liao liao' means the illness has resolved but not completely, with no end in sight. Administering Lizhong Wan warms the Qi of the Spleen and Stomach. The reason for using pills rather than decoctions is that after a major illness, sudden tonification should be avoided.)