经曰∶至阴者肾水也，少阴者冬脉也，其本在肾，其末在肺，皆积水也。又曰∶肾者胃之关
也，关门不利，故聚水而从其类也。上下溢于皮肤，故跗肿腹大，上为喘呼，不得卧者，标
本俱病也。丹溪云∶惟肾虚不能行水，脾虚不能制水，胃与脾合，又胃为水谷之海，因虚而
不能传化，肾水泛滥，反得以浸渍脾土，于是三焦停滞，经络壅塞，水渗于皮肤，注于肌肉
而发肿也。其状目胞上下微起，肢体重着，喘咳怔忡，股间清冷，小便涩黄，皮薄而光，手
按成窟，举手即满是也。古方有十种论症，以短气不得卧为心水；两胁紧痛为肝水；大便
溏为肺水；四肢苦重为脾水；腰痛足冷为肾水；口苦咽干为胆水；下虚上实为大肠水；腹急
肢瘦为膀胱水；小便关泄为胃水；小腹急满为小肠水。又有湿气、毒瓦斯、伤寒后、泻痢后、
气血虚者之五肿。及疳气、 积、锁肚、胸膈作膨、蛔、气虚、冷积者之七胀，亦当详之。
其受湿气者，由脾胃之气敦阜四肢，头面皆肿也。食毒者脾伤，积毒停留于胃也。伤寒下早
者，邪气乘虚而入也。泻痢后者，脾气虚也。皆宜先调
虚，邪正相乱，以致四肢浮
肿，腹肚膨满。亦当先调荣卫，分别阴阳。治法∶宜补中行湿利小便。凡有热者，水气在表
也，可汗之。身无热者，水气在里也，宜下之。腰以上肿，宜利小便；腰已下肿，宜发汗，
此仲景之法也。若遍身肿烦渴，小便赤涩，大便秘结，此属阳水。遍身肿不渴，大便溏泄，
小便清利，此属阴水。阳水兼阳症者，脉必浮数；阴水兼阴症者，脉必沉迟。气若陷下，宜
用二陈加升提之药；如腹胀，少加木香调之。若朝宽暮急，属阴虚，朝用四物汤加参、术；
夕用加减肾气丸。朝急暮宽，属阳虚，朝用六君子汤；夕用加减肾气丸。朝暮皆急，阴阳俱
虚也，用八珍汤主之。真阳虚者，朝用八味地黄丸；夕用补中益气汤。若肚腹痞满，肢体肿胀
，手足并冷，饮食难化，或大便泄泻，呼吸气冷者，此真阳衰败，脾肺肾虚寒不能司摄，而水泛行也，
急用加减肾气丸，否则不治。惟调补脾土，多有生者。
治验
一小儿伤食膨胀，服克伐之剂，小便涩滞，改服五苓散，小便益闭，四肢顿肿。余谓∶脾胃
虚寒，不能通调水道，下输膀胱故也。朝用加减金匮肾气丸，夕用补中益气汤而愈。
一小儿患前症，小便赤频，盗汗发热，朝间用补中益气汤，午间用五味异功散，晚间用六味
地黄丸而愈。后作功课太劳，盗汗发热，用八珍汤、六味丸而痊。
一小儿患前症，饮食少思，大便不实，先用补中益气汤，又用五味异功散而愈。毕姻后复发
，更手足并冷，饮食难化，或吞酸嗳腐，用六君子、炮姜而痊，后又发，用八味地黄丸、补中益气
汤而痊。
一小儿小腹胀坠，小便涩滞，午前为甚。以补中益气汤加木香与朝服；以五味异功散加升麻
、柴胡与夕服，两月余而愈。后饮食失节，腹胀咽酸，用五味异功散、四味茱萸丸而痊。毕姻后，后
患如前，更恶寒腹冷，小便清频，大便不实，手足并冷，用补中益气汤、八味地黄丸而寻愈
。
二陈汤（方见寒吐）
五苓散（方见五淋）
八珍汤（即十全大补汤去黄 、肉桂，方见自汗）
六君子汤（方见内钓）
加减肾气丸（方见腹胀）
八味地黄丸（方见肾脏）
补中益气汤（方见虚羸）
《黄帝内经》说：至阴指的是肾水，少阴指的是冬季的脉象，水肿病的根本在肾，标末在肺，都是水液停聚所致。又说：肾是胃的关口，如果关门不利，就会导致水液积聚并随其同类（水性）流动。水液上下溢于皮肤，所以出现足背浮肿、腹部胀大；向上影响肺部则气喘呼叫，不能平卧，这是标本俱病的情况。朱丹溪说：只有肾虚不能行水，脾虚不能制约水湿，胃与脾相表里，且胃为水谷之海，因虚弱而不能传化水谷，导致肾水泛滥，反过来浸渍脾土，于是三焦停滞，经络壅塞，水液渗入皮肤，注入肌肉而发为肿胀。其症状表现为眼睑上下微微隆起，肢体沉重，气喘咳嗽，心悸怔忡，大腿内侧清冷，小便涩滞色黄，皮肤薄而光亮，手按压后形成凹陷，抬手即恢复饱满。古方有十种论症的说法：以短气不得卧称为心水；两胁紧痛称为肝水；大便溏泄称为肺水；四肢苦重称为脾水；腰痛足冷称为肾水；口苦咽干称为胆水；下虚上实称为大肠水；腹部急迫四肢消瘦称为膀胱水；小便失禁称为胃水；小腹急满称为小肠水。又有湿气、毒瓦斯、伤寒后、泻痢后、气血虚者这五种肿。以及疳气、积滞、锁肚、胸膈作膨、蛔虫、气虚、冷积这七种胀，也应当详细辨析。受湿气影响的，是由于脾胃之气敦厚壅盛于四肢，头面都会浮肿。食毒伤人的，是脾脏受伤，积毒停留在胃中。伤寒过早使用下法的，是邪气乘虚而入。泻痢之后的，是脾气虚弱。这些情况都应当先调理虚损，因为邪正相乱，导致四肢浮肿，腹部膨满。也应当先调和营卫，辨别阴阳。治疗方法：宜补中行湿利小便。凡是有热象的，是水气在表，可以用发汗法。身体无热的，是水气在里，可以用攻下法。腰部以上浮肿，宜利小便；腰部以下浮肿，宜发汗，这是张仲景的方法。如果遍身浮肿且烦渴，小便赤涩，大便秘结，这属于阳水。遍身浮肿但不渴，大便溏泄，小便清利，这属于阴水。阳水兼阳证者，脉象必浮数；阴水兼阴证者，脉象必沉迟。若气机陷下，宜用二陈汤加升提药物；如腹胀，稍加木香调理。若早晨宽舒傍晚紧急，属阴虚，早晨服用四物汤加人参、白术；晚上服用加减肾气丸。早晨紧急傍晚宽舒，属阳虚，早晨服用六君子汤；晚上服用加减肾气丸。早晚皆紧急，是阴阳俱虚，用八珍汤主治。真阳虚者，早晨服用八味地黄丸；晚上服用补中益气汤。若肚腹痞满，肢体肿胀，手足冰冷，饮食难消化，或大便泄泻，呼吸气冷，这是真阳衰败，脾肺肾虚寒不能固摄，导致水泛流行，急需服用加减肾气丸，否则无法治愈。只有调补脾土，多有生机。
治验案例：
一个小儿因伤食导致腹胀，服用克伐药物后，小便涩滞，改服五苓散，小便更加闭塞，四肢突然浮肿。我说：这是脾胃虚寒，不能通调水道，向下输送到膀胱的缘故。早晨服用加减金匮肾气丸，晚上服用补中益气汤而痊愈。
一个小儿患上述病症，小便赤频，盗汗发热，早晨用补中益气汤，中午用五味异功散，晚上用六味地黄丸而痊愈。后来因功课太劳累，再次出现盗汗发热，用八珍汤、六味地黄丸而康复。
一个小儿患上述病症，饮食减少思虑，大便不成形，先用补中益气汤，又用五味异功散而痊愈。结婚后复发，更见手足冰冷，饮食难消化，或吞酸嗳腐，用六君子汤、炮姜而康复，后来又发作，用八味地黄丸、补中益气汤而康复。
一个小儿小腹胀坠，小便涩滞，午前加重。早上给补中益气汤加木香服用；晚上给五味异功散加升麻、柴胡服用，两个多月而痊愈。后来饮食不节制，腹胀咽酸，用五味异功散、四味茱萸丸而康复。结婚后，后来患病如前，更见恶寒腹冷，小便清频，大便不成形，手足冰冷，用补中益气汤、八味地黄丸而迅速痊愈。
二陈汤（方剂见寒吐章节）
五苓散（方剂见五淋章节）
八珍汤（即十全大补汤去掉黄芪、肉桂，方剂见自汗章节）
六君子汤（方剂见内钓章节）
加减肾气丸（方剂见腹胀章节）
八味地黄丸（方剂见肾脏章节）
补中益气汤（方剂见虚羸章节）
The *Classic of Internal Medicine* states: The "Extreme Yin" refers to Kidney Water, and the "Lesser Yin" refers to the Winter pulse. The root of edema lies in the Kidney, while its branch lies in the Lung; both involve the accumulation of fluid. It is also stated: The Kidney serves as the gate of the Stomach. If this gate is not functioning properly, fluids accumulate and flow according to their nature (water-like). When fluids overflow upwards and downwards into the skin, it results in edema of the dorsum of the foot and abdominal distension. Upwardly affecting the Lungs, it causes panting and calling out, with an inability to lie flat; this indicates that both the root and branch are diseased. Zhu Danxi said: Only when the Kidney is deficient and cannot move water, and the Spleen is deficient and cannot control water, does pathology occur. The Stomach and Spleen are exterior-interior related, and the Stomach is the Sea of Food and Fluids. Due to deficiency, it fails to transmit and transform, causing Kidney Water to flood and soak the Spleen Earth. Consequently, the San Jiao (Triple Burner) stagnates, meridians become blocked, and water seeps into the skin and pours into the muscles, manifesting as swelling. Its manifestations include slight puffiness above and below the eyes, heaviness of the limbs, panting and coughing, palpitations, coldness in the groin area, scanty and yellow urine, thin and shiny skin, pitting edema where pressing leaves a depression that fills up immediately upon releasing the hand. Ancient texts describe ten types of syndromes: shortness of breath and inability to lie flat is called Heart Water; tight pain in the hypochondrium is Liver Water; loose stools is Lung Water; severe heaviness of the four limbs is Spleen Water; lower back pain and cold feet is Kidney Water; bitter taste in the mouth and dry throat is Gallbladder Water; deficiency below and excess above is Large Intestine Water; abdominal urgency with emaciated limbs is Bladder Water; urinary incontinence is Stomach Water; urgency and fullness in the lower abdomen is Small Intestine Water. There are also five types of swelling caused by dampness, toxic vapors, post-Febrile Disease, post-dysentery, and Qi-Blood deficiency. Additionally, there are seven types of distension caused by infantile malnutrition (*Gan*), food retention, locked belly, chest/diaphragm bloating, roundworms, Qi deficiency, and cold accumulation, which should be analyzed in detail. Those affected by dampness have thickened and obstructed Qi in the Spleen and Stomach affecting the limbs, with swelling of the head and face. Those injured by food toxins have damaged Spleen function, with accumulated toxins remaining in the Stomach. In cases of premature purging during Febrile Disease, pathogenic factors enter due to deficiency. Post-dysentery cases involve Spleen Qi deficiency. All these situations require first regulating deficiency, as the conflict between pathogenic and healthy factors leads to edema of the limbs and abdominal distension. One must first harmonize Ying (Nutritive) and Wei (Defensive) Qi, and differentiate Yin and Yang. Treatment methods: Supplement the Middle, resolve dampness, and promote urination. For those with heat signs, the fluid qi is at the Exterior, so sweating can be induced. For those without heat, the fluid qi is at the Interior, so purgation is appropriate. Swelling above the waist should be treated by promoting urination; swelling below the waist should be treated by inducing sweating; this is the method of Zhang Zhongjing. If there is generalized edema with irritability and thirst, red and scanty urine, and constipation, this belongs to Yang Water. If there is generalized edema without thirst, loose stools, and clear, profuse urine, this belongs to Yin Water. Yang Water accompanied by Yang syndromes will present with a floating and rapid pulse; Yin Water accompanied by Yin syndromes will present with a deep and slow pulse. If Qi sinks, use Er Chen Tang (Two-Cured Decoction) with herbs that lift and raise; if there is abdominal distension, add small amounts of Muxiang (Aucklandiae Radix) to regulate. If symptoms are relieved in the morning but urgent in the evening, it indicates Yin deficiency; take Si Wu Tang (Four Substances Decoction) with Renshen (Ginseng) and Baizhu (Atractylodis Macrocephalae Rhizoma) in the morning, and Ji Jian Shen Qi Wan (Modified Kidney Qi Pill) in the evening. If urgent in the morning but relieved in the evening, it indicates Yang deficiency; take Liu Jun Zi Tang (Six-Gentlemen Decoction) in the morning, and Ji Jian Shen Qi Wan in the evening. If urgent both morning and evening, it indicates dual deficiency of Yin and Yang; treat primarily with Ba Zhen Tang (Eight-Treasures Decoction). For true Yang deficiency, take Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill) in the morning and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) in the evening. If there is abdominal stuffiness and fullness, limb swelling, cold hands and feet, difficulty digesting food, or loose stools with cold breath, this indicates collapse of true Yang, with Cold-Deficiency of the Spleen, Lungs, and Kidneys failing to consolidate and control, leading to flooding of water. Urgently administer Ji Jian Shen Qi Wan, otherwise it is untreatable. Only by regulating and tonifying Spleen Earth is there hope for survival.
Clinical Cases:
1. A child suffered from abdominal distension due to food retention. After taking harsh draining medicines, urination became difficult. Upon switching to Wu Ling San (Five-Ingredient Powder with Poria), urination became completely obstructed, and the limbs suddenly swelled. I reasoned: This is Cold-Deficiency of the Spleen and Stomach, failing to freely circulate water passages and transport fluids downward to the Bladder. Morning administration of Jia Jian Jin Gui Shen Qi Wan (Modified Golden Cabinet Kidney Qi Pill) and evening administration of Bu Zhong Yi Qi Tang led to recovery.
2. A child presented with the aforementioned symptoms, including red and frequent urination, night sweats, and fever. Morning administration of Bu Zhong Yi Qi Tang, noon administration of Wu Wei Yi Gong San (Five-Ingredient Decoction for Efficacious Work), and evening administration of Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) resulted in recovery. Later, due to excessive labor from studies, night sweats and fever recurred; treatment with Ba Zhen Tang and Liu Wei Wan led to convalescence.
3. A child presented with loss of appetite and unformed stools. Initial treatment with Bu Zhong Yi Qi Tang followed by Wu Wei Yi Gong San resulted in recovery. After marriage, the condition relapsed with cold hands and feet, difficulty digesting food, acid regurgitation, and belching of rotten food. Treatment with Liu Jun Zi Tang and Pao Jiang (Prepared Ginger) led to recovery. Upon subsequent relapse, Ba Wei Di Huang Wan and Bu Zhong Yi Qi Tang were used for recovery.
4. A child presented with lower abdominal distension and heaviness, and difficult urination, worsening before noon. Morning administration of Bu Zhong Yi Qi Tang with Muxiang and evening administration of Wu Wei Yi Gong San with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) led to recovery after more than two months. Later, due to irregular diet, abdominal distension and sour belching occurred; treatment with Wu Wei Yi Gong San and Si Wei Zhu Yu Wan (Four-Ingredient Cornus Pill) led to recovery. After marriage, similar symptoms recurred with aversion to cold, cold abdomen, clear and frequent urination, unformed stools, and cold extremities. Treatment with Bu Zhong Yi Qi Tang and Ba Wei Di Huang Wan led to rapid recovery.
Er Chen Tang (Formula see chapter on Cold Vomiting)
Wu Ling San (Formula see chapter on Five Types of Dysuria)
Ba Zhen Tang (Identical to Shi Quan Da Bu Tang minus Huangqi and Rougui; Formula see chapter on Spontaneous Sweating)
Liu Jun Zi Tang (Formula see chapter on Inner Hook)
Jia Jian Shen Qi Wan (Formula see chapter on Abdominal Distension)
Ba Wei Di Huang Wan (Formula see chapter on Kidney Diseases)
Bu Zhong Yi Qi Tang (Formula see chapter on Emaciation and Weakness)