水肿病 有阴阳 肿，皮肤肿大。初起目下有形如卧蚕，后渐及于一身，按之即起为水
肿，按之陷而不起为气肿。景岳以即起为气，不起为水，究之气行水即行，水滞气亦滞，可
以分，可以不必分也。只以阴水，阳水为分别。
便清利 阴水殃 小便自利、口不渴属寒，名为阴水。
便短缩 阳水伤 小便短缩、口渴属热，名为阳水。
五皮饮 元化方 以皮治皮，不伤中气。方出华元化《中藏经》。
阳水盛 加通防 五皮饮加木通、防己、赤小豆之类。
阴水盛 加桂姜 五皮饮加干姜、肉桂、附子之类。
知实肿 萝枳商 知者，真知其病情，而无两可之见。壮年肿病，骤起脉实者，加萝卜
子、枳实之类。
知虚肿 参术良 老弱病久，肿渐成，脉虚者，加人参、白术之类。
兼喘促 真武汤 肿甚、小便不利、气喘、尺脉虚者，宜真武汤暖土行水。间用桂苓甘
术汤化太阳之气，守服十余剂；继用导水茯苓汤二剂愈。今人只重加味肾气丸，而不知其补
助阴气，反益水邪，不可轻服也。
从俗好 别低昂 以上诸法，皆从俗也。然从俗中而不逾先民之矩 ， 亦可以救人。
五水辨 金匮详 病有从外感而成者，名风水。病从外感而成，其邪已渗入于皮，不
在表而在里者，名皮水。病有不因于风，由三阴结而成水者，名正水。病有阴邪多而沉
于下者，名石水。病有因风因水伤心郁热，名黄汗。《金匮》最详，熟读全书，自得其
旨，否则卤莽误事耳。药方中精义颇详，宜细玩之。
补天手 十二方 越婢汤、防己茯苓汤、越婢加白术汤、甘草麻黄汤、麻黄附子汤、杏
子汤、蒲灰散、 芍桂酒汤、桂枝加黄 汤、桂甘姜枣麻辛附子汤、枳术汤、附方《外台》
防己黄 汤。
肩斯道 勿炎凉 群言淆乱衷于圣，以斯道为己任，勿与世为浮沉，余有浓望焉。
水肿病，分为阴水和阳水两类。肿，指皮肤肿大。初起时眼睑下有形如卧蚕的肿胀，随后逐渐蔓延至全身，按压后凹陷立即恢复的是水肿，按压后凹陷不能立即恢复的是气肿。张景岳认为按压即起为气肿，不起为水肿，但究其根本，气行则水行，水滞则气亦滞，因此可以区分，也可以不区分。只需以阴水和阳水作为分类标准即可。
五皮饮是华元化的方剂，主张“以皮治皮”，且不损伤中焦脾胃之气。此方出自华元化所著的《中藏经》。
若阳水盛实，可在五皮饮基础上加用木通、防己、赤小豆等药物。
若阴水盛实，可在五皮饮基础上加用干姜、肉桂、附子等药物。
若确知为实证肿胀，可斟酌加入萝卜子、枳实等药物。所谓“知者”，是指真正了解病情，没有犹豫不决的看法。壮年患肿病，突然发作且脉象实有力者，宜加萝卜子、枳实之类。
若确知为虚证肿胀，可斟酌加入人参、白术等药物。老弱之人或久病体虚，肿胀逐渐形成且脉象虚弱者，宜加人参、白术之类。
若兼见气喘急促，宜用真武汤。若肿胀严重、小便不利、气喘、尺脉虚弱者，适宜用真武汤温补脾土以利水湿。期间可间服桂苓甘术汤以化太阳经之气，坚持服用十余剂；随后继服导水茯苓汤两剂即可痊愈。如今的人只重视加味肾气丸，却不知道它补助阴气，反而助长水邪，不可轻易服用。
以上诸法虽顺应世俗习惯，但在世俗之中不违背先贤的法度，也可以救人。
关于五种水病的辨别，《金匮要略》中有详细记载。病由外感而成，名为风水。病由外感而成，邪气已渗入皮部，不在表而在里，名为皮水。病不因于风邪，而是由三阴经郁结而成水，名为正水。病有阴邪偏多而沉伏于下部的，名为石水。病因风或因水导致心经受郁热，名为黄汗。《金匮要略》对此论述最为详尽，熟读全书自然能领会其宗旨，否则就会鲁莽行事而误事。药方中的精义颇为详细，应当仔细研读。
掌握治疗水肿的高超技艺，需参考十二首方剂：越婢汤、防己茯苓汤、越婢加白术汤、甘草麻黄汤、麻黄附子汤、杏子汤、蒲灰散、芍桂酒汤、桂枝加黄芪汤、桂甘姜枣麻辛附子汤、枳术汤、以及附方《外台秘要》中的防己黄芪汤。
肩负起传承医学大道的重任，不要随波逐流、趋炎附势。众说纷纭扰乱了圣人的正道，应以继承和发扬这一大道为己任，不要与世俗一同浮沉，我对此寄予厚望。
Edema disease is divided into two categories: Yin Edema and Yang Edema. "Swelling" refers to the enlargement of the skin. Initially, there is swelling under the eyes resembling a sleeping silkworm, which gradually spreads to the whole body. If pressing leaves an indentation that recovers immediately, it is Water Swelling (Shui Zhong); if pressing leaves an indentation that does not recover immediately, it is Qi Swelling (Qi Zhong). Zhang Jingyue considered immediate recovery as Qi swelling and non-recovery as Water swelling. However, fundamentally, when Qi moves, Water moves; when Water stagnates, Qi also stagnates. Therefore, they can be distinguished, or they need not be distinguished. It suffices to classify them simply as Yin Water and Yang Water.
Clear and free urination indicates harm from Yin Water. Urine that is scanty and difficult to pass indicates injury from Yang Water.
Wu Pi Yin (Five-Bark Decoction) is a formula by Hua Yuanhua. It advocates "treating skin with bark" without damaging the Middle Jiao Qi. This formula originates from Hua Yuanhua's *Zhong Zang Jing* (Classic of Internal Organs).
If Yang Water is excessive, add herbs such as Mutong (Akebiae Caulis), Fangji (Stephaniae Radix), and Chixiaodou (Vigna Semen Rubrum) to Wu Pi Yin.
If Yin Water is excessive, add herbs such as Ganjiang (Zingiberis Rhizoma), Rougui (Cinnamomi Cortex), and Fuzi (Aconiti Lateralis Radix Praeparata) to Wu Pi Yin.
If one truly knows it is a Excess-type swelling, consider adding Luobozhi (Raphani Semen) and Zhishi (Aurantii Fructus Immaturus). The term "knowing" implies truly understanding the condition without ambiguity. For young adults with sudden onset edema and a full/excess pulse, add Raphani Semen and Aurantii Fructus Immaturus.
If one truly knows it is a Deficiency-type swelling, consider adding Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma). For the elderly, weak, or those with chronic illness where swelling develops gradually and the pulse is deficient, add Ginseng Radix and Atractylodis Macrocephalae Rhizoma.
If accompanied by panting and shortness of breath, use Zhenwu Tang (True Warrior Decoction). For severe edema, difficulty in urination, panting, and a deficient Chi pulse, Zhenwu Tang is suitable to warm the Spleen Earth and promote water metabolism. In the interim, Guiling Gan Zhu Tang (Cinnamon Twig, Poria, Licorice, and Atractylodes Decoction) can be used intermittently to transform Qi in the Taiyang channel, taken for more than ten doses; subsequently, Dao Shui Fu Ling Tang (Water-Guiding Poria Decoction) taken for two doses will cure the condition. Nowadays, people only emphasize Jiawei Shenqi Wan (Modified Kidney Qi Pill), unaware that it tonifies Yin Qi and thereby exacerbates the Water pathogen; thus, it should not be taken lightly.
The aforementioned methods follow popular custom. However, adhering to custom without violating the standards of the ancients can still save lives.
The differentiation of the Five Waters is detailed in *Jin Gui Yao Lue*. Diseases resulting from external contraction are named Feng Shui (Wind Water). When the pathogen has penetrated into the skin layer, residing not in the exterior but in the interior, it is named Pi Shui (Skin Water). When the disease is not caused by Wind but results from constriction in the Three Yin channels leading to water retention, it is named Zheng Shui (Regular Water). When Yin pathogens are abundant and sink to the lower part, it is named Shi Shui (Stone Water). When Wind or Water causes heat stagnation in the Heart, it is named Huang Han (Yellow Sweat). *Jin Gui Yao Lue* discusses this most comprehensively; reading the entire book thoroughly allows one to grasp its essence, otherwise, one acts rashly and errs. The profound meanings within the prescriptions are quite detailed and deserve careful study.
To master the supreme skills of treating edema, refer to twelve formulas: Yuespi Tang (Yuebi Decoction), Fangji Fuling Tang (Stephania and Poria Decoction), Yuespi Jia Baizhu Tang (Yuebi Decoction plus Atractylodes Macrocephalae), Gancao Mahuang Tang (Licorice and Ephedra Decoction), Mahuang Fuzi Tang (Ephedra and Prepared Aconite Decoction), Xingzi Tang (Apricot Seed Decoction), Puhui San (Puhui Powder), Shaogui Jiu Tang (Peony and Cinnamon Wine Decoction), Guizhi Jia Huangqi Tang (Cinnamon Twig Decoction plus Astragalus), Guigan Jiangzao Maxinfuzi Tang (Licorice, Ginger, Jujube, Ephedra, Magnolia Bark, and Prepared Aconite Decoction), Zhizhu Tang (Immature Bitter Orange and Atractylodes Decoction), and the supplementary formula Fangji Huangqi Tang (Stephania and Astragalus Decoction) from *Waitai Miyao*.
Shouldering the Way, do not be fickle. Conflicting words confuse the heart regarding the Sage's teachings. Take this Way as your own responsibility; do not drift with the worldly tides. I have high hopes for you.