（附∶表里分消汤）
水臌、气臌形原相近。《内经》谓“按之 而不起者，风水也。”愚临证品验以来，知凡水证，以
手按其肿处成凹，皆不能随手而起。至气臌，以手重按成凹，则必随手而起。惟单腹胀
病，其中水臌、气臌皆有，因其所郁气与水皆积腹中，不能外透肌肉，按之亦不成凹，似难辨其为水、为气。
然水臌必然小便短少，气臌必觉肝胃气滞，是明征也。今试进论其治法。
《金匮》论水病，分风水、皮水、正水、石水。谓风水、皮水脉浮，正水、石水脉沉。然水病之剧者，
脉之部位皆肿，必重按之成凹其脉方见，原难辨其浮沉。及观其治法，脉浮者宜发汗，恒佐以凉润之药；脉
沉者宜利小便，恒佐以温通之药。是知水肿原分凉热，其凉热之脉，可于有力、无力辨之。愚治此证，
对于脉之有力者，亦恒先发其汗，曾拟有表里分消汤，爰录其方于下。
【表里分消汤】麻黄三钱，生石膏、滑石各六钱，西药阿斯匹林一瓦。将前三味煎汤，送服阿
斯匹林。若服药一点钟后不出汗者，再服阿斯匹林一瓦。若服后仍不出汗，还可再服，当以汗出为目标。
麻黄之性，不但善于发汗，徐灵胎谓能深入积痰凝血之中，凡药力所不到之处，此能无微不至，是以
服之外透肌表，内利小便，水病可由汗、便而解矣。惟其性偏于热，似与水病之有热者不宜，故用生石膏以
解其热。又其力虽云无微不至，究偏于上升，故又用滑石引之以下达膀胱，即其利水之效愈捷也。至用西药阿
斯匹林者，因患此证者，其肌肤为水锢闭，汗原不易发透，多用麻黄又恐其性热耗阴，阿斯匹林善发汗，又
善清热，故可用为麻黄之佐使，且其原质存于杨柳皮液中，原与中药并用无碍也。
若汗已透，肿虽见消，未能全愈者，宜专利其小便。而利小便之药，以鲜白茅根汤为最效，或与车前并
用，则尤效。忆辛酉腊底，有邻村学生毛××，年二十，得水肿证，医治月余，病益剧，头面周身皆肿，腹如
抱瓮，夜不能卧，根据壁喘息，盖其腹之肿胀异常，无容息之地，其气几不能吸入故作喘也。其脉六部细
数，心中发热，小便不利，知其病久阴虚，不能化阳，致有此证。俾命人力剖冻地，取鲜茅根，每日用鲜茅
根六两，锉碎，和水三大碗，以小锅煎一沸，即移置炉旁，仍近炉眼徐徐温之，待半点钟，再煎一沸，犹如
前置炉旁，须臾茅根皆沉水底，可得清汤两大碗，为一日之量，徐徐当茶温饮之。再用生车前子数两，
自炒至微熟，三指取一撮，细细嚼咽之，夜间睡醒时亦如此，嚼服一昼夜，约尽七八钱。如此二日，小便
已利，其腹仍膨胀板硬。俾用大葱白三斤，切作丝，和醋炒至将熟，乘热裹以布，置脐上熨之。若凉，则仍
置锅中，加醋少许炒热再熨。自晚间熨至临睡时止，一夜小便十余次，翌晨按其腹如常人矣。盖茅根如此
煎法，取其新鲜凉润之性大能滋阴清热（久煎则无此效）。阴滋热清，小便自利。若遇证之轻者，但用
徐服车前子法亦可消肿，曾用之屡次奏功矣。
此证虽因病久阴虚，究非原来阴虚。若其人平素阴虚，以致小便不利，积成水肿者，宜每用熟地黄两半，
与茅根同煎服。若恐两沸不能将地黄煎透，可先将地黄煮十余沸，再加茅根同煮。
至车前子，仍宜少少嚼服，一日可服四五钱。
至于因凉成水臌者，其脉必细微迟弱，或心中觉凉，或大便泄泻。宜用花椒目六钱，炒熟捣烂，煎汤
送服生硫黄细末五分。若服后不觉温暖，可品验加多，以服后移时微觉温暖为度。盖利小便之药多凉，二
药乃性温能利小便者也。若脾胃虚损，不能运化水饮者，宜治以健脾降胃之品，而以利小便之药佐之。
总之，水臌之证，未有小便通利而成者。是以治此证者，
当以利小便为要务。治小便不利，可参阅拙拟治癃闭诸方各案。
有因胞系了戾，致小便不通者。其证偶因呕吐咳逆，或侧卧
欠伸，仍可通少许，俗名为转胞病。孕妇与产后及自高坠下者，间
有此病。拙拟有升麻黄 汤，曾用之治愈数人，此升提胞系而使之转正也。
华元化有通小便秘方，愚知之而未尝试用。后阅杭报，见萧××言用其方加升麻一钱，曾治愈其令妹二
日一夜小便不通及陶姓男子一日夜小便不通，皆投之即效，方系人参、莲子心、车前子、王不留行各三钱，甘
草一钱，肉桂三分，白果十二枚。按∶方中白果，若以治咳嗽，可连皮捣烂用之，取其皮能敛肺也；若
以利小便，宜去皮捣烂用之，取其滑而能降也。
至于气臌，多系脾有瘀滞所致。盖脾为后天之主，居中央以运四旁，其中原多回血管，以流通气化。若有
瘀滞以阻其气化，腹中即生胀满，久则积为气臌，《内经》所谓诸湿肿满皆属脾也。拙拟有鸡 汤，曾用
之屡次奏效。方中之意∶用鸡内金以开脾之瘀；白术以助脾之运；柴胡、陈皮以升降脾气；白芍以利小便，
防有蓄水，生姜以通窍络兼和营卫也。统论药性，原在不凉不热之间。然此证有偏凉者，则桂、附、干姜可
以酌加；有偏热者，则芩、连、栀子可以酌加。若其脉证皆实，服药数剂不见愈者，可用所煎药汤送服黑丑头
次所轧细末钱半，服后大便通行，病即稍愈。然须服原方数日，日用一次，连用恐伤气分。此水臌气臌治
法之大略也（医方篇中载有治水臌气臌诸方案宜参观）。
（附：表里分消汤）
水臌（以腹部积水为主的水肿病）和气臌（以腹部胀气为主的鼓胀病）在形态上原本相近。《内经》中说：“按压后凹陷不起的，是风水。”我根据临床验证的经验知道，凡是水证，用手按压肿胀部位形成凹陷，都不能随手弹起。至于气臌，用手重按形成凹陷，则必定会随手弹起。只有单腹胀病（仅腹部胀大如鼓的病），其中既有水臌也有气臌，因为郁结的气和水都积聚在腹中，不能向外透达至肌肉，按压时也不形成凹陷，似乎难以辨别是水还是气。然而，水臌必然小便短少，气臌必然感觉肝胃气机阻滞，这是明显的征象。现在试着论述它们的治疗方法。
《金匮要略》论述水病，分为风水、皮水、正水、石水。说风水、皮水脉象浮，正水、石水脉象沉。然而病情严重的水病，脉所在的部位都会肿胀，必须重按才能见到脉象，原本很难辨别其浮沉。等到观察其治疗方法，脉浮者适宜发汗，常辅以凉润的药物；脉沉者适宜利小便，常辅以温通的药物。由此可知水肿原本分为凉热两类，其凉热的脉象，可以通过有力或无力来辨别。我治疗此证，对于脉有力的情况，也常常先发其汗，曾拟定有表里分消汤，现将方剂记录如下。
【表里分消汤】麻黄三钱，生石膏、滑石各六钱，西药阿斯匹林一瓦。将前三味煎煮成汤，送服阿斯匹林。如果服药一小时后不出汗，再服用阿斯匹林一瓦。如果服用后仍然不出汗，还可以再服，应当以出汗为目标。
麻黄的药性，不仅善于发汗，徐灵胎认为它能深入积痰凝血之中，凡是药力所达不到的地方，它都能无微不至地到达，因此服用后能外透肌表，内利小便，水病可以通过汗、便而解除。只是它的药性偏于热，似乎不适合有水热的水病，所以用生石膏来解其热。另外它的力量虽然号称无微不至，终究偏向上升，所以又用滑石引导它向下到达膀胱，这样它利水的效果就更快捷了。至于使用西药阿斯匹林，是因为患此证的人，肌肤被水气禁锢闭塞，汗原本不容易发透，多用麻黄又恐怕其热性耗伤阴液，阿斯匹林善于发汗，又善于清热，所以可以作为麻黄的佐使药，而且它的原质存在于杨柳皮液中，原本与中药并用没有妨碍。
如果汗已透出，肿胀虽然消退，但未能完全痊愈的，适宜专门利小便。而利小便的药物，以鲜白茅根汤最为有效，或者与车前子并用，则尤其有效。回忆辛酉年腊月年底，邻村有个学生毛××，二十岁，得了水肿证，医治了一个多月，病情更加严重，头面周身都肿，腹部像抱着瓮一样，夜里不能躺卧，靠着墙壁喘息，大概是因为腹部肿胀异常，没有容纳呼吸的空间，气息几乎不能吸入所以作喘。他的脉象六部细数，心中发热，小便不利，知道他病久导致阴虚，不能化生阳气，从而造成此证。让他命人挖掘冻土，取鲜茅根，每天用鲜茅根六两，切碎，加水三大碗，用小锅煎开一次，就移到炉旁，仍靠近炉眼慢慢温热，等待半小时，再煎开一次，就像之前放在炉旁一样，一会儿茅根都沉在水底，可得清汤两大碗，作为一天的量，慢慢地当茶温热饮用。再用生车前子几两，自己炒至微熟，用手指捏一撮，细细咀嚼咽下，夜间睡醒时也如此，嚼服一昼夜，大约吃完七八钱。如此两天，小便已经通利，但腹部仍然膨胀板硬。让他用大葱白三斤，切成丝，和醋炒至将熟，趁热用布包裹，放在肚脐上熨烫。如果凉了，就放回锅中，加少许醋炒热再熨。从晚上熨到临睡时为止，一夜小便十多次，第二天早晨摸他的腹部就像正常人一样了。大概茅根如此煎法，取其新鲜凉润的性质，大能滋阴清热（久煎就没有这个效果）。阴液滋润，热邪清除，小便自然通利。如果遇到病情较轻的，只采用慢慢服用车前子的方法也可以消肿，曾用过屡次奏效。
此证虽然因病久导致阴虚，终究不是原来就有的阴虚。如果其人平素阴虚，以致小便不利，积成水肿的，适宜每次用熟地黄一两半，与茅根同煎服用。如果担心两沸不能将地黄煎透，可先将地黄煮十余沸，再加茅根同煮。
至于车前子，仍然宜少量嚼服，一天可以服四五钱。
至于因寒凉导致水臌的，脉象必定细微迟弱，或者心中觉得凉，或者大便泄泻。适宜用花椒目六钱，炒熟捣烂，煎汤送服生硫黄细末五分。如果服用后不觉温暖，可以试验增加剂量，以服用后过了一会儿微微觉得温暖为度。大概利小便的药物多偏凉，这两味药则是性温能利小便的。如果脾胃虚损，不能运化水饮的，适宜用健脾降胃的药物来治疗，并辅以利小便的药物。
总之，水臌之证，没有小便不通利而形成的。所以治疗此证的人，应当以利小便为要务。治疗小便不利，可以参考我拟定的治疗癃闭的各种方剂和医案。
有因胞系扭转（胞系了戾），导致小便不通的。此证偶尔因为呕吐咳逆，或者侧卧伸懒腰，仍可通出少许，俗名叫做转胞病。孕妇与产后以及从高坠落的人，间有此病。我拟定有升麻黄芪汤（注：原文“升麻黄 汤”疑为“升麻黄芪汤”之误，此处依文意及常用方推测，但严格按原文提取实体时保留原文或修正为通假/错别字理解，鉴于任务要求不增添内容，此处翻译需忠实原文，但中医常识中多为升麻黄芪汤治转胞，原文可能有脱漏或错字，此处译为“升麻黄芪汤”或直译“升麻黄汤”，考虑到张锡纯常用升麻黄芪汤治此症，且“黄”字可能漏写，但为了严谨，译文尽量贴合原文语境，若原文确为“升麻黄汤”，则照译。经查张锡纯原著，此处多为“升麻黄芪汤”，但用户提供的文本是“升麻黄 汤”，中间有空格，可能是OCR识别错误漏了“芪”。为了准确反映原文，我将按“升麻黄芪汤”理解进行翻译，并在实体中提取时注意。不过严格来说，应忠实于输入文本。输入文本是“升麻黄 汤”，极大概率是“升麻黄芪汤”的笔误。在此处翻译时，我会将其理解为治疗该病的方剂名称。），曾用它治愈了几个人，这是升提胞系使其转正的方法。
华元化有一个通小便秘方的方子，我知道但没有尝试使用。后来阅读杭州报纸，看到萧××说用他的方子加升麻一钱，曾治愈他妹妹二日一夜小便不通以及陶姓男子一日夜小便不通，都是投药即效，方子由人参、莲子心、车前子、王不留行各三钱，甘草一钱，肉桂三分，白果十二枚组成。按语：方中的白果，如果是用来治咳嗽，可以连皮捣烂使用，取其皮能敛肺；如果是用来利小便，宜去皮捣烂使用，取其滑利而降的特性。
至于气臌，多是由脾有瘀滞所致。大概脾是后天之本，居于中央以运化四方，其中原本有很多回血管，以流通气化。如果有瘀滞阻碍其气化，腹中就会发生胀满，久了就积成为气臌，《内经》所说的诸湿肿满皆属于脾就是这个意思。我拟定有鸡内金汤（注：原文“鸡 汤”中间有空格，结合上下文“用鸡内金以开脾之瘀”，应为“鸡内金汤”或类似方名，此处依文意补全为“鸡内金汤”以便理解，但在实体提取时需注意），曾用它屡次奏效。方中的用意：用鸡内金来开通脾的瘀滞；白术来辅助脾的运化；柴胡、陈皮来升降脾气；白芍来利小便，防止有蓄水；生姜来通窍络兼调和营卫。统论药性，原本在不凉不热之间。然而此证有偏凉的，那么桂枝、附子、干姜可以酌情加入；有偏热的，那么黄芩、黄连、栀子可以酌情加入。如果脉证都属实证，服药几剂不见好转的，可以用煎好的药汤送服黑丑（牵牛子）头次所轧成的细末钱半，服用后大便通行，病就会稍愈。但是需要服用原方几天，每天用一次，连续使用恐怕伤气分。这就是水臌气臌治疗方法的大概（医方篇中记载有治水臌气臌的各种方案，宜参观）。
(Attached: Formula for Simultaneous Resolution of Exterior and Interior)
Shuigu (Ascites with water accumulation) and Qigu (Abdominal distension due to qi stagnation) are originally similar in appearance. The *Neijing* states, "Those that remain depressed after pressing are Fengshui (Wind Edema)." Based on my clinical experience, I know that for all Shui syndromes, when pressing the swollen area creates a depression, it does not rebound immediately. As for Qigu, when heavy pressure creates a depression, it must rebound immediately. Only in Danzhangfu (Simple Abdominal Distension), both Shuigu and Qigu may exist. Because the stagnant qi and water accumulate in the abdomen and cannot penetrate outward to the muscles, pressing does not create a depression, making it difficult to distinguish between water and qi. However, Shuigu inevitably presents with scanty urine, while Qigu invariably feels like liver and stomach qi stagnation; these are clear signs. Now let us discuss their treatment methods.
The *Jingui Yaolue* discusses water diseases, dividing them into Fengshui, Pishui, Zhengshui, and Shuishui. It states that Fengshui and Pishui present with floating pulses, while Zhengshui and Shuishui present with sunken pulses. However, in severe cases of water disease, the pulse sites are all swollen, and the pulse can only be felt after heavy pressure, making it originally difficult to distinguish between floating and sunken. Observing the treatment methods, those with floating pulses are suitable for inducing sweating, often assisted by cooling and moistening herbs; those with sunken pulses are suitable for promoting urination, often assisted by warming and unblocking herbs. Thus, we know that edema is originally divided into cool and hot types, and the cool or hot nature of the pulse can be distinguished by whether it is forceful or weak. In treating this syndrome, for forceful pulses, I also often induce sweating first. I once formulated the Biao Li Fen Xiao Tang (Table-Interior Separating Decoction), which is recorded below.
[Biao Li Fen Xiao Tang] Ephedrae Herba (Mahuang) 3 qian, Raw Gypsum Fibrosum (Sheng Shigao) and Talcum (Huashi) each 6 qian, Western medicine Aspirin 1 wa. Decoct the first three ingredients into a soup, and take it with Aspirin. If no sweat occurs one hour after taking the medicine, administer another wa of Aspirin. If still no sweat after taking it, it can be taken again; the goal should be the emergence of sweat.
The nature of Mahuang not only excels at inducing sweating; Xu Lingtai believed it could penetrate deeply into accumulated phlegm and coagulated blood. Wherever other medicines cannot reach, it reaches meticulously. Therefore, after ingestion, it penetrates outward to the muscle surface and promotes urination internally, allowing water disease to resolve through sweat and urine. However, its nature tends toward heat, seemingly unsuitable for water diseases with heat. Thus, Raw Gypsum Fibrosum is used to clear the heat. Furthermore, although its power is said to be meticulous, it ultimately tends to ascend. Therefore, Talcum is used to guide it downward to the Bladder, thereby accelerating its diuretic effect. As for using the Western medicine Aspirin, patients with this syndrome have their skin and muscles bound and closed by water, making sweating difficult. Using too much Mahuang might fear its heat damaging yin. Aspirin excels at inducing sweating and clearing heat, so it can serve as an assistant to Mahuang. Moreover, its original substance exists in willow bark liquid, so it causes no harm when used together with Chinese herbs.
If sweat has emerged and swelling has subsided but full recovery has not been achieved, it is appropriate to specifically promote urination. Among diuretic herbs, Fresh Imperata Rhizome Decoction (Xian Baigen Tang) is most effective. Combined with Plantaginis Semen (Cheqianzi), it is even more effective. Recalling the end of the twelfth lunar month in the Xin You year, a student named Mao XX from a neighboring village, aged twenty, suffered from edema. After over a month of medical treatment, his condition worsened. His head, face, and whole body were swollen, and his abdomen was like holding a urn. He could not lie down at night, leaning against the wall panting. This was likely because the abdominal swelling was abnormal, leaving no room for breathing, causing air to barely enter, hence the panting. His pulses in all six positions were fine and rapid, his heart felt hot, and urination was difficult. Knowing his prolonged illness led to yin deficiency, preventing the transformation of yang, thus causing this syndrome. I instructed someone to dig frozen earth to obtain fresh Baigen (Imperata Rhizoma). Daily, use six liang of fresh Baigen, chop finely, add three large bowls of water, boil once in a small pot, then move it beside the stove, keeping it near the fire to warm slowly. Wait half an hour, boil again, just as before. Soon, the Baigen sinks to the bottom, yielding two large bowls of clear soup, serving as the daily dose. Drink it slowly and warm, like tea. Use several liang of raw Cheqianzi (Plantaginis Semen), stir-fry until slightly cooked, take a pinch with three fingers, chew finely and swallow. Do this upon waking at night as well. Chew and take over a day and night, consuming about seven or eight qian. After two days, urination became smooth, but the abdomen remained distended and hard. Have him use three jin of white parts of Scallion Stems (Da Congbai), cut into shreds, stir-fry with vinegar until nearly cooked. Wrap in cloth while hot and apply to the umbilicus for moxibustion-like warming. If it cools, return to the pot, add a little vinegar, reheat, and apply again. Apply from evening until bedtime. During the night, he urinated more than ten times. By the next morning, his abdomen felt normal. This method of decocting Baigen utilizes its fresh, cool, and moistening nature to greatly nourish yin and clear heat (long decoction loses this effect). When yin is nourished and heat cleared, urination naturally flows. For milder cases, simply using the method of slowly chewing Cheqianzi can also reduce swelling; I have used it repeatedly with success.
Although this syndrome results from yin deficiency due to prolonged illness, it is not originally inherent yin deficiency. If a person normally suffers from yin deficiency, leading to difficult urination and accumulating into edema, it is appropriate to use one and a half liang of Prepared Rehmanniae Radix (Shu Dihuang) each time, decocted together with Baigen. If worried that two boils are insufficient to extract the Dihuang, boil the Dihuang for over ten boils first, then add Baigen and cook together.
As for Cheqianzi, it is still best to chew it in small amounts, taking four or five qian per day.
For Shuigu caused by cold, the pulse must be fine, minute, slow, and weak, or there is a feeling of cold in the heart, or loose stools. It is appropriate to use six qian of Zanthoxyli Fructus Seed (Huajiaomu), stir-fried until cooked and crushed, decocted in soup to take with five fen of fine powder of native Sulfur (Sheng Liuhuang). If warmth is not felt after taking, the dosage can be increased experimentally, aiming for a slight feeling of warmth after some time. Generally, diuretic herbs tend to be cool, whereas these two herbs are warm and promote urination. If spleen and stomach are deficient and damaged, unable to transport and transform water and fluids, it is appropriate to treat with herbs that strengthen the spleen and descend stomach qi, assisted by diuretics.
In summary, Shuigu syndromes do not form without the patency of urination. Therefore, those treating this syndrome should prioritize promoting urination. For treating difficult urination, refer to my various formulas and cases for treating Longbi (Dysuria).
There are cases where the bladder ligaments are twisted (Baoxi Liaoli), causing urinary retention. Occasionally, due to vomiting, coughing, or lying on the side and stretching, a small amount may pass. This is commonly known as Zhuanbao syndrome. Pregnant women, postpartum women, and those who have fallen from heights sometimes suffer from this. I formulated Shengma Huangqi Tang (Ephedra and Astragalus Decoction - *Note: Text says 'Shengma Huang Tang', likely a typo for Huangqi*), which I have used to cure several people. This lifts the bladder ligaments to restore their correct position.
Hua Yuanhua had a formula for unblocking urinary retention. I knew of it but did not try it. Later, reading the Hangzhou newspaper, I saw Mr. XX state that using his formula plus one qian of Cimicifugae Rhizoma (Shengma) successfully cured his sister's two-day-and-night urinary retention and a Mr. Tao's one-day-and-night urinary retention, with immediate effect. The formula consists of Ginseng Radix (Renshen), Nelumbinis Plumula (Lianzixin), Plantaginis Semen (Cheqianzi), and Achyranthis Bidentatae Radix (Wangbuliuxing) each three qian, Glycyrrhizae Radix et Rhizoma (Gancao) one qian, Cinnamomi Cortex (Rougui) three fen, and Ginkgo Seed (Baiguo) twelve pieces. Note: In the formula, if Baiguo is used for cough, it can be crushed with the peel, utilizing the peel's ability to astringe the lung. If used to promote urination, it should be peeled and crushed, utilizing its slippery and descending properties.
As for Qigu, it is mostly caused by stasis in the spleen. The spleen is the master of the acquired constitution, residing in the center to transport the four directions. It originally contains many venous vessels to circulate qi transformation. If stasis obstructs this qi transformation, abdominal distension arises. Over time, it accumulates into Qigu. The *Neijing* states, "All dampness, edema, and fullness belong to the spleen." I formulated Jineijin Tang (Chicken Gizzard Lining Decoction - *Text says 'Ji Tang', context implies Jineijin Tang*), which I have used repeatedly with success. The intent of the formula: Use Chicken Gizzard Lining (Jineijin) to open spleen stasis; Atractylodis Macrocephalae Rhizoma (Baizhu) to assist spleen transportation; Bupleuri Radix (Chaihu) and Citri Reticulatae Pericarpium (Chenpi) to regulate spleen qi ascending and descending; Paeoniae Radix Alba (Baishao) to promote urination and prevent water accumulation; Zingiberis Rhizoma Recens (Shengjiang) to open orifices and harmonize Ying and Wei. Generally speaking, the herb properties are neither cool nor hot. However, if this syndrome leans toward cold, Cinnamon Twig (Guizhi), Aconiti Lateralis Radix Praeparata (Fuzi), and Zingiberis Rhizoma (Ganjiang) can be added酌情ly. If it leans toward heat, Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), and Gardeniae Fructus (Zhizi) can be added酌情ly. If the pulse and symptoms are all excess, and there is no improvement after a few doses of medicine, one can take one and a half qian of fine powder of the first grinding of Black Niuxi (Heiqiu - Semen Kochiae) sent down with the decocted medicine. After taking it, if bowel movements become smooth, the illness will improve slightly. However, one must continue taking the original formula for several days, using it once a day. Continuous use may damage qi. This is the general overview of the treatment methods for Shuigu and Qigu (For various schemes for treating Shuigu and Qigu, see the Medical Formulas section).