经曰。诸气 郁。皆属于肺。诸湿肿满。昏属于脾。又曰。诸腹胀大。敲之如鼓。
皆属于热。盖气郁则生湿。湿郁则生热。湿热相搏。肺失清肃之令。则水不
行而为肿。脾失健运之司。则谷不磨而为胀。甚且清阳不走上窍。浊阴不
走下窍。天地闭塞。金不平木。土不制水。由是肚大。青筋。脐突。背平。足心平。
五脏之阴。越出于外。六腑之阳。反扰于内。斯时而不亟泻其阳。则阴欲入
而阳拒之。阳欲出而阴闭之。则阴阳愈乖。而肿胀益甚。譬之洪水泛滥。不
事疏凿。乃欲以土实之。则愈堤防而愈泛溢。此必然之势也。子和出。立浚
川禹功等法。非不峻烈可畏。然不有荡涤之。则水何由而行。所蓄者。何由
而泄。阴阳失位者。何由而复奠厥居乎。余每见从事温补者。一逢肿胀。辄
进六君子。金匮肾气等。岂不纯正通达。卒至肿胀愈甚。迄无成功。及遇草
泽医。每以大攻大泻药投之。反恒奏绩于俄顷。然后以参调之。以补济之。
善其后图。乃可万全。虽然。此为实热者言也。若老人久病后。及肾元亏损
者。病从阴而发。不从阳而入。前法又不可施。气喘脉弱。喜温恶寒。则金匮
肾气之用桂附。以牛膝车前为引。一则三焦为决渎之官。水道所出。一则
肾为胃关。开窍二阴。谁谓补中不带泻哉。学人扩而充之可也。
一传鼓胀方
第一服
黑丑（二钱半生半熟） 沉香（五分）
共为细末。酒调送。
第二服
陈皮 青皮 五加皮 茯苓皮 大腹皮 莱菔子 苏子 韭子 葶苈子 车前子（各一钱） 琥珀 沉香（各五分）
黑丑（六分半生半熟） 朴硝（三分）
共为细末。酒调送。
第三服
槟榔 浓朴 益智仁 木通 泽泻 白芍药 芫花（各一钱） 沉香 琥珀（各五分） 朴硝（三分） 黑丑（六
分，半生半熟）
共为细末。酒调送。
舟车神 丸 去一切水湿痰饮。
甘遂 大戟 芫花（各一两，俱醋炒） 大黄（二两） 黑牵牛（取头末） 青皮 陈皮 木香 槟榔（各五钱） 轻
粉（一钱）
为末。水丸椒目大。空心服五丸。日三服。痞闷者多服反烦满。宜初服二
丸。每服加一丸。快利为度。戴人每令病者先服百余粒。继以浚川等药
投之。五更当下。种种病出。轻者一二度。重者五六度。方愈。药虽峻急。为
效极神。弱者当根据河间渐攻进。实者从戴人治之。
大圣浚川散
大黄（煨） 牵牛（取头末） 郁李仁（各一两） 木香 芒硝（各三钱） 甘遂（五分）
每服三钱。姜汁调下。戴人每言。导水丸必用禹功散继之。舟车丸必用浚川散继之。
神芎导水丸
黄芩（一两） 黄连 川芎 薄荷（各五钱） 大黄（二两） 滑石 黑丑（取头末各四两）
为末。水丸。有血积者。加桂五钱。
禹余粮丸
蛇含石（三两铁铫盛烧通红钳取出倾入醋中候冷取出研极细） 禹余粮石（三两）
针砂（五两淘净炒干用醋二钟同余粮铫内煮干更用铫并药烧红倾净砖地上候冷研极细） 羌活 川芎
木香 茯苓 牛膝（酒浸） 桂心 白豆蔻 大茴香 蓬术（炒） 附子（炮） 炮姜 京三棱（炒）
青皮 白蒺藜（焙研去刺） 当归（酒浸各五钱）
共为末。入前三味拌匀。蒸饼丸如桐子大。食前白汤下三十丸。至五十
丸。前三味。非甘遂芫花之比。又有各药扶持。虚人老人。亦可服也。是忌
盐。一毫入口。发疾愈甚。服药后。即于小便内旋去。不动脏腑。每日三服。
更以温补药助之。
金匮肾气丸 治脾肾虚。腰重脚肿。小便不利。或肚腹肿胀。四肢浮肿。喘
急痰盛。已成蛊症。其效如神。此症多因脾胃虚弱。治失其宜。元气复伤
而变症者。非此药不能救。
白茯苓（三两） 附子（五钱制） 牛膝 桂 泽泻 车前子 山萸肉 山药 牡丹皮（各一两） 熟地黄（四两）
上为末。和地黄加炼蜜丸。如梧子。每服三钱。空心米饮下。
《黄帝内经》说：各种气机郁滞，都归属于肺；各种湿邪导致的肿胀和腹满，都归属于脾。又说：各种腹部胀大，敲击时声音像鼓一样，都归属于热。大概是因为气机郁滞则产生湿邪，湿邪郁滞则化生热邪。湿热相互搏结，导致肺失去清肃下降的职能，于是水液不能运行而形成水肿；脾失去运化水谷的功能，于是食物不能消化而形成胀满。甚至出现清阳之气不能上升滋养头面七窍，浊阴之气不能下降排出体外，天地之气闭塞不通，金（肺）不能制约木（肝），土（脾）不能克制水（肾）。因此出现肚子大、青筋暴露、肚脐突出、背部平坦、足心平坦等症状。五脏的阴精外越于体表，六腑的阳气反扰于体内。在这个时候如果不紧急泻除亢盛的阳热之邪，那么阴气想要进入却被阳气拒绝，阳气想要外出却被阴气闭阻，这样阴阳更加失调，而肿胀就会更加严重。这就好比洪水泛滥，不从事疏导开凿的工作，却想用泥土去填塞它，那么堤防越坚固，水流反而越泛滥溢出。这是必然的趋势。
刘河间（刘完素）的学生张子和提出了浚川禹功等方法，这些方法虽然峻猛猛烈令人畏惧，但是如果不进行荡涤清理，水液从哪里流通？蓄积的水湿从哪里排泄？失位的阴阳又从哪里恢复其正常的居所呢？我每次见到那些从事温补治疗的医生，一遇到肿胀病症，就立即进用六君子汤、金匮肾气丸等方剂。这些方剂难道不纯正通达吗？最终却导致肿胀更加严重，始终没有成功。等到遇到民间草泽医生，每用大攻大泻的药物投治，反而往往在短时间内奏效。然后用参类药材调理，用补益的方法巩固疗效，善后处理，这样才能万无一失。虽然如此，这是针对实热证而言的。如果是老年人久病之后，以及肾元亏损的人，疾病从阴分发起，不从阳分侵入，前面的攻下方法就不可以施用。如果出现气喘、脉弱、喜温恶寒的症状，那么使用金匮肾气丸中的桂枝、附子，以牛膝、车前子为引经药。一方面因为三焦是决渎之官，是水液出行的通道；另一方面因为肾是胃的关隘，开窍于二阴。谁说补益之中不带泻法呢？学习中医的人应当扩充并充实这方面的知识。
传鼓胀方
第一服：
黑丑（二钱半，生用和熟用各半） 沉香（五分）
共研为细末。用酒调送服用。
第二服：
陈皮、青皮、五加皮、茯苓皮、大腹皮、莱菔子、苏子、韭子、葶苈子、车前子（各一钱） 琥珀、沉香（各五分）
黑丑（六分半，生用和熟用各半） 朴硝（三分）
共研为细末。用酒调送服用。
第三服：
槟榔、浓朴、益智仁、木通、泽泻、白芍药、芫花（各一钱） 沉香、琥珀（各五分） 朴硝（三分） 黑丑（六分，生用和熟用各半）
共研为细末。用酒调送服用。
舟车神丸：去除一切水湿痰饮。
甘遂、大戟、芫花（各一两，都用醋炒制） 大黄（二两） 黑牵牛（取头末） 青皮、陈皮、木香、槟榔（各五钱） 轻粉（一钱）
研为细末。用水泛丸，如花椒籽大小。空腹服用五丸，每日三次。如果有痞闷症状，多服反而烦满，适宜初次服用二丸，每次增加一丸，以大便通畅有利为度。戴人（张子和）通常让病人先服用百余粒（指禹功散等先导药），接着再用浚川散等药物投治。五更时分应当排便，各种病邪随之排出。轻症一至两次，重症五至六次，病才痊愈。药物虽然峻急，但效果极其神奇。体质虚弱者应当根据河间（刘完素）的方法逐渐攻下；体质壮实者按照戴人的方法治疗。
大圣浚川散：
大黄（煨制） 牵牛（取头末） 郁李仁（各一两） 木香、芒硝（各三钱） 甘遂（五分）
每次服用三钱。用姜汁调下。戴人经常说，导水丸必须用禹功散接续服用，舟车丸必须用浚川散接续服用。
神芎导水丸：
黄芩（一两） 黄连、川芎、薄荷（各五钱） 大黄（二两） 滑石、黑丑（取头末各四两）
研为细末。用水泛丸。有血积者，加桂枝五钱。
禹余粮丸：
蛇含石（三两，用铁锅盛放烧得通红，钳取出倒入醋中，冷却后取出，研磨极细） 禹余粮石（三两）
针砂（五两，淘洗干净炒干，用醋两钟同禹余粮在铁锅内煮干，再用铁锅连同药物烧红，倾倒在干净的砖地上，冷却后研磨极细） 羌活、川芎、木香、茯苓、牛膝（酒浸）、桂心、白豆蔻、大茴香、蓬术（炒）、附子（炮制）、炮姜、京三棱（炒）、青皮、白蒺藜（焙干研磨去刺）、当归（酒浸，各五钱）
共研为细末。加入前三味药拌匀。用蒸饼做丸，如梧桐子大小。饭前用白开水送下三十丸，增至五十丸。前三味药，不像甘遂、芫花那样峻烈，又有其他药物扶持，虚人老人也可以服用。服药期间忌盐，一丝盐入口，疾病发作会更严重。服药后，小便随即排出药效，不伤动脏腑。每日三次服用，再以温补药物辅助。
金匮肾气丸：治疗脾肾虚损，腰部沉重脚部浮肿，小便不利，或者肚腹肿胀，四肢浮肿，喘急痰多，已经形成蛊症。其效果如神。这种病症多因脾胃虚弱，治疗不当，元气再次受伤而变生此症。不是这个药不能挽救。
白茯苓（三两） 附子（五钱，制过） 牛膝、桂枝、泽泻、车前子、山萸肉、山药、牡丹皮（各一两） 熟地黄（四两）
以上研为细末。与地黄混合，加入炼蜜做成丸药，如梧桐子大小。每次服用三钱。空腹用米汤送下。
The *Classic of Internal Medicine* states: All qi stagnation and depression belong to the Lung; all dampness-induced swelling and fullness belong to the Spleen. It also states: All abdominal distension and enlargement, where percussion sounds like a drum, belong to Heat. Generally speaking, qi stagnation generates Dampness, and Dampness stagnation generates Heat. When Damp-Heat contend with each other, the Lung loses its command of clear descending and肃 (purification), causing water to fail to circulate and resulting in edema. The Spleen loses its function of transportation and transformation, causing food to fail to be digested and resulting in distension. In severe cases, Clear Yang fails to ascend to the orifices, and Turbid Yin fails to descend through the lower orifices. The Qi of Heaven and Earth becomes blocked, Metal (Lung) fails to control Wood (Liver), and Earth (Spleen) fails to restrain Water (Kidney). Consequently, the abdomen becomes large, green veins are exposed, the umbilicus protrudes, the back is flat, and the soles of the feet are flat. The Yin essence of the Five Zang organs escapes outward, while the Yang Qi of the Six Fu organs disturbs inward. At this time, if one does not urgently purge the excessive Yang, then Yin desires to enter but is rejected by Yang, and Yang desires to exit but is closed off by Yin. Thus, Yin and Yang become increasingly disordered, and the swelling worsens. This is like a flood overflowing; if one does not engage in dredging and channeling, but instead tries to fill it with earth, the more the dikes are reinforced, the more the water overflows. This is an inevitable trend.
Zihe (Zhang Congzheng), a student of Liu Wanju, proposed methods such as Junchuan Yugong. Although these methods are harsh and fierce, if there is no thorough cleansing, how can water flow? How can accumulated fluids be discharged? How can displaced Yin and Yang return to their proper positions? I often see practitioners engaged in warming and tonifying therapies who, upon encountering swelling, immediately administer formulas such as Liujunzi Tang (Six Gentlemen Decoction) and Jin Kui Shenqi Wan (Golden Cabinet Kidney Qi Pill). Are these not pure and unobstructed? Yet ultimately, the swelling worsens, and success is never achieved. Conversely, when encountering folk doctors who use strong purgative and draining medicines, results are often effective almost immediately. Thereafter, using Ginseng to regulate and tonify to consolidate the effect, and managing the aftermath, ensures complete safety. However, this applies only to Excess-Heat patterns. If it is an elderly person after a long illness, or someone with Kidney Yuan deficiency, where the disease originates from the Yin aspect rather than entering from the Yang, the aforementioned purgative methods cannot be applied. If there is panting, weak pulse, preference for warmth, and aversion to cold, then in the use of Guizhi (Cinnamon Twig) and Fuzi (Prepared Aconite Root) in Jin Kui Shenqi Wan, using Niuxi (Achyranthes Root) and Cheqianzi (Plantago Seed) as guiding herbs: on one hand, because the Sanjiao (Triple Burner) is the official of sluices, the pathway of water passage; on the other hand, because the Kidney is the gate of the Stomach, opening into the two yin openings. Who says that tonification does not include purgation? Students should expand and enrich their knowledge in this area.
Formula for Drum Distension
First Dose:
Heiqiu (Black Morning Glory Seed, 2.5 qian, half raw half cooked) Chenxiang (Agarwood, 0.5 fen)
Grind into fine powder. Take with wine.
Second Dose:
Chenpi (Tangerine Peel), Qingpi (Green Tangerine Peel), Wujia Pi (Acanthopanacis Cortex), Fuling Pi (Poria Peel), Dafupi (Areca Peel), Laifuzi (Radish Seed), Suzi (Perilla Seed), Jiuzi (Leek Seed), Tinglizi (Descurainiae Seed), Cheqianzi (Plantago Seed) (each 1 qian) Hupo (Amber), Chenxiang (Agarwood) (each 0.5 fen)
Heiqiu (Black Morning Glory Seed, 0.65 qian, half raw half cooked) Puxiao (Mirabilite, 0.3 fen)
Grind into fine powder. Take with wine.
Third Dose:
Binglang (Betel Nut), Nongpo (Magnolia Bark), Yizhiren (Alpinia Oxyphylla Fruit), Mutong (Akebia Stem), Zexie (Alisma Rhizome), Baishaoyao (White Peony Root), Yuanhua (Genkwa Flower) (each 1 qian) Chenxiang (Agarwood), Hupo (Amber) (each 0.5 fen) Puxiao (Mirabilite, 0.3 fen) Heiqiu (Black Morning Glory Seed, 0.6 qian, half raw half cooked)
Grind into fine powder. Take with wine.
Zhouche Shenwan (Boat Cart Divine Pill): Removes all water-dampness, phlegm, and fluid retention.
Gansui (Kansui Root), Daji (Euphorbia Root), Yuanhua (Genkwa Flower) (each 1 liang, stir-fried with vinegar) Dahuang (Rhubarb Rhizome, 2 liang) Heiqianqiu (Black Morning Glory Seed, head powder) Qingpi (Green Tangerine Peel), Chenpi (Tangerine Peel), Muxiang (Aucklandia Root), Binglang (Betel Nut) (each 5 qian) Qingfen (Calomel, 1 qian)
Grind into powder. Make pills with water, size of pepper seeds. Take five pills on an empty stomach, three times daily. For those with epigastric fullness, taking more may cause irritability and fullness; it is advisable to start with two pills, increasing by one pill per dose, until bowel movement is smooth. Dai Ren (Zhang Congzheng) usually instructed patients to first take over a hundred grains (referring to Yugong San etc.), followed by Junchuan San etc. Bowel movement should occur at wu geng (5-7 AM), expelling various pathogens. Mild cases resolve in one or two times, severe cases in five or six times. Although the medicine is harsh and rapid, the effect is miraculous. For weak constitutions, follow Hejian's method of gradual attack; for strong constitutions, follow Dai Ren's treatment.
Da Sheng Junchuan San (Great Sage River-Dredging Powder):
Dahuang (Rhubarb Rhizome, baked) Qianqiu (Morning Glory Seed, head powder) Yuliren (Prunus Armeniaca Seed) (each 1 liang) Muxiang (Aucklandia Root), Mangxiao (Natrii Sulfas) (each 3 qian) Gansui (Kansui Root, 0.5 fen)
Take 3 qian per dose. Take down with ginger juice. Dai Ren often said: Daoshui Wan must be followed by Yugong San; Zhouche Wan must be followed by Junchuan San.
Shenxiong Daoshui Wan (Divine Xiongerium Water-Guiding Pill):
Huangqin (Scutellaria Root, 1 liang) Huanglian (Coptis Rhizome), Chuanxiong (Ligusticum Rhizome), Bohe (Mentha Herb) (each 5 qian) Dahuang (Rhubarb Rhizome, 2 liang) Huashi (Talcum), Heiqiu (Black Morning Glory Seed, head powder) (each 4 liang)
Grind into powder. Make pills with water. For blood stasis, add Guizhi (Cinnamon Twig) 5 qian.
Yuyuliang Wan (Yuyu Grain Pill):
Shehanshi (Oreodocyma Stone, 3 liang, placed in an iron wok, heated until red hot, removed with tongs, poured into vinegar, cooled, removed, ground extremely fine) Yuyuliangshi (Haematitum, 3 liang)
Zhensha (Needle Sand, 5 liang, washed clean, dried, boiled with two zhong of vinegar together with Yuliangshi in an iron wok until dry, then the wok and medicine are heated red hot, poured onto a clean brick floor, cooled, and ground extremely fine) Qianghuo (Notopterygium Rhizome), Chuanxiong (Ligusticum Rhizome), Muxiang (Aucklandia Root), Fuling (Poria), Niuxi (Achyranthes Root, wine-soaked), Guixin (Cinnamon Heart), Baidoukou (Cardamom), Dahuixiang (Fennel), Pengzhu (Curcuma Rhizome, stir-fried), Fuzi (Prepared Aconite Root, processed), Paojiang (Roasted Ginger), Jingsanleng (Burreed Tuber, stir-fried), Qingpi (Green Tangerine Peel), Baijili (Tribulus Fruit, roasted, ground, thorns removed), Danggui (Angelica Sinensis Root, wine-soaked) (each 5 qian)
Grind into powder. Mix with the first three ingredients. Make pills with steamed bread dough, size of paulownia seeds. Take thirty pills before meals with warm water, up to fifty pills. The first three ingredients are not comparable to Gansui and Yuanhua in harshness, and are supported by other herbs, so they can be taken by the elderly and weak. Salt must be avoided; even a trace of salt entering the mouth will aggravate the disease. After taking the medicine, the effect is excreted through urine, without disturbing the zang-fu organs. Take three times daily, assisted by warming and tonifying medicines.
Jin Kui Shenqi Wan (Golden Cabinet Kidney Qi Pill): Treats Spleen and Kidney deficiency, heavy waist and swollen legs, difficult urination, or abdominal swelling, limb edema, panting and profuse phlegm, already developed into Gu syndrome. Its effect is miraculous. This condition is mostly caused by Spleen and Stomach weakness, improper treatment, and further injury to Yuan Qi leading to changed symptoms. Without this medicine, rescue is impossible.
Baifuling (Poria, 3 liang) Fuzi (Prepared Aconite Root, 5 qian, processed) Niuxi (Achyranthes Root), Gu (Cinnamon Twig), Zexie (Alisma Rhizome), Cheqianzi (Plantago Seed), Shanzhuyu (Cornus Fruit), Shanyao (Dioscorea Rhizome), Mudanpi (Moutan Bark) (each 1 liang) Shudihuang (Prepared Rehmannia Root, 4 liang)
Grind the above into powder. Mix with Dihuang and refined honey to make pills, size of wutong seeds. Take 3 qian per dose. Take on an empty stomach with rice drink.