（第十一）
丹溪云∶脾虚不能制水，肾虚不能行水。胃与脾合为水谷之海，因脾虚而不能传化，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，自目胞下微起，
肢体重着，咳嗽怔忡，股间清冷，小便涩黄，皮薄而光，手按成凹，举手即满是也。古方有十
种论证∶以短气不得卧为心水，两胁紧痛为肝水，大便鸭溏为肺水，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，小便秘涩为胃水，小腹
急满为小肠水。诸家只知治湿多利小便之说，执此一途，用诸利水之药，往往多死。殊不知脾
极虚损，虽劫目前，水气复来，束手待毙。大都小儿尤是饮食伤脾，不能行水而作胀肿。只用
实脾为主，佐之分证治而得之矣。
《脉经》云∶水病脉洪大者可治；微细者不可治。水病胀闭，其脉大软者生；沉细虚小者
死。水病腹大如鼓，实者生，虚者死。
水肿不治证
凡水肿先起于四肢，而后归于腹者不治。大便滑泄与夫唇黑、缺盆平、脐突、足平、背
平，或肉硬，或手掌平，或男从脚下肿而上，女从身上肿而下，并皆不治。
分气饮 治小儿肿胀作喘，气短而急，四肢浮肿。
桔梗（炒） 赤茯苓 陈皮 桑白皮 大腹皮（洗） 枳壳（炒） 半夏（泡） 甘草（炙）
真苏子（微炒） 紫苏（各二钱） 草果（一钱，煨去壳） 加木通
上咀，每服二钱，水一盏，姜三片、枣一枚同煎。
温脾散 治小儿脾不和，虚胀不乳食，憎寒壮热，困倦无力。
诃子肉（炮） 人参（各七钱半） 甘草（二钱半，炙） 白术 木香 茯苓 藿香（泡）
陈皮 黄 桔梗（各半两）
上未，每服二钱，姜、枣煎服。
大橘皮汤 治湿热内攻，腹胀水肿，小便不利，大便滑泄。
陈皮（两半） 木香（二钱半） 滑石（六两） 槟榔（三钱） 茯苓（一两） 猪苓 白术 泽泻
肉桂（各半两） 甘草（一钱）
上咀，每服三钱，水一盏煎服。
实脾散 治小儿阴水发肿，用此先实脾土。
浓朴（姜炒） 白术 木瓜 木香 干姜（炮。各一两） 草果仁 大腹皮 附子 白茯苓
甘草（炙。各半两）
上咀，每服三钱，姜、枣水煎服。
疏凿饮子 治水气通身浮肿，喘呼气急，烦渴，大小便不利。（方见大人门。）
加味五皮饮 治小儿四肢肿满，阳水、阴水皆可服之。
茯苓皮（咀，一钱，内加姜黄一钱） 五加皮 地骨皮 生姜皮 大腹皮 木瓜（各五分）
上作一服，水煎。一方用陈皮、桑白皮，无五加皮。
消肿丸 治小儿水肿喘满，小便不利。
滑石 木通 白术 黑牵牛（炒） 通脱木 茯苓 茯神 半夏 陈皮（各一两） 木香
瞿麦穗 丁香（各半两）
上为末，酒糊丸，梧桐子大。每服二十丸，空心，麦门冬、灯芯汤下。
退肿塌气散 治惊木、积水。用饮过多，停积于脾，故四肢浮肿。
萝卜子 赤小豆（炒） 陈皮（各半两） 木香（一钱） 甘草（三钱）
上咀，姜、枣煎，三岁儿每服二钱。
匀气散 治脾肺气逆喘嗽，面浮，小便不利。
桑白皮（炙） 桔梗（炒） 赤茯苓 甘草（各半两） 陈皮（七钱） 藿香（三钱） 木通（二两）
上咀，每服二钱，姜、灯芯煎服。
三棱丸 治小儿停积，腹胁胀满，干呕恶心，全不入食。
三棱（炮） 木香 神曲（炒） 陈皮 半夏（制。各一两） 丁香 桂心（各半两）
上为末，面糊丸，粟米大。乳食后姜汤下二十丸。
（第十一）
朱丹溪说：脾虚不能制约水液，肾虚不能推动水液运行。胃与脾相合，共同作为受纳和腐熟水谷的“水谷之海”，因脾虚而不能正常传输和消化，导致肾水泛滥，反过来浸渍脾土，于是三焦气机停滞，经络壅塞不通，水湿渗入皮肤，灌注于肌肉，从而引发肿胀。其症状表现为：眼睑下方微微隆起，肢体沉重困倦，咳嗽心悸，大腿内侧清冷，小便涩滞且颜色黄，皮肤薄而光亮，用手按压出现凹陷，抬手后凹陷立即恢复。古代医方中有十种证候的论述：以呼吸短促、不能平卧为心水，两胁紧绷疼痛为肝水，大便像鸭粪一样稀溏为肺水，四肢极度沉重为脾水，腰痛脚冷为肾水，口苦咽干为胆水，下虚上实为大肠水，腹部急迫但四肢消瘦为膀胱水，小便秘涩不通为胃水，小腹胀满急迫为小肠水。各家医家只知道治疗水肿多采用利小便的方法，拘泥于此一途径，使用各种利水药物，往往导致患者死亡。殊不知脾脏极度虚损时，即使暂时劫夺了水气，水湿之气很快又会复发，最终束手待毙。大多小儿的水肿是由于饮食损伤脾胃，不能运化水湿而导致的肿胀。治疗只需以健脾益气为主，辅以辨证施治即可痊愈。
《脉经》说：水肿病脉象洪大的可以治愈；脉象微细的不可治愈。水肿胀满闭塞，脉象大且软的预后良好；脉象沉细虚小的预后不良。水肿病腹部胀大如鼓，实证可生，虚证则死。
水肿不治之证
凡是水肿先从四肢开始，然后才波及腹部的，属于不治之症。大便滑泄不禁，以及嘴唇发黑、缺盆穴处平坦无凹陷、肚脐突出、足背平坦、背部平坦，或者肌肉坚硬，或者手掌平坦，或者男性从脚部向上肿，女性从身体向下肿，都属于不治之症。
分气饮 治疗小儿肿胀伴有喘息，气短而急促，四肢浮肿。
桔梗（炒制） 赤茯苓 陈皮 桑白皮 大腹皮（洗净） 枳壳（炒制） 半夏（泡制） 甘草（炙制）
紫苏子（微炒） 紫苏叶（各二钱） 草果（一钱，煨制去壳） 加木通
以上药材切碎，每次服用二钱，用水一盏，加入生姜三片、大枣一枚共同煎煮。
温脾散 治疗小儿脾胃不和，虚性胀满，不愿吃奶进食，怕冷高热，困倦无力。
诃子肉（炮制） 人参（各七钱半） 甘草（二钱半，炙制） 白术 木香 茯苓 藿香（泡制）
陈皮 黄芪 桔梗（各半两）
以上药材研成粉末，每次服用二钱，用生姜、大枣煎汤送服。
大橘皮汤 治疗湿热内攻，腹部胀满水肿，小便不利，大便滑泄。
陈皮（一两半） 木香（二钱半） 滑石（六两） 槟榔（三钱） 茯苓（一两） 猪苓 白术 泽泻
肉桂（各半两） 甘草（一钱）
以上药材切碎，每次服用三钱，用水一盏煎服。
实脾散 治疗小儿阴水引起的浮肿，先用此方来充实脾土。
厚朴（姜汁炒） 白术 木瓜 木香 干姜（炮制。各一两） 草果仁 大腹皮 附子 白茯苓
甘草（炙制。各半两）
以上药材切碎，每次服用三钱，用生姜、大枣水煎服。
疏凿饮子 治疗水气导致全身浮肿，喘促气急，烦躁口渴，大小便不利。（方剂见成人门。）
加味五皮饮 治疗小儿四肢肿满，阳水和阴水均可服用。
茯苓皮（切碎，一钱，另加姜黄一钱） 五加皮 地骨皮 生姜皮 大腹皮 木瓜（各五分）
以上为一服的量，用水煎煮。另一版本使用陈皮、桑白皮，不用五加皮。
消肿丸 治疗小儿水肿喘满，小便不利。
滑石 木通 白术 黑牵牛（炒制） 通脱木 茯苓 茯神 半夏 陈皮（各一两） 木香
瞿麦穗 丁香（各半两）
以上药材研成粉末，用酒糊制作丸药，大小如梧桐子。每次服用二十丸，空腹时，用麦门冬、灯芯草煎汤送服。
退肿塌气散 治疗惊风、积水。因饮水过多，停积于脾，导致四肢浮肿。
萝卜子 赤小豆（炒制） 陈皮（各半两） 木香（一钱） 甘草（三钱）
以上药材切碎，用生姜、大枣煎煮，三岁儿童每次服用二钱。
匀气散 治疗脾肺气逆导致的喘息咳嗽，面部浮肿，小便不利。
桑白皮（炙制） 桔梗（炒制） 赤茯苓 甘草（各半两） 陈皮（七钱） 藿香（三钱） 木通（二两）
以上药材切碎，每次服用二钱，用生姜、灯芯草煎服。
三棱丸 治疗小儿食积停滞，腹部和胁肋胀满，干呕恶心，完全无法进食。
三棱（炮制） 木香 神曲（炒制） 陈皮 半夏（制过。各一两） 丁香 桂心（各半两）
以上药材研成粉末，用面糊制作丸药，大小如粟米。在乳食之后，用姜汤送服二十丸。
(11)
Zhu Danxi stated: Spleen deficiency fails to control water, and Kidney deficiency fails to move water. The Stomach and Spleen combine to form the "Sea of Water and Grain," responsible for receiving and digesting food and fluids. Due to Spleen deficiency, transportation and transformation are impaired, causing Kidney water to overflow and soak the Spleen earth. Consequently, the Sanjiao (Triple Burner) stagnates, meridians become obstructed, and water seeps into the skin and muscles, resulting in edema. The manifestations include slight swelling under the eyelids, heaviness and fatigue in the limbs, coughing and palpitations, coldness in the inner thighs, scanty and yellow urine, thin and shiny skin that retains an indentation upon pressure which rebounds immediately upon lifting the hand. Ancient formulas describe ten types of edema based on symptoms: shortness of breath and inability to lie flat is Heart Water; tightness and pain in the hypochondrium is Liver Water; loose stools resembling duck feces is Lung Water; severe heaviness in 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; difficult and scanty urination is Stomach Water; and fullness and urgency in the lower abdomen is Small Intestine Water. Many practitioners only know the method of treating dampness by promoting urination, adhering rigidly to this path and using various diuretic herbs, often leading to patient death. They fail to realize that when the Spleen is extremely deficient, even if water qi is temporarily drained, it will return, leaving the physician helpless. Most pediatric edema arises from dietary injury to the Spleen, impairing water metabolism and causing swelling. Treatment should primarily focus on strengthening the Spleen, supplemented by syndrome differentiation.
The *Mai Jing* (Pulse Classic) states: In edema, a洪大 (Hóng Dà, surging and large) pulse indicates a treatable condition; a微细 (Wēi Xì, faint and fine) pulse indicates an untreatable condition. In edema with distension and obstruction, a pulse that is large and soft suggests survival; a pulse that is deep, fine, empty, and small suggests death. In edema with an abdomen swollen like a drum, excess patterns indicate survival, while deficiency patterns indicate death.
Untreatable Edema Patterns
Edema that begins in the four limbs and subsequently spreads to the abdomen is untreatable. Accompanying signs such as slippery diarrhea, black lips, flattening of the Quepen (Lianquan/Collarbone depression), protruding umbilicus, flat dorsum pedis, flat back, hard flesh, or flat palms are all untreatable. Additionally, edema ascending from the feet in males or descending from the body in females is untreatable.
Fenqi Yin (Dividing Qi Decoction) treats pediatric edema with wheezing, shortness of breath, and rapid breathing, along with edema of the four limbs.
Jiegeng (Stellariae Radix, stir-fried), Chifuling (Red Poria), Chenpi (Citri Reticulatae Pericarpium), Sangbaipi (Mori Cortex), Dafupi (Arecae Pericarpium, washed), Zhike (Aurantii Fructus Immaturus, stir-fried), Banxia (Pinelliae Rhizoma, soaked), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried);
Zisuzi (Perillae Fructus, lightly stir-fried), Zisu (Perillae Folium) (each 2 qian). Add Mutong (Akebiae Caulis).
Chop the herbs. Take 2 qian per dose, decoct with one sheng of water, three slices of Shengjiang (Zingiberis Rhizoma Recens), and one Dazao (Ziziphi Jujubae Fructus).
Wenpi San (Warming the Spleen Powder) treats pediatric Spleen-Stomach disharmony, vacuity-type distension, refusal to nurse or eat, aversion to cold with high fever, and lethargy with weakness.
Hezi Rou (Terminaliae Fructus, processed), Ren Shen (Ginseng Radix et Rhizoma) (each 7.5 qian); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (2.5 qian), Baizhu (Atractylodis Macrocephalae Rhizoma), Muxiang (Aucklandiae Radix), Fuling (Poria), Huoxiang (Agastaches Herba, soaked), Chenpi (Citri Reticulatae Pericarpium), Huangqi (Astragali Radix), Jiegeng (Platycodonis Radix) (each half liang).
Grind into powder. Take 2 qian per dose, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Ziziphi Jujubae Fructus).
Da Jupi Tang (Large Citrus Peel Decoction) treats internal attack by damp-heat, abdominal distension and edema, difficult urination, and slippery diarrhea.
Chenpi (Citri Reticulatae Pericarpium) (1.5 liang), Muxiang (Aucklandiae Radix) (2.5 qian), Huashi (Talcum) (6 liang), Binglang (Arecae Semen) (3 qian), Fuling (Poria) (1 liang), Zhuling (Polyporus), Baizhu (Atractylodis Macrocephalae Rhizoma), Zexie (Alismatis Rhizoma); Rougui (Cinnamomi Cortex) (each half liang), Gancao (Glycyrrhizae Radix et Rhizoma) (1 qian).
Chop the herbs. Take 3 qian per dose, decoct with one sheng of water.
Shipi San (Strengthening the Spleen Powder) treats pediatric Yin-water edema; use this first to strengthen Spleen earth.
Houpo (Magnoliae Officinalis Cortex, stir-fried with ginger juice), Baizhu (Atractylodis Macrocephalae Rhizoma), Mugua (Chaenomelis Fructus), Muxiang (Aucklandiae Radix), Jiangjiang (Zingiberis Rhizoma, processed) (each 1 liang); Caoguoren (Tsaoko Fructus Seed), Dafupi (Arecae Pericarpium), Fuzi (Aconiti Lateralis Radix Praeparata), Bai Fuling (Poria) (each half liang); Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) (half liang).
Chop the herbs. Take 3 qian per dose, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Ziziphi Jujubae Fructus).
Shuqiao Yinzi (Scouring Decoction) treats water qi causing generalized edema, wheezing with rapid breathing, irritability and thirst, and difficulty in urination and defecation. (Formula see Adult Section.)
Jiawei Wupi Yin (Modified Five-Bark Decoction) treats pediatric edema and fullness of the four limbs; suitable for both Yang-water and Yin-water.
Fulingpi (Poria Cum Rizomo et Mycelio, chopped, 1 qian, add Jianghuang (Curcumae Longae Rhizoma) 1 qian), Wujia Pi (Acanthopanacis Cortex), Digupi (Lycii Cortex), Shengjiangpi (Zingiberis Rhizoma Recens Cortex), Dafupi (Arecae Pericarpium), Mugua (Chaenomelis Fructus) (each 5 fen).
Take as one dose, decoct with water. Another version uses Chenpi (Citri Reticulatae Pericarpium) and Sangbaipi (Mori Cortex), without Wujia Pi (Acanthopanacis Cortex).
Xiaozhong Wan (Reducing Swelling Pill) treats pediatric edema with wheezing and fullness, and difficult urination.
Huashi (Talcum), Mutong (Akebiae Caulis), Baizhu (Atractylodis Macrocephalae Rhizoma), Heiqianniu (Pharbitidis Semen, stir-fried), Tongtuomu (Pteridis Herba), Fuling (Poria), Fushen (Poria cum Radice), Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium) (each 1 liang); Muxiang (Aucklandiae Radix), Qumai (Dianthi Herba), Dingxiang (Caryophylli Flos) (each half liang).
Grind into powder, make pills with wine paste, size of Sophorae Japonicae Fructus. Take 20 pills per dose on an empty stomach, with a decoction of Maidong (Ophiopogonis Radix) and Dengxincao (Junci Medullae).
Tuizhong Taqi San (Reducing Swelling and Collapsing Qi Powder) treats wind-stroke and fluid retention. Caused by excessive drinking leading to accumulation in the Spleen, resulting in edema of the four limbs.
Luobozǐ (Brassicae Chinensis Semen), Chixiaodou (Phaseoli Radiati Semen, stir-fried), Chenpi (Citri Reticulatae Pericarpium) (each half liang); Muxiang (Aucklandiae Radix) (1 qian), Gancao (Glycyrrhizae Radix et Rhizoma) (3 qian).
Chop the herbs, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dazao (Ziziphi Jujubae Fructus). For a three-year-old child, take 2 qian per dose.
Yunqi San (Harmonizing Qi Powder) treats Spleen-Lung qi rebellion causing wheezing and cough, facial edema, and difficult urination.
Sangbaipi (Mori Cortex, honey-fried), Jiegeng (Platycodonis Radix, stir-fried), Chifuling (Red Poria), Gancao (Glycyrrhizae Radix et Rhizoma) (each half liang); Chenpi (Citri Reticulatae Pericarpium) (7 qian), Huoxiang (Agastaches Herba) (3 qian), Mutong (Akebiae Caulis) (2 liang).
Chop the herbs. Take 2 qian per dose, decoct with Shengjiang (Zingiberis Rhizoma Recens) and Dengxincao (Junci Medullae).
Sanleng Wan (Burreed Pill) treats pediatric food stagnation, abdominal and hypochondriac distension, dry heaving and nausea, and complete loss of appetite.
Sanleng (Sparganii Rhizoma, processed), Muxiang (Aucklandiae Radix), Shenqu (Massae Fermentatae Medicamentosa, stir-fried), Chenpi (Citri Reticulatae Pericarpium), Banxia (Pinelliae Rhizoma, processed) (each 1 liang); Dingxiang (Caryophylli Flos), Guixin (Cinnamomi Ramulum) (each half liang).
Grind into powder, make pills with flour paste, size of Setaria Italicae Semen. Take 20 pills after milk/food, with a ginger decoction.