水肿之症。有阴有阳。察脉观色。问症须详。阴脉沉迟。其色青白。不渴而泻。小便清
涩
脉或沉数。色赤而黄。燥粪赤溺。兼渴为阳。水肿气急而小便涩。血肿气满而四肢寒。
蛊症大要有二。曰单腹胀。曰双腹胀。喘急气满。肿而不安。四肢微肿。此单腹胀。因
内伤
七情所致。取效微迟。四肢浮肿。肚大身重。此双腹胀。因外感风湿所致。取效甚速。又有
水肿气肿之分。以指按肿处。有陷随起。随起者气肿。先须理气。陷指起迟者水肿也。只须
导水立愈。凡人年四十以上。气血壮盛者。得效之后。善自调理。终身不发。五十以后。气
血稍衰。调理不谨。时或再复。此药尚能治之。但屡复屡治。而元气耗。则难为矣。脉
浮
洪易治。沉细难治。浮洪者。只用金不换木香丸。沉细者兼用沉香快脾丸。先服木香流气饮
一论诸气。痞滞不通。胸膈膨胀。口苦咽干。呕吐不食。或肩背腹胁走注刺痛。及喘急
痰嗽
面目虚浮。四肢肿满。大小便闭涩。又治忧思太过。怔忡郁积。香港脚风湿。聚结肿痛。喘
满胀急。此药调顺营卫。流通血脉。快利三焦。安和五脏。凡治蛊胀。宜先用此。
木香流气饮
木香（七钱五分） 丁皮（七钱五分） 藿香（七钱五分） 半夏（汤泡五钱五分） 人参（五
钱）
白术（去芦五钱） 赤茯苓（五钱） 浓朴（姜炒一两） 青皮（去穣二两） 陈皮（四两） 草果（
七钱五分） 槟榔（七钱五分） 香附（二两） 紫苏（二两） 大腹皮（七钱五分） 木瓜（五钱
）白芷（五钱） 麦冬（去心五钱） 莪术（煨七钱五分） 肉桂（七钱半） 木通（一两） 石菖
蒲（五钱） 甘草（一两）
上锉一剂。生姜三片。枣二枚。水一碗半。煎至七分。去渣。热服。本方加沉香、枳壳
、大
黄。去藿香、石菖蒲。名二十四味流气饮。蛊肿。加白豆蔻。肿满。加黑牵牛。头面肿。加
葱白。肚腹肿。加枳实。倍青陈皮。脐至脚肿。加桑白皮。
一论金不换木香丸。治蛊肿之神药也。先服木香流气饮三五剂。通加白豆蔻。次用金不
换木
香丸。至收功后。用沉香化气丸调理。或心头烦热者。竹叶石膏汤。热甚。加黄芩。前贤论
蛊肿之症。有五不治者。面黑如炭。肚大青筋。掌中无纹。脚肿无坑。脐中凸起。此五症亦
能治之间有得生者。如败下黑水者不治。阳事不举者不治。其余青黄红紫。皆能治之。又一
症或肿或消。或作泄泻。知脾弱即泻。名曰洪水横流。服此宜之。其肿自消。其泻自止。忌
一切生冷毒物。油盐酱醋。鱼 鹅鸭。房事等件。无有不效者。
金不换木香丸
大戟（五钱） 芫花（炒五钱） 甘遂（五钱） 黑丑（头末二钱） 生大黄（五钱） 青皮（五
钱）
陈皮（五钱） 南木香（五钱） 青木香（五钱） 胡椒（一钱病合倍用） 川椒（去目五钱） 槟
榔（五钱） 益智仁（
五钱） 射干（三钱） 桑白皮（五钱） 苦葶苈（五钱炒） 大腹皮（五钱） 泽泻（五钱） 木
通（去皮五钱） 连翘（五钱） 砂仁（五钱） 巴豆（去壳半生半熟五钱）
上二十二味为末。醋煮面糊为丸。如梧子大。每服五十丸。壮盛人加七八十丸。第一消
头而
肿。五更初。用葱白酒送下。第二消中膈胸腹肿。五更初。用陈皮汤送下。第三消脐以下脚
肿五更初。用桑白皮汤送下。
沉香快脾丸
青皮（四钱） 陈皮（四钱） 三棱（煨四钱） 莪术（煨四钱） 苍术（米泔浸炒四钱） 白术
（去
芦四钱） 白茯苓（四钱） 砂仁（四钱） 草果仁（四钱） 木香（四钱） 沉香（二钱） 丁香（二
钱） 藿香（四钱） 良姜（四钱） 大腹皮（洗用四钱） 肉桂（四钱） 连翘（四钱） 商陆（白的
四钱） 黑丑（头末四钱） 僵蚕（三钱） 神曲（四钱） 麦芽（四钱） 益智仁（四钱） 雄附子
（五钱看病虚实实者不用）
上二十四味为末。面糊为丸。如梧桐子大。每服三四十丸。仍照前用之。第一。五更葱
白汤下。第二。五更陈皮汤下。第三。五更桑白皮汤下。
沉香化气丸 治蛊常服调理。
青皮 陈皮 三棱 莪术（煨） 人参 白术（去芦） 白茯苓 山药 砂仁 丁香 木香
沉香 槟榔 白豆蔻 石菖蒲（以上各用六钱） 官桂（一两） 萝卜子（二两） 黑丑（头末二
两八钱）
上为末。醋糊为丸。如梧子大。每服五六十丸。姜汤下。
一治前症服药忌盐醋。一百日之后。用药开盐法。
猪苓 泽泻 白术 白茯苓 肉桂 盐（各等分）
上锉。每用七钱。用鲫鱼一个。破肚去净肠杂。将前药入鱼肚内。加麝香少许。入瓦内
火焙黄色。存性为末。姜、枣汤调服。
一论腹胀紧硬如石。或阴囊肿大。先用甘草煎汤一钟。热服之后。即用此药敷之。
大戟 芫花 甘遂 海藻（各等分）
上为末。醋糊和药涂肿处。一加椒目。尤效。
按上诸方。治诸鼓胀肿满殊效。其中有病患气血虚。不敢服者。又有服之而不效者。此
皆
得病日久。或误投攻击药太过。以致脾胃元气虚损之极。宜服后诸方。实有起死回生之功也
一凡看蛊识症。一、朝肿暮消是阳蛊。二、朝消暮肿是阴蛊。三、腹上青筋起。气喘潮
热是
气蛊。四、四肢不收。无肉肚大。是食蛊。五、遍体肿。肚不胀。是翳油蛊。六、遍身潮热
是脾蛊。七、房室过多是肾蛊。八、泄泻潮热是肠蛊。九、衄望上下。大小便不通。是胃蛊
一论水肿。四肢头面皆浮。面肿或单腹鼓胀。皆属脾虚不能制水。气虚不能运化。治之
补元气。养心血。健脾胃。以培其本。清湿热。平肝木。利水道。以治其标。此药主之。
行湿补气养血汤
人参（二钱去芦） 陈皮（二钱） 当归（三钱） 川芎（一钱五分） 白芍（酒炒二钱） 白茯
苓
（三钱） 苏梗（一钱） 不油白术（一钱五分去芦） 川浓朴（姜炒八分） 大腹皮（三钱洗） 萝
卜子（三钱炒） 海金沙（三钱） 木香（八钱） 木通（二钱） 甘草（八分）
上锉。姜、枣煎服。气虚。倍参、苓、术。血虚。倍芎、归芍。小便短少。加猪苓、泽
泻
、滑石。以消其肿也。服后。肿胀俱退。惟面足不消。此阳明经气虚。倍用白术、茯苓。
一论单腹蛊胀。只宜补中行湿。利小便。切不可下。宜用
行湿补中汤
人参（二钱） 白术（麸炒二钱） 白茯苓（三钱） 苍术（米泔浸一钱五分） 陈皮（一钱五
分） 浓朴（姜炒一钱） 黄芩（二钱） 麦冬（去心二钱） 泽泻（二钱）
气不运。加木香八分。木通二钱。气下陷。加柴胡八分。升麻四分。朝宽暮急血虚。加
当归
三钱。川芎一钱五分。白芍炒二钱。香附二钱。黄连姜炒六分。去人参。朝急暮宽气虚。倍
参、术。朝暮急者。气血俱虚。宜双补之。
一论肿胀之症。因内伤而得者。或误服攻击克伐之剂。以致元气虚惫。脾胃伤损。肿胀
尤甚于前。此气血两虚。肾水干涸。用此方。以金匮肾气丸兼进。
加味补中益气汤
黄 （炒二钱） 人参（一钱） 白术（去芦炒二钱） 白茯苓（二钱） 陈皮（八分） 柴胡（
四分
）升麻（三分） 白芍（酒炒一钱五分） 当归（酒炒三钱） 萝卜子（炒三钱） 浓朴（姜炒一钱
）甘草（炙八分） 枳实（麸炒八分）
上锉一剂。生姜煎服。
一论脾肾虚。腰痛脚肿。小便不利。或肚腹胀痛。四肢浮肿。或喘急痰盛。已成蛊症。
其
效如神。此症多因脾肾虚弱。治失其宜。元气复伤而变症者。非此药不能救也。必以补中益
气汤。早晚兼济。可收全功矣。
金匮肾气丸
怀熟地黄（四两） 白茯苓（三两） 牛膝（去芦酒炒一两） 肉桂（一两） 泽泻（一两） 车
前
子（一两） 山萸肉（酒蒸去核一两） 山药（一两） 牡丹皮（一两） 大附子（炮去皮脐五钱）
上为细末。炼蜜为丸。如梧桐子大。每服百丸。空心。米饮送下。临卧时。服补中益气
汤。
一论单腹胀。及脾虚肿满。膈间闭塞。或胃口作痛。此补中有消之意也。
调中健脾丸
黄 （蜜炙二两） 人参（去芦二两） 白术（黄土拌炒六两） 白茯苓（二两） 陈皮（盐水
炒二
两） 半夏（泡七次三两半） 苍术（米泔浸炒二两） 黄连（吴茱萸浸水炒去茱萸二两半） 香
附（
童便浸炒三两） 白芍（炒三两半） 苏子（炒一两五钱） 萝卜子（炒一两半） 山楂肉（炒三两）
薏苡仁（炒三两） 沉香（六两另研） 泽泻（炒一两半） 五加皮（炒二两） 草豆蔻（酒炒一
两） 法制栝蒌（一两用大栝蒌二个镶一孔每个入川椒三钱多年粪 二钱敲米粒大外用棉纸糊
再加纸筋盐泥封固晒干炭火煨通红取出去泥要黑色一并入药）
上为细末。煎荷叶、大腹皮汤。打黄米糊丸。如梧桐子大。每服百丸。日进三服。白滚
汤送下。
上方法制栝蒌。多不便制。予每不用此味。亦护奇功。如有更妙。
按上诸方。治肿胀属虚。皆宜用此王道之剂。病者苦其肿胀难堪。予令朝服丸药。夕服
汤药
或三朝五日。间服蟠桃丸。或石干散一服。谓之下棋打劫而治。病者暂抒一时之宽。医者
一补一攻。亦善治之良法也。
一人脾胃虚弱。肚腹膨胀。遍身肿。按之成窠。其脉沉细。右寸为甚。此脾胃虚寒之症
治
以八味丸。或金匮肾气丸。以补肾阳。行生化之源。至暮服之。小便通。又数剂。肿消。即
止前药。复与六君子汤。加木香、官桂、炮姜。以燥脾导气而瘥。后因不戒慎。病作。但有
气恼。或饮食稍多。即泄泻。仍用八味丸。倍附子。
一儒者失于调养。饮食难化。胸膈不利。或用行气消导药。咳嗽喘促。服行气消导药。肚
腹
渐胀。服行气分利药。睡卧不能。两足浮肿。小便不利。大便不实。脉浮大。按之微细。两
寸皆短。此脾胃亏损。朝用补中益气加姜附。夕用金匮肾气加骨脂、肉果。各数剂。诸症渐
愈。再佐以八味丸。两月乃能步履。却服补中益气。半载而康。
水肿这一病症，有阴证和阳证之分。诊察时需要详细观察脉象、面色并询问症状。
阴证表现为：脉象沉迟，面色青白，口不渴且伴有腹泻，小便清长或涩滞。
阳证表现为：脉象可能沉数，面色赤黄，大便干燥结块，小便短赤，兼有口渴感。
蛊症（指严重的腹水鼓胀病）的大致分类主要有两种：单腹胀和双腹胀。
喘促气急，腹部胀满，身体肿胀而烦躁不安，四肢轻微肿胀，这是单腹胀。它是由内伤七情（喜、怒、忧、思、悲、恐、惊）引起的，见效较慢。
四肢浮肿，肚子大身体沉重，这是双腹胀。它是由外感风湿邪气引起的，见效很快。
又有水肿和气肿的区分。用手指按压肿胀部位，如果凹陷随即弹起，随起者为气肿，治疗必须先调理气机；如果按压后凹陷恢复缓慢，为水肿，只需使用导水药物即可迅速痊愈。
凡是四十岁以上的人，气血壮盛者，在服药见效后，若能善于自我调理，可终身不再复发。五十岁以后，气血稍衰，若调理不慎，病情可能会再次发作。此时此药仍能治疗，但如果反复发作多次治疗，导致元气耗损，那就难以治愈了。
脉象浮洪者易治，脉象沉细者难治。对于浮洪脉者，只需用金不换木香丸；对于沉细脉者，需兼用沉香快脾丸。
先服用木香流气饮。
【论述】诸气郁滞不通，胸膈部膨胀，口苦咽干，呕吐不能进食，或者肩背腹部胁肋部游走性刺痛，以及喘急痰嗽，面目虚浮，四肢肿满，大小便闭涩。又治疗因忧思过度导致的怔忡（心悸）、郁积，香港脚（脚气病）风湿，聚结肿痛，喘满胀急。此药能调顺营卫，流通血脉，通利三焦，安和五脏。凡治疗蛊胀，宜先用此方。
木香流气饮
配方：木香（七钱五分）、丁皮（七钱五分）、藿香（七钱五分）、半夏（汤泡五钱五分）、人参（五钱）、白术（去芦五钱）、赤茯苓（五钱）、浓朴（姜炒一两）、青皮（去穣二两）、陈皮（四两）、草果（七钱五分）、槟榔（七钱五分）、香附（二两）、紫苏（二两）、大腹皮（七钱五分）、木瓜（五钱）、白芷（五钱）、麦冬（去心五钱）、莪术（煨七钱五分）、肉桂（七钱半）、木通（一两）、石菖蒲（五钱）、甘草（一两）。
制法与服法：以上药材锉碎为一剂，加生姜三片、大枣二枚，用水一碗半，煎至七分，去渣，热服。本方加沉香、枳壳、大黄，去掉藿香、石菖蒲，名为二十四味流气饮。蛊肿加白豆蔻；肿满加黑牵牛；头面肿加葱白；肚腹肿加枳实，加倍青皮和陈皮；脐下至脚肿加桑白皮。
【论述】金不换木香丸是治疗蛊肿的神效药。先服用木香流气饮三五剂，同时加白豆蔻。接着用金不换木香丸。待收功后，用沉香化气丸进行调理。如果心头烦热，可用竹叶石膏汤；热甚加黄芩。前贤论述蛊肿之症，有五不治的情况：面色黑如炭，肚子大且有青筋暴露，手掌中无纹路，脚肿按之无坑，肚脐凸起。这五种症状也能治疗，间或有得救生还的。但如果排出败下的黑水则不治，性功能丧失（阳事不举）则不治。其余面色青黄红紫，都能治疗。又有一种症状，时肿时消，有时发生泄泻，知道是脾弱即泻，名叫“洪水横流”，服用此药适宜，其肿自消，其泻自止。忌食一切生冷毒物，油盐酱醋，鱼、鹅、鸭，房事等。没有不有效的。
金不换木香丸
配方：大戟（五钱）、芫花（炒五钱）、甘遂（五钱）、黑丑（头末二钱）、生大黄（五钱）、青皮（五钱）、陈皮（五钱）、南木香（五钱）、青木香（五钱）、胡椒（一钱，病重倍用）、川椒（去目五钱）、槟榔（五钱）、益智仁（五钱）、射干（三钱）、桑白皮（五钱）、苦葶苈（五钱炒）、大腹皮（五钱）、泽泻（五钱）、木通（去皮五钱）、连翘（五钱）、砂仁（五钱）、巴豆（去壳半生半熟五钱）。
制法与服法：以上二十二味药研为末，用醋煮面糊制成丸药，如梧桐子大。每次服五十丸，体质壮盛者加七八十丸。第一阶段消除头部及面部肿胀，五更初，用葱白酒送服；第二阶段消除中膈胸腹肿胀，五更初，用陈皮汤送服；第三阶段消除脐以下脚部肿胀，五更初，用桑白皮汤送服。
沉香快脾丸
配方：青皮（四钱）、陈皮（四钱）、三棱（煨四钱）、莪术（煨四钱）、苍术（米泔浸炒四钱）、白术（去芦四钱）、白茯苓（四钱）、砂仁（四钱）、草果仁（四钱）、木香（四钱）、沉香（二钱）、丁香（二钱）、藿香（四钱）、良姜（四钱）、大腹皮（洗用四钱）、肉桂（四钱）、连翘（四钱）、商陆（白的四钱）、黑丑（头末四钱）、僵蚕（三钱）、神曲（四钱）、麦芽（四钱）、益智仁（四钱）、雄附子（五钱，看病虚实，实证不用）。
制法与服法：以上二十四味药研为末，面糊为丸，如梧桐子大。每次服三四十丸，仍照前述方法服用。第一，五更时用葱白汤送下；第二，五更时用陈皮汤送下；第三，五更时用桑白皮汤送下。
沉香化气丸 治疗蛊胀常服以调理。
配方：青皮、陈皮、三棱、莪术（煨）、人参、白术（去芦）、白茯苓、山药、砂仁、丁香、木香、沉香、槟榔、白豆蔻、石菖蒲（以上各用六钱）、官桂（一两）、萝卜子（二两）、黑丑（头末二两八钱）。
制法与服法：以上研为末，醋糊为丸，如梧桐子大。每次服五六十丸，姜汤送下。
【治法】治疗上述病症服药期间忌盐醋。一百日之后，用药开盐法。
配方：猪苓、泽泻、白术、白茯苓、肉桂、盐（各等分）。
制法与服法：以上锉碎，每用七钱，取鲫鱼一个，破肚去净肠杂，将前药放入鱼肚内，加少许麝香，放入瓦器内火焙至黄色，存性为末，姜、枣汤调服。
【论述】腹胀紧硬如石头，或阴囊肿大。先用甘草煎汤一杯，热服之后，即用此药外敷。
配方：大戟、芫花、甘遂、海藻（各等分）。
制法与服法：以上研为末，醋糊和药涂于肿胀处。再加椒目，效果更佳。
按：上述各方，治疗各种鼓胀肿满殊为有效。其中有病患气血虚弱，不敢服用者；又有服用而不效者。这都是因为得病日久，或误投攻伐药太过，以致脾胃元气虚损至极。宜服用后述诸方，实有起死回生之功。
【识症】凡看蛊症识别症状：一、早晨肿傍晚消是阳蛊；二、早晨消傍晚肿是阴蛊；三、腹部青筋起，气喘潮热是气蛊；四、四肢不收，无肉肚大是食蛊；五、遍体肿，肚子不胀是翳油蛊；六、遍身潮热是脾蛊；七、房室过多是肾蛊；八、泄泻潮热是肠蛊；九、衄血望上下，大小便不通是胃蛊。
【论述】水肿，四肢头面皆浮肿，面肿或单腹鼓胀，都属脾虚不能制水，气虚不能运化。治疗应补元气，养心血，健脾胃，以培其本；清湿热，平肝木，利水道，以治其标。此药主治之。
行湿补气养血汤
配方：人参（二钱去芦）、陈皮（二钱）、当归（三钱）、川芎（一钱五分）、白芍（酒炒二钱）、白茯苓（三钱）、苏梗（一钱）、不油白术（一钱五分去芦）、川浓朴（姜炒八分）、大腹皮（三钱洗）、萝卜子（三钱炒）、海金沙（三钱）、木香（八钱）、木通（二钱）、甘草（八分）。
制法与服法：以上锉碎，姜、枣煎服。气虚，加倍人参、茯苓、白术；血虚，加倍川芎、当归、白芍。小便短少，加猪苓、泽泻、滑石，以消除肿胀。服后，肿胀俱退，惟面部足部不消，此为阳明经气虚，加倍用白术、茯苓。
【论述】单腹蛊胀，只宜补中行湿，利小便，切不可攻下。宜用行湿补中汤。
行湿补中汤
配方：人参（二钱）、白术（麸炒二钱）、白茯苓（三钱）、苍术（米泔浸一钱五分）、陈皮（一钱五分）、浓朴（姜炒一钱）、黄芩（二钱）、麦冬（去心二钱）、泽泻（二钱）。
加减法：气不运，加木香八分、木通二钱；气下陷，加柴胡八分、升麻四分；朝宽暮急血虚，加当归三钱、川芎一钱五分、白芍炒二钱、香附二钱、黄连姜炒六分，去人参；朝急暮宽气虚，倍用人参、白术；朝暮急者，气血俱虚，宜双补之。
【论述】肿胀之症，因内伤而得，或误服攻击克伐之剂，以致元气虚惫，脾胃伤损，肿胀尤甚于前。此为气血两虚，肾水干涸，用此方，以金匮肾气丸兼进。
加味补中益气汤
配方：黄芪（炒二钱）、人参（一钱）、白术（去芦炒二钱）、白茯苓（二钱）、陈皮（八分）、柴胡（四分）、升麻（三分）、白芍（酒炒一钱五分）、当归（酒炒三钱）、萝卜子（炒三钱）、浓朴（姜炒一钱）、甘草（炙八分）、枳实（麸炒八分）。
制法与服法：以上锉一剂，生姜煎服。
【论述】脾肾虚，腰痛脚肿，小便不利，或肚腹胀痛，四肢浮肿，或喘急痰盛，已成蛊症。其效如神。此症多因脾肾虚弱，治失其宜，元气复伤而变症者，非此药不能救也。必以补中益气汤，早晚兼济，可收全功矣。
金匮肾气丸
配方：怀熟地黄（四两）、白茯苓（三两）、牛膝（去芦酒炒一两）、肉桂（一两）、泽泻（一两）、车前子（一两）、山萸肉（酒蒸去核一两）、山药（一两）、牡丹皮（一两）、大附子（炮去皮脐五钱）。
制法与服法：以上为细末，炼蜜为丸，如梧桐子大。每次服百丸，空心，米饮送下。临卧时，服补中益气汤。
【论述】单腹胀，及脾虚肿满，膈间闭塞，或胃口作痛。此方含有补中有消之意。
调中健脾丸
配方：黄芪（蜜炙二两）、人参（去芦二两）、白术（黄土拌炒六两）、白茯苓（二两）、陈皮（盐水炒二两）、半夏（泡七次三两半）、苍术（米泔浸炒二两）、黄连（吴茱萸浸水炒去茱萸二两半）、香附（童便浸炒三两）、白芍（炒三两半）、苏子（炒一两五钱）、萝卜子（炒一两半）、山楂肉（炒三两）、薏苡仁（炒三两）、沉香（六两另研）、泽泻（炒一两半）、五加皮（炒二两）、草豆蔻（酒炒一两）、法制栝蒌（一两，用大栝蒌二个镶一孔，每个入川椒三钱、多年粪二钱，敲米粒大，外用棉纸糊再加纸筋盐泥封固晒干，炭火煨通红，取出去泥，要黑色，一并入药）。
制法与服法：以上为细末，煎荷叶、大腹皮汤，打黄米糊丸，如梧桐子大。每次服百丸，日进三服，白滚汤送下。
注：上述方法中的法制栝蒌，制作多不便，我平时不用此味，也有护奇功。如有更妙的方法更好。
按：上述各方，治疗肿胀属虚证，皆宜用此王道之剂。病人苦于肿胀难堪，我令其早晨服丸药，晚上服汤药，或三朝五日，间服蟠桃丸，或石干散一服，谓之下棋打劫而治。病人暂抒一时之宽，医者一补一攻，也是善治之良法也。
医案一：一人脾胃虚弱，肚腹膨胀，遍身肿，按之成窠，其脉沉细，右寸为甚。此为脾胃虚寒之症。治以八味丸，或金匮肾气丸，以补肾阳，行生化之源。至暮服之，小便通，又数剂，肿消，即止前药。复与六君子汤，加木香、官桂、炮姜，以燥脾导气而瘥。后因不戒慎，病作，但有气恼，或饮食稍多，即泄泻，仍用八味丸，倍附子。
医案二：一儒者失于调养，饮食难化，胸膈不利，或用行气消导药，咳嗽喘促。服行气消导药，肚腹渐胀。服行气分利药，睡卧不能，两足浮肿，小便不利，大便不实，脉浮大，按之微细，两寸皆短。此为脾胃亏损。朝用补中益气加姜附，夕用金匮肾气加骨脂、肉果，各数剂，诸症渐愈。再佐以八味丸，两月乃能步履。却服补中益气，半载而康。
Edema is a disease syndrome that can be classified into Yin and Yang types. Diagnosis requires detailed observation of the pulse, complexion, and inquiry into symptoms.
Yin type presents with: a deep and slow pulse (Chen Chi Mai), bluish-white complexion, no thirst accompanied by diarrhea, and clear or scanty urine.
Yang type presents with: a potentially deep and rapid pulse (Chen Shu Mai), reddish-yellow complexion, dry stool, dark urine, and concurrent thirst.
Edema causing shortness of breath and scanty urine; blood swelling causing abdominal fullness and cold limbs.
Gu Syndrome (referring to severe ascites and abdominal distension) is broadly categorized into two types: Single Abdominal Distension and Double Abdominal Distension.
Shortness of breath, abdominal fullness, body swelling with restlessness, and slight swelling of the four limbs indicate Single Abdominal Distension. This is caused by internal injury from the Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright), and takes effect slowly.
Swelling of the four limbs, large abdomen, and heavy body indicate Double Abdominal Distension. This is caused by external contraction of Wind-Dampness, and takes effect quickly.
There is also a distinction between Water Swelling and Qi Swelling. Pressing the swollen area with a finger: if the depression rebounds immediately, it is Qi Swelling, which requires regulating Qi first; if the depression recovers slowly, it is Water Swelling, which can be cured rapidly using water-draining methods.
For individuals over forty years old with robust Qi and Blood, if they manage their lifestyle well after treatment efficacy, they may never suffer recurrence in their lifetime. After fifty, when Qi and Blood decline slightly, improper management may lead to relapse. At this stage, the medicine can still treat the condition, but repeated relapses and treatments will deplete Yuan Qi (Original Qi), making it difficult to cure.
A floating and surging pulse (Fu Hong Mai) indicates an easy-to-treat case; a deep and fine pulse (Chen Xi Mai) indicates a difficult-to-treat case. For floating and surging pulses, use only Jin Bu Huan Mu Xiang Wan. For deep and fine pulses, combine with Chen Xiang Kuai Pi Wan.
First, administer Mu Xiang Liu Qi Yin.
[Discussion] Various Qi stagnations leading to blockage, chest and diaphragm distension, bitter taste in the mouth, dry throat, vomiting, and inability to eat, or wandering stabbing pain in the shoulders, back, abdomen, and hypochondrium, as well as shortness of breath and phlegm cough, puffy face and eyes, swollen limbs, and constipation/oliguria. It also treats palpitations and depression due to excessive worry/thoughts, Hong Kong Foot (Gout/Jock Itch/Foot Rot - here referring to Jiao Qi/Foot Rot) damp-heat, clustered swelling and pain, and distending fullness. This formula regulates Ying and Wei (Nutritive and Defensive Qi), unblocks blood vessels, promotes San Jiao (Triple Burner) flow, and harmonizes the Five Zang Organs. For treating Gu Distension, this formula should be used first.
Mu Xiang Liu Qi Yin
Ingredients: Mu Xiang (7.5 qian), Ding Pi (7.5 qian), Huo Xiang (7.5 qian), Ban Xia (soaked in boiling water, 5.5 qian), Ren Shen (5 qian), Bai Zhu (deprived of rhizome, 5 qian), Chi Fu Ling (5 qian), Nong Po (stir-fried with ginger, 1 liang), Qing Pi (deprived of albedo, 2 liang), Chen Pi (4 liang), Cao Guo (7.5 qian), Bing Lang (7.5 qian), Xiang Fu (2 liang), Zi Su (2 liang), Da Fu Pi (7.5 qian), Mu Gua (5 qian), Bai Zhi (5 qian), Mai Dong (deprived of heart, 5 qian), E Zhu (roasted, 7.5 qian), Rou Gui (7.5 qian), Mu Tong (1 liang), Shi Chang Pu (5 qian), Gan Cao (1 liang).
Preparation and Administration: Coarsely crush the above ingredients for one dose. Add 3 slices of fresh ginger and 2 jujubes. Decoct with 1.5 bowls of water until reduced to 0.7 bowl. Strain and take hot. Adding Chen Xiang, Zhi Ke, and Da Huang to this formula, while removing Huo Xiang and Shi Chang Pu, creates Er Shi Si Wei Liu Qi Yin. Add Bai Dou Kou for Gu swelling; add Hei Qian Niu for general swelling; add Cong Bai for facial/head swelling; add Zhi Shi for abdominal swelling, doubling Qing Pi and Chen Pi; add Sang Bai Pi for swelling from navel to feet.
[Discussion] Jin Bu Huan Mu Xiang Wan is a miraculous medicine for treating Gu swelling. First, take Mu Xiang Liu Qi Yin for 3-5 doses, adding Bai Dou Kou. Then use Jin Bu Huan Mu Xiang Wan. After recovery, regulate with Chen Xiang Hua Qi Wan. If there is mental heat/restlessness, use Zhu Ye Shi Gao Tang; add Huang Qin if heat is severe. Ancients stated five untreatable conditions for Gu swelling: face black as charcoal, large abdomen with exposed veins, no palm lines, foot swelling without pits, and protruding umbilicus. These five conditions can sometimes be treated, with occasional survival. However, discharge of black foul water is untreatable, and impotence (Yang Shi Bu Ju) is untreatable. Other complexions (blue, yellow, red, purple) are treatable. Another symptom is intermittent swelling and reduction, or diarrhea triggered by spleen weakness, named "Flood Overflowing." Taking this medicine is suitable; swelling subsides, diarrhea stops. Avoid all raw/cold/toxic foods, salt, oil, soy sauce, vinegar, fish, goose, duck, and sexual activity. No ineffectiveness expected.
Jin Bu Huan Mu Xiang Wan
Ingredients: Da Ji (5 qian), Yuan Hua (stir-fried, 5 qian), Gan Sui (5 qian), Hei Chou (first powder, 2 qian), Sheng Da Huang (5 qian), Qing Pi (5 qian), Chen Pi (5 qian), Nan Mu Xiang (5 qian), Qing Mu Xiang (5 qian), Hu Jiao (1 qian, double for severe cases), Chuan Jiao (deprived of eyes, 5 qian), Bing Lang (5 qian), Yi Zhi Ren (5 qian), She Gan (3 qian), Sang Bai Pi (5 qian), Ku Ting Li (stir-fried, 5 qian), Da Fu Pi (5 qian), Ze Xie (5 qian), Mu Tong (peeled, 5 qian), Lian Qiao (5 qian), Sha Ren (5 qian), Ba Dou (deprived of shell, half raw half cooked, 5 qian).
Preparation and Administration: Grind the above 22 ingredients into powder. Make pills using vinegar-boiled wheat paste, size of wutong seeds. Take 50 pills per dose, 70-80 for robust individuals. Phase 1: Eliminate head/facial swelling. Take at dawn (5 AM) with green onion and white wine. Phase 2: Eliminate middle chest/abdominal swelling. Take at dawn with Chen Pi decoction. Phase 3: Eliminate swelling below navel to feet. Take at dawn with Sang Bai Pi decoction.
Chen Xiang Kuai Pi Wan
Ingredients: Qing Pi (4 qian), Chen Pi (4 qian), San Leng (roasted, 4 qian), E Zhu (roasted, 4 qian), Cang Zhu (soaked in rice wash water and stir-fried, 4 qian), Bai Zhu (deprived of rhizome, 4 qian), Bai Fu Ling (4 qian), Sha Ren (4 qian), Cao Guo Ren (4 qian), Mu Xiang (4 qian), Chen Xiang (2 qian), Ding Xiang (2 qian), Huo Xiang (4 qian), Liang Jiang (4 qian), Da Fu Pi (washed, 4 qian), Rou Gui (4 qian), Lian Qiao (4 qian), Shang Lu (white, 4 qian), Hei Chou (first powder, 4 qian), Jiang Can (3 qian), Shen Qu (4 qian), Mai Ya (4 qian), Yi Zhi Ren (4 qian), Xiong Fu Zi (5 qian, do not use for excess patterns).
Preparation and Administration: Grind the above 24 ingredients into powder. Make pills using wheat paste, size of wutong seeds. Take 30-40 pills per dose. Follow previous administration methods: 1. Dawn with green onion decoction; 2. Dawn with Chen Pi decoction; 3. Dawn with Sang Bai Pi decoction.
Chen Xiang Hua Qi Wan Used for long-term regulation of Gu Distension.
Ingredients: Qing Pi, Chen Pi, San Leng, E Zhu (roasted), Ren Shen, Bai Zhu (deprived of rhizome), Bai Fu Ling, Shan Yao, Sha Ren, Ding Xiang, Mu Xiang, Chen Xiang, Bing Lang, Bai Dou Kou, Shi Chang Pu (each 6 qian), Guan Gui (1 liang), Luo Bo Zi (2 liang), Hei Chou (first powder, 2 liang 8 qian).
Preparation and Administration: Grind into powder. Make pills using vinegar paste, size of wutong seeds. Take 50-60 pills per dose with ginger decoction.
[Treatment] During medication for the above conditions, avoid salt and vinegar. After 100 days, use the Salt-Opening Method.
Ingredients: Zhu Ling, Ze Xie, Bai Zhu, Bai Fu Ling, Rou Gui, Salt (equal parts).
Preparation and Administration: Coarsely crush. Use 7 qian per dose. Take one crucian carp, gut thoroughly. Place the herbs inside the fish belly, add a little Moschus (She Xiang). Roast in a clay vessel until yellow, preserving the nature. Grind into powder. Take with ginger and jujube decoction.
[Discussion] Abdominal distension hard as stone, or scrotal swelling. First, drink one cup of Gan Cao decoction hot. Immediately apply this medicine externally.
Ingredients: Da Ji, Yuan Hua, Gan Sui, Hai Zao (equal parts).
Preparation and Administration: Grind into powder. Mix with vinegar paste and apply to swollen areas. Adding Jiao Mu increases efficacy.
Note: The above formulas are highly effective for various distensions and swellings. Some patients with deficient Qi and Blood dare not take them; others show no effect. This is because the disease has lasted long, or excessive attack/draining medicines were misused, severely damaging Spleen-Stomach Yuan Qi. The following formulas should be used, possessing the power to revive the dying.
[Symptom Identification] Recognizing Gu Syndromes: 1. Morning swelling, evening reduction is Yang Gu. 2. Morning reduction, evening swelling is Yin Gu. 3. Abdominal blue veins, asthma, tidal fever is Qi Gu. 4. Limbs unable to move, flesh wasting, large belly is Food Gu. 5. Whole body swelling, non-distended belly is Yi You Gu. 6. Whole body tidal fever is Spleen Gu. 7. Excessive sexual activity is Kidney Gu. 8. Diarrhea with tidal fever is Intestine Gu. 9. Epistaxis looking up/down, obstruction of urination and defecation is Stomach Gu.
[Discussion] Edema affecting limbs and face, or isolated abdominal distension, belongs to Spleen deficiency failing to control water, and Qi deficiency failing to transform. Treatment should tonify Yuan Qi, nourish Heart Blood, strengthen Spleen and Stomach to cultivate the root; clear Damp-Heat, soothe Liver Wood, promote Urinary Dao to treat the branch. This medicine governs it.
Xing Shi Bu Qi Yang Xue Tang
Ingredients: Ren Shen (2 qian, deprived of rhizome), Chen Pi (2 qian), Dang Gui (3 qian), Chuan Xiong (1.5 qian), Bai Shao (wine-stir-fried, 2 qian), Bai Fu Ling (3 qian), Su Geng (1 qian), Bu You Bai Zhu (1.5 qian, deprived of rhizome), Chuan Nong Po (ginger-stir-fried, 0.8 qian), Da Fu Pi (washed, 3 qian), Luo Bo Zi (stir-fried, 3 qian), Hai Jin Sha (3 qian), Mu Xiang (0.8 qian), Mu Tong (2 qian), Gan Cao (0.8 qian).
Preparation and Administration: Coarsely crush. Decoct with ginger and jujube. For Qi deficiency, double Ren Shen, Fu Ling, Bai Zhu. For Blood deficiency, double Chuan Xiong, Dang Gui, Bai Shao. For scanty urine, add Zhu Ling, Ze Xie, Hua Shi to reduce swelling. After taking, swelling subsides, but face and feet remain swollen, indicating Yangming Meridian Qi deficiency; double Bai Zhu and Fu Ling.
[Discussion] Single abdominal Gu distension should only be treated by tonifying the middle and draining dampness, promoting urination. Purging must be avoided. Use Xing Shi Bu Zhong Tang.
Xing Shi Bu Zhong Tang
Ingredients: Ren Shen (2 qian), Bai Zhu (bran-stir-fried, 2 qian), Bai Fu Ling (3 qian), Cang Zhu (rice wash soaked, 1.5 qian), Chen Pi (1.5 qian), Nong Po (ginger-stir-fried, 1 qian), Huang Qin (2 qian), Mai Dong (deprived of heart, 2 qian), Ze Xie (2 qian).
Modifications: For stagnant Qi, add Mu Xiang (0.8 qian), Mu Tong (2 qian); for sinking Qi, add Chai Hu (0.8 qian), Sheng Ma (0.4 qian); for morning relief/evening aggravation (Blood deficiency), add Dang Gui (3 qian), Chuan Xiong (1.5 qian), Bai Shao (stir-fried, 2 qian), Xiang Fu (2 qian), Huang Lian (ginger-stir-fried, 0.6 qian), remove Ren Shen; for morning aggravation/evening relief (Qi deficiency), double Ren Shen and Bai Zhu; for both morning and evening aggravation, both Qi and Blood are deficient, use dual tonification.
[Discussion] Swelling due to internal injury, or misusing attacking/draining agents, leading to exhausted Yuan Qi and damaged Spleen/Stomach, resulting in worse swelling. This is dual Qi-Blood deficiency and dried-up Kidney Water. Use this formula, combined with Jin Gui Shen Qi Wan.
Jia Wei Bu Zhong Yi Qi Tang
Ingredients: Huang Qi (stir-fried, 2 qian), Ren Shen (1 qian), Bai Zhu (deprived of rhizome, stir-fried, 2 qian), Bai Fu Ling (2 qian), Chen Pi (0.8 qian), Chai Hu (0.4 qian), Sheng Ma (0.3 qian), Bai Shao (wine-stir-fried, 1.5 qian), Dang Gui (wine-stir-fried, 3 qian), Luo Bo Zi (stir-fried, 3 qian), Nong Po (ginger-stir-fried, 1 qian), Gan Cao (honey-roasted, 0.8 qian), Zhi Shi (bran-stir-fried, 0.8 qian).
Preparation and Administration: Coarsely crush one dose. Decoct with fresh ginger.
[Discussion] Spleen-Kidney deficiency, lower back pain, foot swelling, difficulty urinating, or abdominal pain, limb edema, or asthma with profuse phlegm, progressing to Gu syndrome. Effect is miraculous. This condition often arises from Spleen-Kidney weakness, improper treatment, and secondary damage to Yuan Qi. Only this medicine can save it. Must combine Bu Zhong Yi Qi Tang morning and evening for full effect.
Jin Gui Shen Qi Wan
Ingredients: Huai Shu Di Huang (4 liang), Bai Fu Ling (3 liang), Niu Xi (deprived of rhizome, wine-stir-fried, 1 liang), Rou Gui (1 liang), Ze Xie (1 liang), Che Qian Zi (1 liang), Shan Yu Rou (wine-steamed, pitted, 1 liang), Shan Yao (1 liang), Mu Dan Pi (1 liang), Da Fu Zi (roasted, skin/navel removed, 5 qian).
Preparation and Administration: Grind into fine powder. Make pills with refined honey, size of wutong seeds. Take 100 pills per dose on an empty stomach with rice drink. Take Bu Zhong Yi Qi Tang before sleep.
[Discussion] Single abdominal distension, Spleen deficiency swelling/fullness, diaphragmatic blockage, or epigastric pain. This formula embodies the principle of tonifying while resolving.
Tiao Zhong Jian Pi Wan
Ingredients: Huang Qi (honey-roasted, 2 liang), Ren Shen (deprived of rhizome, 2 liang), Bai Zhu (soil-mixed stir-fried, 6 liang), Bai Fu Ling (2 liang), Chen Pi (salt-water stir-fried, 2 liang), Ban Xia (soaked seven times, 3.5 liang), Cang Zhu (rice wash stir-fried, 2 liang), Huang Lian (immersed in Wu Zhu Yu water, stir-fried, remove Wu Zhu Yu, 2.5 liang), Xiang Fu (immersed in child's urine, stir-fried, 3 liang), Bai Shao (stir-fried, 3.5 liang), Su Zi (stir-fried, 1.5 liang), Luo Bo Zi (stir-fried, 1.5 liang), Shan Zha Rou (stir-fried, 3 liang), Yi Yi Ren (stir-fried, 3 liang), Chen Xiang (6 liang, separately ground), Ze Xie (stir-fried, 1.5 liang), Wu Jia Pi (stir-fried, 2 liang), Cao Dou Kou (wine-stir-fried, 1 liang), Fa Zhi Gua Lou (1 liang: use two large Gua Lou, make a hole in each, insert 3 qian Chuan Jiao and 2 qian aged feces, break into rice-grain size, wrap in cotton paper then paper-clay-salt mud, dry, roast in charcoal fire until red, remove mud, keep black, mix into medicine).
Preparation and Administration: Grind into fine powder. Decoct He Ye and Da Fu Pi, mix with millet paste to make pills, size of wutong seeds. Take 100 pills per dose, three times daily, with plain boiled water.
Note: The preparation of Fa Zhi Gua Lou is inconvenient; I usually omit it and still achieve miraculous results. Better methods are welcome.
Note: The above formulas treat deficiency-type swelling/distension using "Kingly" (gentle/sustained) methods. Patients suffer unbearable swelling. I prescribe pill medicine in the morning and decoction in the evening, or every 3-5 days, alternate with Pan Tao Wan or Shi Gan San. This is called "Chess-like Attack and Defense" treatment. The patient gets temporary relief; the doctor alternates tonification and attack, which is a good method.
Case 1: A person with weak Spleen-Stomach, abdominal distension, whole-body swelling leaving pits upon pressure, deep fine pulse, especially strong at Right Cun. This is Spleen-Stomach Deficiency-Cold. Treat with Ba Wei Wan or Jin Gui Shen Qi Wan to tonify Kidney Yang and activate the source of transformation. Take in the evening. Once urination flows, continue several doses until swelling subsides, then stop. Switch to Liu Jun Zi Tang, adding Mu Xiang, Guan Gui, Pao Jiang to dry Spleen and guide Qi to recover. Later, due to lack of caution, illness returned with anger or slight overeating leading to diarrhea. Still use Ba Wei Wan, doubling Fu Zi.
Case 2: A scholar neglected health, food indigestion, chest discomfort. Used Qi-moving and digestion-promoting drugs, leading to cough and asthma. Continued Qi-moving drugs led to gradual abdominal distension. Used Qi-moving and diuretic drugs, leading to inability to sleep, bilateral foot edema, oliguria, loose stools, floating large pulse, fine upon pressure, short at both Cuns. This is Spleen-Stomach damage. Morning: Bu Zhong Yi Qi Tang plus Jiang (Ginger) and Fu Zi. Evening: Jin Gui Shen Qi Wan plus Gu Zhi (Cibotium) and Rou Guo (Myristica). Several doses each, symptoms gradually improved. Assisted by Ba Wei Wan, able to walk after two months. Continued Bu Zhong Yi Qi Tang, recovered after half a year.