经曰∶肤胀者，寒气客于皮肤之间，腹大，身尽肿，皮浓，按之 而不起，腹色不变，此其候也。又曰∶
诸湿肿满，皆属于脾。又曰∶水病下为 肿腹大，上为喘呼，不得卧者，标本俱病。夫肿满之证，悉由脾胃之
虚也。脾土喜燥而恶湿。因中气素弱，脾虚无火，故水湿得以乘之，而脾愈不运，则乳食凝而不化，停积于中，
而肿满作焉。治肿者，当以脾胃为本，而以浮肿为标，斯庶几矣。若以消伐克削为能事，未有不致危殆者。
治肿当分上下，经曰∶面肿者风，足肿者湿。凡肿自下而起者，皆因于风，其治在肺，宜发散之，参苏饮
合五皮汤。肿自下而起者，因于肾虚水泛，或因于脾气受湿，宜渗利之。故仲景云∶治湿不利小便，非其治
也。宜五苓散加防己、槟榔。
一身尽肿者，或胎禀不足，卒冒风寒，或因疟痢脾虚，皆能作肿。轻者胃苓丸，重者加味胃苓丸，当与末
条参考。
凡小儿之肿在表者，头痛身热，此风寒在表。宜微汗之，五苓散少加麻黄、葛根、苏叶、杏仁以发之。若
身无热，五苓散加肉桂，膀胱气化，小便利而肿消矣。
阳水肿，身热，大便秘，小便赤涩，烦躁口渴，以五皮汤作煎，送沆瀣丹微下之；阴水肿，身不热，口不
渴，身冷怯寒，二便自调，平胃散加白茯苓、草果、木香、藿香。
凡肿证先起于腹，而散于四肢者可治；先
起于四肢，后归于腹者不可治。
若小儿元气本虚，复遇大病之后，而浑身浮肿，四肢冷，不渴，小便清长，大便滑泄，不思饮食。此阴寒
之极，脾胃将绝，治肿之方俱不可用，惟以四君子汤加青化桂、炮姜、砂仁、白蔻，以救其脾胃，斯可矣。昧
者但见其肿，不知元气之竭绝，而犹消导利水，复以舟车、禹功暨大戟、芫花、甘遂劫夺之者。此杀人之事，
慎之戒之！
《黄帝内经》说：肤胀这种病证，是寒气侵袭在皮肤之间，导致腹部胀大，全身浮肿，皮肤厚实，按压后凹陷不起，腹部颜色没有变化，这就是它的征候。又说：各种湿邪导致的肿胀和腹满，都归属于脾脏病变。还说：水气病在下表现为足肿和腹大，在上表现为气喘呼叫、不能平卧的，这是本（肾）标（肺/脾）俱病。
凡是肿胀和腹满的病证，全都是由脾胃虚弱引起的。脾土喜欢干燥而厌恶潮湿。因为中气原本虚弱，脾虚且无火（阳气不足），所以水湿得以乘虚而入，导致脾运化功能更加停滞，致使乳食凝结而不能消化，停积在中焦，从而产生肿胀和腹满。治疗肿胀，应当以调理脾胃为本，而以消除浮肿为标，这样才差不多。如果只把攻伐消导作为能事，没有不导致危险情况的。
治疗肿胀应当区分上下部位，《内经》说：面部浮肿多因风邪，足部浮肿多因湿邪。凡是从下部开始肿起的，都是由于风邪所致，治疗重点在肺，适宜用发散法，可用参苏饮合五皮汤。如果是从下部开始肿起，是由于肾虚水泛，或者是脾气受湿，适宜用渗利法。所以张仲景说：治疗湿邪如果不通利小便，就不是正确的治法。适宜用五苓散加防己、槟榔。
全身都浮肿的，可能是胎禀不足，突然冒受风寒，或者是因为疟疾、痢疾导致脾虚，都能引起肿胀。轻症用胃苓丸，重症用加味胃苓丸，应当与文末条款参考对照。
凡是小儿体表浮肿，伴有头痛、身热的，这是风寒在表。适宜用微汗法，在五苓散中少加麻黄、葛根、苏叶、杏仁来发汗解表。如果身体没有发热，用五苓散加肉桂，促进膀胱气化，小便利则肿胀消退。
阳水型水肿，表现为身热、大便秘结、小便赤涩、烦躁口渴，用五皮汤煎煮送服沆瀣丹轻微泻下；阴水型水肿，表现为身不热、口不渴、身体寒冷怕冷、二便正常，用平胃散加白茯苓、草果、木香、藿香。
凡是肿胀病证，先从腹部开始，然后消散到四肢的，可以治愈；先从四肢开始，后来汇聚到腹部的，不可治愈。
如果小儿元气本来虚弱，又遭遇大病之后，出现浑身浮肿、四肢冰冷、不口渴、小便清长、大便滑泄、不想吃东西。这是阴寒到了极点，脾胃之气即将断绝，所有治疗肿胀的方剂都不适用，只能用四君子汤加青化桂、炮姜、砂仁、白蔻，来挽救脾胃之气，才可以。愚昧的医者只见其肿胀，不知道元气已经竭绝，仍然使用消导利水的方法，甚至再用舟车丸、禹功散以及大戟、芫花、甘遂等峻烈药物劫夺正气。这是杀人的行为，务必谨慎戒除！
The *Classic of Internal Medicine* states: In the condition of skin distension (Fu Zhang), cold pathogenic factors invade between the skin and muscles, resulting in abdominal enlargement and generalized edema. The skin is thick; upon pressure, the depression does not rise immediately, and the abdominal color remains unchanged. This is its clinical presentation. It further states: All swellings and fullnesses caused by dampness belong to the Spleen. It also states: Water diseases manifesting as lower limb edema and abdominal distension, accompanied by upper respiratory symptoms such as wheezing, gasping, and inability to lie flat, indicate simultaneous involvement of both the root (Kidney) and branch (Lung/Spleen).
All cases of swelling and abdominal distension are fundamentally due to deficiency of the Spleen and Stomach. Earth of the Spleen prefers dryness and dislikes dampness. Due to inherent weakness of the Middle Qi, Spleen deficiency with lack of Fire (Yang energy), water-dampness takes advantage of this vulnerability. Consequently, Spleen transportation becomes stagnant, causing milk and food to congeal and fail to digest, accumulating in the Middle Jiao, thereby generating swelling and distension. When treating swelling, one must take regulating the Spleen and Stomach as the root treatment, while addressing edema as the branch treatment. Only then can success be expected. If one merely relies on purgative and draining methods, it inevitably leads to critical danger.
Treatment of swelling should distinguish between upper and lower locations. The *Classic* states: Facial edema is due to Wind; foot edema is due to Dampness. Swelling originating from below is generally due to Wind pathogen; the treatment focuses on the Lung, employing dispersing methods, such as Shen Su Yin combined with Wu Pi Tang. Swelling originating from below may also result from Kidney deficiency leading to water overflowing, or Spleen Qi being affected by dampness; these require permeating and draining methods. Thus, Zhang Zhongjing stated: Treating dampness without promoting urination is not the correct approach. One should use Wu Ling San added with Fang Ji and Bing Lang.
Generalized edema may arise from insufficient congenital endowment followed by sudden exposure to Wind-Cold, or from Spleen deficiency due to malaria or dysentery, all of which can cause swelling. For mild cases, Wei Ling Wan is used; for severe cases, Jia Wei Wei Ling Wan is employed. Refer to the items at the end of the text for comparison.
When pediatric edema is located in the exterior, accompanied by headache and fever, this indicates Wind-Cold in the exterior. Mild diaphoresis is indicated; add small amounts of Ma Huang, Ge Gen, Su Ye, and Xing Ren to Wu Ling San to induce sweating. If there is no fever, use Wu Ling San added with Rou Gui to promote Bladder Qi transformation; once urination becomes smooth, the edema will subside.
For Yang-type water edema, characterized by fever, constipation, dark and scanty urine, irritability, and thirst, decoct Wu Pi Tang and administer Hang Xie Dan orally to induce mild purgation. For Yin-type water edema, characterized by absence of fever, no thirst, cold body aversion to cold, and normal bowel and bladder movements, use Ping Wei San added with Bai Fu Ling, Cao Guo, Mu Xiang, and Huo Xiang.
In edema conditions, if swelling starts in the abdomen and dissipates to the limbs, it is treatable. If swelling starts in the limbs and later converges into the abdomen, it is untreatable.
If a child has inherently deficient Yuan Qi and subsequently suffers from generalized edema, cold limbs, absence of thirst, clear and profuse urination, loose stools, and anorexia after a severe illness, this indicates extreme Yin-Cold and impending exhaustion of Spleen and Stomach Qi. All formulas for treating swelling are contraindicated. Instead, Si Jun Zi Tang added with Qing Hua Gui, Pao Jiang, Sha Ren, and Bai Kou should be used to rescue the Spleen and Stomach. Ignorant physicians, seeing only the edema but unaware of the exhaustion of Yuan Qi, still employ digestive and diuretic methods, or even use drastic drugs like Zhou Che Wan, Yu Gong San, Da Ji, Yuan Hua, and Gan Sui to rob the righteous Qi. This is akin to murder; one must be cautious and beware!