经曰∶至阴者，肾水也，少阴者，冬脉也，其本在肾，其末在肺，皆积水也。又曰∶肾者，胃之关
也。关门不利，故聚水而从其类也，上下溢于皮肤，故 肿腹大，上为喘呼不得卧者，标本俱病也。丹
溪云∶惟肾虚不能行水，脾虚不能制水，胃与脾合，又胃为水谷之海，因虚而不能传化，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，目胞上下微起，肢
体重着，喘咳怔忡，股间清冷，小便涩黄，皮薄而光，手按成窟，举手即满是也。古方有十种论证，又有
湿气、毒瓦斯、伤寒后、泻痢后、气血虚者之五种，及疳气、症积、锁肚、胸膈作膨、蛔、气虚、冷积者
之七胀，亦当详之。其受湿气者，由脾胃之气敦阜，四肢头面皆肿也。食毒者，脾伤积毒，停留于胃也。
伤寒下早者，邪气乘虚而入也。泻痢后者，脾气虚也。皆宜先调胃气，吹可治肿。其患七胀，皆
由血气不足，脏腑怯弱，表里俱虚，邪正相乱，以致四肢浮肿，腹肚膨满，亦当先调荣卫，分别阴阳，治
法宜补中、行湿、利小便。凡有热者，水气在表也，可汗之。身无热者，水气在里也，宜下之。腰以上肿，
宜利小便，腰以下肿，宜发汗，此仲景之法也。若遍身肿，烦渴，小便赤涩，大便秘结，此属阳水；遍身
肿，不渴，大
便溏泄，小便清利，此属阴水；阳水兼阳证者，脉必浮数，阴水兼阴证者，脉必沉迟，气若陷下，宜用二
陈加升提之药，如腹胀，少加木香调之。若朝宽暮急属阴虚，朝用四物汤加参术，夕用加减肾气丸。朝急
暮宽属阳虚，朝用六君子汤，夕用加减肾气丸。朝暮皆急阴阳俱虚也，用八珍汤主之。真阳虚者朝用八味地
黄丸，夕用补中益气汤。若肚腹痞满，肢体肿胀，手足并冷，饮食难化，或大便泄泻，呼吸气冷者，
此真阳衰败，脾肺肾虚寒不能司摄，而水泛行也，急用加减肾气丸，否则不治，惟调补脾土，多有生者。
《金匮》加减肾气丸
熟地黄（八两） 干山药 山茱萸（各四两） 泽泻 白茯苓 牡丹皮（各三两） 肉桂 附子（炮
）车前子（炒） 牛膝（酒微炒。各一两）
上，各另为末，米糊丸，小豆大。每服三四十丸，空心食前，白汤下。
《黄帝内经》中说：至阴，指的是肾水；少阴，是冬季的脉象。其根本在肾，其标末在肺，都是由于水液停聚所致。又说：肾，是胃的关口。如果这个关口功能失常，就会导致水液积聚并遵循同类相从的规律，向上向下溢于皮肤，所以出现浮肿、腹部胀大；如果上逆导致气喘呼叫、不能平卧，这就是标本俱病。
朱丹溪说：只有肾虚不能运化水液，脾虚不能制约水液。胃与脾相合，且胃为水谷之海，因为虚弱而不能传输转化，导致肾水泛滥，反过来浸渍脾土，于是三焦停滞，经络壅塞，水液渗入皮肤，注入肌肉而引发浮肿。其症状表现为：眼睑上下微微隆起，肢体沉重，气喘咳嗽、心悸怔忡，大腿内侧清冷，小便涩滞发黄，皮肤薄而光亮，用手按压出现凹陷，抬手后凹陷立即恢复。
古代方书有十种水肿的论证，又有湿气、毒瓦斯、伤寒后、泻痢后、气血虚者这五种情况，以及疳气、症积、锁肚、胸膈作膨、蛔虫、气虚、冷积这七种胀病，也都应当详细辨析。其中受湿气影响的，是由于脾胃之气敦厚壅盛，导致四肢和头面都浮肿。食毒引起的，是脾脏受伤积存毒素，停留在胃中。伤寒过早使用下法导致的，是邪气乘虚而入。泻痢之后出现的，是脾气虚弱。这些情况都应当先调理胃气，才可以治疗水肿。
那些患有七种胀病的，都是由血气不足，脏腑怯弱，表里俱虚，邪气与正气相互混乱，导致四肢浮肿，腹部膨满，也应当先调理营卫，辨别阴阳，治疗方法宜用补中益气、行湿利小便。凡是有热象的，说明水气在体表，可以用发汗法。身体没有热象的，说明水气在体内，可以用攻下法。腰部以上浮肿，宜用利小便的方法；腰部以下浮肿，宜用发汗的方法，这是张仲景的治疗方法。
如果遍身浮肿，心烦口渴，小便赤黄涩痛，大便秘结，这属于阳水；如果遍身浮肿，不口渴，大便溏泄，小便清长通利，这属于阴水；阳水兼见阳证者，脉象必定浮数；阴水兼见阴证者，脉象必定沉迟。如果气机陷下，宜用二陈汤加入升提的药物，如腹胀，稍加木香来调顺气机。如果是早晨缓解傍晚加重，属于阴虚，早晨服用四物汤加入人参、白术，晚上服用加减肾气丸。如果是早晨加重傍晚缓解，属于阳虚，早晨服用六君子汤，晚上服用加减肾气丸。早晚都加重，属于阴阳俱虚，用八珍汤主治。如果是真阳虚衰，早晨服用八味地黄丸，晚上服用补中益气汤。
如果出现肚腹痞满，肢体肿胀，手脚冰凉，饮食难以消化，或者大便泄泻，呼吸气息寒冷，这是真阳衰败，脾肺肾虚寒不能固摄，导致水液泛滥流行，急用加减肾气丸，否则无法治愈，只有调补脾土，才多有生机。
《金匮要略》加减肾气丸配方：熟地黄（八两）、干山药、山茱萸（各四两）、泽泻、白茯苓、牡丹皮（各三两）、肉桂、附子（炮制）、车前子（炒制）、牛膝（酒微炒制）（各一两）。
以上药材，分别研为细末，用米糊做丸，如小豆大小。每次服用三四十丸，空腹饭前，用白开水送服。
The *Yellow Emperor's Inner Canon* states: "Zhiyin" refers to Kidney Water; Shaoyin is the pulse of winter. Its root lies in the Kidney, its branch in the Lung, and both involve fluid accumulation. It also states: The Kidney is the gate of the Stomach. If this gate functions improperly, water accumulates and follows the principle of like attracting like, overflowing upward and downward into the skin, resulting in edema and abdominal distension. If it reverses upward causing panting, calling out, and inability to lie flat, this indicates disease in both the root (Ben) and the branch (Biao).
Zhu Danxi said: Only when Kidney deficiency fails to transform water, and Spleen deficiency fails to control water, does pathology arise. The Stomach combines with the Spleen, and the Stomach is the sea of water and grain. Due to deficiency, it fails to transport and transform, causing Kidney water to flood and soak the Spleen Earth. Consequently, the Sanjiao (Triple Burner) stagnates, meridians become blocked, water seeps into the skin, pours into muscles, and causes edema. The manifestations include slight swelling above and below the eyelids, heaviness of the limbs, panting, cough, palpitations, coldness in the groin area, scanty yellow urine, thin and shiny skin, pitting upon pressure that rebounds immediately upon lifting the hand.
Ancient formularies discuss ten types of edema, as well as five conditions caused by dampness, toxic vapors, post-typhoid fever, post-dysentery, and Qi-Blood deficiency. Additionally, seven types of distension—such as those due to malnutrition (Gan Qi), mass accumulation (Zheng Ji), locked abdomen (Suo Du), chest/diaphragm bloating, roundworms, Qi deficiency, and cold accumulation—should also be carefully differentiated. Those affected by dampness suffer from excessive accumulation of Spleen-Stomach Qi, leading to edema in the four limbs and head/face. Those suffering from food toxicity have a damaged Spleen accumulating toxins retained in the Stomach. In typhoid cases treated too early with purgatives, pathogenic factors enter due to deficiency. Post-dysentery cases involve Spleen Qi deficiency. All these should first regulate Stomach Qi before treating edema.
Those suffering from the seven types of distension are caused by insufficiency of Qi and Blood, weakness of Zang-Fu organs, deficiency in both interior and exterior, and chaos between pathogenic and healthy factors, resulting in edema of the four limbs and abdominal distension. Treatment should first regulate Ying (Nutritive) and Wei (Defensive) Qi, differentiate Yin and Yang, and employ methods such as tonifying the Middle, moving dampness, and promoting urination. Where heat signs exist, water qi is in the exterior, and sweating may be induced. Where no heat exists, water qi is in the interior, and purgation is appropriate. Edema above the waist should be treated by promoting urination; edema below the waist should be treated by inducing sweating. This is the method of Zhang Zhongjing.
If the whole body is swollen, accompanied by irritability, thirst, dark/scanty urine, and constipation, this belongs to Yang Water. If the whole body is swollen, without thirst, with loose stools and clear/profuse urine, this belongs to Yin Water. Yang Water combined with Yang syndromes presents with floating and rapid pulses; Yin Water combined with Yin syndromes presents with deep and slow pulses. If Qi sinks, use Erchen Tang (Two-Cured Decoction) with ascending herbs; if abdominal distension occurs, add small amounts of Muxiang (Aucklandiae Radix) to regulate Qi. If symptoms ease in the morning and worsen at night, it indicates Yin deficiency; take Siwu Tang (Four Substance Decoction) with Renshen (Ginseng) and Baizhu (Atractylodis Macrocephalae Rhizoma) in the morning, and Jiajian Shenqi Wan (Modified Kidney Qi Pill) in the evening. If symptoms worsen in the morning and ease at night, it indicates Yang deficiency; take Liujunzi Tang (Six-Gentleman Decoction) in the morning, and Jiajian Shenqi Wan in the evening. If symptoms worsen both morning and night, it indicates dual deficiency of Yin and Yang; treat primarily with Bazhen Tang (Eight-Treasure Decoction). For true Yang deficiency, take Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) in the morning and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) in the evening.
If there is epigastric fullness, limb swelling, cold hands and feet, difficulty digesting food, diarrhea, or cold breath, this indicates collapse of true Yang, with Cold-Deficiency in the Spleen, Lungs, and Kidneys failing to secure and control, leading to flooding of water. Urgently administer Jiajian Shenqi Wan, otherwise it is untreatable. Only by regulating and tonifying Spleen Earth is survival likely.
*Jinkui Yaolue* Modified Kidney Qi Pill Formula: Shudihuang (Prepared Rehmanniae Radix, 8 liang), Ganshanyao (Dioscoreae Rhizoma, 4 liang), Shanzhuyu (Corni Fructus, 4 liang), Zexie (Alismatis Rhizoma, 3 liang), BaiFuling (Poria, 3 liang), Mudanpi (Moutan Cortex, 3 liang), Rougui (Cinnamomi Cortex, 1 liang), Fuzi (Aconiti Lateralis Radix Praeparata, 1 liang), Cheqianzi (Plantaginis Semen, 1 liang), Niuxi (Achyranthis Bidentatae Radix, 1 liang).
Process each herb separately into fine powder. Form pills using rice paste, sized like adzuki beans. Take 30–40 pills per dose, on an empty stomach before meals, washed down with warm water.