腹水肿喘胀。大小便秘者。葶苈木香散。不服水土而肿。胃苓汤。病后腰脚浮肿。为有水气。胃
苓汤加黄连。因患疮。用干疮药太早而致身肿。上半身甚者。羌活胜湿汤加升麻、白芷、苏叶。下半身甚
者。五苓散换茅术。加木瓜、大腹皮。妇人经水先断。后至四肢浮肿。小便不通。通身皆肿。此
血化为水。名曰血分。此病乃七情乖违。脾胃亏损。不能统摄而成。最为难治。日用归脾汤下椒
仁丸一丸。药虽峻厉。数日当效。畏而不用。有养病害身之患。若先小便不利。后至身面浮肿。
经水不通者。血为水败也。名曰水分。用归脾汤送葶苈丸七丸。其经脉不通而化为水。流走四肢。
悉皆肿满者。亦曰血分。其证与水肿相类。而实非水也。归脾汤送人参丸十五丸。皆形气不足。
邪淫隧道。必用此药以宣导其邪。佐以调补元气。庶药力有所仗而行。则邪自不能容。而真气亦
不致于触伤矣。
水肿死证。见一即危。伤肝唇黑及肿。伤心缺盆平。掌无纹。伤脾脐突。伤肾足底平。伤肺
背平肩耸。如卵缩向上。阴囊无缝。及茎肿腐者死。大便滑泄。水肿不消者死。加以喘满。虽暴
病。亦必不治。泄后腹胀而有青筋者死。鼻煽目青。耳焦面黑。破 脱肉者。死期迫矣。先起于
腹。后散于四肢者可治。先起于四肢。后归于腹者死。如肺气不能下行。两足肿溃而小水全无。
腹中之痛不可名状。以手揉左则痛攻于右。揉右则痛攻于左。当脐揉熨则满腹俱痛。叫喊不绝。
利水敷脐之药俱不效。无可治矣。
开鬼门之剂。麻黄、羌活、防风、柴胡、葱白。及柳枝煎洗。洁净府之剂。泽泻、木通、通
草、防己、葶苈、茯苓、猪苓。秋石代盐。去菀陈 之剂。商陆、大戟、甘遂、芫花、牵牛。宣
布五阳之剂。附子、肉桂、干姜、吴茱萸。血肿之剂。琥珀、郁金、刘寄奴、苏木。丹方。治水
肿用灶心赤土升许。烧红。乘热以陈三白酒或火酒淋。澄清。空腹食之愈。血肿。红酒淋服。虚
人。用伏龙肝煎汤澄清。每日煮粥食之。血肿脉证俱实。大便闭者。生莱菔捣汁半盏。和白蜜少
许。隔汤炖热食之。生
牛膝捣绞汁服亦通。但精滑人禁用。丹方。治水肿用虾蟆七只。去头皮足。白酒漂净。同独蒜四
五十枚入猪肚中。白酒煮烂。去虾蟆。食猪肚。食后溲便频。肿即消。又方。活鳢鱼一枚。去肠
垢。入独蒜满腹。白酒煮食。食后大小便与矢气齐通。即消。虚人。 灰分三次砂糖调服。亦消。
消后复胀者。过三四日再服一次。三次必尽。后以健脾理气及温肾药调之。水肿小便不通。诸药
不应。用车前草叶捣烂。绞自然汁一盏。入烧酒半杯炖热。空心通口服。不过七日效。病久虚极。
不胜开泄者。用薏苡四两。汤泡煮数沸。频与热服即通。勿过熟。过熟即不效。赤豆煮汤代茶良。
鲤焦重斤许者。和冬瓜、葱白煮汁食。鲫鱼亦佳。鳢鱼作羹。用醋勿用盐。而千金水肿。蒜醋皆
忌。以其性味之浊也。而血肿尤忌。绿头鸭。或白鸭。同赤豆煮汁。空腹食之。切忌盐酱。入口
病必转甚。以盐能助肾水之邪。豆、麦助湿发热也。不能戒者。用赤豆、大麦面 成黄。以伏龙
肝水澄清。化青盐下之。青盐产砂土。与煮海水成盐不同。能清心滋肾而无助水之患也。忌猪羊
鸡鹅虾蟹麸面及一切生冷炙爆。尤戒房室忧劳醉饱。
〔诊〕脉沉主水。沉而滑。浮而迟。弦而紧。皆水肿。水病腹大。脉实大者生。浮虚者死。水
病腹闭。其脉沉实弦者生。沉细虚小者死。水病一身悉肿。泻利厥逆。脉沉实者急温之。虚大者
必死。加以喘迫。此为命绝。
李士材治钱赏之遍体肿急。脐突背平。法在不治。举家坚请用药。以金匮肾气丸料大剂煎服。
兼进理中汤。五日不效。乃以人参一两。生附三钱。牛膝、茯苓各五钱。小便忽通进食。计服人
参四斤。附子、姜、桂各斤余而安。
刘默生治汪去尘脾虚水逆伤肺。喘嗽不食。小水不通。脉虚不胜补泻。用茯苓五钱。泽泻、
橘红各一钱五分。防风、肉桂、熟附各五分。二服水去。后加入参调理而安。
石顽治王庸若呕逆水肿。溲便涓滴不通。或用五苓、八正不应。六脉沉细如丝。因与金液丹十五
丸。溺如泉涌而势顿平。后以济生肾气培养而安。
腹部水肿，伴有气喘和腹胀，大小便闭塞不通的，用葶苈木香散。因不适应当地水土而引发浮肿的，用胃苓汤。疾病痊愈后腰部和脚部出现浮肿，这是体内有水气停留，用胃苓汤加黄连。因为患疮疡，使用干疮药过早而导致全身浮肿的，上半身浮肿严重的，用羌活胜湿汤加升麻、白芷、苏叶；下半身浮肿严重的，用五苓散将苍术替换为茅术（苍术的一种），并加木瓜、大腹皮。
妇女月经先停止，随后四肢出现浮肿，小便不通，全身皆肿，这是血液化为水液所致，称为“血分”。此病是由于七情失调，脾胃亏损，不能统摄血液而成，最为难治。每日服用归脾汤，送服椒仁丸一丸。药物虽然峻猛，但数日内应当见效。如果畏惧而不用药，会有养病反而伤害身体的祸患。如果是先小便不利，随后身体面部浮肿，月经不通的，是水邪败坏血液，称为“水分”，用归脾汤送服葶苈丸七丸。其经脉不通而化为水液，流注于四肢，全部肿胀满实的，也称为“血分”。其症状与水肿相似，但实际上并非水邪所致。用归脾汤送服人参丸十五丸。这些患者都是形体和气机不足，邪气侵入经络隧道，必须用这些药物来宣通疏导邪气，辅以调补元气，这样药力才有依靠而发挥作用，邪气自然无法存留，真气也不会受到损伤。
水肿的死证，出现一种即为危重：伤肝者嘴唇发黑且浮肿；伤心者锁骨上窝（缺盆）平坦，手掌无纹路；伤脾者肚脐突出；伤肾者足底平坦；伤肺者背部平坦肩膀耸起，如睾丸收缩向上，阴囊无缝隙，以及阴茎肿胀腐烂的，均为死证。大便滑泄不止，水肿不消退的，死。加上气喘胸闷，即使是突发急病，也必定不治。腹泻后腹部胀满且有青筋暴露的，死。鼻翼扇动，目眶发青，耳朵焦枯，面色黧黑，肌肉消瘦脱落的，死期已迫近。水肿先从腹部开始，后来扩散到四肢的，可治；先从四肢开始，后来回流到腹部的，死。如果肺气不能下行，两脚肿胀溃烂且小便全无，腹中疼痛难以名状，用手揉按左侧则疼痛攻向右侧，揉按右侧则疼痛攻向左侧，揉按肚脐周围则满腹俱痛，呼叫喊声不绝，利水和敷脐的药物都无效，这就无可救治了。
开鬼门（发汗）的药物有：麻黄、羌活、防风、柴胡、葱白，以及柳枝煎水外洗。洁净府（利小便）的药物有：泽泻、木通、通草、防己、葶苈子、茯苓、猪苓。以秋石代替食盐。去菀陈莝（去除郁积陈旧之物）的药物有：商陆、大戟、甘遂、芫花、牵牛子。宣布五阳（温补阳气）的药物有：附子、肉桂、干姜、吴茱萸。治疗血肿的药物有：琥珀、郁金、刘寄奴、苏木。
民间验方：治疗水肿用灶心土（伏龙肝）约一升，烧红后，趁热用陈年三白酒或火酒淋浇，澄清后空腹服用即愈。若是血肿，用红酒淋服。体虚之人，用伏龙肝煎汤澄清，每天煮粥食用。血肿脉象和症状都属实证，大便闭结的，用生莱菔（萝卜）捣汁半杯，加少许白蜜，隔水炖热服用。生牛膝捣绞汁服用也能通便消肿，但精气滑泄之人禁用。
民间验方：治疗水肿用青蛙七只，去掉头皮和脚，用白酒漂洗干净，同独头蒜四五十枚放入猪肚中，用白酒煮烂，去掉青蛙，吃猪肚。吃完后小便频繁，肿胀即可消除。又一方：取活黑鱼一条，去掉肠垢，填入独头蒜至满腹，用白酒煮食。吃完后大小便及排气同时通畅，肿胀即消。体虚之人，可用灰分（此处指某种灰烬或特定药材粉末，原文可能有缺字，依文意译为灰分）三次，用砂糖调服，也能消肿。消肿后再次胀满的，过三四日再服一次，三次必能痊愈。之后用健脾理气及温肾药物调理。
水肿小便不通，各种药物无效的，用车前草叶捣烂，绞取自然汁一盏，加入半杯烧酒炖热，空腹通口服下，不超过七日见效。病程长久极度虚弱，不能耐受开泄攻伐药物的，用薏苡仁四两，用汤浸泡煮几沸，频繁给予热服即可通利，不要煮得太熟，煮得太熟就无效了。赤豆煮汤代茶饮用良好。体重约一斤的鲤鱼，同冬瓜、葱白煮汁食用。鲫鱼也很好。黑鱼做羹，用醋不要用盐。而《千金方》治疗水肿，大蒜和醋都忌用，因为其性味浊腻，血肿尤其忌讳。绿头鸭或白鸭，同赤豆煮汁，空腹食用。切忌盐和酱，入口后病情必定加重，因为盐能助长肾水之邪，豆类和麦类助湿发热。如果不能戒除盐酱，可用赤豆、大麦面炒成黄色，用伏龙肝水澄清后，化开青盐送服。青盐产于砂土中，与煮海水成的盐不同，能清心滋肾而没有助水的祸患。忌食猪、羊、鸡、鹅、虾、蟹、麸面及一切生冷炙烤食物。尤其戒除房事、忧思劳累和醉酒饱食。
〔诊法〕脉象沉主水病。沉而滑，浮而迟，弦而紧，都是水肿的脉象。水病腹部胀大，脉象实大的预后良好，浮虚的预后不良。水病腹部闭塞不通，脉象沉实弦的预后良好，沉细虚小的预后不良。水病全身悉肿，伴有腹泻、四肢厥冷，脉象沉实的需紧急温补，脉象虚大的必定死亡。加上气喘急促，这是命绝之兆。
李士材治疗钱赏之全身肿胀急迫，肚脐突出，背部平坦，按照医理属于不治之症。全家坚决请求用药。他用金匮肾气丸的大剂量煎服，同时进服理中汤。五天没有效果，于是用人参一两，生附子三钱，牛膝、茯苓各五钱，小便忽然通畅并能进食。共计服用人参四斤，附子、生姜、肉桂各一斤余而痊愈。
刘默生治疗汪去尘脾虚导致水气上逆伤肺，气喘咳嗽不能进食，小便不通，脉象虚弱不能承受补泻药物。他用茯苓五钱，泽泻、橘红各一钱五分，防风、肉桂、熟附子各五分。服药两次后水气去除了，后来加入人参调理而痊愈。
石顽治疗王庸若呕吐逆乱伴水肿，小便点滴不通。有人用五苓散、八正散无效。六脉沉细如丝。于是给予金液丹十五丸，尿液如泉涌出而病势顿时平复。后来用济生肾气丸培养正气而痊愈。
Abdominal edema accompanied by asthma and abdominal distension, with constipation of both stool and urine, is treated with Tingli Muxiang San (Lepidium and Costus Powder). Edema caused by inability to adapt to local climate and water is treated with Weiling Tang (Atractylodes Macrocephala and Poria Decoction). Post-illness edema in the lower back and feet indicates the presence of pathogenic water qi; it is treated with Weiling Tang (Atractylodes Macrocephala and Poria Decoction) added with Huanglian (Coptis Rhizome). Edema resulting from using drying agents for sores too early: if the upper body is more severely affected, treat with Qianghuo Shengshi Tang (Notopterygium and Dryopteris Decoction) added with Shengma (Cimicifugae Rhizoma), Baizhi (Angelicae Dahuricae Radix), and Suye (Perillae Folium); if the lower body is more severely affected, use Wuling San (Poria Pill) replacing Cangzhu (Atractylodis Rhizoma) with Maozhu (a variety of Atractylodes), and add Mugua (Chaenomelis Fructus) and Dafupi (Arecae Pericarpium).
In women, if menstruation stops first followed by edema of the four limbs, urinary obstruction, and generalized swelling, this is blood transforming into water, termed "Blood Partition" (Xuefen). This condition arises from emotional disharmony and spleen-stomach deficiency failing to control blood, making it extremely difficult to treat. Daily administration of Guipi Tang (Restore the Spleen Decoction) with one pill of Jiaoren Wan (Pepper Seed Pill) is indicated. Although the medication is potent, improvement should occur within a few days. Fearful refusal to use these drugs risks harming the body while attempting to nurture health. If urinary difficulty precedes facial and bodily edema, with amenorrhea, it is water destroying blood, termed "Water Partition" (Shuifen), treated with Guipi Tang (Restore the Spleen Decoction) delivering seven Tingli Wan (Lepidium Pills). When meridians are blocked and transform into water flowing to the limbs causing full swelling, it is also called "Blood Partition." The symptoms resemble edema but are not truly water retention. Treat with Guipi Tang (Restore the Spleen Decoction) delivering fifteen Renshen Wan (Ginseng Pills). These patients suffer from insufficiency of form and qi, with pathogens invading the collaterals; such medications are necessary to vent and guide out the pathogens, assisted by tonifying primordial qi. Thus, the medicinal force has support to act, pathogens cannot remain, and true qi is not damaged.
Critical signs of fatal edema include any one of the following: Liver injury manifests as black lips and swelling; Heart injury as flat clavicular fossae (Quepen) and palm lines disappearing; Spleen injury as protruding umbilicus; Kidney injury as flat soles; Lung injury as flat back and shrugging shoulders, testicles retracting upward, seamless scrotum, or swollen and putrid penis—all indicate death. Profuse loose stools with persistent edema indicate death. Asthma and chest fullness, even in acute onset, are untreatable. Abdominal distension with visible blue veins after diarrhea indicates death. Nasal flaring, cyanotic eye orbits, scorched ears, black face, and muscle wasting indicate imminent death. Edema starting in the abdomen and spreading to limbs is treatable; starting in limbs and returning to the abdomen is fatal. If lung qi fails to descend, leading to ulcerated edema of both legs and complete anuria, with indescribable abdominal pain where pressing the left side causes pain on the right and vice versa, and pressing the navel causes whole-abdomen pain with incessant crying, diuretics and umbilical applications fail; this is incurable.
Diaphoretic agents (Kai Guimen) include Mahuang (Ephedrae Herba), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Congbai (Allii Fistulosi Bulbus), and willow branch washes. Diuretic agents (Jing Jingfu) include Zexie (Alismatis Rhizoma), Mutong (Akebiae Caulis), Tongcao (Tetrapanacis Medulla), Fangji (Stephaniae Tetrandrae Radix), Tingli (Lepidii Semen), Fuling (Poria), and Zhuling (Polyporus). Shi Yanshi (Mineral Salt) can replace table salt. Agents to remove accumulated stagnation (Qu Yuan Chen) include Shanglu (Phytolaccae Radix), Daji (Euphorbiae Pekinensis Radix), Gansui (Kansui Radix), Yuanhua (Genkwa Flos), and Qianniu (Pharbitidis Semen). Agents to disseminate Yang qi include Fuzi (Aconiti Lateralis Radix Praeparata), Rougui (Cinnamomi Cortex), Ganjiang (Zingiberis Rhizoma), and Wuzhuyu (Evodiae Fructus). Agents for blood edema include Hupo (Fossilia Os Sacrum), Yujin (Curcumae Longae Radix), Liujinu (Artemisiae Anomalous Herb), and Sumu (Sappan Lignum).
Prescriptions: For edema, roast about one sheng of Zaixin Tudi (Caosinis Cauda/Fire-warmed Soil) until red, pour aged three-white wine or strong liquor over it while hot, clarify, and drink on an empty stomach. For blood edema, use red wine. For deficient persons, decoct Caosinis Cauda, clarify, and cook porridge daily. For blood edema with excess pulse/symptoms and constipation, crush fresh Radish (Laifu) to extract half a cup of juice, mix with honey, warm in a double boiler, and consume. Fresh Achyranthes Bidentata Juice (Niuxi) also promotes urination but is contraindicated in those with seminal emission.
Another prescription: Boil seven frogs (removed skin/feet, washed in white wine) with 40-50 cloves of garlic inside a pig's stomach in white wine until soft. Eat the stomach; urination increases, and edema subsides. Another method: Boil one live snakehead fish (with gutted viscera stuffed with garlic) in white wine and eat. Urination and flatus resume simultaneously, and edema resolves. For deficient persons, take ash powder three times with sugar; edema subsides. If bloating recurs after resolution, repeat every 3-4 days for three courses, then regulate with spleen-tonifying, qi-regulating, and kidney-warming herbs.
For edema with anuria unresponsive to other drugs: Crush fresh Plantago leaf (Cheqian Cao), extract one cup of juice, mix with half cup of distilled liquor, warm, and drink on an empty stomach; effect within seven days. For chronic, extremely deficient patients intolerant to draining methods: Soak Coix Seed (Yiyiren) in water, boil briefly, drink frequently while hot; do not overcook. Red bean tea is beneficial. Roast a ~1 jin carp, decoct with winter melon and green onion whites, and consume. Crucian carp is also good. Snakehead fish soup with vinegar, no salt. *Qianjin Fang* advises avoiding garlic and vinegar for edema due to their turbid nature, especially for blood edema. Duck (green-headed or white) cooked with red beans, eaten on an empty stomach without salt/soy sauce. Salt exacerbates kidney water pathology; beans/wheat generate damp-heat. If salt cannot be avoided, use roasted red bean and barley flour clarified with Caosinis Cauda water, taken with Qingyan (Green Salt/Sand Earth Salt), which clears heart/kidney without aiding water. Avoid pork, mutton, poultry, seafood, bran, raw/cold, and fried foods. Strictly avoid sexual activity, worry, fatigue, and excessive eating/drinking.
[Pulse Diagnosis] Deep pulses indicate water disease. Deep-slippery, floating-slow, string-tight pulses all indicate edema. In abdominal edema, solid-large pulses indicate survival; floating-empty pulses indicate death. In abdominal closure, deep-solid-stringy pulses indicate survival; deep-fine-empty-small pulses indicate death. In generalized edema with diarrhea and cold extremities, deep-solid pulses require urgent warming; large-empty pulses indicate certain death. Asthma with this indicates terminal failure.
Li Shicai treated Qian Shangzhi with generalized tense edema, protruding umbilicus, and flat back—prognosis hopeless. Family insisted on treatment. Prescribed large dose of Jin Gui Shen Qi Wan (Golden Cabinet Kidney Qi Pill) combined with Lizhong Tang (Regulate the Middle Decoction). No effect after five days. Then administered Ren Shen (Ginseng Root) 1 liang, Sheng Fuzi (Prepared Aconite Root) 3 qian, Niuxi (Achyranthes Root) and Fuling (Poria) 5 qian each. Urination suddenly resumed, appetite returned. Total consumption: 4 jin Ginseng, >1 jin each of Fuzi, Ginger, and Cinnamon. Patient recovered.
Liu Mosheng treated Wang Quchen with spleen-deficient water counterflow injuring lungs, causing asthma, cough, anorexia, and anuria. Pulse was weak, intolerant to tonification or purgation. Prescribed Fuling 5 qian, Zexie and Ju Hong (Citri Reticulatae Pericarpium) 1.5 qian each, Fangfeng and Rougui (Cinnamon Bark) 0.5 qian each, Shu Fuzi (Prepared Aconite) 0.5 qian. After two doses, water receded. Later supplemented with Ren Shen for recovery.
Shi Wan treated Wang Yongruo with vomiting, edema, and complete anuria. Wuling San and Bazheng San failed. Six pulses were deep-fine like threads. Administered Jin Ye Dan (Golden Liquid Pill) 15 pills. Urine flowed like a spring, condition stabilized. Later cultivated with Jisheng Shen Qi Wan (Jisheng Kidney Qi Pill) for recovery.