（肿者。皮肤肿大也。胀者。心腹胀满也。臌者。心腹痞满。而四肢瘦小。昔人谓之蛊
肿症。从来有气肿水肿之辨。内经以按之 而不起者为气。即起者为水。后医多反其说。
然气滞水亦滞。水行气亦行。正不必分。总以不起为肿甚。即起为肿轻。肾囊及茎中肿。大
多死。
脉本沉。 若浮而弦。宜发汗。 若浮而鼓指有力。宜越脾汤。 若浮在皮外。多死。 若
沉而紧。宜麻黄细辛附子之类。 若沉而缓。易愈。 若沉而微细。宜温补。
初起。面上微肿。两目下名卧蚕。更肿些。一身觉重滞。微喘。小便不利。即肿症之渐。
宜
如皮肤肿大。气喘小便不利。宜
五皮饮。
上肿。宜发汗。加苏叶防风杏仁各三钱。下肿。宜利水。加猪苓防己各二钱。木通一钱。
小水多。为阴水。加附子干姜各二钱。白术三钱。川椒木香各一钱。小便不利。为阳水。加
防己猪苓知母各二钱。凡脉虚人羸。宜加白术人参肉桂附子。脉实人健。加莱菔子枳壳各二
钱。凡畏风之甚。宜加生黄 。三四钱。或再加附子二钱。（八十）
如小便点滴俱无。气喘口不渴。宜
滋肾丸。（九十四）
如前药不效。宜用济生肾气丸。药料作汤服。或前症愈后。亦以此丸服一月收功。
济生加减肾气丸。（一百零九）
如服利水之药。而小便愈少者。
补中益气汤。
首煎照常服。二煎服后。以手指探吐。（五）
愚按。水肿病。浅者照上法治之愈矣。深者。必遵金匮五水而治之。余着有金匮浅注。
颇有发明。风水由于外邪。法宜发汗。皮水者。外邪已去经而入皮。故不恶风。病在皮间。
故内不胀而外如鼓皮病不涉于内。故口不渴。然水在于皮。亦必从汗以泄之也。石水病在脐
下。阴邪多沉于下。法用麻黄附子甘草汤。重在附子。以破阴也。黄汗者。外邪伤心。郁热
成黄。胸满。四肢头面俱肿。病在于上。法用桂枝汤。加黄 。啜热粥以取微汗。重在桂枝。
以化气。尤赖啜粥取汗。以发内外交郁之邪也。唯正水一症。正内经所谓三阴结谓之水。结
则脉沉。水属阴则脉迟。三阴结。则下焦阴气不复与胸中之阳相调。水气格阳则为喘。其目
窠如蚕。一身尽肿。可知金匮之论甚精。徐忠可之注甚妙。试节录之。金匮云。寸口脉浮而
迟。浮脉则热。迟脉则潜。热潜相搏。名曰沉。趺阳脉浮而数。浮脉即热。数脉即止。热止
相搏。名曰伏。沉伏相搏。名曰水。
沉则脉络虚。伏则小便难。虚难相搏。水走皮肤。即为水矣。徐忠可注云。此段论正水
之由也。谓人身中健运不息。所以成云行雨施之用。故人之汗。以天地之雨名之。人之气。
以天地之疾风名之。寸口脉主上。犹之天道必下济而光明。故曰阴生于阳。趺阳脉主下。犹
之地轴必上出而旋运。故曰卫气起于下焦。今寸口脉浮而迟。浮主热。乃又见迟。迟者。元
气潜于下也。既见热脉。又见潜脉。是热为虚热。而潜为真潜。故曰热潜相搏名曰沉。言其
所下济之元气。沉而不复举也。今趺阳脉浮而数。浮主热。乃又见数。数者。卫气止于下也。
既见热脉。又且止脉。是于客气为热。而真气为止。故曰热止相搏名曰伏。言其宜上出之卫
气。伏而不能升也。从上而下者。不返而终沉。从下而上者。停止而久伏。则旋运之气几乎
熄矣。熄则阴水乘之。故曰沉伏相搏名曰水。见非止客水也。又恐人之不明乎沉伏之义。故
又曰。络脉者。阴精阳气所往来也。寸口阳气沉而在下。则络脉虚。小便者。水道之所从出
也。跌阳真气止而在下。气有余即是火。火热甚。则小便难。于是上不能运其水。下不能出
其水。又焉能禁水之胡行乱走耶。故曰虚难相搏。水走皮肤。即为水矣。水者。即身中之阴
气。合水饮而横溢也。沉伏二义。俱于浮脉见之。非真明天地升降阴阳之道者。其能道只字
耶。
此仲景所以为万世师也。徐忠可此注。妙不可言。独惜仲景不立方。忠可又不补出应用
何方。致世之患此者。或死于庸医之舟车丸神佑丸疏凿饮子等方。或死于明医之实脾饮济生
肾气丸补中益气汤导水茯苓汤等方。以挺与刃。余又不忍坐视而不救。故拟方于后。
（肿，是指皮肤肿大。胀，是指心腹部胀满。臌，是指心腹部痞塞胀满，而四肢消瘦细小。古人称之为蛊肿症。历来有气肿和水肿的区分，《内经》认为按压后凹陷不起的是气肿，按之即起的是水肿。后世医生多与此说法相反。然而气滞则水亦滞，水行则气亦行，正不必强行区分。总之，按之不起说明肿胀严重，按之即起说明肿胀较轻。若肾囊及阴茎中肿胀，大多预后不良，属死证。
脉象本应沉，若见浮而弦，宜用发汗法；若浮而按之鼓指有力，宜用越脾汤；若浮在皮表浅层，大多预后不良，属死证；若沉而紧，宜用麻黄细辛附子汤之类；若沉而缓，容易治愈；若沉而微细，宜用温补法。
疾病初起时，面部轻微浮肿，眼下名为“卧蚕”，随后全身沉重滞涩，微喘，小便不利，这是肿症的渐增表现。
上半身肿，宜发汗，加苏叶、防风、杏仁各三钱；下半身肿，宜利水，加猪苓、防己各二钱，木通一钱。若小便量多，为阴水，加附子、干姜各二钱，白术三钱，川椒、木香各一钱；若小便不利，为阳水，加防己、猪苓、知母各二钱。凡是脉虚体瘦的人，宜加白术、人参、肉桂、附子；凡是脉实身体健壮的人，加莱菔子、枳壳各二钱。凡是特别怕风的，宜加生黄芪三四钱，或再加附子二钱。（第八十条）
如果前述药物无效，宜用济生肾气丸，将药材煎汤服用。或者在前症痊愈后，也以此丸服用一个月以巩固疗效。济生加减肾气丸。（第一百零九条）
如果服用利水药后，小便反而更少，宜用补中益气汤。第一煎照常服用，第二煎服用后，用手指探喉催吐。（第五条）
愚者按语：水肿病，病情浅表的照上述方法治疗即可痊愈；病情深重的，必须遵循《金匮要略》中关于五水的论述来治疗。我著有《金匮浅注》，颇有发明见解。风水是由于外邪所致，治法宜发汗；皮水是外邪已去，由经入皮，所以不怕风；病位在皮间，所以内部不胀而外部如鼓皮；皮病不涉及内脏，所以口不渴。然而水在皮间，也必须通过发汗来宣泄。石水病在脐下，阴邪多沉于下部，治法用麻黄附子甘草汤，重在附子，以破阴邪。黄汗是外邪伤心，郁热成黄，胸满，四肢头面俱肿，病位在上，治法用桂枝汤，加黄芪，喝热粥以取微汗，重在桂枝以化气，尤其依赖喝粥取汗，以发散内外交郁之邪。唯有正水这一症，正如《内经》所说“三阴结谓之水”，结则脉沉，水属阴则脉迟。三阴结，则下焦阴气不再与胸中之阳相协调，水气格拒阳气则为喘，其眼窝如蚕状，全身尽肿。可知《金匮》的论述非常精妙，徐忠可的注解也非常巧妙。试节录如下：《金匮》说：“寸口脉浮而迟，浮脉主热，迟脉主潜。热与潜相互搏结，名叫沉。趺阳脉浮而数，浮脉即热，数脉即止。热与止相互搏结，名叫伏。沉与伏相互搏结，名叫水。”“沉则脉络虚，伏则小便难。虚与难相互搏结，水走皮肤，即为水矣。”徐忠可注解说：“这段论述正水的成因。谓人身中健运不息，所以成就云行雨施的作用。故人的汗，以天地的雨命名；人的气，以天地的疾风命名。寸口脉主上，犹如天道必下济而光明，所以说阴生于阳。趺阳脉主下，犹如地轴必上出而旋运，所以说卫气起于下焦。如今寸口脉浮而迟，浮主热，却又见迟，迟者，元气潜藏于下也。既见热脉，又见潜脉，这是热为虚热，而潜为真潜，所以说‘热潜相搏名曰沉’，言其所下济的元气，沉而不复举起。如今趺阳脉浮而数，浮主热，却又见数，数者，卫气停止于下也。既见热脉，又且见止脉，这是客气为热，而真气为止，所以说‘热止相搏名曰伏’，言其宜上出的卫气，伏而不能升也。从上而下者，不返而终沉；从下而上者，停止而久伏，则旋运之气几乎熄灭了。熄则阴水乘之，所以说‘沉伏相搏名曰水’，见非只是客水停留。又恐人们不明白沉伏的含义，所以又说：‘络脉者，是阴精阳气所往来的地方。寸口阳气沉而在下，则络脉虚。小便者，是水道所从出的地方。跌阳真气止而在下，气有余即是火，火热甚，则小便难。于是上不能运其水，下不能出其水，又怎能禁止水胡行乱走呢？’所以说‘虚难相搏，水走皮肤，即为水矣’。水，就是身中的阴气，合水饮而横溢。沉和伏两义，都见于浮脉之中，不是真正明白天地升降阴阳之道的人，能说出只字吗？”
这就是仲景之所以成为万世师表的原因。徐忠可的这个注解，妙不可言。可惜仲景没有立方，忠可也没有补出应用何方，导致世间患此病的人，有的死于庸医使用的舟车丸、神佑丸、疏凿饮子等方，有的死于明医使用的实脾饮、济生肾气丸、补中益气汤、导水茯苓汤等方，如同挺刃杀人。我不忍坐视不救，所以拟定方剂在后面。
(Swelling, *Zhong*, refers to the enlargement of the skin. Distension, *Zhang*, refers to fullness and distension in the heart and abdomen. Drum-like swelling, *Gu*, refers to stuffiness and fullness in the heart and abdomen with emaciation of the four limbs. Ancients called this condition Gu-swelling syndrome (*Guzhong zheng*). Historically, there has been a distinction between Qi edema (*Qizhong*) and Water edema (*Shuizhong). The *Neijing* states that pitting upon pressure indicates Qi, while non-pitting or immediate rebound indicates Water. Later physicians often reversed this view. However, when Qi stagnates, Water also stagnates; when Water moves, Qi also moves. It is not necessary to strictly distinguish them. Generally, non-pitting indicates severe swelling, while immediate rebound indicates mild swelling. Swelling of the scrotum and penis usually carries a poor prognosis (death).
The pulse should originally be Deep (*Chen*). If it is Floating (*Fu*) and Wiry (*Xian*), sweating therapy (*Fahan*) is indicated. If it is Floating and forceful upon pressing, Yuepi Tang (*Yuepi Decoction*) is indicated. If it is Floating superficially at the skin level, it usually indicates death. If it is Deep and Tight (*Jin*), formulas like Mahuang Xixin Fuzi Tang (*Ephedra, Asarum, and Aconite Decoction*) are indicated. If it is Deep and Slow (*Huan*), recovery is easy. If it is Deep and Fine/Thready (*Wei Xi*), warming and tonifying methods are indicated.
At the onset, slight facial edema appears, specifically under the eyes known as "Silkworm" (*Wocan*). Subsequently, the body feels heavy and sluggish, with slight panting and difficult urination; this marks the progression of swelling syndrome.
If the skin is swollen, accompanied by panting and difficult urination, Wupi Yin (*Five-Bark Drink*) is indicated.
For upper body swelling, induce sweating by adding Ziyefangfeng Xingren Sanqian (*Perilla Leaf, Saposhnikovia, and Apricot Seed, 3 qian each*). For lower body swelling, promote diuresis by adding Zhuling Fangji Erqian (*Polyporus and Stephania, 2 qian each), Mutong Yiqian (*Akebia, 1 qian*). If urine volume is high, it is Yin Water (*Yinshui*); add Fuzi Ganjiang Erqian (*Aconite and Dried Ginger, 2 qian each), Baizhu Sanqian (*Atractylodes Macrocephala, 3 qian*), Chuanjiao Muxiang Yiqian (*Sichuan Pepper and Costus Root, 1 qian each*). If urination is difficult, it is Yang Water (*Yangshui*); add Fangji Zhuling Zhimu Erqian (*Stephania, Polyporus, and Anemarrhena, 2 qian each*). For patients with Deficient pulses and emaciation, add Baizhu Renshen Rougui Fuzi (*Atractylodes, Ginseng, Cinnamon Bark, and Aconite*). For patients with Excess pulses and robust constitutions, add Laifuzi Zhike Erqian (*Radish Seed and Aurantium, 2 qian each*). For those severely afraid of wind, add Sheng Huangqi 3-4 qian (*Raw Astragalus*), or add Fuzi 2 qian (*Aconite*). (Article 80)
If there is no urine output at all, accompanied by panting and no thirst, Zishen Wan (*Kidney-Nourishing Pill*) is indicated. (Article 94)
If previous medications are ineffective, Jisheng Shenqi Wan (*Jisheng Kidney-Qi Pill*) should be used, decocted as a soup. Alternatively, after the initial symptoms resolve, take this pill for one month to consolidate the cure. Jisheng Jiajian Shenqi Wan (*Modified Jisheng Kidney-Qi Pill*). (Article 109)
If taking diuretic herbs results in even less urine, Buzhong Yiqi Tang (*Tonify the Middle and Augment the Qi Decoction*) is indicated. Take the first decoction as usual. After taking the second decoction, induce vomiting by stimulating the throat with fingers. (Article 5)
Commentary: For edema, if the pathology is superficial, treating according to the above methods will lead to recovery. If deep, one must follow the "Five Waters" theory from the *Jinkui Yaolue*. I have written *Jinkui Qianzhu* (*Annotated Brief Explanation of Jinkui*), which offers significant insights. Fengshui (*Wind-Water*) is caused by external pathogens; the treatment principle is sweating. Pishui (*Skin-Water*) occurs when external pathogens leave the meridians and enter the skin, so there is no aversion to wind. The disease is in the skin layer, so there is no internal distension but external drum-like tension; since the skin disease does not involve the interior, there is no thirst. However, water in the skin must also be expelled through sweating. Shishui (*Stone-Water*) is located below the umbilicus, where Yin pathogens sink to the lower part; the treatment uses Mahuang Fuzi Gancao Tang (*Ephedra, Aconite, and Licorice Decoction*), emphasizing Fuzi to break Yin. Huanghan (*Yellow Sweat*) involves external pathogens injuring the Heart, leading to stagnant heat turning yellow, chest fullness, and swelling of the four limbs and head/face. The disease is in the upper part; the treatment uses Guizhi Tang (*Cinnamon Twig Decoction*) plus Huangqi (*Astragalus*), drinking hot porridge to induce slight sweating. This emphasizes Guizhi to transform Qi, relying heavily on drinking porridge to sweat to release pathogens trapped internally and externally. Only Zhengshui (*True-Water*) corresponds to the *Neijing* statement: "When the Three Yin channels are knotted, it is called Water." Knotting leads to a Deep pulse; Water belongs to Yin, so the pulse is Slow (*Chi*). When the Three Yin are knotted, the Yin Qi of the Lower Jiao no longer harmonizes with the Yang Qi of the Chest. Water Qi repelling Yang causes panting. The eye sockets resemble silkworms, and the whole body is swollen. Thus, the discussion in *Jinkui* is very precise, and Xu Zhongke's commentary is excellent. I excerpt it here: *Jinkui* says, "The Cun Kou pulse is Floating and Slow. Floating indicates Heat, Slow indicates Submergence. Heat and Submergence interacting is called Chen (Sinking). The Zu Yang pulse is Floating and Rapid. Floating indicates Heat, Rapid indicates Stagnation/Stop. Heat and Stagnation interacting is called Fu (Hidden). Chen and Fu interacting is called Water. Chen implies deficiency in the collaterals, Fu implies difficulty in urination. Deficiency and difficulty interacting cause Water to flow into the skin, resulting in Water disease." Xu Zhongke annotates: "This passage discusses the origin of Zhengshui. It states that the continuous healthy movement in the human body creates the function of clouds and rain. Thus, human sweat is named after heaven's rain, and human Qi is named after heaven's swift wind. Cun Kou pulse governs the Upper, akin to Heavenly Dao descending to illuminate, hence 'Yin is born from Yang.' Zu Yang pulse governs the Lower, akin to Earth's axis rotating upward, hence 'Wei Qi originates from the Lower Jiao.' Now, Cun Kou pulse is Floating and Slow. Floating indicates Heat, yet Slow is seen; Slow means Yuan Qi submerges in the Lower. Seeing both Heat and Submergence pulses means Heat is Deficient Heat, and Submergence is True Submergence. Hence 'Heat and Submergence interacting is called Chen,' meaning the Yuan Qi descending fails to rise again. Now, Zu Yang pulse is Floating and Rapid. Floating indicates Heat, yet Rapid is seen; Rapid means Wei Qi stops in the Lower. Seeing both Heat and Stop pulses means the Guest Qi is Heat, while True Qi is Stopped. Hence 'Heat and Stop interacting is called Fu,' meaning the Wei Qi that should ascend is hidden and cannot rise. What descends from above does not return and finally sinks; what ascends from below stops and remains hidden for long, causing the rotating Qi to nearly extinguish. Extinction allows Yin Water to prevail, hence 'Chen and Fu interacting is called Water,' indicating it is not merely guest water. To prevent misunderstanding of Chen and Fu, it further states: 'Collaterals are where Yin Essence and Yang Qi interact. If Cun Kou Yang Qi sinks to the lower, collaterals become deficient. Urine is the exit of the Water pathway. If Zu Yang True Qi stops in the lower, excess Qi becomes Fire. Severe Fire leads to difficult urination. Thus, the Upper cannot transport water, and the Lower cannot discharge water. How can one forbid water from wandering recklessly?' Hence 'Deficiency and difficulty interacting, water flows into skin, becoming Water disease.' Water is the Yin Qi within the body, combining with fluid retention and overflowing. Both Chen and Fu meanings are seen in the Floating pulse. Only those who truly understand the Dao of Heaven and Earth's ascent/descent and Yin/Yang can articulate this."
This is why Zhang Zhongjing is the teacher for ten thousand generations. Xu Zhongke's annotation is exquisite. Unfortunately, Zhongjing did not prescribe formulas, and Zhongke did not supplement applicable formulas. Consequently, patients suffer deaths from quack doctors using Zhouche Wan, Shenyao Wan, Shuozao Yinzi, etc., or from enlightened doctors using Shipi Yin, Jisheng Shenqi Wan, Buzhong Yiqi Tang, Daoshui Fuling Tang, etc., effectively killing with blades. I cannot bear to sit idle without saving them, so I propose formulas below.