圣济总录论曰。诸家方书。论水病甚详。未尝有言膜外气者。唐天宝间。有徒郁子者。
始着
肾
其病令人虚胀。四肢肿满。按之没指是也。徒郁子之论病本云。膜外气者。或谓水气者。起
于他疾。不可常定。或因疟。或因肾藏中风。或因肺腑伤冷。或因膈上气。或因冲热远行。
或因酒肉中所得。始于肺。终于肾。或因咳嗽。或多涕唾。或因蓄聚冷气。壅塞不散。遂使
肺藏热气攻心。或因肾脏冷气。不能化水流入膀胱。病在大肠膜外。所以切脉不能知。针灸
不能及。盖人肾为命本。不可虚也。本固即叶茂。本虚即易枯。况四时衰旺。皆承肾藏之气
。肾损则五脏皆衰。以致胃弱而脾不磨。气结而小便涩。轻重之候。在大小便耳。若小便不
通则气壅。攻系腹内。冲出膜外。化而为水。使人手足头面浮肿。若大小便微涩则微肿。极
涩则极肿。大小便俱不通。三日即遍身洪肿。至重则阴亦肿。夫阴肿有二。有肿而小便自出
者。有肿而小便极涩者。又有茎头连小腹脐皆肿者。此病为死候。若患此疾。肿亦不常定。
或先手足面目浮肿。或先腰肋微肿。或先手足之肿。其候或消或甚。三五日稍愈。或三五日
再发。亦以小便通涩为候。积渐变成洪肿。妇人得之。与此略同。凡患此疾。令人腹胀烦闷
。胸间气急。此由肺胀。甚即喘如牛吼。坐卧行立不得。或中夜后气攻胸。心肿者。一年二
年方死。有一月两月死者。若将息失度。误食毒物。十日五日即甚也。愚医多以针灸出水为
功。又以鲤鱼赤小豆为药。又令病患饮黄牛尿。服商陆根。反有所损。少有瘥者。大抵此病
。尤忌针灸。华佗云。患水病。未遇良医者。不得针灸。言气在膜外。已化为水。水出即引
出腹中气。水尽则死。扁鹊云。水病在膜外。常药不可疗。惟神针良药可也。有此疾者。宜
向阳行坐。遇阴雨则愈觉壅滞。房中常须存火。服后夜卧。觉胸间热甚。宜含红雪与好茶之
类。慎勿饮酒。及冷茶水。若渴宜吃五灵脂汤。方录在卷后。尤忌盐生冷醋滑。
方
防己汤(出圣济总录)治膜外气。水病。不限年月深浅。洪肿大喘。
防己 大戟 木香 赤茯苓(去黑皮) 海藻(洗) 犀角(屑) 胡椒 白术 葶苈 防
风(去
槟榔(各一
并须新药
锉秤为
心服一
若腹中实者。至日午即转泻下。宜用盆盛验之。必有恶浊黄水。或恶浊青黑物
气化为之泻。若不甚困。慎勿止之。必自住。若觉力乏。即以常服浆粥补之。
服一剂。则还根据此法服之。按徒郁子先生云。服第一剂则病减半。至第二剂则
历试。绝重者。朝服一剂而暮已瘥。根本深者。服药当日肿消能起。但觉小腹
须后剂去之。其药滓慎勿抛弃。布囊盛。悬于风中。他日或觉微有发动。则更
治两人。徒郁子先生云。家有此药滓。悬于户上一家中不患疫气。此饮不独治
病皆治之。若患肺气。不限年月深浅。于此药二十味中。减去大黄及诃黎勒。
以童子小便煎。每日空心服之。当去病根。有患肺气困重者。因逢患水气人。
永瘥。有人一生患香港脚。时时冲心。服此饮亦除根本。以此推之。但是气病皆
气而已。产妇及娠妇服之亦无妨。小儿及老者随意加减。瘥后宜服顺气丸。
顺气丸(出圣济总录)治水气。
防己(一两半) 大黄(二两半) 犀角(镑) 诃黎勒皮 牵牛子 赤茯苓(去黑皮)
葶苈(炒)
皮(去白)
防风
服十丸。
空
药
体气轻健即止。患香港脚人。长合此药。将行备急。服前饮差。百日内。即宜服五灵汤。
五灵汤(出圣济总录)治水气。
诃黎勒皮 木通(锉) 赤茯苓(去黑皮) 防己(锉) 陈橘皮(汤浸去白焙各一两)
上粗
捣筛
有
十水丸(出圣济总录)治膜外水气身肿。
本(去苗土) 泽漆(微炒) 大戟(微炒) 连翘 葶苈(纸上炒) 甘遂(微炒)
芫花(醋浸
尽一两)
上为末
泽漆丸(出圣济总录)治膜外水肿。
泽漆(微炒一两) 水银(炼) 葶苈(纸上炒) 大戟(微炒锉) 郁李仁(汤浸去
皮炒) 枳
壳(
十丸。
空腹米饮下。未利加至十五丸。
牛李子丸(出圣济总录)治膜外水气。
牛李子(炒) 吴茱萸(水浸一宿炒干) 青橘皮(去白炒各半两) 杏仁(汤浸去皮
尖双仁
炒半
每
服三
白牵牛散(出圣济总录)治膜外气。
白牵牛(炒) 青橘皮(去白焙炒) 木通(锉各一两) 上为末。每服一钱匕。煎生
商陆汤
下。
甘遂饼(出圣济总录)治膜外水气。
甘遂 大麦面(各半两) 上为末。以水和作饼子烧熟。热食之。如不利。以熟饮投之。
如利
治膜外气。及气块方。
上以延胡索。不限多少为末。猪胰一具切作块。作炙熟。蘸药末食之。
《圣济总录》论述说:各家医书,对水病的论述非常详尽,却从未提及“膜外气”这一病名。唐代天宝年间,有一位名叫郁子的僧人,才开始著述关于肾脏的(相关理论)。这种病让人身体虚弱胀满,四肢浮肿饱满,按压后凹陷不起。郁子论及此病的本源时说:“膜外气”,也有人称之为“水气”,它起源于其他疾病,病情变化无常。可能因疟疾引起,或因肾脏受风邪侵袭,或因肺腑受寒损伤,或因膈上气机阻滞,或因酷热天气长途跋涉,或因饮食酒肉不当而得。此病始于肺,终于肾;也可能因咳嗽、多涕唾,或因冷气积聚、壅塞不散,导致肺部热气攻心;或因肾脏冷气无法化水,流入膀胱。病变部位在大肠膜外,因此切脉难以察觉,针灸也难以触及。大概因为肾是生命的根本,不可虚弱。根本稳固则枝叶茂盛,根本虚弱则容易枯萎。况且四季的盛衰,都依赖于肾脏之气。肾受损则五脏皆衰,导致胃弱而脾不运化,气机结滞而小便涩滞。病情的轻重,体现在大小便的情况上。如果小便不通,则气机壅滞,攻冲腹内,冲出膜外,化为水液,使人手足头面浮肿。如果大小便轻微涩滞,则轻微浮肿;极度涩滞则极度浮肿;大小便完全不通,三天后全身严重肿胀。病情极重时,阴部也会肿胀。阴肿有两种情况:一种是肿胀但小便自出,另一种是肿胀且小便极度涩滞。还有阴茎头部连小腹、肚脐全部肿胀的,这是死证。如果患此病,肿胀也不固定,有时先从头面手足浮肿,有时先从腰肋微肿,有时先出现手足肿胀。症状或消退或加重,三五天稍好,或三五天后复发,也以小便通利与否为征兆。逐渐积聚会变成严重肿胀。妇女患此病,情况大致相同。凡是患此病,让人腹胀烦闷,胸部气急。这是由于肺胀,严重时喘息如牛吼叫,坐卧行走站立都无法忍受。或者半夜后气攻胸,心脏肿胀的,一年两年后死亡,有一个月两个月死亡的。如果调养失当,误食毒物,五到十天就会加重。庸医多以针灸放水为功效,又用鲤鱼、赤小豆做药,又让病人喝黄牛尿,服用商陆根,反而造成损害,很少有痊愈的。大抵此病,尤其忌讳针灸。华佗说:患水病,未遇到良医之前,不得进行针灸。因为气在膜外,已经化为水,水流出就会引出腹中的气,水尽则人死。扁鹊说:水病在膜外,普通药物不可治疗,只有神针和良药才行。有此病的人,宜面向阳光行走坐卧,遇到阴雨天气则更加觉得壅滞。房中常须保留火种取暖。服药后夜间睡觉,觉得胸口很热,宜含服红雪和好茶之类。千万不要饮酒,以及冷茶水。如果口渴宜喝五灵脂汤,方剂记录在卷后。尤其忌讳盐、生冷、醋、滑腻食物。
防己汤(出自《圣济总录》)治疗膜外气、水病,不限患病时间长短。症状为全身严重肿胀、气喘。
处方:防己、大戟、木香、赤茯苓(去黑皮)、海藻(洗净)、犀角(锉碎)、胡椒、白术、葶苈子、防风(去芦头)、槟榔(各一两)。以上药材必须用新采的药物,锉碎称重。
用法:每次用水二升,煎至一升,去渣温服。
若腹中实者,到了中午就会转泻,应用盆承接验证,必有恶浊黄水,或恶浊青黑物排出。这是气化作用导致的泻下,如果不甚困倦,切勿止泻,必定会自行停止。如果觉得乏力,就用平常喝的浆粥来补益。
服用一剂后,就根据此法继续服用。据郁子先生所说,服用第一剂则病减半,至第二剂则……(原文此处有缺漏,意为疗效显著)。多次试验,对于极重的患者,早晨服用一剂晚上就已痊愈。根本深的患者,服药当天肿胀消退能起床,只是感觉小腹……(原文此处有缺漏,意为仍有不适),需要后续药剂去除余邪。药渣千万不要丢弃,用布袋装好,悬挂在通风处。日后如果觉得微微有发作迹象,则再次使用。郁子先生说,家中若有此药渣,悬挂在门口,一家之中不会患疫气。此饮不仅治病,凡气病皆可治之。如果患肺气病,不限时间长短,在此药二十味中,减去大黄及诃黎勒,以童子小便煎煮,每日空腹服用,可去病根。有患肺气困重者,因逢患水气之人,永不再发。有人一生患香港脚(足痛风/下肢水肿),时时冲心,服用此饮也能除根。以此类推,只要是气病都可治疗。产妇及孕妇服用也无妨。小儿及老人随意加减剂量。痊愈后宜服用顺气丸。
顺气丸(出自《圣济总录》)治疗水气。
处方:防己(一两半)、大黄(二两半)、犀角(镑片)、诃黎勒皮、牵牛子、赤茯苓(去黑皮)、葶苈子(炒)、陈皮(去白)、防风。
用法:研末,炼蜜为丸,如梧桐子大。每服十丸,空腹米饮送下。
体气轻健即停药。患香港脚的人,常备此药,出行以备急用。服用前文所述汤剂痊愈后,百日内,宜服用五灵汤。
五灵汤(出自《圣济总录》)治疗水气。
处方:诃黎勒皮、木通(锉碎)、赤茯苓(去黑皮)、防己(锉碎)、陈橘皮(汤浸去白焙干,各一两)。
用法:捣筛为散。
(注:原文此处似有缺漏,通常应为煎服方法,如每服三钱,水一盏,煎至七分,去渣温服。)
十水丸(出自《圣济总录》)治疗膜外水气身肿。
处方:泽漆(去苗土)、大戟(微炒)、连翘、葶苈子(纸上炒)、甘遂(微炒)、芫花(醋浸……尽一两,原文此处可能有缺字,指炮制程度或用量)。
用法:上药为末,炼蜜为丸,如梧桐子大。
泽漆丸(出自《圣济总录》)治疗膜外水肿。
处方:泽漆(微炒一两)、水银(炼制)、葶苈子(纸上炒)、大戟(微炒锉碎)、郁李仁(汤浸去皮尖炒)、枳壳(麸炒去瓤)。
用法:研末,炼蜜为丸,如梧桐子大。空腹米饮送下十丸,未通便加至十五丸。
牛李子丸(出自《圣济总录》)治疗膜外水气。
处方:牛李子(炒)、吴茱萸(水浸一夜炒干)、青橘皮(去白炒,各半两)、杏仁(汤浸去皮尖双仁炒,半两)。
用法:研末,炼蜜为丸,如梧桐子大。每服三丸,米饮送下。
白牵牛散(出自《圣济总录》)治疗膜外气。
处方:白牵牛(炒)、青橘皮(去白焙炒)、木通(锉碎,各一两)。
用法:上药为末。每服一钱匕,煎生商陆汤送下。
甘遂饼(出自《圣济总录》)治疗膜外水气。
处方:甘遂、大麦面(各半两)。
用法:上药为末,以水和作饼子烧熟。热食之。如不利(未通便),以熟饮投之。如利(已通便),……(原文此处可能有缺字,意指停止服用或观察)。
The *Shengji Zonglu* states: Various medical texts discuss water diseases (Edema) in great detail, yet none have ever mentioned "Qi outside the Membrane" (Membrane-bound Qi disorder). During the Tianbao era of the Tang Dynasty, a monk named Yu Zi began to write about kidney-related pathologies. This disease causes bodily weakness and distension, with fullness and swelling of the four limbs that leave an indentation when pressed. In his discussion on the origin of this disease, Yu Zi stated that "Qi outside the Membrane," also referred to as "Water Qi," originates from other ailments and its presentation is unpredictable. It may arise from malaria, wind-stroke affecting the Kidney organ, cold injury to the Lung or Intestines, Qi stagnation above the diaphragm, strenuous travel in extreme heat, or improper consumption of alcohol and meat. The pathology begins in the Lung and concludes in the Kidney; it may also result from coughing, excessive phlegm and saliva, or the accumulation and obstruction of cold Qi, causing Lung Heat to attack the Heart, or Kidney Cold failing to transform fluids, allowing them to flow into the Bladder. The lesion lies outside the membrane of the Large Intestine, making it difficult to detect via pulse diagnosis and inaccessible to acupuncture. Generally, the Kidney is the root of life and must not be deficient. If the root is solid, the branches flourish; if deficient, they wither easily. Moreover, the waxing and waning of the four seasons all depend on the Qi of the Kidney. Damage to the Kidney leads to the decline of the Five Zang organs, resulting in weak Stomach function and Spleen failure to transport, Qi knotting, and dysuria. The severity of the condition is reflected in urination and defecation. If urination is obstructed, Qi becomes stagnant, attacks the abdomen, breaks through the membrane, transforms into fluid, and causes edema of the hands, feet, head, and face. Mild obstruction of urination and defecation causes mild swelling; severe obstruction causes severe swelling; complete obstruction leads to generalized massive edema within three days. In critical cases, the external genitalia also swell. There are two types of genital edema: one where urine flows spontaneously despite swelling, and another where urination is severely obstructed. Swelling extending from the glans penis to the lower abdomen and umbilicus indicates a fatal prognosis. The swelling in this disease is variable: it may start in the face, hands, or feet; or begin with slight swelling in the waist and ribs; or manifest initially in the extremities. Symptoms may subside or worsen, improving slightly after three to five days, or recurring after a similar period, depending on the patency of urination. Gradually, it develops into massive edema. Women suffering from this disease present similarly. Patients experience abdominal distension, irritability, chest tightness, and shortness of breath due to Lung distension. In severe cases, wheezing resembles a bull's bellowing, preventing sitting, lying down, walking, or standing. If Qi attacks the chest at midnight, causing Heart swelling, death may occur within one to two years, or even one to two months. Improper care or ingestion of toxic substances can exacerbate the condition within five to ten days. Quack doctors often claim success by draining fluid via acupuncture, using Carp and Adzuki Beans as medicine, or instructing patients to drink cattle urine and consume Phytolacca radix (Shanglu), which often causes harm rather than cure. Recovery is rare. This disease particularly contraindicates acupuncture. Hua Tuo stated: For water diseases, do not use acupuncture unless treated by a qualified physician. Since the Qi is outside the membrane and has transformed into water, draining the water draws out the abdominal Qi; once the Qi is exhausted, death ensues. Bian Que stated: Water disease located outside the membrane cannot be treated with ordinary medicines; only divine acupuncture and potent herbs are effective. Patients should sit or walk facing the sun; cloudy or rainy weather exacerbates stagnation. Keep fire sources available for warmth. After taking medication, if one feels intense heat in the chest during sleep, holding Red Snow (a traditional cooling preparation) or good tea may help. Avoid alcohol and cold tea. If thirsty, drink Wulingzhi Decoction (formula recorded at the end of the volume). Strictly avoid salt, raw/cold foods, vinegar, and slippery/greasy foods.
**Fangji Tang** (from *Shengji Zonglu*) treats Membrane-bound Qi disorder and water disease, regardless of duration. Indications include massive edema and panting.
Ingredients: Fangji (*Stephaniae Tetrandrae Radix*), Daji (*Euphorbiae Pekinensis Radix*), Muxiang (*Aucklandiae Radix*), Chifuling (*Poria Cocos cum Ligno*, black skin removed), Haizao (*Sargassum*), Xijiao (*Rhinocerotis Cornu*, shaved), Hujiao (*Piperis Longi Fructus*), Baizhu (*Atractylodis Macrocephalae Rhizoma*), Tinglizi (*Lepidii Semen seu Descurainiae Semen*), Fangfeng (*Saposhnikoviae Radix*, awn removed), Binglang (*Arecae Semen*). Each ingredient weighs 1 liang.
Preparation: Use freshly harvested herbs. Coarsely crush and weigh.
Administration: Decoct with 2 sheng of water until 1 sheng remains. Strain and take warm.
If the abdomen is full, diarrhea will occur around noon. Observe the excrement in a basin; foul yellow water or dark green-black matter will be discharged. This is the result of Qi transformation leading to purgation. If the patient is not excessively weakened, do not stop the diarrhea; it will cease spontaneously. If fatigue occurs, replenish with normal gruel.
After one dose, continue according to this method. According to Mr. Yu Zi, the first dose reduces symptoms by half. Repeated trials show that for extremely severe cases, morning administration leads to recovery by evening. For deep-rooted cases, swelling subsides and the patient can rise on the day of administration, though minor abdominal discomfort may persist, requiring subsequent doses to clear residual pathogens. Do not discard the dregs; store them in a cloth bag and hang in a ventilated area. If slight recurrence occurs later, reuse them. Yu Zi claimed that hanging these dregs at the household entrance prevents epidemic Qi within the family. This decoction treats various Qi disorders. For Lung Qi disorders, modify the twenty ingredients by removing Dahuang (*Rhei Radix et Rhizoma*) and Helile (*Terminalia Chebulae Fructus*). Decoct with urine from an uncircumcised boy. Take on an empty stomach daily to eradicate the root cause. For severe Lung Qi distress caused by exposure to water-disease patients, permanent cure is possible. For lifelong Hong Kong Foot (podagra/chronic lower limb edema) with upward rushing sensation to the heart, this decoction removes the root. By analogy, it treats all Qi disorders. It is safe for postpartum women and pregnant women. Dosage for children and the elderly should be adjusted. After recovery, take Shunqi Wan (Regulate Qi Pill).
**Shunqi Wan** (from *Shengji Zonglu*) treats Water Qi.
Ingredients: Fangji (1.5 liang), Dahuang (2.5 liang), Xijiao (shaved), Helilepi (skin of *Terminalia chebula*), Qianniu (Morning Glory Seed), Chifuling (black skin removed), Tinglizi (stir-fried), Chenpi (orange peel, white pith removed), Fangfeng.
Preparation: Powder, mix with honey, form pills the size of tung tree seeds.
Administration: Take 10 pills with rice water on an empty stomach. Stop when body feels light and vigorous. Patients with Hong Kong Foot should keep this remedy handy for emergencies. After recovering from the previous decoction, take Wuling Tang within 100 days.
**Wuling Tang** (from *Shengji Zonglu*) treats Water Qi.
Ingredients: Helilepi, Mutong (*Akebiae Caulis*), Chifuling (black skin removed), Fangji (coarsely crushed), Chenju pi (orange peel, soaked in water, white pith removed, dried, each 1 liang).
Preparation: Coarsely grind and sieve.
(Administration details appear missing in the source text, typically implying decoction and oral intake.)
**Shishui Wan** (from *Shengji Zonglu*) treats Membrane-bound Water Qi with generalized edema.
Ingredients: Zeqi (*Phytolaccae Radix*, roots and soil removed), Daji (lightly stir-fried), Lianqiao (*Forsythiae Fructus*), Tinglizi (stir-fried on paper), Gansui (*Kansui Radix*, lightly stir-fried), Yuanhua (*Genkwa Flos*, vinegar-soaked... amount specified as 1 liang processed).
Preparation: Powder, mix with honey, form pills the size of tung tree seeds.
**Zeqi Wan** (from *Shengji Zonglu*) treats Membrane-bound Edema.
Ingredients: Zeqi (lightly stir-fried, 1 liang), Shuiyin (Refined Mercury), Tinglizi (stir-fried on paper), Daji (lightly stir-fried and crushed), Yuliren (*Pruni Semen*, soaked in water, skin and twin kernels removed, stir-fried), Zhike (*Aurantii Fructus Percarpium*, bran-fried, core removed).
Preparation: Powder, mix with honey, form pills the size of tung tree seeds.
Administration: Take 10 pills with rice water on an empty stomach. Increase to 15 pills if no bowel movement occurs.
**Niuzi Wan** (from *Shengji Zonglu*) treats Membrane-bound Water Qi.
Ingredients: Niuzi (stir-fried), Wuzhuyu (*Evodiae Fructus*, soaked in water overnight, stir-fried dry), Qingju pi (green orange peel, white pith removed, stir-fried, each 0.5 liang), Xingren (*Armeniacae Semen Amarum*, soaked in water, skin and twin kernels removed, stir-fried, 0.5 liang).
Preparation: Powder, mix with honey, form pills the size of tung tree seeds.
Administration: Take 3 pills with rice water.
**Baiqianniu San** (from *Shengji Zonglu*) treats Membrane-bound Qi.
Ingredients: Baiqianniu (stir-fried), Qingju pi (white pith removed, baked and stir-fried), Mutong (coarsely crushed, each 1 liang).
Preparation: Powder.
Administration: Take 1 qianbi (approx. 3-5 grams) per dose, washed down with decoction of fresh Phytolacca root (*Shanglu*).
**Gansui Bing** (from *Shengji Zonglu*) treats Membrane-bound Water Qi.
Ingredients: Gansui, Damaimian (Barley flour, each 0.5 liang).
Preparation: Powder, mix with water to form cakes, bake until cooked. Eat hot. If no laxative effect, take with warm cooked liquid. If laxative effect occurs... (text incomplete).
**Formula for Membrane-bound Qi and Qi Masses.**
Ingredients: Yanhusuo (*Corydalis Rhizoma*), quantity unspecified, ground to powder. One pig pancreas, cut into pieces, roasted/grilled. Dip the meat into the powder and eat.