肿胀之治，凡脾肾虚证，如前论所列薛氏肾气汤者，诚然善矣，然用之之法，犹当因此
廓充，不宜执也。向余尝治一陶姓之友，年逾四旬，因患伤寒，为医误治，危在呼吸，乃以
大剂参、附、熟地之类，幸得挽回。愈后喜饮，未及两月，忽病足股尽肿，胀及于腹，按之
如鼓，坚而且硬，因其前次之病，中气本伤，近日之病，又因酒湿，度非加减肾气汤不
可治，遂连进数服，虽无所碍，然终不见效，人皆料其必不可治。余熟计其前后，病因本属
脾肾大虚，而今兼以渗利，未免减去补力，亦与实漏卮者何异，元气不能复，病必不能退。
遂悉去利水等药，而专用参附理阴煎，仍加白术，大剂与之，三剂而足胫渐消，二十余剂而
腹胀尽退，愈后人皆叹服，曰∶此证本无生理，以此之胀，而以此之治，何其见之神也。自
后凡治全虚者，悉用此法，无一不效，可见妙法之中，更有妙焉，顾在用者之何如耳。塞因
塞用，斯其最也，学人当切识此意。
一、因食滞气痛胀∶余尝治一姻家子，年力正壮，素日饮酒，亦多失饥伤饱。一日偶因
饭后胁肋大痛，自服行气化滞等药，复用吐法，尽出饮食，吐后逆气上升，胁痛虽止，而上
壅胸膈，胀痛更甚，且加呕吐。余用行滞破气等药，呕痛渐止，而左乳胸肋之下，结聚一块
，胀实拒按，脐腹隔闭，不能下达，每于戌、亥、子、丑之时，则胀不可当。因其呕吐既止
，已可用下，凡大黄、芒硝、棱、莪、巴豆等药，及萝卜子、朴硝、大蒜、橘叶捣罨等
法，无所不尽，毫不能效，而愈攻愈胀，因疑为脾气受伤，用补尤觉不便，汤水不入者凡二
十余日，无计可施，窘剧待毙，只得用手揉按其处。彼云肋下一点，按着则痛连胸腹，及细
为揣摸，则正在章门穴也。章门为脾之募，为脏之会，且乳下肋间，正属虚里大络，乃胃气
所出之道路，而气实通于章门，余因悟其日轻夜重，本非有形之积，而按此连彼，则病在气
分无疑也。但用汤药，以治气病，本非不善，然经火则气散，而力有不及矣。乃制神香散，
使日服三四次，兼用艾火灸章门十四壮，以逐散其结滞之胃气，不三日胀果渐平，食乃渐进
，始得保全，此其证治俱奇，诚所难测。本年春间，一邻人陡患痛胀隔食，全与此同，群医
极尽攻击，竟以致毙，是真不得其法耳，故录此以为后人之式。
治疗肿胀病，凡是脾肾虚证，像前文论述中提到的薛氏肾气汤那样，确实是很好的方法，然而使用它的方法，还应当因此加以扩充变化，不应当拘泥固执。
从前我曾治疗一位姓陶的朋友，年龄超过四十岁，因为患伤寒，被医生误治，生命垂危在呼吸之间，于是用大剂量的参、附子、熟地黄之类的药物，侥幸得以挽回。痊愈后喜欢饮酒，不到两个月，忽然出现足部和腿部全部浮肿，胀气波及腹部，按压时像鼓一样，坚硬而且硬，因为他之前的病，中气本来受伤，最近的病，又因为酒湿，估计非加减肾气汤不可治疗，于是连续服用几剂，虽然没有什么妨碍，但最终不见效果，人们都预料他必定无法治愈。我仔细考虑前后的情况，病因本属于脾肾大虚，而现在兼用渗利（利尿）的药物，未免减少了补益的力量，这跟实心的漏卮（古代盛酒的器具，底部有孔）有什么不同呢？元气不能恢复，病必定不能消退。于是完全去掉利水等药物，而专门使用参附理阴煎，仍然加入白术，用大剂量给他服用，三剂之后足胫逐渐消肿，二十多剂之后腹胀完全消退，痊愈后人们都赞叹佩服，说：“这个病本来没有生机，用这种肿胀的病，用这种治疗方法，为什么见解如此神奇呢。”从此以后凡是治疗全虚证的，全都用这种方法，没有一例不生效的，可见妙法之中，还有更妙的，只在于使用者如何运用罢了。塞因塞用（以补开塞），这是最极致的了，学习的人应当深切认识这个意思。
一、因为食滞气痛胀：我曾经治疗一个姻亲家的儿子，年纪力壮，平时喝酒，也经常饥饱不均。一天偶然因为饭后胁肋部剧烈疼痛，自己服用行气化滞等药物，又用催吐法，把饮食全部吐出，吐后逆气上升，胁痛虽然停止，但上壅胸膈，胀痛更加严重，并且加上呕吐。我用行滞破气等药物，呕吐疼痛逐渐停止，但是左乳胸肋之下，结聚一块，胀实拒按，脐腹隔闭，不能下达，每当戌、亥、子、丑这几个时辰，就胀得难以忍受。因为呕吐已经停止，已经可以用下法，凡是大黄、芒硝、三棱、莪术、巴豆等药物，以及萝卜子、朴硝、大蒜、橘叶捣碎外敷等方法，无所不用，丝毫不能见效，而且越攻伐越胀，于是怀疑是脾气受伤，用补药尤其觉得不便，汤水不进已经有二十多天，没有办法，窘迫危急等待死亡，只得用手揉按其部位。他说肋下一点，按着则痛连胸腹，等到仔细揣摩，则正好在章门穴。章门是脾的募穴，是脏的会穴，而且乳下肋间，正属于虚里大络，是胃气所出的道路，而气实通于章门，我因此悟到它白天轻晚上重，本来不是有形的积块，而按这里牵连那里，那么病在气分毫无疑问。只是用汤药，来治疗气病，本来不是不好，然而经过火（艾灸）则气散，而力量有所不及了。于是制作神香散，让每天服用三四次，同时用艾火灸章门十四壮，来逐散其结滞的胃气，不到三天胀果然逐渐平复，饮食才逐渐进步，才得以保全，这个病症和治疗都很奇特，确实难以预测。本年春天，一个邻居突然患痛胀隔食，完全与此相同，众医生极尽攻伐攻击，竟然导致死亡，这真是没有得到正确的方法罢了，所以记录这个作为后人的榜样。
The treatment of distension and edema, for cases of Spleen and Kidney deficiency as listed in the previous discussion such as Xue's Shenqi Decoction (Kidney Qi Decoction), is indeed excellent; however, the method of its application should be expanded upon accordingly, rather than being applied rigidly.
Previously, I treated a friend surnamed Tao, who was over forty years old. Having contracted Cold Damage (Shanghan) and been mismanaged by other physicians, his life hung in the balance. I used large doses of Ginseng (Renshen), Aconite (Fuzi), and Prepared Rehmannia Root (Shudihuang), among others, and fortunately he was rescued. After recovery, he developed a preference for drinking alcohol. Within two months, he suddenly presented with complete swelling of the legs and thighs, with distension extending to the abdomen. The area felt drum-like upon palpation, hard and firm. Given that his previous illness had already damaged his Middle Qi (Zhong Qi), and his recent condition was exacerbated by dampness from alcohol, I judged that a modified Shenqi Decoction was necessary. I administered several doses consecutively. Although there were no adverse reactions, there was ultimately no effect. Others predicted he would certainly not survive. Upon careful consideration of the antecedents, the root cause was severe Spleen and Kidney deficiency. By adding diuretic and leaching agents (Shenli), I inadvertently diminished the tonifying power, which is akin to pouring water into a leaky vessel. Without the restoration of Yuan Qi (Primordial Qi), the disease could not recede. Therefore, I completely removed the diuretic herbs and exclusively prescribed Shenfu Liyin Decoction (Ginseng and Aconite Decoction to Nourish Yin), adding Atractylodes Macrocephala Rhizome (Baizhu). Administered in large doses, after three doses, the swelling of the lower legs gradually subsided; after more than twenty doses, the abdominal distension completely resolved. Upon recovery, everyone marveled and said, "This case seemed hopeless; treating this type of distension with this method—how miraculous your insight is!" Since then, for all cases of total deficiency, I have employed this method without exception, achieving full efficacy. This demonstrates that within excellent methods, there are even subtler ones, depending entirely on the practitioner's skill. The principle of "treating obstruction with tonification" (Sai Yin Sai Yong) is the ultimate approach here; students must deeply understand this meaning.
1. Distension due to food stagnation and Qi pain: I once treated the son of a relative by marriage. He was in the prime of youth but frequently drank alcohol and suffered from irregular eating habits, often skipping meals or overeating. One day, following a meal, he experienced severe pain in the hypochondrium. He self-medicated with Qi-moving and stagnation-resolving herbs and underwent emesis, expelling all food. After vomiting, rebellious Qi rose upward. Although the hypochondriac pain ceased, the Qi obstructed the chest and diaphragm, causing severe distension and pain, accompanied by vomiting. I used Qi-moving and Qi-breaking herbs, which gradually stopped the vomiting and pain. However, a lump formed under the left breast and rib cage, feeling distended, solid, and tender to pressure. There was obstruction in the umbilical and abdominal regions, preventing downward movement. During the Xu, Hai, Zi, and Chou hours (9 PM to 3 AM), the distension became unbearable. Since vomiting had ceased, purgative therapy was indicated. I exhausted all methods using Cathartic Rhizome (Dahuang), Mirabilite (Mangxiao), Burreed Tuber (Sanleng), Curcuma Rhizome (Ezhu), Croton Seed (Badou), Radish Seed (Luobozhi), Mirabilite, Garlic, and crushed Tangerine Peel poultices, yet achieved no effect. The more I attacked, the more the distension increased. Suspecting damage to Spleen Qi, I found tonification difficult as he could not tolerate any liquid intake for over twenty days. In desperation, awaiting death, I manually palpated the affected area. He pointed out a specific spot under the rib where pressing caused pain radiating to the chest and abdomen. Upon careful examination, this point corresponded exactly to Zhangmen (LR13). Zhangmen is the Front-Mu point of the Spleen and the Hui-Sea point of the Zang organs. Furthermore, the area below the breast and between the ribs corresponds to the Xuli collateral, the pathway through which Stomach Qi emerges, connecting strongly with Zhangmen. I realized that the symptom pattern of being milder during the day and heavier at night was not due to a tangible accumulation, but rather, the pain radiating upon pressure confirmed the pathology was in the Qi level. While decoctions for Qi disorders are generally appropriate, heat therapy disperses Qi, potentially lacking sufficient force. Therefore, I formulated Shenxiang San (Divine Fragrance Powder) for him to take three to four times daily, combined with moxibustion on Zhangmen (LR13) for fourteen moxa cones. This dispersed the stagnant Stomach Qi. Within three days, the distension gradually subsided, and appetite slowly returned, ensuring his survival. Both the presentation and treatment were unusual and difficult to predict. Earlier that spring, a neighbor suddenly suffered from painful distension and food blockage identical to this case. Despite various physicians employing aggressive attacking methods, he died. This was truly due to a lack of proper methodology. I record this case as a model for future practitioners.