吕东生，住德州城内八仙庙街，年三十馀岁，此余友也。是时与余同客湖北，有肺病，于民国九年，忽患大吐血，衰弱殊甚，血止后，心脏衰弱症象大作，诊脉右手细微已极，左手无脉，每隔数分钟，即觉心脏突突跳动，渐渐喘促，失眠，忐忑次数，愈来愈急，心脏将停，询悉曾自服自来血旬馀，毫无效力，症势危笃，以致于此，乃以大补气血之剂与之。服三剂后症象稍轻，左手现结脉，右手现芤脉。原方列下：大台参八钱炙黄芪八钱当归身一两炒枣仁四钱柏子仁四钱龙眼肉四钱炙甘草二钱煎妥二杯分六次一日夜服完。此方服三剂，即见大效，以后共服十六剂，痊愈。但服过五剂以后，药量渐减，以次递减，至全量之半为止，服药之法，亦照蔡姓方法，以次渐减。不可骤然停止服药。
某年见报载段祺瑞先生在沪因大吐血后，患心脏衰弱症极危，经西医用输血法治愈。细审病状即此症，若以此中药治之，百无一失。输血之法，繁重不赀，非普通病家所能办到，亦非普通医院所能办理。吾国自有天然妙药，即本方惜为不关紧要之杂说、杂药所纷乱，例如天王补心丹、孔圣枕中丹等，试之均不验，而此数味良药，即埋藏于此成方之内，余经过若干年之抉择，始得搜寻而出，故特定为治此症之主方表而出之，以告世人过信古人及偏重西医者。
肿胀（五）肿胀（俗名臌症）此指久病虚证之肿胀而言，凡新得实证肿胀，不在此例。
正原因）大病之后，或身体素弱，心脏、肾脏、肺脏、肝脏血行障碍，皆能致此症。俗名臌症而中医注重脾胃失运，寒湿为病，实有精义，此论已中肿胀之的。肺痨病之末期，亦有肿症，不在此例。此症中医主张温补、渗利，与气化之说，互相阐明，有不可思议之妙。余本此理论，治愈极重之肿胀，不知凡几，胜于西药万倍，愿学者注意及之。
（症候）身体衰弱，四肢畏冷，不喜饮水，小便短少，大便不爽，或溏或秘结，胸腹胀闷，渐即咽干、口燥、鼻干，反觉热气上冲，手足浮肿，再重则面目口唇及腹部全肿男子肾囊亦肿，脐部突出或有呕恶，甚则全身浮肿光亮，气喘或有或否，痰饮，肋下恒觉有水潴留，日渐衰弱，不能卧下，皮肤用手按下，凹形不能立时恢复，卒致心脏麻痹而死。西医论脚气症，其浮肿征象，亦与此略同，然非一症，不可不知。
（治法）西医维他命疗法，内服及注射，亦辄效。余曾试验若干次，但非济以中药，不能完全收功，利尿疗法及穿腹术俗称放水，虽一时有效，然非根本治法，亦非善策。中医对此症，曰风、曰寒、曰热、曰湿、曰痰、曰蛊，曰阴水、阳水、曰气分、血分。其治法，则有汗法、有泻法、有补法、有分利、有消导，立方纷杂，故设疑阵，后之人一遵古法，按病施治，百无一生。余见此症之误于汗，误于泻而死者，不知凡几，故敢痛切言之。其实此症中医极有效之治法，仅有补脾胃、扶阳气以固其本，参以渗利以治其标，数语足以概之，第搀入种种说法，种种杂药，则失其效耳。余不敏，四十年来，遇此症不知凡几，其稍轻者，均以余之认定补脾、和胃、渗利六字而治愈，其最重者，则以中西药并用，无不愈者。参看医验。
此病即俗名最可畏之臌症，皆系久病，注意久字为要非新得热性病暴肿可比，亦非仅西医所称之脚气病浮肿，乃周身水分，因全体衰弱已极，热力消失，无自然排泄蒸发之能力所致。治疗稍不得法，必能断送生命之一大危险症也。此症初起，只有手足轻微之浮肿，或肿或消，饮食动作，一如常人。此时期在病者既不认为重症，医者亦多淡漠视之，不加注意，殊不知此可畏之死症，即于此漫不介意之中，而演进不止。迨至病势加重，肿胀不消，或肿过胸腹，或四肢皆肿，男子肿及肾囊，女人肿至头面者，已至危候，症多不治。则种种变相，注意变相二字，最足令医者虚实不分，寒热不分，一入此迷途，杀人之速，易如反掌。继续而来。拘泥古说之中医，若缺乏多年之经验，精锐之眼光，坚固不拔之魄力，遇此场合，则中医历来误人之玄虚学说，似是实非之治法，游离脑际，乘机而来，稍一不慎，此际必受古人之仲种谬说所迷惑。中医大缺点即在此处。若见病者大便干燥，小便又短赤，鼻干、口干、舌有薄苔，咽喉恒觉热气上冲，舌且红而起泡，口渴不思饮水，则必疑为湿，疑为热，而欲一试其泻下法耶，一试其分利法耶，一言以蔽之，必无效也。若见病者咳嗽痰不出，且无唾、无汗、无泪，小便赤短而味特臊，头晕而痛，呕吐不能食，一闻有味之物即便呕吐。大便或微溏，—、日二、三次或燥，或腹痛腹鸣，呃气不出，则又疑为风、疑为寒、疑为热、疑为上实下虚，而欲一试其发汗法耶，一试其补泻兼施法耶，一试其开胃理脾法耶，一言以蔽之，必无效也。夫现某症状，用某古方，何以不效？曰古方误人，不只臌症一端也，此症古方纷纭，古论庞杂，余之试验者，已四十馀年矣，确知古方对此症，分利、消导、顺气、祛湿、祛热，虽不中病，尚不致于立伤人命，惟有泻下及发汗二法，明明系治实证肿胀之方，若误用于久病脉细微之虚肿虚胀，未有不致人于死者，此非古人误今人，实则庸医缺乏真正学识误病家耳。汗下二法，皆治实证肿胀，岂可以治久病之虚证，学者须切识此言，自不致再受古人风寒、湿热、阴水、阳水之迷惑矣。
此症既至危笃，必然变相百出，医者若无真实经验，不易决定虚实寒热，生死关头即在于此。实则久病虚肿，无论现何脉症，均按虚治，适用中医大补元阳之法，及西医之收敛治法，有泄泻者，维他命疗法，无不百发百中，万无一失。此余历经实验，绝无一字虚伪也。例如此症既现小便短赤，附子一味又明明有收缩小便之力，用此治疗，看似药病相反，绝非所宜。然非用此药，不能斡旋人身已失去之元阳，蒸动将死之水气，故加此味于补脾补肾之汤剂内，放胆与服，数剂而后，小便反多而且清白，此中妙谛，非经过多年实验者，不能知之，故余坦白记述也。本病变相，最易令人迷惑者，即是种种现症，巳将虚象掩去，若只见症论症，则此时病变，已非本来面目，又焉得不迷惑犹疑耶？盖病患至此阶段，除肿胀现象，日甚一日外，馀如小便短赤而臊，呕恶，略闻有异味即便呕吐，且呃气不能出。口舌糜烂，呈鲜红色，舌上起泡，口干，但不喜饮水。喉内灼热，恒觉有热气由喉内上冲类似冒烟。胸满壅塞，恒觉胸内壅肿闷塞，一齐上涌。口干无；唾，肺干无痰，目干无泪，鼻干无涕，皮下无汗，一切津液均闭塞不通，大便溏亦有燥者或泄泻，心悸不眠，头晕头重，以上种种疑似实证之现象，不即不离，最易令缺乏经验之医者，举棋不定，虚实混淆，此症生死关键，即系于此。似实似虚之间，医者遇此重症之肿胀，须以十二分之毅力，认定阳虚衰弱，纯为虚寒，血行障碍，水失气化之所致，一切似是实证之点，皆系假象，万不可被其迷惑。中医气化之说，精妙绝伦，纯粹适用于此种之肿胀，绝非西医腹水及脚气等说所能及。是以中医之补阳、补气、补脾、温肾、渗利等法，为根本治疗此症之唯一原则，若再参以西医之收敛疗法，此症有泄泻者适用之，参看后列赵姓医案自明。利尿疗法，用否不关重要，防有流弊，且有一用利尿剂病反加据者，不可不知。维他命疗法，此法最效，中医应采用之．但单独用此法，不能完全有效，故须参用中药也。则此可畏之臌症，必能根本治愈。但病势太重，有时只用中药，或只用西药，往往各有困难，不能即收速效。此句不知经若干年之试验，始确知其如此也。故余对此症，主张中西药互用，病至极重时，万不可试服一、二剂无效，医者即心无所上，改变治疗方针，则大误矣。相济为功，中西药互用之法，除本编所载之医验数方外，学者万不可任意互用，以免危险。必能使一切似实似热之假现象，渐渐退去。而后病者阳气恢复，始能重新蒸动周身内外分泌，使其全部脏腑皮肤，均有排泻水分之能力，则一切津液自通，例如小便、唾、涕等。诸症悉去。口有津液，小便亦多矣。而血行通畅，全体各分泌作用，渐渐恢复，使水分照常排泻于体之内外。注意此内字，盖内分泌之停止，为害更甚于外分泌也。是以此症治疗有效之第一佳兆，即是尿量增加，涕、唾、汗、泪等，一律可以自然发出，血管内不留水分，组织内不留水分，则肿症尽消矣。此病理经过四十馀年之实验，反复讨论始敢确定，望学者勿忽视也，肿消后足痛胀不愈，中药牛膝有特效，分量约在五、六钱，虎胫骨亦可用。
此症中间治法，稍一犹疑，例如服药一、二剂，因病太重，未能见效，即疑药不对症，更换医生，或医者自信不坚，中途改变治疗方针之类，均足误事。必归失败，是以医者临诊疑难大症，要有真识定见，万不可存以药试病之心理，对此症用药之轻重缓急，先后次序，或中或西，均赖医者老练坚定之心手，与夫随机应变，极灵活之心思，起死回生，透视一切确知此症演变至何程度，而后可以与谈中医之神妙，而后可以与谈西医之科学，而后可以称为能治疾病之医。否则人云亦云，古今人均包括在内，必不能治疑难之大病也。
欲研此症之病理，第一即须明了中医气化之精妙理想，经络、脏腑、‘营卫，气血、阴阳、均包括在内。与夫西医之内外组织、分泌、脏器、血管、气管、淋巴、腺、膜等等之生理现象，须知此症向愈之道路，即是使病者身体，恢复其生活力，使其全身机关，一律蒸动活泼，内外通气，血流自然，则大病斯愈。
肿症至极重之时，往往患者自觉向左卧，则体内血液全沉于左侧，向右卧，则全沉于右侧，起立时则觉血液沉坠于两腿。即此现象，可以推知病者血流，已无自然循环流动之活力，一如注死水于皮囊之内，左倾则左注，右倾则右注，可上可下，可左可右，任人颠倒搁置．毫无知觉，毫无自动能力。高明有定见之医者，须一眼觇定，此血流何以不能自动，则必由于生活力之衰微已极。生活力何以衰微至此，则必由于全身神经衰弱已极，早失其知觉运动指挥命令之机能。所以肿病至极重之时，皮肤肌肉无论如何刺激，绝无感觉反应之可言，几如一块死肉，不知痛痒，不知麻木，知有麻木之时，病尚较轻也。皮肉以手按之，凹处不能自起，至此程度，九死一生矣。然治之得法，参照医验纵极危之症，余敢断言，必能有效，其病势好转之现象，始则渐渐感觉麻木痛痒，继则渐渐发生津液，继则四肢温润，皮肤柔和肿消胀去，不麻木，不痛痒，则健康恢复矣。
于此有一治疗本病最妙之真谛，即吾人体内之生活力，及神经赖以生存之热气是也，此热气不足则人弱，热气灭绝则人死。中医药内，唯一有效补助此热气之灵药，即属于大补元阳之方剂，此种方剂，求之西药，则难乎其难，故此症中医所以能挽回生命于危急之顷者，虽有时亦应借助于西药，然其主要方剂，实赖于此种特效之中药，则余敢断言也。
此症关系内外分泌之理，本系参以西医生理立论，亦应详为解说，以告学者。盖此症所以致肿之原因，即系病者内外分泌，渐渐闭塞，停止活动，以致周身水分一滴不能向外排泻，此外字包括脏腑而言所以眼泪、鼻涕、痰唾、汗液，一律闭止，小便亦非常减少，而色浓味臊，每日所饮食之水分，完全停留潴蓄于血管及各组织之内，有空隙松动之处潴留更多愈聚愈多，则内外皆肿。人但见外皮之肿，而不知内脏皆肿也。水无出路，渐向组织松懈处流聚，例如下腹部于是大部分停留于少腹部之下。西医放水之法，穿刺术纯系治标，旋放旋聚，无济于事，故不如中医之温补渗利，一面助其蒸发水分之热力，一面开除排泄水分之道路，标本兼治，百试百验，此中医对肿胀一症，所以有特长也。
此症俗名有臌症之称，西医书载此症有大便干燥现象，然此症亦有大便泄泻者不少，此余之实验谈也。盖因患者至极重时，腹部之肿胀特甚，其病理已如上述，然余既欲阐明中医气化二字，以为根本解决本症之前提，故不得不参合西医分泌生理言之，以资对照。此种生理，系根据科学，毫无可疑，学者须知此症，一方面为生理的不分泌，是以有以上无唾、无涕种种之干燥现象，另一方面为生理的不吸收，故又有液体郁滞，水分潴留体内之壅肿现象。盖分泌与吸收两机能作用不完全，而后演成此症，一言以蔽之，设非神经衰弱，气不蒸化，绝不致分泌与吸收失其平衡也，西医穿腹术俗称放水，为救济一时之法，不可不知。中医肿胀之说，包括于俗称之气臌、水臌。即合西医脚气病与腹水之通称，考西医腹水与脚气病，本系两症，原不可混为一谈，但此二症之原因于肾脏、肺脏、心脏之疾患，而生之血行障碍，因而诱起此二症者不少，且水肿性之脚气，其浆液膜腔亦有显著之蓄水，是二症自有其一部分共同之现象，医者须细心参考，自然运用中医气化之说，则有左右逢源之乐矣。腹水与脚气病理以限于篇幅均从略。
吕东生，居住在德州城内的八仙庙街，年龄三十多岁，是我的朋友。当时他与我一同客居湖北，患有肺病（肺结核）。在民国九年（1920年），他突然发生大量吐血，身体极度衰弱。血止之后，心脏衰弱（心力衰竭）的症状剧烈发作。诊脉时，右手脉搏极其细微，左手无脉。每隔几分钟，他就感到心脏剧烈跳动，逐渐出现气喘急促、失眠、心悸不安，且次数越来越急，感觉心脏即将停止跳动。经询问得知，他曾自行服用“自来血”（一种补血制剂）十几天，毫无疗效，病情危重至此。于是我用大补气血的方剂给他治疗。服用三剂后，症状稍见减轻，左手出现结脉（脉来缓慢而有不规则间歇），右手出现芤脉（浮大中空，如按葱管）。原方如下：大台参八钱，炙黄芪八钱，当归身一两，炒枣仁四钱，柏子仁四钱，龙眼肉四钱，炙甘草二钱。煎煮成两杯药汁，分六次在一昼夜内服完。此方服用三剂即见显著疗效，此后共服用十六剂，痊愈。但在服用五剂之后，药量逐渐减少，依次递减，直至减至全量的一半为止。服药的方法，也参照蔡姓患者的方法，逐渐减量。不可骤然停止服药。
某年看到报纸记载，段祺瑞先生在上海因大量吐血后，患心脏衰弱症，病情极危，经西医采用输血法治愈。仔细审视其病症表现，就是上述这种病症。如果用中药治疗，百无一失。输血之法，繁琐昂贵，不是普通病人所能做到的，也不是普通医院所能办理的。我国自有天然的妙药，就是这个方子，可惜被一些不关紧要的杂说、杂药所混淆。例如天王补心丹、孔圣枕中丹等，试用均不灵验。而这几味良药，就埋藏在这些成方之内。我经过若干年的抉择，才将其搜寻出来，所以特意定为治疗此症的主方，公布于世，以告诫那些过分迷信古人及偏重西医的人。
肿胀（五）：肿胀（俗称臌症）。这里指的是久病虚证引起的肿胀而言。凡是新得的实证肿胀，不在此例。
正原因：大病之后，或身体素来虚弱，心脏、肾脏、肺脏、肝脏的血行障碍，都能导致此症。俗称臌症，而中医注重脾胃失运、寒湿为病，实有精义，这一论述切中了肿胀的要害。肺痨病（肺结核）的末期，也有肿症，不在此例。此症中医主张温补、渗利，与气化之说互相阐明，有不可思议的妙处。我依据这一理论，治愈了极重的肿胀病例，不知凡几，效果胜过西药万倍，希望学者注意这一点。
（症候）：身体衰弱，四肢畏冷，不喜欢饮水，小便短少，大便不爽，或溏泄或秘结，胸腹胀闷，渐渐出现咽干、口燥、鼻干，反而觉得热气上冲，手足浮肿，再重则面目、口唇及腹部全部肿胀，男子肾囊亦肿，脐部突出。或有呕恶，甚则全身浮肿光亮，气喘或有或无，痰饮，肋下常觉得有水潴留，日渐衰弱，不能卧下，皮肤用手按下，凹形不能立即恢复，最终导致心脏麻痹而死。西医论述的脚气病（维生素B1缺乏症），其浮肿征象，也与此大致相同，然而并非同一病症，不可不知。
（治法）：西医的维他命疗法，内服及注射，也往往有效。我曾试验若干次，但如果不配合中药，不能完全收功。利尿疗法及穿腹术（俗称放水），虽然一时有效，但非根本治法，也不是良策。中医对此症，有风、寒、热、湿、痰、蛊、阴水、阳水、气分、血分之说。其治法，则有汗法、泻法、补法、分利、消导，立方纷杂，故设疑阵。后人一遵古法，按病施治，百无一生。我见此症误用汗法、泻法而死的，不知凡几，所以敢痛切言之。其实此症中医极有效的治法，仅有补脾胃、扶阳气以固其本，参以渗利以治其标，数语足以概括之。只是搀入种种说法、种种杂药，则失去疗效。我不才，四十年来，遇到此症不知凡几，其稍轻者，均以我认定的“补脾、和胃、渗利”六字而治愈；其最重者，则以中西药并用，无不愈者。参看医验。
此病即俗名最可畏的臌症，皆系久病，注意“久”字为要，非新得的热性病暴肿可比，亦非仅西医所称之脚气病浮肿。乃周身水分，因全体衰弱已极，热力消失，无自然排泄蒸发之能力所致。治疗稍不得法，必能断送生命的一大危险症也。此症初起，只有手足轻微之浮肿，或肿或消，饮食动作，一如常人。此时期在病者既不认为重症，医者亦多淡漠视之，不加注意，殊不知这可怕的死症，即于此漫不介意之中，而演进不止。迨至病势加重，肿胀不消，或肿过胸腹，或四肢皆肿，男子肿及肾囊，女人肿至头面者，已至危候，症多不治。则种种变相，注意“变相”二字，最足令医者虚实不分，寒热不分。一入此迷途，杀人之速，易如反掌。继续而来。拘泥古说之中医，若缺乏多年之经验，精锐之眼光，坚固不拔之魄力，遇此场合，则中医历来误人之玄虚学说，似是实非之治法，游离脑际，乘机而来，稍一不慎，此际必受古人之种种谬说所迷惑。中医大缺点即在此处。若见病者大便干燥，小便又短赤，鼻干、口干、舌有薄苔，咽喉恒觉热气上冲，舌且红而起泡，口渴不思饮水，则必疑为湿，疑为热，而欲一试其泻下法耶，一试其分利法耶？一言以蔽之，必无效也。若见病者咳嗽痰不出，且无唾、无汗、无泪，小便赤短而味特臊，头晕而痛，呕吐不能食，一闻有味之物即便呕吐。大便或微溏，一日二、三次或燥，或腹痛腹鸣，呃气不出，则又疑为风、疑为寒、疑为热、疑为上实下虚，而欲一试其发汗法耶，一试其补泻兼施法耶，一试其开胃理脾法耶？一言以蔽之，必无效也。夫现某症状，用某古方，何以不效？曰古方误人，不只臌症一端也。此症古方纷纭，古论庞杂，余之试验者，已四十馀年矣。确知古方对此症，分利、消导、顺气、祛湿、祛热，虽不中病，尚不致于立伤人命，惟有泻下及发汗二法，明明系治实证肿胀之方，若误用于久病脉细微之虚肿虚胀，未有不致人于死者。此非古人误今人，实则庸医缺乏真正学识误病家耳。汗下二法，皆治实证肿胀，岂可以治久病之虚证？学者须切识此言，自不致再受古人风寒、湿热、阴水、阳水之迷惑矣。
此症既至危笃，必然变相百出，医者若无真实经验，不易决定虚实寒热，生死关头即在于此。实则久病虚肿，无论现何脉症，均按虚治，适用中医大补元阳之法，及西医之收敛治法。有泄泻者，维他命疗法，无不百发百中，万无一失。此余历经实验，绝无一字虚伪也。例如此症既现小便短赤，附子一味又明明有收缩小便之力，用此治疗，看似药病相反，绝非所宜。然非用此药，不能斡旋人身已失去之元阳，蒸动将死之水气，故加此味于补脾补肾之汤剂内，放胆与服，数剂而后，小便反多而且清白，此中妙谛，非经过多年实验者，不能知之，故余坦白记述也。本病变相，最易令人迷惑者，即是种种现症，已将虚象掩去，若只见症论症，则此时病变，已非本来面目，又焉得不迷惑犹疑耶？盖病患至此阶段，除肿胀现象，日甚一日外，馀如小便短赤而臊，呕恶，略闻有异味即便呕吐，且呃气不能出。口舌糜烂，呈鲜红色，舌上起泡，口干，但不喜饮水。喉内灼热，恒觉有热气由喉内上冲类似冒烟。胸满壅塞，恒觉胸内壅肿闷塞，一齐上涌。口干无唾，肺干无痰，目干无泪，鼻干无涕，皮下无汗，一切津液均闭塞不通，大便溏亦有燥者或泄泻，心悸不眠，头晕头重，以上种种疑似实证之现象，不即不离，最易令缺乏经验之医者，举棋不定，虚实混淆，此症生死关键，即系于此。似实似虚之间，医者遇此重症之肿胀，须以十二分之毅力，认定阳虚衰弱，纯为虚寒，血行障碍，水失气化之所致，一切似是实证之点，皆系假象，万不可被其迷惑。中医气化之说，精妙绝伦，纯粹适用于此种之肿胀，绝非西医腹水及脚气等说所能及。是以中医之补阳、补气、补脾、温肾、渗利等法，为根本治疗此症之唯一原则，若再参以西医之收敛疗法，此症有泄泻者适用之，参看后列赵姓医案自明。利尿疗法，用否不关重要，防有流弊，且有一用利尿剂病反加据者，不可不知。维他命疗法，此法最效，中医应采用之．但单独用此法，不能完全有效，故须参用中药也。则此可畏之臌症，必能根本治愈。但病势太重，有时只用中药，或只用西药，往往各有困难，不能即收速效。此句不知经若干年之试验，始确知其如此也。故余对此症，主张中西药互用，病至极重时，万不可试服一、二剂无效，医者即心无所上，改变治疗方针，则大误矣。相济为功，中西药互用之法，除本编所载之医验数方外，学者万不可任意互用，以免危险。必能使一切似实似热之假现象，渐渐退去。而后病者阳气恢复，始能重新蒸动周身内外分泌，使其全部脏腑皮肤，均有排泻水分之能力，则一切津液自通，例如小便、唾、涕等。诸症悉去。口有津液，小便亦多矣。而血行通畅，全体各分泌作用，渐渐恢复，使水分照常排泻于体之内外。注意此内字，盖内分泌之停止，为害更甚于外分泌也。是以此症治疗有效之第一佳兆，即是尿量增加，涕、唾、汗、泪等，一律可以自然发出，血管内不留水分，组织内不留水分，则肿症尽消矣。此病理经过四十馀年之实验，反复讨论始敢确定，望学者勿忽视也。肿消后足痛胀不愈，中药牛膝有特效，分量约在五、六钱，虎胫骨亦可用。
此症中间治法，稍一犹疑，例如服药一、二剂，因病太重，未能见效，即疑药不对症，更换医生，或医者自信不坚，中途改变治疗方针之类，均足误事。必归失败，是以医者临诊疑难大症，要有真识定见，万不可存以药试病之心理，对此症用药之轻重缓急，先后次序，或中或西，均赖医者老练坚定之心手，与夫随机应变，极灵活之心思，起死回生，透视一切确知此症演变至何程度，而后可以与谈中医之神妙，而后可以与谈西医之科学，而后可以称为能治疾病之医。否则人云亦云，古今人均包括在内，必不能治疑难之大病也。
欲研此症之病理，第一即须明了中医气化之精妙理想，经络、脏腑、营卫、气血、阴阳，均包括在内。与夫西医之内外组织、分泌、脏器、血管、气管、淋巴、腺、膜等等之生理现象，须知此症向愈之道路，即是使病者身体，恢复其生活力，使其全身机关，一律蒸动活泼，内外通气，血流自然，则大病斯愈。
肿症至极重之时，往往患者自觉向左卧，则体内血液全沉于左侧，向右卧，则全沉于右侧，起立时则觉血液沉坠于两腿。即此现象，可以推知病者血流，已无自然循环流动之活力，一如注死水于皮囊之内，左倾则左注，右倾则右注，可上可下，可左可右，任人颠倒搁置，毫无知觉，毫无自动能力。高明有定见之医者，须一眼觇定，此血流何以不能自动，则必由于生活力之衰微已极。生活力何以衰微至此，则必由于全身神经衰弱已极，早失其知觉运动指挥命令之机能。所以肿病至极重之时，皮肤肌肉无论如何刺激，绝无感觉反应之可言，几如一块死肉，不知痛痒，不知麻木，知有麻木之时，病尚较轻也。皮肉以手按之，凹处不能自起，至此程度，九死一生矣。然治之得法，参照医验纵极危之症，余敢断言，必能有效，其病势好转之现象，始则渐渐感觉麻木痛痒，继则渐渐发生津液，继则四肢温润，皮肤柔和肿消胀去，不麻木，不痛痒，则健康恢复矣。
于此有一治疗本病最妙之真谛，即吾人体内之生活力，及神经赖以生存之热气是也，此热气不足则人弱，热气灭绝则人死。中医药内，唯一有效补助此热气之灵药，即属于大补元阳之方剂，此种方剂，求之西药，则难乎其难，故此症中医所以能挽回生命于危急之顷者，虽有时亦应借助于西药，然其主要方剂，实赖于此种特效之中药，则余敢断言也。
此症关系内外分泌之理，本系参以西医生理立论，亦应详为解说，以告学者。盖此症所以致肿之原因，即系病者内外分泌，渐渐闭塞，停止活动，以致周身水分一滴不能向外排泻，此外字包括脏腑而言，所以眼泪、鼻涕、痰唾、汗液，一律闭止，小便亦非常减少，而色浓味臊，每日所饮食之水分，完全停留潴蓄于血管及各组织之内，有空隙松动之处潴留更多，愈聚愈多，则内外皆肿。人但见外皮之肿，而不知内脏皆肿也。水无出路，渐向组织松懈处流聚，例如下腹部，于是大部分停留于少腹部之下。西医放水之法，穿刺术纯系治标，旋放旋聚，无济于事，故不如中医之温补渗利，一面助其蒸发水分之热力，一面开除排泄水分之道路，标本兼治，百试百验，此中医对肿胀一症，所以有特长也。
此症俗名有臌症之称，西医书载此症有大便干燥现象，然此症亦有大便泄泻者不少，此余之实验谈也。盖因患者至极重时，腹部之肿胀特甚，其病理已如上述，然余既欲阐明中医气化二字，以为根本解决本症之前提，故不得不参合西医分泌生理言之，以资对照。此种生理，系根据科学，毫无可疑，学者须知此症，一方面为生理的不分泌，是以有以上无唾、无涕种种之干燥现象，另一方面为生理的不吸收，故又有液体郁滞，水分潴留体内之壅肿现象。盖分泌与吸收两机能作用不完全，而后演成此症，一言以蔽之，设非神经衰弱，气不蒸化，绝不致分泌与吸收失其平衡也。西医穿腹术（俗称放水），为救济一时之法，不可不知。中医肿胀之说，包括于俗称之气臌、水臌。即合西医脚气病与腹水之通称，考西医腹水与脚气病，本系两症，原不可混为一谈，但此二症之原因于肾脏、肺脏、心脏之疾患，而生之血行障碍，因而诱起此二症者不少，且水肿性之脚气，其浆液膜腔亦有显著之蓄水，是二症自有其一部分共同之现象，医者须细心参考，自然运用中医气化之说，则有左右逢源之乐矣。腹水与脚气病理以限于篇幅均从略。
Lu Dongsheng, residing at Baxian Temple Street in Dezhou City, was in his thirties and a friend of mine. At that time, he was staying with me in Hubei as a guest. He suffered from Feilao (Pulmonary Tuberculosis). In the 9th year of the Republic of China (1920), he suddenly experienced massive hematemesis (massive vomiting of blood), becoming extremely weak. After the bleeding stopped, symptoms of Xinshuairuo (Heart Failure) erupted severely. Upon pulse diagnosis, the right hand pulse was extremely fine and minute, while the left hand pulse was imperceptible. Every few minutes, he felt his heart pounding violently, gradually developing panting, insomnia, and palpitations (Xintan), which became increasingly frequent, making him feel as though his heart were about to stop. Inquiry revealed that he had self-administered Zilai Xue (a proprietary blood-tonifying preparation) for over ten days without effect, leading to this critical condition. Therefore, I prescribed a formula to greatly tonify Qi and Blood. After taking three doses, his symptoms slightly alleviated; the left hand pulse showed Jie Mai (Knotted Pulse, slow with irregular pauses), and the right hand pulse showed Kou Mai (Hollow Pulse, floating, large, and empty in the center). The original prescription is as follows: Da Taishen (Codonopsis Radix / Large Tai Shen) 8 qian, Zhi Huangqi (Prepared Astragali Radix) 8 qian, Danggui Shen (Root portion of Angelicae Sinensis Radix) 1 liang, Chao Zaoren (Stir-fried Ziziphi Spinosae Semen) 4 qian, Baizi Ren (Biota Seed) 4 qian, Longyan Rou (Longan Aril) 4 qian, Zhi Gancao (Prepared Licorice Root) 2 qian. Decocted into two cups of liquid, taken in six doses over twenty-four hours. This formula showed significant efficacy after three doses. In total, sixteen doses were taken until full recovery. However, after five doses, the dosage was gradually reduced step by step until it reached half of the original amount. The method of administration also followed the method used for Patient Cai, gradually reducing the dose. One must not stop taking the medicine abruptly.
In a certain year, I saw a newspaper report stating that Mr. Duan Qirui, after suffering massive hematemesis in Shanghai, developed severe Heart Failure. He was cured by Western medicine using blood transfusion therapy. Carefully examining the clinical presentation, it was exactly this syndrome. If treated with Chinese herbal medicine, it would be successful in nearly all cases. Blood transfusion is cumbersome and expensive, unaffordable for ordinary patients and often unavailable in ordinary hospitals. Our country has its own natural miraculous medicine, namely this formula. Unfortunately, it has been obscured by irrelevant theories and miscellaneous drugs. For example, Tianwang Buxin Dan (Emperor of Heaven's Special Pill for Tonifying the Heart) and Kongsheng Zhenzhong Dan (Confucius' Pillow Treasure Pill) have been tried but proved ineffective. These excellent herbs are actually hidden within these established formulas. After years of selection and discernment, I extracted them. Thus, I specifically designated this as the main formula for treating this syndrome and published it to warn those who overly revere ancient texts or rely exclusively on Western medicine.
Swelling (5): Swelling (commonly known as Gubing/Tympanites). Here, it refers to swelling caused by chronic deficiency syndromes. Acute excess-type swelling does not fall under this category.
Etiology: After a major illness, or in individuals with inherent physical weakness, blood circulation disorders in the Heart, Kidney, Lung, or Liver can lead to this syndrome. While commonly called Gubing, Traditional Chinese Medicine (TCM) emphasizes spleen and stomach dysfunction leading to cold-dampness pathogenesis, which holds profound significance. This discussion hits the nail on the head regarding swelling. Late-stage Feilao (Pulmonary Tuberculosis) may also present with edema, but this is excluded here. TCM advocates warming and tonifying, along with promoting diuresis and leaching out dampness, elucidated through the theory of Qi transformation (Qi Hua), revealing marvelous effects. Based on this theory, I have cured numerous cases of severe swelling, far surpassing Western medicines in efficacy. Scholars should pay attention to this.
Symptoms: Physical weakness, aversion to cold in the four limbs, lack of desire to drink, scanty urine, uncomfortable bowel movements (either loose stools or constipation), chest and abdominal distension and stuffiness. Gradually, dry throat, dry mouth, and dry nose appear, accompanied by a sensation of heat rushing upward. Edema of hands and feet occurs; if severe, the face, eyes, lips, and abdomen become fully swollen. In men, the scrotum swells; the umbilicus may protrude. Nausea and vomiting may occur. In extreme cases, the whole body becomes shiny and edematous. Panting may or may not be present. Phlegm-fluid retention is common, with a sensation of fluid accumulation under the ribs. The patient becomes progressively weaker, unable to lie flat. Pitting edema is present (indentation remains after pressure). Ultimately, cardiac paralysis leads to death. Western medicine describes edema in Beriberi (Vitamin B1 deficiency), which shares similar signs, but they are distinct conditions; this distinction must be known.
Treatment: Western Vitamin therapy (oral and injection) is often effective. I have tested it several times, but without combining it with Chinese herbal medicine, complete recovery is difficult. Diuretic therapy and paracentesis (commonly known as "draining water") provide temporary relief but are not fundamental treatments nor good strategies. TCM categorizes this syndrome as Wind, Cold, Heat, Dampness, Phlegm, Gu (parasitic/toxic accumulation), Yin Water, Yang Water, Qi Division, and Blood Division. Treatments include sweating methods, purging methods, tonifying methods, separating and draining, and resolving stagnation. Prescriptions are complex, creating confusion. Later practitioners blindly follow ancient methods, resulting in almost no survivors. I have witnessed countless deaths due to incorrect use of sweating and purging methods for this condition, so I speak with urgency. Actually, the most effective TCM treatment for this syndrome involves tonifying the Spleen and Stomach, supporting Yang Qi to secure the root, combined with promoting diuresis to treat the branch. This summary suffices. The inclusion of various theories and miscellaneous drugs causes loss of efficacy. Over forty years, I have encountered countless cases. Mild cases were cured using my principle of "Tonify Spleen, Harmonize Stomach, Promote Diuresis." Severe cases were cured using a combination of Chinese and Western medicines. See Medical Cases.
This disease, commonly known as the dreaded Gubing, results from chronic illness. The key is the word "chronic," distinguishing it from acute heat-induced swelling or simple Western Beriberi edema. It is caused by systemic fluid retention due to extreme physical decline, loss of thermal energy, and inability to naturally excrete or evaporate fluids. Improper treatment can be fatal. Initially, only slight edema of hands and feet appears, fluctuating in severity, with normal diet and activity. Patients do not consider it serious, and doctors often overlook it. Little do they know this deadly syndrome progresses silently. As the condition worsens, swelling persists, spreading to the chest, abdomen, or limbs. Scrotal swelling in men or facial swelling in women indicates a critical stage, often untreatable. Various "transformations" (atypical presentations) confuse doctors regarding deficiency/excess and cold/heat. Entering this trap leads to rapid fatality. TCM practitioners rigidly adhering to ancient texts, lacking experience and decisive insight, will be misled by obscure theories and pseudo-effective methods. A major flaw of TCM lies here. If a patient presents with dry stool, scanty dark urine, dry nose/mouth, thin tongue coating, sensation of heat rising in the throat, red tongue with blisters, thirst but no desire to drink, one might suspect Dampness or Heat and attempt purging or draining methods. In short, it will be ineffective. If the patient has cough with no sputum, no saliva, no sweat, no tears, dark scanty pungent urine, dizziness/headache, vomiting upon smelling food, loose or hard stools, abdominal pain/borborygmus, and hiccups, one might suspect Wind, Cold, Heat, or Upper Excess/Lower Deficiency, attempting sweating, tonifying-purging combinations, or spleen-stomach regulating methods. Again, it will be ineffective. Why do ancient formulas fail? Because ancient formulas mislead people, not just in Gubing. Ancient theories are chaotic. My forty-plus years of experimentation confirm that while methods like draining, resolving stagnation, moving Qi, dispelling dampness/heat may miss the mark, they rarely kill immediately. Only purging and sweating methods, intended for excess swelling, cause death when misused for chronic deficiency swelling. This is not the ancients' fault but incompetent physicians lacking true knowledge. Scholars must recognize that sweating and purging treat excess, not chronic deficiency, avoiding confusion regarding Wind-Cold, Damp-Heat, Yin/Yang Water.
When the syndrome reaches criticality, manifestations vary wildly. Without real experience, determining deficiency/excess and cold/heat is difficult, marking the life-and-death juncture. Essentially, chronic deficiency swelling should always be treated as deficiency, applying TCM Great Tonification of Primordial Yang and Western astringent therapies. For diarrhea, Vitamin therapy is highly effective. This is based on my extensive experiments, absolutely truthful. For instance, if the patient has dark scanty urine, Fuzi (Aconiti Lateralis Radix Praeparata) seems contraindicated due to its astringent properties on urination. However, only this herb can restore lost Primordial Yang and vaporize stagnant water. Adding it to Spleen/Kidney tonifying decoctions, boldly administered, eventually increases clear urine volume. This subtlety is known only through years of experimentation. The transformations of this disease mask deficiency signs. Treating symptoms alone leads to confusion. At this stage, besides worsening edema, symptoms include dark pungent urine, vomiting triggered by odors, hiccups, oral ulcers, red blistered tongue, dry mouth without thirst, burning throat with heat rising, chest oppression, dry eyes/nose/skin (no tears, mucus, sweat), loose or hard stools, palpitations, insomnia, dizziness. These pseudo-excess signs confuse inexperienced doctors. Between deficiency and excess, the physician must firmly identify Yang deficiency, pure cold, blood stasis, and failure of Qi transformation to move water. All pseudo-excess signs are illusions. The TCM theory of Qi transformation is perfectly suited for this swelling, superior to Western concepts of ascites or Beriberi. Therefore, tonifying Yang, Qi, Spleen, warming Kidney, and promoting diuresis are the only fundamental principles. Combining with Western astringent therapy (for diarrhea) is beneficial. Diuretics are optional and potentially harmful. Vitamin therapy is effective but insufficient alone; it must be combined with Chinese herbs. This will fundamentally cure the dreaded Gubing. However, in severe cases, using only Chinese or only Western medicine has difficulties. It took years of trial to confirm this. Thus, I advocate combined therapy. Do not change treatment plans after one or two ineffective doses. Combined therapy works synergistically. Except for specific cases in this book, scholars should not mix medicines arbitrarily to avoid danger. This approach eliminates pseudo-excess/heat signs, restores Yang Qi, revitalizes internal/external secretions, and enables organs/skin to excrete water. Fluids normalize (urine, saliva, mucus). Circulation improves, secretions recover, and water is excreted normally. Note "internal": endocrine cessation is more harmful than exocrine. The first sign of effective treatment is increased urine output and natural secretion of tears, saliva, sweat, and mucus. No water remains in vessels or tissues, and swelling subsides. This pathology was confirmed after forty years of experimentation. After swelling subsides, persistent foot pain/swelling responds well to Niuxi (Achyranthis Bidentatae Radix, approx. 5-6 qian); Hu Jinggu (Panther Bone) is also usable.
Hesitation in treatment, such as switching doctors or changing plans after one or two doses due to lack of immediate effect, leads to failure. Physicians facing difficult cases must have true insight and determination. Do not test medicines on patients. Treatment intensity, sequence, and choice between Chinese/Western medicine depend on the physician's mature judgment and flexibility. Only then can one discuss the miracles of TCM or the science of Western medicine and truly claim to be a healer. Otherwise, echoing others, whether ancient or modern, guarantees failure in treating difficult diseases.
To study the pathology of this syndrome, one must first understand the exquisite ideal of TCM Qi transformation, including meridians, Zang-Fu organs, Ying-Wei (Nutritive-Defensive Qi), Qi-Blood, and Yin-Yang. Alongside Western physiology of tissues, secretions, organs, vessels, lymph, glands, etc. The path to recovery is restoring the body's vitality, activating all systems, ensuring internal/external ventilation and natural blood flow, thus curing the major illness.
In extreme swelling, patients may feel blood sinking to the left when lying on the left, and to the right when lying on the right. Standing feels like blood sinking into the legs. This indicates loss of natural circulatory vitality, like dead water in a bag, flowing wherever tilted, with no autonomy. A skilled physician must realize this lack of automatic blood flow stems from extreme decline in vitality. Vitality declines due to severe nervous system weakness, losing control over perception and movement. Thus, in extreme swelling, skin and muscles show no response to stimulation, feeling like dead flesh. Numbness indicates a lighter stage; pitting edema that doesn't rebound indicates near-death. However, with proper treatment (see cases), even critical cases respond. Improvement begins with sensation returning (numbness/pain/itch), then generation of fluids, then warm limbs and soft skin. Health recovers.
The deepest truth in treating this disease is the vital heat sustaining life and nerves. Insufficient heat means weakness; extinction means death. The only effective Chinese medicine to supplement this heat belongs to formulas greatly tonifying Primordial Yang. Such formulas are rare in Western medicine. Thus, TCM saves lives in crises, sometimes aided by Western medicine, but primarily relying on these special Chinese herbs.
The mechanism involving endocrine/exocrine functions, based on Western physiology, requires detailed explanation. Swelling occurs because internal/external secretions gradually cease, preventing any fluid excretion. "External" includes organs. Tears, mucus, sputum, sweat stop. Urine becomes scanty, dark, and pungent. Daily fluid intake stays in vessels and tissues, accumulating in loose spaces, causing internal and external swelling. People see external swelling but ignore internal organ swelling. Water flows to loose tissues, e.g., lower abdomen. Western paracentesis is symptomatic only, fluid reaccumulates. TCM warming/tonifying and diuresis help evaporate water and open drainage paths, treating root and branch effectively. This is TCM's specialty.
Western books note dry stool in Gubing, but many cases have diarrhea. This is my experimental observation. When severe, abdominal swelling is prominent. To elucidate "Qi Transformation" as the premise for solving this syndrome, I reference Western secretion physiology for comparison. This physiology is scientific. Patients exhibit non-secretion (dryness: no saliva, mucus) and non-absorption (fluid stagnation, edema). Incomplete secretion and absorption functions cause this syndrome. In short, unless nervous weakness and failure of Qi vaporization occur, secretion/absorption balance is maintained. Paracentesis is a temporary rescue measure. TCM swelling covers Qi Gubing and Water Gubing, corresponding to Western Beriberi and Ascites. Although distinct, both often result from Heart/Lung/Kidney diseases causing blood stasis. Edematous Beriberi also shows serous cavity fluid. They share phenomena. Physicians should apply TCM Qi transformation theory flexibly. Ascites and Beriberi pathologies are omitted due to space.