两寸关脉候俱大，左关尤急。据述前冬因情志抑郁，先见此脉。后觉心烦不安，旧春心
烦稍
定，咳嗽至今不止，舌苔时黄时退，此肝为受病之源，肾为传病之所。夫肝之伤脾，人所易
知，肝之伤肾，人所不识。譬如折花枝安插瓶中，花枝日茂，瓶水日为吸干，肝阳吸引肾阴
，此之谓也。且肺为肾母，子虚必盗母气，不特金不制木，而木反得侮金。肝阳上升，冲心
为烦，冲肺为咳，脉大不敛，舌见黄苔，要皆阳亢阴亏之所使然。所幸寝食如常，别无兼证
。议以滋肾生肝，保金化液，辛温刚愎，似非所宜。复诊脉急依然，连日嗽甚，于前夜卧欠
安，头额手心俱热，是属挟有风温外因。若云阴血之热，当发于日晡，不应发在午前，且其
来也渐，何骤若此。质虚恙久，固不能正从标治，然亦未可过补。仿汪广期前辈风温汤方法
。
安波按∶卓识名论。非熔经铸史者不能。
色白肤嫩，肾气不充，数月病魔，脾元又困，诸医调治，病势日增，请求其本而论治焉
。经
言诸湿肿满，皆属于脾。曩服五苓、五皮，非无所据，但肾为胃关，关门不利，故聚水而从
其类。仲师主用肾气丸，即此意也。若谓童年精气未泄，补之不宜，然治标不应，理应求本
，所谓有者求之，无者求之是已。夫水流湿，火就燥，二阳结，谓之消。三阴结，谓之水。
消者患其有火，水者患其无火。且水病虽出三阴，而其权尤重于肾。肾居水脏而火寓焉，此
火者，真火也，天非此火不能生物，人非此水不能有生。即膀胱津液藏焉，亦必由命门气化
而出。华元化曰∶肾气壮则水还于肾，肾气虚则水散于皮。前服肾气丸颇应，日来饮食不节
，病复再投不效。考诸《己任编》云∶此病单用肾气丸不效，单用补中益气汤亦不效，须用
补中益气汤，吞《金匮》肾气丸。谨宗其旨。
安波按∶于庚长秋，行医于杭笕桥，一士子患水肿，面目无缝，阴大如栲，小水点滴
不爽
，切脉沉细模糊，苔腻白滑，不渴。阅前医有开鬼门者，有洁净府者，有用五子五皮者，有
需《金匮》肾气法者，服之如石投海。余意肾气虚则水泛为肿，以肾气丸为旗鼓之剂，何反
不应。追忆《己任编》有益气阳，送肾气丸之法，翻书令彼视之，伊芳以为然。服之竟验。视
此与先生暗合也。
两寸和关脉的脉象都呈现大脉，左侧关脉尤其急促。据患者叙述，去年冬天因为情志抑郁，首先出现了这种脉象。后来感到心烦不安，今年春天心烦稍微平定，但咳嗽至今没有停止，舌苔有时发黄有时消退，这是肝为受病的根源，肾为传病之所。人们容易知道肝损伤脾，却不知道肝损伤肾。譬如折断花枝插在瓶中，花枝日益茂盛，瓶中的水却日益被吸干，这就是肝阳吸引肾阴的道理。而且肺是肾的母亲，子脏虚弱必然盗取母脏之气，不仅金不能制约木，反而木会反侮金。肝阳上升，冲击心脏导致心烦，冲击肺部导致咳嗽，脉象大而收敛不足，舌见黄苔，这都是阳亢阴亏所导致的。所幸睡眠和饮食如常，没有其他兼夹证候。议论采用滋补肾阴以生肝血，保护肺气以化生津液的方法，使用辛温刚燥的药物，似乎并不适宜。复诊时脉象依然急促，连日咳嗽严重，于前夜睡眠欠安，头额部和手心都发热，这属于夹杂有风温这一外因。如果说这是阴血之热，应当在傍晚时分发作，不应当在午前发作，况且其发病过程应该是逐渐的，为何如此突然？体质虚弱且患病日久，固然不能单纯从标症治疗，然而也不可以过度进补。仿照汪广期前辈的风温汤方法进行治疗。
安波按语：这是卓越的见识和著名的论述。不是融会贯通经典、博览群书的人是不能做到的。
面色白皮肤嫩，肾气不充盈，数月来病魔缠身，脾胃元气又受困，各位医生调理治疗，病情日益加重，请求探究其根本原因来进行治疗。《内经》说各种湿邪肿胀满闷，都归属于脾。以前服用五苓散、五皮饮，并非没有依据，但是肾是胃的关口，关口不利，所以水液积聚而同类相从。张仲景主张使用肾气丸，就是这个意思。如果说童年时期精气未泄，不宜进补，然而治疗标症无效，理应求本，这就是所谓的“有者求之，无者求之”的道理。水往低湿处流，火向干燥处烧，二阳（阳明）结滞，称为消渴；三阴（太阴、少阴、厥阴）结滞，称为水肿。消渴病患者担心体内有火，水肿病患者担心体内无火。而且水病虽然出自三阴，但其关键尤其在于肾。肾居水脏而寓藏真火，这火就是真火，天没有这火不能化生万物，人没有这水不能生存。即使是膀胱津液的贮藏，也必须由命门的气化作用而出。华元化说：肾气壮盛则水液回归肾脏，肾气虚弱则水液散溢于皮肤。之前服用肾气丸颇有疗效，近日饮食不节制，病情复发再次投药无效。考证《己任编》记载：此病单用肾气丸无效，单用补中益气汤也无效，必须使用补中益气汤，吞服《金匮要略》中的肾气丸。谨遵其宗旨。
安波按语：在庚年长秋时节，我在杭州笕桥行医，一位读书人患有水肿，面目浮肿无缝隙，阴囊肿大如斗，小便点滴不通，切脉沉细模糊，舌苔腻白滑，口不渴。查阅前医的治疗方案，有用发汗法（开鬼门）的，有用利小便法（洁净府）的，有用五子衍宗丸和五皮饮的，有用《金匮要略》肾气丸法的，服药后如同石头投入大海毫无反应。我心想肾气虚则水泛为肿，以肾气丸为主药，为何反而无效？回想起《己任编》中有用益气温阳药送服肾气丸的方法，翻书让他看，他认为是这样。服用之后竟然见效。看来这与先生的见解暗合。
The pulses at the Cun (inch) and Guan (bar) positions on both sides are large, with the left Guan pulse being particularly rapid. According to the patient's account, due to emotional depression last winter, this pulse pattern appeared first. Later, he felt restless and irritable; in the spring of this year, the irritability subsided slightly, but the cough has persisted until now. The tongue coating fluctuates between yellow and receding. This indicates that the Liver is the source of the disease, and the Kidney is where the pathology transmits. While it is well known that Liver pathology can injure the Spleen, few realize that Liver pathology can also injure the Kidney. It is like breaking a flower branch and placing it in a vase: as the branch thrives, the water in the vase is gradually absorbed. This is what is meant by Liver Yang attracting and depleting Kidney Yin. Furthermore, the Lung is the mother of the Kidney; when the child organ is deficient, it must steal Qi from the mother organ. Not only does Metal fail to control Wood, but Wood counter-attacks Metal. Rising Liver Yang strikes the Heart causing irritability, and strikes the Lung causing coughing. The pulse is large and fails to gather, and the tongue shows a yellow coating; all these are caused by Hyperactive Yang and Deficient Yin. Fortunately, sleep and appetite remain normal, with no other concurrent syndromes. The proposed treatment is to nourish the Kidney to generate Liver blood, protect the Lung metal to transform fluids. Using pungent-warm and rigidly drying herbs seems inappropriate. At the second visit, the pulse remains rapid, and the cough has been severe for several days. The night before, sleep was restless, and there was heat in the forehead and palms. This belongs to an exogenous factor of Wind-Warmth. If this were heat from Yin-Blood deficiency, it should manifest in the late afternoon (Shi hour), not in the morning. Moreover, its onset should be gradual, why so sudden? Given the weak constitution and chronic illness, one certainly cannot treat solely based on the branch/symptoms, yet one also cannot over-tonify. I will imitate the method of Mr. Wang Guangqi’s *Fengwen Tang* (Wind-Warmth Decoction).
An Bo's Note: This is an insightful and renowned discussion. Only those who have thoroughly mastered the classics and studied history extensively could produce such analysis.
The complexion is pale and the skin tender, indicating insufficient Kidney Qi. For months, the body has been plagued by illness, further distressing the Spleen Yuan (Source). Various physicians have attempted regulation and treatment, yet the condition worsens daily. We request to investigate the root cause to guide treatment. The *Classic of Difficult Issues* states: "All dampness, swelling, and fullness belong to the Spleen." Previous prescriptions of *Wuling San* (Five-Ingredient Powder with Poria) and *Wupi Yin* (Five-Rind Decoction) were not without basis. However, the Kidney serves as the gate of the Stomach; if the gate is not functioning properly, water accumulates and follows its kind. Master Zhang Zhongjing advocated the use of *Shenqi Wan* (Kidney Qi Pill), which embodies this principle. Some might argue that since the patient is young and his essence has not been depleted, tonification is unsuitable. However, since treating the branch symptoms failed, we must seek the root, as stated: "Seek what exists, seek what does not exist." Water flows to damp places, fire moves toward dryness. When the Two Yangs (Yangming) are knotted, it is called Xiao (Consumption/Thirst); when the Three Yins (Taiyin, Shaoyin, Jueyin) are knotted, it is called Shui (Water/Swelling). Those suffering from Xiao fear internal fire; those suffering from Shui fear the lack of fire. Although water diseases originate from the Three Yins, their key lies particularly in the Kidney. The Kidney resides as the Water Organ but houses Fire; this Fire is True Fire. Heaven cannot create life without this Fire, and humans cannot survive without this Water. Even the storage of fluids in the Bladder must emerge through the Qi transformation of the Gate of Life (Mingmen). Hua Yuohua said: "When Kidney Qi is strong, water returns to the Kidney; when Kidney Qi is weak, water scatters into the skin." Previously, taking *Shenqi Wan* yielded good results. Recently, due to irregular diet, the illness relapsed, and subsequent medication was ineffective. Consulting *Jiren Bian*, it records: "For this disease, using *Shenqi Wan* alone is ineffective, and using *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) alone is also ineffective. One must use *Buzhong Yiqi Tang* while swallowing *Shenqi Wan* from *Jingui Yaolue*." I strictly follow this principle.
An Bo's Note: In the autumn of the Geng year, while practicing medicine in Jianqiao, Hangzhou, I treated a scholar suffering from edema. His face and eyes were swollen shut, and his scrotum was enlarged like a measuring basket. Urine output was scanty and difficult. The pulse was deep, fine, and indistinct; the tongue coating was greasy, white, and slippery, with no thirst. Reviewing previous medical records, treatments included inducing sweating (opening the ghost door), promoting urination (cleansing the mansion), using *Wuzi Zongyan Wan* and *Wupi Yin*, or applying the *Jingui Shenqi* method. None worked, like a stone thrown into the sea. I reasoned that Kidney Qi deficiency causes water flooding and swelling; using *Shenqi Wan* as the primary agent should work. Why did it fail? I recalled the method in *Jiren Bian* of using Qi-tonifying and Yang-warming herbs to deliver *Shenqi Wan*. I showed him the book, and he agreed. Upon administration, the treatment proved effective. It appears my insight coincides with the author's.