孕妇脉来滑数，证见便溺不通，二阴牵胀，足膝浮肿，医药滋阴，疏利升举，屡施不验
。按
肺与大肠相表里，又与膀胱通气化，是二便之通闭，肺有所关系焉。金燥水无以生，清肃之
令不能下降，是以二肠交阻。喻氏谓人身之气，全关于肺，肺清则气行，肺浊则气壅。清肺
之热，救肺之燥，治其源也。气行则壅自通，源澄斯流清矣。凡禽畜之类，有肺者有溲，无
肺者无溲，故诸水道不利而成肿满者，以治肺为急。前商清燥救肺，小溲虽通，大便未畅，
足肿未消，二阴仍然牵胀，夜卧不适，口苦舌黄，原方加枯芩梨汁。
安波按∶议论神妙，使读者满舌生津。
经云∶肺气通于鼻。又云∶胆移热于脑，则辛 鼻渊。可知鼻渊一证，病端虽责于肺，
实由
胆热移脑之所使然。证经数载，腥涕流多，肺肾为子母之脏，金被火刑，阴液受伤，加之鼻
窍右侧，旧夏曾已穿溃，甫经收口，左侧又溃一孔，至今红肿未消。经谓热胜则肿。虽由胆
移之热，酝酿为患，但治病须分新久，诊脉数大无力，是属恙久，阴虚阳浮，非新病实热可
比，苦寒伤胃，洵非所宜。计惟壮水保金，冀其水升火降，庶几红肿可消，溃口可敛也。
安波按∶拟清燥救肺法，辅金刹木，即所以治胆清肺，澄源，即所以治肾。
孕妇脉象滑数，症状表现为大小便不通，前后二阴有牵拉胀满感，足部和膝盖浮肿。此前医生采用滋阴、疏利及升举等治法，多次使用均无效。
按语：肺与大肠互为表里，且肺与膀胱的气化功能相通，因此二便的通闭情况与肺的功能密切相关。若肺金燥热导致肾水无法滋生，清肃下降的功能不能正常行使，就会导致大肠和小肠气机阻滞。喻嘉言认为，人身之气主要取决于肺，肺气清则气机运行通畅，肺气浊则气机壅滞。清除肺部的热邪，救治肺部的燥伤，是治疗其根源的方法。气机运行通畅后，壅滞自然解除，源头清澈则水流自清。凡是禽畜类动物，有肺的就有尿液，没有肺的就没有尿液，所以各种水道不利导致肿胀满闷的病证，急当治肺。之前商议采用清燥救肺汤（Qingzao Jiufei Tang），小便虽然通了，但大便仍不畅通，足部肿胀未消，前后二阴依然牵拉胀满，夜间睡眠不适，口苦舌苔黄。在原方基础上加入枯芩（Scutellariae Radix 经炒炭处理）和梨汁。
安波按：议论精妙，使读者读后满口生津。
《内经》说：肺气通于鼻。又说：胆的热邪移注于脑，就会形成鼻渊（Biyuan, nasal sinusitis characterized by profuse discharge）。可知鼻渊这一病证，病因虽归责于肺，实际上是由胆热移注于脑所致。此病经过数年，腥臭鼻涕流出很多，肺与肾为母子之脏，肺金被肝火克制，阴液受损，加上鼻窍右侧，去年夏天已经穿溃，刚刚收口，左侧又溃烂一孔，至今红肿未消。《内经》说：热盛则肿。虽然是由于胆移之热，酝酿成患，但治病必须区分新病与久病。诊得脉象数大无力，属于久病，阴虚阳浮，不能与新病的实热相比。苦寒药物会损伤胃气，确实不适宜使用。计议唯有壮水（Zhuangshui, nourishing Yin to subdue Yang）保金（Baolin, protecting Lung Yin），希望达到水升火降的效果，这样红肿或许可以消退，溃烂的创口或许可以收敛。
The pregnant woman’s pulse is slippery and rapid. Her symptoms include obstruction of urination and defecation, a pulling and distending sensation in the anterior and posterior orifices, and edema of the feet and knees. Previous physicians employed methods such as nourishing Yin, promoting drainage, and raising Qi, but these treatments were repeatedly ineffective.
Commentary: The Lung and Large Intestine are exteriorly-interiorly related, and the Lung communicates with the Bladder regarding Qi transformation. Therefore, the patency or obstruction of urine and stool is closely related to the Lung. If Lung Metal is dry and fails to generate Kidney Water, its clear and descending function cannot descend, resulting in obstruction of the intestinal Qi. Yu Jia Yan (Yu Chang) stated that the Qi of the human body depends entirely on the Lung; when Lung Qi is clear, Qi moves freely, and when Lung Qi is turbid, Qi becomes stagnant. Clearing Lung Heat and rescuing Lung Dryness treats the source. When Qi moves, stagnation resolves naturally; when the source is clarified, the flow becomes clear. Among birds and animals, those with Lungs have urine, and those without Lungs do not. Thus, for various conditions where water passages are obstructed leading to swelling and fullness, treating the Lung is urgent. Previously, it was discussed to use Qingzao Jiufei Tang (Clea-Heat-and-Moisture-Rescuing Decoction). Although urination has resumed, defecation remains unsmooth, foot edema has not subsided, the anterior and posterior orifices still feel pulling and distended, sleep at night is uncomfortable, there is bitter taste in the mouth, and the tongue coating is yellow. To the original prescription, add Chao Kuqin (Stir-baked Scutellariae Radix) and Pear Juice.
An Bo commented: The discussion is profound and subtle, causing the reader to salivate abundantly.
The *Classic of Internal Medicine* states: "Lung Qi connects to the nose." It also states: "When Gallbladder Heat transfers to the Brain, it causes Biyuan (Nasal Sinusitis)." This indicates that although the etiology of Biyuan is attributed to the Lung, it is actually caused by Gallbladder Heat transferring to the Brain. This condition has persisted for several years, with profuse discharge of foul-smelling nasal mucus. The Lung and Kidney are mother-son organs. Lung Metal has been scorched by Fire, injuring Yin fluids. Furthermore, the right side of the nasal cavity had perforated and ulcerated last summer; just as it healed, a new hole ulcerated on the left side, and redness and swelling have not yet subsided. The Classic states: "Excess heat leads to swelling." Although this is due to Gallbladder Heat fermenting and causing pathology, treatment must distinguish between new and chronic diseases. The pulse is rapid, large, and forceless, indicating a chronic condition with Yin deficiency and floating Yang, which cannot be compared to acute excess-heat patterns. Bitter-cold herbs damage Stomach Qi and are indeed inappropriate. The strategy should be to strengthen Water (nourish Yin) to protect Metal (Lung), hoping to achieve the rising of Water and descending of Fire, so that redness and swelling may subside and the ulcerated wound may heal.
An Bo commented: Prescribing the method of Qingzao Jiufei Tang assists Metal to suppress Wood, which is how one treats Gallbladder Heat and clears the Lung; clarifying the source is how one treats the Kidney.