肾肝之邪，木得桂而枯，又以辛散肝经之水，以温肾之真寒湿也。连服十余服，而肿尽消。
朱丹溪治赤岸冯令八官，素饮食不知饱，但食肉必泄，忽遍身发肿，头面加多，致目亦不可开，膈满如筑，
两足麻至膝而止，浑身不可见风，阴器挺长。其脉左沉，而重取不应，右三部虽短小，却有和滑气象。遂令
单煮白术汤饮，早晨空心探而去之。食后，白术二钱、麻黄五分、川芎半钱、防风三分，作汤下保和丸五十丸。
如此者二日，因吐中得汗，通体上截为多，遂得肿宽而眼开，气顺而食进。却于前方中减麻黄、防风，加白术
一钱，木通、通草各半钱，下保和丸五十丸，如此者五日而安。（此即开鬼门之法也。）
罗谦甫治许鲁斋仲平，年五十有八，于至元戊寅五月间，积雨霖淫，面目肢体浮肿，大便溏多，腹胀肠鸣
时痛，饮食减少，脉得弦细而缓。自云年壮时多服牵牛、大黄药，面目四肢时有浮肿，今因阴雨故大发。曰∶
荣运之气，出自中焦者胃也。胃气弱不能布散水谷之气，荣养脏腑经络皮毛，故气行而涩为浮肿，大便溏多而
腹胀肠鸣，皆湿气胜也。四时五脏，皆以胃气为本，有胃气则和平而身安。若胃气虚弱，不能运动滋养，则五
脏脉不和平，本脏之气盛者，其脉独见，（此盛字当活看。）轻则病过，甚则必死。故经曰∶真脏之脉弦，无胃
气则死。（此亦木乘土也，故虚损病宜注意滋养肝木。）今疾幸而未至于甚，尚可调补。人知服牵牛、大黄
为一时之快，不知其为终身之害也。遂以平胃散加白术、茯苓、草豆蔻仁，数服诸症皆愈，饮食进。惟四肢犹肿，
以导滞通经汤主之，良愈。（雄按∶今秋治一山居黄妪患证同此，医者进理中、肾气多剂，其病日甚，束手矣。
余诊之，脉果弦细沉兼数，舌绛口干，肿处赤痛，溲少而热，乃阴虚肝热也。清润不遑，未可因其起于霉雨之
时辄用温燥也。与白头翁汤加金铃、银花、栀子、元参、丹皮、绿豆，数服而症减知饥，渐佐养血充津而愈矣。）
马元仪治华氏子，患腹胀已三月，形色憔悴，而脉沉微。治者但谓邪气盛，不知其正气虚也。《灵枢》曰∶
脉之应于寸口，其大坚以涩者，胀也。《素问》曰∶征其脉与色俱夺者，此久病也。今两脉微弱无神，面色不
华，肢体倦怠，其初亦邪正相搏而成。治者但责其实而忘其虚，攻伐过多，始则邪气当之，继乃转伤元气，运
化失职，升降不利，热者变寒，实者变虚，而病机迁矣。经曰∶足太阴之别，公孙虚则鼓胀。又胃中寒则满胀。
可见中脏虚寒，亦能成胀，不独实病为然也。治法但用温补之剂，健脾胃，补三焦。然须积久成功，不可欲速，
所谓新病可急治，久病宜缓调也。遂恪服加桂理中汤三十余剂，胀渐消，脉渐转，两月后全安。
庄季裕云∶予自许昌遭金狄之难，忧劳艰危，冲冒寒暑，避地东方。丁未八月，抵四滨感 疟，既至琴川，
为医妄治，荣卫衰耗。明年春末，尚苦 肿，腹胀气促，不能食而大便利，身重足痿，杖而后起，得陈了翁家
传，为灸膏肓 ，自丁亥至癸巳，积三百壮。灸之次日，即胸中气平，肿胀俱消，利止而食进，甲午已能肩舆
出谒。后再报之，仍得百壮，自是疾症顿减以至康宁。时亲旧间见此殊功，后灸者数人，宿 皆除。孙真人谓
若能用心方便，求得其穴而灸之，无疾不愈，信不虚也。（《针灸四书》。）
王执中曰∶有里医为李生治水肿，以药饮之不效。以受其延待之勤，一日忽为灸水分与气海穴，翌早观其
面如削矣，信乎水分之能治水肿也。《明堂》故云∶若是水病灸大良，盖以此穴能分水不使妄行耳。但不知《明
堂》又云∶针四分者，岂治其他病，当针四分者耶。
水肿惟得针水沟，若针余穴，水尽即死，此《明堂铜人》所戒也。庸医多为人针水分，杀人多矣。若其他
穴，亦有针得瘥者，特幸焉耳，不可为法也。或用药则禹余粮丸为第一，予屡见人报验，故书于此，然灸水分，
则最为要穴也。（《资生经》。）
姚僧垣治大将军襄乐公贺兰隆，有气疾加水肿，喘息奔急，坐卧不安。或有劝其服决命大散者，其家疑未
能决，乃问僧垣。僧垣曰∶意谓此患不与大散相当，若欲自服，不烦赐问，因而委去。其子殷勤拜请曰∶多时
抑屈，今日始来，竟不可治，意实未尽。僧垣知其可瘥，即为处方，劝使急服便即气通。更服一剂，诸患悉愈。
（《周书》。）
黄司寇葵峰，中年病蛊，得异方，真茅山苍术末也，每清晨米饮调三钱服，不数月强健如故。终身止服术，
七十余终，少停疾作矣。（《广笔记》。）
徐文江夫人，病蛊胀，张涟水治之，百药不效。张曰∶计穷矣，记昔年西山有一妪患此，意其必死，后过
复见之云，遇一方上人得生，徐如言访妪果在也。问其方，以陈葫芦一枚去顶，入酒，以竹箸松其子，仍用顶
封固，重汤煮数沸，去子饮酒尽，一吐几死，吐后腹渐宽，调理渐愈。盖元气有余，而有痰饮者也。若肾虚脾
弱者，宜用《金匮》肾气丸，十全大补汤去当归，加车前子、肉桂。（同上。）
通血香一钱，取小葫芦一个，不去子膜，入香在内，再入煮酒，以所开之盖，合缝封之。以酒入锅，悬葫
芦酒中，挨定不可倾倒，盖锅密煮，以三炷香为率。煮时其香透远墙屋外，煮完取葫芦内药，约有五六钱之数，
病已释然矣。通血香，陕西羊 客人带来，苏杭有。（同上。）
沈孝通观察，中年无子，患中满蛊胀，势孔棘，静养郭外小园中， 然独坐独宿食淡者五年。归脾汤、六
味地黄丸，朝暮间服不辍，连举二子。（同上。）
汪石山治一妇人，五十七岁，五月间因劳夜卧，天热开窗，醒来遍身胀痛，疑是痧症，刮背起紫疙瘩，因
而胸膈胀痛，磨木香服之，致小腹作痛，咳嗽气壅，不能伏枕，吐痰腥臭，每次一二碗，亦或作泻，肛门胀急，
自汗不止，身表浮肿。（纯是肺热壅塞之候。）医作伤寒而用发散，或作肺痈而用寒凉，绵延一月，医皆辞去。
其子来召汪，汪曰∶第未知得何脉耳。告曰∶医谓脉洪数也。曰∶年逾五十，血气已衰，又加小劳，当酷热之时，
又不免壮火食气，其洪乃热伤元气而然，非热脉也。所可虑者，脉不为汗衰，为泄减耳。彼曰∶用生脉汤人参
一钱，麦冬二钱，五味二钱，病似觉甚。曰∶邪重剂轻，宜黄 五钱固表，人参五钱养内，白术三钱、茯苓钱半渗湿
散肿，陈皮七分、吴茱萸四分，消痰下气，再加甘草五分以和之，麦冬一钱以救肺。（雄按∶即知邪重，则生
脉已误，何以犹谓剂轻而竟再误以大补耶？温热客邪，古贤往往疏忽也。）根据法煎服十余帖，后虽稍安，
脉与病相反，终不救。
按∶是症终挟热邪，初时或宜凉膈、白虎为是。
萧万舆曰∶曾氏妇年四旬，素郁怒，嫠居十载，神思为病。忽一日因行经暴怒，血上溢兼致臌胀，或投
散气药不效，且渐笃。曰∶此脏病得之数年，今始显发，丹溪鼓胀论可鉴也。脉之洪短，与病相符，峻补脾
元，不半载可愈。议用六君加姜、桂，倍人参、白术。彼惧不敢服，因改投《金匮》肾气丸，服一月血逆已止，
胀虽如故，未见增剧，为药力未到，须宁耐耳。不信，另延一医恃有神丹，谓旦夕可愈。果投一剂，下咽半
晌而即胀消，便泄进食，静睡精神爽快，举家钦以为神，愿掷百金酬谢而尤刺余之迂缓也。及察前方，乃阿魏、
姜黄、甘遂、甲片、葶苈、牵牛、元胡之属。越数日症仍作，投前药亦随手而应，独气困怠耳。不三日，朝夕
喘满不堪，再投不应，日甚一日，不及旬而殁。
萧从舅曾六海长子，亦原素郁患前症。曰∶此病始本称难治，但广费珍药，又非舌耕清儒所能办，当奈何？
未几有进草药者，彼悦捷法，信服之，饭许大号数声而毙。呜呼！病从何生？药从何治？如此盲妄矜功，顷刻
杀人转 ，谁之咎哉？
吴桥治王英妻，年三十许，病胀满，剂以补中气、利小水者皆无功。久之，喘急而汗沾衣，呕逆不能下，
昏乱殊甚。桥切之，浮取弦数，沉取涩滞，则以为蓄血，下之宜。或以汗多亡阳，丞下则速之毙。桥曰∶否，
病繇血滞故气壅，壅则腾腾上蒸而汗出焉。遂进桃仁承气汤，薄暮始进，呕者半之，中夜下败血三升，喘即定，
乃酣寝，诘朝，腹胀平。（《太函集》。）
聂久吾治司理毛具茨夫人，病两月余。初时每至五鼓胸腹胀，气上冲，不能卧，起坐方安。已而渐至四鼓，
又渐至三鼓即胀。今则二鼓起，而终夜不能卧矣。初以为气血不调，与调气二剂不应。因思其病作于夜间，而
日间不胀，必血虚故，改用四物等补血，数剂病减半。因延诊之，其脉弱，不惟血虚，气亦虚也。改用八物汤
加二陈，十余剂全安。
肝、肾的邪气，桂枝能令木气枯润（此处指调节肝木之气），并用辛散之性疏散肝经的水湿，以温补肾中真寒与湿气。连续服用十余剂后，肿胀完全消退。
朱丹溪治疗赤岸冯姓八官，平素饮食不知节制，但吃肉必定腹泻。忽然全身浮肿，头面部尤为严重，导致眼睛无法睁开，胸膈胀满如被捣击，双腿麻木至膝盖为止，浑身不能见风，生殖器挺长。其脉象左手沉取，重按不应；右手三部脉虽短小，却有和缓滑利的气象。于是让他单煮白术汤饮用，早晨空腹探吐以去之。饭后，用白术二钱、麻黄五分、川芎半钱、防风三分煎汤，送服保和丸五十丸。如此两天，因呕吐中得汗，上半身出汗较多，于是肿胀减轻而眼睛睁开，气顺而食欲增进。随后在前方中减去麻黄、防风，加白术一钱，木通、通草各半钱，再下保和丸五十丸，如此五天而病愈。（这就是“开鬼门”发汗的方法。）
罗谦甫治疗许鲁斋仲平，五十八岁，在至元戊寅五月间，因连绵阴雨，面目肢体浮肿，大便溏泄多，腹胀肠鸣时常疼痛，饮食减少，脉象弦细而缓。自述年轻时多服牵牛子、大黄等药，面目四肢时有浮肿，如今因阴雨天气故大发。说：营卫运行之气，出自中焦的胃。胃气虚弱不能布散水谷的精微之气，以荣养脏腑经络皮毛，所以气行涩滞而成浮肿，大便溏泄多且腹胀肠鸣，都是湿气胜的表现。四时五脏，都以胃气为本，有胃气则平和而身体安康。如果胃气虚弱，不能运动滋养，则五脏脉不和平，本脏之气盛的，其脉独见，（这个“盛”字应当活看），轻则病过，重则必死。所以经书说：真脏之脉弦，无胃气则死。（这也是木乘土的现象，所以虚损病宜注意滋养肝木。）现在的病幸而尚未到严重的地步，还可以调补。人们只知道服用牵牛子、大黄是一时的痛快，不知道它是终身的祸害。于是用平胃散加白术、茯苓、草豆蔻仁，数服后诸症皆愈，饮食增进。只有四肢仍然浮肿，用导滞通经汤主治，痊愈。（徐大椿按：今年秋天我治疗一位山居的黄姓老妪，病症与此相同，医生进用理中汤、肾气丸多剂，病情日益加重，束手无策。我诊察她的脉象果然弦细沉兼数，舌红口干，肿处赤痛，小便少而热，这是阴虚肝热。清润尚且不暇，不可因其起于霉雨之时就轻易使用温燥药。给予白头翁汤加金铃子、金银花、栀子、玄参、牡丹皮、绿豆，数服后症状减轻知饥，逐渐佐以养血充津而痊愈。）
马元仪治疗华氏之子，患腹胀已三个月，形色憔悴，而脉象沉微。治病者只说是邪气盛，不知道是正气虚。《灵枢》说：脉应于寸口，大而坚涩的，是胀病。《素问》说：征验其脉与色都衰夺的，这是久病。现在两脉微弱无神，面色不华，肢体倦怠，起初也是邪正相搏而成。治病者只责备其实证而忘记其虚证，攻伐过多，开始邪气承受，继而转伤元气，运化失职，升降不利，热者变寒，实者变虚，而病机迁延。经书说：足太阴之别穴公孙，虚则鼓胀。又胃中寒则满胀。可见中脏虚寒，也能成胀，不只是实证才这样。治法只用温补之剂，健脾胃，补三焦。然而须积累长久才能成功，不可求快，所谓新病可急治，久病宜缓调。于是恭敬地服用加桂理中汤三十余剂，胀渐消，脉渐转，两个月后完全安康。
庄季裕说：我从许昌遭遇金兵之难，忧劳艰危，冲冒寒暑，避乱东方。丁未年八月，抵达四滨感染疟疾，到了琴川，被医生误治，营卫衰耗。次年春末，还苦于水肿，腹胀气促，不能进食而大便失禁，身重足痿，拄杖而后起，得到陈了翁家传方，为灸膏肓穴，从丁亥年至癸巳年，累计三百壮。灸后的第二天，即胸中气平，肿胀俱消，痢止而食进，甲午年已能坐轿外出拜谒。后来再报效，仍得百壮，从此疾病顿减以至康宁。当时亲友间见此殊功，后来灸的人也数人，宿疾皆除。孙真人说如果能用心方便，求得其穴而灸之，无疾不愈，确实不虚假啊。（《针灸四书》。）
王执中说：有位乡医为李生治疗水肿，用药饮水无效。因为受其邀请招待的恩情，一天忽然为他灸水分和气海穴，第二天早上看他的脸瘦削了，确实水分穴能治疗水肿啊。《明堂》旧说：若是水病灸此穴大良，大概因为这个穴能分水不使妄行耳。但不知道《明堂》又说：针四分者，难道治其他病，当针四分者耶。
水肿只有针刺水沟穴有效，若针其余穴位，水尽即死，这是《明堂铜人》所戒律的。庸医多为人针水分穴，杀人很多了。若其他穴位，也有针刺得好的，只是侥幸罢了，不可作为法则。或者用药则禹余粮丸为第一，我屡见有人验证有效，所以写在这里，然而灸水分穴，则是最为重要的穴位。（《资生经》。）
姚僧垣治疗大将军襄乐公贺兰隆，有气疾加水肿，喘息奔急，坐卧不安。有人劝他服用决命大散，其家人怀疑未能决定，于是问僧垣。僧垣说：我认为此患不与大散相当，若想自行服用，不必赐问，因而离去。其子殷勤拜请说：多时压抑委屈，今日始来，竟不可治，心意实在未尽。僧垣知道可以痊愈，即为处方，劝使急服便即气通。再服一剂，诸患悉愈。（《周书》。）
黄司寇葵峰，中年患蛊胀，得异方，是真茅山苍术末，每清晨米饮调三钱服，不数月强健如故。终身只服术，七十余岁终，少有停疾发作。（《广笔记》。）
徐文江夫人，患蛊胀，张涟水治疗，百药无效。张说：计穷矣，记得昔年西山有一老妪患此，意其必死，后来经过复见之云，遇一方上人得生，徐如言访妪果在也。问其方，以陈葫芦一枚去顶，入酒，以竹箸松其子，仍用顶封固，重汤煮数沸，去子饮酒尽，一吐几死，吐后腹渐宽，调理渐愈。盖元气有余，而有痰饮者也。若肾虚脾弱者，宜用《金匮》肾气丸，十全大补汤去当归，加车前子、肉桂。（同上。）
通血香一钱，取小葫芦一个，不去子膜，入香在内，再入煮酒，以所开之盖，合缝封之。以酒入锅，悬葫芦酒中，挨定不可倾倒，盖锅密煮，以三炷香为率。煮时其香透远墙屋外，煮完取葫芦内药，约有五六钱之数，病已释然矣。通血香，陕西羊客人带来，苏杭有。（同上。）
沈孝通观察，中年无子，患中满蛊胀，势孔棘，静养郭外小园中，悠然独坐独宿食淡者五年。归脾汤、六味地黄丸，朝暮间服不辍，连举二子。（同上。）
汪石山治疗一妇人，五十七岁，五月间因劳累夜卧，天热开窗，醒来遍身胀痛，疑是痧症，刮背起紫疙瘩，因而胸膈胀痛，磨木香服之，致小腹作痛，咳嗽气壅，不能伏枕，吐痰腥臭，每次一二碗，亦或作泻，肛门胀急，自汗不止，身表浮肿。（纯是肺热壅塞之候。）医生当作伤寒而用发散，或作肺痈而用寒凉，绵延一月，医皆辞去。其子来召汪，汪说：第未知得何脉耳。告曰：医谓脉洪数也。曰：年逾五十，血气已衰，又加小劳，当酷热之时，又不免壮火食气，其洪乃热伤元气而然，非热脉也。所可虑者，脉不为汗衰，为泄减耳。彼曰：用生脉汤人参一钱，麦冬二钱，五味二钱，病似觉甚。曰：邪重剂轻，宜黄芪五钱固表，人参五钱养内，白术三钱、茯苓钱半渗湿散肿，陈皮七分、吴茱萸四分，消痰下气，再加甘草五分以和之，麦冬一钱以救肺。（徐大椿按：既知邪重，则生脉已误，何以犹谓剂轻而竟再误以大补耶？温热客邪，古贤往往疏忽也。）根据法煎服十余帖，后虽稍安，脉与病相反，终不救。
按：是症终挟热邪，初时或宜凉膈、白虎为是。
萧万舆说：曾氏妇年四旬，素郁怒，寡妇居十载，神思为病。忽一日因行经暴怒，血上溢兼致臌胀，或投散气药不效，且渐笃。曰：此脏病得之数年，今始显发，丹溪鼓胀论可鉴也。脉之洪短，与病相符，峻补脾元，不半载可愈。议用六君加姜、桂，倍人参、白术。彼惧不敢服，因改投《金匮》肾气丸，服一月血逆已止，胀虽如故，未见增剧，为药力未到，须宁耐耳。不信，另延一医恃有神丹，谓旦夕可愈。果投一剂，下咽半晌而即胀消，便泄进食，静睡精神爽快，举家钦以为神，愿掷百金酬谢而尤刺余之迂缓也。及察前方，乃阿魏、姜黄、甘遂、甲片、葶苈、牵牛、元胡之属。越数日症仍作，投前药亦随手而应，独气困怠耳。不三日，朝夕喘满不堪，再投不应，日甚一日，不及旬而殁。
萧从舅曾六海长子，亦原素郁患前症。曰：此病始本称难治，但广费珍药，又非舌耕清儒所能办，当奈何？未几有进草药者，彼悦捷法，信服之，饭许大号数声而毙。呜呼！病从何生？药从何治？如此盲妄矜功，顷刻杀人转 ，谁之咎哉？
吴桥治疗王英妻，年三十许，病胀满，剂以补中气、利小水者皆无功。久之，喘急而汗沾衣，呕逆不能下，昏乱殊甚。桥切之，浮取弦数，沉取涩滞，则以为蓄血，下之宜。或以汗多亡阳，丞下则速之毙。桥曰：否，病繇血滞故气壅，壅则腾腾上蒸而汗出焉。遂进桃仁承气汤，薄暮始进，呕者半之，中夜下败血三升，喘即定，乃酣寝，诘朝，腹胀平。（《太函集》。）
聂久吾治疗司理毛具茨夫人，病两月余。初时每至五鼓胸腹胀，气上冲，不能卧，起坐方安。已而渐至四鼓，又渐至三鼓即胀。今则二鼓起，而终夜不能卧矣。初以为气血不调，与调气二剂不应。因思其病作于夜间，而日间不胀，必血虚故，改用四物等补血，数剂病减半。因延诊之，其脉弱，不惟血虚，气亦虚也。改用八物汤加二陈，十余剂全安。
The pathogenic factors of the Liver and Kidney: Cinnamon Twig (Guizhi) regulates the Wood element, dispersing water-dampness in the Liver channel with its acrid nature, and warming the true cold-dampness in the Kidney. After taking more than ten doses consecutively, the edema completely subsided.
Zhu Danxi treated Feng Lingbaguan from Chi'an, who was accustomed to overeating without knowing satiety, but always suffered diarrhea after eating meat. Suddenly, his whole body became swollen, especially the head and face, so much so that he could not open his eyes. His chest and diaphragm felt full as if beaten, numbness extended in both legs up to the knees, he could not tolerate wind on his body, and his genitalia were erect and elongated. His pulse was deep on the left, unresponsive to heavy pressure; on the right, although the three positions were short and small, there was a harmonious and slippery quality. He was instructed to boil Baizhu Tang (Atractylodes Macrocephala Decoction) alone and drink it, inducing vomiting in the morning on an empty stomach to expel it. After meals, he took Baizhu (Atractylodis Macrocephalae Rhizoma) 2 qian, Mahuang (Ephedrae Herba) 5 fen, Chuanxiong (Ligustici Chuanxiong Rhizoma) half a qian, and Fangfeng (Saposhnikoviae Radix) 3 fen decocted as a soup, taken with 50 pills of Baohe Wan (Harmonize the Stomach Pills). For two days, through vomiting, he sweated, mostly on the upper part of his body, leading to reduced swelling, opened eyes, smooth qi, and improved appetite. Subsequently, Mahuang and Fangfeng were removed from the previous formula, Baizhu was increased by 1 qian, Mutong (Akebiae Caulis) and Tongcao (Tetrapanacis Medulla) each half a qian were added, and 50 pills of Baohe Wan were administered. This continued for five days until he recovered. (This is the method of "opening the ghost gate," i.e., inducing sweating.)
Luo Qianfu treated Xu Luzhai Zhongping, aged fifty-eight. In May of the Wuyin year of Zhiyuan, due to continuous rain, his face, eyes, limbs, and body swelled. He had frequent loose stools, abdominal distension, borborygmus with occasional pain, and reduced appetite. His pulse was wiry, fine, and slow. He stated that in his youth, he frequently consumed Qianniuzi (Pharbitidis Semen) and Dahuang (Rhei Radix et Rhizoma), causing intermittent swelling of the face and limbs. Now, triggered by rainy weather, it flared up severely. He explained: The qi of Ying and Wei originates from the Middle Jiao, specifically the Stomach. Weak Stomach qi cannot distribute the essence of food and drink to nourish the zang-fu organs, meridians, skin, and hair. Thus, stagnant qi flow leads to edema; frequent loose stools, abdominal distension, and borborygmus are all signs of excessive dampness. The four seasons and five zang organs all rely on Stomach qi as their root. With Stomach qi, the body remains peaceful and healthy. If Stomach qi is weak and fails to move and nourish, the pulses of the five zang organs will be disharmonious. When the qi of a specific zang organ becomes excessive, its pulse appears exclusively. (The term "excessive" here should be interpreted flexibly.) Mildly, the disease progresses; severely, death ensues. Hence, the classics state: A true zang pulse that is wiry indicates no Stomach qi and implies death. (This is also Wood overacting on Earth; thus, deficiency diseases should focus on nourishing Liver Wood.) Fortunately, his condition has not yet reached a critical stage and can still be regulated and tonified. People know that consuming Qianniuzi and Dahuang brings momentary relief but fail to realize it causes lifelong harm. Therefore, Pingwei San (Calm the Stomach Powder) was modified with Baizhu, Fuling (Poria), and Caodoukou Ren (Cardamomi Fructus) to treat him. After several doses, all symptoms resolved, and his appetite returned. Only his limbs remained swollen, so Daozhi Tongjing Tang (Promote Stagnation and Unblock Meridians Decoction) was prescribed, resulting in a good recovery. (Xu Dachun noted: This autumn, I treated an elderly woman named Huang living in the mountains with identical symptoms. Physicians had administered multiple doses of Lizhong Tang (Regulate the Middle Decoction) and Shenqi Wan (Kidney Qi Pill), worsening her condition until they were helpless. My diagnosis revealed a wiry, fine, deep, and rapid pulse, red tongue with dry mouth, red and painful swelling, scanty hot urination, indicating Yin deficiency with Liver heat. Given the urgency of clearing heat and moistening, one should not hastily use warm and drying herbs simply because the onset coincided with damp weather. I prescribed Baitouweng Tang (Patriniae Herb Decoction) modified with Jinlingzi (Meliae Fructus), Yinhua (Lonicerae Japonicae Flos), Zhizi (Gardeniae Fructus), Yuanshen (Scrophulariae Radix), Mudanpi (Moutan Cortex), and Lvdou (Phaseoli Semen Mungo), which reduced symptoms and restored hunger after a few doses. Gradually adding blood-nourishing and fluid-generating herbs led to her recovery.)
Ma Yuanyi treated the son of the Hua family, who suffered from abdominal distension for three months. His complexion was haggard, and his pulse was deep and faint. The treating physician attributed this solely to excess pathogens, ignoring the deficiency of righteous qi. The *Ling Shu* states: When the pulse at the Cun Kou position is large, firm, and choppy, it indicates distension. The *Su Wen* states: When both pulse and complexion show depletion, it signifies a chronic illness. Currently, both pulses are weak and spiritless, his complexion lacks luster, and his limbs feel fatigued. Initially, this resulted from the struggle between pathogenic and righteous qi. However, the physician focused only on excess and neglected deficiency, using excessive attacking methods. Initially, the pathogen bore the brunt, but subsequently, the primordial qi was damaged, leading to failure of transportation and transformation, impaired ascending and descending, transformation of heat into cold, and excess into deficiency, thereby prolonging the pathology. The classics state: The collateral point Gongsun of the Foot-Taiyin Spleen channel, when deficient, causes鼓胀 (drum-like distension). Also, cold in the Stomach causes fullness and distension. This demonstrates that deficiency-cold in the middle zang organs can cause distension, not just excess conditions. The treatment method should employ warm and tonifying agents to strengthen the Spleen and Stomach and tonify the Triple Burner. However, success requires accumulation over time; one must not seek quick results. As the saying goes: Acute diseases may be treated urgently, while chronic diseases require gradual regulation. He faithfully took Jiagui Lizhong Tang (Cinnamon-Modified Regulate the Middle Decoction) for over thirty doses. The distension gradually subsided, the pulse gradually normalized, and after two months, he fully recovered.
Zhuang Jiyu said: During the Jin invasion in Xuchang, I endured worry, toil, hardship, and danger, exposed to cold and heat, seeking refuge in the East. In August of the Dingwei year, upon arriving at Sibin, I contracted malaria. Upon reaching Qin Chuan, improper medical treatment depleted my Ying and Wei qi. By late spring of the following year, I still suffered from edema, abdominal distension, shortness of breath, inability to eat, profuse diarrhea, heaviness of the body, weakness of the legs requiring a cane to stand, and received a family recipe from Chen Liaoweng. I moxaed the Gaohuang (BL43) points. From the Dinghai year to the Guisi year, I accumulated three hundred moxa cones. The day after moxibustion, my chest felt calm, swelling subsided, diarrhea stopped, and appetite improved. By the Jiawu year, I could travel by sedan chair to pay visits. Later, another course of one hundred cones was administered, leading to a sudden reduction in illness until complete health. Relatives and friends witnessing this remarkable result also underwent moxibustion, curing their chronic ailments. Sun Simiao said that if one applies oneself conveniently, locates the correct points, and performs moxibustion, no disease is incurable. This is indeed true. (*Four Books of Acupuncture and Moxibustion*.)
Wang Zhizhong said: A country doctor treated Li Sheng for edema with herbal medicine without effect. Out of gratitude for his hospitality, one day he suddenly moxaed the Shuifen (CV9) and Qihai (CV6) points. The next morning, his face appeared emaciated. Indeed, Shuifen can treat edema. The *Mingtang* classics state: For water diseases, moxibustion is highly effective, precisely because this point separates water and prevents it from flowing recklessly. However, the *Mingtang* also mentions needling four fen. Does this apply to other diseases requiring needle insertion of four fen?
For edema, only needling Shuigou (GV26) is effective. Needling other points may lead to death once the water is exhausted, as warned in the *Mingtang Bronze Man*. Quack doctors often needle Shuifen, killing many people. Although some other points have yielded successful results through needling, it is merely luck and should not be set as a standard. If using herbs, Yuyuliang Wan (Hematite Pill) is the first choice. I have repeatedly seen others report its efficacy, hence recording it here. However, moxibustion on Shuifen is the most crucial point. (*Zisheng Jing*.)
Yao Sengyuan treated General Helan Long, Duke of Xiangle, who suffered from qi disorders compounded by edema, panting, urgency, restlessness in sitting and lying. Some advised taking Jueming Dasan (Life-Deciding Great Powder), but his family hesitated and asked Yao. Yao said: I believe this condition does not match the indications for Dasan. If you wish to take it yourself, no need to ask me, and he departed. His son earnestly begged, saying: We have been suffering for a long time and finally came to you today. It is unacceptable that it cannot be cured; our intent is not fully expressed. Yao knew it could be healed, prescribed a formula, and urged immediate intake, which immediately unblocked the qi. After one more dose, all ailments were cured. (*Book of Zhou*.)
Huang Kuifeng, a Minister of Justice, suffered from gut distension (Gu Zhang) in middle age. He obtained an unusual prescription: pure Cangzhu powder from Mount Mao. Each morning, he mixed three qian with rice water to drink. Within a few months, he regained his strength as before. He took only Cangzhu throughout his life, lived to over seventy, and rarely experienced recurrence of illness. (*Guang Biji*.)
Madam Xu Wenjiang suffered from gut distension. Zhang Lianshui treated her with hundreds of medicines without effect. Zhang said: I am out of ideas. I recall an old woman in West Mountain years ago who had this condition and was expected to die. Later, passing by, I saw her alive, claiming she met a Daoist priest who saved her. Xu followed these words and found the woman indeed. Asking for the prescription: Take an old gourd, remove the top, insert wine, loosen the seeds inside with a bamboo stick, seal the top again, and boil in double-boiler for several boils. Remove the seeds, drink the wine entirely. One episode of vomiting nearly killed her, but afterwards, the abdomen gradually widened, and with conditioning, she recovered. This case involved sufficient primordial qi but with phlegm-fluid retention. For those with Kidney deficiency and Spleen weakness, Shenqi Wan (*Jin Gui Yao Lue*) or Shiquan Dabu Tang (Ten Significant Tonifying Decoction) minus Danggui (Angelicae Sinensis Radix), plus Cheqianzi (Plantaginis Semen) and Rougui (Cinnamomi Cortex), is appropriate. (Ibid.)
Tongxue Xiang (Blood-Penetrating Incense) 1 qian, take a small gourd, do not remove seeds or membrane, place incense inside, add boiling wine, seal tightly with the lid. Place the gourd in a pot of wine, ensure it does not tip over, cover the pot tightly, and boil for the duration of three incense sticks. During boiling, the fragrance penetrates far beyond the walls. After boiling, retrieve the medicine from the gourd, approximately 5-6 qian. The illness will be relieved. Tongxue Xiang was brought by a merchant from Shaanxi and is available in Suzhou and Hangzhou. (Ibid.)
Shen Xiaotong, a regional inspector, childless in middle age, suffered from middle-fullness and gut distension, a critical situation. He rested quietly in a small garden outside the city, sitting and sleeping alone, eating bland food for five years. He continuously took Guipi Tang (Restore the Spleen Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) morning and night, eventually fathering two sons. (Ibid.)
Wang Shishan treated a woman, aged fifty-seven. In May, due to fatigue and night sleeping with windows open in hot weather, she woke up with generalized body pain and distension. Suspecting sha syndrome, her back was scraped, producing purple bumps. Consequently, her chest and diaphragm became painful and distended. She ground and took Muxiang (Aucklandiae Radix), causing lower abdominal pain, cough, qi stagnation, inability to lie flat, expectoration of foul-smelling sputum (one to two bowls per time), occasional diarrhea, urgent anal distension, continuous spontaneous sweating, and superficial body edema. (Purely a presentation of Lung heat obstruction.) Physicians treated it as Taiyang syndrome using dispersing methods, or as Lung abscess using cold/cooling methods. It persisted for a month, and physicians resigned. Her son summoned Wang. Wang said: I only wonder what the pulse is. He replied: The physician said the pulse was surging and rapid. Wang said: Over fifty years old, blood and qi are already declining. Added to minor exertion during extreme heat, the vigorous fire consumes qi. The surging quality is due to heat damaging primordial qi, not a true heat pulse. What is concerning is that the pulse did not diminish with sweating but decreased due to diarrhea. The patient used Shengmai San (Generate the Pulse Powder) with Renshen (Ginseng Radix) 1 qian, Maidong (Ophiopogonis Radix) 2 qian, and Wuweizi (Schisandrae Fructus) 2 qian, feeling the illness seemed worse. Wang said: The pathogen is heavy, the dosage is light. Huangqi (Astragali Radix) 5 qian should be used to secure the exterior, Renshen 5 qian to nourish the interior, Baizhu 3 qian and Fuling 1.5 qian to leach out dampness and dissipate swelling, Chenpi (Citri Reticulatae Pericarpium) 7 fen and Wuzhuyu (Evodiae Fructus) 4 fen to resolve phlegm and direct qi downward, plus Gancao (Glycyrrhizae Radix) 5 fen to harmonize, and Maidong 1 qian to rescue the Lung. (Xu Dachun noted: Knowing the pathogen is heavy, Shengmai San was already a mistake. Why claim the dosage is light and then err further by using major tonification? Ancient sages often overlooked warm-heat exogenous pathogens.) According to the method, decocted and taken for over ten doses. Although slightly relieved later, the pulse contradicted the disease, and ultimately, she could not be saved.
Note: This condition ultimately involves heat pathogens. Initially, Liangge San (Cool the Diaphragm Powder) or Baihu Tang (White Tiger Decoction) would have been appropriate.
Xiao Wanyu said: Madam Zeng, forty years old, prone to depression and anger, widowed for ten years, suffered from mental disturbance. One day, during menstruation, she flew into a rage, causing blood to regurgitate upwards accompanied by abdominal distension. Administering qi-dispersing medicines was ineffective, and the condition worsened. He said: This internal organ disease has existed for years and is now manifesting. Zhu Danxi's discussion on drum distension serves as a warning. The pulse is surging and short, matching the disease. Vigorously tonify the Spleen yuan; recovery can be expected in less than half a year. Proposed Junzi San (Six Gentlemen Powder) modified with Jiang (Zingiberis Rhizoma) and Gui (Cinnamomi Ramulus), doubling Renshen and Baizhu. She feared and dared not take it, so switched to Shenqi Wan (*Jin Gui Yao Lue*). After one month, upward rebellious blood stopped. Although distension remained unchanged, it did not worsen, as the medicinal power had not yet taken effect; patience was required. Disbelieving this, she hired another physician relying on miraculous pills, claiming cure within days. Indeed, after one dose, swallowing halfway, the distension vanished, bowel movements occurred, appetite returned, and she slept peacefully with refreshed spirit. The whole family admired this as divine, willing to throw a hundred taels of silver in reward, criticizing my slowness. Examining the previous prescription, it contained Ewei (Ferulae Resina), Jianghuang (Curcumae Longae Rhizoma), Gansui (Kansui Radix), Jiapian (Testudinis Carapax et Plastrum), Tinglizi (Descurainiae Semen), Qianniuzi, and Yuanhu (Corydalis Rhizoma). Several days later, symptoms recurred. The previous medicine worked instantly again, except for qi exhaustion and fatigue. Within three days, morning and evening wheezing and fullness became unbearable. Re-administration failed. Day by day it worsened, and she died in less than ten days.
Eldest son of Zeng Liuhai, nephew of Xiao, also originally prone to depression, suffered from the same condition. He said: This disease is inherently difficult to treat. But spending heavily on precious medicines is beyond the means of a humble scholar teaching by writing. What should be done? Soon, someone offered herbal remedies. He was pleased with the quick method and believed in them. After a meal, he shouted loudly a few times and died. Alas! Where does the disease come from? How should the medicine treat it? Such blind arrogance in claiming merit kills people in an instant. Whose fault is it?
Wu Qiao treated the wife of Wang Ying, about thirty years old, suffering from distension and fullness. Formulas tonifying Middle qi and promoting urination were ineffective. After a long time, she developed急促 panting, sweat soaking clothes, retching unable to swallow, and severe confusion. Wu palpated her pulse: superficially wiry and rapid, deeply choppy and stagnant. He diagnosed blood stasis and indicated purgation. Others argued that excessive sweating had lost yang, and purging would hasten death. Wu said: No. The illness arises from blood stasis causing qi congestion. Congestion leads to steaming upward and sweating. He administered Tao Ren Chengqi Tang (Peach Kernel and Rheum Decoction). Taken at dusk, vomiting ceased by half. At midnight, three sheng of dark blood were passed. Panting stabilized, she slept soundly. By morning, abdominal distension flattened. (*Tai Han Ji*.)
Nie Jiuwu treated Madam Mao Juzhi, Vice Director, who had been ill for over two months. Initially, every fifth watch (around 1-3 AM), her chest and abdomen distended, qi rushed upward, preventing sleep; she had to sit up to find relief. Gradually, this shifted to the fourth watch, then the third. Now, it started at the second watch, preventing sleep all night. Initially thought to be qi-blood disharmony, two doses of Qi Tiao San (Regulate Qi Powder) were ineffective. Considering the illness occurred at night but not during the day, he deduced blood deficiency. He switched to Siwu Tang (Four Substance Decoction) and similar blood-tonifying formulas. After several doses, symptoms halved. Upon further consultation, her pulse was weak, indicating not only blood deficiency but also qi deficiency. He changed to Bayi Tang (Eight Substance Decoction) combined with Erchen Tang (Two Aged Things Decoction). After over ten doses, she fully recovered.