土，用白芍以土中泻木安脾。〕橘红 木香 沉香〔佐以调和中气。〕热加麦冬，〔散结热而下逆
气。〕渴者尤宜。或加黄连。〔清脾胃之积热，丸制最止邪热。〕有积加枳、曲、山楂、麦芽。〔助脾家之
健运。〕如肥人湿痰，加茅术、半夏。〔燥湿消痰，血家、渴家、汗家勿用。〕如脾虚水肿，加绿豆、
车前。如果虚而挟寒，方可加干姜。〔合理中汤方。〕寒甚则加附、桂。〔补命门之火，以生脾土，否则
不可浪用。〕
此方益气补脾为主，佐以调气之剂，备加减之法，以通其用。若系实症，即于前列诸方，对症取用。
其有不大实，亦不大虚者，本方去参，加减治之，后仍用参补之。按虞天民云∶虚胀必服人参，人参必
肺无热方可服，有热服之，肺火得参而愈甚。肺主出气，邪火挟气两出，脾胃受之，复助积热，则胀急益
加，筋青脐出，危笃立见。故虚胀而不能服参，不救之症也。
二病之脉，实大者可治，虚微者难治，水病脉出者死。〔谓沉按之则无，非浮脉主死也。〕
唇黑或肿，肝伤缺盆平，心伤；脐突，脾伤；足心平，肾伤；背平，肺伤，五伤者死。阴囊及茎肿
腐者死；泻后腹胀而有青筋者死∶大便滑泄，水肿不消者死。水肿先起于腹，后散于四肢者可治，先起于
四肢，后归于腹者死。男从上而下，女从下而上，皆难治，腹胀身热者死，腹胀寒热
如疟者死，腹胀便血，〔脾败不能统血也。〕脉大时绝者死，咳呕腹胀且飧泄，其脉绝者死。〔上为
咳呕，中则胀满，下为飧泄，三焦俱病，六脉已绝，安得不死。〕
（在方剂中加入）白芍，以在脾土中疏泄肝木之气，从而安定脾胃。〕橘红、木香、沉香〔作为佐药，用以调和中和中焦之气。〕若有热象，加麦冬，〔以散结聚之热并降逆气。〕口渴者尤其适宜。或者加入黄连。〔清解脾胃中的积滞之热，用丸剂炮制最能遏制邪热。〕若有食积，加枳实、神曲、山楂、麦芽。〔帮助脾胃的健运功能。〕如果是肥胖之人患有湿痰，加苍术、半夏。〔燥湿化痰，但血虚患者、口渴患者、多汗患者禁止使用。〕如果是脾虚导致的水肿，加绿豆、车前子。如果确实是虚证且夹杂寒邪，才可以加入干姜。〔符合理中汤的方义。〕寒邪严重则加附子、肉桂。〔补益命门之火，以温煦生发脾土，否则不可随意滥用。〕
这个方子以益气补脾为主，佐以调气的药物，具备多种加减变化的方法，以便灵活应用。如果是实证，就在前面列举的各个方剂中，针对具体症状选用。那些既不是特别实、也不是特别虚的患者，本方去掉人参，进行加减治疗后，之后仍用人参来补益。据虞天民说：虚胀必须服用人参，但只有肺中没有热邪的人方可服用，如果有热邪而服用，肺火会因人参而更加旺盛。肺主管呼气，邪火挟带正气一起外泄，脾胃受到侵害，又助长积热，那么腹胀急迫会更加严重，甚至出现筋脉青紫、肚脐突出，危重情况立刻显现。所以，虚胀而不能服用人参的，是不治之症。
这两种病（水肿和胀满）的脉象，实大者可治，微弱者难治，水病脉象浮越无根的会死亡。〔所谓“脉出”，是指沉取时脉搏消失，并非指浮脉主死。〕
嘴唇发黑或肿胀，是肝脏受伤；缺盆（锁骨上窝）平坦凹陷，是心脏受伤；肚脐突出，是脾脏受伤；足心平坦无凹陷，是肾脏受伤；背部平坦无隆起，是肺脏受伤，五脏受损者死亡。阴囊及阴茎肿胀溃烂的死亡；腹泻后腹部胀满且有青色筋脉显露的死亡；大便滑脱失禁，水肿不消退的死亡。水肿先从腹部开始，后来扩散到四肢的可以治疗；先从四肢开始，后来回流到腹部的死亡。男性病势从上往下发展，女性病势从下往上发展，都难以治疗；腹部胀满且身体发热的死亡；腹部胀满且寒热往来像疟疾一样的死亡；腹部胀满且便血，〔这是脾败不能统摄血液所致。〕脉象盛大但时有间歇断绝的死亡；咳嗽呕吐、腹部胀满且完谷不化（飧泄），脉象断绝的死亡。〔上部表现为咳呕，中部表现为胀满，下部表现为飧泄，三焦全部患病，六脉已经断绝，怎么能不死呢。〕
(Bai Shao [Radix Paeoniae Alba]) is used to drain Wood within Earth, thereby calming the Spleen.〕Ju Hong (Exocarpium Citri Reticulatae), Mu Xiang (Radix Aucklandiae), Chen Xiang (Aquilaria Lignum) are added as assistants to harmonize and regulate the Middle Qi.〕If there is Heat, add Mai Dong (Radix Ophiopogonis),〔to dissipate knotted Heat and direct rebellious Qi downward.〕It is especially suitable for those with thirst. Alternatively, add Huang Lian (Coptidis Rhizoma).〔To clear accumulated Heat in the Stomach and Spleen; pill preparation is best to restrain pathogenic Heat.〕If there is food accumulation, add Zhi Shi (Fructus Aurantii Immaturus), Shen Qu (Massa Medicata Fermentata), Shan Zha (Fructus Crataegi), and Mai Ya (Fructus Hordei Germinatus).〔To assist the Spleen's healthy transportation and transformation.〕For obese individuals with Damp-Phlegm, add Cang Zhu (Rhizoma Atractylodis Lanceae) and Ban Xia (Rhizoma Pinelliae).〔To dry Dampness and resolve Phlegm; contraindicated for patients with Blood deficiency, thirst, or excessive sweating.〕For Edema due to Spleen deficiency, add Lu Dou (Semen Phaseoli Vulgaris) and Che Qian (Semen Plantaginis). If it is truly a deficiency pattern complicated by Cold, Gan Jiang (Rhizoma Zingiberis Preparatum) may be added.〔This aligns with the formula principles of Lizhong Tang (Regulate the Middle Decoction).〕If Cold is severe, add Fu Zi (Lateral Radix Aconiti Preparata) and Gui Zhi (Ramulus Cinnamomi).〔To tonify the Fire of the Gate of Vitality (Mingmen) to generate Spleen Earth; otherwise, they should not be used recklessly.〕
This formula primarily focuses on benefiting Qi and tonifying the Spleen, assisted by Qi-regulating agents, with various modification methods prepared to ensure flexible application. If it is an Excess syndrome, one should select from the previously listed formulas according to specific symptoms. For cases that are neither significantly Excess nor significantly Deficient, remove Ren Shen (Radix Ginseng) from this formula, treat with modifications, and subsequently use Ren Shen to tonify. According to Yu Tianmin: In cases of Deficiency-type distension, Ren Shen must be administered; however, Ren Shen can only be taken if there is no Heat in the Lung. If taken when Heat is present, Lung Fire will intensify due to Ren Shen. The Lung governs exhalation; when pathogenic Fire accompanies Qi, both exit together, affecting the Spleen and Stomach, which further aids accumulated Heat, causing distension and urgency to worsen. This leads to cyanotic veins and protruding umbilicus, with critical danger appearing immediately. Therefore, Deficiency-type distension where Ren Shen cannot be tolerated is an incurable condition.
Regarding the pulses for these two diseases (Edema and Distension), if Excess and large, it is treatable; if Deficient and minute, it is difficult to treat. In Water diseases, if the pulse "emerges" (floats without root upon deep pressure), death occurs.〔The term "pulse emerges" refers to the pulse disappearing upon deep palpation, not that a floating pulse indicates death.〕
Black or swollen lips indicate Liver injury; flatness of the Quepen (supraclavicular fossa) indicates Heart injury; protruding umbilicus indicates Spleen injury; flatness of the sole of the foot indicates Kidney injury; flatness of the back indicates Lung injury. Injury to all five Zang organs results in death. Swelling and putrefaction of the scrotum and penis result in death; abdominal distension with visible blue veins after diarrhea results in death; slippery diarrhea with unresolved edema results in death. Edema starting in the abdomen and spreading to the limbs is treatable; edema starting in the limbs and returning to the abdomen results in death. In men, progression from top to bottom is difficult to treat; in women, progression from bottom to top is difficult to treat. Abdominal distension with body heat results in death. Abdominal distension with alternating chills and fever resembling malaria results in death. Abdominal distension with bloody stools,〔due to Spleen failure unable to control blood〕results in death. Pulse that is large but intermittently absent results in death. Cough, vomiting, abdominal distension, and undigested stool diarrhea (Sun Xie) with absent pulses result in death.〔Upper Jiao presents with cough and vomiting, Middle Jiao with distension, Lower Jiao with Sun Xie; disease involves all three Jiaos, and the six pulses have ceased; how can death not occur?〕