《经》曰∶肤胀者，寒气客于皮肤之间。腹大身尽肿，皮浓按之突而不起，腹色变，此其候也，又曰∶诸湿
肿满，皆属于脾。又曰∶水病下为 肿，上为喘呼。不得卧者，标本俱病。若小儿水肿，皆因水停于脾肺二经。
藏于内者∶水停胸中则喘。水停膈下则胀。发于外者，当察其所肿之部位。肿在腰以上者，属风，治宜发汗。
肿在腰以下者，属湿，治宜利水。通身上下皆肿者，系风湿两伤，治宜汗利兼施。肿而喘不得卧，宜逐肺饮。肿
而胀满便秘，宜攻脾水。肿从腹起至四肢者，可治。肿从四肢起至腹者，难治。阳水属实，治宜攻泄。阴水属虚，
治宜温外。
治肿之法，大概尽述于前。其间通权达变，神而明之，存乎其人。又不可执胶柱鼓瑟之见。因作水肿解。
小儿上身肿者，头面肩臂至腰间皆肿也，病由外感风邪，古法仿经所谓开鬼门。主越婢加苍术汤以发汗（如
麻黄、 石膏、生甘草、米泔浸炒苍术等味）。
〔真按〕小儿之肿，自上而起，既系因风，则治宜在肺。古方太猛，但用炒党参五分，倍前胡五分，芽桔
梗一钱，老苏叶五分，真广皮一钱，炙甘草五分，生姜皮一钱，大腹皮一钱，茯苓皮一钱，炒桑白皮一钱，五加
皮一钱，引用灯芯十茎。
小儿下体肿者，腰脐至两足皆肿也，病由脾经湿热所致。古法仿经所谓洁净腑。主内用贴脐法（如巴豆，
去油，四钱，水 粉二钱，硫磺一钱，共研匀成饼，先用新棉一片，包药布贴脐上，外用帛缚时许，自然泻下恶
水，待下三五次，去药，以粥补住）。
内服沉香琥珀丸〔如苦葶苈子一两五钱，郁李仁一两五钱，防己七钱五分，沉香一两五钱，陈皮（去白）
七钱五分，琥珀五钱，杏仁（去皮尖炒）五钱，苏子五钱，赤苓五钱，泽泻五钱，共为细末，炼蜜为丸，如梧桐
子大，以麝香为衣，每服一钱，量儿大小与之，用白滚水下〕。
〔真按〕小儿之肿，自下而起，或因肾虚水泛，或因脾气受湿，古方内外治法，皆极暴烈，此药不宜妄施，
但宜渗利。方用生于术二钱，白云苓二钱，结猪苓二钱，炒泽泻二钱，上肉桂三分，炒防己一钱，花槟榔一钱，
引用生姜一片，灯芯十茎。
《黄帝内经》说：肤胀，是因为寒气停留在皮肤之间。腹部膨大，全身浮肿，皮肤厚实，按压后凹陷不起，腹部颜色改变，这是它的征候。又说：各种湿邪导致的肿胀和痞满，都归属于脾。又说：水病在下表现为下肢浮肿，在上表现为气喘呼叫。不能平卧的，说明表里（本标）都受病了。如果是小儿水肿，都是因为水液停滞在脾、肺两经。
水液藏于体内：水停在胸中就会气喘；水停在膈下就会腹胀。水液表现于体外，应当观察其浮肿的部位。浮肿在腰部以上的，属于风邪所致，治疗适宜用发汗法。浮肿在腰部以下的，属于湿邪所致，治疗适宜用利水法。全身上下都浮肿的，是风湿两邪共同伤害，治疗适宜发汗与利水兼施。浮肿且气喘不能平卧的，适宜逐除肺中的饮邪。浮肿且腹胀便秘的，适宜攻逐脾中的水湿。浮肿从腹部开始蔓延至四肢的，可以治愈。浮肿从四肢开始蔓延至腹部的，难治。阳水属于实证，治疗适宜攻下泄浊。阴水属于虚证，治疗适宜温补固外。
治疗水肿的方法，大体已在前面叙述完毕。其中的灵活变通、神妙明达之处，取决于医者本人。又不可拘泥固执、不知变通。因此撰写了这篇《水肿解》。
小儿上身浮肿，指头面、肩臂直至腰间都浮肿，病因是外感风邪，古法模仿经文所说的“开鬼门”（发汗）。主方用越婢加苍术汤来发汗（如麻黄、石膏、生甘草、米泔浸炒苍术等药味）。
〔陈守真按〕小儿的浮肿，如果从上而起，既然因为风邪，那么治疗应当在肺。古方药力太猛，只需用炒党参五分，前胡加倍至五分，芽桔梗一钱，老苏叶五分，真广皮一钱，炙甘草五分，生姜皮一钱，大腹皮一钱，茯苓皮一钱，炒桑白皮一钱，五加皮一钱，引用灯芯十茎。
小儿下体浮肿，指腰脐至双脚都浮肿，病因是脾经湿热所致。古法模仿经文所说的“洁净腑”（通利小便）。主方内用贴脐法（如巴豆，去油，四钱，水粉二钱，硫磺一钱，共研匀做成饼状，先用新棉一片包裹药饼贴在肚脐上，外用布带捆扎约一个时辰，自然会泻下恶水，待泻下三到五次后，去掉药饼，用粥食来补益脾胃）。
内服沉香琥珀丸〔如苦葶苈子一两五钱，郁李仁一两五钱，防己七钱五分，沉香一两五钱，陈皮（去白）七钱五分，琥珀五钱，杏仁（去皮尖炒）五钱，苏子五钱，赤苓五钱，泽泻五钱，共为细末，炼蜜制成丸药，大小如梧桐子，以麝香为衣，每次服用一钱，根据孩子的大小调整剂量，用白开水送下〕。
〔陈守真按〕小儿的浮肿，如果从下而起，可能是因为肾虚水泛，也可能是因为脾气受湿。古方的内外治法，都极其暴烈，此药不宜妄加施用，只宜用渗湿利水之法。方药用生于术二钱，白云苓二钱，结猪苓二钱，炒泽泻二钱，上肉桂三分，炒防己一钱，花槟榔一钱，引用生姜一片，灯芯十茎。
The *Classic* states: In distension of the skin (Fu Zhang), cold pathogenic factors lodge between the skin and muscles. The abdomen is enlarged, the whole body is swollen, the skin is thick, and pressing it leaves an indentation that does not rise immediately, with a change in abdominal color; this is its clinical manifestation. It also states: All swellings and fullnesses due to dampness belong to the Spleen. Furthermore: Water diseases manifest as edema below and panting/calling out above. Those who cannot lie flat indicate that both the root and branch are diseased. If it is pediatric edema, it is all caused by water retention in the Lung and Spleen meridians.
Water retained internally: Water stagnating in the chest causes panting; water stagnating below the diaphragm causes abdominal distension. Water manifesting externally requires observing the location of the swelling. Swelling above the waist belongs to Wind, and treatment should favor sweating (Diaphoresis). Swelling below the waist belongs to Dampness, and treatment should favor promoting urination (Diuresis). Swelling throughout the entire body indicates injury by both Wind and Dampness, requiring simultaneous sweating and diuresis. Swelling accompanied by panting and inability to lie flat requires driving out fluid retention from the Lungs. Swelling accompanied by abdominal fullness and constipation requires purging water from the Spleen. Swelling starting from the abdomen and spreading to the four limbs is treatable. Swelling starting from the four limbs and spreading to the abdomen is difficult to treat. Yang-type water (Yang Shui) belongs to Excess patterns, treated by purging and draining. Yin-type water (Yin Shui) belongs to Deficiency patterns, treated by warming and securing the exterior.
The methods for treating edema have been generally described above. The flexibility and profound understanding required depend on the practitioner. One must not be rigid or inflexible. Therefore, this treatise on "Edema" is composed.
Pediatric upper-body edema refers to swelling of the head, face, shoulders, arms, down to the waist. The etiology is external contraction of Wind pathogenic factors. Following ancient methods imitating the Classic's concept of "opening the ghost gate" (sweating), the main formula is Yuebi Jia Cangzhu Tang (Yuebi Decoction plus Atractylodis Rhizoma) to induce sweating (ingredients include Ephedrae Herba, Gypsum Fibrosum, Raw Glycyrrhizae Radix et Rhizoma, Cangzhu stir-fried in rice wash water, etc.).
[Chen Shouzhen's Note]: For pediatric edema arising from the top, since it is due to Wind, treatment should focus on the Lungs. Ancient formulas are too harsh. Instead, use Stir-fried Codonopsis Radix 5 fen, doubled Bupleuri Radix 5 fen, Ya Jiegeng (Buddha's Hand Platycodon) 1 qian, Lao Suye (Old Perilla Leaf) 5 fen, Zhen Guangpi (True Tangerine Peel) 1 qian, Honey-fried Glycyrrhizae Radix et Rhizoma 5 fen, Shengjiangpi (Ginger Peel) 1 qian, Dafupi (Areca Peel) 1 qian, Fulingpi (Poria Peel) 1 qian, Chao Sangbaipi (Stir-fried Mulberry Root Bark) 1 qian, Wujiaopi (Acanthopanacis Cortex) 1 qian, with Dengxincao (Juncus Effusus) 10 stems as a guide.
Pediatric lower-body edema refers to swelling from the waist and umbilicus to both feet. The etiology is Damp-Heat in the Spleen meridian. Following ancient methods imitating the Classic's concept of "cleaning the fu-organs" (promoting urination), the main method is internal application via navel sticking (ingredients include Crotonis Fructus, oil removed, 4 qian, Shuifen [White Lead Powder] 2 qian, Liuhuang (Sulfur) 1 qian, ground evenly into a cake. First, wrap the medicine in a piece of new cotton, apply to the navel, and bind tightly with cloth for about one shi (two hours). Naturally, foul water will be discharged. After 3-5 discharges, remove the medicine and replenish with congee).
Internal administration of Chenxiang Hupo Wan (Agarwood and Amber Pill) [ingredients include Ku Tinglizi (Bitter Lepidii Semen) 1 liang 5 qian, Yuliren (Prunus Armeniaca Seed) 1 liang 5 qian, Fangji (Stephaniae Tetrandrae Radix) 7 qian 5 fen, Chenxiang (Aquilariae Lignum Resinatum) 1 liang 5 qian, Chenpi (Citri Reticulatae Pericarpium, white part removed) 7 qian 5 fen, Hupo (Amber) 5 qian, Xingren (Armeniacae Semen Amarum, peeled and tip removed, stir-fried) 5 qian, Suzi (Perillae Fructus) 5 qian, Chiling (Red Poria) 5 qian, Zexie (Alismatis Rhizoma) 5 qian, ground into fine powder, mixed with refined honey to form pills the size of Sophora seeds, coated with Moschus, each dose 1 qian, adjusted according to the child's age, taken with plain boiled water].
[Chen Shouzhen's Note]: For pediatric edema arising from the bottom, it may be due to Kidney Deficiency with water overflowing, or Spleen Qi affected by Dampness. Ancient internal and external treatments are extremely violent; this medicine should not be used recklessly. Only mild diuretic and leaching methods are suitable. The formula uses Sheng Baizhu (Raw Atractylodis Macrocephalae Rhizoma) 2 qian, Bai Yunling (White Cloud Poria) 2 qian, Jie Zhuling (Knot Polyporus) 2 qian, Chao Zexie (Stir-fried Alismatis Rhizoma) 2 qian, Shang Rougui (Super Cinnamon Bark) 3 fen, Chao Fangji (Stir-fried Stephaniae Tetrandrae Radix) 1 qian, Hua Binglang (Flowered Areca Nut) 1 qian, with Shengjiang (Fresh Ginger) 1 slice and Dengxincao (Juncus Effusus) 10 stems as guides.