甲、概况
小儿肿胀，其原因与成人相同，而得之则较成人为易。以肿胀之病源在于脾，而小儿则脾弱易于受病
也。考肿胀一症，肿与胀有别，肿浮满于外，胀则急胀于里。肿有虚实，胀亦有虚实，肿之急而按之满，大
便结而小便赤者实也；肿之宽而按之陷，大便溏而小便清者虚也。胀之坚而按之实，大便秘而身体热者实
也；胀之宽而按之缓，大便溏而身不热者虚也。然肿胀无论虚实，
要莫不起源于脾而关涉于肺肾。盖脾主运化精微，肺主气行治节，肾主分利行水，三者失职，则水壅而不流，
气滞而不调，于是肿胀成矣。肠胃有滞，脾气壅塞而不能运，脾不能上输于肺，则肺亦不能下注于肾，
水行横决而四泛，是肿之实者；肠胃薄弱，脾气衰败而不能运，或肺之治节有亏，或肾之行水无权，水道
淤阻而四泛，是肿之虚者。脾积气滞而不运，是胀之实者；脾衰气虚而不运，是胀之虚者。亦有虚实参半者，
更宜详辨。总之，肿胀之来，或六淫外客，或饮食内伤，其来速者去亦速，多属于实；或情志之病，或劳伤日
积，其来渐者去不易，多属于虚。凡肿，或肿于全身，或肿在头面，或肿在两脚；凡胀，多胀于胸腹。大
率实证皆为易治，虚证皆为难疗也。
乙、治法
凡目胞上下微突如新卧起之状者，为肿病之先兆。肿之来势捷而成于数日之间者，多属实属水，轻者四
肢面目作肿，重者全身肿大，甚至阴囊阴茎亦肿大而呈晶亮之状。通治宜新五皮饮以消其水，甚则甘遂、商陆
之类，亦可量证酌加。若小便不利，肿势不减者，宜新五皮饮加赤小豆、猪苓、泽泻、木通之属；其由咳嗽
不爽，肺气不宣，以致小便不利者宜酌加麻黄以开之。大凡肿在腰上者宜发汗，所谓开鬼门，肿在腰下者宜
利小便，所谓洁净府。然二者之中，究以利小便为要，盖水湿之邪，不利小便，终非其治也。若利小便而犹不
愈，必脾虚而水易留聚，其流虽通，其源未浚，必用健脾之剂如白术、苍术、于术、山药之类，如能
有效。水肿之半虚半实者，宜五苓散或理中汤减干姜加白术、桑皮以治之。肿之来势缓而成于日积月累者，
多属虚属气，然偶有夹水，非由肾之不利，实由脾肺皆虚。治宜实脾饮或复元丹。胀之实者胸腹满，通治宜
藿香正气丸；胀之虚者外观虽急而中空，通治宜调中健脾丸。若病进则渐成臌胀，为难治之证矣
（参看第三章第六节）。
附方
（一）新五皮饮（自制） 治一切身肿。
黄 皮 大腹皮 冬瓜皮 茯苓皮 桑白皮（各等分）
清水煎服。头面肿加麻黄；脚肿去大腹皮加槟榔赤小豆、牛膝；小便不利加木通、车前子；一身俱肿，
腹膨晶亮加白术、猪苓、泽泻、甘遂；呕水泛恶加生姜皮。
（二）五苓散 见第三章第五节。
（三）理中汤 见第一章第四节。
（四）实脾饮 治身重懒食，肢体浮肿，口中不渴，二便不实者。
浓朴 白术 木瓜 附子 木香 草果 干姜 茯苓 大腹皮 加生姜
（五）复元丹 治脾胃俱虚，发为水肿，四肢虚浮，心腹坚胀，小便不痛，两目下肿。
附子 木香 茴香 川椒 浓朴 独活 白术、橘红、吴萸 肉桂 泽泻
（六）藿香正气丸 见第七章第四节。
（七）调中健脾丸 治臌胀，单腹胀。
人参 苍术 黄 吴萸 茯苓 白术 沉香 陈皮 半夏
香附 楂肉 苡米 黄连 白芍 苏子 泽泻 草豆蔻 莱菔子 五加皮 全栝蒌 川椒 碱 荷叶
大腹皮煎汤，打黄米粉糊丸。
（八）地骷髅 治噤口痢疾，伤力黄肿，及肿胀膨胀，不可消导者。
莱菔之老于地内者，瘦而无肉，老而多筋，如骷髅然，掘出煎汤用。
甲、概况
小儿出现肿胀，其病因与成人相同，但小儿比成人更容易患病。因为肿胀的病理根源在于脾脏，而小儿的脾胃功能虚弱，容易受到病邪侵袭。考察“肿胀”这一病症，“肿”与“胀”是有区别的：肿表现为体表浮肿饱满，胀则表现为体内急迫胀满。肿有虚证和实证之分，胀也有虚证和实证之别。如果肿胀急迫，按压时感觉坚实饱满，大便干结，小便赤黄，属于实证；如果肿胀松弛，按压后出现凹陷，大便稀溏，小便清长，属于虚证。如果腹部胀满坚硬，按压时感觉坚实，大便秘结，身体发热，属于实证；如果腹部胀满宽松且舒缓，大便稀溏，身体不发热，属于虚证。然而，无论是肿还是胀，无论虚实，其起源都离不开脾脏，并涉及肺脏和肾脏。因为脾主运化水谷精微，肺主气机运行及治理调节，肾主分清泌浊及行水功能，这三者功能失职，就会导致水液壅滞而不流动，气机阻滞而不调畅，于是形成肿胀。如果肠胃中有积滞，脾气壅塞而不能运化，脾不能将精微上输于肺，肺也不能将水液下注于肾，导致水液泛滥横溢，这是水肿的实证；如果肠胃薄弱，脾气衰败而不能运化，或者肺的治理调节功能不足，或者肾的行水功能无权，导致水道淤阻而四处泛滥，这是水肿的虚证。脾脏积滞气机不畅而不能运化，是腹胀的实证；脾脏衰弱、气虚而不能运化，是腹胀的虚证。也有虚实夹杂的情况，更应当仔细辨别。总之，肿胀的发生，有的是六淫外邪客袭所致，有的是饮食内伤引起，发病迅速的去除也快，多属于实证；有的是情志致病，有的是劳倦损伤日积月累所致，发病缓慢的去除不易，多属于虚证。凡是肿，有的发生在全身，有的在头面部，有的在双脚；凡是胀，多在胸腹部。大体上，实证都容易治疗，虚证都难以治愈。
乙、治法
凡是眼睑上下微微突起，像刚睡醒的样子，这是肿病的先兆。肿胀来得迅猛，在几天之内形成的，多属实证、属水湿为患。轻者四肢和面目浮肿，重者全身肿大，甚至阴囊和阴茎也肿大且呈现晶莹透亮状。通用治疗方法宜用新五皮饮来消除水湿，严重时也可酌情加入甘遂、商陆等药物。如果小便不利，肿胀不退，宜在新五皮饮中加入赤小豆、猪苓、泽泻、木通等药物；如果是由于咳嗽不爽，肺气不宣畅，导致小便不利，宜酌情加入麻黄以宣发肺气。一般来说，腰以上的肿胀适宜发汗，即所谓“开鬼门”（打开毛孔）；腰以下的肿胀适宜利小便，即所谓“洁净府”（清理膀胱）。但在两者之中，终究以利小便更为重要，因为水湿之邪，如果不通过利小便排出，终究不是正确的治法。如果利小便后仍然不愈，必定是脾虚导致水液容易留聚，虽然水流通道已通，但水源未清，必须使用健脾的药物如白术、苍术、于术、山药等，才能见效。对于半虚半实的水肿，宜用五苓散或理中汤减去干姜，加入白术、桑白皮来治疗。肿胀来得缓慢，经日积月累形成的，多属虚证、属气滞，但也偶有水湿夹杂，这并非单纯由肾的功能不利引起，实际上是由于脾肺两虚所致。治疗宜用实脾饮或复元丹。腹胀属实证的，表现为胸腹部胀满，通用治疗宜用藿香正气丸；腹胀属虚证的，外观虽然急迫但内部中空，通用治疗宜用调中健脾丸。如果病情进展，逐渐发展为臌胀，就成为难治的病症了（参看第三章第六节）。
附方
（一）新五皮饮（自制） 治疗各种身体肿胀。
黄皮、大腹皮、冬瓜皮、茯苓皮、桑白皮（各等分）
用清水煎服。头面部肿胀加麻黄；脚部肿胀去掉大腹皮，加入槟榔、赤小豆、牛膝；小便不利加木通、车前子；全身肿胀，腹部膨隆晶莹透亮加白术、猪苓、泽泻、甘遂；呕吐清水、恶心加生姜皮。
（二）五苓散 见第三章第五节。
（三）理中汤 见第一章第四节。
（四）实脾饮 治疗身体沉重、食欲不振、肢体浮肿、口中不渴、大小便不成形者。
浓朴、白术、木瓜、附子、木香、草果、干姜、茯苓、大腹皮，加生姜。
（五）复元丹 治疗脾胃俱虚，引发水肿，四肢虚浮，心腹部坚硬胀满，小便无疼痛感，双眼下方浮肿。
附子、木香、茴香、川椒、浓朴、独活、白术、橘红、吴茱萸、肉桂、泽泻。
（六）藿香正气丸 见第七章第四节。
（七）调中健脾丸 治疗臌胀、单腹胀。
人参、苍术、黄芩、吴茱萸、茯苓、白术、沉香、陈皮、半夏、香附、山楂肉、薏苡仁、黄连、白芍、苏子、泽泻、草豆蔻、莱菔子、五加皮、全瓜蒌、川椒、碱、荷叶。
用大腹皮煎汤，调和黄米粉制成糊状，再制成丸药。
（八）地骷髅 治疗噤口痢疾、劳力过度导致的黄肿，以及无法通过消导法治疗的肿胀膨胀。
指留在地里多年的老萝卜，瘦弱无肉，老而多筋，形状像骷髅一样，挖出来煎汤服用。
A. General Overview
Pediatric edema and distension share the same etiology as in adults, yet children are more susceptible to developing these conditions. This is because the pathological root of swelling lies in the Spleen (Pi), and children have weak Spleen function, making them prone to disease. In examining the syndrome of "swelling" (Zhong Zhang), there is a distinction between "edema" (Zhong) and "distension" (Zhang). Edema manifests as external swelling and fullness, whereas distension presents as internal urgency and bloating. Both edema and distension can be classified into deficiency (Xu) and excess (Shi) patterns. If the swelling is acute, feels firm and full upon palpation, accompanied by constipation and dark urine, it is an Excess pattern. If the swelling is loose, leaves an indentation upon pressure, accompanied by loose stools and clear urine, it is a Deficiency pattern. If abdominal distension is hard and solid upon palpation, accompanied by constipation and fever, it is an Excess pattern. If abdominal distension is loose and relaxed, accompanied by loose stools and no fever, it is a Deficiency pattern. However, regardless of whether it is edema or distension, and regardless of deficiency or excess, the origin invariably involves the Spleen and relates to the Lung (Fei) and Kidney (Shen). The Spleen governs the transformation and transportation of essences; the Lung governs Qi movement and regulatory functions; the Kidney governs differentiation and separation, and water metabolism. When the functions of these three organs fail, water accumulates and stagnates, and Qi becomes obstructed and disordered, resulting in swelling and distension. If there are stagnations in the intestines and stomach, causing Spleen Qi to be blocked and unable to transport, the Spleen cannot send essences up to the Lung, and consequently, the Lung cannot direct water down to the Kidney. Water then floods horizontally and spreads everywhere, constituting the Excess pattern of edema. If the intestines and stomach are weak, Spleen Qi is exhausted and unable to transport, or if the Lung's regulatory function is deficient, or if the Kidney lacks authority over water metabolism, leading to blockage of water pathways and widespread flooding, this constitutes the Deficiency pattern of edema. Stagnation of Qi in the Spleen preventing transport is the Excess pattern of distension; exhaustion of Spleen Qi and deficiency failing to transport is the Deficiency pattern of distension. There are also mixed deficiency-excess cases, which require careful differentiation. In summary, the onset of swelling may be due to external invasion by the Six Evils (Liu Yin) or internal injury from diet; rapid onset implies rapid resolution and usually indicates an Excess pattern. It may also result from emotional disorders or chronic accumulation of fatigue/injury; slow onset implies difficult resolution and usually indicates a Deficiency pattern. Edema may occur throughout the body, on the head and face, or on both feet. Distension typically occurs in the chest and abdomen. Generally, Excess patterns are easy to treat, while Deficiency patterns are difficult to cure.
B. Treatment Methods
If the upper and lower eyelids are slightly protruding, resembling the appearance after waking up, this is a precursor sign of edema. Edema that develops rapidly within a few days is mostly Excess and related to Water-Dampness. Mild cases present with swelling of the limbs, face, and eyes; severe cases involve whole-body swelling, even extending to the scrotum and penis, which become swollen and translucent. The general treatment should utilize Xin Wupi Yin (New Five Peel Decoction) to eliminate water. In severe cases, drugs such as Kansui Radix (Gansui) and Phytolacca Root (Shanglu) may be added according to the condition. If urination is difficult and swelling persists, add Adzuki Bean (Chixiaodou), Polyporus (Zuling), Alisma Rhizome (Zexie), and Akebia Stem (Mutong) to Xin Wupi Yin. If the cause is unrelieved cough and impaired Lung Qi diffusion leading to difficult urination, add Ephedra Herb (Mahuang) to open the Lung Qi. Generally, edema above the waist should be treated by inducing sweating, known as "opening the ghost gate" (Kai Guimen); edema below the waist should be treated by promoting urination, known as "cleaning the bladder house" (Jinganjfu). Among these two methods, promoting urination is ultimately more crucial, as water-dampness pathogens must be expelled via urination for effective treatment. If urination promotion fails to resolve the condition, it indicates Spleen deficiency allowing water retention. Although the flow channels are open, the source remains uncleared; therefore, Spleen-strengthening agents such as Atractylodes Macrocephala Rhizome (Baizhu), Atractylodes Rhizome (Cangzhu), Prepared Atractylodes Rhizome (Yuzhu), and Chinese Yam (Shanyao) must be used to achieve efficacy. For half-deficiency, half-excess edema, use Wuling San (Five-Ingredient Powder with Poria) or Lizhong Tang (Regulate the Middle Decoction) with dried ginger removed, adding Baizhu and Mulberry Root Bark (Sangbai). Edema that develops slowly over months is mostly Deficiency and related to Qi stagnation, though occasionally complicated by water dampness. This is not solely due to Kidney dysfunction but rather Spleen and Lung deficiency. Treatment should employ Shipi Yin (Solidify the Spleen Decoction) or Fuyuan Dan (Restore Origin Pill). Distension characterized by Excess presents with chest and abdominal fullness; the general treatment is Huoxiang Zhengqi Wan (Patchouli Corrective Pill). Distension characterized by Deficiency appears tense externally but hollow internally; the general treatment is Tiaozhong Jianpi Wan (Regulate Middle and Strengthen Spleen Pill). If the condition progresses to become鼓胀 (Gu Zhang / Abdominal Distension/Tympanites), it becomes a difficult-to-treat syndrome (see Chapter 3, Section 6).
Appendix Formulas
(1) Xin Wupi Yin (Self-made): Treats all types of body swelling.
Yellow Skin (Huangpi), Greater Citron Fruit Peel (Dafupi), Winter Melon Peel (Dongguapi), Poria Peel (Fulingpi), Mulberry Root Bark (Sangbaipi) (equal parts).
Decoct in clear water and take orally. Add Mahuang for head/face swelling; remove Dafupi and add Areca Seed (Binglang), Chixiaodou, and Achyranthes Root (Niuxi) for foot swelling; add Mutong and Plantago Seed (Cheqianzi) for difficult urination; add Baizhu, Zuling, Zexie, and Gansui for whole-body swelling with a distended, translucent abdomen; add Ginger Peel (Shengjiangpi) for vomiting water and nausea.
(2) Wuling San: See Chapter 3, Section 5.
(3) Lizhong Tang: See Chapter 1, Section 4.
(4) Shipi Yin: Treats heavy body, poor appetite, limb edema, thirstless mouth, and loose stools/urine.
Magnolia Bark (N Houpu), Baizhu, Quince (Mu Gua), Prepared Aconite Root (Fuzi), Costus Root (Muxiang), Tsaoko Cardamom (Caoguo), Dried Ginger (Ganjiang), Fuling, Dafupi, plus Fresh Ginger (Shengjiang).
(5) Fuyuan Dan: Treats Spleen and Stomach dual deficiency causing edema, flaccid limb swelling, hard and distended heart/abdomen, painless urination, and swelling under the eyes.
Fuzi, Muxiang, Fennel Seed (Huixiang), Sichuan Pepper (Chuanjiao), N Houpu, Angelica Pubescens Root (Duhuo), Baizhu, Tangerine Peel (Juhong), Evodia Fruit (Wuyu), Cinnamon Twig (Rougui), Zexie.
(6) Huoxiang Zhengqi Wan: See Chapter 7, Section 4.
(7) Tiaozhong Jianpi Wan: Treats Gu Zhang and isolated abdominal distension.
Ginseng Root (Renshen), Cangzhu, Scutellaria Root (Huangqin), Wuyu, Fuling, Baizhu, Agarwood (Chenxiang), Chenpi, Pinellia Tuber (Banxia), Cyperus Rhizome (Xiangfu), Hawthorn Flesh (Zharou), Coix Seed (Yimi), Huanglian, White Peony Root (Baishao), Perilla Fruit (Suzi), Zexie, Black Cardamom (Caodoukou), Radish Seed (Laifuzi), Five-Alder Bark (Wujia Pi), Whole Trichosanthes Fruit (Quangualu), Chuanjiao, Alkali (Jian), Lotus Leaf (Heye).
Decoct Dafupi in water, mix with yellow rice flour paste to form pills.
(8) Di Skullou (Earth Skeleton): Treats Jin Kou Li Ji (Anorectic Dysentery), Huang Zhong caused by labor injury, and swelling/distension that cannot be resolved by digestion-promoting methods.
Old radishes left in the ground until they become shriveled, meatless, fibrous, and skeleton-like. Dig them up, decoct in water, and take.