脉沉迟，大便滑，小便利，口不渴，面青白，为阴；脉沉数，大便燥，小便赤，口渴面赤，为阳。大抵脉喜浮大，
忌迟细。
仲景云∶水肿脉浮者死，谓肿盛皮肤甚浓，脉浮于皮毛之外，轻扪之如隔一纸，是死脉。
大凡水肿，先起于腹而后散四肢者，可治；先起于四肢，而后归于腹者，难治。掌肿无
纹者死。大便滑泄，水肿不消者死。唇黑、唇肿、齿焦者死。脐肿突出者死。缺盆平者死。
阴囊及茎俱肿者死。脉绝、口张、足肿者死。足跗肿，膝如斗者死。肚上青筋见，泻后腹肿者死。
灯草萝卜汤（《种福堂》）
治肿胀。
灯草（一大把，先将水四碗煎至三大碗） 萝卜子（一两，微炒） 砂仁（二钱，微炒）
将二味研末，倾入灯草汤内。略滚，即盛入壶内。慢慢吃下，吃尽不见效，如前再煎一
服，俟腹响放屁，小便长，而肿即退。
胀者，心腹胀满。实者胀起于骤然，便实，脉滑而实，宜散之，消导之，攻下之；虚者
胀成于积渐，小便利，大便滑，脉涩小虚微，病在中焦，以参、术补之；病在下焦，以桂、
附、吴萸温之，或兼行滞之品，而标本并治，亦有与肿症相兼者，当参看肿症辨症法。
胀而属热，脉实而滑者，廓清饮主之。
廓清饮
枳壳（二钱） 姜朴（一钱五分） 大腹皮（一钱） 茯苓（二钱） 白芥子（五七分或一二钱）
莱菔子（生捣一钱，如中不甚胀，能食者，不必用） 泽泻（一二钱） 陈皮（一钱）
水煎服。
胀而属寒者，胃苓汤主之。兼小便不利者，四苓散以蒜为丸主之。（二方见肿症）
胀而属七情所致者，宜四七汤主之，逍遥散亦主之。
四七汤
半夏（三钱） 茯苓（三钱） 浓朴（二钱） 苏叶（一钱） 生姜（三片）
水煎服。
此方妙在紫苏叶一味。辛以散结，香以醒脾，而顺气消胀行水，乃其余事。
逍遥散（方见《时方》）
此症宜加半夏二钱，以降逆气；加生麦芽二钱，以达肝气。盖麦先春而萌芽，得春生之气最早也。
胀而属虚者，脉微弱细小，喜摩按，二便利，气衰言微，宜六君子汤、理中汤合八味丸服之。
单腹胀，死症也。或青年壮健，起于骤然，若心下坚大如盘者，以《金匮》桂枝去芍药加麻黄附子细辛汤，直捣其
痰水气血之巢穴。嗣以枳术散消补并施，可救十中之一。然此犹实症也。若虚症难治，攻之则速其危，补之愈增其胀。
余家传有消鼓丹，加白术一两，试用四五剂，不增胀，方可议治。但消鼓丹方中阳起石无真，硫黄非从倭来，亦不能效，
故方亦不列。又名鼓胀，以外实中空，其状如鼓也。又名蛊胀，《易》曰，蛊，坏极而有事也。人病蛊者，脾土败坏，身
不即死，复有事也，事犹病也。
桂枝去芍药加麻黄附子细辛汤（方见《金匮》）
枳术散（方见《金匮》）
白术（四两） 枳实（二两）
研末，每服三钱，谷芽汤送下。
脉象沉而迟缓，大便滑利失禁，小便通畅，口不觉得渴，面色青白，这属于阴证；脉象沉而数急，大便干燥，小便颜色红赤，口渴且面色发红，这属于阳证。一般来说，脉象喜欢浮大，忌讳迟细。
张仲景说：水肿病若见脉浮的会死亡，这是因为肿胀严重，皮肤非常厚，脉象浮越在皮毛之外，轻轻触摸感觉像是隔着一层纸，这是死脉。
大凡水肿病，先从腹部开始然后扩散到四肢的，可以治疗；先从四肢开始然后回流到腹部的，难以治疗。手掌肿胀导致纹路消失的会死亡。大便滑泄不止，水肿不消退的会死亡。嘴唇发黑、嘴唇肿胀、牙齿焦枯的会死亡。肚脐肿胀突出的会死亡。锁骨上窝（缺盆）平坦无凹陷的会死亡。阴囊和阴茎都肿胀的会死亡。脉搏断绝、嘴巴张开、双脚肿胀的会死亡。足背肿胀，膝盖肿得像斗一样大的会死亡。腹部出现青色筋脉显露，泻下后腹部依然肿胀的会死亡。
灯草萝卜汤（出自《种福堂》）
治疗肿胀。
灯心草（一大把，先用四碗水煎煮至三大碗） 萝卜子（一两，轻微炒制） 砂仁（二钱，轻微炒制）
将后两味药研成粉末，倒入灯心草汤中。稍微煮沸，立即盛入壶中。慢慢服用，如果吃完没有效果，像之前那样再煎一服，等到肚子响、放屁，小便增多，那么肿胀就会消退。
胀症，指心腹部胀满。实证引起的胀，是突然发生的，大便干结，脉象滑而有力，适宜用消散、消导、攻下的方法；虚证引起的胀，是逐渐形成的，小便通畅，大便滑利，脉象涩小虚弱细微，病位在中焦，用人参、白术来补益；病位在下焦，用肉桂、附子、吴茱萸来温补，或者兼用行气滞的药物，从而标本同治。也有与肿症同时存在的，应当参考肿症的辨证方法。
胀症属于热证的，脉象实而滑的，以廓清饮为主治方剂。
廓清饮
枳壳（二钱） 姜厚朴（一钱五分） 大腹皮（一钱） 茯苓（二钱） 白芥子（五七分或一二钱） 莱菔子（生捣一钱，如果中焦不是很胀，能进食的，不必使用） 泽泻（一二钱） 陈皮（一钱）
用水煎服。
胀症属于寒证的，以胃苓汤为主治方剂。兼有小便不利的，以四苓散制成蒜丸主治。（这两个方剂见肿症章节）
胀症属于七情（喜、怒、忧、思、悲、恐、惊）所致者，适宜以四七汤为主治方剂，逍遥散也可以主治。
四七汤
半夏（三钱） 茯苓（三钱） 浓朴（二钱） 苏叶（一钱） 生姜（三片）
用水煎服。
这个方子的妙处在于紫苏叶这一味药。辛味可以散结，香气可以醒脾，顺气、消胀、行水是它附带的作用。
逍遥散（方剂见《时方》）
此症适宜加半夏二钱，以降逆气；加生麦芽二钱，以疏达肝气。因为麦子先于春天萌芽，最早得到春生之气。
胀症属于虚证的，脉象微弱细小，喜欢按摩按压，大小便通畅，气衰言微，适宜服用六君子汤、理中汤合八味丸。
单腹胀，是死症。如果是青年壮健之人，突然发作，若心下坚硬如盘状，用《金匮要略》中的桂枝去芍药加麻黄附子细辛汤，直接攻击痰、水、气、血积聚的巢穴。随后用枳术散消补兼施，可以挽救十分之一。然而这还算是实证。如果是虚证则难治，攻伐则会加速危险，补益则会增加胀满。我家传有消鼓丹，加入白术一两，试用四五剂，如果不增加胀满，才可以讨论治疗。但是消鼓丹方中的阳起石不是真品，硫黄如果不是从日本进口的，也不能见效，所以该方也不列出。又名鼓胀，因为外实中空，形状像鼓一样。又名蛊胀，《易经》说，蛊，是坏极而有事发生。人患蛊病，脾土败坏，身体不立即死亡，又有事情发生，这里的“事”犹指疾病。
桂枝去芍药加麻黄附子细辛汤（方剂见《金匮要略》）
枳术散（方剂见《金匮要略》）
白术（四两） 枳实（二两）
研成粉末，每次服用三钱，用谷芽汤送服。
Pulse deep and slow, with loose stools, free urination, no thirst, and a bluish-white complexion, indicates Yin syndrome; pulse deep and rapid, with dry stools, red urine, thirst, and a red complexion, indicates Yang syndrome. Generally, the pulse is favorable when floating and large, but unfavorable when slow and fine.
Zhang Zhongjing stated: In edema, if the pulse is floating, death ensues. This refers to severe swelling where the skin is thick, and the pulse floats outside the skin and hair follicles; light palpation feels as if separated by a sheet of paper, which is a fatal pulse sign.
Generally, in edema, if it starts in the abdomen and then spreads to the four limbs, it is treatable; if it starts in the four limbs and then returns to the abdomen, it is difficult to treat. Death occurs if the palms are swollen such that the creases disappear. Death occurs if there is loose diarrhea and the edema does not subside. Death occurs if the lips are black, swollen, or the teeth are scorched. Death occurs if the umbilicus is swollen and protruding. Death occurs if the supraclavicular fossa (Quepen) is flat. Death occurs if both the scrotum and penis are swollen. Death occurs if the pulse ceases, the mouth is open, and the feet are swollen. Death occurs if the dorsum of the foot is swollen and the knees are swollen like a measuring cup. Death occurs if green veins appear on the abdomen and the abdominal swelling persists after purgation.
Dengcao Luobo Decoction (from *Zhongfutang*)
Treats distension and edema.
Juncus effusus Herb (a large handful, first decocted with four bowls of water until three bowls remain) Raphani Semen (one tael, lightly stir-fried) Amomum Fruit (two qian, lightly stir-fried)
Grind the latter two ingredients into powder, pour into the Juncus effusus Decoction. Boil briefly, then pour into a pot. Drink slowly. If there is no effect after finishing one dose, decoct another dose as before. Wait for abdominal rumbling and flatus, increased urination, and the edema will recede.
Distension refers to fullness and bloating in the heart and abdomen. In excess patterns, distension arises suddenly, accompanied by solid stools and a slippery, forceful pulse; treatment should involve dispersing, digesting, and purging. In deficiency patterns, distension develops gradually, with free urination, loose stools, and a choppy, small, weak, and minute pulse. If the disease is in the Middle Jiao, tonify with Ginseng Radix et Rhizoma and Atractylodis Macrocephalae Rhizoma; if in the Lower Jiao, warm with Cinnamon Twig, Prepared Aconite Root, and Evodia Fruit, possibly combined with Qi-moving agents, treating both root and branch. There may also be cases combined with edema; refer to the differentiation methods for edema.
For distension due to Heat, with a forceful and slippery pulse, use Kuqing Decoction as the primary formula.
Kuqing Decoction
Aurantium Fructus (two qian) Zingiberis Rhizoma Preparatum (one qian five fen) Arecae Pericarpium (one qian) Poria (two qian) Brassicae Semens Album (five to seven fen or one to two qian) Raphani Semen (one qian raw and crushed; omit if epigastric distension is mild and appetite is good) Alisma Rhizome (one to two qian) Tangerine Peel (one qian)
Decoct in water and take orally.
For distension due to Cold, use Weiling Decoction as the primary formula. If accompanied by difficulty in urination, use Siling Powder made into pills with garlic as the primary treatment. (These two formulas are seen in the Edema section.)
For distension caused by the Seven Emotions, use Siqi Decoction as the primary formula; Xiaoyao Powder may also be used.
Siqi Decoction
Pinellia Tuber (three qian) Poria (three qian) Magnolia Bark (two qian) Perilla Leaf (one qian) Fresh Ginger (three slices)
Decoct in water and take orally.
The brilliance of this formula lies in the Perilla Leaf. Its pungency disperses knots, its aroma awakens the Spleen, while regulating Qi, reducing distension, and promoting water metabolism are secondary effects.
Xiaoyao Powder (formula seen in *Shifang*)
For this condition, add Pinellia Tuber (two qian) to descend rebellious Qi; add Raw Barley Sprout (two qian) to unblock Liver Qi. This is because barley sprouts earliest in spring, receiving the Spring-generating Qi first.
For distension due to Deficiency, with a weak, minute, and small pulse, preference for massage and pressure, free urination and defecation, weak Qi, and faint speech, use Liujunzi Decoction, Lizhong Decoction, combined with Bawei Wan (Eight-Ingredient Pill).
Monadic abdominal distension is a fatal condition. However, if a young and robust person suffers sudden onset, with hardness and enlargement under the heart like a plate, use Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang from *Jin Gui Yao Lue* to directly attack the nest of Phlegm, Fluids, Qi, and Blood stasis. Subsequently, apply Zhizhu San to combine elimination and tonification, which can save one in ten. Yet this is still an Excess pattern. If it is a Deficiency pattern, it is difficult to treat; attacking accelerates danger, while tonifying increases distension. My family has a passed-down Gonggu Dan; adding four grams of Atractylodis Macrocephalae Rhizoma, try it for four or five doses. If distension does not increase, treatment can be considered. However, if the Qiyangshi in Gonggu Dan is not genuine, or if Huangqi is not imported from Japan, it will not be effective, so this formula is not listed. It is also called Drum Distension, because it is solid externally and hollow internally, resembling a drum. It is also called Gu Distension. The *I Ching* states: "Gu means extreme decay followed by action." When a person suffers from Gu disease, the Spleen Earth is ruined; the body does not die immediately, but further actions occur; here, "action" refers to disease.
Guizhi Qu Shaoyao Jia Mahuang Fuzi Xixin Tang (formula seen in *Jin Gui Yao Lue*)
Zhizhu San (formula seen in *Jin Gui Yao Lue*)
Atractylodis Macrocephalae Rhizoma (four liang) Immature Bitter Orange (two liang)
Grind into powder. Take three qian per dose, washed down with Hordeum Sprout Decoction.