四肢重痛大便溏，头亦重兮湿气伤，药用二陈（汤加入）苍白术，须求《金匮》再参详。
肿证者，一身肿大，按之重者 而不起，轻者即起。水与气同源，不必分之，以五皮
饮
为主。上半身肿者，宜发汗，加防风、紫苏、杏仁各二钱，下半身肿者，宜利小便，加防己
、白术、地肤子各二钱，虚者合四君子汤，兼服济生肾气丸，实者加葶苈子一钱，莱菔子炒
研三钱。如若不效，以小青龙汤行太阳之水，真武汤安少阴之水，麻黄、甘草二味发皮肤之
水，麻黄附子甘草汤导小腹之水。又以东引桑枝炒紫苏，汤淋取汁，入小黑豆，煮汤服之，
数日其效。又有似肿非肿，而皮肤胀大，名曰气胀，骆氏用神仙九气汤治之。此证不全属于
表，然肿症现于皮肤，故列于表证。
（经义）《平人气象论》曰∶“面肿曰风，足胫肿曰水。”《阴阳别论》曰∶“阴阳结邪，
多阴少阳曰石水，少腹满。”《大奇论》曰∶“肾肝并沉为石水，《灵枢》邪气病形篇曰∶“肾脉微大，为石水。起脐
以下至少腹，睡然睡上
至胃脘，死不治。”《大奇论》曰∶“肝肾并浮为风水。”《水热穴论》曰∶“肾者，胃之
关也，关门不利，故聚水而从其类也。上下溢于皮肤，故为 肿， 肿者，聚水而生病
也。
”“诸水皆生于肾”。“肾者，牝脏也，地气上者属于肾，而生水液也，故曰至阴。涌而劳
甚，则肾汗出，肾汗出逢于风，内不得入于脏腑，外不得越于皮肤，客于元府，行于皮肤，
传为 肿，本之于肾，名曰肾水。”《灵枢·水胀》曰∶“水始起也，目窠上微肿，如新
卧
起之时，其颈脉动，时咳，阴股间寒，足胫肿，腹乃大，其水已成矣。以手按其腹，随手而
起，如里水之形状，此其候也。”又曰∶“肤胀，寒气客于皮肤之间， 然不坠，腹
大，
身尽肿，皮浓，按其腹， 而不起，腹色不变，此其候也。”《灵枢·五癃津液别论》曰
∶
“水溢则为水胀。”《灵枢·九针论》曰∶“下焦溢为水”。《灵枢·胀论》曰∶“夫气之
令人胀也，在于血脉之中耶，脏腑之内乎。”“夫胀者，皆在于脏腑之外，排脏腑而廓胸胁
，胀皮肤，故名曰胀。”夫肤胀与鼓胀，何以别之，然肤胀是皮肤胀也，鼓胀则腹中胀耳，
且色苍黄，腹筋起，肤胀无之，是以异也。
四肢沉重疼痛，大便稀溏，头部也有沉重感，这是湿气损伤了身体。用药可用二陈汤（由半夏、陈皮、茯苓、甘草组成）加入苍术和白术，必须参考《金匮要略》再仔细研究。
所谓肿证，是指全身肿大，按压后凹陷不起的是重证，按压后迅速回弹的是轻证。水与气同源，不必强行区分，以五皮饮为主方治疗。上半身肿胀的，适宜用发汗法，加防风、紫苏、杏仁各二钱；下半身肿胀的，适宜利小便，加防己、白术、地肤子各二钱；体质虚弱的，合用四君子汤，兼服济生肾气丸；体质实盛的，加葶苈子一钱，莱菔子炒研三钱。如果这样治疗无效，用小青龙汤通调太阳经的水湿，真武汤温化少阴经的水气，麻黄和甘草两味药发散皮肤间的水湿，麻黄附子甘草汤引导小腹内的水湿。另外，用东向生长的桑枝炒紫苏，用水淋取汁液，加入小黑豆，煮汤服用，几天后见效。又有看似肿胀实则不是肿胀，而是皮肤胀大的情况，称为气胀，骆氏用神仙九气汤治疗它。此证不完全属于表证，但因为肿胀表现在皮肤，所以列在表证中讨论。
（经文义理）《素问·平人气象论》说：“面部浮肿叫作风水，足胫浮肿叫作水病。”《素问·阴阳别论》说：“阴阳邪气结聚，阴多阳少的叫石水，小腹胀满。”《素问·大奇论》说：“肾脉和肝脉都沉，是石水病，《灵枢·邪气脏腑病形篇》说：“肾脉微大，是石水病。从脐下至少腹肿胀，甚至向上延伸至胃脘部，属死证，无法治愈。”《素问·大奇论》说：“肝脉和肾脉都浮，是风水病。”《素问·水热穴论》说：“肾是胃的关口，如果关门不利，水液就会聚集并同类相从。水液上下溢于皮肤，所以发生浮肿，浮肿就是水液聚集而导致的疾病。”“所有的水病都生于肾。”“肾是牝脏（阴脏），地气上升归属于肾，从而产生水液，所以称肾为至阴之脏。如果剧烈活动劳累过度，则肾汗出，肾汗出后遇到风邪，内不能进入脏腑，外不能透达皮肤，客留于玄府（汗孔），行于皮肤之间，传变为浮肿，病本在肾，名叫肾水。”《灵枢·水胀》说：“水病刚开始时，眼睑下方微微浮肿，像刚睡醒时的样子，颈部人迎脉搏动，时常咳嗽，大腿内侧感觉寒冷，足胫浮肿，腹部随之变大，这说明水气已经形成。用手按压其腹部，随手松开即起，像里面有水的形状，这是它的征候。”又说：“肤胀，寒气客居在皮肤之间，叩之空空然如鼓声但不塌陷，腹部胀大，全身浮肿，皮肤厚实，按压腹部，凹陷不起，腹部颜色不变，这是它的征候。”《灵枢·五癃津液别论》说：“水液泛滥则为水胀。”《灵枢·九针论》说：“下焦水液溢出导致水肿。”《灵枢·胀论》说：“使人发生胀病的，是在血脉之中呢，还是在脏腑之内呢？”“胀病，都在脏腑之外，排挤脏腑，廓清胸胁，胀满皮肤，所以名叫胀。”肤胀和鼓胀，如何区别呢？肤胀是皮肤胀大，鼓胀则是腹部胀大，而且肤色青黄，腹部筋脉突起，肤胀没有这些表现，因此二者不同。
The four limbs feel heavy and painful, the stool is loose, and the head also feels heavy; this is due to injury by dampness. The medication can be Er Chen Tang (Two-Chen Decoction) with added Cang Zhu (Atractylodis Rhizoma) and Bai Zhu (Atractylodis Macrocephalae Rhizoma); one must refer to *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) for further detailed study.
The condition known as edema (Swelling Syndrome) refers to generalized swelling. If pressing the area leaves an indentation that does not immediately rise, it is severe; if it rises quickly after pressure, it is mild. Water and Qi share the same origin and need not be strictly distinguished. The primary formula is Wu Pi Yin (Five-Rind Decoction). For swelling in the upper body, diaphoresis (sweating method) is appropriate; add Fang Feng (Saposhnikoviae Radix), Zi Su (Perillae Folium), and Xing Ren (Armeniacae Semen Amarum), each 2 qian. For swelling in the lower body, promoting urination is appropriate; add Fang Ji (Stephaniae Tetrandrae Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Di Fu Zi (Kochiae Fructus), each 2 qian. For deficiency patterns, combine with Si Jun Zi Tang (Four-Gentlemen Decoction) and concurrently administer Ji Sheng Shen Qi Wan (Kidney-Qi Pill from the Sage's Studio). For excess patterns, add Ting Li Zi (Lepidii Semen) 1 qian, and Chao Yan Lai Fu Zi (Stir-fried and Grounded Raphani Semen) 3 qian. If there is no effect, use Xiao Qing Long Tang (Minor Blue Dragon Decoction) to regulate water in the Taiyang (Greater Yang) channel, and Zhen Wu Tang (True Warrior Decoction) to stabilize water in the Shaoyin (Lesser Yin) channel. Ma Huang (Ephedrae Herba) and Gan Cao (Glycyrrhizae Radix et Rhizoma) disperse water in the skin; Ma Huang Fu Zi Gan Cao Tang (Ephedra, Aconite, and Licorice Decoction) guides water from the lower abdomen. Additionally, stir-fry Sang Zhi (Mori Ramulus) growing towards the east with Zi Su (Perillae Folium), extract the juice by pouring hot water over them, add Hei Xiao Dou (Sojaes Semen Nigrum), boil into a decoction, and take orally; effectiveness appears within a few days. There is also a condition that resembles swelling but is not true swelling, characterized by distension of the skin, called Qi Distension (Qi Bloating). Luo Shi used Shen Xian Jiu Qi Tang (Immortal Nine-Qi Decoction) to treat it. This condition does not entirely belong to exterior syndromes, but because the swelling manifests on the skin, it is listed under exterior syndromes for discussion.
(Interpretation of Classic Texts) *Su Wen: Ping Ren Qi Xiang Lun* (Plain Questions: Discussion on the Normal Pulse and Appearance of Healthy People) states: "Facial swelling is called Wind [Water], and swelling of the calves is called Water." *Su Wen: Yin Yang Bie Lun* (Plain Questions: Discussion on Differentiating Yin and Yang) states: "When Yin and Yang pathogenic factors knot together, having more Yin and less Yang results in Stone Water [Shi Shui], with fullness in the lower abdomen." *Su Wen: Da Qi Lun* (Plain Questions: Discussion on Great Anomalies) states: "If both the Kidney and Liver pulses are deep, it is Stone Water." *Ling Shu: Xie Qi Zang Fu Bing Xing Pian* (Spiritual Pivot: Chapter on Pathogenic Factors and Manifestations of Organ Diseases) states: "If the Kidney pulse is slightly large, it is Stone Water. Swelling from below the navel to the lower abdomen, extending upwards to the epigastrium, indicates a fatal condition that cannot be cured." *Su Wen: Da Qi Lun* states: "If both the Liver and Kidney pulses are floating, it is Wind Water." *Su Wen: Shui Re Xue Lun* (Plain Questions: Discussion on Water-Heat Acupoints) states: "The Kidney is the gate of the Stomach. If the gate is not functioning properly, water accumulates and follows its kind. Overflowing up and down onto the skin causes edema. Edema is caused by the accumulation of water leading to disease." "All water diseases originate in the Kidney." "The Kidney is a Yin organ. Earthly Qi ascending belongs to the Kidney, which generates fluid, hence it is called the Ultimate Yin. When vigorous labor causes excessive sweating, Kidney sweat emerges. If Kidney sweat encounters wind, it cannot enter the interior organs nor escape through the skin, but lodges in the Yuan Fu (primary pores), travels within the skin, and transforms into edema. Rooted in the Kidney, it is named Kidney Water." *Ling Shu: Shui Zhang* (Spiritual Pivot: Water Distension) states: "At the beginning of water disease, the eyelids swell slightly, resembling the appearance upon waking. The neck vessels pulse, there is occasional coughing, coldness in the inner thighs, swelling of the calves, and the abdomen becomes enlarged, indicating that water has formed. Pressing the abdomen with the hand causes it to rise immediately upon release, resembling the shape of water inside; this is its sign." It further states: "In Skin Distension, cold qi lodges between the skin. Percussion sounds hollow like a drum but does not collapse. The abdomen is large, the whole body is swollen, the skin is thick, pressing the abdomen leaves an indentation that does not rise, and the abdominal color remains unchanged; this is its sign." *Ling Shu: Wu Long Jin Ye Bie Lun* (Spiritual Pivot: Discussion on the Five Obstructions and Differentiation of Fluids) states: "Overflowing water leads to water distension." *Ling Shu: Jiu Zhen Lun* (Spiritual Pivot: Discussion on the Nine Needles) states: "Overflow from the Lower Jiao leads to water [edema]." *Ling Shu: Zhang Lun* (Spiritual Pivot: Distension Discussion) states: "What causes distension? Is it in the blood vessels or within the organs?" "Distension occurs outside the organs, pushing against them and expanding the chest and hypochondrium, distending the skin, hence named Distension." How to distinguish Skin Distension from Drum Distension? Skin Distension involves distension of the skin, whereas Drum Distension involves abdominal distension. Furthermore, Drum Distension presents with a sallow-yellow complexion and visible abdominal veins, which are absent in Skin Distension; thus, they are different.