邑北境刘氏妇，年过三旬，因受风得水肿证。
病因 时当孟夏，农家忙甚，将饭炊熟，复自 田间，因作饭时受热出汗，出门时途间受风，
此后即得水肿证。
证候 腹中胀甚，头面周身皆肿，两目之肿不能开视，心中发热，周身汗闭不出，大便干燥，小
便短赤。其两腕肿甚不能诊脉，按之移时，水气四开，始能见脉。其左部弦而兼硬，
右部滑而颇实，一息近五至。
诊断 《金匮》辨水证之脉，谓风水脉浮，此证脉之部位肿甚，原无从辨其脉之浮沉，然即其
自述，谓于有汗受风之后，其为风水无疑也。其左脉弦硬者，肝胆有郁热也，其右脉滑而
实者，外为风束胃中亦浸生热也。至于大便干燥，小便短赤，皆肝胃有热之所致也。当
用《金匮》越婢汤加减治之。
处方 生石膏（一两捣细） 滑石（四钱） 生杭芍（四钱） 麻黄（三钱）
甘草（二钱） 大枣（四枚掰开） 生姜（二钱） 西药阿斯匹林（一瓦）
中药七味，共煎汤一大盅，当煎汤将成之时，先用白糖水将西药阿斯匹林送下，候周身
出汗（若不出汗仍可再服一瓦），将所煎之汤药温服下，其汗出必益多，其小盒饭利，肿即可消矣。
复诊 如法将药服完，果周身皆得透汗，心中已不发热，小便遂利，腹胀身肿皆愈强半，脉象
已近和平，拟再治以滋阴利水之剂以消其余肿。
处方 生杭芍（六钱） 生薏米（六钱捣碎） 鲜白茅根（一两）
药共三味，先将前二味水煎十余沸，加入白茅根，再煎四五沸，取汤一大盅，温服。
效果 将药连服十剂，其肿全消，俾每日但用鲜白茅根一两，煎数沸当茶饮之以善其后。
或问 前方中用麻黄三钱原可发汗，何必先用西药阿斯匹林先发
其汗乎？答曰∶麻黄用至三钱虽能发汗，然有石膏、滑石、
芍药以监制之，则其发汗之力顿减，况肌肤肿甚者，汗尤不易透出也。若因其汗不易出，拟复多加
麻黄，而其性热而且燥，又非所宜。惟西药阿斯匹林，其性凉而能散，既善发汗
又善清热，以之为麻黄之前驱，则麻黄自易奏功也。
或问 风袭人之皮肤，何以能令人小便不利积成水肿？答曰∶小便出于膀胱，膀胱者太阳之腑也。
袭入之风由经传腑，致膀胱失其所司，是以小便不利。麻黄能祛太阳在腑之风，佐以石膏、滑石，更
能清太阳在腑之热，是以服药汗出而小便自利也。况此证肝中亦有蕴热，《内经》谓“肝热病者小便先
黄”，是肝与小便亦大有关系也。方中兼用芍药以清肝热，则小便之利者当益利。至于薏米、茅根，
亦皆为利小便之辅佐品，汇集诸药为方，是以用之必效也。
【背景信息】
书名：医学衷中参西录 作者：张锡纯 朝代：清 章节：1．受风水肿 类别：医论
【待处理原文】
本县北部刘姓妇女，年龄超过三十岁，因感受风邪而患上水肿病。
病因 当时正值初夏，农家农活繁忙，饭煮熟后，又亲自从田间回来，因为做饭时受热出汗，出门途中感受风邪，
此后便患上了水肿病。
证候 腹部胀满严重，头面全身都浮肿，双眼肿胀得无法睁开视物，心中发热，全身汗闭不出，大便干燥，小
便短少且颜色红赤。其双腕肿胀严重无法诊脉，按压许久，水气散开一些，才能见到脉搏。其左部脉象弦而兼硬，
右部脉象滑而颇实，一息近五至（每分钟呼吸四次左右）。
诊断 《金匮要略》辨别水证的脉象，说风水证的脉象浮，此证脉的部位肿胀严重，原本无从辨别脉象的浮沉，但就其
自述，谓于有汗受风之后，其为风水无疑也。其左脉弦硬者，肝胆有郁热也，其右脉滑而
实者，外为风束胃中亦浸生热也。至于大便干燥，小便短赤，皆肝胃有热之所致也。当
用《金匮要略》越婢汤加减治之。
处方 生石膏（一两捣细） 滑石（四钱） 生杭芍（四钱） 麻黄（三钱）
甘草（二钱） 大枣（四枚掰开） 生姜（二钱） 西药阿斯匹林（一瓦）
中药七味，共煎汤一大盅，当煎汤将成之时，先用白糖水将西药阿斯匹林送下，候周身
出汗（若不出汗仍可再服一瓦），将所煎之汤药温服下，其汗出必益多，其小盒饭利，肿即可消矣。
复诊 如法将药服完，果周身皆得透汗，心中已不发热，小便遂利，腹胀身肿皆愈强半，脉象
已近和平，拟再治以滋阴利水之剂以消其余肿。
处方 生杭芍（六钱） 生薏米（六钱捣碎） 鲜白茅根（一两）
药共三味，先将前二味水煎十余沸，加入白茅根，再煎四五沸，取汤一大盅，温服。
效果 将药连服十剂，其肿全消，俾每日但用鲜白茅根一两，煎数沸当茶饮之以善其后。
或问 前方中用麻黄三钱原可发汗，何必先用西药阿斯匹林先发
其汗乎？答曰∶麻黄用至三钱虽能发汗，然有石膏、滑石、
芍药以监制之，则其发汗之力顿减，况肌肤肿甚者，汗尤不易透出也。若因其汗不易出，拟复多加
麻黄，而其性热而且燥，又非所宜。惟西药阿斯匹林，其性凉而能散，既善发汗
又善清热，以之为麻黄之前驱，则麻黄自易奏功也。
或问 风袭人之皮肤，何以能令人小便不利积成水肿？答曰∶小便出于膀胱，膀胱者太阳之腑也。
袭入之风由经传腑，致膀胱失其所司，是以小便不利。麻黄能祛太阳在腑之风，佐以石膏、滑石，更
能清太阳在腑之热，是以服药汗出而小便自利也。况此证肝中亦有蕴热，《内经》谓“肝热病者小便先
黄”，是肝与小便亦大有关系也。方中兼用芍药以清肝热，则小便之利者当益利。至于薏米、茅根，
亦皆为利小便之辅佐品，汇集诸药为方，是以用之必效也。
[Background Information]
Book: Records of Chinese Medicine with Reference to Western Medicine (Yixue Zhongzhong Canxi Lu)
Author: Zhang Xichun
Dynasty: Qing
Chapter: 1. Edema due to Wind-Water
Category: Medical Discussion
[Original Text Processing]
A woman surnamed Liu in the northern part of the county, over thirty years old, contracted edema after being affected by wind pathogen.
Etiology At that time, it was early summer, and farmers were extremely busy. After cooking the rice, she returned from the fields herself. Because she sweated due to heat while cooking, and caught wind on her way out,
she subsequently developed edema.
Symptoms Severe abdominal distension, swelling of the head, face, and whole body, eyes so swollen they cannot open to see, heat sensation in the heart/chest, closed pores with no sweating, dry stool, and scanty dark red urine. Both wrists were so swollen that pulse diagnosis was impossible; after pressing for a while, the water qi dispersed slightly, allowing the pulse to be felt. The left pulse was wiry and hard, the right pulse slippery and quite full, approximately five breaths per minute.
Diagnosis The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) distinguishes water syndrome pulses, stating that wind-water presents with a floating pulse. In this case, the pulse site is severely swollen, making it originally impossible to distinguish floating or sunken qualities. However, based on her self-report of catching wind after sweating, it is undoubtedly wind-water. The wiry and hard left pulse indicates stagnant heat in the Liver and Gallbladder. The slippery and full right pulse indicates external wind binding and internal heat generation in the Stomach. As for dry stool and scanty dark urine, these are caused by heat in the Liver and Stomach. Treatment should use Yuebi Tang (Carpenter's Decoction) from the *Jin Gui Yao Lue*, modified.
Prescription Raw Gypsum (Sheng Shigao, 30g, crushed fine), Talcum (Huashi, 12g), Raw Hang Peony (Sheng Hangshao, 12g), Ephedra (Mahuang, 9g), Licorice Root (Gancao, 6g), Jujube (Dazao, 4 pieces, split), Fresh Ginger (Shengjiang, 6g), Western Medicine Aspirin (1 grain).
The seven Chinese herbs are decocted together in a large cup of water. Just before the decoction is ready, take the Aspirin first with sweet water. Wait for general sweating (if no sweat occurs, another grain can be taken). Then drink the decocted herbal medicine warm. This will promote more sweating, improve urination, and reduce swelling.
Follow-up Visit Following the method, the patient took the medicine completely. Indeed, the whole body perspired thoroughly, the heat sensation in the chest ceased, urination became smooth, and abdominal distension and body swelling improved by more than half. The pulse approached normalcy. It is planned to treat further with a formula nourishing Yin and promoting diuresis to eliminate remaining swelling.
Prescription Raw Hang Peony (Sheng Hangshao, 18g), Coix Seed (Sheng Yimi, 18g, crushed), Fresh White Imperata Rhizome (Xian Baimaogen, 30g).
These three herbs: first decoct the first two in water for about ten boils, add the Imperata Rhizome, boil four or five more times, obtain a large cup of liquid, and take warm.
Effect After taking the medicine for ten doses, the swelling completely disappeared. For follow-up care, use 30g of fresh Imperata Rhizome daily, boiled briefly, as tea.
Questioner: The previous prescription used 9g of Mahuang, which originally could induce sweating. Why use Western medicine Aspirin first to induce sweat?
Answer: Although 9g of Mahuang can induce sweating, its effect is restrained by Shigao, Huashi, and Shaoyao, significantly reducing its sweating power. Moreover, when skin and muscles are severely swollen, sweat is even harder to exude. If one were to increase Mahuang because sweat is difficult to produce, its hot and drying nature would be inappropriate. Only Aspirin, being cool and dispersing, excels at inducing sweat and clearing heat. Using it as a vanguard for Mahuang allows Mahuang to achieve efficacy easily.
Questioner: How does wind invading the skin lead to difficulty in urination and accumulation into edema?
Answer: Urine originates from the Bladder, which is the Fu organ of the Taiyang channel. The invading wind transmits from the channel to the Fu organ, causing the Bladder to lose its governing function, hence difficulty in urination. Mahuang can dispel wind in the Taiyang Fu organ, assisted by Shigao and Huashi, which clear heat in the Taiyang Fu organ. Thus, after taking the medicine and sweating, urination becomes smooth. Furthermore, this case also involves latent heat in the Liver. The *Nei Jing* states, "In Liver heat disease, urine turns yellow first," indicating a significant relationship between the Liver and urination. The prescription uses Shaoyao to clear Liver heat, thereby further promoting urination. As for Yimi and Baomaogen, they are also adjuvants for promoting urination. Combining these herbs in the formula ensures efficacy.