治身重懒食, 肢体浮肿, 口中不渴, 二便不实.
白术 ( 土炒 ) 茯苓 甘草 ( 炙 ) 厚朴 ( 姜炒 ) 大腹子
草果仁 木香 木瓜 附子 干姜 加姜枣煎服. 气虚者加人参.
【注】脾胃虚, 则土不能制水, 水妄行肌表, 故身重浮肿. 用白术,
甘草, 生姜, 大枣, 以实脾胃之虚也. 脾胃寒, 则中寒不能化水, 水
停肠胃, 故懒食不渴, 二便不实. 用姜, 附, 草果, 以温脾胃之寒.
更佐大腹, 茯苓, 厚朴, 木香, 木瓜者, 以导水利气. 盖气者水之母
也,土者水之防也, 气行则水行, 土实则水治, 故名曰实脾也. 然此
方导水利气之力有余, 阴水寒胜而气不虚者, 固所宜也. 若气少声微
,则必以理中汤加附子, 数倍茯苓以君之, 温补元气以行水, 为万当
也.
【按】苓桂术甘汤, 实脾饮, 肾气丸, 皆治阳虚水气之证. 苓桂术甘
汤,治上焦阳虚不能输布, 水留于上, 心下逆满, 气上冲胸, 故用苓
,桂, 术, 甘之品, 扶阳通气输水道也. 实脾饮, 治中焦阳虚不能蒸
化,水渍于中, 外泛作肿, 二便通利, 故用姜, 附, 苓, 术之剂, 培
土温中, 胜寒湿也. 肾气丸, 治下焦阳虚, 不能行水, 小便不利, 肢
体浮肿, 喘急腹胀, 故用桂, 附, 地, 苓之辈, 温而补之, 以行水也
.
治疗身体沉重、食欲不振，肢体浮肿，口中不渴，大小便不成形。
白术（土炒） 茯苓 甘草（炙） 厚朴（姜炒） 大腹子
草果仁 木香 木瓜 附子 干姜 加生姜、大枣煎服。气虚者加人参。
【注】脾胃虚弱，则脾土不能制约水湿，水湿妄行于肌表，所以出现身体沉重和浮肿。使用白术、甘草、生姜、大枣，来补益脾胃的虚弱。脾胃寒凉，则中焦寒邪不能运化水液，水液停聚在肠胃，所以出现食欲不振、口中不渴、大小便不成形。使用干姜、附子、草果，来温煦脾胃的寒邪。再佐以大腹皮、茯苓、厚朴、木香、木瓜，用来通利水道、调畅气机。因为气是水运行的动力（母），土是水的堤防，气行则水行，土实（坚固）则水治（被控制），所以名叫“实脾饮”。然而此方通利水道、调畅气机的力量有余，对于阴水证且寒邪盛而正气不虚的患者，固然适宜。如果患者气少声微（元气不足），则必须用理中汤加入附子，并加倍使用茯苓作为主药，温补元气以推动水液运行，这才是万全之策。
【按语】苓桂术甘汤、实脾饮、肾气丸，都是治疗阳虚导致水气为患的方剂。苓桂术甘汤，治疗上焦阳气虚弱不能输布津液，水停留于上部，心下逆满闷，气上冲胸部，所以用茯苓、桂枝、白术、甘草这些药物，扶助阳气、通畅气机、疏通水道。实脾饮，治疗中焦阳气虚弱不能蒸腾气化，水浸渍于中部，外溢泛发为浮肿，二便通利，所以用干姜、附子、茯苓、白术这类药剂，培补脾土、温中散寒、胜除湿邪。肾气丸，治疗下焦阳气虚弱，不能行水，小便不利，肢体浮肿，喘促急迫、腹部胀满，所以用桂枝、附子、地黄、茯苓等药物，温阳而补益，以推动水液运行。
Treats heaviness of the body, reluctance to eat, edema of the limbs, absence of thirst in the mouth, and loose stools and urine.
Bai Zhu (Atractylodis Rhizoma Praeparatum cum Faxe) Fu Ling (Poria) Gan Cao (Glycyrrhizae Radix et Rhizoma Praeparatum cum Melle) Hou Po (Magnoliae Officinalis Cortex Praeparata cum Zingibere) Da Fu Zi (Arecae Semen) Cao Guo Ren (Tsaoko Fructus Semen) Mu Xiang (Aucklandiae Radix) Mu Gua (Chaenomelis Fructus) Fu Zi (Aconiti Lateralis Radix Praeparata) Gan Jiang (Zingiberis Rhizoma). Decoct with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus) for oral administration. For Qi deficiency, add Ren Shen (Ginseng Radix et Rhizoma).
[Note] When Pi Wei Xu (Spleen-Stomach Deficiency) exists, the Earth element cannot control Water, causing Water to wander recklessly on the muscle surface, resulting in heaviness of the body and edema. Bai Zhu, Gan Cao, Sheng Jiang, and Da Zao are used to solidify the deficiency of Spleen and Stomach. When Pi Wei Han (Spleen-Stomach Cold) exists, the Middle Jiao Cold cannot transform Water, causing Water to stagnate in the intestines and stomach, resulting in reluctance to eat, absence of thirst, and loose stools and urine. Gan Jiang, Fu Zi, and Cao Guo are used to warm the cold of Spleen and Stomach. Furthermore, Da Fu, Fu Ling, Hou Po, Mu Xiang, and Mu Gua are assisted to guide Water flow and regulate Qi. Qi is the mother of Water; Earth is the dam of Water. When Qi moves, Water moves; when Earth is solid, Water is controlled. Hence it is named Shi Pi Yin (Solidify the Spleen Decoction). However, this formula has sufficient power to guide Water flow and regulate Qi, which is indeed suitable for Yin Water syndromes where Cold predominates and Qi is not deficient. If there is scanty Qi and a faint voice, Li Zhong Tang (Regulate the Middle Decoction) plus Fu Zi should be used, with double the amount of Fu Ling as the sovereign drug, to warm and tonify Yuan Qi to move Water, which is the most appropriate method.
[Commentary] Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction), Shi Pi Yin, and Shen Qi Wan (Kidney Qi Pill) all treat syndromes of Water-Qi caused by Yang Xu (Yang Deficiency). Ling Gui Zhu Gan Tang treats Shang Jiao (Upper Jiao) Yang Xu where transport and distribution fail, causing Water to remain above, leading to fullness and rebellion under the heart, and Qi rushing up to the chest. Therefore, drugs such as Fu Ling, Gui Zhi (Cinnamomi Ramulus), Bai Zhu, and Gan Cao are used to support Yang, unblock Qi, and open the Water pathways. Shi Pi Yin treats Zhong Jiao (Middle Jiao) Yang Xu where steaming and transformation fail, causing Water to soak in the middle, overflowing outward to cause edema, while urination and defecation are free. Therefore, agents such as Gan Jiang, Fu Zi, Fu Ling, and Bai Zhu are used to cultivate Earth, warm the Middle, and overcome Cold-Dampness. Shen Qi Wan treats Xia Jiao (Lower Jiao) Yang Xu where Water movement fails, causing difficult urination, edema of the limbs, panting and urgency, abdominal distension. Therefore, items such as Gui Zhi, Fu Zi, Di Huang (Rehmanniae Radix Praeparata), and Fu Ling are used to warm and tonify to move Water.