9.上肿多风宜乎汗, 下肿多湿利水泉, 汗宜越婢加苍术, 利用贴脐
琥珀丹, 外散内利疏凿饮, 喘不得卧苏葶先, 阳水热浚湿神佑, 阴水
实脾肾气丸.
【注】从上肿者, 多外感风邪, 故宜乎汗. 从下肿者, 多内生湿邪,
故宜乎利水. 外散风水, 宜用越婢汤加苍术, 即麻黄, 石膏, 甘草,
苍术也. 内利水湿, 宜用贴脐等法. 一以巴豆去油四钱, 水银粉二钱
,硫黄一钱, 研匀成饼, 先用新绵一片布脐上, 内饼, 外用帛缚, 时
许自然泻下恶水, 待下三五次, 去药以粥补住. 日久形羸, 隔一日取
一次, 一饼可救三, 五人. 一以鲜赤商陆根, 杵烂贴脐上, 以帛缚定
,水自小便出. 一以田螺四个, 大蒜五个, 车前子末三钱, 研成饼,
贴脐中, 以帕缚之, 少时尿利即愈. 或内服沉香琥珀丸, 即苦葶苈子
,真郁李仁, 防己, 沉香, 陈皮, 琥珀, 杏仁, 苏子, 赤茯苓, 泽泻
,麝香也. 若通身肿, 则当外散内利, 宜用疏凿饮子两解之. 若水盛
上攻, 喘急不得卧, 则当用苏子葶苈丸以定喘, 即此二味, 等分为末
,枣肉丸. 阳水属热实者, 热盛宜用大圣浚川散; 湿盛宜用舟车神佑
丸以下之. 二方在『医宗必读』. 阴水属寒虚者, 脾虚不食便软, 宜
用实脾饮; 肾虚胫足冷硬, 宜用肾气丸.
疏凿饮子 茯苓导水汤
10.水肿两解疏凿饮, 和剂茯苓导水汤, 疏凿椒目赤小豆, 槟榔商陆
木通羌, 秦艽大腹苓皮泽, 茯苓导水泽芩桑, 木香木瓜砂陈术, 苏叶
大腹麦槟榔.
【注】水肿, 外散内利两解, 峻者疏凿饮, 即椒目, 赤小豆, 槟榔,
商陆, 木通, 羌活, 秦艽, 大腹皮, 茯苓皮, 泽泻也. 外散内利两解
和者, 茯苓导水汤, 即泽泻, 茯苓, 桑皮, 木香, 木瓜, 砂仁, 陈皮
,白术, 苏叶, 大腹皮, 麦冬, 槟榔也.
9. 上半身浮肿多因风邪所致,适宜采用发汗法治疗;下半身浮肿多因湿邪所致,适宜采用利水法治疗。发汗宜用越婢加苍术汤,利水可利用贴脐疗法如琥珀丹。若需外散风水、内利水湿,可使用疏凿饮子;若出现气喘不能平卧,首选苏子葶苈丸。阳水属热实证者,热盛宜用大圣浚川散,湿盛宜用舟车神佑丸;阴水属寒虚证者,脾虚便溏宜用实脾饮,肾虚足冷宜用肾气丸。
【注】上半身浮肿者,多由外感风邪引起,故适宜发汗。下半身浮肿者,多由内生湿邪引起,故适宜利水。外散风水,宜用越婢汤加苍术,即麻黄、石膏、甘草、苍术。内利水湿,宜用贴脐等方法。一种方法是用巴豆去油四钱、水银粉二钱、硫黄一钱,研匀制成饼状,先用新棉一片敷在肚脐上,放上药饼,外用布带缚紧,片刻后自然泻下恶水,待泻下三至五次后,去掉药物,用粥食补养脾胃。若日久身体虚弱,可隔一日取一次,一个药饼可救治三至五人。另一种方法是用鲜赤商陆根捣烂贴于脐上,用布带固定,水液自然从小便排出。还有一种方法是用田螺四个、大蒜五个、车前子末三钱,研成饼状,贴于脐中,用帕子缚住,不久小便通利即可痊愈。或者内服沉香琥珀丸,即苦葶苈子、真郁李仁、防己、沉香、陈皮、琥珀、杏仁、苏子、赤茯苓、泽泻、麝香。若全身浮肿,则应当外散内利两解,宜用疏凿饮子双向治疗。若水气旺盛上攻,气喘急促不能平卧,则当用苏子葶苈丸以定喘,即这两味药等分为末,用枣肉做成丸剂。阳水属热实证者,热盛宜用大圣浚川散;湿盛宜用舟车神佑丸以下行之。这两个方剂记载在《医宗必读》中。阴水属寒虚证者,脾虚不食、大便溏软,宜用实脾饮;肾虚小腿及足部冷硬,宜用肾气丸。
10. 治疗水肿两解之法,可用疏凿饮子和《太平惠民和剂局方》的茯苓导水汤。疏凿饮子由椒目、赤小豆、槟榔、商陆、木通、羌活、秦艽、大腹皮、茯苓皮、泽泻组成;茯苓导水汤由泽泻、茯苓、桑白皮、木香、木瓜、砂仁、陈皮、白术、苏叶、大腹皮、麦冬、槟榔组成。
【注】水肿,采用外散内利两解之法,病情急重者用疏凿饮子,即椒目、赤小豆、槟榔、商陆、木通、羌活、秦艽、大腹皮、茯苓皮、泽泻。外散内利两解且药性平和者用茯苓导水汤,即泽泻、茯苓、桑白皮、木香、木瓜、砂仁、陈皮、白术、苏叶、大腹皮、麦冬、槟榔。
9. Swelling predominantly in the upper body is often due to Wind, and sweating (Han) is appropriate; swelling predominantly in the lower body is often due to Dampness, and promoting urination (Li Shui) is appropriate. For sweating, Yuebi Jia Cangzhu Tang (Yuebi Decoction with Atractylodis Rhizoma) should be used; for promoting urination, external application methods such as Hupo Dan (Amber Pill) applied to the umbilicus can be utilized. To simultaneously disperse Wind externally and promote urination internally, Shuozao Yinzi (Shuozao Decoction) is indicated; if wheezing and inability to lie flat occur, Suzi Tingli Wan (Perilla Seed and Lepidium Seed Pill) should be used first. For Yang Edema belonging to Heat-Excess patterns, Da Sheng Xunchuan San (Great Sage River-Dredging Powder) is suitable for excessive Heat, and Zhouche Shenyou Wan (Boat and Divine Protection Pill) is suitable for excessive Dampness. For Yin Edema belonging to Cold-Deficiency patterns, Shipin Yin (Spleen-Strengthening Decoction) is suitable for Spleen Deficiency with poor appetite and loose stools, and Shenqi Wan (Kidney Qi Pill) is suitable for Kidney Deficiency with cold and hard calves and feet.
[Note] Swelling in the upper body is mostly caused by exogenous Wind pathogen, hence sweating is appropriate. Swelling in the lower body is mostly caused by endogenous Dampness pathogen, hence promoting urination is appropriate. To disperse Wind-Water externally, Yuebi Tang (Yuebi Decoction) added with Cangzhu (Atractylodis Rhizoma), i.e., Mahuang (Ephedrae Herba), Shigao (Gypsum Fibrosum), Gancao (Glycyrrhizae Radix et Rhizoma), and Cangzhu, is used. To promote urination of Water-Dampness internally, methods such as umbilical application are used. One method involves using Baidu (Crotonis Fructus) de-oiled, four qian; Yushuifen (Calomelas), two qian; and Liuhuang (Sulfur), one qian, ground evenly into a cake. First, place a piece of new cotton on the umbilicus, put the cake on it, and bind tightly with cloth. After a short while, foul water will naturally be discharged. After three to five discharges, remove the medicine and nourish the stomach with porridge. If the body becomes emaciated over time, apply once every other day; one cake can save three to five people. Another method uses fresh Chishanglu Gen (Phytolaccae Radix), pounded until soft, applied to the umbilicus and bound with cloth, allowing water to exit via urine. Another method uses four river snails, five cloves of garlic, and three qian of Cheqianzi Mo (Plantaginis Semen powder), ground into a cake, applied to the center of the umbilicus and bound with a handkerchief; urination will become smooth shortly thereafter, leading to recovery. Alternatively, Chenxiang Hupo Wan (Agarwood and Amber Pill) can be taken orally, which consists of Ku Tingli Zi (Lepidii Fructus), Zhen Yuliren (Pruni Semen), Fangji (Stephaniae Tetrandrae Radix), Chenxiang (Aquilariae Lignum Resinatum), Chenpi (Citri Reticulatae Pericarpium), Hupo (Electri Corium), Xingren (Armeniacae Semen Amarum), Suzi (Perillae Fructus), Chi Fuling (Poria cum Risus), Zexie (Alismatis Rhizoma), and Shexiang (Moschus). If the whole body is swollen, both external dispersion and internal promotion of urination are required, so Shuozao Yinzi (Shuozao Decoction) should be used to resolve both aspects. If Water pathogen surges upward causing severe wheezing and inability to lie flat, Suzi Tingli Wan (Perilla Seed and Lepidium Seed Pill) should be used to calm wheezing, consisting of these two herbs ground equally into powder and formed into pills with jujube flesh. For Yang Edema of Heat-Excess type, Da Sheng Xunchuan San (Great Sage River-Dredging Powder) is used for excessive Heat; Zhouche Shenyou Wan (Boat and Divine Protection Pill) is used for excessive Dampness. These two formulas are recorded in *Yizong Bidu* (Essentials of Medical Learning). For Yin Edema of Cold-Deficiency type, Shipin Yin (Spleen-Strengthening Decoction) is used for Spleen Deficiency with anorexia and soft stools; Shenqi Wan (Kidney Qi Pill) is used for Kidney Deficiency with cold and indurated lower limbs.
Shuozao Yinzi and Fuling Daoshui Tang
10. For the dual treatment of edema (dispersing externally and draining internally), Shuozao Yinzi (Shuozao Decoction) and Fuling Daoshui Tang (Poria Decoction from the *Taiping Huimin Heji Jufang*) are used. Shuozao Yinzi consists of Jiaomu (Semen Sesami Nigrum), Chixiaodou (Vigna Semen Rubrum), Binglang (Arecae Semen), Shanglu (Phytolaccae Radix), Mutong (Akebiae Caulis), Qianghuo (Notopterygii Rhizoma et Radix), Qinjiao (Gentianae Macrophyllae Radix), Dafupi (Bambusae Culm Cortex), Fulingpi (Poria Cum Cortice), and Zexie (Alismatis Rhizoma). Fuling Daoshui Tang consists of Zexie (Alismatis Rhizoma), Fuling (Poria), Sangpi (Mori Cortex), Muxiang (Aucklandiae Radix), Mugua (Chaenomelis Fructus), Sharen (Amomi Fructus Rotundus), Chenpi (Citri Reticulatae Pericarpium), Baizhu (Atractylodis Macrocephalae Rhizoma), Suye (Perillae Folium), Dafupi (Bambusae Culm Cortex), Maidong (Ophiopogonis Radix), and Binglang (Arecae Semen).
[Note] For edema treated with simultaneous external dispersion and internal drainage: for severe cases, Shuozao Yinzi (Shuozao Decoction) is used, comprising Jiaomu (Semen Sesami Nigrum), Chixiaodou (Vigna Semen Rubrum), Binglang (Arecae Semen), Shanglu (Phytolaccae Radix), Mutong (Akebiae Caulis), Qianghuo (Notopterygii Rhizoma et Radix), Qinjiao (Gentianae Macrophyllae Radix), Dafupi (Bambusae Culm Cortex), Fulingpi (Poria Cum Cortice), and Zexie (Alismatis Rhizoma). For milder cases requiring simultaneous external dispersion and internal drainage, Fuling Daoshui Tang (Poria Decoction) is used, comprising Zexie (Alismatis Rhizoma), Fuling (Poria), Sangpi (Mori Cortex), Muxiang (Aucklandiae Radix), Mugua (Chaenomelis Fructus), Sharen (Amomi Fructus Rotundus), Chenpi (Citri Reticulatae Pericarpium), Baizhu (Atractylodis Macrocephalae Rhizoma), Suye (Perillae Folium), Dafupi (Bambusae Culm Cortex), Maidong (Ophiopogonis Radix), and Binglang (Arecae Semen).