治遍身水肿, 喘呼口渴, 大小便秘.
羌活 秦艽 槟榔 大腹皮 商陆 茯苓皮 椒目 木通 泽泻 赤
小豆等分加姜皮, 水煎服.
【注】经曰: 三焦者, 决渎之官, 水道出焉. 若水饮阻于内, 风寒束
于外, 则三焦之气化不行. 上焦之如雾, 中焦之如沤, 同为下焦之如
渎也. 以致水气外泛, 皮肤作肿, 内停腹里作胀, 上攻喘咳呕逆, 下
蓄小便不利, 种种诸证, 而治法总不外乎表里也. 小青龙汤, 真武汤
,越婢汤, 五苓散, 疏凿饮子五方, 皆治有水气兼表里证之药也. 小
青龙汤治表里寒实, 中有水气, 真武汤治里有虚寒, 中兼水气. 二证
俱内不作胀, 外不作肿, 故一以麻, 桂辈散寒以行水; 一以姜, 附辈
温寒以制水也. 越婢汤治表里实热, 中有水气, 五苓散治表里虚热,
中有水气. 故一以麻黄, 石膏, 散肤之水, 清肌之热, 以消肿也; 一
以桂, 苓, 术, 泽, 解肌表热, 利所停水, 以止吐也. 疏凿饮子治表
里俱实, 不偏寒热而水湿过盛, 遍身水肿喘胀便秘者. 故以商陆为君
,专行诸水. 佐羌活, 秦艽, 腹皮, 苓皮, 姜皮, 行在表之水, 从皮
肤而散; 佐槟榔, 赤豆, 椒目, 泽泻, 木通, 行在里之水, 从二便而
出.上下, 内外, 分消其势, 亦犹神禹疏凿江河之意也. 至于越婢汤
:加半夏者, 因喘气上逆, 用之降逆也. 加附子者, 因汗出恶风, 散
表固阳也. 小青龙汤加石膏者, 因喘而烦燥, 用之兼清胃热也. 五苓
散以术, 桂易滑石, 阿胶, 名猪苓汤, 专清阴兼治水也. 真武汤, 去
生姜加人参, 名附子汤, 专温阳不治水也. 由此可知仲景用方, 于群
温剂中, 加以大寒之品; 大寒剂中, 加以辛热之品. 去桂枝加滑石,
则不走外; 去生姜加人参, 则不治水. 其转换变化, 神妙如此, 拘拘
之士, 不足语也.
治疗全身水肿，气喘呼叫，口渴，大小便不通畅。
羌活、秦艽、槟榔、大腹皮、商陆、茯苓皮、椒目、木通、泽泻、赤小豆等分，加姜皮，水煎服。
【注】《内经》说：三焦（主持诸气，疏通水道）是决渎之官，水道由此而出。如果水饮阻滞于体内，风寒束缚于体表，那么三焦的气化功能就不能正常运行。上焦的功能像雾露一样弥漫，中焦的功能像沤泡一样腐熟，都为了下焦像沟渠一样排泄。从而导致水气外泛，皮肤肿胀，水湿内停腹部导致胀满，向上攻冲引起气喘咳嗽呕吐逆乱，向下蓄积导致小便不利，种种症状，治疗方法总离不开表证和里证两个方面。小青龙汤、真武汤、越婢汤、五苓散、疏凿饮子这五个方剂，都是治疗有水气兼有表里证候的药物。小青龙汤治疗表里寒实，中间有水气；真武汤治疗里有虚寒，中间兼有水气。这两种证候都不表现为内部胀满，外部肿胀，所以一个用麻黄、桂枝之类发散寒气以行水；一个用干姜、附子之类温散寒气以制水。越婢汤治疗表里实热，中间有水气；五苓散治疗表里虚热，中间有水气。所以一个用麻黄、石膏，散发肌肤之水，清除肌肉之热，以消除肿胀；一个用桂枝、茯苓、白术、泽泻，解除肌表之热，利导所停之水，以止吐。疏凿饮子治疗表里俱实，不偏寒也不偏热，但水湿过盛，全身水肿、气喘胀满、便秘者。所以用商陆作为君药，专门通行诸处之水。佐使羌活、秦艽、大腹皮、茯苓皮、生姜皮，通行在表之水，从皮肤散发出去；佐使槟榔、赤小豆、椒目、泽泻、木通，通行在里之水，从大小便排出。上下内外，分消其势，也如同大禹疏导江河的本意。至于越婢汤：加半夏，是因为气喘气逆，用它来降逆；加附子，是因为出汗怕风，用来解散表邪固护阳气。小青龙汤加石膏，是因为气喘而烦躁，用它来兼清胃热。五苓散用白术、桂枝替换滑石、阿胶，名为猪苓汤，专门清利阴分兼治水。真武汤去掉生姜加入人参，名为附子汤，专门温阳而不治水。由此可知张仲景使用方剂，在众多的温性药剂中加入大寒之品；在大寒药剂中加入辛热之品。去掉桂枝加入滑石，就不走表散；去掉生姜加入人参，就不治水湿。其转换变化，神妙如此，拘泥固执的人，不足以与他们谈论。
Treats generalized edema, panting and crying out, thirst, and constipation of both stool and urine.
Qianghuo (Notopterygii Rhizoma et Radix), Qinjiao (Gentianae Macrophyllae Radix), Binglang (Arecae Semen), Dafupi (Aurantii Fructus Pericarpium), Shanglu (Phytolaccae Radix), Fulingpi (Poriae Cortex), Jiaomu (Zanthoxyli Semen), Mutong (Akebiae Caulis), Zexie (Alismatis Rhizoma), Chixiaodou (Phaseoli Angularis Semen) in equal parts, add Jiangpi (Zingiberis Recens Pericarpium), decoct in water and take orally.
[Note] The *Neijing* states: The Sanjiao (Triple Burner, responsible for qi transformation and fluid metabolism) is the official of drainage, and the water passages emerge from it. If fluids are obstructed internally, and wind-cold binds externally, then the qi transformation of the Sanjiao cannot function normally. The Upper Jiao is like mist, the Middle Jiao like fermentation, both serving to allow the Lower Jiao to act like a ditch for excretion. This leads to water qi overflowing outward, causing swelling of the skin; water retention internally causing abdominal distension; attacking upward causing panting, cough, vomiting, and regurgitation; accumulating downward causing difficult urination. All these various symptoms are treated by methods that essentially address both exterior and interior patterns. Xiao Qinglong Tang (Minor Blue Dragon Decoction), Zhenwu Tang (True Warrior Decoction), Yebing Tang (Suppress Miasma Decoction), Wuling San (Five-Ling Powder), and Shuozao Yinzi (Draining and Piercing Decoction) are five formulas used to treat conditions with water qi accompanied by exterior-interior syndromes. Xiao Qinglong Tang treats exterior-interior cold-excess with water qi in the center; Zhenwu Tang treats interior deficiency-cold with concurrent water qi. In both these syndromes, there is no internal distension nor external swelling. Therefore, one uses Mahuang (Ephedrae Herba) and Guizhi (Cinnamomi Ramulus) to disperse cold and promote water movement; the other uses Shengjiang (Zingiberis Rhizoma Recens) and Fuzi (Aconiti Lateralis Radix Praeparata) to warm cold and control water. Yebing Tang treats exterior-interior heat-excess with water qi in the center; Wuling San treats exterior-interior deficiency-heat with water qi in the center. Thus, one uses Mahuang and Shigao (Gypsum Fibrosum) to dissipate water from the skin and clear heat from the muscles to reduce swelling; the other uses Guizhi, Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), and Zexie to resolve muscle-surface heat and promote diuresis of retained water to stop vomiting. Shuozao Yinzi treats simultaneous exterior-interior excess, neither leaning towards cold nor heat, but with excessive damp-water, manifesting as generalized edema, panting, distension, and constipation. Therefore, Shanglu is used as the sovereign herb to specifically conduct water throughout the body. Qianghuo, Qinjiao, Dafupi, Fulingpi, and Jiangpi are used as assistants to conduct water located at the exterior, dispersing it through the skin; Binglang, Chixiaodou, Jiaomu, Zexie, and Mutong are used as assistants to conduct water located at the interior, expelling it through the two bowels. By dispersing the pathogenic factor from above, below, inside, and outside, the strategy mirrors the intent of Yu the Great in dredging rivers and canals. Regarding Yebing Tang: Banxia (Pinelliae Rhizoma) is added because of rebellious qi causing panting, using it to direct rebellious qi downward; Fuzi is added because of sweating and aversion to wind, using it to scatter the exterior and secure yang. Xiao Qinglong Tang adds Shigao because of panting accompanied by irritability, using it to simultaneously clear stomach heat. Wuling San replaces Baizhu and Guizhi with Huashi (Talcum) and Ejiao (Asini Corii Colla) to become Zhuling Tang (Polyporus Decoction), which specifically clears the yin aspect while treating water. Zhenwu Tang removes Shengjiang and adds Renshen (Ginseng Radix) to become Fuzi Tang (Aconite Decoction), which specifically warms yang without treating water. From this, we can see that Zhang Zhongjing, when using formulas, adds major cold-natured herbs among groups of warm agents, and adds acrid-hot herbs among major cold agents. Removing Guizhi and adding Huashi prevents the formula from acting on the exterior; removing Shengjiang and adding Renshen shifts the focus away from treating water. Such transformations and variations are so divine and subtle that they are beyond the comprehension of rigid and inflexible scholars.