湿热 脾虚 有阴水 有阳水
夫水肿者由主虚不能制水以致水溢妄行流于经络凝而不散遂成浮肿其症初见目下先有若
卧蚕才起之状肢皮裹水肌肤光亮以手按之随手而起盖肺本属金金能生水水不下降浸乘于肺故
胸满喘嗽而小便不通也
戴云水肿者通身皮肤光薄按之成窟举手即满者是也有阴阳上下之分
丹溪云阴水为病者其脉沉迟而色多青白不烦不渴小便涩而清大便多泄阳水为病者脉沉数
而色多黄赤烦渴小便涩而赤大便秘结
水肿足胫温暖者可治 寒冷者难治
脉诀云水气浮大得延生沉细应当是死别
东垣云阳水脉沉数阴水脉沉迟阳水易治阴水难治
仲景曰腰以下肿者宜利小便腰以上肿者宜发汗
一发汗宜用 麻黄甘草汤
一利小便宜用 五苓散
一治水肿宜先补中燥湿次当开其渗道以决水邪
一阳水浮肿作胀大小便不通宜用 三花神佑丸 十枣丸 神助散 茯苓琥珀丸 海金沙
散
秦艽茯苓汤
一阴水浮肿喘胀者宜用 葶苈木香散 实脾散 续随子丸 白术木香散 疏凿饮子
一实脾先宜 人参白术为君 燥湿宜 苍术茯苓陈皮为臣 分利以木通车前猪苓为佐
行气以木香槟榔为使 此治肿之大略也
水气乘肺遍身浮肿咳嗽喘促小便不利宜用 琥珀丸 清金降气汤
治方
所谓水肿，是由于正气虚弱不能制约水液，导致水液泛滥妄行，流注于经络，凝结而不消散，从而形成浮肿。其症状初起时，眼睑下方先出现像刚睡醒卧蚕那样的肿胀，四肢皮肤包裹着水气，肌肤光亮，用手按压后凹陷随手而起。这是因为肺本属金，金能生水，若水液不能下降，反而浸渍乘袭于肺，所以会出现胸部胀满、气喘咳嗽以及小便不通的症状。
戴云说：全身皮肤光薄，按压后留下坑洞，抬手后坑洞随即填满的，就是水肿。这有阴阳和上下的区分。
丹溪说：患阴水病的，脉象沉迟，面色多青白，不烦躁也不口渴，小便涩滞且清长，大便多泄泻；患阳水病的，脉象沉数，面色多黄赤，烦躁口渴，小便涩滞且色红，大便秘结。
《脉诀》说：水气病脉象浮大的可以延长寿命，脉象沉细的应当判定为死证。
李东垣说：阳水脉象沉数，阴水脉象沉迟。阳水容易治疗，阴水难以治疗。
张仲景说：腰部以下肿的，适宜通利小便；腰部以上肿的，适宜发汗。
其三，治疗水肿适宜先补益中焦、燥湿，其次应当开通渗泄之道以决去水邪。
其四，阳水浮肿伴有胀满，大小便不通的，适宜使用三花神佑丸、十枣丸、神助散、茯苓琥珀丸、海金沙散、秦艽茯苓汤。
其五，阴水浮肿伴有气喘胀满的，适宜使用葶苈木香散、实脾散、续随子丸、白术木香散、疏凿饮子。
其六，治疗实脾（指实证或健脾固本），适宜以人参、白术为君药；燥湿适宜以苍术、茯苓、陈皮为臣药；分利水湿适宜以木通、车前子、猪苓为佐药；行气适宜以木香、槟榔为使药。这是治疗水肿的大致原则。
水气乘袭于肺，导致遍身浮肿、咳嗽气喘、小便不利，适宜使用琥珀丸、清金降气汤。
治疗方剂：
Damp-heat (Shi Re) and Spleen Deficiency (Pi Xu), as well as Yin Edema (Yin Shui) and Yang Edema (Yang Shui).
Edema (Shui Zhong) arises from the deficiency of the host [vital qi] failing to control water, leading to water overflowing and acting recklessly, flowing into the meridians and collaterals, condensing without dispersing, thereby forming edematous swelling. The initial symptoms present with swelling under the eyes resembling a silkworm just after waking; the skin of the limbs wraps around water, and the muscle surface is glossy. Pressing with the hand leaves an indentation that rises immediately upon lifting. This is because the Lung belongs to Metal in the Five Elements, and Metal generates Water. If Water fails to descend and instead inundates and attacks the Lung, it results in chest fullness, wheezing, coughing, and obstruction of urination.
Dai Yun stated: When the skin of the entire body is thin and glossy, pressing leaves a pit that fills up immediately upon lifting the hand, this is Edema. There is a distinction between Yin/Yang and Upper/Lower.
Danxi stated: In cases of Yin Edema, the pulse is deep and slow, the complexion is often bluish-white, there is no irritability or thirst, urination is scanty but clear, and stool is often loose. In cases of Yang Edema, the pulse is deep and rapid, the complexion is often yellowish-red, there is irritability and thirst, urination is scanty and reddish, and stool is constipated.
If the shins and feet of an edema patient are warm, the condition is treatable; if cold, it is difficult to treat.
The Mai Jue (Pulse Classic) states: For Qi-Water disease, a floating and large pulse indicates survival, while a deep and fine pulse indicates death.
Li Dongyuan stated: Yang Edema presents with a deep and rapid pulse, while Yin Edema presents with a deep and slow pulse. Yang Edema is easy to treat, whereas Yin Edema is difficult to treat.
Zhang Zhongjing said: For swelling below the waist, promoting urination is appropriate; for swelling above the waist, inducing sweating is appropriate.
First, for inducing sweating, Mahuang Gancao Tang (Ephedra and Licorice Decoction) is suitable.
Second, for promoting urination, Wuling San (Five-Ingredient Powder with Poria) is suitable.
Third, treating edema requires first tonifying the Middle Jiao and drying dampness, followed by opening the draining pathways to resolve the water pathogen.
Fourth, for Yang Edema with distending swelling and obstruction of both urination and defecation, Sanhua Shenyao Wan (Three-Flower Divine Protection Pill), Shizao Wan (Ten Date Pill), Shen Zhu San (Divine Assistance Powder), Fuling Hupo Wan (Poria and Amber Pill), Haijinsha San (Lygodium Spore Powder), and Qinjiao Fuling Tang (Gentian and Poria Decoction) are suitable.
Fifth, for Yin Edema with distending swelling and wheezing, Tingli Muxiang San (Descurainia and Costus Powder), Shipi San (Solidify the Spleen Powder), Xuisui Zi Wan (Euphorbia Lathyris Pill), Baizhu Muxiang San (Atractylodes Macrocephala and Costus Powder), and Shuozao Yinzi (Scouring Decoction) are suitable.
Sixth, regarding Solidifying the Spleen [treating Spleen deficiency with excess], Ren Shen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) should be used as the Sovereign herb; Cangzhu (Atractylodes Lancea Rhizome), Fuling (Poria), and Chenpi (Tangerine Peel) should be used as the Minister herbs to dry dampness; Mutong (Akebia Stem), Cheqian (Plantago Seed), and Zhuling (Polyporus) should be used as the Assistant herbs to separate and drain; Muxiang (Vladimiria Root) and Binglang (Areca Seed) should be used as the Guide herb to move Qi. This is the general principle for treating swelling.
When Water-Qi attacks the Lung, causing generalized edema, coughing, wheezing, and difficulty in urination, Hupo Wan (Amber Pill) and Qingjin Jiangqi Tang (Clear Metal and Descend Qi Decoction) are suitable.
Treatment Formulas:
Treating Edema by Inducing Sweating:
Mahuang (Ephedrae Herba), Gancao (Glycyrrhizae Radix et Rhizoma).
Decoct two zhong of water until eight fen remains. Take warm. After sweating occurs, avoid exposure to wind.