至元戊寅五月间。霖淫积雨不止。鲁斋许平仲先生。时年五十有八。面目肢体净肿。大便溏多
。腹胀肠鸣。时痛。饮食短少。命予治之。脉得弦细而缓。先生曰。年壮时多曾服牵牛大黄药。面
目四肢。时有浮肿。今因阴雨。故大发。予曰。营运之气。出自中焦。中焦者、胃也。胃气弱不能
布散水谷之气。荣养脏腑经络皮毛。气行而涩为浮肿。大便溏多而腹肿肠鸣。皆湿气胜也。四时五
脏、皆以胃气为本。五脏有胃气。则和平而身安。若胃气虚弱。不能运动。滋养五脏。则五脏脉不
和平。本脏之气盛者。其脉独见。轻则病甚。过则必死。故经曰。真脏之脉弦。无胃气则死。先生之
疾。幸而未至于甚。尚可调补。人知服牵牛、大黄。为一时之快。不知其为终身之害也。遂用平胃
散加白术、茯苓、草豆蔻仁。数服而肠胀、溏泻、肠鸣、时痛皆愈。饮食进。止有肢体浮肿。以导
滞通经汤主之。良愈。
【导滞通经汤】治脾湿有余。及气不宣通。面目手足浮肿。
木香 白术 桑白皮 陈皮（各五钱）
茯苓（去皮。一两）
上 咀。每服五钱。水二盏。煎至一盏。去渣。温服。空心食前。内经曰。湿淫所胜。平以甚
热。以苦燥之。以淡泄之。陈皮苦温。理肺气。去气滞。故以为主。桑白皮甘寒。去肺中水气水肿
胪胀。利水道。故以为佐。木香苦辛温。除肺中滞气。白术苦甘温。能除湿和中。以苦燥之。白茯
苓甘平。能止渴、除湿利。小便。以淡泄之。故以为使也。
至元戊寅年五月期间，连绵阴雨不断。鲁斋许平仲先生，当时五十八岁，面部、眼睛和四肢全身浮肿，大便稀溏次数多，腹部胀满且肠鸣，时常疼痛，饮食量减少，请我诊治。脉象表现为弦细而缓。先生说，年轻时曾多次服用牵牛子和大黄等药物，面部和四肢时常出现浮肿，如今因为阴雨天气，所以病情大发。我说，运行营运的气血津液之气，产生于中焦。中焦就是胃。胃气虚弱不能布散水谷的精微之气，来荣养脏腑、经络、皮毛。气行涩滞导致浮肿，大便稀溏多且腹部肿胀肠鸣，都是湿气胜过的表现。四季五脏，都以胃气为根本。五脏有胃气，则平和安宁身体安康。如果胃气虚弱，不能运动滋养五脏，那么五脏的脉象就不平和。本脏之气盛者，其脉独见，轻则病重，过则必死。所以经书说，真脏之脉弦，无胃气则死。先生的疾病，幸好还没有到严重的程度，还可以调补。人们只知道服用牵牛子、大黄能带来一时的快感，不知道这是终身的危害。于是使用平胃散（Pingwei San, Stabilize the Stomach Powder）加白术、茯苓、草豆蔻仁。服几剂后，肠胀、溏泻、肠鸣、时痛都痊愈了。饮食增加，只剩下肢体浮肿，用导滞通经汤（Daozhi Tongjing Tang, Guide Stagnation and Unblock Meridians Decoction）主治。完全治愈。
【导滞通经汤】治疗脾湿有余，以及气机不宣通，导致的面目手足浮肿。
木香 白术 桑白皮 陈皮（各五钱）
茯苓（去皮，一两）
以上药材切碎，每次服用五钱，加水二盏，煎煮至一盏，去渣滓，温服，空腹饭前服用。《内经》说，湿气淫胜，用平性的甚热药治之，用苦味燥湿，用淡味泄湿。陈皮苦温，理肺气，去气滞，所以作为主药。桑白皮甘寒，去肺中水气水肿胪胀，利水道，所以作为佐药。木香苦辛温，除肺中滞气，白术苦甘温，能除湿和中，用苦味燥湿。白茯苓甘平，能止渴、除湿利小便，用淡味泄湿，所以作为使药。
In May of the Wuyin year of the Zhiyuan era, continuous heavy rain persisted. Mr. Xu Pingzhong of Luzhai, aged fifty-eight at the time, presented with generalized edema of the face, eyes, and limbs, frequent loose stools, abdominal distension with borborygmi, intermittent pain, and reduced appetite; he requested my treatment. The pulse was wiry, fine, and slow. Mr. Xu stated that in his youth, he had frequently taken medicines containing *Lagenariae Fructus Semen* (Qian Niu Zi) and *Rhei Radix et Rhizoma* (Da Huang), experiencing occasional edema of the face and limbs. Due to the current rainy weather, the condition has flared up severely. I replied that the Qi responsible for circulation and transformation originates from the Middle Jiao. The Middle Jiao is the Stomach. When Stomach Qi is weak, it fails to distribute the essence of food and drink to nourish the Zang-Fu organs, meridians, collaterals, skin, and hair. Stagnant Qi flow leads to edema; frequent loose stools, abdominal swelling, and borborygmi are all signs of excessive Dampness. The five Zang organs across the four seasons all take Stomach Qi as their root. If the five Zang organs possess Stomach Qi, they remain harmonious and the body secure. If Stomach Qi is deficient and unable to move and nourish the five Zang organs, their pulses will not be harmonious. When the Qi of a specific Zang organ becomes excessive, its pulse appears exclusively. Mild cases lead to severe illness, and extreme cases result in death. Thus, the Classics state: "The True Zang pulse is wiry; without Stomach Qi, death ensues." Fortunately, your illness has not yet reached a critical stage and can still be regulated and tonified. People know that taking *Lagenariae Fructus Semen* and *Rhei Radix et Rhizoma* brings momentary relief, but do not realize it causes lifelong harm. Therefore, I prescribed *Pingwei San* (Stabilize the Stomach Powder) augmented with *Atractylodis Macrocephalae Rhizoma* (Baizhu), *Poria* (Fuling), and *Alpiniae Katsumadai Semen* (Caodoukou Ren). After several doses, intestinal distension, loose diarrhea, borborygmi, and intermittent pain were all cured, and appetite improved. Only limb edema remained, which was treated with *Daozhi Tongjing Tang* (Guide Stagnation and Unblock Meridians Decoction). He recovered completely.
[Daozhi Tongjing Tang] Treats excess Spleen Dampness and impaired Qi circulation, manifesting as edema of the face, eyes, hands, and feet.
*Costi Rhizoma* (Muxiang), *Atractylodis Macrocephalae Rhizoma* (Baizhu), *Mori Cortex* (Sangbaipi), *Citri Reticulatae Pericarpium* (Chenpi) (each 5 qian)
*Poria* (Fuling) (peeled, 1 liang)
Crush the above herbs. Take 5 qian per dose, add two zhan of water, decoct until one zhan remains, remove dregs, and take warm before meals on an empty stomach. The *Neijing* states: "When Dampness prevails excessively, treat it with neutral-hot agents; dry it with bitter flavors, drain it with bland flavors." *Citri Reticulatae Pericarpium* is bitter and warm, regulates Lung Qi, and removes Qi stagnation, thus serving as the Sovereign herb. *Mori Cortex* is sweet and cold, eliminates Water-Qi, edema, and abdominal distension in the Lungs, and promotes urination, thus serving as the Minister herb. *Costi Rhizoma* is bitter, acrid, and warm, removes stagnant Qi in the Lungs; *Atractylodis Macrocephalae Rhizoma* is bitter and sweet, warm, moistens the middle and eliminates Dampness using bitter drying action. *Poria* is sweet and neutral, stops thirst, eliminates Dampness, and promotes urination using bland draining action, thus serving as the Envoy herb.