尝观肿胀之疾。必发喘急。而喘病则有肿而不胀。胀而不肿者。又有先肿
而后喘。先喘而后肿者。病情既殊。则治之者何可不为之别耶。试究详之。
大抵肿胀在脾。喘满在肺。胀甚于肿。属肝乘脾。肿甚于胀。属肾乘肺。故治
胀之法。先宜平肝。肝平则气调。而不中滞。次用补脾敛肝。土旺则能健运。
土中泻木。白芍药酸以收之。若过于快气。则中州亦伤。而不能复其职矣
治肿之法。先宜清肺。肺清则气降。而不上逆。次用淡渗益阴。淡渗则能利
窍。金藏水中。生地黄苦以坚之。若过于疏泄。则有阳无阴。而亦不能以化
矣。然由肿胀而至于喘者。则求其肿胀之因而调之。不治喘而喘自宁。若
由喘而至于肿胀者。则求其致喘之因而理之。不治肿胀而肿胀自愈。木
火之与金水。易而为治。比之操刃。况乎土位于中。四气昏得乘之也哉。善
治者。必审脏腑所属。而以苦欲补泻求之。庶得乎病之情。而不胶于成法也。
治验
一女人年三旬余。得气喘症。身发肿胀。他医疗已逾年。竟罔效。延余诊之。
脉细带数。行动喘乏。所服破气药无遗。余见其肿甚。用大腹皮陈皮茯
苓泽泻车前中。独入生地白芍药牡丹皮。以阴济阳。上收其逆气。而下
得以化。不三剂减半。数剂乃愈。继以八珍调之。
一男子年十六。近除得感寒症。余与发表消食。至新正四日。竟愈矣。余令
之食粥。其家过慎。止与陈米汤饮。至二十日。复延治。上则发喘。下则发
肿。由足跗至膝上。不惟肿。其色红赤可怪。及按其脉。则微细。问其胸。觉
饥甚。与粥饮入口便喘。余因谓曰。五气养阳。五味养阴。今半月余。止用
陈久米饮。有气无味。阴不济阳。其何能化。然两足通红奈何。余乃谓曰。
此必过食咸味。咸走血就下。随其水而外发。故至此。询之。乃因口淡。任
啖腌菜而然。余以为不必治。急索饭及荤菜。与之半盏竟安。病者欢甚。
少顷又进半盏。易以他荤亦安。余竟教以如是调理。约旬日阴渐旺则
阳化而肿自退果然。
我曾观察肿胀的疾病，必定伴随发喘急的症状。然而喘病中，有只肿不胀的，也有只胀不肿的；还有先出现肿胀而后发喘，或先发喘而后出现肿胀的情况。病情既然不同，治疗者怎能不加以区别呢？试着详细探究一下。
大抵来说，肿胀的病位在脾，喘满的病位在肺。胀比肿更严重，属于肝木乘克脾土；肿比胀更严重，属于肾水乘克肺金。因此，治疗胀的方法，首先应当平抑肝气，肝气平和则气机调畅，不会发生阻滞；其次使用补脾兼以敛肝的药物，脾气旺盛则能健运，在健脾（土）的同时疏泄肝木（木），用白芍药的酸味来收敛肝气。如果过于使用行气破气的药物，则会损伤脾胃（中州），使其不能恢复其职能。
治疗肿的方法，首先应当清肃肺气，肺气清肃则气机下降，不会上逆；其次使用淡渗利湿兼益阴的药物，淡渗之品能通利窍道，金（肺）藏于水（肾）之中，用生地黄苦寒之性来坚阴。如果过于使用疏泄通利的药物，则会导致有阳无阴，也无法化生精微了。
然而，由肿胀发展到喘证的，应当探寻导致肿胀的原因并调理它，不必专门治喘，喘证自然平息。由喘证发展到肿胀的，应当探寻导致喘证的原因并调理它，不必专门治肿胀，肿胀自然痊愈。木火与金水，治疗方法容易改变，这好比操持刀斧一样灵活。何况脾土位于中央，四时之气都可能侵犯它啊。善于治疗的人，必定审察脏腑所属，并根据“苦欲补泻”的理论来求索治法，这样才能符合病情的实际，而不拘泥于固定的成法。
【治疗验案】
有一位三十多岁的女性，患气喘症，身体发生肿胀，其他医生治疗已超过一年，竟然没有效果。请我诊治，脉象细而带数，行动时气喘乏力。她之前服用的全是破气药。我看到她肿胀严重，使用大腹皮、陈皮、茯苓、泽泻、车前子，唯独加入生地、白芍药、牡丹皮，以阴济阳，向上收敛逆乱之气，向下得以化生。不到三剂症状减半，几剂后痊愈。随后用八珍汤调理。
有一位十六岁的男子，近日因感受寒邪患病。我给予发表消食的药物，到正月初四日，竟然痊愈了。我嘱咐他喝粥，他的家人过分谨慎，只给他喝陈年米汤。到了二十日，再次请我治疗。上面发喘，下面发肿，从脚背一直到膝盖以上，不仅肿胀，颜色红赤得奇怪。等到诊察他的脉象，则微细。询问他的胸部感觉，觉得非常饥饿。但喝下粥饮入口便发喘。我对他说：“五气养阳，五味养阴。现在半个多月，只用陈久的米饮，只有气而没有味道，阴不能济阳，怎么能化生呢？但是两脚通红怎么办呢？”我又说：“这一定是因为过食咸味，咸味走血且趋下，随着水气外发，所以到了这种地步。”询问情况，是因为口淡，随意吃腌菜所致。我认为不必专门治疗，急忙索要米饭和荤菜，给他吃了半碗，竟然安适了。病人很高兴。过了一会儿又进了半碗，换成其他荤菜也安适。我最终教他这样调理，大约十天，阴气逐渐旺盛，阳气得以化生，肿胀自然消退，果然如此。
I have observed that in diseases of swelling and distension, panting and urgency (asthma) must occur. However, in diseases of panting, there are cases with swelling but no distension, and cases with distension but no swelling. There are also cases where swelling precedes panting, and cases where panting precedes swelling. Since the clinical manifestations differ, how can practitioners not distinguish between them? Let us investigate in detail.
Generally speaking, swelling and distension relate to the Spleen, while panting and fullness relate to the Lung. When distension is more severe than swelling, it belongs to Liver Wood overacting on Spleen Earth; when swelling is more severe than distension, it belongs to Kidney Water overacting on Lung Metal. Therefore, the method for treating distension should first focus on calming the Liver. Once the Liver is calm, Qi will be regulated and not stagnate. Next, use herbs that tonify the Spleen and astringe the Liver. When Earth is robust, it can transport and transform effectively. In tonifying Earth, one drains Wood; Sour Bai Shao Yao (Radix Paeoniae Alba) is used to astringe. If one uses too many Qi-moving or Qi-breaking herbs, the Middle Jiao (Spleen/Stomach) will be damaged and unable to resume its functions.
The method for treating swelling should first focus on clearing the Lung. Once the Lung is clear, Qi will descend and not rebel upward. Next, use bland-draining herbs that benefit Yin. Bland-draining herbs can open the orifices. Metal (Lung) is stored within Water (Kidney); Bitter Sheng Di Huang (Rhizoma Rehmanniae Preparata) is used to firm the Yin. If one uses too many dispersing and draining herbs, Yang will exist without Yin, and transformation cannot occur.
However, when swelling progresses to panting, one should seek the cause of the swelling and regulate it. Without specifically treating panting, panting will naturally subside. When panting progresses to swelling, one should seek the cause of the panting and regulate it. Without specifically treating swelling, swelling will naturally heal. The treatments for Wood-Fire and Metal-Water are easily altered, comparable to wielding a blade. Moreover, since Earth resides in the center, the four Qi (seasonal pathogens) may all invade it. A skilled practitioner must examine the organ affiliations and seek treatment based on the principles of "Bitter-Desire Tonification and Drainage" (Ku Yu Bu Xie). This way, one will grasp the true nature of the disease and not adhere rigidly to fixed formulas.
[Case Records]
A woman, over thirty years old, suffered from asthma and generalized edema. Other physicians had treated her for over a year with no effect. I was consulted. Her pulse was fine and rapid. She panted and felt fatigued upon movement. She had taken only Qi-breaking herbs previously. Seeing her severe edema, I used Da Fu Pi (Arecae Pericarpium), Chen Pi (Citri Reticulatae Pericarpium), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma), and Che Qian Zi (Plantaginis Semen), but uniquely added Sheng Di Huang (Rehmanniae Radix), Bai Shao Yao (Paeoniae Radix Alba), and Mu Dan Pi (Moutan Cortex). This nourished Yin to support Yang, restrained rebellious Qi above, and facilitated transformation below. In less than three doses, symptoms reduced by half; after several doses, she recovered. Subsequently, Ba Zhen Tang (Eight Treasure Decoction) was used for regulation.
A sixteen-year-old man recently contracted a cold syndrome. I prescribed exterior-releasing and food-dispersing herbs. By the fourth day of the new year, he had recovered. I instructed him to eat congee. His family, being overly cautious, gave him only water boiled from aged rice. On the twentieth day, they sought my treatment again. He presented with upper-body panting and lower-body swelling, extending from the dorsum pedis to above the knees. Not only was he swollen, but the color was remarkably red. His pulse was faint and fine. Upon asking about his chest, he reported extreme hunger. However, whenever he drank congee, he immediately panted. I said, "Five Qi nourish Yang, Five Flavors nourish Yin. For over half a month, you have consumed only aged rice water, which has Qi but no flavor. Yin cannot support Yang, so how can transformation occur? But what of the redness in both feet?" I further stated, "This must be due to excessive consumption of salty flavors. Salty flavors enter the Blood and tend downward, following Water outward, leading to this condition." Inquiry revealed that due to a bland taste preference, he had eaten freely of pickled vegetables. I believed no specific treatment was needed. I urgently requested rice and meat dishes, giving him half a bowl, after which he felt comfortable. The patient was very pleased. After a short while, he ate another half bowl of different meat dishes and remained comfortable. I ultimately advised him to continue this regimen. Approximately ten days later, Yin gradually strengthened, Yang transformed, and the swelling receded, as expected.