张元素曰。阳黄者。大小便赤涩身热。是脾土与心火相搏。为阳病。法当先利小便。后下大便。阴黄者。清便自调。
面目及身黄。四肢冷。是脾虚不能制肾水。宜益黄散。下使君子丸。
少阴肾水。太阴肺金。金本生水。水融两阴。肾邪相传。膀胱是侵。逆于脾土。反被水沉。脾虚失制。随水所淫。
脾既受克。不能生心。水激心火。与肺相临。肺又受害。化原失凭。以致水溢。肾邪纵横。脾易受湿。水乃与并。脾主
四肢。流走 。渗于脉络。皮肤是寻。血亦化水。停积日深。乃作水肿。腹饱筋青。手足面目。悉属水停。或气喘逆。
或口呻吟。或发烦渴。或寒热乘。或小便秘。溺出如针。胸满胁胀。减食失音。背平脐凸。命乃将倾。须洁净府。亦开
鬼门。去菀陈 。内经是箴。当须识此。急早治惩。根由症状。仔细详明。嗟嗟水肿。病岂寻恒。时俗谬妄。河白是称。
遍考方书。古无此名。
曾氏曰。原肿病之由。标本之疾。肾主元气。天一之水生焉。肺主冲化。地四之金属焉。肾为本而肺为标。皆至阴
以积水。其为病也。肾者。胃之关键。关键不利。则枢机不转。水乃不行。渗于脉络皮肤。而为浮肿。当推究内外所因
为治。儿大者。凭脉以明虚实。古方有十种论症。短气不得卧。为心水。两胁紧痛。为肝水。大便鸭溏。为肺水。
四肢苦重。为脾水。腰痛足冷。为肾水。口苦咽干。为胆水。乍虚乍实。为大肠水。腹急肢瘦。为膀胱水。小便闭
涩。为胃水。少腹急满。为小肠水。然脉浮为风为虚。沉伏为水病。沉则脉络虚。伏则小便难。即为正水。脾脉虚大。
多作脾肿。因循不治。乃成水肿。盖脾属土。喜燥而恶湿。常感湿气。湿又喜伤脾。血化为水。土败不能制水。则停蓄
不行。留滞皮肤。故作浮肿。初得病时。见眼胞早晨浮突。午后稍消。急以羌活散疏解。次醒脾散。及间投南星腹皮散。
其脾冷困。则燥以草果、缩砂之类。然此症夏秋冬治之颇易。惟春不然。盖四时之水。无如春水泛溢。兼肝木旺而脾土
受克。不能受水。所以难疗。须徐徐调理取效。若脾热而困。入投燥热药。虽不能生土。亦可胜水。奈杀之太过。土不
胜火。则热愈盛而不食。发热烦渴。又进燥剂。由此面目转浮。致脾败。手足背肿。脐凸。皆脾之外候。有未经发表。
递用下药。一泻肿消。乃曰泻之力。不知脾愈泻而愈虚。不旬月。其肿如初。此世人但知泻肿为最。不求十补而一泻之
论。法当随四时用药解表。通利小便。春以七宝丹加麻黄、桂枝、赤苓、姜、葱。夏以五苓散加麻黄、苡仁、车前子、
姜、葱。秋以清肺饮加羌活、细辛、商陆。姜、葱。冬以冲和饮加白术、生川乌、赤小豆、
姜、葱。次投滋润救脾导水汤剂渗泄之。乃为良法。更以香陆胃苓丸顿服。自安。
有国中便觉痰嗽气喘。小水不通。正属肺肾所主。先服解表散。次投三白散。凡得此病。非一朝夕之故。不可求速
效。以致虚脱。如愈后。再感外风。满面虚浮。用排风散和解。仍服救脾汤剂。免致反复。刘氏曰。治肿非易。补养尤
难。忌食物切须详审。有久不消者。下浚川丸即效。
史演山曰。肿胀二症。此由虚中有积。久患失治。日渐传变。症候多端。随轻重。察盛衰。审表里以主治。先固其
本。后治其标。斯无患矣。受湿肿。食毒瓦斯肿。伤寒虚气入腹肿。泻痢虚气入腹肿。此四种所患病不相同。皆由虚得之。
受湿。谓脾胃受湿冷。久不克化。气浮。四肢头面皆肿。食毒瓦斯肿。由脾胃伤冷积。毒瓦斯停留胃脘。致气入腹。蛊胀肿
急。伤寒由下之太早。乘虚入腹作肿。泻痢久。脾气亦虚。是以致肿。以上宜平调胃气。补脏充实。方可去肿。先服
四味理中汤减半干姜加白术、桑皮。伤寒虚肿。加枳实。作喘加淡豉。泻痢虚胀。宜正气调胃。胃气既壮。救生丹利之。
肿即退。再用观音散调补脏腑。即平复矣。
王履曰。气虚肿。亦名气蛊。血虚肿。亦名血蛊。小儿所患肿胀一门。最为要急。前人少有究竟。然肿胀之作。皆
由荣卫不顺。脏腑怯弱。壅滞三焦。流注百脉。表里俱虚。邪正相乱。以致四肢浮盛。肚腹膨满。多由食毒得之。饮食
得之。症伤得之。饥饱得之。积久不化。故成斯病。病由虚得。或妄乱通下。因虚致虚。根不得去。疾加益甚。是谓坏
症危症。先投荣卫饮子。次服分气饮子以散滞。斯病去矣。
叶桂曰。夏季湿热郁蒸。脾胃气弱。水谷之气不运。湿着内蕴为热。渐至浮肿腹胀。小水不利。治之非法。水湿久
积。逆行犯肺。必生咳嗽喘促。甚则坐不得卧。俯不能仰。危期速矣。大凡喘必生胀。胀必生喘。方书以先喘后胀者治
在肺。先胀后喘者治在脾。亦定论也。金匮有风水、皮水、石水、正水、黄汗。以分表里之治。河间有三焦分消。子和
有磨积逐水。皆有奥义。学人不可不潜心体认。难以概述。阅近代世俗论水湿喘胀之症。以内经开鬼门取汗为表治。分
利小便洁净府为里治。经旨病能篇。谓诸湿肿满。皆属于脾。以健脾燥湿为稳治。治之不效。技穷束手矣。不知凡病皆
本乎阴阳。通表利小便。乃宣经气利腑气。是阳病治法。暖水脏。温脾肾。补后方以驱水。是阴病治法。治肺以轻开上。
治脾必佐温通。若阴阳表里乖违。脏真日漓。阴阳不运。亦必作胀。治以通阳。乃可奏绩。如局方禹余粮丸。甚至三焦
交阻。必用分消。肠胃窒塞。必用下夺。然不得与伤寒实热同例。擅投硝、黄、枳、朴。扰动阴血。若太阴脾脏饮湿阻
气。温之补之不应。欲用下法。少少甘遂为丸可也。其治实症。选用方法。备采葶苈大枣汤、牡蛎泽泻散、甘遂半夏汤、
子和桂苓汤、中满分消饮、五子五皮汤、茯苓防己汤、小青龙汤、木防己汤、泻白散、五苓散、控涎丹、禹功丸、大顺
散、越婢汤。徐姓小儿。单胀数月。服肥儿丸、万安丸、磨积丹、绿矾丸、鸡肫药。俱不效。余谓气分不效。宜治血络。
所谓络瘀则胀也。用归须、桃仁、延胡、山甲、蜣螂、 虫、灵脂、山楂之类为丸。十日全愈。
张元素说：阳黄证，表现为大小便赤红涩痛、身体发热，这是脾土与心火相互搏结所致，属于阳病。治疗法则应当先通利小便，后攻下大便。阴黄证，表现为大小便正常调和，面目及全身发黄、四肢发冷，这是脾虚不能制约肾水所致，适宜使用益黄散，并服用使君子丸。
少阴肾水与太阴肺金，金原本能生水，两阴相融。若肾邪传变，侵犯膀胱，进而逆犯脾土，反而被水气沉困。脾虚失去制约能力，随水气泛滥。脾既受克，不能生养心火，水气激惹心火，并与肺气相邻。肺又受害，化源失凭，导致水液溢满。肾邪纵横，脾易受湿邪侵袭，水湿合而为一。脾主四肢，水湿流走窜动，渗入脉络，寻至皮肤。血液也化为水液，停积日久，形成水肿。腹部胀饱、筋脉青紫，手足面目，都属水液停聚之象。或出现气喘上逆，或口中呻吟，或烦躁口渴，或寒热交作，或小便秘结，排尿如针刺般疼痛，胸胁胀满，食欲减退甚至失音，背部平坦、肚脐凸起，生命即将倾覆。必须采用洁净府（通利小便）的方法，也要开鬼门（发汗解表）。去除郁积的陈腐之物，这是《内经》的箴言。应当认清此理，及早治疗惩戒。探究病因症状，仔细详明。唉！水肿这种病，难道寻常吗？世俗谬误狂妄，竟称“河白”为病名。遍考方书，古代并无此名。
曾氏说：水肿病的由来，涉及本标疾病。肾主元气，是天一之水所生；肺主冲和变化，是地四之金所成。肾为本而肺为标，二者皆属至阴，容易积水致病。其中，肾是胃的关键所在，关键不利，则枢机不转，水液不行，渗入脉络皮肤，成为浮肿。应当推究内外病因进行治疗。年龄较大的儿童，通过脉象来辨明虚实。古方有十种论症：短气不得平卧，称为心水；两胁紧痛，称为肝水；大便像鸭粪一样稀溏，称为肺水；四肢苦于沉重，称为脾水；腰痛足冷，称为肾水；口苦咽干，称为胆水；时而虚弱时而实证，称为大肠水；腹部急迫肢体消瘦，称为膀胱水；小便闭塞涩滞，称为胃水；小腹胀满急迫，称为小肠水。然而，脉浮表示风邪或虚证，脉沉伏表示水病。脉沉则脉络虚，脉伏则小便难，这就是正水。脾脉虚大，多表现为脾肿，如果拖延不治，就会形成水肿。因为脾属土，喜燥恶湿，常感湿气，而湿邪又喜欢伤害脾土，血液化为水液，土败不能制水，于是停蓄不行，留滞皮肤，所以发生浮肿。刚得病时，早晨眼胞浮肿突起，午后稍消，应立即用羌活散疏解，接着用醒脾散，间或投服南星腹皮散。如果是脾冷困倦，则用草果、缩砂等燥湿药。然而此症在夏秋冬三季治疗颇容易，唯独春季不然。因为四季之水，没有比春水泛溢更厉害的，加上肝木旺盛克制脾土，脾不能承受水气，所以难以治疗。必须慢慢调理才能见效。如果是脾热困倦，投入燥热药物，虽然不能生土，也可以胜水，但杀伤太过，土不胜火，则热势更盛而不思饮食，发热烦躁口渴，再进燥剂，由此面目转为浮肿，导致脾败，手足背肿胀，肚脐凸起，这些都是脾的外在征候。如果有未经发表（发汗解表），递次使用下药，一次泻下后肿消，就说这是泻下的力量。不知道脾越泻越虚，不到一个月，其肿胀如初。世人只知道泻肿最好，不懂得“十补而一泻”的理论。法当根据四季用药解表，通利小便。春季用七宝丹加麻黄、桂枝、赤茯苓、生姜、葱白；夏季用五苓散加麻黄、薏苡仁、车前子、生姜、葱白；秋季用清肺饮加羌活、细辛、商陆、生姜、葱白；冬季用冲和饮加白术、生川乌、赤小豆、生姜、葱白。随后投服滋润救脾导水汤剂进行渗泄，这才是良法。再顿服香陆胃苓丸，自然安泰。
有人觉得痰嗽气喘，小便不通，这正属于肺肾所主。先服用解表散，接着投服三白散。凡是得此病，不是一朝一夕的缘故，不可求速效，以致造成虚脱。如果痊愈后，再次感受外风，满面虚浮，用排风散和解，仍服用救脾汤剂，避免反复。刘氏说：治疗肿胀不容易，补养尤其困难。忌口的食物切须详细审查。有久不消退的，服用浚川丸即有效。
史演山说：肿胀二症，这是由于虚中有积，久患失治，日渐传变，症候多端。随着轻重，察盛衰，审表里以主治。先固护其本，后治疗其标，这样就没有祸患了。受湿肿、食毒瓦斯肿、伤寒虚气入腹肿、泻痢虚气入腹肿，这四种所患病不同，都是由虚证引起的。受湿，是指脾胃受湿冷，久不消化，气浮，四肢头面皆肿。食毒瓦斯肿，由脾胃伤于冷积，毒瓦斯停留胃脘，导致气入腹，蛊胀肿急。伤寒由于下法太早，乘虚入腹作肿。泻痢日久，脾气亦虚，因此致肿。以上宜平调胃气，补脏充实，方可去肿。先服四味理中汤减半干姜，加白术、桑白皮。伤寒虚肿，加枳实；作喘加淡豆豉。泻痢虚胀，宜正气调胃，胃气既壮，用救生丹利之，肿即退。再用观音散调补脏腑，即可平复。
王履说：气虚肿，也叫气蛊；血虚肿，也叫血蛊。小儿所患肿胀一门，最为要急，前人少有究竟。然而肿胀之作，皆由营卫不顺，脏腑怯弱，壅滞三焦，流注百脉，表里俱虚，邪正相乱，以致四肢浮盛，肚腹膨满。多由食毒得之，饮食得之，症伤得之，饥饱得之，积久不化，故成斯病。病由虚得，或妄乱通下，因虚致虚，根不得去，疾加益甚，是谓坏症危症。先投荣卫饮子，次服分气饮子以散滞，斯病去矣。
叶桂说：夏季湿热郁蒸，脾胃气弱，水谷之气不运，湿着内蕴为热，渐至浮肿腹胀，小水不利。治之非法，水湿久积，逆行犯肺，必生咳嗽喘促，甚则坐不得卧，俯不能仰，危期速矣。大凡喘必生胀，胀必生喘。方书以先喘后胀者治在肺，先胀后喘者治在脾，也是定论。《金匮要略》有风水、皮水、石水、正水、黄汗，以分表里之治。河间有三焦分消，子和有磨积逐水，皆有奥义，学人不可不潜心体认，难以概述。阅近代世俗论水湿喘胀之症，以内经“开鬼门”取汗为表治，“分利小便洁净府”为里治。《内经·病能篇》谓“诸湿肿满，皆属于脾”，以健脾燥湿为稳治。治之不效，技穷束手矣。不知凡病皆本乎阴阳，通表利小便，乃宣经气利腑气，是阳病治法；暖水脏，温脾肾，补后方以驱水，是阴病治法。治肺以轻开上，治脾必佐温通。若阴阳表里乖违，脏真日漓，阴阳不运，亦必作胀。治以通阳，乃可奏绩。如局方禹余粮丸，甚至三焦交阻，必用分消；肠胃窒塞，必用下夺。然不得与伤寒实热同例，擅投硝、黄、枳、朴，扰动阴血。若太阴脾脏饮湿阻气，温之补之不应，欲用下法，少少甘遂为丸可也。其治实症，选用方法，备采葶苈大枣汤、牡蛎泽泻散、甘遂半夏汤、子和桂苓汤、中满分消饮、五子五皮汤、茯苓防己汤、小青龙汤、木防己汤、泻白散、五苓散、控涎丹、禹功丸、大顺散、越婢汤。徐姓小儿，单胀数月，服肥儿丸、万安丸、磨积丹、绿矾丸、鸡肫药，俱不效。余谓气分不效，宜治血络，所谓络瘀则胀也。用归须、桃仁、延胡索、穿山甲、蜣螂、虻虫、灵脂、山楂之类为丸，十日全愈。
Zhang Yuansu stated: In Yang Jaundice (Yang Huang, jaundice characterized by heat signs), the urine and stool are red and scanty with difficulty in passing, accompanied by fever. This is caused by the struggle between Spleen Earth and Heart Fire, constituting a Yang disease. The treatment principle should be to first promote urination, then purge the bowels. In Yin Jaundice (Yin Huang, jaundice characterized by cold deficiency signs), the urine and stool are normal and harmonious. The face, eyes, and body turn yellow, and the four limbs are cold. This is due to Spleen Deficiency failing to control Kidney Water. It is appropriate to use Yihuang San (Yellow-Boosting Powder) and administer Shijunzi Wan (Quisqualis Pill).
Shaoyin Kidney Water and Taiyin Lung Metal: Metal naturally generates Water, and the two Yin aspects merge. If Kidney pathogenic factors transmit, they invade the Bladder, then counterattack Spleen Earth, and are conversely submerged by Water. Spleen Deficiency loses its controlling ability and follows the flooding of Water. Once the Spleen is overcome, it cannot generate Heart Fire; Water agitates Heart Fire, which approaches Lung Qi. The Lung suffers harm, losing its source of transformation, leading to water overflow. Kidney pathogens run rampant, the Spleen easily suffers from Dampness, and Water merges with it. The Spleen governs the four limbs; Water flows and moves, seeping into the collaterals and seeking the skin. Blood also transforms into Water, accumulating over days and months, resulting in Edema (Shuizhong, swelling due to water retention). Abdominal fullness and cyanotic veins, as well as swelling of the hands, feet, face, and eyes, all belong to water stagnation. There may be panting and rebellious Qi, groaning from the mouth, irritability and thirst, alternating chills and fever, constipation of the small intestine, urination feeling like needle pricks, chest fullness and hypochondriac distension, reduced appetite and loss of voice, a flat back and protruding umbilicus, indicating that life is on the verge of collapse. One must employ methods to purify the Fu organs (promote urination) and open the ghost gates (induce sweating). Remove accumulated stale matter; this is the admonition of the *Neijing* (Inner Canon). One must recognize this, treat urgently and early. Investigate the root causes and symptoms carefully. Alas! Edema is not an ordinary disease. Popular misconceptions are absurd; they call "Hebai" a disease name. Examining medical texts, there was no such name in ancient times.
Zeng stated: The origin of edema involves root and branch diseases. The Kidney governs Yuan Qi, generated from Tianyi Water; the Lung governs Chong transformation, formed from Di Si Metal. The Kidney is the root, and the Lung is the branch; both are extreme Yin and prone to accumulating water. Among them, the Kidney is the key of the Stomach. If the key is obstructed, the pivot does not turn, water does not flow, seeps into collaterals and skin, becoming generalized edema. One must investigate internal and external causes for treatment. For older children, determine deficiency or excess via pulse diagnosis. Ancient formulas describe ten types of syndromes: Shortness of breath and inability to lie flat is Heart Water; tight pain in both hypochondria is Liver Water; duck-like loose stools is Lung Water; heaviness in the four limbs is Spleen Water; lower back pain and cold feet is Kidney Water; bitter taste in the mouth and dry throat is Gallbladder Water; alternating deficiency and excess is Large Intestine Water; abdominal urgency and emaciated limbs is Bladder Water; closed and scanty urination is Stomach Water; urgency and fullness in the lower abdomen is Small Intestine Water. However, a floating pulse indicates Wind or Deficiency; a deep and hidden pulse indicates Water disease. Deep pulse implies deficient collaterals; hidden pulse implies difficult urination, which is Zheng Water (True Water). A large and deficient Spleen pulse often presents as Spleen Swelling. If neglected, it becomes Edema. Since the Spleen belongs to Earth, it prefers dryness and dislikes dampness. It often contracts dampness, and Dampness loves to damage the Spleen. Blood transforms into water; when Earth fails to control Water, it stagnates and does not move, remaining in the skin, thus causing edema. At the onset, the eyelids swell in the morning and subside slightly in the afternoon. Immediately use Qianghuo San (Notopterygium Powder) to disperse and resolve, followed by Xingpi San (Spleen-Awakening Powder), and intermittently administer Nanxing Fupi San (Arisaema and Tangerine Peel Powder). If there is Spleen Cold and fatigue, use drying herbs like Caoguo (Black Cardamom) and Suosha (Amomum). However, this condition is relatively easy to treat in Summer, Autumn, and Winter, but difficult in Spring. Among the waters of the four seasons, none is more overflowing than Spring Water. Additionally, Liver Wood is vigorous and overcomes Spleen Earth, so the Spleen cannot accept water, making it hard to treat. Gradual regulation is required for efficacy. If there is Spleen Heat and fatigue, administering drying-hot drugs may overcome water, though it cannot generate Earth. However, excessive killing leads to Earth failing to withstand Fire, causing intense heat, anorexia, fever, irritability, and thirst. Further administration of drying agents causes the face and eyes to become swollen, leading to Spleen failure, swelling of the dorsum of hands and feet, and protruding umbilicus—all external signs of Spleen decline. If exterior syndrome has not been released, and laxatives are used sequentially, the swelling subsides after one purge, claiming credit for the purgative power. But the Spleen becomes more deficient with each purge. Within a month, the swelling returns to its original state. People only know that purging edema is best, ignoring the theory of "tonify ten times, purge once." The method should involve releasing the exterior according to the seasons and promoting urination. In Spring, use Qibao Dan (Seven-Treasure Pill) added with Mahuang (Ephedra), Guizhi (Cinnamon Twig), Chifuling (Red Poria), Shengjiang (Fresh Ginger), and Congbai (Scallion White). In Summer, use Wuling San (Five-Ingredient Powder with Poria) added with Mahuang, Yiren (Coix Seed), Cheqianzi (Plantago Seed), Shengjiang, and Congbai. In Autumn, use Qingfei Yin (Lung-Clearing Decoction) added with Qianghuo (Notopterygium), Xixin (Asarum), Shanglu (Phytolacca), Shengjiang, and Congbai. In Winter, use Chonghe Yin (Harmonizing Decoction) added with Baizhu (Atractylodes Macrocephala), Sheng Chuanwu (Raw Aconitum Carmichaelii), Chixiaodou (Adzuki Bean), Shengjiang, and Congbai. Subsequently, administer Runzai Jiupi Daoshui Tangji (Moisturizing Spleen-Saving and Water-Guiding Decoction) for渗泄 (percolating and draining). This is a good method. Also, take Xianglu Weiling Wan (Fragrant Phytolacca and Coptis Pill) in one dose, and peace will ensue.
Some feel phlegm, cough, panting, and complete lack of urination; this correctly belongs to the governance of Lung and Kidney. First take Jiebiao San (Exterior-Resolving Powder), then administer Sanbai San (Three-Whites Powder). Any illness obtained is not due to a single day or night; do not seek rapid effects, leading to deficiency collapse. If, after recovery, external Wind is contracted again, causing facial puffiness, use Paifeng San (Wind-Expelling Powder) to harmonize, and continue taking Jiupi Tangji (Spleen-Saving Decoction) to prevent recurrence. Liu stated: Treating swelling is not easy; tonification is even more difficult. Foods to avoid must be carefully examined. For those who do not subside for a long time, Junchuan Wan (River-Dredging Pill) is effective.
Shi Yanshan stated: The two syndromes of swelling and distension arise from deficiency with accumulation. Long-term neglect leads to gradual progression and diverse symptoms. Observe severity, assess excess and deficiency, examine interior and exterior to guide treatment. First secure the root, then treat the branch, and there will be no disaster. Receiving Dampness swelling, Food-Toxic Gas swelling, Cold Damage Qi entering the abdomen causing swelling, and Dysentery Qi entering the abdomen causing swelling—these four diseases differ but all arise from deficiency. "Receiving Dampness" refers to Spleen and Stomach contracting cold-dampness, failing to digest for a long time, causing Qi to float, leading to swelling of the four limbs, head, and face. "Food-Toxic Gas swelling" results from Spleen and Stomach injury by cold accumulation, toxic gas staying in the stomach cavity, causing Qi to enter the abdomen, leading to urgent gu-distension swelling. Cold Damage swelling occurs because purgation was too early, allowing pathogens to enter the abdomen vacuously and cause swelling. Long-term dysentery makes Spleen Qi deficient, thus causing swelling. Above cases should be treated by balancing Stomach Qi and tonifying Zang organs to fill them up, then swelling can recede. First take Siwei Lizhong Tang (Four-Ingredient Lizhong Decoction) with half dosage of Ganjiang (Dried Ginger), adding Baizhu and Sangpi (Mulberry Bark). For Cold Damage deficiency swelling, add Zhishi (Immature Bitter Orange); for panting, add Danshi (Light Fermented Soybean). For dysentery deficiency distension, regulate Stomach Qi with Zhengqi; once Stomach Qi is strong, use Jiusheng Dan (Life-Saving Pill) to drain, and swelling will recede. Then use Guanyin San (Guanyin Powder) to regulate and tonify Zang organs, and recovery will occur.
Wang Lü stated: Qi deficiency swelling is also called Qi Gu; Blood deficiency swelling is also called Blood Gu. The category of swelling in pediatrics is most critical, yet predecessors rarely explored it thoroughly. However, swelling arises from unsmooth Ying and Wei, weak Zang and Fu, obstruction of the Triple Burner, flowing through the hundred vessels, deficiency in both interior and exterior, confusion of pathogenic and righteous Qi, leading to floating and fullness of the four limbs and distension of the abdomen. It mostly results from food toxicity, dietary issues, trauma, irregular eating, and long-term indigestion. The disease stems from deficiency; if indiscriminate purgation is used, deficiency leads to further deficiency, the root is not removed, and the disease worsens, termed a ruined or critical syndrome. First administer Yingwei Yinzi (Ying-Wei Decoction), then Fenqi Yinzi (Qi-Separating Decoction) to dissipate stagnation, and the disease will depart.
Ye Tianshi stated: In summer, damp-heat stagnates and steams, Spleen and Stomach Qi is weak, the Qi of water and grain does not transform, dampness adheres internally generating heat, gradually leading to edema, abdominal distension, and difficult urination. Improper treatment causes water-dampness to accumulate for a long time, reverse and attack the Lung, inevitably causing cough and panting, severe cases unable to sit or lie down, danger imminent. Generally, panting generates distension, and distension generates panting. Medical books state that panting preceding distension is treated in the Lung, and distension preceding panting is treated in the Spleen, which is a definitive conclusion. *Jinkui Yaolue* mentions Fengshui (Wind Water), Pishui (Skin Water), Shishui (Stone Water), Zhengshui (True Water), and Huanghan (Yellow Sweat) to distinguish interior-exterior treatments. Hejian proposed Triple Burner differentiation and separation; Heizi advocated grinding accumulation and driving out water; all have profound meanings. Students must study them earnestly; they are difficult to summarize. Reading modern popular discussions on water-dampness, panting, and distension, using *Neijing*'s "open ghost gates" to induce sweat as exterior treatment, and "purify Fu organs" by separating and draining urine as interior treatment. The *Neijing* chapter "Bingneng" states "All dampness, swelling, and fullness belong to the Spleen," advocating strengthening the Spleen and drying dampness as a stable treatment. If ineffective, skills are exhausted. They do not know that all diseases are rooted in Yin-Yang. Releasing the exterior and promoting urination promotes Jing Qi and Fu Qi, which is the treatment for Yang diseases. Warming the Water Organ (Kidney), warming Spleen and Kidney, and tonifying posterior to drive out water is the treatment for Yin diseases. Treating the Lung requires light opening of the upper; treating the Spleen must assist with warming and unblocking. If Yin-Yang and interior-exterior are discordant, Zhen Qi daily depletes, Yin-Yang does not circulate, swelling will occur. Treatment by unblocking Yang can achieve results. Such as Ju Fang Yuyuliang Wan (Hematite Pill), even if Triple Burner blocks intersect, separation and drainage must be used; if intestines and stomach are blocked, purgation must be used. However, this cannot be equated with Cold Damage excess-heat; arbitrarily administering Xiaoshi (Mirabilite), Huanglian (Coptis), Zhishi, and Houpo disturbs Yin blood. If Taiyin Spleen organ has fluid-dampness blocking Qi, and warming/tonifying fails, if purgation is desired, a small amount of Gansui (Kansui Root) made into pills is acceptable. For treating excess syndromes, selected methods include Tingli Dazao Tang (Descurainia Seed and Jujube Decoction), Muzhi Zexie San (Oyster Shell and Alisma Powder), Gansui Banxia Tang (Kansui and Pinellia Decoction), Hezi Guiling Tang (Hezi's Guiling Decoction), Zhongman Fenxiao Yin (Middle-Fullness Separation Decoction), Wuzi Wupi Tang (Five-Seeds Five-Skins Decoction), Fuling Fangji Tang (Poria and Stephania Decoction), Xiao Qinglong Tang (Minor Green Dragon Decoction), Mufangji Tang (Stephania Decoction), Xiebai San (Drain-Lung Powder), Wuling San (Five-Poria Powder), Kongyan Dan (Saliva-Control Pill), Yugong Wan (Yu-Gong Pill), Dashun San (Great-Shun Powder), Yebi Tang (Wild Cat Decoction). Child surnamed Xu had isolated abdominal distension for months; took Fei'er Wan (Child-Nourishing Pill), Wan'an Wan (Ten-Thousand-Peace Pill), Moji Dan (Accumulation-Grinding Pill), Lvfan Wan (Green Vitriol Pill), Jizhen Yao (Chicken Gizzard Medicine), all ineffective. I said if Qi-b层面 treatment fails, treat Blood collaterals, as "collateral stasis causes distension." Use Guixu (Angelica Sinensis Thorns), Taoren (Peach Kernel), Yanhusuo (Corydalis), Shan Jia (Pangolin Scales), Changlang (Darkling Beetle), Mengchong (Blue Bottle Fly Larva), Lingzhi (Lignus), Shanzha (Hawthorn) made into pills, cured completely in ten days.