三诊 胀势大退，脐突稍收，按之亦渐觉软。既得叠见转机，当仿效方进退。
制川朴（一钱） 木香（五分） 广藿香（一钱） 大腹皮（一钱五分） 上广皮（一钱） 木猪苓
（一钱五分） 泽泻（二钱） 杏桃仁（各二钱） 范志曲（三钱） 瞿麦（三钱） 白茯苓（三钱）
砂仁（七分后下） 西茵陈（一钱） 小温中丸（开水送下）
宣（左） 脉象弦大，久按濡滑腹满不舒，而并无胀大情形，足跗带肿。此气虚脾不运旋，湿寒内
阻。中满之症，图治非易。
西潞党（二钱木香四分煎汁收入） 杭白芍（二钱炙甘草三分拌炒） 连皮茯苓（五钱） 野于术
（一钱枳壳六分煎汁收入） 上徭桂（四分去粗皮后入） 泽泻（二钱） 猪苓（二钱） 制香附（三
钱） 淡吴萸（五分） 姜衣（三分） 鸡内金（一具炙研细末调服）
二诊 投剂之后，脉症尚属和平，未便遽事更张。
野于术（二钱） 砂仁（四粒） 制香附（三钱） 生熟薏仁（各二钱） 木香（三分） 土炒广
皮（一钱） 炒白芍（一钱五分） 茯苓皮（五钱） 上徭桂（四分） 瞿麦（二钱） 生姜衣（三分）
陈米蛀屑（三钱包）
三诊 胀满较松，欲嗳不爽。右关脉尚带弦搏。木旺土衰，木旺则其气冲突，土衰则运化无权。再疏肝
之用，柔肝之体。
制香附（二钱小青皮一钱同炒） 焦秫米（三钱包） 炒白归身（二钱） 炙乌梅肉（一枚） 炒木瓜皮
（一钱五分） 酒炒杭白芍（二钱） 金铃子（切一钱五分） 干橘叶（一钱五分） 陈米蛀屑（绢包三钱）
四诊 脉象柔软，左关部久按才见弦象。两日内胸腹舒泰，并不胀满，起病以来，未有之境。药既应手，
踵效方消息之。
川连（三分吴萸五分同炒） 酒炒白芍（一钱五分） 金铃子（一钱五分） 乌梅（一个） 醋炒青皮（一钱
五分） 焦秫米（三钱包） 炒木瓜皮（一钱五分） 酒炒归身（二钱） 醋炒香附（二钱） 陈米蛀屑（绢包三钱）
某 大腹胀满，筋露脐突，小溲涩少。脾虚而湿热壅滞。鼓胀重症，鞭长莫及。
于术炭 广皮 制香附 木香 猪苓 茯苓皮 砂仁 建泽泻 舟车丸
（原注）服后便溏三次，腹中自觉宽舒。
薛御之 湿盛多痰之体，感冒风邪，袭于肺卫，以致由咳而引动伏饮，咳日以剧，右胁作痛。浊痰弥漫，
神机不运，神识模糊。叠化浊痰，神情转慧。至于痰湿之变态，如阻营卫而为寒为热，郁遏中气，苔起灰
霉困乏脾阳，脾土不能运旋鼓舞，而大便燥结，清中之浊不降，浊中之清不升，而转干燥，传变种种，肌
表之温风，化疹外达，而湿痰究仍内困，所以病退之后，而疲惫自若。渐至气阻湿坠，少腹之满，顿从上
僭，不特入腹过脐而且上支胸脘，食入攻撑大便涩少。右寸细涩，关部弦滑，尺部沉微，左部俱见小弱。
都由脾为湿困，阳气不能营运，土滞而木不扶苏，遂令湿之流于下者，随左升之气而逆从上行，肠胃
流行之机，悉为之阻，为胀为撑之所由来也。下病过中，图治非易。拟条达肝木，泄府浊而运脾阳。冀得
小溲渐畅，湿流气宣，方是好音耳。
淡吴萸（三分蜜水浸后取出焙干盐水炒） 陈皮（一钱蜜水浸后取出焙干陈壁土炒） 连皮苓（五钱）
盐水炒香附（一钱五分） 炒枳壳（一钱） 木猪苓（二钱） 川楝子（切一钱五分） 霞天曲（二钱炒）
鸡内金（一枚要不落水者研调服） 泽泻（一钱五分） 小温中丸（三钱开水送下）
孙（右） 向有痰喘，经月以来，腿足肿胀，渐至腹亦坚，满喘更加甚。肺气不能下输，水湿因而泛溢，深入
重地，有喘脱之虞。勉从先胀于下而复满于上者，亦必先治其上而后治其下之意立方。
桂枝 炙麻黄 光杏仁 大腹皮 制半夏 广皮
煨石膏 连皮苓 炒苏子 炒枳壳
二诊 开经气以通膀胱，犹然不减。鼓胀重症，为势正盛，有喘厥之虞。
葶苈子 汉防己 磨槟榔 磨沉香 香附 光杏仁 防风 茯苓皮 广皮 炒苏子 大腹皮 莱菔子 炙内金
改方加黑锡丹一钱先服。
童（左） 遍体浮肿，身半以上为甚。脾虚水湿泛溢，风与湿搏也。鼓胀重症，未可忽视。
蜜炙麻黄（五分） 防风（一钱） 大腹皮（二钱） 泽泻（一钱五分） 茯苓皮（五钱） 猪苓（二钱）
川芎（一钱） 陈皮（一钱） 羌活（一钱） 瞿麦（三钱） 姜衣（三分） 炒冬瓜皮（一两）
生薏仁（七钱二味煎汤代水）
左 肿退甚速，而杂食甜腻以助湿，甘寒以损脾，以致肿势复起。急宜谨慎口腹，以免自贻伊芳戚之讥。
大腹皮 新会皮 木猪苓 葶苈子 茯苓皮 杏仁泥 黑山栀 白通草 香豆豉 建泽泻 生熟薏仁 枇杷叶
龚（左） 面色目 带黄，腹笥胀大，渐至便利色赤，半载有余，胀势并未以利见消。脉数带滑。良以湿热
充斥三焦。鼓胀重症，不能许治也。
生熟薏仁 藿香 上广皮 木猪苓 建泽泻 赤茯苓 上川朴 茵陈 范志曲 杏仁 大腹皮 方通草
陈（左） 瘕块久而散漫，大腹胀大如鼓，二便不利。脉滞苔白。此脾虚而湿热壅滞三焦。鼓腹重症，勉方图幸。
川朴 茵陈 连皮苓 连皮槟 杏仁 通草 木香 砂仁 炙蟾皮 上广皮 于术 甘遂（二分煨透）
黑丑（四分） 炙内金（一具以上三味研末先调服）
（原注）此方服后泻下，胀退十之三。呕吐，乃甘遂未煨透之故。
二诊 泻下甚畅，大腹亦觉宽畅，但小溲不畅。虽见转机，仍不足恃。
前方去甘遂黑丑，加范志曲姜汁，单用炙内金一钱五分研末调服。
陆（左） 大腹胀大，按之坚硬，阴囊肿胀。脉形濡滞。此脾虚木旺，鼓胀重症，恐难以人力而与造化争功。
勉仿经旨工在疾泻之意。谋事在人，成事在天。
炙蟾皮（五钱） 大腹皮（二钱） 川朴（一钱） 缩砂仁（七分） 连皮苓（三钱） 野于术（一钱五分）
广皮（一钱） 炙内金（一具） 红芽大戟（三分） 甘遂（三分） 千金子（三分四味研细开水先服）
二诊 肿胀稍松，然仍膨大如鼓，小溲不利，阴囊肿胀。鼓胀重症，未可以临时取效，而便为足恃。
大腹皮 广陈皮 川朴 泽泻 炙蟾皮 猪苓 舟车丸（三钱）
马（右） 中空无物者曰鼓，实中有物者曰蛊。少腹有形，盘踞日久，兹则其形渐大，腹胀如箕，按之坚硬。
此气血阻滞不行，致脾土不克旋运。蛊胀重症，不能许治。
酒炒当归须 延胡索 台乌药 南楂炭 沉香曲 蓬莪术 制香附 上广皮
二诊 胀势稍松。姑守前意以觇动静。
金铃子 制香附 台乌药 延胡索 两头尖 当归须 炒蓬术 川桂木 南楂炭 葱白
三诊 胀势较松。然蛊胀重症，仍难图治。
两头尖（三钱） 台乌药（一钱五分） 鹤虱（二钱） 单桃仁（去皮打三钱） 制香附（二钱） 使君子肉（二
钱） 楂炭（三钱） 雷丸（一钱五分） 槟榔（一钱） 婆万病丸（三钱先服）
范（左） 身热大势虽退，脉仍未静，溏泄之后，转为便闭腹笥胀满，按之不柔。此邪少湿多，邪去湿留，湿
困脾土，鼓舞运旋不及，则大肠传化失司，所谓湿闭是也。宜调气泄浊。
川朴 广皮 大腹皮 郁金 小温中丸 桔梗 枳壳 光杏仁 砂仁
江（左） 痰饮咳逆多年，气血逆乱，痰每带红。日来兼感风邪，风与湿合，溢入肌肤，面浮肤肿，喘咳不平，
腹胀脘痞，小便不利。脉数浮滑，舌苔白腻。有喘胀之虞。
前胡（一钱五分） 荆芥（一钱） 光杏仁（三钱） 橘红（一钱） 茯苓皮（四钱） 葶苈（五分）
防风（一钱） 制半夏（一钱五分） 白前（一钱五分） 大腹皮（二钱） 生姜衣（四分） 川朴（一钱）
二诊 痰喘稍平，浮肿亦减，然中脘仍然作胀。肺胃之气，升多降少，致风与湿横溢肌肤。效方再望应手。
大腹皮（二钱） 川朴（一钱） 杏仁（三钱） 生薏仁（四钱） 煨石膏（三钱） 制半夏（一钱五分）
炙麻黄（四分） 陈皮（一钱） 枳壳（一钱） 茯苓皮（三钱炒） 生姜（二片） 冬瓜皮（三钱炒）
三诊 开上疏中，适交节令，痰气郁阻不开，痰出不爽，腹胀面浮足肿，小溲不利。脉形细沉。夫痰饮而
致随风四溢，都缘脾肾阳虚，不能旋运，所以泛滥横行。有喘胀之虞。拟千缗汤出入以开痰，真武以温肾而行水。
制半夏（一钱五分） 橘红（一钱） 大腹皮（二钱） 生姜衣（四分） 真武丸（三钱） 皂荚子（蜜炙
二粒） 枳实（一钱） 连皮苓（三钱） 炒于术（一钱五分）
改方去皂荚子加葶苈。
四诊 开肺之气，温肾之阳，肺合皮毛，遍身自汗，水气因而外越，面浮肤肿大退，胸闷较舒，胀满大退，
痰亦爽利。然大便不行，足肿未消。还是水气内阻，不得不暂为攻逐之。
大腹皮（二钱） 姜衣（四分） 白茯苓（三钱） 冬瓜皮（四钱炒） 泽泻（一钱五分） 上广皮（一钱）
于术（二钱） 生熟薏仁（各二钱） 制半夏（一钱五分） 禹功散（先调服一钱）
五诊 痰化为水，泛溢肌肤，先得畅汗，水湿之气，从汗外溢，继以缓攻，水湿之气，从而下达，故得腹胀
面浮俱减。拟运土分化。再望转机。
葶苈（五分） 橘红（一钱） 冬术（二钱） 大腹皮（二钱） 炒范志曲（二钱） 光杏仁（三钱）
茯苓皮（三钱） 猪苓（二钱） 泽泻（一钱五分） 生熟薏仁（各二钱） 枳壳（七分） 生姜衣（四分）
施芷园 嗜饮湿热素盛，湿酿为浊，浊阻清道。先起鼻塞，经治而愈。于是湿酿成饮，饮阻肺胃。呛咳多
痰，停饮在胃，中州痞阻，壅极而决，上吐下泻者屡。然虽经吐泻，而饮邪之根蒂未除。脾肺胃二脏一腑
之气，已是暗损，遂致痰饮化水，渗入肌肤，火必炎上，水必就下，所以先从足肿，渐及胫股，玉茎阴囊一
皆肿胀，今则腹满脘硬，食入发喘，脉象沉弦，此痰饮而变成水气之症也。花甲之年，舌光无苔，病实正
虚，恐水气逆射于肺，而致喘势暴盛。拟降肺疏胃，运脾利湿，兼进牡蛎泽泻散使之入下。
甜葶苈（七分） 大腹皮（二钱） 五加皮（二钱） 生薏仁（四钱） 泽泻（一钱五分） 川朴（一钱）
连皮苓（四钱） 鸡内金（三钱） 车前子（二钱） 炒冬瓜皮（五钱） 牡蛎泽泻散（三钱）
附录牡蛎泽泻散方（并方解）
牡蛎 泽泻 蜀漆 葶苈 栝蒌根 商陆根（熬） 海藻（洗去咸各等分）
凡肿胀日，甚能得畅泻，病必转轻。然病久元虚，恐气不运药，虽进猛剂，徒然频利，水仍不下曾见频
利而水不下者，服昆山丸药，依然下水而愈。同一泻下，不如择善而行，非畏葸也。湿热壅遏，前人有
牡蛎泽泻散一方，专治水蓄于下，上焦之气，不能下化，故用商陆葶苈，从肺及肾，开其来源之壅，而
后牡蛎海藻之软坚，蜀漆泽泻之开泄，方能得力。用栝蒌根者，恐行水之气过驶，有伤上焦之阴，仍
使之从脾吸阴，还归于上。其方下注云、小溲大畅，即止后服。以商陆行水，有排山倒岳之势也。又、三
白散专治囊肿肤肿腹胀。如牡蛎泽泻散仍未得效，然后服神 丸。此方专下水气之重者。然恐但
利而不泻，宜以重药而轻服之，所谓缓攻是也。此二方皆生平每投辄效者。倘得肿势大退，清其渊
薮，不外五皮五苓之类。扶正可以祛邪，而祛邪即能保正，所以泻下之后，不在补药中求针线也。所
虑者，既泻既利，病仍不退，不虑其虚脱也。三白散用白牵牛，其用黑牵牛者，合茴香二味名禹功散，
亦属屡用屡验，但力量较三白神 两方不如远甚。管见所及，聊备呈阅。
邱景林 痰饮多年，痰多咳嗽，气从上升。迩来两足虚肿，纳减无味，小溲短少，寐中汗出，而往往遗尿
不禁。脉沉弦。重按少力，苔白质腻。脾肺肾三脏均虚，命阳不能化水外出，遂致水溢肌肤，蒸变无权，致
胃纳日以呆顿。开太阳，逐痰水，原属痰饮必效之方，惟久病多虚，姑以阳气为重。
元米炒党参（三钱） 菟丝子（三钱） 制半夏（一钱五分） 茯苓（三钱） 熟附片（三分）
煨益智（一钱） 补骨脂（三钱） 陈皮（一钱） 炒于术（一钱） 炒谷芽（二钱） 玫瑰花（二朵）
又 温助命阳，以生脾土，遗尿得定，而足仍虚肿，胃呆少纳，小溲短少。水溢肌肤，原系脾肾两虚，不能
化水外出。舌白转黄，口腻而苦，湿中生热，遂成湿热壅遏之局。恐变延入腹。拟金匮防己茯苓汤法。
炙绵 （一钱五分） 茯苓（四钱） 汉防己（三钱） 泽泻（二钱） 猪苓（二钱） 大腹皮（二钱）
制苍术（二钱） 宣木瓜（一钱五分） 通草（一钱） 生薏仁（一两） 炒冬瓜皮（一两二味煎汤代水）
三诊 腹胀症状大幅减轻，肚脐突出情况稍有好转，按压时感觉也逐渐变软。既然多次见到病情好转的迹象，应当仿照之前的方剂进行加减调整。
制厚朴（一钱） 木香（五分） 广藿香（一钱） 大腹皮（一钱五分） 陈皮（一钱） 猪苓（一钱五分） 泽泻（二钱） 桃仁、杏仁（各二钱） 神曲（三钱） 瞿麦（三钱） 白茯苓（三钱） 砂仁（七分，后下） 茵陈（一钱） 小温中丸（开水送服）
左脉象弦大，久按则濡滑，腹部胀满不适，但并没有明显的肿大情形，足背伴有浮肿。这是气虚导致脾运化无力，湿寒内阻所致。中焦痞满之症，治疗并非易事。
党参（二钱，用木香四分煎汁兑入） 白芍（二钱，炙甘草三分拌炒） 带皮茯苓（五钱） 白术（一钱，用枳壳六分煎汁兑入） 肉桂（四分，去粗皮后下） 泽泻（二钱） 猪苓（二钱） 制香附（三钱） 吴茱萸（五分） 姜衣（三分） 鸡内金（一具，炙后研细末调服）
二诊 服药之后，脉象和症状尚属平和，不便立即大幅更改方药。
白术（二钱） 砂仁（四粒） 制香附（三钱） 生薏苡仁、熟薏苡仁（各二钱） 木香（三分） 土炒陈皮（一钱） 炒白芍（一钱五分） 茯苓皮（五钱） 肉桂（四分） 瞿麦（二钱） 生姜衣（三分） 陈米蛀屑（三钱，绢包）
三诊 胀满感较前松弛，想要打嗝却打不出来。右关脉仍带弦搏之象。肝木旺盛而脾土衰弱，肝旺则气机冲逆，脾虚则运化无权。再次疏理肝气，柔养肝体。
制香附（二钱，与小青皮一钱同炒） 焦高粱米（三钱，绢包） 炒当归身（二钱） 炙乌梅肉（一枚） 炒木瓜皮（一钱五分） 酒炒白芍（二钱） 川楝子（切，一钱五分） 干橘叶（一钱五分） 陈米蛀屑（三钱，绢包）
四诊 脉象柔软，左关部久按才见弦象。这两日内胸腹舒适，并不胀满，自发病以来从未有过的境界。药物既已见效，便沿袭有效方剂斟酌使用。
黄连（三分，与吴茱萸五分同炒） 酒炒白芍（一钱五分） 川楝子（一钱五分） 乌梅（一个） 醋炒青皮（一钱五分） 焦高粱米（三钱，绢包） 炒木瓜皮（一钱五分） 酒炒当归身（二钱） 醋炒香附（二钱） 陈米蛀屑（三钱，绢包）
某患者 大腹胀满，筋脉暴露，肚脐突出，小便涩少。脾虚且湿热壅滞。鼓胀重症，难以救治。
白术炭 陈皮 制香附 木香 猪苓 茯苓皮 砂仁 泽泻 舟车丸
（原注）服药后排溏便三次，自觉腹部宽舒。
薛御之 体质湿气重多痰，感冒风邪，侵袭肺卫，以致由咳嗽引动体内潜伏的水饮，咳嗽日益加剧，右侧胁肋疼痛。浊痰弥漫，神机不运，神识模糊。多次化解浊痰后，神情转为清醒。至于痰湿的变态表现，如阻滞营卫而导致恶寒发热，郁遏中气，舌苔起灰霉状困乏脾阳，脾土不能运化鼓舞，导致大便燥结，清中之浊不降，浊中之清不升，从而转干燥，传变种种不一。肌表的温风化为疹子外达，但湿痰终究仍内困，所以病退之后，疲惫依旧。渐至气阻湿坠，少腹的胀满，顿时从上僭越，不仅入腹过脐而且上撑胸脘，进食后攻撑，大便涩少。右寸脉细涩，关部弦滑，尺部沉微，左部俱见小弱。这都是因为脾为湿所困，阳气不能营运，土滞而木不扶苏，遂令湿流于下者，随左升之气而逆从上行，肠胃流行之机，全被阻塞，这就是产生胀满撑急的原因。下病过中，治疗非易。拟条达肝木，泄除腑浊而运脾阳。希望得小便渐畅，湿气流散气机宣通，才是好消息。
吴茱萸（三分，蜜水浸后取出焙干，盐水炒） 陈皮（一钱，蜜水浸后取出焙干，陈壁土炒） 带皮茯苓（五钱） 盐水炒香附（一钱五分） 炒枳壳（一钱） 猪苓（二钱） 川楝子（切，一钱五分） 霞天曲（二钱，炒） 鸡内金（一枚，不要落水的，研调服） 泽泻（一钱五分） 小温中丸（三钱，开水送服）
孙（右） 素有痰喘，月经一个月未来，腿足肿胀，渐至腹部也坚硬，喘满更加严重。肺气不能下输，水湿因而泛溢，深入重地，有喘脱的危险。勉强遵循先胀于下而复满于上的原则，也是必须先治其上而后治其下的意思来立方。
桂枝 炙麻黄 光杏仁 大腹皮 制半夏 陈皮
煨石膏 带皮茯苓 炒苏子 炒枳壳
二诊 开通经气以通膀胱，症状依然不减。鼓胀重症，势头正盛，有喘厥的危险。
葶苈子 汉防己 磨槟榔 磨沉香 香附 光杏仁 防风 茯苓皮 陈皮 炒苏子 大腹皮 莱菔子 炙鸡内金
改方加黑锡丹一钱先服。
童（左） 遍体浮肿，身体上半部分更为严重。脾虚水湿泛溢，风与湿相搏。鼓胀重症，不可忽视。
蜜炙麻黄（五分） 防风（一钱） 大腹皮（二钱） 泽泻（一钱五分） 茯苓皮（五钱） 猪苓（二钱） 川芎（一钱） 陈皮（一钱） 羌活（一钱） 瞿麦（三钱） 姜衣（三分） 炒冬瓜皮（一两）
生薏苡仁（七钱，两味煎汤代水）
左 肿退甚速，但因杂食甜腻助湿，甘寒损脾，导致肿势复起。急需谨慎饮食，以免招致自取其辱的讥讽。
大腹皮 新会皮 猪苓 葶苈子 茯苓皮 杏仁泥 黑山栀 白通草 香豆豉 泽泻 生熟薏苡仁 枇杷叶
龚（左） 面色目带黄，腹部胀大，渐至大便色赤，半年多来，胀势并未因通便而消退。脉数带滑。良以湿热充斥三焦。鼓胀重症，不能许诺治愈。
生熟薏苡仁 藿香 陈皮 猪苓 泽泻 赤茯苓 厚朴 茵陈 神曲 杏仁 大腹皮 通草
陈（左） 瘕块久而散漫，大腹胀大如鼓，二便不利。脉滞苔白。此脾虚而湿热壅滞三焦。鼓腹重症，勉强处方图侥幸。
厚朴 茵陈 带皮茯苓 带皮槟榔 杏仁 通草 木香 砂仁 炙蟾皮 陈皮 白术 甘遂（二分，煨透）
黑丑（四分） 炙鸡内金（一具，以上三味研末先调服）
（原注）此方服后泻下，胀退十分之三。呕吐，乃甘遂未煨透的缘故。
二诊 泻下甚畅，大腹亦觉宽畅，但小便不畅。虽见转机，仍不足依靠。
前方去掉甘遂、黑丑，加神曲姜汁，单用炙鸡内金一钱五分研末调服。
陆（左） 大腹胀大，按之坚硬，阴囊肿胀。脉形濡滞。此脾虚木旺，鼓胀重症，恐怕难以凭人力与造化争功。
勉强效仿经旨“工在疾泻”的意思。谋事在人，成事在天。
炙蟾皮（五钱） 大腹皮（二钱） 厚朴（一钱） 缩砂仁（七分） 带皮茯苓（三钱） 白术（一钱五分）
陈皮（一钱） 炙鸡内金（一具） 红芽大戟（三分） 甘遂（三分） 千金子（三分，四味研细开水先服）
二诊 肿胀稍松，然而仍膨大如鼓，小便不利，阴囊肿胀。鼓胀重症，不可以临时取效，就认为是足以依靠的。
大腹皮 广陈皮 厚朴 泽泻 炙蟾皮 猪苓 舟车丸（三钱）
马（右） 中空无物者叫鼓，实中有物者叫蛊。少腹有形，盘踞日久，现在这个形状渐大，腹胀如箕，按之坚硬。
这是气血阻滞不行，导致脾土不能运化。蛊胀重症，不能许诺治愈。
酒炒当归须 延胡索 台乌药 南楂炭 沉香曲 蓬莪术 制香附 陈皮
二诊 胀势稍松。姑且守前意以观察动静。
川楝子 制香附 台乌药 延胡索 两头尖 当归须 炒蓬术 川桂木 南楂炭 葱白
三诊 胀势较松。然而蛊胀重症，仍难治疗。
两头尖（三钱） 台乌药（一钱五分） 鹤虱（二钱） 单桃仁（去皮打，三钱） 制香附（二钱） 使君子肉（二钱） 楂炭（三钱） 雷丸（一钱五分） 槟榔（一钱） 婆万病丸（三钱，先服）
范（左） 身热大势虽退，脉仍未静，溏泄之后，转为便秘腹笥胀满，按之不柔。这是邪少湿多，邪去湿留，湿困脾土，鼓舞运化不及，则大肠传化失司，所谓湿闭是也。宜调气泄浊。
厚朴 陈皮 大腹皮 郁金 小温中丸 桔梗 枳壳 光杏仁 砂仁
江（左） 痰饮咳逆多年，气血逆乱，痰每带红。日来兼感风邪，风与湿合，溢入肌肤，面浮肤肿，喘咳不平，腹胀脘痞，小便不利。脉数浮滑，舌苔白腻。有喘胀的危险。
前胡（一钱五分） 荆芥（一钱） 光杏仁（三钱） 橘红（一钱） 茯苓皮（四钱） 葶苈（五分）
防风（一钱） 制半夏（一钱五分） 白前（一钱五分） 大腹皮（二钱） 生姜衣（四分） 厚朴（一钱）
二诊 痰喘稍平，浮肿亦减，然而中脘仍然作胀。肺胃之气，升多降少，导致风与湿横溢肌肤。效方再望应手。
大腹皮（二钱） 厚朴（一钱） 杏仁（三钱） 生薏苡仁（四钱） 煨石膏（三钱） 制半夏（一钱五分）
炙麻黄（四分） 陈皮（一钱） 枳壳（一钱） 茯苓皮（三钱，炒） 生姜（二片） 冬瓜皮（三钱，炒）
三诊 开上疏中，适交节令，痰气郁阻不开，痰出不爽，腹胀面浮足肿，小便不利。脉形细沉。夫痰饮而致随风四溢，都缘脾肾阳虚，不能旋运，所以泛滥横行。有喘胀的危险。拟千缗汤出入以开痰，真武汤以温肾而行水。
制半夏（一钱五分） 橘红（一钱） 大腹皮（二钱） 生姜衣（四分） 真武丸（三钱） 皂荚子（蜜炙，二粒） 枳实（一钱） 带皮茯苓（三钱） 炒白术（一钱五分）
改方去掉皂荚子加葶苈子。
四诊 开肺之气，温肾之阳，肺合皮毛，遍身自汗，水气因而外越，面浮肤肿大退，胸闷较舒，胀满大退，痰亦爽利。然大便不行，足肿未消。还是水气内阻，不得不暂为攻逐。
大腹皮（二钱） 姜衣（四分） 白茯苓（三钱） 冬瓜皮（四钱，炒） 泽泻（一钱五分） 陈皮（一钱）
白术（二钱） 生熟薏苡仁（各二钱） 制半夏（一钱五分） 禹功散（先调服一钱）
五诊 痰化为水，泛溢肌肤，先得畅汗，水湿之气，从汗外溢，继以缓攻，水湿之气，从而下达，故得腹胀面浮俱减。拟运土分化。再望转机。
葶苈子（五分） 橘红（一钱） 冬术（二钱） 大腹皮（二钱） 炒神曲（二钱） 光杏仁（三钱）
茯苓皮（三钱） 猪苓（二钱） 泽泻（一钱五分） 生熟薏苡仁（各二钱） 枳壳（七分） 生姜衣（四分）
施芷园 嗜饮湿热素盛，湿酿为浊，浊阻清道。先起鼻塞，经治而愈。于是湿酿成饮，饮阻肺胃。呛咳多痰，停饮在胃，中州痞阻，壅极而决，上吐下泻者屡。然虽经吐泻，而饮邪之根蒂未除。脾肺胃二脏一腑之气，已是暗损，遂致痰饮化水，渗入肌肤，火必炎上，水必就下，所以先从足肿，渐及胫股，玉茎阴囊一皆肿胀，今则腹满脘硬，食入发喘，脉象沉弦，这是痰饮而变成水气的病症。花甲之年，舌光无苔，病实正虚，恐水气逆射于肺，而致喘势暴盛。拟降肺疏胃，运脾利湿，兼进牡蛎泽泻散使之入下。
甜葶苈子（七分） 大腹皮（二钱） 五加皮（二钱） 生薏苡仁（四钱） 泽泻（一钱五分） 厚朴（一钱）
带皮茯苓（四钱） 鸡内金（三钱） 车前子（二钱） 炒冬瓜皮（五钱） 牡蛎泽泻散（三钱）
附录牡蛎泽泻散方（并方解）
牡蛎 泽泻 蜀漆 葶苈子 栝蒌根 商陆根（熬） 海藻（洗去咸，各等分）
凡肿胀日，甚能得畅泻，病必转轻。然病久元虚，恐气不运药，虽进猛剂，徒然频利，水仍不下曾见频利而水不下者，服昆山丸药，依然下水而愈。同一泻下，不如择善而行，非畏葸也。湿热壅遏，前人有牡蛎泽泻散一方，专治水蓄于下，上焦之气，不能下化，故用商陆葶苈，从肺及肾，开其来源之壅，而后牡蛎海藻之软坚，蜀漆泽泻之开泄，方能得力。用栝蒌根者，恐行水之气过驶，有伤上焦之阴，仍使之从脾吸阴，还归于上。其方下注云、小溲大畅，即止后服。以商陆行水，有排山倒岳之势也。又、三白散专治囊肿肤肿腹胀。如牡蛎泽泻散仍未得效，然后服神 丸。此方专下水气之重者。然恐但利而不泻，宜以重药而轻服之，所谓缓攻是也。此二方皆生平每投辄效者。倘得肿势大退，清其渊薮，不外五皮五苓之类。扶正可以祛邪，而祛邪即能保正，所以泻下之后，不在补药中求针线也。所虑者，既泻既利，病仍不退，不虑其虚脱也。三白散用白牵牛，其用黑牵牛者，合茴香二味名禹功散，亦属屡用屡验，但力量较三白神 两方不如远甚。管见所及，聊备呈阅。
邱景林 痰饮多年，痰多咳嗽，气从上升。迩来两足虚肿，纳减无味，小便短少，寐中汗出，而往往遗尿不禁。脉沉弦。重按少力，苔白质腻。脾肺肾三脏均虚，命门之火不能化水外出，遂致水溢肌肤，蒸变无权，致胃纳日以呆顿。开太阳，逐痰水，原属痰饮必效之方，惟久病多虚，姑以阳气为重。
元米炒党参（三钱） 菟丝子（三钱） 制半夏（一钱五分） 茯苓（三钱） 熟附片（三分）
煨益智仁（一钱） 补骨脂（三钱） 陈皮（一钱） 炒白术（一钱） 炒谷芽（二钱） 玫瑰花（二朵）
又 温助命门之火，以生脾土，遗尿得定，而足仍虚肿，胃呆少纳，小便短少。水溢肌肤，原系脾肾两虚，不能化水外出。舌白转黄，口腻而苦，湿中生热，遂成湿热壅遏之局。恐变延入腹。拟金匮防己茯苓汤法。
炙绵黄芪（一钱五分） 茯苓（四钱） 汉防己（三钱） 泽泻（二钱） 猪苓（二钱） 大腹皮（二钱）
制苍术（二钱） 宣木瓜（一钱五分） 通草（一钱） 生薏苡仁（一两） 炒冬瓜皮（一两，两味煎汤代水）
Visit 3: The distension has significantly subsided, the protrusion of the umbilicus has slightly receded, and palpation feels gradually softer. Since there have been repeated signs of improvement, one should follow the previous prescription with modifications.
Prepared Magnolia Officinalis Bark (Zhi Houpo) (1 qian), Aromatic Tuber Vine (Muxiang) (5 fen), Guang Huo Xiang (1 qian), Areca Peel (Dafupi) (1.5 qian), Tangerine Peel (Shang Guangpi) (1 qian), Polyporus (Muzhuling) (1.5 qian), Alisma Root (Zexie) (2 qian), Peach Kernel and Apricot Kernel (Xingtaoren) (2 qian each), Fermented Wheat Qu (Fanzhi Qu) (3 qian), Dianthus Flower (Qumai) (3 qian), Poria (Baifuling) (3 qian), Amomum Fruit (Sharen) (7 fen, added later), Artemisia Capillaris (Xiyinchen) (1 qian), Xiao Wen Zhong Wan (Small Warm Middle Pill) (taken with boiled water).
Left pulse is wiry and large; upon prolonged pressing, it becomes soggy and slippery. There is abdominal fullness and discomfort, but no obvious swelling. The dorsum of the feet shows edema. This indicates Qi deficiency leading to Spleen's failure in transportation and transformation, with internal obstruction by Damp-Cold. Treating middle jiao fullness is not easy.
Codonopsis Radix (Xiluodangshen) (2 qian, decocted with 4 fen Muxiang juice and combined), White Peony Root (Hang Baishao) (2 qian, stir-fried with 3 fen Zhi Gancao), Poria with Skin (Lianpi Fuling) (5 qian), Atractylodes Macrocephala Rhizome (Yeyushu) (1 qian, decocted with 6 fen Zhike juice and combined), Cinnamon Twig (Shangyaogui) (4 fen, bark removed, added later), Alisma Root (Zexie) (2 qian), Polyporus (Zhuling) (2 qian), Prepared Cyperus Rhizome (Zhixiangfu) (3 qian), Evodia Fruit (Dan Wuyu) (5 fen), Ginger Skin (Jiangyi) (3 fen), Chicken Gizzard Lining (Jineijin) (1 piece, roasted, ground into fine powder for mixing).
Visit 2: After taking the medicine, the pulse and symptoms are relatively harmonious; it is inappropriate to make sudden changes.
Atractylodes Macrocephala Rhizome (Yeyushu) (2 qian), Amomum Fruit (Sharen) (4 grains), Prepared Cyperus Rhizome (Zhixiangfu) (3 qian), Raw and Cooked Coix Seed (Sheng Shu Yiren) (2 qian each), Aromatic Tuber Vine (Muxiang) (3 fen), Earth-fried Tangerine Peel (Tuchao Guangpi) (1 qian), Stir-fried White Peony Root (Chao Baishao) (1.5 qian), Poria Skin (Fulingpi) (5 qian), Cinnamon Twig (Shangyaogui) (4 fen), Dianthus Flower (Qumai) (2 qian), Ginger Skin (Jiangyi) (3 fen), Rice Weevil Debris (Chenmizhuxie) (3 qian, wrapped in silk).
Visit 3: Distension and fullness are looser than before, with an inability to belch freely. The Right Guan pulse still carries a wiry and pulsating quality. Liver Wood is excessive while Spleen Earth is deficient; excess Wood causes Qi conflict, while deficient Earth lacks the power of transformation. Again, soothe the Liver's function and nourish the Liver's substance.
Prepared Cyperus Rhizome (Zhixiangfu) (2 qian, stir-fried together with 1 qian Xiao Qingpi), Charred Sorghum Grain (Jiaoshumi) (3 qian, wrapped in silk), Stir-fried Angelica Sinensis Root (Chao Baiguishen) (2 qian), Roasted Dark Plum Flesh (Zhi Wumei Rou) (1 piece), Stir-fried Papaya Peel (Chao Mugua Pi) (1.5 qian), Wine-stir-fried White Peony Root (Jiuchao Hang Baishao) (2 qian), Toosendan Fruit (Jinlingzi) (sliced, 1.5 qian), Dried Tangerine Leaf (Gan Jiuye) (1.5 qian), Rice Weevil Debris (Chenmizhuxie) (3 qian, wrapped in silk).
Visit 4: The pulse is soft; the Left Guan position only shows a wiry quality after prolonged pressing. For the past two days, the chest and abdomen have been comfortable without distension, a state never experienced since the onset of illness. Since the medication is effective, continue with the effective formula with adjustments.
Coptis Rhizome (Chuanlian) (3 fen, stir-fried with 5 fen Evodia Fruit), Wine-stir-fried White Peony Root (Jiuchao Baishao) (1.5 qian), Toosendan Fruit (Jinlingzi) (1.5 qian), Dark Plum (Wumei) (1 fruit), Vinegar-stir-fried Green Tangerine Peel (Cu Chao Qingpi) (1.5 qian), Charred Sorghum Grain (Jiaoshumi) (3 qian, wrapped in silk), Stir-fried Papaya Peel (Chao Mugua Pi) (1.5 qian), Wine-stir-fried Angelica Sinensis Root (Jiuchao Guishen) (2 qian), Vinegar-stir-fried Cyperus Rhizome (Cu Chao Xiangfu) (2 qian), Rice Weevil Debris (Chenmizhuxie) (3 qian, wrapped in silk).
Patient [Name Omitted]: Abdominal distension and fullness, exposed veins, protruding umbilicus, scanty and difficult urination. Spleen deficiency with Damp-Heat stagnation. Drum distension is a severe condition, beyond reach.
Charred Atractylodes Macrocephala Rhizome (Yushu Tan), Tangerine Peel (Guangpi), Prepared Cyperus Rhizome (Zhixiangfu), Aromatic Tuber Vine (Muxiang), Polyporus (Zhuling), Poria Skin (Fulingpi), Amomum Fruit (Sharen), Alisma Root (Jian Zexie), Zhou Che Wan (Boat Journey Pill).
(Original Note): After taking the medicine, loose stools occurred three times, and the abdomen felt comfortably relaxed.
Xue Yuzhi: Constitution with excessive Dampness and much Phlegm. Contracted Wind pathogen, attacking Lung and Wei levels, causing latent fluid retention to be triggered by coughing, worsening daily, with pain in the right hypochondrium. Turbid Phlegm pervades, Shen mechanism fails to operate, consciousness is blurred. After repeatedly resolving turbid Phlegm, mental clarity returns. Regarding the transformations of Phlegm-Dampness, such as obstructing Ying and Wei causing chills and fever, stifling Middle Qi, coating resembling grey mold weakening Spleen Yang, Spleen Earth failing to transport and inspire, leading to dry stool, clear turbidity not descending, turbid clarity not ascending, turning dry, with various transmissions. Surface warmth transforms into rashes reaching outward, but Damp-Phlegm remains internally trapped. Thus, after the disease recedes, fatigue persists. Gradually, Qi obstruction and Dampness sinking cause lower abdominal fullness to suddenly rise from below, not only entering the abdomen past the umbilicus but also supporting upwards to the chest and epigastrium. Food intake causes pushing sensations, stool is scanty and difficult. Right Cun pulse is fine and choppy, Guan is wiry and slippery, Chi is deep and faint; Left positions all show small and weak. All result from Spleen being confined by Dampness, Yang Qi unable to circulate, Earth stagnating so Wood does not flourish. Consequently, Dampness flowing downward follows the ascending Qi on the left to reverse upwards. The circulating mechanism of intestines and stomach is completely blocked, which is the origin of distension and pushing. Lower pathology affecting the middle makes treatment difficult. Plan to unblock Liver Wood, drain Fu turbidity, and move Spleen Yang. Hope for gradual smooth urination, dispersion of Dampness, and free flow of Qi, which would be good news.
Evodia Fruit (Dan Wuyu) (3 fen, soaked in honey water, taken out, dried, stir-fried with salt water), Tangerine Peel (Chenpi) (1 qian, soaked in honey water, taken out, dried, stir-fried with old wall earth), Poria with Skin (Lianpi Ling) (5 qian), Salt-water stir-fried Cyperus Rhizome (Yanshui Chao Xiangfu) (1.5 qian), Stir-fried Bitter Orange (Chao Zhike) (1 qian), Polyporus (Muzhuling) (2 qian), Toosendan Fruit (Chuanlianzi) (sliced, 1.5 qian), Xiatian Qu (2 qian, stir-fried), Chicken Gizzard Lining (Jineijin) (1 piece, avoid water contact, grind for mixing), Alisma Root (Zexie) (1.5 qian), Xiao Wen Zhong Wan (3 qian, taken with boiled water).
Sun (Right): History of Phlegm-Wheezing. Menstruation delayed for a month. Leg and foot swelling, gradually extending to hard abdomen. Wheezing and fullness worsen. Lung Qi cannot descend, Water-Dampness overflows, penetrating deep layers, risking wheezing collapse. Tentatively following the principle of treating upper first when swelling starts lower and fills upper.
Cinnamon Twig (Guizhi), Roasted Ephedra Herb (Zhi Mahuang), Light Apricot Kernel (Guang Xingren), Areca Peel (Dafupi), Prepared Pinellia Tuber (Zhi Banxia), Tangerine Peel (Guangpi).
Calcined Gypsum (Wei Shigao), Poria with Skin (Lianpi Ling), Stir-fried Perilla Seed (Chao Suzi), Stir-fried Bitter Orange (Chao Zhike).
Visit 2: Opening meridian Qi to unblock Bladder, yet symptoms remain unchanged. Drum distension is severe, momentum is strong, risking wheezing and syncope.
Descurainia Seed (Tinglizi), Han Fangji (Han Fangji), Ground Betel Nut (Mo Binglang), Ground Agarwood (Mo Chenxiang), Cyperus Rhizome (Xiangfu), Light Apricot Kernel (Guang Xingren), Saposhnikovia Root (Fangfeng), Poria Skin (Fulingpi), Tangerine Peel (Guangpi), Stir-fried Perilla Seed (Chao Suzi), Areca Peel (Dafupi), Radish Seed (Laifuzi), Roasted Chicken Gizzard Lining (Zhi Neijin).
Modified prescription add Hei Xi Dan (Black Tin Pill) 1 qian, take first.
Child (Left): Generalized edema, worse on the upper half of the body. Spleen deficiency with Water-Dampness overflow, Wind combing with Dampness. Drum distension is severe, cannot be ignored.
Honey-roasted Ephedra Herb (Mi Zhi Mahuang) (5 fen), Saposhnikovia Root (Fangfeng) (1 qian), Areca Peel (Dafupi) (2 qian), Alisma Root (Zexie) (1.5 qian), Poria Skin (Fulingpi) (5 qian), Polyporus (Zhuling) (2 qian), Ligusticum Chuanxiong Rhizome (Chuanxiong) (1 qian), Tangerine Peel (Chenpi) (1 qian), Notopterygium Rhizome (Qianghuo) (1 qian), Dianthus Flower (Qumai) (3 qian), Ginger Skin (Jiangyi) (3 fen), Stir-fried Winter Melon Peel (Chao Dongguapi) (1 liang).
Raw Coix Seed (Sheng Yiren) (7 qian, decocted with two ingredients as water substitute).
Left: Edema receded rapidly, but miscellaneous diet of sweet and greasy foods aided Dampness, sweet-cold damaged Spleen, causing edema to recur. Urgent caution in diet is needed to avoid self-inflicted ridicule.
Areca Peel (Dafupi), Xinhui Peel (Xinhui Pi), Polyporus (Muzhuling), Descurainia Seed (Tinglizi), Poria Skin (Fulingpi), Apricot Kernel Paste (Xingren Ni), Black Gardenia Fruit (Hei Shanzhi), White Tongcao (Bai Tongcao), Fermented Soybean (Xiang Douchi), Alisma Root (Jian Zexie), Raw and Cooked Coix Seeds (Sheng Shu Yiren), Loquat Leaf (Pipaye).
Gong (Left): Complexion and eyes yellowish, abdomen distended and large, gradually stool became red. Over half a year, distension did not subside with bowel movements. Pulse rapid and slippery. Due to Damp-Heat filling San Jiao. Drum distension is severe, cure cannot be promised.
Raw and Cooked Coix Seeds (Sheng Shu Yiren), Agastache (Huoxiang), Tangerine Peel (Shang Guangpi), Polyporus (Muzhuling), Alisma Root (Jian Zexie), Red Poria (Chi Fuling), Magnolia Officinalis Bark (Shang Chunpu), Artemisia Capillaris (Yinchen), Fermented Wheat Qu (Fanzhi Qu), Apricot Kernel (Xingren), Areca Peel (Dafupi), Tongcao (Fangtongcao).
Chen (Left): Mass lingering and spreading, abdomen distended like a drum, difficulty in urination and defecation. Pulse stagnant, coating white. Spleen deficiency with Damp-Heat stagnating San Jiao. Drum abdomen is severe, tentatively prescribing for luck.
Magnolia Officinalis Bark (Chunpu), Artemisia Capillaris (Yinchen), Poria with Skin (Lianpi Ling), Areca Nut with Skin (Lianpi Binglang), Apricot Kernel (Xingren), Tongcao (Tongcao), Aromatic Tuber Vine (Muxiang), Amomum Fruit (Sharen), Roasted Toad Skin (Zhi Chanpi), Tangerine Peel (Shang Guangpi), Atractylodes Macrocephala Rhizome (Yushu), Kan Su (Gansui) (2 fen, thoroughly roasted), Black Morning Glory Seed (Hei Chou) (4 fen), Roasted Chicken Gizzard Lining (Zhi Neijin) (1 piece, above three ingredients ground into powder for mixing).
(Original Note): After taking this prescription, diarrhea occurred, distension reduced by 30%. Vomiting was due to Gansui not being roasted thoroughly.
Visit 2: Diarrhea is very smooth, large abdomen feels relaxed, but urination is not smooth. Although signs of improvement appear, it is not yet reliable.
Remove Gansui and Hei Chou from previous prescription, add Fanzhi Qu with Ginger Juice, use only Zhi Neijin 1.5 qian ground into powder for mixing.
Lu (Left): Large abdomen distended and hard, scrotal swelling. Pulse soggy and stagnant. Spleen deficiency with Liver Wood excess. Drum distension is severe, likely difficult to compete with nature through human effort.
Tentatively imitating the classic principle "skill lies in rapid purging". Man proposes, Heaven disposes.
Roasted Toad Skin (Zhi Chanpi) (5 qian), Areca Peel (Dafupi) (2 qian), Magnolia Officinalis Bark (Chunpu) (1 qian), Sand Amomum Fruit (Suosharen) (7 fen), Poria with Skin (Lianpi Ling) (3 qian), Atractylodes Macrocephala Rhizome (Yeyushu) (1.5 qian).
Tangerine Peel (Guangpi) (1 qian), Roasted Chicken Gizzard Lining (Zhi Neijin) (1 piece), Red-root Euphorbia (Hongya Daji) (3 fen), Kan Su (Gansui) (3 fen), Croton Seed (Qianjinzi) (3 fen, four ingredients ground fine, taken first with boiled water).
Visit 2: Swelling and distension slightly loosened, yet still bulging like a drum, urination difficult, scrotal swelling. Drum distension is severe, temporary effect cannot be relied upon.
Areca Peel (Dafupi), Broad-leaved Mandarin Peel (Guang Chenpi), Magnolia Officinalis Bark (Chunpu), Alisma Root (Zexie), Roasted Toad Skin (Zhi Chanpi), Polyporus (Zhuling), Zhou Che Wan (3 qian).
Ma (Right): Hollow without substance is called Gu (Drum); solid with substance is called Gu (Insect/Parasite). Lower abdomen has form, existing for long time, now shape enlarges, abdomen distended like a basket, hard to touch.
This is Qi and Blood stagnation preventing movement, causing Spleen Earth unable to rotate and transform. Insect-distension is severe, cure cannot be promised.
Wine-stir-fried Angelica Sinensis Rootlets (Jiuchao Danggui Xu), Corydalis Rhizome (Yanhusuo), Taio Rhizome (Tai Wuyao), Charred Southern Hawthorn Fruit (Nanzha Tan), Agarwood Qu (Chenxiang Qu), Curcuma Zedoaria Rhizome (Peng Ezhu), Prepared Cyperus Rhizome (Zhixiangfu), Tangerine Peel (Shang Guangpi).
Visit 2: Distension slightly loosened. Temporarily maintaining previous intent to observe dynamics.
Toosendan Fruit (Jinlingzi), Prepared Cyperus Rhizome (Zhixiangfu), Taio Rhizome (Tai Wuyao), Corydalis Rhizome (Yanhusuo), Acronychia Pedunculata (Liangtoujian), Angelica Sinensis Rootlets (Danggui Xu), Stir-fried Curcuma Zedoaria (Chao Pengzhu), Cinnamon Twig (Chuan Guimu), Charred Southern Hawthorn Fruit (Nanzha Tan), Scallion White (Congbai).
Visit 3: Distension relatively loosened. However, insect-distension is severe, still difficult to treat.
Acronychia Pedunculata (Liangtoujian) (3 qian), Taio Rhizome (Tai Wuyao) (1.5 qian), Nettle Parasite (Heshi) (2 qian), Single Peach Kernel (Dan Taoren) (peeled and pounded, 3 qian), Prepared Cyperus Rhizome (Zhixiangfu) (2 qian), Semen Juglandis (Shijunzi Rou) (2 qian), Charred Hawthorn (Zha Tan) (3 qian), Omphalia Lapponica (Leiwan) (1.5 qian), Areca Nut (Binglang) (1 qian), Po Wanbing Wan (3 qian, take first).
Fan (Left): Body heat largely subsided, but pulse remains unsettled. After loose stools, turned to constipation with abdominal fullness, not soft to touch. Pathogen is minor, Dampness is major; pathogen gone, Dampness remains. Dampness confines Spleen Earth, inspiring transformation insufficiently, thus Large Intestine transmission fails. This is called Dampness closure. Should regulate Qi and drain turbidity.
Magnolia Officinalis Bark (Chunpu), Tangerine Peel (Guangpi), Areca Peel (Dafupi), Curcuma Aromatica Rhizome (Yujin), Xiao Wen Zhong Wan, Platycodon Root (Jiegeng), Bitter Orange (Zhike), Light Apricot Kernel (Guang Xingren), Amomum Fruit (Sharen).
Jiang (Left): Chronic Phlegm-Fluid coughing and reversal, Qi and Blood chaotic, Phlegm often bloody. Recently contracted Wind pathogen, Wind combining with Dampness, overflowing into skin and muscles. Facial and cutaneous edema, uneven wheezing and coughing, abdominal distension and epigastric stuffiness, difficult urination. Pulse rapid, floating, slippery; tongue coating white and greasy. Risk of wheezing and distension.
Peucedanum Root (Qianhu) (1.5 qian), Schizonepeta Spike (Jingjie) (1 qian), Light Apricot Kernel (Guang Xingren) (3 qian), Exocarpium Citri Reticulatae (Juhong) (1 qian), Poria Skin (Fulingpi) (4 qian), Descurainia Seed (Tingli) (5 fen).
Saposhnikovia Root (Fangfeng) (1 qian), Prepared Pinellia Tuber (Zhi Banxia) (1.5 qian), Cynanchum Stauntonii Root (Baiqian) (1.5 qian), Areca Peel (Dafupi) (2 qian), Ginger Skin (Jiangyi) (4 fen), Magnolia Officinalis Bark (Chunpu) (1 qian).
Visit 2: Phlegm-wheezing slightly calmed, edema reduced, yet Zhongwan still distended. Lung and Stomach Qi ascend more than descend, causing Wind and Dampness to overflow skin. Hoping for effectiveness from the proven formula.
Areca Peel (Dafupi) (2 qian), Magnolia Officinalis Bark (Chunpu) (1 qian), Apricot Kernel (Xingren) (3 qian), Raw Coix Seed (Sheng Yiren) (4 qian), Calcined Gypsum (Wei Shigao) (3 qian), Prepared Pinellia Tuber (Zhi Banxia) (1.5 qian).
Roasted Ephedra Herb (Zhi Mahuang) (4 fen), Tangerine Peel (Chenpi) (1 qian), Bitter Orange (Zhike) (1 qian), Poria Skin (Fulingpi) (3 qian, stir-fried), Fresh Ginger (Shengjiang) (2 slices), Winter Melon Peel (Dongguapi) (3 qian, stir-fried).
Visit 3: Opening upper and soothing middle, coinciding with solar term change. Phlegm-Qi stagnation not opening, Phlegm not clearing smoothly, abdominal distension, facial and foot edema, difficult urination. Pulse fine and deep. Phlegm-Fluids spreading with wind are due to Spleen and Kidney Yang deficiency, unable to rotate, thus flooding and横行. Risk of wheezing and distension. Plan Qian Min Tang variations to open Phlegm, Zhen Wu Tang to warm Kidney and move Water.
Prepared Pinellia Tuber (Zhi Banxia) (1.5 qian), Exocarpium Citri Reticulatae (Juhong) (1 qian), Areca Peel (Dafupi) (2 qian), Ginger Skin (Jiangyi) (4 fen), Zhen Wu Wan (3 qian), Soap Bean Pod (Zaojiazi) (honey-roasted, 2 pods), Immature Bitter Orange (Zhishi) (1 qian), Poria with Skin (Lianpi Ling) (3 qian), Stir-fried Atractylodes Macrocephala Rhizome (Chao Yushu) (1.5 qian).
Modified prescription remove Zaojiazi, add Tingli.
Visit 4: Opening Lung Qi, warming Kidney Yang. Lung combines with skin and hair, generalized sweating, Water Qi thus escapes outward. Facial and cutaneous edema largely receded, chest tightness relieved, distension greatly reduced, Phlegm clears. Yet stool not passing, foot edema not eliminated. Still Water Qi internal obstruction, must temporarily purge.
Areca Peel (Dafupi) (2 qian), Ginger Skin (Jiangyi) (4 fen), White Poria (Baifuling) (3 qian), Winter Melon Peel (Dongguapi) (4 qian, stir-fried), Alisma Root (Zexie) (1.5 qian), Tangerine Peel (Shang Guangpi) (1 qian).
Atractylodes Macrocephala Rhizome (Yushu) (2 qian), Raw and Cooked Coix Seeds (Sheng Shu Yiren) (2 qian each), Prepared Pinellia Tuber (Zhi Banxia) (1.5 qian), Yu Gong San (take first mixed with 1 qian).
Visit 5: Phlegm transformed into Water, overflowing skin. First obtained profuse sweating, Water-Dampness Qi escaped via sweat. Then gentle purging, Water-Dampness Qi descended downwards. Thus abdominal distension and facial edema both reduced. Plan to move Earth and differentiate. Hope for further improvement.
Descurainia Seed (Tingli) (5 fen), Exocarpium Citri Reticulatae (Juhong) (1 qian), Winter Atractylodes (Dongzhu) (2 qian), Areca Peel (Dafupi) (2 qian), Stir-fried Fermented Wheat Qu (Chao Fanzhi Qu) (2 qian), Light Apricot Kernel (Guang Xingren) (3 qian).
Poria Skin (Fulingpi) (3 qian), Polyporus (Zhuling) (2 qian), Alisma Root (Zexie) (1.5 qian), Raw and Cooked Coix Seeds (Sheng Shu Yiren) (2 qian each), Bitter Orange (Zhike) (7 fen), Ginger Skin (Jiangyi) (4 fen).
Shi Zhiyuan: Habitual drinking, constitution prone to Damp-Heat. Dampness brews into Turbidity, Turbidity blocks clear pathways. Initially nasal congestion, cured by treatment. Then Dampness brewed into Fluid, Fluid obstructed Lung and Stomach. Choking cough with much Phlegm, Fluid retained in Stomach, Middle Jiao blocked, extreme congestion ruptured, frequent vomiting and diarrhea. Although vomited and purged, root of Fluid pathogen not removed. Qi of Spleen, Lung, Stomach organs and fu organ already secretly damaged. Thus Phlegm-Fluid transformed into Water, seeping into skin. Fire flares up, Water flows down. Hence swelling started from feet, gradually involving calves and thighs, penis and scrotum all swollen. Now abdominal fullness and epigastric hardness, food intake triggers wheezing. Pulse deep and wiry. This is Phlegm-Fluid transforming into Water Qi syndrome. At sixty years old, tongue bare without coating, disease excess with Zheng deficiency. Fear Water Qi reversing to shoot into Lung, causing violent wheezing. Plan to descend Lung and soothe Stomach, move Spleen and promote Dampness, concurrently administer Mu Li Ze Xie San to enter lower.
Sweet Descurainia Seed (Tian Tingli) (7 fen), Areca Peel (Dafupi) (2 qian), Five-finger Acanthopanax Root (Wujia Pi) (2 qian), Raw Coix Seed (Sheng Yiren) (4 qian), Alisma Root (Zexie) (1.5 qian), Magnolia Officinalis Bark (Chunpu) (1 qian).
Poria with Skin (Lianpi Ling) (4 qian), Chicken Gizzard Lining (Jineijin) (3 qian), Plantago Seed (Cheqianzi) (2 qian), Stir-fried Winter Melon Peel (Chao Dongguapi) (5 qian), Mu Li Ze Xie San (3 qian).
Appendix: Mu Li Ze Xie San Formula (with explanation)
Oyster Shell (Muli), Alisma Root (Zexie), Paris Polyphylla Smilax Root (Shuqi), Descurainia Seed (Tingli), Trichosanthes Root (Gualougen), Euphorbia Lathyris Root (Shanglugen - roasted), Seaweed (Haizao - washed to remove salt, equal parts).
For swelling days, if profuse purgation can be achieved, disease will surely lighten. However, long-standing disease implies Yuan deficiency, fear Qi cannot move medicine. Even with strong agents, merely frequent urination, Water still not down. Seen cases of frequent urination without Water down, taking Kunshan Wan pills, still discharged Water and healed. Same purgation, better to choose good method, not cowardice. Damp-Heat congestion, predecessors had Mu Li Ze Xie San, specifically for Water accumulating below, Upper Jiao Qi unable to descend and transform. Thus using Shanglu and Tingli, from Lung to Kidney, opening source congestion. Then Muli and Haizhao softening hardness, Shuqi and Zexie opening drainage, can be effective. Using Gualougen, fear moving Water Qi too fast, damaging Upper Jiao Yin, still making it absorb Yin from Spleen, returning to upper. Formula note says: Urine very smooth, stop subsequent doses. Because Shanglu moving Water has overwhelming force. Also, San Bai San specifically treats scrotal cysts, skin edema, abdominal distension. If Mu Li Ze Xie San still ineffective, then take Shen Wan. This formula specifically drains heavy Water Qi. But fear only draining not purging, should use heavy medicine lightly taken, called gentle attack. These two formulas are effective every time used in life. If swelling largely recedes, clearing the abyss, nothing outside Wupi and Wuling categories. Supporting Zheng can dispel Xie, dispelling Xie protects Zheng. Thus after purging, do not seek needlework in tonifying medicines. What is worried is, after purging and draining, disease still not retreating, not worrying about collapse. San Bai San uses Bai Qianniu; using Hei Qianniu combined with Huixiang, two ingredients named Yu Gong San, also frequently used and verified, but strength far inferior to San Bai and Shen formulas. My humble opinion, prepared for review.
Qiu Jinglin: Chronic Phlegm-Fluid, much Phlegm coughing, Qi rising. Recently bilateral feet puffy swelling, decreased appetite without taste, short urine, night sweats, often involuntary urination during sleep. Pulse deep and wiry. Heavy pressing lacks force, coating white, texture greasy. Spleen, Lung, Kidney three organs all deficient, Mingmen Fire unable to transform Water outward. Thus Water overflows skin, steaming transformation powerless, causing Stomach intake daily dull. Opening Taiyang, expelling Phlegm-Water, originally effective formula for Phlegm-Fluid, only long disease mostly deficiency, tentatively focusing on Yang Qi.
Yuanmi stir-fried Codonopsis Radix (Yuanni Chao Dangshen) (3 qian), Dodder Seed (Tusizi) (3 qian), Prepared Pinellia Tuber (Zhi Banxia) (1.5 qian), Poria (Fuling) (3 qian), Prepared Aconite Carapace (Shu Fupian) (3 fen).
Roasted Alpinia Oxyphylla Fruit (Wei Yizhi) (1 qian), Psoralea Fruit (Buguzhi) (3 qian), Tangerine Peel (Chenpi) (1 qian), Stir-fried Atractylodes Macrocephala Rhizome (Chao Yushu) (1 qian), Stir-fried Millet Sprout (Chao Guya) (2 qian), Rose (Meiguihua) (2 flowers).
Again: Warming and assisting Mingmen Fire to generate Spleen Earth, involuntary urination stopped, yet feet still puffy swelling, Stomach dull with little intake, short urine. Water overflowing skin originally due to Spleen-Kidney dual deficiency, unable to transform Water outward. Tongue white turning yellow, mouth sticky and bitter, Heat generated within Dampness, forming Damp-Heat congestion situation. Fear changing extending into abdomen. Plan Jin Gui Fangji Fuling Tang method.
Honey-roasted Astragalus Root (Zhi Mian Huangqi) (1.5 qian), Poria (Fuling) (4 qian), Han Fangji (Han Fangji) (3 qian), Alisma Root (Zexie) (2 qian), Polyporus (Zhuling) (2 qian), Areca Peel (Dafupi) (2 qian).
Prepared Atractylodes Lancea Rhizome (Zhi Cangzhu) (2 qian), Xuanmu Gua (Xuan Mugua) (1.5 qian), Tongcao (Tongcao) (1 qian), Raw Coix Seed (Sheng Yiren) (1 liang), Stir-fried Winter Melon Peel (Chao Dongguapi) (1 liang, two ingredients decocted as water substitute).