（金匮） 治风水，脉浮身重，汗出恶风，及诸风诸湿，麻木身痛。（东垣曰∶麻木为
风，人皆知之，细核则有区别。如久坐亦麻木，绳缚之人亦麻木，非有风邪，乃气不行也。
当补肺气，麻木自去矣。亦有因气虚而风邪入而踞之，所以风为虚象，气虚其本也。）
防己 黄 （一两） 白术（七钱半） 甘草（炙五钱） 每服五钱。加姜枣煎。腹痛
加芍药，喘
苓苍术，气
防己大辛苦寒，通行十二经，开窍泻湿，为治风肿水肿之主药。黄 生用达表，治风注
肤痛
平以
去白术姜枣，加茯苓（为君）桂枝，名防己茯苓汤。（金匮）治水在皮肤，四肢聂聂而
动，名皮水。（防己行经络，茯苓善渗泄，黄 达皮肤，桂枝走肢节。按五水，脉浮恶风，
骨节疼痛，名风水。脉浮 肿，按之没指，其腹如鼓，不恶风不渴，名皮水，当发其汗。又
云恶寒不渴，名风水。不恶寒而渴，名皮水。假令皮水不渴，亦当发汗。脉沉迟自喘，名正
水。脉沉，腹满不喘，水积胞中，坚满如石，名石水。脉沉迟发热，胸满身肿，汗如柏汁，
名黄汗。）
（金匮肾气丸即桂附八味丸，治妇人转胞，无车前牛膝。）治脾肾大虚，肚腹胀大
肢浮肿，喘急痰盛，小便不利，大便溏黄，已成蛊证。亦治消渴，饮一溲一。（经曰∶
胃之关也。关门不利，故聚水而从其类也。上下溢于皮肤，则为 肿。肾消者，肾水
龙雷之火，不安其位。上炎于肺，消渴引饮。饮入于胃，下无火化，直入膀胱，故饮
也。用桂附辛热，引真火归元。地黄纯阴，壮真水滋肾，为治下消之剂。）
熟地黄（四两） 茯苓（三两乳拌） 山药（微炒） 丹皮（酒洗） 山萸肉（酒润） 泽
泻（酒浸）
土为万物之母，脾虚则土不能制水而洋溢。水为万物之源，（天一生水。）肾虚则水不安
其位而妄行，以致泛滥皮肤肢节之间。因而攻之，虚虚之祸，不待言矣。（经曰∶毋盛盛，
毋虚
能生
益肝
六腑
胃之关时其输泄而病于下，以致积水浸淫，无所底止。又曰∶按此方济生以附子为君，此薛
新甫重订以茯苓为君。然肾之关门不开，必以附子回阳，蒸动肾气，其关始开。胃中积水始
下，以阳主开故也。关开，即不用茯苓牛膝车前，而水亦下。关闭，即车前茯苓用至无算，
抑莫之如何矣。用方者将君附子乎？抑君茯苓乎？张景岳曰∶水肿证，乃脾肺肾三脏相干之
病。盖水为至阴，故其本在肾。水化于气，故其标在肺。水惟畏土，故其制在脾。今肺虚则
气不化精而化水，脾虚则土不制水而反克，肾虚则水无所主而妄行。求古治法，惟金匮内加
减肾气汤，为对证之方。予屡用之，无不见效。此虽壮水之剂，而实即脾肺肾三脏之正治也。
盖肾为先天生气之源，若先天元气亏于下，则后天胃气失其所本。而由脾及肺。治节所以不
行，是以水积于下，则气壅于上，而喘胀由生。但宜峻补命门，使气复元，则三脏必皆安矣。
今论其方，如所用桂附，以利阴中之滞。熟地山药山茱，以养阴中之水也。茯苓泽泻车前，
以化阴中之阳也。此能使气化于精，即所以治肺也。补火生土，即所以治脾也。壮水通窍，
即所以治肾也。补而不滞，利而不伐。凡病水肿于中年之后，及气体本弱者，但能随证加减
用之，其应如响，诚诸方之第一，更无出其右者。又曰∶肿胀之治，凡脾肾虚证，如前论加
减肾气汤者，诚然善矣。然用之之法，犹当因此扩充，不宜执也。余尝治一陶姓之友，年逾
四旬，因患伤寒，为医误治，危在呼吸。乃以大剂参附熟地之类，幸得挽回。愈后喜饮，未
及两月，忽病足股尽肿，胀及于腹，按之如鼓，坚而且硬。因其前次之病，中气本伤。近日
之病，又因酒湿，度非加减肾气汤不可。遂连进数服，虽无所碍，然终不见效。人皆料其必
不可治，余熟计其前后病因，本属脾肾大虚，而今兼以渗利，未免减去补力，亦与实漏
KT者何
大剂与之，
（《金匮要略》）治疗风水病，脉象浮、身体沉重、出汗且怕风，以及各类风邪湿邪引起的肢体麻木和身体疼痛。（李东垣说：人们都知道麻木是由风邪引起的，但仔细辨析则有区别。例如久坐也会麻木，被绳子捆绑的人也会麻木，这并不是因为有风邪，而是气机运行不畅所致。应当补益肺气，麻木自然就会消除。也有因为气虚导致风邪侵入并停留其中的情况，所以风邪表现为虚象，气虚才是根本。）
防己一两，黄芪一两，白术七钱半，甘草（炙）五钱。每次服用五钱，加入生姜、大枣煎煮。如果腹痛，加芍药；如果气喘，加茯苓、苍术；如果气滞，加……（原文此处有缺漏或错简，通常指加陈皮或厚朴等理气药，但依原文仅列“气”字，故译为气滞相关处理）。
防己味大辛、苦，性寒，通行十二经脉，开通窍道、泻除湿气，是治疗风肿和水肿的主要药物。黄芪生用可通达体表，治疗风邪注于皮肤引起的疼痛。
去掉白术、生姜、大枣，加入茯苓（作为君药）、桂枝，名为防己茯苓汤。（《金匮要略》）治疗水气停留在皮肤，四肢微微颤动，称为皮水。（防己通行经络，茯苓善于渗湿泄浊，黄芪通达皮肤，桂枝走窜肢节。按五种水病分类：脉浮、怕风、骨节疼痛，称为风水。脉浮、浮肿、按压后凹陷不起，腹部像鼓一样胀满，不怕风也不口渴，称为皮水，应当发汗。又说：怕冷但不口渴，称为风水。不怕冷但口渴，称为皮水。假如皮水不口渴，也应当发汗。脉沉迟且自发性气喘，称为正水。脉沉，腹部胀满但不气喘，水积聚在膀胱中，坚硬胀满如石头，称为石水。脉沉迟发热，胸满身肿，汗出颜色如柏树汁液，称为黄汗。）
（《金匮要略》肾气丸即桂附八味丸，治疗妇人胞宫扭转导致的尿闭，此方不含车前子、牛膝。）治疗脾肾极度虚弱，肚腹胀大，四肢浮肿，气喘急促痰多，小便不利，大便溏薄色黄，已经形成蛊胀证。也治疗消渴病，喝多少尿多少。（《内经》说：胃是排泄的关口。如果关口功能失常，所以水液聚集并随其同类性质泛滥。上下溢于皮肤，则成为水肿。肾消者，是由于肾中龙雷之火不安于本位。向上熏蒸于肺，导致消渴引饮。饮水进入胃中，下方没有真火气化，直接流入膀胱，所以出现饮一溲一的现象。使用桂枝、附子的辛热之性，引导真火回归本源。地黄纯阴，壮盛真水以滋补肾阴，这是治疗下消的方剂。）
熟地黄四两，茯苓三两（用乳汁拌），山药（微炒），丹皮（酒洗），山萸肉（酒润），泽泻（酒浸）。
土是万物的母亲，脾虚则土不能制约水而泛滥。水是万物的源头（天一生水），肾虚则水不安于本位而妄行，以致泛滥于皮肤肢节之间。如果用攻伐的方法治疗，会造成虚上加虚的祸害，这是不言而喻的。（《内经》说：不要使实证更实，不要使虚证更虚。能够滋生肝木，补益六腑，胃的关口失其输泄功能而病于下部，以致积水浸淫，没有止境。又有人说：按照这个方子，济生方以附子为君药，薛新甫重订版以茯苓为君药。然而肾的关门不开，必须用附子回阳，蒸动肾气，门才能打开。胃中的积水才能下行，这是因为阳气主开的原因。门开了，即使不用茯苓、牛膝、车前子，水也能下行。门关着，即使车前子、茯苓用到无穷无尽，也无能为力。使用方剂的人，是将附子作为君药呢？还是将茯苓作为君药呢？张景岳说：水肿证，是脾、肺、肾三脏相互影响的疾病。因为水属于至阴，所以根本在肾。水转化为气，所以标在肺。水畏惧土，所以制约在脾。现在肺虚则气不能化精而化为水，脾虚则土不能制水反而受克，肾虚则水无所主而妄行。寻求古代治法，只有《金匮要略》中的加减肾气汤，是对证的方剂。我多次使用，无不见效。这虽然是壮水之剂，但实际上就是脾、肺、肾三脏的正治之法。因为肾是先天生气的源头，如果先天元气亏虚于下，则后天胃气失去根本。进而由脾波及肺。治节功能所以不行，因此水积于下，气壅于上，喘胀由此产生。只应当峻补命门，使气恢复元气，那么三脏必定都安宁了。现在论述这个方子，如所用桂枝、附子，是用来利导阴中的滞涩。熟地、山药、山茱萸，是用来滋养阴中的水液。茯苓、泽泻、车前子，是用来化生阴中的阳气。这能使气化为精，这就是治疗肺的方法。补火生土，这就是治疗脾的方法。壮水通窍，这就是治疗肾的方法。补而不滞，利而不伤正气。凡是中年以后患水肿病，以及体质原本虚弱的人，只要能随证加减使用它，效果立竿见影，确实是诸方中的第一，没有能超过它的。又说：治疗肿胀，凡是脾肾虚证，像前面论述的加减肾气汤，确实很好。然而使用它的方法，还应当据此扩充，不宜拘执。我曾经治疗一位姓陶的朋友，年龄超过四十岁，因患伤寒，被医生误治，危在旦夕。于是用大剂量的参、附、熟地之类，幸好得以挽回。痊愈后喜欢喝水，不到两个月，忽然双脚大腿全部浮肿，胀及腹部，按压像鼓一样，坚硬而且硬。因为他前次的病，中气本来受伤。最近的病，又因为酒湿，估计非加减肾气汤不可。于是连续进服几剂，虽然没有什么阻碍，但最终不见效。人们都预料他必死无疑，我仔细考虑前后的病因，本属脾肾大虚，而现在兼用渗利药物，未免减少了补益的力量，这也如同对漏壶加水一样（意指无效）。大剂量给予……（原文未完）
(From *Jin Gui Yao Lue*) Treats Feng Shui (Wind Edema), characterized by a floating pulse, heavy body, sweating with aversion to wind, as well as numbness and body pain caused by various wind and damp pathogenic factors. (Li Dongyuan stated: It is well known that numbness is caused by wind, but careful differentiation reveals distinctions. For instance, prolonged sitting causes numbness, and people bound by ropes also experience numbness; this is not due to wind pathogens, but rather the failure of Qi movement. One should tonify Lung Qi, and the numbness will naturally resolve. There are also cases where Qi deficiency allows wind pathogens to invade and lodge themselves; thus, wind manifests as a deficiency pattern, with Qi deficiency being the root.)
Fangji (Stephaniae Tetrandrae Radix) 1 liang, Huangqi (Astragali Membranacei Radix) 1 liang, Baizhu (Atractylodis Macrocephalae Rhizoma) 7 qian 5 fen, Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried) 5 qian. Take 5 qian per dose, decoct with Shengjiang (Zingiberis Recens Rhizoma) and Dazao (Jujubae Fructus). If abdominal pain occurs, add Shaoyao (Paeoniae Radix Alba); if wheezing occurs, add Fuling (Poria) and Cangzhu (Atractylodis Rhizoma); if Qi stagnation occurs... [text incomplete].
Fangji is greatly pungent, bitter, and cold in nature; it unblocks the twelve meridians, opens orifices, and drains dampness, serving as the principal herb for treating wind edema and water swelling. Raw Huangqi reaches the exterior, treating pain caused by wind lodging in the skin.
Remove Baizhu, Shengjiang, and Dazao; add Fuling (as the Sovereign herb) and Guizhi (Cinnamomi Ramulus), naming the formula Fangji Fuling Tang. (From *Jin Gui Yao Lue*) Treats water qi lingering in the skin, with slight tremors in the four limbs, termed Pi Shui (Skin Water/Edema). (Fangji unblocks meridians, Fuling excels at leaching out dampness, Huangqi reaches the skin, and Guizhi travels through the joints. According to the classification of five types of water diseases: Floating pulse, aversion to wind, and joint pain are termed Feng Shui (Wind Water). Floating pulse, edema that leaves an indentation upon pressure, abdominal distension like a drum, without aversion to wind or thirst, are termed Pi Shui (Skin Water); sweating should be induced. Alternatively: Aversion to cold without thirst is Feng Shui; no aversion to cold but with thirst is Pi Shui. Even if Pi Shui presents without thirst, sweating should still be induced. Deep, slow pulse with spontaneous wheezing is Zheng Shui (Correct Water). Deep pulse, abdominal fullness without wheezing, water accumulation in the bladder, hard and full like stone, is Shi Shui (Stone Water). Deep, slow pulse with fever, chest fullness, body swelling, and sweat resembling paulownia juice is Huang Han (Yellow Sweat).)
(Jin Gui Shen Qi Wan, also known as Gui Fu Ba Wei Wan, treats women's Zhuan Bao (displacement of the uterus causing urinary retention), containing no Cheqianzi or Niuxi.) Treats severe deficiency of Spleen and Kidney, abdominal distension and enlargement, limb edema, wheezing with profuse phlegm, difficult urination, loose yellow stools, progressing to Gu Zheng (Gu Distension/Bloating). It also treats Xiao Ke (Wasting-Thirst), where one drinks much and urinates much. (The Classic states: The Stomach is the gate of excretion. If the gate function is impaired, water accumulates and spreads according to its nature. Overflowing up and down into the skin results in edema. In Kidney Xiao, the Dragon-Lei fire within the Kidney fails to remain in its proper position. Flaring upward to the Lung causes wasting-thirst and excessive drinking. When water enters the Stomach, lacking fire below to transform it, it goes directly into the Bladder, hence drinking one part and urinating one part. Using the acrid-hot properties of Guizhi and Fuzi guides the True Fire back to its origin. Shudi (Rehmanniae Radix Preparata) is purely yin, strengthening True Water to nourish the Kidney; this is a formula for treating Lower Xiao.)
Shudi (Prepared Rehmanniae Radix) 4 liang, Fuling (Poria, mixed with milk) 3 liang, Shanyao (Dioscoreae Rhizoma, lightly stir-fried), Danpi (Moutan Cortex, wine-rinsed), Shanzhuyu (Corni Fructus, moistened with wine), Zexie (Alismatis Rhizoma, wine-soaked).
Earth is the mother of all things; when Spleen is deficient, Earth cannot control Water, leading to overflow. Water is the source of all things (Heaven generates One Water); when Kidney is deficient, Water does not stay in its proper position and moves recklessly, flooding between the skin and joints. To attack this with purgatives would cause the disaster of "deficiency making deficiency worse," which needs no further explanation. (The Classic says: Do not reinforce excess, do not aggravate deficiency. [Text fragment regarding Liver/Spleen interaction omitted due to corruption]. When the gate of the Stomach loses its transport and excretion functions, disease arises in the lower part, leading to accumulating water that soaks and spreads without stopping. Another view states: In this formula, Jisheng Fang uses Fuzi as the Sovereign, while Xue Xinpu’s revised edition uses Fuling as the Sovereign. However, if the Kidney's gate does not open, one must use Fuzi to restore Yang and steam the Kidney Qi for the gate to open. Only then can water in the Stomach descend, because Yang governs opening. Once the gate opens, even without Fuling, Niuxi, or Cheqianzi, water will flow down. If the gate is closed, even using unlimited amounts of Cheqianzi and Fuling, nothing can be done. Should the prescriber make Fuzi the Sovereign, or Fuling? Zhang Jingyue said: Edema is a disease involving the interplay of the Spleen, Lung, and Kidney. Since Water is extreme Yin, its root lies in the Kidney. Water transforms into Qi, so its branch lies in the Lung. Water fears Earth, so its control lies in the Spleen. Now, Lung deficiency means Qi cannot transform Essence into Water (but rather creates pathological water); Spleen deficiency means Earth cannot control Water and is counter-attacked; Kidney deficiency means Water has no master and acts recklessly. Seeking ancient treatments, only the Modified Shen Qi Decoction from *Jin Gui* is appropriate. I have used it frequently with success. Although this is a formula to strengthen Water, it essentially treats the Spleen, Lung, and Kidney correctly. The Kidney is the source of Pre-Heaven Qi; if Pre-Heaven Yuan Qi is deficient below, Post-Heaven Stomach Qi loses its foundation, affecting the Spleen and then the Lung. The regulation fails, so water accumulates below, Qi stagnates above, and wheezing and distension arise. One should vigorously tonify the Mingmen (Gate of Life) to restore Qi, thereby calming all three organs. Regarding the prescription: Guizhi and Fuzi benefit the stagnation within Yin; Shudi, Shanyao, and Shanzhuyu nourish the Water within Yin; Fuling, Zexie, and Cheqianzi transform the Yang within Yin. This allows Qi to transform into Essence, which treats the Lung. Tonifying Fire to generate Earth treats the Spleen. Strengthening Water to unblock orifices treats the Kidney. It tonifies without stagnation and drains without damaging healthy Qi. For anyone developing edema after middle age or with inherently weak constitution, if used with symptomatic modifications, the response is immediate. It is truly the premier formula, unsurpassed. Furthermore: In treating swelling, for Spleen and Kidney deficiency patterns as described, the Modified Shen Qi Decoction is indeed excellent. However, its application should be expanded upon, not rigidly adhered to. I once treated a friend surnamed Tao, over forty years old, who suffered from Shang Han (Cold Damage), was mis-treated by other physicians, and was on the verge of death. I saved him with large doses of Renshen, Fuzi, and Shudi. After recovery, he enjoyed drinking. Within two months, his legs and thighs suddenly swelled completely, distending to the abdomen, hard and drum-like. Given his previous illness had injured his Middle Qi, and the recent illness involved alcohol-dampness, I judged that only the Modified Shen Qi Decoction would suffice. I administered several doses consecutively; while there were no adverse reactions, there was ultimately no effect. Everyone predicted he would die. I carefully considered the antecedents and current causes; the root was severe Spleen and Kidney deficiency, but the concurrent use of draining/diuretic herbs inevitably reduced the tonifying power, akin to pouring water into a leaking vessel. Large doses given... [text ends]