凡水肿等证，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，水不归经则逆而上泛，故传入于脾而肌肉浮肿，传入于肺则气息喘急。虽分
而言之，而三脏各有所主，然合而言之，则总由阴胜之害，而病本皆归于肾。《内经》曰∶肾
为胃关，关门不利，故聚水而从其类也。然关门何以不利也？经曰∶膀胱者，州都之官，津
液藏焉，气化则能出矣。夫所谓气化者，即肾中之气也，即阴中之火也；阴中无阳，则气不
能化，所以水道不通，溢而为肿。故凡治肿者必先治水，治水者必先治气，若气不能化，则
水必不利，惟下焦之真气得行，始能传化，惟下焦之真水得位，始能厘清。求古治法，惟薛
立斋先生加减《金匮》肾气汤，诚对证之方也，余屡用之，无不见效，此虽壮水之剂，而实
即脾肺肾三脏之正治也。何也？盖肾为先天生气之源，若先天元气亏于下，则后天胃气失其
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，以化阴中之阳也，熟地、山药、牛
膝，以养阴中之水也，茯苓、泽泻、车前子，以利阴中之滞也；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。此方补而不滞，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
其上者。
一、证有全由脾肺不足而为肿胀者，治宜以四君、归脾之属为主，固是正治之法，然亦
须兼补命门。盖脾土非命门之火不能生，肺气非命门之水不能化。人知土能制水，而不知阳
实制阴，人知气化为精，而不知精化为气也，虚则补母，正此之谓。
一、凡素禀阳盛，三焦多火，而病为水肿者，其证必烦渴喜冷，或面赤便结，或热而喘
嗽，或头面皆肿，或脉见滑实，此湿热相因，阴虚之证也；凡辛香燥热等剂，必所不堪，宜
用六味地黄汤加牛膝、车前、麦冬之类，大剂与之。其有热甚者，宜加减一阴煎加茯苓、泽
泻、车前、牛膝之类主之。其有虚中挟实，胸膈不清，宜加陈皮、白芥子之类佐之。其有生
平不宜熟地者，则单用生地亦可。但此等壮水等剂，必十余服后，方可望效，若先因克伐致
虚者，其效尤迟，慎毋欲速，自求伊芳戚也。
一、凡年少纵酒，致为湿热所乘，元气尚强，脉实有力，而不便于温补者，此当逐去湿
热，亦能速效。宜禹功散、导水丸、浚川散、三花神佑丸之类，皆可择用，泻后宜薄滋味，
戒饮酒，久之方可复元。
古法治肿，大都不用补剂，而多用去水等药，微则分利，甚则推逐，如五苓散、五淋散
、五皮散、导水茯苓汤之类，皆所以利水也；如舟车神佑丸、浚川散、禹功散、十枣汤之类
，皆所以逐水也；再如巴豆、朴硝、针砂、滑石、三棱、蓬术、麝香、琥珀、土狗、地龙、
田螺、水蛭、鲤鱼、鲫鱼、萝匐子、苏子、商陆、葶苈、杏仁、防已。秦艽、木瓜、瞿麦、
通草、浓朴、赤小豆、猪苓、海金砂、五加皮、大腹皮、羌活、独活之类，无非逐水利水之
剂，但察其果系实邪，则此等治法，诚不可废，但必须审证的确，用当详慎也。凡今方士所
用，则悉皆此类，故能晚服而早通，朝用而暮泻，去水斗许，肿胀顿消，效诚速也；但彼不
顾人之虚实，不虑人之死生，惟以见效索谢而去，不知随消随胀，不数日而复，胀必愈甚，
苟以年衰积损之证，而复遭此劫，则百无一生矣。
一、水肿证，以精血皆化为水，多属虚败，治宜温脾补肾，此正法也。然有一等不能受
补者，则不得不从半补，有并半补亦不能受者，则不得不全用分消，然以消治肿，惟少年之
暂病则可，若气血既衰，而复不能受补，则大危之候也。故凡遇此辈，必须千方百计，务救
根本，庶可保全。尝见有专用消伐而退肿定喘者，于肿消之后，必 羸骨立，略似人形，多
则半年，少则旬日，终无免者。故余之治此，凡属中年积损者，必以温补而愈，皆终身绝无
后患。盖气虚者不可复行气，肾虚者不可复利水；且温补即所以化气，气化而全愈者，愈出
自然，消伐所以逐邪，逐邪而暂愈者，愈由勉强，此其一为真愈，一为假愈，亦岂有假愈而
果愈者哉。
一、无论气鼓、水鼓，凡气实可下者，宜用赤金豆，或百顺丸，以渐利之。
凡是水肿这类病证，都是脾、肺、肾三脏相互影响导致的疾病。因为水属于至阴之物，所以其根本在肾；水转化为气，所以其标象在肺；水唯独畏惧土，所以其制约权在脾。如今肺气虚弱，则气不能化生精微而化为水湿；脾气虚弱，则土不能制约水湿反而受水反克；肾气虚弱，则水失去主宰而妄行泛滥，水不循常道而逆乱上泛，所以传入脾脏则肌肉浮肿，传入肺脏则气息喘急。虽然分开来说，三脏各有其主要病变部位，但合起来说，总归是由于阴邪过盛的危害，而病的根本都归于肾。《内经》说：肾是胃的关口，如果关门不利，就会聚积水液并随同类聚集。然而关门为什么不利呢？经书说：膀胱是州都之官，津液藏存于此，经过气化作用才能排出。所谓的气化，就是肾中的气，也就是阴中之火；如果阴中没有阳，气就不能气化，所以水道不通，溢出体外而形成水肿。所以凡是治疗水肿，必须先治水；治水的先决条件是必须治气。如果气不能气化，那么水必然排泄不畅。只有下焦的真气运行通畅，才能传化水液；只有下焦的真水得位，才能澄清浊质。寻求古代的治疗方法，只有薛立斋先生加减使用的《金匮》肾气汤，确实是对症的方剂。我多次使用它，没有不见效的。这虽然是壮水（滋补肾阴）的药剂，但实际上正是针对脾、肺、肾三脏的正治之法。为什么呢？因为肾是先天生气的源头，如果先天元气亏虚于下，那么后天的胃气就失去了根本，进而由脾波及肺，导致治节功能不行，因此水积聚在下部，气壅塞在上部，喘息和胀满由此产生。此时只应当峻补命门，使元气恢复，那么三脏必定都能安宁。现在论述具体的方药：如所用的肉桂、附子，是用来化生阴中之阳的；熟地黄、山药、牛膝，是用来滋养阴中之水的；茯苓、泽泻、车前子，是用来疏通阴中之滞涩的；这些药物能使气在精中气化，这就是在治疗肺；补火以生土，这就是在治疗脾；壮水以通窍，这就是在治疗肾。这个方剂补益而不滞腻，利水而不伤正气。凡是中年以后患水肿病，以及体质原本虚弱的人，只要能够根据证候加减使用，效果迅速，这确实是众多方剂中的第一，没有能超过它的了。
一、有的证候完全由脾肺不足而导致肿胀，治疗应当以四君子汤、归脾汤之类的方剂为主，这固然是正治的方法，但也必须兼补命门。因为脾土如果没有命门之火就不能生化，肺气如果没有命门之水就不能转化。人们只知道土能制水，却不知道实际上是阳能制阴；人们只知道气化为精，却不知道精也能化为气。虚证时补益母脏，说的就是这个道理。
一、凡是素来禀赋阳气偏盛，三焦多火，因而患病为水肿的，其症状一定是烦渴喜冷饮，或者面红大便干结，或者发热伴咳嗽气喘，或者头面部全部浮肿，或者脉象滑实，这是湿热相兼、阴虚的证候。凡是辛香燥热等性质的药剂，患者一定无法承受，应当使用六味地黄汤加入牛膝、车前子、麦冬之类的药物，大剂量给予。其中热势严重的，应当使用加减一阴煎加入茯苓、泽泻、车前子、牛膝之类的药物主治。其中有虚证夹杂实证，胸膈不清爽的，应当加入陈皮、白芥子之类的药物辅助治疗。其中有生平不适合服用熟地黄的，那么单用生地黄也可以。但是这类壮水滋阴的药剂，必须服用十余剂之后，才可以期望见效。如果是因为先前误用攻伐药物导致虚损的，见效尤其缓慢，千万不要急于求成，以免自寻苦恼。
一、凡是年轻人纵欲饮酒，导致被湿热所侵袭，元气尚且强盛，脉象实而有力，且不适宜温补治疗的，这应当驱逐去除湿热，也能快速见效。适宜使用禹功散、导水丸、浚川散、三花神佑丸之类的方剂，都可以选择使用。泻下之后应当饮食清淡，戒除饮酒，久而久之才可以恢复元气。
古代治疗水肿的方法，大多不使用补剂，而多用去水等药物。轻微的用分利法，严重的用推逐法。如五苓散、五淋散、五皮散、导水茯苓汤之类，都是用来利水的；如舟车神佑丸、浚川散、禹功散、十枣汤之类，都是用来逐水的；再如巴豆、朴硝、针砂、滑石、三棱、蓬术、麝香、琥珀、土狗、地龙、田螺、水蛭、鲤鱼、鲫鱼、萝葡子、苏子、商陆、葶苈子、杏仁、防己、秦艽、木瓜、瞿麦、通草、厚朴、赤小豆、猪苓、海金沙、五加皮、大腹皮、羌活、独活之类，无非都是逐水利水的药剂。只要确实考察出是实邪，那么这些治法确实不可废弃，但必须审察证候确切，用药详细谨慎。凡是当今医生所使用的，全都是这类方法，所以能够晚上服药早上通便，早晨用药傍晚泻下，去掉几斗水，肿胀顿时消除，疗效确实迅速；但是他们不顾病人的虚实情况，不考虑病人的生死安危，只凭见效索取报酬便离开，不知道这种消退之后随即再次肿胀，不出几天就会复发，而且肿胀一定会更加严重。如果是年老体衰、积劳损伤的病证，如果再遭受这种劫掠式的攻击，那就百无一生了。
一、水肿证，由于精血都化为了水，多属于虚败之证，治疗应当温补脾肾，这是正法。但是有一类不能耐受补益的病人，就不得不采用半补半消的方法；有连半补半消也不能耐受的，就不得不全用分消法。然而以消法治疗肿胀，只有年轻人暂时患病可以适用；如果气血已经衰弱，而又不能耐受补益，那就是非常危险的征候。所以凡是遇到这类病人，必须千方百计，务必挽救根本，才可能保全生命。我曾经见到有人专门使用消伐药物来退肿定喘，在肿胀消退之后，病人必定瘦骨嶙峋，略似人形，多的半年，少的十天，最终没有能幸免的。所以我治疗这类病症，凡是中年积累损伤的患者，必定通过温补而痊愈，终身绝无后患。因为气虚的人不可以再耗行气机，肾虚的人不可以再利水；况且温补本身就是化气，气化而完全痊愈的，痊愈出于自然；消伐是为了驱逐邪气，驱逐邪气而暂时痊愈的，痊愈出于勉强。这是一个真愈，一个是假愈，难道有假愈而真正痊愈的吗？
Any edema-like syndromes are diseases resulting from the interrelation of the Spleen, Lung, and Kidney. Since water belongs to extreme Yin, its root lies in the Kidney; since water transforms into Qi, its branch manifestation lies in the Lung; since water fears Earth, its control lies in the Spleen. Currently, if Lung Qi is deficient, it cannot transform essence but instead transforms into water; if Spleen Qi is deficient, Earth fails to control Water and is counter-attacked by it; if Kidney Qi is deficient, Water loses its master and acts recklessly. When water does not return to its channels, it rebels and floods upward. Thus, when it transmits to the Spleen, muscles swell; when it transmits to the Lung, breathing becomes rapid and wheezy. Although analyzed separately, each of the three Zang organs has its specific domain, but collectively speaking, it is entirely due to the harm of excessive Yin, with the disease root ultimately归于 (attributed to) the Kidney. The *Neijing* states: "The Kidney is the gate of the Stomach; when the gate is not functional, water accumulates and follows its kind." But why is the gate not functional? The classics state: "The Bladder is the official of the metropolitan area, storing fluids; only through Qi transformation can they be excreted." What is meant by Qi transformation is the Qi within the Kidney, which is also the Fire within Yin. If there is no Yang within Yin, Qi cannot transform, leading to blocked water passages that overflow and cause swelling. Therefore, in treating any edema, one must first treat water; in treating water, one must first treat Qi. If Qi cannot transform, water will certainly not flow freely. Only when the True Qi of the Lower Jiao moves can transmission and transformation occur; only when the True Water of the Lower Jiao assumes its proper position can clarity be restored. Seeking ancient treatment methods, only Mr. Xue Lizhai's modified *Jingui Yaolue* Shenqi Tang (Kidney Qi Decoction) is truly a formula targeting the syndrome. I have used it frequently with consistent efficacy. Although this is a formula for strengthening Water (nourishing Kidney Yin), it is essentially the correct treatment for the Spleen, Lung, and Kidney. Why? Because the Kidney is the source of pre-natal Qi. If pre-natal Yuan Qi is deficient below, post-natal Stomach Qi loses its foundation, affecting the Spleen and then the Lung, causing the regulation mechanism to fail. Consequently, water accumulates below while Qi stagnates above, generating wheezing and distension. In such cases, one should vigorously tonify Mingmen (Gate of Life) to restore Qi, thereby calming all three Zang organs. Regarding the specific prescription: Cinnamon Twig (Guizhi) and Aconite Root (Fuzi) are used to transform Yang within Yin; Prepared Rehmannia Root (Shudihuang), Chinese Yam (Shanyao), and Achyranthes Root (Niuxi) are used to nourish Water within Yin; Poria (Fuling), Alisma Rhizome (Zexie), and Plantago Seed (Cheqianzi) are used to unblock stagnation within Yin. These enable Qi to transform within Essence, thus treating the Lung; supplementing Fire to generate Earth thus treats the Spleen; strengthening Water to open orifices thus treats the Kidney. This formula tonifies without stagnation and drains without damaging healthy Qi. For patients developing edema after middle age or those with inherently weak constitutions, appropriate modifications applied according to the syndrome yield prompt results. It is indeed the premier among formulas, unsurpassed by others.
1. Some syndromes result entirely from Spleen and Lung deficiency causing swelling. Treatment should primarily use formulas like Sijunzi Tang (Four Gentlemen Decoction) or Guipi Tang (Restore the Spleen Decoction). While this is a standard approach, it must also include tonifying Mingmen. This is because Spleen Earth cannot generate without the Fire of Mingmen, and Lung Qi cannot transform without the Water of Mingmen. People know that Earth controls Water, but do not realize that Yang actually controls Yin. People know that Qi transforms into Essence, but do not realize that Essence transforms back into Qi. Tonifying the mother organ in deficiency syndromes refers to this principle.
2. Individuals with innate excess Yang and abundant Fire in the Triple Burner who develop edema typically present with irritability, thirst preferring cold drinks, red face, constipation, fever with cough and wheezing, generalized facial swelling, or slippery and solid pulses. These indicate damp-heat accumulation and Yin deficiency. Formulas with acrid, aromatic, dry, and hot properties are intolerable. Instead, Liuwei Dihuang Tang (Six-Ingredient Pill with Rehmannia) supplemented with Niuxi, Cheqianzi, and Maidong should be administered in large doses. For severe heat, Jianyi Yinyin Jian (Modified One-Yin Decoction) with Fuling, Zexie, Cheqianzi, and Niuxi is indicated. For deficiency complicated by excess with unclear chest and diaphragm, Chenpi and Baijiezi may be added as adjuvants. For those historically unsuitable for Shudihuang, Shengdihuang (Raw Rehmannia Root) alone may be used. However, such Yin-strengthening formulas require more than ten doses before efficacy is expected. If deficiency was caused by prior purgative abuse, recovery is even slower. Do not seek haste, lest you bring upon yourself distress.
3. Young individuals who indulge in alcohol, allowing damp-heat to invade, yet retain strong Yuan Qi and forceful pulses, are unsuitable for warm tonification. In these cases, damp-heat should be expelled for rapid effect. Suitable formulas include Yugong San, Daoshui Wan, Xunchuan San, or Sanhua Shenyao Wan. After purgation, diet should be bland, and alcohol strictly avoided until full recovery.
Ancient treatments for edema rarely used tonics, favoring water-draining agents instead. Mild cases used separation and promotion (diuresis); severe cases used pushing and driving (catharsis/purgation). Examples of diuretics include Wuling San, Wulin San, Wupi San, and Daoshui Fuling Tang. Examples of purgatives include Zhouche Shenyao Wan, Xunchuan San, Yugong San, and Shizao Tang. Other herbs used for draining water include Croton Seed (Badou), Mirabilite (Puxiao), Hematite (Zhensha), Talcum (Huashi), Bupleurum Root (Sanleng), Curcuma Rhizome (Pengzhu), Musk (Shexiang), Amber (Hupo), Dog (Tugou), Earthworm (Dilong), Freshwater Snail (Tianluo), Leech (Shuizhi), Carp (Liyu), Crucian Carp (Jiyu), Arisaema Tuber (Luobuzi), Perilla Seed (Suzi), Phytolacca Root (Shanglu), Lepidium Seed (Tingli), Apricot Kernel (Xingren), Stephania Root (Fangji), Gentian Root (Qinjiao), Papaya (Mugua), Dianthus Seed (Qumai), Tongcao, Magnolia Bark (Houpo), Adzuki Bean (Chixiaodou), Polyporus (Zhuling), Goldthread Rhizome (Haijinsha), Acanthopanax Bark (Wujia Pi), Areca Peel (Dafupi), Notopterygium Rhizome (Qianghuo), and Saposhnikovia Root (Duhuo). All are agents for expelling and draining water. Provided the pathogen is confirmed as excess, these methods are indispensable, provided the syndrome is accurately diagnosed and usage is cautious. Modern practitioners often rely solely on such methods, achieving rapid results where evening dosing leads to morning urination, or morning dosing leads to evening evacuation, removing significant volumes of fluid and instantly reducing swelling. However, they disregard the patient's deficiency or excess, ignoring life and death, seeking payment upon symptom relief and departing. They fail to recognize that swelling recurs shortly after subsiding, becoming progressively worse. If such aggressive treatment is applied to elderly patients with accumulated depletion, survival chances are negligible.
4. Edema syndromes, where essence and blood transform into water, mostly belong to deficiency and collapse. The correct treatment is warming the Spleen and tonifying the Kidney. However, some patients cannot tolerate tonification, necessitating half-tonic/half-draining approaches; others cannot tolerate even half-tonics, requiring complete draining/dispersing methods. Using draining methods for edema is suitable only for young people with acute conditions. If Qi and Blood are depleted and the patient cannot tolerate tonification, it is a critical condition. In such cases, every effort must be made to save the root to preserve life. I have seen cases where only draining and attacking were used to reduce swelling and calm wheezing; after swelling subsided, patients became emaciated skeletons, barely resembling humans. Most died within six months, some within days. My treatment for such cases, especially middle-aged patients with accumulated damage, relies on warm tonification for cure, ensuring no lifelong sequelae. Qi-deficient patients should not have their Qi further consumed; Kidney-deficient patients should not have their water further drained. Warm tonification facilitates Qi transformation; natural recovery follows Qi transformation. Draining expels pathogens; forced temporary recovery follows pathogen expulsion. One is true recovery, the other false. Can false recovery lead to genuine health?
5. Regardless of whether it is Qi Drumming or Water Drumming, if Qi excess allows for purgation, Chijin Dou or Baishun Wan should be used to gradually promote drainage.