（此疾更多，投五皮饮为好）
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，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，而为施治。儿大者凭脉以明虚实，古
方有十种论证，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，小腹急满为小肠水。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、至午后稍消，以羌活散疏解，次醒脾散主之，及间投南星腹
皮散。其脾冷困，则燥以草果、缩砂之类。然此证夏与秋冬治之颇易，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，进退不常，须徐徐调
理取效。若脾热而困，又以药燥之，虽火能生土，亦可胜水。奈何燥之太过，土不敌火，
则热愈甚，而不食发热烦渴医者又进之以燥剂，由此而面目转浮，致脾败而手足背皆肿。
盖手足背与脐凸（音迭）即脾之外候，有未经发表，遽用下药以泻之，则一泻而肿消，乃云
得泻之力，殊不知脾愈泻而愈虚，不逾旬月，其肿如初，此世人只知泻肿为最，而不求其
十补勿一泻之论。法当随四时用药，解表通利小便，春以七宝散加麻黄、桂枝，赤茯苓，
水、姜、葱煎服，夏以五苓散加麻黄、车前子、薏苡仁，秋以清肺饮加羌活、细辛、商
陆，冬以冲和饮加白术、生川乌、赤小豆。以上三药，并用水、姜、葱煎投，滋润救脾导
水汤剂渗泄之，乃为良法。更以香陆胃苓丸、赤苍饮频服，自然获安。盖《内经》云∶开
鬼门（发汗也），洁净府（利小便），平治权衡，以平为期。此之谓也。有初肿便觉痰嗽气喘，小水
不通，正属肺肾所主，先服解表散，次以三白散为治。余证轻者投商陆丸，故经曰∶其
高者因而越之，即涌吐之义也。下者引而竭之，即渗泄之义也。凡得此病非一朝一夕之
故，不可以孟浪之药求其速效，以致虚脱。如愈后再感外风，满面虚浮，用排风汤和解，仍
服前救脾汤剂，免致反复。饮食之忌，惟盐酱齑 湿面，皆味咸能溢水者，并其他生冷
毒物，亦宜戒之。重则半载，轻者三月。须脾胃平复，肿消气实，然后于饮食中，旋以
烧盐少投，则其疾自不再作。故刘氏曰∶治肿非易，补养尤难，所忌者切须详审，有经
久不消者，下浚川丸即效。
（这种病症较为常见，使用五皮饮治疗效果较好。）
关于水肿病的成因，有本病与标病的区别。肾主宰元气，对应天一之水；肺主管冲和化生，对应地四之金。肾为本，肺为标，二者皆属至阴，容易积聚水湿。其发病机理在于：肾是胃的关隘，如果关隘不通利，枢机无法运转，水液便不能正常代谢，渗入脉络和皮肤，从而形成浮肿。治疗时应当推究内外致病原因，进而实施治疗。对于年龄较大的患儿，通过脉诊来明确虚实。古方中有十种水肿的辨证分型：短气且不能平卧的是心水，两胁拘急疼痛的是肝水，大便像鸭粪一样稀溏的是肺水，四肢沉重痛苦的是脾水，腰痛且足部发冷的是肾水，口苦咽干的是胆水，病情忽轻忽重的是大肠水，腹部急迫而肢体消瘦的是膀胱水，小便闭塞涩滞的是胃水，小腹胀满急迫的是小肠水。然而，脉象浮通常主风邪或虚证，脉象沉伏则主水病。脉沉说明脉络空虚，脉伏说明小便困难，这属于正水。脾脉虚大，多表现为脾肿，如果拖延不治疗，就会发展成全身水肿。因为脾属土，喜燥而恶湿，常受湿气侵袭，湿气容易损伤脾脏，导致血液转化为水湿，土气衰败不能制约水湿，于是水湿停蓄不行，滞留于皮肤，所以出现浮肿。
在疾病初起时，如果发现早晨眼睑浮肿突起，到午后稍微消退，应用羌活散疏风解表，接着用醒脾散主治，期间可间歇投服南星腹皮散。如果脾脏寒冷困顿，则用草果、缩砂仁等温热燥湿的药物。然而，此证在夏季以及秋季、冬季治疗颇为容易，唯独春季不同。因为四季的水湿，没有比春季水湿泛溢更严重的了，加之春季肝木旺盛克制脾土，脾土无法承受水湿，所以难以治疗，病情进退无常，必须慢慢调理才能见效。如果脾热而困顿，又用药物的燥性去治疗它，虽然火能生土，也可以胜水，但如果燥热太过，土敌不过火，那么热势会更加严重，导致患儿不进食、发热、烦躁口渴。医生又进用燥剂，因此面目更加浮肿，导致脾败坏，手足背部都出现肿胀。因为手足背部与肚脐凸起（音迭）是脾的外在征候。如果有未经过发汗解表，就急于使用下药泻下，虽然一次泻下后肿胀消退，人们却说是泻下的功劳，殊不知脾脏越泻越虚弱，不超过十天半个月，肿胀会恢复到原来的样子。这是世人只知道泻法消肿最好，而不探究“十补勿一泻”的理论。治疗方法应当顺应四季用药，解表并通利小便。春季用七宝散加麻黄、桂枝、赤茯苓，用水、生姜、葱白煎服；夏季用五苓散加麻黄、车前子、薏苡仁；秋季用清肺饮加羌活、细辛、商陆；冬季用冲和饮加白术、生川乌、赤小豆。以上三种方药，均用水、生姜、葱白煎服，再配合滋润救脾导水汤剂进行渗泄治疗，这才是良法。另外频繁服用香陆胃苓丸、赤苍饮，自然能获得安宁。正如《内经》所说：“开鬼门”（即发汗），“洁净府”（即利小便），权衡调节，以平衡为准则。说的就是这个道理。有的患儿刚出现肿胀就感觉痰多咳嗽、气喘，小便不通，这确实属于肺肾所主，先服用解表散，接着用三白散治疗。其余较轻的证候投服商陆丸，所以经书说：“病位高的因而越之”，即涌吐的意思；“病位低的引而竭之”，即渗泄的意思。凡是得这种病都不是一朝一夕的原因，不能用鲁莽猛烈的药物追求速效，以致造成虚脱。如果痊愈后又感受外风，满面虚浮，用排风汤和解，仍然服用前面的救脾汤剂，以免病情反复。饮食禁忌方面，只有盐、酱、腌菜、湿面，这些都是味道咸能助长水湿的食物，以及其他生冷有毒之物，也都应该戒除。重症需要半年，轻症需要三个月。必须等到脾胃功能平复，肿胀消退，正气充实，然后才能在饮食中逐渐少量加入烧过的盐，这样疾病自然不再发作。所以刘氏说：治疗水肿不容易，补养更为困难，所忌讳的事情必须仔细审查，有经久不消的，服用浚川丸即见效。
(This condition is more common; administering Wupi Yin [Five Peel Decoction] is advisable.)
Regarding the etiology of edema, there are distinctions between root (Ben) and branch (Biao) diseases. The Kidney governs Yuan Qi (Original Qi), corresponding to the Water of Tianyi (Heavenly One). The Lung governs Chonghua (Pulsating Transformation), corresponding to the Metal of Disi (Earthly Four). The Kidney is the root, and the Lung is the branch; both belong to Extreme Yin and are prone to accumulating water. In pathology, the Kidney serves as the key gate of the Stomach. If this gate is obstructed, the pivot mechanism fails to rotate, causing water to stagnate. It then seeps into the collaterals and skin, resulting in edema. Treatment should be based on investigating internal and external pathogenic factors. For older children, pulse diagnosis determines deficiency or excess. Ancient formulas describe ten types of edema: shortness of breath and inability to lie flat characterize Heart Edema; tightness and pain in the two hypochondria characterize Liver Edema; loose stools resembling duck feces characterize Lung Edema; heaviness and discomfort in the four limbs characterize Spleen Edema; lower back pain and cold feet characterize Kidney Edema; bitter taste in the mouth and dry throat characterize Gallbladder Edema; alternating deficiency and excess characterize Large Intestine Edema; abdominal urgency with emaciated limbs characterize Bladder Edema; obstruction and difficulty in urination characterize Stomach Edema; and fullness and urgency in the lower abdomen characterize Small Intestine Edema. However, a floating pulse typically indicates Wind or Deficiency, while a deep and hidden pulse indicates Water disease. A deep pulse suggests emptiness in the collaterals, and a hidden pulse suggests difficulty in urination, which constitutes Zheng Shui (Standard Water Disease). A deficient and large Spleen pulse often indicates Spleen swelling; if neglected, it develops into generalized edema. Since the Spleen belongs to Earth, it prefers dryness and dislikes dampness. It is frequently affected by dampness, which injures the Spleen, transforming blood into water. When Earth fails to control Water, water accumulates and stagnates in the skin, causing edema.
At the onset of the disease, if morning puffiness of the eyelids subsides slightly by afternoon, Qianghuo San [Notopterygium Powder] should be used to disperse and resolve the exterior, followed by Xingpi San [Spleen-Awakening Powder]. Intermittently, Nanxing Fupi San [Arisaema and Tangerine Peel Powder] may be administered. If the Spleen is cold and hindered, drying agents such as Caoguo [Black Cardamom Fruit] and Suosha [Amomum Tsao-ko] should be used. This condition is relatively easy to treat in summer and during autumn and winter, but difficult in spring. Among the four seasons, no water accumulation surpasses that of spring, compounded by the flourishing Wood of the Liver overcoming the Earth of the Spleen, making the Spleen unable to handle water. Thus, treatment is difficult, with fluctuating progress, requiring gradual regulation for efficacy. If the Spleen is hot and hindered, using drying herbs might seem logical since Fire generates Earth and can overcome Water. However, excessive drying causes Earth to be overwhelmed by Fire, intensifying heat, leading to anorexia, fever, restlessness, and thirst. If physicians continue to administer drying agents, facial edema worsens, leading to Spleen failure and swelling of the dorsum of hands and feet. The dorsum of hands and feet, along with umbilical protrusion, are external signs of the Spleen. If purgatives are used abruptly without first resolving the exterior, edema may temporarily subside after one bowel movement. People mistakenly attribute this to the power of purgation, not realizing that purging further weakens the Spleen. Within ten days to a month, the swelling returns to its original state. This occurs because people only know that purging reduces swelling best, ignoring the principle of "ten tonifications rather than one purge." Treatment should follow seasonal variations, resolving the exterior and promoting diuresis. In spring, use Qibao San [Seven Treasures Powder] added with Mahuang [Ephedrae Herba], Guizhi [Cinnamomi Ramulus], and Chifuling [Poria with Red Core], decocted with water, ginger, and scallion. In summer, use Wu Ling San [Five Ingredient Powder with Poria] added with Mahuang, Cheqianzi [Plantaginis Semen], and Yiyiren [Coicis Semen]. In autumn, use Qingfei Yin [Lung-Clearing Infusion] added with Qianghuo [Notopterygii Rhizoma et Radix], Xixin [Asari Radix et Rhizoma], and Shanglu [Phytolaccae Radix]. In winter, use Chonghe Yin [Harmonizing Infusion] added with Baizhu [Atractylodis Macrocephalae Rhizoma], Sheng Chuanwu [Aconiti Kusnezoffii Radix Preparata], and Chixiaodou [Vigna Angularis Semen]. These three prescriptions are decocted with water, ginger, and scallion. Additionally, Zirun Jiupi Daoshui Tang [Moistening and Spleen-Saving Water-Guiding Decoction] should be used for渗泄 (percolation and drainage). Frequent administration of Xianglu Weiling Wan [Fragrant Phytolacca and Cangzhu Weiling Pill] and Chi Cang Yin [Red and Atractylodes Infusion] will naturally bring relief. As stated in the *Neijing* (*Inner Canon*): "Open the ghost gate" (i.e., induce sweating), "Cleanse the clean mansion" (i.e., promote urination), balance and weigh appropriately, aiming for equilibrium. This refers to such cases. Some patients present with phlegm, cough, asthma, and urinary obstruction upon initial swelling, indicating involvement of the Lung and Kidney. First, administer Jiebiao San [Exterior-Resolving Powder], followed by Sanbai San [Three Whites Powder]. For milder cases, Shanglu Wan [Phytolacca Pill] is appropriate. Thus, the classics state: "For those high up, cause them to vomit," meaning emesis; "For those low down, drain them completely," meaning percolation and drainage. This disease does not arise overnight; reckless medicines should not be used for quick results, which could lead to collapse. If wind pathogens are contracted again after recovery, causing facial puffiness, Paifeng Tang [Wind-Expelling Decoction] should be used for harmonization, along with the previous Jiupi Tang [Spleen-Saving Decoction], to prevent recurrence. Dietary taboos include salt, soy sauce, pickles, and wet noodles, all salty foods that exacerbate water retention, as well as other raw, cold, or toxic substances. Severe cases take half a year; mild cases take three months. Only when the Spleen and Stomach recover, swelling subsides, and Qi becomes robust, should roasted salt be gradually introduced into the diet to prevent relapse. Therefore, Liu states: Treating edema is not easy, and nourishment is even more difficult. Taboos must be carefully observed. For chronic cases that do not resolve, Jun Chuan Wan [Jun Chuan Pill] is effective.