陆 经停一载有余，肝气不时横逆，胸脘胁肋疼痛，呕吐酸水，大腹日满，青筋绽露，此属血臌。盖由肝
气错乱于中，脾土受困，血海凝瘀，日积月大，状如怀子，而实非也。今病已极深，药力恐难见效。
川楝子 丹参 归尾 香附（盐水炒） 延胡索 五灵脂（酷炒） 陈皮 砂仁 红花 淡吴萸
朱 肿胀已退，脉象较前稍大，汗出至膝而止。阳气有流通之象，阴湿有消化之机。今以温理中州，中州得
运，庶几决渎流通，寒转为温，否转为泰矣。然须调养百日，庶无反复之虞。
熟附子 冬术 茯苓 通草 桂枝 焦六曲 牛膝 陈皮 泽泻 姜皮
又 肿胀由乎脾肾，阳虚水湿偏淫。通阳化湿水邪平，方法原为对证。面目四肢俱瘪，单单大腹膨
，更兼遗泄再伤阴，久病恐难胜任。
桂枝 陈皮 冬瓜皮 益智仁 姜皮
另∶六味丸三钱，药汁送下。
王 湿热素伏下焦，皮肤顽癣。近感风邪着腠理，陡然寒热，面目上部先肿，蔓延中下，今大腹阴囊足胫
悉肿。据云阳物暴缩，足冷，似属阴寒，然鼻中热气上冲，此乃阳被湿郁，气不
宣通，非阳衰可比。夫诸湿肿满，皆属于脾，而肺主一身气化，俾得肺气宣通，斯风与湿自然而解。
射干 杏仁 大腹皮 苡仁 茯苓 泽泻 桑白皮 冬瓜子 通草 丝瓜络 沉香 琥珀 枇杷叶
渊按∶阳被湿遏，肺气不得宣通，乃麻黄连翘赤小豆汤为的对。五皮饮虽加杏仁、射干，恐仍不能开泄肺表。
复 鼻头色微黑者，有水气。腹满足浮囊肿，水泛而侮土也。腹中气攻胀痛，土虚则木横也。欲泄水，
必崇土；欲平气，必疏木。
吴萸炒川连 沉香 白术 葶苈子 茯苓 大腹皮 香附 陈皮 川朴 泽泻
渊按∶中焦阳气伤矣，左金非崇土之方。肺失通调，膀胱不化，何不用桂枝，且能疏木。
复 面黧腹肿，脉沉而细。此脾肾之阳不化，水湿阻滞于中。症防加剧，姑且渗湿通阳。
肉桂炒白芍 茯苓 猪苓 白术 大腹皮 细辛 泽泻 川朴 陈皮 焦六曲 麦芽 香橼皮
金 风湿相搏，一身悉肿，咽痛发热，咳而脉浮，拟越脾法。
麻杏甘石加赤苓、腹皮、通草。
复 风水者，在表之风邪与在里之水湿合而为病也。其症头面肢体浮肿，必兼咳嗽，故为风水。更兼食积，
其腹必满。三焦不利，法当开上、疏中、达下治之。
羌活 防风 枳壳 杏仁 大腹皮 川朴 茯苓 橘红 泽泻 莱菔子 桑皮 青葱 生姜
渊按∶羌、防不如麻黄，专开手太阴之风水。故古人有越脾、麻黄赤豆等治表实肿胀，无羌、防等方也。
细参本草，自无此等杂治。
冯 产后数十日，忽发肝风，心荡不寐，继以血崩。今周身浮肿，气逆不得安卧，头眩，口不渴，病势
夜重，血虚气胜，木旺土弱也。土弱不制水，水反侮土。土既受木克，又被水侮，是
为重虚。欲培土，先补火，佐以泄木。即《内经》虚者补之，盛者泻之之义。
肉桂 冬术 茯苓 泽泻 大腹皮 木香 陈皮 炮姜 神曲 通草 血珀
渊按∶温而不燥，补而不滞，和养肝脾之气，以招失亡之血，其胀自消。
秦 腹胀足肿，纳食则胀益甚。湿热挟气，填塞太阴，臌胀重症。
川朴 赤苓 大腹皮 青皮 泽泻 枳壳 黑丑 山楂炭 甘遂（面包煨） 通草 生姜
复 腹胀稍宽，足仍浮肿。运脾化湿，冀其渐平。
川朴 赤苓 大腹皮 川椒目 苍术 泽泻 陈皮 焦六曲 黑丑 通草 枳壳 生姜
渊按∶二方乃湿热实胀治法。
三诊 腹盈月余，得食则胀甚。两进攻消运脾之法，胃脘之胀已松，大腹之满未化，再议疏通消导。
旋复花 五加皮 赤苓 泽泻 槟榔 黑丑 鸡内金 木香 通草 砂仁
朱 腹满，面黄，足肿。近因戽水受寒，又加疝痛。脾虚有湿，肾虚有寒。防其疝气上攻，大腹益满。
平胃散去甘草，加茯苓、小茴香、神曲、吴茱萸。
杨 脉沉，小便不利，面目肢体大腹阴囊悉肿，病属里水。鼻中流血，喉间略痛，肺家有郁热也。拟越婢汤。
蜜炙麻黄 杏仁 甘草 石膏 白术 赤苓 泽泻 陈皮 防己 淡芩
复 水湿侵入经络，外溢肌肉。发汗利水诸法，效而不愈。今拟通阳渗泄。
五苓散加巴戟肉、川朴、车前子、陈皮、牛膝、五加皮、大腹皮、姜皮。
王 病后脾虚气滞，浮肿食少，大便溏泄，法当温脾。
党参 茯苓 泽泻 木香 冬术 炮姜 茯神 神曲 砂仁 谷芽
张 痢后阳虚，水湿不化，腹满面浮足肿，而色青黄，脉来虚细。虑延臌胀重症。
川熟附 猪苓 茯苓 白术 党参 上肉桂 泽泻 陈皮 神曲 砂仁
又 温通脾肾之阳，疏利决渎之气，冀其胀消肿退。
熟附子 肉桂 白术 猪苓 泽泻 茯苓皮 冬瓜皮 川朴 陈皮 通草
渊按∶两方治半虚半实，乃通阳泄水法。
尤 脾虚木横，腹中结癖，寒热似疟，延及半载。惟脾虚则营卫不和，故寒热；惟肝横则气血凝滞，
故结瘕。今食少便溏，舌红口渴，大腹日满，足跗浮肿，形肉瘦削，脾肾阴阳两伤。际
此火亢金衰之候，火亢则阴益虚，金衰则木无制，深秋水土败时，虑其增剧。急宜健运和中，稍兼消暑。
喻嘉言所谓刚中柔剂，能变胃而不受胃变。此法是矣。冀其脾胃稍醒为吉。
连理汤加陈皮。
朱 时令水湿内袭，与身中素有之湿热相合，骤然浮肿，充斥上下三焦。拟宣表泻里之法，以消其水。
香薷 川朴 通草 大腹皮 赤苓 泽泻 杏仁 滑石 车前子 莱菔子 葶苈子 葱白头
某 痞块由大疟日久而结，多因水饮痰涎与气相搏而成。久则块散腹满，变为臌胀，所谓癖散成臌也。
脉细如丝，重按至骨乃见弦象，是肝木乘脾也。口干，小便短少，是湿热不运也。匝
月腹日加大，急宜疏通水道，泄木和中。
五苓散加川朴、姜汁炒川连、青皮、陈皮、大腹皮、木香、车前子、通草。
附∶浓朴散
川朴（姜汁炒，三钱） 枳壳（三钱，巴豆七粒合炒黄，去巴豆） 木香（晒干，
研，三钱） 青皮（醋炒，三钱） 陈皮（盐水炒，三钱） 甘遂（面包煨，三钱） 大戟
（水浸，晒干，炒，三钱） 干姜（炒黄，三钱）
共为末。每服一钱，用砂仁、车前子泡汤调下。是治癖块散大成臌之妙剂。
渊按∶此方诚妙。但可施正气不虚者。若久病及老年气血衰弱之人，恐目前稍松，转瞬而胀益甚，
将不可治，用者宜审慎之。
僧 水肿自下而起，腿足阴囊，大腹胸膈，泛滥莫御。今先从上泻下。肺主一身之气，又曰水出高源，
古人开鬼门，洁净府，虽从太阳，其实不离乎肺也。
葶苈子 杏仁 川朴 陈皮 茯苓 川椒目 生姜 大枣
控涎丹，每日服五分。
渊按∶水肿实证，治法如是。经云∶其本在肾，其末在肺。葶苈泻肺，椒目泻肾。控涎丹不及舟车丸合拍。
某 暑湿伏邪挟积，阻滞肠胃，中州不运，大腹骤满，腹中
时痛，痛则大便粘腻，色红如痢，小水短少。脉沉滑数，是积之征也。拟大橘皮汤送下木香槟榔丸。
四苓散加橘红、大腹皮、木香、木通、滑石、砂仁末、川朴。煎汤送木香槟榔丸三钱。
又 气与水相搏，大腹骤满，脉沉，小便不利，大便欲泄不泄。法以疏气逐水。
香薷 大茴香 泽泻 莱菔子 赤苓 大戟 甘遂 枳壳 黑白丑 生姜
王 内有湿热，外着风邪，风与水搏，一身悉肿。此属风水。当发汗。
羌活 香薷 陈皮 防风 赤芩 焦六曲 通草 葱白 生姜
某 腹但胀而不满者，属气，乃木乘脾土也。
川连（姜汁炒） 香附 砂仁 川朴 青皮 焦六曲 怀山药 茯苓 陈皮 泽泻
渊按∶黄连治胀，乃开中州湿热也。土虚木乘之胀，大非所宜。
陆 疟后湿热内蕴，脾胃之气不利，为口糜，为腹胀。姑先和中清化为法。
川朴 川连 焦六曲 赤苓 大腹皮 枳壳 泽泻 黑山栀 陈皮 砂仁
渊按∶连、朴此证甚合。
张 木旺乘脾，腹胀如鼓，形瘦脉细，症属瘅胀。法当温通。
淡干姜 茯苓 川朴 砂仁 怀山药 吴茱萸 陈皮 泽泻 大腹皮
金匮肾气丸五钱，开水送。
渊按∶虚胀治法，以川朴易党参则善。
陶 年甫十三，断无忧郁之理，而腹满如臌，微微内热，将及两月，其义何居？良以童心太甚，饥饱不
调，冷热不节，向有胃寒呕酸之疾，今反不呕，腹渐胀大，饮食不纳，内热时生。是非劳碌伤脾而失运，
寒饮停聚而腹胀也。脾虚故内热生，单单腹胀，名之单胀，然治法不同也。今以温利中州，稍佐苦泄，取柔
中之刚，能平胃而和脾。
党参 茯苓 半夏 陈皮 白芍 川连（吴萸炒） 炮姜 泽泻 川朴 冬瓜皮
渊按∶饮食不节伤脾胀，宜佐消导，如鸡金、谷虫之类。
孙 疮疥平面浮起，渐至腹满，胸闷气塞，小便不利，肿势日甚。水湿之气，一无出路，证成疮臌，防加
气急。发汗而利小便，是两大法门。
麻黄 杏仁 白术 泽泻 茯苓 猪苓 葶苈子 川朴 通草 车前子 姜皮
又 肿势已平，小便通利。前方加减。
防风 白术 半夏 茯苓 陈皮 泽泻 杏仁 川朴 通草 葶苈子 车前子 葱白头 姜皮
孙 脾虚胀满，面浮足肿，小便不利。脉形细数，元气大亏。虑其喘急之变。
党参（元米炒） 牛膝 茯苓 巴戟肉 陈皮 泽泻（盐水炒） 车前子 冬术（土炒） 怀
山药 苡仁 杞子炭 生熟谷芽
沈 先泄泻而后目盲。服单方，目明而渐腹满，是脾虚木横。又服草药，寒性伤中，病成臌胀。其根
已久，恐难骤效。
焦白术 冬瓜皮 川朴 茯苓 陈皮 焦六曲 大腹皮 泽
泻砂仁 苡仁 陈香橼皮
杨 两尺脉滑，湿热积滞在于下焦。小便不利，大腹胀满，是下焦不利，中焦气不通也。
肉桂 赤苓 猪苓 白术 泽泻 大戟 神曲 陈皮 冬瓜皮 姜皮
冯 风水相搏，一身面目悉肿，咳嗽，气升不得卧。症势险重，用越婢法。
麻黄 生甘草 杏仁 石膏 赤苓 泽泻 陈皮 葶苈子 大腹皮 生姜 大红枣
又 用越婢法，虽得微汗，手肿稍退，余肿未消，咳嗽气急，良由劳碌之人，脾胃不足，急不行运。
今以扶脾和中理气，宣达三焦，冀其气化流通。
冬术 生 皮 大腹皮 防己 陈皮 防风 茯苓皮 冬瓜皮 姜皮
何 内有湿热生疮，外受风寒浮肿。风湿相搏，症成疮臌。防加喘急。
防风 羌活 杏仁 大腹皮 橘红 赤苓 桔梗 荆芥 川朴 桑叶 通草
杜 风水相搏，一身暴肿，上则咳嗽，喉有痰声，下则溏泄，小便不利。发汗而利小便，是其大法。
计不出此，迁延匝月，节近清明，天气温暖，肺胃久蕴之风，从中暗化为热。反服肾气汤
方，意欲通阳化水，阳未通而阴先劫，水未化而火反起矣。于是舌燥唇焦齿黑，心烦囊缩，胸腹肤红，
危险之象，已造极中之极。勉拟清肃肺胃，存阴泄热，以冀转机为幸。
生石膏 杏仁 通草 茯苓皮 豆豉 北沙参 麦冬 川贝 丹皮 芦根 鲜薄荷根
绿豆汤代水。
又 肺得热而不降，肝有火而上升，胃居于中，受肝火之冲激，欲降不能而反上逆，由是呕吐不纳矣。
昨用清金以通决渎，幸水道已通，高原得清肃之令。然中焦格拒，艮阳失游溢之权，
似宜转运其中。但肝火炽甚，徒运其中无益也。当清肝之亢，以衰木火之威，胃不受肝之克，而中气得和，
则呕可以宁矣。
川连（姜汁炒） 黄芩（姜汁炒） 半夏 泽泻 陈皮 黑山栀 竹茹（姜汁炒） 茯苓皮 川贝 芦根 枇杷叶
当归龙荟丸（三钱） 绿豆生姜汤送下。
渊按∶风水坏证也。两方应变俱佳。
尤 疟止之后，腹胀足肿，湿热内归太阴，防成疟臌。但小便清利，是属脾虚。拟浓朴温中汤加味。
川朴 茯苓 陈皮 干姜 草豆蔻 木香 半夏 冬瓜皮 姜皮
廉 脾有湿热积气，渐渐腹满足肿，纳食则胀，证成气臌。
白茯苓 川朴 白术 苡仁 苏梗 五加皮 泽泻 陈皮 砂仁 通草
奚 湿热内阻肠胃之间，横连膜原。膜原者，脏腑之外，肌肉之内，膈膜之所舍，三焦决渎之道路，邪
留不去，是为肿胀。胀属气，肿属水。是必理气而疏决渎，以杜肿胀之萌。
黑白丑（各五钱） 莱菔子（一两） 砂仁（一两）
用葫芦大者一枚，将三味纳入，再入陈酒一大杯，隔汤煎一柱香。取出葫芦中药，炒研为末，再以葫芦
炙炭共研和。每晨服二钱。
惠 湿伤脾肾之阳，先腰痛而后足肿，脘中作痛，口沃酸水。用甘姜苓术汤合五苓散加味。
甘草 干姜 茯苓 白术 猪苓 泽泻 肉桂 半夏 陈皮 通草 五加皮
渊按∶沃酸一证，《内经》言热，东垣言寒，究竟辛通药最效。
又 前用辛温通阳，甘淡祛湿，脘痛，足肿，呕酸等症皆除，惟跗肿未退。减其制以调之。
白术 茯苓 泽泻 川断 苡仁 牛膝 陈皮 通草 桑白皮 五加皮
陆姓患者，停经一年多。肝气不时横逆（肝气不舒，横窜胁肋），导致胸脘及胁肋疼痛，呕吐酸水，大腹每日胀满，腹部青筋暴露，这属于血臌（因瘀血阻滞引起的腹部胀大）。这是因为肝气在中焦错乱，脾土受到困阻，血海凝滞成瘀，日积月累腹部变大，状如怀孕，但实际上并非如此。如今病情已经极深，药力恐怕难以见效。
川楝子 丹参 当归尾 香附（盐水炒） 延胡索 五灵脂（醋炒） 陈皮 砂仁 红花 淡吴茱萸
朱姓患者，肿胀已经消退，脉象比之前稍大，出汗到膝盖处停止。这是阳气有流通的迹象，阴湿之气有消散的转机。现在用温补调理中焦脾胃的方法，如果中焦脾胃能够运化，那么水道自然流通，寒气转为温煦，否塞转为通泰。但是需要调养一百天，才没有反复的忧虑。
熟附子 冬术（白术） 茯苓 通草 桂枝 焦六曲（神曲） 牛膝 陈皮 泽泻 姜皮
又诊：肿胀源于脾肾，阳虚导致水湿偏盛泛滥。通阳化湿以平复水邪，方法原本是对症的。但是面目四肢都消瘦瘪陷，只有大腹膨隆，再加上遗精滑泄再次损伤阴液，久病恐怕难以胜任治疗。
桂枝 陈皮 冬瓜皮 益智仁 姜皮
另服：六味地黄丸三钱，用药汁送下。
王姓患者，湿热素来潜伏在下焦，皮肤患有顽固癣疾。近期感受风邪侵袭腠理，突然寒热交替，面目上部先开始肿胀，蔓延至中部和下部，如今大腹、阴囊、足胫全部肿胀。据患者说阴茎突然收缩，脚冷，似乎属于阴寒证，但是鼻中有热气上冲，这是阳气被湿气郁遏，气机不能宣通，不是阳气衰微可比拟的。各种湿肿胀满，都属于脾，而肺主一身的气化，使得肺气宣通，那么风邪与湿气自然就能解除。
射干 杏仁 大腹皮 薏苡仁 茯苓 泽泻 桑白皮 冬瓜子 通草 丝瓜络 沉香 琥珀 枇杷叶
渊按：阳气被湿气遏制，肺气不能宣通，这正是麻黄连翘赤小豆汤的对证方剂。五皮饮虽然加了杏仁、射干，恐怕仍然不能开泄肺表。
复诊：鼻头颜色微黑的人，体内有水气。腹部胀满且足部浮肿囊肿，是水湿泛滥反侮脾土。腹中气攻胀痛，是脾土虚弱则肝木横逆。想要泄水，必须崇厚脾土；想要平息气逆，必须疏泄肝木。
吴茱萸炒黄连 沉香 白术 葶苈子 茯苓 大腹皮 香附 陈皮 厚朴 泽泻
渊按：中焦阳气受损了，左金丸不是崇厚脾土的方剂。肺失通调，膀胱不化，为何不用桂枝，且桂枝还能疏泄肝木。
复诊：面色黧黑腹部肿胀，脉沉而细。这是脾肾之阳不能气化，水湿阻滞于中焦。症状担心加剧，暂且采用渗湿通阳的方法。
肉桂炒白芍 茯苓 猪苓 白术 大腹皮 细辛 泽泻 厚朴 陈皮 焦六曲 麦芽 香橼皮
金姓患者，风湿相搏，全身都肿胀，咽痛发热，咳嗽且脉浮，拟用越婢汤法。
麻黄杏仁甘草石膏汤加赤茯苓、大腹皮、通草。
复诊：风水病，是在表的风邪与在里的水湿合而为病。其症状是头面肢体浮肿，必定兼有咳嗽，所以称为风水。更兼有食积，腹部必然胀满。三焦不利，治法应当开上焦、疏中焦、达下焦进行治疗。
羌活 防风 枳壳 杏仁 大腹皮 厚朴 茯苓 橘红 泽泻 莱菔子 桑白皮 青葱 生姜
渊按：羌活、防风不如麻黄，麻黄专开手太阴肺经的风水。所以古人有用越婢汤、麻黄赤小豆汤等治疗表实肿胀，而没有用羌活、防风等的方子。仔细研究本草，自然不会有这种杂乱的治疗。
冯姓患者，产后几十天，忽然发作肝风，心神荡漾失眠，继而出血崩漏。如今周身浮肿，气逆不能安卧，头晕目眩，口不渴，病情夜间加重，这是血虚气盛，肝木旺盛脾土虚弱。脾土虚弱不能制水，水反而反侮脾土。脾土既受肝木克制，又被水湿反侮，这是重虚。想要培补脾土，先要补火（补肾阳），佐以泄木（疏肝）。即《内经》中“虚者补之，盛者泻之”的意义。
肉桂 冬术 茯苓 泽泻 大腹皮 木香 陈皮 炮姜 神曲 通草 血珀
渊按：温而不燥，补而不滞，调和滋养肝脾之气，以招摄流失之血液，其胀自然消除。
秦姓患者，腹胀足肿，进食后胀感更加严重。湿热挟带气机，填塞太阴脾经，属于臌胀重症。
厚朴 赤茯苓 大腹皮 青皮 泽泻 枳壳 黑丑（牵牛子） 山楂炭 甘遂（面包煨） 通草 生姜
复诊：腹胀稍微宽缓，足部仍然浮肿。运脾化湿，希望其逐渐平复。
厚朴 赤茯苓 大腹皮 川椒目 苍术 泽泻 陈皮 焦六曲 黑丑 通草 枳壳 生姜
渊按：这两个方子是治疗湿热实胀的方法。
三诊：腹部盈满一个多月，得食则胀甚。两次使用攻消运脾的方法，胃脘部的胀感已经缓解，但大腹部的满闷未消除，再议疏通消导之法。
旋覆花 五加皮 赤茯苓 泽泻 槟榔 黑丑 鸡内金 木香 通草 砂仁
朱姓患者：腹部胀满，面色黄，足肿。近期因为戽水受寒，又加上疝痛。脾虚有湿，肾虚有寒。防止疝气上攻，导致大腹更加胀满。
平胃散去掉甘草，加茯苓、小茴香、神曲、吴茱萸。
杨姓患者：脉沉，小便不利，面目肢体大腹阴囊全部肿胀，病属里水。鼻中流血，喉间略微疼痛，肺家有郁热。拟用越婢汤。
蜜炙麻黄 杏仁 甘草 石膏 白术 赤茯苓 泽泻 陈皮 防己 淡黄芩
复诊：水湿侵入经络，外溢肌肉。发汗利水诸法，有效但未痊愈。现在拟用通阳渗泄的方法。
五苓散加巴戟天肉、厚朴、车前子、陈皮、牛膝、五加皮、大腹皮、姜皮。
王姓患者：病后脾虚气滞，浮肿食少，大便溏泄，治法应当温补脾脏。
党参 茯苓 泽泻 木香 冬术 炮姜 茯神 神曲 砂仁 谷芽
张姓患者：痢疾后阳虚，水湿不化，腹满面浮足肿，面色青黄，脉来虚细。担心拖延成臌胀重症。
川熟附子 猪苓 茯苓 白术 党参 上肉桂 泽泻 陈皮 神曲 砂仁
又诊：温通脾肾之阳，疏利决渎之气，希望其胀消肿退。
熟附子 肉桂 白术 猪苓 泽泻 茯苓皮 冬瓜皮 厚朴 陈皮 通草
渊按：两个方子治疗半虚半实证，是通阳泄水法。
尤姓患者：脾虚肝木横逆，腹中结块癖积，寒热似疟，拖延半年。只有脾虚则营卫不和，所以寒热；只有肝气横逆则气血凝滞，所以结瘕。如今食少便溏，舌红口渴，大腹每日胀满，足背浮肿，形体肌肉瘦削，脾肾阴阳两伤。正值火亢金衰的时候，火亢则阴更虚，金衰则木无制约，深秋水土败坏之时，担心病情加剧。急宜健运和中，稍兼消暑。
喻嘉言所说的刚中柔剂，能改变胃的功能而不被胃所改变。这个方法是正确的。希望其脾胃稍醒为吉。
连理汤加陈皮。
朱姓患者：时令水湿内袭，与身体中素有之湿热相合，骤然浮肿，充斥上下三焦。拟用宣表泻里的方法，以消除水气。
香薷 厚朴 通草 大腹皮 赤茯苓 泽泻 杏仁 滑石 车前子 莱菔子 葶苈子 葱白头
某姓患者：痞块由长期疟疾日久结聚而成，多因水饮痰涎与气相搏结而成。久了则块散腹满，变为臌胀，所谓癖散成臌。
脉细如丝，重按至骨乃见弦象，这是肝木乘脾。口干，小便短少，是湿热不运。一个月腹部日益加大，急宜疏通水道，泄木和中。
五苓散加厚朴、姜汁炒黄连、青皮、陈皮、大腹皮、木香、车前子、通草。
附：浓朴散
厚朴（姜汁炒，三钱） 枳壳（三钱，与巴豆七粒合炒黄，去巴豆） 木香（晒干研，三钱） 青皮（醋炒，三钱） 陈皮（盐水炒，三钱） 甘遂（面包煨，三钱） 大戟（水浸晒干炒，三钱） 干姜（炒黄，三钱）
共为末。每服一钱，用砂仁、车前子泡汤调下。这是治疗癖块散大成臌的妙剂。
渊按：此方确实巧妙。但只可施用于正气不虚者。如果是久病及老年气血衰弱之人，恐怕目前稍松，转瞬之间胀感更加严重，将不可治，使用者宜审慎。
僧人：水肿自下而起，腿足阴囊，大腹胸膈，泛滥无法控制。如今先从上面泻下面。肺主一身之气，又说水出高源，古人开鬼门（发汗）、洁净府（利小便），虽然从太阳经论治，其实不离乎肺。
葶苈子 杏仁 厚朴 陈皮 茯苓 川椒目 生姜 大枣
控涎丹，每日服五分。
渊按：水肿实证，治法如此。经文说：其本在肾，其末在肺。葶苈子泻肺，椒目泻肾。控涎丹不及舟车丸配合得当。
某姓患者：暑湿伏邪挟带积滞，阻滞肠胃，中焦不运，大腹骤然胀满，腹中时时疼痛，痛则大便粘腻，色红如痢疾，小便短少。脉沉滑数，这是积滞的征象。拟用大橘皮汤送下木香槟榔丸。
四苓散加橘红、大腹皮、木香、木通、滑石、砂仁末、厚朴。煎汤送木香槟榔丸三钱。
又诊：气与水相搏，大腹骤然胀满，脉沉，小便不利，大便想拉拉不出。治法以疏气逐水。
香薷 大茴香 泽泻 莱菔子 赤茯苓 大戟 甘遂 枳壳 黑白丑 生姜
王姓患者：内有湿热，外着风邪，风与水搏，全身都肿胀。这属于风水。应当发汗。
羌活 香薷 陈皮 防风 赤茯苓 焦六曲 通草 葱白 生姜
某姓患者：腹部只是胀而不满的，属于气病，是肝木乘脾土。
黄连（姜汁炒） 香附 砂仁 厚朴 青皮 焦六曲 怀山药 茯苓 陈皮 泽泻
渊按：黄连治胀，是开通中焦湿热。对于土虚木乘的胀满，非常不适合。
陆姓患者：疟疾后湿热内蕴，脾胃之气不利，导致口糜，腹胀。暂且先以和中清化为法。
厚朴 黄连 焦六曲 赤茯苓 大腹皮 枳壳 泽泻 黑山栀 陈皮 砂仁
渊按：黄连、厚朴对此证很合适。
张姓患者：肝木旺盛乘脾，腹胀如鼓，形体瘦脉细，症属瘅胀。治法应当温通。
淡干姜 茯苓 厚朴 砂仁 怀山药 吴茱萸 陈皮 泽泻 大腹皮
金匮肾气丸五钱，开水送服。
陶姓患者：年仅十三岁，断无忧郁之理，但腹部胀满如臌，微微内热，将近两个月，这是什么道理？大概是因为童心太甚，饥饱不调，冷热不节，向来有胃寒呕酸的疾病，如今反而不呕，腹部渐大，饮食不纳，内热时生。这不是劳碌伤脾而失运，就是寒饮停聚而腹胀。脾虚故内热生，单单腹胀，名为单胀，然而治法不同。现在用温利中焦，稍佐苦泄，取柔中之刚，能平胃而和脾。
党参 茯苓 半夏 陈皮 白芍 黄连（吴茱萸炒） 炮姜 泽泻 厚朴 冬瓜皮
孙姓患者：疮疥平面浮起，渐至腹满，胸闷气塞，小便不利，肿势日益严重。水湿之气，一无出路，证成疮臌，防止加重气喘。发汗而利小便，是两大法门。
麻黄 杏仁 白术 泽泻 茯苓 猪苓 葶苈子 厚朴 通草 车前子 姜皮
又诊：肿势已平，小便通利。前方加减。
防风 白术 半夏 茯苓 陈皮 泽泻 杏仁 厚朴 通草 葶苈子 车前子 葱白头 姜皮
孙姓患者：脾虚胀满，面浮足肿，小便不利。脉形细数，元气大亏。担心其发生喘急的变化。
党参（元米炒） 牛膝 茯苓 巴戟天肉 陈皮 泽泻（盐水炒） 车前子 冬术（土炒） 怀山药 薏苡仁 杞子炭 生熟谷芽
沈姓患者：先泄泻而后目盲。服用单方，眼睛明亮了但渐渐腹满，这是脾虚肝木横逆。又服用草药，寒性伤中，病成臌胀。其根已久，恐怕难有速效。
焦白术 冬瓜皮 厚朴 茯苓 陈皮 焦六曲 大腹皮 泽泻 砂仁 薏苡仁 陈香橼皮
杨姓患者：两尺脉滑，湿热积滞在于下焦。小便不利，大腹胀满，是下焦不利，中焦气不通。
肉桂 赤茯苓 猪苓 白术 泽泻 大戟 神曲 陈皮 冬瓜皮 姜皮
冯姓患者：风水相搏，一身面目全部肿胀，咳嗽，气升不能卧。症势险重，用越婢汤法。
麻黄 生甘草 杏仁 石膏 赤茯苓 泽泻 陈皮 葶苈子 大腹皮 生姜 大红枣
又诊：用越婢汤法，虽然得到微汗，手肿稍退，其余肿胀未消，咳嗽气急，良由劳碌之人，脾胃不足，急不行运。现在以扶脾和中理气，宣达三焦，希望其气化流通。
冬术 生姜 大腹皮 防己 陈皮 防风 茯苓皮 冬瓜皮 姜皮
何姓患者：内有湿热生疮，外受风寒浮肿。风湿相搏，症成疮臌。防止加重气喘。
防风 羌活 杏仁 大腹皮 橘红 赤茯苓 桔梗 荆芥 厚朴 桑叶 通草
杜姓患者：风水相搏，全身暴肿，上则咳嗽，喉有痰声，下则溏泄，小便不利。发汗而利小便，是其大法。
计不出此，迁延一个月，节近清明，天气温暖，肺胃久蕴之风，从中暗化为热。反而服用肾气汤方，意欲通阳化水，阳未通而阴先劫，水未化而火反起矣。于是舌燥唇焦齿黑，心烦囊缩，胸腹肤红，危险之象，已造极中之极。勉拟清肃肺胃，存阴泄热，以冀转机为幸。
生石膏 杏仁 通草 茯苓皮 豆豉 北沙参 麦冬 川贝母 丹皮 芦根 鲜薄荷根
绿豆汤代水。
又诊：肺得热而不降，肝有火而上升，胃居于中，受肝火之冲激，欲降不能而反上逆，由此呕吐不纳。昨天用清金以通决渎，幸水道已通，高原得清肃之令。然中焦格拒，艮阳失游溢之权，似宜转运其中。但肝火炽甚，徒运其中无益也。当清肝之亢，以衰木火之威，胃不受肝之克，而中气得和，则呕可以宁矣。
黄连（姜汁炒） 黄芩（姜汁炒） 半夏 泽泻 陈皮 黑山栀 竹茹（姜汁炒） 茯苓皮 川贝母 芦根 枇杷叶
当归龙荟丸（三钱） 绿豆生姜汤送下。
尤姓患者：疟止之后，腹胀足肿，湿热内归太阴，防成疟臌。但小便清利，是属脾虚。拟用浓朴温中汤加味。
厚朴 茯苓 陈皮 干姜 草豆蔻 木香 半夏 冬瓜皮 姜皮
廉姓患者：脾有湿热积气，渐渐腹满足肿，纳食则胀，证成气臌。
白茯苓 厚朴 白术 薏苡仁 苏梗 五加皮 泽泻 陈皮 砂仁 通草
奚姓患者：湿热内阻肠胃之间，横连膜原。膜原者，脏腑之外，肌肉之内，膈膜之所舍，三焦决渎之道路，邪留不去，是为肿胀。胀属气，肿属水。是必理气而疏决渎，以杜肿胀之萌。
黑白丑（各五钱） 莱菔子（一两） 砂仁（一两）
用葫芦大者一枚，将三味纳入，再入陈酒一大杯，隔汤煎一柱香。取出葫芦中药，炒研为末，再以葫芦炙炭共研和。每晨服二钱。
惠姓患者：湿伤脾肾之阳，先腰痛而后足肿，脘中作痛，口沃酸水。用甘姜苓术汤合五苓散加味。
甘草 干姜 茯苓 白术 猪苓 泽泻 肉桂 半夏 陈皮 通草 五加皮
又诊：前用辛温通阳，甘淡祛湿，脘痛，足肿，呕酸等症皆除，惟跗肿未退。减其制以调之。
白术 茯苓 泽泻 川断 薏苡仁 牛膝 陈皮 通草 桑白皮 五加皮
Patient Lu: Amenorrhea for over a year. Liver Qi occasionally rebels horizontally (Liver Qi stagnation and rebellion), causing pain in the chest, epigastrium, and hypochondrium, vomiting of sour fluid, daily abdominal distension, and exposed abdominal veins. This belongs to Blood Distension (abdominal distension caused by blood stasis). It is due to Liver Qi disorder in the middle jiao, Spleen Earth being constrained, coagulation and stasis in the Sea of Blood, accumulating day by day until the abdomen enlarges like pregnancy, but it is not so. The disease is now extremely deep; medicinal power may hardly take effect.
Chuan Lian Zi (Fructus Toosendan), Danshen (Radix Salviae Miltiorrhizae), Gui Wei (Cauda Rosae Cinnamomoidis), Xiang Fu (Rhizoma Cyperi Rotundi, stir-fried with salt water), Yan Hu Suo (Rhizoma Corydalis), Wu Ling Zhi (Feces Trogopterori, stir-fried with vinegar), Chen Pi (Pericarpium Citri Reticulatae), Sha Ren (Fructus Amomi Rotundus), Hong Hua (Flos Carthami), Dan Wu Zhu Yu (Fructus Evodiae Officinalis).
Patient Zhu: Swelling has receded, pulse is slightly larger than before, sweating stops at the knees. This indicates Yang Qi has a tendency to circulate, and Yin-Dampness has a mechanism to dissipate. Now using warming and regulating the Middle Jiao (Spleen and Stomach) method; if the Middle Jiao can transport, then the Du Dao (water passages) will flow smoothly, cold turns to warmth, and obstruction turns to smoothness. However, one hundred days of recuperation are needed to avoid recurrence.
Shu Fu Zi (Radix Aconiti Lateralis Preparata), Dong Zhu (Bai Zhu, Rhizoma Atractylodis Macrocephalae), Fu Ling (Poria), Tong Cao (Medullia Tetrapanacis), Gui Zhi (Ramulus Cinnamomi Cassiae), Jiao Liu Qu (Massa Medicata Fermentata, charred), Niu Xi (Radix Achyranthis Bidentatae), Chen Pi, Ze Xie (Rhizoma Alismatis), Jiang Pi (Exocarpium Citri Reticulatae Viride).
Re-examination: Swelling stems from Spleen and Kidney; Yang deficiency leads to excessive water-dampness. Warming Yang to transform dampness and calm water pathogen is originally the correct method. However, the face, eyes, and limbs are all emaciated, only the great abdomen is distended, accompanied by seminal emission which further damages Yin. Chronic illness may be difficult to treat.
Gui Zhi, Chen Pi, Dong Gua Pi (Pericarpium Benincasae), Yi Zhi Ren (Fructus Alpiniae Oxyphyllae), Jiang Pi.
Separately: Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) 3 qian, taken with herbal decoction.
Patient Wang: Damp-Heat has been latent in the Lower Jiao, with stubborn skin tinea. Recently affected by Wind pathogen invading the Cou Li (pores and interstices), sudden chills and fever occurred. Swelling started on the upper part of the face and spread to the middle and lower parts. Now the great abdomen, scrotum, and shanks are all swollen. The patient reports sudden retraction of the penis and cold feet, seemingly indicating Cold-Yin pattern. However, hot air rushes up from the nose; this is Yang being depressed by Dampness, with Qi not circulating freely, not comparable to Yang deficiency. All dampness-induced swelling and fullness belong to the Spleen, while the Lung governs the Qi transformation of the whole body. If Lung Qi can circulate freely, Wind and Dampness will naturally resolve.
She Gan (Radix Belamcandae), Xing Ren (Semen Armeniacae Amarum), Da Fu Pi (Pericarpium Arecae), Yi Yi Ren (Semen Coicis), Fu Ling, Ze Xie, Sang Bai Pi (Cortex Mori Radicis), Dong Gua Zi (Semen Benincasae), Tong Cao, Si Gua Luo (Retinervus Luffae Fructus), Chen Xiang (Lignum Aquilariae Resinatum), Hu Po (Electrum), Pi Pa Ye (Folium Loropetal Chinensis var. yunnanense).
Yuanyuan's Note: Yang being suppressed by Dampness, Lung Qi unable to circulate freely, makes Ma Huang Lian Qiao Chi Xiao Dou Tang (Ephedra, Forsythia, and Red Bean Decoction) the precise formula. Although Wu Pi Yin (Five-Peel Powder) adds Xing Ren and She Gan, it may still fail to open and vent the Lung exterior.
Re-examination: A slightly black tip of the nose indicates Water Qi. Abdominal fullness with floating and cystic swelling of the legs indicates Water flooding and insulting Earth (Spleen). Gas attacking and painful distension in the abdomen indicates Earth deficiency leading to Wood rebellion (Liver overacting on Spleen). To drain water, one must strengthen Earth; to calm Qi, one must soothe Wood.
Wu Zhu Yu stir-fried with Chuan Lian (Coptidis Rhizoma), Chen Xiang, Bai Zhu, Ting Li Zi (Semen Lepidii seu Descurainiae), Fu Ling, Da Fu Pi, Xiang Fu, Chen Pi, Chuan Bo (Cortex Magnoliae Officinalis), Ze Xie.
Yuanyuan's Note: The Yang Qi of the Middle Jiao is damaged; Zuo Jin Wan (Left Metal Pill) is not a formula to strengthen Earth. With Lung failing to regulate and Bladder failing to transform, why not use Gui Zhi, which also soothes Wood?
Re-examination: Dark complexion and abdominal swelling, pulse deep and fine. This is Spleen-Kidney Yang failing to transform, with Water-Damp obstructing the middle. Symptoms fear worsening; temporarily employ draining dampness and unblocking Yang.
Rou Gui (Cortex Cinnamomi) stir-fried with Bai Shao (Radix Paeoniae Alba), Fu Ling, Zhu Ling (Poria cum Risus), Bai Zhu, Da Fu Pi, Xi Xin (Herba Asari), Ze Xie, Chuan Bo, Chen Pi, Jiao Liu Qu, Mai Ya (Semen Hordei Germinatum), Xiang Yuan Pi (Pericarpium Citri Reticulatae 'Chachi').
Patient Jin: Wind-Damp battling, whole body swollen, sore throat, fever, cough, and floating pulse. Proposing Yue Bi Fa (Yue Bi Method).
Ma Huang Tang (Ephedra Decoction) plus Chi Fu Ling (Red Poria), Fu Pi, Tong Cao.
Re-examination: Feng Shui (Wind Edema) is when exterior Wind pathogen combines with interior Water-Damp to cause disease. Symptoms include edema of head, face, and limbs, necessarily accompanied by cough, hence called Feng Shui. Additionally, with food retention, the abdomen must be full. San Jiao (Triple Burner) is blocked; the method should be opening the Upper, soothing the Middle, and reaching the Lower.
Qiang Huo (Rhizoma et Radix Notopterygii), Fang Feng (Radix Saposhnikoviae), Zhi Ke (Fructus Aurantii), Xing Ren, Da Fu Pi, Chuan Bo, Fu Ling, Ju Hong (Exocarpium Citri Reticulatae), Ze Xie, Lai Fu Zi (Semen Raphani), Sang Pi, Qing Cong (Scallion Stem), Sheng Jiang (Rhizoma Zingiberis Recens).
Yuanyuan's Note: Qiang Huo and Fang Feng are inferior to Ma Huang, which specifically opens Feng Shui of the Hand-Taiyin Lung Meridian. Thus, ancients used Yue Bi Tang or Ma Huang Chi Xiao Dou Tang for exterior excess swelling, without formulas using Qiang Huo or Fang Feng. Careful study of Materia Medica reveals no such mixed treatments.
Patient Feng: Dozens of days postpartum, suddenly developed Liver Wind, restless mind and insomnia, followed by uterine bleeding. Now whole body swollen, rebellious Qi preventing lying down, dizziness, no thirst, symptoms worse at night. Blood deficiency with Qi excess, Wood flourishing and Earth weak. Weak Earth cannot control Water, so Water insults Earth. Earth is both controlled by Wood and insulted by Water, constituting severe deficiency. To tonify Earth, first tonify Fire (Kidney Yang), assisted by draining Wood. This aligns with the Nei Jing principle: "Tonify the deficient, drain the excess."
Rou Gui, Dong Zhu, Fu Ling, Ze Xie, Da Fu Pi, Mu Xiang (Radix Aucklandiae), Chen Pi, Pao Jiang (Prepared Ginger), Shen Qu (Massa Medicata Fermentata), Tong Cao, Xue Po (Blood Amber).
Yuanyuan's Note: Warming without dryness, tonifying without stagnation, harmonizing and nourishing Liver-Spleen Qi to attract lost blood, the distension will naturally subside.
Patient Qin: Abdominal distension and foot swelling, worsened by eating. Damp-Heat combined with Qi stagnation fills the Taiyin (Spleen) meridian, a severe case of Distension.
Chuan Bo, Chi Fu Ling, Da Fu Pi, Qing Pi (Pericarpium Citri Reticulatae Viride), Ze Xie, Zhi Ke, Hei Chou (Semen Kochiae, black), Shan Zha Tan (Charred Fructus Crataegi), Gan Sui (Radix Euphorbiae Kansui, baked in flour dough), Tong Cao, Sheng Jiang.
Re-examination: Abdominal distension slightly eased, feet still swollen. Transport Spleen and transform dampness, hoping for gradual relief.
Chuan Bo, Chi Fu Ling, Da Fu Pi, Chuan Jiao Mu (Semen Zanthoxyli), Cang Zhu (Rhizoma Atractylodis Lanceae), Ze Xie, Chen Pi, Jiao Liu Qu, Hei Chou, Tong Cao, Zhi Ke, Sheng Jiang.
Yuanyuan's Note: These two formulas are methods for treating Damp-Heat Excess Distension.
Third Visit: Abdominal fullness for over a month, worsened by eating. Two rounds of attacking, reducing, and transporting Spleen methods have relieved epigastric distension, but great abdominal fullness remains. Re-discuss dredging and guiding out.
Xuan Fu Hua (Flos Inulae), Wu Jia Pi (Cortex Acanthopanacis), Chi Fu Ling, Ze Xie, Bing Lang (Semen Arecae), Hei Chou, Ji Nei Jin (Endothelium Corneum Gigeriae Galli), Mu Xiang, Tong Cao, Sha Ren.
Patient Zhu: Abdominal fullness, yellowish face, foot swelling. Recently due to carrying water and catching cold, added hernia pain. Spleen deficiency with dampness, Kidney deficiency with cold. Prevent hernia Qi attacking upward, causing greater abdominal fullness.
Ping Wei San (Peaceful Stomach Powder) minus Gan Cao, add Fu Ling, Xiao Hui Xiang (Fructus Foeniculi), Shen Qu, Wu Zhu Yu.
Patient Yang: Pulse deep, urination difficult, face, limbs, great abdomen, and scrotum all swollen, disease belongs to Interior Water. Nosebleed, slight throat pain, Lung home has stagnant Heat. Propose Yue Bi Tang.
Mi Zhi Ma Huang (Honey-fried Ephedra), Xing Ren, Gan Cao (Licorice Root), Shi Gao (Gypsum Fibrosum), Bai Zhu, Chi Fu Ling, Ze Xie, Chen Pi, Fang Ji (Radix Stephaniae Tetrandrae), Dan Qin (Light Scutellariae Baicalensis Radix).
Re-examination: Water-Damp invades collaterals, overflows into muscles. Sweating and diuresis methods were effective but not curative. Now propose unblocking Yang and leaching out.
Wu Ling San (Five-Ingredient Powder with Poria) plus Ba Ji Rou (Cortex Morindae Officinalis), Chuan Bo, Che Qian Zi (Semen Plantaginis), Chen Pi, Niu Xi, Wu Jia Pi, Da Fu Pi, Jiang Pi.
Patient Wang: Post-illness Spleen deficiency with Qi stagnation, edema, poor appetite, loose stools. Method should warm the Spleen.
Dang Shen (Radix Codonopsis), Fu Ling, Ze Xie, Mu Xiang, Dong Zhu, Pao Jiang, Fu Shen (Poria with Hostwood), Shen Qu, Sha Ren, Gu Ya (Semen Hordei Germinatum).
Patient Zhang: Post-dysentery Yang deficiency, Water-Damp not transforming, abdominal fullness, facial and foot edema, greenish-yellow complexion, pulse deficient and fine. Fear progression to severe Distension.
Chuan Shu Fu (Prepared Aconite), Zhu Ling, Fu Ling, Bai Zhu, Dang Shen, Shang Rou Gui (Top-grade Cinnamon Bark), Ze Xie, Chen Pi, Shen Qu, Sha Ren.
Again: Warm and unblock Spleen-Kidney Yang, dredge Du Dao Qi, hoping for reduction of distension and swelling.
Shu Fu Zi, Rou Gui, Bai Zhu, Zhu Ling, Ze Xie, Fu Ling Pi (Poria Peel), Dong Gua Pi, Chuan Bo, Chen Pi, Tong Cao.
Yuanyuan's Note: Both formulas treat semi-deficient, semi-excess patterns, employing unblocking Yang and draining water methods.
Patient You: Spleen deficiency with Liver Wood rebellion, abdominal masses, chills and fever resembling malaria, lasting half a year. Only Spleen deficiency causes Ying-Wei disharmony, hence chills/fever; only Liver rebellion causes Qi-Blood stasis, hence masses. Now poor appetite, loose stools, red tongue, thirst, daily abdominal fullness, foot dorsum edema, emaciation, Spleen-Kidney Yin-Yang both injured. At this time of Fire hyperactivity and Metal decline, Fire hyperactivity makes Yin more deficient, Metal decline leaves Wood unchecked. In late autumn when Earth-Water fails, fear worsening. Urgently need to strengthen transport and harmonize middle, slightly clearing summer-heat.
Yu Jiayan's concept of "rigid within soft agents," changing stomach function without being changed by it. This method is correct. Hope for Spleen-Stomach awakening is auspicious.
Lian Li Tang (Coptis and Gastrodia Decoction) plus Chen Pi.
Patient Zhu: Seasonal Water-Damp invades internally, combining with inherent Damp-Heat, causing sudden edema filling Upper and Lower Jiao. Propose venting exterior and purging interior to eliminate water.
Xiang Ru (Herba Elsholtziae), Chuan Bo, Tong Cao, Da Fu Pi, Chi Fu Ling, Ze Xie, Xing Ren, Hua Shi (Talcum), Che Qian Zi, Lai Fu Zi, Ting Li Zi, Cong Bai Tou (Scallion White).
Patient [Surname Unknown]: Mass formed from chronic malaria, often due to Water-Drink, Phlegm-Saliva battling with Qi. Long-term mass dispersal leads to abdominal fullness, becoming Distension, so-called "Pi disperses into Gu."
Pulse fine as silk, string-like upon deep pressure, indicating Liver Wood overacting on Spleen. Dry mouth, scanty urine, indicating Damp-Heat not transforming. Abdomen enlarges daily over a month; urgently dredge water passages, drain Wood and harmonize middle.
Wu Ling San plus Chuan Bo, Huang Lian stir-fried with Ginger Juice, Qing Pi, Chen Pi, Da Fu Pi, Mu Xiang, Che Qian Zi, Tong Cao.
Appendix: Nong Po San (Thick Bark Powder)
Chuan Bo (Stir-fried with Ginger Juice, 3 qian), Zhi Ke (3 qian, stir-fried with 7 Ban Dou seeds until yellow, remove Ban Dou), Mu Xiang (Sun-dried, powdered, 3 qian), Qing Pi (Vinegar-fried, 3 qian), Chen Pi (Salt-water fried, 3 qian), Gan Sui (Baked in flour dough, 3 qian), Da Ji (Soaked in water, sun-dried, fried, 3 qian), Gan Jiang (Fried yellow, 3 qian).
Powdered together. Take 1 qian per dose, mixed with Sha Ren and Che Qian Zi decoction. This is an excellent remedy for Pi dispersing into Gu.
Yuanyuan's Note: This formula is indeed clever. But applicable only to those with intact Zheng Qi. For chronic illness or elderly with Qi-Blood weakness, fear temporary relief followed by severe rebound distension, making it untreatable. Users must be cautious.
Monk: Edema starts from below, legs, feet, scrotum, great abdomen, chest, overflowing uncontrollably. Now drain from above downwards. Lung governs body Qi, also said "Water comes from high source." Ancients opened Ghost Gates (sweating) and purified House (diuresis); although starting from Taiyang, it essentially involves the Lung.
Ting Li Zi, Xing Ren, Chuan Bo, Chen Pi, Fu Ling, Chuan Jiao Mu, Sheng Jiang, Da Zao (Jujube).
Kong Xian Dan (Phlegm-Fluid Expelling Pill), 0.5 fen daily.
Yuanyuan's Note: For excess-type edema, treatment is as follows. Classic says: Root in Kidney, branch in Lung. Ting Li Zi drains Lung, Jiao Mu drains Kidney. Kong Xian Dan is less effective than Zhou Che Wan (Boat and Cart Pill).
Patient [Surname Unknown]: Summer-Heat-Damp latent pathogen combined with retention, blocking intestines/stomach, Middle Jiao not transporting, great abdomen suddenly full, intermittent abdominal pain, sticky red stool like dysentery, scanty urine. Pulse deep-slippery-rapid, sign of retention. Propose Da Ju Pi Tang (Large Orange Peel Decoction) to send Xia Ming Bin Lang Wan (Wood Sorrel and Areca Nut Pill).
Si Ling San (Four Poria Powder) plus Ju Hong, Da Fu Pi, Mu Xiang, Mu Tong (Akebia Caulis), Hua Shi, Sha Ren powder, Chuan Bo. Decoct and send Xia Ming Bin Lang Wan 3 qian.
Again: Qi battles with Water, great abdomen suddenly full, pulse deep, urination difficult, urge to defecate but cannot. Method: move Qi and purge water.
Xiang Ru, Da Hui Xiang (Fructus Foeniculi), Ze Xie, Lai Fu Zi, Chi Fu Ling, Da Ji, Gan Sui, Zhi Ke, Hei Bai Chou (Black and White Semen Kochiae), Sheng Jiang.
Patient Wang: Internal Damp-Heat, external Wind pathogen, Wind battles with Water, whole body swollen. This is Feng Shui. Should sweat.
Qiang Huo, Xiang Ru, Chen Pi, Fang Feng, Chi Qin (Red Scutellaria), Jiao Liu Qu, Tong Cao, Cong Bai, Sheng Jiang.
Patient [Surname Unknown]: Abdominal distension without fullness belongs to Qi, Liver Wood overacting on Spleen Earth.
Huang Lian (Stir-fried with Ginger Juice), Xiang Fu, Sha Ren, Chuan Bo, Qing Pi, Jiao Liu Qu, Huai Shan Yao (Dioscoreae Rhizoma), Fu Ling, Chen Pi, Ze Xie.
Yuanyuan's Note: Huang Lian treats distension by clearing Middle Jiao Damp-Heat. Very unsuitable for Spleen deficiency with Wood overaction distension.
Patient Lu: Post-malaria Damp-Heat internal accumulation, Spleen-Stomach Qi not smooth, causing mouth ulcers and abdominal distension. Temporarily use harmonizing middle and clearing transformation method.
Chuan Bo, Huang Lian, Jiao Liu Qu, Chi Fu Ling, Da Fu Pi, Zhi Ke, Ze Xie, Hei Shan Zhi (Black Gardenia Fruit), Chen Pi, Sha Ren.
Yuanyuan's Note: Huang Lian and Chuan Bo fit this condition very well.
Patient Zhang: Liver Wood flourishing overacting on Spleen, drum-like abdominal distension, emaciation, fine pulse, syndrome is Dan Distension. Method should warm and unblock.
Dan Gan Jiang (Light Dried Ginger), Fu Ling, Chuan Bo, Sha Ren, Huai Shan Yao, Wu Zhu Yu, Chen Pi, Ze Xie, Da Fu Pi.
Jin Kui Shen Qi Wan (Golden Cabinet Kidney Qi Pill) 5 qian, taken with boiled water.
Yuanyuan's Note: For deficiency distension, replacing Dang Shen with Chuan Bo is better.
Patient Tao: Only thirteen years old, no reason for depression, yet abdominal fullness like distension, slight internal heat, nearing two months. Why? Likely excessive childishness, irregular diet, improper temperature regulation. Previously had cold-stomach acid regurgitation, now no longer vomiting, abdomen gradually enlarging, food not accepted, internal heat arises. Not劳累 (overwork) damaging Spleen transport, but Cold-Drink stagnation causing distension. Spleen deficiency generates internal heat; single abdominal distension is named Dan Distension (Single Distension), but treatment differs. Now use warming and draining Middle Jiao, slightly assisting bitter drainage, taking rigid within soft, to calm Stomach and harmonize Spleen.
Dang Shen, Fu Ling, Ban Xia (Rhizoma Pinelliae), Chen Pi, Bai Shao, Huang Lian (Stir-fried with Wu Zhu Yu), Pao Jiang, Ze Xie, Chuan Bo, Dong Gua Pi.
Yuanyuan's Note: Diet irregularity damaging Spleen causing distension should assist digestion guides, such as Ji Nei Jin, Gu Ya.
Patient Sun: Sores flat then float, gradually abdominal fullness, chest tightness, Qi blockage, urination difficult, swelling worsening daily. Water-Damp Qi has no exit, syndrome becomes Chuang Gu (Sores Distension), fear adding asthma. Sweating and diuresis are two major gates.
Ma Huang, Xing Ren, Bai Zhu, Ze Xie, Fu Ling, Zhu Ling, Ting Li Zi, Chuan Bo, Tong Cao, Che Qian Zi, Jiang Pi.
Again: Swelling levelled, urination smooth. Modify previous formula.
Fang Feng, Bai Zhu, Ban Xia, Fu Ling, Chen Pi, Ze Xie, Xing Ren, Chuan Bo, Tong Cao, Ting Li Zi, Che Qian Zi, Cong Bai Tou, Jiang Pi.
Patient Sun: Spleen deficiency distension, facial and foot edema, urination difficult. Pulse fine-rapid, Yuan Qi greatly depleted. Fear asthmatic change.
Dang Shen (Stir-fried with Yuan Mi/Rice), Niu Xi, Fu Ling, Ba Ji Rou, Chen Pi, Ze Xie (Salt-water fried), Che Qian Zi, Dong Zhu (Earth-fried), Huai Shan Yao, Yi Yi Ren, Qi Zi Tan (Charred Lycii Fructus), Sheng Shu Gu Ya (Raw/Cooked Barley Sprouts).
Patient Shen: First diarrhea then blindness. Took single prescription, eyes brightened but abdomen gradually filled, Spleen deficiency with Liver Wood rebellion. Took herbal medicine, cold nature damaged middle, disease became Distension. Root is long-standing, fear slow effect.
Jiao Bai Zhu, Dong Gua Pi, Chuan Bo, Fu Ling, Chen Pi, Jiao Liu Qu, Da Fu Pi, Ze Xie, Sha Ren, Yi Yi Ren, Chen Xiang Yuan Pi (Aged Citrus Peel).
Patient Yang: Two Chi pulses slippery, Damp-Heat retention in Lower Jiao. Urination difficult, great abdominal fullness, Lower Jiao blocked, Middle Jiao Qi not flowing.
Rou Gui, Chi Fu Ling, Zhu Ling, Bai Zhu, Ze Xie, Da Ji, Shen Qu, Chen Pi, Dong Gua Pi, Jiang Pi.
Patient Feng: Wind-Water battling, whole body and face swollen, cough, Qi rising preventing lying down. Syndrome dangerous, use Yue Bi method.
Ma Huang, Sheng Gan Cao (Raw Licorice), Xing Ren, Shi Gao, Chi Fu Ling, Ze Xie, Chen Pi, Ting Li Zi, Da Fu Pi, Sheng Jiang, Da Hong Zao (Large Red Date).
Again: Using Yue Bi method, slight sweat obtained, hand swelling receded slightly, rest swelling not gone, cough and asthma persist. Due to hardworking person, Spleen-Stomach insufficient, urgent transport failed. Now support Spleen, harmonize middle, move Qi, vent San Jiao, hoping for Qi transformation flow.
Dong Zhu, Sheng Jiang, Da Fu Pi, Fang Ji, Chen Pi, Fang Feng, Fu Ling Pi, Dong Gua Pi, Jiang Pi.
Patient He: Internal Damp-Heat generating sores, external Wind-Cold causing edema. Wind-Damp battling, syndrome becomes Chuang Gu. Fear adding asthma.
Fang Feng, Qiang Huo, Xing Ren, Da Fu Pi, Ju Hong, Chi Fu Ling, Jie Geng (Radix Platycodonis), Jing Jie (Herba Schizonepetae), Chuan Bo, Sang Ye (Folium Mori), Tong Cao.
Patient Du: Wind-Water battling, sudden whole body swelling, upper cough with phlegm sound, lower loose stool, urination difficult. Sweating and diuresis is the major method.
Not adopting this, delayed a month. Near Qingming, weather warms, Wind long latent in Lung-Stomach secretly transforms to Heat. Instead took Shen Qi Tang, intending to unblock Yang and transform water; Yang not unblocked but Yin first seized, water not transformed but Fire rose. Thus dry tongue, scorched lips, black teeth, vexation, scrotal retraction, red chest/abdomen/skin, danger signs reached extreme. Reluctantly propose clearing Lung-Stomach, preserving Yin and draining Heat, hoping for turning point.
Sheng Shi Gao, Xing Ren, Tong Cao, Fu Ling Pi, Dou Chi (Prepared Soybean), Bei Sha Shen (Radix Glehniae), Mai Dong (Radix Ophiopogonis), Chuan Bei (Bulbus Fritillariae Cirrhosae), Dan Pi (Cortex Moutan), Lu Gen (Rhizoma Imperatae), Xian Bo He Gen (Fresh Mint Root).
Mung Bean Soup replaces water.
Again: Lung gets Heat and does not descend, Liver has Fire and rises, Stom居中 (located in middle), suffers Liver Fire impact, wants to descend but cannot, reverses upward, thus vomiting and refusing food. Yesterday used clearing Metal to open Du Dao, fortunately water passage opened, High Source received clearing command. However, Middle Jiao rejection, Gen Yang loses overflow authority, seems suitable to transport middle. But Liver Fire is intense, merely transporting middle is useless. Must clear Liver hyperactivity to weaken Wood-Fire might, Stomach not controlled by Liver, Middle Qi harmonized, then vomiting can settle.
Huang Lian (Stir-fried with Ginger Juice), Huang Qin (Stir-fried with Ginger Juice), Ban Xia, Ze Xie, Chen Pi, Hei Shan Zhi, Zhu Ru (Stir-fried with Ginger Juice), Fu Ling Pi, Chuan Bei, Lu Gen, Pi Pa Ye.
Dang Gui Long Hui Wan (Angelica Dragon Gallbladder Pill) 3 qian, sent with Mung Bean Ginger Soup.
Yuanyuan's Note: Bad outcome of Feng Shui. Both formulas adapt well.
Patient You: After malaria stops, abdominal distension and foot swelling, Damp-Heat returns to Taiyin, fear becoming Malaria Distension. But urine clear and smooth, indicates Spleen deficiency. Propose Nong Po Wen Zhong Tang (Thick Bark Warming Middle Decoction) modified.
Chuan Bo, Fu Ling, Chen Pi, Gan Jiang, Cao Dou Kou (Cardamomi Fructus), Mu Xiang, Ban Xia, Dong Gua Pi, Jiang Pi.
Patient Lian: Spleen has Damp-Heat and retained Qi, gradually abdominal fullness and foot swelling, worsened by eating, syndrome becomes Qi Distension.
Bai Fu Ling, Chuan Bo, Bai Zhu, Yi Yi Ren, Su Geng (Pericarpium Citri Reticulatae 'Chachi' stem? Or likely Su Geng - Perilla Stem), Wu Jia Pi, Ze Xie, Chen Pi, Sha Ren, Tong Cao.
Patient Xi: Damp-Heat internally blocks intestines/stomach, horizontally connects to Mo Yuan (Membrane Origin). Mo Yuan is outside viscera, inside muscles, residence of diaphragm, road of San Jiao Du Dao. Pathogen stays not going, causes swelling. Distension belongs to Qi, Edema belongs to Water. Must regulate Qi and dredge Du Dao to prevent swelling genesis.
Hei Bai Chou (Each 5 qian), Lai Fu Zi (1 liang), Sha Ren (1 liang).
Take large gourd, insert three ingredients, add one cup aged wine, steam boil for incense stick time. Remove herbs from gourd, stir-fry and powder, mix with gourd charcoal powder. Take 2 qian every morning.
Patient Hui: Damp damages Spleen-Kidney Yang, first back pain then foot swelling, epigastric pain, sour fluid in mouth. Use Gan Jiang Ling Zhu Tang combined with Wu Ling San modified.
Gan Cao, Gan Jiang, Fu Ling, Bai Zhu, Zhu Ling, Ze Xie, Rou Gui, Ban Xia, Chen Pi, Tong Cao, Wu Jia Pi.
Yuanyuan's Note: Sour fluid syndrome, Nei Jing says Heat, Dong Yuan says Cold, ultimately acrid-unblocking drugs are most effective.
Again: Previously used acrid-warm unblocking Yang, sweet-bland removing dampness, epigastric pain, foot swelling, acid regurgitation removed, only foot dorsum swelling remains. Reduce dosage to regulate.
Bai Zhu, Fu Ling, Ze Xie, Chuan Duan (Radix Dipsaci), Yi Yi Ren, Niu Xi, Chen Pi, Tong Cao, Sang Bai Pi, Wu Jia Pi.