脉 脉沉而濡。或浮而数者。为水肿。弦而实。洪而数者为胀满。两关弦缓。两尺紧涩。皆
为肿胀。浮大者可治。沉细而濡者难治。唇肿齿焦。脐肿凸出。掌内无纹者。皆不治。
症 内经曰∶诸湿肿满。口属于脾。又曰诸胀腹大。皆属于热。盖肿胀之症。起自中宫。由
土虚不能制水。水渍妄行。故通身面目手足皆浮肿。名曰水肿。或腹大如豉。而面目四肢不
浮者。名曰胀满。又名鼓肿。皆脾上湿热为病。肿轻而胀重也。
治 按丹溪云∶宜补脾。又须养肺以制木。使脾无贼邪之患。滋肾水以制火。使肺得清化之
源。却盐味以防助病。邪断妄想以保母气。无有不安。仲景云腰以上肿者。宜汗之。麻黄桂
枝之类。腰以下肿者。宜利小便。五苓散之类。大概宜补中。行湿。利小便。切不可下。当
以人参、白术、茯苓为主。佐以陈皮、黄芩、麦门冬、以制肝木、浓朴、苍术、以消胀气
。不运。加木香、木通、以行之。气下陷。加升麻、柴胡、以提之。血虚。加补血药。痰盛
。加利痰药。随症加减。用无不效。
方 索矩三和汤治肿胀
白术（二钱） 陈皮（一钱） 浓朴 苍术（各一钱五分） 甘草（二分） 木通（一钱五分） 紫苏
槟榔（各七分） 海金砂（一钱）
上作一服。水一钟半。灯心二分。同煎。食远服。
气虚。加人参、白茯苓（各一钱五分）。
血虚。加当归、白芍药（各一钱五分）。
腰以上肿者。加麻黄（二钱） 杏仁（一钱） 防风（一钱）、以汗之。腰以下肿者。加茯苓（一
钱五分）、猪苓、泽泻、木通（各一钱）、以利之。
恼怒。加香附（一钱五分）、青皮（五分）、木香（三分）。
小便不利。加泽泻、山栀（各一钱）、木通（一钱五分）。
大便溏。加人参、浓朴（各一钱）、苍术、白芍药（各一钱五分）。
腹胀大而坚者。加萝卜子、莪术（各一钱）。
有痰。加半夏、茯苓（各一钱五分）。
有热。加黄芩、山栀、麦门冬、木通（各一钱）。
元气下陷。加升麻、四分、柴胡（五分）。
又方 中满分散丸治中满气胀水肿。
黄芩（酒炒） 黄连（姜汁炒） 枳实（麸炒） 半夏（姜制） 白术 白茯苓（不去皮） 人参 陈
皮浓朴 苍术（各一两） 猪苓 泽泻（去毛） 姜黄 干姜 砂仁 知母（各五钱）
上为末。炊饼为丸。梧桐子大。每服百丸。滚白汤送下。
【脉象】
脉象沉而软，或浮而数，属于水肿。脉象弦而实，洪大而数，属于胀满。左右关部脉弦缓，左右尺部脉紧涩，都表现为肿胀。脉象浮大的可以治疗；脉象沉细而软的难以治疗。嘴唇肿胀、牙齿焦枯、肚脐突出、手掌内没有纹理的，都属于不治之症。
【症状】
《内经》说：“各种湿邪导致的肿胀和腹满，病位归属于脾。”又说：“各种腹部胀大，都归属于热证。”大概肿胀这类病症，起源于中焦脾胃（中宫），由于脾气虚弱不能制约水液，导致水湿浸渍并妄行泛滥，所以全身、面目、手足都出现浮肿，称为水肿。或者腹部像豆豉一样胀大，但面目四肢不浮肿的，称为胀满，也称为鼓肿。这些都是由于脾经湿热引起的疾病，其中肿较轻而胀较重。
【治法】
按照朱丹溪的说法：应当补益脾气，同时滋养肺金以克制肝木，使脾脏免受肝木贼邪的侵害；滋补肾水以制约心火，使肺脏得到清肃化源的支持；戒除咸味饮食以防助长病邪；断绝妄想以保全母气（肾为脾之母，或土克水，此处指保养根本之气）。这样就没有不安稳的道理。张仲景说：腰以上浮肿的，应当用发汗法治疗，如麻黄、桂枝之类的药物；腰以下浮肿的，应当用利小便的方法治疗，如五苓散之类的方剂。大概原则是宜补益中气，行气化湿，通利小便。切不可使用泻下法。当以人参、白术、茯苓为主药，佐以陈皮、黄芩、麦门冬来抑制肝木；厚朴、苍术来消除胀气。如果气机运行不畅，加木香、木通来行气导滞；如果气机下陷，加升麻、柴胡来提升气机；如果血虚，加入补血药；如果痰多，加入化痰药。根据症状加减用药，没有不有效的。
【方剂】
索矩三和汤，治疗肿胀。
白术（二钱） 陈皮（一钱） 厚朴 苍术（各一钱五分） 甘草（二分） 木通（一钱五分） 紫苏 槟榔（各七分） 海金沙（一钱）
以上为一服剂量，用水一钟半，灯心草二分，共同煎煮。饭后服用。
如果是气虚，加人参、白茯苓（各一钱五分）。
如果是血虚，加当归、白芍药（各一钱五分）。
腰以上浮肿的，加麻黄（二钱）、杏仁（一钱）、防风（一钱），以发汗解表；腰以下浮肿的，加茯苓（一钱五分）、猪苓、泽泻、木通（各一钱），以利水渗湿。
因恼怒致病者，加香附（一钱五分）、青皮（五分）、木香（三分）。
小便不利者，加泽泻、山栀（各一钱）、木通（一钱五分）。
大便溏泄者，加人参、厚朴（各一钱）、苍术、白芍药（各一钱五分）。
腹部胀大且坚硬者，加萝卜子、莪术（各一钱）。
有痰者，加半夏、茯苓（各一钱五分）。
有热者，加黄芩、山栀、麦门冬、木通（各一钱）。
元气下陷者，加升麻（四分）、柴胡（五分）。
又一方：中满分散丸，治疗中满气胀和水肿。
黄芩（酒炒） 黄连（姜汁炒） 枳实（麸炒） 半夏（姜制） 白术 白茯苓（不去皮） 人参 陈皮 厚朴 苍术（各一两） 猪苓 泽泻（去毛） 姜黄 干姜 砂仁 知母（各五钱）
以上研为细末，用蒸饼糊制作成丸，如梧桐子大小。每次服用一百丸，用滚开的白开水送服。
[Pulse]
A pulse that is deep and soft, or floating and rapid, indicates edema (water swelling). A pulse that is wiry and solid, or full and rapid, indicates distension and fullness. Wiry and moderate pulses at both Guan positions (middle position on the radial artery), and tight and choppy pulses at both Chi positions (cubital position on the radial artery), all manifest as swelling and distension. A floating and large pulse is treatable; a deep, fine, and soft pulse is difficult to treat. Swollen lips, scorched teeth, protruding umbilicus, and the absence of lines in the palms are all signs of untreatable conditions.
[Symptoms]
The *Neijing* states: "All dampness-induced swelling and abdominal fullness belong to the Spleen." It also states: "All abdominal distensions and enlargements belong to Heat." Generally, swelling and distension originate from the Middle Jiao (Zhonggong, referring to the Spleen and Stomach region). Due to Spleen Qi deficiency failing to control Water, water fluids infiltrate and act recklessly, causing generalized edema of the entire body, face, eyes, hands, and feet, termed Edema (Shuizhong). If the abdomen is distended like a fermented soybean but the face, eyes, and limbs do not swell, it is termed Distension (Zhangman), also known as Drum Distension (Guzhong). These are all diseases caused by Damp-Heat in the Spleen, where swelling is mild but distension is severe.
[Therapeutic Methods]
According to Zhu Danxi: One should tonify the Spleen, and simultaneously nourish the Lung Metal to restrain Liver Wood, preventing the Spleen from suffering from the encroachment of Liver Wood. Nourish Kidney Water to restrain Heart Fire, allowing the Lungs to obtain a source for clear transformation. Avoid salty flavors to prevent aiding the disease. Cut off delusions to preserve the Mother Qi (Kidney/Root Qi). In this way, there will be no instability. Zhang Zhongjing stated: For swelling above the waist, one should induce sweating, using herbs such as Ephedrae Herba (Mahuang) and Cinnamomi Ramulus (Guizhi). For swelling below the waist, one should promote urination, using formulas such as Wuling San. The general principle is to tonify the Middle Jiao, move dampness, and promote urination. One must absolutely avoid purgative methods. The primary herbs should be Codonopsis Radix (Renshen), Atractylodis Macrocephalae Rhizoma (Baizhu), and Poria (Fuling). Adjunct herbs include Tangerine Peel (Chenpi), Scutellariae Radix (Huangqin), and Ophiopogonis Radix (Maidendong) to restrain Liver Wood; Magnoliae Officinalis Cortex (Houpo) and Atractylodis Rhizoma (Cangzhu) to eliminate distension Qi. If Qi movement is obstructed, add Aucklandiae Radix (Muxiang) and Akebiae Caulis (Mutong) to promote flow. If Qi sinks, add Cimicifugae Rhizoma (Shengma) and Bupleuri Radix (Chaihu) to lift it. If Blood is deficient, add Blood-tonifying herbs. If Phlegm is abundant, add Phlegm-resolving herbs. Adjust according to symptoms, and efficacy is invariably achieved.
[Formulas]
Suo Ju San He Tang (Three-Harmony Decoction of Suo Ju), treating swelling and distension.
Atractylodis Macrocephalae Rhizoma (Baizhu) (2 qian), Tangerine Peel (Chenpi) (1 qian), Magnoliae Officinalis Cortex (Houpo), Atractylodis Rhizoma (Cangzhu) (each 1.5 qian), Glycyrrhizae Radix et Rhizoma (Gancao) (0.2 qian), Akebiae Caulis (Mutong) (1.5 qian), Perillae Folium (Zisu), Arecae Semen (Binglang) (each 0.7 qian), Chrysosplenii Herba (Haijinsha) (1 qian).
Take as one dose. Add 1.5 zhong of water and 0.2 qian of Juncus Arterilis Pith (Dengxincao). Decoct together. Take after meals.
If Qi is deficient, add Codonopsis Radix (Renshen) and Poria (Baifuling) (each 1.5 qian).
If Blood is deficient, add Angelicae Sinensis Radix (Danggui) and Paeoniae Radix Alba (Baishaoyao) (each 1.5 qian).
For swelling above the waist, add Ephedrae Herba (Mahuang) (2 qian), Armeniacae Semen Amarum (Xingren) (1 qian), and Saposhnikoviae Radix (Fangfeng) (1 qian) to induce sweating. For swelling below the waist, add Poria (Fuling) (1.5 qian), Polyporus (Zhuling), Alisma Rhizoma (Zexie), and Akebiae Caulis (Mutong) (each 1 qian) to promote urination.
Due to anger, add Cyperi Rhizoma (Xiangfu) (1.5 qian), Citri Reticulatae Pericarpium (Qingpi) (0.5 qian), and Aucklandiae Radix (Muxiang) (0.3 qian).
For difficult urination, add Alisma Rhizoma (Zexie) and Gardeniae Fructus (Shanzhi) (each 1 qian), and Akebiae Caulis (Mutong) (1.5 qian).
For loose stools, add Codonopsis Radix (Renshen) and Magnoliae Officinalis Cortex (Houpo) (each 1 qian), Atractylodis Rhizoma (Cangzhu), and Paeoniae Radix Alba (Baishaoyao) (each 1.5 qian).
For a large, hard, and distended abdomen, add Raphani Semen (Luobozzi) and Curcumae Zedoinae Rhizoma (Ezhu) (each 1 qian).
If there is Phlegm, add Pinelliae Tuber (Banxia) and Poria (Fuling) (each 1.5 qian).
If there is Heat, add Scutellariae Radix (Huangqin), Gardeniae Fructus (Shanzhi), Ophiopogonis Radix (Maidendong), and Akebiae Caulis (Mutong) (each 1 qian).
If Yuan Qi (Original Qi) sinks, add Cimicifugae Rhizoma (Shengma) (0.4 qian) and Bupleuri Radix (Chaihu) (0.5 qian).
Another Formula: Zhongman Fen San Wan (Middle-Fullness Dispersion Pill), treating middle-fullness Qi distension and edema.
Scutellariae Radix (Huangqin) (stir-fried with wine), Coptidis Rhizoma (Huanglian) (stir-fried with ginger juice), Aurantii Fructus Immaturus (Zhishi) (stir-fried with bran), Pinelliae Tuber (Banxia) (processed with ginger juice), Atractylodis Macrocephalae Rhizoma (Baizhu), Poria (Baifuling, skin not removed), Codonopsis Radix (Renshen), Tangerine Peel (Chenpi), Magnoliae Officinalis Cortex (Houpo), Atractylodis Rhizoma (Cangzhu) (each 1 liang), Polyporus (Zhuling), Alisma Rhizoma (Zexie, hairs removed), Turmeric Rhizome (Jianghuang), Zingiberis Rhizoma Recens (Ganjiang), Amomi Fructus (Sharen), Anemarrhenae Rhizoma (Zhimu) (each 5 qian).
Grind into powder. Make pills using steamed wheat dough, sized like Sophora japonica seeds. Take 100 pills per dose, washed down with boiling plain water.