肿胀之症有水肿气肿血肿虫肿食肿之别五症之中最易治者食肿耳不必分其阴阳以消食之
品分
消之即愈其次难治者则虫肿亦不必分其阴阳盖虫肿即食之变皆伤脾阴而成健脾而济之下虫之
品自然能愈世多留方然用之而不效者何也亦因看不清是阴虚之故而用阳药以去之也吾今留一
奇方专治虫臌最妙最神方名化虫绝神丹每日空腹白滚水送下一两早晚二服服三日即有虫从大
便中出矣服十日肿胀消再服十日全愈不必尽服也此方俱是补阴之品又是杀虫之药脏腑不伤而
反受大益潜移默夺不战之战正妙于战也气臌者乃阳气之郁也世人以水臌法治之转成危症者最
多而气臌从何辨之单胀于两胁之间而手足不十分肿者是又不是虫胀之单胀于腹也此等之病宜
解郁为主而解郁又以舒肝为急吾定一方名为开郁消肿汤此方用柴芍以舒肝气则两胁之胀满自
除又何必用大腹皮与槟榔之消克哉此方可用四剂之后略减其半加入人参三钱连服四剂气臌自
消亡于无事矣血臌之病非气病也乃血症也半由于饮食之失宜半由于思想之太结遂成此病其症
面黄而腹胀手按之如有物在而又不十分大痛手足必然细小者此是血臌也方用破血安全汤此方
大黄用之以逐血然非以补中下之恐有排山倒海之忧今用白术以固腰脐当归生新去旧鳖甲牛膝
入于至坚之中以动之又虑脾气消亡又加人参以醒其气安有脾不健而血不下者乎至于水胀之症
实有阴阳之殊初感之时两足如泥者乃水症也虽是水浸脾土亦因脾气之虚以致邪水相犯然而脾
气之虚又因于胃气之弱是脾阴之病即阳气之衰也初起之时乘其阴气之未亏即以牵牛甘遂二味
各二钱治之水去如响又何水臌之难治乎至于阴虚而成水臌者虽亦是脾经之弱然非胃气之衰盖
命门火衰无火以温脾土以致水泛为痰留于胃脾之内渐侵入四肢非若水症之由外而内也法当用
金匮肾气丸补肾中之火以生脾胃之土而水自归元终亦尽消乌有更有一种纯是阴虚水亦上泛非
肾火之不足者其症满身流水囊大而不能卧大便如常小便亦利饮食知味者是法当用六味地黄汤
一料煎汤恣饮自然奏功如神耳又不可不知之也
化虫绝神丹
鳖甲（一斤） 地栗粉（一斤） 雷丸（二两） 生何首乌（一斤） 甘草（三两） 神曲（半斤） 榧子
肉（半斤） 枳实（五两） 槟榔（三两） 使君子（三两）各为末米饭为丸
开郁消肿汤
柴胡（三钱） 白芍（五钱） 郁金（三钱） 当归（五钱） 红花（五钱） 茯苓（五钱） 薏仁（二两）
枳壳（一钱） 甘草（一分） 陈皮（五分） 神曲（三钱） 半夏（一钱）水煎服
破血安全汤
大黄（一两） 雷丸（五钱） 白术（一两） 枳实（二钱） 肉桂（二钱） 当归（一两） 牛膝（三钱）
鳖甲（三钱） 人参（五钱）水煎服
肿胀这一病症，分为水肿、气肿、血肿、虫肿和食肿五种类型。在这五类病症中，最容易治疗的是食肿。不需要区分其阴阳属性，使用消食的药物进行分消治疗即可痊愈。其次难以治疗的是虫肿，同样不需要区分阴阳，因为虫肿是由饮食积滞转化而来，都会损伤脾阴，只要健脾并配合驱虫药物，自然能够治愈。世间虽然流传着许多方子，但使用时往往无效，为什么呢？也是因为没能看清这是阴虚的缘故，而使用了阳性的药物来攻逐它。我现在留下一个奇方，专门治疗虫臌（因虫积导致的腹部胀大），这个方子最为奇妙灵验，名为“化虫绝神丹”。每天空腹用白开水送服一两，早晚各一次，服用三天后就会有虫子从大便中排出；服用十天后肿胀消退，再服用十天即可完全痊愈，不必服完所有药。此方全部由补阴的药物组成，又是杀虫的药，脏腑不仅不受伤害，反而受到很大的益处，这是一种潜移默化、不战而屈人之兵的治疗方式，正妙在“不战之战”。
气臌，是由于阳气郁结所致。世人用水臌的方法去治疗，导致转为危症的非常多。那么如何辨别气臌呢？如果只有两胁之间胀满，而手足并不十分肿胀的，就是气臌；这又不同于虫胀仅局限于腹部的胀满。这类疾病应当以解郁为主，而解郁又以疏肝为急务。我定下一个方子，名为“开郁消肿汤”。此方用柴胡和白芍来疏肝理气，那么两胁的胀满自然消除，又何必使用大腹皮和槟榔这类消克峻猛的药物呢？此方可以先用四剂，之后剂量减半，加入人参三钱，连续服用四剂，气臌自然消散于无形。
血臌的病，不是气病，而是血症。一半由于饮食不当，一半由于情志思虑过度，从而形成此病。其症状表现为面色黄、腹胀，用手按压感觉里面有物，但疼痛并不十分剧烈，手足必然细小，这就是血臌。方药使用“破血安全汤”。此方中大黄用于驱逐瘀血，但如果不用补益药在中焦固护而直接攻下，恐怕会有排山倒海般的危险。因此，这里用白术来稳固腰脐部位的气血，用当归生新血去旧瘀，鳖甲和牛膝深入至坚之处以推动瘀血；又担心脾气消亡，所以加入人参来提振元气，哪有脾气不健运而瘀血不能下行呢？
至于水胀的病症，确实有阴阳的区别。初感之时，如果两足像泥一样按之凹陷，那是水症。虽然是水湿浸渍脾土，但也因为脾气虚弱，导致邪水相犯。然而脾气的虚弱，又源于胃气的衰弱，这属于脾阴的病，也就是阳气的衰微。在初起之时，趁着阴气尚未亏损，立即使用牵牛子和甘遂各二钱进行治疗，水湿去除得迅速如响，又有什么水臌是难治的呢？至于因阴虚而导致的水臌，虽然也是脾经虚弱，但并非胃气衰败，而是因为命门火衰，没有火来温煦脾土，导致水泛为痰，留在胃脾之内，逐渐侵入四肢，不像水症那样由外入内。治疗方法应当使用金匮肾气丸，补肾中的命门之火以生脾胃之土，水液自然回归本源，最终完全消散。还有另一种情况，完全是阴虚导致水液上泛，并非肾火不足。其症状是满身流水，囊状肿大而不能躺卧，但大便正常，小便通利，饮食知味。这种情况应当使用六味地黄汤一料煎汤，随意饮用，自然会奏效如神。这也是不可不知道的啊。
化虫绝神丹
鳖甲（一斤） 地栗粉（一斤） 雷丸（二两） 生何首乌（一斤） 甘草（三两） 神曲（半斤） 榧子肉（半斤） 枳实（五两） 槟榔（三两） 使君子（三两） 以上各研为末，用米饭做丸。
开郁消肿汤
柴胡（三钱） 白芍（五钱） 郁金（三钱） 当归（五钱） 红花（五钱） 茯苓（五钱） 薏仁（二两） 枳壳（一钱） 甘草（一分） 陈皮（五分） 神曲（三钱） 半夏（一钱） 水煎服。
破血安全汤
大黄（一两） 雷丸（五钱） 白术（一两） 枳实（二钱） 肉桂（二钱） 当归（一两） 牛膝（三钱） 鳖甲（三钱） 人参（五钱） 水煎服。
Swelling disorders are categorized into five types: edema (Shuizhong, water swelling), qi distension (Qizhong, gas swelling), blood stasis swelling (Xuezhuang), insect-induced swelling (Chongzhong), and food stagnation swelling (Shizhong). Among these five, food stagnation swelling is the easiest to treat. There is no need to differentiate between yin and yang syndromes; treating it with food-resolving agents will lead to recovery. The next most difficult to treat is insect-induced swelling, which also does not require yin-yang differentiation. This is because insect swelling is a transformation of food stagnation that damages Spleen Yin. By strengthening the Spleen and administering vermifuge herbs, it can naturally be cured. Although many prescriptions exist in the world, they often fail when used. Why? It is because practitioners fail to recognize the underlying Yin deficiency and instead use Yang-tonifying or acrid-warm drugs to expel the pathogen. I now leave a miraculous prescription specifically for treating abdominal distension caused by parasites (Chonggu), named "Huachong Jueshen Dan" (Insect-Expelling Divine Miracle Pill). Take one qian (approx. 30g) orally with plain boiled water on an empty stomach, twice daily (morning and evening). After three days of administration, worms will appear in the stool. After ten days, the swelling will subside; continue for another ten days for complete recovery. It is not necessary to consume the entire course. This formula consists entirely of Yin-nourishing herbs that also possess vermifuge properties. It benefits the Zang-Fu organs without damaging them, achieving results through subtle influence rather than aggressive confrontation—a strategy superior to direct combat.
Qi distension arises from the stagnation of Qi. Many patients' conditions deteriorate into critical states because practitioners mistakenly treat it using methods for water retention. How then to distinguish Qi distension? If there is distension primarily between the two hypochondriac regions, while the hands and feet are not significantly swollen, it is Qi distension. This differs from insect-induced distension, which is localized solely in the abdomen. Such diseases should be treated primarily by resolving stagnation, with soothing the Liver being the urgent priority. I have formulated a prescription called "Kaiyu Xiaozhong Tang" (Stagnation-Resolving and Swelling-Reducing Decoction). Using Chai Hu (Bupleuri Radix) and Bai Shao (Paeoniae Radix Alba) to soothe Liver Qi will naturally resolve the fullness in the hypochondriac region. Why then resort to harsh draining agents like Da Fu Pi (Arecae Pericarpium) and Bing Lang (Arecae Semen)? Administer four doses of this formula, then reduce the dosage by half. Add Ren Shen (Ginseng Radix et Rhizoma) 3 qian, and continue for four more doses. Qi distension will dissipate spontaneously.
Blood stasis swelling (Xuegu) is not a Qi disorder but a Blood disorder. It arises half from improper diet and half from excessive mental constriction or emotional stress. Symptoms include a sallow complexion, abdominal distension, a sensation of mass upon palpation, mild pain despite the presence of a mass, and thin extremities. This characterizes Blood stasis swelling. The prescribed formula is "Poxue Anquan Tang" (Blood-Breaking and Safety-Guaranteeing Decoction). Da Huang (Rhei Radix et Rhizoma) is used to purge blood stasis. However, purging without supporting the Middle Jiao risks a catastrophic collapse of vital energy. Therefore, Bai Zhu (Atractylodis Macrocephalae Rhizoma) is used to stabilize the waist and umbilical area; Dang Gui (Angelicae Sinensis Radix) generates new blood and eliminates old stasis; Bie Jia (Testudinis Carapax et Plastrum) and Niu Xi (Achyranthis Bidentatae Radix) penetrate deep-seated hardness to move the stasis. To prevent the depletion of Spleen Qi, Ren Shen (Ginseng Radix et Rhizoma) is added to invigorate Qi. How could the Spleen fail to function properly if Qi is secured, thereby preventing the descent of blood stasis?
Regarding water retention disorders, there is indeed a distinction between yin and yang. Initially, if the feet are pitting like mud upon pressure, it is a Water syndrome. Although water dampness invades the Spleen Earth, it is due to Spleen Qi deficiency allowing pathogenic water to invade. This Spleen Qi deficiency stems from weak Stomach Qi, representing a disease of Spleen Yin and the decline of Yang. At the onset, before Yin is depleted, administer Qian Niu Zi (Pharbitidis Semen) and Gan Sui (Kansui Radix), each 2 qian. The water will be eliminated rapidly as if echoing. Thus, what water distension is truly difficult to treat? However, water distension resulting from Yin deficiency, while involving Spleen meridian weakness, is not due to Stomach Qi failure. Instead, it is caused by the decline of Ming Men Fire (Gate of Life Fire), lacking the heat to warm Spleen Earth, leading to water transforming into phlegm, accumulating in the Stomach and Spleen, and gradually invading the limbs. This differs from external water invasion. The treatment method should employ Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet) to tonify Kidney fire to generate Spleen and Stomach Earth, causing water to return to its source and eventually dissipate completely. Furthermore, there is a type of pure Yin deficiency causing water to flood upward, unrelated to insufficient Kidney fire. Symptoms include generalized edema with sac-like swelling making supine position impossible, normal bowel movements, free urination, and preserved appetite/taste. In such cases, Liu Wei Di Huang Tang (Six-Ingredient Rehmannia Pill Decoction) should be decocted and consumed freely. It will produce miraculous effects. This knowledge is indispensable.
Huachong Jueshen Dan (Insect-Expelling Divine Miracle Pill)
Bie Jia (Testudinis Carapax et Plastrum, 1 jin)
Di Li Fen (Dioscorea opposita starch, 1 jin)
Lei Wan (Polyporus Umbellatus sclerotium, 2 liang)
Sheng He Shou Wu (Polygoni Multiflori Radix Praeparata, raw, 1 jin)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 3 liang)
Shen Qu (Massa Medicata Fermentata, 0.5 jin)
Fei Zi Rou (Torreya Seed flesh, 0.5 jin)
Zhi Shi (Aurantii Fructus Immaturus, 5 liang)
Bing Lang (Arecae Semen, 3 liang)
Shi Jun Zi (Quisqualis Fructus, 3 liang)
Grind all ingredients into powder and form pills with rice paste.
Kaiyu Xiaozhong Tang (Stagnation-Resolving and Swelling-Reducing Decoction)
Chai Hu (Bupleuri Radix, 3 qian)
Bai Shao (Paeoniae Radix Alba, 5 qian)
Yu Jin (Curcumae Radix, 3 qian)
Dang Gui (Angelicae Sinensis Radix, 5 qian)
Hong Hua (Carthami Flos, 5 qian)
Fu Ling (Poria, 5 qian)
Yi Yi Ren (Coicis Semen, 2 liang)
Zhi Ke (Aurantii Fructus, 1 qian)
Gan Cao (Glycyrrhizae Radix et Rhizoma, 1 fen)
Chen Pi (Citri Reticulatae Pericarpium, 5 fen)
Shen Qu (Massa Medicata Fermentata, 3 qian)
Ban Xia (Pinelliae Tuber, 1 qian)
Decoct in water and take orally.
Poxue Anquan Tang (Blood-Breaking and Safety-Guaranteeing Decoction)
Da Huang (Rhei Radix et Rhizoma, 1 liang)
Lei Wan (Polyporus Umbellatus sclerotium, 5 qian)
Bai Zhu (Atractylodis Macrocephalae Rhizoma, 1 liang)
Zhi Shi (Aurantii Fructus Immaturus, 2 qian)
Rou Gui (Cinnamomi Cortex, 2 qian)
Dang Gui (Angelicae Sinensis Radix, 1 liang)
Niu Xi (Achyranthis Bidentatae Radix, 3 qian)
Bie Jia (Testudinis Carapax et Plastrum, 3 qian)
Ren Shen (Ginseng Radix et Rhizoma, 5 qian)
Decoct in water and take orally.