（一名伤寒夹肿胀 又名肿胀兼伤寒）
【因】宿病肿胀为本。新感风寒为标。当察其肿之为阴为阳。胀之属寒属热。属虚属实。或但肿而
不胀。或但胀而不肿。或先肿而后胀。或先胀而后肿。或胀而兼喘。或胀而变臌、或胀而成蛊。必先其
所因。伏其所主为首要。
【证】但肿而不胀者。属水被邪结。当辨阴阳。阴水则肢厥体重。先肿下焦。继则一身悉肿。阴
股间寒。足胫
肿甚。按之 而不起。口淡不渴。大便自调。或竟溏泻。小便虽少。却不赤涩。甚或不利。舌苔白滑。
或淡白而胖滑。阳水则面浮恶风。自汗心烦。先肿上焦。遍身尽肿。按之热而即起。口苦而渴。小便黄浊。
或竟赤涩。大便坚燥。或多胶闭。甚则二便不通。阴囊肿大。舌苔黄滑。或深黄而浓腻。但胀而不肿者。
属气被邪裹。气裹食胀。即胃胀。一名谷胀。胸腹满。胃脘痛。上支两胁。妨于食。食即益甚。鼻闻焦臭、
大便甚难。甚则少腹 胀。引腰而痛。舌苔黄腻而浓。气裹痰胀。即肺胀。一名喘胀。胸中痞满。
气喘咳逆。目突如脱。鼻塞涕出。甚则肠鸣濯濯。满腹胀痛。飧泄不化。舌苔白滑而腻。气裹水胀。
即脾肾胀。一名寒胀。肢懈体重。不能胜衣。气闷善哕。睡卧不安。甚则腹满引背。腰髀胀痛。小便癃
闭。舌苔灰滑而腻。气裹血胀。即心肝胀。一名血胀。烦心短气。卧寐不安。甚则胁下满痛。痛引小腹。
腹起红丝。重则青筋亦露。舌色深紫而赤。气裹虫胀。即大小肠胀。一名腑胀。腹大而硬。以指久按。
其硬即移他处。又就所移者按之。其硬又移他处。或大腹。或脐旁。或小腹。无定处。或有物如蚯蚓蠢物。
隐然指下。或凝结如 而耕痛。起伏聚散。上下往来。浮沉出没。变幻多端。舌苔现槟榔纹。隐隐有点如粞。
先肿而后胀者。属水凝气结。先目窠上微肿。如新卧起之状。颈脉动而时咳。身尽肿。手足尤甚。继即由
四肢而入腹。腹乃胀大。初以手按其腹。随手而起。其状如囊裹水。甚则按之 而不起。如糟如泥。舌
苔灰黑而腻。舌本胖大而滑。先胀而后肿者。属气化水行。初则胸腹胀满。起于骤然。按其腹 而不起。
腹色不变。后乃渐散于四肢。气满于皮肤中。身尽肿而皮浓。 然而不坚。舌苔滑白。或薄或浓不一。
胀而兼喘者。属脾水久渍。逆行犯肺。始则腹胀浮肿。小便不利。继即咳嗽气喘。甚则坐不得卧。俯不
得仰。舌苔灰白而滑。或黄白相兼而腻。胀而变臌者。属脾肾阳虚。阴浊满布。独胀于腹。腹膨如鼓。外虽坚满。
中空无物。任入揉按。痛痒不关。初则旦食不能暮食。继即稍进饮食。饱闷难受。四肢日见瘦削。大便
溏而溺涩。舌苔淡白胖滑。胀而成蛊。则非血即虫。非虫即血。虫蛊则腹大如箕。时或胀痛。重按则痛始缓。
四肢瘦削。饮食乍进乍退。面色或红或白。口唇独红。内有白点。多嗜肥甘。饥即口吐涎沫。嘈杂难
忍。饱则腹虽不痛。脘满难受。舌苔有点如粞。血蛊则腹胀如鼓。青筋横绊腹上。或手足有红缕赤痕。
甚则爪甲青紫。小便利。大便黑。舌色紫赤而黯。甚或青紫。总之肿本乎水。胀必有滞。一兼外感风
寒。外证虽有头痛身热。恶寒畏风。而无不先犯胸膈。而为烦闷不舒。气逆呕恶。
【脉】左浮弦。右沉小者。风寒夹阴水肿也。左浮弦。右沉数者。风寒夹阳水肿也。浮大而坚。按之反涩
者。《内经》所谓坚大以涩者胀也。沉迟者为寒胀。沉数者为热胀。沉小者为虚胀。沉滑者为实胀。
弦大浮洪者易治。沉微细小者难治。沉细虚数者不治。
【治】阴水肿。初用麻附五皮饮。温下发汗以消肿。继用胃苓汤。实脾利水以除根。终用香砂理
中汤。健脾阳以培元气。阳水肿。初用五皮饮加荷、翘、浮萍。宣上发汗以消肿。继用大橘皮汤去桂、
术。加木通、车前、琥珀、灯心。通利小便以除根。终用百合茅根汤（苏百合、生桑皮、通草各一钱、
鲜茅根五十支。）清肺气以滋化源。胀病兼感风寒者。初用十味流气饮。先散其表。兼通其里。使表
气达。里气亦松。继治其胀。胀有食痰水血虫之别。虽是气阻。总属邪滞。统以五胀分消丸为主。
（萝卜子四两、巴豆肉十六粒拌炒去油、炙牙皂两半、枳壳四两、烧酒煮干切片炒、生川军一两醋
酒同炒、琥珀末一两、紫降香五钱、蝼蛄十只去足翅上截酒炒各研细、再研极匀、水法丸、
如芥菜子大、用景岳十香丸半料为衣、每服五分、日二夜一、空心吞下。附十香丸方。沉香、木香、丁香、
广皮、皂角刺各二钱半、荔枝核。小茴、香附、乌药、泽泻各五钱、生晒为末。）通用消胀万应汤。
（地蛄蝼三钱、大腹皮二钱、真川朴一钱、莱菔子二钱拌炒春砂仁五分、六神曲钱半、陈香团皮八分、
鸡内金两张、人中白 透五分、灯心五小帚。）送下消臌万应丹。（治黄胆变臌。气喘胸闷、脘痛翻胃、
疳胀结热、伤力黄肿、噤口痢等症、 透人中白一两、地蛄蝼、莱菔子、六神曲各五钱、砂仁二钱、
以上俱炒、陈香团一个、共研细匀、蜜丸、每服五七丸、灯心汤下。）分消其滞以通逐之。一俟胀退
十之七八。即用白术和中汤。除其根以善后。胀而兼喘。初用五子五皮饮。降其气以平喘。气降喘平。
即用大橘皮汤加川朴、腹皮。快脾利溺以消胀。胀消十之六七。终用香砂六君子汤去草加朴。送下加
减肾气丸。（熟地四两、茯苓三两、官桂、泽泻、萸肉、山药、丹皮、车前、牛膝各一两、淡附子五钱、
为末、和熟地同捣蜜丸、每服七八十丸。）通补脾肾以善后。胀而变臌。名曰气臌。俗稍称腹胀。又
称为膨。全属脾肾阳虚。故《内经》谓足太阴虚则膨胀。又曰。脏寒生满病。《内经》鸡矢醴。《东垣》
分消汤。每不济事。予用神香圣术煎为主。朝送天真丹。（青化桂五分、沉香、琥珀、巴戟肉酒浸、
小茴香、补骨脂炒香、葫芦巴炒香、川杜仲炒去丝、川萆 酒浸炒香、黑丑炒香各一两、研极细匀、
如桐子大、每服二钱至三钱、专治阳虚湿胜、腹胀坚大、按之不 、脐腹痼冷、甚则腿肿如斗、囊肿如
升。）夜送禹余粮丸。（禹余粮石、蛇含石、真针砂、同醋煮透 研各三两、制附子、紫 桂、干姜、
茯苓、当归、羌活、川芎、炒蒺藜、淮牛膝、青皮、大茴、蔻仁、广木香、莪术、三棱同醋炒各五钱、
同研细匀、蒸熟为丸、如桐子大、每服二钱至三钱、叶氏去附子、莪术、青皮加赤苓三两、名铁砂丸。忌盐、一毫不可入口、否则发疾愈甚、善治湿滞伤
脾、食不运化、肝郁乘脾、气臌虚胀、小便短涩、久则腿膝脚肿、上气喘息等症、许学士朱丹溪云、
此方乃治臌胀之要药、病从小便内旋去，不动脏腑真气、兼以温和调补气血药助之、真神方也。）峻
补其下。疏启其中。往往十全三四。胀而成蛊。虫蛊易愈。小儿居多。血蛊难痊。妇女为甚。初起通
用五胀分消丸。虫蛊。用槟榔大枣汤送下。（枣儿槟榔炒研三钱、炒香使君子肉、每岁一枚、照此递
加、大红枣十枚、清晨空心服。）血蛊用当归大戟汤送下。（全当归一两、红牙大戟五钱、蜣螂虫焙
四只。）一俟虫下瘀降。胀退十之六七。即以白术和中汤。随症加减。调补脾胃以善后。总而言之。
腰以上肿宜发汗。腰以下肿利小便。即《内经》开鬼门。洁净府。治水肿之正法也。荡涤胃肠。
直清阳明。即《内经》去郁陈 。工在疾泻。近者一下。远者三下。治一切实胀。胀必有滞之正法也。
临病求源。对症发药。皆可反掌收功。惟气臌一症。最为难痊。虽属脾肾阳虚。亦必由阴浊填满。《内经》
所谓浊气在上。则生 胀也。所以直攻不可。蛮补不能。必须温补之中。佐以辛通。通补兼施。以渐
取效。必俟阴散阳通。浊降清升。腹皮日渐宽软。胀大日渐收小。渐次康复。近者一月。远者百日。
乃可克奏全功。但临证时。必先明告病家。此病仍瘫痨臌膈之一。古今医法。从无速愈痼疾之方。务必
耐心调养。戒忿怒。绝房劳。慎起居。节饮食。调剂则缓缓图功。不可以小不效见疑。亦不可以小
见效中止。方有黍谷春回。转危为安之一日。若病者求速愈。医生图速效。概从峻削直攻。其始非不
暂消。其后攻之不消矣。再后愈攻则愈胀。腹皮绷急。以手按之。坚如铁石矣。而其病从此必死不治矣。
【秀按】肿、胀、臌、蛊四端。辨明因证。分际极清。妙在五胀分消丸。取精用宏。执简御繁。以
少胜多。较之王金坛尊重丸。（沉香、母丁香、青木香、炙槟榔、枳实、青皮、广皮、白芷、葶苈、
蔻仁、木通、车前、滑石、参须各四钱、海金砂、胡椒拌炒蝎尾各二钱半、莱菔子炒六钱、白丁香钱
半、郁李净仁两半、共研
细而极匀、姜汁竹沥和为丸、如桐子大、每服五七八丸、日二夜一、莲须葱白三枚生姜皮一钱煎汤下、专治便
闭溺涩之实胀水肿、与琥珀散相间服、服后先大便爽利、六七日、则小便渐长、腹胀渐消、屡收捷效、但要食
淡粥百日、诸般鱼蟹虾及猪羊肉、一不可犯、犯则复发不治。附琥珀散方。琥珀末五钱、黑丑炒香二两半、葶
苈子隔纸炒二两、猪苓、泽泻各炒取末两半、同研细匀、每服三钱、五更时用酸糯米泔水、长葱三根、煎至一
碗、取起去葱、入好酒一杯送下。）尤为力大而效速。即消胀万应汤。白术和中汤两方。看似寻常。实有成
绩。予治胀病。审其起于骤然。先胀于内。后肿于外。小便赤涩。大便秘结。气色红亮。声音高爽。脉滑数有
力者。实胀也。每用万应汤。取其消而不峻。随症佐丸散以缓下之。气胀调下香砂宽中散。水胀调下王氏琥珀
散。痰胀送下竹沥达痰丸。谷胀送下枳实导滞丸。不应。即用木香槟榔丸。（木香、川连、槟榔、川柏、广
皮、青皮、香附、枳壳、三棱、莪术、二味醋炒、黑丑炒香、生军酒炒各二两、芒硝三两、水法丸、每服二三
钱。）血胀送下琥珀人参丸。（党参、五灵脂酒炒各一两、紫 桂、生附子各五钱、赤苓、川芎、沉香、穿甲
酒炒各三钱、共研细匀、浓煎苏木汁为丸、每服钱半至二钱、早晚各一服、张石顽曰、此方人参与灵脂并用、
最能溶血、为血蛊之的方也。）蛊胀送下消疳金蟾丸。（大癞虾蟆十只、将砂仁填满其腹、以线系其脚、倒挂
当风处阴干、炙脆为末、同山楂、枳实、广皮、槟榔、胡连、雷丸、使君子肉炒香、麦芽各一两、党参、于术
各五钱、共研匀细、丸如米粒大、炙甘草粉为衣、每服十丸至十五丸、五更空心时糖汤吞下、善治小儿疳胀、
面黄胀大、肌瘦骨立、奇效。）小便不通。危在旦夕者。送下沉香琥珀丸。（琥珀另研、光杏仁、沉香、广皮、
防己、苏木、赤苓、泽泻各五钱、郁李净仁捣如泥、葶苈隔纸炒各一两、麝香一钱、共研细匀、蜜丸如绿豆
大、每服四五十丸。）阴囊胀大。二便不通者。送下三白散。（白丑炒取头末二两、桑白皮姜汁炒、广皮、木
通各一两、生白术五钱、共研细匀、每服二钱。）酒毒伤胃。积成酒臌者。送下解酲猪肚丸。（雄猪肝一个、装
入小川连末一两、槟榔末五钱、春砂仁末二钱、煨甘遂二钱、白酒药炒二钱、用河水煮极烂、捣透为丸、
每服一钱、如有酒缸内不化之糯米、团成一段者、焙干研细、加入三钱、尤妙。）积久成痞。痞散为臌者。
送下消痞丸。（生香附醋炒四两、延胡索醋炒两半、归尾二两、川芎、红花、浮海石、瓦楞子火 醋淬各
一两、醋打面糊为丸、如桐子大、每服四五十丸。）每多默收敏效。审其成于积渐。先肿于外。后胀于
内。小便淡黄。大便稀溏。气色枯白。语言低怯。脉细微无力者。虚胀也。每用和中汤。取其补而不滞。
随症佐丸散以缓消之。气喘、冲下四磨饮。（即六磨饮子去枳实、木香、大黄、加高丽参汁两匙、和匀同
冲。）不应、吞下《局方》黑锡丹。（黑铅、阿硫黄、煨肉果、紫 桂各五钱、淡附子、沉香、广木香、小茴
香、葫芦巴、补骨脂、阳起石、金铃子各一两、将黑铅熔化、入硫黄候结成片研细、入余药再研极匀、
绿豆粉为丸、每服四五十丸、专治阴气上冲、痰壅气喘、肢冷脉伏、不省人事。）有痰。原方去神曲。加
姜汁炒霞天曲烊冲戈制半夏。继即调下理中化痰丸。（党参、白术、茯苓、干姜各四两、姜半夏六两、炙
黑甘草二两、姜汁糊丸、每服二三钱、专治脾胃虚寒、痰饮内停、食减便溏、咳吐涎沫等症。）脾虚肝旺。
腹胀如鼓者。送下小温中丸。（醋 针砂、制香附、炒于术各四两、姜半夏、云茯苓、广皮、六神曲、川
连、苦参、生甘细梢各一两、共研细匀、醋制神曲糊为丸、每服二三钱、服至溺利者即效、忌盐。）黄胖
水臌。腹膨肿满者。送下大温中丸。（制苍术二两、炒山楂两半、川朴、广皮、青皮、云苓、炒白术、醋
炒针砂各一两、生甘细梢二钱、六神曲糊丸、每服二三钱。）屡多奏效。惟酒客好色。脾肾大虚。病由足
【病因】宿疾肿胀为本，新感风寒为标。必须审察肿胀属阴还是属阳，胀病属寒还是属热，属虚还是属实。有的仅肿而不胀，有的仅胀而不肿；有的先肿后胀，有的先胀后肿；有的胀而兼喘，有的胀变为臌胀，有的胀而成蛊胀。必须先查明其病因，伏其所主，这是首要任务。
【证候】仅肿而不胀的，属于水邪被外邪结聚。应当辨别阴阳：阴水则四肢厥冷、身体沉重，先在下焦肿胀，继而全身浮肿，阴股间感觉寒冷，足胫部肿胀严重，按压凹陷不起，口淡不渴，大便正常，或者完全溏泻，小便虽然量少，但并不赤涩，甚至不通利，舌苔白滑，或淡白胖嫩而滑。阳水则面部浮肿、恶风、自汗、心烦，先在上焦肿胀，继而全身浮肿，按压有热感且迅速回弹，口苦而渴，小便黄浊，或者完全赤涩，大便干结燥硬，或者粘滞闭塞，甚至二便不通，阴囊肿大，舌苔黄滑，或深黄浓腻。
仅胀而不肿的，属于气机被外邪包裹。气裹食胀，即胃胀，又称谷胀，表现为胸腹部满闷，胃脘疼痛，向上支撑两胁，妨碍进食，进食后症状加重，鼻中闻到焦臭味，大便非常困难，严重时少腹胀痛，牵引腰部疼痛，舌苔黄腻而浓。气裹痰胀，即肺胀，又称喘胀，表现为胸中痞塞满闷，气喘咳嗽逆上，眼球突出如脱出状，鼻塞流涕，严重时肠鸣漉漉，全腹胀痛，完谷不化的泄泻，舌苔白滑而腻。气裹水胀，即脾肾胀，又称寒胀，表现为肢体懈怠、身体沉重，连衣服都穿不住，胸闷容易呃逆，睡眠不安，严重时腹部胀满牵引背部，腰部和髀部胀痛，小便癃闭不通，舌苔灰滑而腻。气裹血胀，即心肝胀，又称血胀，表现为心烦短气，卧睡不安，严重时胁下满痛，疼痛牵引小腹，腹部出现红丝，重则青筋暴露，舌色深紫而赤。气裹虫胀，即大小肠胀，又称腑胀，表现为腹部大而坚硬，用手指久按，硬块会移向别处，再按移到的地方，硬块又移向别处，位置不定，在大腹、脐旁或小腹之间移动，有时感觉有像蚯蚓蠕动的东西隐现在指下，或者凝结成块如耕田般疼痛，起伏聚散，上下往来，浮沉出没，变幻多端，舌苔呈现槟榔纹，隐隐有点状如米屑。
先肿后胀的，属于水凝气结。起初眼睑微肿，像刚起床的样子，颈部脉搏跳动且时常咳嗽，全身浮肿，手足尤其严重，接着由四肢蔓延至腹部，腹部胀大。初起用手按腹部，随手而起，形状像囊袋裹着水，严重时按压凹陷不起，如糟如泥，舌苔灰黑而腻，舌体胖大而滑。
先胀后肿的，属于气化不利导致水液运行失常。起初胸腹胀满，突然发生，按腹部凹陷不起，腹部颜色不变，后来逐渐扩散到四肢，气充满在皮肤之中，全身浮肿且皮肤增厚，按之松软但不坚实，舌苔滑白，或薄或厚不一。
胀而兼喘的，属于脾水长期浸渍，逆行侵犯肺部。开始是腹胀浮肿，小便不利，接着咳嗽气喘，严重时坐卧不得，俯仰受限，舌苔灰白而滑，或黄白相间而腻。
胀而变臌的，属于脾肾阳虚，阴浊之气布满体内。只有腹部单独胀大，腹部膨隆如鼓，外表虽然坚满，但内部中空无物，任凭揉按，痛痒无关紧要。起初早晨吃饭不能到晚上吃，后来稍微吃点饮食，就饱闷难受，四肢日渐消瘦，大便溏泄而小便涩滞，舌苔淡白胖滑。
胀而成蛊的，则不是血蛊就是虫蛊。虫蛊则腹部大如簸箕，时而胀痛，重按时疼痛才缓解，四肢消瘦，饮食时进时退，面色或红或白，口唇独红，内有白点，大多嗜好肥甘厚味，饥饿时口中吐涎沫，嘈杂难忍，饱胀时腹部虽不痛，但胃脘满闷难受，舌苔有点状如米屑。血蛊则腹胀如鼓，青筋横布于腹部，或者手足有红缕赤痕，严重时指甲青紫，小便通利，大便黑色，舌色紫赤而暗，甚至青紫。
总之，肿本源于水，胀必有气滞。一旦兼感风寒，虽然有头痛身热、恶寒畏风的表证，但无不先侵犯胸膈，导致烦闷不舒，气逆呕吐恶心。
【脉象】左手脉浮弦，右手脉沉小的，是风寒夹阴水肿。左手脉浮弦，右手脉沉数的，是风寒夹阳水肿。脉浮大而坚，按之反涩的，是《内经》所说的“坚大以涩者胀也”。脉沉迟的是寒胀，脉沉数的是热胀，脉沉小的是虚胀，脉沉滑的是实胀。脉弦大浮洪的易治，脉沉微细小的难治，脉沉细虚数的不治。
【治法】阴水肿，初起用麻附五皮饮，温下发汗以消肿。继用胃苓汤，实脾利水以除根。终用香砂理中汤，健脾阳以培元气。阳水肿，初用五皮饮加荷叶、连翘、浮萍，宣上发汗以消肿。继用大橘皮汤去桂枝、白术，加木通、车前子、琥珀、灯心草，通利小便以除根。终用百合茅根汤（苏百合、生桑皮、通草各一钱，鲜茅根五十支），清肺气以滋化源。
胀病兼感风寒的，初用十味流气饮，先散其表邪，兼通其里气，使表气通达，里气亦松缓。继治其胀。胀病有食、痰、水、血、虫的区别，虽然是气机阻滞，总属邪气停滞，统以五胀分消丸为主方。（萝卜子四两，巴豆肉十六粒拌炒去油，炙牙皂半两，枳壳四两，烧酒煮干切片炒，生川军一两醋酒同炒，琥珀末一两，紫降香五钱，蝼蛄十只去足翅上截酒炒，各研细，再研极匀，水泛为丸，如芥菜子大，用景岳十香丸半料为衣，每服五分，日二次夜一次，空心吞服。附十香丸方：沉香、木香、丁香、广皮、皂角刺各二钱半，荔枝核、小茴香、香附、乌药、泽泻各五钱，生晒为末。）通用消胀万应汤（地蛄蝼三钱，大腹皮二钱，真川朴一钱，莱菔子二钱拌炒春砂仁五分，六神曲钱半，陈香团皮八分，鸡内金两张，人中白透五分，灯心五小帚）送下消臌万应丹（治黄疸变臌，气喘胸闷，脘痛翻胃，疳胀结热，伤力黄肿，噤口痢等症：透人中白一两，地蛄蝼、莱菔子、六神曲各五钱，砂仁二钱，以上俱炒，陈香团一个，共研细匀，蜜丸，每服五七丸，灯心汤下）。以此分消其滞以通逐之。一旦胀退十之七八，即用白术和中汤，除其根以善后。
胀而兼喘的，初用五子五皮饮，降其气以平喘。气降喘平后，即用大橘皮汤加川朴、腹皮，快脾利溺以消胀。胀消十之六七后，终用香砂六君子汤去甘草加厚朴，送下加减肾气丸（熟地四两，茯苓三两，官桂、泽泻、萸肉、山药、丹皮、车前、牛膝各一两，淡附子五钱，为末，和熟地同捣蜜丸，每服七八十丸），通补脾肾以善后。
胀而变臌的，名叫气臌，俗稍称腹胀，又称为膨。全属脾肾阳虚，所以《内经》说足太阴虚则膨胀，又说脏寒生满病。《内经》的鸡矢醴，《东垣》的分消汤，往往不济事。我用神香圣术煎为主方，早晨送服天真丹（青化桂五分，沉香、琥珀、巴戟肉酒浸，小茴香，补骨脂炒香，葫芦巴炒香，川杜仲炒去丝，川萆薢酒浸炒香，黑丑炒香各一两，研极细匀，如桐子大，每服二钱至三钱，专治阳虚湿胜，腹胀坚大，按之不痛，脐腹痼冷，甚则腿肿如斗，囊肿如升），晚上送服禹余粮丸（禹余粮石、蛇含石、真针砂，同醋煮透研各三两，制附子、紫桂、干姜、茯苓、当归、羌活、川芎、炒蒺藜、淮牛膝、青皮、大茴、蔻仁、广木香、莪术、三棱同醋炒各五钱，同研细匀，蒸熟为丸，如桐子大，每服二钱至三钱。叶氏去附子、莪术、青皮加赤苓三两，名铁砂丸。忌盐，一毫不可入口，否则发疾愈甚，善治湿滞伤脾，食不运化，肝郁乘脾，气臌虚胀，小便短涩，久则腿膝脚肿，上气喘息等症。许学士朱丹溪云：此方乃治臌胀之要药，病从小便内旋去，不动脏腑真气，兼以温和调补气血药助之，真神方也）。峻补其下，疏启其中，往往能治愈三四成。
胀而成蛊的，虫蛊易愈，小儿居多；血蛊难痊，妇女为甚。初起通用五胀分消丸。虫蛊，用槟榔大枣汤送下（枣儿槟榔炒研三钱，炒香使君子肉，每岁一枚，照此递加，大红枣十枚，清晨空心服）。血蛊用当归大戟汤送下（全当归一两，红牙大戟五钱，蜣螂虫焙四只）。一旦虫下瘀降，胀退十之六七，即以白术和中汤，随症加减，调补脾胃以善后。
总而言之，腰以上肿宜发汗，腰以下肿利小便，即《内经》开鬼门、洁净府，是治疗水肿的正法。荡涤胃肠，直清阳明，即《内经》去宛陈莝，工在疾泻，近者一下，远者三下，是治疗一切实胀，胀必有滞的正法。临病求源，对症发药，皆可反掌收功。惟气臌一症，最为难痊。虽属脾肾阳虚，亦必由阴浊填满。《内经》所谓“浊气在上，则生䐜胀”也。所以直攻不可，蛮补不能，必须温补之中，佐以辛通，通补兼施，以渐取效。必俟阴散阳通，浊降清升，腹皮日渐宽软，胀大日渐收小，渐次康复。近者一月，远者百日，乃可克奏全功。但临证时，必先明告病家，此病仍瘫痨臌膈之一。古今医法，从无速愈痼疾之方。务必耐心调养，戒忿怒，绝房劳，慎起居，节饮食。调剂则缓缓图功，不可以小不效见疑，亦不可以小见效中止，方有黍谷春回，转危为安之一日。若病者求速愈，医生图速效，概从峻削直攻，其始非不暂消，其后攻之不消矣。再后愈攻则愈胀，腹皮绷急，以手按之，坚如铁石矣。而其病从此必死不治矣。
【秀按】肿、胀、臌、蛊四端，辨明因证，分际极清。妙在五胀分消丸，取精用宏，执简御繁，以少胜多，较之王金坛尊重丸（沉香、母丁香、青木香、炙槟榔、枳实、青皮、广皮、白芷、葶苈、蔻仁、木通、车前、滑石、参须各四钱，海金砂、胡椒拌炒蝎尾各二钱半，莱菔子炒六钱，白丁香钱半，郁李净仁两半，共研细而极匀，姜汁竹沥和为丸，如桐子大，每服五七八丸，日二夜一，莲须葱白三枚生姜皮一钱煎汤下，专治便闭溺涩之实胀水肿，与琥珀散相间服，服后先大便爽利，六七日，则小便渐长，腹胀渐消，屡收捷效，但要食淡粥百日，诸般鱼蟹虾及猪羊肉，一不可犯，犯则复发不治。附琥珀散方：琥珀末五钱，黑丑炒香二两半，葶苈子隔纸炒二两，猪苓、泽泻各炒取末两半，同研细匀，每服三钱，五更时用酸糯米泔水，长葱三根，煎至一碗，取起去葱，入好酒一杯送下。）尤为力大而效速。即消胀万应汤、白术和中汤两方，看似寻常，实有成绩。
我治胀病，审其起于骤然，先胀于内，后肿于外，小便赤涩，大便秘结，气色红亮，声音高爽，脉滑数有力者，实胀也。每用万应汤，取其消而不峻，随症佐丸散以缓下之。气胀调下香砂宽中散，水胀调下王氏琥珀散，痰胀送下竹沥达痰丸，谷胀送下枳实导滞丸，不应，即用木香槟榔丸（木香、川连、槟榔、川柏、广皮、青皮、香附、枳壳、三棱、莪术，二味醋炒，黑丑炒香，生军酒炒各二两，芒硝三两，水法丸，每服二三钱）。血胀送下琥珀人参丸（党参、五灵脂酒炒各一两，紫桂、生附子各五钱，赤苓、川芎、沉香、穿甲酒炒各三钱，共研细匀，浓煎苏木汁为丸，每服钱半至二钱，早晚各一服。张石顽曰：此方人参与灵脂并用，最能溶血，为血蛊之的方也）。蛊胀送下消疳金蟾丸（大癞虾蟆十只，将砂仁填满其腹，以线系其脚，倒挂当风处阴干，炙脆为末，同山楂、枳实、广皮、槟榔、胡连、雷丸、使君子肉炒香，麦芽各一两，党参、于术各五钱，共研匀细，丸如米粒大，炙甘草粉为衣，每服十丸至十五丸，五更空心时糖汤吞下，善治小儿疳胀，面黄胀大，肌瘦骨立，奇效）。小便不通，危在旦夕者，送下沉香琥珀丸（琥珀另研，光杏仁、沉香、广皮、防己、苏木、赤苓、泽泻各五钱，郁李净仁捣如泥，葶苈隔纸炒各一两，麝香一钱，共研细匀，蜜丸如绿豆大，每服四五十丸）。阴囊胀大，二便不通者，送下三白散（白丑炒取头末二两，桑白皮姜汁炒，广皮、木通各一两，生白术五钱，共研细匀，每服二钱）。酒毒伤胃，积成酒臌者，送下解酲猪肚丸（雄猪肝一个，装入小川连末一两，槟榔末五钱，春砂仁末二钱，煨甘遂二钱，白酒药炒二钱，用河水煮极烂，捣透为丸，每服一钱。如有酒缸内不化之糯米，团成一段者，焙干研细，加入三钱，尤妙）。积久成痞，痞散为臌者，送下消痞丸（生香附醋炒四两，延胡索醋炒两半，归尾二两，川芎、红花、浮海石、瓦楞子火淬醋各一两，醋打面糊为丸，如桐子大，每服四五十丸）。每多默收敏效。
审其成于积渐，先肿于外，后胀于内，小便淡黄，大便稀溏，气色枯白，语言低怯，脉细微无力者，虚胀也。每用和中汤，取其补而不滞，随症佐丸散以缓消之。气喘，冲下四磨饮（即六磨饮子去枳实、木香、大黄，加高丽参汁两匙，和匀同冲）。不应，吞下《局方》黑锡丹（黑铅、阿硫黄、煨肉果、紫桂各五钱，淡附子、沉香、广木香、小茴香、葫芦巴、补骨脂、阳起石、金铃子各一两，将黑铅熔化，入硫黄候结成片研细，入余药再研极匀，绿豆粉为丸，每服四五十丸，专治阴气上冲，痰壅气喘，肢冷脉伏，不省人事）。有痰，原方去神曲，加姜汁炒霞天曲烊冲戈制半夏。继即调下理中化痰丸（党参、白术、茯苓、干姜各四两，姜半夏六两，炙黑甘草二两，姜汁糊丸，每服二三钱，专治脾胃虚寒，痰饮内停，食减便溏，咳吐涎沫等症）。脾虚肝旺，腹胀如鼓者，送下小温中丸（醋针砂、制香附、炒于术各四两，姜半夏、云茯苓、广皮、六神曲、川连、苦参、生甘细梢各一两，共研细匀，醋制神曲糊为丸，每服二三钱，服至溺利者即效，忌盐）。黄胖水臌，腹膨肿满者，送下大温中丸（制苍术二两，炒山楂两半，川朴、广皮、青皮、云苓、炒白术、醋炒针砂各一两，生甘细梢二钱，六神曲糊丸，每服二三钱）。屡多奏效。惟酒客好色，脾肾大虚，病由足……
(Also known as Cold Damage with Edema and Distension, or Edema and Distension complicated by Cold Damage)
[Etiology] The chronic disease of edema and distension is the root (Ben), while the newly acquired wind-cold is the branch (Biao). One must examine whether the edema is Yin or Yang, whether the distension is Cold or Heat, and whether it is Deficiency or Excess. Some present only with edema without distension, some only with distension without edema; some have edema first followed by distension, some distension first followed by edema; some have distension accompanied by panting, some distension transforming into Drum Distension (Gu Zhu), some distension becoming Gu Disturbance (Gu Zheng). It is essential to first ascertain the cause and address the primary pathology.
[Symptoms] Cases presenting only with edema without distension belong to water pathogen constrained by external pathogens. Differentiate between Yin and Yang: In Yin Water, there are cold extremities and heavy body, starting with swelling in the lower Jiao, then progressing to whole-body edema. The groin feels cold, swelling in the calves is severe, pitting upon pressure does not rebound, the mouth is bland without thirst, bowel movements are normal or loose, urine volume is low but not red or painful, or even obstructed. The tongue coating is white and slippery, or pale, swollen, and slippery. In Yang Water, there is facial edema, aversion to wind, spontaneous sweating, and irritability. Swelling starts in the upper Jiao and spreads to the whole body. Pressure reveals heat and rebounds quickly. There is bitter taste and thirst, yellow turbid urine, or red and painful urine, dry and hard stools, or sticky obstruction, even complete retention of both stool and urine. The scrotum may be enlarged. The tongue coating is yellow and slippery, or deep yellow and thick/greasy.
Cases presenting only with distension without edema belong to Qi being wrapped by pathogens.
1. Qi wrapping Food Distension (Wei Distension/Grain Distension): Chest and abdominal fullness, epigastric pain radiating to both hypochondria, food intolerance worsening after eating, olfactory hallucinations of burnt smell, severe difficulty in defecation, sometimes lower abdominal pain radiating to the waist. Tongue coating is yellow, greasy, and thick.
2. Qi wrapping Phlegm Distension (Lung Distension/Panting Distension): Chest oppression and fullness, panting, coughing, protruding eyes, nasal congestion with discharge, borborygmus, whole abdominal pain, undigested diarrhea. Tongue coating is white, slippery, and greasy.
3. Qi wrapping Water Distension (Spleen-Kidney Distension/Cold Distension): Limb flaccidity, heavy body unable to bear clothes, chest stuffiness with frequent hiccups, restless sleep, abdominal fullness radiating to the back, waist and thigh pain, urinary retention. Tongue coating is gray, slippery, and greasy.
4. Qi wrapping Blood Distension (Heart-Liver Distension/Blood Disturbance): Irritability, shortness of breath, restless sleep, hypochondriac fullness and pain radiating to the lower abdomen, red filaments appearing on the abdomen, visible blue veins in severe cases. Tongue is deep purple and red.
5. Qi wrapping Parasite Distension (Large/Small Intestine Distension/Fu Distension): Abdomen large and hard. Pressure causes the hardness to move to other locations (epigastrium, umbilicus, or lower abdomen). Sensation of moving masses like earthworms under fingers, or knotty pain shifting up and down. Tongue coating shows betel nut patterns with rice-grain-like spots.
Edema first, then distension belongs to water coagulation and Qi knotting. Initially, eyelids swell slightly like after waking. Neck vessels pulse with occasional coughing. Whole body swells, especially limbs, spreading to the abdomen which becomes distended. Initial pressure rebounds immediately (like a water-filled bag); later, pressure pits deeply like mud. Tongue coating is gray-black and greasy; tongue body is swollen and slippery.
Distension first, then edema belongs to Qi transformation failure leading to water movement issues. Initially, sudden chest and abdominal fullness. Pressure does not rebound, abdominal color unchanged. Later, swelling spreads to limbs, Qi fills the skin causing whole-body edema with thickened, soft, non-firm skin. Tongue coating is slippery white, varying in thickness.
Distension with panting belongs to long-term Spleen Water soaking and counter-flow invading the Lungs. Starts with abdominal distension and edema, poor urination, progressing to coughing and panting, inability to lie flat or lean forward/backward. Tongue coating is gray-white and slippery, or mixed yellow-white and greasy.
Distension transforming into Drum Distension (Gu Zhu) belongs to Spleen-Kidney Yang Deficiency with Yin Turbidity filling the interior. Only the abdomen distends like a drum. Exterior is firm/full, interior is hollow. Rubbing/pressing yields no pain/itch. Initially cannot eat from morning to night; later slight intake causes bloating. Limbs emaciate. Stools loose, urine scanty/painful. Tongue coating is pale, white, swollen, and slippery.
Distension becoming Gu Disturbance involves either Blood or Parasites. Parasitic Gu: Abdomen large like a winnowing basket, intermittent pain relieved by heavy pressure, emaciated limbs, erratic appetite, face red or white, lips red with white spots, craving rich foods, salivation when hungry, intolerable acid regurgitation, epigastric fullness when full. Tongue has rice-grain spots. Blood Gu: Abdomen drum-like, transverse blue veins on abdomen, red threads on limbs/hands/feet, cyanotic nails, clear urine, black stools, tongue purple-red/dark or bluish-purple.
In summary, edema stems from Water; distension implies stagnation. With concurrent Wind-Cold, although exterior symptoms like headache, fever, aversion to cold/wind exist, the pathogen always invades the Chest/Diaphragm first, causing irritability, Qi rebellion, vomiting, and nausea.
[Pulse] Left floating-wiry, Right sinking-small: Wind-Cold with Yin Edema. Left floating-wiry, Right sinking-numerous: Wind-Cold with Yang Edema. Floating-large and firm, yet choppy upon pressure: As per *Nei Jing*, "firm, large, and choppy indicates Distension." Sinking-slow indicates Cold Distension; Sinking-numerous indicates Heat Distension; Sinking-small indicates Deficiency Distension; Sinking-slipping indicates Excess Distension. Wiry-large-floating-hong pulses are easy to treat; Sinking-micro-small pulses are difficult; Sinking-thin-deficient-numerous are untreatable.
[Treatment]
For Yin Edema: Initially use Ma Fu Wu Pi Yin (Ephedra, Aconite, Five-Bark Decoction) to warm, release exterior, and reduce edema. Subsequently use Wei Ling Tang (Stomach-Astringent Decoction) to solidify Spleen and promote urination to eliminate the root. Finally use Xiang Sha Li Zhong Tang (Amomum and Aucklandia Regulate Middle Decoction) to tonify Spleen-Yang and support Yuan Qi.
For Yang Edema: Initially use Wu Pi Yin plus Lotus Leaf, Forsythia, and Lemna to ventilate upper Jiao and release exterior. Subsequently use Da Ju Pi Tang (Large Citrus Peel Decoction) removing Cinnamon Twig and Atractylodes, adding Akebia, Plantago, Amber, and Juncus to promote urination. Finally use Bai He Mao Gen Tang (Lily and Reed Rhizome Decoction) to clear Lung-Qi and nourish the source of transformation.
For Distension complicated by Wind-Cold: Initially use Shi Liu Liu Qi Yin (Ten-Flavor Flowing Qi Decoction) to scatter exterior and unblock interior. Then treat the distension. Distension types (Food, Phlegm, Water, Blood, Parasite) involve Qi obstruction due to pathogenic stagnation. Main formula: Wu Zhang Fen Xiao Wan (Five-Distension Dividing Pill). [Ingredients: Radish Seed, Croton Seed processed, Burnt Toothed Soap Pod, Bitter Orange, Rhubarb, Amber, Purple Sandalwood, Mole Cricket, etc., prepared as pills coated with Shi Xiang Wan]. Administer via Xiao Zhang Wan Ying Tang (Eliminate Distension Ten-Thousand Response Decoction) sending Xia Gu Wan Ying Dan (Eliminate Drum Distension Ten-Thousand Response Pill) to divide stagnation. Once distension reduces by 70-80%, use Bai Zhu He Zhong Tang (Atractylodes Harmonize Middle Decoction) to remove the root.
For Distension with Panting: Initially use Wu Zi Wu Pi Yin (Five-Seed Five-Bark Decoction) to descend Qi and calm panting. Then use Da Ju Pi Tang plus Zedoary and Areca Peel to strengthen Spleen and promote urination. Finally use Xiang Sha Liu Jun Zi Tang removing Licorice adding Zedoary, sending Jian Shen Qi Wan (Modified Kidney Qi Pill) to tonify Spleen-Kidney.
For Distension becoming Drum Distension (Qi Drum): Due to Spleen-Kidney Yang Deficiency. *Nei Jing* states Taiyin deficiency causes distension. Chicken Vinegar Ferment (*Ji Shi Li*) or Dongyuan's Fen Xiao Tang often fail. Use Shen Xiang Sheng Shu Jian (Divine Fragrant Holy Atractylodes Decoction) as main treatment. Morning send Tian Zhen Dan (Heavenly True Pill) for Yang Deficiency with Dampness excess. Evening send Yu Yu Liang Wan (Hematite Pill) for damp-stagnation damaging Spleen, Liver overacting on Spleen, Qi Drum, scanty urine, leg swelling. Strict salt avoidance required. This method tonifies lower and opens middle, achieving 30-40% cure rate.
For Gu Disturbance: Parasitic Gu is easier to cure (common in children); Blood Gu is harder (common in women). Initially use Wu Zhang Fen Xiao Wan. For Parasitic Gu, send with Bin Lang Da Zao Tang (Areca Nut and Jujube Decoction). For Blood Gu, send with Dang Gui Da Ji Tang (Angelica and Spurge Decoction). After parasites/stasis pass and distension reduces, use Bai Zhu He Zhong Tang to regulate Spleen-Stomach.
General Principle: Edema above waist requires diaphoresis ("Open Ghost Gate"); below waist requires diuresis ("Cleanse House"). This is the standard for Edema. Purging intestines/stomach, clearing Yangming ("Remove Stagnant Accumulation") is the standard for Excess Distension. Seek the source, prescribe accordingly. However, Qi Drum is hardest to cure. Direct attack fails, blind tonification fails. Must combine warming-tonification with acrid-unblocking. Gradual effect expected over 1-3 months. Warn patient: No quick cure for chronic diseases. Avoid anger, sexual exhaustion, irregular lifestyle, and diet. Slow progress is key. Rushing leads to worsening, rigid abdomen, and death.
[Commentary by Xiu] Differentiation of Edema, Distension, Drum, and Gu is clear. Wu Zhang Fen Xiao Wan is excellent. Compared to Wang Jin Tan's Zun Zhong Wan (Respect Middle Pill) and Hu Po San (Amber Powder), which are potent but require strict diet (bland porridge for 100 days, avoid fish/meat), my formulas Xiao Zhang Wan Ying Tang and Bai Zhu He Zhong Tang are ordinary yet effective.
For Excess Distension (sudden onset, internal distension then external edema, red face, loud voice, slippery-numerous pulse): Use Wan Ying Tang. Send appropriate pills based on type: Qi (Xiang Sha Kuan Zhong San), Water (Wang Shi Hu Po San), Phlegm (Zhu Li Da Tan Wan), Grain (Zhi Shi Dao Zhi Wan), Blood (Hu Po Ren Shen Wan - Angelica and Dysosma with Ginseng dissolves blood stasis), Gu (Xiao Gan Jin Chan Wan - Toad with Amomum for pediatric malnutrition distension). For critical urinary retention: Chen Xiang Hu Po Wan. For scrotal swelling/obstruction: San Bai San. For Wine Drum: Jie Cheng Zhu Du Wan. For Stagnation turning to Drum: Xiao Pi Wan.
For Deficiency Distension (gradual onset, external edema then internal distension, pale face, weak voice, thready-pulseless): Use He Zhong Tang. Send pills: Panting (Si Mo Yin or Hei Xi Dan for cold-phlegm), Phlegm (Li Zhong Hua Tan Wan), Spleen Deficiency/Liver Excess (Xiao Wen Zhong Wan), Yellow Puffy/Water Drum (Da Wen Zhong Wan). All show repeated efficacy. For wine drinkers with sexual excess and severe Spleen-Kidney deficiency...