股先肿。渐渐胀及于腹。按之如鼓。坚而且硬。咳吐涎沫。气短喘息。脉虽浮大。重按即空。两手脉皆不
及于寸口。初用白术和中汤加霞天曲、戈半夏。服二剂。少腹愈胀。痰涎愈多。二便不利。不能睡卧。继
用薛氏加减肾气汤。服两剂。虽无所碍。亦不见效。遂仿景岳大剂温补法。用理阴煎加参、术、附子。
五剂后足肿渐消。十剂后腹胀大退。终以六君子煎。（即异功散加干姜、）善其后以除根。益
信《内经》久塞其空。塞因塞用之法。以治病起于经年累月。鼓胀全属虚寒者。为精确不磨也。此证却
为俞君所未及。爰赘言之。
【廉勘】肿胀蛊臌诸病。俞氏多从原因疗法。法固至当。然予推求其成病之总因。浅言之。不出外因、内
因、及不内外因之三端。深言之。必从生理上推求病理。从病理上推求病源。汇通古今中外。始有精当之学
识。而后能下正确之诊断。试先论肿。原其病因。陈无择水肿叙论。冒风寒暑湿属外。悲怒忧思属内。饮食劳
逸。背于常经。属不内外。皆致此病。张筱衫曰。肿分阴水、阳水。脾肺肾虚。致水泛者为阴水。湿热浊滞。
致水溢者为阳水。《内经》谓水为至阴。其标在肺。其本在肾。其制在脾。故水溢为肿。无不本于脾肺肾三经。
必先辨明虚实。虚因情志操劳。酒色过度。病后气虚。其肿渐至。实因六淫外客。饮食内伤。忽然浮肿。其来
必速。惟西医谓回血管先有阻塞。然后水溢胞膜而为肿。如心以上大回管有一处阻塞。脑颈手之血。难返心
房。上半身即见肿证。心以下大回管有一处阻塞。肝肾足之血。难返心房。下半身即见肿证。若水但聚在周身
皮膜间。则手足肿。或全体肿。若水聚于腹。则为腹胀。其外因劳倦时。汗气被冷风雨湿遏止。不得外泄于汗
孔。势必由吸管内泄。泄于大小肠则泻。泄于皮膜则为肿。内因身虚心弱。则心房失功用。其力不足以逼血。
血行阻碍。因而血中之水汁。妄从他处渗泄。泄于外膜则为肿。泄于内膜则为胀。故血管水泄为肿。最宜分别
虚实。此与陈无择所云。肾虚则火亏。致阴水凝滞。肺满则泛溢。使阳水沉潜。沉潜则气闭。凝滞则血淖。
经络不通。枢机不转。水乃不行。渗透皮肤。皮肤浮肿。足胫尤甚。两目下肿。腿股间冷。胸腹坚胀。不得正
偃。偃则咳嗽。上为喘急。下为肿满。其说大同而小异。辨其病状。阴水肿。先肿下体腰腹胫跗。后遍身肿。
皮色青白。口不渴。大便溏。小便少。阳水肿。先肿上体肩背手面。后遍身肿。皮色黄赤。口烦渴。大便闭。
溺热涩。气肿。皮浓色苍。一身尽肿。自上而下。按之不成凹而即起。四肢削瘦。胸膜痞满。水肿。皮薄色
泽。肿有分界。自下而上。按之成凹不即起。小便不利。上气喘咳。痛风肿头痛恶风。面浮身肿。皮粗
麻木。流走注疼。黄胆肿。身目俱黄。面浮肢肿。便溏腹满。溺短赤热。妇女水分肿。病发于上。先水肿而后
经断。皮无赤痕。心下坚大。便溏溺少。血分肿。病发于下。先经断而后水肿。皮现赤缕。小腹硬痛。
便黑溺清。更有湿渍于脾。脾气横泄。四肢浮肿。喘不得卧。心腹胀满。饮食难进。湿流于脚。脚
气支满。上攻心胸。脘中胀闷。甚则呕逆。二便不利。此皆水肿之类症。首当甄别。西医谓皮肤水肿。
大约有七。（一）心脏性水肿。皮现青色。呼吸困难。（二）肾脏性水肿。先肿颜脸。尿含蛋白。
（三）炎症性水肿。寒战发热。头痛恶心。皮色赤浊。溺短赤溷。（四）恶液质性水肿。用手压之。皮不
凹陷。先肿于眼睑唇鼻颊颈。后及于腰腹四肢。（五）血管神经性水肿。起自血管运动神经障碍。时用
手指压之。不留痕迹。有硬度弹力性。（六）局部性水肿。多起于水血症或恶液质。或偏肿左侧。或偏肿
右侧。或偏肿上肢。或偏肿下肢。或但头面肿。或但肾囊肿。（七）麻痹性水肿。多生于组织液缺及筋
肉援助。或半侧麻痹。或四肢全麻。予按心脏肾脏性等水肿。多因于情志操劳。酒色过度。吾国通称阴水肿。
症虽属虚。而有虚寒虚热之不同。炎症恶液质局部性等水肿。多因于六淫外客。饮食内伤。吾国通称阳
水肿。症虽属实。而有风热、湿热、积热、瘀热之各异。至于血管神经性水肿。吾国通称气肿。《内经》所
谓肤胀是也。若麻痹性水肿。即吾国所云痛风身肿是也。惟陈氏谓经络不通。枢机不转。水乃不行。渗透
皮肤。此四语实为肿病之总因。与西医回管阻塞。水溢胞膜。其学说病理。可谓中外一揆矣。叶天士先生
曰。初病治气。久必通络。予尝推其理以治肿。及先肿后胀。先胀后肿。每于治肿各方中。佐以行气通
络之品。往往获效。因此予治肿症。但执简以御繁。首分寒热虚实。临病求原以用药。如因寒客皮肤而成
气肿者。林氏所谓肤胀属肺是也。每用叶氏五皮饮。加生香附、紫苏旁枝、鲜葱须等。辛通络气以消肿。
寒郁下焦而成水肿者。《金匮》所谓石水正水是也。每用麻附五皮饮。重用泽兰梗五六钱。温通络气以
退肿。寒饮浸
肺。肺气不化而先喘后肿者。《金匮》所谓溢饮肢肿。支饮咳逆是也。轻则用麻杏三皮饮。（蜜炙麻黄八分、
光杏仁三钱、浙苓皮四钱、新会皮钱半、生姜皮一钱、紫菀、前胡各二钱、牛蒡子钱半、以上即叶氏验方。）
稍重用白果定喘汤。重则用小青龙汤加苓皮、石膏。（生石膏、浙苓皮各一两、先煎代水。）宣肺降气
以行水。寒湿滞脾。脾气失运而先肿后喘者。《内经》所谓诸湿肿满。皆属于脾是也。轻则用大橘皮汤。
稍重用杏苏胃苓汤。（光杏仁三钱、苏子钱半、制苍术八分、真川朴一钱、赤苓、桑皮各三钱、广皮、猪
苓、泽泻、大腹皮各钱半、春砂仁五分、生姜皮八分、此方去杏苏、李惺 先生名加减胃苓汤、统治水肿、
随症寒热虚实加减、用之多验。）重则用加减实脾饮。（老于术二钱、浙茯苓三钱、川朴一钱、青化桂、
黑附块各五分、广木香、酒炒木瓜各八分、生姜皮一钱、大红枣三枚、上沉香磨汁冲四匙、此方去沉香、
肉桂、加草果、炮、姜大腹皮、陈皮、炙甘草、《济生方》名实脾饮、统治阴水发肿、随症加减。）温脾
利湿以降气。风热入肺。肺气肿盛。不能通调水道。致上身肿而喘息者。此中医所谓肺痹。西医所谓肺积气
也。风重热轻者。越婢加半夏汤。散风热以降肺气。热重风轻者。苇茎苈枣汤。（鲜苇茎、即活水芦根之
青色者、冬瓜子各一两、先煎代水、光桃仁七粒、生苡仁五钱、葶苈子二钱、大红枣两枚。）或用荷杏石甘汤。
（苏薄荷八分、光杏仁、栝蒌皮各三钱、霜桑叶、青连翘各二钱、焦栀皮钱半、用生石膏研细八钱、生甘
细梢八分、先煎代水、此皆叶氏验方。）送下清肺葶苈丸。（葶苈隔纸炒、川贝、木通各一两、光杏仁、木
防己各二两、为末、红枣肉丸、每服二三钱、李惺 先生验方。）泻气热以消肿痹。湿热壅肺。肺水肿满。
不能下输膀胱。致小便闭而喘肿者。此中医所谓肺水。西医所谓肺积气与水也。湿郁热蒸者。枇杷叶煎。
（枇杷叶去毛筋净剪碎一两、浙苓皮五钱、先煎代水、光杏仁十粒、生苡仁三钱、淡香豉、飞滑石各钱半、
黑栀皮、川通草各一钱、《叶案》验方。）肃肺气以平喘肿。热重湿轻者。茅根清络饮。（海金砂五钱拌
包飞滑石六钱、生川柏、川通草各钱半、猪苓三钱、杜赤豆四钱、北细辛一分、鲜葱须二
分、用鲜茅根二两、全丝瓜络一枚、煎汤代水、《叶案》验方。）清三焦以定肿喘。积热壅脾。脾气横泄。或上肢
肿而目金黄。或下肢肿而脘腹痞满者。此中医所谓黄肿及香港脚肿者。西医所谓局部性水肿也。手肿面黄者。加
味二金汤。（鸡内金五钱、川朴、猪苓、焦山栀、大腹皮各三钱、通草二钱、用西茵陈一两、海金砂五钱、煎
汤澄清代水、吴氏《条辨》方加味。）去积热以退黄肿。脚肿腹满者。加味大承气汤。（川朴、广皮各二钱、枳
实、槟榔、苡仁、元明粉各三钱、生川军四钱、木瓜钱半。）泻积热以退香港脚。瘀热阻肝。肝络郁塞。或先经
断而后水肿。或先水肿而后经断者。中医所谓血分肿及水分肿者。西医所谓恶液质性水肿也。先经停而后水肿
者。三合绛覆汤。（新绛、旋复花包各二钱、乌贼骨四钱、茜草根一钱、光桃仁九粒、归尾二钱、泽兰五钱、
青葱管五寸冲）送下理冲丸。（生黄 两半、生水蛭一两、当归、桃仁、知母各六钱、生三棱、生莪术各五钱、
共研细匀、蜜丸、每服二钱、以上《叶案》方及张寿甫验方。）通经闭以退水肿。先水肿而后经停者。加减《千
金》鲤鱼汤。（归尾、泽兰、赤芍各三钱、绛通草钱半、生姜皮一钱、连须葱白十个、用活鲤鱼一尾、约重十二两、
马鞭草一两、煎汤代水。）送下沉香琥珀丸。退水肿以通经闭。至若虚肿。或外感病后。失于调养。或内伤情
志。不能解脱。或平素恣酒贪色。日积月累。酿成肿病。皆由肺脾肾三经气化失司。此即西医所谓心脏性及
肾脏性水肿也。肺气虚不能通调水道。致水溢外膜而成肿者。黄 秫米煎。（生黄 四两、北秫米一酒钟、煎
一大碗、用小瓢逐渐呷服、许珊林《观察》验方。）大补宗气以退肿。脾气虚不能为胃行津液。致水聚膜络
而为肿者。乌蠡鱼汤。（生于术、云茯苓各二钱半、广皮红、木瓜蜜炙、桑皮各二钱、秦艽酒洗三钱、生姜皮
钱半、苏叶一钱、用大乌蠡鱼一枚、河水五碗、煎至三大碗、去鱼骨滤清煎药、缪仲淳验方。）不应。则用
水肿至神汤。（浙茯苓二两切小块、生于术黄土炒、杜赤小豆、车前草各一两、大麦须五钱、小枳实二钱、
六神曲四钱、大罐浓煎、须一日夜服尽、连服三剂、溺畅肿消、汪氏方原名水肿神方。）（荣斋按∶此方见
汪日桢《随山宇方
抄》。）大补中气以消肿。肾气虚不能下输膀胱。致水积肾盂而为肿者。先用林氏肾气汤。（桂心五分后煎、黑
附块三分、浙茯苓三钱、淮牛膝炒车前各二钱、大腹绒钱半、川椒目二十粒、林佩琴验方。）温化肾气以通溺
道。继用加减《金匮》肾气汤。（熟地、生淮药、云茯苓各四钱、萸肉、泽泻、丹皮各钱半、紫 桂五分后入、知
母三钱、生白芍五钱、治阴虚不能化阳、致溺闭积成水肿、张寿甫验方。）补化肾气以消水肿。若夫实肿。或
由胸膈停饮。或由腹膜积水。或由胃肠积滞。忽然浮肿。肿必兼胀。停饮以蠲饮万灵汤为主（俞根初方）。积水
惟逐水至神汤最效（炒黑丑三钱、煨甘遂三钱、炒车前一两、紫 桂五分、傅青主男科方。）积滞以枳实导
滞汤最稳（俞根初方）。他如舟车神 丸之逐饮（煨甘遂二钱、芫花醋炒一钱、红牙大戟三钱、黑丑拌炒生川
军各四钱、青皮、广皮各钱半、广木香、轻粉各一钱、尖槟榔三钱、红枣肉煮熟去皮核炼丸、如梧桐子大、先
服三十丸、次服二十丸、服三十丸、以肿退为度、张子和方）。神芎导水丸之泄水（黑丑拌炒生军各五钱、川
芎、薄荷叶各三钱、条芩、川连各二钱、滑石一两、水泛丸、每服三四钱、张子和方）。阴阳攻积丸之祛积
（茱萸、干姜、官桂、川芎各一两、黄连、半夏、橘红、茯苓、槟榔、浓朴、枳实、菖蒲、延胡、人参、沉
香、琥珀、桔梗各八钱、巴霜另研五钱、皂角六两、煎汁泛丸、每服八分、渐加至一钱半、姜汤下、此丸通治
五积六聚、七 八瘕、 癖蛊血痰食、皆效、乔三余方。）对证酌用。皆有捷效。其次论胀。胀病头绪甚繁。先
宜辨有形无形。无形多属气郁。故治以理气为主。有形多属血瘀。故治以通络为君。此胀病之大要也。然必辨
寒热虚实。继辨痰水谷虫。约计十种、分证条治。（一）气胀。多因于七情郁结。气道壅隔。上不得降。下不得
升。胸腹胀满。四肢瘦削。《内经》所谓浊气在上。则生 胀是也。治宜升清降浊。达郁宽中汤。（沉香片五分、莱
砂散一钱、生鸡内金三钱、白芍五钱、归须、真川朴、陈香橼皮各一钱、川柴胡五分、用晚蚕沙五钱、鲜茅根
二两、葱须五分、煎汤代水、廉臣验方）磨冲聚宝丹一丸。（真沉香、广木香、春砂仁各二钱、血竭、乳香各
钱半、玄胡索一钱、麝香八分、没药五分、共研细末、糯米为丸、如弹子大、约重五分、用辰砂钱半为
衣、《和剂局方》、善治气胀、兼治男妇翻胃呕吐、饮食不降、胃脘寒痰结阻、及诸气胀痛、产后血气攻心、
小儿天吊作痛、啼叫不已、通用葱汤磨服。）先通其气以宽胀。继用宣清导浊汤加减。（晚蚕沙四钱拌包
飞滑石四钱、赤苓、猪苓各五钱、蜜炙皂荚子一钱、两头尖一钱包煎、泽兰三钱、鲜葱须三分、叶案验方。）
降浊厘清以除根。（二）血胀。多因络瘀。或早服截疟药。胀在右边者为肝胀。在左边者为脾胀。或妇人
寒郁子宫。子宫积瘀。胀在少腹者为石瘕。《内经》所谓恶血不泻。 以留止。日以益大。可导而下是也。
大腿先出现肿胀，随后逐渐蔓延至腹部。按压腹部时感觉像鼓一样，坚硬且紧绷。伴有咳嗽并吐出涎沫，气短喘息。脉象虽然浮大，但重按则空虚无力。两手脉搏在寸口部位均无法触及。起初使用白术和中汤，加入霞天曲、戈半夏。服用两剂后，小腹胀满反而加重，痰涎增多，大小便不通畅，无法躺卧睡眠。接着改用薛氏加减肾气汤。服用两剂后，虽然身体没有不适感，但也未见疗效。于是仿照张景岳的大剂温补方法，使用理阴煎，加入人参、白术、附子。服用五剂后，足部肿胀逐渐消退；服用十剂后，腹部胀大症状减轻。最后用六君子煎（即异功散加干姜）善后以除病根。这更加让人相信《内经》中“久塞其空，塞因塞用”的治疗法则，对于这种由经年累月积累而成、鼓胀完全属于虚寒性质的病症，是精确不可更改的真理。此证却是俞根初先生未曾涉及到的，因此特意补充说明。
【廉臣按语】关于肿胀、蛊胀等病症，俞氏多从病因疗法入手，这种方法固然恰当。然而我推求其成病的总原因，浅而言之，不外乎外因、内因及不内外因这三端；深而言之，必须从生理上推求病理，从病理上推求病源，汇通古今中外知识，才能拥有精当的学识，从而做出正确的诊断。试先论述水肿。追溯其病因，陈无择在《水肿叙论》中指出：冒受风寒暑湿属于外因；悲怒忧思属于内因；饮食劳逸违背常道属于不内外因，这些都会导致此病。张筱衫说：水肿分为阴水和阳水。脾肺肾虚导致水液泛滥的是阴水；湿热浊滞导致水液溢出的是阳水。《内经》说水是至阴之物，其标在肺，其本在肾，其制约在脾。所以水液溢出形成水肿，无不根源于脾、肺、肾三经。必须先辨别虚实。虚证多因情志操劳、酒色过度、病后气虚，其肿胀逐渐形成；实证多因六淫外邪侵袭、饮食内伤，突然浮肿，其来势必然迅速。只有西医认为回血管（静脉）先有阻塞，然后水液溢出胞膜而形成水肿。如心脏以上的大回管有一处阻塞，脑部、颈部、手部的血液难以返回心房，上半身就会出现肿证；心脏以下的大回管有一处阻塞，肝脏、肾脏、足部的血液难以返回心房，下半身就会出现肿证。如果水液只聚集在周身皮膜之间，则手足肿或全身肿；如果水液聚集在腹部，则为腹胀。其外因在于劳倦之时，汗气被冷风雨湿遏止，不能从汗孔向外排泄，势必由吸管内泄。泄于大小肠则为腹泻，泄于皮膜则为水肿。内因在于身体虚弱，则心房失去正常功能，力量不足以推动血液，血行受阻，因而血液中的水汁妄自从他处渗泄。泄于外膜则为水肿，泄于内膜则为胀满。所以血管水液渗出为水肿，最宜分别虚实。这与陈无择所说的“肾虚则火亏，致阴水凝滞；肺满则泛溢，使阳水沉潜。沉潜则气闭，凝滞则血淖。经络不通，枢机不转，水乃不行。渗透皮肤，皮肤浮肿。足胫尤甚。两目下肿，腿股间冷，胸腹坚胀，不得正偃。偃则咳嗽，上为喘急，下为肿满。”的说法大同小异。辨别病状：阴水水肿，先肿下肢腰腹胫跗，后遍及全身，皮色青白，口不渴，大便溏薄，小便少；阳水水肿，先肿上肢肩背手面，后遍及全身，皮色黄赤，口烦渴，大便闭塞，溺尿热涩。气肿，皮厚色苍，一身尽肿，自上而下，按之不成凹陷且立即弹起，四肢消瘦，胸膈痞满。水肿，皮薄色泽鲜明，肿有分界，自下而上，按之成凹陷且不立即弹起，小便不利，上气喘咳。痛风肿头痛恶风，面浮身肿，皮粗麻木，流走注疼。黄疸肿，身目俱黄，面浮肢肿，便溏腹满，溺短赤热。妇女水分肿，病发于上，先水肿而后月经断绝，皮无赤痕，心下坚大，便溏溺少。血分肿，病发于下，先月经断绝而后水肿，皮现赤缕，小腹硬痛，便黑溺清。更有湿气浸渍于脾，脾气横逆泄泻，四肢浮肿，喘促不得卧，心腹胀满，饮食难进。湿气流注于脚，脚气支满，上攻心胸，脘中胀闷，甚至呕逆，大小便不利。这些都是水肿的类似病症，首先应当甄别。西医认为皮肤水肿大约有七种。（一）心脏性水肿，皮现青色，呼吸困难。（二）肾脏性水肿，先肿颜脸，尿含蛋白。（三）炎症性水肿，寒战发热，头痛恶心，皮色赤浊，溺短赤混。（四）恶液质性水肿，用手压之，皮不凹陷，先肿于眼睑唇鼻颊颈，后及于腰腹四肢。（五）血管神经性水肿，起自血管运动神经障碍，时用手指压之，不留痕迹，有硬度弹力性。（六）局部性水肿，多起于水血症或恶液质，或偏肿左侧，或偏肿右侧，或偏肿上肢，或偏肿下肢，或但头面肿，或但肾囊肿。（七）麻痹性水肿，多生于组织液缺乏及肌肉援助不足，或半侧麻痹，或四肢全麻。我认为心脏、肾脏性等水肿，多因于情志操劳、酒色过度，我国通称阴水肿，症虽属虚，而有虚寒虚热之不同。炎症、恶液质、局部性等水肿，多因于六淫外客、饮食内伤，我国通称阳水肿，症虽属实，而有风热、湿热、积热、瘀热之各异。至于血管神经性水肿，我国通称气肿，即《内经》所谓肤胀。若麻痹性水肿，即我国所云痛风身肿。只有陈氏所说“经络不通，枢机不转，水乃不行，渗透皮肤”，这四句话实为肿病的总因，与西医回管阻塞、水溢胞膜的学说病理，可谓中外一致。叶天士先生说：“初病治气，久必通络。”我曾推究其理来治疗水肿，以及先肿后胀、先胀后肿的情况，每每在治疗水肿的各方的基础上，佐以行气通络的药物，往往获得疗效。因此我治疗肿症，执简御繁，首分寒热虚实，临病求原以用药。如因寒邪客于皮肤而成气肿者，林氏所谓肤胀属肺，每用叶氏五皮饮，加生香附、紫苏旁枝、鲜葱须等，辛通络气以消肿。寒郁下焦而成水肿者，《金匮》所谓石水正水，每用麻附五皮饮，重用泽兰梗五六钱，温通络气以退肿。寒饮浸肺，肺气不化而先喘后肿者，《金匮》所谓溢饮肢肿、支饮咳逆，轻则用麻杏三皮饮（蜜炙麻黄八分、光杏仁三钱、浙苓皮四钱、新会皮钱半、生姜皮一钱、紫菀、前胡各二钱、牛蒡子钱半，以上即叶氏验方），稍重用白果定喘汤，重则用小青龙汤加苓皮、石膏（生石膏、浙苓皮各一两，先煎代水），宣肺降气以行水。寒湿滞脾，脾气失运而先肿后喘者，《内经》所谓诸湿肿满皆属于脾，轻则用大橘皮汤，稍重用杏苏胃苓汤（光杏仁三钱、苏子钱半、制苍术八分、真川朴一钱、赤苓、桑皮各三钱、广皮、猪苓、泽泻、大腹皮各钱半、春砂仁五分、生姜皮八分，此方去杏苏，李惺先生名加减胃苓汤，统治水肿，随症寒热虚实加减，用之多验），重则用加减实脾饮（老于术二钱、浙茯苓三钱、川朴一钱、青化桂、黑附块各五分、广木香、酒炒木瓜各八分、生姜皮一钱、大红枣三枚，上沉香磨汁冲四匙，此方去沉香、肉桂，加草果、炮姜、大腹皮、陈皮、炙甘草，《济生方》名实脾饮，统治阴水发肿，随症加减），温脾利湿以降气。风热入肺，肺气肿盛，不能通调水道，致上身肿而喘息者，此中医所谓肺痹，西医所谓肺积气也。风重热轻者，越婢加半夏汤，散风热以降肺气。热重风轻者，苇茎苈枣汤（鲜苇茎即活水芦根之青色者、冬瓜子各一两，先煎代水、光桃仁七粒、生苡仁五钱、葶苈子二钱、大红枣两枚），或用荷杏石甘汤（苏薄荷八分、光杏仁、栝蒌皮各三钱、霜桑叶、青连翘各二钱、焦栀皮钱半，用生石膏研细八钱、生甘细梢八分，先煎代水，此皆叶氏验方），送下清肺葶苈丸（葶苈隔纸炒、川贝、木通各一两、光杏仁、木防己各二两，为末，红枣肉丸，每服二三钱，李惺先生验方），泻气热以消肿痹。湿热壅肺，肺水肿满，不能下输膀胱，致小便闭而喘肿者，此中医所谓肺水，西医所谓肺积气与水也。湿郁热蒸者，枇杷叶煎（枇杷叶去毛筋净剪碎一两、浙苓皮五钱，先煎代水、光杏仁十粒、生苡仁三钱、淡香豉、飞滑石各钱半、黑栀皮、川通草各一钱，《叶案》验方），肃肺气以平喘肿。热重湿轻者，茅根清络饮（海金砂五钱拌包飞滑石六钱、生川柏、川通草各钱半、猪苓三钱、杜赤豆四钱、北细辛一分、鲜葱须二分，用鲜茅根二两、全丝瓜络一枚，煎汤代水，《叶案》验方），清三焦以定肿喘。积热壅脾，脾气横泄，或上肢肿而目金黄，或下肢肿而脘腹痞满者，此中医所谓黄肿及香港脚肿者，西医所谓局部性水肿也。手肿面黄者，加味二金汤（鸡内金五钱、川朴、猪苓、焦山栀、大腹皮各三钱、通草二钱，用西茵陈一两、海金砂五钱，煎汤澄清代水，吴氏《条辨》方加味），去积热以退黄肿。脚肿腹满者，加味大承气汤（川朴、广皮各二钱、枳实、槟榔、苡仁、元明粉各三钱、生川军四钱、木瓜钱半），泻积热以退香港脚。瘀热阻肝，肝络郁塞，或先经断而后水肿，或先水肿而后经断者，中医所谓血分肿及水分肿者，西医所谓恶液质性水肿也。先经停而后水肿者，三合绛覆汤（新绛、旋复花包各二钱、乌贼骨四钱、茜草根一钱、光桃仁九粒、归尾二钱、泽兰五钱、青葱管五寸冲），送下理冲丸（生黄芪一两半、生水蛭一两、当归、桃仁、知母各六钱、生三棱、生莪术各五钱，共研细匀，蜜丸，每服二钱，以上《叶案》方及张寿甫验方），通经闭以退水肿。先水肿而后经停者，加减《千金》鲤鱼汤（归尾、泽兰、赤芍各三钱、绛通草钱半、生姜皮一钱、连须葱白十个，用活鲤鱼一尾约重十二两、马鞭草一两，煎汤代水），送下沉香琥珀丸，退水肿以通经闭。至于虚肿，或外感病后失于调养，或内伤情志不能解脱，或平素恣酒贪色，日积月累酿成肿病，皆由肺脾肾三经气化失司，此即西医所谓心脏性及肾脏性水肿也。肺气虚不能通调水道，致水溢外膜而成肿者，黄芪秫米煎（生黄芪四两、北秫米一酒钟，煎一大碗，用小瓢逐渐呷服，许珊林《观察》验方），大补宗气以退肿。脾气虚不能为胃行津液，致水聚膜络而为肿者，乌蠡鱼汤（生于术、云茯苓各二钱半、广皮红、木瓜蜜炙、桑皮各二钱、秦艽酒洗三钱、生姜皮钱半、苏叶一钱，用大乌蠡鱼一枚、河水五碗，煎至三大碗，去鱼骨滤清煎药，缪仲淳验方），不应，则用水肿至神汤（浙茯苓二两切小块、生于术黄土炒、杜赤小豆、车前草各一两、大麦须五钱、小枳实二钱、六神曲四钱，大罐浓煎，须一日夜服尽，连服三剂，溺畅肿消，汪氏方原名水肿神方）。（荣斋按：此方见汪日桢《随山宇方抄》。）大补中气以消肿。肾气虚不能下输膀胱，致水积肾盂而为肿者，先用林氏肾气汤（桂心五分后煎、黑附块三分、浙茯苓三钱、淮牛膝炒车前各二钱、大腹绒钱半、川椒目二十粒，林佩琴验方），温化肾气以通溺道。继用加减《金匮》肾气汤（熟地、生淮药、云茯苓各四钱、萸肉、泽泻、丹皮各钱半、紫桂五分后入、知母三钱、生白芍五钱，治阴虚不能化阳，致溺闭积成水肿，张寿甫验方），补化肾气以消水肿。若夫实肿，或由胸膈停饮，或由腹膜积水，或由胃肠积滞，忽然浮肿，肿必兼胀。停饮以蠲饮万灵汤为主（俞根初方）。积水惟逐水至神汤最效（炒黑丑三钱、煨甘遂三钱、炒车前一两、紫桂五分，傅青主男科方）。积滞以枳实导滞汤最稳（俞根初方）。他如舟车神丸之逐饮（煨甘遂二钱、芫花醋炒一钱、红牙大戟三钱、黑丑拌炒生川军各四钱、青皮、广皮各钱半、广木香、轻粉各一钱、尖槟榔三钱、红枣肉煮熟去皮核炼丸，如梧桐子大，先服三十丸，次服二十丸，服三十丸，以肿退为度，张子和方）、神芎导水丸之泄水（黑丑拌炒生军各五钱、川芎、薄荷叶各三钱、条芩、川连各二钱、滑石一两，水泛丸，每服三四钱，张子和方）、阴阳攻积丸之祛积（茱萸、干姜、官桂、川芎各一两、黄连、半夏、橘红、茯苓、槟榔、浓朴、枳实、菖蒲、延胡、人参、沉香、琥珀、桔梗各八钱、巴霜另研五钱、皂角六两，煎汁泛丸，每服八分，渐加至一钱半，姜汤下，此丸通治五积六聚、七瘕八瘕、癖蛊血痰食，皆效，乔三余方），对证酌用，皆有捷效。其次论胀。胀病头绪甚繁，先宜辨有形无形。无形多属气郁，故治以理气为主。有形多属血瘀，故治以通络为君。此胀病之大要也。然必辨寒热虚实，继辨痰水谷虫，约计十种，分证条治。（一）气胀。多因于七情郁结，气道壅隔，上不得降，下不得升，胸腹胀满，四肢瘦削，《内经》所谓浊气在上，则生䐜胀是也。治宜升清降浊，达郁宽中汤（沉香片五分、莱砂散一钱、生鸡内金三钱、白芍五钱、归须、真川朴、陈香橼皮各一钱、川柴胡五分，用晚蚕沙五钱、鲜茅根二两、葱须五分，煎汤代水，廉臣验方），磨冲聚宝丹一丸（真沉香、广木香、春砂仁各二钱、血竭、乳香各钱半、玄胡索一钱、麝香八分、没药五分，共研细末，糯米为丸，如弹子大，约重五分，用辰砂钱半为衣，《和剂局方》，善治气胀，兼治男妇翻胃呕吐，饮食不降，胃脘寒痰结阻，及诸气胀痛，产后血气攻心，小儿天吊作痛，啼叫不已，通用葱汤磨服），先通其气以宽胀。继用宣清导浊汤加减（晚蚕沙四钱拌包飞滑石四钱、赤苓、猪苓各五钱、蜜炙皂荚子一钱、两头尖一钱包煎、泽兰三钱、鲜葱须三分，叶案验方），降浊厘清以除根。（二）血胀。多因络瘀，或早服截疟药，胀在右边者为肝胀，在左边者为脾胀。或妇人寒郁子宫，子宫积瘀，胀在少腹者为石瘕，《内经》所谓恶血不泻，䐜以留止，日以益大，可导而下是也。
The swelling first appears in the thighs, gradually expanding to the abdomen. Palpation reveals a drum-like tension, firm and hard. The patient coughs up saliva and experiences shortness of breath with panting. Although the pulse is floating and large, it feels empty upon heavy pressure. The pulses at the Cun Kou (inch position) on both hands are imperceptible. Initially, Baizhu Hezhong Tang (Atractylodes Macrocephala Decoction for Harmonizing the Middle) was administered with Xiatic Qu (Xiatian Curd) and Ge Banxia (Pinellia Ternata processed with Alum). After two doses, the lower abdominal distension worsened, phlegm and saliva increased, urination and defecation became obstructed, and the patient could not lie down or sleep. Subsequently, Xue Shi Jiajian Shenqi Tang (Dr. Xue’s Modified Kidney Qi Decoction) was used. After two doses, although there was no sense of obstruction, there was no therapeutic effect. Therefore, imitating Zhang Jingyue’s method of large-dose warm tonification, Liyin Jian (Nourishing Yin Decoction) was prescribed with added Renshen (Ginseng Root), Baizhu (Atractylodes Macrocephala Rhizome), and Fuzi (Aconite Lateral Root). After five doses, the foot swelling gradually subsided; after ten doses, the abdominal distension significantly receded. Finally, Liujunzi Jian (Six Gentlemen Decoction)—which is Yigong San (Yigong Powder) plus Ganjiang (Dried Ginger)—was used for convalescence to eradicate the root cause. This further confirms the precision of the *Neijing*’s principle: "For long-standing obstruction, use obstruction-treating methods for obstruction" (Sai Yin Sai Yong). This theory is particularly accurate for cases where the disease has persisted for years and鼓胀 (Drum Distension) is entirely due to deficiency-cold. This syndrome was not covered by Dr. Yu, so I have added this discussion.
[Lianchen’s Commentary]: Regarding diseases such as swelling, ascites, and gu accumulation, Dr. Yu mostly employed etiological therapy, which is indeed appropriate. However, when deducing the general cause of these diseases, superficially speaking, it does not exceed the three categories of external causes, internal causes, and non-internal/external causes. Profoundly speaking, one must deduce pathology from physiology, and disease sources from pathology, integrating ancient and modern, Chinese and foreign knowledge, to possess precise scholarship and thereby make correct diagnoses. Let us first discuss swelling. Tracing its etiology, Chen Wuzhe’s *Preface to Edema* states that exposure to wind, cold, summer-heat, and dampness belongs to external causes; sorrow, anger, worry, and anxiety belong to internal causes; improper diet and labor/rest violating normal routines belong to non-internal/external causes. All these can lead to this disease. Zhang Xiaoshan said: Swelling is divided into Yin Water and Yang Water. Deficiency of Spleen, Lung, and Kidney leading to water overflow is Yin Water; damp-heat and turbid stagnation leading to water spillover is Yang Water. The *Neijing* states that water is the ultimate Yin substance; its manifestation is in the Lung, its root is in the Kidney, and its regulation is in the Spleen. Thus, water overflow causing swelling invariably originates from the Spleen, Lung, and Kidney meridians. One must first distinguish between deficiency and excess. Deficiency arises from emotional strain, overwork, excessive alcohol and sexual activity, or post-illness Qi deficiency, with swelling developing gradually. Excess arises from invasion of the Six Evils (pathogenic factors) or dietary injury, with sudden edema appearing rapidly. Only Western medicine posits that venous blockage precedes fluid extravasation into tissue membranes. If there is a blockage in the superior vena cava above the heart, blood from the head, neck, and arms cannot return to the right atrium, resulting in upper body edema. If there is a blockage in the inferior vena cava below the heart, blood from the liver, kidneys, and legs cannot return to the right atrium, resulting in lower body edema. If fluid accumulates only in the subcutaneous tissues, hands and feet swell, or the whole body swells. If fluid accumulates in the abdomen, it causes abdominal distension. The external cause involves fatigue during sweating, where sweat vapor is blocked by cold, wind, rain, and dampness, preventing excretion through sweat pores. It must then leak via capillaries. Leakage into the large and small intestines causes diarrhea; leakage into skin membranes causes swelling. Internal causes involve physical weakness, where cardiac function declines, lacking the force to propel blood. Blood flow is obstructed, causing plasma to渗漏 (seep) abnormally from other sites. Leakage into outer membranes causes swelling; leakage into inner membranes causes distension. Therefore, distinguishing between deficiency and excess is crucial for vascular edema. This aligns closely with Chen Wuzhe’s statement: "Kidney deficiency leads to Fire decline, causing Yin Water stagnation; Lung fullness leads to overflow, making Yang Water sink. Sinking causes Qi closure; stagnation causes blood liquidity. Meridian blockage and pivot failure prevent water movement. Water penetrates the skin, causing cutaneous edema, especially in the calves and shanks. Swelling under the eyes, coldness in the thighs, hardness and distension in the chest and abdomen, inability to lie flat. Lying flat induces coughing, upper panting, and lower swelling." The theories are largely similar with minor differences. Differentiating symptoms: Yin Water edema starts with swelling in the lower body (waist, abdomen, shins, dorsum of feet), then spreads to the whole body; skin is cyanotic-white, mouth is not thirsty, stool is loose, urine is scant. Yang Water edema starts with swelling in the upper body (shoulders, back, hands, face), then spreads to the whole body; skin is yellow-red, mouth is irritable and thirsty, stool is constipated, urine is hot and difficult. Qi swelling: skin is thick and pale, whole body swollen from top to bottom, pressing leaves no depression and rebounds immediately, limbs are emaciated, chest diaphragm is stuffy. Water edema: skin is thin and lustrous, swelling has clear boundaries, starts from bottom up, pressing leaves a depression that does not rebound immediately, urination is difficult, upper panting and coughing. Gout swelling with headache and aversion to wind: facial and body swelling, rough and numb skin, wandering pain. Jaundice swelling: body and eyes are yellow, facial and limb swelling, loose stool, abdominal fullness, short red-hot urine. Women’s Fluid-component edema: onset from above, edema precedes amenorrhea, skin has no red streaks, epigastric hardness and fullness, loose stool, scant urine. Blood-component edema: onset from below, amenorrhea precedes edema, skin shows red streaks, lower abdomen is hard and painful, black stool, clear urine. Furthermore, dampness soaking the Spleen causes Spleen Qi to scatter horizontally, leading to limb edema, panting with inability to lie down, heart and abdominal fullness, difficulty eating. Dampness flowing to the feet causes Foot Bi (Jiaoqi) with fullness, attacking upward to the heart and chest, epigastric stuffiness, even vomiting, and urinary/fecal obstruction. These are all types of edema that must be differentiated first. Western medicine classifies cutaneous edema into approximately seven types: (1) Cardiac edema: skin is cyanotic, dyspnea. (2) Renal edema: periorbital swelling first, proteinuria. (3) Inflammatory edema: chills, fever, headache, nausea, reddish-cloudy skin, short red turbid urine. (4) Cachectic edema: pressing leaves no indentation, starts in eyelids, lips, nose, cheeks, neck, then waist, abdomen, limbs. (5) Vasoneurotic edema: originates from vasomotor nerve dysfunction, pressing leaves no trace, has hardness and elasticity. (6) Localized edema: often arises from hydremia or cachexia, may affect left or right side, upper or lower limbs, or only face or kidney cysts. (7) Paralytic edema: often due to tissue fluid deficiency and lack of muscular assistance, or hemiplegia, or quadriplegia. I believe cardiac and renal edema are mostly due to emotional strain, overwork, and excessive alcohol/sex, commonly called Yin Water edema in China. Though deficiency-type, they differ in deficiency-cold vs. deficiency-heat. Inflammatory, cachectic, and localized edema are mostly due to Six Evils invasion and dietary injury, commonly called Yang Water edema in China. Though excess-type, they differ in wind-heat, damp-heat, accumulated heat, and stasis-heat. Vasoneurotic edema is commonly called Qi swelling in China, corresponding to *Fuzhang* (Skin Distension) in the *Neijing*. Paralytic edema corresponds to gout-related body swelling in China. Only Chen’s words "Meridian blockage, pivot failure, water stagnation, penetrating skin" truly summarize the general cause of swelling, aligning perfectly with the Western theory of venous blockage and fluid extravasation. Mr. Ye Tianshi said, "In early disease, treat Qi; in chronic disease, unblock collaterals." I have applied this logic to treating swelling, including cases of swelling preceding distension or vice versa, often adding Qi-moving and collateral-unblocking herbs to edema formulas, achieving good results. Thus, my treatment of swelling simplifies complexity by first distinguishing Cold/Heat and Deficiency/Excess, seeking the root before prescribing. For Qi swelling caused by Cold invading skin (Lin’s *Fuzhang* belonging to Lung), I use Ye’s Wupi Yin (Five Peel Decoction) plus Sheng Xiangfu (Cyperus Rotundus), Zisu Pangzhi (Perilla Stem), and Xian Congxu (Green Onion Root) to acridly unblock collateral Qi and reduce swelling. For Edema due to Cold stagnating in the Lower Jiao (*Jingui*’s Shuishui/Shi Shui), I use Mafu Wupi Yin, heavily using Zelangu (Lycopus Lucidus Herb) 5-6 qian to warm and unblock collateral Qi to reduce swelling. For Asthma preceding swelling due to Cold-fluid soaking the Lung (*Jingui*’s Yiyin/Zhiyin), mild cases use Maxing Sanpi Yin (Honey-fried Mahuang 8 fen, Guang Xingren 3 qian, Zhe Lingpi 4 qian, Xin Hui Pi 1.5 qian, Shengjiang Pi 1 qian, Ziwan 2 qian, Qianhu 2 qian, Niubangzi 1.5 qian—Ye’s verified formula); moderate cases use Baiguo Dingchuan Tang; severe cases use Xiao Qinglong Tang plus Lingpi and Shigao (Raw Shigao and Zhe Lingpi 1 liang each, decocted first as water substitute) to diffuse Lung and descend Qi to move water. For Edema preceding asthma due to Cold-Damp stagnating in Spleen (*Neijing*: "All dampness, swelling, and fullness belong to Spleen"), mild cases use Daju Pi Tang; moderate cases use Xingsu Weiling Tang (Guang Xingren 3 qian, Suzi 1.5 qian, Zhi Cangzhu 0.8 qian, Zhen Chuanpu 1 qian, Chi Ling 3 qian, Sangpi 3 qian, Guangpi 1.5 qian, Zhuling 1.5 qian, Zexie 1.5 qian, Dafupi 1.5 qian, Chunsharen 0.5 fen, Shengjiang Pi 0.8 fen. Removing Xingsu, Dr. Li Xing named this Modified Weiling Tang, governing edema with modifications for Cold/Heat/Deficiency/Excess); severe cases use Jiashian Shipin Yin (Lao Baizhu 2 qian, Zhe Fuling 3 qian, Chuanpu 1 qian, Qing Huagui 0.5 qian, Hei Fukuai 0.5 qian, Guangmuxiang 0.8 qian, Jiupaomugua 0.8 qian, Shengjiang Pi 1 qian, Da Hongzao 3 pieces, Shang Chenxiang powder 4 spoons mixed in juice. Removing Chenxiang/Rougui, adding Caoguo, Paojiang, Dafupi, Chenpi, Zhigancao—named Shipin Yin in *Jisheng Fang*, governing Yin Water edema). This warms Spleen, promotes dampness, and descends Qi. For Wind-Heat entering Lung causing Lung edema and inability to regulate water passages, leading to upper body swelling and panting (TCM Feibi/Western Pulmonary Emphysema): if Wind > Heat, use Yebijia Banxia Tang to disperse Wind-Heat and descend Lung Qi; if Heat > Wind, use Weijing Lizaotang (Fresh Weijing/Lu Gen 1 liang, Dongguazi 1 liang, decocted first; Guang Taoren 7 grains, Sheng Yiren 5 qian, Tinglizi 2 qian, Da Hongzao 2 pieces) or Hexing Shigan Tang (Su Bohe 0.8 fen, Guang Xingren 3 qian, Gualoupi 3 qian, Shuang Sangye 2 qian, Qing Lianqiao 2 qian, Jiao Zhipi 1.5 qian, Raw Shigao powder 8 qian, Raw Ganweixushao 0.8 fen, decocted first—all Ye’s verified formulas), followed by Qingfei Tingli Wan (Tingli stir-fried on paper, Chuanbei, Mutong each 1 liang; Guang Xingren, Mugufangji each 2 liang, powdered, pilled with Red Date meat, 2-3 qian per dose—Li Xing’s verified formula) to drain Qi-Heat and reduce swelling/bi. For Damp-Heat congesting Lung causing Lung edema/fullness and inability to transmit to Bladder, leading to urinary retention, panting, and swelling (TCM Feishui/Western Pulmonary Emphysema and Edema): if Damp stagnates with Heat steaming, use Pipaye Jian (Pipaye de-haired/cut 1 liang, Zhe Lingpi 5 qian, decocted first; Guang Xingren 10 grains, Sheng Yiren 3 qian, Dan Xiangchi 1.5 qian, Fei Huashi 1.5 qian, Hei Zhipi 1 qian, Chuan Tongcao 1 qian—*Ye An* verified formula) to肃 (solemnize/clear) Lung Qi and calm panting/swelling. If Heat > Damp, use Maogen Qingluo Yin (Haijinsha 5 qian wrapped with Fei Huashi 6 qian, Sheng Chuanbai 1.5 qian, Chuan Tongcao 1.5 qian, Zhuling 3 qian, Du Chidou 4 qian, Bei Xixin 0.1 fen, Xian Congxu 0.2 fen, decocted with Xian Maogen 2 liang and Quan Sigualuo 1 piece as water substitute—*Ye An* verified formula) to clear Three Jiao and stabilize swelling/panting. For Accumulated Heat congesting Spleen causing Spleen Qi scattering, leading to upper limb swelling with yellow eyes or lower limb swelling with epigastric fullness (TCM Huangzhong/Hong Kong Foot/Jamaican Foot; Western Localized Edema): for hand swelling/yellow face, use Jiawei Erjin Tang (Jineijin 5 qian, Chuanpu, Zhuling, Jiao Shanzhi, Dafupi each 3 qian, Tongcao 2 qian, decocted with Xi Yichen 1 liang and Haijinsha 5 qian as water substitute—Wu’s *Tiaobian* modified formula) to remove accumulated heat and reduce yellow swelling. For foot swelling/abdominal fullness, use Jiawei Dachengqi Tang (Chuanpu, Guangpi each 2 qian, Zhishi, Binglang, Yiren, Yuanmingfen each 3 qian, Sheng Chuanjun 4 qian, Mugua 1.5 qian) to purge accumulated heat and reduce Jamaican Foot. For Stasis-Heat blocking Liver causing Liver Collateral congestion, leading to amenorrhea preceding edema or edema preceding amenorrhea (TCM Blood-component/Fluid-component edema; Western Cachectic Edema): for amenorrhea preceding edema, use Sanhe Jiangfu Tang (Xinjue, Xuanjinhua wrapped each 2 qian, Wuzeigu 4 qian, Qiancaogen 1 qian, Guang Taoren 9 grains, Guiwei 2 qian, Zelau 5 qian, Qingcongguan 5 cun added) followed by Lizhong Wan (Sheng Huangqi 1.5 liang, Sheng Shizhi 1 liang, Danggui, Taoren, Zhimu each 6 qian, Sheng Sanleng, Sheng Ezhu each 5 qian, powdered, honey-pilled, 2 qian per dose—*Ye An* and Zhang Shoufu’s verified formulas) to unblock menses and reduce edema. For edema preceding amenorrhea, use Jiashian *Qianjin* Liyu Tang (Guiwei, Zelau, Chishao each 3 qian, Jiangtongcao 1.5 qian, Shengjiang Pi 1 qian, Lianxu Congbai 10 stalks, decocted with live Carp ~12 liang and Biancao 1 liang as water substitute) followed by Chenxiang Hupo Wan to reduce edema and unblock menses. As for Deficiency Swelling, whether due to poor recovery after exogenous disease, unresolved emotional injury, or chronic indulgence in alcohol/sex accumulating over time, it results from loss of Qi transformation in Lung, Spleen, and Kidney, corresponding to Western Cardiac/Renal Edema. For Lung Qi deficiency failing to regulate water passages causing water overflow into outer membranes (Edema), use Huangqi Shumi Jian (Raw Huangqi 4 liang, Bei Shumi 1 wine cup, decocted to 1 large bowl, sip slowly—Xu Shanlin’s *Observation* verified formula) to greatly supplement Zong Qi and reduce swelling. For Spleen Qi deficiency failing to transport fluids causing water accumulation in membrane collaterals (Edema), use Wuliu Yu Tang (Raw Baizhu, Yun Fuling each 2.5 qian, Guangpihong, Mi-zhi Mugua, Sangpi each 2 qian, Qinjiu-washed Qinjiao 3 qian, Shengjiang Pi 1.5 qian, Sueye 1 qian, decocted with 1 large Wuliu fish and 5 bowls river water until 3 bowls remain, strain fish bones and decoct medicine—Miu Zhongchun’s verified formula). If ineffective, use Shuizhi Zhishen Tang (Zhe Fuling diced 2 liang, Raw Baizhu earth-fried, Du Chixiaodou, Cheqiancao each 1 liang, Daimaixu 5 qian, Xiao Zhishi 2 qian, Liushenqu 4 qian, strong decoction in large pot, taken over 24 hours, 3 doses total, until urination flows and swelling subsides—Wang’s original name Shuizhi Shenfang). [Rongzhai Note: This formula appears in Wang Rizhen’s *Suishanyu Fangchao*.] This greatly supplements Middle Qi to reduce swelling. For Kidney Qi deficiency failing to transmit to Bladder causing water accumulation in renal pelvis (Edema), first use Linshi Shenqi Tang (Guixin 5 fen added late, Hei Fukuai 3 fen, Zhe Fuling 3 qian, Chuan Nixi fried with Cheqian each 2 qian, Dafurong 1.5 qian, Chuanjiaomu 20 grains—Lin Peiqin’s verified formula) to warm-transform Kidney Qi and open urinary pathways. Then use Jiashian *Jingui* Shenqi Tang (Shudi, Sheng Huaiyao, Yun Fuling each 4 qian, Yurou, Zexie, Danpi each 1.5 qian, Zigui 5 fen added late, Zhimu 3 qian, Sheng Baishao 5 qian—treating Yin deficiency failing to transform Yang, causing urinary retention and edema—Zhang Shoufu’s verified formula) to tonify-transform Kidney Qi and eliminate edema. As for Excess Swelling, whether due to retained fluid in Chest/Diaphragm, ascites, or gastrointestinal stagnation, sudden edema always accompanies distension. For retained fluid, Juan Yin Wanling Tang is primary (Yu Genchu’s formula). For ascites, Zhushui Zhishen Tang is most effective (Chao Heichou 3 qian, Wei Gansui 3 qian, Chao Cheqian 1 liang, Zigui 5 fen—Fu Qingzhu’s Andrology formula). For stagnation, Zhishi Daoshi Tang is most stable (Yu Genchu’s formula). Others include Zhouche Shenwan for purging fluid (Wei Gansui 2 qian, Yuanhua vinegar-fried 1 qian, Hongya Daji 3 qian, Heichou fried with Sheng Chuanjun each 4 qian, Qingpi, Guangpi each 1.5 qian, Guangmuxiang, Qingfen each 1 qian, Jianbinglang 3 qian, Red Date meat boiled/skin removed/honey-pilled, size of Sophora seed, take 30 pills then 20 then 30, stop when swelling subsides—Zhang Zihe’s formula), Shenxiong Dao Shui Wan for draining water (Heichou fried with Sheng Jun each 5 qian, Chuanxiong, Boheye each 3 qian, Tiaohuang, Chuanlian each 2 qian, Huashi 1 liang, water-pilled, 3-4 qian per dose—Zhang Zihe’s formula), and Yinyang Gongji Wan for removing accumulation (Zhuyu, Ganjiang, Guangui, Chuanxiong each 1 liang, Huanglian, Banxia, Juhong, Fuling, Binglang, Nongpu, Zhishi, Changpu, Yanhu, Renshen, Chenxiang, Hupo, Jiegeng each 8 qian, Bashuang separately powdered 5 qian, Saojiao 6 liang decocted for pill coating, 0.8 qian per dose increasing to 1.5 qian with Ginger soup—this pill treats all Five Accumulations, Six Gatherings, Seven Zha, Eight Jia, Pi, Gu, Blood, Phlegm, Food stagnation—Qiao Sanyu’s formula). Use according to syndrome for rapid effects. Secondly, discussing Distension. Distension is complex; first distinguish Formless vs. Formed. Formless usually belongs to Qi Stagnation, so treat primarily with Qi-regulating methods. Formed usually belongs to Blood Stasis, so treat primarily with Collateral-unblocking methods. This is the gist of Distension. However, one must distinguish Cold/Heat/Deficiency/Excess, then distinguish Phlegm/Water/Food/Parasites, totaling about ten types, treated by syndrome differentiation. (1) Qi Distension: Mostly due to Seven Emotions stagnation, Qi pathway obstruction, unable to descend upward or ascend downward, causing chest/abdominal fullness and emaciated limbs. *Neijing*: "Turbid Qi staying above generates Dan Distension." Treatment should raise Clear and descend Turbid. Dayu Kuanzhong Tang (Chenxiang Pian 0.5 fen, Laisha San 1 qian, Sheng Jineijin 3 qian, Baishao 5 qian, Guixu, Zhen Chuanpu, Chen Xiangyuange each 1 qian, Chuan Chaihu 0.5 fen, decocted with Wancansha 5 qian, Xian Maogen 2 liang, Congxu 0.5 fen as water substitute—Lianchen’s verified formula), Mo Chong Jubao Dan 1 pill (Zhen Chenxiang, Guangmuxiang, Chunsharen each 2 qian, Xuexue, Rushiang each 1.5 qian, Xuanhusuo 1 qian, Shexiang 0.8 fen, Moyao 0.5 fen, powdered, glutinous rice pill, size of bullet, ~0.5 fen, coated with Chensha 1.5 qian—*Heji Jufang*, excellent for Qi Distension, also treats male/female Fanwei/Vomiting, undescending food, Stomach Cold-Phlegm obstruction, all Qi Pain/Distension, Postpartum Blood/Qi attacking Heart, Infant Tian Diao pain/crying incessantly, generally taken with Scallion Soup ground). First unblock Qi to relieve distension. Then use Xuanqing Daozhuo Tang modified (Wancansha 4 qian wrapped with Fei Huashi 4 qian, Chi Ling, Zhuling each 5 qian, Mi-zhi Zaojiazi 1 qian, Liangtoujian 1 qian bag-decocted, Zelau 3 qian, Xian Congxu 0.3 fen—*Ye An* verified formula) to descend Turbid and clarify Clear to eradicate the root. (2) Blood Distension: Mostly due to Collateral Stasis. Or early use of malaria-intercepting drugs. Distension on the right is Liver Distension; on the left is Spleen Distension. Or women with Cold stagnating in Uterus, Uterine Blood Stasis, distension in lower abdomen is Shixia. *Neijing*: "Malicious Blood not discharged, Dan stays and stops, day by day increasing, can be guided down."