寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

Oedema

Bujong

한글 부종  ·  Pinyin Fu Zhong

Water that has left its channels — read by where the swelling starts, and treated by the route it is sent out

浮腫

The chapter on swelling, and one of the most systematic in the book. It opens with the Neijing's account of the mechanism — the kidney is the gate of the stomach, and when the gate does not open water gathers and follows its own kind — then sets about sorting what results. Zhongjing's five water diseases, the five viscus waters, yang water against yin water, the ten waters of the Bonsa each rooted in a different organ: the chapter offers four overlapping schemes and expects the practitioner to hold them at once. What unifies them is a single clinical question, asked repeatedly and answered concretely — where did the swelling start? Beginning at the eyelids means one thing, at the feet another, at the scrotum a third. From that follows the route: swelling above the lumbus is sweated out, swelling below it drained through the urine, and the formulas divide along that line. Against all of it stands the section on prognosis at 2.12, which lists the cases no medicine reaches, and the section on prohibitions at 2.13, which asks for salt to be given up for three years.

2.1 The Causes of Oedema 浮腫之因

2.1.1
Source원문

腫者, 鍾也. 寒熱氣所鍾聚也. 《醫鑑》

Translation영역
To swell is to mass together. It is cold and heat qi massed and gathered.
Clinical note임상 주석
The chapter opens with a pun that is doing definitional work: 腫, swelling, is glossed by 鍾, to mass or collect. What swells is not tissue growing but something accumulating where it should not.

Uigam 醫鑑

2.1.2
Source원문

諸濕腫滿, 皆屬脾土. 《內經》

Translation영역
All damp swelling and fullness belongs to the spleen earth.
Clinical note임상 주석
One of the nineteen disease mechanisms of the Suwen, and the line every later author in this chapter argues with or from. It assigns oedema to the spleen; the passages that follow immediately complicate that by bringing in lung, kidney and the lower burner.

Naegyeong 內經

2.1.3
Source원문

三陰結, 謂之水. 註曰, 三陰結, 謂脾肺之脉, 俱寒結也. 脾肺寒結, 則氣化爲水. 《內經》

Translation영역
When the three yin are bound, this is called water. The commentary says: the three yin being bound means that the vessels of spleen and lung are both bound by cold. When spleen and lung are bound by cold, qi transforms into water.

Naegyeong 內經

2.1.4
Source원문

下焦溢爲水. 註曰, 下焦爲分注之所, 氣窒不瀉, 則爲溢水. 《內經》

Translation영역
The lower burner overflowing becomes water. The commentary says: the lower burner is the place where what is drunk is divided and channelled off; when the qi is blocked and does not drain, there is overflowing water.

Naegyeong 內經

2.1.5
Source원문

問曰, 少陰何主腎, 腎何以主水. 對曰, 腎者, 至陰也. 至陰者, 盛水也. 肺者, 太陰也. 少陰者, 冬脉也. 故其本在腎, 其末在肺, 皆積水也. 問曰, 腎何以能聚水而生病. 對曰, 腎者, 胃之關也. 關閉不利, 故聚水而從其類也. 上下溢於皮膚, 故爲胕腫, 胕腫者, 聚水而生病也. 《內經》

Translation영역
It was asked: why does the lesser yin govern the kidney, and why does the kidney govern water? The answer: the kidney is the utmost yin, and the utmost yin is where water is abundant. The lung is the greater yin; the lesser yin is the winter vessel. Therefore the root lies in the kidney and the tip in the lung, and in both water accumulates. It was asked: how is it that the kidney can gather water and so produce disease? The answer: the kidney is the gate of the stomach. When the gate does not open freely, water gathers and follows its own kind. Overflowing above and below into the skin, it becomes puffy swelling; and puffy swelling is water gathered so as to produce disease.
Clinical note임상 주석
The central passage of the section and the one the whole chapter rests on. 腎者胃之關 — the kidney is the gate of the stomach — states the mechanism: what is drunk passes through and must be let out, and when the gate does not open it backs up into the flesh. The root-and-tip formulation matters clinically. Root in the kidney, tip in the lung, which is why the chapter treats swelling of the face and chest through the lung and swelling of the legs and abdomen through the kidney, and why the two halves of the body call for different methods at 2.5.

Naegyeong 內經

2.1.6
Source원문

胕腫, 謂皮肉俱腫, 按之陷下, 泥而不起也. 《內經》

Translation영역
Puffy swelling means that skin and flesh swell together; pressed, it sinks in, and stays like mud without rising again.
Clinical note임상 주석
A definition of pitting oedema, and an exact one — the finger sinks, and the depression stays. 泥而不起, like mud without rising, is the image, and it separates this from swelling that resists the finger, which the chapter reads as qi rather than water.

Naegyeong 內經

2.1.7
Source원문

陰陽氣道不通, 四海閉塞, 三焦不瀉, 津液不化, 水穀幷行腸胃之中, 別于迴腸, 留于下焦, 不得滲膀胱, 則下焦脹, 水溢則爲水脹. 《靈樞》

Translation영역
When the qi pathways of yin and yang do not communicate, the four seas are blocked and closed, the three burners do not drain, and the fluids and humours are not transformed. Water and grain travel together within the intestines and stomach, part company at the returning intestine, lodge in the lower burner, and cannot percolate into the bladder — then the lower burner distends, and the water overflowing becomes water distension.

Yeongchu 靈樞

2.1.8
Source원문

水腫, 由脾虛濕勝, 凝閉滲道, 水漬妄行, 故通身面目手足皆浮而腫, 皮薄而光, 手按成窟, 擧手卽滿是也. 或腹大如鼓, 而面目四肢不腫者, 名曰脹滿, 又名鼓脹. 皆脾土濕熱爲病, 腫輕而脹重也. 《丹心》

Translation영역
Water swelling arises from spleen vacuity with damp prevailing, which congeals and closes the percolating pathways so that water soaks and moves recklessly. Hence the whole body, the face and eyes, the hands and feet all float and swell; the skin is thin and shiny, the hand pressed leaves a pit, and lifting the hand it fills again at once. Where instead the abdomen is large as a drum while face, eyes and four limbs do not swell, it is called distension and fullness, also called drum distension. Both are diseases of damp heat in the spleen earth; swelling is the lighter and distension the graver.
Clinical note임상 주석
The passage that separates this chapter from the one that follows it. Oedema is generalized and pits; distension is confined to the abdomen and does not. Danxi calls swelling the lighter of the two, and the Accumulations chapter at 1.7.9 says the same from the other side — once tense distension has set in, no physician can help. 皮薄而光 — the skin thin and shiny — is the visual sign, and it is the one that distinguishes oedema from fat or from a mass.

Dansim 丹心

2.1.9
Source원문

腎熱傳於膀胱, 熱盛逆於脾胃, 脾虛而不能制腎水. 脾主四肢, 故流走而身面皆腫也. 若加喘者, 何以然. 腎水勝而克退脾土, 反勝心火, 心又勝肺, 肺爲心剋, 故喘也. 《錢乙》

Translation영역
Kidney heat is transmitted to the bladder; the heat, being exuberant, counterflows into spleen and stomach, and the spleen being vacuous cannot restrain the kidney water. The spleen governs the four limbs, and so the water flows and travels until body and face all swell. If panting is added, why should this be? Kidney water prevails and drives back the spleen earth, then in turn overwhelms the heart fire; the heart in turn overwhelms the lung, and the lung being restrained by the heart, there is panting.
Clinical note임상 주석
A five-phase chain traced step by step to explain why oedema comes to be accompanied by breathlessness. Read as physiology it is a period construction; read as observation it is accurate — generalized oedema that progresses to dyspnoea is the ordinary course of cardiac and renal failure, and the chapter is registering that the two signs travel together.

Jeon Eul 錢乙

2.1.10
Source원문

久喘, 久瘧, 久痢, 羸悴之餘, 皆患此病. 《入門》

Translation영역
Long-standing panting, long-standing malaria, long-standing dysentery, and the aftermath of emaciation and exhaustion — all of these bring on this disease.
Clinical note임상 주석
Four causes, all of them chronic depletion rather than any acute insult. This is the observation behind the section on nourishing the upright that the Accumulations chapter makes at 1.10, and behind the formulas here that lead with ginseng and white atractylodes.

Immun 入門

2.2 The Signs that Foretell Oedema 浮腫徵兆

2.2.1
Source원문

諸有水氣者, 微腫先見於目下也. 帝曰, 何以言之. 岐伯曰, 水者, 陰也. 目下, 亦陰也. 腹者, 至陰之所居, 故水在腹者, 必使目下腫也. 《內經》

Translation영역
In all who have water qi, a slight swelling appears first below the eyes. The Yellow Emperor said: how is this so? Qi Bo said: water is yin, and the region below the eyes is also yin. The abdomen is where the utmost yin resides; therefore when water is in the abdomen it must cause swelling below the eyes.
Clinical note임상 주석
The chapter's earliest sign, and one worth keeping: swelling under the eyes precedes swelling anywhere else. That is a genuine clinical observation — periorbital oedema on waking is the classic first presentation of nephrotic syndrome, where the loose tissue around the eye fills before the dependent parts do.

Naegyeong 內經

2.2.2
Source원문

目裏微腫, 如臥蚕起之狀, 曰水. 《內經》

Translation영역
When the inner corner of the eye is slightly swollen, in the shape of a lying silkworm raised up, this is called water.
Clinical note임상 주석
臥蚕, the lying silkworm — the fold of tissue beneath the lower lid, swollen and rounded. The image is precise enough that it has stayed in use.

Naegyeong 內經

2.2.3
Source원문

頸脉動, 喘疾咳曰水. 《內經》

Translation영역
When the vessel of the neck pulsates and there is hurried panting with cough, this is called water.
Clinical note임상 주석
頸脉動 is a visibly pulsating vessel in the neck. Paired with breathlessness it is what would now be read as raised jugular venous pressure, and it remains one of the most useful bedside signs of cardiac fluid overload.

Naegyeong 內經

2.2.4
Source원문

足脛腫曰水. 《內經》

Translation영역
When the foot and shin swell, this is called water.

Naegyeong 內經

2.2.5
Source원문

視人之目窠上微壅, 如蚕新臥起之狀, 其頸脉動, 時咳, 按其手足上, 窅而不起者, 風水膚脹也. 鼻頭色微黑者, 有水氣. 《靈樞》

Translation영역
Look at the person: if the socket of the eye is slightly heaped up, in the shape of a silkworm newly lying and raised, if the vessel of the neck pulsates, if there is intermittent cough, and if pressing the hands and feet leaves a hollow that does not rise again — this is wind water and skin distension. When the tip of the nose is slightly black in colour, there is water qi.
Clinical note임상 주석
Four signs gathered into one examination — eye socket, neck vessel, cough, and the pit that does not rise — and then a fifth, a darkening at the tip of the nose. The sequence is a physical examination set out in order, and every element of it is still checked.

Yeongchu 靈樞

2.2.6
Source원문

腰脊者, 身之大關節也. 肢脛者, 人之管以趨翔也. 莖垂者, 身中之機, 陰精之候, 津液之道也. 故飮食不節, 喜怒不時, 津液內溢, 乃下流於睾, 血道不通, 日大不休, 俛仰不便, 趨翔不能, 此病榮然有水也. 《靈樞》

Translation영역
The lumbus and spine are the great joint of the body. The limbs and shins are what a person uses to walk and move. The stalk and its pendant are the pivot within the body, the sign of the yin essence, and the pathway of the fluids and humours. Therefore when food and drink are not regulated and joy and anger keep no season, the fluids overflow within and run downward into the testicles; the blood pathway does not communicate, and day by day it grows without ceasing, so that bending and straightening are not easy and walking is impossible. This disease is water standing full.
Clinical note임상 주석
Scrotal oedema described in its own right, with the mechanism given as fluid running downward and the blood pathway failing. Progressive scrotal swelling to the point that the patient cannot walk is a late sign of severe generalized oedema, and the chapter treats it separately at 2.11.9 with a formula of its own.

Yeongchu 靈樞

2.3 The Forms and Patterns of Oedema 浮腫形證

2.3.1
Source원문

水病下爲䯒腫大腹, 上爲喘呼不得臥者, 標本俱病. 故肺爲喘呼, 腎爲水腫, 肺爲逆不得臥. 《內經》

Translation영역
In water disease, when below there is swelling of the shins and a large abdomen, and above there is panting and gasping with inability to lie down, both tip and root are diseased. The lung produces the panting and gasping, the kidney produces the water swelling, and the lung counterflowing produces the inability to lie down.
Clinical note임상 주석
Root and tip diseased together, which is the chapter's term for the advanced case. 不得臥 — unable to lie down — is orthopnoea, and the Phlegm-Rheum chapter uses the same phrase at 6.4.6 for propping rheum. The two chapters are describing one patient. **Swelling of the legs with breathlessness that prevents lying flat is a cardiac emergency and requires immediate assessment.**

Naegyeong 內經

2.3.2
Source원문

濕勝則濡泄, 甚則水閉胕腫. 《內經》

Translation영역
When damp prevails there is soggy diarrhoea; when it is severe, water is closed off and there is puffy swelling.

Naegyeong 內經

2.3.3
Source원문

水病有五種. 一曰風水, 其脉自浮, 外證, 骨節疼痛, 惡風.

Translation영역
There are five kinds of water disease. The first is wind water: the pulse is of itself floating, and the outward signs are aching pain of the bones and joints with aversion to wind.

Junggyeong 仲景

2.3.4
Source원문

二曰皮水, 脉亦浮, 外證, 胕腫按之沒指, 不惡風, 其腹如鼓, 不渴, 當發其汗.

Translation영역
The second is skin water: the pulse is likewise floating, and the outward signs are puffy swelling in which the pressing finger sinks out of sight, with no aversion to wind, the abdomen like a drum, and no thirst. Sweat should be brought out.

Junggyeong 仲景

2.3.5
Source원문

三曰正水, 其脉沈遲, 外證, 自喘.

Translation영역
The third is true water: the pulse is sunken and slow, and the outward sign is panting of itself.

Junggyeong 仲景

2.3.6
Source원문

四曰石水, 其脉自沈. 外證, 腹滿不喘.

Translation영역
The fourth is stone water: the pulse is of itself sunken, and the outward signs are abdominal fullness without panting.

Junggyeong 仲景

2.3.7
Source원문

五曰黃汗, 其脉沈遲. 身發熱, 胸滿, 四肢頭面腫, 久不愈, 必致癰膿. 又曰, 久則肌肉潰爛, 陰囊足脛水出. 《仲景》

Translation영역
The fifth is yellow sweat: the pulse is sunken and slow. The body is feverish, the chest full, and the four limbs, head and face swell; if it does not resolve for long it must go on to abscess and pus. It is also said: left long, the flesh ulcerates and breaks down, and water issues from the scrotum and the shins.
Clinical note임상 주석
The five waters of the Jingui, distinguished by pulse and by the accompanying signs rather than by the swelling itself — floating for wind and skin water, sunken for the rest. The practical division is stated at skin water: what floats is sweated out. Yellow sweat is the one that ends badly, and the description of the late stage — flesh breaking down, water weeping from the skin of the scrotum and shins — is what severe chronic oedema actually does. **Weeping oedema with skin breakdown is a serious sign requiring urgent care.**

Junggyeong 仲景

2.3.8
Source원문

又有五藏水. 心水者, 其身重, 而少氣不得臥, 煩而躁, 其陰大腫.

Translation영역
There are also the five viscus waters. In heart water the body is heavy, the qi scant and the patient cannot lie down, there is vexation and agitation, and the genitals swell greatly.

Junggyeong 仲景

2.3.9
Source원문

肝水者, 其腹大, 不能自轉側, 脇下腹中痛, 時時津液微生, 小便續通.

Translation영역
In liver water the abdomen is large and the patient cannot turn from side to side unaided; there is pain below the ribside and within the abdomen, from time to time a little fluid is produced, and urination continues to pass.

Junggyeong 仲景

2.3.10
Source원문

肺水者, 身腫, 小便難, 時時鴨溏.

Translation영역
In lung water the body swells, urination is difficult, and from time to time there is duck-slop diarrhoea.

Junggyeong 仲景

2.3.11
Source원문

脾水者, 其腹大, 四肢苦重, 津液不生, 但苦少氣小便難.

Translation영역
In spleen water the abdomen is large and the four limbs are distressingly heavy; fluids are not produced, and there is only the distress of scant qi and difficult urination.

Junggyeong 仲景

2.3.12
Source원문

腎水者, 其腹大, 臍腫, 腰痛, 不得溺, 陰下濕如牛鼻上汗, 其足逆冷而黃瘦. 《仲景》

Translation영역
In kidney water the abdomen is large, the navel swells, the lumbus aches, urine will not pass, the region below the genitals is damp as sweat on an ox's muzzle, and the feet are reverse-cold with a yellow, wasted appearance.
Clinical note임상 주석
Five organs, one line each, and the whole set is distinguished by what accompanies the swelling rather than by the swelling itself. Heart water brings vexation and inability to lie down; kidney water brings cold feet and a swollen navel; lung water brings difficult urine and loose stool. 陰下濕如牛鼻上汗 — damp below the genitals like sweat on an ox's muzzle — is the kind of image the Jingui uses when it wants a sign remembered, and it is the one detail here that cannot be mistaken for anything else.

Junggyeong 仲景

2.3.13
Source원문

其狀目胞上下微腫如裹水, 通身浮腫, 咳喘怔忪, 股間淸涼, 小便澁黃, 皮薄而光, 手按成窟, 擧手卽滿, 是浮腫也. 《直指》

Translation영역
Its form is this: the eyelids above and below slightly swollen as though wrapped around water, the whole body puffy and swollen, cough and panting with throbbing of the heart, coolness between the thighs, urine rough and yellow, the skin thin and shiny, the hand pressed leaving a pit and the pit filling again the moment the hand is lifted — this is oedema.
Clinical note임상 주석
The single most complete description in the chapter, and it works as a checklist: eyelids, whole body, cough and palpitation, cool thighs, scant dark urine, thin shiny skin, and pitting that refills at once. A patient with all of these has the diagnosis.

Jikji 直指

2.3.14
Source원문

又有陽水, 陰水. 陽水多外因, 涉水冒雨, 或感風寒暑濕. 其證先腫上體肩背手臂, 熱渴而二便閉.

Translation영역
There are also yang water and yin water. Yang water is mostly of external cause — wading through water, braving rain, or contracting wind, cold, summerheat or damp. Its pattern is that the upper body swells first, the shoulders, back, hands and arms, with heat and thirst and both passages closed.

Immun 入門

2.3.15
Source원문

陰水多內因, 飮水及茶酒, 飢飽勞役房勞, 其證先腫下體腰腹脛跗, 身涼, 大便利. 《入門》

Translation영역
Yin water is mostly of internal cause — drinking water, tea and wine, hunger and surfeit, toil and sexual taxation. Its pattern is that the lower body swells first, the lumbus, abdomen, shins and insteps, with a cool body and free stool.
Clinical note임상 주석
The most useful of the chapter's four schemes, because it turns on two things the practitioner can establish at once: where the swelling began, and whether the patient is hot or cold. Upper body, hot, constipated is yang water; lower body, cool, loose stool is yin water. The formulas at 2.5 divide on exactly this line — ephedra and gypsum for the first, aconite and dry ginger for the second.

Immun 入門

2.3.16
Source원문

煩渴, 小便赤澁, 大便秘結, 此爲陽水.

Translation영역
Vexing thirst, urine red and rough, stool bound and constipated — this is yang water.

Jeongjeon 正傳

2.3.17
Source원문

不煩渴, 大便溏, 小便不赤澁, 此爲陰水. 《正傳》

Translation영역
No vexing thirst, loose stool, urine neither red nor rough — this is yin water.

Jeongjeon 正傳

2.3.18
Source원문

又曰, 石水者, 腎水停在臍下, 小腹腫大, 結硬如石, 故云石水.

Translation영역
It is also said: in stone water the kidney water stands below the navel, the lower abdomen swells large and binds hard as stone, and so it is called stone water.

Yuchwi 類聚

2.3.19
Source원문

肺水者, 流溢皮膚, 遍身皆腫, 但腹如故, 不滿亦不渴.

Translation영역
In lung water it flows and spills into the skin so that the whole body swells, but the abdomen remains as before, neither full nor thirsty.

Yuchwi 類聚

2.3.20
Source원문

水蠱者, 水毒之氣結聚於內, 令腹漸大, 動搖有聲, 常欲飮水, 皮膚麄惡. 《類聚》

Translation영역
In water gu the qi of water toxin binds and gathers within, causing the abdomen to grow gradually larger, with a sound when it is shaken; the patient constantly wants to drink water, and the skin is coarse and poor.
Clinical note임상 주석
Water gu is the condition the harsh formulas at 2.5.14 and 2.5.15 are for, and the description marks it out from ordinary oedema: the abdomen alone enlarges, fluid can be heard when the patient is shaken, and thirst persists despite the water within. That is ascites with a shifting fluid thrill. **A progressively enlarging abdomen with audible fluid requires medical investigation — cirrhosis, malignancy and heart failure are among the causes.**

Yuchwi 類聚

2.3.21
Source원문

朝寬暮急血虛, 暮寬朝急氣虛, 朝暮急血氣俱虛. 《丹心》

Translation영역
Easier in the morning and tighter in the evening is blood vacuity; easier in the evening and tighter in the morning is qi vacuity; tight both morning and evening is vacuity of blood and qi together.
Clinical note임상 주석
A differentiation by the hour, and a neat one. What the passage is reading is diurnal variation in the swelling, which is real — dependent oedema worsens through the day, while fluid redistributes overnight and shows at the face by morning. Danxi assigns the first to blood and the second to qi; the observation stands regardless of the assignment.

Dansim 丹心

2.4 Pulse Method 脉法

2.4.1
Source원문

脉得諸沈, 當責有水, 身體腫重. 《仲景》

Translation영역
When the pulse is found sunken throughout, water should be held responsible, and the body will be swollen and heavy.

Junggyeong 仲景

2.4.2
Source원문

水病, 脉洪大者可治, 微細者不可治.

Translation영역
In water disease, a surging large pulse can be treated; a faint fine pulse cannot.

Maekgyeong 脉經

2.4.3
Source원문

水病, 腹大如鼓, 脉實者生, 虛者死. 《脉經》

Translation영역
In water disease with the abdomen large as a drum, a replete pulse means life and a vacuous one death.
Clinical note임상 주석
The same prognostic rule the Accumulations chapter repeats five times at 1.4: what matters is not the swelling but whether the patient still has the strength to be treated. Both chapters put it in the pulse section rather than the prognosis section, because it is what the hand finds rather than what the eye sees.

Maekgyeong 脉經

2.4.4
Source원문

水氣得沈脉則逆, 比陰脉也. 《東垣》

Translation영역
When water qi meets a sunken pulse this is counterflow, for it is a yin pulse.

Dongwon 東垣

2.4.5
Source원문

水氣浮大則宜, 沈細則愈而復作.

Translation영역
In water qi a floating large pulse is favourable; sunken and fine means it resolves and then breaks out again.

Deukhyo 得效

2.4.6
Source원문

上氣浮腫, 浮滑可安, 微細難療. 《得效》

Translation영역
In qi rising with oedema, floating and slippery may be settled; faint and fine is hard to cure.

Deukhyo 得效

2.4.7
Source원문

水腫脉多沈伏.

Translation영역
In water swelling the pulse is mostly sunken and hidden.

Jeongjeon 正傳

2.4.8
Source원문

病陽水兼陽證, 脉必沈數, 病陰水兼陰證, 脉必沈遲. 《正傳》

Translation영역
In yang water with yang signs the pulse must be sunken and rapid; in yin water with yin signs the pulse must be sunken and slow.
Clinical note임상 주석
The pulse confirming what the presentation already suggested. Sunken in both, because the water is within; rapid or slow according to whether there is heat behind it. This is the yang water and yin water division of 2.3 checked at the wrist.

Jeongjeon 正傳

2.4.9
Source원문

沈伏相搏, 名曰水, 陽虛陰實, 爲水必矣. 《三因》

Translation영역
Sunken and hidden contending together is called water; yang vacuous and yin replete means water for certain.
Clinical note임상 주석
Five authorities in this short section agree on two things: the water pulse is sunken, and a weak pulse in a swollen patient is the bad sign. The Deukhyo adds the observation that matters most in practice — a sunken fine pulse means the swelling will resolve and then return, which is the course of oedema from chronic organ failure as against oedema from an acute cause.

Samin 三因

2.5 The Treatment Method for Water Swelling 水腫治法

2.5.1
Source원문

治腫脹大法, 宜補中, 行濕, 利小便. 以人參ㆍ白朮爲君, 蒼朮ㆍ陳皮ㆍ茯苓爲臣, 黃芩ㆍ麥門冬爲使, 以制肝木, 少加厚朴, 以消腹脹. 氣不運, 加木香ㆍ木通. 氣下陷, 加升麻ㆍ柴胡. 此補中治濕湯方也. 《丹心》

Translation영역
The great method of treating swelling and distension is to supplement the centre, move damp, and disinhibit urine. Take ginseng and white atractylodes as chief; atractylodes lancea, tangerine peel and poria as deputy; scutellaria and ophiopogon as envoy, to restrain the liver wood; and add a little magnolia bark to disperse abdominal distension. Where the qi does not move, add costus and akebia. Where the qi has fallen, add cimicifuga and bupleurum. This is the formula Supplement the Centre and Treat Damp Decoction.
Clinical note임상 주석
The section opens by building a formula in front of the reader, naming each medicinal by its role and then two pairs of modifications. That the great method begins with supplementing — before moving damp, before freeing the urine — is the chapter's position, and the passages that follow immediately qualify it.

Dansim 丹心

2.5.2
Source원문

治浮腫, 宜以辛散之, 以苦泄之, 以淡滲利之, 使上下分消其濕, 正所謂開鬼門潔淨府. 開鬼門者, 謂發汗也. 潔淨府者, 利小便也. 《東垣》

Translation영역
In treating oedema, scatter it with the acrid, drain it with the bitter, and percolate and disinhibit it with the bland, so that the damp is dispersed above and below — this is precisely what is meant by opening the ghost gate and cleansing the pure treasury. Opening the ghost gate means promoting sweat; cleansing the pure treasury means disinhibiting urine.
Clinical note임상 주석
開鬼門潔淨府 is the Suwen's phrase, and the passage exists to gloss it: the ghost gate is the sweat pores, the pure treasury is the bladder. Two exits for one problem, and the choice between them is the axis of the whole section — 2.5.4 and 2.5.5 below assign each to half the body.

Dongwon 東垣

2.5.3
Source원문

夫爲腫之水, 乃腐濁之氣, 滲透經絡, 流注谿谷, 灌入隧道, 血亦因之而化水. 欲藉脾土以制之, 導腎氣以利之. 殊不知, 脾病則金氣衰, 木寡於畏而來侮土, 脾欲不病, 不可得矣. 治法, 宜淸心經之火, 補養脾土, 全運化之職. 肺氣下降, 滲道開通, 使敗濁之氣稍淸者, 復回而爲氣, 爲血, 爲津液. 甚者, 在上爲汗, 在下爲尿, 以漸而分消矣. 《丹心》

Translation영역
The water that makes the swelling is a rotten, turbid qi. It seeps through the channels and network vessels, flows and lodges in the valleys and hollows, and pours into the tunnels; and blood too is thereby turned into water. One wishes to rely on the spleen earth to restrain it and to conduct the kidney qi so as to disinhibit it — but it is not understood that when the spleen is diseased the metal qi declines, and wood, having little to fear, comes and humiliates earth; so that although one wishes the spleen not to be diseased, it cannot be had. The method should be to clear the fire of the heart channel, supplement and nourish the spleen earth, and make whole its office of movement and transformation. Then the lung qi descends, the percolating pathways open, and what is somewhat clearer among the spoiled turbid qi returns again to become qi, blood and fluids. What is worse becomes sweat above and urine below, and is dispersed by degrees.
Clinical note임상 주석
The most ambitious passage in the section and the one that explains why Danxi's formula supplements before it drains. The argument runs through the five phases: draining the water taxes the spleen, a taxed spleen weakens metal, weakened metal lets wood overwhelm earth, and the spleen is worse off than before. The proposal that follows is unusual — restore what can be restored rather than expel everything. What is clearer among the turbid returns to being qi and blood and fluid; only what is past saving leaves as sweat and urine. That is a therapeutic stance, not just a mechanism.

Dansim 丹心

2.5.4
Source원문

諸有水者, 腰以下腫, 當利小便. 宜五苓散方見寒門ㆍ澤瀉散ㆍ神助散.

Translation영역
In all who have water, where the swelling is below the lumbus, the urine should be disinhibited. Five Poria Powder formula in the Cold Damage chapter, Alisma Powder and Spirit's Aid Powder are appropriate.

Junggyeong 仲景

2.5.5
Source원문

腰以上腫, 當發汗乃愈. 宜麻黃甘草湯ㆍ越脾湯ㆍ防己茯苓湯. 《仲景》

Translation영역
Where the swelling is above the lumbus, sweat should be promoted and it resolves. Ephedra and Licorice Decoction, Spleen-Surpassing Decoction and Stephania and Poria Decoction are appropriate.
Clinical note임상 주석
The chapter's operative rule, stated in two lines and worth memorizing: above the lumbus, sweat; below it, urine. Everything in the formulary divides on this line — the three formulas named here all contain ephedra or work on the surface, and the three named above are all diuretics. The reasoning is anatomical rather than theoretical. Water in the upper body lies nearer the surface and has a shorter route out through the skin; water below has gravity and the bladder on its side.

Junggyeong 仲景

2.5.6
Source원문

陽水, 宜八正散方見小便, 或人參敗毒散方見寒門, 加麻黃ㆍ防風ㆍ黃芩ㆍ梔子服.

Translation영역
For yang water, Eight Corrections Powder formula in the Urine chapter, or Ginseng Vanquish Toxin Powder formula in the Cold Damage chapter with ephedra, saposhnikovia, scutellaria and gardenia added.

Jebang 諸方

2.5.7
Source원문

陰水, 宜實脾散ㆍ胃苓湯ㆍ復元丹. 《諸方》

Translation영역
For yin water, Fortify the Spleen Powder, Stomach-Calming and Poria Decoction and Restore the Origin Elixir are appropriate.
Clinical note임상 주석
The yang water and yin water division of 2.3 turned into prescriptions. Yang water gets cold, draining formulas with ephedra added to open the surface; yin water gets aconite, dry ginger and warm spleen supplements. The two lists share nothing.

Jebang 諸方

2.5.8
Source원문

他病久, 則皆能變水. 因雨濕而浮腫, 宜平胃散方見內傷, 加白朮ㆍ赤茯苓ㆍ草豆蔲. 且服導滯通經湯. 《寶鑑》

Translation영역
Any disease of long standing can turn into water. For oedema arising from rain damp, Calm the Stomach Powder formula in the Internal Damage chapter with white atractylodes, red poria and tsaoko added; and Guide Out Stagnation and Free the Channels Decoction is also taken.
Clinical note임상 주석
他病久, 則皆能變水 — any disease of long standing can turn into water — is the sentence that organizes the seven passages that follow. Each takes one prior illness and names the formula for the oedema it leaves behind.

Bogam 寶鑑

2.5.9
Source원문

飮水過多而浮腫, 宜胃苓湯方見大便ㆍ加減胃苓湯ㆍ退腫塌氣散. 《聖惠》

Translation영역
For oedema from drinking too much water, Stomach-Calming and Poria Decoction formula in the Stool chapter, Modified Stomach-Calming and Poria Decoction and Reduce Swelling and Settle the Qi Powder are appropriate.

Seonghye 聖惠

2.5.10
Source원문

久喘後水氣, 宜分氣飮ㆍ葶藶丸.

Translation영역
For water qi following long-standing panting, Divide the Qi Drink and Lepidium Pill are appropriate.

Immun 入門

2.5.11
Source원문

久瘧變水氣, 宜黃甲丸方見瘧門ㆍ退黃丸方見疸門.

Translation영역
For long-standing malaria turning into water qi, Yellow Carapace Pill formula in the Malaria chapter and Dispel Jaundice Pill formula in the Jaundice chapter.

Immun 入門

2.5.12
Source원문

久痢變水氣, 宜加味腎氣丸, 或補中益氣湯方見內傷, 加炮附子久服.

Translation영역
For long-standing dysentery turning into water qi, Augmented Kidney Qi Pill; or Supplement the Centre and Boost the Qi Decoction formula in the Internal Damage chapter with blast-fried aconite added, taken over a long period.

Immun 入門

2.5.13
Source원문

瘧痢後, 通用五皮散. 《入門》

Translation영역
After malaria or dysentery, Five Peels Powder is used generally.
Clinical note임상 주석
Four sequelae in four lines — panting, malaria, dysentery, and the general case after malaria or dysentery — and the formulas grow milder as the list goes on. Five Peels Powder closes it because a patient who has just come through a wasting illness can bear nothing stronger.

Immun 入門

2.5.14
Source원문

水蠱證, 宜黃米丸ㆍ漆雄丸ㆍ靑木香元方見前陰. 《入門》

Translation영역
For the water gu pattern, Yellow Rice Pill, Lacquer and Realgar Pill and Green Costus Pill formula in the Anterior Yin chapter are appropriate.
Clinical note임상 주석
**The first two formulas named contain croton, raw lacquer and realgar. Neither should be prepared or taken; see their entries. Water gu is ascites and requires medical diagnosis.**

Immun 入門

2.5.15
Source원문

瀉濕泄水, 宜三花神祐丸方見濕門ㆍ煨腎丸ㆍ神助散. 《入門》

Translation영역
To drain damp and discharge water, Three Flowers Spirit-Aid Pill formula in the Dampness chapter, Roasted Kidney Pill and Spirit's Aid Powder are appropriate.

Immun 入門

2.5.16
Source원문

瘡疥變水腫, 宜赤小豆湯. 《入門》

Translation영역
For sores and scabies turning into water swelling, Adzuki Bean Decoction is appropriate.
Clinical note임상 주석
One line, and clinically the sharpest in the section. Swelling that follows skin sores is post-streptococcal acute glomerulonephritis, and the sequence — sores first, oedema after — is exactly how it presents. **In a child or young adult this requires urgent assessment.**

Immun 入門

2.5.17
Source원문

水腫泄瀉, 宜葶藶木香散ㆍ大橘皮湯. 《丹心》

Translation영역
For water swelling with diarrhoea, Lepidium and Costus Powder and Major Tangerine Peel Decoction are appropriate.
Clinical note임상 주석
Oedema with diarrhoea looks like a contradiction — why drain a patient already losing fluid? The classical reading is that the water is in the wrong compartment: it floods the flesh while the intestines pass what should have left as urine. Both formulas redirect it to the urinary route rather than adding to the loss.

Dansim 丹心

2.6 The Ten Water Patterns 十水證

2.6.1
Source원문

一曰靑水, 先從左右脇腫起, 根在肝, 用大戟.

Translation영역
The first is green water. The swelling begins from the left and right ribsides; its root is in the liver, and euphorbia is used.

Bonsa 本事

2.6.2
Source원문

二曰赤水, 先從舌根腫起, 根在心, 用葶藶子.

Translation영역
The second is red water. The swelling begins from the root of the tongue; its root is in the heart, and lepidium seed is used.

Bonsa 本事

2.6.3
Source원문

三曰黃水, 先從腰腹腫起, 根在脾, 用甘遂.

Translation영역
The third is yellow water. The swelling begins from the lumbus and abdomen; its root is in the spleen, and kansui is used.

Bonsa 本事

2.6.4
Source원문

四曰白水, 先從脚腫起, 根在肺, 用桑白皮.

Translation영역
The fourth is white water. The swelling begins from the legs; its root is in the lung, and mulberry root bark is used.

Bonsa 本事

2.6.5
Source원문

五曰黑水, 先從外腎腫起, 根在腎, 用連翹.

Translation영역
The fifth is black water. The swelling begins from the external kidney; its root is in the kidney, and forsythia is used.

Bonsa 本事

2.6.6
Source원문

六曰玄水, 先從面腫起, 根在外腎, 用芫花.

Translation영역
The sixth is mysterious water. The swelling begins from the face; its root is in the external kidney, and genkwa is used.

Bonsa 本事

2.6.7
Source원문

七曰風水, 先從四肢腫起, 根在骨, 用澤瀉.

Translation영역
The seventh is wind water. The swelling begins from the four limbs; its root is in the bones, and alisma is used.

Bonsa 本事

2.6.8
Source원문

八曰石水, 先從腎腫起, 根在膀胱, 用藁本.

Translation영역
The eighth is stone water. The swelling begins from the kidney; its root is in the bladder, and ligusticum is used.

Bonsa 本事

2.6.9
Source원문

九曰高水, 先從小腹腫起, 根在小腸, 用巴豆.

Translation영역
The ninth is high water. The swelling begins from the lower abdomen; its root is in the small intestine, and croton is used.

Bonsa 本事

2.6.10
Source원문

十曰氣水, 或盛或衰, 根在大腸, 用赤小豆. 《本事》

Translation영역
The tenth is qi water. It is now exuberant and now waning; its root is in the large intestine, and adzuki bean is used.
Clinical note임상 주석
Ten waters, each with a colour, a starting point, a root organ and a single medicinal. The diagnostic move is the one the chapter makes throughout — **where the swelling begins is the evidence** — and here it is pushed as far as it will go. The scheme does not hold together internally. Black water is rooted in the kidney but begins at the genitals, while mysterious water is rooted in the genitals but begins at the face; wind water is rooted in the bones, which is not an organ. The colours run green, red, yellow, white, black in five-phase order and then stop, the remaining five being named by other principles altogether. Read as a classification it is unstable. Read as a checklist of where to look first, it is still serviceable. The pill assembled from it is at 2.6.1. **Four of the ten medicinals named — euphorbia, kansui, genkwa and croton — are toxic drastic purgatives.**

Bonsa 本事

2.7 The Bound Yang Pattern 結陽證

2.7.1
Source원문

內經曰, 結陽者, 腫四肢. 註曰, 素嘗氣疾, 濕熱加之, 氣濕熱爭, 故爲腫也. 邪氣漸盛, 正氣漸微, 陽氣衰少, 致邪代正, 氣不宣通. 故四維發腫, 諸陽受氣於四肢也. 今人見手足關節腫痛, 全以爲風治者, 誤矣. 犀角湯主之. 《正傳》

Translation영역
The Neijing says: in bound yang there is swelling of the four limbs. The commentary says: one who has long had a qi disorder, with damp heat added to it, so that qi, damp and heat contend — hence the swelling. The evil qi grows gradually exuberant, the upright qi gradually faint; the yang qi declines and dwindles until evil takes the place of upright, and the qi does not diffuse and communicate. Therefore the four corners break out in swelling, for all the yang receives its qi at the four limbs. People today, seeing swelling and pain in the joints of the hands and feet, treat it entirely as wind — and this is a mistake. Rhinoceros Horn Decoction governs it.
Clinical note임상 주석
A polemical passage, and the argument is worth following. Swollen painful joints in the hands and feet are being treated as wind by everyone, and the Jeongjeon says that is wrong: where damp heat contends with qi at the four limbs, the condition is bound yang and is cleared, not dispersed. The distinction survives translation. Joint swelling with heat is not the same problem as joint pain that shifts with the weather, and the formulas for the two share nothing — this one is built on rhinoceros horn, scrophularia and forsythia, with nothing wind-dispelling in it at all. **Joint swelling with heat requires assessment; septic arthritis and crystal arthropathy must be excluded.**

Jeongjeon 正傳

2.8 The Qi Aspect Pattern and the Blood Aspect Pattern 氣分證血分證

2.8.1
Source원문

氣爲飮隔, 骨痛冷痺, 則曰氣分, 亦曰水分.

Translation영역
Where the qi is separated by rheum, with aching bones and cold impediment, it is called the qi aspect, and also the water aspect.

Jikji 直指

2.8.2
Source원문

經脉不行, 血化爲水, 四肢紅腫, 則曰血分. 皆水氣之所由作也.

Translation영역
Where the channel vessels do not move, blood turns into water, and the four limbs are red and swollen, it is called the blood aspect. Both are the means by which water qi comes about.

Jikji 直指

2.8.3
Source원문

氣分, 宜桂朮湯, 血分, 宜桂苓湯. 《直指》 詳見婦人門

Translation영역
For the qi aspect, Cinnamon and Atractylodes Decoction; for the blood aspect, Cinnamon and Poria Decoction. treated in fuller detail in the Women's chapter
Clinical note임상 주석
A two-way division that turns on what the water is held in. Qi aspect: rheum separates the qi, the bones ache, there is cold impediment — pale swelling in a cold patient. Blood aspect: the channels do not move, blood itself turns to water, the limbs are red and swollen. The second is the more interesting reading. Swelling that is warm and discoloured, as against the pale pitting of simple fluid overload, does point to something obstructing rather than something overflowing — venous or lymphatic rather than cardiac or renal. The formulas divide accordingly: one is warm with no blood medicinal, the other is five parts blood-mover.

Jikji 直指

2.9 Oedema Before and After Childbirth in Women 婦人産前後浮腫

2.9.1
Source원문

詳見婦人門.

Translation영역
Treated in fuller detail in the Women's chapter.
Clinical note임상 주석
A section consisting of a cross-reference and nothing else. Heo Jun keeps the heading so that the reader working through the chapter's order does not conclude the topic was overlooked, and sends them to where it is handled.

Donguibogam · Bujong

2.10 Methods that Draw Water Off Without Medicine Being Taken 不服藥自去水方

2.10.1
Source원문

用丹房奇術ㆍ塗臍膏ㆍ消河餠.

Translation영역
Use the Cinnabar Chamber Marvel, the Navel Paste and the Dispersing the River Cake.
Clinical note임상 주석
Three preparations, all bound over the navel, for the patient who cannot take medicine by mouth. The category is unusual enough to have its own section heading, and the reasoning behind it is practical rather than theoretical — a patient with a tense distended abdomen often cannot keep anything down. **All three are caustic. Croton oil blisters skin, calomel is a mercury compound absorbed through broken skin, and garlic under an occlusive dressing burns. None should be prepared or applied.**

Donguibogam · Bujong

2.11 Medicines for Oedema in General Use 浮腫通治藥

2.11.1
Source원문

宜加減胃苓湯ㆍ四苓五皮湯ㆍ集香湯ㆍ實脾飮ㆍ沈香琥珀丸ㆍ三仁元ㆍ椒豉元ㆍ海金沙散. 《諸方》

Translation영역
Modified Stomach-Calming and Poria Decoction, Four Porias and Five Peels Decoction, Gathered Aromatics Decoction, Fortify the Spleen Drink, Aloeswood and Amber Pill, Three Kernels Pill, Zanthoxylum Seed and Fermented Soybean Pill and Lygodium Spore Powder are appropriate.
Clinical note임상 주석
Eight formulas as an index, ordered from mildest to harshest. It opens with two that combine Pyeongwi-san and Oryeong-san and contain nothing toxic; it closes with Lygodium Spore Powder, which carries kansui and a nyang and a half of morning glory seed. Gathered Aromatics Decoction sits third and is not a treatment at all — the source directs that it be given first to open the channels, and the pattern examined afterwards. That instruction is the most distinctive thing in the list.

Jebang 諸方

2.12 Patterns That Can and Cannot Be Treated 可治不治證

2.12.1
Source원문

凡浮腫, 陰囊軟者, 可治. 《入門》

Translation영역
In oedema generally, where the scrotum is soft, it can be treated.

Immun 入門

2.12.2
Source원문

患腫人, 腹上以手按之, 有窩者, 可治. 《醫鑑》

Translation영역
In a person suffering swelling, if pressing the abdomen with the hand leaves a pit, it can be treated.
Clinical note임상 주석
The two favourable signs are stated first, and both are about whether the tissue still yields. A soft scrotum and an abdomen that pits mean the swelling is fluid that can still be moved; the unfavourable signs that follow are almost all about tissue that has stopped yielding — hard flesh, a flat palm, a protruding navel.

Uigam 醫鑑

2.12.3
Source원문

腫滿善證, 男從上而腫下, 女從下而腫上, 所患未久, 漩利, 腫退喘定則愈矣. 《得效》

Translation영역
The favourable pattern in swelling and fullness: in a man the swelling goes from above downward, in a woman from below upward; the illness is not of long standing, the urine is free, and when the swelling recedes and the panting settles, recovery follows.

Deukhyo 得效

2.12.4
Source원문

男從脚下腫而上, 女從頭上腫而下, 皆不治.

Translation영역
In a man swelling from the feet upward, and in a woman from the head downward — neither can be treated.

Immun 入門

2.12.5
Source원문

男從脚下, 女從頭上腫起, 皆爲逆, 陰陽微妙如此. 《入門》

Translation영역
In a man swelling beginning at the feet, and in a woman at the head, are both counterflow. So subtle is the working of yin and yang.
Clinical note임상 주석
The direction of spread is read differently by sex, on the reasoning that a man is yang and swelling should move with him from above downward, a woman yin and hers from below upward. Movement against that grain is counterflow. The scheme is a construction of the period rather than an observation, and it should be read as such. What survives it is the underlying point, which the chapter makes in several other places: the direction in which swelling spreads is information, and worth asking about.

Immun 入門

2.12.6
Source원문

大凡虛腫, 先起於腹而後散於四肢者, 可活, 先起於四肢而後歸於腹者, 不治.

Translation영역
In vacuity swelling generally, where it begins in the abdomen and afterwards spreads to the four limbs, the patient may live; where it begins in the four limbs and afterwards returns to the abdomen, it cannot be treated.
Clinical note임상 주석
This one is a real observation and it still holds. Swelling that starts peripherally and later fills the abdomen is ascites supervening on peripheral oedema — decompensation — and the prognosis attached to it is accurate for the period.

Jikji 直指

2.12.7
Source원문

至若蠱脹, 而肚上有靑筋.

Translation영역
As for gu distension, there are green sinews on the belly.
Clinical note임상 주석
靑筋 on the abdominal wall are distended superficial veins. In a patient with a distended abdomen this is caput medusae — portal hypertension — and the Jikji lists it among the signs that cannot be treated. The observation is sound and so, for its time, was the prognosis.

Jikji 直指

2.12.8
Source원문

腹滿而大便滑泄.

Translation영역
The abdomen full, with slippery diarrhoea.

Jikji 直指

2.12.9
Source원문

久瘧而轉作虛浮.

Translation영역
Long-standing malaria turning into vacuity puffiness.

Jikji 直指

2.12.10
Source원문

與夫脣黑傷肝, 缺盆平傷心, 臍突傷脾, 足心平傷腎, 背平傷肺, 皆爲不治之證.

Translation영역
Together with these: black lips, the liver damaged; the empty basin level, the heart damaged; the navel protruding, the spleen damaged; the sole of the foot level, the kidney damaged; the back level, the lung damaged — all are patterns that cannot be treated.
Clinical note임상 주석
Five signs, each assigned a viscus, and all five describe the same thing: a hollow that has filled. The supraclavicular fossa, the navel, the arch of the foot, the contour of the back — these are places the body is normally concave, and swelling severe enough to level them is anasarca. The five-phase assignments are the framing; the clinical content is that the swelling has reached every compartment.

Jikji 直指

2.12.11
Source원문

或肉硬或手掌平, 皆不治. 《直指》

Translation영역
Or the flesh hard, or the palm of the hand level — neither can be treated.

Jikji 直指

2.12.12
Source원문

脣腫齒焦者死.

Translation영역
Swollen lips with scorched teeth: death.

Jeongjeon 正傳

2.12.13
Source원문

卒脣腫而蒼黑者死.

Translation영역
Lips suddenly swollen and dark blue-black: death.

Jeongjeon 正傳

2.12.14
Source원문

掌腫無紋者死.

Translation영역
The palm swollen with no lines: death.

Jeongjeon 正傳

2.12.15
Source원문

臍腫凸出者死.

Translation영역
The navel swollen and protruding: death.

Jeongjeon 正傳

2.12.16
Source원문

缺盆平者死.

Translation영역
The empty basin level: death.

Jeongjeon 正傳

2.12.17
Source원문

陰囊莖俱腫者死.

Translation영역
Scrotum and stalk both swollen: death.

Jeongjeon 正傳

2.12.18
Source원문

脉絶, 口張, 足腫者死.

Translation영역
The pulse cut off, the mouth gaping, the feet swollen: death.

Jeongjeon 正傳

2.12.19
Source원문

足趺腫膝如斗者死. 《正傳》

Translation영역
The instep swollen and the knee like a peck measure: death.
Clinical note임상 주석
Eight signs in eight words each, and the compression is the point — this is a list to be memorized and checked. What they have in common is that the swelling has stopped being fluid one can move: the palm has lost its lines, the navel is pushed out, the scrotum and penis are both involved, the knee has become a shape rather than a joint. Read together with the Jikji list above, the chapter's prognostic standard is consistent. Swelling that still pits and still spreads in an orderly direction can be treated. Swelling that has filled every hollow and hardened the tissue cannot.

Jeongjeon 正傳

2.12.20
Source원문

凡水腫, 大喘氣麄不食, 乃腎水盈溢上行, 傍浸於肺也. 不治. 《得效》

Translation영역
In water swelling generally, great panting with coarse breathing and no appetite means that the kidney water has filled to overflowing and travelled upward, soaking sideways into the lung. It cannot be treated.
Clinical note임상 주석
The section closes on the sign that matters most: fluid reaching the lung. 傍浸於肺 — soaking sideways into the lung — is a description of pulmonary oedema, and the judgement attached is what it was before diuretics existed. **Severe breathlessness with oedema is a medical emergency. Nothing in this section should be read as a reason to withhold treatment; it records what could be seen and what could be done in 1613.**

Deukhyo 得效

2.13 Prohibitions 禁忌法

2.13.1
Source원문

凡水腫, 惟忌鹽, 雖毫末許, 不得入口. 若無以爲味, 卽水病去後, 宜以醋少許, 調和飮食. 不能忌鹽, 勿服藥. 果欲去病, 切須忌鹽. 《得效》

Translation영역
In water swelling, salt above all is forbidden; not so much as a hair's breadth of it may enter the mouth. If there is then nothing to give food savour, then once the water disease has gone a little vinegar may be used to season food. One who cannot give up salt should not take medicine at all. If the disease is truly to be driven out, salt must absolutely be forbidden.
Clinical note임상 주석
The most emphatic instruction in the chapter, and the one that has aged best. Sodium restriction is still the first measure in managing oedema of any cause, and the reasoning the chapter cannot state — that salt holds water in the body — does not affect the correctness of the rule. 不能忌鹽, 勿服藥 — one who cannot give up salt should not take medicine at all — is the sharpest sentence. It makes the dietary measure a precondition rather than an adjunct. Two formulas in this chapter extend the prohibition to three years and half a year respectively; see Sinjo-san at 2.5.3 and Bogwon-dan at 2.5.8.

Deukhyo 得效

2.13.2
Source원문

尤忌鍼刺犯之, 流水而死.

Translation영역
Still more strictly forbidden is to violate it with needling; the water runs out and the patient dies.
Clinical note임상 주석
A warning repeated with more detail in the acupuncture section at 2.15.2. Puncturing oedematous tissue produces a weeping wound that does not close, and in a patient already depleted this is a route to infection and fluid loss. The observation is entirely sound.

Deukhyo 得效

2.13.3
Source원문

凡水腫, 極忌甘藥, 助濕作滿. 《入門》

Translation영역
In water swelling, sweet medicines are most strictly forbidden; they assist damp and produce fullness.
Clinical note임상 주석
The rule that explains an absence in the formulary. Licorice appears in this chapter's prescriptions only in small doses and often mix-fried, and the large sweet supplements — rehmannia, ginseng at high dose, honey preparations — are almost entirely missing. Sweet flavour is held to be cloying and to hold damp in place.

Immun 入門

2.13.4
Source원문

病嗽及水, 全宜禁鹽. 《本草》

Translation영역
In disease of cough and of water alike, salt should be wholly forbidden.

Boncho 本草

2.14 Simple Medicinals 單方

2.14.1
Source원문

桑柴灰汁 桑柴灰水淋取淸汁, 煮赤小豆作粥常服, 大下水脹. 《本草》

Translation영역
Mulberry wood ash lye (桑柴灰汁): Pour water through mulberry wood ash and take the clear liquor; boil adzuki beans in it to make a congee and take it regularly. It greatly brings down water distension.
Clinical note임상 주석
Wood ash lye is strongly alkaline and rich in potassium. Whether or not the tradition could say so, a potassium-bearing vehicle for a diuretic bean congee is a reasonable pairing.

Boncho 本草

2.14.2
Source원문

桑白皮 治水腫, 喘急. 桑白皮 四兩, 靑梁米 四合, 同煮爛, 取淸飮. 名桑白皮飮. 《入門》

Translation영역
Mulberry root bark (桑白皮): Treats water swelling with hasty panting. Mulberry root bark 4 nyang and green millet 4 hop, boiled together until soft; take the clear liquid and drink it. It is called Mulberry Root Bark Drink.

Immun 入門

2.14.3
Source원문

白朮 治四肢腫滿. 白朮 三兩剉, 大棗 三枚. 右水煎服, 日三四. 《綱目》

Translation영역
White atractylodes (白朮): Treats swelling and fullness of the four limbs. White atractylodes 3 nyang, cut up, with 3 jujubes. Decoct in water and take, three or four times a day.

Gangmok 綱目

2.14.4
Source원문

澤瀉 逐膀胱三焦停水. 或剉煎服, 或爲末, 白湯調下, 日二三. 《本草》

Translation영역
Alisma (澤瀉): Expels water standing in the bladder and the three burners. Either cut up and decoct, or powder and take stirred into plain hot water, two or three times a day.

Boncho 本草

2.14.5
Source원문

葶藶子 治頭面手足虛腫. 又治水氣喘急. 葶藶子, 隔紙炒爲末, 棗肉和丸小豆大. 麻子煎湯下十丸, 日三. 《東垣》

Translation영역
Lepidium seed (葶藶子): Treats vacuity swelling of the head, face, hands and feet; also treats water qi with hasty panting. Lepidium seed, dry-fried through paper and powdered, made into pills with jujube flesh the size of a small bean; take ten down with a decoction of hemp seed, three times a day.

Dongwon 東垣

2.14.6
Source원문

葶藶子 治水腫, 葶藶 三兩, 爲細末, 防己末 四兩, 綠頭鴨切頭, 瀝血於臼中令血盡, 納藥末, 和鴨頭更搗五千杵, 丸如梧子, 空心, 白湯下十丸. 此藥利小便如神. 《本草》

Translation영역
Lepidium seed (葶藶子), second method: Treats water swelling. Lepidium 3 nyang finely powdered and stephania powder 4 nyang. Cut the head from a green-headed duck and let the blood drain into a mortar until it is spent; put in the powders, add the duck's head, and pound five thousand strokes more. Form pills the size of a firmiana seed and take ten on an empty stomach with plain hot water. This medicine frees the urine marvellously.
Clinical note임상 주석
The duck is not incidental. The chapter states at 2.14.17 that duck's head frees water and cools the blood, and here the bird supplies both the binding medium and part of the action.

Boncho 本草

2.14.7
Source원문

商陸 能瀉十種水病. 取白色生根, 細切, 雜生鯉魚煮作羹湯服之. 《本草》

Translation영역
Pokeweed root (商陸): Can drain the ten kinds of water disease. Take the white raw root, cut it fine, and boil it together with fresh carp to make a broth; take it.
Clinical note임상 주석
The white root is specified. Pokeweed comes in white and red forms, and the chapter elsewhere reserves the red for external use only — see 2.10.1, where red pokeweed is pounded and bound over the navel. **Pokeweed root is toxic. Not suitable for use.**

Boncho 本草

2.14.8
Source원문

牽牛子 治水氣蠱脹. 白丑黑丑(頭末) 各取二錢, 大麥麪 四兩, 和作燒餠. 臨臥, 茶淸嚼下, 降氣爲驗, 名曰二氣散. 《正傳》

Translation영역
Morning glory seed (牽牛子): Treats water qi with gu distension. White and black morning glory seed, first milling only, 2 don of each, with 4 nyang of barley flour, worked into a griddle cake. At bedtime chew it down with clear tea; the qi descending is the sign of effect. It is called Two Qi Powder.

Jeongjeon 正傳

2.14.9
Source원문

牽牛子 水屬腎, 行腎之水, 無如黑牽牛. 取細末入於猪腎, 慢火煨熟, 而溫酒嚼下, 則借腎入腎, 兩得其便, 惡水旣泄, 不復泛溢矣. 《直指》

Translation영역
Morning glory seed (牽牛子), second method: Water belongs to the kidney, and for moving the kidney's water nothing equals black morning glory seed. Take the fine powder, put it into a pig's kidney, roast it through over a slow fire, and chew it down with warm wine. Thus borrowing a kidney to enter the kidney, both find their way; the foul water once discharged does not overflow again.
Clinical note임상 주석
借腎入腎 — borrowing a kidney to enter the kidney — states the reasoning behind a technique this chapter and the Accumulations chapter both use repeatedly. The organ chosen as the vessel is the organ the medicine is meant to reach. Roasted Kidney Pill at 2.5.17 packs kansui into a pig's kidney on the same principle.

Jikji 直指

2.14.10
Source원문

萆麻子 治十種水氣, 五蠱, 瘴氣. 萆麻子去殼, 用麻布包壓去油, 薄攤在木杓內, 仰放在鍋中, 水面上以盖合住, 煮二十餘沸, 以藥無白色爲度, 取出. 每服 六錢, 滾水化開, 空心, 溫服, 不過二三劑. 以小便大利爲效. 《醫鑑》

Translation영역
Castor bean (萆麻子): Treats the ten kinds of water qi, the five gu, and miasmic qi. Shell the castor beans, wrap them in hemp cloth and press out the oil, spread them thinly in a wooden ladle, set it face up in a pot above the water, cover it, and boil twenty or more times until no white remains in the medicine; then take it out. Take 6 don at a dose, dissolved in boiling water, warm and on an empty stomach; no more than two or three doses are needed. Abundant urine is the sign of effect.
Clinical note임상 주석
The whole preparation is about removing the oil — pressed out through hemp cloth, then steamed until the white is gone. That is the toxic fraction, and the elaborate processing is an attempt to be rid of it. **Castor bean contains ricin, one of the most lethal plant toxins known, and no domestic processing makes it safe. This preparation must not be attempted.**

Uigam 醫鑑

2.14.11
Source원문

郁李仁 治水腫, 腹脹喘急, 大小便秘澁. 郁李仁 一兩, 硏取汁, 薏苡仁末 二合, 和煮粥食之. 《入門》

Translation영역
Bush cherry kernel (郁李仁): Treats water swelling with abdominal distension and hasty panting, and stool and urine bound and rough. Bush cherry kernel 1 nyang, ground and the juice taken, with 2 hop of powdered coix seed; boil together into a congee and eat it.

Immun 入門

2.14.12
Source원문

郁李仁 又方, 郁李仁 一合爲末, 和麪作燒餠, 與喫卽大便通利, 氣便差. 《本草》

Translation영역
Bush cherry kernel (郁李仁), second method: Bush cherry kernel 1 hop powdered, worked into flour and made into a griddle cake; given to eat, the stool at once passes freely and the qi is thereby relieved.

Boncho 本草

2.14.13
Source원문

鯉魚 治水腫, 脚滿, 氣急. 鯉魚肉 十兩, 葱白 一握, 麻子一升取汁, 煮作羹, 入鹽豉ㆍ薑ㆍ椒調和, 空心, 食之. 《入門》

Translation영역
Carp (鯉魚): Treats water swelling with the legs full and the breath hurried. Carp flesh 10 nyang, one handful of scallion white, and the juice of 1 seung of hemp seed; boil into a broth, season with salted fermented soybean, ginger and zanthoxylum, and eat on an empty stomach.

Immun 入門

2.14.14
Source원문

鯉魚 又方, 大鯉魚(取肉)ㆍ赤小豆 二升, 以水 一斗同煮, 取二升許汁, 去滓, 分二服, 當下利卽差. 《本草》

Translation영역
Carp (鯉魚), second method: A large carp, the flesh taken, with 2 seung of adzuki beans, boiled together in 1 mal of water down to about 2 seung of liquid; strain off the dregs and divide into two doses. Purging should follow and the patient recovers.
Clinical note임상 주석
Carp and adzuki bean boiled together is the best-known food remedy for oedema in the East Asian tradition and is still eaten. Both ingredients are genuinely diuretic, and a high-protein low-sodium broth is a rational thing to give someone with fluid overload.

Boncho 本草

2.14.15
Source원문

螻蛄 治十種水病, 腫滿, 喘促. (生)土狗 一箇(手足全者硏細), 入縮砂末等分, 老酒調下. 《直指》

Translation영역
Mole cricket (螻蛄): Treats the ten kinds of water disease, with swelling fullness and hasty panting. One raw mole cricket with hands and feet entire, ground fine, with an equal part of powdered amomum, stirred into aged wine and taken.

Jikji 直指

2.14.16
Source원문

螻蛄 又方, 五月五日取螻蛄, 不以多少, 不可見日焙乾, 每一病, 以七箇爲度. 先用七箇頭治上, 次用腹治中, 次用足治下, 皆爲末, 空心, 好酒調下. 《丹心》

Translation영역
Mole cricket (螻蛄), second method: On the fifth day of the fifth month gather mole crickets, however many; they must not see the sun, and are dry-roasted. For each illness seven is the measure. First use the seven heads to treat what is above, next the bellies to treat the middle, next the feet to treat what is below. Powder each and take on an empty stomach stirred into good wine.
Clinical note임상 주석
The insect is divided into three and each part sent to the corresponding part of the body — heads for above, bellies for the middle, feet for below. This is the resemblance reasoning the Accumulations chapter sets out at 1.8.14, applied with unusual literalness, and it appears nowhere else in this chapter.

Dansim 丹心

2.14.17
Source원문

黑豆 治浮腫. 黑豆一升, 水五升, 煮取三升汁去滓, 納酒五升, 更煮取三升去滓, 分三服. 不差, 再合服之. 《本草》

Translation영역
Black soybean (黑豆): Treats oedema. Black soybean 1 seung boiled in 5 seung of water down to 3 seung; strain off the dregs, add 5 seung of wine, boil again down to 3 seung, strain, and divide into three doses. If it does not resolve, prepare and take it again.

Boncho 本草

2.14.18
Source원문

赤小豆 治水腫, 下水氣. 和桑白皮, 或通草, 煮服之.

Translation영역
Adzuki bean (赤小豆): Treats water swelling and brings down water qi. Boil with mulberry root bark, or with tetrapanax, and take.

Boncho 本草

2.14.19
Source원문

赤小豆 又方, 赤小豆 五合, 葫一頭, 生薑 三錢幷碎, 白色商陸 一條切, 同水煮, 豆爛湯成, 去葫ㆍ薑ㆍ商陸, 只細嚼豆, 空腹食之, 旋旋啜汁令盡, 腫立消便止. 《本草》

Translation영역
Adzuki bean (赤小豆), second method: Adzuki bean 5 hop, one bulb of garlic and 3 don of fresh ginger both crushed, and one white pokeweed root cut up; boil together in water until the beans are soft and the broth is made. Remove the garlic, ginger and pokeweed; chew only the beans and eat them on an empty stomach, sipping the broth little by little until it is finished. The swelling disperses at once and then stops.
Clinical note임상 주석
The three strong ingredients are boiled with the beans and then taken out, so that only what passed into the broth is consumed. It is the same containment logic as the croton-and-rice technique the Accumulations chapter uses at 1.13.23 — flavour without the substance. **Contains pokeweed root, which is toxic even in this preparation.**

Boncho 本草

2.14.20
Source원문

冬瓜 水病初得危急, 冬瓜不限多少任喫, 神效. 或取汁服. 久病忌之. 《綱目》

Translation영역
Wax gourd (冬瓜): When water disease is newly contracted and critical, eat wax gourd freely without limit; the effect is marvellous. Or take the juice. In long-standing illness it is to be avoided.
Clinical note임상 주석
The qualification at the end is the useful part: freely in the acute case, avoided when the illness is old. Wax gourd is cold and draining, which suits an acute repletion and does not suit the depleted patient the chapter describes at 2.1.10.

Gangmok 綱目

2.14.21
Source원문

苦瓠瓤 治浮腫, 下水. 取白瓤實, 捻如大豆粒, 以綿裹, 煮一沸, 空心服 七枚, 水自出不止, 大瘦乃差. 三年內愼口味. 《本草》

Translation영역
Bitter gourd pulp (苦瓠瓤): Treats oedema and brings down water. Take the white pulp and its seeds, roll into pieces the size of a soybean, wrap in cotton wool, and boil once. Take seven on an empty stomach; water issues of itself without stopping, and when the patient has greatly thinned the illness resolves. For three years afterwards be careful of what is eaten.

Boncho 本草

2.14.22
Source원문

苦瓠瓤 苦瓠, 須擇用細理, 潔淨者, 不爾, 有毒. 《綱目》

Translation영역
Bitter gourd pulp (苦瓠瓤), note: Bitter gourd must be selected for fine grain and cleanliness; otherwise it is toxic.
Clinical note임상 주석
The source's own warning, and it is the right one. Bitter bottle gourd contains cucurbitacins, which cause violent vomiting and diarrhoea and have killed; the bitterness is the warning sign and the selection criterion given here is an attempt to avoid it. **This should not be used. Cucurbitacin poisoning from bitter gourd is a recognized and occasionally fatal syndrome.**

Gangmok 綱目

2.14.23
Source원문

雞屎 治水腫, 氣腫, 濕腫皆效. 乾雞糞一升炒黃, 好淸酒三椀淬下, 煮作一椀, 濾去滓, 令飮之. 少頃, 腹中大轉動作鳴, 從大便利下, 於膝脚及臍上下先作皺起, 其腫漸消. 病未盡, 再服一劑. 以田螺 二枚, 滾酒淖熟食之卽止, 名雞醴飮. 《醫鑑》

Translation영역
Chicken droppings (雞屎): Treats water swelling, qi swelling and damp swelling, all with effect. Dried chicken droppings 1 seung dry-fried yellow, quenched in 3 bowls of good clear wine, boiled down to one bowl and strained. Give it to drink. After a little while the abdomen turns and rumbles greatly, and it passes down through the stool; the knees, legs and the region above and below the navel first begin to wrinkle, and the swelling gradually disperses. If the illness is not finished, take another dose. Two river snails cooked in boiling wine and eaten will stop it. It is called Chicken Ale Drink.
Clinical note임상 주석
先作皺起 — the skin first begins to wrinkle — is a well-observed sign of resolving oedema, and it is noted at the knees, legs and around the navel, which are where it would show first. That an antidote is provided to stop the action if it goes too far is characteristic of this chapter's better entries.

Uigam 醫鑑

2.14.24
Source원문

靑頭鴨 治十種水病垂死. 靑頭鴨 一隻, 治如食法, 和米幷五味煮令極熟, 作粥, 空腹食之. 白鴨亦好. 《本草》

Translation영역
Green-headed duck (靑頭鴨): Treats the ten kinds of water disease when the patient is near death. One green-headed duck, dressed as for eating, boiled thoroughly with rice and the five flavours to make a congee, eaten on an empty stomach. A white duck is also good.

Boncho 本草

2.14.25
Source원문

靑頭鴨 鴨頭, 能利水而涼血故也. 《入門》

Translation영역
Green-headed duck (靑頭鴨), note: Because the duck's head is able to free water and cool the blood.

Immun 入門

2.14.26
Source원문

蝦蟆 治水腫鼓脹如神. 大蝦蟆 一箇, 以縮砂 七粒, 推入其口, 使呑入腹. 用罐子盛, 鹽泥封固, 炭火煆通紅, 烟盡取出, 候冷去泥, 硏爲末, 作一服. 或酒, 或陳皮湯送下, 候撒屁多, 乃效. 卽下金蟾散也. 《醫鑑》

Translation영역
Toad (蝦蟆): Treats water swelling and drum distension marvellously. One large toad; push seven amomum seeds into its mouth and make it swallow them into the belly. Put it in a jar, seal it fast with salt clay, calcine over charcoal until it glows red through, and when the smoke is spent take it out. When cool, remove the clay, grind to a powder and make one dose. Send it down with wine or with a decoction of tangerine peel; abundant flatus is the sign of effect. This is the Golden Toad Powder.
Clinical note임상 주석
**Toad preparations contain bufotoxins, cardiac glycosides chemically close to digitalis, and deaths from toad-derived medicines are on record. This must not be prepared or taken.**

Uigam 醫鑑

2.14.27
Source원문

蝦蟆 又方, 治水腫脹滿. 蝦蟆 二三枚, 裝在雄猪肚內, 酒煮一伏時, 去蝦蟆, 將肚與酒食盡, 大便屁如雷, 或水下, 其腫自消. 《醫鑑》

Translation영역
Toad (蝦蟆), second method: Treats water swelling with distension and fullness. Two or three toads placed inside the stomach of a boar, boiled in wine for one watch; remove the toads and eat the stomach and the wine entirely. The stool and flatus come like thunder, or water passes down, and the swelling disperses of itself.
Clinical note임상 주석
The toads are removed and only what passed into the pork and wine is consumed — the same containment technique used throughout this chapter and the Accumulations chapter. **Bufotoxins are water- and alcohol-soluble and would pass into the wine. This is not a safe preparation.**

Uigam 醫鑑

2.14.28
Source원문

猪肝 治浮腫脹滿. 猪肝 一具, 細切, 以醋洗, 蒜虀食之. 又以熟水煮, 單喫亦可. 《本草》

Translation영역
Pig liver (猪肝): Treats oedema with distension and fullness. One pig's liver cut fine, washed with vinegar and eaten with garlic pickle. Or it may be boiled in hot water and simply eaten.

Boncho 本草

2.14.29
Source원문

猯肉 治十種水不差垂死. 猯肉 半斤(切), 粳米 三合, 水三升, 入葱椒薑豉, 作粥食之.

Translation영역
Badger meat (猯肉): Treats the ten kinds of water that have not resolved, when the patient is near death. Badger meat half a geun, cut up, with 3 hop of polished rice and 3 seung of water; add scallion, zanthoxylum, ginger and fermented soybean, and make a congee to eat.

Boncho 本草

2.14.30
Source원문

猯肉 又作羹臛食之, 下水大效. 《本草》

Translation영역
Badger meat (猯肉), second method: It may also be made into a thick broth and eaten; it brings down water with great effect.
Clinical note임상 주석
The section closes, as it began, with food. Carp, duck, badger, pig liver, black soybean, adzuki bean, wax gourd — more than half the simples here are things eaten rather than medicines taken, and several are prepared as congee or broth. That is a real difference from the Phlegm-Rheum and Accumulations chapters, whose simples run to minerals and insects. Oedema was approached dietetically, and the two most repeated preparations — carp with adzuki bean, duck congee — are a high-protein low-salt diet arrived at by other means.

Boncho 本草

2.15 Acupuncture and Moxibustion Methods 鍼灸法

2.15.1
Source원문

四肢及面皆浮腫, 灸水分ㆍ氣海, 卽消.

Translation영역
When the four limbs and the face are all swollen, moxa Subun (水分, CV9) and Gihae (氣海, CV6), and it disperses at once.

Jasaenggyeong 資生

2.15.2
Source원문

水腫, 惟得鍼水溝. 餘穴則鍼之, 水盡卽死. 庸醫, 多爲人鍼水分, 殺人多矣. 惟灸水分, 最爲要穴. 盖此穴, 能分水, 不使妄行. 有人患水腫, 灸水分與氣海, 翌日, 面如削矣. 《資生》

Translation영역
In water swelling, only Sugu (水溝, GV26) may be needled. Needle the other points and, the water being spent, the patient dies at once. Common physicians often needle Subun for people, and have killed many. Subun is to be moxaed only — it is the most essential point, for this point can divide the water and keep it from moving recklessly. A person suffered water swelling; Subun and Gihae were moxaed, and by the next day the face was as though pared away.
Clinical note임상 주석
The chapter ends on a prohibition rather than a method, and it is stated more sharply here than anywhere else in the book: needle any point but one and the patient dies, and common physicians have killed many by needling this very point. The warning is clinically correct. Puncturing grossly oedematous tissue produces a weeping wound that will not close, and in a patient already depleted it is a route to cellulitis and continued fluid loss. The same instruction appears among the prohibitions at 2.13.2. The case that closes the chapter — moxa at two points and by the next day the face was as though pared away — is the only outcome report in the chapter, and it is placed last. **Needling oedematous tissue should not be done.**

Jasaenggyeong 資生

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 6, Oedema chapter. The Chinese text is collated against the public-domain Wikisource transcription and a printed edition; original character forms (脉, 人參) are retained. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.