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Swelling and Distension Syndromes. Generally speaking, the root of swelling (Edema) lies in water-dampness, while the cause of distension (Abdominal Distension) lies in Qi stagnation. Swelling is divided into Yang Water and Yin Water. Those caused by external pathogens such as Wind, Dampness, Qi stagnation, or Heat are considered excess syndromes, classified as Yang Water. Conversely, if it arises after a severe illness due to deficiency of Spleen and Lung, leading to an inability to regulate water passages; or due to Heart Fire suppressing Lung Metal, preventing Lung from generating Kidney Water, resulting in difficult urination; or due to Yin deficiency in the Kidney channel, with deficient fire scorching Lung Metal causing scanty urine, and mistakingly using Qi-moving and diuretic agents, gradually progressing to panting, rapid breathing, profuse phlegm, and short, dark urine,酿成 (forming) a swelling syndrome—this internal origin represents a deficiency syndrome, classified as Yin Water.

Regarding distension, the causes are numerous and locations vary. It can be caused by Dampness, depression/stagnation, Cold, Heat, Qi, Blood, Phlegm, accumulation, or parasites, all capable of causing distension. The pathology may reside in Zang organs, Fu organs, collaterals, or skin, affecting any part of the body, interior or exterior. Furthermore, some cases start with Cold which lingers and transforms into Heat; others start as Heat in the Middle but transmit to Cold in the end. Moreover, distension does not necessarily accompany swelling, but swelling invariably accompanies distension, and there are cases where both occur simultaneously. The clinical manifestations are variable, and the pathogenesis is complex and intricate, making it difficult to describe fully.

Therefore, in the medical records, various symptoms are treated as follows: For dampness located in the Lower Jiao, the method of separation and purgation (diuresis) is used. For dampness affecting Upper, Middle, and Lower Jiaos, the method of simultaneous dispersion is employed. For dampness lingering internally, Wuling San (Five-Ingredient Poria Pill) is used to unblock Bladder Qi transformation. For dampness stagnating with heat, Banxia Xiexin Tang (Pinellia Decoction for Draining the Epigastrium) method is applied, using bitter and acrid flavors to promote descending action. For accumulation of damp-heat and Qi/Blood stagnation, Jijin San (Chicken Gizzard Lining Powder) is modified, combining digestion-promoting and diuretic actions. For Qi and Blood stagnation mixed with damp-heat that persists long-term, Xiaowenzhong Wan (Minor Warm Middle Pill) is used to clear Ministerial Fire and strengthen the Middle Jiao transport. For chaotic interaction of damp-heat and cold-water qi, presenting with panting, scanty urine, and generalized edema, Yuyuliang Wan (Hematite Pill) is prescribed to fortify Earth to control Water, warm the Lower Jiao, and drain turbidity. For cold-damp in the Qi level, Ginger (Shengjiang) and Aconite (Fuzi) are used. For cold-damp entering the Blood level, Cinnamon Twig (Guizhi) and Aconite (Fuzi) are used. For excessive dampness transforming into heat in the Upper Jiao, Mahuang Xinggancao Yiyiren Tang (Ephedra, Apricot Seed, Licorice, and Coix Seed Decoction) etc. are used to clear and descend Upper Jiao Qi. For dampness settling in the Lower Jiao causing Bi syndrome, Jiawei Huoluo Dan (Modified Collateral-Unblocking Pill) etc. are used to ventilate and unblock Lower Jiao stagnation. Use of Xiebai and Gualou (Chinese Leek Bulb and Trichosanthes Fruit) aims to lubricate and resolve Qi obstruction in the abdomen and hypochondrium. Use of Zhidu Huangqi and Dangguiwei (Prepared Polygonum Multiflorum Root and Angelica Sinensis Tail) aims to search out and eliminate blood stasis in the meridians. Use of Yuhu Wan, Kongxian Dan, Shenbao Wan, and Shenyong Wan targets phlegm-fluid retention, driven according to severity. These conditions have not yet damaged Zang organ Qi, remaining merely within the Fu organs' upper/lower aspects or the membrane's interior/exterior.

If Stomach Yang is deficient, Renshen (Ginseng) and Fuling (Poria) must be advanced. If Spleen Yang declines, Baizhu (Atractylodes Macrocephala Rhizome) and Fuzi (Aconite Lateralis Radix Praeparata) must be administered. If Kidney is injured, Jiawei Bawei Wan (Modified Eight-Ingredient Pill) or Jisheng Shenqi Wan (Kidney-Qi Pill for Childbearing) are required. Others, such as Dabanzhong Tang (Major Pinellia Decoction) to nourish Yangming Stomach, or Xiaoyao San (Free and Easy Wanderer Powder) to soothe Jueyin Liver, are treatments derived from connected pathologies, representing methods beyond the standard protocols in these records. (Commentary by Yao Yitao)

Xu Lingtai’s Commentary: Distension and fullness, even when accompanied by righteous Qi deficiency, ultimately belong to excess of pathogenic factors. Ancients were cautious about using tonification. Furthermore, distension inevitably involves Dampness; Dampness generates Heat. Thus, the Neijing classifies it as a Heat syndrome. Nowadays, many use warming and tonifying drugs. Although formulas contain draining/diuretic herbs, the assistant herbs cannot overpower the chief tonifying herbs, leading to frequent errors. Careful review of these cases suggests few recoveries and many deaths or deteriorations.

Distension always involves tangible pathological products (such as accumulations or fluid retention); thus, gentle purgation should be applied slowly.