因误下多将脾胃之阴亡矣。胸中之气，因虚而下陷于心之分野，治宜升胃气，以血药治之。
有湿土乘心下，为虚满，若大便秘、能食，浓朴枳实主之。若大便利，芍药、陈皮主之。
有食积痰滞，痞膈胸中，宜消导之。
黄连泻心汤 治虚痞。
黄连（泻心下之土邪） 浓朴（降气）
大消痞丸 治湿土痞、虚痞。
黄连（炒六钱） 姜黄 白术 半夏（各一两） 黄芩（三钱） 甘草（炙） 神曲（炒）
人参（二钱） 宿砂（一钱） 木香 猪苓 泽泻（一钱） 生姜（五钱） 陈皮（三钱） 枳实（炒）
有忧气结中脘，心下痞满，肚皮底微痛，加之，否则不必。
利膈丸 治痰。
黄芩（生一两炒一两） 黄连 南星 半夏（五钱） 枳壳 陈皮（三钱） 白矾（五分）
白术（二钱） 神曲（炒） 泽泻（五钱）
栝蒌丸 治胸痞，胁下逆抢心。
栝蒌 枳实 陈皮
取栝蒌穣皮末熬丸。
胸痞切痛加栀子（烧存性） 附子（炮二两）
脉弦而滑者胀。盛而紧者曰胀（阳中有阴也，可下之愈。）
脉浮而数（浮则虚，数则热。）
趺阳紧而浮（紧为痛则坚满，浮为虚则肠鸣。）
脉虚紧涩者胀（乃忧思结连，脾肺气凝，大肠与胸不平而胀。）
脉浮（为风水、皮水。）
脉弦而迟，必心下坚（乃肝木克脾，土郁结涎，闭于脏气，腑气不舒，胃则胀闭。）
脉沉（为心下黄汗）。
脉沉而滑（亦名风水）。
脉浮而迟（浮热，迟潜，热潜相搏名曰沉，为水必矣。）
脉弦而紧（弦则卫气不行，水走肠间。）
盖水肿因脾虚不能制肾水，肾为胃关，胃关不利则水渍妄行，渗透经络，其
始起也，目窠上微肿，颈脉动，咳，阴股间寒，足胫胀大，水已成矣。按其腹随
手而起，如裹水之状。
气短不得卧为心水；
小肠急满为小肠水；
大便溏泄为肺水；
乍寒乍实为大肠水；
两胁满为汗水；
口苦咽干为胆水；
四肢重为脾水；
小便涩为胃水；
腰痛足冷为肾水；
腹急肢瘦为膀胱水。
风水，脉浮恶风，归之肝；
皮水，脉浮不恶风，不喘渴，按之没指，归之肺；
石水，脉沉而恶风，归之肾；
黄汗，脉沉迟，发热而多涎，归之脾。
盖胀满因脾土极虚，转输失职，胃虽受谷，不能运化精微，隧道壅塞，清浊
相混，湿郁为热，热又生湿，遂成胀满。
又有寒湿抑遏于脾土之中，积而不散而胀，经云∶藏寒生病满是也。
又有五积痰饮，聚而不散，或宿食不化，皆成胀满。
烦心短气，卧不安，为心胀；
虚满咳逆为肺胀；
胁痛引小腹为肝胀；
善哕，四肢悦，体重不胜衣，卧不安，为脾胀；
腰髀痛引背为肾胀；
腹满胃脘痛，妨食，闻焦臭，大便难，为胃胀；
肠鸣痛，冬寒飧泄为大肠胀；
小腹 满引腰痛，为小肠胀；
小腹满而气癃，为膀胱胀；
气满于肤 然，为三焦胀；
胁痛口苦，善太息，为胆胀；
寒气客于肤中，鼓空空不坚，腹身大，色不变，按之不起，为肤胀；
腹胀，身背大，色苍黄，腹筋起，为鼓胀。
治法
治水肿 先使补，脾气实能健运。腰以上肿，汗之；腰以下肿，宜利小便，
主以参术，佐以黄芩、麦门冬。
制肝木腹胀加朴；气不运加沉木香，使其通利为两全矣。
外则湿肿，脉则沉细，用附子。
又有肿痛，乃中寒也，亦加附子。
治胀满 宜大补脾气，行湿散气，主以参术，佐以平胃、五苓；热加芩
连；血虚加四物；有死血加桃仁。
如风寒自表入里变为热胀胃满，宜大承气下之；如积痰宿食胀满，宜消导之、下之。
又论治 肿七证∶
有肺气膈于膜外，营运不得，遍身浮肿，脉浮，宜调肺通气。
有男子脏虚，妇人血虚，伤于冷毒之物成积，凝滞气道不通，腹急气喘，亦
有只腹胀者，脉弦，治宜化积。
有脾寒久年不愈，传为浮肿，且云内有伏热，因于泻利，及其热乘虚入脾，
致胸腹急胀，脉数，治宜解热。
有肉如泥，按之不起，脾土湿病也，脉沉，治宜燥脾。
有脾虚不能制肾水，脾湿如泥，脉沉迟，治宜暖脾元、利水道。
有伤风湿冷湿而肿，气血凝涩，脉浮缓，治宜发散风湿，有久病后浮，是气虚也。
有妇人产后，或经后，是血虚也。其脉虚弱。
消肿丸
活石 木通 黑丑 茯苓 半夏 瞿麦 陈皮 木香 丁香
上酒糊丸，麦门冬汤下。
小胃丸 治肿。
变水汤 治肿。
白术 茯苓 泽泻（二两） 郁李仁（一钱）
上煎，入姜汁，调四君子汤之类。
木香散 治肿。
木香 大戟 白牵牛（各等分）
为末，三钱，以猪腰一双批片掺末，煨熟，空服。更涂甘遂末于脐，饮甘草水。
五皮散 治皮水。
大腹皮 桑白皮 茯苓皮 生姜皮 陈皮 木香
海金砂丸 治肿。
牵牛（生五钱，炒五钱） 甘遂（五钱） 海金砂（三钱） 白术（一两）
中满分消丸 治热胀、气胀、鼓胀。
黄芩 黄连（炒） 姜黄 人参 白术 猪苓 甘草 浓朴（各一两） 茯苓 宿砂
陈皮（各三钱） 枳壳（炒五钱） 半夏（五钱） 知母（炒） 青皮 泽泻 生姜（各四钱） 炊饼丸。
楮实子丸 治胀。
木香塌气丸 治胀。
萝白子（炒） 青皮 陈皮（各五钱） 草豆蔻（面裹煨） 木香（三钱） 胡椒 蝎梢
（二钱半去毒）
广茂溃坚丸 治胀，有积块如石，上喘，浮肿。
浓朴 草豆蔻 归尾 黄芩 益智（各五钱） 甘草 莪术 柴胡 神曲 黄连 泽泻（各
三钱） 吴茱萸 青皮 陈皮（二钱） 红花（一钱） 半夏（七钱） 桃仁 苏木 木香
十水丸 先服。次服尊重丸。
甜葶苈（炒） 泽泻（去毛） 大戟（醋炒） 芫花（醋炒） 桑白皮 汉椒 茯苓 雄黄 甘遂
上为末三钱，用出丝水狗先去一边末，入五更水下，以肉压之，免恶心。
尊重丸 治肿胀喘乏，小便涩，大府闭，虚危甚效。
沉香 丁香 木香 青皮 陈皮 槟榔 枳实（炒） 白丑 参 车前子 苦葶苈（各四钱）
青木香（四钱） 赤茯苓（四钱） 海金砂 胡椒 蝎尾 白豆蔻 活石（二钱五分） 萝白子
（炒六钱） 白丁香（一钱半） 郁李仁（一两五钱）
上姜汁糊丸。
Because of the mistaken use of purgatives, the Yin fluids of the Spleen and Stomach have been largely depleted. The Qi in the chest, due to deficiency, sinks downward into the region governed by the Heart meridian. Treatment should focus on raising Stomach Qi and utilizing blood-invigorating herbs.
If dampness encumbers the Middle Jiao (Earth element), causing a sensation of false fullness below the heart, and if accompanied by constipation and the ability to eat, Magnoliae Officinalis Cortex (Houpo) and Immature Bitter Orange (Zhishi) are the primary herbs. If bowel movements are unobstructed, then Paeoniae Radix Alba (Shaoyao) and Tangerine Peel (Chenpi) are the primary herbs.
If food stagnation and phlegm obstruct the diaphragm and chest, methods for resolving stagnation and guiding out accumulation should be employed.
Huanglian Xiexin Tang (Coptis Decoction to Drain the Heart): Treats deficiency-type痞 (fullness/obstruction).
Coptis Rhizome (Huanglian) (clears Earth-pathogenic factors in the lower chest); Magnoliae Officinalis Cortex (Houpo) (descends rebellious Qi).
Da Xiaopi Wan (Great Pill to Eliminate Fullness): Treats damp-Earth pi syndrome and deficiency-type pi syndrome.
Coptis Rhizome (Huanglian) (6 qian, stir-fried); Curcuma Longa Rhizome (Jianghuang); Atractylodis Macrocephalae Rhizome (Baizhu); Pinellia Tuber (Banxia) (1 liang each); Scutellaria Root (Huangqin) (3 qian); Licorice Root (Gancao) (roasted); Fermented Soybean Bean (Shenqu) (stir-fried);
Ginseng Radix et Rhizoma (Renshen) (2 qian); Amomum Fruit (Suosha) (1 qian); Aucklandiae Radix (Muxiang); Polyporus (Zuling); Alisma Rhizome (Zexie) (1 qian); Fresh Ginger (Shengjiang) (5 qian); Tangerine Peel (Chenpi) (3 qian); Immature Bitter Orange (Zhishi) (stir-fried).
If sorrowful Qi knots in the Zhongwan area, causing fullness below the heart and slight pain at the base of the belly, this herb may be added; otherwise, it is not necessary.
Lige Wan (Diaphragm-Opening Pill): Treats phlegm syndromes.
Scutellaria Root (Huangqin) (1 liang raw, 1 liang stir-fried); Coptis Rhizome (Huanglian); Arisaema Tuber (Nanxing); Pinellia Tuber (Banxia) (5 qian); Aurantium Fructus Immaturus (Zhiqiao); Tangerine Peel (Chenpi) (3 qian); Alum (Baifan) (5 fen);
Atractylodis Macrocephalae Rhizome (Baizhu) (2 qian); Fermented Soybean Bean (Shenqu) (stir-fried); Alisma Rhizome (Zexie) (5 qian).
Gualou Wan (Trichosanthes Pill): Treats chest obstruction (Xiongpi) and rebellious Qi rushing from the hypochondrium to the heart.
Trichosanthes Fruit (Gualou); Immature Bitter Orange (Zhishi); Tangerine Peel (Chenpi).
Take the pulp and skin of Trichosanthes, grind into powder, and decoct to form pills.
For severe pain in chest obstruction, add Gardenia Fruit (Zhizi) (burned to retain nature) and Aconite Lateral Root Preparata (Fuzi) (processed, 2 liang).
A wiry and slippery pulse indicates distension. A surging and tight pulse is termed distension (this indicates Yang containing Yin, and can be cured by purgation).
A floating and rapid pulse (Floating indicates deficiency; Rapid indicates heat).
The Dubo (Foot-Yangming) pulse is tight and floating (Tight indicates pain and hardness/fullness; Floating indicates deficiency leading to borborygmus).
A deficient, tight, and choppy pulse indicates distension (This results from prolonged worry and thought knotting together, causing Qi stagnation in the Spleen and Lung, imbalance between the Large Intestine and Chest, leading to distension).
A floating pulse indicates Wind-Water or Skin-Water.
A wiry and slow pulse inevitably leads to hardness below the heart (This is Liver Wood overacting on Spleen Earth, with Earth stagnation and fluid retention, blocking Zang Qi, causing Fu Qi to be unsmooth, resulting in Stomach distension and closure).
A deep pulse indicates Yellow Sweat below the heart.
A deep and slippery pulse is also called Wind-Water.
A floating and slow pulse (Floating indicates heat, Slow indicates latent [cold]; Heat and Latent cold fighting is termed Chen [Deep], indicating Water disease is certain).
A wiry and tight pulse (Wiry indicates Wei Qi cannot circulate, water flows into the intestines).
Generally, edema arises because Spleen deficiency fails to control Kidney Water. The Kidney is the gate of the Stomach; if the Stomach gate is obstructed, water infiltrates and runs wildly, penetrating the meridians. Initially, there is slight swelling above the eyes, pulsation in the neck vessels, coughing, coldness in the inner thighs, and enlargement of the calves; at this point, water has formed. Pressing the abdomen causes it to rise immediately, resembling a bag filled with water.
Shortness of breath preventing lying flat is Heart Water;
Urgency and fullness in the Small Intestine is Small Intestine Water;
Loose stools are Lung Water;
Alternating chills and fever is Large Intestine Water;
Fullness in both hypochondria is Sweat Water (Han Shui - *Note: likely a specific classification term*);
Bitter taste in the mouth and dry throat is Gallbladder Water;
Heaviness in the four limbs is Spleen Water;
Astringent urination is Stomach Water;
Lower back pain and cold feet is Kidney Water;
Abdominal urgency and emaciated limbs is Bladder Water.
Wind-Water, characterized by a floating pulse and aversion to wind, is attributed to the Liver;
Skin-Water, characterized by a floating pulse without aversion to wind, no panting or thirst, and indentation upon pressure, is attributed to the Lung;
Stone-Water, characterized by a deep pulse and aversion to wind, is attributed to the Kidney;
Yellow Sweat, characterized by a deep-slow pulse, fever, and excessive saliva, is attributed to the Spleen.
Generally, distension and fullness occur because Spleen Earth is extremely deficient, failing in its transportive function. Although the Stomach receives grain, it cannot transform and transport essence and turbidity. The pathways become congested, clear and turbid Qi mix, dampness stagnates and transforms into heat, and heat generates more dampness, eventually forming distension and fullness.
Additionally, cold-dampness suppressing the Spleen Earth accumulates and does not dissipate, causing distension. As stated in the classics: "Diseases arising from internal cold cause abdominal fullness."
Furthermore, Five Accumulations (Wu Ji), Phlegm-Fluids gathering and not dispersing, or undigested food, all result in distension and fullness.
Vexation, shortness of breath, and restless sleep indicate Heart Distension;
False fullness with cough and rebellious Qi indicate Lung Distension;
Hypochondriac pain radiating to the lower abdomen indicates Liver Distension;
Frequent hiccups, lethargy in the four limbs, body heaviness such that one cannot bear the weight of clothes, and restless sleep indicate Spleen Distension;
Pain in the lower back and thigh radiating to the back indicates Kidney Distension;
Abdominal fullness, epigastric pain, difficulty eating, aversion to burnt odors, and difficult defecation indicate Stomach Distension;
Borborygmus and pain, with watery diarrhea in winter cold, indicate Large Intestine Distension;
Lower abdominal fullness radiating to the lower back indicates Small Intestine Distension;
Lower abdominal fullness with urinary obstruction indicates Bladder Distension;
Qi filling the skin, feeling soft upon pressure, indicates Triple Burner Distension;
Hypochondriac pain, bitter taste, and frequent sighing indicate Gallbladder Distension;
Cold Qi lodging in the skin, causing the abdomen to sound hollow and be firm-less, with general swelling but unchanged color, and non-rebounding upon pressure, indicates Skin Distension (Fu Zhang);
Abdominal distension with general and back swelling, sallow-yellow complexion, and visible abdominal veins indicates Drum Distension (Gu Zhang).
Treatment Methods
To treat edema: First use tonification so that Spleen Qi becomes solid and transportation functions well. For swelling above the waist, induce sweating; for swelling below the waist, promote urination. Use Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizome (Baizhu) as main herbs, assisted by Scutellaria Root (Huangqin) and Ophiopogon Tuber (Maidong).
For Liver Wood-induced abdominal distension, add Magnoliae Officinalis Cortex (Houpo); for stagnant Qi, add Aquilaria Wood (Chenxiang) and Aucklandiae Radix (Muxiang) to ensure smooth circulation.
For external dampness causing swelling, with a deep and fine pulse, use Aconite Lateral Root Preparata (Fuzi).
For swelling accompanied by pain, caused by internal cold, also add Aconite Lateral Root Preparata (Fuzi).
To treat distension and fullness: Greatly tonify Spleen Qi, move dampness, and disperse Qi. Use Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizome (Baizhu) as main herbs, assisted by Pingwei San and Wuling San. Add Scutellaria Root (Huangqin) and Coptis Rhizome (Huanglian) for heat; add Siwu Tang for Blood deficiency; add Peach Kernel (Taoren) for static Blood.
If Wind-Cold enters from the exterior and transforms into Heat Distension with Stomach fullness, use Dachengqi Tang to purge. If distension is caused by accumulated phlegm and old food, use methods to resolve stagnation and purge.
Further discussion on treating seven types of swelling syndromes:
If Lung Qi is blocked outside the membranes, preventing normal circulation, causing generalized edema and a floating pulse, regulate Lung Qi and open the airways.
If men have Zang deficiency or women have Blood deficiency, injury from cold-toxic substances forms accumulations, stagnating the Qi channels, causing abdominal urgency and panting (or only abdominal distension), with a wiry pulse; treatment should focus on resolving accumulations.
If Spleen Cold persists for years and transforms into edema, and there is latent heat inside due to diarrhea, allowing heat to enter the Spleen via deficiency, causing urgent chest and abdominal distension with a rapid pulse, treatment should focus on clearing heat.
If flesh is soft like mud and does not rebound upon pressure, this is Spleen Earth dampness; with a deep pulse, treatment should focus on drying the Spleen.
If Spleen deficiency fails to control Kidney Water, and Spleen dampness is like mud, with a deep-slow pulse, treatment should focus on warming the Spleen Yuan and promoting the water passages.
If swelling results from injury to Wind-Damp and Cold-Damp, with stagnant and sluggish Qi and Blood, and a floating-slow pulse, treatment should focus on diffusing Wind-Damp. Swelling after long-term illness indicates Qi deficiency.
Swelling after childbirth or menstruation in women indicates Blood deficiency, with a weak pulse.
Xiaozhong Wan (Reduce Swelling Pill)
Sal-Ammoniac (Naosha); Tetrapanax Pith (Mutong); Black Morning Glory Seed (Heiqiu); Poria (Fuling); Pinellia Tuber (Banxia); Dianthus Flower (Qumai); Tangerine Peel (Chenpi); Aucklandiae Radix (Muxiang); Clove Bud (Dingxiang).
Make pills with wine paste, take with Ophiopogon Decoction (Maidong Tang).
Xiaowei Wan: Treats swelling.
Bianshui Tang: Treats swelling.
Atractylodis Macrocephalae Rhizome (Baizhu); Poria (Fuling); Alisma Rhizome (Zexie) (2 liang); Prunus Armeniaca Seed (Yuliren) (1 qian).
Decoct, add Ginger Juice, and mix with Sizijunzi Tang or similar formulas.
Muxiang San: Treats swelling.
Aucklandiae Radix (Muxiang); Euphorbia Root (Daji); White Morning Glory Seed (Baiqianniu) (equal parts).
Grind into powder, take 3 qian. Slice two pig kidneys, sprinkle powder on them, roast until cooked, and take on an empty stomach. Additionally, apply Kansui Root (Gansui) powder to the navel, and drink Licorice Water.
Wupi San (Five Peel Powder): Treats Skin-Water.
Areca Peel (Dafupi); Mulberry Root Bark (Sangbaipi); Poria Peel (Fulingpi); Fresh Ginger Peel (Shengjiangpi); Tangerine Peel (Chenpi); Aucklandiae Radix (Muxiang).
Haijinsha Wan: Treats swelling.
Morning Glory Seed (Qianniu) (5 qian raw, 5 qian stir-fried); Kansui Root (Gansui) (5 qian); Semina Loranthi (Haijinsha) (3 qian); Atractylodis Macrocephalae Rhizome (Baizhu) (1 liang).
Zhongman Fenxiao Wan: Treats Heat Distension, Qi Distension, and Drum Distension.
Scutellaria Root (Huangqin); Coptis Rhizome (Huanglian) (stir-fried); Curcuma Longa Rhizome (Jianghuang); Ginseng Radix et Rhizoma (Renshen); Atractylodis Macrocephalae Rhizome (Baizhu); Polyporus (Zuling); Licorice Root (Gancao); Magnoliae Officinalis Cortex (Houpo) (1 liang each); Poria (Fuling); Amomum Fruit (Suosha);
Tangerine Peel (Chenpi) (3 qian each); Aurantium Fructus Immaturus (Zhiqiao) (stir-fried, 5 qian); Pinellia Tuber (Banxia) (5 qian); Anemarrhena Rhizome (Zhimu) (stir-fried); Green Citrus Peel (Qingpi); Alisma Rhizome (Zexie); Fresh Ginger (Shengjiang) (4 qian each). Make pills using steamed bun dough.
Chushizi Wan: Treats distension.
Muxiang Taqi Wan: Treats distension.
Radish Seed (Luobai Zi) (stir-fried); Green Citrus Peel (Qingpi); Tangerine Peel (Chenpi) (5 qian each); Cardamom Seed (Caodoukou) (wrapped in flour and roasted); Aucklandiae Radix (Muxiang) (3 qian); Pepper (Hujiao); Scorpion Tail (Xieshao) (2.5 qian, detoxified).
Guangmao Kuijian Wan: Treats distension, hard masses like stones, upper body panting, and edema.
Magnoliae Officinalis Cortex (Houpo); Cardamom Seed (Caodoukou); Angelica Sinensis Root Tail (Guiwei); Scutellaria Root (Huangqin); Alpinia Oxyphylla Fruit (Yizhi) (5 qian each); Licorice Root (Gancao); Curcuma Zedoaria Rhizome (Ezhu); Bupleurum Root (Chaihu); Fermented Soybean Bean (Shenqu); Coptis Rhizome (Huanglian); Alisma Rhizome (Zexie) (3 qian each); Evodia Fruit (Wuzhuyu); Green Citrus Peel (Qingpi); Tangerine Peel (Chenpi) (2 qian); Safflower (Honghua) (1 qian); Pinellia Tuber (Banxia) (7 qian); Peach Kernel (Taoren); Dalbergia Odorifera Wood (Sumu); Aucklandiae Radix (Muxiang).
Shishui Wan: Take first. Then take Zunzhong Wan.
Sweet Thladiantha Fruit (Tingli) (stir-fried); Alisma Rhizome (Zexie) (de-haired); Euphorbia Root (Daji) (vinegar-fried); Genkwa Flower (Yuanhua) (vinegar-fried); Mulberry Root Bark (Sangbaipi); Sichuan Pepper (Hanjiao); Poria (Fuling); Realgar (Xionghuang); Kansui Root (Gansui).
Grind into powder, take 3 qian. Use a dog producing silk-like water (specific preparation method), remove half the powder, take with water at dawn (5th watch), and press with meat to prevent nausea.
Zunzhong Wan: Treats swelling, distension, panting, fatigue, astringent urination, and fecal impaction; very effective for critical deficiency conditions.
Aquilaria Wood (Chenxiang); Clove Bud (Dingxiang); Aucklandiae Radix (Muxiang); Green Citrus Peel (Qingpi); Tangerine Peel (Chenpi); Areca Nut (Binglang); Immature Bitter Orange (Zhishi) (stir-fried); White Morning Glory Seed (Baiqiu); Ginseng Radix et Rhizoma (Renshen); Plantago Seed (Cheqianzi); Bitter Thladiantha Fruit (Kutingli) (4 qian each);
Green Aucklandiae Radix (Qingmuxiang) (4 qian); Red Poria (Chifuling) (4 qian); Semina Loranthi (Haijinsha); Pepper (Hujiao); Scorpion Tail (Xiewei); White Cardamom (Baidoukou); Sal-Ammoniac (Naosha) (2.5 qian); Radish Seed (Luobai Zi) (stir-fried, 6 qian); White Civet Cat Feces (Baidingxiang) (1.5 qian); Prunus Armeniaca Seed (Yuliren) (1 liang 5 qian).
Make pills with Ginger Juice paste.