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Swelling located on the exterior belongs to water retention, while distension located in the interior belongs to qi stagnation. Swelling is divided into Yang Water and Yin Water; distension is divided into Excess Qi and Deficient Qi. Edema caused by damp-heat and turbid stagnation is termed Yang Water; water overflow caused by deficiency of the Lung, Spleen, and Kidney is termed Yin Water. Turbid qi accumulating in the upper jiao constitutes Excess Distension, while failure of Middle Qi to transport constitutes Deficient Distension. Differentiating by location, it can occur in zang-fu organs, meridians, skin, as well as in the upper/lower and interior/exterior aspects of the body. Differentiating by etiology, cold, heat, dampness, phlegm, qi and blood stagnation, and parasitic accumulation can all cause these conditions. Regarding treatment methods, integrating internal and external therapies is essential.

Qi Swelling: The skin is thick and dark-colored, with generalized swelling progressing from top to bottom. Pitting upon pressure does not rebound immediately. This is caused by cold pathogen invading the skin.
Pediatric massage techniques: Divide Yin and Yang (200 repetitions), Push Three Gates (200 repetitions), Retreat Six Fu Organs (200 repetitions), Push Earth of the Spleen (300 repetitions), Move Water into Earth (100 repetitions), Heavenly Gate entering Tiger's Mouth (50 repetitions). Rub the umbilicus rotating left and right (200 repetitions each). When performing pushing techniques, use boiling water; avoid salt, soy sauce, and raw/cold foods.

Edema: Dyspnea appears first, followed by swelling. The skin is thin and lustrous, with swelling progressing from bottom to top. Pitting rebounds immediately upon release. This is caused by irritability, thirst, and preference for drinking due to Spleen deficiency failing to control water. Water insults Earth and rushes upward to the Lung, causing the skin to swell as if wrapped in water.
Pediatric massage techniques: Divide Yin and Yang (200 repetitions), Push Three Gates (200 repetitions), Retreat Six Fu Organs (200 repetitions), Push Earth of the Spleen (300 repetitions), Move Water into Earth (100 repetitions). Rub the umbilicus rotating left and right (200 repetitions each). When performing pushing techniques, use decoction of scallion and ginger; avoid salt, soy sauce, and raw/cold foods.

Commentary: The Classics state: "All dampness-induced swelling and fullness belong to the Spleen." This means that water is the most yin substance; its manifestation is in the Lung, its root is in the Kidney, and its regulation is by the Spleen. Why does the Kidney accumulate water? The Kidney is the gate of the Stomach. When Kidney deficiency occurs, the gate fails to close properly, causing water to rebel and flood upward. The Spleen cannot control it and is instead soaked by water, resulting in muscle edema. The Lung cannot transform it and is overwhelmed by water, resulting in rapid breathing. These are all harms caused by excessive Yin. Thus, it is known that swelling and distension invariably involve the Lung, Spleen, and Kidney. The Lung governs qi transformation, the Spleen governs transportation, and the Kidney governs fluid storage. The Classics state: "The Bladder stores fluids; only through qi transformation can they be excreted." Qi transformation refers to the True Fire of the Mingmen (Gate of Life) in the Right Kidney. If fire declines, it cannot steam and open the Kidney's gate, leading to water accumulation. One must use Gui Fu Shen Qi Wan (Cinnamon Twig and Aconite Pill for the Kidney Qi) to steam and open the gate, allowing accumulated water to descend, because Yang governs opening. This principle applies not only to treating edema but also to treating distension, where the key is unblocking Yang. Swelling diseases rooted in water components prioritize treating water, while regulating qi; when qi transforms, water resolves. Diseases rooted in qi components prioritize regulating qi, while promoting diuresis; when water moves, qi also moves. One must differentiate Yin and Excess/Deficiency. Damp-heat obstruction belongs to Yang patterns; turbid qi coagulation belongs to Yin patterns. In Yang patterns, pressure causes pain; in Yin patterns, pressure causes no pain. Yang patterns originate in the Middle Jiao; Yin patterns originate in the Lower Jiao. All Yang patterns involve heat, and heat often indicates excess. All Yin patterns involve cold, and cold often indicates deficiency. Red urine and constipation with a rapid, forceful pulse indicate Heat and Excess. Clear urine and loose stools with a faint, weak pulse indicate Deficiency and Cold. Yang patterns are treated via the Fu organs using clearing methods; Yin patterns are treated via the Zang organs using warming methods. This outlines the general principles of swelling and distension. Xu Huixi stated: "Even if Zheng Qi (Upright Qi) is deficient in distension-fullness syndromes, it ultimately belongs to Pathogenic Excess. Ancient practitioners were cautious about using tonification methods."

In summary, swelling syndromes are easy to treat, while distension syndromes are difficult. Distension has many complexities; one must differentiate between有形 (tangible/form) and 无形 (intangible/no form). Intangible distension should be dispersed and unblocked; tangible distension may be attacked and purged. For example, if distension worsens after eating, treatment focuses on unblocking the Fu organs. If bowel and bladder movements become regulated but distension persists, the pathology lies in the Zang organs. General treatment methods include sweating, diuresis, separating and eliminating, pungent dispersal, clearing and descending, warming and unblocking, lifting and raising, dredging and draining, tonifying and securing, opening depression, gentle purgation, softening hardness and resolving masses, regulating blood stasis and guiding out stagnation. The overarching principle is unblocking and dispersing; do not use static tonification. That is all. (Ti Li Zi)