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Shen (Case 42): After the cessation of Sanlüe (a type of intermittent malaria occurring every three days), edema appeared in the feet, subsequently spreading to the abdomen and chest/hypochondrium. Appetite decreased significantly, accompanied by shortness of breath and a fine pulse. This is clearly deficiency of both Spleen and Kidney. Spleen deficiency fails to control water metabolism; Kidney cold prevents the Bladder from transforming Qi, leading to a loss of excretory function and resulting in a tendency for water flooding. The most stable treatment method is administering Siming Jiashen Shenqi Wan (Siming Modified Kidney Qi Pill, a formula warming Kidney Yang and promoting Qi transformation to move water) combined with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction, treating Spleen-Stomach Qi deficiency and sinking of Middle Qi), taken separately in the morning and evening. However, this method requires long-term administration to be effective. Moreover, the herbs in the decoctions and pills are costly, affordable only by those with financial means. For a farmer's wife, merely ensuring sufficient daily grain is fortunate enough; how could she afford such medicines? To sit idle and let her die contradicts the heart of a benevolent person. Therefore, I deliberated on a new prescription: to reduce edema, diuresis is necessary; to promote diuresis, regulating Qi must come first. Yet, simply promoting Qi alone is like trying to rain without clouds—how can it work? So, what should be done? One must follow the principle in *Neijing* that "Qi transformation allows fluids to exit," employing methods to warm and promote diuresis.

Zhaomu (Pepper Seed) [1 qian], Dingxiang (Clove) [10 pieces], Laojiangpi (Old Ginger Peel) [7 fen], Jupi (Tangerine Peel) [1.2 qian], Sugeng (Perilla Stem) [8 fen], Tongcao (Tetrapanax Pith) [7 fen], Dafupi (Areca Peel) [2 qian], Zexie (Alisma Rhizome) [1.5 qian], Cheqianzi (Plantago Seed) [1 qian], Fulingpi (Poria Peel) [2 qian].

After five doses, skin itching occurred and appetite increased. After another five doses, skin wrinkled and peeled, bringing immediate relief. Although the previous prescription worked quickly, it represents "treating the acute symptoms" (Ji Ze Zhi Biao), which is not a comprehensive solution. Switched to strengthening Earth (Spleen), promoting Qi, and warming Kidney to hope for a complete cure. Removed Tongcao and Cheqianzi from the previous formula, added Dangshen (Codonopsis Root) [2 qian] and Sheng Dongzhu (Raw Atractylodes Macrocephala Rhizome) [2 qian]. After ten doses, half the illness was gone. Then used Yigong San (Yi Gong Powder, Si Jun Zi Tang plus Chen Pi), adding Huangqi (Astragalus Root), Yiren (Coix Seed), Dingxiang (Clove), Zhaomu (Pepper Seed), Zexie (Alisma Rhizome), Laojiangpi (Old Ginger Peel), and Da Sugeng (Large Perilla Stem). After more than ten doses, diet and daily life returned to normal.

Miss Zhu (14 years old): Edema throughout the upper and lower body, worsening over six months. No desire to eat, delirium during sleep, coughing/wheezing, and a rapid pulse. This is Qi deficiency combined with stagnation, requiring nourishment, unblocking, and calming the Spirit.

Dangshen (Codonopsis Root) [2 qian], Longyanrou (Longan Aril) [7 pieces], Zaoren (Ziziphus Seed) [2 qian], Fushen (Poria with Hostwood) [1.5 qian], Sharenqiao (Amomum Villosum Shell) [1 qian], Yuanzhi (Polygala Root) [1 qian], Da Sugeng (Large Perilla Stem) [1 qian], Jupi (Tangerine Peel) [1 qian], Xingren (Apricot Seed) [2.5 qian, peeled and crushed], Sangpi (Morus Alba Bark) [1.5 qian, stir-fried with honey].

After four doses, swelling around eyes and nose clearly subsided, ankles reduced by half, night sleep became quiet with ability to eat, and Spirit/Qi flow smoothed. Adjusted the ingredients and dosages of the previous formula to prepare pill material. Her father believed she would not survive, visited me to consult a physician for a prognosis of life or death. Now seeing such rapid efficacy, he is endlessly grateful. Generally, although Swelling and Distension are listed as one category, their paths differ. Edema (Zhong) is easier to treat than Distension (Zhang). Distension relates closely to Zang-Fu organs, whereas edema focuses primarily on Water and secondarily on Qi. If one can distinguish deficiency/excess and identify concurrent patterns, achieving quick results is not difficult. To differentiate: if head and feet are both floating/swollen, but the abdomen is not very firm/tight, it is Edema. If only the abdomen is firm/tight like a drum, with prominent veins, it is Dan Zhang (Single Distension), the most severe type. If face/head swells in the morning, feet swell in the evening, but the abdomen is always swollen, it is Distension complicated by Edema. Analyzing these distinctions here aims to clarify vision for students of medicine.

Wang (5 years old): Childhood body swelling, attributed to Lung Qi not dispersing freely and Bladder dysfunction.

Fulingpi (Poria Peel), Jupi (Tangerine Peel), Sangpi (Morus Alba Bark), Dafupi (Areca Peel), Yiren (Coix Seed), Xingren (Apricot Seed), Mutong (Akebia Stem), Cheqianzi (Plantago Seed), Jiangpi (Ginger Peel).

Shen (Case 68): Frail physique, weak Qi, disrupted circulation, mouth ulcers with internal heat, limb swelling, anorexia, deep/fine pulses with rapid quality. This condition is difficult to treat.
Human Qi corresponds to Heaven. Currently mid-summer, Yang Qi expands outward, just as all plants grow lushly. How can humans suppress and contract instead of extending? For young people with robust Qi, if forced by Cold pathogens in winter, they may contract Shanghan (Cold Damage); in spring it transforms into Wenbing (Warm Disease), and in summer into Heat. Treatable cases succeed because the root Qi is substantial; lifting and raising it corrects imbalance and restores harmony with Nature. This case is different. Tentatively prescribing a formula hoping for a slight recovery.

Lianqiao (Forsythia Fruit), Xiangchi (Fermented Soybean), Bohe (Mint), Fangfeng (Saposhnikovia Root), Juhong (Red Tangerine Peel), Xingren (Apricot Seed), Shanzhi (Gardenia Fruit), Renshen (Ginseng Root), Laojiangpi (Old Ginger Peel).

This prescription proved effective, but improvement would not occur until autumn. Maintaining long-term health would be extremely difficult!

Zhao (60 years old): At the age of sixty (completion of a sexagenary cycle), suffered from Edema. Due to Qi deficiency and poor transport, Bladder failed to discharge properly. Not curable in a day or two; patience in taking medicine is required for efficacy.

Dangshen (Codonopsis Root), Huangqi (Astragalus Root), Sheng Dongzhu (Raw Atractylodes Macrocephala Rhizome), Dafupi (Areca Peel), Sugeng (Perilla Stem), Sharenqiao (Amomum Villosum Shell), Juhong (Red Tangerine Peel), Fuling (Poria), Zexie (Alisma Rhizome), Jiangpi (Ginger Peel).

Additionally, added Guishen (Angelica Sinensis Root Body) and Baishao (White Peony Root), Wei Muxiang (Stir-baked Costus Root) to the previous formula; reduced Sharenqiao and Sugeng. Effective: foot edema receded, abdominal distension eased. Prepared as pills to conclude treatment.

Shen (20 years old): Post-malaria facial and foot edema, deep/choppy pulse. Used Upper-Lower Separating Drainage Method.

Suye (Perilla Leaf), Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Fuling (Poria), Zexie (Alisma Rhizome), Yiren (Coix Seed), Jupi (Tangerine Peel), Xiangfu (Cyperus Rhizome), Sharenqiao (Amomum Villosum Shell), Jiangpi (Ginger Peel), Xihe Liu (Salix Caprea Catkin).

Prone to leakage (essence escaping), causing frequent drinking and urination. All essence follows water downward, exiting via Bladder. What looks like rice wash water is Jingye (Essence Fluid); what resembles wine lees is Jingqi (Essence Qi). With fever day and night, how can one avoid emaciation? Those with weak constitutions rarely escape this. Although the previous formula worked, without strongly tonifying Kidney Yin, relapse is inevitable. Thus, removed Shigao (Gypsum Fibrosum) and Huanglian (Coptis Rhizome). After thirty more doses, muscles gradually recovered, eyesight cleared as before.