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I have observed that in diseases of swelling and distension, panting and urgency (asthma) must occur. However, in diseases of panting, there are cases with swelling but no distension, and cases with distension but no swelling. There are also cases where swelling precedes panting, and cases where panting precedes swelling. Since the clinical manifestations differ, how can practitioners not distinguish between them? Let us investigate in detail.

Generally speaking, swelling and distension relate to the Spleen, while panting and fullness relate to the Lung. When distension is more severe than swelling, it belongs to Liver Wood overacting on Spleen Earth; when swelling is more severe than distension, it belongs to Kidney Water overacting on Lung Metal. Therefore, the method for treating distension should first focus on calming the Liver. Once the Liver is calm, Qi will be regulated and not stagnate. Next, use herbs that tonify the Spleen and astringe the Liver. When Earth is robust, it can transport and transform effectively. In tonifying Earth, one drains Wood; Sour Bai Shao Yao (Radix Paeoniae Alba) is used to astringe. If one uses too many Qi-moving or Qi-breaking herbs, the Middle Jiao (Spleen/Stomach) will be damaged and unable to resume its functions.

The method for treating swelling should first focus on clearing the Lung. Once the Lung is clear, Qi will descend and not rebel upward. Next, use bland-draining herbs that benefit Yin. Bland-draining herbs can open the orifices. Metal (Lung) is stored within Water (Kidney); Bitter Sheng Di Huang (Rhizoma Rehmanniae Preparata) is used to firm the Yin. If one uses too many dispersing and draining herbs, Yang will exist without Yin, and transformation cannot occur.

However, when swelling progresses to panting, one should seek the cause of the swelling and regulate it. Without specifically treating panting, panting will naturally subside. When panting progresses to swelling, one should seek the cause of the panting and regulate it. Without specifically treating swelling, swelling will naturally heal. The treatments for Wood-Fire and Metal-Water are easily altered, comparable to wielding a blade. Moreover, since Earth resides in the center, the four Qi (seasonal pathogens) may all invade it. A skilled practitioner must examine the organ affiliations and seek treatment based on the principles of "Bitter-Desire Tonification and Drainage" (Ku Yu Bu Xie). This way, one will grasp the true nature of the disease and not adhere rigidly to fixed formulas.

[Case Records]

A woman, over thirty years old, suffered from asthma and generalized edema. Other physicians had treated her for over a year with no effect. I was consulted. Her pulse was fine and rapid. She panted and felt fatigued upon movement. She had taken only Qi-breaking herbs previously. Seeing her severe edema, I used Da Fu Pi (Arecae Pericarpium), Chen Pi (Citri Reticulatae Pericarpium), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma), and Che Qian Zi (Plantaginis Semen), but uniquely added Sheng Di Huang (Rehmanniae Radix), Bai Shao Yao (Paeoniae Radix Alba), and Mu Dan Pi (Moutan Cortex). This nourished Yin to support Yang, restrained rebellious Qi above, and facilitated transformation below. In less than three doses, symptoms reduced by half; after several doses, she recovered. Subsequently, Ba Zhen Tang (Eight Treasure Decoction) was used for regulation.

A sixteen-year-old man recently contracted a cold syndrome. I prescribed exterior-releasing and food-dispersing herbs. By the fourth day of the new year, he had recovered. I instructed him to eat congee. His family, being overly cautious, gave him only water boiled from aged rice. On the twentieth day, they sought my treatment again. He presented with upper-body panting and lower-body swelling, extending from the dorsum pedis to above the knees. Not only was he swollen, but the color was remarkably red. His pulse was faint and fine. Upon asking about his chest, he reported extreme hunger. However, whenever he drank congee, he immediately panted. I said, "Five Qi nourish Yang, Five Flavors nourish Yin. For over half a month, you have consumed only aged rice water, which has Qi but no flavor. Yin cannot support Yang, so how can transformation occur? But what of the redness in both feet?" I further stated, "This must be due to excessive consumption of salty flavors. Salty flavors enter the Blood and tend downward, following Water outward, leading to this condition." Inquiry revealed that due to a bland taste preference, he had eaten freely of pickled vegetables. I believed no specific treatment was needed. I urgently requested rice and meat dishes, giving him half a bowl, after which he felt comfortable. The patient was very pleased. After a short while, he ate another half bowl of different meat dishes and remained comfortable. I ultimately advised him to continue this regimen. Approximately ten days later, Yin gradually strengthened, Yang transformed, and the swelling receded, as expected.