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Since ancient times, edema affecting the whole body and head/face is relatively easy to treat. However, if only the abdomen is swollen, it becomes a difficult condition to treat. There are inherent reasons for this distinction that must not be overlooked.

The various prescriptions handed down through generations mostly employ harsh, toxic, and coercive methods of attack (Gongjie). These methods damage and deplete the Yuan Qi (Primary Vital Energy) and impair the Spleen and Stomach. They are medicines that should be used once but never again. Even if they achieve temporary efficacy, if the swelling recurs, there will be no further effective treatment available. This is the first reason.

Moreover, in cases of generalized edema, each of the Zang and Fu organs presents specific signs; therefore, herbs that drain the Liver, Lung, Bladder, Large Intestine, and Small Intestine can occasionally yield results. In contrast, isolated abdominal swelling indicates that the central pivot of transportation and transformation (Zhongzhou, referring to the Spleen/Stomach region) has been obstructed for a long time. Consequently, clear Yang fails to ascend, and turbid Yin fails to descend, leading to stubborn aggregation that is difficult to break apart. This is essentially caused by the decline of Spleen Qi. How dare one casually administer drugs that drain the Spleen? This is the second reason.

Furthermore, regarding edema that can be treated with draining methods, such approaches are only suitable for robust individuals from the Northwest or laborers in the fields. They are certainly not tolerated by those who consume rich foods, the elderly, the young, or the delicate. If one were to assert that edema represents a condition of great fullness and excess requiring draining, would post-illness edema and postpartum edema also be treated with draining methods? This is the third reason.

Additionally, ancient texts originally recorded five untreatable conditions for edema: black lips indicate injury to the Liver; a flat suprasternal notch (Quepen) indicates injury to the Heart; an everted umbilicus indicates injury to the Spleen; a flat back indicates injury to the Lung; and flat, full soles indicate injury to the Kidney. These five conditions are considered incurable. The intent behind formulating these prescriptions was not to address incurable syndromes. Why do later practitioners, failing to understand this, universally resort to attacking and draining methods?

Only the method of regulating the Spleen remains viable. Even when Zang and Fu organs present seemingly incurable signs, many cases can still be cured through this approach. This is the fourth reason.

Zhang Hezi advocated using the three methods of sweating, vomiting, and purging to eradicate myriad diseases. Later scholars have suggested that Zhang Hezi’s writings may not be his own work but rather authored by Master Ma Zhengjun. This is indeed an insightful observation. As Chang Zhongming stated, people believe that tonifying agents are ineffective for treating disease. This view stems from an excessive faith in the theories of Liu Wansu and Zhang Hezi, while ignoring the frailty of the Yuan Qi. Therefore, whenever coercive and draining drugs are used, although the swelling may subside rapidly at first, subsequent attacks fail to reduce it, and further attacks become as futile as striking iron or stone. Those who do not understand the pathology might attribute this persistence to the strength of pathogenic factors. However, from the perspective of those who comprehend medical principles, it is merely the result of harsh drugs attacking the body, causing the patient's own Yuan Qi to turn against them. It is akin to driving honest citizens to become bandits. As the saying goes, "Infants stealing weapons and playing in the moat," the situation is exactly like this.

Understanding this principle reveals three methods: the method of nurturing, which involves tonifying the Yuan Qi; the method of gathering, which involves raising the Yang Qi; and the method of dispersing, which involves opening the "ghost gates" (sweating pores) and cleansing the "clean mansion" (bladder/diuresis). Although these three methods do not explicitly mention "draining," the effect of draining is contained within them. Their essence is fully exhausted here.

Mr. Hu Youchen stated: "Abdominal distension must be treated with draining." However, those who truly understand "draining" know that within tonification lies the essence of draining. Readers must grasp this meaning to understand the author's intent.