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The *Classic of Internal Medicine* states: In the condition of skin distension (Fu Zhang), cold pathogenic factors invade between the skin and muscles, resulting in abdominal enlargement and generalized edema. The skin is thick; upon pressure, the depression does not rise immediately, and the abdominal color remains unchanged. This is its clinical presentation. It further states: All swellings and fullnesses caused by dampness belong to the Spleen. It also states: Water diseases manifesting as lower limb edema and abdominal distension, accompanied by upper respiratory symptoms such as wheezing, gasping, and inability to lie flat, indicate simultaneous involvement of both the root (Kidney) and branch (Lung/Spleen).

All cases of swelling and abdominal distension are fundamentally due to deficiency of the Spleen and Stomach. Earth of the Spleen prefers dryness and dislikes dampness. Due to inherent weakness of the Middle Qi, Spleen deficiency with lack of Fire (Yang energy), water-dampness takes advantage of this vulnerability. Consequently, Spleen transportation becomes stagnant, causing milk and food to congeal and fail to digest, accumulating in the Middle Jiao, thereby generating swelling and distension. When treating swelling, one must take regulating the Spleen and Stomach as the root treatment, while addressing edema as the branch treatment. Only then can success be expected. If one merely relies on purgative and draining methods, it inevitably leads to critical danger.

Treatment of swelling should distinguish between upper and lower locations. The *Classic* states: Facial edema is due to Wind; foot edema is due to Dampness. Swelling originating from below is generally due to Wind pathogen; the treatment focuses on the Lung, employing dispersing methods, such as Shen Su Yin combined with Wu Pi Tang. Swelling originating from below may also result from Kidney deficiency leading to water overflowing, or Spleen Qi being affected by dampness; these require permeating and draining methods. Thus, Zhang Zhongjing stated: Treating dampness without promoting urination is not the correct approach. One should use Wu Ling San added with Fang Ji and Bing Lang.

Generalized edema may arise from insufficient congenital endowment followed by sudden exposure to Wind-Cold, or from Spleen deficiency due to malaria or dysentery, all of which can cause swelling. For mild cases, Wei Ling Wan is used; for severe cases, Jia Wei Wei Ling Wan is employed. Refer to the items at the end of the text for comparison.

When pediatric edema is located in the exterior, accompanied by headache and fever, this indicates Wind-Cold in the exterior. Mild diaphoresis is indicated; add small amounts of Ma Huang, Ge Gen, Su Ye, and Xing Ren to Wu Ling San to induce sweating. If there is no fever, use Wu Ling San added with Rou Gui to promote Bladder Qi transformation; once urination becomes smooth, the edema will subside.

For Yang-type water edema, characterized by fever, constipation, dark and scanty urine, irritability, and thirst, decoct Wu Pi Tang and administer Hang Xie Dan orally to induce mild purgation. For Yin-type water edema, characterized by absence of fever, no thirst, cold body aversion to cold, and normal bowel and bladder movements, use Ping Wei San added with Bai Fu Ling, Cao Guo, Mu Xiang, and Huo Xiang.

In edema conditions, if swelling starts in the abdomen and dissipates to the limbs, it is treatable. If swelling starts in the limbs and later converges into the abdomen, it is untreatable.

If a child has inherently deficient Yuan Qi and subsequently suffers from generalized edema, cold limbs, absence of thirst, clear and profuse urination, loose stools, and anorexia after a severe illness, this indicates extreme Yin-Cold and impending exhaustion of Spleen and Stomach Qi. All formulas for treating swelling are contraindicated. Instead, Si Jun Zi Tang added with Qing Hua Gui, Pao Jiang, Sha Ren, and Bai Kou should be used to rescue the Spleen and Stomach. Ignorant physicians, seeing only the edema but unaware of the exhaustion of Yuan Qi, still employ digestive and diuretic methods, or even use drastic drugs like Zhou Che Wan, Yu Gong San, Da Ji, Yuan Hua, and Gan Sui to rob the righteous Qi. This is akin to murder; one must be cautious and beware!