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(Swelling, *Zhong*, refers to the enlargement of the skin. Distension, *Zhang*, refers to fullness and distension in the heart and abdomen. Drum-like swelling, *Gu*, refers to stuffiness and fullness in the heart and abdomen with emaciation of the four limbs. Ancients called this condition Gu-swelling syndrome (*Guzhong zheng*). Historically, there has been a distinction between Qi edema (*Qizhong*) and Water edema (*Shuizhong). The *Neijing* states that pitting upon pressure indicates Qi, while non-pitting or immediate rebound indicates Water. Later physicians often reversed this view. However, when Qi stagnates, Water also stagnates; when Water moves, Qi also moves. It is not necessary to strictly distinguish them. Generally, non-pitting indicates severe swelling, while immediate rebound indicates mild swelling. Swelling of the scrotum and penis usually carries a poor prognosis (death).

The pulse should originally be Deep (*Chen*). If it is Floating (*Fu*) and Wiry (*Xian*), sweating therapy (*Fahan*) is indicated. If it is Floating and forceful upon pressing, Yuepi Tang (*Yuepi Decoction*) is indicated. If it is Floating superficially at the skin level, it usually indicates death. If it is Deep and Tight (*Jin*), formulas like Mahuang Xixin Fuzi Tang (*Ephedra, Asarum, and Aconite Decoction*) are indicated. If it is Deep and Slow (*Huan*), recovery is easy. If it is Deep and Fine/Thready (*Wei Xi*), warming and tonifying methods are indicated.

At the onset, slight facial edema appears, specifically under the eyes known as "Silkworm" (*Wocan*). Subsequently, the body feels heavy and sluggish, with slight panting and difficult urination; this marks the progression of swelling syndrome.

If the skin is swollen, accompanied by panting and difficult urination, Wupi Yin (*Five-Bark Drink*) is indicated.

For upper body swelling, induce sweating by adding Ziyefangfeng Xingren Sanqian (*Perilla Leaf, Saposhnikovia, and Apricot Seed, 3 qian each*). For lower body swelling, promote diuresis by adding Zhuling Fangji Erqian (*Polyporus and Stephania, 2 qian each), Mutong Yiqian (*Akebia, 1 qian*). If urine volume is high, it is Yin Water (*Yinshui*); add Fuzi Ganjiang Erqian (*Aconite and Dried Ginger, 2 qian each), Baizhu Sanqian (*Atractylodes Macrocephala, 3 qian*), Chuanjiao Muxiang Yiqian (*Sichuan Pepper and Costus Root, 1 qian each*). If urination is difficult, it is Yang Water (*Yangshui*); add Fangji Zhuling Zhimu Erqian (*Stephania, Polyporus, and Anemarrhena, 2 qian each*). For patients with Deficient pulses and emaciation, add Baizhu Renshen Rougui Fuzi (*Atractylodes, Ginseng, Cinnamon Bark, and Aconite*). For patients with Excess pulses and robust constitutions, add Laifuzi Zhike Erqian (*Radish Seed and Aurantium, 2 qian each*). For those severely afraid of wind, add Sheng Huangqi 3-4 qian (*Raw Astragalus*), or add Fuzi 2 qian (*Aconite*). (Article 80)

If there is no urine output at all, accompanied by panting and no thirst, Zishen Wan (*Kidney-Nourishing Pill*) is indicated. (Article 94)

If previous medications are ineffective, Jisheng Shenqi Wan (*Jisheng Kidney-Qi Pill*) should be used, decocted as a soup. Alternatively, after the initial symptoms resolve, take this pill for one month to consolidate the cure. Jisheng Jiajian Shenqi Wan (*Modified Jisheng Kidney-Qi Pill*). (Article 109)

If taking diuretic herbs results in even less urine, Buzhong Yiqi Tang (*Tonify the Middle and Augment the Qi Decoction*) is indicated. Take the first decoction as usual. After taking the second decoction, induce vomiting by stimulating the throat with fingers. (Article 5)

Commentary: For edema, if the pathology is superficial, treating according to the above methods will lead to recovery. If deep, one must follow the "Five Waters" theory from the *Jinkui Yaolue*. I have written *Jinkui Qianzhu* (*Annotated Brief Explanation of Jinkui*), which offers significant insights. Fengshui (*Wind-Water*) is caused by external pathogens; the treatment principle is sweating. Pishui (*Skin-Water*) occurs when external pathogens leave the meridians and enter the skin, so there is no aversion to wind. The disease is in the skin layer, so there is no internal distension but external drum-like tension; since the skin disease does not involve the interior, there is no thirst. However, water in the skin must also be expelled through sweating. Shishui (*Stone-Water*) is located below the umbilicus, where Yin pathogens sink to the lower part; the treatment uses Mahuang Fuzi Gancao Tang (*Ephedra, Aconite, and Licorice Decoction*), emphasizing Fuzi to break Yin. Huanghan (*Yellow Sweat*) involves external pathogens injuring the Heart, leading to stagnant heat turning yellow, chest fullness, and swelling of the four limbs and head/face. The disease is in the upper part; the treatment uses Guizhi Tang (*Cinnamon Twig Decoction*) plus Huangqi (*Astragalus*), drinking hot porridge to induce slight sweating. This emphasizes Guizhi to transform Qi, relying heavily on drinking porridge to sweat to release pathogens trapped internally and externally. Only Zhengshui (*True-Water*) corresponds to the *Neijing* statement: "When the Three Yin channels are knotted, it is called Water." Knotting leads to a Deep pulse; Water belongs to Yin, so the pulse is Slow (*Chi*). When the Three Yin are knotted, the Yin Qi of the Lower Jiao no longer harmonizes with the Yang Qi of the Chest. Water Qi repelling Yang causes panting. The eye sockets resemble silkworms, and the whole body is swollen. Thus, the discussion in *Jinkui* is very precise, and Xu Zhongke's commentary is excellent. I excerpt it here: *Jinkui* says, "The Cun Kou pulse is Floating and Slow. Floating indicates Heat, Slow indicates Submergence. Heat and Submergence interacting is called Chen (Sinking). The Zu Yang pulse is Floating and Rapid. Floating indicates Heat, Rapid indicates Stagnation/Stop. Heat and Stagnation interacting is called Fu (Hidden). Chen and Fu interacting is called Water. Chen implies deficiency in the collaterals, Fu implies difficulty in urination. Deficiency and difficulty interacting cause Water to flow into the skin, resulting in Water disease." Xu Zhongke annotates: "This passage discusses the origin of Zhengshui. It states that the continuous healthy movement in the human body creates the function of clouds and rain. Thus, human sweat is named after heaven's rain, and human Qi is named after heaven's swift wind. Cun Kou pulse governs the Upper, akin to Heavenly Dao descending to illuminate, hence 'Yin is born from Yang.' Zu Yang pulse governs the Lower, akin to Earth's axis rotating upward, hence 'Wei Qi originates from the Lower Jiao.' Now, Cun Kou pulse is Floating and Slow. Floating indicates Heat, yet Slow is seen; Slow means Yuan Qi submerges in the Lower. Seeing both Heat and Submergence pulses means Heat is Deficient Heat, and Submergence is True Submergence. Hence 'Heat and Submergence interacting is called Chen,' meaning the Yuan Qi descending fails to rise again. Now, Zu Yang pulse is Floating and Rapid. Floating indicates Heat, yet Rapid is seen; Rapid means Wei Qi stops in the Lower. Seeing both Heat and Stop pulses means the Guest Qi is Heat, while True Qi is Stopped. Hence 'Heat and Stop interacting is called Fu,' meaning the Wei Qi that should ascend is hidden and cannot rise. What descends from above does not return and finally sinks; what ascends from below stops and remains hidden for long, causing the rotating Qi to nearly extinguish. Extinction allows Yin Water to prevail, hence 'Chen and Fu interacting is called Water,' indicating it is not merely guest water. To prevent misunderstanding of Chen and Fu, it further states: 'Collaterals are where Yin Essence and Yang Qi interact. If Cun Kou Yang Qi sinks to the lower, collaterals become deficient. Urine is the exit of the Water pathway. If Zu Yang True Qi stops in the lower, excess Qi becomes Fire. Severe Fire leads to difficult urination. Thus, the Upper cannot transport water, and the Lower cannot discharge water. How can one forbid water from wandering recklessly?' Hence 'Deficiency and difficulty interacting, water flows into skin, becoming Water disease.' Water is the Yin Qi within the body, combining with fluid retention and overflowing. Both Chen and Fu meanings are seen in the Floating pulse. Only those who truly understand the Dao of Heaven and Earth's ascent/descent and Yin/Yang can articulate this."

This is why Zhang Zhongjing is the teacher for ten thousand generations. Xu Zhongke's annotation is exquisite. Unfortunately, Zhongjing did not prescribe formulas, and Zhongke did not supplement applicable formulas. Consequently, patients suffer deaths from quack doctors using Zhouche Wan, Shenyao Wan, Shuozao Yinzi, etc., or from enlightened doctors using Shipi Yin, Jisheng Shenqi Wan, Buzhong Yiqi Tang, Daoshui Fuling Tang, etc., effectively killing with blades. I cannot bear to sit idle without saving them, so I propose formulas below.