及不得用心，其房室等犹三年慎之，永不复重发。不尔者，瘥而更发。重发，不可更治也。（《千金》）
有此疾者，宜向阳行坐。遇阴雨则愈觉壅滞，房中常须存火。服药后，夜卧觉胸间热甚，宜含红雪与好茶之
类，慎勿饮酒及冷茶、冷水。若渴，宜吃五灵汤，尤忌盐、生冷、
醋滑。（《圣济》引徒都子）（按∶五灵汤用诃黎勒、木通、赤茯、防己、陈橘皮。又忌咸食既见《医心方》引
《医门方》，又《本事续集》治十种水病方曰∶忌盐一百二十日，缘盐能化水故也。）
饮食之忌，惟盐酱齑 湿面，皆味咸能溢水者，并其他生冷毒物，亦宜戒之，重则半载，轻者三月。须脾胃
平复，肿消气实，然后于饮食中，旋以烧盐少投，则其疾自不再作。故刘氏曰∶治肿非易，尤难所忌者，切须详
审。（《活幼心书》）
若戒酒色盐酱，此病可保无危，不然去生渐远。（《正传》）
胀有新久∶仲景所叙，大抵病之新成者也；肤胀、鼓胀之属，病之经久者也。诸家惟石顽《医通》以腹满、
鼓胀析为二门，然未能判然辨白。今之所纂，亦姑仍其旧，并合为篇，要在读者分别之耳。如其治法，往往与水
气相出入，须彼此互相参云。
名义 （肿胀之别）古方书鼓疾，俱作钟鼓之鼓，非三虫下着皿字也。盖以斯疾，本因郁气，自腹中鼓起
而为膨胀。况诸肿疾，每以手按之有指痕，唯此疾按之，而腹皮迫急如鼓皮，故论云腹胀如萝（疑箩字），皮紧
如鼓，即此而谓鼓疾也。三虫之蛊，乃南荒之蛮，以蛇、蜈蚣、虾蟆，三虫相制而为毒，中之者，虫啖其胝血而
死，故病乃名蛊字也。医者治疾，不可不究其名义，所谓名不正则言不顺也。（《澹寮》）（按∶水蛊之目，见
《肘后》、《巢源》。然考《千
金》，蛊胀言蛊毒而腹胀者，既名以蛊，则水蛊亦不俟别云中毒，而其义自见。后人不知，遂牵合鼓胀之鼓，
《澹寮》所辨当矣。《格致余论》曰∶以其外虽坚满，中空无物，有似于鼓。其病胶固，难以治疗，又名曰蛊，
若蛊侵蚀，有蛊之义。此说非。见《医统》有说亦误。特《永类》以水蛊为蛊毒，宜从。）
许学士云∶脐腹四肢悉肿者，为水；但腹胀，四肢不甚肿，为蛊（按∶此《千金》文，盖许氏即为鼓胀看
）。蛊即胀也，然胀亦有头面手足尽肿者。大抵先头足肿后腹大者，水也；先腹大后四肢肿者，胀也。（《准
绳》）
胀因阳虚阴积 （脾胃虚弱）腹胀者，由阳气外虚，阴气内积故也。阳气外虚，受风冷邪气，风冷阴气也，
冷积于腑脏之间不散，与脾气相壅，虚则胀，故腹满而气微喘。（《病源论》）
久腹胀者，此由风冷邪气在腹内不散，与脏腑相搏，脾虚故胀，其胀不已，连滞停积，时瘥时发，则成久胀
也。（同上）
胃气胀则令人腹满不能食，此盖脾胃虚弱，冷气搏于阴经，故胃胀满塞而不能饮食。其气虚者，但虚胀而膨
满于腹肋也。（《圣济》）。
《内经》谓浊气在上则生 胀，此阴阳反作，病之逆从也。夫清阳为天，浊阴为地，二者不可相干。今浊
气在上，为阴气干扰，清阳之气郁而不散，所以 塞肠满而常若饱也。（同上）
大抵人之脾胃，主于中州，大腹小腹，是其候也。若阳气外强，阴气内正，则脏气得其平，病何由生。苟或
将理失宜（以上《集成》作大抵胀满之证，多是脾胃素弱，或病后
失调），风寒暑湿得以外袭，喜怒忧思得以内伤，食啖生冷，过饮寒浆，扰动冲和，如是阴气当升而不升，阳气
当降而不降，中焦痞结，必成胀满。更有五疸水气，及妇人血膨，皆令人胀满。（《济生》）
胀谓胀于外，满谓满于中，排脏腑而郭胸胁，急皮肤而露筋脉，脐凸腰圆，鼓之如鼓，胸腹之疾也。间亦有胀
及于头面四肢者，与水肿大同小异，而此则无水耳。大抵饮食不节，起居失宜，房室过劳，忧思无极，久久皆足以
耗其阴守，衰其阳运，致气壅滞留中，而胀满之疾渐起矣。故实者少虚者多，热者少寒者多，成于他脏腑者少，
成于脾胃者多。盖虚则气空浮，故易鼓而大；寒则气凝滞，故易壅而坚。脾胃居中，以胸腹为宫城，属土而化湿，
性缓气屯，故亦易胀易满，此但言其常耳。（《续焰》）
单单腹肿，则中州之地，久窒其四运之轴，而清者不升，浊者不降，互相结聚，牢不可破，实因脾气之衰微
所致，而泻脾之药，尚敢漫用乎。（《寓意草》）
鼓胀之病多不治者，何哉？此脾虚之极，真脏病也，如翻胃、痨瘵亦然。（《心法附余》）
病不必属热 或曰∶诸胀腹大，皆属于热者，何也？此乃病机总辞。假令外伤风寒，有余之邪，自表传
里，寒变为热，而作胃实腹满，仲景以大承气汤治之。亦有膏粱之人，湿热郁于内而成胀满者，此热胀之谓也。
大抵寒胀多而热胀少，治之者宜详辨之。（《东垣试效方》）（按∶此专就新胀而言，然寒多热少，久胀亦然，
《续焰》演论深得其理。）
病因脾胃湿热 心肺阳也，居上；肝肾阴也，居下；脾居中亦阴也，属土。经曰∶饮食入胃，游溢精气，
上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精四
布，五经并行。是脾具坤静之德，而有干健之运，故能使心肺之阳降，肾肝之阴升，而成天地交之泰，是为无病
之人。今也七情内伤，六淫外侵，饮食不节，房劳致虚，脾土之阴受伤，转输之官失职，胃虽受谷，不能运化，
故阳自升阴自降，而成天地不交之否。于斯时也，清浊相混，隧道壅塞，气浊血瘀，郁而为热，热留而久，气化
成湿，湿热相生，遂成胀满，经曰鼓胀是也。（《格致余论》）（按∶此主湿热而立论，殆不免偏见，姑存之。）
病因下焦虚寒 （说见后治宜温补下元条。）
病不外气水 （气血水相因）肿胀之病，原有内外之分。盖中满者谓之胀，而肌肤之胀者亦谓之胀；若以
肿言，则单言肌表，此其所以当辨也。但胀于内者，本由脏病，而肿于外者，亦无不由乎脏病，第脏气之病，各有不
同。虽方书所载，有湿热寒暑血气水食之辨；然余察之经旨，验之病情，则惟在气水二字，足以尽之。故凡治此
证者，不在气分，则在水分，能辨此二者而知其虚实，无余蕴矣。病在气分，则当以治气为主；病在水分，则当
以治水为主。然水气本为同类，故治水者当兼理气，盖气化水自化也；治气者亦当兼水，以水行气亦行也。此中玄
妙，难以尽言，兹虽条列如左，然运用之法，贵在因机通变也。（《景岳》）（按∶《景岳》所条列，具载在后。
《临证指南》姚亦陶曰∶肿胀证，大约肿本乎水，胀由乎气。盖原于此。）
气水血三者，病常相因，有先病气滞而后血结者（如妇人先病气郁，后致月经不行者是也），有病血结而后
气滞者（如妇人先病月经不通，致气滞胀满是也），有先病水肿而血随败者（水积日久，渗透经络，灌入隧道，
血亦化水），有先病血结而水随蓄者（血结则气滞而热蒸成水，妇人月经
不利，化水肿胀，皮肉赤纹、椒仁丸、人参大黄汤），须求其本而治之。（《医碥》）
病由邪起 脏腑外，胸腹中，邪充塞，则胸腹胀矣。经络营卫，气无不到，则血脉皮肤无不胀矣。而欲
知为何部之邪，则先胀处与胀甚处是也。（脾胃受邪，则先从胃脘痞塞起。又属脾胃者，则饮食少；属他脏腑
者，则饮食如常。又胀在皮肤经脉者，饮食亦如常；在肠胃间者，则饮食少，皆宜细察。）更须分虚实，其脏腑
之气本盛，被邪填塞不行者为实；气本不足，因邪所壅者为虚。（虚中亦有挟实，以其邪为食痰血湿等有形之物
也。）（《医碥》）
脉法 迟而滑者胀。盛而紧曰胀。（《脉经》）
病若腹满而喘，脉反滑利而沉者死。（同上）
腹胀，脉浮者生，虚小者死。（《病源论》）（按∶此与《脉经》水病胀闭相同，宜参彼门。又《千金翼》
虚小作虚大。）
脉若见弦，知木来侮土，更为不吉。若见数洪，必湿热之郁。若见迟弱，乃阴寒所凝。浮则气散，外虽满而
中必虚；紧则气敛，外固坚而中更实。浮而大者，元气之振作，与病形相宜，故云可治；虚而小者，知元气之衰
微，又与病形相反，故云危极。（《续焰》）
脉来缓大者属气虚，弦数者为血热。气口紧盛或滑为停滞，濡滑为湿热，弦细为肝邪乘脾。人迎浮弦为风气
外乘，弦细而数为阴邪上逆。若虚大无根为脾胃气衰，沉细短涩为肾脏气绝。（《医通》）
脉弦为肝克脾胃，脉实则胀，此属实。关上脉虚即胀满，此属虚。洪数为热胀，迟弱为阴寒，浮为虚满，紧
为中实。虚数者不可治，实大浮洪者易治，沉微细小者难痊。盛
而紧大，坚以涩，迟而滑，皆胀满。胀而上则喘咳，下则泄泻，脉浮大沉细皆不治。（同上）
诊法∶内水脉沉，外水脉浮，气胀浮沉无定（气时外行，时内聚故也），总以有神（和缓有力也）为佳，最
忌弦细微弱。（《医碥》）
辩证要领 阴阳愆伏，荣卫凝滞，三焦不能宣行，脾胃不能传布，此胀满之所由生也。曰谷胀，曰水胀，
曰气胀，曰血胀，或冷或热，又不可以无别。失饥伤饱，痞闷停酸，旦则阴消阳长，谷气易行，故能饮食，暮则
阴长阳消，谷气难化，故不能食，是为谷胀。脾土受湿，不能制水，水渍于肠胃而溢于体肤，漉漉有声，怔忪喘
息，是为水胀。七情郁结，气道壅隔，上不得降，下不得升，身肿大而四肢瘦削，是为气胀。烦躁漱水，迷妄惊
狂，痛闷呕恶，虚汗厥逆，小便多，大便黑，妇人尤多见之，是为血胀。阳热为邪，则身体有热，胀满而咽干；阴
寒为邪，则吐不下食，胀满而自利，随证剂量是固然尔，抑犹有虚实之辨焉。实者腹中常胀，外坚内痛，按之不
陷，法当为之疏利；虚者时胀时减，虚气留滞，按之则濡，法当以温药和之，此又出于随证剂量之外。（《直指》）
如或大实大满，大小便不利，从权以寒热药下之。或伤酒湿面及味浓之物，膏粱之人，或食已便卧，使湿热
之气不得施化，致令腹胀满，此胀亦是热胀。如或多食寒凉，及脾胃久虚之人，胃中寒则胀满，或脏寒生满病。
（《兰室秘藏》）
朝宽暮急，血虚；暮宽朝急，气虚；终日急，气血皆虚。（《丹溪》）
气胀者，七情郁结，胸腹满闷，四肢多瘦。食胀者，谷
食不化，痞满醋心，不能暮食。虫胀者，腹痛能食，善吃茶叶盐土等物。积胀者，痞块有形，心腹坚硬。水胀者，
停饮肠鸣，怔忡喘息。瘀胀者，跌扑产后，大便黑色。虚胀者，腹柔软而食入倒饱。（《汇补》）
又有一种食鼓者，乃是饮食所伤，初起必先雀目（俗传鸡盲入肚者，即此证也），医家不信，只治眼目，不
知乃是鼓之根也，此时当急用清剂以治之。（《四明心法》）
外有血鼓证，医书俱云是妇人之病，唯喻嘉言谓男子恒有之。（《时方妙用》）
气证水证 病在气分者，因气之滞，如气血之逆，食饮之逆，寒热风湿之逆，气虚不能运化之逆，但治
节有不行者，悉由气分，皆能作胀。凡气分之病，其色苍，其内坚，其胀或连胸胁，其痛或及脏腑。或倏而浮肿者，
阳性急速也。或自上及下者，阳本乎上也，或通身尽肿者，气无不至也。有随按而起者，如按气囊也。然此虽皆
气分，而气病有不同。故有气热而胀者，曰诸胀腹大，皆属于热也。有气寒而胀者，曰胃中寒则 胀，曰脏寒生
满病也。有气湿而胀者，曰诸湿肿满，皆属于脾也。有气虚而胀者，元气虚也，曰足太阴虚则鼓胀也。有气实而
胀者，邪气实也，曰肾气实则胀，曰脾气实则腹胀，曰胃气实则胀也。凡此虽皆胀病，而治之之要，则全在察其
虚实。（按∶原文此有虚实辨，今录在水肿中。）病在水分者，以阴胜于阳而肌肤皆肿，此与气证本有不同。凡
水之为病，其色明润，其皮光薄，其肿不速，每自下而上，按肉如泥，肿有分界，盖阴本于下，而浸渍有渐，皆水
病之证也。观《水胀篇》言寒气之胀，按其腹 而不起；水肿之病，以手按其腹，随手而起，如囊裹水之状，此其
候也。然以愚见及察之证验，则若与此论相反。盖凡是
水证，必按之 而不起，此其水在肉中，如糟如泥，按而散之，猝不能聚，未必如水囊之比。凡随按随起者，亦
惟虚无之气，其速乃然，故辨当若此也。凡欲辨水气之异者，在欲辨其阴阳耳。若病在气分，则阳证阴证皆有
之；若病在水分，则多为阴证。何也？盖水之与气，虽为同类，但阳王则气化，而水即为精；阳衰则气不化，而
精即为水。故凡病水者，本即身中之血气，但其为邪为正，总在化与不化耳。水不能化，因气之虚，岂非阴中
无阳乎，此水肿之病所以多属阳虚也。然水主于肾，气主于肺，水渍于下，而气竭于上，所以下为肿满，上为喘
急，标本俱病，危斯亟矣，此当速救本源，庶保万一。倘以虚喘作实邪，而犹然泄肺，无不败矣。（《景岳》）
If one fails to cultivate the mind and body carefully during this period, precautions regarding sexual activity and other aspects should still be maintained for three years to ensure the disease never recurs. Otherwise, the illness may relapse after recovery. Once it recurs, it becomes difficult to treat further. (From *Qianjin Fang*)
Patients with such conditions should prefer walking or sitting in sunny areas. On rainy days, they may feel more congested and stagnant, so fire sources should always be kept warm in the room. After taking medicine, if one feels intense heat in the chest while lying down at night, it is advisable to hold Red Snow (a medicinal preparation) in the mouth and drink good tea, etc. One must strictly avoid alcohol, cold tea, and cold water. If thirsty, it is suitable to consume Wuling Tang (Five Spirits Decoction), and especially to avoid salt, raw/cold foods, and sour/slippery substances. (From *Shengji Zonglu*, citing Tu Duzi) [Note: Wuling Tang consists of Terminalia chebula (Helilei), Akebia quinata (Mutong), Poria cocos with red bran (Chifu), Stephania tetrandra (Fangji), and aged tangerine peel (Chenju pi). Additionally, avoiding salty foods is mentioned in *Yixin Fang* citing *Yimen Fang*; *Benshi Xuji* states for treating ten types of water diseases: avoid salt for 120 days, because salt can transform into water.]
Dietary taboos mainly include salt, soy sauce, pickles, and wet noodles, all of which are salty and prone to causing water overflow, as well as other raw/cold toxic foods, which should also be avoided. Severe cases require avoidance for half a year, mild cases for three months. Only after the Spleen and Stomach functions have recovered, swelling has subsided, and healthy Qi is substantial, should roasted salt be gradually added in small amounts to the diet, so that the disease will not recur. Thus, Liu said: Treating edema is not easy; the difficulty lies particularly in dietary taboos, which must be examined carefully. (From *Huoyou Xinshu*)
If one abstains from alcohol, sex, salt, and soy sauce, this disease can be guaranteed to be non-fatal; otherwise, death will approach gradually. (From *Zhengchuan*)
Distension (Zhang) has new and old distinctions: The descriptions by Zhang Zhongjing mostly refer to newly formed diseases; types like Skin Distension (Fuzhang) and Drum Distension (Guzhang) refer to long-standing diseases. Among various schools, only Shiwen’s *Yixue Rumen* separated abdominal fullness and Drum Distension into two categories, but failed to clearly distinguish them. The current compilation follows the old example, combining them into one chapter, relying on the reader to differentiate. As for treatment methods, they often overlap with Water Qi diseases, requiring mutual reference.
Regarding Nomenclature (Distinction between Swelling and Distension): Ancient texts use "Drum" (Gu) for drum diseases, referring to the musical instrument, not the character for "Gu" (poison/insect). This is because the disease originates from stagnant Qi rising from the abdomen causing expansion. Moreover, while most swellings leave indentations when pressed, this disease presents with tight abdominal skin resembling a drumhead when pressed. Hence, it is called Drum Disease. "Gu" (Poison/Insect) refers to southern barbarians using snakes, centipedes, and toads to create poison; those bitten die from insects eating their flesh and blood. Physicians must investigate nomenclature, as "if names are not correct, language is not in accordance with truth." (From *Danliao*) [Note: Water Gu appears in *Zhouhou Beiji Fang* and *Bingyuan Lun*. However, checking *Qianjin Fang*, for abdominal distension caused by Gu poison, since it is named Gu, Water Gu does not need separate explanation of poisoning; its meaning is self-evident. Later generations confused it with Drum Distension. *Danliao*'s distinction is correct. *Gezhi Yulun* says: Because it is hard and full externally but empty inside, resembling a drum. Its pathology is stubborn and hard to treat, hence also called Gu, implying erosion like an insect. This view is incorrect. *Yitong* also errs. Only *Yonglei Qianfang* interprets Water Gu as Gu Poison, which should be adopted.]
Xu Xueshi said: Swelling of the umbilicus, abdomen, and limbs indicates Water; only abdominal distension with minimal limb swelling indicates Gu (Note: This text from *Qianjin Fang* suggests Xu viewed it as Drum Distension). Gu means distension, yet distension can also involve head, face, hands, and feet. Generally, swelling starting from head/feet then abdomen indicates Water; swelling starting from abdomen then limbs indicates Distension. (From *Zhunsun*)
Distension due to Yang Deficiency and Yin Accumulation (Spleen-Stomach Weakness): Abdominal distension arises from external Yang deficiency and internal Yin accumulation. External Yang deficiency allows Wind-Cold pathogens to invade. Wind-Cold is Yin Qi; cold accumulates between organs without dispersing, obstructing Spleen Qi. Deficiency leads to distension, causing abdominal fullness and slight wheezing. (From *Bingyuan Lun*)
Long-term abdominal distension occurs when Wind-Cold pathogens remain in the abdomen, battling organs. Spleen deficiency causes distension; persistent distension leads to stagnation and accumulation, recurring intermittently, forming chronic distension. (Ibid.)
Stomach Qi distension causes abdominal fullness and inability to eat, likely due to Spleen-Stomach weakness where Cold Qi battles Yin meridians, causing gastric fullness and obstruction. Qi deficiency results in empty distension and abdominal/flank bloating. (From *Shengji Zonglu*)
*Neijing* states: "Turbid Qi remaining above generates distension," indicating reversed Yin-Yang and pathological reversal. Clear Yang rises to Heaven, Turbid Yin descends to Earth; they should not interfere. Now, Turbid Qi remains above, disturbed by Yin Qi, causing Clear Yang to stagnate, leading to intestinal blockage and constant fullness. (Ibid.)
Generally, Spleen and Stomach govern the Middle Jiao, reflected in the greater and lesser abdomen. If external Yang is strong and internal Yin is balanced, organ Qi is peaceful, and no disease arises. If management is improper (as noted in *Jicheng*, most distension cases stem from inherent Spleen-Stomach weakness or post-illness mishandling), external Wind-Cold-Damp-Heat can invade, and internal Joy-Worry-Sorrow-Thought can injure. Consuming raw/cold foods or excessive cold drinks disturbs harmony, preventing Yin from rising and Yang from descending, resulting in Middle Jiao blockage and distension. Additionally, Five Jaundices, Water Qi, and women's Blood Bloating cause distension. (From *Jisheng Fang*)
Distension (Zhang) refers to external swelling, Fullness (Man) to internal congestion, pushing organs and expanding chest/hypochondrium, tightening skin revealing veins, with protruding umbilicus and round waist, sounding like a drum upon percussion—a disease of chest and abdomen. Occasionally involving head/limbs, it resembles edema but lacks fluid. Generally, irregular diet, improper lifestyle, sexual exhaustion, and endless worry deplete Yin and weaken Yang transport, causing Qi stagnation in the middle and gradual onset of distension. Thus, excess patterns are rare, deficiency common; heat patterns rare, cold common; origin in other organs rare, Spleen-Stomach common. Deficiency makes Qi float easily, causing easy distension; Cold makes Qi stagnant, causing easy hardness. Spleen-Stomach resides centrally, governing chest/abdomen, belongs to Earth transforming Dampness, has slow nature and屯 (accumulated) Qi, thus prone to distension. This describes the norm. (From *Xuyan*)
Isolated abdominal swelling blocks the four axes of rotation in the Middle Jiao, preventing Clear from rising and Turbid from descending, leading to inseparable knotting, truly due to Spleen Qi decline. How dare one casually use Spleen-draining herbs? (From *Yuyi Cao*)
Why is Drum Distension often incurable? It represents extreme Spleen deficiency, a True Organ disease, similar to Fanwei (Regurgitation) and Laozai (Consumption). (From *Xinfa Fuyu*)
Disease is not necessarily Heat-related: Some ask why "all distensions with large abdomen belong to Heat"? This is a general principle of pathogenesis. For instance, external Wind-Cold transforming into Heat entering interior causes Stomach Excess and abdominal fullness, treated by Zhang Zhongjing with Dachengqi Tang. Also, rich individuals with internal Damp-Heat stagnation develop distension, known as Heat Distension. Generally, Cold Distension is more common than Heat Distension; physicians must distinguish carefully. (From *Dongyuan Shixiao Fang*) [Note: This refers to new distension, but Cold > Heat applies to chronic distension too. *Xuyan* explains this deeply.]
Etiology: Spleen-Stomach Damp-Heat. Heart/Lung are Yang residing above; Liver/Kidney are Yin residing below; Spleen is central Yin, belonging to Earth. Classics state: Food enters Stomach, essence floats up to Spleen, Spleen scatters essence to Lung, regulates water passages, sends down to Bladder, distributing fluids and coordinating five meridians. Spleen has Kun (Earth) stillness and Qian (Heaven) movement, allowing Heart/Lung Yang to descend and Liver/Kidney Yin to ascend, creating Heaven-Earth interaction (Tai), representing health. Now, Seven Emotions injure internally, Six Evils invade externally, irregular diet, sexual exhaustion cause deficiency. Spleen Yin is injured, transport official fails. Stomach receives grain but cannot transform, causing Yang to rise and Yin to fall, creating Heaven-Earth separation (Pi). At this time, Clear/Turbid mix, tunnels block, Qi becomes turbid, Blood stasis, stagnates into Heat, Heat stays long, Qi transformation creates Dampness, Damp-Heat generate each other, forming distension, i.e., Drum Distension. (From *Gezhi Yulun*) [Note: This theory focuses on Damp-Heat, possibly biased, preserved here.]
Etiology: Lower Jiao Deficiency-Cold (See later section "Treatment: Warm and Tonify Lower Origin").
Disease involves only Qi and Water (Qi, Blood, Water interrelated): Swelling/Distension has internal/external distinctions. Internal fullness is Distension; external skin swelling is also Distension; Swelling specifically refers to muscle/surface. Distension internally stems from organ disease; swelling externally also stems from organ disease, though different. Although texts mention Damp-Heat/Cold-Heat/Blood/Qi/Water/Food distinctions, observing classics and clinical reality reveals only "Qi" and "Water" suffice. Treatment focuses on Qi branch or Water branch. Knowing their deficiency/excess covers all. Qi branch: treat Qi primarily. Water branch: treat Water primarily. Since Water/Qi are related, treating Water requires regulating Qi (Qi transforms Water); treating Qi requires addressing Water (Water moves Qi). This subtlety is hard to explain fully. Listed below, but application requires flexibility. (From *Jingyue Quanshu*) [Note: Jingyue's list follows. Yao Yitao in *Linzheng Zhinan* said: Swelling roots in Water, Distension stems from Qi.]
Qi, Water, Blood often interact. One may have Qi stagnation first then Blood clotting (e.g., women with Qi depression then amenorrhea); or Blood clotting first then Qi stagnation (e.g., women with amenorrhea then Qi stagnation/distension); or Edema first then Blood corruption (long-term water accumulation penetrates collaterals, blood transforms to water); or Blood clotting first then Water accumulation (Blood clotting causes Qi stagnation, heat steams water, women with irregular menstruation develop edema/distension, red skin lines, treated with Jiaoren Wan, Renshen Dahuang Tang). Seek the root to treat. (From *Yiqi*)
Disease starts from Pathogens: Outside organs, inside chest/abdomen, pathogen filling causes distension. Meridians/Nutritive/Defensive Qi reach everywhere, so blood vessels/skin distend. To identify pathogen location, observe where distension starts and worsens. (Spleen/Stomach affected: starts with epigastric blockage. Spleen/Stomach issues: reduced appetite. Other organs: normal appetite. Skin/meridian distension: normal appetite. Intestine/stomach distension: reduced appetite. Observe carefully.) Distinguish Excess/Deficiency. Organ Qi originally strong, blocked by pathogen = Excess. Qi originally deficient, obstructed by pathogen = Deficiency. (Deficiency may夹杂 Excess due to tangible pathogens like food/phlegm/blood/damp.) (From *Yiqi*)
Pulse Methods: Slow and slippery pulse indicates distension. Surging and tight pulse indicates distension. (From *Maijing*)
If abdominal fullness with wheezing, pulse surprisingly slippery and deep indicates death. (Ibid.)
Abdominal distension, floating pulse indicates survival; deficient/small pulse indicates death. (From *Bingyuan Lun*) [Note: Same as *Maijing* Water Disease Distension/Closure. See that section. *Qianjin Yi* reads deficient/large instead of deficient/small.]
String-like pulse indicates Wood insulting Earth, very inauspicious. Rapid and surging pulse indicates Damp-Heat stagnation. Slow and weak pulse indicates Yin-Cold coagulation. Floating indicates Qi scattering, external fullness but internal deficiency. Tight indicates Qi gathering, external firmness but internal excess. Floating and large indicates vigorous Original Qi, compatible with disease form, hence treatable. Deficient and small indicates declining Original Qi, opposite to disease form, hence critical. (From *Xuyan*)
Slow and large pulse belongs to Qi deficiency; String-like and rapid belongs to Blood Heat. Qi Kou tight/surging or slippery indicates stagnation; Soft and slippery indicates Damp-Heat; String-like and thin indicates Liver Evil attacking Spleen. Ren Ying floating/string-like indicates external Wind; String-like/thin/rapid indicates Yin Evil reversing upward. Deficient/large rootless indicates Spleen-Stomach Qi decline; Deep/thin/short/choppy indicates Kidney Qi exhaustion. (From *Yixue Rumen*)
String-like pulse indicates Liver overcoming Spleen-Stomach; Excess pulse with distension is Excess pattern. Deficient pulse at Guan position with distension is Deficiency pattern. Surging/rapid is Heat Distension; Slow/weak is Yin-Cold; Floating is Empty Fullness; Tight is Central Excess. Deficient/Rapid is untreatable; Excess/Large/Floating/Surging is easily treatable; Deep/Micro/Small/Thin is hard to cure. Surging/Tight/Large, Firm/Choppy, Slow/Slippery all indicate distension. Distension with upper wheezing/cough or lower diarrhea, with Floating/Large/Deep/Thin pulses are all untreatable. (Ibid.)
Diagnosis: Internal Water pulse is Deep; External Water pulse is Floating; Qi Distension pulse is variable Floating/Deep (Qi moves out/in). Generally, Spirit (gentle/strong) is best; String-like/Fine/Weak is taboo. (From *Yiqi*)
Key Differentiation: Yin-Yang disorder, Nutritive/Defensive stagnation, Triple Burner failure to circulate, Spleen-Stomach failure to transport—these cause distension. Grain Distension, Water Distension, Qi Distension, Blood Distension; Cold/Heat must be distinguished. Starving/overeating, blockage/sour retention: Morning Yin declines/Yang grows, Grain Qi moves easily, able to eat; Evening Yin grows/Yang declines, Grain Qi hard to digest, unable to eat—this is Grain Distension. Spleen Earth affected by Dampness, cannot control Water, Water floods intestines/skin, gurgling sound, palpitations/wheezing—this is Water Distension. Seven Emotions knot, Airway blocked, Upper cannot descend, Lower cannot ascend, body swollen/limbs emaciated—this is Qi Distension. Irritability/rinsing mouth, delirium/manic, pain/vomiting, sweating/collapse, frequent urine/black stool, common in women—this is Blood Distension. Yang-Heat pathogen: body heat, distension, dry throat. Yin-Cold pathogen: vomiting/no food intake, distension, spontaneous diarrhea. Dosage according to syndrome is standard, but Excess/Deficiency must be distinguished. Excess: constant abdominal distension, external firm/internal pain, indentation does not sink, treat with draining/unblocking. Deficiency: intermittent distension/reduction, empty Qi stagnation, indentation sinks, treat with warming harmonizing. This goes beyond simple dosage. (From *Zhizhi Fang*)
For severe Excess/Fullness with bowel/bladder obstruction, temporarily use cold/hot purgatives. Alcohol/Damp-Noodles/Strong flavors, rich diet, lying down after eating prevent Damp-Heat transformation, causing distension—this is Heat Distension. Overconsumption of cold/raw foods, or long-term Spleen-Stomach deficiency, Stomach Cold causes distension, or Organ Cold generates fullness disease. (From *Lanshi Micang*)
Morning relief/evening urgency: Blood Deficiency. Evening relief/morning urgency: Qi Deficiency. All-day urgency: Qi and Blood both Deficient. (From *Danxi Xinfa*)
Qi Distension: Seven emotions knot, chest/abdominal fullness, limbs often emaciated. Food Distension: Undigested grain, blockage/sour regurgitation, unable to eat at night. Parasite Distension: Abdominal pain, able to eat, craving tea/salt/earth. Accumulation Distension:有形 masses, heart/abdomen hard. Water Distension: Retained fluid/intestinal rumbling, palpitations/wheezing. Blood Stasis Distension: Trauma/postpartum, black stool. Empty Distension: Soft abdomen, early satiety. (From *Huib*)
Another type, Food Drum, caused by dietary injury. Initially begins with Night Blindness (folklore: chicken blindness entering stomach, i.e., this condition). Physicians disbelieve, treating only eyes, unaware it is the root of Drum. At this stage, urgently use clearing agents. (From *Siming Xinfa*)
External Blood Drum syndrome: Medical books claim it is a women's disease, only Yu Jiayan stated men also have it frequently. (From *Shifang Miaoyong*)
Qi Syndrome vs. Water Syndrome: Disease in Qi branch due to Qi stagnation, e.g., Qi/Blood rebellion, Food/Drink rebellion, Cold/Heat/Wind/Damp rebellion, Qi deficiency failing to transform—all governed by Qi branch, causing distension. Qi branch diseases: pale color, internal firmness, distension may connect to chest/hypochondrium, pain may affect organs. Sudden edema: Yang nature is rapid. Top-down swelling: Yang originates above. Whole-body swelling: Qi reaches everywhere. Indentation rebounds: like pressing air bag. Though all Qi branch, Qi diseases differ. Heat Qi Distension: "All distensions with large abdomen belong to Heat." Cold Qi Distension: "Stomach Cold causes distension," "Organ Cold generates fullness." Damp Qi Distension: "All Dampness swelling/fullness belongs to Spleen." Empty Qi Distension: Original Qi deficiency, "Foot Taiyin deficiency causes Drum Distension." Excess Qi Distension: Pathogenic Excess, "Kidney Qi excess causes distension," "Spleen Qi excess causes abdominal distension," "Stomach Qi excess causes distension." Key to treatment lies in distinguishing Excess/Deficiency. (Note: Original text has Excess/Deficiency differentiation, recorded here in Water Edema.) Disease in Water branch: Yin surpasses Yang, skin/muscle all swollen, distinct from Qi syndrome. Water diseases: bright/moist color, thin/shiny skin, swelling not rapid, usually bottom-up, indentation like mud, defined boundaries, Yin originates below, gradual infiltration—all Water signs. *Shui Zhang Pian* says Cold Qi distension: press abdomen, indentation does not rise; Edema: press abdomen, rebounds immediately, like bag wrapping water. However, my observation contradicts this. All Water syndromes: indentation does not rise, water in flesh like dregs/mud, disperses on pressure, cannot gather quickly, unlike water bag. Immediate rebound is only Empty Qi, fast thus. To distinguish Water/Qi, distinguish Yin/Yang. Qi branch has both Yin/Yang syndromes; Water branch mostly Yin syndromes. Why? Water/Qi are same category. When Yang dominates, Qi transforms, Water becomes Essence; Yang declines, Qi fails to transform, Essence becomes Water. Thus, Water disease is essentially Blood/Qi in body, difference lies in transformation or not. Water fails to transform due to Qi deficiency, isn't this Yin lacking Yang? Hence edema mostly belongs to Yang Deficiency. Water governed by Kidney, Qi by Lung. Water floods below, Qi exhausts above, causing lower swelling/fullness, upper wheezing/urgency, Root/Branch both diseased, critical urgency. Must quickly save Root to preserve life. Mistaking Empty Wheezing for Excess Evil and draining Lung will lead to failure. (From *Jingyue Quanshu*)