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Lu Dongsheng, residing at Baxian Temple Street in Dezhou City, was in his thirties and a friend of mine. At that time, he was staying with me in Hubei as a guest. He suffered from Feilao (Pulmonary Tuberculosis). In the 9th year of the Republic of China (1920), he suddenly experienced massive hematemesis (massive vomiting of blood), becoming extremely weak. After the bleeding stopped, symptoms of Xinshuairuo (Heart Failure) erupted severely. Upon pulse diagnosis, the right hand pulse was extremely fine and minute, while the left hand pulse was imperceptible. Every few minutes, he felt his heart pounding violently, gradually developing panting, insomnia, and palpitations (Xintan), which became increasingly frequent, making him feel as though his heart were about to stop. Inquiry revealed that he had self-administered Zilai Xue (a proprietary blood-tonifying preparation) for over ten days without effect, leading to this critical condition. Therefore, I prescribed a formula to greatly tonify Qi and Blood. After taking three doses, his symptoms slightly alleviated; the left hand pulse showed Jie Mai (Knotted Pulse, slow with irregular pauses), and the right hand pulse showed Kou Mai (Hollow Pulse, floating, large, and empty in the center). The original prescription is as follows: Da Taishen (Codonopsis Radix / Large Tai Shen) 8 qian, Zhi Huangqi (Prepared Astragali Radix) 8 qian, Danggui Shen (Root portion of Angelicae Sinensis Radix) 1 liang, Chao Zaoren (Stir-fried Ziziphi Spinosae Semen) 4 qian, Baizi Ren (Biota Seed) 4 qian, Longyan Rou (Longan Aril) 4 qian, Zhi Gancao (Prepared Licorice Root) 2 qian. Decocted into two cups of liquid, taken in six doses over twenty-four hours. This formula showed significant efficacy after three doses. In total, sixteen doses were taken until full recovery. However, after five doses, the dosage was gradually reduced step by step until it reached half of the original amount. The method of administration also followed the method used for Patient Cai, gradually reducing the dose. One must not stop taking the medicine abruptly.

In a certain year, I saw a newspaper report stating that Mr. Duan Qirui, after suffering massive hematemesis in Shanghai, developed severe Heart Failure. He was cured by Western medicine using blood transfusion therapy. Carefully examining the clinical presentation, it was exactly this syndrome. If treated with Chinese herbal medicine, it would be successful in nearly all cases. Blood transfusion is cumbersome and expensive, unaffordable for ordinary patients and often unavailable in ordinary hospitals. Our country has its own natural miraculous medicine, namely this formula. Unfortunately, it has been obscured by irrelevant theories and miscellaneous drugs. For example, Tianwang Buxin Dan (Emperor of Heaven's Special Pill for Tonifying the Heart) and Kongsheng Zhenzhong Dan (Confucius' Pillow Treasure Pill) have been tried but proved ineffective. These excellent herbs are actually hidden within these established formulas. After years of selection and discernment, I extracted them. Thus, I specifically designated this as the main formula for treating this syndrome and published it to warn those who overly revere ancient texts or rely exclusively on Western medicine.

Swelling (5): Swelling (commonly known as Gubing/Tympanites). Here, it refers to swelling caused by chronic deficiency syndromes. Acute excess-type swelling does not fall under this category.

Etiology: After a major illness, or in individuals with inherent physical weakness, blood circulation disorders in the Heart, Kidney, Lung, or Liver can lead to this syndrome. While commonly called Gubing, Traditional Chinese Medicine (TCM) emphasizes spleen and stomach dysfunction leading to cold-dampness pathogenesis, which holds profound significance. This discussion hits the nail on the head regarding swelling. Late-stage Feilao (Pulmonary Tuberculosis) may also present with edema, but this is excluded here. TCM advocates warming and tonifying, along with promoting diuresis and leaching out dampness, elucidated through the theory of Qi transformation (Qi Hua), revealing marvelous effects. Based on this theory, I have cured numerous cases of severe swelling, far surpassing Western medicines in efficacy. Scholars should pay attention to this.

Symptoms: Physical weakness, aversion to cold in the four limbs, lack of desire to drink, scanty urine, uncomfortable bowel movements (either loose stools or constipation), chest and abdominal distension and stuffiness. Gradually, dry throat, dry mouth, and dry nose appear, accompanied by a sensation of heat rushing upward. Edema of hands and feet occurs; if severe, the face, eyes, lips, and abdomen become fully swollen. In men, the scrotum swells; the umbilicus may protrude. Nausea and vomiting may occur. In extreme cases, the whole body becomes shiny and edematous. Panting may or may not be present. Phlegm-fluid retention is common, with a sensation of fluid accumulation under the ribs. The patient becomes progressively weaker, unable to lie flat. Pitting edema is present (indentation remains after pressure). Ultimately, cardiac paralysis leads to death. Western medicine describes edema in Beriberi (Vitamin B1 deficiency), which shares similar signs, but they are distinct conditions; this distinction must be known.

Treatment: Western Vitamin therapy (oral and injection) is often effective. I have tested it several times, but without combining it with Chinese herbal medicine, complete recovery is difficult. Diuretic therapy and paracentesis (commonly known as "draining water") provide temporary relief but are not fundamental treatments nor good strategies. TCM categorizes this syndrome as Wind, Cold, Heat, Dampness, Phlegm, Gu (parasitic/toxic accumulation), Yin Water, Yang Water, Qi Division, and Blood Division. Treatments include sweating methods, purging methods, tonifying methods, separating and draining, and resolving stagnation. Prescriptions are complex, creating confusion. Later practitioners blindly follow ancient methods, resulting in almost no survivors. I have witnessed countless deaths due to incorrect use of sweating and purging methods for this condition, so I speak with urgency. Actually, the most effective TCM treatment for this syndrome involves tonifying the Spleen and Stomach, supporting Yang Qi to secure the root, combined with promoting diuresis to treat the branch. This summary suffices. The inclusion of various theories and miscellaneous drugs causes loss of efficacy. Over forty years, I have encountered countless cases. Mild cases were cured using my principle of "Tonify Spleen, Harmonize Stomach, Promote Diuresis." Severe cases were cured using a combination of Chinese and Western medicines. See Medical Cases.

This disease, commonly known as the dreaded Gubing, results from chronic illness. The key is the word "chronic," distinguishing it from acute heat-induced swelling or simple Western Beriberi edema. It is caused by systemic fluid retention due to extreme physical decline, loss of thermal energy, and inability to naturally excrete or evaporate fluids. Improper treatment can be fatal. Initially, only slight edema of hands and feet appears, fluctuating in severity, with normal diet and activity. Patients do not consider it serious, and doctors often overlook it. Little do they know this deadly syndrome progresses silently. As the condition worsens, swelling persists, spreading to the chest, abdomen, or limbs. Scrotal swelling in men or facial swelling in women indicates a critical stage, often untreatable. Various "transformations" (atypical presentations) confuse doctors regarding deficiency/excess and cold/heat. Entering this trap leads to rapid fatality. TCM practitioners rigidly adhering to ancient texts, lacking experience and decisive insight, will be misled by obscure theories and pseudo-effective methods. A major flaw of TCM lies here. If a patient presents with dry stool, scanty dark urine, dry nose/mouth, thin tongue coating, sensation of heat rising in the throat, red tongue with blisters, thirst but no desire to drink, one might suspect Dampness or Heat and attempt purging or draining methods. In short, it will be ineffective. If the patient has cough with no sputum, no saliva, no sweat, no tears, dark scanty pungent urine, dizziness/headache, vomiting upon smelling food, loose or hard stools, abdominal pain/borborygmus, and hiccups, one might suspect Wind, Cold, Heat, or Upper Excess/Lower Deficiency, attempting sweating, tonifying-purging combinations, or spleen-stomach regulating methods. Again, it will be ineffective. Why do ancient formulas fail? Because ancient formulas mislead people, not just in Gubing. Ancient theories are chaotic. My forty-plus years of experimentation confirm that while methods like draining, resolving stagnation, moving Qi, dispelling dampness/heat may miss the mark, they rarely kill immediately. Only purging and sweating methods, intended for excess swelling, cause death when misused for chronic deficiency swelling. This is not the ancients' fault but incompetent physicians lacking true knowledge. Scholars must recognize that sweating and purging treat excess, not chronic deficiency, avoiding confusion regarding Wind-Cold, Damp-Heat, Yin/Yang Water.

When the syndrome reaches criticality, manifestations vary wildly. Without real experience, determining deficiency/excess and cold/heat is difficult, marking the life-and-death juncture. Essentially, chronic deficiency swelling should always be treated as deficiency, applying TCM Great Tonification of Primordial Yang and Western astringent therapies. For diarrhea, Vitamin therapy is highly effective. This is based on my extensive experiments, absolutely truthful. For instance, if the patient has dark scanty urine, Fuzi (Aconiti Lateralis Radix Praeparata) seems contraindicated due to its astringent properties on urination. However, only this herb can restore lost Primordial Yang and vaporize stagnant water. Adding it to Spleen/Kidney tonifying decoctions, boldly administered, eventually increases clear urine volume. This subtlety is known only through years of experimentation. The transformations of this disease mask deficiency signs. Treating symptoms alone leads to confusion. At this stage, besides worsening edema, symptoms include dark pungent urine, vomiting triggered by odors, hiccups, oral ulcers, red blistered tongue, dry mouth without thirst, burning throat with heat rising, chest oppression, dry eyes/nose/skin (no tears, mucus, sweat), loose or hard stools, palpitations, insomnia, dizziness. These pseudo-excess signs confuse inexperienced doctors. Between deficiency and excess, the physician must firmly identify Yang deficiency, pure cold, blood stasis, and failure of Qi transformation to move water. All pseudo-excess signs are illusions. The TCM theory of Qi transformation is perfectly suited for this swelling, superior to Western concepts of ascites or Beriberi. Therefore, tonifying Yang, Qi, Spleen, warming Kidney, and promoting diuresis are the only fundamental principles. Combining with Western astringent therapy (for diarrhea) is beneficial. Diuretics are optional and potentially harmful. Vitamin therapy is effective but insufficient alone; it must be combined with Chinese herbs. This will fundamentally cure the dreaded Gubing. However, in severe cases, using only Chinese or only Western medicine has difficulties. It took years of trial to confirm this. Thus, I advocate combined therapy. Do not change treatment plans after one or two ineffective doses. Combined therapy works synergistically. Except for specific cases in this book, scholars should not mix medicines arbitrarily to avoid danger. This approach eliminates pseudo-excess/heat signs, restores Yang Qi, revitalizes internal/external secretions, and enables organs/skin to excrete water. Fluids normalize (urine, saliva, mucus). Circulation improves, secretions recover, and water is excreted normally. Note "internal": endocrine cessation is more harmful than exocrine. The first sign of effective treatment is increased urine output and natural secretion of tears, saliva, sweat, and mucus. No water remains in vessels or tissues, and swelling subsides. This pathology was confirmed after forty years of experimentation. After swelling subsides, persistent foot pain/swelling responds well to Niuxi (Achyranthis Bidentatae Radix, approx. 5-6 qian); Hu Jinggu (Panther Bone) is also usable.

Hesitation in treatment, such as switching doctors or changing plans after one or two doses due to lack of immediate effect, leads to failure. Physicians facing difficult cases must have true insight and determination. Do not test medicines on patients. Treatment intensity, sequence, and choice between Chinese/Western medicine depend on the physician's mature judgment and flexibility. Only then can one discuss the miracles of TCM or the science of Western medicine and truly claim to be a healer. Otherwise, echoing others, whether ancient or modern, guarantees failure in treating difficult diseases.

To study the pathology of this syndrome, one must first understand the exquisite ideal of TCM Qi transformation, including meridians, Zang-Fu organs, Ying-Wei (Nutritive-Defensive Qi), Qi-Blood, and Yin-Yang. Alongside Western physiology of tissues, secretions, organs, vessels, lymph, glands, etc. The path to recovery is restoring the body's vitality, activating all systems, ensuring internal/external ventilation and natural blood flow, thus curing the major illness.

In extreme swelling, patients may feel blood sinking to the left when lying on the left, and to the right when lying on the right. Standing feels like blood sinking into the legs. This indicates loss of natural circulatory vitality, like dead water in a bag, flowing wherever tilted, with no autonomy. A skilled physician must realize this lack of automatic blood flow stems from extreme decline in vitality. Vitality declines due to severe nervous system weakness, losing control over perception and movement. Thus, in extreme swelling, skin and muscles show no response to stimulation, feeling like dead flesh. Numbness indicates a lighter stage; pitting edema that doesn't rebound indicates near-death. However, with proper treatment (see cases), even critical cases respond. Improvement begins with sensation returning (numbness/pain/itch), then generation of fluids, then warm limbs and soft skin. Health recovers.

The deepest truth in treating this disease is the vital heat sustaining life and nerves. Insufficient heat means weakness; extinction means death. The only effective Chinese medicine to supplement this heat belongs to formulas greatly tonifying Primordial Yang. Such formulas are rare in Western medicine. Thus, TCM saves lives in crises, sometimes aided by Western medicine, but primarily relying on these special Chinese herbs.

The mechanism involving endocrine/exocrine functions, based on Western physiology, requires detailed explanation. Swelling occurs because internal/external secretions gradually cease, preventing any fluid excretion. "External" includes organs. Tears, mucus, sputum, sweat stop. Urine becomes scanty, dark, and pungent. Daily fluid intake stays in vessels and tissues, accumulating in loose spaces, causing internal and external swelling. People see external swelling but ignore internal organ swelling. Water flows to loose tissues, e.g., lower abdomen. Western paracentesis is symptomatic only, fluid reaccumulates. TCM warming/tonifying and diuresis help evaporate water and open drainage paths, treating root and branch effectively. This is TCM's specialty.

Western books note dry stool in Gubing, but many cases have diarrhea. This is my experimental observation. When severe, abdominal swelling is prominent. To elucidate "Qi Transformation" as the premise for solving this syndrome, I reference Western secretion physiology for comparison. This physiology is scientific. Patients exhibit non-secretion (dryness: no saliva, mucus) and non-absorption (fluid stagnation, edema). Incomplete secretion and absorption functions cause this syndrome. In short, unless nervous weakness and failure of Qi vaporization occur, secretion/absorption balance is maintained. Paracentesis is a temporary rescue measure. TCM swelling covers Qi Gubing and Water Gubing, corresponding to Western Beriberi and Ascites. Although distinct, both often result from Heart/Lung/Kidney diseases causing blood stasis. Edematous Beriberi also shows serous cavity fluid. They share phenomena. Physicians should apply TCM Qi transformation theory flexibly. Ascites and Beriberi pathologies are omitted due to space.