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Huangdi said: I wish to hear about the manifestations of distension. Qibo said: In cases of Heart Distension, there is mental restlessness, shortness of breath, and restless sleep; in cases of Lung Distension, there is a sensation of empty fullness accompanied by wheezing and coughing; in cases of Liver Distension, there is fullness and pain under the hypochondrium radiating to the lower abdomen; in cases of Spleen Distension, there is frequent hiccups, heaviness and discomfort in the four limbs, a sense of bodily weight such that one cannot bear the weight of clothes, and restless sleep; in cases of Kidney Distension, there is abdominal fullness radiating to the back with a feeling of discomfort, and pain in the waist and hips. This distinguishes the clinical manifestations of distension in the Five Zang Organs. The Yang Channels connect internally with the Six Fu Organs, and the Yin Channels connect internally with the Zang Organs. If the distension originates from the channels, when severe, it can internally obstruct the Qi of the Zang Organs, thus producing the specific pathological forms of each Zang Organ. Alternatively, if external distension arises from an internal Zang disease, the Zang symptoms will necessarily appear first. The same principle applies to the distension of the Six Fu Organs described below. However, in cases of Skin Distension (Fu Zhang), the pathology is confined to the Wei (Defensive) level and does not involve the channels; therefore, no Zang or Fu clinical manifestations will be present.

Distension of the Six Fu Organs: Stomach Distension presents with abdominal fullness, epigastric pain, olfactory hallucinations of a burnt odor, difficulty eating, and constipation; Large Intestine Distension presents with borborygmus and gurgling pain; if exposed to cold again in winter, it leads to undigested diarrhea (Sun Xie); Small Intestine Distension presents with lower abdominal distension and pain radiating to the lower back; Bladder Distension presents with lower abdominal fullness and difficulty urinating (Qi Long); San Jiao Distension presents with Qi filling the skin, feeling soft upon pressure but not hard; Gallbladder Distension presents with pain and distension under the hypochondrium, bitter taste in the mouth, and frequent sighing. This distinguishes the Six Fu Organs, noting that their symptoms vary. These may result from Qi rebellion in the respective channels invading internally, or from internal injury due to food stagnation. As for Zang Distension, it may be caused by Spleen deficiency, Liver Qi stagnation, or Lung Qi rebellion, or by the obstruction of Zang Qi due to the malfunction of the Fu Organs. All these must be carefully examined for etiology and treated accordingly. San Jiao Distension is similar to Skin Distension because both belong to disorders of Qi.

Huangdi said: How does distension arise? What are its causes? Qibo said: When Wei Qi (Defensive Qi) is in the body, it normally runs alongside the vessels through the intermuscular spaces. Its movement has a direction of reverse and smooth flow, with Yin and Yang following each other, thereby achieving harmony with Heaven. The Five Zang Organs function in rotation, the four seasons follow their order, and grains are digested properly. However, if Jue Qi (Rebellious Qi) accumulates below, Ying Qi (Nutritive Qi) and Wei Qi remain stagnant, Cold Qi rebels upward, and True Qi attacks Evil Qi, the two forces collide and combine to form distension. Ying and Wei protect the exterior, while Zang and Fu reside within. The meridians and Qi-Blood circulate continuously with a definite sequence, Yin and Yang following each other in an endless cycle, conforming to the Qi transformation of the Five Elements and four seasons. Detailed principles are found in the section on Ying-Wei and Meridians. The movement of Wei Qi runs alongside the vessels through the intermuscular spaces; although it travels outside the vessels, it must follow the sequential flow of the meridians. If it rebels and loses its measure, with dysregulation of ascending and descending, then Jue Qi accumulates below. Consequently, Ying-Qi, Wei-Qi, and Blood become stagnant and cease to flow. Internal Cold Qi rebels upward, True Qi and Evil Qi attack each other, and Yin and Yang Qi fail to communicate harmoniously. They collide, knot, and obstruct, thereby forming distension disease.

The *Su Wen · Da Qi Lun* states: "Liver Fullness, Kidney Fullness, and Lung Fullness are all Excess patterns, manifesting as swelling." Qi flourishing in the Yang aspect is called swelling; flourishing in the Yin aspect is called fullness. This refers to internal fullness and excess manifesting externally as swelling. For diseases originating internally and extending outward, treatment should first address the interior.

Lung Yong (Obstruction) presents with wheezing and bilateral hypochondriac fullness; Liver Yong presents with bilateral hypochondriac fullness, fright during sleep, and inability to urinate; Kidney Yong presents with fullness from the soles of the feet to the lower abdomen, asymmetry of the calves (one large, one small), swelling of the thighs, limping, and susceptibility to hemiplegia (Pian Gu). This clarifies the clinical manifestations mentioned above for differentiation. Yong is synonymous with Yong (Obstruction), referring to fullness caused by the obstruction of pathogenic factors. Both Lung and Liver Obstruction present with bilateral hypochondriac fullness, but Lung Obstruction involves wheezing, whereas Liver Obstruction involves fright and urinary retention. Kidney Obstruction leads to Qi and Blood stasis from the lower abdomen to the soles, resulting in asymmetric calves, swollen thighs, limping, and alternating left or right hemiplegia. The cause of such obstruction may be internal injury or external contraction, which cannot be definitively determined. This passage explains Zang diseases but omits the Heart and Spleen. The Heart houses the Shen (Spirit) and is the master of the body; if Heart Qi is obstructed, it必然 leads to confusion and mania. The Spleen governs transportation and transformation; if Spleen Qi is obstructed, it causes blockage throughout the entire body, internal and external, presenting differently than the specific symptoms of the three aforementioned Zang organs. By combining this with the preceding text on the distension of the Five Zang Organs, the underlying principles can be understood.