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The etiology of swelling and distension has been thoroughly differentiated in the *Neijing* (Huangdi Neijing, Yellow Emperor's Inner Canon) and the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet). However, the key details within them are obscure and not fully elucidated. The sages of previous dynasties failed to clarify these points, and later practitioners, lacking careful observation, often applied methods for treating deficiency-type edema to patients with excess-type distension, and vice versa. They did not realize that both swelling and distension can present as either deficiency or excess. Swelling floating on the exterior indicates pathology in the meridians and collaterals, belonging to the exterior syndrome; distension fullness in the interior indicates pathology in the stomach and intestines, belonging to the interior syndrome. Fortunately, Scholar Xu (Xu Shuwei) clearly distinguished: edema affecting the four limbs is water disease, whereas abdominal distension with minimal swelling in the limbs is distension disease, thereby elucidating the principle of separate treatment for swelling and distension found in the *Jingui Yaolue*. Later, Zhu Danxi’s works established separate chapters for swelling and distension. Wang Yutai also separated the treatments for edema and distension, which contains profound logic; however, while the chapter on distension clearly lists items such as deficiency, excess, cold, and heat, the chapter on edema fails to detail which passages in the *Neijing* refer to deficiency, which to excess, which to distension, and which to swelling. Furthermore, it does not clarify that "Fengshui" (Wind Edema) in the *Neijing* and "Fengshui" in the *Jingui Yaolue* are two different conditions, leaving me unsatisfied.

The *Lingshu · Jinye Pian* states: "When the Qi pathways of Yin and Yang are unclear, food and fluids accumulate in the stomach and intestines and cannot seep into the bladder, resulting in water distension." This is a general discussion on the origin of water distension. The *Lingshu · Shuizhang Pian* states: "When water disease begins, there is slight swelling under the eyes, followed by abdominal enlargement." "Fuzhang" (Skin Distension) presents with an enlarged abdomen and whole-body swelling with thick skin; "Guzhang" (Drum Distension) presents with an enlarged abdomen and body, similar in size to Fuzhang; "Changtan" (Intestinal Polyp/Mass) occurs when cold qi lodges outside the intestines, forming a mass the size of a chicken egg that gradually enlarges like pregnancy, while menstruation continues regularly; "Shijia" (Stone Mass) arises in the uterus, with closure of the cervical os and irregular menstruation. This section discusses the differentiation between swelling and distension. The *Lingshu · Zhanglun* states: "Heart distension involves mental restlessness and shortness of breath; Lung distension involves empty fullness, wheezing, and coughing; Liver distension involves fullness and pain under the hypochondrium radiating to the lower abdomen; Spleen distension involves frequent hiccups and heavy body; Kidney distension involves abdominal fullness radiating to the back, waist, and thighs; Stomach distension involves epigastric pain and difficulty eating; Large Intestine distension involves borborygmus and pain with gurgling sounds; Small Intestine distension involves lower abdominal distension; Bladder distension involves lower abdominal fullness and urinary retention; Sanjiao distension involves Qi filling the skin; Gallbladder distension involves hypochondriac pain, bitter taste, and sighing." This section details the visible symptoms of distension diseases in the Zang and Fu organs corresponding to each meridian.

The *Lingshu · Shuizhang Pian* further asks: "Can abdominal distension and drum distension be treated with acupuncture?" The answer is: "First, puncture and bleed the collateral vessels at the site of distension, then regulate the meridians." The *Suwen · Fuzhong Lun* states: "Fullness in the heart and abdomen where one can eat in the morning but not in the evening is called Guzhang, treated with Ji Shi Li (Chicken Excrement Fermented Liquid)." Wang Yutai, noting that although both are called Guzhang, their treatments differ based on exterior/interior distinctions, divided them into one being a disease of Qi accumulation and another of Qi stagnation interacting with Blood. I, however, disagree. The *Lingshu · Shuizhang Pian* states: "Abdominal distension with whole-body swelling, equal in magnitude to Fuzhang," indicating that the swelling is widespread on the body surface, not internal distension, thus belonging to the exterior rather than the interior. Hence, it says "first bleed the distended collaterals, then regulate the meridians." This aligns with the *Lingshu · Zhanglun*, which describes Ying Qi circulating along the meridians while Wei Qi rebels and circulates among the muscle intervals, causing Fuzhang, treated by reducing at Zusanli (ST36). These are the same methodological approach. In contrast, the *Suwen · Fuzhong Lun* mentions only heart and abdominal fullness with inability to eat at night, without whole-body swelling, indicating an interior rather than exterior condition; thus, Ji Shi Li is used to descend Qi. This corresponds to the *Neijing* principle: "For fullness in the center, reduce it; after purging, the distension resolves."

The *Suwen · Tangye Laoli Lun* states: "Balance the scales, remove accumulated decay, open the ghost gate (pores), and cleanse the clear mansion (bladder)." This is because Qi is rejected internally while the form manifests externally, causing the body not to fit properly into clothes, indicating simultaneous exterior and interior pathology; therefore, both sweating and diuresis methods are employed. The *Suwen · Ping Re Lun* states: "There is a disease called Kidney Water, presenting with massive facial swelling and difficulty speaking; it is a deficiency pattern and should not be needled, known as Fengshui." It also states: "Simultaneous floating pulse of Liver and Kidney is called Fengshui." Liver Fire is called Thunder Fire, and Kidney Fire is called Dragon Fire. Normally, the pulses of Liver and Kidney are deep; if they become simultaneously floating, it signifies Thunder Fire moving bringing violent winds and rains, and Dragon Fire moving causing waters to surge. These two passages describe excessive Ministerial Fire of Liver and Kidney, leading to overflowing water rising upward. The *Lingshu · Benshu Pian* states: "Shaoyin belongs to the Kidney; the Sanjiao is the palace of drainage, through which water channels exit." The *Suwen · Xuanming Wuqi Pian* states: "Sanjiao disease with Qi fullness makes the lower abdomen particularly hard." It also says: "Water retention leads to distension." These two passages describe insufficient Ministerial Fire of Liver and Kidney, failing to vaporize water, leading to downward accumulation. The *Suwen · Shuire Xuelun* states: "The Kidney is Supreme Yin; Supreme Yin generates water. The Lung is Grand Yin. Thus, the root is in the Kidney, and the branch is in the Lung; both involve water accumulation." This explains that Kidney Water disease connects upward to the Lung. It also states: "The Kidney is the gate of the Stomach; if the gate is not unobstructed, water gathers following its kind." This explains that Kidney Water disease connects upward to the Stomach. It also states: "Excessive exertion damages the Kidney; Kidney sweat enters the pores (Xuanfu) and transforms into swelling. This is Fengshui caused by internal injury to Kidney Water and external invasion of Wind Pathogens."

The *Suwen · Yin Yang Bie Lun* states: "Yin and Yang knot with evil, with much Yin and little Yang, is called Shishui (Stone Water)." It also states: "Three Yin knotted results in water." And: "Simultaneous deep pulse of Liver and Kidney is Shishui." This describes Cold knotting Water Evil, known in later generations as the cold pattern of Yin Water. The *Lingshu · Jingmai Pian* states: "Diseases generated by the Stomach include large abdominal edema and painful swelling of the knees and patellae." It also states: "All swellings belong to Fire; all water edemas are due to combined Damp-Heat." This describes Heat knotting Water Evil, known as the heat pattern of Yang Water. The *Suwen · Zhihen Yao Da Lun* states: "All dampness, swelling, and fullness belong to the Spleen; moreover, excessive Dampness causes water closure and swelling." This indicates that Damp Earth governs the Spleen, leading to Splei Meridian edema. It also states: "What arrives via Taiyin causes swelling." And: "What arrives via Taiyin causes central fullness." This refers to swelling caused by excessive Dampness when Taiyin governs the year. It also states: "When Taiyang governs, excessive Cold causes floating [swelling]." This refers to swelling caused by excessive Cold. It also states: "When Shaoyin governs, Shaoyang wins and revenges; when Shaoyang governs, Shaoyin wins and revenges; furthermore, excessive Heat causes swelling." This refers to swelling caused by excessive Heat when the Sovereign and Ministerial Fires govern the year.

Furthermore, the *Lingshu · Benshen Pian* states: "Spleen Qi excess causes abdominal distension." The *Suwen · Tiaojing Pian* states: "Form excess causes abdominal distension." The *Suwen · Maiyao Jingwei Lun* states: "Stomach Meridian pulse excess causes distension." These describe excess patterns of distension due to Spleen and Stomach congestion. The *Lingshu · Shichuan Pian* states: "Deficiency of Gongsun (SP4) of Foot-Taiyin causes distension." The *Suwen · Taiyin Yangming Lun* states: "Irregular diet and lifestyle entering the Five Zang causes fullness and obstruction." These describe deficiency patterns of distension due to Spleen and Stomach insufficiency. The *Suwen · Fangyi Lun* states: "Cold in the Zang generates fullness diseases." And: "Cold in the Stomach causes distension." These describe cold patterns of distension due to Yang deficiency in the Zang and Fu organs. The *Suwen · Zhihen Yao Da Lun* states: "All distensions with abdominal enlargement belong to Heat." It also states: "Abdominal fullness with difficult defecation, treat Foot-Shaoyin." And: "For distension, treat the Three Yang." These describe heat patterns of distension due to郁热 (stagnant heat) in the Zang and Fu. Above constitutes the *Neijing*'s discussion on swelling and distension.

As for the *Jingui Yaolue*, it states: "Fengshui presents with a floating pulse, joint pain, and aversion to wind; furthermore, Fengshui with floating pulse, heaviness, sweating, and aversion to wind is treated with Fangji Huangqi Tang. Also, Fengshui with aversion to wind, whole-body swelling, floating pulse, no thirst, continuous spontaneous sweating, and no significant heat is treated with Yueshi Tang." Careful study of the *Jingui Yaolue* reveals that a floating pulse indicates the exterior, so treatment focuses on the Taiyang Meridian. This must be a specific type of Wind Edema in the exterior contraction category, distinct from the internal injury Fengshui described in the *Neijing* involving simultaneous floating pulses of Liver and Kidney or facial swelling due to renal exhaustion. It also states: "Pi Shui (Skin Water) also has a floating pulse; exterior symptoms include swelling without thirst, requiring sweating." If sweating is indicated, this directly parallels the treatment of Taiyang Cold Damage. How can this method be applied to internal injury patterns characterized by simultaneous floating pulses of Liver and Kidney, renal exhaustion, massive facial swelling, and deficiency contraindicating needling? If it is due to Liver and Kidney insufficiency, fire decline, and water flooding, Shenqi Wan should be taken to secure the essence; it is inappropriate to use ascending and dispersing exterior-releasing drugs of the Taiyang Meridian. If one considers massive facial swelling and speech impairment as indications for sweating, the classics warn against needling when wearing proper attire and hair ornaments, advocating warm clothing and erroneous needling instead. Although both involve sweating, since needling is contraindicated, how could sweating be appropriate? If sweating is indicated for kidney sweat lodged in the pores due to renal exhaustion, one must recall the warning against forcibly inducing sweating in Shaoyin Cold Damage patterns, which can lead to collapse. If even external Cold Damage patterns in Shaoyin have warnings against sweating, how could ascending and dispersing drugs of the Taiyang Meridian be suitable for internal injury due to renal exhaustion? Based on this argument, the Fengshui in the *Jingui Yaolue* is indeed an external contraction of Taiyang, truly not the internal injury of Liver and Kidney described in the *Neijing*.

Zhang Zhongjing’s works often supplement the *Neijing*. For example, regarding Warm Malaria, the *Neijing* associates it primarily with Shaoyin, yet both describe initial heat followed by cold; however, the *Jingui Yaolue*’s description of Warm Malaria features heat without cold. The *Neijing* states regarding Warm Disease: "Failure to store essence in winter leads to Warm Disease in spring." Zhongjing’s discussion on Wind Warmth states: "After sweating a Taiyang disease, if the body becomes burning hot, it is named Wind Warmth." From these two conditions alone, Zhongjing’s discussions and the *Neijing*’s discussions represent separate categories. The *Jingui Yaolue* also states: "Pi Shui affects the four limbs; water resides in the skin, trembling slightly, treated with Fangji Fuling Tang." This similarly establishes Yang Meridian treatment methods based on the exterior governed by the Three Yang, akin to the previously mentioned floating-pulse Fengshui. It also states: "Zheng Shui has a deep and slow pulse with spontaneous wheezing; Shishui has a naturally deep pulse with abdominal fullness but no wheezing. Both have deep pulses, but wheezing indicates Lung involvement, while non-wheezing indicates Liver-Kidney involvement. The *Jingui Yaolue* establishes Yin Meridian treatment methods based on the interior governed by the Three Yin." It also states: "Huang Han (Yellow Sweat) has a deep and slow pulse, body fever, and if prolonged, will likely lead to abscesses/pus." And: "Li Shui presents with yellow swelling of the whole body and face, deep pulse, and difficult urination." In these two passages, the *Jingui Yaolue* treats deep pulse as indicating the exterior, establishing the principle of prioritizing symptoms over pulses. It also states: "In water diseases, a deep and small pulse belongs to Shaoyin; a floating pulse indicates Wind; empty distension without water is Qi; inducing sweating cures water diseases." This uses deep and floating pulses to differentiate Taiyang and Shaoyin exterior/interior treatments, summarizing the preceding treatments for edema across the Three Yang and Three Yin. It also states: "Heart Water involves shortness of breath and inability to lie down; Liver Water involves abdominal distension and hypochondriac pain; Lung Water involves difficult urination; Spleen Water involves heavy four limbs; Kidney Water involves low back pain and inability to urinate." This supplements the Five Zang Waters in the *Jingui Yaolue* to complement the Five Zang Distensions in the *Neijing*.

The *Jingui Yaolue* also states: "Cunkou pulse is deep and tight; deep indicates water, tight indicates cold. The Duyang pulse should be hidden, but now it is tight, indicating pre-existing Cold Colic." And: "The Duyang pulse should be hidden, but now it is rapid, indicating pre-existing Heat." This utilizes the Lung’s governance of water passages and the Stomach’s governance of food/fluid intake, focusing diagnosis on the Lung and Stomach. It also states: "Swelling above the waist requires sweating; swelling below the waist requires promoting urination." This expands upon the classic saying that facial swelling is Wind and foot swelling is Water, using the upper/lower body to distinguish exterior/interior, extending beyond just pulse depth and floating. However, this mirrors the method of Ma Huang treating the branch and Wuling San treating the root in Taiyang Cold Damage; otherwise, for conditions like massive facial swelling and deficiency contraindicating needling, even if swelling is above the waist, sweating is contraindicated; for conditions like simultaneous deep pulses of Liver and Kidney indicating true Yin depletion, even if swelling is below the waist, diuresis is contraindicated. The above passages constitute the *Jingui Yaolue*’s exclusive discussion on edema.

Later scholars such as Jiezhai, Danxi, and Zhang Sanxi focused solely on the *Neijing* statement "All dampness, swelling, and fullness belong to the Spleen," establishing theories exclusively around the Foot-Taiyin Meridian, neglecting other passages. He Baizhai focused solely on the *Neijing*’s Shishui of Liver and Kidney, prescribing Shenqi Wan from the *Jingui Yaolue*, focusing exclusively on the Foot-Shaoyin Meridian. Xue Xinpu and Zhao Yangkui treated swelling and distension comprehensively by tonifying Kidney and Spleen, basing their methods on the Spleen and Kidney meridians. Danxi also stated: "When Damp-Heat is abundant, Lung Qi becomes depressed, generating water." This addresses the *Neijing* category of Qi depression where Damp-Heat invades the Lung causing swelling. Hejian also stated: "Dryness pathogen affects the Lung, cutting off the source of water, leading to difficult urination and swelling." This supplements the *Neijing*’s omission of Dryness invasion, specifically addressing swelling caused by Dryness-Heat invading the Lung. Unfortunately, later famous physicians, preferring simplicity over complexity, attempted to fix treatment methods to one or two meridians for convenience, unaware that this disease category has many pathways and cannot be summarized by just one or two Zang organs. One must clearly identify which meridian is primarily affected, which is concurrently involved, which Zang organ is injured among the Five Zang, which Fu organ is diseased among the Six Fu, which of the Three Causes initiated the symptom, and which part of the six pulses responds to the diagnosis. Treating according to the disease ensures accuracy.