金氏 寒热拘急，脉不紧数，胃痛，饮入辄呕，中焦痞阻，溺涩痛。宜宣通法。白通草、制半夏、橘白、
草豆蔻、枳壳、苏梗、赤苓、甘草梢、煨姜。一啜症减，痞满未除。用泻心法。半夏、黄连（俱姜汁炒）、黄芩、
干姜、陈皮、枳壳、甘草梢、木通、山栀。二服全安。
殷氏 身热胸痞，气促微咳，呕吐粥饮，痰粘溺涩，经止数月，脉息三五不调，兼带浮数。医投桂、
附热剂，致咽喉肿碍，格阳于上，予谓此怀妊恶阻，兼外感也。宜辛凉以解痰热。用豆豉、杏仁、蒌皮、鲜
竹茹、陈皮、茯苓、制半夏、枇杷叶。二服热退痞消。
张氏 寒热似疟，胸痞不食，汗止腋下。阅所服方，混用枳、朴、楂、 、槟榔、青皮之属。此邪在上焦，
误行克伐，徒伤中下焦耳。予用半夏泻心汤去芩、连、甘草，加柴胡、煨姜、蒌皮、
苏梗、茯苓。数服随愈。
巢氏 发热胸痞，时呕，胀入背胁，脉沉小。仿小陷胸汤。用半夏、栝蒌、枳壳、陈皮、茯苓，加姜煎。
二服病除。
肿在外属水，胀在内属气。肿分阳水阴水，胀别气实气虚。因湿热浊滞，致水肿者，为阳水。因肺脾虚，
致水溢者，为阴水。浊气在上为实胀，中气不运为虚胀。辨其位，则脏腑、脉络、皮肤、上下、表里皆有之。
辨其因，则寒热、湿痰、气血、郁滞、虫积皆致之。经云∶三阴结谓之水。三阴手太阴肺，足太阴脾也。
又云∶浊气在上，则生 胀。此实胀也。又曰∶饮食起居失节，入五脏，则腹满闭实。此虚胀也。又曰∶脏
寒生满病。此寒胀也。又曰∶诸胀腹大，皆属于热。此热胀也。又曰∶营气循脉，卫气逆之，为脉胀，卫
气并脉，循分肉为肤胀。又经论五脏六腑之胀甚详，不备录。岐伯曰∶水始起，目窠微肿，如新卧起之状。
其颈脉动，时咳，阴股间寒，足胫肿，腹乃大，水已成，以手按其腹，随手而起，如裹水之状，光肿如泡。
此水肿也。肤胀者，寒气客于皮肤， 然不坚，腹大，身尽肿，皮浓，按其腹， 而不起，腹色不变，此腹
胀也。皮浓色苍，一身尽肿，或自上而下者，多属气。皮薄色泽，肿有分界，或自下而上者，多属水。
鼓胀者，腹胀身皆大，大与肤胀等，色苍黄，腹筋起，此鼓胀也。肤胀属肺，鼓胀属脾。别有蛊胀，因气血
郁痹，久则凝滞不行，腹形充大，中实有物，非蛊即血，非如鼓胀之腹皮 急，中空无物也。有单腹胀，四肢
不肿，但腹胀也，症最难治。亦名蛊胀。经言诸湿肿满，皆属于脾。又言其本在肾，其末在肺，皆积水也。
肾何以聚水？肾者胃之关也，关门不利，故聚水而从其类也。是知肿胀无不由肺脾肾者，以肺主气化，脾主
运输，肾主藏液也。且胀不必兼肿，肿则或兼胀，亦有肿胀并至者。病在水分，以治水为主，而兼理气，
气化水自化也。病在气分，以理气为主，而兼利水，水行气亦行也。但其间虚实必辨。凡阳症必热，热者多
实；阴症必寒，寒者多虚；溺赤便秘，脉数有力，为实；溺清便泻，
脉微无力，为虚；实者六淫外客，饮食内伤，忽然浮肿，其来必速；虚者情志操劳，酒色过度，病后气虚，
其肿渐至。知此而后治法可详。治水肿，必健脾导水，实脾饮。治鼓胀，必通腑疏肝，草果、浓朴、益智、
青皮、枳壳、牛膝、腹皮。湿在下者，用分利，小厘清饮，大橘皮汤。湿在上中下者，用分消，通草、杏仁、
浓朴、海金砂、木通、鸡内金、陈皮、菔子。湿浊在里者，洁净腑，四苓散、六一散。膀胱为净腑。洁，渗
利也。风水脉浮者，开鬼门，越婢汤。腠理为鬼门。开，发汗也。肺脾不运者，消皮水，防己茯苓汤、五皮饮。
按五水∶风水、皮水、正水、石水、黄汗也。仲景曰∶风水脉浮，骨节疼痛，恶风。皮水脉亦浮，跗肿，按
之没指，不恶风，腹如鼓，不渴，当发汗。正水脉沉迟，身发热，自喘。石水脉沉，腹满不喘。黄汗其脉沉
迟，发热胸满，四肢头面肿，久不愈，必发痈脓。肺气壅热者，用肃降，麦门冬汤加茯苓皮、山栀、滑石、杏
仁、薏苡仁、淡豆豉。脘痞郁热者，用苦降，半夏泻心汤。清阳痞结者，通腑阳，栝蒌、杏仁、半夏、茯苓、
薤白、姜。胃满浊逆者，泄肝木，杏仁、浓朴、槟榔、椒目、吴茱萸、川楝子。胃阳虚者，用温通，人参、
橘白、半夏、砂仁、荜茇、姜。脾阳虚者，用健运，六君子汤加益智、神曲。脾肾阳虚者，用气化，肾气汤。
中气陷者，用升提，补中汤。木邪侮土者，和肝胃，木香、枳壳、白芍、竹茹、木瓜、陈皮、当归。肝经郁热
者，降逆火，山栀、丹皮、黄连、钩藤、青皮、金橘。暴怒伤肝者，平逆气，解肝煎。三焦壅滞者，用疏利，
廓清饮。湿热夹滞者，兼消利，鸡金散。食滞中满者，专消导，和中丸。气虚中满者，兼消补，消导宽中汤。
气虚兼寒者，宜温补，理中汤、温胃饮。气血郁积，夹湿热者，平肝胃，小温中丸。清浊混淆，气喘溺少，通
身肿胀者，暖下泄浊，禹余粮丸。湿热痰积，脉实有力者，涤宿水，禹功散、导水丸，神佑丸。血沫凝涩经隧
者，利搜逐，桃仁承气汤。胀实坚满拒按者，大小承气汤。病后虚肿，及产后面浮足肿者，补元气，六君子汤、
归脾丸。单腹胀症多属腑，腑宜通，勿用滋腻守补，沙苑子、益智、茯苓、牛膝、枳壳、车前子、砂仁壳、
麻仁、郁李仁、椒目、杏仁、栝
萎仁、大腹皮。单腹胀俗名蜘蛛胀，腹肿，四肢瘦，由脾气虚极，真脏已伤也。论中属腑句宜活参。妇人先
肿胀而后经断者，为水分；先经断而后肿胀者为血分。水分，五皮饮送通经丸。血分，通经丸。先喘而后胀者，
治在肺，五皮五子饮。先胀而后喘者，治在脾，理中汤、肾气丸。水肿先起于腹，后散四肢者可治；先起于
四肢，后归于腹者死。凡病水分，皆阴胜，与气分不同。水肿症其色明润，其皮光薄，其肿不速，每自下而
上，按肉如泥，肿有分界。病在气分，则阳症阴症皆有之，若病在水分，多阴症。凡虚肿溺涩，香苏散。湿胜
不化，胃苓汤。湿滞中满，白术丸、枳术丸。因于肺者，五皮饮。因于脾者，补中汤。因肾阴虚，真阳无以化
者，六味丸加牛膝、车前。因肾中命火衰，不能蒸动关门者，肾气丸。夫水为至阴，其标在肺，其本在肾，
其制在脾。肾虚则关闭，其水必逆而上泛，脾不能制而反为水所渍，故肌肉浮肿；肺不能化而反为水所凌，
故气息喘急，皆阴胜之害也。经言膀胱藏津液，气化则能出。所谓气化者，即右肾命门真火也。火衰则不能蒸动
肾之关门，而水聚焉。肾气丸，以桂附蒸动其关，积水始下，以阳主开也。此法不独治水肿，凡治胀者，
其要亦在通阳而已。
凡下气虚乏，中焦气壅，欲散满则恐虚其下，欲补下则满甚于中，当以启峻汤峻补其下，疏启其中，
故气得峻补，则上行而启其中，中焦营运，壅滞疏通，中满自消，下虚自实。经所谓塞因塞用也。若水肿喘促，
清理肺气为主，凡禽畜无肺者无溺，故水肿宜清肺也。
肿胀症，须分阴阳，湿热壅滞属阳，浊气凝滞属阴。阳症按之痛，阴症按之不痛。阳症起于中焦，
阴症起于下焦。阳症治在腑，阴症治在脏。阳症宜清，阴症宜温。毫厘千里，不可不辨。
肿症易治，胀症难治。肿辨阳水阴水，阳水易治，阴水难治。胀症头绪更多，首辨有形无形。无形则轻
剂宣通，有形则重剂攻伐。又须辨在络在经，在腑在脏，经络易治，脏腑难治。又须察虚实，实者可治，虚者难
治，此其大纲也。然后再辨其因寒因热，因湿因痰，因气因血，因滞因积，审而治之。
徐灵胎曰∶胀满症，即使正虚，终属邪实，古人慎用补法。又胀必有湿热，倘胀满或有有形之物，宜缓
下之。湿热无形，滞积有质，宜辨。按胀在肠胃，则食入胀加，治在通腑。若二便通调，则胀在脏，即肝脾肾
等脏，如《灵枢》所论。或胀在肠外三焦脂膜间。《灵枢》所以谓胀皆在脏腑之外，排脏腑而廓胸胁也。
治在辨其阴阳虚实，上下表里，皮肤经络，气分，血分，水分。因寒因热，因湿因郁，因痰饮，因积滞。
或有形无形，宜汗宜利，宜分消，宜辛泄，宜清肃，宜温通，宜升举，宜疏利，宜补摄，宜开郁，宜缓攻，
宜软坚化痞，宜理瘀导滞。要在宣通，勿用守补。若肿症身面大势已退，其肢节足跗之水湿浸润未消，
宜针刺以决其流，此出路也。
Jin, presenting with alternating chills and fever (Hanre), limb stiffness and urgency (Jujin), a pulse that is neither tight nor rapid, stomach pain, vomiting immediately after drinking, obstruction and fullness in the Middle Jiao (Middle Burner), and painful, difficult urination. The appropriate method is to promote circulation and unblock (Xuantong). Prescription: Baiguancao (Tetrapanax Pith), Zhixabanxia (Prepared Pinellia Rhizome), Jubai (Orange Albedo), Caodoukou (Black Cardamom Seed), Zhike (Aurantium Fruit), Sugeng (Perilla Stem), Chiling (Red Poria), Gancaoshao (Licorice Tip), Weijiang (Roasted Ginger). After one dose, symptoms decreased, but the sensation of fullness remained. Switched to the Xiexin Method (Draining Heart Method). Prescription: Banxia (Pinellia Rhizome), Huanglian (Coptis Rhizome) [both stir-fried with ginger juice], Huangqin (Scutellaria Root), Ganjiang (Dried Ginger), Chenpi (Aged Tangerine Peel), Zhike (Aurantium Fruit), Gancaoshao (Licorice Tip), Mutong (Akebia Stem), Shanzhi (Gardenia Fruit). After two doses, complete recovery was achieved.
Yin, presenting with body heat, chest oppression, shortness of breath with slight cough, vomiting of porridge and drinks, sticky phlegm, difficult urination, amenorrhea for several months, pulse irregular at three or five beats per respiration, accompanied by floating and rapid qualities. The physician administered hot herbs such as Guizhi (Cinnamon Twig) and Fuzi (Aconite Root), causing swelling and obstruction in the throat, with Yang Qi repelled upward. I diagnosed this as Ezu (Morning Sickness/Nausea of Pregnancy) complicated by an external contraction. The appropriate method is to use acrid-cool herbs to resolve phlegm-heat. Prescription: Douchi (Fermented Soybean), Xingren (Apricot Seed), Loupi (Trichosanthes Peel), Xianzhuru (Fresh Bamboo Shavings), Chenpi (Aged Tangerine Peel), Fuling (Poria), Zhixabanxia (Prepared Pinellia Rhizome), Pipaye (Loquat Leaf). After two doses, heat subsided and fullness resolved.
Zhang, presenting with chills and fever resembling malaria, chest oppression, anorexia, and sweating limited to the axillae. Reviewing the prescribed formula, it mixed Zhi (Immature Bitter Orange), Po (Magnolia Bark), Zha (Hawthorn Fruit), Shenqu (Medicated Leaven), Binglang (Areca Seed), Qingpi (Green Tangerine Peel), etc. This indicates pathogenic factors located in the Upper Jiao (Upper Burner); mistakenly using purgative methods only injured the Middle and Lower Jiao. I used Banxia Xiexin Tang (Pinellia Decoction to Drain the Epigastrium) removing Huangqin, Huanglian, and Gancao, adding Chaihu (Bupleurum Root), Weijiang (Roasted Ginger), Loupi (Trichosanthes Peel), Sugeng (Perilla Stem), and Fuling (Poria). After several doses, recovery ensued.
Chao, presenting with fever, chest oppression, occasional vomiting, distension extending to the back and hypochondrium, pulse deep and small. Modeled after Xiaoxiantong Tang (Minor Intra-abdominal Obstruction Decoction). Prescription: Banxia (Pinellia Rhizome), Gualou (Trichosanthes Fruit), Zhike (Aurantium Fruit), Chenpi (Aged Tangerine Peel), Fuling (Poria), added fresh ginger for decoction. After two doses, the disease was eliminated.
Edema on the exterior belongs to Water; Distension on the interior belongs to Qi. Edema is divided into Yang Water and Yin Water; Distension is distinguished as Qi Excess and Qi Deficiency. Edema caused by damp-heat and turbid stagnation is called Yang Water. Water overflow caused by Lung and Spleen deficiency is called Yin Water. Turbid Qi remaining in the upper part constitutes Excess Distension; failure of Middle Qi to transport constitutes Deficiency Distension. Differentiating by location involves Zang-Fu organs, collaterals, skin, upper/lower, and interior/exterior. Differentiating by etiology involves cold, heat, damp-phlegm, Qi-Blood, stagnation, and parasitic accumulation. The Classics state: "Obstruction of the Three Yin channels leads to Water." The Three Yin refer to the Hand-Taiyin Lung and Foot-Taiyin Spleen. It also states: "Turbid Qi in the upper part generates distension." This is Excess Distension. It further states: "Irregularities in diet and lifestyle entering the Five Zang lead to abdominal fullness and constipation." This is Deficiency Distension. It states: "Cold in the Zang generates fullness diseases." This is Cold Distension. It states: "All distensions with abdominal enlargement belong to Heat." This is Heat Distension. It states: "Nutritive Qi circulates within the vessels; if Defensive Qi rebels against it, Mai Zhang (Vessel Distension) occurs; if Defensive Qi merges with the vessels and circulates between muscle intervals, Fu Zhang (Skin Distension) occurs." The Classics discuss distensions of the Five Zang and Six Fu extensively, which are not fully recorded here. Qibo stated: "When edema begins, the eye sockets swell slightly, resembling the appearance after waking up. The neck pulses beat, there is occasional coughing, coldness in the inner thighs, swelling of the shins, and then the abdomen enlarges. When water has formed, pressing the abdomen causes it to rise immediately, like a bag of water, shiny like a bubble. This is Edema." Fu Zhang (Skin Distension) occurs when cold qi lodges in the skin, causing distension that is not hard, abdominal enlargement, whole-body swelling, thick skin, and upon pressing the abdomen, the depression does not rise, with unchanged abdominal color. This is Abdominal Distension. Thick skin with dark color, whole-body swelling, moving from top to bottom, mostly belongs to Qi disorders. Thin skin with bright color, swelling with distinct boundaries, moving from bottom to top, mostly belongs to Water disorders. Gu Zhang (Drum Distension) presents with abdominal and bodily enlargement equal to Fu Zhang, dark-yellow complexion, and visible abdominal veins. This is Drum Distension. Fu Zhang relates to the Lung; Gu Zhang relates to the Spleen. There is also Gu Zhang (Parasitic Distension), caused by Qi-Blood stagnation and bi-syndrome, leading to long-term coagulation and immobility, resulting in a large abdominal shape that is solid internally, containing either parasites or blood, unlike Drum Distension where the abdominal skin is tense but hollow. Dan Zhang Chang (Single Abdominal Distension) presents with non-swollen limbs but an enlarged abdomen; this condition is most difficult to treat, also known as Gu Zhang. The Classics say: "All dampness, edema, and fullness belong to the Spleen." It also says: "The root is in the Kidney, the branch is in the Lung; all involve accumulated water." Why can the Kidney accumulate water? The Kidney is the gate of the Stomach; if the gate is unfavorable, water accumulates according to its kind. Thus, edema and distension invariably involve the Lung, Spleen, and Kidney, because the Lung governs Qi transformation, the Spleen governs transportation, and the Kidney stores fluids. Distension need not accompany edema, but edema may accompany distension; sometimes both occur together. If the pathology is in the Water aspect, treatment focuses on resolving water while regulating Qi; when Qi moves, water transforms. If the pathology is in the Qi aspect, treatment focuses on regulating Qi while promoting diuresis; when water moves, Qi also moves. However, excess and deficiency must be differentiated. Yang syndromes are necessarily hot, and heat usually indicates excess; Yin syndromes are necessarily cold, and cold usually indicates deficiency. Red urine, constipation, and a rapid, forceful pulse indicate excess; clear urine, loose stools, and a faint, weak pulse indicate deficiency. Excess cases arise suddenly from six exogenous pathogens or dietary injury, with rapid onset of edema; deficiency cases arise gradually from emotional stress, overwork, excessive sexual activity, or post-illness Qi deficiency. Understanding these allows for detailed treatment strategies. To treat edema, one must strengthen the Spleen and guide out water, using Shipi Yin (Real Spleen Decoction). To treat drum distension, one must unblock the Fu organs and soothe the Liver, using Caoguo (Tsaoko Fruit), Houpo (Magnolia Bark), Yizhi (Alpinia Oxyphylla Fruit), Qingpi (Green Tangerine Peel), Zhike (Aurantium Fruit), Niuxi (Achyranthes Root), Dafupi (Areca Pericarp). For dampness in the lower part, use separation and drainage, with Xiaoli Qingyin or Da Jupi Tang (Large Tangerine Peel Decoction). For dampness in the upper, middle, and lower parts, use separation and elimination, using Tongcao (Tetrapanax Pith), Xingren (Apricot Seed), Houpo (Magnolia Bark), Haijinsha (Lygodium Spores), Mutong (Akebia Stem), Jineijin (Chicken Gizzard Lining), Chenpi (Aged Tangerine Peel), Fuzi (Radish Seed). For damp-turbidity inside, cleanse the Fu organs, using Siling San (Four-Poria Powder) or Liuyi San (Six-to-One Powder). The Bladder is the clean Fu organ. "Cleanse" implies渗利 (percolating and draining). For Fengshui (Wind Edema) with a floating pulse, open the Gui Men (Ghost Gate/Sweat Pores), using Yuespi Tang (Yue Bi Decoction). The Couli (interstices) are the Ghost Gates. "Open" means inducing sweating. For Lung and Spleen dysfunction, eliminate Pi Shui (Skin Water), using Fangji Fuling Tang (Stephania and Poria Decoction) or Wupi Yin (Five-Bark Decoction). Regarding the Five Waters: Fengshui, Pi Shui, Zhengshui, Shishui, and Huanghan (Yellow Sweat). Zhang Zhongjing said: "Fengshui has a floating pulse, joint pain, and aversion to wind. Pi Shui also has a floating pulse, dorsal foot swelling that indents on pressure, no aversion to wind, drum-like abdomen, no thirst, and should be treated by inducing sweating. Zhengshui has a deep, slow pulse, body heat, and spontaneous wheezing. Shishui has a deep pulse, abdominal fullness without wheezing. Huanghan has a deep, slow pulse, fever, chest fullness, swelling of limbs, head, and face; if prolonged, abscesses will develop." For Lung Qi congestion and heat, use descending and purifying methods, modifying Maimendong Tang (Ophiopogon Decoction) with Fulingpi (Poria Skin), Shanzhi (Gardenia Fruit), Huashi (Talcum), Xingren (Apricot Seed), Yiyiren (Coix Seed), and Danshich (Light Fermented Soybean). For epigastric oppression with stagnant heat, use bitter descending methods, Banxia Xiexin Tang. For obstruction of clear Yang, unblock Fu Yang, using Gualou (Trichosanthes Fruit), Xingren (Apricot Seed), Banxia (Pinellia Rhizome), Fuling (Poria), Xiebai (Macrostemon Bulb), and Jiang (Ginger). For stomach fullness with turbid rebellion, drain Liver Wood, using Xingren (Apricot Seed), Houpo (Magnolia Bark), Binglang (Areca Seed), Jiaomu (Pepper Seed), Wuzhuyu (Evodia Fruit), and Chuanlianzi (Szechwan Chinaberry). For Stomach Yang deficiency, use warming and unblocking methods, using Renshen (Ginseng Root), Jubai (Orange Albedo), Banxia (Pinellia Rhizome), Sharen (Amomum Fruit), Bibo (Long Pepper), and Jiang (Ginger). For Spleen Yang deficiency, use strengthening and transporting methods, Liu Junzi Tang (Six Gentlemen Decoction) plus Yizhi (Alpinia Oxyphylla Fruit) and Shenqu (Medicated Leaven). For Spleen-Kidney Yang deficiency, use Qi transformation methods, Shenqi Tang (Kidney Qi Decoction). For Middle Qi sinking, use lifting methods, Buzhong Yiqi Tang (Center-Boosting Qi-Supplementing Decoction). For Wood invading Earth, harmonize Liver and Stomach, using Muxiang (Aucklandia Root), Zhike (Aurantium Fruit), Baishao (White Peony Root), Zhuru (Bamboo Shavings), Mugua (Chaenomeles Fruit), Chenpi (Aged Tangerine Peel), and Danggui (Angelica Sinensis Root). For Liver channel stagnant heat, descend rebellious fire, using Shanzhi (Gardenia Fruit), Danpi (Moutan Bark), Huanglian (Coptis Rhizome), Gouteng (Uncaria Ramulus), Qingpi (Green Tangerine Peel), and Jinju (Kumquat). For sudden anger injuring the Liver, calm rebellious Qi, Jiegan Jian (Liver-Relieving Decoction). For Triple Burner congestion, use dredging and benefiting methods, Kuqing Yin (Clearing Decoction). For damp-heat with stagnation, combine elimination and drainage, Jijin San (Chicken Gold Powder). For food stagnation with central fullness, focus on digestion and guidance, Hezhong Wan (Harmonize Center Pill). For Qi deficiency with central fullness, combine elimination and tonification, Xiaodao Kuanzhong Tang (Guide and Broaden Center Decoction). For Qi deficiency with cold, use warming and tonification, Lizhong Tang (Regulate Middle Decoction) or Wenwei Yin (Warm Stomach Decoction). For Qi-Blood stagnation with damp-heat, calm Liver and Stomach, Xiaowenzhong Wan (Small Warm Center Pill). For confusion of clear and turbid, wheezing, scanty urine, and whole-body swelling, warm the lower and drain turbidity, Yuyuliang Wan (Hematite Pill). For damp-heat and phlegm accumulation with a strong, forceful pulse, purge old water, using Yugong San (Yu Gong Powder), Daoshui Wan (Water-Guiding Pill), or Shenyao Wan (Divine Protection Pill). For blood foam coagulation and sluggish meridians, benefit and search/purge, Taoren Chengqi Tang (Peach Kernel Decoction to Drain the Chest). For distension that is solid, firm, full, and refuses pressure, use Da Xiao Chengqi Tang (Major and Minor Chengqi Decoctions). For post-illness edema and facial/foot swelling after childbirth, tonify primal Qi, using Liu Junzi Tang (Six Gentlemen Decoction) or Guipi Wan (Restore the Spleen Pill). Single abdominal distension mostly belongs to the Fu organs; Fu organs should be unblocked, avoiding cloying and consolidating tonics. Herbs include Shayuanzi (Astragalus Complanatus Seed), Yizhi (Alpinia Oxyphylla Fruit), Fuling (Poria), Niuxi (Achyranthes Root), Zhike (Aurantium Fruit), Cheqianzi (Plantago Seed), Sharenqiao (Amomum Shell), Mahren (Hemp Seed), Yuliren (Prunus Seed), Jiaomu (Pepper Seed), Xingren (Apricot Seed), Gualouren (Trichosanthes Seed), and Dafupi (Areca Pericarp). Single abdominal distension is colloquially called Spider Distension; abdominal swelling with thin limbs results from extreme Spleen Qi deficiency and damage to the True Zang. The statement in the text regarding "belonging to Fu" should be interpreted flexibly. In women, edema preceding amenorrhea is Water Division; amenorrhea preceding edema is Blood Division. For Water Division, use Wupi Yin (Five-Bark Decoction) delivered with Tongjing Wan (Menstruation-Unblocking Pill). For Blood Division, use Tongjing Wan. Wheezing preceding distension indicates treatment should target the Lung, using Wupi Wuzi Yin (Five-Bark Five-Seed Decoction). Distension preceding wheezing indicates treatment should target the Spleen, using Lizhong Tang (Regulate Middle Decoction) or Shenqi Wan (Kidney Qi Pill). Edema starting in the abdomen and spreading to limbs is treatable; starting in limbs and returning to the abdomen is fatal. All Water Division diseases involve Yin excess, differing from Qi Division. Edema symptoms show bright luster, thin smooth skin, slow onset, usually ascending from below, flesh feels like mud upon pressure, and swelling has distinct boundaries. Qi Division diseases can be either Yin or Yang syndromes; Water Division diseases are mostly Yin syndromes. For deficiency edema with difficult urination, use Xiangsu San (Fragrant Su Powder). For dampness excess failing to transform, use Weiling Tang (Guiling Decoction). For damp stagnation with central fullness, use Baizhu Wan (Atractylodes Pill) or Zhizhu Wan (Atractylodes and Aurantium Pill). Etiology involving the Lung uses Wupi Yin (Five-Bark Decoction). Etiology involving the Spleen uses Buzhong Yiqi Tang (Center-Boosting Qi-Supplementing Decoction). Kidney Yin deficiency with inability of True Yang to transform uses Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Niuxi (Achyranthes Root) and Cheqianzi (Plantago Seed). Kidney Mingmen Fire decline unable to vaporize the gate uses Shenqi Tang (Kidney Qi Decoction). Water is supreme Yin; its branch is the Lung, its root is the Kidney, its control is the Spleen. Kidney deficiency leads to gate closure failure, causing water to rebel and flood upward; the Spleen cannot control it and is soaked by water, causing muscle edema; the Lung cannot transform it and is overwhelmed by water, causing wheezing and急促 breathing. These are harms of Yin excess. The Classics state the Bladder stores fluids, and Qi transformation allows them to exit. This Qi transformation refers to the True Fire of the Right Kidney Mingmen. Fire decline fails to vaporize the Kidney gate, leading to water accumulation. Shenqi Tang uses Guizhi (Cinnamon Twig) and Fuzi (Aconite Root) to vaporize the gate, allowing accumulated water to descend, as Yang governs opening. This method treats not only edema but also distension; the key lies in unblocking Yang.
For lower Qi deficiency and Middle Jiao Qi congestion, if one wishes to disperse fullness, fear of emptying the lower arises; if one wishes to tonify the lower, fullness worsens in the middle. One should use Qijun Tang (Qijun Decoction) to strongly tonify the lower and dredge the middle. Thus, with strong tonification, Qi ascends to open the middle, Middle Jiao operations resume, stagnation clears, central fullness vanishes, and lower deficiency becomes solid. This is the Classic principle of "treating obstruction with obstruction" (Sei Yin Sei Yong). For edema with wheezing and distress, clearing Lung Qi is primary. Since birds and beasts without lungs do not produce urine, treating edema requires clearing the Lung.
Distension and edema syndromes must distinguish Yin and Yang. Damp-heat congestion belongs to Yang; turbid Qi stagnation belongs to Yin. Yang syndromes are painful upon pressure; Yin syndromes are painless upon pressure. Yang syndromes originate in the Middle Jiao; Yin syndromes originate in the Lower Jiao. Yang syndromes are treated in the Fu organs; Yin syndromes are treated in the Zang organs. Yang syndromes require clearing; Yin syndromes require warming. A difference of a hair's breadth leads to a thousand miles; this must not be ignored.
Edema syndromes are easy to treat; distension syndromes are difficult to treat. Edema distinguishes Yang Water and Yin Water; Yang Water is easy to treat, Yin Water is difficult. Distension syndromes have more complexities; first distinguish between tangible and intangible forms. Intangible forms require light agents to promote circulation; tangible forms require heavy agents to attack. Further distinguish whether in collaterals or meridians, Fu organs or Zang organs; meridals/collaterals are easy to treat, Zang/Fu organs are difficult. Further observe excess and deficiency; excess is treatable, deficiency is difficult. This is the general outline. Then differentiate etiology: cold, heat, damp, phlegm, Qi, Blood, stagnation, accumulation, and treat accordingly.
Xu Lingtai stated: "Distension and fullness syndromes, even if righteous Qi is deficient, ultimately belong to pathogenic excess; ancients were cautious about using tonification methods. Furthermore, distension must involve damp-heat; if distension/fullness has tangible matter, gentle purging is appropriate. Damp-heat is intangible; stagnation/accumulation has substance; this must be distinguished." Distension in the intestines/stomach worsens after eating; treatment targets unblocking the Fu organs. If bowel movements and urination are regulated, distension resides in the Zang organs, i.e., Liver, Spleen, Kidney, etc., as discussed in the *Lingshu*. Or distension exists outside the intestines in the Triple Burner fatty membranes. The *Lingshu* states distension is always outside the Zang-Fu organs, pushing aside the organs and expanding the chest and hypochondrium. Treatment lies in distinguishing Yin/Yang, excess/deficiency, upper/lower, interior/exterior, skin/collaterals, Qi/Blood/Water divisions. Etiologies include cold, heat, damp, depression, phlegm-fluid, stagnation. Whether tangible or intangible, treatments may include sweating, diuresis, separation/elimination, acrid-draining, purifying-descending, warming-unblocking, lifting, dredging-benefiting, tonifying-holding, opening-depression, gentle-purging, softening-hardness-resolving-masses, regulating-stasis-guiding-stagnation. The key is promoting circulation; avoid conservative tonification. If edema on the body and face has largely subsided but water-damp infiltration in joints and feet remains, acupuncture should be used to drain the flow; this is an exit route.