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[Pulse]
A pulse that is slow and slippery indicates distension. A pulse that is full and tight is termed distension; this represents Yang containing Yin, so purgation should be used. The Dubo (ST42) pulse is tight and floating; tightness indicates pain and abdominal hardness/fullness, while floating indicates deficiency with borborygmus. A string-taut and slow pulse indicates hardness below the heart. Furthermore, Liver Wood overacting on Spleen Earth causes Qi stagnation and phlegm accumulation, blocking Zang Qi and preventing Fu Qi from flowing freely, resulting in chest distension and obstruction. A floating and rapid pulse: floating indicates deficiency, while rapidity indicates excess. In Fengshui (Wind Water) and Pishui (Skin Water), the pulse is floating. A deficient, tight, and choppy pulse indicates distension. Excessive worry and thought cause Qi condensation in the Spleen and Lungs, leading to imbalance between the Large Intestine and Stomach, resulting in distension. A deep pulse is seen in Shuishui (Stone Water) and Huanghan (Yellow Sweat). A floating and slippery pulse is named Fengshui (Wind Water). A floating and slow pulse: floating indicates heat, slow indicates dampness; when damp-heat intertwines, Shuishui (Stone Water) inevitably forms. A string-taut and tight pulse: string-taut means Wei Qi cannot circulate, allowing water to flow into the intestines. When the abdomen is large and drum-like, a solid pulse indicates survival, while a deficient pulse indicates death; a surging and large pulse indicates survival, while a minute pulse indicates death. Abdominal distension with bloody stool, where the pulse is large but intermittent, or extremely small and rapid, both indicate death. In Zhong'e (Sudden Evil Attack), with abdominal distension and limb fullness, a large and slow pulse indicates survival, a tight, large, and floating pulse indicates death, while a tight, fine, and minute pulse can also indicate survival.

[Etiology and Syndromes]
The etiology of swelling and distension starts as one but changes into two, all originating from Spleen-Stomach Earth.
Etiology of Edema: It is generally due to Spleen Deficiency failing to control water. The Kidney is the gate of the Stomach; if it fails to open, water floods and wanders, penetrating the meridians. Initially, there is slight swelling above the eyes, pulsation of the neck vessels, coughing, coldness in the inner thighs, and distension in the calves; only then does the abdomen enlarge, indicating that water pathology has formed. Pressing the abdomen leaves an indentation that rises slowly, resembling a bag of water. Shortness of breath preventing lying flat indicates Heart Water; urgency and fullness in the lower abdomen indicate Small Intestine Water; duck-dung-like loose stools indicate Lung Water; alternating deficiency and excess states indicate Large Intestine Water; hypochondriac pain indicates Liver Water; bitter taste and dry throat indicate Gallbladder Water; heaviness in the four limbs indicates Spleen Water; astringent urination indicates Stomach Water; lower back pain and cold feet indicate Kidney Water; abdominal urgency with emaciated limbs indicates Bladder Water. These ten types of water are called Zhengshui (Standard Water); treatment should be based on examining the pulse and syndrome, differentiating by meridians.
Fengshui (Wind Water): Pulse is floating with aversion to wind, associated with the Liver.
Pishui (Skin Water): Pulse is also floating but without aversion to wind, accompanied by wheezing, thirst, and pitting edema, associated with the Lung.
Shuishui (Stone Water): Pulse is deep, without aversion to wind, associated with the Kidney.
Huanghan (Yellow Sweat): Pulse is deep and slow, with fever and chills predominating, associated with the Spleen.

[Therapeutic Methods]
Swelling above the waist should be treated with diaphoresis (sweating); swelling below the waist should be treated with promoting urination. The main treatment principle is to tonify Spleen Qi to strengthen transportation and transformation, using Ginseng and Atractylodes Macrocephala Rhizome, assisted by Scutellaria Root and Ophiopogon Tuber to restrain Liver Wood. For abdominal distension, add Magnolia Bark; for stagnant Qi, add Ambergris and Costus Root, ensuring free flow to ensure recovery. "Opening the ghost door" (diaphoresis) and "cleansing the residence" (promoting urination) refer to this method. For external dampness swelling, add Prepared Aconite Root when the pulse is deep and fine. For swelling and pain due to interior cold, add Processed Aconite Root.
Distension and fullness result from the failure of Spleen Earth to transport and transform. Although the Stomach receives grain, it cannot transform essence and distribute them; accumulation occurs without dispersal, blockage ensues in the collaterals, clear and turbid Qi mix, dampness stagnates in heat, and heat generates more dampness, eventually forming distension.
Cold-dampness may also suppress and obstruct within Spleen Earth, accumulating without dispersal to cause distension. This corresponds to the Classic saying: "Cold in the Zang organs generates fullness diseases."
Additionally, Five Accumulations, Phlegm-fluid retention, or undigested food may accumulate without dispersal, all leading to distension.
Heart Distension: Vexation, shortness of breath, restless sleep.
Lung Distension: Deficient wheezing, cough, and fullness.
Liver Distension: Hypochondriac pain radiating to the lower abdomen.
Spleen Distension: Frequent hiccups, limb weakness, heavy body unable to bear clothes, restless sleep.
Kidney Distension: Pain radiating to the back, lower back and thigh pain.
Stomach Distension: Abdominal fullness, epigastric pain, aversion to food, smelling burnt odors, difficult defecation.
Large Intestine Distension: Borborygmus and pain, winter cold with undigested stool diarrhea.
Small Intestine Distension: Lower abdominal fullness radiating to the lower back with pain.
Bladder Distension: Lower abdominal Qi fullness with urinary difficulty.
Sanjiao Distension: Qi fullness under the skin.
Gallbladder Distension: Hypochondriac distension and pain, bitter taste, frequent sighing.
Fu Distension: Cold Qi lodging in the skin, swelling but not hard, large abdomen and body, unchanged color, non-pitting upon pressure.
Gu Distension (Drum Distension): Abdominal distension and general body enlargement, sallow yellow complexion, prominent abdominal veins.
Changqin (Intestinal Polyp/Tumor): Cold Qi lodging outside the intestines, battling with Wei Qi, Qi fails to circulate, binding internally, forming a mass like an egg, growing to the size of pregnancy, hard upon pressure, movable upon pushing, with irregular menstruation.
Shijia (Stone Mass): Cold Qi knotting at the Zi Men (cervical os), causing blockage, lochia/blood fails to discharge, accumulating and enlarging daily like a pregnancy, with irregular menstruation, arising in the Baozhong (uterus). Both occur in women and can be expelled via guiding methods.

[Treatment]
For deficiency, tonify Spleen to nourish Lung, drain dampness to disperse Qi. Use Ginseng and Atractylodes Macrocephala Rhizome, assisted by Pingwei San and Poria. For heat, add Scutellaria Root and Coptis Rhizome; for blood deficiency, use Four Substances Decoction; for fixed blood stasis, use Peach Kernel.
For Wind-Cold exterior pathogens entering the interior, transforming into heat causing Stomach excess and fullness, use Da Chengqi Tang (Major Order the Yellow Decoction) to purge. For Phlegm accumulation and retained food, use resolving and guiding methods, or Dahuang Wan (Rhubarb Pill) to purge. This corresponds to the Classic saying: "Remove accumulated decay."
Beyond the above, there is Cold Stomach with Heat Intestine, causing distension and diarrhea. Stomach cold causes Qi contraction and stagnation leading to distension; Intestine heat causes fluids and grain to fail to gather leading to diarrhea. Use Coptis Rhizome, Costus Root, Rhubarb, Magnolia Bark, Poria, Tangerine Peel, and Evodia Fruit.
There is also Heat Stomach with Cold Intestine, causing pain and distension. Stomach heat causes hunger and rapid digestion; Intestine cold causes blood coagulation and vessel tension, hence pain and distension.
Neck swelling, chest swelling, and chest distension are all due to Qi not flowing smoothly, with excess in the upper jiao.
Generalized swelling with cold sensation, chest oppression, inability to eat, with pathology in bone joints, should be treated with diaphoresis.
Contraindications/Prognosis: Black spots on the face indicate Lung collapse; no lines in palms indicate Heart collapse; protruding umbilicus indicates Spleen collapse; swelling of heels indicates Liver collapse; abdominal fullness with visible blue veins indicates Kidney collapse.
Collapse of Ying and Wei with edema indicates death; swollen lips and scorched teeth indicate death; sudden severe pain with dark cyanotic face indicates death; protruding umbilicus indicates death; swelling of scrotum and penis indicates death; absent pulse with open mouth and edema indicates death; foot dorsum swelling like a bowl indicates death.

Bianshui Tang (Water-Changing Decoction) treats swelling and distension.
Atractylodes Macrocephala Rhizome, Poria, Alisma Rhizome (each 2 liang), Prunus Sesquipedalis Seed (2 qian).
Decoct with Ginger Juice, adjust with Ginger and Atractylodes, belonging to Jianzhong (Establish the Middle) category.

Chushi Wan (Cudrania Pill) treats distension.

Muxiang San (Costus Powder) treats swelling.
Costus Root, Kansui Root, White Pharbitis Seed (each 1 liang).
Grind into powder (3 qian per dose). Slice one pair of pig kidneys, sprinkle powder inside, roast until cooked, take on an empty stomach. Apply Kansui powder to the abdomen externally, drink a little Licorice water.

Shizao Wan (Ten Jujube Pill) treats swelling and distension.

Wupi San (Five Barks Powder) treats Pishui (Skin Water) swelling.
Areca Peel, Mulberry Root Bark, Poria Skin, Ginger Skin, Tangerine Peel, Costus Root.

Xiaozhong Wan (Reduce Swelling Pill) contains Talcum, Atractylodes Macrocephala Rhizome, Akebia Stem, Pharbitis Seed, Poria, Pinellia Tuber, Tangerine Peel, Costus Root, Clove, and Lupulin.
Make pills with wine paste, take with Ophiopogon Decoction.

Zhongman Fenxiao Wan (Middle Fullness Dispersing Decoction Pill) treats Heat Distension, Drum Distension, and Qi Distension.
Scutellaria Root (scraped, 1 liang), Coptis Rhizome (stir-fried, 1 liang), Turmeric, Atractylodes Macrocephala Rhizome, Ginseng, Polyporus, Licorice Root (each 1 liang), Poria, Amomum Fruit, Tangerine Peel (each 3 qian), Immature Bitter Orange, Pinellia Tuber (each 5 qian), Magnolia Bark (1 liang).

Guangshu Kuijian Tang (Curcuma Softening Hardness Decoction) treats distension with stone-like masses, upper body wheezing, and edema.
Magnolia Bark, Cardamom Seed, Angelica Sinensis Tail, Scutellaria Root, Alpinia Oxyphylla Fruit (each 5 qian), Licorice Root, Coptis Rhizome, Atractylodes Macrocephala Rhizome, Bupleurum Root, Medicated Leaven, Alisma Rhizome (each 3 qian), Evodia Fruit, Green Tangerine Peel, Tangerine Peel (each 2 qian), Pinellia Tuber (7 qian), Peach Kernel, Sappanwood, Costus Root, Safflower (each 1 qian), Pharbitis Seed (raw and stir-fried, half liang each), Kansui Root (half liang), Gold Sand (3 qian), Atractylodes Macrocephala Rhizome (1 liang).
Decoct and take.

Muxiang Taqi Wan (Costus Settling Qi Pill) treats distension.
Pepper, Cardamom (wrapped in flour, roasted), Costus Root (each 3 qian), Scorpion Tail Tip (3.5 qian, detoxified).

Dabu Zhongqi Xingshi Sanqi Tang (Great Tonification of Middle Qi, Dispersion of Dampness and Qi Decoction)

Michuan Shishui Wan (Secretly Transmitted Ten Waters Pill) followed by Zunzhong Wan to residual water.
Stir-fried Sweet Descurainia Seed, Alisma Rhizome, Croton Seed (shelled, oil removed), Vine-boiled Kansui Root, Genkwa Flower (vine-fried), Kansui Root (vine-fried), Mulberry Root Bark, Sichuan Pepper, Poria, Realgar.
Take 3 qian at dawn with water, press with meat to prevent nausea.

Cheshui Hulu Wan (Water-Draining Gourd Pill) uses Yisaoguang (Galinsoga) as precious ingredient.
Costus Root, Clove (each 3 qian), Agarwood, Black and White Pharbitis Seeds (each 2 qian), Aurantium, Litsea Berry, Angelica Dahurica, Angelica Sinensis (each 1 qian).
Make pills with tea.

Zunzhong Wan (Respectful Center Pill) treats Gu Distension (parasitic abdominal distension). Effective for abdominal distension with edema, rebellious Qi with panting, astringent urination, constipation, and critical deficiency.
Agarwood, Clove, Ginseng, Areca Nut, Costus Root, Green and Tangerine Peel, Immature Bitter Orange, White Pharbitis Seed, Akebia Stem, Plantago Seed, Bitter Descurainia Seed, Red Poria (each 4 qian), Pepper, Goldthread Rhizome, White Cardamom, Scorpion Tail, Talcum (each 2.5 qian), Radish Seed (stir-fried, 6 qian), White Dung (1 qian), Prunus Sesquipedalis Seed (half liang, peeled).
Make pills with Ginger Juice paste, take with Ginger Decoction.

Qi Fen (Qi Division) is similar to Xiongbi (Chest Bi) and Zhongman (Middle Fullness). Zhongman is Qi deficiency; Xiongbi is Qi excess; Qi Fen involves Phlegm-fluid retention.
When Ying and Wei are unfavorable, abdominal fullness and hypochondriac borborygmus follow each other; Qi turns to the Bladder, exhausting Ying and Wei; Yang Qi blockage causes cold body, Yin Qi blockage causes bone pain; early Yang passage causes aversion to cold, early Yin passage causes numbness and paralysis; when Yin and Yang harmonize, Qi flows, Great Qi rotates, and pathogenic Qi disperses; excess leads to flatus, deficiency leads to enuresis, named Qi Fen. Cun Kou pulse slow and choppy: slow indicates Qi deficiency, choppy indicates Blood deficiency; Cold Qi and Phlegm knot, generating water-drink.
In women, if menstruation stops first then disease occurs, it is named Blood Fen; if water disease occurs first then menstruation stops, it is named Water Fen.

Similar Categories: Dampness swelling is common, derived from Zhengshui, including Fengshui, Pishui, Shuishui, Huanghan, etc. Entering the Water Gate, conditions like Spleen Qi leakage, Hongjiaojiao (Charley Horse), skin fullness/distension, Changqin, Shijia, Qi Fen, and Blood Fen are similar.

Category Differentiation:
Distension: Stomach affected by Wind, Spleen affected by Cold, Dampness invasion, Heart Bi, Liver Deficiency, Spleen Injury, Spleen Heat, Fluid Accumulation, Female Jaundice.
Lower Abdominal Distension: Kidney Heat, Sanjiao Deficiency-Cold, Ulcers/Abscesses, Female Labor Jaundice.
Facial Swelling: Lung affected by Wind, Kidney affected by Wind, Stomach Cold, Lung Water.

Discussions:
Seven Types of Swelling:
1. Lung Qi blocked outside the membranes, circulation obstructed, generalized edema, floating pulse; treat by regulating Lung and unblocking Qi.
2. Male Zang deficiency or Female Blood deficiency, injury from cold-toxic substances forming accumulations, blocking Qi channels, abdominal urgency and panting, sometimes limbs not swollen but only abdomen distended, string-taut pulse; treat by resolving accumulations.
3. Chronic Spleen Cold not healing for years, transmitting to edema. Internal latent heat causes diarrhea; when heat enters Spleen via deficiency, causing urgent chest/abdominal distension, rapid pulse; treat by clearing heat.
4. Spleen governs muscles; flesh like mud, non-pitting, Earth dampness disease, deep pulse; treat by drying Spleen.
5. Spleen Deficiency failing to control Kidney Water, Spleen dampness like mud, deep-slow pulse; treat by soothing Spleen Yuan and benefiting water passages.
6. Injury from Wind-Damp or Cold-Damp causing swelling, Qi-Blood stagnation, floating-slow pulse; treat by dispersing Wind-Damp.
7. Long-term illness Qi deficiency causing facial swelling, weak limbs, reckless Qi movement. Postpartum or post-menstrual occurrence indicates Qi deficiency; treat by regulating Qi and nourishing Blood.
Jieyang (Yang Knotting) causes swelling of four limbs. Heat excess causes swelling; four limbs are root of all Yang. Yang knots internally, cannot enter Yin, Heat evil stagnates in four limbs, constipation, this is Heat, not Water. Use Rhinoceros Horn, Scrophularia Root, Forsythia Fruit, Cimicifuga Rhizome, Ophiopogon Tuber, Akebia Stem, Mirabilite.
Hypochondriac fullness, abdominal pain, or chest distension may be due to Meridian Qi stagnation; e.g., hypochondriac fullness indicates Shaoyang Meridian Qi stagnation. Others follow this pattern.
Head, arm, and chest swelling are all due to Qi not flowing smoothly, excess in the upper jiao.
Generalized swelling with cold, chest oppression, inability to eat, pathology in bone joints, treat with diaphoresis.