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Huangdi asked: How do the pulses at the Cun Kou (Inch Port) position indicate distension? Qibo replied: When the pulse is large, firm, straight, and choppy, it indicates distension. Huangdi asked: How can one know which Zang or Fu organ is affected by distension? Qibo said: The Yin meridians correspond to the Zang organs, and the Yang meridians correspond to the Fu organs. Huangdi asked: Does the Qi that causes distension reside within the blood vessels, or inside the Zang and Fu organs? Qibo said: It involves both, but this is not the abode of distension. Huangdi said: I wish to hear about the abode of distension. Qibo said: Distension occurs outside the Zang and Fu organs, pushing against them, expanding the chest and hypochondrium, and causing the skin to swell; hence it is named "distension." Huangdi asked: The Zang and Fu organs are located internally, like precious vessels stored in boxes and cabinets, each having its specific place, different names but residing in the same region, with distinct Qi. I wish to understand the reason behind this. Qibo said: The chest and abdomen are the city walls for the Zang and Fu organs. Danzhong (Conception Vessel 17) is the inner palace of the Heart Master. The Stomach is the Great Granary. The pharynx and lower abdomen are the passages for transmission. The five orifices of the Stomach are the gates of the neighborhoods. Lianquan (Conception Vessel 23) and Yuying are the pathways for body fluids. Therefore, the Five Zang and Six Fu organs have their boundaries, and their diseases present with distinct shapes. Ying Qi (Nutritive Qi) circulates within the vessels; when Wei Qi (Defensive Qi) rebels, it causes Mai Zhang (Vessel Distension). When Wei Qi moves along with the blood vessels through the muscle intervals, it causes Fu Zhang (Skin Distension). Treatment involves reducing the Zusanli (Stomach 36) point. For recent onset, one application suffices; for long-standing cases, three applications suffice. Regardless of deficiency or excess, the skill lies in rapid reduction. Huangdi asked: I wish to hear the manifestations of various distensions. Qibo said: Heart distension presents with vexation, shortness of breath, and restless sleep. Lung distension presents with empty fullness, wheezing, and coughing. Liver distension presents with fullness and pain under the hypochondrium radiating to the lower abdomen. Spleen distension presents with hiccups, heaviness and stuffiness in the four limbs, and a heavy body making it difficult to wear clothes. Kidney distension presents with abdominal fullness radiating to the back with a sense of discomfort, and pain in the waist and thighs. Stomach distension presents with abdominal fullness, epigastric pain, smelling burnt odors from the nose, difficulty eating, and constipation. Large Intestine distension presents with borborygmus and gurgling pain; if exposed to cold in winter, it leads to diarrhea with undigested food. Small Intestine distension presents with lower abdominal fullness radiating to the waist with pain. Bladder distension presents with lower abdominal fullness and urinary retention. Sanjiao (Triple Burner) distension presents with Qi filling the skin, bulging like a drumshell but not hard. Gallbladder distension presents with pain and fullness under the hypochondrium, bitter taste in the mouth, and frequent sighing. For all these types of distension, the principle is one: knowing the reversal and smooth flow ensures the number of needle insertions is accurate. Reducing deficiency and tonifying excess incorrectly causes Shen (Spirit) to leave its chamber, inviting pathogenic factors and losing righteousness, destabilizing the True Qi; this failure by crude practitioners is called premature death. Tonifying deficiency and reducing excess allows Shen to return to its chamber and fills the emptiness for a long time; this is called a skilled practitioner. Huangdi asked: How does distension arise, and why is it named so? Qibo said: Wei Qi on the body usually follows the vessels and circulates through the muscle intervals. Its movement has reversal and smoothness, with Yin and Yang following each other, achieving harmony with Heaven, regulating the Five Zang organs, ordering the Four Seasons, and digesting the Five Grains. However, if Jue Qi (Rebellious Qi) arises below, Ying and Wei Qi stagnate, Cold Qi rebels upward, True Qi and Pathogenic Qi attack each other, and the two Qi clash, forming distension. Huangdi asked: How can confusion be resolved? Qibo said: By aligning with True Qi and integrating three aspects, one can understand. Huangdi asked: You said "regardless of deficiency or excess, the skill lies in rapid reduction, one for recent, three for distant." Now, if three applications fail to work, where is the error? Qibo said: This refers to needling sinking into the muscular adipose tissue without hitting the Qi acupoint. If the Qi acupoint is not hit, Qi becomes internally blocked; if it does not sink into the Huang (membranous) layer, Qi cannot move; if Qi floats upward or stays in the flesh, Wei Qi becomes chaotic, and Yin and Yang reverse. In cases of distension, if reduction should be performed but is not, Qi will not descend. One must change the approach; stop when Qi descends. If Qi does not descend, repeat until it does, ensuring safety and avoiding danger. In treating distension, one must carefully diagnose: reduce when appropriate, tonify when appropriate, just as a drum responds instantly to the beat. How could Qi fail to descend?

For Heart distension, Xinshu (Bladder 15) is the primary point, also taking Lieque (Lung 7). For Lung distension, Feishu (Bladder 13) is the primary point, also taking Taiyuan (Lung 9). For Liver distension, Ganshu (Bladder 18) is the primary point, also taking Taichong (Liver 3). For Spleen distension, Pishu (Bladder 20) is the primary point, also taking Taibai (Spleen 3). For Kidney distension, Shenshu (Bladder 23) is the primary point, also taking Taixi (Kidney 3). For Stomach distension, Zhongwan (Conception Vessel 12) is the primary point, also taking Zhangmen (Liver 13). For Large Intestine distension, Tianshu (Stomach 25) is the primary point. For Small Intestine distension, Zhongliao (Bladder 32) is the primary point. For Bladder distension, Qugu (Conception Vessel 2) is the primary point. For Sanjiao distension, Shimen (Conception Vessel 6) is the primary point. For Gallbladder distension, Yanglingquan (Gallbladder 34) is the primary point. For distension of the Five Zang and Six Fu organs, Zusanli (Stomach 36) is taken. Zusanli is the key acupoint for treating distension.