肿胀虽均由脾胃之伤，而实有不同。气溢皮肤则为肿，气入于脏则为胀。人身心肺为阳而在上，肝肾为阴而居下，
脾胃为阴而居中为土。经曰∶饮食入胃，游溢精气，上输于脾，脾气散精，上归于肺，通调水道，下输膀胱，水精
四布，五经并行。是脾具坤静之德而有干健之运也，故能使心肺阳降，肝肾阴升，天地交泰，永无肿胀之病。此症因
内伤饮食，外感风寒，致伤脾胃，十早。则清浊相混，隧道壅塞，瘀郁成热。热留已久，气化成湿，湿热相生，遂成
浮肿、胀满。其为肿也，有食积、有水积；有泻痢日久脾虚，有伤寒下早。其为胀也，有痰热，有疳气，有食积。痞
癖积肿在腰以上宜汗，腰以下宜利小肠。胀宜消导，有分道，有利小便，酌其虚实寒热而调治。
肿胀主方
茯苓皮 浓朴 苍术 半夏 香附（以上健脾） 枳实 神曲 山楂 青皮（以上治积） 卜子（泄气）
猪苓 泽泻（利小便） 升麻 柴胡（升提气）
食积肿加槟榔、蓬术、麦芽、山楂、神曲。
先下水肿加木通、车前子、滑石，小儿实食积，水肿多耳。伤寒下早，先调脾胃，期脏气充实，
宜人参、山药、薏苡仁，久则肉蔻、诃子，寒则干姜、木香、丁香，热则黄芩、黄连，佐本方，本方仍去消食药。风邪
入肺而气不宣通，肺叶胀，亦能作肿，以肺主皮毛故也。先自眼下卧蚕肿起，喘急，宜小红丸下之，后用桑白皮、桔
梗、杏仁、天花粉、黄芩、贝母、枳壳、木通、防风、黄 二分。防风泻肺实，得黄 而功益神，故用 。胀乃痰热，
不用本方，宜半夏、贝母、胆星、枳实（消痰）。有风，防风、大腹皮、苏子、卜子、桔梗（利气）、猪苓、泽泻、
车前（行水）。先服小红丸，食积先服小黑丸，后用本方。寒热虚热宜本方去苍术，加炒黄芩、黄连（利水）、猪苓、
泽泻、木通、赤芍、车前、滑石、葶苈、商陆、木瓜。补脾，人参、白术、山药、薏苡仁、枳实、浓朴。消食，枳实、
青
皮、槟榔、蓬术、山楂、麦芽、神曲、三棱（分气）、香附、木香、藿香。泄气，大腹皮、苏子、桔梗、卜子。肺胀，桑
白皮、杏仁。上身宜汗，柴胡、升麻、干葛；下体宜利小便，阳水宜黄芩、黄连、山栀、连翘，阴水宜丁香、香附、木
香、
草果、浓朴、干姜。风虽胜湿，宜防风、羌活、蓁艽、椒目、天麻；又能健脾，陷下，升麻、柴胡；有痰宜利痰，贝母、
半夏、胆星、海藻、昆布。
内消丸 治小儿五疳八痢，消食化积，除惊风外，百病可服。
三棱 蓬术 香附（三味醋拌炒） 槟榔 煨
草果 青皮 枳壳 枳实（二味麸炒） 木香 去核山楂 炒神曲 炒麦芽 炒砂仁 去白陈皮。
等分为丸，砂糖汤调服。
辰砂丸（又名大红丸）
川贝母 胆星 天花粉 桔梗 苦杏仁 枳壳 黄芩（各四两） 前胡 防风 制半夏 陈皮 全蝎 地骨皮
山栀（各三两） 黄连 元参（各二两）
痘痧年不用连栀，此药消痰解毒，发散痘痧，蜜丸约重一钱，辰砂为衣，每服一丸，薄荷汤化下。
Although swelling (Edema and Distension) is caused by damage to the Spleen and Stomach, there are actual differences. When Qi overflows into the skin, it forms swelling (Zhong); when Qi enters the Zang organs, it forms distension (Zhang). In the human body, the Heart and Lungs are Yang and located superiorly; the Liver and Kidneys are Yin and located inferiorly; the Spleen and Stomach are Yin, located centrally, and correspond to Earth in the Five Elements. The Classics state: "When food and drink enter the Stomach, their essence floats and overflows, is transported upward to the Spleen, the Spleen scatters the essence, which returns upward to the Lung, regulates the water passages, and transports downward to the Bladder. Water essence is distributed throughout the four directions, and the five meridians run in parallel." This means the Spleen possesses the stillness of Kun (Earth) and the vigorous movement of Qian (Heaven), thereby enabling the Yang of the Heart and Lung to descend and the Yin of the Liver and Kidney to ascend. When Heaven and Earth interact harmoniously, diseases of swelling never occur.
This condition arises from internal injury due to diet and external contraction of Wind-Cold, damaging the Spleen and Stomach. If purgatives are used too early in the course of a Cold Damage disease, Clear and Turbid Qi become mixed, the collaterals and tunnels become obstructed, and stagnation leads to heat. Prolonged retention of heat causes Qi transformation to generate Dampness; Dampness and Heat generate each other, eventually resulting in edema and fullness/distension. Regarding swelling, causes include Food Stagnation or Fluid Retention; prolonged diarrhea/dysentery leading to Spleen Deficiency; or premature purgation in Cold Damage. Regarding distension, causes include Phlegm-Heat, Infantile Malnutrition (Gan Syndrome), or Food Stagnation. For masses, fixed lumps, and swelling above the waist, sweating methods are appropriate; below the waist, draining the Small Intestine (diuresis) is appropriate. Distension should be treated with resolving and guiding-out methods. Treatment pathways vary: some promote urination. One must assess deficiency/excess and cold/heat to adjust treatment accordingly.
Main Formula for Swelling and Distension:
Poria Peel (Fuling Pi), Magnolia Bark (Houpo), Atractylodes Rhizome (Cangzhu), Pinellia Tuber (Banxia), Cyperus Rhizome (Xiangfu) [Above strengthen Spleen]; Immature Bitter Orange (Zhishi), Medicated Leaven (Shenqu), Hawthorn Fruit (Shanzha), Green Tangerina Peel (Qingpi) [Above treat stagnation]; Radish Seed (Boluozi/Laifuzi) [Drain Qi]; Polyporus (Zhuling), Alisma Rhizome (Zexie) [Promote urination]; Cimicifuga Rhizome (Shengma), Bupleurum Root (Chaihu) [Lift Qi].
For swelling due to Food Stagnation, add Areca Seed (Binglang), Curcuma Zedoaria Rhizome (Ezhu), Malt (Maita), Hawthorn Fruit (Shanzha), Medicated Leaven (Shenqu).
For initial water edema, add Akebia Caulis (Mutong), Plantago Seed (Cheqianzi), Talcum (Huashi), as pediatric solid-food stagnation often accompanies edema.
If caused by premature purgation in Cold Damage, first regulate the Spleen and Stomach until organ Qi is substantial. Then use Ginseng Radix (Renshen), Chinese Yam (Shanyao), Coix Seed (Yiyiren). For chronic cases, use Myristica Seed (Roudoukou), Chebula Fruit (Hezi). For cold patterns, use Dried Ginger (Ganjiang), Aucklandia Root (Muxiang), Clove (Dingxiang). For heat patterns, use Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), adjuvanted with the main formula, but remove food-resolving herbs from the main formula.
If Wind pathogen invades the Lung causing Qi obstruction and lung leaf distension, swelling may also occur because the Lung governs the skin and hair. Symptoms typically begin with swelling under the eyes (Wocan area), accompanied by wheezing and urgency. Use Xiaohong Wan (Little Red Pill) to purge, then use Mulberry Root Bark (Sangbaipi), Platycodon Root (Jiegeng), Apricot Seed (Xingren), Trichosanthes Root (Tianhuafen), Scutellaria Root (Huangqin), Fritillaria Bulb (Beimu), Immature Bitter Orange (Zhike), Akebia Caulis (Mutong), Saposhnikovia Root (Fangfeng), and Phellodendron Bark (Huangbo - 2 fen). Fangfeng drains Lung excess; combined with Huangbo, its efficacy is enhanced.
If distension is due to Phlegm-Heat, do not use this main formula. Instead, use Pinellia Tuber (Banxia), Fritillaria Bulb (Beimu), Arisaema with Bile (Danningxing), Immature Bitter Orange (Zhishi) [Resolve phlegm]. If Wind is present, use Saposhnikovia Root (Fangfeng), Betel Nut Stem (Dafupi), Perilla Fruit (Suzi), Radish Seed (Boluozi), Platycodon Root (Jiegeng) [Benefit Qi], Polyporus (Zhuling), Alisma Rhizome (Zexie), Plantago Seed (Cheqian) [Move Water]. Take Xiaohong Wan first; for food stagnation, take Xiaohei Wan first, then use the main formula.
For cold, heat, deficiency, or empty-heat patterns, use the main formula removing Cangzhu, adding fried Scutellaria Root (Huangqin), fried Coptis Rhizome (Huanglian) [Drain water], Polyporus (Zhuling), Alisma Rhizome (Zexie), Akebia Caulis (Mutong), Red Peony Root (Chishao), Plantago Seed (Cheqian), Talcum (Huashi), Lepidium Seed (Tinglizi), Phytolacca Root (Shanglu), Papaya (Mugua). To tonify Spleen, use Ginseng Radix (Renshen), Atractylodes Macrocephala Rhizome (Baizhu), Chinese Yam (Shanyao), Coix Seed (Yiyiren), Immature Bitter Orange (Zhishi), Magnolia Bark (Houpo). To resolve food, use Immature Bitter Orange (Zhishi), Green Tangerina Peel (Qingpi), Areca Seed (Binglang), Curcuma Zedoaria Rhizome (Ezhu), Hawthorn Fruit (Shanzha), Malt (Maita), Medicated Leaven (Shenqu), Burreed Tuber (Sanleng) [Divide Qi], Cyperus Rhizome (Xiangfu), Aucklandia Root (Muxiang), Patchouli Herb (Huoxiang). To drain Qi, use Betel Nut Stem (Dafupi), Perilla Fruit (Suzi), Platycodon Root (Jiegeng), Radish Seed (Boluozi). For Lung distension, use Mulberry Root Bark (Sangbaipi), Apricot Seed (Xingren). Upper body benefits from sweating: Bupleurum Root (Chaihu), Cimicifuga Rhizome (Shengma), Kudzu Root (Gange). Lower body benefits from diuresis: Yang Water uses Scutellaria Root (Huangqin), Coptis Rhizome (Huanglian), Gardenia Fruit (Shanzhi), Forsythia Fruit (Lianqiao); Yin Water uses Clove (Dingxiang), Cyperus Rhizome (Xiangfu), Aucklandia Root (Muxiang), Tsaoko Fruit (Caoguo), Magnolia Bark (Houpo), Dried Ginger (Ganjiang). Although Wind can overcome Dampness, use Saposhnikovia Root (Fangfeng), Notopterygium Rhizome (Qianghuo), Gentiana Macrophylla Root (Qinjiao), Pepper Seeds (Jiaomu), Gastrodia Tuber (Tianma). These also strengthen the Spleen; for sinking Qi, use Cimicifuga Rhizome (Shengma), Bupleurum Root (Chaihu). For phlegm, benefit phlegm drainage using Fritillaria Bulb (Beimu), Pinellia Tuber (Banxia), Arisaema with Bile (Danningxing), Sargassum (Haizao), Ecklonia/Kelp (Kunbu).
Neixiao Wan: Treats pediatric five types of Gan syndrome and eight types of dysentery, resolves food and transforms stagnation. Aside from convulsions/Wind-stroke, it can be taken for hundred diseases.
Ingredients: Burreed Tuber (Sanleng), Curcuma Zedoaria Rhizome (Ezhu), Cyperus Rhizome (Xiangfu) [These three stir-fried with vinegar]; Areca Seed (Binglang), Roasted Tsaoko Fruit (Weigaoguo), Green Tangerina Peel (Qingpi), Immature Bitter Orange (Zhike), Immature Bitter Orange (Zhishi) [The latter two stir-fried with bran], Aucklandia Root (Muxiang), Hawthorn Fruit without cores (Shanzha), Fried Medicated Leaven (Shenqu), Fried Malt (Maita), Fried Amomum Fruit (Sharen), Tangerina Peel without white pith (Chenpi).
Grind into equal parts, form pills, administer with brown sugar water.
Chensha Wan (Also known as Dahong Wan / Big Red Pill):
Ingredients: Sichuan Fritillaria Bulb (Chuanbeimu), Arisaema with Bile (Danningxing), Trichosanthes Root (Tianhuafen), Platycodon Root (Jiegeng), Bitter Apricot Seed (Ku Xingren), Immature Bitter Orange (Zhike), Scutellaria Root (Huangqin) [Each 4 liang]; Peucedanum Root (Qianhu), Saposhnikovia Root (Fangfeng), Processed Pinellia Tuber (Zhi Banxia), Tangerina Peel (Chenpi), Scorpion (Quanxie), Groundcherry Root Bark (Digupi), Gardenia Fruit (Shanzhi) [Each 3 liang]; Coptis Rhizome (Huanglian), Ophiopogon Tuber (Yuanshen/Xuanshen) [Each 2 liang].
In years with smallpox/rash fevers, omit Lianqiao and Shanzhi. This medicine resolves phlegm, detoxifies, and disperses smallpox/rash. Form honey pills weighing approximately 1 qian each, coated with Cinnabar. Take one pill per dose, dissolved in Mint Decoction.