大凡水肿先起于腹，而后散四肢者可治；先起于四肢，而后归于腹者难治。掌肿无纹者
死。大便滑泄，水肿不消者死。唇黑，唇肿，齿焦者死。脐肿突出者死。缺盆平者死。阴囊
及茎俱肿者死。脉绝，口张，足肿者死。足 肿，膝如斗者死。肚上青筋见，泻后腹肿
者死。男从身下肿上，女从身上肿下，皆难治。
凡胀满由于气分者，宜察气之虚实。若胀满在中而不在外者，其病多实，经曰∶中满者
，泻之于内，此之谓也。若果因酒食浓味，气滞脉滑，而大满大实者，宜廓清饮主之；兼胀
兼痛，诸药不效者，宜神香散主之。若脏腑胀实而坚痛者，宜承气汤或百顺丸下之，然必年
壮力强，素无损伤虚弱等证，而暴见胀满者，方可峻攻，否则，只宜缓治。如果气实于中，
而表里俱胀者，宜用蒜瓣以滚汤煮微熟留性，少蘸盐醋，常以佐食，大能破气消滞，亦佳法
也。若气胀而兼小水不利者，宜用四苓散，以半熟蒜捣膏丸服，极妙。
一、饮食停滞，而致胃口中焦胀满者，宜大小和中饮酌用之。兼痛者，宜排气饮主之。
一、怒气逆于中焦，或胀或痛者，宜排气饮、解肝煎之类主之。兼喘胀者，宜四磨饮，
或神香散。
一、大人小儿，素无脾虚泄泻等证，而忽尔通身浮肿，或小水不利者，多以饮食失节，
或湿热所致，宜廓清饮加减主之，或四苓散、胃苓汤之类皆可用；或湿胜者，宜平胃散之类
主之。
一、脾胃虚寒，中气不健，而三焦胀满者，是为气虚中满。其为证也，必多吞酸嗳腐，
恶食恶寒，或常为溏泄，而别无火证火脉者，必属脏寒，此所谓脏寒生满病也，惟宜温补。
寒在中焦者，宜温胃饮、理中汤。寒在下焦者，宜理阴煎、八味地黄汤之类主之。
一、单腹胀者，名为鼓胀，以外虽坚满，而中空无物，其象如鼓，故名鼓胀。又或以血
气结聚，不可解散，其毒如蛊，亦名蛊胀。且肢体无恙，胀惟在腹，故又名为单腹胀，此实
脾胃病也。夫脾胃为中土之脏，为仓廪之官，其脏受水谷，则有坤顺之德，其化生血气，则
有干健之功，使果脾胃强健，则随食随化，何胀之有？此惟不善调摄，而凡七情劳倦，饮食
房闱，一有过伤，皆能戕贼脏气，以致脾土受亏，转输失职，正气不行，清浊相混，乃成此
证。凡治此者，若察其病由中焦，则当以脾胃为主，宜参、 、白术、干姜、甘草之属主之
。若察其病由下焦，则当以命门母气为主，宜人参、熟地、当归、山药、附子、肉桂之属主
之。如果气有痞塞，难于纯补，则宜少佐辛香，如陈皮、浓朴、砂仁、香附、丁香、白芥子
之属。如或水道不利，湿气不行，则当助脾行湿，而佐以淡渗，如猪苓、泽泻、茯苓之属。
若诸药未效，仍当灸治，如后法。以上诸法，大略如此，然病成单鼓，终非吉兆，必其伤败
有渐，然后至此，使非尽扫尘务，加意调理，则未有或免者矣。
一、治胀当辨虚实。若察其果由饮食所停者，当专去食积；因气而致者，当专理其气；
因血逆不通而致者，当专清其血；其于热者寒之，结者散之，清浊混者分利之，或升降其气
，或消导其邪，是皆治实之法也。第凡病肿胀者，最多虚证，若在中年之后，及素多劳伤，
或大便溏滑，或脉息弦虚，或声色憔悴，或因病后，或因攻击太过，而反致胀满等证，则皆
虚损之易见者也。诸如此类，使非培补元气，速救根本，则轻者必重，重者必危矣。若虚在
脾肺者，宜四君子汤、归脾汤之类主之。若脾虚兼寒者，宜理中汤、温胃饮、五君子煎。若
脾虚兼痰者，宜六君子煎。若肾虚兼痰者，宜金水六君煎。若虚在肝肾者，宜六味地黄汤。
若肾虚兼寒者，宜理阴煎，或八味地黄丸，甚者加减《金匮》肾气汤主之。若以虚证而妄行
消伐，则百不活一矣。其有果以少壮停滞，或肝强气逆，或时气亢害为邪者，方可直攻其病
，但辨之宜详，不可忽也。
一、凡外感毒风，邪留肤腠，则亦能忽然浮肿，如东垣所谓八益之邪，自外而入者是也
。然其来必速，其证则必有脉紧及头疼骨痛等证，方是外感之候，先宜解散其邪，如正柴胡
饮、小柴胡汤、败毒散、参苏饮、葛根葱白汤之类，随宜用之。若风因火炽，而表里俱热者
，宜芍药清肝散，或龙胆泻肝汤之类主之。若邪传入里，太阳阳明并病，而胃实热甚，必日
晡潮热，大渴引饮者，白虎汤主之。若大实大满，而热结不退者，大承气汤，或百顺丸下之
。若少阳阳明并病，寒热往来，满而实者，宜大柴胡汤下之。《五常政大论》曰∶下之则胀
已，此之类也。
大凡水肿如果先从腹部开始，然后扩散到四肢的，可以治疗；如果先从四肢开始，然后回流到腹部的，难以治疗。手掌肿胀导致纹路消失的，主死。大便滑泄不止，而水肿不消退的，主死。嘴唇发黑、嘴唇肿胀、牙齿焦枯的，主死。肚脐肿胀突出的，主死。锁骨上窝（缺盆）平坦无凹陷的，主死。阴囊和阴茎都肿胀的，主死。脉搏断绝、口张不合、足部肿胀的，主死。足部肿胀严重，膝盖肿大如斗的，主死。腹部出现青色筋脉显露，且泻下后腹部依然肿胀的，主死。男性从下身向上身肿胀，女性从上身向下身肿胀，都属于难治之症。
凡是胀满属于气分病变的，应当辨别气的虚实。如果胀满位于体内深处而不表现在体表，病证多属实证，《内经》说：“中焦满闷的，要从内部攻泻”，说的就是这种情况。如果确实是因为饮酒厚味，导致气机阻滞、脉象滑利，而出现严重胀满实证的，宜用廓清饮主治；如果兼有胀痛，服用其他药物无效的，宜用神香散主治。如果脏腑胀满坚实且疼痛剧烈的，宜用承气汤或百顺丸攻下，但必须患者年壮力强，平时没有损伤虚弱等证候，而是突然发生胀满的，才可以峻猛攻下，否则，只宜缓慢治疗。如果气实于中，而表里都胀满的，宜用蒜瓣以滚开水煮至微熟以保留药性，少量蘸盐醋，经常作为佐餐食物，能大力破气消滞，也是好方法。如果是气胀且兼有小便不利的，宜用四苓散，配合半熟的蒜捣成膏丸服用，效果极佳。
其一，因饮食停滞，导致胃脘和中焦胀满的，宜酌情使用大小和中饮。兼有疼痛的，宜用排气饮主治。
其一，因怒气逆乱于中焦，导致时而胀满时而疼痛的，宜用排气饮、解肝煎等方剂主治。兼有气喘胀满的，宜用四磨饮，或神香散。
其一，大人小儿，平素没有脾虚泄泻等证候，却忽然全身浮肿，或小便不利的，多因饮食失节，或由湿热所致，宜用廓清饮加减主治，或四苓散、胃苓汤等也都可用；如果是湿邪偏胜的，宜用平胃散等主治。
其一，脾胃虚寒，中气不健，导致三焦胀满的，这称为气虚中满。其症状表现，必定多有吞酸嗳腐，厌恶饮食和寒冷，或者经常大便溏泄，而没有热证和热脉的，必定属于脏寒，这就是所谓“脏寒生满病”，只宜温补。寒邪在中焦的，宜用温胃饮、理中汤。寒邪在下焦的，宜用理阴煎、八味地黄汤等主治。
其一，单腹胀大的，名为鼓胀，因为外表虽然坚硬胀满，但中间空虚无物，形状像鼓，所以叫鼓胀。又或因气血结聚，无法解散，其毒害如同蛊惑，也叫做蛊胀。而且肢体无恙，只有腹部胀大，所以又叫做单腹胀，这实际上是脾胃的病。脾胃是中土之脏，是仓廪之官，其脏器受纳水谷，具有坤顺的德行，其化生血气，具有乾健的功能，如果脾胃强健，则随吃随化，哪里有胀满呢？这只能是不善于调养摄生，凡是七情劳倦、饮食房事，一旦有过度的伤害，都能残害脏气，导致脾土受损，转输功能失职，正气不行，清浊相混，于是形成这种病证。凡是治疗此病的，如果察知病由中焦引起，则应当以脾胃为主，宜用人参、[此处原文缺失，通常指茯苓或类似健脾药]、白术、干姜、甘草等类药材主治。如果察知病由下焦引起，则应当以命门母气为主，宜用人参、熟地、当归、山药、附子、肉桂等类药材主治。如果确有气机痞塞，难以纯用补法，则宜少加辛香之品，如陈皮、厚朴、砂仁、香附、丁香、白芥子等类。如果水道不利，湿气不行，则应当助脾行湿，并佐以淡渗利湿之品，如猪苓、泽泻、茯苓等类。如果各种药物无效，仍应当进行艾灸治疗，如后文所述方法。以上诸法，大致如此，然而病成单鼓，终究不是吉兆，必定是损伤败坏逐渐积累至此，如果不是彻底扫除尘世事务，用心调理，则没有能免除死亡的。
其一，治疗胀满应当辨别虚实。如果察知确实是由饮食停积引起的，应当专门消除食积；因气滞引起的，应当专门调理气机；因血逆不通引起的，应当专门清理瘀血；对于热证的用寒凉药，对于结聚的用消散药，对于清浊混杂的用分利法，或者升降气机，或者消导邪气，这些都是治疗实证的方法。只是凡是患肿胀病的，最多见的是虚证，如果在中年以后，以及平素多劳伤，或者大便溏滑，或者脉象弦虚，或者声音神色憔悴，或者因病后，或因攻伐太过，反而导致胀满等证候的，这些都是虚损容易显现的情况。诸如此类，如果不是培补元气，迅速挽救根本，则轻病必重，重病必危。如果虚在脾肺的，宜用四君子汤、归脾汤等主治。如果脾虚兼寒的，宜用理中汤、温胃饮、五君子煎。如果脾虚兼痰的，宜用六君子煎。如果肾虚兼痰的，宜用金水六君煎。如果虚在肝肾的，宜用六味地黄汤。如果肾虚兼寒的，宜用理阴煎，或八味地黄丸，严重的加减《金匮要略》肾气汤主治。如果以虚证而妄行消伐攻逐，则百无一活。那些确实因为年少体壮停积，或肝强气逆，或时气亢盛为邪的，才可以直接攻逐病邪，但辨证应当详细，不可疏忽。
其一，凡是外感毒风，邪气留滞在皮肤腠理之间，也能忽然浮肿，如东垣所说的八益之邪，自外而入的就是这种情况。然而其来势必然迅速，其症状必定有脉紧及头疼骨痛等证候，这才是外感的征象，先宜解散邪气，如正柴胡饮、小柴胡汤、败毒散、参苏饮、葛根葱白汤等类，随适宜选用。如果风邪因火炽盛，而表里都热的，宜用芍药清肝散，或龙胆泻肝汤等主治。如果邪气传入里，太阳阳明合病，而胃中实热甚，必定日晡时潮热，大渴引饮的，用白虎汤主治。如果大实大满，而热结不退的，用大承气汤，或百顺丸攻下。如果少阳阳明合病，寒热往来，胀满而实的，宜用大柴胡汤攻下。《黄帝内经·五常政大论》说：“用下法则胀满消除”，说的就是这类情况。
Generally, edema that starts in the abdomen and then spreads to the four limbs is treatable; edema that starts in the four limbs and then returns to the abdomen is difficult to treat. Swelling of the palms with disappearance of skin creases indicates death. Sliding diarrhea with persistent edema indicates death. Black lips, swollen lips, and scorched teeth indicate death. Protruding umbilicus indicates death. A flat supraclavicular fossa (Quepen) indicates death. Simultaneous swelling of the scrotum and penis indicates death. Absent pulse, open mouth, and swollen feet indicate death. Severe foot swelling with knees enlarged like a斗 (dou, a unit of measure) indicates death. Visible green veins on the abdomen with abdominal swelling persisting after purgation indicates death. In men, swelling progressing from the lower body upward, and in women, swelling progressing from the upper body downward, are both difficult to treat.
For distension and fullness arising from Qi disorders, one must distinguish between deficiency and excess of Qi. If distension is located internally rather than externally, the pathology is mostly excess. As stated in the classics: "Fullness in the center should be drained from within," which refers to this situation. If it is indeed caused by alcohol and rich foods, leading to Qi stagnation and a slippery pulse, resulting in severe fullness and excess, Kuoqing Yin (Clearing Decoction) should be used as the principal formula. If accompanied by pain and unresponsive to other medicines, Shenxiang San (Divine Fragrance Powder) should be used. If the Zang-Fu organs exhibit fullness, hardness, and severe pain, Chengqi Tang (Coptis Decoction) or Baishun Wan (Hundred Compliance Pill) may be used for purgation. However,峻猛攻下 (drastic purgation) is only permissible if the patient is young and strong, has no history of injury or weakness, and presents with sudden onset of distension; otherwise, slow treatment is appropriate. If Qi is excessive internally while both interior and exterior are distended, garlic cloves boiled in boiling water until slightly cooked (to retain properties), dipped sparingly in salt and vinegar, and consumed frequently as an accompaniment can greatly break Qi stagnation and resolve accumulation, which is also an excellent method. For Qi distension accompanied by difficult urination, Siling San (Four-Ingredient Powder) combined with pills made from mashed semi-cooked garlic is extremely effective.
First, for distension and fullness in the stomach and middle Jiao caused by food stagnation, use Xiaodazhonghe Yin (Minor Great Harmonizing Decoction) or Dazhonghe Yin (Great Harmonizing Decoction) as appropriate. If accompanied by pain, Paiqi Yin (Expel Qi Decoction) is indicated.
Second, for anger causing rebellion in the middle Jiao, resulting in alternating distension and pain, Paiqi Yin (Expel Qi Decoction) or Jiegan Jian (Soothe Liver Decoction) should be used. If accompanied by wheezing and distension, Simo Yin (Four-Mortar Decoction) or Shenxiang San (Divine Fragrance Powder) is indicated.
Third, for adults and children who normally lack signs of Spleen deficiency and loose stools but suddenly develop generalized edema or difficult urination, the cause is often irregular diet or damp-heat. Kuoqing Yin (Clearing Decoction) with modifications is indicated, or Siling San (Four-Ingredient Powder) and Weiling Tang (Stomach-Ling Decoction). If dampness predominates, Pingwei San (Regulate the Stomach Powder) is indicated.
Fourth, for Spleen and Stomach deficiency-cold, weak Middle Qi, and distension of the Three Jiao, this is termed Qi-deficiency central fullness. Symptoms necessarily include acid regurgitation, belching of rotten food, aversion to food and cold, or frequent loose stools, without heat signs or heat pulses. This belongs to Cold of the Zang organs, known as "Cold of the Zang generates fullness diseases," and requires warming and tonification. For Cold in the Middle Jiao, Wenwei Yin (Warm the Stomach Decoction) or Lizhong Tang (Regulate the Center Decoction) is indicated. For Cold in the Lower Jiao, Liyin Jian (Nourish Yin Decoction) or Bawei Dihuang Tang (Eight-Ingredient Rehmannia Decoction) is indicated.
Fifth, isolated abdominal distension is named Guzhang (Drum Distension) because although the exterior is hard and full, the interior is hollow, resembling a drum. It is also called Guzhang (Gu Distension) due to blood and Qi aggregation that cannot be dispersed, with toxicity akin to Gu poison. Since the limbs are unaffected and only the abdomen is distended, it is also called Danzhang (Single Abdominal Distension). This is essentially a disease of the Spleen and Stomach. The Spleen and Stomach are the Earth organs, the officials of the granary. They receive grain and water, possessing the receptive virtue of Kun (Earth), and transform blood and Qi, possessing the vigorous function of Qian (Heaven). If the Spleen and Stomach are strong, food is transformed immediately, so how could there be distension? This arises from poor self-care. Excessive emotional stress, fatigue, improper diet, or sexual indulgence can damage Zang Qi, causing Spleen Earth to decline, transport functions to fail, Zheng Qi (Upright Qi) to stagnate, and clear and turbid Qi to mix, forming this condition. When treating this, if the disease originates in the Middle Jiao, focus on the Spleen and Stomach, using herbs such as Renshen (Ginseng), [Text missing], Baizhu (Atractylodes Macrocephala), Ganjiang (Dried Ginger), and Gancao (Licorice). If the disease originates in the Lower Jiao, focus on the Mingmen (Gate of Life) ancestral Qi, using Renshen (Ginseng), Shudi (Prepared Rehmannia), Danggui (Angelica Sinensis), Shanyao (Dioscorea), Fuzi (Aconite), and Rougui (Cinnamon Bark). If there is Qi blockage making pure tonification difficult, add small amounts of acrid-aromatic herbs like Chenpi (Tangerine Peel), Houpo (Magnolia Bark), Sharen (Amomum Fruit), Xiangfu (Cyperus Rhizome), Dingxiang (Clove), and Baijiezi (White Mustard Seed). If water pathways are obstructed and dampness does not move, assist the Spleen in moving dampness and add diuretic herbs like Zhuling (Polyporus), Zexie (Alisma), and Fuling (Poria). If all medicines fail, moxibustion should be employed as described later. These methods are general guidelines. However, once Single Drum Distension forms, it is ultimately an ill omen, resulting from gradual depletion. Unless worldly affairs are completely abandoned and careful regulation is undertaken, survival is unlikely.
Sixth, treating distension requires distinguishing deficiency and excess. If caused by food stagnation, specifically eliminate the food retention; if caused by Qi, specifically regulate the Qi; if caused by rebellious Blood obstruction, specifically clear the Blood. For heat, use cold herbs; for aggregation, use dispersing herbs; for mixed clear and turbid Qi, use separating and draining methods; or regulate Qi ascent and descent, or digest and guide out pathogens. These are methods for treating excess. However, most cases of swelling involve deficiency. In patients past middle age, or those with chronic labor injuries, loose stools, wiry-deficient pulses, haggard voice and complexion, post-illness states, or over-treatment with purgatives leading to distension, these are evident signs of deficiency. Such cases require rapid tonification of Yuan Qi (Primordial Qi) and rescue of the root; otherwise, mild cases will worsen, and severe cases will become critical. For deficiency in Spleen and Lung, Sizijunzi Tang (Four Gentlemen Decoction) or Guipi Tang (Restore the Spleen Decoction) is indicated. For Spleen deficiency with Cold, Lizhong Tang (Regulate the Center Decoction), Wenwei Yin (Warm the Stomach Decoction), or Wujunzi Jian (Five Gentlemen Decoction) is indicated. For Spleen deficiency with Phlegm, Liu Junzi Jian (Six Gentlemen Decoction) is indicated. For Kidney deficiency with Phlegm, Jinshui Liujun Jian (Metal-Water Six Gentlemen Decoction) is indicated. For deficiency in Liver and Kidney, Liuwei Dihuang Tang (Six-Ingredient Rehmannia Decoction) is indicated. For Kidney deficiency with Cold, Liyin Jian (Nourish Yin Decoction) or Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) is indicated; for severe cases, modified Shenqi Tang (Kidney Qi Decoction) from *Jin Gui Yao Lue* is indicated. Using draining and reducing methods recklessly on deficiency cases results in nearly 100% mortality. Only in cases of true excess due to youth/stagnation, strong Liver Qi rebellion, or epidemic pathogenic factors can direct attack be used, but differentiation must be detailed and not neglected.
Seventh, external toxic wind pathogens remaining in the skin and interstices can also cause sudden edema, as Dongyuan described regarding eight beneficial pathogens entering from outside. However, the onset is rapid, and symptoms must include tight pulse, headache, and bone pain to confirm an external contraction. Initially, disperse the pathogen using Zheng Chaihu Yin (Correct Bupleurum Decoction), Xiao Chaihu Tang (Minor Bupleurum Decoction), Baidu San (Defend Against Toxins Powder), Shensu Yin (Ginseng-Sophora Decoction), or Gegen Congbai Tang (Kudzu-Green Onion Decoction) as appropriate. If Wind combines with Fire causing interior-exterior heat, Shaoyao Qinggan San (Peony Clearing Liver Powder) or Longdan Xiegan Tang (Gentian Draining Liver Decoction) is indicated. If the pathogen enters the interior, involving Taiyang and Yangming concurrent diseases, with severe Stomach excess-heat, afternoon tidal fever, and intense thirst requiring drinking, Baihu Tang (White Tiger Decoction) is indicated. For severe excess-fullness with unresolved heat binding, Dachengqi Tang (Major Coptis Decoction) or Baishun Wan (Hundred Compliance Pill) is used for purgation. For Shaoyang-Yangming concurrent diseases with alternating chills and fever, fullness, and excess, Dachaihu Tang (Major Bupleurum Decoction) is used for purgation. The *Wuchangzheng Dalun* states: "Purgation resolves distension," referring to such cases.