平按；此篇自篇首至恶有不下者乎，见《灵枢》卷六第三十五《胀论》篇，又见
《甲乙经》卷八第三。自黄帝问于岐伯曰水与肤胀至亦刺去其血脉黄帝曰善，见《灵枢》
卷九第五十七《水胀》篇，又见《甲乙经》卷
八第四。自黄帝问于岐伯曰有病心腹满至末，见《素问》卷十一第四十《腹中论》篇，
《甲乙经》见同上。
黄帝曰∶脉之应于寸口，何如而胀？岐伯曰∶其至大坚以涩者胀。（脉之大者，多
血少气。涩者，亦多血少气，微寒。脉口盛紧，伤于饮食。以其脉至，诊有多血少气微
寒，即是伤于饮食为胀也。平按∶《灵枢》其至作其脉。《甲乙》坚下有直字。）黄帝
曰∶何以知腑脏之胀也？岐伯曰∶阴为脏而阳为腑。（诊得阴脉胀者，以为脏胀；诊得
阳脉胀，以为腑胀也。）黄帝曰∶夫气之令人胀也，在于血胀之中耶？腑脏之内乎？
（血脉，谓二十八脉也。问胀所在也。）岐伯曰∶二者皆存焉，然非胀之舍也。（卫气并
脉而行，循分肉之间为胀，血脉及五脏六腑各胀，故曰二者存焉，然非胀之所舍之处也。
平按∶《灵枢》二作三，注云∶一作二。）黄帝曰∶愿闻胀舍。岐伯曰∶夫胀者，皆在
于腑脏之外，排脏腑而郭胸胁、胀皮肤，故命曰胀。（以下言其胀舍，取之脏腑之外胸
胁及皮肤之间，气在其中，郭而排之，故命曰胀。）黄帝曰∶脏腑之在胸胁腹裹之内也，
若匣匮之藏禁器也，各有次舍，异名而同处，一城之中，其气各异，愿闻其故。（以下
脏腑居处也。禁器，比脏腑也。胸胁腹裹，比之匣匮也。次舍者，五脏六腑各有居处也。
脏腑之名虽异，同在一郭之中，然脏腑俱别，请闻同异所由。平按∶《甲乙》无胸胁腹
裹之五字，城作域，《灵枢》同，其故下有“黄帝曰∶未解其意，再问”九字。）岐伯
曰∶夫胸腹者，脏腑之城郭也。（城郭，脏腑所处也。平按∶《灵枢》无城字。）膻中
者，主之官也。（膻中有心肺之气，故是脏腑之官也。平按∶《灵枢》主之官作心主之
宫城，《甲乙》作心主之中宫。）胃者，大仓也。（胃贮水谷以供，故为脏腑大仓也。）
咽喉小肠者，传道也。（咽传水谷而
入，小肠传之而出，喉传气之出入，故为传道也。平按∶《灵枢》道作送。）胃之五窍
者，闾里门户也。（咽、胃、大肠、小肠、膀胱等窍，皆属于胃，故是脏腑闾里门户也。）
廉泉玉英者，津液之道也。故五脏六腑，各有畔界，其病各有形状。（廉泉乃是涎唾之
道，玉英复为溲便之路，故名津液道也。此则脏腑畔界，故脏腑病形各异。平按∶《甲乙》
道下有路字。）营气循脉为脉胀，卫气并脉循分为肤胀。三里而泻，近者一下，远者三
下，毋问虚实，工在疾泻。（以下谓营卫二气为胀。营气循脉周于腹郭为胀，名为脉胀。
卫气在于脉外，旁脉循于分肉之间，聚气排于分肉为肿，称为肤胀。三里以为胀之要穴，
故不问虚实，皆须泻之。其病日近者，可以针一泻；其日远者，可三泻之。下者，胀消
也。终须疾泻，可不致疑矣。平按∶《灵枢》营气循脉下有卫气逆三字。卫气并脉循分
《甲乙》作卫气并血脉循分肉。三里而泻，《甲乙》作取三里泻之。一下，下字《甲乙》
注云∶一本作分，下同。）黄帝曰∶愿闻胀形。（愿闻五脏六腑胀形也。）岐伯曰∶夫
心胀者，烦心短气，卧不安。（平按∶《甲乙》安上有得字。）肺胀者，虚满而喘咳。
肝胀者，胁下满而痛引少腹。脾胀者，喜哕四肢急，体重不能衣。肾胀者，腹满引背怏
然，腰髀痛。（气在脏腑之外，排脏腑，郭胸胁，胀皮肤，时烦心短气卧不安者，以为
心胀。知此，五脏六腑胀皆放此，各从其脏腑所由胀状有异耳。怏，不畅也。平按∶《灵
枢》少腹作小腹，喜哕作善哕，《甲乙》作苦哕。四肢急《灵枢》作四肢烦 ，《甲乙》
作四肢闷。《灵枢》衣上有胜字。怏然《灵枢》作央央然。）六腑胀者∶胃胀，腹满胃
管痛，鼻闻焦臭，妨于食，大便难。大肠胀者，肠鸣而痛濯濯，（肠中水声也。平按∶
《灵枢》、《甲乙》胃管作胃脘。）冬日重感于寒则泄，食不
化。小肠胀者，少腹 胀，引腰而痛。膀胱胀者，少腹满而气癃。三焦胀者，气满于
皮肤中， 然而不坚。胆胀者，胁下痛胀，口中苦，好太息。（香为脾臭，焦为心臭，
今脾胃之病闻焦臭者，以其子病，思闻母气故也。壳，口角反。 ，□□貌。今 ，
似实而不坚也。平按∶泄食《灵枢》作飧泄，《甲乙》作泄飧。少腹满《灵枢》、《甲乙》
作小腹满。 《灵枢》作轻轻，好太息作善太息。）凡此诸胀，其道在一，明知逆顺，
针数不失。（一者，唯知补泻也。补虚泻实得中，故不失也。）泻虚补实，神去其室，
致邪失正，真不可定，粗之所败，谓之夭命。（神室，心脏也。补实泻虚伤神，故神去
心室。神去心室，得于邪气，失其四时正气，致使真伪莫定也。）补虚泻实，神归其室，
久塞其空，谓之良工。（神安其脏，故曰归室。神得归脏，自斯已去，长闭腠理，不令
邪入，谓上工也。）黄帝曰∶胀者焉生，何因而有名？（平按∶《灵枢》无名字。）岐
伯曰∶卫气之在身也，常并脉循分，行有逆顺，阴阳相随，乃得天和，（卫气并脉循于
分肉，有逆有顺，从目循足三阳下为顺，从目循手三阳下为逆，以卫行有逆顺，故阴阳
气得和而顺也。平按∶《灵枢》常下有然字。《甲乙》分下有肉字，《灵枢》同。）五
脏更治，四时有序，五谷乃化。然后厥气在下，营卫留止，寒气逆上，真邪相攻，两气
相薄，乃合为胀。（五脏属于五行，故五脏更王，四时寒暑次序得所，五谷入腹得有变
化也。有寒厥之气，留于营卫之间，营卫不行，寒气逆上，与正气相薄，交争愤起，谓
之为胀。平按∶
更治《灵枢》作更始，《甲乙》作皆治。有序《灵枢》作循叙，《甲乙》作皆叙。薄
《灵枢》作搏。《甲乙》乃合为胀作乃舍为胀。）黄帝曰∶善。何以解惑？岐伯曰∶合
之于真，三合而得。黄帝曰∶善。（行补泻时，近者一取合于真气，即得病愈，远者三
取合于真气，称曰解惑之也。）
黄帝问岐伯曰∶《胀论》言曰∶毋问虚实，工在疾泻，近者一下，远者三下。今有
其三而不下，其过焉在？（前言泻虚补实，神去其室；今言无问虚实，工在疾泻，其故
何也？所谓初病未是大虚，复取三里，故工在疾泻。若虚已成，又取余穴，虚者不可也。
今至三取不消，请言过之所由也。）岐伯曰∶此言陷于肉肓而中气穴者也。（肉肓者，
皮下肉上之膜也，量与肌肤同类。气穴，谓是发胀脉气所发穴也。）不中气穴，则气内
闭；（针其余处，不中胀之气穴，则胀不泄也。平按∶注针袁刻误作计。）针不陷肓，
则气不行；（不陷肓膜，则气不行分肉间也。）不越中肉，则卫气相乱，阴阳相遂。其于
胀也，当泻不泻，气故不下，三而不下，必更其道，气下乃止，不下复始，可以万全，
恶有殆者乎？（针入其皮，起而不下其肉，则卫气行而失次，阴阳之气并也。遂，并也。
由于当泻不泻，故三取不下也。必须更取余穴，以行补泻，以胀消为工，故得万全，必
无危生之祸也。平按∶不越《灵枢》、《甲乙》作上越。相遂《灵枢》作相逐，《甲乙》
作相逆。）其于胀也，必审其诊，当泻则泻，当补则补，如鼓之应桴，恶有不下者乎？
（言诊审者，如鼓应桴，何有不当者也。平按∶诊《灵枢》作HT ，注∶音轸。）
黄帝问于岐伯曰∶水与肤胀、鼓胀、肠覃、石瘕、石水，何以别？（此之六病，有
难分者，故请别之也。平按∶《甲乙》无石水二字。《灵枢》、《甲乙》别下有之字。）
岐伯曰∶水始起也，目果上微 ，如卧新起之状，颈脉动，时咳、阴股间寒，足 ，
腹乃大，其水已成也。以手按其腹，随手而起，如裹水之状，此其候也。（水病之状，
候有六别∶一者，目果微肿；二者，足阳明人迎之脉， 见其动，不待按之；三者，胀
气循足少阴脉上冲于肺，故时有咳；四者，阴下阴股间冷；五者，脚 肿起；六者，腹
如囊盛水状，按之不坚，去手即起。此之六种，水病候也。平按∶《灵枢》、《甲乙》
目果作目窠，微 作微肿。足 《灵枢》作足胫 ，《甲乙》作足胫肿。注 袁刻作
眼。）黄帝曰∶肤胀何以候之？岐伯曰∶肤胀者，寒气客于皮肤之间， 然不坚，腹
大身尽肿，皮浓，按其腹， 而不起，腹色不变，此其候也。（次解肤胀，凡有五别∶
一者，寒气循于卫气，客于皮肤之间；二者，为肿不坚；三者，腹大身肿；四者，皮浓，
按之不起（ ，焉了反，深也）；五者，腹色不变。肤胀所由与候，有斯五别也。平按∶
然《灵枢》作 然。 《甲乙》作腹陷二字。）鼓胀何如？岐伯曰∶腹身皆大，
大与肤胀等也，色苍黄，腹脉起，此其候也。（次解鼓胀，凡有六别∶所由及候，四种
同于肤胀，五者腹色青黄，六者腹上脉络见出，鼓胀之候，有此六别也。平按∶腹身皆
大《灵枢》作腹胀身皆大，《甲乙》作腹身皆肿。《灵枢》、《甲乙》仓作苍，脉起作
筋起，《甲乙》注云∶一本作脉。）肠覃何如？岐伯曰∶寒气客于肠外，与卫气相薄，
气不得营，因其所系，瘕而内着，恶气乃起，息肉乃生。其始也，大如鸡卵，稍以益大，
至其成也，如怀子之状，久者离岁，按之则坚，
推之则移，月事以时，此其候也。（次解肠覃，水停聚也。肠覃凡有六别∶一者，得
之所由，谓寒客于肠外，与卫气合，瘕而为内；二者，所生形之大小；三者，成病久
近，（离，历也）久者或可历于年岁；四者，按之坚硬；五者，推之可移；六者，月经
时下。肠覃所由与状，有斯六种也。平按∶《灵枢》、《甲乙》相薄作相搏。气不得营
《甲乙》作正气不得营。《灵枢》营作荣，瘕作癖，息肉作 肉。《甲乙》离岁作离岁
月。）石瘕何如？岐伯曰∶石瘕生于胞中，寒气客于子门，子门闭塞，气不通，恶血当
泻不泻， 以留止，日以益大，状如怀子，月事不以时下，（次解石瘕，凡有四别∶一
者，瘕住所在；二者，得之所由，谓寒气客子门之中，恶血凝聚不泻所致；三者，石瘕
大小形；四者，月经不以时下。石瘕所由与状，有斯四种。石水一种，缺而不解也。平
按∶气不通《灵枢》作气不得通。）皆生于女子，可导而下。黄帝曰∶肤胀、鼓胀可刺
耶？岐伯曰∶先刺其腹之血络，后调其经，亦刺去其血脉。黄帝曰∶善。（肠覃、石瘕
二病，皆妇人病也。水病刺而去之，肠覃、石瘕可以针刺导而下之，未知肤鼓二胀可刺
已不？先泻其血络以去恶血，后调其经，亦去血络也。平按∶《灵枢》腹之血络作胀之
血络，去其血脉作去其血络。）
黄帝问于岐伯曰∶有病心腹满，旦食则不能暮食，此为何病？岐伯曰∶名为鼓胀。
曰∶治之奈何？曰∶治之以鸡醴，一齐知，二齐而已。黄帝曰∶其时有复发者何也？岐
伯曰∶此饮食不节，故时痛，虽然其病且已，时当痛，气聚于腹。（气满心腹，故旦
食暮不能也，是名鼓
胀。可取鸡粪作丸，熬令烟盛，以清酒一斗半沃之，承取汁，名曰鸡醴，饮取汗，一齐
不愈，至于二齐，非直独疗鼓胀，肤胀亦愈。有复发者，以不慎节饮食故也。平按∶鼓
胀，《素问》新校正云∶“《太素》鼓作谷。”兹本仍作鼓，注同。《素问》、《甲乙》
鸡醴作鸡矢醴，齐作剂，故时痛作故时有病也。时当痛《素问》作时故当病，《甲乙》
作因当风。注取汗袁刻作取汁。）
【平按】：本篇从篇首至“恶有不下者乎”，见于《灵枢》卷六第三十五《胀论》篇，又见于《甲乙经》卷八第三。从“黄帝问于岐伯曰水与肤胀”至“亦刺去其血脉 黄帝曰善”，见于《灵枢》卷九第五十七《水胀》篇，又见于《甲乙经》卷八第四。从“黄帝问于岐伯曰有病心腹满”至末尾，见于《素问》卷十一第四十《腹中论》篇，《甲乙经》见同上。
黄帝说：脉象在寸口部的表现，怎样判断为胀病？岐伯说：脉象大而坚且涩的，是胀病。（脉象大的，多血少气。涩脉，也是多血少气，兼有微寒。脉口盛紧，是饮食所伤。根据脉象表现为多血少气微寒，这就是因饮食损伤导致的胀病。平按：《灵枢》中“其至”作“其脉”。《甲乙经》中“坚”字下有“直”字。）
黄帝说：怎样知道脏腑的胀病？岐伯说：阴脉主脏，阳脉主腑。（诊得阴脉出现胀象，认为是脏胀；诊得阳脉出现胀象，认为是腑胀。）
黄帝说：气导致人发生胀病，是在血脉之中呢？还是在脏腑之内呢？（血脉，指二十八条经脉。这是在询问胀病所在的部位。）岐伯说：两者都存在，然而都不是胀病的居所。（卫气伴随脉道运行，循行于分肉之间形成胀病，血脉及五脏六腑各自发生胀病，所以说两者都存在，然而它们不是胀病停留的地方。平按：《灵枢》中“二”作“三”，注云：一作二。）
黄帝说：我想了解胀病的居所。岐伯说：胀病，都在脏腑之外，排挤脏腑，廓张胸胁，胀大皮肤，所以命名为胀。（以下讲述胀病的居所，取穴在脏腑之外的胸胁及皮肤之间，气在其中，廓张而排挤，所以命名为胀。）
黄帝说：脏腑位于胸胁腹裹之内，就像匣子柜子收藏禁器一样，各有固定的居所，名称不同但处于同一位置，如同一座城池之中，各处的风气各异，我想了解其中的缘故。（以下讲述脏腑的居处。禁器，比喻脏腑。胸胁腹裹，比喻匣子柜子。次舍，指五脏六腑各有居处。脏腑的名称虽然不同，同在一郭之中，然而脏腑彼此区别，请闻同异的原因。平按：《甲乙经》无“胸胁腹裹”五字，“城”作“域”，《灵枢》相同，“其故”下有“黄帝曰∶未解其意，再问”九个字。）
岐伯说：胸腹，是脏腑的城郭。（城郭，是脏腑所处的地方。平按：《灵枢》无“城”字。）膻中，是君主之官。（膻中有心肺之气，所以是脏腑的官长。平按：《灵枢》中“主之官”作“心主之宫城”，《甲乙经》作“心主之中宫”。）胃，是大仓。（胃贮藏水谷以供养全身，所以是脏腑的大仓库。）咽喉和小肠，是传导之官。（咽传递水谷进入，小肠传递糟粕排出，喉传递气的出入，所以称为传导。平按：《灵枢》中“道”作“送”。）胃的五窍，是闾里门户。（咽、胃、大肠、小肠、膀胱等窍，都归属于胃，所以是脏腑闾里的门户。）廉泉和玉英，是津液之道。所以五脏六腑，各有边界，它们的病症各有不同的形状。（廉泉是涎唾之道，玉英是溲便之路，所以称为津液道。这是脏腑的边界，所以脏腑的病形各异。平按：《甲乙经》中“道”下有“路”字。）营气循行于脉中形成脉胀，卫气伴随脉道循行于分肉之间形成肤胀。针刺足三里并采用泻法，病程近的一下针即可，病程远的下针三次，不论虚实，关键在于迅速泻邪。（以下讲述营卫二气导致的胀病。营气循脉周行于腹郭形成胀病，名为脉胀。卫气在脉外，旁脉循行于分肉之间，聚气排于分肉形成肿胀，称为肤胀。三里穴是治疗胀病的重要穴位，所以不问虚实，都需要用泻法。如果发病日子近，可以针刺一次泻邪；如果发病日子远，可以针刺三次泻邪。“下”指胀消。最终必须迅速泻邪，不可迟疑。平按：《灵枢》中“营气循脉”下有“卫气逆”三字。卫气并脉循分，《甲乙经》作“卫气并血脉循分肉”。三里而泻，《甲乙经》作“取三里泻之”。一下，《甲乙经》注云：一本作“分”，下同。）
黄帝说：我想了解胀病的形态。（想听五脏六腑胀病的形态。）岐伯说：心胀的人，心烦短气，睡眠不安。（平按：《甲乙经》中“安”上有“得”字。）肺胀的人，虚满且喘咳。肝胀的人，胁下满痛并牵引少腹。脾胀的人，喜欢呃逆，四肢拘急，身体沉重不能穿衣。肾胀的人，腹部满闷牵引背部感到不畅，腰髀疼痛。（气在脏腑之外，排挤脏腑，廓张胸胁，胀大皮肤，时常心烦短气卧不安的，认为是心胀。知晓这个原理，五脏六腑的胀病都可以参照此例，只是根据各自脏腑的不同而有不同的胀状罢了。怏，是不畅的意思。平按：《灵枢》中“少腹”作“小腹”，“喜哕”作“善哕”，《甲乙经》作“苦哕”。四肢急，《灵枢》作“四肢烦郁”，《甲乙经》作“四肢闷”。《灵枢》中“衣”上有“胜”字。怏然，《灵枢》作“央央然”。）
六腑胀的表现：胃胀，腹部满闷胃脘痛，鼻中闻到焦臭味，妨碍进食，大便困难。大肠胀，肠鸣且痛声濯濯（肠中水声），冬天再次感受寒邪则泄泻，食物不消化。小肠胀，少腹胀满，牵引腰部疼痛。膀胱胀，少腹满闷且小便不通。三焦胀，气充满于皮肤中，轻轻然但不坚实。胆胀，胁下疼痛胀满，口中苦，喜欢长叹息。（香是脾臭，焦是心臭，现在脾胃病闻到焦臭味的，是因为子病思母气所致。壳，口角反切音。 ，形容某种样子。今 字，似实而不坚。平按：泄食，《灵枢》作“飧泄”，《甲乙经》作“泄飧”。少腹满，《灵枢》、《甲乙经》作“小腹满”。 《灵枢》作“轻轻”，好太息作“善太息”。）
凡是这些胀病，治疗的道理在于一个原则，明确知道逆顺，针刺的次数不失误。（一个原则，就是只知道补泻。补虚泻实得当，所以不失误。）泻虚补实，会使神气离开心脏，招致邪气失去正气，真气无法安定，这是粗工造成的败坏，称为夭折性命。（神室，指心脏。补实泻虚伤害神气，所以神离开心室。神离开心室，得到邪气，失去四时正气，致使真伪莫定。）补虚泻实，使神回归心室，长久封闭腠理的空隙，这称为良工。（神安于脏腑，所以说归室。神回归脏腑，从此离去，长久关闭腠理，不让邪气进入，这称为上工。）
黄帝说：胀病是怎么产生的，因为什么而得名？（平按：《灵枢》无“名字”二字。）岐伯说：卫气存在于体内，常伴随脉道循行于分肉之间，运行有逆有顺，阴阳相随，才能得天和之气，（卫气伴随脉道循行于分肉，有逆有顺，从目循足三阳向下为顺，从目循手三阳向下为逆，因为卫气运行有逆顺，所以阴阳气得和而顺。平按：《灵枢》中“常”下有“然”字。《甲乙经》中“分”下有“肉”字，《灵枢》相同。）五脏更替主治，四时有序，五谷才能消化。然后厥气在下，营卫留止，寒气逆上，真邪相攻，两气相搏，于是合成为胀。（五脏属于五行，所以五脏更替王气，四时寒暑次序得当，五谷入腹得以变化。有寒厥之气，留于营卫之间，营卫不行，寒气逆上，与正气相搏，交争愤起，称之为胀。平按：更治，《灵枢》作“更始”，《甲乙经》作“皆治”。有序，《灵枢》作“循叙”，《甲乙经》作“皆叙”。薄，《灵枢》作“搏”。《甲乙经》中“乃合为胀”作“乃舍为胀”。）
黄帝说：好。怎样才能解除疑惑？岐伯说：结合真气，三合而得。黄帝说：好。（施行补泻时，近的取一次穴结合真气，就能病愈；远的取三次穴结合真气，称为解除疑惑。）
黄帝问岐伯说：《胀论》中说：不要问虚实，关键在于迅速泻邪，近的下一针，远的下三针。现在有三次的针刺却不起作用，过错在哪里？（前面说泻虚补实，神去其室；现在说不问虚实，关键在于迅速泻邪，这是什么原因？所谓初病尚未是大虚，再次取三里穴，所以关键在于迅速泻邪。如果已经形成虚证，又取其他穴位，对虚证是不可以的。现在到了三次取穴仍不消退，请说明过错的原因。）岐伯说：这是指针刺陷于肉肓而中气穴的情况。（肉肓，是皮下肉上的膜，量度上与肌肤同类。气穴，是指发胀脉气所发出的穴位。）如果不中气穴，气就会在内闭结；（针刺其余部位，不中胀病的气穴，那么胀气就不消散。平按：注中“针”字袁刻误作“计”。）针刺不陷入肓膜，气就不能运行；（不陷入肓膜，气就不能行于分肉间。）不越过肌肉，卫气就会紊乱，阴阳就会相逐。对于胀病，应当泻而不泻，气所以不能下行，三次针刺后气仍不下行，必须改变取穴方法，气下行才停止，如果不行就重新开始，这样可以万全，哪里有危险的呢？（针刺入皮，提起而不深入肌肉，则卫气运行失序，阴阳之气并乱。遂，并也。由于应当泻而未泻，所以三次取穴气不下行。必须改取其他穴位，以行补泻，以胀消为成功标准，所以能得万全，必定没有危及生命的祸患。平按：“不越”，《灵枢》、《甲乙经》作“上越”。“相遂”，《灵枢》作“相逐”，《甲乙经》作“相逆”。）对于胀病，必须审慎诊断，应当泻则泻，应当补则补，像鼓槌击鼓那样应验，哪里有胀气不下的呢？（说诊断审慎，就像鼓应桴，哪有不当的。平按：诊，《灵枢》作“HT ”，注：音轸。）
黄帝问于岐伯说：水胀、肤胀、鼓胀、肠覃、石瘕、石水，如何鉴别？（这六种病，有难以区分的，所以请求辨别。平按：《甲乙经》无“石水”二字。《灵枢》、《甲乙经》“别”下有“之”字。）岐伯说：水病刚开始时，眼睑微微浮肿，像刚睡醒的样子，颈动脉跳动，时常咳嗽，大腿内侧发冷，脚肿，腹部才变大，这时水已成病。用手按压腹部，随手而起，像包裹着水的状态，这是它的征候。（水病的症状，有六种区别：一，眼睑微肿；二，足阳明人迎脉，显现其跳动，不需按压；三，胀气循足少阴脉上冲于肺，所以时常咳嗽；四，阴部及大腿内侧冷；五，脚胫肿起；六，腹如囊盛水状，按之不坚，抬手即起。这六种，是水病的征候。平按：《灵枢》、《甲乙经》中“目果”作“目窠”，“微 ”作“微肿”。足 《灵枢》作“足胫 ”，《甲乙经》作“足胫肿”。注中 袁刻作“眼”。）
黄帝说：肤胀如何诊断？岐伯说：肤胀，是寒气客居于皮肤之间，轻轻然但不坚实，腹部大全身肿，皮肤厚，按压腹部，凹陷不起，腹色不变，这是它的征候。（其次解释肤胀，共有五种区别：一，寒气循卫气，客于皮肤之间；二，为肿但不坚实；三，腹大身肿；四，皮厚，按之不起（ ，焉了反切音，深也）；五，腹色不变。肤胀的成因与征候，有此五种区别。平按：“然”，《灵枢》作“ ”。 “《甲乙经》作“腹陷”二字。）
鼓胀怎么样？岐伯说：腹部和身体都大，大小与肤胀相等，面色青黄，腹部脉络显露，这是它的征候。（其次解释鼓胀，共有六种区别：成因及征候，四种同于肤胀，五者腹色青黄，六者腹部脉络显露，鼓胀的征候，有此六种区别。平按：“腹身皆大”，《灵枢》作“腹胀身皆大”，《甲乙经》作“腹身皆肿”。《灵枢》、《甲乙经》中“仓”作“苍”，“脉起”作“筋起”，《甲乙经》注云：一本作“脉”。）
肠覃怎么样？岐伯说：寒气客居于肠外，与卫气相搏，气不得营运，因其所系，结成癖块内着，恶气乃起，息肉乃生。开始时，大如鸡蛋，逐渐增大，到形成时，像怀孕的样子，久的超过一年，按压则坚硬，推之可移动，月经按时来潮，这是它的征候。（其次解释肠覃，是水停聚。肠覃共有六种区别：一，得病原因，谓寒客于肠外，与卫气合，结成癖块内着；二，所生形状的大小；三，成病久近，（离，历也）久的可能经历年岁；四，按之坚硬；五，推之可移；六，月经时下。肠覃的成因与状貌，有此六种。平按：《灵枢》、《甲乙经》中“相薄”作“相搏”。气不得营，《甲乙经》作“正气不得营”。《灵枢》中“营”作“荣”，“瘕”作“癖”，“息肉”作“ 肉”。《甲乙经》中“离岁”作“离岁月”。）
石瘕怎么样？岐伯说：石瘕生于胞中，寒气客居于子门，子门闭塞，气不通，恶血当泻不泻，瘀以留止，日渐增大，状如怀孕，月经不能按时来潮，（其次解释石瘕，共有四种区别：一，瘕住所在；二，得病原因，谓寒气客子门之中，恶血凝聚不泻所致；三，石瘕大小形；四，月经不以时下。石瘕的成因与状貌，有此四种。石水一种，缺而不解。平按：“气不通”，《灵枢》作“气不得通”。）都发生于女子，可以用导引或下药的方法使其排出。
黄帝说：肤胀、鼓胀可以针刺吗？岐伯说：先刺腹部的血络，后调理经脉，也要刺去血脉中的瘀血。黄帝说：好。（肠覃、石瘕两种病，都是妇女病。水病刺而去之，肠覃、石瘕可以用针刺导而下之，不知肤胀、鼓胀这两种胀病是否可以针刺？先泻其血络以去除恶血，后调理经脉，也是去除血络。平按：《灵枢》中“腹之血络”作“胀之血络”，“去其血脉”作“去其血络”。）
黄帝问于岐伯说：有心腹满的病，早上吃饭晚上就不能吃，这是什么病？岐伯说：名叫鼓胀。黄帝说：怎么治疗？岐伯说：用鸡醴治疗，服一剂见效，服两剂痊愈。黄帝说：为什么有时复发？岐伯说：这是因为饮食不节制，所以时常疼痛，虽然病暂且好了，但当时应当疼痛，气聚于腹部。（气满心腹，所以早上吃饭晚上不能吃，这叫鼓胀。可用鸡粪做丸，烧令烟盛，用清酒一斗半浇灌，承接取汁，名叫鸡醴，饮用取汗，一剂不愈，至于两剂，不仅独疗鼓胀，肤胀也会痊愈。有复发的，是因为不慎节饮食的缘故。平按：鼓胀，《素问》新校正云：“《太素》鼓作谷。”兹本仍作鼓，注同。《素问》、《甲乙经》中“鸡醴”作“鸡矢醴”，“齐”作“剂”，“故时痛”作“故时有病也”。时当痛，《素问》作“时故当病”，《甲乙经》作“因当风”。注中“取汗”袁刻作“取汁”。）
[Ping An]: This chapter, from the beginning to "how can there be those who do not descend," is found in *Ling Shu* (Spiritual Pivot), Volume 6, Chapter 35, "Treatise on Distension" (Zhang Lun), and also in *Jia Yi Jing* (Classified Classic of Acupuncture and Moxibustion), Volume 8, Chapter 3. From "Huangdi asked Qibo: Water and skin distension" to "also puncture to remove their blood vessels Huangdi said good," it is found in *Ling Shu*, Volume 9, Chapter 57, "Water Distension" (Shui Zhang), and also in *Jia Yi Jing*, Volume 8, Chapter 4. From "Huangdi asked Qibo: There is a disease with fullness in the heart and abdomen" to the end, it is found in *Su Wen* (Basic Questions), Volume 11, Chapter 40, "Treatise on Abdominal Center" (Fu Zhong Lun), and *Jia Yi Jing* is cited above.
Huangdi said: How does the pulse manifestation at the Cun Kou (inch position) indicate distension? Qibo said: When the pulse is large, firm, and choppy (Se), it indicates distension. (A large pulse often indicates abundant blood but deficient Qi. A choppy pulse also indicates abundant blood but deficient Qi, accompanied by slight cold. A full and tight pulse at the Cun Kou indicates injury from diet. Based on the pulse manifestations of abundant blood, deficient Qi, and slight cold, this is distension caused by dietary injury. Ping An: In *Ling Shu*, "its arrival" is written as "its pulse." In *Jia Yi Jing*, the character "zhi" (straight/direct) appears after "jian" (firm).)
Huangdi said: How can one know the distension of the Zang and Fu organs? Qibo said: Yin pulses govern the Zang organs, and Yang pulses govern the Fu organs. (When a distending pattern is diagnosed with Yin pulses, it is considered Zang distension; when diagnosed with Yang pulses, it is considered Fu distension.)
Huangdi said: Does the Qi that causes distension reside within the blood vessels or inside the Zang and Fu organs? (Blood vessels refer to the twenty-eight meridians. This asks about the location of the distension.) Qibo said: Both exist, yet neither is the abode of distension. (Wei Qi (Defensive Qi) travels alongside the vessels, circulating between the muscle intervals to cause distension. Blood vessels and the five Zang and six Fu organs each experience distension, hence it is said both exist. However, they are not the place where distension resides. Ping An: In *Ling Shu*, "two" is written as "three," with a note saying: one version writes "two.")
Huangdi said: I wish to hear about the abode of distension. Qibo said: Distension always occurs outside the Zang and Fu organs, pushing against them, expanding the chest and hypochondrium, and swelling the skin; therefore, it is named distension. (The following describes the abode of distension. The treatment points are located between the Zang and Fu organs externally, in the chest, hypochondrium, and skin. Qi resides here, expanding and pushing, thus named distension.)
Huangdi said: The Zang and Fu organs are located within the chest, hypochondrium, and abdominal covering, like forbidden artifacts stored in boxes and cabinets. Each has its fixed residence, different names but occupying the same space, like various winds within a single city. I wish to understand the reason. (The following discusses the residences of the Zang and Fu organs. Forbidden artifacts metaphorically represent the Zang and Fu organs. The chest, hypochondrium, and abdominal covering metaphorically represent boxes and cabinets. Residences refer to the specific locations of the five Zang and six Fu organs. Although the names of the Zang and Fu organs differ, they share the same enclosure, yet they are distinct. Please explain the reasons for their similarities and differences. Ping An: *Jia Yi Jing* omits the five characters "chest, hypochondrium, and abdominal covering." "City" is written as "domain." *Ling Shu* is the same. After "the reason," there are nine characters: "Huangdi said: I have not understood the meaning, I ask again.")
Qibo said: The chest and abdomen are the city walls of the Zang and Fu organs. (City walls refer to the location of the Zang and Fu organs. Ping An: *Ling Shu* omits the character "city".) Dan Zhong (Chest Center) is the official of the monarch. (Dan Zhong contains the Qi of the Heart and Lungs, thus serving as the chief official of the Zang and Fu organs. Ping An: In *Ling Shu*, "official of the monarch" is written as "palace city of the heart master." In *Jia Yi Jing*, it is written as "central palace of the heart master".) The Stomach is the great granary. (The Stomach stores water and grain to nourish the body, thus serving as the great granary of the Zang and Fu organs.) The pharynx and small intestine are the officials of transmission. (The pharynx transmits water and grain inward, the small intestine transmits waste outward, and the larynx transmits the entry and exit of Qi; thus, they are called officials of transmission. Ping An: In *Ling Shu*, "dao" (way/path) is written as "song" (send).) The five apertures of the Stomach are the gates and doors of the neighborhoods. (The apertures of the pharynx, stomach, large intestine, small intestine, and bladder all belong to the Stomach, thus serving as the neighborhood gates and doors of the Zang and Fu organs.) Lian Quan (Throat Center) and Yu Ying (Jade Flower) are the pathways of fluids and juices. Therefore, the five Zang and six Fu organs each have boundaries, and their diseases manifest in different shapes. (Lian Quan is the pathway for saliva, and Yu Ying is the pathway for urine and feces, hence named the pathway of fluids and juices. These are the boundaries of the Zang and Fu organs, so their pathological forms vary. Ping An: In *Jia Yi Jing*, the character "lu" (road) follows "dao".) Ying Qi (Nutritive Qi) circulating within the vessels causes vessel distension (Mai Zhang). Wei Qi (Defensive Qi) traveling alongside the vessels through the muscle intervals causes skin distension (Fu Zhang). Puncture Zusanli (ST 36) using the reducing method. For recent onset, one puncture suffices; for distant onset, three punctures are needed. Regardless of deficiency or excess, the key lies in rapid reduction. (The following discusses distension caused by Ying and Wei Qi. Ying Qi circulating around the abdominal cavity causes vessel distension, named Mai Zhang. Wei Qi exists outside the vessels, traveling alongside them through the muscle intervals, accumulating Qi and causing swelling in the muscles, named Fu Zhang. Zusanli is an important acupoint for treating distension, so regardless of deficiency or excess, the reducing method is required. If the illness is recent, one puncture reduces the pathogen; if distant, three punctures reduce it. "Xia" means the distension subsides. Ultimately, rapid reduction must be performed without hesitation. Ping An: In *Ling Shu*, three characters "Wei Qi Ni" follow "Ying Qi Xun Mai". *Jia Yi Jing* writes "Wei Qi Bing Xue Mai Xun Fen Rou". *Jia Yi Jing* writes "Qu Zusanli Xie Zhi" for "Sanli Er Xie". For "Yi Xia", *Jia Yi Jing* notes: another version writes "fen" (divide/interval), same below.)
Huangdi said: I wish to hear about the forms of distension. (I wish to hear the forms of distension for the five Zang and six Fu organs.) Qibo said: Those with Heart Distension experience mental restlessness, shortness of breath, and restless sleep. (Ping An: In *Jia Yi Jing*, the character "de" (obtain) precedes "an" (peace/restful).) Those with Lung Distension experience empty fullness, wheezing, and coughing. Those with Liver Distension experience fullness and pain under the hypochondrium radiating to the lower abdomen. Those with Spleen Distension frequently belch, have stiff limbs, heavy body weight, and difficulty wearing clothes. Those with Kidney Distension experience abdominal fullness pulling on the back with a feeling of discomfort, and pain in the waist and thighs. (Qi is outside the Zang and Fu organs, pushing against them, expanding the chest and hypochondrium, and swelling the skin. Frequent mental restlessness, shortness of breath, and restless sleep indicate Heart Distension. Understanding this, the distension of all five Zang and six Fu organs can be inferred similarly, differing only according to their respective organ characteristics. Kuang means uncomfortable or obstructed. Ping An: In *Ling Shu*, "shao fu" (lower abdomen) is written as "xiao fu". "Xi yue" (likes to belch) is written as "shan yue" (often belches) in *Ling Shu* and "ku yue" (suffers from belching) in *Jia Yi Jing*. "Si zhi ji" (limbs stiff) is written as "si zhi fan yu" (limbs vexed/stifled) in *Ling Shu* and "si zhi men" (limbs stuffy) in *Jia Yi Jing*. In *Ling Shu*, the character "sheng" (bear/endure) precedes "yi" (clothes). Kuang ran in *Ling Shu* is written as "yang yang ran".)
Distension of the six Fu organs: Stomach Distension involves abdominal fullness, gastric pain, smelling burnt odors in the nose, obstruction to eating, and difficult defecation. Large Intestine Distension involves borborygmus and gurgling pain (sound of water in the intestines); if exposed to cold again in winter, diarrhea occurs with undigested food. Small Intestine Distension involves lower abdominal distension pulling on the waist and causing pain. Bladder Distension involves lower abdominal fullness and urinary retention. San Jiao (Triple Burner) Distension involves Qi filling the skin, feeling light but not firm. Gallbladder Distension involves pain and distension under the hypochondrium, bitter taste in the mouth, and frequent sighing. (Fragrance is the odor of the Spleen, burnt is the odor of the Heart. Now, in Spleen and Stomach diseases, smelling burnt odors occurs because the child organ is diseased and seeks the mother's Qi. Ke is pronounced with a reverse cut of the mouth corner. [Character missing], describes a certain appearance. The current character implies seeming solid but not firm. Ping An: "Xie Shi" in *Ling Shu* is written as "sun xie" (diarrhea with undigested food), in *Jia Yi Jing* as "xie sun". "Shao fu man" in *Ling Shu* and *Jia Yi Jing* is written as "xiao fu man". In *Ling Shu*, it is written as "qing qing" (lightly/lightly). "Hao tai xi" is written as "shan tai xi" (frequently sighs).)
For all these types of distension, the principle lies in one aspect: clearly understanding reversal and smoothness, and not failing in the number of needle insertions. (One aspect refers solely to knowing tonification and reduction. Properly tonifying deficiency and reducing excess ensures no failure.) Reducing deficiency and tonifying excess causes the Shen (Spirit) to leave its chamber, inviting evil and losing righteousness, making the true essence unstable; this destruction by incompetent physicians is called premature death. (The Shen chamber is the Heart. Tonifying excess and reducing deficiency harms the Shen, causing it to leave the Heart chamber. Leaving the Heart chamber, it invites evil Qi and loses the righteous Qi of the four seasons, making truth and falsehood indistinguishable.) Tonifying deficiency and reducing excess allows the Shen to return to its chamber, sealing the emptiness for a long time; this is called a skilled physician. (The Shen is at peace in the organs, hence returning to the chamber. With the Shen returning to the organs, it departs from evil, and the cou li (pores/skin texture) remain closed, preventing evil entry; this is called a superior physician.)
Huangdi said: How is distension generated, and why is it named so? (Ping An: *Ling Shu* lacks the words "name and form".) Qibo said: Wei Qi (Defensive Qi) in the body constantly travels alongside the vessels through the muscle intervals. Its movement has reversal and smoothness, with Yin and Yang following each other, thereby attaining heavenly harmony. (Wei Qi travels alongside the vessels through the muscle intervals, having both reversal and smoothness. Moving downward from the eyes along the Foot Yang Ming meridians is smooth; moving downward from the eyes along the Hand Yang Ming meridians is reversal. Because Wei Qi movement has reversal and smoothness, the Yin and Yang Qi become harmonious and smooth. Ping An: In *Ling Shu*, the character "ran" (so/thus) follows "chang" (constant). In *Jia Yi Jing*, the character "rou" (flesh/muscle) follows "fen" (interval), same as *Ling Shu*.) The five Zang organs take turns governing, the four seasons follow order, and grains are digested. Then, Jue Qi (Rebellious Qi) arises below, Ying and Wei Qi stagnate, Cold Qi rebels upward, True Qi and Evil Qi attack each other, the two Qi clash, and together they form distension. (The five Zang organs belong to the Five Elements, so they take turns ruling. The four seasons' cold and heat follow order, allowing grains entering the abdomen to transform. Cold-Jue Qi remains between Ying and Wei Qi. Ying and Wei Qi do not circulate, Cold Qi rebels upward, clashing with Righteous Qi, engaging in fierce struggle, which is called distension. Ping An: "Geng Zhi" in *Ling Shu* is written as "Geng Shi" (restart), in *Jia Yi Jing* as "Jie Zhi" (all govern). "You Xu" in *Ling Shu* is written as "Xun Xu" (follow order), in *Jia Yi Jing* as "Jie Xu" (all order). "Bo" in *Ling Shu* is written as "Bo" (clash). In *Jia Yi Jing*, "nai he wei zhang" is written as "nai she wei zhang" (then reside as distension).)
Huangdi said: Good. How can confusion be resolved? Qibo said: Align with the True Qi, achieve harmony through three combinations. Huangdi said: Good. (When applying tonification and reduction, taking one point near aligns with True Qi, leading to recovery; taking three points far away aligns with True Qi, termed resolving confusion.)
Huangdi asked Qibo: The "Treatise on Distension" states: Do not ask about deficiency or excess; the skill lies in rapid reduction, one insertion for recent cases, three for distant ones. Now, even after three insertions, the distension does not subside. Where is the fault? (Previously, it was stated that reducing deficiency and tonifying excess causes the Shen to leave its chamber; now it says do not ask about deficiency or excess, focusing on rapid reduction. What is the reason? It is said that early in the disease, it is not yet severe deficiency, so re-taking Zusanli focuses on rapid reduction. If deficiency has already formed, taking other points is unsuitable for deficiency. Now, reaching three insertions without resolution, please explain the cause of the fault.) Qibo said: This refers to needles sinking into the muscular fat and hitting the Qi acupoints. (Muscular fat is the membrane above the muscle beneath the skin, similar in nature to the skin and flesh. Qi acupoints are the points where the distending meridian Qi emerges.) If the Qi acupoint is not hit, Qi becomes internally blocked; (Puncturing other areas without hitting the Qi acupoint of the distension prevents the distension from dissipating. Ping An: The note mistakenly prints "ji" (plan/count) instead of "zhen" (needle) in Yuan edition.) If the needle does not sink into the fatty membrane, Qi cannot circulate; (Not sinking into the fatty membrane prevents Qi from circulating between the muscle intervals.) If it does not penetrate the muscle, Wei Qi becomes chaotic, and Yin and Yang chase each other. Regarding distension, if reduction is indicated but not applied, Qi will not descend. If three insertions fail to make Qi descend, one must change the method. Only when Qi descends should one stop; if not, restart. This ensures complete safety, how could there be danger? (If the needle enters the skin but is lifted without penetrating the muscle, Wei Qi circulation becomes disordered, and Yin and Yang Qi merge chaotically. Sui means merging/chasing. Because reduction was indicated but not applied, Qi did not descend after three insertions. One must change to other points to apply tonification and reduction, aiming for the subsidence of distension as success, thus achieving complete safety and avoiding life-threatening disasters. Ping An: "Bu Yue" in *Ling Shu* and *Jia Yi Jing* is written as "Shang Yue" (ascend/penetrate). "Xiang Sui" in *Ling Shu* is written as "Xiang Zhu" (chase), in *Jia Yi Jing* as "Xiang Ni" (oppose/reverse).) Regarding distension, one must carefully examine the diagnosis. Reduce when indicated, tonify when indicated. Like a drum responding to a beat, how could distension not subside? (Saying the diagnosis is careful means it responds like a drum to a beat, leaving no room for error. Ping An: "Zhen" in *Ling Shu* is written as "HT ", noted as pronounced "zhen".)
Huangdi asked Qibo: How to differentiate Water Distension, Skin Distension, Drum Distension, Intestinal Polyp (Chang Tan), Stone Mass (Shi Xia), and Stone Water (Shi Shui)? (These six diseases are difficult to distinguish, hence the request for differentiation. Ping An: *Jia Yi Jing* lacks "Shi Shui". *Ling Shu* and *Jia Yi Jing* add "zhi" (particle) after "bie" (differentiate).) Qibo said: At the onset of Water Disease, the eyelids swell slightly, resembling the appearance after just waking up. The neck pulse throbs, there is occasional coughing, coldness in the inner thigh, swelling of the feet, and then the abdomen enlarges. At this point, the water pathology is established. Pressing the abdomen with the hand causes it to rise immediately, like a bag containing water; this is its sign. (The signs of Water Disease include six distinctions: First, slight swelling of the eyelids. Second, the Renying pulse of the Foot Yang Ming meridian shows throbbing without needing pressure. Third, distending Qi rushes upward along the Foot Shao Yin meridian to the lungs, causing occasional coughing. Fourth, coldness in the genital area and inner thighs. Fifth, swelling of the calves. Sixth, the abdomen resembles a bag holding water, soft upon pressure, rising immediately upon release. These six constitute the signs of Water Disease. Ping An: In *Ling Shu* and *Jia Yi Jing*, "mu guo" is written as "mu ke" (eye nest/socket), "wei " as "wei zhong" (slight swelling). "Zu " in *Ling Shu* is written as "zu jing " (calf swelling), in *Jia Yi Jing* as "zu jing zhong" (foot/calf swelling). The note renders as "yan" (eye).)
Huangdi said: How to diagnose Skin Distension? Qibo said: Skin Distension occurs when Cold Qi lodges between the skin and flesh. It feels light but is not firm. The abdomen is large, the whole body is swollen, the skin is thick. Pressing the abdomen leaves an indentation that does not rise immediately, and the abdominal color remains unchanged. This is its sign. (Next, explaining Skin Distension, there are five distinctions: First, Cold Qi follows Wei Qi and lodges between the skin and flesh. Second, it causes swelling but is not firm. Third, the abdomen is large and the body is swollen. Fourth, the skin is thick, and pressing leaves a deep indentation ( , pronounced "yan" with reverse cut, meaning deep). Fifth, the abdominal color does not change. The cause and signs of Skin Distension have these five distinctions. Ping An: "Ran" in *Ling Shu* is written as " ". " " in *Jia Yi Jing* is written as "fu xian" (abdominal depression).)
What about Drum Distension? Qibo said: Both the abdomen and body are enlarged, equal in size to Skin Distension. The complexion is greenish-yellow, and abdominal veins are prominent. This is its sign. (Next, explaining Drum Distension, there are six distinctions. The cause and signs share four similarities with Skin Distension. Fifth, the abdominal color is greenish-yellow. Sixth, abdominal veins are visible. These six constitute the signs of Drum Distension. Ping An: "Fu shen jie da" in *Ling Shu* is written as "Fu Zhang Shen Jie Da" (abdominal distension and body all large), in *Jia Yi Jing* as "Fu Shen Jie Zhong" (abdomen and body all swollen). In *Ling Shu* and *Jia Yi Jing*, "cang" is written as "cang" (green/blue), "mai qi" as "jin qi" (veins emerge). *Jia Yi Jing* notes: another version writes "mai" (vessel).)
What about Intestinal Polyp (Chang Tan)? Qibo said: Cold Qi lodges outside the intestines, clashing with Wei Qi. Qi fails to circulate properly. Due to its attachment, a mass forms and adheres internally. Evil Qi arises, and polyps grow. Initially, it is as large as a chicken egg, gradually increasing. Upon completion, it resembles pregnancy. Long-standing cases may last over a year. Pressing makes it hard; pushing moves it. Menstruation occurs on time. This is its sign. (Next, explaining Chang Tan, it is water accumulation. Chang Tan has six distinctions: First, the cause: Cold lodges outside the intestines, combining with Wei Qi, forming a mass internally. Second, the size of the formed shape. Third, the duration of the disease (Li means passing/experiencing); long cases may span years. Fourth, hardness upon pressing. Fifth, movability upon pushing. Sixth, timely menstruation. The cause and signs of Chang Tan have these six distinctions. Ping An: In *Ling Shu* and *Jia Yi Jing*, "xiang bo" is written as "xiang bo" (clash). "Qi bu de ying" in *Jia Yi Jing* is written as "Zheng Qi bu de ying" (Righteous Qi fails to circulate). In *Ling Shu*, "ying" is written as "rong" (nutritive), "xia" as "pi" (mass), "xi rou" as " rou". In *Jia Yi Jing*, "li sui" is written as "li sui yue" (passing months/years).)
What about Stone Mass (Shi Xia)? Qibo said: Shi Xia originates in the uterus. Cold Qi lodges in the Zi Men (uterine opening). The Zi Men closes, Qi does not flow, and evil blood should be discharged but is retained, accumulating daily and enlarging. It resembles pregnancy, but menstruation does not occur on time. (Next, explaining Shi Xia, there are four distinctions: First, the location of the mass. Second, the cause: Cold lodges in the Zi Men, causing evil blood to coagulate and not discharge. Third, the size and shape of Shi Xia. Fourth, irregular menstruation. The cause and signs of Shi Xia have these four distinctions. Shi Shui is omitted without explanation. Ping An: "Qi bu tong" in *Ling Shu* is written as "Qi bu de tong" (Qi fails to flow).) All occur in women and can be treated by guiding or purging downwards.
Huangdi said: Can Skin Distension and Drum Distension be treated with acupuncture? Qibo said: First puncture the blood collaterals in the abdomen, then regulate the meridians, and also puncture to remove blood from the vessels. Huangdi said: Good. (Chang Tan and Shi Xia are diseases of women. Water disease is treated by puncturing to remove it. Chang Tan and Shi Xia can be guided down via acupuncture. It is unknown whether Skin Distension and Drum Distension can be punctured. First, drain the blood collaterals to remove evil blood, then regulate the meridians, also removing blood from collaterals. Ping An: In *Ling Shu*, "fu zhi xue luo" is written as "zhang zhi xue luo" (distension's blood collaterals), "qu qi xue mai" as "qu qi xue luo" (remove their blood collaterals).)
Huangdi asked Qibo: There is a disease with fullness in the heart and abdomen. One cannot eat dinner if one eats breakfast. What disease is this? Qibo said: It is named Drum Distension. Huangdi said: How to treat it? Qibo said: Treat with Ji Li (Chicken Fermented Wine). One dose brings improvement, two doses bring cure. Huangdi said: Why does it sometimes recur? Qibo said: This is due to unregulated diet, causing occasional pain. Although the disease seems resolved, pain occurs at times because Qi gathers in the abdomen. (Qi fills the heart and abdomen, so one cannot eat dinner after eating breakfast; this is named Drum Distension. One can use chicken dung made into pills, burn until smoke is heavy, pour half a dou of clear wine over it, collect the juice, named Ji Li. Drinking induces sweating. If one dose is ineffective, proceed to two doses. This not only treats Drum Distension but also cures Skin Distension. Recurrence is due to failure to regulate diet carefully. Ping An: For "Gu Zhang", *Su Wen* New Correction states: "*Tai Su* writes 'Gu' as 'Gu' (grain)." This version still uses "Gu" (drum), note same. In *Su Wen* and *Jia Yi Jing*, "Ji Li" is written as "Ji Shi Li" (Chicken Dropping Fermented Wine), "Qi" as "Ji" (dose), "gu shi tong" as "gu shi you bing ye" (thus having disease at times). "Shi dang tong" in *Su Wen* is written as "shi gu dang bing", in *Jia Yi Jing* as "yin dang feng" (due to wind). Note: Yuan edition writes "qu han" (extract sweat) as "qu zhi" (extract juice).)