（附水肿）
鼓胀又名单腹胀。以其中虚外坚。有似于鼓也。鼓胀之作。有得于食者。有得于气者。
有得
于气食兼并者。有先伤于色。而后伤于食者。有先伤于食。而后伤于色者伤于食。则食不能
消。而胃气以窒。伤于气。则肝经受病。而痞塞不通。伤于气食。则肝家有余。脾家不足。
以有余之肝木。克不足之脾土。则气愈结。而食愈不化。由是膨胀紧急。而病日益深矣。先
得于食。而后伤于色。则脾先病。而肾继之。中脘先胀。而后及于小腹。先得于色。而后伤于
食。则肾先病而脾继之。小腹先胀。而后及于中脘。若气与食色三者俱伤。则一齐而发。中
脘小腹两胁尽胀。此病之尤重者也。三者之中又有虚实之分。虚者壳壳然坚而不痛。气满按
之则陷而软。实者内挟宿食或瘀血邪实于内。按之不陷而硬痛。又有眼下忽如卧蚕状者。必
发水肿。然水何自而来耶。盖人身真水真火。消化万物以养生。脾土虚弱。则水流为湿。火
炎为热。湿热郁结经络。浊腐之气。津液与血。皆化为水。水积妄行。面目虚浮。流于膜外
遍身。皮肤光肿。手按成窟。随手而起。上则喘急咳嗽者何也。盖金生水。脾病则肺失降下
之令。故喘嗽。下则足膝 肿者何也。盖肾主水。脾病则湿热下注。故 肿。阳水先肿上体
。肩背手膊属手三阳经也。治宜辛寒散结行气。苦寒泻火燥湿。阴水先肿下体。腰腹胫 。属
足三阴也。治宜苦温燥脾或辛热导气。故男从脚下肿起。女从头上肿起也。逆阴阳微妙。欲
知其死生何以断之。曰鼓胀之病。脐满者重。脐突者死。发热者重。腹如墙壁坚硬者死。水
肿之病。手心足心平满者死。面黑肉硬腹多青筋者死。此断死生之大诀也。大法治鼓胀者。
以实脾去湿宽膨利水为主。不可过于克伐。治水肿者。以行水为主。而后补之。如此治法。
万无一失矣。
（附注：水肿）
鼓胀，又被称为单腹胀。因为患者腹部中间空虚而外部坚硬，形状像鼓一样。鼓胀的成因，有的是因饮食不当所致，有的是因情志气滞所致，有的是因气滞与食积同时存在所致，有的是先因房劳伤肾，而后因饮食伤脾所致，也有的是先因饮食伤脾，而后因房劳伤肾所致。若因饮食受伤，则食物不能消化，导致胃气窒塞；若因气机受伤，则肝经受病，导致痞塞不通；若因气滞与食积共同作用，则肝木有余而脾土不足，以有余之肝木克制不足之脾土，导致气机更加郁结，食物更加难以消化，由此出现腹部膨胀紧急，病情日益加深。若是先因饮食受伤，而后因房劳受伤，则脾脏先发病，肾脏随后受累，中脘部先胀满，然后波及小腹；若是先因房劳受伤，而后因饮食受伤，则肾脏先发病，脾脏随后受累，小腹先胀满，然后波及中脘部。如果气、食、色三者都受到损伤，则会同时发作，表现为中脘、小腹及两胁全部胀满，这是病情最为严重的情况。在这三种情况中又有虚证和实证的区分。虚证表现为腹部虽然坚硬但按之不痛，气满时按压则下陷且柔软；实证表现为内部夹杂宿食或瘀血等邪气实于体内，按压时不下陷且硬痛。另外，如果眼下突然像卧蚕一样的肿胀，必定会并发水肿。那么水湿是从哪里来的呢？大概是因为人身体的真水和真火，负责消化万物以滋养生命。当脾土虚弱时，水流变为湿气，火炎变为热邪，湿热郁结在经络中，浊腐之气、津液和血液，都转化为水湿。水湿积聚并妄行，导致面目虚浮，流注于膜外遍布全身，皮肤光亮肿胀，用手按压会出现凹陷，随手而起。为什么上部会出现喘急咳嗽呢？这是因为金生水，脾病导致肺失去肃降的功能，所以出现喘咳。为什么下部足膝会出现肿胀呢？这是因为肾主水，脾病导致湿热下注，所以出现肿胀。阳水通常先从身体上部开始肿胀，肩背手臂属于手三阳经，治疗宜用辛寒药物散结行气，苦寒药物泻火燥湿；阴水通常先从身体下部开始肿胀，腰腹胫部属于足三阴经，治疗宜用苦温药物燥脾或辛热药物导气。因此男性多从脚下肿起，女性多从头上肿起，这符合阴阳微妙的变化规律。想要判断疾病的生死预后，该如何断言呢？答曰：鼓胀病中，脐部胀满是重症，脐部突出者死；发热者是重症，腹部像墙壁一样坚硬者死。水肿病中，手心足心平满无凹陷者死，面色黧黑肌肉坚硬腹部多有青筋暴露者死。这是判断生死的关键法则。治疗鼓胀的大法，以实脾、去湿、宽膨、利水为主，不可过于使用攻伐药物；治疗水肿的大法，以行水为主，然后再进行补益。按照这样的治法，万无一失。
(Note: Edema)
Gu Zhang (Drum Distension), also known as Dan Dan Fu Zhang (Single Abdominal Distension), is so named because the center of the abdomen is hollow while the exterior is firm, resembling a drum. The etiology of Gu Zhang includes cases caused by dietary indiscretion, those caused by Qi stagnation, those caused by a combination of Qi stagnation and food retention, those where Kidney injury from sexual excess precedes Spleen injury from diet, and those where Spleen injury from diet precedes Kidney injury from sexual excess. Injury from diet leads to indigestion and obstruction of Stomach Qi. Injury from Qi causes disease in the Liver Meridian, resulting in fullness and blockage. When both Qi and food are injured, the Liver becomes excessive while the Spleen becomes deficient; the excessive Liver Wood overacts upon the deficient Spleen Earth, causing further Qi knotting and impaired digestion, leading to progressive abdominal distension and deepening pathology. If diet is injured first followed by sexual excess, the Spleen is affected first and the Kidney subsequently, with initial distension in the Zhong Wan region spreading to the lower abdomen. If sexual excess occurs first followed by dietary injury, the Kidney is affected first and the Spleen subsequently, with initial distension in the lower abdomen spreading to the Zhong Wan region. If Qi, food, and sexual essence are all injured simultaneously, symptoms manifest together with distension in the Zhong Wan, lower abdomen, and both hypochondria, representing the most severe form. Among these, there are Deficiency and Excess patterns. Deficiency presents as firm but non-tender distension, where pressing yields a soft depression. Excess involves internal retention of old food or blood stasis, presenting as hard and painful upon pressure without depression. Additionally, sudden swelling under the eyes resembling a sleeping silkworm indicates impending edema. How does this water arise? The body's True Water and True Fire digest nutrients to sustain life. When Spleen Earth is weak, water transforms into dampness, and fire transforms into heat. Damp-heat stagnates in the meridians, transforming turbid qi, fluids, and blood into water. Accumulated water flows recklessly, causing facial puffiness, spreading outside the membranes throughout the body, resulting in shiny skin swelling that pits on pressure and rebounds quickly. Why does upper body involvement cause panting and coughing? Metal generates Water; Spleen disease impairs Lung descending function, causing panting and cough. Why does lower body involvement cause foot and knee swelling? The Kidney governs water; Spleen disease causes damp-heat to sink downward, causing swelling. Yang-type edema begins in the upper body (shoulders, back, arms belonging to the Hand Three Yang meridians); treatment should use acrid-cold herbs to dissipate nodules and move Qi, and bitter-cold herbs to purge fire and dry dampness. Yin-type edema begins in the lower body (waist, abdomen, shins belonging to the Foot Three Yin meridians); treatment should use bitter-warm herbs to dry the Spleen or acrid-hot herbs to guide Qi. Thus, men often swell from the feet up, and women from the head down, reflecting subtle Yin-Yang dynamics. To determine prognosis: In Gu Zhang, umbilical fullness indicates severity, while umbilical protrusion indicates death; fever indicates severity, while an abdomen hard as a wall indicates death. In Edema, flat palms and soles indicate death; dark complexion, hard flesh, and prominent abdominal veins indicate death. These are the major principles for distinguishing life from death. The general treatment principle for Gu Zhang focuses on strengthening the Spleen, eliminating dampness, relieving distension, and promoting urination, avoiding overly harsh purgatives. The general treatment principle for Edema focuses on promoting water metabolism first, followed by tonification. Adhering to these methods ensures success.