胀满脉弦，土制于木。湿热数洪，阴寒迟弱。
浮为虚满，紧则中实。浮大可治，虚小危极。
胀，谓胀于外。满，谓满于中。排脏腑而廓胸胁，急皮肤而露筋脉，脐凸腰圆，
鼓之如鼓，胸腹之疾也。间亦有胀及于头面四肢者，与水肿大同小异，而此则无水
耳。大抵饮食不节，起居失宜，房室过劳，忧思无极，久久皆足以耗其守阴，衰其
阳运，致气壅滞留中，而胀满之疾渐起矣。故实者少，虚者多。热者少，寒者多。
成于他脏腑者少，成于脾胃者多。盖虚则气空浮，故易鼓而大。寒则气凝滞，故易
壅而坚。脾胃居中，以胸腹为宫城，属土而化湿，性缓气屯，故亦易胀易满。此但
言其常耳。至若五脏六腑盛衰之胀，五运六气胜负之胀，有实者，有热者，有成于
他脏腑者，又不能以此数端尽也。在圆机者自为审别，再宜参看张景岳水胀一论，
斯得之矣。《灵枢》诸胀，则有本神篇所云∶肾气实则胀；（肾主藏。藏已中实，而更加以实，
其为胀也，不言可知。）经脉篇所云∶胃病，则大腹水肿，（胃属土而主中焦。土病不能制水，则水泛滥而腹
大矣。）又云∶胃中寒，则胀满，寒则气滞而壅塞故。又云∶足太阴虚，则鼓胀；（脾足太阴主运，
虚则不运。不运则胀。虚则空，故如鼓也。）邪气脏腑病形篇所云∶三焦病者，腹气满，小腹尤坚，
不得小便，窘急。溢则水留，即为胀，候在足太阳之外大络。（三焦主气，为游行之部。病则
气化滞而游行阻，故病如是。在太阳者，三焦联系膀胱耳。）热病篇所云∶男子如蛊，女子如 。（蛊者，蛊
毒也，胀急如蛊蓄。 者阻也，阻滞如怀孕。皆形容腹之大。）《素问》诸胀，则有脉解篇所云∶太阴所
谓病胀者，太阴子也。十一月，万物气皆藏于中，故曰病胀；（亦气藏而中实，故病如是。）大
奇论所云∶肝满、肺满、肾满皆实，即为肿。肺之壅，喘而两 满。肝壅，两 满，
卧则惊，不得小便。肾壅， 下至少腹满，胫有大小，髀 大跛，易偏枯；（肺主气而呼
吸应。两 肝，主惊主疏泄而经两 ，肾经胫与髀 ，而少腹乃其部分。故肺壅实则气喘而两 满，
肝壅实 满卧惊而艰小便，肾壅实则少腹满而胫髀 大跛偏枯。）调经论所云∶志有余则腹胀；（志为肾
所藏。有余则实，实则胀，与肾气实则胀之义同。）脉要精微论所云∶胃气实则胀；（胃脉下膈属胃络脾。
其支者起于胃口下，循腹里，实则经脉泷涌，故胀。）阴阳应象大论所云∶中满者，泻之于内，（中满实则
从内泻之，如攻下之类。若虚
满、虚胀，泻之反成其害也，不可不审。）又云∶浊气在上，则生 胀；（清阳上升，浊阴下降，浊不降而阴滞
于上， 胀生焉。）生气通天论所云∶因于气为肿，四维相代，阳气乃竭；（气者荣卫脏腑之气也。流
行如常，何肿之有。设或不调不顺，则壅滞而形肿于外。四维乃人之四肢，为诸阳之本，更代俱病，阳气不从此
衰竭乎？即本篇所云失之则外壅肌肉、卫气散解之义。）太阴阳明论所云∶饮食不节、起居不时者，阴受之。
阴受之，则入五脏。入五脏，则 满闭塞；（饮食起居为内伤，内伤则阴受之而入脏。故内则病 满闭塞
也。）平人气象论所云∶盛而紧曰胀；（此言胀病之脉也。盛则气实，紧则气强。皆中有余邪，故胀。）异法
方宜论所云∶脏寒生满病；（此言胀病生于方土也。北土地寒，乳酪为食。外寒敛而内滞腻，故满病生焉。）五
常政大论所云∶适寒凉者胀；（适，往也。适往寒凉之处，外闭内郁，故胀。）刺热篇所云∶下牙车，
为腹满。（此言外部之色应腹中而知胀满也。牙车即牙床转动之处。牙车之下，正应腹中。腹胀者，牙车下当见青
白色。青白为寒，寒则凝滞，故胀也。）《金匮要略》论诸胀满有云∶趺阳脉微弦，法当腹满。不满者
必便难，两 疼痛，此虚寒从下上也。以温药服之。（微弦之脉，阳不能运，腹自当满。设不满亦当
便难、两 痛，正不运、不通故耳。然见于胃足趺阳之脉，则知虚寒自下逆上也。服以温药，则能通、能运而愈矣。
如枳实理中汤之类。）又云∶病者胀满，按之不痛为虚，痛者为实。可下之。舌黄未下者，下之
黄自去。（正虚于内，按以实其虚，故不痛。邪实于内，按以实其实，故痛。）又云∶腹满时减，复如故。
此为寒，当与温药。（得暖必减，如理中汤加丁桂之类。）又云∶病腹满，发热十日，脉浮而数，
饮食如故，浓朴七物汤主之。又云∶按之心下满痛者，此为实也，当下之，（下固可下，
要审其满痛者为何物。）宜大柴胡汤。又云∶腹满不减，减不足言，当须下之，宜大承气
汤。以上诸胀诸满，虽种种不同，然而无一不关于脾胃者。盖脾胃者，土也。居
中而溉四脏，胸腹乃其城府。胸腹胀满，犹城府崩裂。未有城府崩裂，而土能独全
者。有诸中，形诸外，此必然之理也。脉若见弦，知木来侮土，更为不吉。若见数
洪，必湿热之郁。若见迟弱，乃阴寒所凝。浮则气散，外虽满而中必虚。紧则气敛，
外固坚而中更实。浮而大者，元气之振作，与病形相宜，故云可治。虚而小者，知
元气之衰微，又与病形相反，故云危极。外有肠覃、石瘕二种，女子之病也。宝鉴
言之甚详。以其类乎胀满，故附录于此。肠覃者，寒气客于肠外，与卫气相搏，气
不得荣，因有所系癖而内着，恶气乃起， 肉乃生。其始生也，大如鸡卵，稍以益
大，至其成，如怀子之状。久者离岁，按之则坚，推之则移，月事以时下，此其候
也。（夫肠者，大肠也。覃者延也。大肠以传导为事，乃肺之腑也。肺主卫，卫为气。得热则泄，得
冷则凝。今寒客于大肠，
故卫气不荣，有所系止，而结瘕在内贴着，其延久不已，是名肠覃也。气散则清，气聚则浊。结为瘕聚，
所以恶气发起， 肉乃生。小渐益大，至期而鼓其腹，如怀子之状也。此气病而血未病，故月事不断应时而下，本非
妊娠，可以此为辨矣。 露丸、木香通气散主之。）石瘕者，生于胞中。寒气客于子门，子门闭塞，气不得通，
恶血当泻不泻。 以留止，日以益大，状如怀子，月事不以时下，皆生于女子，可导而
下。（夫膀胱为津液之府，气化则能出焉。今寒客于子门，则气塞而不通，血壅而不流， 以留止，结硬如石，是名石瘕
也。
此病先气病而后血病，故月事不来，则可宣导而下出者也。《难经》云∶任之为病，其内若结。男子为七疝，女
子为瘕聚，此之谓也。非大辛之剂不能已也。可服见 丸、和血通经汤。）诸胀满病，腹胀，身热。或腹大胀，四末
清，脱形，泄甚。或腹胀便血，其脉大，时绝。或呕咳，腹胀且飧泄，其脉绝。或
面黑，齿长而垢，腹胀闭，上下不通。或腹胀不得息，善噫善呕。呕则逆，逆则面
赤。不逆则上下不通，不通则面黑，皮毛焦。或手足掌纹不见，或脐凸气促等证，皆主必死。
胀满病脉象呈弦象，是脾土受制于肝木所致。湿热证见数而洪大的脉象，阴寒证见迟而微弱的脉象。
脉浮表示虚性胀满，脉紧表示中焦实证。脉浮大者尚可治疗，脉虚小者病情危重至极。
“胀”，是指形体外部肿胀；“满”，是指胸腹内部痞塞胀闷。邪气排挤脏腑，廓清胸胁部位，使皮肤紧绷而显露筋脉，肚脐突出，腰部圆大，叩击腹部声音如鼓，这是胸腹部的疾病。间或也有胀及头面和四肢的情况，这与水肿大体相同而细节略有差异，但此病体内并无积水。大抵由于饮食不节制，起居不合规律，房事过度劳累，忧思没有止境，久而久之都足以耗伤守持之阴精，衰退阳气之运化，导致气机壅滞停留于中焦，从而逐渐引发胀满的疾病。所以实证较少，虚证较多；热证较少，寒证较多；由其他脏腑病变引起的较少，由脾胃病变引起的较多。因为虚则气机空浮，所以容易鼓胀而变大；寒则气机凝滞，所以容易壅塞而坚硬。脾胃位居中焦，以胸腹为宫城，五行属土而化生湿气，性质缓和而气机屯聚，所以也容易发生胀满。这里只是讲述其常理。至于五脏六腑盛衰引起的胀满，五运六气胜负交替引起的胀满，有实证的，有热证的，有由其他脏腑引起的，又不能仅用上述几点来概括完全。在于圆通机变的大夫自然能够审慎辨别，再适宜参考张景岳关于水胀的论述，就能掌握其中的道理了。《灵枢》中关于各种胀病的记载，则有《本神篇》所说的：肾气实则出现胀满；（肾主藏精。若藏精之中已经充实，再加上实邪，其为胀满的道理，不言而喻。）《经脉篇》所说的：胃病，则大腹水肿，（胃属土而主管中焦。土病不能制约水液，则水液泛滥而导致腹部肿大。）又说：胃中有寒，则出现胀满，这是因为寒邪导致气机停滞而壅塞的缘故。又说：足太阴脾经虚弱，则出现鼓胀；（足太阴脾主运化，虚弱则不能运化。不能运化则产生胀满。脾虚则中空，所以像鼓一样。）《邪气脏腑病形篇》所说的：三焦有病，腹部气机胀满，小腹尤其坚硬，小便不通，窘迫急迫。溢出的水液停留体内，就形成胀满，诊候在足太阳膀胱经外侧的大络。（三焦主司气化，是气游行的部位。生病则气化停滞而游行受阻，所以出现上述病症。在太阳经的表现，是因为三焦与膀胱相联系。）《热病篇》所说的：男子像蛊病，女子像怀孕。（蛊，指蛊毒，腹胀紧急如同蛊毒蓄积。 者阻也，阻滞如同怀孕。都是形容腹部巨大的样子。）《素问》中关于各种胀病的记载，则有《脉解篇》所说的：太阴所谓病胀，是因为太阴对应十一月。此时万物之气都收藏于体内，所以说病胀；（也是气机收藏而中焦充实，所以出现上述病症。）《大奇论》所说的：肝满、肺满、肾满皆属实证，就会形成肿。肺气壅滞，喘息且两胁下胀满。肝气壅滞，两胁下胀满，睡觉时易惊，小便不通。肾气壅滞，从胁下到少腹胀满，小腿粗细不一，大腿粗大且跛行，容易发生偏枯；（肺主气而呼吸相应。两胁是肝经所过，肝主惊骇和疏泄且经脉经过两胁，肾经经过小腿和大腿，而少腹是其分部。所以肺壅实则气喘且两胁下胀满，肝壅实则胁下胀满、睡卧易惊且小便困难，肾壅实则少腹胀满且小腿大腿异常、跛行偏枯。）《调经论》所说的：志有余则出现腹胀；（志为肾所藏。有余则为实证，实证则胀，与肾气实则胀的意义相同。）《脉要精微论》所说的：胃气实则出现胀满；（胃脉向下穿过膈肌属于胃并联络脾。其支脉起于胃口下方，沿着腹腔内部行走，实证则经脉汹涌，所以出现胀满。）《阴阳应象大论》所说的：中焦胀满者，从内部泻之，（中焦胀满实证应当从内部攻下，如使用攻下类药物。如果是虚性胀满、虚性胀气，使用泻法反而会造成危害，不可不审慎。）又说：浊气停留在上部，则产生胀满；（清阳上升，浊阴下降，浊气不降而阴邪停滞于上，胀满由此产生。）《生气通天论》所说的：因气机失调而发生肿，四肢更代发病，阳气就会衰竭；（气是指营卫脏腑之气。如果流行正常，哪里有肿呢？如果不调和不顺，则壅滞而在外形表现为肿。四肢乃人体的四肢，是诸阳之本，如果更代俱病，阳气不因此衰竭吗？即本篇所说的失治则外壅肌肉、卫气散解的意思。）《太阴阳明论》所说的：饮食不节制、起居不按时的人，阴经受邪。阴经受邪，则病入五脏。病入五脏，则出现痞满闭塞；（饮食起居属于内伤，内伤则阴经受邪而入脏。所以内部会出现痞满闭塞的症状。）《平人气象论》所说的：脉盛大且紧叫做胀；（这是说胀病的脉象。盛大则气实，紧则气强。都是中焦有余邪，所以出现胀满。）《异法方宜论》所说的：内脏寒冷产生满病；（这是说胀病生于地域气候。北方土地寒冷，以乳酪为食。外寒收敛而内里滞腻，所以产生满病。）《五常政大论》所说的：适应寒凉环境的人会发生胀满；（适，往也。去往寒凉之处，外闭内郁，所以发生胀满。）《刺热篇》所说的：下牙车穴部位，反映腹满。（这是说外部面色应验腹中情况而知晓胀满。牙车即牙床转动之处。牙车之下，正对应腹中。腹胀者，牙车下应当见到青白色。青白为寒，寒则凝滞，所以发生胀满。）《金匮要略》论述各种胀满时说：趺阳脉微而弦，按法应当腹满。如果不腹满，必定大便困难，两胁疼痛，这是虚寒从下往上逆冲。应用温药服用。（微弦之脉，阳气不能运化，腹部自然应当胀满。假设不腹满也应当大便困难、两胁痛，正是阳气不运、不通畅的缘故。然而出现在胃足趺阳之脉，则知道虚寒自下逆上也。服用温药，则能通畅、能运化而痊愈。如枳实理中汤之类。）又说：病人胀满，按压不痛的为虚证，痛的为实证。可以使用下法。舌苔黄而未使用下法的，使用后黄苔自然会去除。（正气虚于内，按压以充实其虚，所以不痛。邪气实于内，按压以充实其实，所以痛。）又说：腹部胀满有时减轻，过后又像原来一样。这是寒证，应当给予温药。（得暖必然减轻，如理中汤加丁香、肉桂之类。）又说：患腹满病，发热十天，脉浮而数，饮食如常，用浓朴七物汤主治。又说：按压心下部胀满疼痛的，这是实证，当下之，（下法固然可用，但要审察胀痛的是什么邪气。）宜用大柴胡汤。又说：腹部胀满不减，即使减轻也不足挂齿，应当必须使用下法，宜用大承气汤。以上各种胀满病，虽然种种不同，然而无一不与脾胃有关。因为脾胃属土，位居中焦而灌溉四脏，胸腹乃是它的城府。胸腹胀满，就像城府崩裂。没有城府崩裂而土能独自保全的道理。有诸内必形诸外，这是必然的道理。脉象若见弦象，知是肝木来侮脾土，更为不吉利。若见数洪脉，必定是湿热郁结。若见迟弱脉，乃是阴寒凝结。脉浮则气散，外表虽满而中焦必定虚。脉紧则气敛，外表固坚而中焦更实。脉浮而大，是元气振作，与病形相适应，所以说可治。脉虚而小，可知元气衰微，又与病形相反，所以说危重至极。此外还有肠覃、石瘕两种，是女子的疾病。《宝鉴》言之非常详细。因为其类似胀满，所以附录于此。肠覃，是寒气客居在肠外，与卫气相搏结，气不得荣养，因而有所系结癖块而内着，恶气于是兴起，息肉于是生长。它刚开始生成时，大如鸡卵，逐渐增大，到成熟时，像怀孕的样子。久则超过一年，按压则坚硬，推动则移动，月经按时来潮，这是它的征候。（夫肠，是大肠。覃，是延也。大肠以传导为职事，是肺的腑。肺主卫，卫为气。得热则泄，得冷则凝。现在寒气客居在大肠，所以卫气不能荣养，有所系止，而结瘕在内贴着，其延长日久不已，名叫肠覃。气散则清，气聚则浊。结为瘕聚，所以恶气发起，息肉乃生。小渐益大，到期而鼓起腹部，像怀孕的样子。这是气病而血未病，所以月经不断应时而下，本来不是妊娠，可以此为辨别。用露丸、木香通气散主治。）石瘕，生长在胞宫中。寒气客居在子门，子门闭塞，气不得通畅，恶血应当排泄而不能排泄，瘀血因而留止，日渐增大，形状像怀孕，月经不能按时来潮，都发生在女子身上，可以用导下法治疗。（夫膀胱是津液的府库，气化则能排出。现在寒气客居在子门，则气塞而不通，血壅而不流，瘀血因而留止，结硬如石，名叫石瘕。此病先气病而后血病，所以月经不来，则可以宣导而下出。《难经》说：任脉为病，其内感觉像结块。男子为七疝，女子为瘕聚，说的就是这种情况。非大辛热的药物不能治愈。可服用见露丸、和血通经汤。）各种胀满病中，腹胀，身体发热。或者腹部大胀，四肢清冷，形体脱失，泄泻严重。或者腹胀便血，脉象大，时有断绝。或者呕吐咳嗽，腹胀且完谷不化的泄泻，脉象断绝。或者面色黑，牙齿变长且垢秽，腹胀闭塞，上下不通。或者腹胀不能呼吸，喜欢嗳气喜欢呕吐。呕吐则气逆，气逆则面红。不气逆则上下不通，不通则面黑，皮毛焦枯。或者手足掌纹消失，或者肚脐突出气促等证候，都主必死。
When the pulse in distension and fullness is wiry (Xian, wiry), it indicates that Earth (Spleen/Stomach) is controlled by Wood (Liver/Gallbladder). A rapid and surging (Hong, surging) pulse indicates damp-heat; a slow and weak pulse indicates Yin-cold.
A floating (Fu, floating) pulse signifies empty/fullness (Xu-man); a tight (Jin, tight) pulse signifies interior excess. A floating and large pulse is treatable; a deficient and small pulse indicates extreme danger.
"Distension" (Zhang) refers to swelling on the exterior; "fullness" (Man) refers to stuffiness and fullness within the middle. The pathogenic factor displaces the Zang-Fu organs and expands the chest and hypochondrium, tightening the skin and exposing the collaterals, with the umbilicus protruding and the waist appearing round. Percussion of the abdomen produces a drum-like sound. This is a disease of the chest and abdomen. Occasionally, distension extends to the head, face, and limbs. It is largely similar but slightly different from edema (Shui-zhong, water swelling), except that there is no accumulation of fluid in this condition. Generally, irregular diet, improper daily routine, excessive sexual activity, and endless worry and thought can, over time, consume the Yin that guards the body and weaken the Yang's transformative function. This leads to Qi stagnation and retention in the middle Jiao, gradually giving rise to distension and fullness diseases. Therefore, excess patterns are few, while deficiency patterns are many; heat patterns are few, while cold patterns are many; cases originating from other Zang-Fu organs are few, while those originating from the Spleen and Stomach are many. Because deficiency causes Qi to float emptily, it easily becomes distended and enlarged. Cold causes Qi to coagulate and stagnate, making it easily obstructed and hard. The Spleen and Stomach reside in the center, regarding the chest and abdomen as their palace city. They belong to Earth and transform dampness; their nature is slow and their Qi tends to accumulate, so they are prone to distension and fullness. This merely describes the common pattern. Regarding distension caused by the decline or excess of the Five Zang and Six Fu organs, or by the winning and losing of the Five Movements and Six Qi, there are excess patterns, heat patterns, and those arising from other organs, which cannot be fully covered by these few points. It is up to the flexible and astute physician to examine and distinguish them carefully. It is also advisable to refer to Zhang Jingyue's discussion on Water Distension (Shui-zhang), and one will grasp the essence.
In *Ling Shu* (Spiritual Pivot), various discussions on distension include: In the chapter *Ben Shen* (Root of Spirit): "When Kidney Qi is in excess, distension occurs." (The Kidney governs storage. If the storage is already full and further subjected to excess, the resulting distension is self-evident.) In the chapter *Jing Mai* (Meridians): "Stomach disease results in large abdominal edema." (The Stomach belongs to Earth and governs the Middle Jiao. When Earth disease fails to control Water, Water floods and causes abdominal enlargement.) It also states: "Cold in the Stomach results in distension and fullness," because cold causes Qi stagnation and obstruction. It also states: "Deficiency of Foot-Taiyin [Spleen] meridian results in drum-like distension." (Foot-Taiyin Spleen governs transportation and transformation. Deficiency leads to failure of transportation, causing distension. Deficiency implies emptiness, hence resembling a drum.) In the chapter *Xieqi Zangfu Bingxing* (Pathogenic Factors, Zang-Fu Diseases, and Manifestations): "Disease of the Sanjiao [Triple Burner] presents with abdominal Qi fullness, especially hardness in the lower abdomen, inability to urinate, and distress/urgency. Overflowing fluid remains, forming distension. The sign is observed in the large collateral outside Foot-Taiyang [Bladder]." (Sanjiao governs Qi transformation and is the region of Qi circulation. Disease causes Qi transformation stagnation and blocked circulation, hence these symptoms. The manifestation at Taiyang is due to the connection between Sanjiao and Bladder.) In the chapter *Re Bing* (Heat Diseases): "Men resemble Gu [poisonous worm] disease, women resemble pregnancy." (Gu refers to Gu poison; abdominal urgency resembles Gu accumulation. 'Zu' means obstruction, resembling pregnancy due to blockage. Both describe massive abdominal enlargement.)
In *Su Wen* (Basic Questions), various discussions on distension include: In the chapter *Mai Jie* (Pulse Explanation): "What Taiyin calls disease of distension is related to Taiyin Zi [November]. In the eleventh month, the Qi of all things is stored within, hence called disease of distension." (Qi is stored and the interior is full, hence such disease.) In the chapter *Da Qi Lun* (Great Strange Discourse): "Fullness/excess in Liver, Lung, and Kidney, all being excess, results in swelling. Lung congestion causes panting and fullness in both flanks. Liver congestion causes fullness in both flanks, waking with fright during sleep, and inability to urinate. Kidney congestion causes fullness from the flanks down to the lower abdomen, calves varying in size, thighs becoming large with limping, and predisposition to hemiplegia." (Lung governs Qi and respiration. Both flanks are associated with Liver, which governs fright and free flow, and its meridians pass through the flanks. Kidney meridians pass through calves and thighs, and the lower abdomen is its domain. Thus, Lung excess causes panting and flank fullness; Liver excess causes flank fullness, sleep fright, and difficult urination; Kidney excess causes lower abdominal fullness, abnormal calf/thigh size, limping, and hemiplegia.) In the chapter *Tiao Jing Lun* (Regulating Meridians Discourse): "Excess in Zhi [Will/Kidney Essence] results in abdominal distension." (Zhi is stored by the Kidney. Excess implies reality/excess, leading to distension, same meaning as Kidney Qi excess causing distension.) In the chapter *Mai Yao Jing Wei Lun* (Essential Discourse on Pulse Necessities): "Excess in Stomach Qi results in distension." (Stomach meridian passes below the diaphragm, belongs to Stomach, and connects to Spleen. Its branch starts below the stomach gate, runs along the abdominal interior. Excess causes the meridian to surge, hence distension.) In the chapter *Yin Yang Ying Xiang Da Lun* (Great Discourse on Yin-Yang Correspondences): "For central fullness, purge from within." (Central fullness-excess should be purged internally, e.g., using purgatives. If it is empty-fullness or empty-distension, purging causes harm; caution is required.) It also states: "If turbid Qi stays above, distension arises." (Clear Yang ascends, turbid Yin descends. If turbid Qi does not descend and Yin stagnates above, distension arises.) In the chapter *Sheng Qi Tong Tian Lun* (Discourse on Vital Qi Connecting to Heaven): "Swelling due to Qi disorder, when the four extremities alternate in disease, Yang Qi is exhausted." (Qi refers to Ying-Wei and Zang-Fu Qi. If flowing normally, how could there be swelling? If disordered and unsmooth, stagnation occurs and swelling appears externally. The four extremities are the root of all Yang Qi. If they alternate in disease, does not Yang Qi exhaust here? This aligns with the text's meaning: loss of balance causes external muscle congestion and dispersal of Wei Qi.) In the chapter *Tai Yin Yang Ming Lun* (Taoyin and Yangming Discourse): "Those who do not regulate diet and do not follow proper routines suffer Yin invasion. Yin invasion enters the Five Zang. Entering the Zang results in痞满 (Pi-man, stuffiness and fullness) and obstruction." (Diet and routine are internal injuries; internal injury invades Yin and enters the Zang. Hence, internal Pi-man and obstruction occur.) In the chapter *Ping Ren Qi Xiang Lun* (Discourse on Normal People's Qi and Manifestations): "Surging and tight [pulse] is called distension." (This refers to the pulse of distension disease. Surging indicates Qi excess, tight indicates strong Qi. Both imply excess pathogens in the center, hence distension.) In the chapter *Yi Fa Fang Yi Lun* (Discourse on Different Methods and Regions): "Cold in the Zang generates fullness disease." (This explains distension arising from regional climate. Northern lands are cold; people eat milk and cheese. External cold constricts while internal dampness/lubricants stagnate, generating fullness disease.) In the chapter *Wu Chang Zheng Da Lun* (Great Discourse on Five Constant Policies): "Adapting to cold and cool causes distension." ('Shi' means going to. Going to cold and cool places causes external closure and internal depression, hence distension.) In the chapter *Ci Re Pian* (Acupuncture for Heat Chapter): "Below the Yache [dental arch] point corresponds to abdominal fullness." (This indicates external facial color reflects internal abdominal status to know distension. Yache is where the jaw moves. Below Yache corresponds to the abdomen. In abdominal distension, blue-white color should appear below Yache. Blue-white indicates cold; cold causes stagnation, hence distension.)
In *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), discussing various distensions and fullnesses: "Fuyang pulse [pulse at dorsum pedis] is slightly wiry; according to method, abdominal fullness should occur. If there is no fullness, there must be difficulty in defecation and pain in both flanks. This is deficiency-cold rising from below. Treat with warm medicines." (Slightly wiry pulse indicates Yang cannot transform; abdominal fullness naturally follows. Even if no fullness, difficulty in defecation and flank pain indicate failure of transformation and blockage. Since it appears at the Stomach/Fuyang pulse, we know deficiency-cold rises from below. Warm medicines promote flow and transformation, leading to cure, e.g., Zhishi Lizhong Tang.) It also states: "Patients with distension and fullness: pressing without pain indicates deficiency; pressing with pain indicates excess. Purgatives may be used. If the tongue coating is yellow and purgatives have not been used, purging will remove the yellow coating." (Internal deficiency: pressing fills the deficiency, hence no pain. Internal excess: pressing fills the excess, hence pain.) It also states: "Abdominal fullness that decreases occasionally and returns to normal. This is cold; give warm medicines." (Warmth reduces it, e.g., Lizhong Tang plus Dingxiang and Rougui.) It also states: "Patient with abdominal fullness, fever for ten days, floating and rapid pulse, normal appetite. Main treatment: Nongpu Qiwu Tang." It also states: "Pressing the epigastrium reveals fullness and pain. This is excess; it should be purged." (Purging is applicable, but determine the nature of the fullness/pain.) Use Dachaihu Tang. It also states: "Abdominal fullness that does not decrease, or decreases insignificantly. Must be purged. Use Dachengqi Tang."
All the aforementioned distensions and fullnesses, though diverse, are invariably related to the Spleen and Stomach. Spleen and Stomach belong to Earth, reside in the center, and irrigate the four Zang organs. The chest and abdomen are their citadel. Chest and abdominal distension is like the collapse of a citadel. There is no scenario where a citadel collapses yet Earth remains intact. What exists internally manifests externally; this is an inevitable principle. If the pulse is wiry, it indicates Wood insulting Earth, which is even more ominous. If the pulse is rapid and surging, it indicates damp-heat stagnation. If the pulse is slow and weak, it indicates Yin-cold coagulation. Floating pulse indicates Qi dispersion; although the exterior is full, the interior must be deficient. Tight pulse indicates Qi contraction; although the exterior is firm, the interior is more excess. Floating and large pulse indicates vigorous Yuan Qi [Original Qi], compatible with the disease form, hence "treatable." Deficient and small pulse indicates declining Yuan Qi, contrary to the disease form, hence "extremely critical."
Additionally, there are two conditions: Changtan (Intestinal Polyp/Tumor) and Shijia (Stone Mass), which are diseases in women. *Baojian* discusses them in detail. Since they resemble distension and fullness, they are appended here. Changtan: Cold pathogen lodges outside the intestines, battling with Wei Qi [Defensive Qi]. Qi fails to nourish, binding into a mass internally. Evil Qi arises, and flesh polyps grow. Initially, it is egg-sized, gradually enlarging until it resembles pregnancy. After a year or more, it is hard to pressure but movable. Menstruation comes on time. This is its sign. (Chang refers to Large Intestine; Tan means extension. Large Intestine governs transmission, is the Fu organ of Lung. Lung governs Wei, Wei is Qi. Heat dissipates it, cold coagulates it. Now cold lodges in Large Intestine, so Wei Qi fails to nourish, binding and attaching masses internally. Extending long, it is named Changtan. Qi scatters to clear, gathers to turbid. Forming masses, evil Qi arises, polyps grow. Gradually enlarging, belly swells like pregnancy. This is Qi disease, not Blood disease, hence menstruation continues normally. Not pregnancy; distinguish by this. Treat with Bailu Wan and Muxiang Tongqi San.) Shijia: Born in the Baozhong [uterus]. Cold pathogen lodges in Zimen [cervix]. Zimen closes, Qi cannot flow, evil blood should discharge but does not. Blood stasis remains and stops, enlarging daily, resembling pregnancy. Menstruation does not come on time. All occur in women; treat with guiding and purging methods. (Bladder is the storehouse of fluids; Qi transformation allows excretion. Now cold lodges in Zimen, Qi blocks and does not flow, Blood stagnates and does not move, stasis remains and stops, hardening like stone, named Shijia. This disease begins with Qi disorder then Blood disorder, hence menstruation stops; guide and purge to expel. *Nan Jing* says: Ren Mai disease feels like internal knotting. In men, Seven Hernias; in women, Jia Ju [masses]. This is what is meant. Only potent acrid-hot agents can cure. Take Jianlu Wan and Hexue Tongjing Tang.)
Various distension and fullness diseases: Abdominal distension with body heat. Or massive abdominal distension, cold extremities, emaciation, severe diarrhea. Or abdominal distension with bloody stool, large pulse, intermittently absent. Or vomiting and coughing, abdominal distension with undigested food diarrhea, absent pulse. Or black complexion, elongated and dirty teeth, abdominal distension and closure, upper and lower blockage. Or abdominal distension preventing breathing, frequent belching and vomiting. Vomiting causes reversal of Qi; reversal causes red face. No reversal means upper-lower blockage; blockage causes black face and scorched skin/hair. Or disappearance of palm creases, or protruding umbilicus with shortness of breath, etc. These signs all indicate certain death.