有病心腹痛，旦食则不能暮食，名为“鼓胀”。（内伤脾肾，留滞于中，则心腹胀满不能再食，其胀
如鼓，故名“鼓胀”。）治之以鸡矢醴，一剂知，二剂已。（鸡矢之性，能消积下气，通利大、小二便，盖
攻伐实邪之剂也。一剂可知其效，二剂可已其病。凡鼓胀由于停积，及湿热有余者，皆宜用之。若肾脾虚寒发
胀，及气虚中满等症，最所忌也，误服则死。鸡矢醴法∶用羯鸡矢一升，研细炒焦色，地上出火毒，以百沸汤
淋汁；每服一大盏，调木香、槟榔末各一钱，日三服，空腹服，以平为度。
又有用干羯鸡矢八合，炒微焦，入无灰好酒三碗共煎，干至一半许，用布滤汁，五更热饮，则腹鸣，辰、巳时
行二三次，皆黑水也。次日觉足面渐有皱纹，又饮一次，则渐皱至膝上而病愈矣。此二法似用后者为便。）其时
有复发者，饮食不节故也。（鼓胀之病本因留滞，故不可复纵饮食也。）虽然，其病且已时，故当病气聚于腹
也。（病虽将愈而复伤其脾，所以气复聚也。）
应于寸口，其脉大坚以涩者，胀也。（脉大者，邪之盛也；脉坚者，邪之实也；涩因气血之虚而不能流
利也。大都洪大之脉，阴气必衰，坚强之脉，胃气必损，故大坚以涩，则病当为胀。）何以知脏腑？阴为
脏，阳为腑也。（涩而坚者为阴，其胀在脏，大而坚者为阳，其胀在腑。一曰∶脉病在阴，则胀在脏；脉病在
阳，则胀在腑。）夫气之令人胀也，血脉之中，脏腑之内，三者皆存焉，然非胀之舍也。（舍，言留
止之处也。）胀之舍在于脏腑之外，排脏腑而郭胸胁，胀皮肤，故命曰“胀”。（排挤于脏腑之外，以胸胁
为郭而居于皮肤之中，是即胀之所舍。）脏腑之在胸胁腹里之内也，若匣匮之脏禁器也，各有次
舍，异名而同处一域之中，其气各异，盖胸腹，脏腑之郭也。（胸腹者，所以保障五内，故为脏腑之郭。）
膻中者，心主之宫城也。（膻中者，胸中也，肺覆于上，膈膜障于下，为清虚周密之宫，心主之所居
也，故曰“宫城”。）胃者，太仓也。（胃为水谷之海，故曰“太仓”。）咽喉、
小肠者，传达也；（咽喉传送者，谷气自上而入；小肠传送者，清浊自下而出。）胃之五窍者，闾里门户也；
（闾，巷门也。里，邻里也。五家为比，五比为闾，盖二十五家为闾也。五家为轨，十轨为里，盖五十家
为里也。胃之五窍为闾里门户者，非言胃有五窍，正以上自胃脘，下至小肠、大肠，皆属于胃，故曰“闾里门
户”，如咽门、贲门、幽门、阑门、魄门，皆胃气之所行也，故总属胃，谓之“五窍”。）廉泉、玉英者，津
液之道也。（二穴俱属任脉，玉英即玉堂。）故五脏六腑者，各有畔界，
其病各有形状。（畔界各有所属，故病之形见可按也。下文所以辨之。）营气循脉，胃气逆为脉胀。（清者为
营，营在脉中，其气精专，未即致胀。浊者为卫，卫行脉外，其气 疾滑利，而行于分肉之间，故必由卫
气之逆，而后病及于营，则为脉胀，是以凡病胀者，皆发于卫气也。）卫气并脉循分为肤胀。（卫气逆而并
于脉，复循分肉之间，故为肤胀。）三里而泻，近者一下，远者三下，无问虚实，工在疾泻。（三里，足
阳明经穴。阳明为五脏六腑之海而主肌肉，故胀在肌肤者，当以针泻之。一下、三下，谓一次、再次、三次
也。盖邪有远近，故泻有难易耳。）心胀者，烦心短气，卧不安；肺胀者，虚满而喘咳；肝胀者，胁
下满而痛引小腹，脾胀者，善哕，四肢烦 ，体重不能胜衣，卧不安；肾胀者，腹满引背，央央然腰髀痛；
（此五脏之胀也。 ，闷乱也。央央然，困苦貌。）胃胀者，腹满，胃脘痛，鼻闻焦臭，妨于食，大便难；
大肠胀者，肠鸣而痛濯濯，冬日重感于寒，则飧泄不化；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，轻轻然而不坚；胆胀者，胁下痛胀，口中苦，善太息。（
此六腑之胀也。濯濯，肠鸣水声也。飧泄不化，完谷而泄也，气癃，膀胱气闭，小水不通也。）
凡此诸胀者，其道在一。明知逆顺，针数不失，泻虚补实，神去其室，致邪失正，真不可定，粗之所败，
谓之天命，补虚泻实，神归其室，久塞其空，谓之良工。（此下言治胀之得失也。胀有虚实，而当补当泻，
其道唯一，能察者谓之良工，粗者误用。则伤人矣。）卫气之在身也，常然并脉循分肉，行有逆顺，阴阳
相随，乃得天和，五脏更始，四时循序，五谷乃化。（此卫气之常度也。）然后厥气在下，营卫留止，寒
气逆上，真邪相攻，两气相搏，乃合为胀也。（上节言卫气之顺，此节明卫气之逆也。厥逆之
气，自下而上，营卫失常，故真邪相攻而合为胀也。）合之于真，三合而得。（胀虽由于卫气，然有合于血
脉之中者，在经络也；有合于脏者，在阴分也；有合于腑者，在阳分也。三合既明，得其真矣。）无问虚实，
工在疾泻，近者一下，远者三下，其有三而不下者焉。下者，陷于肉肓而中气穴者也。（一下，三下者，言
针当必陷于肉盲，亦必中于气穴，然后可以取效也。）不中气穴，则气内闭，针不陷肓，则气不行，上越
中肉，则卫气相乱，阴阳相逐。（不中穴，不陷肓，则妄中于分肉间矣，故卫气相乱而阴阳之邪反相逐
以乘之也。）其于胀也，当泻不泻，气故不下。（不得其气穴肉肓也。）三而不下，必更其
道，气下乃止，不下复始，针药不二，必审其脉，当泻当补，如鼓应桴，恶有不下者乎！（三而不下，必未
得其所也，故当更穴再刺之，针与药，其法一也。肿胀一症，五脏六腑无不有之。如“胃脉实，
气有余则胀”，“胃病者腹 胀”，“胃脘当心而痛，脾气实则腹胀泾溲不利”，“浊气在上，则生 胀“，
此皆实胀也；“饮食起居失节，入五脏则 满闭塞“，“足太阴之别公孙，虚则鼓胀”，此皆虚胀也∶“胃
中寒则胀满”，“脏寒生满病”，“胃风膈塞不通，腹善胀”；“失衣则 胀”，此皆寒胀也；
“二阴一阳发病，善胀心满”，“手少阴终者，腹胀闭”，“足太阴终者，腹胀闭”，此心脾受伤之胀也；
又如“太阴所至为重跗肿”，及土郁之发，太阴之初气，太阴之胜复，皆湿胜之肿胀也；又曰水运之太过，
寒胜则浮；太阳之司天，太阳之胜复，皆寒胜之肿胀也。有曰少阴之司天，少阴之胜复，少阳之司天，少阳之
胜复，又曰“热甚则肿”，皆火胜之肿胀也；若厥阴之司天、在泉，厥阴之复及阳明之复，是皆木邪侮土
及金气反胜之肿胀也，观此则不惟五脏六腑，即五运六气，亦无不皆有是病。然曰“诸湿肿满，皆属于脾”，
又曰“其本在肾，其末在肺，皆聚水也”，又曰“肾者，胃之关也。关门不利，故聚水而从其类也”，由
此言之，则诸经虽皆有胀，无不干于脾、肺、肾三脏。盖脾属土，其主运化；肺属金，其主气；肾属
水，其主五液。凡五气所化之液，悉属于肾；五液所行之气，悉属于肺；转输于二脏之中，以制水生金者，悉
属于脾。所以肿胀之生，无不由此三者，但症有阴阳、虚实、寒热、新久之别，不可不察焉。）
水与肤胀、鼓胀、肠覃、石瘕、石水，有以别之。（此六症者，病异而形相似，故宜有以别之。覃，
音潭。）水始起也，目窠上微肿，如新卧起之状，（目之下为目窠，微肿如新卧起之状者，形如卧蚕也。）
其颈脉动，时咳，（颈脉，足阳明人迎也。阳明之脉，自人迎下循腹里。由水邪乘之，故为颈脉动，水之标在
肺，故为时咳。）阴股间寒，足胫 ，腹乃大，其水已成矣。（阴邪始于阴分也。）以手按其腹，随
手而起，如裹水之状，此其候也。（凡按水囊者，必随手而起，故病水者亦若是。以上皆水肿之候。）肤胀
者，寒气客于皮肤之间， 然不坚，腹大，身尽肿，皮浓，（ ，鼓声也，寒气客于皮肤之间
者，阳气不行，病在气分，故有声若鼓。气本无形，故不坚。气无所不至，故腹大，身尽肿。若因于水，则有
水处肿，无水处不肿，此为可辨，然有水则皮泽而薄，无水则皮浓。）按其腹， 而不起，腹色不变，此
其候也。（寒气在肤腠之间，按散之则不能猝聚，故 然不起。腹色不变，即皮浓故也，以手按其腹，随
手而起者属水， 而不起者属气，此固然也，然按气囊者亦随手而起，又水在肌肉之中，按而散之，猝不
能聚，如按糟囊者亦 而不起，故未可以起与不起为水气之的辨，但当察其皮浓色苍，或一身尽肿，或自上
而下者多属气，若皮薄色泽，或肿有分界，或自下而上者多属水也。 ，音夭，深也。）鼓胀者，腹胀，身
皆大，大与肤胀等也；色苍黄，腹筋起也。（腹胀，身皆大，与上文肤胀者证同。色苍黄者，亦皮浓腹色不
变之义，但腹有筋起，为稍异耳，盖此亦病在气分，故名鼓胀也。）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。（覃，延布而深也，寒气与卫气相搏，则蓄积不行，留
于肠外，有所系着，故癖
积起， 肉生，病日以成矣。 肉，恶肉也。）其始生也，大如鸡卵，稍以盆大，至其成，如怀子之状，久
者离岁，按之则坚，推之则移，月事以时下也。（离岁，越岁也。寒邪客于肠外，不在胞中，
故无妨于月事，其非血病可知。盖由汁沫所聚而生，此肠覃之候也。）石瘕生于胞中，寒气客于子门，（胞，
即子宫也，男女皆有之∶在男谓之精室，在女谓之血海，子门，即子宫之门也。）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。（ ，凝败之血
也，子门闭塞，则 血留止，其坚如石，故曰“石瘕”。月事不以时下，惟女子有之也，故可以
导血之剂下之。 ，铺杯切。）肤胀、鼓胀亦可刺，先泻其胀之血络，后调其经，刺去其血络也。（先泻其
胀之血络，谓无论虚实，凡有血络之外见者，必先泻之，而后因虚实以调其经也。刺去其血络，即重
明先泻之义，所言者凡六证，而独云肤胀、鼓胀者，盖兼五证而统言之，辞虽简而意则在也。）
有一种病表现为心腹疼痛，早晨吃了饭到了晚上就不能再吃，这种病叫做“鼓胀”。（这是因为内伤脾肾，邪气留滞在中焦，导致心腹胀满、不能进食，腹部胀大像鼓一样，所以称为“鼓胀”。）治疗用鸡矢醴，服一剂见效，服两剂痊愈。（鸡矢的性质，能消除积滞、降逆下气，通利大、小便，这是攻伐实邪的方剂。服一剂可以知道疗效，服两剂可以治愈疾病。凡是因停积以及湿热有余引起的鼓胀，都适宜使用。如果是肾脾虚寒引起的发胀，以及气虚中满等症状，最忌讳使用，误服会导致死亡。鸡矢醴的制作方法：取羯公鸡屎一升，研细炒至焦色，在地上放置以去除火毒，用滚开的水淋取汁液；每次服用一大盏，调入木香、槟榔末各一钱，每日三次，空腹服用，以症状平复为度。
又有用法：用干羯公鸡屎八合，炒至微焦，加入无灰好酒三碗共同煎煮，煎至剩下一半左右，用布过滤取汁，在五更天热饮，则腹部鸣响，辰时、巳时排出二三次，都是黑水。第二天感觉脚面逐渐出现皱纹，再喝一次，皱纹逐渐蔓延到膝盖以上，病就痊愈了。这两种方法，似乎用后一种更方便。）当时有复发的，是因为饮食不节制的缘故。（鼓胀的病本因是留滞，所以不能再放纵饮食。）虽然如此，当病情即将痊愈时，之所以会复发，是因为病气重新聚集在腹部。（病虽然将要痊愈却再次损伤了脾脏，所以气又重新聚集。）
脉象反映在寸口，如果脉象大而坚实且涩，就是胀病。（脉大，说明邪气盛；脉坚，说明邪气实；涩是因为气血虚弱而不能流利运行。大体上洪大的脉象，阴气必然衰少；坚强有力的脉象，胃气必然受损，所以脉大、坚、涩，病应当发展为胀病。）如何知道脏腑病变？阴经对应脏，阳经对应腑。（脉涩而坚属于阴，胀在脏；脉大而坚属于阳，胀在腑。另一种说法：脉病在阴经，则胀在脏；脉病在阳经，则胀在腑。）气导致人发生胀病，血脉之中、脏腑之内，三者都存在气，但这并不是胀病的居所。（舍，指停留止息的地方。）胀病的居所在脏腑之外，排挤脏腑并向外扩张至胸胁，充塞皮肤，所以命名为“胀”。（排挤于脏腑之外，以胸胁为外郭而居于皮肤之中，这就是胀病的居所。）脏腑位于胸胁腹里之内，就像匣子和柜子中的禁器一样，各有固定的处所，名称不同但处于同一区域之中，它们的气各不相同，大概胸腹，就是脏腑的外郭。（胸腹，是用来保障五脏六腑的，所以称为脏腑的外郭。）膻中，是心主的宫城。（膻中，即胸中，肺覆盖在上面，膈膜阻挡在下面，是一个清虚周密的宫殿，是心主居住的地方，所以叫“宫城”。）胃，是太仓。（胃是水谷之海，所以叫“太仓”。）咽喉、小肠，负责传导；（咽喉传送食物，谷气自上而入；小肠传送糟粕，清浊自下而出。）胃的五窍，是闾里的门户；（闾，巷门。里，邻里。五家为比，五比为闾，大约二十五家为闾。五家为轨，十轨为里，大约五十家为里。胃的五窍作为闾里门户，不是说胃有五个孔窍，正是从上面胃脘，下面至小肠、大肠，都属于胃，所以叫“闾里门户”，如咽门、贲门、幽门、阑门、魄门，都是胃气运行的通道，所以总归属于胃，称为“五窍”。）廉泉、玉英，是津液通行的道路。（这两个穴位都属于任脉，玉英即玉堂穴。）所以五脏六腑，各有边界，它们的病症各有形状。（边界各有所属，所以病症的表现可以按察得知。下文因此进行辨别。）营气循行于脉中，胃气逆乱导致脉胀。（清轻的为营，营在脉中，其气精专，不会立即导致胀。浑浊的为卫，卫行于脉外，其气疾滑利，而行于分肉之间，所以必须由卫气逆乱，然后病及于营，才成为脉胀，因此凡是患胀病的人，都发源于卫气。）卫气并入脉中循行于分肉之间导致肤胀。（卫气逆乱并入了脉中，又循行于分肉之间，所以成为肤胀。）针刺足三里并施泻法，病位近的刺一次，病位远的刺三次，不论虚实，关键在于迅速泻邪。（三里，是足阳明经的穴位。阳明经是五脏六腑的海，主肌肉，所以胀在肌肤者，应当用针泻之。一下、三下，指一次、两次、三次。大概邪气有远近之分，所以泻法有难易之别。）心胀，表现为心烦、短气、睡眠不安；肺胀，表现为虚满而喘咳；肝胀，表现为胁下满痛并牵引小腹；脾胀，表现为频繁呃逆、四肢烦闷、身体沉重连衣服都穿不住、睡眠不安；肾胀，表现为腹部满痛牵引背部，困苦不堪地腰髀痛；（这是五脏的胀病。 ，指闷乱。央央然，指困苦的样子。）胃胀，表现为腹部满、胃脘痛、鼻闻焦臭味、妨碍进食、大便困难；大肠胀，表现为肠鸣且痛声濯濯，冬天再次感受寒邪，则完谷不化的泄泻；小肠胀，表现为小腹胀，牵引腰部疼痛；膀胱胀，表现为小腹胀满且小便不通；三焦胀，表现为气充满于皮肤中，轻轻然而不坚硬；胆胀，表现为胁下痛胀、口中苦、喜欢叹气。（这是六腑的胀病。濯濯，指肠鸣水声。飧泄不化，指完谷而泄。气癃，指膀胱气闭，小便不通。）
所有这些胀病，其道理在于一个方面。明确知道逆顺，针刺次数不失当，泻虚补实，如果神气离失其室，招致邪气、失去正气，真气无法安定，这是粗工造成的败坏，却称之为天命；如果能补虚泻实，使神气回归其室，长久地充实空虚之处，这就叫做良工。（这下面讲的是治疗胀病的得失。胀病有虚实之分，应当补或应当泻，道理只有一个，能明察的称为良工，粗工误用就会伤人。）卫气在体内，通常并行于脉中循行于分肉之间，运行有逆有顺，阴阳相随，才能得天和之气，五脏功能更替始新，四时循序运行，五谷才能消化。（这是卫气的正常规律。）然后厥气在下，营卫留滞不行，寒气逆上，真气与邪气相攻，两气相搏结，于是合而为胀。（上一节讲卫气的顺行，这一节阐明卫气的逆行。厥逆之气，自下而上，营卫失常，所以真邪相攻而合为胀病。）结合真气来看，有三方面的结合才能得到确诊。（胀虽然由于卫气引起，但有结合于血脉之中的，在经络；有结合于脏的，在阴分；有结合于腑的，在阳分。三方面的结合既然明了，就得到了真确的诊断。）不论虚实，关键在于迅速泻邪，病位近的刺一次，病位远的刺三次，如果有刺了三次还不奏效的。所谓“下”，是指针陷于肉肓并中于气穴。（一下、三下，是说针必须陷于肉盲，也必须中于气穴，然后才可以取效。）如果不中气穴，则气在内闭塞；针不陷于肉肓，则气不行；向上越出进入肌肉，则卫气相乱，阴阳相互追逐。（不中穴，不陷肓，则是妄中于分肉间，所以卫气相乱而阴阳的邪气反而相互追逐来乘袭人体。）对于胀病，应当泻而不泻，气所以不下。（不得其气穴和肉肓的位置。）刺了三次还不奏效，必须更换针刺的方法，气下行才停止，如果不下行就重新开始，针刺与用药的道理是一样的，必须审察脉象，应当泻就泻，应当补就补，像鼓槌击鼓应声那样准确，哪有不下行的呢！（刺了三次还不奏效，一定是没有得到正确的位置，所以应当更换穴位再刺。针与药，其法一致。肿胀一症，五脏六腑无不涉及。如“胃脉实，气有余则胀”，“胃病者腹中胀”，“胃脘当心而痛，脾气实则腹胀泾溲不利”，“浊气在上，则生 胀”，这些都是实胀；“饮食起居失节，入五脏则痞满闭塞”，“足太阴之别公孙，虚则鼓胀”，这些都是虚胀；“胃中寒则胀满”，“脏寒生满病”，“胃风膈塞不通，腹善胀”；“失衣则胀”，这些都是寒胀；“二阴一阳发病，善胀心满”，“手少阴终者，腹胀闭”，“足太阴终者，腹胀闭”，这是心脾受伤导致的胀；又如“太阴所至为重跗肿”，以及土郁之发，太阴之初气，太阴之胜复，都是湿胜导致的肿胀；又说水运太过，寒胜则浮；太阳之司天，太阳之胜复，都是寒胜导致的肿胀。有说少阴之司天，少阴之胜复，少阳之司天，少阳之胜复，又说“热甚则肿”，都是火胜导致的肿胀；若厥阴之司天、在泉，厥阴之复及阳明之复，这都是木邪侮土及金气反胜导致的肿胀，看这些情况，不仅五脏六腑，就连五运六气，也无不都有这种病。然而说“诸湿肿满，皆属于脾”，又说“其本在肾，其末在肺，皆聚水也”，又说“肾者，胃之关也。关门不利，故聚水而从其类也”，由此而言，虽然各经都有胀病，但没有不牵连到脾、肺、肾三脏的。因为脾属土，主运化；肺属金，主气；肾属水，主五液。凡五气所化的津液，都归属于肾；五液所运行的气，都归属于肺；转输于这两脏之中，以制水生金的，都归属于脾。所以肿胀的产生，无不由这三者引起，只是症状有阴阳、虚实、寒热、新久之别，不可不仔细考察。）
水肿、肤胀、鼓胀、肠覃、石瘕、石水，有什么办法区别它们？（这六种病症，病不同而形态相似，所以应该有办法区别它们。覃，音潭。）水肿刚开始时，眼睑微微肿胀，像刚睡醒的样子，（眼的下方为目窠，微肿像刚睡醒的样子，形状像卧蚕。）颈部的脉搏跳动，时常咳嗽，（颈脉，是足阳明胃经的人迎穴。阳明经脉，从人迎向下沿腹里。由于水邪侵犯，所以颈脉跳动，水的标在肺，所以时常咳嗽。）大腿内侧发冷，小腿浮肿，腹部才变大，这时水病已经形成了。（阴邪始于阴分。）用手按压腹部，随手而起，像包裹着水袋的样子，这是它的征候。（凡按水囊者，必随手而起，所以患水肿的人也像这样。以上都是水肿的征候。）肤胀，是寒气客居在皮肤之间，叩之空空然不坚硬，腹部大，全身都肿，皮厚，（ ，指鼓声，寒气客居在皮肤之间，阳气不行，病在气分，所以有声若鼓。气本来无形，所以不坚硬。气无所不至，所以腹部大，全身都肿。如果是因于水，则有水处肿，无水处不肿，这是可以辨别的，然而有水则皮泽而薄，无水则皮厚。）按压腹部，空空然不起，腹部颜色不变，这是它的征候。（寒气在肤腠之间，按散之则不能猝然聚合，所以空空然不起。腹部颜色不变，即皮厚的缘故，用手按压腹部，随手而起的是水，空空然不起的是气，这当然是对的，然而按气囊者也随手而起，另外水在肌肉之中，按而散之，猝然不能聚合，如按糟囊者也空空然不起，所以不可以起与不起作为水气和气胀的确切辨别，只应当观察其皮厚色苍，或一身尽肿，或自上而下者多属气，若皮薄色泽，或肿有分界，或自下而上者多属水也。 ，音夭，深的意思。）鼓胀，腹部胀大，全身也都大，大小与肤胀相等；肤色苍黄，腹部青筋暴露。（腹部胀大，全身也都大，与上文肤胀的症状相同。色苍黄者，也是皮厚腹部颜色不变的含义，只是腹部有青筋暴露，稍微有些不同，大概这也是病在气分，所以名叫鼓胀。）肠覃，是寒气客居在肠外，与卫气相搏结，气不得荣养，因而有所系着，癖积而内着，恶气乃起，息肉乃生。（覃，延布而深，寒气与卫气相搏结，则蓄积不行，留于肠外，有所系着，所以癖积起，息肉生，病日渐形成。息肉，指恶肉。）它刚开始生成时，大如鸡蛋，渐渐像盆一样大，等到它长成，像怀孕的样子，久的超过一年，按压它则坚硬，推它则移动，月经按时来潮。（离岁，越岁。寒邪客居在肠外，不在胞中，所以不妨碍月经，可知这不是血病。大概由汁沫聚集而生，这是肠覃的征候。）石瘕生于胞中，寒气客居在子门，（胞，即子宫，男女都有：在男谓之精室，在女谓之血海，子门，即子宫之门。）子门闭塞，气不得通，恶血应当泻出不泻出，瘀血留止，日渐增大，形状像怀孕，月经不能按时来潮。这些都发生在女子身上，可以用导引下血的药物治疗。（ ，凝败之血也，子门闭塞，则瘀血留止，其坚如石，所以叫“石瘕”。月经不能按时来潮，只有女子才有，所以可以用导血之剂下之。 ，铺杯切。）肤胀、鼓胀也可以针刺，先泻除胀病部位的血络，然后调理经脉，刺去血络。（先泻除胀病部位的血络，指无论虚实，凡是有血络外现的，必须先泻之，然后根据虚实调理经脉。刺去血络，即重申先泻的意思，所说的六种证候，唯独说肤胀、鼓胀，大概是兼括其他五证而统而言之，言辞虽简而意旨在此。）
There is a disease characterized by pain in the heart and abdomen, where one cannot eat dinner if they have eaten breakfast. This is named "Drum Distension" (Gu Zhang). (This is due to internal injury of the Spleen and Kidney, with pathogenic factors stagnating in the middle jiao, causing distension and fullness in the heart and abdomen, inability to eat, and abdominal distension resembling a drum, hence the name "Drum Distension".) It is treated with Ji Shi Li (Chicken Dropping Wine), showing improvement after one dose and cure after two doses. (The nature of chicken droppings can eliminate accumulation, direct qi downward, and promote urination and defecation; it is an agent that attacks excess pathogens. Improvement can be seen after one dose, and the disease can be cured after two doses. Drum Distension caused by food stagnation or damp-heat excess should all use this. However, for distension caused by Spleen-Kidney deficiency-cold, or middle-fullness due to qi deficiency, it is strictly contraindicated; mistaken administration leads to death. Method for Ji Shi Li: Take one sheng of dried male chicken droppings, grind finely, stir-fry until scorched, place on the ground to remove fire toxicity, pour boiling water over it to extract the juice; take one large cup per dose, mixed with one qian each of powdered Muxiang (Aucklandiae Radix) and Binglang (Arecae Semen), taken three times daily on an empty stomach, stopping when symptoms resolve.) Another method uses eight he of dried male chicken droppings, stir-fried until slightly scorched, boiled together with three bowls of good unadulterated wine until reduced by half, filtered through cloth, and drunk hot at wu geng (early morning); this causes abdominal borborygmus, and during Chen and Si hours (7-11 AM), two or three bowel movements occur, discharging black fluid. The next day, wrinkles gradually appear on the dorsum of the feet; drinking once more causes wrinkles to extend up to the knees, curing the disease. (Of these two methods, the latter seems more convenient.) Recurrences at that time are due to irregular diet. (Since Drum Distension originates from stagnation, one must not indulge in dietary excess.) Although so, when the disease is about to heal, recurrence occurs because pathological qi re-aggregates in the abdomen. (Although the disease is nearly cured, damaging the Spleen again causes qi to re-aggregate.)
At the Cun Kou pulse position, if the pulse is large, firm, and choppy, it indicates distension. (A large pulse indicates abundant pathogens; a firm pulse indicates solid pathogens; choppy indicates deficiency of qi and blood preventing smooth flow. Generally, a surging-large pulse implies declining yin; a firm-strong pulse implies damaged Stomach qi. Thus, large, firm, and choppy pulses indicate the development of distension.) How to distinguish Zang and Fu? Yin meridians correspond to Zang organs, Yang meridians to Fu organs. (Choppy and firm pulses belong to Yin, indicating distension in Zang organs; large and firm pulses belong to Yang, indicating distension in Fu organs. Alternatively: If the pulse pathology is in Yin, distension is in Zang; if in Yang, distension is in Fu.) Qi causing distension exists in blood vessels, inside Zang-Fu organs, and in the three areas mentioned, but these are not the residence of distension. ("Residence" refers to the place where qi stays.) The residence of distension lies outside the Zang-Fu organs, pushing against them outward to the chest and hypochondrium, and filling the skin, hence named "Distension". (Pushing outwards from the Zang-Fu, residing within the skin with the chest-hypochondrium as its outer boundary, this is the residence of distension.) The Zang-Fu organs reside within the chest, hypochondrium, and abdomen, like forbidden artifacts in boxes and cabinets, each having its specific location, different names but sharing the same region, with distinct qi. Essentially, the chest and abdomen serve as the outer wall for the Zang-Fu organs. (The chest and abdomen protect the five viscera, thus serving as the outer wall of the Zang-Fu.) Dan Zhong (Chest Center) is the palace city of the Heart Master. (Dan Zhong refers to the chest center, covered by the Lungs above and diaphragm below, a clear, void, and complete palace where the Heart Master resides, hence called "Palace City".) The Stomach is the Grand Granary. (The Stomach is the sea of water and grain, hence "Grand Granary".) The pharynx and Small Intestine are responsible for transmission. (The pharynx transmits food, allowing grain qi to enter from above; the Small Intestine transmits waste, allowing clear and turbid substances to exit from below.) The five orifices of the Stomach are the gates and doors of the neighborhood. (Lü refers to alley gates; Li refers to neighborhoods. Five families form Bi, five Bis form Lü, roughly twenty-five families make a Lü. Five families form Gui, ten Guis form Li, roughly fifty families make a Li. The five orifices of the Stomach are called neighborhood gates/doors not because the Stomach has five physical holes, but because from the upper Stomach body down to the Small and Large Intestines, all belong to the Stomach. Thus, gates like the Pharyngeal gate, Cardia, Pylorus, Ileocecal valve, and Anus are all pathways for Stomach qi, collectively belonging to the Stomach, termed "Five Orifices".) Lian Quan and Yu Ying are the channels for body fluids. (Both points belong to the Ren Mai; Yu Ying is equivalent to Yu Tang point.) Therefore, the Five Zang and Six Fu organs each have boundaries, and their diseases present with distinct shapes. (Boundaries have specific associations, so disease manifestations can be palpated and identified. The following text elaborates on this.) Ying Qi circulates within the vessels; rebellious Stomach qi causes vessel distension. (Clear essence becomes Ying, circulating within vessels, possessing refined qi that does not immediately cause distension. Turbid essence becomes Wei Qi, circulating outside vessels, possessing swift and slippery qi moving between muscle intervals. Thus, only when Wei Qi rebels does the pathology affect Ying, resulting in vessel distension. Hence, all distension diseases originate from Wei Qi.) When Wei Qi merges with vessels and circulates along muscle intervals, it causes cutaneous distension. (Rebellious Wei Qi merges into vessels and circulates along muscle intervals, causing cutaneous distension.) Needle San Li (Zusanli, ST36) with reducing method: for nearby pathology, needle once; for distant pathology, needle three times. Regardless of deficiency or excess, the key is rapid reduction. (San Li is an acupoint of the Foot-Yangming Meridian. Yangming is the sea of the Five Zang and Six Fu organs and governs muscles; thus, distension in skin and muscles should be treated with needle reduction. "Once" and "three times" refer to single or repeated needling. Pathogens vary in distance, so reduction difficulty varies.) Heart distension presents with vexation, shortness of breath, and restless sleep; Lung distension presents with empty fullness, wheezing, and coughing; Liver distension presents with fullness and pain under the hypochondrium radiating to the lower abdomen; Spleen distension presents with frequent hiccups, limb restlessness, heavy body unable to bear clothes, and restless sleep; Kidney distension presents with abdominal fullness radiating to the back, and severe lumbar and thigh pain. (These are distensions of the Five Zang organs. , denotes mental distress. Yang yang ran describes a state of hardship.) Stomach distension presents with abdominal fullness, epigastric pain, smelling burnt odors, difficulty eating, and constipation; Large Intestine distension presents with borborygmus and gurgling pain, and if exposed to cold in winter, results in undigested diarrhea; Small Intestine distension presents with lower abdominal fullness radiating to the lower back; Bladder distension presents with lower abdominal fullness and urinary retention; San Jiao distension presents with qi filling the skin, feeling light but not hard; Gallbladder distension presents with hypochondriac pain and fullness, bitter taste, and frequent sighing. (These are distensions of the Six Fu organs. Zhuo zhuo describes intestinal gurgling. Sun xie refers to undigested stool in diarrhea. Qi long refers to bladder qi obstruction and urinary retention.)
All these distensions share one underlying principle. Understanding reversal and normalcy, maintaining correct needle frequency, reducing deficiency and tonifying excess—if Shen (Spirit) leaves its chamber, inviting pathogens and losing righteousness, true qi becomes unstable. This failure attributed to "heaven's will" is actually the result of incompetent practitioners. Conversely, tonifying deficiency, reducing excess, returning Shen to its chamber, and filling emptiness defines a skilled practitioner. (This section discusses the gains and losses in treating distension. Distension has deficiency and excess types, requiring appropriate tonification or reduction. Those who discern this are skilled; incompetence harms patients.) Wei Qi normally circulates with vessels along muscle intervals, with reversible and forward flows, yin and yang following each other, achieving heavenly harmony, allowing Zang organs to renew functions, seasons to follow order, and grains to digest. (This is the normal state of Wei Qi.) Then, jue qi (rebellious qi) arises below, Ying and Wei stagnate, cold qi rebels upward, true qi and pathogens attack each other, two qi clash, and combine to form distension. (The previous section described normal Wei Qi flow; this section explains rebellious Wei Qi. Rebellious qi rises from below, disrupting Ying and Wei, causing true qi and pathogens to clash and form distension.) Combining with true qi, there are three combinations to confirm diagnosis. (Although distension stems from Wei Qi, it may combine with blood vessels in meridians; combine with Zang in yin divisions; combine with Fu in yang divisions. Clarifying these three combinations yields true diagnosis.) Regardless of deficiency or excess, the key is rapid reduction: needle once for nearby, three times for distant. If three needles fail, change the approach. "Reducing" means the needle must penetrate into the muscle fat (huang) and hit the qi acupoint. (Needling once or three times implies the needle must reach the huang and acupoint to be effective.) If not hitting the acupoint, qi closes internally; if not penetrating the huang, qi does not move; if rising into muscle flesh, Wei Qi becomes chaotic, and yin-yang chase each other. (Missing the acupoint and huang means striking randomly between muscle layers, causing Wei Qi chaos and allowing yin-yang pathogens to invade.) For distension, failing to reduce when necessary prevents qi descent. (Failing to locate the correct acupoint and huang.) If three needles fail, change the method; stop only when qi descends. If it doesn't descend, restart. Acupuncture and herbal medicine follow the same principle: carefully examine the pulse, reduce when needed, tonify when needed. Like a drum responding to a beat, how could it fail to descend? (Three failures mean incorrect positioning; change points and needle again. Acupuncture and herbs share the same logic. Swelling affects all Zang-Fu. Examples of excess distension include "Stomach meridian excess causes distension," "Stomach disease causes abdominal distension," "Spleen excess causes abdominal distension and urinary/fecal dysfunction," "Turbid qi above causes distension." Examples of deficiency distension include "Irregular diet entering Zang causes blockage," "Deficiency in Foot-Taiyin collateral Gongsun causes Drum Distension." Examples of cold distension include "Cold in Stomach causes fullness," "Visceral cold causes fullness," "Stomach wind causes obstruction and distension," "Exposure to cold causes distension." Examples of Heart-Spleen injury distension include "Two Yin-One Yang disease causes distension and chest fullness," "End stage of Hand-Shaoyin causes abdominal closure," "End stage of Foot-Taiyin causes abdominal closure." Examples of dampness-induced swelling include "Taiyin arrival causes severe edema," "Earth depression onset," "Taiyin initial qi," "Taiyin victory/reversal." Examples of cold-induced swelling include "Water transport excess," "Cold victory causes floating," "Sun-Taiyang ruling heaven," "Sun-Taiyang victory/reversal." Examples of fire-induced swelling include "Shao-Yin ruling heaven," "Shao-Yin/Shao-Yang victory/reversal," "Extreme heat causes swelling." Examples of wood invading earth or metal counter-attacking include "Jue-Yin ruling heaven/in泉," "Jue-Yin/Metal recovery." Observing these, not only Zang-Fu but also Five Movements and Six Qi involve this disease. However, "All dampness swelling/fullness belongs to Spleen," "Root in Kidney, branch in Lung, all gather water," "Kidney is the gate of Stomach; if gate fails, water gathers." Thus, although all meridians can have distension, none do not affect Spleen, Lung, and Kidney. Spleen (Earth) governs transformation; Lung (Metal) governs qi; Kidney (Water) governs five fluids. Fluids transformed by five qi belong to Kidney; qi moving five fluids belongs to Lung; transmission between these two to control water generating metal belongs to Spleen. Therefore, swelling originates from these three, differing only in yin-yang, deficiency-excess, cold-heat, and chronicity. Careful observation is essential.)
How to differentiate Edema, Cutaneous Distension, Drum Distension, Intestinal Polyps (Chang Qin), Stone Mass (Shi Xia), and Stone Water? (These six conditions differ in pathology but resemble each other morphologically, requiring differentiation. Qin sounds like tan.) Edema begins with slight swelling of the eye sockets, resembling the appearance after waking up. (The area below the eye is the eye socket; slight swelling resembles a sleeping silkworm.) Neck pulse throbs, occasional coughing. (Neck pulse refers to Renying, ST9 of Foot-Yangming. Yangming channel descends from Renying along the abdomen. Water pathogen invasion causes neck pulse throbbing; water's manifestation relates to Lungs, causing cough.) Coldness in the inner thighs, swelling of calves, then abdominal enlargement indicates established water disease. (Yin pathogen starts in yin divisions.) Pressing the abdomen causes immediate rebound, like pressing a water bag; this is the sign. (Pressing a water bag causes rebound; similarly, edema patients show this. Above are signs of edema.) Cutaneous Distension occurs when cold qi lodges between skin layers, sounding hollow like a drum but not hard, with abdominal enlargement, whole-body swelling, and thick skin. (Describes drum-like sound; cold qi blocks yang qi, affecting qi level, hence drum sound. Qi is formless, hence not hard. Qi pervades everywhere, hence general swelling. Unlike water which swells only where present, this is distinguishable. Water makes skin shiny/thin; lack of water makes skin thick.) Pressing the abdomen remains hollow without rebound, abdominal color unchanged; this is the sign. (Cold qi in skin/collaterals scatters upon pressure, not aggregating quickly, hence no rebound. Unchanged color due to thick skin. Rebound indicates water; no rebound indicates qi. However, pressing air sacs also rebounds; water in muscles scatters without quick aggregation like pressing dregs, also no rebound. Thus, rebound alone isn't definitive. Observe thick/pale skin, general swelling, or top-down progression suggests qi; thin/shiny skin, defined borders, or bottom-up progression suggests water. Yao means deep.) Drum Distension features abdominal distension, whole-body enlargement equal to Cutaneous Distension; pale-yellow complexion, and visible abdominal veins. (Abdominal and whole-body enlargement matches Cutaneous Distension. Pale-yellow implies thick skin/unabdominal color, but visible veins distinguish it. Also qi-level pathology, hence "Drum Distension".) Intestinal Polyps (Chang Qin) occur when cold qi lodges outside intestines, clashing with Wei Qi, preventing nourishment, attaching firmly, forming masses, generating evil qi, and producing polyps. (Qin means spreading deep. Cold-Wei Qi clash accumulates outside intestines, attaching firmly, forming masses/polyps, progressing slowly. Polyps refer to malignant growths.) Initially small as a chicken egg, growing to basin size, eventually resembling pregnancy. Long-standing cases exceed a year. Firm upon pressure, movable upon pushing, menstruation continues regularly. (Exceeding a year. Cold qi outside uterus, not affecting menses, proving non-blood origin. Caused by fluid accumulation. Signs of Chang Qin.) Stone Mass (Shi Xia) forms in the uterus. Cold qi lodges at Zi Men (uterine mouth). (Uterus exists in both sexes: Jing Shi in males, Blood Sea in females. Zi Men is uterine opening.) Zi Men closes, qi blocked, bad blood should discharge but doesn't, stagnant blood accumulates, enlarging daily, resembling pregnancy, menstruation delayed. Occurs only in women, treatable with blood-moving purgatives. (Stagnant blood hardens like stone, hence "Stone Mass". Menstrual delay unique to women, hence blood-moving treatment. Pu bei qie is pronunciation guide.) Cutaneous and Drum Distension can also be needled. First reduce blood collaterals involved in distension, then regulate meridians, removing blood collaterals. (Reduce externalized blood collaterals regardless of deficiency/excess, then regulate based on pattern. Removing collaterals reiterates reduction. Mentioning only Cutaneous and Drum Distension covers all six conditions concisely.)