肿胀一证，经云∶五脏六腑，无不有之。再考全经，如脉要论曰∶胃脉实，气有余则胀
。病
形篇曰∶胃病者，腹肿胀，胃脘当心而痛。本神篇曰∶脾气实则腹胀，经溲不利。应象论曰
∶浊气在上，则生 胀。此皆实胀也。太阴阳明论曰∶饮食起居失节，入五脏则腹满闭塞。
师传篇曰∶足太阴之别，分孙虚则鼓胀，此皆虚胀也。经脉篇曰∶胃中寒则胀满。方宜论曰
∶脏寒生满病。风论曰∶气隔塞不通则善胀，失衣则善胀，皆寒胀也。阴阳别论曰∶二阴一
阳发病，善胀心满。诊要经终篇曰∶手少阴终者，腹胀闭，足太阴终者，腹胀闭，此心脾受
伤之胀也。此外如六元正纪、至真大要等论曰∶太阴所至为跗肿，及土郁之发，太阴之初气
，太阴之胜复，皆湿胜之肿胀也。或曰∶水运太过，寒胜则浮。
或曰∶太阴司天，
太阳胜复，皆寒胜之肿胀也。或曰∶少阴司天，
少阴胜复，少阳司天，少阴胜复，热胜则肿
，皆火胜之肿胀也。或曰∶厥阴司天在泉，厥阴之复
。或曰∶阳明之复，皆水邪之侮土，及金气反胜之肿胀。由是观之，则不惟五脏六腑，即五
运六气，亦各有肿胀矣。然经有提其纲者，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。可见诸经虽皆有肿胀，无不由于脾肺肾者。盖脾土主运
行，肺金主气化，肾水主五液，凡五气所行之液，悉属于肾；五液所行之气，悉属于肺；转
二藏以制水生金者，悉属于脾，故肿胀不外乎三经也。但阴阳虚实，不可不辨。大抵阳证多
热，热者必实；阴证必寒，寒者多虚；先胀于内，而后及于外者多实；先肿于外，而后及乎
里者多虚；小便黄赤，大便秘结者多实；小便清白，大便溏泄者多虚；脉滑数有力者多实；
弦浮微细者多虚；形色红黄，气息长者多实，容颜憔悴者，声短促者多虚。凡诸实证，必以
六淫有余伤其外，饮食怒气伤其内，故致气逆不行，三焦壅闭。此则多在气分，无处不到，
故不分部位，而多通身浮肿。又或气实于中，又为单腹胀急，然阳邪急速，其至必暴，每成
于数日之间，此惟少壮者多有之。但破其急气，利其壅滞，则病无不愈，此治实之道也。若
是虚证，必以五志积劳，酒色过度，伤其脾肾，日积月累，其来有渐，每成于经月之后，此
多成于中年之外。其形证脉气，必有虚寒之候，显然可见，非若实证之暴至，而邪热壅结，
肝气悍逆之有因也。则治实恒易，理虚颇难耳！然虚有在气者，有在水者。在气者，以脾气
虚寒，不能运化，所谓气满中虚者。在水者，以脾虚不能制水，则寒水反侮脾土，泛滥为邪
。其始也，必从阴分渐次而升，按肉如泥，肿有界分，所谓水膨水胀者也。然水虽制于脾，
实则统于肾。盖肾本水藏，而元阳生气所由出。若肾中阳虚，则命门火衰，既不能自制阴寒
，又不能温养脾土，阴阳不得其正，则化而为邪矣。夫气即火也。精即水也，气之与水
，本为同类，但在化与不化耳。故阳旺则化精而为气，阳衰则不化而为水，即为邪。凡火盛
水亏则病燥，水盛火亏则病湿。故火不能化，则精不从阳，而精化为水。所以水肿之证，多
属阳虚，故曰寒胀多，热胀少也。然观丹溪之治肿胀云∶清浊相混，隧壅闭而为热，热留为
湿湿热相生，遂成肿满。治宜补其肝，又须养肺金以制木，使脾无邪贼之患，滋肾水以制火
，使肺得清化之权。夫制火可以保金，独不虑其害土乎？若以此法，施于阳实而热者则可，
若以治阳虚而气弱者，岂不反助阴邪而益其病哉？更有不明虚实，专执下则胀已之一法，虽
得少宽于一时，真气愈衰，未几而肿胀再作，遂至不救，殊可叹也！余于此证察其实者，直
清阳明，反掌收功。苟涉虚者，温补肝肾，渐次康复；或虚实混淆，阴阳疑似者，宁先以治
不足之法，探治有余，若不投而病反加者，不宜补也，不妨易辙，自无大害。若误以治有余
之法治不足，而曾经峻攻者，真气复伤，虽神丹不能疗矣！其有不大虚不大实者，先以清利
见攻，继以补中调摄，此治虚之道也。又有标实而本虚者，泻之不可。攻之无功，极为危险
。在病名有鼓胀与蛊胀之殊，鼓胀者，中空无物，皮肤绷急，多属于气；蛊胀者，中实有物
，腹形充大，非蛊即血也。在女科有气分血分之殊，气分者，心胸坚大，而病发于上，先病
水肿而后经断；血分者，血结胞门，而病发于下，先因经断而后水肿。在治法有理肺理脾之
殊，先喘而后胀，治在肺；先胀而后喘，治在脾。以上诸治，其大略也，贵在神而明之，庶
可免于虚虚实实之害矣！
肿胀这一病证，经典医籍记载：五脏六腑，没有哪个脏腑不会发生肿胀。再考证《黄帝内经》全书，如《脉要精微论》说：胃脉实盛，气有余就会发生胀满。《病形篇》说：胃病的人，腹部肿胀，胃脘部当心而痛。《本神篇》说：脾气实盛则腹胀，大小便不利。《阴阳应象大论》说：浊气停留在上部，就会产生胀满。这些都属于实胀。《太阴阳明论》说：饮食起居失于节制，邪气传入五脏就会导致腹满闭塞。《师传篇》说：足太阴脾经的别络，若分孙脉虚弱则会出现鼓胀，这些都属于虚胀。《经脉篇》说：胃中有寒就会胀满。《异法方宜论》说：内脏寒冷会产生满闷的病证。《风论》说：气机隔塞不通就容易发生胀满，受寒就容易发生胀满，这些都属于寒胀。《阴阳别论》说：少阴和阳明发病，容易胀满且心胸痞满。《诊要经终论》说：手少阴心经之气终结时，会出现腹胀闭塞；足太阴脾经之气终结时，也会出现腹胀闭塞，这是心和脾受伤导致的胀满。此外如《六元正纪大论》、《至真要大论》等篇章说：太阴湿土之气所至，会出现足背浮肿，以及土气郁结发作时，太阴初之气阶段，太阴胜复之时，都是湿气偏胜导致的肿胀。有人说：水运太过，寒气偏胜则出现浮肿。有人说：太阴司天，太阳寒水胜复，都是寒气偏胜导致的肿胀。有人说：少阴君火司天，少阴胜复；少阳相火司天，少阴胜复，热气偏胜则出现肿胀，这些都是火气偏胜导致的肿胀。有人说：厥阴风木司天或在泉，厥阴复气；或者说：阳明燥金复气，都是水邪侮犯脾土，以及金气反克导致的肿胀。由此看来，不仅五脏六腑，就连五运六气，也各自有导致肿胀的因素。然而经典中提出了纲领性的论述，说：各种湿邪导致的肿胀满闷，都归属于脾。又说：病的根本在肾，病的标末在肺，都是水液积聚所致。又说：肾是胃的关口，如果关门不利，所以水液积聚并随同类之物（水）泛滥。由此可见，虽然各经都可能有肿胀，但无不与脾、肺、肾三脏有关。因为脾土主司运化，肺金主司气化，肾水主司五液，凡是五气运行所产生的津液，都归属于肾；五液运行所产生的气机，都归属于肺；转输这两脏以制约水生金的关系，都归属于脾，所以肿胀不外乎这三条经络/脏腑。但是阴阳虚实，不可不辨别。大体上阳证多热，热者必定属实；阴证必寒，寒者多属虚；先在体内胀满，然后波及体外的多属实；先在体外浮肿，然后波及内部的多属虚；小便黄赤，大便秘结的多属实；小便清长色白，大便溏泄的多属虚；脉象滑数有力的多属实；脉象弦浮微细的多属虚；面色红黄，气息粗长的多属实，面容憔悴，声音短促的多属虚。凡诸实证，必定是因为六淫外邪有余损伤体表，或者饮食、怒气损伤体内，从而导致气机逆乱不行，三焦壅塞闭阻。这多在气分，无处不到，所以不分具体部位，而多见全身浮肿。或者又因气实于中，表现为单腹胀急，然而阳邪来势急速，其发病必然猛烈，往往在数日之间形成，这多见于青壮年人。只要破除其急迫之气，通利其壅滞，那么病就没有不愈的，这是治疗实证的方法。如果是虚证，必定是因为七情积劳，酒色过度，损伤了脾肾，日积月累，其发病缓慢，往往在数月之后形成，这多见于中年以后的人。其形体症状、脉象气机，必有虚寒的表现，显而易见，不像实证那样突然到来，也不是邪热壅结、肝气悍逆有所因由。所以治疗实证常常容易，调理虚证颇为困难！然而虚证有在气分的，有在水分的。在气分的，是因为脾气虚寒，不能运化，所谓“气满中虚”。在水分的，是因为脾虚不能制水，则寒水反而侮犯脾土，泛滥成为邪气。起初，必定从阴分逐渐上升，按压肌肉如泥，肿胀有界限分明，这就是所谓的“水膨”、“水胀”。然而水虽受制于脾，实则统属于肾。因为肾本是水脏，而元阳生气由此发出。如果肾中阳虚，则命门火衰，既不能自制阴寒，又不能温养脾土，阴阳失去正常状态，就转化为邪气了。夫气就是火，精就是水，气和水，本来属于同类，区别在于转化还是不转化罢了。所以阳气旺盛则能化精为气，阳气衰弱则不能转化而为水，这就成为了邪气。凡是火盛水亏则生病变干燥，水盛火亏则生病变湿。所以火不能化，则精不从阳，而精化为水。因此水肿之证，多属于阳虚，所以说寒胀多，热胀少。然而观察朱丹溪治疗肿胀的说法：清浊相混，隧道壅闭而产生热，热停留成为湿，湿热相生，遂成肿满。治疗应当补益肝脏，又须滋养肺金以制约肝木，使脾免受邪贼侵害，滋补肾水以制约心火，使肺得到清化的权力。制约火可以保护金，难道就不担心伤害土吗？如果用这种方法，施用于阳实而热的患者是可以的，但如果用来治疗阳虚而气弱的患者，岂不是反而助长阴邪而加重病情吗？更有不明白虚实，专门执着于“下法则胀止”这一种方法的人，虽然暂时得到少许缓解，但真气更加衰败，不久之后肿胀再次发作，最终导致无法救治，实在令人叹息！我对于这种病证，察其实证者，直接清泻阳明，转眼就能收效。如果涉及虚证，温补肝肾，逐渐康复；或者虚实混淆，阴阳疑似难辨者，宁可先用治疗不足（补法）的方法，试探性地治疗有余（攻法），如果不投药而病情反而加重的，说明不宜进补，不妨改变治法，自然不会有大的危害。如果错误地用治疗有余（攻法）的方法来治疗不足（虚证），并且曾经经过峻猛攻下的，真气再次受伤，即使是神丹也不能治愈了！那些不大虚也不大实的，先用清利兼攻的方法，继之以补中调摄，这是治疗虚证的方法。又有标实而本虚的，泻之不可，攻之无功，极为危险。在病名上有鼓胀与蛊胀的区别，鼓胀，中空无物，皮肤绷急，多属于气；蛊胀，中实有物，腹形充大，不是蛊毒就是瘀血。在女科方面有气分与血分之殊，气分者，心胸坚大，而病发于上，先病水肿而后月经停止；血分者，血结胞宫之门，而病发于下，先因月经停止而后出现水肿。在治法上有理肺与理脾的不同，先喘而后胀，治疗在肺；先胀而后喘，治疗在脾。以上各种治法，只是大概原则，贵在灵活通达，明辨细微，才可以避免虚虚实实（使虚者更虚，实者更实）的危害啊！
The syndrome of swelling and distension, as stated in the classics, occurs in all five zang organs and six fu organs. Further examination of the *Huangdi Neijing* (Yellow Emperor's Inner Canon) reveals: The *Suwen* chapter "Mai Yao Jing Wei Lun" (Essential Questions on Pulse Diagnosis) states: When the stomach pulse is excess and qi is surplus, distension occurs. The "Bing Xing Pian" (Chapter on Disease Manifestations) states: In stomach disease, there is abdominal swelling and pain in the epigastrium corresponding to the heart. The "Ben Shen Pian" (Chapter on Root Spirit) states: When spleen qi is excess, abdominal fullness occurs, and urination and defecation are obstructed. The "Yin Yang Ying Xiang Da Lun" (Great Treatise on Yin-Yang and Correspondences) states: If turbid qi remains in the upper jiao, distension arises. These are all cases of excess distension. The "Tai Yin Yang Ming Lun" (Treatise on Taiyin and Yangming) states: Irregularities in diet and lifestyle allow pathogens to enter the five zang organs, causing abdominal fullness and obstruction. The "Shi Chuan Pian" (Chapter on Master's Transmission) states: Deficiency in the collateral branches and minute vessels of the Foot-Taiyin Spleen Meridian leads to drum-like distension; these are all cases of deficiency distension. The "Jing Mai Pian" (Chapter on Meridians) states: Cold in the stomach causes fullness and distension. The "Yi Fa Fang Yi Lun" (Treatise on Different Methods and Regions) states: Cold in the internal organs generates fullness diseases. The "Feng Lun" (Treatise on Wind) states: Obstruction of qi flow leads to frequent distension; exposure to cold leads to frequent distension; these are all cold-induced distensions. The "Yin Yang Bie Lun" (Treatise on Differences between Yin and Yang) states: Disease involving Shaoyin and Yangming often presents with distension and chest fullness. The "Zhen Yao Jing Zhong Pian" (Chapter on Essential Points of Meridian Termination) states: When the Hand-Shaoyin Heart Meridian terminates, abdominal distension and closure occur; when the Foot-Taiyin Spleen Meridian terminates, abdominal distension and closure occur; this indicates distension due to injury of the Heart and Spleen. Furthermore, chapters such as "Liu Yuan Zheng Ji Da Lun" (Great Treatise on the Six Origins and Correct Statutes) and "Zhi Zhen Yao Da Lun" (Great Treatise on the Essentials of True Pathogens) state: Arrival of Taiyin dampness leads to edema of the dorsum of the foot; occurrences of earth stagnation, the initial qi phase of Taiyin, and Taiyin victory/reversal phases all result from dampness excess leading to swelling. Some say: Excessive water transport and cold excess lead to floating edema. Some say: Taiyin ruling heaven, with Sun (Taiyang) victory/reversal, results from cold excess leading to swelling. Some say: Shaoyin ruling heaven, with Shaoyin victory/reversal; Shaoyang ruling heaven, with Shaoyin victory/reversal, result from heat excess leading to swelling; these are all fire excess-induced swellings. Some say: Jueyin wind ruling heaven or earth, Jueyin reversal; or Yangming reversal, result from water evil insulting earth, or metal qi counter-attacking, leading to swelling. Thus, not only do the five zang and six fu organs cause swelling, but the Five Movements and Six Qi also each have factors causing swelling. However, the classics provide a general principle: "All dampness-induced swelling and fullness belong to the Spleen." It also states: "The root is in the Kidney, the branch is in the Lung; all are accumulations of water." It further states: "The Kidney is the gate of the Stomach; if the gate is not functional, water accumulates and follows its kind." Therefore, although various meridians may present with swelling, it invariably stems from the Spleen, Lung, and Kidney. The Spleen Earth governs transportation and transformation; the Lung Metal governs qi transformation; the Kidney Water governs the five fluids. All fluids produced by the movement of the five qi belong to the Kidney; all qi generated by the movement of the five fluids belongs to the Lung; the regulation of water generating metal through the transfer of these two organs belongs to the Spleen. Thus, swelling does not exceed these three organs. However, one must distinguish between yin/excess and yang/deficiency. Generally, yang syndromes involve heat, and heat implies excess; yin syndromes involve cold, and cold implies deficiency. Distension starting internally and spreading externally usually indicates excess; edema starting externally and affecting the interior usually indicates deficiency. Yellow-red urine and constipation indicate excess; clear-white urine and loose stools indicate deficiency. Slippery, rapid, and forceful pulses indicate excess; wiry, floating, faint, and fine pulses indicate deficiency. Red-yellow complexion and long breath indicate excess; haggard appearance and short breath indicate deficiency. All excess syndromes are caused by excess pathogenic factors of the Six Evils injuring the exterior, or diet and anger injuring the interior, leading to rebellious qi stagnation and blockage of the Sanjiao (Triple Burner). This affects the qi level, reaching everywhere, resulting in generalized edema without specific localization. Alternatively, qi excess in the middle leads to isolated abdominal distension and urgency. Since yang pathogens move rapidly, their onset is violent, often developing within days; this is common in young and strong individuals. Breaking the urgent qi and unblocking stagnation ensures recovery; this is the method for treating excess. If it is a deficiency syndrome, it is caused by accumulation of labor from seven emotions, excessive alcohol and sexual activity, injuring the Spleen and Kidney over time. The onset is gradual, often appearing after months, common in middle-aged people. The physical signs, symptoms, and pulse/qi will clearly show deficiency-cold characteristics, unlike the sudden onset of excess syndromes characterized by heat accumulation and rebellious liver qi. Thus, treating excess is relatively easy, while managing deficiency is difficult. Deficiency can be in the qi or in the water. Qi-level deficiency involves spleen qi deficiency and cold, unable to transform, described as "fullness of qi with emptiness in the center." Water-level deficiency involves spleen deficiency failing to control water, allowing cold water to insult spleen earth and flood as evil. Initially, it rises gradually from the yin levels; pressing the flesh leaves an indentation like mud, with distinct boundaries, known as "water bloating" or "water distension." Although water is controlled by the Spleen, it is ultimately governed by the Kidney. The Kidney is the water organ, from which primordial yang qi emerges. If kidney yang is deficient, the Fire of the Gate of Life declines, unable to control yin-cold or warm the spleen earth. Yin and yang lose their balance, transforming into evil. Qi is fire; essence is water. Qi and water are of the same category, differing only in transformation. Strong yang transforms essence into qi; weak yang fails to transform, turning essence into water, becoming evil. Fire excess and water deficiency lead to dryness; water excess and fire deficiency lead to dampness. If fire cannot transform, essence does not follow yang, and essence turns into water. Therefore, edema syndromes mostly belong to yang deficiency, hence "cold distension is common, heat distension is rare." Observing Zhu Danxi's treatment of swelling: He stated that mixing of clear and turbid, blockage of tunnels, and retention of heat generate dampness; heat and dampness generate swelling and fullness. Treatment should tonify the Liver, nourish Lung Metal to control Wood, protecting the Spleen from evil invasion, and nourish Kidney Water to control Fire, allowing the Lung to maintain clear transformation. Controlling fire protects metal, but does this not harm earth? This method is suitable for yang-excess and heat syndromes, but applying it to yang-deficiency and qi-weakness would aggravate yin evil and worsen the condition. Others, ignorant of excess and deficiency, rigidly adhere to purgation to stop distension. Though temporarily relieved, true qi declines further, and swelling recurs, leading to untreatable conditions, which is lamentable. I observe excess syndromes and directly clear Yangming, achieving quick results. For deficiency, I warm and tonify the Liver and Kidney for gradual recovery. In cases of mixed excess/deficiency or ambiguous yin/yang, I prefer first using tonification for deficiency to probe for excess. If symptoms worsen without medication, tonification is contraindicated, and the approach should be changed to avoid harm. Using excess-treatment methods on deficiency, especially after harsh purgation, injures true qi further, making even divine medicines ineffective. For mild deficiency/excess, use clearing/draining with mild purging, followed by mid-jiao tonification and regulation; this is the method for deficiency. For superficial excess with root deficiency, purging is ineffective and dangerous. Regarding disease names, there is a distinction between Drum Distension (Gu Zhang) and Gu Distension (Gu Zhang - homophone, different character). Drum Distension is hollow, with tight skin, mostly related to qi. Gu Distension has solid contents, with enlarged abdomen, related to parasites or blood stasis. In gynecology, there is a distinction between Qi Level and Blood Level. Qi Level: Firm and large chest/abdomen, disease starts above, edema precedes amenorrhea. Blood Level: Blood clots at the uterus gate, disease starts below, amenorrhea precedes edema. Regarding treatment methods, there is a distinction between regulating the Lung and regulating the Spleen. Wheezing preceding distension is treated in the Lung; distension preceding wheezing is treated in the Spleen. These are the general principles. Mastery and flexibility are required to avoid the harm of "treating deficiency as excess" or "treating excess as deficiency."