肿胀之原，《内经》、《金匮》辨别分悉。但其中节目，隐而未彰。前代诸贤，皆未
发明，后人不察，往往以虚肿之法，施之实胀之人，实胀之法，施之虚肿之症。不知肿胀二病
，皆有虚实。肿浮于外，病在经络，表也；胀满于中，病在肠胃，里也。赖许学士分明四肢
肿为水，但腹胀，四肢不甚肿为胀，发《金匮》肿胀分治之旨。后丹溪书，以肿胀二症，
各立一门。王宇泰以水肿胀满，分立治法，皆有至理；但胀满症中，分明虚实寒热诸条，
而水肿门，未详《内经》何条是虚，何条是实，何条是胀，何条是肿，又不发明《内经》
风水与《金匮》风水，各自一症，余心未慊。《灵枢·津液篇》曰∶阴阳气道不清，水谷
并于肠胃之中，不得渗入膀胱，则为水胀。此总论水胀之原也。《水胀篇》曰∶水始起也，
目窠下微肿，腹乃大。肤胀者，腹大，身尽肿，皮浓；鼓肿者，腹胀身皆大，大与肤胀等；
肠覃者，寒气客于肠外，大如鸡卵，稍益大，如怀子之状，月事以时下；石瘕生于胞中，子
门闭塞，月事不以时下。此分论肿胀之二症也。《胀论》曰∶心胀者，烦心短气；肺胀者，
虚满喘咳；肝胀者，胁下满，痛引小腹；脾胀者，善哕，体重；肾胀者，腹满，引背腰髀痛
；胃胀者，胃脘痛，妨于食；大肠胀者，肠鸣而痛，濯濯有声；小肠胀者，小腹 胀；
膀胱胀者，小腹满而气癃；三焦胀者，气满于皮肤；胆胀者，胁痛，口苦太息。此分论五脏
六腑胀病，各经之见症也。《水胀篇》又曰∶腹胀、鼓胀可刺乎？曰先泻其胀之血络，后调
其经。《腹中论》曰∶心腹满，旦食不能暮食，名为臌胀，治以鸡矢醴。王宇泰因见同曰鼓
胀也，而治法有表里不同，乃分一以气聚之病，一以气停与血相搏之病，而桢以为未然。夫
《水胀篇》曰∶腹胀身皆大，大与肤胀等，则知肿于遍身，非胀于内，在表不在里，故曰
先泄其胀之血络，后调其经。此与《胀论篇》所谓营气循脉，卫气逆，并循分肉，为肤胀
，三里而泻，同一法门也。《腹中论》，但曰心腹满，旦食不能暮食，则遍身未皆大，在里
不在表，故用鸡矢以下，此即《内经》所谓“中满者泻之，泄之则胀已”，是也。《汤液篇
》曰∶平治极衡，去菀陈 ，开鬼门，洁净府。此因气拒于内，形施于外，形不与衣相
保，表里俱病，故兼用发汗利小便二法也。《评热论》曰∶有病肾水者，面 庞然壅，
害于言，虚不当刺，名曰风水。又曰∶肝肾并浮为风水。夫肝火曰雷火，肾火曰龙火，肝肾
之脉本沉，今并浮则雷火动而疾风豪雨，龙火动而水附波扬，此二条言肝肾之相火太过，泛
滥其水而上浮也。《灵枢·本输篇》曰∶少阴者属肾；三焦者，决渎之腑也。水道出焉。《
宣明五气篇》曰∶三焦病气满，小腹尤坚。又云∶水留即为胀。此二条言肝肾之相火不及，
不能蒸动其水而下积也。《水热篇》曰∶肾者至阴也，至阴盛水也，肺者太阴也，故其本
在肾，其末在肺，皆积水也，此言肾水为病，上连于肺也。又曰∶肾者，胃之关也，关门不
利，故聚水而从其类也。此言肾水为病，上连于胃也。又曰∶勇而劳肾，肾汗客于玄府，传
为肿，此内伤肾水，外受风邪之风水也。《阴阳别论》曰∶阴阳结邪，多阴少阳，名
曰石水。又曰∶三阴结为水。又曰∶肝肾并沉为石水。此言寒结水邪，后世所名阴水之寒症
也。《经脉篇》曰∶胃所生病，大腹水肿，膝膑肿痛。又曰∶诸 肿，皆属于火；诸水
肿者，湿热相兼也。此言热结水邪，后世所名阳水之热症也。《至真要大论》∶诸湿肿满，
皆属于脾；又湿胜则水闭 肿，此言湿土主脾，而为脾经水肿之症也。又云∶太阴所至
为肿。又太阴所至为中满。此言湿土司天，湿淫所胜之肿胀也。又云∶太阳司天，寒
胜则浮，此言寒淫所胜之肿胀也。又云∶少阴司天，少阳胜复。少阳司天，少阴胜复；又云
∶热胜则肿。此言君相二火司天，热淫所胜之肿胀也。又按∶《本神篇》曰∶脾气实则腹胀
。《调经篇》曰∶形有余则腹胀。《脉要篇》曰∶胃脉实则胀。此言脾胃壅滞而为胀病之实
症也。《师传篇》曰∶足太阴之公孙虚则胀。《太阴阳明篇》曰∶饮食起居失节，入五脏则
满闭塞，此言脾胃不足而为胀病之虚症也。《方宜论》曰∶藏寒生满病。又胃中寒则
胀满，此言脏腑阳虚而为胀病之寒症也。《至真要大论》∶诸胀腹大，皆属于热。又曰，腹
满大便不利，取足少阴。又曰∶胀取三阳。此言脏腑郁热而为胀病之热症也。以上，乃《内
经》之论肿胀二症也。至《金匮》则曰∶风水脉浮，骨节疼痛恶风；又云∶风水脉浮身重，
汗出恶风者，防己黄 汤主之。又云∶风水恶风，一身悉肿，脉浮不渴，续自汗出，无大热
，越婢汤主之。细玩《金匮》，以脉浮主表，皆从太阳经主治，此必是外感门另是太阳之风
水，非《内经》肝肾并浮，及勇而劳肾，而 庞然，内伤风水也。又云∶皮水其脉亦浮
，外症 肿不渴，当发其汗。夫曰发其汗，直与太阳经伤寒同兹治法矣。岂可以此法而
治肝肾并浮，勇而劳肾，而 庞然，虚不当刺之内伤症乎。若云肝肾不足，火衰水泛，
则以肾气丸摄服之可也，未宜以太阳经表药升散之；若以为面 庞然壅，害于言，宜发
其汗也，则经衣冠文物有不当刺之戒，温衣谬刺。同是发汗，今刺尚不可，汗岂所宜乎。若以勇
而劳肾，肾汗客于玄府而当发也，则伤寒少阴症，又有强发厥竭之戒。夫伤寒少阴外感症，
尚有不应汗之戒，今太阳升散之药，反为劳肾内伤症所宜乎，以此论之，则《金匮》之风水
，乃是太阳之外感，实非《内经》肝肾之内伤。夫仲景之书，往往补《内经》之缺，如温
疟论《内经》之温疟，一主少阴，然二者皆先热后寒；《金匮》之论温疟，则但热不寒。《
内经》之论温病曰∶冬不藏精，春必温病。仲景之论风温，则曰太阳病发汗已，身灼热，名
风温。即此二症，仲景之论，与《内经》之论，各自一条。《金匮》又曰∶皮水四肢肿，水
在皮肤中，聂聂动，防己茯苓汤。此亦与上章脉浮风水，以三阳主表而立阳经治法者也。又
曰∶正水，其脉沉迟，外症自喘；石水其脉自沉，外症腹满不喘，二症同是脉沉，而以自喘
主肺，不喘主肝肾，《金匮》以三阴主里而立阴经治法者也。又云∶黄汗，其脉沉迟，身发
热，久不愈，必致痈脓。又云∶里水者，一身面目黄肿，其脉沉，小便不利。此二条，《金
匮》以脉沉主表，立从症不从脉之法也。又云∶水之为病，其脉沉小，属少阴，浮者为风，
无水而虚胀者为气，水发其汗即已。此又以脉沉脉浮，以分太阳少阴表里主治，而总结上文
三阳三阴水肿治法也。又云心水少气不得卧，肝水腹大胁下痛，肺水小便难，脾水四肢苦重
，肾水腰痛不得溺。此以《内经》有五脏之胀，《金匮》复补出五脏之水也。《金匮》又曰
∶寸口脉沉而紧，沉为水，紧为寒，趺阳之脉当伏，今反紧，本有寒疝。又曰∶趺阳之脉当
伏，今反数，本自有热。此以肺主通调水道，胃主出纳水谷，而以肺胃两家为延医也。又曰
∶腰以上肿者，宜发汗；腰以下肿者，宜利小便。此以经文面肿为风，脚肿为水，而以身之
上下，以分表里，推展于脉沉脉浮之外也。然此乃同伤寒太阳经麻黄治标，五苓治本之法；
不然，则面 庞然，虚不当刺等症，腰以上虽肿，而发汗在所不取，肝肾并沉，真阴虚
涸之症，腰以下虽肿，利小便又所不用也。以上诸条，乃《金匮》专论水肿之一症也。至于
后代节斋、丹溪、张三锡，皆以《内经》“诸湿肿满，皆属于脾”，独指足太阴一经立论，
不及乎诸条者也。何柏斋独指《内经》肝肾石水，发金匮肾气丸为治，又单主足少阴一经者
也。薛新甫、赵养葵以补肾补脾为肿胀统治，而以脾肾二经为法者也。丹溪又曰∶湿热气
盛，则肺郁成水，此言《内经》诸气 郁，湿热乘肺作肿一门也。河间又云∶燥邪干肺
，绝水之源，则小便不利而为肿。此因《内经》独缺燥淫一条，千古从未发明，而特补燥热
乘肺作肿一门也。奈后代名贤，厌烦喜简，欲将一二经络，印定治法，以为易便，不知此症
门路甚多，断难以一二脏为总括者也。但当认明何经所主，何经兼见，五脏中何脏有伤，六
腑中何腑受病，三因中何因起症，六脉中何部应诊。因病治之，无不中病。
肿胀的病因，《内经》和《金匮要略》中已有详尽的辨别。但其中的关键细节，隐晦而未显明。前代各位贤达，都未能阐明，后人不加考察，往往用治疗虚肿的方法，施用于实胀的患者；用治疗实胀的方法，施用于虚肿的病证。不知道肿胀这两种病，都有虚实之分。肿浮于体表，病在经络，属于表证；胀满于体内，病在肠胃，属于里证。幸亏许学士（许叔微）明确区分：四肢浮肿为水病，仅腹部胀满而四肢不甚肿者为胀病，阐发了《金匮要略》中肿胀分治的宗旨。后来朱丹溪的著作，将肿胀两症各立一门。王宇泰将水肿与胀满分立治法，都有至理；但在胀满症中，分明列出了虚实寒热等条目，而在水肿门中，未详细阐明《内经》中哪条是虚、哪条是实、哪条是胀、哪条是肿，也没有阐明《内经》中的“风水”与《金匮要略》中的“风水”是两种不同的病症，我心里对此仍不满意。
《灵枢·津液篇》说：“阴阳气道不清，水谷并聚于肠胃之中，不能渗入膀胱，就形成水胀。”这是总论水胀的成因。《灵枢·水胀篇》说：“水病刚开始时，眼睑下微微浮肿，随后腹部变大。”“肤胀”，腹部大，全身浮肿，皮肤厚；“鼓胀”，腹部胀身体都大，大小与肤胀相等；“肠覃”，寒气客居在肠外，肿块大如鸡蛋，逐渐增大，像怀孕的样子，月经按时来潮；“石瘕”生于胞宫，子门闭塞，月经不能按时来潮。这是分论肿胀这两个病症。《灵枢·胀论》说：“心胀，心烦短气；肺胀，虚满喘咳；肝胀，胁下满痛，牵引小腹；脾胀，容易呃逆，身体沉重；肾胀，腹部满，牵引背腰大腿痛；胃胀，胃脘痛，妨碍进食；大肠胀，肠鸣且痛，发出濯濯的声音；小肠胀，小腹胀；膀胱胀，小腹胀满且小便不通；三焦胀，气充满于皮肤；胆胀，胁痛，口苦长叹息。”这是分论五脏六腑胀病，各经所见的症状。
《灵枢·水胀篇》又说：“腹胀、鼓胀可以针刺吗？回答说：先刺破胀满部位的血络放血，然后调理经脉。”《素问·腹中论》说：“心腹满，早上吃了饭晚上还觉得饱不能吃，名叫臌胀，用鸡矢醴治疗。”王宇泰因为看到同样叫鼓胀，但治法有表里不同，于是将其分为一种是以气聚为主的病，一种是以气停与血相搏为主的病，但我认为这不对。《灵枢·水胀篇》说：“腹胀身皆大，大小与肤胀相等”，由此可知肿遍全身，不是胀在内，是在表不在里，所以说“先泄其胀之血络，后调其经”。这与《灵枢·胀论篇》所说的营气循脉运行，卫气逆行，并循行于分肉之间，形成肤胀，取足三里穴泻之，是同一法门。《素问·腹中论》，只说心腹满，早上吃饭晚上不能吃，则遍身并未都大，在里不在表，所以用鸡矢醴以下气，这正是《内经》所谓“中满者泻之，泄之则胀已”，说的就是这个道理。
《素问·汤液醪醴论》说：“平治于权衡，去菀陈莝，开鬼门，洁净府。”这是因为气拒于内，形体施于外，形体不与衣服相保，表里俱病，所以兼用发汗和利小便两种方法。《素问·评热病论》说：“有病名为肾水的，面部庞然大肿，言语不利，虚证不应当针刺，名叫风水。”又说：“肝肾脉并浮，称为风水。”肝火称为雷火，肾火称为龙火，肝肾的脉本来沉，现在并浮，则是雷火动而疾风豪雨，龙火动而水波扬，这两条讲的是肝肾的相火太过，泛滥其水而上浮。《灵枢·本输篇》说：“少阴属肾；三焦，是决渎之腑，水道由此而出。”《素问·宣明五气篇》说：“三焦病气满，小腹尤其坚硬。”又说：“水停留即为胀。”这两条讲的是肝肾的相火不及，不能蒸动其水而下积。《素问·水热穴论》说：“肾者是至阴，至阴盛则生水；肺者是太阴，所以其本在肾，其末在肺，都是积水。”这是说肾水为病，上连于肺。又说：“肾，是胃的关口，关门不利，所以聚水而从其类也。”这是说肾水为病，上连于胃。又说：“勇力过度损伤肾脏，肾汗出于玄府，传变为肿，这是内伤肾水，外受风邪的风水。”
《素问·阴阳别论》说：“阴阳结邪，多阴少阳，名叫石水。”又说：“三阴结为水。”又说：“肝肾脉并沉为石水。”这是说寒结水邪，后世所称阴水的寒症。《灵枢·经脉篇》说：“胃所生的病，有大腹水肿，膝膑肿痛。”又说：“诸肿，皆属于火；诸水肿者，是湿热相兼。”这是说热结水邪，后世所称阳水的热症。《素问·至真要大论》说：“诸湿肿满，皆属于脾；又湿胜则水闭肿。”这是说湿土主脾，而为脾经水肿之症。又说：“太阴所至为肿。”又说：“太阴所至为中满。”这是说湿土司天，湿淫所胜之肿胀。又说：“太阳司天，寒胜则浮。”这是说寒淫所胜之肿胀。又说：“少阴司天，少阳胜复；少阳司天，少阴胜复；又说：热胜则肿。”这是说君相二火司天，热淫所胜之肿胀。
另外按：《灵枢·本神篇》说：“脾气实则腹胀。”《素问·调经篇》说：“形有余则腹胀。”《素问·脉要精微论》说：“胃脉实则胀。”这是说脾胃壅滞而为胀病的实症。《灵枢·师传篇》说：“足太阴之公孙虚则胀。”《素问·太阴阳明论》说：“饮食起居失节，入五脏则满闭塞。”这是说脾胃不足而为胀病的虚症。《素问·异法方宜论》说：“藏寒生满病。”又说：“胃中寒则胀满。”这是说脏腑阳虚而为胀病的寒症。《素问·至真要大论》说：“诸胀腹大，皆属于热。”又说：“腹满大便不利，取足少阴。”又说：“胀取三阳。”这是说脏腑郁热而为胀病的热症。以上，是《内经》关于肿胀两症的论述。
至于《金匮要略》则说：“风水脉浮，骨节疼痛恶风；又说：风水脉浮身重，汗出恶风者，用防己黄芪汤主治。又说：风水恶风，一身悉肿，脉浮不渴，续自汗出，无大热，用越婢汤主治。”仔细研读《金匮要略》，以脉浮主表，都从太阳经主治，这必定是外感门中另有的太阳之风水，并非《内经》中肝肾并浮，以及因勇力劳肾而面庞然壅的内伤风水。又说：“皮水其脉亦浮，外症浮肿不渴，当发其汗。”如果说发其汗，直接就是与太阳经伤寒相同的治法了。岂可以用此法来治疗肝肾并浮、勇力劳肾、面庞然壅、虚不当刺的内伤症呢？如果说肝肾不足，火衰水泛，则以肾气丸摄服即可，不宜用太阳经表药升散；如果认为是面庞然壅、害于言，宜发其汗，那么经文中有衣冠文物不当刺的戒律，温衣谬刺。同样是发汗，现在针刺尚且不可，发汗难道适宜吗？如果是因勇力劳肾，肾汗客于玄府而应当发汗，那么伤寒少阴症，又有强发汗导致厥竭的戒律。伤寒少阴外感症，尚有不应汗的戒律，如今太阳升散之药，反而成为劳肾内伤症所适宜的吗？以此论证，则《金匮要略》的风水，乃是太阳之外感，实在不是《内经》中肝肾之内伤。
张仲景的书，往往补《内经》之缺，如温疟论《内经》之温疟，一主少阴，然而二者都是先热后寒；《金匮要略》论温疟，则但热不寒。《内经》论温病说：“冬不藏精，春必温病。”仲景论风温，则说：“太阳病发汗已，身灼热，名风温。”仅这两症，仲景的论述与《内经》的论述，各自是一条。《金匮要略》又说：“皮水四肢肿，水在皮肤中，聂聂动，用防己茯苓汤。”这也是与上一章脉浮风水，以三阳主表而立阳经治法相同。又说：“正水，其脉沉迟，外症自喘；石水其脉自沉，外症腹满不喘，两症同是脉沉，而以自喘主肺，不喘主肝肾，《金匮要略》以三阴主里而立阴经治法。”又说：“黄汗，其脉沉迟，身发热，久不愈，必致痈脓。”又说：“里水者，一身面目黄肿，其脉沉，小便不利。”这两条，《金匮要略》以脉沉主表，立从症不从脉之法。又说：“水之为病，其脉沉小，属少阴，浮者为风，无水而虚胀者为气，水发其汗即已。”这是又以脉沉脉浮，来分太阳少阴表里主治，而总结上文三阳三阴水肿治法。又说：“心水少气不得卧，肝水腹大胁下痛，肺水小便难，脾水四肢苦重，肾水腰痛不得溺。”这是以《内经》有五脏之胀，《金匮要略》又补出五脏之水。
《金匮要略》又说：“寸口脉沉而紧，沉为水，紧为寒，趺阳之脉当伏，今反紧，本有寒疝。”又说：“趺阳之脉当伏，今反数，本自有热。”这是以肺主通调水道，胃主出纳水谷，而以肺胃两家为延医依据。又说：“腰以上肿者，宜发汗；腰以下肿者，宜利小便。”这是以经文面肿为风，脚肿为水，而以身之上下，来分表里，推展于脉沉脉浮之外。然而这乃是同伤寒太阳经麻黄治标，五苓治本的方法；不然，则面庞然壅、虚不当刺等症，腰以上虽肿，而发汗在所不取；肝肾并沉、真阴虚涸之症，腰以下虽肿，利小便又所不用也。以上诸条，是《金匮要略》专门论述水肿这一病症。
至于后代节斋、丹溪、张三锡，都以《内经》“诸湿肿满，皆属于脾”，独指足太阴一经立论，不及其他条文。何柏斋独指《内经》肝肾石水，发《金匮要略》肾气丸为治，又单主足少阴一经。薛新甫、赵养葵以补肾补脾为肿胀统治，而以脾肾二经为法。丹溪又说：“湿热气盛，则肺郁成水。”这是说《内经》诸气郁，湿热乘肺作肿一门。河间又说：“燥邪干肺，绝水之源，则小便不利而为肿。”这是因《内经》独缺燥淫一条，千古从未发明，而特补燥热乘肺作肿一门。无奈后代名贤，厌烦喜简，欲将一二经络，印定治法，以为易便，不知道此症门路甚多，断难以一二脏为总括者也。只应当认明何经所主，何经兼见，五脏中何脏有伤，六腑中何腑受病，三因中何因起症，六脉中何部应诊。因病治之，无不中病。
The etiology of swelling and distension has been thoroughly differentiated in the *Neijing* (Huangdi Neijing, Yellow Emperor's Inner Canon) and the *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet). However, the key details within them are obscure and not fully elucidated. The sages of previous dynasties failed to clarify these points, and later practitioners, lacking careful observation, often applied methods for treating deficiency-type edema to patients with excess-type distension, and vice versa. They did not realize that both swelling and distension can present as either deficiency or excess. Swelling floating on the exterior indicates pathology in the meridians and collaterals, belonging to the exterior syndrome; distension fullness in the interior indicates pathology in the stomach and intestines, belonging to the interior syndrome. Fortunately, Scholar Xu (Xu Shuwei) clearly distinguished: edema affecting the four limbs is water disease, whereas abdominal distension with minimal swelling in the limbs is distension disease, thereby elucidating the principle of separate treatment for swelling and distension found in the *Jingui Yaolue*. Later, Zhu Danxi’s works established separate chapters for swelling and distension. Wang Yutai also separated the treatments for edema and distension, which contains profound logic; however, while the chapter on distension clearly lists items such as deficiency, excess, cold, and heat, the chapter on edema fails to detail which passages in the *Neijing* refer to deficiency, which to excess, which to distension, and which to swelling. Furthermore, it does not clarify that "Fengshui" (Wind Edema) in the *Neijing* and "Fengshui" in the *Jingui Yaolue* are two different conditions, leaving me unsatisfied.
The *Lingshu · Jinye Pian* states: "When the Qi pathways of Yin and Yang are unclear, food and fluids accumulate in the stomach and intestines and cannot seep into the bladder, resulting in water distension." This is a general discussion on the origin of water distension. The *Lingshu · Shuizhang Pian* states: "When water disease begins, there is slight swelling under the eyes, followed by abdominal enlargement." "Fuzhang" (Skin Distension) presents with an enlarged abdomen and whole-body swelling with thick skin; "Guzhang" (Drum Distension) presents with an enlarged abdomen and body, similar in size to Fuzhang; "Changtan" (Intestinal Polyp/Mass) occurs when cold qi lodges outside the intestines, forming a mass the size of a chicken egg that gradually enlarges like pregnancy, while menstruation continues regularly; "Shijia" (Stone Mass) arises in the uterus, with closure of the cervical os and irregular menstruation. This section discusses the differentiation between swelling and distension. The *Lingshu · Zhanglun* states: "Heart distension involves mental restlessness and shortness of breath; Lung distension involves empty fullness, wheezing, and coughing; Liver distension involves fullness and pain under the hypochondrium radiating to the lower abdomen; Spleen distension involves frequent hiccups and heavy body; Kidney distension involves abdominal fullness radiating to the back, waist, and thighs; Stomach distension involves epigastric pain and difficulty eating; Large Intestine distension involves borborygmus and pain with gurgling sounds; Small Intestine distension involves lower abdominal distension; Bladder distension involves lower abdominal fullness and urinary retention; Sanjiao distension involves Qi filling the skin; Gallbladder distension involves hypochondriac pain, bitter taste, and sighing." This section details the visible symptoms of distension diseases in the Zang and Fu organs corresponding to each meridian.
The *Lingshu · Shuizhang Pian* further asks: "Can abdominal distension and drum distension be treated with acupuncture?" The answer is: "First, puncture and bleed the collateral vessels at the site of distension, then regulate the meridians." The *Suwen · Fuzhong Lun* states: "Fullness in the heart and abdomen where one can eat in the morning but not in the evening is called Guzhang, treated with Ji Shi Li (Chicken Excrement Fermented Liquid)." Wang Yutai, noting that although both are called Guzhang, their treatments differ based on exterior/interior distinctions, divided them into one being a disease of Qi accumulation and another of Qi stagnation interacting with Blood. I, however, disagree. The *Lingshu · Shuizhang Pian* states: "Abdominal distension with whole-body swelling, equal in magnitude to Fuzhang," indicating that the swelling is widespread on the body surface, not internal distension, thus belonging to the exterior rather than the interior. Hence, it says "first bleed the distended collaterals, then regulate the meridians." This aligns with the *Lingshu · Zhanglun*, which describes Ying Qi circulating along the meridians while Wei Qi rebels and circulates among the muscle intervals, causing Fuzhang, treated by reducing at Zusanli (ST36). These are the same methodological approach. In contrast, the *Suwen · Fuzhong Lun* mentions only heart and abdominal fullness with inability to eat at night, without whole-body swelling, indicating an interior rather than exterior condition; thus, Ji Shi Li is used to descend Qi. This corresponds to the *Neijing* principle: "For fullness in the center, reduce it; after purging, the distension resolves."
The *Suwen · Tangye Laoli Lun* states: "Balance the scales, remove accumulated decay, open the ghost gate (pores), and cleanse the clear mansion (bladder)." This is because Qi is rejected internally while the form manifests externally, causing the body not to fit properly into clothes, indicating simultaneous exterior and interior pathology; therefore, both sweating and diuresis methods are employed. The *Suwen · Ping Re Lun* states: "There is a disease called Kidney Water, presenting with massive facial swelling and difficulty speaking; it is a deficiency pattern and should not be needled, known as Fengshui." It also states: "Simultaneous floating pulse of Liver and Kidney is called Fengshui." Liver Fire is called Thunder Fire, and Kidney Fire is called Dragon Fire. Normally, the pulses of Liver and Kidney are deep; if they become simultaneously floating, it signifies Thunder Fire moving bringing violent winds and rains, and Dragon Fire moving causing waters to surge. These two passages describe excessive Ministerial Fire of Liver and Kidney, leading to overflowing water rising upward. The *Lingshu · Benshu Pian* states: "Shaoyin belongs to the Kidney; the Sanjiao is the palace of drainage, through which water channels exit." The *Suwen · Xuanming Wuqi Pian* states: "Sanjiao disease with Qi fullness makes the lower abdomen particularly hard." It also says: "Water retention leads to distension." These two passages describe insufficient Ministerial Fire of Liver and Kidney, failing to vaporize water, leading to downward accumulation. The *Suwen · Shuire Xuelun* states: "The Kidney is Supreme Yin; Supreme Yin generates water. The Lung is Grand Yin. Thus, the root is in the Kidney, and the branch is in the Lung; both involve water accumulation." This explains that Kidney Water disease connects upward to the Lung. It also states: "The Kidney is the gate of the Stomach; if the gate is not unobstructed, water gathers following its kind." This explains that Kidney Water disease connects upward to the Stomach. It also states: "Excessive exertion damages the Kidney; Kidney sweat enters the pores (Xuanfu) and transforms into swelling. This is Fengshui caused by internal injury to Kidney Water and external invasion of Wind Pathogens."
The *Suwen · Yin Yang Bie Lun* states: "Yin and Yang knot with evil, with much Yin and little Yang, is called Shishui (Stone Water)." It also states: "Three Yin knotted results in water." And: "Simultaneous deep pulse of Liver and Kidney is Shishui." This describes Cold knotting Water Evil, known in later generations as the cold pattern of Yin Water. The *Lingshu · Jingmai Pian* states: "Diseases generated by the Stomach include large abdominal edema and painful swelling of the knees and patellae." It also states: "All swellings belong to Fire; all water edemas are due to combined Damp-Heat." This describes Heat knotting Water Evil, known as the heat pattern of Yang Water. The *Suwen · Zhihen Yao Da Lun* states: "All dampness, swelling, and fullness belong to the Spleen; moreover, excessive Dampness causes water closure and swelling." This indicates that Damp Earth governs the Spleen, leading to Splei Meridian edema. It also states: "What arrives via Taiyin causes swelling." And: "What arrives via Taiyin causes central fullness." This refers to swelling caused by excessive Dampness when Taiyin governs the year. It also states: "When Taiyang governs, excessive Cold causes floating [swelling]." This refers to swelling caused by excessive Cold. It also states: "When Shaoyin governs, Shaoyang wins and revenges; when Shaoyang governs, Shaoyin wins and revenges; furthermore, excessive Heat causes swelling." This refers to swelling caused by excessive Heat when the Sovereign and Ministerial Fires govern the year.
Furthermore, the *Lingshu · Benshen Pian* states: "Spleen Qi excess causes abdominal distension." The *Suwen · Tiaojing Pian* states: "Form excess causes abdominal distension." The *Suwen · Maiyao Jingwei Lun* states: "Stomach Meridian pulse excess causes distension." These describe excess patterns of distension due to Spleen and Stomach congestion. The *Lingshu · Shichuan Pian* states: "Deficiency of Gongsun (SP4) of Foot-Taiyin causes distension." The *Suwen · Taiyin Yangming Lun* states: "Irregular diet and lifestyle entering the Five Zang causes fullness and obstruction." These describe deficiency patterns of distension due to Spleen and Stomach insufficiency. The *Suwen · Fangyi Lun* states: "Cold in the Zang generates fullness diseases." And: "Cold in the Stomach causes distension." These describe cold patterns of distension due to Yang deficiency in the Zang and Fu organs. The *Suwen · Zhihen Yao Da Lun* states: "All distensions with abdominal enlargement belong to Heat." It also states: "Abdominal fullness with difficult defecation, treat Foot-Shaoyin." And: "For distension, treat the Three Yang." These describe heat patterns of distension due to郁热 (stagnant heat) in the Zang and Fu. Above constitutes the *Neijing*'s discussion on swelling and distension.
As for the *Jingui Yaolue*, it states: "Fengshui presents with a floating pulse, joint pain, and aversion to wind; furthermore, Fengshui with floating pulse, heaviness, sweating, and aversion to wind is treated with Fangji Huangqi Tang. Also, Fengshui with aversion to wind, whole-body swelling, floating pulse, no thirst, continuous spontaneous sweating, and no significant heat is treated with Yueshi Tang." Careful study of the *Jingui Yaolue* reveals that a floating pulse indicates the exterior, so treatment focuses on the Taiyang Meridian. This must be a specific type of Wind Edema in the exterior contraction category, distinct from the internal injury Fengshui described in the *Neijing* involving simultaneous floating pulses of Liver and Kidney or facial swelling due to renal exhaustion. It also states: "Pi Shui (Skin Water) also has a floating pulse; exterior symptoms include swelling without thirst, requiring sweating." If sweating is indicated, this directly parallels the treatment of Taiyang Cold Damage. How can this method be applied to internal injury patterns characterized by simultaneous floating pulses of Liver and Kidney, renal exhaustion, massive facial swelling, and deficiency contraindicating needling? If it is due to Liver and Kidney insufficiency, fire decline, and water flooding, Shenqi Wan should be taken to secure the essence; it is inappropriate to use ascending and dispersing exterior-releasing drugs of the Taiyang Meridian. If one considers massive facial swelling and speech impairment as indications for sweating, the classics warn against needling when wearing proper attire and hair ornaments, advocating warm clothing and erroneous needling instead. Although both involve sweating, since needling is contraindicated, how could sweating be appropriate? If sweating is indicated for kidney sweat lodged in the pores due to renal exhaustion, one must recall the warning against forcibly inducing sweating in Shaoyin Cold Damage patterns, which can lead to collapse. If even external Cold Damage patterns in Shaoyin have warnings against sweating, how could ascending and dispersing drugs of the Taiyang Meridian be suitable for internal injury due to renal exhaustion? Based on this argument, the Fengshui in the *Jingui Yaolue* is indeed an external contraction of Taiyang, truly not the internal injury of Liver and Kidney described in the *Neijing*.
Zhang Zhongjing’s works often supplement the *Neijing*. For example, regarding Warm Malaria, the *Neijing* associates it primarily with Shaoyin, yet both describe initial heat followed by cold; however, the *Jingui Yaolue*’s description of Warm Malaria features heat without cold. The *Neijing* states regarding Warm Disease: "Failure to store essence in winter leads to Warm Disease in spring." Zhongjing’s discussion on Wind Warmth states: "After sweating a Taiyang disease, if the body becomes burning hot, it is named Wind Warmth." From these two conditions alone, Zhongjing’s discussions and the *Neijing*’s discussions represent separate categories. The *Jingui Yaolue* also states: "Pi Shui affects the four limbs; water resides in the skin, trembling slightly, treated with Fangji Fuling Tang." This similarly establishes Yang Meridian treatment methods based on the exterior governed by the Three Yang, akin to the previously mentioned floating-pulse Fengshui. It also states: "Zheng Shui has a deep and slow pulse with spontaneous wheezing; Shishui has a naturally deep pulse with abdominal fullness but no wheezing. Both have deep pulses, but wheezing indicates Lung involvement, while non-wheezing indicates Liver-Kidney involvement. The *Jingui Yaolue* establishes Yin Meridian treatment methods based on the interior governed by the Three Yin." It also states: "Huang Han (Yellow Sweat) has a deep and slow pulse, body fever, and if prolonged, will likely lead to abscesses/pus." And: "Li Shui presents with yellow swelling of the whole body and face, deep pulse, and difficult urination." In these two passages, the *Jingui Yaolue* treats deep pulse as indicating the exterior, establishing the principle of prioritizing symptoms over pulses. It also states: "In water diseases, a deep and small pulse belongs to Shaoyin; a floating pulse indicates Wind; empty distension without water is Qi; inducing sweating cures water diseases." This uses deep and floating pulses to differentiate Taiyang and Shaoyin exterior/interior treatments, summarizing the preceding treatments for edema across the Three Yang and Three Yin. It also states: "Heart Water involves shortness of breath and inability to lie down; Liver Water involves abdominal distension and hypochondriac pain; Lung Water involves difficult urination; Spleen Water involves heavy four limbs; Kidney Water involves low back pain and inability to urinate." This supplements the Five Zang Waters in the *Jingui Yaolue* to complement the Five Zang Distensions in the *Neijing*.
The *Jingui Yaolue* also states: "Cunkou pulse is deep and tight; deep indicates water, tight indicates cold. The Duyang pulse should be hidden, but now it is tight, indicating pre-existing Cold Colic." And: "The Duyang pulse should be hidden, but now it is rapid, indicating pre-existing Heat." This utilizes the Lung’s governance of water passages and the Stomach’s governance of food/fluid intake, focusing diagnosis on the Lung and Stomach. It also states: "Swelling above the waist requires sweating; swelling below the waist requires promoting urination." This expands upon the classic saying that facial swelling is Wind and foot swelling is Water, using the upper/lower body to distinguish exterior/interior, extending beyond just pulse depth and floating. However, this mirrors the method of Ma Huang treating the branch and Wuling San treating the root in Taiyang Cold Damage; otherwise, for conditions like massive facial swelling and deficiency contraindicating needling, even if swelling is above the waist, sweating is contraindicated; for conditions like simultaneous deep pulses of Liver and Kidney indicating true Yin depletion, even if swelling is below the waist, diuresis is contraindicated. The above passages constitute the *Jingui Yaolue*’s exclusive discussion on edema.
Later scholars such as Jiezhai, Danxi, and Zhang Sanxi focused solely on the *Neijing* statement "All dampness, swelling, and fullness belong to the Spleen," establishing theories exclusively around the Foot-Taiyin Meridian, neglecting other passages. He Baizhai focused solely on the *Neijing*’s Shishui of Liver and Kidney, prescribing Shenqi Wan from the *Jingui Yaolue*, focusing exclusively on the Foot-Shaoyin Meridian. Xue Xinpu and Zhao Yangkui treated swelling and distension comprehensively by tonifying Kidney and Spleen, basing their methods on the Spleen and Kidney meridians. Danxi also stated: "When Damp-Heat is abundant, Lung Qi becomes depressed, generating water." This addresses the *Neijing* category of Qi depression where Damp-Heat invades the Lung causing swelling. Hejian also stated: "Dryness pathogen affects the Lung, cutting off the source of water, leading to difficult urination and swelling." This supplements the *Neijing*’s omission of Dryness invasion, specifically addressing swelling caused by Dryness-Heat invading the Lung. Unfortunately, later famous physicians, preferring simplicity over complexity, attempted to fix treatment methods to one or two meridians for convenience, unaware that this disease category has many pathways and cannot be summarized by just one or two Zang organs. One must clearly identify which meridian is primarily affected, which is concurrently involved, which Zang organ is injured among the Five Zang, which Fu organ is diseased among the Six Fu, which of the Three Causes initiated the symptom, and which part of the six pulses responds to the diagnosis. Treating according to the disease ensures accuracy.