（《灵枢·胀论》全 附∶肿胀治法）
黄帝曰∶脉之应于寸口，如何而胀？岐伯曰∶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。）黄帝曰∶何以知
脏腑之胀也？岐伯曰∶阴为脏，阳为腑。（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藏，
脉病在阳则胀在腑。亦通。）黄帝曰∶夫气之令人胀也，在于血脉之中耶？脏腑之内乎？岐伯曰∶三者皆存焉，然非胀之
舍也。（舍，言留止之处也。）黄帝曰∶愿闻胀之舍。岐伯曰∶夫胀者，皆在于脏腑之外，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。）黄帝曰∶脏腑之在胸胁腹里之内也，若匣
匮之藏禁器也，各有次舍，异名而同处，一域之中，其气各异，愿闻其故。（此下仍当有岐伯答辞一节，必阙失也。）黄
帝曰∶未解其意，再问。岐伯曰∶夫胸腹，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，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。膻，唐坦切。）胃者，太
仓也。（胃为水谷之海，故曰太仓。）咽喉小肠者，传送也。（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。周礼∶五家为比，五比为闾。盖二十五家为闾也。《风俗通》曰∶
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，非言胃在五窍，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，故总属胃之五窍。轨音癸。）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。畔音叛。）营气循脉，卫气逆为脉胀。（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。）
黄帝曰∶愿闻胀形。（此下辨胀病之形证也。）岐伯曰∶夫心胀者，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，腹满引背中央然，腰髀痛。（此五
脏之胀也。 ，闷乱也。央央然，困苦貌。 ，美本切。）六腑胀∶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。飧音孙。 音嗔。癃，良中切。）
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，谓之夭命，
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，无二歧也。能
察者谓之良工，彼粗者误用，则伤人之命矣。）黄帝曰∶胀者焉生？何因而有？岐伯曰∶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。）黄帝曰∶善。何以解惑？岐伯曰∶合之于真，三合而得。帝曰∶善。（不得其真，所以生惑。
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。）
黄帝问于岐伯曰∶《胀论》言无问虚实，工在疾泻，近者一下，远者三下，今有其三而不下者，其过焉在？（不下者，
言胀不退也。）岐伯对曰∶此言陷于肉肓而中气穴者也。（上文云一下三下者，言针当必陷于肉肓，亦必中于气穴，然后
可以取效也。肓义见本类后六十七。）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，可以万全，乌有殆者乎？（三而不下，必未得其所也，故
当更穴再刺之。）其于胀也，必审其KT ，当泻则泻，当补则补，如鼓应桴，恶有不下者乎？（唇疡曰KT ，盖胀之微
甚，必见于唇，故当审之于此，以察其虚实。然KT 字未妥，必脉字之误也。KT ，疹同。桴音孚。愚按∶肿胀一证，
观本篇之义，则五脏六腑无不有之。再考诸篇，如《脉要精微论》曰∶胃脉实，气有余则胀。《邪气脏腑病形篇》曰∶胃
病者，腹 胀，胃脘当心而痛。《本神篇》曰∶脾气实则腹胀，泾溲不利。《阴阳应象大论》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 满闭塞。《经脉篇》曰∶足太阴之别公孙，虚则鼓胀。此皆
虚胀也。《师传篇》曰∶胃中寒则腹胀。《异法方宜论》曰∶脏寒生满病。《风论》曰∶胃风鬲塞不通，腹善满，失衣则
胀。此皆寒胀也。《阴阳别论》曰∶二阴一阳发病，善胀心满。《诊要经终论》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》、《至真要》等论，有云太阴所至为重 肿，及土郁之发，太阴之初气，
太阴之胜复，皆湿胜之肿胀也。有曰水运之太过，有曰寒胜则浮，有曰太阳之司天，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，有曰热胜则肿，皆火胜之肿胀也。有曰厥阴之司天在泉，厥阴
之复，有曰阳明之复，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
《至真要大论》曰∶诸湿肿满，皆属于脾。《水热穴论》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，然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。但证有阴阳虚实，如诸论之所云者，不可不辨。大都阳证多热，热者多实；
阴证多寒，寒者多虚。先胀于内而后及于外者多实，先肿于表而后甚于里者多虚。小便黄赤，大便秘结者多实；小水清
白，大便稀溏者多虚。脉滑数有力者多实，弦浮微细者多虚。形色红黄，气息粗长者多实；容颜憔悴，音声短促者多虚。
凡是实症，必以六淫有余伤其外，或饮食怒气伤其内，故致气道不行，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，则为单腹胀急，然阳邪急速，其至必暴，每成于旬日数日之间，此惟少壮者多有之，
但破其结气，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，或酒色过度，伤其脾肾，日积月累，
其来有渐，此等病候，多染于中年之外，其形证脉气，必有虚寒之候，显然可察，非若实证之暴至，而邪热壅结、肝气
悍逆之有因也。治实者本无所难，最难者在治虚耳。然虚有在气者，有在水者。在气者，以脾气虚寒，不能运化，所谓
气虚中满者是也。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
有分界，所谓水臌水胀者是也。然水虽制于脾，而实主于肾，盖肾本水脏，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。夫气即火也，精即水也，气之与水，本为同类，
但在于化与不化耳。故阳王则化，而精能为气；阳衰则不化，而水即为邪。凡火盛水亏则病燥，水盛火亏则病湿。故火
不能化，则阴不从阳，而精气皆化为水，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，坠道壅塞而为热，热留为湿，湿热相生，遂成胀满，治宜补其脾，又须养肺金以制木，使脾无贼邪之患，滋肾水
以制火，使肺得清化之令。其说重在湿热，而犹以制火为言。夫制火固可保金，独不虑其不生土乎？若以此法施于阳实
而热者则可，若以治阳虚而气不化者，岂不反助阴邪而益其病哉？故予之治此，必察其果系实邪，则直清阳明，除之极
易；凡属虚劳内损者，多从温补脾肾而愈，俱得复元。或临证之际，有虚实未明，疑似难决者，则宁先以治不足之法，
探治有余，若果未投而病反加甚，是不宜补也，不妨易辙，自无大害。倘药未及病，而病自甚者，其轻重真假，仍宜详
察。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。或从清利，暂见平复，使不大补脾肾以培根
本，虽愈目前，未有不危亡踵至者，此治虚之道也。夫肿胀之病，多有标实本虚，最为危候，若辨之不明，则祸人非浅。）
（《灵枢·胀论》全文 附：肿胀治法）
黄帝问：脉象在寸口部位的反映，如何判断是胀病？岐伯回答：脉象大而坚涩的，就是胀病。（脉大，说明邪气盛。脉坚，说明邪气实。脉涩是因为气血虚弱而不能流利运行。一般来说，洪大的脉象，阴气必然衰少；坚强有力的脉象，胃气必然受损，所以脉象大、坚、涩，疾病应当表现为胀。）黄帝问：怎样知道脏腑的胀病呢？岐伯回答：阴代表脏，阳代表腑。（脉涩而坚的属于阴，胀在脏。脉大而坚的属于阳，胀在腑。另一种说法是：脉病在阴分则胀在脏，脉病在阳分则胀在腑，这也讲得通。）黄帝问：导致人胀的气，是在血脉之中呢？还是在脏腑之内呢？岐伯回答：三者都存在，但这并不是胀病的居所。（“舍”，指停留止息的地方。）黄帝说：我想听听胀病的居所在哪里。岐伯说：胀病，都在脏腑之外，排挤脏腑并向外扩张胸胁，充塞皮肤，所以命名为胀。（排挤于脏腑之外，以胸胁为外廓，而居于皮肤之中，这就是胀病的所在之处。）黄帝说：脏腑位于胸胁腹里之内，就像匣子和柜子里收藏的禁器一样，各有固定的处所，名称不同但位置相邻，同在一个区域中，但它们的气各不相同，我想听听其中的原因。（这下面原本应该还有一段岐伯的回答，必定是缺失了。）黄帝说：还没理解您的意思，再请问一次。岐伯说：胸腹，是脏腑的外廓。（胸腹，用来保护五脏六腑，所以称为脏腑的外廓。）膻中，是心包络的宫城。（膻中，即胸中。肺覆盖在上面，横膈膜遮挡在下面，形成清虚周密的宫殿，是心主居住的地方，所以叫宫城。“膻”，读音为唐坦切。）胃，是太仓。（胃是水谷汇聚的海，所以叫太仓。）咽喉和小肠，负责传送。（咽喉负责传送，使谷气从上面进入。小肠负责传送，使清浊之气从下面排出。）胃的五窍，是闾里的门户。（“闾”，是巷门。“里”，是邻里。《周礼》记载：五家为一比，五比为闾。大概二十五家为一闾。《风俗通》说：五家为一轨，十轨为里。大概五十家为里。所谓胃的五窍是闾里门户，不是说胃有五个窍，而是指从上自胃脘，下至小肠大肠，都属于胃的范畴，所以称为闾里门户。如咽门、贲门、幽门、阑门、魄门，都是胃气运行的通道，所以总归属于胃的五窍。“轨”音癸。）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，它们的病变各有不同的形态。（边界各有所属，所以疾病的形状出现时可以按察得到。“畔”音叛。）营气循行于脉中，卫气逆乱会导致脉胀。（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，才会形成脉胀。因此凡是患胀病的人，都发源于卫气。）卫气并入脉中并循行于分肉之间，会导致肤胀。（卫气逆乱并合于脉中，又循行于分肉之间，所以形成肤胀。）针刺足三里穴进行泻法，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。（足三里，是足阳明经的穴位。阳明经是五脏六腑气血汇聚的大海且主管肌肉，所以胀在肌肤者应当用针泻之。“一下三下”，指一次、再次、三次。因为邪气有远近之分，所以泻法有难易之别。）
黄帝说：我想听听胀病的形证。（这下面辨析胀病的形证。）岐伯说：心胀，表现为心烦短气，睡眠不安。肺胀，表现为胸部虚满且喘咳。肝胀，表现为胁下满痛并牵引小腹。脾胀，表现为经常呃逆，四肢烦闷沉重，身体重到连衣服都穿不住，睡眠不安。肾胀，表现为腹部满痛牵引背部中央，腰部和大腿疼痛。（这是五脏的胀病。“烦”，指闷乱。“央央然”，指困苦的样子。“美本切”。）六腑胀：胃胀，表现为腹部满，胃脘痛，鼻子闻到焦臭味，妨碍进食，大便困难。大肠胀，表现为肠鸣且疼痛如水声濯濯，冬天再次感受寒邪，就会发生完谷不化的泄泻。小肠胀，表现为小腹胀满，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之中，轻轻软软且不坚硬。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。“飧”音孙。“嗔”音嗔。“癃”，良中切。）
大凡这些胀病，其道理在于一点，明白气的逆顺，针刺的次数就不会失误，泻虚补实，如果神气离失，就会导致邪气深入、正气丧失，真气无法安定，这是庸医造成的败坏，称之为夭折命运；如果能补虚泻实，神气回归体内，长久地充实空虚之处，这就叫做良工。（这下面讲述治疗胀病的得失。胀病有虚实之分，该补该泻，道理只有一个，没有两条歧路。能明察此理的人称为良工，那些粗疏的医生误用，就会伤害人的性命。）黄帝问：胀病是怎么产生的？是什么缘故引起的？岐伯回答：卫气在人身上的常态，常常并行于脉中并循行于分肉之间，运行有逆有顺，阴阳相互跟随，才能符合自然和谐，五脏功能更替更新，四时顺序遵循规律，五谷才能消化。（这是卫气的正常规律。）然后厥逆之气在下，营卫留滞不行，寒气逆上，真气和邪气相互攻伐，两气相搏结，于是合成为胀病。（上一节讲卫气的顺行，这一节阐明卫气的逆行。厥逆之气，从下向上，营卫失常，所以真邪相攻而合为胀病。）黄帝说：好。怎样才能解除疑惑？岐伯回答：结合真气来考察，有三方面的合参才能得出真谛。黄帝说：好。（得不到真气真谛，所以产生疑惑。胀病虽然由于卫气引起，但有合于血脉之中的，在经络方面；有合于脏的，在阴分方面；有合于腑的，在阳分方面。这三方面的合参既然明了，就得到了真谛。）
黄帝问岐伯说：《胀论》中说无论虚实，关键在于迅速泻邪，病位近的刺一次，病位远的刺三次，现在有的人刺了三次却胀不退，过错在哪里？（“不下”，指胀气不退。）岐伯回答说：这是指针刺陷于肉肓而没有中气穴的缘故。（上文说一下三下，意思是针刺必须陷入肉肓，也必须中于气穴，然后才能取效。“肓”的含义见本类后第六十七篇。）如果不中气穴，气就会在内闭塞；针刺不陷入肉肓，气就不能运行；如果只向上越入肌肉，卫气就会混乱，阴阳邪气相互追逐。（如果不中穴，不陷肓，就会妄中于分肉间。所以卫气混乱，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，气所以不能下行。（没有得到正确的穴位和肉肓部位。）刺了三次还不退，必须更换治疗方法，气下行才停止，如果不退再重新开始，可以万无一失，哪里有危险的呢？（刺了三次还不退，一定是没找对地方，所以应当更换穴位再刺。）对于胀病，必须审察唇部的KT（此处疑为脉字之误），应当泻的就泻，应当补的就补，像鼓槌击鼓应声那样准确，怎么会有胀气不退的呢？（嘴唇生疮疡叫KT，大概胀病的轻重，一定表现在嘴唇上，所以应当在此审察以观察虚实。然而“KT”字不妥，必然是“脉”字的误写。“KT”，同“疹”。“桴”音孚。我按语：肿胀这一病症，观本篇的意义，则五脏六腑无不都有。再考证其他篇章，如《脉要精微论》说：胃脉实，气有余则胀。《邪气脏腑病形篇》说：胃病，腹部胀，胃脘当心而痛。《本神篇》说：脾气实则腹胀，大小便不利。《阴阳应象大论》说：浊气在上，则生胀。这些都是实胀。《太阴阳明论》说：饮食起居失节，入五脏则痞满闭塞。《经脉篇》说：足太阴之别公孙，虚则鼓胀。这些都是虚胀。《师传篇》说：胃中寒则腹胀。《异法方宜论》说：脏寒生满病。《风论》说：胃风格塞不通，腹部常满，受冷则胀。这些都是寒胀。《阴阳别论》说：二阴一阳发病，善胀心满。《诊要经终论》说：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。此外如《六元正纪》、《至真要要大论》等论述，有说太阴所至为重肿，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。有说水运太过，有说寒胜则浮，有说太阳之司天，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，有说热胜则肿，都是火胜导致的肿胀。有说厥阴之司天在泉，厥阴之复，有说阳明之复，这都是木邪侮土及金气反胜导致的肿胀。看这些，不仅五脏六腑，就连五运六气，也无不都有这种病。然而《至真要大论》说：诸湿肿满，皆属于脾。《水热穴论》说：其本在肾，其末在肺，都是聚水所致。又说：肾是胃的关口，关门不利，所以聚水而从其同类。由此而言，虽然各经都有胀，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；转输于这两脏之间，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。但证候有阴阳虚实，如各种论述所说的那样，不可不辨别。大体上阳证多热，热者多实；阴证多寒，寒者多虚。先胀于内而后波及于外的多实，先肿于表而后加重于里的多虚。小便黄赤，大便秘结的多实；小便清白，大便稀溏的多虚。脉滑数有力的多实，弦浮微细的多虚。形色红黄，气息粗长的多实；容颜憔悴，声音短促的多虚。凡是实证，必定是由于六淫有余损伤其外，或饮食怒气损伤其内，导致气道不行，三焦壅闭，这多在气分，无处不到，所以不分部位而多全身浮肿；或者气实于中，则为单腹胀急，然而阳邪急速，其到来一定猛烈，往往在旬日数日之间形成，这多见于青壮年，只要破其结气，利其壅滞，病没有不愈的，这是治疗实证的方法。如果是虚证，必定是由于五志积劳，或酒色过度，损伤脾肾，日积月累，其来势缓慢，这类病候，多染于中年之后，其形证脉气，必有虚寒的征候，明显可察，不像实证那样暴至，也没有邪热壅结、肝气悍逆的原因。治疗实证本来不难，最难的是治疗虚证。然而虚证有在气的，有在水的。在气的，是因为脾气虚寒，不能运化，所谓气虚中满是也。在水的，是因为脾虚不能制水，则寒水反侮脾土，泛滥为邪，起初一定从阴分开始，逐渐上升，按压肌肉如泥，肿有分界，所谓水臌水胀是也。然而水虽受制于脾，实则主于肾，因为肾本是水脏，而元阳生气由此而出。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，阴阳不得其正，则化为邪气。气就是火，精就是水，气与水，本是同类，区别在于化与不化罢了。所以阳气旺盛则化，精就能转化为气；阳气衰弱则不化，水就成为邪气。凡火盛水亏则病燥，水盛火亏则病湿。所以火不能化，则阴不从阳，精气都化为水，所以水肿的证候多属于阳虚，所以说寒胀多，热胀少。然而看朱丹溪治疗肿胀，说清浊相混，坠道壅塞而为热，热留为湿，湿热相生，遂成胀满，治疗应当补脾，又须养肺金以制木，使脾无贼邪之患，滋肾水以制火，使肺得清化之令。他的学说重在湿热，并且还要提到制火。制火固然可以保金，难道不考虑它不生土吗？如果用这种方法治疗阳实而热的还可以，如果用来治疗阳虚而气不化的，岂不是反而助长阴邪而加重病情吗？所以我治疗这个病，一定要审察是否确实是实邪，如果是，直接清泻阳明，除去它非常容易；凡是属于虚劳内损的，多从温补脾肾而痊愈，都能恢复元气。或者临证时，有虚实未明，疑似难决的，则宁可先用治疗不足的方法，试探性地治疗有余，如果果然药未投下而病反而加重，是不宜补的，不妨改变方法，自无大害。倘若药未到病所，而病自己加重，其轻重真假，仍应详细察辨。如果误用治疗有余的方法来治疗不足，并且曾经峻猛攻伐，真气再次受伤，即使是神丹也不能治愈了。或者从清利入手，暂时见到平复，如果不大力补益脾肾以固根本，虽然现在好了，没有不随后危亡的，这是治疗虚证的方法。夫肿胀的病，多有标实本虚，是最为危重的证候，如果辨别不明，则祸害人不浅。）
(The "Treatise on Distension" from *Ling Shu* - Complete Text [Appendix: Treatment Methods for Swelling and Distension]
Yellow Emperor asked: How does the pulse at Cun Kou reflect distension? Qi Bo replied: A pulse that is large, firm, and choppy indicates distension. (A large pulse indicates an abundance of pathogenic factors. A firm pulse indicates excess of pathogenic factors. Choppi-ness is due to deficiency of Qi and Blood failing to flow smoothly. Generally, a surging and large pulse implies a decline of Yin Qi; a firm and strong pulse implies damage to Stomach Qi. Therefore, a pulse that is large, firm, and choppy suggests the disease manifests as distension.) Yellow Emperor asked: How can one know which Zang or Fu organ is affected by distension? Qi Bo replied: Yin corresponds to Zang organs, and Yang corresponds to Fu organs. (A choppy and firm pulse belongs to Yin, with distension in the Zang organs. A large and firm pulse belongs to Yang, with distension in the Fu organs. Another interpretation states: if the pulse pathology is in Yin, distension is in the Zang; if in Yang, distension is in the Fu. This is also valid.) Yellow Emperor asked: Does the Qi causing distension reside within the blood vessels, or inside the Zang and Fu organs? Qi Bo replied: It exists in all three places, but these are not the dwelling place of distension. ("She" refers to the place where it stays and rests.) Yellow Emperor said: I wish to hear about the dwelling place of distension. Qi Bo replied: Distension resides outside the Zang and Fu organs, pushing against them and expanding into the chest and hypochondrium, filling the skin. Hence it is named distension. (It pushes outward from outside the Zang and Fu, using the chest and hypochondrium as its outer boundary, residing within the skin; this is the location of distension.) Yellow Emperor said: The Zang and Fu organs are located within the chest, hypochondrium, and abdomen, like forbidden artifacts stored in boxes and cabinets. Each has its fixed abode, different names but adjacent locations, all within one region, yet their Qi differs. I wish to understand why. (There should originally be another paragraph of Qi Bo's answer here, which must have been lost.) Yellow Emperor said: I do not fully understand your meaning; let me ask again. Qi Bo replied: The chest and abdomen are the outer walls of the Zang and Fu. (The chest and abdomen protect the internal organs, thus serving as the outer walls of the Zang and Fu.) Dan Zhong is the palace city of the Heart Master. (Dan Zhong is the center of the chest. The Lung covers above, and the diaphragm blocks below, forming a clear, empty, and dense palace, the residence of the Heart Master, hence called the palace city. "Dan" is pronounced Tang Tan Qie.) The Stomach is the Grand Granary. (The Stomach is the sea of water and grain, hence called the Grand Granary.) The pharynx and small intestine are responsible for transmission. (The pharynx transmits, allowing grain Qi to enter from above. The small intestine transmits, allowing clear and turbid substances to exit from below.) The five openings of the Stomach are the gates of the neighborhood. ("Lu" means alley gate. "Li" means neighborhood. The *Rites of Zhou* records: five families form a Bi, five Bis form a Lu. Approximately twenty-five families make up a Lu. *Feng Su Tong* says: five families form a Gui, ten Guis form a Li. Approximately fifty families make up a Li. Saying the five openings of the Stomach are the gates of the neighborhood does not mean the Stomach has five openings literally, but rather that from the upper stomach opening down to the small and large intestines, all belong to the Stomach, hence called the gates of the neighborhood. Such as the pharyngeal gate, cardiac orifice, pyloric gate, ileocecal valve, and anal gate, are all channels through which Stomach Qi flows, so they collectively belong to the five openings of the Stomach. "Gui" is pronounced Gui.) Lian Quan and Yu Ying are the pathways for fluids. (Both acupoints belong to the Ren Mai. Yu Ying is the same as Yu Tang.) Therefore, the Zang and Fu organs each have their boundaries, and their diseases present with distinct shapes. (Boundaries have specific affiliations, so the manifestations of disease can be palpated. "Pan" is pronounced Pan.) Ying Qi circulates within the vessels; when Wei Qi rebels, it causes vessel distension. (Clear substances form Ying Qi, which resides within the vessels. Its Qi is refined and concentrated, not immediately causing distension. Turbid substances form Wei Qi, which travels outside the vessels. Its Qi is swift, slippery, and moves between the muscle intervals. Thus, only when Wei Qi rebels does the pathology affect Ying Qi, resulting in vessel distension. Therefore, all cases of distension originate from Wei Qi.) When Wei Qi merges with the vessels and circulates along the muscle intervals, it causes skin distension. (Wei Qi rebels and merges with the vessels, then circulates along the muscle intervals, causing skin distension.) Needle San Li (Zusanli) to drain. For nearby conditions, needle once; for distant conditions, needle three times. Regardless of deficiency or excess, the key lies in rapid draining. (San Li is an acupoint of the Foot-Yangming Meridian. The Yangming Meridian is the sea of Qi and Blood for the Zang and Fu organs and governs the muscles. Therefore, distension in the skin and muscles should be treated by needling to drain. "Once and three times" refers to one, two, and three sessions. Because pathogens vary in distance, the difficulty of draining varies.)
Yellow Emperor said: I wish to hear about the forms of distension. (This section discusses the signs and symptoms of distension diseases.) Qi Bo replied: Heart distension presents with mental restlessness, shortness of breath, and restless sleep. Lung distension presents with empty fullness in the chest, wheezing, and coughing. Liver distension presents with fullness and pain under the hypochondrium radiating to the lower abdomen. Spleen distension presents with frequent hiccups, heaviness and discomfort in the four limbs, body weight so great that one cannot bear the weight of clothes, and restless sleep. Kidney distension presents with abdominal fullness and pain radiating to the center of the back, and pain in the waist and thighs. (These are the distensions of the five Zang organs. "Fan" refers to mental oppression. "Yang Yang Ran" describes a state of distress. "Mei Ben Qie".) Six Fu Distensions: Stomach distension presents with abdominal fullness, epigastric pain, smelling burnt odors from the nose, difficulty eating, and constipation. Large Intestine distension presents with borborygmus and gurgling pain. If exposed to cold again in winter, it leads to undigested diarrhea. Small Intestine distension presents with lower abdominal fullness and pain radiating to the waist. Bladder distension presents with lower abdominal fullness and urinary retention. San Jiao distension presents with Qi filling the skin, feeling light and soft but not hard. Gallbladder distension presents with pain and fullness under the hypochondrium, bitter taste in the mouth, and frequent sighing. (These are the distensions of the six Fu organs. "Zhuo Zhuo" refers to the sound of water in the intestines. "Sun Xie Bu Hua" refers to diarrhea with undigested food. "Qi Long" refers to closure of Qi in the bladder and inability to urinate. "Sun" is pronounced Sun. "Chen" is pronounced Chen. "Long" is pronounced Liang Zhong.)
In general, the principle behind all these distensions is singular: knowing the reversal and smoothness of Qi, and the number of needle insertions without error, draining deficiency and tonifying excess. If the Shen (Spirit) leaves its chamber, it leads to the invasion of pathogens and loss of righteousness, making the True Qi unstable. This failure by incompetent physicians is called premature death. Conversely, tonifying deficiency and draining excess allows the Shen to return to its chamber and fills the emptiness over time; this is called a skilled practitioner. (This section discusses the gains and losses in treating distension. Distension has deficiency and excess types, requiring either tonification or drainage. The principle is unique, with no divergence. Those who can discern this are called skilled practitioners; those who are crude and misuse treatment harm people's lives.) Yellow Emperor asked: How is distension generated? What is the cause? Qi Bo replied: Normally, Wei Qi in the body runs alongside the vessels and along the muscle intervals. Its movement has reversal and smoothness, with Yin and Yang following each other, achieving harmony with Heaven. The five Zang organs renew their functions, the four seasons follow their order, and grains are digested. (This is the normal regulation of Wei Qi.) Then, rebellious Qi arises from below, Ying and Wei Qi stagnate, Cold Qi rebels upward, and True Qi and Pathogenic Qi attack each other. The two Qi interlock and combine to form distension. (The previous section discussed the smooth flow of Wei Qi; this section clarifies the rebellion of Wei Qi. Rebellious Qi rises from below, disrupting Ying and Wei, causing True and Pathogenic Qi to clash and form distension.) Yellow Emperor said: Excellent. How can confusion be resolved? Qi Bo replied: By aligning with the True Qi, combining three aspects to obtain the truth. Yellow Emperor said: Excellent. (Without grasping the True Qi, confusion arises. Although distension stems from Wei Qi, it combines with the blood vessels in the meridians, with Zang organs in the Yin aspect, and with Fu organs in the Yang aspect. Once these three combinations are clear, the truth is obtained.)
Yellow Emperor asked Qi Bo: The "Treatise on Distension" states that regardless of deficiency or excess, the key is rapid drainage: once for nearby conditions, three times for distant ones. Now, some patients do not improve after three treatments. Where is the fault? ("Not descending" means the distension does not subside.) Qi Bo answered: This refers to needles sinking into the muscular fat (Huang) but missing the Qi acupoints. (When it says "once or three times," it implies the needle must sink into the Huang and hit the Qi acupoint to be effective. The meaning of "Huang" is seen in Article 67 of this category.) Missing the Qi acupoint causes internal Qi blockage; failing to sink into the Huang prevents Qi movement. If the needle goes too high into the muscle, Wei Qi becomes chaotic, and Yin and Yang pathogens chase each other. (Missing the acupoint and not sinking into the Huang means striking randomly between muscle intervals. Thus, Wei Qi becomes chaotic, and Yin/Yang pathogens attack the body.) For distension, if drainage is indicated but not performed, Qi fails to descend. (Failure to locate the correct acupoint and Huang area.) If three insertions do not work, the method must be changed. Stop only when Qi descends; if it doesn't, restart. This ensures safety; where is the danger? (If three insertions fail, the location was likely incorrect, so changing the acupoint and needling again is necessary.) For distension, one must examine the lips' KT (likely a typo for Pulse), drain if indicated, tonify if indicated. Like a drum responding to a strike, how could distension not subside? (Sores on the lips are called KT. The severity of distension manifests on the lips, so examining here helps assess deficiency/excess. However, "KT" is inappropriate and likely a typo for "Mai" (Pulse). "KT" is synonymous with "Zhen" (rash). "Fu" is pronounced Fu. My commentary: Regarding swelling and distension, this chapter implies all Zang and Fu organs can be affected. Other texts confirm this: *Su Wen: Essential Essentials of Pulse Diagnosis* states: Excess Stomach pulse and surplus Qi cause distension. *Su Wen: Pathogenic Factors and Organ Diseases* states: Stomach disease involves abdominal distension and epigastric pain. *Su Wen: Original Spirit* states: Excess Spleen Qi causes abdominal distension and difficult urination/defecation. *Su Wen: Yin-Yang Ying Xiang Da Lun* states: Turbid Qi staying above causes distension. These are all excess distensions. *Su Wen: Tai Yin Yang Ming Lun* states: Irregular diet and lifestyle entering the five Zang causes obstruction and fullness. *Su Wen: Meridians* states: Deficiency in the Luo-connecting vessel of Foot-Taiyin (Gongsun) causes drum-like distension. These are deficiency distensions. *Su Wen: Teacher's Transmission* states: Cold in the Stomach causes abdominal distension. *Su Wen: Different Methods and Suitable Areas* states: Cold in the Zang generates fullness diseases. *Su Wen: Wind Treatise* states: Stomach wind causes blockage and frequent abdominal fullness, worsening with cold exposure. These are cold distensions. *Su Wen: Yin-Yang Differentiation* states: Disease involving Two Yin and One Yang causes distension and heart fullness. *Su Wen: Diagnostics and Meridian Termination* states: Termination of Hand-Shaoyin and Foot-Taiyin meridians involves abdominal distension and closure. These are distensions due to Heart and Spleen injury. Furthermore, *Su Wen: Six Yuan Zheng Ji* and *Zhi Yao Da Lun* mention: Tai Yin arrival causes heavy swelling; Earth depression onset, Tai Yin initial Qi, Tai Yin victory/reversal all involve dampness-induced swelling. Water transport excess, Cold victory causing floating, Tai Yin ruling heaven/victory-reversal all involve cold-induced swelling. Shao Yin/Shao Yang ruling heaven/victory-reversal and Heat victory causing swelling involve fire-induced swelling. Jue Yin ruling heaven/in泉, Jue Yin reversal, Yang Ming reversal involve Wood insulting Earth and Metal counter-winning swelling. Thus, not only Zang/Fu, but also Five Movements and Six Qi can cause this disease. However, *Zhi Yao Da Lun* states: All dampness, swelling, and fullness belong to the Spleen. *Shui Re Xue Lun* states: The root is in the Kidney, the branch in the Lung, both gathering water. It also says: The Kidney is the gate of the Stomach; if the gate is dysfunctional, water gathers and multiplies. Thus, although all meridians can have distension, none do not affect the Spleen, Lung, and Kidney. The Spleen belongs to Earth, governing transformation and transportation; the Lung belongs to Metal, governing Qi; the Kidney belongs to Water, governing the five fluids. Fluids transformed by the five Qi belong to the Kidney; Qi moving the five fluids belongs to the Lung; transfer between these two organs to control Water generating Metal belongs to the Spleen. Therefore, swelling and distension arise from these three. However, syndromes differ in Yin/Yang and deficiency/excess, as described in various treatises, which must be distinguished. Generally, Yang syndromes are often hot and excess; Yin syndromes are often cold and deficient. Distension starting internally and spreading externally is often excess; swelling starting externally and worsening internally is often deficient. Yellow/red urine and constipation indicate excess; clear/white urine and loose stools indicate deficiency. Slippery, rapid, forceful pulses indicate excess; wiry, floating, faint, fine pulses indicate deficiency. Red/yellow complexion and coarse breathing indicate excess; haggard appearance and short voice indicate deficiency. All excess syndromes result from external injury by the Six Excess Pathogens or internal injury by diet and anger, leading to blocked Qi flow and San Jiao congestion. This affects the Qi level, reaching everywhere, often causing generalized edema without specific localization. Or, Qi excess in the middle causes isolated abdominal distension. Yang pathogens are swift and violent, appearing suddenly within days or weeks, common in young adults. Breaking Qi stagnation and unblocking congestion cures this; this is the method for treating excess. Deficiency syndromes result from emotional labor or excessive alcohol/sex damaging the Spleen and Kidney over time. These develop gradually, often affecting middle-aged people. Signs show obvious deficiency-cold patterns, unlike the sudden onset of excess syndromes with heat congestion or liver Qi rebellion. Treating excess is easy; treating deficiency is hardest. Deficiency can be in Qi or Water. Qi deficiency involves Spleen deficiency-cold failing to transform, known as Qi-deficiency central fullness. Water deficiency involves Spleen failing to control Water, allowing Cold Water to insult Earth, flooding as pathogen. It starts in the Yin aspect, rising gradually, leaving pitting edema with defined borders, known as Ascites/Water Distension. Although Water is controlled by the Spleen, it is governed by the Kidney. The Kidney is the Water organ, source of Primordial Yang Qi. If Kidney Yang is deficient, Mingmen Fire declines, failing to control Cold or warm the Spleen. Yin and Yang lose balance, becoming pathogenic. Qi is Fire; Essence is Water. They are similar but differ in transformation. Strong Yang transforms, turning Essence into Qi; weak Yang fails to transform, turning Water into pathogen. Fire excess/Water deficiency causes dryness; Water excess/Fire deficiency causes dampness. If Fire cannot transform, Yin does not follow Yang, and Essence/Qi become Water. Thus, edema mostly belongs to Yang deficiency, explaining why cold distension is more common than hot distension. However, Zhu Danxi treated swelling by saying mixed clear/turbid substances and blocked pathways cause heat; heat retains dampness, generating distension. He advocated tonifying Spleen, nourishing Lung Metal to control Wood, and nourishing Kidney Water to control Fire. His focus was on damp-heat and controlling Fire. Controlling Fire protects Metal, but does it not hinder Earth generation? This method works for Yang-excess/heat, but for Yang-deficiency/non-transformation, it aids Yin pathogens and worsens the condition. Therefore, I always check for true excess before clearing Yangming easily. For deficiency exhaustion, warming and tonifying Spleen/Kidney restores health. If deficiency/excess is unclear, I prefer tonifying deficiency first to probe excess. If symptoms worsen without medication, tonification is contraindicated, and methods can be changed safely. If symptoms worsen despite medication, severity and真假 (true/false) must be carefully observed. Misusing excess-treatment on deficiency, especially after harsh purging, damages True Qi beyond repair even with divine medicine. Clearing/draining may temporarily relieve symptoms, but without strongly tonifying Spleen/Kidney to secure the root, relapse and death are inevitable. This is the method for treating deficiency. Swelling/distension often presents with superficial excess and root deficiency, a critical condition. Unclear differentiation causes severe harm.)