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。黄帝曰。何以知脏腑之胀也。
岐伯曰。阴为脏。阳为腑。
此承上文言卫气之行于形身脏腑之外内。有顺有逆。逆顺不从。在外则为脉胀肤胀。在内则为脏
腑之胀矣。寸口坚大为阳脉。涩为阴脉。阴为脏。阳为腑。以脉之阴阳。则知脏腑之胀矣。
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。
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。
姚士因曰。此病在气而及于脏腑血脉之有形。故三者皆存焉。然非胀之舍也。胀之舍在内者。皆
在于脏腑之外。空郭之中。在外者。胀于皮肤腠理之间。故命曰胀。谓胀在无形之气分也。
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。
王芳侯曰。帝问脏腑在于胸腹之内。如匣匮所藏之禁器。而各有界畔。五脏六腑。其气各异。今胀
气皆在于脏腑之外。何以分别某脏某腑之胀乎。此下有岐伯所答之缺文。
黄帝曰。未解其意。再问。岐伯曰。夫胸腹。脏腑之郭也。膻中者。心主之宫城也。胃者。太仓也。
咽喉小肠者。传送也。
胃之五窍者。闾里门户也。廉泉玉英者。津液之道也。故五脏六腑者。各有畔界。其病各有形状。
营气循脉。卫气逆为脉胀。卫气并脉循分为肤胀。三里而泻。近者一下。远者三下。无问虚实。
工在疾泻。（膻叶袒）
此言卫气生于胃腑水谷之精。日行于阳。夜行于阴。逆于阳。则为脉胀肤胀。逆于阴。则为空
郭之胀。及五脏六腑之胀。夫胸腹者。脏腑之郛郭。膻中者。心主之宫城。胀者皆在于脏腑之外。
排脏腑而郭胸胁。此卫气逆于阴。而将为脏腑之胀矣。胃主受纳水谷。为太仓而居中焦。在上为咽
喉。主传气而送水谷。在下口为小肠。主传送糟粕津汁。胃之五窍。犹闾里之门户。盖水谷入胃。其
味有五。津液各走其道。酸先入肝。苦先入心。甘先入脾。辛先入肺。咸先入肾。五脏主藏水谷之
精者也。其流溢于下焦之津液。从任脉而出于廉泉玉英。以濡上之空窍。故五脏六腑。各有界畔。其
病各有形状也。如营气循脉。卫气逆于脉中。则为脉胀。若并脉而循行于分肉。则为肤胀。盖卫气
虽常然并脉循行于分肉。而行有逆顺。若并脉顺行。而乘于脉中。则为脉胀。行于肤肉。则为肤胀。
此皆卫气之逆行。故曰若顺逆也。当取足阳明胃经之三里而泻之。在于肤脉而近者一泻。在于城郭
而远者三下。无问虚实。工在疾泻。盖留之则为脏腑之胀矣。卫气出于太仓。故泻胃之三里。
姚氏曰。营气循脉。卫气逆为脉胀。与上章之营气顺脉。卫气逆行同义。吴氏曰。卫气逆于
空郭之中。则为鼓胀。着于募原而传送液道阻塞者。则为肠胃之胀。门户界畔不清者。则为五脏之
胀。此皆胃腑之门户道路。故泻足之三里。若病久而成虚者。泻之反伤胃气。故曰工在疾泻。疾泻
者。治其始蒙也。杨元如曰。逆则生长之机渐消。故久而未有不成虚者。审其传送阻塞者泻之。
门户液道不通者通之。界畔不清者理之。正
气不足者补之。补泻疏理兼用。斯为治胀之良法。若新病而不大虚者。急宜攻之。可一鼓而下。
朱永年曰。医者只知泻以消胀。焉知其中之门户道路。知其门户道路。可以批却导 矣。故本经乃
端本澄源之学。
倪冲之曰。廉泉玉英者。津液之道也。液道不通。则空窍闭塞。而气逆于中矣。故治胀者当先
通其津液。故曰若欲下之。必先举之。朱卫公曰。液者。所以灌精濡空窍者也。其别气出于耳而
为听。宗气上出于鼻而为臭。浊气出于胃。走唇舌而为味。其精阳气。上走于目而为睛。故液道不
通。则诸气皆逆矣。
黄帝曰。愿闻胀形。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。央央
然。腰髀痛。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。胀鸣而痛濯
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。
吴氏曰。此卫气逆于城郭之中。而为脏腑之胀也。愿闻胀形者。问五脏六腑之胀形。始在无形
而及于有形也。
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。谓之夭命。补虚泻实。神归其室。久塞其空。谓之良工。
姚氏曰。其道在一者。谓三合而为一也。逆顺者。谓营行脉中。卫行脉外。相逆顺而为行也。塞
其空者。外无使经脉肤腠疏空。内使脏腑之神气充足。自无厥逆之患矣。此良工治未病也。莫仲
超曰。上节言无问虚实。
工在疾泻。此复曰泻虚补实。神去其室。是又当审其邪正而补泻之。圣人之虑深矣。学人不可不深体之。
王芳侯曰。神者先天之精。水谷之精。两精相抟。合而为神。
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。四时有序。五谷乃化。然后厥气在下。营卫留止。寒气逆上。真邪相攻。
两气相抟。乃合为胀也。
此言卫气逆行。因下焦寒气之所致也。夫卫气之在身也。常然并脉。循于分肉。而行有逆顺。盖
卫气与脉内之营气。相逆顺而行也。阴阳相随者。谓脉外之营卫。相将而行。阴阳清浊。有逆有顺。
乃得天和。应天气之右旋而西转。经水皆归于东流。得天地自然之和气也。五脏更始者。谓营行于
脏腑经脉。外内出入。阴阳递更。终而复始也。四时有序者。谓卫气日行于阳。夜行于阴。应四时
寒暑之往来也。阴阳和平。五谷乃化。而营卫生焉。此先论其阴阳和调。然后论厥逆之因。乃厥气
在下。营卫留止。寒气逆上。真邪相攻。两气相抟。乃合为胀也。
黄帝曰善。何以解惑。岐伯曰。合之于真。三合而得。帝曰善。
真者。所受于天。与谷气并而充身者也。下焦先天之真元。上与阳明相合。化水谷之精微。生此
营卫二气。元真之气。通会于腠理。与营卫合并。而充行于形身者也。故营卫二气。合之于真元。三
合而得其厥逆之因矣。如天真之气。厥逆在下。则营卫之气。留止于上矣。下焦寒水之气上逆。则真
邪相攻。营卫两气相抟。乃合而为胀也。吴氏曰。元真之气。天乙之真元也。与寒水之气相合。故
真邪相抟。则真气反厥于下。而寒气反逆
于上矣。真气不得上合于营卫。则营卫留止矣。
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。岐伯对曰。此言陷于肉肓。而中气穴者也。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。其于胀也。当泻不泻。气故不下。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。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。（肓音荒KT 之忍切与胗同）
此论卫气逆于内而为脏腑之胀者。有城郭募原之分也。募原者。脏腑之膏肓也。夫卫气之逆于
内而为胀者。在于宫城空郭之中。故取之三里。三下而已。今有其三而不下者。此陷于肉肓。而中
气穴故也。故针不中气穴。则气闭于内而不得外出。针不陷肓。则气不行而不能上越。故三而不下
者。必更其道。取之气穴。恶有不下者乎。按气穴有三百六十五以应一岁。即上纪之胃脘。下纪之
关元诸穴。非 谷之会。是以中肉则卫气相乱。阴阳相逐。盖卫气行于皮肤脏腑之肉理。今入于气
穴。故不当取之肉也。姚氏曰。按金匮玉函云。腠者。是三焦通会元真之处。理者。是皮肤脏腑之纹
理也。夫脏腑之纹理。乃脏腑募原之肉理。而肉理之中有脉系。卫气陷于肓膜。而入于脉络。故当取
之气穴也。王芳侯曰。按素问有气府论。气穴论。总属手足三阴三阳之经脉。而分腑与穴者。谓腑者
藏也。压遏血气之藏于内也。穴者窟也。气从此而出入者也。
黄帝说：脉象在寸口部的表现，怎样能反映出胀病？岐伯说：脉象大而坚涩的，就是胀病。黄帝问：怎样知道是脏腑哪一处的胀病呢？
岐伯说：阴经对应脏，阳经对应腑。
这段文字承接上文，论述卫气在形体、脏腑之外内运行，有顺行和逆行两种情况。如果逆乱不顺，在外则表现为脉胀、肤胀；在内则表现为脏腑之胀。寸口脉象坚实大者为阳脉，涩滞者为阴脉。根据脉象的阴阳属性，就可以判断是脏还是腑发生了胀病。
黄帝问：导致人发生胀病的邪气，是在血脉之中呢，还是在脏腑之内呢？岐伯说：这三者（血脉、脏腑、皮肤腠理）都存有邪气，但都不是胀病的根本所在（舍）。
黄帝说：我想听听胀病的根本所在在哪里。岐伯说：所谓的胀病，都发生在脏腑之外，排挤脏腑，扩张胸胁廓，充塞皮肤，所以命名为“胀”。
姚士因说：这种病始于气分，进而影响到脏腑、血脉等有形的部位，所以说三者都存在邪气。然而，胀病的根本所在，在内者，都在脏腑之外的空廓之中；在外者，胀于皮肤腠理之间。所以命名为“胀”，意指胀病在于无形的气分。
黄帝说：脏腑位于胸胁腹里之内，就像匣子柜子里收藏的珍贵器物一样，各有固定的处所，名称不同但同处于一个区域之中，它们的氣机各不相同。我想听听其中的道理。
王芳侯说：黄帝问脏腑位于胸腹之内，如同匣柜所藏的禁器，各有界限。五脏六腑的气机各不相同。现在胀气都位于脏腑之外，如何分别是哪一脏或哪一腑的胀病呢？下文有岐伯回答的缺文。
黄帝说：我还是没理解其中的意思，再请问。岐伯说：胸腹，是脏腑的外廓。膻中，是心包络的宫城。胃，是太仓（储藏水谷的地方）。咽喉和小肠，负责传送。胃的五窍，如同里巷的门户。廉泉和玉英，是津液运行的通道。所以五脏六腑，各有边界，它们的病变也各有不同的形态。
营气循行于经脉之中，卫气逆乱则导致脉胀；卫气与脉并行并渗入分肉之间则导致肤胀。针刺足三里穴进行泻法，病位近的一下针即可，病位远的需下针三次，不论虚实，关键在于迅速泻实。（此处原文可能有误，“膻叶袒”疑为衍文或错简，暂略去不译或视为无关字符）
这段文字论述卫气生于胃腑水谷的精微，白天行于阳分，夜晚行于阴分。若逆乱于阳分，则导致脉胀、肤胀；若逆乱于阴分，则导致空廓之胀及五脏六腑之胀。胸腹是脏腑的外郭，膻中是心主（心包）的宫城。胀病都发生在脏腑之外，排挤脏腑，扩张胸胁。这是卫气逆乱于阴分，将要导致脏腑之胀的表现。胃主受纳水谷，作为太仓居于中焦。在上部连接咽喉，主管传输气体和水谷；在下部连接小肠，主管传送糟粕和津汁。胃的五窍，就像里巷的门户。因为水谷进入胃中，其味分为五类，津液各自走向不同的通道：酸味先入肝，苦味先入心，甘味先入脾，辛味先入肺，咸味先入肾。五脏主要储藏水谷的精微。那些流溢到下焦的津液，从任脉而出，经过廉泉、玉英，以滋润上部的空窍。所以五脏六腑各有边界，其病变也各有形态。例如营气循行于脉中，卫气逆乱于脉中，就导致脉胀；如果卫气并脉而行，散布于分肉之间，就导致肤胀。盖卫气虽然通常并脉循行于分肉，但运行有顺逆之分。如果卫气并脉顺行，却乘袭于脉中，就导致脉胀；行于肤肉，就导致肤胀。这些都是卫气的逆行，所以说“若顺逆也”（意为无论顺逆，只要异常即为病）。应当取足阳明胃经的足三里穴进行泻法。病位在肤脉且较近的，泻一次；病位在脏腑外廓且较远的，泻三次。不论虚实，关键在于迅速泻实。因为如果留滞不去，就会形成脏腑之胀。卫气出于太仓（胃），所以泻胃经的足三里穴。
姚氏说：“营气循脉，卫气逆为脉胀”，与上一章“营气顺脉，卫气逆行”意义相同。吴氏说：卫气逆乱于空廓之中，就导致鼓胀；附着于募原且传送液道阻塞的，就导致肠胃之胀；门户边界不清的，就导致五脏之胀。这些都是胃腑的门户道路，所以要泻足部的足三里穴。如果病程长久已成虚证，再用泻法反而会损伤胃气，所以说“工在疾泻”（指在初期及时泻实）。所谓“疾泻”，是指治疗其初起萌芽阶段。杨元如说：气机逆乱则生长之机逐渐消减，所以时间久了没有不变成虚证的。审查其传送阻塞的予以泻除，门户液道不通的予以疏通，边界不清的予以调理，正气不足的予以补益。补法、泻法、疏理兼用，这才是治疗胀病的良法。如果是新病且不太虚的，急宜攻伐，可以一举而下。朱永年说：医生只知道用泻法来消除胀满，哪里知道其中涉及的门户道路呢？知道了门户道路，就可以像解剖牛体一样批隙导窾（顺着自然结构解决问题）。所以本经是正本清源之学。倪冲之说：廉泉和玉英是津液运行的通道。液道不通，则空窍闭塞，气机逆乱于中。所以治疗胀病应当先通利津液，所以说“若欲下之，必先举之”（想向下通泄，必须先向上宣发/提升）。朱卫公说：液，是用来灌注精髓、濡润空窍的。别气出于耳而表现为听觉，宗气上出于鼻而表现为嗅觉，浊气出于胃，走唇舌而表现为味觉，精阳气上走于目而表现为视觉。所以液道不通，诸气都会逆乱。
黄帝说：我想听听胀病的形态。岐伯说：心胀的病证，心烦短气，睡眠不安。肺胀的病证，胸部虚满而喘咳。肝胀的病证，胁下满痛并牵引小腹。脾胀的病证，经常呃逆，四肢烦扰沉重，身体重得连衣服都穿不动，睡眠不安。肾胀的病证，腹部满闷牵引背部，心中愊愊然不适，腰髀疼痛。六腑胀的病证：胃胀的病证，腹部满闷，胃脘痛，鼻子闻到焦臭味，妨碍进食，大便困难。大肠胀的病证，肠鸣作痛，声音濯濯，冬天再次感受寒邪，就会导致完谷不化的泄泻。小肠胀的病证，小腹胀满，牵引腰部疼痛。膀胱胀的病证，小腹胀满，小便不通畅（气癃）。三焦胀的病证，气充满于皮肤之中，轻轻然但不坚硬。胆胀的病证，胁下痛胀，口中发苦，喜欢叹气。
吴氏说：这是卫气逆乱于城郭（胸腹）之中，而导致的脏腑之胀。“愿闻胀形”，是询问五脏六腑胀病的形态，说明疾病开始于无形之气，进而影响到有形之质。
凡是这些胀病，其道理在于一点。明确知道逆顺的关系，针刺的次数不失误。对于虚证用补法，对于实证用泻法。如果神气离失其室，招致邪气，丧失正气，真气就无法安定。粗疏的医生会导致病情败坏，称之为夭折性命。如果是补虚泻实，使神气回归其室，久久充实其空虚，这就称为良工。
姚氏说：“其道在一”，是指天、地、人三才合而为一。所谓逆顺，是指营气行于脉中，卫气行于脉外，相互逆顺而行。“塞其空”，是指外部不让经脉皮肤腠理疏空，内部使脏腑的神气充足，自然就没有厥逆的祸患了。这是良工治未病的思想。莫仲超说：上一节说“无问虚实，工在疾泻”，这里又说“泻虚补实，神去其室”，这是又要审察邪正关系而进行补泻。圣人的思虑深远啊，学习者不可不深刻体会。王芳侯说：神，是由先天之精和水谷之精，两精相搏合而产生的。
黄帝说：胀病是怎么产生的？有什么原因？岐伯说：卫气在身体里，通常并随经脉，循行于分肉之间，运行有顺有逆。阴阳相随，才能达到天和的状态。五脏功能更替有序，四时变化规律正常，五谷才能消化。然后如果有厥逆之气在下，营卫之气停留停止，寒气逆乱向上，真气和邪气相互攻击，两股气相互搏击，于是结合形成胀病。
这段文字论述卫气逆行，是由于下焦寒气所致。卫气在身体里，通常并随经脉，循行于分肉之间，运行有顺有逆。盖卫气与脉内的营气，是相互逆顺而行的。所谓“阴阳相随”，是指脉外的营卫二气，相伴而行，阴阳清浊，有逆有顺，才能达到天和的状态，顺应天气右旋西转、经水东流的天地自然和气。所谓“五脏更始”，是指营气在脏腑经脉中运行，内外出入，阴阳递更，终而复始。所谓“四时有序”，是指卫气白天行于阳分，夜晚行于阴分，顺应四时寒暑的往来。阴阳平和，五谷才能消化，营卫之气由此产生。这里先论述阴阳调和，然后论述厥逆的原因。即厥气在下，营卫留止，寒气逆上，真邪相攻，两气相抟，于是结合形成胀病。
黄帝说：好。怎样才能解除疑惑？岐伯说：将营卫之气与真元之气相合，三合而得其理。帝曰：好。
真元之气，是禀受于先天，并与水谷之气合并以充养身体的。下焦的先天真元，上与阳明胃气相合，化生水谷的精微，生成营卫二气。元真之气，通会于腠理，与营卫合并，充盛运行于形体周身。所以营卫二气，与真元相合，三合而得到了厥逆的原因。如果天真之气厥逆在下，那么营卫之气就会留止于上。下焦寒水之气上逆，则真邪相攻，营卫两气相抟，于是结合形成胀病。吴氏说：元真之气，是天乙的先天真元。与寒水之气相合，所以真邪相抟时，真气反而厥逆于下，而寒气反而逆乱于上。真气不能上合于营卫，则营卫之气就会留止。
黄帝问岐伯说：《胀论》中说“无问虚实，工在疾泻”，病位近的下一针，远的下三针。现在有下了三针而胀气仍不消退的情况，过错在哪里？岐伯回答说：这是因为针刺陷于肌肉的肓膜，而没有中准穴位。如果不中穴位，气就会在内闭阻；针刺不陷入肓膜层次，气就不能上行发散。如果只刺中肌肉，则卫气混乱，阴阳互相追逐排斥。对于胀病，应当泻而不泻，气所以不能下行。下了三针还不消退，必须改变针刺的方法，气下行后才停止。如果气不下，重新按正确方法施治，可以达到万全，哪里有危险的呢？对于胀病，必须审察KT（同“胗”，诊视/病状），应当泻的就泻，应当补的就补，像鼓槌击鼓那样应声而响，哪有胀气不消退的呢？（注：肓音荒，KT 音忍切，同“胗”）
这段文字论述卫气逆乱于内而导致脏腑之胀，有城郭和募原的区别。募原，是脏腑的膏肓部位。卫气逆乱于内导致胀病，位于宫城空廓之中，所以取足三里穴，下针三次即可。现在有下了三针仍不消退的，是因为针刺陷于肉肓，而中准了气穴（此处逻辑似有矛盾，结合上下文意解：若未中气穴或陷于非穴位之肉肓，则无效。原文意指若操作不当，如陷于肉肓而未中气穴，或中肉而非气穴，则无效。此处译文依原文字面及医理修正理解：若针刺陷于肉肓而未中气穴，或仅中肉而未达气穴，则无效。原文“此陷于肉肓，而中气穴者也”可能是指正确的操作应该是陷于肉肓并中气穴，或者是指之前的错误在于陷于肉肓但未中气穴。根据后文“不中气穴...针不陷肓...故当取之气穴”，推测前句意为：现在的失败是因为（之前）陷于肉肓（非穴位深层）且未中气穴，或者是指正确的治法应是针对陷于肉肓的病位，选取气穴。鉴于原文“此言陷于肉肓，而中气穴者也”语意稍显晦涩，结合下文解释，理解为：此段讲的是针对病在肉肓的情况，应当中取气穴。若未中气穴...）。故如果不中穴位，气就在内闭阻；针刺不深入至肓膜层次，气就不能上行发散。如果只刺中肌肉，卫气就会混乱，阴阳互相追逐。对于胀病，应当泻而不泻，气所以不能下行。下了三针还不消退，必须改变其道，取气穴，哪有不下行的呢？据考，气穴有三百六十五个以应一岁，如上纪的胃脘穴，下纪的关元穴等，并非仅仅是水谷之会。所以如果只刺中肌肉，卫气就会混乱，阴阳互相追逐。盖卫气行于皮肤脏腑的纹理之间，现在要进入气穴，所以不应当只取肌肉部分。姚氏说：据《金匮玉函》记载，腠，是三焦通会元真的地方；理，是皮肤脏腑的纹理。脏腑的纹理，就是脏腑募原的肉理，而肉理中有脉系。卫气陷于肓膜，而入于脉络，所以应当取气穴。王芳侯说：据《素问》有《气府论》、《气穴论》，总属手足三阴三阳的经脉。区分腑与穴，谓腑是藏蓄之处，压抑血气于内；穴是窟窿，气从此出入。
Huangdi said: How do the pulse manifestations at the Cun Kou (inch position) reflect distension? Qibo replied: A pulse that is large, firm, and choppy indicates distension. Huangdi asked: How can one determine which Zang or Fu organ is affected by distension?
Qibo replied: Yin meridians correspond to Zang organs, and Yang meridians correspond to Fu organs.
This passage continues from the previous text, discussing the circulation of Wei Qi (Defensive Qi) inside and outside the body and organs, which can be either smooth or reversed. If the flow is not smooth, it manifests externally as Mai Distension (distension of the vessels) or Fu Distension (distension of the skin); internally, it manifests as distension of the Zang or Fu organs. At the Cun Kou, a firm and large pulse is a Yang pulse, while a choppy pulse is a Yin pulse. By observing the Yin-Yang nature of the pulse, one can determine whether the distension involves a Zang or a Fu organ.
Huangdi asked: Does the pathogenic Qi causing distension reside in the blood vessels, or within the Zang and Fu organs? Qibo replied: Pathogenic factors exist in all three locations (vessels, organs, and skin/subcutaneous tissue), but these are not the primary seat (She) of distension.
Huangdi said: I wish to hear where the primary seat of distension lies. Qibo replied: Distension occurs outside the Zang and Fu organs, compressing them, expanding the chest and hypochondrium, and filling the skin. Therefore, it is named "Distension."
Yao Shiyin stated: This disease originates in Qi and subsequently affects the tangible aspects of Zang/Fu organs and blood vessels; thus, factors exist in all three areas. However, the primary seat of distension, when internal, lies in the empty spaces outside the Zang and Fu organs; when external, it lies between the skin and interstices. Hence, it is called "Distension," indicating that distension resides in the formless Qi aspect.
Huangdi said: The Zang and Fu organs are located within the chest, hypochondrium, and abdomen, like precious artifacts stored in boxes and cabinets. Each has its specific location, different names, yet they share the same region while having distinct Qi dynamics. I wish to understand the reason behind this.
Wang Fanghou noted: Huangdi asks how to distinguish which Zang or Fu organ is distended when the distending Qi is located outside the organs, given that each organ has boundaries and distinct Qi. There appears to be missing text in Qibo's subsequent response.
Huangdi said: I still do not understand. Please explain further. Qibo replied: The chest and abdomen are the outer walls (Guo) of the Zang and Fu organs. Dan Zhong (Chest Center) is the palace city of the Heart Master (Pericardium). The Stomach is the Great Granary (Tai Cang). The pharynx and small intestine are responsible for transmission. The five orifices of the stomach are like the gates of neighborhoods. Lian Quan and Yu Ying are the pathways for Body Fluids. Thus, the Zang and Fu organs have distinct boundaries, and their diseases present with specific shapes/symptoms.
Ying Qi (Nutritive Qi) circulates within the vessels. When Wei Qi rebels, it causes Mai Distension. When Wei Qi moves along with the vessels and permeates the muscle intervals, it causes Fu Distension. One should needle San Li (ST36) using the reducing method. For conditions close to the surface, one needling suffices; for distant conditions, three needleings are required. Regardless of deficiency or excess, the key for the skilled practitioner is rapid reduction.
This section explains that Wei Qi is generated from the essence of water and grain in the Stomach. It travels through the Yang during the day and the Yin at night. Rebellion in the Yang leads to Mai Distension and Fu Distension; rebellion in the Yin leads to distension of the empty spaces and the Zang/Fu organs. The chest and abdomen are the outer walls of the organs; Dan Zhong is the palace of the Heart Master. Distension occurs outside the organs, compressing them and expanding the chest/hypochondrium. This represents Wei Qi rebelling in the Yin, leading to organ distension. The Stomach receives and stores water and grain, acting as the Great Granary in the Middle Jiao. Superiorly, it connects to the pharynx, transmitting Qi and food; inferiorly, it connects to the small intestine, transmitting waste and fluids. The five orifices of the stomach are like neighborhood gates. Since food enters the stomach and has five flavors, Body Fluids follow different paths: sourness enters the Liver first, bitterness the Heart, sweetness the Spleen, pungency the Lung, and saltiness the Kidney. The Zang organs store the essence of water and grain. The fluids overflowing into the Lower Jiao exit via the Ren Mai through Lian Quan and Yu Ying to moisten the upper orifices. Thus, the Zang and Fu organs have boundaries, and their diseases manifest differently. For instance, if Ying Qi circulates in the vessels and Wei Qi rebels within them, Mai Distension occurs. If Wei Qi accompanies the vessels and spreads into the muscle intervals, Fu Distension occurs. Although Wei Qi usually travels with the vessels through the muscles, its movement can be smooth or rebellious. If it travels smoothly with the vessels but invades the vessel interior, it causes Mai Distension; if it travels in the flesh, it causes Fu Distension. These are all reversals of Wei Qi. Therefore, one should reduce ST36 on the Foot Yangming Meridian. For superficial/distal conditions near the skin/vessels, one reduction suffices; for deeper/distant conditions in the "walls" (organs), three reductions are needed. Regardless of deficiency or excess, the skilled practitioner acts quickly to reduce. Retention of Qi leads to organ distension. Since Wei Qi originates from the Great Granary (Stomach), reducing ST36 is indicated.
Yao stated: "Ying Qi circulates in the vessels; Wei Qi rebellion causes Mai Distension" shares the same meaning as the previous chapter's "Ying Qi follows the vessels smoothly; Wei Qi moves in reverse." Wu stated: When Wei Qi rebels in the empty spaces, it causes Drum Distension (Gu Zhang); when it adheres to the Mu Yuan (Omenta/Mesentery) and blocks fluid transmission, it causes Intestinal/Stomach Distension; when the gates and boundaries are unclear, it causes Zang Distension. These are all pathways of the Stomach Fu, hence reducing foot ST36 is indicated. If the disease has become chronic and deficient, reducing again would damage Stomach Qi; thus, "the skilled practitioner acts quickly to reduce" refers to treating the initial stage. Yang Yuanru stated: Reversal gradually diminishes the mechanism of growth, so long-standing cases inevitably become deficient. One must examine blockages in transmission and reduce them; unblock blocked gates and fluid pathways; regulate unclear boundaries; tonify insufficient Zheng Qi. Combining tonification, reduction, and regulation is the excellent method for treating distension. For new-onset distension without severe deficiency, aggressive attack is urgent, potentially resolving it in one strike. Zhu Yongnian stated: Physicians only know to reduce to eliminate distension, ignoring the gates and pathways. Understanding these allows one to dissect according to natural structures. Thus, this classic is about addressing the root and clearing the source. Ni Chongzhi stated: Lian Quan and Yu Ying are fluid pathways. Blockage here closes the orifices and causes Qi reversal. Therefore, treating distension requires first unblocking fluids, hence "If you wish to drain downwards, you must first lift upwards." Zhuweigong stated: Fluids nourish essence and moisten orifices. Branch Qi exits the ears for hearing; Zong Qi (Gathering Qi) exits the nose for smell; Turbid Qi exits the stomach for taste via lips/tongue; Essence-Qi ascends to the eyes for vision. If fluid pathways are blocked, all Qi becomes rebellious.
Huangdi said: I wish to hear the forms of distension. Qibo replied: In Heart Distension, there is mental restlessness, shortness of breath, and disturbed sleep. In Lung Distension, there is false fullness, wheezing, and coughing. In Liver Distension, there is fullness and pain under the hypochondrium radiating to the lower abdomen. In Spleen Distension, there is frequent hiccups, irritability and heaviness in the four limbs, body weight such that even clothes feel burdensome, and disturbed sleep. In Kidney Distension, there is abdominal fullness radiating to the back, a feeling of oppression (Ai Ai Ran), and pain in the waist and thighs. Regarding Fu Distension: In Stomach Distension, there is abdominal fullness, epigastric pain, smelling burnt odors from the nose, difficulty eating, and difficult defecation. In Large Intestine Distension, there is borborygmus and pain (Zhuo Zhuo sound); if exposed to cold in winter, it leads to undigested diarrhea. In Small Intestine Distension, there is lower abdominal distension radiating to the waist and pain. In Bladder Distension, there is lower abdominal fullness and urinary retention (Qi Long). In San Jiao Distension, Qi fills the skin, feeling light but not hard. In Gallbladder Distension, there is painful distension under the hypochondrium, bitter taste in the mouth, and frequent sighing.
Wu stated: This describes Wei Qi rebelling within the "city walls" (chest/abdomen), causing organ distension. "Wishing to hear the forms" asks about the manifestations of Zang/Fu distension, showing the progression from formless Qi to tangible pathology.
For all these distensions, the principle lies in one point: clearly understanding reversal and smoothness, and applying acupuncture counts accurately. Tonify deficiency and reduce excess. If Shen (Spirit) leaves its chamber, it招致邪气 (attracts pathogens) and loses righteousness, making the true Qi unstable. A crude physician’s failure is called premature death. Conversely, tonifying deficiency and reducing excess allows Shen to return to its chamber and fills the emptiness; this is called a skilled artisan.
Yao stated: "The principle lies in one" means the harmony of Heaven, Earth, and Humanity. "Reversal and smoothness" refers to Ying Qi moving in the vessels and Wei Qi moving outside, interacting in reverse and smooth patterns. "Filling the emptiness" means preventing external疏空 (looseness/emptiness) of vessels and skin, and ensuring internal abundance of Zang/Fu Shen Qi, thereby avoiding reversal disorders. This is the skilled artisan’s prevention of disease. Mo Zhongchao noted: The previous section said "regardless of deficiency/excess, act quickly to reduce"; this section says "reduce deficiency, tonify excess, Shen leaves its chamber." This implies one must assess pathogen vs. righteous Qi before tonifying/reducing. The Sage’s foresight is profound; students must deeply comprehend this. Wang Fanghou stated: Shen is formed by the interaction of congenital essence and food essence.
Huangdi asked: How does distension arise? What is the cause? Qibo replied: Wei Qi in the body usually travels with the vessels and through the muscle intervals, with movement being either smooth or reversed. When Yin and Yang follow each other, Harmony with Heaven is achieved. The Five Zang organs function in rotation, the Four Seasons follow order, and grains are digested. However, if Jue Qi (Rebellious Qi) arises below, Ying and Wei Qi stagnate, Cold Qi rebels upward, True Qi and Pathogenic Qi attack each other, and the two Qi types clash, resulting in distension.
This section explains that Wei Qi reversal is caused by Cold Qi in the Lower Jiao. Wei Qi usually travels with vessels through muscles, with smooth or reversed movement. "Yin and Yang following each other" means Ying and Wei outside the vessels move together; Yin/Yang and Clear/Turbid have smooth or reversed flows, achieving Heavenly Harmony, mirroring the sky’s rotation and rivers’ flow. "Five Zang organs rotating" means Ying Qi circulates through organ meridians, entering/exiting, cycling endlessly. "Four Seasons orderly" means Wei Qi travels Yang by day and Yin by night, responding to seasonal changes. When Yin/Yang are peaceful, grains digest, and Ying/Wei are generated. This first discusses Yin/Yang harmony, then the cause of reversal: Jue Qi below, stagnation of Ying/Wei, upward rebellion of Cold, clash of True/Pathogenic Qi, leading to distension.
Huangdi said: Excellent. How can confusion be resolved? Qibo replied: By combining [Ying, Wei, and Zhen] Qi, the triad yields the answer. Emperor said: Excellent.
Zhen Qi (True Qi) is received from Heaven and combined with Grain Qi to nourish the body. The congenital Zhen Yuan of the Lower Jiao combines with Yangming (Stomach/Large Intestine) to transform grain essence into Ying and Wei Qi. Yuan Zhen Qi communicates through the Cou Li (interstices), merges with Ying/Wei, and circulates throughout the body. Thus, Ying and Wei Qi combine with Zhen Yuan, and the triad reveals the cause of reversal. If Tian Zhen Qi rebels downward, Ying/Wei Qi stagnates upward. If Lower Jiao Cold Water Qi rebels upward, True and Pathogenic Qi clash, and Ying/Wei Qi combats, resulting in distension. Wu stated: Yuan Zhen Qi is the primordial essence of Heaven. Combined with Cold Water Qi, when True and Pathogenic Qi clash, True Qi rebels downward and Cold Qi rebels upward. True Qi cannot combine with Ying/Wei, causing stagnation.
Huangdi asked Qibo: The Treatise on Distension states "regardless of deficiency/excess, act quickly to reduce," needing one needling for close conditions and three for distant ones. Now, if three needleings fail to resolve distension, where is the error? Qibo replied: This occurs when the needle sinks into the Muscular Huang (Blind Tissue) but misses the Qi Acupoint. If the Qi Acupoint is missed, Qi closes internally. If the needle does not sink into the Huang layer, Qi cannot ascend and disperse. If only muscle is pierced, Wei Qi becomes chaotic, and Yin/Yang chase each other. For distension, if reduction is indicated but not applied, Qi will not descend. If three needleings fail, one must change the approach. Once Qi descends, stop. If it doesn't descend, restart correctly. This ensures safety; danger is unlikely. For distension, one must examine the condition (Zhen). Reduce if indicated, tonify if indicated. Like a drum responding to a beat, how could distension remain unresolved? (Note: Huang sounds like 'huang'; KT is pronounced 'ren', same as 'Zhen').
This section discusses distension caused by Wei Qi reversing internally, distinguishing between City Walls and Mu Yuan (Omenta). Mu Yuan is the Huang/Gao of the organs. Distension due to internal Wei Qi reversal lies in the empty spaces of the palace/city walls, so ST36 is used, requiring three needleings. If three needleings fail, it is because the needle sank into muscular Huang without hitting the Qi Acupoint, or hit muscle instead of acupoint. If the acupoint is missed, Qi closes internally. If the Huang layer is not reached, Qi cannot ascend. Thus, if three needleings fail, change the method to target Qi Acupoints. There are 365 Qi Acupoints corresponding to the year, such as Wei Wan (Upper Ji) and Guan Yuan (Lower Ji), which are not merely gatherings of grain. Piercing only muscle causes Wei Qi chaos and Yin/Yang conflict. Wei Qi travels in skin/flesh textures; now targeting Qi Acupoints, one should not just pierce muscle. Yao stated: According to *Jin Gui Yu Han*, Cou (pores) are where San Jiao communicates Yuan Zhen; Li (textures) are skin/flesh patterns. Organ textures are the fleshy layers of Mu Yuan, containing vessel systems. Since Wei Qi sinks into Huang membranes and enters vessels, Qi Acupoints must be targeted. Wang Fanghou stated: *Su Wen* has chapters on Qi Fountains and Qi Acupoints, covering all Six Yin/Yang meridians. Distinguishing Fu and Acupoints: Fu stores and suppresses Blood/Qi internally; Acupoints are cavities where Qi enters and exits.