寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

Distension

Changman

한글 창만  ·  Pinyin Zhang Man

A belly hard outside and hollow within — the seven distensions, and a disease the chapter calls a true-viscus disease

脹滿

The gravest of the three chapters in this volume, and the one the other two keep pointing at. Accumulations says at 1.7.9 that once tense distension has formed, no physician can help; Oedema says at 2.1.8 that swelling is the lighter of the two and distension the graver. Here the case is set out from the inside. Danxi's opening passage gives the mechanism — the spleen's yin damaged, clear and turbid mixed, the passages blocked, damp and heat engendering each other until the belly is firm outside and hollow within like a drum, and being hard to treat is also called gu, as though something were eating it away. The chapter then sorts what follows twice over: 3.4 defines seven distensions by their signs, and 3.5 answers the same seven with formulas, in a different order. Against all of it stands 3.9, which names distension a true-viscus disease alongside stomach reflux and taxation consumption — and then closes by asking whether a person with a disease may therefore go without medicine, and whether they may do without a physician.

3.1 The Source of Distension and Fullness 脹滿之源

3.1.1
Source원문

帝曰, 脹者焉生, 何因而有. 岐伯曰, 衛氣之在身也, 常然幷脉, 循分肉, 行有逆順. 陰陽相隨, 乃得天和, 五藏更始, 四時有序, 五穀乃化. 然後厥氣在下, 榮衛留止, 寒氣逆上, 眞邪相攻, 兩氣相搏, 乃合爲脹也. 榮氣循脉, 衛氣逆爲脉脹, 衛氣幷脉循分爲膚脹. 《靈樞》

Translation영역
The Yellow Emperor said: how does distension arise, and from what cause does it come to be? Qi Bo said: the defence qi in the body constantly runs alongside the vessels and follows the partings of the flesh, travelling now with the current and now against it. When yin and yang follow one another, the harmony of heaven is obtained, the five viscera begin again in turn, the four seasons keep their order, and the five grains are transformed. But when reversal qi lies below and the construction and defence lodge and stay, cold qi counterflows upward; the true and the evil attack one another, the two qi contend, and joining they become distension. Where the construction qi follows the vessels and the defence qi counterflows, it is vessel distension; where the defence qi runs alongside the vessels and follows the partings of the flesh, it is skin distension.
Clinical note임상 주석
The Lingshu's account, and it locates distension in the defence qi rather than in any organ. The two kinds named at the end are distinguished by where the defence qi goes wrong — in the vessels or in the flesh — which is a different axis from the seven distensions the chapter sets out at 3.4.

Yeongchu 靈樞

3.1.2
Source원문

凡人七情內傷, 六淫外侵, 飮食失節, 房勞致虛, 脾土之陰受傷, 轉輸之官失職, 胃受水穀不能運化. 故陽自升陰自降, 而成天地不交之否. 於是淸濁相混, 隧道壅塞, 氣化濁血瘀鬱爲熱, 熱留而久, 氣化成濕, 濕熱相生, 遂成脹滿. 經曰, 鼓脹, 是也. 以其外雖堅滿, 中空無物, 有似乎鼓. 其病膠固, 難以治療, 故又名曰蠱, 若蟲侵蝕, 有蠱之義. 《丹心》

Translation영역
When the seven affects damage within, the six excesses invade without, food and drink lose their measure, and sexual taxation brings on vacuity, the yin of the spleen earth is damaged, the office of conveyance and transport fails in its charge, and the stomach receives water and grain but cannot move and transform them. Thus yang rises of itself and yin descends of itself, and there comes about the stagnation in which heaven and earth do not communicate. Then clear and turbid are mixed together, the tunnels are blocked and stopped, the qi turns turbid and the blood stagnates and is depressed into heat; the heat lodging long, the qi turns to damp, and damp and heat engender one another, so that distension and fullness are formed. The classic calls it drum distension, and this is it — for though it is firm and full without, it is hollow and empty within, having the likeness of a drum. The disease is gluey and fixed and hard to treat, and so it is also called gu, as though insects were eating into it; that is the sense of gu.
Clinical note임상 주석
The chapter's definitional passage. Two names are given and each carries an image: drum distension because the belly is hard outside and hollow within, gu because the disease is fixed and will not shift, as though something were eating it from inside. 天地不交之否 is the twelfth hexagram, stagnation — heaven above and earth below, each moving away from the other so that nothing passes between. The formula at 3.7.3 is named for the eleventh hexagram, its opposite, and aims at exactly this.

Dansim 丹心

3.1.3
Source원문

飮食不節, 起居不時者, 陰受之, 陰受之則入五藏, 入五藏則䐜滿閉塞. 《內經》

Translation영역
Where food and drink are not regulated and activity and rest keep no hours, the yin receives it; the yin receiving it, it enters the five viscera, and entering the five viscera there is distension and fullness with blockage and closure.

Naegyeong 內經

3.1.4
Source원문

濁氣在上, 則生䐜脹. 註曰, 濁氣, 謂寒氣也. 寒氣在上, 聚而不散, 則成脹. 《內經》

Translation영역
When turbid qi is above, distension is engendered. The commentary says: turbid qi means cold qi. Cold qi being above, it gathers and does not disperse, and so distension is formed.
Clinical note임상 주석
The passage the whole of 3.7 is built on. Turbid qi above is not merely a location but an inversion — what should have descended has risen — and the formulas there treat it by raising the clear rather than by attacking the fullness.

Naegyeong 內經

3.1.5
Source원문

足太陰之脉, 病腹脹, 足陽明之脉, 病亦腹脹. 《靈樞》

Translation영역
When the vessel of the foot greater yin is diseased there is abdominal distension; when the vessel of the foot yang brightness is diseased there is likewise abdominal distension.

Yeongchu 靈樞

3.1.6
Source원문

太陰所至爲畜滿. 脾爲陰中之太陰, 無陽則不能化五穀, 乃大寒爲脹滿. 故脉經云, 胃中寒則脹滿, 此之謂也. 《東垣》

Translation영역
Where the greater yin arrives there is storing and fullness. The spleen is the greater yin within yin; without yang it cannot transform the five grains, and great cold then becomes distension and fullness. Hence the Maekgyeong says that cold in the stomach brings distension and fullness — this is what is meant.

Dongwon 東垣

3.1.7
Source원문

凡脹初起是氣, 久則成水. 治比水腫更難. 盖水腫飮食如常, 鼓脹飮食不及常. 病根深痼, 必三五年而後成. 治腫, 惟補中行濕足矣. 治脹, 必補中行濕, 兼以消導. 更斷鹽醬音樂妄想, 不責速效, 乃可萬全. 《入門》

Translation영역
In distension generally, at its first arising it is qi; left long, it becomes water. To treat it is harder than to treat water swelling. For in water swelling food and drink are as usual, while in drum distension food and drink fall short of the usual. The root of the disease is deep and fixed, and three or five years must pass before it is formed. To treat swelling, supplementing the centre and moving damp is enough. To treat distension, one must supplement the centre and move damp and disperse and conduct besides. Further, salt and soy, music and idle fancies must be cut off, and a quick result must not be demanded — then all may be made whole.
Clinical note임상 주석
The passage that sets this chapter against the one before it, and the distinguishing sign is simple and usable: in oedema the patient eats normally, in drum distension they do not. What follows is a statement about time. The root is deep and fixed, three to five years in forming, and a quick result must not be demanded. The prohibitions go beyond diet — salt and soy, but also music and idle fancies — which places this among the conditions the chapter treats as arising from the whole manner of a life rather than from an insult.

Immun 入門

3.2 The Forms and Patterns of Distension 脹滿形證

3.2.1
Source원문

中滿腹脹者, 其面目四肢不腫, 而腹肚脹起, 中空似鼓者, 是也. 《醫鑑》

Translation영역
In central fullness with abdominal distension, the face and eyes and the four limbs do not swell, while the belly rises distended, hollow within like a drum — this is it.

Uigam 醫鑑

3.2.2
Source원문

臍腹四肢悉腫者, 爲水. 但腹脹, 四肢不甚腫者爲蠱, 蠱卽脹也. 《本事》

Translation영역
Where navel, abdomen and the four limbs all swell, it is water. Where the abdomen alone is distended and the four limbs are not much swollen, it is gu; and gu is distension.
Clinical note임상 주석
The single most useful distinction in the chapter, stated twice over in two passages: if the limbs swell with the belly it is oedema, if the belly swells alone it is distension. The Oedema chapter gives the same rule from its side at 2.1.8.

Bonsa 本事

3.2.3
Source원문

腹滿䐜脹, 支膈胠脇, 下厥上冒, 過在足太陰陽明. 《內經》

Translation영역
Abdominal fullness and distension, propping at the diaphragm and the flanks and ribside, reversal below and clouding above — the fault lies in the foot greater yin and yang brightness.

Naegyeong 內經

3.2.4
Source원문

脹有虛實. 虛脹, 陰寒爲邪, 吐利不食, 時脹時減, 按之則陷而軟.

Translation영역
Distension may be vacuous or replete. In vacuity distension the evil is yin cold: there is vomiting and diarrhoea with no appetite, the distension comes and goes, and pressing it sinks in and is soft.

Immun 入門

3.2.5
Source원문

實脹, 陽熱爲邪, 身熱咽乾, 常脹內痛, 按之不陷而硬. 《入門》

Translation영역
In repletion distension the evil is yang heat: the body is feverish and the throat dry, the distension is constant with pain within, and pressing it does not sink in but is hard.
Clinical note임상 주석
A two-way test done with the hand. Press the belly: if it sinks and is soft the distension is vacuous and cold, if it resists and is hard it is replete and hot. The pair of signs that go with each — vomiting and diarrhoea against fever and dry throat, intermittent against constant — confirm what the hand finds. This is the chapter's most practical passage and it governs the whole formulary. Vacuity distension gets aconite and dry ginger at 3.5.5; repletion distension gets rhubarb and coptis at 3.5.6.

Immun 入門

3.2.6
Source원문

腹滿, 按之不痛爲虛. 痛者爲實, 可下之.

Translation영역
In abdominal fullness, pressing without pain is vacuity; where there is pain it is repletion and may be purged.

Junggyeong 仲景

3.2.7
Source원문

腹脹時減, 復如故, 此爲寒, 宜溫之.

Translation영역
Where abdominal distension lessens at times and then returns as before, this is cold and should be warmed.

Junggyeong 仲景

3.2.8
Source원문

腹滿不減, 減不足言, 須當下之. 《仲景》

Translation영역
Where abdominal fullness does not lessen, or lessens so little as not to be worth speaking of, it must be purged.
Clinical note임상 주석
Zhongjing's three lines add a second test to the one above. Pressure distinguishes soft from hard; time distinguishes intermittent from constant. A distension that eases and returns is cold and warmed; one that never eases is repletion and purged. 減不足言 — lessening so little as not to be worth speaking of — is the kind of clinical qualification that makes the rule usable rather than absolute.

Junggyeong 仲景

3.3 Pulse Method 脉法

3.3.1
Source원문

其脉大堅而濇者, 脹也. 《靈樞》

Translation영역
A pulse large, firm and rough indicates distension.

Yeongchu 靈樞

3.3.2
Source원문

脉盛而緊, 曰脹. 《內經》

Translation영역
A pulse exuberant and tight is called distension.

Naegyeong 內經

3.3.3
Source원문

脹滿脉弦脾制於肝, 洪數熱脹遲弱陰寒, 浮爲虛滿緊則中實, 浮則可治虛則危急. 《脉決》

Translation영역
In distension and fullness a wiry pulse means the spleen is restrained by the liver; surging and rapid, heat distension; slow and weak, yin cold. Floating indicates vacuity fullness, tight indicates repletion within. Floating may be treated; vacuous is dangerous and urgent.

Maekgyeol 脉決

3.3.4
Source원문

關上脉虛, 則內脹.

Translation영역
When the pulse at the bar is vacuous, there is distension within.

Jeongjeon 正傳

3.3.5
Source원문

遲而滑者, 脹.

Translation영역
Slow and slippery indicates distension.

Jeongjeon 正傳

3.3.6
Source원문

虛而緊澁者, 脹.

Translation영역
Vacuous with tightness and roughness indicates distension.

Jeongjeon 正傳

3.3.7
Source원문

或弦而遲, 或浮而數, 皆脹也. 《正傳》

Translation영역
Whether wiry and slow or floating and rapid, both are distension.

Jeongjeon 正傳

3.3.8
Source원문

諸氣脹滿, 浮大可療, 虛小難保. 《得效》

Translation영역
In all qi distension and fullness, a floating large pulse may be cured; vacuous and small is hard to preserve.
Clinical note임상 주석
The same prognostic rule that closes the pulse sections of the two chapters before this one: a strong pulse in a distended patient can be treated, a weak one cannot. Accumulations states it at 1.4 and Oedema at 2.4, and all three place it last. What is added here is the wiry pulse read as the liver restraining the spleen — a mechanism rather than a prognosis, and the one that justifies bupleurum appearing in so many of this chapter's formulas.

Deukhyo 得效

3.4 The Seven Distension Diseases 脹病有七

3.4.1
Source원문

夫脹者, 皆在于藏府之外, 排藏府而郭胸脇, 脹皮膚, 故命名脹. 《靈樞》

Translation영역
Distension in every case lies outside the viscera and bowels: it pushes the viscera and bowels aside, walls in the chest and ribside, and distends the skin — and so it is named distension.
Clinical note임상 주석
The anatomical definition, and it is precise. The fullness is not within any organ but in the space around them, pressing them aside. That is ascites described from the outside.

Yeongchu 靈樞

3.4.2
Source원문

脹有寒脹ㆍ熱脹ㆍ穀脹ㆍ水脹ㆍ氣脹ㆍ血脹ㆍ蠱脹.

Translation영역
Distension comprises cold distension, heat distension, grain distension, water distension, qi distension, blood distension and gu distension.

Hoechun 回春

3.4.3
Source원문

脹病, 亦謂鼓脹.

Translation영역
Distension disease is also called drum distension.

Hoechun 回春

3.4.4
Source원문

其脇痛面黑, 是氣鼓.

Translation영역
Where the ribside is painful and the complexion black, it is qi drum.

Hoechun 回春

3.4.5
Source원문

脇滿, 小腹脹滿, 身上有血絲縷, 是血鼓.

Translation영역
Where the ribside is full, the lower abdomen distended and full, and there are threads of blood on the body, it is blood drum.
Clinical note임상 주석
身上有血絲縷 — threads of blood on the body — are spider naevi and dilated surface veins, and together with a distended abdomen and ribside fullness they point to portal hypertension. The Accumulations chapter records the abdominal version of the same sign at 1.12.7, where green sinews on the belly are listed among the signs that cannot be treated.

Hoechun 回春

3.4.6
Source원문

噯氣作酸, 飽悶腹脹, 是食鼓.

Translation영역
Where there is belching with sourness, oppressive fullness and abdominal distension, it is food drum.

Hoechun 回春

3.4.7
Source원문

惡寒, 手足厥冷, 瀉去淸水, 是水鼓.

Translation영역
Where there is aversion to cold, reverse-cold of the hands and feet, and clear water passed in the stool, it is water drum.

Hoechun 回春

3.4.8
Source원문

胸腹脹滿, 有塊如鼓者, 是痞散成鼓. 《回春》

Translation영역
Where the chest and abdomen are distended and full and there is a lump like a drum, it is glomus scattered and become drum.
Clinical note임상 주석
Five drums named by their accompanying signs, each identifiable at the bedside: black complexion and ribside pain for qi, blood threads for blood, sour belching for food, cold extremities and watery stool for water, and a palpable lump for glomus turned to drum. 痞散成鼓 is the one that connects this chapter to the Accumulations chapter directly — a glomus lump that has spread until the whole belly is drum-like. That is the progression Accumulations warns of at 1.7.9.

Hoechun 回春

3.4.1 Cold Distension 寒脹

3.4.1.1
Source원문

寒脹者, 腹滿濡, 時減, 吐利厥冷, 宜溫之. 《得效》

Translation영역
In cold distension the abdomen is full but yielding, lessening at times, with vomiting and diarrhoea and reverse-cold; it should be warmed.
Clinical note임상 주석
The six subsections that follow each define one distension in a single passage. Cold distension is the vacuity distension of 3.2.4 under another name — soft to the hand, intermittent, with cold signs — and the formulas for it are at 3.5.5.

Deukhyo 得效

3.4.2 Heat Distension 熱脹

3.4.2.1
Source원문

熱脹者, 以陽幷陰, 則陽實陰虛, 陽盛生外熱, 陰虛生內熱, 脉必浮數, 浮則爲虛, 數則爲熱. 陰虛不能宣導, 飮食如故, 腹中脹滿者, 爲熱脹. 《得效》

Translation영역
In heat distension, yang joins with yin so that yang is replete and yin vacuous; yang exuberant engenders heat without, yin vacuous engenders heat within. The pulse must be floating and rapid — floating indicating vacuity, rapid indicating heat. The yin being vacuous cannot diffuse and conduct; food and drink are as usual and the abdomen is distended and full — this is heat distension.
Clinical note임상 주석
飮食如故 — food and drink as usual — is the detail that matters. The chapter states at 3.1.7 that in drum distension the appetite falls short; where it does not, and the belly is distended with heat signs, the case is less grave. That is consistent with 3.12, where appetite preserved is among the favourable signs.

Deukhyo 得效

3.4.3 Grain Distension 穀脹

3.4.3.1
Source원문

失飢傷飽, 痞悶停酸, 朝則陰消陽長, 穀氣易行, 故能食, 暮則陰長陽消, 穀氣難化, 故不能食, 是爲穀脹.

Translation영역
Missing meals and then damaging by surfeit, with glomus oppression and sour matter standing: in the morning the yin wanes and the yang waxes, the grain qi travels easily and so the patient can eat; in the evening the yin waxes and the yang wanes, the grain qi is hard to transform and so they cannot eat. This is grain distension.
Clinical note임상 주석
The diurnal pattern is the diagnosis: able to eat in the morning, unable by evening. The Suwen's rule that yang waxes with the day and yin with the night is applied to digestion, and the result is a description of delayed gastric emptying that anyone could verify by asking. The formula at 3.5.1.1 states the same sign in its indication — food eaten in the morning cannot be eaten again at evening.

Jikji 直指

3.4.4 Water Distension 水脹

3.4.4.1
Source원문

脾土受濕, 水漬於腸胃而溢於皮膚, 漉漉有聲, 怔忪喘息, 是爲水脹. 《直指》

Translation영역
The spleen earth receives damp, water soaks into the intestines and stomach and spills over into the skin, there is a gurgling sound, and throbbing of the heart with panting breath. This is water distension.
Clinical note임상 주석
漉漉有聲 is the audible fluid the Phlegm-Rheum chapter describes at 6.4.3 and the Oedema chapter at 2.14.15 — a succussion splash. Of the seven distensions this is the one that overlaps most with the previous chapter, and the formulas at 3.5.2 are diuretics.

Jikji 直指

3.4.5 Qi Distension 氣脹

3.4.5.1
Source원문

七情鬱結, 氣道壅塞, 上不得降, 下不得升, 身體腫大, 四肢瘦削, 是爲氣脹. 《直指》

Translation영역
The seven affects depressed and bound, the qi pathways blocked and stopped, what is above unable to descend and what is below unable to rise, the body swollen large and the four limbs wasted away. This is qi distension.
Clinical note임상 주석
身體腫大, 四肢瘦削 — the body swollen large and the limbs wasted — is the shape the chapter calls spider gu at 3.5.7.3, and there it is named the end stage. Here it defines a category rather than a prognosis, which is a reminder that the seven are stages as much as kinds.

Jikji 直指

3.4.6 Blood Distension 血脹

3.4.6.1
Source원문

煩燥漱水, 迷忘驚狂, 痛悶嘔逆, 小便多大便黑, 婦人多有之, 是爲血脹. 《直指》

Translation영역
Vexation and agitation with rinsing the mouth without swallowing, confusion and forgetfulness, fright and mania, painful oppression and retching counterflow, copious urine and black stool — women commonly have it. This is blood distension.
Clinical note임상 주석
Two signs here are worth carrying. 漱水 — rinsing the mouth without swallowing — is the classical marker of blood stasis rather than true thirst, and the formula at 3.5.4.2 names it in its indication. Black stool is melaena, which in a patient with a distended abdomen and spider naevi completes a picture of variceal bleeding on portal hypertension. Confusion, forgetfulness and mania alongside them would now be read as hepatic encephalopathy. The passage gathers into one category signs that belong together for reasons the tradition could not state. **Black stool is a medical emergency requiring immediate assessment.**

Jikji 直指

3.5 The Treatment Method for Distension and Fullness 脹滿治法

3.5.1
Source원문

適寒涼者脹, 下之則脹已. 《內經》

Translation영역
Those who take to cold and cool things become distended; purge them and the distension ends.

Naegyeong 內經

3.5.2
Source원문

中滿者, 瀉之于內. 《內經》

Translation영역
Where there is central fullness, drain it from within.

Naegyeong 內經

3.5.3
Source원문

諸腹脹大, 皆屬於熱. 大槪寒脹多而熱脹少也. 《內經》

Translation영역
All abdominal distension and enlargement belongs to heat. Broadly, however, cold distension is common and heat distension uncommon.
Clinical note임상 주석
The Neijing line and its correction in the same breath. One of the nineteen disease mechanisms assigns all distension to heat; the chapter records it and then says that in practice cold distension is the commoner. That the qualification is placed immediately after the quotation, rather than argued for elsewhere, is characteristic of how Heo Jun handles inherited doctrine.

Naegyeong 內經

3.5.4
Source원문

鼓脹, 宜補中行濕, 此脾虛之甚. 必須遠音樂, 斷厚味, 大劑人參ㆍ白朮, 佐以陳皮ㆍ茯苓ㆍ蒼朮之類. 《丹心》

Translation영역
For drum distension, supplement the centre and move damp; this is spleen vacuity in the extreme. Music must be kept at a distance and rich flavours cut off, with large doses of ginseng and white atractylodes assisted by tangerine peel, poria, atractylodes lancea and the like.

Dansim 丹心

3.5.5
Source원문

治法, 理宜補脾. 又須養肺金以制木, 使脾無賊邪之慮, 滋腎水以制火, 使肺得淸化之令. 却鹽味以防助邪, 斷妄想以保母氣, 無有不安. 醫者, 不察病源, 急於取效, 病者, 苦於脹急, 喜行利藥, 以求一時之快, 殊不知寬得一日半日, 其脹愈甚, 病邪甚矣, 眞氣傷矣, 去死不遠. 此病之起, 固非一年, 根深蔕固, 欲取速效, 自求禍耳. 知王道者, 可與語此也. 《丹心》

Translation영역
The method in principle is to supplement the spleen. One must further nourish the lung metal so as to restrain wood, that the spleen need not fear a robbing evil; and enrich the kidney water so as to restrain fire, that the lung may obtain the mandate of clear transformation. Set aside salt flavour to prevent assisting the evil, and cut off idle fancies to preserve the mother qi — then there is nothing that will not be at peace. Physicians, not examining the source of the disease, are in haste for a result; patients, distressed by the urgency of the distension, are glad to take disinhibiting medicines in search of a moment's ease. They do not understand that having gained a day or half a day of relief, the distension grows worse still, the disease evil more severe, the true qi damaged — and death not far off. The arising of this disease was certainly not the work of a year; its root is deep and its stem fixed, and to want a quick result is to court disaster. With one who knows the kingly way, this may be discussed.
Clinical note임상 주석
The longest and most pointed passage in the chapter, and it is about the relationship between physician and patient as much as about treatment. Both are in a hurry for opposite reasons — the physician for a result, the patient for relief — and the diuretic that satisfies both buys half a day and costs more than it gives. 王道, the kingly way, is the Mencian term for rule by virtue rather than by force, set against 霸道, the way of the hegemon. Applied to medicine it means treating the root patiently rather than seizing the symptom, and Danxi invokes it to say that this argument can only be had with someone who already accepts that premise.

Dansim 丹心

3.5.6
Source원문

凡腹脹, 須用薑製厚朴. 初得是氣脹, 宜行氣疏導之劑, 木香ㆍ檳榔ㆍ枳殼ㆍ靑皮ㆍ陳皮之類. 久則成水脹, 宜行濕利水之劑, 蒼朮ㆍ白朮ㆍ茯苓ㆍ澤瀉ㆍ防己之類. 《正傳》

Translation영역
In abdominal distension generally, ginger-processed magnolia bark must be used. Newly contracted, it is qi distension, and medicines that move qi and course and conduct are appropriate — costus, areca, bitter orange, green tangerine peel, tangerine peel and the like. Left long it becomes water distension, and medicines that move damp and disinhibit water are appropriate — atractylodes lancea, white atractylodes, poria, alisma, stephania and the like.
Clinical note임상 주석
The staging the chapter set out at 3.1.7 turned into two medicinal lists. New distension is qi and is moved; old distension is water and is drained. The instruction that opens it — magnolia bark, ginger-processed, in every case — is the one constant across both stages.

Jeongjeon 正傳

3.5.7
Source원문

肥人腹脹, 是濕, 宜蒼朮ㆍ茯苓ㆍ滑石ㆍ澤瀉.

Translation영역
In a stout person abdominal distension is damp: atractylodes lancea, poria, talc and alisma are appropriate.

Jeongjeon 正傳

3.5.8
Source원문

瘦人腹脹, 是熱, 宜芩ㆍ連ㆍ梔子ㆍ厚朴.

Translation영역
In a thin person abdominal distension is heat: scutellaria, coptis, gardenia and magnolia bark are appropriate.

Jeongjeon 正傳

3.5.9
Source원문

色白人, 是氣虛, 宜人參ㆍ白朮ㆍ白茯苓ㆍ陳皮. 《正傳》

Translation영역
In a person of pale complexion it is qi vacuity: ginseng, white atractylodes, white poria and tangerine peel are appropriate.
Clinical note임상 주석
Three lines that select by constitution rather than by sign — stout, thin, pale — and assign each a mechanism and four medicinals. It is the quickest differentiation in the chapter and the one a practitioner could apply before asking a single question.

Jeongjeon 正傳

3.5.10
Source원문

中滿比脹稍輕, 俗云倒飽, 是也. 詳見內傷 《入門》

Translation영역
Central fullness is somewhat lighter than distension; what is commonly called being full backwards is this. treated in fuller detail in the Internal Damage chapter

Immun 入門

3.5.11
Source원문

脹有穀脹ㆍ水脹ㆍ氣脹ㆍ血脹. 又有寒脹ㆍ熱脹ㆍ蠱脹.

Translation영역
Distension comprises grain distension, water distension, qi distension and blood distension; and also cold distension, heat distension and gu distension.
Clinical note임상 주석
The same seven named at 3.4.2, but in a different order — the four by cause first, then the three by nature. The subsections that follow take this second order, which is why the chapter's treatment sequence does not match its diagnostic one.

Donguibogam · Changman

3.5.1 Grain Distension — Treatment 穀脹

3.5.1.1
Source원문

宜雞矢醴散ㆍ大異香散.

Translation영역
Chicken Droppings Ale Powder and Greater Strange Fragrance Powder are appropriate.

Donguibogam · Changman

3.5.2 Water Distension — Treatment 水脹

3.5.2.1
Source원문

宜防己椒藶丸ㆍ木香散ㆍ椒豉丸方見浮腫.

Translation영역
Stephania, Zanthoxylum Seed and Lepidium Pill, Costus Powder and Zanthoxylum Seed and Fermented Soybean Pill formula in the Oedema chapter are appropriate.

Donguibogam · Changman

3.5.3 Qi Distension — Treatment 氣脹

3.5.3.1
Source원문

宜三和湯ㆍ分心氣飮方見氣門ㆍ氣鍼元ㆍ金蟾散.

Translation영역
Three Harmonies Decoction, Divide the Heart Qi Drink formula in the Qi chapter, Qi Needle Pill and Golden Toad Powder are appropriate.

Donguibogam · Changman

3.5.4 Blood Distension — Treatment 血脹

3.5.4.1
Source원문

宜人參芎歸湯ㆍ散血消腫湯ㆍ桃奴丸.

Translation영역
Ginseng, Chuanxiong and Angelica Decoction, Disperse Blood and Reduce Swelling Decoction and Withered Peach Pill are appropriate.

Donguibogam · Changman

3.5.5 Cold Distension — Treatment 寒脹

3.5.6 Heat Distension — Treatment 熱脹

3.5.6.1
Source원문

宜七物厚朴湯ㆍ枳殼剉散ㆍ中滿分消丸.

Translation영역
Seven Substances Magnolia Bark Decoction, Bitter Orange Cut Powder and Divide and Disperse Central Fullness Pill are appropriate.
Clinical note임상 주석
The two Jungmanbunso formulas sit in adjacent subsections treating opposite patterns — the decoction for cold distension above, the pill for heat distension here. The pill's own source line says plainly that it does not treat cold distension, which is the chapter's way of keeping them apart.

Donguibogam · Changman

3.5.7 Gu Distension — Treatment 蠱脹

3.6 Medicines for Distension and Fullness in General Use 脹滿通治藥

3.6.1
Source원문

宜半夏厚朴湯ㆍ廣朮潰堅湯ㆍ濟生紫蘇子湯ㆍ大正氣散ㆍ四香散ㆍ撞關飮子ㆍ沈香飮ㆍ分消湯ㆍ四聖丸ㆍ木香檳榔丸ㆍ四炒枳殼丸ㆍ木香分氣丸ㆍ消脹元ㆍ木香消脹元ㆍ蓽澄茄元. 《諸方》

Translation영역
Pinellia and Magnolia Bark Decoction, Curcuma Break Down Hardness Decoction, Jisheng Perilla Seed Decoction, Major Correct the Qi Powder, Four Aromatics Powder, Break Through the Barrier Drink, Aloeswood Drink, Divide and Disperse Decoction, Four Sages Pill, Costus and Areca Pill, Four Fryings Bitter Orange Pill, Costus Divide the Qi Pill, Disperse Distension Pill, Costus Disperse Distension Pill and Cubeb Pill are appropriate.
Clinical note임상 주석
Fifteen formulas as an index, and the range within it is wide. It opens with Dongwon's twenty-five-medicinal decoction and closes with an eleven-medicinal pill of aromatics; the only paediatric formula in the chapter sits in the middle, and so does the one whose preparation runs to four separate fryings. None of the fifteen contains a drastic purgative, which distinguishes this list from the general lists of the Accumulations and Oedema chapters.

Jebang 諸方

3.7 Turbid Qi Above Engenders Distension 濁氣在上則生䐜脹

3.7.1
Source원문

內經曰, 淸氣在下, 則生飱泄, 濁氣在上, 則生䐜脹. 註曰, 濁氣, 寒氣也. 寒在上焦, 則水穀精微之氣, 不能運化, 鬱結而爲脹滿.

Translation영역
The Neijing says: when clear qi is below, swill diarrhoea is engendered; when turbid qi is above, distension is engendered. The commentary says: turbid qi is cold qi. Cold being in the upper burner, the essential and subtle qi of water and grain cannot be moved and transformed, but is depressed and bound and becomes distension and fullness.
Clinical note임상 주석
The two halves of the Neijing line are a matched pair: clear qi fallen below produces undigested diarrhoea, turbid qi risen above produces distension. Both are failures of direction rather than of substance, which is why the formulas in this section lead with cimicifuga and bupleurum.

Naegyeong 內經

3.7.2
Source원문

一人患脹, 夜分尤甚, 脉弦而細, 正是濁氣在上生䐜脹也. 先灸中脘穴名, 引胃中生發氣上行陽道, 後以木香順氣湯服之, 良愈. 《寶鑑》

Translation영역
A person suffered distension which was worst in the depth of night, with a pulse wiry and fine. This was precisely turbid qi above engendering distension. First Jungwan (中脘, CV12) was moxaed, to draw the engendering and effusing qi of the stomach upward along the yang pathway; afterwards Costus Normalize the Qi Decoction was taken, and he recovered well.
Clinical note임상 주석
A case in three lines, and the order is the point: moxa first to set the direction, decoction second to hold it. Distension worst in the depth of night is the observation that made the diagnosis — yin is at its height then, and the turbid is heaviest.

Bogam 寶鑑

3.7.3
Source원문

吳茱萸湯ㆍ沈香交泰丸, 亦治此證. 《丹心》

Translation영역
Evodia Decoction and Aloeswood Communicate with Peace Pill also treat this pattern.

Dansim 丹心

3.8 Abdominal Distension in Cold Damage and Heat Disease 傷寒熱病腹脹滿

3.8.1
Source원문

詳見寒門.

Translation영역
Treated in fuller detail in the Cold Damage chapter.
Clinical note임상 주석
A section consisting of a cross-reference alone, as at Bujong 2.9. The heading is kept so that a reader working through the chapter's order does not take the topic for an omission.

Donguibogam · Changman

3.9 Distension Is a True-Viscus Disease 脹滿乃眞臟病也

3.9.1
Source원문

脹滿, 由脾虛之極, 乃眞藏病也. 如反胃, 勞瘵亦然, 皆眞藏病也. 凡人之病, 眞藏不病, 則五行相生相制, 以適於平, 雖不服藥而自愈. 如火極傷金, 則有水以制之, 有土以生之. 如木極克土, 則有金以制之, 有火以生之. 所謂亢則害承迺制也. 雖然, 亦有惡藥忌醫而誤之者. 盖正氣與病邪不相兩立, 一勝則一負, 久則病劇正脫, 而不免於死. 然則有病不服藥可乎, 不用醫可乎. 《丹心》

Translation영역
Distension and fullness arise from spleen vacuity in the extreme, and it is a true-viscus disease. Stomach reflux and taxation consumption are likewise, all of them true-viscus diseases. In human illness generally, where the true viscus is not diseased, the five phases engender and restrain one another so as to come to a balance, and though no medicine be taken the patient recovers of themselves. Thus where fire in the extreme damages metal, there is water to restrain it and earth to engender it; where wood in the extreme overwhelms earth, there is metal to restrain it and fire to engender it. This is what is meant by saying that what is excessive does harm, and what succeeds it restrains it. Even so, there are also those who go wrong by loathing medicine and shunning physicians. For the upright qi and the disease evil cannot both stand; when one prevails the other is defeated, and left long the disease grows severe and the upright deserts, so that death is not escaped. That being so — may a person who has a disease go without taking medicine? May they do without a physician?
Clinical note임상 주석
The most carefully argued passage in the chapter, and it does two things at once. First it places distension among the true-viscus diseases, alongside stomach reflux and taxation consumption — conditions in which the organ itself has failed rather than been assailed. The five-phase argument that follows explains why ordinary illness resolves on its own: each excess has something to restrain it and something to replenish what it damaged. In true-viscus disease that self-correction is gone. Then it turns. Having established that this is the gravest class of illness, Danxi does not conclude that treatment is futile — he uses it to argue the opposite. The upright and the evil cannot both stand; one must prevail. The chapter therefore closes on two rhetorical questions rather than a prognosis. Read against 3.5.7.3, where three treatments are listed and then all three are called useless, the two passages are in genuine tension. The chapter does not resolve it.

Dansim 丹心

3.10 Distension with Diarrhoea 脹滿泄瀉

3.10.1
Source원문

腹脹經久, 忽瀉數升, 晝夜不止. 服藥不驗, 乃爲氣脫, 最難救. 取益智仁濃煎湯服之, 立愈. 《入門》

Translation영역
Where abdominal distension has passed a long time and suddenly several seung are passed in diarrhoea, not ceasing day or night, and medicines taken have no effect — this is qi desertion, and it is hardest of all to save. Take alpinia strongly decocted and give it; recovery is immediate.
Clinical note임상 주석
氣脫, qi desertion, is the collapse that follows massive fluid loss, and the passage names it the hardest of all to save. That a single medicinal is then offered — alpinia alone, strongly decocted — is characteristic of the emergency entries in these chapters: when there is no time, one thing that binds. **Sudden profuse diarrhoea in a patient with chronic abdominal distension is an emergency. It requires immediate medical care.**

Immun 入門

3.11 The Method of External Application 外敷法

3.11.1
Source원문

治積聚, 脹滿, 血蠱等病, 宜外敷神膏, 及外敷藥.

Translation영역
For accumulation and gathering, distension and fullness, blood gu and the like, the Spirit Paste for External Application and the External Application Medicine are appropriate.
Clinical note임상 주석
**Both preparations are caustic. The second is built on euphorbia, genkwa and kansui — all toxic and absorbed through skin — and its instructions deliberately pair them with licorice taken by mouth, which the tradition holds incompatible. Neither should be prepared or applied.**

Donguibogam · Changman

3.12 Patterns That Can and Cannot Be Treated 可治不可治證

3.12.1
Source원문

脹滿得之未久, 或脹或消, 腹皮稍軟, 不泄不喘, 隨治隨差. 若臍心突起, 利後腹脹急, 久病羸乏, 喘息不得安, 名曰脾腎俱敗, 不治. 《得效》

Translation영역
Where distension and fullness have not long been contracted, where it distends at times and disperses at times, where the skin of the belly is somewhat soft, and there is neither diarrhoea nor panting — treatment brings recovery as it goes. But where the centre of the navel protrudes, where the abdomen tightens with distension after purging, where long illness has brought emaciation and exhaustion, and panting breath will not settle — this is called spleen and kidney both defeated, and cannot be treated.
Clinical note임상 주석
The favourable and unfavourable side by side, and the criteria are the same ones the Oedema chapter uses at 2.12: is the tissue still soft, is the course still fluctuating, is the breathing still quiet. 利後腹脹急 — the abdomen tightening after a purge — is the sign worth carrying. Fluid that reaccumulates faster after each drainage is the mark of a process that will not be reversed by drainage, and in a patient already wasted it is what the passage calls spleen and kidney both defeated.

Deukhyo 得效

3.12.2
Source원문

腹脹身熱脉大, 是一逆也.

Translation영역
Abdominal distension with fever and a large pulse is the first counterflow.

Yeongchu 靈樞

3.12.3
Source원문

腹鳴而滿, 四肢淸泄, 其脉大, 是二逆也.

Translation영역
The abdomen rumbling and full, the four limbs cold with diarrhoea, and the pulse large, is the second counterflow.

Yeongchu 靈樞

3.12.4
Source원문

腹大脹, 四末淸, 脫形泄甚, 是三逆也.

Translation영역
The abdomen greatly distended, the four extremities cold, the form wasted away and the diarrhoea severe, is the third counterflow.

Yeongchu 靈樞

3.12.5
Source원문

腹脹便血, 其脉大時絶, 是四逆也. 幷不治. 《靈樞》

Translation영역
Abdominal distension with blood in the stool, and a pulse large but at times cut off, is the fourth counterflow. None of these can be treated.
Clinical note임상 주석
Four counterflows, and what they share is a large pulse in a patient who has nothing left — wasted, cold at the extremities, losing fluid or blood. A full pulse where the body is empty is read as the qi escaping rather than as strength, and that is the reading the Oedema and Accumulations chapters also give at their prognosis sections. The fourth adds blood in the stool with a pulse that intermits. **Gastrointestinal bleeding in a patient with chronic abdominal distension is an emergency.**

Yeongchu 靈樞

3.12.6
Source원문

腹滿咳逆, 不得小便, 不治.

Translation영역
Abdominal fullness with cough and counterflow, and urine that will not pass, cannot be treated.

Deukhyo 得效

3.12.7
Source원문

腹大滿而下泄, 不治. 《得效》

Translation영역
The abdomen greatly full with diarrhoea below cannot be treated.

Deukhyo 得效

3.12.8
Source원문

脹滿或兼身熱, 皆不可治. 《綱目》

Translation영역
Distension and fullness with fever besides cannot in any case be treated.

Gangmok 綱目

3.12.9
Source원문

久病羸乏, 卒然脹滿喘息不得, 與夫臍心突起, 或下利頻頻, 未見一愈者耳. 《直指》

Translation영역
Long illness with emaciation and exhaustion, sudden distension and fullness with breath that will not come, together with the centre of the navel protruding, or frequent diarrhoea below — of these not one has been seen to recover.
Clinical note임상 주석
未見一愈者 — not one has been seen to recover — is a statement about what the author had witnessed rather than a doctrinal judgement, and it is the plainer for that. The three signs gathered here recur across all nine passages of this section: a protruding navel, breath that will not settle, and persistent diarrhoea. In modern terms these are umbilical herniation from tense ascites, respiratory compromise from diaphragmatic splinting, and the fluid and electrolyte loss that follows. The section is describing decompensated liver disease, and its prognosis was correct for its time.

Jikji 直指

3.13 Simple Medicinals 單方

3.13.1
Source원문

凡十四種.

Translation영역
Fourteen kinds in all.

Donguibogam · Changman

3.13.2
Source원문

厚朴 治腹脹, 乃結者散之. 神藥也. 《湯液》

Translation영역
Magnolia bark (厚朴): Treats abdominal distension — what binds, it scatters. It is a marvellous medicine.

Tangaek 湯液

3.13.3
Source원문

厚朴 有人心腹脹滿, 只以厚朴細剉薑製, 每取五錢或七錢, 薑七片同煎服, 滓又煎服五六次卽愈. 《資生》

Translation영역
Magnolia bark (厚朴), second method: A person had distension and fullness of the heart and abdomen. Magnolia bark alone, finely cut and ginger-processed, was taken at 5 or 7 don a time and decocted with 7 slices of ginger; the dregs were decocted again and taken, five or six times in all, and he recovered.

Jasaenggyeong 資生

3.13.4
Source원문

厚朴 腹脹必少佐以厚朴者, 盖其味辛能散, 以氣聚上焦故也. 《丹心》

Translation영역
Magnolia bark (厚朴), note: In abdominal distension a little magnolia bark must always be used as assistant, for its flavour is acrid and able to scatter, the qi having gathered in the upper burner.
Clinical note임상 주석
Three passages for one medicinal, which the chapter gives to no other. Magnolia bark appears in nearly every formula in this chapter, and 3.5.6 makes it a standing instruction — in abdominal distension generally, ginger-processed magnolia bark must be used.

Dansim 丹心

3.13.5
Source원문

大戟 治脹. 取大棗一斗, 置鍋內, 與大戟同水煮熟, 去大戟不用. 旋旋吃棗無時, 棗盡卽效. 《易老》

Translation영역
Euphorbia (大戟): Treats distension. Take one mal of jujubes, put them in a pot, and boil them through in water together with euphorbia; then discard the euphorbia and do not use it. Eat the jujubes little by little at any time, and when they are finished the effect follows.
Clinical note임상 주석
The containment technique in its simplest form — a toxic medicinal boiled with a food that is then eaten alone. It is the same reasoning as Sipjo-tang, where ten jujubes carry the three purgatives, except that here the purgative is thrown away and only what passed into the fruit is taken. **Euphorbia is toxic and this preparation should not be attempted.**

Yeokro 易老

3.13.6
Source원문

鸕鷀屎 治脹滿. 取屎炒黃色作末, 每一錢溫水調下卽效.

Translation영역
Cormorant droppings (鸕鷀屎): Treats distension and fullness. Dry-fry the droppings to a yellow colour, powder them, and take 1 don stirred into warm water; the effect follows at once.

Boncho 本草

3.13.7
Source원문

鸕鷀屎 雷公云, 體寒腹大, 全賴鸕鶿是也. 《本草》

Translation영역
Cormorant droppings (鸕鷀屎), note: Leigong said that for a cold body with a large abdomen one relies entirely on the cormorant — this is it.
Clinical note임상 주석
**Ingesting bird droppings carries a serious infection risk and should not be attempted.**

Boncho 本草

3.13.8
Source원문

蝦蟆 治蠱脹. 取一箇, 去內腸, 入螻蛄七枚, 新瓦上焙焦乾爲末, 糊丸酒服. 《綱目》

Translation영역
Toad (蝦蟆): Treats gu distension. Take one toad, remove the entrails, put in seven mole crickets, dry-roast on a new tile until scorched, powder, make paste pills and take with wine.
Clinical note임상 주석
A third variant of the toad preparation, after the amomum filling at 3.5.3.3 and the pig's stomach method at Bujong 2.14.18. Here mole crickets fill the cavity, and both animals are held to move water. **Toad preparations contain bufotoxins, cardiac glycosides chemically close to digitalis, and deaths from toad-derived medicines are on record. This must not be prepared or taken.**

Gangmok 綱目

3.13.9
Source원문

雞屎 治穀脹, 及諸脹. 取屎白炒黃, 湯漬之, 取淸汁服之. 《本草》

Translation영역
Chicken droppings (雞屎): Treats grain distension and all distensions. Take the white part, dry-fry it yellow, steep it in hot water, and take the clear liquor.

Boncho 本草

3.13.10
Source원문

黑豆 和桑柴灰汁煮服. 下水鼓, 腹脹效. 《本草》

Translation영역
Black soybean (黑豆): Boil with mulberry wood ash lye and take. It brings down water drum, with effect on abdominal distension.

Boncho 本草

3.13.11
Source원문

赤小豆 下脹滿. 以桑柴灰水煮作粥常服. 《本草》

Translation영역
Adzuki bean (赤小豆): Brings down distension and fullness. Boil in mulberry wood ash water to make a congee and take regularly.
Clinical note임상 주석
Both beans are prepared in mulberry wood ash lye, exactly as at Bujong 2.14.1. The lye is strongly alkaline and potassium-bearing, which makes it a reasonable vehicle for a diuretic bean congee whether or not the tradition could say why.

Boncho 本草

3.13.12
Source원문

紫蘇莖葉 治心腹脹滿. 煮作飮如茶常服. 《本草》

Translation영역
Perilla stalk and leaf (紫蘇莖葉): Treats distension and fullness of the heart and abdomen. Boil it into a drink like tea and take regularly.

Boncho 本草

3.13.13
Source원문

蔓菁子 治心腹脹. 取一合搗爛, 水一升和硏濾取汁, 一盞頓服. 或自吐, 或利, 或汗, 腹中自寬. 《本草》

Translation영역
Turnip seed (蔓菁子): Treats distension of the heart and abdomen. Take 1 hop, pound to a pulp, grind with 1 seung of water, strain and take the juice, one jan at a draught. Either vomiting or purging or sweating follows of itself, and the abdomen loosens of itself.
Clinical note임상 주석
The three routes are named without a preference between them — vomiting, purging or sweating, whichever the body chooses. That is unusual; most entries in these chapters specify the route and take it as the measure of effect.

Boncho 本草

3.13.14
Source원문

蘿蔔子 治脹滿. 炒硏水煮如茶常服妙.

Translation영역
Radish seed (蘿蔔子): Treats distension and fullness. Stir-fry, grind, boil in water like tea and take regularly, with excellent effect.

Sokbang 俗方

3.13.15
Source원문

蘿蔔子 蘿葍取子, 陳根煮服亦佳. 《俗方》

Translation영역
Radish seed (蘿蔔子), second method: Take the seed of the radish; the old root boiled and taken is also good.

Sokbang 俗方

3.13.16
Source원문

大麥麪 治脹. 常食最佳. 大麥飯亦好. 《俗方》

Translation영역
Barley flour (大麥麪): Treats distension. Eaten regularly it is best of all; barley rice is also good.

Sokbang 俗方

3.13.17
Source원문

桑枝茶 下氣消脹. 常服最佳.

Translation영역
Mulberry twig tea (桑枝茶): Downbears qi and disperses distension. Taken regularly it is best of all.

Boncho 本草

3.13.18
Source원문

桑枝茶 或和赤豆, 作粥亦良. 《本草》

Translation영역
Mulberry twig tea (桑枝茶), second method: Or mixed with adzuki beans and made into a congee, it is likewise good.

Boncho 本草

3.13.19
Source원문

烏牛尿 治久患氣脹. 取熱尿, 空心服一升, 日一服, 氣散卽止. 《本草》

Translation영역
Black ox urine (烏牛尿): Treats qi distension long suffered. Take the urine warm, 1 seung on an empty stomach once a day; when the qi has scattered, stop.
Clinical note임상 주석
**Ingesting animal urine carries a serious infection risk and offers no established benefit. This should not be attempted.**

Boncho 本草

3.13.20
Source원문

椒目 治水蠱, 能行水. 作末, 溫水調一錢服之. 《本草》

Translation영역
Zanthoxylum seed (椒目): Treats water gu and is able to move water. Powder it and take 1 don stirred into warm water.
Clinical note임상 주석
The section closes with the medicinal that opens the section's most-used formula, Banggichoryeok-hwan at 3.5.2.1. Zanthoxylum seed is distinguished from the pericarp in this database and is the part credited with moving water rather than warming. Of the fourteen simples here, six are ordinary foods — black soybean, adzuki bean, perilla, turnip seed, radish seed, barley — which is the same dietetic leaning the Oedema chapter shows at 2.14. The chapter's severest formulas and its gentlest advice sit a few pages apart.

Boncho 本草

3.14 Acupuncture and Moxibustion Methods 鍼灸法

3.14.1
Source원문

腹中膨脹, 取內庭.

Translation영역
For swelling distension within the abdomen, take Naejeong (內庭, ST44).

Gangmok 綱目

3.14.2
Source원문

水蠱, 取偏歷.

Translation영역
For water gu, take Pyeollyeok (偏歷, LI6).

Gangmok 綱目

3.14.3
Source원문

鼓脹, 取臍上下左右, 各刺二寸二分.

Translation영역
For drum distension, take points above, below, and to the left and right of the navel, needling each to 2 chon 2 pun.
Clinical note임상 주석
**Needling to this depth around the navel of a patient with tense ascites risks perforating bowel and puncturing the peritoneum, and the Oedema chapter warns at 2.15.2 that needling such tissue kills. This must not be attempted.**

Gangmok 綱目

3.14.4
Source원문

單蠱脹, 取水分鍼入二寸半, 或灸五十壯.

Translation영역
For single gu distension, take Subun (水分, CV9), needling to 2.5 chon, or moxa fifty cones.
Clinical note임상 주석
A flat contradiction between two chapters of the same book, and worth recording as such. The Oedema chapter's warning is the sounder of the two: needling fluid-filled tissue produces a wound that weeps and does not close. **Do not needle this point in a patient with ascites or oedema.**

Gangmok 綱目

3.14.5
Source원문

脹滿, 取足三里瀉之.

Translation영역
For distension and fullness, take Jok Samni (足三里, ST36) and drain it.

Gangmok 綱目

3.14.6
Source원문

凡脹, 皆取三里.

Translation영역
In distension generally, Samni (三里, ST36) is taken in every case.

Gangmok 綱目

3.14.7
Source원문

又取中脘ㆍ氣海, 或鍼, 或灸. 《綱目》

Translation영역
Also take Jungwan (中脘, CV12) and Gihae (氣海, CV6), either needling or moxaing.
Clinical note임상 주석
The chapter closes on the two points its own case history used. At 3.7.2 a patient whose distension was worst at night was moxaed at Jungwan first, to draw the stomach qi upward along the yang pathway, and given the decoction afterwards — moxa to set the direction, medicine to hold it. Samni, named twice here, is the standing point for the stomach channel and the one the chapter treats as always applicable.

Gangmok 綱目

About this translation 凡例

Base text: Donguibogam (東醫寶鑑, 1613 first edition), Miscellaneous Disorders, Volume 6, Distension chapter. The Chinese text is collated against the public-domain Wikisource transcription and a printed edition; original character forms (脉, 人參) are retained. Terminology follows Wiseman & Feng, A Practical Dictionary of Chinese Medicine. Translation and clinical notes are original to this site. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.