灵枢·胀论 Miraculous Pivot · On Distension
黄帝曰：脉之应于寸口，如何而胀？The Yellow Emperor said: When the pulse is felt at the Cunkou (the radial artery at the wrist), how can one tell if there is distension?
黄帝说：在寸口出现什么脉象是发生了胀病呢？
岐伯曰：其脉大坚以涩者，胀也。Qibo said: If the pulse is large, firm, and unsmooth, it indicates distension.
岐伯说：脉象表现出大而坚或坚而涩的，就是发生了胀病。
黄帝曰：何以知脏腑之胀也。The Yellow Emperor said: How can one know which of the zang-fu organs is affected by distension?
黄帝说：如何鉴别是五脏胀病或是六腑胀病呢？
岐伯曰：阴为脏，阳为腑。Qibo said: The yin pertains to the zang organs, and the yang pertains to the fu organs.
岐伯说：出现脉象坚而涩的阴脉是五脏胀，出现脉象大而坚的阳脉是六腑胀。
黄帝曰：夫气之令人胀也，在于血脉之中耶，脏腑之内乎？The Yellow Emperor said: When qi causes distension in a person, does it occur in the blood vessels or within the zang-fu organs?
黄帝说：大凡气的运行不畅可以使人发生胀病，其病所是在血脉里面呢？还是在脏腑里面呢？
岐伯曰：三者皆存焉，然非胀之舍也。Qibo said: It can exist in all three places (blood vessels, zang organs, and fu organs), but none of them is the actual location where distension resides.
岐伯说：胀病与血脉、脏、腑三者都有关系，但是这些都不是胀病的发病部位。
黄帝曰：愿闻胀之舍。The Yellow Emperor said: I would like to hear about the actual location of distension.
黄帝说：我想听一听胀病的发病部位。
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。Qibo said: As for distension, it is all outside the zang-fu organs. It presses against the zang-fu organs, surrounds the chest and hypochondrium, and causes the skin to swell. Therefore, it is called distension.
岐伯说：凡是胀病都是发生在脏腑之外，它向内压挤脏腑，向外扩张胸胁，使皮肤发胀，所以称为“胀”。
黄帝曰：脏腑之在胸胁腹里之内也，若匣匮之藏禁器也，名有次舍，异名而同处，一域之中，其气各异，愿闻其故。（《医部全录》注曰：此处必缺岐伯所答之言。）The Yellow Emperor said: The zang-fu organs are located inside the chest, hypochondrium, and abdomen, just like precious objects stored in a box. Each has its own name, location, and although they have different names, they are in the same area. The qi within them is different. I would like to hear the reason for this. (Annotation in "Complete Records of the Medical Department": There must be a missing reply from Qibo here.)
黄帝说：脏腑存于胸廓腹腔之内，就像在匣柜中收藏的秘密物件一样，它们在体腔内各有一定的位置和不同的名称，都是居于胸腹腔之中，同在体腔中的脏腑又有不同的功能，我想听一听其中的缘故。（此处原经文遗漏了岐伯的回答。）
黄帝曰：未解其意，再问。The Yellow Emperor said: I still don't understand this. I'll ask again.
黄帝说：你所说的意思没能理解，请再讲解一下。
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。Qibo said: "The chest and abdomen are like the outer enclosures of the zang-fu organs. The Danzhong is the imperial palace of the Heart Governor. The stomach is like the Grand Granary.
岐伯说：“胸腹是脏腑的外廓。膻中是心脏的宫城。胃容纳食物就像仓库一样。
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。The throat and small intestine are for transportation. The five orifices of the stomach are like the gates of the neighborhood. Lianquan and Yuying are the passages for body fluids.
咽喉和小肠是传送饮食物的通路。胃的五窍（指咽门、贲门、幽门、阑门、魄门），像守卫街巷的各道门户。廉泉、玉英是津液外泄的通路。
故五脏六腑者，各有畔界，其病各有形状。Therefore, each of the five zang and six fu organs has its own boundaries, and their diseases have different manifestations.
五脏六腑有各自的边界，发病后也有不同的症状表现。营气在脉中顺行、
营气循脉、卫气逆为脉胀；卫气并脉循分为肤胀。When the nutrient qi circulates along the meridians and the defensive qi moves in the opposite direction, it causes meridian distension. When the defensive qi combines with the meridians and circulates along the muscle regions, it causes skin distension.
卫气逆行于脉外，就会发生脉胀；卫气并入脉中，循行于分肉之间，就会发生肤胀。
三里而泻，近者一下，远者三下。无问虚实，工在疾泻。”Needle at Zusanli and perform draining. For a recent onset, one needling may be enough; for a long-standing condition, three needlings may be required. Regardless of whether it is a deficiency or excess condition, the key for the physician is to drain quickly."
治疗时可取足三里穴，施用泻法。如果是新患的胀病，针一次就能治愈，如果是已患时间较长的胀病，需针刺三次。不论是虚证是实证，胀病初起时，关键在于急用泻法以去其邪。”
黄帝曰：愿闻胀形。The Yellow Emperor said: I would like to hear about the manifestations of distension.
黄帝说：我想听一听胀病的症状。
岐伯曰：“夫心胀者烦心短气，卧不安。肺胀者，虚满而喘咳。Qibo said: For heart distension, there are symptoms such as vexation in the heart, shortness of breath, and restlessness during sleep. For lung distension, there is a feeling of emptiness and fullness accompanied by wheezing and coughing.
岐伯说：“心胀病，心中烦乱，气短，睡眠不安。肺胀病，呼吸无力，胸部气胀而虚满，气喘咳嗽。
肝胀者，胁下满而痛引小腹。脾胀者，善哕，四肢烦悗，体重不能胜衣，卧不安。For liver distension, there is fullness under the hypochondrium and pain that radiates to the lower abdomen. For spleen distension, there is frequent hiccupping, restlessness in the limbs, a feeling that the body weight is too much to bear the clothes, and restlessness during sleep.
肝胀病，胁下胀满疼痛而牵引至少腹。脾胀病，呃逆频频，四肢胀闷不舒，身体沉重不能胜衣，睡眠不安宁。
肾胀者，腹满引背央央然，腰髀痛。For kidney distension, there is fullness in the abdomen that radiates to the back with a dull pain, and there is also pain in the waist and hips.
肾胀病，腹胀满牵引背部胀闷不舒，腰部和大腿疼痛。
六腑胀，胃胀者，腹满，胃脘痛，鼻闻焦臭，妨于食，大便难；For the distension of the six fu organs: For stomach distension, there is fullness in the abdomen, pain in the stomach area, a burnt smell can be smelled through the nose, which affects eating, and difficulty in defecation.
六腑的胀病，胃胀病，腹部胀满，胃脘疼痛，鼻中常觉得闻到焦糊的气味而妨碍正常的饮食，大便不通畅。
大肠胀者，肠鸣而痛濯濯，冬日重感于寒，则餐泄不化；For large intestine distension, there is gurgling in the intestine accompanied by pain, and if there is a severe cold attack in winter, there will be undigested food in the stools.
大肠胀病，肠鸣有声而腹部疼痛，如果在冬季又感受寒邪，就会出现完谷不化的泄泻。
小肠胀者，少腹䐜胀，引腰而痛；膀胱胀者，少腹满而气癃；For small intestine distension, there is distension in the lower abdomen that radiates to the waist with pain. For bladder distension, there is fullness in the lower abdomen and difficult urination.
小肠胀病，小腹胀满，牵引腰部疼痛。膀胱胀病，小腹胀满而小便不利。
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。For the distension of the Triple Energizer, there is fullness of qi in the skin, which is soft and not firm. For the distension of the Gallbladder, there is pain and distension under the hypochondrium, a bitter taste in the mouth, and a tendency to sigh frequently.
三焦胀病，肢体胀满，气充满在皮肤之间，用手按时空而不坚实。胆胀病，胁下胀满疼痛，口苦，常作深呼吸而叹气。
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；For all these types of distension, the principle is the same. Clearly understand the normal and abnormal conditions, perform the correct number of needlings, and avoid draining the deficiency and reinforcing the excess. Otherwise, the spirit will leave its abode, pathogenic factors will be introduced while the healthy qi is lost, and the true qi cannot be stabilized. This is what the unskilled physicians do wrong and will lead to a shortened lifespan.
以上的这些胀病，它们的病机和治疗都有共同的规律，只要明确气血运行逆顺的道理，并且正确地运用针刺方法，就能够治愈。但如果虚证用了泻法、实证用了补法，就会使得神气耗散，邪气侵袭而正气损伤，真气不能安定，这种低劣的医术所造成的恶果，就会导致人的寿命缩短。
补虚泻实，神归其室，久塞其空，谓之良工。”Reinforce the deficiency and drain the excess, so that the spirit returns to its abode, and block the pathogenic entry for a long time. This is what a skilled physician does.
如果做到虚证用补法、实证用泻法，就会使得神气内守，经常保持正气充足而肌肉腠理充实，这才是高明的医生。”
黄帝曰：胀者焉生？何因而有？The Yellow Emperor said: How does distension occur? What causes it?
黄帝说：胀病是怎样发生的？是什么原因引起的呢？
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。Qibo said: "The defensive qi in the body usually moves along with the meridians, follows the muscle regions, and its movement has a normal direction. Yin and yang follow each other, and only then can it achieve harmony with nature. The five zang organs start their functions anew, follow the sequence of the four seasons, and then the five grains can be digested.
岐伯说：“卫气在体内运行，总是依傍着经脉而循行于分肉之间，它的运行有逆顺的不同，营气、卫气在脉内、脉外相互伴随，与自然界阴阳变化的规律相合，五脏之气的交替运行，就像四季变化一样有固定的次序，饮食物也可以正常地化生精微营养周身。
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。”Then, if there is reversed qi in the lower part of the body, the nutrient and defensive qis stop their circulation, cold qi moves upward in the opposite direction, the true qi and pathogenic factors attack each other, and when the two types of qi struggle against each other, they combine to form distension."
如果阴阳失调气逆于下，营气、卫气稽留而不能流行，寒邪侵入人体而上逆，正气与邪气相互斗争而搏结在一起，就形成了胀病。”
黄帝曰：善。何以解惑？The Yellow Emperor said: Good. How can one solve the doubts?
黄帝说：好。能不能再解释清楚一下呢？
岐伯曰：合之于真，三合而得。Qibo said: Combine it with the true qi, and when the three are combined, one can get the answer.
岐伯说：邪气侵入人体与正气相搏结，分别停留在血脉、五脏、六腑三个地方，其反映出的症状就可以知道是否是发生胀病。
帝曰：善。The Yellow Emperor said: Good.
黄帝说：好。
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？The Yellow Emperor asked Qibo: In the "On Distension" chapter, it is said: "Regardless of whether it is a deficiency or excess condition, the key for the physician is to drain quickly. For a recent onset, one needling may be enough; for a long-standing condition, three needlings may be required." Now, if after three needlings, the condition does not improve, where is the mistake?
（在讨论了本篇之后，）黄帝又向岐伯询问说：《胀论》篇讲过：“不论是虚证是实证，胀病初起时，关键在于急用泻法以去其邪。如果是新患的胀病，针一次就能治愈，如果是已患时间较长的胀病，需针刺三次。”但是，现在有针刺三次还不见效的，治疗的失误在哪里呢？
岐伯对曰：“此言陷于肉肓而中气穴者也。不中气穴，则气内闭。Qibo replied: "This means that the needle has penetrated into the deep muscular layer but missed the acupoints. If the acupoints are not hit, the qi inside will be blocked.
岐伯说：“之前所说的针刺一次就能治愈，是指针刺时能够深入肌肉的空隙，刺中了气血输注的穴位而言。
针不陷肓，则气不行，上越中肉，则卫气相乱，阴阳相逐。If the needle does not penetrate the muscular layer, the qi will not move. If the needle penetrates too far into the muscle, the defensive qi will be in disorder, and yin and yang will chase each other.
如果没有刺中穴位，或没有深入肌肉的间隙，则经气依旧不能通畅而邪气仍停留在体内，若邪气上越，妄中肌肉，使得卫气更加逆乱，营气和卫气相互排斥更加不协调。
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？In the case of distension, if draining should be done but is not done, the qi will not go down. If after three needlings the qi does not go down, one must change the needling method. Stop when the qi goes down. If it does not go down, start again. This way, it can be completely safe. How could there be any danger?
对于胀病而言，当泻而未泻，厥逆之气不能下行病就不能治愈，在针刺三次后厥逆之气仍不下，就要更换针刺的部位，使厥逆之气下行才停止治疗，如果胀病仍不见好，可以再次调整部位重新针刺，这样可保证治愈，怎么会有危重的病情呢？
其于胀也，必审其胗，当泻则泻，当补则补，如鼓应桴，恶有不下者乎？”In the case of distension, one must carefully examine the condition, drain when it should be drained, and reinforce when it should be reinforced. It will be like hitting a drum with a drumstick, and how could there be any situation where the condition does not improve?"
对于那些不是危急的胀病，要采取治本的方法，仔细观察胀病的症状，当泻就泻，当补就补，就如同鼓之应槌而响一样，病邪哪里有不除的道理啊！”
