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First, select acupoints from the Kidney and Bladder meridians. The preceding chapter of the Classic states: "The fifty-seven acupoints are those selected from these two meridians." Furthermore, the Classic says: "In Kidney disease, characterized by abdominal distension and leg swelling, one should select the blood vessels of its meridians (Shaoyin and Taiyang)," which refers to selecting the blood aspect of these two meridians.

Second, select blood collaterals (Xueluo). The preceding text of the Classic states: "Select the blood in the skin collaterals and drain them all," which is the meaning here.

Third, select the Stomach meridian. The Classic states: "Among the diseases generated by the Foot-Yangming Stomach Meridian, there is large abdominal edema; one should observe the excess or deficiency, heat or cold, and sinking conditions to select points for treatment," which is the meaning here.

Fourth, select Weiyang (BL39). The Classic states: "In Sanjiao disease, characterized by inability to urinate and water overflowing causing edema, select Weiyang (BL39)," which is the meaning here.

Fifth, use tube needles (Tongzhen) to drain water. First, puncture with a Pi needle (Bizhen), then apply the tube needle after puncturing. Withdraw the needle and insert the tube, advancing and withdrawing repeatedly to exhaust the fluid accumulation. One must wait until the flow is firm and urgent; if the flow is slow, the patient will feel vexed; if the flow is rapid, the patient will feel calm. Puncture once every other day, stopping only when the fluid is exhausted. (Tube needles are needles with a hollow cavity like a cylinder, used to drain water.)

[From *Cuo Yao Fang*] For generalized edema: Moxibustion on Shuifen (CV9) and Zhongwan (CV12). Reducing method on Neiting (ST44), Xingjian (LR2), and Zulinqi (GB41); immediate relief follows.

[Zhu Danxi] For Water Qi disease, where the skin is painful and cannot tolerate clothing, the lower abdomen is full and firm, urine is yellow, and the body feels moist: Moxibustion on Zhangmen (LR13) and Wuyi (ST15). Needling Yinjiao (RN7) and Zhangmen (LR13).

[Hua Tuo] For external waist edema, starting with swelling in the waist: Moxibustion on Ganshu (Liver Mu point) and Shuifen (CV9).
For internal edema with sallow complexion: Moxibustion on Weiwuan (ST10), Tonggu (SP10), Qihai (CV6), and Shuifen (CV9).
For bladder/lower jiao edema, rooted in the Heart, with red urine: Moxibustion on Xinshu (BL15), Jueque (CV14), and Qihai (CV6).
For abdominal edema originating from the Spleen, with yellow urine: Moxibustion on Pishu (BL20), Weiwuan (ST10), and Shuifen (CV9).
For lung wheezing with edema, starting from the chest, with white urine: Moxibustion on Feishu (BL13) and Ganshu (Liver Mu point).
For edema starting from the soles of the feet: Moxibustion on Baihuanxu (BL30), Shuifen (CV9), and Zhongfeng (LR4).
For edema of the four limbs and generalized floating edema: Moxibustion on Danshu (Gallbladder Mu point).
For edema of the two hypochondria with emaciated limbs, starting from the ribs: Moxibustion on Zhangmen (LR13) and Qimen (LR14).
For Small Intestine edema, starting from the umbilicus: Moxibustion on Qihai (CV6).

[From *Bao Ming Ji*] Five Pulses discussing Five Waters moxibustion methods:
Green Water, moxa Liver Jing-Well point. (Corresponds to String-like pulse/Xian Mai.)
Red Water, moxa Heart Ying-Spring point. (Corresponds to Surging pulse/Hong Mai.)
Yellow Water, moxa Pishu (BL20). (Corresponds to Moderate pulse/Huan Mai.)
White Water, moxa Lung Meridian. (Corresponds to Choppy pulse/Sai Mai.)
Black Water, moxa He-Sea point of the Kidney Meridian. (Corresponds to Deep pulse/Chen Mai.)

[From *Jia Yi Jing*] Generalized body swelling: Guanmen (ST45) governs it. Edema with abdominal distension and skin swelling: Zusanli (ST36) governs it. Wind-water with knee swelling: Shangjuxu (ST37) governs it. Wind-water with facial swelling and dark complexion: Jiexi (ST41) governs it. Wind-water with facial swelling: Chongyang (ST42) governs it. Retained fluid in the water pathway with chest and hypochondriac fullness: Bleed Xiangu (ST43); immediate resolution. Facial swelling: Shangxing (GV23) governs it; first select Yixi (BL54), then Tianyou (TE16) and Fengchi (GB20). Edema: If the Renzhong area is full and lips are everted, death ensues; Shuigou (GV26) governs it. Severe edema with umbilicus level with the abdomen: Moxa the center of the umbilicus; without rational treatment, it is incurable.

[From *Su Wen*] Slight swelling of the eye sockets resembling a sleeping silkworm indicates Water disease. (From *Ping Ren Qi Xiang Lun*) Swelling of the calves and shins indicates Water disease.

[Zhang Zhongjing] After diarrhea, if the patient is thirsty and desires water, has difficulty urinating, and develops abdominal fullness and subsequent swelling, what is this? The answer is: This is Water disease. If urination becomes free and sweating occurs, it will heal spontaneously. The Fuyang pulse should be hidden/deep; if it is now rapid, indicating underlying heat that digests food and causes frequent urination, but now urination is difficult, this suggests impending Water disease. The Cun Kou pulse is floating and slow. Floating indicates Heat; Slow indicates Submergence. The interaction of Heat and Submergence is called Chen (Deep). The Fuyang pulse is floating and rapid. Floating indicates Heat; Rapid indicates Restlessness/Stagnation. The interaction of Heat and Restlessness is called Fu (Hidden). The interaction of Chen and Fu is called Water. Chen implies emptiness in the collateral vessels; Fu implies difficulty in urination. The interaction of Emptiness and Difficulty allows Water to move into the skin, forming Water disease.

[From *Su Wen*] Pulsation of the neck artery, wheezing, and rapid coughing indicate Water disease. (From *Ping Ren Qi Xiang Lun*)

[Zhang Zhongjing] In Feng Shui (Wind-Water) disease, the pulse is naturally floating, with external signs of joint pain and aversion to wind. (*Zhen Jing · Lun Ji Zhen Chi Pian* states: Observing slight swelling above the eye sockets as if just awakened, pulsation of the neck artery, occasional coughing, and pitting edema upon pressing the hands and feet indicates Feng Shui skin distension. Additionally, Zhang Zhongjing states: If the Taiyin pulse is floating and tight, joint pain is expected, but if there is no pain, instead feeling heavy and achy, without thirst, and healing with sweat, this is Feng Shui. Treatment is described in the Yang Deficiency section earlier.)

Pi Shui (Skin-Water) also presents with a floating pulse. External signs include generalized edema that pits upon pressure, aversion to wind is absent, the abdomen is drum-like, and there is no thirst. Sweating should be induced. (It is also stated: Thirst without aversion to cold indicates Pi Shui. Generally, Feng Shui involves aversion to cold and no thirst; Pi Shui involves no aversion to cold but thirst. Even if Pi Shui presents without thirst, sweating should still be induced. Treatment is described in the Yang Deficiency section.) Zheng Shui (True Water) presents with a deep and slow pulse, with external signs of spontaneous wheezing.

Shi Shui (Stone Water) presents with a naturally deep pulse, with external signs of abdominal fullness but no wheezing. (*Da Qi Lun Pian* states: When both Kidney and Liver pulses are deep, it is Shi Shui; when both are floating, it is Feng Shui.)

Huang Han (Yellow Sweat) presents with a deep and slow pulse, body fever, chest fullness, and swelling of the limbs, head, and face. If prolonged, it inevitably leads to abscesses and pus. (It is also stated: Body swelling with coldness, resembling Zhou Bi, chest oppression, inability to eat, intermittent pain, evening restlessness, and insomnia indicate Yellow Sweat. Treatment is described in the Jaundice section.)

[Zhang Zhongjing] Xin Shui (Heart Water): The body is heavy with shortness of breath, inability to lie flat, vexation and restlessness, and significant swelling of the genitals. Gan Shui (Liver Water): Abdominal distension, inability to turn over independently, pain in the hypochondrium and abdomen, occasional production of saliva, and intermittent urination. Fei Shui (Lung Water): Generalized swelling, difficulty urinating, and frequent loose stools resembling duck droppings. Pi Shui (Spleen Water): Abdominal distension, heaviness in the limbs, lack of saliva generation, shortness of breath, and difficulty urinating. Shen Shui (Kidney Water): Abdominal distension, umbilical swelling, lower back pain, inability to urinate, dampness in the genital area resembling sweat on an ox's nose, cold feet, and a sallow, emaciated face. (Another version states: Stools are conversely hard.)

[Wang Wuze] Generally, edema accompanied by a rapid pulse indicates latent deficiency-cold; over time, it becomes deep and hidden. Deep and hidden pulses indicate Yang deficiency and Yin excess, inevitably leading to Water disease. Facial edema with pain, dark color, excessive sweating, and aversion to wind belongs to Kidney Wind. (Treatment is in the Various Winds section.) Black lips indicate Liver injury; a flat clavicular fossa indicates Heart injury; protruding umbilicus indicates Spleen injury; flat soles indicate Kidney injury; a flat back indicates Lung injury. These five injuries are incurable.

[Zhang Zhongjing] When various deep pulses are found, one must suspect Water, presenting with body swelling and heaviness. In Water disease, a pulse that floats outwards (without root) indicates death. (Wang Wuze states: Generally, a floating pulse with rapidity indicates latent deficiency-cold; over time, it becomes deep and hidden. Deep and hidden pulses indicate Yang deficiency and Yin excess, inevitably leading to Water disease.)

[From *Mai Jing*] In Water disease, a洪大 (Surging-Large) pulse is treatable; a 微细 (Fine-Threadlike) pulse is untreatable. In Water disease, if the abdomen is distended like a drum, a solid pulse indicates survival; a deficient pulse indicates death. Water disease patients often die at midnight. (Full text see Diagnosis of Death and Life.)

[Zhang Zhongjing] In various Water diseases, if the patient is thirsty yet has diarrhea and frequent urination, sweating methods are contraindicated.

[From *Su Wen*] The Emperor asked: A patient with Kidney Wind has facial swelling and obstruction, impairing speech. Can they be needled? Qibo answered: Deficiency should not be needled. If needled inappropriately, the pathogenic factor will arrive in five days. The Emperor asked: What will happen upon arrival? Qibo answered: There will be shortness of breath and intermittent fever. The fever rises from the chest and back to the head, with hot hands, dry and bitter mouth, thirst, yellow urine, swelling under the eyes, borborygmus, heavy body making walking difficult, amenorrhea, vexation, inability to eat, inability to lie supine, and coughing when supine. This disease is named Feng Shui (Wind-Water), discussed in the Needling Methods. The Emperor asked: Explain the theory. Qibo answered: Where pathogens gather, Qi must be deficient. Yin deficiency attracts Yang pathogens, causing shortness of breath, intermittent fever, and sweating. Yellow urine indicates heat in the lower abdomen. Inability to lie supine is due to disharmony in the Stomach. Coughing when supine is due to upward pressure on the Lungs. In all cases of Water Qi, slight swelling appears first under the eyes. The Emperor asked: Why? Qibo answered: Water is Yin; Eyes are also Yin. The abdomen is the residence of Supreme Yin. Therefore, if water is in the abdomen, swelling under the eyes must occur. Rebellious True Qi causes bitter mouth and dry tongue. Inability to lie supine results in coughing up clear fluid. All Water disease patients cannot lie down; lying down causes fright, and fright worsens coughing. Borborygmus originates in the Stomach. Pathogens affecting the Spleen cause vexation and anorexia; inability to eat is due to Stomach obstruction. Heavy body and difficulty walking relate to the Stomach meridian in the foot. Amenorrhea is due to closure of the Bao Mai (Uterine Vessel), which connects to the Heart and links to the Bao Zhong. Now, Qi presses upward on the Lungs, preventing Heart Qi from descending, thus amenorrhea occurs. (From *Ping Re Bing Lun*)

[Zhang Zhongjing] Question: A patient suffers from Water disease, with swelling of the face, eyes, body, and limbs, and difficulty urinating. Pulse diagnosis does not mention Water, but rather chest pain, Qi rushing up the throat as if a piece of roasted meat is stuck, with mild coughing and wheezing. If this matches your description, what is the pulse like? Master said: The Cun Kou pulse is Deep and Tight. Deep indicates Water; Tight indicates Cold. Deep and Tight interact, knotting at the Guan Yuan point. Initially, it was subtle and unnoticed in youth. After Yang declines, Ying and Wei interfere. Yang damage leads to Yin excess. Knotting Cold moves subtly, Tight Qi rushes upward, causing throat obstruction and hypochondriac urgency/pain. Physicians mistook it for retained fluid and purged heavily. The Qi attack did not cease, and the disease remained. Later, vomiting was induced, causing Stomach deficiency, vexation, dry throat, desire for water, difficulty urinating, undigested food, and swelling of the face, eyes, hands, and feet. Then Ting Li Wan was given to drain water. It seemed slightly better initially, but overeating caused swelling to return, chest/hypochondriac pain, and sensations resembling Ben Tun (Running Piglet). Water overflowed, causing floating cough and wheezing. One must first attack the Rushing Qi to stop it, then treat the cough. Once cough stops, wheezing heals. Treat new disease first; old disease follows later.

[Zhu Danxi] Lu Shi Yi Jing Differentiation of Water Distension: The *Nei Jing* states: All Qi stagnation and depression belong to the Lungs. All Dampness, swelling, and fullness belong to the Spleen. All abdominal distension and enlargement belong to Heat. Dampness is the Qi of Earth; Earth is the child of Fire. Thus, Dampness often arises from Heat, and Heat can transform from Dampness (child influencing mother). For all swelling diseases, treating Dampness should be primary. Due to different accompanying factors, treatments vary. *Lei Li* discusses treating swelling by focusing on draining Water, suggesting guiding Kidney Qi to resolve it. Is this logical? Spleen Earth weakens, internally affected by Seven Emotions, externally by Six Qi, losing its transport and transformation function. Clear and turbid mix, stagnating into Water. *Lei Li* attributes the root and branch to Lung, Kidney, and Stomach, neglecting the Spleen. It subsequently states that excessive Lung Metal generates Water, water fluids act recklessly, Qi closes, pivot mechanisms block, causing swelling. If Spleen Earth is diseased, Lung is its child. How can the child become excessive and generate Water? If swelling water truly comes from Lung Qi, nourishing Kidney Yin and executing descending functions would create the source of transformation, preventing swelling. Now, water penetrates meridians and flows into valleys, being turbid and corrupt Qi, obstructing Jin Ye. Over time, it enters tunnels, blood transforms into water. To rely on Spleen Earth to control it and guide Kidney Qi to promote diuresis ignores that Spleen disease invites Liver Wood invasion. Child Qi also declines; Wood lacks fear, making Spleen disease inevitable. Treatment should clear Heart Fire, tonify Spleen Earth, restore transport functions, allow Lung Qi to descend, open seepage pathways, allowing clearer turbid Qi to revert to Qi, Blood, and Jin Ye; severe cases exit as sweat above and urine below, gradually dissipating. Now, failing to state this clearly, but speaking of controlling/drying Water, is this not like Bai Gui using neighboring states as ditches? The Classic states swelling is caused by Jin Ye filling the Guo (cavity/body), not by Lung Metal excess. It also states Qi rejects internally and耗 (consumes) externally, blaming the inability to seep and transport turbid Qi. It also says: Open Ghost Gates (sweat pores), Clean Pure Houses (bladder). Ghost Gates are skin/collaterals, belonging to Lung; Pure House is Bladder, belonging to Kidney. I have never heard of guiding Kidney Qi. Annotations on clothing/culture mention Yin Essence depletion; can Kidney Qi really be guided? Zhang Zhongjing said treating Dampness promotes urination, which is the meaning of cleaning the Pure House. If one considers Qing Jing (Pure/Clear) as Kidney and guides it, does it align with the Classic? Qian Zhongyang said Kidney has no draining method; how can it be lightly guided? Someone asks: The Classic says dredge and cleanse the Five Zang organs, is this not guiding Kidney? I say: This follows the previous statement that Five Yangs are already distributed. If Ghost Gates are open and Pure House is clean, Yang Qi of the Five Palaces distributes smoothly, and turbid Qi is naturally dredged and cleansed. What does this have to do with Kidney Qi?