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Zhu Danxi said: The pulse in edema is mostly deep and hidden. If it is Yang water accompanied by Yang syndromes, the pulse must be deep and rapid (Shu). If it is Yin water accompanied by Yin syndromes, the pulse must be deep and slow (Chi). A pulse that is deep and slippery indicates Feng Shui (Wind Edema). A pulse that is floating and slow, or wiry and tight, all indicate swelling diseases. In water diseases, a洪大 (Hong Da, surging and large) pulse is treatable, while a 微细 (Wei Xi, fine and thin) pulse is untreatable. In water disease with distension and constipation, a floating and large pulse that is light upon palpation indicates survival (favorable prognosis), whereas a deep, fine, empty, and small pulse indicates death (unfavorable prognosis). In abdominal edema where the belly is large like a drum, a solid pulse indicates survival, while a deficient pulse indicates death; a Hong Da pulse indicates survival, while a Wei Xi pulse indicates death. In Zhong E (sudden severe illness due to evil qi) with abdominal distension and fullness of the four limbs, a large and slow pulse indicates survival, while a floating and tight pulse indicates death. In abdominal distension with bloody stool, a large pulse with intermittent interruptions or extreme severity, or a small and rapid pulse, indicates death. In swelling diseases, if the pulse is tight and both Ying (Nutrient) and Wei (Defensive) Qi are exhausted, and the face is swollen, it indicates death.

[Critical Signs of Edema] Generally, if edema starts in the abdomen and then spreads to the four limbs, it is treatable; if it starts in the four limbs and then returns to the abdomen, it is untreatable. Swelling of the palms resulting in the disappearance of skin creases indicates death. Sliding diarrhea with persistent edema indicates death. Black lips, swollen lips, and scorched teeth indicate death. Protruding and swollen umbilicus indicates death. Flat supraclavicular fossae (Que Pen) indicate death. Swelling of both the scrotum and penis indicates death. Exhaustion of the pulse, open mouth, and swollen feet indicate death. Swollen feet with knees protruding like a measuring cup indicate death. Visible green veins on the abdomen with abdominal swelling persisting after diarrhea indicates death. For men, edema spreading from the lower body upward, and for women, edema spreading from the upper body downward, are both difficult to treat.

In the "Tang Ye Lao Li Lun" chapter of *Su Wen*, the Yellow Emperor asked: There are cases where the disease does not originate from the hair follicles (body surface), but rather the Yang Qi of the five Zang organs is exhausted. Fluids fill the chest cavity, only the Po (Lung Spirit) remains alone, isolated Jing (Essence) is within, and Qi is depleted outside. The form is so emaciated that it cannot even maintain its clothes. This condition involves urgent swelling in the four limbs and internal organ agitation. This is Qi blocked internally and pathology manifesting externally. How should it be treated?

Qibo replied: One should balance and regulate using weighing scales (metaphor for diagnostic assessment), remove accumulated old debris (Wan Chen), slightly move the four limbs, wear warm clothing, apply Miu Ci (diagonal needle insertion) at corresponding sites, to restore the normal form. Open the Gui Men (Ghost Gate/sweat pores), clean the Jing Fu (Clean Mansion/bladder). (Note from *Neijing Yaozhi*: "Not originating from hair follicles" means the disease arises internally. Yin Qi is abundant inside, Yang Qi is exhausted, unable to enter the abdomen, hence "Yang Qi of the five Zang organs is exhausted." Jin Ye (Fluids) refers to water, filling the chest and skin. Yin accumulates internally, water Qi causes distension, attacking the Lung upwards, leaving Lung Qi isolated and critical. Po is the spirit of the Lung. Kidney is the harm of water; as the child, it fails to save the mother, hence "its Po remains alone." If Yin Jing is damaged internally and Yang Qi is depleted externally, the San Jiao becomes closed and overflowing, water passages do not flow, water fills the skin, causing body swelling, hence "the form cannot maintain its clothes." In such cases, the pulses in the four limbs are rapid and agitated internally affecting the Lung. Lung movement refers to rapid breathing and coughing. Such conditions involve water Qi rejecting within the peritoneum and swelling manifesting on the body's exterior. Investigating root and branch, can this be resolved? "Ping Zhi Quan Heng" means examining the pulse for floating or deep. Floating pulse indicates exterior syndrome; deep pulse indicates interior syndrome. For interior, use purgation; for exterior, use sweating. Hence "Open Gui Men, Clean Jing Fu." "Qu Wan Chen Cuo" means removing long-standing water accumulation, like grass clippings that should not remain in the body. Thus, *Yu Ji Wei Yi* states: Gui Men refers to something profound and invisible, referring to sweat pores whose opening and closing are unseen. When pathogenic Qi enters, it struggles with healthy Qi, pores close, causing chills and fever. Since the pathogen resides in the exterior, one should induce sweating to expel the pathogen via the gate. This is another term for sweating, a general rule for expelling exterior pathogens. Jing Fu refers to the Bladder, which has no internal entry but an external exit, serving as the mansion for clear fluids. When Kidney Qi transforms grain essence into fluid and seeps into the bladder, Qi constrains it to form urine for excretion. The Kidney governs the Lower Jiao, controlling the opening and closing of the orifices. Lung and Spleen Qi regulates water passages, transporting downwards to the Bladder. Through Qi transformation, water flows and naturally clears. Otherwise, dysuria, turbidity, or stranguria occur, becoming water Qi overflowing into the interstices, causing various swellings. If curved, accumulated old weeds obstruct the body, these substances must be purged to achieve clarity, making these two methods appropriate. Exterior is treated by sweating, interior by purging, balancing treatment. Although the classic states: Water diseases originate from the Lung and Kidney meridians, why do ancient and modern formulas rarely discuss treating water turbidity by purging Kidney Qi? Because Kidney Yin executes descending functions, being the source of generation yet often insufficient. When Yin Jing is depleted internally, Sheng Qi (Vital Qi) cannot transform, leading to edema, which is already exhausted. How much more so when the Lung is weak and maternal Qi is isolated? Therefore, Li Dongyuan said: If treated with sweet, bland, draining, and Yang-promoting herbs, with solitary Yang and no Yin, how can transformation occur? This deeply extracts the subtleties of the above treatment examples. For instance, retained fluid damaging the Spleen Earth is like soil turning to mud in rain. Or, caused by Seven Emotions, affecting the Hand and Foot Taiyin meridians, causing body and facial swelling resembling water Qi, using formulas that dry the Spleen and guide Qi will cure it. One aspect is like mud receiving gentle wind and warm sun, where water dampness leaves and Yang transforms, allowing natural growth; the other is Lung Qi opening and venting, promoting drainage and unblocking, so water Qi does not stagnate in the Spleen. This aligns with "All dampness, swelling, and fullness belong to Spleen Earth; All Qi frustration and depression belong to Lung," differing from the mechanism of water Qi disease caused by Yin-Yang imbalance, thus not requiring the methods of "Opening Gui Men and Cleaning Jing Fu".)