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(One treatise, forty-nine prescriptions, three syndrome descriptions, two moxibustion methods)

The treatise states: Generally speaking, edema (water disease) is difficult to cure. After recovery, one must be particularly cautious about diet. Patients with edema often have cravings for food, which makes this disease hard to heal. Some physicians in past dynasties, following worldly trends and seeking profit, disregarded the patients' lives. When a patient desired food, they advised eating sheep heads and hooves; under such circumstances, not a single patient recovered. Furthermore, in this disease, both Qi and water are in a state of excess within the hundred vessels. Physicians all wish to treat it by purging. However, sheep heads and hooves are extremely tonifying; how can recovery be achieved? Therefore, herbs used to treat edema mostly include Lepidium Seed (Tingli, 葶苈) and others. The *Materia Medica* states: Long-term use of Lepidium Seed causes severe deficiency. Thus, unless an edema patient has been chronically deficient, one must not sever their root foundation. There is also Gu distension (Gu Zhang), where only the abdomen is distended without swelling; whereas in water distension, the limbs, face, and eyes are all swollen. If physicians are not skilled in diagnosis, they may treat Gu distension with water-draining medicines, or treat water distension with Gu-toxin medicines. Or, if there is merely distension, they still use water-draining medicines. As Zhang Zhongjing said: "Foolish physicians kill them." The following taboos are recorded: mourning periods, postpartum state, music and entertainment, sexual intercourse, noisy play, all fish, all meats, all raw and cold foods, vinegar and slippery foods, garlic, sticky foods, rice and beans, and greasy foods. The prescriptions for treating Gu distension are detailed in the Miscellaneous Prescriptions chapter, found in Volume 24, Gu Toxin chapter. The aforementioned prohibited foods should not be eaten, nor should one exert mental effort. Items not prohibited are listed below each prescription. Regarding taboos on sexual intercourse, etc., one must be cautious for three years to prevent recurrence. Otherwise, even if cured, recurrence will make further treatment impossible. Ancient formulas include Shishui Wan (Ten Waters Pill), which has been verified many times; it mostly promotes bowel movements rather than urination, so it is not recorded here.

The Yellow Emperor asked Qibo: How can one distinguish between Edema (Shui), Skin Distension (Fuzhang), Drum Distension (Guzhang), Intestinal Polyps (Changqin), and Ovarian Tumors (Shijia)? Qibo replied: At the onset of Edema, there is slight swelling above the eye sockets (recorded as "slight obstruction" in *Ling Shu* and *Tai Su*), resembling the appearance after just waking up. The neck vessels pulse, there is occasional coughing, coldness in the inner thighs, and swelling of the calves. Only then does the abdomen enlarge, indicating that water has formed. Pressing the abdomen with the hand causes it to rise immediately upon release, resembling a bag wrapped around water; this is its sign. In Skin Distension, cold qi lodges between the skin and flesh. The abdomen is hollow yet firm (recorded as "not firm" in *Tai Su* and *Wai Tai Mi Yao*), the abdomen is large, the whole body is swollen, the skin is thick, pressing the abdomen leaves an indentation that does not rebound (recorded as such in *Tai Su*), and the abdominal color remains unchanged; this is its sign. In Drum Distension, the abdomen is distended and the body is swollen, similar in size to Skin Distension, the complexion is dark yellow, and the abdominal veins are prominent; this is its sign. In Intestinal Polyps, cold qi lodges outside the intestines and clashes with Wei Qi (recorded as Stomach Qi in *Tai Su*). Zheng Qi cannot circulate, leading to binding masses that inject inward, causing evil qi to arise and polyps to form. Initially, they are as large as a chicken egg, gradually increasing in size until they resemble pregnancy. In long-standing cases, the cervical os becomes blocked, Qi cannot flow freely, and evil blood should be discharged but remains stagnant, enlarging daily, resembling pregnancy. Menstruation does not occur on time. These conditions occur only in women and can be treated by guiding and draining them. The Yellow Emperor asked: Can Skin Distension and Drum Distension be treated with acupuncture? Qibo replied: First, drain the blood collaterals in the abdomen, then regulate the meridians, and puncture to remove blood stasis. The Master said: Diseases include Wind-Edema, Skin-Edema, Correct-Edema, Stone-Edema, and Yellow Sweat. In Wind-Edema, the pulse is naturally floating, external signs include bone and joint pain, and aversion to wind. In Skin-Edema, the pulse is also floating, external signs include edema that indents deeply upon pressure, no aversion to wind, abdomen like a drum, no thirst, and treatment should induce sweating. In Correct-Edema, the pulse is deep and slow, external signs include spontaneous wheezing. In Stone-Edema, the pulse is naturally deep, external signs include abdominal fullness (recorded as pain in *Mai Jing*), without wheezing. In Yellow Sweat, the pulse is deep and slow, the body feels feverish, there is chest fullness, swelling of the limbs, head, and face; if untreated for a long time, it will inevitably lead to abscesses and pus. In Heart-Edema, the body is heavy (or swollen) and short of breath, unable to lie down, irritable and restless, with swelling of the genitalia. In Liver-Edema, the abdomen is large and the patient cannot turn over independently, with pain in the hypochondrium and abdomen, occasional production of saliva, and intermittent urination. In Spleen-Edema, the abdomen is also large, the limbs suffer from heaviness, saliva is not produced, there is only shortness of breath, and difficulty urinating. In Lung-Edema, the body is swollen, urination is difficult, and stools are loose like duck droppings. In Kidney-Edema, the abdomen is large, the umbilicus is swollen with lower back pain, inability to urinate, dampness in the genitalia resembling sweat on a cow's nose, cold feet, and a thin face. The Master said: For all edema cases, if swelling is below the waist, promote urination; if swelling is above the waist, induce sweating for recovery. A question was raised: After diarrhea, if the patient is thirsty and drinks water, has difficulty urinating, and develops abdominal fullness followed by swelling, what is the cause? The Master said: This condition should be considered Water Disease. If urination becomes free and sweating occurs, it will heal spontaneously (or heal within a month). At the beginning of any edema, swelling appears first above the eyes, resembling the color of an old silkworm, accompanied by pulsation of the neck vessels, coldness in the thighs, fullness in the calves, and deep indentation upon pressure. If water has already formed, it is still treatable. This disease arises from deficiency and damage.

After a major illness or diarrhea, or in postpartum women, if ingested water fails to transform, and the Triple Burner leaks, causing difficulty in urination, the fluids bind and accumulate, eventually flowing into the various meridians.

There are ten types of edema, five of which are incurable. The first is black lips, injuring the Liver. The second is a flat Supraclavicular Fossa (Quepen), injuring the Heart. The third is protruding umbilicus, injuring the Spleen. The fourth is a flat back, injuring the Lungs. The fifth is flat and full soles, injuring the Kidneys. These five injuries are definitely incurable.

In all edema cases, one must taboo fluid leaking from the abdomen. If fluid leaks from the abdomen, death occurs within one month; this is strictly forbidden.