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Chen Liangfu stated: Fetal qi stagnation leads to dampness accumulation, resulting in edema of the body, hypochondrium, and abdomen, panting with shortness of breath, and astringent, difficult urination. The treatment principle should be to unblock stagnant qi and promote water metabolism, primarily using Zexie San (Alisma Powder).

The *Ji Yin Gang Mu* commentary notes: Zi Man (a condition characterized by excessive abdominal distension and generalized edema occurring after the fifth month of pregnancy) occurs after the fifth or sixth month of pregnancy, differing from Zi Qi (pregnancy-related edema due to qi stagnation) and Zi Zhong (pregnancy-related swelling of limbs and face). This is because as the fetus grows, the abdomen becomes full; fullness causes qi to float upward, leading to generalized edema where pathogenic factors have no specific locus. Simply resolving qi stagnation and promoting diuresis will lead to recovery.

The *Jin Gui Yao Lue* states: In pregnancy, when there is water qi retention, symptoms include heaviness of the body, difficult urination, chills resembling cold water being splashed on the skin, and dizziness upon rising. The primary formula is Kuizi Fuling San (Abelmoschus Seed and Poria Powder).

Xu Zhongke explained: When there is water qi, although severe swelling may not yet be present, the water pathways within the meridians are already obstructed. Wei qi (defensive qi) carries water dampness and cannot flow smoothly, causing the qi of the entire body to be stagnant due to water retention, hence the heaviness of the body. If water flows freely and smoothly, but if it regurgitates, it leads to difficult urination. Chills occur because Wei qi does not circulate properly. Dizziness occurs because internal water qi causes Jue Yang fire to rebel against Yin qi and steam upwards, causing visual disturbances and dizziness.

Xue Lizhai stated: For the aforementioned symptoms, if accompanied by chest fullness and abdominal distension, inability to urinate, and generalized edema, use Likou Tang (Carp Decoction) from the *Qian Jin Fang*. If there is Spleen-Stomach deficiency, combine with Sijunzi Tang (Four Gentlemen Decoction). If there is puffy edema of the face and eyes, and limbs feeling like they hold water, use Quansheng Baizhu San (Quansheng Atractylodes Macrocephala Powder); if ineffective, use Liujunzi Tang (Six Gentlemen Decoction). If there is Spleen deficiency with damp-heat causing lower body swelling, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Fuling (Poria). If caused by irregular diet leading to vomiting and diarrhea, use Liujunzi Tang. If legs and feet swell, accompanied by panting, oppression, restlessness, or fluid oozing from between fingers/toes, use Tianxianteng San (Aristolochia Vine Powder). If there is Spleen-Lung qi stagnation, use Jiawei Guipi Tang (Modified Restore the Spleen Decoction), assisted by Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder).

Shen Zhai commented: The above eight points describe the syndrome of Zi Man within the context of pre-partum swelling. Zi Man involves entanglement of water and blood, retained water due to dampness, closure of menstrual blood, and confusion of clear and turbid qi. The root cause is always Spleen Earth deficiency, failing to control water. Therefore, Xue Lizhai’s treatment methods focus primarily on invigorating the Spleen, leaching out dampness, smoothing qi, and calming the fetus. To claim, as the *Ji Yin Gang Mu* does, that simply purging qi and promoting diuresis cures the condition, is a fallacy. One must incorporate Xue Lizhai’s medication strategies to address the root cause. As for the following three points by Chen Liangfu, although named "fetal water," their clinical reality is identical to Zi Man under different names.