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Fu Zhang (Skin Distension) occurs when Cold Evil lodges between the skin and flesh. Percussion yields a drum-like sound, yet the abdomen is not firm; the abdomen is distended, the whole body is swollen, and the skin is thick. Pressing the abdomen leaves an indentation that does not rise immediately, and the abdominal color remains unchanged; this is the manifestation of Fu Zhang.

Fu Zhang arises from Yang Deficiency with Cold Evil lodging in the skin. There is no Water Evil internally, only Qi deficiency causing swelling; thus, percussion sounds like a drum and it is not firm, with thickened skin. Pressing the abdomen causes an indentation that does not rebound because Qi is deficient and cannot push upwards. The abdominal color remaining unchanged distinguishes it from Shui Zhang (Water Distension), where the skin is thin and lustrous, and indentations rebound immediately upon release. "Yao" (杳) implies depth or depression.

Gu Zhang (Drum Distension) presents with abdominal distension and generalized bodily enlargement, comparable in degree to Fu Zhang. The complexion is pale yellow, and abdominal collateral vessels are prominent; this is the manifestation of Gu Zhang.

This condition results from internal injury to the Liver and Spleen, causing cyanosis and jaundice to appear simultaneously, along with abdominal distension and protruding veins. Its etiology differs from Shui Zhang and Fu Zhang, and its symptoms are distinct. It is similar to the case mentioned later regarding inability to eat at night after eating in the morning, treated with Ji Shi Li (Chicken Dropping Fermented Liquid).

Chang Qun (Intestinal Polyp/Tumor) occurs when Cold Evil lodges outside the intestines, struggling with Wei Qi (Defensive Qi). Qi fails to circulate properly, becomes anchored, and forms fixed masses. Evil Qi arises, and polyps grow. Initially, the mass is the size of a chicken egg, gradually enlarging until it resembles pregnancy. In chronic cases lasting over a year, the mass feels firm upon pressure but can be moved by pushing. Menstruation still arrives on time; this is the manifestation of Chang Qun.

Chang Qun begins with Cold Evil lodging outside the intestines, within the shell of the body, which is the region of Wei Qi circulation. Cold Evil struggles with Qi, forming fixed accumulations, generating Evil Qi, and producing polyps. Over years, it grows large like pregnancy; it is firm on pressure but movable. Since the accumulation is in the Qi level, blood vessels remain patent, allowing menstruation to proceed on schedule. This is because it binds with Wei Qi, which circulates outside the vessels.

Shi Jia (Stone Mass) originates in the Bao Zhong (Uterus/Womb). Cold Evil lodges at the Zi Men (Os Uteri/Cervical Orifice), causing closure. Qi fails to flow freely, and Evil Blood (stagnant blood) should be discharged but is retained, stopping and accumulating daily. It enlarges progressively, resembling pregnancy, and menstruation does not occur on time. Shi Jia occurs exclusively in women and can be treated by guiding and purging downward.

Shi Jia results from Cold Evil lodging at the Zi Men, taking shape from blood, forming a stone-hard mass, hence the name. Located in the Bao Mai (Uterine Collaterals), it resembles pregnancy, commonly known as Ghost Fetus. Because Evil Blood is retained rather than discharged, stasis blocks menstruation. Unlike Chang Qun above, which involves the Qi level, Shi Jia involves the Blood level. Both occur in women and require treatment via promoting free flow and guiding downward. The Yellow Emperor also asked about Shi Shui (Stone Water), but Qibo did not answer; the principle is detailed in the previous volume under Various Wind Syndromes.