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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The Kidney belongs to the Supreme Yin (Zhi Yin), and the Supreme Yin stores abundant water. The Lung belongs to the Great Yin (Tai Yin). Shaoyin is the pulse of winter. Therefore, the root of edema lies in the Kidney, while its branch lies in the Lung; both are caused by the accumulation of fluid.

The Yellow Emperor asked: Why can the Kidney accumulate fluid and cause disease? Qibo replied: The Kidney is the gate of the Stomach. If this gate is obstructed, fluid will accumulate and spread according to its nature, overflowing upwards and downwards onto the skin, thus causing edema.

Edema refers to disease caused by the accumulation of fluid. Therefore, in water diseases, lower manifestations include abdominal distension and swelling, while upper manifestations include asthma, dyspnea, and inability to lie flat. This indicates that both the root (Kidney) and the branch (Lung) are diseased. Thus, Lung disease manifests as asthma, dyspnea, and inability to lie flat, while Kidney disease manifests as edema.

Fluid overflows from the Lower Jiao (Lower Burner) to become water. Wang Bing commented: The Lower Jiao is the site where fluids are distributed and excreted. If Qi stagnation prevents excretion, it overflows and becomes water.

When the Lung transfers cold to the Kidney, this condition is called Yong Shui (Surging Water). (See symptoms below under the formula Tingli Wan).

In all cases of water qi disease, slight swelling first appears under the eyes.

The *Ling Shu: Zhen Jing* (Needling Classic) states: When water disease begins, there is slight swelling above the eye sockets, resembling the appearance after just waking up. The carotid pulse at the neck throbs, there is occasional coughing, coldness between the thighs, and swelling of the ankles and calves. When the abdomen becomes large, the water disease is established. Pressing the abdomen with the hand causes the indentation to rise immediately upon release, resembling a bag filled with water. This is the sign of water disease.

The legs and shins are the pillars of the human body, used for walking and running. The penis and scrotum are the mechanisms of the body, indicators of Yin essence, and pathways for Jin Ye (Body Fluids). Therefore, if dietary habits are irregular and emotions like joy and anger are not regulated in time, Jin Ye will overflow internally and flow downward into the testicles. This leads to obstruction in the blood channels, resulting in continuous enlargement. Bending and stretching become inconvenient, and walking becomes difficult. This disease is caused by Ying Wei (Nutritive and Defensive Qi) stagnation with water retention, neither ascending nor descending.

Respectfully noted: The *Neijing* discusses various water qi diseases as primary diseases of the respective Zang organs. The citations from the *Zhen Jing* emphasize that diet and Seven Emotions (Qi Qing) can also cause such diseases. This reveals the subtlety of pathogenesis. However, dampness edema and Qi edema are initially quite similar. Yet, pressing with the hand leaves an indentation that does not immediately recover in dampness edema. Dampness and water differ in severity. Moreover, Qi edema and various forms of water disease have different morphological signs. The key lies in careful examination during clinical practice.

Diseases include Feng Shui (Wind Water), Pi Shui (Skin Water), Zheng Shui (Regular Water), and Shi Shui (Stone Water).

If the Cun Kou (Radial artery at the wrist) pulse is deep and slippery, it indicates internal water qi. Symptoms include swollen face and eyes, fever, or heavy and achy body, or aversion to wind, with generalized swelling. If the pulse is floating, there is no thirst, continuous spontaneous sweating occurs without significant heat, these all belong to Feng Shui.

Pi Shui has a floating pulse. External signs include swelling; pressing the area yields resistance or immediate rebound (as per "Ji Zhi"), there is no aversion to wind, the abdomen is drum-like, and there is no thirst. Sweating therapy should be employed. For Pi Shui characterized by four-limb edema and water qi residing in the skin, with slight trembling movements in the limbs, Fangji Fuling Tang (Acanthopanacis Senticosi and Poria Decoction) is the primary treatment.

Zheng Shui has a deep and slow pulse. External signs include spontaneous asthma.

Shi Shui has a naturally deep pulse. External signs include abdominal fullness without asthma.

Huang Han (Yellow Sweat) combined with Feng Shui has a naturally floating pulse. External signs include joint pain and aversion to wind.

Xin Shui (Heart Water) patients have a heavy body, shortness of breath, inability to lie flat, irritability, dryness, and significant swelling of the genitalia.

Gan Shui (Liver Water) patients have abdominal distension, inability to turn over independently, pain in the hypochondrium and abdomen, frequent production of saliva, and intermittent urination.

Fei Shui (Lung Water) patients have bodily swelling, difficulty in urination, and frequent loose stools resembling duck feces.

Pi Shui (Spleen Water) patients have abdominal distension, heavy and painful limbs, lack of Jin Ye generation, only feeling short of breath, and difficulty in urination.

Shen Shui (Kidney Water) patients have abdominal distension, umbilical swelling, lower back pain, inability to urinate, dampness in the genitalia resembling sweat on a bull's nose, cold feet, and a thin face.

Li Shui (Interior Water) patients have yellowish and swollen face and body, a deep pulse, and unfavorable urination, which leads to water disease.

For all water diseases, if swelling is below the waist, diuresis (promoting urination) should be used; if swelling is above the waist, sweating therapy should be used. Only then will the patient recover.

Note: The above discussion on the signs and symptoms governed by the five Zang organs differs fundamentally from discussions in other classics. See details below under Shenjin San. Careful examination is required.