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Huangdi asked: How can one differentiate between edema (Shui), distension of the skin (Fuzhang), drum-like distension (Guzhang), intestinal polyps (Changqin), and stone masses in the uterus (Shijia)? Qibo replied: When edema first begins, there is slight swelling above the eye sockets, resembling the appearance after just waking up; the pulse at the neck moves; there is occasional coughing; a sensation of coldness between the inner thighs; swelling of the calves; and subsequently, the abdomen becomes enlarged. Once the edema has fully formed, pressing the abdomen with the hand causes it to rise immediately upon release, resembling a state where water is wrapped inside; this is its clinical manifestation.

Distension of the skin (Fuzhang) occurs when cold qi lodges between the skin and flesh. The abdomen is distended but not firm to the touch; the entire body is swollen; the skin is thickened; pressing the abdomen leaves an indentation that does not rebound quickly; and the abdominal color remains unchanged; this is its clinical manifestation.

Drum-like distension (Guzhang) presents with abdominal and bodily swelling similar to Fuzhang, but the complexion is pale yellow, and the abdominal collateral vessels are prominent; this is its clinical manifestation.

Intestinal polyps (Changqin) occur when cold qi lodges outside the intestines and contends with Wei Qi (Defensive Qi). Zheng Qi (Upright Qi) fails to circulate properly, leading to attachment and formation of a mass within. Evil qi arises, and polyps grow. Initially, the mass is the size of a chicken egg and gradually enlarges. Upon full development, it resembles a cup. After many years, it feels hard to pressure but movable upon pushing; menstruation still occurs on time; this is its clinical manifestation.

Stone masses in the uterus (Shijia) originate in the Bao Zhong (uterus). Cold qi lodges at the Zi Men (cervical os), causing closure and obstruction of Qi flow. Evil blood that should be discharged is retained and stagnates, enlarging daily until it resembles a cup. Menstruation does not occur on time. These conditions occur only in women and can be treated by guiding and purging downward methods.

A question was posed: Can Fuzhang and Guzhang be treated with acupuncture? The answer was: First, puncture the blood collaterals in the abdomen, then regulate the meridians, and also puncture to remove stagnant blood. Another question arose: What disease is characterized by fullness in the heart and abdomen, where one cannot eat dinner if they ate breakfast? The answer was: This is called Guzhang. It is treated with Jishi Li (Chicken Excrement Fermented Liquid); improvement is seen after one dose, and recovery after two doses. Why does it sometimes recur? Because of irregular diet and drinking habits. Thus, the disease appears intermittently. Although the acute phase may subside, wind qi tends to accumulate in the abdomen.

For Feng Shui (Wind Edema) and Fuzhang, the "Fifty-Nine Acupoints" needling method (recorded as Fifty-Seven in *Ling Shu*) is used, targeting all visible blood collaterals in the skin. For pure water retention (Tu Shui) without other symptoms, first needle three cun below Huan Gu, retain the needle, guide the Qi inward, withdraw, and repeat to drain the water completely. The area must be tightly bound; loose binding causes irritability, while tight binding brings calmness. Needle every other day until the water is exhausted. During medication, observe dietary restrictions: during needling, drink only water; during drinking, do not eat; during eating, do not drink; avoid all other foods for 135 days.

If edema patients have complete fullness in the Ren Zhong (philtrum) and everted lips, it indicates a fatal prognosis; Shuigou (GV26) governs this condition. If edema is severe enough to flatten the umbilicus, moxibustion on Shenque (CV8) is indicated; improper treatment leads to incurability. For edema with water qi moving within the skin, Yinjiao (CV7) governs this. For edema with abdominal distension and water qi moving within the skin, Shimen (CV5) governs this. For Shi Shui (Stone Water) with pain radiating to the hypochondrium and distension, dizziness, headache, and generalized heat, Guanyuan (CV4) governs this. For chills and large abdominal Shi Shui, Siman (KI14) governs this. For Shi Shui, needle Qichong (ST30); Shi Shui is also governed by Zhangmen (LR13) and Ranggu (KI2); Shi Shui is also governed by Tianquan (HT2). For excessive Qi in the abdomen, abdominal distension with counterflow Qi (or water distension counterflow), and inability to lie down, Yinlingquan (SP9) governs this. For retained fluid in the water mechanism with chest and hypochondriac fullness and distension, needle Xangu (ST41) and bleed to achieve immediate relief. For edema with skin swelling, Zusanli (ST36) governs this. For large hernias, masses, and accumulations in the Bao Zhong (uterus) causing pain radiating to the Yin region, with distressing upward and downward discharge, tonize Chize (LU5) and Taixi (KI3); also apply tonification to the Cun Kou pulse of the Hand-Yangming Large Intestine Meridian.