黄帝问于岐伯曰。水与肤胀。鼓胀。肠覃。石瘕。石水。何以别之。（覃音尽）
余伯荣曰。此章论寒水之邪而为水。是肤胀鼓胀肠覃石瘕诸证。经云。太阳之上。寒水主之。
寒者。水之气也。肾与膀胱。皆积水也。故曰石水。石水者肾水也。如水溢于皮间。则为皮水。寒
乘于肌肤。则为肤胀。留于空郭。则为鼓胀。客于肠外。则为肠覃。客于子门。则为石瘕。皆水与
寒气之为病也。夫邪之所凑。其正必虚。外之皮肤肌腠。内之脏腑募原。肠胃空郭。皆正气之所循
行。气化则水行。气伤则水凝聚而为病。是以凡论水病。当先体认其正气。知正气之循行出入。则
知所以治之之法矣。
岐伯答曰。水始起也。目窠上微肿。如新卧起之状。其颈脉动。时咳。阴股间寒。足胫肿。腹
乃大。其水已成矣。以手按其腹。随手而起。如裹水之状。此其候也。
余氏曰。此太阳膀胱之水。溢于皮肤而为水胀也。太阳之气。营运于肤表。此水随气溢而为病
也。太阳之脉。起于目内 。上额交巅。循颈而下。目窠上微肿。水循经而溢于上也。其颈脉动。
水伤气而及于脉也。咳者。水邪上乘于肺也。阴股寒。足胫肿。太阳之气虚。而水流于下也。腹大者。
水泛而土虚也。水在皮中。故按之随手而起。如裹水之状。此其候也。
黄帝曰。肤胀何以候之。岐伯曰。肤胀者。寒气客于皮肤之间。 然不坚。腹大。身尽肿。皮
浓。按其腹 而不起。腹色不变。此其候也。（ 音空鼓声 音杳）
余氏曰。寒者。水之气也。此无形之气。客于皮肤而为虚胀也。无形之气。故 然不坚。
气胀。故腹大身尽肿也。寒气在于肌腠。故皮浓 深也。夫水在皮中。故按之即起。此病在气。故
按其腹。 而不起。腹色不变者。寒气在皮肤。而脾土未伤也。
鼓胀何如。岐伯曰。腹胀身皆大。大与肤胀等也。色苍黄。腹筋起。此其候也。
余氏曰。此寒气乘于空郭之中。所谓脏寒生满病也。脏寒者。水脏之寒气盛。而火土之气衰也。
身皆大者。脾主肌肉也。色苍黄。腹筋起者。土败而木气乘之也。
肠覃何如。岐伯曰。寒气客于肠外。与卫气相搏。气不得营。因有所系。癖而内着。恶气乃起。
息肉乃生。其始生也。大如鸡卵。稍以益大。至其成。如怀子之状。久者离脏。按之则坚。推之则
移。月事以时下。此其候也。（脏旧文岁今改正）
此寒气客于肠外而生覃也。夫卫气夜循脏腑之募原。行阴二十五度。寒气客于肠外。与卫气相
搏。则卫气不得营行矣。因有所系。癖而内着者。此无形之气。相搏于肠外空郭之中。而着于有形
之膏募也。是以血肉之恶气乃起。息肉乃生。而成此覃。久则离于脏腑之脂膜。如怀子之虚悬。按
之则坚。推之则移。不涉于脏腑。故月事以时下。此其候也。
石瘕何如。岐伯曰。石瘕生于胞中。寒气客于子门。子门闭塞。气不得通。恶血当泻不泻。
以留止。日以益大。状如怀子。月事不以时下。皆生于女子。可导而下。
余氏曰。胞中。血海也。在少腹内。男子之血。上唇口而生髭须。女子月事以时下。寒气客
于子门。则 门闭。而胞中之血。当泻不泻。留积而成 块。日以益大。状如怀子。血留胞中。故
月事不以时下。覃瘕皆生于女子。治之者可导下之。
黄帝曰。肤胀鼓胀可刺耶。岐伯曰。先泻其胀之血络。后调其经。刺去其血络也。
余氏曰。肤胀者。寒气客于外。鼓胀者。寒气客于内。故先泻其胀之血络。后调其经。刺去其
血络。盖先泻其外。后调其内。而复治其外。外内之相通也。任氏曰。肠覃石瘕。乃有形之血积。
可从气分而导之。肤胀鼓胀。乃无形之气胀。可从血络而泻之。血气之相通也。
Huangdi asked Qibo: How can one differentiate between Shuizhang (Water Distension), Fuzhang (Skin Distension), Guzhang (Drum Distension), Changqin (Intestinal Polypoid Mass), Shijia (Stone Fibroid), and Shishui (Stone Water)? ("Qin" is pronounced like "Jin")
Yu Borong stated: This chapter discusses how pathogenic cold-water qi leads to water metabolism disorders, resulting in syndromes such as Fuzhang, Guzhang, Changqin, and Shijia. The Classic states: "At the level of Taiyang, Cold-Water governs." Cold is the qi manifestation of water. The Kidney and Bladder are prone to accumulating fluid, hence it is called Shishui. Shishui refers to a disorder of Kidney Water. If water overflows into the subcutaneous tissue, it becomes Pi Shui (Skin Water); if cold pathogen invades the muscle and skin, it becomes Fuzhang; if it remains in the abdominal cavity's empty spaces, it becomes Guzhang; if it lodges outside the intestines, it becomes Changqin; if it lodges at the Zi Men (Os Uteri/Cervix), it becomes Shijia. All these diseases are caused by water and cold pathogen. Wherever pathogenic factors gather, the healthy qi must be deficient. The external skin and intermuscular spaces, and the internal Zang-Fu organs, Mu Yuan (Assemblage Origins), and intestinal cavities are all pathways for the circulation of healthy qi. When qi transformation functions normally, water flows smoothly; when qi mechanism is damaged, water condenses and causes disease. Therefore, whenever discussing water disorders, one must first ascertain the state of healthy qi. Understanding the entry and exit of healthy qi circulation allows one to determine the treatment methods.
Qibo replied: In the early stage of Shuizhang, there is slight swelling above the eye sockets, resembling the appearance after just waking up. There is palpable pulsation in the neck vessels. Coughing occurs intermittently. There is coldness in the inner thighs. Swelling of the calves follows. Subsequently, the abdomen enlarges, indicating that the water distension has fully formed. Pressing the abdomen with the hand results in immediate rebound without indentation, resembling a bag filled with water. This is the clinical presentation.
Master Yu stated: This is water from the Taiyang Bladder channel overflowing into the skin, causing water distension. The qi of the Taiyang channel circulates on the body surface, and water overflows along with the qi, causing disease. The Taiyang meridian originates from the inner canthus, ascends to the forehead, intersects at the vertex, and descends along the neck. Slight swelling above the eye sockets indicates water overflowing upward along the meridian. Palpable neck pulsations indicate that water pathogen damages qi and affects the vessels. Coughing indicates water pathogen ascending to overwhelm the Lung. Coldness in the inner thighs and calf swelling indicate deficiency of Taiyang qi and downward accumulation of water. Abdominal enlargement indicates water flooding and Spleen Earth deficiency. Since water resides in the subcutaneous layer, pressing causes immediate rebound, presenting as if wrapped in water. This is the clinical presentation.
Huangdi asked: How is Fuzhang diagnosed? Qibo answered: Fuzhang occurs when cold pathogen lodges between the skin and muscles. Percussion yields a hollow drum-like sound, and the mass is not hard. The abdomen is distended, and the entire body is swollen. The skin is thickened. Pressing the abdomen does not produce an indentation that rebounds. The abdominal skin color remains unchanged. This is the clinical presentation.
Master Yu stated: Cold is the qi manifestation of water. This formless qi lodges in the skin, causing false distension. Because it is formless qi, percussion yields a hollow sound and it is not hard. Because it is qi distension, the abdomen is large and the whole body is swollen. Cold pathogen residing in the muscle layers causes the skin to thicken and the pathology to be deep-seated. When water is in the subcutaneous layer, pressing causes immediate rebound. Here, the pathology is in the qi level, so pressing the abdomen does not cause rebound. The unchanged abdominal skin color indicates that the cold pathogen is only in the skin and has not yet injured the Spleen Earth.
What about Guzhang? Qibo answered: The abdomen is distended, and the entire body is enlarged to a degree similar to Fuzhang. However, the complexion is pale yellow, and the abdominal veins are prominent. This is the clinical presentation.
Master Yu stated: This is cold pathogen invading the empty spaces of the abdominal cavity, which is referred to as "Zang Cold generating fullness disorders." Zang Cold means excessive cold in the Water Zang (Kidney) and deficiency of Fire and Earth qi (Heart and Spleen). Whole-body enlargement occurs because the Spleen governs the muscles. Pale yellow complexion and prominent abdominal veins indicate Spleen Earth failure allowing Liver Wood qi to invade.
What about Changqin? Qibo answered: Cold pathogen lodges outside the intestines and contends with Wei Qi (Defensive Qi). Wei Qi cannot circulate properly, becoming bound and adhering internally. Evil qi arises, and polyps grow. Initially, the mass is the size of a chicken egg. It gradually increases in size until maturity, resembling pregnancy. In long-standing cases, the mass is detached from the Zang-Fu organs. It feels hard upon pressure but moves when pushed. Menstruation still occurs on time. This is the clinical presentation. (The character "Sui" in old texts is corrected to "Zang").
This describes a Qin-type mass generated by cold pathogen lodging outside the intestines. Wei Qi circulates through the Mu Yuan of the Zang-Fu during the night, traversing the Yin levels twenty-five times. Cold pathogen lodging outside the intestines contends with Wei Qi, preventing its normal circulation. Due to binding, the formless qi contends in the empty spaces outside the intestines and adheres to the tangible fat and Mu Yuan tissues. Consequently, evil qi in the blood and flesh arises, polyps form, and this Qin mass develops. Over time, it detaches from the fatty membranes of the Zang-Fu, hanging loosely like a pregnancy. It is hard to press but movable. Since it does not involve the interior of the Zang-Fu, menstruation proceeds on schedule. This is the clinical presentation.
What about Shijia? Qibo answered: Shijia originates in the Bao Zhong (Uterus/Womb). Cold pathogen lodges at the Zi Men (Cervix), causing closure. Qi flow is obstructed. Evil blood should be discharged but fails to do so, remaining stagnant. It enlarges daily, resembling pregnancy. Menstruation does not occur on time. These conditions occur exclusively in women and can be treated by guiding and purging downwards.
Master Yu stated: Bao Zhong is the Sea of Blood, located in the lower abdomen. In men, blood ascends to the lips and mustache to grow hair; in women, menstruation occurs regularly. Cold pathogen lodging at the Zi Men causes closure. Blood in the Bao Zhong should be discharged but remains stagnant, forming masses that enlarge daily, resembling pregnancy. Blood stagnating in the Bao Zhung prevents regular menstruation. Both Changqin and Shijia occur in women and can be treated with downward guiding methods.
Huangdi asked: Can Fuzhang and Guzhang be treated with acupuncture? Qibo answered: First, puncture and drain the collateral vessels associated with the distension. Then, regulate the meridians by removing the blood from the collaterals.
Master Yu stated: Fuzhang involves cold pathogen lodging externally, while Guzhang involves cold pathogen lodging internally. Therefore, one first drains the collateral vessels of the distension, then regulates the meridians, and removes the blood from the collaterals. This implies treating the exterior first, then regulating the interior, and finally addressing the exterior again, reflecting the connection between interior and exterior. Master Ren stated: Changqin and Shijia are tangible blood accumulations and can be guided from the Qi level. Fuzhang and Guzhang are intangible Qi distensions and can be drained via the blood collaterals. This utilizes the principle of the interconnection of Qi and Blood.