诸本无篇字。
水始起也（止）此其候也 马云。病方起时。目之下为窠。（俗云卧蚕）其微有所肿。如新卧起之
状。大抵人之卧起者。其目窠上必肿也。颈脉即人迎穴也。此脉动于颈。而咳动于内。在阴股则冷。在足胫则
肿。在上腹则大。以手按其腹。则随手而起。如裹水状。此水病已成。而可验者也。（按素问阴阳别论云三阴
结谓之水启玄子云三阴者谓脾肺之脉俱寒结也脾肺寒结则气化为水又按本经五癃津液篇有云五谷之精气和合而
为膏者内渗入于骨空补益脑髓而下流于阴股阴阳不和则使液溢而下流于阴髓液皆减而下下过度则虚虚故腰背痛
而胫 阴阳气道不通四海闭塞三焦不泻津液不化水谷并于肠胃之中别于回肠留于下焦不得渗膀胱则下焦胀水溢
则为水胀又按论疾诊尺篇言风水肤胀视人之目窠上微肿如新卧起状其颈脉动时咳按其手足 而不起则当知随手
而起为有水无风 而不起为有风有水也）张云。阳明之脉。自人迎下循腹里。而水邪乘之。故为颈脉动。水之
标在肺。故为时咳。阴股间寒。足胫 。腹乃太阴。邪始于阴分也。HT 、 同。凡按水囊者。必随手而起。
故病水者亦若是。以上皆水肿之候。简案、平人气象论曰。颈脉动喘疾咳曰水。目窠微肿。如卧蚕起之状曰水。
亦与本节及论疾诊尺篇文同。不谓之人迎而谓颈脉者。非诊之而始知其动之疾。以其望而知颈脉之疾也。
肤胀者（止）此其候也 甲乙。 、作壳壳。张云。 、鼓声也。寒气客于皮肤之间者。阳气不行。
病在气分。故有声若鼓。气本无形。故不坚。气无所不至。故腹大。身尽肿。若因于水。则有水处肿。无水处
不肿。此为可辨。然有水则皮泽而薄。无水则皮浓。寒气在肤腠之间。按散之。则不能猝聚。故 而不起。腹
色不变。即皮浓故也。愚按、此上两条云。以手按其腹。随手而起者属水。 而不起者属
气。此固然也。然按气囊者。亦随手而起。又水在肌肉之中。按而散之。猝不能聚。如按糟囊者。亦 而不起。
故未可以起与不起。为水气的辨。但当察其皮浓色苍。或一身尽肿。或自上而下者。多属气。若皮薄色泽。或
肿有分界。或自下而上者。多属水也。简案、论疾诊尺篇云。按其手足上。 而不起者。风水肤胀也。亦与本
节同。又金匮要略云。皮水其脉亦浮。外证跗肿。按之没指。不恶风。又云。按其手足上。陷而不起者。风水。
巢源云。燥水谓水气溢于皮肤。因令肿满。以指画肉上。则隐隐成文本者。名曰燥水。以指画肉上。随画随散。
不成文本者。名曰湿水。由此推之。肤胀、即金匮所谓皮水、风水。巢源所谓燥水也。然胀不可拘起与不起之
说。当为实验之言也。壳、玉篇。物皮空也。 字亦从鼓从空。盖中空之义。诸注为鼓声。岂有不坚而有声之
理乎。
腹胀（止）此其候也 马云。鼓胀与肤胀等。不言按之起与不起。当亦是不起者。惟其腹筋起者为辨。
又按素问腹中论。黄帝曰。有病心腹满。旦食则不能暮食。名为何病。岐伯曰。名为鼓胀。治之以鸡矢醴。一
剂知。二剂已。此方果有奇验云。李云。鼓胀肤胀。大同小异。只以色苍黄。腹筋起为别耳。
肠覃（止）此其候也 甲乙。癖、作瘕。 、作息。离脏、作离岁月三字。诸本唯作离岁。独志改作离
脏。张云。覃、延布而深也。寒气与卫气相搏。则 积不行。留于肠外。有所系着。故癖积起 肉生。病日以
成矣。 肉、恶肉也。离岁、越岁也。寒邪客于肠外。不在胞中。故无妨于月事。其非血病可知。盖由汁沫所
聚。而生此肠覃之候也。简案、覃义未详。盖此与蕈同。慈在切。唐韵。菌生木上。又玉篇。
蕈、地菌也。肠中垢滓。凝聚生 肉。犹湿气蒸郁。生蕈于土木。故谓肠覃。正字通。方书、鼻疣曰 肉。亦
谓之 菌。鼻通息。故从息。 菌乃与肠蕈之义符。但以鼻息释 者。误。说文。 、寄肉也。即生息一肉之
义。甲乙作息肉可证。离岁、历岁也。离训历。见诗小雅小宛疏。肠覃治方。陈氏三因有乌喙丸。罗氏卫生宝
鉴有 露丸。见 丸等。当并考。
石瘕（止）可导而下 甲乙。下下有之字。张云。 、凝败之血也。子门闭塞。则 血留止。其坚如石。
故曰石瘕。月事不以时下。惟女子有之也。故可以导血之剂下之。按篇首帝有石水之问。而此下无答。必阙失
也。考之阴阳别论曰。阴阳结邪。多阴少阳曰石水。少腹肿。其义即此。简案、说文。 、凝血也。五脏生成
篇。赤如 血死是也。导、谓坐导药。其病在胞中。故用坐药以导下之。张注非。
先泻其胀之血络（止）去其血络也 甲乙。胀、作腹后。血络、作血脉。张云。先泻其胀之血络。谓
无论虚实。凡有血络之外见者。必先泻之。而后因虚实以调其经也。刺去其血络。即重明先泻之义。按本篇自
水而下所言者。凡六证。而此独以二证之刺为问者。盖水俞五十七穴。已详于水热穴论。故不必再问。此云肤
胀鼓胀者。盖兼五证而统言之。辞虽简而意则赅也。
各版本中均无“篇”字。
水病初起时（以下描述其征候）马云说：疾病刚开始发作时，眼下眼睑会出现如卧蚕般的微肿，就像刚睡醒时的样子。大抵人睡觉或起床时，眼窝上方必然会有些浮肿。颈脉即人迎穴处的脉搏，此脉在颈部跳动，咳嗽时搏动更明显于内侧；大腿根部感觉寒冷，小腿肿胀，腹部胀大。用手按压腹部，手移开后腹部随即弹起，像包裹着水的状态。这是水病已经形成，可以验证的征象。（按《素问·阴阳别论》说：“三阴结谓之水”，启玄子王冰注解说：“三阴”指的是脾肺之脉俱有寒邪凝结。脾肺寒邪凝结则气化功能失常，转化为水液。又按本经《五癃津液篇》说：“五谷的精微之气和合而成膏脂，内渗入骨空以补益脑髓，下流至大腿根部。若阴阳不和，则使津液外溢并下流至阴部，导致髓液减少。下部过度亏损则虚，虚则腰背疼痛且小腿……阴阳气道不通，四海闭塞，三焦不能通泻，津液不化，水谷之气并入肠胃之中，分别于回肠，留滞于下焦，不能渗入膀胱，导致下焦胀满，水液溢出则为水胀。”又按《论疾诊尺篇》说：“风水肤胀，观察患者眼窝上方微肿，像刚睡醒的样子，颈部脉搏跳动且时常咳嗽，按压手足背部凹陷不起的，应当知道是‘随手而起’为有水而无风，‘凹陷不起’为有风兼有水。”）张景岳说：阳明经脉从人迎穴向下沿循腹里，水邪乘虚侵袭，所以出现颈脉跳动。水的标证在肺，所以时常咳嗽。大腿间寒冷，足胫肿胀，腹部胀满是太阴脾经受邪，病邪始于阴分。HT、同。凡按压充满水的气囊，必定随手弹起，所以患水病的人也是如此。以上都是水肿的征候。简案：《平人气象论》说：“颈脉跳动、气喘、急咳称为水病；眼窝微肿，像卧蚕起的样子称为水病。”这也与本节及《论疾诊尺篇》的文字相同。不称为人迎而称为颈脉，是因为不是通过切诊才知其跳动急促，而是通过望诊就知道颈脉跳动急促。
肤胀（以下描述其征候）《甲乙经》中，“ ”写作“壳壳”。张景岳说：“ ”指鼓声。寒气客居在皮肤之间，阳气运行不畅，病在气分，所以声音像敲鼓一样。气本来没有形体，所以腹部不坚硬。气无所不至，所以腹部胀大，全身浮肿。如果是因水所致，则有水的地方肿胀，无水的地方不肿胀，这是可以辨别的。然而若有水，皮肤润泽而薄；若无水，皮肤厚。寒气在肤腠之间，按压后散开，不能迅速聚拢，所以按压后凹陷不起。腹部颜色不变，就是因为皮肤厚的缘故。愚按：上面两条说，用手按压腹部，随手弹起的属于水病，凹陷不起的属于气病。这固然正确。然而按压充满空气的气囊，也会随手弹起；另外水在肌肉之中，按压后散开，也不能迅速聚拢，像按压酒糟袋一样，也会凹陷不起。所以不能仅凭凹陷与否来辨别是水还是气，只应当观察皮肤是否厚色苍，或者全身尽肿，或者从上往下肿的，多属于气；若皮肤薄色泽润，或者肿胀有界限，或者从下往上肿的，多属于水。简案：《论疾诊尺篇》说：“按压手足背部，凹陷不起的，是风水肤胀。”这也与本节相同。又《金匮要略》说：“皮水脉也浮，外证跗肿，按之没指，不恶风。”又说：“按压手足背部，凹陷不起的是风水。”巢元方《诸病源候论》说：“燥水是指水气溢于皮肤，因而令身体肿满。用手指划过皮肤，隐隐形成痕迹的，名叫燥水；用手指划过皮肤，随划随散，不成痕迹的，名叫湿水。”由此推断，肤胀就是《金匮要略》所说的皮水、风水，以及《诸病源候论》所说的燥水。然而对于胀病的判断不可拘泥于“起”与“不起”的说法，应当作为实证检验的话来看待。“壳”，《玉篇》解释为物体皮中空。“ ”字也从鼓从空，大概是中空的意思。各位注家解释为鼓声，难道有不坚硬却有声音的道理吗？
腹胀（以下描述其征候）马云说：鼓胀与肤胀等同，没有说按压后起与不起，应当也是不起的情况。只有腹部青筋暴露才是辨别的关键。又按《素问·腹中论》，黄帝问：有心腹满，早上吃饭晚上就不能吃的病，叫什么病？岐伯说：名叫鼓胀。用鸡矢醴治疗，一剂见效，二剂痊愈。据说这个方子果然有奇效。李云说：鼓胀和肤胀大同小异，只是以面色苍黄、腹部青筋暴露作为区别。
肠覃（以下描述其征候）《甲乙经》中，“癖”写作“瘕”，“ ”写作“息”，“离脏”写作“离岁月”三字。各版本只作“离岁”，唯独志丹改作“离脏”。张景岳说：“覃”意为延伸铺展且深。寒气与卫气相搏结，则气血积聚不行，留滞在肠外，有所系着，所以癖积兴起，长出息肉，病情日益形成。“ ”肉，即恶肉。“离岁”即越岁。寒邪客居在肠外，不在胞宫，所以不影响月经，可知这不是血病。大概是由汁沫聚集，而产生这种肠覃的征候。简案：“覃”的含义不详。大概这与“蕈”同义，音慈在切，《唐韵》解释为菌生长在木上。又《玉篇》解释：“蕈”是地菌。肠中的垢滓凝聚生长出息肉，就像湿气蒸郁，在土木上生出蘑菇一样，所以叫肠覃。《正字通》说：医书中，鼻疣叫做息肉，也称为息菌。鼻子通呼吸，所以从“息”旁。“息菌”与“肠覃”的意义相符。但以鼻息来解释“ ”是错误的。《说文解字》：“ ，寄肉也。”即生长在鼻孔内的息肉之义。《甲乙经》作“息肉”可以证明。“离岁”即经历一年。“离”训为“历”，见于《诗·小雅·小宛》疏。治疗肠覃的方剂，陈氏《三因极一病证方论》中有乌喙丸，罗氏《卫生宝鉴》中有露丸，见 丸等，应当一并考证。
石瘕（以下描述其征候）可引导而下《甲乙经》中，“下”下有“之”字。张景岳说：“ ”指凝败之血。子门闭塞，则瘀血留止，坚硬如石头，所以叫石瘕。月经不能按时来潮，只有女子才有这种病。所以可以用导血的药剂使其下行。按篇首黄帝有关于石水的提问，而此处没有回答，必定是原文缺失。考之《阴阳别论》说：“阴阳结邪，多阴少阳曰石水，少腹肿。”其意义与此相同。简案：《说文解字》：“ ，凝血也。”《五脏生成篇》说：“赤如 血死”即是此意。“导”，指坐药导入。病在胞宫，所以用坐药导入使其下行。张景岳的注解不对。
先泻其胀之血络（以下描述刺法）去其血络也《甲乙经》中，“胀”作“腹后”，“血络”作“血脉”。张景岳说：“先泻其胀之血络”，意思是无论虚实，凡是体表可见的血络，必须先泻除，然后根据虚实调理经脉。刺去血络，即重申了先泻的原则。按本篇自水病以下所言的病证，共有六种，而此处独独询问两种病证的针刺方法。大概是因为“水俞五十七穴”已在《水热穴论》中详述，所以不必再问。这里说肤胀、鼓胀，大概是兼括五种病证而统而言之，言辞虽然简略但意思完备。
All versions lack the character "Pian" (Chapter).
When water disease first begins (the following describes its signs), Master Yun says: When the disease is just starting, there will be a slight swelling under the eyes resembling silkworms (commonly known as "sleeping silkworm"), looking like the state after just waking up. Generally, when people lie down or get up, the area above the eye sockets must swell slightly. The neck pulse refers to the Renying (ST9) acupoint; this pulse beats in the neck and moves more noticeably internally during coughing; there is coldness in the inner thigh, swelling in the calves, and distension of the upper abdomen. Pressing the abdomen with the hand causes it to rise immediately upon removal, resembling a bag filled with water. This indicates that water disease has formed and can be verified. (Note: *Suwen: Yin Yang Bie Lun* states: "Obstruction of the Three Yin meridians is called Water." Qixuanzi [Wang Bing] explains: "Three Yin" refers to the Spleen and Lung meridians both having cold obstruction. Cold obstruction in Spleen and Lung leads to Qi transformation failing and converting into water. Also, *Lingshu: Wu Long Jin Ye Pian* states: "The essence of grains combines to form fat, which infiltrates bone cavities to nourish the brain marrow and flows down to the thighs. If Yin and Yang are disharmonious, fluids overflow and flow downward to the yin region, reducing marrow fluid. Excessive deficiency below leads to emptiness, causing lower back pain and... blockage of Yin-Yang Qi channels, closure of the Four Seas, failure of Sanjiao to drain, non-transformation of fluids, and water-grain qi merging into the intestines and stomach, separating at the ileum, remaining in the lower jiao without permeating the bladder, causing lower jiao distension; overflowing water results in water distension. Also, *Lun Ji Zhen Chi Pian* states: "For Feng Shui and Fu Zhang, observe if the area above the eye sockets is slightly swollen like after waking, if the neck pulse beats and there is frequent coughing, pressing the hands and feet leaves an indentation that does not rebound indicates water without wind, while indentation that remains indicates wind with water.") Zhang Jingyue says: The Yangming meridian descends from Renying along the abdominal interior; water pathogen attacks it, causing neck pulse beating. The manifestation of water lies in the Lung, hence occasional coughing. Coldness in the inner thighs and swelling in the calves indicate Taiyin Spleen involvement, with pathogen starting in the Yin aspect. HT, same as. When pressing a water-filled sac, it rebounds immediately; thus, patients with water disease behave similarly. These are all signs of edema. Summary: *Ping Ren Qi Xiang Lun* states: "Beating neck pulse, panting, and rapid coughing indicate Water; slight swelling of eye sockets resembling rising silkworms indicates Water." This aligns with this section and *Lun Ji Zhen Chi Pian*. It is called "neck pulse" rather than Renying because the rapid beating is known through observation (Wang Zhen) rather than palpation alone.
Fu Zhang (Skin Distension) (the following describes its signs): In *Jia Yi Jing*, " " is written as "Ke Ke". Zhang Jingyue says: " " refers to the sound of a drum. Cold pathogen lodging between the skin prevents Yang Qi from circulating; the disease is in the Qi level, hence the sound resembles a drum. Qi is formless, so the abdomen is not hard. Qi pervades everywhere, so the abdomen is large and the whole body swells. If caused by water, only areas with water swell, distinguishing it from Qi distension. However, if there is water, the skin is lustrous and thin; if no water, the skin is thick. Cold in the skin and interstices disperses upon pressure and cannot gather quickly, so indentation does not rebound. Abdominal color remains unchanged due to thick skin. My view: The previous two paragraphs state that rebounding upon pressure belongs to Water, while non-rebounding belongs to Qi. This is true. However, pressing an air-filled sac also rebounds; water within muscles disperses upon pressure and does not gather quickly, like pressing a dregs-filled bag, also resulting in non-rebound. Thus, one cannot distinguish Water from Qi solely by rebounding or not. One should observe if the skin is thick and pale, or if swelling is generalized or descending, which mostly belongs to Qi. If the skin is thin and lustrous, or swelling has boundaries or ascends, it mostly belongs to Water. Summary: *Lun Ji Zhen Chi Pian* states: "Pressing hands and feet leaving indentation that does not rebound indicates Feng Shui and Fu Zhang," consistent with this section. *Jin Gui Yao Lue* states: "Pi Shui pulse is floating, external signs include dorsum edema, pitting on pressure, no aversion to wind." It also states: "Indentation not rebounding on hands/feet indicates Feng Shui." Chao Yuanfang's *Zhu Bing Yuan Hou Lun* states: "Zao Shui [Dry Water] is water qi overflowing skin causing swelling; tracing skin with finger leaves faint marks, named Zao Shui; marks dissipate immediately, named Shi Shui [Damp Water]." From this, Fu Zhang corresponds to Pi Shui/Feng Shui in *Jin Gui* and Zao Shui in *Yuan Hou*. However, judgment of distension should not be rigidly based on rebounding, but treated as empirical evidence. "Ke" (*Yu Pian*) means hollow skin of objects. " " derives from Drum and Kong (empty), implying hollowness. Annotators interpreting it as drum sound ignore the logic of sound without hardness.
Abdominal Distension (the following describes its signs): Master Yun says: Gu Zhang (Drum Distension) is similar to Fu Zhang; since rebounding is not mentioned, it likely does not rebound. The key distinction is protruding abdominal veins. Also, *Suwen: Fu Zhong Lun*: Yellow Emperor asks about heart/abdominal fullness where morning food prevents evening eating. Qibo names it Gu Zhang, treated with Ji Shi Li (Chicken Dropping Fermented Liquid), effective in one dose, cured in two. Li Yun says: Gu Zhang and Fu Zhang are largely similar, distinguished by sallow-yellow complexion and protruding abdominal veins.
Chang Qin (Intestinal Polyp/Tumor) (the following describes its signs): In *Jia Yi Jing*, "Pi" is written as "Jia", " " as "Xi", and "Li Zang" as "Li Sui Yue" (three characters). Most versions have only "Li Sui"; Zhidan changed it to "Li Zang". Zhang Jingyue says: "Qin" means extending deeply. Cold Qi combats Wei Qi, causing stagnation outside the intestines, attaching and forming polyps (" " meat, meaning bad flesh), progressing over years ("Li Sui" means crossing a year). Cold lodges outside intestines, not in the uterus, so menstruation is unaffected, proving it is not a blood disease but accumulation of juices/mucus. Summary: Meaning of "Qin" is unclear; likely same as "Xun" (mushroom). Intestinal debris condensing into polyps is like dampness generating mushrooms on wood/earth. Zhengzitong notes medical texts call nasal warts "Xi Rou" or "Xi Jun" (breath-related). *Shuowen* defines " " as parasitic flesh (polyp). *Jia Yi* using "Xi Rou" confirms this. "Li Sui" means passing a year; "Li" means experience/pass, per *Shi Jing* commentary. Formulas for Chang Qin include Wu Hui Wan (*San Yin Fang*) and Lu Wan (*Wei Sheng Bao Jian*), to be cross-referenced.
Shi Jia (Stone Mass) (the following describes treatment): Can be guided down. In *Jia Yi Jing*, "down" has "Zhi" added. Zhang Jingyue says: " " denotes coagulated/bad blood. Closure of Zi Men (cervical os) causes blood stasis, hard as stone, hence Shi Jia. Menstruation is delayed; this occurs only in women. Hence, blood-guiding herbs can induce discharge. Note: The chapter starts with Yellow Emperor asking about Shi Shui [Stone Water], but lacks an answer here, likely missing text. *Yin Yang Bie Lun* states: "Yin-Yang evil knotting, more Yin less Yang is Shi Shui, with lower abdominal swelling," matching this context. Summary: *Shuowen* defines " " as coagulated blood. *Wu Zang Sheng Cheng Pian* mentions "Red like blood death." "Dao" refers to vaginal suppositories. Disease is in the uterus, hence suppositories are used. Zhang's note is incorrect.
First drain the distended blood collaterals (the following describes needling): Remove blood collaterals. In *Jia Yi Jing*, "Zhang" is "Fu Hou", "Xue Luo" is "Xue Mai". Zhang Jingyue says: "First drain distended blood collaterals" means regardless of deficiency/excess, visible surface collaterals must be drained first, then regulate meridians based on excess/deficiency. Needling out collaterals reiterates draining first. This chapter discusses six conditions below Water; only two are asked about needling because Water Acupoints (57 points) were detailed in *Shui Re Xue Lun*. Mentioning Fu Zhang and Gu Zhang covers all five conditions comprehensively; words are brief but meaning is complete.