（《灵枢·水胀篇》全）
黄帝问于岐伯曰∶水与肤胀、鼓胀、肠覃、石瘕、石水，何以别之？（此六证者，病异而形相似，故宜有以别之。
覃音潭。瘕，加、驾二音。）岐伯答曰∶水始起也，目窠上微肿，如新卧起之状，（目之下为目窠。微肿如新卧起之状者，
形如卧蚕也。窠音科。）其颈脉动，时咳，（颈脉，足阳明人迎也。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 ，腹乃大，其水已成矣。（阴邪始于阴分也。 ，肿同。）以手按其腹，
随手而起，如裹水之状，此其候也。（凡按水囊者必随手而起，故病水者亦若是。以上皆水肿之候。）
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，（ ，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。 音空。）按其腹 而不起，腹色不变，此其候
也。（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之的辨。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。又风水肤胀义，详脉色类十八。 音夭，深也。）
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。（腹胀身皆大，与上文肤胀者证同，
色苍黄者，亦皮浓腹色不变之义，但腹有筋起为稍异耳。盖此亦病在气分，故名鼓胀也。又鼓胀义见前五十五。）
肠覃何如？岐伯曰∶寒气客于肠外，与卫气相搏，气不得荣，因有所系，癖而内着，恶气乃起， 肉乃生。（覃，延
布而深也。寒气与卫气相搏，则搐积不行，留于肠外，有所系着，故癖积起， 肉生，病日以成矣。着肉，恶肉也。卫
气留于腹中，义出《卫气失常篇》，详针刺类二十六。癖音僻。 音息。）其始生也，大如鸡卵，稍以益大，至其成，如
怀子之状，久者离岁，按之则坚，推之则移，月事以时下，此其候也。（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。）
石瘕何如？岐伯曰∶石瘕生于胞中，寒气客于子门，（胞，即子宫也，男女皆有之，在男谓之精室，在女谓之血海。
子门，即子宫之门也。义详三焦包络命门辨中，见《附翼》三卷。）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。 ，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，详见本类前六。 ，铺杯切。）
黄帝曰∶肤胀鼓胀可刺邪？岐伯曰∶先泻其胀之血络，后调其经，刺去其血络也。（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，辞虽简而意则在也。）
（《灵枢·水胀篇》全文）
黄帝向岐伯问道：水肿、肤胀、鼓胀、肠覃、石瘕、石水这六种病证，如何加以区别？（这六种病证，病因不同但外形相似，所以应当有方法加以辨别。覃音同“潭”。瘕，读音为“加”或“驾”。）
岐伯回答说：水肿刚开始发生时，眼睑下方微微肿胀，像刚睡醒时的样子，（眼睛下方称为目窠。微微肿胀像刚睡醒的样子，形状如同卧蚕。窠音同“科”。）颈部脉搏跳动，时常咳嗽，（颈脉，指足阳明胃经的人迎穴。阳明经脉，从人迎穴向下沿腹部内侧行走，水邪侵犯此处，所以导致颈脉跳动。水的病变表现在肺，所以出现时常咳嗽。）大腿内侧感觉寒冷，小腿浮肿，腹部随之变大，此时水病已经形成。（阴邪始于阴分。胻，同“肿”。）用手按压腹部，手离开后凹陷随即弹起，像包裹着水的状态，这就是水肿的征候。（凡是按压水囊，必然随手弹起，所以患水病的人也是如此。以上都是水肿的征候。）
黄帝问：肤胀如何诊断？岐伯说：肤胀是因为寒气停留在皮肤之间，叩击时发出空空的声音且不坚硬，腹部胀大，全身都浮肿，皮肤增厚，（ ，是鼓声。寒气停留在皮肤之间，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，所以按之不坚硬。气无所不到，所以腹部胀大且全身浮肿。如果是因水引起的，则有水的地方肿胀，无水的地方不肿胀，这是可以辨别的。然而有水则皮肤润泽而薄，无水则皮肤增厚。 音同“空”。）按压腹部，凹陷不能立即恢复，腹部颜色不变，这就是肤胀的征候。（寒气在皮肤腠理之间，按压使气散开，但不能迅速聚集，所以凹陷不能立即恢复。腹部颜色不变，就是因为皮肤增厚的缘故。我按语：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。然而按压气囊，也会随手弹起；另外水在肌肉之中，按压使其散开，也不能迅速聚集，像按压酒糟袋一样，也是凹陷不起，所以不能单凭是否弹起来作为区分水气和气病的绝对标准。只应当观察皮肤是否增厚色苍，或者全身都肿，或者从上往下肿的，多属于气病；如果皮肤薄色泽润，或者肿胀有界限，或者从下往上肿的，多属于水病。另外风水和肤胀的意义，详见脉色类第十八。 音同“夭”，意为深。）
鼓胀怎么样？岐伯说：腹部胀大，身体也都肿大，大小与肤胀相等，面色青黄，腹部筋脉凸起，这就是鼓胀的征候。（腹部胀大身体肿大，与上文肤胀的症状相同，面色青黄，也是皮肤增厚腹部颜色不变的意思，只是腹部有筋脉凸起稍微不同罢了。大概这也是病在气分，所以名叫鼓胀。另外鼓胀的意义见前五十五篇。）
肠覃怎么样？岐伯说：寒气停留在肠外，与卫气相互搏结，气不能正常荣养，因而有所羁绊，癖积内着，恶气于是产生，赘肉于是生长。（覃，延伸布散而深入。寒气与卫气相互搏结，则积聚不行，留于肠外，有所羁绊附着，所以癖积兴起，赘肉生长，疾病日益形成。着肉，即恶肉。卫气停留于腹中，意义出自《卫气失常篇》，详见针刺类第二十六。癖音同“僻”。 音同“息”。）它刚开始生成时，大小像鸡蛋，逐渐增大，等到形成时，像怀孕的样子，病程长的超过一年，按压它则坚硬，推动它则移动，月经按时来潮，这就是肠覃的征候。（离岁，即越岁。寒邪客居在肠外，不在胞宫，所以不妨碍月经，这就知道它不是血病。大概是由汁沫聚集而生，这是肠覃的征候。）
石瘕怎么样？岐伯说：石瘕生于胞宫中，寒气客居于子门，（胞，就是子宫，男女都有，在男性称为精室，在女性称为血海。子门，就是子宫的门。意义详见三焦包络命门辨中，见《附翼》第三卷。）子门闭塞，气不能通畅，败血应当排出却排不出，瘀血因而留止，一天天增大，形状像怀孕，月经不能按时来潮，都发生在女子身上，可以用导引通下的方法治疗。 ，是凝结腐败的血。子门闭塞，则瘀血留止，其坚硬如石头，所以叫石瘕。月经不能按时来潮，只有女子才有，所以可以用通血的药剂攻下。按：篇首黄帝问了石水，但这里没有回答，必定是原文缺失。考证《阴阳别论》说：阴阳结聚邪气，阴多阳少叫做石水，小腹胀肿。其意义就在这里，详见本类前六。 ，铺杯切。）
黄帝问：肤胀和鼓胀可以用针刺治疗吗？岐伯说：先刺破胀满部位的血络放血，然后调理经脉，刺去那些血络。（先刺破胀满部位的血络放血，意思是无论虚实，凡是有血络显露在外的，必须先泻除，然后根据虚实情况调理经脉。刺去血络，就是再次强调先泻的原则。按：本篇从水病开始，所说的共有六种病证，而这里唯独询问这两种病证的针刺疗法，大概是因为水俞五十七穴，已经在《水热穴论》中详细说明，所以不必再问。这里提到肤胀和鼓胀，大概是兼括其他五种病证而总体而言，言辞虽然简略，但意旨已包含在内。）
(Full text of "Water Swelling" chapter from *Ling Shu*)
Huangdi asked Qibo: How can we distinguish between edema (Shui), skin distension (Fu Zhang), drum distension (Gu Zhang), intestinal polyps (Chang Qin), stone masses (Shi Jia), and stone water (Shi Shui)? (These six conditions have different etiologies but similar appearances, so there must be ways to differentiate them. Qin is pronounced like "Tan". Jia is pronounced as "Jia" or "Jia".)
Qibo replied: When edema first begins, the area below the eyes swells slightly, resembling the appearance after just waking up (The area below the eye is called Mu Ke. Slight swelling resembling the post-sleep state looks like a silkworm lying down. Ke is pronounced like "Ke"). The pulse at the neck throbs, and there is occasional coughing (The neck pulse refers to the Renying point of the Foot-Yangming Stomach Meridian. The Yangming meridian descends from Renying along the interior of the abdomen; when water pathogen invades this area, it causes the neck pulse to throb. The manifestation of water pathology is in the Lung, hence the occasional cough). There is coldness in the inner thighs, swelling in the calves, and the abdomen enlarges; at this point, the water disease is established (Yin pathogen starts in the Yin aspects. Ting, same as "Zhong" [swelling]). Pressing the abdomen with the hand results in immediate rebound, resembling a bag filled with water; this is the sign of edema (When pressing a water-filled sac, it always rebounds immediately; thus, patients with water disease behave similarly. The above points describe signs of edema).
Huangdi asked: How is skin distension diagnosed? Qibo said: Skin distension occurs when cold qi lodges between the skin and muscles. Percussion yields a hollow sound, and the abdomen is not hard. The abdomen is large, and the entire body is swollen, with thickened skin ( Kong represents the sound of a drum. When cold qi lodges between the skin, Yang qi fails to circulate, and the pathology is in the Qi aspect, producing a sound like a drum. Qi has no form, hence it feels soft. Qi pervades everywhere, causing abdominal distension and full-body swelling. If caused by water, only areas with water swell, while others do not, allowing for differentiation. However, if there is water, the skin is lustrous and thin; if dry, the skin is thick. Kong is pronounced like "Kong"). Pressing the abdomen leaves an indentation that does not immediately recover, and the abdominal color remains unchanged; this is the sign of skin distension (Cold qi in the skin and interstices disperses upon pressure but cannot quickly re-aggregate, hence the indentation persists. Unchanged abdominal color is due to thickened skin. My commentary: The previous two paragraphs stated that immediate rebound indicates water, while persistent indentation indicates Qi. This is generally true. However, pressing an air-filled sac also rebounds; furthermore, if water lies within the muscles, pressing disperses it, preventing quick re-aggregation, similar to pressing a bag of dregs, which also shows persistent indentation. Therefore, rebound alone is not the definitive criterion for distinguishing water from Qi. One should observe whether the skin is thick and pale, whether the swelling is generalized or descending, which often indicates Qi disorders; whereas thin, lustrous skin, localized swelling, or ascending swelling often indicates Water disorders. For further details on Wind-Water and Skin Distension, see Pulse and Color Class, Chapter 18. Yan means deep.)
What about drum distension? Qibo said: The abdomen is distended and the body is enlarged, comparable in size to skin distension. The complexion is greenish-yellow, and abdominal veins are prominent; this is the sign of drum distension (Abdominal distension and bodily enlargement are consistent with the symptoms of skin distension mentioned earlier. Greenish-yellow complexion implies thickened skin and unchanged abdominal color, differing mainly by the prominence of abdominal veins. Generally, this is also a pathology in the Qi aspect, hence named Drum Distension. See Chapter 55 for further meaning of Drum Distension.)
What about intestinal polyps (Chang Qin)? Qibo said: Cold qi lodges outside the intestines and contends with Wei Qi (Defensive Qi). Qi fails to nourish properly, becomes bound, and forms fixed accumulations. Evil Qi arises, and flesh growths develop (Qin means extending deeply. Contention between cold qi and Wei Qi leads to stagnation and accumulation outside the intestines, binding and lodging, causing fixed accumulations and flesh growths, with the disease progressing daily. Zhuo Rou refers to abnormal flesh. The retention of Wei Qi in the abdomen is discussed in the *Wei Qi Buxiang* chapter; see Needling Class, Chapter 26. Pi is pronounced like "Pi". Xi is pronounced like "Xi"). Initially, it is the size of a chicken egg, gradually increasing until it resembles pregnancy. After more than a year, it feels firm upon pressure but moves upon pushing. Menstruation occurs on time; this is the sign of intestinal polyps (Li Sui means exceeding a year. Cold pathogen lodges outside the intestines, not in the uterus, so menstruation is unaffected, indicating it is not a blood disorder. It likely arises from the aggregation of fluids and juices; this is the sign of intestinal polyps.)
What about stone masses (Shi Jia)? Qibo said: Stone masses arise in the uterus (Bao refers to the uterus, present in both men and women; in men, it is called the Essence Chamber; in women, the Sea of Blood. Zi Men is the gate of the uterus. See *San Jiao Bao Luo Ming Men Bian* in *Fu Yi*, Vol. 3). The gate of the uterus closes, Qi fails to circulate, and evil blood should be discharged but is retained. The mass grows day by day, resembling pregnancy, and menstruation is delayed. These occur only in women and can be treated with draining methods ( Xi refers to coagulated and degenerated blood. Closure of Zi Men causes blood stasis, becoming hard as stone, hence "Stone Jia". Delayed menstruation is unique to women, so blood-draining agents can be used to purge it. Note: Huangdi asked about Shi Shui at the beginning, but there is no answer here, implying a textual loss. Checking the *Yin Yang Bie Lun*: "Yin-Yang knotting with evil, where Yin is excessive and Yang deficient, is called Shi Shui, with lower abdominal swelling." The meaning aligns here; see Class 6. Xi is pronounced "Pu Bei".)
Huangdi asked: Can skin distension and drum distension be treated with acupuncture? Qibo said: First, drain the collateral vessels associated with the distension, then regulate the meridians, removing the collateral vessels (Draining the collaterals of distension means that regardless of deficiency or excess, any visible external collaterals must first be drained, followed by regulating the meridians based on deficiency or excess. Removing collateral vessels reiterates the principle of initial drainage. Note: From the section on Water, six conditions are discussed. Why ask specifically about needling for these two? Because the 57 Water Acupoints were detailed in the *Shui Re Xue Lun*, so no further question was needed. Mentioning Skin Distension and Drum Distension here likely encompasses all five conditions collectively; though concise, the intent is included.)