Classica Sinica Medica

Water Distension

水脹

Shuǐ zhàng

A chapter of differential diagnosis, conducted entirely by touch. Six conditions are named at the outset; five are then described, and the reader is expected to tell them apart by the behaviour of the abdomen under the hand.Water rises when pressed and subsides again, like a bag of water. Skin distension stays sunken, and the skin over it does not change colour. Drum distension is as large as skin distension but shows greenish-yellow skin and standing sinews. Intestinal swelling is a hard, movable mass that does not disturb menstruation. Stone concretion is a growing mass that does, and occurs only in women.The sixth condition, stone water, is named in the question and never described — a gap in the received text that no commentary has been able to fill.The distinctions are small and practical, and the chapter is a good example of how much the Lingshu can do without a single theoretical excursus. It ends with a line of treatment: drain the blood vessels, then regulate the channels.

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12 paragraphs
黃帝問于歧伯曰：水與膚脹、鼓脹、腸覃、石瘕、石水，何以别之？ 黄帝问于歧伯曰：水与肤胀、鼓胀、肠覃、石瘕、石水，何以别之？
Huáng Dì wèn yú Qí Bó yuē: shuǐ yǔ fū zhàng, gǔ zhàng, cháng tán, shí jiǎ, shí shuǐ, hé yǐ bié zhī?
黄帝问岐伯说：水病与肤胀、鼓胀、肠覃、石瘕、石水，怎样区别？
The Yellow Emperor asked Qi Bo: How are water disease, skin distension, drum distension, intestinal swelling, stone concretion and stone water distinguished?
歧伯答曰：水始起也，目窠上微腫，如新臥起之狀，其頸脉動，時欬，陰股間寒，足脛瘇，腹乃大，其水已成矣。以手按其腹，隨手而起，如裹水之狀，此其候也。 歧伯答曰：水始起也，目窠上微肿，如新卧起之状，其颈脉动，时欬，阴股间寒，足胫瘇，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。
Qí Bó dá yuē: shuǐ shǐ qǐ yě, mù kē shàng wēi zhǒng, rú xīn wò qǐ zhī zhuàng, qí jǐng mài dòng, shí kài, yīn gǔ jiān hán, zú jìng zhǒng, fù nǎi dà, qí shuǐ yǐ chéng yǐ. yǐ shǒu àn qí fù, suí shǒu ér qǐ, rú guǒ shuǐ zhī zhuàng, cǐ qí hòu yě.
岐伯回答说：水病初起的时候，眼窝上微微浮肿，像刚睡醒的样子，颈部的脉跳动，时常咳嗽，大腿内侧发冷，小腿肿胀，肚子才大起来，这是水已经形成了。用手按他的腹部，随手而起，像裹着水一样，这就是它的证候。
Qi Bo answered: When water first arises, there is slight swelling above the eye sockets, as after just waking; the neck vessels throb, there is occasional cough, cold in the inner thigh, and swelling of the shins; then the belly grows large, and the water is formed. Press the abdomen and it rises at once under the hand, as though water were wrapped inside. That is its sign.
黃帝曰：膚脹，何以候之？ 黄帝曰：肤胀，何以候之？
Huáng Dì yuē: fū zhàng, hé yǐ hòu zhī?
黄帝说：肤胀怎样诊察？
The Emperor said: How is skin distension recognised?
歧伯曰：膚脹者，寒氣客于皮膚之間，𪔣𪔣然不堅，腹大，身盡腫，皮厚，按其腹，窅而不起，腹色不變，此其候也。 歧伯曰：肤胀者，寒气客于皮肤之间，𪔣𪔣然不坚，腹大，身尽肿，皮厚，按其腹，窅而不起，腹色不变，此其候也。
Qí Bó yuē: fū zhàng zhě, hán qì kè yú pí fū zhī jiān, kōng kōng rán bù jiān, fù dà, shēn jìn zhǒng, pí hòu, àn qí fù, yǎo ér bù qǐ, fù sè bù biàn, cǐ qí hòu yě.
岐伯说：肤胀是寒气停留在皮肤之间，按起来空软不坚，腹部胀大，全身都肿，皮肤厚，按他的腹部，深陷而不随手起来，腹部颜色不变，这就是它的证候。
Qi Bo said: In skin distension cold qi lodges between the skin and flesh; it feels hollow and soft, not firm. The abdomen is large and the whole body swollen, the skin thick. Press the abdomen and it stays sunken, not rising with the hand, and the colour of the abdomen is unchanged. That is its sign.
鼓脹何如？ 鼓胀何如？
gǔ zhàng hé rú?
鼓胀又是怎样的？
What of drum distension?
歧伯曰：腹脹身皆大，大與膚脹等也，色蒼黃，腹筋起，此其候也。 歧伯曰：腹胀身皆大，大与肤胀等也，色苍黄，腹筋起，此其候也。
Qí Bó yuē: fù zhàng shēn jiē dà, dà yǔ fū zhàng děng yě, sè cāng huáng, fù jīn qǐ, cǐ qí hòu yě.
岐伯说：腹部胀满，全身都大，大的程度与肤胀相同，颜色青黄，腹部的筋脉凸起，这就是它的证候。
Qi Bo said: The abdomen is distended and the whole body large, as large as in skin distension, but the colour is greenish-yellow and the abdominal sinews stand out. That is its sign.
腸覃何如？ 肠覃何如？
cháng tán hé rú?
肠覃又是怎样的？
What of intestinal swelling?
歧伯曰：寒氣客于腸外，與衛氣相摶，氣不得榮，因有所繫，癖而内著，惡氣乃起，瘜肉乃生。其始生也，大如雞卵，稍以益大，至其成，如懷子之狀，久者離歲，按之則堅，推之則移，月事以時下，此其候也。 歧伯曰：寒气客于肠外，与卫气相抟，气不得荣，因有所系，癖而内著，恶气乃起，瘜肉乃生。其始生也，大如鸡卵，稍以益大，至其成，如怀子之状，久者离岁，按之则坚，推之则移，月事以时下，此其候也。
Qí Bó yuē: hán qì kè yú cháng wài, yǔ wèi qì xiāng tuán, qì bù dé róng, yīn yǒu suǒ xì, pǐ ér nèi zhuó, è qì nǎi qǐ, xī ròu nǎi shēng. qí shǐ shēng yě, dà rú jī luǎn, shāo yǐ yì dà, zhì qí chéng, rú huái zǐ zhī zhuàng, jiǔ zhě lí suì, àn zhī zé jiān, tuī zhī zé yí, yuè shì yǐ shí xià, cǐ qí hòu yě.
岐伯说：寒气停留在肠外，与卫气相互搏结，气不能正常运行，因而有所系结，癖积在内附着不去，恶气于是产生，瘜肉于是生长。它初生的时候，大如鸡蛋，渐渐长大，到成形的时候，像怀孕的样子，病程久的跨越一年，按上去坚硬，推它能够移动，月经按时来潮，这就是它的证候。
Qi Bo said: Cold qi lodges outside the intestines and knots with the guarding qi, so that qi cannot run freely. Something becomes tethered, a mass clings within and does not leave, evil qi arises and a polypous growth forms. At first it is the size of a hen’s egg; it gradually enlarges, and when formed it looks like a pregnancy. In long cases it lasts beyond the year. Press it and it is hard; push it and it moves. Menstruation comes on time. That is its sign.
石瘕何如？ 石瘕何如？
shí jiǎ hé rú?
石瘕又是怎样的？
What of stone concretion?
歧伯曰：石瘕生于胞中，寒氣客于子門，子門閉塞，氣不得通，惡血當寫不寫，衃以留止，日以益大，狀如懷子，月事不以時下，皆生于女子，可導而下。 歧伯曰：石瘕生于胞中，寒气客于子门，子门闭塞，气不得通，恶血当写不写，衃以留止，日以益大，状如怀子，月事不以时下，皆生于女子，可导而下。
Qí Bó yuē: shí jiǎ shēng yú bāo zhōng, hán qì kè yú zǐ mén, zǐ mén bì sāi, qì bù dé tōng, è xuè dāng xiè bù xiè, pēi yǐ liú zhǐ, rì yǐ yì dà, zhuàng rú huái zǐ, yuè shì bù yǐ shí xià, jiē shēng yú nǚ zǐ, kě dǎo ér xià.
岐伯说：石瘕生在胞宫之中，寒气停留在子门，子门闭塞，气不能通，恶血当泻而不能泻，凝积的血停留下来，一天天长大，形状像怀孕，月经不按时来潮，都生在女子身上，可以用引导的方法使它下行。
Qi Bo said: Stone concretion is born in the womb. Cold qi lodges at the uterine gate, the gate closes, qi cannot pass, and the bad blood that should be drained is not drained. Clotted blood remains and stays, growing larger day by day, so that it looks like a pregnancy, and menstruation does not come on time. It occurs only in women, and may be guided downward.
黃帝曰：膚脹鼓脹，可刺邪？ 黄帝曰：肤胀鼓胀，可刺邪？
Huáng Dì yuē: fū zhàng gǔ zhàng, kě cì xié?
黄帝说：肤胀和鼓胀，可以针刺吗？
The Emperor said: May skin distension and drum distension be needled?
歧伯曰：先寫其脹之血絡，後調其經，刺去其血絡也。 歧伯曰：先写其胀之血络，后调其经，刺去其血络也。
Qí Bó yuē: xiān xiè qí zhàng zhī xuè luò, hòu tiáo qí jīng, cì qù qí xuè luò yě.
岐伯说：先泻去胀处的血络，然后调理它的经脉，刺去那些血络就是了。
Qi Bo said: First drain the blood vessels of the distension, then regulate the channels, needling away those blood vessels.

Textual notes

Readings follow the base edition; significant variants are recorded here.

  1. 目窠上微腫目窠上微腫

    窠讀 kē，穴也、窩也，目下陷處即目窠。水始起必先見於目下者，水屬陰，其性下而皮薄之處易見。此與《素問·評熱病論》「目下腫」同爲水病之早期徵。

  2. 足脛瘇足脛腫

    瘇即腫之異體，從疒從重，讀 zhǒng。脛謂小腿。水氣下注，故脛先腫。本篇前後腫、瘇並見，各仍其形，不強爲畫一。

  3. 𪔣𪔣然不堅𪔣𪔣然不堅

    𪔣讀 kōng，狀鼓聲，此以形容按之空軟而有聲應。膚脹在皮膚之間，其氣浮，故按之不堅而空。此字爲Ext-B字形，字庫或不載，錄文仍存其形，義則以空軟爲說。

  4. 窅而不起窅而不起

    窅讀 yǎo，深也、陷也，謂按之深陷而不能隨手復起。此與水病「隨手而起」正相反，一按即起者水在皮裏，按而不起者氣在膚間，二者之辨全在此一字。

  5. 腸覃腸覃

    覃讀 tán，延也、及也，謂寒氣延及腸外而結成此物，非覃思之覃。病名取義於蔓延，故其形漸大而能移動。與石瘕之著於胞中者，一在腸外，一在胞內。

  6. 衃以留止衃以留止

    衃讀 pēi，凝血也，從血從不，與《素問》諸篇「衃血」一律。衃以留止，謂惡血凝而成塊，留於胞中而不去，故日以益大。若作衄，則爲鼻出血，於此不通。

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APA

Huangdi Neijing · Lingshu 黃帝內經靈樞 (Compiled over the same span as the Suwen; the present text was put in order in the Tang.). Shuǐ zhàng 水脹 [Water Distension], Chapter 57. In Classica Sinica Medica. Base text: 《黃帝素問靈樞經》十二卷八十一篇，宋·史崧校定并音釋。據上海涵芬樓《四部叢刊》子部影印明趙府居敬堂刊本錄入，卷首牌記題「上海涵芬樓景明趙府居敬堂刊本」，並記原書版匡高營造尺六寸三分、寬四寸四分。目錄末行作「元二十四卷今併爲十二卷計八十一篇」。底本與影印本均屬公有領域。 Retrieved 29 October 2026, from https://classicstcm.com/classics/huangdi-neijing-lingshu/water-distension/

MLA

"Shuǐ zhàng 水脹 [Water Distension]." Huangdi Neijing · Lingshu 黃帝內經靈樞, chapter 57, Classica Sinica Medica, 2026, https://classicstcm.com/classics/huangdi-neijing-lingshu/water-distension/. Accessed 29 Oct. 2026. Base text: 《黃帝素問靈樞經》十二卷八十一篇，宋·史崧校定并音釋。據上海涵芬樓《四部叢刊》子部影印明趙府居敬堂刊本錄入，卷首牌記題「上海涵芬樓景明趙府居敬堂刊本」，並記原書版匡高營造尺六寸三分、寬四寸四分。目錄末行作「元二十四卷今併爲十二卷計八十一篇」。底本與影印本均屬公有領域。

Chinese scholarly

《黃帝內經靈樞·水脹》（Huángdì Nèijīng Língshū）。《黃帝素問靈樞經》十二卷八十一篇，宋·史崧校定并音釋。據上海涵芬樓《四部叢刊》子部影印明趙府居敬堂刊本錄入，卷首牌記題「上海涵芬樓景明趙府居敬堂刊本」，並記原書版匡高營造尺六寸三分、寬四寸四分。目錄末行作「元二十四卷今併爲十二卷計八十一篇」。底本與影印本均屬公有領域。Classica Sinica Medica，2026 年 10 月 29 日 存取，https://classicstcm.com/classics/huangdi-neijing-lingshu/water-distension/。

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