《灵枢·水胀篇》云∶有水胀与肤胀鼓胀肠覃石瘕五者之分。《金匮》《千金》论云∶
水有十者，其名不同，所感各异。盖水之始起也，未尝不自心肾而作。夫心与肾能生脾肺，
今心肾气亏，不能滋养脾肺，故土不能制水，水渍妄行，三焦不泻，气脉闭塞，枢机不通，
喘息奔急，水气盈溢，渗漏经络，皮肤溢满，目窠微肿如卧蚕之状，此其候也。其肤胀鼓胀
，于胀满别论其详，惟肠覃石瘕二证，妇人有此，起自血分之疾，各有治法，难与水胀病同
。夫水肿病皆起于脏腑，诸书谓十水者，一曰青水，根于肝，先从面肿，渐行周身；二曰赤
水，根于心，先从胸肿而起；三曰黄水，起于脾肿，从腹起；四曰白水，起于肺，先从脚肿
，而喘嗽上气也；五曰黑水，起于肾，从四肢而起；六曰玄水，起于胆，先头面而至足胫肿
；七曰风水，起于胃；先自四肢肿，而至通身，及腹胀满；八曰石水，根于膀胱，其状起于
脐下，面腹独大者是也；九曰里水，起于小肠，先小腹而渐至肿也；十曰气水，起于大肠，
其状乍来乍去，乍盛乍虚。此其候也；皆因上下不通，关窃不利，气血痞膈，阴阳不调而致
此也。《素问》云∶面肿为风，足肿为水。然此当分阴水阳水、少壮老弱而治之。若阴水为
肿，脉来沉伏，色多青白，不烦渴，小便涩而清，大便自泄，治宜实脾；阳水为肿，脉来沉
数，色多赤黄，或烦渴，小便赤而难去，大便多秘，治宜疏气荡涤。凡看水肿之病，先要有
其在何部分而得之，必当以本经求之而用药。若腰以上肿者，治宜发汗，其腰以下肿者，当
利小便。大抵治法强健脾元，土壮则能运化，运化则血气充，血气充则阴阳和，和则水归元
矣。
若少壮充实患此，脉来浮大有力，当导去其水。年老虚弱得此，补中行湿为先，若气下
陷者，即当提之。盖脾者养命之本，肾者乃生气之原也，不可不究，二脏之虚实，慎不可辄
用大戟芫花甘遂巴遂牵牛之药，大利其水，暂取其效。水去则脾土愈败，久则危殆。若五伤
证见，则难治之。肝伤者则唇黑，脾伤者则脐凸，肺伤者则背平，心伤则缺盆平，肾伤则足
心平。此证若一二发，是皆难治疗，学人鉴之。
《灵枢·水胀篇》说：有水胀、肤胀、鼓胀、肠覃、石瘕这五种病证的区分。《金匮要略》和《千金方》论述说：水病有十种，名称不同，致病原因各异。大概水病初起时，未尝不是从心和肾开始发作的。心与肾能生养脾肺，如今心肾之气亏损，不能滋养脾肺，所以土（脾）不能制约水，水液泛滥妄行，三焦排泄功能失常，气脉闭塞，枢纽机能不通畅，出现喘息急促，水气充盈溢满，渗漏于经络，皮肤肿胀饱满，眼睑微肿像卧蚕的样子，这是它的征候。至于肤胀和鼓胀，关于胀满的详细情况另行讨论，只有肠覃和石瘕这两种证候，妇女会有此病，起自血分的疾病，各有治疗方法，难以与水胀病混同。
水肿病都起于脏腑，各书所说的十种水病，第一种叫青水，根源在肝，先从面部浮肿，逐渐蔓延至全身；第二种叫赤水，根源在心，先从胸部浮肿而起；第三种叫黄水，起于脾，从腹部开始浮肿；第四种叫白水，起于肺，先从脚部浮肿，伴有气喘咳嗽气逆；第五种叫黑水，起于肾，从四肢开始浮肿；第六种叫玄水，起于胆，先从头面浮肿而至足胫肿胀；第七种叫风水，起于胃，先自四肢浮肿，而至全身，并伴有腹胀满；第八种叫石水，根源在膀胱，其症状是从脐下开始，只有面和腹部特别肿大；第九种叫里水，起于小肠，先从小腹开始逐渐浮肿；第十种叫气水，起于大肠，其症状是忽来忽去，忽盛忽虚。这是它的征候；都是因为上下不通利，关窍不利，气血痞塞阻隔，阴阳不调而导致的。《素问》说：面部浮肿属于风邪，足部浮肿属于水湿。然而这里应当区分阴水和阳水，根据患者年少壮实或年老体弱来治疗。如果是阴水导致的水肿，脉象沉伏，面色多青白，不烦躁口渴，小便涩滞且清长，大便自行泄泻，治疗宜健脾实土；如果是阳水导致的水肿，脉象沉数，面色多赤黄，或者烦躁口渴，小便赤红且排出困难，大便多秘结，治疗宜疏理气机荡涤水邪。凡是诊治水肿病，首先要有其在哪个部位得病的概念，必须依据本经求索来用药。如果腰部以上浮肿，治疗宜发汗；腰部以下浮肿，应当利小便。大抵治疗方法在于强健脾胃元气，土气壮盛则能运化，运化正常则气血充盛，气血充盛则阴阳调和，调和则水液归于本源。
如果是年少壮实之人患此病，脉象浮大有力，应当导引去除其水邪。如果是年老虚弱之人患此病，以补中益气祛湿为先，如果有气陷下坠的情况，就应当提升气机。因为脾是养命的根本，肾是生气之源，不可不探究这两脏的虚实，千万不可轻易使用大戟、芫花、甘遂、巴豆、牵牛子这些药物，大力利尿取水，暂时取得疗效。水邪去除后脾土更加败坏，时间久了就会危及生命。如果出现五伤的症状，就很难治疗了。肝受伤则嘴唇发黑，脾受伤则肚脐突出，肺受伤则背部平塌，心受伤则锁骨上窝平陷，肾受伤则足心平陷。这种病症如果一两次发作，都是难治的，学习中医的人要引以为鉴。
The *Ling Shu · Shui Zhang Pian* states: There are distinctions among five conditions: Shui Zhang (Water Swelling), Fu Zhang (Skin Swelling), Gu Zhang (Drum Distension), Chang Qin (Intestinal Polyp), and Shi Jia (Stone Fibroid). The *Jin Gui Yao Lue* and *Qian Jin Fang* discuss that there are ten types of water diseases with different names and varying etiologies. Generally, when water disease first arises, it invariably originates from the Heart and Kidney. The Heart and Kidney generate and nourish the Spleen and Lung; now, if Qi of the Heart and Kidney is deficient, they cannot nourish the Spleen and Lung, causing Earth (Spleen) to fail in controlling Water. Consequently, Water floods and acts recklessly, the San Jiao (Triple Burner) fails to excrete, Qi and vessels become blocked, the pivot mechanism is obstructed, leading to panting and urgency. Water Qi overflows, seeps into the collaterals, causing the skin to swell and fill up, with the eye sockets slightly swollen like a lying silkworm; this is its presentation. As for Fu Zhang and Gu Zhang, details regarding distension are discussed separately. Only Chang Qin and Shi Jia occur in women, originating from disorders of the Blood aspect, each having specific treatments, and thus difficult to conflate with Shui Zhang.
All edema diseases originate from the Zang-Fu organs. Books mention ten types of water: First is Qing Shui (Green Water), rooted in the Liver, starting with facial swelling and gradually spreading to the whole body; Second is Chi Shui (Red Water), rooted in the Heart, starting with chest swelling; Third is Huang Shui (Yellow Water), originating from the Spleen, starting with abdominal swelling; Fourth is Bai Shui (White Water), originating from the Lung, starting with foot swelling, accompanied by panting, coughing, and rebellious Qi; Fifth is Hei Shui (Black Water), originating from the Kidney, starting with limb swelling; Sixth is Xuan Shui (Dark Water), originating from the Gallbladder, starting from the head and face down to the shins; Seventh is Feng Shui (Wind Water), originating from the Stomach, starting from the limbs to the whole body, accompanied by abdominal distension; Eighth is Shi Shui (Stone Water), rooted in the Bladder, characterized by swelling starting below the umbilicus, with only the face and abdomen becoming large; Ninth is Li Shui (Interior Water), originating from the Small Intestine, starting from the lower abdomen and gradually swelling; Tenth is Qi Shui (Qi Water), originating from the Large Intestine, characterized by symptoms that come and go, wax and wane. This is its presentation; all result from obstruction above and below, failure of the gates and orifices, stagnation of Qi and Blood, and disharmony of Yin and Yang. The *Su Wen* states: Facial swelling is due to Wind, foot swelling is due to Water. However, one must distinguish between Yin Water and Yang Water and treat based on whether the patient is young and robust or old and weak. If edema is caused by Yin Water, the pulse is deep and hidden, the complexion is mostly blue-white, there is no irritability or thirst, urination is scanty but clear, and stool is loose; treatment should focus on strengthening the Spleen. If edema is caused by Yang Water, the pulse is deep and rapid, the complexion is mostly red-yellow, there may be irritability and thirst, urine is red and difficult to pass, and stool is often constipated; treatment should focus on regulating Qi and purging dampness. When diagnosing edema, one must first determine which part of the body is affected and seek the corresponding meridian to prescribe medication. If swelling is above the waist, treatment should induce sweating; if swelling is below the waist, diuresis should be employed. Generally, the treatment method strengthens the Spleen and Stomach Yuan Qi; when Earth is strong, it can transform and transport; when transformation and transportation function normally, Qi and Blood become abundant; when Qi and Blood are abundant, Yin and Yang harmonize; when harmonized, Water returns to its source.
If a young and robust person suffers from this, with a floating, large, and forceful pulse, one should guide out the pathogenic Water. If an elderly and weak person suffers from this, tonifying the Middle and resolving dampness should be prioritized; if there is sinking of Qi, it should be lifted. For the Spleen is the root of nourishing life, and the Kidney is the origin of generating Qi; their deficiency and excess must not be ignored. One must be cautious not to arbitrarily use drastic herbs such as Da Ji (Euphorbiae Pekinensis Radix), Yuan Hua (Genkwa Flos), Gan Sui (Kansui Radix), Ba Dou (Crotonis Fructus), and Qian Niu Zi (Pharbitidis Semen) to forcefully promote urination for temporary effect. Once Water is removed, the Spleen Earth becomes further damaged, leading to danger over time. If signs of Five Injuries appear, the condition is difficult to treat. Injury to the Liver manifests as black lips; injury to the Spleen manifests as protruding umbilicus; injury to the Lung manifests as a flat back; injury to the Heart manifests as a flat supraclavicular fossa; injury to the Kidney manifests as a flat sole. If this condition recurs once or twice, it is difficult to treat; students of medicine should take note.