3 Edema

Edema is a disorder of muscular tumefaction. In this section, edema refers to mild tumefaction, in which urinary test shows no marked abnormal changes and nephrotic edema is not included.

Syndrome differentiation and treatment

Edema due to dampness and heat

It manifests sublumbar edema, abdominal fullness, dyspnea, dysphoria with thirst, unsmooth urination and defecation, yellowish and greasy fur, deep and rapid pulse. It is advisable to dispel water and clear away heat The prescription used is Muli Zexie Powder (Powder of Concha Ostreae and Rhizome Alismatis ). Take the powder by mixing it in rice soup three times a day, five to ten grams. After smooth urination, reduce the dosage accordingly or stop the administration. The modified Sanren Decoction (Decoction of Three Kinds of Kernels) may be applied in the case of the mild symptoms of dampness-heat stagnation.

Edema due to qi deficiency

It manifests edema of the face and limbs which happens and vanishes alternately, lassitude, hypodynamia, pale and lustreless complexion, short breath, anorexia, pale tongue with a little fur, slow and weak pulse. In the case of yang deficiency of the spleen and stomach, edema is marked, especially on the lower limbs, with the concurrent manifestations of epigastric and abdominal distension, loose stool, scanty urine, sallow complexion, cold limbs, pale and slippery fur, deep and slow pulse. It is suitable to strengthen the spleen and eliminate dampness. In the case of mild symptoms, after soaking Baizhu (Rhizoma Atractylodis Macorcephalae ) in waxgourd decoction for a night, remove Baizhu (Rhizoma Atractylodis Macrocephalae) and add Yiyiren (Semen Coicis) to the decoction to be decocted for oral administration; in the case of severe symptoms, use the modified Shenling Baizhu Powder (Powder of Ginseng, Poria and Bighead Atractylodes); in the case of severe edema due to yang deficiency of the spleen and stomach, it is suitable to warm the spleen and promote diuresis with the modified Shipi Decoction (Decoction for Reinforcing the Spleen).

Edema due to yang deficiency

It manifests general edema which is particularly severe below the waist, soreness and flaccidity of the waist and knees, aversion to cold, cold limbs, reduced amount of urine, pale tongue with white fur, deep and weak pulse. In the case of prolonged renal yang deficiency, yang impairment involving yin, symptoms mainly due to renal yin deficiency may occur as well which manifest as repeated onset of edema, mental fatigue, soreness of the waist, seminal emission, dry mouth and throat, dysphoria with feverish sensation of the chest, palms and soles, red tongue, thready and rapid pulse. It is advisable to warm the kidney to promote diuresis. The prescription used is the modified Jisheng Shenqi Pill (Life-Preserving Pill for Replenishing the Kidney Qi) in combination with Zhenwu Decoction (Decoction for Strengthening the Spleen Yang).

Edema due to qi stagnation

It manifests marked edema of the abdomen and limbs with normal skin color, bulging abdomen like a drum when tapped, oppressed sensation and distension of the chest, susceptibility to eructation, smooth urination, white fur and taut pulse. It is advisable to activate qi flow, remove qi stagnation and promote diuresis. The prescription used is Kuanzhong Decoction with additional Muxiang (Radix Aucklandiae), Xiangfu ( Rhizoma Cyperi) and Qingpi (Pericarpium Citri Reticulatae Viride). In the case of gastric fullness, belching, loose stool, greasy fur and slippery pulse, it is advisable to dry dampness, activate the spleen, remove food retention and regulate the stomach with the modified prescription of Pingwei Powder (Peptic Powder) in combination with Baohe Pill (Lenitive Pill).

Edema due to yin deficiency

This is commonly seen in the patients who have not recovered from deficiency of yin and blood following the febrile disease, with the manifestations of mild edema of limbs, or low fever, flushed complexion, feverish palms and soles, dry mouth and throat, mental fatigue, deep red tongue with a little fur, feeble and thready or knotted and intermittent pulse. It is suitable to nourish and tonify the kidney yin and promote diuresis simultaneously. The prescription used is Zuogui Pill with additional Fuling (Poria) and Zexie (Rhizoma Atismatis ), or the modified Fumai Decoction (Decoction of Prepared Licorice ) with large dosage of Gancao (Radix Glycyrrhizae).