Edema

Subcutaneous retention of fluid which leads to puffiness of the head, face, eyelids, limbs, abdomen and even the whole body is called edema. The causative factors are invasion of the body by the exogeneous pathogenic wind and water dampness, and internal injury by food or overstrain, which results in disturbance of water circulation and overflow of water. Since the water circulation in the body is related to the regulatory function of the lung qi, transporting function of the spleen qi, activity of the kidney qi and water communication of the three jiao, the functional derangement of the lung, spleen, kidney and three jiao may lead to edema. Clinically edema is divided into two patterns: yin edema and yang edema, according to their etiology and pathogenesis.

Etiology and Pathogenesis

Invasion of the wind upon the lung causes dysfunction of the lung in dispersion. The lung dominates the surface of the body and is associated with the skin and hair. If the lung is attacked by wind, the lung qi fails to regulate the water passages and send the water down to the bladder, leading to the confrontation between wind and water and the overflow of water to the superficial part of the body, and thus edema appears.

Living in a damp place, wading through water or drenching by rain makes water dampness attack the body. Irregular food intake causes failure of the spleen in normal transportation and transformation arid impairment of downward flow of water dampness. In either case there may be overflow of water dampness to the superficial part of the body, resulting in edema.

Overstrain injures the spleen, leading to gradual weakness of the spleen qi, which fails to distribute the essence to the lung and to the whole body. Water is also retained if the spleen function in transporting and transforming fluid is impaired. Once the spleen fails to control water and lets it flow over, edema results.

Indulgent sexual activities damage the kidney qi, and also the function of the bladder. Retention of water follows and edema results.

According to the above - mentioned, edema resulting from invasion by wind, drenching by rain and irregular food intake is of yang nature, while that resulting from overstrain, internal injury and indulgent sexual activity, leading to weakness of the spleen and kidney, is of yin nature.

However, the prolonged yang edema may lead to gradual weakness of the body resistance and increased water retention, and turn into yin edema. Pathogenetically, edema is closely related to the dysfunction of the lung, spleen and kidney.

Differentiation

Yang edema:

Main manifestations: Abrupt onset of edema with puffy face and eyelids and then anasarca, lustrous skin, accompanied by chills, fever, thirst, cough, asthma and reduced urine output, thin white tongue coating, superficial or rolling, rapid pulse.

Analysis: In case of internal accumulation of water and external invasion by wind, confrontation between them causes an abrupt onset of edema starting from the upper portion of the body, as the wind is a pathogenic factor of yang nature and characterized by upward going. If the function of the bladder is impaired, the urine output is reduced. When the wind water attacks the lung, cough, asthma, aversion to wind and chills result. If heat is dominant, there are thirst, fever and rolling rapid pulse. Thin white tongue coating and superficial pulse indicate wind water of cold nature.

Yin edema:

Main manifestations: Insidious onset of edema, at first on the pedis dorsum or eyelids, and then over the whole body, especially remarkable below the lumbar region, accompanied by sallow complexion, aversion to cold, cold limbs, soreness of the back and loins, general weakness, epigastric fullness, abdominal distension, loss of appetite, loose stools, pale tongue, white coating, deep, thready pulse.

Analysis: Because of weakness of yang in the spleen and the kidney, yin is in excess and qi fails to transport water, causing overflow of water dampness in the lower portion of the body, and hence appears pitting edema which is especially remarkable below the lumbar region. In case of lowered function of the spleen and kidney, qi is unable to nourish the face, so the complexion is sallow. Weakened kidney yang with declined Mingmen fire is insufficient to warm the body, so there is aversion to cold with cold limbs. The lumbus is the house of the kidney. If the kidney qi is weakened and water dampness excessive, soreness is felt in the back and loins. In case of hypoactivity of the spleen yang, the function bf transportation and transformation is weak, so epigastric fullness, loss of appetite, abdominal distension and loose stools result. Pale tongue, white coating, deep, thready pulse are also signs of deficiency of the spleen and kidney yang with excess of water dampness.

Treatment

Yang edema (Wind)

Method: The points of the Lung and Spleen Meridians are selected as the principal points. Even movement is applied to clear the lung, relieve the exterior symptoms and remove the retained fluid. After the exterior symptoms are relieved, refer to method for yin edema.

P/T – expel Wind, promote Lung function

Acupuncture

[LU7 - LI4 - LI6 - SP9 - BL39]. or
[[BL13 - LU5] - [TH5 & LI4] - BL22 - *SP9 - DU26]]

Explanation: Edema above the lumbus should be treated by diaphoresis, therefore, LU7 and LI4 are used to clear the lung and relieve the exterior symptoms by diaphoresis, while edema below the lumbus should be treated by diuresis, then LI6 and SP9 are applied to remove dampness and promote diuresis. BL39 is able to regulate the qi activity of the sanjiao and water passages.

Yin edema:

Method: The points of the Spleen and Kidney Meridians are selected as the principal points. Reinforcing in combination with moxibustion is applied to warm the spleen and kidney.

Acupuncture

Spleen

[BL20 - BL23 - RN9 - RN4 - KI7 - ST36]. or
[BL20 - BL22 - RN6 - RN9 - ST36 - SP6] moxa

Kidney

• P/T – warm and tonify Kidney Yang, transform Qi
• [BL23 - RN4 - BL22 - RN9 - BL20 - ST36]
  (heavy moxa on RN4)

Supplementary points:

Facial puffmess: DU26.
Edema on the pedis dorsum: GB41, SP5.

Explanation: Yin edema is caused by decline of the kidney yang that fails to control water and by weakness of the spleen qi that leads to impairment of transportation in the middle jiao. Acupuncture and moxibustion to BL20, BL23 and KI7 may warm the primary yang of the spleen and kidney and remove cold water. Moxibustion to RN9 and RN4 may promote the water circulation and reinforce the primary qi respectively. Reinforcing on ST36 promotes the transporting and tranforming function of the spleen and stomach, restoring normal distribution of the fluid.

Alternative Treatment Methods

• auricular- LU SP KI, BL, subcortex
• 3 edge needle- bleed BL 40, SP 9, BL 23 (chronic)
• 7 star needle- BL meridian

Remarks

In the context of edema, acute and chronic nephritis and malnutrition are included.