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Edema, caused by spleen deficiency failing to control water, leads to water flooding and erratic movement. Treatment should involve using Ginseng Radix et Rhizoma (Renshen) and Atractylodis Macrocephalae Rhizoma (Baizhu) to tonify spleen qi, so that spleen qi becomes solid, enabling natural transportation and transformation, and normal ascending and descending functions. By mobilizing the pivot of the middle jiao, water flows naturally; this differs from the water-draining methods of Wuling San (Five-Ingredient Powder with Poria) or Shenyu Wan (Divine Protection Pill). It is appropriate to employ methods of tonifying the center, moving dampness, and promoting urination. One must absolutely avoid [misusing purgatives]. The main prescription is Erchen Tang (Two-Aged Decoction) added with Baizhu, Renshen, and Cangzhu (Atractylodis Rhizoma), assisted by Huangqin (Scutellariae Radix), Maidong (Ophiopogonis Radix), and Chao Zhizi (Fried Gardenia Fruit) to restrain excessive liver wood. If abdominal distension is present, add Houpo (Magnoliae Officinalis Cortex) in small amounts; if qi fails to move, add Muxiang (Aucklandiae Radix) and Mutong (Akebiae Caulis); if qi sinks, add Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) to lift it, adjusting according to the disease. One must use methods to tonify the middle and move dampness, combined with Erchen Tang for treating dampness and adding lifting herbs, which can moisten the stool and increase urine output. For postpartum edema, the primary treatment must be greatly tonifying blood and qi, with small additions of Cangzhu and Fuling (Poria), allowing water to descend naturally; a large dose of Baizhu should be used to tonify the spleen. If there is stagnation and fullness, use Banxia (Pinelliae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), and Xiangfu (Cyperi Rhizoma) to constrain it; if heat is present, one should clear lung metal, using Maidong and Huangqin. One formula uses Zhizi (Gardeniae Fructus): remove the skin, take out the seeds, fry them, crush them, and send down with rice decoction; if the stomach heat pathology is located above, use it with the skin.

To treat hot-water edema, use 5 qian of Zhizi, 1.5 qian of Muxiang, and 2.5 qian of Baizhu, cut into pieces, and decoct with swift-flowing water for administration. To treat water swelling, use Daye (Euphorbiae Pekinensis Radix) and Xiangru (Elsholtziae Herba), decoct strongly into a paste, and form pills to dispel summerheat and promote urination. Daye powdered, formed into ten pills with date flesh, is used to drain small amounts of urine, suitable for cases with excess pathogenic factors requiring rapid intervention.

Dai Yun stated: Edema refers to the condition where the entire body's skin is swollen and shiny like blisters. Treatment should focus on strengthening the spleen, leaching out dampness, promoting urination, and advancing food intake. Patients with sufficient primordial qi may undergo purgative therapy.

[Appendix] Swelling below the waist should be treated by promoting urination; swelling above the waist should be treated by inducing sweating. This is an essential method of Zhang Zhongjing. Many practitioners only know the theory that treating dampness requires promoting urination, sticking rigidly to this path and using various water-draining drugs, often resulting in death. Others use powerful purgatives such as Daoshui Wan (Water-Guiding Pill), Zhouche Wan (Boat-Carriage Pill), and Shenyu Wan, which is a sign of hastening death. Because the spleen is extremely deficient and failing, further purgation increases deficiency. Although immediate relief may be achieved by forcibly draining, yin and righteous qi are damaged, yet the disease returns immediately. At this point, one should primarily greatly tonify the central palace (spleen/stomach), adjusting for accompanying symptoms; otherwise, death will ensue. One should use Yan Shi Shipi San (Yan’s Spleen-Strengthening Powder) with modifications. For water disease with yang patterns accompanied by yang symptoms, the pulse must be deep and rapid; for water disease with yin patterns accompanied by yin symptoms, the pulse must be deep and slow. Water diseases vary. Jia Luoyang believed that untreated edematous disease inevitably becomes a stubborn ailment; even Bian Que could not save them. Thus, we know that the danger and severity of edema are unlike other diseases. What allows humans to preserve their life is water and grain. Water is governed by the kidney; earth and grain are governed by the spleen. Only when the kidney is deficient can it fail to move water; only when the spleen is deficient can it fail to control water. The stomach and spleen combine qi; the stomach is the sea of water and grain. Due to deficiency, transmission and transformation fail. Therefore, kidney water overflows and instead infiltrates spleen earth, causing the three jiao to stagnate and meridians to block. Water seeps into the skin and pours into the muscles, causing swelling. Its manifestations include: slight bulging of the eyelids, heavy limbs, coughing and wheezing, palpitations, coldness between the thighs, scanty yellow urine, thin and shiny skin, pitting upon pressure that rebounds immediately. Treatment methods: If the body has heat, water qi is in the exterior, and sweating may be induced; if the body has no heat, water qi is in the interior, and purgation may be used. Among these, promoting urination, smoothing qi, and harmonizing the spleen must not be delayed. Although the syndrome may allow purgation, one must weigh the severity and cannot excessively use fierce agents like Yuanhua (Kadupul Flower), Daye, or Gansui ( Kansui Root). Once released, they cannot be recalled. I fear that harsh drainage is easy, but consolidation is difficult; if water qi returns, there will be no way to treat it. Wind-swelling features rough skin, numbness and insensitivity, and migrating pain; Qi-swelling features thick skin, emaciated limbs, and abdominal/hypochondriac distension. Red threads and marks between the skin indicate Blood-swelling. Pregnant women may also have false swelling due to qi blocking the water pathway; this only requires smoothing qi and calming the spleen. With unimpeded diet, swelling subsides spontaneously after delivery. Generally, edema starting in the abdomen and then spreading to the four limbs is treatable; edema starting in the four limbs and then returning to the abdomen is untreatable. Loose stools, black lips, flat clavicular fossa, protruding umbilicus, flat dorsum of feet, flat back, hard flesh, flat palms, or men swelling upward from the feet, women swelling downward from the body, are all untreatable. If the whole body is swollen, with irritability, thirst, red and scanty urine, and constipation, this belongs to Yang Water. First use Wupi San (Five-Peel Powder) or Simo Yin (Four-Mortar Drink) with ground fresh Zhiqiao (Immature Bitter Orange); for severe cases, use Shuozao Yin (Scouring Decoction). If the whole body is swollen, without irritability or thirst, with loose stools and scanty, non-red/non-astringent urine, this belongs to Yin Water. Use Shipi Yin (Spleen-Strengthening Drink) or Muxiang Liqi Yin (Muxiang Qi-Moving Drink).

For Yang Water edema, burn rotten lotus leaves to ash, preserve nature, powder them, and administer with rice drink. If the condition allows purgation, use Sansheng San (Three-Sage Powder) containing Qian Niu Zi (Pharbitidis Semen), Zhishi (Aurantii Fructus Immaturus), and radish, depending on size, deficiency/excess, and qi sufficiency. For those with sufficiency of qi, select Sanhua Shenyu Wan (Three-Flower Divine Protection Pill), Zhouche Wan, or Yugong San. Avoid eating sheep head and trotters, as their nature strongly supplements water; eating them results in less than one in a hundred recoveries.

Attached Formulas

Jiawei Wupi San (Modified Five-Peel Powder): Treats swelling and fullness of the four limbs; applicable to both Yang Water and Yin Water.
Chenpi, Sangbaipi (Mori Cortex), Chi Fulingpi (Red Poria Peel), Shengjiangpi (Fresh Ginger Peel), Dafupi (Arecae Seed Peel) (each 1 qian). Add Jianghuang (Curcumae Longae Rhizoma) (1 qian), Mugua (Chaenomelis Fructus) (1 qian).
Take as one dose, decoct in water. Another method: Remove Chenpi and Sangbai, use Wujiapi (Acanthopanacis Cortex) and Digupi (Lycii Cortex).

Shuozao Yinzi (Scouring Decoction): Treats water qi causing generalized edema, panting and急促 breathing, irritability and thirst, difficulty in urination and defecation, and intolerance to hot medicines.
Zexie (Alismatis Rhizoma), Chixiaodou (Adzuki Bean, fried), Shanglu (Phytolaccae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Dafupi, Jiaomu (Zanthoxyli Semen), Mutong, Qinjiao (Gentianae Macrophyllae Radix), Binglang (Areca Seed), Fulingpi (equal parts).
Cut into pieces. Decoct in water, add five slices of ginger.

Da Jupi Tang (Large Tangerine Peel Decoction): Treats internal attack of damp-heat, abdominal distension and edema, dysuria, and loose stools.
Chenpi (1 liang), Muxiang (2.5 qian), Huashi (Talcum, 6 liang), Binglang (3 qian), Fuling (1 liang), Zhuling (Polyporus), Baizhu, Zexie, Rougui (Cinnamomi Cortex) (each half liang), Gancao (Licorice Root, 2 qian).
Add five slices of fresh ginger, decoct in water and take.

Shizao Wan (Ten-Date Pills): Treats water qi, edema of the four limbs, upper body panting and急促 breathing, and difficulty in urination and defecation.
Gansui (Kansui Root), Daye, Yuanhua (equal parts).
Powder these ingredients. Boil date flesh to make pills the size of paulownia seeds. Take thirty pills early morning with hot water, until purged. Take again the next morning. Do not take too much for deficient persons.

Another Method: Treats false swelling.
Xiangfu (Cyperi Rhizoma) in any amount, soak in child’s urine for one day and night. Take out, change to fresh child’s urine, soak for another day and night. Take out again, change to fresh child’s urine, soak for one more day and night. Rub off the skin, dry in the sun.
Powder these ingredients. Make pills the size of walnut seeds with vinegar paste. Take seventy pills, delivered with Simingwei Liuqi Yin (Twenty-Four-Ingredient Qi-Moving Drink).

Yan Shi Shipi San (Yan’s Spleen-Strengthening Powder):
Houpo (processed), Baizhu, Mugua, Dafuzi (Areca Seed), Fuzi (Aconiti Lateralis Radix Praeparata), Muxiang, Caoguoren (Tsaoko Cardamomi Fructus), Bai Fuling, Ganjiang (Dried Ginger, processed) (each 1 liang), Gancao (honey-fried, half liang).
Cut into pieces. Decoct with five slices of ginger and one date. Take at any time.

Muxiang Liqi Yin: See Qi Category.
Simo Yin: See Panting Category.
Sanhua Shenyu Wan, Zhouche Wan: Both see Damp-Wetness Category.

Yugong San:
Hei Qian Niu (Black Pharbitis Seed, first flour, 4 liang), Huixiang (Fennel, fried, 1 liang).
Powder these ingredients. Mix with fresh ginger juice, take 1-2 qian before sleep. Can add Baizhu 1 liang.

Jiawei Zhizhu Tang (Modified Aurantium and Atractylodes Decoction): Treats qi blocked by phlegm-fluids, hardness and distension in the epigastrium, named Qi Fen.
Zhike (Aurantii Fructus), Baizhu, Zisu Jingye (Perillae Caulis et Folium), Gui (Cinnamon Twig), Chenpi, Binglang, Beigan (Platycodonis Radix), Muxiang, Wulingzhi (Trogopterori Faeces, fried) (each 2 fen), Banxia, Fuling, Gancao (each 1.5 fen).
Decoct in water, add three slices of ginger.

Taishui Syndrome: Whenever a woman has chronic wind-cold-dampness, pregnancy causes foot swelling, or generalized swelling with urgent abdominal distension, it is named Taishui (Fetal Water).

Simingwei Liuqi Yin: See Qi Category.