Library

The *Classic* states: In distension of the skin (Fu Zhang), cold pathogenic factors lodge between the skin and muscles. The abdomen is enlarged, the whole body is swollen, the skin is thick, and pressing it leaves an indentation that does not rise immediately, with a change in abdominal color; this is its clinical manifestation. It also states: All swellings and fullnesses due to dampness belong to the Spleen. Furthermore: Water diseases manifest as edema below and panting/calling out above. Those who cannot lie flat indicate that both the root and branch are diseased. If it is pediatric edema, it is all caused by water retention in the Lung and Spleen meridians.

Water retained internally: Water stagnating in the chest causes panting; water stagnating below the diaphragm causes abdominal distension. Water manifesting externally requires observing the location of the swelling. Swelling above the waist belongs to Wind, and treatment should favor sweating (Diaphoresis). Swelling below the waist belongs to Dampness, and treatment should favor promoting urination (Diuresis). Swelling throughout the entire body indicates injury by both Wind and Dampness, requiring simultaneous sweating and diuresis. Swelling accompanied by panting and inability to lie flat requires driving out fluid retention from the Lungs. Swelling accompanied by abdominal fullness and constipation requires purging water from the Spleen. Swelling starting from the abdomen and spreading to the four limbs is treatable. Swelling starting from the four limbs and spreading to the abdomen is difficult to treat. Yang-type water (Yang Shui) belongs to Excess patterns, treated by purging and draining. Yin-type water (Yin Shui) belongs to Deficiency patterns, treated by warming and securing the exterior.

The methods for treating edema have been generally described above. The flexibility and profound understanding required depend on the practitioner. One must not be rigid or inflexible. Therefore, this treatise on "Edema" is composed.

Pediatric upper-body edema refers to swelling of the head, face, shoulders, arms, down to the waist. The etiology is external contraction of Wind pathogenic factors. Following ancient methods imitating the Classic's concept of "opening the ghost gate" (sweating), the main formula is Yuebi Jia Cangzhu Tang (Yuebi Decoction plus Atractylodis Rhizoma) to induce sweating (ingredients include Ephedrae Herba, Gypsum Fibrosum, Raw Glycyrrhizae Radix et Rhizoma, Cangzhu stir-fried in rice wash water, etc.).

[Chen Shouzhen's Note]: For pediatric edema arising from the top, since it is due to Wind, treatment should focus on the Lungs. Ancient formulas are too harsh. Instead, use Stir-fried Codonopsis Radix 5 fen, doubled Bupleuri Radix 5 fen, Ya Jiegeng (Buddha's Hand Platycodon) 1 qian, Lao Suye (Old Perilla Leaf) 5 fen, Zhen Guangpi (True Tangerine Peel) 1 qian, Honey-fried Glycyrrhizae Radix et Rhizoma 5 fen, Shengjiangpi (Ginger Peel) 1 qian, Dafupi (Areca Peel) 1 qian, Fulingpi (Poria Peel) 1 qian, Chao Sangbaipi (Stir-fried Mulberry Root Bark) 1 qian, Wujiaopi (Acanthopanacis Cortex) 1 qian, with Dengxincao (Juncus Effusus) 10 stems as a guide.

Pediatric lower-body edema refers to swelling from the waist and umbilicus to both feet. The etiology is Damp-Heat in the Spleen meridian. Following ancient methods imitating the Classic's concept of "cleaning the fu-organs" (promoting urination), the main method is internal application via navel sticking (ingredients include Crotonis Fructus, oil removed, 4 qian, Shuifen [White Lead Powder] 2 qian, Liuhuang (Sulfur) 1 qian, ground evenly into a cake. First, wrap the medicine in a piece of new cotton, apply to the navel, and bind tightly with cloth for about one shi (two hours). Naturally, foul water will be discharged. After 3-5 discharges, remove the medicine and replenish with congee).

Internal administration of Chenxiang Hupo Wan (Agarwood and Amber Pill) [ingredients include Ku Tinglizi (Bitter Lepidii Semen) 1 liang 5 qian, Yuliren (Prunus Armeniaca Seed) 1 liang 5 qian, Fangji (Stephaniae Tetrandrae Radix) 7 qian 5 fen, Chenxiang (Aquilariae Lignum Resinatum) 1 liang 5 qian, Chenpi (Citri Reticulatae Pericarpium, white part removed) 7 qian 5 fen, Hupo (Amber) 5 qian, Xingren (Armeniacae Semen Amarum, peeled and tip removed, stir-fried) 5 qian, Suzi (Perillae Fructus) 5 qian, Chiling (Red Poria) 5 qian, Zexie (Alismatis Rhizoma) 5 qian, ground into fine powder, mixed with refined honey to form pills the size of Sophora seeds, coated with Moschus, each dose 1 qian, adjusted according to the child's age, taken with plain boiled water].

[Chen Shouzhen's Note]: For pediatric edema arising from the bottom, it may be due to Kidney Deficiency with water overflowing, or Spleen Qi affected by Dampness. Ancient internal and external treatments are extremely violent; this medicine should not be used recklessly. Only mild diuretic and leaching methods are suitable. The formula uses Sheng Baizhu (Raw Atractylodis Macrocephalae Rhizoma) 2 qian, Bai Yunling (White Cloud Poria) 2 qian, Jie Zhuling (Knot Polyporus) 2 qian, Chao Zexie (Stir-fried Alismatis Rhizoma) 2 qian, Shang Rougui (Super Cinnamon Bark) 3 fen, Chao Fangji (Stir-fried Stephaniae Tetrandrae Radix) 1 qian, Hua Binglang (Flowered Areca Nut) 1 qian, with Shengjiang (Fresh Ginger) 1 slice and Dengxincao (Juncus Effusus) 10 stems as guides.