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Damp-heat (Shi Re) and Spleen Deficiency (Pi Xu), as well as Yin Edema (Yin Shui) and Yang Edema (Yang Shui).

Edema (Shui Zhong) arises from the deficiency of the host [vital qi] failing to control water, leading to water overflowing and acting recklessly, flowing into the meridians and collaterals, condensing without dispersing, thereby forming edematous swelling. The initial symptoms present with swelling under the eyes resembling a silkworm just after waking; the skin of the limbs wraps around water, and the muscle surface is glossy. Pressing with the hand leaves an indentation that rises immediately upon lifting. This is because the Lung belongs to Metal in the Five Elements, and Metal generates Water. If Water fails to descend and instead inundates and attacks the Lung, it results in chest fullness, wheezing, coughing, and obstruction of urination.

Dai Yun stated: When the skin of the entire body is thin and glossy, pressing leaves a pit that fills up immediately upon lifting the hand, this is Edema. There is a distinction between Yin/Yang and Upper/Lower.

Danxi stated: In cases of Yin Edema, the pulse is deep and slow, the complexion is often bluish-white, there is no irritability or thirst, urination is scanty but clear, and stool is often loose. In cases of Yang Edema, the pulse is deep and rapid, the complexion is often yellowish-red, there is irritability and thirst, urination is scanty and reddish, and stool is constipated.

If the shins and feet of an edema patient are warm, the condition is treatable; if cold, it is difficult to treat.

The Mai Jue (Pulse Classic) states: For Qi-Water disease, a floating and large pulse indicates survival, while a deep and fine pulse indicates death.

Li Dongyuan stated: Yang Edema presents with a deep and rapid pulse, while Yin Edema presents with a deep and slow pulse. Yang Edema is easy to treat, whereas Yin Edema is difficult to treat.

Zhang Zhongjing said: For swelling below the waist, promoting urination is appropriate; for swelling above the waist, inducing sweating is appropriate.

First, for inducing sweating, Mahuang Gancao Tang (Ephedra and Licorice Decoction) is suitable.

Second, for promoting urination, Wuling San (Five-Ingredient Powder with Poria) is suitable.

Third, treating edema requires first tonifying the Middle Jiao and drying dampness, followed by opening the draining pathways to resolve the water pathogen.

Fourth, for Yang Edema with distending swelling and obstruction of both urination and defecation, Sanhua Shenyao Wan (Three-Flower Divine Protection Pill), Shizao Wan (Ten Date Pill), Shen Zhu San (Divine Assistance Powder), Fuling Hupo Wan (Poria and Amber Pill), Haijinsha San (Lygodium Spore Powder), and Qinjiao Fuling Tang (Gentian and Poria Decoction) are suitable.

Fifth, for Yin Edema with distending swelling and wheezing, Tingli Muxiang San (Descurainia and Costus Powder), Shipi San (Solidify the Spleen Powder), Xuisui Zi Wan (Euphorbia Lathyris Pill), Baizhu Muxiang San (Atractylodes Macrocephala and Costus Powder), and Shuozao Yinzi (Scouring Decoction) are suitable.

Sixth, regarding Solidifying the Spleen [treating Spleen deficiency with excess], Ren Shen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome) should be used as the Sovereign herb; Cangzhu (Atractylodes Lancea Rhizome), Fuling (Poria), and Chenpi (Tangerine Peel) should be used as the Minister herbs to dry dampness; Mutong (Akebia Stem), Cheqian (Plantago Seed), and Zhuling (Polyporus) should be used as the Assistant herbs to separate and drain; Muxiang (Vladimiria Root) and Binglang (Areca Seed) should be used as the Guide herb to move Qi. This is the general principle for treating swelling.

When Water-Qi attacks the Lung, causing generalized edema, coughing, wheezing, and difficulty in urination, Hupo Wan (Amber Pill) and Qingjin Jiangqi Tang (Clear Metal and Descend Qi Decoction) are suitable.

Treatment Formulas:

Treating Edema by Inducing Sweating:
Mahuang (Ephedrae Herba), Gancao (Glycyrrhizae Radix et Rhizoma).
Decoct two zhong of water until eight fen remains. Take warm. After sweating occurs, avoid exposure to wind.