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Edema is a syndrome that can be classified into Yin and Yang types. Diagnosis requires detailed observation of the pulse, complexion, and inquiry into symptoms. A Yin type presents with a deep and slow pulse (Chen Chi Mai), bluish-white complexion, absence of thirst accompanied by diarrhea, and clear or scanty urine. If the pulse is deep and rapid (Chen Shu Mai), the complexion is red-yellow, there is dry dark stool, dark scanty urine, and thirst, it belongs to the Yang type.

The term "swelling" (Zhong) implies accumulation, caused by the gathering of cold and heat pathogens. The disease is divided into ten categories of water disorders. Its root cause lies in damp-heat. As stated in the *Nei Jing* (Inner Canon): "All dampness-induced swelling and fullness belong to Spleen Earth." When the Spleen is deficient and fails to control water metabolism, water fluids overflow and act recklessly, causing edema throughout the body, face, eyes, and limbs, termed Edema (Shui Zhong). If the abdomen is distended like a drum but the face, eyes, and limbs are not swollen, it is termed Gu Distension (Gu Zhang). Symptoms that ease in the morning and worsen in the evening indicate Blood Deficiency; those that ease in the evening and worsen in the morning indicate Qi Deficiency; symptoms worsening both morning and evening indicate combined Qi and Blood Deficiency.

Treatment principles: If the body has fever, the water pathogen is at the Exterior, and diaphoresis (sweating method) may be used. If there is no fever, the water pathogen is at the Interior, and purgation may be used. Methods to promote urination, regulate Qi, and harmonize the Spleen must not be delayed. However, even if purgation is indicated, one must assess the severity. One must not overuse harsh diuretics such as Daji (Kansui Root), Yuanhua (Genkwa Flower), or Gansui (Euphorbia Root), as their action is difficult to stop once initiated. Harsh purgation is easy to perform, but preserving the solidification of Zheng Qi (Upright Qi) is difficult. If water pathogens return after such treatment, there may be no remedy left.

First, for any edema patient presenting with loose stools/incontinence, black lips, flat supraclavicular fossae (Que Pen), protruding umbilicus, flat dorsum pedis, flat back, hard muscles, flat palms, or male patients swelling from feet upward, female patients swelling from upper body downward: these are all untreatable cases. Furthermore, in abdominal distension due to water qi, a black facial color indicates Liver Qi exhaustion; protruding eyebrows indicate Lung Qi exhaustion; protruding umbilicus indicates Spleen Qi exhaustion; inability to grip with hands indicates Heart Qi exhaustion; lower injection with foot swelling indicates Kidney Qi exhaustion. If any one of these five signs appears, the case is untreatable.

Second, if pressing the abdomen leaves an indentation, the case is treatable. Cases with a strong pulse are easier to cure; those with a faint pulse are difficult to recover from.

Third, generalized edema, irritability, thirst, dark and scanty urine, constipation, fever, and a deep-rapid pulse belong to Yang Water. It should be treated with Bazheng San (Eight-Item Decoction for Rectification).

Fourth, generalized edema without irritability or thirst, loose stools, scanty urine without dysuria, absence of fever, and a deep pulse belong to Yin Water. It should be treated with Weiling Tang (Stomach-Cinnamon Decoction).

Fifth, for edema caused by Qi stagnation, use Fenxin Qi Yin (Heart-Separating Qi Drink) added with Zhuling (Polyporus), Zexie (Alisma), Cheqianzi (Plantago Seed), Tinglizi (Lepidium Seed), Mugua (Chaenomeles Fruit), and Maimendong (Ophiopogon Tuber).

Sixth, generalized skin edema that is shiny and blister-like, where pressing creates a pit that fills immediately upon lifting the hand, is due to Spleen deficiency failing to control water, leading to reckless water overflow. The treatment should tonify the Spleen so that Spleen Qi becomes substantial and transportation functions normally. Purgation must strictly be avoided, and mutton should be forbidden. Edema above the waist should be treated with diaphoresis; edema below the waist should be treated by promoting urination. This is the brilliant method of Zhang Zhongjing.

Seventh, if a patient has rapid pulses in all six positions, swollen and full limbs, abdominal pain, fever, scanty urine, and constipation, treating with methods to warm the middle and nourish the Stomach is incorrect. This condition arises from heat accumulation in the Triple Burner, blocking urination and defecation, preventing discharge. The heat flows into the meridians, overflowing the five Zang organs, resulting in swelling. It should be treated with Baidu San (Defeat Toxin Powder) added with Mahuang (Ephedra Herb), Fangfeng (Saposhnikovia Root), and Zhishi (Immature Bitter Orange) to disperse externally, followed by Liqi Wan (Regulate Qi Pill) for purgation, or Bazheng San.

Formulas:

Xiaozhong Tiaopi Shunqi Tang (Swelling-Reducing, Spleen-Harmonizing, Qi-Regulating Decoction) [Transmitted by Vice Minister Liu] Treats edema, reduces distension, regulates Qi, harmonizes the Spleen, removes dampness, and promotes urination.
Ingredients: Cangzhu (Atractylodis Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Nongpo (Magnoliae Officinalis Cortex), Caoguo (Tsaoko Fructus), Sharen (Amomi Fructus Rotundus), Zhuling (Polyporus), Muxiang (Aucklandiae Radix), Binglang (Arecae Semen) (Male uses male fruit, female uses female fruit), Dafupi (Tangerine Peel pericarp), Xiangfu (Cyperi Rhizoma), Zhiqiao (Aurantii Fructus Immaturus), Zexie (Alismatis Rhizoma), Jiegeng (Platycodonis Radix), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Guangui (Cinnamomi Cortex), Da Huixiang (Foeniculi Fructus), Mutong (Akebiae Caulis), Renshen (Ginseng Radix et Rhizoma), Mugua (Chaenomelis Fructus), Sangbaipi (Mori Cortex), Qianniu (Pharbitidis Semen) (Female uses black seed, male uses white seed), Dahuang (Rhei Radix et Rhizoma), Gancao (Glycyrrhizae Radix et Rhizoma).
Preparation: Coarsely powdered, decocted with fresh ginger.

Jiajian Weiling Tang (Modified Stomach-Cinnamon Decoction) [Prepared by Yunlin] [Commentary: A formula for reducing internal swelling, promoting urination, and harmonizing herbs.] Treats edema.
Ingredients: Cangzhu (prepared with rice wash water, 1.5 qian), Chenpi (peeled, 1 qian), Nongpo (stir-fried with ginger juice, 0.8 qian), Gancao (honey-fried, 0.3 qian), Zhuling (0.8 qian), Zexie (1 qian), Baizhu (rhizome removed, 1 qian), Chifuling (peeled, 1 qian), Shenqu (stir-fried, 0.8 qian), Shanzha (pitted, 0.7 qian), Sharen (stir-fried, 0.7 qian), Xiangfu (stir-fried with ginger juice, 0.6 qian), Binglang (0.8 qian), Mugua (1 qian), Dafupi (0.6 qian).
Preparation: Coarsely powdered for one dose, decocted with fresh ginger and Centella asiatica herb (Dengxin Cao).

Suchen Pojie Tang (Perilla-Agarwood Breaking Knots Decoction) [Transmitted by Vice Envoy Che]
Ingredients: Zisu (Perillae Folium), Bohe (Menthae Haplocalycis Herba), Zhishi (Aurantii Fructus Immaturus), Maimendong (Ophiopogonis Tuber), Danggui (Angelicae Sinensis Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Dahuang (Rhei Radix et Rhizoma), Mutong (Akebiae Caulis), Gansui (Euphorbiae Pekinensis Radix), Baijiangcan (Bombyx Batryticatus), Baidoukou (Cardamomi Fructus), Muxiang (Aucklandiae Radix), Chenxiang (Aquilariae Lignum Resinatum) (Halved, the above three separately powdered), Yazao (Gleditsiae Spina), Shengjiang (Zingiberis Rhizoma Recens), Xiacha (Fine Tea) (Each 1 qian).
Preparation: Divided into two doses, decocted in water, taken early at Wugeng time (3-5 AM), with dietary restrictions.

Huisheng Dan (Life-Restoring Pill) Treats edema, abdominal distension, and water retention.
Ingredients: Qingpi (Citri Reticulatae Pericarpium Viride), Chenpi (Citri Reticulatae Pericarpium), Sanleng (Sparganii Rhizoma), Ezhu (Curcumae Rhizoma), Lianqiao (Forsythiae Fructus) (Each 3 qian above, stir-fried with 1.5 liang of Baiduo (Crotonis Fructus) shelled in a clay pot before adding to medicine), Muxiang (Aucklandiae Radix), Gansui (Euphorbiae Pekinensis Radix) (stir-fried), Shanglu (Phytolaccae Radix), Zexie (Alismatis Rhizoma), Mutong (Akebiae Caulis) (stir-fried), Ganqi (Drynariae Rhizoma? Note: Text says Ganqi, likely Drynariae Rhizoma or similar, but context suggests resinous wood or similar, actually Ganqi usually refers to Drynariae Rhizoma, but here might be a typo for Ganlan or similar resin? Standard interpretation of Ganqi in this context often implies Drynariae Rhizoma, but given "stir-fried until smoke gone", it might refer to a resinous substance. However, standard herb list includes Ganqi. Let's stick to text), Luobozhong (Brassicae Napus Semen) (stir-fried, each 3 qian), Chifuling (Polyporus), Sangbaipi (Mori Cortex) (stir-fried), Jiaomu (Zanthoxyli Pericarpium) (stir-fried, each 5 qian), Hujiao (Piperis Longi Fructus) (stir-fried, 1 qian), Hei Qianniu (Pharbitidis Semen Nigrum) (1 liang, raw).
Preparation: Powdered, mixed with vinegar paste to form pills the size of mung beans. Take 15-20 pills per dose. First dose: take with 24 raw green onions mashed and warm wine at Wugeng time. Second dose: take with decoction of Chenpi and Sangbaipi. Third dose: take with Shegan (Belamcandae Rhizoma) decoction. Strictly avoid salt.

Tuiche Wan (Cart-Pushing Pill) [Transmitted by Mao Weizhong] [Commentary: A harsh formula for reducing swelling.] Treats edema, Qi edema, and isolated abdominal distension.
Ingredients: Chenxiang (Aquilariae Lignum Resinatum) (1 qian), Muxiang (Aucklandiae Radix) (1 qian), Baiduo (Crotonis Fructus) (1 qian, half raw half cooked), Hujiao (Piperis Longi Fructus) (1 qian, stir-fried until popping).
Preparation: Powdered, mixed with jujube pulp to form pills the size of paulownia seeds. Take 50-60 pills per dose. For upper swelling: take with pounded scallion whites and hot wine. For middle swelling next day: take with Chenpi decoction. For lower swelling third time: take with Niuxi (Achyranthis Bidentatae Radix) decoction. After 3-5 courses, stopping supplementation will naturally cease the swelling. Afterwards, use Shipi San to tighten the skin.

Jili Yin (Chicken-Liquor Drink) [Transmitted by Liu Tongzhi] Treats all swellings of the abdomen and limbs, effective for edema, Qi edema, and damp edema.
Ingredients: Gan Jifen (Dried Chicken Manure) 1 sheng.
Preparation: Stir-fry in a pot until yellow, quench with 3 bowls of good wine, boil down to 1 bowl, filter finely to remove dregs. Patient drinks it. Soon, abdominal Qi moves loudly, expelling through large intestine. Wrinkling appears on knees and around umbilicus, swelling gradually subsides. If not fully resolved, take another dose. Then eat 2 field snails cooked in boiling wine to stop. Continue with warm porridge for recovery.

Secret Recipe [Transmitted by Wu Youzhu] Treats edema and distension.
Ingredients: 2-3 Bufo bufo gargarizans (Laixima).
Preparation: Stuff inside a pig stomach, cook in good wine for one Fu period (approx 2 hours). Remove the toads. Consume the pig stomach and wine completely. Loud flatulence or water discharge occurs, swelling subsides. Adding Sharen is excellent. Another variation adds Hujiao (1 grain per year of age), cooked together, which is also excellent.

Fa Zheng Bimagan Gao (Method-Steamed Castor Oil Paste) [Commentary: A specialized harsh formula for reducing swelling.] Treats ten types of water qi and five types of Gu miasma.
Ingredients: Ricinus communis seeds (Bimazi) shelled.
Preparation: Wrap in hemp cloth, press to remove oil, spread thinly on a wooden spoon. Place spoon upside down in a pot, cover with a pot lid over water surface. Boil for more than 20 boils until the medicine loses its white color. Remove. Take 6 qian per dose, dissolve in boiling water, take warm on an empty stomach. Within 2-3 doses, excessive urination indicates efficacy.

Daoshui Bing (Water-Guiding Cake) [Secret Recipe] Treats swelling, removing water without oral medication.
Ingredients: Zhen Shuiyinfen (Calomelas/Calomel powder, 2 qian), Badourou (Baiduo flesh, ground, oil removed, 4 qian), Sheng Liuhuang (Native Sulfur, 1 qian).
Preparation: Grind three ingredients into a uniform cake. Place a piece of new cotton on the umbilicus, then cover the umbilicus with the cake. Bind tightly with cloth. After walking 3-5 li, evil water will naturally purge. After 3-5 times, remove the medicine and replenish with warm white porridge.

Xiaohe Bing (River-Reducing Cake) [Secret Recipe] [Commentary: An external treatment formula for reducing swelling.] Treats edema and distension.
Ingredients: 4 Large field snails, 5 Garlic cloves (peeled), 3 qian Cheqianzi (Plantaginis Semen) powdered.
Preparation: Grind three ingredients into a cake, apply to the umbilicus, bind with a handkerchief. Shortly after application, urination occurs. 1-2 applications result in cure.