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(This condition is more common; administering Wupi Yin [Five Peel Decoction] is advisable.)

Regarding the etiology of edema, there are distinctions between root (Ben) and branch (Biao) diseases. The Kidney governs Yuan Qi (Original Qi), corresponding to the Water of Tianyi (Heavenly One). The Lung governs Chonghua (Pulsating Transformation), corresponding to the Metal of Disi (Earthly Four). The Kidney is the root, and the Lung is the branch; both belong to Extreme Yin and are prone to accumulating water. In pathology, the Kidney serves as the key gate of the Stomach. If this gate is obstructed, the pivot mechanism fails to rotate, causing water to stagnate. It then seeps into the collaterals and skin, resulting in edema. Treatment should be based on investigating internal and external pathogenic factors. For older children, pulse diagnosis determines deficiency or excess. Ancient formulas describe ten types of edema: shortness of breath and inability to lie flat characterize Heart Edema; tightness and pain in the two hypochondria characterize Liver Edema; loose stools resembling duck feces characterize Lung Edema; heaviness and discomfort in the four limbs characterize Spleen Edema; lower back pain and cold feet characterize Kidney Edema; bitter taste in the mouth and dry throat characterize Gallbladder Edema; alternating deficiency and excess characterize Large Intestine Edema; abdominal urgency with emaciated limbs characterize Bladder Edema; obstruction and difficulty in urination characterize Stomach Edema; and fullness and urgency in the lower abdomen characterize Small Intestine Edema. However, a floating pulse typically indicates Wind or Deficiency, while a deep and hidden pulse indicates Water disease. A deep pulse suggests emptiness in the collaterals, and a hidden pulse suggests difficulty in urination, which constitutes Zheng Shui (Standard Water Disease). A deficient and large Spleen pulse often indicates Spleen swelling; if neglected, it develops into generalized edema. Since the Spleen belongs to Earth, it prefers dryness and dislikes dampness. It is frequently affected by dampness, which injures the Spleen, transforming blood into water. When Earth fails to control Water, water accumulates and stagnates in the skin, causing edema.

At the onset of the disease, if morning puffiness of the eyelids subsides slightly by afternoon, Qianghuo San [Notopterygium Powder] should be used to disperse and resolve the exterior, followed by Xingpi San [Spleen-Awakening Powder]. Intermittently, Nanxing Fupi San [Arisaema and Tangerine Peel Powder] may be administered. If the Spleen is cold and hindered, drying agents such as Caoguo [Black Cardamom Fruit] and Suosha [Amomum Tsao-ko] should be used. This condition is relatively easy to treat in summer and during autumn and winter, but difficult in spring. Among the four seasons, no water accumulation surpasses that of spring, compounded by the flourishing Wood of the Liver overcoming the Earth of the Spleen, making the Spleen unable to handle water. Thus, treatment is difficult, with fluctuating progress, requiring gradual regulation for efficacy. If the Spleen is hot and hindered, using drying herbs might seem logical since Fire generates Earth and can overcome Water. However, excessive drying causes Earth to be overwhelmed by Fire, intensifying heat, leading to anorexia, fever, restlessness, and thirst. If physicians continue to administer drying agents, facial edema worsens, leading to Spleen failure and swelling of the dorsum of hands and feet. The dorsum of hands and feet, along with umbilical protrusion, are external signs of the Spleen. If purgatives are used abruptly without first resolving the exterior, edema may temporarily subside after one bowel movement. People mistakenly attribute this to the power of purgation, not realizing that purging further weakens the Spleen. Within ten days to a month, the swelling returns to its original state. This occurs because people only know that purging reduces swelling best, ignoring the principle of "ten tonifications rather than one purge." Treatment should follow seasonal variations, resolving the exterior and promoting diuresis. In spring, use Qibao San [Seven Treasures Powder] added with Mahuang [Ephedrae Herba], Guizhi [Cinnamomi Ramulus], and Chifuling [Poria with Red Core], decocted with water, ginger, and scallion. In summer, use Wu Ling San [Five Ingredient Powder with Poria] added with Mahuang, Cheqianzi [Plantaginis Semen], and Yiyiren [Coicis Semen]. In autumn, use Qingfei Yin [Lung-Clearing Infusion] added with Qianghuo [Notopterygii Rhizoma et Radix], Xixin [Asari Radix et Rhizoma], and Shanglu [Phytolaccae Radix]. In winter, use Chonghe Yin [Harmonizing Infusion] added with Baizhu [Atractylodis Macrocephalae Rhizoma], Sheng Chuanwu [Aconiti Kusnezoffii Radix Preparata], and Chixiaodou [Vigna Angularis Semen]. These three prescriptions are decocted with water, ginger, and scallion. Additionally, Zirun Jiupi Daoshui Tang [Moistening and Spleen-Saving Water-Guiding Decoction] should be used for渗泄 (percolation and drainage). Frequent administration of Xianglu Weiling Wan [Fragrant Phytolacca and Cangzhu Weiling Pill] and Chi Cang Yin [Red and Atractylodes Infusion] will naturally bring relief. As stated in the *Neijing* (*Inner Canon*): "Open the ghost gate" (i.e., induce sweating), "Cleanse the clean mansion" (i.e., promote urination), balance and weigh appropriately, aiming for equilibrium. This refers to such cases. Some patients present with phlegm, cough, asthma, and urinary obstruction upon initial swelling, indicating involvement of the Lung and Kidney. First, administer Jiebiao San [Exterior-Resolving Powder], followed by Sanbai San [Three Whites Powder]. For milder cases, Shanglu Wan [Phytolacca Pill] is appropriate. Thus, the classics state: "For those high up, cause them to vomit," meaning emesis; "For those low down, drain them completely," meaning percolation and drainage. This disease does not arise overnight; reckless medicines should not be used for quick results, which could lead to collapse. If wind pathogens are contracted again after recovery, causing facial puffiness, Paifeng Tang [Wind-Expelling Decoction] should be used for harmonization, along with the previous Jiupi Tang [Spleen-Saving Decoction], to prevent recurrence. Dietary taboos include salt, soy sauce, pickles, and wet noodles, all salty foods that exacerbate water retention, as well as other raw, cold, or toxic substances. Severe cases take half a year; mild cases take three months. Only when the Spleen and Stomach recover, swelling subsides, and Qi becomes robust, should roasted salt be gradually introduced into the diet to prevent relapse. Therefore, Liu states: Treating edema is not easy, and nourishment is even more difficult. Taboos must be carefully observed. For chronic cases that do not resolve, Jun Chuan Wan [Jun Chuan Pill] is effective.