4 Edema
Edema refers to dropsy of eyelid, face, four limbs, chest and abdomen or even the whole body due to accumulation of fluid in the muscles resulting from disturbance of the lung, spleen and kidney in distributing and excreting fluid. Clinically, edema is divided into yang edema and yin edema.
2.2.4.4.1 Yang edema
Yang edema, of sthenia in nature, is marked by swelling above the waist and short duration due to exogenous pathogenic wind or spreading of fluid and dampness.
Clinical manifestations: Dropsy of face and eyelids, eventually involving the whole body with rapid development, smooth and bright skin, scanty urine, accompanied by fever, aversion to wind and cold, aching pain of limbs, sore-throat, thin fur and floating pulse; or dropsy of the whole body with stow development, depression under pressure, heaviness of the limbs, epigastric and abdominal fullness and oppression, poor appetite, nausea and regurgitation, whitish greasy tongue fur as well as soft and slow pulse.
Analysis of symptoms: Dysuria and sudden dropsy are due to disorder of fluid distribution and spreading of fluid in the muscles resulting from dysfunction of the lung to disperse and regulate caused by wind attack; dropsy of head and eyelids with the involvement of the whole body due to the fact that wind tends to float upwards and change and that wind comes into combination with fluid; fever, aversion to wind and cold, aching pain of limbs, sore-throat, thin fur and floating pulse are due to pathogenic wind invading the lung and failure of the lung to disperse; general edema and heaviness of limbs are due to encumbrance of the spleen by fluid and dampness which leads to failure of yangqi to rise, dysfunction of transformation and extravasation of fluid; dysuria or scanty urine is due to internal accumulation of fluid and dampness, dysfunction of the triple energizer to control fluid and disturbance of the bladder to transform qi; epigastric and abdominal fullness and oppression, poor appetite, regurgitation and nausea are due to encumbrance of the spleen and stomach by dampness which affects ascent and descent.
Key points for syndrome differentiation. This syndrome is marked by rapid onset and development of edema primarily involving the eyelids, face and head as well as severe edema of the upper part of the body.
2.2.4.4.2 Yin edema
Yin edema is marked by asthenia of spleen and kidney qi, severe edema of the part below the waist and long duration, usually caused by asthenia of the healthy qi due to prolonged illness, internal impairment due to overstrain and consumption of spleen and kidney yang.
Clinical manifestations: Repeated relapse of edema, severity below the waist, depression under pressure, epigastric and abdominal distension and oppression, poor
appetite and loose stool, dispiritedness, fatigue of limbs, cold body and limbs, preference for warmth, or aching cold sensation of loins and knees, scanty urine, dull or pale complexion, pale and bulgy tongue with white and slippery fur as well as sunken, slow and weak pulse.
Analysis of symptoms: Edema and scanty urine are due to spreading of fluid and dampness resulting from failure of the asthenic spleen yang to warm and transport and failure of asthenic kidney yang to transform qi; repeated relapse of edema, severity below the waist and depression under pressure are due to asthenia of spleen and kidney yang, accumulation of fluid and dampness, downward migration of dampness as well as heavy and sticky nature of dampness; cold body and limbs, aching cold sensation of loins and knees, dull or pale complexion, dispiritedness and fatigue of limbs are due to asthenia of spleen and kidney Fang and decline of mingmen fire to warm and nourish the body; epigastric and abdominal distension and oppression, poor appetite and loose stool are due to asthenia of spleen yang and inability to transport and transform; pale and bulgy tongue, white and slippery fur as well as sunken, slow and weak pulse are signs of yang asthenia and internal exuberance of dampness.
Key points for syndrome differentiation: Repeated relapse of edema, long duration, severity below the waist, accompanied by asthenia of spleen and kidney yang.
