Edema

//TCM Pathology:// =Edema (Shui Zhong)= Edema is an extra fluid accumulation in the body. The fluid stays in the tissue, resulting in swelling of the eyelids, face, limbs, trunk or entire body.

Relevant Biomedical Diseases
-Edema

Differentiating between Yin & Yang Edema
wind, damp (water-damp/D-H/toxins) || Internal Cause SP/KI xu or Yang type mistreatment || Skin: tight & bright, not really pitting || Shui comes from below - up, whole body Skin - soft, not bright, pitting || BM: constipation Urine: Dark Yellow Thirst: Thirsty Tongue: red tongue w/ yellow fur Pulse: slippery or w/ rapid || Cold Loose/water stool Clear & reduce/increased Not thirsty Pale tongue w/ white fur Deep & weak ||
 * || Yang Edema || Yin Edema ||
 * Etiology || External Cause
 * Involved Organs || LU, SP || SP, KI ||
 * Quality of Syndrome || excess/heat/exterior or interior syndrome || xu/cold/interior syndrome ||
 * Onset || Acute || Gradual ||
 * Duration of Disease || Short || Long ||
 * Edema Characteristics || Shui comes from above - down, whole body
 * Accompanied Symptoms || Temp: fever, aversion to wind

Relationship
Even though there is a difference between Yin & Yang edema, they can be interchanged or transform into one another. Long lasting Yang type - Vital Qi xu day by day + excessive water retention -> Yin type Yin type- + external pathogen invasion, excessive exterior syndrome treat it as Yang type first. Can not turn into a pure Yang pattern

Treatment Principles
Kai Gui Men [Open the ghost door]- Fa Han - Diaphoresis Jie Jing Fu [very clean place]- Li Niao - Diuresis Qu Yu Chen Cuo [remove stagnation old garbage] - Qu Xie - Remove stasis /damp/stagnation
 * Su Wen:**

Yao Yi Shang Zhong, Fa Han; Yao Yi Xia Zhong, Li Xiao Bian //Method A:// Different tx based on different location of edema - above waist: diaphoresis; below waist: diuresis //Method B:// Different tx based on Yin/Yang Yang edema: eliminate pathogen - diaphoresis/diuresis Yin edema: strengthen vital Qi (SP, KI) + eliminate pathogen
 * Jin Gui Yao Lue:**

Ji Ze Zhi Qi Biao - Treat the incidental under urgent situation Huan Ze Zhi Qi Ben - Treat the fundamental while the condition of the disease permits

Attack by Wind/wind-heat/wind-cold

 * Signs:**
 * Symptoms:** Wind-Heat or Wind-Cold symptoms
 * Tongue:** Red with yellow/white coat
 * Pulse:** rapid/slippery
 * Treatment Principle:** Dispel wind & Clear Heat, ventilate the lung, remove water
 * Acupuncture Treatment:** [CV-9, ST-28, BL-22, SP-9, KI-7, BL-39] + LU-7, TW-5, LI-4, BL-12, BL-13
 * Herbal Treatment:** Yue Bi Jia Zhu Tang

External Toxins from infectious disease invades interior

 * Signs:** Toxin heat: having had skin or other external infection or swelling, pain, ulceration of pharanx or throat
 * Symptoms:** Wind-Heat symptoms
 * Tongue:** Red with thin yellow coat
 * Pulse:** rapid, slippery, floating
 * Treatment Principle:** Promote Lung dispersion & detoxification, inducing diaphoresis, eliminate edema
 * Acupuncture Treatment:** [CV-9, ST-28, BL-22, SP-9, KI-7, BL-39] + LI-4, LI-11, GV-14, Shi Xuan, Ying spring points (SP-10)
 * Herbal Treatment:** Ma Huang Lian Qiao Chi Xiao Dou Tang + Wu Wei Xiao Du Yin

Retention of Water-Dampness

 * Signs:** Generalized pitting edema (concave under pressure) over the whole body esp. in the lower extremities, scanty urine
 * Symptoms:** retention of water-dampness
 * Tongue:** white, slippery, greasy coat
 * Pulse:** deep, slow, slippery
 * Treatment Principle:** Fortify Spleen & transform dampness, invigorate Yang and drain water
 * Acupuncture Treatment:** [CV-9, ST-28, BL-22, SP-9, KI-7, BL-39] + ST-36, CV-12, BL-20 (LU-7, BL-13)
 * Herbal Treatment:** Wu Pi Yin + Wei Ling Tang

Accumulation of Damp-Heat

 * Signs:** Generalized edema, moist shiny skin, edema over the whole body, degree of edema is rather significant
 * Symptoms:** accumulation of Damp-Heat
 * Tongue:** red tongue w/ yellow, greasy coat
 * Pulse:** deep & rapid, or soft
 * Treatment Principle:** Dispel Damp & Clear Heat
 * Acupuncture Treatment:** [CV-9, ST-28, BL-22, SP-9, KI-7, BL-39] + LI-4, LI-11 (ST-44)
 * Herbal Treatment:** Shu Zao Yin Zi

Spleen Yang Deficiency

 * Signs:** Generalized pitting edema that is more severe below the waist
 * Symptoms:** Spleen Yang deficiency symptoms
 * Tongue:** Pale, puffy tongue; white, greasy, slippery coat
 * Pulse:** Deep & slow, or Deep & weak
 * Treatment Principle:** Warm & strengthen the Spleen Yang, transform dampness and remove water
 * Acupuncture Treatment:** [CV-9, ST-28, BL-22, SP-9, KI-7, BL-39] + CV-4, CV-6, CV-8, CV-12, ST-25, ST-36, SP-3, BL-20
 * Herbal Treatment:** Shi Pi San OR Fu Zi Li Zhong Wan

Kidney Yang Deficiency

 * Signs:** Generalized pitting edema that is more severe below the waist
 * Symptoms:** Kidney Yang deficiency symptoms
 * Tongue:** Pale, puffy tongue; white coat
 * Pulse:** Deep, slow & forceless or Deep & weak
 * Treatment Principle:** Warm & strengthen the Kidney Yang, transform Qi and move water to disperse swelling
 * Acupuncture Treatment:** [CV-9, ST-28, BL-22, SP-9, KI-7, BL-39] + BL-23, KI-3, GV-4 + CV-4, CV-6, CV-8, CV-12, ST-25, ST-36, SP-3, BL-20
 * Herbal Treatment:** Ji Sheng Shen Qi Wan + Zheng Wu Tang

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Definition:
an increase in the extravascular portion of the extracellular fluid

Etiology:
Edema may be localized or systemic, depending on the cause. The term ascites refers to fluid accumulation in the peritoneal cavity; anasarca refers to systemic, gross edema. Causes of edema include injury to the capillary lining (from bacterial, chemical, thermal, or mechanical agents), and hypersensitivity reactions, as well as the conditions listed under "differential diagnosis".

Somatic Therapies:
• qigong • tai qi chuan

Nutrition:
therapeutic foods: • if Damp, eat foods that dispel Dampness, tonify and harmonize Spleen/Stomach • if Kidney Xu (Deficiency), eat foods that tonify the Kidney • foods rich in Vitamin B-complex

specific remedies: • crack open a fresh coconut and drink the juice three times daily (Yin-fang and Cheng-jun, p. 86) • for congestive heart failure: drink 5 fl oz. fresh coconut juice three times daily (Butt and Bloomfield, p. 134) • for edema of malnutrition: take 60 g hazelnut kernels and 30 g adzuki beans, cover with water and boil until beans turn to pulp, adding water as needed. Serve twice daily (Yin-fang and Cheng-jun, p. 114) • for edema of malnutrition: take 250 g black eyed peas and pork bones and cook into a soup (Chao-liang, Qing-rong, Bao-zhen, p. 65) • simmer 250 g yellow soybeans in a liter of water until reduced to 1/4 its volume. Add an appropriate measure of sweet wine, eat this three times daily (Chao-liang, Qing-rong, Bao-zhen, p. 71) avoid: • food intolerances • salt in all forms

Botanicals
• Achillea millefolium: deficient kidney action (Ellingwood, p. 356) • Adonis vernalis (toxic): arrhythmia accompanied by edema and dyspnea (Felter, p. 156) • Apis mellifera (toxic) (honey bee): acute onset, edema of cellular tissues; throat, nasal passages, in diphtheria and scarlet fever (Ellingwood, p. 450) • Apocynum cannabinum (toxic): diuretic, local edema, general atonicity, feeble heart action, "dropsical effusion" (Ellingwood, p. 230, Mitchell, p. 19) • Arnica montana (toxic): (Felter, p. 207) • Cactus grandiflorus (toxic): diuretic, sedative (Felter, p. 254) • Chimaphila umbellata: improves kidney function, weakness and loss of appetite; with scanty urine (Felter, p. 288; Harper-Shove, p. 175; Mitchell, p. 13) • Convallaria majalis (toxic): of cardiac origin (Felter, p. 322) • Crataegus oxyacantha: of cardiac origin (Felter, p. 326) • Equisetum arvense: associated with kidney diseases (Harper-Shove, p. 175) • Euonymus atropurpureus (toxic): (Felter and Lloyd, p. 737) • Galium aparine: mild diuretic, tonic (Anderson Geller) • Iris versicolor (toxic): of thorax, heart and abdomen (Harper-Shove, p. 175) • Juniperus communis: abdominal, dropsy from renal suppression (Harper-Shove, p. 174; Priest and Priest, p. 85) • Ligusticum levisticum (lovage): renal edema; see formulae (British Herbal Pharmacopoeia, p. 131) • Parietaria diffusa: edema of renal origin (British Herbal Pharmacopoeia, p. 131) • Petroselinum sativum: dropsy, especially following scarlatina and other exanthematous diseases (Felter and Lloyd, p. 1454) • Pilosella officinarum: edema of renal origin (British Herbal Pharmacopoeia, p. 159) • Polygala senega: not from cardiac lesions (Harper-Shove, p. 175) • Polytrichum juniperum: powerful diuretic (in strong infusion) (Felter and Lloyd, p. 1537) • Strophanthus hispidus: cardiac, ascites from hepatic cirrhosis (Felter and Lloyd, p. 1848) • Zea mays: due to heart condition (Ellingwood, p. 437)

Chinese Formulae
• Fen Xiao Tang; Alisma 16 (patent): Water Stagnation: Pitting edema and ascites, scanty urine, constipation (Fen Xiao: Bensky and Barolet, p. 182; Alisma: Dharmananda, 1990, p. 34). • Hoelen Five Herbs F. (Wu Ling San): Spleen Yang Xu (Deficiency), Spleen Invaded by Cold-Damp: headache, urinary difficulty, heavy sensation, diarrhea, vertigo (Hsu, p. 516, Yeung, p. 244, Dharmananda, p. 173, Bensky and Barolet, p. 174). • Vitality C. (Zhen Wu Tang); Ba Wei Di Huang Wan (Eight Flavor Rehmannia Pill) (patent): Spleen Yang Xu (Deficiency) and Kidney Yang Xu (Deficiency): generalized edema, loose stools, abdominal pain worse with cold (Vitality: Hsu, p. 278, Yeung, p. 287, Dharmananda, 1986, p. 207, Bensky and Barolet, p. 197; Ba Wei: Fratkin, p. 189). • Shi Pi Yin: Spleen Yang Xu (Deficiency): generalized edema worse in lower part of body, cold extremities, anorexia, no thirst (Bensky and Barolet, p. 199). • Hoelen and Areca C. (Wu Pi San) (more Damp and Stagnation); Stephania and Hoelen C. (Fang Ji Fu Ling Tang) (more Deficiency): Spleen Qi Xu (Deficiency), Spleen Distressed by Dampness and Liver Qi Stagnation: generalized edema, heavy sensation, labored breathing (Hoelen: Hsu, p. 519, Yeung, p. 246, Bensky and Barolet, p. 178; Stephania: Hsu, p. 475, Yeung, p. 93, Bensky and Barolet, p. 180). • Wei Ling Tang: Spleen Invaded by Cold-Damp: edema in face and eyes, abdominal bloating, anorexia, loose stool (Yeung, p. 240, Bensky and Barolet, p. 176) • Stephania and Astragalus C. (Fang Ji Huang Qi Tang): Spleen Qi Xu (Deficiency) and Wind Damp, Edema: Wei (Protective) Qi Xu (Deficiency), sweating, aversion to wind (Hsu, p. 477, Yeung, p. 94, Dharmananda, p. 343, Bensky and Barolet, p. 179). • Hoelen and Areca C. (Wu Pi San) plus siler (fang feng), perilla leaf (zi su ye), schizonepeta (jing jie) and angelica (bai zhi): Wind Damp: edema above the waist (Hsu, p. 519, Yeung, p. 246, Bensky and Barolet, p. 178). • Shi Lin Tong Pian (patent): Lower Warmer Damp-Heat: edema associated with nephritis. (Zhu, p. 212) • Tang Kuei and Peony C. (Dang Gui Shao Yao San): Liver Xue Xu (Blood Deficiency) and Spleen Qi Xu (Deficiency) with underlying Kidney Qi Xu (Deficiency): slight edema of the lower limbs during pregnancy (Hsu, p. 585, Yeung, p. 77, Dharmananda, p. 177, Bensky and Barolet, p. 251). • Wan Dai Tang: Spleen Distressed by Dampness and Liver Qi Stagnation: edema during menstruation or pregnancy, with profuse whitish leukorrhea (Bensky and Barolet, p. 369).

Acupuncture
after assessing the person and palpating, consider these patterns: (External) Wind-Water; Damp-Heat; Yang Xu (Deficiency); Water Stagnation; Spleen Qi Xu (Deficiency), Spleen Yang Xu (Deficiency); Spleen Distressed by Dampness and Liver Qi Stagnation; Spleen Invaded by Cold-Damp; Liver Xue Xu (Blood Deficiency); Kidney Qi Xu (Deficiency); Kidney Yang Xu (Deficiency)

» illustrative combinations: • Kd-10, CV-9 and St-36: "to disinhibit urine and disperse water swelling" (Ellis, et al, 1988, p. 254) • UB-13, UB-20, LI-4 and Sp-9: promote urination to resolve Dampness (edema) (Liu, p. 316) • GV-26 and GV-21 for Xu (Deficient) floating facial edema (Shanghai, p. 158) • Ht-7, UB-15 and UB-23; Ht-9 and Kd-8; St-36, St-43, GB-30 and LI-4; Sp-6, TW-7 and CV-5 for cardiac edema (Mann, p. 111) • CV-9 and Sp-9 for edema, esp. periumbilical (Shanghai, p. 286; Ellis, et al, 1988, p. 155) • CV-9 (d. D) and St-28 (D) then needle St-36 and CV-7: "For intolerable water-related diseases that present with abdominal fullness and vacuity swelling that refuses to abate." (Ellis, et al, 1988, p. 354); • Sp-9 and LI-6: eliminate Damp; cause diuresis and treat edema of the waist (Finkelstein, p. 29) • CV-9 and St-28: treat edema and aid weight loss (Finkelstein, p. 87) • CV-9, St-28, Sp-6 and GB-28; Kd-7 for ascites (Mann, p. 109) • CV-4, CV-9, St-36, Sp-9 and Sp-6 for retention of urine or ascites (Shanghai, p. 286) • GB-31, Sp-4, Sp-9 and GB-30; UB-54/40, UB-57, UB-58 and UB-62 for edema of the feet (Mann, p. 111) • UB-20 and UB-23 (+ and D): tonify Fire (gives birth to Wood); eliminate Damp-Cold • UB-20 and St-36 (+ and D): tonify Spleen, Earth controls Water • CV-3 -> CV-2: assist transforming functions of Qi; dispel Damp-Heat • CV-9 and CV-11: regulate water metabolism and induce diuresis (Finkelstein, p. 87)

Homeopathy
• Ammonium carbonicum: primary remedy for pulmonary edema; ear noises, cold perspiration • Antimonium tartaricum: edema and impending paralysis of lungs • Apis mellifica: pulmonary edema, irregular and slow pulse extending to right arm • Arsenicum album: pulmonary edema, great prostration, irregular pulse, cold sweat, dyspnea • Kali carbonicum: pulmonary edema, distended stomach, dyspnea • Phosphorus: pulmonary edema, dilated heart (esp. right ventricle), violent palpitation • Sanguinaria: pulmonary edema

Subtle Support
• notes: A#, B, C, D#, E, G, G#

• chords: diminished 8th, C Major, D# Major, G# Major (Gimbel, p. 116)

cardiovascular: • The Barcarole • The Blue Danube • Chopin's A minor Waltz • Tango music • Humoresque • Cui's Orientale • Song of India • Donna e Mobile • Oley Speak's Sylvia (Heline, p. 18)

Mind/Body
• Who or what won't you let go of? What are you afraid of losing? (Hay, 1984, p. 162, 169)

Chinese psychophysiology: • Spleen ~ Pi governs digestion and manifests in the muscle tissues; resolves Dampness and Phlegm; governs the Xue (Blood); maintains upbearing, and relates to the ability to assimilate, stabilize, and feel balanced and centered. » Healthy expressions are fairness, openness, deep thinking, and reminiscence. » Spleen Xu (Deficiency) signs include slightness (deficient "form"); abundant elimination; morning fatigue; cold, wet feet (Seem, p. 28); abdomen taut and distended like a drum; craving for sweets; flatulence; nausea; mild edema; memory failure; heavy feeling in legs; easy bruising; pale lips; loose stools; muscular weakness; and, indirectly, obesity. Deficiency of Spleen Qi or Yang leads to accumulation of Dampness and ultimately an excess state. » Spleen Shi (Excess) signs include heaviness (excess "form"); large abdomen; great sighing; sadness; obsessions and nightmares (Seem, p. 28); abdominal pain; irregular appetite; stickiness in the mouth and on lips; red lips; chest congestion; fatigue; and constipation. » The excessive use of the mind in thinking, studying, concentrating, and memorizing over a long period of time tends to weaken the Spleen. This also includes excessive pensiveness and constant brooding. (Maciocia, p. 241) Likewise, inadequate physical exercise, overexposure to external Dampness, and excess consumption of sweet and/or Cold foods will also deplete the Spleen.

• Lung ~ Fei is the home of the Po (Corporeal Soul); governs the Qi; regulates the rhythm of respiration, the pulse, and all bodily processes; relates to strength and sustainability; moves and adjusts fluid metabolism; and controls the pores. » Healthy expressions are righteousness and courage. » Weakness, dysfunction, and illness associated with excessive grief, sadness, worry, and depression.

• Kidney ~ Shen houses the Zhi (Will); expresses ambition and focus; governs Water to regulate body fluids; and displays the effects of aging, chronic degenerative processes, and extreme stress. » Healthy expressions are gentleness, groundedness, and endurance. » Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); hearing loss; fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch. » Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

Integrative Therapies
A person with edema, or fluid retention and swelling of various parts of the body, should see a physician to find out the cause. If the cause is from anemia or kidney, liver, or heart disease, this must be treated. Some other less serious causes of edema are birth control pills, premenstrual syndrome, or a diet extremely low in protein. An imbalance of sodium and potassium in the body also causes fluid retention. This can be from too much salt in the diet or a lack of potassium from fruit and vegetable sources.

The treatment of edema varies with the different causes. Many people include far too much salt in their diet, especially elderly people who begin to lose their salt taste sensitivity. These people may also be eating less vegetables because of dentures, and they may exercise less and sit for long periods of time. All of this contributes to water retention.

Before the menstrual period there is a rise in estrogen, which causes water retention. Birth control pills also do this. For more information, refer to the article on premenstrual syndrome ("PMS").

You may now want to take notes.

THE FOLLOWING SUPPLEMENTS ARE USED FOR EDEMA AND CAN BE TAKEN UNTIL SYMPTOMS IMPROVE: 1. Magnesium – 600 milligrams per day. May be taken with an equal amount of calcium. 2. A multivitamin tablet – Take daily, according to the manufacturer's directions. 3. Vitamin B6 – 100 milligrams per day. In cases of premenstrual edema, this dose is doubled for the 10 days preceding the period. For water retention due to birth control pills, also consider using another form of contraception.

CONSIDERING THE DIET… • Pregnant women have a tendency to get edema if they are not getting enough protein in the diet for themselves and their babies. Pregnant women need to eat about 100 grams of protein per day – for example, 2 boiled eggs for breakfast, 4 ounces of meat or chicken for lunch, and 8 ounces of fish for dinner. They also need to eat lots of vegetables, salads, and fruits. For more information, refer to the article on pregnancy. • If you suffer from edema which is NOT caused by anemia, pregnancy, or protein defi-ciency, you may benefit from 2 or 3 days of a diet limited to vegetable and fruit juices. Carrot and beet juices are particularly good as well as watermelon juice. Follow this with a low salt diet, high in fruits, vegetables, and whole grains.

HERBS FOR EDEMA: Make a tea of 1 part Licorice Root and 2 parts Dandelion root and leaf – Use 1 tablespoon of the herbal mixture per cup of water. Simmer 5 minutes. Steep 20 minutes. Take 3 cups per day. If you use the herbs in a tincture, which is a liquid herbal extract, use 50 drops of the mixture 3 times a day.

YOU CAN ALSO USE THE FOLLOWING, WHICH HAVE DIURETIC ACTIVITY: • Potassium – 100 milligrams per day. • A tea can be made from equal parts of Buchu, Juniper Berries, ground up Parsley, and Cleavers. Use a heaping tablespoon of the herbs per cup of boiling water. Steep for 20 minutes. Drink 4 to 5 cups per day. The herbs may also be used in capsule form – 2 capsules, 4 times a day with a glass of water.

Caution: Juniper Berries are contraindicated in pregnancy.

HOMEOPATHY From the following homeopathic medicines, choose the one that best matches your symptoms. Dissolve 3 pellets under the tongue twice a day until symptoms are relieved. • Apis 6C: For swelling when the skin is pinkish, tender to touch, and feels better with cold compresses. • Lac caninum 12C: For breast swelling before periods.

Note: A wide range of homeopathic medicines can be helpful for individuals with edema. Consultation with a health care professional trained in homeopathic prescribing will usually be the best way to select the correct medicine.

IF SWELLING FOLLOWS A TRAUMA TO AN AREA OF THE BODY… • Use the RICE treatment, which is rest, ice, a compression wrap, and elevation. You can also refer to the article on "Sprains", which explains other useful measures.

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Orthomolecular Treatment
-Papain (pain relief)