Swelling

Swelling

Swelling is both a water-related disease and a qi-related disease. Patients with blood loss often experience edema and swelling—why is this the case? Because blood and qi, as well as water and fire, are mutually dependent and interdependent. I have previously discussed the theory of water, fire, and blood qi, as well as methods for regulating menstruation and eliminating phlegm, and now I will reiterate without hesitation: qi is essentially water, and when there is qi in the blood, there is also water. Thus, sweat exists in the muscles, moisture in the mouth and nose, and water in the cells—water and blood naturally coexist without conflict. For patients with blood loss, when the blood becomes diseased, the water is also affected. When water accumulates in the cells, it leads to urinary stones; when water invades the spleen and stomach, it causes bloating; and when water permeates the skin, it results in edema. Treatment methods: For skin edema, treatment should start with the lungs, as the lungs govern the skin and hair. The lungs are the origin of water, and when lung qi flows, water flows as well; therefore, Xiebai San with apricot kernels, Jiegeng, Zisu, and Fuling can be used, along with Wupi Yin for treatment. For abdominal bloating, treatment should focus on the spleen, strengthening the earth and promoting water drainage, so that water flows and the earth becomes firm⁽¹⁾, with Weiling Tang as the primary treatment, and Liu Junzi Tang with Yiren and Fangji also being effective. For water accumulation in the cells and lower abdominal bloating, Wuling San is used, along with Zhu Ling Tang. All forms of water are governed by the kidneys, and when kidney qi transforms, water throughout the body—both inside and outside—is transformed as well, making Liu Wei Di Huang Wan an appropriate choice.

All the aforementioned prescriptions are balanced formulas, but physicians must also distinguish between yin and yang and add cold or hot ingredients accordingly to achieve effectiveness. If the patient experiences thirst and red urine, with a preference for cool pulses, it indicates yang water, so Gui, Bo, Qin, Lian, Shan Zhi, Shigao, Tiandong, and Maidong can be added. If the patient's mouth and urine are clear, with a preference for warm pulses, it indicates yin water, so Gui, Fu, Ganjiang, Wuyu, and Xixin can be added. Patients with blood loss predominantly exhibit yang water, with very little yin water, so physicians must conduct a thorough on-site assessment.

Additionally, when blood stasis flows and causes swelling, it represents a transformation of blood into water. This is analogous to the transformation of women's uterine fluid into blood, men's seminal fluid into blood, and wound-related blood accumulation into pus. Once blood transforms into water, treatment should follow the same principles as above, adjusting cold and hot ingredients accordingly, and adding Amber, Sanqi, Danggui, Chuanxiong, Taonu, and Puhuang to address both blood and water simultaneously. Historically, when women experienced menstrual irregularities and swelling, it was believed that water had transformed into blood, termed "water phase." When menstruation ceased and swelling occurred, it was thought that blood had transformed into water, termed "blood phase." In reality, the treatment approach should always prioritize addressing water-related issues, with adjustments made according to specific circumstances. Observing the theories of "women's water phase" and "women's blood phase" reveals that the reason why patients with blood disorders often experience swelling is precisely due to the "water phase" and "blood phase" phenomena. This differs from general edema cases, so avoid indiscriminate use of Zhouche Wan and Xiaoshui Shengyu Tang. Further details can be found in the section on blood swelling.

[Note] (1) Tu Dun: "Dun" means solid and substantial. "Tu Dun" indicates strong digestive function of the spleen.

[Commentary] This article argues that blood-related swelling is essentially a water-related disease, based on the view that qi is water and blood contains qi, meaning blood inherently contains water. For skin edema, lung qi should be activated to promote water drainage, using Xiebai San with adjustments. For abdominal bloating, the spleen should be strengthened to facilitate water drainage, using Weiling Tang and Liu Junzi Tang with adjustments. For lower abdominal bloating, the bladder should be cleared to treat water accumulation, using Wuling San and Zhu Ling Tang with adjustments. Overall, edema throughout the body can be treated from the perspective of the kidneys, using Liu Wei Di Huang Wan. These treatment methods still require careful consideration of whether the condition leans toward cold or hot, as well as the presence of blood stasis, with adjustments made on a case-by-case basis. For cold tendencies, add Gui, Fu, Ganjiang, Wuyu, and Xixin; for hot tendencies, add Zhi, Qin, Shan Zhi, Shigao; and for blood stasis, add Amber, Sanqi, Danggui, Chuanxiong, Taonu, and Puhuang.