Chronic Edema
Overview
Chronic edema falls under the category of "edema" in TCM, often caused by dysfunction of the lung, spleen, and kidney, leading to impaired fluid metabolism. The root is in the kidney, regulated by the spleen, and manifested in the lung. Clinically characterized by swelling of the face, eyelids, limbs, or even the whole body, with insidious onset, prolonged course, and recurrent attacks. Common patterns include spleen-kidney yang deficiency, water-dampness immersion, and qi stagnation with blood stasis. The key pathogenesis is yang qi deficiency, impaired qi transformation, and internal retention of water-dampness. Treatment should warm yang and promote diuresis, strengthen the spleen and resolve dampness, and invigorate blood and unblock collaterals, requiring gradual resolution.
Pattern differentiation (clinical patterns)
Spleen-Kidney Yang Deficiency Pattern
Generalized edema, more pronounced below the waist, pitting edema that does not rebound, scanty urine, cold and aching waist and knees, aversion to cold with cold limbs, pale and dull complexion, fatigue and lack of strength, pale and swollen tongue with white slippery coating, and a deep fine pulse.
Warm and tonify the spleen and kidney, transform qi and promote water metabolism.
Water-Dampness Immersion Pattern
Generalized edema with pitting that leaves an indentation, scanty urine, heaviness and fatigue of the body, chest tightness and poor appetite, nausea and desire to vomit, white greasy tongue coating, and a deep moderate pulse.
Strengthen the spleen and resolve dampness, unblock yang and promote diuresis.
Qi Stagnation and Blood Stasis Pattern
Prolonged edema that does not subside, purplish dark skin or ecchymosis, dark dull complexion, fixed stabbing pain in the lumbar region, difficult urination, purple dark tongue with petechiae, and a choppy pulse.
Invigorate blood and resolve stasis, move qi and promote diuresis.
Connections
Daily care & prevention
Patients should follow a low-salt diet, with daily salt intake not exceeding 3 grams; appropriately control fluid intake and record urine output. Avoid prolonged standing or sitting, and elevate lower limbs during rest. Keep warm and prevent external contractions. Consume spleen-strengthening and dampness-resolving foods such as adzuki bean, coix seed, and Chinese yam. Engage in moderate activities like walking and tai chi, avoiding fatigue. Maintain emotional balance and regularly monitor weight and blood pressure.
When to seek medical care
Seek immediate medical attention if there is a sudden decrease in urine output, difficulty breathing, chest tightness, shortness of breath, nausea and vomiting, altered consciousness, severe generalized edema, or signs of pleural or ascitic fluid. Also be alert to skin ulceration and infection, fever, and chills.