Water swelling

Also water; water qì; water distension. An accumulation of water under the skin giving rise to diffuse puffy swelling in the region of the head, face, limbs, or the whole body. Water swelling is essentially attributable to impairment of

Biomedical correspondence: cardiogenic edema, nephrotic edema, hepatogenic edema, nutritional edema, and endocrinologic edema.

• the lung’s function of governing the waterways,
• the spleen’s function of warming and transforming water-damp, and/or
• the kidney’s qì transformation (production and discharge of urine).

Water swelling is regarded as a disease that can be divided into yīn patterns and yáng patterns. Yīn water is due to spleen-kidney yáng vacuity. Yáng water, which is far less common, occurs in repletion patterns in which external evils disturb the lung’s governance of the waterways.

In addition to water swelling, there is also qì swelling, which is characterized by swelling that rebounds instantly and which occurs in qì stagnation patterns.

Water accumulating in the abdomen, giving rise to an enlarged distended abdomen called drum distension in Chinese medicine, corresponding to ascites in biomedicine, is considered by some to fall within the realm water swelling.

Water swelling patterns have been classified in different ways. For example, Essential Prescriptions of the Golden Cabinet (金匮要略 jīn guì yào lüè) distinguishes between wind water, skin water, regular water, and stone water. Dān-Xī’s Heart-Approach (丹溪心法 dān xī xīn fǎ) differentiates yīn water and yáng water. A primary distinction exists between yīn water and yáng water, discussed below.

See wind water; qì swelling; vacuity puffiness; puffy swelling. It is also labeled according to location: see puffy face; sleeping silkworms beneath the eyes; swelling of the feet; swelling of the feet and lower legs. See also yellow swelling; swelling of pregnancy. Compare cold damage water amassment pattern; toxin swelling; distension.

Yīn Water (阴水 yīn shuǐ)

A disease pattern chiefly characterized by water swelling, most pronounced below the waist (especially the feet and ankles), that pits under pressure and does not rebound instantly.

Pathogenesis: Yīn water arises when, in spleen yáng vacuity, water-damp is not warmed and transformed and/or when, in kidney yáng vacuity, impaired qì transformation affects the production and discharge of urine, causing fluid to accumulate in the body. When the spleen fails to move and transform water, this is often called spleen failing to dam water. When kidney yáng vacuity causes accumulation of fluids, this is often referred to as kidney vacuity water flood or yáng vacuity water flood. If qì vacuity gives rise to blood stasis, the obstructive effect of static blood can worsen the condition. Kidney yáng vacuity commonly figures more prominently in yīn water. Spleen-kidney yáng vacuity stems from any of the following factors:

• constitutional insufficiency;
• dietary irregularities;
• enduring illness; or
• general decline of health in later life.

Analysis of signs

• Swelling: The swelling first affects the instep of the foot and lower limbs, although it sometimes begins with puffiness of the eyes and face. It pits under pressure and does not rebound instantly when pressure is released. This is due to kidney vacuity water flood and/or the spleen failing to dam water.
• Spleen vacuity: Oppression and distension in the stomach duct and abdomen; reduced eating; sloppy stool; lassitude of spirit; cumbersome limbs; and bright-white facial complexion.
• Kidney vacuity: Scant urine and cold aching lumbus and knees.
• Qì vacuity with blood stasis: Blood stasis stemming from qì vacuity can obstruct the movement of water. It may manifest in stasis speckles on the tongue, numbness and tingling, and even purple patches on the skin.
• Cold: Fear of cold and cold limbs.
• Tongue: Enlarged tongue with white fur.
• Pulse: Sunken, slow, and weak.

Treatment

Medicinal therapy: Warm the kidney, fortify the spleen, boost qì, and free yáng. For prominence of spleen yáng vacuity, use Spleen-Firming Powder (实脾散 shí pí sǎn). For prominence of kidney yáng vacuity, use Golden Cabinet Kidney Qì Pill (金匮肾气丸 jīn guì shèn qì wán) or True Warrior Decoction (真武汤 zhēn wǔ tāng).

Acumoxatherapy: CV‑9 (shuǐ fēn), CV‑6 (qì hǎi), BL‑22 (sān jiāo shù), SP‑6 (s ān yīn jiāo), BL‑39 (wěi yáng), SP‑9 (yīn líng quán) , and ST‑36 (zú sān lǐ) are general points for swelling. For spleen yáng vacuity, add BL‑20 (pí shù), CV‑12 (zhōng wǎn), and LR‑13 (zhāng mén). For debilitation of kidney yáng, add BL‑23 (shèn shù), GV‑4 (mìng mén), KI‑3 (tài xí), and KI‑7 (fù liū).

Yáng Water (阳水 yáng shuǐ)

A disease pattern chiefly characterized by swelling of the eyes and upper limbs first or swelling of the upper and lower limbs at the same time.

Pathogenesis: Yáng water arises from:

• externally contracted wind-evil (wind-cold or wind-heat) and/or
• internally arising water-damp or internally arising damp-heat impairing lung, spleen, and/or kidney functions.

Analysis of signs: Signs vary depending on the offending evil.

• Wind and water contending with each other: Rapid swelling from the eyes and face downward that springs back after pressure is released; heat effusion and aversion to cold, and other signs of wind-heat or wind-cold, such as cough, painful swollen throat, or panting; thin white tongue fur; a pulse that is floating and tight or slippery or a pulse that is slippery and rapid or sunken and tight. Water swelling of this kind is often referred to as wind water. See wind and water contending with each other. This is treated by coursing wind, diffusing the lung, and disinhibiting water using yuè bì tāng (Spleen-Effusing Decoction) or yuè bì jiā zhú tāng (Spleen-Effusing Decoction Plus White Atractylodes). In acumoxatherapy, use points such as CV‑9 (shuǐ fēn), CV‑6 (qì hǎi), BL‑22 (sān jiāo shù), ST‑36 (zú sān lǐ), BL‑11 (dà zhù), BL‑13 (fèi shù), LI‑4 (hé gǔ), GV‑26 (shuǐ gōu), and LI‑6 (piān lì).
• Water-damp saturation: Gradual swelling of the limbs that engulfs the fingers when pressure is applied; oppression in the chest, torpid intake, upwelling and nausea; generalized heaviness and lassitude of spirit; white slimy tongue fur; moderate pulse. This type is often associated with damp and wet environments. This is treated by warming and moving spleen yáng, transforming dampness, and moving water using wǔ líng sǎn (Poria Five Powder).
• Damp-heat congestion: Generalized swelling; shiny stretched skin; heat vexation and thirst; short voidings of yellow urine; sloppy stool with ungratifying defecation or dry bound stool; yellow tongue fur; a pulse that is soggy and rapid or sunken and rapid. Stool and pulse vary with the predominance of dampness or heat. This is treated by clearing heat, coursing wind, and dispelling dampness using bái hǔ jiā guì zhī tāng (White Tiger Decoction Plus Cinnamon Twig).

Differentiation from Qì Swelling and Toxin Swelling

Qì swelling (气肿 qì zhǒng): Water swelling with signs of qì stagnation. It arises when qì stagnation inhibits the movement of water-damp. The swelling pits under pressure but rebounds immediately when pressure is released. Accompanying signs include somber skin complexion, emaciation, fullness and distension in the abdomen and rib-side, sometimes with abdominal pain stretching into the rib-side. The swelling may occur suddenly and may spread from the upper body downward. The skin feels thick to the touch, and the swelling rebounds after pressure is released.

Qì swelling is treated by rectifying qì and transforming dampness, dispersing swelling, and eliminating fullness, using formulas such as jū pí jiān wán (Tangerine Peel Decocted Pill). In acumoxatherapy, it is treated using CV‑9 (shuǐ fēn), CV‑6 (qì hǎi), BL‑20 (pí shù), BL‑22 (sān jiāo shù), ST‑26 (tiān shū), PC‑6 (nèi guān), LR‑3 (tài chōng), ST‑36 (zú sān lǐ), TB‑6 (zhī gōu), SP‑6 (sān yīn jiāo), and SP‑9 (yīn líng quán).

Toxin swelling (肿毒 zhǒng dú): Swelling attributable to heat toxin, characterized by localized swelling with heat and pain. It is important to distinguish this from the above-described forms of swelling. Examples of toxin swelling are the swelling of cheeks in mumps and the swelling of welling-abscesses, boils, and sores. Toxin swelling roughly corresponds to inflammatory edema in biomedicine. It is treated with formulas such as xiān fāng huó mìng yǐn (Immortal Formula Life-Giving Beverage) or wǔ wèi xiāo dú yǐn (Five-Ingredient Toxin-Dispersing Beverage).

Etymology

Chin 水 shuǐ, water; 肿 zhǒng, swelling. In ancient times, it was referred to simply as shuǐ, water; the term 水肿 shuǐ zhǒng did not become popular until the Suí and Táng Dynasties. The Chinese term shuǐ zhǒng is used in Western medicine to render the term edema. Water swelling is preferred in the Chinese medical context because it reflects the notion of the waterways whose regulation is governed by the lung, distillation of water by the kidney (the water viscus), and the movement and transformation of water-damp by the spleen. The term edema, from the Greek oidēma, swelling, fails the make the notion of water explicit.