Swelling that occurs in women before or during menstruation and subsides on its own after menstruation is called menstrual edema. If the swelling is unrelated to the menstrual cycle, it is not within the scope of this condition.

bubble_chart Pattern Analysis

1. Spleen-kidney Yang Deficiency︰During menstruation, there is facial puffiness and swelling of the limbs, with pitting edema upon pressure, cold body and extremities, soreness and weakness in the lower back and knees, loose and thin stools, clear and scanty urine, and heavy menstrual flow with pale color. The tongue texture is pale and swollen, with thin and slippery coating, and the pulse is deep, thin, and weak. This is often caused by constitutional spleen-kidney yang deficiency, leading to water-dampness retention. During menstruation, the spleen and kidney yang become even more deficient, resulting in the spleen's inability to transport dampness and the kidney's inability to warm and transform fluids, causing water-dampness to overflow into the skin and muscles, leading to menstrual edema. The key diagnostic points are: facial puffiness and limb swelling, cold body and extremities, loose and thin stools, clear urine, soreness and weakness in the lower back and knees, pale and swollen tongue with white and slippery coating, and deep, thin, and weak pulse. The treatment should focus on warming the kidney and strengthening the spleen, tonifying qi to reduce swelling, using the modified Kidney Qi Pill from the Golden Cabinet.
2. Spleen Deficiency with Dampness Retention︰In each menstrual cycle, there is facial and limb edema that leaves indentations when pressed, poor appetite, nausea, epigastric and abdominal distension, and frequent but loose stools. The tongue is pale or enlarged with a thin, greasy coating, and the pulse is soggy. This is due to constitutional spleen deficiency with weakened qi, internal accumulation of dampness turbidity, and outward diffusion to the muscles and interstices. The clinical manifestations include: facial and pedal edema during menstruation, which is relatively mild, without signs of kidney yang deficiency such as cold intolerance, cold limbs, or soreness and weakness of the waist and knees. Instead, there are symptoms of spleen deficiency, such as anorexia, nausea, and epigastric and abdominal distension and fullness. The treatment should focus on tonifying qi, strengthening the spleen, and resolving dampness to reduce swelling. The recommended formula is Ginseng, Poria and White Atractylodes Powder with modifications.

bubble_chart Documentation

1. 《Gynecology Clinical Manual of Chinese Medicine·Menstrual Edema》"Qi stagnation and dampness obstruction type main symptoms: swelling of the face and limbs before menstruation, irregular menstruation, slight abdominal distension and fullness pain. Thin greasy or white greasy tongue coating, soft and thin or wiry and thin pulse. Treatment method: invigorating the spleen and resolving dampness, regulating qi and dispersing swelling. Prescription: Daozhi Tongjing Decoction combined with Four Ingredients Decoction with modifications."