bubble_chart Concept

Pediatric edema refers to the symptom of water and dampness retention in a child's body, overflowing into the skin, causing swelling of the head, face, limbs, abdomen, back, and even the whole body.

Edema is discussed in detail in the Neijing. Suwen. Yinyang Bie Lun states: "Three yin constipation is called water." Lingshu. The chapter on water swelling says: "When water begins to rise, the eye socket is slightly swollen, like the appearance of just waking up." Suwen. Tangye Laoli Lun proposes the treatment method of "balancing and regulating, removing stagnation and accumulation..., opening the pores of sweat ducts, and cleansing the organs." Jingui Yaolue classifies edema into "wind edema," "skin edema," "typical edema," "stony edema," and five zang-organs water. It was not until Zhu Dan-xi that edema was summarized into two major categories: "yang edema" and "yin edema." Previous understandings of pediatric edema also fall within the above scope, but are mostly classified into "qi swelling" and "edema."

bubble_chart Pattern Analysis

1. Wind-Water Contending with Each Other︰The onset is abrupt, with fever, aversion to wind, cough, initial eyelid edema, followed by swelling of the limbs and whole body, dark urine, thin greasy tongue coating, and floating rapid pulse. It belongs to the yang edema excess pattern. This is often due to the weak constitution of children, insufficient qi and blood, allowing wind pathogens to invade and lodge in the exterior, clashing with internal water qi, leading to water-dampness overflowing into the skin. Wind, being a yang pathogen, tends to ascend, hence initial eyelid edema occurs. Wind edema obstructs the skin and muscles, causing swelling of the limbs and whole body. External invasion of wind pathogens impairs the lung's dispersing and descending functions, disrupting water passage regulation and downward transport to the bladder, resulting in fever, aversion to wind, cough, edema, and dysuria. Treatment should focus on dispersing wind and releasing the exterior, ventilating the lung to promote water movement. Prescriptions such as Spleen-Qi Effusing plus Atractylodes Decoction or Ephedra, Forsythia and Rice Bean Decoction with modifications are recommended.
2. Dampness-heat︰Generalized edema with shiny and moist skin, abdominal distension and fullness, feverish sensation, thirst, scanty dark urine, dry stool, yellow greasy tongue coating, and slippery rapid pulse. This belongs to the yang edema excess pattern. It is often caused by the zang-fu organs of children not yet being fully developed, improper diet leading to food stagnation and dampness accumulation, dampness-heat stagnation, dysfunction of qi movement in the middle energizer, disturbance of qi transformation in the triple energizer, and failure of qi to promote water transformation, resulting in water overflowing into the limbs. Hence, generalized edema with shiny skin and tense anasarca is observed. Internal accumulation of dampness-heat leads to feverish sensation, thirst, and scanty dark urine. Dampness obstructs qi movement, causing abdominal distension and fullness, yellow greasy tongue coating, and slippery rapid pulse. Treatment should focus on promoting urination to drain dampness and separating dampness-heat. The recommended formulas are modified Five Ingredients with Poria Powder combined with Five-Peel Decoction, or modified Dredging and Channelling Decoction.
3. Spleen Yang Deficiency︰Generalized edema with pitting upon pressure, {|###|}complexion㿠白{|###|}, {|###|}heavy body懶動{|###|}, epigastric fullness and {|###|}anorexia{|###|}, {|###|}loose stool{|###|} with scanty urine, pale tongue with white slippery coating, and soggy slow pulse. This is often caused by postnatal malnutrition in children, improper diet, excessive consumption of raw or cold foods, {|###|}injury spleen yang{|###|}, failure of the spleen to control water, and water-dampness infiltration leading to edema. As stated in Suwen.Zhizhenyao Da Lun: "All dampness syndromes with swelling and fullness are ascribed to the spleen." Its clinical features include generalized edema with pitting that is slow to rebound, {|###|}complexion㿠白{|###|}, {|###|}heavy body懶動{|###|}, chest oppression and {|###|}anorexia{|###|}, {|###|}loose stool{|###|} with scanty urine, pale tongue with white slippery coating, and soggy slow pulse. Treatment should focus on {|###|}warming and activating spleen yang{|###|}, {|###|}resolving dampness{|###|}, and promoting water movement. The formula of choice is Spleen-Strengthening Decoction with modifications. Due to the spleen yang's inability to transform and transport water-dampness, water-dampness overflows and causes edema, with {|###|}heavy body{|###|} and {|###|}loose stool{|###|} as characteristic features. Between the two, the condition is relatively mild. Moreover, prolonged deficiency of spleen yang often affects kidney yang, and decline of kidney yang is frequently accompanied by insufficiency of spleen yang, hence the two have a mutually causative relationship.
4. Kidney Yang Deficiency︰Facial and body edema, particularly severe swelling below the waist, with pitting upon pressure, cold body and limbs, soreness and weakness in the lower back and knees, scanty urine, a pale and swollen tongue with a white greasy coating, and a deep, thin, and slow pulse. This condition is often caused by congenital deficiency, postnatal malnourishment, or prolonged illness leading to kidney yang deficiency, which fails to warm and transform fluids, resulting in impaired water metabolism and edema. As stated in the Zhubing Yuanhou Lun (Volume 21): "The kidney governs water, and the lung governs qi. When the kidney is deficient, it cannot control water, leading to abnormal water movement." When {|106|}kidney yang{|107|} is weak, the bladder loses its proper opening and closing function, disrupting water pathways, hence the facial and body edema, especially below the waist, with pitting upon pressure. Other symptoms like cold body and limbs, soreness and weakness in the lower back and knees, and a deep, thin, and slow pulse are clear signs of {|108|}kidney yang deficiency{|109|}. Treatment should focus on {|110|}warming and tonifying kidney yang{|111|} and {|112|}warming yang qi to promote diuresis{|113|}. Recommended formulas include the {|114|}True Warrior Decoction{|115|} or the modified {|116|}Kidney Qi Pill{|117|} from the {|118|}Jingui Yaolue{|119|}. Due to the inability of {|120|}kidney yang{|121|} to warm and transform fluids, water accumulates, leading to edema. Clinically, this must present with cold signs such as cold body and limbs, a slow pulse, etc., which are more severe.

Pediatric edema should first be differentiated into yin-yang deficiency and excess. Yang edema is of excess type, with the pathogenic factors being relatively superficial, often manifesting as edema in the upper half of the body, with moist and shiny skin that rebounds upon pressing. Treatment should focus on promoting sweating and diuresis. Yin edema is of deficiency type, with deeper pathogenic factors and already deficient healthy qi, often manifesting as edema in the lower half of the body, with dull and grayish skin that leaves a pit upon pressing. Treatment should focus on supporting the healthy qi and promoting diuresis. If the healthy qi is still strong and can withstand purgation, the application of elimination prior to tonification may be considered. However, since children's constitution is not fully developed, their zang-fu organs are delicate, and purgative methods must be applied with caution. Otherwise, it often leads to the detriment of deficiency and becomes difficult to remedy.

bubble_chart Documentation

1. Youke Fahui．Swelling Disease "Swelling in children after cough, malaria, or sores is all deficiency swelling." "Swelling caused by exposure to wind Rain Water (2nd solar term) and dampness is excess swelling, and is generally treated with Weiling Pill. This is a family tradition." "For all types of swelling in children, regardless of deficiency or excess, Weiling Pill and Wupi Decoction are used. This is a family tradition." "If swelling occurs with wheezing and cough, it should be treated with Pepperweed Seed Pill." "If there is swelling without other illnesses, treat according to where the swelling starts. If it starts from the face and the upper body swells first, this is wind swelling, and should be treated with Wupi Decoction plus Perilla Leaf and Saposhnikovia Root. If it starts from the feet and the lower body swells first, this is dampness swelling, and should be treated with Five Ingredients with Poria Powder plus Stephania Tetrandra and Akebia Stem."