bubble_chart Concept

Swelling of the limbs refers to a symptom of edema and distension in the upper and lower limbs. Some cases present with simultaneous swelling of all four limbs, while others may only involve the upper or lower limbs, or be limited to one side.

bubble_chart Pattern Analysis

1. Dampness-heat︰Swelling of the limbs, joint swelling and pain, burning sensation of the skin, red and shiny skin, accompanied by fever, aversion to wind, thirst, and restlessness. The tongue coating is yellow, greasy, and slightly dry, and the pulse is slippery and rapid. The patient's constitution is inherently prone to excessive yang qi, compounded by invasion of wind-cold dampness pathogens. Heat is constrained by cold, and over time, the cold also transforms into heat, leading to this condition. Dampness-heat obstructs the collaterals, causing poor circulation of qi and blood, which stagnates in the meridians, resulting in swelling of the limbs. Heat is a yang pathogen, hence the symptoms of joint swelling and pain, localized burning, redness, and swelling. Treatment involves clearing heat, dispersing wind, and eliminating dampness. The recommended formula is White Tiger and Cinnamon Twig Decoction.
2. Qi Stagnation in the Skin and Superficial Tissues︰Swelling of the limbs with a subjective feeling of distension, pale skin color, rebounding upon pressure as if elastic, or accompanied by chest and hypochondriac distension and oppression, frequent sighing, etc. The tongue texture is pale with a white coating, and the pulse is wiry. It is mostly caused by emotional distress compounded by external pathogens invading the body surface, leading to disharmony of nutrient-defense and stagnation of qi. When qi stagnates at the body surface, it obstructs the Jingmai, causing blockage of nutrient-defense, hence the swelling of the limbs and the sensation of distension. Since the condition leans toward qi stagnation, the swelling rebounds upon pressure. It is also accompanied by chest and hypochondriac distension, frequent sighing, and other signs of liver qi stagnation. Treatment involves moving qi to promote circulation, assisted by warming and dispersing. The recommended formula is Cyperus, Perilla, Fistular Onion Stalk and Fermented Soybean Decoction.
3. Cold-dampness Stagnation︰Pain in the joints of the limbs, with fixed locations of pain or particularly severe in the lower limbs, swelling of the limbs, clumsiness and heaviness in the hands and feet, and difficulty in movement. The tongue texture is pale, and the pulse is soggy and slow. Cold-dampness stagnates, and dampness turbidity accumulates in the channels , hence the swelling of the limbs, heaviness in the joints, and clumsiness in the hands and feet. The treatment aims to dissipate cold and eliminate dampness, with the prescription of Wuchi Decoction selected.
4. Qi Deficiency and Blood Stasis︰Swelling of the limbs, difficult to rebound upon pressing, cold hands and feet, or numbness and weakness in movement; or swelling of both lower limbs with purple ecchymosis on the skin; even hemiplegia may be observed. The tongue is pale white, possibly with ecchymosis, and the pulse is wiry and choppy. Qi deficiency and blood stasis, Jingmai obstruction, hence the swelling of the limbs that is difficult to rebound upon pressing, numbness of the skin, skin purpura, with symptoms that may be milder in the morning and worsen in the evening. Treatment should focus on tonifying qi, invigorating blood, and resolving stasis, using Taohong Yin supplemented with Astragalus Root and Cinnamon Twig.

Swelling of the limbs should be differentiated based on cold, heat, deficiency, and excess. Although the causes of the disease are often related to wind, cold, and dampness, individual constitutions vary, with some leaning towards heat and others towards cold. Therefore, clinical diagnosis should follow the principle of "identifying the cause through examination and treating based on the cause."

bubble_chart Documentation

1. Jingyue Quanshu．Swelling "The disease of swelling originally has internal and external distinctions. Fullness in the middle is called distension, and swelling of the skin and muscles is also called distension. If we speak of swelling alone, it refers only to the surface of the body, which is why it should be distinguished. However, internal distension is fundamentally caused by organ disease, and external swelling is also invariably due to organ disease, though the diseases of organ qi differ. Although the medical texts record distinctions between dampness-heat, cold, heat, blood, qi, water, and food, based on my observation of the classics and clinical conditions, it is sufficient to focus on the two characters of qi and water. Therefore, in treating this condition, if it is not in the qi aspect, then it is in the water aspect. Being able to distinguish these two and understand their deficiency and excess leaves no further mystery. If the disease is in the qi aspect, then treatment should focus on regulating qi; if the disease is in the water aspect, then treatment should focus on regulating water.