bubble_chart Concept

Swelling and pain in the legs refer to the swelling and pain in the lower limbs. Ancient medical texts often described this condition under categories such as bi syndrome and wind-pain. This condition is distinct from swelling and pain limited to the knee area and also differs from simple leg swelling. The following discussion pertains to swelling and pain in the legs below the hip joint.

bubble_chart Pattern Analysis

1. Cold-dampness︰Swelling and pain in both legs, or swelling and pain in one leg, aggravated by cold, joints unable to flex or extend, unchanged skin, heavy body, aversion to wind, unwilling to remove clothing, wiry and tight or wiry and slow pulse, white and slippery tongue coating. $Cold-dampness leg swelling and pain versus dampness-heat leg swelling and pain! Both conditions are caused by external pathogens. Whether from sitting or lying on damp ground, exposure to rain or dew, soaking in water, or particularly from living in a damp environment, the lower limbs are easily affected. Dampness invades the skin and flesh, transforming into cold or heat depending on the body's constitution. A yang-deficient body tends toward cold transformation, while a yin-deficient body tends toward heat transformation. Whether cold-dampness or dampness-heat, both can obstruct the collaterals and cause localized swelling and pain. Their common features are: swelling and pain in the lower limbs, restricted joint movement, and a coated tongue. The key points for differentiation are: cold-dampness leg swelling and pain presents with a cold affected limb, aggravated by cold, wiry and tight or wiry and slow pulse, white and greasy or slippery tongue coating. Dampness-heat leg swelling and pain presents with fever in the affected limb, especially in the soles of the feet, pain less related to weather changes, wiry, slippery, and rapid pulse, yellow and greasy tongue coating. Cold-dampness leg swelling and pain should be treated by dispelling dampness and dispersing cold, using Aconite Main Root Decoction, or Wind-Dampness Dispelling Notopterygium Decoction; dampness-heat leg swelling and pain should be treated by clearing heat and dispelling dampness, using Pain-Relieving Decoction, or Three Marvel Pill.
2. Dampness-heat︰Swelling and pain in one or both legs, palpable fever, desire to place the soles on cool surfaces, scanty dark urine, dry stool, wiry-slippery-rapid pulse, yellow greasy tongue coating. The affected limb has fever, especially severe on the sole, pain not significantly related to weather changes, wiry-slippery-rapid pulse, yellow greasy tongue coating. For cold-dampness leg swelling and pain, treatment should focus on eliminating dampness and dispersing cold, with prescriptions such as Aconite Main Root Decoction, or wind-dampness-removing Notopterygium Decoction; for dampness-heat leg swelling and pain, treatment should focus on clearing heat and dispelling dampness, with prescriptions such as Pain-Relieving Decoction, or Three Marvel Pill.
3. Static Blood︰Swelling or unilateral leg swelling with distending pain, or swelling with stabbing pain, severe pain upon pressure, loss of skin elasticity, or dark purple skin, deep and choppy pulse, dark purple tongue or ecchymosis on the tongue edges. The disease cause is complex, possibly due to lingering external pathogens that penetrate from the meridians into the collaterals, leading to stasis and obstruction of the collateral vessels, resulting in swelling and pain; or due to internal damage from the seven emotions, depression and stagnation of qi movement, causing poor blood circulation and subsequent swelling and pain; or it may be caused by trauma or sprains. The key points of pattern identification are: leg swelling with pain or swelling with stabbing pain, or worsening at night, often accompanied by a choppy pulse, purple tongue, and tight, inelastic skin on the affected limb. Treatment should focus on invigorating blood and resolving stasis, and the recommended formula is General Pain Stasis-Expelling Decoction.

There is another type of leg swelling and pain caused by overexertion, which results from prolonged walking or standing leading to tendon misalignment and blood pooling in the lower limbs. The local veins protrude, resembling earthworms, and the characteristic color is bluish-purple. Treatment should focus on moving qi and blood, and unblocking the meridians, using herbs such as Chinese Angelica, Peony Root, Unprocessed Rehmannia Root, Cinnamon Twig, Floweringqince Fruit, Astragalus Root, Achyranthes Root, and Dragon's Blood Resin. In severe cases, insect-based medicines can be added as appropriate.

Secondly, the treatment of leg swelling and pain can also involve selecting channel-guiding herbs based on the location of the pain, or combining with acupuncture and moxibustion therapy. For leg swelling and pain with a mix of deficiency and pathogenic factors, the treatment should balance the deficiency and excess of healthy qi and pathogenic qi, either by tonifying first and then dispersing, dispersing first and then tonifying, or combining both. For chronic swelling and pain where healthy qi is compromised, it is crucial to avoid dispersing without tonifying, as this may leave lingering issues.

bubble_chart Documentation

1. "Chinese Medical Dictionary": "Leg pain... If it is on the front side, it belongs to the Yangming meridian, and Dahurian Angelica, Cimicifuga Rhizome, and Pueraria are recommended. If it is on the back side, it belongs to the taiyang meridian, and Notopterygium and Saposhnikovia Root are recommended. If it is on the outer side, it belongs to the shaoyang meridian, and Bupleurum and Notopterygium are recommended. If it is on the inner side, it belongs to the jueyin meridian, and green tangerine peel and Evodia are recommended. If it is on the inner front side, it belongs to the taiyin meridian, and Atractylodes Rhizome and Dahurian Angelica are recommended. If it is on the inner back side, it belongs to the shaoyin meridian, and Pubescent Angelica and Alisma are recommended."
2. "Zhangshi Yitong" : "Pain in the thigh... If there is dampness-heat, the painful area will be swollen, heavy, and difficult to move, Two Wonderful Herbs Powder with additions such as Qiang, Fang, Sheng, Chai, Zhu, and Cao can be used. Alternatively, Dehumidifying Soup or Eliminating Dampness Soup can be selected. If there is cold and heat with swelling and pain, beware of the possibility of abscess formation."
3. "Danxi Xinfa" : "If there is swelling and pain in the limbs with a choppy and rapid pulse, this is due to static blood, and Peach Kernel, Carthamus, Chinese Angelica, Sichuan Lovage Rhizome, and Rhubarb Rhizoma can be used to mildly purge it."