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Edema in pregnant, abbreviated as "edema in pregnant," refers to the symptom of swelling that begins on the feet and gradually extends to the lower limbs, and in severe cases, affects the entire body, starting from the third or fourth month of pregnancy and lasting until the sixth or seventh month. If "swelling of the feet begins in the eighth or ninth month of pregnancy, it is still considered normal. The condition is mild and does not escalate severely, and it will naturally disappear after childbirth, so it does not necessarily require treatment. It is not comparable to swelling that occurs as early as the third or fourth month of pregnancy." ("Shen's Nyuke Jiyao Annotation and Correction: Edema in Pregnant")

This condition is referred to as "child-element/phase qi" in the "Chanru Ji," Jingxiao Chanbao calls it "polyhydramnios," Furen Liangfang refers to it as "fetal swelling," Bencao Gangmu terms it "pregnancy edema," and also calls it "pregnancy swelling," among other names. It is commonly known as "glazed fetus." Yizong Jinjian synthesizes the discussions of previous scholars and categorizes the swelling based on the month of pregnancy, extent, severity, and nature, dividing it into "child-element/phase qi," "edema in pregnant," "wrinkled feet," and "brittle feet."

This condition and "fetal water" are both types of swelling that occur during pregnancy. Both can present with generalized swelling, but this condition is characterized by swelling of the limbs, while the latter is most notably marked by abnormal abdominal enlargement and severe respiratory distress. Therefore, it is discussed in a separate section.

Women who first develop edema or water swelling and then become pregnant are not within the scope of this condition.

bubble_chart Pattern Analysis

1. Spleen Deficiency︰During several months of pregnancy, the face appears puffy and swollen, with swelling extending to the limbs and gradually spreading throughout the body. The skin has a pale yellow hue, and the swollen areas are thin and shiny, with indentation upon pressure that does not quickly rebound. Symptoms include shortness of breath, lack of strength, cold limbs, a bland taste in the mouth, poor appetite, or loose stools. The tongue texture is pale, with a thin, white, and moist coating, and the pulse is slow, slippery, and weak. This condition arises from a naturally weak spleen and stomach, further weakened by pregnancy, or due to improper diet in early pregnancy, vomiting and diarrhea injuring the spleen and stomach, or excessive consumption of raw and cold foods damaging spleen yang. Spleen deficiency leads to an inability to transport and transform water-dampness, compounded by the fetus obstructing qi movement and circulation. As a result, water-dampness accumulates and permeates the limbs and skin, causing swelling. Treatment should focus on strengthening the spleen and promoting water metabolism, commonly using White Atractylodes Powder. If swelling is more severe in the lower body, Middle-Tonifying Qi-Replenishing Decoction with Poria can be added. If the condition is caused by improper diet, vomiting, or diarrhea, Six Gentlemen Decoction is recommended. For cases with swollen, tense limbs and difficulty urinating, Akebia Stem Powder is used.
2. Kidney Deficiency︰From the fifth or sixth month of pregnancy, facial puffiness and limb swelling begin, with thin and shiny skin at the swollen areas, pressing feels like mud; the complexion is dull, palpitation and shortness of breath occur, the lower limbs are cold, the waist is sore and the legs are weak, the tongue texture is pale, the coating is white or white and greasy yet moist, and the pulse manifestation is deep and slow. "It is truly due to the congealing of genuine yin to nourish the fetal essence, the kidney's yang qi being unable to spread, thus the water pathways overflow uncontrollably." ("Shen's Gynecological Essentials Annotations and Corrections · Edema in Pregnancy") The kidneys act as the gate of the stomach; kidney deficiency leads to the gate's malfunction and water accumulation causing swelling. Therefore, spleen deficiency as a disease primarily manifests in middle deficiency and impaired transportation, inevitably accompanied by insufficient middle qi and weakened spleen yang (shortness of breath and lack of strength, pale yellow skin, cold limbs, loose and thin stools, pale tongue texture, and a slow, slippery, and weak pulse) as well as dampness encumbering the spleen earth (bland taste in the mouth, loss of appetite, white and moist tongue coating) and other symptoms. Kidney deficiency as a disease primarily manifests in yang deficiency and abnormal qi transformation, inevitably accompanied by insufficiency of the lower origin (dull complexion, sore waist and weak legs, cold lower limbs, deep and slow pulse). Regarding its treatment, one should boost the fire to disperse yin and transform qi to move water, using the formula True Warrior Decoction.
3. Qi Stagnation︰In the third or fourth month of pregnancy, swelling of the limbs often begins in the feet and gradually extends to the legs. The swollen areas show no change in skin color, and pressing leaves a depression that immediately rebounds when the finger is lifted. Symptoms may include chest tightness, hypochondriac distension, dizziness, irritability, poor appetite, a white and greasy tongue coating, and a wiry-slippery pulse. This condition arises because, during the third or fourth month of pregnancy, the growing fetus obstructs the movement of qi, compounded by liver qi stagnation, which disrupts the normal ascent and descent of qi. As a result, yang qi fails to rise, and turbid yin accumulates without dispersing. The distinguishing features of this swelling are: the skin color remains unchanged, and although pressing leaves a depression, it rebounds immediately upon lifting the finger. This differs markedly from the edema due to spleen deficiency or kidney deficiency in pregnancy, where the skin appears thin and shiny, and the depression from pressing lingers for a long time. The swelling is usually confined to the lower limbs and is often accompanied by clinical manifestations of liver depression qi stagnation (chest tightness, hypochondriac distension, dizziness, irritability, and a wiry-slippery pulse). Treatment should focus on regulating qi and moving stagnation, commonly using Dutchmanspipe Vine Powder.

In clinical practice, it is common to encounter edema in pregnant women due to qi stagnation accompanied by dampness and spleen deficiency combined with qi stagnation. The former is caused by liver depression leading to spleen dysfunction, and spleen deficiency resulting in the inability to transport dampness; the latter is due to spleen deficiency leading to liver depression, and qi stagnation causing poor water passage.

For qi stagnation accompanied by dampness, the treatment involves soothing the liver and regulating qi, supplemented by invigorating the spleen and draining dampness, using Dutchmanspipe Vine Powder combined with Powder of Four Ingredients with Poria; for spleen deficiency with qi stagnation, the treatment should focus on invigorating the spleen and resolving dampness, supplemented by regulating qi and moving stagnation, using White Atractylodes Powder with Dried Tangerine Peel and Submature Bitter Orange.

bubble_chart Documentation

1. Puji Fang．Pregnancy Diseases Section: "After the formation of the fetus in the third month of pregnancy, the feet gradually swell from the instep to below the knees, making walking difficult, leading to breathlessness, poor appetite, and symptoms resembling water retention, even to the point where yellow fluid seeps from between the toes, known as child-element/phase qi. This condition only subsides after childbirth. This is due to the woman's inherent wind qi or blood wind in the Chong and Ren meridians. It is not advisable to recklessly administer decoctions, as excessive treatment may lead to difficulties during labor and unforeseen complications. Therefore, it is essential to treat this condition before childbirth."
2. 《Shen's Nyuke Jiyao Commentary．Edema in Pregnancy》: "There is also a condition of phlegm stagnation. Although phlegm is a type of water, its condensed and thick nature prevents it from spreading throughout the skin. It only blocks the qi pathways, causing qi to not circulate freely, which can also lead to swelling. The skin color does not change, so qi-regulating medicinals are ineffective. Adding phlegm-resolving ingredients will naturally yield results."