Edema (Textbook diagnosis)

Diagnosis We will focus on nephritis and nephrosis (also known as nephrotic syndrome), even

though the former can occur without edema, and not all cases of edema are due to renal disease. Other diseases that can cause edema will also be briefly mentioned.

In Japan, edema was traditionally divided into a number of types, including water qi (shui qi), phlegm and thin mucus (tan in/tdnyin), water swelling (sui shu/shut zhong), distention and fullness (cho man/zhang man), and rotten swelling (ko cho/gu zhang). Note that water qi became known as water swelling in later periods and that water swelling also came to be one of the terms used for edema in general. These conditions cannot be attributed on a one-to-one basis to modern day diseases such as edema due to heart disease, nephritis, or nephrosis, but as is often the case, they include and overlap many of these conditions.

Water qi disease encompasses a variety of conditions, ranging from waterlogged obesity to nephrosis. Classically, water qi disease is said to have its root in the Kidneys and its branch in the Lungs because the condition is brought about by Kidney yin deficiency coupled with Lung qi deficiency. When the Kidneys lose their ability to grasp fluids, the fluids migrate toward the surface of the body. If the Lung qi is not deficient, it will expel the fluids from the surface and also drive them back to the Kidneys. However, when the Lung qi is deficient, there will be an increased amount of water collecting near the surface of the skin. In addition, in water qi disease, the yin deficiency heat dries out the fluids of the Kidneys and harms the Spleen and Stomach. Both processes—the drying out of the fluids and the inability to grasp fluids—can occur simultaneously. This is somewhat akin to drying a floor with a very dry mop. When the heat spreads to the Spleen and Stomach, the production of fluids by the Spleen is adversely affected and/or the Stomach heat consumes the fluids. The result in both cases is that there is a decrease in the amount of fluids being delivered to the Kidneys, leading to puffiness. From this, we can see why the Kidneys are likened to water, while the Spleen is classically likened to an earthen dike or embankment. The Kidneys are also said to be the gateway to the Stomach, which basically means that if the Kidneys are deficient, the Stomach will be deficient, and vice versa. From the above pathology, it is clear that water qi diseases should in general be treated as a pattern of Kidney deficiency/yin deficiency/heat.

Phlegm and thin mucus disease occurs when the Spleen is deficient, which affects the absorption of water by the Stomach and Intestines, thereby leading to a buildup of water. We can further subdivide these problems into phlegm and thin mucus. Phlegm is basically the product of water and heat from any source.

For instance, we can say that phlegm plays a role in the development of urinary problems if they arose as a result of Spleen deficiency/yin deficiency heat spreading to the Kidneys and Bladder and causing a buildup of water. At the same time, heat can spread to the Lungs and the Liver simultaneously. This pattern is often seen in nephritis or nephrosis. My brother {Takio Ikeda) commented on this to me when he said “The Spleen has the capacity to push out water, [and] so Kidney disease should be treated by tonifying the Spleen.” Thin mucus, by contrast, is caused by Spleen deficiency coupled to deficiency of the yang qi of the Stomach and Intestines, causing a buildup of water. It is common to find this pattern in congestive heart disease and also in cases where there is unexplained puffiness of the face.

As we have seen above, nephritis and nephrosis can be a result of either Kidney deficiency/yin deficiency/heat or Spleen deficiency/yin deficiency/heat. Distinguishing between the two should be based on the symptoms and the pulse, but can be quite difficult in practice. In the classics, there is a school of thought that edema is due to Spleen deficiency (e.g., Chapters 29 and 45 of Basic Questions), and there is another school that says it is due primarily to Kidney deficiency (e.g.. Chapter 34 of Basic Questions, Chapter 2 of the Divine Pivot, and Chapter 40 of the Classic of Difficulties).

What we can say is that when edema is present, a floating and big or flooding pulse, or a floating, big, and deficient pulse will likely be present, all of which indicate a preponderance of yang qi. Cases of nephritis with Kidney deficiency/yin deficiency/heat typically have an appetite and sometimes also have high blood pressure. On the other hand, cases of nephritis where the pulse is sunken, fine, thin, and deficient, and that also have gastrointestinal symptoms as well as poor urine flow, are caused by a pattern of Spleen deficiency/yin deficiency or Spleen deficiency/yang deficiency. In either case, if the left proximal pulse is hard, the prognosis is poor.

Cases of acute nephritis can also be caused by Spleen deficiency/Liver excess/heat. In this case, the pulse would be sunken, wiry, and excessive. Also, the number of people with kidney failure that are on dialysis machines is growing recently. These patients tend to have pulses that are difficult to read and therefore pose problems in determining the pattern. Based on my experience, they typically have either a Spleen deficiency yin/deficiency or Spleen deficiency/yang deficiency pattern.

In those cases where there is kidney disease as well as high blood pressure, concentrate on improving the health of the kidneys and the blood pressure will take care of itself. There is no need to emphasize treating the high blood pressure during your selection of points.

Finally, in such classics as Essentials from the Golden Cabinet, terms such as distention, fullness, and drum-like distention {^31 ko cho/gu zhdng) are used to describe disease states when the abdomen is big and full like a drum and the face, eyes, arms, and legs are also pufly. Ascites, which can be seen in cases of cirrhosis, is perhaps one such disease state. Temporary improvement in the condition can be obtained by using the treatment for Spleen deficiency/yang deficiency/cold pattern. If there is some Liver heat rising to the surface, then a Spleen deficiency/Liver excess/heat pattern treatment protocol should be followed.

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