Traditional Diagnosis and Treatment of Swelling and Edema in TCM

The Yellow Emperor asked Qi Bo: How should we distinguish between water swelling, skin swelling, bloating, intestinal masses, and stone-like masses or urinary stones?

Qi Bo replied: If the lower eyelid of the patient is slightly swollen, resembling the appearance after just waking up, if the carotid artery in the neck is visibly pulsing, there is a persistent cough, a sensation of coldness on the inner thighs, swelling in the ankles and lower legs, and a bloated abdomen, these are signs that water retention (edema) has developed. When pressing on the patient’s abdomen, and upon releasing the pressure, the abdomen does not retain any indentation, much like pressing on a water-filled bag, this is the characteristic of water retention.

The Yellow Emperor asked: How should skin swelling be diagnosed?

Qi Bo said: Skin swelling occurs when cold pathogens invade between the skin and muscles. The patient will experience abdominal bloating, and when percussion is performed, it will produce a drum-like sound. Upon pressing the abdomen, it will feel hollow but not hard. The whole body may appear puffy, with thickened skin. When pressing on the abdomen, the indentation will remain after releasing pressure, and the skin color remains normal. This is the symptom of skin swelling.

The Yellow Emperor asked: What are the symptoms of bloating (distension) disease?

Qi Bo said: In bloating disease, both the abdomen and the whole body become swollen, similar to skin swelling. However, in bloating disease, the skin takes on a bluish-yellow hue, and the abdominal veins become prominent and distended. These are the key characteristics of bloating disease.

The Yellow Emperor asked: What are the symptoms of intestinal masses (Cháng Tán)?

Qi Bo replied: When cold pathogens invade the body, they obstruct the normal flow of Wei Qi (defensive energy). As a result, this stagnation leads to the formation of polyps, which start off small—about the size of an egg—and grow larger over time. Once the disease is formed, the patient may appear pregnant, with the disease developing over a long period—sometimes even years. When pressing on the abdomen, it feels hard, and it moves when pushed. However, menstruation continues normally. This is the symptom of intestinal masses.

The Yellow Emperor asked: What are the characteristics of stone-like masses (Shí Jiǎ)?

Qi Bo replied: Stone-like masses form in the uterus due to cold pathogens blocking the cervical opening, causing blood and Qi to stagnate. This leads to the accumulation of menstrual blood, which cannot be expelled properly and begins to form clots that remain in the uterus, gradually growing larger. The abdomen becomes distended, resembling pregnancy, and menstruation becomes irregular. This disease mainly affects women. The treatment should focus on invigorating blood circulation, breaking up stagnation, and promoting the downward flow of blood to clear the obstruction.

The Yellow Emperor asked: Can acupuncture be used to treat skin swelling and bloating?

Qi Bo replied: When treating these conditions, the first step is to use acupuncture to release the blood stasis in the meridians. Then, depending on the nature of the illness—whether it is excess or deficiency—adjust the meridian flow accordingly and clear any blood stasis.