Face Swollen, Legs Swollen, Whole Body Puffy? Doctor Luo Tianyi’s Pingwei San (Calm the Stomach Powder) & Daozhi Tongjing Tang (Guide Stagnation and Unblock the Channels Decoction) for Edema
Patient search words: edema / swelling / puffy face / swollen legs / loose stools ｜ Medical terms: edema · spleen deficiency with dampness excess · spleen-stomach yang deficiency
Opening scene: a May of endless rain, and a 58-year-old master swells up
In the fifth month of the zhiyuan wuyin year (1278 AD), just as summer began, the rain settled in and would not stop — steady, relentless drizzle (lin yin bu zhi), day after day, as if the sky had forgotten how to clear.
💬 Note from Doctor Luo: See how Doctor Luo Tianyi opens a case: he sets the climate scene first. That is the habit of a good physician — show the weather in which the illness was born before anything else. The zhiyuan wuyin year falls in the reign of Emperor Shizu (Kublai Khan) of the Yuan dynasty; by this time Doctor Luo Tianyi was already approaching sixty.
In that endless rain, a man fell ill. He was Master Xu Pingzhong of Luzhai (鲁斋许平仲先生), fifty-eight years old.
Who was the patient? Eyelids puffed like silkworms, shins that dimple under a finger
What illness did Master Xu have? Swelling of the face, eyes, and limbs — his face was puffy, his eyes swollen, his arms and legs bloated.
💬 Note from Doctor Luo: This is what we call edema today. In fact, edema is extremely common now, and many people don’t even recognize it: some notice their hands feel tight when they make a fist in the afternoon; elderly folks touch the shin bone (the tibia) in the morning and it dimples under a finger; others wake with eyelids puffy as if a silkworm were resting on them — all of these are signs of edema.
On top of the swelling, he had loose stools in great quantity — stools that never firmed up, sticky and mushy (the kind that “stick to the toilet”), frequent and voluminous; abdominal distension; borborygmus — his belly gurgled and sloshed with water sounds; periodic pain — he often felt bellyache; and scanty food intake — he had no appetite. His pulse: wiry, thready, and slow (xian xi er huan).
Where was the root? In his youth, morning glory seeds and rhubarb were his daily laxatives
Master Xu himself explained: when I was young, I took a great deal of qianniuzi (morning glory seeds) and dahuang (rhubarb).
💬 Note from Doctor Luo: Qianniuzi is the “black and white chou” (hei bai chou) — a fierce purgative that drains dampness, promotes urination, and opens the bowels; dahuang (rhubarb) needs no introduction — take it and the belly aches and everything pours out. The dose of such medicines must be strictly controlled, and they must never be used long-term.
Back then Master Xu probably had some constipation, so he took them daily — even when nothing was wrong — and as a result his face and limbs swelled on and off. Why? The fierce purgatives kept attacking downward and wrecked his spleen and stomach. Then came this stretch of endless rain; the cold-damp intensified and the illness erupted fully — the spleen and stomach’s yang qi was already insufficient, and external damp and cold slipped in through the weakness to further damage the organs. The spleen and stomach were cold and deficient, the dampness heavy — and so cold-dampness (han shi) was born.
Diagnostic highlight 1: nutritive qi comes from the middle jiao — the spleen and stomach are the source of the whole body’s nourishment
How did Doctor Luo Tianyi analyze it? He began with ying qi and wei qi: ying qi (nutritive qi) is the material basis of nourishment, moving inside the vessels; wei qi (defensive qi) is the fierce protective force on the outside that guards the body.
💬 Note from Doctor Luo: The Huangdi Neijing (Yellow Emperor’s Inner Classic) says “ying qi originates from the middle jiao, wei qi from the lower jiao.” Why does ying qi come from the middle jiao? Because where does nourishment come from? The spleen and stomach absorb nutrients from food and transform them into what the body can use, distributing them throughout the body — that energy source is the spleen and stomach. Doctor Luo Tianyi says “the middle jiao is the stomach” — by “stomach” he means the spleen and stomach together.
What happens when the spleen and stomach weaken? They can no longer transport and transform food and water, can no longer nourish the organs, channels, skin, and hair of the whole body — nourishment is produced, but there is no strength to deliver it; the roads are blocked, and wherever it stalls, it pools, and pooling gradually turns into edema.
💬 Note from Doctor Luo: Here is a crucial principle: water itself is neither good nor bad. Use it well and send it through the body — it is nourishment; fail to use it and leave it dammed inside, where it accumulates like a lake — it becomes something harmful: water-dampness and phlegm-dampness (shui shi tan shi). So the body’s upright qi (zheng qi) — the qi of the spleen and stomach — is the real key.
Diagnostic highlight 2: in all four seasons, the five organs take stomach qi as their root
Doctor Luo Tianyi loved to cite the Huangdi Neijing. He said: in all four seasons, the five organs all take stomach qi as their root.
The Huangdi Neijing says: the five organs all receive their qi from the stomach; the stomach is the root of the five organs.
💬 Note from Doctor Luo: This is not something Doctor Luo Tianyi made up — his school had solid grounds for it. The nourishment of the five organs comes entirely from the spleen and stomach. When the five organs have stomach qi, the pulse is even and the body is well; when stomach qi weakens and can no longer distribute nourishment to nourish the five organs, the pulses of the five organs lose their evenness. When you take the pulse, if there is vitality in it, if stomach qi is present, the person can live. When stomach qi is gone, the situation is dangerous — the Neijing says “when the genuine organ pulse appears and there is no stomach qi, death follows.” That is the signal of critical illness.
Doctor Luo Dalun also told two stories from his own experience:
💬 Note from Doctor Luo: When I was first studying Chinese medicine, I saw an old physician treat a desperately difficult patient. The patient took the flatbread handed to him, and the longing in his eyes was impossible to hide — he grabbed it and ate. The old physician said: “Stomach qi is still present — he can be saved!” and immediately wrote a regulating prescription. People at a nursing home once told me: many elderly people have better appetites than the young — but the moment they suddenly stop eating much, they are often gone soon after. That is what Chinese medicine means by the loss of stomach qi. While stomach qi is present, a person lives; once it is gone, the person is finished. This is the root of the body.
The question Doctor Luo Tianyi always asked: are your stools formed or not?
Having reached this point in the diagnosis, Doctor Luo Tianyi told Master Xu: your illness, fortunately, has not reached that severe stage; it can still be regulated and tonified — I can rescue you. But one question is crucial — how are your stools?
💬 Note from Doctor Luo: In Chinese medicine, when treating illness caused by damage to the spleen and stomach, if the stools are normal, the spleen and stomach functions are still working and the disease is easy to treat; if the stools are unformed, draining downward in diarrhea, with the lower origin unsecured — then the disease is hard to treat. That is the general rule, so in treating such illness you must always ask about the stools first — it is absolutely crucial.
The mistake Master Xu had made, Doctor Luo Tianyi exposed in one sentence: “People seek only the pleasure of the moment, not knowing that it harms them for life.” The moment the bowels clogged, he took rhubarb and morning glory seeds — seeking instant relief, unaware that it would harm him for a lifetime.
💬 Note from Doctor Luo: The same happens today: many elderly people, the moment they get constipated, buy rhubarb or senna leaves — one dose and it works, so satisfying — but after a while it stops working, and worse, it damages the upright qi (zheng qi). Purgatives should only be used when the pathogen is vigorous; in ordinary times, when the body is deficient, never touch them.
Formula 1: Pingwei San as the base, plus baizhu, fuling, and caodoukou — attack the dampness first
The first formula Doctor Luo Tianyi wrote: Pingwei San (Calm the Stomach Powder), plus baizhu (white atractylodes), fuling (poria), and caodoukou (katsumadai cardamom).
What is Pingwei San? Cangzhu (black atractylodes), houpo (magnolia bark), chenpi (aged tangerine peel), and gancao (licorice), decocted together with fresh ginger and red dates; strain and drink the liquid — the ginger and dates are indispensable!
💬 Note from Doctor Luo: Pingwei San is a classic formula, specifically for excessive cold-dampness in the spleen and stomach: a bloated, stuffy belly, inability to eat much, nausea and vomiting, belching, a tasteless mouth, swelling of the limbs, a heavy tired body that only wants to lie down, unformed stools — and the tongue coating is always white, thick, and covering the whole tongue, with a lot of saliva on it. Today Tongrentang sells Pingwei Wan (Calm the Stomach Pills) — a quick online search will find them. Huoxiang Zhengqi San (Agastache Upright Qi Powder) and Buhuanjin Zhengqi San (Golden-Not-Even-Changed Upright Qi Powder) are both derived from Pingwei San with additions and subtractions — which shows that it is the foundational formula for removing dampness and reviving the yang qi of the spleen and stomach.
There is much subtlety in the formula: cangzhu is the sovereign (jun) — pungent, fragrant, bitter, and warm, with great power to dry dampness; it attacks, driving dampness outward. Baizhu is chiefly defensive — stronger at tonifying the spleen, and it too removes dampness. Cangzhu and baizhu are often used together — one attacks, one guards. Houpo moves qi and eliminates dampness, working with cangzhu to move qi, dry dampness, and activate the spleen. Chenpi regulates qi — descending lung qi and removing turbid dampness. Gancao harmonizes the middle, reconciling all the herbs and strengthening the spleen and stomach.
💬 Note from Doctor Luo: Why is the spleen so afraid of dampness? The spleen and stomach belong to Earth, and they love dryness and hate dampness — Earth controls Water; “when water comes, earth dams it” — when the Earth is normal, it can control the water. But when the spleen and stomach are injured and the upright qi is insufficient, cold-dampness traps them, the spleen can no longer transport and transform — and distension and swelling follow. Here Doctor Luo Tianyi adds baizhu and fuling, strengthening the power to remove dampness and tonify the spleen; and adds caodoukou to rouse the spleen and stomach’s qi and dissolve the dampness. The whole formula is warming in character, while tonifying the spleen and removing dampness at the same time.
Formula 2: most of the dampness gone, only the swelling remains — Daozhi Tongjing Tang
After a few doses, the distension, loose stools, borborygmus, and periodic pain were all cured, and his appetite returned. Only some swelling of the limbs remained.
Doctor Luo Tianyi judged: a little spleen-dampness remains, but the main problem is that qi is not being opened and circulated — the channels are not free, so the face, hands, and feet are still swollen. So he wrote a second formula: Daozhi Tongjing Tang (Guide Stagnation and Unblock the Channels Decoction), specifically for excess spleen-dampness with unopened qi and swelling of the face, hands, and feet. Composition: chenpi as sovereign, sangbaipi (mulberry root bark) as assistant, plus muxiang (costus root), baizhu, and white fuling.
💬 Note from Doctor Luo: This formula was composed entirely under the guidance of the Huangdi Neijing. The Neijing’s principle for treating dampness: “When dampness prevails, pacify it with bitter and warm, assist it with sour and pungent, dry it with bitter, and drain it with bland.” When dampness has not yet transformed into heat, it is usually because yang qi is insufficient and cannot control the water-dampness, so you need bitter-warm herbs to pacify it, bitter herbs to dry the dampness, and bland herbs to percolate it out. Look at the formula: baizhu is bitter, sweet, and warm — it removes dampness: that is “dry it with bitter.” White fuling is sweet and neutral — it percolates and drains dampness: that is “drain it with bland.” Muxiang is pungent, bitter, and warm — it removes stagnant qi from the lung and regulates qi to dispel dampness. Every herb matches the principle.
Why is chenpi the sovereign? Because the lung governs the qi of the entire body, and the lung is the upper source of water — to dissolve water-dampness, you must mobilize the lung’s energy. Chenpi is bitter and warm; it regulates lung qi, removes qi stagnation, and opens the channels.
💬 Note from Doctor Luo: The most brilliant touch here is sangbaipi (mulberry root bark). Chenpi, baizhu, and muxiang are all warm — but sangbaipi is sweet and cold. Why add one cool herb? Because the lung corresponds to autumn, and autumn’s qi moves downward (as the weather turns cool, qi descends and contracts). When regulating the lung, you must not make it too hot; you must go along with the lung’s “autumn descent” pattern. Sangbaipi enters the lung and spleen channels; it drains the lung to stop wheezing, promotes urination to reduce swelling, removes water-qi from the lung, and also treats “lu zhang” (abdominal distension with the belly skin stretched taut). Once the lung qi descends, the water of the whole body descends with it — this single cool herb gives the entire formula “the momentum of autumn.” Mostly warm herbs plus one cool one — this is clinical experience (sangbaipi disperses edema) combined with Neijing theory (composing formulas by nature and flavor).
Directions: each dose five qian (about 15 g), two cups of water decocted down to one cup, strain, take warm, on an empty stomach before food — so the medicine reaches the channels and the spleen and stomach quickly and drives out the dampness before food can interfere. Result: liang yu — a full and excellent recovery.
Why did the Jin-Yuan physicians all love the Neijing? — a great turning point in the history of Chinese medicine
💬 Note from Doctor Luo: Have you noticed that Doctor Luo Tianyi cites the Huangdi Neijing in every case? Behind this lies a great turning point in Chinese medical history. Before the Song dynasty, doctors treated with formulas but did not explain principles: in the Tang dynasty there was the Qianjin Fang (Thousand Gold Formulas), with little theory — nothing but formulas. The Song dynasty’s Taiping Huimin Heji Jufang (Formulary of the Peaceful Benevolent Dispensary) went further — essentially a list of formulas; even Su Shi published a formula book — headache? Here are a dozen formulas, try them one by one; hot, cold, warm, cool — no theory; if you hit the right one, fine; if you hit the wrong one, trouble. Then came the four great masters of the Jin-Yuan period, each school’s doctrine arose, and physicians began to explain principles: formulas must operate under theoretical guidance, so every case cited the Neijing and the Shang Han Lun (Treatise on Cold Damage). It was from this time that Chinese medicine truly began to be guided by theory in prescribing formulas and in treatment. Even the rule of “sovereign, minister, assistant, courier” (jun chen zuo shi) was emphasized and articulated by Zhang Yuansu, Doctor Luo Tianyi’s own teacher.
Aftercare: master the rhythm between attack and tonify
This case also teaches us a sequence for regulating the body:
💬 Note from Doctor Luo: When things are acute, attack quickly — Pingwei San has the force to drive out the dampness; then tonify the spleen and open the channels at the same time — in Daozhi Tongjing Tang, baizhu tonifies the spleen and chenpi opens the channels. The record does not go much further, but real aftercare would then focus on tonification, slowly rebuilding the spleen and stomach with ren shen (ginseng), baizhu, and huang qi (astragalus), together with whole grains. Attack in acute phases, combine attack and tonify, and end with tonification as the mainstay — that is the program for regulating the body.
And Doctor Luo Dalun’s final reminder:
💬 Note from Doctor Luo: The two things most worth remembering from this case: first, do not use purgatives like qianniuzi (morning glory seeds), dahuang (rhubarb), or senna leaves as daily laxatives — “seeking the pleasure of the moment, not knowing that it harms you for life.” Second, the qi of the spleen and stomach is the root of the body — when dampness is heavy (rainy overcast days, air conditioning, living near water, the cold damp of Central China winters), protect the spleen and stomach all the more. When the spleen and stomach are strong, water-dampness cannot run rampant.
Case source: Weisheng Baojian (Precious Mirror of Hygiene), medical case of Doctor Luo Tianyi; commentary based on public lectures by Doctor Luo Dalun (PhD in TCM diagnostics, Beijing University of Chinese Medicine).