Whole-Body Swelling That Pits When Pressed? Doctor Zhang Xichun Treats Edema from Yin Deficiency by Nourishing Yin and Promoting Urination
Search terms this page answers: whole-body swelling / edema / puffiness / pitting edema / cannot urinate properly / scanty red urine / fever at 3 to 5 pm / hot palms and soles / dry mouth, wanting cold drinks / restless heat in the five centers
Medical terms: edema (yin-deficiency type) · deficiency of the yin aspect · nephritis · yin deficiency with internal heat · bone-steaming tidal fever (a deep, radiating heat that rises in waves, classically in the afternoon)
Opening: whenever we hear "edema," everyone thinks of yang deficiency
Today we continue the stories of how Doctor Zhang Xichun treated illness — and this one is about edema (whole-body swelling). When you hear the word edema, what is the first thought that pops into your head? For most people it is yang deficiency — kidney yang not sufficient. But the patient in today’s case, in Doctor Zhang Xichun’s telling, had edema caused by yin deficiency — and the treatment followed a completely different line of thinking.
💬 Note from Doctor Luo: Edema is a very complicated illness. Some people swell all over, some only in the upper body, some only in the lower body. In Chinese medicine the causes are often many: sometimes it comes from external contraction — for example, catching wind (as people say, "I got winded"), where the external pathogen attacks the kidneys, which is what we today call nephritis; both acute and chronic nephritis easily produce edema. Sometimes the cause is damp-heat. And for internally generated edema, most people think of yang deficiency — kidney yang insufficient, unable to steam and transform the fluids, so water just stays in the body. So whenever edema is mentioned, everyone treats it as yang deficiency. But today’s case — Doctor Zhang Xichun specifically shows us: yin deficiency can also cause edema.
Who was the patient? A young man in his early twenties from a neighboring village
The patient was from a family in a neighboring village of Doctor Zhang Xichun, and he was in his early twenties — very young. How did the illness begin? Like this: this young man had been yin deficient for a long time, and constantly felt burning heat — he always felt hot over his whole body.
💬 Note from Doctor Luo: You all know the signs of yin deficiency — dry mouth and tongue, always wanting cold drinks. Why? Because the yin inside the body is insufficient. So what exactly is this "yin"? I keep introducing this idea: yin is the material foundation inside the body that governs stillness and moistening. For example, blood belongs to yin, and body fluids also belong to yin. These still, moistening things are mostly liquid. So what is yin deficiency equivalent to? It is like a car engine that has lost both its coolant and its lubricating oil — how could the engine not overheat when it runs? This is what is called deficient heat (xu re).
How far had it gone? Head, face and whole body swollen
As deficient heat arose from the yin deficiency, the young man gradually began to have difficult urination — the passage was never smooth, urine output decreased while frequency increased, and every time it was difficult. Then, little by little, this turned into edema.
💬 Note from Doctor Luo: The manifestations of yin deficiency are usually little feelings of heat everywhere: hot palms and soles, dry mouth and thirst, wanting cold things, restless heat in the five centers (palms, soles and chest), plus a restless mind and easily dry stools — the deficient heat consumes and injures the body fluids. When it gets worse, there is also bone-steaming tidal fever: bone-steaming means the heat steams outward from deep inside — when you lightly touch the skin you seem to feel nothing, but the more you press, the more you feel the heat inside; tidal fever means the heat rises in waves, coming and going. This patient constantly had burning heat, then difficult urination, and gradually the edema.
His symptoms were these: head, face and whole body were all swollen; if you pressed a swollen spot with your hand, it left a pit that took a while to slowly return after you let go. Then there was afternoon tidal fever — from 3 to 5 pm, like the tide, the heat would come out. His heart always felt hot. The urine was scanty and reddish in color, and he only passed urine about once in a day and a night. As for the pulse: left position wiry and thin, right position wiry and slightly hard, rapid, six beats per breath — beating rather fast.
💬 Note from Doctor Luo: There is an old saying: "Men fear putting on boots, women fear wearing hats." Among people with edema, men fear the feet swelling first, as if putting on boots; women fear the head and face swelling first, as if putting on a hat. This patient’s head, face and whole body were all swollen — the illness was serious. And afternoon tidal fever is mostly a sign of yin deficiency.
What did Doctor Zhang Xichun think? The yin aspect was depleted — the kidney could no longer filter water
The moment Doctor Zhang Xichun took the pulse, he understood in his heart. He said: this is depletion of the yin aspect — yin deficiency. The kidney had been injured by deficient heat and had become inflamed — in his words, "the kidney was injured by deficient heat and became inflamed" — so the kidney could no longer filter the body fluids or free the urination.
💬 Note from Doctor Luo: Doctor Zhang Xichun judged this to be "nephritis," using the language of his era. Looking at it today, it may not really have been nephritis — it could well have been a functional problem producing these symptoms. His overall judgment was: the yin aspect depleted, the kidney unable to filter water and promote urination. Now about that pulse — left position wiry and thin: the left wrist corresponds to the heart, liver and kidney, and wiry-thin indicates that the liver’s free-flowing (shu xie) power was insufficient; when the liver’s ability to spread and regulate declines, it can cause difficult urination. Right position wiry and hard: the right wrist corresponds to the lung, spleen and life-gate, and wiry-hard indicates damp-heat in the stomach; damp-heat flows downward and can also cause difficult urination. So this illness also involved the liver and the spleen.
What to do? Doctor Zhang Xichun said one should use herbs that greatly nourish the true yin — the true yin must be replenished. Once the yin is sufficient and the heat recedes, the body will recover on its own. And if after nourishing yin the stomach heat is cleared, the liver wood, moistened by kidney water, will be able to spread and regulate again — at that point one only needs to add a little medicine to open the urination.
The prescription: first support the righteous qi, then nourish yin, and add something to promote urination
Doctor Zhang Xichun’s way of composing formulas is a classic worth learning. The first formula:
Dried Huai Chinese yam 30 g (sheng huai shan yao — tonifies the spleen and supports the righteous qi) + raw Rehmannia 18 g (sheng huai di huang — nourishes yin, cools the blood) + white peony (bai shao — astringes and softens the liver, promotes urination) + Scrophularia (xuan shen — moistens, clears heat, nourishes kidney water) + large sweet wolfberry (da gan gou qi — tonifies the liver and kidney) + Glehnia root (sha shen — nourishes yin) + talc (hua shi — promotes urination). Decoct together into one large bowl; take warm.
💬 Note from Doctor Luo: Look at this line of thinking — the very first herb is dried Huai Chinese yam 30 g. What is it doing? Tonifying the spleen. This is exactly the brilliance of Doctor Zhang Xichun’s way of treating illness: since there is dampness and water, he first supports the righteous qi — first fills up the spleen — then uses raw Rehmannia with yin-nourishing herbs, white peony to astringe and soften the liver (white peony also promotes urination), Scrophularia, wolfberry and Glehnia root to nourish yin, and finally a little talc to promote urination. Support the righteous qi as the foundation, add yin-nourishing on top, then a bit of medicine to open the urine — this formula is a classic.
Four doses in: the urine passed freely, half the swelling was gone
How did it work? Four doses in a row: the urination was no longer so difficult — it was normal; about half the swelling of the head, face and whole body was gone; and the afternoon fever had disappeared. But the heart still felt a little hot, and the pulse was still fast, coming down from six beats per breath to five.
💬 Note from Doctor Luo: What does this tell us? It tells us that the yin aspect had still not been fully replenished. What to do? On the basis of nourishing the true yin, add a little more water-draining medicine — the same general idea, just adjust the formula.
Changing the formula: cooked Rehmannia takes the stage — tonifying kidney essence comes first
For the second formula, Doctor Zhang Xichun brought out cooked Huai Rehmannia (shu huai di huang), opening with 30 g — a comparatively heavy dose. Then white peony 18 g (astringe the liver, soften the liver, promote urination), dried Huai Chinese yam 15 g (now that tonifying the spleen is no longer the first priority, the amount is reduced), large sweet wolfberry 15 g (tonify liver and kidney essence), arborvitae seed (bai zi ren), Scrophularia (xuan shen), Glehnia root (sha shen — nourish yin), raw plantain seed 9 g (sheng che qian zi, wrapped in a cloth bag), Poria 6 g (yun ling — drains dampness), and fresh cogongrass rhizome 15 g (xian bai mao gen).
💬 Note from Doctor Luo: What is cooked Rehmannia for? As I have explained, cooked Rehmannia greatly tonifies the essence of the liver and kidney, and above all the kidney essence. If you nourish the essence and on that foundation add yin-nourishing herbs, the effect is the best. That is why Doctor Zhang Xichun used cooked Rehmannia at 30 g and put it first — at this stage, nourishing kidney essence is the first priority. There is also a small detail in the formula: why add arborvitae seed? Doctor Zhang Xichun believed it has three major functions: first, settle the heart and calm the spirit; second, moisten the liver, useful when the liver’s free-flowing is insufficient; third, moisten the kidney and nourish kidney yin. Two birds with one stone — on one side it helps the liver spread and regulate, on the other it nourishes kidney yin. Also note that the plantain seed must be put in a cloth bag: plantain seeds are tiny and crumbly; after decocting they cannot be fully strained out, so bagging the herb makes the medicine drinkable.
The secret of cogongrass rhizome: Doctor Zhang Xichun’s distinctive decoction method
In this formula, fresh cogongrass rhizome 15 g plays a fairly important role. Cogongrass rhizome promotes urination and clears damp-heat; in treating kidney illness caused by damp-heat or heat, it is used constantly — this usage is one of Doctor Zhang Xichun’s very distinctive insights.
💬 Note from Doctor Luo: Usually Doctor Zhang Xichun used fresh cogongrass rhizome; if fresh material was truly unavailable, dried material would do. And how is this rhizome decocted? There is a technique. If using it alone — say the person has difficult urination and the urine is yellow, and you want to open the urine and clear a little damp-heat: put the rhizome in water and boil. At first the rhizome floats on top; the moment it sinks to the bottom, turn off the fire — at that point the decoction is ready to drink. If it is used inside a formula, decoct the other herbs first, and when they are nearly done, add the cogongrass rhizome and let it go a little longer. Take one large bowl of the decoction warm. If fresh cogongrass rhizome is not available, fresh common reed rhizome can be substituted; and if fresh reed rhizome cannot be found either, dried material will do.
Six doses and cured: Chinese yam congee with fresh pear juice as aftercare
How did this formula work? After six doses in a row, all the swelling was gone, and the pulse had returned to normal. Doctor Zhang Xichun told him he could stop the decoction. How to finish the job? — Doctor Zhang Xichun’s aftercare for depleted patients always followed this routine: dried Huai Chinese yam powder, 30 g a day, cooked into a congee, with a little fresh pear juice stirred in, taken as a snack.
💬 Note from Doctor Luo: Consider: a patient whose head, face and whole body were swollen came to Doctor Zhang Xichun and, in about ten doses altogether, the swelling completely disappeared, the pulse returned to normal, and he basically recovered. This shows how skilled Doctor Zhang Xichun really was. Why do I pull this case out to discuss it alone? Because most people, when they hear edema, think of yang deficiency — and when they meet an edema from yin deficiency, they tend to think, "Is that possible?" — yin-deficiency edema really exists. This is the benefit of reading case records: there is a whole course on medical cases in Chinese medicine universities. What is it for? To broaden your experience and knowledge. The physician writes the case down; when you read it, you know such a possibility exists, and if you ever meet it you will know what to do. A clinician who has practiced for a long time carries countless cases in his heart: the moment he sees a patient he thinks — this is just like case so-and-so; a famous doctor treated this before; let me check the book again, yes it is the same, this is how I should handle it — this is what keeps a person from gradually being boxed in by his own limits.
A bonus story: my own mother once had yin-deficiency edema, too
Speaking of this, Doctor Luo Dalun told a true story from his own family. He said: my own elderly mother once had yin-deficiency edema as well.
💬 Note from Doctor Luo: One period, my mother told me that her legs and feet felt heavy. Before that, our family’s attention had been focused on my father, because his health had always been poor, so we paid somewhat less attention to my mother. Then one day she told me her feet were swollen like little steamed buns — when she soaked her feet at night, she saw that pressing left a pit. By the usual diagnosis, lower-limb edema is often kidney yang insufficiency with poor qi transformation — mostly yang deficiency. But when I looked at my mother’s tongue it was red, and her pulse was fast — what does that say? Yin deficiency. She has a yin-deficient constitution; it did not arise overnight, and it is connected to heredity from her parents. So I especially want to emphasize: parents must get their own bodies in good shape before having children — otherwise your constitution is very easily passed to your child. That kind of constitution is especially hard to adjust and may be something the child must watch for a lifetime. For example, a child who inherits yin deficiency from the parents must all his life watch out: eat less beef, eat less hot-natured food.
So how did Doctor Luo treat her? Treatment based on pattern discrimination — whatever pattern she has right now, that is what I treat. He never warmed the yang or transformed dampness at all; his thinking was exactly the same as Doctor Zhang Xichun’s — nourish yin: Huai Chinese yam, cooked Rehmannia, raw Rehmannia, asparagus root (tian dong), Glehnia root — all yin-nourishing herbs, with just a little phlegm-resolving medicine added. The result: one or two doses showed clear improvement, and in five doses she completely recovered — no matter how you pressed, there was no pit left; the water was completely transformed and resolved.
💬 Note from Doctor Luo: Case records like Doctor Zhang Xichun’s are classics. If you see patients every day, you know that these records are all compilations of experience, and the cases he selected are all highly representative — from this one case alone you learn: there is a whole group of people with yin deficiency; yin deficiency can cause edema and all kinds of problems; if you nourish yin and add a little water-draining medicine, you can dissolve that edema. Once we ordinary people know this, when we meet such a situation we understand that edema comes in many types, and one of them is edema caused by yin deficiency. Spending a little time each day listening and broadening your experience — if you ever encounter it, you can protect your family. That is one of the best rewards of studying Chinese medicine.
Compiled from Doctor Luo Dalun’s narration of Doctor Zhang Xichun’s case records; the case comes from Records of Chinese Medicine with Western Reference (《医学衷中参西录》), published serially 1918–1934.