Qianghuo Shengshi Decoction for Functional Edema: A Case Report
Zhejiang Journal of Traditional Chinese Medicine, 1997, (5:206) published a clinical practice report on treating functional edema with modified Qianghuo Shengshi Tang. The medication regimen in that article is: Qianghuo (Notopterygii Rhizoma), Duhuo (Angelicae Pubescentis Radix), Gaoben (Ligustici Rhizoma), Fangfeng (Saposhnikoviae Radix), Chuanxiong (Chuanxiong Rhizoma), Manjingzi (Viticis Fructus) each 10 g, Zhi Gancao (honey-fried Glycyrrhiza) 6 g. For qi deficiency add Dangshen (Codonopsis) and Chao Baizhu (fried Atractylodis Macrocephalae Rhizoma); for scant urine add Fulingpi (Poria peel), Zexie (Alismatis Rhizoma), Cheqianzi (Plantaginis Semen), and Mutong (Akebiae Caulis); for food stagnation add Guya (Oryzae Fructus Germinatum), Maiya (Hordei Fructus Germinatum), Chao Laifuzi (fried Raphani Semen), and Shanzha (Crataegi Fructus); for kidney yang deficiency add Bajitian (Morindae Radix) and Xianlingpi (Epimedii Herba). One dose daily, decocted in water; take 2 days on, 1 day off; 30 days constitutes one course.
The article reported 25 cases. In all cases urine output increased after 2 doses, and after 8 consecutive doses the edema had basically resolved. Of 15 patients who took one full course, edema disappeared completely, body weight decreased to varying degrees, chest tightness and abdominal distension resolved, and there was no recurrence at 1-year follow-up. Six patients' symptoms resolved after 10-15 doses; 4 did not recur at 1 year, and the other 2 recurred after half a year but still responded to the same formula. Four patients took fewer than 6 doses; because they took too little, they were not followed long-term.
Functional edema is generally thought to result from weak immunity, nephritis, and similar causes. Patients with malignant tumors may also develop functional edema, especially when lymphatic return is obstructed; such patients often lack a good treatment, and this clinical report may be of reference.
Qianghuo Shengshi Tang is a formula created by Li Dongyuan, from his famous work Discrimination of Internal and External Damage (Neiwaishang Bianhuo Lun). It treats wind-damp attacking the exterior, presenting with heavy pain of the head and body or generalized pain, difficulty turning over, slight aversion to wind and cold, a white tongue coating, and a floating, moderate pulse. It is a commonly used formula for rheumatoid arthritis and wind-damp-type colds. Besides their acrid-warm exterior-releasing action, the herbs in the formula also dispel dampness and reduce swelling. Using this formula for functional edema is a TCM "lifting the lid off the pot" (ti hu jie gai) method.
Depending on the patient's presentation, adding qi-tonifying, diuretic, digestive, or kidney-tonifying herbs gives better targeting. Although I have not yet personally used this regimen, its compositional logic is very reasonable, and I recommend patients with such problems try it themselves. None of the herbs in the formula has notable toxicity or side effects, so safety is high.