TCM Treatment Principles for Pulmonary Edema
Pulmonary edema is most often seen in patients with chronic lung disease (such as lung cancer, interstitial pneumonia, chronic bronchitis, or asthma) combined with cardiac or renal insufficiency, and is not uncommon among elderly patients with chronic lung disease. It typically causes four main symptoms—cough, copious sputum, wheezing, and edema—and may trigger associated symptoms such as chest oppression, chest pain, shoulder pain, and inability to lie flat.
Treatment usually relies on diuretics to remove the fluid, but after prolonged use an inverse dose-response appears: the drug works at first, then not only fails but worsens constitutional weakness.
In TCM, pulmonary edema belongs to the zhongzhang (swelling) diseases. The Ming-dynasty physician Zhang Jingyue wrote with great precision in Jingyue Quanshu: "All swelling disorders arise from the mutual involvement of the lung, spleen, and kidney. Because water is the most yin, its root lies in the kidney; because water is moved by qi, its branch lies in the lung; because water fears earth, its control lies in the spleen. Now if lung qi does not transform fluids, water overflows; if the spleen is deficient, earth fails to control water and is instead overacted upon; if the kidney is deficient, water has no master and runs wild." Treating pulmonary edema therefore requires simultaneously fortifying the spleen, boosting the kidney, and dispersing the lung; one must not simply see water and treat water.
Zhang Zhongjing's Shanghan Lun and Jingui Yaolüe contain several formulas for pulmonary edema—Ling Gui Zhu Gan Tang (Poria-Cinnamon-Atractylodes-Licorice Decoction), Jinkui Shenqi Wan, Zhenwu Tang, and Mahuang Tang—all classic formulas for fluid-retention disorders. But for chronic patients these may bring temporary relief without lasting effect. Formulating treatment for pulmonary edema therefore requires building on prior experience, incorporating modern medical findings, and innovating to achieve better results.
TCM spleen-strengthening, water-draining herbs—such as Huangqi (Astragalus), Fuling (Poria), Zhuling (Polyporus), Baizhu (Atractylodes), Fangji (Stephania), Cheqianzi (Plantain), Yiyiren (Coix), Hulu (Bottle gourd), Cangzhu (Atractylodes lancea), and Laifuzi (Raphanus seed)—can play a role in relieving acute symptoms such as chest oppression and cough-asthma. Modern pharmacology finds that these diuretics reduce arteriovenous resistance, improve venous return, and lower pulmonary artery pressure, so that edema, cough, wheezing, and chest oppression are relieved. During acute attacks, combining TCM spleen-strengthening herbs with Western diuretics works faster.
But fortifying the spleen easily taxes the kidney, and excessive water-draining damages healthy qi. Too many diuretics, Chinese or Western, exhaust the patient's zheng qi, causing fatigue and listlessness. While fortifying the spleen and draining water, TCM therefore also supplements the patient's kidney essence. Those with kidney-yin deficiency use Liuwei Dihuang Wan and Erzhi Wan to nourish kidney yin; those with yang deficiency use Guifu Dihuang Wan or Jinkui Shenqi Wan to warm kidney yang. Kidney-yin deficiency tends to present with deficiency-fire flaring upward, vexation, insomnia, and dry mouth; kidney-yang deficiency with aversion to cold, cold limbs, no desire to drink, clear long urine, and a water-slippery tongue coating.
For pulmonary edema patients, moderately using lung-dispersing, asthma-calming herbs such as Zhima Huang (Honey-fried Ephedra), Zisu (Perilla), Sangbaipi (Morus bark), and Xingren (Apricot kernel) yields twice the result. Some patients still have an exterior pattern, such as fever and aversion to cold, in which case exterior-releasing herbs such as Guizhi (Cinnamon twig), Mahuang (Ephedra), Xiangru (Mosla), Lianqiao (Forsythia), and Bohe (Mint) should be added. When using lung-dispersing, asthma-calming herbs, the doses of Mahuang and Xiangru should be slightly larger and they should be decocted longer. If sputum is copious and cough prominent, add cough-stopping and phlegm-resolving herbs such as Chenpi (Tangerine peel), Zhuru (Bamboo shavings), Banxia (Pinellia), Ziwan (Aster), Kuandonghua (Tussilago), Jiegeng (Platycodon), Beimu (Fritillaria), and Gancao (Licorice).
Chronic patients have long courses and the maxims that prolonged illness leads to deficiency and prolonged illness leads to stasis apply. Treating pulmonary edema therefore also requires judging, from clinical signs, whether deficiency and blood stasis are present. If zheng qi is weak, add Dangshen (Codonopsis), Renshen (Ginseng), Xiyangshen (American ginseng), Maidong (Ophiopogon), Wuweizi (Schisandra), Tusizi (Cuscuta), Shayuanzi (Astragali complanati semen), Mohanlian (Eclipta), Nüzhenzi (Ligustrum), and Gouqizi (Lycium) as appropriate. If blood stasis is present (usually shown by dark lips and tongue), add Danshen (Salvia), Chishao (Red peony), and Chuanxiong (Ligusticum) to improve microcirculation.
After the acute episode, patients must protect their health: quit smoking and alcohol, guard against wind-cold, exercise regularly, keep regular hours, and avoid staying up late. Pulmonary edema patients usually have underlying disease and easily relapse when immunity drops, triggered by respiratory or gastrointestinal infections.
To strengthen immunity, after acute symptoms subside the physician may use Guipi Wan, Jiuzhuan Huangjing Gao, or Shengmai Yin for a period of follow-up care. And, according to local climate changes, give preventive immune-boosting treatment ahead of each seasonal transition.