Annotated Thirteen Edema Formulas from the Waitai Miyao

The twenty-six "water disease" sections of the Waitai Miyao (Arcane Essentials from the Imperial Library) specifically collect thirteen formulas for treating edema. All thirteen promote diuresis and reduce swelling, and remain of reference value today; they are transcribed below.

Fan Wang's Edema Formula

Tinglizi (Semen Descurainiae) 1 liang (fried black), Gansui (Radix Kansui) 1 liang (fried), Wuzhuyu (Fructus Evodiae) 4 liang.

Pound the three separately and sift; combine with honey into pills the size of a parasol tree seed; take up to five pills. The Jingxin Lu says take three pills, three times daily.

Annotation: This formula uses Tinglizi and Gansui, 1 liang each (both must be fried); both are key diuretic herbs. Gansui is toxic and is now mostly processed or omitted, but it has good diuretic and swelling-reducing effect and is a drastic water-purgative. These two are commonly used in treating various edemas. This formula heavily uses Wuzhuyu; Wuzhuyu itself is not a diuretic, but it strongly warms the middle and downbears qi. Wuzhuyu is heavily pungent and hot, able to scatter and move; edema patients have obstructed triple burner, and driven by Wuzhuyu the triple burner function recovers and water is easily eliminated. Such medication embodies the strength of TCM. Here "parasol seed" means the seed of Firmiana simplex, about the size of a pea. Take 3-5 pills each time, up to three times daily.

Another Tinglizi Pill, Edema Formula.

Tinglizi 1 sheng (fried), Wuzhuyu 1 sheng.

Pound and sift the two separately, combine with honey, and pound 20,000 times until the pill is formed; take two parasol-seed-sized pills with water. If no effect, increase, aiming for convenient urination and bowel movement. If it causes purgation, take only one dose in the early morning. If no purgation but urination becomes convenient, take two or three times daily. Keep taking until the swelling subsides. Also called Er Li Pill.

Annotation: Compared with the above, this omits Gansui. In fact, omitting Gansui makes the medication safer. The parasol seed is again Firmiana seed; both above formulas are made into pills, and the dose per take is actually small, so it is safe. Here two pills are to be taken with water; if effect is not obvious, gradually increase until bowel and bladder are freely open. Wuzhuyu irritates the stomach and intestines and may cause diarrhea. If the patient has diarrhea after taking it, take only once in the morning. If no diarrhea but urine flows freely, take two to three times daily. Continue until the edema subsides. This formula is called both Tinglizi Pill and Er Li Pill; "Er Li" means convenient urination and defecation.

Another: Urine-promoting, swelling-reducing, Yulihe (Yuliren) Pill Formula.

Yuliren (Semen Pruni) 3 fen, Songluo (Usnea) 3 fen, Haizao (Sargassum) 2 fen, Guixin (Cinnamomi cortex) 2 fen, Dahuang (Rhubarb) 5 fen, Tinglizi 5 fen (fried), Huanglian (Coptis) 2 fen, Tongcao (Tetrapanax medulla) 2 fen, Shiwei (Pyrrosia, hair removed) 1 fen.

Pound and sift the nine herbs; combine with honey into parasol-seed pills. Take seven pills with water before meals, twice daily; gradually increase until effective.

Annotation: This formula uses both bowel-opening Yuliren and Dahuang, and urine-promoting Haizao, Guixin, Tinglizi, Tongcao and Shiwei, plus heat-clearing toxin-resolving Huanglian and toxin-resolving hemostatic Songluo; its composition is comprehensive. Judging by the actions of its herbs, like the Er Li Pill above it reduces swelling by promoting both bowel and bladder. Shiwei and Songluo both stop bleeding, so this formula suits edema patients with a bleeding tendency. It is also made into parasol-seed pills; take seven pills with water before meals, twice daily. If bowel and bladder are not free, the dose may be gradually increased.

Another Edema Formula, Da Binglang Pill.

Binglang (Areca) 3 liang, Guixin 3 liang, Pao Fuzi (processed Aconitum) 2 liang, Gualou (Trichosanthes) 3 liang, Xingren (Apricot kernel) 3 liang (fried), Ganjiang (Dried ginger) 2 liang, Zhigancao 2 liang, Mahuang (Ephedra, nodes removed) 3 liang, Huangqi (Astragalus) 3 liang, Fulin (Poria) 3 liang, Houpo (Magnolia bark) 2 liang, Tinglizi 3 liang (fried), Jiaomu (Zanthoxylum seed) 3 liang, Wuzhuyu 5 ge, Baizhu (Atractylodes) 3 liang, Fangji (Stephania) 2 liang.

Sift the sixteen herbs; combine with honey into two parasol-seed-sized pills, twice daily. If no effect, gradually increase to four; if still no effect, add two more pills; if no bowel movement, take four; mild purgation is the sign of effect. This treats edema and virtual obesity in the old and young, and retained swelling causing asthma after serious illness; it is excellent. Avoid Haizao, Songcai, pork, cold water, raw scallion, peach and plum, and rich soured foods.

Annotation: This formula was considered a large formula in the Tang and before. Judging by its composition, it treats edema due to spleen-kidney yang deficiency with internal retention of water-dampness. It uses Pao Fuzi, Guixin, Ganjiang, Wuzhuyu, Mahuang and Chuanjiaomu to warm yang and scatter cold, then Fulin, Fangji, Baizhu, Huangqi and Tinglizi to fortify the spleen and promote diuresis, plus Binglang, Xingren, Gualou and Houpo to downbear qi and dissipate distension; Zhigancao harmonizes the herbs. Together they achieve warming yang and scattering cold, fortifying the spleen and promoting diuresis, and moving qi and reducing distension. This formula has good efficacy for edema due to yang deficiency with water flooding.

The Xiaopin Edema Formula

Dadou (Soybean) 3 sheng.

Boil the single herb in 6 sheng of water until cooked; strain out the beans and let the juice settle; add 5 sheng of fine wine and simmer over low heat until like maltose; take 1 sheng, gradually increasing, aiming for mild purgation.

Annotation: This uses only 3 sheng of soybeans; soybean both diureses and is rich in protein. Soybean decoction boiled with rice wine has good diuretic and swelling-reducing effect. This is somewhat like modern albumin infusion to maintain nutrition and osmotic pressure, and can serve as dietary therapy for edema. But if the edema is due to cancer, soy milk should be drunk directly rather than boiled with wine.

Another Taopi Wine, Edema Formula.

Taopi (Peach bark) 3 jin (scrape off the outer black bark, take the inner yellow bark), Nüqu (yeast) 1 sheng, Shumi (glutinous millet) 1 sheng.

Boil the peach bark in 3 dou of water to yield 1 dou; steep the yeast in 5 sheng of the decoction and steam the grain in the other 5 sheng; ferment as for wine. When ripe, strain off the dregs; take 1 ge, three times daily. Those who tolerate wine may increase, marked by heat in the body; abundant urine means the disease is leaving and the patient recovers. Avoid raw cold, wine and wheat, and all poisonous foods.

Annotation: This is a Tang medicinal wine, made by boiling peach bark (the outermost black bark removed, leaving only the yellow inner bark), then fermenting the decoction with yeast and steamed millet. This is hard to prepare today and impractical to apply.

Another Shexiang Powder, Edema Formula.

The Qianjin (Sun Simiao's Qianjin Fang) says: treats women with shortness of breath and emaciation, generalized edema, tight loose skin.

Shexiang (Moschus) 3 zhu, Yuanhua (Genkwa) 3 fen (fried), Gansui 3 fen.

Combine and sift the three; take half a coin-spoonful with wine; for the old and frail, one-third of a coin-spoon. May also be pillowed: strong adults take ten small-bean-sized pills, the old take five. The Qianjin also adds Xionghuang (Realgar), using 6 zhu of both Shexiang and Xionghuang; the Zhouhou (Zhouhou Beiji Fang) also adds Renshen 2 fen.

Annotation: This is a derivative of Zhang Zhongjing's Shizao Decoction. Yuanhua and Gansui are highly toxic but also drastic water-purgatives, strong diuretics in Chinese medicine; a little Shexiang adds blood-activating channel-unblocking. This formula mainly treats edema in women with shortness of breath and weakness and generalized swelling; such edema is somewhat similar to ascites and pelvic effusion in late gynecological tumors. But it must be used very carefully for safety. This formula has some anti-tumor action.

Another Edema Formula, Shanglu Ointment.

Shanglu (Phytolacca) root 1 jin, Pig fat (lard) 1 jin (render first, yielding about 2 sheng). Fry the two together until yellow; strain; rub the ointment on the swelling. May also take a little. Avoid dog meat. The Qianjin says: apply and cover with paper; reapply when dry; it is cured within three days.

Annotation: This is an external edema formula: Shanglu root and lard are boiled together until the root turns yellow, strained, and the resulting ointment solidifies on cooling into a fat-like salve. Repeatedly applying this salve, or taking a little, treats edema. The book does not record details, so we do not know where to apply it—perhaps on the edematous skin, or on the navel. This is a transdermal delivery method; Shanglu root here has a strong diuretic action.

The Jiyan Edema Formula

Urine of a yellow bull; drink 3 sheng at once; if no sensation, add more until purgation. For the old and young, start small, drinking half. The following formula may also be used.

Annotation: This uses yellow bull urine to treat edema; it is not practicable today.

Another Edema Formula.

One pig kidney, divided into seven slices; Gansui 1 fen, ground and sifted into a powder, dusted onto the kidney. Roast gently until cooked and eat; take up to three or four slices then stop. You should feel gurgling in the abdomen, moving to below both ribs, and convenient urination; when water is expelled you recover. If three or four slices produce no sensation, eat all seven.

Annotation: This uses pig kidney, following the TCM tradition of "flesh replenishing flesh," because TCM holds that edema is mostly due to kidney deficiency. A pig kidney is cut into seven pieces; Gansui 1 fen is ground fine and dusted on like pepper, then the kidney is roasted like kebab and eaten—a dietary therapy. A Tang "fen" equals about 0.3-0.5 g today; although Gansui is toxic, such a microdose is still safe.

The Qianjin Yi Edema Formula

Tinglizi 6 liang (raw), Guixin 2 liang.

Pound the two, combine with honey into pills; take ten parasol-seed pills with water, twice daily. Avoid garlic, wheat, pork, chicken and greasy foods.

Annotation: This uses Tinglizi and Rougui in a 3:1 ratio, made into parasol-seed pills; take ten pills each time, twice daily. Both Tinglizi and Rougui diurese and reduce swelling; the formula is simple and also reduces swelling by diuresis.

The Bixiao Edema Formula

Zaojia (Gleditsia) one stick (peeled, roasted), Wuxi 5 liang.

Boil the two in 2 sheng of wine for six boils; wring out the dregs and take all at once; soon urinate 2-3 sheng and the swelling subsides. Avoid all meat, wheat, raw cold, salty and soured foods for one year.

Annotation: It is not known which herb Wuxi is in this formula.

Another Formula

Take one bitter hu (bottle gourd).

Boil the single herb in 1 shi of water for the time it takes to cook a meal; strain, decoct the juice down to make hu-bean-sized pills; take two pills, and urination should follow; afterward eat small-bean congee. Be careful not to drink water; effective.

Annotation: Hu is the bottle gourd, also called hizi, the gourd we commonly know. The bottle gourd has a strong diuretic action and is sold in vegetable markets; eating it directly also diureses strongly. I often have patients with ascites, pleural effusion or difficult urination use hizi and winter melon as dietary therapy. The bitter hu is not the edible hizi of daily use but an ancient gourd used for dippers or wine flasks; because it is bitter it is not edible. Here the bitter hu is boiled, removed, and the juice concentrated into broad-bean-sized pills; take two pills, again aiming for increased urination.

These thirteen formulas are actually diuretics discovered by the ancients in practical life; edema can be treated by diuresis. But if the edema is caused by cancer or cirrhosis, besides using these diuretic methods to relieve the condition, one must also simultaneously take drugs that suppress tumor progression or treat the cirrhosis, so that both branch and root are addressed.