病 案
TCM Case:Chronic Edema
Mr Gao，male，58 years old.1st consultation 14th May
Main complaint:Lower limbs edema and feet numbness for over half a year.
Medical History:The patient suffered from lower limbs edema and feet numbness for over half a year which worsened when standing for long period of time.He was diagnosed with weakness of the kidney and was hospitalized without any curative effect.On May 9th，he was hospitalized again due to a relapse of lower limbs edema.He was treated by predisone1),albumin2) and so on.He was discharged after the symptoms resolved.However，the edema occurred again 5 days later and he came for treatment.The patient had a history of dilated cardiopathy and cardiac function grade3.He took digoxin3) and cordarone4) daily.
Presenting symptoms:Mental fatigue,general edema especially in the lower limbs，feet numbness，burning heat sensation in the left sole，dry mouth，scanty and clear urine，a pale dark tongue with teeth marks with a white tongue coating and a deep and thin pulse.
Physical Examination:Pitting edema in the waist and back(+)and in the lower limbs below the knees，dilated heart edge to the left，regular heart beat at 64 bpm.Urine routine test:PRO(++++)，UPQ 7.9 g/24h.blood biochemical test:TP 32g/L，ALB 20g/L，BUN 9.2 mmol/L，Cr 161μmol/L
Pattern Differentiation
In Chinese Medicine,Nephrotic syndromes pertaining to edema have a close relationship with the spleen，kidney，lung and Triple Energizer.The spleen is the earth organ and the foundation of acquired constitution，while the kidney governs the Mìng Mén fire and is the foundation of congenital constitution.The transformation and transportation functions of the spleen depend on the warmth of kidney yang and in turn，the kidney essence lies on the constant replenishment of food essence transformed and transported by the spleen.Thus，these two organs supplement and promote each other.If the spleen yang is insufficient with weak functions of transformation and transportation then the food essence production will fall short and inevitably lead to kidney essence insufficiency and failure of the spleen to control water manifesting in general edema especially worse in the lower limbs.Feet numbness and burning sensation in the left sole are signs of obstruction due to stasis.The symptoms of dry mouth，a pale dark tongue with teeth marks and a white tongue coating and the deep and thin pulse are signs of obstruction impairing the passage of the body fluid.In this case，the disease location is in the spleen and kidney with a root deficiency and branch excess.
Diagnosis
TCM Diagnosis:Edema due to spleen and kidney deficiency with stasis impairing the body fluid passage
Western Medicine Diagnosis:Nephrotic edema
Treatment(https://www.daowen.com)
In this case,the pathomechanism mainly lies in dampenss retention due to spleen deficiency causing the stasis obstruction impairing the body fluid passage.As a result，it manifests as general edema especially severe in the lower limbs，feet numbness and burning sensation on the left sole.
Principles:
·Fortify the spleen to promote urination
·Warm qi to drain dampness
·Dispel stasis and nourish yin
Formula:Modified Sì Jūn Zǐ Tāng( Four Gentlemen Decoction)combined with Zhū Líng Tāng(Polyporus Decoction)and Shēng Mài Sǎn(Pulse-Engendering Powder)
注释：
1）predisone泼尼松（肾上腺皮质激素）
2）albumin 白蛋白，清蛋白
3）digoxin 地高辛
4）cordarone 胺碘酮