Edema in Pregnancy in Chinese Medicine

In Chinese medicine, edema in pregnancy was given different names according to its location

Zi zhong, meaning ‘edema of pregnancy’, indicated edema of the face and whole body together with scanty urination.
Zi man, meaning ‘fullness of pregnancy’, indicated swelling of the body with abdominal distention and breathlessness.
Zi qi, meaning ‘Qi of pregnancy’, referred to edema below the knees, with scanty urination, and was caused by Dampness.
Zhou jiao, meaning ‘wrinkled foot’, indicated edema of the feet from Dampness.
Cui jiao, meaning ‘brittle foot’, referred to edema of the feet from overflowing of Water.

Etiology

Irregular diet: Excessive consumption of greasy and dairy foods injures the Spleen-Yang. Deficient Spleen-Yang fails to transform and transport fluids which accumulate under the skin in the form of edema.
Excessive physical work, exercise or lifting: Excessive physical work and especially lifting may weaken Kidney-Yang. Deficient Kidney-Yang fails to transform and excrete fluids which may accumulate under the skin and cause edema.
Emotional stress: Worry, anger, frustration and resentment may all lead to stagnation of Qi. Stagnant Qi fails to transform and transport Water which may accumulate in the form of edema. This pathological process is aggravated after the fifth month of pregnancy when the fetus grows rapidly and it obstructs Qi.

Pathology

The pathology of edema of pregnancy can be differentiated into two basic types, one from deficiency, the other from excess; the former deficiency of Spleen- and/or Kidney-Yang and the latter stagnation of Qi. The edema from Spleen- or Kidney- Yang deficiency is characterized by the accumulation of Water under the skin, while that from stagnation of Qi is characterized by the accumulation of Dampness under the skin. The main diagnostic difference is that in the former case there is pitting of the skin on pressure, while in the latter there is not.

Identification of patterns and treatment

The main treatment principle is to tonify Spleen- and Kidney-Yang or move Qi and eliminate stagnation to treat the Root; to treat the Manifestation one needs to promote the transformation and excretion of fluids with diuretic herbs. Particular care should be taken with herbs that transform fluids in pregnancy: these should be used in small doses. In most cases, it might be advisable to include Kidney tonics that calm the fetus (such as Xu Duan Radix Dipsaci or Tu Si Zi Semen Cuscutae) to counterbalance the downward-draining effect of diuretic herbs.

Spleen-Yang deficiency

Clinical manifestations: Edema early in the pregnancy, swelling of face or whole body, yellowish and shiny skin, a feeling of oppression of the chest, breathlessness, tiredness, loose stools, cold limbs.
Tongue: Pale, wet.
Pulse: Weak.
Treatment principle: Strengthen the Spleen, tonify Yang, resolve edema.

Kidney-Yang deficiency

Clinical manifestations: Edema early in the pregnancy, worse in the ankles, breathlessness, cold legs, backache.
Tongue: Pale and wet.
Pulse: Weak, Deep.
Treatment principle: Strengthen the Kidneys, tonify Yang, resolve dema.

Stagnation of Qi

Clinical manifestations: Edema beginning towards the fourth month of pregnancy, first in the feet, no pitting, abdominal distension, irritability.
Tongue: slightly Red on the sides.
Pulse: Wiry.
Treatment principle: Move Qi and eliminate stagnation.

Prognosis and prevention

Edema during pregnancy can be alleviated but it cannot be resolved completely, because the longer the pregnancy goes on, the weaker the Kidneys will become and therefore the more fluids will be retained. Also, the longer the pregnancy goes on, the greater the tendency for fluids to accumulate due to the sheer weight of the baby in the abdomen. The pregnant woman should be advised to rest, avoid lifting heavy objects, eat a regular, balanced diet, avoid greasy and dairy foods, and control her emotions to prevent or relieve edema during pregnancy.