Hey there David (or other teachers), so I'm curious if you have any insights into differentiating the root causes of edema. I know it can sometimes be associated with declining kidney or heart function, or possibly can be liver (western) related. Aside from getting bloodwork and a MD assessment done to assess organ function, do you have any recommendations on how this could be differentiated by me? It's tough cause all my clients are distance so I can't do the physical assessments like I used to when I'd see people in person. Also based on what I recently learned in the TCM classes, it seems like as chi holds blood in the vessels, would chi deficiency be a part of this, even though I guess it'd technically be fluids leaking not necessarily blood? Just curious your thoughts on that. Thank you kindly Sajah

To add on real quick, I guess my main purpose for the question is to me giving diuretics and such to drain the fluids, while helping the symptom doesn't really seem to get to the root which I obviously want to make sure is addressed. Thanks.

First where is the edema ? Feet or lower legs often is circulatory , this could be of cardiac or vascular (endothelial dysfunction, atherosclerosis, Buerger’s disease, intermittent claudication) origin. Feeling pulses in the ankles (not that you can do that on-line) tells you if they have adequate peripheral circulation. If not consider Gotu Kola, Ginger, Butchers Broom, Cinnamon, Hong Hua, Rosemary, etc. Abdominal edema is more likely due to lfulminent liver disease, although this can cause edema of the legs as well. Here is an overview of causes of edema Causes Edema occurs when tiny blood vessels in the body, also known as capillaries, leak fluid. The fluid builds up in nearby tissues. The leak leads to swelling. Causes of mild cases of edema include: Sitting or staying in one position for too long. Eating too much salty food. Being premenstrual. Being pregnant. Edema also can be a side effect of some medicines. These include: High blood pressure medicines. Nonsteroidal anti-inflammatory medicines. Steroid medicines. Estrogens. Certain diabetes medicines called thiazolidinediones. Medicines use to treat nerve pain. Sometimes edema can be a sign of a more serious condition. Illnesses that can cause edema include: Congestive heart failure. Congestive heart failure causes one or both of the heart's lower chambers stop pumping blood well. As a result, blood can back up in the legs, ankles and feet, causing edema. With cardiac issues look for creases in the ear lobes, elevated AST, LDH, Troponin, Congestive heart failure can also cause swelling in the stomach area. This condition also can cause fluid to build up in the lungs. Known as pulmonary edema, this can lead to shortness of breath. Liver damage. This liver damage from cirrhosis can cause fluid to build up in the stomach area. and in the legs. This fluid buildup in the stomach area is known as ascites.with liver disease look for yellow sclera’s , yellow palms or soles of feet, elevated AST, ALT, GGT, All Phos, total globulin Kidney disease. Kidney disease can cause fluid and salts in the blood to build up. Edema linked to kidney disease usually occurs in the legs and around the eyes. Kidney damage. Damage to the tiny, filtering blood vessels in the kidneys can result in nephrotic syndrome. In nephrotic syndrome, decreased levels of protein in the blood can lead to edema. With Kidney damage or disease look for elevated eGFR, creatinine, Uric acid, LDH, AST, BUN, Phosphorus, in TCM tongue diagnosis look for a puffy, red tongue with a deep central vertical crease with horizontal cracks radiating from the central crack Deep vein thrombosis, also called DVT. Sudden swelling in one leg with pain in the calf muscle can be due to a blood clot in one of the leg veins. DVT requires medical help right away. Problems with the system in the body that clears extra fluid from tissues. If the body’s lymphatic system is damaged, such as by breast cancer surgery, the lymphatic system might not drain well. I use a combination of Self Heal, Cleavers and Figwort for treating post-surgical lymphedema Severe, long-term lack of protein. An extreme lack of protein in the diet over time can lead to edema. You see this in starvation, extreme vegan diets (over decades) and alcoholism/drug addiction Risk factors The following increases the risk of edema: Being pregnant. Taking certain medicines. Having a long-lasting illness, such as congestive heart failure or liver or kidney disease. Having surgery that involves a lymph node. Complications If left untreated, edema can cause: Swelling that gets more and more painful. Problems walking. Stiffness. Stretched skin, which can itch. Increased risk of infection in the swollen area. Scarring between layers of tissue. Less blood flow. Less ability of the of arteries, veins, joints and muscles to stretch. Increased risk of skin ulcers

Thank you for this... very thorough response I appreciate it. I forgot to note where it's located... ankles and feet predominantly. Some minor varicosities in the lower legs/backs of knees as well. She just got some bloodwork done from her primary care doc which I will have in hand soon. She said she'd gotten hepatitis when she was in her early 20's (in her mid 70's now) and has a pretty sallow complexion, also has clear liver line on the face between eyes (from what I've learned from Margi), along with pretty chronic constipation, so my sense has been perhaps with the liver. But doesn't seem to have ascites. For the interim I gave her a relatively simple circulatory stimulant, diuretic, astringent formula for some symptomatic relief till we can dig deeper into root. Anyways thanks again good sir!

Hey David, just thought I'd follow up here again as I got the bloodwork back, which is certainly confirming what to me appear to be a pretty severe liver situation. Bilirubin is at 2.5, Alk Phos at 165, AST 128, and ALT 49. Lipid panel WNL. Platelet count is pretty low too, at 84. With the AST:ALT ratio being well over 2:1, it seems like she might have a relatively high degree of liver damage, yes? Never had a client with levels like before. Any additional thoughts or insights you might share are most welcome. Thanks again David.

If I am reading your post accurately, your patient most likely does have some type of liver issue, but not necessarily a severe one. With severe liver disease the ALT is usually 10-15 times above normal , the Alk Phos would also be higher. AST can be liver related but also pancreas, heart, muscle, etc. while all of these are elevated most are slightly or moderately elevated. Possibly suggesting fatty liver (NAFLD). I am concerned about the platelet count, is it really 84 ? Or 84,000 (still very low). Severe liver disease (not indicated by their liver enzymes) can cause very low platelets. So this is a bit confusing and worrisome . Are they bleeding easily ? Thrombocytopenia can also be caused by autoimmune disease, cancer, hepatitis, alcohol abuse, etc. Is this person seeing a physician, they need more testing and a diagnosis. Once it is clear what is happening, herbs, diet, etc may or may not be very useful. This is a situation where as herbalists we need to refer to someone who has better tools and training in diagnosis.

Don’t buy into the “liver lines” being an accurate indicator of liver dysfunction, it is inaccurate more than not. Look at liver enzymes (GGP, ALT, AST, Alk Phos), and if severe enough for anasarca you would usually see yellow scleras , palms or soles of the foot. Constipation can have a liver/GB component but can also be due to hypochlorhydria (common in 70 yo people), gut dysbyosis, magnesium deficiency, etc . The fact that someone had hepatitis 50 years ago if Hep A has little bearing on current hepatic function.