I have a 62 year old female patient with Sp, Lu and Ki Qi Deficiency accompanied by Phlegm/Damp Accumulation. She has been suffering from severe edema of the pannus for over 1 year. At times, it has become infected, causing cellulitis. Currently it is just severly edematous (pitting edema), heavy and uncomfortable. She will only take patent herbs and Jin Gui Shen Qi Wan was the most help. While it diminished the edema greatly, it did not resolve it. Unfortunately, we had to stop this formula due to her development of palpitations while taking it. In the course of trying several different patents I have noticed increased edema with the administration of any Sp Qi tonic. I am curious to others' thoughts on why this would occur. I am also hoping for thoughts on another patent that could be helpful for her. We have tried Wu Ling San, Xiang Sha Liu Jun Wan, Wu Pi San, Wei Ling Tang and Fang Ji Huang Qi Wan. Her pulses are generally deep, weak and slippery. Tongue is pale purple with thin white coat, puffy and scalloped. Diet and exercise are also being addressed. Thank you for your thoughts!
How much jin gui shen qi wan was she taking and for how long before she developed palpitations? When you say it was "the most help" - how much help in very exact terms was it and for how long was it helpful - i.e. did the symptoms come right back after removing it?
How quickly did she start showing signs of edema with the other spleen tonics? - within a week, a couple doses? For the spleen tonics, the way I would think about it is that all that water has to go somewhere it may just simply overload the system - which is why I'm curious how quickly you saw more retention.... Any other digestive problems? What are all her other related symptoms that you used to come up with the diagnosis besides the tongue?
Another thing to keep in mind is the patient's weight. Is she over weight? It is very common in Chinese medicine for overweight people to have very deep pulses, which are often interpretted also as weak. This is often erroneously thought to be deficiency. It often is not (often the pulse has sort of a dead, gelatinous feel to it; this indicates blood stasis and damp retention, not necessarily deficiency). When people are overweight, the arteries get compressed (by as much as an additional 50% per 10 pounds). This causes systemic blood stasis and highly taxes the heart. If this is the case with your patient, the patient likely needs blood movers with only a portion of the formula for damp clearing. Often, blood movers are more effective at eliminating dampness than damp resolving herbs alone. Your thoughts on using Fang Ji Huang Qi Tang may be very good (as this resolves damp and strengthens the heart), but the patient may very well need 80% of the formula to be blood moving (Xue Fu Zhu Yu Tang, Shao Fu Zhu Yu Tang, Ge Xia Zhu Yu Tang, etc. or Evergreen's Circulation SJ which contains all 3 of those formulas).
Also, if the patient is overweight, it is very important to address that with diet. Keep in mind also that most people at that age are already diabetic or prediabetic and most of some form of insulin resistance and/or reactive hypoglycemia. This means the patient MUST cut down the carbs/sugar (that includes rice!)
But more information is definitely needed. Hope that helps.
In answer to your questions... The patient has the following Western Dx: obesity, DM II, hypertension, asthma, lymphedema and arthritis. She was taking 8 pills, 3 times a day of the Min Shan patent Jin Gui Shen Qi Wan and this reduced her abdominal edema greatly. After stopping it, within 1 week there was a mild to moderate increase in edema. After 1-2 days of any spleen tonic she would report a major increase in edema. She does not report digestive issues other than burping with certain foods. She does overeat and dines out frequently and is aware of the need to decrease sodium in her diet. She does pretty good with carbs (per her report) and her fasting blood sugars run in the 140s. The support for my diagnosis is as follows:
Sp Qi Deficiency: obesity, weak and soft muscles, bleeds and bruises easily, fatigue
Ki Qi Deficiency: frequent urination, occasional incontinence, weak/painful low back and knees, asthma, water retention, nocturia (about 3-4 times/night), fatigue, age
Lu Qi Deficiency: asthma, sensitivity to smells, hx frequent colds/bronchitis, shortness of breath with activity
Thanks again for all your input. It has been extremely valuable!