For symptoms of water retention with cold extremities, Pu Hui San is the primary treatment.
Pu Hui San
Calamus (Pu Huai) 7 parts, Talcum (Hua Shi) 3 parts
Grind the above two ingredients into a powder, and take a dose of one thumb-sized spoon three times a day.
In cases of water retention, the patient experiences generalized swelling, difficulty urinating, a deep pulse, and coldness in the extremities. This condition is caused by an excess of dampness and stagnation of yang. Symptoms may also include a lack of aversion to wind and cold, short or yellowish urine, and a yellow greasy tongue coating. Pu Hui San clears damp-heat and promotes urination. In the formula, Talcum clears heat and promotes water metabolism; Calamus, when roasted to a blackened state, invigorates blood circulation, dispels stasis, and reduces swelling.
Patients with water retention often present with cold hands and feet. This is due to the accumulation of dampness and heat obstructing the yang qi, preventing it from reaching the extremities, which is different from the coldness in the extremities caused by yang deficiency and internal cold.
Clinically, this formula can be modified to treat chronic nephritis, nephrotic syndrome, and water retention due to menstrual disorders in women. For treating water retention in women with menstrual disorders, additional herbs such as Poria (Fu Ling), Achyranthes (Niu Xi), Motherwort (Yi Mu Cao), and others can be added.
Dr. Cao Yingfu reported a case where the external application of roasted calamus ash on the body resulted in the resolution of edema. When using Pu Hui San externally to dispel water, it is primarily for patients who cannot take decoctions. This Pu Hui San is made from roasted calamus ash, which differs from the above formula.
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