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It’s edema that has “exterior” qualities.

• It starts from the eyelids to the legs and then the whole body.
• Happens quickly.
• With exterior manifestations i.e. 恶寒发热.

Diagnostics: Deficient or Replete

You check this from asking about whether they perspire easily.

• No perspiration means that the exterior is replete, usually a sign of a replete constitution that needs help with perspiration from 麻黄. Add 姜、枣、草 and it’s one herb away from 越婢汤
  • Only if you see signs of internal heat, add 石膏 - 石膏 is best at 清泻气分实热. By adding 石膏, you now have 越婢汤.
    • Adding 白术 (or is it 苍术?) will help the edema via its 渗湿 function. You now have 越婢加术汤.
  • The other consideration is 溢饮 a 表实-type 风水相搏证. Here, you don’t just have exterior qualities. There’ll also be 内饮. 溢饮 can otherwise be called 小青龙汤证
    • 小青龙汤 is the representative formula for表实外寒内(寒)饮证.
    • Consider 大青龙汤 (which again uses the strong spreading quality of 麻、桂) but now includes 石膏 because 小青龙汤之内饮 has 郁而化热 - see below content on hot/cold diagnosis.)
• Perspiration mean that the exterior is deficient, usually a sign of a deficient constitution that cannot withstand the dispersive action of 麻黄.
  • 防己黄芪汤 is used instead. Instead of using perspiration, it builds wei qi while encouraging urination. 黄芪 does both. 汉防己 also can 利尿. Add 白术 and 甘草 and it’s done.

Diagnostics: Hot or Cold

We have to decide whether the nature of the pathogen is hot or cold (风热 or 风寒). If it’s hot, you’ll get 发热 > 恶寒, perhaps even a swollen sore throat. If it’s cold, then you’ll get 恶寒 > 发热, perhaps even deficient-type 喘咳.

• For wind-cold: Milder herbs are used, like 桂枝，苏叶，防风
• For wind-heat: herbs from 银翘散 are used, e.g. 连翘，桔梗，板蓝根，鲜芦根
  • Do not forget 麻黄连翘赤小豆汤 from 《伤寒论》which deals with 郁热在里-type 风水在表 edema. note its similarity in terms of 证 to 大青龙汤 which has 内饮郁而化热. It’s got:
    • 麻、杏 (宣降)
    • 连翘 (清热)
    • 桑白皮 (泻肺热、利尿)
    • 赤小豆 (利尿) - used less clinically these days, but we can always use other diuretic herbs.