Safety and Clinical Course of Oryeongsan-Based Korean Medicine Combination Treatment in a Post-Stroke Patient with Unilateral Edema and Comorbid Chronic Kidney Disease: A Case Report

Background: Post-stroke unilateral limb edema is common but difficult to manage in patients with chronic kidney disease (CKD), in whom conventional diuretics may compromise renal function. Evidence regarding Korean medicine interventions in this population remains limited. This case report describes the clinical course and safety of Oryeongsan-based Korean medicine combination treatment in a post-stroke patient with unilateral edema and comorbid CKD.Case Presentation: A 71-year-old man with CKD stage G3a-G3b (baseline estimated glomerular filtration rate [eGFR], 42.9 mL/min/1.73 m²) was admitted 207 days after right middle cerebral artery infarction with left-sided hemiparetic pitting edema. Based on pattern identification of spleen-kidney yang deficiency with water-dampness retention, 38 days of combination treatment were administered, including Oryeong-san, Saam acupuncture (Bi-jeong-gyeok and Shin-jeong-gyeok) with EX-UE9/EX-LE10 electroacupuncture, moxibustion, electrical stimulation therapy, and temporomandibular joint balancing therapy. Renal function was monitored at six time points.Results: The sum of bilateral limb circumference differences decreased from +9.0 cm to +5.4 cm (minimum, +1.1 cm on day 10). The Numerical Rating Scale score for edema improved from 8 to 3, and pitting edema became negative from day 25 onward. Renal function remained stable: eGFR increased from 42.9 to 49.1 mL/min/1.73 m², and serum creatinine decreased from 1.69 to 1.51 mg/dL, with blood urea nitrogen and electrolyte levels within the reference ranges. No adverse events were observed. Functional outcomes, including the Korean version of the Modified Barthel Index (83) and the modified Rankin Scale (3), were maintained.Conclusion: Oryeongsan-based Korean medicine combination treatment may improve post-stroke unilateral edema while preserving renal function in patients with comorbid CKD, suggesting a potentially safe option when conventional diuretics are contraindicated. Prospective observational studies are warranted.