Twenty patients with bilateral localized lower leg edema were treated with acupuncture alone followed by combination therapy with acupuncture and Kampo formulas. The effects of treatment were examined after the first acupuncture session. Lower limb circumference significantly decreased from 29.1 ± 6.8 cm to 28.1 ± 7.0 cm (mean ± SD) (p < 0.01). In addition, the area of ankle edema decreased from 22.6 ± 10.6 cm2 to 14.2 ± 7.2 cm2 (p < 0.05). Subcutaneous tissue thickness, as measured via ultrasound, significantly decreased at the lower limbs and ankles from 10.4 ± 3.8 mm to 7.8 ± 3.4 mm and 10.1 ± 2.9 mm to 8.2 ± 3.0 mm, respectively (p < 0.05). In contrast, there was no change in subcutaneous echogenicity observed in the lower limbs. Following acupuncture, patients underwent combination therapy with acupuncture and Kampo formulas. As a result, area of ankle edema significantly decreased from 24.1 ± 2.5 cm2 to 3.0 ± 2.1 cm2 (p < 0.01). Moreover, symptoms resolved with respect to edema and coldness (p < 0.05). However, no change was observed in laboratory parameters. This study highlights the efficacy of acupuncture in improving lower leg edema. In addition, combination therapy with acupuncture and Kampo formulas seemed to be effective in the treatment of leg edema.