How to treat edema?
Diagnostic points of edema:
Concurrent syndrome
Possible diagnosis
It is often generalized edema and develops slowly. Accompanied by hunger and chronic wasting diseases (such as malignant tumor, tuberculosis, severe anemia, etc.). ).
nutritional oedema
Female, mild or moderate edema, more than 7- 10 days before menstruation, subsides after menstrual cramps, often accompanied by irritability, insomnia, headache, laziness, fatigue and other symptoms.
premenstrual tension syndrome
It starts at ankles and lower limbs, and gets worse after fatigue. The edema spread upward and aggravated, and the jugular vein bulged. In severe cases, it can spread to the whole body or be accompanied by pleural effusion and peritoneal effusion.
cardiac failure
Early eyelid and facial edema are most obvious after getting up in the morning. It can develop into systemic edema, and its distribution has little to do with body position. Urine examination showed proteinuria and tubular urine.
Nephritis and renal insufficiency
It is common in the ankle and gradually spreads upward, and may be accompanied by ascites, but there is often no edema in the head, face and upper limbs. Spider nevus, jaundice and hepatosplenomegaly can be seen.
cirrhosis
After acupressure, the skin has no obvious depression, accompanied by sallow dryness, alopecia, slow response and moderate anemia.
Myxedema caused by thyroxine deficiency
Long-term use of corticosteroids, mild edema of lower limbs or face.
Aldosteronism, caused by endocrine disorders.
The local edema at one end of the limb is usually caused by poor local venous and lymphatic reflux or increased capillary permeability.
Embolic phlebitis, filariasis, local inflammation, trauma or allergy, etc.
Edema is a disease characterized by water retention in the body and skin overflow, which is manifested as head, face, eyelids, limbs, abdomen, back and even whole body edema.
Second, the historical evolution
1. Disease name and classification: This disease is called "water" in Neijing, and it can be divided into "Feng Shui", "Shi Shui" and "water gushing" according to different symptoms. Syndrome differentiation and treatment of wet disease in syndrome differentiation and treatment in syndrome differentiation and treatment in syndrome differentiation and treatment in syndrome differentiation and treatment in treatment, syndrome differentiation and treatment in treatment and treatment in treatment, which can be divided into five types: geomantic omen and skin. In Song Dynasty, edema was strictly used and divided into two categories: yin water and yang water. "Fang Jisheng's Edema Gate" said: "Yin water is a disease, the pulse is heavy and late, the color is more bluish and white, not annoying and not thirsty, the urine is less and clear, and the stool is more watery ... Yang water is a disease, the pulse is heavy and Huang Chi, or annoying or thirsty, the urine is red and astringent, and the stool is more closed."
2. Etiology and pathogenesis: Su Wenshui's Theory of Hot Blood points out: "The brave will work hard, and the kidneys will sweat. When encountering the wind, they can't enter the internal organs or go out to the skin. You can go to acupuncture points and walk in the skin, which will be a kind of swelling. " "Therefore, it is in the kidney, and its end is in the lung." On Su Wenzhizhen also pointed out that "all dampness and distension belong to the spleen". In the Ming Dynasty, Li Qian put forward the theory of the etiology of sores, toxin and edema in "Introduction to Medicine".
3. Treatment of swelling: Su Wen's theory of soup and fermented grains puts forward the treatment principle of "leveling and balancing, going to the garden to exorcise ghosts and cleaning the house". In the treatment, two principles of sweating and diuresis were put forward: "If there is water, it is appropriate to urinate, and if there is water above the waist, it is appropriate to treat it by sweating." Ren Zhai, Zhi Zhi and Xu Fang established the method of promoting blood circulation and promoting diuresis in Zhang Fang Lun to treat blood stasis and edema. 4. Nursing and prognosis: In the Tang Dynasty, Sun Simiao proposed that salt should be avoided in edema, and pointed out that there are five incurable edema: "First, facial edema is black, which is liver failure; Second, the palm is swollen without texture, which is heart failure; Third, the waist swelling has no texture, which is the death of lung damage; Fourth, those who can't afford yin swelling are renal failure; 5. Umbilical fullness leads to spleen failure. "
Etiology and pathogenesis
One syndrome type of edema is caused by wind pathogen attacking the exterior, sore toxin invading the interior, exogenous damp pathogen, improper diet, congenital deficiency and chronic illness and fatigue. The pathogenesis of this disease is lung disorder, spleen loss of transport, kidney failure of opening and closing, and unfavorable triple energizer.
I. Reasons
Cold and feng shui fight each other.
The wind invades the lung surface, causing the yang to run poorly.
Damp-heat toxin invades water and accumulates edema.
Sore poison invades damp heat and accumulates yin water.
Feel the dampness of the spleen, soak in the dampness of the water and stop it.
Poor diet, weak spleen yang.
Physical weakness caused by overwork
Renal dysarthria
Deficiency of kidney yang
Schematic diagram of pathogenesis of edema disease
Second, the pathogenesis
1. Pathogenesis key points: The basic pathological changes of edema are pulmonary insufficiency, spleen insufficiency, renal insufficiency and unfavorable gasification of triple energizer.
2. Pathological viscera: among lung, spleen and kidney, the key is kidney.
3. Physical properties: Yang water is true, which is mostly caused by exogenous wind evil, sore poison and water dampness. Yin water belongs to deficiency or mixture of deficiency and excess, which is mostly caused by diet fatigue, insufficient endowment and chronic illness.
4. Physical factors: wind evil, water dampness, sore poison and blood stasis.
5. Mechanical conversion: Yang water and Yin water can be converted or mixed with each other.
Generally speaking, yang water is easy to disappear and yin water is difficult to treat.
Diagnostic points
I. Diagnostic basis
1. Edema starts from eyelids or lower limbs, and then reaches the whole body of limbs.
2. Only the eyelids or ankles are swollen in light cases, and the whole body is swollen in severe cases; Even the abdomen is full, and asthma can't lie flat; In more serious cases, urinary incontinence or oliguria, nausea and vomiting, foul breath in the mouth, nosebleeds, headaches, convulsions, delirium and other crises may occur.
3. Have a history of moth-eaten, palpitation, sore poison, purpura and chronic diseases.
Second, disease and syndrome differentiation
1. Edema and bloating
water swelling
swell
Special point
The head, face or lower limbs are swollen first, and then no blue veins are exposed in the whole body and abdominal wall.
Single abdominal distension, pale face, exposed abdominal vein, no swelling of limbs, or mild edema of limbs in the later stage.
complexion
Fresh and bright, gray and black in the later period.
Pale yellow, red face, blood moles on neck and chest.
Pathological viscera
Lung, spleen and kidney
Liver, spleen and kidney
2. Water edema of yin and yang
classify
Symptomatic characteristics
Shui Yang
Yinshui
cause of a disease
Wind pathogen, sore poison and water dampness
Eating fatigue, visceral loss caused by congenital or acquired factors
Course of disease and potential diseases
Short and urgent
Long and slow
Edema site
The head and face are obvious
The lower limbs are worse.
complexion
Bright and thin
Yellowing and gray stagnation
depressed
Press to reply easily.
Press reply hard.
First, the key points of syndrome differentiation
The syndrome of edema should first distinguish between yang water and yin water and distinguish their pathological attributes. Yang water is real and is caused by wind, humidity, heat and poison. Yin water mostly belongs to substance deficiency and excess. Because the spleen and kidney are weak, qi will not turn into water, and blood stasis will stop water for a long time.
Secondly, it is necessary to distinguish the pathological changes of lung, spleen, kidney and heart. Finally, for those who are mixed with reality and are sick, we should carefully distinguish between reality and reality.
Second, the principle of treatment
Sweating, diuresis and purgation are the three basic principles for treating edema, and the specific application varies with yin and yang deficiency. Yang water is mainly used to eliminate evil spirits, and it should be sweaty, diuretic or expelled, and at the same time, it should be combined with methods such as clearing away heat and toxic materials, regulating qi and eliminating dampness. Yin water should be based on strengthening the body resistance, strengthening the spleen and warming the kidney, supplemented by methods such as diuresis and nourishing yin, promoting blood circulation and removing blood stasis. For those who mix reality, we should give consideration to both, or attack first and then make up for it, or both.
Third, the classification of syndrome differentiation and treatment
(A) Yang water
1. Feng Shui competition certificate
Eyelid edema, followed by swelling of limbs and whole body, comes quickly, and there are many symptoms such as aversion to cold, fever, sore limbs and dysuria. Those who are prone to wind-heat are accompanied by sore throat, red tongue and slippery pulse. People with wind-cold aversion to cold, cough and asthma, thin and white tongue coating, and slippery or tight pulse.
Treatment: dispelling wind and clearing heat, dispersing lung and activating water.
Representative: Yuemai Jiajiashu Decoction.
Commonly used drugs: Herba Ephedrae, Semen Armeniacae Amarum, Radix Saposhnikoviae, Duckweed, Atractylodis Rhizoma, Poria, Alismatis Rhizoma, Semen Plantaginis, Gypsum Fibrosum, Cortex Mori and Scutellariae Radix.
Syndrome changes: if you see sweat pathogen and deficiency of Wei-yang, you should add and subtract Ji Fang Huangqi Decoction to replenish qi and promote blood circulation; If the exterior syndrome is gradually resolved, those who are severe and have persistent edema can be treated as water-wet immersion syndrome.
2. Poison invasion syndrome
Eyelid swelling, extending to the whole body, bright skin, less urine and red color, sores and even ulceration all over the body, fever due to bad wind, red tongue, thin yellow fur, floating or slippery pulse.
Treatment: dispersing lung and detoxifying, promoting diuresis and reducing swelling.
Representative: ephedra, forsythia and red bean soup combined with Wuwei disinfection drink.
Commonly used drugs: Herba Ephedrae, Almond, Cortex Mori, Semen Phaseoli, Flos Lonicerae, Flos Chrysanthemi Indici, Herba Taraxaci, Herba Violae, and Herba Gynostemmatis.
3. Water wet impregnation certificate
General edema, obvious lower limbs, no finger pressure, short urination, heavy physical weakness, chest tightness, anorexia, aversion to evil, white greasy fur, slow pulse, slow onset and long course of disease.
Treatment: transport spleen to eliminate dampness, and activate yang to promote diuresis.
Representative: Five Skin Drinks with Ling Wei Soup.
Commonly used drugs: Cortex Mori, Pericarpium Citri Tangerinae, Pericarpium Arecae, Poria, Ginger, Rhizoma Atractylodis, Cortex Magnolia Officinalis, Pericarpium Citri Tangerinae, Fructus Tsaoko, Ramulus Cinnamomi, Atractylodis Rhizoma, Poria, Polyporus and Alismatis Rhizoma.
4. Damp-heat syndrome
The whole body is swollen, the skin is tight and bright, chest tightness and fullness, hot and thirsty, short and red urine, or dry stool, red tongue, yellow and greasy fur, heavy or thin pulse.
Treatment: divided into damp heat.
Representative: Shu Chi's consonants are added and subtracted.
Commonly used drugs: Notopterygium Rhizoma, Gentiana macrophylla, Radix Saposhnikoviae, Pericarpium Arecae, Poria Peel, Ginger Peel, Polyporus, Poria, Alisma orientalis, Akebia Akebia, Zanthoxylum bungeanum, Semen Phaseoli, Cortex Phellodendri, Phytolacca acinosa, Areca catechu and Radix et Rhizoma Rhei.
(2) Yin water
1. Spleen yang deficiency syndrome
Long-term swelling of the body, especially below the waist, depression, abdominal distension, tightness and difficulty in recovery. loose stool has a dull complexion, fatigue, weakness of limbs, short and red urine, pale tongue, white greasy or slippery fur, and slow or weak pulse.
Treatment: invigorating spleen, warming yang and promoting diuresis.
Representative: Shipi drink is added and subtracted.
Commonly used drugs: Zingiberis Rhizoma, Radix Aconiti Lateralis Preparata, Fructus Tsaoko, Ramulus Cinnamomi, Rhizoma Atractylodis Macrocephalae, Poria, Radix Glycyrrhizae Preparata, Rhizoma Zingiberis Recens, Fructus Jujubae, Poria, Rhizoma Alismatis, Semen Plantaginis, Fructus Chaenomelis, Radix Aucklandiae, Cortex Magnolia Officinalis, and Pericarpium Arecae.
Syndrome changes: weak temper, edema all over the body, sallow complexion, severe head and face in the morning, edema of lower limbs during exercise, fatigue of eating, frequent defecation, thin and greasy tongue coating, weak pulse, so it is advisable to invigorate qi and spleen, regulate qi and eliminate dampness.
2. Deficiency of kidney-yang syndrome
Repeated increase or decrease of edema, facial edema below the waist, making it difficult to depress, decreased or increased urine output, backache and cold pain, cold limbs, chills and fatigue, pale complexion, even palpitation, chest tightness, dyspnea, abdominal distension, pale and fat tongue, white fur, and deep or slow pulse.
Treatment: Warming kidney to help yang, transforming qi and benefiting water.
Representatives: Jisheng Shenqi Pill and Zhenwu Decoction.
Commonly used drugs: Radix Aconiti Lateralis Preparata, Cortex Cinnamomi, Radix Morindae Officinalis, Herba Epimedii, Atractylodis Rhizoma, Poria, Alismatis Rhizoma, Semen Plantaginis, and Achyranthis Radix.
Syndrome changes: recurrent kidney yin deficiency and edema, mental fatigue, backache and nocturnal emission, dry mouth and thirst, fever of five senses, red tongue and rapid pulse. The treatment should be based on nourishing kidney and yin, benefiting water and dampness, and adding Alisma orientale, Poria cocos and sunflower seeds to Zuogui Pill.
Turtle shell, oyster shell, Eucommia bark, mistletoe, wild chrysanthemum and selfheal can be added for patients with kidney deficiency and liver depression, dizziness, headache, palpitation, leg weakness and quadriplegia.
The course of disease is lingering, repeated, healthy qi is declining day by day, exogenous pathogenic factors are recurring, and the symptoms are fever, aversion to cold, frequent swelling and toxicity, and short and red urine. This is a syndrome of excess and deficiency, and we should treat it symptomatically if we are in a hurry. First, we should treat it from geomantic omen, but we should take into account the deficiency of vital qi, and we should not use drugs to relieve exterior symptoms. Yuemai Decoction is the main method, and traditional Chinese medicines such as Dangshen and Semen Cuscutae should be added to strengthen the body and eliminate evil spirits.
3. Syndrome of blood stasis blocking water
Edema lasts for a long time, with different swelling potentials, edema in limbs or whole body, mainly in lower limbs, ecchymosis on the skin, tingling in the waist, or hematuria, dark purple tongue, white fur and deep and thin pulse.
Treatment: promoting blood circulation and removing blood stasis, promoting qi circulation and promoting blood circulation.
Representative: Taohong Siwu Decoction and Wuling Powder.
Commonly used drugs: Radix Angelicae Sinensis, Radix Paeoniae Rubra, Radix Salviae Miltiorrhizae, Herba Leonuri, Carthami Flos, Camptotheca acuminata, Fructus Lipuidambaris, Semen Persicae, Ramulus Cinnamomi, Radix Aconiti Lateralis Preparata, Poria, Alismatis Rhizoma, and Semen Plantaginis.
Preventive nursing
1. Avoid wind evil.
2. Prevent water intrusion.
3. Pay attention to your diet. Patients with edema should avoid salt, those with severe swelling should have a salt-free diet, and those with mild swelling should have a low-salt diet (3-4 grams of salt per day). After the swelling is reduced, you should also be careful not to eat too salty.
4. Keep your skin clean and avoid scratches.
5. Record the daily amount of water and liquid.
6. Insist on treatment and follow up regularly.
7. Combination of leisure and relaxation.
Prepare clinical evidence
1. Improve the ability of clinical diagnosis and syndrome differentiation: The etiology and pathological changes of edema syndrome are complex, involving many viscera. Therefore, mastering the pathogenic characteristics of different causes and the syndrome characteristics of different zang-fu organs is conducive to improving the clinical syndrome differentiation ability.
2. Correct use of the method of attacking and draining water: The method of attacking and draining water is a method for treating yang water, which is only applicable to those who are very swollen at the beginning of the disease, healthy qi is still flourishing, sweating and diuresis are ineffective, but there is indeed a pulse at present.
3. Application of the method of removing blood stasis and promoting diuresis: For edema with blood stasis, the method of promoting blood circulation and removing blood stasis and promoting diuresis is often an important link to improve the curative effect of edema.
4. Use of nephrotoxic drugs: In recent years, it has been found that traditional Chinese medicines containing aristolochic acid, such as Aristolochia, Aristolochia manshuriensis, Stephania tetrandra and Leonurus japonicus, also have certain nephrotoxicity, so patients with edema should avoid using them in large doses for a long time.
5. Treat the serious changes of edema in time.
/question/3 136 1 10 . html