What is edema? What are the symptoms and sequelae?
The cause of disease
Causes of body fluid imbalance: plasma colloid osmotic pressure decreased; The hydrostatic pressure in the capillary increases; The permeability of capillary wall increased; Lymphatic reflux is blocked.
1, plasma colloid osmotic pressure decreased.
It can be found in malabsorption or malnutrition in protein and kidney diseases with massive proteinuria. When the amount of plasma albumin drops to 25g/L or the total protein drops to 50g/L, edema can occur, which is systemic.
2. The hydrostatic pressure in the capillary increases.
It can be seen in venous obstruction or venous reflux disorder caused by various reasons. Local venous reflux obstruction causes tissue edema or hydrops in corresponding parts, such as gastrointestinal wall edema and ascites caused by cirrhosis, and vena cava reflux obstruction in heart failure causes systemic edema.
3. The permeability of capillary wall is increased.
Vasoactive substances (histamine, kinin), bacterial toxins and hypoxia can increase the permeability of capillary wall and cause edema. The edema of inflammatory lesions is mainly due to the increase of capillary wall permeability, and angioneurotic edema and edema caused by allergic reaction also belong to this mechanism. This edema usually occurs in the damaged part of the blood vessel wall.
4. Lymphatic reflux is blocked
After radical mastectomy, the local lymphatic circulation is destroyed after axillary lymph node resection, and edema of the affected upper limb may occur. In filariasis, edema of lower limbs and scrotum often occurs because lymphatic vessels are blocked by worms. In addition, embolization of cancer cells with extensive lymphatic vessels can cause local edema.
clinical picture
1, systemic edema
(1) Congestive heart failure and constrictive pericarditis caused by heart disease, rheumatism, hypertension and other diseases such as valves and myocardium.
(2) Acute glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome, pyelonephritis in renal failure stage, renal arteriosclerosis, renal tubular lesions, etc.
(3) Liver diseases such as liver cirrhosis, liver necrosis, liver cancer and acute hepatitis.
(4) Nutritional factors ① Insufficient intake of primary food can be seen in hunger caused by war or other reasons (such as severe famine); ② Secondary dystrophic edema is found in many pathological conditions, such as secondary anorexia (anorexia nervosa, severe anorexia, gastrointestinal diseases, vomiting during pregnancy, oral diseases, etc. ); Digestion and absorption disorders (insufficient digestive juice, intestinal peristalsis, etc.). ); Excessive excretion or loss (extensive burns and exudation, acute or chronic blood loss, etc.). ), protein's synthetic function is impaired, and severe diffuse liver disease.
(5) Pregnancy factors: the second half of pregnancy, hypertensive disorder complicating pregnancy, etc.
(6) Endocrine diseases: syndrome of abnormal secretion of antidiuretic hormone, hyperadrenocortical function (Cushing's syndrome, hyperaldosterone secretion), hypothyroidism (hypofunction of anterior pituitary gland, hyposecretion of thyrotropin-releasing hormone in hypothalamus), hyperthyroidism, etc.
(7) Idiopathic factors This kind of edema is a syndrome with unknown or undetermined reasons (there may be more than one reason), which is more common in women and often related to menstrual cycle.
2, local edema
(1) Lymphatic primary lymphedema (congenital lymphedema, early lymphedema) and secondary lymphedema (tumor, infection, surgery, etc. ).
(2) Vein obstructive tumor compression or tumor metastasis, local inflammation, venous thrombosis, thrombophlebitis, etc. It can be divided into chronic venous insufficiency, superior vena cava obstruction syndrome, inferior vena cava obstruction syndrome and other venous obstruction.
(3) Inflammation is the most common local edema. See erysipelas, furuncle, etc.
(4) allergic urticaria, serum sickness, and allergic reactions such as food, drugs and irritating topical drugs.
(5) Angioneurotic allergy is allergic or neurotic and can be induced by insects, mechanical stimulation, warm stimulation or emotional excitement. Some cases are related to heredity.
therapeutic method
Traditional Chinese medicine believes that the viscera most closely related to water-liquid metabolism are lung, spleen and kidney, and the dysfunction of these three viscera is the key to edema. Therefore, in the treatment of edema, TCM generally takes dispersing lung, strengthening spleen and warming kidney as the basic principle, and the specific methods are as follows.
1, dispersing lung and promoting diuresis: The main clinical manifestations are fever, aversion to cold, aversion to wind, headache, joint pain of limbs, cough, thin and white tongue coating and floating pulse. Edema first appears on the face and then spreads to the whole body, which is unfavorable for urination. Traditional Chinese medicine calls this edema feng shui, which is more common in acute nephritis or acute attack of chronic nephritis. Commonly used prescriptions include Yuemai Jiashu Decoction, Ephedra Forsythia Red Bean Decoction and so on. Commonly used drugs include Herba Ephedrae, Gypsum Fibrosum, Ginger, Atractylodis Rhizoma, Radix Saposhnikoviae, Cortex Mori, Flos Lonicerae, Fructus Forsythiae, Herba Menthae, Radix Peucedani, Semen Phaseoli, Semen Plantaginis, Rhizoma Alismatis, Rhizoma Imperatae, and Herba Leonuri.
2, spleen and dampness, diuresis and swelling; The clinical manifestations are depressed edema all over the body, especially below the waist, fatigue, less urine, poor appetite, chest tightness, greasy fur and thready pulse. The commonly used prescription is Wuling Powder combined with Wupi Drink, and the commonly used drugs are Poria, Polyporus, Alisma orientalis, Atractylodis Rhizoma, Ramulus Cinnamomi, Cortex Mori, Pericarpium Arecae, Ginger Peel, Pericarpium Citri Tangerinae, Poria Peel, etc. Herba Ephedrae, Semen Armeniacae Amarum and Semen Lepidii are added for patients with upper body edema or even asthma; Tetrandra root, Sichuan pepper, magnolia bark, etc. are used for lower body swelling. For example, excessive damp-heat, upset and thirsty, short and red urine, constipation, yellow and greasy fur, yellow increase, Akebia Akebia, Cirsium japonicum and so on.
3, warming the spleen, promoting qi and benefiting water; This method is suitable for people with spleen-yang deficiency and weak constitution. The main clinical manifestations are edema of lower limbs, difficulty in recovery, chest tightness and abdominal distension, anorexia and loose stool, sallow complexion, listlessness, cold limbs, short and red urine, pale tongue with white fur and slow pulse. The commonly used prescription is Shipiyin, and the medicines are Poria, Atractylodis Rhizoma, Radix Aconiti Lateralis Preparata, Zingiberis Rhizoma, Magnolia Officinalis, Radix Aucklandiae, Pericarpium Arecae, Fructus Chaenomelis, Fructus Tsaoko, Radix Glycyrrhizae, Polyporus, Alismatis Rhizoma, Radix Codonopsis, Radix Astragali, etc. You can add.
4, warming the kidney and promoting diuresis: suitable for those with kidney yang decline. The main manifestations are high edema all over the body, especially below the waist, soreness in the waist and knees, cold limbs, listlessness, cold complexion, short and red urine, light and fat tongue, teeth marks and weak pulse. Commonly used prescriptions include Zhenwu decoction, Jinkui Shenqi pill and so on. The medicine comprises Poria, Atractylodis Rhizoma, Radix Paeoniae Alba, Radix Aconiti Lateralis Preparata, Rhizoma Zingiberis Recens, Cortex Moutan, Alismatis Rhizoma, Rhizoma Dioscoreae, Corni Fructus, Cortex Cinnamomi, etc.