Excessive fluid retention in tissue spaces or body cavities is called edema. However, edema usually refers to an increase in body fluids in tissue spaces. An increase in body fluids in a body cavity is called effusion. Edema can be localized or systemic. Generalized edema is often accompanied by serosal effusion, such as ascites, pleural effusion, and pericardial effusion.
Cause
Causes of imbalance of body fluid balance: reduced plasma colloid osmotic pressure; increased hydrostatic pressure in capillaries; increased permeability of capillary walls; obstruction of lymph backflow .
1. Decreased plasma colloid osmotic pressure
It is seen in protein malabsorption or malnutrition and kidney diseases accompanied by large amounts of proteinuria. When the plasma albumin level drops to 25g/L or the total protein level drops to 50g/L, edema may occur and is systemic.
2. Increased hydrostatic pressure in capillaries
It is seen in venous obstruction or venous return disorder caused by various reasons. Obstruction of local venous return causes tissue edema or water accumulation in the corresponding parts. For example, liver cirrhosis causes gastrointestinal wall edema and ascites, and vena cava return obstruction in heart failure causes generalized edema.
3. Increased permeability of capillary walls
Vasoactive substances (histamine, kinins), bacterial toxins, hypoxia, etc. can increase the permeability of capillary walls and Cause edema. Edema in inflammatory lesions is mainly due to the increased permeability of capillary walls, and edema caused by angioedema and allergic reactions also belongs to this mechanism. This type of edema usually occurs where blood vessel walls have been damaged.
4. Lymphatic drainage is blocked
After radical mastectomy for breast cancer, due to the destruction of local lymph circulation after axillary lymph node resection, edema of the affected upper limb may occur; in the case of filariasis, the lower limbs and Because the lymphatic vessels in the scrotum are blocked by worms, edema of the lower limbs and scrotum often occurs. In addition, extensive cancer cell embolism in lymphatic vessels can cause local edema.
Clinical manifestations
1. Generalized edema
(1) Various causes such as heart disease, rheumatism, hypertension, and various causes such as valves and myocardium. Congestive heart failure, constrictive pericarditis, etc. caused by lesions.
(2) Kidney diseases: acute glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome, pyelonephritis, renal failure stage, renal arteriosclerosis, renal tubular lesions, etc.
(3) Liver diseases: cirrhosis, liver necrosis, liver cancer, acute hepatitis, etc.
(4) Nutritional factors ① Primary insufficient food intake, seen in hunger caused by war or other reasons (such as severe famine); ② Secondary dystrophic edema seen in a variety of pathological conditions , such as secondary underfeeding (anorexia nervosa, lack of appetite in severe illness, gastrointestinal diseases, vomiting during pregnancy, oral diseases, etc.); digestive and absorption disorders (insufficient digestive juices, hyperactive intestinal motility, etc.); excessive excretion or loss (large-area burns and exudation, acute or chronic blood loss, etc.) as well as impaired protein synthesis, severe diffuse liver disease, etc.
(5) Pregnancy factors: second half of pregnancy, gestational hypertension, etc.
(6) Endocrine diseases syndrome of abnormal secretion of antidiuretic hormone, hyperadrenocortical function (Cushing syndrome, hyperaldosteronism), hypothyroidism (anterior hypopituitarism, hypothalamic stimulating hormone secretion) Insufficient secretion of thyroxine-releasing hormone), hyperthyroidism, etc.
(7) Idiopathic factors This type of edema is a syndrome with unknown or undetermined causes (there may be more than one cause). It is more common in women and is often related to the menstrual cycle.
2. Localized edema
(1) Lymphatic primary lymphedema (congenital lymphedema, early-onset lymphedema), secondary lymphoid edema Edema (tumor, infection, surgery, etc.).
(2) Venous obstruction: 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 obstructions.
(3) Inflammatory is the most common local edema. Seen in erysipelas, boils, etc.
(4) Allergic reactions: urticaria, serum sickness, allergic reactions to food, drugs, irritating external drugs, etc.
(5) Vascular neuropathy is an allergic reaction or neurogenic reaction, which can be induced by insects, mechanical stimulation, thermal stimulation or emotional excitement. Some cases are related to genetics.
Treatment methods
Traditional Chinese medicine believes that the organs most closely related to water metabolism are the lungs, spleen, and kidneys. The dysfunction of these three organs is the key to causing edema. Therefore, when treating edema, traditional Chinese medicine generally uses the basic principles of rejuvenating the lungs, strengthening the spleen, and warming the kidneys. The specific methods are as follows.
1. Xuanfei and diuresis: the main clinical manifestations are fever, aversion to cold, aversion to wind, headache, soreness of limbs and joints, cough, thin tongue coating and floating pulse caused by external attack of wind evil. Swelling first appears on the face, then spreads throughout the body, making it difficult to urinate. Traditional Chinese medicine calls this kind of edema Feng Shui, and it is more common in acute nephritis or acute attacks of chronic nephritis. Commonly used prescriptions include Yue Jia Shu Decoction and Ephedra Forsythia Chixiaodou Decoction; commonly used drugs include ephedra, gypsum, ginger, atractylodes, saposhnikovia, mulberry bark, Shuanghua, forsythia, mint, dandelion, adzuki bean, psyllium, zebra. Diarrhea, Imperata cogongrass root, Motherwort, etc.
2. Strengthen the spleen and reduce dampness, diuretic and reduce swelling; clinical manifestations include pitting edema all over the body, especially below the waist, weight and fatigue, less urine, indigestion, chest tightness, greasy coating, and wet pulse. Commonly used prescriptions are Wuling Powder and Wupi Yin. Commonly used drugs include Poria, Polyporus, Alisma, Atractylodes, Cinnamomum twig, Morus alba, Dafupi, ginger peel, tangerine peel, Poria peel, etc. If the upper body is swollen or even wheezing, add ephedra, almonds, and Tilizi; if the lower body is swollen, add Fangji, Sichuan pepper, Magnolia officinalis, etc.; if there is excess dampness and heat, irritability and thirst, short and red urine, constipation, yellow and greasy coating, add Rhubarb, Akebia, thistle, etc.
3. Warm the body and strengthen the spleen, promote qi and diuresis; this method is suitable for those with weak spleen yang. The main clinical manifestations are severe edema of the lower limbs, which is difficult to recover when pressed, chest tightness and abdominal distension, poor appetite and loose stools, sallow complexion, fatigue and cold limbs, small amount of urine, pale tongue with white coating, and slippery and slow pulse. Commonly used prescriptions are Shipiyin. The medicines include: Poria, Atractylodes, Aconite, Ginger, Magnolia officinalis, Acosta, Dabupi, Papaya, Caoguo, Licorice. Polyporus, Alisma, Codonopsis, Astragalus, etc. can be added. .
4. Warming the kidneys and diluting water: suitable for those with weak kidney yang. The main symptoms include high degree of edema all over the body, especially below the waist, soreness and weakness in the waist and knees, cold limbs and chills, mental fatigue, pale complexion, oliguria, pale tongue with tooth marks, and weak and thready pulse. Commonly used prescriptions include Zhenwu Decoction, Jingui Shenqi Pills, etc. The medicines include Poria, Atractylodes, White Peony, Aconite, Ginger, Rehmannia glutinosa, Paewan, Alisma, Yam, Cornus, Cinnamon, etc.