Analysis:
When it comes to edema, people always immediately think of whether there is something wrong with the kidney. It is easy to find that there is moisture on your feet, and it is easy for ordinary people to notice that your fingers can't bounce when you press the instep. Some patients can also observe that the shoes are tightened and the indentation of socks is deepened.
There are many reasons for edema. First of all, it depends on one foot or two feet. The edema of one foot is a local problem, such as venous embolism, varicose veins, cellulitis, arthritis, and some are caused by poor local blood or lymphatic circulation after trauma surgery. Local problems usually have nothing to do with other organs of the whole body. As for the edema of both feet, of course, we should also consider the local problems that occur simultaneously on both sides.
As for bilateral edema, the most common cause of edema in girls is related to female hormones. Taking birth control pills, supplementing female hormones after menopause and injecting ovulation-promoting drugs, some women will have periodic edema with the change of menstrual cycle hormones. However, some female hormones are pathological, such as polycystic ovary disease.
Another thing to consider is taking other drugs, such as diuretics, which are often contained in popular cocktail diet pills. When patients do not take diuretics, they will have edema, look fat and gain weight, so they will take more diuretics, thus forming a vicious circle and even affecting renal function. In addition, some antihypertensive drugs, such as calcium blockers and vasodilators, may cause edema, and most patients can improve after switching to other drugs. Taking non-steroidal painkillers and anti-inflammatory drugs are also common reasons. There is another kind of patients who can't find the cause, but these patients don't have much influence except a little discomfort and appearance considerations.
In addition to drugs and hormones, other causes of edema are to consider the abnormalities of kidney, heart and liver functions. Heart failure leads to poor venous return and edema, and when edema occurs, patients usually have symptoms of dyspnea, and a clear diagnosis can be made by knowing the medical history. As for the edema caused by the liver, it is mainly caused by cirrhosis and low serum albumin. Generally speaking, from cirrhosis to edema of lower limbs, other signs of cirrhosis should be obvious, such as ascites, spider nevus and male breast development. And physical examination can make a differential judgment.
As for the edema caused by kidney, it may be due to excessive albumin loss in nephrotic syndrome, which leads to low serum albumin, such as some nephritis, diabetic nephropathy and systemic lupus erythematosus. Usually, patients will find persistent bubbles when urinating, which can be found by simple urine examination. In addition, it may be that the kidney function is poor and the water cannot be discharged. Renal function can be checked by blood test. But poor renal function does not necessarily lead to edema. Sometimes, because the function of kidney urine concentration is reduced, the urine volume of some patients increases, and patients have to get up several times at night to urinate. At this time, they should be careful about the possibility of dehydration, which will worsen renal function. Edema is a common symptom, which may be related to renal function, but renal disease is not the only cause. The real cause can be determined by blood drawing, urine test and asking about medical history and drugs taken.
Edema refers to the excessive accumulation of body fluids in the space outside blood vessels, which is one of the common clinical symptoms. Different from obesity, edema is characterized by obvious depression when fingers press less subcutaneous tissue.
Systemic edema can be divided into:
(1) Cardiogenic edema: common in congestive heart failure, acute and chronic pericarditis, etc.
(2) Nephrogenic edema: It is common in glomerulonephritis, pyelonephritis and nephrotic syndrome.
(3) Hepatogenic edema: common in viral hepatitis, liver cirrhosis, etc.
(4) dystrophic edema: it is common in hypoproteinemia and vitamin Bl deficiency.
(5) Edema caused by connective tissue disease: common in lupus erythematosus, scleroderma and dermatomyositis.
(6) Allergic edema: such as serum sickness.
(7) Endocrine edema: common in Sheehan's disease, hypothyroidism and Cushing's syndrome.
(8) Idiopathic edema: such as functional edema.
(9) Drugs: The edema caused by drugs is caused by taking anti-inflammatory painkillers to affect the renal excretion function, or the steroid preparation "Mei Lingdan" damages the adrenal function. Others such as anemia edema and toxic edema in pregnancy.
Local edema includes:
(1) Venous obstructive edema: It is common in thrombophlebitis and varicose veins of lower limbs.
(2) Lymphatic obstructive edema: common in elephantiasis caused by filariasis and chest edema caused by mumps. (3) Inflammatory edema: it is common in local edema caused by erysipelas, furuncle and cellulitis.
(4) Reactive edema: It is common in angioneurotic edema and contact dermatitis.
Many people's edema is physical and does not need any treatment. But it is best to ask a doctor to do a simple screening of heart, liver, kidney and adrenal gland at the time of onset, so as to determine the cause and realize early treatment or long-term observation and follow-up. Remember, don't go everywhere to see a doctor or abuse diuretics because you can't find a reason.
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Sweating and detumescence method
The method of sweating and detumescence is called "opening the gate of hell" in Neijing. Zhang Zhongjing said: "Swelling above the waist is the cure for sweating." Therefore, this treatment is mainly used for upper body swelling, or upper body swelling first and then whole body swelling, resulting in aversion to cold, bad wind, fever and other symptoms. Clinically, appropriate sweating methods should be selected according to the specific conditions of different patients.
1. Chilling and sweating, wind evil hurts fur, water evil blocks skin, and stagnates heat. Symptoms include edema of limbs, aversion to cold, fever, joint pain, spontaneous sweating, thirst, Huang Chi in urine and rapid pulse. Treatment with Yuemai Fujiashu Decoction, pungent and cool, expelling wind, clearing away pathogenic factors, strengthening soil and promoting diuresis. Ephedra sinica 10g, gypsum 20g, ginger 10g, licorice 10g, 4 Chinese dates and Atractylodes macrocephala 12g. First, decoct Herba Ephedrae in water, remove foam, and then decoct the rest drugs. If cough occurs at the same time, add Pinellia ternata 10g to reduce adverse reactions and relieve cough.
2. Warming the heart, sweating, geomantic omen, muscle abscess and lung failure. Symptoms include edema of limbs, aversion to cold, anhidrosis, and floating pulse. Treat with Su Xiang Drink to relieve sweating and swelling. Cyperus rotundus10g, perilla10g, dried tangerine peel 8g, licorice 6g, onion 6g and ginger 6g. Boil the water several times, remove the residue and take it at any time. If the symptoms are edema of limbs, fever, aversion to cold, general pain, profuse sweating, floating pulse and irritability, Daqinglong decoction can be used to relieve pain, warm sweat, reduce swelling and remove annoyance. Ephedra10g, cassia twig 6g, roasted licorice 6g, almond10g, ginger10g, jujube 4g and gypsum 20g. First, decoct Herba Ephedrae with water, remove foam, and then decoct other medicinal materials together.
3. Help yang to sweat outside, water evil stops inside, and zhengyang is insufficient. Symptoms include edema of limbs, joint pain, sweating, bad wind and heavy pulse. Treating with ephedra and aconite decoction can help yang to sweat and reduce swelling. Ephedra sinica10g, aconite root10g, and licorice root 6g. First decoct Herba Ephedrae with water, remove foam, and then decoct the rest of the medicinal materials.
Diuretic detumescence method
The method of diuresis and detumescence is called "clearing the palace" in Neijing. Zhang Zhongjing said: "If it is swollen below the waist, it is necessary to urinate." Therefore, this treatment is mainly used for edema concentrated in the lower part of the body, or edema first appears in the lower part of the body, and then the whole body swells. Appropriate diuretic methods should be adopted according to the specific conditions of different patients in clinic.
1. transforming qi and diuresis "Bladder, the official of the state, body fluid is stored, and it can be vaporized." Water binds the bladder, which is not conducive to gasification. Symptoms include edema of limbs, dysuria, aversion to cold and fever, sweating and thirst, and floating pulse. Treating with Wuling powder, regulating qi and benefiting water. Ramulus Cinnamomi 10g, Rhizoma Atractylodis Macrocephalae 12g, Poria cocos 12g, Rhizoma Alismatis 20g, Polyporus 12g, and * * * are ground into powder, and taken with boiling water or decocted in water.
2. Wenyang Diuretic "Kidney, the stomach is also closed, it is not appropriate to close the door, so it gathers water and follows its class." Excessive pathogenic water leads to stagnation of kidney yang, but it can't be closed, and stagnant water leads to swelling. Symptoms include edema of limbs, cold limbs, unfavorable urination, small abdominal distension and heavy pulse. Treatment with Zhenwu decoction, warming yang, diuresis and detumescence. Take aconite10g, Poria10g, fried atractylodes10g, ginger10g, and Radix Paeoniae Alba10g, and add water for decoction.
3. Han Gan stopped diuresis and stopped bladder and urethra obstruction. Symptoms include edema of limbs, dysuria, or dripping pain, dry mouth and heavy pulse. Often with a self-made prescription, sweet and cold diuretic swelling. 20g of wax gourd peel, 0/0g of reed rhizome/kloc-,0/0g of lalang grass rhizome/kloc-,0/0g of pyrrosia/kloc-,0/0g of coix seed/kloc-,0/0g of almond/kloc-,and 0/0g of rush (or medulla tetrapanacis)/kloc-.
4. Bitter cold and diuresis. Xia Yue will hurt cold water, which flows through the skin, and heat will inhibit it. Symptoms include swelling of limbs, short urine, yellow color, thirst, red tongue and rapid pulse. Guadi decoction is used to treat bitter cold, diuresis and detumescence. 20 melon stalks (melon stalks or loofah stalks can be used) are decocted in water.
Drainage and detumescence
Water evil overflows and condenses in it, and the triple energizer is blocked and gasification is blocked. Symptoms include abdominal swelling, swelling of limbs, dysuria and heavy pulse. The treatment method is to add and subtract Ten Jujube Decoction to induce diuresis and reduce swelling. Divide Daphne genkwa (parched), Radix Kansui, Radix Euphorbiae into equal parts, and grind into fine powder for later use. When in use, take 10 jujubes, split them, decoct them in water to remove residues, and add 2g of medicinal powder for oral administration. This medicine can only be taken in the morning, not at night. If the urine and urine are still blocked after taking the medicine, wait until the next day. This recipe has a strong taste, so it is not suitable for a strong person who is not ill. For safety reasons, the powder can be mashed with jujube and used as pills; Or it is safer to mix the powder with vinegar and apply it to the abdomen.
Purging lung and reducing swelling
Lung is the source of water god, which leads to the decline of river water and the passage of waterways. Water evil blocks the lungs and the upper source is blocked, so the river is derelict and the waterway is impassable. Symptoms include limb edema, chest tightness, cough and wheezing. Treatment with Li Ting jujube Xie Fei soup, Xie Fei swelling. Lepidium seed (stir-fried, mashed) 15g, 4 jujubes. First, add water to jujube, remove dregs, add prickly heat seeds, decoct, remove dregs and take orally.
Removing blood stasis and detumescence
Blood stasis, qi stagnation, loss of work, unfavorable gasification, and long-term internal heat. Symptoms include edema of limbs, dysuria and thirst; Women's menstruation is unfavorable and their pulse is heavy and astringent. Treating with Puhui powder or small decoction, promoting blood circulation, removing blood stasis, diuresis and detumescence. Puhui powder: Puhui 10g, talc 5g, * * * ground into fine powder, washed with water, 1, three times a day. Xiaotangjing recipe: Angelica sinensis 10g, Paeonia Rubra 10g, Myrrha 6g, Amber 6g, Ramulus Cinnamomi 6g, Asari 3g, Musk 1g, decocted in water three times a day.
Opening knot and detumescence method
Yin and cold qi stagnates, gasification is not feasible, and waterways are impassable. Symptoms include edema of limbs, cold syncope, abdominal fullness, heart obstruction and bowel sounds; Or body cold and bone pain, or aversion to cold, or numbness, heavy pulse and so on. Ma Xin Fuzi Decoction, which is used for treating liver dryness, transports the atmosphere, opens the knot and reduces swelling. Ramulus Cinnamomi 10g, Rhizoma Zingiberis Recens 10g, Radix Glycyrrhizae Preparata 6g, Fructus Jujubae 1, Herba Ephedrae 6g, Asari 6g, and Radix Aconiti Lateralis Preparata 10g, decocted in water three times a day.
In addition to the above, there is also a kind of "virtual swelling" and a kind of "wind swelling" in clinic. Although they all show swelling, their etiology and pathogenesis are quite different from edema, so we should pay attention to distinguish them.
There are also
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