There is a saying that
Excessive fluid accumulation in the interstitial spaces is called edema. Edema is often more obvious at first in areas with loose skin such as the eyelids, face, scrotum, and lower limbs. In patients who have been bedridden for a long time, it appears in the buttocks and waist. The skin in the edema area becomes tight, swollen, and in severe cases, the skin becomes shiny or even oozes water.
Diagnostic points of edema:
Associated symptoms
Possible diagnosis
It is often generalized edema and develops slowly. Accompanied by hunger and chronic wasting diseases (such as malignant tumors, tuberculosis, severe anemia, etc.).
Nutritional edema
In women, mild or moderate edema occurs all over the body. It occurs more than 7-10 days before menstruation and subsides after menstruation. It is often accompanied by irritability, irritability, Insomnia, headache, laziness, fatigue and other symptoms.
Premenstrual tension syndrome
Starts in the ankles and lower limbs and worsens after exertion. The edema spreads upward and becomes more severe, and jugular veins may be distended. In severe cases, it may spread throughout the body or be accompanied by pleural or abdominal effusion.
Heart failure
Early eyelid and facial edema is most obvious after getting up in the morning. It can develop into generalized edema, and its distribution has little relationship with body position. Urinalysis shows proteinuria and cast urine.
Nephritis and renal insufficiency
It is often first seen in the ankle, gradually spreads upward, and may be accompanied by ascites, but there is usually no edema in the head, face and upper limbs. Spider nevi, jaundice, liver and spleen enlargement can be seen.
Liver cirrhosis
There is no obvious depression in the skin after acupressure, but the skin is yellow, dry, hair loss, slow to react, and moderate anemia can be seen.
Myxedema, caused by thyroid hormone deficiency
Long-term use of corticosteroids, mild edema of the lower limbs or face.
Hyperaldosteronism, caused by endocrine disorders
Localized edema at one end of the limb, often due to poor local venous and lymphatic drainage or increased capillary permeability.
Embolitic phlebitis, filariasis, local inflammation, trauma or allergies, etc.
Eedema is the retention of fluid in the body, which overflows the skin, manifesting on the head, face, eyelids, limbs, abdomen and back , or even a type of disease characterized by general edema.
2. Historical evolution
1. Disease name and classification: This disease is called "water" in the "Nei Jing", and is divided into "feng shui" and "stone water" according to different symptoms. ”, “gushing water”. "The Synopsis of the Golden Chamber: Combined Treatment of Water-Qi Diseases and Pulse Syndrome" takes the exterior and interior as the main link and divides it into five types: Feng Shui, Pi Shui, Zheng Shui, Shi Shui and Huang Han. Yan Yonghe in the Song Dynasty divided edema into two categories: yin water and yang water. "Jisheng Fang Edema Gate" says: "Yin water is a disease, the pulse is slow and slow, blue and white in color, neither irritated nor thirsty, the urine is astringent and clear, and the stool is profuse...Yang water is a disease, and the pulse is slow and slow. , yellow and red color, irritability or thirst, red and astringent urine, and frequent constipation."
2. Cause and pathogenesis: "Su Wen·Shui-Hot Acupuncture Theory" points out: "Being brave and overworked, Then the sweat from the kidneys, when exposed to the wind, cannot enter the internal organs, and cannot penetrate the skin externally. It can travel in the acupoints and travel in the skin, causing tarsal swelling." "So its root is in the kidneys, and its end is in the lungs." "Suwen·Zhizhenyao Dalun" also points out: "All dampness, swelling and fullness belong to the spleen." Li Zhen's "Introduction to Medicine: Edema" in the Ming Dynasty proposed the etiology theory of edema caused by sores.
3.. Treatment of swelling: "Suwen·Tangyeyoulilun" puts forward the treatment principle of "treating calmly and balancing, removing the garden, Chen Shu... Open the gate of ghosts and clean the house". In terms of treatment, the two principles of sweating and diuresis are put forward: "For those with water and swelling below the waist, urination should be facilitated. Swelling above the waist should be cured by sweating." "Renzhai Zhizhi Fang·Xu Zhong Fang Lun" created Use the method of promoting blood circulation and diuresis to treat blood stasis and edema. 4. Nursing care and prognosis: Sun Simiao of the Tang Dynasty stated in "Essential Prescriptions for Emergencies: Edema" that salt must be avoided for edema, and pointed out that there are five incurable causes of edema: "1. Swelling and blackness of the face means liver failure; 2. swollen palms If there is no texture, it means heart failure cannot be treated; 3. If the waist is swollen and has no texture, it means lung damage cannot be treated; 4. If the yin is swollen, it means kidney failure cannot be treated; 5. If the umbilicus is full and swollen, it means spleen failure cannot be treated."
Etiology and Pathogenesis
Edema is a syndrome. The causes include wind evil attacking the surface, internal sores, exogenous dampness, improper diet, insufficient endowment, long-term illness and fatigue, which lead to the formation of this disease. The mechanism is that the lungs fail to regulate their circulation, the spleen fails to transfer and transport, the kidneys fail to open and close, and triple burner qi transformation is unfavorable.
1. Causes of the disease
Cold, wind and water compete with each other
Wind attacks the superficial lungs and causes loss of Xuantongyang water
Heat and dampness invades the promiscuous water Damp retention and edema
Dampness and heat invading the sores and accumulating Yin water
Feeling water dampness, loss of transmission of spleen, water dampness, soaking, blood stasis, obstruction and water stop
Irregular diet and spleen control Weak yang
Strong desire and physical weakness
Loss of kidney opening and closing
Weak kidney yang
Schematic diagram of the etiology and pathogenesis of edema
2. Pathogenesis
1. Key points of pathogenesis: The basic pathological changes in the onset of edema are lack of circulation of the lungs, loss of spleen transfer, loss of kidney opening and closing, and poor gasification of the triple burner.
2. Diseased organs: lungs, spleen, kidneys, the key is the kidneys.
3. Physical nature: Yang water is true, mostly caused by external wind evil, sores, and water-dampness. Yin water is deficient or a mixture of deficiency and excess, mostly caused by fatigue due to diet, insufficient endowment, and chronic illness.
4. Physical factors: wind evil, water-dampness, sores, and blood stasis.
5. Mechanical transformation: Yang water and Yin water can be converted into each other or mixed.
As for the outcome of edema, generally speaking, Yang water is easy to eliminate, while Yin water is difficult to treat.
Key points of diagnosis
1. Diagnosis basis
1. Edema first starts in the eyelids or lower limbs, and then spreads to the limbs and the whole body.
2. In mild cases, only the eyelids or shins are swollen, in severe cases, the whole body is swollen; in severe cases, the abdomen is distended and full, and asthma can not lie down; in more severe cases, anuria or oliguria, nausea and vomiting, and oral There are dangers such as foul smell, nosebleeds, toothache, headache, convulsions, coma and delirium.
3. Have a history of breast cancer, palpitations, sores, purpura and chronic illness and physical weakness.
2. Identification of disease and syndrome
1. Edema and Swelling
Eedema
Bulging
Characteristics
The head, face or lower limbs are swollen first, and then spread to the whole body, with no exposed veins on the abdominal wall.
One abdomen is distended, complexion is yellow, abdominal wall veins are exposed, limbs are not swollen, and mild limb edema may be seen in the later stage
Skin color
Bright and shiny, in the later stage Grayish color
Palescent, red streaks on the face, and bloody moles on the neck and chest
Lessed internal organs
Lungs, spleen, kidneys
Liver, spleen , kidney
2. Edema Yang water and Yin water
Classification
Symptoms and characteristics
Yang water
Yin water
Cause< /p>
Wind evil, sores, water-dampness
Fatigue due to diet, and loss of internal organs caused by congenital or acquired factors
Course and condition of the disease
Short, acute
Long, slow
Swelling area
Obvious on head and face
Particularly on lower limbs
Skin Color
Bright and thin
Chlorescent and gray sluggish
Sunkenness
Easy to press back
Press Difficult to recover
1. Key points of syndrome differentiation
The syndrome of edema must first differentiate between yang water and yin water, and distinguish their pathological attributes. Yang water is true, and the retention of water vapor is caused by wind, dampness, heat, and poison. Yin water is often deficient in nature and excess in nature. Due to the weakness of the spleen and kidneys, the qi cannot transform into water, and for a long time, stasis and water cessation will be seen.
Secondly, the diseased organs should be identified, including the lungs, spleen, kidneys, and heart. Finally, for patients with a mixture of deficiency and excess and multiple internal organs diseases, the primary and secondary should be carefully distinguished between deficiency and excess.
2. Treatment principles
The three basic principles for treating edema are sweating, diuresis, and purging water. The specific application varies depending on the deficiency and excess of yin and yang. Yang water is mainly used to dispel evil spirits, and should be used to induce sweating, diuresis or expelling, and at the same time, it should be combined with methods such as clearing away heat, detoxifying, regulating qi and reducing dampness. Yin water should be mainly used to strengthen the body, strengthen the spleen and warm the kidneys, and should also be used to diuretic, nourish yin, and activate blood circulation. , removing blood stasis and other methods. For those with a mixture of false and true symptoms, we should take into account both, either attacking first and then replenishing, or applying both attack and replenishment.
3. Classification of Syndrome and Treatment
(1) Yang Shui
1. Feng Shui Syndrome
Swollen eyelids, followed by limbs The whole body is swollen, and the onset is rapid. Symptoms include aversion to cold, fever, soreness in the limbs and joints, and difficulty in urination. Those with wind-heat symptoms may be accompanied by swelling and pain in the throat, red tongue, and a slippery and rapid pulse.
Those with a preference for wind-cold may also experience aversion to cold, cough and wheezing, thin white tongue coating, and a slippery or tight pulse.
Treatment method: dispel wind, clear away heat, clear the lungs and circulate water.
Representative prescription: Yuejiajiashu Decoction.
Commonly used medicines: ephedra, almond, saposhnikovia, duckweed, atractylodes, poria, alisma, plantain, gypsum, mulberry bark, skullcap.
Syndrome changes: If you see sweating, bad wind, and Wei Yang is already deficient, use Fangji Huangqi Decoction to replenish qi and move water; if the superficial syndrome gradually resolves, and the patient is heavy and the edema does not go away, you can use Fangji Huangqi Decoction. Treatment of water-wet maceration syndrome.
2. Symptoms of toxin invasion and sexual intercourse
Swelling of eyelids, extending to the whole body, shiny skin, oliguria and red urine, body sores, and even ulcers, wind, fever, and red tongue , thin yellow fur, floating or slippery pulse.
Treatment method: Xuanfei, detoxification, diuresis and swelling.
Representative recipe: Ephedra, Forsythia and Adzuki Bean Decoction combined with Wuwei Disinfectant Drink.
Commonly used medicines: ephedra, almond, mulberry bark, adzuki bean, silver flower, wild chrysanthemum, dandelion, purpurea and geranium.
3. Water-soaked maceration syndrome
General edema, obvious lower limbs, no finger when pressed, short urine, heavy body, chest tightness, anorexia, general nausea, white and greasy coating, The pulse is slow, the onset is slow, and the course of the disease is long.
Treatment method: activate the spleen and resolve dampness, unblock yang and diuresis.
Representative prescription: Wupiyin Heweiling Decoction with or without modification.
Commonly used medicines: mulberry bark, tangerine peel, big belly bark, poria bark, ginger peel, atractylodes, magnolia bark, tangerine peel, grass fruit, cassia twig, atractylodes, poria, polyporus, and Alisma.
4. Damp-heat congestion syndrome
Swelling all over the body, tight and shiny skin, tightness in the chest and epigastrium, irritability and thirst, short and red urine, or dry and hard stools, red tongue, The coating is yellow and greasy, and the pulse is rapid or wet.
Treatment method: Distinguish dampness and heat.
Representative recipe: Shuzhe Yinzi addition and subtraction.
Commonly used medicines: Qianghuo, Gentian, Fangfeng, Dabupi, Poria, ginger peel, Polyporus, Poria, Alisma, Akebia, Peppercorns, adzuki bean, Phellodendron, Phytolacca, betel nut, raw rhubarb.
(2) Yin water
1. Syndrome of spleen yang deficiency
The body is swollen for a long time, especially below the waist, and the depression is difficult to recover when pressed, and the epigastrium Abdominal distension and stuffiness, loss of appetite and loose stools, dull complexion, mental fatigue, tired limbs, lack of urine, pale tongue, white greasy or slippery coating, slow or weak pulse.
Treatment method: Strengthen the spleen, warm yang and diuresis.
Representative prescription: Shipi Yin with or without addition.
Commonly used medicines: dried ginger, aconite, grass nut, cassia twig, atractylodes, poria, licorice, ginger, jujube, poria, alisma, plantain, papaya, costus, magnolia officinalis , big belly.
Changes: Weak spleen, edema all over the body, sallow complexion, severe head and face symptoms in the morning, swelling of the lower limbs when moving, fatigue due to inability to eat, normal or loose stools, excessive urination, thin and greasy tongue coating, If the pulse is weak, the treatment should be to replenish qi and strengthen the spleen, circulate qi and remove dampness, and add or subtract Shenlingbaizhu powder.
2. Kidney yang deficiency syndrome
Edema waxes and wanes repeatedly, the face is swollen and the body is swollen, and the area below the waist is too deep to bear, and the urine output is reduced or increased, and the waist is sore, cold, and painful. Cold limbs, timidity and fatigue, pale complexion, palpitations and chest tightness, shortness of breath and difficulty lying down, enlarged and distended abdomen, pale and fat tongue with white coating, and slow and weak pulse.
Treatment method: Warm the kidneys and help yang, transform qi and circulate water.
Representative prescription: Jisheng Shenqi Pills combined with Zhenwu Decoction.
Commonly used medicines: Aconite, cinnamon, Morinda officinalis, Xianlingpi, Atractylodes, Poria, Alisma, Plantago, and Achyranthes.
Syndrome: Kidney yin deficiency, repeated attacks of edema, mental exhaustion, backache and nocturnal emission, thirst and dryness, five palpitations and heat, red tongue, thin and weak pulse, etc. Treatment should mainly nourish kidney yin, and also relieve water and dampness. Take Zuogui Pills plus Alisma, Poria cocos, winter sunflower seeds, etc.
For those with kidney deficiency and liver hyperactivity, dizziness, headache, palpitation, weak legs, and pale limbs, add turtle shell, oyster, Eucommia ulmoides, locust, wild chrysanthemum, and prunella vulgaris.
The course of the disease is lingering, repeated and unresolved, the righteousness is declining day by day, and external evils are felt again. The symptoms include fever, aversion to cold, increased swelling, and lack of urine. This is a syndrome of mixed deficiency and excess, with deficiency in origin and excess in the treatment. When it is urgent, treat the symptoms, first treat it based on Feng Shui, but you should take into account the deficiency of healthy qi, and do not overuse external medicine. Yueji Decoction is the main one, and you can add Codonopsis pilosula, Cuscuta seeds and other medicines that nourish the temperature and kidneys, and use it at the same time to strengthen the body and dispel evil. .
3. Syndrome of blood stasis and water
Edema that persists for a long time and varies in severity, edema of the limbs or the whole body, mainly the lower limbs, ecchymosis on the skin, tingling in the waist, Or accompanied by hematuria, dark purple tongue, white coating, and deep, thready pulse.
Treatment method: activate blood circulation, remove blood stasis, transform qi and circulate water.
Representative prescription: Taohong Siwu Decoction combined with Wuling Powder.
Commonly used medicines: Angelica sinensis, red peony root, salvia miltiorrhiza, motherwort, safflower, Lingxiao flower, passepartout, peach kernel, cinnamon twig, aconite, poria, alisma, plantain.
Prevention and care
1. Avoid wind evil attacks.
2. Prevent moisture from invading.
3. Adjust your diet accordingly. Patients with edema should avoid salt. Those with severe swelling should eat a salt-free diet, while those with mild swelling should eat a low-salt diet (3-4 grams of salt per day). After the swelling subsides, attention should also be paid to a diet that is not too salty.
4. Keep the skin clean and avoid scratching the skin.
5. Record the amount of water in and out every day.
6. Continue treatment and follow up regularly.
7. Combine elegance and smooth emotions.
Clinical Syndrome Preparation
1. Improve the ability of clinical diagnosis and syndrome differentiation: Edema syndrome has complex causes, complex and changeable pathological changes, and involves many organs. Therefore, it is necessary to understand the causes of different causes. Characteristics, as well as syndrome characteristics of different viscera lesions, are conducive to improving clinical syndrome differentiation capabilities.
2. Correctly use the method of attacking the water and driving it down: The method of attacking the water and driving it down is a method of treating yang water. It should only be used when the body is very swollen at the beginning of the disease and the righteousness is still strong. Use sweating and diuresis. The method is invalid, but the current pulse evidence is indeed present.
3. Application of blood stasis and diuresis method: For edema caused by blood stasis, activating blood circulation, removing blood stasis and diuresis method is often an important step in improving the efficacy of edema.
4. Use of nephrotoxic drugs: Recent studies have found that traditional Chinese medicines containing aristolochic acid, such as Aristolochia, Akebia, Fangji, Motherwort, etc., also have certain nephrotoxicity, so patients with edema should avoid taking them. Dosage, long-term use.
5. Treat severe cases of edema.