Edema refers to a kind of disease characterized by edema of head, face, eyelids, limbs, abdomen and back, and even the whole body, which is caused by feeling exogenous pathogens, eating disorders, or excessive fatigue.
The incidence of this disease is high, and the curative effect of traditional Chinese medicine is good.
This disease is called "water" in Neijing, and it can be divided into geomantic omen, Shi Shui and gushing water according to different symptoms. The chapter "Soul Pivot and Water Swelling" describes its symptoms in detail, such as "When the water rises, the eyes are slightly swollen, like lying on your back, the neck is throbbing, sometimes coughing, the thighs are cold, the feet and shin are swollen, and the abdomen is big, so the water is full." Put your hand on your abdomen and get up at will, as if you were wrapped in water. This is also waiting. As for the cause of the disease, Su Wenshui's treatise on blood points out: "So it is in the kidney and it ends in the lung." . "Su Wenzhi's treatise on true greatness also points out:" All wet swelling belongs to the spleen. "Visible, in the era of Neijing, edema disease has a clear understanding. Synopsis of the Golden Chamber calls this disease "water vapor", which can be divided into five categories according to the causes and symptoms: geomantic omen, skin water, normal water, Shi Shui and yellow sweat. According to the five zang-organs syndrome, it can be divided into heart water, lung water, liver water, spleen water and kidney water. It was not until the Yuan Dynasty that edema was divided into yin water and yang water, pointing out: "If the whole body is swollen, thirsty, the urine is red and astringent, and the stool is blocked, this belongs to yang water; "If the whole body is swollen, not thirsty, loose stool, less urine, not astringent and not red, this is yin water." This classification method is still of great significance in guiding clinical syndrome differentiation. In the Ming Dynasty, "Introduction to Medicine and Classification of Miscellaneous Diseases and Edema" proposed that scabies could cause edema, and recorded the phenomenon that "carbuncle became swollen after applying medicine". The Qing Dynasty's "Syndrome Treatment and Edema" summarized the previous treatment methods for edema, and thought that the great method for treating edema was "regulating the middle energizer and strengthening the spleen, from top to bottom, and the water and dampness disappeared by itself." At the same time, six methods for treating edema are listed: treating yin and yang, treating sweating, clearing damp heat, warming cold and dampness, nourishing yin deficiency and attacking evil. He has made his own contribution to improving the etiology and syndrome differentiation of edema.
Edema caused by acute and chronic glomerulonephritis, nephrotic syndrome, congestive heart failure, endocrine disorders and nutritional disorders in western medicine can be treated according to this section.
Etiology and pathogenesis
The operation of body fluid depends on the promotion of qi, that is, it depends on the transmission of temper, the promotion of lung qi, the promotion of heart qi and the evaporation of kidney qi. When the functions of these viscera are normal, the triple energizer will play a decisive role, and the bladder will be smoothly gasified and micturited, thus maintaining normal water-liquid metabolism. . On the other hand, if exogenous pathogenic factors such as wind, cold, damp-heat, water immersion, sores, fatigue, chronic illness, physical weakness, etc. cause the above-mentioned visceral dysfunction. , bladder gasification, fluid retention, skin hydrops, can cause edema.
1. Wind pathogen attacks from the outside, the lung is out of tune with wind pathogen, the lung stays in the lung, and the lung is out of tune with blood. The upper side can't release body fluid to nourish the skin, and the lower side can't be regulated by the waterway, which turns into urine, leading to wind suppression and water resistance, feng shui fights, water staying in the body, flooding the skin and edema.
2. Damp toxic foam, which belongs to lung, spleen, lung and spleen. Carbuncle, sore and poison are born in the skin, but they can't be cleaned up and return to the lungs and spleen. Spleen injury can't produce fluid, and lung injury can't produce fluid, which leads to water retention in the body and flooding the skin, causing edema. "Fang Jisheng Edema" said: "There are young people who have sores due to blood heat, swollen and thirsty, and have less urine. This is thermal expansion. "
3. The water is wet and the temper is sleepy. Spleen likes dryness and hates dampness. Living in wetlands for a long time, or wading in the rain and moisture invading; Or improper diet, overeating and cold, can make the spleen wet and sleepy, lose the function of transport and transformation, lead to water stagnation, stay in the body, widespread skin and edema.
4. Damp heat is abundant, and triple energizer stagnates. "Sanjiao is the official, and the waterway is out." Damp-heat invades and lasts for a long time; Or damp stagnation turns into heat, and damp heat overflows, so that the spleen and stomach of the middle energizer lose the function of ascending and descending turbidity, and the triple energizer stagnates, causing water to stay in the body and overflow the skin, causing edema.
5. Diet fatigue, eating disorder of the spleen and stomach, or excessive fatigue, or spleen injury due to long-term illness, impaired temper, water and liquid transport and metabolism disorder, which makes water and liquid stay in the body, flood the skin and produce edema.
6. Deficiency of kidney qi and abnormal gasification "The kidney has water dirty and governs body fluid." Poor fertility, overworked house, or long-term illness that damages the kidney, leads to kidney qi deficiency and failure, which can't turn qi into water, thus making the bladder gasify abnormally and opening and closing unfavorably, causing water to stay in the body, flooding the skin and causing edema.
The above reasons are single and mixed, which makes the condition more complicated. The disease is located in lung, spleen and kidney, which is closely related to heart. The basic pathogenesis is that the lung loses its function of promoting blood circulation, the spleen loses its function of blood transfusion, the kidney loses its function of opening and closing, and the bladder gasifies abnormally, which leads to the retention of body fluid and flooding the skin. In pathogenesis, lung, spleen and kidney are interrelated and influence each other. For example, edema caused by lung and spleen will reach the kidney for a long time, leading to kidney deficiency aggravating edema; Kidney yang deficiency, fire does not warm the soil, spleen yang is also deficient, the soil does not make water, and edema is aggravated; Kidney deficiency and flooding will make lung qi not fall, leading to the loss of its function of dispersing and lowering, thus aggravating edema. Edema caused by exogenous pathogens, sores and damp heat is mostly located in the lungs and spleen; The edema caused by internal injuries is mostly located in the spleen and kidney. Therefore, the pathogenesis of edema of lung, spleen and kidney is kidney-oriented, with lung as the standard and spleen as the instrument of water control, just as Jingyue Quanshu Swelling says: "Edema and other syndromes are all diseases related to lung, spleen and kidney. Covering water is the most yin, so it is in the kidney; Water is soluble in qi, so it is marked in the lung; Water is only afraid of soil, so it is made in the spleen. Today, lung deficiency means that qi does not turn into refined water, spleen deficiency means that soil does not make water, and instead, kidney deficiency means that water has no owner and acts rashly. "
In addition, blood stasis and unfavorable triple energizer waterway often make edema stubborn and difficult to heal.
clinical picture
Edema first started from the eyelids, and then spread to the head, face, limbs, abdomen and back, and even the whole body swelled. Some edema starts from the lower limbs and then spreads to the whole body. In light cases, only the eyelid or gaskin is swollen, while in severe cases, the whole body is swollen, and the swollen skin is tense and bright, which will swell immediately after being suppressed, or the skin will be slack, which is not easy to recover after being suppressed, even like mud. If the swelling is serious, abdominal distension, chest tightness, palpitation, asthma, inability to lie flat, dark lips, lack of basin, umbilical process, equal back, and pleural effusion may occur.
diagnose
1. Edema starts from the eyelid at first, then spreads to the head, face, limbs, abdomen and back, and even the whole body is swollen, and some of them start from the lower limb gaskin and then reach the whole body. In light cases, only the eyelids or feet and gaskin are swollen; In severe cases, the whole body is swollen, and the swollen part is depressed, and the depression can be recovered quickly or slowly. If the swelling is serious, it may be accompanied by pleural effusion and abdominal distension, chest tightness and palpitation, asthma and inability to lie down.
2. There may be a history of moth-eaten, palpitation, sore poison, purpura, exogenous pathogens, chronic illness and physical weakness.
3. Routine urine test, 24-hour urine protein quantification, routine blood test, erythrocyte sedimentation rate, plasma albumin, blood urea nitrogen, creatinine, humoral immunity, electrocardiogram, cardiac function measurement, renal B-ultrasound and other laboratory tests are helpful for diagnosis and differential diagnosis.
differential diagnosis
Swelling edema refers to a kind of disease manifested as edema of head, face, eyelids, limbs, abdomen, back and even whole body. Patients with severe edema may also have pleural effusion and ascites. Abdominal distension is mainly ascites, but limbs can also appear, and even edema all over the body, so this disease needs to be differentiated from abdominal distension.
The main causes of abdominal distension are improper diet, emotional injury, chronic illness, jaundice, accumulation of syndrome, schistosomiasis invasion, overwork, spleen deficiency and so on. The main pathogenesis is dysfunction of liver, spleen and kidney, qi stagnation and blood stasis, and water accumulated in abdomen. Abdominal distension occurs first in clinic, and edema of lower limbs or even the whole body occurs only when the condition is serious, and there are many blue veins standing out on the abdominal wall.
The main causes of edema are exogenous wind, cold, dampness and heat, soaking in water, soaking in sore poison, eating fatigue and chronic illness. The main causes are pulmonary insufficiency, spleen insufficiency, renal insufficiency and abnormal bladder gasification, which leads to water retention in the body and water flooding the skin. Its symptoms are edema of eyelids, head or lower limbs, edema of limbs and whole body gradually, abdominal distension only when the condition is serious, and no blue veins are exposed on the abdominal wall.
treatment according to syndrome differentiation
Key points of syndrome differentiation
The distinction between yang water and yin water and yang water: lung function and spleen health are lost due to wind evil, water dampness, sore poison and damp heat. The onset is more acute and the course of disease is shorter, once every few days. Swelling mostly starts from the head and spreads to the whole body from top to bottom, or the upper body is swollen, and the swollen skin is tense and bright, and it will start as soon as it is suppressed. Often accompanied by upset, thirst, red urine, constipation and other exterior, solid, heat syndrome. Yin water: it is mostly caused by fatigue of diet, chronic illness, deficiency of both spleen and kidney, and unfavorable gasification. The onset is slow, mostly gradual, or transformed from yang water, with a long course of disease. Most of the swelling starts from the lower limbs and gradually reaches the whole body, or it is very swollen below the waist. The swollen skin is slack and it is not easy to recover when pressed. What's more, like mud, not thirsty. Often see less urine but not red or astringent, loose stool, mental fatigue and fear, and so on.
Although the basis of syndrome differentiation is yang water and yin water, which are essentially different, it should be noted that under certain conditions, yang water and yin water can also be transformed into each other and need to be identified from a dynamic perspective. If yang water persists for a long time, healthy qi is weak and water evil grows, it can be turned into yin water; On the other hand, if exogenous pathogenic factors are induced by yin water, the lung will lose its function, the spleen will lose its health, and the swelling will increase sharply, which can also be manifested as excess heat syndrome, and yang water will be the first treatment.
Principles of treatment
For the treatment of edema, Lao Lun Chapter of Suwen Decoction puts forward three basic principles, namely, removing the old spine, opening the door of hell and cleaning the house. The meaning of Zhang Zhongjing's Neijing is put forward in the synopsis of the golden chamber, syndrome of controlling water, qi and disease pulse: "Those with water should urinate if they are swollen below the waist;" Swelling above the waist is the cure for sweating. " Dialectically applied sweating and urination, right; The influence of later generations is far-reaching, and it is still in use today. According to the above, the treatment principle of edema should be divided into yin and yang. Yang water is mainly used for sweating, diuresis, lung and spleen. Excessive water can be temporarily attacked as appropriate, and pathogenic factors are always eliminated. Yin water is mainly used for warming yang, benefiting qi, strengthening spleen, tonifying kidney, strengthening heart, promoting diuresis and removing blood stasis, and should be treated as appropriate. It is usually treated by strengthening the body resistance and benefiting qi. Seeing both reality and surplus, we will attack and make up for it.
treatment according to syndrome differentiation
"yang water"
Feng shui flooding
Symptoms: edema starts from the eyelid, then the limbs and the whole body swell, even the eyelid edema, unable to close your eyes, acute onset, aversion to cold and fever, limb pain, short urine and other symptoms. People who are prone to wind-heat are accompanied by sore throat, thirst, red tongue and slippery pulse. People with wind-cold aversion to cold and no sweat, headache, stuffy nose, cough and asthma, thin and white tongue coating, and slippery or tight pulse. If edema is serious, this type can also be seen by pulse depth.
Treatment: dispelling wind and clearing heat, dispersing lung and activating water.
Prescription: Yuemai Jiajiashu Decoction.
This prescription uses ephedra to disperse lung and sweat to relieve exterior syndrome, so as to remove exterior dampness; Gypsum plaster can relax tendons and clear heat; Atractylodes macrocephala, Glycyrrhiza uralensis Fisch, Ginger and Jujube strengthen the spleen and eliminate dampness, which means worshiping soil and making water. Duckweed, Poria cocos and Alisma orientalis can be added as appropriate to help diffuse lung, promote diuresis and reduce swelling. If wind-heat is excessive, Fructus Forsythiae, Radix Platycodi, Radix Isatidis and fresh lalang grass rhizome can be added to clear away heat, relieve sore throat, detoxify and disperse hard mass, cool blood and stop bleeding; If the wind and cold are severe, remove the gypsum and add perilla leaf, cassia twig and divaricate Saposhnikovia root to help ephedra relieve exterior syndrome; If the cough and asthma are severe, almond and Peucedanum praeruptorum can be added to reduce qi and relieve asthma; If you see that sweat is evil and Wei qi is weak, use Ji Fang Huangqi Decoction to help Wei relieve exterior syndrome. If the symptoms and signs are gradually relieved and the weight and edema do not retreat, it can be treated as water-wet immersion type.
Fresh duckweed, regardless of quantity, is decocted and bathed. Used in the early stage of acute nephritis, the whole body is swollen, especially in the head and face. It is better to sweat. Avoid the wind and cold after sweating, and don't catch cold.
Wet poison soaking
Symptoms: skin sores, even ulceration, sore throat, or worm-eaten swelling and pain, followed by eyelid edema, and spread to the whole body, adverse urination, fever due to bad wind, red tongue, thin yellow fur, floating or slippery pulse.
Treatment: It is suitable for lung detoxification, diuresis and detumescence.
Prescription: ephedra, forsythia and red bean soup combined with Wuwei disinfection drink.
Ephedra, almond and catalpa bark (instead of mulberry bark) are used in front to promote lung function and promote diuresis, forsythia is used to clear away heat and dissipate stagnation, and adzuki beans are used to promote diuresis and reduce swelling; Flos Lonicerae, Flos Chrysanthemi Indici, Herba Taraxaci, Herba Violae, and Herba Solani Stellati are used in the rear to enhance the power of eliminating dampness and detoxifying.
If sepsis is very serious, dandelion and viola yedoensis should be reused; If wet and erosive, Radix Sophorae Flavescentis, Rhizoma Smilacis Glabrae and Cortex Phellodendri are added. For those with severe wind itching, Cortex Dictamni and Kochiae Fructus are added; If blood heat is red and swollen, Cortex Moutan and Radix Paeoniae Rubra are added; If the stool is blocked, increase the yellow nitrate.
Water wet impregnation
Symptoms: general edema, short and red urine, physical weakness, chest tightness and abdominal distension, loss of appetite, aversion, white and greasy fur, slow pulse, slow onset and long course of disease.
Treatment: strengthen the spleen and eliminate dampness, and promote yang and diuresis.
Prescription: Ling Wei Soup and Wupi Drink.
Atractylodes macrocephala and Poria are used to strengthen the spleen and eliminate dampness, Atractylodes lancea, Magnolia Officinalis and Pericarpium Citri Tangerinae are used to strengthen the spleen and eliminate dampness, Polyporus umbellatus and Alisma orientalis are used to induce diuresis to reduce swelling, and Cinnamon is used to warm yang and turn qi into water. After that, Cortex Mori, Pericarpium Citri Tangerinae, Pericarpium Arecae, Poria, and Rhizoma Zingiberis Recens were used to invigorate the spleen, eliminate dampness, and promote qi circulation and diuresis. If the upper body is swollen or even wheezing, Herba Ephedrae, Semen Armeniacae Amarum and Semen Lepidii can be added to disperse the lung and drain water, which will cause wheezing.
Stagnation of damp-heat
Symptoms: edema, tense and bright skin, chest tightness and fullness, upset and thirsty, or bitter and sticky mouth, short and red urine, dry stool, red tongue, yellow and greasy fur, and slippery or heavy pulse.
Treatment: divided into damp heat.
Prescription: Shu Chi silver.
Notopterygium root and Gentiana macrophylla in the prescription dispel wind and relieve exterior syndrome, so that the water on exterior syndrome can relieve exterior syndrome; Pericarpium Arecae, Poria, and Rhizoma Zingiberis Recens cooperate with Notopterygii Rhizoma and Radix Gentianae Macrophyllae to remove skin moisture; Alisma orientalis, Akebia Akebia, Zanthoxylum bungeanum, and kidney beans are matched with Phytolacca acinosa and Areca catechu to facilitate defecation and take away the water evil in the house from the bottom. Dredging exterior is beneficial to dredging interior, which helps to dredge exterior, separate exterior from interior, and relieve damp-heat evil, so that swollen heat can be eliminated by itself. If the abdomen is full and the stool is blocked, you can combine Zanthoxylum bungeanum and Huangwan to help stop diarrhea, so that water can be discharged from the stool; If the symptoms are dysuria and hematuria, and the pathogenic damp-heat is poured into the bladder, which hurts blood collaterals, you can add blood-cooling and hemostatic products, such as Cirsium japonicum and imperata rhizome. If the swelling is serious, and you can't lie down with heavy breathing, the pulse is strong, and there is water in your chest, you can use Granule Jujube Xie Fei Decoction combined with Wuling Powder to add almonds, Ji Fang and Akebia, so as to purge the lungs and drain water, and take it up and down; Dampness and heat for a long time will cause dryness and damage yin, with symptoms of dry mouth, dry throat and dry stool. Zhu Ling decoction can be used to nourish yin and promote diuresis.
As for the attack and drainage, it is originally a method to treat yang water, which means "removing ridges and ridges" in Neijing. However, it should be used with caution. It is only suitable for patients with high body edema, asthma, palpitation, ascites, dysuria, constipation or dry stool, aversion to food, heavy and strong pulse and healthy qi. At this time, we must seize the opportunity. If we are in a hurry, we must treat the target, and directly grasp the water potential by combining attack and pursuit, so that the water evil can quickly stay away from defecation. You can use ten jujube soups. Once the flood recedes, we will discuss the adjustment to make it better.
Black and white ugly 65g, brown sugar 125g, ginger 500g, jujube 60g, ground into fine powder or pounded into pills, and taken three times a day. Nephrotic edema has a good effect of eliminating water, but it is not consolidated.
"yin water"
Spleen yang deficiency
Symptoms: body swelling, especially below the waist, depression, abdominal distension, anorexia, dull complexion, listlessness, cold limbs, short and red urine, pale tongue, white greasy or slippery fur, slow or weak pulse.
Treatment: Warming yang and invigorating spleen, regulating qi and promoting diuresis.
Prescription: Shipi drink.
In the prescription, dried ginger, aconite root and Amomum tsao-ko warm the yang to dispel cold and regulate qi, while Atractylodes macrocephala, Poria, Radix Glycyrrhizae Preparata, Ginger and Jujube strengthen the spleen and replenish qi, Pericarpium Arecae, Poria and Fructus Chaenomelis diuresis, and Radix Aucklandiae, Cortex Magnolia Officinalis and Pericarpium Arecae regulate qi and promote blood circulation. Atractylodis Rhizoma, Ramulus Cinnamomi, Polyporus, and Alisma orientalis can be added to patients with excessive dampness, abdominal distension, and short and red urine to enhance the efficacy of regulating qi and diuresis. If the symptoms are fatigue, shortness of breath, and qi deficiency, Radix Astragali and Ginseng can be added to invigorate the spleen and replenish qi.
There is also a kind of edema, which is due to long-term eating disorder, insufficient intake, or weakness of the spleen and stomach, physical activity is reduced, subtle, sallow at first glance, mild edema all over the body, very swollen head and face in the morning, very swollen lower limbs after sitting for a long time, fatigue and fatigue during eating, defecation or defecation, body edema, normal or excessive urination, and weak pulse. This is different from the above-mentioned spleen-yang deficiency and excess water, because the spleen is weak, and it can't clear yang and can't be adjusted. Shen Ling Baizhu Powder can be used for supplementing qi and nourishing yang, strengthening spleen and eliminating dampness. Adding Radix Astragali and Ramulus Cinnamomi to promote qi and yang and eliminate dampness; For patients with yang deficiency, aconite and psoralea corylifolia are added to warm kidney and help yang, so as to strengthen gasification. Moreover, proper attention should be paid to nutrition, and soybeans and peanuts can be used as paving treatments, which can be cured.
Kidney yang decline
Symptoms: facial edema, especially below the waist, palpitation and shortness of breath, cold pain and soreness in the waist, decreased urine output, cold limbs, chills and fatigue, pale or gray face, pale tongue, white fur, deep and thin pulse or delayed weakness.
Treatment: Warming kidney to help yang, transforming qi and benefiting water.
Prescription: Jisheng Shenqi Pill, Zhenwu Decoction.
Kidney is the dirty of fire and water. According to the principle that yin and yang are mutually rooted, those who are good at nourishing yang must seek yang from yin, and then yin helps yang, which is endless in biochemistry. So use Liuwei Dihuang Pill to nourish kidney yin. Using aconite and cinnamon to warm kidney yang, the combination of the two drugs will make water replenish fire and warm kidney yang; Diuretic with Atractylodes macrocephala, Poria, Alisma orientalis and Plantago asiatica; Ginger warms the cold gas; Paeonia lactiflora opens the yin knot to facilitate urination. Achyranthes bidentata leads the medicine downward, reaching the lower coke and strengthening the waist and knees.
If palpitation, astringent lips, pulse deficiency or knot or number are caused by water evil, inhibition of heart yang and blood stasis as internal resistance, it is advisable to reuse Radix Aconiti Lateralis Preparata, and add Ramulus Cinnamomi, Radix Glycyrrhizae Preparata, Radix Salviae Miltiorrhizae and Herba Lycopi to warm yang and remove blood stasis; If palpitation, shortness of breath, fatigue, cold limbs, spontaneous sweating, dark purple tongue, pulse deficiency or stagnation, edema, Zhenwu decoction should be used as the main ingredient, and ginseng, cassia twig, salvia miltiorrhiza and Eupatorium adenophorum should be added. Heart and kidney yang should be warmed to remove blood stasis and promote diuresis. If you see shortness of breath, excessive breathing, less inhalation, sweating, and floating pulse, it is the water evil that affects the lungs and the kidneys. Ginseng, clam, Schisandra chinensis, Cornus officinalis, oyster and keel should be reused to prevent asthma.
This syndrome is lingering, healthy qi is declining day by day, exogenous evil is heavy, and the symptoms are aversion to cold, fever, swelling and short and red urine. At this time, it can be treated according to geomantic omen, but it is necessary to take into account the lack of vital qi and not to use external medicine. Mahuang Fuzi Asarum Decoction combined with Wupi Decoction is the main method, and drugs such as Radix Codonopsis, Radix Astragali and Semen Cuscutae can be added as appropriate to strengthen the body resistance and eliminate pathogens.
If the disease reaches the later stage, the kidney yang will decline for a long time, resulting in deficiency of kidney yin, and symptoms such as repeated edema, fatigue, backache and nocturnal emission, dry mouth and throat, fever due to five annoyances, red tongue with little coating, and rapid pulse appear. Treatment should be based on nourishing kidney and yin, benefiting water and dampness, but nourishing yin should not be too cold and too greasy, and yang should be damaged by waterproof evil. Alisma orientalis and Poria cocos can be added into Zuogui Pill.
If kidney yin deficiency, water without wood, liver and kidney yin deficiency, hyperactivity of liver yang, excess on the upper body and deficiency on the lower body, symptoms such as flushing, dizziness, headache, palpitation and insomnia, backache and nocturnal emission, weakness in walking, or trembling limbs, it is advisable to nourish yin and subdue yang, with Zuogui Pill, mother-of-pearl, oyster, keel and turtle shell as the main products for subduing yang.
Spleen-yang deficiency syndrome and kidney-yang deficiency syndrome often appear at the same time, showing spleen-kidney yang deficiency and excessive water and dampness. Therefore, the two methods of invigorating spleen and warming kidney often go hand in hand, but to distinguish the severity of spleen and kidney deficiency, the treatment should be focused.
Edema lasts for a long time and blood stasis is blocked. Its treatment is often combined with the method of promoting blood circulation and removing blood stasis, which means that blood can be drained. Motherwort, Eupatorium adenophorum, peach kernel and safflower are commonly used in modern clinic. Practice has proved that it can strengthen diuretic effect.
prognosis
Where the course of edema is short, or edema caused by malnutrition, as long as it is treated in time and nursed back to health reasonably, the prognosis is generally good. If the course of the disease is long, it will recur, and it will be difficult to heal if you are in love with deficiency and evil. If the swelling is serious, the symptoms are black lips, uneven pelvis, flat umbilical process, flat feet and flat back, or palpitation, swollen lips, shortness of breath, inability to lie down, and even urinary incontinence and bleeding. These are all very critical. For example, a long illness leads to vital qi failure, turbid pathogens overflowing, foul smell in the mouth, nausea and vomiting; Liver wind moves internally, causing headaches, convulsions and other symptoms, and the prognosis is poor. It is easy to get rid of the syndrome every time, so we should closely observe the changes of the condition and deal with them in time.
Prevention and adjustment
This disease is very edema, so you should eat a salt-free diet. When the swelling gradually subsides, we should gradually change to a low-salt diet and finally return to a normal diet. Avoid spicy, tobacco and alcohol and other irritating foods. If the swelling is caused by malnutrition, it is not necessary to overemphasize avoiding salt, but to eat a nutritious protein diet in moderation. In addition, we should pay attention to health care, don't overwork, especially control the atrium and ventricle to prevent injury, prevent exogenous diseases in daily life, strengthen nursing and avoid bedsores.
Modern research
Renal edema
1. Primary glomerulonephritis
Zhong believes that the pathogenesis of chronic glomerulonephritis is deficiency of both spleen and kidney, damp-heat internal resistance, qi stagnation and blood stasis. 48 cases of edema were treated according to symptoms by establishing Yiqi Bushen Huoxue Decoction. Results 40 cases completely disappeared, 5 cases improved, and the total effective rate was 93.75%. This recipe has a good effect on eliminating proteinuria and improving hematopoietic function, blood pressure and immune function [journal of traditional chinese medicine1993; (10): 6 10) In addition, in recent years, the treatment of glomerulonephritis by stages and types has achieved remarkable results. 420 cases of acute glomerulonephritis were treated with Ye's traditional Chinese medicine, which was divided into two stages according to the course of disease: the peak period of evil and the recovery period. The peak period of pathogenic factors can be divided into wind-heat, damp-heat, wind-cold, cold-dampness syndrome, with eliminating pathogenic factors as the main factor; The recovery period is divided into two types: yang deficiency and qi deficiency. The treatment method is to remove the remaining evil and strengthen the body resistance. Results The clinical cure rate was 83.65438 0%, and the improvement rate was 65438 06.9%. 3 10 cases were followed up for a long time, and most of them were in good condition [journal of traditional chinese medicine1993; (7): 12)。
2. Nephrotic syndrome
Lu et al. conducted a series of clinical and animal experiments on the treatment of nephrotic syndrome with Huangqi Danggui mixture (two equal parts), and found that although the mixture could not directly reduce urine protein, it could promote the synthesis of liver albumin and skeletal muscle protein, thus improving hypoalbuminemia and overall protein reserve under the condition of massive proteinuria in nephrotic syndrome, thus playing a therapeutic role in nephrotic syndrome. Through the experimental observation of experimental wooden mouse nephrotic syndrome model, Huangqi Danggui mixture can not only reduce cholesterol and triglyceride, but also reduce low density lipoprotein and apolipoprotein cholesterol. Nephrology and immunohistochemistry confirmed that the crystal reduced lipid and glomerular sclerosis index (P
cardiogenic edema
In recent years, Chinese medicine has explored the treatment of congestive heart failure and edema caused by it in many aspects. For example, "Shen Shi" treated 60 cases of congestive heart failure with high dose of Wanfu Fang Jia [Wannian Qing, Fuzi (decocted first) and Lepidium], and the effective rate was 88.93%[ journal of traditional chinese medicine, Zhejiang1990; (5): 195) zhangxin used Qiangxin decoction to treat 50 cases of chronic congestive heart failure, with a total effective rate of 94% [journal of traditional chinese medicine, Zhejiang 1992]. (9):387)。 Jiang believes that heart and kidney are related to heart failure in the elderly, the pathological factor is blood stasis, the pathogenesis is yang deficiency and weak qi, and water stops bleeding and blood stasis. The treatment effect of simple western medicine is poor. 72 cases were treated with Yishen Huoxue decoction combined with small dose of western medicine, and the effective rate was 69.4%. He thinks that the combination of traditional Chinese and western medicine can control senile heart failure quickly with few side effects [journal of traditional chinese medicine1993; (2):95)。 Liang et al. discussed the ideas and methods of treating congestive heart failure with traditional Chinese medicine, and thought that traditional Chinese medicine was effective in treating heart failure, especially for patients with latent heart failure, refractory heart failure and digitalis poisoning, showing its unique advantages. In the treatment of heart failure, we should emphasize syndrome differentiation, but don't ignore the reference significance of western medicine in disease differentiation. Making full use of various detection methods of modern medicine to accurately identify the basic pathological changes of heart failure can not only judge the prognosis and curative effect, but also avoid blindness and reduce mistakes, so that therapeutic drugs have certain rules to follow. Generally speaking, the indications of traditional Chinese medicine in treating heart failure are mostly patients with degree II heart failure, and patients with degree III heart failure and refractory heart failure advocate the treatment of integrated traditional Chinese and western medicine. Especially in case of emergency, western medicine should be used first to save the emergency, so as not to delay the illness. Heart failure is located in the heart, but not limited to the heart. Heart disease can affect organs such as lung, spleen, kidney and liver for a long time. On the contrary, other visceral diseases will also affect the heart and evolve into heart-qi, heart-yang deficiency or heart-yang deficiency, blood stasis and so on. For example, cor pulmonale and heart failure are caused by prolonged lung diseases, which affect the spleen, kidney and heart, and produce symptoms such as cough and asthma, phlegm retention, palpitation and edema. At this time, the lung, spleen and kidney are deficient, the heart and yang are involved, and qi and blood are exhausted. Besides warming Tongxinyang, promoting blood circulation and removing blood stasis, we should also pay attention to warming kidney, invigorating spleen and promoting diuresis, purging lung and relieving asthma. Zhenwu Decoction plus Ramulus Cinnamomi, Radix Astragali, Semen Persicae, Carthami Flos, Radix Salviae Miltiorrhizae, Lumbricus, and Semen Lepidii is often used to treat cor pulmonale and heart failure. Clinical observation has obvious curative effect on improving cardiopulmonary function and anti-infection ability of the body. Heart failure is caused by a long illness, and it is a syndrome of deficiency and excess. Deficiency of heart-qi and heart-yang is the pathological basis, blood stasis is the central pathological link, and blood stasis, phlegm turbidity and drinking water are the empirical symptoms. Because blood stasis, phlegm turbidity, drinking water and other evils are produced on the basis of deficiency of viscera, it can be seen that they are caused by insufficient essence. Therefore, the emphasis on treatment is to strengthen the healthy energy and consolidate the foundation, and we must never blindly attack and chase, which will hurt the healthy energy. The whole process of heart failure is often accompanied by blood stasis. Therefore, the treatment of heart failure should pay attention to promoting blood circulation and removing blood stasis. On the basis of strengthening the body resistance, combined with different basic diseases and pathological mechanisms of heart failure, drugs should be selected in a targeted manner. If rheumatic heart disease occurs, peach kernel, safflower, Spatholobus suberectus and hematoxylin are commonly used to promote blood circulation, remove blood stasis and dredge collaterals. On the basis of deeply understanding the etiology, pathology and pathogenesis of heart failure, it will be better and more accurate to analyze and discuss the theory of traditional Chinese and western medicine, seek the combination point and guide medication. For example, some patients with heart failure received digital treatment, resulting in digital poisoning and conduction block. At this time, on the premise of basic syndrome differentiation, commonly used drugs such as Epimedium, Rhizoma Curculiginis, Asari, Herba Ephedrae and Notoginseng can improve the conduction block [journal of traditional chinese medicine1998; 39(4):242]。