The classification methods of edema are as follows: ① According to the degree of edema, it can be divided into systemic edema (systemic edema) and local edema; (2) according to the location of edema, such as brain edema, laryngeal edema, pulmonary edema, lower extremity edema, etc. ③ According to the causes of edema, it can be divided into cardiac edema, renal edema, hepatic edema, inflammatory edema, malnutrition edema, lymphatic edema, idiopathic edema (unknown cause) and so on.
1. Systemic edema
According to its etiology, it can be divided into the following categories:
(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: It is common in viral hepatitis and liver cirrhosis.
(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) Others: anemic edema and toxic edema during pregnancy.
most
Edema refers to water and liquid staying in the body, causing edema in the head, face, eyelids, limbs, abdomen, back and even the whole body. Edema is a manifestation of systemic qi disorder, which is closely related to lung, spleen, kidney and triple energizer. According to the different symptoms, it can be divided into yang water and yin water, which are common in nephritis, cor pulmonale, liver cirrhosis, malnutrition and endocrine disorders.
Pathogenesis of medical records
(1) Rheumatism invades from the outside, stays in the lungs, the lungs do not fall, the waterways are blocked, and water overflows the skin, resulting in edema.
(2) Dietary fatigue, injury to the spleen and stomach, transport disorder, stagnant water, skin overflow and edema.
(3) Overworking the house will hurt the kidney internally, so that qi can't be converted into water, and when it is wet, water will remain, and when it overflows, it will be swollen.
Syndrome differentiation treatment
(A) Yang water
Main symptoms: acute onset, slight swelling of the face at first, then swelling of the whole body, bright skin, bright vulvar cyst, chest tightness and shortness of breath. Or cold without sweat, white and slippery fur, tight pulse; Or sore throat, thin yellow fur and floating pulse.
Treatment: mainly take points of lung and spleen meridians. Acupuncture is used to tonify deficiency and stop diarrhea, to disperse lung and relieve exterior syndrome, and to promote diuresis and diuresis; When exogenous pathogenic factors retreat, it is advisable to treat them with yin water.
Prescription: Legqog Hegu Tablet Li Yinling Dog Stomach Ulcer
Fang Yi: Yang-water is a kind of disease, which is caused by lung qi failing to declare and water dampness stopping inside. Swelling above the waist is suitable for sweating, and it is necessary to take Lieque, Hegu to sweat and relax muscles and dredge lung qi. Swelling below the waist is beneficial to urination, so taking Pianli and Yinlingquan to facilitate urination to eliminate edema; Weiyang is the point where the triple energizer meets the lower energizer, which can adjust the gasification function of the triple energizer and eliminate edema.
(2) Yin water
The main symptoms: slow onset, tarsal edema gradually reaching the whole body, body swelling, especially below the waist, and a concave shape, and slow recovery, dull skin, short urine. Or abdominal distension, loose stool, weakness of limbs, white and greasy tongue coating and slow pulse; Or backache and leg weakness, chills and cold limbs, mental fatigue, pale tongue with white fur, heavy and thin pulse and weakness.
Treatment: Points of Foot Taiyin and Shaoyin Meridian are the main points. Acupuncture supplemented with moxibustion can warm spleen and kidney, promote diuresis and reduce swelling.
Prescription: the moisture in spleen and kidney will return to Guanyuan Sanyinjiao.
Fang Yi; Yin-water is caused by yang deficiency of spleen and kidney. Acupuncture at Pi Shu, Shen Shu and Fu Liu can warm spleen and kidney yang and promote the gasification of triple energizer. Moxibustion is beneficial to water and eliminates edema; Moxibustion Guan Yuanpei tonifies the yuan, and the temperature supplements the lower coke; Tonifying Sanyinjiao, invigorating spleen and promoting diuresis.
Other therapies
Auricular acupuncture
Acupoints: lung, spleen and kidney under the bladder cortex of triple energizer.
Methods: Take 2-3 acupoints at a time and moderately stimulate them every other day. You can also bury beans in ear acupuncture points.
2. Localized edema
(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) Allergic edema: common in angioneurotic edema and contact dermatitis.
food therapy
(1) Corn Stigma and Imperata rhizome drink: 50g of corn Stigma and 50g of Imperata rhizome, decocted in soup, with appropriate amount of sugar, and taken in batches. Water suitable for the sun.
(2) Red bean carp soup: 60g red bean, carp 1 strip (intestine removed), ginger10g, * * * stew soup, no salt, fish and soup. Suitable for yin water.
(3) Astragalus thin broth: 60 grams of Astragalus, appropriate amount of lean meat, * * * soup, no salt, eat meat and drink soup. Suitable for yin water.
[Edit this paragraph] The pathogenesis of edema
Under physiological conditions, the human body's interstitial fluid is in constant exchange and renewal, but the amount of interstitial fluid is relatively constant. The maintenance of constant fluid volume between tissues depends on the balance of fluid exchange inside and outside blood vessels and the balance of fluid exchange inside and outside the body. If these two kinds of balance are broken, it may lead to excessive body fluid accumulation in tissue space or body cavity.
First, the imbalance of fluid exchange inside and outside blood vessels leads to the increase of interstitial fluid.
The factors leading to the imbalance of fluid exchange inside and outside blood vessels are:
1. Capillary hydrostatic pressure increases.
The main reason for the increase of capillary hydrostatic pressure is the increase of venous pressure, which is caused by the following factors:
① Cardiac insufficiency: Right cardiac insufficiency blocks the reflux of superior and inferior vena cava, which increases systemic venous pressure, which is an important cause of cardiogenic edema; Left ventricular dysfunction hinders pulmonary venous return and increases pressure, which is an important cause of pulmonary edema.
② Thrombosis or embolism and tumor compression can increase local venous pressure and form local edema.
③ The increase of blood volume can also cause the increase of capillary hydrostatic pressure. The increase of capillary hydrostatic pressure will lead to the increase of effective hydrostatic pressure, average actual filtration pressure and interstitial fluid output.
2. Plasma colloid osmotic pressure is decreased.
The decrease of plasma colloid osmotic pressure is due to the decrease of plasma protein. Albumin is the most important factor to determine the plasma colloid osmotic pressure. Causes of albumin decrease:
① The reduction of synthesis can be seen in the lack of synthetic raw materials caused by malnutrition or the low ability to synthesize albumin caused by severe liver dysfunction.
② Loss is more common in nephrotic syndrome. Due to the serious damage of glomerular basement membrane, a large amount of albumin is lost from urine.
③ The catabolism of albumin is enhanced by the increase of malignant tumor and chronic infection.
(4) Hemodilution is seen in the retention of sodium and water in the body or excessive non-colloidal solution input, thus reducing the plasma albumin concentration. The decrease of plasma colloid osmotic pressure leads to the decrease of effective colloid osmotic pressure, and the increase of average actual filtration pressure leads to the increase of interstitial fluid production.
3. The permeability of microvascular wall is increased.
Common in inflammation, hypoxia, acidosis and so on. Because the concentration of plasma protein is much higher than that of interstitial fluid, the increase of microvessel wall permeability makes plasma protein penetrate into interstitial fluid, which leads to the decrease of plasma colloid osmotic pressure, the increase of interstitial fluid colloid osmotic pressure, the decrease of effective colloid osmotic pressure and the increase of average actual filtration pressure. This edema fluid has a high protein content, which can reach 30g/L-60g/L, and is called exudate.
The above three factors lead to the increase of interstitial fluid. At this time, lymphatic reflux can be compensated. If the increase of tissue fluid exceeds the compensatory ability of lymphatic reflux, excessive body fluid can accumulate in the stroma, leading to edema.
4. Lymphatic reflux is blocked
Found in filariasis, tumors, etc. In filariasis, a large number of adults block lymphatic vessels; Some malignant tumors can invade and block lymphatic vessels, and tumors can also compress lymphatic vessels; In radical mastectomy, a large number of lymphatic vessels are removed, which will lead to the obstruction of lymphatic reflux. Lymphatic reflux is an important factor against edema because it has great potential. When the amount of tissue fluid is increased to a critical value, lymphatic reflux can be increased by 10-50 times, and then obvious concave edema will appear. In addition, lymphatic reflux is also the only way for interstitial protein to return to the blood, which can reduce the osmotic pressure of interstitial fluid. When the pressure increases due to the increase of interstitial fluid, part of the fluid can flow back through the capillary, while protein remains in the interstitial fluid, so the content of protein in the edema fluid is high (see Figure 6-2), which can reach 40g /L -50g /L L. Compared with the inflammatory exudate, this edema fluid is sterile and has fewer cells. Protein is mostly small molecular protein, and there is no high molecular weight protein such as fibrinogen.
Second, the imbalance of internal and external liquid exchange leads to sodium and water retention.
Under normal circumstances, the intake and discharge of sodium and water maintain a dynamic balance, thus keeping the volume of extracellular fluid constant. Kidney is the main organ that excretes sodium and water, which can be regulated, so it plays an important role in maintaining the volume of extracellular fluid.
Various reasons reduce the excretion of sodium and water in the kidney, resulting in the total intake of sodium and water being greater than the excretion, so sodium and water retention occurs in the body. There may be three types of renal sodium excretion and water reduction: ① GFR reduction, no renal tubular reabsorption; ② The glomerular filtration rate remained unchanged and renal tubular reabsorption increased; ③ The decrease of glomerular filtration rate is accompanied by the increase of renal tubular reabsorption.
1.GFR decreased.
(1) Diseases of the kidney itself: Some kidney diseases make the kidney's ability to excrete sodium and water low, such as acute glomerulonephritis. Due to the swelling of capillary endothelial cells, thrombus is formed in capillary lumen, and inflammatory exudate and proliferating cells (including mesangial cells and endothelial cells) press capillary, which makes capillary narrow or even occluded and reduces renal blood flow. Fibrin and cells accumulate in the glomerular capsule cavity, forming a large number of crescent bodies and blocking the glomerular capsule cavity; Both reduce GFR. In chronic glomerulonephritis and chronic renal failure, a large number of nephrons are destroyed, and the number of nephrons with filtration function is obviously reduced, which reduces the filtration area and GFR.
(2) Decreased effective circulating blood volume: seen in congestive heart failure, nephrotic syndrome, ascites due to liver cirrhosis and malnutrition. The decrease of effective circulating blood volume reduces renal blood flow, and at the same time, due to the corresponding decrease of arterial blood pressure, the sympathetic-adrenal medullary system is excited through the baroreceptors of carotid sinus and aortic arch, which leads to the contraction of renal blood vessels and further reduces renal blood flow. The decrease of renal blood flow weakens the stimulation of afferent arteriole baroreceptors, causes the activation of renin-angiotensin system, further constricts renal blood vessels, and leads to the decrease of GFR.
2. The reabsorption of sodium and water by renal tubules is increased.
Under physiological conditions, 99%-99.5% of sodium and water filtered from glomerulus are reabsorbed by renal tubules. Therefore, in most cases, the increase of renal tubular reabsorption plays a more important role in sodium and water retention. The factors leading to the increase of sodium and water reabsorption are:
(1) filtration score increased:
Filtration fraction (FF) refers to the ratio of glomerular filtration rate to renal plasma flow, which is usually about 20% (120/600). When the effective circulating blood volume decreases, the renal plasma flow and glomerular filtration rate decrease. Generally, the renal plasma flow decreases by about 50%, but the GFR decrease is not as significant as the former. This is because the output arteriole contracts more than the input arteriole. Suppose that it decreases from 65,438+0.20 ml/min to 90ml/min, and FF increases from 20% to 30% (90/300). The increase of FF means the increase of non-colloidal body fluid filtered out by glomerulus. In this way, the hydrostatic pressure of capillaries around the proximal convoluted tubule decreases, and the plasma colloid osmotic pressure increases, thus promoting the reabsorption of sodium and water by the proximal convoluted tubule.
(2) Decreased atrial natriuretic peptide:
Atrial natriuretic peptide is a peptide hormone consisting of 265,438+0 ~ 35 amino acid residues. It can inhibit the reabsorption of sodium and the release of aldosterone and ADH in proximal convoluted tubule, thus promoting the excretion of sodium and water. When the effective circulating blood volume decreases, the excitability of atrial traction receptor decreases, the secretion of ANP decreases, and the sodium and water reabsorbed by proximal convoluted tubule increases. At the same time, the inhibition of aldosterone and ADH release is weakened, which aggravates sodium and water retention.
(3) renal blood flow redistribution:
Physiologically, 90% of renal blood flow enters cortical nephron. The decrease of effective circulating blood volume causes the excitement of sympathetic-adrenal medullary system and the activation of renin-angiotensin system, which leads to renal vasoconstriction. Because the afferent arterioles of cortical nephron are sensitive to catecholamine, the blood flow of cortical nephron is obviously reduced, and the blood flow through proximal nephron is increased. This change is called renal blood flow redistribution. Because the medullary loop of the proximal nephron is thin and long, it goes deep into the intramedullary hyperosmotic area and is accompanied by straight small blood vessels, so its renal tubule has strong ability to reabsorb sodium and water. Due to the increase of blood flow near medullary nephron, the reabsorption of sodium and water by medullary loop increases.
(4) Aldosterone and ADH increased:
When the effective circulating blood volume decreases and the renin-angiotensin-aldosterone system (RAAS) is activated, aldosterone and ADH secretion increase, and severe liver diseases can also reduce their inactivation.
[Edit this paragraph] The characteristics of edema and its influence on the body.
First, the performance characteristics of subcutaneous edema
1. Indentation edema
When excessive body fluids accumulate in the subcutaneous tissue space, the skin becomes pale, swollen, wrinkles become shallow, local temperature is low, and elasticity is poor. If you press a part of the skin with your fingers (such as the medial malleolus, anterior tibial region or frontozygomatic region), if there is a depression, it is called concave edema or frank edema. After the finger is released, it takes several seconds to 1 minute to calm down. This is because there is a lot of free water in the subcutaneous tissue gap when there is concave edema. Because pressing increases the local pressure, free water moves to a lower pressure, so low pressure occurs. After the finger is released, the time when the free water returns to its original position is the time when the depression subsides.
2. Recessive edema
In fact, before the obvious concave edema appeared, the liquid in the gap had increased, but there was no depression in the compressed part. This condition is called "latent edema". This is because the liquid is absorbed by the gel net in the gap and becomes the bound water in the gel state. Only when the liquid in the gap increases and the water pressure between tissues increases from -0.87kPa (-6.5mmHg) to above 0kPa (0mmHg), the free water in the gap will increase obviously.
Second, the characteristics of systemic edema
1. Decreased urine output and increased weight.
Common systemic edema includes cardiogenic edema, hepatogenic edema and nephrogenic edema, and sodium and water retention is an important intermediate link of these edema. Because the basic mechanism of sodium and water retention is renal sodium excretion and water reduction, patients often show decreased urine volume, low urine sodium content (except in oliguria stage of renal failure) and weight gain. Weight gain is caused by a significant increase in the volume of extracellular fluid. Because the sodium water retention is as high as several liters, and the body weight increases 10%, there may still be no obvious concave edema. Therefore, urine volume and urine volume are sensitive indicators of edema. Observing the dynamic changes of urine volume and weight can reflect the growth and decline of edema.
2. Edema caused by different reasons has different distribution parts.
Cardiogenic edema caused by right ventricular dysfunction first appears in the low hanging part of the body. When standing and sitting, edema at the ankle first appears; In supine position, edema first appears in the sacrum. The edema caused by liver cirrhosis is mainly ascites. Renal edema is manifested as eyelid edema in the morning and can also spread to the face. When the disease worsens, systemic edema may occur. The factors affecting the distribution characteristics of edema are:
① Gravity and posture: If the right heart fails, edema will appear in the lowest part. This is because when the right heart fails, the reflux of the superior and inferior vena cava is blocked and the venous pressure is increased, which leads to the increase of capillary hydrostatic pressure. Capillary hydrostatic pressure is also affected by gravity, and the capillary pressure in the lowest part is higher, so edema first appears in the lowest part.
② Local hemodynamic factors: For example, liver cirrhosis leads to the obstruction of hepatic venous return, which increases the hepatic venous pressure and its capillary hydrostatic pressure and becomes an important cause of ascites.
③ Characteristics of tissue structure: the eyelid tissue is loose, the skin is thin and stretched, the pressure between tissues is low, and edema fluid is easy to gather here. Renal edema does not exist due to the increase of capillary hydrostatic pressure. In the supine state at night, edema fluid accumulates in the eyelid with loose tissue, and edema is more obvious in the morning.
Third, the effect of edema on the body.
Edema has many adverse effects on the body, which depends on the location, degree, occurrence speed and duration of edema.
1. Cytodystrophy
Excessive liquid accumulation in the stroma increases the distance between tissue cells and capillaries and prolongs the transportation time of oxygen and nutrients; The accumulation of edema fluid will also compress local capillaries, leading to decreased blood flow and cell malnutrition. The edema site is prone to tissue damage and ulcer, which is not easy to heal.
2. Organ dysfunction
Edema can lead to dysfunction of corresponding organs, such as gastrointestinal mucosal edema can affect digestion and absorption, pulmonary edema can cause respiratory dysfunction, pericardial effusion can affect heart pumping function, laryngeal edema can cause airway obstruction and even suffocation, and brain edema can cause intracranial pressure to increase and even form cerebral hernia, which is life-threatening. If the rapid occurrence of edema in important organs is harmful, but the slow occurrence of edema in non-critical parts, such as limb edema, may not have much impact on the body.
[Edit this paragraph] Interpretation of traditional Chinese medicine:
Edema, name of disease. My body is wet, and my face, limbs, chest and abdomen and even my whole body are swollen. Su Wenshui's theory of blood: "Therefore, lung asthma, kidney edema, lung can not lie down, and points are lost, both of which are left by moisture." In ancient times, it was also called water, water vapor and water disease. Synopsis of the Golden Chamber: The pulse syndrome of water-gas disease can be divided into Fengshui, Shui Pi, Zhengshui and Shi Shui. It is also divided into five internal organs: upset water, lung water, liver water, spleen water and kidney water. Later generations are divided into yang water and yin water. "Danxi Heart Edema": "If the body is swollen and thirsty, the urine is red and astringent, and the stool is blocked, this is yang water. Drink with five skins or four grinds first, add grinding to produce bitter orange, and then dilute the water. If the whole body is swollen and not thirsty, loose stool, the urine is not astringent or red. This is yin water, so you should drink spleen or wood flow. " Edema is closely related to spleen, lung and kidney. "Jing Yue Quan Shu Treating Edema": "Lung deficiency will vaporize water but not essence, while spleen deficiency will soil water but not gram. Kidney deficiency makes the water act rashly without the owner. If the water does not return to the meridian, it will go against the upper, so it will enter the spleen and the flesh will swell, and it will be short of breath when entering the lungs. " The treatment principle of edema in synopsis of the golden chamber is: "If there is water, those who are swollen below the waist should urinate;" If it is swollen above the waist, you should sweat. "The empirical evidence is mostly the invasion of external evils, and the qi activity is abnormal. Treatment should mainly be to eliminate pathogens. Dispelling wind and dispersing lung, promoting diuresis and inducing diuresis, and using Mahuang Forsythia Red Bean Decoction, Yuemecca Decoction and Wuling Powder. Deficiency syndrome is mostly caused by yang deficiency of spleen and kidney, which can not transport water and dampness. Treatment should be based on strengthening the body resistance, combined with prescriptions such as warming kidney and strengthening spleen, benefiting qi and activating yang, Zhenwu decoction and Lizhong decoction. Also pay attention to the care of diet and daily life, such as taboo, beware of colds and so on. Look at Feng Shui, Shi Shui, positive water, skin water, internal water and gas water.