Friday, May 26, 2017

GENERALISED VIEW ON OEDEMA

A condition when there is an abnormal accumulation of fluid in the interstitium, located beneath the skin and in the cavities of the body, which may cause severe pain has been called as oedema. Its common manifestation is a swelling wherein the amount of interstitial fluid can be determined by the balance of fluid homeostasis; and the increased secretion of fluid into the interstitium. It has been broadly classified as - Cutaneous oedema or "pitting oedema" & Non-Pitting Oedema.
Grading of edema
Absent Absent
Grade + Mild: Both feet / ankles
Grade ++ Moderate: Both feet,
plus lower legs,
hands or lower arms
Grade +++ Severe: Generalised
bilateral pitting edema,
including both feet,
legs, arms and face
A low plasma oncotic pressure is widely cited for the edema of nephrotic syndrome, most physicians note that the edema may occur before proteinuria is noticed or fall in plasma protein level is noticed. In accordance with the ayurvedic view it is important to understand the sheathed environment where oedema occurs. The environment is mainly lipoproteinous in the sense of it being surrounded and made up of lipoprotein. Proteins in the Ayurvedic context may be interpreted as (Prithvi+Agni+Akash). It may be considered that Vata and Jal due to induction of microvascular injuries take the place of Akash and combine with Prithvi to create a stiff and lesioned site with rubour; in progressive state Prithvi is reduced and Agni is replaced with Jal component which is increased. In this condition prakruti tends to shift towards parthivo-jalaja which will retain water and hence impair drainage across the channels, thereby causing oedema. The classic point here to be noted stands along three factors –
Loss of heat symbolic of reduced pitta
Increase of jal symbolic of increasing kapha
Reduced pain symbolic of sedative property of shleshma which prevents vata prasar which again points towards increasing kapha and hence water retention presenting as oedema.
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