The loss of body fluids is the most compensatory ability in the human body. The so-called compensatory function of human body, also known as "compensatory action", refers to a physiological or pathological phenomenon that needs to be adapted or compensated by strengthening the function of an organ or tissue. Let's take a look at the loss of body fluids in the human body.

The human body has the strongest compensation ability for body fluid loss 1 Modern medicine believes that the human body has a powerful compensation function. Physiologically, for example, the tactile function and auditory function of the fingers of the blind are often different from those of ordinary people. The limbs muscles of manual workers tend to become hypertrophy and strong because they meet the needs of labor, and their contractility is strengthened.

Pathologically, patients with mild acidosis often achieve acid-base balance in the body by deepening and accelerating compensatory breathing; Patients with arterial trunk obstruction usually compensate for blood supply by expanding collateral circulation ... It can be said that the compensation function of human body participates in almost all physiological and pathological processes of human body.

Theoretically speaking, such a powerful compensatory function of human body will inevitably have a great influence on the cognitive diseases and treatment methods of traditional Chinese medicine.

Limited by the historical and realistic medical environment, TCM has gradually come down from the past "syndrome differentiation and treatment" to the present "syndrome differentiation and treatment". However, it is debatable whether the compensatory function of human body is considered in the process of syndrome differentiation and treatment.

For example, the author searched Neijing and Treatise on Febrile Diseases and found no description of the disease. Then, damp-heat syndrome should be a supplement to TCM theory in later generations (a theory first appeared in Jing's damp-heat). The crux of the problem is, what is the etiology and pathogenesis of damp-heat syndrome? Using the theory of "correspondence between man and nature" in traditional Chinese medicine, the author seems to have found the answer:

First, both damp and heat cause diseases, such as "heatstroke" in a damp and hot environment; Second, dampness causes disease and stagnation of fire, which is mostly attributed to damp-heat syndrome of liver and gallbladder in traditional Chinese medicine. Both views regard "heat" as "heat evil". However, based on the compensatory function of human body and the theory of correspondence between man and nature, there may be a third explanation: "heat" is a pathological compensatory state of human body to dampness evil, and its principle is to achieve the purpose of eliminating dampness by causing human body to heat.

The above viewpoint can be proved by the understanding of "exogenous cold" in traditional Chinese medicine. Mahuang Decoction in Treatise on Febrile Diseases is mainly used to treat headache, fever, body pain, low back pain, joint pain, bad wind, asthma and anhidrosis. Describe the symptoms caused by exogenous wind-cold and its treatment. There are two key issues in this description that deserve attention:

First, why does exogenous cold cause fever; Second, since you have a fever, why are you still treated with Xinwen drugs? Modern medicine believes that fever caused by exogenous wind-cold in traditional Chinese medicine is a series of physiological and biochemical reactions after human body is infected with pathogenic microorganisms such as bacteria and viruses or their products, thus stimulating human immune system, promoting blood circulation and achieving the purpose of anti-toxin and detoxification.

In this process, the increase of body temperature is actually the embodiment of human compensatory function. Therefore, as long as the body temperature is controlled within a certain range, modern medicine does not advocate immediate "antipyretic" treatment. This is more clear to Chinese medicine. Traditional Chinese medicine believes that "heat" caused by exogenous wind-cold belongs to "standard" syndrome. In the course of treatment, instead of "clearing away heat", spicy drugs are used to help yang dispel cold. Therefore, the compensatory function of human body can be summarized as the category of TCM's understanding of disease targets and essence.

The author believes that due to the lack of attention to this function, there may be many misunderstandings in the clinical diagnosis and treatment of modern Chinese medicine. In addition to the above-mentioned "damp-heat" syndrome, other symptoms, such as yin damaging yang and damp-heat diarrhea, may be the concrete embodiment of human compensatory function. Yang deficiency may be the result of the balance between yin and yang, and diarrhea may be the compensatory function of the body to eliminate damp heat. At this time, simply tonifying yang or stopping diarrhea may not achieve the therapeutic purpose, but will aggravate the condition.

The theory of human compensatory function and the correspondence between man and nature seems to explain two problems faced by TCM:

First, it can explain or integrate the theories of various academic schools of traditional Chinese medicine. For example, "damp heat in middle energizer": the theory of Vulcan school is to further apply warm drugs to help yang dry dampness; The theory of attacking faction is to benefit water and eliminate dampness, so that the heat will be exhausted; The theory of Wentong School is that when moisture evaporates, heat will disappear. All three methods can achieve the purpose of eliminating "damp heat".

Second, it can explain many scholars' doubts about syndrome differentiation and treatment: many scholars have found in clinical practice that when the symptoms of patients basically conform to the description of a certain item in Treatise on Febrile Diseases, direct application of classical prescriptions will often achieve good clinical efficacy, but the treatment process may be quite different from the results of syndrome differentiation and treatment.

Based on the above considerations, the author believes that in the clinical practice of traditional Chinese medicine, the influence of human compensatory function on syndrome differentiation results should be considered, so as to establish a more accurate "treatment" method.

The human body has the strongest ability to compensate for the loss of body fluids. Dehydration refers to the loss of a large amount of body fluids in a short period of time. The most common causes are severe diarrhea and hyperhidrosis, and the intake is seriously insufficient. Hypertonic dehydration is equivalent to losing 10% of human body weight. At this time, the skin elasticity is poor, the color is dark, the eye socket is deep, the eyes are difficult to close, there are no tears, and the oral mucosa is extremely dry. Poor mental state, indifferent expression, disturbance of consciousness, lethargy and even coma. In severe cases, limbs are cold, oliguria or anuria, heart rate increases, blood pressure drops, and shock symptoms appear.

Shock is a pathophysiological process that occurs when various harmful factors attack, which is characterized by decreased effective circulating blood volume and insufficient tissue perfusion, and then cell metabolism and dysfunction and organ dysfunction occur. Its development and prognosis depend on many factors, such as whether the pathogenic factors can be controlled in time and effectively, whether the treatment is timely and appropriate, and the severity of the function damage of important organs.

The development of shock has stages, which can be divided into compensatory period (ischemia and hypoxia period), reversible decompensation period (stasis and hypoxia period) and refractory period (irreversible period). Or it can be divided into prophase, metaphase and anaphase (near-death period), and there is no clear objective standard to distinguish between them. Generally speaking, if it is found early and treated in time, the shock will be easily reversed, otherwise it will leave the function of important organs or lead to death.

With the development of medical science and technology and the deepening of research level, the understanding of the pathogenesis of shock has entered the cellular, subcellular and molecular level from microcirculation, and a new and deeper understanding of the metabolic dysfunction of cells during shock has been obtained. Many new theories and understandings have been put forward, and new progress has been made in the treatment of shock.

The human body has the strongest ability to compensate for the loss of body fluids. 3. The cause of shock.

Shock is a systemic critical pathological process caused by powerful pathogenic factors acting on the body. Common reasons are:

(1) Blood loss and body fluid loss

1. Massive blood loss can cause hemorrhagic shock, which can be seen in trauma, gastric ulcer bleeding, esophageal variceal bleeding and postpartum hemorrhage. The occurrence of shock depends on the speed and amount of blood loss. Generally, when the blood loss is less than 10% of the whole body blood volume within 15 minutes, the body can maintain the stability of blood pressure and tissue perfusion through compensation. If the rapid blood loss exceeds about 20% of the total blood volume, it can cause shock; More than 50% of the total blood volume often leads to rapid death.

2. The loss of body fluids caused by severe vomiting, diarrhea, intestinal obstruction and sweating will also lead to a sharp decline in effective circulating blood volume.

(2) Burn

Large-scale burns with a large amount of plasma loss can lead to burn shock. Burn shock is related to pain and hypovolemia in the early stage, and can be secondary to infection and develop into septic shock in the later stage.

(3) trauma

Severe trauma can lead to traumatic shock. Especially in wartime, this kind of shock is related to pain and blood loss.

The above three kinds of shock all reduce the effective blood volume, which is collectively called hypovolemic shock.

(4) Infection

Severe infection, especially gram-negative bacterial infection, can often cause septic shock. Bacterial endotoxin plays an important role in shock caused by gram-negative bacteria. Intravenous injection of endotoxin can cause endotoxin shock. Septic shock is often accompanied by sepsis, so it is also called septic shock. Septic shock can be divided into two types according to hemodynamic characteristics: hypodynamic shock and hyperdynamic shock.

(5) Allergy

Injecting certain drugs (such as penicillin), serum preparations or vaccines into people with allergic constitution can cause anaphylactic shock, which belongs to type I allergic reaction. The pathogenesis is related to the combination of IgE and mast cell surface antigen, which leads to the release of histamine and bradykinin into the blood, the expansion of vascular bed volume and the increase of capillary permeability.

Anaphylactic shock and septic shock both increase the volume of vascular bed. In septic shock, blood cells adhere, leading to microcirculation stagnation. In hyperkinetic septic shock and anaphylactic shock, blood vessels dilate, the area of vascular bed increases, and the effective circulating blood volume is relatively insufficient, which leads to the decrease of tissue perfusion and blood return.

(vi) Acute heart failure

Large-scale acute myocardial infarction, acute myocarditis, pericardial tamponade and severe arrhythmia (atrial fibrillation, ventricular fibrillation) cause a significant decrease in cardiac output, effective circulating blood volume and perfusion volume, which is called cardiogenic shock.

(7) Strong nerve stimulation

Severe pain, high spinal anesthesia or injury can cause neurogenic shock.

Second, the classification of shock

The commonly used classification method is based on the etiology and the initial link of occurrence.

(a) according to the etiology of classification

1, hemorrhagic shock.

2. Burn shock

3. Traumatic shock

4. Septic shock

5. Anaphylactic shock.

6. Cardiogenic shock

7. Neurotic shock

(2) According to the initial stage of shock.

1, hypovolemic shock is seen in blood loss, fluid loss, burns or trauma. Decreased blood volume leads to insufficient venous return, decreased cardiac output and decreased blood pressure. Due to the inhibition of decompression reflex, sympathetic nerve is excited, peripheral blood vessels contract and tissue perfusion is further reduced.

2. In vascular shock anaphylactic shock, due to the action of histamine, kinin, complement and slow reaction substances, the posterior arteriole expands, the venule contracts, the microcirculation stagnates and the permeability increases. Hyperdynamic septic shock,

Because vasodilators are more effective than vasoconstrictors, they cause hemodynamic characteristics of high output and low resistance. Neurogenic shock is caused by anesthesia or injury and intense pain stimulation that inhibits sympathetic vasoconstriction, resulting in transient vasodilation and blood pressure drop. At this time, microcirculation perfusion may not be significantly reduced. Some people think that this is not a real shock.

3. Cardiogenic shock Cardiogenic shock is a shock caused by acute heart pump failure or severe arrhythmia, which is common in large-scale acute myocardial infarction, heart surgery, heart ischemia-reperfusion injury, etc. Cardiogenic shock has a sudden onset, high mortality and poor prognosis.