Introduction to Thromboembolic Vasculitis

Proprietary Chinese Medicines for Thromboembolic Vasculitis 4 Medicines Related to Thromboembolic Vasculitis 1 Pinyin xuè shuān bì sāi xìng mài guǎn yán

2 English Reference

buerger's disease

thromboangitis obliterans

3 Overview

Thromboembolic vasculitis is the name of the condition. It refers to chronic occlusive inflammatory lesions of peripheral blood vessels. It belongs to the category of "paralysis" and "gangrene" in Chinese medicine. The etiology of this disease is unknown, and its triggering factors are closely related to freezing, trauma and smoking [1].

Thromboembolic vasculitis, also known as idiopathic gangrene, is a common chronic progressive vascular disease. The main clinical manifestations are local skin color and temperature changes of the affected limbs, intermittent claudication, static pain, and in severe cases, ulcers and gangrene can occur, and young and middle-aged men are most likely to suffer from it. Modern medicine on the pathogenesis of vasculitis so far there is no unified understanding, generally believe that, more closely related to sympathetic nerve dysfunction and autoimmune reaction. And inhalation of marriages is currently recognized as a triggering factor at home and abroad. In addition, cold, humidity, infection, trauma, etc. can be a potential trigger.

Thromboembolic vasculitis belongs to the category of "gangrene" in Chinese medicine, which is also called "canker sores" and "cold fingers". As early as in the "Huangdi Neijing Lingshu - carbuncle gangrene", there is a more detailed description of gangrene, which involves the etiology of the disease, symptoms, treatment principles and prognosis and other aspects. In the Jin, Sui and Tang dynasties, in the book "Liu Juan Zi Ghost Legacy Fang" and "Bijiu Qian Jin Yao Fang", the understanding of demodicosis was deepened, and the specific surgical treatment plan of "cutting the poison in the flesh and cutting the poison in the bone" was proposed. After the Song and Ming dynasties, the diagnosis and treatment of gangrene in Chinese medicine were further systematized, and many medical doctors made more specific elaboration on the cause and treatment of gangrene, and at the same time, there were also a lot of special articles and books on gangrene. In terms of treatment, in addition to internal Chinese medicine and surgical excision, there are also acupuncture and moxibustion, fumigation and external application. If the account of gangrene before the Qing Dynasty is still mostly categorized as diabetic gangrene, then, since the Qing Dynasty, the etiology of the symptoms of gangrene has begun to approach the symptoms of vasculitis. For example, Ma Peizhi Surgical Case says: "When wading in cold water, gas and blood are frozen, and the accumulation of cold for a long time turns into heat." "The beginning of the toe wood cold, followed by the red and purple color, hot swelling of the tarsus, the toes are still cold, skin, flesh, sinews and bones are dead, the joints are gradually cracked, sewage seepage, tendon breaks and meat away from the off."

Modern since the mid-50s reported the Chinese medicine cure thrombophilic vasculitis, caused great concern in the medical community, after repeated clinical summarization and validation, four wonderful Yongan soup, Yang and soup, Gu Bu Tang, through the veins of the blood soup of a class of prescription for the treatment of vasculitis efficacy, and gradually obtain the surgical clinician's recognition. 70 years since the convening of the national concordance of the meeting, to discuss the diagnosis, observation and diagnosis of vasculitis, and the observation and diagnosis of vasculitis, and the diagnosis of vasculitis. Since the 70's, many national meetings have been held to discuss the diagnosis of vasculitis, observation indicators and efficacy assessment standards of the standardized dagger, so that the clinical observation and research of thromboembolic vasculitis has been greatly advanced a step forward, the literature is increasingly reported, according to incomplete statistics, over the past 40 years, published in the domestic medical journals of the preparation of class diagnosis and treatment of vasculitis in the Chinese medicine literature of more than 140, observation of the case in more than 300 cases (excluding individual cases). In diagnosis, some lyrical methods and new indexes related to modern medicine have been applied and verified in clinic. In treatment, the treatment principles of activating blood circulation and removing blood stasis, clearing heat and removing toxins, and warming menstruation and dispersing cold have been summarized, especially activating blood circulation and removing blood stasis has become a recognized and promising treatment principle. Based on the combination of identification of evidence and disease, the treatment methods of Chinese and Western medicine, internal and external treatment, conservative treatment and surgical treatment have greatly improved the clinical efficacy, significantly reduced the amputation rate of the affected limbs, and reduced the recurrence rate. At present, the general reported clinical effectiveness rate of about 90%.

Thromboembolic vasculitis (thromboangiitis obliterans) is also known as Bürger disease. It is characterized by the involvement of moderately large arteries and veins, especially the vessels of the lower limbs, recurrent inflammation and thrombosis, causing circulatory disorders, claudicatio intermittens and gangrene of the limbs. The vast majority occur in men, aged 20 to 40 years.

4 Lesions

Early for some segments of small arteries, endocarditis, the wall of the fibrinoid necrosis, with neutrophil infiltration, can appear multinucleated giant cells, the lumen due to the complication of thrombosis and occlusion. The lesion gradually involves larger arterial segments. Inflammatory cell infiltration is also present in the arterial mesentery and periphery, and the lesions often involve accompanying veins. Mechanized thrombi rich in neocapillaries and inflammatory cells are said to be a characteristic feature of the disease, and recanalization of the thrombus may occur after mechanization, leaving plaque-like intimal scarring, and usually no significant disruption of the intima-media elastic lamina.

5 etiology and pathogenesis

The etiology of this disease is related to external cold and dampness, dietary disorders, seven emotions or excessive room excesses, and chronic illnesses. On its pathogenesis, ancient and modern literature has elaborated, careful study of the various theories, can be summarized as the following four:

Yang Qi weakness, cold blood stasis Long-term illness of the spleen and kidney Yang Qi is not full, the yin and cold multiply and attack. Cold condensation and lead, the blood stasis; cold and damp guest in the meridian flesh, the blockage of the veins, beat in the fluid bone marrow, the folding injury to the blood, to the Rongwei condensation and astringent, can not moisturize the four end of the limb pain, necrosis, and even shedding, living in a cold place is particularly susceptible to suffer.

Dampness is embedded, encounter obstruction of the veins Long guest wetlands or dietary disorders, can accumulate wet brewing phlegm. Dampness is heavy and sticky, it is easy to damage the yang qi, blocking the qi, so that the blood transport loss of its smooth, for a long time, the dampness of the evil heat, dampness, phlegm, heat, and can also be stagnant blockage of the meridians, so that the blood is stagnant and can not be, then the five toes necrosis.

Liver and kidney yin deficiency, heat and toxicity blazing Room is not regular, emotional upset, then the kidney water loss, phase fire, liver wood loss of nourishment, blood does not glorify the tendons. If you are addicted to spicy, tobacco and alcohol, you will have dampness and heat, which will turn into fire and vaporize your internal organs and make your liver lose tendon, spleen lose meat and kidney lose bone, and then you will become a gangrene disease.

The deficiency of qi and blood, and the stagnation of veins, qi and blood run all over the body, and it is important to circulate the blood smoothly. If the gas is weak, the blood is incompetent, the blood is weak, the gas is not born, the blood is blocked, the collaterals lose their moistening, and the four end of the gas and blood can not be full of, the poisonous evil agglomeration, the gas and blood stagnation, then the occurrence of vasculitis, the long-term disease is more common in weak people.

In short, the main lesion of this disease in the blood, and the heart, liver, spleen, kidney and other organs of the relationship between the most, for close, because the heart of the main vein, liver main tendon, spleen main meat, kidney main bone. Disease of this is the lack of yang qi, qi and blood weakness, the symptoms of the disease for the blood stasis, dampness, heat and toxicity stagnation, tendons and meridians, corruption of blood and rotting flesh. If the condition for a long time, necrosis of limbs and joints, the wound does not heal, pus and blood constantly, can lead to great injury to qi and blood.

6 Diagnostic points

Diagnostic points of this disease: ① Mostly seen in smoking men under 40 years old. The vast majority of lower limb involvement. ② the onset of the affected limbs distal cold, cold, numbness, soreness, followed by intermittent claudication, and finally developed into resting pain, especially at night. (iii) The skin of the extremity is purplish red or pale, and the skin temperature decreases. Calf muscle atrophy, and then toe ulceration, dry or wet necrosis. The dorsalis pedis and/or posterior tibial artery pulsations are diminished or absent. ④ Positive limb *** placement test. ⑤ Rule out other arterial occlusive lesions. Hemograms assist in the diagnosis. [1]

7 Identification and typing

The clinical identification and typing of this disease is not yet standardized. Now according to local reports are summarized in the following five types:

1. Yin cold stagnation affected limbs numbness and pain, local skin pale, touch cold, cold aggravated, warm is reduced. The traumatized surface is white or dark red, delayed healing. The tongue is pale, the moss is thin and white, and the pulse is thin and late.

2. Blood stasis obstruction Fixed persistent pain in the affected limb or toe (finger), with obvious resting pain. The skin of the affected limb is purplish red, dark red or purple, especially obvious when sagging, dry skin, thickened toenails, withered flesh and withered hair. The tongue is reddish-red or purplish-dark with petechiae, the tongue coating is thin and white, and the pulse is dull and astringent.

3. Damp-heat downstream injection of the affected limb cold pain, often wandering. Soreness, heaviness, fatigue when walking, the lower limbs may appear striated lumps or nodules, redness, swelling, heat and pain, mild ulceration or gangrene at the extremities. The patient may be accompanied by a heavy head and sleepy body, and a stuffy and dull epigastric region. The tongue is red, the tongue coating is yellow or white, and the pulse is slippery or stringy.

4. Heat and toxicity is blazing. Ulcer or gangrene occurs in the affected limb, followed by serious infection, redness, purple pain, swelling is diffuse, and there is a lot of pus with a bad odor. Systemic symptoms may include high fever and chills, irritability, dry stools and yellow urine. The tongue is reddish-red, the tongue coating is yellowish greasy, yellowish dry or black-brown moss, and the pulse is slippery and flooding or stringy and fine.

5. Qi and blood deficiency The patient is weak, emaciated and yellowish, thin and weak, with dry and flaky skin, dry and thickened toe (finger) nails, muscle atrophy, slow growth of wounds that do not heal for a long time, and grayish, dark red granulation with scanty pus. The tongue is pale, the tongue coating is thin and white, and the pulse is dull and weak.

8 Treatment 8.1 Efficacy standards

In the past decade, the national academic conference on the diagnosis of thromboembolic vasculitis and efficacy standards, there have been a number of discussions, but so far there is still no uniformity. The efficacy criteria used in most of the current literature can be divided into the following four levels.

Clinical cure: disappearance of major symptoms, complete healing of wounds, alleviation or significant improvement of blood circulation disorders in the affected limbs, and no recurrence within one year of resumption of work.

Apparent effect: most of the clinical symptoms disappeared or significantly reduced, static pain disappeared, skin temperature and color significantly improved, the wound healed or close to healing, blood circulation is mildly impaired, and can work.

Improvement: the symptoms are reduced, the trauma is smaller than before, the circulation of the affected limb is improved, but still can not work.

Ineffective: after one to three months of treatment, clinical symptoms and signs are not improved, or even aggravated.

8.2 Acupuncture treatment

Acupuncture treatment: take the affected limb relevant meridian sites sensitive reaction points as the main points, combined with the onset of the site and the symptoms of the meridian matching points as the principle. Lower limbs choose pulse root (in the second sacral vertebra next to the opening of 3 inches under 0.5 inches), on the ququan (in the bent knee on the medial stripe head 3 inches of the posterior edge of the femur), the pulse is born (in the ququan straight on the 3 inches of the posterior edge of the femur); points: disease in the lesser toes to take the spleen meridian yinlingquan, dijie; in the disease in the dorsum of the foot and the second and third toes to take the foot, the three li, fenglong; in the disease in the four toes and the outer lower leg to take the foot of the lesser yang meridian yanglingquan, hanging bells. Upper limbs, choose Quchi, Qingling, hand inverse injection (in the forearm flexion side of the center line, wrist and elbow cross stripe line midpoint); with points: the disease in the thumb and index finger with the hand Sanli; disease in the ring finger with the Wai Guan; disease in the little finger with the Tongli; forearm palm cold swelling to take the Daling, Yangchi (moxibustion), Laogong. Operation method: solid heat with diarrhea, deficiency cold with tonic method, deficiency and solid with flat tonic and flat diarrhea method. Generally, 1 to 5 points are used each time, once a day or between days, 15 times for a course of treatment. For necrotic ulcers should be combined with traditional Chinese medicine or antimicrobials. Or consider surgical treatment. [1]

8.3 Typology

(1) Yin-cold stagnation

Treatment: warming the meridians and dispersing cold, activating blood circulation.

Addition and subtraction: remove cinnamon stick and add cinnamon if cold condensation is severe; add Chuanwu, Caowu, Yanhu for pain; add Coix Seed and Cangzhu for wetness; add frankincense, myrrh and safflower if blood stasis is obvious.

Dosage: 1 dose per day, decocted in water for 2 times, 1 time in the morning and 1 time in the evening.

Therapeutic effect: 32 cases were treated with this method together with acupuncture and external treatment, resulting in 11 cases of clinical cure, 12 cases of apparent effect, 8 cases of improvement, 1 case of ineffectiveness, with a total effective rate of 96.9%.

Commonly used prescriptions: Angelica four reverse soup, Gu Bu Tang, Gui Zhi and Zi Zi Tang, blood warming soup, Yang He Tang.

(2) Blood stasis and obstruction

Treatment: Promote blood circulation, eliminate blood stasis and relieve pain.

Prescription: 15 grams of Angelica sinensis, 10 grams of Paeonia lactiflora, 10 grams of Rhizoma Ligustici Chuanxiong, 10 grams of Dilong, 10 grams of Mamaku, 1o grams of Cinnamon twig, 12 grams of Achyranthes bidentata, 10 grams of peach kernel, 10 grams of safflower, 15 grams of Salvia miltiorrhiza, 10 grams of Yujin, 30 grams of Cynanchum officinale, 10 grams of Perforated Carpenteria, and 10 grams of Wu Yao.

Addition and subtraction: with Yang deficiency, add slices of Guan Yu, cinnamon; with pain, add Yan Hu; with swelling of the affected limbs, add papaya, Poria; with spleen deficiency, add Cang Baijiao; with ulceration of the wound, oozing pus, add dandelion, honeysuckle.

Dosage: 1 dose per day, decoction 2 times, morning and evening service.

Therapeutic efficacy: the main method, with other external treatment (part of the surgical treatment), **** treatment of 144 cases of vasculitis patients, 52 cases of clinical cure, 72 cases of apparent effect, 20 cases of improvement, the total effective rate of 100%.

Commonly used prescriptions: peach red four things soup, blood circulation soup, blood circulation soup, blood circulation soup, diaphragm under the blood circulation soup, angelica blood circulation soup.

(3) Dampness and heat under the sobbing

Treatment: clearing heat and dampness, promoting blood circulation.

Prescription: 15 grams of honeysuckle, 10 grams of forsythia, 30 grams of dandelion, 10 grams of scutellaria, 10 grams of cypress, 12 grams of xuan shen, 10 grams of fenugreek, 10 grams of castor seed, 12 grams of angelica, 15 grams of coix seed, 10 grams of hyssop, 10 grams of wood, 10 grams of dandelion, 10 grams of dillon, 30 grams of chickweed vines, 30 grams of red beans.

Add and subtract: local redness and swelling obviously, or ulcer oozing pus more plus fungus Chen, gardenia; Swelling more, wet bias heavy plus poria, poria; Pain dramatically plus Yanhu, make milk did not; Accompanied by qi stagnation plus neem.

Therapeutic effect: treatment of 104 cases of vasculitis patients, with local external washing, clinical cure 66 cases, 32 cases of improvement, ineffective 6 cases, the total effective rate of 94.2%.

Commonly used prescription: four wonderful Yongan soup, Yin Chen red bean soup.

(4) Heat and toxicity blazing

Treatment: clearing heat and removing toxins, resolving blood stasis and clearing the channels.

Prescription: 30 grams of dandelion, 15 grams of dicotyledonin, 15 grams of honeysuckle, 10 grams of forsythia, 15 grams of xuan shen, 15 grams of raw land, 10 grams of red peony, 10 grams of dandelion, 10 grams of cypress, 10 grams of gardenia, 12 grams of comfrey, 15 grams of Salvia miltiorrhiza, 12 grams of Angelica sinensis, 10 grams of Achyranthes bidentata, 12 grams of lutong.

Add and subtract: dry stools plus raw rhubarb; pain plus Yanhu, make milk did not; dry mouth and thirst plus smallpox powder, dendrobium; with qi deficiency plus tai zi ginseng, astragalus, ginseng; dampness plus Cangzhu, coix seed.

Dosage: 1 dose per day, 2 doses per day for severe cases, warm water decoction. The dregs of the medicine are added to the water to make a thick decoction and smoked daily.

Therapeutic effect: 22 cases of heat and blood stasis type vasculitis were treated with this method, 8 cases were cured, 7 cases were improved, 7 cases were ineffective, and the total effective rate was 68.2%.

Commonly used prescription: four wonderful Yongan soup, five flavors disinfection drink, Xianfang living life drink.

(5) Qi and blood deficiency

Treatment: replenish qi and buckwheat blood, blood circulation.

Prescription: 30 grams of roasted Astragalus, 12 grams of fried Radix Codonopsis pilosulae, 10 grams of Radix Angelicae Sinensis, 15 grams of Salviae Miltiorrhizae, 10 grams of Atractylodes Macrocephala, 10 grams of Radix Paeoniae Alba, 10 grams of Chinese hyssop, 15 grams of honeysuckle, Rhizoma Ligustici Chuanxiong 1O gram, XuanShenGen 15 grams of dendrobium 10 grams of chicken-blooded vine 15 grams of Dictyostelium 10 grams of Dicotylosporium 30 grams.

Addition and subtraction: Yang Qi weakness, plus the slices, Cistanches; dry moon and kidney yin deficiency, plus the raw land, turtle version; dampness and heat toxicity, plus Coix Seed, root of bluebells, Yin Chen, gardenia; the positive deficiency can be added to take the Ten Complete Great Replenishment Pills; blood stasis is obvious, plus Peach Kernel, safflower.

Dosage: 1 dose per day, water decoction 2 times, morning and evening divided service.

Therapeutic effect: the treatment of 41 cases of vasculitis patients, in addition to serving traditional Chinese medicine, local ulcers with helium-neon laser irradiation, clinical cure 31 cases, 6 cases of improvement, ineffective 4 cases. The average healing time was 45 days, and the total effective rate was 90%. At the same time, the immunity index observation was carried out, and it was found that after the treatment, the lymphocyte conversion rate of the patients was elevated from the low level before the treatment, and the IgG and IgA decreased significantly, while the IgM and complement C3 did not have any significant change.

Commonly used prescriptions: Ginseng Nourishing Rong Tang, Shiquan Daxin Tang, Gu Bu Tang.

8.4 Specialized treatment

(1) Blood circulation injection

Composition: 150 g of Salvia miltiorrhiza, 100 g of safflower, 50 g of cinnamon, 150 g of Angelica sinensis, 150 g of Rhizoma Chuanxiong, 150 g of Cortex Eucommiae, 150 g of Duchenne, 250 g of goat bone.

Methods of use: the above medicines are made into injections, each ampoule of 2 ml contains 2 grams of raw medicine. Intramuscular injection, 2 to 4 ml per day, twice a day, 15 days for a course of treatment, pregnant women and those with bleeding tendency should be cautious.

Therapeutic efficacy: the use of this drug for the treatment of cold-type vasculitis 30 cases, while taking Chinese medicine decoction (cinnamon sticks, ripened earth, hyssop, chicken blood vine, Codonopsis pilosulae, astragalus, dry ginger, fine Xin, red peony), the clinical cure of 23 cases, 6 cases of improvement, ineffective 1 case, the total effective rate of 96.6%. The total effective rate was 96.6%. After follow-up, there were 2 cases of recurrence within one year.

(2) blood circulation soup

Composition: 35 grams of Salvia miltiorrhiza, red peony, chicken-blooded vine, Dilong, frankincense, myrrh, Wuzui Snake 15 grams each, Angelica sinensis, safflower, licorice 10 grams, 7.5 grams of Sinensis, centipede 3.

Add and subtract: cold and damp stagnation, Yang Qi does not reach the add epiphyllum, cinnamon, cinnamon sticks, Chuanwu, Caowu, Fenghui, Cangzhu; damp-heat add cypress, castor seed; heat and toxin blazing add honeysuckle, dicotyledon, dandelion, forsythia, dandelion; long-term disease, deficiency of qi and blood, trauma surface does not converge, the flesh buds are not fresh, add ginseng, angelica sinensis, the cooked land, the first Wu, such as beneficial to the qi and blood products.

Methods of use: the above 1 dose per day, water decoction 2 times, morning and evening service. The dregs of the medicine is decocted again, and the affected area is washed warmly, 3 times a day (late ulcerated with Taiyi ointment on the affected area, 2 times a day).

Therapeutic effect: the treatment of 11 cases of vasculitis patients, clinical cure 6 cases, 4 cases of apparent effect, 1 case of improvement, the total effective rate of 100%.

(3) vasculitis soft

Composition: 12 grams of rosin, 10 grams of leeches, scorpion 8 grams.

Usage: on the three flavors *** research fine powder, each 3 grams, warm water to serve, 3 times a day. 30 days a course of treatment. Local external application of pine tung paste (rosin 220 grams, finely ground, with 100 ml of raw tung oil into a paste), once a day.

Therapeutic effect: 20 cases of vasculitis treated with this formula, were clinically cured.

(4) pulse dredging formula

Composition: 0.5 grams of musk, Salvia divinorum, Lulutong 100 grams each, the system of frankincense, myrrh, 30 grams each of the ground dragon, 15 grams of gecko.

Addition and subtraction: Yin cold type is first given to ripened earth, antler gel, white mustard seed, cinnamon, ephedra, ginger, licorice and other medicines decoction for 1 week. In the qi stagnation and blood stasis type, danshen, peach kernel, safflower, milky vetch, red peony, wuling yi, sanlang, curcuma, lutong and other medicines are firstly given to be decocted for 1 week. Damp-heat type is first given with Yin Chen, Cow Knee, Silver Flower, Red Bean, Salviae Miltiorrhizae, Chicken Blood Vine, Coix Seed, Cangzhu, Fenghui, Zedoaria etc. for 1 week. For the heat-toxic type, first take Yinhua, forsythia, milkweed, dandelion, dicotyledonin, hemipterocarpus, hemipterocarpus, Radix et Rhizoma Dioscoreae, Salviae Miltiorrhizae, hyssop, and other herbs for 1 week. For Qi and blood deficiency type, first take ginseng, atractylodes, white peony, poria, chuanxiong, licorice, angelica, radix Rehmanniae Praeparata, radix et Rhizoma Dioscoreae, radix et Rhizoma Dioscoreae, cinnamon, etc. for 1 week. Local treatment: redness and swelling apply Danshen San (earth honeycomb, Danshen); heat without swelling apply Yihuang San (thick park, licorice, rhubarb, cypress, turmeric, Angelica dahurica, star fruit, Chenpi, Rhizoma Atractylodis Macrocephalae, pollen); ulceration with pus apply Golden Flower San (calcined gypsum, fried lead, ice); ulceration without pus apply Haifusan (made of milky mucilage, ice).

Dosage: 1 dose per day, decoction twice, morning and evening.

Efficacy: 214 cases of treatment, 101 cases of clinical cure, 19 cases of significant effect, 86 cases of improvement, 8 cases of ineffective, the total effective rate of 96.3%.

(5) pulse inflammation spirit pill

Composition: ten Gonglao 60 grams, 60 grams of golden hair dog spine, 60 grams of Wei Ling Xian, 60 grams of papaya, 30 grams of blood exhaustion, 60 grams of white peony, 60 grams of raw land, cinnamon sticks 30 grams, Wuzui Snake 60 grams, 30 grams of Haitong Pi, 30 grams of dandelion, 30 grams of cow's knee, the old stork 60 grams, 30 grams of Hansenbergia, 60 grams of Astragalus, 30 grams of angelica sinensis, 60 grams of Cortex Eucommiae. 60g of Radix Rehmanniae Praeparata, 30g of Radix Pseudostellariae, 30g of Betel nut, 30g of Safflower, 30g of Snake, 30g of Fenghuang, 30g of Boswellia serrata, 30g of Myrrh, 30g of Acorus calamus.

Usage: the above drugs *** research fine powder, through the No. 8 sieve, honey for the pill, each pill weighs 10 grams. Every morning and evening to take 1 pill, warm water to send down. Serious patients can be served 3 times a day. 20 days a course of treatment, avoid acid, spicy, wine, marriage, housework during the medication.

Efficacy: **** treatment of 11 cases, clinical cure 9 cases, 1 case of interruption of treatment, 1 case is invalid, the total effective rate of 81.8%.

(6) Compound Tongxin injection

Composition: red peony, peach kernel, ginkgo biloba, danshen, angelica sinensis, mao dongqing, tulasurin.

Dosage: the above drugs are made into injections, each 10 ml or 20 ml, containing 34 grams or 68 grams of raw drugs, respectively. Inject once a day, 1 to 2 sticks each time. Methods: Diluted with 500 ml of pulsatile liquid, rapidly push 50 ml through the arteries of the affected limbs, and the remaining drugs are slowly titrated. After 10 consecutive days of rest for 3 to 5 days, then continue treatment, 30 times for a course of treatment. With the internal Chinese medicine, the cold type with Yanghe Tang plus and minus; stagnation type with Angelica blood circulation Tang plus and minus; heat and toxicity type with SiMiaoYongAn Tang plus and minus; damp-heat type with YinChenChekShouBouTang plus and minus; the repair stage with GuBuTang plus and minus; deficiency of qi and blood with BazhenTang or ginseng nourishing RongTang.

Therapeutic efficacy: *** treatment of 252 cases (of which 15 cases for intravenous administration), 143 cases were cured clinically, 53 cases showed significant effect, 21 cases improved, 35 cases were ineffective, the total effective rate was 86.1%. The total effective rate was 87.8% in the intravenous group.

(7) Vascular II

Composition: honeysuckle, forsythia, angelica, red peony, peach kernel, safflower, rhizoma rhizoma, rhizoma ligustici, danpi, yanhou, cinnamon sticks, centipede.

Method of use: the above medicines are made into dry granular punch. Each time 10 grams, 3 times a day, with ulcers external application of whole scorpion cream.

Therapeutic efficacy: the treatment of 46 patients with vasculitis with this formula, clinical cure 20 cases, 17 cases of apparent effect, 6 cases of improvement, 3 cases of ineffective, the total effective rate of 93.5%. The total effective rate is 93.5%. The effect is better on patients with cold dampness.

(8) yellow horse wine (external)

Composition: white wine (or 75% alcohol) 5000 ml, 60 grams of Huanglian, strychnine 30 grams.

Usage: put the yellow rhizome, strychnine soaked in white wine, one week after the dregs of the medicine filtered. Wash the wounds of the affected limbs once a day with the wine, and for those with severe pain, wash the wounds several times with yellow strychnine soaked gauze

Outside. After washing the wound can be used again with other ointment external application.

Therapeutic effect: the use of yellow horse wine soaked wash wound, and then use the ointment change, pain effect is remarkable. 62 patients with an average of 6.7 days of basic pain relief, the shortest 2 days. Whether cured or not, can achieve basic pain relief.

(9) pine tung paste

Composition: rosin Z00 grams, raw tung oil 100 milliliters.

Usage: the rosin into a fine powder, and raw tung oil into a paste, coated wounds, once a day.

Therapeutic effect: **** treatment of 20 cases of vasculitis patients, at the same time, the internal service of vasculitis powder (rosin, leeches, scorpion), are clinically cured.

(10) Degangrene wash only (external)

Composition: sumac, safflower, Guan Gui, dry ginger, frankincense, myrrh, millennium health, camphor 10 grams each, 20 grams of chicken blood vine, 6 grams of fine Xin, 15 grams of Turbinaria.

Usage: the above medicines with water decoction soup liquid, while hot, smoked the affected limbs, 2 to 3 times a day.

8.5 Experiences of Elderly Chinese Medicine Practitioners

Zhu Renkang medical case

Li x x, male, 28 years old. Date of first consultation: November 4, 1958. Complaints of cold pain in the left foot, intermittent claudication for 10 months, ulceration of the tip of the left little toe for 1 month. left heel pain started in January 1958, followed by pain in the anterior part of the toes and the toes, and then calf swelling and pain after walking, which was alleviated by resting, and intermittent claudication for more than 10 months. The disease is worsening day by day, 1 month ago, the left foot little toe toe end formation of ulcers, pain is severe, sleepless nights. The patient is a sand turner, long-term damp and cold, addicted to smoking for more than 10 years.

Examination: yellowish color, thin, left foot little toe ulcer about 1 × 1cm, a little yellow secretion, rotting flesh is not off. The dorsum of the foot was dull purple, the left foot was cold, and the dorsal artery of the foot was still palpable. The pulse is slippery, and the moss is yellow and slightly greasy.

Diagnosis: Thromboembolic vasculitis (gangrene). The evidence belongs to cold condensation and dampness obstruction, meridian paralysis, Qi and blood can not be sent to severe pain, difficult to walk. The patient's positive qi is gradually depleted, the cold is depressed and heat is transformed into heat, and when the heat wins, the flesh is corroded and the little toe is ulcerated. The treatment should be to pass and camp, clearing heat and dampness.

Prescription: 30 grams of silver flowers, 9 grams of tail, 9 grams of dandies, 9 grams of red peony, 4.5 grams of milk did not prepare, 4.5 grams of silky gourd, 9 grams of dillon, 9 grams of Ermiao Pill (package), 9 grams of Hai Feng Teng, 9 grams of rhinoceros pills (swallowed separately).

Second diagnosis: 8 doses of medicine, moss yellow and greasy gradually, pain relief, change to four wonderful Yongan soup: 60 grams of Angelica sinensis, 30 grams of silver flowers, 30 grams of Radix et Rhizoma Ginseng, 15 grams of Glycyrrhiza Uralensis.

Third diagnosis: the above medicine to serve 4 doses, the pain is obviously reduced, the toe end of the rotting flesh is not yet off, the tongue is still yellow greasy moss, smooth pulse. Add 15 grams of Poria cocos, 9 grams of Coix seed, 3 doses.

The fourth diagnosis: the little toe rot to close the mouth, only the foot down to the ground is still painful, the ulcerated surface of the mouth is slightly broken, flow a little secretion. The above add astragalus 9 grams, *** service more than 20 doses, gradually see the mouth. Continue to observe 3 months, the basic cure.

Press: patients with vasculitis generally have a history of cold and cold, the most avoided immediately to the fire, or hot water, otherwise it is very easy to suffer from this disease. This is the way of prevention, vital. In the early stage and second stage of this disease, cold condensation and blood stasis, blocked in the meridians and collaterals, not through the pain. The medicine focuses on warming the meridians and dispersing cold, activating blood circulation, and restoring Yang to relieve pain. In the late stage of cold depression heat, heat victory is meat rot, bone rot, should be a large dose of nourishing yin and qi, clearing heat and toxins, to Gu Bu Tang, four wonderful Yongan Tang, etc. Figure of treatment, so that as far as possible to avoid amputation.

8.6 Patterns of medication

Analyzing the use of medicines in special formulas in 25 literature reports from 1980 to 1990, *** 81 flavors of medicines were used, of which more than 100 cases were observed, and 28 flavors were reported in more than 2 literature reports, and the list is as follows:

Frequency of application (cases) Reported literature (articles) Medicines ? Substances ＞1000 18 Angelica sinensis. 700～1000 7～11 Salvia miltiorrhiza, Astragalus membranaceus, Boswellia serrata, Myrrh, Shouguan, and Dilong. 500～699 2～5 毛冬青、蜈蚣、党参、乌梢蛇、延胡、水蛏、附子。 300～499 5～8 Rhizoma Ligustici Chuanxiong, Ginkgo Biloba, Radix Paeoniae Alba, Radix et Rhizoma Glycyrrhizae, Radix Achyranthis Bidentatae, Rhizoma Lucidum. 100～299 2～17 Peach kernel, safflower, xuan shen, chickweed vine, cinnamon stick, dandelion, wilsonia, rosin. <100 3 Dangpi, blood exhaust, forsythia.

Among the 31 medicines listed in the above table, the medicines for activating blood circulation and removing blood stasis accounted for 50%. Thus, it is easy to see that the law of activating blood circulation and removing blood stasis has become the main law of the treatment of vasculitis. There are also many medical doctors believe that the disease to the virtual in the real majority, the treatment should be "attack and complementary", or complementary to toxin, or complementary in the attack, and thus the genus ginseng and astragalus application more. Clinical practice has proved that the use of astragalus and large dosage, the efficacy of many good. In recent years, insect medicine for the treatment of thromboembolic vasculitis shows better prospects. This table lists the first 14 flavors of the drug, there are 5 flavors are insect drugs. The prescription "Six Insects San" and the "Tongxin Tablet" used in Guang'anmen Hospital are also composed of leeches, gadflies, Eupolyphaga, Ophiopogon, Dilong, and centipedes.

8.7 Other therapies

(1) Acupuncture and moxibustion

①Body acupuncture

Acupuncture points: main points: meridian channel, sea of blood, shakuzawa, sanyinjiao, yanglingquan, upper jiuxu, lower jiuxu. Supporting points: heat and toxicity plus Taixi, Fuxiao, Yuji, Liejiao; blood stasis plus Liejiao, diaphragm Yu; qi and blood double deficiency plus Liejiao, Yuji; kidney deficiency plus danzhong, yin valley, Taixi, diaphragm Yu.

Operation: Both sides are taken to the commonly used points, according to the symptoms of the addition of matching points. Cold dampness with warm needles line tonic method, 2 times a day, 40 minutes each time, at the same time moxibustion Taiyuan. Blood stasis is treated with flat tonic and flat diarrhea techniques, twice a day for 15 minutes each time. Heat toxicity was treated with the Lift-Insertion-Diarrhea method, 3 times a day, 20 minutes each time. For Qi and Blood deficiency, use the tonic method, 1 time daily, 60 minutes each time. Kidney deficiency with tonic method, 1 time per day, 60 minutes each time.

Efficacy: the application of this method for the treatment of 77 patients with vasculitis, 52 cases of clinical cure, 13 cases of significant effect, 8 cases of improvement, 4 cases of ineffectiveness, the total effective rate of 94.8%.

② moxibustion

Acupuncture: main points: three groups a. Qihai, Zhongkou, danzhong, Yangchi, foot Sanli, Chongyang, Taixi, Lung Yu, Heart Yu, Liver Yu, Spleen Yu, Kidney Yu; b. Prado, Shentang, diaphragm Yu, diaphragm, Chikubing; c. Huanjiu, Yanglingquan, Commission, Chengshan, Kunlun.

Operation: the first group of acupoints each moxibustion 3 strong; the second group of acupoints each moxibustion 2 strong; the third group of acupoints needling, after getting the qi does not leave the needle. Every other day, 10 times for a course of treatment.

Therapeutic effect: ****treatment of 8 cases (2 cases in early, 6 cases in the middle), 5 cases of clinical cure (2 cases in early, 3 cases in the middle), 3 cases of improvement. Follow-up for 2 years, the 5 cured cases did not recur.

(2) Single prescription

① Trance wood powder

Prescription: Trance wood.

Dosage: 30-50 grams per dosage for decoction, 5-10 grams per dosage for crushing powder, 2-3 times a day.

Add and subtract: add silver flower, forsythia and root of bluegrass if heat and toxicity are in favor; add peach kernel, safflower, red peony and danshen if blood stasis is in favor; add cinnamon stick, fine pungent and dry ginger if cold condensation is in favor; and add astragalus, codonopsis, angelica sinensis, and ripened earth if the body is weak.

Efficacy: the treatment of 14 patients, clinical healing 9 cases, 3 cases of improvement, invalid 2 cases.

② white flower salvia preparation

Composition: white flower salvia.

Usage: a. White-flowered ginseng people soaked in white wine, remove the dregs of the wine, 20-30 ml per service, the heaviest can be served 50 ml, 3 times a day. b 30-60 grams of white-flowered ginseng decoction, 2-3 times a day. c white-flowered ginseng made of injections, 2-4 ml per time, intramuscular injection, 1-2 times a day. d. White-flowered ginseng can be used to treat the symptoms of the disease.

Therapeutic efficacy: *** treatment of 147 cases, 33 cases cured, 70 cases of apparent effect, 32 cases of improvement, 12 cases of ineffective, the total effective rate of 91.8%. Clinically show that the effect of wine is better than decoction and injection.

③ cat bone powder

Composition: a. Raw cat bone 1, even the head and tail, burned ash storage, research fine for the end. b. Cat meat 500 grams, 60 grams of Astragalus, 60 grams of Coix lacryma. c. 60 grams of Astragalus, 15 grams of Angelica sinensis, Rhizoma Ligustici Chuanxiong 10 grams, 30 grams of raw land, XuanShen 20 grams, 3 grams of XinXin, tortoise version of 20 grams, 20 grams of turtle shells, 3 grams of crab ashes, 30 grams of snakehead, 30 grams of silver flowers charcoal. d. The cat bone powder is used to cure 70 cases, and 32 cases are treated. 30 grams, 20 grams of Phellodendron Bark, 30 grams of Di Ding, 20 grams of Hyssop, 10 grams of Atractylodes macrocephala.

Dosage: cat bone powder punch, 1.5 grams each time, 3 times a day. Cat meat simmered with astragalus and coix seed, stewed and cooked, served with cat meat. Chinese medicine decoction 1 dose per day, divided into morning and evening 2 times decoction.

③ Chinese medicine anesthesia therapy

Liquid: Zhongma Ⅰ, Zhongma Ⅱ, or scopolamine injection.

Dosage: Zhongma Ⅰ 5 ml or Zhongma Ⅱ 3 ml, each with chlorpromazine 12.5 ~ 25 mg, intramuscular injection, static injection or intravenous drip can be. Once a day or once every 1~2 days, after 5~6 times in a row, it can be rested for 3~5 days. Generally the pain disappears can be stopped.

Efficacy: treatment of stage II severe vasculitis 30 cases, 20 cases of significant effect, 6 cases of improvement, 4 cases of ineffective, the total effective rate of 86.7%. It is believed that this method of pain relief is better than dulcolax, so that the skin temperature rises, walking prolonged, sagging swelling subsides, wound healing accelerated.

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8.8 Other measures

Supportive therapy: for poor health, especially for those with more serious infections, a nutritious diet can be given, with high doses of vitamin B and vitamin C. For those who can not eat, intravenous fluids can be given, and attention should be paid to correcting the disorders of water and electrolytes, and for those who are anemic, small amounts of blood transfusions can be given several times.

Surgical therapy: the necrotic tissue can be surgically removed. If the trauma is large and the epidermis grows slowly, it is feasible to do skin grafting. For the necrotic toes (fingers), surgical excision can be performed.

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