Thrombotic Phlebitis
Thrombotic phlebitis is an inflammatory reaction of the venous wall caused by different factors. Sometimes, it is associated with venous thrombosis. When the disease is present in the superficial group of veins, it is called superficial phlebitis which commonly seen in the superficial veins of limbs and the thoraco-epigastric walls. If the disease occurs in the deep veins, it is known as deep phlebitis usually occurring in the veins of legs, pelvic cavity and in the superior and inferior vena cava. This disease falls into the categories of "e mai" (superficial phlebitis), (venous hyperemia) and (rheumatism with the blood vessel involved) in TCM.
Superficial Phlebitis
Main Points of Diagnosis
1. There is pain, swelling and obvious tenderness in the superficial veins along the limbs or the thoracoepigastric walls. Besides, some hard cord-like swollen masses may be felt. 2. It is accompanied by fever and discomfort all over. 3. after the acute stage, there are some cord-like masses which will remain for a long time in the affected area with pigmentation in the local skin.
Differentiation and Treatment of Common Syndromes
1. Internal Treatment
1) Acute Stage Main Symptoms and signs: In the affected areas, there is redness, swelling, pain, tenderness and cord-like masses, Other symptoms and signs such as yellow and greasy fur on the tongue, soft and rapid or taut and rapid pulse may appear. Therapeutic Principle: In the cases of superficial phlebitis of limbs, its therapeutic principles are clearing away pathogenic heat and dampness and promoting blood circulation to remove blood stasis. For cases of superficial phlebitis of the chest and abdominal wall, the therapy aims at clearing away pathogenic heat and toxin and promoting qi and blood circulation. Recipe No.1: Decoction of Four Wonderful herbs for Quick Restoration of Health with additional ingredients honeysuckle flower figwort root Chinese angelica root red peony root achyranthes root phellodendron bark scutellaria root capejasmine fruit forsythia fruit atractylodes rhizome fangji root arnebia root licorice root safflower All the above herbs are to be decocted in water for oral administration for those who have superficial thrombotic phlebitis of limbs. Recipe No.2: Decoction of Oriental Wormwood and Red Bean oriental wormwood red bean spatholobus stem honeysuckle flower honeysuckle stem raw Job's tears seed atractylodes rhizome flavescent sophora root fangji root oriental water plantain rhizome phellodendron bark achyranthes root red peony root All the above herbs are to be decocted in water for oral administration for cases of superficial thrombotic phlebitis of limbs. Recipe No.3: Bupleurum Decoction for Removing Heat Bupleurum Root honeysuckle flower red sage root red peony root scutellaria root capejasmine fruit forsythia fruit Chinese angelica root ligusticum rhizome safflower curcuma root nutgrass flatsedge rhizome All the above herbs are to be decocted in water for oral administration for the treatment of superficial phlebitis of thoraco-abdominal wall. 2) Chronic Stage Main Symptoms and Signs: The local skin of the affected area is dark purple in color. There are some hard cord-like subcutaneous swollen masses which are not painful when they are pressed. Other features are some ecchymoses on the tongue, and soft and slow pulse. Therapeutic Principle: Promoting blood circulation, removing the stasis and clearing out the obstruction in the channels to resolve masses. Recipe: Red Decoction for Promoting Blood Circulation red sage root red peony root Chinese angelica root spatholobus stem loranthus mulberry mistletoe achyranthes root ligusticum rhizome milkvetch root curcuma root All the above herbs are to be decocted in water for oral administration. 2. External Treatment 1) At the early stage, of the illness, Paste of Isatis Leaf or Golden Paste may be applied onto the affected parts. 2) At the chronic stage, Powder for Promoting Blood Circulation and Reducing Pain may be decocted. Its hot decoction is used for fumigating and washing the affected parts, twice a day. The ingredients of the powder are as follows. speranskia herb corydalis tuber Chinese angelica root-tip turmeria rhizome pepertree pricklyash peel erythrina bark clematis root frankincense myrrha notopterygium root dahurian angelica root sppan wood acanthopanax bark safflower
smilax glabra rhizome
Deep Phlebitis Main Points of Diagnosis 1.There is a pain in the affected limbs and it is made more severe by movements and walking and often accompanied with fever. 2. A swelling may occur in the affected limbs and a tenderness will appear in the affected parts. When the dorsum pedis of the affected leg bends, is will cause an ache in the muscles of the shank (i.e. positive Hoffmann's sign). The temperature of the sick limbs may change, a little higher than normal or the limbs may even be cold locally for a short time. 3. Thrombotic Phlebitis of the Shank: There is a pain and a tenderness in the gastrocnemius muscle of the shank. A swelling may occur in the dorsum pedis and the ankle. Hoffmanns' sign is positive. 4. Femoral Thrombophlebitis: There is pyrexia and tenderness at the medial part of the thigh, popliteal fossa and shank. The shank and ankle may be slightly hydropic. 5. Thrombotic Phlebitis of the Iliofemoral Vein: Its onset is sudden and acute with fever (not exceeding 39¡æ.). There is a pain and an obvious swelling in the affected leg. The skin of the affected parts appears pale. In serious cases it is livid i color. There is an obvious tenderness in the medial aspect of the thigh. The superficial veins in the proximal part of the thigh and the lower abdominal wall often dilate. Differentiation and Treatment of Common Syndromes 1. Internal Treatment 1) Downward Flow of Damp-Heat Main symptoms and Signs: At the early stage of the illness there is pyrexia, pain, swelling and an obvious tenderness with thin yellow or yellow greasy fur, taut rapid or slippery rapid pulse. Therapeutic Principle: Clearing away pathogenic heat and dampness and promoting blood circulation to remove blood stasis. Recipe: Modified Diction of Four Wonderful Herbs for Quick Restoration of Health or Decoction of Oriental Worm-wood and Red Bean (All the above two recipes may be seen in the part of Superficial Phlebitis). 2) Severe Dampness and Blood Stasis Main Symptoms and Signs: In the affected limbs there are such symptoms as continuous swelling, distending pain, obvious tenderness, dark red skin or ecchymoses, pigmentation, superficial venous engorgement, telangiectasis, red tongue or with ecchymoses and white and greasy fur, soft-thready or deep-moderate pulse. Therapeutic Principle: Promoting blood circulation to remove stasis, removing dampness and dredging channels. Recipe: Red Sage Decoction for Promoting Blood Circulation red sage root red peony root Chinese angelica root honeysuckle flower achyranthes root globethistle root oriental water plantain rhizome Chinese flowering quince chuanxiong rhizome safflower earthworm fangji root All the above herbs are decocted in water for oral use. Main Symptoms and Signs: At the late stage of the illness, the patient feels tired and fatigued. there is swelling, heavy sensation and distending pain at the affected parts. The pain will be mild in the morning and serious in the evening, Other features are ache at the waist, aversion to cold, pale tongue with thin and white fur ,deep and slow pulse. Therapeutic Principle: Warming the Kidneys and Strengthening the Spleen milkvetch root pilose asiabell root bighead atraclylodes rhizome Chinese angelica root Chinese yam rhizome achyranthes root spatholobus stem red sage root prepared aconite root dried ginger rhizome tangerine peel Chinese flowering quince Job's tears seed tuckahoe All the above herbs are decocted in water for oral use. 2. External Treatment The herbs of Powder for Promoting blood Circulation and Reducing Pain see the part of Superficial Phlebitis) are to be decocted in water for fumigating and washing the affected parts of the limbs, 30-60 minutes each time, 1-2 times a day.
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