2 English reference chilblain [Chinese medicine terminology examination and approval Committee. Terminology of Traditional Chinese Medicine (2004)]
Chilblain [Chinese medicine terminology review committee]. Terminology of traditional Chinese medicine (20 13)]
3 Chinese medicine chilblain [1] is the name of disease syndrome [2]. See Danxi method. Also known as freezing wind and chilblain [2]. It refers to the diseases that occur when the exposed parts are attacked by cold pathogens, mainly manifested as swelling, hardness, dark red, cold, itching, pain, and even dark purple skin. It is a localized erythema inflammatory skin injury caused by long-term exposure to cold environment. Localized frostbite is mild, with local swelling, numbness, itching, bruising or blisters, and even ulceration into sores as the main symptoms; Patients with systemic frostbite are seriously ill, showing hypothermia, stiff limbs and even death due to yang deficiency.
Frostbite is a common disease in winter, most patients have the nature of frostbite. It heals itself after warming up in spring, but it is easy to recur in the following winter.
Frostbite is equivalent to frostbite in western medicine [3].
3. 1 Etiology and pathogenesis of chilblain "Surgical Xuan" chilblain records: "chilblain is mostly affected by its cold, with initial pain, followed by swelling of the face, hands and feet, bleeding, and fever when it is warm. There are also weak people, and those who are not tolerant of their cold have them. "
According to the record of chilblain, canker sore and swelling sore in Etiology: "In the severe winter months, wind, snow, cold and poisonous gas hurt the skin, and the blood gas is astringent, so it is frozen and red and swollen, and becomes chilblain."
Frostbite is skin damage caused by cold [2]. It is formed by cold and frostbite of skin and stagnation of qi and blood [2].
Frostbite is caused by yang deficiency, invasion of cold, poor circulation of qi and blood, impassability of meridians and stagnation of qi and blood.
In winter or cold and humid environment, coupled with the weakness of qi and blood at ordinary times, or because of hunger, or after illness, or because of sedentary, less exercise, the invasion time of cold evil is too long, which consumes Yang Qi, leading to poor circulation of qi and blood, stagnation of qi and blood stasis, chilblain and even skin rot. In addition, sudden cold with heat, or sudden heat with cold, can also cause qi and blood stasis, ulceration into sores. Excessive cold pathogen, excessive consumption of yang, can die of yang failure.
3.2 Frostbite The symptoms of frostbite mostly occur in bare parts such as hands, feet and auricles [2]. At first, the skin of the affected area was pale, and gradually turned into reddish purple patches, accompanied by burning pain, itching or numbness, and even festered into sores, which were difficult to heal [2].
Patients with chilblain have been attacked by cold pathogens for a long time, and their hands, feet, auricles and cheeks are red, swollen, cold, itchy and painful, and even their skin is purple and black [1].
3.3 Diagnosis of chilblain 3.3. 1 Typical clinical manifestations of chilblain Localized chilblain mainly occurs in exposed parts such as the back of the hand, heel and auricle, and is mostly symmetrical. In light cases, the skin in the frozen part is pale first, then red and swollen, or has induration and plaque, red edge and blue center, and feels burning and numb, and it is burning and itchy when it is warm. In severe cases, blisters or lumps of different sizes appear, the skin is pale or dark red, or turns purple, the pain is severe, or the feeling disappears, and dark red blood blisters appear locally. Purulent blood oozes out after the blood blister breaks, and the closure is slow, which often takes more than 1 ~ 2 months.
If infected with poison, it will become wet gangrene. The whole body may be accompanied by fever, aversion to cold and even invagination syndrome.
People with systemic chilblain have chills at first, then they feel dull, weak, blurred vision, hallucinations, drowsiness, unconsciousness, gradually lower body temperature, dilated pupils, dull light reflex, shallow breathing, weak pulse, and even stop breathing and heartbeat and die.
3.3.2 The classification of frostbite is divided into three degrees according to the severity of frostbite.
I degree (erythema chilblain): The epidermis is damaged, and the skin is red, painful and itchy.
Second degree (blister chilblain): when the damage reaches the dermis, it first appears red and swollen, and then blisters or blood blisters of different sizes appear, causing local insensitivity and severe pain.
ⅲ degree (necrotizing chilblain): the skin is damaged to the whole layer, and in severe cases, it can reach the subcutaneous layer, and the muscle or the whole limb is necrotic. Generally, blisters appear 3-7 days after injury, with limited limb movement, purple-black lesions and obvious edema and pain around them. In about 7 days, dry gangrene appeared, and the affected part completely lost its feeling and function. After about 2-3 weeks, the frostbite necrotic tissue was separated from the normal tissue.
3.4 Diseases that need to be differentiated from chilblain 3.4. 1 erysipelas are common in meat and fishery workers, and the fingers or the back of the hand are red and flaky, accompanied by itching and pain, but they are migratory, and generally disappear by themselves in about 2 weeks without ulceration.
3.4.2 Erythema multiforme mostly occurs on the back, palm, sole and face of hands and feet. Skin lesions are erythema and blisters, typical iris erythema, often accompanied by fever, joint pain and other symptoms.
3.5 Treatment of chilblain The treatment of chilblain should be warming yang to dispel cold and harmonizing camp and health [2]. Oral Danggui Sini Decoction [2]. External application of Tieyang ointment or Kurenai Rin wine [2]. You can also wash the affected area with ginger juice and pepper decoction [2]. For patients with ulceration and pain, Yuhong ointment [2] is used externally.
3.5. 1 treatment based on syndrome differentiation 3.5. 1. 1 cold blood stasis type chilblain refers to cold blood stasis, local numbness and cold pain, blue or dark red skin color, swelling and caking, or blisters, itching and cold hands and feet.
3.5. 1. 1. 1 Symptoms are chills, cold limbs, pale face, then redness, burning pain or itching, numbness, or blisters, lumps, dark purple skin, dull feeling or disappearance; The tongue is pale with white fur and thin pulse.
3.5. 1.65438+ cold coagulation, qi stagnation and blood stasis, the skin color is red, swollen and purple; Stagnation of qi and blood leads to pain, itching, numbness, and even no feeling at all. A pale tongue with white fur and thin pulse is a sign of the invasion of cold evil.
3.5. 1. 1.3 treatment: warming yang to dispel cold and harmonizing ying and Wei.
3.5. 1. 1.4 Modified Danggui Sini Decoction.
3.5. 1.2 Cold-yang-declining chilblain refers to cold-yang-declining, characterized by chills, numbness of limbs, hallucinations, blurred consciousness, lethargy, weak breathing, even unconsciousness, pale purple tongue and white fur.
3.5. 1.2. 1 Symptoms: chills, cold limbs, burnout, drowsiness and weak breathing; The tongue is pale with white fur, and the pulse is heavy and thin.
3.5. 1.2.2 Dialectical analysis shows that the invasion of cold pathogens will damage yang qi, and the orthogonal struggle of pathogens will lead to chills; When the yang drops, you will be tired and sleepy, and your breathing will be weak; If yang can't get warm, his limbs will get cold; The tongue is pale with white fur and weak pulse, which is a sign of cold flourishing and yang failing.
3.5. 1.2.3 treatment: restoring yang to rescue the adverse events, warming meridians and dredging veins.
3.5. 1.2.4 Sini decoction plus ginseng soup treatment prescription.
3.5. 1.3 frostbite with cold coagulation and heat refers to frostbite syndrome with local necrosis after frostbite, festering and purulent wound surface, swelling and blackening around, aggravated pain, fever, dry mouth, red tongue, yellow tongue coating and rapid pulse [3
3.5. 1.3. 1 Symptoms: the affected area is dark red and swollen, even burning, rotting and purulent; Aversion to cold, fever and dry mouth; Red tongue, yellow fur and thready pulse.
3.5. 1.3.2 Dialectical analysis shows that cold evil invades, qi and blood stagnate, heat turns over time, external evil is heavy, evil is contending, and cold and heat hate each other; Dry mouth caused by heat injury to body fluid; Heat is not as rotten as meat, but it is red, swollen and rotten, and pus is dripping; A red tongue with yellow fur and a number of pulse strings is a sign of excessive pathogenic heat.
3.5. 1.3.3 treatment: clearing away heat and toxic materials, regulating qi and promoting blood circulation.
3.5. 1.3.4 Prescription for Simiao Yong 'an Decoction plus Astragalus membranaceus, Diding and Gongying. If the pain is severe, Rhizoma Corydalis, Olibanum and Myrrha can be added.
3.5. 1.4 Qi-deficiency and blood-stasis type chilblain (Qi-deficiency and blood-stasis type chilblain) refers to chilblain with common symptoms of Qi-deficiency and blood-stasis, characterized by listlessness, shortness of breath, laziness in speaking, pale complexion, unsmooth wound surface, redness and redness around the wound, numbness, pale tongue coating, thready pulse or weakness [
3.5.2 If the external treatment method is not broken, eggplant stalks, pepper stalks or Ai Qi, winter melon peel and cinnamon can be decocted in water and soaked in hot water 10g, 1 ~ 2 times a day for 30min each time.
If it is broken, you can use Zichuang ointment and Huadu powder ointment.
I and II degree chilblains were smeared with 10% ethanol solution of Zanthoxylum bungeanum or chilblain cream twice a day and bandaged. If the blister is large, the liquid in the blister should be pumped out first, and then the above drugs should be applied. If there is local toxic erosion or ulcer, red ointment or berberine ointment should be applied externally, 65,438+0 times a day; in addition, 90g of Mori Ramulus, 30G of Glycyrrhiza uralensis Fisch, or 30g of Glycyrrhiza uralensis Fisch can be decocted in water, then smoked and soaked, twice a day. Or the soft frostbite of Hongling wine.
Disinfect the skin around the affected area with 75% alcohol or oxamine, suck out the liquid in the blister, and then wrap it with red ointment gauze to keep warm. When ulcerated, it was mixed with Jiuyidan for external application, and the dressing was changed daily 1 time. If necrotic tissue dissolves, debridement should be performed. After the carrion is completely removed, red ointment mixed with Shengji powder should be applied externally.
3.5.3 Patients with severe systemic frostbite treated by other therapies should take first aid measures. First of all, let them get out of the cold environment quickly, take off their cold and wet clothes, shoes and socks, and give them hot drinks, tea and wine. Artificial respiration, oxygen supply and anti-shock treatment are feasible according to the condition. For rapid rewarming of frozen patients, it is advisable to soak the patients in warm water at 38℃ ~ 42℃ for more than 20 minutes until the nail beds of fingers (toes) are washed clean and the tongue feels for about 65,438+00 minutes, then take them out to dry and continue to keep warm. Should cooperate with intravenous injection of glucose solution. And the temperature of the liquid should be 25℃ ~ 32℃ to supplement sugar and electrolyte. It is forbidden to rub with snow, bake with fire or take a cold bath.
3.6 prevention of frostbite frostbite focuses on prevention, and attention should be paid to cold and warmth and appropriate activities [2].
1. Take cold-resistant exercises in daily life, such as washing your face with cold water, washing your feet with cold water, or swimming in winter.
2. When working in a cold environment, keep your limbs warm and dry.
3. The exposed parts such as opponents, feet, ears and nose should be well protected, and shoes and socks should not be too tight.
4. Working hours in cold environment should not be too long.
5. It should not be heated or baked immediately after freezing to prevent ulceration and sores.
Frostbite in western medicine is similar to "frostbite" and "chilblain" recorded in Chinese medicine literature.
4. 1 English name chilblain
4.2 alias kibe is used for chilblain; Pernio; Frostbite swelling poison
4.3 classification dermatology > physical dermatosis > cold dermatosis
4.4 ICD number T69. 1
4.5 Epidemiology of common diseases in winter, most patients have chilblain. It heals itself after warming up in spring, but it is easy to recur in the following winter. There is no other related content description at present.
4.6 Etiology Cold is the main cause of this disease, and all factors that can increase cold conduction and convection can promote the formation of this disease, such as humidity and wind speed. In addition, the decline in the adaptability of body tissues to cold also plays an extremely important role in the formation of this disease.
Long-term cold of the skin can cause subcutaneous artery contraction, long-term paralysis and expansion of blood vessels, congestion of veins, telangiectasia with increased permeability, and plasma infiltration into tissue spaces. Sudden changes in temperature, humid air, sweaty hands and feet, poor peripheral blood circulation, anemia, lack of exercise, and tight shoes and socks can all contribute. Frostbite is more common in children, young women or sedentary people.
4.7 Typical symptoms of skin lesions are limited finger cover, bean size, purple swelling and edema patches or induration, unclear boundary, bright red edge, blue-purple center, tense and bright surface, cold touch, fading after pressing, and slow recovery after removing pressure. Frostbite is a local congestive erythema and ulceration caused by long-term cold and humidity. It is common in fingers, back of hand, toes, instep, foot margin, auricle, nose tip and so on. , and is often presented symmetrically. At the beginning, dark purple edema spots appeared locally, the boundary was unclear, the oppression subsided, and the touch was wet and cold. I feel numb in the early stage, itchy gradually, and aggravated after heating. In severe cases, blisters may appear, which will form ulcers after rupture. The course of the disease is prolonged, which often occurs in winter solstice and ends in warm spring.
4.8 The pathogenesis of cold causes skin vasoconstriction, local skin ischemia and hypoxia, and metabolic disorder. Long-term vascular paralysis and dilation, congestion and plasma exudation cause local tissue edema, blister formation, tissue necrosis and ulcer formation. Humidity and wind speed can accelerate body surface heat dissipation, so the incidence of chilblain in wet and windy areas in winter is higher than that in dry areas. In addition, autonomic nerve disorder, poor blood supply to limbs, tight shoes and socks, sweaty hands and feet, lack of exercise, malnutrition, anemia and some chronic diseases are often the causes of this disease.
4.9 Clinical manifestations of chilblain Typical skin lesions are localized fingertip, broad bean size, dark purple swelling and edema patches or induration, with unclear boundary, bright red edge, blue-purple center, tense and bright surface, cold touch, fading after pressing, and slow recovery after removing pressure. In severe cases, swelling is aggravated, and blisters can be formed on the surface, containing yellowish or bloody serous fluid. After the blister is broken, erosion or ulcer can be formed. Multi-symmetry occurs in the distal extremities, especially in the fingers, back of hand, foot margin, heel, cheek and auricle, or unilaterally. It mostly occurs in children and young women, especially those with poor blood supply to limbs and sweaty hands and feet. Feel itchy, burning and swollen. Itching is aggravated after feeling hot, and those with erosion or ulcer feel pain. It starts in winter every year, heals itself after the weather gets warmer, and the course of disease is prolonged.
4. The complications of10 chilblain include itching, burning and swelling. Itching is aggravated after feeling hot, and those with erosion or ulcer feel pain.
4. 1 1 Histopathological examination showed that the skin lesions of chilblain mainly showed dermal edema, perivascular mononuclear cell infiltration, vascular wall edema and vacuole formation, which was called villous edema. Keratinocyte necrosis is common in the lower epidermis.
4. 12 diagnosis According to its clinical manifestations and characteristics of frequent occurrence in winter, it is generally not difficult to make a diagnosis.
4. 13 differential diagnosis 4. 13. 1 erythema multiforme also occurs on the back of the hand and the edge of fingers, but the damage is polymorphic, with typical iridescent erythema, also known as target-like damage, purple in the middle, red in the edge and no congestion. After acute treatment, it is more common in spring and autumn.
4. 13.2 erythema nodosum is common in the extended leg, with obvious inflammation and severe pain, no blisters and ulcers, and has nothing to do with cold season.
4. 13.3 acrocyanosis is more common in adult women. The legs are blue, the skin is cold and slightly swollen, and the distal end is heavy in color and does not fester. Symptoms do not exist, symptoms exist all the year round, regardless of season.
4. 14 The treatment and prevention of chilblain should focus on strengthening the body, especially the hand and foot movements, so as to promote blood circulation. Attention should be paid to keeping limbs warm and dry. After freezing, it should not be dried on fire or soaked in hot water.
It is most important to prevent frostbite, such as keeping your body and face warm when winter comes. Treatment can only treat the symptoms, warming yang and dispelling cold, and harmonizing camp and health. You can take Danggui Sini Decoction, apply Yang Xie Ning ointment for external use, or rub it with HongLing wine. You can also wash the affected area with pungent and warm agents such as ginger juice and pepper, and you can also prevent it. If it has become a sore, you should choose Yuhong ointment for external use.
4. 14. 1 systemic therapy (1) vasodilator application: nicotinic acid 50 ~ 100 mg, three times a day; Cinnarizine (Naoyizine) 25mg, 3 times a day; Nifedipine (Nifedipine) is effective in treating severe recurrent chilblain 20mg, three times a day, and hand and foot injuries for 8 days.
(2) Vitamin E, 0. 1 ~ 0.2g, three times a day.
4. 14.2 The principle of local treatment is to diminish inflammation, reduce swelling and promote local blood circulation.
(1) patients with unbroken skin lesions: At the initial stage of onset, try to soak chilblain in warm water for 2 ~ 3 minutes, then in cold water 1 minute, twice a day, and extend the soaking time appropriately to improve the blood circulation at the body end. Pepper tincture (3-5 fresh peppers, soaked in 250g of 75% alcohol or white wine, sealed for 7 days) can be used for external use 2-3 times a day, and 10% camphor alcohol, 10% camphor ointment, turpentine, chilblain ointment, honey lard ointment (containing 70%) can also be added.
(2) Those who have been broken: wet compress with 3% boric acid solution after breaking, and apply externally with 10% camphor ointment, chilblain cream, honey pig ointment, and 10% fish fat ointment after seepage stops. It is also effective to mix 60 grams of honey and 60 grams of lard with 1 teaspoon of ginger juice to make ointment for external application.
4. 14.3 physical therapy ultraviolet erythema dose irradiation 2 ~ 3 times/week, in early winter, irradiation has a good effect on skin lesions. He-Ne laser local irradiation, 2 ~ 3 times/week, 5 ~ 65438±05min each time. Audio frequency electrotherapy, 1 time /d,1time is a course of treatment, which has a certain preventive effect before recurrence every year.
4. 15 prognosis onset every winter, self-healing after the weather gets warmer, and the course of disease is prolonged.
4. 16 prevent frostbite, strengthen exercise and nutrition, enhance physical fitness, promote blood circulation, and improve the body's adaptability to cold. In cold season, we should pay attention to local warmth, gloves, shoes and socks should not be too tight, and frozen parts should not be baked and soaked in hot water immediately; Apply vaseline or other grease to the cold-prone parts to protect the skin. Regular local * * * and warm water bath to improve blood circulation.
4. 17 related drugs: oxygen, nicotinic acid, cinnarizine, nifedipine, vitamin e, camphor, boric acid, fish fat and Sini decoction.
4. 18 related examination of nicotinic acid and vitamin e
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