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. It is concluded that chilblain is the disease name [1]. That is chilblain [1].
Chilblain [2] is the name of the disease [1]. See Danxi method. Also known as frozen furuncle [1]. 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, local swelling, numbness, itching, bruising, or blistering, or even festering into sores; 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, and most patients have 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].
4 Frostbite The etiology and pathogenesis of frostbite record: "Frostbite is mostly affected by its cold, causing initial pain and secondary swelling and bleeding of the face, hands and feet, 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 [1]. It is formed by cold wind hurting skin and stagnation of qi and blood [1].
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.
5 Symptoms of frostbite Frostbite mostly occurs in exposed parts such as hands, feet and auricles [1]. The skin of the affected area was pale at first, and gradually turned into purple erythema, accompanied by burning pain, itching or numbness, and even ulcerated into a sore, which was difficult to heal [1].
Patients with chilblain have been attacked by cold pathogens for a long time, and their hands, feet, auricles, cheeks and other parts appear red, swollen, cold, itchy and painful, and even their skin is purple and black [2].
6 Diagnosis of chilblain 6. 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 area is pale at first, then red and swollen, or has induration, plaque, red edge and blue heart, and feels burning and numb, and feels burning and itching 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.
6.2 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.
7 diseases that need to be differentiated from chilblain 7. 1 erysipelas are more common in meat and fishery workers, and the fingers or the back of the hand are red and flaky, with itching and pain at the same time, but they are migratory and generally disappear by themselves in about 2 weeks without ulceration.
7.2 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 and joint pain.
8 Treatment of chilblain The treatment of chilblain should be warming yang to dispel cold and harmonizing camp and health [1]. Oral Danggui Sini Decoction [1]. External use of Yang ointment or Kurenai Rin wine rub [1]. You can also wash the affected area with ginger juice and pepper decoction [1]. For patients with ulceration pain, Yuhong ointment [1] should be used externally.
8. 1 Treatment based on syndrome differentiation 8. 1. 1 Cold coagulation and blood stasis type chilblain refers to cold coagulation and blood stasis, local numbness and cold pain, blue or dark red skin color, swelling and caking, or blisters, itching, cold hands and feet, pale tongue and white coating.
8. 1. 1. 1 Symptoms are chills, cold limbs, pale face, then redness, burning pain or itching, numbness, or blisters, lumps, purple skin, dullness or disappearance; The tongue is pale with white fur and thin pulse.
8. 1. 1.2 Dialectical analysis of coldness shows that the human body has cold limbs and pale skin; Cold coagulation, qi stagnation and blood stasis, then 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.
8. 1. 1.3 treatment: warming yang to dispel cold, and harmonizing ying and Wei.
8. 1. 1.4 Fang Jiawei Danggui Sini Decoction.
8. 1.2 Cold-yang-declining chilblain refers to cold-yang-declining, characterized by frequent chills, numbness of limbs, hallucinations, confusion, lethargy, weak breathing, even unconsciousness, purplish tongue, white tongue coating and slightly heartbroken pulse.
8. 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.
8. 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.
8. 1.2.3 treatment: restoring yang to rescue the adverse events and warming the blood vessels.
8. 1.2.4 Prescription for curing four pests plus ginseng soup.
8. 1.3 frostbite with cold coagulation and heat refers to frostbite syndrome with local necrosis after frostbite, festering and purulent wound surface, dark redness and fever around, aggravated pain, dry mouth and fever, red tongue with yellow coating and rapid pulse [3].
8. 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.
8. 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 with righteousness, aversion to cold and fever; 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.
8. 1.3.3 treatment: clearing away heat and toxic materials, regulating qi and promoting blood circulation.
8. 1.3.4 Fang Simiao Yong 'an Decoction with Radix Astragali, Herba Violae and Gongying. If the pain is severe, Rhizoma Corydalis, Olibanum and Myrrha can be added.
8. 1.4 chilblain of qi deficiency and blood stasis refers to chilblain with common symptoms of qi deficiency and blood stasis, such as mental fatigue, shortness of breath, lazy speech, pale complexion, unsmooth wound surface, dark red swelling around the wound, numbness, pale tongue, white tongue coating, weak pulse or weakness [3].
8.2 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 10g, once a day 1 ~ 2 times, each time for 30 minutes.
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.
8.3 For patients with severe systemic frostbite treated by other treatments, first aid measures should be taken. First, the patients should be quickly separated from the cold environment, take off their cold and wet clothes, shoes and socks, and give them hot drinks, hot tea and warm 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.
9 Prevention of chilblain focuses on prevention, paying attention to cold protection and appropriate activities [1].
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. Hands, feet, ears, nose and other exposed parts should be 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.
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