The disease belongs to surgery.
3 Disease Overview Gangrene in flank, gangrene in rib and deep gangrene all belong to gangrene syndrome occurring in rib. Gangrene of hypochondriac ribs is born in soft meat under ribs; Gangrene of ribs is born in ribs; Underarm 10 cm intercostal gangrene causes deep gangrene. Although the names of the three diseases are different, and the locations and syndromes are slightly different, their meridian distribution, clinical manifestations and treatment methods are quite similar, so they are discussed together. It is equivalent to tuberculosis of chest wall and sternum in modern medicine.
The diagnosis point 1 is more common in people under 30 years old who are thin and weak, and most of them are men.
2. Have a history of tuberculosis or lung surgery before the onset.
3. At first, it was mostly deep in the chest wall muscles, between the ribs, with dull pain and white swelling.
4. After about 3 to 4 months, the pus gradually swells up, which can be as big as a cup or bowl. The pain is unbearable, and the skin will turn red when it collapses.
5. After the collapse, the pus is thin and has flocculent substances, which can damage the periosteum. People with damaged bones can come into contact with rough dead bones by penetrating through the wound; The infiltrator put a piece of tissue paper on the sore surface, and the patient saw the tissue paper shaking when breathing.
6.x-ray examination showed that the rib or sternum was destroyed as rib tuberculosis, but no bone destruction was found, so the diagnosis of chest wall tuberculosis could not be ruled out.
7. Non-suppurative costal chondritis, the lesion often invades 2~4 costal cartilage, especially the second costal cartilage. The affected cartilage often bulges obviously, with pain and tenderness, consistent skin color, hard texture and no fluctuation, and X-ray examination shows no obvious bone change.
5 dialectical analysis 1, this disease is due to the deficiency of vital qi, plus anger stagnation, stagnation into fire, burning body fluid as phlegm, stagnation in collaterals, and obstruction in liver and gallbladder. It is characterized by unchanged skin color, swelling and dull pain, and prolonged course of disease. Once it is broken, it will cause pus, which is difficult to heal and even damage the periosteum.
2, the two threats are distributed by the liver and gallbladder, with more qi and less blood. At the initial stage, it was mainly manifested as liver depression and qi stagnation. In addition to local swelling and pain, it is often accompanied by hypochondriac attacks and pain, irritability and aggravation of emotional exhaustion. At the stage of suppurative formation or early festering, it is mainly manifested as yin deficiency of liver and kidney, wind and fire spreading inward, swelling gradually turning red, accompanied by symptoms of yin deficiency and fire flourishing, such as vexation, night sweats, sun fever, flocculent substances in pustules, etc. After collapse, or long-term unhealed, the symptoms of deficiency of both qi and blood and physical weakness are more common. The treatment is mainly to clear the liver and relieve depression, and to eliminate stagnation.
6. Syndrome Differentiation and Treatment 6. 1 Liver Depression and Qi Stagnation Syndrome
Pain in hypochondriac region, unchanged skin color, accompanied by hypochondriac pain or swelling discomfort, or paroxysmal channeling pain, inability to lean sideways, loss of appetite, irritability, emotional disorder, red tongue, thin and white fur, and thready pulse.
processing method
Clearing the liver and relieving depression, resolving food stagnation.
Herbs on the prescription
1, the main prescription: Chaihu Qinggan Decoction (such as Medicine Zong Jin Jian) and Erchen Decoction (such as Taiping Huimin Hejiju Formula), and the modified prescription: 6 grams of Chaihu, 9 grams of Paeonia Rubra, 9 grams of Scutellaria baicalensis, 9 grams of Stemona Stemona, 9 grams of Salvia Miltiorrhiza, 9 grams of Toosendan Fructus, 9 grams of processed Cyperus rotundus, 6 grams of dried tangerine peel and 3 grams of raw licorice. Decoct with water, daily 1 dose.
2. Chinese patent medicine (1) Huang Xi Pill, 3g each time, twice a day, with warm water. (2) Xiaojin Dan, for usage, see Yin-cold syndrome in Huandiaoju.
3. Single prescription: Dangsan (Liu Luxiang Formula) Prescription: 30 centipedes, scorpion 100g, white mustard seed 15g. * * * Fine grinding, divided into 60 packages. At the end of each medication, put the 1 packet into the 1 egg with small holes, stir it evenly and steam it; Twice a day, 30 days as a course of treatment.
6.2 Yin deficiency and fire excess syndrome.
The lump gradually turns red and soft, with emaciation, cough without phlegm, or less and thick phlegm, dry mouth, fever, hot flashes in the morning, night sweats, palpitations and shortness of breath. Red tongue with thin yellow fur and weak pulse.
processing method
Nourishing yin to reduce fire, supporting poison and protecting membrane.
Herbs on the prescription
1. The main prescription: Baizhi Huangtang (Janice et al.' Medical Zong Jin Jian'), Heqing Bone Powder (Wang Kentang's' Standard of Syndrome Differentiation and Treatment'). Revised prescription: Rhizoma Anemarrhenae 9g, Cortex Phellodendri 9g, Radix Bupleuri 9g, Cortex Lycii 12g, Carapax Trionycis 15g, Radix Glycyrrhizae 6g, and Carapax Trionycis 9g.
2, Chinese patent medicine (1) white Dihuang pills, honey pills 9 grams each time, honey pills 6 grams each time, twice a day, take warm water. (2) Dabuyin Pills, 9 grams of honey pills each time and 6 grams of honey pills each time, 2-3 times a day, and take ginger salt soup or light salt water on an empty stomach. (3) Protective film powder, 6 grams each time, twice a day, washed with warm yellow wine or rice soup.
3. Unilateral refers to the unilateral of liver depression and qi stagnation.
6.3 Deficiency of both Qi and Blood Syndrome
After the ulcer, the color of the sore surface is not fresh, the pus is thin, dripping endlessly, or stinking and rotting. Physical emaciation, pale or sallow complexion, pale lips and little blood, mental fatigue, shortness of breath and spontaneous sweating, chills, dizziness, palpitations and insomnia. The tongue is pale with thin white fur and weak pulse.
processing method
Tonify qi and blood.
Herbs on the prescription
1, the main prescription: Ginseng Angelababy Decoction (such as Medical Records) plus or minus prescription: 9 grams of Codonopsis pilosula, 9 grams of Radix Astragali preparata, 9 grams of Radix Angelicae Sinensis, 9 grams of Radix Paeoniae Alba, 9 grams of fried atractylodes, 9 grams of Poria, 6 grams of dried tangerine peel, 9 grams of Stemona Stemona, 9 grams of Scutellariae Radix, 9 grams of Salvia Miltiorrhiza Radix, 3 grams of Radix Glycyrrhizae preparata, 6543.
2. Chinese patent medicine
(1) Ginseng Yang Rong Pill, 9g each time, twice a day, with warm boiled water.
(2) Shiquan Dabu Pills, 9 grams of honey pills each time, 6 grams of honey pills each time, twice a day, with warm boiled water.
3. Unilateral refers to the unilateral of liver depression and qi stagnation. Off-site treatment
1. At the initial stage, Yang ointment was mixed with Kurenai Rin Dan for external application, or mixed ointment was applied externally.
2. If the pus does not disappear, you can use aconite tablets for moxibustion to warm the affected area and promote the maturity of pus. Abscess should be cut to discharge pus, and the knife method should be shallow to prevent damage to the intima.
3. After the collapse, drain with Qisandan thread and apply Taiyi ointment. If you encounter loose dead bones, you can take them out with tweezers. For those with pus cavity and carrion, curettage or focus removal can be used as appropriate. When pus is exhausted, use Shengji powder to close the mouth and apply Taiyi ointment externally.
6.4 Other therapies 1, diet refer to "scrofula" diet.
2, prevention and care
(1) Enhance nutrition, avoid mental disorders, and avoid spicy and greasy products.
(2) Abstinence, so as to avoid sores and flesh color, or aggravate pain.
In ancient books, hypochondriac carbuncle and deep carbuncle "The Complete Book of Surgical Syndrome and Treatment": [Volume III: Syndrome and Treatment of Three Axillary Ribs (Counting Three Syndrome Types)] Carbuncle is simple and three inches, between axils. Gangrene of costal carbuncle, one of which is sandwiched between ribs. The carbuncle is born under the ribs near the soft flesh, and it is also a carbuncle. According to the principle of carbuncle of yang and gangrene of yin. ...
The operation was a great success: [Volume II divided the upper part (carbuncle)] The ribs were pounded into pus. Shaped like swelling. But his stomach has no veins stood out. The umbilical cord will not extend into the other ear. Deep gangrene poses a threat. It was neither red nor hard at first. It will explode after a long time. Like a baby crying. ...
"Essentials of Surgical Psychology": [Volume Seven Ribs] Sink into the next inch and squat down to get it. Internal and external treatment of gangrene of the same rib. Those who have carbuncles in soft parts such as ribs, chest, sides, waist and abdomen should be treated as if they are about to collapse. ...
Golden mirror of medical record: [Operation rolls down the rib] Deep gangrene enters the next inch, and you can get it by squatting. Internal and external treatment of gangrene of the same rib. Those who have carbuncles in soft parts such as ribs, chest, sides, waist and abdomen should be treated as if they are about to collapse. ...
Encyclopedia of surgical treatment based on syndrome differentiation: [Volume I] Name of carbuncle