To investigate the efficacy of Chinese medicine fumigation therapy in the treatment of chronic lower limb ulcers. METHODS: 132 patients with chronic lower limb ulcers with qi deficiency and blood stasis were randomly divided into 88 cases in the treatment group and 44 cases in the control group; the control group was treated with conventional surgical drug exchange and internal treatment with traditional Chinese medicine, while the treatment group was fumigated with Chinese medicine to benefit qi, activate blood and promote muscle production on the basis of the treatment in the control group; the wound healing rate and wound healing time of the two groups were observed after 3 weeks of treatment. Results: In the treatment group, 22 cases were cured, 26 cases showed efficacy, 38 cases were effective, and 2 cases were invalid, with a total effective rate of 97.70%; in the control group, 8 cases were cured, 7 cases showed efficacy, 21 cases were effective, and 8 cases were invalid, with a total effective rate of 81.80%. Conclusion: Chinese medicine fumigation therapy can significantly promote the healing of chronic lower extremity ulcers, with significant clinical efficacy, and the method is simple and easy to operate without obvious adverse reactions, so it is worthy of clinical promotion and application.
Chronic lower limb ulcer is a common and frequent disease in surgical clinic. It is an important and urgent problem in the field of surgery. 88 cases of chronic lower extremity ulcers were treated by Chinese medicine fumigation therapy in the Department of Traditional Chinese Medicine and Surgery of Shanghai Longhua Hospital from June 2009 to December 2009. The clinical efficacy is remarkable and is reported as follows.
1. Clinical data
1.1 Study subjects Patients with chronic lower extremity ulcers with evidence of qi deficiency and blood stasis who were hospitalized in the Department of Traditional Chinese Medicine Surgery of Longhua Hospital, Shanghai University of Traditional Chinese Medicine from June 2009 to December 2009.
1.2 Diagnostic criteria
1.2.1 Diagnostic criteria in Western medicine The skin ulcer wounds of the lower extremities caused by various reasons, which have not healed for more than 1 month after conventional treatment.
1.2.2 Diagnostic criteria of Chinese medicine and diagnostic criteria of Chinese medical evidence The Chinese medicine industry standard of the People’s Republic of China? Diagnostic Efficacy Criteria for Chinese Medical Evidence [1].
1.2.2.1 Diagnostic criteria for TCM An ulcer is seen locally on the lower extremity, varying in size, mostly superficial, with a gray, light red or purple surface and yellow pus moss on the surface or attached to it, with a sunken sore, the edge of which is shaped like a jar mouth, and the pus is clear and thin, grayish black or greenish, with a fishy odor. The ulcer may be surrounded by wet sores, varicose veins, and hyperpigmentation. The sore is difficult to heal, easy to ulcerate after healing, and recurrent.
1.2.2.2 Diagnostic criteria of TCM symptoms
Qi deficiency and blood stasis: the ulcer is long-standing, the rotting flesh has been removed, the thick white border is raised, the flesh buds on the sore surface are purple and dark but not fresh, the skin around the sore is swollen, the complexion is dark, the plate is wooden and hard, or the veins are exposed. The tongue is dark red or light purple, or there is petechiae, the tongue coating is white and greasy, and the pulse is thin and astringent.
1.3 Inclusion criteria The cases met the criteria of Western medicine diagnosis and Chinese medicine diagnosis and symptoms of the disease; lower extremity ulcer wound area ≥ 2 M2; age ≥ 18 years, male and female; informed consent, signed the informed consent form, and volunteered to be tested.
1.4 Exclusion criteria Those who did not meet the diagnostic criteria and inclusion criteria. Patients who meet the diagnostic criteria and inclusion criteria but have one of the following conditions: combined with serious primary diseases such as cardiovascular, cerebrovascular, liver, kidney and hematopoietic system, psychiatric patients; combined with neurotrophic disorders; combined with diabetes mellitus, patients with unstable glycemic control; combined with serious infections, patients in critical condition; pregnant or lactating women; allergic or allergic to treatment drugs; arterial disease ulcers; cancerous ulcers or tuberculosis ulcers. Patients with arterial ulcers, cancer ulcers, tuberculosis ulcers, radioactive ulcers, decubitus ulcers, leprosy ulcers, syphilis ulcers, ulcers with exposed tendons and bones, and those who are not treated as prescribed, cannot judge the efficacy or have incomplete information.
1.5 Observation indexes
Trauma healing rate: Trauma healing rate = (original trauma area – unhealed trauma area)/original trauma area×100％.
1.6 General information 132 patients were randomly assigned to the treatment and control groups in a ratio of 2:1. 88 cases in the treatment group, 60 males and 28 females; the youngest was 18 years old and the oldest was 92 years old, with a mean age of 64.24±16.13 years; the shortest duration of disease was 1.5 months and the longest was 480 months, with a mean of 29.28±73.92 months; the smallest initial trauma area was 2 cm2 and the largest was 380 cm2, with a mean of 22.92±48.08 cm2. There were 40 varicose venous ulcers, 19 diabetic ulcers, 13 soft tissue infected ulcers, 14 traumatic or trauma combined with infected ulcers, and 2 ulcers of other causes. In the control group, there were 44 cases, 31 males and 13 females; the youngest was 18 years old, the oldest was 90 years old, the average age was 68.77±19.34 years old; the shortest duration of disease was 1.5 months, the longest was 482 months, the average duration of disease was 29.49±100.29 months; the smallest initial wound area was 2 cm2, the largest was 360 cm2, the average was 22.49±54.94 The differences in gender, age, disease duration and initial wound area between the two groups were statistically insignificant (P>0.05) and comparable.
2. Treatment methods
2.1 Treatment group
2.1.1 External treatment
2.1.1.1 Chinese medicine fumigation therapy The intelligent Chinese medicine fumigation steam self-control therapy instrument (Changxing Sanzhou Electronic Scientific Instrument Factory, model: XJZA-Ⅱ) was used to perform Chinese medicine fumigation. Fumigation method: use 300ml (provided by the Chinese medicine preparation room of the hospital) of the decoction of Chinese herbal medicines such as raw astragalus, angelica, danshen, safflower and cinnamon, etc. to benefit qi, blood circulation and muscle production, add water to 1000ml~1100ml and heat it up, then fumigate the affected part with the liquid steam after waiting for the temperature (the water temperature is about 40℃), keeping the affected part at a distance of 25cm~30cm from the jet of the fumigation instrument, which is tolerable; 40min each time. 1 time per day for 3 weeks as a course of treatment.
2.1.1.2 Routine surgical dressing change Disinfect the skin around the sore with 75% alcohol cotton balls, then gently swab the sore surface with 1:5000 furacilin cotton balls to clean the secretions; mix the sore surface with myogenic powder and red oil paste gauze to cover the paste, and use white jade paste to cover the paste if you are allergic to red oil paste; change the dressing once a day.
2.1.2 Internal treatment with Chinese herbal medicine: Benefit Qi, invigorate Blood, eliminate blood stasis and promote muscle growth. The formula is based on the addition and subtraction of tonic yang and return to five soup. Commonly used drugs include Astragalus membranaceus, Radix Codonopsis pilosulae, Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Radix Paeoniae Alba, Salviae Miltiorrhizae, Peach kernel, Safflower, Radix et Rhizoma gastrodiae, Radix Chuangyuang. Add and subtract: if the sore surface is pale or light red, add Atractylodes and Poria; if the sore surface is purple or green, add leeches; if the skin is hard and knotted, add Trigonella, Curcuma longa and White Mustard Seed; if the swelling is obvious, add Yimu Cao, Zelenia and Lutong; if the deficiency of Qi is obvious, use Astragalus for 60g-120g; if the deficiency of blood is obvious, add Radix Rehmanniae, Radix Rehmanniae and White Peony; if the deficiency of Yin is obvious, add Radix Rehmanniae, Radix et Rhizoma Ginseng and Radix et Rhizoma Macrocephala. Decoction with water, one dose daily, divided into two doses (provided by the Chinese medicine preparation room of the hospital).
2.2 Control group Only conventional surgical drug exchange and internal treatment with traditional Chinese medicine were given.
Xu Jie-Nan, Que Hua-Fa
Department of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Abstract OBJECTIVE: To investigate the efficacy of Chinese herbal fumigation therapy in the treatment of chronic lower limb ulcers. Methods: 132 patients with chronic lower extremity ulcers with Qi deficiency and blood stasis were randomly divided into 88 cases in the treatment group and 44 cases in the control group; the control group was treated with conventional surgical drug exchange and internal treatment with traditional Chinese medicine, while the treatment group was fumigated with Chinese medicine to benefit Qi, activate blood and promote muscle production based on the treatment of the control group; the wound healing rate and wound healing time of the two groups were observed after 3 weeks of treatment. Results: In the treatment group, 22 cases were cured, 26 cases showed efficacy, 38 cases were effective, and 2 cases were invalid, with a total effective rate of 97.70%; in the control group, 8 cases were cured, 7 cases showed efficacy, 21 cases were effective, and 8 cases were invalid, with a total effective rate of 81.80%. Conclusion: Chinese medicine fumigation therapy can significantly promote the healing of chronic lower limb ulcers with significant clinical efficacy, and the method is simple and easy to operate without significant adverse reactions, so it is worthy of clinical promotion and application. Xu Jie-nan, Department of Surgery, Shanghai Longhua Hospital
Keywords: chronic lower extremity ulcers; Chinese medicine fumigation; Chinese medicine external treatment; Qi deficiency and blood stasis evidence
Clinical study on treatment of 88 cases of chronic lower limbs ucler with washing with Chinese medicine
Jie-nan XU, Hua-fa QUE
Surgical of TCM, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
Abstruct Objective: To explore the effect of washing with Chinese medicine for chronic lower limbs ucler. Methods: A total of 132 cases of chronic lower limbs ucler with Qi-defense limbs ucler with Qi-deficiency and Blood-stasis Syndrome were divided into treatment group (88 cases) and control group (44 cases) at random; 44 cases of control group were treated by common surgical dressing change and Differentiating Syndrome Treatment of TCM.88 cases of treatment group were treated by 88 cases of treatment group were treated by washing with Chinese medicine on the treatment basis of control group. Results: In treatment group,22 cases were cured,26 cases were markedly effective In control group, 8 cases were cured, 7 cases were markedly effective, 21 cases were effective, the effective rate reached 97.70%. In control group,8 cases were cured,7 cases were markedly effective,21 cases were effective,8 cases were ineffective,the effective rate reached 81.80% ,with statistical significance (P<0.01). Conclusion: Washing with Chinese medicine has very significant efficacy in promoting the wound healing for chronic lower limbs ulcer, and the Washing with Chinese medicine has very significant efficacy in promoting the wound healing for chronic lower limbs ulcer, and the advantages of simple operation,low relapse.This therapy is worth popularizing.
Key words：chronic lower limbs ucler；washing with Chinese medicine；TCM external therapy；Qi-deficiency and Blood-stasis Syndrome
Chronic lower limb ulcer is a common and frequent disease in surgical clinics. It is an important and urgent problem in the field of surgery. 88 cases of chronic lower extremity ulcers were treated with Chinese medicine fumigation therapy from June 2009 to December 2009 in the Department of Traditional Chinese Medicine and Surgery of Shanghai Longhua Hospital. The clinical efficacy is remarkable and is reported as follows.
1 Clinical data
1.1 Study subjects Patients with chronic lower extremity ulcers with evidence of qi deficiency and blood stasis who were hospitalized in the Department of Traditional Chinese Medicine Surgery of Longhua Hospital, Shanghai University of Traditional Chinese Medicine from June 2009 to December 2009.
1.2 Diagnostic criteria
1.2.1 Diagnostic criteria in Western medicine The skin ulcer wounds of the lower extremities caused by various reasons, which have not healed for more than 1 month after conventional treatment.
1.2.2 Diagnostic criteria of Chinese medicine and diagnostic criteria of Chinese medical evidence “Industry standard of Chinese medicine of the People’s Republic of China? Diagnostic Efficacy Criteria for Chinese Medical Evidence [1].
1.2.2.1 Diagnostic criteria for TCM An ulcer is seen locally on the lower extremity, varying in size, mostly superficial, with a gray, light red or purple surface and yellow pus moss on the surface or attached to it, with a sunken sore, the edge of which is shaped like a jar mouth, and the pus is clear and thin, grayish black or greenish, with a fishy odor. The ulcer may be surrounded by wet sores, varicose veins, and hyperpigmentation. The sore is difficult to heal, easy to ulcerate after healing, and recurrent.
1.2.2.2 Diagnostic criteria of TCM symptoms
Qi deficiency and blood stasis: the ulcer is long-standing, the rotting flesh has been removed, the thick white border is raised, the flesh buds on the sore surface are purple and dark but not fresh, the skin around the sore is swollen, the complexion is dark, the plate is wooden and hard, or the veins are exposed. The tongue is dark red or light purple, or there is petechiae, the tongue coating is white and greasy, and the pulse is thin and astringent.
1.3 Inclusion criteria The cases met the criteria of Western medicine diagnosis and Chinese medicine diagnosis and symptoms of the disease; lower extremity ulcer wound area ≥ 2 M2; age ≥ 18 years, male and female; informed consent, signed the informed consent form, and volunteered to be tested.
1.4 Exclusion criteria Those who did not meet the diagnostic criteria and inclusion criteria. Patients who meet the diagnostic criteria and inclusion criteria but have one of the following conditions: combined with serious primary diseases such as cardiovascular, cerebrovascular, liver, kidney and hematopoietic system, psychiatric patients; combined with neurotrophic disorders; combined with diabetes mellitus, patients with unstable glycemic control; combined with serious infections, patients in critical condition; pregnant or lactating women; allergic or allergic to treatment drugs; arterial disease ulcers; cancerous ulcers or tuberculosis ulcers. Patients with arterial ulcers, cancer ulcers, tuberculosis ulcers, radioactive ulcers, decubitus ulcers, leprosy ulcers, syphilis ulcers, ulcers with exposed tendons and bones, and those who are not treated as prescribed, cannot judge the efficacy or have incomplete information.
1.5 Observation indexes
Trauma healing rate: Trauma healing rate = (original trauma area – unhealed trauma area)/original trauma area×100％.
1.6 General information 132 patients were randomly assigned to the treatment and control groups in a ratio of 2:1. 88 cases in the treatment group, 60 males and 28 females; the youngest was 18 years old and the oldest was 92 years old, with a mean age of 64.24±16.13 years; the shortest duration of disease was 1.5 months and the longest was 480 months, with a mean of 29.28±73.92 months; the smallest initial trauma area was 2 cm2 and the largest was 380 cm2, with a mean of 22.92±48.08 cm2. There were 40 varicose venous ulcers, 19 diabetic ulcers, 13 soft tissue infected ulcers, 14 traumatic or trauma combined with infected ulcers, and 2 ulcers of other causes. In the control group, there were 44 cases, 31 males and 13 females; the youngest was 18 years old, the oldest was 90 years old, the average age was 68.77±19.34 years old; the shortest duration of disease was 1.5 months, the longest was 482 months, the average duration of disease was 29.49±100.29 months; the smallest initial wound area was 2 cm2, the largest was 360 cm2, the average was 22.49±54.94 The differences in gender, age, disease duration and initial wound area between the two groups were statistically not significant (P>0.05) and were comparable.
2 Treatment methods
2.1 Treatment group
2.1.1 External treatment
2.1.1.1 Chinese medicine fumigation therapy The intelligent Chinese medicine fumigation steam self-control therapy instrument (Changxing Sanzhou Electronic Scientific Instrument Factory, model: XJZA-Ⅱ) was used to perform Chinese medicine fumigation. Fumigation method: use 300ml (provided by the Chinese medicine preparation room of the hospital) of the decoction of Chinese herbal medicines such as raw astragalus, angelica, danshen, safflower and cinnamon, etc. to benefit qi, blood circulation and muscle production, add water to 1000ml~1100ml and heat it up, then fumigate the affected area with the liquid steam after waiting for the temperature (the water temperature is about 40℃), keeping the affected area at a distance of 25cm~30cm from the jet of the fumigation instrument, which is tolerable; 40min each time. 1 time per day for 3 weeks as a course of treatment.
2.1.1.2 Routine surgical dressing change Disinfect the skin around the sore with 75% alcohol cotton balls, then gently swab the sore surface with 1:5000 furacilin cotton balls to clean the secretions; mix the sore surface with myogenic powder and red oil paste gauze to cover the paste, and use white jade paste to cover the paste if you are allergic to red oil paste; change the dressing once a day.
2.1.2 Internal treatment with Chinese herbal medicine: Benefit Qi, invigorate Blood, eliminate blood stasis and promote muscle growth. The formula is based on the addition and subtraction of tonic yang and return to five soup. Commonly used drugs include Astragalus membranaceus, Radix Codonopsis pilosulae, Rhizoma Atractylodis Macrocephalae, Radix Angelicae Sinensis, Radix Paeoniae Alba, Salviae Miltiorrhizae, Peach kernel, Safflower, Radix et Rhizoma gastrodiae, Radix Chuangyuang. Add and subtract: if the sore surface is pale or light red, add Atractylodes and Poria; if the sore surface is purple or green, add leeches; if the skin is hard and knotted, add Trigonella, Curcuma longa and White Mustard Seed; if the swelling is obvious, add Yimu Cao, Zelenia and Lutong; if the deficiency of Qi is obvious, use Astragalus for 60g-120g; if the deficiency of blood is obvious, add Radix Rehmanniae, Radix Rehmanniae and White Peony; if the deficiency of Yin is obvious, add Radix Rehmanniae, Radix et Rhizoma Ginseng and Radix et Rhizoma Macrocephala. Decoction with water, one dose daily, divided into two doses (provided by the Chinese medicine preparation room of the hospital).
2.2 The control group was given only routine surgical drug exchange and internal treatment with traditional Chinese medicine.
3 Therapeutic efficacy analysis
3.1 Efficacy criteria Refer to the “Chinese medicine industry standard of the People’s Republic of China? Diagnostic Efficacy Criteria for TCM Evidence” [1] and the “Shanghai Diagnostic and Treatment Routine for TCM Evidence” (2nd edition) [2].
3.1.1 Clinical healing: complete healing of the trauma.
3.1.2 Effective: The wound surface is significantly reduced, ≥75%.
3.1.3 Effective: reduction of trauma, <75% or ≥25%.
3.1.4 Ineffective: wound reduction, <25%, or even enlargement.
3.2 Treatment results
In the treatment group of 88 cases, 22 cases were cured, 26 cases were effective, 38 cases were effective, 2 cases were invalid, and the total effective rate was 97.70%. In the control group of 44 cases, 8 cases were cured, 7 cases were effective, 21 cases were effective, 8 cases were invalid, and the total effective rate was 81.80%. No adverse reactions occurred in 88 cases in the treatment group.
4 Discussion
Chronic lower limb ulcers belong to the category of “ulcers” and “polyposis” in Chinese medicine. On the basis of long-term clinical research, we believe that the pathogenesis of chronic skin ulcers is characterized by the deficiency of the root and the symptoms of the disease, with the deficiency of blood stasis as the root and the dampness and heat and toxicity as the symptoms, so we propose the theory of “tonifying the deficiency and generating muscle” and “eliminating stasis and generating muscle” in the treatment, and establish the Therefore, the theory of “tonifying the deficient muscle” and “eliminating stasis to create muscle” was proposed in the treatment, and the treatment method of “benefiting qi and resolving stasis” was established [3].
The method of surgery, the most important external treatment”, the “Compendium of Ulcerology” pointed out: “Sores and ulcers are diseases that occur outside, external medicine is particularly important. All light and shallow evidence, relying exclusively on external treatment, can certainly receive full success; and danger of large ulcers, especially must rely on external treatment appropriate, interactive for use, this ulcer doctor’s study”. Chronic lower limb ulcers are located at the end of the limb, the blood and Qi are difficult to reach, and the ulcers are superficial in location.
Chinese medicine fumigation therapy, also called steam therapy and steam bath therapy, is a Chinese medicine external treatment method guided by the theory of Chinese medicine, using the steam generated by the decoction of drugs to achieve the purpose of treatment by fumigation of the organism. Chinese medicine fumigation therapy has a long history and has been commonly used by doctors for many generations. For example, the Yellow Emperor’s Classic of Internal Medicine has mentioned fumigation therapy several times, and the Suwen? It is clearly stated in the book “The cold one is hot, the hot one is cold ……”, which is the first time that fumigation therapy is listed as an important and common treatment rule and method. In the Eastern Han Dynasty? The “Golden Killing” by Zhang Zhongjing already contains the use of bitter ginseng soup fumigation fox confusion disease eclipsed in the lower part of the person.
It is generally believed that the mechanism of action of herbal fumigation therapy: (1) pharmacological effect: In the process of fumigation, the active ingredients such as alkaloids, amino acids, glycosides, plant antibiotics, tannin and various trace elements, as well as volatile oil-like substances with strong fragrance such as ketones, aldehydes and alcohols are emitted in the water vapor and directly act on the surface of the body to play local therapeutic effects, while these active ingredients Through the absorption and penetration of skin mucosa, sweat glands sebaceous glands into the body, through blood circulation throughout the body tissues and organs, to play a systemic therapeutic effect [4]. (2) Thermal effect: the warming effect of Chinese medicine fumigation therapy acts on the human body, which can directly cause vasodilatation and accelerated blood flow, and also induce the denaturation and decomposition of tissue protein trace, forming vasoactive substances such as histamine and vasoactive peptide, resulting in accelerated blood circulation and improved microcirculation. At the same time, warmth strengthens the molecular movement and increases the exchange of substances inside and outside the cells. Warmth also causes changes in cell membranes and their internal ultrastructure, enhanced mitochondrial peroxidase activity, increased cellular metabolism, and promotes protein synthesis and energy metabolism [5]. (3) Combined action of medicine and heat: through the action of heat, the skin pores are opened, the capillaries of the skin mucosa are dilated and congested, the circulation of blood and lymphatic fluid is promoted, the absorption and penetration of drugs in the local area are accelerated, and the therapeutic purpose is more easily achieved, and those herbs with pungent aroma are particularly easy to be absorbed in a warm environment, thus strengthening the drug action. At the same time, during the fumigation process, the massage of the skin by drugs, warmth and steam airflow stimulates the acupuncture points in the area, stimulates the meridian qi and mobilizes the meridians to better play the overall role of moving qi and blood.
In this study, 88 patients with chronic lower extremity ulcers with Qi deficiency and blood stasis were treated with the combination of Chinese herbal fumigation therapy to benefit Qi, invigorate blood and promote blood circulation, and 22 cases were clinically cured, 26 cases were significantly effective, 38 cases were effective, and 2 cases were ineffective, with a total effective rate of 97.70%, and the difference was significant when compared with the control group without Chinese herbal fumigation therapy (P<0.01). It indicates that the Chinese herbal fumigation therapy can significantly promote the healing of chronic lower limb ulcers with significant clinical efficacy. In the fumigation formula, Astragalus membranaceus tonifies the vital energy to support the sore, warms the spleen and stomach to promote the growth of muscle, and is an important medicine for sores and carbuncles; Angelica sinensis nourishes the blood to promote the growth of muscle, disperses blood stasis, reduces swelling, activates blood circulation and relieves pain; Salvia miltiorrhiza and Safflower invigorate the blood to dispel blood stasis and relieve pain; Cinnamomum cassia warms the meridians, and the combined use of all the herbs contributes to the function of benefiting the qi to invigorate the blood to promote the growth of muscle. Modern pharmacology proves that Astragalus and Angelica have the effects of improving immunity, stimulating cell proliferation and differentiation in hematopoietic tissues, antioxidant, dilating peripheral blood vessels, and antibacterial, while Angelica, Salvia and Safflower have the effects of dilating blood vessels, inhibiting platelet aggregation and anti-thrombosis, improving microcirculation, and anti-inflammatory and analgesic [6]. The intelligent Chinese medicine fumigation steam self-control therapeutic instrument used in this study uses multi-point spraying, which can make full and even contact between the medicinal steam and the affected part, and the therapeutic instrument uses electronic temperature controller to make the temperature controlled, which basically ensures that the temperature in the box is constant, and these technical improvements significantly improve the therapeutic effect of Chinese medicine fumigation. In addition, the treatment time and steam temperature of the treatment instrument can be adjusted by self-control, and the operation is easy, and the patient's body position can be sitting or horizontal during treatment, which is relatively free and comfortable, without obvious adverse reactions.
This clinical study shows that herbal fumigation therapy can significantly promote the healing of chronic lower limb ulcers with significant clinical efficacy, and the method is simple and easy to operate without obvious adverse reactions, so it is worthy of clinical promotion and application.
3.1.1 Clinical healing: complete healing of the trauma.
3.1.2 Significant effect: The trauma surface is obviously reduced, ≥75%.
3.1.3 Effective: reduction of trauma, <75% or ≥25%.
3.1.4 Ineffective: wound reduction, <25%, or even enlargement.
3.2 Treatment results
In the treatment group of 88 cases, 22 cases were cured, 26 cases were effective, 38 cases were effective, 2 cases were invalid, and the total effective rate was 97.70%. In the control group of 44 cases, 8 cases were cured, 7 cases were effective, 21 cases were effective, 8 cases were invalid, and the total effective rate was 81.80%. No adverse reactions occurred in 88 cases in the treatment group.
4, Discussion
Chronic lower limb ulcers belong to the category of “ulcers” and “sores” in Chinese medicine. Based on long-term clinical research, we believe that the pathomechanism of chronic skin ulcers is characterized by deficiency of the root and the symptoms, with deficiency of blood and stasis as the root and dampness and heat and toxicity as the symptoms, so we propose the theory of “tonifying deficiency and generating muscle” and “eliminating stasis and generating muscle” in treatment, and establish Therefore, the theory of “tonifying the deficient muscle” and “eliminating stasis to create muscle” was proposed in the treatment, and the treatment method of “benefiting qi and resolving stasis” was established [3].
The method of surgery, the most important external treatment”, the “Compendium of Ulcerology” pointed out: “Sores and ulcers are diseases that occur outside, external medicine is particularly important. All light and shallow evidence, relying exclusively on external treatment, can certainly receive full success; and dangerous large ulcers, especially must rely on external treatment is appropriate, interactive for use, this ulcer doctor’s study. Chronic lower limb ulcers are located at the end of the limb, the blood and Qi are difficult to reach, and the ulcers are superficial in location.
Chinese medicine fumigation therapy, also called steam therapy and steam bath therapy, is a Chinese medicine external treatment method guided by the theory of Chinese medicine, using the steam generated by the decoction of drugs to achieve the purpose of treatment by fumigation of the organism. Chinese medicine fumigation therapy has a long history and has been commonly used by doctors for many generations. For example, the Yellow Emperor’s Classic of Internal Medicine has mentioned fumigation therapy several times, and the Suwen? It is clearly stated in the book “The cold one is hot, the hot one is cold ……”, which is the first time that fumigation therapy is listed as an important and common treatment rule and method. In the Eastern Han Dynasty? The “Golden Killing” by Zhang Zhongjing already contains the use of bitter ginseng soup fumigation fox confusion disease eclipsed in the lower part of the person.
It is generally believed that the mechanism of action of herbal fumigation therapy: (1) pharmacological effect: In the process of fumigation, the active ingredients such as alkaloids, amino acids, glycosides, plant antibiotics, tannin and various trace elements, as well as volatile oil-like substances with strong fragrance such as ketones, aldehydes and alcohols are emitted in the water vapor and directly act on the surface of the body to play local therapeutic effects, while these active ingredients Through the absorption and penetration of skin mucosa, sweat glands sebaceous glands into the body, through blood circulation throughout the body tissues and organs, to play a systemic therapeutic effect [4]. (2) Thermal effect: the warming effect of Chinese medicine fumigation therapy acts on the human body, which can directly cause vasodilatation and accelerated blood flow, and also induce the denaturation and decomposition of tissue protein trace, forming vasoactive substances such as histamine and vasoactive peptide, resulting in accelerated blood circulation and improved microcirculation. At the same time, warmth strengthens the molecular movement and increases the exchange of substances inside and outside the cells. Warmth also causes changes in cell membranes and their internal ultrastructure, enhanced mitochondrial peroxidase activity, increased cellular metabolism, and promotes protein synthesis and energy metabolism [5]. (3) Combined action of medicine and heat: through the action of heat, the skin pores are opened, the capillaries of the skin mucosa are dilated and congested, the circulation of blood and lymphatic fluid is promoted, the absorption and penetration of drugs in the local area are accelerated, and the therapeutic purpose is more easily achieved, and those herbs with pungent aroma are particularly easy to be absorbed in a warm environment, thus strengthening the drug action. At the same time, during the fumigation process, the massage of the skin by drugs, warmth and steam airflow stimulates the acupuncture points in the area, stimulates the meridian qi and mobilizes the meridians to better play the overall role of moving qi and blood.
In this study, 88 patients with chronic lower extremity ulcers with Qi deficiency and blood stasis were treated with the combination of Chinese herbal fumigation therapy to benefit Qi, invigorate blood and promote blood circulation, and 22 cases were clinically cured, 26 cases were significantly effective, 38 cases were effective, and 2 cases were ineffective, with a total effective rate of 97.70%, and the difference was significant when compared with the control group without Chinese herbal fumigation therapy (P<0.01). It indicates that the Chinese herbal fumigation therapy can significantly promote the healing of chronic lower limb ulcers with significant clinical efficacy. In the fumigation formula, Astragalus membranaceus tonifies the vital energy to support the sore, warms the spleen and stomach to promote the growth of muscle, and is an important medicine for sores and carbuncles; Angelica sinensis nourishes the blood to promote the growth of muscle, disperses blood stasis, reduces swelling, activates blood circulation and relieves pain; Salvia miltiorrhiza and Safflower invigorate the blood to dispel blood stasis and relieve pain; Cinnamomum cassia warms the meridians, and the combined use of all the herbs contributes to the function of benefiting the qi to invigorate the blood to promote the growth of muscle. Modern pharmacology proves that Astragalus and Angelica have the effects of improving immunity, stimulating cell proliferation and differentiation in hematopoietic tissues, antioxidant, dilating peripheral blood vessels, and antibacterial, while Angelica, Salvia and Safflower have the effects of dilating blood vessels, inhibiting platelet aggregation and anti-thrombosis, improving microcirculation, and anti-inflammatory and analgesic [6]. The intelligent Chinese medicine fumigation steam self-control therapeutic instrument used in this study uses multi-point spraying, which can make full and even contact between the medicinal steam and the affected part, and the therapeutic instrument uses electronic temperature controller to make the temperature controlled, which basically ensures that the temperature in the box is constant, and these technical improvements significantly improve the therapeutic effect of Chinese medicine fumigation. In addition, the treatment time and steam temperature of the treatment instrument can be adjusted by self-control, and the operation is easy, and the patient's body position can be sitting or horizontal during treatment, which is relatively free and comfortable, without obvious adverse reactions.
This clinical study shows that Chinese medicine fumigation therapy can significantly promote the healing of chronic lower limb ulcers with significant clinical efficacy, and the method is simple and easy to operate without obvious adverse reactions, which is worthy of clinical promotion and application.