Secondary lower extremity deep venous valve insufficiency syndrome, i.e., post-thrombotic lower extremity venous syndrome. Due to the valve damage after venous thrombosis, venous hypertension, venous blood reverse flow to superficial vein through traffic branch, superficial vein varicose, subcutaneous stasis, formation of ulcer, not easy to cure. 1, etiology and pathology: After deep vein thrombosis, it is absorbed and mechanized for 2-4 months, and then after a considerable period of time, it is mechanized and recanalized or becomes a fibrous core. This outcome is determined by the site of embolization and the degree of embolism. In the lower extremities where the thrombus is located proximal to the inguinal ligament, the chances of recanalization are minimal, i.e., where the thrombus is located in the ilio-femoral vein, the vast majority of them fail to recanalize. When the thrombus is located in the femoral N vein, the recanalization rate is 95%, and the superficial femoral vein has a 50% patency rate. Post-thrombotic syndrome of the deep veins of the lower extremities is currently categorized into 3 types. Type I (distal inguinal ligament type): that is, the primary thrombus is in the intramuscular venous plexus of the calf, or the thrombus originating in the N vein or femoral vein grows and multiplies, and extends no further than the inguinal ligament; these thrombi can be recanalized and retubularized, and the subsequent pathology is the disruption of valves and ankle-transportation-branching insufficiency. Deep vein blood flows backwards into the superficial veins through the valvular insufficiency of the traffic branches, and venous hypertension in the lower extremities forces the blood flow into the tissue interstitial space and causes localized swelling. Plasma proteins and erythrocytes can also leak outward into the tissue space, causing a mild inflammatory reaction, after the disintegration of erythrocytes, brown pigmentation, and after a long period of time, there is “stagnant dermatitis” and ulcers, the ulcers stubbornly do not heal, and the limb swelling becomes more and more serious. Type II (proximal inguinal ligament): Thrombosis of a vein from the vena cava to the inguinal ligament. The thrombus in this section rarely recirculates, and its main pathological change is the obstruction of blood return to the lower limb. Since the thrombus does not extend to the distal segment, the function of N-femoral valves and ankle traffic branch valves are not damaged. In other words, the calf muscle pump is still intact, forcing the deep venous blood to return to the heart through the collateral circulation during exercise. It is common for the veins of the medial inguinal ligament to become enlarged, and for the veins of the pubic symphysis to become enlarged. They can also return to the inferior vena cava through the uterine, paravalvular, and ovarian veins, which is why this type of woman is less likely to have symptoms than a man. More walking or hiking feel lower limbs i pain, swelling, lying down after the decline, light pigmentation, the formation of ulcers is slow. Type III (mixed): that is, the thrombus involves the entire lower limb, from the iliac vein to the femoral vein, the N vein, the intramuscular venous plexus of the calf and the traffic branch. The thrombus may grow from the calf intramuscular vein in a collateral fashion, or it may be a primary iliofemoral vein thrombus, which extends retrogradely and involves the distal veins, including the traffic branch. Those who suffer from this disease have a history of extensive deep venous thrombosis, which is more severe, and the thrombus is located at the distal end, which tends to recanalize, but the valves are damaged and are located proximally, which is not easy to recanalize and hinders venous return, thus it has both of the above two symptoms, such as Stasis dermatitis, ulcers, superficial varicose veins, claudication signs, limb swelling, etc. According to TCM, this disease is caused by dampness-heat compression and stagnation of blood in the meridians. Or due to carrying heavy loads, standing for a long time, poor qi and blood circulation. Or after trauma, surgery, or prolonged bed rest after childbirth, the blood is slow and stagnant, damaging the meridians. Clinical manifestations and signs The basic pathophysiological change caused by deep vein thrombosis is superficial venous hypertension during exercise. Normal ankle superficial vein pressure during exercise is 0-4kPa (0-30mmHg). Primary superficial varicose vein pressure 6.0-8.0kPa (45-60mmHg), distal inguinal ligament, ankle vein pressure after femoral N vein embolism 10.0-12.0kPa (75-90mmHg), iliac-femoral vein thrombosis in the proximal segment of inguinal ligament, and ankle vein pressure after iliac-femoral vein thrombosis 13.3kPa (100mmHg). Their clinical manifestations were also inconsistent. If the lesion belongs to the distal segment of the inguinal ligament type, it mainly manifests lower limb calf swelling, most obvious in the middle and lower 1/3 of the calf, hyperpigmentation and ulceration, predominantly in the ankle joint. The thighs above the knee tend to be normal and not swollen. Proximal or mixed inguinal ligament, clinical manifestations of swelling of the entire leg, previous onset of pain or tenderness in the inguinal ligament area. There is generalized fever. Localized trophic ulcers are often present in the later stages of the disease. The three types of clinical manifestations of this disease are as follows: (1) type I (inguinal ligament distal section type): the lesion site is located in the deep veins and the traffic branch valve insufficiency, inverted venous static body pressure of 10.0-12.0kPa (75-90mmHg), the swelling occurs in the lower and middle third of the lower leg, inner and outer ankle stagnant dermatitis is more pronounced, the superficial veins of the lower extremities are enlarged, and claudication signs are light. (2) Type II (inguinal ligament proximal segment type): the lesion site is located in the iliofemoral vein outflow tract obstruction, reflux obstruction venous pressure 13.3kPa (100mmHg), swelling to the entire lower limb, thighs than the calf is obvious, stagnant dermatitis is relatively light, the appearance of the time is relatively late, lying down and resting to alleviate the medial thighs, the perineum, the external iliac superficial venous varicosities, claudication signs are light. (3) Type III (mixed): the lesion site is located in the deep veins and traffic branch valve insufficiency combined with iliofemoral vein outflow tract obstruction, reflux and reflux obstruction venous venous static pressure of 13.3kPa (100mmHg), the entire limb is swollen, stagnant dermatitis is relatively heavy, the scope of the large, ulcerated, and is not easy to heal, the venous varicose veins appeared late, the signs of claudication is heavy. 3, auxiliary examination: (1) venography: venography in the diagnosis of lower extremity deep venous valve insufficiency, venous reflux disorders and venous obstruction and other disorders, the most valuable. In retrograde venography, if it is after femoral-N vein embolism, it shows poorly in the contrast, the edge is not neat, the valves are defective, the contrast agent passes through the traffic branch of valve insufficiency and flows backward to the superficial vein, the superficial vein shows up early in the contrast, and the traffic branch of the deep vein of the calf is dilated, and the emptying is delayed. In retrograde femoral venography, the contrast agent flows directly backwards into any segment of the femoral vein above the knee. In iliofemoral vein obstruction disorders, it is not easy to show using a single retrograde venography, and it is necessary to use a combination of retrograde and iliac crest myelography, which can show the proximal and distal planes of iliofemoral vein obstruction, and also see the deep distal segments of the obstruction, the thick collateral branches, as well as the venous substitution situation in the pelvis. (2) Color Doppler ultrasonography: Doppler examination can visualize the size and thickness of the lumen, the smoothness of the wall and the obstruction. Volume tracers cannot show normal waveforms in partial obstruction of the common femoral vein, nor can they change with respiration, nor do they have cyclic changes. 4. Diagnosis and treatment: The identification of this disease focuses on the differentiation of cold, heat, deficiency and reality. Cold people like warmth and fear of cold, ankle like wrapped in cotton, or like to use hot water fumigation. The hot part of the stagnant part of the red, swollen, hot, touch more painful, or even, the whole body fever. In the case of deficiency, the disease is long, tired and lazy, fatigue and self-sweating, panic when moving, pale sores, granulation edema, sores do not heal for a long time. The solid part of the solid, depressed part, swelling and hard, smooth and shiny skin, or even set off red heat and pain, yellow and greasy moss or petechiae, pus thick, solid flesh buds. (1) damp-heat injection evidence: limb swelling is obvious, calf with stagnant lesions heavier, stagnant parts of the complication of infection, redness, swelling, heat, pain, red tongue, moss white greasy or yellow greasy, pulse sinking fast; treatment should be to clear the heat and detoxification, blood circulation and eliminate blood stasis, the prescription used in the three wonderful soup combined with the eight Zhen San plus and minus: cypress, hyssop, Cangzhu, Angelica sinensis, double flowers, Poria, papaya, Fangzhi and so on; the heat is heavy with dandelion, dandelion. (2) blood stasis and dampness: severe swelling of the affected limbs, heavy stasis, and stasis dermatitis, superficial varicose veins of the lower limbs, red tongue or ecchymosis, white greasy moss, smooth pulse; treatment should facilitate the dampness of the collaterals and activate blood circulation and eliminate blood stasis, the formula used in the Ermiao Tang, Ba Zhen Tang, Sanyan Tang plus and minus: Cow’s Knee, Cangzhu, papaya, preventing hexagrams, Poria, Red peony, Coix Seed, Coix seed, Kou Renmi, Huo Xiang; dampness, plus Psyllium, Poria, Zegna; stasis, plus Wang Bu Liuxing, Wang Bu Liuxing, Wang Dongshan, Pangshan, Poria, red peony, Job’s tears, Coix seed, Kou Renmi, Huo Xiang; heat, plus Dandelion, Di Ding. Add Wang Buliuxing, Andrographis paniculata, Tuyuan, rhubarb. (3) spleen and kidney yang deficiency: the affected limb swelling, walking and standing obviously, the morning is light, the afternoon is heavy, sometimes cold and discomfort, tiredness and weakness, less thirsty, pale tongue, thin white moss, pulse is sunken; treatment should be warm yang to strengthen the spleen, the formula used to warm the yang to strengthen the spleen soup with subtractions: Codonopsis, Astragalus, Poria, Atractylodes macrocephala, Angelica sinensis, Job’s tear grains, Kou Ren Mi, Zedo, Pogonium, Clove, and so on. 5, Western medical treatment: (1) general treatment: deep vein thrombosis valve insufficiency, no matter which type, should elevate the limbs to rest properly, wrapped in elastic bandage or compression of superficial veins of the support, in addition to the discretion of the additional anticoagulant drugs, in order to prevent secondary thrombosis. Appropriate rest, elevation of the limb, and flexion and extension activities, which is a usual, effective and easy to implement. Elevate the limbs above the level of the heart at least 4 times a day, each time not less than 20 minutes, when lying down, it is best to lower limbs, especially the affected limbs for flexion and extension movements, which can promote the return of blood to the lower limbs, reduce the degree of stagnation of the lower limbs. This can promote blood return to the lower limbs, reduce the degree of stagnation. Long-term exercise can preserve the limbs, delay or prevent the occurrence of trophic changes in the boot area, and can even promote wound healing. ② elastic bandage bandage or external compression support can control superficial venous hypertension, prolong the time of edema, delay the occurrence of trophic changes in the boot area skin and subcutaneous tissues, to prevent the formation of ulcers, on the formation of ulcers, but also a more therapeutic approach. Among them, the most effective method is intermittent elastic bandage wrapping method. Intermittent elastic bandage wrapping method: the affected limb every morning when you get up, with the elastic bandage or elastic stockings, after the night bed removal. Bandage from the dorsum of the foot wrapped until below the knee joint, compression of the entire calf and the foot of the superficial veins, the intensity of compression to be able to deflate the superficial veins without affecting the arterial blood supply and deep venous return as a criterion; boot area should be stable and solid compression, often update the elastic bandage, in order to maintain sufficient elasticity. (2) Surgical treatment: Traffic branch ligation, diversion surgery, venous valve segment transplantation and ulcer debridement and replacement surgery, skin grafting, etc. can be used as appropriate. 6.Other therapies: If there is ulcer formation, according to the condition of the local Chinese medicine and patent medicine can be used locally and externally, which can promote the healing of the ulcer.