Methods
1.Application therapy
If the local redness and swelling are obvious, apply golden ointment or Qing Dai ointment externally. If the skin is dry and dark, apply red oil ointment externally. If the local skin is cold and dark, apply punch and ointment externally.
2.Hoop circumference therapy
For obvious local redness and swelling, or fat swelling of the affected toe, which is difficult to disappear after a long time, use Ruyi Jinhuang San mixed with Qingliang Oil emulsion oil, etc. to make a paste, and apply the medicine evenly around the sore to normal tissue, the range should be slightly larger than the affected area, and have a certain thickness, and keep the proper humidity.
3.Excision and drainage therapy
It is applicable to those who have abscess formation or poor pus out. Early incision and drainage should be made to reduce pressure, and attention should be paid to keep the drainage unobstructed. After the incision, the drainage can be given to the medicine twist dipped in Jiuyi Dan. However, when there is gas gangrene, effective treatment should be carried out according to the principle.
4.Wet dressing therapy
Applicable to more pus and heavy odor, drainage, or traumatic flesh has been exhausted, the new muscle is difficult to grow. The former can be used to clear heat, detoxify and moisten the Chinese herbal decoction, while the latter can be used to support and remove blood stasis and create muscle. 6 to 8 layers of gauze are soaked with the Chinese herbal medicine solution and applied to the affected area without dripping. Take off every few minutes to repeat the moistening solution and continue to apply the dressing, or drip the solution on the gauze frequently to keep the sore surface at a certain humidity level. Apply oiled gauze externally.
5.Cancellation of rotten muscle method
In the early stage of the sore, when it is difficult to remove the rotten flesh, the main method is to “remove the poison and rot” by thinly spreading the sore inside the wound with Jiuyi Dan and covering it with red ointment gauze to remove the pus and rot; in the late stage when the rot is removed and newborn, the main method is to “remove the stasis and create muscle” by thinly spreading the sore with myosin and Yunnan Baiyao and covering it with White jade ointment, red oil ointment, compound yellow raw muscle healing ointment gauze to produce muscle and long skin to close the mouth until the wound is healed.
6.Dragline method
Applicable to penetrating sinus tracts or pockets of pus. Under routine disinfection and anesthesia, a low auxiliary incision can be made, and after probing with a silver bulb probe, 4 to 6 strands of No. 4 silk thread are passed through the canal lumen, and Jiu Yi Dan is applied to the silk thread every day, and the silk thread is dragged back and forth several times so that Jiu Yi Dan is dragged into the canal, and the dragging thread is removed after 10 to 14 d, and the canal lumen can be healed after 7 to 10 d of padded cotton wrapping therapy.
7.Infusion therapy
For deeper sore cavity or subfascial or intermuscular infection foci connected, or small sores with basal pus rot not yet exhausted, drug line drainage cannot be in place. Insert an infusion needle into the sinus tract with a syringe and slowly inject a solution to clear heat, moisten and detoxify the sore, or use 0.15% methotrexate, or select a highly sensitive antibiotic solution for short-term flushing of the sore cavity according to the results of pus culture. For those with pus decay and high protrusion of granulation tissue, flush with 3% sodium chloride solution. For decay and dehiscence, inject with muscle-generating and closing solution.
8.Nibbling therapy
For large and deep sores, rotting flesh tissue is difficult to fall off, in the infection control, blood circulation improved, gangrene into dry, necrotic boundary is clear, should be gradually trimmed in stages and batches to remove rotting flesh, in order not to bleed or slightly bleeding, no obvious pain for the degree; for dry gangrene, must first use external red oil cream to soften the necrotic tissue, and then perform “nibble therapy “Clear the wound. Generally, some of the tissue that hinders the growth of granulation, epithelium can be gradually repaired, pay attention to the distal end of the first removed, the proximal end removed; loose first removed, firm removed; necrotic soft tissue first removed, rotting bone removed, and try to protect the fascia and tendon tissue.
9.Wrapping therapy with cotton pad
It is suitable for those who have exhausted the rotten flesh on the sore surface, new flesh is growing, and the surrounding tissues have sinus cavities. After the use of pus removing medicine, the pus on the trabecular surface is reduced, the secretion becomes pure and clear, no pus and decay filth, and the culture of pus smear suggests no bacterial growth, the cotton pad can be used to press the cavity, and then the bandage can be used to press and wrap the affected area, so that the cavity wall is pressed tightly, and the medicine is changed once a day to promote the adhesion and closure of the cavity. 7~10d after the cavity is closed, the cotton pad can be continued to press and wrap the bandage for 10~14d to consolidate the therapeutic effect.
10.Toe amputation
It is suitable for those who have dry gangrene at the toe end, exposed bone at the toe end or osteomyelitis formation, and sores that are difficult to heal. When the systemic condition is stable, infection is controlled, blood sugar is stable, and the gangrene is clearly demarcated, the affected toe can be removed under local anesthesia.
Discussion
1, the combination of Chinese and Western medicine whole body treatment and local external treatment of diabetic foot belongs to the category of “gangrene” and “thirst” in Chinese medicine. We believe that the pathogenesis of diabetic foot is most closely related to dampness, heat, fire toxicity, qi and blood stagnation and yin deficiency or qi deficiency, and its pathogenesis is characterized by deficiency and evil, evil qi causing stasis, stasis obstruction and injury, and decay causing damage, resulting in the interaction of deficiency, evil, stasis, and decay, which are mutually causal changes, resulting in a variety of different pathological evidence. Therefore, the clinical evidence must be based on the symptoms, examine the course of the disease, divide the stages, and at the same time combine the severity of dampness, heat, fire and toxicity, the strength and weakness of evil and other specific circumstances, local treatment and systemic treatment to take into account, and focus on. Acute attack, the disease is sudden and rapid development, the condition is critical, damp-heat and fire toxin is spreading, and the competition between good and evil is intense, it is appropriate to use systemic treatment as a whole, control blood sugar, control infection, improve circulation, and use a large dose of cool blood, heat, dampness and detoxification products to control the evil, protect fluid and nourish yin, quickly cut off and reverse the disease; local wounds should not be taken too early to completely clean, bad toe amputation and other surgical treatment, otherwise, often make The disease is aggravated and gangrene spreads and expands. During the remission period, blood sugar and infection are effectively controlled, circulation is improved, and dampness and heat have been removed, so according to the nature of gangrene, local external treatment should be the main method, and internal medicine should be taken to support the righteousness and Yingtoxicity, clear heat and dampness to promote wound healing.
2, phased identification of the comprehensive use of external treatment: “the method of surgery, the most important external treatment” “external treatment of the theory, that is, the theory of internal treatment, external treatment of the law, that is, the law of internal treatment, the difference is the law ear. Reasonable, appropriate and timely external treatment is the key to treating diabetic foot and reducing the high amputation rate and disability rate. The external treatment should be selected according to the different periods of diabetic foot development. In the acute attack period, when the evil toxin is rampant, compressing method, hoop therapy, dipping therapy, wet compressing therapy can be used, especially Qingliang oil transferring compressing Jinhuang San hoop around the local area, which has the effect of hooping and gathering, converging sores and toxins, clearing heat and detoxifying, dispersing blood stasis and relieving swelling and pain, which can promote the dissipation of redness and swelling and confine the swelling to those with obvious local redness and swelling and unclear boundaries, and promote the receding of fat swelling of the affected toe, which is difficult to disappear after a long time. During the improvement and remission period or recovery period, according to the changes of the wound surface, we can choose the method of compressing, the method of eliminating decay and creating muscle, the method of drug twisting and drainage, wet compressing therapy, nibbling therapy, infusion therapy and cotton pad method to promote the healing of the sore surface and shorten the course of treatment. Wet gangrene, the formation of abscesses, early incision and drainage decompression, and according to the trauma or bacterial culture and drug sensitivity test, local available Chinese medicine decoction soak, wet dressing or antibacterial drugs wet dressing to control infection, so that wet gangrene into mixed or dry gangrene, feasible “nibble therapy” gradually remove inactivated necrotic degenerative tissue. Dry gangrene, do not see black on the cut, you can first use the thick paste of oil applied externally, simmering pus to promote tissue softening, and then perform “nibbling therapy” to clear the wound. These two stages, often according to the shape and quality of the pus, color, smell, combined with the results of the trauma pus bacterial culture, the choice of pus removal drugs to control the infection of the sore surface. If the pus is yellowish white and thick, it is mostly due to Staphylococcus aureus, Streptococcus hemolyticus and other gram-positive bacterial infections, and can be externally applied with eighty-two dan and nine one dan; if the pus is greenish black, thin like water, or has bubbles, or is fishy and foul-smelling, it is mostly due to Pseudomonas aeruginosa, Escherichia coli and other gram-negative bacteria, or anaerobic bacteria and mold growth, and antibiotics are often insensitive, and can be externally applied with seventy-three dan and five five dan for a short period of time, or a decoction of compound Chinese medicine, to be soaked and wetly applied at temperature. The affected area, often with significant effect. When the pus is rotten, the pus can be given to the raw muscle, white jade cream, punch and cream, compound yellow raw muscle healing oil cream, pad cotton wrapping method, and pay attention to keep the wound moist. For those who have formed penetrating sinus tracts or ulcers, the wire dragging therapy developed from drug twist drainage and wire hanging therapy is used, in which silk threads mixed with pus removing drugs are dragged to drain the pus and rot, and the degenerated necrotic flesh tissue that hinders the granulation and epithelial tissue needs to be removed. This not only avoids the shortcomings of large trauma, heavy damage and prolonged repair time caused by complete expansion and drainage, but also accelerates the healing of the trauma and shortens the course of treatment.
3, pay attention to the treatment of bone or tendon exposed trauma diabetic foot ulcers is characterized by the development of more bone disease and lesions along the tendon, therefore, the treatment of bone or tendon exposed trauma is an urgent clinical problem to be solved. For the tendons and bones without obvious necrosis, we can apply topical Chinese herbal medicines to the exposed area, such as myogenic powder, Yunnan Baiyao, red oil paste gauze, Fuhuangbiotic healing oil, rehabilitation new solution, etc., to remove the stasis and muscle, and use mercury-containing antiseptic agents with caution. The inactivated tissues around the tendons and bones should be preserved, so as to promote the growth of granulation tissues and cover the exposed bones or tendons, and then continue to use stasis-generating herbs to promote epithelial proliferation and complete healing of the wound.