Diabetic foot (DF) is one of the major secondary conditions of diabetes mellitus. It is a foot lesion caused by loss of sensation due to ischemia and peripheral neuropathy in diabetic patients with vasculopathy, and is complicated by infection. It has a high disability rate and seriously affects the health and quality of life of patients. The clinical characteristics of the foot are cold or burning, numbness, pain and other sensory abnormalities, or even ulceration and necrosis. In recent years, the incidence of diabetic foot has increased sharply with the continuous improvement of people’s living standard, long-term poor living habits, and high incidence of diabetes. Since 1999, the author has used self-designed detoxification and stasis-clearing soup as the main treatment for diabetic foot, and has achieved good clinical results. 97 cases with complete case information are summarized below: Zhang Hongliang, Peripheral Vascular Disease Department, Anyang Vasculitis Hospital, Anyang 1 Clinical Data 1 1 General Data
Among the 97 patients, 63 were men and 34 were women; the oldest was 73 years old, the youngest was 47 years old, and the average age was 54 years old. Among them, 7 cases were under 50 years old, 39 cases were 51-60 years old, 41 cases were 61-70 years old, and 10 cases were over 71 years old;
The shortest duration of the disease was 7 months, and the longest was 14 years. The shortest duration was 7 months and the longest was 14 years. 51 cases were accompanied by ulceration. 1 2 Diagnostic criteria
Referring to the criteria established by the Committee of Peripheral Vascular Diseases of the Chinese Society of Integrative Medicine in 1995: typical symptoms such as coldness, burning, numbness, pain, and even ulceration and necrosis of the affected foot, and a history of diabetes mellitus (using the diagnostic criteria of diabetes mellitus established by the WHO Expert Advisory Committee in 1999) for more than 2 years were used to confirm the diagnosis. 1 3 Treatment method
Chinese herbal medicine was given to detoxify and resolve stasis (basic formula: rhubarb, Huanglian, Erhua, forsythia, peach kernel, red peony, gecko, diagonal dragon, piercing sorrel, leech, whole worm, yanhuosuo, safflower, danshen, angelica, Chuanxiong, centipede, etc.), one decoction per day, one month as a course. If the Qi deficiency is obvious, add Radix et Rhizoma Ginseng, Radix Astragali, Atractylodes Macrocephala, Poria; if the pain is severe and it is difficult to sleep, add Boswellia, Myrrh, Rice husk; if the ulceration and necrosis, secondary infection, can be applied topically with five yellow liquid (Rhizoma Rheum, Rhizoma Huanglian, Rhizoma Cypress, Scutellaria, ice chips each equal parts of wine bubble) wet compresses. At the same time, oral hypoglycemic drugs were taken to control blood sugar. 2 Efficacy criteria and results 2 1 Efficacy criteria
Referring to the standard set by the Peripheral Vascular Disease Committee of the Chinese Society of Integrative Medicine in 1995, cure: stable diabetic condition, basic disappearance of limb symptoms, complete healing of the trauma, walking speed of 100~120m/h, continuous walking for more than 1500m, and significant improvement of peripheral blood circulation disorders and limb hemogram. Significant improvement: symptoms improved significantly, limb wound healed or nearly healed, walking speed as above, able to walk more than 500m, limb peripheral circulation disorder and limb hemogram improved. Progression: symptoms are reduced, limb trauma is close to healing or reduced in size, walking speed is the same as above, able to walk more than 300m,
The peripheral circulation disorder and the hemogram of the limb have improved. Ineffective: No improvement or worsening of symptoms and signs. 2 2 Treatment results 2 2 Treatment results: 57 cases were cured, 26 cases were significantly improved, 8 cases were improved, and 6 cases were invalid. The total effective rate was 93.81%. 3 Discussion Diabetic foot (DF) is one of the most common chronic secondary diseases of diabetes mellitus. Modern medicine believes that this disease is related to three factors: lower limb atherosclerosis, lower limb artery occlusion ischemia, neuropathy and infection,
The occurrence of atherosclerosis is closely related to the metabolic disorder caused by diabetes mellitus, so diabetes mellitus often causes this disease, and the lower limbs appear cold, numbness, pain, intermittent claudication, if long-term ischemia will cause dry necrosis of the toe end. On the basis of this secondary infection of corrosive bacteria, complicated by lower limb reflux disorders can appear wet gangrene. The disease has long been recognized in Chinese medicine, but it does not have a specific name, but is classified under the category of “gangrene” according to clinical manifestations. For example, in “Ling Shu. Carbuncle Chapter>> “The name of the gangrene in the toe, the appearance of red and black, death is not treated; not red and black is not dead, not decaying emergency chop of, not is dead.” Another example is the Song dynasty Zhu Rui Zhang << Health Baojian>> recorded “…… thirsty people, the foot and knee hair malignant sores, the treatment of death is not saved.” The reason for this is actually stagnation of the meridians, and the causes of stagnation of the meridians are nothing more than the burning of Ying Yin and the invasion of external evil. The deficiency is the inability to resist the evil, and the evil of dampness and heat will take advantage of the deficiency to enter, and the internal heat of yin deficiency, and the heat will rot the meat, and the meat will rot into pus and poison, and the weakness of qi to transport blood, and the lack of blood flow will paralyze the veins, and the veins will be blocked, and the extremities will lose their glory. The pathogenesis of the disease is Yin deficiency and dryness and heat, and over time, the dryness and heat is internalized, the Ying Yin is burned, the operation is not smooth and becomes stasis, the blood stasis is blocked, the veins and ligaments are blocked, and the limbs appear to be cold, numb, burning and other abnormal sensory symptoms. Or the prolonged thirst disease leads to Qi and Yin injury, Yin and Yang deficiency, deficiency of the right and evil invasion, blood clotting and blockage, stasis for a long time into heat, heat and flesh decay and ulceration, necrosis. The treatment is based on the addition and subtraction of Detoxification and Stasis Removal Soup, which can achieve satisfactory results. In addition, this disease is a secondary disease of diabetes mellitus, and treatment of this disease should be carried out under the premise of active treatment of diabetes mellitus and blood sugar control.