What is Raynaud’s syndrome?
Raynaud syndrome is an arterial spasm disorder, a syndrome in which spasm of small arteries at the extremities causes a series of skin color changes on the hands or feet. It can be divided into two categories: primary and secondary.
The primary form is Raynaud disease, which occurs without any associated systemic disease or identifiable underlying cause. Secondary cases are also known as Raynaud phenomenon, which means that there is an underlying disease that causes Raynaud phenomenon. The latter is more common and important clinically, accounting for about 2/3 of the cases, while Raynaud’s disease is rare.
Etiology
The etiology of Raynaud’s disease is unclear and may be related to neuroendocrine dysfunction, as some cases are aggravated during menstruation. Patients often have a family history, which may also be related to heredity. It is more common in young women, with a male to female ratio of 1:10.
Raynaud’s phenomenon can be seen in many primary underlying diseases, the most common being connective tissue diseases, especially scleroderma. Systemic erythema vera, vasculitis, rheumatoid arthritis, dermatomyositis, etc. can also occur. Other causes include: occlusive atherosclerosis, cryoglobulinemia, neurovascular compression diseases such as thoracic outlet syndrome, and occupational diseases such as air hammer disease with long-term application of vibrating tools. In addition, the application of certain drugs such as ergot and beta blockers can also cause. Raynaud’s phenomenon secondary to connective tissue disease is more common in women; in men, it is more common in middle-aged and elderly patients secondary to occlusive atherosclerosis.
Pathophysiology
The pathophysiological changes of Raynaud’s syndrome can be divided into three phases: (1) spastic ischemic phase: spasm occurs first in finger and toe arteries, followed by spasm in capillaries and small veins, and pale skin. (ii) Stasis and hypoxia phase: the arterial spasm subsides first, the blood in the capillaries is depressed and hypoxic, and the skin appears cyanotic. ③Dilated and congested period: After all spasms are released, there is reactive vasodilatation and congestion, and the skin is flushed. Then it turns to normal skin color.
Raynaud’s syndrome
XiaoNuo syndrome is an episodic spasm of the finger arteries and small finger arteries induced by cold or emotional stimuli, showing lesions characterized by pallor, cyanosis and flushing of both fingers. The disease is most common in young women and occurs in both fingers, but can also involve both toes. The causes of this disease are directly related to cold stimulation, abnormal sympathetic excitation, and endocrine disorders. The Raynaud’s syndrome is often associated with multiple immune connective tissue diseases (such as dermatomyositis, scleroderma, rheumatoid arthritis, arteriosclerosis, dry syndrome, etc.) and is therefore thought to be related to abnormal immune function of the body.
Clinical manifestations
1. The skin of the fingers is pale at the onset, then turns cyanotic after a few minutes, then turns from cyanosis to flushing, and then the skin color returns to normal. Generally, it takes about 15-30 minutes to turn from pale to normal. When pale and cyanotic, there is numbness, tingling, coldness and dullness of sensation at the end of the fingers. There is mild burning, swelling and pain when the change to flushing occurs. It disappears with the return of normal skin color.
2. Both hands develop simultaneously and symmetrically. It starts at the end of the fingers and gradually expands to the whole fingers and metacarpals, but does not exceed the palm surface.
3, the disease for a long time and repeatedly frequent, manifested as finger skin thinning, tight, hard and tough, accompanied by joint failure or stiffness, or even resting pain and finger ulcers.
4.Patients often have mental symptoms such as emotional agitation, depression, sadness, paranoia, insomnia, dreaminess, and pain around the body.
5, often in the cold season or encounter cold stimulation, or emotional stimulation attack.
6.Most often seen in women aged 20~40.
Diagnosis
1. Based on clinical manifestations and history of recurrent attacks.
2.Cold water test: Immerse hands in 4℃ water for 1 minute to see if skin changes are induced. Or after measuring finger skin temperature at 20℃ room temperature, immerse hands in 4℃ water for 2 minutes and observe the skin temperature recovery time, more than 30 minutes is positive.
3.Microcirculation examination: examination at the onset helps to diagnose.
4.Arteriogram, immune function test and several biochemical tests to exclude related class of diseases.
Treatment
1.Western medicine treatment
(1) If the primary disease is found, treatment of the primary disease is the main treatment.
(2) Psychological guidance treatment: according to the patient’s condition, give glutamate, valium or sedative drugs, or antidepressants.
(3) There are also treatment with vasodilator drugs, such as toltrazurin, reserpine, etc.
2.Chinese medicine treatment
(1) Internal treatment method
(1) Liver depression and qi stagnation: the onset of emotional agitation, depression in the past, sometimes there is dysfunctional pain in the ribs, chest tightness, pain in the body, dullness, appetite is sometimes good and sometimes bad, coating thin white, pulse string.
Treatment: De-stress the liver and activate blood circulation.
Herbs: Chai Hu 10g, Radix Paeoniae Alba 10g, Radix Angelicae Sinensis 15g, Radix Aromaticus 10g, Citrus Aurantium 10g, Ulmus 10g, Glycyrrhiza Glabra 10g, Cinnamomum 10g, Pericarpium Citri Reticulatae 10g, Rhizoma Atractylodis Macrocephalae 10g, Rhizoma Chuanxiong 10g, Radix Mulberry 15g.
② deficiency of the heart and spleen: the onset of mood swings, the face is less florid, palpitations and trepidation, insomnia, dizziness, fatigue, loss of appetite, fatty tongue, thin or weak pulse.
Treatment: Strengthening the spleen and nourishing the heart, tonifying Qi and blood.
Remedy: Astragalus membranaceus 20g, Atractylodes macrocephala 10g, Radix Angelicae Sinensis 10g, Radix Codonopsis pilosulae 10g, Fructus Dactylodes 6g, Fructus Jujubae 10g, Fructus Mu Xiang 10g, Fructus Schisandrae 6g, Poria 15g, Fructus Longan 10g, Radix Glycyrrhiza Uralensis 10g, Fructus Sandhi 5g, Fructus Santorum 15g.
Cold condensation of the meridians: every cold onset, usually cold limbs, like warmth and fear of cold, especially during the attack, numbness, tingling, cold at the end of the fingers (toes), longer cyanosis, accompanied by slight swelling, dark tongue or bruises, sunken pulse.
Treatment: Warming the meridians and dispersing cold, invigorating the blood and clearing the veins.
Herbs: Astragalus membranaceus 20g, Gui Zhi 10g, Radix Angelicae Sinensis 15g, Radix Paeoniae Alba 10g each, Rhizoma Chuanxiong 10g, Radix Glycyrrhiza Uralensis 10g, Radix et Rhizoma Sinensis 4g, Safflower (0g, Peach kernel 10g, Cornu Cervi Pantotrichum 3g, Radix Santalum 20g, Radix et Rhizoma Cuspidatae 5g.
Damp-heat obstruction: recurrent attacks, swelling and tightness of the skin of the fingers (toes), stiffness of the joints, painful peeling, often with resting pain, may be accompanied by ulceration or gangrene of the fingers (toes), red tongue with yellow coating or yellow greasy coating, and aria string with partial number.
Treatment: Clearing heat and dampness, clearing the channels and relieving spasm.
Remedies: 30 grams of honeysuckle, 20 grams of red peony, 10 grams of Chuanxiong, 15 grams of angelica, 10 grams of atractylodes, 15 grams of genkoshen, 6 grams of licorice, 15 grams of wu hua, 10 grams of stiffness, 10 grams of dilaemon, 30 grams of dandelion, 10 grams of loofah.
(2) External treatment method
Recipe: 30 grams of Sichuan pepper wood, 50 grams of pepper root, 11 grams of dried ginger, 20 grams of sumac, 20 grams of wei ling xian, decoction of water, diffuse washing of hands, once a day.
(3) Acupuncture treatment: take acupuncture points Quchi, Neiguan, Hegu, Zhongzhu, Houxi, Sanyinjiao, Feosanli, Yanglingquan, Taichong, once every other day, and use the finger-end puncture and bloodletting method during attacks.
Prevention and recuperation
1. Pay attention to heat preservation to prevent frostbite.
2. Keep your mood relaxed and increase physical activity.
3, the first disease should actively find the primary cause.