Raynaud’s syndrome refers to paroxysmal spasms of the arteries in the extremities. It often develops under the influence of factors such as cold stimulation or emotional stress, and is characterized by intermittent pale, cyanotic and flushed changes in the skin color of the extremities. It is usually more severe in the upper extremities and occasionally in the lower extremities. It is reported that modern acupuncture treatment of Raynaud’s disease, the earlier domestic reports are seen in 1974, in the same year foreign scholars also published an article on the cure of the disease with ear acupuncture. However, until the early 1980s, case reports were still the main focus, emphasizing the use of moxibustion or warm acupuncture method to warm the meridians. In recent years, clinical observations of multiple cases have emerged one after another, still advocating the combination of acupuncture and moxibustion to guide Yang Qi and warm the meridians, or finger-end release of blood to invigorate the blood and move Qi. When operating, special attention is paid to Qi to the disease. According to the statistics of 74 patients collected in this paper, the efficiency of acupuncture in the treatment of Raynaud’s disease is about 95%. Causes: Raynaud’s disease (Raynaud’s syndrome) is mainly the spasm of small arteries at the extremities, the cause of which is not completely clear, and may be related to the following factors: 1, central nervous system dysfunction, making sympathetic nerve hyperfunction; 2, increased adrenaline and norepinephrine content in the blood circulation; 3, the condition is often aggravated during menstruation and alleviated during pregnancy, so some people think it is related to endocrine; 4, the extremities 5. It is also believed that initially the small arteries of the extremities have an excessive response to cold, and then due to long-term vasospasm, the arterial intima hyperplasia and poor blood flow, if there are various physiological factors that reduce the blood flow of the small arteries of the extremities, they can act on the diseased arteries and cause attacks; 6. 7, immune and connective tissue diseases, such as systemic lupus erythematosus, scleroderma, polyarteritis nodosa, dermatomyositis, rheumatoid arthritis, polymyositis, mixed connective tissue disease, hepatitis B antigen-induced vasculitis, drug-induced vasculitis, and Sjogren’s syndrome; 8, obstructive arterial lesions, such as occlusive atherosclerosis, thromboembolic vasculitis, etc.; 9, physical factors 10, certain drugs, such as ergot, lead, thallium, arsenic poisoning, polyvinyl chloride, beta-blockers, cytotoxic drugs, contraceptives, etc.; 11, factors affecting neurovascular mechanisms such as cervical rib, anterior oblique muscle syndrome, thoracic, exit syndrome, improper use of crutches to compress the axilla, tumor compression of the brachial plexus and subclavian vessels, cervical spondylitis or rupture of the nucleus pulposus, peripheral neuritis, spinal cord cavitation or spinal consumption, etc.; 12. Increased cold agglutinin or cold globulinemia in the blood, true erythrocytosis, paroxysmal hemoglobinuria, etc.; 13. Some are associated with migraine and variant angina. Complications Raynaud’s disease can cause occlusion of small blood vessels, resulting in ischemic necrosis of the finger ends. In severe cases, flattening and gangrene of the finger (toe) ends may occur, and the end finger bones may be necrotic, absorbed and dissolved due to ischemia, resulting in shortening or finger amputation. In some patients with low resistance, ulceration due to ischemia at the end of the finger may lead to osteomyelitis and sepsis, which are the most serious complications of the disease. Proper and timely application of anti-infective drugs can help prevent these complications. Clinical manifestations Patients often have seizures after exposure to cold or cold temperatures in the fingers, or they may be triggered by emotional stress and nervousness. The attack is characterized by a sudden whitening of the skin color of the fingers (toes), followed by a bruise and then a flush, with intermittent attacks. It is more common in the fingers and less common in the toes. The attack often starts from the tip of the little finger and ring finger, and gradually extends to the whole finger or even the palm as the lesion progresses, but the thumb is less common, accompanied by localized coldness, numbness, tingling and discomfort or other abnormal sensations. The whole body and local temperature are sometimes decreased, but the radial artery or dorsalis pedis artery pulses are normal. The initial attacks tend to resolve on their own within a few minutes to about half an hour. When the skin turns flushed, it is often accompanied by a burning and stinging sensation and then turns to a normal color. The attack can be discontinued if local heating, rubbing the affected limb, waving the limb, etc. are applied during the attack. When the disease progresses, the symptoms worsen, the attacks are frequent, and each attack can last for more than an hour, and sometimes it is necessary to immerse the hands and feet in warm water to stop the attack. Ancillary tests 1. cold stimulation test 2. reactive congestion test 3. fist clenching test 4. nail wrinkle microcirculation Diagnostic criteria There is no unified standard for Raynaud’s disease, referring to the diagnostic criteria formulated by domestic and foreign experts and scholars, if the following criteria are met, the diagnosis can be made. Even so, there are individual cases that appear 12 years after the appearance of Raynaud’s phenomenon, before showing scleroderma changes, so we should carefully search for the cause. 1. It occurs in 20-40 year olds who are introverted. 2.Cold or emotional excitement can induce Raynaud’s phenomenon attack. 3, Bilateral involvement. 4. Normal arterial pulsation in the affected area. 5. There is usually no tissue necrosis, or only minimal subcutaneous necrosis in the late stage, usually confined to the fingertips. 6, No other system can be explained. 7. The duration of the disease is more than 2 years. Diagnosis The vast majority of patients with Raynaud’s syndrome can be diagnosed based on a history of intermittent changes in skin color at the extremities. However, it is best to observe the onset of symptoms, the nature, extent, degree and duration of skin color changes. These typical symptoms can be induced by immersing the patient’s hands or feet in cold water or by exposure to cold air. In order to detect the related diseases that may be committed early, the medical history should focus on the presence of systemic connective tissue diseases and vascular diseases such as arteriosclerosis and vasculitis, the history of vascular trauma; the history of ergotamine, beta-blockers and contraceptive medications; and the occupational history of long-term application of vibrating tools. Physical examination should focus on signs suggestive of systemic connective tissue disease: such as thinning, tightening of the skin, capillary dilation, rash, dry mouth and lips; thickening of synovial membranes, exudate or other evidence suggestive of arthritis. The skin of the fingers should be carefully observed for ulcers or hyperkeratotic areas of healed ulcers; peripheral arterial pulsations should be noted; and the presence of carpal tunnel syndrome should also be alerted and noted. Patients who are not found to have associated diseases should be followed up for a long time. The most important aspect of treatment for Raynaud’s syndrome is the treatment of the primary cause. Symptomatic treatment of the disease is divided into pharmacotherapy, biofeedback and surgery, which are chosen according to the patient’s specific situation. Drug therapy The following drugs are used clinically: (1) Priscol: also known as tolazoline, 25-50mg per dose orally, 4-6 times daily, after meals. For severe local pain and ulcer formation, the dose can be increased to 50-100mg per dose. 25-50mg per dose by intramuscular, intravenous or intra-arterial injection, 2-4 times daily. In some patients, it may cause side effects such as hot flashes, fainting, dizziness, headache, nausea, vomiting and chicken skin. (2) Reserpine (reserpine): Because of its catecholamine and serotonin removal effects. It is a drug with a longer history and better efficacy in the treatment of Raynaud’s syndrome. It is recommended by many authors. The oral dose varies widely, and Kontos reported that oral administration of 1 mg/d for 1 to 3 years resulted in a reduction in the number of symptomatic episodes and a decrease in the degree of symptoms. In recent years, many scholars have reported that direct puncture of the brachial artery followed by slow injection of reserpine (0.25-0.5 mg in 2-5 ml of saline) can significantly improve the symptoms and maintain the effect for 10-14 days. The need for repeated injections at intervals of 2 to 3 weeks has limited the application of this method because of the damage to the arteries. However, many scholars believe that it is still worth trying for severe cases of combined limb ulcers. The injection of reserpine after intravenous block is a local route of drug administration. The method is to place a tourniquet on the main elbow joint, puncture the distal vein, inject air into the tourniquet balloon to maintain the pressure at 33.3 kPa (250 mmHg), and then slowly inject 0.5 mg of reserpine dissolved in 50 ml of saline into the vein to allow the drug to return to the extremity. This method is simpler than the intra-arterial injection method, and the therapeutic effect is similar. The therapeutic effect is usually maintained for 7 to 14 days. (3) nifedipine: nifedipine is a calcium channel blocker that blocks action potential formation and smooth muscle contraction by reducing the calcium storage capacity or calcium binding capacity of calcium ion storage sites on the myocyte membrane, thus causing vasodilation. Clinical studies have shown that it can significantly improve the clinical symptoms of moderate and severe Raynaud’s syndrome. (4) guanethidine (quanet-hidine): It has similar effect as reserpine, and is taken orally 5-10mg each time, 3 times a day. It can also be used in combination with phonoxy-benzamine at a daily dose of 10-30 mg. about 80% of patients. (5) Methyldopa (methyl dopa): the daily dose is 1~2g, most patients can receive the effect of preventing Raynaud’s syndrome attack. Blood pressure should be taken into account when administering the drug. Recently, some experts have reported that the following drugs have also been effective in the treatment of Raynaud’s syndrome. Prostaglandins: Prostaglandin E1 (PGE1) and prostacyclin (PGI2) both have the effect of vasodilatation and inhibition of platelet aggregation. The efficacy is satisfactory in Raynaud’s syndrome with infected gangrene of the fingers. Intravenous infusion of PGE 110ng/min for 72 hours. Infusion of PGI1 (7.5ng/kg/min for 5 hours) was administered once a week for 3 times. The treatment effect usually lasts for 6 weeks. Stanozol: It is an anabolic steroid hormone with fibrinolytic enzyme activation and has been reported to dissolve fibrin deposited in finger arteries as well as reduce plasma viscosity. It was administered orally 5 mg twice daily for 3 months. In addition, topical application of 205 nitroglycerin ointment, 4-6 times daily, can significantly reduce the number of Raynaud’s sign episodes and numbness and pain by clinical use. Traditional Chinese medicine and acupuncture have some value in the treatment of this disease, but further clinical research is needed to develop them. Biofeedback therapy Biofeedback therapy is the use of the body’s normal non-perceptible or difficult to perceive biological information using equipment to probe, amplify, and through the recording and display system into a signal, so that patients feel these functional changes, so that they can associate their own certain feelings with somatic functions, and to some extent regulate these functions. Jacobson reported in 1973 Application of biofeedback to treat Raynaud’s application of biofeedback to treat 20 cases of Raynaud’s syndrome. The method was to divide the 20 cases into 2 groups of 10 cases each. The first group used a thermometer connected to a light indicator system to measure a certain skin temperature every 15 seconds, and when the temperature rose or stabilized, the thermometer of the indicator system did not glow when the temperature fell. The patients thus received a visual stimulus reflecting the skin temperature. The second group received self-control training. They were told to absorb deeply, relax, and then recall pleasant warm experiences such as showering in the warm sun, lying on a soft sandy beach with the waves lapping gently around them. Each session was conducted for 1 hour. The patients were asked to perform the same training for 15 minutes a day at home, 3 times a week in the first month, 2 times a week in the first month, and once a week in the third month. The treatment efficacy was similar in both groups. The treated patients maintained a skin temperature of 21.4°C (22.2°C to 23.0°C for normal subjects) when entering a cold room at 3.3°C, while it dropped to 19.5°C on average before the treatment. Biofeedback therapy is a new therapy carried out in clinical research in the past 10 years, and its method is simple, without any pain and side effects to patients, and the literature reports some efficacy, which is worth further exploration.