Surgical measure.
Sympathectomy. Sympathectomy is useful in eliminating the vasospastic manifestations of the disease and aiding in the establishment of collateral circulation to the skin. It may also relieve the mild or moderate forms of rest pain. If amputationof a digit is necessary, sympathectomy may aid in healing of the surgical wound.
Arterial grafts. Arterial grafting procedures are seldom indicated in patients with Buerger's disease because they do not usually have significant occlusive disease in the iliofemoral region.
Amputation. The indications for amputation are similar in many respects to those outlined for the atherosclerotic group, although the approach should be more conservative from the point of view of preservation of tissue. Most patients with
Buerger's disease who are managed carefully and stop smoking do not require amputation of the fingers or toes. It is almost never necessary to amputate the entire hand, but amputation below the knee is occasionally necessary because of gangrene or severe pain in the foot.
Treatment in traditional Chinese medicine:Herb therapy
For accumulation of cold and stasis of Qi.
The pain of the legs and toes of the patient is related to cold weather and intermittent claudication is common. The affected foot is pale and cold. Most patients are men and heavy smokers. The dorsal pulse of foot becomes weak or not felt. The rule of treatment is to eliminate the stagnant and activate the blood with Tao Huang Shi Wu Tang Jia Jian.
The formula is composed of:
Chinese angelica 25g
Unpeeled root of herbaceous peony 25g
Prepared rhizome of rehmannia rhizoma 12g
Chuanxiong 12g
Peach kernel 12g
Safflower 12g
Cassia 18g
Root of red rooted salvia 25g
Ox-knee 15g
Wildginger 2g
Milk veteh 30g
Dragon's blood 10g
Decoction and dosage. Each dose is simmered twice and the broth of each mixed,half of the mixed broth each time, twice a day.
The pain of the legs and toes of the patient is complicated with intermittent claudication and signs and symptoms such as redness, swelling and heat of the foot, gangrene of the fingers or toes with excruciating pain at first and necrosis and sloughing off of the skin, subcutaneous tissues, muscles and bones after a long time. The dorsal pulse of the foot is weak or may not be felt. The rule of treatment for this type is to dissipate heat and to detoxify the body with Si Miao Yun An Tang Jia Jian.
Constituents of the formula:
Honeysuckle flower 60g
Chinese angelica 30g
Root of Zhejiang fingwort 30g
Peach kernel 12g
Safflower 12g
Unpeeled root of herbaceous peony 30g
Chuanxiong 20g
Fresh or dried root of rehmannia 20g
Skullcap 10g
Corktree 10g
Chinese violet 30g
Weeping forsythia 30g
Patrinia villosa 30g
Decoction and dosage is the same.
Acupuncture therapy
Points: Sp4 Gongsun, G8 Shugu and Bafeng (extra)
Method: All the above points are punctured each time and the needles are retained for 20 minutes. The therapy is given once daily.
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